Early start denver model(ESDM)is a comprehensive early intervention approach for the children with autism spectrum disorder(ASD)between 12-month-old-36-month-old.The model is built upon the theoretical foundations of applied behavior analysis,denver model(DM),and pivotal response treatment,and it is one of the naturalistic developmental behavioral interventions.Compared with the other early intervention methods,ESDM is not limited by the environment of intervention;it encompasses all the areas of development during teaching practice and has been widely adopted for the early intervention of the children with ASD,and achieves the satisfactory therapeutic effect.The ESDM typically uses an intensive one-on-one intervention approach,but variabilities have emerged in its practical application,such as group ESDM(G-ESDM),parent-implemented ESDM(P-ESDM),and peer-mediated ESDM.In particular,G-ESDM and P-ESDM have provided the learning opportunities for more families,showing a broad application prospect.This study reviews the theoretical foundations,teaching models,and the effects of various intervention modalities of the ESDM in the treatment of ASD;combined with the domestic and international research findings,this study offers a reference for further studies on the mechanism of ESDM intervention for ASD.

Objective To assess the impact of ultrasound-guided fascia iliaca compartment block on major cardiovascular events and postoperative prognosis in patients with lower limb aortoiliac occlusive disease(ASO).Methods This study was a retrospective study including 353 patients with lower limb arterial reconstruction surgery for ASO at Xiamen Hospital Affiliated to Zhongshan Hospital of Fudan University from January 2018 to January 2022.Patients were divided into two groups based on different anesthesia:the group receiving ultrasound-guided fascia iliaca block combined with sciatic nerve block(Group B)and the group receiving monitored anesthesia care(MAC)(Group M).The primary outcome was the occurrence of major adverse cardiovascular events after lower limb arterial reconstruction surgery in ASO patients.The secondary outcomes included the incidence of non-cardiac postoperative myocardial injury,postoperative amputation,and other adverse reactions such as postoperative delirium,nausea,and vomiting as well as postoperative laboratory indicators.By using propensity score matching to balance baseline characteristics before surgery,the impact of different anesthesia methods on the occurrence of MACE and prognosis after surgery in ASO patients was analyzed.Results After propensity score matching,the incidence of MACE in Group B was lower compared with Group M(10%vs.3.4%,P=0.038);The incidence of MINS in Group B(33%vs.25%,P=0.200);The amputation rate of Group B(4.2%vs.3.4%,P＞0.99);The incidence of complications in Group B was(6.8%vs.4.2%,P=0.39);There was no statistically significant differ-ence in postoperative laboratory indicators between the two groups(P＞0.05).Multivariate analysis showed that nerve block(OR=0.25,95%CI:0.05～0.93),postoperative HBG(OR=0.95,95%CI:0.91～0.99)were in-dependent factors in reducing the incidence of MACE.Conclusion Ultrasound-guidance fascia iliaca compartment block and sciatic nerve block could reduce the risk of major adverse cardiovascular events in patients undergoing lower limb arterial revascularization surgery.

OBJECTIVE To observe the clinical efficacy of Yangyin Jiedu Decoction in the prevention and treatment of acute ra-diation-induced oral mucositis(RTOM).METHODS A total of 80 inpatients who were diagnosed with head and neck tumors by pathological examination and received radiotherapy in the Department of Radiotherapy,Affiliated Hospital of Nanjing University of Chi-nese Medicine from November 2021 to September 2023 were selected and randomly divided into an observation group and a control group with 40 cases in each group.The control group was given mouthwash treatment from the onset of RTOM symptoms until the symp-toms disappeared;the observation group was given Yangyin Jiedu Decoction from the first day of radiotherapy on the basis of the treat-ment of the control group until the end of radiotherapy.During the treatment,the onset time,duration and incidence of grade Ⅱ-ⅣRTOM in the two groups were observed;the pain numerical rating scale(NRS)score,Karnofsky performance status(KPS)score,body mass index(BMI)changes were evaluated;and the levels of serum inflammatory factors[C-reactive protein(CRP),interleukin 6(IL-6),interleukin 1β(IL-1β),tumor necrosis factor α(TNF-α)]were detected.RESULTS After radiotherapy,RTOM ap-peared in both groups to varying degrees.The incidence of grade Ⅱ-Ⅳ RTOM,the onset time,duration and NRS score of RTOM in the observation group were significantly better than those in the control group(P<0.05,P<0.01).After radiotherapy,the levels of se-rum CRP,IL-6,IL-1β and TNF-α in the observation group were lower than those in the control group(P<0.05,P<0.01).After radiotherapy and 1 month of follow-up,the KPS score and BMI in the observation group were higher than those in the control group(P<0.05,P<0.01).CONCLUSION Yangyin Jiedu Decoction can decrease the incidence and severity of RTOM in patients with head and neck tumors,shorten its duration,improve the quality of life of patients,downregulate the level of inflammatory cytokines,and has a preventive effect on RTOM caused by radiotherapy in patients with head and neck tumors.

