The mean age of multiple myeloma (MM) patients was 60 years old,most of whom are not eligible for transplantation.Goals for elderly patients is to prolong survival time and ensure quality of life by achieving the best response.Prolonged treatment or maintenance therapy in elderly patients could improve the quality of clinical response and extend progression-free survival.Further study is needed to determine whether novel treatment regimens could improve adverse prognosis of high-risk cytogenetic patients.Optimal individualized regimens should be found to improve tolerability and treatment efficacy.

Recent studies have shown that multiple myeloma (MM) is preceded by a premalignant state called monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM).Some of the genetic changes of MM are also present in MGUS and SMM,including chromosomal translocations,copy number changes,somatic mutations and so on.This article discusses the genetic heterogeneity.

Objective To evaluate the efficacy and safety of long-term nebulized corticosteroids and inhaled bronchodilators therapy on asthma in long term poor controlled elderly patients.Methods Prospective,randomized control study was conducted.63 elderly asthma patients,who received inhaled corticosteroids or combined with other long-term medication treatment for asthma control for more than 3 months but were still in moderate to severe persistent asthma state,were randomly divided into nebulizer treatment group (n=31) and dry powder inhalation group (n=32),and they were treated correspondingly with Budesonide inhalation suspension 1 mg and Salbutamol 2.5 mg BidorBudesonide/Formoterol powder 320/9 μg inhalation Bid.Patients in the two groups were evaluated for the differences in lung function,acute exacerbations of asthma,asthma control test (ACT) and adverse effects after 12-week treatment.Results The improvement in morning peak expiratory flow (PEF) and ACT score were better in the test group than in the control group [(29.2 ±14.4) ml vs.(15.8±13.5)ml,(4.8±2.2) vs.(3.0±2.7),t=3.715 and 2.897,P=0.000 and 0.005],but there were no statistical differences in average daily use of relievers and severe acute exacerbations between the test and control groups (t=1.512,P=0.136;x2=2.238,P=0.135).The local adverse effects caused by inhaled corticosteroids had no significant difference between the two groups.Conclusions Compared with the powder inhalation,the nebulizer inhalation administration of corticosteroids and bronchodilators could improve the asthma symptoms and lung function better in elderly patients with serious asthma condition and shows a good safety in tbe12 weeks of continuous treatment.

Objective To evaluate the hematologic effects of linezolid in advanced aged patients with hospital onset of infection.Methods The clinical characteristics and complete blood routine examination results of 45 elderly patients aged(92.9±5.2)years treated with linezolid over 600 mg of lowest dose everyday for more than 72 hours were retrospectively analyzed.Results Among the 45patients,20 patients(44.4％)had substantially lower platelet,6 patients(13.3％)lower haemoglobin,1 patient(2.2％)lower absolute neutrophil,and the linezolid treatment in 19 patients were discontinued due to hematological system adverse reactions.The significant drop in platelet occurred at(10.2±3.3)days after treatment.The significant drop in hemoglobin occurred at(9.8±3.0)d after treatment.The lowest count of platelet and hemoglobin took place at(13.1±3.9)d and (10.5±3.5)d after treatment,respectively.The drops in platelet and hemoglobin of some patients took place after cease of treatment.Stepwise logistic regression analysis revealed that treatment duration(OR =1.407,P＜0.05)and creatinine clearance rate(OR=0.732,P＜0.05)were the risk factors for thrombocytopenia.Conclusions The elderly patients using linezolid more likely suffer from adverse reactions of hematological system,particularly thrombocytopeniawhich is significantly more common in patients with renal insufficiency and prolongation of treatment time.The blood routine examination should be monitored closely when elderly patients are treated with linezolid.

Objective To observe the X-ray appearance and clinical value of galactography.Methods 600 cases of galactorrhea confirmed by pathologly underwent galactography,among them,298 cases were blood type(49.8%),150 cases were serum type(25%),106 were rinsing type(17.7%) and others were 46 cases(7.7%).Results On galactography,the ductsl were divided into 3 groups: 345 cases were foliar type(59%),127 were ramate type(26.2%),87 were trunk type(14.8%).The main radiographic characteristics of lesions were mammary ductal ectasia in 578(96.3%),ductal distortion in 561(93.5%),irregular filling defect in ducts in 349(58.2%),and ductal damage in 39(6.5%).42 cases were breast carcinomas(7%),312 were intraductal papillary tumors(52%),129 were mammary ductal ectasia(21.5%),26 were mammary ductal mastitis(4.3%),49 were proliferous disease(8.2%),25 were mammary cyst(4.2%),17 were negative anamnesis(2.8%).Conclusion Galactography is beneficial in diagnosis of the pathogenesis of galactorrhea.

