Objective:To assess the preliminary efficacy and safety of modified Société Internationale d′Oncologie Pédiatrique Epithelial Liver Tumor Study Group (SIOPEL)-4 protocol for pediatric hepatoblastoma (HB) with lung metastases.Methods:This prospective cohort study enrolled 27 newly diagnosed pediatric HB with lung metastases who received the modified SIOPEL-4 protocol at Shanghai Children′s Medical Center, Shanghai Jiao Tong University School of Medicine, and Shanghai Children′s Hospital between January 2020 to December 2023. Clinical characteristics, lung response rates to induction chemotherapy, treatment outcomes, prognostic factors and sever chemotherapy toxicities at different stages were analyzed. Survival analysis was performed by Kaplan-Meier method. Univariate prognostic analysis was conducted by Log-Rank test.Results:Of the 27 patients, there were 17 males and 10 females, with the age of 21 (15, 33) months. During the follow-up of 31 (12, 45) months for 17 continuous complete remission patients, 4 cases disease progression (2 cases death) and 6 cases relapse were observed. The 2-year event free survival (EFS) and overall survival (OS) rate was (58±11)% and (89±7)%, respectively. All the 27 patients had response to block 1-3 induction chemotherapy (cisplatin+doxorubicin), with 14 cases (52%) achieving complete response and 13 cases (48%) achieving partial response of lung metastatic lesions, the 2-year EFS rate was (81±12)% and (34±14)%, respectively ( χ 2=6.76, P=0.009), the 2-year OS rate was 100% and (79±13)%, respectively ( χ2=2.12, P=0.145). Patients with caudate lobe tumors or ≥10 pulmonary metastatic nodules had significantly lower EFS rates ( χ2=5.36, 7.84, P=0.021, 0.005, respectively). The incidence of grade 3/4 neutropenia after block 1-3 induction chemotherapy, CD (carboplatin+doxorubicin), and VI (vincristine+irinotecan) consolidation chemotherapy was 90% (73/81), 75% (58/77), and 31% (11/35), respectively. The incidence of grade 3/4 thrombocytopenia was 77% (62/81), 69% (53/77), and 14% (5/35), respectively. The incidence of grade 3/4 infections was 64% (52/81), 25% (19/77), and 20% (7/35), respectively. The differences between the groups were statistically significant ( χ2=43.51, 42.69, 33.00, all P<0.001). Two patients (10%) of the 20 evaluable patients for ototoxicity occurred grade 3 and higher hearing impairment, with 1 patient requiring a hearing aid. Conclusions:The modified SIOPEL-4 regimen shows good preliminary efficacy and safety in treating pediatric HB with lung metastases. The prognosis for patients with residual lesions in the lungs after induction chemotherapy needs to be improved. Attention should be given to the ototoxicity induced by high-dose cisplatin chemotherapy.

Objective To analyze the application of combined respiratory training in Mycoplasma-associated bronchopneumonia children and its effect on pulmonary function under family-centered model.Methods A total of 150 Children with Mycoplasma-associated bronchopneumonia treated at Hangzhou Children's Hospital from April 2023 to April 2024 were selected as subjects.The children were divided into control group(n=75)and study group(n=75)using a randomized digital table method.The control group received standard interventions,while the study group received family-centered combined respiratory training in addition to control group's treatment.The two groups were compared in terms of pulmonary function,symptom improvement duration,treatment compliance,and patient satisfaction.Results After intervention,compared with the control group,children in study group had higher forced vital capacity(FVC),forced expiratory volume in one second(FEV1),FEV1/FVC levels,total treatment compliance and satisfaction,the improvement time of cough,fever and dyspnea were shorter,the difference were statistically significant(P＜0.05).Conclusion The use of family-centered combined respiratory training can improve the pulmonary function of children with mycoplasma infection and bronchopneumonia,shorten the time for symptom improvement,and improve the treatment compliance and satisfaction of children.

Hepatic ischemia-reperfusion injury （HIRI） is an inevitable major complication during surgical procedures such as liver transplantation and partial hepatectomy， and its prevention and treatment are hotspots and difficulties in clinical practice. This article reviews the mechanism of injury caused by energy metabolism disorders during liver ischemia-reperfusion and related treatment strategies and summarizes the current advances in metabolism-related therapies， in order to provide new ideas for further clarifying the onset mechanism of HIRI and exploring effective clinical prevention and treatment strategies for HIRI.

