Objective: To investigate the clinical and prognostic characteristics of newly diagnosed multiple myeloma (NDMM) patients with myelofibrosis (MF). Methods: The clinical data of 160 NDMM patients admitted to Henan Provincial People's Hospital from January 2012 to July 2022 were analyzed retrospectively. They were divided into MF group(n=74) and non-MF group(n=86) according to whether combined with MF. Patients in MF group were further splited into MF-1 group (n=47) and MF-2/3 group (n=27). All patients were treated with bortezomib and immunomodulatory-based combination therapy. The efficacy was evaluated after 4 courses, and the clinical features and prognosis between the two groups were compared. The deadline for follow-up was December 30, 2022 and the median follow-up period [M (Q1, Q3)] was 23.5 (14.4, 40.5) months. Kaplan-Meier method was used for survival analysis, and Cox regression model was used to analyze the influencing factors of survival. Results: Among 160 patients with NDMM, 91 were males and 69 were females, with a median age [M (Q1, Q3)] of 59 (54, 69) years. In MF group, the bone marrow immature plasma cell percentage, total plasma cell percentage were 9.6% (3.2%, 28.5%) and 36.4% (18.5%, 51.1%), respectively, which were higher than 6.0% (1.2%, 17.2%) and 24.0% (12.0%, 46.0%) of the non-MF group (both P<0.05). Hb level was 84.0(74.5, 100.5)g/L and PLT was (151.99±90.68) ×109/L in the MF group, which were lower than 96.0 (81.0, 112.0)g/L and (180.38±85.32) ×109/L of non-MF group (both P<0.05). But there were no significant differences in ISS stage, karyotypic and fluorescence in situ hybridization (FISH) high-risk genetic abnormalities between the two groups (all P>0.05). Objective response rate (ORR), overall survival (OS) and progression-free survival (PFS) were not significantly different between the two groups (all P>0.05). The rate of 17p- was 25.9% (7/27) in MF-2/3 group, which was higher than 8.1% (7/86) of non-MF group (P=0.049). The median OS of the MF-2/3 group was 25.0 (95%CI: 23.6-26.4) months, which was shorter than that of the non-MF group (54.0 months, P=0.031). Multivariate Cox regression analysis showed that grade MF-2/3 was not a risk factor for OS in NDMM patients (HR=1.507, 95%CI: 0.624-3.993, P=0.425). Conclusions: The ratio of bone marrow immature plasma cells and total plasma cells in NDMM patients with MF are higher than that in patients without MF, and the Hb and PLT are lower than that in patients without MF. NDMM patients with grade 2/3 MF have shorter survival than those without MF.

目的:观察研究柔肝降脂汤治疗非酒精性脂肪肝(NAFLD)患者的临床效果,分析疗程与肝功能及炎症因子的相关性.方法:回顾性分析在郑州大学第五附属医院2020年1月至2022年1月期间治疗的117例NAFLD患者,全部患者均在该院接受柔肝降脂汤治疗,查询全部患者治疗前、治疗1疗程、治疗3疗程时的肝功能指标:谷丙转氨酶(ALT)、谷草转氨酶(AST)、γ谷氨酸氨基转移酶(γ-GT)、受控衰减参数(CAP),血清炎症因子:白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、转换生长因子-β1(TGF-β1)、γ-干扰素(IFN-γ)水平,体脂率及身体质量指数(BMI)的变化情况,分析治疗疗程与各项指标的相关性.结果:患者治疗1疗程时血清γ-GT、ALT、AST水平、CAP、血清IL-6、TNF-α、TGF-β1、IFN-γ水平及BMI均低于治疗前,且治疗3疗程时γ-GT、ALT、AST水平、CAP、血清IL-6、TNF-α、TGF-β1、IFN-γ水平及BMI均低于治疗1疗程时,差异具有统计学意义(P＜0.05);所有患者的肝功能、血清炎症因子水平、体脂率、BMI均与治疗疗程呈负相关,其中IL-6、γ-GT、ALT、AST、CAP与治疗疗程具有高度相关性,TNF-α、TGF-β1、IFN-γ、体脂率、BMI与治疗疗程具有中度相关性.结论:柔肝降脂汤治疗NAFLD,能够有效改善患者的肝功能、抑制血清炎症因子的高水平,降低患者体脂率与BMI,且各项效果与治疗疗程具有明确相关性.

