Objective To investigate the change of the intestinal permeability,the expression level of intestinal trefoil factor (ITF) mRNA and the relationship between them after total body irradiation (TBI),and explore the effect of TBI on the development of intestinal permeability and the expression level of ITF mRNA.Methods Twenty two BALB/c mice were randomly divided into 4 equal groups: 3 groups at 4,8 and 12 d after TBI with the total dose of 8.0 Gy and the dose rate of 1.0 Gy/min respectively,and a control group.Lactulose (L) and mannitol (M) were perfused into the esophagus before the experiment and urine samples were collected.Liquid chromatography was used to measure the L/M excretion ratio in the urine samples collected 4,8,and 12 days after the TBI.And then the mice were killed with their intestine were taken out.The expression of ITF mRNA in the jejunum tissue was detected by real-time fluorescence quantitative PCR.Results The urine L/M ratio levels of the groups 4,8 and 12 days after TBI were (0.5092 ± 0.0352),(0.7174 ± 0.0116),and (0.7295 ± 0.0533) respectively,all significantly higher than that of the control group [(0.2908 ± 0.0533),F = 321.47,P ＜ 0.05].The ITF mRNA expression levels of groups 4,8 and 12 days after TBI were (0.78612 ±0.1428),(0.2521 ±0.1223),and (0.2306 + 0.0221 ) respectively,all significantly lower than that of the control group [( 1.3498 + 0.0476),F = 235.71 ,P ＜ 0.05].The urine L/M ratio was significantly negatively correlated with the expression of ITF mRNA in all TBI groups (r = - 0.985,P ＜ 0.01 ).Conclusions The intestinal permeability increases and the expression level of ITF mRNA decreases after TBI.The urine L/M ratio is negatively correlated with the expression level of ITF mRNA after TBI.ITF is involved in protection against intestinal permeability induced by TBI.

Objective To investigate the potential mechanism of intestinal trefoil factor(ITF)against methotrexate (MTX)- induced injury in intestinal mucosa. Methods Cultured IEC-6 cells were divided into groups as follows: blank group, MTX treated group, ITF treated group and experimental group treated with gradient concentrations of ITF plus MTX. Expression of E-cadherin mRNA was determined by Real-Time polymerase chain reaciton (RT- PCR). The activity of matrix metalloproteinase(MMP)-2 and MMP-9 was measured by gelatin zymogramphy. Caspases-3 activity was measured by colorimetric assay. Cell proliferation was assessed by cell counting kit-8 (CCK-8)assay. Migration of IEC-6 in vitro was observed using modified Boyden chamber assay. Results The expression of E-cadherin mRNA in experimental group (treated with 0.1 mg/ml or 1 mg/ml of ITF) was significantly down-regulated (0. 538±0. 109 or 0. 528±0. 132, respectively) in comparison with MTX treated group (0. 763±0. 139) with significant difference (P=0. 021 or P=0. 025, respectively). There was no significant difference in activity of MMP-2 and MMP-9 among groups (P＞0. 05). When compared with MTX treated group (0. 090 ±0. 011 ), the activity of Caspase3 in experimental group (treated with 0. 1 mg/ml or 1 mg/ml of ITF) was significantly decreased (0. 077±0. 009, P=0. 032 or 0. 044±0. 009,P=0. 005, respectively). There was no statistical difference in cell proliferation between experimental group (treated with 1 μg/ml, 0.01 mg/ml, 0. 1 mg/ml or 1.0 mg/ml of ITF) and MTX treated group (P=0. 132,0. 150,0. 114 or 0. 367, respectivley). More migratory cells attached to the bottom surface of the membrane in experiment group (treated with 0. 1 mg/ml or 1 mg/ml of ITF) in comparison with MTX treated group (P ＜0. 001 ). Moreover, more migratory cells were found in experimental group treated with 1.0 mg/ml of ITF than those in group treated with 0. 1 mg/ml of ITF (P＜0. 001). Conclusions Without cell proliferation, the protective effect of ITF is related to its functions of promoting cell migration and inhibiting cell apoptosis, which may down-regulate expression of E-cadherin mRNA.