The expert consensus on the clinical treatment of herpes zoster with fire needling was developed, and the commonly used fire needling treatment scheme verified by clinical research was selected to form a standardized diagnosis and treatment scheme for acute herpes zoster and postherpetic neuralgia (PHN), so as to answer the core problems in clinical application. The consensus focuses on patients with herpes zoster, and forms recommendations for 9 key clinical issues, covering simple fire needling and TCM comprehensive therapy based on fire needling, including fire needling combined with cupping, fire needling combined with Chinese herb, fire needling combined with cupping and Chinese herb, fire needling combined with filiform needling, fire needling combined with moxibustion, and provides specific recommendations and operational guidelines for various therapies.
Humans ; Herpes Zoster/therapy* ; Acupuncture Therapy/instrumentation* ; Consensus ; Clinical Protocols

Objective To distinguish Cremastra appendiculata(D.Don)Makino,Pleione yunnanensis Rolfe and Pleione bulbocodioides,and its easily confusing products Oreorchis patens and Iphigenia indica Kunth using the ITS sequence in DNA barcodes;To explore the genetic diversity of Cremastra appendiculata germplasm resources.Methods Three different original Cremastra appendiculata,Pleione yunnanensis Rolfe and Pleione bulbocodioides,and their easily confusing products Cremastrae Pseudobulbus of Oreorchis patens and Iphigenia indica Kunth were selected as the research objects,and the genomic DNA of the above samples were extracted by the modified CTAB method,and then the ITS sequences were amplified,sequenced and spliced by PCR technology.The Kimura 2-Parameter(K2P)model was used to calculate the genetic distance,and the phylogenetic tree was constructed with the help of neighbour joining method(NJ)for genetic relationship analysis.Results Except for the Iphigenia indica Kunth species that were not found during the BLAST search,the BLAST comparison results of the other samples were higher than 95%.At the same time,the results of phylogenetic tree showed that Cremastra appendiculata,Pleione yunnanensis Rolfe and Pleione bulbocodioides were clustered into one branch,respectively,and the easily confusing products were also respectively clustered into one branch.Conclusion The ITS sequence in DNA barcodes can be used to accurately distinguish Cremastra appendiculata,Pleione yunnanensis Rolfe and Pleione bulbocodioides,and its easily confusing products Oreorchis patens and Iphigenia indica Kunth.

Objective To investigate the clinical and CT findings features of nonaneurysmal perimesencephalic subarachnoid hem-orrhage(NAPSAH).Methods A retrospective analysis was conducted on 19 cases of NAPSAH confirmed by clinical treatment and follow-up,and their clinical and CT findings features were summarized.Results All patients exhibited mild clinical symptoms and had a good prognosis without complications.The sites of NAPSAH involved the anterior cistern in 17 cases,the suprasellar cistern in 8 cases,the interpeduncular cistern in 7 cases,the anterior cistern only in 1 case,and the suprasellar cistern only in 1 case;Among them,4 cases had vertebrobasilar dolichoectasia(VBD)and 3 cases had tortuous prolongation of vertebrobasilar artery.Conclusion The incidence of NAPSAH is low,the clinical symptoms are mild and good prognosis.It has typical imaging features.Most of its hemorrhage sites are confined to the anterior cistern,suprasellar cistern and interpeduncular cistern.Combining clinical and CT find-ings helpful to improve the accuracy of diagnosis.

Metal elements are widely present in people's daily environment. With the increase of industrial activities, people are facing more metal exposures than ever before, and even several metal elements have been detected in follicular fluid. Most people live with environmental background levels of metal exposure rather than occupational long-term exposure. Therefore, the term "environmental metals" in this paper refers specifically to the metals in people's daily background environment. It is important to investigate the potential effects of environmental metal exposure on female fertility. In this paper, we summarize the latest research progress on the effects of environmental metal element exposure on women's reproductive health, discuss the toxicity mechanisms of metal elements, and propose possible detoxification and intervention strategies to provide scientific evidence for the protection of women's reproductive health.

The aim of this study is to identify the cause of death of a South China tiger cub at the Meihuashan breeding institute of Fujian Province.Pathogenic bacteria were isolated and cultured from liver,spleen,lung and other tissue samples of the dead South China tiger aseptically.The iso-lated bacteria were identified through morphological observation,biochemical characterization,sequence analysis of housekeeping gene gyrB,virulence gene detection,animal pathogenicity test and drug sensitivity test.A pathogenic Aeromonas hydrophila strain,designated FJ/Tiger-201809 was successfully isolated from the trachea of dead South China tiger.The nucleotide sequence ho-mology between the isolate and 11 strains of Aeromonas gyrB ranged from 91.2％to 99.1％,with the highest homology of 99.1％observed with Aeromonas hydrophila(AF208251.1).Genetic evo-lution analysis showed that the isolated strain FJ/Tiger-201809 was in the same evolutionary branch as other reference strains of Aeromonas hydrophila and was closely related.The pathoge-nicity test in mice showed artificial infection of mice with the strain resulted in varying degrees of lesions in several organs of the mice,and the median lethal dose(LD50)was 1 × 107.8 CFU/mL.Virulence gene test results showed that the isolate FJ/Tiger-201809 carried two virulence genes,aer and act.The results of drug sensitivity test showed that FJ/Tiger-201809 was highly sensitive to enrofloxacin and ampicillin among 18 commonly used antibiotics,relatively sensitive to penicil-lin G and doxycycline,and resistant to the other 14 antibiotics.In conclusion,this study isolated and identified a strain of Aeromonas hydrophila from a dead South China tiger with multiple drug resistance and strong pathogenicity,which provided an important reference for the prevention and control of bacterial diseases in South China tiger.

