Objective:To summarize the clinical features, treatments and prognoses of aggressive natural killer cell leukemia (ANKL) in children.Methods:Clinical data and follow-up results were retrospectively reviewed for one hospitalized case of ANKL in June 2019.Through a literature search, the relevant items were retrieved from the databases of China National Knowledge Infrastructure, WanFang and PubMed using the Chinese and English keywords of "aggressive natural killer cell leukemia" and "children" up to December 2021.Results:This 8-year-old girl was diagnosed with ANKL by flow cytometric immunophenotype and immunohistochemical stain.Fever was the initial manifestation accompanied by sallow complexion, fatigue, enlargement of liver, spleen and lymph node and hematopenia of three lines.Allogeneic hematopoietic stem cell transplantation (allo-HSCT) was performed after chemotherapy.As of April 2022, the child stayed in a disease-free survival state after follow-ups for over 2 years.The literature search finally yielded 7 eligible Chinese and 10 English reports with a total of 17 pediatric ANKLs.In this group, there were fever (n=15), rash (n=1), perineal mass (n=1) and diarrhea, vomiting and other digestive tract symptoms (n=1). Six cases were misdiagnosed during an early stage of disease.4 cases received chemotherapy alone, 3 cases received chemotherapy regimen for acute lymphoblastic leukemia, 1 child died and one death occurred after received chemotherapy regimen of "cisplatin + vincristine + doxorubicin + ifosfamide". Allo-HSCT was performed in 5 patients after remission with chemotherapy and one child died from multiple organ failure at 9 months after allo-HSCT.Nine cases gave up treatment.Conclusions:ANKL has a rapid disease progression, diverse clinical manifestations, easy misdiagnosis and poor prognosis.For suspected ANKL cases, clinicians perform multiple bone perforations at multiple sites and immunophenotype by flow cytometry as soon as possible to confirm the diagnosis.Currently allo-HSCT offers a long-term survival of ANKL patients.

【Objective】 To explore the analytical methods for detecting data in the process of quality inspection of blood component samples. 【Methods】 The quality inspection data of blood component samples from 2018 to 2022 in our center were collected. Based on the principles of statistical process control, control charts were created using Minitab software to analyze key test items. 【Results】 The P control chart was used to analyze the pass rate of platelet content and revealed one out-of-control point. The normality test was performed on plasma protein content to analyze the causes of data fluctuations for further improvement. The mean and range control chart was utilized for hematocrit measurement, with abnormal data trends detected. Further analysis of the normality test and process capability analysis was conducted, resulting in a Cpk value of 0.67. 【Conclusion】 By applying statistical process control methods, the study employed P control charts to analyze count data in the quality inspection of blood component samples, conducted normality tests for measurement data, and utilized mean and range control charts to identify abnormal data trends. For data conforming to a normal distribution, the process capability index (Cpk) was calculated to explore effective monitoring methods for ensuring stability in the blood supply process.

