Objective:To further improve the understanding of paroxysmal nocturnal hemoglobinuria (PNH), we retrospectively analyzed and summarized the clinical characteristics, treatment status, and survival status of patients with PNH in Zhejiang Province.Methods:This study included 289 patients with PNH who visited 20 hospitals in Zhejiang Province. Their clinical characteristics, comorbidity, laboratory test results, and medications were analyzed and summarized.Results:Among the 289 patients with PNH, 148 males and 141 females, with a median onset age of 45 (16-87) years and a peak onset age of 20-49 years (57.8% ). The median lactic dehydrogenase (LDH) level was 1 142 (604-1 925) U/L. Classified by type, 70.9% (166/234) were classical, 24.4% (57/234) were PNH/bone marrow failure (BMF), and 4.7% (11/234) were subclinical. The main clinical manifestations included fatigue or weakness (80.8%, 235/289), dizziness (73.4%, 212/289), darkened urine color (66.2%, 179/272), and jaundice (46.2%, 126/270). Common comorbidities were hemoglobinuria (58.7% ), renal dysfunction (17.6% ), and thrombosis (15.0% ). Moreover, 82.3% of the patients received glucocorticoid therapy, 70.9% required blood transfusion, 30.7% used immunosuppressive agents, 13.8% received anticoagulant therapy, and 6.3% received allogeneic hematopoietic stem cell transplantation. The 10-year overall survival (OS) rate was 84.4% (95% CI 78.0% -91.3% ) . Conclusion:Patients with PNH are more common in young and middle-aged people, with a similar incidence rate between men and women. Common clinical manifestations include fatigue, hemoglobinuria, jaundice, renal dysfunction, and recurrent thrombosis. The 10-year OS of this group is similar to reports from other centers in China.

Objective:To evaluate the efficacy and safety of hypomethylating agents (HMA) in patients with myelodysplastic syndromes (MDS) .Methods:A total of 409 MDS patients from 45 hospitals in Zhejiang province who received at least four consecutive cycles of HMA monotherapy as initial therapy were enrolled to evaluate the efficacy and safety of HMA. Mann-Whitney U or Chi-square tests were used to compare the differences in the clinical data. Logistic regression and Cox regression were used to analyze the factors affecting efficacy and survival. Kaplan-Meier was used for survival analysis. Results:Patients received HMA treatment for a median of 6 cycles (range, 4-25 cycles) . The complete remission (CR) rate was 33.98% and the overall response rate (ORR) was 77.02%. Multivariate analysis revealed that complex karyotype ( P=0.02, OR=0.39, 95% CI 0.18-0.84) was an independent favorable factor for CR rate. TP53 mutation ( P=0.02, OR=0.22, 95% CI 0.06-0.77) was a predictive factor for a higher ORR. The median OS for the HMA-treated patients was 25.67 (95% CI 21.14-30.19) months. HMA response ( P=0.036, HR=0.47, 95% CI 0.23-0.95) was an independent favorable prognostic factor, whereas complex karyotype ( P=0.024, HR=2.14, 95% CI 1.10-4.15) , leukemia transformation ( P<0.001, HR=2.839, 95% CI 1.64-4.92) , and TP53 mutation ( P=0.012, HR=2.19, 95% CI 1.19-4.07) were independent adverse prognostic factors. There was no significant difference in efficacy and survival between the reduced and standard doses of HMA. The CR rate and ORR of MDS patients treated with decitabine and azacitidine were not significantly different. The median OS of patients treated with decitabine was longer compared with that of patients treated with azacitidine (29.53 months vs 20.17 months, P=0.007) . The incidence of bone marrow suppression and pneumonia in the decitabine group was higher compared with that in the azacitidine group. Conclusion:Continuous and regular use of appropriate doses of hypomethylating agents may benefit MDS patients to the greatest extent if it is tolerated.

