Gecacitinib hydrochloride tablets (gecacitinib for short, and formerly known as "jaktinib hydrochloride tablets") is a novel JAK and ACVR1 inhibitor, which not only blocks the JAK-STAT signaling pathway by inhibiting the activities of JAK1, JAK2, JAK3, and TYK2, thereby alleviating inflammation and splenomegaly symptoms, but also reduces hepcidin transcription by inhibiting ACVR1 activity, thereby improving iron metabolism imbalance and anemia. Data from phases Ⅱ and Ⅲ clinical trials suggest that gecacitinib can both alleviate splenomegaly and reduce constitutional symptoms in patients with myelofibrosis (MF) who are na?ve to JAK inhibitors or have been exposed to ruxolitinib, as well as improve anemia in patients with MF. This article describes the mechanisms of action, pharmacokinetic characteristics, clinical efficacy, and treatment-related adverse effects of gecacitinib in the treatment of MF, providing references for the rational application of this drug in MF.

Objective:To compare the differences in the prevalence of mild micro-hepatic encephalopathy (MHE) among patients with cirrhosis by using the psychometric hepatic encephalopathy score (PHES) and the Stroop smartphone application (Encephal App) test.Methods:This prospective, multi-center, real-world study was initiated by the National Clinical Medical Research Center for Infectious Diseases and the Portal Hypertension Alliance and registered with International ClinicalTrials.gov (NCT05140837). 354 cases of cirrhosis were enrolled in 19 hospitals across the country. PHES (including digital connection tests A and B, digital symbol tests, trajectory drawing tests, and serial management tests) and the Stroop test were conducted in all of them. PHES was differentiated using standard diagnostic criteria established by the two studies in China and South Korea. The Stroop test was evaluated based on the criteria of the research and development team. The impact of different diagnostic standards or methods on the incidence of MHE in patients with cirrhosis was analyzed. Data between groups were differentiated using the t-test, Mann-Whitney U test, and χ2 test. A kappa test was used to compare the consistency between groups. Results:After PHES, the prevalence of MHE among 354 cases of cirrhosis was 78.53% and 15.25%, respectively, based on Chinese research standards and Korean research normal value standards. However, the prevalence of MHE was 56.78% based on the Stroop test, and the differences in pairwise comparisons among the three groups were statistically significant (kappa = -0.064, P < 0.001). Stratified analysis revealed that the MHE prevalence in three groups of patients with Child-Pugh classes A, B, and C was 74.14%, 83.33%, and 88.24%, respectively, according to the normal value standards of Chinese researchers, while the MHE prevalence rates in three groups of patients with Child-Pugh classes A, B, and C were 8.29%, 23.53%, and 38.24%, respectively, according to the normal value standards of Korean researchers. Furthermore, the prevalence rates of MHE in the three groups of patients with Child-Pugh grades A, B, and C were 52.68%, 58.82%, and 73.53%, respectively, according to the Stroop test standard. However, among the results of each diagnostic standard, the prevalence of MHE showed an increasing trend with an increasing Child-Pugh grade. Further comparison demonstrated that the scores obtained by the number connection test A and the number symbol test were consistent according to the normal value standards of the two studies in China and South Korea ( Z = -0.982, -1.702; P = 0.326, 0.089), while the other three sub-tests had significant differences ( P < 0.001). Conclusion:The prevalence rate of MHE in the cirrhotic population is high, but the prevalence of MHE obtained by using different diagnostic criteria or methods varies greatly. Therefore, in line with the current changes in demographics and disease spectrum, it is necessary to enroll a larger sample size of a healthy population as a control. Moreover, the establishment of more reliable diagnostic scoring criteria will serve as a basis for obtaining accurate MHE incidence and formulating diagnosis and treatment strategies in cirrhotic populations.

Objective:To evaluate the compliance with Chinese Residency Training Program of radiation oncology and provide reference for the improvement of system reform and base construction.Methods:An survey was conducted among residents who had completed residency training program of radiation oncology by online questionnaires in four dimensions, including the fulfillment of training center in hardware, personnel and procedures, the compliance with syllabuses, mechanism of trainee evaluation, and the passing rate and satisfaction degree of trainees.Results:The results showed that most training centers fulfilled the requirement of equipment, mentoring personnel and procedures. The training syllabuses had been followed and integrated with organization multi-modalities. The trainees with high degree of satisfaction accounted for 65.6%, and the final qualification passing rate reached 75.5%. However, there were less reference textbooks, insufficient training in general medicine, limited clinical practice, and low output in academic publication.Conclusions:The residency training program of radiation oncology has been established in China and achieved notable progress. For the further improvement, quantitative optimization of procedures, increasing opportunity of practice and strengthening scientific research involvement would be beneficial.

