BACKGROUND:Despite unrelated cord blood transplantation is expected to become an important method for treating malignant hematological diseases,the manifestation and clinical characteristics of acute graft-versus-host disease in the gastrointestinal tract still require further in-depth investigation. OBJECTIVE:To analyze the clinical characteristics of intestinal acute graft-versus-host disease after unrelated cord blood transplantation. METHODS:A retrospective analysis was conducted on 668 malignant hematological disease patients after unrelated cord blood transplantation who underwent hematopoietic stem cell transplantation subspecialty in the Department of Hematology,First Affiliated Hospital of University of Science and Technology of China from December 2016 to December 2020.Among them,clinical data of 138 patients with intestinal acute graft-versus-host disease were analyzed,including 76 males and 62 females,with a median age of 13(1-62)years.All patients were treated with a myeloablative regimen(without antihuman thymocyte globulin)and cyclosporin A combined with mycophenolate mofetil to prevent graft-versus-host disease. RESULTS AND CONCLUSION:(1)The patients with intestinal acute graft-versus-host disease had diarrhea of varying degrees,most of which were yellow-green,yellow-brown watery stools or mucous stools.53 patients(38.4%)had blood stools,82 patients(57.9%)had skin involvement,18 patients(13.0%)had a secondary intestinal bacterial infection,and 90 patients(65.2%)had cytomegaloviremia.(2)The clinical characteristics of patients(70 cases,50.7%)with grade 1-2 intestinal acute graft-versus-host disease were compared with those(68 cases,49.3%)with grade 3-4 intestinal acute graft-versus-host disease.It was found that the age of grade 3-4 intestinal acute graft-versus-host disease patients was higher than that of grade 1-2 intestinal acute graft-versus-host disease patients(P<0.001),and they were complicated with cytomegaloviremia probably(P=0.035).Diarrhea lasted longer(P=0.00)and the length of hospital stay increased substantially(P<0.001).However,there were no significant differences in recipient gender,pre-transplant disease status,HLA matching,diagnosis,combined skin graft-versus-host disease,and secondary intestinal infection rate in patients of the two groups.(3)These findings conclude that the clinical characteristics of intestinal acute graft-versus-host disease after unrelated cord blood transplantation are complex,which affects the prognosis and quality of life of patients seriously and requires early identification and precise treatment.

Objective:To understand the status quo of postoperative exercise adherence in patients with non-small cell lung cancer (NSCLC) and analyze the pathways through which disease perception, exercise self-efficacy, and coping style influence postoperative exercise adherence based on the Revised Common Sense Model (CSM) .Methods:NSCLC patients who underwent surgery in the Department of Thoracic Surgery of the First Affiliated Hospital of Anhui Medical University from March to September 2023 were selected by convenience sampling. Data were collected using a general information questionnaire, the Postoperative Exercise Adherence Questionnaire for Lung Cancer Patients, the Brief Illness Perception Questionnaire (BIPQ), and the Exercise Self-Efficacy Scale for Lung Cancer Patients.Results:A total of 245 questionnaires were distributed, with 241 valid responses collected. The postoperative exercise adherence score among the 241 NSCLC patients was (39.70±9.55). Exercise self-efficacy and coping style partially mediated the relationship between disease perception and exercise adherence, accounting for 81.31% and 13.64% of the total indirect effects, respectively. Exercise self-efficacy and coping style also had a chain mediating effect between disease perception and exercise adherence, accounting for 5.05% of the total indirect effects.Conclusions:The level of exercise adherence in NSCLC patients needs improvement. Negative disease perception not only directly negatively affects exercise adherence but also indirectly affects it through the mediating roles of exercise self-efficacy and coping style. Clinical healthcare providers should focus on guiding patients to develop healthy disease perceptions, increase their confidence in participating in exercise, and encourage the adoption of positive coping styles to enhance exercise adherence levels.

Objective This study aimed to explore the relationship between the spontaneous changes of mesiodistal angulation of lower second molars(L2M)and individual clinical characteristics in patients with early permanent dentition correction.Methods A total of 44 patients with a total of 88 mandibular second molars were included in this study after screening.Based on the frequency distribution histogram of the initial angle of inclina-tion(L2M initial angle)of the L2M crown before treatment,it was divided into three groups:Group A:small angle group,L2M initial angle is 0°～17.5°;Group B:medium angle group,L2M initial angle is 17.5°～42.5°;Group C:large angle group,L2M initial angle is 42.5°～60°.According to whether L2M has erupted and exposed most of the crown,it was divided into erupted group and unerupted group.According to the mandibular plane angle,it can be divided into high angle,low angle,and average angle.CBCT reconstructed panoramic images were used to measure the mesiodistal inclination of L2M and analyze the relationship between each group and the change in mesiodistal inclination angles of L2M.Results After treatment,L2M mesiodistal angulation in the small angle,large angle,non-eruption,and high angle groups became more significant.The angle in the middle angle group was significantly smaller.The L2M mesiodistal angulation in the eruption and average angle group did not change significantly.The angles of ANB,Y-axis,and mandibular plane have no correlation with the initial angle of L2M.Conclusion The L2M in patients with large and high angles is more likely to topple during a correc-tion.During the correction,the L2M tends to approach the normal axial inclination.

