Objective:To explore the effects of goals-activity-motor enrichment(GAME) therapy on the function of gross and fine motion in infants at high risk of cerebral palsy.Methods:Prospective study.A total of 116 children at high risk of cerebral palsy who met the inclusion criteria and were admitted to the Rehabilitation Department of Qingdao Women and Children′s Hospital from November 2017 to November 2019 were selected in a randomized, single-blind, controlled trial, and randomly divided into control group (58 cases) and observation group (58 cases) according to the random number table method.The two groups were then divided into mild group, moderate group and severe group according to the gross motor quotient(GMQ) of Peabody Motor Development Scale-2 (PDMS-2). During treatment, 4 cases of shedding occurred in the control group and 8 cases in the observation group, respectively.Finally, 54 cases were included in the control group and 50 cases in the observation group.The control group was given regular early intervention rehabilitation, whereas the observation group was given GAME treatment.The Gross Motor Function Measure-88 (GMFM-88), the GMQ of PDMS-2 and the fine motor quotient (FMQ) of PDMS-2 were used to assess the motor function of children before intervention and after 12 weeks of treatment.The Chi- square test or Fisher′ s exact test was used to compare gender-specific data, while the t-test was used to compare age-specific data and rehabilitation evaluation indices. Results:The GMFM-88 scores, GMQ, and FMQ of children in both groups improved significantly after treatment, and the difference was statistically significant [control group GMFM-88: (63.52±10.06) scores vs.(47.02±8.19) scores, t=-19.770, GMQ: 83.02±15.52 vs.73.56±14.72, t=-18.180, FMQ: 81.19±14.88 vs.71.22±13.92, t=-18.413, all P<0.05; observation group GMFM-88: (68.06±10.82) scores vs.(46.16±8.73) scores, t=-32.856, GMQ: 89.98±18.10 vs.72.94±13.84, t=-17.089, FMQ: 88.34±18.08 vs.72.26±13.74, t=-15.370, all P<0.05], and the GMFM-88, GMQ, and FMQ scores of the observation group were significantly higher than those of the control group after treatment, with statistically significant differences(GMFM-88: t=-2.176, GMQ: t=-2.111, FMQ: t=-2.210, all P<0.05). In the observation group, the added value score and quotient of mild group and moderate group were significantly increased compared with that of severe group, and the differences were statistically significant [GMFM-88 added value: the mild group (24.11±3.36) scores and moderate group (22.91±3.46) scores were compared with the severe group (15.70±4.08) scores, t=5.881, 5.164, all P<0.05, GMQ added value: the mild group (19.61±6.83) and moderate group (18.27±6.61) were compared with the severe group (9.80±4.29), t=4.098, 3.915, all P<0.05, the added value of FMQ: mild group (18.72±7.11) and moderate group (17.36±6.10) were compared with severe group (8.50±5.82), t=3.873, 3.863, all P<0.05]. Conclusions:GAME treatment is more effective than early rehabilitation training at improving gross and fine motor function in infants at high risk of cerebral palsy.Its benefits on mild and moderate infants at high risk of cerebral palsy are superior.

Objective:To explore any effect of the single- and dual-task treadmill training on the functioning of children with bilateral spastic cerebral palsy.Methods:Fifty children with bilateral spastic cerebral palsy were randomly divided into a single-task treadmill training group (the control group, n=25) and a dual-task treadmill training group (the observation group, n=25). All of the children also received routine rehabilitation training, and the control and observation groups also conducted single- and dual-task treadmill training in addition to the routine rehabilitation training, respectively. Before and after 2 months of treatment, each child′s gross motor functioning was quantified using sections D (standing) and E (walking, running and jumping) of the Gross Motor Function Measurement-88 (GMFM-88) instrument. Balance was quantified using the Pediatric Balance Scale (PBS) and walking mobility was quantified using a 1 minute walking test (1MWT). Modified and dual task Timed Up and Go (mTUG) tests and dual-task effects (DTE) tests were also administered. Results:There were no significant differences in average test scores between the two groups before the treatment. After the treatment significant improvement was observed in both groups. There was no significant difference between the two groups in terms of average GMFM-88, PBS and 1MWT scores, but significantly greater improvement was observed in the average dual-task mTUG and DTE results of the observation group.Conclusion:Both single- and dual-task treadmill training are effective supplements to routine rehabilitation training for children with bilateral spastic cerebral palsy. Dual-task treadmill training is more effective than the single-task version.

