Objective:To conduct a nationwide physician survey to better understand clinicians’ disease awareness, treatment patterns, and experience of Waldenstr?m macroglobulinemia (WM) in China.Methods:This cross-sectional study was conducted from February 2022 to July 2022 by recruiting clinicians with WM treatment experience from hematology, hematology-oncology, and oncology departments throughout China. Quantitative surveys were designed based on the qualitative interviews.Results:The study included 415 clinicians from 219 hospitals spread across thirty-three cities and twenty-two provinces. As for diagnosis, the laboratory tests prescribed by physicians for suspected WM patients were relatively consistent (92% -99% recommendation for laboratory, 79% -95% recommendation for pathology, 96% recommendation for gene testing, and 63% -83% recommendation for imaging examination). However, from a physician's perspective, there was 22% misdiagnosis occurred in clinical practice. The rate of misdiagnosis was higher in lower-level hospitals than in tertiary grade A hospitals (29% vs 21%, P<0.001). The main reasons for misdiagnosis were that WM was easily confused with other diseases, and physicians lacked the necessary knowledge to make an accurate diagnosis. In terms of gene testing in clinical practice, 96% of participating physicians believed that WM patients would require gene testing for MYD88 and CXCR4 mutations because the results of gene testing would aid in confirming diagnosis and treatment options. In terms of treatment, 55% of physicians thought that the most important goal was to achieve remission, while 54% and 51% of physicians wanted to improve laboratory and/or examination results and extend overall survival time, respectively. Among patients with treatment indications, physicians estimated that approximately 21% of them refused to receive treatment, mainly owing to a lack of affordable care and disease awareness. When selecting the most appropriate treatment regimens, physicians would consider patient affordability (63% ), comorbidity (61% ), and risk level (54% ). Regimens containing Bruton tyrosine kinase inhibitor (BTKi) were most widely recommended for both treatment-na?ve and relapsed/refractory patients (94% for all patients, 95% for treatment-na?ve patients, and 75% for relapsed/refractory patients), and most physicians recommended Ibrutinib (84% ). For those patients who received treatment, physicians reported that approximately 23% of patients did not comply with the treatment regimen due to a lack of affordability and disease awareness. Furthermore, 66% of physicians believe that in the future, increasing disease awareness and improving diagnosis rates is critical. Conclusions:This study is the first national physician survey of WM conducted in China. It systematically describes the issues that exist in WM diagnosis and treatment in China, such as a high rate of misdiagnosis, limited access to gene testing and new drugs, and poor patient adherence to treatment. Chinese doctors believe that improving doctors’ and patients’ understanding of WM is one of the most urgent issues that must be addressed right now.

Objective:To build the three different risk prediction models for peripherally inserted central catheter (PICC) -associated thrombosis based on machine learning algorithm, and compare the performance of the models, so as to provide a basis for evaluating and preventing PICC-associated thrombosis.Methods:The PICC-associated Thrombasis Risk Factor Questionnaire was developed based on the best evidence and expert consultation. From January 2016 to October 2020, convenience sampling was used to select 626 patients with PICC in the Affiliated Hospital of Jiangsu University as the research object to collect clinical data. Based on machine learning algorithms, Support Vector Machine (SVM) , XGBoost and Logistic regression methods were used to construct three different PICC-associated thrombosis risk prediction models, which were evaluated and compared.. Model evaluation indicators included Matthews correlation coefficient ( MCC) , F1 value, area under the receiver operating characteristic curve ( AUC) and Brier score. Results:A total of 30 variables were included, and the predictors included four aspects, namely, demographic data of patients, patient condition, treatment factors, and catheter-related factors. For the model verified on the test set, the Logistic regression prediction model had lower scores than the XGBoost and SVM prediction models in terms of MCC and F1 values. On AUC, the Logistic regression prediction model score was equal to SVM and smaller than XGBoost. On Brier, the Logistic regression prediction model scored higher than the XGBoost and SVM prediction models. Conclusions:The performance of the prediction model based on the machine learning algorithm XGBoost and SVM is superior to the traditional Logistic regression model in terms of sensitivity and accuracy. Thrombotic predictors can help guide medical and nursing staff to identify high-risk patients and reduce the incidence of PICC-associated thrombosis.

Objective:To establish a program for the prevention and management of parastomal hernia in patients with ostomy.Methods:Based on literature analysis and clinical needs, combined with the individual and family self-management theory (IFSMT), a preliminary plan for prevention and management of parastomal hernia was developed with the framework of case management model. Sixteen experts were selected for two rounds of Delphi expert consultations to analyze and screen indicators at all levels to calculate the expert′s positive coefficient, authority coefficient and coordination coefficient to analyze the credibility of expert consultation results.Results:The effective recovery rates of the two rounds of expert letter inquiries were 88.89% and 100.00%, the authoritative coefficients were 0.825 and 0.844, and the two rounds of Kendall′s W values were 0.221 and 0.269, which were statistically significant( P<0.01). The concentration of indicators is high. Finally, a programe for parastomal hernia prevention and management based on the self-management theory of individual and family consisting of 6 first-level indicators,16 second-level indicators and 42 third-level indicators was obtained. Conclusion:The programe for prevention and management of parastomal hernia based on individual and family self-management theory has high reliability and scientificity, and can provide a basis for the study of parastomal hernia prevention and management.

