Objective To compare the effects of glutathione and tiopronin in chemo -induced liver injury respectively.Methods 122 patients with gastrointestinal cancer who were diagnosed with chemo -induced liver injure were chosen.According to random number table,they were divided into treatment group(63 cases)and control group(59 cases).The control group were given glutathione 1.8g/d intravenously,while the treatment group were given tiopronin 0.2g/d.Both treatments lasted a week.Liver function indexes before /after the treatment were observed respectively,as well as the symptoms of every patient.The adverse drug reactions of both treatments were also observed.Results The remission ratio of the treatment group and the control group was 90.48% and 81.35%, respectively,the difference of the two groups was statistically significant(χ2 =7.65,P <0.05).The liver function indexes of the two groups before the treatment had no significant differences(t =0.75,1.23,0.97,0.95,all P >0.05);after both treatment the indexes were significantly improved,and ALT,TBIL,AST and ALP between the two groups were significantly different(t =4.67,6.13,4.76,6.90,all P <0.05).The adverse drug reactions of the two groups had no significant difference(χ2 =0.42,P >0.05),and no severe adverse drug reactions were observed in our research.Conclusion Tiopronin is more effective in treating chemo -induced liver injure caused by capetcitabine /5-FU and oxaliplatin,when compared with glutathione.And no severe adverse drug reaction were observed in our research.

Objective: To understand the pathogen spectrum composition of non-bacterial respiratory infections in Pinghu City, Zhejiang Province, so as to provide insights for the prevention and control of respiratory infectious diseases. Methods: A total of 592 throat or nasopharynx swab samples were collected from fever patients in Pinghu First People's Hospital from Jamuary 2021 to November 2022. Multiple real-time fluorescence quantitative polymerase chain reaction was used to detect the nucleic acids of rhinovirus (RhV), respiratory syncytial virus (RSV), parainfluenza virus (PIV), adenovirus (ADV), metapneumovirus (MPV), coronavirus (CoV), Boca virus (Boca), enterovirus (EV), influenza virus (Flu), chlamydia pneumoniae (CP) and mycoplasma pneumoniae (MP). The detection rates of pathogens and mixed infections in different age groups and seasons were analyzed. Results: A total of 212 samples were tested positive for at least one pathogen's nucleic acid from 592 samples, with a total detection rate of 35.81%. The detection rates of RhV (9.80%), PIV (7.26%), Flu (6.76%), RSV (4.39%) and CoV (3.72%) were relatively high. The detection rates were higher among patients at ages of 0 to 2 years and 3 to 17 years than among patients at ages of 18 to 59 years, and in autumn than in spring and winter (all P<0.05). Twenty-three samples were infected by mixed pathogens, accounting for 3.89%. The mixed infections were all detected two pathogens, with PIV, CoV, RhV, and ADV predominant. Conclusions From 2021 to November 2022, the main pathogens of non-bacterial respiratory infections in Pinghu City were RhV, PIV, FLu, RSV and CoV, and there were mixed infections. It is necessary to strengthen the prevention and control of respiratory infection in infants and children.

Objective To evaluate the efficacy of double filtration plasmapheresis (DFPP) in the treatment of patients with refractory rheumatoid arthritis (RA). Methods Eighty-two patients were randomly aesigned,42 to the DFPP group and 40 to the no-DFPP group. All patients previously experienced an incomplete response to 2-3 dis-ease-modifying antirheumatic drugs (DMARDs) and 1-2 nonsteroidal anti-inflammatory drugs (NSAIDs) or predni-sene. All patients received sulphasalazine (SASP,0.75 g three times daily) plus methotrexate (MTX, 10 mg orally once weekly). DFPP was performed once a week for 2-3 sessions. A total of 121 plasmapheresis procedures were per-formed in 42 patients. Control patients did not receive sham DFPP. The efficacy measures recorded one day after the final treatment and latest month in follow up for 12～24 months included the American College of Rheumatology 20% ,50% ,and 70% improvement criteria (ACR20, ACR50, and ACR70), the Health Assessment Questionnaire estimate of disability (HAQ); and the disease activity index. Results Patients in the DFPP group had ACR 20, ACR 50 and ACR 70 improvements of 100% ,92.9% and 81.0%,as compared with the patients in no-DFPP group 17.5% ,0,and 0 (P<0.001). Significant change from baseline was observed in HAQ scores in the DFPP group but not in the no-DFPP group (P<0.001). The changes from baseline in the disease activity scores were significantlygreater than in the no-DFPP group (P<0.001). Conclusion DFPP therapy significantly alters the signs and symp-toms of refractory RA. There are significant increases in physical function and improvement in quality of life.

