Neurofibromatosis type 1 (NF1) presents with a diverse range of symptoms that can affect the skin, bones, eyes, central nervous system, and other organs. This article reports the diagnosis and treatment process of a patient with NF1 complicated by bilateral severe-to-profound sensorineural hearing loss. Genetic testing revealed a heterozygous variant of NF1 NM_ 000267.3: c.4054_ 4058del(p.Ser1352LeufsTer20, supporting the diagnosis of NF1. After thorough evaluation, a right cochlear implantation was performed, yielding satisfactory postoperative results. This case suggests that NF1 patients may exhibit phenotypic heterogeneity and atypicality, providing a reference for clinicians in the diagnosis and treatment of such patients.

Objective To investigate the current status of rumination and professional grief among hospice nurses,and to explore the mediating effect of death attitude between the two.Methods A total of 323 nurses in hospitals with hospice services and hospice wards in Hangzhou City were surveyed from April to July 2024 by convenience sampling method.They were investigated with general information questionnaire,Event Related Rumination Inventory,Death Attitude Profile-Revised,and Grief State Scale for Nurses by convenience sampling method.The structural equation model was used to analyze the mediating effect of death attitude between rumination and professional grief among hospice nurses.Results A total of 331 questionnaires were collected,among which 8 invalid questionnaires were deleted,and 323 valid questionnaires were retrieved,with the valid questionnaire recovery rate of 97.58％.The score of intrusive rumination dimension for hospice nurses was 13.34(7.00,20.00),and the score of deliberate rumination dimension was 16.92(11.00,24.00).The negative attitude towards death scored 38.35(29.00,48.00),while the positive attitude towards death scored 62.88(49.00,78.00).The total score of Grief State Scale for Nurses was 47.05(40.00,53.00).Hospice nurses'intrusive rumination was positively correlated with negative attitudes toward death,professional grief,and negatively correlated with positive attitudes toward death(all P＜0.05);deliberate rumination was negatively correlated with negative attitudes toward death,professional grief,and positively correlated with positive attitudes toward death(all P＜0.05).Negative death attitudes and positive death attitudes partially mediated between intrusive rumination and professional grief,with mediation effects of 0.053 and 0.037,accounting for 12.70％and 9.25％of the total effect.Negative death attitudes and positive death attitudes similarly partially mediated between deliberate rumination and professional grief,with mediation effects of-0.033 and-0.080,accounting for 10.03％and 21.33％of the total effect.Conclusion Death attitudes are a mediating variable between hospice nurses'rumination and professional grief.Nursing managers can take effective measures to improve hospice nurses'ruminative contemplation ability and positively guide positive attitudes toward death,thereby reducing their professional grief levels.

Objective To investigate the current status of rumination and professional grief among hospice nurses,and to explore the mediating effect of death attitude between the two.Methods A total of 323 nurses in hospitals with hospice services and hospice wards in Hangzhou City were surveyed from April to July 2024 by convenience sampling method.They were investigated with general information questionnaire,Event Related Rumination Inventory,Death Attitude Profile-Revised,and Grief State Scale for Nurses by convenience sampling method.The structural equation model was used to analyze the mediating effect of death attitude between rumination and professional grief among hospice nurses.Results A total of 331 questionnaires were collected,among which 8 invalid questionnaires were deleted,and 323 valid questionnaires were retrieved,with the valid questionnaire recovery rate of 97.58％.The score of intrusive rumination dimension for hospice nurses was 13.34(7.00,20.00),and the score of deliberate rumination dimension was 16.92(11.00,24.00).The negative attitude towards death scored 38.35(29.00,48.00),while the positive attitude towards death scored 62.88(49.00,78.00).The total score of Grief State Scale for Nurses was 47.05(40.00,53.00).Hospice nurses'intrusive rumination was positively correlated with negative attitudes toward death,professional grief,and negatively correlated with positive attitudes toward death(all P＜0.05);deliberate rumination was negatively correlated with negative attitudes toward death,professional grief,and positively correlated with positive attitudes toward death(all P＜0.05).Negative death attitudes and positive death attitudes partially mediated between intrusive rumination and professional grief,with mediation effects of 0.053 and 0.037,accounting for 12.70％and 9.25％of the total effect.Negative death attitudes and positive death attitudes similarly partially mediated between deliberate rumination and professional grief,with mediation effects of-0.033 and-0.080,accounting for 10.03％and 21.33％of the total effect.Conclusion Death attitudes are a mediating variable between hospice nurses'rumination and professional grief.Nursing managers can take effective measures to improve hospice nurses'ruminative contemplation ability and positively guide positive attitudes toward death,thereby reducing their professional grief levels.