Objective:To investigate the ethics and existing problems of experimental animals in medical experiments and experimental teaching, and to formulate countermeasures so that animal ethics and animal welfare can be truly reflected in medical experiments.Methods:In this study, a "Basic Function Experiment Center Animal Experiment Questionnaire" with 25 questions was formulated from three aspects: the ethical cognition of experimental animals, whether animal experiments are ethical or not, how to view the problems of animal ethics and experimental teaching and the cognition of virtual simulation experiment teaching. Questionnaire was sent to Hubei University of Medicine to investigate the international students of Batch 2017 (5-year program), undergraduates of Batch 2017 (5-year program) and nursing students of Batch 2018 (4-year program) as well as teachers, researchers and employees of laboratory animal center (all with bachelor degree or above). The survey results were expressed as percentage.Results:The recovery rate of the questionnaire in this study was 98.04%(2 451/2 500), among which the practitioners, teachers and researchers in the laboratory animal center clearly understood the ethics of experimental animals, but there was a widespread phenomenon of lagging ethics among the students. For example, 16.24% (398/2 451) students had not received animal experiment ethics education and training, 29.46% (722/2 451) were not clear about animal protection laws and regulations, 7.14% (175/2 451) thought animal experiments were immoral; 29.54% (724/2 451) had vague cognition of animal welfare and ethical knowledge; 25.91% (635/2 451) were not familiar with the operation steps; 9.38% (230/2 451) were indifferent to the extra treatment of animals due to operation errors, 7.83% (192/2 451) chose to give up the experiment in the treatment of animals after massive bleeding, only 5.43% (133/2 451) chose to continue the experiment after timely hemostasis and infusion, and 9.26% (227/2 451) chose to do operations unrelated to the experiment. After the experiment, 2.28% (56/2 451) chose to kill the animals by bloodletting, only 5.51% (135/2 451) chose excessive anesthesia euthanasia, and 1.96% (48/2 451) chose to kill the animals by cervical dislocation and violence. Only 15.79% (387/2 451) chose to remember the dead animal for 2 minutes. Only 32.56%(798/2 451) of the respondents understood virtual simulation experiment, 34.92% (856/2 451) of the respondents thought that virtual simulation experiment or experimental teaching video could be used to replace the existing live animal experiment, 77.56% (1 901/2 451) believed that the construction of virtual simulation laboratory should be strengthened.Conclusion:It is imperative to strengthen the education of students' ethics of experimental animals, which is conducive to the establishment of correct ethics of experimental animals for medical students, so that the "3R" principle and animal welfare can be truly implemented in experimental teaching and scientific research experiments.

Objective: 18F-fluorodeoxyglucose (FDG) PET/CT is often used for detecting malignancy in patients with newly diagnosed hemophagocytic lymphohistiocytosis (HLH), with acceptable sensitivity but relatively low specificity. The aim of this study was to improve the diagnostic ability of 18F-FDG PET/CT in identifying malignancy in patients with HLH by combining 18F-FDG PET/CT and clinical parameters. Materials and Methods: Ninety-seven patients (age ≥ 14 years) with secondary HLH were retrospectively reviewed and divided into the derivation (n = 71) and validation (n = 26) cohorts according to admission time. In the derivation cohort, 22 patients had malignancy-associated HLH (M-HLH) and 49 patients had non-malignancy-associated HLH (NM-HLH). Data on pretreatment 18F-FDG PET/CT and laboratory results were collected. The variables were analyzed using the Mann-Whitney U test or Pearson’s chi-square test, and a nomogram for predicting M-HLH was constructed using multivariable binary logistic regression. The predictors were also ranked using decision-tree analysis. The nomogram and decision tree were validated in the validation cohort (10 patients with M-HLH and 16 patients with NM-HLH). Results: The ratio of the maximal standardized uptake value (SUVmax) of the lymph nodes to that of the mediastinum, the ratio of the SUVmax of bone lesions or bone marrow to that of the mediastinum, and age were selected for constructing the model. The nomogram showed good performance in predicting M-HLH in the validation cohort, with an area under the receiver operating characteristic curve of 0.875 (95% confidence interval, 0.686–0.971). At an appropriate cutoff value, the sensitivity and specificity for identifying M-HLH were 90% (9/10) and 68.8% (11/16), respectively. The decision tree integrating the same variables showed 70% (7/10) sensitivity and 93.8% (15/16) specificity for identifying M-HLH. In comparison, visual analysis of 18F-FDG PET/CT images demonstrated 100% (10/10) sensitivity and 12.5% (2/16) specificity. Conclusion 18F-FDG PET/CT may be a practical technique for identifying M-HLH. The model constructed using 18F-FDG PET/CT features and age was able to detect malignancy with better accuracy than visual analysis of 18F-FDG PET/CT images.

