Multiple myeloma is a multi-step disease, and different steps have different sensitivities to chemotherapy and radiotherapy. Low sensitivity can result in recurrent and refractory multiple myeloma. The growth of myeloma cells, apoptosis inhibition and drug resistance depend on the participation of immunomodulatory cytokines and vascular endothelial growth factors, such as IL-6 and VEGF. Thalidomide, an effective drug for multiple myeloma, has both anti-angiogenesis effect and immunoregulatory function; but long term use of thalidomide can result in complications such as deep venous thrombosis. Immunomodulatory drugs (IMiDs)are more effective thalidomide analogues and they have become a focus of study. IMiDs have anti-angiogenesis effect; they can co-stimulate T cell subgroup, induce cytokine production, and increase the quality and quantity of NK cells, exerting cytotoxic effect against tumor cells via antibody dependent manner. This article reviews the mechanism of IMiDs in treatment of multiple myeloma and the preliminary result of the clinical trails.

Objective: To review clinical characteristics of cardiac and pericardial hydatid cysts and assess the results of surgical treatment. Methods: From February 1978 to July 1999, 13 patients were diagnosed as heart and/or pericardium echinococcosis. There were nine male and four female. Their age ranged from 8 to 36 years ［mean (23.0±8.5) years］. 10 patients were symptomatic and 3 were asymptomatic. 3 patients had involvement of liver or lung. Pathologic cardiac murmur or cardiac enlargements were found in 10 patients. All patients were examined with chest roentgenograms, electrocardiogram and echocardiography. The serologic test was positive in 11 cases and negative in 3 cases. One right atrial cyst was removed under extracorporal circulation. 4 single pericardial cyst and multi-pericardial cyst were resected, 6 myocardial cysts and one complicated myocard ial and pericardial cysts were resected through puncture-aspiration endocystect omy. Results: All patients were followed up from six months to six years ［mean (3.5±1.5) years］. One late death occurred ten-month after operation, and the cause of death was heart failure. 3 patients had recurrence and were reoperated. Conclusion: The clinical characters may vary according to the number, size and location of cysts. Echocardiography is important for surgical planning. The results of endocystectomy of cardiac and pericardial echinococcosis were excellent.

Objective To evaluate the value of mini-thoracotomy for open heart surgery.Methods From December 1995 to January 2008,810 patients including 660 cases of congenital heart diseases,129 cases of valvular heart diseases and 21 cases of heart myxoma,underwent open heart surgery by mini-thoracotomy through cardiopulmonary bypass in our hospital.Among the cases,superior median sternotomy was performed on 36 patients,inferior median sternotomy was made on 59,right parasternal mini-thoracotomy was carried out in 3,right anterolateral thoracotomy was done on 658,and right axillary mini-thoracotomy was used in 54.A total of 382 patients received beating-heart surgery.Results The postoperative mortality in our patients was 1.5%(12 cases).In this series,the mean postoperative mechanical ventilation time,drainage volume,and hospital stay were(6.7?4.2) hours,(210?165) ml,and(7.4?4.9) days respectively.421 of the patients received no blood transfusion.None of the patients developed sternal dehiscence or mediastinal infection.Follow-up was available in 690(85%) of the patients up to a mean of(48.2?25.3) months,none of them died during the period.The cardiac function of the patients was significantly improved after the operation(preparation vs postoperation: 310 cases vs 478 cases for grade Ⅰ,438 vs 212 for grades Ⅱ-Ⅲ,and 62 vs 0 for grade Ⅳ,Z=-13.21,P=0.000).The mean cardiothoracic ratio was decreased significantly after the operation(0.51?0.11 vs 0.53?0.08,t=4.065,P=0.000),while the left ventricular ejection fraction was increased markedly(0.63?0.11 vs 0.57?0.11,t=-10.529,P=0.000).Conclusions The mini-thoracotomy is superior in cosmetic results and the postoperative morbidity rates of sternal malformation and infection.Proper selection of patients,good exposure of the surgical field,and skillful surgical procedures are crucial for the outcomes of the operation.

