Objective:To explore the efficacy and safety of ibrutinib for the treatment of newly treated and relapsed refractory (R/R) lymphoplasmacytic lymphoma (LPL) /Waldenstr?m macroglobulinemia (WM) .Methods:Retrospectively collected clinical data of 98 cases of newly treated and R/R LPL/WM patients who received ibrutinib treatment at the Hematology & Blood Diseases Hospital of the Chinese Academy of Medical Sciences from March 2016 to June 2023, and analyzed their efficacy and safety.Results:A total of 98 LPL/WM patients were included, which consisted of 45 newly treated patients and 53 R/R patients. Of these, 74 were males (75.5%) and the cohort had a median age of 64 (42-87) years. Eighty-eight patients were eligible for efficacy evaluation with a median treatment time of 20.8 (2.1-55.0) months, a major remission rate (MRR) of 78.4%, and an overall response rate (ORR) of 85.2%. The MRR and ORR of the newly treated patients were 78.4% and 86.5%, respectively, whereas the MRR and ORR of the R/R patients were 78.4% and 84.3%, respectively. There were no statistically significant differences in MRR and ORR between the initial treatment and R/R patients (all P values >0.05) . The median follow-up period was 29.1 (2.9-50.3) months and the median overall survival time for newly treated and R/R patients was not reached. The median progression-free survival time was 23.5 (95% CI 10.5-36.5) months and 45.0 (95% CI 34.0-56.0) months, respectively, with no statistically significant differences (all P values >0.05) . There were 25 deceased patients and no deaths were related to ibrutinib treatment. The main adverse reactions of ibrutinib were thrombocytopenia (5.1%) , pneumonia (8.1%) , and hyperuricemia (21.4%) . The incidence of atrial fibrillation was 2.0%. Conclusion:Ibrutinib exhibits good efficacy and safety for newly treated and R/R LPL/WM patients.

Objective:To establish a prediction model of acute gastrointestinal injury (AGI) above grade II in elderly patients with severe pneumonia, and to evaluate and validate the model internally.Methods:A retrospective analysis was performed on 268 patients aged >65 years with severe pneumonia admitted to the Second People′s Hospital of Hefei from June 2019 to May 2022 (207 cases in the training set and 61 cases in the verification set). Sixteen indicators, including age, sex, underlying disease, pneumonia Severity index (PSI) score, dosage of sedative and analgesic drugs, and mechanical ventilation time of all patients were collected. After logistic regression analysis in the training set, a model was established to predict AGI above grade Ⅱ in elderly patients with severe pneumonia. Receiver operating characteristic (ROC) curve was drawed and correction curve was used to evaluate the reliability of the model. The model was internally validated by validation set data.Results:Among 207 patients with severe pneumonia in the training set, 50 patients developed AGI above grade Ⅱ during treatment. The prediction model was established by logistic regression analysis as follows: When L=Sequential Organ Failure Assessment (SOFA)×0.181+ PSI score×0.066+ propofol dosage×0.607+ reifentanil dosage×1.187, L>19.288, it can be considered that patients with severe pneumonia have a 93.24% chance of developing grade Ⅱ or above AGI. The ROC curve showed that the model was well differentiated, AUC=0.960. H-L test indicated (χ 2=7.39, P=0.496>0.05) the model fit was good. The sensitivity and specificity of the model were 82.00% and 96.82% respectively. AUC=94.58% (sensitivity 81.25%, specificity 93.33%), H-L test indicated ( χ 2=4.51, P=0.808>0.05) the prediction accuracy was 90.16%. Conclusions:The prediction model for AGI after severe pneumonia in elderly patients can be used clinically to help predict the occurrence of AGI in elderly patients with multiple injuries.

