The treatment of relapsed and refractory multiple myeloma has always been a problem among hematologic malignant tumor treatment.Compared with the initial therapy,there are worse therapeutic effects and more affecting factors of selecting treatment since the existence of drug resistance in relapsed myeloma.In this review,the therapeutic effects of single and combinational use of several novel agents such as thalidomide,lenalidomide and bortezomib were evaluated in treating relapsed and refractory multiple myeloma.The clinical results of some new anti-myeloma agents were also reported.

The incidence of venous thromboembolism (VTE) in multiple myeloma patients is higher than that of normal population. In this review, recent advances about thrombosis in multiple myeloma are studied,including the mechanism,risk factors,therapy and prevention of thrombosis.

BACKGROUND:Platelet-rich plasma gel contains some kinds of growth factors, which play important roles in repair of local trauma and bone defects. Platelet-rich plasma gel is now more and more studied as tissue engineering scaffolds, but there are no unified preparation methods.
OBJECTIVE:To summarize the studies about the preparation methods of platelet-rich plasma gel and the growth factors in platelet-rich plasma gel in recent years, and to compare different methods in order to find which one is better.
METHODS:A online search of PubMed database from January 1980 to January 2013 and China National Knowledge Infrastructure from January 1980 to January 2013 was performed with the key words of“platelet-rich plasma, platelet-rich plasma gel, tissue engineering”in English and Chinese, respectively. The studies about detection and preparation methods of platelet-rich plasma were included and those unrelated to platelet-rich plasma were excluded. Final y, 322 articles were gained and 67 articles were included in result analysis.
RESULTS AND CONCLUSION:Al preparation methods have their advantages. We should select the suitable method according to the goal of study. With the further study of platelet-rich plasma, it wil become more and more important for bone defect repair and tissue engineering research.

BACKGROUND: Schwann cells are the only glial cells in the peripheral nervous system and play an important role in the regeneration of peripheral nerves, while they have poor proliferation capacity and decreased activity, need allografts, and are difficult to culture in vitro. OBJECTIVE: To analyze the feasibility of repairing neurologic defects with tissue-engineered nerves constructed with Schwann cells derived from bone marrow stromal stem cells. DESIGN, TIME AND SETTING: Randomized controlled observation was conducted at Heilongiiang Institute of Veterinary Pharmaceutics between March 2004 and April 2005.MATERIALS: Twenty-four 8-weck-old female Wistar rats were used to establish animal models with 10 nun defect of sciatic nerve. METHODS: Twenty-four rats were divided into 3 groups by random digits table, tissue-engineered nerve group, polylactic acid robe group and autologons nerve group, with 8 rats in each group. Tissue-engineered nerve group: tissue-engineered nerve Was used to bridge neurologic defect, which was constructed with Schwann cells derived from bone marrow stromal stem cells, natural extracelhilar matrix gel and degradable polylactic acid tube. Polylactic acid robe group: injecting extracellular matrix gel into degradable polylactic acid tube to bridge neurologic defect. Autologous nerve group: 10 mm of nerve was cut and performed end-to-end anastomosis after revolving 180 degrees. MAIN OUTCOME MEASURES: Functional recovery of sciatic nerve was detected with electrophysiological observation of nerve, and histological observation and axon count of the newly generated nerve tissue at 12 weeks after transplantation. RESULTS: After introduction, adult bone marrow stromal stem cells had the morphology and properties of Schwann cells. The regenerated nerve had grown to the distal end passing through the defect at 12 weeks after transplantation. The detection indexes in the tissue-engineered nerve group and autologous nerve group were better than that in the polylactic acid tube group (P < 0.05), there were no significant differences between the tissue-engineered nerve group and autoiogous nerve group (P < 0.05); The degradation and absorption of polylactic acid tube were obvious in the tissue-engineered nerve group and autologous nerve group. CONCLUSION: Human bone marrow stromal stem cells can be induced to differentiate into Schwann cells in vitro, and tissue-engineered nerve constructed with Schwann cells, extracellular matrix and degradable polylactic acid tube can repair peripheral neurologic defect.

Medical quality control is at the core of the various managerial tasks of the hospital and the managerial ideas involved determine the quality of the control. The authors analyze in depth the structural features of fundamental, link and terminal medical quality, and in light of their experience in hospital management, put forward a principle of and a framework of ideas for medical quality control. The principle is as follows: focusing on the patients, putting quality at the core, laying equal stress on fundamental, link and terminal quality, and promoting simultaneously self-control and supervision in an all-round way. The framework of ideas is as follows: focusing on the patients should be based on putting quality at the core; fundamental medical quality should be based on basic rules and regulations; link medical quality should be based on the "three basics and three aspects of strictness" ; and terminal medical quality should be based on the education and involvement of the entire staff.

