Objective·To investigate the efficacy and safety of a dose-reduced,all-oral lenalidomide/melphalan/prednisone acetate(RMP)regimen in elderly and frail patients with newly diagnosed multiple myeloma(NDMM).Methods·Elderly and frail NDMM patients who visited the Department of Hematology of Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,and the Third People's Hospital of Kunshan from April 2018 to March 2024 were retrospectively included.Clinical data and laboratory indicators were collected,and all patients were treated with the RMP regimen.SPSS 27.0 and R software were used for statistical analysis.Independent t-test was applied to normally distributed quantitative data,Mann-Whitney U test to non-normally distributed quantitative data,and x2 test and Fisher's exact probability method to qualitative data.Kaplan-Meier survival curves and Log-rank test were used for survival analysis.Results·Among the 22 elderly and frail NDMM patients treated with RMP,the median age was 76.3(68.4,95.0)years,and the median follow-up time was 25.5 months.The overall response rate(ORR)was 68.2%,and the rate of≥very good partial response(VGPR)was 36.4%.The median progression-free survival(PFS)was 20.53 months.The median PFS in the≤75-year-old group was 25.23(95%CI 12.95?37.52)months,while in the>75-year-old group it was 18.23(95%CI 14.86?21.61)months.There was no significant difference between the two groups.The median PFS in the≥partial response(PR)group was 20.67(95%CI 13.57?27.76)months,and in the

Objective:To investigate disease characteristics of patients with psoriatic arthritis (PsA) based on the PsA cohort in West China Hospital, so as to provide a reference for clinicians in its diagnosis, treatment, and evaluation strategy formulation.Methods:A cross-sectional study was carried out, and a descriptive analysis was conducted on clinical data from PsA patients who were treated at the Department of Dermatology, West China Hospital, Sichuan University between April 2, 2020, and January 21, 2025. Demographic characteristics, clinical manifestations, laboratory and imaging findings, and treatment modalities were analyzed.Results:A total of 530 PsA patients were included, of whom 332 (62.6%) were males and 198 (37.4%) were females, with ages of 44.1 ± 12.4 years. Skin lesions preceded joint symptoms in 452 patients (85.3%), with time intervals ( M [ Q1, Q3]) of 8.0 (3.0, 15.0) years. Overweight or obesity was observed in 319 patients (60.2%), and 188 (35.5%) had comorbid fatty liver. Peripheral joint involvement was common (485 cases, 91.5%), with the proximal interphalangeal joints being most frequently affected by tenderness (172 cases, 35.5%) and swelling (119 cases, 24.5%) ; the number of enthesitis cases identified by ultrasonography (116 cases, 23.9%) was significantly higher than that by clinical examination (82 cases, 15.5%) ; axial joint involvement was observed in 258 patients (48.7%), with the sacroiliac joints most commonly affected (201 cases, 77.9%). Regarding treatment, conventional systemic drugs were predominant in the treatment of psoriasis prior to the diagnosis of PsA; after the diagnosis of PsA, the number of patients receiving targeted therapies increased to 334 (63.0%), with interleukin-17 inhibitors being the most common (140 cases, 26.4%), followed by tumor necrosis factor-α inhibitors (106 cases, 20.0%) and Janus kinase inhibitors (39 cases, 7.4%) . Conclusions:PsA predominantly affects males over 40 years old and is characterized by preceding skin lesions, delayed diagnosis, and multiple comorbidities. High-frequency ultrasound has advantages in the early detection of peripheral enthesitis. Further attention is needed for managing comorbidities such as fatty liver and obesity-related metabolic conditions.

