BackgroundSibling relationships play a critical role in shaping anxiety symptoms in firstborn children. Anxiety symptoms often originate in early childhood and can persist into adolescence and adulthood. However， there is insufficient research on anxiety symptoms in preschool children， especially firstborn preschool children. ObjectiveTo explore the influencing factors of anxiety symptoms among firstborn preschool children， so as to provide references for the intervention of anxiety symptom for children in families with multiple children. MethodsFrom October to December 2021， a total of 8 449 children from 234 kindergartens in Longhua District of Shenzhen were included using a cluster sampling method. Sibling Inventory of Behavior （SIB） and Spence Preschool Anxiety Scale （SPAS） were used to investigate. Logistic regression analysis was used to identify influencing factors of anxiety symptoms in firstborn preschool children. ResultsA total of 8 419 （99.64%） valid questionnaires were collected. Anxiety symptoms were detected in 344（4.09%） firstborn preschool children. Statistically significant differences were observed between anxiety group and non-anxiety group in terms of household registration， monthly family income， maternal age， maternal education level， paternal education level， family living conditions and whether they are left-behind children （χ²/t=9.906， 33.490， 5.136， 13.485， 9.690， 17.332， 21.975， P<0.05 or 0.01）. Compared with non-anxiety group， children in the anxiety group scored higher on the SIB dimensions of rivalry， aggression and avoidance （t=165.322， 74.471， 286.419， P<0.01）， and lower on companionship， empathy and teaching （t=59.133， 42.417， 39.112， P<0.01）. Risk factors for anxiety symptoms in firstborn preschool children included left-behind children， as well as negative sibling relationships characterized by rivalry and avoidance （OR=1.195， 1.143， 1.260， P<0.05 or 0.01）. ConclusionFirstborn preschool children who are left-behind are more susceptible to anxiety symptoms. Negative sibling relationships， characterized by competition and avoidance， may also contribute to the emergence of anxiety symptoms in firstborn preschool children.

Objective To detect the expression level of 4-aminobutyrate aminotransferase(ABAT)in bone marrow of patients with myelodysplastic syndrome(MDS),and analyze its influence on clinicopathological features and prognosis of patients.Methods From January 2016 to March 2020,92 patients with MDS and 30 patients with acute myeloid leukemia(AML)from the First Affiliated Hospital of Xingtai Medical College were retrospectively collected.Meanwhile,30 patients with immunothrombocytopenia who did not develop MDS or other clonal diseases of the blood system during a 3-year follow-up were collected as control group.Real-time quantitative fluorescent PCR(qRT-PCR)was used to detect the relative expression level and methylation level of ABAT mRNA of all patients,and the relative expression level and methylation level of ABAT mRNA among different clinical characteristics of MDS patients were compared.Multivariate logistic regression analysis was used to analyze the risk factors affecting the adverse prognosis of MDS.The clinical value of detecting ABAT methylation level in predicting poor prognosis of MDS patients was analyzed by receiver operating characteristic(ROC)curve.Kaplan-Meier method was used to calculate the 3-year survival rate between groups with different ABAT mRNA relative expression levels and methylation levels,and log-rank test was used for their comparison.Results The expression level of ABAT mRNA in MDS group(0.42±0.08)was lower than that in control group(0.56±0.15)and AML group(0.52±0.10),while the methylation level of ABAT(32.51±5.32)was higher than that of AML group(26.21±4.58)and control group(10.25±4.31),and the differences were significant(t=4.251,4.562;10.415,8.326,all P<0.001).The methylation level of ABAT in high-risk patients(42.65±5.32)was higher than that in low-risk patients(25.63±4.16),intermediate-risk-1 patients(30.59±2.51)and intermediate-risk-2 patients(33.25±3.69)by IPSS risk grade,and the differences were significant(t=8.329,7.077,15.874,all P<0.001).Poor Karyotype analysis result[OR(95%CI):4.973(1.524～8.581),P=0.004],high IPSS risk grade[OR(95%CI):8.542(2.365～14.521),P<0.001]and ABAT hypermethylation level[OR(95%CI):6.178(1.589～13.021),P<0.001]were the risk factors affecting the poor prognosis of MDS.The cut-offvalue of ABAT methylation level to predict the poor prognosis of MDS were 30.54,and the area under the curve(AUC),the sensitivity and specificity were 0.92,0.874 and 0.851,respectively.The 3-year survival rate of the high ABAT methylation group(>30.54)was 66.67%,which was lower than that of the low ABAT methylation group(≤30.54)was 93.18%,with significant difference(Log-rank x2=9.814,P=0.002).Conclusion The ABAT methylation levels in MDS bone marrow increase,which is a risk factor affecting the poor prognosis of patients.ABAT basal level>30.54 is expected to become a factors predicting the poor prognosis of patients.

