Objective: To understand the current status and associated factors of sleep problems among preschool children in Hainan Province, so as to provide scientific evidence for improving sleep health in this population. Methods: From January 2021 to June 2022, a total of 4 105 preschool children aged 3-6 years from 62 kindergartens in Hainan Province were selected using stratified cluster random sampling method. Demographic information and lifestyle habits were collected through the Hainan Province Child Growth and Development Survey Questionnaire. The Children s Sleep Habits Questionnaire (CSHQ) was employed to assess sleep status. Unconditional binary Logistic regression model was applied to investigate the associated factors of sleep problems among preschool children. Results: The overall CSHQ score for children was 58.03±18.84, with 80.95% of preschool children exhibiting sleep related issues. The top three most prevalent sleep problem domains were bedtime resistance (72.42%), sleep anxiety ( 54.88 %), and parasomnias (38.86%). Logistic regression analysis revealed that higher family annual income ( OR=0.60, 95%CI = 0.45-0.79), higher maternal education level ( OR=0.53, 95%CI =0.32-0.89), regular or daily vitamin D supplementation ( OR=0.77, 95%CI =0.60-0.99), and fully self initiated eating behavior ( OR=0.71, 95%CI =0.59-0.85) were negatively related with children s sleep problems; in addition, screen exposure ( OR=1.27, 95%CI =1.06-1.51) and picky eating ( OR= 1.47 , 95%CI =1.21-1.78) were positively related to children s sleep problems (all P <0.05). Conclusion The high detection rate of sleep problems among preschool children in Hainan Province is multifactorially associated with family environment, dietary habits, and lifestyle behaviors.

Purpose: This study aimed to evaluate the safety and efficacy of gemcitabine and cisplatin (GP) regimen in combination with immune checkpoint inhibitor sintilimab as neoadjuvant therapy for muscle-invasive bladder cancer (MIBC) patients and the feasibility of the following selective bladder sparing surgery. Materials and Methods: Patients with histopathologically confirmed urothelial carcinoma without distant metastases (T2-4a, N ≤ 1, M0, American Joint Committee of Cancer 8th) and with adequate organ function will be enrolled. The therapeutic regimen was sintilimab 200 mg once on day 8, gemcitabine 1,000 mg/m2 and cisplatin 35 mg/m2 once on days 1 and 8, every 21 days for four cycles. The primary endpoint was pathologic complete response (pCR, pT0N0) rate. The secondary end points were ypT < 2 rate, R0 resection rate, event-free survival, and safety. Results: From May 4, 2020, to May 20, 2023, 55 patients were enrolled. Forty-six patients were evaluated for efficacy. Among the 42 patients who underwent surgery, 16 patients (38.0%) achieved pCR. Thirty-three patients (78.6%) achieved pT < 2. With a median follow-up of 15.7 months, the 1-year event-free survival was 91.3%. Notwithstanding the poor pathological baseline characteristic of a high T3-T4a proportion (39.1%), a promising bladder preservation (including 22 patients transurethral resection of bladder tumor, 5 patients partial cystectomy, and 4 surveillances) rate was achieved (67.4%). The most common grade ≥ 3 treatment-related adverse events was neutropenia (n=15, 27.3%), which was related to chemotherapy. There were no grade 3 immune-related adverse events. Conclusion Neoadjuvant GP plus sintilimab is a promising regimen for MIBC patients, with relatively high pT < 2 rate and triggering the emerging roles for the multi-disciplinary team decision-making for bladder sparing surgery.

