Purpose:To investigate the effects and side- ef fects of thalidomide in the treatment of relapsed and refractory multiple myelom a (MM).Methods:There were thirteen men and two women aged 33～7 6 (median 58) years in thalidomide alone group. Two cases were newly diagnosed my eloma; twelve of them were refractory myeloma, including three relapsed cases wh o had experienced autologous peripheral blood stem cell transplantation (AutoPBS CT); another one is primary plasma cell leukemia. The starting dose was 100mg/d, escalating up to a maximum of 800mg/d. The combination group included twenty me n and seven women aged 40～81 (median 56) years of which case was newly diagnose d myeloma; twenty-five cases were refractory myeloma, two of whom relapsed after AutoPBSCT; another one was primary plasma cell leukemia. Dexamethasone 40mg/d w as used at d 1-4 , d 9-12 , d 17-20 when the dose of thalidomide increased to 400mg/d. Each cycle lasted for one month.Results: The total response rate was 42.9% and 57.7% in thalidomide alone group and in co mbination group, respectively. The response rate in refractory patients was 33.3 % and 44.0% in thalidomide alone group and in combination group, respectively. T here was no difference between the two groups in response rates. Both of the two groups had side effects of constipation and skin rash, etc. in different degree s but usually tolerable. Conclusions:Both thalidomide alone and thalidomide combined with dexamethasone was effective in the treatment of relap sed and refractory MM.

Objective To sum up the clinical experience of the diagnosis and treatment of membranous glomerulopathy associated with chronic graft-versus-host disease(cGVHD) following allogeneic stem tell transplantation(alloSCT).Methods One case of acute acute lymphoblastic leukemia(received) HLA complete matched alloSCT and subjected to methopterin and Tacrolimus(FK506)postoperatively for prevention of GVHD.Nineteen days after operation,the patient suffered from(acute) GVHD and recovered by using methylprednisolone.On the day of 182 and 235 after transplantation,FK506 and prednisone were withdrawn.Five days later,cGVHD occurred,showing liver(dysfunction) and nephrotic syndrome.Membranous glomerulopathy(stage II) was pathologically (diagnosed) and treated with FK506 and prednisone.Results In membranous glomerulopathy,the(patient) got albuminuria(++++),leukocytes 75/?L,epicytes(359.5)/?L,pathological casts(+),24-h urine protein(4.28) g.Renal biopsy revealed that glomeruli were slightly enlarged,partial(capillary) compressed to be closed,glomerular basement membrane(GBM) was slightly thickened and mesangium slightly proliferate.Masson stain indicated the deposition of pink material along the glomerular capillary walls.And IgG(+++),C3(+++) and IgA(++) were detected at the GBM in a granular pattern by immunofluorescent stain.Electron microscopy showed numerous subepithelial(deposits).After treatment with prednisone and FK506 for 2 months,proteinuria was gradually(decreased).Conclusions GVHD associated membranous glomerulopathy should be considered when the patient got nephrotic syndrome or proteinuria after alloSCT.Renal biopsy is beneficial to the diagnosis of GVHD.Glucocorticoid and FK506 is effective in the treatment of GVHD.

20?10 6/L were observed in the blood. No patients presented bone pain, fever, abnormal function of liver and kidney, and so on. Conclusions:Our results indicated that rhG-CSF is efficacious and safe in auto-PBSCT for patients with plasma cell diseases. Therefore, the expense of hospitalization would be reduced significantly.

Objective To assess the volume and function of right atrium(RA) in patients with chronic pulmonary hypertension(PH) by echocardiography and explore the influencing factors of these changes.Methods The study include 20 healthy participants as the control group and 57 patients with chronic PH as the case group.The patients were divided into three groups: low-grade PH, midrange PH and severe PH.Maximal RA volume index(VmaxI), minimal RA volume index(VminI), pre-atrial contraction RA volume index( VpreI), reservoir volume index(RVI), conduit volume index(CVI), contraction-chamber volume index (CCVI) were measured and calculated.The diameter of tricuspid valve and the late-diastole peak velocity of the bloodstream(Va) were measured,and then RA ejection force(RAEF) could be calculated.Systolic strain rate(RASRs), early diastolic strain rate (RASRe), and late diastolic strain rate (RASRa) of RA free wall were measured respectively.The correlation between pulmonary arterial systolic pressure (PASP), right ventricular ejection fraction(RVEF),the tissue Doppler of RV free wall(Ea/Aa) and the parameters of RA were analysed,and the main factors influencing the volume and function of RA were exploxed.Results With the rising of PASP, the RA volume changed obviously.And CCVI, RAEF, RVI, RASRs and the absolute value of RASRa increased gradually, but CVI decreased gradually.PASP, RVEF and Ea/Aa correlated with the parameters of RA.The main factors influencing the Vprel were EDVI, Ea/Aa and the course of disease,and VpreI and PASP mainly influenced the RAEF.Conclusions In patients with chronic PH the volume and function of RA changed,and some index of which was infuenced by PASP, RVEF, Ea/Aa and so on.