OBJECTIVES: This study examined the associations between adverse childhood experiences (ACEs) and diabetes within a social-ecological framework, incorporating personal and environmental unfavorable conditions during childhood from family, school, and community contexts. METHODS: Data were obtained from the China Health and Retirement Longitudinal Study (2014 life history survey and 2015 survey), including 9,179 participants aged ≥45 years. ACEs were collected through self-report questionnaires, and participants were categorized based on the number of distinct ACEs experienced (0, 1, 2, 3, or ≥4 ACEs). Diabetes was defined by biomarkers, self-reported diagnosis, and treatment status. Logistic regression was conducted to explore the associations between ACEs and diabetes. Subgroup analyses were conducted by gender, age, and obesity status. RESULTS: Compared with participants without ACEs, those exposed to any ACE (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.01 to 1.40), 3 ACEs (OR, 1.32; 95% CI, 1.07 to 1.62) and ≥4 ACEs (OR, 1.29; 95% CI, 1.07 to 1.56) had an increased risk of diabetes. For each additional ACE, the risk of diabetes increased by about 5%. Regarding the source of ACEs, those originating from the family (OR, 1.23; 95% CI, 1.08 to 1.41) were associated with diabetes. In terms of specific ACE types, family members with substance abuse (OR, 1.23; 95% CI, 1.01 to 1.52), emotional abuse (OR, 1.28; 95% CI, 1.12 to 1.46), and poor parental relationship (OR, 1.25; 95% CI, 1.09 to 1.43) were associated with diabetes. CONCLUSIONS ACEs, particularly those originating from the family, were associated with diabetes. Interventions aimed at preventing and mitigating ACEs are essential for the early prevention of diabetes.

Objective:To analyze the spatial distribution characteristics and spatial aggregation of the epidemic of severe fever with thrombocytopenia syndrome(SFTS) in Yantai City of Shandong Province, and to provide basis for formulating effective SFTS prevention and control measures.Methods:The epidemic data of SFTS confirmed cases in each township (street) in Yantai City, Shandong Province from 2015 to 2020 were collected from the "China Disease Prevention and Control Information System Infectious Disease Monitoring and Reporting System", and ArcGIS 10.2 software was used for spatial autocorrelation analysis.Results:From 2015 to 2020, a total of 839 SFTS cases were reported in Yantai City, including 124 deaths; with an average annual incidence rate of 2.14/100 000, and a total case fatality rate of 14.78%. Global spatial autocorrelation analysis showed that the distribution of SFTS cases in Yantai City from 2015 to 2020 showed a positive spatial correlation, with the highest spatial correlation in 2015 (Moran's I = 0.25, Z = 5.66, P < 0.001), and the lowest in 2018 (Moran's I = 0.16, Z = 3.69, P < 0.001). Local spatial autocorrelation and hotspot analysis showed that the epidemic areas of SFTS were mainly in some mountainous and hilly townships (streets) of Laizhou City, Penglai District, Qixia City, Zhaoyuan City, and Haiyang City. Conclusions:The distribution of SFTS epidemic in Yantai City has obvious regional clustering. Intervention measures such as publicity, education and monitoring should be strengthened in high-incidence areas to reduce the incidence of the disease.

Objective:To explore the family resilience resources in parents of children with congenital pseudarthrosis of the tibia (CPT) , so as to provide a reference for formulating nursing intervention to improve their family resilience.Methods:From December 2020 to January 2021, purposive sampling was used to select 13 father or mother of children with CPT in the Department of Orthopedics of Hunan Children's Hospital as the research object. Semi-structured interviews were conducted with parents of children with CPT using the phenomenological method in qualitative research. Colaizzi 7-step method was used to organize, summarize, analyze and refine the data.Results:The family resilience resources of parents of children with CPT were reflected in three aspects, namely, personal resources, family resources and social resources.Conclusions:Family resilience interventions should make full use of their own resources when implemented in parents of children with CPT. Individualized continuous intervention should be provided by taking into account the learning ability and psychological state of the children's parents and in combination with specific needs. The intervention target should include as many family members as possible, and strengthen the establishment of a diversified support system to help parents of children with a large number of social resources.

