Frontline combination of dasatinib and low-intensity chemotherapy in adults with de novo Philadelphia chromosome-positive acute lymphoblastic leukemia.

BACKGROUND: Studies on dasatinib-based low-intensity induction regimens and post-remission strategies are limited in China. Therefore, we conducted a single-center phase 2 trial in newly diagnosed adult patients with Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL) to establish the efficacy and safety of this treatment approach. RESEARCH DESIGN AND METHODS: Patients received one month of dasatinib plus low-intensity chemotherapy and two months of dasatinib monotherapy for induction, followed by a single course of high-dose methotrexate for consolidation. Subsequently, they underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) or tyrosine kinase inhibitor (TKI)-based treatment for maintenance therapy between October 2015 and August 2022. RESULTS: Twenty-two patients were enrolled. Median age was 45 years (range, 20-71). The rates of major and complete molecular responses in the third month were 18.2% and 40.9% respectively. With a median follow-up of 15 months (range, 5-89), the estimated 3-year disease-free survival (DFS) and overall survival (OS) were 52.4% and 73.2%, respectively. The TKI-based cohort had a significantly poorer DFS (p = 0.014) and OS (p = 0.008) than the allo-HSCT cohort. CONCLUSIONS: Our results suggest that dasatinib-based low-intensity chemotherapy is safe and effective as an induction strategy in the Chinese population. Allo-HSCT plays a crucial role in the long-term outcomes of patients with Ph+ ALL. CLINICAL TRIAL REGISTRATION: The trial was registered at ClinicalTrials.gov as NCT02690922.

Modulation of starch structure, swallowability and digestibility of 3D-printed diabetic-friendly food for the elderly by dry heating.

Elderly people often experience difficulty in swallowing and have impaired regulation of the nervous system. Furthermore, their blood glucose level can rise easily after eating. Therefore, functional foods that are easy to swallow and can maintain blood glucose at a lower level have been an important research topic in recent years. In this study, 3D printing was combined with dry heating to modify the starch in white quinoa and brown rice to develop whole grain foods with Osmanthus flavor that meet the dietary habits of the elderly. The samples were tested for printability, swallowing performance, and in vitro digestion. The results showed that after dry heating, all samples had shear-thinning properties and could pass through the extrusion nozzle of the printer smoothly. Both white quinoa and brown rice showed improved printability and self-support compared to the control. B45 (white quinoa, dry heating for 45 min) and C45 (brown rice, dry heating for 45 min) had significant elasticity and greater internal interaction strength during swallowing to resist disintegration of food particles during chewing. B45, C30, and C45, conformed to class 4 consistency and were characterized by easy swallowing of the diet. Further, dry heating resulted in greater resistance to enzymatic degradation of white quinoa and brown rice starch, with overall in vitro digestibility lower than the control.

Comparison of volume-controlled ventilation, pressure-controlled ventilation and pressure-controlled ventilation-volume guaranteed in infants and young children in the prone position: A prospective randomized study.

STUDY OBJECTIVE: To explore if the pressure-controlled ventilation (PCV) and pressure-controlled ventilation-volume guaranteed (PCV-VG) modes are superior to volume-controlled ventilation (VCV) in optimizing intraoperative respiratory mechanics in infants and young children in the prone position. DESIGN: A single-center prospective randomized study. SETTING: Children's Hospital, Zhejiang University School of Medicine. PATIENTS: Pediatric patients aged 1 month to 3 years undergoing elective spinal cord detethering surgery. INTERVENTIONS: Patients were randomly allocated to the VCV group, PCV group and PCV-VG group. The target tidal volume (VT) was 8 mL/kg and the respiratory rate (RR) was adjusted to maintain a constant end tidal CO2. MEASUREMENTS: The primary outcome was intraoperative peak airway pressure (Ppeak). Secondary outcomes included other respiratory and ventilation variables, gas exchange values, serum lung injury biomarkers concentration, hemodynamic parameters and postoperative respiratory complications. MAIN RESULTS: A total of 120 patients were included in the final analysis (40 in each group). The VCV group showed higher Ppeak at T2 (10 min after prone positioning) and T3 (30 min after prone positioning) than the PCV and PCV-VG groups (T2: P = 0.015 and P = 0.002, respectively; T3: P = 0.007 and P = 0.009, respectively). The prone-related decrease in dynamic compliance was prevented by PCV and PCV-VG ventilation modalities at T2 and T3 than by VCV (T2: P = 0.008 and P = 0.015, respectively; T3: P = 0.015 and P = 0.014, respectively). Additionally, there were no significant differences in other secondary outcomes among the three groups. CONCLUSION: In infants and young children undergoing spinal cord detethering surgery in the prone position, PCV-VG may be a better ventilation mode due to its ability to mitigate the increase in Ppeak and decrease in Cdyn while maintaining consistent VT.

