Objective:To explore the potential value of dynamic changes of inflammatory factors in evaluating the efficacy of platinum regimen in the first-line treatment of advanced lung adenocarcinoma(LUAD).Methods:A total of 121 patients with advanced LUAD without common target mutations who were admitted to Dongtai People's Hospital to receive first-line treatment with platinum regimen from January 2021 to January 2023 were selected,and relevant clinical data such as general information,hematuria routine,angiogenic factors,serum tumor markers,inflammatory factors,immunoglobulin and T lymphocyte indexes were collected and statisti-cally analyzed.Patients in complete response(CR)group and partial response(PR)group were classified as chemotherapy sensitive group;stable(SD)group and progressive(PD)group were classified as chemotherapy insensitive group according to response evaluation criteria in solid tumors(RECIST).Through univariate and multi-factor Logistics regression analysis,the influencing factors of first-line treatment efficacy of platinum regimen in patients with advanced LUAD were analyzed,and the regression equation y=1-1/(1+e-z)prediction model was established and verified.Receiver operating characteristic(ROC)curve was used to analyze the potential value of dynamic changes of inflammatory factors in evaluating the efficacy of platinum-based first-line treatment for advanced LUAD.Results:①Univariate and multivariate Logistic regression analysis showed that CEA,TNF-α,IL-6,IL-8,IL-18,IL-1β and hs-CRP were still the influencing factors for the efficacy of first-line chemotherapy of platinum regimen in patients with advanced LUAD(P<0.05).②Inflammatory factors TNF-α,IL-6,IL-8,IL-18,IL-1β and hs-CRP were included in multivariate Logistic regression analysis.After correcting confounders(Model 5),high levels of TNF-α,IL-6,IL-8,IL-18,IL-1β and hs-CRP were positively correlated with insensitivity after first-line chemotherapy of platinum regimen in advanced LUAD patients(P<0.05).Restrictive cubic spline model analysis showed that the dynamic changes of inflammatory factors and the insensitivity of patients with advanced LUAD after first-line chemotherapy all had a nonlinear dose-response relationship.With the increases of TNF-α,IL-6,IL-8,IL-18,IL-1β and hs-CRP levels,patients with advanced LUAD have a greatly increased risk of desensitization after first-line chemotherapy.③Stratified interaction test analysis showed that tumor stage,differentiation degree and lymph node metastasis before and after correction factors were significantly correlated with expressions of inflammatory factors(all P<0.05,all P interaction<0.05).④Prediction model based on the influence factors of inflammatory factors was well distinguished and accurate,the area under ROC curve(AUC)before and after internal validation for detecting chemotherapy sensitivity in patients with advanced LUAD treated with platinum regimen first-line therapy was 0.87(95%CI:0.81～0.93)and 0.88(95%CI:0.82～0.95),respectively,and the sensitivity were 89.69%and 89.75%,respectively,the specificity were 91.77%and 91.85%,respectively.Conclusion:Dynamic changes of inflammatory factors is an important factor affecting the chemotherapy efficacy of patients with advanced LUAD treated with platinum-containing regimen.With the significant decrease of inflammatory factors,the sensitivity of patients to chemotherapy is also significantly increased.

