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Objective: To investigate the prognosis and related factors impacting renal response in newly diagnosed multiple myeloma (NDMM) patients with renal impairment. Methods: A total of 375 NDMM patients diagnosed at the Department of Hematology, the First Affiliated Hospital of Nanjing Medical University from August 2012 to April 2022 were retrospectively recruited. Patients were categorized into non-renal impairment group( n =273) and renal impairment group ( n =102) according to renal function at initial diagnosis. All patients received≥2 cycles of bortezomib-based induction chemotherapy after admission. The hematological response included stringent complete response (sCR), complete response (CR), very good partial response (VGPR), partial response (PR) and stable disease (SD). The renal responses were defined as CR, PR, minor response (MR) and non-response (NR). General clinical data of the patients were collected, and patients were followed up by telephone. The follow-up deadline was December 3, 2022, and the median follow-up time [ M ( Q 1 , Q 3 )] was 42 (22, 61) months. Kaplan-Meier analysis was used to plot the survival curve. The log-rank test was utilized for inter-group comparisons. Multivariate logistic regression modeling facilitated the exploration of associated factors impacting renal response. Results: In the renal impairment group, there were 68 males and 34 females with a median age [ M ( Q 1 , Q 3 )] of 64 (58, 69) years. In the non-renal impairment group, there were 149 males and 124 females with a median age of 62 (54, 68) years. Compared with the renal impairment group, the age, lactate dehydrogenase and 24-hour urinary protein quantity were increased, the proportion of patients with light chain M protein and the proportion of patients at the DS-Ⅲ stage, ISS-Ⅲ stage and R-ISS-Ⅲ stage were higher, the hemoglobin level and the proportion of patients receiving autologous hematopoietic stem cell transplantation were lower in the renal impairment group (all P <0.05). In 102 patients with renal impairment, renal responses of CR, PR, MR and NR were obtained in 53 (52.0%), 8 (7.9%), 18 (17.6%), 23 (22.5%) patients, respectively, and the overall response rate was 77.5% (79/102). Kaplan-Meier survival curve revealed that the median progression-free survival (PFS) was 24.0 (95% CI : 18.3-29.7) months in the renal impairment group, which was shorter than 31.0 (95% CI : 24.7-37.3) months in the non-renal impairment group ( P =0.003). The median overall survival (OS) was 46.0 (95% CI : 36.5-55.5) months in the renal impairment group, which was shorter than 79.0 (95% CI : 59.9-98.1) months in the non-renal impairment group ( P =0.002). Among the renal impairment group, patients with renal response of less than PR exhibited a median PFS of 19.0 (95% CI : 9.7-28.3) months, which was shorter than 28.0 (95% CI : 21.4-34.5) months for those achieving PR or better ( P =0.048). The median OS was 31.0 (95% CI : 23.5-38.5) months in renal response with less than PR group, which was also worse than 57.0 (95% CI : 42.8-71.2) months for those who achieved PR or better ( P =0.003). The results of multivariate logistic regression showed that hematological response achieving VGPR or better was a factor associated with renal response achieving PR ( OR =4.20, 95% CI : 1.20-14.68, P =0.025). Conclusions: The prognosis of NDMM patients with renal impairment is poor. The hematological response with VGPR or better is related to the renal response achieving PR.

POEMS syndrome is a rare plasma cell dysplasia. Its clinical manifestations include polyneuropathy, monoclonal protein, increased extravascular volume load, endocrinopathy, organomegaly and skin changes. The complex and atypical symptoms at presentation make early diagnosis challenging due to multiple system involvement. Peripheral neuropathy, limb numbness, is the most common initial symptom of this disease. However, case reports of increased extravascular volume load are rare. This article collected and analyzed the clinical data of two groups of patients with different initial symptoms (increased extravascular volume load and limb numbness). The clinical characteristics and treatment responses were summarized.

Objective: To analyze the prognostic value of del(1p32) in patients with newly diagnosed multiple myeloma (MM)., Methods: The clinical data of 341 newly diagnosed MM attended in Jiangsu Province Hospital were retrospective analyzed. Clinical characteristic combined with genetic features, especially del(1p32), were analyzed for survival and prognostic of patients., Results: Among the 341 patients with newly diagnosed MM, 24(7.0%) patients were del(1p32) positive. The progression-free survival (PFS) and overall survival (OS) were significantly shorter in MM patients with del(1p32) than those without del(1p32) (PFS: P < 0.001;OS: P < 0.001). The COX proportional-hazards model showed that del (1p32) was an independent risk factor for PFS and OS of patients with MM. The patients with both 1q21 gain/amplification and del(1p32), as "double-hit chromosome 1", have worse prognosis than those with only 1q21 gain/amplification or only del(1p32) (PFS: P < 0.001; OS: P < 0.001)., Conclusion: Del(1p32) is an independent risk factor for PFS and OS of patients with MM. Del(1p32) detection should be widely used in the prognostic analysis for newly diagnosed MM patients.

The current version of Jing Xiao Chan Bao is believed to be the earliest medical book on gynecology remaining in China. It has three problems: formulae missing, lack of fluency in the text, and thus difficulties in proofreading and editing. These problems are still there because there are very few versions of Jing Xiao Chan Bao left in China and so it is difficult to do further studies to make comparisons. The Waseda University Library announced that the version they held was a handwritten. It provides a new version for further research of this book. This version was believed to be compiled and edited by Japanese scholars based on Medical Prescription Analogues (Yi Fang Lei Ju) and therefore appears to be similar to the South Song Dynasty version. Using archival research, it was found that in the version at Waseda University Library, the content organisation, the number of formulas, and the use of taboo words is different from those in the current version in China. In this sense, it is believed that this version is valuable and meaningful for archival and clinical research for traditional Chinese medicine.

Objective: To investigate the clinical efficacy of body-surface guide plates for lateral segmental positioning in the thoracolumbar spine., Methods: From March 2018 to March 2021, 768 gerontal patientss underwent percutaneous vertebroplasty with balloon dilatation due to thoracolumbar compression fracturess, 356 males and 412 females. aged from 64 to 92 years old with an average of (77.9±13.5) years old. All patients were treated in hospital within 1 week after injury. All patients underwent preoperative localization, and were divided into localization plate group and locator group according to different localization methods. There were 390 patients in the localization plate group, 180 males and 210 females, aged from 64 to 92 years old, with an average age of (78.4±14.3) years old. There were 378 patients in the locator group, 176 males and 202 females, aged from 64 to 90 years old, with an average age of (77.5±13.4) years old. After preliminary positioning with the above two methods, skin markers were made, cloth was routinely disinfected, and the spinal lateral position was fluoroscopically examined after the fine needle was inserted into the marked point and the vertical body at the near tail end. The accuracy of the original positioning method was evaluated. The number of times, time and accuracy of positioning of the two groups of patients were compared and analyzed., Results: The specific data of patient positioning in the two groups were collected for statistical analysis. The number of times of fluoroscopy in the positioning plate group and the locator group was(3.3±0.5) times and (5.0±1.2) times, and the positioning time was (60.4±9.4) s and (105.0±30.9) s, respectively. The accuracy of fluoroscopy was 97.5% (380/390) and 85.7% (324/378), respectively, with statistical significance ( P <0.05)., Conclusion: The lateral segmental positioning plate of the body surface spine has the advantages of simple operation, accurate positioning, and reducing X-ray radiation for patients, which is worthy of clinical application.

Objective: To investigate the therapeutic effect and prognostic value of oligoclonal bands (OB) in multiple myeloma (MM) patients after autologous stem cell transplant (ASCT). Methods: The data of 156 patients with MM who underwent ASCT after inductive treatment in the Department of Hematology, Jiangsu Provincial People's Hospital from December 2013 to February 2022 were retrospectively analyzed, including 91 males and 65 females. The median age was 56 (26, 71) years. Patients were divided into two groups according to OB formation after ASCT treatment, including OB group ( n =60) and non-OB group ( n =96). The last follow-up date was August 31, 2023, and the follow-up period was 42 (18, 117) months. The clinical baseline characteristics and efficacy of the two groups were compared. Progression-free survival (PFS) and overall survival (OS) were compared between the two groups by Kaplan-Meier method. Cox risk regression modal was used to analyze the risk factors associated with prognosis. Results: There were no significant differences in age, type, stage, risk stratification, extramedullary disease (EMD), proportion of circulating plasma cells and induction therapy regimen between OB and non-OB groups (all P >0.05). The proportion of patients in OB group who achieved complete response (CR) or above after ASCT treatment was 93.3% (56/60), which was higher than that in non-OB group (80.2%, 77/96) ( P =0.024). The negative rate of minimal residual disease (MRD) in OB group was 66.7% (40/60), which was higher than that in non-OB group (34.4%, 33/96) ( P =0.001). The median PFS and OS in the OB group were not reached, and the median PFS and OS in the non-OB group were 28 (2, 80) months and 86 (2, 100) months, respectively. The PFS ( P <0.001) and OS ( P =0.017) of patients with OB were considerably longer. In the Cox multivariate analysis, OB was an independent prognostic factor for PFS in MM patients ( HR =0.314, 95% CI : 0.153-0.644, P =0.002). Subgroup analysis showed that among high-risk patients with mSMART, the OS of patients in OB group was not reached, which was significantly better than that of non-OB group [71 (2, 90) months, P =0.046]. However, no significant difference was observed in the OS of patients with OB and those with non-OB in standard risk group (not reached vs not reached, P =0.103). In those with EMD at diagnosis, patients with OB had significantly better OS than those with non-OB [not reached vs 47 (6, 74) months, P =0.037]. However, no significant difference was observed in the OS of patients with OB and those with non-OB in those without EMD at diagnosis [not reached vs 86 (2, 100) months, P =0.130]. Conclusions: OB formation after ASCT treatment in MM patients is related to the efficacy and prognosis. OB formation can increase the negative MRD rate, prolong the OS and improve the prognosis, especially for newly diagnosed patients with extramedullary disease or patients with high-risk genetic characteristics.

