Objective:To evaluate the effectiveness and safety of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in children with stage 4/M neuroblastoma (NB).Methods:This study was a prospective, single-arm, multicenter clinical trial conducted by Sun Yat-sen Memorial Hospital, Children′s Hospital of Nanjing Medical University, Children′s Hospital, Zhejiang University School of Medicine, the First Affiliated Hospital of Guangxi Medical University, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. From March, 2019 to August, 2023, 25 children with confirmed with stage 4/M NB and received allo-HSCT were enrolled. The patients received either unrelated cord blood transplantation (UCBT) or peripheral blood stem cell transplantation (PBSCT). Conditioning regimens for UCBT was fludarabine+busulfan+cyclophosphamide+topotecan, and for PBSCT was fludarabine+busulfan+melphalan+thiotepa+antithymocyte globulin, respectively. Until the last follow-up date of September, 2023, the overall survival (OS) rate and event free survival (EFS) rate were analyzed to evaluate efficacy. The engraftment rate and transplant-related complications were statistically assessed to evaluate safety. Survival analysis was performed using the Kaplan-Meier method.Results:Of the 25 patients, there were 15 males and 10 females. The age at transplantation was 5.7 (3.8, 7.3) years. The engraft rate was 100%, with recovery time of neutrophil as 15.7 (12.5, 17.0) d, and the recovery time of platelets as 33.5 (18.0, 48.0) d. Seventeen of the 25 children (68%) developed acute graft versus host disease (aGVHD), occurred at 18.0 (13.0, 22.5) d after transplantation, including 13 of grade Ⅲ-Ⅳ cases. The main sites of aGVHD were skin and intestinal tract. After treatment, 13 cases improved, 4 patients developed chronic graft-versus-host disease (cGVHD). After allo-HSCT, 14 children received maintenance therapy. Twenty of the 25 patients survived, the 2-year cumulative OS rate was (80±9)%, and 2-year EFS rate was (56±11)%. Nine cases (36%) relapsed, the time from allo-HSCT to disease relapse was 10.9 (5.5, 16.0) months. Five cases (20%) died. The hematopoietic stem cell transplantation associated mortality rate was 4% (1/25).The 2-year OS rate of patients who had partial remission prior to allo-HSCT was significant lower than those who had complete remission prior to allo-HSCT ((33±25)% vs. 100%, P=0.037). Conclusion:allo-HSCT is an effective treatment for patients with stage 4/M NB.

Objective:To explore the different categories of organizational involution among ICU nurses and its relationship with job burnout, so as to provide a basis for optimizing medical organization management strategies.Methods:From January to February 2025, 318 ICU nurses from four ClassⅢ hospitals in Taizhou City were selected as research subjects using convenience sampling. The General Information Questionnaire, Nursing Burnout Scale, and Organizational Involution Scale were used to conduct the survey. Latent profile analysis was used to identify latent categories of organizational involution among ICU nurses, and one-way analysis of variance was used to explore differences in ICU nurses' job burnout scores across different latent categories of organizational involution. A total of 318 questionnaires were distributed, and 306 valid questionnaires were returned, with a valid return rate of 96.23%.Results:The 306 ICU nurses' organizational involution was divided into three latent categories of low involution-high efficiency group (34.97%, 107/306), moderate involution-systemic consumption group (42.81%, 131/306), and high involution-total imbalance group (22.22%, 68/306). There were statistically significant differences in job burnout scores between different latent categories of organizational involution among ICU nurses ( P<0.05) . Conclusions:The overall level of organizational involution among ICU nurses is moderately high, and there is heterogeneity. There is a correlation between organizational involution and job burnout. Nursing managers should optimize organizational management, break the negative cycle of organizational involution and job burnout, and improve nurses' job satisfaction.

