Objective To investigate the therapeutic effects and side effects of FLAG and MEA regimen in the treatment of relapsed and refractory adult acute myeloid leukemia.Methods Use retrospective analysis to Observe the therapeutic effects and side effects of the 51 cases of relapsed and refractory adult acute myeloid leukemia (M3 except) from January 2009 to June 2012 in our hospital,which are divided into FLAG group (23 cases) and MEA group (28 cases) according to chemotherapy.Results In FLAG group,the rate of complete remission was 30.4 ％ (7/23),the rate of partial remission was 17.4 ％ (4/23),the effective rate was 47.8 ％ (11/23).In MEA group,the rate of complete remission was 35.7 ％ (10/28),the rate of partial remission was 21.4 ％ (6/28),the effective rate was 57.1％ (16/28),difference between two groups was not statistically significant. Both groups appeared Ⅳ degrees myelosupression,and there were no significant differences between them on incidences of secondary infection [95.7 ％ (22/23) vs 89.3 ％ (25/28)] and haemorrhagia [82.6 ％ (19/23) vs 85.7 ％ (24/28)].Difference on cardiac toxicity was statistically significant.Conclusions Compared with MEA regimen, FLAG regimen are similar effective and can be well tolerated,which has lower cardiac toxicity. Thus, FLAG regimen can be used as first-line treatment for relapsed and refractory adult acute myeloid leukemia.

Objective To investigate the effect of postremission consolidation therapy with intermedium-dose cytarabine (MDAC) in elderly patients with acute myelogenous leukemia (AML). Methods Clinical data of 61 elderly AML patients (except M3) in postremission who achieved complete remission (CR) in two period of remission induction program were retrospectively analyzed. Results There were 26 cases in MDAC group and 35 cases in standard-dose cytarabine (SDAC) group. In MDAC group and SDAC group, the relapse free survival (RFS) time were 42.7 months and 16.0 months respectively (P= 0.002), the overall survival (OS) time were 44.6 months and 18.2 months respectively (P= 0.004), and the cumulative relapse frequencies rates were 26.9 % (7/26) and 54.3 % (19/35) respectively (x 2= 4.567, P= 0.033). However, 3 years OS rate of the two groups were 23.1%(6/26) and 8.6%(3/35) (x 2=2.496, P=0.114) , and there was no significant difference in the incidence of adverse reactions between the two groups (all P > 0.05). Conclusion MDAC could improve RFS and OS for the elderly AML patients in postremission who received CR in the early stage, and the incidence of adverse reactions is similar to that of SDAC.

Objective To evaluate diagnostic endoscopic submucosal dissection(D-ESD) for gastric intraepithelial neoplasia(GIN).Methods From January 2012 to May 2016,64 patients with biopsy-proven LGIN who accepted magnifying endoscopy combined with digitalchromoendoscopy(ME-DCE) and D-ESD in Gastrointestinal Endoscopy Center of Nanfang Hospital affiliated to Southern Medical University were retrospectively analyzed in this study.The consistency of ME-DCE prediction with D-ESD pathologic outcome was analyzed by using Kappa test.According to D-ESD pathologic outcome,the two groups were analyzed with independent t-test,chi-square test,or Fisher's exact probability test.Results Sixty-four patients with biopsyproven LGIN were enrolled;25 and 39 patients were predicted by ME-DCE as LGIN and HGIN/differentiated adenocarcinoma respectively;27 and 37 patients were diagnosed as LGIN and HGIN/differentiated adenocarcinoma by D-ESD respectively.ME-DCE prediction was well consistent with D-ESD pathologic outcome(k =0.676).According to pathologic outcome of D-ESD,no significant difference was observed in lesion size,biopsy amount,D-ESD sample size,complete resection rate,operation time period,complications,length of hospital stay,or in-hospital cost(P＞0.05).Conclusion ME-DCE can be proposed when the endoscopic biopsy indicates LGIN.And D-ESD should be performed for definitive diagnosis when the MEDCE indicates HGIN/differentiated adenocarcinoma.

Objective: To construct a novel tissue engineering complex, BMSCs sheet-RADA16 scaffold, by combining cell sheet and self-assembled peptides.. Methods: The self-assembled peptide RADA16 scaffold was wrapped with the BMSCs cell sheet. The morphology of the cells and the complex were observed by SEM and confocal laser microscopy, and the proliferation of cells was assessed by CCK-8. The osteogenic differentiation of BMSCs was examined by detection of related gene expression with RT-PCR. Results: Compared with the BMSCs cell sheet, the numbers of cells on RADA16 scaffold growth rapidly at 3 rd-8 th day, and BMSCs were more on the scaffold than those on the cell sheet (P＜0. 05) . RT-PCR results showed that the expression level of osteogenesis-related genes was higher in the complex (P＜0. 05) . Conclusion: BMSCs Sheet-RADA16 Scaffold may promote proliferation and osteogenic differentiation of BMSCs.

