Proteasome inhibitor bortezomib has a very powerful anti-myeloma effect on both preclinical and clinical trails.it has been widely used in the treatment of newly diagnosed,refractory and relapse multiple myeloma.Its side effects were well tolerant and manageable.

2014 International Myeloma Working Group (IMWG) summit was held in Milan at June 2014.During this meeting,the criteria of asymptomatic and symptomatic multhiple myeloma was revised.No benefit was shown with conventional treatment for asymptomatic patients.Frontline therapy in newly diagnosed multiple myeloma,also in elderly patients was discussed.Individualized treatment,especially for genetic risk stratification should be done,but randomized control studies needed to be done to confirm its feasibility.

Objective To assess the role of combined use of laparoscopy with diagnostic peritoneal lavage (DPL) in the diagnosis of abdominal stab injury (ASI). Methods From March 2005 to June 2010,21 cases of abdominal and thoracoabdominal stab injuries were analyzed retrospectively.All the cases were diagnosed laparoscopically first.If no significant injury was detected,1 000 ml of normal saline was infused through the abdominal trocar into the peritoneal cavity and routine/regular study on RBCs,WBC,amylase and bile of the effluent fluid was made. ResultsLaparoscopic diagnosis was positive in five cases,including two cases of diaphragmatic injuries,one traumatic bleeding of liver capsule,one small intestinal perforation and one stomach wall perforation.Laparoscopic diagnosis was negative in 16 cases,of which two were detected as intestinal perforation and repaired by laparotomy.The operation time was (120 ± 35.6) min and the hospital stay was (5.3 ± 3.4) d.There were no major complications after operation. Conclusion Combining the visual advantage of laparoscopy with the sensitivity and specificity of DPL can effectively improve the diagnosis of ASI.

Objective To evaluate the effectiveness of UV-B radiat io n exclusively on a variety type of leukoderma .Methods In open trail, 45 cases of a variety of leukoderma were randomly selected including preg nant striates (20 cases), stretch marks (1 case), postoperative petechia (4 case s), traumatic petechia (10 cases), radiation petechia (2 cases), generalized vit iligo (6 cases) and leukoderma with unknown cause (2 cases) were treated with Re lume UV-B re-pigmentation generator (photo range 290-320 mm), once per week with an adjusting dose for 3-20 treatments. Results 42 cases c ompleted with followed-up after 14 months of UV-B radiation microphototherapy. 64.3% (27 cases) achieved excellent results, including 10 cases of pregnant str iates, 8 cases of traumatic petechia, 4 cases of postoperative petechia and 5 c ases of peneralized vitiligo. 28.6% patients were satisfied with results (12 ca ses), including 7 cases of pregnant striates, 1 case of traumatic petechia, 1 c ase of generalized vitiligo, 1 case of stretch mark and 2 cases of leukoderma wi th unknown causes. 7.1% (3 cases) had no effect. 33.3% (14 cases) required suppl emental treatment after 2-5 months of the initial therapy. Conclusion The UV-B radiation microphototherapy is effective in restoring pigmenta tion in those affected by a variety of leukoderma except radiation petechia. The result of repigmentation is related to the type of leukoderma.

Many complex symptoms are observed in multiple myeloma and the most common symptom is bone damage, decreased renal function, increased infection susceptibility, anemia and peripheral neuropathy. Moreover some patients have other accompanying disease, such plasmacytoma and amyloidosis.Symptoms in multiple myeloma are the important basis for initiating anti-myeloma therapy. This paper is to review the pathophysiology of the complication of multiple myeloma and its treatment.

Recent studies have shown that multiple myeloma (MM) is preceded by a premalignant state called monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM).Some of the genetic changes of MM are also present in MGUS and SMM,including chromosomal translocations,copy number changes,somatic mutations and so on.This article discusses the genetic heterogeneity.

The immunomodulatory drugs (IMiD) thalidomide and lenalidomide,and the proteasome inhibitor (PI) bortezomib have dramatically improved clinical outcomes for patients with relapsed/refractory multiple myeloma(MM).But a part of patients become refractory or intolerant to these agents.Numerous agents are currently in clinical development,including new IMiD (pomalidomide),new PI (eg,carfilzomib,MLN9708,and marizomib),histone deacetylase inhibitors (eg,panobinostat and vorinostat) and signal transduction modulators (eg,perifosine),and have demonstrated promising anti-myeloma activity in patients with relapsed/refractory MM,particularly in those who are refractory to approved novel agents.This article describes antimyeloma agents currently available or in clinical development for relapsed/refractory patients.

The 48th annual meeting of the American Society of Clinical Oncology (ASCO) was held in Chicago from June 1-5 2012 and the risk-adapted therapy of multiple myeloma (MM) was discussed.MM is a heterogeneous disease and all patients should be accepted risk-adapted therapy. According to cytogenetic abnormalities, MM patients are divided into three groups,standard risk, intermediate risk and high risk.Patients with standard risk may received 4 cycles Rd regimes (lenalidomide plus low dose dexamethasone) or VCD regimes (bortezomib,cyclophosphamide,dexamethasone) for induction therap.Patients with intermediate risk may received 4 cycles VCD regimes for induction therapy.Patients with high risk may received 4 cycles VRD regimes (bortezomib,lenalidomide,dexamethasone) for induction therapy.After induction treatment,patients can received autologous hematopoietic cell transplantation or consolidation/maintenance therapy. The determination of which patients are eligible for autologous hematopoietic cell transplantation according age,comorbidities and performance status.

Multiple myeloma is a malignancy of plasma cells and renal function impairment is one of common complications of multiple myeloma.Light-chain deposition in renal tubules which induces renal tubular disease is the major pathogenesis of renal impairment.The renal function impairment should be estimated based on glomerular filtration rate in multiple myeloma patients. Bortezomib with high-dose dexamethasone is effective to myeloma patients with renal impairment and improves renal function.Treatment experience of thalidomide is limited,but it can be used at the standard dosage to patients with renal failure.Lenalidomide is effective and can reverse renal impairment of several myeloma patients when this agent is used at reduced doses according to renal function.

Objective To understand the cause and pathogenesis,clinical and pathological features,diagnosis,treatment and prognosis of Casdeman's disease (CD). Methods One patient with CD which has transformed into Hodgkin's lymphoma in the end was analysed and the review were included. Results Castleman' s disease was a lymphoproliferative disorder with benign hyperplastic lymphnodes histologically characterized by follicular hyperplasia and capillary proliferation with endothelial hyperplasia. Based on the characteristic of pathology it was subdivided into three subtypes, hyaline vascular variant, plasma cell variant and mixed variant. The clinical manifestation of CD was multiplicity,including the lymphadenectasis and the involvement of the muhisystem of the body. The early diagnosis was depended on the histopathology,and the different histopathology has the distinct prognosis. The prognosis of local Castleman's disease (LCD) was good but the muhicentric Casdeman's disease (MCD) was poor. Conclusion The different histopathology of CD were determined according to the different clinical manifestations and prognosis.