Effective symptom management can alleviate the physical and psychological distress experienced by patients with cancer, improve quality of life, and contribute to treatment adherence and improve clinical outcomes. However, most existing guidelines are developed for healthcare professionals, and patients and the public have limited access to standardized and comprehensible guidance on symptom management. To address this gap and to facilitate effective communication and shared decision-making, this study proposes the development of a patient version of the cancer symptom management guideline. The development process will adhere to the methodological framework recommended by the Guidelines International Network and the World Health Organization. The GRADE approach will be employed to assess the certainty of evidence and to formulate recommendations. In addition, the process will be informed by the Appraisal of Guidelines for Research and Evaluation Ⅱ (AGREE Ⅱ) instrument and the Reporting Items for Practice Guidelines in Healthcare-Public or Patient Versions of Guidelines (RIGHT-PVG). This protocol outlines the establishment of the guideline working group, the identification and prioritization of key questions, evidence retrieval and appraisal, and the formulation of recommendations, with the aim of ensuring methodological rigor and transparency in the development of the patient guideline and providing methodological reference for similar guideline initiatives.

Objective To analyse and explore whether there is a causal association without confounding factors between malignant haematological diseases and frailty based on a bidirectional Mendelian randomisation(MR)analysis,and to provide a theoretical basis for clinical management of the frailty associated with malignant haematological diseases.Methods In December 2023,the IEU OpenGWAS database(https://gwas.mrcieu.ac.uk/)was searched to acquire the datasets in genome-wide association studies(GWAS)derived from non-overlapping multi-ethnic populations based on Mendelian Randomisation(MR)analysis.The bidirectional causal association was verified utilising the two-sample MR approach.Single nucleotide polymorphisms(SNPs)of the frailty index(FI)(n=175,226),haematological malignancies(n=212,453),multiple myeloma/malignant plasmacytoma(n=218,792),and follicular lymphoma(n=181,278)were used as the study instruments.Results The analysis with the statistic inverse variance weighted method(IVW)showed that haematological malignancies(OR=1.00,95%CI:0.98-1.00,P=0.797),multiple myeloma/malignant plasma cell tumours(OR=1.00,95%CI 0.99～1.01,P=0.982),and follicular lymphoma(OR=1.00,95%CI:0.99～1.01,P=0.314)were not causally associated with genetically predicted FI.Similarly,FI was not significantly or causally correlated with haematological malignancies(OR=0.89,95%CI:0.25～3.12,P=0.861),multiple myeloma/malignant plasma cell tumours(OR=0.52,95%CI:0.00～3.13,P=0.473),and follicular lymphoma(OR=1.06,95%CI:0.00～5.19,P=0.944).Conclusion No causal relationship between the malignant haematological diseases and frailty was found in this study.It suggests that other factors might exist to cause the malignant haematological frailty.

Objective To analyse and explore whether there is a causal association without confounding factors between malignant haematological diseases and frailty based on a bidirectional Mendelian randomisation(MR)analysis,and to provide a theoretical basis for clinical management of the frailty associated with malignant haematological diseases.Methods In December 2023,the IEU OpenGWAS database(https://gwas.mrcieu.ac.uk/)was searched to acquire the datasets in genome-wide association studies(GWAS)derived from non-overlapping multi-ethnic populations based on Mendelian Randomisation(MR)analysis.The bidirectional causal association was verified utilising the two-sample MR approach.Single nucleotide polymorphisms(SNPs)of the frailty index(FI)(n=175,226),haematological malignancies(n=212,453),multiple myeloma/malignant plasmacytoma(n=218,792),and follicular lymphoma(n=181,278)were used as the study instruments.Results The analysis with the statistic inverse variance weighted method(IVW)showed that haematological malignancies(OR=1.00,95%CI:0.98-1.00,P=0.797),multiple myeloma/malignant plasma cell tumours(OR=1.00,95%CI 0.99～1.01,P=0.982),and follicular lymphoma(OR=1.00,95%CI:0.99～1.01,P=0.314)were not causally associated with genetically predicted FI.Similarly,FI was not significantly or causally correlated with haematological malignancies(OR=0.89,95%CI:0.25～3.12,P=0.861),multiple myeloma/malignant plasma cell tumours(OR=0.52,95%CI:0.00～3.13,P=0.473),and follicular lymphoma(OR=1.06,95%CI:0.00～5.19,P=0.944).Conclusion No causal relationship between the malignant haematological diseases and frailty was found in this study.It suggests that other factors might exist to cause the malignant haematological frailty.

