BACKGROUND:Autologous hematopoietic stem celltransplantation is an effective treatment for multiple myeloma. After chemotherapy, autologous hematopoietic stem celltransplantation becomes a standard therapeutic regimen for multipla myeloma, and numerous units and centers have reported that. How to reduce toxic and adverse reactions of the drugs, transplantation-related complications and improvement of long-term survival have been present foci.
OBJECTIVE:To summarize the new progress of autologous hematopoietic stem celltransplantation in the treatment of multiple myeloma.
METHODS:We retrieved PubMed and China National Knowledge Infrastructure database, Vip database, Wanfang database, free medicaljournals.com source for articles published from January 2006 to November 2012 concerning autologous hematopoietic stem celltransplantation in the treatment of multiple myeloma. The key words were“autologous hematopoietic stem celltransplantation, multiple myeloma”. A total of 46 articles were included.
RESULTS AND CONCLUSION: Large-dose chemotherapy combined with autologous hematopoietic stem celltransplantation for multiple myeloma obtained better outcomes compared with the traditional chemotherapy. However, many patients could not relieve after single autologous hematopoietic stem celltransplantation, and the disease recurred final y. Al ogeneic hematopoietic stem celltransplantation was limited by donor source, and treatment-associated fatality rate was high, so its use was confined. Therefore, present new development direction included twice autologous hematopoietic stem celltransplantation, autologous transplantation combined with al ogeneic transplantation with reduced-intensity conditioning regimens as wel as drug on the basis of single autologous hematopoietic stem celltransplantation. Novel drug proteasomes inhibitor and immunomodulator in inducer remission, pretreatment and sustaining stages obviously improved total reaction rate of multiple myeloma therapy and long-term survival.

Objectives To analyse the clinical feature,drug and surgical treatment and prognosis of rheumatic diseases associat- ed corneal melting.Design Retrospective case series.Participants 14 patients (22 eyes) with rheumatic diseases associated corneal melting.Methods The clinical data of patients were analysed,including history,visual acuity,slit-lamp microscopy examination,drug and surgical treatment and follow-up results.Main Outcome Measures The clinical feature,therapeutic effects and recurrence. Results The follow-up was 6～24 months.Rheumatic diseases associated corneal melting always firstly occurred from the upper corneal limbus.The marginal lesions of cornea included melting of the stroma,resulting in corneal thinning or even perforation,with neovascu- larization.The corneal lesions in 4 eyes were within 1 quadrant,10 eyes within 2 quadrants,6 eyes within 3 quadrants,and 2 eyes in 4 quadrants.Eight eyes of 5 cases,whose corneal lesions were thinner than 2/3 of normal corneal thickness,received 1% cyclosporine A and 0.5% heparin eyedrops.Among those,the lesions in 3 eyes of 2 cases progressed worse.Fourteen eyes of 9 cases,whose corneal lesions were thicker than 2/3 of normal corneal thickness,received marginal lamellar keratoplasty.Among those,recurrent signs were noted in 10 eyes of 6 cases.Conclusions Rheumatic diseases associated corneal melting has typical clinical features.Local cy- closporine A and heparin treatment are effective for patients in early stage.A high recurrent rate is found for patients in late stage re- ceived marginal lamellar keratoplasty.

