Bone disease is a major morbidity factor in patients with multiple myeloma and significantly affects their overall survival.A complex interplay between malignant plasma cells and other marrow cells results in the generation of a microenvironment to enhance both tumor growth and bone destruction.Bisphosphonates have consistently reduced the incidence of skeletal-related events in patients with multiple myeloma.However,their use is burdened with side-effects,including the risks of osteonecrosis of the jaw and kidney failure,suggesting that they should be discontinued after prolonged administration.New molecular targets of cell cross-talk in myeloma bone marrow are therefore under intensive investigation and new drugs are exploring in preclinical and clinical studies of myeloma bone disease.This review would focus on novel agents in myeloma bone disease.

Bruton tyrosine kinase (BTK) is a non-receptor tyrosine kinase which belongs to the Tec kinase family and plays an important role in B cell receptor signaling.Nowadays,BTK has been a nove] target for treating some B cell malignancies.Recently,some studies have confirmed that BTK inhibitor,PCI-32765 (ibrutinib),can effectively treat chronic lymphocytic leukemia,mantle cell lymphoma and so on.This review will discuss the preclinical and clinical development of this BTK inhibitor in B cell malignancies.

BACKGROUND:There are various internal fixators in treatment of distal femoral fracture. The commonly used fixators are locking compression plate, anterograde intramedul ary nails and retrograde intramedul ary nails. However, the efficacy of three common fixation is controversial.
OBJECTIVE:To compare the effect of locking compression plate, anterograde intramedul ary nails and retrograde intramedul ary nails for treatment of distal femoral fracture, and to select the appropriate internal fixation method.
METHODS:From May 2007 to November 2007, 118 patients with distal femoral fractures were treated with internal fixation in the hospital and their clinical data were analyzed retrospectively. Among them, 38 cases received locking compression plate, 21 cases received anterograde intramedul ary nails, and 59 cases received retrograde intramedul ary nails. The intraoperative blood loss, operative time, fracture healing time and rate of good postoperative recovery of knee joint in three groups were compared.
RESULTS AND CONCLUSION:Al the involved 118 patients were fol owed up for 14-26 months, average 20 months. No patients developed infection. Except one case delayed bone defect healing due to the fractures and was completely healed after bone fil ing at 19 weeks, the other cases healed within 4.5 months. There was no significant difference in fracture healing time among three groups (P>0.05). Intraoperative blood loss and operation time in anterograde intramedul ary nail group and retrograde intramedul ary nail group were superior to locking compression plate group. In addition, anterograde intramedul ary nail group was superior to retrograde intramedul ary nail group, with significant difference (P<0.05). Kolment grading fine rate in locking compression plate, anterograde intramedul ary nail and retrograde intramedul ary nail groups was 76.3%, 52.4%and 76.3%respectively. Retrograde intramedul ary nail fixation is firm, stable and reliable, with less intraoperative blood loss, shorter operation time, smal trauma, and easy fracture reset, especial y in the recovery of knee joint function. Compared with locking compression plate and anterograde intramedul ary nail, retrograde intramedul ary nailing treatment of distal femoral fractures has more advantages.

AIM: To develop a RP-HPLC method of determining ginsenoside Rg1 and ginsenoside Re in Wu-(shenqi) Oral Liquid(Radix et Rhizoma Ginseng,Radix Astragali,Fructus Ligustri Lucidi,etc.). METHODS: Hypersil-C_(18) column was used at 30 ℃.The mobile phase consisted of acetonitrile-water(103∶400) with 0.05% H_3PO_4.The detection wavelength was set at 203 nm.The flow rate was 1.0 mL/min. RESULTS: The linear ranges for ginsenoside Rg1 and ginsenoside Re were 0.188-6.016 ?g(r=0.999 9) and 0.197-6.323 ?g(r=(0.999)),respectively.Its average recoveries were 99.53% with RSD of 0.96% and 99.13% with RSD of 0.62%,respectively. CONCLUSION: This method is simple,accurate,reproducible,and can be used for the determination of ginsenoside Rg1 and ginsenoside Re in Wushenqi Oral Liquid.

