Beijing Chuiyangliu Hospital

Thrombosis represents a significant complication in leukemia patients, associated with treatment interruption and reduced survival outcomes. Although multiple risk prediction models have been developed, their methodological quality and applicability remain uncertain. This review aims to evaluate existing risk prediction models for thrombosis in patients with leukemia. We conducted comprehensive literature searches across nine databases from the inception to August 4, 2025. Two reviewers independently performed study selection, data extraction, and quality assessment using the CHARMS checklist and PROBAST tool. Of 1825 initially identified records, 14 studies comprising 16 prediction models were included. Development cohorts ranged from 102 to 1252 participants. Model discrimination measured by AUC/C-index varied between 0.641-0.917. Internal validation was performed in nine studies, while only one conducted external validation. Key predictors included central venous catheter placement, prior history of thrombosis, D-dimer levels, platelet count, white blood cell count, the Eastern Cooperative Oncology Group (ECOG) score, chemotherapy/radiotherapy, comorbidities, type of leukemia, use of hemostatic drugs, and age. All studies were rated high risk of bias, and five raised major concerns regarding applicability. Sensitivity analyses excluding chronic leukemia studies, excluding non-English publications and excluding dissertations yielded consistent overarching conclusions. In summary, current models often report moderate to good apparent discrimination, but are limited by methodological shortcomings and inadequate validation. All models should be considered exploratory and not ready for routine clinical use without prospective external validation. Future research should prioritize prospective, multicenter cohorts with standardized outcome adjudication and rigorous internal/external validation across diverse leukemia subtypes.

ObjectiveTo evaluate the efficacy, safety, and predictive biomarker of a third‐generation tyrosine kinase inhibitor (3G‐TKI; ponatinib or olverembatinib) combined with azacitidine in chronic myeloid leukemia (CML) in myeloid blast phase.MethodsWe conducted a single‐center, prospective study combining 3G‐TKI with azacitidine in 28‐day cycles. The primary end point was a major hematologic response (MaHR) by cycle 2. The trial is registered in Chinese Clinical Trial Registry (ChiCTR2200055887)ResultsIn total, 37 patients were studied. The median follow‐up was 30 months (interquartile range, 24–40 months). Twenty‐five patients achieved a MaHR by cycle 2, 30 returned to chronic phase. Ten patients underwent transplantation. The patients who underwent transplantation had higher 3‐year probability of survival compared with nontransplanted patients (50%; [95% confidence interval (CI), 9%–37%] versus 18% [95% CI, 3%–33%]; p = .01). The regimen was well tolerated. In adjusted logistic/Cox regression analyses, KRAS mutation was significantly associated with a lower MaHR rate (odds ratio, 0.1; 95% CI, 0–0.8; p = .03), worse progression‐free survival (PFS; hazard ratio [HR], 3.1; 95% CI, 1.1–8.6; p = .04), and worse survival (HR, 8.2; 95% CI, 2.5–26.8; p < .001); PTPN11 mutation was associated with worse PFS (HR, 5.1; 95% CI, 1.2–22.2; p = 0.03) and worse survival (HR, 9.6; 95% CI, 2.2–41.5; p = .002); and increasing numbers of non‐ABL1 mutations were associated with worse PFS (HR, 1.2; 95% CI, 1.0–1.3; p = .04). Transcriptomic analysis revealed that patients who did not achieve a MaHR experienced activation of cancer‐, metabolism‐, oxidative phosphorylation‐related pathways. The KRAS signaling pathway was significantly activated in patients who lost MaHR during treatment.Conclusions3G‐TKI with azacitidine is an effective and safe therapy providing more chance to receive a transplantation for CML in myeloid blast phase. Potential biomarkers associated with outcomes were identified.

