Tic disorders in children refer to the neurodevelopmental disorders usually occurring in childhood and adolescence.Guided by the theory of five-zang-organ correlation,Professor Li Yirui approaches the treatment of tic disorders in children and comorbidities primarily from the perspective of liver-spleen disharmony,and points out that the pathogenesis is due to liver-spleen disharmony,wind-phlegm disturbance,and mutual involvement of the five zang organs.In clinical practice,Professor Li established the therapeutic principle of regulating the liver and spleen,extinguishing wind,and resolving phlegm,and adopted the four liver-regulating methods(calming liver,soothing liver,clearing liver,and softening liver)to extinguish wind and stop tics,as well as the four spleen-regulating methods(replenishing spleen,activating spleen,awakening spleen,and dredging spleen)to strengthen body resistance and support healthy qi.The self-formulated Fupi Xifeng Decoction(composed of Pseudostellariae Radix,Atractylodis Macrocephalae Rhizoma,Poria,Glycyrrhizae Radix et Rhizoma,Bupleuri Radix,Paeoniae Radix Alba,Uncariae Ramulus cum Uncis,Gastrodiae Rhizoma,Pinelliae Rhizoma Praeparatum,Citri Reticulatae Pericarpium,Os Draconis,etc.)serves as the basic formula,herbs directing to the affected regions were flexibly used,and insect drugs were occasionally adopted for refractory cases.The treatment for tic disorders in children focus on simultaneous regulation of the five zang-organs by modified use of herbs for dispersing wind and benefiting lung,tranquilizing heart and calming spirit,and supplementing liver and kidney to address comorbidities and secondary symptoms.Additionally,integrated internal-external treatment,relieving the discomforts physically and mentally,and family-centered comprehensive care are also taken into account to achieve optimal outcomes.

Multiple plant lineages have independently evolved sex chromosomes and variable kary-otypes to maintain their sessile lifestyles through constant biological innovation.Morus notabilis,a dioecious mulberry species,has the fewest chromosomes among Morus spp.,but the genetic basis of sex determination and karyotype evolution in this species has not been identified.In this study,three high-quality genome assemblies were generated for Morus spp.[including dioecious M.notabilis(male and female)and Morus yunnanensis(female)]with genome sizes of 301-329 Mb and were grouped into six pseudochromosomes.Using a combination of genomic approaches,we found that the putative ancestral karyotype of Morus species was close to 14 protochromosomes,and that sev-eral chromosome fusion events resulted in descending dysploidy(2n=2x=12).We also charac-terized a～6.2-Mb sex-determining region on chromosome 3.Four potential male-specific genes,a partially duplicated DNA helicase gene(named MSDH)and three Ty3_Gypsy long terminal repeat retrotransposons(named MSTG1/2/3),were identified in the Y-linked area and considered to be strong candidate genes for sex determination or differentiation.Population genomic analysis showed that Guangdong accessions in China were genetically similar to Japanese accessions of mul-berry.In addition,genomic areas containing selective sweeps that distinguish domesticated mul-berry from wild populations in terms of flowering and disease resistance were identified.Our study provides an important genetic resource for sex identification research and molecular breeding in mulberry.

Objective:To explore the status quo of perceived responses to capitalization attempts and work flow of clinical nurses, and analyze the correlation between them.Methods:Using the convenient sampling method, a total of in some Class Ⅲ Grade A hospitals of Hangzhou City 567 clinical nurses from three Class Ⅲ Grade A hospitals in Hangzhou were selected as research objects from June to December 2019. Nurse Work Flow Questionnaire (NWF) and Chinese version of Perceived Responses To Capitalization Attempts Scale (PRCA) were used to investigate and to analyze the relationship between perceived responses to capitalization attempts and work flow of clinical nurses. In this study, a total of 567 questionnaires were issued and 551 valid questionnaires were returned, with a recovery rate of 97.18%.Results:The total score of PRCA of 551 clinical nurses was (52.74±8.96) , the total score of NWF for clinical nurses was (112.26±23.42) . Pearson correlation analysis results showed that active construction score of clinical nurses was positively correlated with the score of all dimensions of Nurse Work Flow Questionnaire, while clinical passive construction, passive destruction and active destruction of nurses were negatively correlated with scores of each dimension of Nurse Work Flow Questionnaire ( P<0.05) . After controlling for general demographic data, results of the hierarchical regression of influencing factors for work flow of clinical nurses showed that the active construction of perceived responses to capitalization attempts positively affected the clinical nurses' work flow experience, while passive construction, passive destruction and active destruction all had negative effects on clinical nurses' work flow experience, which could explain 29.1% of the variance of "work flow" variable. Conclusions:Nursing managers should actively improve the active construction response methods in perceived responses to capitalization attempts of clinical nurses and avoid passive construction, active destruction, passive destruction and other response methods, so as to enhance sense of work flow of clinical nurses and improve quality of clinical nursing.