Purpose: This study aimed to investigate the prognostic value of lymph node ratio (LNR) in patients with locally advanced gastric cancer who received neoadjuvant chemotherapy. Materials and Methods: We retrospectively enrolled gastric cancer patients treated with neoadjuvant chemotherapy and curative surgery at the First Affiliated Hospital of Zhejiang University from 2004 to 2015 as the study cohort. Patients with the same inclusion criteria treated in 2016–2017 were enrolled as the validation cohort. Kaplan-Meier curves were assessed using the log-rank test to analyze the differences in overall survival (OS).Multivariate survival analysis was performed using the Cox proportional hazards model.The areas under the receiver operating characteristic curve of ypN and LNR categories for predicting the actual 3-year OS were compared. Results: A total of 265 patients were included in the proposal cohort. The median number of retrieved lymph nodes (rLNs) was 32. The number of positive lymph nodes (pLNs) increased as rLN increased (P=0.037), but the LNR remained relatively constant (P=0.462). The LNR was categorized into 4 groups according to the prognosis: ypNr0, node-negative with rLN>25; ypNr1, node-negative with rLN≤25 or 00.3. In the validation cohort of 43 enrolled patients, there was a clear distinction in OS that significantly (P<0.001) varied depending on the LNR values and LNR was the only independent prognostic factor in multivariate analysis (P<0.001). Conclusions LNR was an independent prognostic factor for survival of patients with gastric cancer after preoperative chemotherapy and might be an alternative predictor for ypN stage.

Objective: To validate the method for measuring the TPV and OAR doses and 2D dose distribution in IMRT through using TLD and radiochromic film. Methods: Eight medical linear accelerators (Valian, Elekta, Siemens) were selected. The polystyrene phantom provided by IAEA was CT scanned and the image obtained was transferred to TPS for formulation of treatment plan, prescription of PTV and OAR doses and calculation of corresponding monitoring unit (MU), IMRT was performed on the phantom using 6 MV X-ray. Irradiated TLDs and films were measured and evaluated at the Secondary Standard Dosimetry Laboratory at the Radiation Safety Institute of Chinese Center for Disease Control and Prevention. Results: According to IAEA requirement, the relative deviations between TLD-measured and TPS-planned doses were within ±7.0% for the prescribed PTV and OAR doses. As measured result, the PTV values for 8 accelerators were in the range of 0.6% to 5.9%, consistent with the IAEA requirements, whereas the OAT values for 8 accelerators were within -0.6% to 7.0%, consistent the requirements. As IAEA required, the 2D dose distribution passing rate of 3 mm/3% should be higher than 90%. The film-measured and TPS-planned values for 8 accelerators were within 90.2% to 100.0%, consistent with the requirements. Conclusions TLD and radiochromic film are feasible in validating the PTV and OAR doses and the 2D dose distribution pass rate in IMRT. This method can be widely used in quality audit and internal verification in IMRT in medical institutiions on a large scale.

Objective:To evaluate the rationality of the "Sandwich Principle teaching mode" adopted in our teaching of internal medicine and verify the necessity of its "Intergroup intersecting discussion".Methods:33 students majoring in traditional Chinese medicine were divided into control group (taught by standard process of sandwich principle) and experiment group (taught by simplified process of sandwich principle). The Dundee Ready Education Environment Measure (DREEM) was used to evaluate students' feelings toward the two teaching modes.Results:The total score of DREEM in the control group was higher than that in the experiment group, with statistically significant difference; the total score in the academic perception subscale in the control group was higher than that in the experiment group, among which the scores of "I have faith in passing the exam this year" and other 2 items were better than that in the experiment group, with statistically significant difference ( P<0.05); there were no statistical difference in the total scores of other perception subscales between the two groups( P>0.05), but the scores of the 9 items including "the atmosphere is very harmonious in the clinical teaching process" in the control group were significantly better than those in the experiment group, with statistically significant difference( P<0.05). Conclusion:The teaching mode of Sandwich Principle can create a positive and effective learning environment for supporting students. "Intergroup intersecting discussion" can encourage students to actively participate in the teaching process, and help increase their academic confidence and sense of achievement in learning. It is also helpful to build a harmonious teacher-student relationship and create a relaxing and pleasant learning environment so that students can gain a better learning experience. Therefore, "Intergroup intersecting discussion" is indispensable in medical teaching.

