Objective: To examine the Longitudinal influence of perceived discrimination on pro social behavior of left alone junior middle school students and to explore the longitudinal mediating role of teacher-student relationship and classmate relationship, so as to provide a reference for improving pro social behavior of left behind junior middle school students. Methods: The Perceived Discrimination Questionnaire, Teacher-Student Relationship Questionnaire, Classmate Relationship Questionnaire and Prosocial Behavior Questionnaire were used to conduct two follow up surveys on 930 left behind junior middle school students in Guizhou Province at two time points, in mid November 2021(T1) and mid May 2022(T2). Deviation corrected Bootstrap method was used to examine the mediating effect of T2 teacher-student relationship and T2 classmate relationship on the impact of T1 discrimination perception on T2 pro social behavior. Results: The perceptions of discrimination, teacher-student relationship, classmate relationship, and pro social behavior scores of the left behind junior high school students were (1.98±0.94) (4.13± 0.77 ) (3.54±0.91) (3.52±0.75) for T1, and (3.98±0.83)(3.42±0.86)(3.48±0.72) for teacher-student relationship, classmate relationships and pro social behavior scrores of T2. After controlling for gender, age and self assessment of family economic status, T1 perceived discrimination negatively predicted T2 pro social behavior ( β =-0.07); and T1 perceived discrimination indirectly influenced T2 pro social behavior through T2 teacher-student relationship, and mediated effect value was -0.02(95% CI = -0.02 to -0.01); and T1 perceived discrimination indirectly influenced T2 pro social behavior through T2 classmate relationship, mediated effect was -0.03(95% CI =-0.05 to -0.02)( P <0.05). Conclusions Perceived discrimination not only directly reduces pro social behavior of left behind junior middle school students, but also indirectly and negatively affects pro social behavior of left alone junior middle school students by reducing teacher-student relationship and classmate relationship.

Objective:To analyze the accuracy of lung ultrasound and chest X-ray in the diagnosis of neonatal pulmonary disease.Methods:We prospectively collected newborns that needed chest X-ray examination to diagnose pulmonary disease from twelve neonatal intensive care units across the country between June 2019 and April 2020.Each newborn was examined by lung ultrasound within two hours after chest X-ray examination.All chest X-ray and lung ultrasound images were independently read by a radiologist and a sonographer.When there was a disagreement, a panel of two experienced physicians made a final diagnosis based on the clinical history, chest X-ray and lung ultrasound images.Results:A total of 1 100 newborns were enrolled in our study.The diagnostic agreement between chest X-ray and lung ultrasound(Cohen′s kappa coefficient=0.347) was fair.Lung ultrasound(area under the curve=0.778; 95% CI 0.753-0.803) performed significantly better than chest X-ray(area under the curve=0.513; 95% CI 0.483-0.543) in the diagnosis of transient tachypnea of the newborn( P<0.001). The accuracy of lung ultrasound in diagnosing neonatal respiratory distress syndrome, meconium aspiration syndrome, pneumonia and neonatal pulmonary atelectasis was similar to that of chest X-ray. Conclusion:Lung ultrasound, as a low-cost, simple and radiation-free auxiliary examination method, has a diagnostic accuracy close to or even better than that of chest X-ray, which may replace chest X-ray in the diagnosis of some neonatal lung diseases.It should be noted that both chest X-ray and lung ultrasound can only be used as auxiliary means for the diagnosis of lung diseases, and it is necessary to combine imaging with the clinical history and presentation.