Objective:To explore the different categories of organizational involution among ICU nurses and its relationship with job burnout, so as to provide a basis for optimizing medical organization management strategies.Methods:From January to February 2025, 318 ICU nurses from four ClassⅢ hospitals in Taizhou City were selected as research subjects using convenience sampling. The General Information Questionnaire, Nursing Burnout Scale, and Organizational Involution Scale were used to conduct the survey. Latent profile analysis was used to identify latent categories of organizational involution among ICU nurses, and one-way analysis of variance was used to explore differences in ICU nurses' job burnout scores across different latent categories of organizational involution. A total of 318 questionnaires were distributed, and 306 valid questionnaires were returned, with a valid return rate of 96.23%.Results:The 306 ICU nurses' organizational involution was divided into three latent categories of low involution-high efficiency group (34.97%, 107/306), moderate involution-systemic consumption group (42.81%, 131/306), and high involution-total imbalance group (22.22%, 68/306). There were statistically significant differences in job burnout scores between different latent categories of organizational involution among ICU nurses ( P<0.05) . Conclusions:The overall level of organizational involution among ICU nurses is moderately high, and there is heterogeneity. There is a correlation between organizational involution and job burnout. Nursing managers should optimize organizational management, break the negative cycle of organizational involution and job burnout, and improve nurses' job satisfaction.

Objective:To evaluate the effectiveness and safety of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in children with stage 4/M neuroblastoma (NB).Methods:This study was a prospective, single-arm, multicenter clinical trial conducted by Sun Yat-sen Memorial Hospital, Children′s Hospital of Nanjing Medical University, Children′s Hospital, Zhejiang University School of Medicine, the First Affiliated Hospital of Guangxi Medical University, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. From March, 2019 to August, 2023, 25 children with confirmed with stage 4/M NB and received allo-HSCT were enrolled. The patients received either unrelated cord blood transplantation (UCBT) or peripheral blood stem cell transplantation (PBSCT). Conditioning regimens for UCBT was fludarabine+busulfan+cyclophosphamide+topotecan, and for PBSCT was fludarabine+busulfan+melphalan+thiotepa+antithymocyte globulin, respectively. Until the last follow-up date of September, 2023, the overall survival (OS) rate and event free survival (EFS) rate were analyzed to evaluate efficacy. The engraftment rate and transplant-related complications were statistically assessed to evaluate safety. Survival analysis was performed using the Kaplan-Meier method.Results:Of the 25 patients, there were 15 males and 10 females. The age at transplantation was 5.7 (3.8, 7.3) years. The engraft rate was 100%, with recovery time of neutrophil as 15.7 (12.5, 17.0) d, and the recovery time of platelets as 33.5 (18.0, 48.0) d. Seventeen of the 25 children (68%) developed acute graft versus host disease (aGVHD), occurred at 18.0 (13.0, 22.5) d after transplantation, including 13 of grade Ⅲ-Ⅳ cases. The main sites of aGVHD were skin and intestinal tract. After treatment, 13 cases improved, 4 patients developed chronic graft-versus-host disease (cGVHD). After allo-HSCT, 14 children received maintenance therapy. Twenty of the 25 patients survived, the 2-year cumulative OS rate was (80±9)%, and 2-year EFS rate was (56±11)%. Nine cases (36%) relapsed, the time from allo-HSCT to disease relapse was 10.9 (5.5, 16.0) months. Five cases (20%) died. The hematopoietic stem cell transplantation associated mortality rate was 4% (1/25).The 2-year OS rate of patients who had partial remission prior to allo-HSCT was significant lower than those who had complete remission prior to allo-HSCT ((33±25)% vs. 100%, P=0.037). Conclusion:allo-HSCT is an effective treatment for patients with stage 4/M NB.