OBJECTIVETo evaluate the clinical effect of implanted cardioverter-defibrillators (ICD) for primary prevention of sudden cardiac death.

METHODSAccording to ACC/AHA Guideline of ICD implantation (2005), 35 patients successfully received ICD/CRT-D implantation for primary prevention of sudden cardiac death in our hospital from January 2006 to December 2009. All the patients were followed up for a mean of 2 years.

RESULTSDuring the follow up, 11 (31.43%) patients experienced ventricular arrhythmic episodes, for which 16 defibrillation therapies and 75 anti-tachycardia pacing (ATP) therapies were delivered without mistaken shock or death. The incidence rate of NVM was 100%, that of PVT was 66.67%, Brugada syndrome 50%, HCM 25% and DCM 16.67%. Of these episodes, the incidence of VF episodes among PVC patients was 87.5% (14 beats), ventricular tachycardia PVC was 82.28% (65 times), 5 beats in NVM patients, 4 beats in HCM and Brugada syndrome patients, and 1 beat in DCM patients. No ICD implantation-related complication was detected, and no ventricular tachycardia induced syncope occurred in these cases. All patients showed improved quality of life after the implantation.

CONCLUSIONICD implantation can prevent malignant ventricular arrhythmia episodes, especially for PVT, NVM and Brugada syndrome in high risk SCD patients, demonstrating the value of implantation of ICD as a primary prevention in high-risk SCD patients.

Adult ; Aged ; Death, Sudden, Cardiac ; epidemiology ; prevention & control ; Defibrillators, Implantable ; Female ; Humans ; Male ; Middle Aged ; Primary Prevention

Objective To analyze the clinical characteristics and prognostic factors of elderly patients with cytogenetically normal acute myeloid leukemia (CN-AML). Methods A total of 104 initial CN-AML patients were enrolled in this retrospective study. The clinical characteristics were collected and analyzed retrospectively. Factors affecting complete remission (CR) were analyzed by using chi square test. Univariate and multivariate analyses of prognostic factors were performed by using Kaplan-Meier and Cox hazard regression model respectively. Results After the first chemotherapy, 72 of 104 patients were able to be evaluated the efficacy, the CR rate was 38.9%(28/72) and total response rate was 55.6%(40/72). The white cell count<100 × 109/L and NPM1 mutation were related to a higher CR rate [59.4%(38/64) vs. 12.5%(1/8), 83.3%(10/12) vs. 36.4%(8/22), P<0.05]. Among 104 patients, the median overall survival (OS) was 6.9 months. Univariate analysis results demonstrated that age≥70 years, secondary AML, white cell count≥100×109/L, FLT3-ITD mutation, CD7 expression, achieving CR beyond 2 cycles of induction therapy and CCI score≥2 were influence factors on OS. In multivariable analysis, FLT3-ITD mutation (HR=7.61, 95%CI 1.80-32.11, P= 0.006) and achieving CR beyond 2 cycles of induction therapy (HR= 10.11, 95 % CI 2.38-43.03, P=0.002) were independent prognostic factors for OS in elderly patients with CN-AML. Conclusion The prognosis of elderly patients with CN-AML is the result of the combined effect of many factors, FLT3-ITD mutation and achieving CR beyond 2 cycles of induction therapy are independent prognostic factors in elderly patients with CN-AML.

Objective To explore the status quo and influencing factors of caring efficacy of nursing undergraduate students so as to provide reference for improving their caring efficacy. Method A cross-sectional study was conducted. Totally 274 nursing undergraduate students from 10 general hospitals in Sichuan Province were surveyed by using general information questionnaire, professional model scale for nursing students, professional identity questionnaire for nursing students and caring efficacy scale. Results The average score of caring efficacy of undergraduate nursing students was (4.00 ±0.64), which was lower that of jurior nurse before training (4.55±0.34) and after training (4.98±0.27). The average score of career identity and professional model (3.63±0.68) were postively related with career effevtieness (all P＜0.001). The care from family, medical staffs, job-taking benefits and dimission risks, social comparison and self-reflection were the main factors influencing caring efficacy (P＜0.01), which explained 40.9％ of the varianceof caring efficacy among undergraduate nursing students. Conclusions Caring efficacy of the nursing students was above the middle level, but lower than that of clinical junior nurses. Their professional model and professional identity were positively correlated with caring efficacy. It is necessary to establish a good professional model, through example education, perfect career planning and improve the professional identity of nursing undergraduate students, so as to improve their caring efficacy of nursing students, and then improve the quality of nursing team reserves.