Edge smoothing optimization method in DMD digital lithography system based on dynamic blur matching pixel overlap technique.

Due to digital micromirrors device (DMD) digital lithography limited by non-integer pixel errors, the edge smoothness of the exposed image is low and the sawtooth defects are obvious. To improve the image edge smoothness, an optimized pixel overlay method was proposed, which called the DMD digital lithography based on dynamic blur effect matching pixel overlay technology. The core of this method is that motion blur effect is cleverly introduced in the process of pixel overlap to carry out the lithography optimization experiment. The simulation and experimental results showed that the sawtooth edge was reduced from 1.666 µm to 0.27 µm by adopting the 1/2 dynamic blur effect to match pixel displacement superposition, which is far less than half of the sawtooth edge before optimization. The results indicated that the proposed method can efficiently improve the edge smoothness of lithographic patterns. We believe that the proposed optimization method can provide great help for high fidelity and efficient DMD digital lithography microfabrication.

Impact of intravenous administration of nalbuphine at different time points for postoperative analgesia and sedation in adenotonsillectomized children: a prospective, randomized controlled trial.

Objective: To compare the efficacy of intravenous administration of nalbuphine at different time points for postoperative analgesia and sedation in adenotonsillectomized children. Methods: Patients with obstructive sleep apnea syndrome scheduled for adenotonsillectomy were randomly divided into group A (patients received intravenous nalbuphine 0.2 mg/kg before anesthesia induction), group B (patients received intravenous nalbuphine 0.2 mg/kg 10 min before the end of surgery), and group C (patients did not receive nalbuphine injection). The time points for measuring outcomes were before anesthesia induction (T0), extubation (T1), and 0, 15, 30, or 45 min in the postanesthesia care unit (PACU) (T2-T5, respectively). Results: There were 40 patients in group A, 41 patients in group B and 39 patients in group C. Patients in group B had significantly lower FLACC (Face, Legs, Activity, Cry, Consolability) pain scores at T2-T5 than those in group C (all p<0.05). Patients in group B had higher Ramsay Sedation Score at T2-T4 than those in group C (all p<0.05). The proportion of patients who received remedial analgesia in the PACU in group A (17.5%, p=0.008) and group B (9.8%, p<0.001) was significantly lower than that in group C (46.2%). Conclusion: Intravenous administration of nalbuphine 10 min before the end of adenotonsillectomy in children could decrease pain intensity and increase sedation levels during the recovery period with the reduction of remedial analgesia in the PACU.Trial registration number ChiCTR2200060118.

Risk factors associated with prolonged intensive care unit stay following surgery for total anomalous pulmonary venous connection: a retrospective study.

BACKGROUND: Prolonged intensive care unit (ICU) stays consume medical resources and increase medical costs. This study identified risk factors associated with prolonged postoperative intensive care unit (ICU) stay in children with total anomalous pulmonary venous connection (TAPVC). METHODS: The medical records of 85 patients who underwent surgical repair of TAPVC were retrospectively analyzed. The patients were divided into prolonged-stay and standard-stay groups. The prolonged stay group included all patients who exceeded the 75th percentile of the ICU stay duration, and the standard stay group included all remaining patients. The effects of patient variables on ICU stay duration were investigated using univariate and logistic regression analyses. RESULTS: Patient median age was 41 (18-103) days, and median weight was 3.80 (3.30-5.35) kg.Postoperative duration of ICU stay was 11-68 days in the prolonged stay group (n = 23) and 2-10 days in the standard stay group (n = 62). Lower preoperative pulse oximetry saturation (SpO2), higher intraoperative plasma lactate levels, and prolonged postoperative mechanical ventilation were independent risk factors for prolonged ICU stay. Preoperative SpO2 < 88.5%, highest plasma lactate value > 4.15 mmol/L, and postoperative mechanical ventilation duration was longer than 53.5 h, were associated with increased risk of prolonged ICU stay. Young age, low body weight, subcardiac type, need for vasoactive drug support, emergency surgery, long anesthesia time, low SpO2 after anesthesia induction, long cardiopulmonary bypass (CPB) and aortic clamp times, high lactate level, low temperature, large volume of ultrafiltration during CPB, large amounts of chest drainage, large red blood cells (RBCs) and plasma transfusion, and postoperative cardiac dysfunction may be associated with prolonged ICU stay. CONCLUSIONS: Lower preoperative SpO2, higher intraoperative plasma lactate levels, and prolonged postoperative mechanical ventilation were independent risk factors for prolonged ICU stay in children with TAPVC. When SpO2 was lower than 88.5%, the highest plasma lactate value was more than 4.15 mmol/L, and the postoperative mechanical ventilator duration was longer than 53.5 h, the risk of prolonged ICU stay increased. Improved clinical management, including early diagnosis and timely surgical intervention to reduce hypoxia time and protect intraoperative cardiac function, may reduce ICU stay time.

