Leukemia is a critical disease with a high incidence and extremely high fatality rate.Immune escape by leukemia stem cells(LSC)is the main factor for recurrence and progression after remission.Clinical diagnosis and treatment by Traditional Chinese Medicine(TCM)have distinct advantages of syndrome differentiation and treatment.Based on the purpose of diagnosis and treatment,leukemia treatment by TCM emphasizes the harmony of yin and yang to restore human functions,which is conducive to improve autoimmunity and conforms to the mechanism of intervention for tumor cell immune escape.This article discusses the mechanism and research progress of TCM interventions in LSC immune escape based on literature and TCM theory.

Objective In order to discuss the rationality of clinical use of medication and the strategies of serious adverse reactions(SADR),the reports of SADRs caused by nedaplatin for injection were summarized and analyzed.Methods Methods Serious adverse reactions to all medicines reported to the National Adverse Reaction Monitoring Centre(NARMC)in Tongji Hospital Affiliated to Tongji Medical College,Huazhong University of Science and Technology from January 2012 to December 2021 were collected,and a retrospective analysis of 90 patients among those cases with SADR after nedaplatin injection was carried out.Results The occurrence of SADRs was not related to the gender.In monotherapy with nedaplatin,the rate of serious adverse effects was high with the first use of nedaplatin(74.3%).The incidence of adverse reactions was highest within 30 minutes and 2-14 days,including severe allergic reaction(34.4%)and grade Ⅱ-Ⅳ myelosuppression(51.2%),respectively.Drug withdrawal and symptomatic treatment were often the preferred treatment methods in clinical practice.Conclusion While using nedaplatin as a chemotherapy regimen,especially for the first time,patients should be closely monitored for the occurrence of severe anaphylaxis within 30 minutes and severe bone marrow suppression within 2 weeks.A rescue emergency plan for resuscitation and regular checking of the hemogram should be made to prevent the occurrence of serious adverse reactions.

【Objective】 To explore the current status and development trend of research on external therapies in traditional Chinese medicine (TCM) for insomnia over the past 10 years through bibliometrics and visual analysis, to provide references for further research on the topic. 【Methods】 Literature relating to TCM external therapies for insomnia from January 1, 2012 to December 31, 2021 was retrieved from Chinese databases, including China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science and Technology Journal Database (VIP), and from the Web of Science Core Collection (WOSCC) for English articles. CiteSpace, VOSviewer, Scimago Graphica, and NoteExpress software were used to analyze publication volumes of the papers and how they were distributed in different journals, as well as to visualize the data of the countries, authors, institutions, and keywords. 【Results】 A total of 6 085 papers were obtained, of which 5 592 were from the Chinese databases and 493 were from the English database, with their publication volumes growing steadily year on year. Approximately 45 countries and regions were found to have published research on the topic. In terms of Chinese publications, the author with the most papers published was CHEN Yunfei from Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine. The closest collaboration was between LIU Chengyong from the Affiliated Hospital of Nanjing University of Chinese Medicine and YUE Zenghui from Hunan University of Chinese Medicine. In terms of English publications, the author with the most papers published was MAO Junj from Sloan-Kettering Cancer Research Center, USA, and LAO Lixing from the University of Hong Kong was his closest partner in collaboration. Heilongjiang University of Chinese Medicine was the institution with the most Chinese publications, and Shanghai University of Traditional Chinese Medicine was the one with the most English papers published. Studies on the topic were published in 386 Chinese journals and 205 English journals, respectively. Nowadays, the clinical application of TCM external treatments for insomnia, the selection of meridians and acupoints, therapies for insomnia and its related diseases are research hotspots. The combined use of different TCM external therapies is a trend in the treatment of insomnia and its concomitant diseases, especially in the fields of oncology, nursing, and psychiatric disorders. The exploration of mechanisms of TCM external therapies for insomnia is also a key direction for future research. In clinical practice, the commonly used external therapies for insomnia include acupuncture, ear-acupressure with beans, acupoint application, etc. The commonly selected acupoints are auricular points, Sishencong (EX-HN1), Shenmen (HT7), etc. The frequently studied meridians are Ren, Du, Qiao, etc. The insomnia concomitant diseases are depression, stroke, anxiety, etc. 【Conclusion】 A wealth of research results have been accumulated in the treatment of insomnia by TCM external therapies, but authoritative research results are not so many. Therefore, institutions in different countries should strengthen communications and cooperation, and researchers should be encouraged to make innovations and breakthroughs on the basis of inherited TCM external therapies, so as to produce more valuable research results and improve TCM external therapies for providing better treatments for patients with sleep disorders.

