Objective:To investigate the efficacy and safety of Rituximab (RTX) in the treatment of children with frequently relapsing/steroid-dependent nephrotic syndrome (FRNS/SDNS) and to analyze the factors influencing the efficacy.Methods:Case series study.The clinical data of children with FRNS/SDNS who received B-cell-guided RTX (single dose: 375 mg/m 2, maximum dose: 500 mg, one additional dose when peripheral blood CD19 + B lymphocytes ≥0.01) in the First Affiliated Hospital of Zhengzhou University from September 2019 to March 2022 were retrospectively collected.The frequency of relapse and cumulative dose of glucocorticoids before and after RTX treatment were compared.The Kaplan-Meier method was used to analyze relapse-free survival rate and FRNS/SDNS-free survival rate after RTX treatment.The influencing factors of relapse were analyzed using the Cox proportional hazards regression model. Results:Totally 47 children were enrolled, including 35 males and 12 females; the age of first application of RTX was 10.2 (6.9, 13.0) years; 33 children had used one type of immunosuppressant before, and 14 children had used two or more types of immunosuppressant before; the dose of RTX treatment was 3.0 (2.0, 3.0). The frequency of relapse[0(0, 0.55) times/year vs.1.62 (1.09, 2.40) times/year] and cumulative dose of glucocorticoids[0.12 (0.05, 0.21) mg/(kg·d) vs.0.40 (0.20, 0.56) mg/(kg·d)] after RTX treatment significantly decreased compared with previous immunosuppressive treatment ( Z=-5.56, -5.54, all P<0.001). The relapse-free survival rates at 6, 12, 18 and 24 months after treatment were 80.9%, 72.3%, 68.1% and 68.1%, respectively, and the FRNS/SDNS-free survival rates were 93.6%, 89.4%, 89.4% and 89.4%, respectively.Univariate Cox regression analysis showed that the high frequency of relapse during previous immunosuppressive therapy was a risk factor for relapse after RTX treatment ( P<0.05). Of the 14 children who relapsed, 6 occurred in children whose CD19 + B lymphocytes<0.01, and the frequency of relapse after RTX treatment was significantly higher than those whose CD19 + B lymphocytes≥0.01 ( Z=-2.84, P=0.005). No severe adverse reactions occurred during RTX treatment and follow-up. Conclusions:The B-cell-guided RTX is effective and safe in the treatment of FRNS/SDNS in children.The high frequency of relapse during previous immunosuppressive therapy is a risk factor for relapse after RTX treatment, and relapse in the state of B lymphocyte depletion predicts poor outcomes of RTX treatment.

Background Fatigue driving is an important cause of road traffic accidents in modern society, and the fatigue condition of heavy-duty commercial truck drivers has attracted widespread attention. Research on the fatigue status and influencing factors of heavy-duty commercial truck drivers in China is relatively rare at present. Objective To analyze the main characteristics of fatigue among heavy-duty commercial truck drivers and the impacts of factors such as working hours, insomnia, and occupational burnout on their fatigue status. Methods Using cluster sampling method, a cross-sectional study was conducted from July to August 2023, enrolling heavy-duty commercial truck drivers in long-distance freight logistics markets (stations) located in three administrative regions of W City, Xinjiang Uygur Autonomous Region. A self-designed questionnaire was used to collect demographic and occupational characteristics of heavy-duty commercial truck drivers, and the Chinese versions of Fatigue Scale-14 (FS-14), Athens Insomnia Scale (AIS), and Maslach Burnout Inventory General Survey (MBI-GS) were used to evaluate their fatigue, insomnia, and occupational burnout status, respectively. Mann-Whitney U test and Kruskal-Walls H test were used to compare intergroup differences, and Spearman correlation coefficient was used to analyze the correlation between variables. Hierarchical regression models were used to study the impacts of selected variables on fatigue status. Results This study obtained 311 valid questionnaires, with a valid recovery rate of 88.86% (311/350). The physical fatigue, mental fatigue, and total fatigue scores of the survey subjects in M (P₂₅, P₇₅) were 3.00 (2.00, 4.00), 2.00 (1.00, 3.00), and 5.00 (4.00, 6.00), respectively. The comparison results showed that, except for smoking, there were statistically significant differences in total fatigue scores between different groups of age, marital status, number of children, educational level, service length of freight transportation, average daily working time, and average monthly income (P<0.05). The difference in total fatigue score among the groups without sleep disorders, with suspected insomnia, and with insomnia was statistically significant (P<0.001). The difference in total fatigue score among the groups without occupational burnout, with moderate occupational burnout, and with severe occupational burnout was also statistically significant (P<0.001). Positive correlations were found between insomnia score and scores of physical fatigue (r_s=0.507), mental fatigue (r_s=0.547), and total fatigue (r_s=0.618) (P<0.001). Hierarchical regression models revealed that having more children, extended daily working hours, insomnia, and increased scores of decreased personal accomplishment were negative factors affecting the fatigue status of heavy-duty commercial truck drivers (P<0.05), and the final regression equation was: total fatigue score=7.579+0.581×number of children+0.916×average daily working time+0.434×score of AIS+0.754×score of reduced personal accomplishment. Conclusion The fatigue status of heavy-duty commercial truck drivers is not optimistic. An increase in the number of children, extended daily working hours, severe insomnia symptoms, and increased scores of decreased personal accomplishment associate with their worse fatigue status.