Objective:To systematically review the development trajectory and predictors of cancer-related fatigue (CRF) in breast cancer patients.Methods:The article on CRF development trajectories of breast cancer patients using latent growth modeling research was electronically retrieved in PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure, WanFang Data, VIP, and China Biomedical Literature Database. The search period was from database establishment to March 3, 2023. Two researchers conducted article screening, data extraction, and article quality evaluation, and summarized the results using descriptive analysis.Results:A total of 12 longitudinal studies were included, and 2 to 5 CRF trajectory classifications were found. Five studies described severity-based trajectories, four reported variability trends, and three delved into multidimensional patterns. Predictors of the high fatigue group were identified, including depressive symptoms, sleep disorders, anxiety, high body mass index, chronic stress, poor overall health, childhood adversity, chemotherapy, cytokines sTNF receptor-RII, IL-1 β, IL-10, and so on.Conclusions:The latent growth modeling reveals relative and similar heterogeneity trajectories of CRF, with inconsistent evidence for distinguishing different factors. It is necessary to conduct validation and in-depth research in a diverse environment, and improve the standardization of mixed model reporting, so as to provide information for early screening and the development of personalized intervention strategies.

Objective:To explore hot spots and trend of medical education quality assurance research in China and provide reference for future research.Methods:We searched the database of CNKI, VIP, Wanfang Database for published studies on quality assurance of medical education research in China. In the form of knowledge mapping, word frequency analysis, social network analysis and cluster analysis were used to explore the research hot spots from the perspective of high frequency keywords. SATI3.2 and Excel tables were used as statistical analysis tools for bibliographic information, the field extraction and word frequency statistics of literature keywords. Using SPSS 20.0, cluster analysis was carried out according to the similarity matrix of high frequency keywords co-occurrence.Results:Totally 249 articles were included in the study and 33 high frequency words were taken into account. The research hot spots of medical education quality assurance in China were divided into four categories: the practical application of medical education quality assurance, the effective methods of medical education quality assurance, the exploration of the construction of medical education quality assurance system, and the management of medical teaching quality assurance.Conclsion:Medical education in our country should perfect the safeguard measures to form characteristic theory framework, explore other methods for medical education quality assurance, establish medical education education quality guarantee system, and strengthen the teaching quality monitoring. The future researches should comply with the national "Double First-rate" construction and the development trend of international medical education, and enhance the research of connotative quality assurance.

Objective:To explore the current status of central venous catheter (CVC) maintenance knowledge, attitude and practice among Intensive Care Unit (ICU) nurses, and analyze its influencing factors.Methods:From March to May 2021, convenience sampling was used to select 445 ICU nurses from 9 ClassⅢ Grade A hospitals in Anhui Province as the research object. The self-designed General Information Questionnaire and CVC Maintenance Knowledge, Attitude and Practice Questionnaire for ICU Nurses were used to investigate the nurses. Multiple linear regression was used to explore the influencing factors of CVC maintenance knowledge, attitude and practice among ICU nurses. A total of 445 questionnaires were distributed, 11 invalid questionnaires were excluded, and 434 valid questionnaires were recovered, and the valid recovery rate was 97.5%.Results:Among 434 ICU nurses, the scores of CVC maintenance knowledge, attitude, and practice dimensions were (22.14±3.16) , (37.31±3.28) , and (75.65±6.35) , respectively. The results of multiple linear regression analysis showed that hospital category and CVC training times were the influencing factors of ICU nurses' CVC maintenance knowledge ( P<0.05) . CVC training times, educational background, ICU working years, and ICU category were the influencing factors of ICU nurses' CVC maintenance attitude ( P<0.05) . ICU working years, CVC training times, professional title and hospital category were the influencing factors of ICU nurses' CVC maintenance practice ( P<0.05) . Conclusions:ICU nurses have a good attitude to CVC maintenance, but the level of knowledge and practice needs to be improved. Nursing managers should focus on ICU nurses with low educational background, short ICU working years, low professional titles, non-teaching hospitals and few trainings, strengthen relevant knowledge training, increase the level of CVC maintenance practice, and then improve the quality of nursing.

