Objective:To investigate the change of chemical exchange saturation transfer (CEST) imaging in the bilateral substantia nigra (SN) and red nucleus (RN) of Parkinson disease (PD), and to explore the value of CEST-MRI for the clinical application of PD.Methods:This was a cross-sectional study. A total of 45 PD patients (PD group) and 21 sex-, age-, and cognitive-function matched normal control subjects (NC group) were retrospectively enrolled from December 2012 to July 2015 in Beijing Hospital. All subjects underwent brain CEST-MRI and routine MRI. Based on the MATLAB software package, the 4-pool Lorentz fitting model was applied to analyze the signal change of CEST imaging, which could acquire the mean amplitudes of the 4-pool parameters including Amide, nuclear overhauser enhancement (NOE), direct water saturation (DS) and magnetization transfer (MT) in the bilateral SN and RN. Independent samples t test and Mann-Whitney U test were used to compare CEST parameters between the PD group and the NC group and controlled by Bonferroni correction. The combined model was constructed based on parameters with inter-group differences after correction. The receiver operating characteristic curve and area under the curve (AUC) were used to evaluate the diagnostic efficiency of the CEST parameters and the combined model. Results:Compared with the NC group, the left SN Amide value, left RN Amide value, and right SN NOE value were reduced in the PD group, and the difference was statistically significant ( t=-3.59, corrected P=0.026; t=-3.77, corrected P=0.016; Z=-3.27, corrected P=0.017). The left SN Amide value, the left RN Amide value, the right SN NOE value, and the combined model all had good diagnostic efficacy in the differentiation of the PD group from the HC group (AUCs of 0.78, 0.79, 0.75, and 0.81, respectively). The combined model had the highest AUC value (0.81) and specificity (97.78%), the Amide value of left SN had the highest sensitivity (93.33%). Conclusions:Quantitative analysis of CEST-MRI based on the 4-pool Lorentz fitting model shows significant differences in the CEST quantitative indicators of the SN and RN between the PD group and the NC group, demonstrating good potential for clinical application in the diagnosis of PD.

Objective To investigate the impact of preoperative abdominal aortic balloon occlusion and modified uterine vascular occlusion on repeat cesarean delivery in patients with placenta previa and placenta accreta spectrum disorders.Methods A total of 97 patients with placenta previa and placenta accreta spectrum disorders who underwent repeat cesarean section at Hefei Maternal and Child Health Hospital between April 2016 and Decem-ber 2022 were included in this study.Among them,the control group consisted of 48 cases who underwent abdominal aortic balloon occlusion before the operation,while the observation group comprised 49 cases who underwent modified uterine vascular occlusion during the operation.Intraoperative and postoperative complications were observed and compared between the two groups.Results The number of bilateral uterine artery embolization post-operation and the average hospitalization cost in the observation group were significantly lower compared to those in the control group(P<0.05).However,there were no significant differences observed between the two groups regarding average intraoperative blood loss,red blood cell suspension transfusion volume,hysterectomy rate,and bladder rupture rate(P>0.05).Conclusions Both surgical methods effectively reduce intraoperative bleeding in the treatment of repeat cesarean section in patients with placenta previa and placenta accreta spectrum disorders.However,modified uterine vascular occlusion demonstrates no complications related to vascular intervention or X-ray exposure,ensuring high maternal and child safety while significantly reducing hospitalization costs.Therefore,it is highly recommended for clinical promotion.

Hypoxemia is a common complication of pneumonia, asthma, and bronchopulmonary dysplasia in children.Rapid identification of hypoxemia is of great significance for the disposal and management of critical children.Pulse oximetry is recognized by the World Health Organization as the best way to monitor hypoxemia in children, and it can monitor pulse oxygen saturation noninvasively and continuously.Based on the related literature at home and abroad, combined with the clinical needs of pediatrics, the " Expert consensus on clinical application of pulse oximetry in children" is formulated to improve the understanding of pediatricians and nurses on the application in pediatric clinical practice, principle, operation techniques, and limitations of pulse oximetry.