Objective:To explore the application value of combined detection of p16 and human papillomavirus (HPV) typing in the diagnosis of cervical intraepithelial neoplasia (CIN).Methods:A total of 8 346 patients aged between 25 years old and 65 years old at Baoji Central Hospital of Shaanxi Province from February 2019 to February 2020 were selected. There were 2 882 patients with cervical lesions diagnosed by colposcopy biopsy. Patients were divided into the different groups based on the age range, and then the condition of HPV infection in all age groups was analyzed. Taking biopsy as the gold standard and according to the pathological results, the detection rate of p16 and HPV typing and the diagnostic value of the single and combined detection in CIN were also analyzed.Results:The age group with the highest positive rate of p16 and HPV was 31-40 years old [47.42% (1 014/2 427) and 36.84% (894/2 427), respectively], followed by 41-50 years old group [30.15% (907/2 942) and 28.11% (827/2 942)], and there were statistically significant differences in positive rate of p16 and HPV in all age groups (all P < 0.05). Among 2 882 patient with cervical lesions diagnosed by pathological examination, there were 2 572 cases (89.24%) of p16 positive, and 2 169 cases (75.26%) of HPV positive. With the disease progression of cervical lesions, the positive rate of p16 and HPV was gradually increased, and the positive rate of p16 of inflammation, CINⅠ, CINⅡ, CIN Ⅲ, cervical squamous cell carcinoma (SCC) was 11.68% (23/197), 94. 85% (1 105/1 165), 93.57% (771/824), 96.76% (538/556), 96.43% (135/140), respectively; the positive rate of HPV was 17.77% (35/197), 77.60% (904/1 165), 80.22% (661/824), 80.40% (447/556), 87.14% (122/140), respectively, and HPV infection was mostly HPV16/18 infection type with the disease progression of cervical lesions. The sensitivity, specificity, positive predictive value and negative predictive value in detecting CIN of HPV was 75.26%, 81.13%, 67.78% and 86.14%, respectively; the sensitivity, specificity, positive predictive value and negative predictive value in detecting CIN of p16 was 89.24%, 84.74%, 75.51% and 93.72%, respectively; the diagnostic efficacy of p16 was higher than that of HPV in detecting CIN, and the difference was statistically significant ( P < 0.05). The sensitivity, specificity, positive predictive value and negative predictive value of HPV combined with p16 in detecting CIN was 94.10%, 91.33%, 85.12%, 96.71%, which were higher compared with those of single detection (all P < 0.05). Conclusions:HPV infection mainly occurs in women aged 31-40 years old followed by 41-50 years old, and the infected population of CIN tends to be younger. p16 is superior to HPV in detecting the diagnostic efficacy of CIN; combined detection of p16 and HPV can increase the sensitivity and specificity, reduce the rate of misdiagnosis, and can play a key clinical value in early diagnosis and treatment of CIN.

Objective:To investigate the status quo of readiness for hospital discharge of patients with coronary heart disease after percutaneous coronary intervention(PCI)and analyze the main factors affecting readiness for hospital discharge.Methods:With a cross-sectional survey method, a total of 343 patients with coronary heart disease after PCI in the Affiliated Hospital of Southwest Medical University were selected by convenience sampling method and investigated by General Information Questionnaire, Readiness for Hospital Discharge Scale, Care Transitions Measure and Self-Efficacy Questionnaire of coronary heart disease. Multiple linear regression analysis was used to analyze the influence factors.Results:The total score of Readiness for Hospital Discharge Scale of patients with coronary heart disease after PCI was 94.33±8.67. The score of quality of care transitions was 47.59±5.51 and that of self-efficacy was 39.19±8.08. Multiple linear regression analysis showed that five variables including self-efficacy, length of hospital stay, marital status, residence and family history of coronary heart disease entered into the regression equation ( P<0.01), which could explain 50.0% of the variations of readiness for hospital discharge. Conclusions:The readiness for hospital discharge of patients with coronary heart disease after PCI is at the middle level. The main influencing factors are self-efficacy, length of hospital stay, marital status,residence and family history of coronary heart disease. Nurses should attach importance to the self-efficacy of patients and pay attention to high-risk groups. By improving patients′ self-efficacy and giving targeted guidance ahead, in order to improve patients′ perception of readiness for hospital discharge.