In recent years,considerable progress has been made in the treatment of multiple myeloma(MM).However,despite the current improved prognosis of this malignancy,it always ends in relapse and therefore new therapeutic approaches are urgently needed to overcome it.The chimeric antigen receptor(CAR)-T cells targeting B cell maturation antigen(BCMA),cluster of differentiation 19(CD19),cluster of differentiation 38(CD38) and kappa light chains have been evaluated,and have achieved remarkable results in clinical trials.However,even when MM is treated with CAR-T cell therapy,most patients eventually relapse,which is the greatest limitation of this therapy.This paperreviewedthe research progress,limitations and optimization of CAR-T cell immunotherapy in the treatment of MM.

Gefitinib and erlotinib are the first generation of targeted therapeutic agents approved for the treatment of advanced non-small cell lung cancer. Despite a dramatic initial response, most patients subsequently and ultimately become resistant to the drugs. Recent studies have proposed various mechanisms of such resistance, some of which related to a second mutation in epidermal growth factor receptor, aberrant activation of other tyrosine kinase receptors, bypassing signal pathways and constitutive activation of downstream signal molecules. Other researches also associated the drug resistance to internalization of epidermal growth factor receptor and changes in tumor microenvironment. Furture studies need to focus on overcoming or reversing resistance to the drugs and developing new targeted therapeutic agents.

Objective To interview the work feelings of the Middle youth patients with peritoneal dialysis. Methods Using the purposive sampling method, 11 patients were interviewed, and analyzed the content of the interview. After the interview, data were transcribed and extracted the keywords. Results Eight keywords were extracted, the patients had four positive feelings:self-perceived burden relived;more social support; more glad, negative feelings relived; peritoneal dialysis could be sure. 4 negative themes were extracted:tedious;had economic pressure;lack of self-realization;could not take the family burden. Conclusions Work can improve the living conditions of middle youth patients with peritoneal dialysis. More patients should be encouraged to return to work.

Objective To establish a HPLC method to determine the antiseptics in compound dexamethasone acetate cream and evaluate the usage rationality of antimicrobial preservatives. Methods The content of ethyl hydroxybenzoate was calculated by external standard with HPLC.The effectiveness of antimicrobial preservatives was measured according to the preservative effectiveness test in ChP(2015edition) by inoculating 5 kinds of test microorganisms including Pseudomonas aeruginosa,Escherichia coli,Staphylococcusaureus,Candida albicans and Aspergillusniger.Results The linear ranges of ethyl hydroxybenzoate was 6.63-132.6 μg/mL ( r =0.999 7 ) .The average recoveries was 99.2%.The samples from different batche had different antimicrobial effectiveness due to the content of ethyl hydroxybenzoate.Conclusion The described method can be used in the determination of the preservatives of ethyl hydroxybenzoate in compound dexamethasone acetate cream.At present the use of antibacterial agent is arbitrary, it is necessary to strengthen research and supervision.

A systematic comparative study ou the morphology and histology of the rhizomes of polygonatum including "Huangjing" and "Yuzhu" currently available on the Chinese market werepresented. The differences between this two types of herbal medicines were given.

Objective To explore the expression and clinical significance of chromogranin A (CgA) and synaptophysin (Syn) in gastroenteropancreatic neuroendocrine tumors (GEP-NET).MethodsThe data of sixty-six GEP-NET patients treated in the First Affiliated Hospital of Nanjing Medical University were collected between Jan.2003 and May 2009.The expression of CgA and Syn in the tissue of GEP-NET was detected by immunohistochemistry, and its association with clinicopathological characteristics and prognosis of GEP-NET were analyzed.Results In these 66 patients,the positive rate of Syn (87.9％,58/66) was higher than that of CgA (71.3％,47/66,x2 =5.63,P=0.02).CgA and Syn were simultaneously expressed in 64.6％ patients (42/66).In the tissues of GEP-NET,the expression of CgA was related with lymph node metastasis and TNM stages,not related with patients' gender,age,tumor location,function,degree of differentiation,tumor size,infiltration and distant metastasis. Syn was not related with all the above clinicopathological parameters.Three-year survival rate in CgA negative group (47％) was significantly lower than that in positive group (78％,x2 =0.00,P=0.01).ConclusionsSyn was more sensitive than CgA in the diagnosis of GEP-NET.CgA in some extent indicates the prognosis of GEP-NET.