Objective:To explore the potential value of dynamic changes of inflammatory factors in evaluating the efficacy of platinum regimen in the first-line treatment of advanced lung adenocarcinoma(LUAD).Methods:A total of 121 patients with advanced LUAD without common target mutations who were admitted to Dongtai People's Hospital to receive first-line treatment with platinum regimen from January 2021 to January 2023 were selected,and relevant clinical data such as general information,hematuria routine,angiogenic factors,serum tumor markers,inflammatory factors,immunoglobulin and T lymphocyte indexes were collected and statisti-cally analyzed.Patients in complete response(CR)group and partial response(PR)group were classified as chemotherapy sensitive group;stable(SD)group and progressive(PD)group were classified as chemotherapy insensitive group according to response evaluation criteria in solid tumors(RECIST).Through univariate and multi-factor Logistics regression analysis,the influencing factors of first-line treatment efficacy of platinum regimen in patients with advanced LUAD were analyzed,and the regression equation y=1-1/(1+e-z)prediction model was established and verified.Receiver operating characteristic(ROC)curve was used to analyze the potential value of dynamic changes of inflammatory factors in evaluating the efficacy of platinum-based first-line treatment for advanced LUAD.Results:①Univariate and multivariate Logistic regression analysis showed that CEA,TNF-α,IL-6,IL-8,IL-18,IL-1β and hs-CRP were still the influencing factors for the efficacy of first-line chemotherapy of platinum regimen in patients with advanced LUAD(P<0.05).②Inflammatory factors TNF-α,IL-6,IL-8,IL-18,IL-1β and hs-CRP were included in multivariate Logistic regression analysis.After correcting confounders(Model 5),high levels of TNF-α,IL-6,IL-8,IL-18,IL-1β and hs-CRP were positively correlated with insensitivity after first-line chemotherapy of platinum regimen in advanced LUAD patients(P<0.05).Restrictive cubic spline model analysis showed that the dynamic changes of inflammatory factors and the insensitivity of patients with advanced LUAD after first-line chemotherapy all had a nonlinear dose-response relationship.With the increases of TNF-α,IL-6,IL-8,IL-18,IL-1β and hs-CRP levels,patients with advanced LUAD have a greatly increased risk of desensitization after first-line chemotherapy.③Stratified interaction test analysis showed that tumor stage,differentiation degree and lymph node metastasis before and after correction factors were significantly correlated with expressions of inflammatory factors(all P<0.05,all P interaction<0.05).④Prediction model based on the influence factors of inflammatory factors was well distinguished and accurate,the area under ROC curve(AUC)before and after internal validation for detecting chemotherapy sensitivity in patients with advanced LUAD treated with platinum regimen first-line therapy was 0.87(95%CI:0.81～0.93)and 0.88(95%CI:0.82～0.95),respectively,and the sensitivity were 89.69%and 89.75%,respectively,the specificity were 91.77%and 91.85%,respectively.Conclusion:Dynamic changes of inflammatory factors is an important factor affecting the chemotherapy efficacy of patients with advanced LUAD treated with platinum-containing regimen.With the significant decrease of inflammatory factors,the sensitivity of patients to chemotherapy is also significantly increased.

Objectives:To investigate the clinical and genetic features of young Chinese patients with myeloproliferative neoplasms (MPN) .Methods:In this cross-sectional study, anonymous questionnaires were distributed to patients with MPN patients nationwide. The respondents were divided into 3 groups based on their age at diagnosis: young (≤40 years) , middle-aged (41-60 years) , and elderly (>60 years) . We compared the clinical and genetic characteristics of three groups of MPN patients.Results:1727 assessable questionnaires were collected. There were 453 (26.2%) young respondents with MPNs, including 274 with essential thrombocythemia (ET) , 80 with polycythemia vera (PV) , and 99 with myelofibrosis. Among the young group, 178 (39.3%) were male, and the median age was 31 (18-40) years. In comparison to middle-aged and elderly respondents, young respondents with MPN were more likely to present with a higher proportion of unmarried status (all P<0.001) , a higher education level (all P<0.001) , less comorbidity (ies) , fewer medications (all P<0.001) , and low-risk stratification (all P<0.001) . Younger respondents experienced headache (ET, P<0.001; PV, P=0.007; MF, P=0.001) at diagnosis, had splenomegaly at diagnosis (PV, P<0.001) , and survey (ET, P=0.052; PV, P=0.063) . Younger respondents had fewer thrombotic events at diagnosis (ET, P<0.001; PV, P=0.011) and during the survey (ET, P<0.001; PV, P=0.003) . JAK2 mutations were found in fewer young people (ET, P<0.001; PV, P<0.001; MF, P=0.013) ; however, CALR mutations were found in more young people (ET, P<0.001; MF, P=0.015) . Furthermore, mutations in non-driver genes (ET, P=0.042; PV, P=0.043; MF, P=0.004) and high-molecular risk mutations (ET, P=0.024; PV, P=0.023; MF, P=0.001) were found in fewer young respondents. Conclusion:Compared with middle-aged and elderly patients, young patients with MPN had unique clinical and genetic characteristics.