Variant acute promyelocytic leukemia with IRF2BP2-RARA fusion gene: a case report and literature review Wu Chengye, Yang Shiwei, Li Yulong, Dong Xiaoyan, Yu Runhong, Zhang Lin, Shang Baojun, Shi Pingling, Zhu Zunmin Institute of Hematology of Henan Provincial People's Hospital, Henan Key Laboratory of Hematopathology, Henan Provincial Engineering Research Center of CART Cell Treatment and Transformation, Henan Key Laboratory of Stem Cell Differentiation and Modification, Zhengzhou 450003, China; Henan Eye Institute, Henan Provincial People's Hospital, Zhengzhou 450003, China Corresponding author: Zhu Zunmin, Email: zhuzm1964@163.com

Objective The aim of this study was to explore the implication of serum adiponectin（APN）, 25-hydroxyvitamin D [25-（OH）D] and apolipoprotein B（ApoB） level changes in patients with nonalcoholic fatty liver disease（NAFLD）. Methods A total of 117 patients with NAFLD and 51 healthy individuals were enrolled in our hospital between August 2018 and May 2021, and all underwent liver stiffness measurement（LSM） by Fibroscan. Serum 25-（OH）D level was detected by chemiluminescence, and serum APN and ApoB levels were detected by ELISA. Results Based on the controlled attenuated parameters（CAP）, the simple fatty liver（SFL） was found in 37 cases, the non-alcoholic steatohepatitis（NASH） was found in 58 cases and the fatty liver-induced cirrhosis was found in 22 cases, and out of them, no liver fibrosis was determined in 81 patients with NAFLD and progressive liver fibrosis in 36 cases; serum APN and 25-（OH）D levels in patients with NAFLD were（9.7±1.9）μg/mL and（30.8±6.4）nmol/L, both significantly lower than [（12.9±2.7）μg/mL and（57.9±8.1）nmol/L, respectively, P＜0.05], while serum ApoB level was（1.2±0.2）g/L, significantly higher than [（0.7±0.1）g/L, P＜0.05] in healthy persons; serum APN and 25-（OH）D levels in patients with cirrhosis were（7.9±1.3）μg/mL and（24.3±6.9）nmol/L, both significantly lower than [（9.2±2.1）μg/mL and（30.5±7.4）nmol/L, respectively, P＜0.05] in patients with NASH or [（11.5±2.5）μg/mL and（35.1±7.1）nmol/L, respectively, P＜0.05] in patients with SFL, while serum ApoB level was（1.5±0.2）g/L, significantly higher than [(（1.3±0.3）g/L, P＜0.05] in patients with NASH or [（0.9±0.1）g/L, P＜0.05] in patients with SFL; serum APN and 25-（OH）D levels in patients with progressive liver fibrosis were（8.1±1.4）μg/mL and（25.3±6.7）nmol/L, both significantly lower than [（10.4±2.2）μg/mL and（33.2±7.5）nmol/L, P＜0.05], while serum ApoB level was（1.6±0.3）g/L, significantly higher than [（1.0±0.2）g/L, P＜0.05] in patients without liver fibrosis. Conclusion Serum APN, 25-（OH）D and ApoB levels are abnormal in patients with NAFLD, which might help predict the disease severity and the progression of liver fibrosis.