Objective:To assess the efficiency of modified enrichment method for cell-free fetal DNA (cffDNA) through purified superparamagnetic beads during non-invasive prenatal testing (NIPT).Methods:A total of 26 252 pregnant women undergoing NIPT at the Maternal and Child Health Care Hospital of Haidian District from December 2017 to September 2022 were recruited and randomly assigned into the conventional group ( n = 10 573) and the modified enrichment group ( n = 15 679), who were then subjected to the screening and enrichment of the cffDNA using a conventional and modified technique, respectively. High-risk pregnant women detected by NIPT were subjected to invasive prenatal diagnosis. All women were followed up for their pregnancy outcomes, and the detection efficacy of the two methods was compared in terms of fragment size, concentration of cffDNA, duplicate detection rate, and indices of clinical laboratory tests. Results:The fragment size of the main peak of the cell-free DNA library of the modified enrichment group was significantly lower than that of the conventional group [267 (264, 269) bp vs. 294 (292, 296) bp, P<0.01], while the concentration of cffDNA was significantly higher [21.86% (17.61%, 26.36%) vs. 9.08% (6.87%, 11.87%), P<0.01]. In addition, the duplicate detection rate (0.740% vs. 2.02%, χ2=83.90, P<0.01) and detection failure rate (0.006% vs. 0.057%, P<0.05) in the modified enrichment group were significantly lower than those of the conventional group. The combined positive predictive value (PPV) in both high-risk (64.3% vs. 76.1%) and low-risk (35.3% vs. 45.5%) pregnant women from the modified enrichment group was slightly lower than those from the conventional group, though no significant difference was detected. There was one false negative case for trisomy 21 among the high-risk pregnant women from the conventional group, and no false negative case was found in the modified enrichment group. Conclusion:The modified technique to screen and enrich the cffDNA has significantly enhanced the relative concentration of cffDNA and reduced the failure and duplication detection rate of NIPT, which has significantly reduced the incidence of false negative cases due to the low concentration of cffDNA, and greatly increased the overall detection efficacy of NIPT.

