Objective To compare the adverse reactions to pegasparaginase(PEG-ASP)and Erwiniaasparaginase(ASP)in the treat-ment of pediatric acute lymphoblastic leukemia(ALL)and to provide clinical guidance for treatment.Methods A total of 13 patients who were switched from PEG-ASP to Erwinia ASP due to allergic reactions during the induction phase of ALL treatment at the Depart-ment of Hematology and Oncology,Children's Hospital Affiliated of Zhengzhou University between February 2022 and February 2023 were selected as the case group.A control group of 26 patients treated with PEG-ASP and matched for sex at a ratio of 1∶2 was also selected.Pre-and post-treatment coagulation function,blood biochemistry,blood ammonia level,and gastrointestinal reactions were compared between the groups.Results There were no significant differences in AST,TB,UB,TC,TG,AMY,UN,Cr,APTT,and Fbg levels between the two groups,pre-and post-treatment.However,ALT,GGT,BB,and Glu levels were higher in the control group,whereas albumin was lower than in the case group(P<0.05).Both groups had an increased post-treatment blood ammonia level(P<0.05),with significantly a higher level observed in the case group than in the control group(P<0.001).No significant differences in adverse gastro-intestinal reactions were observed between the two groups.Conclusion Erwinia ASP and PEG-ASP affected liver function in pediatric ALL re-induction therapy with minimal effects on coagulation and weaker gastrointestinal reaction.Erwinia ASP significantly affected the blood ammonia level,and both treatments caused mild gastrointestinal reactions.Regular blood ammonia monitoring,post Erwinia ASP treatment,is recommended.

Objective To compare the adverse reactions to pegasparaginase(PEG-ASP)and Erwiniaasparaginase(ASP)in the treat-ment of pediatric acute lymphoblastic leukemia(ALL)and to provide clinical guidance for treatment.Methods A total of 13 patients who were switched from PEG-ASP to Erwinia ASP due to allergic reactions during the induction phase of ALL treatment at the Depart-ment of Hematology and Oncology,Children's Hospital Affiliated of Zhengzhou University between February 2022 and February 2023 were selected as the case group.A control group of 26 patients treated with PEG-ASP and matched for sex at a ratio of 1∶2 was also selected.Pre-and post-treatment coagulation function,blood biochemistry,blood ammonia level,and gastrointestinal reactions were compared between the groups.Results There were no significant differences in AST,TB,UB,TC,TG,AMY,UN,Cr,APTT,and Fbg levels between the two groups,pre-and post-treatment.However,ALT,GGT,BB,and Glu levels were higher in the control group,whereas albumin was lower than in the case group(P<0.05).Both groups had an increased post-treatment blood ammonia level(P<0.05),with significantly a higher level observed in the case group than in the control group(P<0.001).No significant differences in adverse gastro-intestinal reactions were observed between the two groups.Conclusion Erwinia ASP and PEG-ASP affected liver function in pediatric ALL re-induction therapy with minimal effects on coagulation and weaker gastrointestinal reaction.Erwinia ASP significantly affected the blood ammonia level,and both treatments caused mild gastrointestinal reactions.Regular blood ammonia monitoring,post Erwinia ASP treatment,is recommended.