Objective:To investigate the association of blood oxidative stress level with hypertriglyceridemia in the elderly aged 65 years and older in China.Methods:A total of 2 393 participants aged 65 years and older were recruited in 9 longevity areas from Heathy Aging and Biomarkers Cohort Study, during 2017 to 2018. Information on demographics characteristic, life style and health status were collected by questionnaire and physical examination, and venous blood was collected to detect the levels of blood oxidative stress and hypertriglyceridemia. The linear or non-linear association between oxidative stress and hypertriglyceridemia was described by restrictive cubic splines (RCS) fitting multiple linear regression model. The generalized linear mixed effect model was conducted to assess the association between oxidative stress and hypertriglyceridemia.Results:A total of 2 393 participants, mean age was 84.6 years, the youngest was 65 and the oldest was 112, the male was 47.9%(1 145/2 393), the triglyceride level was (1.4±0.8) mmol/L. The hypertriglyceridemia detection rate was 9.99%(239/2 393). The results of multiple linear regression model with restrictive cubic spline fitting showed that MDA level was linear association with triglyceride level; SOD level was nonlinear association with triglyceride level. MDA level had significantly association with hypertriglyceridemia, and the corresponding OR value was 1.063 (95% CI: 1.046,1.081) with 1 nmol/ml increment of blood MDA; SOD level had significantly association with hypertriglyceridemia, and the corresponding OR value was 0.986(95% CI: 0.983,0.989) with 1 U/ml increment of blood SOD. Conclusion:Among the elderly aged 65 and older in 9 longevity areas in China, MDA and SOD levels were associated with the risk of hypertriglyceridemia.

Objective:To investigate the association of blood oxidative stress level with hypertriglyceridemia in the elderly aged 65 years and older in China.Methods:A total of 2 393 participants aged 65 years and older were recruited in 9 longevity areas from Heathy Aging and Biomarkers Cohort Study, during 2017 to 2018. Information on demographics characteristic, life style and health status were collected by questionnaire and physical examination, and venous blood was collected to detect the levels of blood oxidative stress and hypertriglyceridemia. The linear or non-linear association between oxidative stress and hypertriglyceridemia was described by restrictive cubic splines (RCS) fitting multiple linear regression model. The generalized linear mixed effect model was conducted to assess the association between oxidative stress and hypertriglyceridemia.Results:A total of 2 393 participants, mean age was 84.6 years, the youngest was 65 and the oldest was 112, the male was 47.9%(1 145/2 393), the triglyceride level was (1.4±0.8) mmol/L. The hypertriglyceridemia detection rate was 9.99%(239/2 393). The results of multiple linear regression model with restrictive cubic spline fitting showed that MDA level was linear association with triglyceride level; SOD level was nonlinear association with triglyceride level. MDA level had significantly association with hypertriglyceridemia, and the corresponding OR value was 1.063 (95% CI: 1.046,1.081) with 1 nmol/ml increment of blood MDA; SOD level had significantly association with hypertriglyceridemia, and the corresponding OR value was 0.986(95% CI: 0.983,0.989) with 1 U/ml increment of blood SOD. Conclusion:Among the elderly aged 65 and older in 9 longevity areas in China, MDA and SOD levels were associated with the risk of hypertriglyceridemia.

OBJECTIVE: To assess the association of single nucleotide polymorphisms (SNPs) of STK39 gene with response to hydrochlorothiazide among ethnic Han Chinese patients with essential hypertension. METHODS: In total 118 patients with essential hypertension were recruited. All participants had received six weeks of treatment with hydrochlorothiazide 25 mg daily. Blood pressure (BP) and heart rate (HR) were measurement every 2 weeks. Genotypes of STK39 rs3754777 and rs6749447 were determined using a SNaPshot technique. RESULTS: A significant difference was found in ΔSBP between individuals with rs3754777 CC, CT and TT and those with rs3754777 CC and CT-TT (P<0.05). A significant difference was also detected in ΔDBP between those with rs3754777 CC and CT-TT (P<0.05). No significant difference was found in ΔSBP and ΔDBP between individuals with STK39 rs6749447 GG, GT and TT (all P>0.05). Relative risk analysis showed that STK39 rs3754777 was significantly associated with BP response to hydrochlorothiazide (OR=0.416, 95%CI=0.189-0.918, P<0.05). CONCLUSION Polymorphisms of STK39 rs3754777 may be associated with BP response to hydrochlorothiazide among ethnic Han Chinese with essential hypertension.
Asian Continental Ancestry Group ; Essential Hypertension ; Genotype ; Humans ; Hydrochlorothiazide ; Polymorphism, Single Nucleotide ; Protein-Serine-Threonine Kinases ; genetics