Perspectives on Novel Technologies of Processing and Monitoring the Safety and Quality of Prepared Food Products.

With the changes of lifestyles and rapid growth of prepared food industry, prepared fried rice that meets the consumption patterns of contemporary young people has become popular in China. Although prepared fried rice is convenient and nutritious, it has the following concerns in the supply chain: (1) susceptible to contamination by microorganisms; (2) rich in starch and prone to stall; and (3) vegetables in the ingredients have the issues of water loss and discoloration, and meat substances are vulnerable to oxidation and deterioration. As different ingredients are used in prepared fried rice, their food processing and quality monitoring techniques are also different. This paper reviews the key factors that cause changes in the quality of prepared fried rice, and the advantages and limitations of technologies in the processing and monitoring processes. The processing technologies for prepared fried rice include irradiation, high-voltage electric field, microwave, radio frequency, and ohmic heating, while the quality monitoring technologies include Raman spectral imaging, near-infrared spectral imaging, and low-field nuclear magnetic resonance technology. These technologies will serve as the foundation for enhancing the quality and safety of prepared fried rice and are essential to the further development of prepared fried rice in the emerging market.

Case report: Application of targeted NGS for the detection of non-canonical driver variants in MPN.

Background: JAK2, CALR, and MPL gene mutations are recognized as driver mutations of myeloproliferative neoplasms (MPNs). MPNs without these mutations are called triple-negative (TN) MPNs. Recently, novel mutation loci were continuously discovered using next-generation sequencing (NGS), along with continued discussion and modification of the traditional TN MPN. Case presentation: Novel pathogenic mutations were discovered by targeted NGS in 4 patients who were diagnosed as JAK2 unmutated polycythaemia vera (PV) or TN MPN. Cases 1, 2, and 3 were of patients with PV, essential thrombocythemia (ET), and primary myelofibrosis (PMF); NGS detected JAK2 p.H538_K539delinsQL (uncommon), CALR p.E380Rfs*51 (novel), and MPL p.W515_Q516del (novel) mutations. Case 4 involved a patient with PMF; JAK2, CALR, or MPL mutations were not detected by qPCR or NGS, but a novel mutation SH2B3 p.S337Ffs*3, which is associated with the JAK/STAT signal transduction pathway, was found by NGS. Conclusion: NGS, a more multidimensional and comprehensive gene mutation detection, is required for patients suspected of having MPN to detect non-canonical driver variants and avoid the misdiagnosis of TN MPN. SH2B3 p.S337Ffs*3 can drive MPN occurrence, and SH2B3 mutation may also be a driver mutation of MPN.

Technological innovations enhance postharvest fresh food resilience from a supply chain perspective.

Fresh food is rich in nutrients but is usually seasonal, perishable, and challenging to store without degradation of quality. The inherent limitations of various preservation technologies can result in losses in all stages of the supply chain. As consumers of fresh foods have become more health-conscious, new technologies for intelligent, energy-efficient, and nondestructive preservation and processing have emerged as a research priority in recent years. This review aims to summarize the quality change characteristics of postharvest fruits, vegetables, meats, and aquatic products. It critically analyzes research progress and applications of various emerging technologies, which include: the application of high-voltage electric field, magnetic field, electromagnetic field, plasma, electrolytic water, nanotechnology, modified atmosphere packaging, and composite bio-coated film preservation technologies. An evaluation is presented of the benefits and drawbacks of these technologies, as well as future development trends. Moreover, this review provides guidance for design of the food supply chain to take advantage of various technologies used to process food, reduce losses and waste of fresh food, and this improve the overall resilience of the supply chain.

