Objective: To evaluate the relationship between gastric cancer (GC) and precancerous lesions and bile reflux.Methods: Medical records of 30 465 participants who underwent gastroscopy between January and December 2018 in our center were reviewed. Their age, sex, time of endoscopy, endoscopic/histologic diagnosis and grade of bile reflux were recorded. The participants were further divided into the chronic gastritis group (n = 27 807), a precancerous lesion group (n = 1943) and a GC group (n = 715). The χ 2 tests and hierarchical analyses were performed.Results: Patients aged 18-27 years had a higher bile reflux rate than those aged 28-37 and 68-75 years (P < 0.001), while it did not differ between patients aged <50 years and those over 50 years (P = 0.639). It was lower in men than in women (P < 0.001). The bile reflux rate did not differ in terms of months, seasons and half of the year (all P > 0.05), but differed between morning and afternoon when they underwent the endoscopy (P = 0.000). There was an interrelationship between the severity of gastric mucosal disease and bile reflux grade (r = 0.171). After excluding the effects of sex, age and time of endoscopy on bile reflux, bile reflux rate in chronic gastritis and precancerous lesions was lower than in gastric cancer (P < 0.01).Conclusions: Bile reflux may be a risk factor for gastric cancer and precancerous lesions. A high grade of bile reflux may be associated with the progression of gastric mucosal diseases.bile reflux, gastric neoplasms, gastritis, intestinal metaplasia, precancerous lesions | INTRODUCTIONAs the fifth most common malignant tumor worldwide, more than one million new cases of gastric cancer (GC) were estimated to be diagnosed in 2018; while the cancer-related mortality rate of GC is the third highest (equivalent to one in every 12 deaths worldwide). 1 In China the incidence and mortality of GC are also high. 2 According to the Correa model, despite its complex etiology GC usually begins with atrophic gastritis, intestinal metaplasia or atypical hyperplasia, and progresses to carcinogenesis. 3 Helicobacter pylori (H. pylori) infection, patient's age, sex, * These authors contributed equally to this work.

Background: In Shanghai there are 1.2 million people with hypertension, many of whom have difficulty in affording medical treatment. Community based, anti-hypertensive clubs have been created to provide health education but education alone is often ineffective. Lifestyle change programmes have shown some potential for reducing blood pressure but in previous trials have required specialist staff and extensive contact. We have previously demonstrated that self-management programmes delivered by health professionals, such as a nurse who has had short training in self-management techniques can change health behaviour and reduce symptoms. This study was designed to evaluate the benefits of a simple, cognitivebehavioural, self-management programme for hypertension based around a hypertension manual and delivered in the setting of a community anti-hypertensive club in Shanghai.

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To the editor.Despite the significant progress made in treating acute myeloid leukemia (AML) in the last decade, 10%-40% of the patients with standard induction chemotherapy still did not achieve complete remission (CR), 1 and 50%-70% of the patients in the first CR were at risk for relapse. 2 Although few of these patients can be cured with conventional salvage therapy, 2,3 they need to be evaluated regarding eligibility for allogeneic hematopoietic stem cell transplantation (HSCT), the most potent therapeutic strategy for patients who achieve CR after relapse. 2 Before transplantation, salvage chemotherapy regimens need to be employed to reduce the leukemia burden.In relapsed/refractory AML, fludarabine, cytarabine, combination with granulocyte colony-stimulating factor (G-CSF) (FLAG) were used as a reinduction therapy and resulted in only 38.2% CR. 4 Wrzesień-Kuś A et al. utilized the combination of cytarabine, cladribine, and G-CSF as the induction therapy in patients with refractory or early relapsed AML, obtaining a 50% CR rate with 17% early death. 5 Subsequent studies evaluated FLAG plus idarubicin (FLAG-Ida) or FLAG-Ida plus gemtuzumab ozogamicin (FLAGO-Ida) in adult patients with refractory/relapsed AML, showing that the CR/CR with an incomplete blood count recovery (CRi) rate was 51%, with 9% of induction deaths. 6 These data demonstrated the therapy limitation of FLAG in relapsed/refractory AML and the prospects of FLAG combination with other specific drugs.Chidamide is a new histone deacetylase (HDAC) inhibitor of the benzamide class, and it has been approved by China Food and Drug Administration (CFDA) in treating peripheral T-cell lymphoma in China. Additionally, evidence demonstrated that

Masson, E.Etude SISTER: sickle cell disease and steroïds. Risque d'hospitalisation pour crise vaso-occlusive chez les patients atteints de drépanocytose après exposition ambulatoire aux corticoïdes systémiques en France. EM-Consulte https://www.em-consulte.com/ article/1486161/etude-sister-sickle-cell-disease-and-steroids-ris. Odièvre M-H, Marcellus C, Pointe HD, et al. Dramatic improvement afterTocilizumab of severe COVID-19 in a child with sickle cell disease and acute chest syndrome.

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Purpose: We report the efficacy and safety of venetoclax plus decitabine-based treatment in heavily pre-treated relapsed or refractory acute myeloid leukaemia (RR-AML) in a realworld setting. Patients and Methods: There were 22 patients in this study and the median age was 47.5 (12-84) years old, including 11 males and 11 females. Among them, 8 patients were relapsed AML including 2 patients relapsed after HSCT and 14 patients with primary refractory AML including 4 secondary AML. The median number of cycles of previous chemotherapy was 4 (range, 2-10). Results: After a course of venetoclax plus decitabine-based treatment, 9 patients achieved complete remission (CR) and 1 patient achieved complete remission with incomplete haematological recovery (CRi). The overall response rate (ORR) was 45.5% and the CR rate was 40.9%, and the median time to reach CR/CRi was 21 (13-46) days. Four of the 10 CR/ CRi patients relapsed again, and the median time of relapse was 5 (1.0-24) months. The oneyear overall survival rate was 31.8%, and the median survival time was 6 months (95% CI, 1-9 months). The one-year overall survival rate of 10 CR/CRi patients was 59.1%, and the 12 NR patients was 10.4% (p=0.001). Nausea and vomiting occurred in 11 patients (50.0%). All patients had grade IV neutropenia and IV thrombocytopenia (100%). Pneumonia occurred in 14 patients (63.6%) and septicaemia occurred in 2 patients (9.0%). The cause of death in all patients was primary disease progression, and no patients died due to the side effects. Conclusion:The efficacy of venetoclax plus decitabine-based treatment in the real-world treatment of heavily pre-treated RR-AML is similar to that in clinical trials, and the side effects are controllable.