Multiple myeloma (MM) is a hematologic malignancy of differentiated plasma cells that accumulate in the bone marrow,where a complex microenvironment made by different cell types supports proliferation,survival,and drug resistance of tumor cells.MicroRNAs (miRNAs) are short non-coding RNAs that regulate gene expression at post-transcriptional level.Emerging evidence indicates that miRNAs are aberrantly expressed or functionally deregulated in MM cells as the result of multiple genetic or epigenetic mechanisms and that also the tumor microenvironment regulates MM cell functions by miRNAs.Consistently,modulation of miRNA levels in MM cells has been demonstrated to impair their functional interaction with the bone marrow microenvironment and to produce significant antitumor activity to overcome the protective bone marrowmilieu.This review will describe the most recent findings on miRNA function in the context of MM bone marrow microenvironment,focusing on the therapeutic potential of miRNA-based approaches.

Objective To study the clinical value of X -ray examination in the diagnosis of bone and joint trauma and soft tissue changes .Methods 60 patients diagnosed with bone and joint trauma admitted in our hospital from January 2012 to January 2014 were selected and given anterior and posterior X -ray, patients with no definite diseases were given varus -valgus position shooting in order to further determine definite diseases , relative data were then collected .Results X -ray examination could assistthe development of treatment plans .X-ray plain films could not directly demonstrate the soft tissue changes without the auxiliary method of MRI .Conclusion Patients u-sually only pay attention to the severity of fracture but ignore the obvious trauma fractures and soft tissue changes .The application of X-ray examination enables the patients to attach importance to the treatment of traumatic soft tissue changes, and is worthy of promotion .

Objective To investigate the clinical and serologic features of scleroderma overlap syndromes.Methods Scleroderma overlap syndrome was diagnosed in 67 patients referred to our department from January 2003 to August 2013.Clinical and laboratory date were retrospectively analyzed.Comparisons between groups were tested by t test and chi-square test and Fisher exact method.Results ① Sixty-seven patients satisfied the criteria for scleroderma overlap syndrome,and 66 were female.The incidence of additional connective tissue diseases in the overlap syndrome group was systemic lupus erythematosus (SLE) in 27％,Sj(o)gren's syndrome (SS) in 24％,rheumatoid arthritis in 16％,dermatomyositis or polymyositis in 10％,two or more connective tissue diseases in 22％ respectively.② Systemic sclerosis preceded the development of additional connective tissue diseases was frequent (58％).The median onset age of SSc in SSc-SLE was younger,in contrast,SSc-SS was older.③ Antinuclear antibody (ANA) was positive in 87％ of patients,rheumatoid factor (RF) was in 42％.Anticentromere antibody (ACA) was more common in SSc-SS,RF and anti-cyclic citrullinated peptide (CCP) antibody were more frequent in SSc-RA,anti ds-DNA antibody was more common in SSc-SLE.Conclusion SSc-SLE is more common in scleroderma overlap syndrome in particular,and the median onset age of SSc in SSc-SLE is younger than others.There are distinct clinical and serological features that may predict the possibility of SSc patients with overlap syndrome.

Objective We reported 5 unusual cases of multiple myeloma (MM) initially presented as polyarthritis.Special attention should be paid to this very unusual scenario.Methods Five cases who presented initially as polyarthritis and finally diagnosed as MM were administered to Peking University People's Hospital and 11 cases from literature were reported.The clinical symptoms and laboratory parameters were analyzed respectively.Results The primarily affected joints were small joints,such as metacarpophalangeal joints,proximal interphalangeal joint,metatarsophalangeal and temporomandibular joints,but large joints such as wrists,elbows,shoulders,knees,ankle joints could be involved,too.Fourteen of 16 patients were misdiagnosed as rheumatoid arthritis (RA).Renal dysfunction presenting as high level of serum creatinine or proteinuria was detected in 14 cases.Laboratory tests showed elevated erythrocyte sedimentation rate or C reactive protein level in 13 cases.Anemia was detected in 9 cases.Hypercalcemia was detected in half of the patients.Hyperglobu-linemia was detected in 6 cases.The serum level of free M-protein was markedly elevated in 14 cases.Auto-antibodies were negative,except that rheumatoid factor was positive in 1 case.Conclusion It is important to pay attention to the clinical pictures presented as polyarthritis with negative autoantibodies,and associated with renal dysfunction,anemia and hypergammaglobulinemia.MM is important in the differential diagnosis.

