Objective:To investigate the application value of dermoscopy and reflectance confocal microscopy (RCM) in identifying field cancerization in actinic keratosis (AK) in the elderly.Methods:A retrospective analysis was conducted on clinical, dermoscopic, and RCM features of elderly (> 60 years old) patients, who were confirmedly diagnosed with AK and had complete medical records at Shanghai Skin Disease Hospital from January 2022 to December 2023.Results:A total of 132 elderly patients with AK were included. Dermoscopy showed brownish-gray pseudonetwork pigment patterns, follicular horn plugs, irregular branched vessels, and rosette signs in AK lesions. Histopathological examination in 51 patients revealed that 47 (92.16%) were confirmedly diagnosed with AK. Field cancerization was observed in 106 patients (80.3%), among whom 66 (62.26%) had irregular branched vessels, 88 (83.02%) predominantly exhibited brownish-gray pseudonetwork pigment patterns, and 83 (78.30%) showed scattered brown pigment networks/fingerprint-like patterns. Post-treatment follow-up of 63 patients showed varying degrees of changes in vascular and pigment structures by dermoscopy, with significant reductions in follicular horn plugs and superficial yellow-white scales or keratin masses. RCM examinations in 41 AK patients all showed disordered arrangements of keratinocytes presenting as atypical honeycomb patterns, with atypical cells in the AK lesions; in the field cancerization areas of 20 patients, RCM revealed keratinocytes disorderedly arranged in an irregular honeycomb pattern, with some keratinocytes exhibiting mild atypia. Thirty-four AK patients underwent dynamic RCM monitoring before and after 1, 3 and 6 months of ALA-PDT treatment, which showed gradual regularization of arrangements of keratinocytes and reduction of atypical cells, as well as reappearance of atypical keratinocytes upon recurrence.Conclusions:The incidence of field cancerization was relatively high in elderly AK patients. Dermoscopy and RCM are helpful for the early identification of AK and field cancerization, especially in patients with multiple lesions and with difficulties in multi-site biopsy.

Objective:To investigate the application value of dermoscopy and reflectance confocal microscopy (RCM) in identifying field cancerization in actinic keratosis (AK) in the elderly.Methods:A retrospective analysis was conducted on clinical, dermoscopic, and RCM features of elderly (> 60 years old) patients, who were confirmedly diagnosed with AK and had complete medical records at Shanghai Skin Disease Hospital from January 2022 to December 2023.Results:A total of 132 elderly patients with AK were included. Dermoscopy showed brownish-gray pseudonetwork pigment patterns, follicular horn plugs, irregular branched vessels, and rosette signs in AK lesions. Histopathological examination in 51 patients revealed that 47 (92.16%) were confirmedly diagnosed with AK. Field cancerization was observed in 106 patients (80.3%), among whom 66 (62.26%) had irregular branched vessels, 88 (83.02%) predominantly exhibited brownish-gray pseudonetwork pigment patterns, and 83 (78.30%) showed scattered brown pigment networks/fingerprint-like patterns. Post-treatment follow-up of 63 patients showed varying degrees of changes in vascular and pigment structures by dermoscopy, with significant reductions in follicular horn plugs and superficial yellow-white scales or keratin masses. RCM examinations in 41 AK patients all showed disordered arrangements of keratinocytes presenting as atypical honeycomb patterns, with atypical cells in the AK lesions; in the field cancerization areas of 20 patients, RCM revealed keratinocytes disorderedly arranged in an irregular honeycomb pattern, with some keratinocytes exhibiting mild atypia. Thirty-four AK patients underwent dynamic RCM monitoring before and after 1, 3 and 6 months of ALA-PDT treatment, which showed gradual regularization of arrangements of keratinocytes and reduction of atypical cells, as well as reappearance of atypical keratinocytes upon recurrence.Conclusions:The incidence of field cancerization was relatively high in elderly AK patients. Dermoscopy and RCM are helpful for the early identification of AK and field cancerization, especially in patients with multiple lesions and with difficulties in multi-site biopsy.