Objective·To investigate the efficacy and safety of a dose-reduced,all-oral lenalidomide/melphalan/prednisone acetate(RMP)regimen in elderly and frail patients with newly diagnosed multiple myeloma(NDMM).Methods·Elderly and frail NDMM patients who visited the Department of Hematology of Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,and the Third People's Hospital of Kunshan from April 2018 to March 2024 were retrospectively included.Clinical data and laboratory indicators were collected,and all patients were treated with the RMP regimen.SPSS 27.0 and R software were used for statistical analysis.Independent t-test was applied to normally distributed quantitative data,Mann-Whitney U test to non-normally distributed quantitative data,and x2 test and Fisher's exact probability method to qualitative data.Kaplan-Meier survival curves and Log-rank test were used for survival analysis.Results·Among the 22 elderly and frail NDMM patients treated with RMP,the median age was 76.3(68.4,95.0)years,and the median follow-up time was 25.5 months.The overall response rate(ORR)was 68.2%,and the rate of≥very good partial response(VGPR)was 36.4%.The median progression-free survival(PFS)was 20.53 months.The median PFS in the≤75-year-old group was 25.23(95%CI 12.95?37.52)months,while in the>75-year-old group it was 18.23(95%CI 14.86?21.61)months.There was no significant difference between the two groups.The median PFS in the≥partial response(PR)group was 20.67(95%CI 13.57?27.76)months,and in the

OBJECTIVE: To explore the effects of different endotracheal tube cuff pressure management modes on cuff sealing and the pressure exerted on the tracheal wall. METHODS: A prospective self-controlled study was conducted. Eleven patients undergoing endotracheal intubation and mechanical ventilation with an automatic airway management system (AGs) admitted to the Second Medical Centre of the Chinese People's Liberation Army General Hospital from October 1, 2020, to April 1, 2022, were enrolled as the study subjects. Within 24 hours after the establishment of artificial airway and mechanical ventilation, four cuff pressure management modes were randomly applied to each patient for 24 hours in sequence: automatic cuff pressure management mode [modeI: the safe range of cuff pressure was set at 20-35 cmH₂O (1 cmH₂O≈0.098 kPa), and the CO₂ pressure above the endotracheal tube cuff was automatically detected by AGs every 5 minutes to determine the cuff sealing status, and the cuff pressure was automatically adjusted], constant cuff pressure (25 cmH₂O) management mode (mode II: the cuff pressure was monitored by AGs through a pressure sensor, and the cuff pressure was maintained at 25 cmH₂O via a pressure pump), constant cuff pressure (30 cmH₂O) management mode (mode III: the cuff pressure was monitored by AGs through a pressure sensor, and the cuff pressure was maintained at 30 cmH₂O via a pressure pump), and manual cuff pressure management mode (mode IV: the cuff pressure was manually measured by nurses every 6-8 hours using a cuff pressure gauge to keep the cuff pressure at 25-30 cmH₂O after inflation). The CO₂ pressure above the endotracheal tube cuff (at 60-minute intervals) and the cuff pressure changes (at 50-ms intervals) were recorded to compare the differences in number of cuff leaks [no leak was defined as CO₂ pressure = 0, small leak as 0 < CO₂ pressure < 2 mmHg (1 mmHg≈0.133 kPa), and large leak as CO₂ pressure ≥ 2 mmHg] and cuff pressure among modesI-IV. RESULTS: A total of 24 CO₂ pressure measurements were taken per patient across the four modes, resulting in a total of 264 detections for each mode. Regarding the cuff leak, the total number of leak and large leak in modeIwas significantly lower than that in modes II-IV [total leak: 30 cases (11.36%) vs. 81 cases (30.68%), 70 cases (26.52%), 103 cases (39.02%); large leak: 15 cases (5.68%) vs. 50 cases (18.94%), 48 cases (18.18%), 66 cases (25.00%), all P < 0.05]. There was no significant difference in the number of cuff leak between modes II and III, and mode IV had the most severe cuff leak. In terms of cuff pressure, since mode IV required blocking the cuff tube from the AGs tube and the AGs cuff pressure management module did not actually work, real-time monitoring of cuff pressure was not possible. Therefore, cuff pressure changes were only analyzed in modes I-III. Each of the 11 patients underwent 24-hour cuff pressure monitoring under modes I-III, with 19 008 000 monitoring times for each mode. The cuff pressure in mode I was between that in modes II and III [cmH₂O: 27.09 (26.10, 28.14) vs. 26.60 (25.92, 27.47), 31.01 (30.33, 31.88), both P < 0.01]. Moreover, the number of extreme values of cuff pressure > 50 cmH₂O in mode I was significantly lower than that in modes II and III [19 900 cases (0.105%) vs. 22 297 cases (0.117%), 27 618 cases (0.145%), both P < 0.05]. CONCLUSION Dynamically monitoring the CO₂ pressure above the cuff to guide the adjustment of endotracheal tube cuff pressure can achieve better cuff sealing with a relatively lower cuff pressure load.