Objective: To investigate the characteristics of cytopenia and its impact on prognosis in patients with relapsed and refractory multiple myeloma (RRMM) after B-cell maturation antigen (BCMA) chimeric antigen receptor T-cell (CAR-T) immunotherapy therapy. Methods: Clinical data of 36 RRMM patients received BCMA CAR-T therapy at the First Affiliated Hospital of Nanjing Medical University from April 2017 to March 2023 were retrospectively collected. Among them, there were 17 males and 19 females, with an age [ M (Q 1 , Q 3 )] of 62 (53, 67) years. The follow-up deadline was August 31, 2023, and the follow-up time [ M (Q 1 , Q 3 )] was 33 (10, 30) months. The characteristics of cytopenia at different time points before lymphodepleting chemotherapy and after CAR-T cell infusion in all patients were analyzed. Kaplan-Meier method was used to compare the differences in progression-free survival (PFS) and overall survival (OS) in patients with different clinical characteristics. Single-cell sequencing analysis was used to analyze the changes in hematopoietic stem cells in three patients after CAR-T cell therapy. Results: The incidence of cytopenia after BCMA CAR-T cell therapy in 36 RRMM patients reached 100%. The incidence of neutropenia peaked on the 7th and 28th day after cell infusion with a biphasic pattern of change.Patients with all grade neutropenia reached 61.1% (22/36) and grade 3 or higher reached 33.3% (12/36) on the 7th day, while patients with all grade neutropenia reached 67.9% (19/28) and grade 3 or higher reached 28.6% (8/28) on the 28th day ( P< 0.001),respectively. The occurrence rate of lymphopenia reached a peak on the day of CAR-T cell infusion [97.2% (35/36) patients showed lymphopenia, while 80.6% (29/36) patients showed grade 3 or higher lymphopenia] ( P< 0.001).The incidence of all grade of thrombocytopenia and severe thrombocytopenia (grade 3 or higher) peaked on the 14th day after cell infusion, with the rates of 69.4% (25/36) and 30.6% (11/36) respectively, which had a prolonged duration( P< 0.001). Even after 12 months, 40% (8/20) of patients still experienced thrombocytopenia.The incidence of anemia peaked on the 7th and 14th day after cell infusion, with a rate of 100% (36/36) ( P< 0.001). 50% (10/20) of patients still had anemia even 12 months after cell infusion. Kaplan-Meier survival analysis showed that patients with thrombocytopenia < grade 3 had undefined OS, while patients with thrombocytopenia ≥grade 3 had shorter OS [17 (95% CI : 2-32) months, χ 2 =4.154, P =0.042], indicating a poorer prognosis. However, there was no statistically significant difference in the relationship between other cytopenia and survival (all P> 0.05). Single-cell sequencing analysis of bone marrow cells revealed decreased proliferation, increased apoptosis, and cell cycle arrest of hematopoietic stem cells after CAR-T cell infusion. Conclusions: All patients experienced varying degrees of cytopenia after receiving BCMA CAR-T cell infusion, and patients with thrombocytopenia ≥grade 3 had shorter OS and poorer prognosis.

Objective: This study aimed to investigate the influence of FGFR3 gene mutations on the clinical characteristics and prognosis of patients with newly diagnosed multiple myeloma (NDMM) . Methods: A total of 198 patients with NDMM admitted to the Department of Hematology in Jiangsu Province Hospital between January 2016 and February 2023 were retrospectively analyzed. Next-generation sequencing and cytoplasmic light chain immunofluorescence with fluorescence in situ hybridization were performed for all patients. The prognostic significance of FGFR3 mutation and clinical features were analyzed using the Log-rank test and Cox proportional hazards model. Results: Among 198 patients, 28 carried the FGFR3 gene mutation. These patients had significantly lower serum albumin levels, higher β(2)-microglobulin levels, advanced Revised International Staging System stages, more frequent occurrence of t (4;14) , and shorter median progression-free survival (PFS) time (28 months vs 33 months, P =0.024) and overall survival (OS) time (54 months vs undefined, P =0.028) than patients without FGFR3 mutation. Additionally, patients carrying either FGFR3 mutation or t (4;14) had lower PFS (30 months vs 38 months, P =0.012) and OS (54 months vs undefined, P =0.017) than those without. The Cox proportional hazards model identified FGFR3 mutation as an independent risk factor for PFS and OS. Conclusion: FGFR3 gene mutation was an unfavorable independent prognostic predictor for NDMM.

Objective: To evaluate the prognostic value of Mayo MASS and R2-ISS staging systems in patients newly diagnosed with multiple myeloma (MM) . Methods: A total of 371 patients newly diagnosed with MM in Jiangsu Province Hospital were included in the study. Cytoplasmic light chain immunofluorescence with fluorescence in situ hybridization (cIg-FISH) was performed to detect cytogenetic abnormality. Clinical characteristics were combined to analyze the disease stage and evaluate the prognosis. Results: There were 37 (10.0%), 264 (71.0%), and 70 (18.8%) patients in R-ISS stage Ⅰ, Ⅱ, and Ⅲ, respectively. The median progression-free survival (PFS) times were 37, 25, and 14 months ( P <0.001). The median overall survival (OS) times were not reached (NR), 66, and 30 months ( P <0.001). There were 71 (19.1%), 140 (37.7%), and 160 (43.2%) patients in Mayo MASS stages Ⅰ, Ⅱ, and Ⅲ, and the median PFS times periods were 43, 27, and 19 months ( P <0.001), and the median OS times were NR, NR, 35 months, respectively ( P <0.001). There were, 23 (6.2%), 69 (18.6%), 222 (59.8%), and 57 (15.4%) patients in R2-ISS stages Ⅰ, Ⅱ, Ⅲ, and Ⅳ, respectively. The median PFS times were 47, 31, 25, and 15 months ( P =0.001), and the median OS times were NR, NR, 49, and 55 months, respectively ( P <0.001) . Conclusion: Based on the R-ISS staging system, Mayo MASS, and R2-ISS prognostic staging system incorporated 1q21+, which allows a better stratification. However, the proportion of stage Ⅲ patients in Mayo MASS and R2-ISS staging systems is relatively high, which is considered related to the high incidence of 1q21+ and ISS Ⅲ in the Chinese population.

Objective: To explore the risk and location of multiple malignancies in patients with hematologic malignancies who were followed up for 9 years in Jiangsu Province Hospital and to evaluate the impact of the second primary malignancy on survival of patients., Methods: The incidence and survival of multiple malignancies in 7 921 patients with hematologic malignancies from 2009 to 2017 were analyzed retrospectively., Results: A total of 180 (2.3%, 180/7 921) patients developed second malignancy, of whom 58 patients were diagnosed with hematologic malignancies as the first primary malignancy, and 98 patients developed hematologic malignancies as second primary malignancy, and the other 24 cases were diagnosed with the second malignancy within 6 months after the first primary malignancy was diagnosed, which was difined as multiple malignancies occurring simultaneously. In 180 patients, 18 cases developed two hematologic malignancies successively, and 11 patients developed more than 3 primary cancers (among them, 2 female patients were diagnosed with 4 primary cancers). Patients with lymphoma and multiple myeloma (MM) as the second primary malignancy had poorer survival than patients with lymphoma and MM as the first primary malignancy. Patients with chronic myeloid leukemia as the second primary malignancy were also associated with inferior overall survival., Conclusion: In this study, 2.3% of hematologic malignancy patients had multiple mali-gnancies, lymphoma and MM as the second primary malignancy had poor survival.

