Diagnosis and treatment of multiple myeloma in Hunan Province / 中南大学学报(医学版)

OBJECTIVES@#There is less clinical data on multiple myeloma (MM) in China, and the aim of this study was to collect and analyze the clinical data of newly diagnosed multiple myeloma (NDMM) patients in Hunan Province during 1 year, to understand the real clinical features and treatment outcome for Hunan Province patients with MM, and to strengthen the understanding of the standardized diagnosis process and treatment plan of MM.@*METHODS@#The clinical data of 529 patients with NDMM in 12 large-scale general hospitals in Hunan Province from January 1 to December 31, 2019 were collected and analyzed, including baseline data, treatment regimens, duration of treatment, and adverse reactions. The clinical characteristics, treatment, and safety of patients were analyzed by SPSS 21.0.@*RESULTS@#Among the 529 NDMM patients, the age was 33-90 (median 64) years and the male-female ratio was 1.38꞉1. The clinical features ranged from high to low were as follows: Bone pain (77.7%), anemia (66.8%), renal insufficiency (40.6%), hypercalcemia (15.1%). Typing: IgG 46.5%, IgA 24.6%, IgD 2.6%, IgM 0.8%, light chain 15.7%, double clone 3.0%, no secretion 0.6%, absence 6.2%. Staging: Durie-Salmon stage I, II, and III were 4.5%, 10.6%, 77.3%, respectively, and 40 cases (7.6%) missed this data. International Staging System (ISS) stage I, II, and III were 10.4%, 24.4%, and 47.6%, respectively, and 93 cases (17.6%) were missing. Revised International Staging System (R-ISS) stage I, II, and III were 5.5%, 27.0%, 23.1%, respectively, and 235 cases (44.4%) missed this data. Among the 98 NDMM patients in the Third Xiangya Hospital, Central South University, Durie-Salmon (DS) stage missing 2.0%, ISS stage missing 12.3%, and R-ISS stage missing 12.3%.Treatment: Among the 529 patients,475 received treatment, the rate of treatment was 89.8%; 67.4% of the patients were able to complete four courses of chemotherapy at induction phase, 90.3% of the patients received proteasome inhibitor based combination chemotherapy regimen more than once, 67.2% received immunomodulator based regimen more than once, and 59.8% of the patients received proteasome inhibitor and immunomodulator based combination chemotherapy regimen more than once. Curative: Overall response rate (ORR) and high quality response rate (HQR) of the 4-course group were better than those of the 2-course group (ORR: 85% vs 65%, P=0.006; HQR: 68.3% vs 24.0%, P<0.001). The HQR of the standard chemotherapy group was better than that of the non-standard chemotherapy group (65.1% vs 48.2%, P=0.035). Adverse reactions during treatment included hematologic toxicity (17.5%), peripheral neuropathy (24.8%), gastrointestinal adverse events (23.8%), pulmonary infection (25.9%), herpes zoster (4.6%), and venous thrombotic events (1.7%).@*CONCLUSIONS@#In 2019, the missed diagnosis rate of MM patients was high, the medium age of diagnosis was older, and the accuracy of patient diagnosis was not high. There is a great difference among medical centers, especially in the stage and risk stratified, nearly half of NDMM patients are not diagnosed with R-ISS stage; the lack of cytogenetic data needs to be supplemented by follow-up studies. A high proportion of patients with NDMM present with bone pain and anemia.Patients received treatment have higher use of chemotherapy regimens containing proteasome inhibitors and/or immunomodulators, but there is a significant gap among different medical centers, and standardized treatment needs to be strengthened. The safety during chemotherapy is controllable.