Objective: To investigate the curative effect of auricular deformity repaired by concha cartilage. Methods: From January 2017 to June 2018, 15 cases with auricular deformities were repaired using the autologous concha cartilage which combined with the retroauricular flap or retroauricular fascia with skin grafting. 9 males and 6 females, aged 10-40 with an average age of 19; 3 cases of upper 1/3 traumatic auricle defect, 2 cases of congenital Stahl's ear, 5 cases of congenital cup-shaped ear and 5 cases of congenital cryptotia. Results: Total 15 patients were followed up for 12-18 months after the surgery. The area of concha cartilage resection was about 0.5 cm×1.0 cm. The shape and size of the repaired ears were similar to the healthy ear. The transplanted cartilages were not absorbed or deformed. The incision was healed well and retroauricular flap, retroauricular fascia, and skin grafting were preserved well without complications like hemorrhage, necrosis, and infection. Conclusions This method is harmless and simple, which has reliable and satisfactory effects on various auricular deformities.

Objective:To improve awareness about infratentorial dural arteriovenous fistula (DAVF).Methods:Three cases of DAVF in the First Affiliated Hospital of Soochow University from September 2017 to September 2019 were retrospectively analyzed in terms of clinical features, cerebrospinal fluid (CSF) analysis, brain imaging and treatment, and followed up through telephone call.Results:Case 1: A 43-year-old woman, in chronic but acute aggravated course, presented with weakness of both lower limbs and urination and defecation dysfunction. Brain magnetic resonance imaging (MRI) revealed abnormal signal in medulla. CSF analysis demonstrated aquaporin-4 antibodies positive. Misdiagnosed as neuromyelitis optica spectrum disorders, the treatment was poor. Then digital subtraction angiography (DSA) showed DAVF at the left infratentorial area, and endovascular treatment was operated. Relapse was not observed in two-year follow up. Case 2: A 57-year-old woman, in chronic progressive course, mainly manifested as memory loss, but progressed with dysphagia, fever, coma. Treatment as “central nervous infection” was poor. Then DSA showed DAVF at the bilateral transverse-sigmoid sinus area, and endovascular treatment was operated with embolized partial fistulas. The patient died from lung infection within two months. Case 3: A 52-year-old man, in subacute course, was treated in the Gastroenterology Department with clinical manifestion of stubborn nausea and vomiting. Brain MRI revealed abnormal signal in medulla, with prominent vessel flow voids nearby. Then DSA showed DAVF at the craniocervical junction, and endovascular treatment was operated. Relapse was not observed in six-month follow up.Conclusions:DAVF has a variety of clinical manifestations, and infratentorial DAVF can manifest as acute neurological dysfunction involving the brain stem, cerebellum, spinal cord, which may be easily misdiagnosed. When brain MRI showed intracranial abnormal signal, the possibility of DAVF should be considered. DSA remains the gold standard to diagnose DAVF. Endovascular embolization is the main treatment of infratentorial DAVF at present. Prognosis depends on clinical presentation and fistula classification.

Objective To investigate the effecs of evidence-based nursing of the treatment with propranolol forthe intractable infantile hemangiomahemangioma. Methods Dividing the children who were treated with propranolol into experimental groups and matched groups randomly according to the random number table each 42 .The experimental group adopted evidence-based care,according to PICO tool description of the problem and combining the results of theresponsibility nurse′s regular follow-up and assessment to come up with evidence-based problems,seeking for high-level evidences,combining the existing conditions of careand having formulated corresponding care norms,contingency plans for adverse reactions,healthy education card,the operation videos and other measures and they are implemented.The control group adopted the routine care procedure.two groups of effects were determined by the Achauer level 4 classification after 12 months of treatment,and evaluating the condition of occur of blood pressure drop ,slow heart beat ,diarrhea, sleepdisorders, hypoglycemia and other adverse reactions in both groups during the process of treatment. Results there was statistical significance in the difference of two groups′Achauer 4 levels. The numbers of Ⅰ, Ⅱ, Ⅲ, and Ⅳ in the two groups were 3, 7, 20, 12, and 11, 15, 11, 5, respectively (t1=1372, t2=2132, P<0.05). The two groups had a statistically significant difference in blood pressure, heart rate, diarrhea, sleep disorder, and low blood sugar response. The numbers of two groups were 12, 2, 3, 6, 1 and 26, 15, 12, 21, 8 respectively (χ2=6.098-12.464, all P<0.05). Conclusions Evidence-based nursing enhances the treatment effectiveness of theintractable infantile hemangioma with propranolol effectively and has preventing the occur of adverse reactions during the process of treatment.