Objective: This study aimed to examine the relationship between low T3 syndrome (LT3S) and the prognosis of newly diagnosed multiple myeloma (NDMM) patients. Methods: A retrospective examination of 211 NDMM patients treated at the Department of Hematology, Jiangsu Provincial People's Hospital from July 2009 to December 2020 was performed, and all patients received thyroid function testing to determine if they had LT3S. We investigated the relationship between LT3S and clinical features, as well as its impact on MM prognosis. Results: Of the 211 patients, 119 were males, and 92 were females, with a median age of 60 (33-86) years. Patients with LT3S had significantly higher levels of β(2)-microglobulin, C-reactive protein, and blood creatinine compared to those with normal T3 levels. They also had lower levels of hemoglobin, platelets, and serum albumin, as well as more advanced ISS stages ( P <0.001) . Patients with LT3S had shorter progression-free survival (PFS) (16 months vs 30 months, P =0.003) and overall survival (OS) (57 months vs 75 months, P =0.004) than patients without LT3S. LT3S was found to be a standalone unfavorable factor in multivariate analysis, LT3S was an independent unfavorable factor in predicting both PFS ( HR =2.114, 95% CI 1.271-3.516, P =0.004) and OS ( HR =2.231, 95% CI 1.088-4.577, P =0.029) . Conclusions: Low T3 syndrome was an independent unfavorable prognostic predictor for NDMM.

Objective: To assess the efficacy of induction chemotherapy followed by allogeneic hematopoietic stem cell transplantation (allo-HSCT) in the treatment of FLT3-ITD(+) acute myeloid leukemia (AML) with normal karyotype. Methods: The clinical data of FLT3-ITD(+) AML patients with normal karyotype in the First Affiliated Hospital of Nanjing Medical University from Jan 2018 to March 2021 were retrospectively analyzed. Results: The study included 49 patients with FLT3-ITD(+)AML, 31 males, and 18 females, with a median age of 46 (16-59) years old. All patients received induction chemotherapy, and 24 patients received sequential allo-HSCT (transplantation group) . The median follow-up time was 465 days, the one-year overall survival (OS) from diagnosis was (70.0 ± 7.4) %, and one-year disease-free survival (DFS) was (70.3±7.4) %. The one-year OS was significantly different between the transplantation group and the non-transplantation group [ (85.2 ± 7.9) % vs (52.6 ± 12.3) %, P =0.049]. but one-year DFS [ (84.7 ± 8.1) % vs (55.2 ± 11.9) %, P =0.061] was not. No significance was found in one-year OS between patients with low-frequency and high-frequency FLT3-ITD(+) ( P >0.05) . There were 12 patients with high-frequency FLT3-ITD(+) in the transplantation and the non-transplantation groups, respectively. The one-year OS [ (68.8 ± 15.7) % in the transplantation group vs (26.2 ± 15.3) % in the non-transplantation group, P =0.027] and one-year DFS [ (45.5 ± 21.3) % in the transplantation group vs (27.8±15.8) % in the non-transplantation group, P =0.032] were significantly different between the two groups. Conclusion: Induction chemotherapy followed by allo-HSCT can enhance the prognosis of FLT3-ITD(+) patients, particularly those with FLT3-ITD high-frequency mutation.

Objective: To analyze the clinical features, imaging characteristics, treatment options and prognosis of prostatic abscess (PA), and provide some new ideas for the diagnosis and treatment of the disease., Methods: This retrospective study included 11 cases of confirmed PA treated in the Fifth Medical Center of PLA General Hospital. We analyzed the clinical data obtained from the electronic medical records, including basic demographic statistics, risk factors, clinical symptoms, laboratory results, imaging findings, treatment methods, treatment-related complications and outcomes., Results: The 11 patients diagnosed with PA between May 2016 and August 2022 were aged (64.18 ± 7.19) years and all had at least 1 comorbidity, including 5 cases of diabetes mellitus (45.5%) and 8 cases of dysuria (72.8%). PA was confirmed in 3 cases by CT and in 8 cases by MRI, 6 (54.5%) multifocal and 10 (90.9%) >2 cm in diameter, with a median size of 3.84 cm. After admission, positive urine culture was found in 3 cases, positive blood culture in 1, Klebsiella pneumoniae in 2 and Enterococcus Faecalis in 1. Three of the patients were treated by intravenous administration of antibiotics alone, and the other 8 by transurethral PA unroofing in addition. Antibiotics medication lasted for a median of (12.9 ± 3.88) d and hospital stay averaged (19.18 ± 8.20) d. The patients were followed up for 3 months, which revealed the presence of PA in 2 of the cases treated with antibiotics alone, but not in any of the cases treated by surgery., Conclusion: PA is relatively rare and has no specific symptoms clinically. Imaging examination is very important for accurate diagnosis, and transurethral PA unroofing plus antibiotics administration could be considered as an optimal management of the disease.

Objective: To investigate the in vitro inhibitory activity of a novel class Ⅰ and Ⅱb selective histone deacetylase (HDAC) inhibitor, purinostat mesylate (PM) , in diffuse large B-cell lymphoma and its mechanism. Methods: The 3- (4,5-dimethylthiazol-2-yl) -2,5-diphenyl tetrazolium bromide method was used to detect the effect of PM on cell proliferation. The effects of PM on cell cycle and apoptosis were detected by flow cytometry. The acetylation levels of HDAC substrate, cell cycle protein, apoptosis-related protein, and oncogene protein expression were detected by Western blot. Results: PM significantly inhibited the proliferation of lymphoma SUDHL-4 and SUDHL-6 cells and increased the acetylation levels of HDAC substrates H3, H4, and α-tubulin. In cell cycle experiments, PM induced G(0)/G(1) phase arrest in SUDHL-4 and SUDHL-6 cells. Western blot experiment showed that PM could significantly downregulate the expression of cyclin-dependent kinases Cdk2, Cdk4, Cdk6, cyclin D1, and cyclin E and upregulate the expression of CDK inhibitor protein p21. In the apoptosis experiment, PM could induce the apoptosis of SUDHL-4 and SUDHL-6 cells. Western blot experiment demonstrated that PM promoted endogenous apoptosis by activating caspase-3 kinase and affecting antiapoptotic protein Bcl-2. In addition, PM could downregulate the expression of oncogene marker proteins MYC, IKZF1, and IKZF3. Conclusion: PM has an efficient biological activity in vitro for diffuse large B-cell lymphoma, including double-hit lymphoma, and provides valuable experimental evidence for PM in clinical treatment.

Objective: To analyze the clinical characteristics of multiple myeloma(MM) patients with early relapse., Methods: A total of 50 MM patients with early relapse (≤12 months) and 50 matched controls with late relapse (>12 months) were selected. The time from diagnosis to relapse and related clinical data of the 100 patients were retrospectively analyzed, and the factors associated with early relapse were identified. Kaplan-Meier curve was used to analyze the overall survival (OS) time of the whole cohort. Area under the curve (AUC) was used to evaluate the effect of circulating plasma cells on early recurrence of the patients., Results: The results showed that high-risk cytogenetics (FISH) (P=0.005), and ISS stage III (P=0.008) were associated with early recurrence of the patients. For patients with early relapse, high-risk FISH showed poor survival. Compared with the patients with late relapse, most of the chromosome karyotype of patients with early relapse showed quantitative and structural abnormalities. The expression of circulating plasma cells was significantly increased in patients with early recurrence group (P=0.0318). The response to initial treatment was poor in the early recurrence group (P=0.001), and the prognosis was significantly worse than those in the late recurrence group (median OS: 38 vs 81 months, P=0.002)., Conclusion: Early relapse is a marker poor prognostic in MM patients, and such patients should be focused on the improving their prognosis.

Objective: To investigate the longitudinal changes of white matter microstructural based on diffusion tensor imaging in parents who lost their only child without psychiatric disorders and its relationship with symptoms of posttraumatic stress disorder (PTSD). Methods: Parents who had who lost their only child and without psychiatric disorders in Jiangsu Province, from September 2016 to March 2017, were retrospectively collected (TENP group, 32). MRI scans were performed at baseline and at the end of 5-year follow-up, and the Clinician Administered PTSD Scales (CAPS) were used for assessing the severity of symptoms. Additionally, sex, age and education level matched healthy subjects were recruited as healthy controls (control group, 27) and underwent MRI scanning using the same protocol. The differences of fractional anisotropy (FA) values between TENP group and control group at baseline were analyzed by using Tract-based spatial statistics method, and the brain areas of lateral differences were used as the regions of interest for longitudinal follow-up analysis of TENP group. Partial correlation analysis was used to evaluate the relationship between FA values changes in longitudinal differences in brain regions and CAPS scores. Results: Compared with the control group, FA values of the right cingulate gyrus, Uncinate fasciculus, superior longitudinal fasciculus, corticospinal tract, Inferior fronto-occipital fasciculus, Inferior longitudinal fasciculus and forceps major in TENP group were decreased at baseline ((0.613±0.032) vs (0.631±0.034), (0.539±0.048) vs (0.563±0.045), (0.534±0.033) vs (0.558±0.039), (0.560±0.038) vs (0.580±0.030), (0.519±0.023) vs(0.549±0.024), (0.489±0.038) vs (0.518±0.027), (0.499±0.027) vs (0.533±0.032); all P <0.05). From baseline to follow-up, scores of trauma reexperience symptoms and avoidance/numbness symptoms were decreased ((5.2±2.8) vs (8.1±4.9), (4.0±3.2) vs (6.6±5.4); all P <0.05); FA values of the right corticospinal tract, Inferior fronto-occipital fasciculus, Inferior longitudinal fasciculus and forceps major were decreased ((0.523±0.049) vs (0.537±0.049), (0.568±0.052) vs (0.590±0.050), (0.540±0.063) vs (0.559±0.059), (0.520±0.059) vs (0.547±0.059); all P <0.05); The decrease of FA values of the right Inferior fronto-occipital fasciculus and right Inferior longitudinal fasciculus was negatively correlated with the decrease of avoidance/numbness symptoms scores ( r =-0.458, -0.374, respectively, all P <0.05). Conclusions: The trauma of parents who lost their only child can result in impaired microstructural integrity of white matter. As the post-traumatic time goes by, parents who have lost their only child do not develop to PTSD and other psychiatric disorders, and the clinical symptoms are alleviated, the damage of the white matter microstructure continued to progress.

