Epigenomic imbalance drives abnormal transcriptional processes,promoting the onset and progression of cancer.Although defective gene regulation generally affects carcinogenesis and tumor suppression networks,tumor immunogenicity and immune cells involved in antitumor responses may also be affected by epigenomic changes,which may have significant implications for the development and application of epigenetic therapy,cancer immunotherapy,and their combinations.Herein,we focus on the impact of epigenetic regulation on tumor immune cell function and the role of key abnormal epigenetic processes,DNA methylation,histone post-translational modification,and chromatin structure in tumor immunogenicity,and introduce these epigenetic research methods.We emphasize the value of small-molecule inhibitors of epigenetic modulators in enhancing antitumor immune responses and discuss the challenges of developing treatment plans that combine epigenetic therapy and immuno-therapy through the complex interaction between cancer epigenetics and cancer immunology.

Objective:To introduce and validate the Pediatric Nausea Assessment Tool (PeNAT) and the Baxter Retching Faces Scale (BARF) in the assessment of chemotherapy induced nausea in Chinese children with malignant neoplasms, and to explore the cut-off value for rescue antiemetic.Methods:A prospective descriptive study was conducted, 244 children in Sun Yat-sen University Cancer Center with malignant neoplasms who received chemotherapy were selected by convenience sampling from July to August 2021. PeNAT, BARF, Visual Analogue Scale (VAS) and the Faces Pain Scale-Revised(FPS-R) were used to assess the severity of nausea and pain before and after chemotherapy, before and 30-60 minutes after the use of rescue antiemetic or analgesic. After chemotherapy, the children also were asked the changes of nausea severity and whether antiemetic was needed.Results:A test-retest reliability was conducted on the patients with the same severity of nausea before and after chemotherapy, and the intraclass correlation coefficient of the PeNAT and BARF were 0.940 (both P<0.05). After chemotherapy, the PeNAT and BARF were 1.5(1.0, 2.0) and 2.0(0, 2.0) points, which were significantly higher than the 1.0(1.0, 1.0) and 0(0, 0) points before chemotherapy ( Z = - 9.19, - 9.09, both P<0.01). The PeNAT and BARF of 11 cases receiving antiemetic before medication were 4.0 (4.0, 6.0) and 3.0(2.0, 4.0) points, which were higher than the 0(0, 2.0) and 1.0(1.0, 2.0) points without antiemetic ( Z = - 4.03, - 3.86, both P<0.05). After chemotherapy, the correlation coefficients between PeNAT or BARF and VAS-nausea were r = 0.933, 0.957 (both P<0.01), and FPS-R were r = 0.192, 0.189 (both P<0.05). After using antiemetic, PeNAT and BARF were 2.0(2.0, 3.0) and 2.5(2.0, 4.0) points, which were significant different than the 3.0(3.0, 3.8) and 4.0(4.0, 8.0) points before using antiemetic ( Z = - 2.97, - 2.83, both P<0.05). According ROC curves and cut-off values, it was determined that PeNAT≥3 and BARF≥4 had clinical significance and require clinical intervention. Conclusions:PeNAT and BARF have excellent reliability and validity in the assessment of chemotherapy induced nausea in children with malignant neoplasms, they can effectively identify the requirement of rescue antiemetic, and evaluate the efficacy of antiemetic.

Hip fractures are among the most common fractures in the elderly, presenting to be a leading cause of disability and mortality. Surgical treatment is currently the main treatment method for hip fractures. The incidence of perioperative malnutrition is increased after hip fractures in the elderly due to the comorbidities, decreased basal metabolic rate, accelerated protein breakdown, weakened anabolism and surgical stress. However, malnutrition not only increases the incidence of postoperative complications, but also leads to increased mortality, indicating an important role of perioperative nursing management of nutrition for the elderly patients with hip fractures. At present, there still lacks scientific guidance and application standards on perioperative nursing management of nutrition for the elderly patients with hip fractures. Therefore, the Orthopedic Nursing Committee of Chinese Nursing Association and the Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Expert consensus on perioperative nursing management of nutrition for elderly patients with hip fractures ( version 2023) according to evidence-based medical evidences and their clinical experiences. Fourteen recommendations were made from aspects of nutrition screening, nutrition assessment, nutrition diagnosis, nutrition intervention and nutrition monitoring to provide guidance for perioperative nursing management of nutrition in elderly patients with hip fractures.

