Diffuse pediatric-type high-grade glioma (pHGG), H3- and isocitrate dehydrogenase (IDH)-wild-type, is a World Health Organization (WHO) grade 4 diffuse glioma with malignant histological features, which typically affects in children and adolescents. This multidisciplinary treatment case involves a 24-year-old young female patient initially diagnosed via biopsy. After concurrent chemoradiotherapy reduced the tumor size, complete resection was achieved, followed by adjuvant therapy with temozolomide and regorafenib. After recurrence, the tumor was resected again, and a second course of radiotherapy was administered, but the disease ultimately progressed rapidly, with an overall survival exceeding 32 months. pHGGs are highly malignant, aggressive, and associated with poor prognosis. Accurate diagnosis and targeted intervention require close collaboration among a multidisciplinary team, which highlights the critical value of multidisciplinary manage-ment in clinical practice.

Neurodevelopmental disorders(NDDs)are chronic developmental brain disorders that can affect cognition,motor,social adaptation,behavior and so on due to multiple genetic or acquired causes.Natural polysaccharides are synthesized by living organisms,located in the cell wall,inside and between cells,and outside the cells,and are essential components of life activities.Previous studies have found that natural polysaccharides play an important role in neurological diseases,which mainly ameliorate the behavioral abnormalities and clinical symptoms caused by anti-oxidative stress,anti-neuronal apoptosis,anti-neuroinflammation,anti-excitatory amino acid toxicity,and regulation of the brain-gut axis.This review summarizes the intervention role of 17 bioactive polysaccharides from plants and fungi in neurological diseases,aiming to provide new ideas for the research and treatment of NDDs.

Abtract Objective:To establish a graphite furnace atomic absorption spectroscopy,and to determine the content of aluminum in the hemofiltration base solution.Methods:The standard addition method of atomic absorption of graphite furnace was used to add matrix modifier to determine the content of aluminum.Results:Aluminum has a good linear relationship in the range of 0-20 μg·L-1,r=0.998;The detection limit concentration was 0.91 μg·L-1.The average recovery rate was 96.5％.The results of the three batches were 3.299,1.232 and 2.431 μg·L-1,respectively.Conclution:This method can effectively measure the content of aluminum in hemofiltration base solution products,and control the raw materials,production and packaging of products that may introduce pollution pathways.It is recommended that enterprises pay attention to the detection of aluminum content in the on hemofil-tration base solution to minimize the risk of contamination and ensure the quality of products.

Objective:To develop an HPLC method with gradient elution for the simultaneous determination of 4 bacteriostatic agents in triamcinolone acetonide econazole cream from the different manufacturers.Methods:The test was performed on a Waters Symmetry C18 column(250 mm ×4.6 mm,5 μm)under gradient elution of metha-nol(A)and methanol-0.02 mol·L-1 sodium dihydrogen phosphate solution(B).The flow rate of 1.0 mL·min-1 and the column temperature was 35 ℃.The detection wavelengths were 228 nm and 254 nm.Results:The good separation of the bacteriostatic agents peaks were achieved.The linear ranges of benzoic acid,methyl hydroxybenzoate,ethylparaben and propylparaben fell into 0.010 348-0.155 22 mg·mL-1,0.009 876-0.148145 mg·mL-1,0.010 106-0.151 588 mg·mL-1 and 0.010 259-0.153 882 mg·mL-1 respectively.The av-erage recoveries were 99.68％(RSD=2.35％),100.21％(RSD=1.78％),100.47％(RSD=1.59％)and 100.06％(RSD=1.65％)respectively.The LODs were 3 × 10-5 mg·mL-1,1.67 × 10-5 mg·mL-1,1.67 × 10-5 mg·mL-1 and 1.67 × 10-5 mg·mL-1 respectively.Conclusion:The established method is sensitive and accurate,and has the good separation.It provides the reliable basis for the quality control of triamcinolone ace-tonide econazole cream.

Frailty denotes a nonspecific clinical condition characterized by a decrease of physiological reservation in multiple systems, which makes individuals extremely vulnerable to stressors. Frailty increases the incidence of adverse outcomes and death of patients. However, frailty is reversible and preventable. Therefore, this article reviews theoretical models, assessment tools and influencing factors of frailty in elderly patients with hematologic maligilancy, so as to provide references for medical staff to carry out frailty management and related research in elderly patients with hematologic maligilancy.