BACKGROUND:More and more elderly patients have hip fractures because of diverse reasons, and most of the fractures are unstable fractures combined with the displacement of the lesser trochanter. At present, there are stil many reports about using dynamic hip screw to repair unstable intertrochanteric fractures, and the effect is obvious. However, there are stil great controversies regarding whether lesser trochanter fixation is performed during the repair process. OBJECTIVE:To evaluate the effect of using dynamic hip screw combined with the lesser trochanter fixation to repair intertrochanteric fractures and the occurrence of hip coxa vara after repair through a meta-analysis. METHODS:The PubMed, EMCC, CBM, CNKI, VIP and Wanfang databases were retrieved by computer for randomized controled trials on whether lesser trochanter reduction fixation was performed during the process of dynamic hip screw internal fixation for repair of intertrochanteric fractures. The quality of the included studies was evaluated according to the pre-designated inclusion and exclusion criteria. The available data were extracted and analyzed using the RevMan5.2 software. RESULTS AND CONCLUSION:A total of 10 randomized controled trials involving 604 patients were included. Among them, 298 cases were assigned to the dynamic hip screw combined with lesser trochanter fixation group, and 306 cases to the lesser trochanter unfixed group. The meta-analysis results indicated that hip coxa vara, other postoperative complications, the excelent and good rate of efficacy in the dynamic hip screw combined with lesser trochanter fixation group were al superior to those in the lesser trochanter unfixed group (alP < 0.000 1), and for hip coxa vara, the parameters were odds ratio=0.17, 95% confidence interval (0.07, 0.41),Z=3.99,P< 0.000 1. The operation time and the amount of blood loss in the lesser trochanter unfixed group were superior to those in the dynamic hip screw combined with lesser trochanter fixation group (alP < 0.000 1). These results suggest that the lesser trochanter unfixed therapy has the advantages of relatively simple operation, shorter operative time and less blood loss during the process of dynamic hip screw internal fixation for repair of unstable intertrochanteric fractures. However, the excelent and good rates of efficacy, hip coxa vara and other postoperative complications were superior in patients with intertrochanteric fracture above the Tronzo-Evans III type who received dynamic hip screw combined with lesser trochanter fixation to those who received lesser trochanter unfixed therapy. The results indicate that dynamic hip screw combined with lesser trochanter fixation for repair of intertrochanteric fracture is beneficial to prevent hip coxa vara and other complications.

Objective To evaluate the role of contrast enhanced ultrasound in treatment of ultrasound guided high intensity fo‐cused ultrasound ablation for uterine fibroids .Methods Forty eight women with uterine fibroids were allocated into contrast en‐hanced group(25cases ,42fibroids) and non contrast enhanced group(23 cases ,35 fibroids) .The average volume of fibroids and the non perfused volume and the fractional ablation and adverse effects between the tow groups were compared .Results Non perfused volume was observed in all fibroids of the two groups after high intensity focused ultrasound ablation through sulphur hexafluoride micro bubbles .The average non perfused volume was 19 .5(18 .2)cm3 and 22 .5(14 .5)cm3 ,fractional ablation was (78 ± 18)% and (87 ± 13)% of the uterus immediately after HIFU respectively .The average non perfused volume was 18 .6(18 .2)cm3 and 19 .5 (18 .7)cm3 ,fractional ablation was (85 .7 ± 15 .2)% and (87 .6 ± 8 .0)% of the uterus two days after HIFU .There was no signifi‐cant difference was observed in average non perfused volume and the fractional ablation between the two groups(P>0 .05) .During HIFU procedure ,more patients in non contrast enhanced group complained sacral pain than those in contrast enhanced group(P<0 .05) .Conclusion Contrast enhanced ultrasound is an accurate method in assessing the treatment effect of HIFU and could be safely used during HIFU treatment for uterine fibroids ,shorten therapy time ,and decrease side reaction .

Objective To explore the diagnosis and surgical treatment of duodenal trauma.Methods A retrospective study was accomplished on the clinical data of 52 patients with duodenal trauma.Results Of 52 patients with duodenal trauma,11 cases were simply anterior wall trauma,41 cases were anterior and posterior wall trauma and 6 cases were complicated with other organs traumatic.All patients were treated by surgery,and 45 cases were cured and 7 cases died.Conclusions Duodenal trauma often betides when patients have suffered road accident or closed impact injury in abodomen.Anterior wall trauma is often complicated with contrecoup of corresponding posterior wall.The diagnosis of posterior wall trauma is easily missed and the leakage of duodenum often happens in the operation.It is critical to check the doubtful cases with careful operations research and select reasonable and appropriate operation types for the diagnosis and surgical treatment of duodenal trauma.

Aged ; Female ; Humans ; Maxillary Sinus ; parasitology ; Myiasis ; Nasal Cavity ; parasitology

Objective: To observe the effects and immunological mechanism of continuous blood(purification)(CBP) in treatment of children with infectious shock.Methods: Twelve children with infectious shock treated with continuous veno-venus hemofiltration(CVVH) in intensive care unit(ICU) from June 2002 to October 2005 were selected as CBP treatment group,and 20 children with infectious shock without the(treatment) were selected as controls at the same time.The levels of pH,oxygenation index,HCO~-_3,base(excess(BE)),blood urea nitrogen(BUN),serum creatinine(SCr),blood pressure and acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) were examined before and 24,48 hours after treatment dynamically,while the levels of tumor necrosis factor?(TNF?),interleukin1(IL1),IL6 and IL8 were detected and analyzed by SPSS 10.0 software.Results: Among the 12 patients,8 cases survived,4 cases died and the mortality rate was 33.3%.In CBP treatment group,APACHE Ⅱdecreased after treatment,and other biochemical parameters were all improved,plasma concentrations of TNF?,IL1 and IL8 decreased(P

