Allogeneic stem cell transplantation (allo-HSCT) is probably the only treatment for multiple myeloma (MM) with a curative potential.However,the application of allo-HSCT is limited by the high transplant-related mortality (TRM).Although the introduction of reduced intensity conditioning (RIC) has lowered the TRM associated with myeloablative conditioning,there is no improvement in survival of allo-RIC compared to autologous stem cell transplantation (auto-HSCT).New strategies are discussed with the aim of lowering transplant toxicity and boosting the graft-versus-myeloma effect,and these are urgently needed to make allo-RIC safer and more effective for myeloma patients.In this review,results from studies of allo-HSCT in MM are presented.

For transplantation-eligible multiple myeloma patients,induction treatment of triple drug regimens followed by the collection of hematopoietic stem cells is generally recommended.For transplantationeligible patients,high-dose melphalan remains the standard regimen.Consolidation after transplantation has shown an improvement in response rates.Maintenance therapy with bortezomib or lenalidomide (or both in very-high-risk patients) is a reasonable option for long-term disease control and improvement in overall survival.Application of new agents into therapy of multiple myeloma should result in improved outcomes and long-term disease control.

Objective To evaluate the decompression performance of anti pressure ulcer cushions with different materials and structures. Methods The common cotton cushion, sponge cushion, 3D fabric cushion, and upper 3D fabric and lower sponge cushion were analyzed by XSensor pressure sensor testing system. The pressure distribution, the pressure peak and the average pressure were analyzed to compare the decompression performance and the comfortable capability. Results and Conclusion The upper 3D fabric and lower sponge cushion can en-sure the decompression performance with excellent permeability. Both decompression and air comfort permeability should be the future di-rection of ulcer cushions research and production.

Objective To explore the expression and its clinical significance of immunoglobulin G4 (IgG4) in inflammatory bowel disease (IBD) by detecting the expression of IgG4 in the serum and intestinal mucosa of patients with IBD.Methods From March 2015 to August 2016,68 patients with ulcerative colitis (UC),132 patients with Crohn's disease (CD) and 52 healthy controls were collected.The serum levels of IgG4 were detected by immunonephelometry.The expression of IgG4 in intestinal mucosa was analyzed by immunohistochemistry.Five high power fields (HPF) were randomly selected in each specimen.C-reaction protein (CRP) and erythrocyte sedimentation rate (ESR) of patients with UC,patients with CD and healthy controls were detected.The extent of disease,clinical type,disease activity scores (UC scored by Mayo score system,CD scored by Crohn's disease activity index (CDAI)) and current treatment were collected.The correlation between IgG4 expression and CRP,ESR,Mayo score and CDAI were analyzed.Independent sample t test,Chi square test and Pearson's correlation were performed for statistical analysis.Results The results of immunonephelometry indicated that the serum levels of IgG4 of patients with UC,CD and healthy controls were (0.79±-0.61),(0.69±0.59) and (0.41±0.32) g/L,respectively;all were lower than standard level 1.35 g/L.The results of immunohistochemistry revealed that the number of IgG4 positive cells in the colonic mucosa of active UC and CD patients were higher than that of healthy controls ((15.42±12.47)/HPF,(18.65±12.46)/HPF and (4.71±4.14)/HPF),and the differences were statistically significant (t=5.392 and 8.450,both P＜0.05).There was no statistically significant difference in mucosal IgG4 expression between UC,CD patients at remission phase and healthy controls ((4.72±4.23)/HPF,(5.30±4.87)/HPF and (4.71±4.14)/HPF,both P＞0.05).There was no statistically significant difference in mucosal IgG4 expression between UC and CD patients at active phase and remission phase (both P＞0.05).The case number of active patients,CRP,ESR and Mayo scores of IgG4 positive UC patients were all higher than those of IgG4 negative group(x2 =5.499,t=2.811,3.471 and 4.676;all P＜0.05).The number of active patients,CRP,ESR and CDAI of IgG4 positive CD patients were all higher than those of IgG4 negative group(x2 =4.341,t=3.842,3.892 and 2.935,all P＜ 0.05).In UC patients,the number of IgG4 positive cells was positively correlated with CRP,ESR and Mayo scores (r=0.382,0.381 and 0.470;P=0.001,0.003 and P＜0.01).The number of IgG4 positive cells was positively correlated with CRP,ESR and CDAI in CD patients (r=0.199,0.209 and 0.201;P=0.022,0.016 and 0.021).Conclusions The expression level of IgG4 significantly increased in the intestinal mucosa of IBD patients correlated with the activity of disease.The expression level of [gG4 may be one of the parameters to evaluate the activity of IBD.