Objective:To explore the care burden of the primary caregivers of maintenance hemodialysis (MHD) patients and its correlation with psychological resilience and social support.Methods:From January 2020 to December 2021, 97 MHD patients and 97 primary caregivers admitted to Zhumadian Central Hospital were selected by convenient sampling. The subjects were investigated with the Zarit Caregiver Burden Interview (ZBI) , Connor-Davidson Resilience Scale (CD-RISC) and Social Support Rating Scale (SSRS) . Pearson correlation analysis was used to explore the correlation between the care burden, psychological resilience and social support of the main caregivers of MHD patients. Model 4 in the PROCESS macro program was used to test the intermediary model, and the significance of the intermediary effect was tested by Bootstrap analysis. A total of 97 questionnaires were distributed, and the effective recovery rate was 100.00%.Results:There were statistically significant differences in the ZBI scores of MHD patients' main caregivers with different ages, with or without other care workers, total care time, daily care time, psychological resilience and social support ( P<0.05) . The total ZBI score of the main caregivers of MHD patients was (42.39±10.61) , of which 1.03% (1/97) had no or very mild burden, 44.33% (43/97) had mild burden, 50.52% (49/97) had moderate burden, and 4.12% (4/97) had severe burden. The total score of CD-RISC of the main caregivers of MHD patients was (53.09±5.69) , of which 79.38% (77/97) of the main caregivers had low-level resilience, and 20.62% (20/97) of the main caregivers had medium-level resilience. The total SSRS score of the main caregivers of MHD patients was (30.33±7.19) , of which 21.65% (21/97) of the main caregivers had low-level social support, 76.29% (74/97) of the main caregivers had medium-level social support, and 2.06% (2/97) of the main caregivers had high-level social support. The care burden of the main caregivers of MHD patients was negatively correlated with psychological resilience and social support, and psychological resilience was positively correlated with social support ( P<0.05) . Social support positively predicted psychological resilience and negatively predicted care burden ( P<0.05) . Psychological resilience negatively predicted care burden ( P<0.05) . The intermediary model (dependent variable was care burden; independent variable was social support; intermediary variable was psychological resilience) had a significant intermediary effect. The indirect effect accounted for 79.23% of the total effect, and the direct effect accounted for 20.77% of the total effect. Conclusions:The main caregivers of MHD patients have moderate care burden, and social support can directly affect the care burden, and also indirectly affect the care burden through the mediation of psychological resilience.

Objective:To explore the effectiveness of blended learning in the clinical teaching of wound care clinic.Methods:Blended learning based on WeChat and offline CBL teaching method was constructed by applying evidence-based nursing. Totally 125 interns from the wound care clinic of our hospital were selected as subjects, among which 62 didn't receive the blended learning (control group), and 63 received the blended learning (observation group). At the end of the two-week practice, the effectiveness of the two teaching methods was compared. The objective evaluation was carried out in the forms of theory test, practice evaluation and comprehensive quality questionnaire combined with online self-test and offline practice. All data were analyzed by SPSS 20.0 statistical software.Results:The scores of theory test, practice evaluation and comprehensive quality assessment in the observation group were all higher than those in the control group ( P<0.001). Conclusion:The blended learning with WeChat as the medium can guide student active learning, consolidate the basic knowledge, improve the efficiency of teaching, stimulate the enthusiasm of practice, and improve the comprehensive quality. It's a clinical teaching method that can be used for reference.