Objective To assess the application values of real-time three-dimensional transesophageal ultrasound (RT3D-TEE) technology in the diagnosis and treatment of artificial mitral paravalvular leak (PVL). Methods Fifty-one cases of artificial mitral PVL patients were received two-dimensional transesophageal ultrasound (2D-TEE) and RT3D-TEE examination before and after surgery. Accuracy analysis was performed between the two kinds of test. Results The diagnostic accuracy of RT3D-TEE technique in patients with PVL drain port positionwas significantly higher than that of 2D-TEE technology , and the data of PVL drain port size by RT3D-TEE technique is significantly larger than that of 2D-TEE technique (P < 0.05, respectively). Conclusion The PVL laboratory diagnosis based on RT3D-TEE is accurate and reliable , and RT3D-TEE can assist doctors to diagnose before operation , and can provide real-time ultrasound information from intraoperative monitoring , and monitor the postoperative efficacy of patients .

Objective To develope a new Real-time quantitative PCR assay using SYBR green as fluorescence reporter, which is rapid, specific, sensitive, cheap and accurate for the detection of mycoplasma pneumoniae(MP), and evaluated its clinical application value.Methods The sequence of the 23S rRNA gene in MP type strain FH was selected as amplified regions, and specific primers were designed.Then the related plasmids were extracted as standards,and the absolute quantitative standard curve was established.The sensitivity ,specificity of the fluorescence quantitative PCR assay was compared with the nest-PCR and kit;To calculate correlation coefficient, coincidence rate and kappa coefficient, clinical samples were detected using above-mentioned methods and cultivation,respectively.Results The detection sensitivity of the new real-time PCR and nest-PCR was 10 copies of FH DNA,while the kit 100 copies.In the specificity tests,the MP sample was positive,while mycoplasma hominis and other four bacteria were all negative.We applied this real-time PCR assay ,nest-PCR, kit and cultivation to 182 clinical specimens, and the detection rates were 55.49％, 52.75％, 47.25％ and 39.01％ ,respectively.The total consistency rate and Kappa coefficient of the new real-time PCR method and nest-PCR were 89.6％ ,0.790, respectively;while those of the new method and cultivation were 83.5 ％ ,0.678, respectively.The total consistency rate and Kappa coefficient of the new real-time PCR method and the kit were 89.6％ ,0.792,respectively;and the correlation coefficient of these two methods was 0.923,P ＜ 0.001.Conclusion Compared with other methods, the new real-time PCR assay could be used to detect mycoplasma pneumoniae quickly and economically, with high sensitivity and specificity ,revealing great utility value on varied instrumentation platforms.

Objectives To investigate the efficacy and toxicity of bortezomib based combination therapy for Chinese patients with relapsed or refractory multiple myeloma(MM),and to determine the combination regimen,dosage and cycles in application of bortezomib for MM therapy.Methods Forty-six patients with refractory or relapsed myeloma were treated with bortezomib(1.3 mg/m2)as an intravenous bolus twice weekly for 2 weeks on day 1,4,8,and 11 in a 3-4 week cycle,in combination with dexamethasone,dexamethasone plus thalidomide, CD(C-cytoxan,D-dexamethasone),MD(M- mitoxsnteone),DCEP(E-etoposide,P-platinol),and DT-PACE regimens(T-thalidomide,A-adriamycin). Response to bortezomib was evaluated according to the criteria of the International Myeloma Working Group (IMWG)before initiation of each cycle.Adverse events were graded according to the National Cancer Institute Common Toxicity Criteria,version 3.0.Forty-nine matched patients with relapsed and refractory MM who received thalidomide based combination therapy were used as a historical control group.Results Among 43 of the 46 patients whom could be evaluated,the overall response rate was 72.1%(the control group was 51.0%,P＜0.05),including complete response in 5 patients(11.6%),very good partial response in 12 patients(27.9%),and partial response in 14 patients(32.6%).The overall response rate after one and two cycles was 30.2%and 58.1%(P＜0.05),respectively.The frequent adverse events were thromboeytopenia(62.8%),fatigue(55.8%),nausea(51.2%)and peripheral neuropathy (30.2%);all of the events could be tolerated.The most common adverse event in the control group was constipation(69.4%),followed by fatigue(59.2%)and dizziness(46.9%).Conclusions Bortezomib based combination therapy is a new effective therapy in relapsed or refractory myeloma patients with a higher response rate and difierent toxicities as compared with thalidomide based combinations.

