BACKGROUND:Osteoporotic vertebral compression fractures have a high rate of recurrent fractures in adjacent vertebrae after percutaneous vertebroplasty,but the cause of their occurrence is still controversial. OBJECTIVE:To explore the influencing factors of adjacent vertebral re-fractures after percutaneous vertebroplasty in patients with single-segment osteoporotic vertebral compression fractures. METHODS:A retrospective analysis was performed in 210 patients admitted to the Fifth Hospital of Wuhan City,Second Affiliated Hospital of Jianghan University from June 2016 to June 2020,who had been diagnosed with new single-segment osteoporotic vertebral compression fractures by X-ray and MRI examinations,and received percutaneous vertebroplasty.The patients were followed up for more than 18 months.The general preoperative data and postoperative indicators were collected.The general preoperative data included age,sex,body mass index,fracture segment location,fracture days,fracture cause,whether accompanied by diabetes mellitus,whether accompanied by renal and thyroid dysfunction,and visual analogue scale score on admission.The postoperative indicators included recovery rate of anterior edge of the vertebral body after operation,degree of dispersion of bone cement,leakage of bone cement,use of bone material,single or bilateral injection of bone cement,recovery rate of the injured vertebral mid-column after operation,local Cobb angle of the injured vertebra after operation.According to their real conditions,the patients were divided into a group without adjacent vertebral re-fractures(n=190)and a group with adjacent vertebral re-fractures(n=20).The presence or absence of postoperative re-fracture of the adjacent vertebrae of the injured spine was used as the dependent variable and the categorical variables such as preoperative general data and postoperative indicators were used as independent variables for statistical analysis. RESULTS AND CONCLUSION:After percutaneous vertebroplasty,patients with adjacent vertebral re-fractures showed significant differences in age,body mass index,postoperative vertebral body anterior edge recovery rate,degree of cement dispersion,and cement leakage from those without adjacent vertebral re-fractures(P<0.05).However,sex,time of fracture,cause of fracture,presence of diabetes or kidney disease or thyroid disease,location of the initial vertebral fracture segment,mode of cement injection,local Cobb angle of the injured vertebra,recovery rate of the injured vertebral mid-column,and use of bone tissue were not statistically significant in relation to re-fracture of the adjacent vertebra after percutaneous vertebroplasty(P>0.05).Multivariate Logistic regression analysis showed that age,vertebral body anterior edge recovery rate and cement leakage were independent risk factors for re-fractures of the adjacent vertebra after percutaneous vertebroplasty.To conclude,age,vertebral body anterior edge recovery rate and leakage of bone cement are the influencing factors of adjacent vertebral re-fractures after percutaneous vertebroplasty.However,factors such as the degree of bone cement dispersion and the local Cobb angle of the injured vertebra were not correlated with adjacent vertebral re-fractures after percutaneous vertebroplasty.

Abstract Cognitive behavior therapy (CBT) is one of the main psychotherapeutic methods used to treat anxiety disorders in children and adolescents. Art therapy, based on psychotherapy theory and methods, is rising in popularity abroad. At present, foreign scholars have started to apply cognitive behavioral art therapy (CBAT) for patients with anxiety disorders. Based on the current findings, children and adolescents with developing cognitive functions may also benefit from this therapy. This article summarizes the application status of CBAT in the treatment of anxiety disorder in patients at home and abroad, and innovatively explores its therapeutic potential for anxiety disorders in children and adolescents in China, thus providing a novel perspective that can address the shortcomings of CBT.

Objectives:To investigate the clinical and genetic features of young Chinese patients with myeloproliferative neoplasms (MPN) .Methods:In this cross-sectional study, anonymous questionnaires were distributed to patients with MPN patients nationwide. The respondents were divided into 3 groups based on their age at diagnosis: young (≤40 years) , middle-aged (41-60 years) , and elderly (>60 years) . We compared the clinical and genetic characteristics of three groups of MPN patients.Results:1727 assessable questionnaires were collected. There were 453 (26.2%) young respondents with MPNs, including 274 with essential thrombocythemia (ET) , 80 with polycythemia vera (PV) , and 99 with myelofibrosis. Among the young group, 178 (39.3%) were male, and the median age was 31 (18-40) years. In comparison to middle-aged and elderly respondents, young respondents with MPN were more likely to present with a higher proportion of unmarried status (all P<0.001) , a higher education level (all P<0.001) , less comorbidity (ies) , fewer medications (all P<0.001) , and low-risk stratification (all P<0.001) . Younger respondents experienced headache (ET, P<0.001; PV, P=0.007; MF, P=0.001) at diagnosis, had splenomegaly at diagnosis (PV, P<0.001) , and survey (ET, P=0.052; PV, P=0.063) . Younger respondents had fewer thrombotic events at diagnosis (ET, P<0.001; PV, P=0.011) and during the survey (ET, P<0.001; PV, P=0.003) . JAK2 mutations were found in fewer young people (ET, P<0.001; PV, P<0.001; MF, P=0.013) ; however, CALR mutations were found in more young people (ET, P<0.001; MF, P=0.015) . Furthermore, mutations in non-driver genes (ET, P=0.042; PV, P=0.043; MF, P=0.004) and high-molecular risk mutations (ET, P=0.024; PV, P=0.023; MF, P=0.001) were found in fewer young respondents. Conclusion:Compared with middle-aged and elderly patients, young patients with MPN had unique clinical and genetic characteristics.

