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Our research aims at the analysis of various stone scoring systems which are referred to as STONE scoring system (SSS) in this study. GUY’s scoring system and RUSS scoring system (RSS) are utilized to predict stone-free status (SFS) after surgery and problems after percutaneous nephrolithotomy (PCNL) for harder stones. The data of 68 patients with renal calculi who received FURL in Ren Ji Hospital from Jan 2020 to Mar 2021 are collected as the study subjects. There were 44 male and 24 female patients, with an average age of 55.6 ± 11.4 years. Reliability analysis of related influencing factors (IF) of stone clearance rate (SCR) and multiple scoring systems after flexible ureteroscopic lithotripsy (FURL) was performed. Relevant factors with statistical significance for postoperative SCR were selected for logistic regression analysis (RA). According to the SSS score, GSS classification, and RUSS score, the SCR after FURL was statistically analyzed. The results showed that the P values corresponding to stone position (lower caliceal), cumulative stone diameter (CSD), urinary tract infection, and external physical vibration lithecbole (EPVL) were less than 0.05. The area under the ROC curve of RUSS score, SSS score, and GSS grading was 0.932, 0.841, and 0.533, respectively. The main IF of SCR after FURL were stone location (lower caliceal), CSD, urinary tract infection, and EPVL. The RUSS score system was the best in the evaluation of SCR after FURL. In the previous research, the score systems such as CROES (CRS), SSS, S-ReS, C, and GSS for the prediction of SFS were compared. In our analysis, we have compared the RUSS scoring system which has proven to be giving better results as compared to SSS and GSS. We also performed the regression analysis and found that the stone location shows the strongest correlation of all the other factors for stone clearing rate.

Psychiatric nurses often experience burnout and other mental health symptoms. However, few studies have examined these phenomena and gender-specific associated factors during the COVID-19 pandemic. We surveyed a national sample of psychiatric nurses (N = 8971) from 41 tertiary psychiatric hospitals in China as part of a large national survey conducted during the pandemic. The Maslach Burnout Inventory-Human Service Survey was used to assess burnout and the Depression, Anxiety, and Stress Scale-21 was used to assess mental health symptoms. Binary logistic regression analyses were used to explore factors associated with burnout in the entire sample and separately by gender. The overall prevalence of burnout was 27.27%, with the rate in male psychiatric nurses (32.24%) being significantly higher than that in female psychiatric nurses (25.97%). Many key demographic factors (such as the male gender and marital status), work-related variables (such as a mid-level professional title, having an administrative position, longer working hours, more monthly night shifts, and the perceived negative impact of the COVID-19 pandemic on medical work) were significantly associated with burnout in the whole sample. Moreover, burnout was associated with depression, anxiety, and stress symptoms in the whole sample. Gender-specific factors associated with burnout were also identified: burnout was associated with night shifts in male psychiatric nurses, whereas it was associated with single or married marital status, a mid-level professional title, and having an administrative position among female psychiatric nurses. The high rates of burnout and mental health symptoms in psychiatric nurses need attention from hospital administrators. While mental health symptoms, longer working hours, and the perceived impact of COVID-19 are associated with burnout in both genders, gender-specific factors also warrant special attention when developing gender-specific interventions.

Alcohol liver disease (ALD) has become a global threat to human health. It is associated with a wide range of liver diseases including alcohol fatty liver, steatosis, fibrosis and cirrhosis, and finally leads to liver cancer and even death. Centranthera grandiflora is a traditional Chinese medicinal herb commonly used to treat ALD, but no research about its mechanism is available. This study evaluated the hepatoprotective effect and mechanism of C. grandiflora against alcohol-induced liver injury in mice. We found that the ethanol extracts of C. grandiflora (CgW) alleviated the alcohol-induced liver injury, enhanced the levels of antioxidant enzymes, and reduced the amount of lipid peroxides. CgW also affected cell apoptosis by inhibiting the activity of Bax, cleaved-caspase 3 and cleaved-caspase 9, and increasing the activity of Bcl-2. In conclusion, the results showed that CgW can effectively improve ALD through alleviating oxidative stress and inhibiting cell apoptosis for the first time. This study suggested that C. grandiflora is a promising herbal medicine for ALD treatment.

Radiotherapy uses high-energy X-rays or other particles to destroy cancer cells and medical practitioners have used this approach extensively for cancer treatment (Hachadorian et al., 2020). However, it is accompanied by risks because it seriously harms normal cells while killing cancer cells. The side effects can lower cancer patients' quality of life and are very unpredictable due to individual differences (Bentzen, 2006). Therefore, it is essential to assess a patient's body damage after radiotherapy to formulate an individualized recovery treatment plan. Exhaled volatile organic compounds (VOCs) can be changed by radiotherapy and thus used for medical diagnosis (Vaks et al., 2012). During treatment, high-energy X-rays can induce apoptosis; meanwhile, cell membranes are damaged due to lipid peroxidation, converting unsaturated fatty acids into volatile metabolites (Losada-Barreiro and Bravo-Díaz, 2017). At the same time, radiotherapy oxidizes water, resulting in reactive oxygen species (ROS) that can increase the epithelial permeability of pulmonary alveoli, enabling the respiratory system to exhale volatile metabolites (Davidovich et al., 2013; Popa et al., 2020). These exhaled VOCs can be used to monitor body damage caused by radiotherapy.

Background The prognosis difference based on the depth of tumor muscularis propria invasion in gastric cancer (GC) was still debated, and therapy strategy for stage IB GC patient required further investigation. Methods A total of 380 patients with pT2 GC after radical surgery were retrospectively analyzed, including 185 in superficial muscularis propria (sMP) group and 195 in deep muscularis propria (dMP) group. Results The overall survival (OS) was significantly better for patients in sMP group than for patients in dMP group (P = 0.007). In multivariate analysis, depth of tumor invasion, pN stage, age, primary location, positive expression of p53, elevated maximal LDH, elevated initial CA19-9 and AFP level were independent prognostic factors for OS. The sMP group had a significantly better OS than dMP group (P = 0.014) in pN0 stage. After further stratification, the survival outcomes were not significantly different between deep muscularis propria tumor invasion without lymph node metastasis (dMPN0) group (stage IB) and superficial muscularis propria tumor invasion with stage 1–2 lymph node metastasis (sMPN1–2) group (stage II) (P = 0.100). Patients with adjuvant chemotherapy had a statistically better survival than those without in dMPN0 group (P = 0.045) and dMPN0 patients with adjuvant chemotherapy had better OS than sMPN1–2 patients (P = 0.015). In addition, greater postoperative survival could be observed in sMPN0 patients than dMPN0 patients in p53-positive group (P = 0.002), and similar OS could be seen between dMPN0 patients with p53-positive and T2N1–2 patients (P = 0.872). Conclusion As a unique subclassification of stage IB GC, appropriate adjuvant chemotherapy should be considered for patients with dMPN0 stage. In addition, positive expression of p53, elevated LDH could be potential factors in identifying the different prognoses for stage IB GC patients.

