Objective To investigate the effect of intensive phototherapy for neonatal hyperbilirubinemia on cellular immune function and short-term immune-related adverse effects.Methods Totally 180 infants with hyperbilirubi-nemia were treated with different light intensity,the efficacy,cellular immune function and immune adverse effects were followed up for six months after discharge.Results After phototherapy,serum interleukin-6(IL-6)in both groups were decreased and CD4+(%)and CD4+/CD8+were increased than that before phototherapy.The decrease rate of total bilirubin in the intensive phototherapy group was significantly faster than that in the conventional photo-therapy group,at the same time,the total duration of phototherapy and hospital stay were significantly shorter than that in the conventional phototherapy group(P＜0.05).No statistical significance in the incidence of diarrhea,rash,fever and hypo-calcemia during hospitalization and no immune-related adverse effects in 6 months after discharge were recorded.Conclusions Compared with conventional phototherapy,intensive phototherapy reduces serum bilirubin level more quickly and shorten the duration of phototherapy and hospital stay.No common adverse effects nor immune-related adverse effects are recorded during hospitalization and the period of six months after discharge.

To construct and validate a deep learning-based bone age prediction model for children living in both plain and highland regions.

To construct and validate a deep learning-based bone age prediction model for children living in both plain and highland regions.

Due to long-term use of immunosuppressant, poor immune function and a higher risk of critical diseases after novel coronavirus pneumonia in kidney transplant recipients, it is of significance to deliver prophylactic vaccination for this high-risk population. Studies have shown that the immune reaction of kidney transplant recipients to novel coronavirus vaccine is significantly lower than that of healthy counterparts. Standard vaccination program in the United States, such as 2 doses of messenger RNA (mRNA) vaccine, fails to provide sufficient protection for kidney transplant recipients. Many studies have proven that increasing the frequency of vaccination for kidney transplant recipients may enhance the vaccine efficacy. Nevertheless, the role of adjusting immunosuppressive therapy in increasing vaccine efficacy remains to be elucidated. In this article, the importance, effectiveness and particularity of novel coronavirus vaccine for kidney transplant recipients and the effect of immunosuppressive therapy on the efficacy of novel coronavirus vaccine were reviewed, aiming to provide reference on the vaccination for kidney transplant recipients.

Objective To investigate the characteristics of spatial orientation language comprehension and expression behavior ofchildren with autism. MethodsA three-ladder test was designed to test the comprehension and expression of "(go/come) to" sentences, including general subject-predicate sentences, conjunctive-predicate sentences with displacement purposes, and conjunctive-predicate sentences with displacement modes. March to June, 2022, the test was conducted on 17 children with autism from a special education school and 17 healthy children matched the scores of Peabody Picture Vocabulary Test-Chinese revised from a kindergarten. The typical errors were analyzed for children with autism. ResultsThe main effects of sentence ladders (F > 3.718, P < 0.05) and children groups (F > 8.782, P < 0.001) were significant on comprehension and expression of sentences, while the performance was poor for the complex sentences and for the children with autism. The common types of errors in expression were missing components, mixed sentences, autonomous sentences, inaccurate wording, inconsistent content, blending errors and non-response. The numbers and the distribution of error types were quite different from the children with autism to the healthy children. ConclusionChildren with autism are more difficult to understand and express "(go/come) to" sentences, mainly manifested in a higher error frequency and more kinds of error.

ObjectiveTo analyze the typical performance of initiating and responding behaviors of turn-taking in operational games for autistic children with low language function in special education schools and to provide a reference for intervention of turn-taking behaviors in operational games. MethodsFrom November, 2021 to January, 2022, a total of 23 autistic children with low language function (language ability ≤ three years old) in Shanghai Putuo District Qixing School were selected. Their linguistic ability was evaluated. A behavioral assessment approach was used to evaluate the behavior of initiating and responding behaviors of turn-taking in three operational games. The typical errors in initiating behaviors were summarized as difficult to initiate, untimely initiation, no response and abnormal initiation. The typical errors in responding behaviors of turn-taking in operational games were summarized as difficult to respond, untimely response, no response and abnormal response. ResultsThere was no significant differences in the performance of initiating behaviors among three types of operational games (χ² = 11.106, P = 0.196), and there were significant differences in the performance of responding behaviors among operational games (χ² = 26.256, P = 0.001). The initiating behaviors were postively correlated with word comprehension (r = 0.420, P < 0.05), word naming (r = 0.510, P < 0.05), and sentence imitation (r = 0.505, P < 0.05). The responding behaviors were postively correlated with word comprehension (r = 0.546, P < 0.01), word naming (r = 0.728, P < 0.01), sentence comprehension (r = 0.668, P < 0.01) and sentence imitation (r = 0.656, P < 0.01). ConclusionAutistic children with low language function showed different typical behaviors of initiating and responding behaviors of turn-taking in operational games. It is suggested that when designing training programs for turn-taking skills, targeted interventions should be made to address the typical types of errors in response and initiation turns, and individualized intervention programs should be designed to enhance children's communicative efficacy in play game and promote their language development and social participation.