Objective: To explore the indication and surgery scope for laparoscopic extraperitoneal lymphadenectomy in locally advanced cervical cancer. Methods: Laparoscopic extraperitoneal lymphadenectomy was initially performed on patients with locally advanced cervical cancer. The results of preoperative computed tomography (CT) images and serum level of squamous cell carcinoma antigen (SCC-Ag) were analyzed, and the diagnostic efficiencies of the minimum axial diameter (MAD) of lymph node on CT≥0.5 cm, ≥1.0 cm, serum level of SCC-Ag alone or combined to predict the extraperitoneal lymph node metastases were compared. The high-risk factors of common iliac lymph node (CILN) and para-aortic lymph node (PALN) metastases were also analyzed. Results: The lymph node metastasis rate of 81 patients who received the laparoscopic extraperitoneal lymphadenectomy was 59.3% (48/81). The CILN and/or PALN metastasis rate was 24.7%(20/81), and among them, the MAD of CILN and/or PALN ≥0.5 cm on CT images were in only 7 patients. The threshold of SCC-Ag for evaluating lymph node metastasis was 4.8 ng/ml. The accuracy, specificity and Youden index of SCC-Ag≥4.8+ MAD≥1.0 cm group for predicting lymph node metastasis were 78.3%, 100% and 0.6, respectively, and were significantly higher than 57.9%, 12.1% and 0.1 of MAD≥0.5 cm group, 71.1%, 75.8% and 0.4 of MAD≥1.0 cm group, 65.0%, 57.7% and 0.3 of SCC-Ag≥4.8 ng/ml group and 68.3%, 65.4% and 0.4 of SCC-Ag≥4.8 ng/ml+ MAD≥0.5 cm group (P<0.05). All of the 21 patients in SCC-Ag≥4.8 ng/ml+ MAD≥1.0 cm group were detected to occur lymph node metastases, and the metastasis rate of CILN and/or PALN was 38.1%. While only 4 cases of 17 patients in SCC-Ag<4.8 ng/ml+ MAD<1 cm group were confirmed to occur CILN metastases. The difference of lymph node metastasis rate between these two groups was statistically significant (P<0.001). The pathological type, the number of PLN with MAD≥1.0 cm, at least one of the PLN MAD≥1.0 cm and/or MAD of CILN and/or PALN was 0.5~1.0 cm were associated with the CILN and/or PALN metastases (all P<0.05). Conclusions Those patients with MAD≥1.0 cm+ SCC-Ag≥4.8 ng/ml and with high-risk factors of CILN and/or PALN metastases should undergo laparoscopic extraperitoneal lymphadenectomy to provide explicit guidance for the subsequent therapy. However, the incidence of lymph node metastasis of patients with SCC-Ag<4.8 ng/ml combined with MAD<1.0 cm is low, therefore these patients can accept concurrent chemoradiotherapy directly.

Objective To explore the indication and surgery scope for laparoscopic extraperitoneal lymphadenectomy in locally advanced cervical cancer. Methods Laparoscopic extraperitoneal lymphadenectomy was initially performed on patients with locally advanced cervical cancer. The results of preoperative computed tomography (CT) images and serum level of squamous cell carcinoma antigen (SCC?Ag) were analyzed, and the diagnostic efficiencies of the minimum axial diameter (MAD) of lymph node on CT≥0.5 cm,≥1.0 cm, serum level of SCC?Ag alone or combined to predict the extraperitoneal lymph node metastases were compared. The high?risk factors of common iliac lymph node (CILN) and para?aortic lymph node ( PALN) metastases were also analyzed. Results The lymph node metastasis rate of 81 patients who received the laparoscopic extraperitoneal lymphadenectomy was 59.3%(48／81). The CILN and／or PALN metastasis rate was 24.7%(20／81), and among them, the MAD of CILN and／or PALN ≥0.5 cm on CT images were in only 7 patients. The threshold of SCC?Ag for evaluating lymph node metastasis was 4.8 ng／ml. The accuracy, specificity and Youden index of SCC?Ag≥4.8+MAD≥1.0 cm group for predicting lymph node metastasis were 78.3%, 100% and 0.6, respectively, and were significantly higher than 57.9%, 12.1% and 0.1 of MAD≥0.5 cm group, 71.1%, 75.8% and 0.4 of MAD≥1.0 cm group, 65.0%, 57.7% and 0.3 of SCC?Ag≥4.8 ng／ml group and 68.3%, 65.4% and 0.4 of SCC?Ag≥4.8 ng／ml+MAD≥0.5 cm group ( P＜0.05). All of the 21 patients in SCC?Ag≥4.8 ng／ml+MAD≥1.0 cm group were detected to occur lymph node metastases, and the metastasis rate of CILN and／or PALN was 38.1%. While only 4 cases of 17 patients in SCC?Ag＜4.8 ng／ml+MAD＜1 cm group were confirmed to occur CILN metastases. The difference of lymph node metastasis rate between these two groups was statistically significant (P＜0.001).The pathological type, the number of PLN with MAD≥1.0 cm, at least one of the PLN MAD≥1.0 cm and／or MAD of CILN and／or PALN was 0.5～1.0 cm were associated with the CILN and／or PALN metastases ( all P＜0.05). Conclusions Those patients with MAD≥1.0 cm+SCC?Ag≥4.8 ng／ml and with high?risk factors of CILN and／or PALN metastases should undergo laparoscopic extraperitoneal lymphadenectomy to provide explicit guidance for the subsequent therapy. However, the incidence of lymph node metastasis of patients with SCC?Ag＜4.8 ng／ml combined with MAD＜1.0 cm is low, therefore these patients can accept concurrent chemoradiotherapy directly.