Objective:To analyze clinical characteristics and genetic characteristics of children with ATP sensitive potassium passage (K ATP-HI). Methods:Forty-five children with genetically confirmed K ATP-HI and their families admitted to Beijing Children′s Hospital of Capital Medical University between February 2002 and December 2018 were selected as the study subjects. A detailed retrospective analysis of the patient's clinical characteristics, diagnosis and treatment process, disease-causing gene carrying status and later follow-up data was performed. ABCC8/KCNJ11 gene was sequenced by second-generation sequencing technology. Results:Among 45 children with K ATP-HI, 34 cases (75.6%) were neonatal onset, the first symptoms of 21 cases (46.7%) were convulsions. 39 cases had been treated with diazoxide, including 12 cases (30.8%) with good efficacy, 16 cases (41%) with poor efficacy and 11 cases with uncertain efficacy. Octreotide was further applied in 18 patients with uncertain or ineffective efficacy after diazoxide treatment, and 13 cases (72.2%) were effective, 3 cases were ineffective, and 2 cases were uncertain. 10 CHI patients who were ineffective to drug treatment or had clearly focal lesions confirmed by 18F-dopa positron emission by computed tomography ( 18F-DOPA PET) scans had undergone surgical treatment, 8 of which underwent partial pancreatectomy and blood glucose returned to normal after the operation; the other 2 cases underwent subtotal pancreatectomy and both had secondary diabetes after operation. Among 45 children with K ATP-HI, 1 case carried both ABCC8 and KCNJ11 mutations, 10 cases carried ABCC8 compound heterozygous mutations, and the remaining 34 cases carried ABCC8/KCNJ11 single genetic mutation. Among them, 21 cases had paternal inheritance, and 3 cases had maternal inheritance, 6 cases were identified with de novo mutations. Conclusions:Diazoxide treatment was ineffective for most K ATP-HI children, but octreotide had a higher effective rate. Partial pancreatectomy for focal type patients had a higher cure rate, and there was a risk of secondary diabetes after subproximal pancreatectomy, so it was very important to clarify the histological type of children before surgery. ABCC8 gene mutations and KCNJ11 gene mutations were the main pathogenic genes of K ATP-HI. Among patients carrying mutations in single ABCC8 or KCNJ11 gene mutation, K ATP-HI inherited by paternity were the majority. Some K ATP-HI children can relieve the hypoglycemia symptoms by themselves.

【Objective】 To investigate the epidemiology of HTLV by conducting HTLV nucleic acid detection among voluntary blood donors, so as to provide basis for the decision making of blood screening strategy. 【Methods】 The HTLV blood nucleic acid(NAT) screening platform was established based on the existing NAT for HBV / HCV / HIV screening. HTLV (type 1 + 2) detection was carried out in 5 368 blood donors, and the results were analyzed. 【Results】 No NAT-yielding of HTLV- 1, -2 type was found in a total of 5 368 voluntary blood donor from January to August 2019. 【Conclusion】 Qianxinan, currently, is very low epidemic or non epidemic as none of HTLV infections was found among blood donors and no significant differences in the epidemiology of HTLV were notable between the counties and cities. It, however, still needs further investigation in the future.

Cancer treatments may improve the long-term survival rate of young patients with breast cancer, but also lead to a decrease in fertility. With the younger incidence of breast cancer in China, the fertility needs of this group have received more attention, and fertility preservation technology suitable for cancer patients is developing continuously. However, there are still many problems in the implementation of fertility preservation for young breast cancer patients in China. Patients and breast surgeons have insufficient understanding and conservative attitudes towards fertility preservation technology. And there is a lack of reproductive experts in the treatment process. What′s more, the long-term follow-up and information management of patients undergoing fertility preservation are defective. In response to the above, this paper discusses how to deal with patients with potential reproductive needs in clinical practice from the perspective of breast surgeons. The first is to improve their own understanding of fertility preservation, such as the progress of relevant technologies and applicable population, when to intervene, when and how to get pregnant after cancer treatment. Secondly, education for patients must be strengthened, which should include not only fertility preservation, but also scientific contraceptive methods during cancer treatment and treatment measures for unexpected pregnancy. Finally, hospitals and relevant units should standardize the multidisciplinary team of breast cancer, and strengthen the comprehensive management of young breast cancer patients, thus to provide young breast cancer patients with more scientific cancer treatment programs and more reproductive opportunities.

