Pediatric vertigo presents with complex etiologies, and its clinical diagnosis and management can be challenging due to children's limited ability to describe their symptoms. Recurrent vertigo episodes in children, who are at a critical stage of development, can readily lead to emotional disorders in both the children themselves and their guardians. This article reports a case of benign paroxysmal vertigo of childhood（BPVC） in a child who sought care from multiple providers. The child was found to have a patent foramen ovale（PFO） and mild emotional disorder. By analyzing challenges encountered during the diagnostic and management process in this case of recurrent pediatric vertigo, this study provides practical guidance for rational selection of diagnostic techniques and the comprehensive assessment of disease status in pediatric vertigo/dizziness.
Child ; Humans ; Affective Symptoms/complications* ; Foramen Ovale, Patent/complications* ; Vertigo/complications*

Chronic lymphocytic leukemia(CLL)is a mature B-lymphocyte proliferative tumor with significant heterogeneity.Studies have demonstrated that aberrant activation of the B-cell receptor(BCR)signaling pathway repre-sents the central mechanism underlying CLL.In recent years,inhibitors targeting the BCR signaling pathway have marked-ly improved the prognosis of patients with CLL.This review summarizes the specific roles and clinical applications of the BCR and its associated signaling pathways in CLL pathogenesis,describes how BCR modulates the tumor microenviron-ment,and delineates the metabolic reprogramming mediated by BCR signaling.

Objective:To investigate the predictive value of maximum tumor diameter and the peripheral blood neutrophil to lymphocyte ratio (NLR) before radiotherapy for the occurrence of esophageal fistula after radiotherapy in patients with esophageal squamous cell carcinoma (ESCC) .Methods:A total of 98 patients with ESCC who underwent radiotherapy in Hefei Cancer Hospital, Chinese Academy of Sciences from February 2017 to February 2021 were selected, and the patients were divided into esophageal fistula group (13 cases) and no esophageal fistula group (85 cases) according to whether esophageal fistula occurred during the follow-up process. The prognostic nutritional index (PNI) , NLR, and systemic inflammatory response index (SIRI) were calculated. Univariate and multivariate logistic regression were used to analyze the influencing factors of esophageal fistula, and the predictive value of each indicator was evaluated by using the receiver operator characteristic (ROC) curve.Results:There were no statistically significant differences in age, smoking history, diabetes mellitus history, gender, concurrent chemotherapy and alcohol history between the esophageal fistula group and the no esophageal fistula group (all P>0.05) , while there were statistically significant differences in PNI ( t=2.24, P=0.041) , NLR ( t=3.75, P=0.001) , SIRI ( t=2.68, P=0.015) . Univariate analysis showed that tumor length ( OR=1.16, 95% CI: 1.01-1.35, P=0.043) , maximum tumor diameter ( OR=1.63, 95% CI: 1.11-2.39, P=0.012) , PNI ( OR=0.83, 95% CI: 0.71-0.98, P=0.023) , NLR ( OR=1.94, 95% CI: 1.20-3.12, P=0.007) and SIRI ( OR=1.82, 95% CI: 1.03-3.24, P=0.041) were related to esophageal fistula. Multivariate analysis showed that maximum tumor diameter ( OR=2.17, 95% CI: 1.02-4.94, P=0.033) and NLR ( OR=2.40, 95% CI: 1.89-6.59, P=0.018) were independent influencing factors for the development of esophageal fistula in patients with ESCC after radiotherapy. ROC curve analysis showed that the area under the curve of maximum tumor diameter before radiotherapy combined with NLR for predicting esophageal fistula in patients with esophageal squamous cell carcinoma after radiotherapy was 0.83 (95% CI: 0.74-0.90) , which was greater than that of maximum tumor diameter before radiotherapy (0.71, 95% CI: 0.63-0.81, Z=1.80, P=0.039) and NLR (0.74, 95% CI: 0.67-0.85, Z=1.64, P=0.046) alone. Conclusions:The maximum tumor diameter before radiotherapy and NLR are closely related to the occurrence of esophageal fistula in ESCC after radiotherapy, and these factors are expected to serve as key predictors of the occurrence of esophageal fistula.