Social alienation significantly impacts maintenance hemodialysis (MHD) patients. This study aimed to identify key factors associated with social alienation in MHD patients using association rule mining to inform interventions. A cross-sectional study enrolled 250 MHD patients from 11 centers (March-April 2025). Social alienation was assessed using the General Alienation Scale (GAS). Sociodemographic, clinical, and treatment variables were analyzed using the Apriori algorithm with thresholds: support ≥ 30%, confidence ≥ 50%, lift > 1. Among participants, 49.2% (n = 123) reported social alienation. Seven strong association rules were identified. Key combinations included: Urban employee insurance + thrice-weekly dialysis (support 58.8%, confidence 54.4%); Male + urban employee insurance + thrice-weekly dialysis (support 36.8%, confidence 54.4%); Age 36-50 + Han ethnicity (support 31.2%, confidence 56.4%). A dialysis treatment plan of 4-5h per week for three times, middle-aged working patients, and limited support were prominent risk factors. Social alienation in MHD patients is multifactorial. Interventions should include flexible dialysis scheduling, multidisciplinary psychosocial support, and community networks. Policy reforms addressing insurance-related employment stress are needed. Data-driven strategies enhance chronic disease management.

Hepatocellular carcinoma (HCC) is the 6th most common cancer worldwide and claims roughly 700,000 lives each year; nearly 50% of global HCC fatalities occur in China. To conduct a comprehensive meta-analysis identifying predictors of sorafenib efficacy in combination with thermal ablation for HCC treatment. A comprehensive literature search was conducted up to October 2024, reviewing 720 identified studies. From these, 19 studies were selected that included a total of 3,341 participants with HCC at baseline. The meta-analysis examined the effects of sorafenib in combination with physical thermal ablation, using odds ratios (ORs) and 95% confidence intervals (95% CIs). Analyses were performed using two-sided methods and either fixed-effect or random-effects models, depending on the level of heterogeneity. The meta-analysis revealed that combining physical thermal ablation with sorafenib significantly improved outcomes in HCC patients: Overall survival (OS) was more than doubled (OR = 2.03; 95% CI: 1.55-2.67; p < 0.001), recurrence rates were significantly reduced (OR = 0.62; 95% CI: 0.39-0.98; p = 0.04), and overall treatment efficacy was markedly higher (OR = 2.53; 95% CI: 1.61-3.96; p < 0.001) compared with thermal ablation alone. In individuals with HCC, physical thermal ablation and sorafenib had significantly higher OS, lower recurrence rates, and high overall efficacy compared to physical thermal ablation. To validate this discovery, more research is needed, and caution must be implemented when interacting with its values.

Abstract Sepsis-associated encephalopathy (SAE) is a diffuse dysfunction of the nervous system resulting from sepsis originating outside the central nervous system. The elderly (≥65 years of age) are a particularly vulnerable population, and the emergency department is typically the first point of contact after onset. Clinical symptoms in elderly patients with SAE are often atypical, compounded by a high burden of underlying diseases and complications, which frequently leads to underdiagnosis or misdiagnosis. These patients are at an increased risk of long-term or permanent central nervous system impairment, making rapid and accurate diagnosis and treatment especially critical. Currently, there are no standardized diagnostic or treatment guidelines tailored specifically to geriatric SAE. This expert consensus, grounded in evidence-based medicine and clinical experience, offers recommendations on the risk factors, clinical characteristics, diagnosis, and treatment of geriatric SAE. The goal is to standardize care, improve diagnostic accuracy, reduce mortality, and enhance patient outcomes.

A case report. Presentation of transpedicular approach for endoscopic spine surgery (ESS) in a patient with thoracic spine metastases from lung cancer with incomplete paralysis. The spine is the most colonized site for tumor bone metastases, and approximately 5-10% of patients develop symptoms of nerve and spinal cord compression. Traditional open surgery is the best management strategy to address patients' neurological symptoms, but its demanding physical status and low clinical benefit in end-stage patients limit its application in spinal metastases. With the accumulation of experience and technological breakthroughs in ESS, this technology has become an ideal choice for palliative treatment of patients with end-stage spinal metastases. A patient with thoracic spine metastasis from lung cancer with incomplete paralysis was treated with ESS using a transpedicular approach. A patient with lung cancer thoracic spine metastasis with incomplete paralysis was unable to tolerate traditional open surgery due to her physical condition, so our team used the strategy of spinal endoscopic decompression with tumor resection via transpedicular approach to treat him. After the operation, the patient's pain and neurological symptoms were significantly relieved, and he regained the ability to walk on himself within two months. Moreover, the technique prolonged his survival while safeguarding his quality of life. ESS is ideal for patients with end-stage spinal metastases.