BACKGROUND:Allogeneic hematopoietic stem cell transplantation is an effective and even the only way to cure various hematological diseases,but the short-term mortality rate is relatively high after transplantation. OBJECTIVE:To investigate the risk factors affecting the overall survival of patients with hematological diseases in the short term(within 100 days)after allogeneic hematopoietic stem cell transplantation,so as to reduce mortality and effectively prevent related risks in the short term(within 100 days)after allogeneic hematopoietic stem cell transplantation. METHODS:Clinical data of 585 patients with hematological diseases who underwent allogeneic hematopoietic stem cell transplantation at the Hematopoietic Stem Cell Transplantation Center of First Affiliated Hospital of Zhengzhou University from January 1,2018 to June 30,2021 were retrospectively analyzed.The risk factors that affected overall survival within 100 days after allogeneic hematopoietic stem cell transplantation were explored. RESULTS AND CONCLUSION:A total of 585 patients with hematologic diseases underwent allogeneic hematopoietic stem cell transplantation.92 patients died within 100 days after transplantation,with a mortality rate of 15.7%(92/585).The median age of death cases was 26.5 years old(1-56 years),and the median survival time of death cases was 48 days(0-97 days).Univariate analysis exhibited that age≥14 years old,acute graft-versus-host disease,grade IV acute graft-versus-host disease,bacterial bloodstream infection,as well as carbapenem-resistant organism bloodstream infection,were risk factors for overall survival within 100 days after allogeneic hematopoietic stem cell transplantation(P<0.05).Multivariate regression analysis showed that age≥14 years old,grades Ⅲ-Ⅳ acute graft-versus-host disease,bacterial bloodstream infection,and carbapenem-resistant organism bloodstream infections were independent risk factors for overall survival(within 100 days)in patients after allogeneic hematopoietic stem cell transplantation.Hazard ratios were 1.77(95%CI 1.047-2.991),7.926(95%CI 3.763-16.695),2.039(95%CI 1.117-3.722),and 3.389(95%CI 1.563-7.347),respectively.In conclusion,all-cause mortality rate after allogeneic hematopoietic stem cell transplantation is relatively high in the short term.A timely diagnosis and effective treatment of bacterial bloodstream infection and acute graft-versus-host disease are essential to improving allogeneic hematopoietic stem cell transplantation outcomes.

Objective:To investigate the teaching effects of blended teaching based on massive open online courses (MOOC) combined with team-based learning (TBL) for the general elective course First Aid for Burns for non-medical college students. Methods:We assigned 73 non-medical college students choosing the Common Home Health Issues and Care course in the spring semester of 2023 to receive blended teaching based on MOOC and TBL (experimental group), and 113 non-medical college students choosing the same course in the spring semester of 2024 to receive traditional lecture-based learning (control group). A self-evaluation questionnaire was used to evaluate the teaching effects and satisfaction with the course of the two groups. SPSS 27.0 was used to perform the t-test and chi-square test. Results:The experimental group showed significantly higher proportions of students who had a complete mastery of knowledge of first aid for burns (54.8% vs. 33.6%, P<0.01) and students who provided positive feedback on improving autonomous learning ability (98.6% vs. 78.8%, P<0.001), improving the ability of teamwork (100.0% vs. 68.1%, P<0.001), improving communication ability (98.6% vs. 72.6%, P<0.001), and overall satisfaction with the course (97.3% vs. 76.6%, P<0.001) compared with the control group. Conclusions:The blended teaching model based on MOOC and TBL can improve the teaching effects of First Aid for Burns for non-medical college students, enhancing their autonomous learning, teamwork, and communication abilities. This method is applicable to medical general education courses, which is worthy of promotion and application.

Objective:To analyze and compare the practical value of serum cystatin C(Scys C)and serum creatinine(SCr)in the assessment of kidney function in older adults.Methods:A retrospective, cross-sectional study was performed in 2 450 participants who were divided into a non-elderly group(<65 years)and an elderly group(≥65 years).Glomerular filtration rate(GFR), Scys C and SCr were measured by 99mTc-DTPA clearance, particle-enhanced immunoturbidimetry and an oxidase method, respectively.The χ2 test was used to compare increases in percentage of Scys C and SCr at the same GFR level.The screening value of Scys C and SCr for GFR<60 ml·min -1·1.73m -2was evaluated by the area under curve(AUC)of the receiver operating characteristic(ROC)curve.Values of 95% reference ranges were established for Scys C and SCr at different GFR levels. Results:The proportions of the general population with increased Scys C were 82.74%(556/672)and 94.74%(90/95), respectively, for GFR levels between 30~59 ml·min -1·1.73m -2and <30 ml·min -1·1.73m -2, while only 38.24%(257/672)and 75.79%(72/95)had elevated SCr levels( χ2=278.328, 13.571, both P<0.001).For the above GFR intervals, the proportions of older adults with increased Scys C were 84.81%(240/283)and 100.00%(43/43)respectively, and the proportions for non-elderly adults with increased Scys C were 81.23%(316/389)and 90.38%(47/52)( χ2=1.463, 4.364, P=0.226, 0.037), respectively.The screening value of Scys C for GFR<60 ml·min -1·1.73m -2was slightly better than SCr in terms of sensitivity, specificity and the Youden index.However, the sensitivity and specificity of Scys C in older adults were 76.4% and 75.7%, respectively, both lower than 78.7% and 84.0% in non-older adults.The variability of Scys C increased progressively with age.The reference range for Scys C was higher in older adults than in non-older adults at the same GFR level. Conclusions:When screening for GFR<60 ml·min -1·1.73m -2, the sensitivity and specificity of Scys C are slightly better than those of SCr, but are lower in older adults than in non-older adults.Scys C levels are higher and more variable in older adults.Using Scys C to assess GFR may lead to over-diagnosis of chronic kidney disease in older adults.