Objective Compared with patients with insomnia,the clinical characteristics and polysomnography(PSG)results from patients with co-morbid insomnia and obstructive sleep apnea(COMISA)were analyzed.The analysis was conducted to investigate clinical manifestations,sleep physiological characteristics,and related risk factors of COMISA patients.Methods A total of 134 patients with insomnia were enrolled and divided into two groups based on whether their apnea-hypopnea index(AHI)was≥5 events/hour:the COMISA group(69 patients)and the insomnia-only group(65 patients).The COMISA group was further divided into a mild OSA subgroup of 41 cases and a moderate-to-severe OSA subgroup of 28 cases;and then into a mild insomnia subgroup of 37 cases and a moderate-to-severe insomnia subgroup of 32 cases.The demographic characteristics,Pittsburgh sleep quality index(PSQI),self-rating depression scale(SDS),self-rating anxiety scale(SAS),Epworth sleepiness scale(ESS)and PSG results were analyzed.Results Compared with the insomnia-only group,the COMISA group had a higher proportion of men,a higher age,a higher body mass index(BMI),a higher proportion of smoking,a higher proportion of snoring,a lower average blood oxygen saturation and lowest blood oxygen saturation,a higher proportion of N2 stage,and a lower proportion of N3 stage and R stage(P<0.05).Compared with the mild OSA subgroup,the moderate-to-severe OSA subgroup had a higher BMI index,a higher proportion of snoring,a higher SAS score,a lower average blood oxygen saturation and lowest blood oxygen saturation,a higher proportion of N1 stage,and a lower proportion of N3 stage(P<0.05).Compared with the subgroup of mild insomnia,the subgroup of moderate-to-severe insomnia in the COMISA group had a higher proportion of hypnotic drug use(P<0.01),but there was no significant difference between the two groups in PSG results(P>0.05).Logistic regression analysis showed that older age(OR=1.07,P<0.01)and higher BMI(OR=1.41,P<0.01)were risk factors for the co-occurrence of OSA in insomnia patients.Conclusion Patients with COMISA have worse objective sleep quality at night than those with insomnia-only,and patients with more severe OSA have poorer objective sleep quality.In clinical practice,it is important to be aware of the risk of comorbid OSA for patients with insomnia who are older and have a higher BMI.

Objective Compared with patients with insomnia,the clinical characteristics and polysomnography(PSG)results from patients with co-morbid insomnia and obstructive sleep apnea(COMISA)were analyzed.The analysis was conducted to investigate clinical manifestations,sleep physiological characteristics,and related risk factors of COMISA patients.Methods A total of 134 patients with insomnia were enrolled and divided into two groups based on whether their apnea-hypopnea index(AHI)was≥5 events/hour:the COMISA group(69 patients)and the insomnia-only group(65 patients).The COMISA group was further divided into a mild OSA subgroup of 41 cases and a moderate-to-severe OSA subgroup of 28 cases;and then into a mild insomnia subgroup of 37 cases and a moderate-to-severe insomnia subgroup of 32 cases.The demographic characteristics,Pittsburgh sleep quality index(PSQI),self-rating depression scale(SDS),self-rating anxiety scale(SAS),Epworth sleepiness scale(ESS)and PSG results were analyzed.Results Compared with the insomnia-only group,the COMISA group had a higher proportion of men,a higher age,a higher body mass index(BMI),a higher proportion of smoking,a higher proportion of snoring,a lower average blood oxygen saturation and lowest blood oxygen saturation,a higher proportion of N2 stage,and a lower proportion of N3 stage and R stage(P<0.05).Compared with the mild OSA subgroup,the moderate-to-severe OSA subgroup had a higher BMI index,a higher proportion of snoring,a higher SAS score,a lower average blood oxygen saturation and lowest blood oxygen saturation,a higher proportion of N1 stage,and a lower proportion of N3 stage(P<0.05).Compared with the subgroup of mild insomnia,the subgroup of moderate-to-severe insomnia in the COMISA group had a higher proportion of hypnotic drug use(P<0.01),but there was no significant difference between the two groups in PSG results(P>0.05).Logistic regression analysis showed that older age(OR=1.07,P<0.01)and higher BMI(OR=1.41,P<0.01)were risk factors for the co-occurrence of OSA in insomnia patients.Conclusion Patients with COMISA have worse objective sleep quality at night than those with insomnia-only,and patients with more severe OSA have poorer objective sleep quality.In clinical practice,it is important to be aware of the risk of comorbid OSA for patients with insomnia who are older and have a higher BMI.