Objective: To analyze the associations among body mass index (BMI), learning screen/gaming screen exposure and executive function in preschool children in Anhui Province, so as to provide a basis for promoting the development of executive function in preschool children. Methods: In June 2022, a stratified cluster sampling and convenience sampling methods were used to survey 3 534 mothers of preschool children in Wuhu City, Luan City, and Fuyang City, Anhui Province. The Behavior Rating Inventory of Executive Function-Preschool Version (BRIEF-P) was used to assess the preschool childrens executive function abnormalities. Binary Logistic regression was conducted to examine the relationships among BMI, learning screen/gaming screen exposure, and their combined effects on executive function abnormalities. Results: The detection rate of abnormal executive function in preschool children was 9.65%. Logistic regression analysis showed that after adjusting for the confounding factors such as pregnancyinduced hypertension, primary caregivers, family per capita monthly income and family structure, the risk of abnormal executive function of children in overweight/obesity group and high learning screen/gaming screen exposure group increased significantly (overweight/obesity:OR=1.78, 95%CI=1.31-2.42, learning screen exposure:OR=1.48, 95%CI=1.18-1.86, gaming screen exposure:OR=1.50, 95%CI=1.18-1.91,P<0.05). Compared with children with normal BMI and low learning screen/gaming screen screen exposure, those with both overweight/obesity and high learning screen/gaming screen exposure had a significantly greater risk of executive function abnormalities (OR=2.07, 95%CI=1.29-3.31; OR=2.42, 95%CI=1.59-3.68,P<0.05). Conclusions Overweight/obesity and high learning screen/gaming screen exposure are important risk factors for executive function abnormalities in preschool children. Therefore, actively guiding preschool children to develop healthy life habits to promote the normal development of their executive functions is essential.

Objective:To analyze the fail mode of neoadjuvant therapy combined with surgery for locally advanced esophageal squamous cell carcinoma (ESCC) after long-term follow-up.Methods:Clinical data of consecutive 238 patients with locally advanced resectable ESCC who underwent neoadjuvant therapy combined with surgery in Zhejiang Cancer Hospital from September 2012 to October 2019 were retrospectively analyzed. The failure mode in the whole cohort was analyzed after long-term follow-up. The overall survival (OS) and disease free survival (DFS) rates were analyzed by Kaplan-Meier method. Survival differences were determined by log-rank test.Results:The pathological complete response (pCR) rate was 42.0% in 238 patients. After a median follow-up of 46.1 months, tumor progression occurred in 96 patients (40.3%), including 25 patients (10.5%) with local recurrence, 61 patients (25.6%) with distant metastases, and 10 patients (4.2%) with simultaneous local recurrence and distant metastases. The median OS and DFS were 64.7 months and 49.9 months. And the 3-, 5-, and 7-year OS and DFS rates were 70.0%, 52.8%, 36.4% and 63.5%, 42.5%, and 30.0%, respectively. The 3-, 5-, and 7-year locoregional recurrence-free survival rates and distant metastasis-free survival rates were 86.0%, 71.4%, 61.2% and 70.6%, 55.9%, 43.0%. Compared with non-pCR patients, the overall progression rate and distant metastasis rate of pCR patients were lower (26.0% vs. 50.7%, 16.0% vs. 32.6%, both P<0.05). And the 3-, 5-, and 7-year OS (83.0% vs. 60.2%, 69.7% vs. 41.7%, 50.4% vs. 27.7%, all P<0.001) and DFS rates (80.4% vs. 51.4%, 63.9% vs. 31.2%, 45.9% vs. 20.3%, all P<0.001) were significantly better in pCR patients. Conclusions:Distant metastasis is the main failure mode of patients with locally advanced ESCC after neoadjuvant therapy. Patients with postoperative pCR can achieve better long-term survival.