Objective To investigate etiologic characteristics of hand, foot, and mouth disease (HFMD) in a sentinel hospital in Guangzhou from 2017 to 2021, and to provide a scientific basis for the prevention and control of HFMD. Methods Descriptive epidemiologic methods were used to analyze the etiologic characteristics of mild cases of HMFD during 2017-2021. Results A total of 1 633 specimens of mild cases of HMFD were collected from 2017 to 2021. The total enterovirus (EV) positive rate was 78.41%, among which the positive rates of the main pathogen Cox A6, Cox A16, Cox A10, and EV71 were 40.83%, 17.68%, 6.13%, and 1.62%, respectively. The total positive rate of enteroviruses and the positive rate of enteroviruses of all types in each year were statistically different (P<0.001). In 2017-2021, the prevalence of HFMD in Guangzhou was mainly Cox A6, followed by Cox A16 which had the highest positive rate in 2018 (24.62%). The positive rate of EV71 decreased year by year. Cox A6 was highly prevalent from June to December every year, while the detection rate of Cox A16 was high from April to August every year. The positive detection rate of EV71 was high from January to May in 2017 and low from 2018 to 2021, with no epidemic peak. Conclusion From 2017 to 2021, the main pathogen of HMFD in Guangzhou is Cox A6, not EV71 or CoxA16, which suggests that it is of great significance to strengthen the monitoring of epidemic trend of HFMD for the prevention and control of HFMD.

Objective:To explore the facilitating and inhibitory factors influencing the behavior of young patients to share medical electronic word-of-mouth (eWOM) on internet platforms, so as to provide insights for the improvement of healthcare quality.Methods:In May 2022, 271 undergraduate students from universities in Zhejiang province were selected by convenient sampling to survey their motivations to share eWOM with a self-designed questionnaire. Multiple regression analysis was used to examine the impact of different motivational factors on the sharing intention of young patients.Results:Only 16 respondents (5.9%) had previously published medical eWOM. Egoistic motivation, altruistic motivation, medical experience, and comment habits were significant factors that promoted patients to share eWOM, with egoistic motivation ( β=0.212, P<0.001) having the greatest impact and comment habit ( β=0.139, P=0.003) having the least impact. Distrust, low self-efficacy and involvement, perceived reluctance, and perceived uselessness were significant factors inhibiting patients from publishing eWOM. Of them, distrust ( β=-0.161, P<0.001) and perceived reluctance ( β=-0.161, P=0.001) had the greatest impact, and low self-efficacy and involvement had the least impact ( β=-0.134, P=0.003). Conclusions:To enhance the positive attitude of young patients towards sharing eWOM, it is important to focus on their personal benefits and provide high-quality healthcare experiences. Building trust among patients in the platform is crucial, and efforts should be made to reduce operational barriers. Additionally, educating and raising awareness among young patients regarding the significance and influence of healthcare reviews is important.

Objective: To compare the safety between cervical conization (CC) alone and hysterectomy for patients with adenocarcinoma in situ (AIS) of the cervix. Methods: Patients diagnosed with AIS after CC during 2007–2021 were identified by computerized databases at Women’s Hospital of Zhejiang University School of Medicine. A total of 453 AIS patients were divided into 2 groups according to uterus preservation: hysterectomy group (n=300) and CC(s) alone group (n=153). The prevalence of residual disease and disease recurrence was compared between patients treated by CC(s) alone and hysterectomy. The prevalence of residual disease in specimens from women who had a hysterectomy and repeat CC were compared between positive and negative margins of CC. The factors influencing residual disease and disease recurrence were assessed. Results: Among 310 specimens from women who had a hysterectomy or repeat CC, the prevalence of residual disease was 50.6% (45/89) for a positive margin and 2.3% (5/221) for a negative margin (p=0.000). Four patients had recurrence of vaginal intraepithelial neoplasia in those treated by hysterectomy and one had recurrence of cervical squamous intraepithelial neoplasia in those treated by CC(s) alone. The prevalence of recurrence was 0.7% (1/153) for CC(s) alone and 1.3% (4/300) for hysterectomy (p=0.431). Hysterectomy did not influence residual disease or disease recurrence. Conclusion CC is an efficacious and safe option for patients with AIS of the cervix provided the margin is negative.