Objective To analyze the clinical features and clinical significance of patients with inflammatory bowel disease (IBD) complicated by thrombosis.Methods From March 14th,2001 to February sixth 2017,at Nanjing General Hospital of Nanjing Military Command,27 IBD patients with thrombosis diagnosed by clinical symptoms,endoscopy,imaging and pathology were enrolled.During the same period,81 gender and age matched IBD patients without thrombosis were included in the control group.The basic data,information of IBD diagnosis and treatment and thrombotic events of patients were collected and analyzed.T-test and Chi-square test were performed for statistical analysis.Binary logistics regression was used for risk factors analysis.Results The mean age of diagnosis of IBD patients with thrombosis was (44.8 ± 15.8) years,which was higher than that of the IBD patients of control group ((36.0 ± 14.4) years),and the difference was statistically significant (t =2.69,P =0.008).Among 27 IBD patients with thrombosis,arterial thrombosis was 51.9％ (14/27),deep venous thrombosis of the lower extremity veins was 29.6％ (8/27),portal venous system involved was 11.1％ (3/27),pulmonary embolism was 3.7％ (1/27) and disseminated intravascular coagulation accounted for 7.4％ (2/27).Nine patients (33.3％,9/27) underwent surgery six months before the diagnosis of thrombosis.The results of binary logistic regression indicated that the age of diagnosis and vascular catheterization were independent risk factors for thrombosis in IBD patients (odds ratio (OR) =1.04,95％ confidence interval (CI) 1.01 to 1.07,P=0.01;0R=5.64,95％ CI 1.39 to 22.96,P=0.02).After medicine treatment or surgery,81.5％ (22/27) of the patients improved,9.1％ (2/22) were worse and 13.6％ (3/22) died.Conclusion Screening and prevention of thrombosis should be paid attention in IBD patients with a history of vascular catheterization,at active phase and older age when diagnosed.

Objective To investigate the correlation between plasma homocysteine(Hcy)level and lower extremity atherosclerotic disease(LEAD)in elderly patients of Chinese Han nationality with primary hypertension.Methods A total of 144 elderly Chinese Han outpatients with primary hypertension aged 60-90 years (92 cases in men,52 in women)were randomly recruited in our department from January 2015 to January 2017.The diagnosis of LEAD was confirmed in this study by ankle brachial index(ABI)≤0.90(ABI normal value=1.00-1.40).The patients were divided into three different plasma Hcy level groups:low-(＜ 10 μmol/L),middle-(10-29 μmol/L),and high-Hcy level group(≥30 μmol/L).The differences in Hcy,ABI,toe branchial index,high density lipoprotein,apolipoprotein-A1,and baPWV were compared between three different Hcy level groups.Pearson correlation was established between the influencing factors and serum level of Hcy.Moreover,binary logistic regression model was used to determine the independent risk factors for LEAD among elderly Chinese Han patients with primary hypertension.Results The values of apolipoprotein A-1,high density lipoprotein cholesterol,ankle brachial index,and toe brachial index were higher in the low Hcy group than in the middle-and high Hcy-group(P＜0.05).The ankle brachial index was higher in the middle Hcy group than in the high Hcy group(P＜0.05).The brachial-ankle pulse wave velocity was higher in the high Hcy group than in the middle and low Hcy group (P ＜ 0.05).No statistically significant difference was found in age,gender,body mass index,mean arterial pressure,triglyceride,low density lipoprotein cholesterol,blood urea nitrogen,serum creatinine,blood uric acid,and plasma hypersensitivity C-reactive protein among the three groups(all P＞0.05).Pearson correlation analysis showed that the level of serum Hcy was positively correlated with brachial-ankle pulse wave velocity (r=0.637,P =0.000),while it was negatively correlated with ankle brachial index,toe branchial index,high density lipoprotein cholesterol,and apolipoprotein A-1 (r =-0.743,-0.257,-0.240,-0.449,all P＜0.05).Binary Logistic regression model showed that gender,Hcy,and low density lipoprotein cholesterol level were independent risk factors for LEAD in elderly Chinese Han patients with primary hypertension.Conclusions Plasma Hcy level is an independent risk factor for LEAD in elderly Chinese Han patients with primary hypertension,and it is positively correlated with this disease.

Objective To explore the effective management of emergency treatment in emergencies in new media era.Methods Collecting and analyzing related information of blood donation in Hangzhou "7·21" explosion accident,"7·5" bus arson incident and Wenchuan "5·12" earthquake were carried out,after the media reports.Results The speed of blood donation of Hangzhou citizens in response to the "7·21" Hangzhou explosion in new media was faster than that in the traditional media coverage of the "7·5" bus arson incident and Wenchuan "5·12" earthquake lagged for 24 hours to 48 hours,respectively;During the event,the proportion of blood donors who donated 400 ml of blood was significantly lower than that of normal working days (P ＜0.05),while the proportion of blood donors who donated 300 ml of blood was significant increased (P ＜0.05) only during the "7·21" explosion accident.Conclusions In response to the emergencies of the new media era,the blood collection institutions should take full advantage of the golden 4 hours through the systematic planning of the whole platform such as public opinion monitoring,public opinion,organization and management,personnel deployment and material security.

Objective To strengthen the voluntary blood donation publicity through the analysis of the voluntary blood donation.Methods The ratio of voluntary blood donation was statistically analyzed between staffs in some Medical institutions in Hangzhou and Ordinary people.Results The ratio of voluntary blood donation in ordinary people is 1.82％,which is higher than the national data (1.05％).The ratio of medical institutions in Hangzhou is 9.54％,which is far higher than ordinary people.The data of provincial,civic and private medical institutions are 10.20％,6.11％ and 15.42％,respectively.Conclusion The ratio of voluntary blood donation is different between different level hospitals,and the staffs in medical institutions are more willing to donate blood than ordinary people.