Objective:To assess the safety and efficacy of thiotepa, busulfan, and etoposide (TBE) conditioning followed by autologous hematopoietic stem-cell transplantation (TBE auto-HSCT) in primary central nervous system lymphoma (PCNSL) patients.Methods:Clinical data from 27 PCNSL patients who received TBE auto-HSCT at the Fifth Medical Center of PLA General Hospital between November 1, 2021, and April 30, 2024, were retrospectively analyzed.Results:Twenty-seven patients [16 males, 11 females; median age 57 (23–72) years] were included, with 12 (44.4%, 12/27) over 60. Twenty-five had newly diagnosed PCNSL and 2 were relapsed. Median time from diagnosis to transplantation was 6.9 (5.0–10.0) months. TBE auto-HSCT increased complete remission (CR) rate from 63.0 to 96.3% ( P= 0.005), and 9 of 10 patients in partial remission achieving CR post-transplant. Median follow-up was 24.5 months (range 2.0–36.0). Two-year progress-free and OS rates were (87.2±6.9) % and (88.6±6.2) %, respectively. Common grade 3 nonhematologic adverse events were diarrhea (18.5%, 5/27) and bacterial infections (14.8%, 4/27). One patient (64 years old) died from carbapenem-resistant Enterobacteriaceae infection within 2 months post-transplant, yielding a 100-day treatment-related mortality of 3.7% (1/27) . Conclusion:TBE-conditioned high-dose chemotherapy with auto-HSCT is effective, safe, and well-tolerated in PCNSL patients, including the elderly.

Objective:To assess the safety and efficacy of thiotepa, busulfan, and etoposide (TBE) conditioning followed by autologous hematopoietic stem-cell transplantation (TBE auto-HSCT) in primary central nervous system lymphoma (PCNSL) patients.Methods:Clinical data from 27 PCNSL patients who received TBE auto-HSCT at the Fifth Medical Center of PLA General Hospital between November 1, 2021, and April 30, 2024, were retrospectively analyzed.Results:Twenty-seven patients [16 males, 11 females; median age 57 (23–72) years] were included, with 12 (44.4%, 12/27) over 60. Twenty-five had newly diagnosed PCNSL and 2 were relapsed. Median time from diagnosis to transplantation was 6.9 (5.0–10.0) months. TBE auto-HSCT increased complete remission (CR) rate from 63.0 to 96.3% ( P= 0.005), and 9 of 10 patients in partial remission achieving CR post-transplant. Median follow-up was 24.5 months (range 2.0–36.0). Two-year progress-free and OS rates were (87.2±6.9) % and (88.6±6.2) %, respectively. Common grade 3 nonhematologic adverse events were diarrhea (18.5%, 5/27) and bacterial infections (14.8%, 4/27). One patient (64 years old) died from carbapenem-resistant Enterobacteriaceae infection within 2 months post-transplant, yielding a 100-day treatment-related mortality of 3.7% (1/27) . Conclusion:TBE-conditioned high-dose chemotherapy with auto-HSCT is effective, safe, and well-tolerated in PCNSL patients, including the elderly.

Objective:This study investigated the efficacy and safety of denosumab (DENOS) versus zoledronic acid (ZOL) in the bone disease treatment of newly diagnosed multiple myeloma.Methods:The clinical data of 80 patients with myeloma bone disease (MBD) at the Fifth Medical Center of PLA General Hospital between March 1, 2021 and June 30, 2023 were retrospectively reviewed. Eighteen patients with severe renal impairment (SRI, endogenous creatinine clearance rate<30 ml/min) were treated with DENOS, and 62 non-SRI patients were divided into DENOS (30 patients) and ZOL group (32 patients) .Results:Hypocalcemia was observed in 26 (33%) patients, and 22 patients developed hypocalcemia during the first treatment course. The incidence of hypocalcemia in the non-SRI patients of DENOS group was higher than that in the ZOL group [20% (6/30) vs 13% (4/32), P=0.028]. The incidence of hypocalcemia in SRI was 89% (16/18). Multivariate logistic regression analysis revealed that endogenous creatinine clearance rate<30 ml/min was significantly associated with hypocalcemia after DENOS administration ( P<0.001). After 1 month of antiresorptive (AR) drug application, the decrease in the serum β-C-terminal cross-linked carboxy-telopeptide of collagen type I concentrations of SRI and non-SRI patients in the DENOS group were significantly higher than that in the ZOL group (68% vs 59% vs 27%, P<0.001). The increase in serum procollagen type Ⅰ N-terminal propeptide concentrations of patients with or without SRI in the DENOS group were significantly higher than that in the ZOL group (34% vs 20% vs 11%, P<0.05). The level of intact parathyroid hormone in each group increased after AR drug treatment. None of the patients developed osteonecrosis of the jaw and renal adverse events, and no statistically significant differences in the overall response rate, complete remission and stringent complete remission rates were found among the groups ( P>0.05), and the median PFS and OS time were not reached ( P>0.05) . Conclusions:In the treatment of MBD, DENOS minimizes nephrotoxicity and has strong AR effect. Hypocalcemia is a common adverse event but is usually mild or moderate and manageable.

