Objectives:This study aimed to compare the clinical characteristics between light-chain cardiac amyloidosis(AL-CA)and transthyretin cardiac amyloidosis(ATTR-CA). Methods:A retrospective analysis was conducted in patients diagnosed with AL-CA and ATTR-CA at Peking University Third Hospital from January 2011 to October 2023.There were 35 patients diagnosed with AL-CA(AL-CA group)and 21 patients diagnosed with ATTR-CA(ATTR-CA group).Clinical manifestations,ECG,echocardiography and cardiac magnetic resonance(CMR)results were compared between patients with AL-CA and ATTR-CA. Results:Compared to the AL-CA group,the ATTR-CA group has a higher proportion of males(54.3%vs.90.5%,P=0.005),the proportion of patients with hypertension was lower(42.9%vs.9.5%,P=0.009).In terms of clinical manifestations,edema,proteinuria,renal insufficiency and serous effusion were more common in the AL-CA group,while the incidence of limb numbness was higher in the ATTR-CA group(all P＜0.05).There were significant differences in the incidence of limb lead low voltage(57.1%vs.28.6%,P=0.038)and conduction block(14.3%vs.61.9%,P=0.001)between the AL-CA group and ATTR-CA group on ECG.Although the AL-CA group had a shorter time interval from initial symptoms to diagnosis(6.0[2.0,15.0]months vs.35.0[14.0,56.5]months,P=0.002)and less pronounced left ventricular thickening on echocardiography(interventricular septum thickness:[13.3±2.0]mm vs.[15.7±2.2]mm,P=0.001;left ventricular mass:[198.4±67.8]g vs.[246.6±53.5]g,P=0.009)and CMR(interventricular septum thickness:[16.0±2.1]mm vs.[18.9±3.8]mm,P=0.033;left ventricular mass:[132.9±45.3]g vs.[194.7±50.8]g,P=0.011),the proportion of patients with NYHA grades Ⅲ-Ⅳ(48.6%vs.19.0%,P=0.027)was higher,the levels N-terminal B-type natriuretic peptide precursor and cardiac troponin T levels were higher(both P＜0.05),and the 1-year survival rate was lower in the AL-CA group than in the ATTR-CA group(65.7%vs.100%,P=0.001). Conclusions:AL-CA and ATTR-CA had differences in clinical and ECG manifestations.While the severity of left ventricular hypertrophy was less pronounced in AL-CA compared to ATTR-CA,cardiac function and prognosis were worse in AL-CA than in ATTR-CA.

Objective To investigate the compatible stability of esketamine hydrochloride,sufentanil citrate,butorphanol tartrate,and metoclopramide in 0.9%sodium chloride injection,and to provide a reference for the rational use of medication for postoperative analgesia.Methods The four drugs were compounded by simulating the clinical concentrations of the drugs,and the samples were taken at 0,4,8,12,24 and 48 h under light-shielded and light-exposed conditions at room temperature.The appearance,pH value,relative drug content,and insoluble particles were determined.Results The appearance of esketamine hydrochloride,sufentanil citrate,butorphanol tartrate,and metoclopramide concoction was clear at 48 h.The pH values were in the range of 4.69 to 4.79,and the relative drug content of the four drugs were in the range of 95%to 105%.The number of insoluble particles exceeded the specified range in the Chinese Pharmacopoeia(2020 edition)at 4 h and 8 h.Conclusions Under light-shielded and light-exposed conditions at room temperature,the appearance,pH value and relative drug content of the compounded solution remained stable for 48 h.However,the number of insoluble particles exceeded the specified standard.Therefore,it is not recommended to mix the above 4 drugs with 0.9%sodium chloride injection for use in analgesic pumps.

