Objective To compare the efficacy and safety of standard or reduced doses of bortezomib combined with adriamycin and dexamethasone in patients with multiple myeloma (MM).Methods Fifty-two newly diagnosed,refractory and relapsed patients received bortezomib [1.3 mg/m2 (standard dose group,26 patients) or 1.0-1.1 mg/m2 (reduced dose group,26 patients) on day 1st,4th,8th and 11 th],and adriamycin (10 mg/m2) plus dexamethasone (40 mg/d) on day 1 st-4th,and were treated for 1-6 courses.Adverse events were graded and compared.Results After treatment,the overall response rate of standard dose group [80.8％(21/26)] and reduced dose group [88.5％(23/26)] had no significant difference (P =0.739).The rate of neutropenia and thrombocytopenia in two groups had no significant difference[23.1％(6/26) vs.15.4％(4/26),P=0.281 ; 11.5％(3/26) vs.7.7％(2/26),P=0.620].The rate of Ⅲ-Ⅳ grade peripheral nerve disease,herpes zoster,lack of power and abdominal distension in standard dose group were significantly higher than those in reduced dose group [15.4％(4/26) vs.3.8％(1/26),P =0.038;26.9％(7/26) vs.7.7％(2/26),P =0.029;38.5％(10/26) vs.15.4％(4/26),P=0.045; 19.2％(5/26)vs.3.8％ (1/26),P =0.028].Conclusion Reduced dose of bortezomib appears to result in similar overall response rate,but better tolerance and safety compared with standard dose.

Objective To construct a prognostic prediction model for hepatocellular carcinoma (HCC) based on immune and metabolism related genes, analyze the prognostic immune response of HCC patients, and screen potential drugs for HCC treatment through drug sensitivity analysis. Methods HCC expression profiling and clinical data were obtained from The Cancer Genome Atlas (TCGA) database, and a list of immune-related genes was obtained from the Immport database; the Perl language was used to extract metabolism-related pathway gene sets from the Molecular Signatures Database(MSig DB), and co-expression related genes were found through differential analysis and co-expression analysis; the univariate Cox regression analysis, the least absolute shrinkage and selection operator (LASSO) regression analysis, and multivariate Cox regression analysis were used to screen prognosis-related genes and construct a risk prognosis model for HCC, and risk scores for all HCC samples were calculated. Using the median risk score as the critical value, the reliability of the prognostic model was evaluated through risk curves, Kaplan-Meier survival analysis, receiver operating characteristic (ROC) curves, independent prognostic analysis, and Nomograms. The correlations between risk scores and pathway enrichment analysis as well as immune cell infiltration were analyzed. Drug sensitivity analysis was used to identify potential therapeutic drugs for HCC. Results Five immune and metabolic genes with independent prognostic value were obtained, and a prognostic model based on immune and metabolic genes was constructed. Survival analysis showed that in the total dataset, training group and validation group, the survival rate of the low-risk group was significantly higher than that ofthe high-risk group (P < 0.05). The areas under the ROC curves of the prognostic model for the training group at 1, 3 and 5 years were 0.780, 0.699 and 0.706 respectively. Cox regression analysis showed that grading and risk score could be used as independent prognostic factors for HCC (P < 0.05), with a concordance index of 0.734 (95%CI, 0.669 to 0.798), indicating good model performance. Immune cell infiltration results showed significant differences in resting NK cells, monocytes, M0 macrophages, and M1 macrophages between the high-risk and low-risk groups (P < 0.05). Drug sensitivity analysis screened 12 drugs that may have potential therapeutic effects in HCC patients (P < 0.01). Conclusion The prognostic model of HCC based on five immune and metabolic genes has good predictive performance, and can be used as a new indicator for prognosis evaluation; the 12 drugs screened out have potential efficacy for HCC.