Objective: To investigate the influence of the number of high-risk cytogenetic abnormalities (HRCA) on the clinical characteristics and prognosis of patients with newly diagnosed multiple myeloma (MM) . Methods: A total of 360 patients with newly diagnosed MM admitted to Jiangsu Province Hospital between November 2013 and September 2020 were included in this study. Cytoplasmic light chain immunofluorescence with fluorescence in situ hybridization (cIg-FISH) was used to detect HRCA. Cytogenetic abnormalities were combined with clinical characteristics and outcomes for further analysis. Results: Among the 360 patients, 120 patients (33.3%) presented with no HRCAs, and 175 (48.6%) , 61 (16.9%) , and four (1.1%) patients had one, two, and three HRCA (s) , respectively. Patients were divided into three groups, including the no-HRCA group, one-HRCA group, and ≥two-HRCA group, according to the number of HRCAs. There were significant differences in the R-ISS stage, hemoglobin level, albumin level, and the proportion of bone marrow plasma cells among the three groups ( P <0.05) . The COX proportional-hazards model identified extramedullary disease ( P =0.018) , HRCA ≥ 2 ( P =0.001) , and absence of autologous hematopoietic stem cell transplantation ( P <0.001) as independent risk factors for progression free survival (PFS) and identified lactate dehydrogenase (LDH) level ≥ 220 U/L ( P <0.001) , HRCA ≥2 ( P =0.001) , and absence of autologous hematopoietic stem cell transplantation ( P =0.005) as independent risk factors for overall survival (OS) . The median PFS was 28 months, 22 months, and 14 months ( P =0.005) for the three cohorts, and their OS was not reached,60 months, and 30 months ( P =0.001) , respectively. Conclusions: HRCA ≥ 2 is an independent risk factor for decreased survival in patients with newly diagnosed MM. More HRCAs result in heavier tumor burden, as well as a higher risk of disease progression and death.

Objective: To investigate the research trend and scope of prevention of central venous catheter-related bloodstream infection (CRBSI) in burn patients. Methods: The scoping review method was adopted. Pre-retrieval was carried out with search terms of ", , " and "central venous catheter, infection, catheter-related bloodstream infection, burn". On the basis of pre-retrieval, different retrieval formulas were formulated to retrieve researches related to central venous CRBSI in burn patients in China National Knowledge Internet , Wanfang Database , VIP Database , PubMed , Embase , CINAHL , and Cochrane Library from the establishment of each database to August 2020. Data were extracted from the included literature, including the first author, research publication time, research country, research type, diagnosis basis and intervention measures of central venous CRBSI, research sample selection, incidence related to infection, and research conclusion. Results: A total of 20 randomized controlled trials, quasi-experimental studies, case-control studies, cohort studies, and implementation researches published in 1990-2020 were included in this study with the first authors from China, the United States of America, or Argentina. The diagnostic bases for central venous CRBSI in burn patients were not uniform in the included literature, including adopting the Guidelines of American Centers for Disease Control and Prevention, Diagnostic Criteria for Nosocomial Infection , and other diagnostic criteria without specifying the source. The intervention measures included the use of new materials such as antibiotics coated catheter and ethanol impregnated port protectors, multidisciplinary cooperation, and comprehensive preventive measures. The sample size in the included literature was small, and the sample selection was different, including the number of patients and the the number of placement of central venous catheter. The outcome indicators for infection in the included literature were diversified. The incidence per 1 000 days of central venous CRBSI was 20.41‰-29.1‰ of patients in control group in China, the incidence per 1 000 days of central venous CRBSI was mostly <16.6‰ in control group in foreign countries, and the incidence of central venous CRBSI was decreased to varying degrees after implementing the corresponding intervention measures. Related research conclusions showed that new materials, multidisciplinary cooperation, and comprehensive preventive measures had good effects on prevention of central venous CRBSI in burn patients. Conclusions: The researches on prevention of central venous CRBSI in burn patients in China start early and the research types are diversified. The diagnostic criteria of central venous CRBSI in burn patients are not uniform, intervention measures have shifted from standardizing relevant operational measures to exploring the prevention effects of new materials, multidisciplinary cooperation, and multiple measures, and the latter has good effects on preventing central venous CRBSI in burn patients.

Healthy aging is the primary goal of healthcare for older adults in aging societies. The prevention of physical disabilities and dementia is becoming more important. As frailty involves both the physical and cognitive domains, detecting and preventing cognitive frailty early on is key to reversing cognitive diseases such as dementia. In this study, a concept analysis strategy (Walker & Avant, 2019) was applied to define the concept of cognitive frailty in older adults and identify the attributes of (1) presence of subjective cognitive decline or mild cognitive impairment, (2) exclusion of concurrent Alzheimer's disease or other dementia, (3) concomitant physical frailty, and (4) it is revisable. Using the constructed model, borderline and contrary cases were used to explain the concept of cognitive frailty. Finally, the antecedent and consequence factors of cognitive frailty were identified and the empirical measurement tools were evaluated. This analysis may be used to improve nurses' understanding of cognitive frailty in older adults and to benefit clinical practice and further research.

Objective: To investigate sensitization rate of cow's milk in children, and explore its clinical features. Methods: This study enrolled a total of 818 patients under 18 years old with suspected food allergy who were admitted to the Allergy department in Beijing Shijitan Hospital during June 2018 to November 2020. The ImmunoCAP fluorescent enzyme-linked immunoassay system was used to quantify cow milk-specific immunoglobulin E (sIgE). Mild sensitization to cow's milk was defined as Radio-Allergo-Sorbent-Test (RAST) class 1, moderate sensitization was defined as class 2-3 and severe sensitization was class 4-6. Statistical methods such as χ 2 test, independent sample t -test, one-way analysis of variance, and Spearman correlation analysis were used to retrospectively clarify differences of cow's milk sensitization rate between ages of children and elaborate its clinical features. Results: Overall sensitization rate of cow's milk reached 25.7% (210/818). Positive rate of cow milk sensitization (39.2%), cow milk sIgE levels [0.93 (0.52, 2.62)] kU/L, and moderate to severe sensitization rate (23.5%) were highest in infants aged between 0-3 years old. The sensitization rate and severity of sensitization declined with age. Most common clinical manifestation of cow milk sensitization was skin symptoms (50.0%), followed by respiratory symptoms (38.9%) and gastrointestinal symptoms (36.1%). Skin symptoms were the most common manifestation in 0-3 year-old group (47.3%), and respiratory symptoms were more common in 4-6 and 7-18 year-old groups (58.7%, 56.0%). Multiple-sensitization rate of patients with moderate to severe cow milk sensitization was 74.1%, most of which (70.4%) were co-sensitized by other food allergens, and 31.5% were co-sensitized by inhaled allergens. Conclusions: In population with age under 18 years old, infants aged between 0-3 years old suffered highest cow milk sensitization rate and increased sensitization severity. Then the severity decreased with age increasing. Patients with cow milk sensitization manifested skin symptoms most.

Gobiids are widespread invasive species, with many species from this group usually invade into the same ecosystem simultaneously. Understanding the mechanisms underlying the coexi-stence of different gobiid species in the sympatric habitats is a key issue in fish invasion ecology. Incorporating morphological analyses, spatial distribution survey, and trophic analyses, we examined the coexistence strategy of Mugilogobius myxodermus and related species (the earlier invaders) in Dianchi Lake, Yunnan, China. Our results showed significant differences in morphology and spatial distribution among the four invasive gobies species ( i.e ., M. myxodermus , Micropercops swinhonis , Rhinogobius giurinus and Rhinogobius cliffordpopei ). The spatial niche index of M. myxodermus was the highest. Food composition between M. myxodermus and other gobies was significantly different, with the former mainly feeding on Chydorus ovalis and Cypris sp. The trophic diversity index of M. myxodermus was the highest. Overall, we found that morphological differences, spatial niche diffe-rentiation, and trophic niche differentiation contributed to the coexistence of the gobies in Dianchi Lake, which could help M. myxodermus reduce interspecific competition. Importantly, the feeding strategy is the key factor determining population size and habitas of M. myxodermus during their competition with the other gobies, and finally contributing to the dominant position in the study area.

