Objective:To assess the use of R-R interval (RRI) sequence data collected via wearable devices to evaluate emotional dynamic factors in adolescents with depressive disorders, and to analyze their impact on diagnosis and severity assessment.Methods:Clinical data were prospectively collected from 154 adolescent inpatients with depressive disorders (132 females, 22 males; age 12-18, mean: 13.5±1.6 years) treated at the Child Psychiatry Ward of Beijing Anding Hospital, Capital Medical University between January 2023 and January 2024.A control group of 152 healthy adolescents (62 females, 90 males; age 12-18, mean 14.5±1.3 years) was recruited during the same period. RRI data were obtained using the built-in photoplethysmography (PPG) sensor in the HUAWEI Band 7 wearable device. The device′s integrated emotion evaluation system extracted arousal and emotional valence (as indicators of emotional dynamics) from the collected RRIs. A Long Short-Term Memory (LSTM) network was employed to develop a model for depression diagnosis and severity prediction, while a random forest model was applied to generate receiver operating characteristic (ROC) curves to evaluate model performance. Binary Logistic regression was conducted to investigate the influence of arousal and emotional valence on depression diagnosis and severity.Results:A total of 429 records were collected and analyzed from 306 participants. The LSTM-based diagnosis and severity assessment models achieved area under the curve (AUC) of 0.896 9 and 0.715 3, respectively, indicating good model performance. Binary Logistic regression analysis showed that arousal and emotional valence had significant effects on diagnosis and severity. Specially, lower arousal in both the first 4 hours ( β=-8.906, 95%CI:-17.497 to -0.315) and second 4 hours ( β=-3.033, 95%CI:-5.109 to -0.957) significantly predicted positive depression diagnosis ( β=-1.219, 95%CI:-2.205 to -0.233), while emotional valence in the second 4 hours showed a trend toward a positive association ( β=0.675, 95%CI:-0.107-1.457). First 4-hour emotional valence: significantly positive association with severity ( β=0.322, 95%CI: 0.067-0.577), second 4-hour arousal level: negative association with severity ( β=-0.258, 95%CI:-0.527 to 0.011), whereas arousal in the second 4 hours had a marginal negative effect (β=-0.258, 95% CI:-0.527 to 0.011). Conclusion:RRI may serve as a useful auxiliary measure in diagnosing depressive disorders and predicting severity among adolescents. Wearable smart devices offer promising potential for screening emotional dynamic factors related to adolescent depression.

The cellular and molecular components of the tumor immune microenvironment (TIME) and their information exchange processes significantly influence the trends of anti-tumor immunity. In recent years, numerous studies have begun to evaluate TIME in the context of previous cancer treatment strategies. This review will systematically summarize the compositional characteristics of TIME and, based on this foundation, explore the impact of current cancer therapies on the remodeling of TIME, aiming to provide new insights for the development of innovative immune combination therapies that can convert TIME into an anti-tumor profile.
Tumor Microenvironment/immunology* ; Humans ; Neoplasms/therapy* ; Immunotherapy/methods* ; Animals

Objective:To assess the use of R-R interval (RRI) sequence data collected via wearable devices to evaluate emotional dynamic factors in adolescents with depressive disorders, and to analyze their impact on diagnosis and severity assessment.Methods:Clinical data were prospectively collected from 154 adolescent inpatients with depressive disorders (132 females, 22 males; age 12-18, mean: 13.5±1.6 years) treated at the Child Psychiatry Ward of Beijing Anding Hospital, Capital Medical University between January 2023 and January 2024.A control group of 152 healthy adolescents (62 females, 90 males; age 12-18, mean 14.5±1.3 years) was recruited during the same period. RRI data were obtained using the built-in photoplethysmography (PPG) sensor in the HUAWEI Band 7 wearable device. The device′s integrated emotion evaluation system extracted arousal and emotional valence (as indicators of emotional dynamics) from the collected RRIs. A Long Short-Term Memory (LSTM) network was employed to develop a model for depression diagnosis and severity prediction, while a random forest model was applied to generate receiver operating characteristic (ROC) curves to evaluate model performance. Binary Logistic regression was conducted to investigate the influence of arousal and emotional valence on depression diagnosis and severity.Results:A total of 429 records were collected and analyzed from 306 participants. The LSTM-based diagnosis and severity assessment models achieved area under the curve (AUC) of 0.896 9 and 0.715 3, respectively, indicating good model performance. Binary Logistic regression analysis showed that arousal and emotional valence had significant effects on diagnosis and severity. Specially, lower arousal in both the first 4 hours ( β=-8.906, 95%CI:-17.497 to -0.315) and second 4 hours ( β=-3.033, 95%CI:-5.109 to -0.957) significantly predicted positive depression diagnosis ( β=-1.219, 95%CI:-2.205 to -0.233), while emotional valence in the second 4 hours showed a trend toward a positive association ( β=0.675, 95%CI:-0.107-1.457). First 4-hour emotional valence: significantly positive association with severity ( β=0.322, 95%CI: 0.067-0.577), second 4-hour arousal level: negative association with severity ( β=-0.258, 95%CI:-0.527 to 0.011), whereas arousal in the second 4 hours had a marginal negative effect (β=-0.258, 95% CI:-0.527 to 0.011). Conclusion:RRI may serve as a useful auxiliary measure in diagnosing depressive disorders and predicting severity among adolescents. Wearable smart devices offer promising potential for screening emotional dynamic factors related to adolescent depression.

