BACKGROUND: Delayed platelet engraftment is a common complication after umbilical cord blood transplantation (UCBT), and there is no standard therapy. Avatrombopag (AVA) is a second-generation thrombopoietin (TPO) receptor agonist (TPO-RA) that has shown efficacy in immune thrombocytopenia (ITP). However, few reports have focused on its efficacy in patients diagnosed with thrombocytopenia after allogeneic hematopoietic stem cell transplantation (allo-HSCT). METHODS: We conducted a retrospective study at the First Affiliated Hospital of the University of Science and Technology of China to evaluate the efficacy of AVA as a first-line TPO-RA in 65 patients after UCBT; these patients were compared with 118 historical controls. Response rates, platelet counts, megakaryocyte counts in bone marrow, bleeding events, adverse events and survival rates were evaluated in this study. Platelet reconstitution differences were compared between different medication groups. Multivariable analysis was used to explore the independent beneficial factors for platelet implantation. RESULTS: Fifty-two patients were given AVA within 30 days post-UCBT, and the treatment was continued for more than 7 days to promote platelet engraftment (AVA group); the other 13 patients were given AVA for secondary failure of platelet recovery (SFPR group). The median time to platelet engraftment was shorter in the AVA group than in the historical control group (32.5 days vs . 38.0 days, Z  = 2.095, P  = 0.036). Among the 52 patients in the AVA group, 46 achieved an overall response (OR) (88.5%), and the cumulative incidence of OR was 91.9%. Patients treated with AVA only had a greater 60-day cumulative incidence of platelet engraftment than patients treated with recombinant human thrombopoietin (rhTPO) only or rhTPO combined with AVA (95.2% vs . 84.5% vs . 80.6%, P  <0.001). Patients suffering from SFPR had a slightly better cumulative incidence of OR (100%, P  = 0.104). Patients who initiated AVA treatment within 14 days post-UCBT had a better 60-day cumulative incidence of platelet engraftment than did those who received AVA after 14 days post-UCBT (96.6% vs . 73.9%, P  = 0.003). CONCLUSION Compared with those in the historical control group, our results indicate that AVA could effectively promote platelet engraftment and recovery after UCBT, especially when used in the early period (≤14 days post-UCBT).
Humans ; Female ; Male ; Thrombocytopenia/etiology* ; Adult ; Retrospective Studies ; Cord Blood Stem Cell Transplantation/adverse effects* ; Middle Aged ; Adolescent ; Young Adult ; Thiazoles/adverse effects* ; Platelet Count ; Receptors, Thrombopoietin/agonists* ; Child ; Thiophenes

Objective:To integrate qualitative research on the experience of type 2 diabetes patients using self-management APP, so as to provide evidence support for the design and promotion of highly accepted diabetes self-management APP.Methods:This study is a Meta-synthesis. Qualitative research on experience of type 2 diabetes patients using self-management APP was retrieved through computer in China National Knowledge Infrastructure (CNKI) , WanFang, VIP, China Biology Medicine disc Literature Database, PubMed, Web of Science, Cochrane Library, Embase, CINAHL, PsycINFO, Ovid (LWW Journals) , Scopus Chinese and English databases. The retrieval time limit was from the establishment of the database to April 30, 2022. According to the quality evaluation criteria for qualitative research of the Joanna Briggs Institute (JBI) Evidence-Based Health Care Center, the methodology of the included article was evaluated, and the included article was integrated with the method of pooled Meta-synthesis.Results:A total of 11 articles were included, 48 research findings were extracted and summarized into 3 integration results and 14 new categories. The integration results included that self-management APP promoted patients to form continuous self-management behavior and improved physical and mental health, obstacle factors that affected patients' use of APP, and patients' suggestions for improving the function of APP.Conclusions:Patients feel the benefits of self-management APP, such as correct understanding of diabetes, disease control, and improvement of psychological status. When developing relevant APP, we should pay attention to the change of patient behavior, design the APP function based on user needs, conduct cultural adjustment, improve training and technical support, and improve its acceptance and promotion.