Afferent baroreflex failure(ABF)is a rare disease.It refers to the clinical syndrome caused by the impairment of the afferent limb of the baroreflex or its central connections at the level of the medul-la.The recognized causes include trauma,surgery in related areas(radical neck tumor surgery,carotid endarterectomy),neck radiotherapy,brain stem stroke,tumor growth paraganglioma and hereditary diseases,among which the most common cause is extensive neck surgery or radiotherapy for neck cancer.The main manifestations are fluctuating hypertension,orthostatic hypotension,paroxysmal tachycardia and bradycardia.This case is a young man,whose main feature is blood pressure fluctuation,accom-panied by neurogenic orthostatic hypotension(nOH).After examination,the common causes of hyper-tension and nOH were ruled out.Combined with the previous neck radiotherapy and neck lymph node dissection,it was considered that the blood pressure regulation was abnormal due to the damage of carotid sinus baroreceptor after radiotherapy for nasopharyngeal carcinoma and neck lymph node dissection,which was called ABF.At the same time,the patient was complicated with chronic hyponatremia.Com-bined with clinical and laboratory examination,the final consideration was caused by syndrome of in-appropriate antidiuretic hormone(SIADH).Baroreceptors controlled the secretion of heart rate,blood pres-sure and antidiuretic hormone through the mandatory"inhibition"signal.We speculate that the carotid sinus baroreceptor was damaged after neck radiotherapy and surgery,which leads to abnormal blood pres-sure regulation and nOH,while the function of inhibiting ADH secretion was weakened,resulting in higher ADH than normal level and mild hyponatremia.The goal of treating ABF patients was to reduce the frequency and amplitude of sudden changes in blood pressure and heart rate,and to alleviate the on-set of symptomatic hypotension.At present,drug treatment is still controversial,and non-drug treatment may alleviate some patients'symptoms,but long-term effective treatment still needs further study.The incidence of ABF is not high,but it may lead to serious cardiovascular and cerebrovascular events,and the mechanism involved is extremely complicated,and there are few related studies.The reports of rele-vant medical records warn that patients undergoing neck radiotherapy or surgery should minimize the da-mage to the baroreceptor in the carotid sinus in order to reduce the adverse prognosis caused by complica-tions.

We conducted a prospective study to assess the non-inferiority of adjuvant chemotherapy alone versus adjuvant concurrent chemoradiotherapy (CCRT) as an alternative strategy for patients with early-stage (FIGO 2009 stage IB-IIA) cervical cancer having risk factors after surgery. The condition was assessed in terms of prognosis, adverse effects, and quality of life. This randomized trial involved nine centers across China. Eligible patients were randomized to receive adjuvant chemotherapy or CCRT after surgery. The primary end-point was progression-free survival (PFS). From December 2012 to December 2014, 337 patients were subjected to randomization. Final analysis included 329 patients, including 165 in the adjuvant chemotherapy group and 164 in the adjuvant CCRT group. The median follow-up was 72.1 months. The three-year PFS rates were both 91.9%, and the five-year OS was 90.6% versus 90.0% in adjuvant chemotherapy and CCRT groups, respectively. No significant differences were observed in the PFS or OS between groups. The adjusted HR for PFS was 0.854 (95% confidence interval 0.415-1.757; P = 0.667) favoring adjuvant chemotherapy, excluding the predefined non-inferiority boundary of 1.9. The chemotherapy group showed a tendency toward good quality of life. In comparison with post-operative adjuvant CCRT, adjuvant chemotherapy treatment showed non-inferior efficacy in patients with early-stage cervical cancer having pathological risk factors. Adjuvant chemotherapy alone is a favorable alternative post-operative treatment.
Female ; Humans ; Uterine Cervical Neoplasms/drug therapy* ; Prospective Studies ; Quality of Life ; Neoplasm Staging ; Chemoradiotherapy ; Chemotherapy, Adjuvant/adverse effects* ; Adjuvants, Immunologic ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Retrospective Studies

OBJECTIVE To establish a total quality management system for pharmacy intravenous admixture services （PIVAS）， in order to promote the standardization， accuracy and rationalization of clinical intravenous infusion. METHODS Based on information system in PIVAS， the management system and quality monitoring items of the whole process before， during and after PIVAS infusion preparation were formulated. The quality control and quality improvement were carried out regularly with quality management tools and methods such as PDCA （plan， do， check， process） cycle， quality control circle， and root cause analysis. The main quality control indexes of PIVAS were retrospectively analyzed before （in 2019） and after PDCA cycle management （in 2020 and 2021）. RESULTS The indexes of quality monitoring in the whole process of PIVAS infusion preparation， such as the score of drug quality management， the drug residue qualification rate and the qualified rate of drug content in infusion， were increased from 92 points， 79%， 86.4% in 2019 to 99 points， 92%， 99.8% in 2021， respectively. The indexes of safe and rational drug use， such as the ratio of intravenous irrational medical orders， the rate of drug repercussion， the rate of antibiotics use， and the rate of TCM injection use decreased from 0.98%， 6.1%， 40.55%， 39.70% to 0.23%， 3.2%， 37.18%， 26.00%， respectively. CONCLUSIONS The established total quality management system for PIVAS can improve the quality management level in the infusion preparation process， improve the quality of infusion preparation and promote clinical safe and rational drug use.