Esophageal stent implantation is the most commonly used clinical treatment for malignant esophageal obstruction.Driven by several biotechnological advances,great progress has been made in the clinical application of esophageal stents in the past few years.Therefore,it is extremely important for interventional physicians to have a thorough understanding of the mechanical properties and material properties of various esophageal stents.More and more clinical evidences indicate that esophageal stents,especially 125I radioactive esophageal stent,possess exceptional targeted drug delivery capabilities,which enables the physicians to formulated an individualized diagnosis and treatment plan that is more suitable for the patient's situation,so as to significantly improve the therapeutic accuracy.This review aims to systematically introduce the respective advantages of different esophageal stents,to discuss the biggest problems faced in the current clinical work,and to summarize the latest advances in cancer treatment,including the fields of both basic experimental study and clinical research.This review also explicates the design ideas and working principles of various esophageal stents in detail,discusses the development prospect of stent surface modification technology such as covered stents and drug-eluting stents,and makes judgment of the effectiveness and safety of these types of stents in alleviating malignant esophageal obstruction.

Objective:This study aimed to evaluate the efficacy and safety of daratumumab as a maintenance treatment after autologous hematopoietic stem cell transplantation (auto-HSCT) in patients with newly diagnosed multiple myeloma (NDMM) .Methods:The clinical data, hematological and renal response, and safety of 15 post-transplant patients with NDMM who had received daratumumab maintenance between May 1, 2022 and June 30, 2023 were retrospectively analyzed.Results:Fifteen patients (11 males and 4 females) with a median age of 58 (41-72) years were included. Thirteen patients did not receive daratumumab during induction therapy and auto-HSCT, 6 patients had renal impairment, and nine patients had high-risk cytogenetics. The median infusion of daratumumab was 12 (6-17) times, and the median duration of maintenance was 6 (1.5-12) months. The treatment efficacy was evaluated in all 15 patients, and daratumumab maintenance therapy increased the rate of stringent complete response from 40% to 60%. The renal response rate and median estimated glomerular filtration rate of six patients with RI-NDMM were also improved. During daratumumab maintenance therapy, the most common hematological grade 3 adverse event (AE) was lymphopenia [4 of 15 patients (26.67%) ], whereas the most common nonhematologic AEs were infusion-related reactions [7 of 15 patients (46.67%) ] and grade 3 pneumonia [5 of 15 patients (33.33%) ]. The five patients with pneumonia were daratumumab naive [5 of 13 patients (38.46%) ], with a median of 8 (6-10) infusions. Among them, the chest computed tomography of three patients showed interstitial infiltrates, and treatment with methylprednisolone was effective. With a median follow-up of 12 months, the 1-year overall survival rate was 93.33%, and only one patient died (which was not related to daratumumab treatment) .Conclusions:Daratumumab was safe and effective as a maintenance agent for post-auto-HSCT patients with NDMM, and AEs were controllable. The most common nonhematologic AE was grade 3 pneumonia, and a less dose-intense maintenance regimen for the first 8 weeks could reduce the incidence of pneumonia.