Objective:To systematically review the risk prediction models for hypoglycemia in diabetic patients.Methods:The literatures published up to March 25, 2022 was retrieved from PubMed, Embase, Web of Science, Cochrane Library, CINAHL, MEDLINE, China National Knowledge Infrastructure, Wanfang, VIP and SinoMed. Two researchers independently screened the literatures, extracted information, and applied the PROBAST tool to evaluate the quality of the included models.Results:A total of 11 literatures and 13 models were included. The area under the receiver operating characteristic curve or C statistic of all models was 0.666-0.890, with a high risk of bias and a low risk of applicability, and the most included predictors were chronic kidney disease and age. The main reason for the bias in the model were insufficient number of events in the dependent variable, improper handling of continuous variables, and screening of predictors by single factor analysis. Conclusions:The existing hypoglycemia risk prediction models for diabetic patients are still in the development stage, and medical and nursing staff can choose the existing hypoglycemia models according to the results of this systematic review and clinical practice. In the future, we should improve the existing models based on tools or carry out large-sample, multi-center, prospective cohort studies, and build a high-quality hypoglycemia risk prediction model for diabetic patients that is more suitable for China based on more comprehensive and accurate statistical methods and clinical data.

Health behavior decision-making often involves the balance of gains and losses at different time points,which affects the choice and maintenance of health behaviors.As a cognitive processing method of"pre-experiencing"future events,Episodic Future Thinking(EFT)can promote the formation of health intentions and health behavior change by increasing the value of future health outcomes.This paper reviews the concept,intervention model and action effect of EFT in health behaviors,in order to provide references for nurses to innovate health education and behavior management from the perspective of behavioral economics.

Objective:To analyze the clinical characteristics of patients suffering from plastic bronchitis (PB) caused by Mycoplasma pneumoniae (MP) and explore its risk factors as well. Methods:A retrospective analysis on clinical and laboratory data of PB children caused by MP and treated in Department of Respiratory in Children′s Hospital of Soochow University from January 2011 to December 2017, compared with MP pneumonia(MPP) children without PB in the same period.Meanwhile, Logistic regression analysis was performed. Results:Among the 306 MPP children, there were 50 cases in the PB group and 256 cases in the non-PB group.Compared with children in the non-PB group, children in PB group were higher in terms of age [(82.74±35.17)months vs.(66.63±35.67) months], percentage of neutrophils (0.705 8±0.139 1 vs.0.605 7±0.162 6), C reactive protein(CRP) [17.4(10.21, 42.86) mg/L vs.11.43(4.55, 23.66) mg/L], D-dimer(DD) [1 071 (279.5, 2 386.5) μg/L vs.523 (233, 1 099.5) μg/L], lactate dehydrogenase(LDH) [491.1 (342.3, 607.4) U/L vs.394.9 (319.1, 512.8) U/L], erythrocyte sedimentation rate(ESR)[25.0 (17.0, 36.0) mm/1 h vs.15.5(9.0, 28.0) mm/1 h], aspartate aminotranferase(AST) [33.5(26.1, 49.3) U/L vs.29.2(24.0, 37.2) U/L], alanine aminotransferase (ALT) [19.1(11.45, 31.50) U/L vs.13.6 (10.3, 23.15) U/L], IgA [1.46(0.98, 2.12) mg/L vs.1.15 (0.64, 1.60) mg/L], CD3 -CD (16+56)+ (0.155 0±0.088 6 vs.0.120 2±0.071 5), allergy history [44.0%(22/50 cases) vs.25.8%(65/256 cases)], mixed infection [38.0% (19/50 cases) vs.24.6%(63/256 cases)], and microscopic mucosal erosion [10.0%(5/50 cases) vs.2.3%(6/256 cases)] (all P<0.05). Logistic regression analysis displayed that allergy history ( OR= 5.604, 95% CI: 1.937-16.216), age ( OR = 3.142, 95% CI: 1.425-6.929), percentage of neutrophils ( OR=2.387, 95% CI: 1.088-5.238), CRP ( OR=3.959, 95% CI: 1.072-14.662), and DD ( OR=7.824, 95% CI: 2.824-21.673) were independent risk factors for PB caused by MP infection (all P<0.05). The cut-off values of age, percentage of neutrophils, CRP, and DD were 64 months, 0.70, 35 mg/L, and 2 000 μg/L. Conclusions:Children with PB caused by MP often develop in older and allergic children who have stronger inflammatory reactions, immune disorders, and hyperfibrinolysis.

