Objective:To explore the role of PDCA cycle in the standardized residency training in the department of hematology.Methods:Thirty residents trained in the department of hematology of Peking University Third Hospital from January 2019 to September 2019 were enrolled into experimental group, and 36 residents trained from January 2018 to December 2018 were enrolled into control group. Experimental group received the PDCA cycle teaching method and control group did the traditional one. At the end of the training, the results of theory examination and practical operation skills examination of the two groups were compared. The statistical significance was analyzed on the assessment scores and teaching satisfaction between the two groups. SPSS 20.0 was used for t test. Results:Compared with the control group, the examination scores and teaching satisfaction of the residents in the experimental group were higher than those in the control group ( P < 0.05). Conclusion:The teaching mode of PDCA cycle is conducive to improving the effect of standardized residency training in the department of hematology.

ObjectiveTo analyse treatments and prognostic factors of T cell non-Hodgkin lymphoma (T-NHL). MethodsNinety-one patients with T-NHL were retrospectively analyzed, and clinical features,histopathology, laboratory data were included in Kaplan-Meier and prognostic analysis. Results Median age was 38 years,58 (63.7 ％) had high-intermediate and high risk by IPI,72 (79.1％) presented with advanced stage disease,extranodal disease was present in 64.8 ％ of patients.The overall response rate (ORR) for the whole group was 63.8 ％,and the estimated 3,5-year ORR were 55.5 ％,41.3 ％ respectively.Compared with CHOP-like regimen, the addition of etoposide could improve the survival of patients, meanwhile radiation therapy could improve the outcome of patients with NK/T cell lymphoma and mediastinal bulky disease, and consolidation chemotherapy with HSCT could improve the survival and reduce the recurrence of patients.Clinical stage,B symptoms,ECOG score,the level of LDH,extranodal involvment,anemia,initial treatment outcome, IPI score, the level of serum albumin and fibrinogen were predictive to overall survival. Cox multivariate analysis showed initial treatment outcome and B symptoms were independent prognostic factors.IPI and m-PIT were useful for stratified patients into different prognostic risk groups. Conclusion T-NHL is a heterogeneous group of malignancies with an inferior long term outcome. New treatment modality needs to be explored for these patients,and new drugs and HSCT may be good choices.

Objective:To analyze the characteristics of hospital infection of hematological disease, so as to provide reference for clinical therapy. Methods: Bacterial strains and antimicrobial resistance of pa-tients with hospital infection in Department of Hematology, Peking University Third Hospital from Jan. 2011 to Dec. 2013 were identified and analyzed retrospectively. The specimens were from their blood, urine, sputum, throat swabs and etc. Results:Among the total of 168 isolates of bacteria,the majority of the bacteria strains were from sputum (42. 9%);114(67. 9%) bacteria strains were gram negative and 54(32. 1%) bacteria strains were gram positive;the pathogen testing showed that 20. 8% were Pseudo-monas aeruginosa,18. 5% Escherichia coli,17. 9% Staphylococcus aureus, 9. 5% Klebsiellar pneumonia, 5. 9% Staphylococcus epidermis and 27. 4% other bacteria ;The gram negative bacilli to cefepime, ami-kacin and carbapenems showed the lowest antimicrobial resistance rates, and S. aureus showed the lowest antimicrobial resistance rates to vancomycin and linezolid. Conclusion:Patients with hemopathy are the main population of hospital infections, the gram negative bacteria are the most common pathogens. It is very important to promptly know the change in distribution of the pathogens in order to rationally select antibiotics and reduce the incidence of bacterial infections.

Objective To analyse the clinical characteristics,treatments and prognosis of the chemotheray-induced lung injury in malignant hematological diseases patients.Methods 26 malignant hematological diseasespatients with chemotheray-induced lung injury were collected.The clinical characteristics,chemotherapy regimen,treatments and prognosis of the patiants were retrospectively analyzed.Results Among 26 patients,10 patients were male and 16 patients were famale.The dignosis were nonHodgkin's lymphoma (16 cases),leukemia (9 cases) and multiple myeloma (1 case).The chemotherapy regimens inducing lung injure probably were R-CHOP,R-BEACOP and BEACOP in lymphoma,while they were HA,AA,DA and IA in leukemia.The symptoms of lung injury in these patients were fever,cough,hemoptysis,dyspnea,fatigue,or asymptomatic radiological examination revealed.Pulmonary diffuse infiltration and shadows were showed in CT scan.21 cases were cured by hormone therapy,5 cases died of lung injury,2 cases died of tumor recurrence after lung injury cured.There was no effect on the quality of life in most cured patients.Conclusion The lung injury induced by chemotherapy has no specific clinical characteristics and diagnostic criteria,and it could progress rapidly to cause death.But early dignosis and early hormonal treatment can obtain good therapeutic effect.The occurrence regularity and clinical characteristics should be studied furtherly.

