Objective:To explore the predictive value of a regression model based on diffusion kurtosis imaging (DKI) parameters for prediction of the recurrence risk in patients with estrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER-2)-negative early invasive breast cancer.Methods:A retrospective cross-sectional study was designed. The clinicopathological (age, histological grade, Ki-67 level, etc.) and imaging data of 50 patients (50 lesions) with ER-positive, HER-2 negative early invasive breast cancer who underwent treatment at Wuxi People′s Hospital from January 2016 to December 2018 were retrospectively analyzed. All patients were female, aged 29 to 81 years, and underwent pre-operation conventional MRI and DKI examinations. The volume of breast fibroglandular tissue (FGT), background parenchymal enhancement (BPE), and internal enhancement features were recorded; the peak enhancement (PH), peak enhancement rate, time to peak, mean kurtosis (MK), and mean diffusivity (MD) were calculated. Based on the 21-gene recurrence risk scores, patients were divided into low recurrence risk group and medium-high recurrence risk group. Independent sample t test, Mann-Whitney U test, χ2 test were used to compare the differences of various indicators between the two groups. Two logistic models were constructed with age, PH, MD, and MK as independent variables (Pre1), and with Ki-67, age, PH, MD, and MK as independent variables (Pre2), respectively. The efficacy of the models in predicting low recurrence risk in patients was assessed using receiver operating characteristic curve and area under the curve (AUC). Results:There were 25 cases in the low recurrence risk group and 25 cases in the medium-high recurrence risk group. The differences in age, FGT, PH, MD, MK, and Ki-67 between the low recurrence risk group and the medium-high recurrence risk group were statistically significant (all P<0.05), while other indexes showed no statistically significant differences (all P>0.05). The AUC of Pre1 in predicting low recurrence risk of ER-positive, HER-2 negative early invasive breast cancer was 0.87, with a sensitivity of 0.76 and specificity of 0.88. The AUC of Pre2 for predicting the low recurrence risk of ER-positive, HER-2 negative early invasive breast cancer was 0.92, with a sensitivity of 0.84, and specificity of 0.92. Conclusions:A multi-parameter model based on DKI can effectively predict the recurrence risk of ER-positive and HER-2 negative breast cancer. The model with combination of Ki-67 can further improve the predictive efficacy, and help effectively identify patients at low recurrence risk.

Objective To explore the effectiveness of high-definition diffusion weighted imaging(DWI)sequence combined with T1 WI-fat suppression(FS)dynamic contrast enhancement(DCE)sequence for preoperative T-stage of rectal cancer by using 3.0T MRI standardized scanning.Methods A retrospective analysis was conducted on MRI images of 57 patients with rectal cancer confirmed by pathology.Before surgery,the patients underwent 3.0T MRI standardized rectal cancer scan methods,including routine sequence,high-definition DWI sequence,and T1 WI-FS DCE sequence,etc.Then two experienced physicians evaluated the T-stage of preoperative rectal cancer through high-definition DWI(transverse and sagittal sections)and T1 WI-FS DCE sequences in the double-blind method.Using the postoperative pathological results of rectal cancer as the"gold standard",two sequences were combined to evaluate the accuracy,sensitivity,and specificity of rectal cancer T-stage.Results Among the 57 cases,there were 9 cases of upper rectal cancer,39 cases of middle rectal cancer,and 9 cases of lower rectal cancer.The accuracy rates of preoperative T-stage diagnosis for rectal cancer by two evaluator were both 85.7％(6/7)in T1 stage,88.2％(15/17)and 94.1％(16/17)in T2 stage,96.9％(31/32)and 93.8％(30/32)in T3 stage,and both 100.0％(1/1)in T4 stage.For evaluator 1,the sensitivity and specificity of the rectal cancer T-stage diagnosis were 96.1％and 83.3％,and for evaluator 2 were 94.1％and 83.3％,respectively.For rectal cancer MRI diagnosis,the accuracy rates and sensitivity were higher when combining the high-definition DWI sequence and T1 WI-FS DCE sequence,compared with a single high-definition DWI sequence or T1 WI-FS DCE sequence,and the difference was statistically significant.The average preoperative apparent diffusion coefficient(ADC)value of rectal cancer was compared between the corresponding postoperative pathological T1 to T4 stage groups,and the difference was statistically significant.Conclusion The combination of high-definition DWI sequence and T1 WI-FS DCE sequence improves the accuracy of rectal cancer T-stage,providing assistance for personalized clinical treatment.