Background and aims:Inflammatory factors play significant roles in the development and occurrence of hepatocellular carcinoma(HCC).However,the tumor-protective functions of growth differentiation factors(GDFs)in HCC are yet to be clarified.In this study,we aimed to evaluate the expression levels of 10 GDFs in tumor and paratumor tissues from patients with HCC and perform in vitro and in vivo ex-periments to elucidate the role of GDF7 in regulating the proliferation and metastasis of HCC.Methods:The gene expression of 10 GDFs was compared between HCC and paratumors using The Cancer Genome Atlas dataset and patient-derived tissues.A tumor microarray containing 108 HCC tissue samples was used to explore the prognostic value of GDF7 expression.Loss-of-function experiments were also performed in vitro and in vivo to investigate the role of GDF7 in HCC.Results:The mRNA and protein levels of GDF7 were significantly lower in HCC tumors than in para-tumors(P＜0.001).Kaplan-Meier analysis showed that decreased GDF7 expression in HCC was asso-ciated with worse overall survival(5-year rate:61.8％vs.27.5％,P＜0.001)and increased recurrence risk(P＜0.001).Multivariate Cox regression analysis demonstrated that low GDF7 expression,the presence of microvascular invasion,and elevated alpha-fetoprotein(AFP)levels were independent risk factors for tumor recurrence and poor survival.Downregulation of GDF7 also increased the tumor growth in HCC cells and in an HCC xenograft model.GDF7 knockdown promoted migration and invasion via epithelial-mesenchymal transition.Meanwhile,a negative correlation between JunB proto-oncogene(JUNB)and GDF7 was observed in HCC tissues.Modulating JUNB levels altered GDF7 protein expression.Conclusions:GDF7 is a potential biomarker for predicting superior outcomes in patients with HCC.GDF7 amplification is a potential therapeutic option for HCC.

Objective:To explore the clinical manifestations, pathogenesis, and therapeutic approaches of disseminated intravascular coagulation (DIC) associated with chimeric antigen receptor T-cell (CAR-T) therapy for B-lymphoblastic lymphoma.Methods:Retrospective collection and analysis were conducted on the clinical data of a patient with B-lymphoblastic lymphoma who received CAR-T therapy in the Hematology Department of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, in April 2020. To review the literatures, Chinese databases (CNKI, Wanfang Database) and PubMed were searched form database inception up to November 2024 using the retrieval entries "chimeric antigen receptor T-cell therapy", "CAR-T", "coagulation", "bleeding", and "thrombosis" .Results:The patient, a 32-year-old male, diagnosed with B-lymphoblastic lymphoma for over 10 months, relapsed after three cycles of chemotherapy and allogeneic hematopoietic stem cell transplantation, with bone marrow cytology indicating 20.24% abnormal phenotype B-lineage precursor cells. After CAR-T cell infusion at a dose of 4×10 6/kg, the patient developed grade 2 cytokine release syndrome (CRS) on day 2, nasal bleeding on day 4, high fever again on day 9, with worsening coagulation parameters, DIC and persistent hypofibrinogenemia. After treatment with tocilizumab, corticosteroids to counteract CRS, and active replacement therapy such as administration of blood product and fibrinogen, the patient’s CRS and coagulation abnormalities gradually improved. The patient was followed up for 16 months regularly after CAR-T therapy, with CAR-T cells sustained and minimal residual disease remained negative as assessed by bone marrow flow cytometry. Subsequently, the patient stopped taking oral immunosuppressants on his own, which aggravated rejection reaction complicated with infection. The patient and his family requested to be discharged and lost the follow-up. A total of 20 relevant English articles and 6 Chinese articles were retrieved from the literature search. Conclusion:CAR-T-associated coagulopathy occurs alongside CRS. It is characterized by hypofibrinogenemia, and is life-threatening when progressing to DIC. Anti-CRS and replacement therapies have proven to be effective treatment strategies.