Efficacy of fluoroscopy-guided superior hypogastric nerve block on pain degree after uterine artery embolization / 中华放射学杂志

Objective:To investigate the clinical efficacy of superior hypogastric nerve block (SHNB) in relieving pelvic pain after uterine artery embolization (UAE).Methods:Totally 50 patients of UAE before the curettage of uterine incision pregnancy were selected in Affiliated Zhenjiang Fourth People′s Hospital,Jiangsu University from February 2019 to December 2020 and were randomly divided into SHNB group( n=22) and control group( n=28) using random number table. The SHNB group underwent fluoroscopy-guided SHNB before UAE, and the control group received dizocine 10 mg intramuscularly before embolization. Both groups were treated with curettage 24 h after UAE. The pain scores were evaluated by using a numerical rating scale (NRS) to compare the pain scores between the two groups atthe time period A1 (from the beginning of UAE to immediate postoperative period) and at the time period A2 (from leaving the interventional operating room to the time before curettage). Data was recorded and compared between the two groups at the time period from the beginning of UAE surgery to the time before curettage for the doses of opioids used.The differences inage and weight between the two groups were compared by independent sample t test, and the NRS score and morphine dose were compared by Mann-whitney U test. Results:All patients completed SHNB and UAE without serious complications.There was no significant difference in age and weight between the two groups ( P>0.05).The maximum pain scores in the SHNB group were lower than those in the control group at both the A1 and A2 time periods[0(0, 0.25) vs. 3.00 (2.00, 4.00), and 2.50 (0.75, 5.50) vs. 4.00 (3.25, 7.00); Z=-4.932, -2.351, P<0.05]. The equivalent dose of morphine required in the SHNB group was lower than that of the control group [0(0, 10.00) vs. 10.00 (5.00, 15.00)mg, Z=-2.247, P=0.025]. Conclusion:Fluoroscopic-guided SHNB is a safe, effective, and minimally invasive way to reduce pain and the opiate dose after UAE.

Clinical analysis of red blood cell transfusion in patients with bone marrow failure / 中国输血杂志

【Objective】 To explore the clinical factors affecting the efficacy of red blood cell (RBC) transfusion in patients with bone marrow failure diseases (BMFD). 【Methods】 81 patients with BMFD admitted to our hospital from June, 2012 to May, 2020 were analyzed retrospectively. Hemoglobin (Hb) was used as quantitative judgment basis, and multiple stepwise regression analysis was used to screen out various factors affecting the efficacy of red blood cell transfusion. 【Results】 229 occasions of RBC transfusion were performed in 81 patients, and 129 refractory transfusions occurred, accounting for 51.97%. The clinical effect of RBC transfusion is related to hemorrhage, hepatosplenomegaly, infection, blood transfusion frequency, anemia degree and BSA. Multiple stepwise regression analysis showed that infection, hemorrhage and blood transfusion frequency are important factors affecting the infusion effect. 【Conclusion】 The efficacy of RBC transfusion in BMFD patients is affected by various clinical factors. Clinicians should personalize the infusion strategy, so as to improve the transfusion efficacy by reducing the transfusion frequency, and bleeding as well as avoiding the transfusion during fever.

Increasing the thermostability of glutamate decarboxylase from Lactobacillus brevis by introducing proline / 生物工程学报

Glutamate decarboxylase, a unique pyridoxal 5'-phosphate-dependent enzyme, catalyzes α-decarboxylation of L-glutamate to γ-aminobutyrate. However, glutamate decarboxylase from different sources has the common problem of poor thermostability that affects its application in industry. In this study, proline was introduced at 13 different positions in glutamate decarboxylase by using the design strategy of homologous sequence alignment between Thermococcus kodakarensis and Lactobacillus brevis CGMCC No.1306. A mutant enzyme G364P with higher thermostability was obtained. Compared to the wild type, thermostability of the mutant G364P was significantly improved, the half-life time (t1/2) at 55 °C and the semi-inactivation temperature (T₅₀ ¹⁵) of the mutant G364P increased 19.4 min and 5.3 °C, respectively, while kcat/Km of the mutant enzyme remained nearly unchanged. Further analysis of their thermostability by molecular dynamics simulations were performed. The root mean square deviation of G364P and root mean square fluctuation in the loop region including G364 were lower than the wild type at 313 K for 10 ns, and G364P increased one hydrophobic interaction in the loop region. It proves that mutation of flexible 364-Gly to rigid proline endows glutamate decarboxylase with enhanced thermostability.

