Objective:To investigate the attributes and influencing factors of care needs for maternal after perinatal loss, and to provide a reference for promoting maternal physical and mental health and improving the quality of care.Methods:From February to June of 2023, a cross-sectional study was used, 222 maternal after perinatal loss were selected by the convenience sampling method and completed a battery of questionnaires, including a general information questionnaire, the Distress Thermometer (DT), the Perceived Social Support Scale (PSSS), the Attitudes Toward Seeking Professional Psychological Help Scale-Short Form (ATSPPH-SF) and Kano Model-based Questionnaire on Care Needs for Maternal after Perinatal Loss.Results:A total of 207 maternal after perinatal loss were included in the complete data, (31.12±4.55) years old, (68.64 ± 10.70) of PSSS, (16.10 ± 3.43) of ATSPPH-SF. The care needs for maternal after perinatal loss included 4 must-be quality, 8 one-dimensional quality and 13 attractive quality. Multiple linear regression analysis showed that education level ( t=2.28), the PSSS score ( t=2.15) and the ATSPPH-SF score ( t=3.94) were the main influencing factors of care needs for maternal after perinatal loss (all P<0.05). Conclusions:Health care professionals should gradually improve the nursing service system according to the priority division of care needs attributes of maternal after perinatal loss, and develop personalized care according to different influencing factors.

Objective:To explore the status quo and influencing factors of postnatal sense of security in patients with hypertensive disorder complicating pregnancy.Methods:This study was a cross-sectional study. Using the convenience sampling method, a total of 215 patients with hypertensive disorder complicating pregnancy and their spouses who gave birth in Women's Hospital of Nanjing Medical University from December 2022 to May 2023 were selected as the research objects. The general data questionnaire, Parents' Postnatal Sense of Security (PPSS), Ego-Resiliency Scale (ERS) and Perceived Social Support Scale (PSSS) were used to investigate them. Multiple linear regression analyses were used to explore the factors influencing postpartum security in patients with hypertensive disorders complicating pregnancy.Results:A total of 215 questionnaires were sent out in this study, and 202 were effectively collected, with an effective recovery rate of 94.0%. The total score of PPSS maternal version for 202 patients with hypertensive disorder complicating pregnancy was (59.32±6.81), while the total score of PPSS paternal version for spouses was (41.28±5.24). The results of multiple linear regression analysis showed that the number of antenatal examinations accompanied by family members, the effect of postpartum blood pressure control, the current state of mother and child, postnatal sense of security of spouse, ego-resiliency and perceived social support were the influencing factors of postnatal sense of security in patients with hypertensive disorder complicating pregnancy ( P<0.05) . Conclusions:The postnatal sense of security in patients with hypertensive disorder complicating pregnancy is at a medium high level. Medical personnel should focus on patients with hypertensive disorder complicating pregnancy who are accompanied by their family members less times, poor postpartum blood pressure control and postpartum separation from mother and child, providing them with targeted clinical care to improve their postnatal sense of security.

Objective:To investigate the status of grief among maternal spouse after perinatal loss, and analyze its influencing factors, so as to provide some reference for male grief supporting strategic.Methods:Using the convenient sampling method, 180 male spouses of hospitalized women in the Department of Obstetrics from Nanjing Maternity and Child Health Care Hospital from March to October 2022 were recruited. A cross-sectional survey was conducted by the general questionnaire, the Perinatal Grief Scale, the Family Adaptability and Cohesion Scale Ⅱ-Chinese Version, the Social Support Rating Scale, and the Simplified Coping Style Questionnaire.Results:The overall score of the Perinatal Grief Scale in male spouses of women who experienced a perinatal loss was (61.57 ± 14.14) points. The score of the Family Adaptability and Cohesion Scale Ⅱ-Chinese Version was (121 ± 14.42) points, the score of the Social Support Rating Scale was (34.23 ± 7.21) points, and the score of the Simplified Coping Style Questionnaire was (36.08 ± 7.64) points. Multiple linear regression analysis showed that participation in fetal interaction, loss of fetal age, social support and family adaptability were the main factors affecting male grief ( P<0.05). Conclusions:The grief among male spouses of women who experienced a perinatal loss is at a low level. The clinical medical staff can refer to the influencing factors and implement effective support, such as respecting the male's father status, coordinating social support resources, and improving the family's coping ability, in order to alleviate men's grief and help them return to normal life.