This paper summarizes the intraoperative care of 9 ovarian cancer patients undergoing cytoreductive surgery combined with intraperitoneal hyperthermic perfusion chemotherapy.During the operation,strict aseptic procedure,protection and isolation of normal organs were emphasized to prevent postoperative infections and diffusion of cancer cells.During intraperitoneal hyperthermic perfusion chemotherapy,the nursing care focused on tube management to maintain unobstructed and fluid volume,prevention of fluid leakage,skin care and prevention of pressure induced injuries.

Objective To investigate clinical value of three-dimensional transvaginal sonography (3D-TVS) in the diagnosis of septate uterus and the relationship between its parameters and adverse pregnancy.Methods From Mar.2010 to Sept.2011,73 patients (aged 23-35 years) with septate uterus who were diagnosed by 3D-TVS in Fujian Province Maternal and Child Health Hospital were enrolled in this retrospective study.The septum width,septum angle,septum length and the length of remaining uterine cavity were measured among the patients with subseptate uterus,and then,the distortion rate was calculated.The hysteroscopic surgery was used as the gold standard,and the diagnostic titer of 3D-TVS in the diagnosis of septate uterus was determined.Receiver operating characteristic curve (ROC) were plotted to evaluate the diagnostic titer of uterine parameters measured by 3D-TVS in predicting the adverse pregnancy outcome among patients with subseptate uterus.Univariate logistic regression was used to analyze the effectiveness of uterine parameters on adverse pregnancy outcome.Results Using hysteroscopic surgery as the gold standard,the coincidence rate of diagnosis of septate uterus by 3D-TVS was 94％ (69/73).Among the patients with septate uterus,25％ (17/69)were complete septate uterus,75％ (52/69) were subseptate uterus.Among patients with subseptate uterus,the septum length [(2.2 ± 0.6) cm] and distortion rate in patients with adverse pregnancy(0.60 ± 0.10)were significantly higher than those without adverse pregnancy [(1.5 ±0.6) cm,0.43 ±0.13,both P ＜0.05].However,no significant difference in the width,angle and length of septum were observed between the two groups (P ＞ 0.05).The area under ROC curve (AUC) of septum length and distortion rate in determining adverse pregnancy were 0.833 (95％ CI:0.721-0.944) and 0.800 (95％ CI:0.671-0.929),respectively.The optimal cutoff point of septum length was 1.94 cm,with the sensitivity was 74.3％ and the specificity was 76.5％ ; the optimal cutoff point of distortion rate was 0.48,with the sensitivity was 77.1％ and the specificity was 76.5％.The expectation morbidity ratio of adverse pregnancy was 2.717,3.067 and 0.514 by every adding level of septum length,distortion rate,and length of remaining uterine cavity,respectively.Conclusions 3D-TVS showed high accuracy in diagnosis of septate uterus.The septum length and distortion rate may predict the risk of adverse pregnancy,and the value of them can be used for screening adverse pregnancy in clinical practice.

Objective To study the relationship of the antepartum foramen ovale (FO),the ratios of foramen ovale and aorta (FO/AO) and postpartum ostium secundum atrial septal defect (ASD).Methods Nine hundred fifty-eight fetuses were divided into 5 groups by gestational age,18-22 weeks,23-26 weeks,27-30 weeks,31-34 weeks,35-40 weeks.The diameter of FO and aortic (AO) and FO/AO were measured by fetal echocardiography,the postpartum echocardiography were followed up more than 12 months after birth.ANOVA was used to compare FO,AO,FO/AO with different gestational age.Regression equation estimate was used to compare the relationship of FO and AO with gestational age.Independent sample T test was used to compare FO and FO/AO with postpartum ostium secundum ASD and postpartum normal heart.Results There was significant difference in FO and AO among 5 groups(P =0.000),FO and AO increased with increasing gestational age.There was significant difference in antepartum FO,FO/AO between postpartum ostium secundum ASD and postpartum normal heart (P =0.000).Conclusions Antepartum FO and FO/AO provide clinical value in observing postpartum ostium secundum ASD.