Expression of miRNA-630 in bladder urothelial carcinoma and its clinical significance / 华中科技大学学报（医学）（英德文版）

Many studies informed that microRNAs (miRNAs) could function as diagnostic and prognostic indicators in several cancers. The aims of this study were to explore the expression of miR-630 in bladder urothelial carcinoma and its clinical significance for the evaluation of cancer prognosis. A total of 116 patients with bladder urothelial carcinoma were obtained in this retrospective study between May, 2012 and Sep. 2015. Quantitative real-time PCR (qRT-PCR) was conducted to evaluate the expression level of miR-630. The chi-square test was used to examine the associations between miR-630 expression and the clinicopathological features. The Kaplan-Meier method was conducted to explore the survival status of urothelial carcinoma patients. The log-rank test was used to analyze differences in survival rate. The results showed an obvious increase in miR-630 expression from normal bladder to bladder urothelial carcinoma (P=0.027). Additionally, patients with higher miR-630 expression had significantly shorter disease-free survival (DFS) (P=0.043) and overall survival (OS) (P=0.038) than those with lower miR-630 expression. Furthermore, multivariate analysis revealed that up-regulation of miR-630 was an independent prognostic factor for both DFS (P=0.042) and OS (P=0.046). It was demonstrated that miR-630 may be a novel and valuable prognostic factor for bladder urothelial carcinoma.

Improving effect of Tujia Medicine Tianzhusan on learning and memory impairment caused by cerebral ischemia / 中草药

Objective: To investigate the therapeutic effects of Tianzhusan (TZS) on the related indexes of learning and memory impairment of rats with vascular dementia (VD) caused by cerebral ischemia. Methods: The rats' models were prepared by a permanent ligation of the bilateral common carotid arteries. After ig administration for 63 d, the learning and memory abilities of rats were observed with Morris water maze, the pathological changes in hippocampus were detected with HE staining and Nissl staining, and the expression levels of microtubule associated protein-2 (MAP-2) and synaptophysin-1 (SYN-1) in hippocampus were evaluated by immunohistochemistry. Results: The latent period of rats in the model group was longer than that in the control group obviously (P < 0.05). However, the latent period of rats in Nimodipine and TZS groups was shortened after ig administration by different degrees. HE staining showed that the neuronal cells appeared necrosis and deformation in CA1 and CA3 areas of hippocampus of rats in the model group, while Nimodipine and TZS could reduce these injuries. Nissl staining showed that TZS could increase the number of Nissl bodies in CA1 and CA3 areas of hippocampus. Nimodipine and TZS could improve the expression level of MAP-2 in hippocampus. The rats in the model group had a high expression of SYN-1 in CA1 and dentate gyrus areas, but a low expression in CA3 area. Nevertheless, TZS could increase the expression of SYN-1 in CA3 area. Conclusion: TZS could improve the learning and memory abilities of VD rats by relieving the damage of neuronal cell, promoting the synthesis of neurotransmitters, and regulating the expression levels of MAP-2 and SYN-1.

Study on active ingredient and mechanism in preventing vascular dementia of Tianzhusan coming from Tujia medicine / 中国中药杂志

To make clear of the absorbed components of Tianzhusan (TZS) and its possible mechanism in preventing vascular dementia (VD), the rats' models of VD were prepared by a permanent ligation of the bilateral common carotid arteries. After 60 days, rats were administrated with TZS for 0.1 g x kg(-1), and the volume is 0.02 mL x g(-1). After 3 days, the medicated serum was prepared and detected by UPLC, and then we predicted the possible chemical structure of the absorbed components of TZS. According to the absorbed components, the potential targets of TZS were found by ligand profiling of Discovery Studio 3.5. All of these target genes were submitted to DAVID onine for gene set enrichment analysis (GSEA). The 5 absorbed components of TZS have been predicted, and four of them have been identified as parishin B, parishin C, parishin, pennogenin-3-O-alpha-L-rhamnopyranosy-(1-->2)-beta-D-glucoside. Through reverse finding targets, we got 861 pharmacophore models and 9 pathways from KEGG, BIOCARTA after document verification. These results showed that the efficacy mechanism of TZS on VD perhaps were be related with these absorbed components and pathways. If the traditional herbs could be proved effective by efficacy tests, the serum pharmacochemistry, computer-aided drug design, system biology and other technologies can be used in the next experiments, which will be beneficial to fast discovery of material basis and mechanisms of traditional medicine coming form ethnic minorities.

