Objective:To investigate the factors contributing to in-hospital mortality among elderly patients aged 80 and above with gastrointestinal bleeding(GIB).Additionally, it seeks to assess the predictive ability of the electronic frailty index(eFI)in determining the risk of in-hospital mortality in GIB patients.Methods:A retrospective analysis was performed among 624 patients aged 80 and above with GIB who were admitted to Beijing Hospital between July 2013 and September 2019.The patients were categorized into two groups based on their discharge outcomes: those who survived and those who did not.The eFI was developed using a cumulative deficit model utilizing data from the hospital's electronic medical records.The study examined the clinical features and risk factors associated with in-hospital mortality among these elderly patients.The effectiveness of eFI in predicting in-hospital mortality in elderly patients with gastrointestinal bleeding was evaluated by calculating the area under the curve(AUC)of the receiver operating characteristic(ROC)curve.Results:Among a total of 624 patients aged between 80 and 102 years, the average age was(83.0±6.4)years, with 339 being male.A majority of the patients, 581 cases(93.1%), had an eFI ≥ 0.15.A comparison between the survival group(380 cases)and the death group(244 cases)revealed that the latter had higher eFI values(0.39±0.09 vs.0.29±0.11, t=-11.452, P<0.001), along with higher rates of heart failure, chronic kidney disease, and malignant tumors, as well as lower body mass index, hemoglobin, albumin, and total cholesterol levels, and higher alanine aminotransferase and D-dimer levels(all P<0.05).Logistic regression analysis indicated that eFI( OR=2.322, 95% CI: 1.840-2.929, P<0.001), malignant tumor( OR=1.833, 95% CI: 1.141-2.860, P<0.001), and albumin<35 g/L( OR=1.826, 95% CI: 1.200-2.777, P<0.001)were independent risk factors for in-hospital death in elderly patients aged 80 and over with gastrointestinal bleeding.With every 0.1 increase in eFI, the risk of in-hospital death rose by 1.322 times.The AUC of eFI for predicting in-hospital mortality was 0.751(95% CI: 0.713-0.789, P<0.001).An eFI of ≥0.33 demonstrated a sensitivity of 77.9% and a specificity of 60.3% in predicting in-hospital mortality in elderly patients aged 80 and over with GIB. Conclusions:The eFI serves as an important independent risk factor for in-hospital mortality among patients aged 80 and above who experience GIB.It can effectively assess the prognosis of elderly individuals facing GIB.

Objective:To evaluate the efficacy and prognostic factors of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with secondary acute myeloid leukemia (sAML) .Methods:In this multicenter, retrospective clinical study, adult patients aged ≥18 years who underwent allo-HSCT for sAML at four centers of the Zhejiang Hematopoietic Stem Cell Transplantation Collaborative Group from January 2014 to November 2022 were included, and the efficacy and prognostic factors of allo-HSCT were analyzed.Results:A total of 95 patients were enrolled; 66 (69.5%) had myelodysplastic syndrome-acute myeloid leukemia (MDS-AML) , 4 (4.2%) had MDS/MPN-AML, and 25 (26.3%) had therapy-related AML (tAML) . The 3-year CIR, LFS, and overall survival (OS) rates were 18.6% (95% CI 10.2%-27.0%) , 70.6% (95% CI 60.8%-80.4%) , and 73.3% (95% CI 63.9%-82.7%) , respectively. The 3-year CIRs of the M-AML group (including MDS-AML and MDS/MPN-AML) and the tAML group were 20.0% and 16.4%, respectively ( P=0.430) . The 3-year LFSs were 68.3% and 75.4%, respectively ( P=0.176) . The 3-year OS rates were 69.7% and 75.4%, respectively ( P=0.233) . The 3-year CIRs of the groups with and without TP53 mutations were 60.0% and 13.7%, respectively ( P=0.003) ; the 3-year LFSs were 20.0% and 76.5%, respectively ( P=0.002) ; and the 3-year OS rates were 40.0% and 77.6%, respectively ( P=0.002) . According to European LeukmiaNet 2022 (ELN2022) risk stratification, the 3-year CIRs of patients in the low-, intermediate-, and high-risk groups were 8.3%, 17.8%, and 22.6%, respectively ( P=0.639) . The three-year LFSs were 91.7%, 69.5%, and 65.6%, respectively ( P=0.268) . The 3-year OS rates were 91.7%, 71.4%, and 70.1%, respectively ( P=0.314) . Multivariate analysis revealed that advanced disease at allo-HSCT and TP53 mutations were independent risk factors for CIR, LFS, and OS. Conclusion:There was no significant difference in the prognosis of patients who underwent allo-HSCT among the MDS-AML, MDS/MPN-AML, and tAML groups. Advanced disease at transplantation and TP53 mutations were poor prognostic factors. ELN2022 risk stratification had limited value for predicting the prognosis of patients with sAML following allo-HSCT.