Humans ; Intubation, Intratracheal/instrumentation* ; Pressure ; Prospective Studies ; Respiration, Artificial ; Male ; Airway Management/methods* ; Female ; Middle Aged

Objective : To analyze the differential expression profile of miRNAs in amniotic fluid exosomes of fetu- ses with Down syndrome (DS) and provide insights for identifying novel biomarkers for the prenatal diagnosis of DS . Methods : Amniotic fluid samples were collected from fetuses with DS and chromosomally normal fetuses . Exo- somes were isolated from the amniotic fluid and subjected to high-throughput sequencing. Differentially expressed miRNAs were identified , and target genes were predicted using TargetScan and miRanda. Target genes located on chromosome 21 were selected , and their biological functions and associated diseases were analyzed using Gene- Cards , HGNC , NCBI Gene , UniProtKB/Swiss-Prot , Ensembl , and OMIM databases . GO and KEGG enrichment analyses were performed to investigate the biological functions of the enriched genes . Results : A total of 59 differ- entially expressed miRNAs were identified , including 31 upregulated and 28 downregulated miRNAs . Based on a fold change > 2 and P < 0. 05 , 10 upregulated and 9 downregulated miRNAs with the highest expression levels were selected . Key miRNAs included hsa-let-7b-5p , hsa-let-7c-5p , hsa-let-7b-3p _ 1ss22CT , and hsa-miR-199b-5p , with BACH1 and IFNAR1 identified as their shared target genes . GO analysis revealed that the enriched target genes were primarily involved in protein binding , metal ion binding , transferase activity , DNA binding , transcriptional regulation by RNA polymerase Ⅱ , and nucleotide binding. KEGG pathway analysis indicated that the target genes were mainly associated with metabolic pathways , cancer-related pathways , the PI3K-Akt signaling pathway , and the Rap1 signaling pathway . Conclusion Differential expression of miRNAs in amniotic fluid exosomes was ob- served between DS fetuses and those with normal karyotypes . Combined analysis with placental miRNAs revealed hsa-miR-199b-5p as a common differentially expressed miRNA in both DS amniotic fluid and placenta. It is hypoth- esized that BACH1 and IFNAR1 , shared target genes of hsa-miR-199b-5p , hsa-let-7b-5p , hsa-let-7c-5p , and hsa- let-7b-3p_1ss22CT , may play a role in the pathogenesis of DS .