Objective To investigate the efficacy of switching to co-formulated elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide (E/c/F/TAF) combined with sofosbuvir/velpatasvir (SOF/VEL) in the treatment of previously untreated chronic hepatitis C patients with HIV/HCV co-infection and the changes in blood lipid levels. Methods This prospective cohort study was conducted among 10 previously untreated chronic hepatitis C patients with HIV/HCV co-infection who attended Department of Infectious Diseases in Tangdu Hospital from July 2019 to May 2021 and achieved continuous HIV suppression after antiretroviral treatment (ART). As for anti-HIV therapy, the ART regimen was switched to the E/c/F/TAF regimen for 32 weeks, and for anti-HCV therapy, the SOF/VEL regimen was started since week 4 after switching and lasted for 12 weeks. Related indices were monitored before and after switching to E/c/F/TAF for anti-HCV therapy and SOF/VEL for anti-HCV therapy, including body weight, body mass index, HCV genotype, alpha-fetoprotein, liver stiffness measurement, CD4 + T cell count, CD4 + T/CD8 + T ratio, hepatic and renal function parameters, blood lipids, HIV RNA, HCV RNA, SVR12, SVR24, and adverse reactions. The Mann-Whitney U test was used for comparison of continuous data between two groups, and a Spearman correlation analysis was performed. Results After 4 weeks of treatment with E/c/F/TAF, 10 patients (HCV genotypes 2a and 1b) had HIV RNA below the lower limit of detection (20 IU/ml) and a significant reduction in albumin ( Z =-2.801, P =0.003 7), with the other indices remaining stable, and the patients reported significant improvements in the adverse events of anti-HIV therapy with the former ART regimen. After 4 weeks of E/c/F/TAF combined with SOF/VEL, the patients had HCV RNA below the lower limit of detection (15 IU/ml), and both SVR12 and SVR24 reached 100%; after 12 weeks of anti-HCV therapy, there were significant reductions in alanine aminotransferase ( Z =-2.732, P =0.004 8) and aspartate aminotransferase ( Z =-2.501, P =0.010 7) and significant increases in total cholesterol (TC) ( Z =-2.797, P =0.003 9) and low-density lipoprotein cholesterol (LDL-C) ( Z =-2.343, P =0.018 5), with a significantly positive correlation between them ( r =0.87, P < 0.001), and all the other indices were normal. Conclusion For previously untreated chronic hepatitis C patients with HIV/HCV co-infection, switching to E/c/F/TAF combined with SOF/VEL has good efficacy, tolerability, and safety, and the combination of the two regimens can avoid drug interaction, achieve a high HCV cure rate, and maintain HIV suppression. Transient increases in TC and LDL-C are observed during combination treatment, which suggests dyslipidemia caused by HCV infection and the pharmacological action of this regimen.

Objective: To evaluate risk factors for NEC in in term infant. Methods: Risk factors associated with NEC were investigated using a retrospective case-control design.43 patients with Bell's stage NEC≥Ⅱ were identified.Each case was paired with two GA-and weight-matched controls.Data were collected from medical records, including oligohydramnios, ICP,neonatal asphyxia, MAS,neonatal septicemia, CHD,neonatal shock, gestational diabetes, PROM,fetal distress, hypertensive disorders in pregnancy, and univariate/logistic regression analysis was employed. Results: A total of 43 cases and 86 controls were enrolled.The demographic characteristics of the two groups were not statistically significant.The onset time of 43 cases was 2～17 d after birth and the average time was 6.3 d.The single factor analysis indicated that the two group had statistical significance in oligohydramnios, MAS,CHD,neonatal septicemia, neonatal asphyxia, gestational diabetes, neonatal shock, PROM,fetal distress and hypertensive disorders in pregnancy.Logistic regression analysis suggested that CHD(OR=4.27,P=0.029),neonatal septicemia(OR=2.77,P=0.007),Oligohydramnios(OR=2.42,P=0.010),PROM(OR=2.11,P=0.013),neonatal asphyxia(OR=2.06,P=0.031),MAS(OR=1.89,P=0.017),hypertensive disorders in pregnancy(OR=1.86,P=0.015),gestational diabetes(OR=1.75,P=0.032),neonatal shock(OR=1.65,P=0.024)and fetal distress(OR=1.35,P=0.021) were significantly associated with NEC. Conclusion Oligohydramnios, MAS,CHD,neonatal asphyxia, neonatal septicemia, neonatal shock, PROM,fetal distress, hypertensive disorders in pregnancy and gestational diabetes may be associated with an increased risk of NEC in term infant.