Objective:To investigate the clinical manifestations, diagnostic and therapeutic strategies, for thrombocytopenia after BCMA/CS1 bispecific chimeric antigen receptor T-cell (CAR-T cell) therapy in patients with multiple myeloma.Methods:Retrospective collection and analysis were conducted on the clinical data of a patient with multiple myeloma who received BCMA/CS1 bispecific CAR-T cell therapy in the Hematology Department of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, in June 2021. To review the literature, Chinese databases (CNKI, Wanfang Database) and PubMed were searched from their inception up to November 2024 using the keywords "chimeric antigen receptor T-cell therapy", "thrombocytopenia", "CAR-T", "BCMA", and "CS1" .Results:A 72-year-old male patient was diagnosed with light chain κ-type multiple myeloma (R-ISS stage Ⅱ) in a local hospital and had a prolonged treatment course with poor disease control despite multiple adjustments of chemotherapy regimens. The patient met the inclusion criteria for the BCMA/CS1 dual-target CAR-T cell clinical trial (NCT04662099) and achieved complete remission two months after receiving a low dose of CAR-T cells. On the 8th day after CAR-T cell infusion, the patient developed grade 3 cytokine release syndrome, followed by severe gastrointestinal bleeding and persistent grade ≥3 thrombocytopenia, accompanied by a significant increase in thrombopoietin levels, with no megakaryocytes observed in bone marrow cytology. After treatment with rituximab, significant improvement was observed with platelet count gradually increased. However, the patient experienced persistent malnutrition and cachexia, and transferred to the gastroenterology department, after which follow-up was lost. A total of 24 relevant English articles and 8 Chinese articles were retrieved from the literature search.Conclusion:CAR-T cell therapy associated thrombocytopenia is characterized by thrombocytopenia and megakaryocyte production disorders. Persistent thrombocytopenia increases the risk of bleeding, and the use of CD20 monoclonal antibodies and supportive therapy can effectively improve thrombocytopenia.

Objective:To investigate the clinical manifestations, diagnostic and therapeutic strategies, for thrombocytopenia after BCMA/CS1 bispecific chimeric antigen receptor T-cell (CAR-T cell) therapy in patients with multiple myeloma.Methods:Retrospective collection and analysis were conducted on the clinical data of a patient with multiple myeloma who received BCMA/CS1 bispecific CAR-T cell therapy in the Hematology Department of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, in June 2021. To review the literature, Chinese databases (CNKI, Wanfang Database) and PubMed were searched from their inception up to November 2024 using the keywords "chimeric antigen receptor T-cell therapy", "thrombocytopenia", "CAR-T", "BCMA", and "CS1" .Results:A 72-year-old male patient was diagnosed with light chain κ-type multiple myeloma (R-ISS stage Ⅱ) in a local hospital and had a prolonged treatment course with poor disease control despite multiple adjustments of chemotherapy regimens. The patient met the inclusion criteria for the BCMA/CS1 dual-target CAR-T cell clinical trial (NCT04662099) and achieved complete remission two months after receiving a low dose of CAR-T cells. On the 8th day after CAR-T cell infusion, the patient developed grade 3 cytokine release syndrome, followed by severe gastrointestinal bleeding and persistent grade ≥3 thrombocytopenia, accompanied by a significant increase in thrombopoietin levels, with no megakaryocytes observed in bone marrow cytology. After treatment with rituximab, significant improvement was observed with platelet count gradually increased. However, the patient experienced persistent malnutrition and cachexia, and transferred to the gastroenterology department, after which follow-up was lost. A total of 24 relevant English articles and 8 Chinese articles were retrieved from the literature search.Conclusion:CAR-T cell therapy associated thrombocytopenia is characterized by thrombocytopenia and megakaryocyte production disorders. Persistent thrombocytopenia increases the risk of bleeding, and the use of CD20 monoclonal antibodies and supportive therapy can effectively improve thrombocytopenia.