Objective:To investigate the effect of midline venous catheterization on patients with intracranial infection who received intravenous therapy.Methods:A total of 118 patients with intracranial infection who were admitted to The First Affiliated Hospital of Zhengzhou University from August 2019 to November 2021 were selected for the prospective study. According to the different methods of intravenous catheterization, they were divided into an indwelling needle group and a midline group, with 59 cases in each group. The indwelling needle group had 31 males and 28 females who were 39-75 years old, and peripheral-intravenously indwelled needles. The midline group had 36 males and 23 females who were 36-72 years old, and took midline venous catheterization. The puncture success rates, catheter placement, indwelling times, puncture times, complications, usage costs, and patient satisfaction were compared between the two groups. The indwelling time, puncture times, and cost were expressed as ( xˉ± s), and were compared between these two groups by independent-sample t test. The complications were expressed as cases (%), and were compared by χ2 test. The satisfaction was expressed as cases (%), and compared by rank sum test. Results:Compared with the indwelling needle group, the midline group had a higher one-time success rate [91.52%(54/59), χ2=5.081, P<0.05] and lower catheter/indwelling needle slippage and accidental extubation rates [5.09%(3/59)、1.70%(1/59), χ2=4.236、11.670,all P<0.05]. The indwelling time in the midline group was longer than that in the indwelling needle group , and the number of punctures was lower than that in the indwelling needle group ( t=133.261、50.935,all P<0.05). The total incidence of complications in the midline group was 3.39% (2/59), which was lower than that in the indwelling needle group 20.34% (12/59), and the patient satisfaction was higher than that in the indwelling needle group [96.61% (57/59) vs. 79.66% (47/59)]. There was no statistical difference in the cost between the two groups ( t=0.445, P>0.05). Conclusion:Compared with peripheral venous catheterizaiotn, midline venous catheterization can increase the catheter indwelling time, reduce the number of punctures and incidence of complications, and improve patient satisfaction without increasing the cost.

我国目前关于建筑节能和建筑空调系统的研究大都是针对系统设备的设计及施工环节,对系统的运行能耗现状和运维管理人员配置及管理措施的研究相对较少.本文通过采取调查问卷与实地测量相结合的形式,对目前情况下郑州市内六个楼宇集中空调系统在夏季的实际运行与管理现状进行调研,进一步了解了建筑节能措施和集中空调运行措施在实际运行管理层面的落实情况,为集中空调实际运行时节能工作的开展提供思路.

目的 探讨心脏康复护理对心肌梗死介入治疗患者心功能及预后的影响.方法 80例心肌梗死介入治疗患者随机分为两组各40例,对照组给予常规护理,试验组在常规护理基础上给予心脏康复护理,比较两组的心功能、主要不良心血管事件(MACE)及护理满意度.结果 干预后,试验组的LVEF显著高于对照组,LVEDd、LVESd均显著低于对照组(P<0.05).试验组的MACE发生率显著低于对照组,护理满意度显著高于对照组(P<0.05).结论 心脏康复护理应用于心肌梗死介入治疗患者效果显著,有助于改善患者的心功能,降低不良心血管事件的发生风险.

目的 探讨ABCB1 SNP rs1045642与CES1 SNP rs2244613基因多态性对非瓣膜性心房颤动患者服用达比加群酯的抗凝疗效的影响.方法 选取2020年5月至2021年6月在郑州大学第五附属医院心内科住院的80例非瓣膜性心房颤动患者作为研究对象.检测患者ABCB1 SNP rs1045642与CES1 SNP rs2244613的基因型,测定患者服用达比加群酯后的血药浓度以及相关凝血指标,包括活化部分凝血活酶时间(APTT)和凝血酶时间(TT),并在患者治疗期间观察记录出血事件.分析ABCB1 SNP rs1045642与CES1 SNP rs2244613基因多态性对患者的达比加群血浆浓度、凝血指标和出血风险的影响.结果 ABCB1 SNP rs1045642和CES1 SNP rs2244613的基因型分布均符合Hardy-Weinberg平衡(HWE).ABCB1 SNP rs1045642与达比加群血浆浓度、凝血指标均无显著关联(P>0.05);此位点上不同基因型与房颤患者在治疗期间的出血事件发生率无关(P>0.05).CES1 SNP rs2244613与达比加群峰浓度无显著性相关(P>0.05),对比达比加群的谷浓度,等位基因(C)携带者较非携带者显著降低(P<0.001);达比加群谷浓度时携带次要等位基因(C)的患者血浆APTT与TT的检测结果显著低于非携带次要等位基因(C)的患者(P<0.05);与非携带者相比,等位基因(C)携带者轻微出血的事件发生率显著降低(P<0.05).结论 ABCB1 SNP rs1045642基因位点的基因多态性可能不会影响房颤患者口服达比加群酯后的抗凝疗效.CES1 SNP rs2244613基因位点的多态性分析表明,携带次要等位基因(C)可以使服用达比加群酯治疗的房颤患者的血药浓度谷值及轻微出血风险降低.

