ObjectiveTo investigate the optimal termination time for acupuncture in treating patients with acute peripheral facial paralysis and its cost-effectiveness. MethodsA total of 120 eligible patients with acute-stage peri-pheral facial paralysis were randomly assigned to either the mild dysfunction termination group and the complete recovery termination group， with 60 patients in each group. Both groups received the standard acupuncture treatment protocol. Treatment in the mild dysfunction termination group was terminated when the Sunnybrook facial grade scale （SFGS） score first reached or exceeded 83 points， while that in the complete recovery termination group was terminated when the SFGS score first reached or exceeded 95 points. Assessments were conducted before treatment， 6 and 12 months after onset. SFGS， facial disability index （FDI） including physical function （FDIp） and social function （FDIs）， self-rating anxiety scale （SAS）， and self-rating depression scale （SDS） scores were assessed before treatment， and 6 and 12 months after onset. Any acupuncture-related adverse events during treatment were recorded for safety evaluation. Treatment sessions and medical costs including direct costs， indirect costs， insurance coverage， total societal costs， and patient out-of-pocket expenses were also recorded， and an economic evaluation was conducted including cost-effectiveness ratio （CER） and incremental cost-effectiveness ratio （ICER）. ResultsUltimately， 56 patients in the mild dysfunction termination group and 55 in the complete recovery termination group completed the follow-up. At 6 and 12 months after onset， SFGS and FDIp scores in both groups improved significantly while FDIs， SAS and SDS scores decreased （P＜0.05）. Comparison of scores between groups 6 months and 12 months after onset showed no statistically significant differences （P＞0.05）. During the trial， the incidence of adverse events was 13.3% （8/60） in the mild dysfunction termination group and 18.3% （11/60） in the complete recovery termination group， with no statistically significant difference （P＞0.05）. The number of treatment sessions， total social costs， and out-of-pocket expenses in the mild dysfunction termination group were significantly lower than those in the complete recovery termination group （P＜0.05）. The CER of the mild dysfunction termination group in SFGS， FDIp， FDIs， SAS， and SDS scores was lower than that of the complete recovery termination group. The ICER analysis showed that continuing treatment until full recovery incurred an additional cost of 573.30 CNY/point in SFGS improvement， whereas 1-point improvement in FDIp， FDIs， SAS， and SDS required 21,355.25 CNY， 1779.60 CNY， 3713.96 CNY， and 2755.52 CNY， respectively. ConclusionFor acupuncture in treating acute peripheral facial palsy， terminating treatment when mild dysfunction is achieved yields long-term efficacy comparable to that of continuing treatment until complete recovery， while significantly reducing medical costs and socioeconomic burden.

Objective: Establishment of a HPLC method for six chemical components in Saposhnikovia divaricata (prim-O-glucosylcimifugin, cimifugin, 5-O-methylvisamminoside, sec-O-glucosylhamaudol, psoralen, and imperatorin), comparison of the advantages and disadvantages of the dual-standard linear calibration method and the relative retention time method, and investigation of the feasibility of the linear calibration using two reference substances for qualitative analysis of multiple components in Saposhnikovia divaricata.
Methods: A HPLC method was employed, using 21 different brands and models of C18 columns. The mobile phase consisted of acetonitrile (A) and 0.02% phosphoric acid aqueous solution (B), with gradient elution (0-20 min, 18%A; 20-45 min, 18%A-50%A; 45-60 min, 50%A). The column temperature was set at 30 ℃, the flow rate was 1 mL·min^-1, and the detection wavelength was 254 nm.
Results: The results predicted by the linear calibration using two reference substances were accurate and superior to those of the relative retention time method, and the six components exhibited good linear relationships within their respective ranges.
Conclusion: The established linear calibration using two reference substances accurately predicts the retention times of the target components. This method is stable and reliable, providing a reference for the establishment of digital standards in traditional Chinese medicine.