Objective:To determine the risk factors of perioperative cerebral oxygen supply and utilization and cerebral activity in newborns with congenital heart disease(CHD).Methods:In this prospective cohort study, NIRS and amplitude integrated EEG(aEEG) performed before and after surgery were used to assess cerebral oxygen supply and utilization and cerebral activity in these newborns. Cerebral tissue oxygenation index(TOI) and fractional tissue oxygen extraction(FTOE) measured from NIRS for each patient were compared to background pattern and SWC of aEEG before and after surgery. Analysis included clinical characteristics and explore the risk factors of TOI, FTOE.Results:90 CHD newborns were obtained. Pre- and postoperative TOI were 0.56±0.05 and 0.59±0.03, both of them were lower than the average for normal newborns( P<0.05). Pre- and postoperative FTOE were 0.36±0.07 and 0.39±0.04. TOI and FTOE were significantly improved after surgery( P<0.05). There was negative correlation between the TOI improvement after surgery and SpO 2 of right upper limb( β: -0.202). Patient with Respiratory support before surgery had lower preoperative TOI levels( β: -0.879). Preoperative SpO 2 was higher, then preoperative TOI was also higher( β: 0.214). The postoperative FTOE of who had lower amplitude showed by aEEG was significantly lower( P<0.05). The postoperative TOI of who had immature SWC was lower than mature SWC( P<0.05). Delayed chest closure was a risk factor for postoperative death. Conclusion:TOI in children with CHD improved significantly after operative, especially in patient with cyanosis CHD. Preoperative TOI is positively related to SpO 2. It’s positive correlation between cerebral activity and cerebral oxygen utilization. The patient who has immature SWC showed lower cerebral oxygen supply. Monitoring cerebral activity and oxygenation may be useful in perioperative management and cerebral protection of newborns with CHD.

Objective:To analyze the risk factors associated with hemorrhagic complications at the puncture site after femoral artery access cerebrovascular interventions and construct a bleeding risk scale.Methods:Two hundred and fifteen patients who underwent femoral artery puncture interventions in the neurointerventional department ward of the First Affiliated Hospital of Zhengzhou University from April to October 2020 were selected for the study, including 60 cases in the complication group and 155 cases in the control group. The patients′ general data, interventional procedure-related data and laboratory tests were analyzed univariately and then incorporated into a binary multi-factor logistic regression analysis to determine independent risk factors, and a bleeding risk scale was constructed according to the regression model.Results:Compared with the control group, there was a statistically significant increase in the incidence of women, diabetes mellitus, use of glucose-lowering drugs, proportion of (anticoagulant/antiplatelet drugs) use and irritability in the complication group ( χ2 values were 4.94-15.81, all P<0.05); age, BMI, HbA1c, prothrombin time activity, and sheath size and operative time were higher than those of the control group, and prothrombin time and creatinine values were lower than those of the control group, with statistically significant differences ( t values of -6.25 to 2.80, respectively, all P<0.05). Multifactorial logistic regression analysis showed that gender ( OR=0.09, 95% CI 0.025-0.302), BMI ( OR=1.736, 95% CI 1.462-2.115), HbA1c ( OR=1.775, 95% CI 1.107-2.845), and use of anticoagulant/antiplatelet drugs ( OR= 0.082, 95% CI 0.015- 0.448) and time to surgery ( OR=1.031, 95% CI 1.012-1.052) were independent risk factors for bleeding complications. In the risk scale: the total score was -3 to 13, and risk existed for a score ≥5. The sensitivity of this scale was 83.3%, the specificity was 92.3%, and the area under the ROC curve was 0.878 ( P<0.001, 95% CI 0.818 to 0.938). Conclusions:Female, high BMI, high HbA1c, anticoagulant/antiplatelet drug use, and long procedure time can increase the risk of bleeding complications at the femoral artery puncture. The predictive model has good predictive performance and can be extended for use.

Surgical innovation is an important part of surgical research and practice. The evaluation of surgical innovation through the stages is similar to those for drug development, but with important differences. The Idea, Development, Exploration, Assessment, and Long-term follow-up (IDEAL) Framework and Recommendations represent a new paradigm for the evaluation of surgical intervention and devices which was developed in 2009. The IDEAL is a five-stage framework involving the nature stages of surgical innovation, together with recommendations for surgical research pathway. The Framework and Recommendations were updated and published in 2019, which added a pre-IDEAL stage if necessary. The updated IDEAL also underlines the purpose, key question and ethical issues for each stage. In the first paper of IDEAL Framework and Recommendations series, we conducted a comprehensive introduction of IDEAL (e.g. the development, updates and application of IDEAL) to promote the dissemination and application of IDEAL in China.