目的:观察不同溶栓时间对急性心肌梗死患者溶栓效果和心功能的影响.方法:回顾性分析2019年3月至2021年1月该院收治的110例急性心肌梗死患者的临床资料,根据不同溶栓时间分为A组(发病6 h内溶栓治疗)33例、B组(发病6～12 h溶栓治疗)41例、C组(发病12 h后溶栓治疗)36例.比较三组不良心脏事件发生率、血管融通率、死亡率、治疗前后QRS评分和心功能指标水平[左室收缩末期容积、左室舒张末期容积和左室射血分数].结果:A组血管融通率明显高于B组和C组,B组血管融通率明显高于C组,差异有统计学意义(P<0.05).治疗后,A组QRS评分明显低于B组和C组,B组QRS评分明显低于C组,差异有统计学意义(P<0.05).治疗后,A组左室收缩末期容积和左室舒张末期容积均明显低于B组和C组,B组左室收缩末期容积和左室舒张末期容积均明显低于C组;A组左室射血分数明显高于B组和C组,B组左室射血分数明显高于C组,差异有统计学意义(P<0.05).三组不良心脏事件发生率和死亡率比较,差异均无统计学意义(P>0.05).结论:心肌梗死患者发病后6 h内接受溶栓治疗可提高血管融通率,降低QRS评分,改善心功能指标水平,效果优于发病6～12 h及以后溶栓治疗.

目的 探讨针对性护理在肾癌根治切除联合腔静脉癌栓取出术后的应用效果.方法 选取2017年5月至2018年4月郑州大学第一附属医院收治的78例接受肾癌根治切除联合腔静脉癌栓取出术治疗的患者.患者均在达芬奇机器人辅助全腹腔镜引导下接受上述手术治疗.根据护理方式将患者分为对照组(39例)与观察组(39例).对照组患者接受围手术期常规护理.在常规护理的基础上,对观察组患者进行预防下肢静脉血栓的针对性护理干预.比较两组手术相关指标,包括首次下床活动时间、住院时间、住院费用.分别于护理前后采用焦虑自评量表(SAS)评估患者的心理状态.比较两组术后并发症.结果 观察组首次下床活动时间和住院时间短于对照组,住院费用少于对照组(P<0.05).护理后,观察组SAS评分低于对照组(P<0.05).观察组术后并发症发生率较对照组低(P<0.05).结论 对接受达芬奇机器人辅助全腹腔镜下肾癌根治切除联合腔静脉癌栓取出术治疗的患者采取预防下肢静脉血栓的针对性护理措施,能够促进患者恢复,改善心理状态,降低术后下肢静脉血栓及其他相关并发症的发生率.

目的 基于细胞因子信号转导抑制因子1(SOCS1)/信号传导与转录激活因子3(STAT 3)信号通路探讨微小RNA-155(miRNA-155)对川崎病幼鼠心肌损伤的影响.方法 取30只小鼠,采用干酪乳杆菌胞壁成分(LCWE)诱导川崎病模型,随机分为模型组、抑制组、阴性对照组,各10只,另取10只为正常对照组.抑制组、阴性对照组分别将含有miR-155抑制序列(miR-155-inhibitor)和无义随机序列(miR-155-inhibitor-NC)的质粒脂质体复合物,按每只200μL经尾静脉注入小鼠体内;正常对照组和模型组按每只200μL注射磷酸缓冲盐溶液,干预第1天、第7天分别注射1次.采用定量聚合酶链式反应(qPCR)法检测心肌组织miR-155表达水平,酶联免疫吸附法(ELISA)检测血清心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平;苏木精-伊红(HE)染色观察心肌组织病理学变化,流式细胞仪检测脾脏Th17/Treg细胞分化情况,qPCR法和免疫印迹法(Western Blotting)检测心肌组织SOCS1 mRNA、STAT3 mRNA和SOCS1、STAT3蛋白及STAT3磷酸化(p-STAT3)蛋白水平.结果 与阴性对照组和模型组比较,抑制组心肌组织miR-155表达水平及血清cTnI、CK-MB、TNF-α、IL-6水平降低(P<0.05);HE染色显示,抑制组心肌纤维较模型组和阴性对照组明显改善;抑制组脾脏Th17细胞占CD4+细胞比例降低,Treg细胞占CD4+细胞比例升高(P<0.05);抑制组SOCS1 mRNA及SOCS1蛋白水平升高,p-STAT3蛋白水平降低(P<0.05).结论 抑制miR-155可改善川崎病引起的心肌损伤,可能通过调控SOCS1/STAT3信号通路进而发挥心肌保护作用.

