Objectives:This study aimed to analyze the clinical and molecular characteristics of carbapenem-resistant Enterobacteriaceae (CRE) bloodstream infection (BSI) in patients with hematological diseases and to explore prognostic risk factors.Methods:This retrospective study included patients with hematologic diseases with CRE BSI at the Institute of Hematology and Blood Diseases Hospital from January 2015 to December 2022. The clinical features, carbapenemase test results, antimicrobial treatments, and outcomes were analyzed.Results:A total of 120 patients developed CRE BSI. Escherichia coli (58/120, 48.3%) was the most prevalent Enterobacteriaceae, followed by Klebsiella pneumoniae (52/120, 43.3%). A total of 93 CRE strains were tested for carbapenemase, of which 75 strains produced carbapenemase (metalloenzyme: 51 strains; serine enzyme: 24 strains). The 30-day mortality rate after BSI was 24.2% (29/120). Univariate analysis revealed significantly lower mortality in patients treated with the ceftazidime-avibactam-containing regimen than in those treated with other antibiotics (7.8% vs 36.2%, P<0.001). Moreover, initiating active therapy within 24 h of BSI onset significantly reduced mortality (15.0% vs 33.3%, P=0.019). The proportion of patients with CRE colonization receiving active therapy within 12 and 24 h was significantly higher compared with patients without colonization (12 h: 14.5% vs 34.1%, P=0.012; 24 h: 40.8% vs 65.9%, P=0.008). Multivariate analysis revealed that septic shock ( HR=24.436, 95% CI 4.148 - 143.966, P<0.001) and pulmonary infection ( HR=9.346, 95% CI 2.718-32.140, P<0.001) were independent risk factors for death within 30 days. Appropriate therapy was initiated within 24 h ( HR=0.225, 95% CI 0.059 - 0.851, P=0.028), and treatment with the ceftazidime-avibactam-containing regimen ( HR=0.082, 95% CI 0.018-0.362, P=0.001) significantly reduced mortality. Conclusion:The prognosis of CRE BSI in patients with hematological diseases is poor. Timely, appropriate therapy and receipt of a ceftazidime-avibactam-containing regimen can improve survival and prognosis.

Objective:To evaluate the efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in young patients with high-risk multiple myeloma (HRMM) and analyzed the factors affecting patient prognosis.Methods:In this retrospective study, we analyzed the clinical data of 14 patients with HRMM with cytogenetic abnormalities or high-risk biological factors who underwent allo-HSCT at the Hematopoietic Stem Cell Transplantation Center of the Institute of Hematology & Blood Diseases Hospital between November 2016 and November 2022.Results:There were seven males and seven females included in the study, with a median age of 39.5 (31-50) years at the time of allo-HSCT. The median number of treatment lines before transplantation was 2 (1-6) . Before allo-HSCT, 42.9% (6/14) of the patients did not achieve complete remission, while 35.7% (5/14) of the patients achieved measurable residual disease positivity. After transplantation, all patients were evaluated for their treatment response, and the overall response rate was 100% (14/14) . All 14 patients successfully underwent allo-HSCT, with median engraftment times for neutrophils and platelets of 11 (10-14) days and 13 (9-103) days, respectively. Acute grade Ⅱ-Ⅳ graft-versus-host disease (GVHD) occurred in five patients (35.7%) , and two patients (14.3%) developed moderate-to-severe chronic GVHD. The median follow-up time after allo-HSCT was 18.93 (4.10-72.53) months, with an expected 2-year transplant-related mortality rate of 7.1% (95% CI 0%-21.1%) and an expected 2-year overall survival rate of 92.9% (95% CI 80.3%–100.0%) . Moreover, the expected 1-year and 2-year progression-free survival rates were 92.9% (95% CI 80.3%-100.0%) and 66.0% (95% CI 39.4%-100.0%) , respectively, and the 2-year cumulative incidence of relapse was 28.9% (95% CI 0%-56.7%) . Upfront allo-HSCT following complete remission after induced therapy and the presence of chronic GVHD might be favorable prognostic factors. Conclusion:allo-HSCT is an effective treatment for improving the prognosis of young patients with HRMM.