Background. Up to now, an accurate nomogram to predict the lung metastasis probability in Ewing sarcoma (ES) at initial diagnosis is lacking. Our objective was to construct and validate a nomogram for the prediction of lung metastasis in ES patients. Methods. A total of 1157 patients with ES from the Surveillance, Epidemiology, and End Results (SEER) database were retrospectively collected. The predictors of lung metastasis were identified via the least absolute shrinkage and selection operator (LASSO) and multivariate logistic analysis. The discrimination and calibration of the nomogram were validated by receiver operating characteristic (ROC) curve and calibration curve. Decision curve analysis (DCA) was used to evaluate the clinical usefulness and net benefits of the prediction model. Results. Factors including age, tumor size, primary site, tumor extension, and other site metastasis were identified as the ultimate predictors for the nomogram. The calibration curves for the training and validation cohorts both revealed good agreement, and the Hosmer&ndash, Lemeshow test identified that the model was well fitted (p &gt, 0.05). In addition, the area under the ROC curve (AUC) values in the training and validation cohorts were 0.732 (95% confidence interval, CI: 0.607&ndash, 0.808) and 0.741 (95% CI: 0.602&ndash, 0.856), respectively, indicating good predictive discrimination. The DCA showed that when the predictive metastasis probability was between 1% and 90%, the nomogram could provide clinical usefulness and net benefit. Conclusion. The nomogram constructed and validated by us could provide a convenient and effective tool for clinicians that can improve prediction of the probability of lung metastasis in patients with ES at initial diagnosis.

Lei Xia,1,* Li Wen,1,2,* Xiangxi Meng,1 Nina Zhou,1 Xiaoyi Guo,1 Teli Liu,1 Xiaoxia Xu,1 Feng Wang,1 Hua Zhu,1 Zhi Yang1 1Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing, 100142, People’s Republic of China; 2Guizhou University School of Medicine, Guiyang, Guizhou, 550025, People’s Republic of China*These authors contributed equally to this workCorrespondence: Hua Zhu; Zhi YangKey Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing, 100142, People’s Republic of ChinaTel +86 010-88196196; +86 010-88196495Email zhuhuananjing@163.com; pekyz@163.comBackground: In recent years, nuclear medicine imaging and therapy for prostate cancer have radically changed through the introduction of radiolabeled prostate-specific membrane antigen (PSMA)-binding peptides. However, these small molecular probes have some inherent limitations, including high nephrotoxicity and short circulation time, which limits their utility in biological systems.Methods and Results: In this study, organic melanin nanoparticles were used to directly label the long half-life radionuclide 124I (t1/2=100.8 h), and PSMA small molecular groups were efficiently bonded on the surface of nanoparticles to construct the PSMA-targeted long-retention nanoprobe 124I-PPMN, which has the potential to increase tumor uptake and prolong residence time. The results showed that the nanoprobe could substantially aggregate in the tumors of prostate cancer xenograft mice and was visible for more than 72 h. Positron Emission Computed Tomography (PET) imaging showed that the nanoprobe could be used for precise imaging of prostate cancer with high expression of PSMA. In addition, organic melanin nanoparticles labeled with an elemental radionuclide achieved a stable, metal-free structure. Cell experiments and mouse toxicity experiments indicated that the nanoprobe has high safety.Conclusion: The new nanoprobe constructed in this study has high specificity and biocompatibility. In the future, combined with the multifunctional potential of melanin nanoparticles, this nanoprobe is expected to be used in the integrated theranostics of prostate cancer.Keywords: prostate cancer, 124I, PET, PSMA, melanin nanoparticles

Background: Tauopathies are a group of neurodegenerative disorders, including Alzheimer’s disease (AD) and frontotemporal lobar degeneration with tau pathology. Hyperphosphorylation modification promotes tau protein misfolding and aggregation into neurofibrillary tangles, leading to impairments of synaptic plasticity and learning and memory. However, very limited therapeutic strategies are available. Objective: In the present study, we wanted to investigate the potential effects of Dihydroartemisinin (DHA) on tauopathies. Methods: We constructed adeno-associated virus carrying hTau cDNA (AAVhTau) to establish a mouse model of tauopathy through intrahippocampal microinjection. Using a combination of behavioral test, electrophysiological recording, and western blotting assay, we examined the neuroprotective effects of DHA on learning and memory deficits in mice with tauopathy. Results: DHA improved learning and memory and increased hippocampal CA1 long-term potentiation (LTP) in mice overexpressed human tau (hTau) in the hippocampus. More importantly, further study revealed that DHA could induce protein O-GlcNAcylation modification and reduce protein phosphorylation. O-GlcNAc transferase inhibitor alloxan could suppress DHA-induced protein O-GlcNAcylation, and subsequently prevent therapeutic effect of DHA on the deficits of learning and memory as well as synaptic plasticity in hTau mice. Conclusion: These results indicate that DHA may exert neuroprotective role in tauopathy through a crosstalk between O-GlcNAcylation and phosphorylation, suggesting a potential therapeutic for learning and memory deficits associated with tau pathology.

BackgroundChildhood-onset asthma (COA) has become a major and growing problem worldwide and imposes a heavy socioeconomic burden on individuals and families; therefore, understanding the influence of early-life experiences such as breastfeeding on COA is of great importance for early prevention.ObjectivesTo investigate the impact of breastfeeding on asthma in children under 12 years of age and explore its role at two different stages of age in the UK Biobank cohort.MethodsA total of 7,157 COA cases and 158,253 controls were obtained, with information regarding breastfeeding, COA, and other important variables available through questionnaires. The relationship between breastfeeding and COA were examined with the logistic regression while adjusting for available covariates. In addition, a sibling analysis was performed on 398 pairs of siblings to explain unmeasured family factors, and a genetic risk score analysis was performed to control for genetic confounding impact. Finally, a power evaluation was conducted in the sibling data.ResultsIn the full cohort, it was identified that breastfeeding had a protective effect on COA (the adjusted odds ratio (OR)=0.875, 95% confidence intervals (CIs): 0.831~0.922; P=5.75×10-7). The impact was slightly pronounced in children aged 6-12 years (OR=0.852, 95%CIs: 0.794~0.914, P=7.41×10-6) compared to those aged under six years (OR=0.904, 95%CIs: 0.837~0.975, P=9.39×10-3), although such difference was not substantial (P=0.266). However, in the sibling cohort these protective effects were no longer significant largely due to inadequate samples as it was demonstrated that the power was only 23.8% for all children in the sibling cohort under our current setting. The protective effect of breastfeeding on COA was nearly unchanged after incorporating the genetic risk score into both the full and sibling cohorts.ConclusionsOur study offered supportive evidence for the protective effect of breastfeeding against asthma in children less than 12 years of age; however, sibling studies with larger samples were warranted to further validate the robustness our results against unmeasured family confounders. Our findings had the potential to encourage mothers to initiate and prolong breastfeeding.

On 21 March 2022, a China Eastern Airlines plane with 132 people on board crashed and all people are presumed dead. This study aimed to explore mental health symptoms and attitudes toward the plane crash among flight and train attendant students and the general public. A cross-sectional online survey was conducted two weeks after the plane crash. Mental health symptoms, including posttraumatic stress symptoms (PTSS), depressive, anxiety, and insomnia symptoms were assessed. A total of 494 participants were included, of which 183 were flight (n = 140) and train (n = 43) attendant students (aged 17.3 ± 1.7 years, 80.9% were female), and 311 were sampled from the general population (aged 26.7 ± 7.8 years, 62.1% were female). The prevalence of depressive, anxiety, and insomnia symptoms, and PTSS was 51.9%, 40.4%, 25.1%, and 12.6% in the transportation students, and 45.3%, 36.0%, 17.4%, and 4.2% in the general public sample, respectively. The students reported more frequent insomnia symptoms and PTSS than the general public sample. In the student group, compared with those without PTSS, those with PTSS reported significantly higher rates of depressive, anxiety, and insomnia symptoms. Two weeks after a plane crash, mental health symptoms are common in the general public and transportation students, with the latter being more likely to have PTSS symptoms. Our findings suggest the importance to identify risk groups when developing interventions after indirect exposure to traumatic events.