SUMMARY The mesothelium,which consists of a monolayer of mesothelial cells,extends over the sur-face of the serosal cavities(pleura,pericardium,peritoneum and tunica vaginalis).Mesothelial tumours of the tunica vaginalis is rare compared with those arise from pleura or peritoneum.According to World Health Organization 2022 Classification of Urinary and Male Genital Tumours(5th edition),mesothelial tumours of the tunica vaginalis were categorized into adenomatoid tumour,well-differentiated papillary mesothelial tumour(WDPMT)and mesothelioma.Since WDPMT of tunica vaginalis was rare,there was no consensus concerning the treatment of it.In this case report,a 29-year-old man who had endured intermittent right scrotal pain for 8 months,aggravating scrotal pain for 2 weeks was admitted.No symptoms,such as frequent,urgent,or painful urination were shown.Physical examination revealed the enlargement and tenderness of right scrotum,with no signs of lifting pain.The most recent scrotal ultrasonography be-fore surgery revealed right hydrocele with maximum depth of 4 centimeters and poor blood flow of right testis.Under the circumstance of patient's chronic history of testicular hydrocele,he underwent an emer-gency operation of right scrotal exploration and hydrocelectomy under epidural anesthesia.After opening the vagina tunic cavity,spot-like bleeding was observed on the right testicle,epididymis and vaginalis surface.The vaginalis was obviously thickened and the inner and outer walls were smooth.The post-operative histopathology revealed a grayish-brown tissue with a thickness of 0.3-0.5 cm,smooth inner and outer walls,and a suspected WDPMT with a diameter of 1.5 cm.Immunohistochemical staining showed positive for Calretinin,BAP1,WT-1,CK5/6,D2-40 and P16,which confirmed the diagnosis of WDPMT.To sum up,the purpose of this case report was to raise awareness of a rare disease WDPMT,which was usually asymptomatic and could be diagnosed by pathology and immunohistochemistry.The disease should be differentiated from testicular torsion,epididymitis,orchitis and oblique inguinal hernia in symptoms,and from malignant mesothelioma and adenomatoid tumour in pathology.Because of the rarity of the cases,there was no unified standard for the treatment of WDPMT at present.The common treatment methods reported in literature included orchidectomy and vaginectomy.Due to the lack of un-derstanding of this disease,postoperative follow-up was still recommended for at least 5 years.

Objective To explore the feasibility of ultrasonic measurement of the skin to hyoid bone distance,skin to epiglottis distance and skin to anterior commissure of vocal cords distance for predicting difficult laryngoscopy exposure in obstructive sleep apnea hypopnea syndrome(OSAHS)patients.Methods One hundred and fifty OSAHS patients with ASAⅠ-Ⅲ level,who underwent elective uvulopalatopharyngoplasty(UPPP)surgery under general anesthesia,were analyzed.Rountine airway assessment(Mallampati classification)and ultrasound measurement of the skin to hyoid bone distance,skin to epiglottis distance and skin to anterior commissure of vocal cords distance were performed before anesthesia.Intubation under direct laryngoscopy and the classification of laryngoscopy exposure was recorded.Cormack-Lehane classification Ⅲ-Ⅳ grade was defined as difficult laryngoscopy exposure.According to the classification results,patients were divided into two groups:non-difficult laryngoscopy exposure group and difficult laryngoscopy exposure group.We analyzed and compared the Malampati grading and ultrasound measurements between two groups.The receiver operating characteristic(ROC)curve and the optimal cut-off point of ultrasonic measurements were calculated.The effects of different methods for predicting difficult laryngoscopy exposure were analyzed.Results The proportion of cases whose Mallampati airway classification grade>Ⅱ in difficult laryngoscopy exposure group was significantly more than that in non-difficult laryngoscopy exposure group(P＜0.05).The skin to hyoid bone distance and skin to epiglottis distance in difficult laryngoscopy exposure group were significantly longer than those in non-difficult laryngoscopy exposure group(P＜0.05).The optimal cut-off point of the skin to hyoid bone distance and skin to epiglottis distance were 1.12 cm and 2.23 cm respectively.There was no significant difference in the skin to anterior commissure of vocal cords distance between two groups.Conclusions Ultrasound measurement of the skin to hyoid bone distance and skin to epiglottis distance had a good predictive value in difficult laryngoscopy exposure of the OSAHS patients.

