In this last decade,one of the major advances in the management of multiple myeloma has been the introduction of the novel agents thalidomide,bortezomib,and lenalidomide as part of treatment in young patients eligible for high-dose therapy (HDT) and autologous stem cell transplantation (ASCT).These drugs have markedly improved the rate of complete remission both before and after ASCT without substantially increasingly toxicity.The implementation of an ‘optimal strategy’ consisting of novel-agent-based induction,HDT,and the use of novel agents in consolidation and maintenance may result in 5-year survival rate of 80 ％ and cure might be considered in a subset of patients who present with good prognostic features at the time of diagnosis.Nevertheless,the high efficacy of the novel agents has led some groups to test these agents upfront without ASCT.At the end of 2014,preliminary randomized data favor early ASCT plus novel agents over novel agents alone.Therefore,the optimal approach to the treatment of multiple myeloma is still to propose the most effective treatment that should involve the use of frontline ASCT in young patients eligible for HDT.This article reviews the latest research presented at the 56th American Society of Hematology (ASH) annual meeting on the multiple myeloma and its clinical management.

Multiple myeloma (MM) is a plasma cell malignancy. With the development of the understanding of MM, the diagnosis is no more limited to bone marrow biopsy and imageological examination. Serum free light chain, cytogenetic analysis and molecular biology study are becoming increasingly widely used, which give us a deeper under-standing of the mechanisms of MM and provide us with a clearer prognosis evaluation. Here is to make a review of the diagnosis and its development of MM from laboratory examination, diagnosis criteria and classiifcation.

Objective To study features and significance of clinical stages and types of severe acute respiratory syndrome (SARS). Methods The clinical features of 330 patients with SARS were analyzed by SPSS 11.0 and SDAS software packages, and the standard for classification of clinical stages and types of SARS were studied. Results The disease course of SARS could be divided into four stages, namely, incubation stage, initial stage, climax stage and convalescence stage. The period of incubation stage was 1~12 (5.70?2.45) days. The initial stage was the pathoformic phase during 1 st~10 th (3.98?2.48) days after the onset. The fever was the first symptom and there were usually no catarrhal symptoms. Meanwhile, no abnormality was found in the chest X-ray examination. The climax stage included 3 sequential phases of pulmonary inflammatory exudation, pulmonary tissue consolidation and ARDS or multi-organ failure. In the phase of pulmonary inflammatory exudation, there were serious cough, mild shortness of breath and hypoxemia. Furthermore, chest X-ray examination showed that there was exaggeration of lung markings, haziness or patchy opacity. In the phase of pulmonary tissue consolidation, type I respiratory failure was usually seen in the patients. Shortness of breath and hypoxemia became more serious. Chest X-ray examination showed that the area of consolidation continued to enlarge to include the entire lung. The convalescence stage usually appeared 3 weeks after the onset and lasted for 5～56 (24.37?8.81) days. This stage could further be divided into phase I (complete recovery) and phase II (possible existence of pulmonary fibrosis). SARS could be clinically classified into mild type (ordinary type), severe type and extremely severe type (fulminant type) with a mortality of zero, 5.76% and 61.54%, respectively. There were very great differences in clinical features in three types of SARS. Conclusions SARS could be divided into the incubation stage, initial stage, climax stage and convalescence stage. The climax stage included 3 phases, i.e. pulmonary inflammatory exudation, pulmonary tissue consolidation, and ARDS or MOF. The convalescence stage could be divided into phase I (complete recovery) and phase II (possible existence of pulmonary fibrosis). SARS could be classified as mild type, severe type and extremely severe type.