Objective: This study aimed to investigate the clinical characteristics, treatment options, and prognosis of multiple myeloma (MM) patients complicated with extramedullary plasmacytoma (EMP). Methods:The case of MM concurrent with EMP are rare. During the period between June 2005 and June 2013, clinical experience, diagnosis, and treatment of MM with EMP cases were retrospectively analyzed. Results:Fourteen cases were diagnosed with MM complicated with EMP in the Third Hospital of Peking Uni-versity, Beijing, China. Among these 14 cases, seven were males and seven were females. The mean age of patients was 56.9 years (ranging from 40 to 80 years old). Nine of the cases were diagnosed with EMP during the preliminary diagnosis, and the remaining five cases developed EMP during the course of treatment. Among the 14 cases, six were solitary EMPs and eight were multiple EMPs. Among the multiple EMP cases, five died, one showed disease progression, and two demonstrated partial regression. Conclusion:The prognosis of MM complicated with EMP is poor. Thus, new treatment strategies should be further explored.

OBJECTIVE:To investigate the compatibility stability of Fat-soluble vitamin (Ⅱ)/Water-soluble vitamin for in-jection with common electrolytes. METHODS:Referring to clinical common dose,Fat-soluble vitamin (Ⅱ) for injection/Wa-ter-soluble vitamin for injection collective packing [containing Fat-soluble vitamin(Ⅱ) for injection 2 ampoules and Water-soluble for injection 1 ampoule] were respectively mixed with Glucose injection,Potassium chloride injection,Concentrated sodium chlo-ride injection,Sodium bicarbonate injection,Potassium aspartate injection,Potassium aspartate and magnesium aspartate injection, Sodium glycerophosphate injection,Multi-trace elements injection (Ⅱ) to obtain mixture A-H. At room temperature (25 ℃),these mixtures were investigated in terms of appearance,pH value,osmotic pressure molar concentration and the number of insolu-ble particles at 0,1,2,3,4 h. The contents of bacterial endotoxin were tested at 0,4 h. RESULTS:Within 4 h after mixing, there was no significant change in appearance of those mixtures;pH value of mixture H changed greatly (RSD=5.13%,n=5), and that of mixture D and G increased significantly. The osmotic pressure molar concentration of those mixtures had no significantly change(RSD<2%,n=5)and lower than 600 mOsmol/kg. The bacterial endotoxin tests of those mixtures were negative. Two and four hours after mixing,the number of insoluble particles ≥10 μm in mixture B was increased significantly;2,3,4 h after mix-ing,the number of insoluble particles ≥10 μm in mixture E,F,H were increased significantly;0 ,1,2,3,4 h after mixing,the number of insoluble particles ≥10 μm in mixture G was increased significantly. There was statistical significance in the number of insoluble particle ≥10 μm in above mixtures compared to mixture A at the same time point(P<0.05),but it was in line with the standard of 2015 pharmacopeia. One,two,three and four hours after mixing,the number of insoluble particle ≥10 μm in mixture D was increased significantly,there was statistical significance compared to mixture A at the same time point(P<0.05);the num-ber of insoluble particle ≥10 μm in mixture D was beyond prescribed scope of pharmacopeia at 2,3,4 h after mixing. Within 4 h after mixing,both the number of insoluble particle ≥10 μm in mixture C and the number of insoluble particle ≥25 μm in edch mixture had no significant change,in accordance with pharmacopeia standard. CONCLUSIONS:Fat-soluble vitamin (Ⅱ)/Wa-ter-soluble vitamin for injection is not suitable for mixing with Multi-trace elements injection(Ⅱ),Sodium glycerophosphate injec-tion or Sodium bicarbonate injection due to great change of pH value and the number of insoluble particles.