ObjectiveTo analyze hospitalized death related factors in elderly patients with nonST-segment elevation myocardial infarction (NSTEMI). MethodsThree hundred and two patients (≥65 years old) with NSTEMI were included. Thirty-two patients of them died in hospital (death group). Their clinical data were retrospectively analyzed and correlated factors for in-hospital death were evaluated. ResultsCompared with survival group, patients in death group were more likely to have 3 or more chronic diseases,heart function killip grades Ⅲ- Ⅳ, heart rate＞ 100/min and peripheral blood WBC count＞10X 10＜'9＞/L on admission (all P＜:0.05). There was no significant difference in fasting plasma glucose level and serum creatinine on admission between the two groups (both P:＞0.05). But after glomerular filtration rate(eGFR) were estimated by the modified abbreviated MDRD equations based on the Chinese CKD patients, patients in death group were more likely to be with renal dysfunction and pulmonary infection (both P＜0.01 ). Multiple logistic regression analysis showed that heart function killip grades Ⅲ-Ⅳ, renal dysfunction evaluated by eGFR, pulmonary infection on admission were the independent predictors for in-hospital death in elderly patients with NSTEMI. ConclusionsCoexistence of 3 or more chronic diseases is a related factor of death and heart function killip grades Ⅲ-Ⅳ, renal dysfunction evaluated by eGFR and pulmonary infection are the independent predictors for in-hospital death in elderly patients with NSTEMI.

Epstein-Barr virus (EBV) positive diffuse large B cell lymphoma (DLBCL) is a rare type of B cell lymphoma associated with chronic EBV infection. The main subtype is activated B cell-like and it′s invasive. The response to combined chemotherapy is worse than that of EBV negative patients, and the prognosis is poor. As the researches on pathogenesis and biological characteristics of EBV positive DLBCL deepen, new therapeutic strategies are emerging, such as antiviral therapy, monoclonal antibody, inhibitors of signaling pathway and immunotherapy including cellular immunotherapy and immune checkpoint inhibitor. These new therapeutic strategies can improve the efficacy and reduce the occurrence of adverse reactions.

OBJECTIVETo study the expression and clinicopathologic significance of cancer stem cell markers CD44v6 and CD24 in ovarian serous carcinoma tissues.

METHODSOne hundred and two cases of ovarian carcinoma diagnosed during the period from June, 2001 to December, 2010 were retrieved from archival files. The histology slides were reviewed and a two-tier system for grading of ovarian serous carcinoma was applied. The expression of CD44v6 and CD24 was detected by immunohistochemistry using EnVision method. The relationship between CD44v6/CD24 expression and various clinicopathologic parameters was analyzed.

RESULTSThere were 46.1% (47/102) and 59.8% (61/102) cases expressing CD44v6 and CD24, respectively. Both CD44v6 and CD24 expression showed positive correlation with higher histopathologic grade (P = 0.003 and P < 0.05, respectively). CD24 expression also correlated with the presence of lymph node metastasis (P < 0.05). There was no statistically significant relationship between the expression of these two markers (χ(2) = 0.394, P = 0.530). The age of the patients, histopathologic grade, clinical stage and nodal status correlated with progression-free survival time (P < 0.05). CD44v6 expression and histopathologic grade correlated with the overall survival time (P < 0.05). Patient age was an independent poor prognostic factor by multivariate analysis.

CONCLUSIONSCD44v6 expression, age older than 50 years, high clinical stage and presence of lymph node metastasis are associated with poor prognosis in patients with ovarian serous carcinoma. The two-tier system for grading of ovarian serous carcinoma is useful in predicting survival; and high tumor grade represents an important poor prognostic indicator for ovarian serous carcinoma.

Adult ; Age Factors ; Aged ; CD24 Antigen ; metabolism ; Cystadenocarcinoma, Serous ; metabolism ; pathology ; surgery ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Hyaluronan Receptors ; metabolism ; Immunohistochemistry ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Grading ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Ovarian Neoplasms ; metabolism ; pathology ; surgery ; Proportional Hazards Models ; Retrospective Studies ; Survival Rate ; Young Adult

