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 Pesticide exposure may impact the reproductive health of women undergoing assisted reproductive technology (ART). However, data on pesticide exposure levels in women undergoing ART in China are scarce, and current research on influencing factors is limited. Objective To evaluate the preconceptional pesticide exposure levels and identify potential determinants among women undergoing ART. Methods This study was designed as a cross-sectional survey and recruited 508 women undergoing ART from July 2017 to December 2018 at the fertility clinic of the International Peace Maternity and Child Health Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. Gas chromatography/liquid chromatography-tandem mass spectrometry was used to determine the metabolite concentrations of organophosphate pesticides (OPs), pyrethroid pesticides (PYRs), and neonicotinoid pesticides (NEOs) in urine. The sum of molar concentrations of the three pesticide classes (∑₂OPs, ∑₂PYRs, and ∑₂NEOs) were calculated. A questionnaire was used to collect demographic characteristics, dietary habits, and behavioral information. Multiple linear regression was employed to analyze the associations of demographic characteristics, dietary habits, and behavioral variables with the concentrations of pesticide metabolites in urine among the participants. Results The median creatinine-adjusted concentrations of ∑₂OPs, ∑₂PYRs, and ∑₂NEOs in this study were 419.77, 2.95, and 20.36 nmol·g⁻¹, respectively. The multiple linear regression results showed that the urinary concentration of ∑₂OPs was 42.88% higher in the participants with daily vegetable intake than in those who consumed vegetables ≤3 d per week (P<0.05), and the urinary concentration of ∑₂PYRs was 37.24% higher in the participants with daily fruit intake than in those who consumed fruits ≤3 d per week (P<0.01). Similarly, the urinary concentrations of ∑₂NEOs were 24.51% and 29.30% higher in the participants who consumed fruits daily and 4-6 d per week, respectively, than in those who consumed fruits ≤3 d per week (P<0.05). Besides, we also found that the urinary concentration of ∑₂PYRs was negatively correlated with body mass index (BMI) in the participants (P<0.05). Furthermore, the urinary concentration of ∑₂NEOs was not only positively correlated with age (P<0.05), but also significantly associated with pet ownership and infertility causes among the participants. Specifically, the participants who continued to own pets after conception had a 30.11% higher urinary concentration of ∑₂NEOs than those who never owned pets (P<0.05), and the participants with infertility due to female factors had a 24.10% lower urinary concentration of ∑₂NEOs than those who received ART treatment for infertility caused by male factors (P<0.05). Conclusion The women undergoing ART in Shanghai are widely exposed to pesticides. Age, BMI, frequency of vegetable and fruit intake, pet ownership, and infertility causes may be related to the pesticide exposure levels in this population. However, more human data are needed to confirm these findings.

Refractory acute T-lymphoblastic leukemia (T-ALL), which is characterized by a low sensitivity to conventional induction therapy and poor prognosis, poses significant challenges during treatment. This study reported a case of refractory T-ALL patient with mutations in the JAK1, JAK3, and STAT5B genes from Nanjing University’s Gulou Hospital. Following an unsuccessful course of standard VDLP regimen chemotherapy, the treatment was modified to include ruxolitinib in combination with venetoclax and azacitidine. Subsequent to this therapy, the patient achieved bone marrow minimal residual disease (MRD) negativity. Notably, pleural effusion and mediastinal mass significantly improved the post-chest cavity infusion of dexamethasone combined with etoposide at the same stage. The patient also underwent allogeneic hematopoietic stem cell transplantation upon achieving bone marrow remission and was followed up until January 2024. Ruxolitinib combined with venetoclax and azacytidine has shown promising efficacy and safety in treating refractory T-ALL harboring the JAK1, JAK3, and STAT5B mutations, providing a novel therapeutic approach for such patients.