Objective:To explore the alterations in functional connectivity density (FCD) resulted from mild cognitive impairment (MCI) and their correlations with cognitive scores in various cognitive domains in patients with Parkinson's disease (PD).Methods:Forty-three PD patients admitted to Department of Neurology, Sixth Affiliated Hospital of Nantong University from January 2022 to April 2024 were selected and divided into PD-MCI group (MoCA scores<26) and PD with normal cognition (PD-NC) group (MoCA scores≥26) according to Montreal Cognitive Assessment (MoCA). Another 23 middle-aged and elderly healthy volunteers (HC group) matched with PD patients in age, gender and education level were recruited at the same period. Resting-state functional MRI (rs-fMRI) data were collected and whole brain FCD was calculated. Differences of clinical data, whole brain FCD, and FCD in brain regions with significantly different FCD among the 3 groups were compared. Efficiency of FCD in brain regions with significantly different FCD between PD-MCI group and PD-NC group in differentially diagnosing PD-MCI and PD-NC was analyzed by receiver operating characteristic (ROC) curve. Pearson correlation was used to the analyze the correlations of FCD in brain regions with significantly different FCD with MoCA score and cognitive scores in various cognitive domains.Results:Among the 43 patients, 23 were into the PD-MCI group and 20 into the PD-NC group. PD-MCI group had significantly lower scores in the visuospatial and executive function, abstraction, and delayed memory cognitive domains than PD-NC group ( P<0.05). Brain regions with significantly different FCD among the 3 groups were the right parahippocampal gyrus, left gyrus rectus, right rolandic operculum, left middle occipital gyrus, right precentral gyrus, left middle frontal gyrus, and left medial superior frontal gyrus. Compared with the HC group, the PD-MCI group and PD-NC group had significantly increased FCD at the right parahippocampal gyrus, left gyrus rectus and right rolandic operculum, statistically decreased FCD at the right precentral gyrus, left middle frontal gyrus, and left medial superior frontal gyrus ( P<0.05). Compared with the HC group, the PD-MCI group had significantly increased FCD at the left middle occipital gyrus ( P<0.05). Compared with the PD-NC group, the PD-MCI group had significantly decreased FCD at the right parahippocampal gyrus, and statistically increased FCD at the left middle occipital gyrus and left middle frontal gyrus ( P<0.05). Area under ROC curve (AUC) of FCD in brain regions with significantly different FCD in discriminating PD-MCI and PD-NC was 0.878, with sensitivity of 90.0% and specificity of 91.3%. FCD at right parahippocampal gyrus, left middle occipital gyrus and left middle frontal gyrus was negatively correlated with MoCA score ( P<0.05); FCD at right parahippocampal gyrus was positively correlated with cognitive scores in the visuospatial and executive function, and delayed memory domains ( P<0.05); FCD at left middle occipital gyrus was negatively correlated with cognitive scores in the executive function and visual-spatial skills, and abstraction domains ( P<0.05); FCD at the left medial frontal gyrus was negatively correlated with cognitive scores in the visuospatial and executive function, abstraction and delayed memory domains ( P<0.05). Conclusions:Abnormal FCD can be noted in some brain regions of PD patients, enjoying differences between PD-MCI patients and PD-NC patients. Combined FCD in brain regions with significantly different FCD has high value in differentially diagnosing PD-MCI and PD-NC, and FCD in brain regions with significantly different FCD is correlated with cognitive function changes in PD patients.

This article reports the pharmacotherapy process of a clinical pharmacist participating in the treatment of acute liver injury caused by nintedanib in a patient with lung cancer complicated with interstitial pneumonia.Clinical pharmacist analyzed the rapid increase of liver enzymes in patients by excluding their past drug use history,stopping suspicious drugs and searching domestic and foreign literature,and determined that the association with nidanib was very likely according to RUCAM scale.The clinical pharmacies suggesteded stopping nintedanib and taking liver protection treatment actively.The clinician adopted the suggestion,and finally the patient's liver function improved after 20 days of treatment.Clinical pharmacists demonstrate their value by analyzing the causes and characteristics of liver injury in patients,assisting physicians in the timely identification and management of adverse reactions,and participating in clinical practice.This article can provide a reference for the diagnosis and treatment of similar cases of acute liver injury.

Objective:To investigate the effects of applying the "4C" teaching method combined with the Gibbs' reflective cycle to clinical nursing teaching in the department of urology.Methods:A total of 68 nursing students who practiced in the urology department of our hospital were divided using a lottery method into experimental group ( n=35, entering the second and third wards for internship) and control group ( n=33, entering the first and fourth wards). The experimental group was taught using the "4C" teaching method combined with the Gibbs' reflective cycle, including four teaching steps (connection, concept, concrete practice, and conclusion) and regular reflective discussions. The control group received traditional teaching, which covered entrance education, centralized theoretical training, skills demonstration, and exit assessment. At the end of internship, the two groups were compared in terms of self-directed learning ability, nursing competency, and theoretical and practical scores. SPSS 23.0 was used to perform the t test. Results:The self-directed learning scores of the experimental group and the control group were (227.37±12.91) and (207.09±16.27), respectively. The nursing competency scores were (156.66±12.49) and (138.06±17.23), respectively. The experimental group was significantly superior to the control group in self-directed learning ability ( t=5.71, P<0.001), nursing competency ( t=5.12, P<0.001), theoretical score ( t=3.03, P=0.004), and practical score ( t=4.88, P<0.001). Conclusions:The "4C" teaching method combined with the Gibbs' reflective cycle can effectively improve nursing students' self-directed learning ability and nursing competency, and help them better master knowledge and skills.