ObjectiveTo construct a prediction model for high responsiveness to short-term aerobic training in patients with Parkinson's disease (PD) based on dual-task gait assessment, and to provide evidence for identifying individuals who are most likely to benefit from such interventions. MethodsA total of 42 patients with PD who visited the outpatient clinic of Tianjin Huanhu Hospital between August 29, 2023 and December 19, 2024 were enrolled. All participants completed a 4-week home-based aerobic cycling training program and underwent dual-task gait assessments pre- and post-training. Patients were classified into high-response group (n = 12) and low-response group (n = 30) according to whether the improvement in gait speed reached the minimal clinically important difference of 0.1 m/s. The clinical validity of this grouping was verified by comparing differences in cardiopulmonary exercise testing parameters and dual-task gait indicators between the two groups pre- and post-training. Based on baseline characteristics, Firth's penalized maximum likelihood logistic regression was applied to construct a predictive model for high responsiveness, and the discriminative performance of the model was assessed preliminarily. ResultsThe high-response group showed significantly greater improvement in gait speed, step length, cadence and the anaerobic threshold to maximal oxygen uptake ratio after training compared with the low-response group (P < 0.05), confirming the clinical validity of the grouping. The baseline anaerobic threshold to maximal oxygen uptake ratio (OR = 3.348), body mass index (OR = 2.229) and age (OR = 0.428) demonstrated certain discriminative ability in the present sample. The area under the receiver operating characteristic curve was 0.831, with an overall prediction accuracy of 81.0%, specificity of 83.3% and sensitivity of 75.0%. Robustness of the model was confirmed via internal validation using the Bootstrap method, which suggested that the results were informative, but further validation was still required. ConclusionThe anaerobic threshold/maximal oxygen uptake ratio, body mass index and age may predict the response to short-term aerobic training in patients with PD.

Objective:To retrospectively analyze the clinical efficacy and safety of biological agents in the treatment of psoriasis in the elderly.Methods:A retrospective study was conducted. A total of 124 patients aged ≥ 65 years with moderate-to-severe psoriasis (psoriasis area and severity index [PASI] score ≥ 3 points or body surface area [BSA] ≥ 3%), who were treated with biological agents at the Department of Dermatology and Venereology, People's Hospital of Xinjiang Uygur Autonomous Region, from June 2020 to December 2023, were collected. PASI, BSA, and dermatology life quality index (DLQI) scores were recorded at weeks 0 (pre-treatment), 4, 12, and 24 after the beginning of treatment to evaluate the efficacy. The proportions of patients achieving ≥ 75% and 90% improvements in PASI scores (PASI75 and PASI90, respectively) were calculated, and adverse reactions were recorded. Data were processed using SPSS 29.0 and GraphPad Prism 10.0 software. Normally distributed continuous variables were presented as mean ± standard deviation, while non-normally distributed continuous variables were presented as median with upper and lower quartiles ( Q1, Q3). Wilcoxon signed-rank test was used for comparisons of non-normally distributed data between groups, and chi-square test and Fisher's exact test were used for comparing categorical data. Results:Among the 124 patients, there were 72 males (58.1%) and 52 females (41.9%), and their ages ranged from 65 to 87 years. Treatment regimens included secukinumab for 86 patients (69.4%), ustekinumab for 15 (12.1%), ixekizumab for 14 (11.3%), guselkumab for 5 (4.0%), and adalimumab for 4 patients (3.2%). The pre-treatment PASI, BSA, and DLQI scores [ M ( Q1, Q3) ] were 12.2 (7.8, 19.6) points, 16.0% (10.2%, 25.0%), and 16 (11, 20) points respectively, which significantly decreased to 0.8 (0, 1.2) points, 1.0% (0, 2.0%), and 0 (0, 3) points respectively at week 24 after the start of treatment ( Z = 9.66, 9.66, 9.63, respectively, all P < 0.01). The proportions of patients achieving PASI75 at weeks 4, 12, and 24 were 42.7% (53/124), 80.6% (100/124), and 93.5% (116/124) respectively, and those achieving PASI90 were 13.7% (17/124), 48.4% (60/124), and 85.5% (106/124) respectively. There were no significant differences in the proportions of patients achieving PASI75 and PASI90 between the subgroups with and without comorbidities, as well as between the early-onset psoriasis subgroup and late-onset psoriasis subgroup at weeks 4, 12, and 24 (all P > 0.05). Among the 124 patients, 42 were followed up for over 2 years, and the proportions of patients achieving PASI75 and PASI90 after 2 years of treatment were 71.4% (30 cases) and 54.8% (23 cases), respectively. Adverse reactions occurred in 13 patients, including upper respiratory infections in 4 patients (3.2%), elevated aminotransferase levels in 3 patients (2.4%), eczematoid dermatitis in 2 patients (1.6%), pruritus in 2 patients (1.6%), nodular prurigo in 1 patient (0.1%), and vitiligo in 1 patient (0.1%) . Conclusion:Biological agents showed rapid and marked efficacy in the treatment of moderate-to-severe psoriasis in the elderly, with few and mild adverse reactions, suggesting high safety and overall marked efficacy.