Objective:To investigate the dosimetric effects of complex cardiac-respiratory motion in cardiac stereotactic body radiotherapy (CSBRT).Methods:A cardiac motion phantom was employed to simulate patient-specific cardiac-respiratory motion in 10 cases. The measured doses obtained under the phantom motion state were compared with the calculated doses in radiotherapy treatment planning for clinical patients. Moreover, 18 groups of design-based cardiac-respiratory motion were simulated. The radiation doses under the phantom motion state were measured using radiochromic films and compared with those under the resting state.Results:In the patient-specific cardiac-respiratory motion group, the gamma passing rate (GPR) under the 3%/2 mm standard between the measured and the calculated doses was 90.0% ± 7.0%. The correlation coefficient of the respiratory motion amplitude in the superior-inferior (SI) dimension with the GPR was -0.86 ( P=0.01). In the design-based cardiac-respiratory motion groups, the increase in the amplitude of cardiac-respiratory motion reduced the consistency between the dynamic dose and the static reference dose. Especially, the increase in the respiratory motion amplitude produced the most pronounced effect, reducing the width of the 90% isodose line in the respiratory motion direction, with a mean slope of -1.6. Additionally, the increase in the penumbra corresponds to a mean slope of 1.4. Conclusions:The respiratory motion amplitude serves as a primary factor influencing the dose accuracy of CBSRT. The characteristics and dosimetric effects of cardiac-respiratory motion are patient-specific, thus necessitating the assessment of cardiac-respiratory motion characteristics before CBSRT to individualize the application of motion management techniques for enhanced treatment accuracy.

Objective:To explore the effect of continuous large-volume hemofiltration combined with somatostatin on the prognosis of patients with acute severe pancreatitis.Methods:A total of 106 patients with acute severe pancreatitis who were treated in the People′s Hospital of Xinjiang Uygur Autonomous Region from October 2019 to October 2021 were enrolled retrospectively and they were divided into drug group (53 cases) and filtration group (53 cases) according to different treatment methods. The patients in the drug group were given somatostatin instillation on the basis of routine treatment, and the patients in the filtration group were given continuous large-volume hemofiltration therapy on the basis of the drug group. The serum amylase level, clinical efficacy, clinical indicators and prognosis were compared between the two groups.Results:After treatment for 3 d and 1 week, the levels of serum amylase in the drug group were lower than those in the filtration group: (385.62 ± 15.57) U/L vs.(426.83 ± 18.21) U/L, (110.75 ± 7.68) U/L vs. (162.74 ± 9.12) U/L, there were statistical differences ( P<0.05). The total effective rate in the filtration group was higher than that in the drug group: 90.57%(48/53) vs. 75.47%(40/53), χ2 = 4.28, P<0.05. The hospitalization time, gastrointestinal decompression time and recovery time of bowel sounds in the filtration group were shorter than those in the drug group: (17.21 ± 4.01) d vs. (20.56 ± 4.57) d, (5.46 ± 1.56) d vs. (7.98 ± 1.79) d, (5.43 ± 2.11) d vs. (6.78 ± 2.54) d, there were statistical differences ( P<0.05). After treatment for 3 d and 1 week, the scores of gastrointestinal function and acute physiology and chronic health assessment (APACHE) Ⅱ in the filtration group were lower than those in the drug group: after treatment for 3 d: (1.64 ± 0.35) scores vs. (1.89 ± 0.41) scores, (23.42 ± 2.71) scores vs. (27.62 ± 3.01) scores; after treatment for 1 week: (0.67 ± 0.21) scores vs. (1.01 ± 0.32) scores, (9.78 ± 1.21) scores vs. (15.62 ± 1.58) scores, there were statistical differences ( P<0.05). After treatment for 28 d, the fatality rate in the filtration group was lower than that in the drug group: 5.66%(3/53) vs. 20.75%(11/53), χ2 = 5.27, P<0.05. Conclusions:Bedside continuous bulk hemofiltration with somatostatin in the treatment of severe acute pancreatitis can effectively reduce the serum amylase level, promote the recovery of gastrointestinal function, improve the clinical symptoms and prognosis.