Objective To analyze the value of Wilms tumor 1(WT1)gene combined with mul-tiparameter flow cytometry for minimal residual disease(FCM-MRD)in evaluating prognosis of chil-dren with acute myeloid leukemia(AML).Methods The clinical data and general information of 76 children with AML were retrospectively analyzed.Before treatment,WT1 gene expression was detec-ted by real-time fluorescence quantitative polymerase chain reaction(qRT-PCR)in all the children,and MRD was detected by FCM.All the children were followed up for a year,and they were divided into good prognosis group(n=40)and poor prognosis group(n=36)according to prognosis condition.The changes of WT1 gene and MRD before treatment and 3,9 and 12 months after treatment were observed in both groups;the changes of WT1 gene and MRD before and after treatment were com-pared in the children with different therapeutic plans;the relationships of clinicopathological features with WT1 gene expression and positive rate of FMM-MRD were analyzed in AML children.Spearman correlation coefficient was used to analyze the relationships of WT1 gene expression and positive rate of FCM-MRD with the prognosis of AML children;the Kaplan-Meier survival curve was drawn to an-alyze the effects of WT1 gene expression and positive rate of FMM-MRD on the recurrence of AML-children and their correlations;the receiver operating characteristic(ROC)curve was drawn to ana-lyze the efficiencies of single detection with WT1 gene and FMM-MRD and combined detection in predicting prognosis of AML children;the relationships of WT1 gen and MRD with FLT3 ITD/TKD mutation were analyzed in AML children.Results The WT1 expression levels and positive rates of FCM-MRD at 9 and 12 months after treatment in the good prognosis group were significantly lower than those in the poor prognosis group(P＜0.05);the WT1 gene expression level and positive rate of FCM-MRD in children with DAH chemotherapy regimen were lower than those in children with DAE chemotherapy regimen,while the rate of good prognosis was higher than thatin children with DAE chemotherapy regimen,but there were no significant differences between children with different chemotherapy regimens(P＞0.05);the WT1 gene expression and the positive rate of FCM-MRD were significantly correlated with white blood cell count,FAB typing,bone marrow primitive cells,and cytogenetic grouping in AML children(P＜0.05).Spearman correlation coefficient analysis showed the WT1 gene expression and positive rate of FCM-MRD were significantly negatively correla-ted with prognosis of AML children(P＜0.05);the Kaplan-Meier survival curve validation showed that overall survival(OS)and progression free survival(PFS)in children with high expression of WT1 were significantly lower than those in children with low expression of WT1(x2=4.215,9.530;P=0.040,0.002),and OS and PFS in children with positive FCM-MRD were also signifi-cantly lower than those in children with negative FCM-MRD(x2=5.144,6.381;P=0.023,0.012);the Spearman correlation coefficient analysis showed that the WT1 gene expression was sig-nificantly negatively correlated with OS and PFS in AML children(P＜0.05);the ROC curve showed that the area under the curve of WT1 combined with FCM-MRD was significantly higher than that of single indicator detection,with a sensitivity of 88.89％and a specificity of 87.50％;the Spearman correlation analysis showed that there were no significant correlations of WT1 gene expres-sion and positive rate of FCM-MRD with FLT3 ITD/TKD mutation(P＞0.05).Conclusion The expression level of WT1 and the positive rate of FCM-MRD show specific changes in AML children with different prognosis,and are strongly correlated with the prognosis of AML children.Combined detection of the two indicators can effectively predict the prognosis of AML children.