Objective:To explore the application effects of a teaching for understanding (TfU) model based on outcome-based education (OBE) in clinical nursing internship in dermatology.Methods:We assigned 34 nursing interns at the department of dermatology of a grade A tertiary hospital in Chengdu in 2021 to observation group to receive instruction using an OBE-based TfU model and another 34 nursing interns in 2022 to control group to be taught using a traditional teaching model. The two groups were compared for theoretical and practical assessment scores, core competencies, clinical communication, and satisfaction with teaching. SPSS 26.0 was used to perform the t-test and chi-square test. Results:The observation group had significantly higher scores than the control group for theoretical assessment [(90.63±2.84) vs. (85.84±4.50)] and practical assessment [(93.15±1.67) vs. (91.12±2.71)]; core competencies overall [(154.38±8.05) vs. (150.18±6.96)] and lifelong learning [(20.18±1.90) vs. (18.85±1.85)], general clinical skills [(23.06±3.30) vs. (18.85±1.85)], and critical thinking and reasoning ability [(11.68±1.47) vs. (10.62±1.41)]; and communication abilities overall [(90.94±5.36) vs. (84.50±5.79)] and harmonious relationship establishment [(20.21±1.86) vs. (18.76±1.92)], patient problem confirmation [(16.91±1.69) vs. (15.26±2.09)], keen listening [(17.35±1.32) vs. (15.44±2.06)], and effective information transmission [(8.91±1.60) vs. (7.85±1.73)] compared with the control group (all P<0.05). The score of satisfaction with teaching of the observation group was significantly higher than that of the control group [(94.12±4.99) vs. (90.53±7.38), P<0.05). Conclusions:The TfU model based on OBE can effectively improve nursing students' theoretical and practical assessment scores, core competencies, communication skills, and satisfaction with internship teaching, which is conducive to their all-round development and professional practice. In addition, this study provides innovative ideas and reform directions for clinical nursing practice teaching.

Objective To solve the problem of large data volume,multiple dimensions and low value for assisting traditional Chinese medicine clinical diagnosis in home health perception layer devices.Methods Based on the principles of traditional Chinese medicine diagnosis,this paper divides home health data into three types:complementary,redundant,and collaborative,and proposes a solution for data fusion at the levels of device data,home events,and traditional Chinese medicine symptoms.Results The proposed data fusion solution in this paper enables the data collected by various devices in the home environment to work together,extracts home data that is more valuable for traditional Chinese medicine diagnosis,and reduces the real-time pressure on the home network bandwidth caused by the sensors on the home side.Conclusion The construction of an open IoT ecosystem for home health based on multiple devices is a huge project,which includes the construction of perception layer hardware,data cleaning,fusion,normalization,labeling,modeling,and other aspects.This paper focuses on the idea of home health data fusion,which can provide directions for cleaning up heterogeneous data from multiple sources at home and also provide ideas for subsequent data labeling and modeling with traditional Chinese medicine characteristics,thus providing more valuable decision-making assistance for traditional Chinese medicine clinical practice.

We summarize the most important advances in RNA delivery and nanomedicine. We describe lipid nanoparticle-based RNA therapeutics and the impacts on the development of novel drugs. The fundamental properties of the key RNA members are described. We introduced recent advances in the nanoparticles to deliver RNA to defined targets, with a focus on lipid nanoparticles (LNPs). We review recent advances in biomedical therapy based on RNA drug delivery and state-of-the-art RNA application platforms, including the treatment of different types of cancer. This review presents an overview of current LNPs based RNA therapies in cancer treatment and provides deep insight into the development of future nanomedicines sophisticatedly combining the unparalleled functions of RNA therapeutics and nanotechnology.