Objective To compare the short-term efficacy and safety of inflatable video-assisted mediastinoscopic transhiatal esophagectomy (IVMTE) and minimally invasive transthoracic esophagectomy (MITE) in the treatment of esophageal cancer. Methods The Cochrane Library, EMbase, PubMed, Wanfang Database, VIP, and CNKI were searched. Literatures related to the short-term efficacy and safety of IVMTE and MITE in the treatment of esophageal neoplasms published from the establishment of the database to December 2023 were searched and meta-analysis was conducted by using RevMan5.4. Quality of case control study or cohort study was assessed by the Newcastle-Ottawa Scale (NOS) and quality of randomized controlled trial was assessed by Cochrane Handbook. Results A total of 14 studies (12 case control studies and 1 prospective cohort study wiht NOS score more than 7 points and 1 randomized controlled trial wiht low bias risk) were included, comprising 1 163 patients, with 525 in the IVMTE group and 638 in the MITE group. The results of meta-analysis revealed that the IVMTE group exhibited significantly shorter operative time [MD=−60.42, 95%CI (−83.78, −37.07), P<0.001] and postoperative hospital stay [MD=−2.44, 95%CI (−2.93, −1.94), P<0.01] compared to the MITE group. Moreover, intraoperative blood loss [MD=−34.67, 95%CI (−59.11, −10.23), P=0.005], three-day postoperative drainage [MD=−286.66, 95%CI (−469.93, −103.40), P=0.002], incidence of postoperative pulmonary infection [OR=0.38, 95%CI (0.26, 0.56), P<0.001], lung leakage rate [OR=0.12, 95% CI (0.02, 0.63), P=0.01] and overall complication rate [MD=0.41, 95%CI (0.22, 0.75), P=0.004] were all lower in the IVMTE group compared to those in the MITE group. However, the MITE technique demonstrated superiority over IVMTE regarding intraoperative lymph dissection number [MD=−3.52, 95%CI (−6.36, –0.68), P=0.02] and intraoperative recurrent laryngeal nerve injury [OR=1.78, 95%CI (1.22, 2.60), P=0.003]. No significant difference was observed between both methods concerning anastomotic fistula. Conclusion Compared to MITE, IVMTE has advantages such as shorter operation time, less intraoperative blood loss, shorter hospital stay, less postoperative drainage within 3 days, and a lower incidence of pulmonary complications. In terms of laryngeal recurrent nerve injury and lymphatic dissection, MITE operation offers more benefits.

Objective To predict the constitutive parameters of a superelastic model of plantar soft tissues based on random forest(RF)and backpropagation(BP)neural network algorithms to improve the efficiency and accuracy of the method for obtaining constitutive parameters.Methods First,a finite element model for a spherical indentation experiment of plantar soft tissues was established,and the spherical indentation experiment process was simulated to obtain a dataset of nonlinear displacement and indentation force,divided into training and testing sets.The established RF and BP neural network(BPNN)models were trained separately.The constitutive parameters of plantar soft tissues were predicted using experimental data.Finally,the mean square error(MSE)and coefficient of determination(R2)were introduced to evaluate the accuracy of the model prediction,and the effectiveness of the model was verified by comparison with the experimental curves.Results Combining the RF and BPNN models with finite element simulation was an effective and accurate method for determining the superelastic constitutive parameters of plantar soft tissues.After training,the MSE of the RF model reached 1.370 2×10-3,and R2 was 0.982 9,whereas the MSE of the BPNN model reached 4.858 1×10-5,and R2 was 0.999 3.The inverse-determined constitutive parameters of the plantar soft tissues suitable for simulation were obtained.The calculated response curves for the two predicted sets of constitutive parameters were in good agreement with the experimental curves.Conclusions The prediction accuracy for the superelastic constitutive parameters of plantar soft tissues based on an artificial intelligence algorithm model is high,and the relevant research results can be applied to study other mechanical properties of plantar soft tissues.This study provides a new method for obtaining the constitutive parameters of plantar soft tissues and helps to quickly diagnose clinical problems,such as plantar soft tissue lesions.