Objective:To explore the correlation between the expression of signaling lymphocyte activation molecule family 6 (SLAMF6) on peripheral blood CD8 +T cells and perforin and granzyme B and the clinical significance in patients with newly diagnosed severe aplastic anemia(SAA). Methods:The indicators of blood routine and bone marrow and peripheral blood samples of 32 newly diagnosed SAA patients admitted to Henan Provincial People′s Hospital from January 2016 to June 2019 were collected for retrospective analysis. Flow cytometry was used to detect the expression of SLAMF6, perforin and granzyme B on samples CD8 +T cell before therapy and 6 months after therapy (11 cases received transplantation, 21 cases received immunosuppressive therapy [IST]). Spearman correlation analysis was performed to determine the association between clinical indicators and laboratory test results. The expression of SLAMF6, perforin and granzyme B was also detected in 10 healthy people (normal group) and 13 myelodysplastic syndromes/paroxysmal nocturnal hemoglobinuria (MDS/PNH) patients (MDS/PNH group). Results:(1) At diagnosis: the expression of SLAMF6 was significantly lower in the SAA group than that in the normal group and the MDS/PNH group ([56.40±6.37]% vs [84.34±5.81]% and [82.24±4.98]% (both P<0.001]). The expression of perforin was significantly higher in the SAA group (32.73±8.46) than that in the normal control group (23.75%±5.10%), and the MDS/PNH group (26.12%±5.53%) (both P<0.05). The expression of granzyme B was also significantly higher in the SAA group (36.23%±7.94%) than that in the normal control group (21.67%±5.05%) and the MDS/PNH group (21.79%±5.10%) (both P<0.001). The expression of SLAMF6 was positively correlated with the hemoglobin ( r=0.804), and reticulocyte absolute values ( r=0.656) in peripheral blood, percentage of granulocytes ( r=0.643) and erythrocytes ( r=0.622) in bone marrow of SAA patients (all P<0.05). Expression of SLAMF6 was negatively correlated with perforin ( r=-0.792) and granzyme B ( r=-0.908) on CD8 +T cells in patients with SAA (both P<0.001). (2) After treatment: the expression of SLAMF6 in peripheral blood CD8 +T cells of 30 surviving patients was higher than pre-treatment ([79.19±12.69]% vs [56.40±6.37]%, P<0.001). The expressions of perforin and granzyme B were lower than pre-treatment level (both P<0.05). The expression of SLAMF6 on CD8 +T cells in 11 transplanted patients was higher than before transplantation ([86.54±3.75]% vs [56.40±7.35]%, P<0.001). The expressions of perforin and granzyme B were lower than before transplantation (both P<0.05). The expression of SLAMF6 on CD8 +T cells in 12 IST-respond patients was higher than that before treatment, while the perforin and granzyme B levels were lower than pre-treatment (all P<0.05). The post-treatment expressions of SLAMF6, perforin and granzyme B were similar as before treatment levels in 7 IST-unrespond patients (all P>0.05). Conclusion:SLAMF6 is significantly down-regulated on CD8 +T cells in newly diagnosed SAA, negatively correlated with the effective factors of CD8 +T cells, which might participate in the immune regulatory of CD8 +T cells as a negative regulatory factor in patients with SAA. The SLAMF6 is significantly up-regulated after hematopoietic recovery, while there is no significant change in treatment-unrespond patients, which could thus serve as an useful diagnostic and therapeutic index of patients with SAA.

