POEMS syndrome is a rare condition associated with plasma cell disorders， and it often involves multiple systems and has diverse clinical manifestations. This article reports two cases of POEMS syndrome with hepatosplenomegaly as the initial manifestation. During the course of the disease， the patients presented with lower limb weakness， hepatosplenomegaly， lymph node enlargement， ascites， hypothyroidism， positive M protein， and skin hyperpigmentation， and ¹⁸F-FDG PET-CT imaging revealed bone lesions mainly characterized by osteolytic changes and plasma cell tumors. There was an increase in the serum level of vascular endothelial growth factor. The patients were finally diagnosed with POEMS syndrome， and the symptoms were relieved after immunomodulatory treatment.

Objective:To evaluate the role of cancerous inhibitor of protein phosphatase 2A (CIP2A) in preoperative sleep deprivation (PSD)-induced aggravation of postoperative cognitive dysfunction (POCD) in aged mice.Methods:One hundred and ten healthy C57BL/6J mice of either sex, aged 18-20 months, weighing 29-35 g, were divided into 5 groups ( n=22 each) using a random number table method: sham operation group (S group), abdominal surgery group (O group), PSD + abdominal surgery group (D+ O group), CIP2A shRNA + abdominal surgery group (CS+ O group), and CIP2A shRNA+ PSD+ abdominal surgery group (CS+ D+ O group). At 14 days before surgery, control shRNA lentivirus was injected into the hippocampus in S, O and CS+ O groups, and CIP2A shRNA was injected into the hippocampus in D+ O and CS+ D+ O groups. PSD was carried out for 3 consecutive days prior to surgery. Cognitive function was assessed using the Morris water maze test at days 7-11 after surgery. The mice were sacrificed under deep anesthesia at day 3 after surgery, and hippocampal tissues were obtained to determine the expression of CIP2A, high mobility group box 1 (HMGB1), ionized calcium-binding adapter molecule 1 (Iba-1), alpha subunit of protein phosphatase 2A (PP2Aa), catalytic subunit of protein phosphatase 2A (PP2Ac), phosphorylated tau protein (p-tau) (S396), and p-tau (S404) (by Western blot), levels of reactive oxygen species (ROS), malondialdehyde (MDA), and superoxide dismutase (SOD), and count of Iba-1 positive cells in the hippocampal CA1 region (using immunofluorescence staining). Results:Compared with S group, the escape latency was significantly prolonged, the frequency of crossing the platform was reduced, duration of stay in the target quadrant was shortened, the expression of CIP2A, Iba-1 and HMGB1 was up-regulated, PP2Ac expression was down-regulated, levels of ROS and MDA and count of Iba-1 positive cells were increased, and the activity of SOD was decreased in O group ( P<0.05). Compared with O group, the escape latency was significantly prolonged, the frequency of crossing the platform was reduced, duration of stay in the target quadrant was shortened, the expression of CIP2A, Iba-1 and HMGB1 was up-regulated, PP2Ac expression was down-regulated, levels of ROS and MDA and count of Iba-1 positive cells were increased, and the activity of SOD was decreased in D+ O group, and the escape latency was significantly shortened, the frequency of crossing the platform was increased, duration of stay in the target quadrant was prolonged, the expression of CIP2A, Iba-1 and HMGB1 was down-regulated, PP2Ac expression was up-regulated, levels of ROS and MDA and count of Iba-1 positive cells were decreased, and the activity of SOD was increased in CS+ O group ( P<0.05). Compared with D+ O group, the escape latency was significantly shortened, the frequency of crossing the platform was increased, duration of stay in the target quadrant was prolonged, the expression of CIP2A, Iba-1 and HMGB1 was down-regulated, PP2Ac expression was up-regulated, levels of ROS and MDA and count of Iba-1 positive cells were decreased, and the activity of SOD was increased in CS+ D+ O group ( P<0.05). There was no significant difference in PP2Aa expression among the five groups ( P>0.05). Conclusions:The mechanism by which PSD aggravates POCD is related to up-regulating the expression of CIP2A and promoting oxidative stress responses, neuroinflammatory responses and phosphorylation of tau protein in aged mice.