Adherence to reporting guidelines contributes to report methodology and outcomes of research distinctly and transparently. There are some checklists with specific study types related to surgery on the EQUATOR Network’s website. However, the IDEAL framework focuses on stepwise evaluation of surgical innovation through all stages with some key elements, which those existing guidelines may not mention. This likely results in the inaccuracy in reporting in studies attempting to follow the IDEAL recommendations and suggests a pressing need for IDEAL reporting guidelines. Considering these limitations, the IDEAL developed the IDEAL reporting guidelines between October 2018 and May 2019. The paper aimed to provide interpretation of IDEAL reporting guideline, and promote its understanding and use among Chinese researchers.

Objective:To investigate the safety of inter-hospital referral and the prognosis of neonatal with critical congenital heart disease.Methods:The criticality score, transit distance and time, and the prognosis of 237 newborns with critical congenital heart disease in Guangdong Provincial People′s Hospital from July 2016 to July 2018 were retrospectively analyzed.Results:A total of 237 children were included (162 male and 75 female) with the median age of 6 days and the median body weight of 2.98 kg.The median transit distance was 90 km.The average value of neonatal critical illness score (NCIS) was (86.54±9.05) scores before transport; 136 cases were greater than 90 scores, 84 cases between 70 and 90 scores, 17 cases less than 70 scores; while the average NCIS was (87.05±8.19) scores when arrived at neonatal intensive care unit (NICU), 138 cases were greater than 90 scores, 82 cases between 70 and 90 scores, 17 cases less than 70 scores.There were no significant differences in the scores of critical cases before and after transfer according to the transfer time and distance ( t=0.346, P>0.05). There was no one death occurred during the transfer process.All over, 222 cases were cured and discharged from the hospital after surgery and or medical interventional treatments, 15 cases died after giving up treatment or losing the opportunity for surgery. Conclusions:It is safe and effective of the inter-hospital transport for the rescue of infants with critical congenital heart disease when followed the principles and transport rules and regulations, with trained workers and special equipments.

Objective: To analyze the neurodevelopmental outcome and its risk factors in infants with CHD at 18 months of age. Methods: Eighteen-month-old infants with CHD at the follow-up clinic of our hospital were selected. The Bayley scales of infant development(BSID) were used to evaluate the levels of mental development(MDI) and psychomotor development(PDI). The clinical features during hospitalization were reviewed, and the risk factors of MDI and PDI were analyzed. Results: A total of 116 children with CHD underwent BSID evaluation at 18 months of age. Both the MDI(95.38±22.98) and PDI(87.84±22.57) of the cohort were significantly lower than the average value of the normal population(P<0.05). In infants with cyanotic CHD, the MDI was higher(β=17.218). The longer the length was of the hospital stay, the lower the PDI(β=-0.577). In patients undergoing cardiopulmonary bypass surgery, the PDI was higher(β=11.956). Compared to infants with relatively normal behavior, the PDI of infants with mild behavioral problems was lower(β=-10.605). Conclusion Children with CHD who underwent cardiac surgery have delayed neurodevelopmental outcomes compared with those of healthy children. The outcomes of infants with cyanotic CHD or undergoing cardiopulmonary bypass surgery was better than others. Long hospital stays and mild behavioral problems were risk factors for poor neurodevelopmental outcomes.