Objective:To retrieve, evaluate, and summarize the best evidence for the assessment of gastrointestinal function in critically ill patients by bedside ultrasound.Methods:Guidelines, evidence summaries, group standards, expert consensus, systematic reviews, and randomized controlled trials on the assessment of gastrointestinal function in critically ill patients by bedside ultrasound were retrieved by computer on domestic and foreign guideline websites, society websites and databases based on evidence-based nursing. The search period was from January 1, 2010 to April 30, 2021. The quality of the article was independently assessed by two researchers using the Appraisal of Guidelines for Research and Evaluation Ⅱ and the critical appraisal tool of the Joanna Briggs Institute (JBI) in Australia (2016) . Combined with the judgment of the research team, the data from the article that met the criteria were extracted and the evidence was graded and recommended according to the JBI quality level of evidence system (2014 Edition) .Results:A total of 22 articles were included, involving 5 guidelines, 1 evidence summary, 1 group standard, 6 expert consensuses, 4 systematic reviews, and 5 randomized controlled trials. A total of 33 pieces of evidence were summarized from 6 aspects, namely, the feasibility of nurses applying bedside ultrasound, fundamentals of ultrasound assessment of gastrointestinal tract, ultrasound assessment of gastric contents, ultrasound assessment of gastric motility, ultrasound assessment of bowel, ultrasound guided enteral nutrition program.Conclusions:Nurses who have been systematically trained can use ultrasound to assess gastrointestinal function in critically ill patients in real time. Ultrasound-guided enteral nutrition for critically ill patients needs to be standardized and improved, and many studies need to be carried out.

Objective: To investigate the clinical effectiveness of anterior cervical discectomy and fusion (ACDF)plus plating in the treatment of unstable Hangman's fractures. Methods: A retrospective case series study was carried out to analyze 12 patients who received ACDF plus plate internal fixation for unstable Hangman's fracture admitted to Sir Run Run Shaw Hospital affiliated to Zhejiang University School of Medicine from July 2014 to July 2018. There were nine males and three females, aged 24-70 years with an average of 46.2 years. According to Levine-Edwards typing, there were seven patients of type Ⅱ, four patients of type Ⅱ A and one patient of type Ⅲ. There were two patients of grade D and 10 patients of grade E according to the American Spinal Injury Association (ASIA) classification. The operation time, intraoperative blood loss and the operational complications were recorded. At 3 days, 1, 3, 6, 12 and 24 months after operation, the height of intervertebral disc, physiological curvature of cervical spine, fracture healing and bone graft fusion were evaluated. The recovery of neurological function was assessed by ASIA, and the neck pain relief and function improvement was assessed by visual analogue scale (VAS) and the neck disability index (NDI). Results: All patients were followed for 6-48 months(mean, 27.7 months). The operation time ranged from 50-100 minutes, with an average of 72.5 minutes. The intraoperative blood loss was 30-120 ml (mean, 65.8 ml). No serious complications occurred during and after operation. Two patients had dysphagia after operation, and the symptoms were relieved at the follow-up of 3 months. All patients achieved bony fusion of C_2-3 within the 6 month follow-up. No subsidence or migration of cages and significant loss of intervertebral space height were observed. The patient's neck and occipital pain was relieved obviously, and the flexion, extension and rotation of cervical spine were good. The neurologic dysfunction of two patients of ASIA Grade D recovered after surgery, and the final ASIA grade was E. The VAS score was decreased from 5.0 (4.0, 6.0)points preoperatively to 1.0(0, 1.0)points at the last follow-up (P<0.01). The NDI score was improved from (28.5±6.4)points preoperatively to (5.3±2.7)points at the last follow-up (P<0.01). Conclusion ACDF combined with plate internal fixation can provide immediate postoperative stability, high fusion rate, less complications, less pain, and satisfactory function recovery.

Objective To analyze the clinical features of candida arthritis and to conduct literature review to improve diagnosis and treatment.Methods From January 2008 to June 2018,eighteen patients (5 females and 13 males) with candida arthritis were admitted to two hospitals.The mean age at diagnosis was 59±8 (range 48-71 years).The diagnosis was determined based on joint fluid aspirate in all cases and on intra-operative samples in 1 patients.Seventeen patients received MR examination,and on epatient who underwent total knee arthroplasty underwent knee X-ray examination.The clinical features,risk factors,clinical manifestations,etiology,treatment and prognosis are recorded.Results Knee joints were involved in all patients as infection sites.Seventeen patients had risk factors for candida infection,including diabetes mellitus in 2 patients,artificial joint replacement in 1,and glucocorticoid injection in the joint cavity in 16.Swelling and pain were presented in all cases.Peripheral blood leukocytes were increased or normal,while C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were increased.Magnetic resonance showed joint effusion and slip membrane hyperplasia.Joint turbidity and synovial hyperplasia were presented by arthroscopy.X-ray demonstrated swelling of soft tissue around the prosthesis and bone absorption around the prosthesis.The most frequent species was non-candida albicans.Susceptibility to antifungals was tested in all cases.Thirteen patients underwent surgery combined with antifungal therapy,while 4 patients only received antifungal therapy and 1 patient refused to treat.The duration of antifungal therapy was from 6 weeks to 52 weeks (median,12 weeks).Twelve cases were treated with fluconazole and 1 with voriconazole,1 with voriconazole and fluconazole,1 with fluconazole combined with lipid formulation amphotericin B,1 with terbinatine and fluconazole,1 with flucytosine combined with tluconazole.Seventeen cases were followed up for 3 to 72 months.At final follow-up,twelve patients were healed,while 1 case was amputated and 4 patients relapsed and refused further treatment.Conclusion As a rare disease,candida arthritis is usually happened after artificial joint replacement and in high-risk patients with diabetes and immunosuppressant applications.In immunoeompetent patients without surgery,infection may be related to multiple injections into the joim cavity with glucocorticoids.The infection may be difficult to be diagnosed and with poor prognosis.Surgery with long-term antifungal therapy is required.