Objective To explore the clinicopathologic features,diagnostic criteria and clinical prognostic factors of Goblet cell carcinoid (GCC) of the appendix.Methods The clinical and pathological data from 6 GCC patients were analyzed including age,clinical stage,surgical procedure,outcome,macroscopic features,histological sections and immunohistochemistry.Results The median age was 49.67 years old.Clinically,4 patients presented the signs and symptoms of acute appendicitis,while 2 patients presented the signs and symptoms of abdominal pain.4 patients of them undergone the simple appendectomy,the other 2 undergone the right hemicolectomy.All patients who had undergone the operation treatment survived.One patient was lost to the follow-up.Macroscopically,no masses were found in the appendix.Microscopically,4 cases showed that the tumor cells were identical to the goblet cell normal small intestinal crypts morphologically.The atypia,necrosis and mitotic figures of neoplasm cells were absent.2 cases were composed of small,discrete acini,tubules lined by a single layer of cuboidal or columnar cell,the signet-ring cells were uniform with pattern of infiltration being nests,rosrttes,or clumps without a dintinct lumen.All GCC cases were positive to Syn,4 cases were positive to CgA,some cases expressed NSE,CD56,CK7,CK20,Ki-67 index of 5 cases was under 2 ％,the other 1 was 3 ％.None had lymph node metastases,intestinal metastases or ovary metastases.Conclusions GCC of appendix is a rare neoplasm,and has more aggressive behaviour than classic carcinoids.Positive expression of Syn and CgA is necessory for the diagnosis of GCC,Ki-67 index may suggest the grading of tumor.

ObjectiveA survey of the status quo of community nursing health resources in Shao xing countryside was carry out in order to rationally allocate medical resource,optimize quality of medical employees and construct modern rural community nursing patterns.MethodsA survey for 19 health service organizations and 381 nurses in rural communities was carried out with questionnaires.Results There existed regional differences in medical resources.The medical resources per ten thousand people were limited,only 0.7 health education room,1.2 recovery rooms,0.4 women and children′s health center.There was 1 nurse for every 1877 rural residents.The average age of nurses was (30.84±6.88) years old.Nurses on professional health education,community arevention of diseases only accountel for 43.8％.Community nuses of different ages and with different degrees had different knowledge requirements.ConclusionsThe medical resources are limited and imbalanced.The employees are too young and they have only low level of education and are not professional enough.Rational allocation of resources,optimization of personnel structure and abundance of on-the-job training is urgently needed.

Objective To study donor liver regeneration in recipients after split liver transplantation. Methods Liver volume regeneration was assessed by CT and hepatic function review. Results The graft to standard liver volume ratio of recipient one at POD120 and POD360 was 114%,97% with liver volume regeneration ratio of -11.0%,-24.3% respectively. For recipient two it was 96%,100% and 24.4%,30.0%,respectively. The graft to standard liver volume ratio of recipient three at POD60 was 86% with a regeneration ratio of 12.0%. For recipient four at POD60 it was 90% and 20.0% respectively. The hepatic function in all recipients became normal gradually. Conclusion The transplanted donor liver after split liver transplantation has strong ability of regeneration and is capable of normal hepatic function in the recipient.

