Objective:To investigate the efficacy and safety of bendamustine combined with anti-CD20 monoclonal antibody in the first-line treatment of older patients with indolent B-cell non-Hodgkin lymphoma (B-iNHL) .Methods:The clinical data of 159 patients with B-iNHL enrolled in 16 hospitals from Jiangsu Cooperative Lymphoma Group from December 1, 2019, to April 20, 2024, were analyzed for regimen efficacy and safety. Bendamustine plus rituximab (BR) and bendamustine plus obinutuzumab (BG) were administered to 139 (87.4% ) and 20 (12.6% ) patients, respectively.Results:Among the 159 patients, 101 (63.5% ) were male and 58 (36.5% ) were female, with a median age of 69 years (range: 60–84). Efficacy could be assessed in 138 (86.8% ) patients. The efficacy assessment demonstrated that the overall response rate was 92.0% with complete and partial remissions in 75 (54.3% ) and 52 (37.7% ) cases, respectively. With a median follow-up of 24 months (range: 4–64), the progression-free survival rate was (87.5 ± 3.0) % and the overall survival rate was (83.2 ± 3.3) %. Of the 27 patients who died, 6 (22.2% ) died due to disease progression. The mean applied dose of bendamustine per cycle was 73.0 (50.8–89.7) mg/m 2 per day, administered on days 1 and 2. Adverse events of grade 3 or higher were reported in 53 (33.3% ) patients, with infection (30 cases,18.9% ) and neutropenia (24 cases, 15.1% ) demonstrating the highest incidence. Conclusion:Bendamustine combined with anti-CD20 monoclonal antibody demonstrated good efficacy and is well-tolerated in the first-line treatment of elderly patients with B-iNHL.

Objective:To analyze the status of social support and the influencing factors of support utilization among general practitioners.Methods:An investigation on the status of social support and the influencing factors of support utilization was conducted among general practitioners (GPs) from 6 communities in Shanghai Minhang District selected by simple sampling method in February 2023. The investigation included a questionnaire survey containing basic information and intervention measures (emotional support, information support, tool support); and assessments of the Social Support Rate Scale (SSRS), Perceived Social Support Scale, General Self-Efficacy Scale, Quality of Work Life Scale, Trait Coping Style Scale, and Psychological Resilience Scale. The association of social support status with various characteristics of GPs and their perceived social support and trait coping style was analyzed, and the influencing factors of social support utilization were determined.Results:A total of 184 questionnaires were distributed and 184 valid questionnaires were collected, with an effective recovery rate of 100.00%. Among the 184 participants, 55 (29.89%) had a general level of social support, and 129 (70.11%) were satisfied with their social support. The total score of SSRS was (37.49±8.41), with the objective support dimension scoring (9.67±3.42), subjective support scoring (20.04±4.52), and support utilization scoring (7.77±2.09). Univariate analysis showed significant differences in social support levels among respondents with different marital status, number of children, emotional support, informational support, instrumental support, positive coping, negative coping, psychological resilience, compassion fatigue, general self-efficacy, and perceived social support status ( P<0.05). Multiple linear regression analysis indicated that marital status, family support, professional skills, positive coping, and negative coping were independent influencing factors of social support. Among these factors, being married, having family care support, professional titles and skills and positive coping had a positive impact on social support levels, while negative coping had a negative impact ( P<0.05). Further stepwise multiple linear regression analysis showed that friend support, positive coping and family care were positive influencing factors for support utilization, while negative coping was a negative influencing factor ( P<0.05). Conclusion:The levels of social support among GPs in Minghang district of Shanghai are relatively high. Marital status, family support, professional title and skills and positive coping are positive factors for social support; and friend support, positive coping and family support are positive factors for support utilization.

Objective To explore the different potential subtypes of psychosocial adaptation among young and middle-aged stroke patients,and analyze the relationship between different potential subtypes and quality of life,so as to provide references for the subsequent development of targeted interventions.Methods A total of 406 young and middle-aged stroke patients in 4 tertiary hospitals in Suzhou from June 2023 to June 2024 were recruited by convenience sampling.The General Information Questionnaire,the Self-Report Psychosocial Adjustment to Illness Scale and the EuroQol five-dimensional questionnaire were conducted for investigation.Latent profile analysis was used to explore the potential subtypes of psychosocial adaptation among young and middle-aged stroke patients.Generalized linear regression analysis was conducted with quality of life as dependent variables.Results A total of 380 young and middle-aged stroke patients were included.The psychosocial adaptation of patients could be classified into 3 potential subtypes:high adaptation level type(23.90％),medium adaptation level with health concerns type(46.40％),and low adaptation level with psychological barriers type(29.70％).The results of generalized linear regression analysis showed that potential subtypes of psychosocial adaptation were the influencing factors for quality of life in young and middle-aged stroke patients(P＜0.05).Conclusion There was group heterogeneity in psychosocial adaptation among young and middle-aged stroke patients,and the potential subtype of psychosocial adaption was an important factor affecting the quality of life of patients.It is suggested that medical staff should focus on patients with low adaptation level with psychological barriers type,and take targeted interventions according to characteristics of different subtypes of patients,so as to improve their quality of life.