Objective:To explore the effect of methylphenidate (MPH) sustained-release tablets on the sleep characteristics of children with attention deficit hyperactivity disorder (ADHD).Methods:A total of 23 children with ADHD were included in the MPH group, and treated with sustained variable doses of methylphenidate sustained-release tablets, and overnight polysomnograms (PSG) were performed at baseline, 2 weeks of treatment, and 6 weeks of treatment.At the same time, 21 matched normal children were recruited as control group for PSG.SPSS 22.0 was used for statistical analysis, and the mean ± standard deviation, M( P25, P75) and percentage were used for statistical description according to the type of data.Paired t test or analysis of variance was used for comparison of sleep parameters. Results:At baseline, children in MPH group had lower sleep efficiency (SE (%)) ((86.7±12.4)%, (90.9±7.5)%), longer sleep latency (SOL) ((21.1±12.4) min, (18.1 ±13.0) min), shorter rapid eye movement onset latency (ROL) ((145.2±35.2)min, (155.6±57.7)min), and the differences were statistically significant (all P<0.05). Compared with baseline, children in MPH group after 2 weeks of treatment had prolonged SOL ((27.2±6.4)min, (21.1±12.4) min), shortened ROL((127.2±32.1) min, (145.2±35.2) min) and REM phase time((70.5±13.8) min, (79.8±15.3)min) and significantly lower SE (%) ((83.1±15.4)%, (86.7±12.4)%), and the differences were statistically significant (all P<0.05). There was no significant difference in the SOL, ROL, REM phase time, and SE (%) sleep parameters of children in the MPH group after 6 weeks of treatment and baseline (all P>0.05). The sleep parameters such as %TST, number of awakenings and time of awakening of WASO in N1, N2, N3 and R phase of MPH group were not statistically significant among baseline, 2 weeks of treatment and 6 weeks of treatment (all P> 0.05). Conclusion:Children with ADHD present lower sleep efficiency, more difficulty to fall asleep, and shortened REM latency.MPH has a certain negative effect on the sleep of ADHD children in the first 2 weeks, which worsens the sleep problems of ADHD children.After 6 weeks of continuous treatment, the effect of MPH on sleep gradually improved.

Objective To investigate the prevalence and related factors of musculoskeletal diseases in nurses by means of qualitative and quantitative research, and to have a discussion on the inner experiences of nurses. Methods 1 012 clinical nurses, from one hospital during March 2019 to May 2019, were selected as research objects by convenience sampling method. The Nordic musculoskeletal disease questionnaire was used for investigation,and SPSS 21.0 was used for statistical analysis. In the qualitative study,5 ICU nurses were selected by objective sampling method. Data were collected by semi-structured interview method,and analyzed by content analysis method. Results The annual prevalence rate of musculoskeletal diseases in clinical nurses was mainly in the neck (53.2%, 538/1 012), followed by the waist and back (48.5%, 491/1 012), hip and leg (45.2%, 457/1 012). Logistic regression analysis of neck related factors showed that BMI (P=0.039), repeated operation for one minute (P=0.007), and staff shortage in the Department (P=0.027) were the influencing factors of musculoskeletal diseases. Qualitative research extracted the following two themes:negative psychological experience of nurses under high workload and positive psychological experience of nurses. Conclusion The prevalence of neck is the highest among those of other musculoskeletal diseases in clinical nurses, which is related to many related factors. In the professional environment of nurses, nurses have high self-protection willingness and ability. It is suggested to strengthen support from hospital, family and other aspects, reduce the prevalence rate, and improve the quality of work and family life of nurses.

Objective To investigate the influence factors for immediate outcome after thymectomy for patients with myasthenia gravis (MG). Methods The clinical data of 108 patients with MG who received thymectomy in the Department of Thoracic Surgery, the Second Affiliated Hospital of Zhengzhou University from July 2009 to July 2012 were retrospectively investigated, including gender, age, duration of disease, clinical classification, pathological classification of thymus and anti-acetylcholine receptor antibodies (AChRab). The immediate outcome after thymectomy was also observed. Thirty-two cases of MG who had immediate outcome after thymectomy were enrolled into experimental group, while 76 cases who did not have immediate outcome after thymectomy were regarded as control group. Results The immediate outcome after thymectomy was associated with duration of disease (χ2=98.550, P<0.01), clinical classification (χ2=40.434, P<0.01), pathological classification of thymus (χ2=11.154, P=0.004) and AChRab (χ2=5.590, P=0.018). There were statistically significant differences between the two groups in the one-year (31.3% in the experimental group vs 14.5% in the control group, χ2=4.046, P=0.044), two-year (40.6% vs 21.1%, χ2=4.392, P=0.036) and three-year complete remission rates (46.9% vs 25.0%, χ2=4.995, P=0.025). Conclusion Duration of disease, clinical classification, pathological classification of thymus and AChRab could be influence factors for immediate outcome and complete remission for patients with MG after thymectomy.