Objective: To investigate the refractive progression and associated factors of children of different ages and refractive status, and to provide guidance on myopia prevention and control program formulation and work practice. Methods: A total of 20 kindergartens, primary schools, and secondary schools in 2 districts of Shanghai were selected based on the existing cohort, and baseline data in 2015 and one year follow up data in 2016 were collected from 1 510 children aged 4 to 14, including cycloplegic spherical equivalent refraction (SER), axial length (AL), and corneal curvature. The distribution and progression of SER and AL in children of different ages and refractive status were analyzed, and the influencing factors of SER progression (ΔSER) were explored using multiple linear regression. Results: ΔSER remained relatively stable at age 4 and 5 (average -0.08 to -0.07 D/year), and SER drifted significantly towards myopia (average -0.50 to -0.31 D/year) in all groups older than 6 years, dropping back to -0.44 to -0.33 D/year after age 11; Elongation of AL (ΔAL) was 0.27 to 0.35 mm/year in 4 to 10 years group, and decreased to 0.15 to 0.22 mm/year in 11 to 14 years group. The ΔSER and ΔAL were greatest in the new onset myopes [(-0.90± 0.05 )D, (0.51±0.02)mm], followed by the low myopia group [(-0.68±0.04)D, (0.36±0.02)mm], then followed by the moderate to high myopia group[(-0.49±0.06)D，(0.23±0.03)mm] and the lowest in the hyperopia group[(-0.21±0.02)D, ( 0.26 ±0.01)mm], with a statistically significant difference among these groups ( P <0.05). Age ( β =-0.07), baseline SER ( β = 0.05 ) and ΔAL ( β =-0.78) were independent influencing factors for refractive progression in the 4 to 10 years old group, while ΔAL( β =-1.55) was the only independent influencing factor in the 11 to 14 years old group ( P <0.05). Conclusion The elongation of AL in preschoolers is mostly physiologically and should be prevented from growing beyond the physiological range by increasing outdoor activities. The primary students, as well as students with pre myopia or low myopia are the priority groups for dynamic monitoring and intervention in myopia prevention and control.

Objective To evaluate prospectively the side effects and tolerance of docetaxel with concurrent late-course hyperfractionated radiotherapy after breast-conserving surgery for stage T1-T2 breast cancer, and to assess the value of this treatment in shortening the treatment time and reducing the economic burden among patients. Methods A total of 20 patients with T1-T2 breast cancer were recruited after they underwent breast-conserving surgery. The acute radiation response classification, treatment completion rate, disease-free survival, hospital stays, and treatment costs were observed. Radiotherapy for all patients was started before the last single-agent docetaxel chemotherapy. Results The completion rate of treatment and the good rate of cosmetic effect reached 100%. The main adverse reactions were hematological toxicity (leukopenia) and skin reactions, which were tolerated. The median follow-up time was 30.1 months, and the follow-up rate was 100%. The average total treatment time of this hyperfractionated radiotherapy with concurrent docetaxel was four weeks, and the total hospitalization cost savings was approximately 10, 000 yuan. The 21-month disease-free survival rate was 100%. Conclusion Stage T1-T2 breast cancer can tolerate hyperfractionated radiotherapy with concurrent chemotherapy after a breast-conserving operation. The procedure results in good local control and satisfactory cosmetic effects, with high health and economic value.

Objective:To explore the optimum time of ambulation of atrial fibrillation patients after radiofrequency ablation, to provide basis for patients' early postoperative rehabilitation.Methods:By convenient sampling method, a total of 120 patients with atrial fibrillation after radiofrequency ablation were collected at Yanghu Branch and City Branch of Changzhou Second People's Hospital from January 2020 to May 2021. They were divided into the early group, middle group and late group according to the random number table method, each group were 40 cases. All patients received routine postoperative intervention, the time of ambulation were 4, 6 and 12 h after operation in the early group, middle group and late group, respectively. The complication rate within 24 h after operation was compared among the three groups, and the comfort level of the three groups at 24, 48 and 72 h after operation was evaluated with Comfort Status Scale (GCQ).Results:Finally, 111 patients were included, including 37 in the early group, 38 in the middle group and 36 in the late group. There was no significant difference in the incidence of bleeding or hematoma, urinary retention, lumbago within 24 h after operation among the three groups ( P>0.05). The incidence of postural hypotension within 24 h after operation in the early group was 2.7% (1/37), which was lower than 21.1% (7/38) and 25.0% (9/36) in the middle and late groups, with a statistically significant difference ( χ2=4.86, 7.67, both P<0.05). At 48 and 72 h after operation, the scores of physiological dimension, psychological dimension and the total score of GCQ in the early group were (20.68 ± 3.07), (22.54 ± 3.35), (81.68 ± 6.11) and (22.54 ± 3.73), (24.38 ± 2.49), (84.92 ± 6.37), higher than those in the middle group (19.16 ± 2.19), (21.32 ± 2.27), (78.24 ± 5.58), (20.93 ± 2.85), (22.32 ± 2.04), (81.66 ± 6.56), and those in the late group (18.44 ± 1.50) (21.31 ± 1.99), (78.06 ± 4.32), (20.89 ± 2.25), (21.58 ± 1.86), (80.28 ± 6.44), the differences were statistically significant ( t values were 2.19-4.15, all P<0.05). Conclusions:Ambulation at 4 h after operation does not increase peripheral vascular complications, but can reduce the incidence of postural hypotension and improve the comfort of patients with atrial fibrillation after radiofrequency ablation.