Objective To compare the outcomes of patients with non-variceal upper gastrointestinal bleeding (NVUGIB) taking aspirin for primary prophylaxis to those not taking it.Methods Patients without any vascular disease (coronary artery or cerebrovascular disease) who were admitted to the 89th Hospital of PLA between 2006 and 2016 with non-variceal upper gastrointestinal bleeding were included.The frequencies of in-hospital mortality,re-bleeding,severe bleeding,need for surgery or embolization,and of a composite outcome of the 4 bleeding related adverse outcomes were compared between patients receiving aspirin and those on no antithrombotics.We also compared the frequency of in hospital complications and length of hospital stay between the two groups.Results Of the 179 eligible patients,47 were on aspirin and 132 patients were on no antithrombotics (control group).Patients in the aspirin group (58.4 years) were elder than that in controls (66.8 years) (P ＜0.01).Patients in the aspirin group had significantly more co-morbidities,including diabetes mellitus [25.5 ％ (12/47) vs 12.1％ (16/132)] and hypertension [46.8％ (22/47) vs 28.0％ (37/132)],respectively,as well as dyslipidemia [21.3％ (10/47) vs 6.1％ (8/132)] (P ＜ 0.01).Smoking was more frequent in the aspirin group [36.2％ (17/47) vs 22.7％ (30/132),P ＜ 0.05].The frequencies of endoscopic therapy and surgery were similar in both groups,while the frequencies of in-hospital complications and re-bleeding were similar in the two groups,too.However,the patients who were on aspirin had lower in hospital mortality rates (2.1％ vs 13.6％,P ＜0.01),shorter hospital stay (4.9 d vs 7.0 d,P ＜0.05),and fewer composite outcomes (10.6％ vs 24.2％,P ＜ 0.05).Conclusions Patients who present with NVUGIB while receiving aspirin for primary prophylaxis had fewer adverse outcomes.Thus aspirin may have a protective effect beyond its cardiovascular benefits.

Objective To evaluate the effect of targeted monitoring and comprehensive intervention measures on reducing the occurrence of catheter-associated urinary tract infection(CAUTI)in patients in non-intensive care unit(Non-ICU).Methods In quarter 4 of 2015,patients with indwelling urinary catheter in clinical departments were conducted a baseline survey(before intervention),risk factors for CAUTI in patients were analyzed,targeted monitoring programmes and comprehensive intervention measures were initiated in 2016(after intervention),incidence of CAUTI before and after intervention was compared.Results After taking intervention measures,hand hygiene compliance rate increased from 78.51%in quarter 4 of 2015 to 92.99%in quarter 3 of 2016 and 90.73%in quarter 4 of 2016(x2=7.342,3.998,respectively,both P<0.05),the correct disposal rate of patients' urinary catheterization system increased from 72.83%in quarter 4 of 2015 to 95.44%in quarter 4 of 2016(x2=30.267,P<0.05).A total of 12 067 patients with indwelling urinary catheter were monitored,incidence of CAUTI dropped from 1.03%(24/23 313)in quarter 4 of 2015(before intervention)to 0.53%(14/26 595)in quarter 4 of 2016(after intervention),difference was statistically significant(x2=4.126,P=0.042).Conclusion Improving the quality of urinary catheterization system in patients with indwelling catheter through targeted monitoring can effectively reduce the incidence of CAUTI in patients in Non-ICU.

Objective To evaluate hospital acquired infection control using the risk assessment method of hazard vulnerability analysis (HVA). Methods The HVA risk assessment method was used to screen out two hospital-level priority improvement projects in hospital acquired infection management in 2016, and assess the relative risk of the risk factors,for selective intervention according to the"20% -80% principle". 2015 was set as baseline survey, while the first and second half of 2016 as the outcome evaluation stage. The comparison of the count data was performed using the χ2test. Results Baseline survey of hand hygiene found the compliance rate and high-touch surface cleaning pass rate as 64.4% and 57.0% respectively. The first stage of evaluation found the rate as 69.0% and 73.7% respectively, while in the second stage rate was 72.9% and 82.4% respectively. These differences were statistically significant (P<0.001). Baseline survey found the incidence of hospital acquired infection and surgical site infection as 1.26% and 0.29% respectively, while the figures in the stage of evaluation were 1.07% and 0.22% respectively,figures being statistically significant (P<0.05). Conclusions The HVA risk management proves significant for the prevention and control of hospital acquired infection, as it can identify and assess risk factors of hospital acquired infection,for better risk control.