Objective:The purpose of this paper is based on the concept of enhanced recovery after surgery, to discuss the timing of taking food and water in knee arthroplasty patients, as well as its feasibility and safety, so as to improve the quality of quality nursing services.Methods:The 226 knee arthroplasty patients in Luoyang Orthopedic-Traumatological Hospital (Henan Provincial Orthopedic Hospital) from September 2020 to November 2021 were selected and divided into a control group and a experimental group using the random number table method, with 113 cases in each group. The control group adopted a conventional postoperative feeding management method; the experimental group adopted the early and timely feeding management method after comprehensive assessment. The data were compared between the two groups, including the incidence and severity of postoperative nausea and vomiting within 6 h and from 6 to 24 h after surgery , the incidence of thirst and hunger at 2 h, 4 h and 6 h postoperatively, and the comfort level.Results:The incidence of postoperative nausea and vomiting was lower in the experimental group [19.5%(22/113), 13.3%(15/113)] than in the control group [32.7%(37/113), 23.9%(27/113)] within 6 h and from 6 to 24 h after surgery, and the severity (21 cases of gradeⅠ, 10 cases of gradeⅡand 6 cases of grade Ⅲ) was also lower than in the control group (17 cases of gradeⅠ, 29 cases of gradeⅡand 18 cases of grade Ⅲ), and the differences were all statistically significant ( χ2 = 5.16,4.21, Z = -2.72, P<0.05). The incidence of thirst were lower in the experimental group [14.2%(16/113), 8.0%(9/113), 2.7%(3/113)] than in the control group [26.5%(30/113), 29.2%(33/113), 40.0%(35/113) at 2 h, 4 h and 6 h postoperatively, and the incidence of hunger at 4 h and 6 h postoperatively [11.5%(13/113), 8.0%(9/113)] were lower than in the control group [32.7%(37/113), 34.5%(39/113)], with statistically significant differences ( χ2 values were 5.35 to 32.39, all P<0.05). The postoperative comfort scale scores of physiological (31.04 ± 1.00) and psychological (33.50 ± 1.45) were higher in the experimental group than in the control group (27.46 ± 1.78) and (31.37 ± 1.29), and the differences were statistically significant ( t values were -102.36 to -66.26, all P<0.05). Conclusions:Early postoperative feeding management at the right time reduces the incidence and severity of postoperative nausea and vomiting inknee arthroplasty patients. In addition, it can also reduce the incidence of thirst and hunger, and improve patients′ postoperative physiological and psychological comfort, which has a facilitating effect on achieving rapid recovery of patients.

Objective:To investigate the variation characteristics and influencing factors of HIV/AIDS subtypes in Wuxi city of Jiangsu Province from 2014 to 2016.Methods:HIV/AIDS population in Wuxi city in 2014 was selected as the research object, and the HIV molecular epidemiology and follow-up study were carried out. Collect epidemiological information, extract DNA from blood samples, amplify pol gene fragment by nest-PCR and sequence, use ChromasPro 1.6 software and MEGA 7.0 software to construct the HIV-1 sequence database, and use FastTree2.1.10 software to construct the phylogenetic tree to confirm the subtype; in 2016, the same population was followed up, and the HIV subtype variation was analyzed, and the influencing factors of subtype variation were explored by multivariate logistic regression. Results:A total of 612 HIV/AIDS cases in 2014 and 2016 were collected. The age of the subjects was mainly 30 years old or above (85.46%, 523/612), and the proportion of people over 50 years old was higher (228/612, 37.25%). The main route of transmission was homosexuality, accounting for 49.67%. A total of 1224 samples were detected and CRF01 _ AE、CRF07_ BC、B、CRF08_ BC、CRF67_ 01B、CRF55_ 01B、CRF68_ 01B, 7 subtypes of HIV-1 and 5 unique recombinant types (URFs) was detected. CRF01_ AE and CRF07_ BC was still the main genotype in Wuxi, Jiangsu Province, accounting for 66.75%. There were 29 cases (3.56%) of URFs recombinant strains. During 2014-2016, the variation rate of subtypes was 14.63%, and the most common variation was CRF01_ AE changes to CRF07_ BC(13.95%). Marital status (OR=0.363, 95% CI: 0.137-0.964) and baseline CD4 level (OR=0.414, 95% CI: 0.192-0.891) were associated with subtype variation.Conclusions:The HIV-1 subtypes of HIV/AIDS patients in Wuxi city are diverse and complex, the proportion of recombinant subtypes is rising, the URFs that are difficult to determine the genotype increase significantly, and the variation rate of HIV-1 subtypes among HIV/AIDS infected people is high. It is necessary to strengthen the monitoring of HIV-1 subtypes.