Efficacy of low dose amphotericin B for treating invasive fungal infection in hematologic malignancies / 中国综合临床

Objective To investigate the efficacy and safety of low dose amphotericin B for treating invasive fungal infection (IFI) in hematologic malignancies.Methods Ninety-eight patients with hematologic diseases who visited our hospital from January 2008 to June 2012 were randomly divided into the control group (n =47) and the treatment group(n =51).Patients in the control group were treated with amphotericin B,50-60 mg per day and patients in treatment group were given amphotericin B,25-30 mg per day.Clinical efficacy and side effects were compared between the two groups.Results There was no significant difference on the median cumulative dose between the control group and the treatment group(725 (175,1595) mg vs 735 (225,1485) mg,P =0.834).But there was significant difference on median treatment days between the control group and the treatment group(19(8,34) d vs 29(11,58) d,P =0.000).After treatment for 14 days,the patients who can be evaluated for efficacy were 37 and 48 cases respectively in the control group and in the treatment group,and there was no significant difference on the total efficacy rate,the rate of progress and the rate of fever between the control group and the treatment group (all P ＞ 0.05).There were 14 patients and 6 patients terminated treatment because of adverse reaction,and the difference was significant (29.8％ vs 11.8％,P =0.027).The side effect rates of hepatic and renal impairment in the control group was significantly higher than that in the treatment group(27.7％ (13/47) vs 11.8％ (6/51),P =0.047).Conclusion The efficacy of 25-30 mg per day's amphotericin B treatment is not lower than amphotericin B at 50-60 mg per day on IFI in hematologic malignancies.It is not only relatively safe and less expensive,but also operability and practicality in the treatment of IFI.

Design and research of an interface compatible non-contacting respiratory signal detection system / 生物医学工程学杂志

Respiration-induced displacements of organs greatly affect the safety and efficiency of high intensity focused ultrasound (HIFU) tumor therapy system. The key to solve this problem is accurate, real-time detection of respiratory signals. The present study gives a new design of an interface compatible non-contacting respiratory signal detection system using the method of irradiating the laser beam onto certain region of the surface of human body that is intensely influenced by the breathing movements (mostly the breast or the dorsum) at a certain angle, and meanwhile using a camera to acquire information from the location of the laser projection. Then we can draw a curve of the location of laser projection versus time base, that is the respiration curve. This respiratory signal detection method is non-contacting, interface compatible and easy to be integrated into the treatment system.

The alteration of immune functions in patients with acute leukemia complicated with invasive fungal infection / 中华传染病杂志

Objective To explore the relationship between immune functions of patients with acute leukemia (AL) and invasive fungat infection (IFI). Methods T lymphocyte subpopulations and natural killer (NK) cells in 61 AL patients complicated with IFI at first visit, AL remission, the time of IFI onset and 4 weeks after antifungal treatment were measured by flow cytometry. Meanwhile,levels of IgG, IgM and IgA were detected by immunoturbidimetry. The statistical analysis was done using ANOVA, t test and chi-square test. Results CD3+ , CD3+ CD4+ , CD8+ CD28+ T lymphocyte as well as CD4+/CD8+ ratio at the time of IFI onset in AL patients were all lower than those at first visit, AL remission and 4 weeks after antifungal treatment (F= 25.6,26.6,13. 1,167.9; all P＜0.05), while CD8+ CD28- T lymphocyte were higher than those at first visit, AL remission and 4 weeks after antifungal treatment (F= 220.2,P＜0.01). CD3+ , CD3+ CD4+ and CD4 + /CD8+ ratio of patients who responded effectively to antifungal treatment were all higher than those of non-responders (t=3.75,8. 61,3.17; all P＜0.05). The serum levels of IgG, Igm and IgA at first visit, ALremission, the time of IFI onset and 4 weeks after treatment were similar (F=0.78,0.72,0.81; all P ＞0.05). The effect rate of antifungal therapy in AL remission group was higher than that in nonremission group (87% vs 53%,x2 = 7.62, P＜0.05). Conclusions The cellular immune functions are impaired severely in AL patients complicated with IFI, while the levels of IgG, IgM and IgA are similar during IFI. Therefore, the efficacy of antifungal therapy may partly depend on the recovery of cellular immune functions and remission of AL.

