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ObjectiveTo establish an item response theory (IRT) model for functional assessment of spinal muscular atrophy based on the Hammersmith functional motor scale expanded.MethodsA total of 23 patients with SMA were treated with corrective treatment in the Department of Geriatric Neurology and the Department of Pediatrics of the First Affiliated Hospital with Nanjing Medical University from February 2021 to June 2023. IRT was constructed using these repeated measurement data based on stack design. The comparisons between well-fitted models were based on likelihood ratio. And item guessing, carelessness, difficultyand personal abilities (θ) of selected optimal model were calculated. Differential test functioning (DTF) test was conducted for gender and rehabilitation therapy to test the bias. Monte Carlo simulation was used to prove that the item difficulty distribution of the model was not affected by the sampling process. And person-item plot was drawn according to the median expected difficulty. and the differences in the difficulty of each item in HFMSE scale and personal abilities among each evaluations were discussed.ResultsA total of 32items were included in this study and 4 alternative models were constructed. Three-parametric logistic model was selected as the optimal model with the best fitness (P＞0.05, M2 statistics = 479.75). In 3PLM, the caution of all items was 1, and the discrimination, guessing and difficulty of the items were calculated. There were no DTFs for gender and rehabilitation therapy. The results showed high reliability (Cronbach's α = 0.955, LCRC = 0.981) and validity [θ value is positively correlated with the original total score (P

ObjectiveBased on Hammersmith Function Motor Scale Expanded （HFMSE），the study aimed at constructing item response model （IRM） to evaluate the functioning of patients with spinal muscular atrophy （SMA） and exploring the metrical characteristics of HFMSE.MethodsWe recruited 23 SMA patients who received corrective treatment in the Department of Geriatric Neurology and the Department of Pediatrics of the First Affiliated Hospital with Nanjing Medical University from February 2021 to June 2023. IRM was constructed using these repeated measurement data based on stack design［1］. ，The comparisons between well-fitted models were based on likelihood ratio. And item guessing，carelessness，difficultyand personal abilities （θ） of selected optimal model were calculated. Differential test functioning （DTF） test was conducted for gender and rehabilitation therapy to test the bias. Monte Carlo simulation was used to prove that the item difficulty distribution of the model was not affected by the sampling process. And person-item plot was drawn according to the median expected difficulty. and the differences in the difficulty of each item in HFMSE scale and personal abilities among each evaluations were discussed.ResultsA total of 32items were included in this study and 4 alternative models were constructed. Three-parametric logistic model was selected as the optimal model with the best fitness （p > 0. 05，M2 statistics = 479. 75）. In 3PLM，the caution of all items was 1，and the discrimination，guessing and difficulty of the items were calculated. There were no DTFs for gender and rehabilitation therapy. The results showed high reliability （Cronbach's α = 0. 955，LCRC = 0. 981） and validity ［θ value is positively correlated with the original total score （P-5TTS2. A person-item plot showing the location of item parameters and individual parameters on the personal abilities （θ） scale was used to observe the relationship between θ values and item difficulties.ConclusionThe IRT model based on HFMSE offered a new approach to evaluate functional levels of SMA patients and difficulties of items. The calculation of item guessing，carelessness and difficulty of selected optimal model provides recommendations for better clinical practice of HFMSE. The study offers a new perspective for the assessment of the functions of SMA patients and guidance for the development of rehabilitation programs.

ObjectiveTo explore the effects of after-school tutoring for school-age children on their emotions and behaviors， and to provide a basis for developing after-school tutoring and psychological support strategies for school-age children.MethodsFour elementary schools in a district of Shanghai were selected by simple random sampling method. Whole group sampling was conducted by class， and parents of students were surveyed by general questionnaire and the scale of strengths and difficulties. Information was collected on the basic conditions of children and families and the results were compared and analyzed.ResultsThis study showed that 88.26% of children attended extracurricular classes， of which 26.16% attended 3 or more classes， 42.5% attended cultural classes， 28.3% attended sports classes， and 59.8% attended art classes. Children who did not attend classes had higher pro-social scores. Children who attended reading class had lower scores for emotional problems that was a protective factor for emotional problems. Children who chose extracurricular programs in sports and reading also had lower overall scores for difficulties. Excessive use of electronic devices by school-age children on weekdays or weekends had a negative effect on emotional and conduct problem scores regardless of whether they chose extracurricular programs. It appeared that the choice of cultural programs， art programs and different levels of exercise intensity had no effect on children's emotions and behaviors.ConclusionFor children with low pro-social level， extracurricular classes should be carefully selected. For extracurricular classes， more reading and sports-related courses can be considered， which have positive effects on school-age children’s emotions and behaviors. Regardless of the choice of extracurricular classes， try to avoid excessive online classes.

Objective To evaluate the clinical efficacy of off-pump coronary artery bypass grafting in the treatment for acute myocardial infarction. Methods A total of 43 patients with acute myocardial infarction who were given off-pump coronary artery bypass grafting (OPCAB) surgery by the same medical team in Department of Cardiovascular Surgery of our hospital from February 2014 to January 2020 were enrolled as the treatment group, and their clinical data were collected and retrospectively analyzed. Among them, there were 5 females and 38 males, at a mean age of 62.40±9.14 years, 20 cases (46.5%) of left main coronary artery disease and 23 cases (53.5%) of multi-vessel disease, and 8 cases (18.6%) of ST-segment elevation myocardial infarction (STEMI), and 35 cases (81.4%) of non-ST-segment elevation myocardial infarction (NSTEMI). Another 46 patients of non-acute myocardial infarction who also underwent OPCAB during the same period were randomly selected and assigned into the control group, including 8 females and 38 males (62.40±9.14 years old), and 25 cases (54.3%) of left main disease and 21 cases (45.7%) of multi-vessel disease. The clinical indicators during the operation, at the first day following operation, and during the hospitalization period were collected and compared between the 2 groups. Results In the treatment group, 2 patients were converted to operation under cardiopulmonary bypass because of intraoperative ventricular fibrillation, 1 patient died of arrhythmia, and 1 experienced postoperative cerebral infarction. In the control group, there was no death and 1 case developed cerebral infarction. However, as for the clinical indicators during the operation, at the first day following operation, and during hospitalization, there were no significant differences between the 2 groups. Conclusion Off-pump coronary artery bypass grafting is safe and effective for patients with acute myocardial infarction.

Objective To compare the efficiency between on- and off-pump coronary artery bypass grafting (CABG) in elderly patients by propensity score matching (PSM). Methods From June 2014 to June 2019, a total of 301 patients (older than 70 years) undergoing CABG in our department were recruited in this study. For 51 patients underwent off-pump CABG (OPCABG), they were 44 males and 7 females, at an age of 70 to 83 (73.31±2.73) years. Another 51 patients including 46 males and 5 females, aged 70-78 (72.82±1.86) years, were selected from the remaining 250 patients treated with on-pump CABG (ONCABG) by PSM. Postoperative recovery was analyzed and compared between the 2 groups. Results There were no statistical differences in the mortality and cases needing intra-aortic balloon pump between the OPCABG and the ONCABG groups. But the former group had shorter endotracheal intubation (10.64±5.07 vs 15.07±5.35 h, P=0.000), less drainage volume at the day after surgery (307.15±132.16 vs 480.78±130.42 mL, P=0.000), and lower percentage of the patients needing continuous renal replacement therapy when compared with the ONCABG group. Conclusion Both OPCABG and the ONCABG surgeries are effective treatment for the elderly patients with coronary heart disease. However, OPCABG is superior to ONCABG in accelerating postoperative recovery and reducing postoperative complications.