This article reports a rare case of thrombotic microangiopathy (TMA) with renal involvement complicated by allogeneic hematopoietic stem cell transplantation (allo-HSCT). The patient appeared increased serum creatinine 20 d after allo-HSCT, and gradually appeared hypertension, oliguria and edema. Despite discontinuing suspected medications, serum creatinine level did not decrease. Treatment with basiliximab and mycophenolate mofetil was initiated to prevent rejection, leading to gradual normalization of urine output and serum creatinine level. However, after stopping mycophenolate mofetil, the patient experienced recurrent increased blood pressure and decreased pulse oximetry, responding well to prednisone but recurring upon cessation, with gradually increased serum creatinine level. Renal pathology indicated that chronic TMA after allo-HSCT caused renal injury, primarily affecting the glomeruli. The renal function achieved long-term stability through low-dose prednisone and symptomatic treatment. By reviewing relevant literature, we discussed the clinical manifestations, laboratory tests, pathological features and treatment strategies of TMA with renal involvement complicated by allo-HSCT.

Objective:To summarize the clinical characteristics of elderly patients with stage Ⅰ diffuse large B-cell lymphoma (DLBCL) and analyze the factors associated with prognosis.Methods:A case series study was conducted by retrospectively collecting clinical data from patients aged over 60 years with newly diagnosed stage Ⅰ DLBCL across 20 medical centers in Jiangsu Province, China, between June 2010 and April 2023. The involved site, classification and treatment plan were summarized. The primary endpoints were progression-free survival (PFS) and overall survival (OS). Statistical analyses were performed using the Kaplan-Meier method, and Cox regression model.Results:The study included 255 patients with a median age of 69 years, of whom 130 (51.0%) were male, 66 (25.9%) were aged ≥75 years and 26 (10.1%) had a high Charlson Comorbidity Index (CCI) score of ≥2. Extranodal involvement was observed in 163 (63.9%) patients, with the stomach (37.4%, 61/163), intestine (19.0%, 31/163), testes (11.0%, 18/163), and breast (7.4%, 12/163) being the most frequently affected sites. The non-germinal center B-cell (non-GCB) subtype was prevalent in 63.7% of patients (142/223), with no significant difference between the nodal and extranodal groups ( P=0.681). Furthermore, 73.9% (184/249) and 11.7% (29/249) of patients received the R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) and R-miniCHOP regimen, respectively. The overall 3-year PFS rate was 81.5%, and the 3-year OS rate was 85.6%. Patients aged ≥75 years ( HR=2.910, 95% CI 1.565-5.408, P=0.001) and/or with a CCI score ≥2 ( HR=2.324, 95% CI 1.141-4.732, P=0.020) had a significantly poorer PFS. Incorporating age ≥75 years and CCI score ≥2 into the stage-modified international prognostic index (sm-IPI) can better stratify the prognosis of elderly patients with stage Ⅰ DLBCL. The 3-year PFS rate was 48.7% in the high-risk group versus 85.7% in the low-risk group ( P<0.001). Conclusions:Our findings show that the elderly patients with stage Ⅰ DLBCL were predominantly characterized by extranodal involvement (particularly in the stomach and intestinal tract) and non-GCB subtype. Age ≥75 years and CCI ≥2 were identified as independent prognostic factors. The newly established sm-IPI-75-CCI incorporating these factors demonstrated superior prognostic discrimination compared to conventional risk assessment systems.

