Objective:To explore the clinical manifestations, pathogenesis, and therapeutic approaches of disseminated intravascular coagulation (DIC) associated with chimeric antigen receptor T-cell (CAR-T) therapy for B-lymphoblastic lymphoma.Methods:Retrospective collection and analysis were conducted on the clinical data of a patient with B-lymphoblastic lymphoma who received CAR-T therapy in the Hematology Department of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, in April 2020. To review the literatures, Chinese databases (CNKI, Wanfang Database) and PubMed were searched form database inception up to November 2024 using the retrieval entries "chimeric antigen receptor T-cell therapy", "CAR-T", "coagulation", "bleeding", and "thrombosis" .Results:The patient, a 32-year-old male, diagnosed with B-lymphoblastic lymphoma for over 10 months, relapsed after three cycles of chemotherapy and allogeneic hematopoietic stem cell transplantation, with bone marrow cytology indicating 20.24% abnormal phenotype B-lineage precursor cells. After CAR-T cell infusion at a dose of 4×10 6/kg, the patient developed grade 2 cytokine release syndrome (CRS) on day 2, nasal bleeding on day 4, high fever again on day 9, with worsening coagulation parameters, DIC and persistent hypofibrinogenemia. After treatment with tocilizumab, corticosteroids to counteract CRS, and active replacement therapy such as administration of blood product and fibrinogen, the patient’s CRS and coagulation abnormalities gradually improved. The patient was followed up for 16 months regularly after CAR-T therapy, with CAR-T cells sustained and minimal residual disease remained negative as assessed by bone marrow flow cytometry. Subsequently, the patient stopped taking oral immunosuppressants on his own, which aggravated rejection reaction complicated with infection. The patient and his family requested to be discharged and lost the follow-up. A total of 20 relevant English articles and 6 Chinese articles were retrieved from the literature search. Conclusion:CAR-T-associated coagulopathy occurs alongside CRS. It is characterized by hypofibrinogenemia, and is life-threatening when progressing to DIC. Anti-CRS and replacement therapies have proven to be effective treatment strategies.

Objective:To investigate the clinical manifestations, diagnostic and therapeutic strategies, for thrombocytopenia after BCMA/CS1 bispecific chimeric antigen receptor T-cell (CAR-T cell) therapy in patients with multiple myeloma.Methods:Retrospective collection and analysis were conducted on the clinical data of a patient with multiple myeloma who received BCMA/CS1 bispecific CAR-T cell therapy in the Hematology Department of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, in June 2021. To review the literature, Chinese databases (CNKI, Wanfang Database) and PubMed were searched from their inception up to November 2024 using the keywords "chimeric antigen receptor T-cell therapy", "thrombocytopenia", "CAR-T", "BCMA", and "CS1" .Results:A 72-year-old male patient was diagnosed with light chain κ-type multiple myeloma (R-ISS stage Ⅱ) in a local hospital and had a prolonged treatment course with poor disease control despite multiple adjustments of chemotherapy regimens. The patient met the inclusion criteria for the BCMA/CS1 dual-target CAR-T cell clinical trial (NCT04662099) and achieved complete remission two months after receiving a low dose of CAR-T cells. On the 8th day after CAR-T cell infusion, the patient developed grade 3 cytokine release syndrome, followed by severe gastrointestinal bleeding and persistent grade ≥3 thrombocytopenia, accompanied by a significant increase in thrombopoietin levels, with no megakaryocytes observed in bone marrow cytology. After treatment with rituximab, significant improvement was observed with platelet count gradually increased. However, the patient experienced persistent malnutrition and cachexia, and transferred to the gastroenterology department, after which follow-up was lost. A total of 24 relevant English articles and 8 Chinese articles were retrieved from the literature search.Conclusion:CAR-T cell therapy associated thrombocytopenia is characterized by thrombocytopenia and megakaryocyte production disorders. Persistent thrombocytopenia increases the risk of bleeding, and the use of CD20 monoclonal antibodies and supportive therapy can effectively improve thrombocytopenia.