Objective:To investigate the knowledge, attitudes, and practices (KAP) of pulse oximetry among pediatric healthcare providers in China and analyze the factor influencing the KAP.Methods:A self-developed questionnaire was used for an online research on the KAP of 11 849 pediatric healthcare providers from 31 provinces, autonomous regions, and municipalities of China from March 11 to 14, 2022.The factors influencing the KAP of pulse oximetry among pediatric healthcare providers were examined by Logistic regression. Results:The scores of KAP, of pulse oximetry were 5.57±0.96, 11.24±1.25 and 11.19±4.54, respectively.The corresponding scoring rates were 69.61%, 74.95%, and 55.99%, respectively. Logistic regression results showed that the gender and working years of pediatric healthcare providers, the region they were located, and whether their medical institution was equipped with pulse oximeters were the main factors affecting the knowledge score (all P<0.05). Main factors influencing the attitude score of pediatric healthcare providers included their knowledge score, gender, educational background, working years, region, medical institution level, and whether the medical institution was equipped with pulse oximeters (all P<0.05). For the practice score, the main influencing factors were the knowledge score, gender, age, and whether the medi-cal institution was equipped with pulse oximeters (all P<0.05). Conclusions:Chinese pediatric healthcare providers need to further improve their knowledge about and attitudes towards pulse oximetry.Pulse oximeters are evidently under-used.It is urgent to formulate policies or guidelines, strengthen education and training, improve knowledge and attitudes, equip more institutions with pulse oximeters, and popularize their application in medical institutions.

Objective:To analyze the risk factors of bronchopulmonary dysplasia(BPD)in very preterm infants(VPI), and to provide scientific basis for the prevention and treatment of BPD in VPI.Methods:A prospective multicenter study was designed to collect the clinical data of VPI in department of neonatology of 28 hospitals in 7 regions from September 2019 to December 2020.According to the continuous oxygen dependence at 28 days after birth, VPI were divided into non BPD group and BPD group, and the risk factors of BPD in VPI were analyzed.Results:A total of 2 514 cases of VPI including 1 364 cases without BPD and 1 150 cases with BPD were enrolled.The incidence of BPD was 45.7%.The smaller the gestational age and weight, the higher the incidence of BPD( P<0.001). Compared with non BPD group, the average birth age, weight and cesarean section rate in BPD group were lower, and the incidence of male infants, small for gestational age and 5-minute apgar score≤7 were higher( P<0.01). In BPD group, the incidences of neonatal respiratory distress syndrome(NRDS), hemodynamically significant patent ductus arteriosus, retinopathy of prematurity, feeding intolerance, extrauterine growth restriction, grade Ⅲ~Ⅳ intracranial hemorrhage, anemia, early-onset and late-onset sepsis, nosocomial infection, parenteral nutrition-associated cholestasis were higher( P<0.05), the use of pulmonary surfactant(PS), postnatal hormone exposure, anemia and blood transfusion were also higher, and the time of invasive and non-invasive mechanical ventilation, oxygen use and total hospital stay were longer( P<0.001). The time of starting enteral nutrition, cumulative fasting days, days of reaching total enteral nutrition, days of continuous parenteral nutrition, days of reaching 110 kcal/(kg·d) total calorie, days of reaching 110 kcal/(kg·d) oral calorie were longer and the breastfeeding rate was lower in BPD group than those in non BPD group( P<0.001). The cumulative doses of amino acid and fat emulsion during the first week of hospitalization were higher in BPD group( P<0.001). Multivariate Logistic regression analysis showed that NRDS, invasive mechanical ventilation, age of reaching total enteral nutrition, anemia and blood transfusion were the independent risk factors for BPD in VPI, and older gestational age was the protective factor for BPD. Conclusion:Strengthening perinatal management, avoiding premature delivery and severe NRDS, shortening the time of invasive mechanical ventilation, paying attention to enteral nutrition management, reaching whole intestinal feeding as soon as possible, and strictly mastering the indications of blood transfusion are very important to reduce the incidence of BPD in VPI.