Objective:To explore the clinical value of sarcopenia and vitamin D deficiency on gluco-corticoid induced osteoporosis (GIOP) in patients with rheumatoid arthritis (RA).Methods:Three hundred and eleven patients with RA from January 2017 to December 2018 were enrolled in the study. One hundred and fifty-eight sex, age-matched normal subjects were recruited as control group. Clinical and laboratory features, daily dosage and treatment duration of glucocorticoid (GC) were recorded in detail. Skeletal muscle mass was measured by biological electrical impedance. Serum levels of 25-hydroxy vitamin D [25(OH)D] were examined using electro-chemiluminescence. Bone mineral density (BMD) at total hip and lumbar vertebra were detected by dual energy X-ray absorptiometry (DEXA). Numerical data and categorical data comparisons were analyzed using χ2 test, non-parametric test, Logistic regression analysis test. Results:① The prevalence of osteoporosis (OP) in RA patients was 33.4%(104/311), which was higher than that in the control group 12.7%(20/158)( χ2=23.267, P<0.01). Percentage of GC taking in 311 RA patients was 56.6%(176/311), and the prevalence of GIOP was 40.9%(72/176). The prevalence of sarcopenia in RA patients was 61.7%(192/311), which was higher than that in the control group [9.0%(14/156), χ2=117.310, P<0.01]. The prevalence of vitamin D deficiency in RA patients was 81.7%(254/311), which was higher than that in control group [38.0%(60/158), χ2=90.415, P<0.01]. ② The prevalence of OP in RA without sarcopenia was 17.6% (21/119), which was lower than that in patients with sarcopenia [43.2%(83/192), χ2=21.601, P<0.01]. In condition without GC, the prevalence of OP in RA without sarcopenia was 9.8%(6/61), which was significantly lower than that in patients with sarcopenia [35.1%(26/74), χ2=11.834, P<0.01]. Under circumstances with GC, the prevalence of OP in RA without sarcopenia (25.9%, 15/58), which was significantly lower than that in patients with sarcopenia (48.3%, 57/118, χ2=8.103, P<0.01). ③ No matter whether existing vitamin D deficiency or not, the prevalence of OP in RA without GC was 23.7%(32/135), which was significantly lower than that in patients with GC [40.9%(72/176), χ2=10.161, P<0.01]. In patients without vitamin D deficiency, the prevalence of OP in RA without GC was 21.4%(6/28), which was similar to that in patients with GC [31.0%(9/29), χ2=0.678, P>0.05]. In the case of vitamin D deficiency, the prevalence of OP in RA without GC was 24.3%(24/107), which was significantly lower than that in patients with GC [42.9% (63/147), χ2=9.370 2, P<0.01]. ④ In RA patients with GC, age( t=5.313, P<0.01), Sharp score ( Z=2.999, P<0.01), disease duration ( Z=2.141, P<0.05) and treatment duration of GC ( Z=2.460, P<0.05) were higher in group with GIOP than that in group without GIOP, while erythrocyte sedimentation rate (ESR)( Z=2.262, P<0.05), C-reactive protein levels (CRP) ( Z=2.551, P<0.05) and body mass index (BMI) ( t=2.425, P<0.05) were lower and the composition ratio of X-ray staging was worse ( χ2=12.484, P<0.01).⑤ Logistic regression analysis (LR Backward) showed that female gender [ OR(95% CI)=14.240(3.878, 52.288), P<0.01], age [ OR(95% CI)=1.079(1.042, 1.118), P<0.01] and sarcopenia [ OR(95% CI)=2.470(1.192, 5.120), P<0.05] were the risk factors for GIOP in RA patients. Conclusion:The proportion of treatment with GC in RA patients is very high (about 60%), and the prevalence of GIOP is 40.9%, which is closely related to sarcopenia and vitamin D deficiency.