Objective To study and compare the clinical efficacy between intravitreal conbercept injection and (or) macular grid pattern photocoagulation in treating macular edema secondary to non-ischemic branch retinal vein occlusion (BRVO).Methods Ninety eyes of 90 patients diagnosed as macular edema secondary to non-ischemic BRVO were enrolled in this study.Forty-eight patients (48 eyes) were male and 42 patients (42 eyes) were female.The average age was (51.25 ± 12.24) years and the course was 5-17 days.All patients were given best corrected visual acuity (BCVA),intraocular pressure,slit lamp with preset lens,fluorescence fundus angiography (FFA) and optic coherent tomography (OCT) examination.The patients were divided into conbercept and laser group (group Ⅰ),laser group (group Ⅱ) and conbercept group (group Ⅲ),with 30 eyes in each group.The BCVA and central macular thickness (CMT) in the three groups at baseline were statistically no difference (F=0.072,0.286;P=0.930,0.752).Patients in group Ⅰ received intravitreal injection of 0.05 ml of 10.00 mg/ml conbercept solution (conbercept 0.5 mg),and macular grid pattern photocoagulation 3 days later.Group Ⅱ patients were given macular grid pattern photocoagulation.Times of injection between group Ⅰ and Ⅲ,laser energy between group Ⅰ and Ⅱ,changes of BCVA and CMT among 3 groups at 1 week,1 month,3 months and 6 months after treatment were compared.Results Patients in group Ⅰ and Ⅲ had received conbercept injections (1.20 ± 0.41) and (2.23 ± 1.04) times respectively,and 6 eyes (group Ⅰ) and 22 eyes (group Ⅲ) received 2-4 times re-injections.The difference of injection times between two groups was significant (P＜0.001).Patients in group Ⅱ had received photocoagulation (1.43 ±0.63) times,9 eyes had received twice photocoagulation and 2 eyes had received 3 times of photocoagulation.The average laser energy was (96.05 ±2.34) μV in group Ⅰ and (117.41 ±6.85) μV in group Ⅱ,the difference was statistical significant (P=0.003).BCVA improved in all three groups at last follow-up.However,the final visual acuity in group Ⅰ and group Ⅲ were better than in group Ⅱ (t=4.607,-4.603;P＜0.001) and there is no statistical significant difference between group Ⅲ and group Ⅰ (t=-0.802,P=0.429).The mean CMT reduced in all three groups after treating for 1 week and 1 month,comparing that before treatment (t=-11.855,-10.620,-10.254;P＜0.001).There was no statistical difference of CMT between group Ⅰ and Ⅲ at each follow up (t=0.404,1.723,-1.819,-1.755;P=0.689,0.096,0.079,0.900).CMT reduction in group Ⅰ was more than that in group Ⅱ at 1 week and 1 month after treatments (t=-4.621,-3.230;P＜0.001,0.003).The CMT in group Ⅲ at 3 month after treatment had increased slightly comparing that at 1 month,but the difference was not statistically significant (t=1.995,P=0.056).All patients had no treatment-related complications,such as endophthalmitis,rubeosis iridis and retinal detachment.Conclusions Intravitreal conbercept injection combined with macular grid pattern photocoagulation is better than macular grid pattern photocoagulation alone in treating macular edema secondary to non-ischemic BRVO.Combined therapy also reduced injection times comparing to treatment using conbercept injection without laser photocoagulation.