Objective:To understand the epidemic characteristics and influential factors of brucellosis patients in Laizhou, Shandong Province, and to provide scientific basis for prevention and control of brucellosis.Methods:Retrospective analysis was conducted to collect the surveillance data and epidemiological investigation results of confirmed cases of brucellosis in Laizhou from 2016 to 2019 through the "Infectious Disease Report Information Management System of the China Disease Prevention and Control Information System". The general situation, epidemiological characteristics, and clinical characteristics of brucellosis were analyzed by descriptive epidemiology. Using the case-control study method, 81 confirmed cases of brucellosis and 162 healthy people in the same area, same gender and same age as confirmed cases were selected to analyze the influential factors of brucellosis.Results:Totally 222 cases of brucellosis had been reported in Laizhou, with an average annual incidence of 6.57/100 000. The onset age of brucellosis was mainly from 45 to 59 years old, accounting for 46.40% (103/222); male-to-female ratio was 2.42 ∶ 1.00 (157 ∶ 65); the occupation distribution was mainly farmer, accounting for 95.95% (213/222). The onset time of brucellosis was mainly from March to July, accounting for 58.11% (129/222). Cases of brucellosis were reported in 17 townships (streets) of Laizhou, and the top five townships were Zhuqiao, Shahe, Tushan, Chengguo and Yidao towns in order of incidence. Among 222 cases of brucellosis, the shortest interval from onset to diagnosis was 5 d, the longest was 36 d, and the median was 11 d. The main clinical manifestations of the patients were fever (89.19%, 198/222), fatigue (80.63%, 179/222), joint muscle soreness (72.97%, 162/222), and a few accompanied by liver, spleen and testis enlargement. The logistic regression analysis showed that contact with urine, feces and other excrements of diseased animals [odds ratio ( OR) = 6.244, 95% confidence interval ( CI): 1.609 - 24.231] and family members suffering from brucellosis ( OR = 16.363, 95% CI: 2.250 - 119.023) were risk factors of brucellosis. Conclusions:The incidence of brucellosis is mainly among 45 - 59 middle-aged farmers in Laizhou and the incidence peaks in spring and summer. Direct contact with excrements of diseased animals and family members suffering from brucellosis are the risk factors of brucellosis. Health departments should carry out health education and behavioral intervention for farmers in the season and areas with high incidence of brucellosis, so as to improve personal awareness of protection.

Objective:To investigate the gross motor function, manual ability and language communication of children with cerebral palsy (CP) and their correlation.Methods:A total of 318 children with CP (132 with spastic diplegia, 27 with spastic quadriplegia, 32 with spastic hemiplegia, 54 with dyskinesia, 41 with ataxia and 32 children with multiple difficulties) aged 4 to 12 years were classified according to the Gross Motor Function Classification System (GMFCS), the Manual Ability Classification System (MACS), and the Communication Function Classification System (CFCS). Spearman correlation coefficients were used to analyze the correlation among the three ratings.Results:Only 125 of the 318 children (39%) had the same classification level according to all three scales, showing moderate correlation and different levels for patients with different types of disability. The GMFCS and MACS levels of the subjects with spastic quadriplegia and those with dyskinesia were highly correlated. The GMFCS and CFCS levels of the hemiplegic children and those with spastic quadriplegia were also highly correlated. The MACS and CFCS levels were strongly correlated for children with spastic quadriplegia and multiple disabilities.Conclusions:The functioning of children with CP differs with their CP subtype. Correlations among the three functional assessments also differ for children with different subtypes. Combining the three classification systems provides a more comprehensive picture of the children′s ability to function in daily life.