Objectives:This study aimed to analyze the clinical and molecular characteristics of carbapenem-resistant Enterobacteriaceae (CRE) bloodstream infection (BSI) in patients with hematological diseases and to explore prognostic risk factors.Methods:This retrospective study included patients with hematologic diseases with CRE BSI at the Institute of Hematology and Blood Diseases Hospital from January 2015 to December 2022. The clinical features, carbapenemase test results, antimicrobial treatments, and outcomes were analyzed.Results:A total of 120 patients developed CRE BSI. Escherichia coli (58/120, 48.3%) was the most prevalent Enterobacteriaceae, followed by Klebsiella pneumoniae (52/120, 43.3%). A total of 93 CRE strains were tested for carbapenemase, of which 75 strains produced carbapenemase (metalloenzyme: 51 strains; serine enzyme: 24 strains). The 30-day mortality rate after BSI was 24.2% (29/120). Univariate analysis revealed significantly lower mortality in patients treated with the ceftazidime-avibactam-containing regimen than in those treated with other antibiotics (7.8% vs 36.2%, P<0.001). Moreover, initiating active therapy within 24 h of BSI onset significantly reduced mortality (15.0% vs 33.3%, P=0.019). The proportion of patients with CRE colonization receiving active therapy within 12 and 24 h was significantly higher compared with patients without colonization (12 h: 14.5% vs 34.1%, P=0.012; 24 h: 40.8% vs 65.9%, P=0.008). Multivariate analysis revealed that septic shock ( HR=24.436, 95% CI 4.148 - 143.966, P<0.001) and pulmonary infection ( HR=9.346, 95% CI 2.718-32.140, P<0.001) were independent risk factors for death within 30 days. Appropriate therapy was initiated within 24 h ( HR=0.225, 95% CI 0.059 - 0.851, P=0.028), and treatment with the ceftazidime-avibactam-containing regimen ( HR=0.082, 95% CI 0.018-0.362, P=0.001) significantly reduced mortality. Conclusion:The prognosis of CRE BSI in patients with hematological diseases is poor. Timely, appropriate therapy and receipt of a ceftazidime-avibactam-containing regimen can improve survival and prognosis.

Objective:To explore the effectiveness of Acute Care of the Elderly(ACE)model and its existing problems in the clinical practice for older adults with acute clinical conditions.Methods:Using the random number table method, a random number sequence was generated, and the patients admitted to the Department of Geriatrics of Shenzhen Nanshan Hospital due to acute diseases From January 2019 to September 2021 were enrolled in the ACE model intervention group(160 cases)and the control group(77 cases)in a 2: 1 ratio.The inclusion criteria were based on disease severity, frailty assessment, and activity of daily living(ADL)assessment.The intervention time was 1-3 weeks.Outcomes of the patients include ADL, hospitalization days, hospitalization expenses, drug proportion, human resource investments, adverse events, 30-day readmission rate, and 1-year mortality.Results:There were no significant difference in baseline indicators such as frailty index and ADL score between the two groups at admission.The ADL score(Barthel index)of the ACE group was significantly improved compared with the control group at discharge(81.71±14.23 vs.70.9±23.89, P<0.001)and at 30 days after discharge(85.84±15.25 vs.68.29±30.91, P<0.001). The hospital cost[(12 735.81±6 541.41)￥ vs.(16 391.54±12 962.34)￥, P=0.002], drug proportion(21.34% vs.28.93 %, P=0.036)and 30-day readmission rate(13.1% vs.23.4%, P=0.037)of the ACE group were significantly lower compared to the control group.The human resource input(32.97±6.72 vs.25.03±5.31, P=0.008)and patient satisfaction(98.23% vs.90.66%, P=0.031)in the ACE group were significantly higher than those of the control group.(4)The incidence of adverse events during hospitalization was significantly lower in the ACE group than in the control group in terms of aspiration(0.63% vs.20.8%, P<0.001), falls(0 vs.10.4%, P<0.001), incontinence dermatitis(0 vs.3.9%, P=0.033), and 1-year mortality(6.3% vs.24.7%, P<0.001). There was no significant difference in the average length of stay(8.98±4.25 vs.10.03±5.32, P=0.101), pressure sores(13.01±4.77 vs.13.27±4.89, P=0.364), DVT risk score(8.53±2.79 vs.8.89±2.76, P=0.340)and medical staff satisfaction(73% vs.80%, P=0.240)between the two groups. Conclusions:The ACE model helps to reduce the disability rate of elderly patients with frailty, adverse events during hospitalization, save drug costs, and improve patient satisfaction.It is worth promoting in geriatric practice, but its localization management details and processes still face many challenges.