Objective:To construct and test the reliability and validity of an assessment scale for self-management of patients with dry eye, so as to help patients establish dry eye related health behaviors.Methods:Based on the knowledge attitude and practice theory, the initial scale was constructed on the basis of literature review and qualitative interview, and revised through Delphi expert consultation and expert argumentation. After the preliminary investigation, 211 dry eye patients treated in the dry eye nursing outpatient department of Beijing Tongren Hospital from August 2023 to January 2024 were selected by convenience sampling method for questionnaire investigation to test the reliability and validity of the scale.Results:Among 211 dry eye patients, there were 58 males and 153 females, aged (39.31 ± 12.81) years old. The scale of self-management of patients with dry eye included 27 items in 3 dimensions: knowledge, attitude and behavior. The authority coefficient of the two rounds of expert consultation was 0.86, and the Kendall coordination index increased from 0.175 to 0.223 (both P < 0.01). The cumulative variance contribution rates of the three dimensions were 41.843%, 54.219% and 44.273%, respectively. The Cronbach α coefficient of the scale was 0.787, and the Spearman-Brown coefficient was 0.641. Conclusions:The scale of self-management of patients with dry eye has good reliability and validity and can be used in the assessment of dry eye patients to provide a reference basis for targeted guidance and intervention.

With the deepening of the concept of enhanced recovery after surgery(ERAS),clinical techniques and applications aimed at reducing perioperative stress,reducing postoperative complications,and promoting early postoperative recovery have gradually attracted attention.Transcutaneous electrical acu-point stimulation(TEAS),as a new type of combination of transcutaneous electrical nerve stimulation and acupuncture acupoint technology,has significant effects in reducing body stress,improving the quality of postoperative recovery,and reducing postoperative complications.The purpose of this article is to review the research progress of TEAS in early postoperative recovery at home and abroad in recent years,so as to pro-vide a reference for optimizing perioperative anesthesia management.

Objective:To gain a deep understanding of the supportive care needs of families of children with retinoblastoma (RB) through qualitative research.Methods:From March to May 2022, a semi-structured interview was conducted using purposive sampling to select the family members of 15 RB children in the Department of Eye Tumor of Beijing Tongren Hospital affiliated to Capital Medical University. Colaizzi 7-step analysis method was used to refine, extract, and analyze interview data.Results:The supportive care needs of the families of RB children were summarized into three themes and six sub-themes, namely, psychological needs (emotional listening and psychological support), knowledge needs (disease knowledge needs, children's post discharge guidance, internet resource needs), and economic needs (social resource integration) .Conclusions:RB, as a malignant eye tumor, often brings a heavy burden to families. Family members of children generally experience negative emotions such as anxiety and depression, as well as a lack of knowledge. The economic burden on families is heavy, and there is a high demand for supportive care. The supportive care program for families of RB children is not yet perfect, and nurses should provide emotional support and professional assistance to the families, providing help and guidance in psychological counseling, knowledge needs, economic assistance, and other aspects.