Esophageal squamous cell carcinoma (ESCC) represents one of the most common malignancies and is the fifth leading cause of cancer-related deaths. Long intergenic non-coding RNAs (lincRNAs) have been suggested to be dysregulated in various types of cancers, and a growing number of lincRNAs have been implicated to be functional in the ESCC progression. In this study, we examined the role of linc00941 in the ESCC progression and explored the underlying molecular mechanisms. The bioinformatics analysis identified the up-regulation of linc00941 in the ESCC tissues. Further in vitro studies showed that linc00941 was up-regulated in ESCC cell lines. The loss-of-function studies demonstrated that linc00941 knockdown suppressed ESCC cell proliferation, invasion and migration, and also suppressed the in vivo tumor growth. Furthermore, bioinformatics prediction along with luciferase reporter assay and RNA immunoprecipitation assay implied that linc00941 acted as a competing endogenous RNA for miR-877-3p, and linc00941 regulated ESCC cell progression via at least targeting miR-877-3p. Subsequently, miR-877-3p targeted prostate transmembrane protein, androgen induced 1 (PMEPA1) 3’ untranslated region and repressed PMEPA1 expression in ESCC cells; overexpression of PMEPA1 attenuated the inhibitory effects of linc00941 knockdown on the ESCC cell progression. Linc00941 knockdown suppressed epithelial-mesenchymal transition (EMT) via targeting miR-877-3p/PMEPA1 axis in ESCC cells. In conclusion, our results indicated the oncogenic role of linc00941 in ESCC, and knockdown of linc00941 suppressed ESCC cell proliferation, invasion, migration and EMT via interacting with miR-877-3p/PMEPA1 axis.

To compare the clinical and radiologic outcomes of patients with different 3-dimensional (3D) hemivertebra morphologies undergoing posterior-only hemivertebra resection and fusion.The files of patients with congenital scoliosis (CS) due to single hemivertebra undergoing posterior-only hemivertebra resection and fusion from January 2010 to January 2018 were reviewed. After evaluating the 3D computed tomography images, CS patients were divided into a unison hemivertebra group and a discordant hemivertebra group. Clinical outcomes, radiologic outcomes, and incidence of complications were compared.A total of 42 consecutive patients with CS patients due to a single hemivertebra undergoing posterior-only hemivertebra resection and fusion were included in this study. The Cobb angle of the segmental curve was significantly improved postoperatively and at the last follow-up in both groups (all P0.05). At both postoperation and the last follow-up, no significant differences were found in the incidence of complications, Cobb angle of the segmental curve, correction rate of the segmental curve, or other radiologic outcomes between the unison hemivertebra group and discordant hemivertebra group (all P0.05). Compared with the unison hemivertebra group, increased operation time (P = 0.006) and intraoperative blood loss (P = 0.037) were found in the discordant hemivertebra group.For CS patients with unison hemivertebra or discordant hemivertebra, satisfactory radiologic results were obtained by posterior-only hemivertebra resection and fusion. In terms of surgery, the radiologic outcomes of discordant hemivertebra patients were similar to those of unison hemivertebra patients, but discordant hemivertebrae could easily result in longer operation time and more intraoperative blood loss.

BACKGROUND: Prostate transmembrane protein androgen-induced 1 (PMEPA1), a critical checkpoint of multiple signaling pathways, has been demonstrated to play a crucial role in various types of cancers. However, little is known about its function in non-small cell lung cancer (NSCLC). OBJECTIVE: Our objective is to explore the function of PMEPA1 and its potential mechanisms in NSCLC progression. METHODS: PMEPA1 expression and prognostic significance in adenocarcinoma of lung cancer (LUAD) and squamous cell carcinoma of lung cancer (LUSC) were determined using Gene Expression Profiling Interactive Analysis (GEPIA). Next, a series of cell assays were performed to examine whether overexpression or depletion of PMEPA1 affected the malignant behaviors of NSCLC H1299 cells, such as proliferation and migration. Luciferase reporter gene assays and SP600125 (a JNK inhibitor) were employed to ascertain the regulatory relationship between PMEPA1 and JNK. RESULTS: PMEPA1 is overexpressed in LUAD and LUSC tissues and portends a worse prognosis for cancer patients. Gain and loss of function experiments demonstrated that PMEPA1 executes oncogenetic function in H1299 cells. Mechanism studies elucidated that PMEPA1 stimulated the transcriptional activity of the JNK pathway. CONCLUSION: PMEPA1 increased the H1299 cell viability, proliferation, and migration which works, at least partially, by triggering the JNK activity. Hence, our findings support that the PMEPA1/JNK axis might be a promising therapeutic target for this challenging disease.

Objectives. Tacrolimus is characterized by high pharmacokinetic variability in combination with a narrow therapeutic range. However, influence of donor CYP3A5 genotype and graft-to-recipient body weight ratio (GRWR) on tacrolimus’ pharmacokinetics after pediatric living donor liver transplantation (LDLT) remains unclear. Methods. A total of 174 LDLT recipients ( n = 40 ), SS/EX ( n = 38 ), LS/NEX ( n = 48 ), and LS/EX ( n = 48 ). Pharmacokinetics of tacrolimus and clinical outcomes were analyzed. Results. The relationships between the concentration-dose ratio and donor CYP3A5 genotypes and graft size were examined 3, 7, 14, and 30 days after the transplantation. Tacrolimus C0 levels varied greatly among groups, although recipients started with the same initial dosage. LS/EX recipients had significantly lower C0 levels in comparison with those of other groups. The use of CYP3A5-EX-grafts and a greater GRWR both resulted in significantly higher TAC dose requirements and lower C/D ratios. However, the significance of GRWR no longer exists 3 months after transplantation. The multivariate generalized linear mixed model analysis showed that donor CYP3A5 genotypes ( F = 11.876 ; P = 0.01 ) and GRWR ( F = 4.631 ; P = 0.033 ) were independent impact factors for C/D ratios 3, 7, 14, and 30 days after transplantation. Donor CYP3A5-EX genotype was associated with significantly increasing risks of infectious complications and significantly lower Cylex ATP values. However, no significant difference was observed in acute rejections among 4 groups. Conclusions. Monitoring of C0 levels alone is not reliable to guide tacrolimus administration. Donor CYP3A5 and GRWR both significantly affect tacrolimus pharmacokinetics after pediatric LDLT. The use of Cylex ATP tests would be helpful to avoid overimmunosuppression.