Objective To observe the value of multimodal imaging for diagnosis of cardiac space-occupying lesions.Methods Data of 70 patients with cardiac space-occupying lesions who underwent echocardiography and cardiac CT(CCT)were retrospectively analyzed,among them 35 also underwent cardiac MRI(CMRI).The value of multimodal imaging for diagnosis of cardiac space-occupying lesions were explored according to the results of surgical pathology or clinical diagnosis.Results Among 70 cases,benign tumors were confirmed by surgical pathology in 43 cases,while malignant tumors were confirmed by surgical pathology in 3 cases and clinically diagnosed in 1 case.Meanwhile,non-tumor-occupying lesions were clinically diagnosed in 23 cases,all obviously shrunken after treatments.Among 70 cases,echocardiography correctly diagnosed 57 cases,misdiagnosed 8 cases and unclearly diagnosed 5 cases,with diagnostic accuracy rate of 81.43%(57/70).CCT correctly diagnosed 63 cases,misdiagnosed 4 cases but missed 3 cases,with diagnostic accuracy rate of 90.00%(63/70).CMRI outcomes in all 35 cases were consistent with surgical pathologic results,with diagnostic accuracy rate of 100%(35/35).Conclusion Multimodal imaging might provide objective evidences for diagnosis and treatment of cardiac space-occupying lesions.

Objective:To evaluate the effectiveness of pharmaceutical services of direct to patients (DTP) sale pharmacy, taking the out-hospital pharmacy service of hypothyroidism caused by camrelizumab as an example.Methods:The electronic drug records of patients who received camrelizumab (the medicine was purchased from 3 stores under the Gaoji Suxiang Specialty Pharmacy in Hefei from July 1, 2019 to July 31, 2021) were collected and their medical history information and pharmacy service data provided by DTP pharmacists were recorded. The occurrence, intervention measures, and outcomes of camrelizumab-related hypothyroidism, as well as the patient′s compliance to the intervention were analyzed descriptively.Results:A total of 489 patients were entered in the analysis, including 341 males and 148 females, aged (61±12) years with an range from 18 to 75 years. The drug was used for lung cancer in 129 patients, esophageal cancer in 112 patients, liver cancer in 60 patients, nasopharyngeal carcinoma in 8 patients, lymphoma in 4 patients, and other tumors beyond indications in 176 patients. The median treatment time of camrelizumab in these patients was 4 months, ranging from 1 to 24 months. Camrelizumab was used in monotherapy in 129 patients, in combination with chemotherapy in 156 patients, in combination with targeted drugs in 97 patients, in combination with both chemotherapy and targeted drugs in 83 patients, and in combination with both chemotherapy and radiotherapy in 4 patients; the additional treatment plans were unknown in 20 patients. Among the 489 patients, 16 patients experienced hypothyroidism, with an incidence of 3.3%, of which 6 were actively identified by pharmacists in DTP pharmacy. All 16 cases of hypothyroidism were judged to be associated with camrelizumab by the Naranjo causality evaluation method, and the severity was grade 2 in 15 cases and grade 1 in 1 case. The patient with grade 1 hypothyroidism did not receive medical intervention; camrelizumab was stopped due to disease progression, which resulted in an improvement in hypothyroidism. All 15 patients with grade 2 hypothyroidism received treatment with levothyroxine sodium. In the following 1 week, patient compliance was good, average, and poor in 3, 8, and 5 cases, respectively. Pharmacists provided corresponding interventions based on the main items that affected patient compliance. As of the end of this study, among the 15 patients with grade 2 hypothyroidism, the thyroid function turned normal in 4 patients (including 1 who stopped levothyroxine sodium due to arrhythmia), was improved in 2 patients, and had persistent condition in 9 patients.Conclusion:Out-hospital pharmaceutical services provided by pharmacists in DTP pharmacy helps to ensure patient compliance and safe medication.