Objective To analyze the toxicity of dose adjusted-BEACOP (DA-BEACOP,classic CHOP regimen plus etoposide and (or) bleomycin with or without rituximab) regimen for poor-prognosis lymphoma.Methods 89 patients with poor-prognosis lymphoma who had been treated in-patient at Peking University Third Hospital during August 2002 and February 2012 were retrospectively studied.All patients received at least 1 cycle of DA-BEACOP regimen.Results 3-4 grade adverse events were observed in 74 (83.1％) patients,most of which was myelosuppression (73 cases,82.0 ％).There was not death related with the treatment.Compared to male patients,female patients suffered higher rates of grade 3-4 of toxicity (94.2 ％,33/35 vs 75.9 ％,41/54) (P =0.024).The rate of grade 3-4 of hematological toxicity in patients who were pretreated with ≥3 cycles of chemotherapy than that in patients receiving≤2 cycles of chemotherapy (95.9 ％,47/49 vs 75.0 ％,30/40) (P =0.004),while the rate of 3-4 hematological toxicity in pret-radiotherapy posed patients was higher than that in their counterparts who did not receive radiotherapy (95.9 ％,47/49 vs 75.0 ％,30/40) (P =0.022).Conclusion The DA-BEACOP regimen showed manageable toxicity in patients with poor-prognosis lymphoma.

Objective To explore the pain assessment methods of severe senile dementia patients and nursing measures of reducing the pain stress. Methods 40 severe senile dementia patients were randomly divided into assessment group and control group (20 patients per group). Two groups were evaluated by Chinese version of Pain Assessment in Advanced Dementia Scale (C-PAINAD) with routine medical treatments-venipuncture, in addition, corresponding non-drug treatments was only given in assessment group Two groups were reevaluated by C-PAINAD 60 minutes later. Results All of the 40 patients had different degree pain during the routine medical treatments , there was no difference between the two groups ( P > 0. 05 ). The reevaluated scorns of assessment group were signitieanfly lower than that of control group ( P < 0. 01 ). Conclusions Pains are very common among severe senile dementia patients during the routine medical treatments and can be evaluated by C-PALNAD. Corresponding non--drug treatments could reduce the harmful effects of pain on senile dementia patients.

A hydroponic experiment carried out to study the effect of five Cd levels on growth and photosynthesis of two tomato cultivars showed that the addition of 0.1 micromol/L Cd induced a slight increase in plant height of Hezuo 903 and the SPAD (the Soil-Plant Analyses Development) value of the 2 cultivars. However, at higher Cd levels, i.e., 1 and 10 micromol/L, root length and volume, plant height, and SPAD value were all significantly reduced. On an average of the 2 cultivars, exposure to 1 and 10 micromol/L Cd for 33 d reduced plant height by 18.9% and 46.4% and SPAD value by 11.2% and 31.6%, compared with control, respectively. Similarly, root length was reduced by 41.1% and 25.8% and root volume by 45.2% and 63.7%, respectively. The addition of Cd in the growth medium also had significant deleterious effect on net photosynthetic rate (Pn) and intracellular CO(2) concentration (Ci), with Pn being reduced by 27.2% and 62.1% at 1 micromol/L and 10 micromol/L Cd treatments compared to the control, respectively, while Ci increased correspondingly by 28.4% and 39.3%.
Cadmium ; toxicity ; Lycopersicon esculentum ; drug effects ; growth & development ; metabolism ; Photosynthesis ; drug effects ; Plant Leaves ; drug effects ; growth & development ; metabolism ; Plant Roots ; drug effects ; growth & development ; Seedlings ; drug effects ; growth & development ; metabolism

Objective To explore the influence of hematopoietic growth factors on the TBI patients in the conditioning regimen for stem cell transplantation,and to evaluate the effect of cytokines on treatment of acute radiation disease.Methods The usage of hematopoietic growth factors,implantations and the side-effects of the patients and donors of TBI in the conditioning regimen for stem cell transplantation were retrospectively analysed from 1990 to 2012,and the effect and side-effects of cytokines on the hematopoietic function recovery and stem cell mobilization were observed.Results All patients recovered from their hematopoietic function except one died due to the side-effecs.The median time of white blood cell recover was 10 d in auto-SCT and 12 d in allo-SCT in the G-CSF group.The median day of platelet recovery was 11.67 ± 1.53 in rhIL-11 arm and 13.70 ±6.27 in no rhIL-11 arm in the auto-SCT group.The incidence rates of dental ulcer and diarrhea in the TBI patients were 48％ and 44％,respectively.The occurrence of side-effect was rare in the period of cytokines treatment,but was over 50％ during stem cell mobilization.Conclusions Cytokines play very important roles in the hematopoietic function recovery and stem cell mobilization in the TBI patients.