Purpose: Due to the preservation of the entire stomach after endoscopic resection, the occurrence of metachronous gastric cancer (MGC) remains a possibility. In this study, we investigated the incidence and risk factors for MGC in patients with early gastric cancer who underwent endoscopic submucosal dissection (ESD) and successfully eradicatedHelicobacter pylori. Materials and Methods: A retrospective analysis was conducted of 1,191 patients who underwent ESD and successfully eradicated H. pylori at the Affiliated Drum Tower Hospital of Nanjing University. Endoscopic surveillance was performed at 3, 6, and 12 months post-resection, and annually thereafter. MGC was defined as the development of a new cancer at a site other than the primary gastric cancer site, at least 1 year after the initial endoscopic resection. Results: A total of 77 patients were diagnosed with MGC during a median follow-up of 41.5 months. Kaplan-Meier analysis showed a 5-year cumulative incidence of MGC of 9.4% after successful H. pylori eradication. Multivariate analysis of the training set using Cox proportional hazards models identified male sex, severe atrophic gastritis, multiple gastric cancers before H. pylori eradication, and smoking history as independent risk factors for MGC.The nomogram exhibited favorable discrimination, with area under the curves of 0.767 and 0.822 in the training set and 0.724 and 0.745 in the testing set at 3 and 5 years, respectively. Conclusions Patients with gastric cancer who undergo endoscopic resection, even after successful H. pylori eradication, should undergo annual and continuous endoscopic surveillance for MGC.

Objective: To investigate the trend in incidence and change in age at onset of malignant tumor in cancer registration areas of Jiangsu Province from 2009 to 2021, so as to provide the evidence for formulating cancer prevention and control strategies and optimizing the allocation of healthcare resources. Methods: Incidence data of malignant tumor cases from 2009 to 2021 were collected from the aggregated database of 16 qualified cancer registries of Jiangsu Province. The crude incidence, age-specific incidence, average age at onset, proportion of age-specific incidence, and proportion of incidence in cases aged ≥60 years were calculated by genders and urban/rural areas, and age-standardized using the Segi's world standard population. The trend in incidence of malignant tumor from 2009 to 2021 was evaluated using average annual percent change (AAPC). The trend in average age at onset of malignant tumor from 2009 to 2021 was evaluated using the linear regression model. Results: From 2009 to 2021, a total of 703 185 cases of malignant tumor were reported in Jiangsu Province, comprising 400 970 males and 302 215 females. The crude incidence of malignant tumor increased from 268.26/100 000 in 2009 to 380.97/100 000 in 2021 (AAPC=2.880%, P<0.05). From 2009 to 2021, the world population-standardized incidence of malignant tumor showed upward trends in the total population, females, and urban and rural areas (AAPC=0.635%, 2.332%, 0.795%, and 0.385%, all P<0.05), while a downward trend was observed in males (AAPC=-0.608%, P<0.05). From 2009 to 2021, the crude incidence of malignant tumor in the groups aged 0-<30 years, 30-<40 years, 40-<50 years, 60-<70 years, and ≥80 years showed upward trends (AAPC=3.160%, 4.462%, 1.295%, 0.569%, and 1.496%, all P<0.05), a downward trend was found in the group aged 50-<60 years (AAPC=-0.860%, P<0.05), while no statistically significant trend was observed in the group aged 70-<80 years (P>0.05). The world population-standardized average age at onset showed downward trends in the total population, females, and urban areas, with average annual decreases of 0.085, 0.223, and 0.136 years, respectively (all P<0.05). Conversely, an upward trend was observed in males, with an average annual increase of 0.081 years (P<0.05). No statistically significant trend was found in rural areas (P>0.05). Compared with 2009, the proportion of malignant tumor incidence cases increased in all age groups between 20-<50 years in 2021. Additionally, the proportion of malignant tumor cases aged over 60 years showed a downward trend from 2009 to 2021 (AAPC=-0.322%, P<0.05). Conclusions From 2009 to 2021, the overall incidence of malignant tumor in registration areas of Jiangsu Province showed an upward trend, with the age at onset tending to become younger. There were differences in the incidence trends across genders and urban/rural areas.