OBJECTIVE: To explore the three-dimensional ultrasound locatization in endoscopic thyroidectomy for multinodular goiter (MG). METHOD: Thirty two patients with MG underwent ET via bilateral areolar approach. Preoperative ultrasonography were used to locate lesions and marked in the 3-D map designed by us. Dur ing ET procedure, surgery skills were adopted to expose inferior pole of thyroid, glands in the area of Berry ligament or (and) upper pole were retained according to the preoperative location map. RESULT: According to the preoperative ultrasonic orientation, 3 lobectomy were performed in 15 cases of unilateral lesions, 12 subtotal thyroidectomy were performed in 17 cases of bilateral lesions, and 5 patients performed unilateral lobectomy add partial thyroidectomy. All patients had successful ET using bilateral areola approach. No conversions to open surgery, no complication occurred, and no nodules were found missing in the postoperative ultrasonography examinations. CONCLUSION Preoperative ultrasonic orientation and intraoperative operating skills are contributing to a successful ET for MG.
Adolescent ; Adult ; Aged ; Endoscopy ; methods ; Female ; Goiter, Nodular ; diagnostic imaging ; surgery ; Humans ; Imaging, Three-Dimensional ; Male ; Middle Aged ; Thyroidectomy ; methods ; Ultrasonography ; Young Adult

BACKGROUND:Intra-articular injection of sodium hyaluronate is an effective method for the treatment of knee osteoarthritis, with significant effect and less adverse reactions, but the mechanism is unclear. OBJECTIVE:Through testing the malondialdehyde and superoxide dismutase levels in the synovial fluid of knee osteoarthritis before and after injection of sodium hyaluronate, to evaluate the clinical efficacy of sodium hyaluronate in the treatment of knee osteoarthritis. METHODS:Thirty-seven patients with knee osteoarthritis (40 knees) were enroled and divided into mild (n=10, 10 knees), moderate (n=17, 18 knees), and severe (n=10, 12 knees) groups according to the Japan's knee osteoarthritis indications. Patients were subjected to intra-articular injection of 25 mg sodium hyaluronate, once a week for 5 weeks. The levels of malondialdehyde and superoxide dismutase in the synovial fluid before and 4 weeks after treatment were detected, and then clinical effects were evaluated based on the clinical scores according to the Japan’s knee osteoarthritis indications. RESULTS AND CONCLUSION: The indication rating results of the mild and moderate groups were decreased significantly 4 weeks after injection (P < 0.05), but there were no significant difference in the severe group before and after treatment. The malondialdehyde level in the synovial fluid was decreased obviously in the three groups at 4 weeks after injection (P < 0.05), while the level of superoxide dismutase was increased remarkably (P < 0.05). These findings indicate that sodium hyaluronate can treat knee osteoarthritis by reducing the malondialdehyde level and increasing superoxide dismutase level in the synovial fluid, but this method is more suitable for treatment of mild to moderate knee osteoarthritis.

Objective:To establish the quality control method for compound Jieyu granules. Methods:Liquorice was identified by TLC. saikosaponin a, Saikosaponin d and rutin were determined by HPLC. Results:The spots on TLC plates were clear without any in-terference. The linearity was achieved within the range of 0. 508-16. 200 μg (r=0. 999 8) for saikosaponin a, 0. 503-16. 100 μg(r=0.999 7) for saikosaponin d, and 0.130-4.250 μg(r =0.999 9) for rutin. The average recovery was 99.7%(RSD =2.03%), 99. 8%(RSD=1. 44%) and 102. 6%(RSD=1. 40%), respectively. Conclusion:The method is simple, reliable and accurate, and can be applied as the quality control method for compound Jieyu granules.