Objective:To investigate the clinical manifestation, therapy, and prognosis of Susac syndrome and enhance the understanding of this disease.Methods:A case summary was made.The clinical data of two siblings with Susac syndrome treated at Children′s Medical Center, Peking University First Hospital in January 2024 were summarized.Reported cases of pediatric Susac syndrome were reviewed.Results:The onset of the disease in the two siblings was at the age of 3.00 and 6.75 years, with recurrent headaches, tinnitus, hearing loss and encephalopathy symptoms.Cranial magnetic resonance imaging showed multiple cerebral microbleeding and microinfarction lesions, " snowball like" in the corpus callosum and diffuse white matter edema in the brain.Audiometry revealed sensorineural hearing loss.In one case, ophthalmic fluorescein angiography revealed ischemic changes due to branch retinal artery occlusions.No pathogenic variants were detected in gene testing.This child was diagnosed with Susac syndrome, and the symptoms were improved after treatment with Corticosteroids and Rituximab.No relapse was observed during the 9-month follow-up.A total of 20 pediatric cases of Susac syndrome were retrieved, including 18 reported previously and 2 cases from this study.There were 2 boys and 18 girls, with the age of onset ranging from 2.5 to 17.0 years.The common initial symptoms included headache (19 cases), vertigo and tinnitus or hearing loss (9 cases), and vision impairment or visual field defect (4 cases). The symptoms were improved after immunotherapy.Conclusions:With a low incidence, Susac syndrome is rare in children and difficult to diagnose.There may be a genetic predisposition in such disease.Early diagnosis and immunotherapy can low the relapse and improve the prognosis.

Objective:To investigate the clinical manifestation, therapy, and prognosis of Susac syndrome and enhance the understanding of this disease.Methods:A case summary was made.The clinical data of two siblings with Susac syndrome treated at Children′s Medical Center, Peking University First Hospital in January 2024 were summarized.Reported cases of pediatric Susac syndrome were reviewed.Results:The onset of the disease in the two siblings was at the age of 3.00 and 6.75 years, with recurrent headaches, tinnitus, hearing loss and encephalopathy symptoms.Cranial magnetic resonance imaging showed multiple cerebral microbleeding and microinfarction lesions, " snowball like" in the corpus callosum and diffuse white matter edema in the brain.Audiometry revealed sensorineural hearing loss.In one case, ophthalmic fluorescein angiography revealed ischemic changes due to branch retinal artery occlusions.No pathogenic variants were detected in gene testing.This child was diagnosed with Susac syndrome, and the symptoms were improved after treatment with Corticosteroids and Rituximab.No relapse was observed during the 9-month follow-up.A total of 20 pediatric cases of Susac syndrome were retrieved, including 18 reported previously and 2 cases from this study.There were 2 boys and 18 girls, with the age of onset ranging from 2.5 to 17.0 years.The common initial symptoms included headache (19 cases), vertigo and tinnitus or hearing loss (9 cases), and vision impairment or visual field defect (4 cases). The symptoms were improved after immunotherapy.Conclusions:With a low incidence, Susac syndrome is rare in children and difficult to diagnose.There may be a genetic predisposition in such disease.Early diagnosis and immunotherapy can low the relapse and improve the prognosis.

Objective:To understand the effect of presenteeism behavior of nurses on patient satisfaction and to explore the correlation between them.Methods:This study was a cross-sectional study. In December 2019, the convenient sampling method was adopted to select 500 in-service responsible nurses and 500 inpatients under the charge of the responsible nurses in 5 Class Ⅲ Grade A hospitals in Henan Province as the research objects. The responsible nurses were surveyed by general information questionnaire and Presenteeism Behavior Scale and patients in charge were surveyed by Inpatient Satisfaction and Experience Monitoring Scale.Results:A total of 435 valid questionnaires were collected from responsible nurses and patients in charge. The score of Presenteeism Behavior Scale of 435 nurses was (2.62±0.93) and the score of Inpatient Satisfaction and Experience Monitoring Scale of 435 patients was (4.50±0.49) , showing negative correlation ( r=-0.19, P<0.01) . Conclusions:The level of nurses' presenteeism behavior is at a moderate level and patient satisfaction is at an upper-middle level. Nurses' presenteeism behavior affects patient satisfaction. The higher the incidence of nurses' presenteeism behavior, the lower the patient satisfaction. It is recommended to reduce nurses' presenteeism behavior and improve patient satisfaction.