Chronic lymphocytic leukemia(CLL)is a mature B-lymphocyte proliferative tumor with significant heterogeneity.Studies have demonstrated that aberrant activation of the B-cell receptor(BCR)signaling pathway repre-sents the central mechanism underlying CLL.In recent years,inhibitors targeting the BCR signaling pathway have marked-ly improved the prognosis of patients with CLL.This review summarizes the specific roles and clinical applications of the BCR and its associated signaling pathways in CLL pathogenesis,describes how BCR modulates the tumor microenviron-ment,and delineates the metabolic reprogramming mediated by BCR signaling.

Objective:To analyze the pregnancy outcomes in patients with positive anti-centromere antibodies(ACA)receiving in vitro fertilization(IVF)-embryo transfer(ET)and natural conception.Methods:A case-control study was used to retrospectively analyze the clinical data of 3955 patients who received IVF-ET therapy and had the results of antinuclear antibody(ANA)spectrum at Zhejiang Provincial People's Hospital from June 2016 to June 2023.Patients with positive ACA and negative ACA were matched at a ratio of 1∶3 using propensity score matching.Embryo outcomes of IVF were compared between the two groups,and the impact of different fertilization methods and the use of immunosuppressants on pregnancy outcomes were analyzed using self-matching.The natural conception and disease progress were followed up for ACA-positive patients after IVF failure.Results:The ACA-positive patients accounted for 0.86%of all IVF patients(34/3955)and 2.51%of total ANA-positive IVF patients.Regardless of whether patients received conventional IVF(c-IVF)or intracytoplasmic sperm injection(ICSI),the ACA-positive group exhibited significant differences in oocyte maturity and fertilization compared to the ACA-negative group(both P＜0.01).Moreover,the ACA-positive group had a decreased number of D3 suboptimal embryos and D3 optimal embryos(both P＜0.05).In 5 cases of ACA-positive patients who underwent ICSI cycles,the two pronucleus(2PN)rate did not increase compared to c-IVF cycles(P＞0.05),and there was a decrease in the number of D3 high-quality embryos and D3 suboptimal embryos(both P＜0.05).After 1-2 months of immuno-suppressant treatment,12 ACA-positive patients underwent c-IVF/ICSI again,and there were no changes in egg retrieval and fertilization before and after medication(both P＞0.05),but there was an improvement in the 2PN embryo cleavage rate(P＜0.05).The number of embryos transferred was similar between the ACA-positive and negative groups,but the ACA-positive group had significantly lower embryo implantation rate and clinical pregnancy rate compared to the ACA-negative group(both P＜0.05),with no significant differences in the miscarriage rate between the two groups(P＞0.05).Twenty-seven ACA-positive patients attempted natural conception or artificial insemination after IVF failure,resulting in a total of 7 cases of clinical pregnancy.Conclusions:Serum ACA positivity may disrupt oocyte maturation and normal fertilization processes,with no improvement observed with ICSI and immunosuppressant use.However,ACA-positive patients may still achieve natural pregnancy.

Idiopathic pulmonary fibrosis (IPF) is a chronic debilitating lung disease with unknown etiology, complex syndromes and prolonged illness, which is difficult to cure. Based on the theory of "spleen is the envoy" in Huang Di Nei Jing, this article explained the TCM meaning of "spleen is the envoy" and the relationship between spleen and other four organs, especially the relationship between spleen and lung. It is believed that the onset of IPF is due to deficiency of lung and spleen qi, loss of solid defense and evil invasion of the nutritive and defensive levels; qi deficiency and depression lead to heat damage to yin, while long-term blood damage to collaterals involves yang. The pathological process shows the changes from qi entering blood and from meridian to collateral, which eventually leads to the imbalance of qi and blood, yin and yang, the stagnation of phlegm and blood stasis, the obstruction of lung collateral, the mixture of excess and deficiency, and the lingering is difficult to heal. In the treatment, the "spleen is the envoy" is the center, the lung and spleen are treated together, the qi of lung and spleen is strengthened, the yin of lung and stomach is nourished, and finally the root is protected. The treatment is based on syndrome differentiation, modified with syndromes, and the methods of promoting blood circulation, resolving phlegm, warming yang and dredging collaterals are supplemented in time, which provides a new idea for enriching the differentiation and treatment of IPF in TCM.

