Objective:To investigate the differential diagnostic value of 18F-FDG PET/CT in multiple myeloma (MM) and unknown osteolytic metastasis (UOM). Methods:A retrospective study was performed on 18F-FDG PET/CT imaging of 43 patients (29 males, 14 females, age: (61.5±12.9) years) with multiple bone destructions and without extraosseous primary malignant tumor between June 2017 and March 2020 in Tenth People′s Hospital of Tongji University. Through follow-up, 20 patients (13 males, 7 females, age: (61.1±12.2) years) were pathologically confirmed as MM and 23 patients (16 males, 7 females, age: (61.4±13.9) years) were pathologically confirmed as UOM. The whole body skeleton was categorized to 8 sites including skull, spine, ribs, pelvis, sternum, clavicle, scapula and limb bone. The differences of the cross-sectional length of the lesion, cortical bone damage, SUV max and the distribution of imaging agent were compared between the two groups in different parts. Independent-sample t test and Mann-Whitney U test were used to analyze data. Results:The UOM group was invisible on clavicles, and spine and pelvis were the most predilection sites in both MM and UOM groups (spine: 41.30%(299/724) and 49.37%(117/237); pelvis: 24.45%(177/724) and 26.58%(63/237)). The cross-sectional length of lesions in the skull, spine, ribs, pelvis and limb bone in MM group were significantly shorter than those in UOM group (5.45(4.30, 8.06) vs (13.89±11.66) mm, 6.15(3.89, 10.06) vs 11.48(7.73, 16.90) mm, 7.01(4.59, 10.56) vs (24.61±16.22) mm, 8.20(5.14, 13.71) vs (21.12±13.31) mm, (8.48±5.75) vs (19.13±14.26) mm; z values: from -8.88 to -2.52, t=-2.76, P<0.001 or P<0.05) and SUV max of above lesions and scapula in MM group were significantly lower than those in UOM group (1.50(1.00, 2.20) vs 17.15±11.40, 2.60(2.00, 4.10) vs 8.20(5.65, 11.90), 2.30(1.40, 5.28) vs 10.58±5.52, 2.50(1.80, 3.90) vs 9.34±6.01, 3.08±2.41 vs 11.38±6.38, 2.45(1.50, 4.43) vs 6.90(4.63, 17.80); z values: from -13.87 to -2.41, t=-4.85, P<0.001 or P<0.05). The imaging agents in lesions on the skull, spine, ribs, pelvis, scapula and limb bone were more evenly distributed in MM group, while the imaging agents in lesions were more unevenly distributed in UOM group. On the skull, spine and ribs sites, the MM group was more likely to show no cortical bone damage; however, the UOM group showed cortical bone damage in the above sites. Conclusion:It is helpful for doctors to distinguish MM and UOM by comparing the cross-sectional length of the lesion, cortical bone damage, SUV max and the distribution of imaging agent in 18F-FDG PET/CT imaging before getting pathologic results.

Objective: To explore the prognostic factors in newly diagnosed multiple myeloma (NDMM) patients with 1q21 amplification/gain treated with bortezomib-based regimens followed by autologous hematopoietic stem cell transplantation (ASCT) . Methods: We retrospectively assayed 35 NDMM patients with 1q21 amplification/gain who received bortezomib-based chemotherapy followed by ASCT and maintenance therapy between January 2008 and August 2015. Results: ①The median age of 35 patients were 49(33-63)years old. Ratio of male to female was 22∶13. Monosomy1q21 amplification/gain was only seen in 3(8.6%) patients, the other 32 patients were with additional cytogenetic abnormalities including 13q14 deletion, t(11,14), t(4,14), t(14,16), 17p deletion and complex karyotype aberrations. ②The complete remission (CR) rate was 57.0% (20/35), the very good partial remission(VGPR) rate was 37.1%(13/35) and the partial remission (PR) rate was 5.7%(2/35) after ASCT. At a median follow-up of 24 (8-85) months, 3-year estimated progression free survival (PFS) and overall survival (OS) rate were (66.5±9.7)% and (69.6±9.9)%, respectively. ③As 13 patients with high-risk cytogenetic abnormalities, the median PFS and OS time was 26 and 28 months. The 3-year estimated PFS and OS was (28.0±15.9)% and (36.5±16.4)%, respectively. Another 22 patients without other high-risk cytogenetic abnormalities, the median PFS and OS time was 54 months and not reached. The 3-year estimated PFS and OS was (71.5±12.7)% and (92.3±7.4)% in this group, respectively. The presence of additional other high-risk cytogenetic abnormalities resulted in significantly shortened PFS (χ²=5.404, P=0.020) and OS (χ²=7.596, P=0.006) compared with no high-risk cytogenetic patients. Conclusion NDMM patients with isolated1q21 amplification/gain were rarely and usually had additional other cytogenetic abnormalities. The outcomes in this group treated with bortezomib-based chemotherapy followed by ASCT and maintenance therapy were satisfied, additional other high-risk cytogenetic abnormalities made PFS and OS further shortened.