Background As a key process in transcriptional regulatory mechanisms, alternative splicing (AS) plays a crucial role in maintaining the diversity of RNA and protein expression, and mediates the immune response in infectious diseases, especially for the COVID-19. Therefore, urgent data gathering and more research of AS profiles in microbe-infected human cells are needed to improve understanding of COVID-19 and related infectious diseases. Herein, we have created CASA, the COVID-19 Alternative Splicing Atlas to provide a convenient computing platform for studies of AS in COVID-19 and COVID-19-related infectious diseases. Methods In CASA, we reanalyzed thousands of RNA-seq datasets generated from 65 different tissues, organoids and cell lines to systematically obtain quantitative data on AS events under different conditions. A total of 262,994 AS events from various infectious diseases with differing severity were detected and visualized in this database. In order to explore the potential function of dynamics AS events, we performed analysis of functional annotations and drug-target interactions affected by AS in each dataset. RNA-binding proteins (RBPs), which may regulate these dynamic AS events are also provided for users in this database. Results CASA displays microbe-induced alterations of the host cell splicing landscape across different virus families and helps users identify condition-specific splicing patterns, as well as their potential regulators. CASA may greatly facilitate the exploration of AS profiles and novel mechanisms of host cell splicing by viral manipulation. CASA is freely available at http://www.splicedb.net/casa/.

Background The pivotal role of long noncoding RNAs (lncRNAs) in cancer immune responses has been well established. This study was conducted with the aim of exploring the molecular mechanism of lncRNA small nucleolar RNA host gene 12 (SNHG12) in immune escape of non-small cell lung cancer (NSCLC). Methods Expression of lncRNA SNHG12, programmed cell death receptor ligand 1 (PD-L1), ubiquitin-specific protease 8 (USP8), and human antigen R (HuR) in NSCLC tissues and cells was measured, and their binding relationship was determined. NSCLC cell proliferation and apoptosis were assessed. Peripheral blood mononuclear cells (PBMCs) were co-cultured with NSCLC cells. The ratio of CD8+ T cells, PBMC proliferation, and inflammatory factors were determined. lncRNA SNHG12 localization was assessed via subcellular fractionation assay. The half-life period of mRNA was determined using actinomycin D. Xenograft tumor models were established to confirm the role of lncRNA SNHG12 in vivo. Results LncRNA SNHG12 was found to be prominently expressed in NSCLC tissues and cells, which was associated with a poor prognosis. Silencing lncRNA SNHG12 resulted in the reduction in proliferation and the promotion of apoptosis of NSCLC cells, while simultaneously increasing PBMC proliferation and the ratio of CD8+ T cells. Mechanically, the binding of lncRNA SNHG12 to HuR improved mRNA stability and expression of PD-L1 and USP8, and USP8-mediated deubiquitination stabilized the protein level of PD-L1. Overexpression of USP8 or PD-L1 weakened the inhibition of silencing lncRNA SNHG12 on the immune escape of NSCLC. Silencing lncRNA SNHG12 restricted tumor growth and upregulated the ratio of CD8+ T cells by decreasing USP8 and PD-L1. Conclusion LncRNA SNHG12 facilitated the immune escape of NSCLC by binding to HuR and increasing PD-L1 and USP8 levels.

Background Intraventricular hemorrhage (IVH) is a common complication in preterm infants that has poor outcomes, especially in severe cases, and there are currently no widely accepted effective treatments. Erythropoietin has been shown to be neuroprotective in neonatal brain injury. Objective The objective of this study was to evaluate the protective effect of repeated low-dose recombinant human erythropoietin (rhEPO) in preterm infants with IVH. Methods This was a single-blinded prospective randomized controlled trial. Preterm infants ≤ 32 weeks gestational age who were diagnosed with IVH within 72 h after birth were randomized to receive rhEPO 500 IU/kg or placebo (equivalent volume of saline) every other day for 2 weeks. The primary outcome was death or neurological disability assessed at 18 months of corrected age. Results A total of 316 eligible infants were included in the study, with 157 in the rhEPO group and 159 in the placebo group. Although no significant differences in mortality (p = 0.176) or incidence of neurological disability (p = 0.055) separately at 18 months of corrected age were seen between the rhEPO and placebo groups, significantly fewer infants had poor outcomes (death and neurological disability) in the rhEPO group: 14.9 vs. 26.4%; odds ratio (OR) 0.398; 95% confidence interval (CI) 0.199–0.796; p = 0.009. In addition, the incidence of Mental Development Index scores of

Objective To investigate the risk factors and to construct a nomogram for the prediction of postoperative neck tilt (PNT) in patients with Lenke I and II adolescent idiopathic scoliosis (AIS). Methods A total of 95 patients with Lenke I and II AIS who underwent posterior segmental spinal instrumentation and fusion between the years 2010 and 2018 (with an average 2-year follow-up) at a single institution were retrospectively investigated. The full spine X-rays of patients were measured preoperatively, postoperatively, and at the final follow-up. Variables were compared between the PNT group (n = 33) and the non-PNT group (n = 62), and univariate and multivariate logistic regressions were performed to identify the independent predictors for the occurrence of PNT. The discrimination and calibration of the nomogram were validated by the receiver operating characteristic curve and calibration curve. Results Variables including the preoperative neck tilt, postoperative upper instrumented vertebrae imbalance, postoperative T1 tilt, and decreasing values in the main thoracic curve (ΔMTC) minus decreasing values in the proximal thoracic curve (ΔPTC) (ΔMTC − ΔPTC) were identified as the predictors for the nomogram. The area under the receiver operating characteristic curve was 0.900 (95% confidence interval, 0.857–0.932). Meanwhile, the calibration curve revealed good agreement, and the Hosmer and Lemeshow test determined that the model was well fitted. Conclusions Preoperative neck tilt, postoperative upper instrumented vertebrae imbalance, postoperative T1 tilt, and ΔMTC–ΔPTC are predictors for the nomogram. The nomogram can provide surgeons with a simple and effective tool to predict the occurrence and development of patients with PNT in Lenke I and II AIS.

Objective To compare the pedicle morphology of nondystrophic scoliosis secondary to neurofibromatosis type 1 (ND-NF1) scoliosis secondary to neurofibromatosis type 1 (NF1-S) and adolescent idiopathic scoliosis (AIS) using computed tomography (CT) in a consistent classification system. Methods The transverse pedicle widths of cancellous and cortical channels were measured using preoperative spinal CT images (T1–L5) and then classified as having type A–E pedicles; type B, C, D, and E pedicles were regarded as abnormal. A subset of these patients, a postoperative CT was performed to evaluate the accuracy of pedicle screw placement. According to the perforation of the medial or lateral pedicle walls by the pedicle screw, the placement of screw was classified by a grade ranging from 0 to 3, and grades 2 and 3 were regarded as misplacement. Results In total, 3230 pedicles were measured and classified, and the incidence rate of abnormal pedicles in the ND-NF1 group was significantly greater than that of the AIS group (65.9% vs. 61.4%, P = 0.03). The misplacement rate in the ND-NF1 group was significantly greater than that in the AIS group (12.2% vs. 7.4%; P = 0.01), and in terms of the corresponding 1100 pedicles, the incidence rate of abnormal pedicles in the ND-NF1 group was higher than that in the AIS group (71.7% vs. 64.9%; P = 0.02). Conclusions The incidence rate of abnormal pedicles in patients with ND-NF1 is significantly greater than that of patients with AIS, and it may the reason for the higher misplacement rate of pedicle screws in patients with ND-NF1.