Objective:To explore the effect of health education based on the forgetting curve in maintenance hemodialysis patients.Methods:A total of 84 patients undergoing maintenance hemodialysis in the First Affiliated Hospital of Nanjing Medical University from March 2017 to March 2020 were enrolled and divided into in the observation group (43 cases) and in the control group (41 cases) using the random number table. The control group received conventional health education, and the observation group conducted health education based on the forgetting curve. Six months after intervention, disease cognition level, self-management ability, quality of life of the two groups were compared.Results:Six months after intervention, disease cognition level, self-management ability, quality of life scores of the observation group were higher than those of the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Health education based on the forgetting curve can help maintenance hemodialysis patients enhance the awareness of diseases, promote the development of self-management ability, and improve their quality of life.

Objective:To investigate the current status of medical record coders and their resignation tendency, and put forward suggestions for the training and team building of medical record coders.Methods:From April to May 2020, a questionnaire survey was conducted among the medical record coders in 27 DRG payment pilot hospitals in Anyang, Henan. Statistical analysis was conducted on the profile of the medical case department, basic personal information, professional quality, job satisfaction and resignation intention. Kendall coefficient was used to analyze the factors related to the resignation intention.Results:There were 98 coders in the surveyed hospitals, including 43 full-time coders and 55 part-time coders. Eighty-three valid questionnaires were recovered, and the effective recovery rate was 84.7%. Among them, 29(34.9%) had education level of junior college or below, 51(61.4%) had junior title or below, 15(18.1%) had medical information or case management as their major, 29(34.9%) coders had not obtained a coding certificate, 31(37.3%) were dissatisfied with the salary system, and 14(16.9%) had a tendency to leave. The medical record coders with lower professional titles, coding certificates and lower salary satisfaction were more likely to have the intention of resignation.Conclusions:Medical record coders in Anyang were challenged with such problems as shortage of manpower, low percentage of coding certificate holders and low salary satisfaction. Title, code certificate issuance and salary satisfaction were correlated with their resignation intention. Hospital managers should strengthen the importance of medical record coding and coders, and establish a reasonable salary, title evaluation and performance incentive system, so as to improve the attractiveness of coder position.

Objective:To compare the health knowledge of newly admitted patients with recurrent hypertensive stroke around 10 years, and analyze the influencing factors of health knowledge of patients.Methods:From September 2008 to December 2009 and from September 2018 to December 2019, convenience sampling was used to select newly admitted patients with recurrent hypertensive stroke from 3 ClassⅢ Grade A hospitals in Guangzhou as the research objects, and the Stroke Knowledge Questionnaire (SKQ) was used for investigation. In the two stages around 10 years, 120 and 130 questionnaires were distributed, and 109 and 116 valid questionnaires were returned with the valid response rates of 90.83% and 89.23%, respectively.Results:The education level, per capita monthly income of the family, family history of stroke, diabetes mellitus and hyperlipidemia, and smoking of the patients before and after 10 years were statistically significant ( P<0.05) . After 10 years, SKQ total scores, dimension scores in exercise, medication, stroke risk factors, stroke auras, and stroke management of patients were higher than those of 10 years ago, and dimension scores low-salt diet and smoking were lower than 10 years ago, and the differences were statistically significant ( P<0.05) . Conclusions:The level of health knowledge of newly admitted patients with recurrent hypertensive stroke is higher than that of 10 years ago, but education on low-salt diet and smoking cessation knowledge should be further strengthened.

Objective To investigate the relationship between perineural invasion (PNI) and the clinicopathological features of cervical cancer,and to explore its influence on the prognosis of cervical cancer patients.Methods Retrospective analysis the clinical data of 76 patients with early cervical cancer who received radical hysterectomy + pelvic lymphadenectomy ± paraaortic lymphadenectomy from November 2015 to December 2019 in Xuanwu Hospital.The clinicopathological characteristics of the postoperative pathological results of cervical cancer patients were analyzed to explore the related factors of PNI and its influence on prognosis.Results Single factor analysis suggested that the incidence of PNI was related to tumor diameter,depth of stroma invasion,lymph-vascular space invasion,lymph node metastasis and clinical stage (P ＜ 0.05).Multivariate analysis suggested that the infiltration depth of stroma invasion was the risk factor of PNI (P ＜ 0.05).K-M analysis showed that there was no significant difference in disease-free survival and overall survival between PNI positive and PNI negative patients (P ＞ 0.05).Conclusions PNI is related to the depth of interstitial infiltration.PNI has no significant effect on the short-term recurrence rate and short-term survival rate of cervical cancer patients.