Objective:To investigate the application values of bone marrow morphology, bone marrow immunohistochemistry, flow cytometry, fluorescence in situ hybridization (FISH) and cytogenetic testing in newly diagnosed multiple myeloma.Methods:A total of 280 patients with multiple myeloma who were newly diagnosed in Tianjin KingMed Diagnosis Center from September 2018 to August 2019 were collected. The bone marrow biopsy was carried out according to the routine method, and bone marrow morphology, bone marrow immunohistochemistry, flow cytometry immunophenotyping, FISH and cytogenetic testing were performed. The detection results of each method were compared.Results:In 280 patients, the bone marrow immunohistochemistry results showed that the median ratio of plasma cells was higher than those of bone marrow morphology (20 cases, 0.675 vs. 0.300) and flow cytometry (47 cases, 0.650 vs. 0.147), and the differences were statistically significant ( Z = -3.883, P < 0.01; Z = -5.947, P < 0.01). Flow cytometry results showed that the positive rates of CD38, CD138, κ, λ, CD56 and CD19 were 100.0% (280/280), 100.0% (280/280), 57.5% (161/280), 42.5% (119/280), 62.1% (174/280) and 19.3% (54/280); bone marrow immunohistochemistry results showed that the positive rates of CD38, CD138, κ, λ and CD56 were 98.9% (277/280), 98.2% (275/280), 57.5% (161/280), 42.5% (119/280) and 62.1% (174/280); there was no statistical difference between the two detection methods in the detection coincidence rate of the same detection index (all P > 0.05). Among patients who underwent FISH detection, the detection rate of gene abnormalities was 69.9% (93/133); the detection rate of abnormalities by direct fluorescence in situ hybridization (D-FISH) was 42.9% (57/133); the detection rate of abnormalities by CD138 immunomagnetic sorting myeloma cells (MACS)-FISH was 82.7% (110/133). Among patients who underwent G-band karyotyping, the detection rate of abnormal karyotype was 38.5% (85/221). FSIH, especially MACS-FISH, had a higher detection rate of cytogenetic abnormalities than G-band karyotyping, and the difference was statistically significant ( χ2 = 65.697, P < 0.05). Conclusion:The comprehensive application of bone marrow morphology, bone marrow immunohistochemistry, flow cytometry, FISH (especially MACS-FISH), cytogenetic testing and other detection methods is more helpful for the diagnosis of multiple myeloma, and may be useful for prognostic judgment.

Objective To analyze the immunophenotypic characteristics of the patients with minimal residual disease (MRD) positive acute B lymphocytic leukemia (B-ALL). Methods The leukemia-associated immunophenotype (LAIP) of 106 cases with MRD positive B-ALL from Department of Hematology, Tianjin KingMed Diagnois Center between June 2014 and January 2016 were retrospectively analyzed. CD10, CD13/CD33, CD19, CD38, CD58, CD45 and other antibodies were used to analyze the MRD of B-ALL. Results All the patients were positive for CD19. CD34 was negatively or weakly positive expressed in 27 cases (25.4％). CD10 was negatively or weakly positive expressed in 23 cases (21.7％). CD10 was strongly positive in 24 cases (22.6％). Totally, CD10 was weakly or strongly expressed in 47 cases (44.3％). CD58 was strongly positive in 98 cases (92.5％). CD13/CD33 was positively or weakly positive expressed in 64 cases (60.4％). CD38 was negative or weakly expressed in 33 cases (31.1％). CD45 was negative in 21 cases (19.8％). 15 cases (14.1％) were positive for 6 types of LAIP; 30 (28.3％) cases were positive for 5 types of LAIP; 42 (39.6％) cases were positive for 4 types of LAIP; 13 (12.3％) cases were positive for 3 types of LAIP;5 cases (4.7％) were positive for 2 types of LAIP; only one case (0.9％) was positive for 1 type of LAIP. Conclusion The combination of CD58, CD13/CD33, CD10, CD38 and CD34 antibodies can distinguish the neoplastic blast/immature B lymphocytes from progenitor B cells. This strategy has a high accuracy for the judgement of MRD in B-ALL.