Objective:To compare the effect of modified postauricular transverse incision and traditional vertical incision for microvascular decompression in the treatment of hemifacial spasm.Methods:Prospective study method was used. A total of 116 patients with hemifacial spasm in Handan Central Hospital from January 1, 2019 to January 1, 2020 were selected, and divided into two groups according to the admission order. Both groups underwent microvascular decompression; control group (57 cases) received traditional vertical incision, while treatment group (59 cases) received modified postauricular transverse incision. The brainstem auditory evoked potential (BAEP), pain degree, surgical indicators, facial aesthetic satisfaction and complications were compared between two groups.Results:After treatment, the BAEP of latency, wave interval and wave amplitude in the two groups increased compared with that before treatment, and the BAEP of latency, wave interval and wave amplitude in the treatment group were higher than those in the control group: (1.89 ± 0.15) ms vs. (1.62 ± 0.21) ms, (7.89 ± 0.15) ms vs. (6.25 ± 0.41) ms, (1.79 ± 0.19) ms vs. (1.54 ± 0.11) ms ( P<0.05). After treatment, the visual analogue score (VAS) of patients in the two groups decreased compared with that before treatment, and the VAS of patients in the treatment group was lower than that in the control group: (1.15 ± 0.27) points vs. (2.18 ± 0.24) points ( P<0.05). The operation time, intraoperative bleeding volume and postoperative scar length of patients in the treatment group were less than those in the control group: (60.41 ± 3.81) h vs. (76.87 ± 3.87) h, (30.18 ± 4.19) ml vs. (56.87 ± 4.15) ml and (4.18 ± 1.07) cm vs. (6.87 ± 1.05) cm ( P<0.05). The satisfaction rate of patients in the treatment group was higher than that in the control group: 91.53% (54/59) vs. 71.93% (41/57) ( P<0.05). The complication rate of patients in the treatment group was lower than that in the control group: 5.08% (3/59) vs. 21.05% (12/57) ( P<0.05). Conclusions:Compared with traditional vertical incision, the modified transverse incision for microvascular decompression in the treatment of hemifacial spasm can reduce intraoperative blood loss and postoperative scar area, enhance brainstem auditory evoked potential, and improve facial aesthetics, which is worthy of recommendation.

Objective:To explore the effects of graded nutritional nursing based on Prognostic Nutritional Index (PNI) in patients with cervical cancer undergoing concurrent chemoradiotherapy.Methods:Totally 414 patients with cervical cancer who were treated in Henan Cancer Hospital from December 2020 to December 2021 were selected by convenience sampling, and they were randomly divided into the study group and the control group according to the random number table, with 207 patients in each group. All patients received the same concurrent chemoradiotherapy. Patients in the control group were given nutritional nursing under the guidance of NRS2002, while patients in the study group were given graded nutritional nursing based on PNI. The PNI, levels of albumin (ALB) , prealbumin (PA) , transferrin (TRF) , immunoglobulin A (IgA) , immunoglobulin G (IgG) and adverse reactions were compared between the two groups.Results:Finally, 197 patients were included in the study group, and 195 patients were included in the control group. At the eighth week of treatment, the PNI of the study group was better than that of the control group, and the difference was statistically significant ( P<0.05) . In the first and third weeks of treatment, the levels of ALB, PA, TRF, IgA and IgG in the two groups gradually decreased, but the levels of ALB, PA, TRF, IgA and IgG in the study group were higher than those in the control group, and the difference was statistically significant ( P<0.01) . During concurrent chemoradiotherapy, the incidences of nausea and vomiting, enteral nutrition intolerance, bone marrow suppression, and cancer-related fatigue in the study group were lower than those in the control group, with statistically significant differences ( P<0.05) . Conclusions:PNI-based graded nutritional nursing to cervical cancer patients undergoing concurrent chemoradiotherapy can improve the nutritional status and immune level of patients and reduce the incidence of related complications.