Objective:To analyze the expression of CD27 on T lymphocytes in the microenvironment of multiple myeloma (MM), and explore whether CD27 level or the CD27-/CD27+ ratio of T-cell affect the prognosis of MM patients.Methods:A total number of 103 newly-diagnosed MM patients from January 2016 to June 2019 were enrolled in the Affiliated Cancer Hospital of Harbin Medical University. All patients received bortezomib-based three-drugs combination regimen. The expression of CD27 on T lymphocytes in bone marrow aspirate samples was detected by flow cytometry before any treatment. MM patients were divided into two groups according to the CD27 level: CD27-high expression group (CD27 expression on T-cells ≥20%) and CD27-low expression group (CD27 expression on T-cells <20%). The clinical characteristics, treatment response and prognosis of patients between the two groups were analyzed using χ 2-test. The survival and clinical information of patients were compared using Kaplan-Meier method, and the related factors related to the survival of MM were analyzed using Cox proportional risk model. Results:Among 103 MM patients, 68 cases (66.0%) were included in CD27 high expression group, and 35 cases (34.0%) were included in low expression group. The percentage of bone marrow plasma cells and β2-MG level in CD27 high expression group were higher than those in CD27 low expression group significantly (54.4% [37/68] vs 22.9% [8/35], χ2=9.352, P=0.002;58.8% [40/68] vs 37.1% [13/35], χ2=4.348, P=0.037), and the proportion of ISS stage Ⅱ-Ⅲ in CD27 high expression group was higher than the counterpart (79.4% [54/68] vs 60% [21/35], χ2=4.399, P=0.036). After 4 cycles of three-drug combination therapy, the overall response rate ( ORR=stringent complete response+complete response+very good partial response+partial response) of the low CD27 expression group was higher than the high expression group (82.9% [29/35] vs 38.2% [26/68], χ2=18.489, P<0.01). The deep response rate to treatment (stringent complete response+complete response+very good partial response) was higher (48.6% [17/35] vs 27.9% [19/68], χ2=4.326, P=0.038), and the progression, free surviva (PFS) was longer (21months vs.14.1months, t=18.655, P<0.001) in the low expression group compared with CD27-high group. Univariate analysis showed that CD27-/CD27+T lymphocyte ratio, ISS stage Ⅱ-Ⅲ, age ≥65 years, β2-Mg ≥3.5 mg/L, and plasma cell proportion ≥30% were associated with the poor prognosis of MM patients, and the differences were significant statistically ( P<0.05). Multivariate analysis showed that CD27-/CD27+T lymphocyte ratio was an independent prognostic factor for 2-year overall survival (OS)( HR=2.425, 95% CI 1.216-4.835, P=0.012) and 2-year PFS ( HR=1.881, 95% CI 1.085-3.260, P=0.024) in MM patients. Conclusions:The expression of CD27 in T lymphocytes is correlated with the prognosis, treatment response and progression-free survival of MM. The ratio of CD27-/CD27+T lymphocytes is an independent prognostic indicator.

OBJECTIVETo investigate the clinicopathological characteristics, diagnostic criteria and differential diagnosis of placental chorioangioma.

METHODSTwenty-five cases of placental chorioangioma were analyzed for their clinical data, histomorphology and immumohisto chemical staining. Relevant literature was reviewed.

RESULTSThe average age of the 25 patients was 29 years. Fourteen patients had full-term pregnancy, 10 had preterm labor, and 1 had intrauterine fetal death. Nineteen patients had pregnancy complications. The tumors presented as red or dusty pink nodules with clear borders. The tumor size ranged from 1 to 16 cm. Microscopically, the tumors possessed abundant capillaries or cavernous blood spaces lined by hyperplastic endothelial cells. These cells were positive for CD34 and Ki-67 index < 10%.

CONCLUSIONSPlacental chorioangioma is a rare benign tumor of the placenta, and is associated with various pregnancy complications. Misdiagnosis of cell-rich type tumor should be avoided.

Adult ; Diagnosis, Differential ; Endothelial Cells ; pathology ; Female ; Fetal Death ; Hemangioma ; pathology ; Humans ; Infant, Newborn ; Placenta ; pathology ; Placenta Diseases ; pathology ; Pregnancy ; Pregnancy Complications, Neoplastic ; pathology ; Stillbirth

Objective To assess and compare the incidence,clinical characteristics,treatment,and prognosis of acute heart failure patients from different grades hospitals in Beijing.Methods In this prospective internet prognosis registered study (Beijing AHF Registry),a total of 3 335 consecutive patients admitted to 14 emergency departments in Beijing from January 1st 2011 to September 23rd 2012 were enrolled.According to hospital grade,these patients were divided into two groups,349 patients were from secondary hospitals,and 2 956 patients were from tertiary hospitals.Results Among the 3 335 patients,the medium age was 71 (58,79) years,and male accounted for 53.16％.The most common underlying disease were coronary disease (43.27％),hypertension (17.73％),cardiomyopathy (16.07％) etc.The average treatment time in Emergency Department was 66.82 h.The emergency department mortality rate was 3.81％ (127 cases).The 30-day and 1-year cumulative all-cause mortality were 15.3％ and 32.27％,respectively.The 30-day and 1-year cumulative all-cause readmission were 15.64％ and 46.89％,respectively.Compared with patients in tertiary hospitals,patients in secondary hospitals had more onset acute heart failure patients (63.64％ vs.49.93％),shorter emergency department treatment time (12 h vs.41 h),lower discharge rate (3.43％ vs.37.45％) and emergency department mortality(1.58％ vs.4.09％).Compared with those in tertiary hospitals,1-year cumulative all-cause mortality (25.6％ vs.33.2％),cardiovascular disease mortality (20.2％ vs.26.0％),aggravated heart failure mortality (22.4％ vs.28.8％) were lower in secondary hospitals.Following propensity score matching,compared to tertiary hospitals,patients in secondary hospitals showed lower utilization rate of beta-blockers and ACEFARB (4.51％ vs.28.17％,1.41％ vs.9.58％),except the pironolactone.Conclusion Acute heart failure in emergency department is associated with a high mortality rate and readmission rate.There is still a big gap between guidelines recommend medication current treatments for acute heart failure.