BACKGROUND:Allogeneic hematopoietic stem cell transplantation is an important treatment for malignant hematological diseases,and delayed postoperative platelet implantation is a common complication that seriously affects the quality of patient survival;however,there are no standard protocols to improve platelet implantation rates and prevent platelet implantation delays. OBJECTIVE:To compare the safety and efficacy of oral Herombopag Olamine versus subcutaneous recombinant human thrombopoietin for promoting platelet implantation in patients with malignant hematological diseases undergoing haploid hematopoietic stem cell transplantation. METHODS:Clinical data of 163 patients with malignant hematological diseases who underwent haploidentical hematopoietic stem cell transplantation from January 2016 to October 2022 were retrospectively analyzed.A total of 72 patients who started to subcutaneously inject recombinant human thrombopoietin at+2 days were categorized into the recombinant human thrombopoietin group;a total of 27 patients who started to orally take Herombopag Olamine at+2 days were categorized into the Herombopag Olamine group;and 64 patients who did not apply Herombopag Olamine or recombinant human thrombopoietin were categorized into the blank control group.The implantation status,incidence of acute graft-versus-host disease of degree II-IV within 100 days,1-year survival rate,1-year recurrence rate,and safety were analyzed in the three groups. RESULTS AND CONCLUSION:(1)The average follow-up time was 52(12-87)months.The implantation time of neutrophils in the blank control group,recombinant human thrombopoietin group,and Herombopag Olamine group was(12.95±3.88)days,(14.04±3.71)days,and(13.89±2.74)days,respectively,with no statistically significant difference(P=0.352);the implantation time of platelets was(15.16±6.27)days,(17.67±6.52)days,and(17.00±4.75)days,with no statistically significant difference(P=0.287).(2)The complete platelet implantation rate on day 60 was 64.06%,90.28%,and 92.59%,respectively,and the difference was statistically significant(P<0.001).The subgroup analysis showed that the difference between the blank control group and the recombinant human thrombopoietin group was statistically significant(P<0.001),and the difference between the blank control group and the Herombopag Olamine group was statistically significant(P=0.004).The difference was not statistically significant between the recombinant human thrombopoietin group and Herombopag Olamine group(P=0.535).(3)100-day II-IV degree acute graft-versus-host disease incidence in the blank control group,recombinant human thrombopoietin group,and Herombopag Olamine group were 25.00%,30.56%,and 25.93%,respectively,and the difference was not statistically significant(P=0.752).(4)The incidence of cytomegalovirus anemia,cytomegalovirus pneumonia,and hepatic function injury had no statistical difference among the three groups(P>0.05).(5)During the follow-up period,there was no thrombotic event in any of the three groups of patients.(6)The results showed that recombinant human thrombopoietin and Herombopag Olamine could improve the platelet implantation rate of malignant hematological disease patients after haploidentical hematopoietic stem cell transplantation,with comparable efficacy and good safety.

Objective:To develop an intelligent surveillance system for identifying upper gastrointestinal high-risk patients and assigning surveillance intervals, and to verify its efficacy.Methods:The endoscopic and pathological reports of 23 035 patients undergoing endoscopy at Renmin Hospital of Wuhan University from January to October 2021 were collected retrospectively. A training set of 17 934 patients (January to August) and a test set of 5 101 patients (September to October) were established. Keywords in the endoscopic and pathological reports were extracted by the intelligent surveillance system, and high-risk patients were automatically identified and classified into 7 risk levels. Then the standardized surveillance intervals were assigned based on the guideline. Guideline-based surveillance intervals assigned by expert endoscopists based on endoscopic and pathological reports were used as the golden standard. The accuracy of the intelligent surveillance system was calculated. Of the patients within the test set, 189 were hospitalized and the surveillance intervals given by physicians could be obtained from the electronic health records. The accuracy of the intelligent surveillance system with that of physicians from different departments was compared. Then 67 patients were randomly selected from 189 patients by simple random sampling to evaluate the adjunctive effect of the system in assigning surveillance intervals among 3 endoscopists.Results:The overall accuracy of the intelligent surveillance system in identifying upper gastrointestinal high-risk patients was 99.94% (5 098/5 101), and that of assigning surveillance intervals to correctly included patients was 100.00% (534/534). The intelligent surveillance system achieved significantly higher accuracy compared with all physicians from different departments [98.94% (187/189) VS 35.45% (67/189), χ2=118.01, P<0.001] as well as physicians from department of gastroenterology [100.00% (117/117) VS 24.79% (29/117), χ2=86.01, P<0.001]. With the assistance of the intelligent surveillance system, the endoscopists' accuracy of assigning surveillance intervals to 67 patients was significantly improved [55.22% (111/201) VS 22.39% (45/201), χ2=58.68, P<0.001]. Conclusion:The intelligent surveillance system can accurately identify upper gastrointestinal high-risk patients and assign surveillance intervals according to risk levels, which can alleviate the workload of doctors and improve the follow-up rate of patients.