Objective To explore the effects of different storage time of bone marrow specimens on the expressions of different antigens in normal plasma cells (nPC) and clone plasma cells (cPC) by flow cytometry. Methods The bone marrow samples of 12 patients with multiple myeloma (MM) who were treated in Beijing Chaoyang Hospital from September 2017 to January 2018 were selected as MM group. The minimum residual disease (MRD) level in MM group was 10-3-10-2. The bone marrow samples of 12 patients without plasma cell diseases were used as control group. Bone marrow samples were anticoagulated with ethylenediaminetetraacetic acid dipotassium (EDTA-K2) and stored at 2-8 °C. The fluorescent antibodies CD56, CD138, CD45, CD38, CD117, CD81 and cκ, cλ, CD45, CD38, CD19, CD27 were labeled at 0, 24, 48 and 72 h, respectively. The average fluorescence intensity (MFI) of the above 10 antigens expressed in nPC and cPC was analyzed by Diva software. The proportion and absolute count of nPC in control group and cPC in MM group were analyzed. Results In control group, when stored for 24 h, compared with 0 h, the difference of MFI of antigens in nPC was not statistically significant (P ＞ 0.05). When stored for 48 h, compared with 0 h, the MFI of CD38, CD138, CD27, cκ and cλ in nPC decreased, and the differences were statistically significant (28 943±6 591 vs. 23 569±7 587, P＝ 0.018; 1 412±399 vs. 817±223, P＝ 0.014;12 855±3 734 vs. 9 210±3 660, P＝ 0.005; 26 712±9 025 vs. 17 247±5 078, P＝ 0.026; 17 707±8 633 vs. 8 307±3 158, P ＝ 0.049); the MFI of CD45 increased, and the difference was statistically significant (7 694± 2 525 vs. 9 184±1 332, P ＝ 0.037). When stored for 72 h, compared with 0 h, the MFI of cκ and cλ increased, but the differences were not statistically significant (both P ＞ 0.05). In MM group, when stored for 24 h, compared with 0 h, the difference in MFI of antigens in cPC was not statistically significant (P＞ 0.05). When stored for 48 h, compared with 0 h, the MFI of CD38, CD138, CD81, cκ and cλ decreased, and the differences were statistically significant (16 664±11 744 vs. 10 130±10 026, P＝ 0.003; 2 041±1 145 vs. 1 371±696, P＝ 0.047; 2 679±784 vs. 1 524±1 153, P＝ 0.025; 29 102±18 138 vs. 18 372±10 327, P＝0.038; 16 314±12 728 vs. 9 752±6 271, P＝0.034). When stored for 72 h, compared with 0 h, the MFI of cκ and cλ increased, but the differences were not statistically significant (both P＞ 0.05). The absolute count of nPC and cPC gradually decreased with the prolongation of the storage time, and the difference was statistically significant (both P<0.05) when stored for 0 h and 24 h. There was no significant difference in the percentage of nPC and cPC among different storage time (all P ＞ 0.05). Conclusion Different storage time of bone marrow samples has effects on the MFI of antigens and absolute count of nPC and cPC, and the detection should be completed within 48 h.

Objective:To investigate whether ferroptosis of nerve cells exists in a rat model of neuropathic pain (NP), and to explore the mechanism of O 3 treatment of NP. Methods:Sixty male SD rats were randomly divided into three groups: neuropathic pain model group (NP group), sham operation group (Sham group) and ozone group (O 3 group). The partial sciatic nerve ligation was used in the NP and O 3 groups to construct a neuropathic pain model. The Sham group was subjected to sham surgery. In the O 3 group, 15 μl of O 3 (40 μg/ml) was injected locally at the injury site, and the NP and Sham were injected with the same amount of air, once per day. The mechanical contraction response threshold (MWT) and thermal contraction latency (TWL) of the rats were measured 1 day before the surgery (T0) and 1, 3, 7, 14 days after the surgery (T1 to T4). The spinal cord segments of rats were collected. The expression levels of glutathione peroxidase 4 (GPX4) and long chain fatty acid coenzyme A synthetase 4 (ACSL4) at T1 to T4 was detected using Western Blot. The number of NeuN+ neuron cells in the spinal dorsal horn at T4 was detected using immunofluorescence technology. The specific changes of ferroptosis at T4 was observed by a transmission electron microscopy. Iron deposition in the spinal dorsal horn at T1 to T4 was measured using ferroptosis kits. Results:Compared with the Sham group, rats in the NP group and O 3 group showed decreasing of MWT decreased and shortening of TWL at T2 to T4, decreasing of NeuN+ neurons in spinal dorsal horn at T4, specific changes of ferroptosis in mitochondria at T4, and increasing of iron content in nerve tissue at T2 to T4. Compared with the Sham group, rats in NP group showed decreasing of GPX4 level and increasing of ACSL4 level. Compared with the NP group, rats in the O 3 group showed increasing of MWT and prolonging of TWL at T2 to T4, increasing of the GPX4 level and decreasing of ACSL4 level at T2 to T4, increasing of the number of NeuN+ neuron cells in the spinal dorsal horn, improving of the mitochondrial atrophy of nerve cells, and decreasing of the iron content in nerve tissue at T2 to T4. The above results are statistically significant (all P<0.05). Conclusions:The mechanism of O 3 in treating neuropathic pain may be through inhibition of iron death.