Objective: To investigate the correlation of emotional and behavioral problems with sleep problems in children with cerebral palsy, so as to provide reference for intervention of emotional and behavioral problems in children. Methods: A cross sectional survey was conducted, and 402 children aged 6-18 with cerebral palsy who were adopted by social welfare institutions in Guangzhou City from January 2023 to January 2024 were selected to investigate their full time nurses. The Parents Strengths and Difficulties Questionnaire (SDQ) was used to assess the emotional and behavioral problems of children with cerebral palsy, and the Children s Sleep Habits Questionnaire (CSHQ) was used to assess sleep problems. Multiple linear regression analysis was used to analyze the correlation between the sleep problem of children with cerebral palsy and the emotional and behavioral problems. Results: The prevalence of emotional and behavioral difficulties among children with cerebral palsy was 15.7%. The median sleep problem score of children with emotional and behavioral problems [37.0(36.0, 41.0)] was significantly higher than that of children without emotional and behavioral [35.0(34.0, 36.0)] ( Z =-5.74, P <0.01). The results of multiple linear regression analysis showed that after adjusting covariables such as age, gender, cerebral palsy classification, language retardation, visual impairment and epilepsy, the total sleep problem score of children with cerebral palsy was positively correlated with the total difficulty score ( β= 0.28, 95%CI =0.17-0.34, P <0.05). Conclusions Sleep problems in children with cerebral palsy are associated with emotional and behavioral difficulties. Understanding of the management of sleep problems in children with cerebral palsy should be enhanced to reduce the incidence of emotional and behavioral problems in children with cerebral palsy.

OBJECTIVE: To investigate the clinical application of high-frequency color Doppler ultrasound (HFCDU) in detecting perforators in the deep adipose layers for harvesting super-thin anterolateral thigh flap (ALTF). METHODS: Between August 2019 and January 2023, 45 patients (46 sides) with skin and soft tissue defects in the foot and ankle were treated, including 29 males and 16 females, aged from 22 to 62 years, with an average of 46.7 years. The body mass index ranged from 19.6 to 36.2 kg/m ², with an average of 23.62 kg/m ². The causes of injury included traffic accident injury in 15 cases, heavy object crush injury in 20 cases, mechanical injury in 8 cases, heat crush injury in 1 case, and chronic infection in 1 case. There were 20 cases on the left side, 24 cases on the right side, and 1 case on both sides. After thorough debridement, the wound size ranged from 5 cm×4 cm to 17 cm×11 cm. All patients underwent free super-thin ALTF transplantation repair. HFCDU was used to detect the location of the perforators piercing the deep and superficial fascia, as well as the direction and branches of the perforators within the deep adipose layers before operation. According to the preoperative HFCDU findings, the dimensions of the super-thin ALTF ranged from 6 cm×4 cm to 18 cm×12 cm. The donor sites of the flaps were directly sutured. RESULTS: A total of 55 perforators were detected by HFCDU before operation, but 1 was not found during operation. During operation, a total of 56 perforators were found, and 2 perforators were not detected by HFCDU. The positive predictive value of HFCDU for identifying perforator vessels was 98.2%, and the sensitivity was 96.4%. Among the 54 perforators accurately located by HFCDU, the orientation of the perforators in the deep adipose layers was confirmed during operation. There were 21 perforators (38.9%) traveled laterally and inferiorly, 12 (22.2%) traveled medially and inferiorly, 14 (25.9%) traveled laterally and superiorly, 5 (9.3%) traveled medially and superiorly, and 2 (3.7%) ran almost vertically to the body surface. Among the 54 perforators accurately located by HFCDU, 35 were identified as type 1 perforators and 12 as type 2 perforators (HFCDU misidentified 7 type 2 perforators as type 1 perforators). The sensitivity of HFCDU in identifying type 1 perforators was 100%, with a positive predictive value of 83.3%. For type 2 perforators, the sensitivity was 63.2%, and the positive predictive value was 100%. The surgeries were successfully completed. The super-thin ALTF had a thickness ranging from 2 to 6 mm, with an average of 3.56 mm. All super-thin ALTF survived, however, 1 flap experienced a venous crisis at 1 day after operation, but it survived after emergency exploration and re-anastomosis of the veins; 1 flap developed venous crisis at 3 days after operation but survived after bleeding with several small incisions; 3 flaps had necrosis at the distal edge of the epidermis, which healed after undergoing dressing changes. All 45 patients were followed up 6-18 months (mean, 13.6 months). Three flaps required secondary defatting procedures, while the rest had the appropriate thickness, and the overall appearance was satisfactory. CONCLUSION Preoperative application of HFCDU to detect the perforator in the deep adipose layers can improve the success and safety of the procedure by facilitating the harvest of super-thin ALTF.
Male ; Female ; Humans ; Thigh/surgery* ; Plastic Surgery Procedures ; Prospective Studies ; Skin Transplantation ; Free Tissue Flaps ; Burns ; Soft Tissue Injuries/surgery* ; Ultrasonography, Doppler, Color ; Crush Injuries/surgery* ; Perforator Flap ; Treatment Outcome