Echocardiography is the primary method for noninvasive evaluation of cardiovascular system in children. However, conventional echocardiography cannot observe and analyze transient cardiac events and transient phases due to its low temporal resolution, nor can it evaluate the mechanical properties of myocardium. In recent years, ultrasonic imaging technology, and the improvement of computing capacity greatly promoted the development of the ultrafast cardiac shear wave imaging, allowing the speed of 5 000 frames/s via chest cardiac imaging, has fast dynamic movement of heart tissue, real-time observation for myocardial properties, function and blood flow to the heart pattern advantages, can better diagnose cardiovascular disease in children. In this paper, the principle of ultrafast cardiac shear wave imaging and its recent application in pediatric cardiac imaging are reviewed.

Objectives:To explore health-related quality of life (HRQoL) and identify its associated variables in Chinese patients with Philadelphia-negative myeloproliferative neoplasms (MPNs) .Methods:In this cross-sectional study, anonymous questionnaires were distributed to adult patients with MPNs to assess symptom burden measured by MPN-10 and HRQoL measured by Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) .Results:The data from 1405 respondents with MPNs, including 645 (45.9%) with essential thrombocythemia (ET) , 297 (21.1%) with polycythemia vera (PV) , and 463 (33.0%) with myelofibrosis (MF) , were analyzed. 646 (46.0%) respondents were male. The median age was 56 (range, 18-99) years. The mean MPN-10 scores were 13.0±12.7, 15.0±14.7, and 21.0±16.6 ( P<0.001) , and the physical component summary (PCS) and mental component summary (MCS) scores were 48.0±8.5, 47.0±9.0, and 42.0±10.0 ( P<0.001) and 51.0±11.0, 50.0±10.8, and 49.0±11.1 ( P=0.002) for respondents with ET, PV, and MF, respectively. Respondents with MF reported the lowest score of physical functioning, role functioning, emotional functioning, cognitive functioning, social function, and global health status (all P<0.01) and the highest score of fatigue, pain, dyspnea, appetite loss, diarrhea, and financial problems (all P<0.05) in EORTC QLQ-C30. Multivariate analyses revealed that higher MPN-10 scores were significantly associated with lower PCS (-0.220 to -0.277, P<0.001) and MCS (-0.244 to -0.329, P<0.001) scores; increasing age (-1.923 to -4.869; all P<0.05) , lower PCS score. Additionally, comorbidity (ies) , symptom at diagnosis, splenomegaly, anemia, unknown driver gene, and higher annual out-of-pocket cost were significantly associated with lower PCS and/or MCS scores. However, age ≥ 60 years, urban household registration, concomitant medication, and receiving ruxolitinib therapy in respondents with MF were associated with higher MCS scores. Weak correlations were found between MPN-10 score (except the subscale of appetite loss and constipation) and EORTC QLQ-C30 score in majority of subscales in respondents with ET (| r| = 0.193-0.457, all P<0.001) , PV (| r| = 0.192-0.529, all P<0.01) , and MF (| r| = 0.180-0.488, all P<0.001) , respectively. Conclusions:HRQoL in patients with MPN was significantly reduced, especially in patients with MF. Sociodemographic and clinical variables were significantly associated with the HRQoL in patients with MPNs.