Objective:To prepare 99Tc m-hydrazinonicotinamide(HYNIC)-αCD8/Fab ( 99Tc m-αCD8/Fab), and explore the predictive value of 99Tc m-αCD8/Fab SPECT/CT imaging for the efficacy of anti-programmed death-1 (PD-1) immunotherapy. Methods:The αCD8/Fab was modified with HYNIC- N-hydroxysuccinimide (NHS) and IRDye800-NHS to form HYNIC-αCD8/Fab and IRDye800-αCD8/Fab (Dye-αCD8/Fab), respectively. 99Tc m-αCD8/Fab was prepared in sodium bicarbonate buffer (pH=8.5), with SnCl 2 being used as the reducing agent. The labeling yield and radiochemical purity of 99Tc m-αCD8/Fab and its stability in PBS and fetal bovine serum (FBS) were tested in vitro. The mouse spleen and human peripheral blood lymphocytes were isolated for cell-specific binding and blocking experiments of 99Tc m-αCD8/Fab in vitro. SPECT/CT imaging was used to analyze the specific binding ability of the 99Tc m-αCD8/Fab probe in CT26 colon cancer mouse models (BALB/c). The near infrared fluorescence imaging and SPECT/CT imaging were performed to detect the intra-tumoral CD8 + T cell infiltration after anti-PD-1 therapy in tumor bearing mice, and the results were further verified by HE and immunofluorescence staining. CD8 + T cell depletion study was performed to determine the role of CD8 + T cells in the tumor responses to anti-PD-1 therapy. Two-way analysis of variance was used to compare the data difference. Results:The labeling yield of 99Tc m-αCD8/Fab was 90% with a high radiochemical purity (95%) and good stability in vitro (radiochemical purity still more than 80% after 720 min in PBS and FBS). 99Tc m-αCD8/Fab could specifically bind to mouse CD8 + T cells ((10.30±0.81) percent added radioactive dose (%AD)/10 6 cells), compared with the binding ability in human peripheral blood lymphocytes group and CD8 antibody blocking group ((1.78±0.61) and (1.59±0.25) %AD/10 6 cells; F=10.07, P<0.001). SPECT/CT imaging showed that 99Tc m-αCD8/Fab had markedly higher tumor uptake in the CT26 colon cancer mouse models. Near-infrared fluorescence imaging showed that the tumor uptake of 99Tc m-αCD8/Fab in the responsive group was significantly higher than in the nonresponsive group after anti-PD-1 treatment ((8.9±1.1)% vs (7.1±0.8)%; F=4.69, P=0.024), and SPECT/CT imaging found the similar result. HE and immunofluorescence staining of tumor and lymph nodes showed that the proportion of lymphocyte infiltration was higher in the responsive group. Furthermore, CD8 + T cell depletion significantly reversed the therapeutic effect of anti-PD-1 immunotherapy in tumor-bearing mice. Conclusions:In this study, 99Tc m-αCD8/Fab was successfully obtained. CD8-specific SPECT imaging could sensitively visualize the tumor-infiltrating CD8 + T cells, suggesting the potential application value to predict and evaluate the efficacy of immunotherapy in the clinical settings.

BACKGROUND: Chronic noise exposure is one environmental hazard that is associated with genetic susceptibility factors that increase Alzheimer's disease (AD) pathogenesis. However, the comprehensive understanding of the link between chronic noise stress and AD is limited. Herein, we investigated the effects of chronic noise exposure on AD-like changes in senescence-accelerated mouse prone 8 (SAMP8). METHODS: A total of 30 male SAMP8 mice were randomly divided into the noise-exposed group, the control group, and aging group (positive controls), and mice in the exposure group were exposed to 98 dB SPL white noise for 30 consecutive days. Transcriptome analysis and AD-like neuropathology of hippocampus were examined by RNA sequencing and immunoblotting. Enzyme-linked immunosorbent assay and real-time PCR were used to further determine the differential gene expression and explore the underlying mechanisms of chronic noise exposure in relation to AD at the genome level. RESULTS: Chronic noise exposure led to amyloid beta accumulation and increased the hyperphosphorylation of tau at the Ser202 and Ser404 sites in young SAMP8 mice; similar observations were noted in aging SAMP8 mice. We identified 21 protein-coding transcripts that were differentially expressed: 6 were downregulated and 15 were upregulated after chronic noise exposure; 8 genes were related to AD. qPCR results indicated that the expression of Arc, Egr1, Egr2, Fos, Nauk1, and Per2 were significantly high in the noise exposure group. These outcomes mirrored the results of the RNA sequencing data. CONCLUSIONS These findings further revealed that chronic noise exposure exacerbated aging-like impairment in the hippocampus of the SAMP8 mice and that the protein-coding transcripts discovered in the study may be key candidate regulators involved in environment-gene interactions.

Objective:To explore the effects of professional perception based empathy training on clinical communication competency, perceived professional benefits and self-efficacy of junior nurses.Methods:The study was designed with the quasi-experimental study. From March to September 2018, a total of 67 junior nurses with low levels of self-efficacy at Henan Cancer Hospital were recruited as subjects with the way of voluntary registration. All of nurses were divided into 5 groups, 12 to 15 nurses in each group. This study carried out the face-to face empathy training taking professional perception as the main content5 times for 5 weeks. The effects were evaluated with the Nurses' Clinic Communication Competency Scale, Nurses' Perceived Profession Benefits Questionnaire and the General Self-efficacy Scale (GSES) before and after training. SPSS 22.0 statistical software was used in statistical analysis.Results:There were three nurses quitting the training and 64 nurses completed the training. Among 64 nurses, the total average scores of clinic communication competency, perceived professional benefits and general self-efficacy after training were (3.75±0.66) , (4.65±0.40) and (2.53±0.20) respectively higher than those before training with statistical differences ( t=5.058, 7.911, 25.979; P<0.01) . Conclusions:Professional perception based empathy training can improve clinical communication competency, perceived professional benefits and self-efficacy of junior nurses which could be further expanded and applied in nurses.