Objective Thymic epithelial tumors(TET) consist of thymoma and thymic carcinoma. The purpose of this study was to investigate the diagnostic value of 18 F-fluorodeoxyglucose (FDG) coinci-dence SPECT imaging in TET. Methods 18 F-FDG coincidence SPECT images of 37 TET patients ( male 16, female 21, age range 24-82 years; mean age 55 years) were retrospectively analyzed according to the simplified WHO histological classification: high survival thymoma (types A, AB and B1 ), median survival thymoma (types B2 and B3 ), and low survival thymoma (thymic carcinoma). Qualitative visual interpreta-tion was based on foci of18F-FDG uptake'higher than that of normal mediastinum. Turnour/lung radioactivity ratio (TLR) was calculated from the counts of region of interest (ROI) drawn around the mass and over a comparable area of normal lung tissue in TET patients. The distribution of18F-FDG uptake was compared with the enhanced CT findings. TLR was also correlated with the Ki67-1abeling index. Statistical comparison for TLR in different groups were performed with variance analysis. Results Thirty-four TET were positive and 3 negative ( A, A, AB) by 18 F-FDG coincidence SPECT images. The differences among the 3 sub-groups were statistically significant (F=9.99,P<0.05). The TLR of these 3 subgroups was variable: 1.42±0.27, 2.13±0.74, 3.00±1.19, respectively. A close correlation (r=0.613, P=0.002) of the TLR with the Ki67 labeling index (n= 22) was found. In addition, 18 F-FDG coincidence SPECT detected two metastases ( anterior chest wall and right supraclavicular fossa lymph node) that were not identified on enhanced CT. Conclusions 18 F-FDG coincidence SPECT is useful in differentiating subgroups of thymic epithelial tumors and in identifying more invasive thymic lesions.18 F-FDG may be a novel tracer that ena-bles in vivo evaluation of cellular proliferation in human TET.

Objective To explore the effects of high intensity focused ultrasound (HIFU) on cell multiplication and apoptosis at exposure coverage and marginal zone and the expression of vascular endothelial growth factor (VEGF) and proliferating cell nuclear antigen and apoptosis of subcutaneous neurogliocytoma in nude mice. Methods Eighteen nude mice bearing subcutaneous human neurogliocytoma were consecutively ablated in 20s by an extracorporeal HIFU with 9.7MHz transducer (the focal length of 4.5mm and focal intensity 2500W/cm2). The 18 nude mice were randomly di?vided into 7 d group,14 d group and 30 d group according to sacrifice date. Immunohistochemical method, TdT-mediat?ed dUTP nick end labeling method were used to examine the expression of vascular endothelial growth factor and prolifer?ating cell nuclear antigen and apoptosis at exposure coverage, marginal zone and normal zone, respectively. Results The expression of VEGF and proliferating cell nuclear antigen were evident at exposure coverage, marginal zone and normal zone in 7, 14 and 30 days after ablation. The expression of proliferating cell nuclear antigen and apoptosis were absent at exposure coverage in 7,14 and 30 days after ablation. The percentage of VEGF expression was lower in marginal zone than in normal zone (23.79%± 3.11% vs. 46.16%± 2.43%) in 7 d after ablation (F=110.03,P<0.05). The percentage of VEGF expression was also lower (10.94%±3.95%) in exposure coverage than in normal zone (46.16%±2.43%) in 7 d af?ter ablation (F=272.80,P<0.05). The percentage of VEGF expression was lower in marginal zone than in normal zone (17.17%±2.89%vs. 43.47%±3.77%) in 14 d after ablation (F=152.05,P<0.05). The percentage of VEGF expression was lower in marginal zone than in normal zone (9.27%± 2.08%vs. 44.58%± 3.34%) in 30 d after ablation (F=274.1,P<0.05 2). The proliferating cell nuclear antigen labeling index(PCNA LI) was lower in marginal zone than in normal zone ((33.04%±4.31%vs. 65.15%±3.85%) in 7 d after ablation (F=242.46, P<0.05). The PCNA LI was lower in marginal zone than in normal zone (21.05%± 1.96%vs. 62.99%± 3.34%) in 14 d after ablation (F=413.52, P<0.05). The PCNA LI was lower in marginal zone than in normal zone (6.36%± 0.51% vs. 62.07%± 18.07%) in 30 d after ablation, (F=729.59, P<0.05) .The apoptotic index (AI) was higher in marginal zone than in normal zone (26.10%±4.54%vs. 1.43%±0.35%) in 7 d after ablation, (F=216.22, P<0.05). The apoptotic index(AI) was higher in marginal zone than in normal zone (65.70%± 1.14% vs. 1.82%± 0.31%) in 14d after ablation (F=1448.64, P<0.05). The apoptotic index (AI) was higher in marginal zone than in normal zone (82.02%± 3.98% vs. 2.52%± 0.29%) in 30d after ablation (F=2244.33, P<0.05). Conclusion The present study demonstrates that an extracorporeal HIFU with 9.7MHz transducer (the focal length of 4.5mm and fo?cal intensity 2500W/cm2) can completely ablate neurogliocytoma at exposure coverage and inhibit the proliferation of neurogliocytoma at marginal zone. Thus, HIFU may be a new and selective treatment for neurogliocytoma.