Objective:To explore the effectiveness of applying the ADDIE (analysis, design, develop, implement, evaluate) Model in clinical teaching for nursing interns in spine surgery department.Methods:Using a convenience sampling method, 44 nursing interns in the Department of Orthopedics at Peking Union Medical College Hospital were selected as the control group from July 2021 to May 2022, and were taught using traditional methods. From July 2022 to May 2023, 45 nursing interns were selected as the observation group, and a teaching team was formed to design a training program based on the five stages of the ADDIE instructional design model. This program was tailored to improve the overall clinical competence of the spinal surgery nursing interns. After training, the teaching effects were evaluated based on knowledge test scores, skills test scores, overall clinical competence, and teaching satisfaction.Results:After the training, the skills test scores in specialized nursing for the observation group were (94.87±1.10) points, higher than the control group's (93.98±1.41) points, with a statistically significant difference ( P<0.01). The observation group also scored higher than the control group in clinical judgment, organizational effectiveness, overall performance, and total score in the Mini-Clinical Evaluation Exercise, with statistically significant differences ( P<0.01). Additionally, the observation group reported higher satisfaction with the teaching plan and methods compared to the control group ( P<0.05) . Conclusions:Clinical teaching for spinal surgery nursing interns based on the ADDIE instructional design model can improve their specialized practical skills and overall clinical competence. The interns also expressed a high level of acceptance for this teaching design model.

Objective:To evaluate the relationship of early tumor shrinkage and depth of tumor response with the clinical efficacy and pro-gnosis of programmed death-1(PD-1)inhibitor combined with trastuzumab and first-line chemotherapy in the treatment of HER-2-positive advanced gastric cancer.Methods:We retrospectively analyzed data from 40 patients treated with this combination at Nanjing Drum Tower Hospital,The Affliated Hospital of Nanjing University Medical School from June 2018 to March 2023.Key metrics included early tumor shrinkage(ETS),depth of response(DpR),objective response rate(ORR),disease control rate(DCR),progression-free survival(PFS),overall survival(OS),and adverse reactions.Survival analysis using Log-rank test and Kaplan-Meier method,and plot PFS and OS survival curves.COX regression analysis for correlation testing.Results:The patient's ORR was 77.5%,DCR was 100%,complete response rate was 15.0%,medi-an PFS(mPFS)was 11.10 months,and median OS(mOS)was 30.77 months.COX univariate analysis showed that tumor differentiation,liver metastasis,distant lymph node metastasis,DpR were related to PFS and OS(all P<0.05),ETS was only related to PFS(P=0.010),and PD-L1 ex-pression was not related to PFS and OS.There was a significant difference in mPFS between patients with ETS≥35%and ETS<35%(P=0.008),while there was no significant difference in mOS(P=0.076);There were significant differences in mPFS and mOS between patients with DpR≥40%and DpR<40%(P=0.001).COX multivariate analysis showed that DpR is an independent factor affecting PFS and OS,and distant lymph node metastasis is an independent factor affecting OS.The overall tolerance to treatment of the patients was good,with no grade 4 or above treatment-related adverse reactions or death.Conclusions:ETS and DpR may be predictive indicators of the efficacy and prognosis of PD-1 inhibitors combined with trastuzumab and first-line chemotherapy for HER-2 positive advanced gastric cancer.

Objective:To observe any effect of percutaneous tibial nerve stimulation (PTNS) combined with electro-acupuncture on detrusor overactivity after a spinal cord injury.Methods:Forty spinal cord injury survivors with neurogenic detrusor overactivity were randomly assigned to a control group or an observation group, each of 20. Both groups received routine bladder training and electro-acupuncture modulating 3 sacral spinal nerves. The observation group also received 20 minutes of bilateral PTNS five times a week for 8 weeks. The frequency was 10Hz with a pulse width of 200μs. Before and after the treatment, both groups′ urination frequency, incontinence and average daily urine volume were assessed using a urodynamics analyzer, bladder diaries and an incontinence quality of life questionnaire (I-QOL).Results:After treatment, the average involuntary detrusor contraction volume (IDCV), maximum detrusor pressure at filling time (P det·max), bladder compliance (BC), residual volume and the TL value of the electromyogram of the urethral sphincter (LgTLR) had all improved significantly in both groups. The 1st IDCV, BC and LgTLR of the observation group were then significantly better than in the control group, on average, with the average P det·max and residual volume significantly lower than in the control group. The average daily single urine output and I-QOL score of both groups had increased significantly, while the average daily urination frequency and frequency of urinary incontinence had decreased significantly. Both were again significantly better in the observation group. Conclusion:Combining percutaneous electrical stimulation of the tibial nerves with electro-acupuncture can effectively inhibit detrusor overactivity after a spinal cord injury, reducing urinary incontinence.