Objective To explore the relationship between immature platelet fraction(IPF) with severity of sepsis and prognosis in patients with septic shock.Methods A total of 40 patients admitted to intensive care units of Tianjin First Central Hospital from June 2016 to June 2017 were enrolled.Of them,10 patients contracted non-sepsis infected,13 patietns with septic shock,and 17 patients with non-complicated sepsis.Ten healthy subjects were recruited as control groups from Tianjin Medical University.IPF and immature reticulocyte fraction (IRF) were detected,and SOFA and APACHE Ⅱ scores were calculated,and clinical findings of all groups were recorded.The differences in IPF and IRF between the groups were analyzed.The relationship between the IPF and SOFA score was studied,and the role of IPF in the diagnosis of septic shock was evaluated.Statistical methods include t test,MarmWhitney test,Spearman correlation analysis,and ROC procedure,and P＜0.05 was considered significant.Results Significantly higher IPF level was observed in patients with sepsis than that in patients with nonsepsis infection.(6.25 + 2.92) vs.(2.49 ± 1.03),P＜0.01.Significantly higher IPF level was observed in patients with septic shock than that in patients with non-complicated sepsis(4.71 ± 1.79) vs.(8.25 ± 2.94),P＜0.01.IPF correlated with sepsis severity scores (7.41 ± 3.51) vs.(4.5 ± 1.7),P=0.005;r=0.58,P=0.001.This study presented the highest diagnostic accuracy for the presence of sepsis by all studied clinical and laboratory parameters (AUC=0.78,P=0.01).Conclusion IPF levels could be used as a biomarker for diagnosis and severity of sepsis.

Objective To observe the effect of prescription of traditional Chinese medicine (TCM) Lianggesan on clinical efficacy for treatment of patients with acute respiratory distress syndrome (ARDS). Methods Fifty-two patients consistent with the Berlin diagnostic criteria of ARDS admitted to the departments of intensive care unit (ICU) of Tianjin Hospital and of the First Tianjin Center Hospital from May 1, 2015 to April 30, 2016 were enrolled, and they were divided into a Chinese medicine group (24 cases) and a control group (28 cases) by lottery. The anti-infection, reduction of phlegm, mechanical ventilation and symptomatic support treatment were given to the two groups, additionally Chinese medicine group received TCM Lianggesan (particles) including ingredients: fructus forsythiae 30 g, radix scutellariae 10 g, fructus gardeniae 10 g, henon bamboo leaf 10 g, rhubarb 10 g, herba menthae 6 g, natrii sulfas 6 g, radix glycyrrhizae 15 g, adding water to punch the particles in 50 mL liquid, taken by nasal feeding or orally drinking, in the morning and in the evening, twice a day. Before and after treatment, the differences in levels of oxygenation index, tumor necrosis factor-α (TNF-α) and positive end expiratory pressure (PEEP) were compared between the two groups. Results After treatment, the oxygenation indexes of the two groups were significantly higher than those before treatment, the levels of TNF-α and PEEP of the two groups were significantly lower than those before treatment, and the degrees of changing in the Chinese medicine group were more significant than those of the control group [oxygenation index (mmHg, 1 mmHg = 0.133 kPa): 267.45±38.67 vs. 235.26±30.62, TNF-α (mg/L):24.37±5.46 vs. 28.31±5.41, PEEP (cmH2O, 1 cmH2O = 0.098 kPa): 4.58±1.61 vs. 5.93±1.61, all P < 0.05]. Conclusion TCM Lianggesan can effectively eliminate the inflammatory mediators of patients with ARDS, improve the respiratory function and promote the recovery of the disease.

The heart and kidney damage is a clinical disease commonly seen, the 2 organs can interact with each other as cause and effect, leading to a series of clinical symptoms which is the cardiorenal syndrome (CRS). In 2008, according to the connection between the heart and kidney, the nephrologists Ronco, etc, completed the definition and classification of CRS, including type Ⅰ and type Ⅲ of CRS being acute cardiorenal syndrome (ACRS). ACRS refers to the fact that when the damage of heart or kidney dysfunction influences each other leading to a clinical syndrome caused by a sharp deterioration of cardiorenal function. At present, no definite diagnostic criteria for ACRS have yet been made. The pathogenesis of ACRS may be related to the renin-angiotensin-aldosterone system (RAAS), nitric oxide-reactive oxygen species (NO-ROS) system, inflammatory reaction, the excessive activation of sympathetic nervous system and so on. Clinically, about 50% of ACRS patients are accompanied by acute decompensated cardiorenal dysfunction or failure, that seriously impact on the patients' clinical prognosis and survival rate, so it is necessary to find an effective therapeutic regimen. At present, the treatments of ACRS have mainly the diuretic, angiotensin converting enzyme inhibitor (ACEI), angiotensin receptor inhibitor (ARB), β-receptor blocker, positive inotropic drugs, recombinant human erythropoietin, recombinant human brain natriuretic peptide, continuous blood purification (CBP) etc, and traditional Chinese medicine (TCM) also has a certain effect for improving the clinical symptoms of ACRS patients. Now the pathogenesis, diagnosis, and combined treatment of TCM and western medicine for treatment of ACRS are summarized.