Objective:To investigate whether in vitro cultured human bone marrow mesenchymal stem cells (BMSCs) express sodium taurocholate cotransporting polypeptide (NTCP), assess their susceptibility to hepatitis B virus (HBV) infection and analyze the role of NTCP during HBV infection. Methods:BMSCs were infected with HBV-positive serum under different conditions. HBV DNA load in cell culture supernatants as well as in BMSCs and the amount of hepatitis B virus surface antigen (HBsAg) and hepatitis B virus e antigen (HBeAg) in cell culture supernatants were detected. To analyze the role of NTCP, BMSCs were first transfected with small interfering RNA targeting NTCP (NTCP-siRNA) and then infected with HBV-positive serum under different conditions. Virus loads and the amount of HBsAg and HBsAg were also detected. Western blot assay was performed to measure the expression of NTCP in BMSCs in each group.Results:In vitro cultured adherent BMSCs were susceptible to HBV infection albeit with a really low efficiency, but the infection efficiency was significantly increased when infecting the BMSCs in suspension. NTCP was expressed in BMSCs and the expression could be upregulated during HBV infection, especially in BMSCs in suspension. HBV infection was blocked when BMSCs were transfected with NTCP-siRNA. Conclusions:In vitro cultured human BMSCs were susceptible to HBV infection and the expressed NTCP served as a functional receptor for HBV. Human BMSCs could be used as a highly susceptible and stable cell model that needed no molecular adjuvant modification for research on the early stages of the HBV life cycle and for development of antiviral therapy.

Objective: To investigate factors affecting X-ray structure of the spine in patients with ankylosing spondylitis (AS). Methods: A total of 206 AS patients were recruited. Clinical and laboratory parameters in AS patients were recorded in detail. Disease activity index [Bath ankylosing spondylitis disease activity index (BASDAI), ankylosing spondylitis disease activity score (ASDAScrp)], X-ray structural damage index-modified stoke ankylosing spondylitis spine score (mSASSS) and grading results of radiographic examination of sacroiliac joint were calculated. Statistical analysis using Statistical Package form Soci-science(SPSS) 17.0 Chi-square test, rank test, Logistics regression analysis and other statistical methods were used. Differences of mSASSS levels, spine involvement (mSASSS>0) and rates of bone bridge formation were compared between different groups. Results: Incidences of spine involvement (100%) and bone bridge formation(65.2%) in AS patients ≥40 years old were significantly higher than those in AS patients <40 years old (90.6%、31.9%)(χ²=4.651, P=0.031; χ²=16.647, P<0.01), and the level of mSASSS was also higher (Z=5.575, P<0.01). In AS patients with BMI ≥24 kg/m², disease duration ≥5 years (49.2%, 50.4%), rates of bone bridge formation was significantly higher than those in AS with BMI <24 kg/m², but the disease duration (34.5%, 19.7%)(χ²=4.014, P=0.045; χ²=18.173, P=0.03), and mSASSS values were significantly higher (Z=2.281, P=0.023, Z=4.828, P<0.01). Bone bridge formation rate in smoking patients (50.6%) was significantly higher than that in non-smoking patients (31.0%) (χ²=7.346, P=0.007) and mSASSS value was significantly higher (Z=2.045, P=0.041). Bone bridge formation rates in AS with high-ESR and high-CRP(48.6%, 49.0%) were significantly higher than those in patients with normal-ESR and normal-CRP(25.6%, 28.9%)(χ²=10.784, P=0.001; χ²=8.102, P=0.004) and mSASSS value was clearly higher(Z=2.379, P<0.01; Z=3.112, P<0.01). Bone bridge formation rate in AS with BASDAI≥4 or ASDAScrp≥2.1 groups (52.8%, 46.4%) were significantly higher than that in AS with BASDAI<4 or ASDAScrp<2.1 groups (34.2%, 30.7%) (χ²=5.681, P=0.017; χ²=4.646, P=0.031) and mSASSS values were significantly higher (Z=3.887, P<0.01; Z=3.895, P=0.004). Rates of bone bridge formation among different X-ray grading of sacroiliac joint (10.8%, 35.6%, 60.3%) and MRI findings (33.3%, 50.0%, 15.4%) differed with each other (χ²=25.714, P<0.01; χ²=6.855, P=0.032). Logistics regression analysis showed that BMI [OR(95%CI)=1.145(1.037, 1.265), P<0.01], disease duration [OR(95%CI)=1.144(1.055, 1.239), P<0.01], smoking [OR(95%CI)=2.832(1.343, 5.969), P<0.01] and sacroiliac joint X-ray staging [OR(95%CI)=2.584(1.337, 4.997), P<0.01] were risk factors for the bone bridge formation in spine of AS. Conclusion Spinal involvement in AS is related to disease activity. Bone bridge formation correlateswith disease duration, BMI and disease-status, especially with smoking.

