Objective:To investigate the factors that influence the prolongation of gestation following emergency cervical cerclage.Methods:This retrospective study included 88 singleton pregnant women who were diagnosed with cervical incompetence and underwent emergency cervical cerclage at 12-26 weeks of gestation in the Jiaxing Maternity and Child Health Care Hospital from January 1, 2019 to September 1, 2022. The participants who delivered after 28 gestational weeks were assigned to the success group ( n=77), while those who delivered or miscarried before 28 gestational weeks were assigned to the failure group ( n=11). Two independent sample t-test or Mann-Whitney U test was used for comparison between groups. The factors affecting the prolongation of gestation after the procedure were selected by univariate analysis and multiple regression equations. Results:The success rate (delivery rate≥28 weeks) was 87.5% (77/88). There were six women delivered at 28-31 +6 weeks of gestation (6/77, 7.8%), two at 32-33 +6 weeks of gestation (2/77, 2.6%), 16 at 34-36 +6 weeks of gestation (16/77, 20.8%), and 53 at 37 weeks of gestation or later (53/77, 68.8%). Multiple regression analysis indicated that three times of early pregnancy miscarriage ( β=－5.1, 95% CI: -9.5 to -0.7), five times of early pregnancy miscarriage ( β=－11.8, 95% CI: -22.1 to -1.6), had two live births ( β=－6.9, 95% CI: -12.9 to -0.9), gestational age at cerclage ( β=－0.6, 95% CI: -1.0 to -0.3), external cervical os dilation<15 mm ( β=－12.1, 95% CI: -22.5 to -1.8) and ≥15 mm before cerclage ( β=－11.0, 95% CI: -21.4 to -0.71) were factors affecting the prolongation of gestation after cerclage. After adjusting for maternal age and weight before emergency cervical cerclage, five times of early pregnancy miscarriage ( β=－18.1, 95% CI: -28.3 to -7.8), gestational age at cerclage ( β=－0.6, 95% CI: -1.0 to -0.3), and external cervical os dilation≥15 mm before cerclage ( β=－11.4, 95% CI:－21.2 to -1.6) remained the significant influencing factors (all P<0.05). Conclusion:The number of early pregnancy miscarriages, gestational age at cerclage, and the width of external cervical os dilation before cerclage≥15 mm are the factors that influence the prolongation of gestation after the emergency cervical cerclage procedure.

Objective:To investigate the changes of disease constitution in general practice outpatients before and after COVID-19 pandemic.Methods:Rank-sum ratio (RSR)method and Pareto method were used to comprehensively analyze the disease composition of patients in general practice outpatients in Huacao Community Health Service Center of Shanghai from January 2019 to December 2021.Results:The number of visits to general practice clinic decreased from 2019 to 2021. The top five diseases in RSR were circulatory system, endocrine, nutrition and metabolism, respiratory system, digestive system, and nervous system(RSR=1.000,0.917,0.896,0.813 and 0.750), all of which were classified as Class A factors, with a cumulative composition ratio of 80.45%. Taking the above 5 categories as the main diseases, and consistency analysis was performed for the annual changes. The coefficient of concordance of the top five diseases was poor, and not statistically significant ( WR=0.956, χ 2=11.47, P>0.01), suggesting that the disease spectrum was changed. The visits of patients with respiratory diseases dropped from the 2nd place to the 3rd after COVID-19 pandemic, with an average annual change rate of-14.31%, the lowest among all diseases. Among the top five diseases, nervous system disease had the highest annual change rate (7.68%). Among the factors affecting health status and contact with health care institutions, eye and appendage diseases ranked the first with the annual change rate of 12.97% and 10.35%,respectively. Conclusions:After the outbreak of COVID-19 pandemic, the disease spectrum in general practice clinics has changed. Measures must be taken in time to meet the needs for medical care.