Objective: Comparing the benefit of Abidor, lopinavir/ritonavir and recombinant interferon α-2b triple combination antiviral therapy and lopinavir/ritonavir and interferon dual combination antiviral therapy to hospitalized novel coronavirus pneumonia 2019 in Zhejiang province. Methods: A multi-center prospective study was carried out to compare the effect of triple combination antiviral therapy with dual combination antiviral therapy in 15 medical institutions of Zhejiang Province. All patients were treated with recombinant interferon α-2b (5 million U, 2 times/d) aerosol inhalation. 196 patients were treated with abidol (200 mg, 3 times/d) + lopinavir / ritonavir (2 tablets, 1 time/12 h) as the triple combination antiviral treatment group. 41 patients were treated with lopinavir / ritonavir (2 tablets, 1 time/12 h) as the dual combination antiviral treatment group. The patients who received triple combination antiviral therapy were divided into three groups: within 48 hours, 3-5 days and > 5 days after the symptom onset. To explore the therapeutic effects of triple combination antiviral drugs and dual combination antiviral drugs, as well as triple combination antiviral drugs with different antiviral initiate time. SPSS17.0 software was used to analyze the data. Results: The time of virus nucleic acid turning negative was (12.2 ± 4.7) days in the triple combination antiviral drug group, which was shorter than that in the dual combination antiviral drug group [(15.0 ± 5.0) days] (t = 6.159, P < 0.01 ). The length of hospital stay [12 (9, 17) d] in the triple combination antiviral drug group was also shorter than that in the dual combination antiviral drug group [15 (10, 18) d] (H = 2.073, P < 0.05). Comparing the antiviral treatment which was started within 48 hours, 3-5 days and > 5 days after the symptom onset of triple combination antiviral drug group, the time from the symptom onset to the negative of viral shedding was 13 (10,16.8), 17 (13,22) and 21 (18-24) days respectively (Z = 32.983, P < 0.01), and the time from antiviral therapy to the negative of viral shedding was (11.8±3.9) , (13.5±5.1) and (11.2±4.3) d. The differences among the three groups were statistically significant (Z=32.983 and 6.722, P<0.01 or<0.05). Conclusions The triple combination antiviral therapy of Abidor, Lopinavir/Litonavir and recombinant interferon α-2b showed shorter viral shedding time and hospitalization time compared with the dual combination antiviral therapy. The earlier the time to initiate triple antiviral treatment, the shorter the time of virus shedding.

Objective:To compare the efficacy of the combination of abidol, lopinavir/ritonavir plus recombinant interferon α-2b (rIFNα-2b) and the combination of lopinavir/ritonavir plus rIFNα-2b for patients with COVID-19 in Zhejiang province.Methods:A multicenter prospective study was carried out to compare the efficacy of triple combination antiviral therapy and dual combination antiviral therapy in 15 medical institutions of Zhejiang province during January 22 to February 16, 2020. All patients were treated with rIFNα-2b (5 million U, 2 times/d) aerosol inhalation, in addition 196 patients were treated with abidol (200 mg, 3 times/d) + lopinavir/ritonavir (2 tablets, 1 time/12 h) (triple combination group) and 41 patients were treated with lopinavir/ritonavir (2 tablets, 1 time/12 h) (dual combination group). The patients who received triple combination antiviral therapy were further divided into three subgroups: <48 h, 3-5 d and >5 d according the time from the symptom onset to medication starting. The therapeutic efficacy was compared between triple combination group and dual combination group, and compared among 3 subgroups of patients receiving triple combination antiviral therapy. SPSS 17.0 software was used to analyze the data.Results:The virus nucleic acid-negative conversion time in respiratory tract specimens was (12.2±4.7) d in the triple combination group, which was shorter than that in the dual combination group [(15.0±5.0) d] ( t=6.159, P<0.01). The length of hospital stay in the triple combination group [12.0 (9.0, 17.0) d] was also shorter than that in the dual combination group [15.0 (10.0, 18.0) d] ( H=2.073, P<0.05). Compared with the antiviral treatment which was started within after the symptom onset of in the triple combination group, the time from the symptom onset to the viral negative conversion was 13.0 (10.0, 17.0), 17.0 (13.0, 22.0) and 21.0 (18.0, 24.0) d in subgroups of 48 h, 3-5 d and >5 d, respectively ( Z=32.983, P<0.01), while the time from antiviral therapy to viral negative conversion was (11.8±3.9), (13.5±5.1) and (11.2±4.3) d, respectively( Z=6.722, P<0.05). Conclusions:The triple combination antiviral therapy of abidol, lopinavir/litonavir and rIFNα-2b shows shorter viral shedding time and shorter hospitalization time, compared with the dual combination antiviral therapy; and the earlier starting triple combination antiviral therapy will result in better antiviral efficacy.