Objective:To explore the effects of empathic nursing combined with therapeutic communication on self-burden, negative emotions and coping styles in elderly inpatients with coronary heart disease.Methods:Using the convenient sampling, a total of 135 elderly patients with coronary heart disease who were admitted to Second Hospital of Shanxi Medical University from February 2020 to May 2021 were selected as the research objects. The patients were divided into the observation group ( n=67) and the control group ( n=68) by the random number table method. The control group was given empathy nursing and routine psychological intervention, while the observation group was given empathy nursing combined with therapeutic communication intervention. Self Perceived Burden Scale (SPBS) , Self-Rating Anxiety Scale (SAS) , Self-Rating Depression Scale (SDS) and Medical Coping Modes Questionnaire (MCMQ) were used to evaluate self-burden, negative emotions and coping styles of patients before and after intervention. Results:After the intervention, scores of SPBS, SAS and SDS of the observation group were lower than those of the control group, and the differences were statistically significant ( P<0.05) . The face dimension score in the MCMQ of the observation group was higher than that of the control group, and the avoidance and yield dimension scores were lower than those of the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Empathy nursing combined with therapeutic communication in elderly inpatients with coronary heart disease can help relieve the patients' sense of self-burden and improve negative emotions and coping styles, which has high application values.

Objective:To explore the effect of behavioral training of creative art therapy(CAT) on interpersonal communication in teenagers.Methods:Eighty teenagers were randomly divided into study group( n=40) and control group( n=40).The study group was received the behavioral training of CAT (12 times, each activity lasts for 120 min), and the control group did not take part in the behavioral training of CAT.The two groups were measured with self-esteem scale(SES), shyness scale(SS) and social anxiety scale for children(SASC) before and after behavior training.SPSS 17.0 software was used for statistical analysis, and t-test variance analysis and Mann-Whitney U test were used to compare the differences between groups or within groups. Results:Before and after behavioral training, changes in the SES total score (7.00(5.00, 9.75) vs 1.00(0, 2.00)), the SS total score (7.00(6.00, 12.75) vs 2.00(1.00, 3.00)), the SASC total score (5.00(2.00, 8.75) vs 0(0, 1.00)) and two factor scores (3.00(0.25, 5.00) vs 1.00(0, 1.00), 2.00(1.00, 4.00) vs 0(0, 1.00))in the study group were obviously higher than those in the control group( Z=-7.347, -7.338, -5.841, -4.122 and -5.393, all P<0.05).The score differences of the SASC total score ((7.19±3.82) vs (3.21±3.04)) and two factor scores ((4.00±2.23) vs (1.68±2.05), 3.00 (1.00, 5.00) vs 2.00 (0, 2.00)) of girls were significantly higher than those of boys in the study group ( t=-3.611, -3.398, Z=-2.111, P=0.001, 0.002, 0.035). Conclusion:Behavioral training of CAT can improve teenagers' self-esteem, relieve their shyness and social anxiety, as well as promote their interpersonal communication.

Objective:To investigate the effect of art behavior intervention of yoga training on patients with insomnia comorbid depressive disorder.Methods:Totally 66 patients with insomnia comorbid depressive disorder were randomly divided into the study group( n=36) and the control group( n=30). All patients in two groups were given pharmacotherapy, while the patients in the study group were received art behavior intervention of yoga training for 20 times.Using self-made general information questionnaire to collect the patients' demographic and clinical characteristics.Polysomnography(PSG) was performed to measure objective sleep parameters.The Pittsburgh sleep quality index(PSQI), Hamilton depression scale(HAMD) and Hamilton anxiety scale(HAMA) were used to measure subjective sleep quality, depressive symptoms and anxiety symptoms at baseline and at the end of the interventions. Results:The score differences of pre-and post-intervention in the two group of PSQI total score((11.00±2.72) vs(9.00±2.22)), habitual sleep efficiency((2.02±0.81) vs (1.53±0.77)), daytime dysfunction((1.75±0.90) vs(0.96±0.85)), HAMD total score((12.19±6.25) vs(8.03±5.67)) and HAMA total score(13.00(8.25, 16.75) vs 7.00(5.00, 9.25))in the study group were obviously higher than those in the control group( t=3.220, 2.516, 3.595, 2.806, Z=-3.616, all P<0.05). Conclusion:Art behavior intervention of yoga training can improve sleep quality, depression and anxiety symptoms in patients with insomnia comorbid depressive disorder, which will be applied and popularized in clinical practice.