Objective:To study the clinicopathological significance of cyclin D1 expression in Rosai-Dorfman disease (RDD).Methods:Seventeen cases of RDD were evaluated by HE, immunohistochemical staining and molecular genetic analysis. Expression of cyclin D1 was compared between RDDs and control group that included 29 cases of reactive histiocytosis, 9 cases of IgG4-related disease, and 2 cases of Erdheim-Chester disease.Results:Cyclin D1 was expressed in RDDs (17/17), reactive histiocytosis (11/29), IgG4-related diseases (3/9), and Erdheim-Chester disease (2/2), respectively, with nuclear staining in the RDD cells or proliferative histiocytes. Chi-square test showed that expression of cyclin D1 was significantly higher in RDDs than in reactive histiocytosis and IgG4-related diseases ( P<0.01), but not in Erdheim-Chester diseases ( P>0.05). The expression threshold for recalculating the percentage of cyclin D1 positive cells was 27.5% (AUC=0.981 , P<0.01) by ROC curve. However, CCND1 gene had no rearrangement detected by fluorescence in situ hybridization, but with increased copies of gene in some RDD cells. ARMS-PCR analysis also did not detect KRAS, BRAF and NRAS gene mutations in any cases. Conclusions:Cyclin D1 may serve as an additional diagnostic marker for RDDs. Its high expression may be related to activation of MAPK pathway, but the pathogenetic significance of cyclin D1 in RDDs needs further study.

Objective: To study the clinicopathological features of primary hepatic extranodal marginal zone lymphoma of mucosa associated lymphoid tissue (MALT lymphoma) and hepatic pseudolymphoma, and to discuss their differential diagnosis, treatment and prognosis. Methods: Three primary hepatic MALT lymphomas and two hepatic pseudolymphomas collected from January 2012 to March 2017 in the First Affiliated Hospital of Nanjing Medical University were evaluated by HE and immunohistochemistry(IHC), in-situ hybridization and immunoglobulin (Ig) gene rearrangement detection, and the relevant literature reviewed. Results: In the three MALT lymphomas, tumor cells infiltrated the portal areas with nodular pattern, and invaded the surrounding normal liver with serpiginous configuration and formation of confluent sheets. A number of bile ducts were entrapped within the lesions, and showed lymphoepithelial lesion. Reactive lymphoid follicles were present and surrounded by tumor cells, consisting of predominantly centrocyte-like cells and monocytoid B cells. There were clusters of epithelioid histiocytes in one case. The tumor cells were positive for CD20, PAX5 and negative for CD5, CD23, CD10, bcl-6, and cyclin D1. In the two hepatic pseudolymphomas, the lesions presented as solitary nodules well-demarcated from the surrounding liver tissue; one case was partially encapsulated with fibrous tissue. Entrapped bile ducts were only found at the edge of the lesions without lymphoepithelial lesion. The lesions comprised of massive lymphoid proliferation consisting predominantly of reactive lymphoid follicles, but not monocytoid B-cells or atypical cells. By IHC, a mixture of B- and T-cell population was identified. A monoclonal rearrangement of the Ig gene was detected in all three MALT lymphomas but not in two pseudolymphomas. Interphase fluorescence in situ hybridiazation test for MALT1 break-apart gene was positive in two cases of MALT lymphomas and EBER was negative in all studied cases. Conclusions Primary heptic MALT lymphoma and pseudolymphoma are both rare lymphoid proliferative lesions of liver. These two lesions have overlapping histological and IHC features and are top differential diagnosis to each other. A combination analysis of morphology, immunophenotype and Ig gene rearrangement is helpful to distinguish between them.