Objective: To investigate the association between cysteine level and lumbar spine (LS) bone mineral density (BMD) among children with cerebral palsy, so as to provide a basis for bone health enhancement among children with cerebral palsy. Methods: A total of 149 children aged 10-18 with cerebral palsy who were admitted to the G city Social Welfare Institute (Luogang District) from January 2023 to January 2024. Basic demographic characteristics of children with cerebral palsy were extracted from medical records system. Cysteine levels were measured using the enzyme cycling method. LS BMD of the children was determined by specialized rehabilitation physicians using dual energy X ray absorptiometry, and the corrected BMD Z -scores for LS were calculated. Non restrictive cubic splines and segmented multiple linear regression were employed to analyze the correlation between cysteine levels and age specific height Z -scores (HAZ scores) for LS BMD in children with cerebral palsy. Results: The median cysteine concentration in children with cerebral palsy was 9.13(8.42, 10.30)μmol/L, with significantly higher levels in spastic type children [9.28(8.53，10.49)μmol/L] compared to non spastic types [8.64(7.89，9.66)μmol/L]( Z=-2.46，P <0.05). The median LS BMD HAZ score was -1.07( -2.10 , -0.16), and the detection rate of decreased bone mass was 29.5%. There was an "L" shaped association between serum homocysteine concentration and LS BMD HAZ score in children with cerebral palsy. When serum homocysteine concentration was below 8.7 μmol/L, a significant negative correlation was observed between LS BMD HAZ score and serum homocysteine concentration ( B=-0.32, 95%CI =-1.06 to -0.15, P <0.05). Conclusions The significant negative correlation between cysteine levels and LS BMD in children with cerebral palsy at lower cysteine concentrations, which suggests a potentially higher sensitivity to the influence of homocysteine than healthy children and adolescents, warranting attention even if not reaching the standard of hyperhomocysteinemia.

In order to further standardize the diagnosis and treatment of long-term systemic complications in kidney transplant recipients,Branch of Organ Transplantation of Chinese Medical Association initiated the formulation of"Clinical Diagnosis and Treatment Guidelines for Long-term Systemic Complications in Kidney Transplant Recipients in China".Experts on organ transplantation were organized to summarize and integrate the latest progress in this field based on existing clinical guidelines,systematic evaluations,case studies,expert consensus.The guideline was formed after multiple rounds of discussion and reaching a consensus which included complications of hematological system,central nervous system,cardiovascular system,ocular,cutaneous and osteoporosis disorders.The full text focuses on 27 clinical problems and forms 40 recommendations,mainly involving the risk factors,classification,diagnosis,treatment and prevention of various complications.This guideline graded the quality of evidence and the strength of recommendation for each clinical issue using 2009 Oxford Centre for Evidence-Based Medicine(OCEBM)Grading and Strength of Recommendation criteria,so as to provide reference for the diagnosis and treatment of late complications,comprehensively improve the management capacity of clinicians to benefit kidney transplant recipients.

