Objective:To evaluate the efficacy and safety of hypomethylating agents (HMA) in patients with myelodysplastic syndromes (MDS) .Methods:A total of 409 MDS patients from 45 hospitals in Zhejiang province who received at least four consecutive cycles of HMA monotherapy as initial therapy were enrolled to evaluate the efficacy and safety of HMA. Mann-Whitney U or Chi-square tests were used to compare the differences in the clinical data. Logistic regression and Cox regression were used to analyze the factors affecting efficacy and survival. Kaplan-Meier was used for survival analysis. Results:Patients received HMA treatment for a median of 6 cycles (range, 4-25 cycles) . The complete remission (CR) rate was 33.98% and the overall response rate (ORR) was 77.02%. Multivariate analysis revealed that complex karyotype ( P=0.02, OR=0.39, 95% CI 0.18-0.84) was an independent favorable factor for CR rate. TP53 mutation ( P=0.02, OR=0.22, 95% CI 0.06-0.77) was a predictive factor for a higher ORR. The median OS for the HMA-treated patients was 25.67 (95% CI 21.14-30.19) months. HMA response ( P=0.036, HR=0.47, 95% CI 0.23-0.95) was an independent favorable prognostic factor, whereas complex karyotype ( P=0.024, HR=2.14, 95% CI 1.10-4.15) , leukemia transformation ( P<0.001, HR=2.839, 95% CI 1.64-4.92) , and TP53 mutation ( P=0.012, HR=2.19, 95% CI 1.19-4.07) were independent adverse prognostic factors. There was no significant difference in efficacy and survival between the reduced and standard doses of HMA. The CR rate and ORR of MDS patients treated with decitabine and azacitidine were not significantly different. The median OS of patients treated with decitabine was longer compared with that of patients treated with azacitidine (29.53 months vs 20.17 months, P=0.007) . The incidence of bone marrow suppression and pneumonia in the decitabine group was higher compared with that in the azacitidine group. Conclusion:Continuous and regular use of appropriate doses of hypomethylating agents may benefit MDS patients to the greatest extent if it is tolerated.

Objective:To explore the real maternal and infant care experience and needs of spouses of puerperal women, so as to provide a basis for improving maternal and infant care capacity and participation of spouses and promoting maternal and infant health.Methods:Guided by dyadic coping theory, the semi-structured interviews were conducted among 18 spouses of puerperal women who gave birth at the First Affiliated Hospital of Soochow University from July to September 2022 using the phenomenological research method, and the recording data were analyzed by Colaizzi phenomenon analytical method.Results:Three themes were extracted, including positive experience of maternal and infant care of spouses of puerperal women (positive psychological emotions, adjustment of perceptions and behaviors, understanding of social support), negative experience of maternal and infant care of spouses of puerperal women (negative psychological emotions, poor care competence, imbalance during life and work), diversified needs for maternal and infant care of spouses of puerperal women (the need for multidimensional knowledge and skills, the suggestion of building continuous health education platform, the expectation of support from family).Conclusions:Medical staff should provide the spouses of puerperal women with diversified maternal and infant care and professional continuing nursing according to their experience and needs. Meanwhile, the family support system should be improved to enhance their sense of competence and participation in maternal and infant care and promote maternal and infant health.

Lymphoma is a common hematological malignant tumor which poses a great threat to human health. Chemotherapy, molecular targeted therapy, and hematopoietic stem cell transplantation constitute the main treatment methods for lymphoma, however, there are still some patients with lymphoma suffer from drug resistance, relapse and refractory. Ferroptosis is a newly discovered mode of programmed cell death, which is related to iron-dependent lipid peroxidation damage. Targeting ferroptosis provides a novel landscape for inhibiting the growth of lymphoma. We reviewed the mechanism of ferroptosis from the initial signals, intermediate events, effect stages, defense mechanisms and summarized the research progress of ferroptosis in lymphoma, providing novel therapeutic targets in the treatment of lymphoma.

Objective:To investigate the diagnosis and treatment of multicentric Castleman disease (MCD).Methods:The diagnosis and treatment of one MCD patient admitted in Hangzhou First People's Hospital in July 2020 was analyzed and related literatures were reviewed.Results:The patient was a 55-year-old male with anemia, elevated globulin levels and IgG4 > 10 g/L, and enlarged lymph nodes. He was undiagnosed for 7 years. Lymph node biopsy revealed a large number of polyclonal plasma cell hyperplasia, and the ratio of IgG4/IgG was less than 0.40; the serum interleukin (IL)-6 was more than 6 000 pg/ml and then he was eventually diagnosed as MCD (plasma cell type). Rituximab + cyclophosphamide + dexamethasone (RCD) regimen was not effective, and it was changed to anti-IL-6 receptor antibody tocilizumab for 2 courses and then the patient obtained good results.Conclusions:Castleman disease is a rare disease with a poor prognosis. It has high heterogeneity and is easy to be misdiagnosed clinically. The diagnosis requires pathological examination. IL-6 is considered to be closely related to the onset of Castleman disease and has become an effective target for treatment.