Background Cerebral palsy (CP), the most common physical disability of childhood, is a nonprogressive movement disorder syndrome. Eighty percent of cases are considered idiopathic without a clear cause. Evidence has shown that cytokine abnormalities are widely thought to contribute to CP. Methods An association between 6 SNPs (rs12244380, rs2025345, rs12722561, rs4749926, rs2104286 and rs706778) in IL2RA (interleukin 2 receptor subunit alpha) and CP was investigated using a case–control method based on 782 CP cases and 778 controls. The allele, genotype and haplotype frequencies of SNPs were assessed using the SHEsis program. Subgroup analyses based on complications and clinical subtypes were also conducted. Results Globally, no differences in genotype or allele frequencies for any SNPs remained significant after Bonferroni correction between patients and controls, except rs706778, which deviated from Hardy–Weinberg equilibrium and was excluded from further analyses. However, subgroup analysis revealed a significant association of rs2025345 with spastic tetraplegia (P genotype = 0.048 after correction) and rs12722561 with CP accompanied by global developmental delay (P allele = 0.045 after correction), even after Bonferroni correction. Conclusions These findings indicated that genetic variations in IL2RA are significantly associated with CP susceptibility in the Chinese Han population, suggesting that IL2RA is likely involved in the pathogenesis of CP. Further investigation with a larger sample size in a multiethnic population is needed to confirm the association.

Light-mediated nanotherapeutics have recently emerged as promising strategies to precisely control the activation of therapeutic reagents and imaging probe both in vitro and in vivo, largely ascribed to their unique properties, including minimally invasive capabilities and high spatiotemporal resolution. Nanoscale metal–organic frameworks (NMOFs), a new family of hybrid materials consisting of metal attachment sites and bridging ligands, have been explored as a new platform for enhanced cancer diagnosis and therapy due to their tunable size, modifiable surface, good biocompatibility, high agent loading and, most significantly, their ability to be preferentially deposited in tumors through enhanced permeability and retention (EPR). Especially the light-driven NMOF-based therapeutic platform, which not only allow for increased laser penetration depth and enhanced targeting, but also enable imaging-guided or combined treatments. This review provides up-to-date developments of NMOF-based therapeutic platforms for cancer treatment with emphasis on light-triggered therapeutic strategies and introduces their advances in cancer diagnosis and therapy in recent years. Graphic Abstract

Patients with mental disorders are at increased risk of premature mortality. Psychiatric inpatients are a particularly vulnerable population, yet data on the mortality rate and causes of death among psychiatric inpatients in a national sample are scarce.We analyzed data collected from patients who died during psychiatric hospitalization in 2019 and 2020 from 41 psychiatric hospitals in China.In total, 719 inpatients died over the study period. There were more deaths in 2019 (N = 409, 56.9%) compared to 2020 (N = 310, 43.1%). The mean age was 73.3 ± 16.5 years old, with males significantly younger than females (71.5 ± 16.9 vs. 75.9 ± 15.6, p 0.001). Sudden death accounted for 11.5% of all deaths. The cause was unknown for 31.2% of cases. Among those with known causes of death, respiratory disorders were most common in patients with psychotic disorders (41.9%) and mood disorders (29.8%). Suicide accounted for 17.0% of deaths in patients with mood disorders.Patients who died during psychiatric hospitalization were overall older (70 years), and more than one in ten died due to sudden death. While respiratory disorders accounted for the largest proportion of known causes, the causes were unknown in nearly one-third. Death due to suicide, a preventable cause, remained common among patients with mood disorders. Evidence-based interventions should be implemented.

Objective To compare the outcomes of FURSL and m-PNL in the management of upper calyceal calculi larger than 2 cm. Methods A total of 75 patients with upper calyceal calculi larger than 2 cm that were treated by FURSL (n = 37) or mini-PNL (n = 38) were retrospectively analysed. The mean age, sex, stone burden, operative time, complications, length of hospitalization, and stone-free rate (SFR) were compared between the groups. The success of the procedure was defined by the absence of residual stones or residual fragments smaller than 4 mm on computed tomography at 4 weeks postoperatively. Results The two groups had comparable preoperative parameters. The mean operative time was significantly longer in the mini-PNL group than in the FURSL group (87.8 vs. 69.8 min, p p p = 0.258). The SFR for the mini-PNL group was 89.5%, and that of the FURSL group was 81.1%; the difference was not significantly different (p = 0.304). Conclusions Both FURSL and mini-PNL are effective and safe for the management of upper calyceal calculi larger than 2 cm. Of these two procedures, mini-PNL is less time consuming, FURSL is associated with faster recovery. FURSL can be considered a good alternative treatment in selected patients.

Sepsis is a life-threatening disease characterized by a defensive response to damage. The immune response in patients with sepsis is overenhanced in the early stages and suppressed in the later stages, leading to poor prognosis. Metabolic reprogramming and epigenetic changes play a role in sepsis. Metabolic intermediates such as elevated succinic acid levels are significantly altered in patients with sepsis. Succinic acid, a metabolic intermediate of the tricarboxylic acid cycle, participates in energy supply and plays a role in metabolic reprogramming. Simultaneously, as an epigenetic regulator, it participates in gene transcription, translation, and post-translational modifications. It also participates in the inflammatory response, hypoxia, and the production of reactive oxygen species via endocrine and paracrine pathways. In this review, we have discussed the effects of succinic acid on sepsis and its therapeutic potential.

The pathogenesis of coronary heart disease is closely related to blood stasis. Taohong Siwu decoction (THSW for short) is one of the most widely used prescriptions for activating blood and removing stasis. Clinical research has confirmed its curative effect on coronary heart disease. However, its underlying mechanism remains unclear. Therefore, this paper reviewed the clinical efficacy of THSW and determine its effective components based on a comprehensive literature review. Furthermore, the core components and targets of THSW in treating coronary heart disease using molecular docking were verified, and the interaction sites were predicted to construct a theoretical basis for the clinical application of THSW.

To investigate the effect of intermittent pneumatic compression (IPC) combined with rehabilitation training on patients with acute cerebral infarction and motor impairment, seventy-four patients with acute cerebral infarction and hemiplegia were randomly and equally divided into two groups, the control group and the IPC treatment group. The patients in the control group received conventional drug therapy and rehabilitation training, and the patients in the treatment group received the IPC treatment in addition to the treatment given in the control group. Motor function, the primary outcome, of the two groups was evaluated by Fugl–Meyer motor function scores. The Barthel index assessment scale was used to evaluate the ability to perform activities of daily living of the two groups, as a secondary outcome. All these indicators were collected and compared before treatment and at 7 days, 14 days, and 30 days after treatment. The incidence of adverse reactions associated with treatment was also recorded. At 7, 14, and 30 days after treatment, the Fugl–Meyer scores (27.16 ± 7.37, 33.41 ± 7.16 and 38.72 ± 7.65) and Barthel scores (47.16 ± 7.37, 52.41 ± 7.16, and 56.09 ± 8.32) of the treatment group were also significantly higher than those (23.65 ± 3.11, 26.13 ± 3.25, and 28.75 ± 5.92; 44.15 ± 3.11, 46.63 ± 3.25 and 47.75 ± 4.22) of the control group (all P

Aim To survey the use of alcohol, and its correlates by mental health professions in China, a nation where there is rapid increase in alcohol consumption and problems. Methods As a part of a large-scale, nation-wide online survey of healthcare professionals, we collected demographic variables and other health-related variables anonymously. The Alcohol Use Disorder Identification Test-Concise (AUDIT-C) was used to collect data on alcohol use. Results 13,980 mental health professionals completed the survey (4382 doctors, 9339 nurses and 259 clinical psychologists), representing 64% of the total targeted. Respondents were predominantly female (75.1%). Alcohol consumption was reported by 41.8% of participants (by 53.9% of doctors, 36.2% of nurses and 40.5% of clinical psychologists). Based on the cut-off scores of the AUDIT-C (≥3 for women and ≥4 for men), 7.5% were classified as probable alcohol misusers in the past year, and the rates were 10.2% in doctors, 6.3% in nurses and 5.8% in clinical psychologists. Multiple logistic regression showed that male sex (OR = 3.772; CI = 3.206–4.439), being a doctor (OR = 1.259; CI = 1.052–1.506), being divorced or widowed (OR = 1.979; CI = 1.467–2.666), having an associate degree or less (OR = 1.809; CI = 1.040–3.147), working in Northeast China (OR = 1.538; CI = 1.281–1.848) and the habit of smoking (OR = 3.345; CI = 2.280–3.967) were significantly associated with alcohol misuse. Conclusions Alcohol use and misuse were relatively common among mental health professionals in China, and male sex, being a doctor, with lower education, working in Northeast China and cigarette smoking were significant associations. Awareness and interventions are recommended to promote healthier use of alcohol in this professional group, especially among risk subgroups.

