Objective:To identify the risk factors for acute graft-versus-host disease (aGVHD) in patients with acute myeloid leukemia (AML) undergoing haploidentical hematopoietic stem cell transplantation (HID-HSCT) .Methods:A total of 141 AML patients who underwent HID-HSCT at the Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences, from January 2020 to July 2021 were included. The cumulative incidence of aGVHD was analyzed using the Fine-Gray competing risk model, with relapse and death as competing events, to compare differences between groups. Potential risk factors were evaluated by univariable and multivariable Cox proportional hazards regression analyses to determine their independent effects on aGVHD.Results:Among the 141 patients, 86 (61.0%) were male and 55 (39.0%) were female, with a median age at transplantation of 34 years. Within 100 days post-transplant, 59 patients developed grade Ⅱ-Ⅳ aGVHD, whereas 86 patients experienced no or grade Ⅰ aGVHD (the grade 0-Ⅰ aGVHD group) . Survival analysis showed that the 3-year overall survival was 68.7% (95% CI: 57.7%-81.9%) in the grade Ⅱ-Ⅳ aGVHD group, compared with 78.8% (95% CI: 70.4%-88.3%) in the grade 0 - Ⅰ aGVHD group, with the difference not being statistically significant ( P=0.190) . Univariable analysis identified donor age ( P=0.020, HR=1.020, 95% CI: 1.000-1.040) and the female donor-male recipient sex combination ( P=0.033, HR=1.980, 95% CI: 1.160-3.380) as risk factors for grade Ⅱ-Ⅳ aGVHD. Multivariable analysis confirmed that donor age ( P=0.005, HR=1.026, 95% CI: 1.008-1.047) and the female donor-male recipient sex combination ( P=0.002, HR=2.339, 95% CI: 1.354-4.037) were independent risk factors for aGVHD. Patients receiving grafts from donors aged >45 years had a significantly higher 100-day cumulative incidence of grade Ⅱ-Ⅳ aGVHD compared with those receiving grafts from donors ≤45 years [54.7% (95% CI: 42.3%-67.0%) vs 31.6% (95% CI: 21.0%-42.1%) , P=0.006]. Similarly, patients with the female donor-male recipient sex combination had a higher 100-day cumulative incidence of grade Ⅱ-Ⅳ aGVHD than those with other sex combinations [56.8% (95% CI: 40.4%-73.1%) vs 36.9% (95% CI: 27.5%-46.3%) , P=0.015]. Conclusion:Older donor age and the female donor-male recipient sex combination remain independent risk factors for aGVHD in patients with AML undergoing HID-HSCT.

Objective:To evaluate the early and mid-term efficacy of physician-modified fenestrated endovascular repair combined with inner branch techniques for aortic pathologies complicated by aberrant subclavian artery (ASA).Methods:A retrospective case series was conducted, including 24 patients with ASA-associated aortic pathologies who underwent thoracic endovascular aortic repair (TEVAR) with physician-modified fenestration and inner branch reconstruction at 7 centers in China from February 2021 to March 2025. The cohort comprised 18 males and 6 females, with an age of (54.4±11.7) years (range:37 to 80 years). Pathological diagnoses included aortic aneurysm in 7 patients (29.2%), aortic dissection in 11 (45.8%; 6 chronic, 4 subacute, 1 acute), and penetrating aortic ulcer in 6 (25.0%; 3 with concomitant intramural hematoma). Preoperative planning was performed using three-dimensional CT angiographic reconstruction, incorporating both the greater-curvature hemodynamic length and the centerline wall-adherent length. Fenestration sites were verified on three-dimensional printed models, and precise fenestrations were created at the covered stent-graft locations corresponding to the subclavian artery and ASA anatomy. Patients subsequently underwent TEVAR combined with supra-aortic revascularization as indicated, followed by completion ascending aortography to evaluate the sealing of the main stent-graft and the patency of fenestrated or branched stents. Perioperative outcomes, complications, and early-to mid-term clinical efficacy were analyzed.Results:All procedures were technically successful. Immediate angiography identified one case of minor type Ⅳ endoleak that resolved spontaneously on 3-month follow-up CT angiography, and one case of mild type Ⅱ endoleak that was left untreated with a stable false lumen during follow-up. One patient died on postoperative day 7 of an undetermined cause. The mean follow-up period was (23.1±11.3)months (range:3 to 37 months). During follow-up, one patient developed mild bilateral lower-limb weakness 1 month after surgery. Vascular occlusion and spinal cord infarction were excluded, and the symptoms were considered related to postoperative spinal hemodynamic changes; the weakness resolved after blood pressure adjustment without recurrence. No other complications, including upper limb ischemia, spinal cord ischemia, or posterior circulation ischemia, were observed. Throughout follow-up, all branch and main stents remained patent with good structural integrity, without migration or device-related complications.Conclusions:Physician-modified fenestration combined with inner branch techniques for ASA-associated aortic pathologies is technically feasible and yields satisfactory early and mid-term results. Long-term outcomes require further follow-up.