Objective To evaluate the feasibility and effect of sequential treatment by the heated humidified high flow nasal cannula oxygen therapy (HFNC) in mechanically ventilated patients following endotracheal tube extubation.Methods A prospective randomized controlled trial was conducted. Forty-nine patients with the sequential treatment after tracheal intubation extraction admitted to Department of Critical Care Medicine of Shanghai Tenth People's Hospital from January 1st to December 31st 2016 were enrolled. The patients were randomly divided into HFNC group (n = 25) and non-invasive positive pressure ventilation (NPPV) group (n = 24) in accordance with the random numbertable. During the study, arterial blood gas and the sputum viscosity were assessed at 12, 24, and 48 hours after NPPV or HFNC treatment, and the nasal and facial pressure ulcers within 1 week was also recorded. Receiver operating characteristic curve (ROC) was plotted, and the effect of NPPV or HFNC on oxygenation was analyzed.Results Among the 25 patients in the HFNC group, 1 patient who was re-intubated and 2 patients who were changed to NPPV were excluded, and a total of 22 patients with complete data were enrolled in HFNC group. Among the 24 patients in the NPPV group, 1 patient who gave up the treatment and 1 patient who was re-intubated were excluded, and a total of 22 patients with complete data were enrolled in NPPV group. After the sequential treatment, most patients in NPPV group showed moderate viscous sputum (12, 12 and 10 cases at 12, 24 and 48 hours, respectively), whereas the patients in HFNC group showed thin sputum (15, 16 and 15 cases at 12, 24 and 48 hours, respectively). Sputum viscosity of patients in HFNC group at each time point was significantly lower than that in NPPV group (allP < 0.01). Arterial oxygen saturation (SaO2) and arterial partial pressure of oxygen (PaO2) at 12, 24 and 48 hours in the HFNC group were significantly higher than those in the NPPV group [SaO2: 0.978±0.009 vs. 0.906±0.139 at 12 hours, 0.976±0.019 vs. 0.924±0.103 at 24 hours, 0.973±0.019 vs. 0.935±0.079 at 48 hours; PaO2 (mmHg, 1 mmHg = 0.133 kPa): 97.85±22.99 vs. 79.24±25.86 at 12 hours, 108.10±43.87 vs. 84.44±29.24 at 24 hours, 102.31±39.02 vs. 79.04±27.46 at 48 hours, allP < 0.05], however, the difference in arterial partial pressure of carbon dioxide (PaCO2) at all of the time points between the two groups was not significant. In NPPV group, 4 patients with nasal and facial pressure ulcers was found, and all with Ⅰ phase of pressure ulcers, and no nasal and facial pressure ulcers was found in HFNC group, which was significantly decreased as compared with NPPV group (χ2 = 4.400,P = 0.036). A good effect of oxygen therapy was defined as PaO2 at 48 hours after the sequential treatment was increased by 20% as compared with that before the treatment. ROC curve analysis showed that the area under the ROC curve (AUC) of HFNC on improving oxygenation was higher than that of NPPV (0.917 vs. 0.830); when PaO2 at 48 hours after HFNC treatment was 76.25 mmHg, the sensitivity was 100%, and the specificity was 75.0%.Conclusions Compared with NPPV, adoption of HFNC as sequential treatment is a feasible manner in dealing with the mechanically ventilated patients after endotracheal tube extubation, which can improve the oxygenation as well as reducing the degree of sputum viscosity and incidence of nasal and facial pressure ulcers. HFNC is a promising therapy, which may be worthy to recommend broadly in such a clinical situation.

Objective To analyze the HIV-infection related behaviors among unmarried youths in rural areas of Liangshan prefecture from 2011 to 2013 and factors that influencing the HIV transmission in the population under research.Methods According to the HIV sentinel surveillance methods for data collection,EpiData 3.1 and SPSS 19.0 were used to handle data and both Chi-square test and logistic regression were used to explore the related factors.Results A total number of 5 871 qualified youths were involved in this study from 2011 to 2013 with the prevalence rate on HIV infection among those unmarried youths from the rural areas as 3.45％ (201/5 833).27.56％ (1 607/ 5 833) of them had been working outside their hometown area.31.72％ (1 850/5 833) of the unmarried youths had sexual experiences,with 41.46％ (767/1 850) of them had casual sex but the rate of consistent condom use was only 3.46％ (64/1 850).5.04％ (294/5 833) of the unmarried youths admitted of ever having used drugs,with 34.35％ (101/294) of them having the experiences of injecting,with 84.16％ (85/101) of them sharing needles.Rates on factors as:working outside the resident areas,ever having had casual sexual behaviors,drug use and injecting drug use were seen higher among HIV infections,with differences statistically significant (X2=88.72,104.43,4.20,154.39,55.94,P＜0.05).Results from the logistic regression showed that factors as:being male,Yi ethnicity,illiteracy,experience of working outside the resident area,never or casual condom use and needle-sharing drug use etc.would significantly increase the risk of HIV infection.Conclusions HIV infection among unmarried youths from rural areas in Liangshan prefecture called for attention because of the high rates of risk behaviors.Factors as:having had sexual experiences with low condom use,popular injecting drug use with needle sharing,being male,under Yi ethnicity,with lower education level and ever working outside the resident area etc.were under risks that related to HIV infection for unmarried youths in this area.