【Objective】 To investigate the activity level of coagulation factor Ⅺ(FⅪ) in IVIG products, which would provide support for improving the safety and quality control of IVIG products in China. 【Methods】 A total of 71 batches of IVIG products(half of which were closed to expiry date) from 23 domestic manufacturers (brands) were submitted for inspection and assayed for procoagulant activity including FⅪa, FⅪ and NAPTT activity with a chromogenic assay, coagulation proenzymes levels using one stage clotting assays and non-activated partial thromboplastin time (NAPTT). 【Results】 FⅪa(mIU/mL): 32 lots of IVIGs from 15 manufacturers(brands) possessed activities below 0.1 or the detection limit of the assays, 24 IVIG lots from 12 manufacturers were between 0.1~1(0.39±0.20), the remaining 15 IVIG lots from 6 manufacturers had FⅪa activity greater than 1 up to 47(13.27±15.61). FⅪ(mIU/mL): there were no detectable activities of FⅪ in 58 lots from 21 manufacturers, the other 13 lots from 6 manufacturers had IVIGs between 13~309(69.0±98.1), which included in 15 lots of IVIG whose FⅪa activity were greater than 1mIU/mL. NAPTT(s): The coagulation times for aforementioned 15 IVIG lots were all above 150s in the NAPTT test. The NAPTT ratios varied between 0.67 and 0.94(0.83±0.07), and 7 of 15 IVIGs had NAPTT ratios below or equal to 0.8. 【Conclusion】 There are substantial differences in the FⅪ and FⅪa activities in the IVIG preparations from 23 different manufacturers. Most of them had a lower activities; certain lots from specific manufacturers had relatively higher FⅪa activities. Manufactures should evaluate the manufacturing processes and monitor IVIG preparations for the presence of factor Ⅺ-like activity in case of thrombotic risks.

Glioma-associated microglial cells, a key component of the tumor microenvironment, play an important role in glioma progression. In this study, the mouse glioma cell line GL261 and the mouse microglia cell line BV2 were chosen. First, circadian gene expression in glioma cells co-cultured with either M1 or M2 microglia was assessed and the exosomes of M2-polarized and unpolarized BV-2 microglia were extracted. Subsequently, we labeled the exosomes with PKH67 and treated GL261 cells with them to investigate the exosome distribution. GL261 cell phenotypes and related protein expression were used to explore the role of M2 microglial exosomes in gliomas. Then a specific miR-7239-3p inhibitor was added to verify miR-7239-3p functions. Finally, the mouse subcutaneous tumorigenic model was used to verify the tumorigenic effect of M2 microglial exosomes in vivo. Our results showed that in gliomas co-cultured with M2 microglia, the expression of the BMAL1 protein was decreased (P < 0.01), while the expression of the CLOCK protein was increased (P < 0.05); opposite results were obtained in gliomas co-cultured with M1 microglia. After treatment with M2 microglial exosomes, the apoptosis of GL261 cells decreased (P < 0.001), while the viability, proliferation, and migration of GL261 cells increased. Increased expression of N-cadherin and Vimentin, and decreased E-cadherin expression occurred upon treatment with M2 microglial exosomes. Addition of an miR-7239-3p inhibitor to M2 microglial exosomes reversed these results. In summary, we found that miR-7239-3p in the glioma microenvironment is recruited to glioma cells by exosomes and inhibits Bmal1 expression. M2 microglial exosomes promote the proliferation and migration of gliomas by regulating tumor-related protein expression and reducing apoptosis.

Objective:To explore the effect of goals-activity-motor enrichment (GAME) intervention on the motor function of infants with a mild or moderate developmental disorder.Methods:Randomized, single-blind, controlled trials were applied. Totally 108 infants with mild-to-moderate developmental delay, aged 0 to 12 months, were randomly divided into an observation group and a control group, each of 54. Both groups were further divided into two subgroups, a less-than-6-month-old subgroup and a not-less-than-6-month-old subgroup. All of the children received 30 minutes of routine rehabilitation training five days a week and a 60-minute family intervention every day. In addition, the control group was given traditional neuro-developmental treatment (NDT) while the observation group was provided with an intervention based on the GAME program. Before and after 8 weeks of treatment, both groups were evaluated using the Alberta infant motor scale (AMIS).Results:After the intervention, both groups′ average total scores and average scores in the different positions were significantly better than before the intervention. The average AIMS scores of the observation group supine, prone and seated, as well as their average total score were significantly higher than those of the control group after the intervention. There were no significant differences in the AIMS score increases in the different positions between the two subgroups. However, the increase in average total AIMS score of the less-than-6-month-old subgroup was significantly greater than that of the older subgroup.Conclusion:The GAME protocol can improve the motor function of infants with mild to moderate developmental disorders more effectively than a traditional NDT program. The effect is greater with younger infants.