Objective:To study the differentially expressed genes (DEG) during the differentiation of human induced pluripotent stem cells (hiPSC) and human embryonic stem cells (hESC) into pericytes and endothelial cells, and to identify key molecules and signaling pathways that may regulate this differentiation process.Methods:hiPSC and hESC were selected and expanded using mTeSR medium. A "two-step method" was used to induce the differentiation of hiPSC and hESC into pericytes and endothelial cells. Pericytes were identified using immunofluorescence staining, while endothelial cells were isolated and identified using flow cytometry. Total RNA samples were extracted on days 0, 4, 7, and 10 of differentiation and consistently significant DEGs were screened. Gene ontology (GO) enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) signal pathway enrichment analysis were performed on the screened DEGs.Results:Both hiPSCs and hESCs successfully differentiated into pericytes and endothelial cells under induction conditions. Transcriptome sequencing results showed that with the extension of differentiation time, the DEGs in hiPSCs and hESCs were significantly upregulated or downregulated, following a generally consistent trend. During the differentiation process, marker genes for pericytes and endothelial cells were significantly upregulated. A total of 491 persistent DEGs were detected in both hiPSC and hESC, with 164 unique to hiPSCs and 335 to hESCs, while 8 DEGs were co-expressed in both cell lines. Among these, SLC30A3, LCK, TNFRSF8, PRDM14, and GLB1L3 showed sustained downregulation, whereas CLEC18C, CLEC18B, and F2RL2 exhibited sustained upregulation. GO enrichment analysis revealed that DEGs with sustained upregulation were primarily enriched in terms related to neurogenesis, differentiation, and developmental proteins, while DEGs with sustained downregulation were enriched in terms related to membrane structure and phospholipid metabolic processes. KEGG pathway analysis showed that upregulated genes were primarily enriched in cancer-related pathways, pluripotency regulatory pathways, the Wnt signaling pathway, and the Hippo signaling pathway, whereas downregulated genes were predominantly enriched in metabolism-related pathways. Conclusions:During the differentiation of hiPSC and hESC into pericytes and endothelial cells, 8 DEGs exhibit sustained specific expression changes. These changes may promote pericyte and endothelial cell differentiation by activating the Wnt and Hippo pathways, inhibiting metabolic pathways, releasing the maintenance of stem cell pluripotency, affecting the cell cycle, and inhibiting cell proliferation.

Objective To investigate the shedding of CAV2-ΔE3-CGS after immunization and the background of canine adenovirus (CAV) infection, and to establish a dual fluorescent quantitative PCR detection method for rabies virus (RV) and canine adenovirus type 2 (CAV2). Methods A dual fluorescent quantitative PCR detection method was established by designing specific primers and probes for E1 gene of CAV and G gene of RV for the detection of CAV2-ΔE3-CGS. Oral swabs, anal swabs and environmental samples of stray dogs from experimental animal farm and dog detention center were tested. Results The standard curves generated by this method were Y=-3.351 × logX + 44.895, R² = .999 and Y=-3.413 × logX + 45.192, R²=0.996, respectively. The linear relationships were good, and the minimum detection limits were both 102 copies/μL. CAV2-ΔE3-CGS was not detected in experimental animal farm. CAV was detected in dog detention center, and the positive rates were 5.88% (5/85) in oral swabs, 8.24% (7/85) in anal swabs, and 4% (1/25) in environmental samples. Conclusion The dual fluorescent quantitative PCR method can be used for the detection of CAV2-ΔE3-CGS after immunization and the investigation of CAV infection. The present study has shown that no CAV2-ΔE3-CGS has been detected after immunization and CAV infection rate of stay dogs is low in Shanghai. CAV2-ΔE3-CGS oral immunization meets requirement and is applicable.