Relapse/refractory multiple myeloma must be the main tough for the current clinical therapy,thus at the 56th American Society of Hematology annual meeting the latest treatment studies for the disease in 2014 were described in detail,including the joint application of drugs,the new drug clinical research,the safety and efficacy that could be inspiring.This chapter shows the mechanism of these new drug action,as well as the methods and side effects.

BACKGROUND:Percutaneous kyphoplasty with bone cement injection for repair of multi-segmental thoracolumbar vertebral osteoporotic fractures can restore the compressed vertebral height, correct deformity and reduce complications. OBJECTIVE: To explore the therapeutic effects of percutaneous kyphoplasty with bone cement in patients with multi-segmental thoracolumbar vertebral osteoporotic fractures. METHODS:Eighty patients with multi-segmental thoracolumbar vertebral osteoporotic fractures were enroled, 29 males and 51 females, aged 61-78 year, including 52 case of two-segmental vertebral fractures, 22 cases of three-segmental vertebral fractures, 6 cases of four-segmental vertebral fractures. Al the patients were divided into experimental group and control group randomly. Patients in the control group were given active basic treatment and anti-osteoporosis treatment and stayed in bed. Patients in the experimental group were given percutaneous kyphoplasty with bone cement injection on the above basis. Al the patients were folowed-up 12 months after treatment. Then the Oswesty dysfunction index, Barthel index, visual analog scale score, and theanterior vertebral height and midline height, Cobb angle were compared between the two groups. RESULTS AND CONCLUSION: In the experimental group, the Oswesty dysfunction index, Barthel index, visual analog scale score, and the anterior vertebral height and midline height, Cobb angle were al significantly improved at 3 days, 3 months and 12 months after treatment than before (P < 0.05). In the control group, the Oswesty dysfunction index, Barthel index and visual analog scale score were improved significantly at 3 and 12 months after treatment (P < 0.05), while the anterior vertebral height and midline height were improve dramaticaly at 12 months after treatment (P < 0.05). Compared with the control group, the experimental group showed better the Oswesty dysfunction index and Cobb angle than the control group at 12 months after treatment (P < 0.05), but there were no difference in the other indicators between the two groups. No adverse reactions associated with bone cement material occurred in the experimental group. Taken together, the percutaneous kyphoplasty with bone cement injection can rapidly relieve pain in patients with multi-segmental thoracolumbar vertebral osteoporotic fractures, which can correct kyphosis and improve patient's quality of life.

BACKGROUND: The bone fragments from spinal vertebral fracture can enter into vertebral canal to cause neural functional injury. The restoration of neural function after injury is mainly determined by the character and extent of primary injury, and is related with the spinal injured range. Early imageological analysis can evaluate the degree and range of spinal injury to preliminarily evaluate the therapeutic method and prognosis of the patient.OBJECTIVE: To explore the merit of MRI in the evaluation of function prognosis in compressive fracture induced by spinal trauma or primary osteoporosis to provide a gist for early rehabilitative intervention.DESIGN: A case retrospective study by employing patients with benign vertebral compressive fracture as subjects.SETTING: Department of Imageology of Henan Provincial Hebi Mineral Bureau General Hospital, Department of Radiology of affiliated hospitals of two universities.PARTICIPANTS: Totally 107 cases(123 vertebras) of benign vertebral compressive fracture with complete clinical data including 65 cases of trauma (trauma group, 71 vertebras) and 42 cases of osteoporosis(osteoporosis group, 52 vertebras) were selected from 125 spinal MRI testees of the first affiliated hospital of Beijing Medical University and the first affiliated hospital of Xinxiang Medical College for retrospective analysis.INTERVENTIONS: MRI images of the compressive vertebras in 107 cases (123 vertebras) induced by acute trauma or primary osteoporosis were comparatively analyzed by two vice botanic physicians with blindness method.Vertebral compression was classified into "wedge-shaped" or "flat-shaped" based on the difference between anterior and posterior height of the deformed vertebras and the shapes to observe whether there was bone fragment or not and typical fracture line.RESULTS: MRI manifestation of osteoporosis compression: medullary signal was completely kept in the deformed vertebras with the mixture of high signals. The anterior superior angle of vertebra stuck into vertebral canal. Strip low signal was under the endplate of T1 vertebra. The anterior and posterior vertebral border had normal morphology or slightly sucked with smooth margin. Vertebral vein was clearly displayed. MRI manifestation of traumatic compression: vertebra had relatively even low signal and kept partial medullary signals. Vertebra was obviously deformed with para-vertebral hematoma. There was fracture line or usually accompanied with medullary edema, and cystic degeneration. Vertebral enhancement was an important manifestation of fracture rehabilitative stage, which was the indicator for the judgment of fresh or old fracture.CONCLUSION: MRI can differentiate spinal traumatic fracture and primary osteoporosis fracture, judge fracture time, and preliminarily evaluate the function and prognosis of the patient.