Objective To analyze the clinical features of severe acute respiratory syndrome(SARS) in order to look for premonitory signs of deterioration of patients suffering from SARS. Methods Three hundred and thirty patients with SARS referred to the Chinese Disease Center(CDC) in Beijing were studied retrospectively by SPASS and SDAS software. The data reviewed included clinical manifestations, laboratory findings, and X-ray pictures. Results The prognosis of mild SARS was good with a cure ratio of 100%. Chest radiography revealed opacity or small subtle opacity in lung periphery in 53.1%, there were no signs of acute lung injury in 67.2%, and the opacity disappeared rapidly. In patients with severe SARS, the disease course was longer(41.3?5.6day), the duration of high fever was longer (8.66?3.22day), with the highest temperature reaching 39.04?0.71℃. The duration of respiratory insufficiency was also longer(8.80?4.56day), and 71.8% of them manifested acute lung injury, involving a large area of the lung, with central lesions in 21.8% or mixed in 50%. The opacity was denser, and it took a longer period to resolve. The levels of LDH, HBDH, ESR and CK-MB were high, with HBDH/LDH ratio ranged from 0.8 to 1.0. The mortality was high(14.54%). Logistic regression analysis showed that the premonitory mode of deterioration of the disease was P y=1=? s /(1+? s)(S=-10.598+0.102A+0.592B+0.077C+0.494D), with sensitivity of 86.67%, and specificity 80%, and it was correlated with age, duration of respiratory insufficiency, ESR, and duration of high temperature. Conclusions The premonitory mode of deterioration of SARS is a new, simple, low-cost, biomathematically and pathophysiogically based index. It allows the prediction of deterioration and severity of SARS.

Objective To analyze the single factor affecting prognosis of SARS, and to establish a model of regression analysis for multiple factors affecting the prognosis of the disease. Methods SPSS 11.0 and SDAS software packages were used to retrospectively analyze the clinical features of SARS in 165 clinically confirmed severe cases. Meanwhile, single-factor and logistic multivariate regression analyses were conducted for SARS prognosis to establish a regression model for SARS prognosis analysis. Results (1) In patients with SARS, the age was significantly correlated to prognosis (r=0.506, P0, then P y=1 was over 0.5, it denoted death of the patient. In condition of S

Multiple myeloma (MM) is a hematological malignancy caused by the clonal expansion ofbone marrow plasmacytes.It accounts for 10 ％ of all hematological malignancies.The proteasome,an intracellular enzyme complex that degrades ubiquitin-tagged proteins to regulate protein levels within the cell,plays an important role in maintaining cellular homeostasis.Proteasome inhibitors proved to be significantly effective in the clinical treatment of MM.In recent years,the application of the proteasome inhibitor has led to increased survival rates in MM patients.Bortezomib is the first proteasome inhibitor that has been approved by the US Food and Drug Administration due to its ability to reversibly inhibit the 26 s proteasome functions.Despite the fact that Bortezomib improves medical treatment,many patients experience difficulty responding to this drug and some patients who do respond eventually relapse.These results have led researchers to investigate new proteasome inhibitors with mechanisms different from those of Bortezomib.Some drugs that bind to the active site of the proteasome and irreversibly inhibit the complex have recently been developed and are currently being tested in advanced clinical trials.Here,we will elaborate on the proteasome inhibitors targeting MM and focus on newly discovered inhibitors that may overcome the resistance to Bortezomib.

Despite many recent advances in the treatment of multiple myeloma (MM), the course of the disease is characterized by a repeating pattern of periods of remission and relapse as patients cycle through the available treatment options. Evidence is mounting that long-term maintenance therapy may help suppressing residual disease after definitive therapy, prolonging remission and delaying relapse. For patients undergoing autologous stem cell transplantation (ASCT), lenalidomide maintenance therapy has been shown to improve progression-free survival (PFS), however, it is still unclear whether this translates into extended overall survival (OS). For patients ineligible for ASCT, continuous therapy with lenalidomide and low-dose dexamethasone is shown to improve PFS and OS (interim analysis) compared with a standard, fixed-duration regimen of melphalan, prednisone, and thalidomide in a large phase Ⅲ trial. Other trials have also investigated thalidomide and bortezomib maintenance for ASCT patients, and both agents have been evaluated as continuous therapy for those who are ASCT ineligible. However, some important questions regarding the optimal regimen and duration of therapy must be answered by prospective clinical trials before maintenance therapy, and continuous therapy should be considered routine practice. This article reviewed the available data on the use of maintenance or continuous therapy strategies and highlights ongoing trials reported in the 57th American Society of Hematology (ASH) annual meeting that would help to further define the role of these strategies in the management of patients with newly diagnosed MM.