Concurrent chemoradiotherapy (CCRT) refers to the simultaneous treatment of chemotherapy and radiotherapy, and the effect of radiotherapy is enhanced with low-dose chemotherapy, which can reduce tumor recurrence and metastasis and improve clinical prognosis of patients. At present, the main factors for the increase of radiosensitivity of concurrent chemotherapy is that concurrent chemotherapy prevents the repair of tumor cells, and chemotherapy and radiotherapy act on different cell cycles and have synergistic effects. However, even for patients with locally advanced cervical cancer (LACC) who have undergone CCRT, the 5-year survival rate is only 60%, which is still not ideal. In order to improve the efficacy, researchers have conducted a series of exploratory studies, which consist of the combination of targeted drugs and immunodrugs, and neoadjuvant regimens before CCRT, etc. Although targeted or immunologic drugs are effective treatment of LACC, in view of the lack of large-scale evidence-based medical evidence, multi-center prospective and randomized phase III clinical trials and high-level articles are needed to improve the level of evidence-based medicine. This consensus summarizes several key evidence-based medical studies published recently, especially the clinical research progress in targeted and immunological therapies, providing reference for domestic peers.

Background: Several risk factors have been identified that compromise the treatment outcome in patients with early-to-mid-stage cervical cancer (CC) who are primarily treated with radical surgery. However, there is no report on the impact of intraoperative frozen pathology examination of vaginal margins on the prognosis of patients with CC. This study aimed to conduct a randomized controlled trial (RCT) to determine whether selective vaginal resection can reduce the incidence of operative complications and the risk of postoperative radiotherapy. The impact of the length of the vagina removed in radical hysterectomy (RH) on prognosis and quality of life (QoL) for IB2–IIA2 CC patients will be investigated. Methods A multicenter, non-inferiority, RCT at 7 institutions in China is designed to investigate the effect of intraoperative frozen pathology exam of vaginal margin in RH on the survival outcomes for patients with IB2–IIA2 CC. Eligible patients aged 18–70 years will be randomly assigned online by one-to-one random allocation to receive intraoperative frozen pathology exam of vaginal margin or not. If frozen pathology indicates positive margin, continue resection of 1 centimeter of vaginal tissue until negative margin is achieved. The primary end point is 2-year disease-free survival (DFS). Adverse events (AEs) caused by further vagina resection, 5-year DFS, 2-year overall survival (OS), 5-year OS and AEs caused by radiotherapy and QoL are secondary end points. A total of 310 patients will be enrolled from 7 tertiary hospitals in China within 3-year period and followed up for 5 years.Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR2000035668

Background: Several risk factors have been identified that compromise the treatment outcome in patients with early-to-mid-stage cervical cancer (CC) who are primarily treated with radical surgery. However, there is no report on the impact of intraoperative frozen pathology examination of vaginal margins on the prognosis of patients with CC. This study aimed to conduct a randomized controlled trial (RCT) to determine whether selective vaginal resection can reduce the incidence of operative complications and the risk of postoperative radiotherapy. The impact of the length of the vagina removed in radical hysterectomy (RH) on prognosis and quality of life (QoL) for IB2–IIA2 CC patients will be investigated. Methods A multicenter, non-inferiority, RCT at 7 institutions in China is designed to investigate the effect of intraoperative frozen pathology exam of vaginal margin in RH on the survival outcomes for patients with IB2–IIA2 CC. Eligible patients aged 18–70 years will be randomly assigned online by one-to-one random allocation to receive intraoperative frozen pathology exam of vaginal margin or not. If frozen pathology indicates positive margin, continue resection of 1 centimeter of vaginal tissue until negative margin is achieved. The primary end point is 2-year disease-free survival (DFS). Adverse events (AEs) caused by further vagina resection, 5-year DFS, 2-year overall survival (OS), 5-year OS and AEs caused by radiotherapy and QoL are secondary end points. A total of 310 patients will be enrolled from 7 tertiary hospitals in China within 3-year period and followed up for 5 years.Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR2000035668