Objective:To explore the diagnostic value of high-frequency ultrasound and mobile digital X-ray in neonatal necrotizing enterocolitis(NEC)and the consistency in staging of NEC,in order to provide reference for early clinical diagnosis and targeted intervention measures.Methods:The clinical data of 84 suspected NEC neonates(with abdominal distension,vomiting,bloody stool,etc.)who were treated in our hospital from Mar 2023 to Mar 2024 were retrospectively analyzed.After admission,they were all examined by high-frequency ultrasound and mobile digital X-ray,and the clinical comprehensive diagnosis(combining clinical symptoms,laboratory indicators,surgical pathology)results were used as the"gold standard"to compare the diagnostic results and efficacy of high-frequency ultrasound and mobile digital X-ray examinations alone and in combination for NEC.The consistency between the diagnostic results of the two methods for different stages of NEC and the clinical comprehensive diagnosis results was analyzed using Kappa value.Results:The comprehensive clinical diagnosis results showed that among 84 suspected NEC neonates,56 were positive and 28 were negative.Among the 56 cases of NEC,20 cases were in stageⅠ,25 cases in stageⅡ,and 11 cases in stage Ⅲ.The results of mobile digital X-ray examination showed that 43 were positive and 41 were negative.The results of high-frequency ultrasound examination showed that 45 were positive and 39 were negative.The results of high-frequency ultrasound combined with mobile digital X-ray diagnosis showed that 55 were positive and 29 were negative.The sensitivity and accuracy of high-frequency ultrasound combined with mobile digital X-ray examination for NEC diagnosis were higher than those of high-frequency ultrasound examination or mobile digital X-ray examination alone(P＜0.05).Moreover,the missed diagnosis rate of the combined detection was lower(P＜0.05).The results of mobile digital X-ray diagnosis showed that there were 17 cases in stageⅠ,16 cases in stage Ⅱ,and 10 cases in stage Ⅲ.The consistency Kappa value with the comprehensive clinical diagnosis results was 0.618(P＜0.01).The results of high-frequency ultrasound diagnosis showed that there were 17 cases in stage Ⅰ,18 cases in stage Ⅱ,and 10 cases in stage Ⅲ.The consistency Kappa value was 0.701(P＜0.01).The results of high-frequency ultrasound combined with mobile digital X-ray diagnosis showed that there were 20 cases in stage Ⅰ,23 cases in stage Ⅱ,and 12 cases in stage Ⅲ.The consistency Kappa value was 0.886(P＜0.01).Conclusion:High-frequency ultrasound combined with mobile digital X-ray can improve the diagnostic accuracy of NEC,and can be used clinically to assess the stage of NEC early,providing a reference for early clinical evaluation and diagnosis,as well as targeted intervention treatment plans.

Objective:To discuss the pay equity of operating room nurses in public hospitals and provide reference for promoting the salary performance reform of operating rooms.Methods:Using purposive sampling method, 22 cases of operating room nurses from 8 public hospitals in Sichuan Province were selected for semi-structured in-depth interviews from December 2023 to May 2024, and the themes were summarized and distilled by Colaizzi phenomenological data analysis.Results:Twenty-two operationg room nurses were interviewed, 6 males and 16 females with 25-55 years old. The sense of pay equity of operating room nurses was refined into 3 themes and 8 subthemes: ① sense of distributional equity: different representative groups have different views on the basic salary of the position, demand attention to the difference between different subspecialty surgeries, explicit the value embodiment of professional ability, and support for learning and growth; ②sense of procedural equity: the pay policy reflects the interests of the majority of the nurses, and the right to have a say in and ask questions about the pay policy; ③sense of interactive equity: explain the rationale for the pay policy information, focusing on nurses′feelings and perceptions.Conclusions:The sense of fairness of nurses in the operating rooms of public hospitals is expressed in the results of the distribution of subspecialty surgical work, the process of salary decision-making, and the sense of fairness in the interaction between supervisors and subordinates. Nursing managers should pay attention to the reasonable distribution of the pay-earnings ratio of the salaries of nurses in the operating rooms, safeguard the rights of nurses in the process of salary distribution, and pay attention to the sense of the operating room nurses in the implementation of the process or in deciding the results in order to enhance their fairness psychology.