Objective:To explore the clinical manifestations, pathogenesis, and therapeutic approaches of disseminated intravascular coagulation (DIC) associated with chimeric antigen receptor T-cell (CAR-T) therapy for B-lymphoblastic lymphoma.Methods:Retrospective collection and analysis were conducted on the clinical data of a patient with B-lymphoblastic lymphoma who received CAR-T therapy in the Hematology Department of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, in April 2020. To review the literatures, Chinese databases (CNKI, Wanfang Database) and PubMed were searched form database inception up to November 2024 using the retrieval entries "chimeric antigen receptor T-cell therapy", "CAR-T", "coagulation", "bleeding", and "thrombosis" .Results:The patient, a 32-year-old male, diagnosed with B-lymphoblastic lymphoma for over 10 months, relapsed after three cycles of chemotherapy and allogeneic hematopoietic stem cell transplantation, with bone marrow cytology indicating 20.24% abnormal phenotype B-lineage precursor cells. After CAR-T cell infusion at a dose of 4×10 6/kg, the patient developed grade 2 cytokine release syndrome (CRS) on day 2, nasal bleeding on day 4, high fever again on day 9, with worsening coagulation parameters, DIC and persistent hypofibrinogenemia. After treatment with tocilizumab, corticosteroids to counteract CRS, and active replacement therapy such as administration of blood product and fibrinogen, the patient’s CRS and coagulation abnormalities gradually improved. The patient was followed up for 16 months regularly after CAR-T therapy, with CAR-T cells sustained and minimal residual disease remained negative as assessed by bone marrow flow cytometry. Subsequently, the patient stopped taking oral immunosuppressants on his own, which aggravated rejection reaction complicated with infection. The patient and his family requested to be discharged and lost the follow-up. A total of 20 relevant English articles and 6 Chinese articles were retrieved from the literature search. Conclusion:CAR-T-associated coagulopathy occurs alongside CRS. It is characterized by hypofibrinogenemia, and is life-threatening when progressing to DIC. Anti-CRS and replacement therapies have proven to be effective treatment strategies.

Objective:To investigate the clinical manifestations, diagnostic and therapeutic strategies, for thrombocytopenia after BCMA/CS1 bispecific chimeric antigen receptor T-cell (CAR-T cell) therapy in patients with multiple myeloma.Methods:Retrospective collection and analysis were conducted on the clinical data of a patient with multiple myeloma who received BCMA/CS1 bispecific CAR-T cell therapy in the Hematology Department of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, in June 2021. To review the literature, Chinese databases (CNKI, Wanfang Database) and PubMed were searched from their inception up to November 2024 using the keywords "chimeric antigen receptor T-cell therapy", "thrombocytopenia", "CAR-T", "BCMA", and "CS1" .Results:A 72-year-old male patient was diagnosed with light chain κ-type multiple myeloma (R-ISS stage Ⅱ) in a local hospital and had a prolonged treatment course with poor disease control despite multiple adjustments of chemotherapy regimens. The patient met the inclusion criteria for the BCMA/CS1 dual-target CAR-T cell clinical trial (NCT04662099) and achieved complete remission two months after receiving a low dose of CAR-T cells. On the 8th day after CAR-T cell infusion, the patient developed grade 3 cytokine release syndrome, followed by severe gastrointestinal bleeding and persistent grade ≥3 thrombocytopenia, accompanied by a significant increase in thrombopoietin levels, with no megakaryocytes observed in bone marrow cytology. After treatment with rituximab, significant improvement was observed with platelet count gradually increased. However, the patient experienced persistent malnutrition and cachexia, and transferred to the gastroenterology department, after which follow-up was lost. A total of 24 relevant English articles and 8 Chinese articles were retrieved from the literature search.Conclusion:CAR-T cell therapy associated thrombocytopenia is characterized by thrombocytopenia and megakaryocyte production disorders. Persistent thrombocytopenia increases the risk of bleeding, and the use of CD20 monoclonal antibodies and supportive therapy can effectively improve thrombocytopenia.