Objective:To explore the prognostic value of lymphocyte subsets in adult hemophagocytic syndrome (HPS).Methods:A total of 172 adult HPS patients diagnosed in 8 medical centers from January 2013 to August 2020 were selected for the study, of whom 87 were male (50.6%, 87/172), and 85 were female (49.4%, 85/172), with 68 survivors and 104 deaths. The clinical data were summarized, and variables such as lymphocyte subsets, immunoglobulin characteristics and fibrinogen were retrospectively analyzed, and the correlation between the mentioned variables and patient prognosis was analyzed. The optimal cut-off values of continuous variables were calculated by MaxStat, and the prognostic factors of HPS patients were screened based on the Cox proportional hazard regression model.Results:The median age of HPS patients was 56 (42, 66) years old, and the 5-year cumulative survival rate was 37.4% (37.4/100). The median age, platelet and albumin were 48 (27, 63) years, 84×10 9/L and 32.3 g/L in the survival group, and 59 years, 45.5×10 9/L, and 27.3 g/L in the death group, respectively. The differences between the two groups was statistically significant ( Z=?3.368, P=0.001; Z=?3.156, P=0.002; Z=?3.431, P=0.001). Patients with differentiated cluster 8+(CD8+)<11.1%, CD3+<64.9%, CD4+>51%, and CD4/CD8 ratio>2.18 had poor prognosis (χ 2=7.498, P=0.023; χ 2=4.169, P=0.041; χ 2=4.316, P=0.038; χ 2=9.372, P=0.002). Multivariable analysis showed that CD4/CD8 ratio, age, fibrinogen and hemoglobin were independent prognostic factors in HPS patients ( HR=2.435, P=0.027; HR=5.790, P<0.001; HR=0.432, P=0.018; HR=0.427, P=0.018). Conclusion:Peripheral blood lymphocyte subsets can be used to evaluate the prognosis of patients with HPS; CD4/CD8 ratio, age, fibrinogen, and hemoglobin are independent prognostic factors in HPS patients.

Objective:To explore the correlation of miRNA-509 (miR-509) expression level with the clinical characteristics and prognosis in acute myeloid leukemia (AML) patients.Methods:The RNA-seq expression data and clinical data of 162 newly diagnosed AML patients (non-M 3 subtype) based on the World Health Organization (WHO) classification were obtained from the Cancer Genome Atlas (TCGA) database (Project ID:TCGA-LAML). The final follow-up time was April 30th, 2013. According to the different treatment methods, all cases were firstly divided into the chemotherapy group and allogeneic hematopoietic stem cell transplantation (allo-HSCT) group. Each group was subdivided into high miR-509 group and low miR-509 group according to the median relative expression of miR-509, respectively; the clinical characteristics of both groups were analyzed. The effects of miR-509 relative expression level on overall survival (OS) and event-free survival (EFS) of AML patients in chemotherapy group and allo-HSCT group were compared. On the other hand, cases were divided into two groups based on the median relative expression level of miR-509, then each group were further divided into the chemotherapy subgroup and allo-HSCT subgroup according to different treatment methods. The differences of OS and EFS of AML patients with different miR-509 expression in chemotherapy and allo-HSCT subgroups were compared. Results:All the 162 AML patients were firstly divided into chemotherapy group (90 cases) and allo-HSCT group (72 cases). Each group was subdivided into high miR-509 and low miR-509 group according to the median relative expression of miR-509 (chemotherapy group: 14.07, allo-HSCT group: 14.85), respectively. There were no statistically significant differences in the proportion of patients with gender, white blood cell count at initial diagnosis, bone marrow blast/naive cells ratio, peripheral blood blast/naive cells ratio and France-America-British (FAB) subtype between high miR-509 and low miR-509 subgroups in chemotherapy subgroup and allo-HSCT subgroup (all P > 0.05). In the chemotherapy group, low miR-509 group comprised more cases with intermediate prognosis compared to high miR-509 group[68.9% (31/45) vs. 42.2% (19/45), χ2 = 6.48, P = 0.011]. No significant differences in the proportion of patients with other risk stratification were found between both subgroups (all P > 0.05). Of the 90 cases in chemotherapy group, the median OS time in low miR-509 group (45 cases) and high miR-509 group (45 cases) was 10.2 months and 6.7 months, respectively. The 5-year OS rates of the two subgroups in chemotherapy group were 17.9% and 17.0%, and the 5-year EFS rates were 16.9% and 18.2%.There were no significant differences in OS and EFS of low miR-509 group and high miR-509 group ( P = 0.575, P = 0.436). In the allo-HSCT group (72 cases), longer OS and EFS were observed in low miR-509 group compared with high miR-509 group, and the differences were statistically significant ( P = 0.006, P = 0.022). All the 162 cases were divided into low miR-509 group (81 cases) and high miR-509 group (81 cases) based on the median expression level of miR-509 (14.19). In the low miR-509 expression group, cases administered allo-HSCT had a better OS in comparison with those administered chemotherapy ( P<0.001). The EFS of the allo-HSCT group was better than that of chemotherapy group, but the difference was not statistically significant ( P = 0.079). In the high miR-509 expression group, the allo-HSCT group had a better OS compared with that of the chemotherapy group ( P = 0.043). There was no significant difference in the EFS between the allo-HSCT group and chemotherapy group in high miR-509 group ( P = 0.154). Conclusions:The expression level of miR-509 may be helpful in the treatment selection of AML patients. Allo-HSCT can improve the prognosis of patients with low expression of miR-509.