Objective:To investigate the short term outcomes and postoperative respiratory complications of patients with chronic thromboembolic pulmonary hypertension(CTEPH) treated by pulmonary endarterectomy(PEA).Methods:45 consecutive CTEPH patients underwent PEA between December 2017 and January 2020 in our institution were enrolled, including 25 females and 20 males. The mean age of operation was 51.2(25-70) years old. 24(53.5%) patients were in New York Heart Association(NYHA) functional class Ⅲ-Ⅳ. The mean PVR before operation was 923(461-2 711) dyn·s·cm -5. All patients’ data were entered in a prospective database, divieded into patients with respiratory complications group(WRC)and without respiratory complications group(WORC). To assess risk factors for postoperative respiratory complications and its effect on short term outcomes. Results:There was a significant reduction in mPAP(from 37 mmHg to 20 mmHg) and PVR(from 923 dyn·s·cm -5 to 293 dyn·s·cm -5) in the entire group. The in-hospital mortality rate was 4.4%(2 cases), died due to postoperative cardiogenic circulatory failure, even with VA-ECMO treatment and mediastinal infection, respectively. Postoperative respiratory complications occurred in 32 patients(71.1%). The most common complications were reperfusion pulmonary edema 44.4%(20 cases) and residual pulmonary hypertension 11.1%(5 cases). The WRC group showed a tendency to have longer periods of mechanical ventilation, longer ICU stays and more ICU costs. Independent predictors of postoperative respiratory complications were time from symptom onset to PEA>36 months( OR=12.2, 95% CI: 2.1-70.7, P=0.005)and six-minute walking distance<300 m( OR=12.6, 95% CI: 1.1-138.0, P=0.0038). Conclusion:Pulmonary endarterectomy is an effective and safe treatment for CTEPH. Postoperative respiratory complications were mainly determined by symptom onset time and pre-operative status. Patients with CTEPH should consider PEA surgery early.

Objective:To investigate the effects of sedatives on the activity of the diaphragm assessed by ultrasound and the timing of extubation in elderly patients after elective surgery.Methods:All 60 eligible elderly patients were randomly divided into three groups: the propofol group, the midazolam group and the control group(n=20, each group). Remifentanil was used in the three groups to keep the Critical Care Pain Observation Tool(CPOT)score less than 3.Patients in the propofol and midazolam groups were given propofol and midazolam sedation respectively, and the Richmond Agitation Sedation Scale(RASS)score was maintained at -2.Diaphragmatic activity was measured, the time from the end of the operation to extubation was recorded, and delirium was evaluated, and the above results were compared with those of the control group, which did not receive sedatives.Results:The activity of the diaphragm was lower in the propofol and midazolam groups than in the control group[(1.10±0.12)cm, (1.17±0.30)cm vs.(1.63±0.25)cm, F=30.170, P=0.000], and there was no significant difference between the propofol group and the midazolam group( t=25.340, P=0.615). There was no significant difference in duration of extubation among the propofol, midazolam and control groups[(1.41±2.08)d, (1.25±1.53)d vs.(1.19±1.40)d, F=0.089, P=0.915]. The incidence of delirium was higher in the midazolam group than in the propofol and control groups[55.0%(11/20), 20.0%(4/20) vs.15.0%(3/20), χ2=5.230, P=0.022, χ2=7.030, P=0.008)], but the difference between the propofol group and control group was not statistically significant( χ2=0.170, P=0.677). Conclusions:The application of sedatives after elective surgery has an effect on the activity of the diaphragm in elderly patients, and the effects of propofol and midazolam are similar.However, propofol and midazolam have no influence on the duration of extubation in elderly patients after elective surgery.Compared with propofol, midazolam increases the incidence of delirium in elderly patients after elective surgery.