Objective To evaluate the efficacy and safety of Qianliejiedu capsule in the treatment of chronic prostatitis. Methods A multi-central,randomized,double-blind clinical trial was conducted.A total of 209 patients diagnosed as chronic prostatitis were randomly divided into two groups:the trial group were treated with Qianliejiedu Capsule,5 pills were taken orally for each time,twice a day;the control group were given Qianlietai Pill,5 pills were taken orally for each time and 3 times a day.All patients of the tWO groups were treated for 4 weeks,The efficacy was evaluated by urethra irritating,painful or discomfortable symptoms,and the WBC count in EPS after the treatment.Clinical criteria divided into 4 types,cure:symptom score compared with a decrease≥90%;markedly effective:symptom score compared with a decrease of 60%to 89%;effective:symptom score comparedwith a decrease of 30%to 59%;invalid:symptom score compared with a decrease of＜30%.Results There were 102 patients in the treatment group,11 got cured,49 cases were remarkably effectire,28 eases were effective,14 eases were ineffective and the total effective rate was 86.2%(88/102).There were 98 patients in the treatment group,4 got cured,38 cases were remarkably effective,35 cases were effective,21 cases were ineffective,and the total effective rate was 78.6%(77/98).The trial group and the control group could improve the symptoms such as frequent micturition,the remaining urine,the lower abdomen ache,the urethra stabbing pain,the unwell perineum,the waist and sacrum ache,the moist scrotum,and the testicle ache.The vanishing rate of the trial group was 87.6%,82.1%,74.5%,84.1%,93.7%,80.3%,82.5%,82.3%;and the control group was 74.7%,73.0%,71.0%,74.2%,71.4%,67.9%,72.3%,76.2%.The vanishing rates of frequent micturition symptom of the 2 groups were significantly different(P=0.032).The result of WBC of the trial group before treatment was as follows:WBC 10-19 28 cases,WBC 20-29 33 cases,WBC≥30 41 cases.The result of WBC of the trial group after treatment was as follows:WBC＜10 45cases,WBC 10-19 34 cases,WBC 20-29 20 cases,WBC≥30 3 cases.The result of WBC of the control group before treatment was as follows:WBC 10-19 26 cases,WBC 20-29 35 cases,WBC:≥30 37 cases.The result of WBC of the control group after treatment was as follows:WBC＜10 42 caaes,WBC 10-19 33 cases,WBC 20-29 15 cases,WBC≥30 8 cases.There were significant differences between the before and after treatment results(P＜0.05).Two cases in the trial group and 3 cases in the control group had mild adverse reactions such as nausea,epigastric discomfort,and watery stool. Conclusion Qianliejiedu capsule is effective and safe for the treatment of chronic prostatitis.