Objective To understand the distribution of HIV-1 subtype in Wuxi city,to predict the local HIV-1 epidemics.Methods Samples were collected from the'CD4+T lymphocyte monitoring cohort study'in Wuxi from April 2013 to July 2016.HIV-1 gene was amplified,sequenced and with HIV-1 sequence database constructed,using both the ChromasPro 1.6 and MEGA 7.0 softwares.Bayesian phylogenetic inference was used to rebuild the history of HIV-1 transmission,while BEAST 1.7.2 and FastTree 2.1.10 software were used for data analysis.Statistical analysis using SPSS 22.0 software.Results Among the 205 subjects of HIV-1 infection,32.68％(67/205) of them were over 50 years old.Seven subtypes (including CRF01_AE,CRF07_BC,CRF67_01B,B,CRF08_BC,CRF68_0B,CRF78_cpx) and one of the unique recombinant forms (URFs) were detected.The main subtypes were CRF01_ AE (51.67％,93/180) and CRF07_BC (17.22％,31/180).Differences between subtypes and ways of transmission were statistically significant (x2=16.99,P≤0.05).The proportion of CRF67_01B (12.78％,23/180) was higher than before.Results from Bayesian phylogenetic inference analysis showed that the evolution rate was 2.29 × 10-3 and Time to the Most Recent Common Ancestor (tMRCA) was 2 003.10.CRF67_01B was probably related to the reference strains from Jiangsu and Anhui provinces,and had been spreading in Wuxi since 2003.Conclusions HIV-1 subtypes seemed complex and diverse in Wuxi city in 2013-2016,with CRF67_01B being pervasive.Continuous molecular monitor program was still needed to provide reference for the prediction of epidemics,from the molecular perspective.

Objective To study the mechanical properties and degradation behavior of biodegradable silicon-covered magnesium alloy stent in vitro,to investigate the technical feasibility of its implantation into rabbit esophagus and to observe the tissue reaction in vivo.Methods The mechanical compression recovery properties and the degradation behavior of biodegradable silicon-covered magnesium alloy stent were tested in vitro.A total of 30 healthy Holland rabbits were randomly divided into silicon-covered magnesium alloy stent group (n=15) and control group (n=15).For rabbits in the silicon-covered magnesium alloy stent group fluoroscopy-guided insertion of the stent into the lower third segment of esophagus was conducted,while for rabbits in the control group no intervention was adopted.One,2 and 4 weeks after the implantation of the stent,esophagography was performed for all rabbits of both groups,and each time every 5 rabbits from both groups were sacrificed,the specimens were collected and sent for histological examinations.Results In vitro test indicated that biodegradable silicon-covered magnesium alloy stent had good flexibility and elasticity,and in phosphate-buffered saline with pH 4.0 or pH 7.4 it degraded more slowly than bare magnesium alloy stent.In vivo test showed that the stent implantation could be well tolerated by all experimental rabbits.Before stent insertion the esophageal diameter was(9.2±0.8) mm,and at one,2 and 4 weeks after stent insertion the esophageal diameters were (9.7±0.7) mm,(9.6±0.8) mm and (9.6±0.5) mm respectively (P＞0.05).In the silicon-covered magnesium alloy stent group,stent displacement occurred in 6 rabbits in one week (n=l),2weeks (n=1) and 4 weeks (n=4).After stent implantation,the tissue reactions such as esophageal wall injury,collagen deposition,etc.were not obviously different from those in the control group (P＞0.05).Conclusion It is technically feasible to insert silicon-covered magnesium alloy stent into the rabbit's esophagus,the stent can provide sufficient support for at least 2 weeks,the stent displacement rate is low and acceptable,and no severe esophageal wall injury and collagen deposition are observed.