Objective To summarize the diagnostic and therapeutic experience of a patient with chronic graft versus host disease (cGVHD) related polymyositis (PM) after allogeneic hematopoietic stem cell transplantation (allo-HSCT).Methods A patient with acute lymphocytic leukemia in com- plete remission received sibling allo-HSCT,and cyclosporine and methotrexate were adopted to pre- vent GVHD.Results Eleven days after HSCT,WBC＞0.5?10~9/L,13 days after HSCT,PLT＞20?10~9/L;27 days after HSCT,chromosome analysis of bone marrow cells showed 99% donor type. Seventeen days after HSCT,Ⅰ~0 acute GVHD of skin occurred,and it was cured by intravenous injec- tion of dexamethasone and methotrexate.Eight months after HSCT,cGVHD of liver happened.Al- though treated by tacrolimus and azathioprine,enzymes of liver were still elevated.At last,tacrolimus combined with sirolimus were used,and enzymes of liver subsided gradually.However,the serum creatine phosphokinase (CK) began to rise from 9 U/L to 3010 U/L,and fatigue all over the patient occurred.Finally,the symptom relapsed,and disability involved with the origin of limbs appeared. The electromyogram and magnetic resonance imaging of concerned muscles confirmed the PM diagno- sis.Although treated with methylprednisolone and plasma exchange,the patient died due to asphyxia, while the CK as high as 21 010 U/L.Conclusion PM is a rare kind of manifestations of cGVHD. When the key muscle tissue was involved,the prognosis is poor.

BACKGROUND:Proximal femoral nail antirotation and femoral head replacement could quickly recover hip function in intertrochanteric fractures in the elderly, but whose efficacy is better remains controversial. OBJECTIVE:To compare the differences in the effects of proximal femoral nail antirotation and femoral head replacement on intertrochanteric fractures in the elderly by using a meta-analysis. METHODS:The relevant literatures were searched in PubMed, Cochrane, CNKI, Wanfang database and VIP, and other relevant journal such asChinese Journal of Orthopaedicsand Orthopedic Journal of Chinafor articles published in recent five years. Randomized controled trials concerning proximal femoral nail antirotation and femoral head replacement for the treatment of intertrochanteric fractures in the Chinese elderly were colected. Baseline data, operation time, intraoperative blood loss, postoperative out-of-bed time, length of stay, Harris score, complication rate and number of death were colected and processed using RevMan 5.30 software for meta analysis. RESULTS AND CONCLUSION:Totaly 37 clinical controled trials with 3 216 patients were recruited. Meta-analysis results showed that compared with femoral head replacement, proximal femoral nail antirotation was at a disadvantage in postoperative out-of-bed time, length of stay and joint function in the early stage. No significant difference in complication and mortality was detected between proximal femoral nail antirotation and femoral head replacement. However, proximal femoral nail antirotation had some advantages such as short operation time, smal trauma, and less intraoperative blood loss, and showed good midterm and long-term outcomes of joint function.

Objective To explore the effect of the nursing risk assessment and early warning intervention mode in decreasing the risk of the clinical administration .Methods The risk management theory was applied in the nursing management of clinical administration , and the nursing risk of clinical administration was effectively evaluated through the failure mode and effect analysis of the risk management tool .The early warning intervention of different grades was carried out according to the Risk Priority Number ( RPN) .Results The total value at risk of administration after the intervention was decreased by 39.58%.The incidence rate of nursing adverse events caused by the administration was 0.06% after the intervention, and was lower than 0.14% before the intervention, and the difference was statistically significant (χ2 =4.67,P<0.05).Conclusions Application of the nursing risk assessment and early warning intervention can decrease the incidence rate of nursing adverse events caused by the administration so as to ensure the safety in patients .

OBJECTIVE: We propose a strategy for identifying subgroups with the treatment effect from the survival data of a randomized clinical trial based on accelerated failure time (AFT) model. METHODS: We applied adaptive elastic net to the AFT model (designated as the penalized model) and identified the candidate covariates based on covariate-treatment interactions. To classify the patient subgroups, we utilized a likelihood-based change-point algorithm to determine the threshold cutoff point. A two-stage adaptive design was adopted to verify if the treatment effect existed within the identified subgroups. RESULTS: The penalized model with the main effect of the covariates considerably outperformed the univariate model without the main effect for the trial data with a small sample size, a high censoring rate, a small subgroup size, or a sample size that did not exceed the number of covariates; in other scenarios, the latter model showed better performances. Compared with the traditional design, the adaptive design improved the power for detecting the treatment effect where subgroup effect exists with a well-controlled type Ⅰ error. CONCLUSIONS The penalized AFT model with the main effect of the covariates has advantages in subgroup identification from the survival data of clinical trials. Compared with the traditional design, the two-stage adaptive design has better performance in evaluation of the treatment effect when a subgroup effect exists.

OBJECTIVE: To explore the application and advantages of conditional inference forest in survival analysis. METHODS: We used simulated experiment and actual data to compare the predictive performance of 4 models, including Coxproportional hazards model, accelerated failure time model, random survival forest model and conditional inference forest model based on their Brier scores. RESULTS: Simulation experiment suggested that both of the two forest models had more accurate and robust predictive performance than the other two regression models. Conditional inference forest model was superior to the other models in analyzing time-to-event data with polytomous covariates, collinearity or interaction, especially for a large sample size and a high censoring rate. The results of actual data analysis demonstrated that conditional inference forest model had the best predictive performance among the 4 models. CONCLUSIONS Compared with the commonly used survival analysis methods, conditional inference forest model performs better especially when the data contain polytomous covariates with collinearity and interaction.
Data Analysis ; Proportional Hazards Models ; Sample Size ; Survival Analysis