OBJECTIVE To study the imp rovement effects of total flavonoids of Psidium guajava leaves on myocardial hypertrophy in hypertensive model rats. METHODS Ten rats were randomly selected from 60 healthy SD rats as the normal group ； other 50 rats established hypertensive model ，and 44 rats with successful modeling were randomly divided into model group ， anisomycin group [p38 mitogen-activated protein kinase （p38 MAPK）activator，1 mg/kg]，total flavonoids of P. guajava leaves+ anisomycin group （200 mg/kg total flavonoids+ 1 mg/kg anisomycin ）and total flavonoids of P. guajava leaves group （200 mg/kg） by random volume mass ranking method ，with 11 rats in each group. Rats in normal group and model group were given 3％ hydroxymethylcellulose sodium solution ，and other groups were given relevant solution intragastrically ，once a day ，for consecutive 6 weeks. Blood pressure （systolic blood pressure ，diastolic blood pressure ，mean arterial pressure ），cardiac index and left ventricular index were measured. The levels of tumor necrosis factor-α（TNF-α），interleukin-1β（IL-1β）and IL- 6 in myocardial tissue were detected. The pathomorphological changes of myocardial tissue were observed. The expression of p 38 MAPK， phosphorylated p 38 MAPK （p-p38 MAPK），extracellular regulated protein kinase 1/2 （ERK1/2），phosphorylated ERK 1/2 （p-ERK1/2），c-Jun N-terminal kinase （JNK）and phosphorylated JNK （p-JNK）in myocardial tissue were detected. RESULTS Compared with normal group ，the systolic blood pressure ，diastolic blood pressure ，mean arterial pressure ，cardiac index ，left ventricular index as well as the levels of TNF-α，IL-1β and IL-6 and protein expression of p-p 38 MAPK，p-ERK1/2 and p-JNK in myocardial tissue were increased significantly in anisomycin group and model group （P＜0.05）；it was also found that hypertrophy of cardiomyocytes ，disorder of myocardial fibers ，looseness，edema and proliferation of connective tissue between myocardial fibers，increased infiltration of inflammatory cells ，etc. Compared with anisomycin group and model group ，the le vels of above indexes in total flavonoids of P. guajava leaves+ anisomycin group and total flavonoids of P. guajava leaves group were decreased significantly （P＜0.05）； cardiomyocytes were 163.com slightly larger and arranged reasonably ；the degree of myocardial hypertrophy，looseness，edema and proliferation of connective tissue were relieved ，and the improvement effect of total flavonoids of P. guajava leaves group was more significant （P＜0.05）. CONCLUSIONS The total flavonoids of P. guajava leaves can reduce blood pressure and improve myocardial hypertrophy in hypertensive model rats. Its mechanism may be related to the inhibition of p38 MAPK signal pathway activity and the expression of inflammatory factors.

Objective:To explore the clinical features and survival of newly diagnosed follicular lymphoma (FL) patients with diffuse large B-cell lymphoma (DLBCL) component.Methods:1845 newly diagnosed FL patients aged ≥ 18 years with grades 1-3a in 11 medical centers in China from 2000 to 2020 were included, and patients with DLBCL component were screened. The clinical data and survival data of the patients were retrospectively analyzed, and the prognostic factors were screened by univariate and multivariate analysis.Results:146 patients (7.9% ) with newly diagnosed FL had DLBCL component. The median age was 56 (25-83) years, 79 males (54.1% ) . The pathology of 127 patients showed the proportion of DLBCL component. Patients were divided into two groups according to whether the proportion of DLBCL component was ≥ 50% . The study found that patients with DLBCL component ≥ 50% had higher grade 3 ratio (94.3% vs 91.9% , P=0.010) , Ki-67 index ≥ 70% ratio (58.5% vs 32.9% , P=0.013) and PET-CT SUVmax ≥ 13 ratio (72.4% vs 46.3% , P=0.030) than patients with DLBCL component<50% . All patients received CHOP or CHOP like ± rituximab chemotherapy. The overall response rate (ORR) was 88.2% , and the complete response (CR) rate was 76.4% . In the groups with different proportions of DLBCL component, there was no significant difference in the remission rate after induction treatment and the incidence of disease progression within 2 years after initiation of treatment (POD24) ( P<0.05) . The overall estimated 5-year progression free survival (PFS) rate was 58.9% , and the 5-year overall survival (OS) rate was 90.4% . The 5-year OS rate of POD24 patients was lower than that of non POD24 patients (70.3% vs 98.5% , P<0.001) . Compared with non maintenance treatment of rituximab, maintenance treatment of rituximab could not benefit the 5-year PFS rate (57.7% vs 58.8% , P=0.543) , and the 5-year OS rate had a benefit trend, but the difference was not statistically significant (100% vs 87.8% , P=0.082) . Multivariate analysis showed that failure to reach CR after induction treatment was an independent risk factor for PFS ( P=0.006) , while LDH higher than normal was an independent risk factor for OS ( P=0.031) . Conclusion:FL patients with DLBCL component ≥50% have more invasive clinical and pathological features. CHOP/CHOP like ± rituximab regimen can improve the clinical efficacy of patients. Rituximab maintenance therapy can not benefit the PFS and OS of patients. Failure to reach CR after induction therapy was the independent unfavorable factor for PFS.