Objective:To explore status and influencing factors of surveillance in colorectal post-polypectomy patients.Methods:Patients who underwent colorectal polypectomy in Renmin Hospital of Wuhan University between April 1, 2019 and June 30, 2019 were retrospectively studied. The surveillance information was obtained through electronic health record and telephone call. Status and influencing factors of surveillance in colorectal post-polypectomy patients were evaluated. Logistic regression model was used for multivariate analysis to determine independent risk factors influencing surveillance.Results:A total of 268 colorectal post-polypectomy patients and their surveillance information were reviewed, of whom 153 (57.09%) patients received surveillance colonoscopy, and 115 (42.91%) patients did not. Univariate analysis showed that the source of patients (outpatients VS inpatients, χ 2=5.68, P=0.017), department (others VS department of gastroenterology, χ 2=6.64, P=0.010), and the number of polyps (1/(2~4)/≥5, χ2=7.32, P=0.026) influenced the outcome of surveillance. Logistic regression model indicated that department of gastroenterology ( P=0.039, OR=2.12, 95% CI:1.04-4.34), risk level 3 ( P=0.040, OR=1.92, 95% CI:1.03-3.58) and the number of polyps ≥5 ( P=0.016, OR=2.89, 95% CI:1.22-6.83) were independent risk factors influencing surveillance. Conclusion:Patients visit the department of gastroenterology or had a risk level 3 or ≥5 polyps are more likely to opt for surveillance following the procedure.

To study the microbiological contamination of endoscopic forceps channel at the time of reception and after disinfection, and gain a preliminary understanding of their real disinfection quality, then analyse the problems and make recommendations. A total of 115 endoscopes received at Renmin Hospital of Wuhan University from June 2022 to December 2023 were chosen. Microbiological sampling and strain identification of the endoscopic forceps channel were carried out at the time of reception of the endoscopes and after cleaning and disinfection, respectively, then the qualified disinfection rate and microbial detection rate were compared. The overall qualified disinfection rate after cleaning and disinfection of endoscopes received (91.3%, 105/115) was higher than that at reception (57.4%, 66/115, χ 2=37.026, P<0.001). The overall microbiological detection after cleaning and disinfection of endoscopes received (13.0%, 15/115) was lower than that at reception (48.7%, 56/115, χ 2=41.000, P<0.001), the detection rate of high pathogenic organisms after cleaning and disinfection (7.0%, 8/115) was lower than that at reception (29.6%, 34/115, χ 2=24.039, P<0.001), low pathogenic organisms after cleaning and disinfection (6.1%, 7/115) was lower than that at reception (19.1%, 22/115, χ 2=13.067, P<0.001). At the time of reception, the qualified disinfection rate was low and the microbiological detection rate was high, and there may become a greater risk of cross-infection; after cleaning and disinfection, the qualified disinfection rate was increased and the microbiological detection rate was decreased, which may greatly reduce the risk of patient infection. Therefore, it is recommended that attention should be paid to the disinfection quality monitoring of endoscopes received before putting into clinical use.