Objective To explore the chromosome,molecular genetic abnormalities and survival prognosis of adults with acute leukemia(non-M3 type).Methods A total of 148 adult patients with acute leukemia who visited the Department of Hematology of Fuyang People's Hospital from December 2019 to December 2022 were selected as the research subjects.The chromosome karyotype and molecular genetic characteristics of the patients were detected and analyzed by using chromosome banding analysis techniques(R-banding)and fluorescence in situ hybridization.The general information,laboratory examina-tions and prognosis of the patients were collected from the medical records and questionnaires of the subjects.The Kaplan-Meier method was used to draw the survival curve.The survival analysis was tested by the Log-Rank method.Results Among the 148 adult patients with acute leukemia,62 developed acute lymphoblastic leukemia(ALL),with the majority of subtypes being B,and 86 developed acute myeloid leukemia(AML),with the majority of subtypes being M2 and M5.Bone marrow chromosome examination was successfully performed in 141 patients,and there was no significant difference in the proportion of abnormal bone marrow chromosome karyotypes between AML patients and ALL patients(x2=1.864,P＞0.05).A total of 143 patients completed fusion gene examination,and the results showed that 28 of 81 AML patients were fusion gene positive,including 8 cases(9.87％)of mixed lineage leukemia-rearranged(MLL-R)fusion gene,and 20 of 62 ALL patients were fusion gene positive,including 6 cases(9.68％)of MLL-R fusion gene.The incidence of hepatosplenomegaly was significantly higher in patients with positive MLL-R than in patients with negative MLL-R(x2=3.645,P＜0.05),and the incidence of elevated peripheral leukocyte count(≥100 x 109 L-1)was also higher in patients with positive MLL-R than in patients with negative MLL-R(x2=7.051,P＜0.05).The incidence of abnormal bone marrow chromosome karyotype was higher in patients with positive MLL-R than in patients with negative MLL-R(x2=13.961,P＜0.05).There was no significant difference in leukemia typing,age,gender,platelet count and hemoglobin level between patients with positive MLL-R and those with negative MLL-R(P＞0.05).In the ALL group,there was no significant difference in remission rate,relapse rate and mortality rate between MLL-R positive and MLL-R negative patients(P＞0.05);in the AML group,there was no significant difference in remission rate,relapse rate and mortality rate between MLL-R positive and MLL-R negative patients(P＞0.05).There was no significant difference in mortality rate between leukemia patients who received chemotherapy and bone marrow stem cell transplantation(P＞0.05).The 1-year event free survival(EFS)rates of ALL and AML patients were(41.90±3.20)％and(38.20±2.20)％,respectively,and there was no significant difference in the 1-year EFS rate between the ALL and AML patients(x2=0.512,P＞0.05).The 1-year overall survival(OS)rates of ALL and AML patients were(60.50±4.20)％and(58.20±4.60)％,respectively,and there was no significant difference in the 1-year OS rate between the ALL and AML patients(x2=0.175,P＞0.05).The 1-year EFS rates of MLL-R positive and MLL-R negative patients were(34.60±2.70)％and(36.20±3.10)％,respectively,and there was no significant difference in the 1-year EFS rate between the MLL-R positive and MLL-R negative patients(x2=0.579,P＞0.05).The 1-year OS rates of MLL-R positive and MLL-R negative patients were(37.30±4.20)％and(56.60±5.20)％,respectively,and there was a significant difference in the 1-year OS rate between the MLL-R positive and MLL-R negative patients(x2=4.092,P＜0.05).Conclusion There is no significant difference in abnormal chromosome karyotype between AML and ALL patients.The fusion gene MLL-R can be found in both AML and ALL patients.Although MLL-R positive patients are more likely to have hepatosplenomegaly,abnormal chromosome karyotype and elevated leukocyte count,the efficacy shows no significant difference between MLL-R positive patients and negative patients.The current treatment for AML and ALL patients is mainly chemotherapy.Although MLL-R negative patients have better 1-year OS rates than MLL-R positive patients,there is no significant difference in the 1-year EFS rate between MLL-R positive and MLL-R negative patients.

