Autism spectrum disorder (ASD) is a neurodevelopmental disorder, which is manifested by symptoms such as difficulties in social interaction and communication, stereotypical repetitive behaviors, and narrow areas of interests.At present, the intervention methods for ASD mainly include behavioral intervention, pharmacological intervention, physical intervention, exercise intervention, complementary and alternative medicine intervention.With the progress of science and technology and in-depth research, the intervention methods of ASD will develop in the direction of personalized intervention, deep learning technology, gene therapy and neurofeedback technology.These new intervention methods would hopefully improve the treatment effect and the quality of life of patients.

Objective:To describe the characteristics, etiology and patterns of outpatients and inpatients patients with moderate or severe valvular heart disease (VHD).Methods:This is a cross-sectional study. Outpatients and inpatients with moderate or severe VHD who underwent transthoracic echocardiography for first examination from 1 st January 2001 to 1 st January 2020 in Southwest Hospital, Army Medical University were enrolled. Data were collected from medical records and big data platform of Southwest Hospital. Characteristics of age and gender, etiology and types of VHD were descriptively analysed. Results:A total of 68 354 patients with moderate or severe VHD were enrolled. The age was 63 (50, 72) years. And 35 706 (52.24%) patients were female. (1) Age characteristics: There was similar age trend between male and female patients with moderate or severe VHD. The number of patients increased firstly and then decreased and reached its peak in the age group of 65-69 years old. The peak age of mitral stenosis patients was 45-49 years, which was earlier than that of whole patients with moderate or severe VHD. The median age of patients with bicuspid aortic valve was 42 years. (2) Gender characteristics: The proportion of tricuspid regurgitation, pulmonary regurgitation, mitral regurgitation, mitral stenosis and valve surgery in female patients with moderate or severe VHD were higher than those in male patients. The proportion of aortic regurgitation, aortic stenosis and bicuspid aortic valve in male patients with moderate or severe VHD were significantly higher than those in female patients (all P<0.05). (3) Etiology: The proportion of rheumatic VHD was 13.07% (8 934/68 354), which was higher than that of degenerative VHD (0.67% (458/68 354)). (4) Types of VHD: Tricuspid regurgitation made contribution to the largest proportion with 60.72% (41 503/68 354), followed by mitral regurgitation, aortic regurgitation, mitral stenosis, pulmonary regurgitation and aortic stenosis. Conclusions:There are certain regional characteristics in the prevalence of moderate or severe VHD in southwest China, suggesting different attention should be paid on the whole process of refined management of moderate or severe VHD.

Objective:To construct a postoperative nursing plan for liver transplant recipients using the NANDA international, nursing outcomes classification, nursing intervention classification (NANDA-I-NOC-NIC) link (referred to as NNN-link) as the theoretical framework, so as to optimize the nursing process after liver transplantation and improve the quality of nursing.Methods:This study retrospectively collected nursing diagnoses with a postoperative usage rate of over 50% from 300 liver transplant recipients at Shulan (Hangzhou) Hospital from January 2019 to December 2021, and matched nursing outcomes and measures based on the NNN-link theory framework. After two rounds of Delphi expert consultation and group discussion, the entry content was rated, discussed, and modified to form the final version of the postoperative NNN-link for liver transplant recipients.Results:In two rounds of expert consultation, the recovery rates were 96.67% (29/30) and 100.00% (29/29) , respectively. The expert authority coefficients were 0.83 and 0.84, respectively. The Kendall harmony coefficients for the second round were 0.50, 0.38, 0.35. The final postoperative NNN-link for liver transplant recipients included 15 nursing diagnoses, 42 nursing outcomes, and 106 nursing measures.Conclusions:The process of constructing the postoperative NNN-link for liver transplant recipients is scientific and reasonable, and the entries are highly specialized, which can provide reference for clinical nursing after liver transplantation.