Objective To assess the nutritional status in elderly patients with chronic renal insufficiency (CRI) and reveal the key factors affecting the nutritional status. Methods A total of 310 elderly patients with CRI who received hospitalization treatment and outpatient follow-up in the hospital from January 2021 to June 2024 were selected as the investigation subjects. The nutritional status of patients was evaluated by mini-nutritional assessment (MNA) questionnaire, and the nutritional status and dietary structure of patients were comprehensively evaluated by anthropometric indicators [height, weight, body mass index (BMI), upper arm circumference, calf circumference], biochemical indicators [serum albumin (ALB), prealbumin (PA), hemoglobin (Hb), transferrin (TF)] and 24-hour dietary review method. According to the investigation results of nutritional status, the patients were divided into good nutrition group (MNA score≥24 points), nutritional risk group (MNA score of 17-23.5 points) and malnutrition group (MNA score<17 points). Univariate analysis was adopted to screen the potential influencing factors of elderly CRI. Multivariate logistic regression model was applied to analyze the influencing factors of malnutrition in elderly CRI patients. Results Among the 325 questionnaires were distributed, but only 310 valid questionnaires were recovered, with an effective recovery rate of 95.38%. Investigation results revealed that among the 310 patients, 29.35% (91 cases) had good nutritional status, and 42.26% (131 cases) had nutritional risk, and 28.39% (88 cases) had malnutrition. Univariate analysis indicated that there were statistical differences in BMI, CRI staging, serum ALB, PA, Hb, TF, protein intake and total calorie intake among the good nutrition group, the nutritional risk group and the malnutrition group (P<0.05). Multivariate logistic regression analysis suggested that low BMI (OR=0.903, 95%CI: 0.867-0.941), high CRI stage (OR=1.091, 95%CI: 1.053-1.130), low serum ALB (OR=0.907, 95%CI: 0.867-0.948), PA (OR=0.918, 95%CI: 0.888-0.949), Hb (OR=0.944, 95%CI: 0.909-0.997), TF (OR=0.912, 95%CI: 0.874-0.952), insufficient protein intake (OR=0.924, 95%CI: 0.882-0.969) and insufficient total calorie intake (OR=0.938, 95%CI: 0.909-0.968) were influencing factors for malnutrition in elderly patients with CRI (all P<0.05). Drawing ROC curve of malnutrition in elderly patients with CRI according to the prediction probability of logistic regression model found that the AUC, sensitivity, specificity, 95%CI and Youden index were 0.976, 93.18%, 92.34%, 0.953-0.990 (P<0.05) and 0.855. Conclusion The incidence rate of malnutrition is high in elderly patients with CRI, and is mainly affected by factors such as low BMI, high CRI stage, low serum ALB, PA, Hb and TF levels and insufficient protein and total calorie intakes. In addition, logistic regression model has high predictive value and can provide a reference for early clinical identification of high-risk population with malnutrition among elderly patients with CRI.

Primary female genital system lymphoma(PFGSL)is a rare subtype of extranodal lymphoma and patients commonly present in the department of gynecology.At present,there is a lack of uniform standards for the treatment of PFGSL.Although the classification of lymphoid neoplasmas was updated by the World Health Organization classification of haematolymphoid tumors in 2016,PFGSL was still not elaborated in sufficient detail.Most cases of PFGSL are non-Hodgkin lymphoma,involving the ovary and cervix.In some cases,involvement of uterine corpus,vagina,and vulva is reported.In this article,we report two cases of non-Hodgkin lymphoma in the female genital system,one from the uterus and the other from the ovary.By presenting the diagnosis and treatment of the two cases and reviewing the literature,we aim to provide a reference for clinicians in recognizing and treating rare cases.
Female ; Humans ; Genital Neoplasms, Female/diagnosis* ; Lymphoma, Non-Hodgkin/diagnosis* ; Ovarian Neoplasms