Objective To observe the effectiveness and safety of DiaSphere embolized microsphere TACE for treating primary hepatocellular carcinoma(HCC).Methods Totally 188 patients with HCC were prospectively enrolled and randomly assigned to research group(n=93)and control group(n=95),who underwent TACE with DiaSphere embolized microspheres and Embosphere embolized microspheres,respectively.The incidence of TACE-related adverse events were recorded.The therapeutic efficacy 1 month after the first TACE,also 1 and 3 months after the last TACE,and liver functions 1 month after the first and last TACE were compared between groups.Results In research group,there were 69 cases underwent 1 time TACE,22 cases underwent 2 times and 2 cases underwent 3 times TACE,while in control group,there were 82 cases underwent 1 time and 13 cases underwent 2 times TACE,respectively.No statistical difference of the incidence of adverse events was found between groups(77.42%[72/93]vs.76.84%[73/95],P=1.000).One month after the first TACE,7 cases in research group and 11 cases in control group were lost to follow-up,respectively.One month after the last TACE,12 cases were lost to follow-up in both groups,and 3 months after the last TACE,28 cases were lost to follow-up in both groups.No significant difference of objective response rate nor disease control rate was found between groups at the above time points(all P＞0.05).One month after the first and last TACE,liver function indicators were not different between groups(all P＞0.05).Conclusion Both the short-term efficacy and safety of TACE with DiaSphere embolized microspheres for treating HCC were good.

Objective To observe the effectiveness and safety of DiaSphere embolized microsphere TACE for treating primary hepatocellular carcinoma(HCC).Methods Totally 188 patients with HCC were prospectively enrolled and randomly assigned to research group(n=93)and control group(n=95),who underwent TACE with DiaSphere embolized microspheres and Embosphere embolized microspheres,respectively.The incidence of TACE-related adverse events were recorded.The therapeutic efficacy 1 month after the first TACE,also 1 and 3 months after the last TACE,and liver functions 1 month after the first and last TACE were compared between groups.Results In research group,there were 69 cases underwent 1 time TACE,22 cases underwent 2 times and 2 cases underwent 3 times TACE,while in control group,there were 82 cases underwent 1 time and 13 cases underwent 2 times TACE,respectively.No statistical difference of the incidence of adverse events was found between groups(77.42%[72/93]vs.76.84%[73/95],P=1.000).One month after the first TACE,7 cases in research group and 11 cases in control group were lost to follow-up,respectively.One month after the last TACE,12 cases were lost to follow-up in both groups,and 3 months after the last TACE,28 cases were lost to follow-up in both groups.No significant difference of objective response rate nor disease control rate was found between groups at the above time points(all P＞0.05).One month after the first and last TACE,liver function indicators were not different between groups(all P＞0.05).Conclusion Both the short-term efficacy and safety of TACE with DiaSphere embolized microspheres for treating HCC were good.

Objective:To identify the risk factors for acute graft-versus-host disease (aGVHD) in patients with acute myeloid leukemia (AML) undergoing haploidentical hematopoietic stem cell transplantation (HID-HSCT) .Methods:A total of 141 AML patients who underwent HID-HSCT at the Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences, from January 2020 to July 2021 were included. The cumulative incidence of aGVHD was analyzed using the Fine-Gray competing risk model, with relapse and death as competing events, to compare differences between groups. Potential risk factors were evaluated by univariable and multivariable Cox proportional hazards regression analyses to determine their independent effects on aGVHD.Results:Among the 141 patients, 86 (61.0%) were male and 55 (39.0%) were female, with a median age at transplantation of 34 years. Within 100 days post-transplant, 59 patients developed grade Ⅱ-Ⅳ aGVHD, whereas 86 patients experienced no or grade Ⅰ aGVHD (the grade 0-Ⅰ aGVHD group) . Survival analysis showed that the 3-year overall survival was 68.7% (95% CI: 57.7%-81.9%) in the grade Ⅱ-Ⅳ aGVHD group, compared with 78.8% (95% CI: 70.4%-88.3%) in the grade 0 - Ⅰ aGVHD group, with the difference not being statistically significant ( P=0.190) . Univariable analysis identified donor age ( P=0.020, HR=1.020, 95% CI: 1.000-1.040) and the female donor-male recipient sex combination ( P=0.033, HR=1.980, 95% CI: 1.160-3.380) as risk factors for grade Ⅱ-Ⅳ aGVHD. Multivariable analysis confirmed that donor age ( P=0.005, HR=1.026, 95% CI: 1.008-1.047) and the female donor-male recipient sex combination ( P=0.002, HR=2.339, 95% CI: 1.354-4.037) were independent risk factors for aGVHD. Patients receiving grafts from donors aged >45 years had a significantly higher 100-day cumulative incidence of grade Ⅱ-Ⅳ aGVHD compared with those receiving grafts from donors ≤45 years [54.7% (95% CI: 42.3%-67.0%) vs 31.6% (95% CI: 21.0%-42.1%) , P=0.006]. Similarly, patients with the female donor-male recipient sex combination had a higher 100-day cumulative incidence of grade Ⅱ-Ⅳ aGVHD than those with other sex combinations [56.8% (95% CI: 40.4%-73.1%) vs 36.9% (95% CI: 27.5%-46.3%) , P=0.015]. Conclusion:Older donor age and the female donor-male recipient sex combination remain independent risk factors for aGVHD in patients with AML undergoing HID-HSCT.