Enteral nutrition plays an irreplaceable role in the nutritional treatment of critically ill patients. In order to help clinical medical staff to manage the common complications during the implementations of enteral nutrition for critically ill patients, the consensus writing team carried out literature retrieval, literature quality evaluation, evidence synthesis. Several topics such as diarrhea, aspiration, high gastric residual volume, abdominal distension, etc. were assessed by evidence-based methodology and Delphi method. After two rounds of expert investigations, Expert consensus on prevention and management of enteral nutrition therapy complications for critically ill patients in China (2021 edition) developed, and provided guidance for clinical medical staff.

Objective:To assess the feasibility and efficacy of radiofrequency catheter ablation (RFCA) of arrhythmias with low dose X-ray in children guided by three-dimensional mapping system.Methods:Fourteen children with tachyarrhythmia who were transferred to Tianjin Medical University General Hospital after being hospitalized in Tianjin Children′s Hospital and underwent RFCA from April 2017 to May 2018 were included.The results of intraoperative electrophysiological examination, intraoperative X-ray dosage,the immediate success rateand complications of RFCA,and the recurrence during the follow-up for at least 6 months were recorded.Results:Among the 14 children, 11 cases were diagnosed with supraventricular tachycardia.Five cases had atrioventricular reentrant tachycardia (AVRT) which included two cases with left accessory pathway and three cases with right accessory pathway, and four cases had atrioventricular nodular reentrant tachycardia (AVNRT), one case had atrial flutter (AFL), one case had both AFL and AVNRT. One case had focal atrial tachycardia, one case had ventricular tachycardia, and one case had premature ventricular contraction. Eleven cases underwent RFCA with zero radiation, and 3 cases underwent atrial septal puncture with low dose X-ray. The exposure amounts were 3.85, 3.23 and 4.67 mGy, respectively. No complications occurred except for one case with AVRT had atrioventricular block and recovered to normal in 25 days after operation.During the follow-up of 7 to 20 months, no arrhythmias had been found in 13 cases, and one case with AVRT and AFL recurred.Conclusion:Under the guidance of three-dimensional mapping system, RFCA of tachyarrhythmia with low dose X-ray in children is feasible.

Objective: To investigate the primary clinical efficacy of Collinear clamp assisted reduction and proximal femoral nail antirotation(PFNA) in the treatment of medial-lateral irreducible intertrochanteric fractures. Methods: From January 2012 to December 2016, a total of 21 cases of medial-lateral irreducible intertrochanteric fractures of femur who were treated with Collinear clamp assisted reduction and PFNA in Lishui Hospital of Zhejiang University were selected.There were 12 males and 9 females, with a mean age of 76.7 years(ranged 51 to 91). According to Arbeitsge-meinschaft für Osteosynthesefragen/The Association for the Study of Internal Fixation(AO/ASIF) classification, there were 6 cases of type 31-A1 fractures, 11 cases of type 31-A2 fractures, 4 cases of type 31-A3 fractures.All patients were followed and the clinical results and functional rehabilitation were evaluated during perioperative period and after short term followed-up. Results: The mean operation time was 61.7min(ranged 40-110min). The mean intraoperative blood loss was 131.7mL(ranged 45-450mL). The average hospitalization days was 13.6d(ranged 7-29d). There were no severe complications and exacerbation of coexisting medical disease.All patients were followed up for 10 to 18 months (average 13.3 months) after treatment.The fracture union was obtained in all patients at the final follow-up.No poor healing, failure of internal fixation, cut-out of proximal screws, varus deformity, re-fractures occurred after operation.The clinical results were evaluated according to Harris hip score, 6 cases achieved excellent results, 13 cases were good, 2 cases were fair at last follow-up.The excellent and good rate of the hip joint function was 90.5%. Conclusion Surgical treatment of medial-lateral irreducible intertrochanteric fractures with Collinear clamp assisted reduction and PFNA can result in excellent reduction and function.This technique has less injury and faster recovery.However, the long-term effect needs to evaluate by follow-up.