Objective To study the effect of S1P on HLF cell fibrosis and its mechanism. Methods (1) The expression of ECM in HLF cells was analyzed by using Western Blot after treatment by S1P(1 μmol/L), FTY720-P(5μmol/L),ponesimod(5μmol/L)and SEW2871(5μmol/L)24 h;(2)The HLF cells were pre-treated using selective S1PR antagonist W146(1 μmol/L),JTE-013(0.2 μmol/L),and TY-52156(1.25 μmol/L)1 h before incubation by S1P and S1PR agonists 24 h and then the expression of ECM was analyzed;(3)The HLF cells were pre-incubated using JTE-013(0.2μmol/L)and TY-52156(1.25μmol/L)for 1 h and then the expression of ECM was analyzedafter being treated by S1P and S1PR agonists 24 h. Results (1)S1P and selective S1P receptor agonist increased the expression of ECM to various extents;(2)The S1P1R antagonist W146 did not affectthe expression of ECM induced by S1P and S1PR agonists and S1P2R antagonist JTE-013 and S1P3R antagonist TY-52156 both decreased the expression of ECM induced by S1P and S1PR agonists;(3)The expression of ECM induced by S1P and S1PR agonists further decreased using both JTE-013 and TY-52156 but not using ponesimod. Conclusion S1P2R and S1P3R are activated under the influence of S1P so as to increase the synthesis of ECM and promote fibrosis gene expression in HLF cells.

Objective To transform hospital information service mode based on palm hospital based on WeChat.Methods Palm hospital based on WeChat was described from the aspects of background,execution and key points,whose effects and problems were analyzed.Results Palm hospital interfaced with hospital information system,changed the traditional medical service flow and doctor-patient communication,and posed a new mode for mobile medical service.Conclusion Palm hospital based on WeChat is one mode for embodiment of internet+ medical service,and may be of references and prospects for mobile medicine.

OBJECTIVETo profile the clinicopathologic features of a series of grey zone lymphoma (GZL) cases with hybrid features of diffuse large B-cell lymphoma (DLBCL) and classical Hodgkin lymphoma (CHL), with a purpose to gain an in-depth understanding of the borderline B-cell neoplasm.

METHODSThe clinical, morphologic and immunophenotyical characteristics of 16 cases were retrospectively analyzed.

RESULTSThe patients were mostly male adults, with a male to female ratio of 1.7: 1.0 and a mean age of 40.2 years. Eight patients presented with peripheral nodal lesions and five cases with mediastinal involvement. Histologically and immunophenotypically, the 16 cases were classified into three sub-categories. In 4 cases, the morphologic features resembled CHL more closely, but the neoplastic cells showed uniform and intense positive staining of CD20 (pattern 1). Although the initial impression of the other 8 cases was that of DLBCL, the expression levels of CD20 and PAX5 were variable, and CD30 or CD15 was positive (pattern 2). A characteristic feature of pattern 3, observed in the remaining 4 cases, demonstrated a broad spectrum of morphology with hybrid features of both CHL and DLBCL. The neoplastic cells in pattern 3 were positive for CD20, CD30 and CD15. EBV-LMP1 was detected in 6 of the 11 tested cases. Clinically, most patients with GZL seemed insensitive to immuno-chemotherapy of the R-CHOP regimen.

CONCLUSIONSThe diagnostic criteria for GZL with features intermediate between DLBCL and CHL is proposed by the three histologic patterns commonly seen in these lesions. Cases presented with peripheral lesions might differ from those with mediastinal presentation pathologically. At current time, there is no effective treatment for these borderline B-cell lymphomas and the prognosis is poor.

Adolescent ; Adult ; Aged ; Antibodies, Monoclonal, Murine-Derived ; therapeutic use ; Antigens, CD20 ; metabolism ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Cyclophosphamide ; therapeutic use ; Diagnosis, Differential ; Doxorubicin ; therapeutic use ; Female ; Hodgkin Disease ; drug therapy ; metabolism ; pathology ; Humans ; Ki-1 Antigen ; metabolism ; Lewis X Antigen ; metabolism ; Lymphoma, Large B-Cell, Diffuse ; drug therapy ; metabolism ; pathology ; Male ; Middle Aged ; PAX5 Transcription Factor ; metabolism ; Prednisone ; therapeutic use ; Prognosis ; Retrospective Studies ; Rituximab ; Vincristine ; therapeutic use ; Viral Matrix Proteins ; metabolism ; Young Adult