Objective:To investigate the clinical features,therapeutic methods,therapeutic efficacy,and prognostic characteristics of older patients with acute myeloid leukemia(AML).Methods:We collected data from 134 older patients with AML treated at Peking University International Hospital between January 2015 and February 2023.White blood cell count,bone marrow primitive cell count,cytogen-etic and molecular characteristics,and European LeukemiaNet(ELN)risk stratification at initial diagnosis were retrospectively ana-lyzed.Patients were assigned into two groups according to treatment plan―high-intensity chemotherapy and low-dose treatment―to determine whether intensive chemotherapy would yield survival benefits during treatment and the factors affecting survival.Results:Among 36 patients treated with high-intensity chemotherapy,22(61.1%)achieved complete response(CR);among 90 treated with low-intensity therapy,46(51.1%)achieved CR;and among 19 treated with azacitidine(AZA)+ venecra(VEN),14(73.7%)achieved CR.Medi-an overall survival(OS)was 15 months for high-intensity chemotherapy and 14.5 months for low-intensity treatment(P=0.226).According to ELN risk stratification,patients in the low,medium,and high risk groups exhibited OS of 18,14,and 9 months,respectively(P=0.009).OS for high-intensity chemotherapy and low-dose therapy was 22 and 15 months in the low-risk group(P=0.745),9 and 15 months in the medium-risk group(P=0.783),and 9 and 8 months in the high-risk group(P=0.739),respectively.Patients in the intensive chemotherapy group(n=36)had an OS of 15 and 17 months(P=0.689)compared with AZA+VEN treatment(n=19).The prognosis of six patients with TP53 mutation was significantly worse than those without the mutation,and the median OS was 2 months and 14 months,respectively(P=0.004).One-and 3-year survival rates for the low-,medium-and high-risk groups were 79%,53%,and 44%,and 41%,20%,and 3%,respectively.Multivariate analysis revealed that high peripheral blood white blood cell count(P=0.034),ELN risk stratification(P=0.002),and complications(P=0.017)were correlated with OS,while treatment intensity,age,sex,and bone marrow primitive cell count were not significantly correlated with OS.Conclusions:High-intensity chemotherapy did not yield a significant survival benefit in older patients with AML;however,this result needs to be confirmed in patients at low risk.Patients with TP53 mutations had a poor prognosis.Multivariate analyses revealed that baseline mo-lecular characteristics,leukocyte count,and comorbidities were more important than treatment intensity in predicting survival among older patients with AML.

Objective To describe the status of the post-discharge coping difficulties in women with hypertensive disorders of pregnancy(HDP),and to explore its influencing factors.Methods A total of 280 women with HDP from a tertiary A maternity hospital in Nanjing City were investigated with the general information questionnaire,the post-discharge coping difficulty scale-new mother form,the readiness for hospital discharge study-new mother form,the family APGAR index.The factors influencing post-discharge coping difficulties in women with HDP were analyzed using univariate analysis and multiple linear regression.Results 238 valid questionnaires were collected,with a response rate of 85.0%.The score of the post-discharge coping difficulties in women with HDP was 5.07±1.69,which is at a middle level.The results of multiple linear regression analysis showed that parity,primary caregiver during the postpartum period,HDP type,readiness for hospital discharge,family APGAR index were influencing factors of post-discharge coping difficulties in women with HDP(P＜0.05).Conclusion Post-discharge coping difficulties in women with HDP remains to be further improved,and it is affected by many factors.Medical staff should pay more attention to post-discharge coping difficulties of such parturients,formulate targeted continuation care programs according to relevant influencing factors,comprehensively improve their coping ability,and reduce their coping difficulties after discharge.

Objective:To summarize the scope of relevant research on the psychological state of parents during perinatal loss of re-pregnancy, and summarize the research status, so as to provide reference for future research and intervention.Methods:From the establishment of the database to December 2020, the literatures of China biomedical literature database, China Knowledge Network, VIP, Wanfang database, Medline, CINAHL, Web of Science, psychINFO and Cochrane Library were searched, the studies related to the psychological state, feelings and experience of the population were screened, and the JBI scope Review Guide was used as the methodological framework for analysis.Select the research related to the psychological state, feelings and experience of the population, and use the JBI scope review guide as the methodological framework for analysis.Results:Finally, 25 literatures were included, including 11 qualitative studies and 14 quantitative studies. Perinatal loss leads to an increased risk of psychological diseases when parents were re-pregnants, facing a complex mixture of new hope and uncertainty, and fathers were even more troubled by dual identity, but some parents could still benefit from perinatal loss.Conclusions:At present, China is lack of attention to the parents of perinatal loss of re-pregnancy. Medical staff should respect the differences of parents′ emotional expression, formulate targeted intervention measures, reduce the negative impact of perinatal loss, and guide the generation of positive psychology of the parents of re pregnancy.

Objective:To explore the clinical phenotype and genotype of a family with hereditary hypofibrinogenemia.Methods:Activated partial thrombin time (APTT), prothrombin time (PT),thrombin time (TT) and thrombelastogram (TEG) were tested in all family members. Fibrinogen activity and antigen were detected by Clauss method and immunoturbidimetric method respectively. All exons and flanking sequences of fibrinogen FGA,FGB,FGG genes were analyzed by PCR, and the products were subjected to Sanger sequencing.Results:The proband represented prolonged PT and TT, low Fg activity and antigen, elevated K value and decreased Angle value in TEG. Other family members reported similar changes including proband′s father,daughter and son, and his elder brother and his niece. Exon 5 c.510_512 of FGG gene in the proband revealed a minor deletion mutation.Conclusion:The novel heterozygous missense mutation of exon 5 c.510_512del (Gln170_Ile171 del ins His) of FGG gene is the molecular mechanism that leads to hereditary hypofibrinogenemia in this family.