Objective To evaluate the efficacy of double filtration plasmapheresis (DFPP) combined with immunosuppressive agents (leflunomide plus methotrexate) on synovitis in magnetic resonance imaging (MRI) in patients with high active rheumatoid arthritis (RA). Methods Fifty eight patients with RA (disease duration 6 months to 12 years) were randomly divided. Thirty-one were randomized to the treatment group and 27 were randomized to the control group. All patients received leflunomide 10 mg, two times daily; plus methotrexate 15 mg orally once weekly. DFPP was performed in the treatment group once 1-2 weeks for 3-4 sessions. Control patients did not receive DFPP. All patients underwent contrast-enhanced MRI of the right wrist at the baseline and 6 months, 1 month in the treatment group. The signs including synovitis pannus, bone marrow edema and effusion were observed on MRI. The scoring of synovial hypertrophy, pannus, bone marrow edema were measured according to the outcome measures in RA MRI scoring system. Comparisons between groups were performed with paired-samples t test and independent-sample t test. Results The MRI synovitis score, MRI pannus score and MRI bone marrow edema in the treatment group was (1.4±1.6), (0.13± 0.35) and (5±4) respectively,so was significantly lower than that of the control group [respectively for (7.9± 1.3), (2.76±0.43), (16±12),P<0.01]. 53% of the treatment group satisfied both the disease activity score 28-joint assessment and MRI synovitis assessment (no enhancement of synovium or pannus, no effusion), but none in the control group (P<0.01). Significant changes at 1 month was observed in DAS28 and HAQ scores (P<0.01), but not in the MRI synovitis score, MRI pannus score, MRI bone marrow edema score and effusion in the treatment group (P>0.05). Conclusion DFPP combined with immunosuppressive agents can significantly improve synovitis in MRI in patients with high active RA. Improvement of the signs of MRI is later than that in the clinic. So imaging assessment may be necessary for accurate evaluation of disease status and selection of therapy.

Objective To explore the clinical features, diagnosis and treatment of ectopic thyroid gland and to improve the management of ectopic thyroid. Methods The clinical data of 15 cases of ectopic thyroid in our hospital and the literatures were analyzed. The clinical features of ectopic thyroid gland, its diagnosis and the treatment were summarized. Results Of the 15 cases, 13 cases underwent operation. Among them, 9 cases showed symptom relief and their thyroid gland function resumed normal with no reoccurrence, 3 cases were complicated by temporary hypothyroidism and 1 case was misdiagnosed and mistreated, resulting in permanent hypothyroidism and lifetime thyroid hormone replacement. Conclusions Ectopic thyroid gland is a rare disease which was frequently misdiagnosed and mistreated. Improvement of related examination is essential in reducing misdiagnosis and mistreatment.

Multiple myeloma(MM)is a common hematological malignancy of the elderly.It is characterized by the involvement of multiple organs and its treatment becomes more difficult when aging and frailty exert their influence.In elderly MM patients, frailty is associated with poor tolerance to treatment and poor outcomes.Individualized therapy based on frailty assessment can minimize treatment-related adverse effects and reduce the rate of treatment interruptions, thereby improving the survival in elderly patients.In this review, we aim to provide an overview of the frailty assessment systems for MM patients.We also discuss their clinical applications, issues to be addressed, and future directions for optimizing MM-specific frailty assessment to guide MM treatment in frail elderly patients.