Objective:To evaluate and summarize the relevant evidence on skin flap management in patients with breast cancer after mastectomy at home and abroad.Methods:Domestic and foreign clinical decision-making systems, guideline websites, professional societies websites, evidence-based databases, and original research databases were systematically searched for clinical practice guidelines, expert consensus, evidence summary and systematic evaluation on skin flap management in patients with breast cancer after mastectomy. The retrieval period was from January 2010 to April 2020. Two researchers with evidence-based nursing knowledge independently screened the search results and evaluated the quality.Results:A total of 24 articles were included, including 17 systematic reviews, 2 evidence summaries, 3 expert consensus and 2 clinical decisions. The 17 best pieces of evidence were summarized from three aspects, including preoperative, intraoperative and postoperative management.Conclusions:Existing evidence covers the three aspects of preoperative, intraoperative and postoperative management. In clinical applications, system changes should be taken as the main entry point to realize the transformation of evidence to the clinic, so as to reduce the occurrence of postoperative flap complications, increase patient satisfaction, improve the quality of nursing and reduce medical costs.

Objective:To summarize the clinical characteristics of children with interleukin-1 receptor associated kinase 4 (IRAK4) deficiency.Methods:The clinical data of a child with IRAK4 deficiency who was admitted to the Department of Neurology of Shenzhen Children′s Hospital for several times from June 2019 to August 2020 were retrospectively analyzed. Related literature up to January 2021 with the key words "IRAK4 gene variation", and "interleukin-1 receptor-associated kinase 4 deficiency" in PubMed, CNKI, Wanfang, and CQVIP databases were searched. The clinical characteristics of this disease were summarized and analyzed.Results:The boy was 6 years of age and had recurrent respiratory tract infections. He was improved after antibiotic treatment. His clinical manifestation included Streptococcus pneumoniae meningoencephalitis, multiple sclerosis, invasive discitis and inflammatory bone destruction. Family-based whole exome sequencing showed that the boy had a homozygous frameshift variation in the IRAK4 gene, NM_016123.3:C.540del (p.Phe180leufs*26), and both parents were heterozygous. A total of 23 cases were reported in ten English articles. Together with this case, there were 24 cases, including 13 males and 11 females. The age of onset was 8 days to 7 years. The main manifestations were recurrent invasive bacterial infection, including 11 cases with Streptococcus pneumoniae meningitis, 9 cases with Streptococcus pneumoniae and (or) Staphylococcus aureus septicemia, 1 case with Pseudomonas aeruginosa meningitis, 1 case of salmonella infection, and 1 case with Staphylococcus aureus skin abscess. Only 1 case had recurrent virus infection. There were 2 patients with autoimmune diseases, 1 with autoimmune encephalitis and the other one with juvenile idiopathic arthritis. Among the 24 cases, 10 died (9 in infancy). Most of the surviving children were diagnosed early and received antibiotics preventively and intravenous immunoglobulin (IVIG). Their susceptibility to infection decreased year by year, and could be close to normal children at the age of 14 years. Among the 24 cases, 21 cases had homozygous variation of IRAK4 gene and 3 cases had complex heterozygous variation. There were 15 kinds of variation, including 9 kinds of frameshift variation, 4 kinds of nonsense variation and 2 kinds of missense variation. One candidate variation hotspot was c.877 c>T (3 cases). Conclusions:IRAK4 deficiency mainly manifest as recurrent and invasive bacterial infection, with Streptococcus pneumoniae meningitis or septicemia being the most common. A few patients are complicated with autoimmune diseases. The mortality rate is high in infancy, early diagnosis and treatment can avoid severe illness or death.