Objective:To evaluate the effect of the positive P-glycoprotein expression on the efficacy of patient-controlled intravenous analgesia (PCIA) with sufentanil or pentazocine in patients with cancer pain.Methods:This was a retrospective cohort study. The medical records of patients with cancer pain of either sex, aged 54-71 yr, weighing 49-67 kg, with TNM stage Ⅱ-Ⅳ, who were treated in People′s Hospital of Lishui from January 2020 to January 2024, were collected. The expression of P-glycoprotein in tumor tissues was determined by the immunohistochemical method. Patients with negative P-glycoprotein expression in tumor tissues were divided into 2 groups: sufentanil group (group S 1) and pentazocine group (group P 1). Patients with positive P-glycoprotein expression in tumor tissues were divided into 2 groups: sufentanil group (group S 2) and pentazocine group (group P 2). The patients in 4 groups received 48 h of PCIA when visual analogue scale > 5 cm. The PCIA solution contained sufentanil 2 μg/kg and tropisetron 10 mg in 100 ml of normal saline in S 1 and S 2 groups or pentazocine 3 mg/kg+ tropisetron 10 mg in 100 ml of normal saline in P 1 and P 2 groups. The PCIA pump was set up to deliver a 1 ml bolus dose with a 10-min lockout interval and background infusion at 2 ml/h after a loading dose of 5 ml. Flurbiprofen 50 mg was intravenously injected when visual analogue scale > 3 cm during analgesia. The consumption of sufentanil, pentazocine and flurbiprofen within 4 h, >4-12 h, > 12-24 h and > 24-48 h of PCIA was recorded. The occurrence of adverse reactions such as respiratory depression (SpO 2<90%), nausea or/and vomiting, pruritus and bradycardia was recorded. Results:One hundred patients were finally included, with 25 in each group. There was no significant difference in the consumption of sufentanil, usage rate of flurbiprofen and incidence of respiratory depression, nausea and vomiting, pruritus and bradycardia during analgesia at each time period during PCIA between group S 1 and group S 2 ( P>0.05). Compared with group P 1, the consumption of pentazocinein was significantly increased within 4 h, > 4-12 h, and > 24-48 h of PCIA ( P<0.05), and no significant change was found in the usage rate of flurbiprofen at each time period and the incidence of respiratory depression, nausea or/and vomiting, pruritus and bradycardia during analgesia in group P 2 ( P>0.05). Conclusions:Positive P-glycoprotein expression may weaken the efficacy of PCIA with pentazocine, but exerts no effect on the efficacy of PCIA with sufentanil in patients with cancer pain.