Objective:To evaluate the effectiveness of pharmaceutical services of direct to patients (DTP) sale pharmacy, taking the out-hospital pharmacy service of hypothyroidism caused by camrelizumab as an example.Methods:The electronic drug records of patients who received camrelizumab (the medicine was purchased from 3 stores under the Gaoji Suxiang Specialty Pharmacy in Hefei from July 1, 2019 to July 31, 2021) were collected and their medical history information and pharmacy service data provided by DTP pharmacists were recorded. The occurrence, intervention measures, and outcomes of camrelizumab-related hypothyroidism, as well as the patient′s compliance to the intervention were analyzed descriptively.Results:A total of 489 patients were entered in the analysis, including 341 males and 148 females, aged (61±12) years with an range from 18 to 75 years. The drug was used for lung cancer in 129 patients, esophageal cancer in 112 patients, liver cancer in 60 patients, nasopharyngeal carcinoma in 8 patients, lymphoma in 4 patients, and other tumors beyond indications in 176 patients. The median treatment time of camrelizumab in these patients was 4 months, ranging from 1 to 24 months. Camrelizumab was used in monotherapy in 129 patients, in combination with chemotherapy in 156 patients, in combination with targeted drugs in 97 patients, in combination with both chemotherapy and targeted drugs in 83 patients, and in combination with both chemotherapy and radiotherapy in 4 patients; the additional treatment plans were unknown in 20 patients. Among the 489 patients, 16 patients experienced hypothyroidism, with an incidence of 3.3%, of which 6 were actively identified by pharmacists in DTP pharmacy. All 16 cases of hypothyroidism were judged to be associated with camrelizumab by the Naranjo causality evaluation method, and the severity was grade 2 in 15 cases and grade 1 in 1 case. The patient with grade 1 hypothyroidism did not receive medical intervention; camrelizumab was stopped due to disease progression, which resulted in an improvement in hypothyroidism. All 15 patients with grade 2 hypothyroidism received treatment with levothyroxine sodium. In the following 1 week, patient compliance was good, average, and poor in 3, 8, and 5 cases, respectively. Pharmacists provided corresponding interventions based on the main items that affected patient compliance. As of the end of this study, among the 15 patients with grade 2 hypothyroidism, the thyroid function turned normal in 4 patients (including 1 who stopped levothyroxine sodium due to arrhythmia), was improved in 2 patients, and had persistent condition in 9 patients.Conclusion:Out-hospital pharmaceutical services provided by pharmacists in DTP pharmacy helps to ensure patient compliance and safe medication.

Objective To compare the dose distribution between volumetric-modulated arc therapy ( VMAT ) and intensity-modulated radiotherapy ( IMRT ) in patients with brain metastases receiving hippocampus-sparing whole brain radiotherapy. Methods Forty-six patients with brain metastases admitted to our hospital from 2013 to 2016 were recruited in this study. After fusing the CT and MRI images, the hippocampus was delineated on the fusion images. The three-grade hippocampal avoidance regions were created by using a volumetric expansion of 3,5 and 10 mm surrounding the hippocampus. The planning target volume ( PTV) was calculated by subtracting the 5-mm expansion surrounding the hippocampus from the whole brain. The prescription dose was 30 Gy/10 fractions. The 7-field IMRT and single arc VMAT were designed for each case. The dose distribution of PTV,hippocampus and other organs at risk ( OARs) were evaluated in both plans. Results The PTV was statistically compared between VMAT and IMRT:V95:95. 90％ and 94. 97％( P=0. 000 );V90:98. 17％ and 97. 48％( P=0. 000 );CI:0. 825 and 0. 813 ( P=0. 013);HI:0. 277 and 0. 289(P=0. 025).The hippocampal dose was also compared between VMAT and IMRT:the Dmax of hippocampus was 1698. 9 cGy for VMAT and 1784. 9 cGy for IMRT (P=0. 002).TheDmean of hippocampus was 1183. 8 cGy for VMAT and 1112. 7 cGy for IMRT (P=0. 000).No statistical significance was observed between IMRT and VMAT in protecting the OARs except the chiasma opticum ( 3262. 6 cGy and 3529. 3 cGy,P=0. 000).The MU and treatment time of VMAT and IMRT were 651 and 2768( P=0. 000) ,and 188 s and 504 s ( P=0. 000) . Conclusions The dose distribution of PTV in VMAT is significantly better than that in IMRT. VMAT is advantageous in protecting the hippocampus than IMRT. VMAT can significantly shorten treatment time and MU and enhance the equipment utilization. Besides, VMAT can achieve the goal of protecting the hippocampus and meet the prescription dose requirement of PTV.