Objective: To analyze the clinical characteristics of recurrent thrombosis in patients with polycythemia vera (PV) and essential thrombocythemia (ET) to probe the risk factors for recurrent thrombosis in patients with ET and PV. Methods: The clinical data of 104 ET and PV patients with thrombosis in Beijing Anzhen Hospital from February 2001 to November 2016 were retrospectively analyzed. Thrombosis reoccurred in 38 patients. Statistical analyses were performed by multivariate logistic regression for risk factors of recurrent thrombosis in ET and PV patients. Results: Recurrent thrombosis occurred in 36.5% of patients with ET/PV, the total incidence rate in ET and PV patients was 9.8% patient-years, 12.3% patient-years and 5.7% patient-years in ET and PV respectively. There were a total of 56 re-thrombotic events, and 42.1% of events occurred within 1 year after the first thrombosis. The arterial re-thrombosis was 97.4% (most of acute coronary syndrome, ACS), and venous events was 2.6%. The most common cases of re-thrombosis were ACS in ET patients (18 cases, 64.3%), and cerebral infarction in PV patients (7 cases, 70.0%). The number of PV patients with 2 times or more re-thrombotic events was significantly higher than that of ET patients (9 cases, 90.0% vs 7 cases, 25.0%). The proportion of the patients with WBC>12.5×10⁹/L or Hct>45%, and thrombosis history or splenomegaly and high risk thrombotic events were higher than those with a single thrombus (52.6% vs 31.8%; 50.0% vs 30.0%; 86.8% vs 13.6%; 84.2% vs 33.3%; 52.6% vs 15.2%; 94.7% vs 53.0%; P values were 0.036,0.046, <0.001, <0.001, <0.001 and <0.001, respectively). Logistic regression analysis showed that thrombosis history (OR=13.697, P=0.025), splenomegaly (OR=13.301, P=0.034) and high risk stratification of thrombotic events (OR=44.618, P=0.025) were independent risk factors for recurrent thrombotic events. Conclusions ET and PV patients had a higher risk of re-thrombosis. The incidence of re-thrombosis in ET was higher than in PV, ACS was more common cases of re-thrombotic events; but PV patients were more susceptible to multiple re-thromboses than ET ones, also with more cerebral infarction. Previous thrombus history, splenomegaly and high risk stratification of thrombotic events were independent risk predictors for re-thrombosis of ET and PV patients.

Objective: To confirm early (6 hours) exercise in patients with partial hepatectomy is safe and feasible. Methods: The control group included 211 patients who qualified for partial liver resection before the accelerated rehabilitation surgery (ERAS), 218 patients with partial hepatectomy who met the entry criteria after the implementation of ERAS were taken as test group, get out of bed 24 hours after routine mission in control group, activity of 6 hours after operation in ERAS group. To observe the time of getting out of bed and the incidence of postoperative complications in 2 groups. Results: Comparison with control group, early exercise time of patients in ERAS group after surgery. The incidence of postoperative complications decreased was 14.3% (31/218) while 34.6%(73/211) of the control group. The difference was statistically significant (χ²=299.3, 18.270, P < 0.01). And did not increase the risk of falls, incision pain, postoperative bleeding. Conclusion Liver partial resection is safe and effective for patients with 6 hours post-operative exercise, worth clinical application.

Objective: To determine the clinical benefits of internal mammary sentinel lymph node biopsy (IM-SLNB) acquired by breast cancer patients with clinically positive axillary lymph node (ALN), and further optimize the IM-SLNB indications. Methods: All primary breast cancer patients with clinically positive ALN from February 2014 to September 2017 were prospectively recruited in this study. IM-SLNB was performed under the guidance of the modified injection technique. The success rate and visualization rate of IM-SLNB, metastatic rate of internal mammary sentinel lymph node (IMSLN) and its related factors were analyzed, and the clinical benefits were accessed according to the current guidelines. Results: Among 126 patients, all of 94 patients (74.6%) who showed internal mammary drainage successfully underwent IM-SLNB. The incidence of internal mammary artery bleeding and pleural lesion were 4.3%(4/94) and 9.6%(9/94), respectively. The metastatic rate of IMSLN was 38.3% (36/94), which was significantly associated with the number of positive ALN (P<0.001) and tumor size (P=0.024). The lymph node staging of 94 patients who underwent IM-SLNB was more accurate. Among them, 36 cases with positive IMSLN underwent internal mammary radiotherapy (IMRT), while the other 58 cases with negative IMSLN avoided radiotherapy. Conclusions IM-SLNB should be routinely performed in patients with positive ALN. IM-SLNB can provide more accurate staging and guide tailored IMRT to benefit more breast cancer patients.