Background Occupational injuries, which can result in absenteeism, disability, or death, are closely related to poor working conditions. However, the improvement of operating conditions are often time-consuming and require significant economic inputs. Both occupational psychology and enterprise risk factors have been proved to be related to the occurrence of occupational injuries, but their roles in the influence path of adverse working conditions leading to occupational injuries remain unclear. Objective To explore the roles of occupational psychology and enterprise risk factors in the impact of adverse working conditions on occupational injury, so as to provide a scientific basis for enterprises with adverse working conditions to carry out targeted occupational injury intervention programs. Methods The survey data of 5997 manufacturing enterprises were obtained from the European Survey of Enterprises on New and Emerging Risks (ESENER) database. The data on enterprise risk characteristics, occupational injuries, working conditions, and occupational psychological factors were extracted and assigned. Occupational injury differences by enterprise categories were examined by chi-square test. Correlations between interest variables were evaluated by Spearman test. Path analysis with Bootstrap method was conducted using AMOS 26 software, and ratio of chi-square statistic to degree of freedom (χ²/ν), comparative fit index (CFI), Tucker-Lewis index (TLI), and root mean square error of approximation (RMSEA) were used to evaluate the path model candidates. The effect size and its proportion were calculated for variables (occupational psychological factors, enterprise risk factors, and adverse working conditions) included in the final model. Results The M (P₂₅, P₇₅) scores of occupational injuries, adverse working conditions, and occupational psychological factors were 40 (20, 50), 50 (30, 60), and 20 (10, 30), respectively. The enterprises that reported occupational injuries accounted for 25.5% (1550 enterprises) of the total enterprises. Proportions of the enterprises that reported occupational injuries varied significantly by company scale, branch companies, temporary employment, language barriers, and establishment time (P<0.05). The results of Spearman test showed that occupational injuries were positively correlated with working conditions (r_s=0.440), occupational psychological factors (r_s=0.205), company scale (r_s=0.307), temporary employment (r_s=0.282), and language barriers (r_s=0.158); but negatively correlated with branch companies (r_s=−0.180) and establishment time (r_s=−0.176) (P<0.05). In the path analysis, the fitness indexes of the final model were χ²/ν=2.85, CFI=0.997, TLI=0.993, and RMSEA=0.018 (90%CI: 0.011, 0.025). The indirect effect size values and constituent ratios of enterprise risk factors and occupational psychological factors in the effect of adverse working conditions on occupational injuries were 0.166 (30.01%) and 0.013 (3.13%) respectively. The indirect effect size value of occupational psychological factors in the effect of enterprise risk factors on occupational injuries and its constituent ratio were 0.022 and 6.85%. Conclusion Enterprises with adverse working conditions may control the risk of occupational injuries by offering better solutions to surmount language barriers and temporary employment, developing occupational psychological intervention and optimization programs such as improving working hours system. At the same time, large enterprises, enterprises without branches, or enterprises with a long history are the focus of occupational injury prevention and control.

Globally, manufacturing workers are one of the most vulnerable groups to occupational injuries. Occupational injuries can lead to absenteeism, disability or even death, and most of the inflicted workers involve young adults aged 18-40 years, suggesting a safety and health problem that needs close attention. In the working environment of manufacturing industry, there are a variety of occupational injury risk factors, involving individuals, equipment, environment, and management, which should be considered comprehensively. This study found comprehensive research coverage on the influencing factors of occupational injuries in manufacturing industry at individual, environmental, and management levels at home and abroad, and rich research results on the impacts of psychological factors on occupational injuries. However, factors associated with occupational injuries in equipment safety and engineering like man-machine environment need further research. Influencing factors at all levels should be comprehensively considered in the surveillance and intervention of occupational injuries in manufacturing industry to protect health and safety of workers.