Objective To explore the influence of corporate governance at public hospitals on their nature of public welfare,in order to provide reference for promoting the reform of public hospital corporate governance.Methods Hypotheses of such impacts were raised by means of literature review. 460 questionnaires were collected from site survey,and four factors of public hospital corporate governance were used as independent variables,and five factors of the public welfare performance as dependent variables,for a correlation analysis and multiple linear regression analysis.Results A clear correlation is found among medical service level,and decision-making mechanism,the mechanism of key employees recruit/evaluation/incentive and their constraints (P < 0.05 ).Completion status of public health services is significantly correlated with the mechanism of recruit/evaluation/incentive and constraint,and their supervision mechanism as well(P <0.05).Medical technology level and cost of medical services are significantly correlated with decision-making mechanism.Conclusions In consideration of public hospital corporate governance,such mechanisms as decision-making,supervision,recruit,evaluation,incentive and constraint for key employees play a key role for public welfare performance.It is recommended to promote the hospital corporate governance reform from the above aspects.

Objective To observe the effect of tanshinone IIA on the myocardial calmodulin (CaM) and calmodulin dependent protein kinase II (CaMK) mRNA expression and heart function of acute myocardial infarction rats. Methods A total of 100 rats were randomly divided into the sham operation group, the model group, and the tanshinone ⅡA group. The model of acute myocardial infarction was established by the ligation of left anterior descending coronary artery ligation with 45 min, and reperfusion with 45 min, and the above process was repeated 3 times. Tanshinone IIA group was treated with intravenous injection of 10 mg/kg sodium tanshinone ⅡA, while the sham operation group and the model group with 10 mg/kg saline, and all treatment last 7 days. The mRNA expressions of CaM and CaMKII were determined. TTC staining was used to observe areas of myocardial infarction. The left ventricular maximum rise/fall rate (±LVdp/dtmax), myocardial contraction tension, heart rate and heart function index were detected pre-and post-treatment by the Langendorff device perfusion of isolated heart. Results Compared with the model group, the mRNA expression of and CaM mRNA (1.29 ± 0.19 vs. 2.31 ± 0.21) and CaMK II (1.10 ± 0.07 vs. 2.13 ± 0.18) in the tanshinone IIA group were significantly lower (P<0.05), and the areas of myocardial infarction (25.12%± 0.43%vs. 35.15%± 0.64%) significantly decreased (P<0.05), and the IT (2.03 ± 0.14 g vs. 1.06 ± 0.12 g), the ±LV dp/dtmax (4 701.2 ± 135.3 mmHg/s vs. 3 214.7 ± 110.2 mmHg/s, 2 518.7 ± 65.4 mmHg/s vs.1 960.3 ± 62.5 mmHg/s) significantly increased (P<0.05). Conclusion Tanshinone IIA may protect myocardial ischemia by regulating the mRNA expression of CaM and CaMKⅡ.

Objective To investigate the correlation between the use density of antibiotic and antifungal drugs and the positive rate of aspergillus in our hospital from 2009 to 2013,in order to provide a scientific basis for rational use of antibiotic and antifungal drugs. Methods The use density of carbapenems,two third-generation cephalosporins,and antifungal drugs,and the positive rate of aspergillus in our hospital from 2009 to 2013 were studied retrospectively. Their correlation was analyzed using SPSS software. Results There was significantly positive correlation between the use density of imipenem and that of fluconazole (r=0.913,P<0.05).The use density of biapenem was positively correlated with that of voriconazole (r=0.915,P<0.05).The use density of biapenem and that of voriconazole was positively correlated with positive rate of aspergillus,respectively ( r=0.918,r=0.955,both P<0.05).The other antibiotic and antifungal drugs were not significantly correlated to the positive rate of aspergillus.