Objective To explore the effect of amifostine combined with low-dose cyclosporine in treatment of refractory immune thrombocytopenia effect and related mechanisms.Methods 60 cases of refractory immune thrombocytopenia patients using parallel randomized controlled groups, divided into three groups, 20 cases in each group, amifostine group were treated with amifostine, cyclosporine group were treated with cyclosporine, amifostine+CSA group received amifostine+cyclosporine A treatment.The platelet count, platelet membrane glycoprotein antibody, lymphocyte subsets and bone marrow megakaryocyte count were observed and compared.Results After different treatment of three, six months, the level of platelet count of patients in three groups were compared with the group before treatment were significantly increased, and the treatment of platelet count level of amifostine group and cyclosporine group were significantly lower than that of amifostine +CSA group, the difference was statistically significant (P<0.05), there was no significant difference between amifostine group and cyclosporine group.The total efficacy of amifostine+CSA group was significantly higher than the other two groups, the difference was statistically significant ( P<0.05 ) , there was no significant difference between amifostine group and cyclosporine group.After the treatment, the platelet membrane glycoprotein GPIIb/IIIa antibody levels in three groups were significantly increased, and ring the detection level of amifostine+CSA group after treatment was significantly higher than the other two groups, the difference was statistically significant (P<0.05), there was no significant difference between amifostine group and cyclosporine group.After treatment, the three groups of CD4 +, CD4 +/CD25 +and CD4 +/CD8 +levels were significantly increased, CD8 +decreased significantly, the difference was statistically significant (P<0.05).And the level of change after treatment with amifostine +cyclosporine group was significantly higher than that of the other two groups, the difference was statistically significant (P<0.05), there was no significant difference between amifostine group and cyclosporine group.After treatment, the number of bone marrow megakaryocytes in the three groups was significantly lower than that before treatment , the level of count after treatment with amifostine +cyclosporine was significantly lower than that of the other two groups, the difference was statistically significant (P<0.05).there was no significant difference between amifostine group and cyclosporine group.The adverse reactions of amifostine group and amifostine+CSA group were significantly lower than that in cyclosporine group, the difference was statistically significant (P<0.05).there was no significant difference between amifostine group and amifostine+CSA group.Conclusion Amifostine combined with low dose of cyclosporine in treatment of refractory immune thrombocytopenia can play a synergistic effect, improve the therapeutic effect, and effectively reduce the dosage and adverse reactions.

RBRVS assessment system has been carried out in hospital performance management,which meets the needs of the reform of public hospitals and hospital fine management.The one year practice at the hospital has built a new model of performance management based on the RBRVS assessment system.Calculation of the RVS point values and CF values of the operations and determination of such indexes as the indirect workload reference coefficient of the grades,will yield the amount of the performance bonus of individual departments and posts.The new model proved effective in improving staff incentives and efficiency,saving human resource cost and controllable materials.However,its design and implementation is a complex systematic engineering in need of measures suited to local conditions and steady progress.

Clinical data of 153 patients with multiple myeloma admitted from January 2005 to December 2015 were retrospectively reviewed,including 56 cases complicated with herpes zoster (case group) and 97 cases without herpes zoster (control group).The risk factors for herpes zoster in multiple myeloma patients were analyzed by univariate and multivariate logistic regression.Univariate analysis showed that herpes zoster significantly associated with albumin/globulin ratio (A/G) ＜ 0.5 (x2 =10.989,P ＜0.05),unremitted myeloma(x2 =12.310,P ＜ 0.05),neutropenia (x2 =8.100,P ＜ 0.05) and treatment with bortezomib(x2 =9.465,P ＜ 0.05).Multivariate logistic regression analysis showed that herpes zoster was positively correlated with A/G ＜ 0.5 (OR =6.344,95％ CI:1.511-26.645,P ＜ 0.05),neutropenia (OR =6.402,95％ CI:1.420-28.869,P ＜ 0.05),treatment with bortezomib (OR =7.335,95％ CI:1.587-33.911,P ＜ 0.05);and negatively correlated with remitted myeloma (OR =0.064,95％ CI:0.017-0.237,P ＜ 0.05).It is necessary to take corresponding countermeasures targeting the risk factors to prevent herpes zoster in multiple myeloma patients.

Objective:To explore the influencing factors of concurrent infection in elderly patients with malignant lymphoma undergoing chemotherapy, construct a risk prediction model and verify its effectiveness.Methods:A total of 92 elderly patients with malignant lymphoma admitted to Department of Hematology in the First Affiliated Hospital of Wenzhou Medical University from January 2019 to August 2021 were selected as the research objects by the convenient sampling method. The age, gender, nutritional risk, activities of daily living (ADL), comorbidities, occurrence of infection, treatment time and prognosis of the patients were collected. The independent risk factors for concurrent infection in elderly patients with malignant lymphoma undergoing chemotherapy were analyzed, and the risk prediction model and line graph were constructed for internal validation by Bootstrap.Results:Logistic regression analysis showed that ADL score, nutritional screening score and Charlson's Weighted Index of Comorbidities (CCI) score were independent risk factors for concurrent infection in elderly patients with malignant lymphoma undergoing chemotherapy ( P<0.05). The prediction model of concurrent infection in elderly patients with malignant lymphoma undergoing chemotherapy was established, namely Z=0.983×CCI score +1.075× nutritional screening score +0.645×ADL score -5.115. The C-index of the prediction model nomogram was 0.785 [95% CI (0.692-0.879) ], indicating good differentiation. According to the correction curve verified internally by Bootstrap, the absolute error of the possibility prediction of the nomogram model was 0.028, which was in good consistency. Conclusions:The risk prediction model of concurrent infection in elderly patients with malignant lymphoma chemotherapy is constructed based on ADL score, nutritional screening score and CCI score, which are easy to obtain and evaluate, and the nomogram of the prediction model is established with good differentiation and consistency.