Objective:To explore the effectiveness of the comprehensive healthcare management model for children with bacterial meningitis after discharge.Methods:This study was a retrospective cohort study that included 268 children with bacterial meningitis who were discharged from the infectious medicine ward of Beijing Children′s Hospital from September 2018 to September 2023. The children were managed with a multidisciplinary collaborative comprehensive healthcare management model after discharge. Outpatient data at 1 month and 6, 12 and 24 months after discharge were collected, including (height, weight, body mass index, nutritional feeding status, hearing and vision screening results, Gesell developmental assessment results and intervention guidance services. The follow-up interval or frequency was dynamically adjusted or increased according to the child′s situation. The paired sample t-test and chi square test were applied to compare the differences in Gesell developmental quotient (DQ) and developmental delay rate between the first and last assessments to preliminarily explore the effectiveness of the comprehensive healthcare management model for children with bacterial meningitis after discharge. Results:All the 268 children completed their first assessment one month after discharge, and 37 children were found to have abnormal physical growth, mainly obesity (28 children), and another 9 children were malnutrition. Nutritional intervention and feeding guidance services were provided to all the 37 children, and as of the last follow-up, 20 children′s physical growth evaluations had turned normal. A total of 188 children completed at least 2 developmental assessments, with an interval of (14.2±9.4) months between the first and last assessments (range: 3.1-49.5 months). The DQ values of in the energy region of adaptability, gross motor skills, fine motor skills, language, and personal social skills at the last assessment were significantly higher than those at the first assessment [(91.93±13.28) vs (80.73±15.96) points, (91.69±12.96) vs (78.31±16.58) points, (89.32±16.11) vs (80.68±15.63) points, (90.10±16.65) vs (82.04±18.43) points, (92.01±14.05) vs (77.82±17.42) points]; moreover, the rates of developmental delay in each energy region were significantly lower than those at the initial assessment (9.6% vs 35.1%, 9.6% vs 42.0%, 18.1% vs 33.0%, 13.3% vs 31.9%, 9.6% vs 42.0%) (all P<0.05). Among the 200 children who completed the hearing screening, 18 were found with hearing abnormalities, and 2 were diagnosed with hearing loss in the Otolaryngology Department. Among 217 children who completed vision screening, 23 had abnormalities, and 5 were diagnosed with ophthalmic abnormalities in Ophthalmology Department (2 with strabismus, 2 with refractive errors, and 1 with optic nerve injury). Two children were found to have autism-like behavior during monitoring, and were referred to a developmental behavior clinic to be diagnosed with autism spectrum disorder and were given early diagnosis and intervention guidance. Conclusion:The comprehensive healthcare management model for children with bacterial meningitis after discharge can integrate clinical and healthcare resources, which is beneficial for improving the prognosis and enhancing the quality of life for children with special health status.

Objective:To investigate the impact of elevated glucose-induced RNA oxidation on pancreatic β-cell function, activity, and underlying molecular mechanisms.Methods:Rat pancreatic islet β-cell tumour INS-1 cells were cultured in vitro and subjected to nucleic acid oxidation assessment using isotope dilution ultra-high performance liquid tandem mass spectrometry(ID LC MS/MS)following high glucose exposure.In vitro simulation of increased RNA oxidation in INS-1 cells was achieved using 8-oxoguanosine-5'-triphosphate(8-oxoGTP).Cell proliferation was evaluated through CCK-8 assay, apoptosis was measured via flow cytometry, and gene expression of insulin(INS), pancreatic-duodenal homologous cassette 1(PDX1), cysteine-aspartate proteinase 3(Casp3), and cysteine aspartate protease 6(Casp6)was analyzed at the mRNA level.Additionally, whole transcriptome sequencing was performed to elucidate the molecular mechanisms underlying the impact of RNA oxidation on INS-1 cells.Results:Elevated glucose levels induced an increase in RNA oxidation within INS-1 cells.This heightened RNA oxidation led to the inhibition of INS-1 cell proliferation, a reduction in mRNA levels of INS and PDX1 genes, and the promotion of apoptosis-related casp3 and casp6 gene mRNA synthesis.Transcriptome sequencing analysis unveiled that the elevated RNA oxidation caused differential expression of mRNA, lncRNA, miRNA, and circRNA in INS-1 cells.This included a significant down-regulation of transcription factors such as Mafa, Pdx1, Pax6, and Mnx1, alongside an up-regulation of various miRNAs like rno-miR-124-3p, rno-miR-133a-3p, rno-miR-3120, rno-miR-212-3p, and rno-miR-7a-2-3p.These molecular changes contributed to the altered expression of associated lncRNAs, ultimately hindering insulin synthesis and secretion, as well as β-cell proliferation.Conclusions:Increased RNA oxidation down-regulates the levels of key β-cell transcription factor mRNAs, contributes to the differential expression of related non-coding RNAs(ncRNAs), particularly lncRNAs, impacts β-cell insulin synthesis and secretion, hinders cell proliferation, and serves as a significant factor in β-cell dysfunction and decreased activity in type 2 diabetes mellitus(T2DM).