Objective: To explore the relationship of maternal adverse childhood experiences(ACEs) with mother child relationship, so as to provide reference for parent child relationship and child health promotion. Methods: In June 2021, children aged 3-6 years old of 36 kindergartens in three areas in Anhui Province were selected by stratified cluster sampling method, follow up data were collected in December 2021, and a total of 6 111 children were included in the study. Maternal ACEs and mother child relationship were respectively assessed using the Adverse Childhood Experiences International Questionnaire(ACEs-IQ)and the Child Parent Relationship Scale (CPRS). A multiple linear regression model was established to analyze the association of maternal ACEs and mother child relationship in preschool children. Results: History of maternal childhood sexual abuse, physical neglect and peer bullying were negatively associated with mother child intimacy ( r =-0.03, -0.03, -0.03, P <0.05). Maternal emotional abuse, physical abuse, sexual abuse, emotional neglect, physical neglect, peer bullying, community violence, and total family dysfunction were positively associated with mother child dependence and mother child conflict ( r =0.09, 0.08, 0.05, 0.14, 0.06, 0.11, 0.08, 0.04; 0.18, 0.17, 0.07, 0.20, 0.11, 0.16, 0.12, 0.10, P <0.01). There was no statistically significant between all types of maternal ACEs and mother child intimacy in boys( P >0.05). Mothers with a history of physical abuse, sexual abuse and peer bullying had a statistically significant relationship between mother child intimacy in girls( β =-0.17, -0.62, -0.19, P <0.05). All types of maternal ACEs were positive predictors of mother child conflict between boys and girls( β =0.37-1.96, P <0.05). There was statistical significance between maternal childhood sexual abuse and mother child dependence of boys( β =0.53, P <0.05), but no statistical significance between maternal childhood sexual abuse and mother child dependence of girls( P >0.05). All other types of maternal ACEs were positive predictors of mother child dependence( β =0.09-0.41, P <0.05). Conclusion Maternal ACEs are associated with poor mother child relationship among preschool children, and maternal ACEs should be actively followed, which is of great significance for improving the parent child relationship and promoting child healthy development.

Objective: To explore the relationship and gender difference between family rearing styles with emotional and behavior problems in preschool children aged 3-6 years, so as to provide reference for early prevention and intervention of children s emotional and behavior problems. Methods: Using the method of stratified cluster sampling, 9 647 children aged 3-6 years old from 36 kindergartens in Wuhu, Lu an and Fuyang of Anhui Province were selected in June 2021. Primary caregivers were investigated with self designed questionnaire, Strengths and Difficulties Questionnaire (parents version) and Parental Rearing Style Scale. Results: The detection rate of elevated SDQ total difficulty score was 6.5%, with boys (7.1%) higher than that of girls (5.8%). The detection rate of abnormal emotional behavior were significantly higher in children with high scores on doting, laissez faire, autocracy and inconsistency of family rearing style, compared with those in the low score group ( χ 2=210.32, 203.87, 102.70, 212.69, P <0.01 ), and the detection rate increased with the increase of score. However, the detection rate of abnormal emotional behavior in the high score group of democracy was significantly lower than that in the low score group ( χ 2=156.24, P <0.01), and the detection rate decreased with the increase of score. Logistic regression analysis showed that high level doting ( OR =4.31), laissez faire ( OR = 4.16), autocracy ( OR =3.36) and inconsistency ( OR =4.76) of family rearing style were associated with high risk of children s emotional behavior problems, while high level of democracy ( OR =0.34) in family rearing style was associated with low risk of emotional behavior problems. The comparison between boys and girls showed that the risk of emotional and behavioral problems in the indulgent rearing style of boys was significantly higher than that of girls ( OR =1.90, 2.13) ( P <0.05). Conclusion Family rearing styles are associated with emotional and behavioral problems among preschool children. Boys are sensitive to the negative impact of doting rearing style. Good rearing styles is beneficial to the prevention and control of children s emotional and behavioral problems.

Objective: To investigate the prevalence of hyperactive behavior and risk factors among preschool children, and to provide a reference for early intervention of problem behavior. Methods: A total of 7 982 children aged 3-6 were selected from 30 kindergartens by multi stage stratified cluster random sampling in 5 areas, Anhui Province, and their parents were surveyed with Conners Parent Rating Scales(PSQ) and Related factors questionnaire from June to July 2020. Results: A tollay of 126 children were detected with hyperactivity behaviors, with a detection rate of 1.6%. The detection rate of boys (2.2%) was higher than that of girls (0.8%). The difference was statistically significant ( χ 2=26.51, P <0.01). Among 126 hyperactive children, 40(31.7%)had another type of behavior problem, and 82(65.1%)had two or more additional behavior problems. The results of Logistic regression analysis showed that boy( OR =2.85, 95% CI =1.88-4.30), sleep deprivation( OR =1.87, 95% CI =1.31-2.68), occupation of mother being farmer or otherwise( OR =1.81, 95% CI =1.11-2.94) were associated with more hyperactivity behavior. While, living with parents in the past six months ( OR =0.61, 95% CI =0.40-0.92) was associated with less hyperactivity behavior( P <0.05). Conclusion Early intervention of preschool children s behavior problems should focus on boys, maintain reasonable sleep time and increase parental care.