To assess the role of the difference between the proximal junctional angle (PJA) and rod contouring angle (RCA) (PJA-RCA) in the development of postoperative proximal junctional angle (PJK) in Lenke I and II adolescent idiopathic scoliosis (AIS) patients.We performed a retrospective analysis of 84 Lenke I and II AIS patients who underwent posterior segmental spinal instrumentation and fusion between 2012 and 2018 (minimum follow-up of 1.5 years and an average follow-up of 2 years) at a single institution. The full-spine x-ray films taken at the preoperative, postoperative, and final follow-ups were measured for each patient. The radiographic parameters were compared between the PJK and non-PJK groups, and binary logistic regression with forward elimination (conditional) was also performed to identify the risk factors for the occurrence of PJK.Among the 84 patients (mean age: 14.63 ± 1.33 years), the overall incidence of PJK was 23.81%. The PJK group showed a larger preoperative pelvic incidence (55.66° ± 8.66° vs. 50.29°±8.27°, P = 0.045), thoracic kyphosis (TK) (32.44° ± 5.60° vs. 27.19° ± 5.14°, P = 0.007) and sagittal vertical axis (SVA) (40.99 ± 21.82 mm vs. 18.13 ± 28.64 mm, P = 0.013) than the non-PJK group. Postoperatively, the PJK group showed a larger decrease in the TK (-10.62° ± 3.19° vs. -5.56° ± 1.17°, P0.001) and SVA (-24.28 ± 18.22 mm vs. -10.83 ± 15.02 mm, P = 0.007). In addition, the PJK group had significantly larger postoperative PJA (9.83° ± 2.64° vs. 5.77° ± 3.06°, P0.001) and postoperative PJA-RCA (6.56° ± 3.69° vs. 1.55° ±3.32°, P 0.001). The proportion of patients with a PJA-RCA value greater than 5° was significantly larger in the PJK group (65.00% vs. 18.75%, P0.001). At the last follow-up, the PJK patients had significantly larger TK (35.11° ± 5.51° vs. 26.53° ± 4.71°, P0.001) and SVA (22.83 ±23.12 mm vs. 3.46 ±26.24 mm, P = 0.038). Binary logistic regression analysis showed that decreases in TK and postoperative PJA-RCA were the primary contributors to PJK in patients with AIS.Large postoperative PJA-RCA and decreased TK are risk factors for PJK in Lenke I and II AIS patients, especially those with PJA-RCA greater than 5°, and the occurrence of PJK should be highly considered.

STUDY DESIGN Retrospective analysis. OBJECTIVE The aim of this study was to develop and validate a nomogram for the prediction of lung metastasis in patients with malignant primary spinal tumors. SUMMARY OF BACKGROUND DATA In patients with malignant primary spinal tumors, lung metastasis is usually found by computed tomography (CT) and is considered to be an essential factor affecting the prognosis and survival. METHODS We retrospectively collected 580 malignant primary osseous spinal neoplasms patients from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2015. The least absolute shrinkage and selection operator (LASSO) and multivariate logistic analysis were used to identify independent factors. These prognostic factors were included in the nomograms. The nomograms were validated based on its calibration, discrimination, and clinical utility. The overall survival of the patients was analyzed using the Kaplan-Meier method and the survival differences were tested by the log-rank test. RESULTS We randomly divided all these patients (n = 580) into a training cohort (n = 408) and a validation cohort (n = 172). The results showed that the risk of lung metastasis was independently influenced by histologic type, use of surgery, clinical T stage, clinical N stage, and tumor extension (all P

Objective To perform a meta-analysis exploring the correlation between cervical lordosis (CL) and sagittal spine alignment in patients with adolescent idiopathic scoliosis (AIS) after surgery for determining a surgical strategy. Methods We searched 3 electronic databases for studies discussing the correlation between CL and spine sagittal alignment in patients with AIS. Studies reported from the inception of the database to June 2019 were retrieved without any language restrictions. Summary correlation coefficient (r) values were extracted from each study, and 95% confidence intervals (CIs) were calculated. In addition, we conducted subgroup analyses in different curve type subgroups with at least 2 studies. Results Ten relevant studies involving 539 patients were evaluated in this meta-analysis. The Pearson correlation (r) for CL and the T1 slope was –0.69; (95% CI, –0.79 to –0.54). The fixed-effects summary correlation between CL and thoracic kyphosis in patients was moderate (r = –0.40; 95% CI, –0.48 to –0.31). In addition, the fixed-effects summary correlations between CL and lumbar lordosis (r = 0.19; 95% CI, 0.07–0.30), pelvic incidence (r = –0.08; 95% CI, –0.20 to 0.04), pelvic tilt (r = –0.06; 95% CI, –0.18 to 0.06), and sacral slope (r = –0.06; 95% CI, –0.18 to 0.06) in patients were weak. Conclusions There is a strong negative correlation between CL and the T1 slope in patients with AIS. Given the lack of robust clinical evidence, these findings warrant verification by large prospective registries and randomized trials with long follow-up periods.

Poor air quality can result in a variety of respiratory disorders. However, the air quality index (AQI) and the level of fine particulate matter (PM2.5) on the progression and prognosis of nonsmall-cell lung cancer (NSCLC) are unclear.We launched a cohort study focused on the relationship between air quality and overall survival as well as progression, incorporating data from 590 patients with NSCLC in our medical center between November 1, 2013 and March 1, 2016. Forty-nine patients from Sichuan Cancer Hospital were used for validation.Cases with poorer AQI 6 months before NSCLC diagnosis were more likely to progress to stage III to IV NSCLC than controls (OR = 2.61, 95% CI 1.35-5.24, p = 0.005). Similarly, if exposed to high levels of PM2.5 during these 6 months, overall survival was poor (HR [95% CI] = 1.53 [1.13, 2.07], p = 0.006). According to multivariate analysis, age, gender, KPS, PM2.5, hyperlipemia, and NSCLC stage were independent risk factors of overall survival. A predictive model developed by these factors above yielded a favorable agreement (C-index = 0.758) on the calibration curve. External validation was conducted by 46 patients from Sichuan Cancer Hospital displaying an AUC of 0.724 (0.684-0.763).PM2.5 and AQI levels affect disease progression and long-term survival in NSCLC patients. An overall survival prediction model based on the PM2.5 level can help clinicians predict the risk of death in NSCLC.

