Objective:To study the survival and prognostic factors for the recurrent extracranial malignant germ cell tumors (MGCTs) in children, and to explore feasible salvage treatment.Methods:A retrospective study.Pediatric patients with recurrent extracranial MGCTs diagnosed in Shanghai Children′s Medical Center between January 2010 and January 2020 were retrospectively recruited.Comprehensive treatment regimens included surgery, chemotherapy and radiation.Kaplan-Meier survival analysis and Cox regression model were employed to analyze the survival and prognostic factors for children with recurrent extracranial MGCTs.Results:A total of 172 children with extracranial MGCTs were treated, including 21 (12.2%) recurrent cases.The median time of MGCT recurrence after the end of the first treatment was 11 months.Finally, 19 patients were recruited after excluding 2 non-eligible cases, including 10 boys and 9 girls with the age at recurrence of 26 (8-170) months.The follow-up time was 57 (13-122) months.Salvage chemotherapy, complete resection and radiotherapy were performed in 16, 14 and 4 patients, respectively.The 4-year overall survival (4yr-OS) rate was (82.5±9.2)%(19 cases). The 4yr-OS rate was significantly higher in patients managed with surgery but without adjuvant chemotherapy at the initial treatment (13 cases) than those managed with chemotherapy at the initial treatment (6 cases)[(92.3±7.4)% vs.(60.0%±21.9)%, P=0.002]. Univariant and Cox multivariant regression analyses showed that failure to achieve the normal range of alpha fetoprotein after 3 cycles of chemotherapy significantly influenced the survival of recurrent extracranial MGCTs. Conclusions:For patients with recurrent extracranial MGCTs, comprehensive treatment approaches like complete surgical resection, chemotherapy, and radiotherapy offer a favorable survival rate.Specifically, recurrent and re-treated patients who initially received surgery alone without adjuvant chemotherapy have a higher survival rate compared to those who received chemotherapy during the initial treatment.

Objective:To explore the genetic etiology and clinical outcome of a child with co-morbid progressive IgA nephropathy and COQ8B-associated glomerulopathy. Methods:A child who was admitted to Peking University First Hospital on March 2, 2021 was selected as the study subject. Genomic DNA was extracted from peripheral blood samples from the child and his parents and sister. Whole exome sequencing was carried out, and candidate variant was verified by Sanger sequencing. This study was approved by Medical Ethics Committee of the Peking University First Hospital (Ethics No. 2016[1029]).Results:The child, a 7-year-old boy who had developed proteinuria 8 months before, was diagnosed with IgA nephropathy (M1E1S1T1C1). With steroid, cyclophosphamide, cyclosporine and angiotensin-converting enzyme inhibitor therapy, partial remission of proteinuria was achieved. However, his serum creatinine level had increased from 53.8 mol/L at the onset of disease to 86.7 mol/L after 3.9 years, along with massive proteinuria. Kidney biopsy still indicated IgA nephropathy (M0E0S1T0C0). The child was found to harbor a homozygous c. 737G>A (p.Ser246Asn) missense variant of the COQ8B gene, for which his parents and sister were heterozygous carriers. The variant was predicted to be pathogenic (PS1+ PM2_Supporting+ PM3+ PP3+ PP4) based on the guidelines from the American College of Medical Genetics and Genomics. The child was treated with high-dose coenzyme Q10 in combination with steroid and/or mycophenolate mofetil, though his serum creatinine level still increased to 286 mol/L after 7.3 years, which conformed to a chronic kidney disorder with glomerular filtration rate category of G3b. Conclusion:The homozygous c.737G>A missense variants of the COQ8B gene probably underlay the progressive kidney dysfunction in this child. For children with IgA nephropathy presenting with atypical clinical manifestations, unsatisfactory therapeutic effect, and/or early onset of kidney function decline, coexistence of other diseases should be suspected.