Objective: To evaluate the effect of Triangle hierarchical management among community patients with hypertension, so as to provide insights into the improvements of standardized hypertension management. Methods: Patients with newly diagnosed hypertension from 2 community health service centers in Qiantang District of Hangzhou City by the end of 2020 were randomly assigned to the conventional group and the Triangle group. Patients in the conventional group were given health management services according to the requirements of basic public health service standard for one year, while patients in the Triangle group were given Triangle hierarchical management. The blood pressure, self-management behaviors, treatment compliance, smoking, alcohol consumption and exercise were collected using the self-management behavior scale, treatment compliance scale and self-designed questionnaires, and were compared before and after intervention with analysis of covariance and generalized estimation equations. Results: Totally 200 patients with hypertension were recruited, including 100 patients in the conventional group and 100 patients in the Triangle group. There were no significant differences between the two groups before implementation of interventions in terms of gender, age, educational level or occupation (P>0.05). The reduction in blood pressure, increase in the score of treatment, diet, exercise and living habitat management and the total score of self-management behaviors, increase in the score of adherence to medication regimens, daily living management behaviors, smoking and alcohol consumption preference and the total score of treatment compliance, and increase in the number of patients with normal standard of quitting smoking, quitting alcohol consumption, exercise and blood pressure were significantly higher in the Triangle group than in the conventional group after intervention (P<0.05). Conclusions Triangle hierarchical management may increase the treatment compliance, improve the self-management behavior and facilitate hypertension control among hypertensive patients, which may be popularized for health management among community patients with hypertension.

Objective:To investigate the clinical features of Epstein-Barr virus associated lymphoproliferative disease in children and to improve the understanding of this disease.Methods:This study included the children with Epstein-Barr virus associated lymphoproliferative disease admitted to the First Affiliated Hospital of College of Medicine of Zhejiang University from January 2014 to December 2018.Data of these children were collected, including age, clinical manifestations, laboratory results, treatment and outcome.The clinical features and therapeutic effects were analyzed.Results:A total of 114 cases(mean age 6 years, 0~17 years)were enrolled in this study, including 53 males and 61 females.There were 107 cases(93.86%) in the mild group (38 cases of EBV infection and 69 cases of infectious mononucleosis) and 7 cases in the severe group (6.14%). Six cases of the severe group were T cell or NK cell proliferation.Compared with the mild group, the load of EBV-DNA was higher in the severe group, but there was no significant difference( χ2=0.957, P>0.05). The IgM in severe group was significantly lower( Z=-2.041, P<0.05). But the differences in the level of immune function including IgA, IgG, CD4 + cell and CD8 + cell between the severe group and the mild group were not significant.The cases in the mild group had improved after antiviral treatments.Among the severe group, 3 cases survived after treatment, another 1 case was diagnosed as hydroa vacciniforme-like EBV-related proliferative disease (HV-like LPD). After antiviral treatment, the effect was not good, then after high-dose IVIG treatment and Bortezomib combined with methylprednisolone treatment, the EBV-DNA load decreased and the condition improved.While 1 case lost to follow-up, there were 2 cases with EBV-associated hemophagocytic syndrome and 1 case with EBV-associated lymphoma died after chemotherapy or transplantation. Conclusion:EBV-associated lymphoproliferative disease may manifest as a condition similar to infectious mononucleosis.High IgE, low IgM or high DNA load may indicate poor prognosis.Immune function after EBV infection may have different effects on prognosis.When the infected lymphocyte types are NK or T cells, it may indicate poor prognosis.The efficacy of transplantation and chemotherapy in severe cases is still uncertain.