Homozygous deletion (HD) of CDKN2A and CDKN2B (CDKN2A/B

Neonatal hypoxic-ischemic encephalopathy (HIE) induced by perinatal asphyxia is a major cause of neurological disability among infants. Dihydroartemisinin (DHA), derived from artemisinin, well known as an anti-malarial medicine, was proved to be able to inhibit oxidative stress and inflammation. However, whether those functions of DHA play roles in hypoxic-ischemic brain damage (HIBD), an animal model of HIE in patient which also been observed to have oxidative stress and inflammation, is unknown. In this study, we demonstrated that the DHA treatment on newborn rats significantly relieved the neuron loss and motor and cognitive impairment caused by HIBD. One of the underlying mechanisms is that DHA enhanced the anti-oxidant capacity of HIBD rats by up-regulating the total antioxidant capacity (T-AOC), gluathione reductase (GR) and catalase (CAT) while down regulating the pro-oxidative substances including hydrogen peroxide (H2O2), total nitric oxide synthase (T-NOS) and inducible nitric oxide synthase (iNOS). Thus, our study illustrated that DHA could alleviate the damage of brains and improve the cognitive and motor function of HIBD rats by inhibiting oxidative stress, provided an opportunity to interrogate potential therapeutics for affected HIE patients.

This study was aimed at two image segmentation methods of three-dimensional (3D) U-shaped network (U-Net) and multilevel boundary sensing residual U-shaped network (RUNet) and their application values on the auxiliary diagnosis of lung cancer. In this study, on the basis of the 3D U-Net segmentation method, the multilevel boundary sensing RUNet was worked out after optimization. 92 patients with lung cancer were selected, and their clinical data were counted; meanwhile, the lung nodule detection was performed to obtain the segmentation effect under 3D U-Net. The accuracy of 3D U-Net and multilevel boundary sensing RUNet was compared on lung magnetic resonance imaging (MRI) after lung nodule segmentation. Patients with benign lung tumors were taken as controls; the blood immune biochemical indicators progastrin-releasing peptide (pro-CRP), carcinoembryonic antigen (CEA), and neuron-specific enolase (NSE) in patients with malignant lung tumors were analyzed. It was found that the accuracy, sensitivity, and specificity were all greater than 90% under the algorithm-based MRI of benign and malignant tumor patients. Based on the imaging signs for the MRI image of lung nodules, the segmentation effect of the RUNet was clearer than that of the 3D U-Net. In addition, serum levels of pro-CRP, NSE, and CAE in patients with benign lung tumors were 28.9 pg/mL, 12.5 ng/mL, and 10.8 ng/mL, respectively, which were lower than 175.6 pg/mL, 33.6 ng/mL, and 31.9 ng/mL in patients with malignant lung tumors significantly ( P < 0.05 ). Thus, the RUNet image segmentation method was better than the 3D U-Net. The pro-CRP, CEA, and NSE could be used as diagnostic indicators for malignant lung tumors.

Asparagine synthetase deficiency (ASNSD) is a rare neurometabolic disease caused by variations of the ASNS gene. It manifests as microcephaly, severe developmental delay, and spastic quadriplegia. 71% of ASNSD patients died during early infancy. We aim to investigate mutations related to intractable epilepsy in one Chinese genealogy.Head Magnetic Resonance Imaging (MRI), whole exome sequencing (WES), and Liquid Chromatography-Mass Spectrometry (LC-MS) to help 2 patients with intractable epilepsy find the underlying mechanisms of disease.These two patients had a compound heterozygous mutation (c.224A G, p.N75S and c.1612A G, p.M538V) in the ASNS gene, of which c.1612A G was a novel mutation. The asparagine levels in patients' plasmas were normal. In addition, they had a later onset, longer survival, and were milder than previously reported ASNSD patients.Two patients were diagnosed with a milder form of ASNSD. Clinically, the asparagine level in the patient's plasma cannot be used as the only basis to diagnose this disease. This study has expanded the disease phenotype spectrum of ASNSD and broadened the variation profile of the ASNS gene, which can assist in the clinical diagnosis and treatment of ASNSD patients.

Preterm complications and neonatal asphyxia are the leading causes of death in those under 5 years of age. However, little information exists for the province of Henan, China. The purpose of this study was to explore changes in the live birth profile in a provincial hospital over the past 32 years in Henan, China.A retrospective analysis was conducted to reveal the characteristics of live neonates from 1987 to 2018.There were 118 253 live births during the period, including 19 798 (16.74%) preterm births. The neonatal death rate was 6.45‰, and the top risk factor was preterm birth complications and birth asphyxia. Before 1998, neonatal death occurred primarily among term infants. Between 1999 and 2018, preterm infants, especially extreme and very preterm infants with very low birthweight, constituted more than half of all mortalities, and the preterm birth rate increased from 5.94% in 1999 to 16.69% in 2018. The risk factors associated with preterm birth were being male (aOR = 1.18, P 0.001), advanced maternal age (35 years old; aOR = 1.08, P = 0.008), gravidity ≥2 (aOR = 1.15, P 0.001), parity ≥2 (aOR = 1.50, P 0.001), placenta previa (aOR = 7.41, P 0.001), twin or multiple births (aOR = 10.63, P 0.001), hypertension (aOR = 2.08, P 0.001), and rupture of membrane (aOR = 5.03, P 0.001).The preterm birth rate has increased over the past 32 years from 4.98% to 16.69% in a provincial hospital in China. Preterm birth was the leading reason for neonatal death, and birth asphyxia was the major risk factor for death in term infants.

Background Coronavirus disease 2019 (COVID-19) quickly developed into a global pandemic and affected patients’ mental health. However, little is known about psychological experience of patients with COVID-19. The aim was to elucidate the psychological experience of patients with confirmed COVID-19 in Wuhan, at the initial stage of the pandemic. Methods This study was conducted using a phenomenological approach in a qualitative study. Thirteen patients with confirmed COVID-19 from a COVID-19-designated hospital in Wuhan, were recruited between March 15th and April 20th, 2020 via purposive sampling. Semi-structured in-depth interviews were conducted face-to-face. The interview data were analyzed using inductive thematic analysis. Results The psychological experience of patients was summarized into three themes: mental distress related to COVID-19, expectations of life scenarios after discharge, and making sense of the experience. These themes were classified into 10 sub-themes. Patients experienced confusion, uncertainty, worry, guilt and concern. Both positive and negative expectations of life scenarios after discharge were reported, manifested as expectations about making up for lost time with family, anxiety about social discrimination and feelings of helplessness about poor financial security. Moreover, patients perceived strength of abundant social support and awareness of social responsibility from their unique experience to cope with their condition. Conclusions This study demonstrated that patients with confirmed COVID-19 in Wuhan underwent complex psychological experience, both positive and negative at the initial stage of the pandemic. These findings will contribute to the delivery of effective mental health care to safeguard patients’ wellbeing.