Objective To explore the prevalence and reference value of disease features of patients with spondyloarthritis. Methods Spondyioarthritis features and laboratory indexes and radiographic indexes of 505 patients with spondyloarthritis (SpA) including 353 patients with ankylosing spondylitis (AS), 62 patients with non-radiographic axial spondyloarthritis (nr-axSpA) and 90 patients with peripheral spondyloarthritis (pSpA) were recorded. One-way analysis of variance, Kruskal-Wallis test, x2-test, Logistic regression were used for statistical analysis. Results Sex ratio ( x2=20.673, P<0.01), age ( x2=22.258, P<0.01), disease duration ( x2=76.052, P<0.01) were different among AS, nr-axSpA and pSpA. Besides, Bath ankylosing spondylitis disease activity index (BASDAI), ankylosing spondylitis disease activity score (ASDAScrp), erythrocyte sedimentation rate (ESR), C-reactionprotein (CRP) and Bath ankylosing spondylitis functional index (BASFI)were different among SpA subgroups ( x2/F=13.196-40.028, P<0.01). Prevalence of inflammatory back pain, peripheral arthritis, preceding infection, positive human lymphocyte antigen (HLA)-B27 and elevated CRP were different among SpA subgroups ( x2=11.416, 32.657, P<0.01). Prevalence of dactylitis in SpA with positive HLA-B27 was lower than that in SpA with negative HLA-B27 ( x2=5.414, P=0.02). Prevalence of enthesitis and dactylitis in SpA patients with peripheral arthritis was higher than that in SpA without peripheral arthritis involvement ( x2=7.177, 14.428, P<0.01). Prevalence of good response to Non-steroid anti-inflammatory drugs. (NSAIDs) in patients with anterior uveitis involvement was higher than SpA without anterior uveitis involvement ( x2=4.578, P=0.032). SpA patients were stratified by total number of SpA features into 4 subgroups (n≤1, n=2, n=3, n≥4). Prevalence of inflammatory back pain, positive HLA-B27, good response to NSAIDs were the top three in all subgroups. Inflammatory back pain and HLA-B27 (+) were risk factors for axSpA (OR=3.254, 3.323, P<0.01). Peripheral arthritis, dactylitis, and preceding infection were risk factors for pSpA (OR=3.759, 4.134, 17.044, P<0.01). Conclusion Inflammatory back pain, HLA-B27 (+) and good response to NSAIDs should be emphasized for the diagnosis of SpA. Inflammatory back pain and HLA-B27(+) always means axSpA. Peripheral arthritis, dactylitis and preceding infection always indicates pSpA.

Purpose To observe the changes of perineal body morphology and modulus of primiparas with real-time shear wave elastography (SWE) combined with gray-scale ultrasound and to explore the influence of delivery on perineal body tension. Materials and Methods One hundred and sixty primiparas after 42 to 56 days of delivery in the Department of Gynecology and Obstetrics of the First Affiliated Hospital of Nanchang University from December 2016 to August 2017 were enrolled and divided into cesarean section group (n=80) and vaginal delivery group (n=80). Meanwhile, 100 healthy married nulliparous women during the same period were selected as nulliparous group. Perineal body depth, height and Young's modulus were measured by using gray-scale sonography and SWE at resting state and retraction status. Values of each ultrasonic parameter were analyzed. Results Difference of perineal body depth and height contraction amplitude was of statistical significance among subjects in the three groups (P<0.05). The mean Young's modulus of perineal body during resting state and retraction status in nulliparous group was higher than those in the cesarean section group and vaginal delivery group, while that in cesarean section group was higher than that in vaginal delivery group. The differences were statistically significant (P<0.05). Conclusion Different delivery modes have different effects on female perineal body muscle, among which vaginal delivery is of more obvious damage to perineal body.