With the development of thyroid pathology in the past decade, thyroid pathological diagnosis has entered the era of molecular pathology. As the most influential academic journal in the field of pathology in China, Chinese Journal of Pathology has published nearly one hundred articles related to thyroid diseases in the past decade. These results have made a great difference to the scientific research and clinicopathological diagnosis of thyroid diseases in China, and have also provided Chinese data for the pathological communication of thyroid diseases internationally. Pathologists should make full use of thyroid cytology and histopathology, combined with molecular testing and digital intelligence technology, to play a core guiding role in the multidisciplinary precise diagnosis and treatment of thyroid diseases.

As an important parameter in the field of pathological morphology,tumor budding is the histological ba-sis for tumor invasion and metastasis,which is reflected in various types of cancer,such as oropharyngeal cancer,colo-rectal cancer,esophageal cancer,lung cancer,uterine cancer,etc.The in-depth study of tumor budding by scholars suggests that it can be used as a prognostic indicator for head and neck squamous cell carcinoma(HNSCC).This arti-cle aims to review the research progress on the occurrence,grading,and prediction of cancer prognosis in tumor bud-ding,with the hope of providing assistance in clinical treatment decision-making for HNSCC.

Objective To compare the effects of perfusion tube and pressure air gun on endoscopic channels drying by using the stripped endoscope model,so as to explore the application value of perfusion tube in endoscopic channels drying.Methods After the standard manual cleaning and disinfection process,the stripped endoscope model was randomly divided into group A and group B.Each group was subjected to 30 tests.Group A was injected with a perfusion tube,and group B was injected with a pressure air gun.The liquid residues in the endoscope tubes were observed visually and with a magnifying lens,and the time of thorough drying of the endoscope channels and the physical fatigue of the operators were compared between the two groups.Results The average drying time of the group A was(366.47±75.74)s,the average drying time of the group B was(338.40±65.81)s,there was no significant difference between the two groups(t=-1.53,P=0.131).The fatigue degree of the group A was lower than group B(t=16.79,P＜0.01).Conclusion There is no statistical difference in the air delivery time between the perfusion tube and the pressure air gun drying endoscopic tube,and the operator's physical fatigue is light when the perfusion tube is used,so it is recommended to use the perfusion tube drying endoscopic tube in clinic.