Objective To investigate the effect of drug-eluting bead DACE(DEB-TACE)combined with systemic treatment for hepatocellular carcinoma(HCC)in different locations.Methods A total of 204 HCC patients who underwent DEB-TACE combined with systemic therapy(targeted and immunotherapy)were retrospectively collected.According to the anatomical location of HCC,86 cases with lesions located at the main trunk of portal vein(PV)or within 1 cm of the first PV branch were classified into central type group,while 118 cases with lesions located at the other areas were classified as peripheral type group.Follow-up was regularly performed after DEB-TACE until August,2024.The objective response rate(ORR)and disease control rate(DCR)at 1,3,6 and 12 months after DEB-TACE,also patients'progression-free survival(PFS)and overall survival(OS)were compared between groups.Results All patients were followed up for a median of 32.6 months,during which 164 cases died.Significant differences of ORR at 1 and 3 months after DEB-TACE(77.91％[67/86]vs.89.83％[106/118],34.88％[30/86]vs.54.24％[64/118])and DCR at 3 and 6 months after DEB-TACE(51.16％[44/86]vs.66.95％[79/118],34.88％[30/86]vs.50.00％[59/118])were found between groups(all P＜0.05).Patients'PFS(30.18[9.12,48.54]months)and OS(37.36[17.79,56.68])in peripheral type group were better than those in central type group(20.11[11.35,28.87]months and 23.24[3.11,43.47]months,x2=3.971,4.162,P=0.048,0.041).Conclusion The effect of DEB-TACE combined with systemic treatment for peripheral type HCC was better than for central type HCC.

Objective:To explore the diagnostic value of high-frequency ultrasound and mobile digital X-ray in neonatal necrotizing enterocolitis(NEC)and the consistency in staging of NEC,in order to provide reference for early clinical diagnosis and targeted intervention measures.Methods:The clinical data of 84 suspected NEC neonates(with abdominal distension,vomiting,bloody stool,etc.)who were treated in our hospital from Mar 2023 to Mar 2024 were retrospectively analyzed.After admission,they were all examined by high-frequency ultrasound and mobile digital X-ray,and the clinical comprehensive diagnosis(combining clinical symptoms,laboratory indicators,surgical pathology)results were used as the"gold standard"to compare the diagnostic results and efficacy of high-frequency ultrasound and mobile digital X-ray examinations alone and in combination for NEC.The consistency between the diagnostic results of the two methods for different stages of NEC and the clinical comprehensive diagnosis results was analyzed using Kappa value.Results:The comprehensive clinical diagnosis results showed that among 84 suspected NEC neonates,56 were positive and 28 were negative.Among the 56 cases of NEC,20 cases were in stageⅠ,25 cases in stageⅡ,and 11 cases in stage Ⅲ.The results of mobile digital X-ray examination showed that 43 were positive and 41 were negative.The results of high-frequency ultrasound examination showed that 45 were positive and 39 were negative.The results of high-frequency ultrasound combined with mobile digital X-ray diagnosis showed that 55 were positive and 29 were negative.The sensitivity and accuracy of high-frequency ultrasound combined with mobile digital X-ray examination for NEC diagnosis were higher than those of high-frequency ultrasound examination or mobile digital X-ray examination alone(P＜0.05).Moreover,the missed diagnosis rate of the combined detection was lower(P＜0.05).The results of mobile digital X-ray diagnosis showed that there were 17 cases in stageⅠ,16 cases in stage Ⅱ,and 10 cases in stage Ⅲ.The consistency Kappa value with the comprehensive clinical diagnosis results was 0.618(P＜0.01).The results of high-frequency ultrasound diagnosis showed that there were 17 cases in stage Ⅰ,18 cases in stage Ⅱ,and 10 cases in stage Ⅲ.The consistency Kappa value was 0.701(P＜0.01).The results of high-frequency ultrasound combined with mobile digital X-ray diagnosis showed that there were 20 cases in stage Ⅰ,23 cases in stage Ⅱ,and 12 cases in stage Ⅲ.The consistency Kappa value was 0.886(P＜0.01).Conclusion:High-frequency ultrasound combined with mobile digital X-ray can improve the diagnostic accuracy of NEC,and can be used clinically to assess the stage of NEC early,providing a reference for early clinical evaluation and diagnosis,as well as targeted intervention treatment plans.