Objective:To explore the prognostic influencing factors of adult lymphoma-associated hemophagocytic syndrome (LAHS) based on multicenter data.Methods:The clinical data of 86 LAHS patients diagnosed in 9 medical centers of Huaihai Lymphoma Working Group from January 2015 to August 2020 were retrospectively analyzed. The optimal cut-off value of continuous variables was obtained based on MaxStat algorithm. Cox proportional hazard regression model was used for univariate and multivariate analyses. Kaplan-Meier method was used for survival analysis, and log-rank test was performed.Results:Among the 86 adult LAHS patients, 50 (58.1%) were males and 36 (41.9%) were females, the median age of the patients was 57 years old (19-76 years old), and the median overall survival (OS) time was 1.67 months (95% CI 0.09- 3.24 months). The most common pathologic type was diffuse large B-cell lymphoma (58 cases, 67.44%). Based on MaxStat algorithm, the optimal cut-off values of age, albumin, serum creatinine, lactate dehydrogenase, fibrinogen and platelet count were 64 years old, 30.1 g/L, 67 μmol/L, 1 045 U/L, 4.58 g/L and 72×10 9/L, respectively. Multivariate analysis showed that patient's age, lactate dehydrogenase, albumin and fibrinogen levels were independent influencing factors for OS (all P < 0.05). Conclusions:LAHS is dangerous and progresses quickly. Patients with age ≥ 64 years old, lactate dehydrogenase ≥ 1 045 U/L, fibrinogen ≥ 4.58 g/L and albumin < 30.1 g/L have poor survival.