Clinical and biological characteristics and prognosis of patients with biclonal multiple myeloma Cheng Wei, Li Yulong, Huang Zhoufeng, Li Zhaobo, Dong Xiaoyan, Shang Baojun, Zhang Lin, Shi Jie, Zhu Zunmin Department of Hematology, Zhengzhou University People's Hospital, Institute of Hematology, Henan Province People's Hospital, Henan Key Laboratory of Stem Cell Regulation and Differentiation, Zhengzhou 450003, China Corresponding author: Zhu Zunmin, Email:zhuzm1964@163.com

目的 探讨阴道镜下子宫颈管搔刮术ECC在检出宫颈高级别上皮内病变或癌变中的作用及相关因素分析.方法 回顾性分析2018年7月——2019年6月因宫颈癌筛查(即妇科基液细胞学TCT、HPV)异常在郑大二附院妇科门诊阴道镜室行阴道镜下多点活检术+ECC的患者共257例,以LEEP或CKC术后病理结果为金标准,讨论ECC对于检出宫颈高级别上皮内病变及以上病变(HSIL+)的意义及相关因素分析.结果 发现HSIL+的宫颈管搔刮术其检出率为:10.51％(27/257).单因素分析发现:患者年纪(P=0.025)、细胞学表现(P=0.000)、HPV16/18型感染状态(P=0.001)、转化区可见性(P=0.003)、阴道镜印象(P=0.000)与ECC的HSIL+检出率比较差异有统计学意义;多因素回归分析发现,ECC对于HSIL+的检出率与年纪(P=0.014)、细胞学表现(P=0.006)、HPV16/18型感染状态(P=0.023)、转化区可见性(P=0.006)以及阴道镜印象(P=0.000)相关.结论 在阴道镜下全面评估印象及多点活检术的基础上,ECC额外检出作用虽然有限,然不可少.提倡对阴道镜检查未见异常或异常程度低于筛查异常级别的状态下,以及对于2型、3型转化区的女性,尤其高龄女性常规行ECC,可额外增加HSIL+的检出率.

目的:分析不同肠外营养支持方式在晚期胃癌患者中的应用效果及安全性。方法:收集华中阜外医院2017年1月至2018年6月收治的晚期胃癌患者95例，所有患者均行肠外营养支持，根据肠外营养支持方式的不同分为深静脉置管组(32例)、外周静脉置入中心静脉导管组(34例)和浅静脉留置针组(29例)。比较三组患者免疫功能、留置时间及置管成功率，记录并比较三组患者局部渗液、静脉炎等并发症发生情况。结果:外周静脉置入中心静脉导管组、深静脉置管组操作时间及留置时间均显著高于浅静脉留置针组，且外周静脉置入中心静脉导管组操作时间及留置时间均显著高于深静脉置管组，差异均有统计学意义(均 P<0.05)。营养支持10 d后三组患者CD3 ＋、CD4 ＋及CD4 ＋/CD8 ＋均显著升高，CD8 ＋显著降低，三组患者CD3 ＋、CD4 ＋、CD8 ＋及CD4 ＋/CD8 ＋比较差异均无统计学意义(均 P>0.05)。三组患者静脉炎、静脉血栓形成、导管堵塞及局部渗液发生率比较差异均无统计学意义(均 P>0.05)。 结论:三种肠外营养支持方式均能改善晚期胃癌患者的免疫功能，不过相较于浅静脉留置针，外周静脉置入中心静脉导管及深静脉置管留置时间更长，且减少了静脉炎的发生。