Objective To explore the influence of spiritual care training program on nurses' spiritual well-being and spiritual care competency. Methods From March to September 2018,a total of 80 nurses working in a provincial cancer hospital were recruited by voluntary registration to participate in this study. They were randomly divided into experimental group(n=40)and control group(n=40)by random number table. The experimental group received the specially designed spiritual care training twice a month for 6 consecutive months on the basis of regular vocational studies. The main forms included expert lectures,group interventions, providing spiritual care for cancer patients,and clinical case reporting. The control group participated in the vocational study organized by the hospital for 6 consecutive months. Before and after the training,the Nurses' Spiritual Health Scale and the Spiritual Care Cognitive Scale were used to investigate and test the nurses in two groups,and the implementation effect was compared. Results After 6 months of training, the total scores of Nurses' Spiritual Health Scale and the Spiritual Care Cognitive Scale in the experimental group were (106.30±8.72)and(185.75±16.53), which were higher than those in the control group, and the differences were statistically significant(t=5.38,4.52;P< 0.01);the scores in each dimension were also higher than those in the control group, and the differences were statistically significant(t=2.22-5.22,P< 0.05). And in the experimental group the total scores and scores in each dimension of Nurses' Spiritual Health Scale and the Spiritual Care Cognitive Scale after the intervention were higher than before the intervention, and the differences were statistically significant(t=3.18-8.99,P<0.01). Conclusions The spiritual care training program based on the concept of self-growth with patients can improve nurses' spiritual well-being and nurses' perceptions of spiritual care.

Objective:To explore the effects of career cognition evaluation-based empathy ability training in nurses with moderate and severe level of job burnout.Methods:This study belonged to quasi-experimental study with comparison before and after intervention. From August 2018 to January 2019, a total of 58 nurses with moderate and severe level of job burnout volunteered as subjects in Henan Cancer Hospital.All of the 58 nurses were divided into four groups, 12 to 15 cases in each group. The face to face career cognition-based empathy ability training was carried out for 6 times within 6 weeks. The training effects were compared with the Maslach Burnout Inventory-general Survey (MBI-GS) , General Well-being Schedule (GWB) and Professional Identity Scale before and after training.Results:The score of job burnout of nurses decreased from (11.50±1.13) before training to (7.87±1.87) after training; the total score of general well-being increased from (65.52±10.84) to (77.00±9.49) ; the score of professional identity raised from (30.22±7.90) to (38.03±8.59) with statistical differences ( t=12.864, -6.351, 7.972; P<0.01) . Conclusions:Careercognition-based empathy ability training can alleviate the burnout of nurses with moderate and severe level of job burnout, improve nurses' professional identity and happiness index.

Objective: To compare the positive rate of microbiological examination in different clinical specimens, and to provide reliable basis for improving the quality of microbiological examination and management of nosocomial infection. Methods: A total of 2 028 bacterial culture specimens were collected from the hospitalized patients in the Second People's Hospital of Jinanfrom March 2016 to February 2018.The samples were examined by Micro Scan autoSCAN4 automatic bacteriological identification analyzer.Strictly according to the specification of the standard operation, the positive rates of microbial testingof all kinds of clinical specimens were statistically analyzed. Results: The positive rate of microbiological examination in 2 028 clinical specimens was 44.33%.The positive rate of microbiological examination in sputum was the highest(58.96%), followed by ophthalmic secretion(40.64%), eye contents(37.96%), urine(34.55%), blood(21.11%). Conclusion The positive rate of microbiological examination is different in different clinical specimens.The epidemiological situation of nosocomial infection can be understood by analyzing the microbiological examination of different clinical specimens in clinic.In order to provide a reliable basis for clinical prevention and treatment of nosocomial infection, and to further improve the positive rate of clinical microbiological examination, we should actively carry out improvement countermeasures against its influencing factors.