Objectives:To explore health-related quality of life (HRQoL) and identify its associated variables in Chinese patients with Philadelphia-negative myeloproliferative neoplasms (MPNs) .Methods:In this cross-sectional study, anonymous questionnaires were distributed to adult patients with MPNs to assess symptom burden measured by MPN-10 and HRQoL measured by Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) .Results:The data from 1405 respondents with MPNs, including 645 (45.9%) with essential thrombocythemia (ET) , 297 (21.1%) with polycythemia vera (PV) , and 463 (33.0%) with myelofibrosis (MF) , were analyzed. 646 (46.0%) respondents were male. The median age was 56 (range, 18-99) years. The mean MPN-10 scores were 13.0±12.7, 15.0±14.7, and 21.0±16.6 ( P<0.001) , and the physical component summary (PCS) and mental component summary (MCS) scores were 48.0±8.5, 47.0±9.0, and 42.0±10.0 ( P<0.001) and 51.0±11.0, 50.0±10.8, and 49.0±11.1 ( P=0.002) for respondents with ET, PV, and MF, respectively. Respondents with MF reported the lowest score of physical functioning, role functioning, emotional functioning, cognitive functioning, social function, and global health status (all P<0.01) and the highest score of fatigue, pain, dyspnea, appetite loss, diarrhea, and financial problems (all P<0.05) in EORTC QLQ-C30. Multivariate analyses revealed that higher MPN-10 scores were significantly associated with lower PCS (-0.220 to -0.277, P<0.001) and MCS (-0.244 to -0.329, P<0.001) scores; increasing age (-1.923 to -4.869; all P<0.05) , lower PCS score. Additionally, comorbidity (ies) , symptom at diagnosis, splenomegaly, anemia, unknown driver gene, and higher annual out-of-pocket cost were significantly associated with lower PCS and/or MCS scores. However, age ≥ 60 years, urban household registration, concomitant medication, and receiving ruxolitinib therapy in respondents with MF were associated with higher MCS scores. Weak correlations were found between MPN-10 score (except the subscale of appetite loss and constipation) and EORTC QLQ-C30 score in majority of subscales in respondents with ET (| r| = 0.193-0.457, all P<0.001) , PV (| r| = 0.192-0.529, all P<0.01) , and MF (| r| = 0.180-0.488, all P<0.001) , respectively. Conclusions:HRQoL in patients with MPN was significantly reduced, especially in patients with MF. Sociodemographic and clinical variables were significantly associated with the HRQoL in patients with MPNs.

Objective To study the evaluation index system for home treatment quality of negative pressure therapy. Methods Two-round Delphi expert consultation method was used to consult 20 experts, so as to initially establishthe quality evaluation index system. Results An evaluation index system for home treatment quality of negative pressure therapy was formed, including 4 items of primary indexes, 13 items of secondary indexes and 30 items of tertiary indexes. Conclusions The evaluation index system for home treatment quality of negative pressure therapy in patients with chronic wounds has a clear hierarchy, the reliability of the research results is high, which provides a standardized reference for the objective evaluation of the work and the continuous improvement of nursing quality.

Objective To explore the clinical application value and nursing experience of Urgotul parcel technology used for the treatment of surface abscess incision and drainage of the wound. Methods A total of 150 patients with surface abscess incision and drainage of the wound who received treatment in our hospital wound care room divided into A group, B group and C group (each group had 50 cases). Considering the characteristics of outpatients and the requirements of ethics, A group of patients from January to May of 2017 received the technology of Urgotul parcel alginate dressing with silver, B group of patients from June to December of 2016 received the treatment by the Mesalt and C group of patients from November 2015 to May 2016 used petrolatum gauze. After the infection control, each group received the treatment by Urgotul. Observe the difference with wound healing time, infection control time, the pain score of removing the dressings and filling of dressings, the number and the cost of wound care of patients. Results In A group, the scores of infection control time, wound healing time, the pain score of removing the dressings and filling of dressings, the number and the cost of wound care were (5.1±1.4) days, (22.9± 6.5) days, (1.3 ± 0.9) points, (1.9 ± 1.2) points, (6.6 ± 1.9) times, (603.81 ± 116.82) yuan, B group were (6.7 ±1.4) days, (24.7±7.2) days, (1.8±1.0) points, (4.1±1.4) points, (11.5±3.3) times, (736.94±203.81) yuan, and C group were (11.1 ± 2.1) days, (31.7 ± 3.8) days, (4.62 ± 1.3) points, (2.4 ± 1.1) points, (31.7 ± 3.7) times, (1617.20 ± 303.98) yuan. The difference between the three groups was statistically significant (F=30.48-931.29, all P<0.01). In infection control time, the pain score of removing the dressings, the number and the cost of wound care A group was better than B group and C group (P<0.05). The wound healing time of A group was shorter than C group (P<0.01), but was the same as B group (P>0.05). Filling of dressings the patients in A group and C group felt less pain than B group (P<0.01), and the pain scores in both A group and C group are same (P>0.05). Conclusions Urgotul parcel technology is able to control infection effectively, promote wound healing, Alleviate the pain of changing medicine, reduce the times and costs of wound care, improve patient compliance for patients with surface abscess incision and drainage of the wound. So Urgotul parcel technology has a significant role in these patients.