Objective:To investigate the relationship between neutrophil/lymphocyte ratio (NLR) and bone mineral density (BMD) in rheumatoid arthritis (RA), and to evaluate its diagnostic value in RA with osteoporosis.Methods:134 RA patients and 69 healthy subjects were screened and NLR levels were compared between the two groups. Bone mineral density of lumbar L1-4 and femoral neck was measured by dual energy X-ray absorption (DXA), and the patients were divided into normal bone mass group (44 cases), reduced bone mass group (47 cases) and osteoporosis group (43 cases). Height, weight, course of disease, mean platelet volume, erythrocyte sedimentation rate (ESR), C-reactionprotein (CRP), complement C3, complement C4, rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP) antibody, bone mineral density and other related indicators were recorded. The differences of NLR, body mass index(BMI) gender, age and other indicators among the three groups were compared by One-way Analysis of Variance (ANOVA) and Kruskal-Wallis test, or χ2 test. Correlation analysis was conducted to detect the correlation between NLR, bone mass and each indicator, and ordered multi-classification Logistic regression analysis was used to evaluate the im-pact of each indicator on osteoporosis, and receiver operating characteristic curve (ROC) was used to predict the diagnostic value of NLR and combined related indicators on osteoporosis. Results:NLR of RA patients (3.1±1.7) was higher than that of healthy controls (1.7±0.5) ( F=21.27, P<0.001). In the osteoporosis group, the reduced bone mass group, and the normal bone mass group, age (66±8), (62±10), (50±13), disease course (15±10), (9±8, (7±7), BMI (20±4) kg/m 2, (22±3) kg/m 2, (24±3) kg/m 2, NLR (3.9±2.3, 2.7±1.2, 2.6±1.0), CRP (41±43) mg/L, (28±34) mg/L, (18±26) mg/L, ESR (46±30) mm/1 h, (36±26) mm/1 h, (26±20) mm/1 h were significantly different among the three groups ( χ2=32.92, P<0.001; H=17.41, P<0.001; F=12.04, P<0.001; H=11.62, P=0.030; H=13.78, P=0.001; F=7.18, P=0.001). Correlation analysis showed that NLR was correlated with CRP, ESR, anti-CCP antibody, femoral neck bone mineral density, DAS28 score and age. The correlation coefficients were 0.49 ( P<0.001), 0.39 ( P<0.001), 0.30( P<0.001), -0.18( P=0.042), 0.50( P<0.001), 0.17( P=0.046), respectively. Femoral neck was correlated with age, BMI, course of disease, CRP, ESR. The correlation coefficients were -0.46( P<0.001), 0.38 ( P<0.001),-0.39 ( P<0.001), -0.34 ( P<0.001), the correlation coefficients of L1-4 with age, BMI, CRP and ESR were -3.41( P<0.001), 0.39( P<0.001), -0.22( P=0.010), -2.42( P=0.005), respectively. There was no correlation between bone mineral density and DAS28 and anti-CCP antibody. Ordered multi-classification Logistic regression analysis showed that: age, course of disease, NLR and ESR were risk factors for osteoporosis, and their OR values were 1.12 ( P<0.001), 1.05 ( P=0.025), 1.29 ( P=0.031), 1.02 ( P=0.039), 0.28 ( P=0.008), respectively. Body mass index ( OR=0.76, P<0.001) were protective factors. ROC curve showed that the AUC area of NLR was 0.68, the AUC area of NLR, BMI, age, sex and course of disease was 0.90, the cut-off value was 0.20, sensitivity was 0.95, and specificity was 0.73[95% CI(0.84, 0.95)]. Conclusion:In osteoporosis, NLR is related to bone mass and disease activity of patients with rheumatoid arthritis. Combined with other related indexes, NLR can be used as a predictive diagnostic index and has a guiding role in clinical practice.

Objective:To observe the regulatory effect of p38 mitogen-activated protein kinase (p38 MAPK) on aquaporin 4 (AQP4) in rats after hydrocephalus, and to explore its significance in hydrocephalus prevention.Methods:Fifty SD rats were randomly divided into sham-operated group ( n=10), hydrocephalus group ( n=20), and hydrocephalus+inhibitor (SB203580) group (SB group, n=20). The rat models of hydrocephalus in the latter two groups were prepared by intracerebroventricular injection of kaolin suspension; rats in the sham-operated group were injected with same amount of normal saline into the lateral ventricle. The p38 MAPK specific inhibitor SB203580 (10 mg/kg) was intraperitoneally injected into the rats of SB group on the 8 th d of modeling for 7 consecutive d; same volume of dimethylsulfoxide was given to the rats of hydrocephalus group on the 8 th d of modeling for 7 consecutive d; rats in the sham-operated group did not give any treatment. The severity of hydrocephalus in these rats was observed by MRI. The inflammatory factor tumor necrosis factor (TNF)-α level in the cerebrospinal fluid was detected by enzyme-linked immunosorbent assay (ELISA). The AQP4 and TNF-α mRNA expressions were detected by real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR). The phosphorylated p38 MAPK and AQP4 expressions in the periventricular brain tissues were detected by Western blotting and immunohistochemistry. Results:No hydrocephalus developed in sham-operated group and hydrocephalus developed in the latter two groups. As compared with sham-operated group, hydrocephalus group and SB group had significantly increased lateral ventricle volume, significantly aggravated periventricular edema, significantly higher EVAN's index, and statistically increased brain water content ( P<0.05). Two weeks after modeling, the TNF-α expression levels in cerebrospinal fluid of sham-operated group, hydrocephalus group and SB group were (20.49±0.96), (42.04±3.17), and (28.00±3.71) pg/mL, respectively, with significant differences ( F=186.000, P<0.001); the TNF-α expression level in SB group was significantly higher than that in sham-operated group and significantly lower than that in hydrocephalus group ( P<0.05). Two weeks after modeling, the TNF-α and AQP4 mRNA expression levels in brain tissues of the three groups were significantly different ( P<0.05); the TNF-α and AQP4 mRNA expression levels in hydrocephalus group were significantly higher than those in sham-operated group and SB group ( P<0.05). Correlation analysis showed that there was a positive linear correlation between AQP4 mRNA expression and TNF-α mRNA expression in hydrocephalus group ( r=0.511, P=0.026), and there was a positive linear correlation between AQP4 protein expression and phosphorylated p38 MAPK protein expression in hydrocephalus group and SB group ( r=0.560, P=0.013; r=0.463, P=0.030). Immunohistochemical staining results showed that AQP4 expression was abundant in glial cells of the three groups; the p38 MAPK distribution was uniform and non-polar; the phosphorylated p38 MAPK protein expression in the hydrocephalus group was significantly higher than that in the sham-operated group, and that in the SB group returned to the level of the sham-operated group. Conclusion:The p38 MAPK pathway is involved in the positive regulation of AQP4 expression, which could be inhibited by SB203580.