Objective To investigate the chemical constituents in the vines of Piper hancei for obtaining a more comprehensive understanding on its effective components. Methods Compounds were separated by column chromatography with silica gel and polyamide, and their structures were elucidated by spectral analysis and chemical evidence (IR, UV, MS, (~1H-NMR), (~(13)C-NMR)). Results Nine compounds were isolated from the chloroform extract fraction. Their structures were identified as: futoamide (Ⅰ), trichostachine (Ⅱ), retrofractamide A (Ⅲ), pipercide (Ⅳ), guineensine (Ⅴ), piperine (Ⅵ), piperettine (Ⅶ), piperovatine (Ⅷ), and (2E, 4E)-N-isobutyl-7-(3, 4-methylenedioxyphenyl)-hepta-2, 4-dienamide (Ⅸ). (Conclusion )Compounds Ⅱ-Ⅳ and Ⅶ-Ⅸ are isolated from the plant for the first time.

BACKGROUND:Arthroscopic anterior cruciate ligament (ACL) reconstruction is the conventional surgical treatment at present for patients with severe anterior cruciate ligament injury or fracture. However, the opinions varies about whether the ACL remnant should be preserved, and its impact on the knee proprioception gets more and more attention. OBJECTIVE:To compare the influence of arthroscopic ACL reconstruction with remnant preservation or not on the proprioception of the knee joint using a meta-analysis. METHODS:We retrieved randomized control ed studies on arthroscopic ACL reconstruction with remnant preservation or not from 2001 to 2016. Meta-analysis was used to compare postoperative threshold to detection of passive motion (TTDPM), passive angle regeneration test, joint position sense and KT-1000/2000, IKDC, and Lysholm scores between remnant preservation or not. RESULTS AND CONCLUSION:(1) A total of 11 randomized control ed trials were included. (2) The meta-analysis results showed that postoperative TTDPM [OR=-0.50,95%CI(-0.74,-0.26), P<0.0001], passive angle reproduction [OR=-0.13, 95%CI(-0.26,-0.01), P=0.03<0.05] and Lysholm scores [OR=1.25, 95%CI(0.63, 2.06), P=0.0002], IKDC scores (OR=1.28, 95%CI([0.27, 2.28], P=0.01] in preserving-remnant were superior to removing-remnant for arthroscopic ACL reconstruction. However, there were no statistical y significant differences in KT1000/2000 scores [OR=-0.05, 95%CI(-0.13, 0.03), P=0.24] and joint position sense [OR=-0.30, 95%CI(-0.79, 0.18), P=0.22]. (3) In the arthroscopic ACL reconstruction, retained stump postoperative proprioception recovered wel and can obtain satisfactory clinical effect. However, prospective large-sample long-term randomized control ed trials are needed for verification.

Aim To detect the effect of Bio on impro-ving insulin resistance and explore its molecular mech-anism. Methods The HepG2 liver cells were derivat-ed by high concentration insulin to establish the insulin resistance cell model, and the cells were intervened by Bio. The glucose consumption was measured by glu-cose oxidase and peroxidase ( GOD-POD) assay. The expression of PPARγmRNA was detected by RT-PCR. The expression of PPARγ protein was detected by Western blot method. Results The glucose consump-tion was significantly decreased in the insulin resist-ance cells after incubated with 1 . 72 × 10 -5 mol · L-1 insulin ( P<0. 05 ) . 10 -5 ,10 -6 ,10 -7 mol · L-1 Bio increased the glucose consumption 135%,62%,39%separately in the insulin resistance cells. RT-PCR a-nalysis of PPARγ showed that Bio raised the PPARγmRNA. Western blot analysis displayed that the pro-tein of PPARγ with Bio was increased. Conclusion Bio can improve the insulin resistance of the HepG2 cells, and the molecular mechanism may be relevant with raising PPARγ expression.