The epidemic situation of influenza A(H1N1) throughout the world had evoked close attention of the World Health Organization(WHO).WHO director-general pointed out that the pandemic alert level had been set at 3,which was then raised by WHO from 3 to 4 and from 4 to 5 two days later.The present paper focused on the finding of influenza virus,the influenza prevalence in history,and introduced the scientific countermeasures for influenza A(H1N1),including the spreading of influenza virus,the clinical features,treatment,main measures of prevention and control,etc.

OBJECTIVE To evaluate the status of the anxiety and depression in the inpatients of the otolaryngology with hospital anxiety and depression scale(HADs). METHODS A cross-sectional study was conducted from October 2014 to September 2016 at the Department of Otolaryngology, Affiliated Hospital of Yan'an University. We recruited 624 Chinese otolaryngology's inpatients to determine the prevalence of anxiety and depression using the HADs. HADs consists of 14 items, depression(seven items) and anxiety(seven times), each with four choices numbered alphabetically. Each of the subscales' scores ranges from 0 to 21, corresponding to total scores of 0 to 42, with higher scores indicating greater distress. Psychological distress was assessed for adult inpatients among the department of otolaryngology by a standardized HADs. In addition, the nasal bone fracture patients were treated as control and compared it to other diseases. Demographic data and clinical information collected from the patients and their hospital records were reviewed. RESULTS 1. Patients with sensorineural hearing loss, secretory otitis media, sudden sensorineural hearing loss, benign paroxysmal positional vertigo, peripheral facial paralysis, chronic sinusitis, polyp of vocal cord, laryngeal paralysis, fungal sinusitis and OSAHS revealed depressive and anxiety symptoms in comparison with the control. 2. Psychological distress of patients with sensorineural hearing loss and laryngeal paralysis were significantly related to education, which the anxiety or depression scores tended to increase with the education(P<0.05). CONCLUSION Depression and anxiety disorders were common in the local population of otolaryngology's inpatients. Recognizing the predictors for psychiatric morbidity could assist clinicians to identify those patients with a predisposition to developing psychiatric complications, and refer them for appropriate treatment. We recommend screening for psychological distress in patients with some otolaryngological diseases using a simple HAD tool to identify those patients who might benefit from a more psychologically based approach to therapy.

Objective To investigate the epidemic status of endemic fluorosis in Shandong Province,Jining City,and to provide a basis for prevention and control of the disease.Methods Based on Shandong Provincial Project Technical Solutions for Endemic Fluorosis,Rencheng,Jinxiang,Yutai,Jiaxiang and Liangshan Counties in Jining were selected as monitoring sites.According to the illness situation of mild,moderate or serious districts,one village was selected as a major survey site from each county(district).There were a total of 15 such villages selected.Survey content included drinking water fluorine level; dental fluorosis of children,adults' clinical skeletal fluorosis and urinary fluorine levels; water and urinary fluoride content were determined by the method of fluoride ion selective electrode; dental fluorosis of children was diagnosed by Deans method and clinical diagnosis was based on the Diagnostic Criteria of Endemic Skeletal Fluorosis (WS 192-2008).Results Sixty-one water samples from 15 villages of five counties (districts) were tested.Fluoride levels of 9 out of the 61 samples were exceeded the national standard (＞ 1.0 mg/L),and the rate was 14.75％; 1 sample ＞ 2.0 mg/L,and the maximum water fluoride was 2.25 mg/L.Seven hundred and seventeen people's real time urinary fluoride was detected in the 15 villages,including 420 children and 297 adults,and the geometric mean were 1.53 and 1.69 mg/L,respectively.Clinical examination of 755 children aged 8 to 12 showed that the detection rate of dental fluorosis was 26.89％ (203/755); defect rate was 9.12％(29/755) and dental fluorosis index weres 0.65.The detection rate of clinical skeletal fluorosis of 11 565 adults was 4.76％(550/11 565),including 303 moderate or serious cases.Conclusions The situation of excessive water fluorine in outside environment in Jining City has been controlled at a certain degree; groups urinary fluoride level is closed to the normal upper limit; the prevalence of dental fluorosis or skeletal fluorosis has been suppressed at a certain degree,therefore,the results of control should be further consolidated and expanded,in order to completely eliminate the fluoride hazard.