Objective:To investigate the quality of life of diabetes patients managed by the“1+1+1”contracted family physician services and to analyze the influencing factors.Methods:A survey on quality of life of diabetic patients in the community was conducted in Shanghai Huacao township from July 2018 to September 2018. A total of 413 residents managed by the contracted family physician services in 3 villages of Huacao township were selected by stratified cluster random sampling as study subjects, including 203 diabetes patients and the 210 healthy subjects (control group). The self-prepared questionnaire was applied for survey of general information and the quality of life was evaluated with the MOS 36-item short form health survey (SF-36) in two groups. The linear stepwise regression model was deployed to analyze the factors related to the quality of life of diabetes patients.Results:The total scores of SF-36 were (711.36±103.40) and (736.72±85.42) in diabetic group and control group, respectively. The total score and the scores of reported health transition, physical function, general health, physiological contents in diabetic group were significantly lower than those of control group ( t=-2.712, -2.326, -4.872, -5.509, -3.504, P<0.05); however, there were no significant differences in role-physical, bodily pain, role-emotional, mental health, vitality, social function, and psychological contents between the two groups ( P>0.05). The univariate regression analysis indicates that age, educational degree, score on the quality of sleep, stressful life event, usual mental state, and the years of contracted family doctor service were associated with the quality of life of diabetes patients ( t/ F=3.373, 3.216, 5.716, 58.146, 28.325, 14.450, P<0.05). Stepwise multiple linear regression analysis showed that stressful life event, usual mental state, and the years of contracted family doctor service were the independent factors related to the quality of life in diabetes patients ( t=7.157, 4.741, -2.779, 2.129, P<0.05). Conclusion:Under the“1+1+1”contracted family doctor service mode, the quality of life of diabetes patients in the community is very close to that of the healthy population in several dimensions. The study has also revealed that the duration of contracted family physician service and other factors can influence the quality of life of diabetic patients.

Objective:Factors influencing the prognosis of hemophagocytic lymphohistiocytosis (HLH) in adults were analyzed based on multicentric data.Methods:Clinical data of 124 adult patients with HLH diagnosed in eight medical centers in the Huaihai Lymphoma Working Group from March 2014 to July 2020 were collected. The optimal truncation value of continuous variables was obtained based on the Maxstat algorithm, X-Tile software, and restricted cubic spline. Cox proportional risk regression model was used to construct the adult HLH risk prediction model, and the visualization of the model was realized through the histogram. The bootstrap resampling method was used to verify the model, C-index and calibration curve was used to verify the histogram, and the prediction accuracy was checked. Kaplan-Meier analysis was used to calculate the survival rate and draw the survival curve. Furthermore, the differences between groups were tested by log-rank.Results:The median age of the 124 patients was 55 (18-84) years, including 61 (49.19%) males. The most common etiology was infection. Serum ferritin increased in 110 cases (88.71%) , hepatosplenomegaly in 57 cases (45.97%) . Of the 124 patients, 77 (62.10%) died, and the median survival time of the patients was 7.07 months. Univariate results showed that the prognosis of adult HLH was influenced by sex, age, fibrinogen, serum creatinine, alanine aminotransferase, and albumin ( P<0.05) . The results of multivariate analysis showed that gender, platelet, albumin, alanine aminotransferase, and treatment regimens were independent influencing factors for prognosis. Based on the above five risk factors, the prediction model of the histogram was established, and the C-index of the model was 0.739. Finally, the calibration chart showed good consistency between the observed and predicted values of HLH. Conclusion:The prognosis of the adult hemophagocytic syndrome is influenced by many factors. Gender, platelet, albumin, alanine aminotransferase, and treatment regimens are independent risk factors. Therefore, the established histogram provides a visual tool for clinicians to evaluate the prognosis of adult HLH.