Objective:To evaluate the efficacy by using domestic recombinant human thyroid-stimulating hormone (rhTSH) in patients with differentiated thyroid cancer (DTC) before or after 131I therapy. Methods:From May 2019 to November 2020, a total of 24 patients with DTC (5 males, 19 females, median age 41 years) in Peking Union Medical College Hospital and Affiliated Tumor Hospital of Zhengzhou University were enrolled into the open-label, dose escalation phase Ⅰ study. All patients were divided into 4 domestic rhTSH dose groups: 0.9 mg×1 d (group A), 0.9 mg×2 d (group B), 1.8 mg×1 d (group C), 1.8 mg×2 d (group D) in succession, with 6 patients in each group. Each patient underwent rhTSH phase and thyroid hormone withdrawal (THW) phase. The end point included safety, tolerability, the quality of life (hypothyroidism symptom and sign score (Billewicz score), profile of mood states (POMS)), effectiveness (thyroid-stimulating hormone (TSH) and thyroglobulin (Tg) levels, diagnostic whole-body scan (Dx-WBS)) and pharmacokinetic characteristics (peak time, peak concentration) of rhTSH. Paired t test and Wilcoxon signed rank test were used for statistical analysis. Results:There were no dose-limiting toxicities, serious adverse events, or no grade ≥3 adverse events reported. The quality of life in rhTSH phase was significantly better than those in THW phase, including the lower Billewicz score (-53.00(-53.00, -53.00) vs -39.50(-47.00, -23.00); S=119.50, P<0.001) and the lower POMS score (91.92±12.06 vs 99.67±19.13; t=0.95, P=0.025). Serum TSH level was increased from 0.04(0.02, 0.11) mU/L (baseline) to 150.00(105.20, 173.31) mU/L 24 h after the last rhTSH administration, which was increased along with the elevation of rhTSH doses. In the THW phase, patients′ TSH levels were≥30 mU/L after 23 d (median) of THW, with the median of 73.51(57.22, 106.22) mU/L. Median Tg level of baseline was 0.10(0.10, 0.41) μg/L, which reached a peak of 0.85(0.12, 3.01) μg/L at 48 h after rhTSH administration. The peak Tg level in the THW phase was 0.88(0.15, 8.04) μg/L. The Dx-WBS consistency rate between rhTSH and THW phase was 95.8%(23/24). Conclusion:rhTSH is a safe and effective method to stimulate the serum Tg level and radioiodine uptake in patients undergoing post-operation or post- 131I assessment for DTC, as well as maintain a higher quality of life in comparison to THW phase.

Objective:To investigate the differences in the expression of microRNA (miR)-216a and its target gene SerpinB5 at the tissue level, and the effects of miR-216a on the proliferation of different liver cancer cells by regulating the expression of SerpinB5.Methods:Through bioinformatics prediction and selection of miR-216a that regulated SerpinB5. the expressions in liver cancer and normal tissues were detected by real time polymerase chain reaction (PCR). The miR-216a simulacrum and inhibitor, si-Serpinb5 and pcdna3.1-Serpinb5 to HepG2 and MHCC97H (97H) were transfected with liposomes, respectively. Real time PCR and Wester-Blot were used to detect the expression of miR-216a and SerpinB5 before and after transfection, and CCK8 was used to detect the influence of both on the proliferation of liver cancer cells.Results:The expression of miR-216a in human liver cancer tissues was higher than that in adjacent tissues, and the difference was statistically significant ( P < 0.01). The expression of SerpinB5 in human liver cancer tissues was lower than that adjacent tissues, and the difference was statistically significant ( P < 0.01). In HepG2 and 97H, miR-216a inhibitor and SerpinB5 overexpression group showed down-regulated miR-216a expression, which was statistically different from the control group ( P < 0.01). The proliferation of miR-216a inhibitor and pcdna3.1-serpinb5 group was lower than the control group, with statistically significant differences ( P < 0.01). Conclusions:The high expression of SerpinB5 can inhibit the proliferation of liver cancer cells, suggesting that SerpinB5 may have an anti-oncogene effect. MiR-216a may negatively regulate the expression of SerpinB5 and affect the proliferation of HCC cells.