Objective:To analyze the risk factors of bronchopulmonary dysplasia(BPD)in very preterm infants(VPI), and to provide scientific basis for the prevention and treatment of BPD in VPI.Methods:A prospective multicenter study was designed to collect the clinical data of VPI in department of neonatology of 28 hospitals in 7 regions from September 2019 to December 2020.According to the continuous oxygen dependence at 28 days after birth, VPI were divided into non BPD group and BPD group, and the risk factors of BPD in VPI were analyzed.Results:A total of 2 514 cases of VPI including 1 364 cases without BPD and 1 150 cases with BPD were enrolled.The incidence of BPD was 45.7%.The smaller the gestational age and weight, the higher the incidence of BPD( P<0.001). Compared with non BPD group, the average birth age, weight and cesarean section rate in BPD group were lower, and the incidence of male infants, small for gestational age and 5-minute apgar score≤7 were higher( P<0.01). In BPD group, the incidences of neonatal respiratory distress syndrome(NRDS), hemodynamically significant patent ductus arteriosus, retinopathy of prematurity, feeding intolerance, extrauterine growth restriction, grade Ⅲ~Ⅳ intracranial hemorrhage, anemia, early-onset and late-onset sepsis, nosocomial infection, parenteral nutrition-associated cholestasis were higher( P<0.05), the use of pulmonary surfactant(PS), postnatal hormone exposure, anemia and blood transfusion were also higher, and the time of invasive and non-invasive mechanical ventilation, oxygen use and total hospital stay were longer( P<0.001). The time of starting enteral nutrition, cumulative fasting days, days of reaching total enteral nutrition, days of continuous parenteral nutrition, days of reaching 110 kcal/(kg·d) total calorie, days of reaching 110 kcal/(kg·d) oral calorie were longer and the breastfeeding rate was lower in BPD group than those in non BPD group( P<0.001). The cumulative doses of amino acid and fat emulsion during the first week of hospitalization were higher in BPD group( P<0.001). Multivariate Logistic regression analysis showed that NRDS, invasive mechanical ventilation, age of reaching total enteral nutrition, anemia and blood transfusion were the independent risk factors for BPD in VPI, and older gestational age was the protective factor for BPD. Conclusion:Strengthening perinatal management, avoiding premature delivery and severe NRDS, shortening the time of invasive mechanical ventilation, paying attention to enteral nutrition management, reaching whole intestinal feeding as soon as possible, and strictly mastering the indications of blood transfusion are very important to reduce the incidence of BPD in VPI.

The chemotherapy combined with photothermal therapy has been a favorable approach for the treatment of breast cancer. In present study, nanoparticles with the characteristics of photothermal/matrix metalloproteinase-2 (MMP-2) dual-responsive, tumor targeting, and size-variability were designed for enhancing the antitumor efficacy and achieving "on-demand" drug release markedly. Based on the thermal sensitivity of gelatin, we designed a size-variable gelatin nanoparticle (GNP) to encapsulate indocyanine green (ICG) and doxorubicin (DOX). Under an 808 nm laser irradiation, GNP-DOX/ICG responded photothermally and swelled in size from 71.58 ± 4.28 to 160.80 ± 9.51 nm, which was beneficial for particle retention in the tumor sites and release of the loaded therapeutics. Additionally, GNP-DOX/ICG showed a size reduction of the particles to 33.24 ± 4.11 nm and further improved drug release with the degradation of overexpressed MMP-2 in tumor. In the subsequently performed