Objective To investigate the impact of autologous platelet-rich plasma on postoperative bleeding and patient prognosis in individuals undergoing heart valve surgery.Methods This study is a retrospective cohort study that included patients who underwent heart valve surgery at Xiamen Hospital,Zhongshan Hospital,Fudan University from September 2018 to January 2023.The patients were divided into two groups based on whether they underwent autologous platelet-rich plasma(aPRP)collection before surgery:Group A(no PRP collection)and Group B(PRP collection group).The main endpoint measure was the volume of pericardial mediastinal drainage on the day of surgery(D0),the first postoperative day(D1),and the second postoperative day(D2).The secondary endpoint indicators included postoperative mechanical ventilation time,duration of mediastinal drainage tube reten-tion,length of stay in the intensive care unit(ICU),postoperative hospitalization time,incidence of adverse events during postoperative hospitalization,and postoperative coagulation function.Propensity score matching was used to balance preoperative baseline characteristics,including gender,age,Body Mass Index(BMI),prothrombin time(PT),International Normalized Ratio(INR),platelet count(PLT),activated clotting time(ACT),ASA grade,NYHA grade,surgical name,surgical method,and preoperative comorbidities.Based on the matched data,the effect of PRP on postoperative bleeding and prognosis in patients following heart valve surgery was investi-gated.Results After propensity score matching,Group B patients showed a significant decrease in D2 drainage volume compared to Group A[(132.42±84.11)vs.(218.39±160.39),P = 0.01].Additionally,Group B had significantly shorter postoperative mechanical ventilation time[(1.88±0.99)vs.(2.7±2.47),P = 0.015],ICU stay time[(3.07±2.01)vs.(4.97±6.26),P = 0.006],and pericardial mediastinal drainage retention time[(5.72±1.85)vs.(9.23±5.05),P = 0.01].Moreover,the overall incidence of adverse events was reduced in Group B compared to Group A[5(8.3%)vs.14(23%),P = 0.024].At D0,D1,and D2,there was no statisti-cally significant difference in hospital stay or postoperative coagulation function between the two groups of patients.Conclusions PRP has been proven to minimize pericardial mediastinal drainage on the second postoperative day,as well as the duration of mechanical ventilation,ICU stay,retention of pericardial mediastinal drainage,and over-all incidence of postoperative adverse events.

Objective:To construct an evaluation indicator system of nursing quality in Ophthalmological Daytime Operation Room and provide a reference for objectively assessing the nursing quality in ophthalmological Daytime Operation Room.Methods:From January to August 2020, the evaluation indicator system of nursing quality in Ophthalmological Daytime Operation Room was constructed by literature retrieval, semi-structured interviews, Delphi's expert correspondence inquiries, and hierarchical analysis based on Donabedian's structure-process-outcome model.Results:The effective response rates of the questionnaires for the two rounds of expert correspondence inquiries were 100.0%; the expert authority coefficients were 0.851 and 0.858; and the expert coordination coefficients were 0.098-0.264. The evaluation indicator system of nursing quality in ophthalmological daytime operation room finally constructed included 3 primary indicators, 11 secondary indicators, and 57 tertiary indicators.Conclusions:The evaluation indicator system of nursing quality in Ophthalmological Daytime Operation Room constructed in this study is highly scientific and reliable, which can comprehensively and objectively assess and continuously improve the nursing quality of Ophthalmological Daytime Operation Room.