Objective To evaluate the effect of dexmedetomidine postconditioning combined with limb ischemic postconditioning on myocardial ischemia-reperfusion (I/R) injury in rats.Methods Fifty male Sprague-Dawley rats,aged 2-3 months,weighing 275-335 g,were randomly divided into 5 groups (n =10 each) using a random number table:sham operation group (group S);I/R group;dexmedetomidine postconditioning group (group DP);limb ischemic postconditioning group (group LP);dexmedetomidine postconditioning combined with limb ischemic postconditioning group (group DLP).Myocardial I/R was induced by occlusion of the left anterior descending branch of coronary artery for 30 min followed by 180 min reperfusion.At 15 min before reperfusion,dexmedetomidine 50 μg/kg was injected intraperitoneally in DP and DLP groups,while normal saline 0.5 ml was injected intraperitoneally in I/R and LP groups.In LP and DLP groups,the animals underwent 10 min ischemia of bilateral hind limbs starting from 10 min before reperfusion,followed by reperfusion.Blood samples were taken from the internal carotid artery at 180 min of reperfusion for determination of the plasma creatine kinase-MB (CK-MB) and glutathione peroxidase (GSH-Px) activities and the concentrations of cardiac troponin I (cTnI),malondialdehyde (MDA),interleukin-1beta (IL-1β),IL-6 and tumor necrosis factor-alpha (TNF-α).Myocardial specimens were obtained at 180 min of reperfusion for determination of the myocardial infarct size.Results Compared with group S,the plasma CK-MB activity,myocardial infarct size and plasma cTnI,MDA,TNF-α,IL-1β and IL-6 concentrations were significantly increased,and GSH-Px activity was significantly decreased in I/R,DP,LP and DLP groups (P＜0.05).Compared with group I/R,the plasma CK-MB activity,myocardial infarct size and plasma cTnI,MDA,TNF-α,IL-1β and IL-6 concentrations were significantly decreased,and the GSH-Px activity was significantly increased in DP,LP and DLP groups (P<0.05).Compared with DP and LP groups,the plasma CK-MB activity,myocardial infarct size and plasma cTnI,MDA,TNF-α,IL-1β and IL-6 concentrations were significantly decreased,and the GSH-Px activity was significantly increased in group DLP (P ＜ 0.05).Conclusion Dexmedetomidine postconditioning combined with limb ischemic postconditioning provides better efficacy than either alone in reducing the myocardial I/R injury in rats,and the mechanism may be related to the inhibition of lipid peroxidation and systemic inflammatory responses.

Stem cells are those with long-term self-renewal and produce differentiated cells at least one end of the cell capacity. Stem cell transplantation can be used for the treatment of many kind of liver diseases which includes acute liver failure, inherited metabolic liver diseases, as well as end-stage liver disease. This Article summarizes the types of stem cell types applied for treatment of liver diseases, stem cell tracing technology, as well as the clinical application of stem cells. It also discusses the problems existed and the research focus.

OBJECTIVETo explore the relationship between continuous thrombocytopenia and sepsis in patients with severe burns.

METHODSClinical data of 148 severely burned patients admitted to our,two burn centers from January 2007 to December 2011 and conforming to the study criteria were retrospectively analyzed. All patients were divided into sepsis group (n =44) and non-sepsis group (n = 104) according to the presence or absence of sepsis within post burn day (PBD) 30. The data of age, gender, total burn area, full-thickness burn area, fluid infusion volume within post burn hour (PBH) 24, plasma concentration of calcium ion on PBD 1, plasma concentration of albumin on PBD 1, platelet count on PBD 1, acute physiology and chronic health evaluation (APACHE) II score on admission, the presence or absence of hypovolemic shock or inhalation injury on admission, the presence or absence of disseminated intravascular coagulation (DIC) within PBH 48, operation or no operation within PBD 3, thrombocytopenia duration within PBD 10, and mortality were statistically compared between two groups to screen the independent risk factors of sepsis. Data were processed with t test, chi-square test, single factor Logistic regression analysis, and multi-factor Logistic regression analysis.