Objective:To develop a Cognitive Assessment Scale for Spinal Cord Injury (SCI) Rehabilitation and conduct reliability and validity tests in community-dwelling patients with SCI.Methods:Based on expectation value theory, social cognition theory, and goal setting theory, a Cognitive Assessment Scale for SCI Rehabilitation was developed through literature review, group discussions, patient trials, and expert verification. From February to December 2021, convenience sampling was used to select 231 community-dwelling patients with SCI as research subjects, including 67 community-dwelling patients with SCI who participated in rehabilitation training at Shanghai Sunshine Rehabilitation Center and 164 patients with SCI in the "Hope Home" WeChat group of Shanghai Sunshine Rehabilitation Center. Research subjects were surveyed using the Cognitive Assessment Scale for SCI Rehabilitation (patient version), 9-item depression scale of Patient Health Questionnaire, 7-item Generalized Anxiety Disorder Scale, EuroQol 5 Dimension-Visual Analogue Scale (EQ-VAS), General Self-Efficacy Scale, and general information questionnaire. SPSS 16.0 software and Amos 21.0 software were used for correlation analysis and reliability and validity testing.Results:The Cognitive Assessment Scale for SCI Rehabilitation (patient version) included two primary dimensions, eight secondary dimensions, and 24 items. The trial showed good results among patients with SCI and their caregivers, and experts generally agreed. Exploratory factor analysis found that the scale were divided into recognition dimension and understanding dimension. Cronbach's α coefficient of the scale was 0.98, the correlation coefficient between each item and its corresponding dimension was 0.75 to 0.88, and our results indicated good test-retest reliability. Correlation analysis showed that patient anxiety and depression scores were negatively correlated with rehabilitation cognitive scores ( P<0.05), and self-efficacy, quality of life were positively correlated with rehabilitation cognitive scores ( P<0.05) . Conclusions:The Cognitive Assessment Scale for SCI Rehabilitation is scientific and feasible, with good reliability and validity, and can be used to evaluate the rehabilitation cognition of community-dwelling patients with SCI.

Advanced gastric cancer(AGC)includes locally unresectable gastric cancer(GC),metastatic GC,and postoperative recurrent GC.Due to delayed diagnosis and lack of effective treatment for AGC,the median survival time of AGC patients is only 6-12 months.At present,the main treatment goal of AGC is to improve symptoms and prolong the survival time of patients receiving sequential chemotherapy.Although the therapeutic effect of systemic therapy on AGC is gradually becoming apparent,the patient's prognosis is far from expected.In addition,targeted therapy and novel immunotherapy have drawbacks such as high incidence of drug resistance,high toxic side effects,and heavy economic burden on patients.Therefore,finding new therapeutic targets and developing anti-tumor drugs is a key issue that urgently needs to be addressed.According to reports,abnormal activation of the hepatocyte growth factor(HGF)/cellular-mesenchymal epithelial transition factor(c-MET)pathway plays a crucial role in the progression of GC and the occurrence of multi-line resistance and may be a potential therapeutic target for GC.In recent years,some HGF/c-MET-targeting small molecule tyrosine kinase inhibitors(TKIs)have been found to show good clinical effects in the treatment of GC.Meanwhile,new HGF/c-MET inhibitors(such as monoclonal antibodies,bispecific antibodies,antibody drug conjugates,etc.)have shown good anti-tumor activity in preclinical studies,but they are all at different stages of clinical research,and their efficacy and safety still need further confirmation.This review elaborates on the latest research progress of HGF/c-MET inhibitors in the treatment of AGC and discusses the main reasons and strategies for drug resistance,aiming to provide better guidance for the treatment of AGC and provide reference for future research.

Objective: To explore the association between exposure to bedroom night light during sleep and emotional symptoms in children and provide a scientific basis for subsequent effective prevention and intervention. Methods: In December 2021, 1 926 students from grades 4 to 6 were recruited to conduct a student questionnaire survey in two primary schools in Tianchang of Chuzhou City, Anhui Province. The data, including general demographic information, use of night lights and curtains, emotional symptoms, and other information, was collected. Binary Logistic regression analysis was used to examine the correlation between night light use and children s emotional symptoms. Results: The reporting rates of depression symptoms, generalized anxiety symptoms, social phobia, and obsessive compulsive symptoms of the children were 2.5%, 2.6%, 3.4% and 2.5%, respectively. About 12.6% of children often sleep with a night light on, and 22.0% of children did not close the curtains. Binary Logistic regression analysis revealed that frequent sleep with night lights was associated with an increased risk of depression symptoms( OR=2.29, 95%CI = 1.04- 5.03), social phobia ( OR=1.93, 95%CI =1.02-3.64) and obsessivecompulsive symptoms ( OR=3.44, 95%CI =1.72-6.88) in children( P < 0.05). Conclusion There is a positive correlation between bedroom night light exposure during sleep and the detection rate of children s emotional symptoms. The attention should be paid to bedroom light environment of children during sleep to reduce the adverse effects of night light exposure on the mental health.