Objective To analyze the characteristics of left ventricular systolic function in Kawasaki disease (KD) patients with intravenous immunoglobulin (IVIG) resistant during acute phase by two-dimensional speckle tracking imaging (2D STI).Methods IVIG resistant patients (n=40) as well as age and gender matched IVIG responder patients (n=40) were selected from KD patients in acute phase.Patients in IVIG resistant group were further divided into coronary artery dilation (CAD) subgroup and no coronary artery dilation (NCAD) subgroup.Then conventional echocardiography,2D STI and laboratory indexes were acquired and compared between IVIG resistant group and IVIG responder group,as well as between CAD and NCAD subgroup.ROC curve analysis was used to determine threshold values of 2D STI measurements associated with IVIG resistance.Results Compared with IVIG responder group,coronary artery dilation,left ventricular mass and left ventricular mass index increased,systolic global longitudinal strain (GLS) and systolic global circumferential strain (GCS) decreased,albumin,erythrocyte sedimentation rate,C-reactive protein and platelet increased in IVIG resistant group (all P＜0.05).Taking absolute GLS 16.8％ as a threshold,the area under curve (AUC) was 0.769 (P=0.021),sensitivity,specificity in diagnosis of IVIG resistant was 79.27％,68.36％.Taking absolute GCS 15.9％ as a threshold,AUC was 0.749 (P=0.038),sensitivity,specificity in diagnosis of IVIG resistant was 71.43％,57.28％.Conclusion IVIG resistant KD patients present significantly greater systolic dysfunction compared with responders in patients with KD,which may be the results of myocardium infection other than coronary artery lesions.2D STI may predict myocardial injury in IVIG resistant KD patients.

Objective To assess the value of shear-wave elastic modulus for differential diagnosis of benign and malignant breast lesions using Meta-analysis.Methods Relevant Chinese and foreign articles about shear-wave elastography for differentiating benign and malignant breast lesions were collected from the literatures published before Apr.2016.Meta-analysis was conducted to assess the overall ability of the shear wave elastic modulus including Emax,Emea,Eratio and Esd.Results Totally 31 studies were brought into the Meta-analysis.The summarized sensitivity (SSEN) and summarized specificity (SSPE) of Emax were 0.87(95％CI [0.83,0.91]) and 0.91 (95％CI [0.87,0.93]).The SSEN and SSPE of Emea were 0.84 (95％CI [0.77,0.89]) and 0.88 (95％CI [0.84,0.91]),The SSEN and SSPE of Eratio were 0.88(95％CI [0.83,0.91]) and 0.87 (95％CI [0.80,0.91],the SSEN and SSPE of gsd were 0.85 (95％CI [0.80,0.89]) and 0.90 (95％CI [0.85,0.94]).The summarized receiver operator characteristic analysis showed that the area under the curve of E E Eratio and Esd were 0.95,0.93,0.93 and 0.93.Conclusion The shear wave elastic modulus contribute to differentiate benign and malignant breast lesions.Among these indices,Emax is the best one.

Objective To systematically analyze and assess the overall value of transrectal shear wave elastograpy in diagnosis of prostate cancer (PCa) using Meta-analysis.Methods Relevant Chinese and foreign papers diagnosing PCa with transrectal shear wave elastograpy published before December 2016 were searched.The references were evaluated and screened according to the criteria of diagnostic research.The selected references were analyzed by Meta-Disc 1.4 and Stata 12.0 statistical software.Results Eight articles were included in the present Meta-analysis.Five of these literatures were about transrectal shear wave elastograpy in diagnosis of PCa,the summarized sensitivity (SEN) and summarized specificity (SPE) in diagnosis of PCa were 0.80 (95％CI [0.75,0.84]) and 0.75 (95％CI [0.71,0.79]),respectively;the positive likelihood ratios (PLR) and negative likelihood ratios (NLR) were 3.60 (95 ％ CI [2.57,5.05]) and 0.17 (95 ％ CI[0.08,0.37]),respectively;the area under SROC curves was 0.895.Five of these literatures were about transrectal shear wave elastograpy supplemental prostatic biopsy in diagnosis of PCa,the summarized SEN and SPE were 0.86 (95％ CI [0.83,0.88]) and 0.84 (95％CI [0.82,0.85]) respectively;the PLR and NLR were 5.81 (95％CI [3.07,10.99]) and 0.14 (95％CI [0.04,0.49]) respectively;the area under SROC curves were 0.924.Conclusion Transrectal shear wave elastograpy has better clinical value in detection of PCa and can be used to supplemental prostatic biopsy.