Objective:To investigated the prevalence of anxiety and depression symptoms in patients with colorectal polyps in part of Xinjiang area and to explore the associated influencing factors related to psychological status, and to provide evidence and clues to promote the diagnosis and treatment of psychosomatic diseases in digestive system.Methods:From December 2021 to June 2022, at the First Affiliated Hospital of Shihezi University, the Fourth Division Hospital of Xinjiang Production and Construction Corps, the Third Division Hospital of Xinjiang Production and Construction Corps (Kashgar Hospital), the Thirteenth Division Red Star Hospital of Xinjiang Production and Construction Corps, the Tenth Division Beitun Hospital of Xinjiang Production and Construction Corps, the Seventh Division Hospital of Xinjiang Production and Construction Corps, the Fifth Division Hospital of Xinjiang Production and Construction Corps, patients who underwent colonoscopy and colorectal polyps detected were enrolled. The generalized anxiety disorder scale-7 (GAD-7) was used to screen anxiety symptoms, and the patient health questionaire-8 (PHQ-8) was performed to screen depression symptoms, and the general situation questionnaire was used to collect clinical information of patients. The questionnairs were completed via the Questionnaire Star platform or paper questionnaire, and a database was established. The patients were divided into groups according to whether with anxiety and depression symptoms. Multivariable logistic regression models was performed to analyze the factors related to anxiety and depression.Results:A total of 516 questionnaires were distributed and collected, among which 9 questionnaires were incomplete and 507 questionnaires were valid, the effective rate of questionnaires was 98.26%. The detection rates of anxiety and depression symptoms in 507 patients with colorectal polyps were 21.50%(109/507) and 19.33%(98/507), respectively. The results of multivariable logistic analysis revealed that female ( OR=3.87, 95% confidence interval (95% CI) 2.30 to 6.51, P<0.001), maximum diameter of polyp ( OR=1.74, 95% CI 1.14 to 2.67, P=0.011), perception of polyps as cancer ( OR=13.96, 95% CI 1.48 to 132.07, P=0.022), and the occurrence of gastrointestinal symptoms after polyp detection ( OR=5.43, 95% CI 1.74 to 16.92, P=0.004) were independent risk factors of anxiety in patients with colorectal polyps. Female ( OR=2.42, 95% CI 1.47 to 4.00, P=0.001), the number of polyps ( OR=1.07, 95% CI 1.01 to 1.13, P=0.028) and the count of gastrointestinal symptoms ( OR=2.04, 95% CI 1.34 to 3.10, P=0.001) were independent risk factors of depression in patients with colorectal polyps. Conclusion:Gender, polyp size, number of polyps, disease perception, and concomitant gastrointestinal symptoms are associated with anxiety and depression in patients with colorectal polyps.

Objective:To explore the clinical effects of a series of posture intervention strategies on correcting abnormal fetal position, so as to provide a basis for Clinical position management and promotion of natural delivery.Methods:This study was a randomized controlled trial. The convenience sampling method was used to select 196 full-term primiparas women with abnormal fetal orientation confirmed by ultrasound as single fetal head position in the Women′s Hospital, School of Medicine, Zhejiang University from March to October 2022 as the research objects. They were divided into control group 106 cases and research group 90 cases by random number table method. The control group received normal nursing and chose comfortable position by themselves during labor. The research group received a series of ultrasound-guided postural intervention strategies for postural management in the first and second stages of labor on the basis of normal nursing. The angle of progression and the midline angle, the fetal orientation, fetal orientation during complete uterine orifice and delivery outcome were compared between the two groups.Results:Finally, 190 cases were included, 105 cases in the control group and 85 cases in the research group. There were 76 vaginal deliveries in the research group and 95 in the control group. The rate of anterior occipital position and the angle of fetal head rotation in the research group were 73.68% (56/76) and 64.55 (37.90, 85.55)°, which were higher than 45.26% (43/95) and 33.00 (14.00, 60.00)° in the control group;the midline angle of the research group was 57.10(38.50, 75.80)°, which was lower than 80.00 (52.50, 90.30)° of the control group. There was significant difference between the two groups ( χ2 = 14.14, Z = 4.17, - 3.74, all P<0.01). The first stage of labor was 522.50 (413.00, 695.00) minutes and the total stage of labor was 611.00 (488.00, 812.00) minutes in the research group, which was lower than 620.00 (450.00, 795.00) and 700.00 (539.00, 904.00) minutes in the control group ( Z = - 2.34, - 2.03, both P<0.05). Conclusions:The application of the serial position intervention strategy under the ultrasound guidance during the labor process can improve the abnormal fetal position, shorten the first stage of labor time effectively and safely, while it does not have any significant effect on the improvement of the delivery outcome.