Objective:To investigate the alterations in brain functional activity before and after chemotherapy in breast cancer patients with chemotherapy-related cognitive impairment (CRCI) using resting-state functional magnetic resonance imaging (rs-fMRI) and their relations with cognitive impairment.Methods:A prospective observational study was performed; female breast cancer patients with CRCI admitted to Department of Oncology, Affiliated Hospital 6 of Nantong University were recruited, and age- and education level-matched female healthy controls were chosen. Before and one month after chemotherapy, statuses of cognitive function, depression and anxiety in breast cancer patients with CRCI were evaluated by Montreal cognitive assessment (MoCA), functional assessment of cancer therapy-cognitive function (FACT-cog), self-rating depression scale (SDS), and self-rating anxiety scale (SAS); subsequently, conventional MRI and resting-state functional magnetic resonance imaging (rs-fMRI) were conducted. The healthy controls accepted MoCA, SDS, and SAS, followed by conventional MRI and rs-fMRI. Differences in clinical data and amplitude of low-frequency fluctuation (ALFF, rs-fMRI brain spontaneous neural activity index) were compared between breast cancer patients with CRCI before chemotherapy and healthy controls, and in the breast cancer patients with CRCI between before and after chemotherapy. Taking the brain regions with significant differences in ALFF before and after chemotherapy in breast cancer patients with CRCI as seed points, the difference in whole-brain functional connectivity (FC) before and after chemotherapy was compared in breast cancer patients with CRCI. Pearson or Spearman correlation tests were used to analyze the correlations of ALFF and FC in brain regions with significant differences in ALFF with cognitive function scores in breast cancer patients with CRCI.Results:(1) A total of 22 breast cancer patients with CRCI and 22 healthy controls were enrolled. Compared with the healthy controls, the breast cancer patients with CRCI before chemotherapy had significantly higher SDS and SAS scores ( P<0.05). Compared with breast cancer patients with CRCI before chemotherapy, the breast cancer patients with CRCI after chemotherapy had significantly lower MoCA, FACT-cog-perceived cognitive impairment, FACT-cog-comment from others on cognitive function, and FACT-cog-perceived cognitive ability ( P<0.05). (2) Compared with those before chemotherapy, breast cancer patients with CRCI after chemotherapy exhibited significantly increased ALFF in the right precuneus, right middle occipital gyrus, and left superior frontal gyrus, while statistically decreased FC in the right middle occipital gyrus-left middle temporal gyrus, right precentral gyrus-right middle temporal gyrus, and left superior frontal gyrus-left fusiform gyrus ( P<0.05). (3) ALFF in the right precentral gyrus in breast cancer patients with CRCI after chemotherapy was negatively correlated with difference value of FACT-cog before and after chemotherapy ( r=-0.497, P=0.018) and difference value of PCA before and after chemotherapy ( r s=-0.436, P=0.042); FC in the left superior frontal gyrus-left fusiform gyrus was positively correlated with score of FACT-cog-perceived cognitive impairment ( r=0.621, P=0.002). Conclusion:Chemotherapy induces compensatory enhancement of spontaneous neural activity in multiple brain regions in breast cancer patients with CRCI, accompanied by FC disruption at specific brain areas, which are associated with cognitive impairment.

Objective To identify independent predictors of prognosis in MMNS and to examine the expression of CD4,CD8,CD20 and their relationship with prognosis.Methods 87 patients with MMNS were retrospectively an-alyzed to summarize their clinicopathologic characteristics;the expression of CD4,CD8,and CD20 in MMNS were observed by EnVision immunohistochemical staining(IHC)to analyze the relationship between the expression of these markers and prognosis.Results MMNS with sinus,surrounding tissue invasion,larger tumor and higher AJCC stage showed a worse prognosis.No significant correlation was found among sex,age,histological type,melanin granules,mitotic figures and survival rate.The counts of CD4+,CD8+and CD20+TILs in intra-tumoral stroma were positively correlated with the density of TILs at the base of the tumor.CD20+B cells did not have a central tendency to aggregate to form tertiary lymphoid structures,whether in the intratumoral stroma or in the basal stroma of the tumor,the three cell subsets were admixed.There was no statistically significant difference in OS be-tween CD4+,CD8+,and CD20+subsets.Conclusions The number of CD20+B cells was significantly less than that of CD4+and CD8+T cells in both the intratumoral stroma and the basal stroma of the tumor,and tertiary lymphoid structures fail to be formed,which,unlike cutaneous malignant melanoma,might be a cause of the poor prognosis of MMNS.

Objective To explore the impact of family sandplay therapy based on the narrative concept on family resilience and sense of meaning in life among gastric cancer patients.Methods A total of 104 gastric cancer patients were selected and randomly divided into control group and experi-mental group,with 52 patients in each group.The control group received routine nursing care,while the experimental group received family sandplay therapy based on the narrative concept in addition to routine nursing care.Both groups were assessed using the Chinese Family Resilience Assessment Scale(C-FRAS)and the Chinese Meaning in Life Questionnaire(C-MLQ)before the intervention and at 1 month and 3 months post-intervention.The scores of scales were compared.Results After interven-tion,the total C-FRAS score and score of each dimension were higher in the experimental group than those in the control group,and both the total C-FRAS score and score of each dimension showed an upward with time extension.The total C-MLQ score and score of each dimension were also higher in the experimental group compared with the control group(P＜0.05).Conclusion Family sandplay therapy based on the narrative concept can enhance family resilience and sense of meaning in life a-mong gastric cancer patients.