Clinical pharmacology is an important discipline that bridges clinical medicine and pharmacology. In the teaching practice, it is necessary to keep up with educational reform and adopt the seminar teaching method combined with case-based learning (CBL), so as to practically improve the benefits of both "teaching" and "learning". The teaching of ideology and politics in the curriculum is the key to cultivate students' high sense of responsibility and noble medical ethics, and realize the goal of moral education. At present, in the teaching of clinical pharmacology of antineoplastic drugs, there are problems such as students' weak basic knowledge of oncology pharmacology, separation of "teaching" and "learning" due to the traditional teaching method, outdated teaching materials, and low motivation of students. Therefore, this paper takes this part of the course teaching as an example to initially explore the role of the innovative model of "Seminar-CBL-Ideological and Political Education " in the teaching practice of clinical pharmacology, with the hope of stimulating the students' interest in learning, cultivating students' correct outlook on the world, life, and values, achieving the goals of "teaching" and "learning", and providing reference for optimizing clinical pharmacology education.

Objective To screen mitochondria-related genes in Crohn's disease (CD) based on the Gene Expression Omnibus (GEO) database, construct an artificial neural network diagnostic model and evaluate its performance. Methods The CD-related datasets GSE186582 and GSE102133 were downloaded from the GEO database for differential expression genes (DEGs) screening. The intersection of DEGs and mitochondrial genes from the MitoCarta 3.0 database was obtained. Least absolute shrinkage and selection operator regression and random forest algorithms were used to identify CD-specific genes and construct an artificial neural network diagnostic model. The model was further validated by the validation set GSE95095, and the diagnostic performance was evaluated by the area under the curve (AUC) of the receiver operating characteristic curve. The immune cell infiltration in CD was assessed by the CIBERSORT algorithm, and the relationship between biomarkers and infiltrated immune cells was investigated. Results A total of 551 DEGs were obtained, including 275 upregulated and 276 downregulated genes. There were 20 mitochondria-related genes associated with CD. A total of 9 mitochondria-related feature genes (SOD2, MTHFD2, BPHL, PXMP2, RMND1, AGXT2, MAOA, HMGCS2, MAOB) were screened by two machine learning algorithms. An artificial neural network diagnostic model was constructed by the selected feature genes. The values of AUC of the model in the training and validation groups were 0.956 and 0.736 respectively. Immune cell infiltration analysis showed that the feature genes were associated with resting memory CD4⁺ T cells, activated memory CD4⁺ T cells, activated dendritic cells, neutrophils, and CD8⁺ T cells. Conclusion The artificial neural network diagnostic model for CD based on 9 mitochondrial genes has good predictive performance.

Ankle Fractures ; Femoral Fractures ; Fracture Fixation, Internal ; Humans ; Patella/surgery* ; Patellar Dislocation/surgery*

Antibodies, Monoclonal, Humanized ; therapeutic use ; Atypical Hemolytic Uremic Syndrome ; drug therapy ; surgery ; China ; Humans ; Kidney Transplantation ; Male

OBJECTIVETo make a preliminary assessment of the feasibility of Endo GIATM Radial Reload with Tri-StapleTM Technology(Radial Reload) in laparoscopic anterior resection of low rectal cancer.

METHODSClinical data of 21 low rectal cancer patients undergoing laparoscopic anterior resection with the Radial Reload in our department between July 2014 and July 2015 were retrospectively analyzed.

RESULTSAll the rectums were achieved complete transection by the first stapler device firing and all the operations were performed successfully. No patient were converted to open surgery. The operative time ranged from 110.0 to 180.0(140.5±16.6) minutes, the blood loss ranged from 50.0 to 100.0(66.8±11.4) ml, and the distal resection margin ranged from 1.0 to 3.0(1.8±0.7) cm. Tumor cells were not discovered in all the postoperative pathological samples of distal resection margin. Among 21 cases, stage I( was found in 14 cases, stage II( in 4 cases and stage III( in 3 cases. There were no anastomotic bleeding and anastomotic leakage. There was no local recurrence and distant metastasis during a median follow-up of 6 months(1 to 13 months) postoperatively.

CONCLUSIONThe application of Radial Reload in laparoscopic anterior resection of low rectal cancer is feasible with satisfactory efficacy.