Objective To describe the clinical features of patients with primary sclerosing cholangitis(PSC)in China based on a nationwide multicenter patient cohort,and to investigate the risk factors for prognosis.Methods A retrospective cohort study was conducted among the patients with a confirmed diagnosis of PSC based on the electronic medical record system of seven grade A tertiary hospitals across the country,and related data were extracted.The Mann-Whitney U test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups.The Kaplan-Meier method was used to estimate liver transplant-free survival,and the log-rank test was used for comparison of survival rate between PSC patients with different features.The Cox regression model was used to identify independent risk factors for the prognosis of PSC patients and the interactions between key factors.Results A total of 107 patients were enrolled,among whom 55.6%(55/99)had large-duct PSC and 29.0%(31/107)had comorbidity with inflammatory bowel disease(IBD).The positivity rate of anti-neutrophil cytoplasmic antibody(ANCA)was 32.9%(24/73),and 50.0%(40/80)of the patients had an increase in IgG/IgM.The median symptom-to-diagnosis interval was 1 year(<1-4.0),and 38.3%(41/107)of the patients had progressed to decompensated cirrhosis at the time of diagnosis.The median liver transplant-free survival time was 114 months(95%confidence interval[CI]:62-166),with a 5-year survival rate of 65.7%.The multivariate analysis showed that an increase in total bile acid(TBA)(hazard ratio[HR]=1.006,95%CI:1.002-1.010,P=0.001)and a prolonged symptom-to-diagnosis interval(HR=1.252,95%CI:1.059-1.480,P=0.009)were independent risk factors for prognosis.The interaction analysis showed that compared with the female patients with TBA<50 μmol/L,both male and female patients with TBA≥50 μmol/L had a significant increase in the risk of liver transplantation or death(male:HR=16.563,95%CI:2.103-130.449,P<0.001;female:HR=17.009,95%CI:2.113-136.934,P<0.001),and compared with the patients with an age of<45 years and a TBA level of<50 μmol/L,the patients with an age of≥45 years and a TBA level of≥50 μmol/L had a significant increase in the risk of liver transplantation or death(HR=10.729,95%CI:1.325-86.859,P=0.026).Compared with the female patients with an symptom-to-diagnosis interval of≤2 years,the male patients with a symptom-to-diagnosis interval of>2 years had an increased risk of liver transplantation or death(HR=4.825,95%CI:1.725-13.644,P=0.003),and compared with the patients with an age of<45 years and a symptom-to-diagnosis interval of≤2 years,the patients with an age of<45 years and a symptom-to-diagnosis interval of>2 years had an increased risk of liver transplantation or death(HR=4.983,95%CI:1.366-18.173,P=0.015).Conclusion Compared with the reports from Western countries,large-duct PSC is also the main type of PSC in China,but with a relatively low proportion,and there is also a relatively low proportion of patients with IBD or positive ANCA.An increase in TBA and a prolonged symptom-to-diagnosis interval are independent risk factors for prognosis,with significant interactions with age and sex.This suggests that early screening and intervention should be enhanced to improve prognosis.