Objective:To analyze the depressive symptoms of physical and mental workers and the impact of their behavior and lifestyle on their depressive symptoms.Methods:In August 2022, a cross-sectional study design was adopted to select 553 workers as research subjects using cluster sampling. General demographic information, health-related behaviors and lifestyles were collected, and their depressive symptoms were evaluated using the Chinese version of the Patient Health Questionnaire 9 (PHQ-9). The differences in general demographic information, health-related behaviors and lifestyles between physical and mental workers were analyzed, and logistic regression was used to analyze the influencing factors of depressive symptoms in occupational populations.Results:Among the 553 subjects, 317 were physical workers (57.32%) and 236 were mental workers (42.68%). Statistically significant differences were observed between the two groups in terms of education level, monthly income, smoking rate, regular physical exercise rate and appropriate sleep time rate ( P<0.05). The score and the detection rate of depression symptoms among physical workers were (9.67±2.75) points and 20.82% (66/317), respectively, which were higher than those of mental workers [(8.34±2.18) points, 12.71% (30/236) ] ( t=6.13, χ 2=6.20, P<0.05). The results of logistic regression analysis showed that smoking, regular physical exercise, appropriate sleep time and mental work were influencing factors of depressive symptoms among the occupational population ( OR=1.592, 95% CI: 1.316-1.825; OR=0.659, 95% CI: 0.416-0.830; OR=0.502, 95% CI: 0.257-0.717; OR=0.839, 95% CI: 0.522-0.967; P<0.05) . Conclusion:The depressive symptoms of physical workers are more serious than those of mental workers. Low education level, not frequently participating in physical exercise, smoking and sleep disorder are potential risk factors that affect the depressive symptoms of the occupational population.

Tooth extraction is a common and widely employed therapeutic procedure in oral and maxillofacial surgery.Minimally invasive tooth extraction can reduce both physical and psychological trauma to the patients,and is widely recommended as a first-line clinical treatment.But currently no guidelines or consensus has been available to provide a systematic introduction of minimally invasive tooth extraction to guide the clinical practices.To address this issue,this consensus,based on a comprehensive literature review and clinical experiences of experts,systematically summarizes the indications,target patients,and contraindications of minimally invasive tooth extraction,the overall workflow of this procedure(preoperative preparation,surgical steps,postoperative management,postoperative instructions,medications,and follow-up),and its common postoperative complications to provide a comprehensive guidance for clinical application of this technique.

Objective:To investigate the current status of literature reading report and clinical research ability among professional postgraduate students in pediatrics, and to provide a reference for cultivating high-quality pediatric talents.Methods:A total of 91 professional postgraduate students majoring in pediatrics were selected as research subjects from five affiliated hospitals of Zhengzhou University, and according to whether they participated in literature reading report, they were divided into participating group with 38 students and non-participating group with 53 students. The method of questionnaire combined with interview was used to investigate the implementation of literature reading report, the willingness to participate in literature reading report, and the current status of clinical research ability. SPSS 25.0 was used to perform the chi-square test and the Wilcoxon rank-sum test.Results:In the participating group, 60.53% (23/38) of the students thought that there was a significant improvement in clinical research ability after literature reading report, and in the non-participating group, 94.12% (48/51) of the students wanted to carry out literature reading report. Compared with the non-participating group, the participating group had significantly higher publication rate, project participation rate, academic exchange rate, and literature reading quantity ( P<0.05) and significantly better abilities of literature search and reading, professional English, and PPT presentation ( P<0.05), while there were no significant differences between the two groups in the scores of statistical analysis ability, project design ability, clinical thinking ability, and evidence-based medicine ability ( P>0.05). Conclusions:Literature reading report can promote the improvement in clinical research ability among professional postgraduate students in pediatrics, and it should be carried out regularly for a long time with adherence to the principle of clinical orientation and emphasis on the reading of methodology and statistics in literature.

Tooth extraction is a common and widely employed therapeutic procedure in oral and maxillofacial surgery.Minimally invasive tooth extraction can reduce both physical and psychological trauma to the patients,and is widely recommended as a first-line clinical treatment.But currently no guidelines or consensus has been available to provide a systematic introduction of minimally invasive tooth extraction to guide the clinical practices.To address this issue,this consensus,based on a comprehensive literature review and clinical experiences of experts,systematically summarizes the indications,target patients,and contraindications of minimally invasive tooth extraction,the overall workflow of this procedure(preoperative preparation,surgical steps,postoperative management,postoperative instructions,medications,and follow-up),and its common postoperative complications to provide a comprehensive guidance for clinical application of this technique.