Background Currently,there has been a gradual increase in the incidence of mental diseases,becoming a problem that has attracted great concern of the general public.Zhuhai is a core city of the Guangdong-Hong Kong-Macao Greater Bay Area,and the local government have attached great importance to the mental health of residents.The systematic study on the mental health has focused largely on pregnant women and medical workers,yet few are on the adult residents.Objective To investigate the prevalence and its influencing factors of anxiety and depression among adult residents in Zhuhai,so as to provide references for formulating targeted psychological intervention strategies.Methods From September 1 to December 1,2021,a cohort of 5 600 permanent residents aged 18 years and above in Zhuhai were selected through multistage sampling.All participants were subjected to complete Patients' Health Questionnaire Depression Scale-9 item(PHQ-9),Generalized Anxiety Disorder Scale-7 item(GAD-7)and National Mental Health Literacy Questionnaire based on Wenjuanxing software.Then Logistic regression was employed to identify the factors associated with anxiety and depression among the residents.Results Among the 5 600 residents,depressive symptoms were detected in 842(15.04％)residents and anxiety symptoms in 579(10.34％)residents.Logistic regression analysis yielded that female gender(OR=1.488),living in Doumen district(OR=1.942),junior college/undergraduate level(OR=3.602),postgraduate and above(OR=5.904),irregular meal pattern(OR=3.320),comorbid chronic diseases(OR=3.244),disqualification of self-assessment(OR=3.414)and disqualification of mental health skill(OR=2.131)were risk factors for depression symptoms,whereas age≥25 years old(of all age groups OR<1),monthly per capita income>20 000 yuan(OR=0.438)and exercising≥3 times a week(OR=0.431)were protective factors for depression symptoms.Age of 25～34 years old(OR=2.051),living in Jinwan district(OR=1.729)or Doumen district(OR=1.901),junior college/undergraduate level(OR=2.955),postgraduate and above(OR=6.662),irregular meal pattern(OR=2.741),comorbid chronic diseases(OR=3.535),disqualification of self-assessment(OR=3.325)and disqualification of mental health skill(OR=1.838)were risk factors for anxiety symptoms,while monthly per capita income of 6 001～9 000 yuan(OR=0.665)and exercising≥3 times a week(OR=0.572)were protective factors for anxiety symptoms.Conclusion The mental health status of adult residents in Zhuhai is affected by various factors,including gender,age,region of residence,education level,meal pattern,exercise frequency and chronic diseases.

Objective:To evaluate the effect of applying high-fidelity simulation model in the teaching of lower urinary tract injury.Methods:A total of 50 junior medical students majoring in clinical medicine were enrolled. They were randomly assigned to the control group or the experimental group. The students in the control group were taught using the traditional method involving PPT presentation and videos on lower urinary tract anatomy, surgical basis of lower urinary tract injury, and operative methods for lower urinary tract injury. The students in the experimental group were taught using the simulation model for observation and related operation. After four class hours (40 minutes/class hour) of teaching, the students in the two groups were subjected to theoretical assessment and questionnaire survey. The differences between the two groups were compared and analyzed using the t and χ 2 tests in SPSS 26.0. Results:The total scores of theoretical assessment were (36.80±4.00) and (33.12±3.62) in the experimental group and the control group, respectively, and the difference was significant ( P<0.05). The results of the questionnaire showed that the self-evaluation of the experimental group was better than that of the control group in the mastery of theoretical knowledge, clinical operation, early treatment, operation process, and key steps, and the differences were statistically significant ( P<0.05). Conclusions:Compared with the traditional teaching method, the high-fidelity simulation model improves the efficiency of learning anatomy knowledge and operation process, and promotes the mastery of important and difficult knowledge in lower urinary tract injury. This method merits popularization.

OBJECTIVE: To explore the clinical characteristics and genetic basis of a child with autism spectrum disorder (ASD) in conjunct with congenital heart disease (CHD). METHODS: A child who was hospitalized at the Third People's Hospital of Chengdu on April 13, 2021 was selected as the study subject. Clinical data of the child were collected. Peripheral blood samples of the child and his parents were collected and subjected to whole exome sequencing (WES). A GTX genetic analysis system was used to analyze the WES data and screen candidate variants for ASD. Candidate variant was verified by Sanger sequencing and bioinformatics analysis. Real-time fluorescent quantitative PCR (qPCR) was carried out to compare the expression of mRNA of the NSD1 gene between this child and 3 healthy controls and 5 other children with ASD. RESULTS: The patient, an 8-year-old male, has manifested with ASD, mental retardation and CHD. WES analysis revealed that he has harbored a heterozygous c.3385+2T>C variant in the NSD1 gene, which may affect the function of its protein product. Sanger sequencing showed that neither of his parent has carried the same variant. By bioinformatic analysis, the variant has not been recorded in the ESP, 1000 Genomes and ExAC databases. Analysis with Mutation Taster online software indicated it to be disease causing. Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), the variant was predicted to be pathogenic. By qPCR analysis, the expression level of mRNA of the NSD1 gene in this child and 5 other children with ASD was significantly lower than that of the healthy controls (P < 0.001). CONCLUSION The c.3385+2T>C variant of the NSD1 gene can significantly reduce its expression, which may predispose to ASD. Above finding has enriched the mutational spectrum the NSD1 gene.
Male ; Child ; Humans ; Autism Spectrum Disorder/genetics* ; Heart Defects, Congenital/genetics* ; Computational Biology ; Genomics ; Mutation ; RNA, Messenger/genetics* ; Histone-Lysine N-Methyltransferase/genetics*