Objective:This study aims to investigate the characteristics of gene mutation and clinical prognosis in de novo acute myeloid leukemia (AML) patients with myelofibrosis (MF) .Methods:From January 1, 2016, to February 1, 2020, 103 newly diagnosed AML patients in Henan Provincial People’s Hospital who simultaneously underwent bone marrow biopsy examination were included. They were divided into the AML-MF group (MF grades 1-3) and the AML without MF group (MF grade 0) , and the clinical features, gene alterations, chemotherapy efficacy, and prognosis were compared between the two groups retrospectively.Results:①MF was confirmed in 44.7% of AML patients (46/103) , of which 84.8% (39/46) were MF-1 and 15.2% (7/46) were MF-2/3, while MF was not confirmed in 55.3% (57/103) of AML patients. The median of WBC in the AML-MF group was significantly higher than in the AML without MF group [11.205 (0.69-191.82) ×10 9/L vs 4.64 (0.18-95.10) ×10 9/L, P=0.024]. More patients in the AML-MF group had nucleated erythrocytes in the peripheral blood (43.5% vs 24.6% , χ2=4.119, P=0.042) . All four AML-M 0 patients were in the AML-MF group, while AML without MF group had a higher proportion of AML-M 2 ( P=0.014) . ②FLT3-ITD and NPM1 mutations were more frequent in the AML-MF group ( P=0.021 and 0.039) , while CEBPA mutation was more frequent in the AML without MF group ( P=0.029) . ③The CR rate in the AML-MF group was significantly lower than in the AML without MF group (69.7% vs 93.2% ) ( χ2 =7.412, P=0.006) . Multivariate analysis showed that MF, especially the grade of fibrosis, was an independent risk factor for CR in de novo AML. ④The 3-year OS of patients in the AML-MF group was significantly lower than in the AML without MF group (20.5% vs 72.2% , χ2=4.032, P=0.045) . Subgroup analysis showed that OS and PFS of AML-MF1 and AML-MF 2/3 groups were also significantly worse than those of the AML without MF group ( P=0.001) and MF, especially MF ≥2, was an independent marker for inferior OS and PFS in de novo AML ( P=0.021 and 0.044) . Conclusion:AML-MF has unique laboratory and clinical characteristics. MF is an independent risk factor for CR, OS, and PFS in AML. Evaluation of MF is very significant for therapy efficacy and prognosis judgment in de novo AML.

目的 探究Pender健康促进模式在膀胱癌尿流改道腹壁造口术后患者创伤后成长中的应用效果.方法 选取160例接受膀胱癌尿流改道腹壁造口术治疗患者,根据数字表法将其随机分为观察组、对照组各80例,对照组予常规护理,观察组予Pender健康促进模式护理,对比分析两组患者护理前后的健康行为状况、抑郁焦虑评分、创伤成长水平、生活质量评分及造口相关知识知晓度评分等情况.结果 观察组患者护理后的健康行为状况评分总分(133.81±6.54)分明显高于对照组患者的健康行为状况评分总分(119.55±5.65)分(P<0.05).观察组患者护理后3个月的抑郁评分(50.38±3.53)分、焦虑评分(47.64±5.29)分明显低于对照组患者的抑郁评分(53.46±3.58)分、焦虑评分(51.53±6.01)分,差异有统计学意义(P<0.05).观察组患者护理后6个月的创伤成长水平评分(60.25±7.93)分明显高于对照组患者的创伤成长水平评分(55.61±7.19)分(P<0.05).观察组患者护理后的心理领域评分(52.79±5.23)分、生理领域评分(40.09±4.79)分、环境领域评分(47.01±5.87)分及社会关系评分(33.38±2.31)分与对照组患者的心理领域评分(48.07±4.54)分、生理领域评分(36.80±4.11)分、环境领域评分(44.24±5.44)分及社会关系评分(28.79±2.01)分相比明显较高(P<0.05).观察组患者护理后的造口相关知识知晓度总分(95.67±2.14)分明显高于对照组患者的造口相关知识知晓度总分(93.45±2.78)分(P<0.05).结论 Pender健康促进模式在膀胱癌尿流改道腹壁造口术后患者创伤后成长中的应用效果显著,改善焦虑抑郁情绪,提高创伤成长能力,改善生活质量,增加患者造口相关知识知晓度.