Objective: To investigate the role of momordica protein MAP30 in multiple myeloma (MM) and the possible mechanism. Methods: Human myeloma RPMI-8226, NCI-H929 and U266 cells were treated with MAP30 at different concentration (1-10 μmol/L) and then the proliferation rates of cells were detected by CCK-8 assay.Annexin V/PI flow cytometry was used to evaluate the apoptosis rate of myeloma cells, and the expressions of apoptosis-related protein (PARP), autophagy-related proteins (LC3II, P62) andAkt/mTOR pathway-related proteins in multiple myeloma cells were also detected via Wb. The changes in cell proliferation, apoptosis and autophagy after the treatment of MAP30 combined with autophagy agonist rapamycin (Rap) or autophagy inhibitor bafilomycin (Baf) were observed by CCK-8, flow cytometry and Wb, respectively. Results: MAP30 (1-10 μmol/L) inhibited the proliferation of myeloma cells in a time- and dose-dependent manner (P<0.05 or P<0.01). With MAP30 acting on myeloma cells alone, the apoptosis and autophagy of MM cells, as well as the expression of PARP cleavage and LC3II increased while the expression of P62 decreased significantly (all P< 0.05 or P<0.01). After being treated with MAP30+Baf, compared with MAP30 treatment alone, the cell proliferation was remarkably enhanced while cell apoptosis and cell autophagy were suppressed, besides, the expression of PARP cleavage and LC3II were decreased and P62 level was augmented (all P<0.05 or P<0.01). Conversely, after being treated with MAP30+Baf, compared with MAP30 treatment or Baf treatment alone, cell proliferation and P62 level were reduced, while apoptosis and autophagy as well as the expressions of PARP cleavage and LC3II level were increased (all P<0.05 or P<0.01). The expressions of p-AKT and p-mTOR were significantly reduced with the effect of MAP30 on myeloma cells (all P<0.05). Conclusion: MAP30 can promote the apoptosis and autophagy of myeloma cells throughAKT/mTOR pathway, which may provide a new therapeutic strategy for treatment of multiple myeloma.

Objective:To further improve the understanding of paroxysmal nocturnal hemoglobinuria (PNH), we retrospectively analyzed and summarized the clinical characteristics, treatment status, and survival status of patients with PNH in Zhejiang Province.Methods:This study included 289 patients with PNH who visited 20 hospitals in Zhejiang Province. Their clinical characteristics, comorbidity, laboratory test results, and medications were analyzed and summarized.Results:Among the 289 patients with PNH, 148 males and 141 females, with a median onset age of 45 (16-87) years and a peak onset age of 20-49 years (57.8% ). The median lactic dehydrogenase (LDH) level was 1 142 (604-1 925) U/L. Classified by type, 70.9% (166/234) were classical, 24.4% (57/234) were PNH/bone marrow failure (BMF), and 4.7% (11/234) were subclinical. The main clinical manifestations included fatigue or weakness (80.8%, 235/289), dizziness (73.4%, 212/289), darkened urine color (66.2%, 179/272), and jaundice (46.2%, 126/270). Common comorbidities were hemoglobinuria (58.7% ), renal dysfunction (17.6% ), and thrombosis (15.0% ). Moreover, 82.3% of the patients received glucocorticoid therapy, 70.9% required blood transfusion, 30.7% used immunosuppressive agents, 13.8% received anticoagulant therapy, and 6.3% received allogeneic hematopoietic stem cell transplantation. The 10-year overall survival (OS) rate was 84.4% (95% CI 78.0% -91.3% ) . Conclusion:Patients with PNH are more common in young and middle-aged people, with a similar incidence rate between men and women. Common clinical manifestations include fatigue, hemoglobinuria, jaundice, renal dysfunction, and recurrent thrombosis. The 10-year OS of this group is similar to reports from other centers in China.