Objective:To investigate the current state of death cognition among healthcare providers in hematology department and their attitudes toward hospice care for patients with hematologic malignancies.Methods:A cross-sectional investigation study was conducted. A total of 198 medical staff in hematology department of 4 teaching hospitals, including the First School of Clinical Medicine of Guangdong Medical University, Fujian Medical University Union Hospital, the Affiliated Hospital of Putian University and the First Affiliated Hospital of Gannan Medical University from March 2024 to June 2024 were selected as the investigation subjects. The general situation and background of medical staff in hematology department were investigated by using the "General Sociological Questionnaire". "Death Attitude Description Scale (Chinese version)" was used to investigate the status of death cognition among medical staff in hematology department. "Frommelt Attitudes Toward Care of the Dying Scale Form B (Chinese version)" was used to investigate the hospice care attitude of medical staff in hematology department. The survey results of doctors and nurses were compared.Results:There were 105 doctors and 93 nurses in hematology department included in this study. A total of 198 qualified "General Sociology Questionnaires" were collected. After excluding 6 unqualified questionnaires, 192 copies of "Death Attitude Description Scale (Chinese version)" and "Frommelt Attitudes Toward Care of the Dying Scale Form B (Chinese version)" were collected. There were statistically significant differences in gender, educational background, political status and experience of taking care of terminally ill patients between doctors and nurses (all P < 0.05). The scores of approaching acceptance, neutral acceptance, death escape, death fear and flight acceptance were (4.35±0.37), (4.03±0.51), (2.98±0.62), (2.54±0.29) and (2.19±0.42) points, respectively in the doctor group; the corresponding scores were (3.12±0.41), (3.89±0.46), (2.66±0.63), (2.81±0.57) and (2.37±0.65) points, respectively in the nurse group, and the differences between the 2 groups were statistically significant (all P < 0.05). The total score of hospice care attitude of doctors in hematology department was (108±15) points, and that of nurses was (116±13) points, and the difference was statistically significant ( t = -3.61, P < 0.001). The hospice care attitude of doctors and nurses towards patients with hematologic malignancies is generally between positive and neutral. The nurse group showed more recognition of the positive role of the patient's family members in the process of hospice care, and the doctor group showed more recognition of the promoting role of medical staff in hospice care. There were statistically significant differences in hospice care attitude scores of medical staff in hematology department to patients with different occupational background, gender, age, place of residence, family discussion about death, whether the only child, whether they had the experience of taking care of terminally ill patients, and whether they suffered from serious illness and religious belief (all P < 0.05). Conclusions:The death cognition of medical staff in hematology department is neutral, and they show a certain sense of hospice care.

Objective:To investigate the clinical manifestation, diagnosis and treatment of chronic lymphocytic leukemia patients with renal involvement.Methods:The clinical data of a chronic lymphocytic leukemia patient with nephrotic syndrome as the initial manifestation in Fujian Provincial People's Hospital in October 2020 were retrospectively analyzed, and the related literature was reviewed.Results:The patient was a 68-year-old male with recurrent edema and foam urine as the initial manifestations, and he was diagnosed as nephrotic syndrome in the nephrology department. After treatment, the symptoms showed no significant improvement, and the lymphocyte count gradually increased. The patient was diagnosed as chronic lymphocytic leukemia in the hematology department. After ibrutinib monotherapy, the lymphocyte count and urine protein gradually decreased to normal levels, and the clinical efficacy evaluation of the patient was complete remission at the end of follow-up.Conclusions:Chronic lymphocytic leukemia with nephrotic syndrome as the initial manifestation is rare, and the clinical presentations are variable. Early diagnosis is the guarantee of successful treatment. The efficacy and safety of first-line Bruton tyrosine kinase inhibitor monotherapy are good.

Using novel virtual reality (VR) technology to carry out the construction of clinical medical examination question bank, while deepening the reform of clinical medical course examination, it continues to innovate the medical professional evaluation system and improve the flexibility, diversity and scientificity of clinical medicine in teaching and assessment. It is of great and far-reaching significance to improve the teaching level and the quality of medical education in medical colleges and universities. This paper analyzes and discusses the necessity and feasibility of building a clinical medical examination question bank, and the advantages and prospects of integrating VR technology to carry out the construction of clinical medical examination question bank. At the same time, the exploration and practice of the examination question bank construction based on VR technology disscussed in detail would provide innovative thinking and reference for the clinical medical teaching and evaluation, medical personnel training and other aspects in China.