We investigated the effects of different biochar application patterns on soil nutrient contents and element transformation, with soil samples being collected from two five-year field experiments in Phaeozem and Luvisol amended with biochar at annual low-rate (AL, 22.5 t·hm -2 ·a -1 ) and intervalic high-rate (IH, 112.5 t·hm -2 ·5 a -1 ). Changes of soil total carbon (C), nitrogen (N) and phosphorus (P) contents as well as the related enzyme activities were measured under different biochar application patterns to provide fundamental information for the straw utilization and soil fertility improvement in agroecosystem. Results showed that total C and organic N contents in AL treatment were significantly higher than those in IH treatment in Phaeozem soil. Compared with the control, the decreases of dehydrogenase activity in AL treatment was more pronounced than that in IH treatment in Phaeozem soil, and the increases of protease activity in IH treatment was pronounced than that in AL treatment in Luvisol. Compared with Luvisol soil, the application of biochar had stronger effect on total soil C and organic N contents in Phaeozem soil. Application of biochar significantly increased the activities of soil dehydrogenase and protease in Luvisol soil, but decreased the activity of soil dehydrogenase. Soil types and biochar application patterns interacted to affect soil C and N contents, microbial metabolic activity, N- and P-related enzyme activities. In summary, soil types and biochar addition affected soil properties and microbial characteristics, which would provide important information for straw application and soil management.

Objective: To develop a universal screwdriver for sealing the end of the central hole of the femoral interlocking intramedullary nail, so as to shorten the operation time of the tail cap implantation of the intramedullary nail and improve the accuracy of implantation., Methods: Total 77 patients with intertrochanteric fractures underwent femoral interlocking intramedullary nail (FIIN) surgery from June 2018 to June 2019. There were 28 males and 49 females, aged 55 to 80 (76.22± 7.32) years old, and course of disease was 20 to 40 h. All patients were divided into universal screwdriver group (39 cases) and ordinary screwdriver group (38 cases) according to whether the self-developed universal screw was applicable during the operation. The blood loss during tail cap implantation, the time of tail cap implantation, the success rate of one-time implantation, and the postoperative curative effect were compared between two groups., Results: All patients were followed up for 12 to 36 months, with an average of(20.00±6.38) months. The bleeding volume and the time of tail cap implantation in the universal screwdriver group were significantly lower thanthose in the ordinary screwdriver group ( P <0.05);The one-time success rate (100%) of the universal screwdriver group was significantly higher than that of the ordinary screwdriver group (75.4%)( P < 0.05);at the last follow-up, the efficacy scores of two groups were improved compared with preoperatively, but the efficacy scores of the universal screwdriver group were significantly better than those of the ordinary screwdriver group( P <0.05)., Conclusion: The universal screwdriver is easy to operate during the operation when using the cap of the femoral intramedullary nail, the operation time is shortened, the amount of bleeding is reduced, and the treatment effect is satisfactory.

Objective: To study the risk factors associated with the hospital survival rate of elder patients with acute respiratory distress syndrome (ARDS) in Medical/Respiratory Intensive Care Units (MICUs/RICUs) by evaluating the prognosis, and therefore to provide insight into patient treatment strategy. Methods: Twenty MICUs/RICUs of 19 general hospitals in mainland China participated in the multicenter prospective cohort study carried out from Mar 1 st , 2016 to Feb 28 th , 2018. Patients who met the criteria of Berlin ARDS and older than 65 years were recruited. Baseline data, risk factors of ARDS, ventilator setup and prognosis data were collected from all patients. Univariant and multivariant regression analysis were conducted to analyze the factors associated with the prognosis. Results: 170 elder ARDS patients (age≥65 years) met the Berlin ARDS criteria, among whom 8.8% (15/170), 42.9% (73/170) and 48.2% (82/170) patients had mild, moderate and severe ARDS, respectively. The most common predisposing factor for elder ARDS was pneumonia, which was present in 134 patients (78.8%). 37.6% (64/170) patients were treated with noninvasive mechanical ventilation (NIV), but 43.8% (28/64) cases experienced treatment failure. 76.5% (130/170) patients were treated with invasive mechanical ventilation. All patients 80 years or older were given invasive mechanical ventilation. 51.8% (88/170) cases had complications of non-pulmonary organ failure. 61.8% (105/170) patients deceased during hospital stay. Multivariant logistic analysis showed that the independent risk factors for hospital survival rate in elder patients with ARDS were SOFA score ( P= 0.030, RR= 0.725, 95% CI 0.543-0.969), oxygen index after 24 hours of ARDS diagnosis ( P= 0.030, RR= 0.196, 95% CI 0.045-0.853), accumulated fluid balance within 7 days after diagnosis of ARDS ( P= 0.026, RR= 1.000, 95% CI 1.000-1.000) and shock ( P= 0.034, RR= 0.140, 95% CI 0.023-0.863). Conclusion: Among 20 ICUs, the high mortality rate of elder patients with ARDS was correlated with higher 24 hour SOFA score, lower 24 hour oxygen index after ARDS diagnosis, more positive fluid balance within 7 days and concomitant shock. The conservative fluid strategy within 7 days of ARDS diagnosis may benefit the elder ARDS patients.

Objective: To investigate the effect of remote ischemic preconditioning (RIPC) on contrast-induced acute kidney injury (CI-AKI) in patients with chronic total occlusion (CTO) after percutaneous coronary intervention (PCI). Methods: A total of 282 patients undergoing PCI at Zhongda Hospital Affiliated to Southeast University between June 2017 and January 2019 were prospectively enrolled. The patients were randomly divided into RIPC group ( n =142) and control group ( n =140). CI-AKI was defined as an increase in level of cystatin C (CysC)≥10% above baseline at 24 h after contrast administration. Baseline characteristics and the incidence of CI-AKI were compared between the two groups. The multivariate logistic regression analysis was further used to analyze the independent risk factors of CI-AKI. Results: There were no significant differences in age, gender, smoking, hypertension, diabetes, stroke and old myocardial infarction, coronary artery bypass graft surgery, previous PCI history and laboratory test indicators, target vessel and pathological characteristics of CTO lesions, contrast agent dosage, J-CTO (Multicenter CTO Registry in Japan) score, SYNTAX (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) score, PCI success rate and stent number between the two groups ( P >0.05). The incidence of CI-AKI was significantly lower (18.3% vs 29.3%, P =0.036) in RIPC group than that of control group. Multivariate logistic analysis found that creatinine [odds ratio ( OR )=1.018,95% CI : 1.006-1.030, P =0.003], CysC ( OR =5.200, 95% CI :2.714-9.963, P< 0.001),contrast agent dosage ( OR =1.013,95% CI : 1.007-1.019, P< 0.001) and J-CTO score ( OR =1.834, 95% CI : 1.145-2.939, P =0.012) were independent risk factors of CI-AKI. However, RIPC was an independent protective factor of CI-AKI ( OR =0.391, 95% CI : 0.199-0.765, P =0.006). Conclusion: RIPC before contrast agent administration prevents CI-AKI in CTO patients undergoing PCI.

Objective: To explore the feasibility of reconstruction of nasal tip with septal cartilage and auricular cartilage. Methods: From September 2018 to October 2019, 17 patients (two males and fifteen females) with low noses underwent rhinoplasty under general anesthesia. The age of the patients ranged from 19 to 39, with an average of 27 years old. Among them, all the 17 cases were primary rhinoplasty. During the operation, autologous nasal septum cartilage was used as septal extension graft to extend the caudal septum, and the auricular cartilage was used to enhance the stability of the strut and to elevate the tip for adjusting the shape of nose by making into spreader graft, columellar strut graft, derotation graft and onlay graft. The nasal dorsum was filled with polytetrafluoroethylene. Digital scanning technology was used to evaluate the nasal structure before and after operation. SPSS 22 software was used to analyze the data with paired t -test. Results: The follow-up was from 6 to 12 months, with an avaerge of 7.6 months. Seventeen patients were satisfied with postoperative nasal morphology and height. There was no infection, prosthesis displacement, skin flap necrosis, no auricle deformation and other complications. Statistical software SPSS 22 performed paired t- test on the preoperative and postoperative data obtained by digital technology: postoperative nasal length and nasal tip protrusion increased compared with that before surgery, and it was statistically significant(length:(3.60±0.77)mm, tip protrusion:(3.61±0.64)mm, t value was -19.203 and -23.132 respectively, both P <0.001). The nasolabial Angle was smaller than that before surgery, and the data were statistically significant(3.40°±2.11°, t =6.635, P <0.001). Conclusion: The nasal tip and nasal septum extension complex constructed by autogenous nasal septal cartilage combined with auricular cartilage can increase the length of nasal tip, increase the height of nasal tip and reduce the angle of nasolabial angle.