Cancer treatments may improve the long-term survival rate of young patients with breast cancer, but also lead to a decrease in fertility. With the younger incidence of breast cancer in China, the fertility needs of this group have received more attention, and fertility preservation technology suitable for cancer patients is developing continuously. However, there are still many problems in the implementation of fertility preservation for young breast cancer patients in China. Patients and breast surgeons have insufficient understanding and conservative attitudes towards fertility preservation technology. And there is a lack of reproductive experts in the treatment process. What′s more, the long-term follow-up and information management of patients undergoing fertility preservation are defective. In response to the above, this paper discusses how to deal with patients with potential reproductive needs in clinical practice from the perspective of breast surgeons. The first is to improve their own understanding of fertility preservation, such as the progress of relevant technologies and applicable population, when to intervene, when and how to get pregnant after cancer treatment. Secondly, education for patients must be strengthened, which should include not only fertility preservation, but also scientific contraceptive methods during cancer treatment and treatment measures for unexpected pregnancy. Finally, hospitals and relevant units should standardize the multidisciplinary team of breast cancer, and strengthen the comprehensive management of young breast cancer patients, thus to provide young breast cancer patients with more scientific cancer treatment programs and more reproductive opportunities.

Objective: To analyze the clinical features and genetic characteristics of Chinese children with glutamate dehydrogenase type of congenital hyperinsulinism (GDH-HI). Methods: Pedigrees with 10 GDH-HI children admitted to Beijing Children′s Hospital from February 2008 to December 2018 were selected as subjects. Clinical features, the detection of pathogenic genes and follow-up data were retrospectively analyzed. Polymerase chain reaction DNA (PCR-DNA) direct sequencing method and second generation sequencing technique were used to analyze the GLUD1 genetic sequences of 10 GDH-HI children and their relatives. Results: Of the 10 GDH-HI children, 9 had normal birth weight and 1 was a giant. Nine patients were accompanied by asymptomatic hyperammonemia, and one had normal blood ammonia. 9 had ever been treated with diazoxide, which was all effective. All 10 children carried GLUD1 gene mutations, 5 patients carried c. 965C>T (p.R322H) GLUD1 gene mutation, and the remaining 5 cases carried c. 1388A>T (p.N463I), c. 1495C>A(p.G499C), c. 1493C>T(p. S498L), c. 1519G>A(p.H507Y) and c. 1388A>G(p.N463S), respectively. 9 cases (90%) had de novo mutations, and 1 case had paternal autosomal dominant inheritance. 8 children were followed up in long term. One child had spontaneous remission in 8 years after being diagnosed, and seven patients required long-term oral diazoxide to maintain normal blood glucose levels, two of whom had epilepsy. Conclusions The birth weight of children with GDH-HI in China was usually normal. A small number of GDH-HI children had normal serum ammonia levels. Most of the GLUD1 gene mutations in GDH-HI children in China were de novo mutations, among which the GDH p. R322H mutation was a hot spot mutation in Chinese children with GDH-HI. Most of GDH-HI children were diazoxide-responsive. As the disease progresses, some children may have epilepsy, and a few children have a tendency to relieve by themselves.