Objective:To evaluate the early and mid-term efficacy of physician-modified fenestrated endovascular repair combined with inner branch techniques for aortic pathologies complicated by aberrant subclavian artery (ASA).Methods:A retrospective case series was conducted, including 24 patients with ASA-associated aortic pathologies who underwent thoracic endovascular aortic repair (TEVAR) with physician-modified fenestration and inner branch reconstruction at 7 centers in China from February 2021 to March 2025. The cohort comprised 18 males and 6 females, with an age of (54.4±11.7) years (range:37 to 80 years). Pathological diagnoses included aortic aneurysm in 7 patients (29.2%), aortic dissection in 11 (45.8%; 6 chronic, 4 subacute, 1 acute), and penetrating aortic ulcer in 6 (25.0%; 3 with concomitant intramural hematoma). Preoperative planning was performed using three-dimensional CT angiographic reconstruction, incorporating both the greater-curvature hemodynamic length and the centerline wall-adherent length. Fenestration sites were verified on three-dimensional printed models, and precise fenestrations were created at the covered stent-graft locations corresponding to the subclavian artery and ASA anatomy. Patients subsequently underwent TEVAR combined with supra-aortic revascularization as indicated, followed by completion ascending aortography to evaluate the sealing of the main stent-graft and the patency of fenestrated or branched stents. Perioperative outcomes, complications, and early-to mid-term clinical efficacy were analyzed.Results:All procedures were technically successful. Immediate angiography identified one case of minor type Ⅳ endoleak that resolved spontaneously on 3-month follow-up CT angiography, and one case of mild type Ⅱ endoleak that was left untreated with a stable false lumen during follow-up. One patient died on postoperative day 7 of an undetermined cause. The mean follow-up period was (23.1±11.3)months (range:3 to 37 months). During follow-up, one patient developed mild bilateral lower-limb weakness 1 month after surgery. Vascular occlusion and spinal cord infarction were excluded, and the symptoms were considered related to postoperative spinal hemodynamic changes; the weakness resolved after blood pressure adjustment without recurrence. No other complications, including upper limb ischemia, spinal cord ischemia, or posterior circulation ischemia, were observed. Throughout follow-up, all branch and main stents remained patent with good structural integrity, without migration or device-related complications.Conclusions:Physician-modified fenestration combined with inner branch techniques for ASA-associated aortic pathologies is technically feasible and yields satisfactory early and mid-term results. Long-term outcomes require further follow-up.

Objective:To investigate the incidence of radiation pneumonitis (RP) induced by 125I seed implantation for the treatment of malignant lung tumors and analyze related dosimetric parameters. Methods:A retrospective analysis was conducted on 31 cases of malignant lung tumors treated with 125I seed implantation from January 2017 to December 2022 at Hebei Provincial Tumor Radioactive Seeds Implantation Diagnosis and Treatment Center. These cases consisted of eight patients with squamous cell carcinoma, 10 patients with adenocarcinoma, and 13 patients with metastatic cancer in other sites. At 1-6 months after treatment, these patients received postoperative chest CT scans, with the efficacy evaluated based on the Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1), including the objective response rate (ORR) and the disease control rate (DCR). The efficacy of RP was evaluated using the Radiation Therapy Oncology Group (RTOG) criteria. Postoperative dosimetric parameters, including D90 (minimum peripheral dose received by 90% of the target volume), V8 (percentage of lung volume receiving 8 Gy), V32 (percentage of lung volume receiving 32 Gy), and Dmean (mean radiation dose) of the affected lung, were statistically analyzed. The relationships of the RP occurrence with postoperative D90, V8, V32, and Dmean were analyzed by comparison with relevant external radiotherapy data, to identify the parameters that are correlated closely with RP occurrence. Results:All the patients underwent successful surgeries. The postoperative efficacy evaluation after six months showed complete response (CR) in 11 cases, partial response (PR) in 11 cases, stable disease (SD) in eight cases, and progressive disease (PD) in one case, with an overall response rate (ORR) of 71.0%, and a disease control rate (DCR) of 96.8%. Three patients suffered RP, with an incidence rate of 9.7%. Postoperative V8, V32, and Dmean could not serve as predictive indicators for RP. Follow-up observation revealed that three RP cases (3/5) exhibited postoperative D90 exceeding 170 Gy and no RP cases (0/26) showed postoperative D90 below 170 Gy. Conclusions:In the treatment of malignant lung tumors with 125I seed implantation, there is a certain correlation between RP and postoperative D90, while there is no correlation between it and V8, V32, and Dmean.