Objective:To analyze the efficacy and safety of the biological agent infliximab (IFX) in the treatment of pediatric Crohn′s disease.Methods:A total of 86 children with Crohn′s disease who had received IFX in three hospitals (Ruijin Hospital, Ruijin Hospital North and Shanghai Children's Hospital) in Shanghai from January 2007 to December 2017 were included in this retrospective study. The efficacy of IFX was assessed by comparing clinical and laboratory data before and after IFX treatment. Student t test, Mann-Whitney U test or chi-square test were used to analyze the data of the two groups. Logistic reggression analysis were used to analyze the effects of variables such as age, clinical characteristics, disease behavior and combined medications on the efficacy and safety of IFX. Results:Among the 86 children with Crohn′s disease in the study, 50 were males and 36 females. The IFX treatment was initiated at 12.0 (7.1, 13.6) years of age, and the follow-up period was 94.1 (47.8, 185.5) weeks. Efficacy analysis showed that in the induction remission phase, the clinical response rate was 97% (79/81) and the remission rate was 74% (60/81). In the maintenance remission phase, the clinical response rate was 75% (51/68) and the remission rate was 68% (46/68). After 34 weeks of treatment with IFX, pediatric Crohn′s disease activity index (PCDAI) (5 (0, 10) vs. 36 (26, 45)), C-reactive protein (3 (1, 8) vs. 8 (3, 31) mg/L), erythrocyte sedimentation rate (10 (6, 10) vs. 35 (20, 50) mm/1 h), platelet ( (327±107)×10 9vs. (438±159) ×10 9/L), albumin ((37±6) vs. (30±6) g/L), hemoglobin ((116±16) vs. (103±18) g/L), change of body weight (-0.5±1.2 vs. -1.0±0.9), anemia (29% (20/68) vs. 75% (51/68)), and perianal disease (13/21 vs. 0) were significantly improved (all P<0.05). By the end of 34 weeks of IFX treatment, 25% (17/68) of children experienced secondary loss of response to IFX. Logistic reggression analysis showed that PCDAI>30 was positively correlated with secondary loss of response ( OR=3.823, 95% CI 1.015 -15.328, P=0.048), and combined with azathioprine was conducive to maintaining efficacy of IFX ( OR=0.440, 95% CI 0.106 -1.033, P=0.044). The IFX-related adverse events included infusion reactions in 17% (15/86) and infections in 42% (36/86) of children. Analysis showed that age<6 years was a risk factor for infusion reactions (χ 2=6.556, P=0.010), and combined use of steroids (χ 2=5.230, P=0.022) may increase the incidence of infection. Conclusions:IFX is effective in the treatment of pediatric Crohn′s disease with favorable safety. Reducing secondary loss of response to IFX is an urgent issue that need to be addressed. At the same time, it is necessary to pay close attention to the adverse events during IFX treatment.

Objective:To explore the relationship between work stress, sense of coherence (SOC) and compassion fatigue (CF) among oncological nurses, and to study the mediating role of SOC between work stress and CF in oncological nurses.Methods:Totally 370 oncological nurses from 7 ClassⅢ Grade A hospitals in Anhui Province between November 2019 and January 2020 were conveniently selected and investigated with the Chinese Nurse Work Stressor Scale, Sense of Coherence Scale-13, Professional Quality of Life and the general information questionnaire. AMOS 21.0 and SPSS 23.0 were used for statistical analysis of the data. A total of 370 questionnaires were distributed and 345 valid questionnaires were returned.Results:The work stress of oncological nurses was negatively correlated with their SOC ( r=-0.547, P<0.01) , and positively correlated with job burnout and secondary trauma ( r=0.607, 0.418; P<0.01) ; SOC was negatively correlated with job burnout and secondary trauma ( r=-0.581, -0.405; P<0.01) . SOC played a mediating role between the work stress, job burnout and secondary trauma of oncological nurses, and the mediating effect accounted for 45.81% and 33.82% of the total effect, respectively. Conclusions:SOC is a mediating variable between the work stress and CF of oncological nurses. Actively assessing the level of nurses' SOC and providing interventions are helpful to reduce CF caused by work stress.

On the basis of full respect for medical autonomy of patients, advance care planning (ACP) is implemented to help patients to realize treatment and nursing in accordance with their wishes so as to improve the quality of life of them in the end stage of disease. This paper reviewed the influencing factors of ACP to put out the existing problems and future research direction from perspectives of obstruction and promotion in order to provide a reference for further research and practice of ACP in China.

Objective To systematically review the effect of functional exercise on the prevention of radiation-induced trismus among patients with nasopharyngeal carcinoma(NPC). Methods Articles about the randomized controlled trials(RCT)of functional exercise to prevent radiation-induced trismus in patients with NPC after radiotherapy were retrieved from the established date of databases to the 31st December of 2018 in electronic databases such as Cochrane Library,PubMed,EMbase,China National Knowledge Internet (CNKI),VIP and Wanfang database. After literature selection,extraction and literature quality evaluation by two people according to inclusion and exclusion criteria,Revman 5.3 was used for Meta-analysis of outcome indicators. Results A total of 10 articles were enrolled,including 978 patients. The quality grade of all included literature was B. Maximum interincisal opening(MIO)is the outcome index of 6 articles. Meta-analysis showed that functional exercise could alleviate the reduction of MIO in NPC patients receiving radiotherapy [MD=4.59,95％CI(3.29,5.90),P<0.0001]. The degree of difficulty in opening the mouth was the outcome index of 8 articles. The results of Meta-analysis showed that functional exercise had a positive effect on the improvement of the difficulty of opening mouth in NPC patients[OR=0.23,95％CI(0.13,0.41),P<0.0001]. Conclusions Functional exercise can delay the process of reducing MIO of patients with NPC after radiotherapy,reducing the difficulty of opening the mouth,and have a positive effect on improving function and patients' quality of life.