BACKGROUND: This study retrospectively analyzed the application value of lung cancer immunotherapy prognostic index (LIPI) and iSEND immune scoring system in advanced non-small cell lung cancer (NSCLC) patients treated with immunotherapy in China, in order to find guidance for clinical development of NSCLC treatment plan. METHODS: The clinical data of 178 patients with advanced NSCLC treated with immunotherapy were analyzed retrospectively. LIPI and iSEND immune scores were performed, receiver operating characteristic (ROC) curves were drawn, and the predictive values of two models for objective response rate (ORR), disease control rate (DCR), and progression-free survival (PFS) were compared. Kaplan-Meier method was used for survival analysis, and Cox regression analysis method was used for univariate analysis and multivariate analysis. RESULTS: The area under the curver (AUC) of ORR, DCR and PFS predicted by iSEND immune score were 0.616, 0.634 and 0.631 respectively; LIPI were 0.789, 0.750 and 0.732 respectively, which were higher than iSEND immune score (P<0.05). The median PFS of patients in LIPI score groups 0, 1 and 2 were 9.9 months, 6.1 mon and 3.7 mon respectively; The median PFS of patients with good, moderate and poor iSEND immune scores were 9.9 mon, 7.0 mon and 3.5 mon respectively, with statistically significant differences (P<0.001). In the immunotherapy subgroup, the median PFS of patients with different LIPI and iSEND immune scores was also statistically significant. Cox regression analysis showed that the derived neutrophil to lymphocyte ratio (dNLR), lactic dehydrogenase (LDH) and PFS were independently correlated (P<0.05). CONCLUSIONS LIPI and iSEND immune scoring system can effectively predict the efficacy and prognosis of advanced NSCLC treated with immunotherapy, and LIPI has higher predictive value than iSEND immune scoring system.
Humans ; Carcinoma, Non-Small-Cell Lung/therapy* ; Lung Neoplasms/therapy* ; Retrospective Studies ; Immunotherapy ; Prognosis ; Immunologic Factors ; Neutrophils

Objective:To investigate how gender differences between the donor and the recipient affect the effectiveness of antithymocyte globulin (ATG) and pure peripheral blood stem cell (PBSC) hematopoietic stem cell transplantation (haplo-HSCT) in the treatment of malignant hematological diseases.Methods:From February 2015 to September 2020, 648 hematological malignancies patients underwent myeloablative condition regimen haplo-HSCT treatment at the Bone Marrow Transplant Center of the First Affiliated Hospital of Zhejiang University. The median age was 32 (14-62) years, with 363 males (56.0% ) and 285 females (44.0% ) present. 242 cases of acute lymphoblastic leukemia (ALL) (37.3% ) , 293 cases of acute myeloid leukemia (AML) (45.2% ) , 56 cases of myelodysplastic syndrome (MDS) (8.7% ) , 27 cases of non-Hodgkin's lymphoma (NHL) (4.2% ) , and 30 cases of other hematological malignancies (4.6% ) .Results:① The 3-year overall survival (OS) , DFS, the incidence of Ⅱ-Ⅳ grade acute graft-versus-host disease (aGVHD) , the incidence of Ⅲ-Ⅳ grade aGVHD, the 3-year incidence of moderate & severe chronic GVHD (cGVHD) , severe cGVHD, the 3-year incidence of relapse, and NRM of the whole group were (73.10±1.90) % , (70.80±1.90) % , (33.96±1.87) % , (13.08±1.33) % , (35.10±2.14) % , (10.66±1.38) % , (19.43±1.67) % , and (9.80±1.24) % , respectively. ②There was no statistically significant difference between the donor-recipient gender match and donor-recipient gender mismatch groups in the 28-day cumulative neutrophil engraftment rate, 28-day cumulative platelet engraftment rate, the incidence of Ⅱ-Ⅳ grade aGVHD, the incidence of Ⅲ-Ⅳ grade aGVHD, 3-year OS, 3-year DFS, the cumulative incidence of relapse, NRM, and incidence of moderate & severe cGVHD, severe cGVHD. ③The 28-day cumulative neutrophil engraftment rate did not differ statistically between the male-female, female-female, male-male, and female-male groups ( P=0.148) . The incidence of Ⅱ-Ⅳ grade aGVHD, the incidence of Ⅲ-Ⅳ grade aGVHD, 3-year OS, 3-year DFS, cumulative relapse rate, and NRM, and the incidence of cGVHD were not statistically different among the four groups ( P>0.05) . The 28-day cumulative platelet engraftment rate of the female-male group was significantly lower than male-female group, and the female-female group [ (91.45±2.63) % vs. (94.77±1.75) % , P=0.004; (91.45±2.63) % vs. (95.54±2.05) % , P=0.005]. No significant difference existed in the 28-day cumulative platelet engraftment rate between the female-male group and the male-male group [ (91.45±2.63) % vs. (95.08±1.41) % , P=0.284]. ④Among patients ≤35 years old, the 3-year incidence of severe cGVHD patients receiving sister donors and sibling donors were (26.71±5.90) % and (10.33±4.43) % , respectively ( P=0.054) . Patients accepting daughter donors and son donors had a 3-year incidence of moderate and severe cGVHD that was 40.07% vs. 27.41% , respectively, among those over 35 (40.07±6.65) % vs. (27.41±4.54) % ( P=0.084) . ⑤Female donors to male recipients had a significantly lower 28-day cumulative platelet engraftment rate compared to the other groups [ (91.45±2.63) % vs. (95.08±0.95) % , P=0.037]. ⑥ Female donors to male recipients had a significantly lower 28-day cumulative platelet engraftment rate than the other groups in the ATG-Fresenius (ATG-F) 10 mg/kg group [ (89.29±4.29) % vs. (94.49±1.45) % , P=0.037]. But when compared to the other groups in the Rabbit Antihuman Thymocyte Immunoglobulin (rATG-T) 6 mg/kg group, the 28-day cumulative platelet implantation rate between female donors and male recipients was not significantly different [ (93.44±3.38) % vs. (95.62±1.26) % , P=0.404]. Conclusion:The main clinical outcomes of patients with malignant blood diseases following transplantation are unaffected by the gender combination of the donor and patient in the haplo-HSCT mode based on ATG and PBSC sources. Female donors to male recipients have a lower 28-day cumulative platelet engraftment rate and longer platelet engraftment times.