Objective To evaluate the clinical efficacy of standardized house dust mite allergen specific immunotherapy (SIT) for rhinitis and asthma in children. Methods Forty-two children with allergic rhinitis and asthma who received a standardized house dust mite allergen SIT in our hospital were enrolled in our study. The result of allergen skin prick test, serum specific IgE levels (sIgE) of house dust mite and dust mite,pulmonary function and symptom scores were analysed before and at one year after treatment in all children. Results Skin indexes of house dust mite and dust mite, symptom score were significantly decreased at one year after treatment,but the levels of house dust mite and dust mite sIgE,lung function test (FVC,FEVt,MEF25-75) showed no significant differences. Conclusion Children with allergic rhinitis and asthma have significant improvements in their skin sensitivity and clinical symptoms by given SIT for one year,but the impact of SIT on airway inflammation needs further observation.

Objective To investigate the changes of follicular helper T cells (Tfh cells) and Tfh cells associated molecules in the peripheral blood (PB) of patients with malignant lymphoid diseases (MLD) dynamically, and explore their roles on pathogenesis of the diseases. Methods Fifty-five patients with MLD were enrolled in this study,including 9 patients with acute lymphocyte leukemia (ALL), 30 patients with non-Hodgkin lymophoma (NHL) and 16 patients with multiple myeloma (MM), and 10 healthy controls (NC) of similar age were also enrolled. The percentage of CD4+CXCR5+cells (Tfh cells) and expression of ICOS+, PD1+among the T cells were detected by flow cytometry (FCM), while the levels of interleukin 21 (IL-21) in plasma were detected by ELISA tests. Results The percentage of Tfh cells and expression of ICOS and/or PD-1 in PB of all untreated patients were significantly higher than those of NC (all P< 0.01), and MM group< ALL group 0.05), and apparently lower than those who achieved PR (P< 0.05). The percentages of Tfh cells in patients with T-ALL and T-NHL were higher than those in patients with B-ALL and B-NHL (P> 0.05), and much higher than NC (P< 0.01). The concentration of IL-21 in patients were much higher than that in NC [(326.56±32.44) pg/ml] (P<0.01), and MM group

Objective To study the influence of walking exercise training on heart function, left heart ventricle structure and plasma brain natriuretie peptide (BNP) concentration in patients with chronic heart failure ( CHF), to explore the sense of exercise training.Methods A total of 223 CHF patients were randomly assigned to a guided rehabilitation group, a non-guided rehabilitation group and a control group.All patients were given basic medicine treatment, and the guided rehabilitation group was administered guided walking exercise training program, while the non-guided rehabilitation group was encouraged to do exercise freely but with no guidance.Blood pressure, 6 min walking distance test, plasma concentration of BNP and echocardiography were measured in all patients before and after exercise training.Results At entry to the study, there was no significant difference among the 3 groups with regard to blood pressure, 6 rain walking distance and BNP level as well as echocardiographic parameters including left ventrieular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDd).A follow-up at the 6th month after intervention, the amount of readmission patients in guided rehabilitation group were significantly less than those in non-guided rehabilitation and control groups ( P < 0.05 ).It was also revealed that the plasma concentration of BNP decreased significantly ( P < 0.01 ) ; LVEF and 6 min walking distance improved significantly ( P < 0.01 ) in the guided rehabilitation group when compared with baseline and 6-month follow-up of the non-guided rehabilitation and control groups.However, there observed no significant change with regard to LVEDd.Conclusion Walking exercise training can improve exercise endurance in CHF patients and is safety; but has no influence on left heart ventricular structure in short time.