OBJECTIVETo assess the association of G protein-coupled estrogen receptor(GPER) gene polymorphism with social function of children with attention deficit hyperactivity disorder (ADHD).

METHODSThe social function of 135 children with ADHD were assessed by Weiss Functional Impairment Scale-Parent form (WFIRS-P). The coding region of GPER gene of all patients was subjected to Sanger sequencing. The association of polymorphisms with the social function of the ADHD children was analyzed.

RESULTSIn the case group, the social function scores of Learning and School and Risky Activities of boys were significantly higher than those of girls (t=2.704, P=0.008; t=2.289, P=0.027). No significant difference was found in the genotypic frequencies of the c.-9T/C and c.789G/A loci between different genders. But the learning and school scores of those with a TC genotype for the c.-9T to C locus were significantly higher than those with a TT genotype (t= 2.159, P=0.033).

CONCLUSIONFor children with ADHD, the social function of Learning and School of those with a TC genotype of the GPER gene c.-9T/C locus is more severely damaged compared with those with a TT genotype.

Objective To discuss the methods and evaluate the effects of initial muscle-enclosing protection of large segment of exposed Achilles tendon and second stage repair of Achilles tendon rupture complicated with cuta-neous defect.Methods Among patients treated between August 2005 to April 2014 in our hospital,there were 32 patients,who were diagnosed with Achilles tendon rupture complicated with cutaneous defect.Of the 32 patients, there are 21 male and 11 female.Their ages range from 23 to 69,with an average age of 46.2 ±3.5.In all the patients described above,there are soft tissue contusion injuries and cutaneous defects on their posterior lower legs near the ankles,with the area of skin defects ranging from 3cm ×4cm to 5 ×12cm,and the Achilles tendons were ruptured, extracted,dissociated and completely uncovered.All patients were initially treated with triceps surae muscle-enclosing method to put aside and protect the large segment of exposed Achilles tendon.Later,the ruptured Achilles tendons were repaired,together with the transfer of skin flap to repair skin defects,at the second stage.The therapeutic effects were evaluated during postoperative follow-up periods.Results The mean follow-up period was 18 months,ranged from 11 to 32 months.According to the therapeutic effect evaluation standard of Arner-Lindholm,there were Excellent results in 22 patients,Good in 7 cases and Poor in 3 cases,with a combined excellent/good rate of 90.62%.Conclusion Initial muscle-enclosing protection of large segment of exposed Achilles tendon and second stage repair of Achilles tendon rupture complicated with cutaneous defect is advantageous to the function of patients with rapid recovery.

Objective To investigate the incidence and CT imaging features of abdominal splenosis with a previous splenectomy.Methods 94 consecutive patients with a history of splenectomy underwent abdominal contrast CT examination between April 2010 and December 2012 and were recruited for this study.These patients were devided into two groups according to the reason for which splenectomy was performed.Descriptive statistics were calculated for clinical incidence of abdominal splenosis,and subsequently CT imaging features and diagnosis of abdominal splenosis were discussed.Results In this series,29 cases (30.85％) with abdominal splenosis were found in 94 patients.Abdominal splenosis was found in all of 20 cases with more than one year history of posttraumatic splenectomy,and in 17.31％ (9 of 52) of cases with more than one year history of non-traumatic splenectomy (P ＜ 0.05).There were 60 nodules found on CT examinations in these 29 cases.All nodules were 50 mm or smaller.All nodules appeared of homogeneous soft-tissue density on plain CT scan.The nodules showed significant enhancement during arterial phase on postcontrast CT scan,with continuous significant homogeneous enhancement during portal venous phase.Conclusions Abdominal splenosis following posttraumatic splenectomy are more common than previously suggested.Knowledge of typical CT imaging appearances and the history of splenectomy may prevent mistaking as tumors.