Objective:To provide scientific evidence for infection prevention and control by analyzing the risk factors of surgical site infection, which can move forward the gateway of infection prevention and control.Methods:The surgery-related information of patients admitted to the Department of General Surgery and Department of Orthopedics, People's Hospital of Guangnan Hospital of Yunnan province from November 2016 to August 2019 was retrospectively analyzed. According to whether postoperative surgical site infection occurred, the patients were divided into an infection group and a non-infection group. Logistic regression model was used to analyze the risk factors of surgical site infection.Results:A total of 9 346 patients, consisting of 117 patients in the infection group and 9 229 patients in the non-infection group, were included for final analysis. In the infection group, the incidence of surgical site infection was 1.25%. Multivariate analysis showed that hypoproteinemia ( OR = 2.585), unclean incision ( OR = 3.243 and 5.125), and operation duration more than 3 hours ( OR = 2.315), blood transfusion ( OR = 2.239), drainage tube placement ( OR = 2.133) and indwelling catheter placement ( OR = 1.973) were the independent risk factors for surgical site infection, while prophylactic use of antibiotics was a protective factor ( OR = 0.383). Conclusion:Individual factors, operation-related factors, and treatment-related factors are closely related to the occurrence of surgical site infection. Much attention should be paid to the clinical issues like preoperative hypoproteinemia, perioperative prophylactic use of antibiotics and postoperative drainage tube and indwelling catheter placement.