Mechanism Study of Ultrasonic Vibration-Assisted Microgroove Forming of Precise Hot-Pressed Optical Glass.

Microgroove structures with helical pitches in a wavelength level are increasingly required in optical areas. However, conventional manufacturing techniques generate relatively high stresses during pressing, resulting in poor precision when forming microgrooves. This paper reports on the mechanism of the ultrasonic vibration-assisted microgroove forming of precise hot-pressed optical glass. A finite element (FE) thermocompression model of the viscoelastic material was developed and the entire forming process was numerically simulated using coupled thermal-structural analysis. The analysis of several process parameters was carried out using orthogonal experiments, from which the optimum combination of parameters was selected. The glass thermoforming process is also assisted by ultrasonic vibration. The thermal and mechanical effects of vibration improved material flow and optimized forming results. The average maximum stress in the glass during the forming process was only 3.04 × 10-3 Mpa, while the maximum stress in the hot-pressing stage without ultrasound was 1.648 Mpa. The stress results showed that the material-forming stress is significantly reduced.

Technological advances in protein extraction, structure improvement and assembly, digestibility and bioavailability of plant-based foods.

Plant-based foods are being considered seriously to replace traditional animal-origin foods for various reasons. It is well known that animals release large amounts of greenhouse gases into the environment during feeding, and eating animal-origin foods may also cause some health problems. Moreover, animal resources will likely be in short supply as the world population grows. It is highly likely that serious health problems ascribed to insufficient protein intake in some areas of the world will occur. Studies have shown that environmentally friendly, abundant, and customizable plant-based foods can be an effective alternative to animal-based foods. However, currently, available plant-based foods lack nutrients unique to animal-based foods. Innovative processing technologies are needed to improve the nutritional value and functionality of plant-based foods and make them acceptable to a wider range of consumers. Therefore, protein extraction technologies (e.g., high-pressure extraction, ultrasound extraction, enzyme extraction, etc.), structure improvement and assembly technologies (3D printing, micro-encapsulation, etc.), and technologies to improve digestibility and utilization of bioactive substances (microbial fermentation, physical, etc.) in the field of plant-based foods processing are reviewed. The challenges of plant-based food processing technologies are summarized. The advanced technologies aim to help the food industry solve production problems using efficient, environmentally friendly, and economical processing technologies and to guide the development of plant-based foods in the future.

Efficacy and safety comparison of esketamine-propofol with nalbuphine-propofol for upper gastrointestinal endoscopy in children: a multi-center randomized controlled trial.

Background and Aims: Anesthetics such as propofol, esketamine and nalbuphine are used during the upper gastrointestinal endoscopy to achieve and maintain the desired sedation level. The aim of the study was to evaluate the effectiveness and safety of propofol-nalbuphine and propofol-esketamine in children. Methods: A multi-centered study was performed at three tertiary class-A hospitals. Children between 3 and 12 years old undergoing diagnostic painless upper gastrointestinal endoscopy were included and randomly divided into esketamine or nalbuphine group to estimate the primary outcome of successful endoscope insertion. The patients were given esketamine 0.5 mg/kg and propofol 2 mg/kg intravenously in esketamine group, with nalbuphine 0.2 mg/kg and propofol 2 mg/kg in the nalbuphine group. The primary outcome was success rate for the first attempt of endoscope insertion in each group. Secondary outcomes included the safety of both anesthesia regimens and gastroenterologist's satisfaction. We used the Face, Leg, Activity, Cry and Consolability (FLACC) scale to evaluate the level of pain before and during the procedure and the Pediatric Anesthesia Emergence Delirium (PAED) scale to assess the level of agitation and delirium after awakening from anesthesia. Results: Among 246 patients, 200 were randomly included in the final intention-to-treat analysis, with 100 patients in each group. The success rate for the first attempt of endoscope insertion in the esketamine group was higher than the nalbuphine group (97% vs. 66%; P < 0.01). The heart rate and mean arterial pressure after intraoperative administration in the esketamine group were higher than those in the nalbuphine group, while the delirium incidence during awakening was higher in esketamine group (all P < 0.05). Conclusion: The success rate for the first attempt of endoscope insertion of children undergoing upper gastrointestinal endoscopy in the esketamine group was higher than the nalbuphine group, propofol-related hemodynamic changes were reduced accordingly, while the incidence of esketamine-related adverse effects could be high. Clinical Trial Registration: Chinese Clinical Trial Registry: ChiCTR2000040500.