Objective To evaluate the effects of midazolam pretreatment on inflammatory responses and cell apoptosis during intestinal ischemia-reperfusion (I/R) in mice.Methods Thirty healthy male Kunming mice,weighing 18-22 g,were equally and randomly divided into 3 groups using a random number table:sham operation group (S group),I/R group,and midazolam pretreatment group (M group).Intestinal I/R was produced by occlusion of the superior mesenteric artery for 20 min followed by reperfusion.In group M,midazolam 1 mg/kg was injected intraperitoneally,and intestinal I/R was produced 30 min later.At 24 h of reperfusion,the mice were sacrificed,and intestinal tissues were removed for microscopic examination and for determination of the expression of interleukin-6 (IL-6),tumor necrosis factor-alpha (TNF-α) and caspase-3.Intestinal damage was assessed and scored according to Chiu.Results Compared with group S,Chiu's scores were significantly increased,and the expression of IL-6,TNF-α and caspase-3 was significantly up-regulated in I/R and M groups (P＜0.05).Compared with group I/R,Chiu's scores were significantly decreased,and the expression of IL-6,TNF-α and caspase-3 was significantly down-regulated in group M (P＜0.05).Conclusion Midazolam pretreatment can reduce intestinal I/R injury,and the mechanism is related to inhibition of inflammatory responses and cell apoptosis in mice.

The "flipped classroom" teaching model practiced in the teaching ofcurriculum was introduced. Firstly, the roles and responsibilities of teachers were clarified, indicating teachers provided examples and lectures, and a comprehensive assessment system was established. Secondly, the "flipped classroom" teaching model was split into online learning, classroom learning and offline learning. Online learning aimed at forming a study report by a wide search of relevant information, which was submitted to teachers for review and assessment. Classroom learning was designed to communicate study ideas among students and teachers. Offline learning was intended to revise and improve the study report and refined learning methods. Lastly, the teaching practice effects of "flip classroom" were evaluated by comprehensive rating and questionnaire assessment, which assessed the overall performance of students and overall levels of paper; the learning ability was enhanced, and the interest and motivation of learning were also improved. Therefore, "flipped classroom" teaching mode was suitable for the curriculum of, and could be recommended into the teaching practice of related curriculum of acupuncture and tuina.

Objective To comprehend the differencesof the cognition status of nurse-patient relationship between nurses and patients and provide the evidence for targeted continuing nursing education . Methods Total of 141 nurses and 150 patients had been accepted self-design questionnaire about the cognition status of nurse-patient relationship.Results There were 47.33% of nurses and 47.52% of patients believed that both nurses and patients took the main responsibility to cause nurse-patient disputes , and there was no statistical difference between nurse and patient (χ2 =3.686, P >0.05 ).According to the results of questionnaire,60.67%of patients wanted to build up a relationship like family with nurse while 58.87% of nurses wanted to keep relationship like friend with patient (χ2 =101.210,59.392, respectively; P<0.01). Conclusions This study can provide evidence for continuing education according to the requirement of nurse and patient. We should enhance nurses ’ knowledge of psychology and etiquette , promote nurse-patient communication and rule out biased information from nurses and patients , and aim to build up a continuing education system leading by a harmony nurse-patient relationship for nurses .