Objective:To observe and analyze the risk factors related to vitreous re-hemorrhage (PVH) after anti-VEGF drugs combined with vitrectomy (PPV) in patients with proliferative diabetic retinopathy (PDR).Methods:Retrospective analysis study. From April 2017 to July 2018, 100 eyes of 87 PDR patients who were diagnosed in Jiaxing Eye Hospital and received anti-VEGF drugs combined with 25G PPV were included in the study. Among them, there were 44 eyes in 38 males and 56 eyes in 49 females. The age ranged from 26 to 83 years, with an average age of 57.72±8.82 years. All patients were type 2 diabetes, with an average duration of diabetes 10.84±6.03 years. All affected eyes were assisted by the same doctor with a non-contact wide-angle lens under the standard three-channel 25G PPV of the flat part of the ciliary body. Five to 7 days before the operation, intravitreal injection of ranibizumab or conbercept 0.05 ml (10 mg/ml) was performed. The incidence of PVH was observed. The age of PVH patients, duration of diabetes, vision before operation, average fasting blood glucose and average postprandial blood glucose before operation, systolic blood pressure and diastolic blood pressure before surgery, laser treatment before surgery, lens removal during operation, intraocular filling during operation, retinal laser points during operation, and fundus lesions during operation (hyperplasia film, Retinal hemorrhage, vascular occlusion, proliferative retinal traction, retinal hiatus, retinal detachment, exudation, neovascularization) were analyzed to find out the cause of PVH. Spearman bivariate correlation analysis and binary logistic regression analysis were performed on the data.Results:Of the 100 eyes of 87 patients, PVH occurred in 17 eyes (17%). There were statistically significant differences in the number of eyes with vascular occlusion and proliferative traction during surgery in patients with and without PVH ( χ2=5.741, 8.103; P<0.05). There was no significant difference in age ( t=-1.364), duration of diabetes ( t=0.538), preoperative vision ( t=1.897), preoperative fasting blood glucose level ( t=1.938), preoperative postprandial blood glucose level ( t=1.508), preoperative systolic blood pressure ( t=-0.571), preoperative diastolic blood pressure ( t=0.275), whether received laser treatment ( χ2=2.678), the number of laser points during operation ( t=0.565), whether received lens removal during operation ( χ2=0.331), whether found new blood vessels during operation ( χ2=2.741) and whether received intraocular filling during operation ( χ2=0.060) between the patients with and without PVH ( P>0.05). Spearman's bivariate correlation analysis showed that patients with low vision, poor control of fasting blood glucose levels, vascular occlusion and proliferative retinal traction during the operation were related risk factors for PVH ( rs=0.208, 0.229, 0.240, 0.285; P<0.05). Binary logistic regression analysis showed that fundus vascular occlusion and hyperplastic retinal traction may be independent risk factors for PVH during surgery ( OR=5.175, 13.915; P<0.05). Conclusion:Fundus vascular occlusion and retinal traction caused by fibrovascular membrane hyperplasia in PPV may be independent risk factors for PVH in patients with PDR after anti-VEGF drugs combined with PPV.

Objective To investigate the surgical methods and the differences of postoperative complications in esophageal canccr patients aged 60 years and over undergoing different operation models.Methods A total of 542 elderly esophageal cancer patients who underwent thoracic surgery at our hospital between January 2010 and December 2016 were enrolled.Patients were divided into 4 groups:left thoracic incision operation group (n =202),lvor-Lewis two incisions operation group (right chest posterolateral and upper abdomen median) (n=251),three incision operation group (left neckright chest-abdominal midian (n =29),and McKneown under-endoscope minimally invasive operation group (n=60).Clinical data,including the postoperative days,numbers of lymph nodes dissection,pulmonary infection,serous membrane fluid,arrhythmia,chylous fistula,gastric emptying dysfunction and anastomotic leakage,were retrospectively compared between the four groups.Results There was no significant difference in the postoperative days,serous membrane fluid,arrhythmia,chylous fistula,gastric emptying dysfunction and anastomotic leakage (P ＞ 0.05).The number of lymph nodes dissection in Sweet group,Ivor-Lewis group,Mckeown operation group and minimally invasive Mckneown group were (12.9±7.4)、(19.3±8.6)、(14.3±6.9)and(15.4±7.3)respectively.The number of lymph nodes dissection was more in the Ivor-Lewis group than in the other three groups (F =23.915,P =0.000).Sweet group,Ivor-Lewis group,Mckeown group and minimally invasive Mckneown group were 31.7％、40.2％、24.1％ and 50.0％ respectively.The incidence of pulmonary infection was higher in the minimally invasive surgery group than in the other three groups (x2 =9.941,P =0.019).Conclusions Ivor-Lewis surgery is more effective in lymph nodes dissection and has a lower incidence of complications in elderly esophageal cancer patients.The minimally invasive surgery group has a higher incidence of pulmonary infection than in the other surgical groups,which may be related with the immaturity of endoscopic technique.