Objective To analyze the feasibility and advantage of indocyanine green(ICG)fluorescence imaging technique in the thoracoscopic anatomical segmentectomy.Methods Patients with small pulmonary nodules who underwent thoracoscopic anatomical segmentectomy in our department from January 2023 to June 2024 were selected and divided into the ICG fluorescence group(35 cases determining intersegmental plane through ICG fluorescence imaging method)and the modified inflation-deflation group(42 cases determining intersegmental plane through modified inflation-deflation method)according to different methods of determining intersegmental plane.The surgery-related indicators including time of intersegmental plane occurrence,operation time,number of lymph node dissection,postoperative duration of chest tube and postoperative hospital stay as well as the occurrence of complications in the two groups were counted.Patients over 60 years old in two groups were selected and the differences in surgery-related indicators were analyzed.Results The time of intersegmental plane occurrence and operation time in the ICG fluorescence group were shorter than those in the modified inflation-deflation group,with statistically significant differences(P<0.05).There was no significant difference in the number of lymph node dissection,postoperative duration of chest tube or postoperative hospital stay between the two groups(P>0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).The time of intersegmental plane occurrence,operation time and postoperative hospital stay of patients over 60 years old in the ICG fluorescence group were shorter than those in the modified inflation-deflation group,with statistically significant differences(P<0.05).Conclusion ICG fluorescence imaging method can display the intersegmental plane clearly and quickly,which can shorten the time of intersegmental plane occurrence and hospital stay in elderly patients with pulmonary nodules.

Objective·To investigate the effect of plasma exchange combined with classical chemotherapy on renal function in patients with multiple myeloma(MM).Methods·A retrospective analysis was conducted on data from patients newly diagnosed with MM in the Department of Hematology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,between October 2021 and September 2023.Sixty-eight MM patients admitted from October 2021 to September 2022 served as the control group,and 41 patients admitted from October 2022 to September 2023 comprised the experimental group.The control group received classical chemotherapy for MM[PAD(bortezomib+adriamycin+dexamethasone)or PCD(bortezomib+cyclophosphamide+dexamethasone)],and the experimental group underwent plasma exchange before classic chemotherapy.The frequency of plasma exchange was determined according to the clearance rate of M-protein in patients,with the criterion being a reduction of more than 40%in plasma M-protein levels after exchange,and the total number of exchanges ranged from 1 to 3 sessions.After 2 chemotherapy courses,the free light chain difference(dFLC),serum creatinine(Scr),and other renal function indexes were compared between the two groups.Results·Compared with the control group,the experimental group showed no statistically significant difference in dFLC levels.The Scr level decreased[67.00(54.00,75.00)μmol/L vs 77.50(63.00,94.00)μmol/L,P=0.011],and the estimated glomerular filtration rate(eGFR)increased[97.80(92.80,101.30)mL/(min·1.73 m2)vs 85.80(61.35,95.35)mL/(min·1.73 m2),P<0.001]after treatment.Before treatment,the numbers of patients with MM-related severe renal injury[eGFR<50 mL/(min·1.73 m2)]were 41 in the control group and 28 in the experimental group.After treatment,8 patients(19.51%)in the control group achieved complete renal response[eGFR≥60 mL/(min·1.73 m2)],while 12 patients(42.86%)in the experimental group achieved the same,with the difference being statistically significant(P=0.036).After two courses of treatment,the overall response rates(ORR)of the control group and the experimental group were 76.47%and 92.68%,respectively,and the difference in overall therapeutic efficacy was statistically significant(P=0.031).Conclusion·Plasma exchange combined with classical chemotherapy can significantly reduce the Scr levels and increase eGFR in MM patients within a short period,ameliorating the MM-related renal impairment to some extent and improving clinical treatment outcomes.