Objective:To systematically evaluate the life experience of patients with postpartum depression.Methods:PubMed, web of science, EMBASE, Scopus, PsychINFO, the Cochrane Library, CNKI, VIP, Wanfang and China biomedical database were searched for qualitative studies on life experience of patients with postpartum depression from the establishment to January 2021. The quality of articles was evaluated by the quality evaluation standard of JBI evidence-based health care center (2016) in Australia, and the results were summarized for meta integration.Results:A total of 23 studies were included, 50 complete results were extracted, 9 new categories were summarized, and 3 integrated results were obtained. Integration result 1: negative psychological emotion experience and coping style; integration result 2: personal role change and social environment influence; integration result 3: needs and obstacles.Conclusions:To improve the public′s cognition of postpartum depression, get the understanding of relatives and the attention of medical staff; pay attention to the life experience of patients with postpartum depression, give all-round support, meet the needs of pregnant women, promote the adaptation of mother′s role, and provide reference for medical staff to give humanized intervention.

OBJE CTIVE To mine and analyze t he cardiac adverse drug reaction （ADR）signals induced by febuxostat in post-marketing experience ，and to provide reference for rational drug use in clinic. METHODS Reporting odds ratio （ROR） method was used to mine the ADR signals induced by febuxostat from the FDA Adverse Event Reporting System during the first quarter of 2009 to the fourth quarter of 2020；the information of cardiac disease signals was counted and analyzed. RESULTS A total of 209 ADR signals were detected in 8 282 adverse drug event （ADE）reports with febuxostat as the primary suspected drug ， involving 27 cardiac signals and 754 ADE reports. The most reported signals were symptoms （262 reports），including dizziness ， oedema peripheral，chest pain ，palpitations and gravitational oedema and so on ，followed by coronary atherosclerotic heart disease signal，heart failure signal ，arrhythmia signal ，sudden cardiac death signal （233，157，90，12 reports，respectively）. More than half of the signals were mentioned in the drug instructions ，while the unmentioned signals were mainly kinds of cardiac failure ， arrhythmia and extrasystoles ，etc. The patients with cardiac ADEs who received febuxostat were more male than female ，and the age was 60 and over ；the drug dosage was mostly 40 mg/d or 80 mg/d as recommended in the drug instructions ，and cardiac ADEs mostly occurred within 1 month of medication. CONCLUSIONS Routine attention should be paid to the cardiac safety of febuxostat during medication ，further evaluation and validation of febuxostat-induced cardiac ADR signals are still needed.

Objective:To explore the value of "conceive, design, implement, and operation" (CDIO) combined with cluster training mode in clinical teaching of cardiopulmonary resuscitation (CPR).Methods:A total of 108 interns of General Hospital of Southern Theater Command from January 2019 to November 2020 were included in the study, and they were randomly divided into control group ( n=54) and observation group ( n=54). The control group used the cluster training mode for CPR teaching, and the observation group used CDIO combined with the cluster training mode for CPR teaching. The theoretical performance, operation performance, comprehensive ability, chest compression quality and CPR time of the two groups of interns were compared, and the scores of post competency and satisfaction of the two groups of interns were evaluated. SPSS 22.0 was used for t test and chi-square test. Results:The scores of theory, operation and comprehensive ability in the observation group were higher than those in the control group. Compared with those before training, the compression depth, compression frequency and chest rebound rate of the observation group were higher than those of the control group. The observation group found that the patients' unconscious judgment of pulse free time, the time from the occurrence of ventricular fibrillation to the start of automated external defibrillator (AED), and the time to complete AED were lower than those in the control group. The five dimensions of practical ability, critical thinking ability, coordination ability, career development ability, psychological characteristics and the total score of post competency in the observation group were higher than those in the control group ( P < 0.05). The satisfaction of the observation group with the teaching teacher, practice content, practice form and practice effect was higher than that of the control group ( P<0.05). Conclusion:The application of CDIO combined with cluster training in clinical CPR teaching can improve the interns' theoretical performance, operational performance and comprehensive ability, improve the quality of external chest compression and CPR time, make the interns have good communication ability and post competency, and finally improve the interns' satisfaction.

