Objective To investigate the clinical characteristics of elderly patients with multiple myeloma and their prognostic factors.Methods 100 multiple myeloma patients with age≥ 60 years and 100 multiple myeloma patients with age <60 years who admitted in our hospital from December 2007 to December 2015 were collected as research subjects.100 patients with age ≥60 years were divided into elderly multiple myeloma group,100 cases with aged <60 years were divided into non -elderly multiple myeloma group.The clinical data and laboratory results of two groups were compared,the prognosis factors in elderly patients with multiple myeloma were analyzed.Results The incidence rate of ISS stage Ⅰ -Ⅱ in elderly multiple myeloma group (45.0%)was lower than non -elderly multiple myeloma group (60.0%),the incidence rate of stage Ⅲ was higher than non -elderly multiple myeloma group (χ2 =4.511,P <0.05).The infection incidence of elderly multiple myeloma group(30.0%)was higher than non -elderly multiple myeloma group(15.0%)(χ2 =10.452,P <0.05 ).The hemoglobin,serum albumin contents of elderly multiple myeloma group [(83.7 ±19.8)g/L,(27.89 ±6.87)g/L]were less than non -elderly multiple myeloma group[(92.1 ±22.5)g/L,(33.15 ±7.69)g/L](t =4.297,4.426,all P <0.05).The calcium content,the propor-tion of bone marrow plasma cells,serum creatinine and blood β-microspheres protein levels of elderly multiple mye-loma group [(2.51 ±0.41)mmol/L,(39.43 ±18.64)%,(182.24 ±125.47)μmol/L,(9.02 ±6.24)mg/L]were higher than non -elderly multiple myeloma group [(2.36 ±0.48)mmol/L,(37.45 ±19.86)%,(143.25 ± 116.43)μmol/L,(5.87 ±3.41)mg/L](t =5.945,4.196,4.375,4.264,all P <0.05).The median survival time of elderly multiple myeloma patients were significantly correlated with the patients'age,the proportion of plasma cells in bone marrow,blood β2 -microglobulin,albumin,and ISS staging (χ2 =4.125,3.254,8.542,5.748,9.244,all P <0.05).Conclusion The condition of elderly myeloma patients is more serious,age,proportion of plasma cells in bone marrow,blood β2 -microglobulin,albumin and ISS stage affect myeloma patients prognosis.

BACKGROUND: Educative instruction is good for the improvement of learning and behavior disorder in children with learning disorder. If this educative instruction were individualized, i. e. different education is provided for different individual, it would receive even better effects.OBJECTIVE: To explore the method and effect of educative instruction for children with learning disorder to accumulate experiences for the development of their learning potentials.DESIGN: A paired(pairing the subjects with similar age and learning disorder) case analysis based on the suffers .SETTING: A medical college of some university.PARTICIPANTS: Eight children with learning disorder were selected from Zhenjiang City Dongwu Kindergarten or Zhenjiang City Dagang Central Primary School. These 8 cases suffered from 4 types of disorders including clumsiness, seclusive personality, language disorder, and poor learning ability. Eight cases were randomly divided into education group and control group.METHODS: Cases of control group received normal educations without specific interventions. Cases of education group received individual customized educative instructions. The educative effects were observed after 3 months.MAIN OUTCOME MEASURES: The improvement of clumsiness, seclusive personality, language disorder or poor learning ability in children with learning disorder.RESULTS: Cases of education group had better psychological and behavior improvements than that of control group after individual educative instruction.CONCLUSION: Individual educative instruction for children with learning disorder is an effective approach for the development of their learning potentials.

Objective:To evaluate the efficacy and safety of hypomethylating agents (HMA) in patients with myelodysplastic syndromes (MDS) .Methods:A total of 409 MDS patients from 45 hospitals in Zhejiang province who received at least four consecutive cycles of HMA monotherapy as initial therapy were enrolled to evaluate the efficacy and safety of HMA. Mann-Whitney U or Chi-square tests were used to compare the differences in the clinical data. Logistic regression and Cox regression were used to analyze the factors affecting efficacy and survival. Kaplan-Meier was used for survival analysis. Results:Patients received HMA treatment for a median of 6 cycles (range, 4-25 cycles) . The complete remission (CR) rate was 33.98% and the overall response rate (ORR) was 77.02%. Multivariate analysis revealed that complex karyotype ( P=0.02, OR=0.39, 95% CI 0.18-0.84) was an independent favorable factor for CR rate. TP53 mutation ( P=0.02, OR=0.22, 95% CI 0.06-0.77) was a predictive factor for a higher ORR. The median OS for the HMA-treated patients was 25.67 (95% CI 21.14-30.19) months. HMA response ( P=0.036, HR=0.47, 95% CI 0.23-0.95) was an independent favorable prognostic factor, whereas complex karyotype ( P=0.024, HR=2.14, 95% CI 1.10-4.15) , leukemia transformation ( P<0.001, HR=2.839, 95% CI 1.64-4.92) , and TP53 mutation ( P=0.012, HR=2.19, 95% CI 1.19-4.07) were independent adverse prognostic factors. There was no significant difference in efficacy and survival between the reduced and standard doses of HMA. The CR rate and ORR of MDS patients treated with decitabine and azacitidine were not significantly different. The median OS of patients treated with decitabine was longer compared with that of patients treated with azacitidine (29.53 months vs 20.17 months, P=0.007) . The incidence of bone marrow suppression and pneumonia in the decitabine group was higher compared with that in the azacitidine group. Conclusion:Continuous and regular use of appropriate doses of hypomethylating agents may benefit MDS patients to the greatest extent if it is tolerated.