Objective: To evaluate the prognostic significance of early phase full donor chimerism (FDC) after myeloablative allogeneic peripheral blood stem cell transplantation (allo-PBSCT). Methods: The clinical data of 72 hematological patients received myeloablative allo-PBSCT from Feb. 2016 to Jul. 2017 were analyzed retrospectively. The median age was 36.5 years (range 4-59), 44 were males and 28 females. Of the donors, there were 35 HLA matched sibling donors, 27 haploidentical donors and 10 unrelated donors. Polymerase chain reaction amplification of short tandem repeat sequence (PCR-STR) was used to detect donor cell chimerism (DC) rate of recipient bone marrow at one, two and three months after transplantation. Results: The median follow-up was 462 d (range: 47-805 d), 55 cases were still alive, and 45 cases were disease-free survival (DFS) at the end of follow-up. The 2-year overall survival (OS) and DFS were (68.9±7.7)% and (59.5±6.3)%, respectively. A number of 16 cases underwent relapses, with 2-year cumulative incidence of (24.1±5.3)%. The median time of recurrence was 157(32-374) d. Forty cases (55.6%) developed acute graft-versus-host diseases (aGVHD), with median time of 35.5 (13-90) d. Chronic GVHD (cGVHD) occurred in 23 patients (31.9%), with median time of 169 (94-475) d. Univariate analysis found the following factors were not related to OS, DFS or relapse rate (RR), including age, sex, blood type and sex of donor-recipient, occurrence of aGVHD and cGVHD. The OS and DFS in cases reached FDC and no FDC at two months after transplantation were (85.2±6.9)% vs (66.1±7.7)% (P=0.051) and (76.7±7.7)% vs (48.9±8.1)% (P=0.021), respectively. The RR rate in FDC group was lower than that in no FDC group [(16.6±6.8)% vs (30.4±7.8)%, P=0.187, respectively]. Conclusion The present study confirmed the important value for predicting the prognosis with whether or not the patients reached FDC at the early phase after allo-PBSCT. The OS and DFS in cases with FDC at two months after transplantation were significantly higher than those of no FDC patients.

Objective To investigate the influence of acupuncture on learning and memorial function and the expression of BDNF in prefrontal cortex of rats with sleep deprivation (SD), for providing theoretical evidence for treating sleep deprivation with acupuncture.Method Sixty Wistar rats were randomly divided into a control group, a model group, and an acupuncture group, 20 rats in each group. SD models were established by the modified multiple platform methods; the acupuncture group was intervened by acupuncture at Shenmen (HT 7); while the control group was left intact. Respectively after SD for 24 h and 72 h, the learning and memorial function was tested by using Morris water maze. Ten the rats were sacrificed to collect brain for detecting the expression of BDNF in prefrontal cortex via immunohistochemical method.Result The body weight, learning and memorial function, and the expression of BDNF in prefrontal cortex of the acupuncture group and model group were significantly different from those of the control group after SD for 24 h and 72 h (P<0.05). The learning and memorial function of the acupuncture group was significantly different from that of the model group after SD for 24 h and 72 h (P<0.05). The body weight and expression of BDNF in prefrontal cortex of the acupuncture group were significantly different from those of the model group after SD for 72 h (P<0.05).Conclusion Acupuncture can obviously improve the decline of the function of learning and memory of the SD rats, and also up-regulate the declined expression of BDNF in prefrontal cortex caused by SD.