Feasibility analysis of intrathecal administration strategy of nusinersen based on Cobb angle in children with spinal muscular atrophy.

AIM: This retro-prospective observational study described the experience in lumbar puncture procedures in children with spinal muscular atrophy (SMA) with and without neuromuscular scoliosis in a single center. The technical feasibility of intrathecal nusinersen administration was the main limiting factor. STUDY DESIGN: A total of 457 technically successful intrathecal injections based on a hierarchical strategy in Cobb angle were reviewed in 81 SMA children aged 0.75-13.5 years who were referred for nusinersen injections in our hospital from October 2019 to December 2022. RESULTS: Under local anesthesia, conventional lumbar puncture was performed on 47 patients without spinal deformity (Cobb angle of 0-10°) and 20 patients with moderate scoliosis (Cobb angle of 10-50°). Ultrasound-assisted lumbar puncture was performed on 12 patients with moderate scoliosis but lordosis. A combination of ultrasound imaging and three-dimensional CT under sedation was performed in the remaining 14 patients with severe scoliosis (Cobb angle >50°). No severe complications were found. CONCLUSION: Cobb angle is an important basis for intrathecal administration of nusinersen. It is feasible and suitable to carry out intrathecal nusinersen injection under ultrasound combined with three-dimensional CT imaging for children with severe scoliosis.

Application of laryngeal mask airway anesthesia with preserved spontaneous breathing in children undergoing video-assisted thoracic surgery.

Purpose: To investigate the feasibility and safety of non-intubated general anesthesia with spontaneous breathing combined with paravertebral nerve blocks (PVNB) in young children undergoing video-assisted thoracic surgery (VATS) and to determine its significance for rapid recovery after pediatric thoracic surgery. Methods: The data of 46 children aged 6-36 months with an American Society of Anesthesiologists status of I-II who underwent elective VATS under general anesthesia were retrospectively analyzed. Of these patients, 25 underwent non-intubated general anesthesia with spontaneous breathing combined with PVNB (non-intubation group), and 21 received conventional intubated general anesthesia combined with local infiltration anesthesia (intubation group). The following perioperative parameters were compared between the two groups: heart rate (HR), mean arterial pressure, saturation of pulse oximetry (SpO2), partial pressure end-tidal carbon dioxide, time from the completion of the operation to extubation or removing laryngeal masks, time to first feeding after the operation, length of postoperative in-hospital stay, incidence of postoperative complications, and hospitalization expenses. Results: The operations were completed successfully in both groups. When the non-intubation group was compared with the intubation group, the minimal SpO2 level during the surgery was higher (93% vs. 88%, P < 0.001), which might indicate better oxygenation. There was no significant difference of the duration of surgery and intraoperative blood loss between two groups. Compared to the intubation group, the duration of anesthesia (P = 0.027), time from the completion of the operation to extubation (P < 0.001), time to the first feeding after surgery (P < 0.001), and length of postoperative in-hospital stay (P < 0.001) were significantly reduced in the non-intubation group. The incidence of postoperative complications was not significantly different. Conclusions: Non-intubated general anesthesia with spontaneous breathing combined with PVNB is safe and feasible in young children undergoing VATS and can promote rapid recovery in young children undergoing thoracoscopic surgery.

Aberrant serotonergic signaling contributes to the hyperexcitability of CA1 pyramidal neurons in a mouse model of Alzheimer's disease.

Hyperactivity of pyramidal neurons (PNs) in CA1 is an early event in Alzheimer's disease. However, factors accounting for the hyperactivity of CA1 PNs remain to be completely investigated. In the present study, we report that the serotonergic signaling is abnormal in the hippocampus of hAPP-J20 mice. Interestingly, chemogenetic activation of serotonin (5-hydroxytryptamine; 5-HT) neurons in the median raphe nucleus (MRN) attenuates the activity of CA1 PNs in hAPP-J20 mice by regulating the intrinsic properties or inhibitory synaptic transmission of CA1 PNs through 5-HT3aR and/or 5-HT1aR. Furthermore, activating MRN 5-HT neurons improves memory in hAPP-J20 mice, and this effect is mediated by 5-HT3aR and 5-HT1aR. Direct activation of 5-HT3aR and 5-HT1aR with their selective agonists also improves the memory of hAPP-J20 mice. Together, we identify the impaired 5-HT/5-HT3aR and/or 5-HT/5-HT1aR signaling as pathways contributing to the hyperexcitability of CA1 PNs and the impaired cognition in hAPP-J20 mice.