Background: Several risk factors have been identified that compromise the treatment outcome in patients with early-to-mid-stage cervical cancer (CC) who are primarily treated with radical surgery. However, there is no report on the impact of intraoperative frozen pathology examination of vaginal margins on the prognosis of patients with CC. This study aimed to conduct a randomized controlled trial (RCT) to determine whether selective vaginal resection can reduce the incidence of operative complications and the risk of postoperative radiotherapy. The impact of the length of the vagina removed in radical hysterectomy (RH) on prognosis and quality of life (QoL) for IB2–IIA2 CC patients will be investigated. Methods A multicenter, non-inferiority, RCT at 7 institutions in China is designed to investigate the effect of intraoperative frozen pathology exam of vaginal margin in RH on the survival outcomes for patients with IB2–IIA2 CC. Eligible patients aged 18–70 years will be randomly assigned online by one-to-one random allocation to receive intraoperative frozen pathology exam of vaginal margin or not. If frozen pathology indicates positive margin, continue resection of 1 centimeter of vaginal tissue until negative margin is achieved. The primary end point is 2-year disease-free survival (DFS). Adverse events (AEs) caused by further vagina resection, 5-year DFS, 2-year overall survival (OS), 5-year OS and AEs caused by radiotherapy and QoL are secondary end points. A total of 310 patients will be enrolled from 7 tertiary hospitals in China within 3-year period and followed up for 5 years.Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR2000035668

Objective:To determine the direction of traction that has the least influence on temporomandibular joint (TMJ) during mandibular distraction osteogenesis(MDO).Methods:(1) The three-dimensional finite element model was established after the mandible data were obtained by cone beam computed tomography (CBCT) scanning, and the validity of the model was verified. (2) Based on the verified three-dimensional finite element model, the distraction osteogenesis of mandible was carried out with six different directions. (3) The effects of different traction directions on disc pressure, osteotomy displacement, temporal bone pressure and condylar pressure were measured.Results:(1)In the thinnest area of the articular disc, the direction of the minimum stress on the upper and lower surfaces of the disc was "along the direction of the mandible, parallel to the surface of the mandible" . (2) Under the same load, the displacement of each osteotomy surface along the traction direction was different, but the difference was not big, and the effect was basically the same. (3) "Along the direction of the mandible, parallel to the surface of the mandible" and "along the direction of the mandible and parallel to the sagittal plane" had less pressure on the temporal bone than other situations, and the two directions of traction were parallel to the mandible. After the force decomposition, the direction of the condyle was the smallest, so the pressure on the condyle was smaller.Conclusions:A satisfactory TMJ model can be obtained by DICOM. The traction force of "along the direction of the mandible body, parallel to the surface of the mandible body" and "along the direction of the mandible body and parallel to the sagittal plane" had the least effect on the TMJ. When designing the traction direction of MDO, we should not only consider the influence of surgery on the shape of jaw and upper respiratory tract, but also weigh in the influence of traction direction on the TMJ, and determine the direction of traction which has the least influence on the TMJ.

Objective:To determine the direction of traction that has the least influence on temporomandibular joint (TMJ) during mandibular distraction osteogenesis(MDO).Methods:(1) The three-dimensional finite element model was established after the mandible data were obtained by cone beam computed tomography (CBCT) scanning, and the validity of the model was verified. (2) Based on the verified three-dimensional finite element model, the distraction osteogenesis of mandible was carried out with six different directions. (3) The effects of different traction directions on disc pressure, osteotomy displacement, temporal bone pressure and condylar pressure were measured.Results:(1)In the thinnest area of the articular disc, the direction of the minimum stress on the upper and lower surfaces of the disc was "along the direction of the mandible, parallel to the surface of the mandible" . (2) Under the same load, the displacement of each osteotomy surface along the traction direction was different, but the difference was not big, and the effect was basically the same. (3) "Along the direction of the mandible, parallel to the surface of the mandible" and "along the direction of the mandible and parallel to the sagittal plane" had less pressure on the temporal bone than other situations, and the two directions of traction were parallel to the mandible. After the force decomposition, the direction of the condyle was the smallest, so the pressure on the condyle was smaller.Conclusions:A satisfactory TMJ model can be obtained by DICOM. The traction force of "along the direction of the mandible body, parallel to the surface of the mandible body" and "along the direction of the mandible body and parallel to the sagittal plane" had the least effect on the TMJ. When designing the traction direction of MDO, we should not only consider the influence of surgery on the shape of jaw and upper respiratory tract, but also weigh in the influence of traction direction on the TMJ, and determine the direction of traction which has the least influence on the TMJ.