Objective: To evaluate the performance and application of a fast nucleic acid detection system for testing severe acute respiratory syndrome virus 2 (SARS-COV-2). Methods: Clinical samples were collected from February to July 2020 from Beijing Center for Diseases Prevention and Control and the Laboratory Department of China-Japan Friendship Hospital, to evaluate the sensitivity, specificity, anti-interference ability, precision and clinical sample coincidence rate of fast nucleic acid detection system for SARS-CoV-2. The analytical sensitivity was determined by a dilution series of 20 replications for each concentration. Analytical specificity study was performed by testing organisms whose infection produces symptoms similar to those observed at the onset of corona virus disease 2019 (COVID-19), and of the normal or pathogenic microflora that may be present in specimens collected. Potential interference substances were evaluated with different concentration in the interference study. Precision study was conducted by estimating intra-and inter-batch variability. Clinical evaluation was performed by testing 230 oropharyngeal swab specimens and 95 sputum specimens in fast nucleic acid detection system, comparing with conventional real-time fluorescent quantitative PCR (RT-qPCR) and clinical diagnostic results. Results: The analytical sensitivity of SARS-CoV-2 using fast nucleic acid detection system was 400 copies/ml. The result is negative for testing with the organisms that may likely in the circulating area or causing similar symptoms with SARS-CoV-2 and human nucleic acid, indicating that no cross reactivity with organisms. The results of precision test showed that the Coefficient of variation of Ct value of high, medium and low concentration samples was 1.90%-3.92%, and all of them were less than 5% in intra-and inter-batch testing. The results of the samples were still positive after adding the potential interfering substances, indicating that the possible interfering substances in the samples had no effect on the results. 98.46% and 97.85% diagnosis results of fast nucleic acid detection system were consistent with RT-qPCR and clinical diagnostic results, respectively. Conclusion: The fast nucleic acid detection system based on molecular parallel reaction can be used as a selection method for SARS-CoV-2 testing.

Objective: Explore the application of plasma glucosylsphingosine level in the follow-up treatment of patients with Gaucher disease. Methods: Two groups of patients with Gaucher disease were enrolled, who regularly received imiglucerase treatment in Xinhua Hospital, Shanghai Jiao Tong University School of Medicine between January 2017 and July 2020. Group 1 was 6 initially treated patients, including 1 case of chitotriosidase deficiency, aged 10-43 years old, 4 females and 2 males. The blood routine test, chitotriosidase activity and plasma glucosylsphingosine level were measured during pre-and post-treatment. Group 2 were 6 cases of Gaucher disease including 3 cases of chitotriosidase deficiency, who received long-term specific treatment in the same hospital, aged 17 to 32 years, 2 females and 4 males. The plasma glucosylsphingosine level was detected in the follow-up treatment during January 2017 to July 2020. Results: Patients in group 1 had a significant increase in plasma platelets after 12 months of treatment ( P< 0.05), and also a significant increase in plasma hemoglobin after 30 months of treatment ( P< 0.05). The chitotriosidase activity of 5 patients in group 1 significantly decreased after 18 months of treatment ( P< 0.05), the median value of the chitotriosidase activity decreased by 7 278 nmol·ml(-1)·h(-1) at 30 months of treatment. While only 3 months after treatment, the plasma glucosylsphingosine levels of 6 patients in group 1 decreased significantly ( P< 0.05), the median value of the glucosylsphingosine levels decreased by 259.7 μg/L at 30 months of treatment. The plasma glucosylsphingosine levels in group 1 patients were positively correlated with chitotriosidase activity, with spearman of 0.863, P< 0.001. In group 2, 6 patients with Gaucher disease that had been treated for a long period of time, showed normal peripheral blood routine tests, normal liver and spleen volume. However, the plasma glucosphingosine levels in group 2 patients decreased significantly during 2017-2020 ( P< 0.05). Compare to the initial values, the median value of the last glucosphingosine levels in group 2 patients had been reduced by 23.4 μg/L. Conclusion: The detection of plasma glucosylsphingosine levels in patients with Gaucher disease could be used for short-term and long-term follow-up of treatment.

Objective: To compare the clinical characteristics and outcomes of patients newly diagnosed with multiple myeloma(NDMM)with bone-related extramedullary(EM-B)disease and those with extraosseous extramedullary(EM-E)disease and to address their prognostic factors. Methods: The clinical features, outcomes, and prognostic factors were retrospectively analyzed in 80 patients with NDMM with extramedullary disease. Results: Among 80 patients with extramedullary disease, 51 had EM-B and 29 EM-E. The level of β(2)-microglobulin(5.82 mg/L vs 3.99 mg/L, P =0.030), lactate dehydrogenase(256 U/L vs 184 U/L, P =0.003), 1q21 amplification rate(78.6% vs 53.1%, P =0.035), and Ki-67 proliferation index(50% vs 25%, P =0.002)in the EME group were significantly higher than those in the EM-B group. The posieive rate of CD56(14.3% vs 66.7%)and overall response rate(60% vs 82.3%)in EM-E group were significantly lower than those in EM-B group. The median overall survival (OS)of patients with EM-E and EM-B was 14.5 and 49.5 months, and the median progression-free survival(PFS)of the two groups was 9.0 and 18.0 months. Patients with EM-E had a significantly shorter OS( P =0.035)and PFS( P < 0.001)than those of patients with EM-B, whereas the PFS did not significantly differ( P =0.263)when patients accepted proteasome inhibitor(PI)-based regimens for induction therapy. Multivariate analysis with Cox model showed the best response that did not achieve partial response(PR)was an independent poor prognostic factor for both OS and PFS in NDMM patients with EM-E( P =0.031, P =0.005), ISS-III, and the best response that did not achieve PR were independent prognostic factors for the shorter OS in patients with NDMM with EM-B( P =0.009, P =0.044). Conclusions: The clinical characteristics and outcomes of patients with NDMM with EM-E are different from patients with EM-B. Outcomes of patients with EM-E is significantly poor. PI induction therapy improved the PFS of patients with EM-E.

Objective: To understand the epidemiological characteristics and clinical features of rotavirus-, norovirus-, adenovirus-and astrovirus-associ ated acute gastroenteritis in children under 5 years old in Beijing from Octorber, 2015 to March, 2017. Methods: In the intestinal clinic of 6 hospitals in 6 districts of Beijing, information and stool samples of the first 30 patients with acute gastroenteritis who are under the age of 5 years are collected monthly.Rotavirus, norovirus, adenovirus and astrovirus are identified by PCR.Descriptive epidemiological method was used to describe the epidemiological characteristics of diarrhea caused by rotavirus, norovirus, adenovirus and astrovirus in Beijing. One-way analysis of variance was used to analyze the Vesikari clinical severity score of of acute gastroenteritis caused by each virus. Unconditional logistic regression analysis was used to analysis the associated factors of clinical features. Results: Of the 2 052 samples, 709 (34.6%) were non-mixed infections: the positive rate of rotavirus, norovirus, adenovirus and astrovirus were 20.0%, 7.5%, 4.2% and 2.9%, respectively. A total of 135 cases (6.6%) were mixed infection. The mean and standard deviation of Vesikari clinical severity score was 8.0±3.1 for rotavirus associated acute gastroenteritis, which was significantly higher than norovirus (6.4±2.4, P <0.001), adenovirus (6.2±2.1, P <0.001) and astrovirus (6.1±2.0, P <0.001). The comparison of clinical features showed that compared with astrovirus, the children under 5 years old infected with rotavirus were more likely to have a diarrhea ≥5 days ( OR =3.334), have vomiting ≥3 times within one day ( OR =8.788), have vomiting≥1 day ( OR =3.963), have a Vesikari clinical severity score ≥11 severe cases ( OR =13.194). Norovirus infected cases were prone to have vomiting≥3 times in 1 day ( OR =5.710).Adenovirus infected cases were prone to have a diarrhea≥5 days ( OR =2.616). When using rotavirus as a reference, children under 5 years of age were less likely to develop fever≥38.4 ℃ after infection with norovirus ( OR =0.397) or adenovirus ( OR =0.280). Conclusions: The results of this study showed that the characteristics of acute gastroenteritis caused by different viruses are different. The clinical symptoms caused by rotavirus are more serious. Children under 24 months of age are at high risk of rotavirus infection. Effective preventive measures such as vaccination should be taken as soon as possible.

Phosphorus is a key nutrient for all plant species and a limiting factor for grassland ecosystem function. In recent years, in response to the rapid increase of global nitrogen deposition, soil phosphorus contents and phosphatase activities changed to varying degrees in grassland ecosystems. We conducted a meta-analysis to examine the responses of soil pH, total phosphorus (TP), available phosphorus (AP), as well as activities of alkaline phosphatase (AlP) and acid phosphatase (AcP) in soils to nitrogen addition amount, nitrogen type, experimental duration, and sampling depth. The correlation between soil pH and phosphatase response ratio was investigated. The results showed that nitrogen addition significantly reduced soil pH, TP and AlP activity, while significantly increased AcP activity, but had no significant effect on AP. Soil pH and AlP activity significantly decreased under nitrogen addition >5 g·m -2 ·a -1 , and AcP activity significantly increased under high nitrogen addition (>10 g·m -2 ·a -1 ). The contents of TP and AP significantly decreased when nitrogen addition was 5-10 g·m -2 ·a -1 . NH 4 NO 3 treatment significantly reduced soil TP and increased AcP activity, while urea treatment significantly reduced soil pH and AlP activity. Across all nitrogen addition amounts, when the experiment duration was 3 to 10 years, soil TP content and AlP activity were significantly reduced. Soil pH was significantly reduced after three years nitrogen addition, and AcP activitiy was significantly increased after 10 years nitrogen addition. In the 0-10 cm soil layer, the TP content and AlP activity significantly decreased, while the AP content significantly increased. In >10 cm soil layer, the AP content was significantly decreased. The significant negative correlation between soil pH and AcP activity indicated that change in soil pH caused by nitrogen addition may be an important factor for the variation of soil phosphatase activity.