Objective:To explore the inhibitory effect of long non-coding RNA (lncRNA) KCNQ1 overlapping transcript 1 (KCNQ1OT1) by targeting microRNA-199a-5p (miR-199a-5p) on the apoptosis of human lens epithelial cells (LECs).Methods:The anterior lens capsule tissue of 23 age-related cataract patients who underwent cataract surgery in Xinxiang First People's Hospital from December 2018 to August 2019 was collected.At the same time, anterior lens capsules from 20 healthy donor were collected.The expressions of KCNQ1OT1 and miR-199a-5p in the tissues were detected by real-time fluorescence PCR.Human LECs SRA01/04 cultured in vitro were divided into blank control group, model control group, small interfering RNA-negative control (siR-NC) group, siR-KCNQ1OT1 group, miR-NC group, miR-199a-5p group, siR-KCNQ1OT1+ anti-miR-NC group and siR-KCNQ1OT1+ anti-miR-199a-5p group.No intervention was administered to blank control group.Cells in model control group were cultured with 100 μmol/L H 2O 2 for 24 hours to establish oxidative stress injured model, and cells in the other six groups were transfected with corresponding transfection reagents for 6 hours by liposome method according to grouping, and then treated with 100 μmol/L H 2O 2 for 24 hours.The expressions of KCNQ1OT1 and miR-199a-5p in lens anterior capsule tissue and LECs cells were determined by real-time fluorescent quantitative PCR.Cell viability was detected with thiazolyl blue (MTT). Cell apoptosis was analyzed by flow cytometry.The expressions of B-cell lymphoma/leukemia-2 (bcl-2) and bcl-2 related X protein (Bax) proteins were assayed by Western blot.The superoxide dismutase (SOD) activity and malondialdehyde (MDA) content were measured by enzyme-linked immunosorbent assay (ELISA). The targeting relationship between KCNQ1OT1 and miR-199a-5p was verified by dual luciferase reporter experiment.The study protocol was approved by an Ethics Committee of Xinxiang First People's Hospital (No.2019-001). Written informed consent was obtained from relatives of patient. Results:The relative expression of KCNQ1OT1 in the anterior capsule of patients with age-related cataract was 2.41±0.42, which was significantly higher than 0.97±0.19 of normal people, and the relative expression of miR-199a-5p in the capsule of patients with age-related cataract was 0.36±0.12, which was lower than 1.04±0.15 of normal people, and the differences were statistically significant ( t=14.112, 16.507; both at P<0.001). Compared with blank control group, the relative expressions of KCNQ1OT1 and bax protein, cell apoptosis rate and MDA content were significantly increased, and the relative expressions of miR-199a-5p and bcl-2 protein, cell viability and SOD activity were significantly reduced in model control group, showing statistically significant differences (all at P<0.001). Compared with siR-NC group, the relative expressions of KCNQ1OT1 and bax protein, cell apoptosis rate and MDA content in cells of siR-KCNQ1OT1 group were decreased, while the relative expression of bcl-2 protein, cell survival rate and SOD activity were increased, and the differences were statistically significant (all at P<0.05). Compared with miR-NC group, the KCNQ1OT1-wild type (WT) luciferase activity in miR-199a-5p group was significantly decreased, with a statistically significant difference ( t=21.131, P<0.001). The relative expression levels of miR-199a-5p and bcl-2 proteins, cell survival rate and SOD activity were significantly increased, and the relative expression of bax protein, cell apoptosis rate and MDA content were significantly decreased in miR-199a-5p group than those in miR-NC group, and the differences were statistically significant (all at P<0.05). The relative expression levels of miR-199a-5p and bcl-2 proteins, cell survival rate and SOD activity were significantly lower, and the cell apoptosis rate, relative expression of bax protein and MDA content were significantly higher in siR-KCNQ1OT1+ anti-miR-199a-5p group than those in siR-KCNQ1OT1+ anti-miR-NC group, and the differences were statistically significant (all at P<0.05). Conclusions:The inhibition of KCNQ1OT1 can promote the cell viability of human LECs, inhibit H 2O 2-induced cell apoptosis and oxidative stress, and the mechanism may be related to the up-regulation of miR-199a-5p.

Objective To investigate the impairment of intertemporal choices in adolescents with positive and negative schizophrenic symptoms.Methods 30 adolescent schizophrenia patients with positive symptoms (positive symptoms group),30 adolescent schizophrenia patients with negative symptoms (negative symptoms group)and 30 healthy controls were selected.All the subjects were investigated with intertemporalchoice Test.Results (1) Under now conditions ((37.22±30.92)％,(19.67±16.35)％,P＜0.05)),notnow conditions ((35.74±31.69)％,(19.33± 18.07)％,P＜0.05)) and overall condition ((36.48±30.44) ％,(19.50± 13.82)％,P＜0.05)),the ratio of later-large (LL) choice in negative symptoms group were significantly higher than those in the healthy controls.Under now conditions ((37.22±30.92) ％,(20.37±22.33) ％,P＜0.05)),not-now conditions ((35.74± 31.69) ％,(22.04±22.05) ％,P＜ 0.05)) and overall condition ((36.48±30.44) ％,(21.20±21.57) ％,P＜0.05)),the ratio of LL choice in negative symptoms group were significantly higher than those in positive symptoms group.There were no differences in the ratio of LL choice between positive symptoms group and healthy controls (P＞ 0.05).(2)Pearson correlation analysis showed that the Vocabulary Fluency Test of negative symptoms group was positively correlated with LL selection ratio under now conditions (r=0.411,P=0.024).Conclusion The ability of intertemporal choices in adolescents schizophrenia patients with negative symptoms is impaired remarkably,while this kind of ability is impaired unremarkable in adolescence with negative symptoms.The ability of intertemporal choices in adolescents schizophrenic patients with negative symptoms is correlated with cognitive executive function.