Objective To investigate the relationship between clinical efficacy and cage subsidence,and to identify the risk factors of cage subsidence after transforaminal lumbar interbody fusion (TLIF) in treating single level lumbar disc herniation and lumbar spondylolisthesis.Methods According to the inclusion/exclusion criteria,a series of 107 patients who underwent TLIF with polyetheretherketone (PEEK) cage in our department were evaluated retrospectively between May 2011 and May 2014.Intervertebral space height and segmental angle were measured on the preoperative and postoperative iconography according to the metrical software.All patients were divided into cage subsidence group (cage subsidence ≥ 2 mm) and cage non-subsidence group (cage subsidence ＜ 2 mm) based on the threshold value of intervertebral space height via X-ray.The Oswestry disability index (ODI) and visual analogue scale (VAS) was used to evaluate the clinical efficacy.Univariate analysis and logistic regression analysis were performed to identify the potential risk factors.Results Of all 107 patients,thirty-six patients (15 males and 21 females)aged 52.61 ± 13.82 years were divided into in the cage subsidence group with an average follow-up duration 26.33±7.66 months,seventy-one patients aged 53.80± 14.94 years,28 males and 43 females in the cage non-subsidence group,were followed-up for 23.82±8.95 months.There was no significant difference between cage subsidence group and cage non-subsidence group in gender,age,course of disease and time of follow-up (P＞ 0.05).The average 2.79±0.78 mm (range 2.02-5.53 mm) subsidence was observed in cage subsidence group.The preoperative intervertebral space height,postoperative intervertebral space height,postoperative segmental angle were related to cage subsidence by univariate analysis (P ＜ 0.05).Postoperative intervertebral space height [OR=1.864,95％CI(1.207,2.879) mm] was the risk factor of cage subsidence by logistic regression (P ＜ 0.05).There was no significant difference between cage subsidence group and cage non-subsidence group in ODI and VAS (P ＞ 0.05).Conclusion Cage subsidence is affected by the preoperative intervertebral space height,postoperative intervertebral space height,and postoperative segmental angle.Postoperative intervertebral space height is the independent risk factor of cage subsidence.Over distraction of intervertebral space height could increase the risk of cage subsidence.

Objective:To explore the diagnostic value of ultrasound-guided fine needle aspiration biopsy(US-FNAB)for thyroid nod-ules.Methods:The clinical characteristics and cytopathological diagnosis of patients with thyroid nodules in Tianjin Medical University General Hospital were analyzed retrospectively;the results of the cytopathological and pathological diagnoses were compared and an-alyzed.Results:Of the 1,241 US-FNAB samples,the ratio of men to women with thyroid nodules was 1:3.83(257/984).The incidence of thyroid nodules gradually increased from the age of 20 years and declined after the age of 60 years.The nodules,which were less than or equal to 1.0 cm in size,accounted for 51.57%(640 cases),and Thyroid Imaging Reporting And Data System(TIRADS)classifica-tion 4 accounted for 86.38%(1 072 cases).Of cyto-pathological diagnoses,22.00%(273 cases)were non-diagnostic,9.75%(121 cases) were benign,30.62%(380 cases)were atypia with undetermined significance,32.15%(399 cases)were suspicious for malignancy,and 5.48%(68 cases)were malignant.In the 302 patients who underwent surgery,the number of cases of clear diagnoses,unavailable di-agnoses,and atypia of undetermined significance were 203,21,and 78,respectively.In the 203 cases of clear diagnoses,the sensitivi-ty,specificity,positive predictive value,negative predictive value,precision,and misdiagnoses following US-FNAB of thyroid nodules were 100.00%(201/201),50.00%(1/2),99.50%(201/202),100.00%(1/1),99.51%(202/203),and 0.49%(1/203),respectively.In the 78 cases that were atypia of undetermined significance,the malignancy rate was 70.51%.Whether the atypia of undetermined signifi-cance was malignant or not was related to the TIRADS classification(P<0.05),and not related to the age,sex,tumor size,or location of the nodules(P>0.05).Conclusions:US-FNAB has high diagnostic value for thyroid nodules and is worthy of being popularized widely.If it replaced some intra-operative frozen sectioning procedures,it may reduce intra-operative waiting time and financial burden of pa-tients.