Detailed knowledge on tissue-specific metabolic reprogramming in diabetic nephropathy (DN) is vital for more accurate understanding the molecular pathological signature and developing novel therapeutic strategies. In the present study, a spatial-resolved metabolomics approach based on air flow-assisted desorption electrospray ionization (AFADESI) and matrix-assisted laser desorption ionization (MALDI) integrated mass spectrometry imaging (MSI) was proposed to investigate tissue-specific metabolic alterations in the kidneys of high-fat diet-fed and streptozotocin (STZ)-treated DN rats and the therapeutic effect of astragaloside IV, a potential anti-diabetic drug, against DN. As a result, a wide range of functional metabolites including sugars, amino acids, nucleotides and their derivatives, fatty acids, phospholipids, sphingolipids, glycerides, carnitine and its derivatives, vitamins, peptides, and metal ions associated with DN were identified and their unique distribution patterns in the rat kidney were visualized with high chemical specificity and high spatial resolution. These region-specific metabolic disturbances were ameliorated by repeated oral administration of astragaloside IV (100 mg/kg) for 12 weeks. This study provided more comprehensive and detailed information about the tissue-specific metabolic reprogramming and molecular pathological signature in the kidney of diabetic rats. These findings highlighted the promising potential of AFADESI and MALDI integrated MSI based metabolomics approach for application in metabolic kidney diseases.

Objective: To search for specific metabolites in the lungs of pneumonia rats fed with a high-calorie diet, as well as explore the changes in the lung metabolites of young rats treated with Yinlai Decoction (YD) and its effects on inflammation-related metabolic pathways.Methods: Lipopolysaccharides (LPS) and a special high-calorie diet were used to induce Sprague Dawley (SD) rats to simulate the intestinal state of infant pneumonia. Liquid chromatography-mass spectrometry technology (LC-MS/MS) was used to detect metabolites in each group. Supervised orthogonal partial least squares discriminant analysis (OPLS-DA) model values were used for the detection results to find the differential metabolites. The metabolic pathways that are involved with the differential metabolites were clarified through enrichment analysis and topological analysis. Finally, the T cell receptor signaling pathway (TCR) signal conversion was analyzed by the network pharmacology method. Results: In the high-calorie diet combined with pneumonia group (M3), a total of 55 metabolites were determined to be different from the normal group (N). A total of 36 metabolites were determined to be different from those in the lung metabolites of the YD treatment group (T1). YD had a regulatory effect on glutathione metabolism, arginine and proline metabolism, ascorbic acid and aldehyde metabolism and phenylalanine metabolism. And the small molecule metabolites could act on the FYN and lymphocyte-specific protein tyrosine kinase (LCK) target proteins in the TCR signaling pathway, thereby affecting the immune function of the lungs. Conclusion: A high-calorie diet can cause abnormal sphingolipid metabolism in the lungs of young rats, thereby creating chronic lung inflammation in young rats. YD has a beneficial effect when used to treat young rats with LPS-induced pneumonia fed on high-calorie diets. Its mechanisms of action may affect the body's immune pathways by regulating the oxidative stress pathway affected by glutathione metabolism.

Objective:To analyze the clinical efficacy and safety of decitabine combined with CAG regimen in treatment of elderly patients with acute myeloid leukemia (AML).Methods:Decitabine combined with CAG regimen (experimental group) and CAG regimen alone (control group) were used to treat elderly patients with AML. The randomized controlled trials (RCT) were retrieved from PubMed database, Cochrane Library, Embase database, China Notional Knowledge Infrastructure (CNKI), Wanfang database and VIP database and references listed in all studies. The data of RCT that met the inclusion criteria were extracted, and the quality was evaluated and cross-checked independently according to Cochrane Handbook for Systematic Reviews of Interventions, and then Meta-analysis was conducted by using StataMP 14.0 software.Results:A total of 16 studies and 1 090 patients were included. Compared with the control group, the experimental group had a higher complete remission rate and total effective rate, and the differences were statistically significant ( RR=1.63, 95% CI 1.40-1.89, P < 0.01; RR=1.39, 95% CI 1.27-1.51, P < 0.01). In terms of adverse reactions, the incidence of fever in the experimental group was higher than that in the control group, and the difference was statistically significant ( RR=2.06, 95% CI 1.54-2.75, P < 0.01). Conclusion:Meta-analysis showed that decitabine combined with CAG regimen has a better clinical efficacy in the treatment of elderly patients with AML, but there are more severe adverse reactions.

Objective:To investigate the cell morphology difference of peripheral blood and bone marrow between patients with refractory anemia (RA) and megaloblastic anemia (MA).Methods:Studies were retrieved from China Notional Knowledge infrastructure (CNKI), WanFang and VIP database, and then the references listed in all studies were further searched. The data of included studies were extracted and the quality was evaluated, and then meta-analysis was made by using Stata14.0 software.Results:A total of 41 literatures and 3 192 patients were included. In terms of clinical features, the incidence of lymphadenopathy in RA patients was higher than that in MA patients ( OR = 0.43, 95% CI 0.22-0.84, P = 0.014). In the peripheral blood test, the incidence of pancytopenia, the simultaneously decreased number of young granulocytes and red granulocytes and MCV > 100 fl in MA patients was higher than that in RA patients; the differences were statistically significant ( OR = 2.56, 95% CI 2.04-3.21, P < 0.01; OR = 1.93, 95% CI 1.47-2.53, P < 0.01; OR = 4.29, 95% CI 2.20-8.37, P < 0.01), but the incidence of simultaneously severer decreased number of white blood cells and hemoglobin in RA patients was higher than that in MA patients, and the positive rate ofPAS in nuclear cells was higher, and the difference was statistically significant ( OR = 0.55, 95% CI 0.37-0.82, P = 0.003; OR = 0.00, 95% CI 0.00-0.01, P < 0.01). In the bone marrow morphology examination, the incidence of erythroid lesions, megaloblastic, granulocyte lesions and lymphoid small megakaryocytes in RA patients was higher than that in MA patients; the differences were statistically significant ( OR = 0.03, 95% CI 0.03-0.04, P < 0.01; OR = 3.55, 95% CI 2.29-5.51, P < 0.01; OR = 0.06, 95% CI 0.05-0.08, P < 0.01; OR = 0.01, 95% CI 0.00-0.01, P < 0.01). Conclusions:RA patients have a higher positive rate of peripheral nucleated PAS and severer bone marrow erythroid lesions, granulocytic lesions, and lymphoid megakaryocytes, whereas MA have severer peripheral blood pancytopenia, MCV>100 fl and simultaneous reduction of young granulocytes and red granulocytes.