Objective To analyze the value of Wilms tumor 1(WT1)gene combined with mul-tiparameter flow cytometry for minimal residual disease(FCM-MRD)in evaluating prognosis of chil-dren with acute myeloid leukemia(AML).Methods The clinical data and general information of 76 children with AML were retrospectively analyzed.Before treatment,WT1 gene expression was detec-ted by real-time fluorescence quantitative polymerase chain reaction(qRT-PCR)in all the children,and MRD was detected by FCM.All the children were followed up for a year,and they were divided into good prognosis group(n=40)and poor prognosis group(n=36)according to prognosis condition.The changes of WT1 gene and MRD before treatment and 3,9 and 12 months after treatment were observed in both groups;the changes of WT1 gene and MRD before and after treatment were com-pared in the children with different therapeutic plans;the relationships of clinicopathological features with WT1 gene expression and positive rate of FMM-MRD were analyzed in AML children.Spearman correlation coefficient was used to analyze the relationships of WT1 gene expression and positive rate of FCM-MRD with the prognosis of AML children;the Kaplan-Meier survival curve was drawn to an-alyze the effects of WT1 gene expression and positive rate of FMM-MRD on the recurrence of AML-children and their correlations;the receiver operating characteristic(ROC)curve was drawn to ana-lyze the efficiencies of single detection with WT1 gene and FMM-MRD and combined detection in predicting prognosis of AML children;the relationships of WT1 gen and MRD with FLT3 ITD/TKD mutation were analyzed in AML children.Results The WT1 expression levels and positive rates of FCM-MRD at 9 and 12 months after treatment in the good prognosis group were significantly lower than those in the poor prognosis group(P＜0.05);the WT1 gene expression level and positive rate of FCM-MRD in children with DAH chemotherapy regimen were lower than those in children with DAE chemotherapy regimen,while the rate of good prognosis was higher than thatin children with DAE chemotherapy regimen,but there were no significant differences between children with different chemotherapy regimens(P＞0.05);the WT1 gene expression and the positive rate of FCM-MRD were significantly correlated with white blood cell count,FAB typing,bone marrow primitive cells,and cytogenetic grouping in AML children(P＜0.05).Spearman correlation coefficient analysis showed the WT1 gene expression and positive rate of FCM-MRD were significantly negatively correla-ted with prognosis of AML children(P＜0.05);the Kaplan-Meier survival curve validation showed that overall survival(OS)and progression free survival(PFS)in children with high expression of WT1 were significantly lower than those in children with low expression of WT1(x2=4.215,9.530;P=0.040,0.002),and OS and PFS in children with positive FCM-MRD were also signifi-cantly lower than those in children with negative FCM-MRD(x2=5.144,6.381;P=0.023,0.012);the Spearman correlation coefficient analysis showed that the WT1 gene expression was sig-nificantly negatively correlated with OS and PFS in AML children(P＜0.05);the ROC curve showed that the area under the curve of WT1 combined with FCM-MRD was significantly higher than that of single indicator detection,with a sensitivity of 88.89％and a specificity of 87.50％;the Spearman correlation analysis showed that there were no significant correlations of WT1 gene expres-sion and positive rate of FCM-MRD with FLT3 ITD/TKD mutation(P＞0.05).Conclusion The expression level of WT1 and the positive rate of FCM-MRD show specific changes in AML children with different prognosis,and are strongly correlated with the prognosis of AML children.Combined detection of the two indicators can effectively predict the prognosis of AML children.

Objective:To explore the expression of fructose bisphosphate aldolase A (ALDOA) in the bone marrow of patients with acute myeloid leukemia (AML) and the correlation with clinical features and prognosis.Methods:The bone marrow samples of 90 newly diagnosed AML (non-acute promyelocytic leukemia) patients and 18 allogeneic hematopoietic stem cell transplantation donors who were treated from January 2013 to December 2015 in the First Affiliated Hospital of Zhengzhou University and the Children's Hospital Affiliated to Zhengzhou University were collected. The relative expression level of ALDOA mRNA in bone marrow samples was detected by using real-time quantitative polymerase chain reaction (qRT-PCR). Clinical data of these patients were retrospectively analyzed, and the patients were divided into continuous complete remission (CR) group and refractory recurrent (RR) group according to the clinical response and follow-up results. The differences of the relative expression level of ALDOA mRNA between AML group and the normal control group, CR group and RR group were analyzed. Univariate and multivariate Cox regression risk model were used for analysis of factors influencing prognosis of AML patients.Results:The relative expression level of ALDOA mRNA in AML group was higher than that in normal control group [(5.71±0.44) vs. (1.10±0.08), t = 4.74, P<0.001]. The relative expression level of ALDOA mRNA in the RR group was higher than that in the CR group [(6.69±0.67) vs. (4.30±0.36) , t = 2.79, P < 0.001]. In addition, there were statistically significant differences in the proportion of patients with ALDOA mRNA high expression and those with ALDOA mRNA low expression stratified by the number of white blood cell, the proportion of bone marrow blasts and whether complete remission could be achieved or not after 1 course of induction therapy (all P < 0.05). Overall survival in patients with ALDOA high expression was worse than that in patients with ALDOA low expression ( χ2 = 5.59, P = 0.018). Multivariate analysis showed that white blood cell count, prognosis stratification, whether complete remission could be achieved or not after 1 course of induction therapy and ALDOA expression were the independent prognostic factors for the death of AML patients (all P < 0.05). Conclusions:ALDOA may play an important role in the development and progression of AML, and the expression level of ALDOA in the bone marrow can be used as an index for the prognosis assessment of AML patients and may be a potential therapeutic target for AML.