Objective:To analyze the depressive symptoms of physical and mental workers and the impact of their behavior and lifestyle on their depressive symptoms.Methods:In August 2022, a cross-sectional study design was adopted to select 553 workers as research subjects using cluster sampling. General demographic information, health-related behaviors and lifestyles were collected, and their depressive symptoms were evaluated using the Chinese version of the Patient Health Questionnaire 9 (PHQ-9). The differences in general demographic information, health-related behaviors and lifestyles between physical and mental workers were analyzed, and logistic regression was used to analyze the influencing factors of depressive symptoms in occupational populations.Results:Among the 553 subjects, 317 were physical workers (57.32%) and 236 were mental workers (42.68%). Statistically significant differences were observed between the two groups in terms of education level, monthly income, smoking rate, regular physical exercise rate and appropriate sleep time rate ( P<0.05). The score and the detection rate of depression symptoms among physical workers were (9.67±2.75) points and 20.82% (66/317), respectively, which were higher than those of mental workers [(8.34±2.18) points, 12.71% (30/236) ] ( t=6.13, χ 2=6.20, P<0.05). The results of logistic regression analysis showed that smoking, regular physical exercise, appropriate sleep time and mental work were influencing factors of depressive symptoms among the occupational population ( OR=1.592, 95% CI: 1.316-1.825; OR=0.659, 95% CI: 0.416-0.830; OR=0.502, 95% CI: 0.257-0.717; OR=0.839, 95% CI: 0.522-0.967; P<0.05) . Conclusion:The depressive symptoms of physical workers are more serious than those of mental workers. Low education level, not frequently participating in physical exercise, smoking and sleep disorder are potential risk factors that affect the depressive symptoms of the occupational population.

Objective:To investigate the clinicopathological and genetic features of confined placental mosaicism (CPM) and its effect on fetal intrauterine growth.Methods:Fourteen CPM cases of Haidian Maternal and Children Health Hospital were collected from May 2018 to March 2022. Clinicopathological examination on placental specimens and molecular genetic analysis were performed.Results:The age of the parturient women ranged from 27 to 34 years, with an average age of (30.0±3.54) years. The gestational weeks ranged from 35 +1 to 41 +2 weeks. There were 4 premature births and 10 term births, among which 6 were female and 8 were male fetuses. Nine cases (9/14) had adverse pregnancy outcomes, including 7 cases of fetal growth restriction. The weight of CPM placenta decreased, with 6 cases below the 10th percentile of weight standards and 5 cases between the 10th and 25th percentile. All 14 CPM placental specimens showed morphological changes of perfusion dysfunction to varying degrees, with mainly placental-maternal vascular malperfusion followed by placental-fetal vascular malperfusion. The mosaic chromosomes in different CPM cases varied, with 16-trisomy/monosomy mosaicism being the most common followed by 7-trisomy and 21-trisomy/monosomy mosaicism. The mosaic proportion was unequal in different parts of the same CPM placenta, with the mosaic proportion of umbilical cord, fetal membranes, fetal surface, maternal surface, and edge ranging from 1% to 70%. Conclusions:The mosaic chromosomes in different CPM cases vary, and the mosaic proportion is unequal in different parts of the same CPM placenta. The pathological morphology is mainly manifested as perfusion dysfunction, which can lead to adverse pregnancy outcomes such as fetal growth restriction and preterm birth.

Mitochondrial DNA depletion syndrome (MDS) is a group of genetic diseases in which the number of mitochondrial DNA copies is severely decreased due to mutations in nuclear genes and affects energy metabolism in several tissues and organs. Renal involvement of MDS is often manifested as proximal renal tubular disease, while MDS combined with nephrotic syndrome is rare. This paper report a case of child with mitochondrial DNA depletion syndrome 8A (MTDPS8A) complicated with nephrotic syndrome due to compound heterozygous variants of RRM2B gene. The child mainly presented with epilepsy, auditory dysfunction, and nephrotic syndrome as clinical manifestations. The histopathological findings indicated focal segmental glomerulosclerosis (collapsing variant). The child was treated with glucocorticoid combined with immunosuppressant, energy support and symptomatic treatment, while the effect was not significant. He continued to experience progressive deterioration of renal function during the six-month follow-up period and had a long-term peritoneal dialysis for maintenance therapy.