OBJECTIVE: To analyze the gene mutation characteristics and survival time of patients with newly diagnosed acute myeloid leukemia (AML) based on next-generation sequencing(NGS) gene detection. METHODS: A retrospective analysis was conducted on the clinical data of 92 patients with AML (non APL) admitted to our hospital from January 2018 to May 2022. AML related genes tested were using NGS, the mutation characteristics and survival time of AML patients were analyzed. RESULTS: Among the 92 patients, 41 were males and 51 were females. A total of 38 types of gene mutations were detected. Six-two patients carried at least one gere mutation, while no gene mutations were detected in 30 patients. In the group with favourable prognosis (n =14), the frequencies of higher gene mutations were NRAS, KIT (21.43%, n =3), KRAS (14.29%, n =2). In the group with intermediate prognosis (n =64), the gene mutation frequencies from high to low were DNMT3A (18.75%, n =12), NPM1 (17.19%, n =11), IDH2, FLT3-ITD, CEBPA (12.50%, n =8), TET2 (10.94%, n =7). In the poor prognosis group (n =14), ASXL1, TP53, EZH2, NRAS had higher gene mutation frequency than others(14.29 %, n =2 ). Statistical analysis revealed that KIT had a relative hotspot of mutations in the intermediate-risk group, and DNMT3A had a relative hotspot of mutations in the high-risk group (P < 0.05). The correlation analysis of genes with high mutation rates in different prognostic groups, such as NRAS, KIT, IDH2, DNMT3A, NPM1, and FLT3-ITD, with prognosis found that KIT was a factor affecting OS (P < 0.05), while no significant differences were observed for the others(P >0.05). CONCLUSION The frequency of gene mutations is high in AML patients, 67.4% of the patients carried at least one gene mutation. The mutation frequency varies among different genes in patients with different karyotypes, and there are obvious dominant mutations. KIT and DNMT3A can be used as factors for evaluating the prognosis of AML.
Humans ; Leukemia, Myeloid, Acute/genetics* ; Nucleophosmin ; Mutation ; Prognosis ; Retrospective Studies ; Male ; Female ; High-Throughput Nucleotide Sequencing ; Middle Aged ; DNA Methyltransferase 3A ; Adult ; Aged ; Survival Analysis ; Proto-Oncogene Proteins c-kit/genetics*

Mycophenolic acid (MPA), the active moiety of both mycophenolate mofetil (MMF) and enteric-coated mycophenolate sodium (EC-MPS), serves as a primary immunosuppressant for maintaining solid organ transplants. Therapeutic drug monitoring (TDM) enhances treatment outcomes through tailored approaches. This study aimed to develop an evidence-based guideline for MPA TDM, facilitating its rational application in clinical settings. The guideline plan was drawn from the Institute of Medicine and World Health Organization (WHO) guidelines. Using the Delphi method, clinical questions and outcome indicators were generated. Systematic reviews, Grading of Recommendations Assessment, Development, and Evaluation (GRADE) evidence quality evaluations, expert opinions, and patient values guided evidence-based suggestions for the guideline. External reviews further refined the recommendations. The guideline for the TDM of MPA (IPGRP-2020CN099) consists of four sections and 16 recommendations encompassing target populations, monitoring strategies, dosage regimens, and influencing factors. High-risk populations, timing of TDM, area under the curve (AUC) versus trough concentration (C₀), target concentration ranges, monitoring frequency, and analytical methods are addressed. Formulation-specific recommendations, initial dosage regimens, populations with unique considerations, pharmacokinetic-informed dosing, body weight factors, pharmacogenetics, and drug‍-‍drug interactions are covered. The evidence-based guideline offers a comprehensive recommendation for solid organ transplant recipients undergoing MPA therapy, promoting standardization of MPA TDM, and enhancing treatment efficacy and safety.
Mycophenolic Acid/administration & dosage* ; Drug Monitoring/methods* ; Humans ; Organ Transplantation ; Immunosuppressive Agents/administration & dosage* ; Delphi Technique