RESULTSBetween two groups, there were statistically significant differences in total burn area, full-thickness burn area, plasma concentration of calcium ion on PBD 1, plasma concentration of albumin on PBD 1, APACHE II score on admission, presence or absence of hypovolem- ic shock on admission, presence or absence of inhalation injury on admission, presence or absence of DIC within PBH 48, and mortality (with t values from 2.433 to 4.082, χ2 values from 8. 818 to 31.528, P < 0.05 or P < 0.01). Furthermore, the duration of thrombocytopenia within PBD 10 in sepsis group was (5.2 ± 2.4) d, which was significantly longer than that in non-sepsis group [(2.9 ± 1.9) d, t =6. 189, P <0.01]. There were no statistically significant differences in the other indexes between two groups (with t values from 0.971 to 1. 250, χ2 values respectively 0. 054 and 1.529, P values above 0.05). Single factor and multi-factor Logistic regression analysis indicated that APACHE II score on admission and duration of thrombocytopenia within PBD 10 were closely related to occurrence of sepsis (with odds ratio respectively 1. 140 and 1.569, P values below 0.01).

CONCLUSIONSDuration of thrombocytopenia within PBD 10 is one of the risk factors for sepsis in severely burned patients, which can reflect pathophysiological changes in the body, thus providing predictive value for the occurrence of sepsis.

Aged ; Albumins ; Burn Units ; Burns ; blood ; complications ; diagnosis ; Humans ; Predictive Value of Tests ; Regression Analysis ; Retrospective Studies ; Sepsis ; blood ; etiology ; Shock ; blood ; etiology ; Thrombocytopenia

Objective:To analyze identify method of mild cognitive impairment. Methods:The Wechsler Adult Intelligence Scale-Chinese Revised (WAIS-RC) and Wechsler Memory Scale-Chinese Revised (WMS-RC) were examined in 150 patients with memory complaints. 63 individuals whose intelligence quotient (IQ) and memory quotient (MQ) over 85 were designated as normal elderly group;and 33 individuals whose IQ scores over 85 and MQ score between 70 and 84 as mild cognitive impairment(MCI-1) group; and 25 individuals whose IQ scores over 85 and MQ scores between 55 and 69 as MCI-2 group; 29 individuals whose IQ scores and MQ scores less than 85 and conformed with DSM-Ⅳ as Alzheimer disease group.Results: Picture short memory and mental control (B)showed the highest identification between the 2 MCI groups and normal elderly group. Besides, visual reproduction played an important role in mild memory decline (MCI-1) group. Tactile memory, logical memory and associated learning played an important role in moderate memory decline (MCI-2) group.Conclusion: Picture short memory and mental control (B) contribute to identify MCI speedily and effectively.

Objective:To assess clinical validity of the Chinese version of Mattis Dementia Rating Scale (DRS) in differentiating dementia of Alzheimer type (AD). Methods:Administered the DRS, mini-mental state examination (MMSE) and clinical dementia rating(CDR) to 61 outpatients with AD and 104 healthy elderly subjects in Shanghai.Results:There was significant correlation between DRS and the total score,and DRS and MMSE.DRS of the AD group had significant correlation with CDR.Its significant correlation with CDR suggested satisfactory concurrent validity of the scale. The optimal DRS cutoff score for AD according to education level revealed a sensitivity of 85%～94% and a specificity of 90%～94%.Conclusion:The DRS is a clinically valid test for the detection of AD and its severity of cognitive impairment.

Objective To investigate the clinical characteristics and therapy of acute perforation of gastric carcinoma(APGC) to improve the diagnosis,treatment and prognosis of APGC. Methods Forty cases of APGC admitted to Gong liao hospital of Zhenping county.Of the forty patients,ten underwent repair of perforation,twenty-one cases underwent palliative gastrectomy (six of them underwent lymphadenectomy three weeks after previous gastrectomy );five subjected to radical gastrectomy. two underwent gastrostomy or jejunostomy for nutrition.One underwent drainage and peritoneal lavage only;1 received non-operative therapy.Results Four patients died in this series.The 1-,2-,3-years survival rate was 83.3%(30/36),52.8%(19/36),27.8%(10/36)respectively. Conclusions Early diagnosis and adopting resection of gastric cancer plus comperhensive treatment can improve the prognosis of patients with APGC.