Hepatocellular carcinoma (HCC) is one of the most common causes of cancer-related death, and most patients with HCC are diagnosed at an advanced stage. Before 2017, tyrosine kinase inhibitors were the main drugs for the treatment of advanced hepatocellular carcinoma. With the emergence of immune checkpoint inhibitors (ICIs), immunotherapy has gradually brought new hope to such patients. At present, the combination of ICIs and other systemic or local treatments has become a potential strategy for the treatment of advanced hepatocellular carcinoma, and some of these combinations have been included in large-scale clinical trials. The main challenges of immunotherapy for advanced hepatocellular carcinoma include the exploration of predictive biomarkers, management of immune-related adverse events, and exploration of effective combination regimens. This article provides the latest research progress on the single or combined use of ICIs and other immunotherapy for hepatocellular carcinoma and discusses the limitations of current research and clinical application and the future development direction.

This paper summarized professor ZHANG Boli's experience in treating stubborn bi （痹） with the herbal pair of Ruxiang （Olibanum）- Moyao （Myrrha）. The basic pathogenesis of stubborn bi is channel and collateral stasis and obstruction. Ruxiang and Moyao are thus used in mutual reinforcement to rectify qi and diffuse bi， activate blood and relieve pain， thereby removing static and obstructed qi and blood， unblocking the obstructed channels and colla-terals， which is especially suitable for stubborn bi caused by channel and collateral obstruction. In clinical practice， the herbal pair of Ruxiang-Moyao is used together with qi-moving and blood-activating medicinals to treat chest bi by expelling stasis and diffusing stagnation， dissipating cold and unblocking vessels. To treat long-term wither and weakness in late stage of stroke， the medicinals of boosting qi and invigorating blood， unblocking channels and venting collaterals can be added to the herbal pair so as to soothe and drain vessels and collaterals， harmonize and regulate qi and blood. Simiao Yongan Decoction （四妙勇安汤） can be integrated in the treatment of vessel bi by moving qi and dissolving stasis， and for the long-term stubborn vessel bi， integrated internal and external treatment is suggested by external use of Ruxiang-Moyao to vent bi with aromatics. Moreover， it is emphasized to use the herbal pair of Ruxiang-Moyao in accordance with indications and cautions.

At present, most of the research on hip exoskeleton robots adopts the method of decoupling analysis of hip joint motion, decoupling the ball pair motion of hip joint into rotational motion on sagittal plane, coronal plane and cross section, and designing it into series mechanism. Aiming at the problems of error accumulation and man-machine coupling in series mechanism, a parallel hip rehabilitation exoskeleton structure is proposed based on the bionic analysis of human hip joint. The structure model is established and the kinematics analysis is carried out. Through the OpenSim software, the curve of hip flexion and extension, adduction and abduction angle in a gait cycle is obtained. The inverse solution of the structure is obtained by the D-H coordinate system method. The gait data points are selected and compared with the inverse solution obtained by ADAMS software simulation. The results show that the inverse solution expression is correct. The parallel hip exoskeleton structure can meet the requirements of the rotation angle of the hip joint of the human body, and can basically achieve the movement of the hip joint, which is helpful to improve the human-computer interaction performance of the exoskeleton.
Humans ; Exoskeleton Device ; Hip Joint ; Gait ; Biomechanical Phenomena ; Computer Simulation