Objective:To analyze and synthesize the care experience of caregivers of patients with spinal cord injury.Methods:Qualitative research on the care experience of caregivers of patients with spinal cord injury was retrieved by computer in Chinese and English databases such as PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI) , Wanfang Database, VIP, and China Biomedical Literature Database. The retrieval time was from the establishment of the database to December 11, 2020. The quality of the articles was evaluated by the quality evaluation criteria for qualitative research of the Joanna Briggs Institute (JBI) Evidence-Based Health Care Center in Australia, and the results were pooled for Meta-synthesis.Results:A total of 8 articles were included, and 33 research results were extracted, and 8 new categories were summarized, and 3 integrated results were synthesized. Integrated result 1 was the change in caregiver's psychological experience (In the process of long-term care, the psychological process of the caregiver was constantly changing, and a positive care experience was obtained through psychological support) . Integrated result 2 was the change in personal and social relationships (Caregivers' personal roles and social relationships were affected by taking care of patients for a long time, seeking multiple social supports, and gradually adjusting and adapting) . Integrated result 3 was the change in knowledge and skills (Due to the sudden nature of spinal cord injury, caregivers lacked caring knowledge and skills and were eager to learn caring skills) .Conclusions:The care experience of caregivers of patients with spinal cord injury is multifaceted. Medical and nursing staff should pay attention to the care needs and real experience of caregivers, provide them with professional care guidance and support, help them to be well qualified as caregivers, and improve the physical and mental health and quality of life of patients with spinal cord injury and their caregivers.

Issues caused by maxillofacial tumours involve not only dealing with tumours but also repairing jaw bone defects. In traditional tumour therapy, the systemic toxicity of chemotherapeutic drugs, invasive surgical resection, intractable tumour recurrence, and metastasis are major threats to the patients' lives in the clinic. Fortunately, biomaterial-based intervention can improve the efficiency of tumour treatment and decrease the possibility of recurrence and metastasis, suggesting new promising antitumour therapies. In addition, maxillofacial bone tissue defects caused by tumours and their treatment can negatively affect the physiological and psychological health of patients, and investment in treatment can result in a multitude of burdens to society. Biomaterials are promising options because they have good biocompatibility and bioactive properties for stimulation of bone regeneration. More interestingly, an integrated material regimen that combines tumour therapy with bone repair is a promising treatment option. Herein, we summarized traditional and biomaterial-mediated maxillofacial tumour treatments and analysed biomaterials for bone defect repair. Furthermore, we proposed a promising and superior design of dual-functional biomaterials for simultaneous tumour therapy and bone regeneration to provide a new strategy for managing maxillofacial tumours and improve the quality of life of patients in the future.
Biocompatible Materials ; Bone Regeneration ; Bone and Bones ; Humans ; Quality of Life

Objective:To systematically evaluate the experience of self-management in peritoneal dialysis patients.Methods:Databases including PubMed, Embase, Web of Science, the Cochrane Library, PsycInfo, Scopus and CNKI, Wanfang, VIP, CBM and Google Scholar were searched and relevant qualitative research on self-management experience of peritoneal dialysis patients was retrieved with a time limitation from the establishment of the databases to April 6, 2020. The quality of articles was evaluated by the quality evaluation standard of qualitative research of JBI evidence-based health care center (2008) , and the results were Meta integrated.Results:A total of 8 studies were included, and 26 complete research results were extracted. We summed up 10 new categories, and obtained 3 integrated results. Integration result 1: cognitive and behavioral management. Patients try to maintain the independence and confidence of peritoneal dialysis management through facing renal failure and adapting to dialysis treatment. Integration result 2: crisis identification and management of complications. Through continuous learning of knowledge and skills related to dialysis treatment, as well as identification and treatment of worsening symptoms, patients can improve their ability of crisis identification and management. Integration result 3: role and social relationship management. Patients constantly adjust their roles and emotions to adapt to changes in daily life and maintain social functions and strive to strengthen communication with medical care, family and society to obtain social relationship support, and increase patients' confidence in self-management.Conclusions:The self-management of peritoneal dialysis patients involves many aspects. The medical staff should give understanding, guidance, and support to the patients' self-management and self-care process in combination with family and society, to help them with better self-management and improve their quality of life.