Soil freeze-thaw could affect nitrogen (N) availability. The N transformation is closely related with soil microbes. The effect of soil freeze-thaw on the soil bacterial communities in the temperate zone is still not clear. We hypothesized that freeze-thaw events could affect the diversity and composition of bacterial communities, thereby changing the contents of soil dissolved nitrogen pools as well as the N transformation process. In this study, microcosms with different freeze-thaw cycles (six and fifteen cycles) were designed, with the constant temperature at 2 ℃ as the control. The results showed that the contents of dissolved total nitrogen, dissolved inorganic nitrogen, microbial biomass nitrogen and net nitrogen mineralization rate were decreased significantly in response to increasing cycles of freeze-thaw. The number of freeze-thaw cycles did not affect bacterial α diversity. In contrast, the duration of incubation was positively correlated with bacterial α diversity including Chao1 and Shannon indices. Freeze-thaw treatment significantly affected the function and composition of bacterial communities, but the number of freeze-thaw cycles had little effect on the bacterial community structure. The partial redundant analysis showed that under freeze-thaw treatments, both the composition and function of bacterial community were significantly related to soil dissolved N pools and N transformation processes.

Biosafety is an important guarantee of the new coronavirus laboratory test. The accident treatment of sample overflow and sprinkle is a necessary part of the emergency plan for testing activities. Beijing Preventive Medicine Association coordinated biosafety experts of COVID-19 laboratories from Beijing CDC, to write up "The standard for handling of accidents of corona virus disease 2019 sample (T/BPMA 0005-2020)" . The group standard was based on the guidelines of China and WHO, and combined with the practical experience of COVID-19 epidemic and the principle of "scientific, normative, applicable and feasible" . Through all kinds of risk Assessment, it included the spillover of samples caused by the packing of COVID-19 (highly pathogenic) samples, the overflow and sprinkle in the laboratory during the detection operation, and the spillage accident occurred during the transfer of samples in the same building. The standard could guide and standardize the handling methods of accidental overflow and sprinkle that may occur in the SARS-CoV-2 testing laboratories in the city.

The objective evaluation of human settlement in cities helps find the problems exposed in urban development and make targeted adjustments to improve urban environment. Taking the downtown of Fuzhou as the research area, the residential area as the research unit, using multi-source data such as meteorological monitoring data, remote sensing imagery, map points of interest data (POI), and land planning data, we constructed monitoring system of urban human settlement from four aspects: environmental health and comfort, traffic convenience, city safety, and life conve-nience. The TOPSIS method was used to conduct a comprehensive evaluation of human settlement. The results showed that the human settlement level of downtown Fuzhou was quite different, which was high in the central area and low in the peripheral areas. The human settlement index was high in the middle of the urban area, low in the eastern and southern areas, with mixed high and low values in the western and northern areas. In each index layer, the characteristics of high-high agglomeration and low-low agglomeration of traffic convenience and life convenience were consistent with the distribution of high and low value clusters of the human settlement. Convenient transportation and complete service facilities had a greater impact on human settlement. The environmental health and comfort were characterized by interior low and edge high of the city, while city safety was characterized by interior high and edge low.

Urease in soil, as the most important enzyme catalyzing urea hydrolysis, plays an important role in nitrogen supply of grassland ecosystems. While the effects of different carbon additions on extracellular urease in grassland soil are well understood, their effects on soil intracellular urease remain unknow. Moreover, whether the responses of intracellular and extracellular urease to carbon additions are consistent need to be clarified. With a field experiment in Hulun Buir grassland of Inner Mongolia, we investigated soil intracellular and extracellular urease activities in chernozem under four treatments, including carbon-free (C 0 ), 250 (C 250 ), and 500 (C 500 ) kg C·hm -2 ·a -1 , using glucose as carbon source. Further, we analyzed their relationships with soil properties. Carbon additions significantly increased soil intracellular urease activity and its ratio to total urease activities and total urease activity, but did not affect soil extracellular urease activities. There was significant positive correlation between soil intracellular urease activity and microbial biomass, suggesting that the increases of soil intracellular urease activities were mainly caused by the increases of microbial biomass. Results of structural equation modeling (SEM) analysis showed that carbon additions indirectly increased soil intracellular urease activities by affecting microbial biomass.

The theory of ecomorphology predicts that species with similar morphological traits can occupy similar ecological niche, which may cause competitive exclusion. To apply this theory into fish invasion ecology research is of significance for understanding the interaction between native and invasive species. Here, we compared the morphological difference between two native (Oryzias pectoralis, Oryzias curvinotus) and one invasive species (Gambusia affinis) to explore the competitive exclusion among them. The results showed that despite O. pectoralis and O. curvinotus were sympa-tric species, they varied in spatial distribution. Such a result supported the theory of ecomorphology, which predicts that two species with similar morphological traits might have strong competition. Moreover, their population density exhibited a significant negative relationship with that of G. affinis. The morphology of G. affinis and both Oryzias species were more similar when comparing to other fish in the assemblage. Results from the cluster analysis showed that G. affinis and Oryzias species were close in a branch, with extremely low spatial niche overlap between invasive mosquitofish and native Oryzias species. There was significant negative correlation between the population abundance of mosquitofish and Oryzias species. All the results suggested that mosquitofish led to population decline of both Oryzias species, due to the ecomorphological similarity. More studies are needed to better understand the mechanisms of G. affinis invasion in habitats of native Oryzias species.

Volatile organic compounds (VOCs) are one of the key atmospheric pollutants associated with great impact on air quality. Industrial sources have become the most important source of VOCs emissions in China, of which the chemical industry accounts for a large part. At present, more than half of chemical manufacturers are clustered in chemical industrial parks (CIPs), thus the control of VOCs in CIPs is crucial. This study analyzed the production processes of the fine chemical industry and the principle of VOCs production, and then proposed an accounting model of VOCs emissions associated with production processes, based on a typical fine chemical industrial park:Hangzhou Bay Shangyu Economic and Technological Development Area (HSEDA). The quantity of VOCs generation in the main production processes, such as feeding, heating, chemical reaction gas take-off, cleaning, vacuum pumping, pressure release, and evaporating, were calculated. Meanwhile, the chemical process simulation software Aspen was also employed to simulate the VOCs generation in these processes. The methods were applied to 14 representative products in HSEDA and the feature of VOCs generation in the chemical processes mentioned above, and components were revealed. The results of the two methods were compared, and the difference between the two methods was within±22% except for the pressure release process. The model and accounting methods proposed in this study will have sound applicability in accounting for VOCs emissions in fine chemical industrial parks underpinned by quantitative chemical industry production parameters.

Objective: To investigate the expression level of T lymphocyte subsets in elderly patients with newly diagnosed multiple myeloma (NDMM), and to evaluated the prognostic value of T lymphocytic abnormalities in elderly NDMM patients., Methods: Pretreated peripheral blood of 39 newly diagnosed elder patients with MM was tested by multi-parameter flow cytometry (MFC) to quantitatively detect T lymphocyte subsets, including CD4 + T cell, CD8 + T cell, and CD4/CD8 ratio. The prognostic values T-lymphocyte subset were evaluated in newly diagnosed elderly patients with MM., Results: The median follow-up time was 21.5 (range, 3.0-66.0) months. Absolute counts of CD4 + T cell and CD4/CD8 ratio positively correlated with prognosis. In the multivariate COX analysis, lower CD4/CD8 ratio and CD4 + T cell counts were identified to be independent adverse prognostic factors for OS., Conclusion: Lower CD4/CD8 ratio and CD4 + T cell counts at initial diagnosis are independent unfavorable prognostic factors for elderly patients with MM, and T lymphocyte subsets are crucial indicators for MM patients' prognosis.

Abstract: Objective To study the medical malpractice cases involving death, and discuss the identification ideas and methods of medical malpractice cases. Methods A total of 291 medical malpractice cases involving death accepted and settled from January 2012 to December 2017 at the Judicial Appraisal Center of Southern Medical University were collected. Based on the age, gender, hospital level, clinical department, whether or not autopsy was performed, cause of death, cause of medical mistakes, causality and causative potency of the appraised person, statistical analysis was made. Results There were more males than females in medical malpractice cases involving death. Mostly young adults or children were involved in these cases. The number of cases involving tertiary hospitals was the highest; among the clinical departments, the internal medicine department had the largest number of cases, followed by surgery, obstetrics and gynecology, pediatrics, etc. Autopsy rate has a trend of increasing year by year. Most patients die from the natural outcomes of their disease or ineffective treatment. Most hospitals have certain medical mistakes, and have an indirect correlation with the patient's death, mainly slight factors. Conclusion Judicial appraisal of medical malpractice should follow the principle of "one-effect and multi-cause", and comprehensively consider various factors such as, the diseases and constitution of the patient, natural outcomes of the diseases, the current medical technology and the level of diagnosis and treatment of the hospital, etc., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Forensic Medicine.)