Intraoperative hypothermia in the neonate population: risk factors, outcomes, and typical patterns.

The risk factors, outcomes, and typical patterns of intraoperative hypothermia were studied in neonates to better guide the application of insulation measures in the operating room. This retrospective study enrolled 401 neonates undergoing surgery under general anaesthesia with tracheal intubation, including abdominal surgery, thoracic surgery, brain surgery, and others. The study collected basic characteristics, such as age, sex, weight, birth weight, gestational week, primary diagnosis and American Society of Anaesthesiologists (ASA) grade. Perioperative data included preoperative body temperature, length of hospital stay, length of intensive care unit (ICU) stay, intubation time, postoperative bleeding, postoperative pneumonia, postoperative death, and total cost of hospitalization. Intraoperative data included surgical procedures, anaesthesia duration, operation duration, blood transfusion, fluid or albumin infusion, and application of vasoactive drugs. The incidence of intraoperative hypothermia (< 36 °C) was 81.05%. Compared to normothermic patients, gestational week (OR 0.717; 95% CI 0.577-0.890; P = 0.003), preoperative temperature (OR 0.228; 95% CI 0.091-0.571; P = 0.002), duration of anaesthesia (OR 1.052; 95% CI 1.027-1.077; P < 0.001), and type of surgery (OR 2.725; 95% CI 1.292-5.747; P = 0.008) were associated with the risk of intraoperative hypothermia. Patients with hypothermia had longer length of ICU stay (P = 0.001), longer length of hospital stay (P < 0.001), and higher hospital costs (P < 0.001). But there were no association between clinical outcomes and intraoperative hypothermia in the multivariable regression adjusted analysis. The lowest point of intraoperative body temperature was approximately 1 h 30 min. Then, the body temperature of patients successively entered a short plateau phase and a period of slow ascent. The greatest decrease in body temperatures occurred in preterm babies and neonates with preoperative hypothermia. The lowest core temperatures that occurred in neonates with preoperative hypothermia was lower than 35 °C. This study shows that there is a high incidence of intraoperative hypothermia in the neonate population. The intraoperative body temperature of neonates dropped to the lowest point in 1-1.5 h. The greatest decrease in core temperatures occurred in preterm babies and neonates with lower preoperative temperature.

The differences of hemogram, myelogram, and driver gene mutations in classic myeloproliferative neoplasms.

The aim of this study was to explore and compare routine blood features and pathological characteristics of bone marrow tissues in essential thrombocythemia (ET), polycythemia vera (PV), primary myelofibrosis, prefibrotic stage (prePMF) and overt fibrotic stage (overtPMF), and the correlation between common driver gene mutations and clinical manifestations of myeloproliferative neoplasms (MPN). Methods: We analyzed 259 MPN patients treated at Tongji Hospital of Huazhong University of Science and Technology from January 2016 to December 2020. Results: Among ET, PV, prePMF, and overtPMF, the median leukocyte counts of PV and prePMF were significantly higher than those of ET. The average hemoglobin level of overtPMF was significantly lower than that of ET, PV, and prePMF. ET and prePMF had higher platelet counts than PV and overtPMF, whereas ET had the lowest platelet distribution width. Regarding hematopoietic tissues in the bone marrow, enlarged megakaryocytes were easily found in ET, PV, and prePMF, whereas the average diameter of megakaryocytes in prePMF was smaller than in ET, and PV showed various sizes of megakaryocytes. An increased M/E ratio and dilation of sinus were seen more frequently in PMF. Additionally, JAK2-positive patients tended to have significantly higher leukocyte counts than CALR-positive patients in ET and PMF.

Study on Instant Delivery Service Riders' Safety and Health by the Effects of Labour Intensity in China: A Mediation Analysis.