Objective To evaluate the clinical efficacy of Memotherm TM stent,a type of metallic stent in the management of secondary ureteropelvic junction obstruction. Methods From October 1995 to June 2001,13 cases (10 males and 3 females,mean age of 41 years) of secondary ureteropelvic junction obstruction underwent the Memotherm TM stenting.They were all followed up for an average of 26 months by B ultrasound,IVU,radionuclide renography and ureteroscopy. Results Of the 13 case,8 were cured,and 3 achieved improvement,while 2 cases failed.The main complications of endoprosthetic fibrotic stricture occurred in 5 cases.The forceps or YAG laser through ureteroscopy was used to remove the endoprosthetic fibrotic tissues. Conclusions Memotherm TM stent is mostly effective in the treatment of patients with secondary ureteropelvic junction obstruction,especially for patients who has undergone multiple operations or those are ineligible for open surgery.This procedure can significantly reduce the recurrence of ureterostenosis.

Objective To summarize the causes of failed drainage of double J ureteral stents following ureteroscopy. Methods From June 2000 to March 2003,the double J ureteral stents were placed for 3972 patients (2184 males and 1788 females)following ureteroscopy.The stents were placed through retrograde approach in 3138 cases,through antegrade approach in 1497 cases.The patients were followed up until the ureteral stents were retrieved. Results Of the 4635 cases,failed drainage of double J ureteral stent was found in 115 cases (2.48%).The main causes were severe extra luminal obstruction,serious steinstrasse,severe ureteral stricture and overperiod placement of ureteral stents. Conclusions Correctly identifying the indications for ureteroscopy and the placement of double J ureteral stents as well as close follow up are the keys to reduce the failure rate of drainage of double J ureteral stents following ureteroscopy.

The protein,the fats,the carbohydrate and the nucleic acid are the main constituent material of normal cell and organizations. In the early process of becoming malignant,these chemical substance's structure,the conformation and quantity has had the obvious change,but this time clinical symptoms and medicine phantom study still has not obvious change.But the Raman spectrum can actually reflect these changes.Therefore the Raman spectrum technology becomes important means of the malignant tumor early diagnosis and the cancer mechanism research hopefully.This article makes a summary on the present as well as the progress reviewed of Raman spectrum technology in the tumor research application.

Objective To describe the preoperative factors of prolonged intensive care unit length of stay after coronary artery bypass grafting. Methods From 1997 to 2009, 1318 patients underwent isolated CABG in our hospital. Retrospective analysis was performed on these cases. Univariate and multivariate analyses for preoperative risk factors were performed. Prolonged length of ICU stay was defined as initial admission to ICU exceeding 72 h. Results The mean age of patients ( 322women and 996 men) was (67.4±9.4) years. Of 1318 patients undergoing isolated CABG from 1997 to 2009, 205 experienced prolonged length of ICU stay. The length of ICU stay was (40.1 ± 22.5 ) hours and ( 122.6 ± 48.7 ) hours separately.Overall in-hospital mortality was higher among these 205 patients ( 13.7% vs. 1.2%, P ＜0.05 ). The overall mortality was 3.1%. In univariate analyses, there were statistically significant differences with respect to the percentage of CPB, total bypass time, cross-clamp time, number of distal anastomoses, use of pressor agent, use of intro-aortic balloon pump,time of ventilation and hospital mortality. The significant risk factors were age, NYHA class Ⅲ/Ⅳ, left ventricular ejection fraction(LVEF) ＜0.40, renal failure, cerebrovascular and/or peripheral vascular disease, chronic obstructive pulmonary disease, recent acute myocardial infarction, prior percutaneous coronary intervention, left main stenosi, three-vessels disease. The variables entered into the multivariate logistic regression were age, NYHA class Ⅲ/Ⅳ, LVEF ＜0.40, renal failure, chronic obstructive pulmonary disease, recent acute myocardial infarction, prior percutaneous coronary intervention, three-vessels disease. According to the outcome of multivariate logistic regression, we can conclude the model of probability forecast and create a new variable named Pre. The area under ROC curve of the new variable Pre was larger than other variables. Conclusion The main risk factors of prolonged ICU length of stay were LVEF ＜ 0.40, recent acute myocardial infarction, renal failure and chronic obstructive pulmorary disease. The AUC of variable Pre was higher than other' s , which indicated that new variable Pre combining each variable was more valuable than single variable with respect to prediction. A predicted probability of 0. 754 was used as cut-off point for the prognostic test.

Multiple myeloma (MM) is a heterogeneous disease.The prognosis of MM varied a lot among different patients.One of the main basis of risk stratification is genetic abnormality,which including the number or structure anomaly of chromosomes,genetic aberrations,signaling pathway disorders and epigenetic changes.The risk stratification is being revised with the development of FISH,gene-expression profiling and next-generation sequencing.These combined approaches would hopefully transform the current one-for-all care into a more tailored,individual therapeutic strategy for MM patients and would finally improve their quality of lives.