Feasibility Studies ; Humans ; Laparoscopy ; instrumentation ; Neoplasm Recurrence, Local ; Operative Time ; Rectal Neoplasms ; surgery ; Rectum ; surgery ; Retrospective Studies ; Surgical Stapling

OBJECTIVETo carry out genetic testing for a family affected with pulmonary hypertension (PH) as the initial sign of hereditary hemorrhagic telangiectasia (HHT).

METHODSHigh throughput sequencing was performed to detect potential mutation in the coding regions of endoglin (ENG), activin receptor-like kinase 1 (ACVRL1) and mothers against decapentaplegic homolog 4 (SMAD4) genes.

RESULTSA pathogenic heterozygous c.814C>T (p.Gln272Ter) mutation of the ACVRL1 gene was identified in the proband. Her mother and two sons have carried the same mutation.

CONCLUSIONThe c.814C>T (p.Gln272Ter) mutation of the ACVRL1 gene probably underlies the disease in this family. Genetic testing should be recommended to HHT patient, in particular those with pulmonary hypertension.

Activin Receptors, Type II ; genetics ; Child ; Endoglin ; genetics ; Female ; Genetic Testing ; High-Throughput Nucleotide Sequencing ; Humans ; Hypertension, Pulmonary ; etiology ; genetics ; Male ; Middle Aged ; Mutation ; Telangiectasia, Hereditary Hemorrhagic ; complications

Scoliosis is a complex spinal three-dimensional malformation with complicated pathogenesis, often associated with complications as thoracic deformity and shoulder imbalance. Because the acquisition of specimen or animal models are difficult, the biomechanical study of scoliosis is limited. In recent years, along with the development of the computer technology, software and image, the technology of establishing a finite element model of human spine is maturing and it has been providing strong support for the research of pathogenesis of scoliosis, the design and application of brace, and the selection of surgical methods. The finite element model method is gradually becoming an important tool in the biomechanical study of scoliosis. Establishing a high quality finite element model is the basis of analysis and future study. However, the finite element modeling process can be complex and modeling methods are greatly varied. Choosing the appropriate modeling method according to research objectives has become researchers' primary task. In this paper, the author reviews the national and international literature in recent years and concludes the finite element modeling methods in scoliosis, including data acquisition, establishment of the geometric model, the material properties, parameters setting, the validity of the finite element model validation and so on.
Biomechanical Phenomena ; Computer Simulation ; Finite Element Analysis ; Humans ; Scoliosis ; physiopathology ; surgery ; Spine ; pathology

Objective: To investigate the etiology, clinical features, treatment and outcome of nephrotic syndrome associated with chronic mercury poisoning. Methods: From June 2013 to April 2018, Beijing Chaoyang Hospital, Capital Medical University received 33 patients with chronic mercury-neutral nephrotic syndrome. The clinical manifestations, laboratory tests, treatment methods, and outcomes were analyzed. Results: Among the 33 patients, 27 patients had mercury exposure due to daily-life contact and the other 6 patients were caused by iatrogenic mercury. The symptom was characterized by typical nephrotic syndrome such as lower extremity edema and proteinuria at first onset. The treatment was based on mercury-removing treatment, 19 cases were treated with mercury removal alone, 16 cases were completely relieved; 10 cases were treated with mercury removal and glucocorticoids, all of which were completely relieved; 4 cases were treated with mercury removal, glucocorticoids and immunosuppressive agents, all complete remission; clinical complete remission rate is about 90.9% (30 cases in total) . Urinary mercury levels decreased the fastest between the first and second courses of mercury treatment, but the total amount of urine protein increased. As the amount of urinary mercury excreted increased, the total amount of urine protein decreased gradually (Z=2.86, P<0.01) . Conclusion The clinical features of chronic mercury-induced nephrotic syndrome are non-specific, easy to be misdiagnosed and missed. The treatment is mainly treated with mercury removal treatment. The prognosis is good. In severe cases, glucocorticoid therapy can be supplemented.