Objective To evaluate the efficacy of ultrasound-guided adductor canal block (ACB) for analgesia after tibial fracture.Methods American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes,aged 18-64 yr,with body mass index of 18-24 kg/m2,scheduled for elective internal fixation for unilateral tibial fracture under general anesthesia,were enrolled in this study.The tracheal tube was removed after operation,and then the patients were admitted to the postanesthesia care unit.The visual analog scale score was recorded.Eighty patients with visual analog scale score＞3 were divided into 2 groups (n =40 each) using a random number table method:control group (group C) and ACB group.Patient-controlled intravenous analgesia (PCIA) was performed at the end of operation.Patients underwent ACB on the affected side,and 0.375％ ropivacaine 20 ml was injected in group ACB.Sufentanil 0.1-0.2 μg/kg was intravenously injected in group C.Ramsay sedation scores were recorded immediately after entering the postanesthesia care unit (T0) and at 15 and 30 min and 1,2,4,8 12 and 24 h after block (T1-8).When visual analog scale scores ＞3 points and the pain could not be relieved through pressing the PCA pump,tramadol 1-2 mg/kg was intramuscularly injected.Patients were followed up for 24 h after surgery,and the postoperative consumption of sufentanil,pressing time of PCA and patients' satisfaction scores were recorded.The occurrence of postoperative nausea and vomiting,respiratory depression and hypoxemia and length of postoperative hospital stay were also recorded.Results Compared with group C,the postoperative consumption of sufentanil,pressing time of PCA,requirement for and consumption of tramadol,incidence of postoperative nausea and vomiting and oversedation,and Ramsay sedation score at T1-5 were significantly decreased,and the patients' satisfaction score were increased in group ACB (P＜0.05).Conclusion Ultrasound-guided ACB exerts better analgesic efficacy after tibial fracture with fewer adverse reactions.

Objective To analyze the clinical efficacy of combined or single use of clofibrate and cytarabine in the treatment of adult patients with myelodysplastic syndromes (MDS) or acute leukemia (AL).Methods Clofarabine combined with cytarabine was used in the combined group and clofarabine or cyarabine alone was used in the control group.All the studies about cytarabine and clofarabine were searched in PubMed,Cochrance Library,Embase,CNKI,Wanfang and VIP database by computer,and then the data was extracted.Results The complete remission rate of the combined group was higher than that of the control group [33.1％ (93/281) vs.18.2％ (35/192),and the difference was statistically significant (RR =1.85,95％ CI 1.31-2.60,P ＜ 0.01).The overall response rate of the combined group was higher than that of the control group [44.0％ (124/282) vs.23.2％ (46/198)],and the difference was statistically significant (RR =1.92,95％ CI 1.44-2.56,P ＜ 0.01).However,the incidence of skin adverse reactions in the combined group was also higher than that in the control group [38.8％ (104/268) vs.3.1％ (6/192)],and the difference was statistically significant (RR =7.76,95％ CI 3.68-16.38,P ＜ 0.01).Conclusion The combination of clofarabine and cytarabine in the treatment of adult patients with MDS or AL has better clinical efficacy than single application,but it also has more serious skin adverse reactions.

Objective To investigate the current status of urinary incontinence (UI) at the third trimester of pregnancy among primiparas in Guangdong Province.Methods The convenience sampling method was adopted to conduct the retrospective analysis on 714 primiparas in 3 hospitals of Guangdong Province from June 2015 to March 2016.International Consultation on Incontinence Questionnaire Urinary Incontinence Short-Form Chinese was used to investigate the occurrence status of UI at the third trimester of pregnancy among primiparas.And its influencing factors were analyzed.Results Among 714 primiparas,192 cases (26.9％) developed UI during the third trimester of pregnancy,in which stress UI accounted for 67.2％ (129/192).The prepregnancy BMI and abortion had statistical difference between.the UI patients and non-UI patients (P＜0.05).The multivariate Logistic regression results showed that pre-pregnancy BMI was correlated with UI at the trimester stage of pregnancy (OR =1.077,P＜0.05).Conclusion Pre-pregnancy BMI might be an independent risk factor of UI occurrence at the third trimester of pregnancy.