Objective:To investigate the efficacy of osettinib in the treatment of first-line tyrosine kinase inhibitor-resistant advanced lung adenocarcinoma and its effects on carcinoembryonic antigen (CEA) and vascular endothelial growth factor (VEGF) levels.Methods:Seventy-two patients with first-line tyrosine kinase inhibitor-resistant advanced lung adenocarcinoma (T790M test negative or rejected) who received treatment in Jinhua Guangfu Cancer Hospital from June 2017 to June 2019 were included in this study. They were randomly assigned to undergo either conventional pemetrexed plus cisplatin (control group, n = 36) or osimertinib mesylate (observation group, n = 36) for 4 successive weeks. Before and after 4 weeks of treatment, serum CEA and VEGF levels were measured. Curative effects were evaluated. Adverse reactions and 6-month, 1-year and 2-year survival rate were recorded. Results:Effective rate and disease-control rate in the observation group were 80.6% (29/36) and 94.4% (34/36) respectively, which were significantly higher than 58.3% (21/36) and 75.0% (27/ 36) in the control group ( χ2 = 4.193, 5.261, both P < 0.05). Before treatment, there were no significant differences in serum CEA and VEGF levels between the two groups (both P > 0.05). Compared with before treatment, serum CEA and VEGF levels were significantly increased after treatment (both P < 0.05). After treatment, serum CEA and VEGF levels in the observation group were (5.36 ± 0.33) U/mL and (121.56 ± 11.57) ng/L respectively, which were significantly lower than those in the control group [(8.25 ± 0.54) U/mL, (163.68 ± 14.59) ng/L, t = 27.399, 13.572, both P < 0.001]. The incidence of adverse reactions in the observation group was significantly lower than that in the control group [19.4% (7/36) vs. 44.4% (16/36), χ2 = 5.173, P = 0.011]. 6-month, 1-year and 2-year survival rate were 94.29%, 77.14% and 60.00% respectively, in the observation group and 91.43%, 54.29% and 34.29% respectively in the control group. There was no significant difference in 6-month overall survival rate between the two groups ( χ2 = 0.352, P = 0.251). 1-year and 2-year survival rate in the observation group were significantly higher than those in the control group ( χ2 = 4.058, P = 0.044; χ2 = 4.644, P = 0.031). Conclusion:Ositinib is effective in the targeted treatment of first-line tyrosine kinase inhibitor-resistant advanced lung adenocarcinoma. It can effectively decrease serum CEA and VEGF levels and prolong the survival of patients, thereby exhibiting a clinical application value.

Translational medicine refers to translating basic research achievements into the clinical application for diagnosis and treatment. There are still many issues of gastric cancer to be solved in clinical diagnosis and treatment. We need to focus on clinical questions, by means of basic research and multidisciplinary intersection approach, to further improve the overall efficacy of gastric cancer. Based on Ruijin Hospital′s translational research experiences, in this paper, the authors describe the future direction in the field of translational research, such as the etiology and pathogenesis of gastric cancer, tumor markers for early diagnosis, prediction of recurrence and metastasis, classification criteria, evaluation of chemotherapy, tumor heterogeneity, targeted therapy, immunotherapy and research platform establishment. In addition, here we share our perspective of the research on serum biomarkers, specific antibodies and improvement of drug delivery for gastric cancer.

OBJECTIVE: To explore the application value of computer-aided diagnosis technology based on deep residual network in the diagnosis of occupational pneumoconiosis(hereinafter referred to as pneumoconiosis). METHODS: A total of 5 424 digital radiography chest images were collected from occupational health examiners using a convenient sampling method.These images were used to establish a data set. After training with the data set, the pneumoconiosis computer-aided diagnosis system was used to independently diagnose the test set images(50 positive and negative cases each) and output a positive probability value. Six diagnostic physicians with varied ages and different experiences performed independent diagnosis on the test set and assisted diagnosis with reference to computer results. The diagnostic accuracy was evaluated using the area under the receiver operating characteristic curve(AUC) value, sensitivity, and specificity.The Kappa consistency test was used to evaluate the diagnostic consistency. RESULTS: The AUC value, sensitivity, specificity, and Kappa value of pneumoconiosis diagnosis increased after using computer-aided diagnosis. The sensitivity increased from 0.74 to 0.85(P<0.05)and the Kappa value increased from 0.64 to 0.79(P<0.05). The AUC value increased from 0.90 to 0.95, and the specificity increased from 0.89 to 0.94, but there were no statistical difference(P<0.05). CONCLUSION: Computer-aided diagnosis can improve the sensitivity and consistency of pneumoconiosis screening and reduce the differences in diagnosis among physicians.