Objective: To evaluate efficacy of the BiRd regimen, a combination of clarithromycin, lenalidomide, and dexamethasone, in the treatment of patients with relapsed/refractory multiple myeloma (RRMM) . Methods: Patients with RRMM treated with BiRd between September 11, 2013 and August 1, 2016 at six centers were included to evaluate overall survival rate (ORR) , clinical benefit rate (CBR) , progression-free survival (PFS) , overall survival (OS) , as well as adverse events. Results: Of 30 patients with RRMM, 27 patients were evaluable, and ORR and CBR were 51.9% (14/27) and 66.7% (18/27) respectively, including 1 sCR (3.7%) , 3 CR (11.1%) , 3 VGPR (11.1%) , and 7 PR (25.6%) . In 13 patients with prior Rd, ORR and CBR were 38.5% (5/13) and 61.5% (8/13) respectively, of which 5 patients with ≥MR carried high-risk cytogenetic[ (e.g.17p- or t (4;14) ] together with at least one of other adverse-prognostic cytogenetic (e.g.13q- and/or 1q21+) . In 24 patients with prior bortezomib-based therapy, ORR and CBR were 45.8 and 62.5%, respectively. With a median follow-up time of 14.9 (range 1.0-33.8) months, the median PFS and OS were 12.0 (95%CI 11.6-12.4) and 27.6 (95%CI 15.1-40.1) months, respectively. The BiRd regimen was well tolerated. Conclusion The BiRd regimen is an effective and safety protocol for RRMM, including those carrying high-risk cytogenetic markers.

Objective To evaluate the efficacy and safety of lenalidomide in a real-world clinical practice in Chinese patients with multiple myeloma (MM).Methods It was a prospective,multi-center,observational study.A total of 165 consecutive patients with MM treated with lenalidomide-based regimens were enrolled in 12 hospitals from June 2013 to November 2015.Relevant information was recorded,such as baseline clinical data,cytogenetic abnormalities,treatment regimens,and duration of treatment,safety,and survival.Results (1)There were 126 relapsed and refractory MM (RRMM) patients,25 newly diagnosed patients and 19 maintenance patients.The evaluable RRMM patients accounted for 120 cases,among which 74 cases(61.7％) reached the partial response (PR) or above,and a very good partial response (VGPR) in 16 patients (13.3％),a complete response (CR) in 14 cases (11.7％),a strictly complete response (sCR) in 4 cases (3.3％).Thus,a VGPR or above in 34 patients accounted for 28.3％.(2)The median follow-up was 13 months,the median time to progression 12 months.The median survival after receiving lenalidomide was 19 months,and the median overall survival (OS) was 62 months.(3) The univariate analysis in 120 RRMM patients suggested that prognostic factors for significant improvement in PFS included normal karyotype,international staging system (ISS) Ⅰ-Ⅱ,t(4;14) negative (detected by fluorescence in situ hybridization),non-bortezomib resistance and response to previous regimens.As to OS,nonbortezomib resistance,response to previous regimens and non-primary refractoriness were positive factors.Multivariate analysis showed that the response to previous regimens (PR or better) was an independent good prognostic factor for progress-free survival (PFS),non-bortezomib resistance and non-primary refractoriness for OS.(4) Grade 3 or 4 adverse events that occurred in more than 10％ of all enrolled patients were neutropenia (12.7％),leukocytosis (11.5％) and thrombocytopenia (12.7％).Owing to intolerance of toxic side effects,7 cases withdrew lenalidomide.Conclusions No matter what combination,regimens containing lenalidomide are effective to RRMM patients with overall response rate 61.7％,a time to progression 12 months and an overall survival 62 months.The toxicity is quite tolerable and manageable.In addition,the response to previous treatment (reached PR or above) is the independent good prognostic factor for PFS,non-bortezomib resistance and non-primary refractoriness for OS.Clinical trail registration Clinicaltrials.gov,NCT01947309