Objective:To explore the status quo of the second victim experience and support in clinical nurses, and analyze the mediating effect of psychological capital between organizational support and the second victim experience and support.Methods:From March to April 2020, totally 264 clinical nurses from 2 Class Ⅲ Grade A hospitals in Zhejiang Province were selected by convenient sampling and investigated with the general information questionnaire for nurses, Nurse Psychological Capital Questionnaire, Organization Support Scale and Second Victim Experience and Support Scale. Totally 264 questionnaires were distributed, and 259 valid questionnaires were collected, accounting for an effective recovery rate of 98.11%. SPSS 19.0 was used for statistical analyses.Results:The total scores of second victim experience and support, psychological capital and organizational support of the 259 clinical nurses were (32.73±8.15) , (83.49±9.74) and (40.23±9.88) , respectively. Correlation analysis showed that the total score of organizational support of clinical nurses was negatively correlated with second victim experience and support ( r=-0.404, P<0.01) , and the total score of positively correlated with psychological capital ( r=0.417, P<0.01) , and the total score of psychological capital was negatively correlated with second victim experience and support ( r=-0.365, P<0.01) . The mediating effect analysis revealed that the mediating effect of psychological capital between organizational support and the second victim experience and support was significant ( P<0.01) , and the mediating effect accounted for 40.29% of the total effect. Conclusions:The second victim experience and support level of clinical nurses is relatively high. Psychological capital can account for some relationship between organizational support and the second victim experience and support. The second victim experience and support levels in clinical nurses with a high organizational support after facing adverse events in patients are low, which has a direct negative effect. Medical institutions should establish an organizational support system centered on improving the negative state of the second victim, the non-punitive management system for adverse events as well as the responsibilities and content of the professional psychological counseling team, in order to effectively respond to the adverse effects of patients' adverse events on clinical nurses as the second victim, help them adopt active coping methods, and improve their psychological capital levels, thereby improving the quality of clinical nursing services.

OBJECTIVE： To compare the cost-effectiveness of long-effect and short-effect granulocyte stimulating factor in prevention and treatment of bone marrow suppression induced by chemotherapy for lung malignancies， and to provide reference for rational drug use in the clinic. METHODS： A retrospective analysis was conducted for 132 cases who used granulocyte stimulating factor to prevent and treat bone marrow suppression induced by chemotherapy for lung malignancies in the Affiliated Tumor Hospital of Zhengzhou University during Jan. 2017 to Jun. 2018. Among them， 60 cases were treated with Recombinant human granulocyte stimulating factor injection （short-effect， group A）， and 72 cases were treated with Polyethylene glycol recombinant human granulocyte stimulating factor injection （long-effect， group B）. Clinical efficacies， the occurrence of bone marrow suppression and ADR were compared between 2 groups. Cost was calculated， and cost-effectiveness analysis was conducted. Sensitivity analysis was conducted by down-regulating 20％ drug price. RESULTS： The total response rates of group A and B were 71.7％ and 75.0％， without statistical significance （P＞0.05）. There was no statistical significance in the incidence and duration of bone marrow suppression or the incidence of ADR （P＞0.05）. Average treatment costs of the two groups were （335.91±180.34） and （1 982.75±603.15） yuan； the cost of group A was significantly lower than that of group B （P＜0.05）. The cost-effectiveness ratio of them were 4.69 and 26.44， while group A as a reference， incremental cost-effectiveness ratio of group B was 494.55. The sensitivity analysis results were in agreement with the cost-effectiveness analysis. CONCLUSIONS： The effectiveness of Recombinant human granulocyte stimulating factor injection is similar to that of Polyethylene glycol recombinant human granulocyte stimulating factor injection for the prevention and treatment of bone marrow suppression induced by chemotherapy for lung malignancies. But the cost-effectiveness ratio of the former is lower than that of the latter.

Objective To investigate the expression of bone marrow γ-H2AX in the patients with multiple myeloma(MM) and its correlation with the prognosis.Methods The patients with newly diagnosed MM in this hospital were selected as the case group,and the patients with non-hemopoietic system tumor without obvious morphological abnormalities by bone marrow smear and biopsy served as the control group.The immunohistochemistry was adopted to detect the expression level of bone marrow γ-H2AX in the cases group and control group,the image-Pro Plus(IPP) semiquantitative analysis was performed.The expression differences were compared between the two groups,moreover the case group was re-divided into the strong expression group and weak expression group according to γ-H2AX expression level.Then the relation ship between γ-H2AX expression level and the prognosis in the patients with MM.Results The bone marrow γ-H2AX expression level in the case group was significantly higher than that in the control group (P＜0.05);the level of γ-H2AX expression in the strong expression group was significantly stronger than that in the weak expression group (P＜0.05).Conclusion The level of γ-H2AX expression was higher among MM patients,and the over expression of γ-H2AX predicts the shorter survival time.