Objective: To analyze the clinical characteristics of cases of novel coronavirus pneumonia and a preliminary study to explore the relationship between different clinical classification and liver damage. Methods: Consecutively confirmed novel coronavirus infection cases admitted to seven designated hospitals during January 23, 2020 to February 8, 2020 were included. Clinical classification (mild, moderate, severe, and critical) was carried out according to the diagnosis and treatment program of novel coronavirus pneumonia (Trial Fifth Edition) issued by the National Health Commission. The research data were analyzed using SPSS19.0 statistical software. Quantitative data were expressed as median (interquartile range), and qualitative data were expressed as frequency and rate. Results: 32 confirmed cases that met the inclusion criteria were included. 28 cases were of mild or moderate type (87.50%), and four cases (12.50%) of severe or critical type. Four cases (12.5%) were combined with one underlying disease (bronchial asthma, coronary heart disease, malignant tumor, chronic kidney disease), and one case (3.13%) was simultaneously combined with high blood pressure and malignant tumor. The results of laboratory examination showed that the alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin (ALB), and total bilirubin (TBil) for entire cohort were 26.98 (16.88 ~ 46.09) U/L and 24.75 (18.71 ~ 31.79) U/L, 39.00 (36.20 ~ 44.20) g/L and 16.40 (11.34- ~ 21.15) mmol/L, respectively. ALT, AST, ALB and TBil of the mild or moderate subgroups were 22.75 (16.31- ~ 37.25) U/L, 23.63 (18.71 ~ 26.50) U/L, 39.70 (36.50 ~ 46.10) g/L, and 15.95 (11.34 ~ 20.83) mmol/L, respectively. ALT, AST, ALB and TBil of the severe or critical subgroups were 60.25 (40.88 ~ 68.90) U/L, 37.00 (20.88 ~ 64.45) U/L, 35.75 (28.68 ~ 42.00) g/L, and 20.50 (11.28 ~ 25.00) mmol/L, respectively. Conclusion The results of this multicenter retrospective study suggests that novel coronavirus pneumonia combined with liver damage is more likely to be caused by adverse drug reactions and systemic inflammation in severe patients receiving medical treatment. Therefore, liver function monitoring and evaluation should be strengthened during the treatment of such patients.

Because of the lack of typical clinical manifestations, infection is difficult to be diagnosed in patients with hematological malignancies, resulting in high mortality. Neutrophil CD64 (nCD64) has been used in the early diagnosis of infection for many years and has been proved to be highly sensitive and specific. However, it is rarely used in the diagnosis of hematological malignancies with infection. This paper reviews the main influencing factors and coping methods in the diagnosis of hematological malignancies with infection.

Objective: To evaluate the left ventricular systolic synchrony and investigate the early diagnostic value of left ventricular systolic dyssynchrony on cardiotoxicity caused by anthracyclines in patients with diffuse large B-cell lymphoma (DLBCL). Methods: Thirty-two patients (22 males, 10 females, age: 22-73(54.4±14.2) years) from June 2016 to January 2019 with confirmed DLBCL and normal gated myocardial perfusion imaging (GMPI) before anthracyclines chemotherapy were enrolled prospectively. GMPI was performed after 6 cycles or more of chemotherapy. Changes of myocardial markers, electrocardiogram (ECG) indicators, left ventricular function indicators including left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), peak filling rate (PFR), summed motion score (SMS) and summed thickening score (STS) as well as left ventricular systolic synchrony indicators including phase bandwidth (BW), phase standard deviation (SD) and entropy before and after anthracyclines chemotherapy were analyzed. Paired t test, Wilcoxon signed rank test and χ² test were used for data analysis. Results: Compared with pre-chemotherapy, the left ventricular systolic synchrony indicators were significantly higher than those before chemotherapy (BW: (42.81±11.37)° vs (29.28±8.68)°; SD: (11.65±4.64)° vs (8.79±3.14)°; entropy: (39.84±5.51)% vs (36.19±5.94)%; t values: -9.132 to -3.173, all P<0.05). There were no significant differences in other indicators (t values: -1.161 to 1.750, z values: -1.633 to -0.096, all P>0.05). Of 32 patients, 13 patients (40.62%) had left ventricular systolic dyssynchrony, and the rate of chemotherapy-induced left ventricular systolic dyssynchrony was significantly higher than that of left ventricular dysfunction (15.62%, 5/32; χ²=4.947, P=0.025). All 5 patients with left ventricular dysfunction caused by chemotherapy had left ventricular systolic dyssynchrony. The LVEF of the chemotherapy-induced left ventricular systolic dyssynchrony group was significantly lower than that of the left ventricular systolic synchronization group ((54.54±9.25)% vs (66.79±7.65)%; t=4.087, P<0.01). Conclusion Left ventricular systolic dyssynchrony can be appeared in DLBCL patients after chemotherapy and is significantly earlier than left ventricular dysfunction, which can be an early indicator of cardiotoxicity caused by anthracycline chemotherapy.