Objective To determine the genotype of dengue virus (DENV) and its molecular characteristics of E gene from 1 case imported from Bangladesh to Wuhu city.Methods The viral RNA was extracted from patient serum sample,the serotype of DENV was determined by Real-time RT-PCR through screening the universal and serotypes 1/2/3/4 of DENV.The completed sequence of DENV E gene was amplified,the phylogenetic tree of E gene was constructed by MEGA 7.0 software,and the nucleotide and amino acid sequences alignments of E gene were analyzed.Results Patient serum was positive for DENV type 2 nucleic acid.The DENV type 2 belonged to the Cosmopolitan genotype by phylogenetic analysis of the E gene,and it had the highest homology with the isolate D2/Malaysia/1408aTw which was imported from Malaysia to Taiwan in 2014,the homologies of nucleotide and amino acid reached 99.60％ and 99.80％,respectively.Totally 6 nucleotides (42:G→A;141:G→A;490:G→A;516:A→G;954:A→G;1344:C→ T) and 1 amino acid (164:V→I) had changed in E gene.E protein possessed attenuated strain characteristic site E126-E and virulent strain characteristic site E383-385-E-P-G.Conclusions The imported patient is infected with DENV type 2 and the virus is originated from Malaysia.

Objective To investigate and analyze the reasons for the omission of adjuvant radiotherapy after breast-conserving surgery (BCS) in patients with breast cancer.Methods The clinicopathologial characteristics and socioeconomic data of 55 breast cancer patients undergoing BCS without postoperative adjuvant radiotherapy in our hospital from 2012 to 2016 were retrospectively analyzed.Results Among the 55 patients who did not receive radiotherapy,25 patients were due to low local recurrence risk,12 patients were due to economic or family reasons,12 patients were due to fear of adverse reactions of radiotherapy,and 5 patients were not recommended by primary physicians for radiotherapy.In addition,3 cases with multiple distant metastases and 3 cases with concomitant thyroid cancer didn't received radiotherapy.Conclnsions Low risk local recurrence is the main reason for the omission of adjuvant radiotherapy,followed by the fear of radiation-induced toxicity and poor financial support.Patient education and medical insurance may improve the adjuvant radiotherapy compliance.

Objective To design bundle treatment plan in the early stage for severe human infection by avian influenza H7N9, and explore its clinical efficacy and application value. Methods Fifteen patients with severe human infection by avian influenza H7N9 in Guizhou Province from December 29th, 2016 to June 7th, 2017 were enrolled. Patients admitted from March 6th, 2017 to June 7th, 2017 served as a prospective observation period (bundle treatment group), and those from December 29th, 2016 to March 5th, 2017 were selected as a historical control period (conventional treatment group). Conventional treatment group was given conventional treatment such as isolation, anti-virus, symptomatic treatment, and traditional Chinese medicine and so on. Bundle treatment group was given bundle treatment on the basis of conventional treatment, including isolation, anti-virus, respiratory support, restrictive fluid management, immunotherapy, inhibition of inflammation, antibiotic therapy, nutritional support, prevention of hospital acquired infection (HAP), individual sedation, continuous blood purification (CBP) for acute kidney injury (AKI) and severe acute respiratory distress syndrome (ARDS) patients, and intensive care. A cluster of bundle treatment team was set up to ensure that all measures carried out smoothly. The gender, age, onset to diagnosis time, acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, oxygenation index (PaO2/FiO2) at admission, the length of intensive care unit (ICU) stay, total hospitalization time and prognosis of the two groups were observed. Correlation analysis between bundle therapy and prognosis was analyzed by Spearman correlation analysis. Receiver operating characteristic (ROC) curve was drawn, and the clinical value of bundle treatment was analyzed. Results There was no significant difference in gender, age, onset to diagnosis time, APACHEⅡscore, PaO2/FiO2, the length of ICU stay, or total hospitalization time between bundle treatment group (n = 9) and conventional treatment group (n = 6), but the death patients in the bundle treatment group was significantly fewer than those in conventional treatment group (cases:2 vs. 5, χ2= 3.225, P = 0.041). Correlation analysis showed that there was a significant correlation between the mortality and whether received bundle treatment or not in patients who infected by avian influenza H7N9 (r = -0.875, P = 0.018). ROC curve analysis showed that the area under the ROC curve (AUC) of non-bundle treatment for predicting the death in patients with severe human infection by avian influenza H7N9 was 0.938, 95% confidence interval (95%CI) was 0.795-1.000, the sensitivity was 88.88%, and the specificity was 98.62%. Conclusions Early bundle therapy has a significant effect on severe human infection by avian influenza H7N9, which can improve the prognosis and reduce the mortality of patients. It is worthy for clinical application.