Objective To analyze the clinical courses and outcomes of COVID-19 cases and the influencing factors in Guangdong province and provide basis for the formulation or adjustment of medical care and epidemic control strategy for COVID-19. Methods We collected demographic data, medical histories, clinical courses and outcomes of 1 350 COVID-19 patients reported in Guangdong as of 4 March 2020 via epidemiological investigation and process tracking. Disease severity and clinical course characteristics of the patients and influencing factors of severe illness were analyzed in our study. Results Among 1 350 cases of COVID-19 cases in Guangdong, 72 (5.3%) and 1049 (77.7%) were mild and ordinary cases, 164 (12.1%) were severe cases, 58 (4.3%) were critical cases and 7 (0.5%) were fatal. The median duration of illness were 23 days ( P 25 - P 75 : 18-31 days) and the median length of hospitalization were 20 days ( P 25 - P 75 : 15-27 days). For severe cases, the median time of showing severe manifestations was on the 12th day after onset ( P 25 - P 75 : 9th to 15th days), and the median time of severe manifestation lasted for 8 days P 25 - P 75 : 4-14 days). Among 1 066 discharged/fetal cases, 36.4% (36/99) and 1.0% (1/99) of the mild cases developed to ordinary cases and severe cases respectively after admission; and 5.2% (50/968) and 0.6% (6/968) of the ordinary cases developed to severe cases, and critical cases respectively after admission. In severe cases, 11.4% developed to critical cases (10/88). The influencing factors for severe illness or worse included male (a HR =1.87, 95% CI : 1.43-2.46), older age (a HR =1.67, 95% CI : 1.51-1.85), seeking medical care on day 2-3 after onset (a HR =1.73, 95% CI : 1.20-2.50) pre-existing diabetes (a HR =1.75, 95% CI : 1.12-2.73) and hypertension (a HR =1.49, 95% CI : 1.06-2.09). Conclusions The course of illness and length of hospitalization of COVID-19 cases were generally long and associated with severity of disease clinical outcomes. The severe cases were mainly occurred in populations at high risk. In the epidemic period, classified management of COVID-19 cases should be promoted according to needs for control and prevention of isolation and treatment for the purpose of rational allocation of medical resources.

Since December 2019, the corona virus disease 2019 (COVID-19) caused by the 2019 novel coronavirus (2019-nCoV) has been reported in Wuhan, Hubei Province. Almost 70% of patients susceptible to 2019-nCoV are over age of 50 years, with extremely large proportion of critical illness and death of the elderly patients. Meanwhile, the elderly patients are at high risk of osteoporotic fractures especially osteoporotic vertebral compression fractures (OVCF). During the prevention and control of COVID-19 epidemic, orthopedists are confronted with the following difficulties including how to screen and protect OVCF patients, how to accurately diagnose and assess the condition of OVCF patients with suspected or confirmed COVID-19, and how to develop reasonable treatment plans and comprehensive protective measures in emergency and outpatient clinics. In order to standardize the diagnosis and treatment of patients with OVCF diagnosed with COVID-19, the authors jointly develop this expert consensus. The consensus systematically recommends the standardized emergency and outpatient screening and confirmation procedures for OVCF patients with suspected or confirmed COVID-19 and protective measures for emergency and outpatient clinics. Moreover, the consensus describes the grading and classification of OVCF patients diagnosed with COVID-19 according to the severity of illness and recommends different treatment plans and corresponding protective measures based on the different types and epidemic prevention and control requirements.