Objective:To design and implement a registration system based on Elasticsearch,so as to solve the problems of the conventional registration system included single method of appointment and registration,and one-sidedness information of search registration platform,and to meet the growing needs of patients for diversified and intelligent medical registration and treatment.Methods:The browser/server(B/S)architecture was used to implement the design of registration system.The front-end used the neuron organic object description language(NOODL)language to render the interface,and implemented interaction between function methods and interface data through Typescript.The Elasticsearch search engine implemented high efficient search functions.The back-end processed the requirements of data through the(edge-based cloud object storage)ECOS system,and stored business data in the MySQL database.The system included a three-layer architecture with application layer,service layer and storage layer,which can realize a series of functions such as login and registration,search for appointments,link appointments,scan code for appointments,and setting appointment information by doctors.Results:The registration system based on Elasticsearch can realize multiple methods of appointment registration such as online search appointment,exclusive link appointment of hospital,appointment by scanning code,etc.,which was suitable to multiple platforms such as Web and mobile device.It has been applied in many overseas medical institutions.As of June 2023,the system possessed 219 doctors,and had serviced for 19,903 patients,and had completed 62,737 appointments,which saved a lot of time for patients to seek medical treatment,and improved operation efficiency of hospital.Conclusion:The registration system based on Elasticsearch can meet the diversified and intelligent needs of patients for medical treatment,which can provide comprehensive,accurate and intelligent services of appointment and treatment for patients,and can effectively improve the efficiency of appointment and treatment.

Objective:To construct an evaluation framework with detailed indices for demonstration units (wards) of enteral nutrition nursing, in order to improve the competence of nurses in enteral nutrition nursing and inform the specialized development of enteral nutrition demonstration units (wards).Method:On the basis of literature review and expert discussion, a preliminary draft was developed, and the Delphi expert consultation method was used to conduct two rounds of consultation with 15 clinical experts in the field of enteral nutrition nursing from 15 tertiary hospitals.Results:The effective response rates of questionnaires in two rounds of consultations were both 100%. The first round of expert consultation showed an authority coefficient of 0.90 and a coefficient of variation of 0 to 0.167, while the second round showed an authority coefficient of 0.93 and a coefficient of variation of 0 to 0.113. The Kendall harmony coefficients were 0.338 and 0.368, respectively. Finally, the evaluation framework with detailed indices for the demonstration unit (ward) of enteral nutrition nursing was formed, which consisted of 3 primary indicators, 16 secondary indicators, 54 tertiary indicators, and 62 detailed items.Conclusions:The evaluation framework we developed for the demonstration unit of enteral nutrition nursing follows the diagnosis and treatment process of enteral nutrition management for inpatients, including the triad of structure, process, and outcome. The framework is objective and practical, and can inform the daily practice of enteral nutrition nursing demonstration units (wards) and the development of enteral nutrition nursing specialties.

Objective:To understand the nutritional nursing competence in the enteral nutrition demonstration wards at this stage, so as to inform subsequent training plan.Methods:From September to October in 2023, nurses from 287 institutions involved in the enteral nutrition demonstration ward construction project were selected using convenience sampling. Questionnaires on general characteristics and self-assessment scale on nutrition nursing competence were used for online survey. The status quo and influencing factors of nutrition nursing competence in included institutions were analyzed.Results:A total of 5 409 valid questionnaires were collected, with a response rate of 62.63%. The total score of nutrition nursing competence was 74.74±16.11, with the least subtotals in the domain of nutrtion knowledge. Multiple linear regression showed that influencing factors of nutrition nursing competence includes years of working, department, registered dietitian or not, nutrition management specialist or not, completion of the curriculum in enteral nutrition demonstration ward construction project, and training/supervision arranged by their department concerning nutrtion nursing and relevant evaluation criteria ( P<0.05). Conclusions:The nutritional nursing competence of clinical nurses in the wards involved in enteral nutrition demonstration ward construction project still needs to be improved. Seniors should take into consideration the varying nutritional nursing competence among junior nurses and nurses from different departments, and strengthen the training on nutrition knowledge. It should be encouraged for nurses to actively participate in nutritionist training. Actions including enhancing nutrition specialist training, establishing the multidisciplinary collaborative nutrition care team and conducting regular supervision and assessment should be implemented in the future, to improve the nutritional nursing competence among nurses.