Objective To explore the effective means and important significance for preventing the born of neonatal patients with severe thalassemia.Methods Among the pregnant women and spouses receiving prenatal examination in our hospital from January 2013 to December 2015 were performed the thalassemia screening and gene diagnosis,49 couples carrying the same type thalassemia were conducted the prenatal amniotic fluid thalassemia gene diagnosis and follow up after prenatal diagnosis.Results In 49 couples carrying the same type thalassemia,the main gene mutation types of α-thalassemia detected by the gene diagnosis were --SEA/aα(50.0％),-α3.7/αa (36.5％) and-α4.2/αa (11.5％),which of β-thalassemia were CD17/N(42.0％),CD41-42/N (26.0％) and IVS-Ⅱ-654/N(22.0％).The results of prenatal diagnosis showed that there were 4 cases of HbH disease,2 cases of Bart's hydrops fetus,10 cases of severe β-thalassemia,19 a-thalassemia carriers,10 β-thalassemia carriers,1 case of co-inheritance of a-and β-thalassemia,and 3 health fetuses.The follow up results were consistent with those of prenatal diagnosis.Conclusion Conducting prenatal screening and diagnosis of thalassemia in pregnant women can effectively prevent the birth of neonatal patients with severe thalassemia.

Objective:To investigate the expression level of synaptophysin (Syn), tissue neuronal cell adhesion molecule 56 (CD56) and chromogranin A (CgA) in 92 primary esophageal small cell carcinoma (PESC) and to explore its repationship with clinicopathological features and clinical outcome. Methods:Immunohistochemical studies of CD56, CgA, and Syn were performed in 92 paraffin-embed-ded tissues with clinical-related information obtained from 500,000 esophageal and gastric cardia carcinoma databases established by Henan Key Laboratory for Esophageal Cancer Research of the First Affiliated Hospital of Zhengzhou University in Henan, China. Binary logistic regression was used to analyze the correlations of CgA, Syn, and CD56 expression with clinicopathological features. Kaplan-Mei-er survival analysis and Cox proportional hazards regression models were performed for univariate and multivariate survival analyses. Log-rank test was used to compare the difference in survival rates. Results:The CgA-positive expression rate in PESC at lower segment of esophagus (72.2%) was higher than those at the middle and lower segments (41.1%, 10.0%) (P=0.001). The expression level of CD56, CgA, and Syn was not correlated with gender (P=0.262, 0.998, 0.931), age (P=0.250, 0.998, 0.703), tumor invasion (P=0.253, 0.997, 0.061), and lymph node metastasis (P=0.767, 0.998, 0.613). Univariate analysis showed no survival influence in patients with and without lymph node metastasis (P=0.563). Multivariate survival analysis showed that patients with PESC mixed squamous cell car-cinoma (HR=2.58;95%Cl, 1.11-5.98) and higher CgA protein expression (HR=1.87;95%Cl, 1.02-3.43) exhibited a longer survival time than those with pure PESC and without CgA expression. Conclusion:Tissue CgA level was associated with tumor location in PESC. His-tological type and tissue CgA expression were independent important prognostic factors, and lymph node metastasis exerted no influ-ence on survival in PESC.