Objective To develop an evaluation system for quality palliative care and provide an evaluation tool for quality palliative care service.Methods A preliminary evaluation system was drafted by using literature review and group discussion,aligning with the U.S.National Consensus Project for Quality Palliative Care(NCP).The system was revised and refined by two rounds of Delphi consultation with 15 palliative care experts(including specialists in clinical practice,nursing management,nursing research and education)from Tier-IIIA hospitals in Guangdong Province.Indicator weights were determined via consensus.Results Both rounds of expert consultation achieved 100.00%response rates.Expert authority coefficient(Cr)was 0.855.The importance scores of the level-1,level-2 and level-3 indicators of the second round of expert consultation were 4.90-5.00,4.80-5.00 and 4.37-5.00,respectively.Coefficients of variation were 0-0.06,0-0.1 and 0-0.19,respectively.The full score ratio ranged between 0.93 and 1.00,0.8 and 1.00,and 0.67 and 1.00.Kendall's W coefficients were 0.214,0.287 and 0.245,respectively(all P<0.01).The nine level-1 indicators were identified as care structure and process,physiological care,psychological care,social care,mental care,cultural care,end-of-life care,ethical care and quality improvement,with the weight coefficients of 0.123,0.153,0.110,0.106,0.098,0.082,0.119,0.092 and 0.117,respectively.The final evaluation system for quality palliative care included 9 indicators in level-1,22 in level-2 and 69 in level-3.Conclusion The evaluation system for quality palliative care developed on the basis of NCP is scientifically innovative and valid in content.Further studies are required to evaluate its validity..

This paper explores the application and advancements of cross-cultural nursing concepts in the management of ICU patients. It identifies the core elements of humanistic care from a cross-cultural perspective, introduces relevant international research findings, and provides an in-depth analysis of existing challenges within the domestic healthcare context. Constructive suggestions are proposed to enhance the quality of life of ICU patients.

Objective:To construct a humanistic care nursing program for adult ICU patients, providing guidance for the clinical practice of humanistic care in ICUs.Methods:Based on a literature review and clinical practice experience, a preliminary humanistic care nursing program for adult ICU patients was drafted. From August to September 2024, the Delphi method was used to conduct two rounds of expert consultation with 16 experts to revise the content of each item and the overall program, resulting in the final version of the humanistic care nursing program for ICU adult patients. The experts' engagement was measured by the effective response rate of the questionnaires, their authority by the expert authority coefficient, and the coordination of expert opinions by the Kendall's coefficient of concordance.Results:The effective response rate for the Delphi expert consultation questionnaires was 100.00% (16/16) in both rounds. The expert authority coefficients were 0.872 and 0.875, respectively. After the second round of consultation, the Kendall's coefficients for the importance, applicability, and feasibility of each level of item ranged from 0.119 to 0.313 ( P<0.05). The final humanistic care nursing program for adult ICU patients included three first-level items, 12 second-level items, and 55 third-level items. Conclusions:The humanistic care nursing program for adult ICU patients constructed in this study is scientific, targeted, and feasible, providing guidance for the clinical practice of humanistic care in ICU settings.

Objective To develop an evaluation system for quality palliative care and provide an evaluation tool for quality palliative care service.Methods A preliminary evaluation system was drafted by using literature review and group discussion,aligning with the U.S.National Consensus Project for Quality Palliative Care(NCP).The system was revised and refined by two rounds of Delphi consultation with 15 palliative care experts(including specialists in clinical practice,nursing management,nursing research and education)from Tier-IIIA hospitals in Guangdong Province.Indicator weights were determined via consensus.Results Both rounds of expert consultation achieved 100.00%response rates.Expert authority coefficient(Cr)was 0.855.The importance scores of the level-1,level-2 and level-3 indicators of the second round of expert consultation were 4.90-5.00,4.80-5.00 and 4.37-5.00,respectively.Coefficients of variation were 0-0.06,0-0.1 and 0-0.19,respectively.The full score ratio ranged between 0.93 and 1.00,0.8 and 1.00,and 0.67 and 1.00.Kendall's W coefficients were 0.214,0.287 and 0.245,respectively(all P<0.01).The nine level-1 indicators were identified as care structure and process,physiological care,psychological care,social care,mental care,cultural care,end-of-life care,ethical care and quality improvement,with the weight coefficients of 0.123,0.153,0.110,0.106,0.098,0.082,0.119,0.092 and 0.117,respectively.The final evaluation system for quality palliative care included 9 indicators in level-1,22 in level-2 and 69 in level-3.Conclusion The evaluation system for quality palliative care developed on the basis of NCP is scientifically innovative and valid in content.Further studies are required to evaluate its validity..

This paper explores the application and advancements of cross-cultural nursing concepts in the management of ICU patients. It identifies the core elements of humanistic care from a cross-cultural perspective, introduces relevant international research findings, and provides an in-depth analysis of existing challenges within the domestic healthcare context. Constructive suggestions are proposed to enhance the quality of life of ICU patients.