Good sleep is essential for children′s physical and mental health, growth, and development.Adequate and high-quality sleep positively impacts children′s quality of life, memory, learning, attention, mood, and behavior.Children of different ages have different sleep needs.Children have various sleep problems in different cultures.Therefore, it is significant to guide children to get healthy sleep by popularizing the sleep problems of Chinese children of all ages and in all dimensions.Based on China′s social and cultural background, this paper summarizes the contents related to children′s sleep physiology, good sleep habits, common sleep problems, sleep apnea disorders, hypnagogic sleep, narcolepsy, insomnia, and other issues that interfere with children′s sleep.Chinese sleep experts summarize and interpret the 100 sleep health problems of children that medical workers and parents are most concerned about.To promote children′s sleep health and popularize solutions to sleep problems.

Objective:To investigate the knowledge, attitudes, and practices (KAP) of pulse oximetry among pediatric healthcare providers in China and analyze the factor influencing the KAP.Methods:A self-developed questionnaire was used for an online research on the KAP of 11 849 pediatric healthcare providers from 31 provinces, autonomous regions, and municipalities of China from March 11 to 14, 2022.The factors influencing the KAP of pulse oximetry among pediatric healthcare providers were examined by Logistic regression. Results:The scores of KAP, of pulse oximetry were 5.57±0.96, 11.24±1.25 and 11.19±4.54, respectively.The corresponding scoring rates were 69.61%, 74.95%, and 55.99%, respectively. Logistic regression results showed that the gender and working years of pediatric healthcare providers, the region they were located, and whether their medical institution was equipped with pulse oximeters were the main factors affecting the knowledge score (all P<0.05). Main factors influencing the attitude score of pediatric healthcare providers included their knowledge score, gender, educational background, working years, region, medical institution level, and whether the medical institution was equipped with pulse oximeters (all P<0.05). For the practice score, the main influencing factors were the knowledge score, gender, age, and whether the medi-cal institution was equipped with pulse oximeters (all P<0.05). Conclusions:Chinese pediatric healthcare providers need to further improve their knowledge about and attitudes towards pulse oximetry.Pulse oximeters are evidently under-used.It is urgent to formulate policies or guidelines, strengthen education and training, improve knowledge and attitudes, equip more institutions with pulse oximeters, and popularize their application in medical institutions.

Objective To investigate the causes and risk factors of postpartum hemorrhage (PPH) in hepatitis B virus (HBV) infected parturient.Methods Retrospective analysis was performed on the 1021 HBV infected parturient from Shanghai Public Health Clinical Center from July 2005 to June 2011.The comparisons were done by chi-square test.Results Among 1021 cases of HBV infected parturient,868 (85.01％) were asymptomatic and the PPH rate was 2.76％ (24/868) ;the remaining 153 cases (14.99％) were chronic active hepatitis B and the PPH rate was 16.99％(26/153).The difference between two groups was statistically significant (x2 =56.541,P＜0.01).The total incidence rate of PPH was 4.89％ (50/1021) and 17 cases (34.00％) were postpartum hemorrhage＞1000mL.The causes of PPH included uterine inertia (30/50,60.00％),abnormal placenta (11/50,22.00％),dysfunction of coagulation (5/50,10.00％) and lesion of birth canal (4/50,8.00％).The risk factors of PPH included delivery mode (x2 =6.528,P=0.038),abortion times (x2 =16.269,P=0.000),delivery times (x2 =6.990,P=0.008),ALT levels (x2=56.541,P=0.000) and HBV DNA (x2 =64.706,P=0.000).Conclusions The main causes of PPH in HBV infected parturient include uterine inertia,abnormal placenta,lesion of birth canal and dysfunction of blood coagulation.PPH is correlated with abortion times,delivery times,delivery mode,liver function and HBV DNA.The incidence of PPH in parturient with chronic active hepatitis B is higher than asymptomatic parturient.