Objective:To investigate the efficacy and related influencing factors of autologous hematopoietic stem cell transplantation(auto-HSCT)as first-line consolidation therapy for newly diagnosed elderly patients with diffuse large B cell lymphoma(DLBCL).Methods:Retrospective study of clinical characteristics, therapeutic effect, and prognostic factors of newly diagnosed DLBCL elderly patients with an International Prognostic Index(IPI)score≥3 who underwent auto-HSCT in the Affiliated People's Hospital of Ningbo University from January 2015 to August 2020.Results:Among the 31 patients, 18 were males and 13 were females, with a median age of 65(60-75)years.The 13 cases(41.9%)were involved in 2 sites outside lymph nodes, and 13 cases(41.9%)were involved in bone marrow.IPI medium and high risk(IPI=3 points)was found in 21 cases(67.7%), high risk(≥4 points)in 10 cases(32.2%). Before transplantation, 21(67.7%)patients achieved complete remission(CR), and the other 10(32.3%)patients were in the partial remission(PR). All patients after transplantation achieved hematopoietic reconstitution.The median time for neutrophil and platelet engraftment were 10(9-16)days and 12(8-58)days respectively.During a median follow-up of 20.9(3.1 to 73.0)months after transplantation, transplant-related mortality within 100 days was 3.2%(1/31). The 2-year overall survival(OS)and progression-free survival(PFS)were(77.2±8.4)% and(72.7±8.3)%, respectively.Multivariate Cox analysis showed that the achieved partial remission status before auto-hematopoietic stem cell transplantation[OS( HR=30.064, 95% CI: 2.231-405.209, P=0.010), PFS( HR=9.165, 95% CI: 1.926-43.606, P=0.005)], and CD34 + cell count in graft <3×10 6/kg[OS( HR=12.004, 95% CI: 1.234-116.807, P=0.032), PFS( HR=6.115, 95% CI: 1.325-28.221, P=0.020)]were the independent poor prognostic factor affecting both OS and PFS in elderly lymphoma patients. Conclusions:Auto-HSCT may improve the survival rate of carefully selected elderly patients with DLBCL.Pretransplant disease status and the number of CD34 + cells in the graft are important factors to predict the efficiency of auto-HSCT of the patients.

Abstract Mental disorders represent 45% of the global disease burden among children and adolescents aged 10-24 years old. It is crucial to develop effective interventions that can be integrated into daily school activities in order to provide convenient and accessible mental health services for students and faculty members. The study conducts a randomized controlled trial to examine universal mental health promotion among children. The current protocol aims to develop a universal resilience focused program, which focuses on emotional regulation, coping, and problem solving. A total of 20 classes from two primary schools in grades 4-5 in Anhui, Tianchang were randomly assigned to either the intervention or waitlist group. This training consisted of 14 weekly 40 minute sessions of manualized interventions that were compatible with regular curricular activities. It is expected that this current intervention will enhance the psychological resilience of children and evaluate the effectiveness of promoting mental health among children followed up on indicators of depressive and anxiety symptoms, psychological resilience, oppositional defiant and conduct problems by questionnaires at baseline and after the intervention.

Objective: The study aimed to develop Questionnaire for Parental Acceptability of School based Depression Symptom Screening by Delphi method, so as to provide a reference and suggestions for promoting screening adolescents depression. Methods: The study was conducted through the literature review and two rounds of the Delphi expert consultation. The initial construction of scale dimension and item was conducted through the literature search. A survey of 12 experts from 6 different provinces, cities and regions in China was conducted, and the Delphi technique was used to collect and analyze expert opinions data about the importance and feasibility of questionnaire content. The dimensions and specific items of the questionnaire were finally determinded. Results: The response rates were 100% in both rounds of Delphi consultation. Kendall coordination degree W =0.22 ( χ 2=63.72, P <0.01), which showed the agreement of expert opinions. The initial scale consisted of 4 dimensions and 17 items, including parental cognition of school based depression screening, parental cognition of school depression screening results feedback and management, parental attitude of school based depression screening, parental utilization of mental health services. After two rounds of expert consulattion, the final scale consisted of 3 first grade dimensions including parental cognition of depression symptom, parental attitude of school based depression symptom screening and parental mental health promotion behaviour, and also cinsisted of 4 second grade dimensions including parental knowledge of depression symptom, parental attitude of school based depression symptom screening, parental choice preference of school based depression symptom screening, parental utilization of mental health services, which had a total of 25 items. Conclusion The questionnaire is developed for assessing parental acceptability of school based depression screening and associated factors. The finding will facilitate mental health services providers in the screening implementation, but further empirical research is still needed.