Objective:This study aimed to evaluate the global research landscape, identify trends, and determine hotspots concerning hepatoma recurrence post-liver transplantation.Methods:We conducted a bibliometric analysis usinga systematic search was conducted in the Web of Science Core Collection database from Jan. 1992 to Oct. 2023 to identify relevant articles on hepatoma recurrence after liver transplantation. Articles were selected based on inclusion and exclusion criteria and analyzed for publication trends by country/region, journal, author, institution, citation, and keyword. Visualization tools such as Citespace, VOSviewer, and Bibliometric.com were utilized for statistical analysis, identification of emerging trends, and clustering of keyword co-occurrence.Results:Out of 4,936 articles retrieved, 1,189 were included in the final analysis. There was a notable increase in publications on hepatoma recurrence following liver transplantation from 1992 to 2021, peaking in 2021 both globally (n=103) and nationally (n=32). China has the largest number of publications in this field (n=308), maintaining significant collaboration with the United States, South Korea, Japan, Canada. 'Liver Transplantation’ journal had the highest number of publications (n=113). Zhejiang University was the leading institution (n=74), with Academician Zheng Shusen being the most prolific scholar (n=76 publications). Citation emergence detection found that Italian scholar Mazzaferro's Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective, exploratory analysis published on The Lancet Oncology in 2009 had the highest burst strength (36.98). Five bursting keywords were identified: alpha fetoprotein, model, validation, sorafenib, and risk. Cluster analysis of keyword co-occurrence revealed five primary research themes: the medication for hepatocellular carcinoma recurrence after liver transplantation, recipient selection criteria, prognostic factors, development and validation of recurrence prediction model, and local treatments for hepatocellular carcinoma.Conclusions:The study underscores rapid advancements in the research on hepatocellular carcinoma recurrence post-liver transplantation over the past three decades, with significant contributions from Chinese scholars, particularly from Zhejiang University and Academician Zheng Shusen. The evolving research hotspots have shifted from transplantation experiences and recipient selection criteria to early post-transplant recurrence risk prediction and therapeutic strategy development.

Objective To analyze the effect of Meleis transition theory in the intervention of family caregivers of advanced lung cancer patients.Methods From January 2022 to June 2023,94 patients with advanced lung cancer and their family caregivers treated in 4 hospitals of a tertiary A hospital in Zhejiang Province were selected by convenience sampling method,and they were divided into a control group(n=47)and an experimental group(n=47)according to random number table method.The family caregivers of the experimental group received a four-week intervention based on the Meleis transition theory on the basis of routine nursing education,including role recognition,disease knowledge,life care,psychological support,and social resource connection.Family caregivers in the control group received routine nursing education,caregiving education and guidance.The differences in the readiness,caring ability,psychological burden and patients'quality of life were compared between the 2 groups.Results There was no lost follow-up cases in the control group and experimental group.After intervention,the preparation,ability,and quality of life of family caregivers in the experimental group were better than those in the control group,and the psychological burden of caregivers was significantly lower than that in the control group(P＜0.05).Conclusion The intervention of caregiving ability of family caregivers based on Meleis transition theory can effectively improve the caregiving ability of caregivers,reduce the psychological burden of caregivers,improve the quality of care,and improve the quality of life of patients.