In this study, we hypothesized that the chronic use of clozapine affects cytokine expression and has a greater effect on female patients than on male patients. The aims of this study were to detect (1) whether serum cytokine levels were altered in patients with chronic schizophrenia after clozapine treatment compared with age- and sex-matched healthy controls, (2) whether there was a gender difference in serum cytokine levels after clozapine treatment, and (3) whether there was a correlation between serum cytokine levels and clozapine daily dosage in patients with schizophrenia.Forty-nine inpatients with schizophrenia treated with clozapine and fifty-three sex- and age-matched healthy controls were recruited. The patients' psychiatric symptoms were measured by the Positive and Negative Syndrome Scale (PANSS). Blood samples from both patients and healthy controls were collected. Serum IL-1β, IL-2, IL-6, IL-17, IFN-γ, and TNF-α levels were measured in duplicate by sandwich enzyme-linked immunosorbent assay.We found that chronic clozapine treatment in patients with schizophrenia resulted in the abnormal expression of serum cytokines, such as IL-2, IL-6, IL-17, and TNF-α, compared with the healthy controls. In addition, there was a gender difference in the abnormal expression of cytokines between male and female patients with schizophrenia. In the female group, IL-2 serum levels were lower than those in the male group. Interestingly, there was a positive correlation between serum IL-2 levels and the daily clozapine dosage in female patients with schizophrenia.Findings from our study have shown clear evidence that clozapine had a greater effect on immune function in female patients with schizophrenia.

Pediatric trigeminal neuralgia has been rarely reported in the literature, which were only 28 cases. Although microvascular decompression (MVD) has been widely accepted as effective therapy for trigeminal neuralgia, the etiology and surgical treatment of pediatric ones are seldom addressed. We report our experience with MVD for pediatric trigeminal neuralgia patients with emphasis on the vascular conflict patterns and surgical skills.This retrospective report included 11 pediatric TN patients, who underwent MVD and were followed for 3-86 months. The data were retrospectively analyzed with emphasis on the clinical features.This series included 4 boys and 7 girls with average age of 13 ± 3.4 years old, their onset age were from 7 to 18 years old. The singular vein and combined artery/vein conflictions account for 7/11. 9 (81.8%) patients achieved immediate excellent outcomes. One recurrence was observed after 5 months and refused the second surgery.The etiology of pediatric onset trigeminal neuralgia is still vascular conflict, whose patterns are different from adults, of which combined artery/vein and singular venous compression patterns have a much more higher proportion. Because of the smaller operative space and fragile-thin venous wall with adhesion to other structures, it is much more difficult to decompress the trigeminal nerve among pediatric patients. Sufficient arachnoid release, full exploration, and decompression along the trigeminal nerve were necessary, which will increase the excellent rate among pediatric patients.

Rationale: Transformation to small cell lung cancer (SCLC) is one of the mechanisms of resistance to epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs). However, no standard treatment is available after the transformation. In addition, gastric metastasis of primary lung cancer is rarely observed; thus, little is known about its metastatic characteristics. Patient concerns: A 58-year-old male patient was treated with gefitinib (0.25 g /day) as the 1st line treatment due of recurrence after surgical resection for EGFR exon 19 mutation pulmonary adenocarcinoma. However, he experienced recurrence with positive T790 M, and osimertinib (80 mg/day) was administered as the 2nd line therapy. Diagnosis: One year and 6 months after osimertinib initiation, he complained of stomachache, and a diagnostic gastroscopy biopsy confirmed small cell lung cancer in the gastric body, indicating osimertinib-induced phenotypic transformation. Interventions and outcomes: The patient was treated with etoposide and platinum chemotherapy and maintenance therapy with osimertinib. Finally, the patient achieved a partial response after 4 cycles. Lessons: Timely second biopsies should be considered in the diagnosis of phenotypic transformation. After transformation, chemotherapeutic treatment with etoposide and platinum and maintenance therapy with osimertinib inhibited the progression of the disease.

BACKGROUND Countries in the world have taken actions to prevent venous thromboembolism (VTE) in hospitals. We have conducted a study in China to assess the establishment of hospital-based systems for VTE prevention and management. METHODS A nationwide hospital survey was conducted in China to collect hospital-level metrics on their system for VTE prevention between 2019 and 2020. We analyzed hospital-level metrics potentially influencing the implementation of thromboprophylaxis using a multivariable regression model. Characteristics of the hospital, organizational structure, quality control, and staff training were analyzed. RESULTS Among 435 hospitals responding to the survey, 328 (75.4%) were able to implement thromboprophylaxis. They performed VTE and bleeding risk assessments and had prophylactic interventions. Institutional VTE steering committee and unit-based working group were set up in 317 (72.9%) and 339 (77.9%) hospitals, respectively. More than 80% of the hospitals performed quality control and staff training. In contrast, digitalization of risk assessment was only accomplished in 196 (45.1%) hospitals. Proportions of the aforementioned metrics were consistently higher in tertiary hospitals than secondary hospitals (P < 0.01) except for quality control. There were geographical disparities in the establishment of VTE steering committees (P = 0.0004). In multivariable analysis, VTE steering committee was an independent factor for the implementation of thromboprophylaxis (odds ratio, 2.22, 95% confidence interval, 1.17-4.23). Working group, quality control, and training on VTE were also positively associated with the implementation of thromboprophylaxis. CONCLUSIONS In-hospital VTE prevention has been undertaken in China, but system establishment remains suboptimal. Implementation of VTE prevention programs was associated with a decrease in thrombolytic events. Hospitals with VTE steering committees performed better on implementing preventive strategies. Suboptimal adoption of information digitization was identified, and the implementation of computer supporting techniques would be expected to improve the implementation of thromoboprophylaxis.

In order to explore the effect of exercise nursing intervention for pelvic floor muscle function recovery at 42 days postpartum, this paper conducts experimental research through controlled experiments, combines statistical methods to carry out digital processing, and sets a single variable of nursing intervention to provide a basis for experimental control, and statistical test results are used for effect evaluation. It has been discovered via experimental study that pelvic floor muscle function recovery exercise training for normal delivery women may enhance the mother’s compliance with the pelvic floor muscle function exercise. Moreover, it can reduce the occurrence of urinary incontinence and pelvic organ prolapse, improve the postpartum pelvic floor function of postpartum women, improve the quality of life, and have a significant recovery effect. In addition, it is a simple, noninvasive, and highly safe continuation nursing measure, which can effectively improve the quality of obstetric care and has strong clinical use value.

OBJECTIVE: To study the correlation of fractional anisotropy (FA) on magnetic resonance diffusion tensor imaging with Neonatal Behavioral Neurological Assessment (NBNA) score in preterm infants, and to study the role of FA in evaluating white matter development from the perspective of imaging. METHODS: A prospective study was performed for 98 preterm infants who were admitted to the Neonatal Intensive Care Unit of the Third Affiliated Hospital of Zhengzhou University within 24 hours after birth from October 2016 to January 2020. According to the results of NBNA, they were divided into an abnormal group with 51 infants (NBNA score

Depression is one of the most prevalent and disabling mental health problems in college students. Previous studies have established cross-sectional associations between negative bias in prospection e.g., increased negativity in future simulation, low self-efficacy, and depressive symptoms. Nevertheless, the temporal bidirectional associations between them are rarely examined. In the current study, we collected valid data on 276 college students at two time points within a 10 week interval. Cross-lagged panel analysis was applied to investigate the relationships between proportions of negative future events, levels of self-efficacy, and depressive symptoms. Results suggested depressive symptoms predict subsequent proportions of negative prospections and levels of self-efficacy. Inversely, neither prospection nor self-efficacy predicted depression. Temporal correlations between prospection and self-efficacy were also not significant. Since this is one of the first studies that attempts to figure out temporal links between these mutually informing factors, more longitudinal research is needed to draw a firm conclusion. This study provides new insights into the relationship between negative biases in cognitions and depressive symptoms and highlights the need to intervene early with depressive symptoms before any possible cognitive distortions in college students.