Objective:To explore the clinical manifestations, pathogenesis, and therapeutic approaches of disseminated intravascular coagulation (DIC) associated with chimeric antigen receptor T-cell (CAR-T) therapy for B-lymphoblastic lymphoma.Methods:Retrospective collection and analysis were conducted on the clinical data of a patient with B-lymphoblastic lymphoma who received CAR-T therapy in the Hematology Department of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, in April 2020. To review the literatures, Chinese databases (CNKI, Wanfang Database) and PubMed were searched form database inception up to November 2024 using the retrieval entries "chimeric antigen receptor T-cell therapy", "CAR-T", "coagulation", "bleeding", and "thrombosis" .Results:The patient, a 32-year-old male, diagnosed with B-lymphoblastic lymphoma for over 10 months, relapsed after three cycles of chemotherapy and allogeneic hematopoietic stem cell transplantation, with bone marrow cytology indicating 20.24% abnormal phenotype B-lineage precursor cells. After CAR-T cell infusion at a dose of 4×10 6/kg, the patient developed grade 2 cytokine release syndrome (CRS) on day 2, nasal bleeding on day 4, high fever again on day 9, with worsening coagulation parameters, DIC and persistent hypofibrinogenemia. After treatment with tocilizumab, corticosteroids to counteract CRS, and active replacement therapy such as administration of blood product and fibrinogen, the patient’s CRS and coagulation abnormalities gradually improved. The patient was followed up for 16 months regularly after CAR-T therapy, with CAR-T cells sustained and minimal residual disease remained negative as assessed by bone marrow flow cytometry. Subsequently, the patient stopped taking oral immunosuppressants on his own, which aggravated rejection reaction complicated with infection. The patient and his family requested to be discharged and lost the follow-up. A total of 20 relevant English articles and 6 Chinese articles were retrieved from the literature search. Conclusion:CAR-T-associated coagulopathy occurs alongside CRS. It is characterized by hypofibrinogenemia, and is life-threatening when progressing to DIC. Anti-CRS and replacement therapies have proven to be effective treatment strategies.

Objective:To investigate the knowledge, attitudes, and practices (KAP) of pulse oximetry among pediatric healthcare providers in China and analyze the factor influencing the KAP.Methods:A self-developed questionnaire was used for an online research on the KAP of 11 849 pediatric healthcare providers from 31 provinces, autonomous regions, and municipalities of China from March 11 to 14, 2022.The factors influencing the KAP of pulse oximetry among pediatric healthcare providers were examined by Logistic regression. Results:The scores of KAP, of pulse oximetry were 5.57±0.96, 11.24±1.25 and 11.19±4.54, respectively.The corresponding scoring rates were 69.61%, 74.95%, and 55.99%, respectively. Logistic regression results showed that the gender and working years of pediatric healthcare providers, the region they were located, and whether their medical institution was equipped with pulse oximeters were the main factors affecting the knowledge score (all P<0.05). Main factors influencing the attitude score of pediatric healthcare providers included their knowledge score, gender, educational background, working years, region, medical institution level, and whether the medical institution was equipped with pulse oximeters (all P<0.05). For the practice score, the main influencing factors were the knowledge score, gender, age, and whether the medi-cal institution was equipped with pulse oximeters (all P<0.05). Conclusions:Chinese pediatric healthcare providers need to further improve their knowledge about and attitudes towards pulse oximetry.Pulse oximeters are evidently under-used.It is urgent to formulate policies or guidelines, strengthen education and training, improve knowledge and attitudes, equip more institutions with pulse oximeters, and popularize their application in medical institutions.