Adjacent segment degeneration (ASDeg) is a common complication occurring in patients after lumbar fusion, mainly manifested as adjacent disc herniation, adjacent vertebral fracture or spondylolisthesis, adjacent segment scoliosis, adjacent segment spinal canal stenosis or facet joint degeneration, etc. When patients with imaging manifestations of ASDeg present with clinical symptoms such as lumbosacral pain, root lower limb pain or intermittent claudication, it is called adjacent segment disease (ASDis), and reoperation is often required at this time. At present, open surgery has been widely used in the treatment of symptomatic ASDis, including fusion via posterior approach and transforaminal approach, etc. The traditional surgery is effective, but it always has many disadvantages, such as large surgical trauma, large intraoperative blood loss, long operation time and hospital stay, and slow postoperative recovery. Therefore, surgeons are actively trying to apply various minimally invasive procedures to the treatment for symptomatic ASDis. Anterior lumbar interbody fusion (ALIF) has better recovery effect on intervertebral space height and lumbar lordosis, but it also has higher risk of vascular, urinary system and abdominal organ injury. Minimally invasive transforaminallumbar interbody fusion (MIS-TLIF) has a significant effect on the protection of muscles (such as multifidus muscle) and ligaments. However, compared with open surgery, MIS-TLIF has a limited effect on the correction of coronal and sagittal malformations, and has a higher incidence of superior facet joint violation. lateral lumbar interbody fusion (LLIF) has significant correction effect on coronal and sagittal malformations, complete treatment of intervertebral space, high intervertebral fusion rate, and good intervertebral space height recovery. However, due to the influence of the iliac crest, the surgical segment of LLIF is limited, and there is a risk of injury to the lumbar plexus and iliac vessels at the lower lumbar spine. Extreme lateral lumbar interbody fusion (XLIF) has a low risk of iliac vascular injury, little impact on the original internal fixation, and good interbody fusion effect. However, XLIF is not suitable for patients with a history of retroperitoneal surgery, retroperitoneal abscess, or vascular anatomical abnormalities, and neurological monitoring is often needed during surgery. Compared with open surgery, oblique lumbar interbody fusion (OLIF) has the advantages of less surgical trauma and low risk of common complications (such as dural injury). However, due to the need to pull the sympathetic nerve during operation, OLIF may lead to postoperative limb cold and heat disorders, thus affecting the judgment of surgical decompression effect. Percutaneous endoscopic lumbar discectomy (PELD) can fully decompress the nerve and dural sac while causing less damage to the posterior spinal structure. However, it is not suitable for patients with ASDis complicated with severe spinal stenosis, lumbar spondylolisthesis or cauda equina syndrome. At the same time, PELD has a steeper learning curve than other procedures. Percutaneous endoscopic lumbar interbody fusion (PELIF) also has the disadvantages of steep learning curve and easy to damage outlet nerve, but it has the advantages of less blood loss, shorter hospital stay, faster recovery, and fewer complications (such as deep vein thrombosis and pulmonary embolism) compared with open surgery. This paper reviews the advantages and disadvantages of different minimally invasive procedures in the treatment of symptomatic ASDis and the indications of different minimally invasive procedures through literature retrieval, in order to provide reference for the future minimally invasive methods in the treatment of symptomatic ASDis.

OBJECTIVETo study the chemical constituents of the leaves of Psidium guajava.

METHODThe chemical constituents were isolated by column chromatography on silica gel, Sephadex LH-20 and MPLC. Their structures were elucidated on the basis of spectral analysis.

RESULTNine compounds were isolated from this plant, and the structure of them were identified as ursolic acid (1), 2alpha-hydroxyursolic acid (2), 2alpha-hydroxyoleanolic acid (3), morin-3-O-alpha-L-arabopyranoside (4), quercetin (5), hyperin (6), myricetin-3-O-beta-D-glucoside (7), quercetin-3-O-beta-D-glucuronopyranoside (8), 1-O-galloyl-beta-D-glucose (9).

CONCLUSIONCompounds 3, 7-9 were isolated from this plant for the first time.

Objective To evaluate the safety,feasibility of the application of "four-quadrant" tumor target-artery positioning in "zero-ischemia" retroperitoneal laparoscopic partial nephrectomy.Methods A retrospective study was conducted on 25 patients who underwent retroperitoneal laparoscopic partial nephrectomy from November 2016 to March 2017 by single surgeon.There were 15 males and 10 females with a mean age of (52.6 ± 11.9) years old.The mean diameter of the tumor was (3.8 ± 0.5) cm.The mean R.E.N.A.L.score was (9.0±1.3).The mean GFR of the operation side was (49.2±11.4) ml/(min · 1.73 m2) before the operation.All 25 patients underwent 3 Dimentional CT for the reconstruction of their renal models.The tumor target-artery was located in "four-quadrant" system,which based on the boundary between tumor and renal parenchyma.Perioperative outcomes including the estimated blood loss (EBL),operation time,complications and oncological outcomes were carefully collected and analyzed.Results Of all the 25 patients,21 patients underwent "zero-ischemia" retroperitoneal laparoscopic partial nephrectomy,the mean operation time was (106.1 ± 18.8) min,the mean EBL was (162.2 ±68.0) ml with no transfusion case.4 patients converted to conventional retroperitoneal laparoscopic partial nephrectomy,the operation time was 110-140 min,the EBL was 350-500 ml and the warm-ischemia time was 12-20 min respectively.The pathological outcome shows renal cell carcinoma in 24 patients and papillary renal cell carcinoma in 1 patient with all negative margins.The mean GFR of the operation side was (45.1 ± 10.2) ml/(min · 1.73 m2) after three months of the surgery and shows no statistical difference (P =0.268).Conclusion The application of the "four-quadrant" tumor target-artery positioning in " zeroischemia" retroperitoneal laparoscopic partial nephrectomy is a safety and feasible method in terms of accurate location of the target-artery,better postoperative renal function,low EBL and reasonable oncological outcomes.