Objective Proximal humerus fracture is the most common upper-arm osteoporotic fracture in elderly patients and the result of treatment directly affects the physiological function of the shoulder .This article discusses the clinical effect of the locking proximal humeral plate ( LPHP) combined with anti-osteoporosis drugs in the treatment of osteoporotic comminuted proximal humerus fractures in elderly patients . Methods This study included of 47 elderly osteoporotic patients with comminuted proximal humerus fractures treated from April 2009 to March 2012 and with complete follow-up data.According to the Neer classification , the patients were divided into groups A (LPHP treatment, n=23, including 13 cases of three-part fractures and 10 cases of four-part fractures) and B (LPHP+anti-osteoporosis drugs, n=24, including 13 cases of three-part fractures and 11 cases of four-part fractures). Results All the patients were followed up for 14 to 38 (mean 23.6) months.The postoperative healing time was significantly shorter in group B than in group A ([96.57 ±2.59]d vs [115.91 ±2.73]d, P<0.05), and the excellence rate was remarkably higher in B than in A (91.7%vs 78.3%,P<0.05). Conclusion With the advantages of short healing time and high excellence rate , LPHP+anti-os-teoporosis drugs is superior to simple LPHP in the treatment of osteoporotic comminuted proximal humerus fractures in elderly patients.

Objective To investigate the characteristic and the value of renal solid lesions' boundary at contrast-enhanced ultrasonography(CEUS). Methods The study included 225 patients (124 males, 101 females) with renal 239 solid lesions [133 renal cell carcinoma(RCC) and 106 benign lesions]. The enhanced mode of lesion boundary at CEUS was observed. The histopathologic pseudocapsule of RCCs was analysed.Results Enhanced modes of all lesions' boundary at CEUS were classified as: type Ⅰ , iso-enhanced boundry in whole phase, 82.85 % (198 of 239) ;type Ⅱ , a perilesional annular highly-enhanced signal at early phase,4.18% (10 of 239);type Ⅲ ,perilesional annular highly-enhanced signal in whole phase,9.62% (23 of 239) ;type Ⅳ, perilesional annular highly-enhanced signal in midium and late phase, 1.25 % (3 of 239) ;type Ⅴ ,iso-enhanced boundry in the mdium and late phase with no enhancment at early phase, 2. 09% (5 of 239). The distribution of types Ⅰ , Ⅱ , Ⅲ between groups were significant different( P=0.000, 0.046,0. 000), the type Ⅳ and Ⅴ was not ( P = 0.256,0.068). The distribution of perilesional annular highlyenhanced signal between benign and RCC groups was statistically different (x2=29. 681, P=0.000).Regared it as a diagnostic criteria of RCC,the sensitivity was 26.32% (35/133) ,the specificity was 99.06%(105/106) ,the positive predictive value was 97.22% (35/36),the negative predictive value was 51.72%(105/203) ,and the accuracy was 58.58% (140/239). The perilesional annular highly-enhanced signal was not correlated with the pseudocapsule in pathology ( P = 1. 000). Conclusions The boundary enhancement mode of renal solid lesions at CEUS was divided into five types. The perilesional annular highly-enhanced signal was important in diagnosis of RCC,which was not correlated with the pseudocapsule in pathology.

To study xanthones from the barks of Garcinia xanthochymus, the constituents were isolated by normal-phase and reverse-phase silica gel column chromatography from the EtOAc extract. Their structures were elucidated by spectral analysis. Three new xanthones were purified and identified as 1,2,5-trihydroxy-6-methoxyxanthone (1), 1,4,6-trihydroxy-5-methoxyxanthone (2), 1,2,7-trihydroxy-4-( 1,1-dimethylallyl) xanthone (3).