Objective To observe the effects of ultrasound-guided laryngeal nerve block combined with intratracheal surface anesthesia on the intubation reaction of double-lumen endotracheal tube in elderly hypertensive patients.Methods Sixty elderly hypertensive patients,including 37 males and 23 females, with ASA physical statusⅡor Ⅲ,aged 65-85 years,scheduled for thoracic surgery under general anesthesia requiring one-lung ventilation,were equally and randomly divided into either laryngeal nerve block combined with intratracheal surface anesthesia group (group S)or general anesthesia group (group C).Internal jugular vein blood samples were taken to measure the plasma concentrations of epinephrine (E)and norepinephrine (NE) when patients entering the operating room (T0 ),before intubation (T1 ),immediately after intubation (T2 ),at 1 min (T3 ),3 min (T4 ),5 min (T5 )and 10 min (T6 )after intubation.Adverse e-vents,such us hypertension and tachycardia,were recorded during induction and intubation.Results Com-pared with T0 ,the plasma concentrations of E and NE were significantly increased at T2-T5 in group C (P<0.05 or P <0.01),while there were no such significant changes in group S.The plasma concentration of E and NE at T2-T5 in group S were significantly lower than that in group C (P <0.05 or P <0.01).The incidence of hypertension in group S was significantly lower than that in group C during induction of intuba-tion (0% vs 37%,P <0.01).There were no hypotension,tachycardia and bradycardia during induction and intubation in both groups.Conclusion Ultrasound-guided laryngeal nerve block combined with intratra-cheal surface anesthesia can effectively inhibit the intubation reaction of double-lumen endotracheal tube in elderly hypertensive patients,which is helpful for maintaining the hemodynamic stability during anesthesia induction.

Objective To observe the safety and efficacy of different concentration of remifen-tanil TCI combined with dexmedetomidine for awake nasal intubation in cervical spine surgery patients and explore the clinical suitable concentrations for remifentanil TCI.Methods Sixty cervical spine surgery patients undergoing selective surgery under general anaesthesia (male 40 cases,female 20 ca-ses,aged 18-68 years,ASA Ⅰ or Ⅱ)were randomly divided into three groups according to TCI con-centration of remifentanil.The plasma concentration of remifentanil TCI of group A,B,C were 1.5 ng/ml,2.0 ng/ml,2.5 ng/ml respectively,which combined with dexmedetomidine 1 μg/kg.The value of MAP,HR,SpO2 ,RR were recorded when patients entering the operating room(T1 ), before intubation(T2 ),immediately after tracheal tube passing through nasopharynx(T3 ),immedi-ately after tracheal intubation(T4 ),immediately after tracheal tube cuff inflated(T5 )and 1min after intubation(T6 ).The success rate of first intubation were recorded.The incidence of cough,limb movement,respiratory depression,awareness and other adverse reactions during intubation were re-corded.Results In group A,MAP and HR at T3-T5 were significantly higher than those at T1 (P <0.05);SpO2 at T4-T6 and RR at T3-T6 were significantly lower than those at T1 (P <0.05)in group C.In group A,the incidence of cough and limb movements were significantly higher than those in group B,C(P <0.05).In group C,the incidence of respiratory depression was significantly higher than that in group A,B(P <0.05).Conclusion TCI concentration 2.0 ng/ml for remifentanil com-bined with dexmedetomidine can effectively inhibit the stress response to intubation with little respira-tory depression and can be widely used for awake nasal intubation in cervical spine surgery patients.