Objective:To evaluate the effect of intestinal carbapenem-resistant Enterobacteriaceae (CRE) active screening combined with enhanced intervention in the prevention and control of nosocomial infection in patients admitted to the hematological ward.Methods:Patients who were admitted to the Department of Hematology in a tertiary-care general hospital from March 1, 2017 to December 31, 2019 and underwent chemotherapy or immunosuppressive therapy comprised the intervention group. They were screened for intestinal CRE at least thrice. From December 1, 2016 to February 28, 2017, patients who underwent chemotherapy or immunosuppressive therapy without active intestinal CRE screening in the Department of Hematology formed the control group. Both the patient groups were monitored for CRE infection in real time. The χ2 test was used to compare the changes in the CRE infection rate and mortality in high-risk patients before and after the active screening. Results:During the intervention period, the CRE colonization rate of patients was 16.46% (66/401) ; in terms of disease distribution, the colonization rate of acute leukemia was the highest 23.03% (26/113) . Of the 66 colonized patients, 27 (40.9%) patients were identified as positive for CRE at the first screening, 15 (22.7%) were identified at the time of the second screening, and the remaining 24 (36.4%) were identified at the third or subsequent screening; Carbapenem-resistant Klebsiella pneumoniae (CRPK) strains were dominant among the pathogens, accounting for 54.55% (36/66) . During the active screening period, the CRE infection rate (2.49%) and mortality rate (50.00%) of high-risk patients were significantly lower than those of the controls (11.30% and 69.23%, respectively) . The pathogens of 10 CRE infection patients during the intervention period were exactly the same as the previous active screening pathogens, and the coincidence rate was 100%.Conclusion:The CRE colonization rate was the highest in patients with acute leukemia who were admitted in the hematology wards. CRPK is the main pathogen of CRE colonization, infection, and death. Increasing the frequency of screening can significantly raise the positive rate of screening, Active screening can effectively reduce the incidence and subsequent mortality of CRE in high-risk patients admitted in the hematological wards. High coincidence rate between CRE screening positive pathogens and subsequent CRE infection pathogens. Intestinal CRE screening can serve as an indicator of CRE bloodstream infection in patients with hematological diseases as well as provide information for antibiotics therapy.

bjective? To expLore the mentaL response and nursing demands of spouses of puerpera in the puerperium and to provide support and assistance to famiLy-centered humanistic nursing in the department of obstetrics. Methods? TotaLLy 15 spouses of puerpera at day 3 post deLivery in a Class Ⅲ Grade A hospitaL in Suzhou were seLected by purposive sampLing from November 2017 to January 2018. Their reaL experience was coLLected by Live recording and semi-structured in-depth interview using quaLitative phenomenoLogicaL methods, and the data were organized, summarized and anaLyzed using content anaLysis. ResuLts? TotaLLy 4 categories were refined: adaptation to the roLe of husband, adaptation to the roLe of father, mentaL response and nursing demands. ConcLusions? The emotions of the spouses of puerpera in the puerperium fLuctuated significantLy, and their mentaL response vary from phase to phase. Attention shouLd be paid to the roLe awareness, responsibiLity, mentaL activity and nursing demands and information support and psychoLogicaL care shouLd be properLy provided according to their roLe awareness, responsibiLity and mentaL response.

Objective: To understand the status of constipation, anxiety and depression among patients with placenta previa and to explore the relationship between them, in order to identify early predictor of constipation. Methods: Zung′s Self-Rating Anxiety Scale (SAS) and Zung′s Self-Rating Depressive Scale (SDS) were applied among 92 patients with placenta previa. Finally, 83 valid questionnaires were recovered. Results: The incidence of anxiety and depression were 50.6%(42/83) and 33.73%(28/83) respectively within 48 hours of hospitalization and the incidence of constipation was 71.08%(59/83) within three days in hospital. The incidence of constipation in emotional disorder group were greater than that in non-emotional disorder group (χ²=11.97, 6.81, P < 0.01). The degree of anxiety and depression were positively correlated with the occurrence of constipation (r=0.48, 0.35, P < 0.01 or 0.05). The correlation of anxiety and constipation was higher. Conclusions The heavier degree of negative emotions, the higher occurrence of constipation in patients with placenta previa during hospitalization. Anxiety can be used as an early predictor of constipation.

To retrospectively analyze the prognostic significance of plasma Epstein -Barr virus (EBV) DNA in 122 patients with diffuse large B cell lymphoma (DLBCL).Plasma EBV DNA positivity was related to advanced disease stage ( P =0.030 ) , B symptoms ( P =0.004 ) and elevated serum lactic dehydrogenase (LDH) (P=0.001).Furthermore, univariate analysis indicated that plasma EBV DNA level was associated with worse overall survival (OS) (HR=0.223, 95%CI 0.096-0.518, P<0.001) and worse progression free survival (PFS) (HR =4.417, 95%CI 1.911 -10.208, P <0.001), whereas multivariate analysis showed plasma EBV DNA as a probable independent prognostic factor of clinical outcome(HR=0.409, 95%CI 0.166-1.008, P=0.052).

Objective To improve the understanding of clinician' treatment of pregnancy with acute lymphoblastic leukemia. Method To analyze tretrospectively the diagnosis and treatment process of 1 case with acute lymphoblastic leukemia from December 13, 2016, and discuss the selection of the timing of termination of pregnancy. Results The patient was a 28 years old female. She was dignosed for acute lymphocytic leukemia in the third trimester. She bore a healthy baby boy in caesarean section after a dexamethasone treatment for two days. Then she recevied a series of standard chemotherapy. But she suffered a cerebral hemorrhage during treatment, and surgical pathology made a definite dignosis of central nervous system leukemia.Finally, She was out of danger after rescue. Conclusion Postoperative chemotherapy is a feasible option for the treatment of acute leukemia after the termination of pregnancy.