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Burkitt lymphoma is a highly aggressive B-cell non-Hodgkin lymphoma characterized by rapid growth, and Burkitt lymphoma originating in the tonsil is rare. Most of the cases have no obvious specific symptoms in the early stage, and the clinical symptoms are varied. Children’s symptoms are more atypical, which are easy to be misdiagnosed and missed. We report a case of adolescent with unilateral tonsil enlargement in our hospital, who was diagnosed with Burkitt lymphoma (BL). For patients with rapid enlargement of the tonsils in a short period, asymmetry of the tonsils (Brodskyscale tonsil size difference ≥ 2 degrees), mainly local symptoms but without obvious systemic symptoms, and rare enlarged lymph nodes in the neck, and no obvious abnormalities in laboratory tests, CT or MRI examination of the neck, or further PET/CT examination should be completed in time. When suspected malignant tumors revealed on imaging, especially high value of SUVmax on PET/CT, tonsil biopsy should be performed. Early detection. Early diagnosis can improve the prognosis of Burkitt lymphoma. In this case, the diagnosis was timely and accurate. Surgical resection of the left tonsil alleviated local symptoms in this cas, and chemotherapy treatment was timely completed after postoperative pathology. Efficacy of surgery combined with chemotherapy is good for the patient and long-term follow-up is available.

Background: Guidance has showed positive effects on promoting inquiry-based learning in science education. While an increasing number of studies focus on the design of guidance in simulation-based inquiry learning due to recent technology developments, how different designs of a same type of guidance affect learning remains a question. Objectives: This study reviews the (quasi-)experimental research on the learning effects of differently designed guidance in simulation-based inquiry learning in the past decade (2011-2020). The investigation is guided by two questions: how differently designed guidance affects inquiry-based learning in simulated environments in terms of learning process and learning outcomes, and what role technology plays in the design of guidance. In particular, we report on studies that compares the effects of a same type (process constraints/prompts/heuristics/scaffolds/metacognitive supports/direct presentation of information) of guidance with different instructional designs, and select a total of 28 peer-reviewed journal articles. The results indicate no equivocal tendency of effectiveness towards a specific design. Instead, each type of guidance has related factors that may influence its effectiveness. Three major factors that related to optimization of inquiry learning guidance in simulation-based environments are identified: the learner factor, the pedagogical factor, and the technological factor.

Background Degenerative lumbar spinal stenosis (DLSS) is a costly disease that mainly occurs during the old age, which seriously affects the normal life. There are many treatment options for DLSS. The development and clinical application of high-quality clinical practice guidelines are major ways to improve the diagnosis and treatment of DLSS. Objective To provide a reference for the development and reporting of clinical practice guidelines of DLSS, with guidelines of DLSS evaluated using AGREEⅡ and RIGHT, from the perspectives of methodology and quality. Methods Databases were searched for clinical practice guidelines, consensuses and specifications about DLSS, including CBM, CNKI, Wanfang Data, VIP, PubMed, Medlive, WHO, the National Institute for Health and Care Excellence, Guidelines International Network, National Guideline Clearinghouse and Scottish Intercollegiate Guideline Network from January 1, 2010 to January 1, 2022. The methodological quality and reporting quality of included studies were evaluated by two raters independently. And the recommendations in the studies were compared under the uniform grading criteria. Results Six studies were enrolled, including four guidelines and two consensuses. One guideline is based on TCM, and the other three are evidence-based guidelines. The evaluation results of AGREEⅡ showed that the ratio of the actual total score to the full score of the six included studies was 78.2%, 53.6%, 45.7%, 37.7%, 28.2% and 15.0%, from highest to the lowest. RIGHT evaluation showed that the ratio of the actual total score to the full score of the four guidelines was 72.9%, 72.9%, 62.9% and 34.3%, from highest to the lowest. A total of 46 therapeutic and 11 non-therapeutic recommendations were developed in the six studies. Conclusion The methodological quality and reporting specification of the present DLSS guidelines and consensuses require to be further improved. Further reference should be made to international standards such as AGREE Ⅱ and RIGHT in the process of guideline development and reporting. Surgical treatment is the preferred recommendation for patients with moderate or severe DLSS.

Objective To study anxiety and depression in Chinese patients with cystic fibrosis (CF). Methods Clinical data from 28 CF patients in the cystic fibrosis registry study of Peking Union Medical College Hospital were collected and analyzed. Hospital anxiety and depression scale was used to identify anxiety and depression. Results The cohort had 42.9% (12/28) males with a mean age of 23±4.8 years. 14 patients (50%) had anxiety or depression. Among them, 8 subjects (28.6%) had moderate and severe anxiety or depression, and 5 patients (17.9%) were with moderate and severe anxiety, and 7 patients(25%) with moderate and severe depression. One patient(3.6%) had severe anxiety, no patients with severe depression, and four patients (14.3%) had both moderate and severe anxiety and depression. Compared to patients without anxiety or depression, patients with anxiety had significantly lower FVC% pred (54.5%±18.8% with anxiety, 80.0%±14.6% without anxiety or depression, P＜0.05), and patients with depression had significantly lower FEV1% pred (41.6%±21.6% with depression, 64.2%±20.9% without anxiety or depression, P＜0.05) and FVC% pred (53.9%±21.0% with depression, 80.0%±14.6% without anxiety or depression, P＜0.01). Conclusions Half of CF patients have anxiety or depression, with a high comorbidity rate of anxiety and depression and a low prevalence of severe anxiety or depression in our cohort. CF patients with anxiety or depression have worse pulmonary ventilationy function compared to CF patients without anxiety or depression.