Objective:To search, evaluate and summarize the evidence related to the maintenance of peripheral arterial duct flushing systems in children for clinical reference.Methods:Up To Date, BMJ, Nathional Institute for Health and Care Excellence(NICE), Chinese Medlive, Cochrane Library, Joanna Briggs Institute(JBI), CINAHL, METSTR, PubMed, Wanfang, CNKI, VIP were used to collect secondary evidence resources about management and maintenance of peripheral arterial duct flushing systems in children. After the quality evaluation of each type of literature, the evidence was extracted and summarized.Results:A total of 9 articles were included in the research. The 22 pieces of best evidence were obtained from 7 aspects, including basic requirements of children′s peripheral arterial duct flushing systems, arterial flushing method, flushing rate of injection pump system, flushing pressure of pressurized bag pump system, arterial flushing fluid, replacement and maintenance of children′s arterial catheter flushing system, and continuous improvement of arterial catheter maintenance.Conclusions:The best evidence for the establishment and maintenance of pediatric peripheral arterial duct flushing systems provides a basis for clinical decision, but practice testing is still needed.

Objective:To compare fibrosis-driving cells in patients with primary myelofibrosis (PMF) and patients with myelodysplastic syndromes (MDS) with myelofibrosis (MF) (MDS-MF) .Methods:Bone marrow biopsy sections of patients with newly diagnosed PMF and MDS (10 each randomly selected for MF-0/1, MF-2, and MF-3) were stained with specific immunofluorescence antibodies to label Gli1, LeptinR, alpha smooth muscle actin (α-SMA) , CD45, and ProcollagenⅠ. Images captured by confocal microscopy were analyzed by Fiji-ImageJ to calculate the cell counts of Gli1 +, LeptinR + cells, and fibrosis-driving cells including α-SMA +, α-SMA +/Gli1 +, α-SMA +/LeptinR +, and ProcollagenⅠ +/CD45 + cells. Results:Patients with PMF and MDS with MF-2/3 had higher LeptinR +, α-SMA +, α-SMA +/Gli1 +, and Procollagen Ⅰ +/CD45 + cell counts compared with those with MF-0/1 (all P values<0.05) . However, patients with PMF with MF-2/3 presented with higher Gli1 + and α-SMA +/LeptinR + cell counts than those with MF-0/1 ( P=0.001 and 0.006) , whereas these cells were similar between patients with MDS with MF-0/1 and MF-2/3 ( P=0.169 and 0.067) . In patients with MF-0/1, all fibrosis-driving cells did not differ between PMF and MDS (all P>0.05) . However, in patients with MF-2/3, Procollagen Ⅰ +/CD45 + cell counts were higher in patients with PMF compared with those with MDS ( P=0.007) , while other fibrosis-driving cell counts were similar between these two groups (all P>0.05) . MF grade and fibrosis-driving cell counts were not correlated with overall survival in patients with either PMF or MDS. Conclusion:α-SMA + cells in patients with PMF originated from both Gli1 + and LeptinR + cells, whereas α-SMA + cells in patients with MDS-MF only originated from Gli1 + cells; patients with PMF had higher ProcollagenⅠ +/CD45 + cell counts than those with MDS-MF.