Objective:To predict the Ki-67 expression grading in patients with mass breast cancer based on multimodal ultrasound features to aid clinical diagnosis and treatment.Methods:Ninety-three female patients (93 masses in total) with breast cancers confirmed by pathological examination were retrospectively included in the Second Affiliated Hospital of Harbin Medical University from September 2017 to September 2020. According to the immunohistochemical results, the patients were divided into Ki-67 high expression group (55 cases) and Ki-67 low expression group (38 cases). The qualitative and quantitative features from two-dimensional gray-scale ultrasound, color Doppler flow imaging (CDFI), shear wave elastography (SWE) and contrast-enhanced ultrasound (CEUS) images of all breast masses were retrospectively analyzed, differential features were analyzed based on logistic regression algorithm. ROC curves and Kappa test were used for the evaluation of diagnosis.Results:The univariate analysis revealed statistically significant differences between the two groups for conventional ultrasound features (size, shape, margins), SWE features (stiff rim sign, Eratio), and CEUS features (perfusion defect, IMAX) (all P<0.05). In the multiple logistic regression analysis, the margins, stiff rim sign, and perfusion defect were the independent factors for predicting the Ki-67 expression (all P<0.05). The performance of the predictive model was 0.882 (95%confidence interval of 0.798-0.940, P<0.05) with the sensitivity of 0.818 and specificity of 0.790. Conclusions:A preliminary analysis of the relationship between multi-modal ultrasound features and Ki-67 expression grading in mass breast cancers was performed based on logistic regression algorithm to provide more imaging information for clinical treatment and prognosis assessment.

Objective:To investigate whether ultrasound features, mammographic features and immunohistochemical indicators show any association with rates of axillary pathologic complete response(pCR) in cN 1 breast cancer patients receiving neoadjuvant chemotherapy(NAC), and to construct prediction models of axillary pCR to predict axillary lymph nodes (ALN) status, so as to select suitable patients for less invasive axillary surgery after NAC. Methods:This retrospective study evaluated 134 consecutive cN 1 breast cancer patients with ALN metastasis who underwent NAC in the Second Affiliated Hospital and Tumor Hospital of Harbin Medical University from July 2020 to July 2022. According to the pathological results of ALN surgery after NAC, the cases were divided into pCR and non pathologic complete respose(npCR) groups. The ultrasound images, mammographic images and immunohistochemical indicators of the two groups were compared. In terms of logistic regression algorithm, the model A(the ultrasound model), the model B(the ultrasound combined with mammography model), the model C(the ultrasound combined with immunohistochemistry model) and the model D(the ultrasound combined with mammography and immunohistochemistry model) were respectively established for predicting the pathological state of axillary lymph nodes in breast cancer patients, ROC curves were plotted to evaluate the performance of the models, and the diagnostic efficiency of different models was compared by Delong′s test. The model with the best predictive performance was shown in a nomogram. Results:①The P values between two groups of the short diameter of ALN, the ratio of long/short diameter of ALN, fatty hilum and central hilar vascularity, mammographic spiculation, estrogen receptor(ER), progesterone receptor(PR), human epidermal growth factor receptor 2(HER2) were <0.05 by the t test and χ 2 test analysis. ②The ratio of long/short diameter and fatty hilum in the model A were independent factors for predicting the pathological status of ALN after NAC. The independent predictors of model B and Model C were respectively added with mammographic spiculation and immunohistochemical indicators (ER, PR) on the basis of model A. In the model D, the ratio of long/short diameter, short diameter, fatty hilum, mammographic spiculation, and immunohistochemical indicators (ER, PR) remained significant independent predictors associated with axillary pCR. ③The area under ROC curve (AUC) of the model A, B, C, D was 0.78, 0.84, 0.84 and 0.89, respectively. The sensitivity was 0.71, 0.80, 0.78 and 0.86, the specificity was 0.76, 0.74, 0.76 and 0.80, and the accuracy was 0.73, 0.76, 0.77 and 0.83, respectively. ④Delong′s test showed the model D had an improved AUC of 0.89(0.89 vs 0.78, 0.84, 0.84, all P<0.05). Conclusions:The prediction models combining bi-modal imaging and immunohistochemical indicators show good prediction ability and can provide reference for selecting suitable patients for less invasive axillary surgery after NAC.