Objective To analyse the cognitive dysfunction early after non-cardiac surgery in elderly. MethodsEighteen elderly patients undergoing selective non-cardiac surgery were investigated. General anesthesia was used in 11 patients and combined epidural-spinal anesthesia in 7 cases. The operations involved orthopedic, thoracic, abdominal and urologic surgeries. The patients were premedicated with phynoharbital 0. 1g and scopolamine 0. 3mg. Results All patients suffered from typical POCD that occurred during 1 to 3 days after operation. The symptoms were more severe at night. The patients with POCD were treated effectively with intravenous injection of midozolam and muscle injection of haloperidol in 15 cases. The symptoms of POCD were attenuated by injection of pethidine in 2 cases. One case had to be given intravenous infusion of propofol continually for 16 hours. All patients were cured without psychological complications before discharge Conclusion POCD is a common complication in the elderly and should be treated actively.

Objective To analyze the risk factors of metastasis and biological characteristics of patients with gastroenteropancreatic neuroendocrine tumor (GEP-NET).Methods One hundred and forty patients with neuroendocrine (NET) confirmed pathologically were collected between Jan.1993 and Mav 2009,and were divided into relative benign tumors or malignant tumors according to WHO prognostic criteria about GEP-NET.The clinicopathological parameters that related with metastasis of NETs were analyzed by univariate and Logistics regression methods,and the biological behavior characteristics was assessed further.Results GEP-NET showed a maximum incidence at age of 45-54 years for man and of 35-44 years for women.The onset of NET varied in age according to location of primary tumors(P<0.01).The onset age of patients with pancreas NET was lowest(42.92 years).The location that demonstrated the greatest incidence of GEP-NET was pancreas.The univariate analysis showed that gender,age,differentiation,location of primary tumors and maximum diameter of NETs were significantly associated with metastasis of GEP-NET(all P values<0.01).Logistic regression analysis revealed that the site,diameter and differentiation of tumor were the most important predictors for metastasis.The mean age of patients with malignant NET (54.78 years)was older than that of patients with relative benign NET (44.12 years,P<0.01).Conclusions The NET are more commonly found in pancrease.The location of primary tumor,diameter and differentiation of NET are important predictors for tumor metastasis.Poorly differetiated NET are common in patients with gastrointestinal NET or elderly NET patients.

Objective In order to provide a large quantity of retinal pigment epithelial cells (RPE cells) in vitro, we want to estab-lish method for culturing pig RPE cells. Methods RPE cells were separated with trypsin and cultured in vitro. The cells were identified by immunohistochemical staining with anti-human keratin and transmission electron microscope (TEM). Results Cultured RPE cells gradually presented transparent and fusiform shape. Immunohistochemical staining demonstrated that the cells were stained by anti-human keratin, and the cultured cells showed typical ultrastructure of RPE cells. Conclusion The cultured cells may be the foundation of pig RPE cells.

The role of serotonergic system in vasovagal syncope (VVS) has been more concerned.Serotonin is a kind of neurotransmitter which is widely distributed in central nervous system.There are kinds of serotonergic receptors on postsynaptic membrane,among which 5-HT1A receptors participate in the mechanism of central blood pressure depression and promote the release of hormones such as prolactin and adrenocorticotrophic hormone.Acute administration of selective serotonin reuptake inhibitors (SSRIs) during head-up tilt test (HUT) blocks the reuptake of serotonin in the synapse space and thus increases stimulation of the serotonin receptors,which induces syncope episode.Long-term administration of SSRIs downregulates the postsynaptic serotonergic receptors,thus it weakens the reaction to the rapid change of serotonin concentration, which results in rapid depression of sympathic nerves and prevention of syncope episode.These demonstrate that central serotonergic system may participate in the pathogenesis of VVS and SSRIs are important for the diagnosis and treatment of VVS.