Objective:To understand clinical effect of a homemade infants wrist hand thumb joint fixtures to prevent the unplanned extubation (UEX) in radial arterial puncture tube in children with congenital heart disease.Methods:From October 2016 to October 2019, 150 cases infants patients with simple congenital heart disease in cardiac surgery of the First Affiliated Hospital of University of Science and Technology of China were selected as the research objects, and the radial artery invasive manometric tube was routinely indwelling after operation. Subjects were randomly divided into observation group and control group, with 75 cases in each group. In the observation group, the wrist joint of children was fixed with homemade fixation device. The control group used conventional fixation methods to fix the wrist joint of infants. The incidence of pressure injury and unplanned extubation were compared between the two groups.Results:There was 1 case (1.33%) pressure injury in the observation group and 2 cases (2.67%) in the control group, and there was no statistical significance in the two groups ( P>0.05). The unplanned extubation rate of radial artery pressure tube occurred in 5 cases (6.67%) in the observation group, and lower than that in the control group (17/75, 22.67%) ( χ2=7.67, P<0.01). When children in the state of agitation and very agitation, the incidence of unplanned extubation rate in the observation group was 0 and 4.35%(1/23), lower than that in the control group 15.79%(6/38) and 35.00% (7/20), respectively ( χ2=6.19, 6.64, both P<0.05). With the extension of ICU time, the incidence of unplanned extubation rate was increased. The incidence of unplanned extubation rate was 4.76% (2/42) and 9.09% (3/33) in the observation group and 18.18%(8/44) and 29.03% (9/31) in the control group when ICU time was ≤24 h and>24 h, respectively. The difference was statistically significant ( χ2=5.51, 4.17, both P<0.05). Conclusions:The homemade wrist thumb joint fixtures device for infants does not increase the pressure injury of the fixed part, and can reduce the incidence of unplanned extubation of radial artery manometric tube in children with congenital heart disease.

From the perspective of doctor-patient relationship, this paper put forward the external and internal paths led by the social atmosphere value of respecting medicine and health. The external path is that lead the mass media and publicize positive public opinion; popularize medical knowledge and narrow the distance between doctors and patients; strengthen humanistic care and relieve psychological stress; establish positive models and carry forward advanced deeds; increase salary packages and embody labor value; improve the practice environment and implement safety initiatives. The internal path is that strengthen professional ability and improve professional quality; improve communication skills and enhance mutual understanding; pay attention to psychological counseling and psychological protection; establish prevention awareness and protect personal safety; strengthen professional belief and create an atmosphere of respecting doctors, so as to make respect for medicine and health become common practice.

The impact of parental obesity on offspring health attracts increasing attention with the rising obese population worldwide. Much more studies have concentrated on the influences of maternal obesity, while studies regarding paternal obesity were relatively few and mainly focused on glucose and insulin regulation, adiposity, etc. Several large cohort studies and animal experiments have shown that paternal obesity can damage the neuropsychological development in offspring, which has become a risk factor for autistic spectrum disorders, cognitive disorders, and lower intelligence quotient, and epigenetic studies have explored the related mechanisms. This review summarizes the progress in this field, aiming to provide a reference for basic and clinical research in the future.