Objective To explore the indication and surgery scope for laparoscopic extraperitoneal lymphadenectomy in locally advanced cervical cancer. Methods Laparoscopic extraperitoneal lymphadenectomy was initially performed on patients with locally advanced cervical cancer. The results of preoperative computed tomography (CT) images and serum level of squamous cell carcinoma antigen (SCC?Ag) were analyzed, and the diagnostic efficiencies of the minimum axial diameter (MAD) of lymph node on CT≥0.5 cm,≥1.0 cm, serum level of SCC?Ag alone or combined to predict the extraperitoneal lymph node metastases were compared. The high?risk factors of common iliac lymph node (CILN) and para?aortic lymph node ( PALN) metastases were also analyzed. Results The lymph node metastasis rate of 81 patients who received the laparoscopic extraperitoneal lymphadenectomy was 59.3%(48／81). The CILN and／or PALN metastasis rate was 24.7%(20／81), and among them, the MAD of CILN and／or PALN ≥0.5 cm on CT images were in only 7 patients. The threshold of SCC?Ag for evaluating lymph node metastasis was 4.8 ng／ml. The accuracy, specificity and Youden index of SCC?Ag≥4.8+MAD≥1.0 cm group for predicting lymph node metastasis were 78.3%, 100% and 0.6, respectively, and were significantly higher than 57.9%, 12.1% and 0.1 of MAD≥0.5 cm group, 71.1%, 75.8% and 0.4 of MAD≥1.0 cm group, 65.0%, 57.7% and 0.3 of SCC?Ag≥4.8 ng／ml group and 68.3%, 65.4% and 0.4 of SCC?Ag≥4.8 ng／ml+MAD≥0.5 cm group ( P＜0.05). All of the 21 patients in SCC?Ag≥4.8 ng／ml+MAD≥1.0 cm group were detected to occur lymph node metastases, and the metastasis rate of CILN and／or PALN was 38.1%. While only 4 cases of 17 patients in SCC?Ag＜4.8 ng／ml+MAD＜1 cm group were confirmed to occur CILN metastases. The difference of lymph node metastasis rate between these two groups was statistically significant (P＜0.001).The pathological type, the number of PLN with MAD≥1.0 cm, at least one of the PLN MAD≥1.0 cm and／or MAD of CILN and／or PALN was 0.5～1.0 cm were associated with the CILN and／or PALN metastases ( all P＜0.05). Conclusions Those patients with MAD≥1.0 cm+SCC?Ag≥4.8 ng／ml and with high?risk factors of CILN and／or PALN metastases should undergo laparoscopic extraperitoneal lymphadenectomy to provide explicit guidance for the subsequent therapy. However, the incidence of lymph node metastasis of patients with SCC?Ag＜4.8 ng／ml combined with MAD＜1.0 cm is low, therefore these patients can accept concurrent chemoradiotherapy directly.

Objective: To identify a pig model with bilateral external ear defects accompanied by aural atresia and investigate its application in plastic surgery. Methods: Erhualian×Shaziling F₂ pig inbreeding population was introduced, and examination of external ear morphology was conducted in all individuals. Temporal computed tomography scanning and mutational detection of HOXA1 gene were conducted in one affected and one normal individuals. Results: In Erhualian×Shaziling F₂ pig inbreeding population, there were 57 normal and 18 affected individuals among the 75 pigs. Affected subjects presented bilateral external ear defects accompanied by aural atresia; temporal computed tomography scanning showed bilateral aural atresia and dysplasiaof middle ear; and gene detection identified homozygous mutation of HOXA1 gene. Conclusions Pig model with HOXA1 gene homozygous mutation resembles human microtia at different levels. Our findings provide the theoretical basis for its application to study further pathological mechanism for human microtia.