The Instant Delivery Service (IDS) riders' overwork by "self-pressurisation" will not only reduce the level of their physical and mental health but also lose their lives in safety accidents caused by their fatigue riding. The purpose of this article is to examine whether there is overwork among IDS riders in big and medium cities in China? What's going on with them? Based on the Cobb-Douglas production function in the input-output theory, this study characterised the factors on IDS riders' safety and health associated with labour intensity. A mediating model with moderating effect was adopted to describe the mediation path for the 2,742 IDS riders who were surveyed. The results of moderating regression demonstrated that (1) 0.4655 is the total effect of labour intensity on the safety and health of IDS riders. (2) 0.3124 is the moderating effect that working hours make a greater impact on labour intensity. (3) The mediating effect of work pressure is the principal means of mediation both upstream and downstream.

Clinical Effect and Safety Analysis of 2.5 µg/kg DEX Nasal Drop in Child Undergoing Ultrasound Examination.

In order to meta-analyze the clinical effect and safety of dexmedetomidine (DEX) intranasal sedation in child ultrasound examination, literature retrieval is carried out in Wanfang Medicine, PubMed database, domestic medical research journals. The relevant medical information literature on clinical effects and safety are analyzed by using Rev Man 5.2 software. The retrieved literature is screened according to the research object, method, disease type and other criteria. The results of meta-analysis show that dexmedetomidine intranasal sedation is applied to child undergoing ultrasound examination, and the SPO2 and sedation time are significantly higher than those in the conventional sedation group (P < 0.05). The time/score is significantly lower than that in the conventional sedation group (P < 0.05), and the incidence of adverse reactions in the dexmedetomidine intranasal sedation group is significantly lower than that in the conventional sedation group (P < 0.05).

Application value of multiparametric MRI for evaluating iron deposition in the substantia nigra in Parkinson's disease.

Objective: This study aimed to investigate the application value of multi-parametric magnetic resonance imaging (MRI) in the diagnosis of iron deposition in the substantia nigra dense zone in Parkinson's disease (PD) and to evaluate the diagnostic value of the correlation among multi-parametric imaging indicators, clinical stage, and disease duration. Materials and methods: Thirty-six patients with clinically confirmed PD and 36 healthy controls were enrolled. The disease course was recorded, and PD severity was graded using the Hoehn-Yahr (H-Y) scale. All subjects underwent magnetic sensitivity weighted imaging (SWI), neuromelanin magnetic resonance imaging (NM-MRI), and a T2*mapping sequence. Based on the fusion of the NM-MRI and SWI amplitude maps, phase maps, and T2*MAPPING value maps, NM-MRI was used to delineate the dense zone of the substantia nigra, which was divided into three sub-regions: upper, middle, and lower. In this way, the amplitude, phase, and R2* values of each sub-region and the average value of the sum of the three sub-regions were obtained simultaneously in the SWI amplitude, phase, and T2*MAPPING maps. The multi-parameter imaging indices were compared between the two groups, and the correlation between them and clinical indices was evaluated in the PD group. Results: The upper (amplitude, phase value, R2* value), middle, and lower (amplitude) right substantia nigra compact zones were significantly different between the PD and control groups. The upper (phase value, R2* value) and middle (amplitude) areas of the left substantia nigra compact zone were also significantly different between the two groups (all P < 0.05). The mean values (amplitude, phase value, R2* value) of the right substantia nigra densification zone and the mean values (phase value) of the left substantia nigra densification zone were also significantly different (all P < 0.05). Amplitudes in the middle and lower parts of the right substantia nigra dense zone were negatively correlated with the H-Y grade (middle: r = -0.475, P = 0.003; lower: r = -0.331, P = 0.049). Amplitudes of the middle and lower parts of the dense zone of the left substantia nigra were negatively correlated with the H-Y grade (middle: r = -0.342, P = 0.041; lower: r = -0.399, P = 0.016). The average amplitude of the right substantia nigra compact zone was negatively correlated with the H-Y grade (r = -0.367, P = 0.027). The average R2* value of the compact zone of the left substantia nigra was positively correlated with the H-Y grade (r = 0.345, P = 0.040). Conclusion: Multiparametric MRI sequence examination has application value in the evaluation of iron deposition in the dense zone of the substantia nigra in PD. Combined with NM-MRI, fusion analysis is beneficial for accurately locating the substantia nigra compact zone and quantitatively analyzing the iron deposition in different sub-regions. Quantitative iron deposition in the middle and lower parts of the substantia nigra dense zone may become an imaging biological indicator for early diagnosis, severity evaluation, and follow-up evaluation of PD and is thus conducive for clinical diagnosis and treatment evaluation.