Objective To investigate the levels and clinical significance of homocysteine (Hcy) and neutrophil-to-lymphocyte ratio (NLR) in patients with nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM). Methods A total of 528 patients with NAFLD who were treated in Department of Endocrinology, The First Affiliated Hospital of Jinzhou Medical University, from January to December 2019 were enrolled, and according to the presence or absence of T2DM, they were divided into non-T2DM group and T2DM group. A total of 79 T2DM patients without NAFLD were selected randomly. General data and laboratory markers were recorded for the three groups. A one-way analysis of variance was used for comparison of normally distributed continuous data between groups, and the chi-square test was used for comparison of categorical data between groups; a binary logistic regression analysis was used to determine risk factors, and odds ratio ( OR ) and its 95% confidence interval ( CI ) were used to represent relative risk; the receiver operating characteristic (ROC) curve was used to evaluate predictive efficiency. Results The T2DM group had significantly higher systolic blood pressure (SBP), diastolic blood pressure, and body mass index than the non-T2DM group (all P < 0.05), and there were significant differences between any two of the three groups in Hcy, NLR, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transpeptidase, uric acid, and fasting blood glucose (all P < 0.05). There were significant differences in neutrophil count, lymphocyte count, and high-density lipoprotein cholesterol (HDL-C) between the T2DM group and the non-T2DM group (all P < 0.05), and there was a significant difference in total cholesterol between the T2DM group and the simple T2DM group and between the non-T2DM group and the simple T2DM group ( P < 0.05). SBP ( O R =1.040, 95% C I : 1.015-1.065), HDL-C ( OR =0.040, 95% CI : 0.007-0.228), NLR ( OR =6.285, 95% C I : 1.504-27.108), and Hcy ( O R =1.291, 95% C I : 1.127-1.423) were independent risk factors for NAFLD with T2DM. Hcy had an area under the ROC curve (AUC) of 0.741 (95% CI : 0.698-0.783, P < 0.01) in predicting NAFLD with T2DM, with a Youden index of 0.394, a sensitivity of 69.6%, and a specificity of 69.8% at the optimal cut-off value of 15.31 μmol/L. NLR had an AUC of 0.782 (95% C I : 0.744-0.820, P < 0.01) in predicting NAFLD with T2DM, with a Youden index of 0.443, a sensitivity of 72.1%, and a specificity of 72.2% at the optimal cut-off value of 2.12. Hcy combined with NLR had an AUC of 0.845 (95% C I : 0.812-0.878, P < 0.01) in predicting NAFLD with T2DM, with a Youden index of 0.549, a sensitivity of 71.8%, and a specificity of 83.1%. Conclusion Hcy and NLR are risk factors for NAFLD with T2DM and have a certain predictive value. Combined measurement of Hcy and NLR can improve the diagnostic efficiency of NAFLD with T2DM and help clinicians with diagnosis in the early stage.

Objective:To establish a model for predicting the mental health status of nurses based on machine learning algorithm.Methods:In February 2020, the nurses from Shantou Central Hospital and Cancer Hospital of Shantou University Medical College were recruited by convenience sampling, investigated using the Self-reporting Inventory, Coping Style Questionnaire, Social Support Rating Scale and Work Attitude Scale. Mental health status was treated as a dichotomous variable, and candidate predictors were screened out by univariate and multivariate Logistic regression analysis. The subjects were randomly divided into a training set (80%) and a test set (20%). Then five prediction models of nursing staff mental health status were constructed using the five machine learning methods (Logistic Regression, Artificial Neural Network, C5.0 Decision Tree, Bayesian Network and Support Vector Machine), verified and compared to screen out the model with the highest predictive efficiency.Results:A total of 415 nurses were enrolled, and the positive detection rate of mental health symptoms was 20.48%. According to univariate and multiple Logistic regression analysis, candidate predictors were work attitude ( OR=1.098, 95% CI 1.028-1.174), self-accusation ( OR=7.703, 95% CI 2.014-29.468), problem-solving( OR=0.131, 95% CI 0.025-0.686), the number of night shifts per month ( OR=0.204, 95% CI 0.073-0.573)and support availability ( OR=0.830, 95% CI 0.701-0.984). The accuracy of prediction of Logistic Regression, Artificial Neural Network, C5.0 Decision Tree, Bayesian Network and Support Vector Machine were 84.21%, 85.53%, 82.89%, 78.95%, 84.21%. The area under the ROC curve was 0.801, 0.825, 0.777, 0.583, 0.774. Artificial Neural Network was significantly more effective than Logistic regression, C5.0 Decision Tree, Bayesian Network and Support Vector Machine (DeLong test, P<0.05). Conclusions:The machine learning based predictive models for nursing staff mental health status has higher predictive value, which can be applied into nursing staff mental health screening decisions to accurately grasp its dynamic changes, early identification of high-risk mental health abnormalities and early intervention. Work attitude, self-accusation, problem-solving, the number of night shifts per month and support availability was predictors to construct predictive models.