Objective To explore the correlations between different traditional Chinese medicine (TCM) syndromes and the heart rate variability (HRV) accompanying patients with chest pain,and to provide a referen()for clinical syndrome differentiation in such patients.Methods A prospective study was conducted.()hundred and seventeen patients with chest pain admitted into Longhua Hospital Affiliated to Shanghai U()of TCM from January 2015 to October 2016 were assigned in a study object,and according to the diffe()TCM syndromes,they were divided into syndrome of qi deficiency with blood stasis,the blood sta()the deficiency of qi and yin,suppression of the chest yang,phlegm and blood stasis,qi-stagnan ()syndromes.In the same period,123 healthy people having undergone physical examination wer()control group.The time domain indexes of HRV were recorded by dynamic electrocardiogr()normal control group were compared to those of patients with different TCM syndrom()distribution in different TCM syndromes and various HRV time domain indexes we()cycle time domain indexes were as follows:the average standard deviation o()standard deviation of R-R interval (SDNN),24 hours standard deviation of()5 minutes (SDANN),24 hours the mean square root of difference values,()were observed in both groups.Results The chest pain patients a()accounting for the largest proportion (35 cases,29.9％),and ac()smallest proportion (5 cases,4.3％) in the study group;the nu()syndrome (17 cases vs.14 cases),blood stagnation of hea()(6 cases vs.2 cases) and qi-stagnation and blood stasis s()in men;the numbers of patients with deficiency of qi()(4 cases vs.2 cases) in men were more than thos()female patients were lower than those in maj()66.8 (33.4,33.4) vs.103.4 (39.7,135.4),124.7 (88.0,143.4) vs.167.0 (90.5,230.1),84.0 (22.5,132.6) vs.152.4 (31.4,240.0),all P ＜ 0.05].The SDANN in patients with chest discomfort accompanied by any one of the above mentioned types of TCM syndrome was significantly lower than that in the control group,and its degree of descent was more remarkable in the patients with qi deficiency with blood stasis,the blood stagnation of heart and suppression of the chest yang syndromes (ms:74.86± 25.69,80.39± 20.53,70.97± 23.53 vs.131.30± 34.70,all P ＜ 0.05);the SDNN of patients with deficiency of qi and yin syndrome was higher than that in the blood stagnation of heart syndrome,phlegm and blood stasis,and qi-stagnation and blood stasis syndrome significantly (ms:181.25 ± 65.20 vs.97.88± 23.61,84.28 ± 22.34,89.93 ± 8.43,all P ＜ 0.05);the RMSSD of patients with deficiency of qi and yin syndrome was increased significantly compared with that in the healthy controls and in patients with the blood stagnation of heart syndrome (ms:91.94 ± 44.02 vs.28.00± 10.50,32.21 ± 18.25,both P ＜ 0.05).Conclusions Patients with chest pain accompanied by different TCM syndrome types may develop obvious heart rate variability,and the descent of SDANN level was the most significant.The analysis of HRV changes in such patients has positive significance for their diagnosis and treatment.

Objective To summarize the clinical experience of surgical intervention for cardiac neoplasm in a fetus . Methods A 32-year-old pregnant woman was admitted to our hospital for complaint of fetal cardiac neoplasm .A separated het-erogenic cardiac occupying lesion was identigied at right atrium of the fetus by echocardiography , whose size is 2.85 cm ×2.25 cm, but the pathogenic origin still remained uncertain, maybe originate from ether pericardium or atrium.The annulus of tri-cuspid valve was compressed nearly 50% with the presence of amount of pericardial effusion.The fetal heart rate decreased at some fetal position resulting in the compression to the heart.So an Ex-utero Intrapartum Therapy(EXIT) procedure was per-formed under the supply of placenta at the 32 weeks of pregnancy.Cesarean section was performed with intact umbilicus and fe-tal circulation by obstetricians.Consequently, the median sternotomy of this fetus and pericardiotomy were performed , with 30 ml clear pericardial effusion drained .The tumor was confirmed to be giant right atrial neoplasm after the intraoperative explora-tion.Considering on the high risk of the cardiopulmonary bypass and limited time for EXIT , the giant atrial neoplasm was left alone with delayed sternum closure after the effectively decompression of the heart .The omphalotomy was successfully per-formed after the EXIT surgery.The neoplasm resection and the repair for its defect on right atrium were performed with cardiop-ulmonary bypass 2 days later.Results Convalesce of this mother was quite good after cesarean resetion .Hemodynamics of the premature baby was satisfatory after the resection of right atrial neoplasm which pathological report was benign hemangioma . Conclusion Via multiple disciplines collaboration , EXIT intervention for fetus is feasible and safe under adequate prepara-tion.