Objective To explore the experience of infantile liver transplantation ,reconstructing portal vein (PV) and avoid the higher incidence of portal vein low flow and complications .Methods The clinical data were reviewed for 152 infantile liver transplantations performed by a single surgery group .And 114 cases with PV risk factors underwent customized PV reconstructions .All of them were diagnosed as cholestatic liver diseases and 106 (93％ ) belonged to biliary atresia .Forty-two cases (36％ ) had 2 or more risk factors .Results Most cases (n= 106 ,93％ ) underwent living donor transplantations using lateral left graft while another 8 cases had deceased donor transplantations . Four types of PV reconstructions were adopted based upon individual conditions :left/right branch of PV trunk (n= 103) ,autogenous patch PV venoplastic reconstruction (n= 3) ,duct-to-duct of PV trunk (n= 5) and donor PV duct-to-recipient confluence of SMV/CV and SV (n= 3) .Graft size reduction was performed when GRWR > 4 .5％ (n= 16) .During a median follow-up period of 6 .5 (1 .5-13) months ,there were 3 LPVF (2 .6％ ) ,2PVS (1 .7％ ) and 1 PVT (0 .8％ ) .Three LPVF cases was corrected by PV stenting ,two cases of PVS were stable after anticoagulation therapy while one PVT case undergoing thromboectomy plus PV stenting resumed a normal PV flow .Conclusions PV reconstruction of high-risk infants require comprehensive risk evaluations ,precise surgical skills and customized strategies .For PV complications ,stenting is both safe and feasible .

Objective To explore the diagnosis and treatment of parvovirus B19 infection-associated anemia after pediatric liver transplantation (LT) .Methods The clinical data were retrospectively reviewed for 2 children with severe anemia caused by parvovirus B19 infection after LT .Case 1 was a 2-year-old girl with a weight of 10 .7 kg .Classical orthotopic LT was performed due to ornithine carbamoyltransferase deficiency . Hemoglobin level began to progressively decline since Day 2 post-transplantation .And case 2 was a 5-month-old girl with an age of 5 months and a weight of 7 .2 kg .She underwent classic orthotopic LT for biliary atresia and decompensated liver cirrhosis .Hemoglobin level progressively declined at nearly 2 months post-transplantation . Results In case 1 ,bone marrow aspiration was performed at Day 54 post-transplantation .There was pure red cell aplasia and the detection of microvirus B19 nucleic acid was positive .Intravenous immunoglobulin was prescribed at a dose of 2 .5 g/day for 10 days ,tacrolimus was switched to cyclosporine and hemoglobin level spiked from 62 to 105 g/L after one-month treatment .In case 2 ,hemoglobin decreased to 44 g/L at 2 .5 months post-transplantation and the result of polymerase chain reaction of parvovirus B 19 was 9 .7 × 107 copies/ml .Then intravenous immunoglobulin was dosed at 2 .5 g/day for 10 days and hemoglobin level rose to 122 g/L at 25 days after treatment . Hemoglobin level decreased to 63 g/L again at 4 .5 months post-transplantation .Anemia was corrected by intravenous immunoglobulin injection plus a temporary discontinuation of tacrolimus and a reduced dose of tacrolimus .Conclusions Infection of parvovirus B19 can cause pure red cell aplasia after LT in children . Early diagnosis with intravenous immunoglobulin and modification of immunosuppressive regimen can obtain excellent therapeutic efficacies .

Objective? To explore the reasons of hypertensive patients' uncontrolled blood pressure before onset of ischemic stroke so as to provide clinical evidence for stroke prevention. Methods? The phenomenological analysis method in qualitative research was applied. From February to June 2016, 15 hypertensive ischemic stroke patients with hypertensive cerebral infarction and low medication adherence admitted to the department of neurology of three tertiary hospitals in Guangdong province were selected and participated in qualitative interviews. Results? By Colaizzi phenomenological analysis method, the medication misconception of patients were summarized into 4 themes: estimating physical condition by self-feeling, holding the opinion that there was few relation between "whether monitoring blood pressure", "forgetting medication","stopping medication because of various reasons" and cerebral infarction. Conclusions? There are some misunderstandings in the cognition of taking medicine before the onset of hypertensive cerebral infarction. It suggests that we should strengthen blood pressure monitoring and health education of drug compliance in hypertensive patients and hypertensive cerebral infarction patients, so as to improve the effect of primary prevention and secondary prevention of stroke.