Objective: To investigate the positive rate for 2019-nCoV tests and co-infections in Wuhan district. Methods: A total of 8 274 cases in Wuhan were enrolled in this cross-sectional study during January 20 to February 9, 2020, and were tested for 2019-nCoV using fluorescence quantitative PCR. Both respiratory tract samples (nasopharynx, oropharynx, sputum and alveolar lavage fluid) and non-respiratory tract samples (urine, feces, anal swabs, blood and conjunctival sac swabs) were collected. If both orf1ab and N genes are positive, they are classified as nucleic acid test positive group; if both orf1ab and N genes are negative, they are classified as negative group; if single gene target is positive, they are classified as suspicious group. Individuals were divided into male group and female group according to sex. At the same time, 316 patients were tested for 13 respiratory pathogens by multiplex PCR. Results: Among the 8 274 subjects, 2 745 (33.2%) were 2019-nCoV infected; 5 277 (63.8%) subjects showed negative results in the 2019-nCoV nucleic acid test; and 252 cases (3.05%) was not definitive (inconclusive result). The age of cases with COVID-19 patients and inconclusive cases was significantly higher than that of cases without 2019-nCoV infection (40 vs 56, t=27.569, P<0.001; 52 vs 56, t=6.774, P<0.001). The positive rate of 13 respiratory pathogens multiple tests was significantly lower in 104 subjects who were positive for 2019-nCoV compared with those in subjects who were negative for 2019-nCoV test (5.77% vs 18.39%, χ²=24.105, P=0.003). Four types of respiratory tract samples and five types of non-respiratory tract samples were found to be positive for 2019-nCoV nucleic acid test. Conclusion The 2019-nCoV nucleic acid positive rate in male is higher than in female. Co-infections should be pay close attention in COVID-19 patients. 2019-nCoV nucleic acid can be detected in non-respiratory tract samples.

Objective To explore the clinical diagnostic value of bedside lung ultrasound in emergency (BLUE) for patients with postoperative hypoxemia in intensive care unit (ICU). Methods Fifty patients with hypoxemia after ICU surgery postoperation were enrolled in Beijing China-Japan Friendship Hospital from April 2017 to October 2018, the chest X-ray, BLUE and chest CT examinations were performed at the same time, and the diagnostic result of chest CT was the gold standard. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate of the 3 methods in the diagnosis of hypoxemia were statistically analyzed, and the results of diagnostic consistency of 3 methods were compared. Results The chest CT findings showed there were 40 cases with different degrees of pneumothorax, pleural effusion, pulmonary consolidation and atelectasis in 50 patients. When the chest X ray was used to diagnose hypoxemia as the pathogenesis, the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy rate were 32.5%, 60.0%, 76.47%, 18.18% and 38.0% respectively; the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy rate of BLUE were 80.0%, 70.0%, 91.43%, 46.67% and 78.0% respectively. The consistency test showed that the chest X-ray diagnosis rate of postoperation hypoxemia as the cause was significantly lower than that of chest CT (Kappa = 0.091, P = 0.047) and BLUE (Kappa =0.107, P = 0.031). The consistancy was relatively good when the diagnosis rate of postoperation hypoxemia obtained from BLUE regimen was compared with that obtained from chest CT (Kappa = 0.634, P = 0.000). Conclusion The use of BLUE for diagnosis of hypoxemia being the pathogenesis of the postoperative patients in ICU is superior to the use of routine chest X ray, and compared with applying chest CT, BLUE is faster, more convenient and worthy to be clinically applied widely.

Positive end-expiratory pressure (PEEP) is a common method to maintain alveolar patency in patients undergoing mechanical ventilation. However, in patients undergoing tracheotomy, alveolar collapse often occurs due to bedridden, aspiration, and other factors. There is currently no effective means to provide PEEP support for such patients. The application of a high-flow oxygen inhalation device with a PEEP valve was designed to provide patients with continuously adjustable PEEP, which helps to improve the patient's oxygenation and maintain the lung's physiological functions.