Objective To investigate the perioperative effects of simultaneous fixation and staging fixation in polytrauma patients combined with spine injury and long bone fracture.Methods A retrospective case control study was conducted to analyze the clinical data of 41 severe polytrauma patients with unstable spine combined with long bone fracture admitted from June 2009 to June 2015.There were 30 males and 11 females,aged 21-66 years [(41.2 ± 12.2)years].The injured spinal segments included cervical vertebrae in 11 patients,thoracic vertebrae in 15,lumbar vertebrae in 23,sacrococcygeal vertebrae in two,as well as injuries at two or more different segments in 10 patients.The long bone fracture segments included humerus in six patients,radius and ulna in 14,femur in 15,tibia and fibula in 14,as well as injuries at two or more different segments in eight patients.The injury severity score (ISS) were all ≥ 15 points.According to the timing of operation,the patients were divided into the simultaneous operation group (20 patients) and the staging operation group (21 patients).In the simultaneous operation group,there were 16 males and four females,aged (43.1 ± 12.6)years,and internal or external fixations of spine and long bone were performed at stage Ⅰ.In the staging operation group,there were 14 males and seven females,aged (40.1 ± 11.9)years.Spine fixation surgery was performed first,and then surgery for long bone fracture was performed after the conditions were stabilized.Spinal surgery methods included anterior subtotal vertebral resection,bone graft plate internal fixation,posterior laminectomy and decompression,and lateral mass screw or pedicle screw internal fixation.Plate and interlocking nail were used for internal fixation of long bone fracture,and single arm bracket for external fixation.The preoperative hospitalization time,operation time,operative blood loss (intraoperative hemorrhage and postoperative drainage),postoperative complications,hospitalization time and Frankel score of spinal cord injury before and after operation were compared between the two groups.Results The preoperative hospital stay was (9.3 ± 6.7) days in the simultaneous operation group and (5.6 ± 5.0) days in the staging operation group (P ＞ 0.05).The simultaneous operation group had significantly longer operation time [(4.9 ± 2.0) hours] than the staging operation group [(3.2 ± 1.2) hours] (P ＜ 0.01),more operative blood loss [(1 322.6 ± 507.1) ml] than the staging operation group [(1 036.7 ± 233.9) ml] (P＜0.05),and shorter hospitalization stay [(22.8 ± 12.6)days] than the staging operation group [(33.0 ± 15.4) days] (P ＜ 0.05).The complication incidence of the simultaneous operation group [45％ (9/20)] was significantly lower than that of the staging operation group [86％ (18/21)] (P ＜ 0.01).No significant difference was found in Frankel score between the simultaneous operation group [(3.3 ±1.7)points] and the staging operation group [(3.1 ± 1.5)points] (P ＞0.05).Conclusion For polytrauma patients combined with spine injury and long bone fracture,simultaneous operation can reduce hospitalization time and complication incidence compared with staging operation.

Objective To evaluate the clinical application of modified bony landmark measurement ( MBLM ) to deal with leg length discrepancy ( LLD ) during total hip arthroplasty ( THA ). Methods We retrospectively analyzed the 36 patients in whom MBLM was used to deal with LLD during THA from January 2014 to May 2015 at Department of Orthopaedics, The Second Hospital of Fuzhou. They were 17 men and 19 women, aged from 42 to 78 years ( average, 68.7 ± 10.1 years ). They were divided into 3 groups according to their pre-operative LLD value ( d ) : 16 cases in group A with d≤10 mm, 11 cases in group B with 10 mm ＜d≤20 mm and 9 cases in group C with d ＞ 20 mm. After the sizes of prosthetic cup and femoral component and the location of implant were determined using preoperative X-ray, a special formula was used to calculate the prosthetic length of femoral head neck and the osteotomy area at the femoral neck. MBLM was used to measure the leg lengths before hip joint dislocation and after placement of the hip implant. The neck length and depth of the femoral component was adjusted according to the measurements. Post-operative X-ray was used to measure the LLD ( d'). The value of MBLM in judgment of LLD during THA was assessed by comparison of d and d' and analysis of distribution of d' . Results The postoperative d' ( 6.0 ± 3.0 mm) was signifi-cantly shorter than the preoperative d ( 11.0 ± 5.0 mm) ( t＝5.145, P ＜0.001 ). There were 30 cases with d' ≤ 10 mm, 6 cases with 10 mm ＜d'≤ 20 mm and 0 case with d' ＞ 20 mm. The cases with d'≤ 10 mm were significantly more than those with d ≤ 10 mm and the cases with d' ＞ 20 mm significantly fewer than those with d ＞ 20 mm ( χ2＝15.500, P＝0.000 ) . Conclusion MBLM used during THA is a reliable method to judge the leg lengths so that LLD can be effectively reduced after THA.