In order to meet the requirements of medical teaching contents and curriculum system reform, we adopt the experience ofHarvard University School of Medicine to integrate Biochemistry and Cell Biology into a new one—— "Chemistry and Biology of theCell". We have carried out the integration of the two courses three times. In this new course, repeated contents have been reduced, thelinkage of the two courses has been increased, and the burden of students was lightened,which makes students contact the clinic earlierand enables to improve the students' ability to solve problems.

Objective:To investigate the efficacy and safety of zanubrutinib combined regimens for treatment of elderly patients with central nervous system lymphoma (CNSL).Methods:The clinical data of 3 elderly patients with CNSL who received zanubrutinib combined regimens from July 2020 to March 2022 in the Affiliated Suzhou Hospital of Nanjing Medical University were retrospectively analyzed. Two of them were primary central nervous system lymphoma (PCNSL) and one was secondary central nervous system lymphoma (SCNSL). Relevant literature was reviewed at the same time.Results:The two patients with PCNSL were treated with zanubrutinib in combination with rituximab and lenalidomide (Z-R 2) regimen. One of them achieved complete remission (CR) after 6 cycles, and the other patient achieved partial remission (PR) after 1 cycle of Z-R 2 regimen. The patient with SCNSL was diagnosed with diffuse large B-cell lymphoma (DLBCL) previously and suffered from central nervous system relapse after achieving CR. The patient achieved PR after 2 cycles of Z-R 2 regimen, and then achieved CR followed by 4 cycles of zanubrutinib in combination with rituximab and high-dose methotrexate (Z-R-HD-MTX) regimen. Two of the three patients were still in CR until April 2022, and the longest disease-free survival time was 15 months. There were no severe adverse reactions during the treatment. Conclusions:Zanubrutinib combined regimens for 3 elderly patients with CNSL have shown promising effect and well tolerance, which may be considered as novel treatment for CNSL patients who are unable to tolerate severe chemotherapies or autologous hematopoietic stem cell transplantations.

Objective To summarize the clinical effect and adverse reactions of avatrombopag combined with tacrolimus in the treatment of elderly patient with refractory severe aplastic anemia.Methods An elderly patient with refractory severe aplastic anemia was treated with avatrombopag and tacrolimus,and the literature review on the mechanism of action and safety of avatrombopag and ta-crolimus was conducted.Results The patient was treated with a combination of cyclosporine,testos-terone undecanoate,and itraconazole for 6 months without success,and developed liver and kidney dysfunction.The medication was discontinued,and the patient was treated with a combination of avatrombopag(20 mg,once per day)and tacrolimus(1 mg,twice per day).After 9 months of treat-ment,the patient's platelet count increased to 54 × 109/L,the hemoglobin increased to 124 g/L,the white blood cells increased to 8.23 × 109/L,liver and kidney function also returned to normal level,and no other adverse reactions such as thrombotic events were observed.After treatment,CD4/CD8 de-creased,CD8+T cells increased,and the proportion of Treg cells increased as well.Conclusion The combination of avatrombopag and tacrolimus is effective and well tolerated in the treatment of elderly patient with refractory aplastic anemia,but the long-term follow-up observation and continued accumu-lation of cases are still needed in the future.

Objective To investigate the expression of programmed death-1(PD-1) and programmed death ligand-1 (PD-L1) in peripheral T-lymphocytes from patients with chronic periodontitis and its significance and to clarify its role in the development of chronic periodontitis.Methods A total of 73 subjects were included in the study and divided into three groups,chronic periodontitis (30 cases),chronic gingivitis(25 cases) and 18 healthy controls.The peripheral blood was collected and PD-1/PD-L1 expression in the surface of CD4+ T lymphocytes and CD8+ T lymphocytes was examined by flow cytometry.Blood samples from 16 chronic periodontitis patients were collected at week 0 and 6 after initial therapy for 6 weeks and PD-1 and PD-L1 expression in the surface of CD4+ and CD8+ T lymphocytes was also determined by flow cytometry.The data were statistically analyzed.Results The percentage of PD-1 expression in CD4+ and CD8+ T lymphocytes of chronic periodontitis group [(16.7 ± 5.5) ％,(20.8 ± 5.1) ％] and chronic gingivitis group [(14.2 ± 6.1) ％,(14.5 ± 4.3) ％] were higher than that of healthy controls [(9.5 ± 2.1) ％,(8.1 ± 1.9) ％] (P ＜ 0.05).The percentage of PD-L1 expression in CD4+ and CD8+ T lymphocytes of chronic periodontitis group [(24.2 ± 7.1) ％,(15.3 ± 6.8) ％] and chronic gingivitis group [(12.4 ±6.0) ％,(11.2 ± 5.5) ％] were higher than that of healthy controls [(4.7 ± 1.2) ％,(3.2 ± 2.3) ％] (P ＜ 0.05).The percentage of PD-1/PD-L1 expression in CD4+ T lymphocytes and CD8+ T lymphocytes of the chronic periodontitis group were significantly decreased after initial therapy(P ＜ 0.05).Conclusions The expression of PD-1 and PD-L1 in peripheral CD4+ T lymphocytes and CD8+ T lymphocyte of chronic periodontitis patients was up-regulated and was associated with periodontal condition.The initial therapy reduced the expression of PD-1 and PD-L1.

Objective To summarize the clinical effect and adverse reactions of avatrombopag combined with tacrolimus in the treatment of elderly patient with refractory severe aplastic anemia.Methods An elderly patient with refractory severe aplastic anemia was treated with avatrombopag and tacrolimus,and the literature review on the mechanism of action and safety of avatrombopag and ta-crolimus was conducted.Results The patient was treated with a combination of cyclosporine,testos-terone undecanoate,and itraconazole for 6 months without success,and developed liver and kidney dysfunction.The medication was discontinued,and the patient was treated with a combination of avatrombopag(20 mg,once per day)and tacrolimus(1 mg,twice per day).After 9 months of treat-ment,the patient's platelet count increased to 54 × 109/L,the hemoglobin increased to 124 g/L,the white blood cells increased to 8.23 × 109/L,liver and kidney function also returned to normal level,and no other adverse reactions such as thrombotic events were observed.After treatment,CD4/CD8 de-creased,CD8+T cells increased,and the proportion of Treg cells increased as well.Conclusion The combination of avatrombopag and tacrolimus is effective and well tolerated in the treatment of elderly patient with refractory aplastic anemia,but the long-term follow-up observation and continued accumu-lation of cases are still needed in the future.