Effect of fluoride on expression of telomerase reverse transcriptase expression and proliferating cell nuclear antigen in germ cells of rats' testes / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To study the damages of fluoride on the male reproductive system in rat testes.</p><p><b>METHODS</b>A total of 30 male SD rats were randomly divided into control group, high, low dose fluorine treated groups, which were given normal saline ,20 mg/kg sodium fluoride, and 10mg/kg sodium fluoride respectively. After 39 days the change of the weight of rats and the number of sperms were observed. The change of telomerase reverse transcriptase(TERT) and proliferating cell nuclear antigen (PCNA) were observed by using in situ hybridization and radioimmunoassay respectively.</p><p><b>RESULTS</b>The weight was (273.39 +/- 20.68), (240.00 +/- 21.39) g in NaF treated groups, which was lower than that in control group(P < 0.05); The rate of TERT expression in germ cells of testes in NaF treated groups was (13.89 +/- 4.86)% and (6.33 +/- 4.42)% respectively, which was significantly lower than that in control group (P < 0.05). The rate of PCNA expression in germ cells of tests in NaF treated groups was (0.71 +/- 0.05)%, (0.60 +/- 0.08)% respectively, which also was significant lower than that in control group(P < 0.05). The number of sperms was (18.31 +/- 1.20)10(10)/L, (9.17 +/- 1.38)10(10)/L, which was lower than that in control group (P < 0.05).</p><p><b>CONCLUSION</b>Fluorine possibly damages the male reproductive system by reducing the expression of TERT and PCNA.</p>

Study on the pharmacolinetics,tissue distridution and excretion of nerve growsth factof in mice / 第二军医大学学报

Objective:To study the pharmacokinetics,thissue distribution and secretion of nerve growth factor(NGF)in mice.Methods:The conecntration of NGF in various body fluids and tissue were determined by isotope tracer combined SDSPAGE method.Results:The plasma concenmtration-time curve was in accordance with the two-compartment pharmacokinetic model.The elimation half-life(t1/2β)was 3.1.The half-life of distribution(t1/2ka)was 5min.Tpeak was 25 min.AUC was 72.4 mg·kg-1·h-1.The concentrations of NGF were high in thyroid,blood,submaxillary glands,superior cervical ganglion,adrenasl and kidneys.Conclusion:NGF has a wide distribution,high tissue concentrationa nd excrtet mainly through the urine.

Study on the pharmacolinetics,tissue distridution and excretion of nerve growsth factof in mice / 第二军医大学学报

Objective:To study the pharmacokinetics,thissue distribution and secretion of nerve growth factor(NGF)in mice.Methods:The conecntration of NGF in various body fluids and tissue were determined by isotope tracer combined SDSPAGE method.Results:The plasma concenmtration-time curve was in accordance with the two-compartment pharmacokinetic model.The elimation half-life(t1/2β)was 3.1.The half-life of distribution(t1/2ka)was 5min.Tpeak was 25 min.AUC was 72.4 mg·kg-1·h-1.The concentrations of NGF were high in thyroid,blood,submaxillary glands,superior cervical ganglion,adrenasl and kidneys.Conclusion:NGF has a wide distribution,high tissue concentrationa nd excrtet mainly through the urine.

A Case of Congenital Patent Urachus / 대한비뇨기과학회지

Urachal anomalies are very rare. The umbilicus and the structures which lead to its formation rarely cause trouble except in patients with an error. Embryologically, the urachus represents the vestigial remnant of the allantois which, in the fetus, communicates with the cloaca. The patent urachus results from failure of luminal closure of the urachus Herein a case of congenital patent urachus reported with a brief review of literatures.