Wastewater treatment plants (WWTPs) are regarded as the main source for antibiotic resistant genes (ARGs). To explore the features regarding the distribution of ARGs in wastewater with complicated composition in treatment plants, wastewater samples from a chemical industry park that produced antibiotics were selected. qPCR was applied to detect the type and abundance of ARGs in the wastewater flows from the WWTPs. The results indicated that 16 types of ARGs were detected from the wastewater from the WWTPs, among which sulfonamide resistance genes and tetracycline resistance genes were the dominant ARGs that appeared in the wastewater. Additionally, intI 1 was detected and its abundance was correlated with that of sulfonamide resistance genes. This indicated that intI 1 may promote the migration and transformation of sulfonamide resistance genes. The pharmaceutical factories in the park mainly synthesize macrolide antibiotics. Because of the selective pressure, the absolute abundance of ermB in the wastewater was much higher than that in the other industrial wastewater. The total ARGs decreased by 1.16 log via traditional biological treatment process, and the total ARGs decreased by 2.46 log via the Fenton process. The results showed that the removal effects of deep treatment processes on ARGs were better than that of biological treatment in this wastewater treatment process. Highly abundant and movable ARGs already exist in the water body, and their release from WWTPs without effective treatment poses high risks to the environment.

Fine roots are sensitive to changes in the soil environment, and play an important role in plant growth and development. To clarify the relationship between fine root traits and rhizosphere soil nutrient characteristics, fine roots of trees belonging to different diameter classes in six-year-old Zenia insignis plantation were sampled. The results showed that root biomass, root length density and root volume density increased with the increases of diameter class. Specific root length and specific root area showed the trend of first rising and then falling and rising again with the increases of diameter class. Root tissue density did not change with diameter class. There were significant diffe-rences in soil pH, water content, total carbon, total phosphorus, ammonium nitrogen, nitrate nitrogen and total available nitrogen contents of rhizosphere soil belonging to different diameter classes. The concentrations of soil total carbon, total nitrogen, nitrate nitrogen and total available nitrogen in the rhizosphere soil of large diameter trees were relatively higher, while the soil water content, total phosphorus and ammonium nitrogen contents of small diameter trees were relatively higher. The concentrations of soil total nitrogen, total carbon, nitrate nitrogen and total available nitrogen were significantly positively correlated with root biomass, root length density and root volume density. The concentrations of soil total phosphorus was significantly positively correlated with root tissue density of fine roots, but negatively correlated with specific root length and specific root area. Soil water content was significantly positively correlated with root biomass and root volume density. Soil pH was significantly positively correlated with the specific root length and specific root area of fine roots, but negatively correlated with root tissue density. Our results provide scientific basis for the selection of excellent germplasm resources of Z. insignis.

The influence of temperature (30-45℃) and ammonia-nitrogen volume load on the nitrification function and microbial community of activated sludge in an aerobic tank of a sewage treatment plant were investigated under simulated high-temperature stress in the summer. Meanwhile, the bioaugmentation effectiveness of the middle-temperature-enriched nitrifying sludge (with or without acclimation) was evaluated in two biological treatment systems under high-temperature shock. The results showed that the ammonium-nitrogen (NH 4 + -N) removal efficiency and the nitrifying bacteria content of the aerobic activated sludge at 30-40℃ were above 90% and up to 4.55% and decreased to 40% and 1.97% at 45℃, respectively. To quickly recover the nitrification function of the biological system under high-temperature shock in the summer, the middle-temperature-enriched nitrifying sludge was acclimated at 40℃ for 61 d and achieved (60±5) mg·(L·h) -1 nitrification activity. Then, its bioaugmentation efficiency was compared with that of the middle-temperature-enriched nitrifying sludge. In the bioaugmentation test, 10% of NH 4 + -N was removed in the reactor inoculated with 5% (volume fraction) of the acclimated nitrifying sludge, while the reactor needed inoculate with 10% (volume fraction) of the middle-temperature-enriched sludge to achieve the same removal efficiency. The results suggested that middle-temperature-enriched nitrifying sludge, after acclimating at 40℃, has a better enhancement effect under a high-temperature shocking load.

Objective: To analyze clinical characteristics of severe community-acquired pneumonia during pregnancy and its outcomes, and to explore the relevant risk factors. Methods: From September 2012 to September 2017, 324 398 pregnancies admitted in 7 tertiary hospitals were included. Clinical data of 33 cases of pregnancies with severe community-acquired pneumonia (severe pneumonia group) and 214 cases of pregnancies with common community-acquired pneumonia (control group) were reviewed retrospectively, including the clinical information, manifestations, laboratory examinations and pregnancy outcomes. Relevant risk factors were analyzed by multivariate logistic regression analysis. Results: (1) General data: pregnancies with severe community-acquired pneumonia accounted for 0.010% (33/324 398) of hospitalized pregnancies, the gestational age of two groups were (28±8) and (23±8) weeks, body mass index were (21.7±2.1) and (25.5±3.4) kg/m(2), rate of low income were 54.5% (18/33) and 31.8% (68/214) , respectively. The differences between two groups were all statistically significant (all P< 0.05). No significant differences were found in age, pregnancy and parity times, rate of main pregnant complications such as diabetes and hypertension, educational level, asthma and onset seasons between two groups (all P> 0.05). (2) Clinical data: the severe pneumonia group had significantly higher incidence of fever [100.0% (33/33) vs 75.2% (161/214) ], shortness of breath (90.9% vs 16.8%) compared with the control group (all P< 0.05) .The median peripheral leukocytes counts were 12.3×10(9)/L and 10.2×10(9)/L, the hemoglobin level were (84±18) and (107±14) g/L,the albumin level were (26±4) and (37±3) g/L, the median serum urea nitrogen level were 3.7 and 2.4 mmol/L, the serum creatinine level were (72±25) and (45±11) μmol/L, respectively in two groups. The differences were all statistically significant (all P< 0.05). No significantly statistical differences were found in coagulation indicator and cardiac function between two groups (all P> 0.05). (3) Treatments: in severe pneumonia group, 12 patients (36.4%,12/33) needed invasive mechanical ventilation, 9 patients (27.3%,9/33) needed non-invasive mechanical ventilation, average time of mechanical ventilation was (7±4) days;8 patients (24.2%,8/33) with septic shock needed vasoactive drugs. However, there was no patient in control group needing mechanical ventilation and vasoactive drugs. (4) Pregnant outcomes: one patient (3.0%,1/33) died in the severe pneumonia group, while no death occurred in the control group. The hospital stay between two groups were (15.1±4.1) and (7.0±1.9) days, the rates of abortion and stillbirth between two groups were 42.4% (14/33) and 3.3% (7/214) , the rates of premature were 10/19 and 6.3% (13/207) , the rates of cesarean were 15/19 and 43.0% (89/207) , the rates of low birth weight newborn were 17/19 and 14.0% (29/207) , the rates of infected newborn were 15/19 and 10.1% (21/207) , the birth weights were (2 165±681) and (3 102±400) g, respectively. The differences between two groups were all statistically significant (all P< 0.05). (5) Multivariate logistic regression analysis demonstrated that anemia, low body mass index, hypoproteinemia were risk factors for severe pneumonia in pregnancy (all P< 0.05) . Conclusions: Pregnancy with severe community-acquired pneumonia may be complicated by multiple organ dysfunctions, lead to adverse outcomes. Anemia, malnutrition are risk factors for pregnancy with severe pneumonia. Active and effective treatment may improve its prognosis.

Ozone-biological activated carbon (O 3 -BAC) was studied for the advanced removal of organics from micro-polluted source water in the water supply plant P located in J City in the Yangtze Delta Region. The results show that 19.2% of the permanganate index, 10.4% of total organic carbon, and 23.0% of UV 254 were removed by the advanced treatment of O 3 -BAC. Eight types of polycyclic aromatic hydrocarbon (PAH), 16 types of organochlorinated pesticides (OCPs), and five types of haloacetic acids (HAAs) were detected in the source water. The total concentrations were 53.9-100.0, 6.5-41.8, and 2.5×10 3 -1.1×10 4 ng·L -1 , respectively. The advanced O 3 -BAC treatment removed 32.5% of PAHs and 25.9% of OCPs, greatly improving the effluent of the conventional water supply process. However, HAAs were mainly removed with the conventional process, with a removal rate of 33.8%-87.0%. After the advanced treatment with O 3 -BAC, the amount of chloroacetic acid slightly decreased, while the concentration of bromoacetic acid slightly increased.