Objective To assess the estimated 10-year risk of stroke among hypertensive outpatients known with diabetes from cardiovascular clinics of 36 tertiary hospitals in China and to analyze the characteristics of the risk factors and the 10-year risk of stroke between the southern and the northern patients.Methods A multi-center prevalence survey was conducted from October 2011 to June 2012.Hypertensive outpatients known with diabetes were enrolled from cardiovascular clinics of 36 tertiary hospitals in China.A total of 15 914 outpatients were included in the final analysis.The 10-year probability of stroke was evaluated by the Framingham stroke risk profile.According to the 10-year probability of stroke,patients were divided into low risk (≤ 5％),medium risk (6％ ～9％) and high risk (≥10％).Results (1) Of all the hypertensive outpatients known with diabetes,the mean age was (64.6 ± 10.1) years and the mean systolic pressure was (138.7 ± 19.3) mmHg(1 mmHg =0.133 kPa).Among them,7.4％ with atrial fibrillation,11.2％ with left ventricular hypertrophy,57.2％ with cardiovascular diseases,17.1％ smokers and 37.0％ using mono-hypoglycemic agent.The southern patients who were older with more smokers had higher proportions of men and left ventricular hypertrophy,lower Levels of systolic blood pressure,and lower proportions of other cardiovascular diseases than those of the northern patients (all P ＜ 0.05).(2) The mean 10-year probability of stroke was (20.9 ± 16.2) ％.The southern patients had a higher mean 10-year probability of stroke than that of the northern patients [(22.4 ± 17.1)％ vs (19.7 ± 15.2)％] (P ＜ 0.01).After adjusted by age and sex,the southern patients still had a higher mean 10-year probability of stroke (P ＜0.05).(3) All the patients had 7.7％ with low risk,17.4％ with medium risk,and 74.9％ with high risk.The southern patients had lower proportions of low and medium risk than those of the northern patients (6.7％ vs 8.4％,15.5％ vs 18.9％),but had a higher proportion of high risk than that of the northern patients (77.7％ vs 72.7％,all P ＜ 0.01).Conclusions Among the hypertensive outpatients known with diabetes from the cardiovascular clinics of our study,most of them were at the 10-year high risk of stroke.The southern patients had a higher mean 10-year probability of stroke than that of the northern patients.

Objective To study the preventive and therapeufic effect of sheep bone collagen peptide (SBCP) on osteoporosis of ovariectomized rats. Method Thirty-two 3.5 mon unmated SD female rats were randomly divided into 4 groups by weight:blank group (sham operation), control group (ovariectomized), sample 1 group (ovariectomized and fed freeze drying SBCP) and sample 2 group (ovariectomized and fed spray drying SBCP). Seven days after ovariectomy,the blank group and ovariectomized group were given distilled water (1 ml/100 g?d), the sample 1 and sample 2 group were given sample 1 and sample 2 (1000mg/kg.d). Body weight, feed efficiency, serum bone metabolizing index and bone density (BD), length and diameter of femur were measured 10 w later. Results The alkaline phosphatase (ALP) of ovariectomized or control group was significantly increased, but the increase was restrained in sample 1 and sample 2 group. The BGP of ovariectomized group was significantly higher than that of the blank group, and the BGP of sample 1 and sample 2 group was lower than that of the ovariectomized group, nearly equal to the blank group. The BD of ovariectomized group was declined significantly, but that of sample 1 and sample 2 group was declined slowly. The BD of sample 2 group washigher than that of ovariedomized group, even similar to the blank group. The length and diameter of femur in the sample groups were larger than those of ovariectomized group. The effect of sample 1 and sample 2 on serum bone metabolism indices and femur size was not significantly different. Conclusion Sheep bone collagen polypeptide can reduce the resorption of bone, promote bone growth, and also reduce postmenopausal osteoporosis effectively. The different drying methods have no difference in the anti-osteoporosis effect.

?AIM:To evaluate the clinical outcomes of Nd:YAG laser capsulotomy in the treatment of early stage capsular block syndrome ( CBS) .?METHODS:Eighteen patients (21 eyes) with early stage capsular block syndrome were treated using Nd:YAG laser by anterior capsulotomy only or combined with posterior capsulotomy from January 2010 to July 2015 in Anyang Eye Hospital. Uncorrected distance visual acuity, intraocular pressure, spherical equivalent, depth of anterior chamber were observed preoperatively and 2wk postoperatively.?RESULTS:Seventeen eyes simply underwent peripheral anterior capsulotomy with Nd:YAG laser. Four eyes were combined with posterior capsulotomy. Compared with preoperative, uncorrected distance visual acuity improved, intraocular pressure returned to normal, degree of myopia reduced, depth of anterior chamber had deepened.? CONCLUSION: Nd: YAG laser capsulotomy is an effective treatment for early stage capsular block syndrome.