Objective To investigate the clinical characteristics of plasma cell malignancies with t(11;14) and the effect of t(11;14) on prognosis. Methods A cohort of 380 newly diagnosed patients with plasma cell malignancies were analyzed,including 146 females and 234 males.There were 370 cases of newly diagnosed multiple myeloma (NDMM), as well as 10 cases of primary plasma cell leukemia (PCL). The relationship between the categorical variables was evaluated by using the bilateral Fisher exact probability test, with 95 % confidence interval. Results Of 370 NDMM cases, t(11;14) was detected in 101 cases (27.3 %). Of 10 PCL cases, 8 cases displayed t(11;14). The detection rate of t(11;14) was significantly higher in IgD, IgM and non-secreting MM [50.9 % (27/53)] than that in IgA MM [21.6 % (16/78)] and IgG [28.4 % (52/183)] (both P= 0.002). The rate of CD56+in t(11;14) positive group was lower than that in t(11;14) negative group [51.6 % (48/93) vs. 72.0 % (167/232), P= 0.001], and the rate of CD117+was also significantly decreased [23.7 % (22/93) vs. 37.7 % (87/231), P= 0.019]. There were 86 cases of non-t(11;14) IgH rearrangement in 269 cases of NDMM without t(11;14), which mainly were t(4;14) or t(14;16). The detection rate of high risk MM was only 11.9 %(12/101)in t(11;14)positive group,while that rate was 27.5 % (74/269) in t(11;14) negative group, the difference was statistically significant (P = 0.001). Conclusion MM with t(11;14)displays distinct biological,clinical and laboratory features,it is a heterogeneous disease.

Objective: To observe the effect of angiotensin ( 1-7) ［Ang( 1-7) ］on the apoptosis and angiogenesis of fibroblasts in the oral submucosal fibrosis ( OSF) ，and to explore the effect preliminarily mechanism． Methods: Fibroblasts were isolated and cultured from human buccal mucosal tissue，the cell morphology was observed by inverted microscope，and the expression of vimentin was detected by immunofluorescence staining ; areca nut extract (ANE) was used to induce human fibroblasts to simulate the in vitro model of fibroblasts in OSF，the experimental groups included control group ( normally cultured cells) ，ANE group ( 100 μg/ ml ANE cultured cells for 48 hours) ，ANE + low-dose Ang( 1-7) group ( 100 μg/ ml ANE + 10－7 mol /L Ang ( 1-7) cultured cells for 48 h) ， ANE + high-dose Ang( 1-7) group ( 100 μg/ ml ANE + 10－5 mol /L Ang( 1-7) cultured cells for 48 h) ，immunofluorescence staining detected the expression of α-smooth muscle actin ( α-SMA) ，ELISA method detected the content of Collagen I and Collagen Ⅲ in the cell culture supernatant，MTT method detected cell proliferation activity， flow cytometry detected cell apoptosis ，the tubule formation experiment detected the vascularization of human umbilical vein endothelial cell(HUVEC) ; After the mRFP-GFP-LC3 virus was transferred to the cells，the level of autophagy was detected by immunofluorescence staining，Western blot detected the expression of autophagy-related protein Beclin-1 and the ratio of LC3-Ⅱ/ LC3-Ⅰ . Results: The isolated and cultured cells were in a long spindle shape，and Vimentin was positively expressed，indicating that fibroblasts were successfully isolated ; Compared with the ANE group，the fluorescence expression of α-SMA protein in ANE low dose Ang( 1-7) group and ANE + high dose Ang( 1-7) group significantly decreased，the contents of Collagen I and Collagen Ⅲ in the culture supernatant were reduced (P＜0．05) ，cell proliferation activity decreased (P＜0．05) ，and cell apoptosis rate increased (P < 0．05) ，the cell culture supernatants of the two groups inhibited the angiogenesis of HUVEC (P＜0．05) ，endophagosomes were reduced (P＜0．05) ，Beclin-1 protein expression was reduced (P ＜0．05) ，and the ratio of LC3- Ⅱ / LC3-Ⅰ was down-regulated (P ＜0．05 ) ; in addition ，the effect of ANE + high-dose Ang ( 1-7 ) group was stronger than that of ANE + low-dose Ang( 1-7) group (P＜0．05) ． Conclusion Ang( 1-7) can inhibit the activation of fibroblasts induced by ANE，promote cell apoptosis，and reduce the angiogenesis of HUVEC，this mechanism may be related to the regulation of cell autophagy.