Objective:To analyze the clinical characteristics, risk factors for critical illness and death of severe adenovirus pneumonia in children, so as to provide clinical evidences for early diagnosis and reliable treatment.Methods:A total of 75 pediatric cases with severe adenovirus pneumonia admitted to Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from January to October 2019 were studied. The clinical features, laboratory and imaging data, therapeutic approaches, efficacy of the treatments and prognosis were investigated retrospectively. Patients were divided into severe group and critical group. Chi square test and Mann-Whitney U rank sum test were used to analyze the data of the two groups. The risk factors for critical illness and death were analyzed by univariate and multivariate Logistic regression. Results:Among the 75 children, there were 52 males and 23 females, aged from 3 months to 8 years, including 30 of severe cases and 45 of critical case. The positive rate of adenovirus antigen in nasopharyngeal swab was 21% (15/72), and the positive rate of serum adenovirus IgM antibody was only 13% (10/75). However, the positive rate of adenovirus nucleic acid in nasopharyngeal swab was 75% (21/28). What is more, the positive rates of metagenomics next generation sequencing (mNGS) in plasma and bronchoalveolar lavage fluid were 92% (33/36) and 96% (54/56), respectively, of which 95% (63/66) were confirmed as adenovirus type 7. Relatively high dose of ribavirin and integrated therapeutic approaches (respiratory support, glucocorticoids, immunoglobulin and organ supportive therapies) were used. The recovery rate was 77% (58/75), the improvement rate was 8% (6/75) and the mortality rate was 15% (11/75). The proportion of children with the duration of fever longer than 3 days after ribavirin treatment in the critical group was significantly higher than that in the severe group(51% (18/35) vs. 8% (2/26), χ 2=12.949, P<0.05). The risk factors for critical illness were younger than 4 years, longer duration of fever before and after admission to PICU, oxygenation index<300 mmHg (1 mm Hg=0.133 kPa), ferritin>1 000 μg/L, lactate dehydrogenase (LDH)>1 500 U/L, 5 lung lobes involvement, pleural effusion and (or) air leakage (all P<0.05). Among them, 5 lung lobes involvement was the independent risk factor for critical illness (adjusted OR=49.641, 95% CI 4.186-588.618, P=0.002). Risk factors for death included longer duration of fever after being admitted to PICU, oxygenation index<100 mmHg, ferritin>2 000 μg/L, interleukin (IL)-6>100 ng/L, LDH>1 500 U/L, pleural effusion and (or) air leakage (all P<0.05). Among them, IL-6>100 ng/L was the independent risk factor for the mortalities of critically ill children (adjusted OR=16.094, 95% CI2.059-25.787, P=0.008). Conclusions:The mortality rate of severe pediatric adenovirus pneumonia caused by adenovirus type 7 is high. High positive rates of adenovirus nucleic acid in nasopharyngeal swabs and mNGS in plasma or bronchoalveolar lavage fluid contribute to early diagnosis, and mNGS can also be used for serotyping. Younger children under 4 years of age, persistent fever, extensive pulmonary lesions and significantly increased inflammatory cytokines such as IL-6 are warning indicators for critical illness and poor prognosis. Relatively high dose of ribavirin combined with integrated therapeutic approaches are beneficial for prognosis.

Objective:Based on the policy goals of family doctors′ contracted services, to build an indicator system as policy tools for policy outcomes assessment and policy delivery optimization.Methods:Through literature and policy review, an evaluation conceptual framework was built based on policy goals of family doctors′ contracted services, and an indicator system was established using Delphi method.Results:Upon consultation of 21 experts, an indicator system for policy effect assessment of the family doctors′ contracted services was established, covering both policy implementations and goal effects. This system consisted of 7 level-2 indicators and 23 level-3 indicators.Conclusions:The indicator system oriented to policy goals, ensures the pertinence of policy effect assessment to play a strong guidance on practical implementation of the family doctors′ contracted services.

Objective:To analyze the policy implementation of family doctors′ contracted services in different regions based on practices in typical regions.Methods:From April to October 2019, we conducted field investigations in 14 regions, collected data on policy formulation and implementation, organizational form and service content of contracting service, incentive mechanism and capacity development. By means of key persons′ interview, we tried to understand the background of district/county policy implementation, as well as policy delivery and existing difficulties. The measurement data were expressed by means, and the qualitative data were used to extract the key content through semantic analysis.Results:The policy of family doctors′ contracted services had been promoted from pilot exploration to normative development. 71.0% of responsible entities of the contracted services in research regions were family doctor teams. Contraction fee has begun to reflect the value of family doctors′ work, while the average contracted service fees in the eastern, central and western regions were 125, 31.25 and 42.5 yuan/person/year respectively. Comprehensive incentives and health insurance policies in some regions played a role in promoting contracted services.Conclusions:It is necessary to establish the family doctors′ " three roles" management concept, namely health gatekeeper, rights exchanger and resource coordinator; strengthen the professional training and capacity promoting of family doctors, implement the connotation of contracted service fees and economic incentives, in order to play the policy′s basic role in constructing a health-centered system.