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare multi-system disease that presents significant diagnostic challenges due to its complexity and low incidence (White and Dubey, 2023). It affects males and females equally, though males may exhibit more active disease at diagnosis and often require more aggressive treatment (Liu et al., 2023). The hallmark features of EGPA include delayed-onset asthma, eosinophilia in tissues and blood, and vasculitis affecting small to medium-sized arteries (White and Dubey, 2023). EGPA falls under the category of antineutrophil cytoplasmic antibody (ANCA)‍-associated vasculitis (AAV), whereas only about half of EGPA patients test positive for ANCA (Khoury et al., 2023).
Humans ; Male ; Hemorrhage/etiology* ; Granulomatosis with Polyangiitis/complications* ; Heart Arrest/etiology* ; Early Diagnosis ; Eosinophilia/diagnosis* ; Kidney Diseases/etiology* ; Churg-Strauss Syndrome/complications* ; Middle Aged

Infectious keratitis (IK) is a leading cause of blindness worldwide, primarily resulting from improper contact lens use, trauma, and a compromised immune response. The pathogenic microorganisms responsible for IK include bacteria, fungi, viruses, and Acanthamoeba. This review examines standard therapeutic agents for treating IK, including broad-spectrum empiric antibiotics for bacterial keratitis (BK), antifungals such as voriconazole and natamycin for fungal infections, and antiviral nucleoside analogues for viral keratitis (VK). Additionally, this review discusses therapeutic agents, such as polyhexamethylene biguanide (PHMB), for the treatment of Acanthamoeba keratitis (AK). The review also addresses emerging drugs and the challenges associated with their clinical application, including anti-biofilm agents that combat drug resistance and nuclear factor kappa-B (NF-κB) pathway-targeted therapies to mitigate inflammation. Furthermore, methods of Photodynamic Antimicrobial Therapy (PDAT) are explored. This review underscores the importance of integrating novel and traditional therapies to tackle drug resistance and enhance drug delivery, with the goal of advancing treatment strategies for IK.

Objective A randomized controlled trial was conducted on colonoscopy inpatient and outpatients to compare the efficacy and safety of water exchange(WE)colonoscopy and CO2 convention insufflation colonoscopy in elderly patients.Methods 340 patients underwent fully sedated colonoscopy were randomly divided into two groups according to colonoscopy with either WE colonoscopy group(WE group)and CO2 insufflation colonoscopy group(CO2 group).The two groups were compared in terms of Boston bowel preparation scale(BBPS),withdrawal time,cecal intubation time,cecal intubation success rate,abdominal compression,willingness to repeat,polypdetectionrate(PDR),adenoma detection rate(ADR),and safety.Results The cecal intubation success rate was significantly higher in WE group(100.0%)compared with CO2 group(96.5%),the difference was statistically significant(P=0.013).The average cecal intubation time of WE group was(10.50±1.79)min,which was longer than that of CO2 group(7.55±1.50)min,and the difference was statistically significant(P<0.01).Comparison of withdrawal time and BBPS between the two groups,the differences were not statistically significant(P>0.05).The abdominal pressure rate was lower in WE group(5.9%)compared with CO2 group(13.5%),the difference was statistically significant(P=0.017).The rate of willingness to re-examination in the WE group was 98.2%,which was significantly higher than the 93.5%in the CO2 group.The PDR in WE group(80.6%)was higher than that in CO2 group(70.6%),the ADR in WE group(67.1%)was higher than that in CO2 group(50.6%),the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that WE group was an effective factor in improving ADR(O＾R=2.027,P<0.01).The overall adverse events were less than 3%,with no difference between the two groups(P=1.000).Conclusion The use of WE colonoscopy has a better improved efficacy in elderly patients,and safety should be ensured by individualized assessment of the patient's co-morbidities,bowel preparation tolerance,and willingness prior to the procedure.