Objective To evaluate the high?risk factors for brain metastases after prophylactic cranial irradiation ( PCI), and to provide a basis for personalized treatment. Methods A retrospective analysis was performed in 188 patients with limited?stage small?cell lung cancer who received PCI in our hospital from 2005 to 2010. The Kaplan?Meier method was used to calculate the cumulative rate of brain metastases. The log?rank test and the Cox model were used for the univariate and multivariate analyses of the potential factors for the cumulative incidence of brain metastases, respectively. Results In the 188 patients, 31 ( 16?5%) had brain metastases. The 1?, 2?, and 3?year cumulative incidence rates of brain metastases were 4%, 15%, and 20%, respectively. The univariate analysis showed that staged Ⅲ disease before treatment, elevated levels of tumor markers, incomplete remission after chemoradiotherapy, and local?regional relapse were risk factors for high incidence of brain metastases ( P= 0?044, 0?037, 0?005, 0?007) . The multivariate analysis revealed that incomplete remission after chemoradiotherapy and local?regional relapse after chemoradiotherapy were risk factors for high incidence of brain metastases after PCI ( P= 0?003, 0?040 ) . Conclusions Patients with incomplete remission or local?regional relapse after chemoradiotherapy have high incidence of brain metastases after PCI. For those patients, a frequent follow?up of the central nervous system plus salvage cranial irradiation might provide an alternative to PCI.

OBJECTIVE:To investigate the feasibility,safety and efficacy of domestic small waist big edge-type occluder for patients with multiple outlets sac-type membranous ventricular septal defection (VSD),and summarize its technical problems and the choice of treatment strategies.METHODS:A total of 20 patients with sac-type membranous VSD,underwent left ventricular angiography at left anterior oblique 45°-60° plus CAOD 20°-25°;the left ventricular entrance diameters were 7-21 (10.9±5.2) mm,more than 2 outlets in the right ventricular surfaces,and the largest outlet diameters were 3-10 (4.8±2.9) mm.According to the result from transthoracic echocardiography (TTE) and angiography,the sac-bag size,shape,location,extent of tissue adhesion,and stability were determined.Different types of small waist big edge-type occluder were implanted,and the occluder diameter was 5-14 (4.6±2.8) mm.Following 15 minutes of blocking,the immediate effects of occlusion were observed through repeating left ventricuiar angiography and TTE.All patients rechecked ultrasonic cardiography and electrocardiogram at 5-7 days of hospital stay,and 1,3,6 and 12 months following surgery.All patients took aspirin tablets for 6 months.RESULTS:Of 20 patients,17 cases underwent domestic small waist big edge occluder,blocked successfully through left ventricular entrance,2 cases were successful using symmetry block,and 1 case was failed.Intraoperative occlusion did not affect the aortic valve and tricuspid valve function.There were 1 case with left bundle branch block and 1 case with right bundle branch block during the operation,and all recovered within a week by using hormone therapy.After 6 months,the cardiac sizes were reduced to different degrees.CONCLUSION:It is safe and effective to treat multiple outlets sac-shaped membranous VSD with domestic small waist big edge-type occluder.The key technology,according to the sac size,shape,firmness,outlet orientation,import size,and the size of aortic stump,is to determine the block site and to select a suitable occluder.