目的:探讨乳腺癌患者术后创伤后成长状况及心理弹性训练效果.方法:纳入2017年1月-2018年6月收治的122例乳腺癌术后化疗患者的临床资料为研究对象,并随机分为对照组和观察组各61例.采用成人心理弹性量表(RSA)评估所有患者术后化疗初期创伤后成长水平,对照组术后化疗期间采用常规干预,观察组在对照组的基础上运用心理弹性训练干预,对比两组患者干预前后创伤后成长水平、心理弹性水平以及心理状况的变化.结果:①本组患者术后化疗初期创伤后成长总分(66.39±17.89)分;②干预前两组患者创伤后成长各个维度评分以及总分比较无明显差异(P＞0.05),干预后观察组各个维度评分以及总分明显高于对照组(t=2.632,4.411,4.354,3.052,5.128,3.733;P＜0.05);③干预前两组患者心理弹性在人际关系、新可能性、个人力量、精神改变以及欣赏生活等各个维度评分比较无明显差异(P＞0.05),干预后观察组各个维度评分明显高于对照组(t=2.113,3.358,3.803,3.995,3.706;P＜0.05);④干预前两组SAS、SDS评分无明显差异(P＞0.05),干预后观察组SAS、SDS评分明显低于对照组(t=3.959,3.837;P＜0.05).结论:心理弹性训练可提高患者的心理弹性水平、创伤后成长水平,改善患者的心理状态.

Objective: To investigate the expression levels of programmed death protein 1 (PD-1)、T cell immunoglobulin domain and mucin domain 3(TIM-3)、lymphocyte activating gene 3 (LAG-3) and B and T lymphocyte attenuator (BTLA) in Diffuse large B-cell lymphoma, not otherwise specified (DLBCL, NOS) and their effects on prognosis. Methods: The paraffin specimens of 30 patients with DLBCL, NOS newly diagnosed in People's Hospital of Zhengzhou University were stained with immunohistochemistry. The effects of single positive and co-expression of the above molecules on progression-free survival (PFS) phase and overall survival (OS) phase were analyzed. Results: There was no significant difference in prognosis between PD-1, TIM-3, LAG3, BTLA single positive group and single negative group. The median PFS phase of PD-1 and TIM-3 co-expression group and TIM3 and BTLA co-expression group were 26 and 24 months respectively, which were both lower than the 54 months (P=0.021) and 47 months (P=0.037) in non-co-expression group. The median PFS phase and OS phase of PD-1, TIM-3 and LAG-3 co-expression group were 17 and 25 months respectively, which were significantly lower than the 41 months (P=0.024) and 60 months (P=0.015) of non-co-expression group. The median PFS phase and OS phase of PD-1, TIM-3, LAG-3 and BTLA co-expression group were 18 and 26 months respectively, which were significantly lower than the 40 months (P=0.038) and 57 months (P=0.041) of non-co-expression group. Conclusions: In patients with DLBCL, NOS, those with PD-1 and TIM-3 co-expression as well as those with TIM-3 and BTLA co-expression have poor PFS phase. Patients with PD-1, TIM-3 and LAG-3 co-expression and patients with PD-1, TIM-3, LAG-3 and BTLA co-expression have poor PFS and OS phase.

目的 探讨直立倾斜试验对不明原因晕厥的应用价值.方法 选取2018-11—2019-11郑州大学第二附属医院门诊和住院收治的晕厥患者170例,行直立倾斜试验.结果 (1)170例患者中阳性98例(57.65％),其中1型60例(61.22％),2型12例(12.24％),3型26例(26.53％);(2)98例阳性患者中女性阳性68例(69.38％),男性阳性30例(30.62％)(χ2=20.129,P<0.001);(3)98例阳性患者中SNHUT阳性88例(51.76％),BHUT阳性10例(5.88％)(χ2=87.222,P<0.001);(4)SNHUT倾斜5分钟内出现阳性症状81例(82.65％),SNHUT倾斜5 min后出现阳性症状17例(17.35％)(χ2=58.722,P<0.001).结论 直立倾斜试验可以对不明原因晕厥进行初步晕厥筛查,在临床诊断血管迷走性晕厥方面具有明显优势,因此,具有重要的临床诊断与治疗价值.