Lenalidomide is an oral immunomodulator with multiple functions including immune regulation, anti-tumor, and regulation of tumor microenvironment. Since the United States Food and Drug Administration (FDA) approved lenalidomide for the treatment of mantle cell lymphoma, recent studies have indicated that lenalidomide monotherapy or lenalidomide combinations in other types of lymphoma also has broad prospects. The treatment progress of lenalidomide in lymphoma will be summarized in this paper based on the new reports in the 57th American Society of Hematology (ASH) annual meeting.

It put forward the mechanism of drug pricing and price-adjusting based on classification of drug value.It can set different prices according to different value The higher the value is,the higher the price will be.It could embody the principle of good quality,good price so as to and ensure the unity of price and value.

Objective To explore the microsurgical technique and results of the large acoustic neurinoma and the facial nerve preservation.Methods 35 cases of large acoustic neurinoma treated microsurgically were analyzed retrospectively.Results Total resection was achieved in 33 patients,subtotal in one patient and partial in one patient.The facial nerve was preserved completely in 32 cases (91.4%).One died postsurgery.Conclusion The application of microsurgical techniques and rational selection of operational approach can remarkably increase the total removal rate and facial nerve preservation rate.

PET-CT is the only current medical imaging technology to provide both metabolic and morphologic information in anatomical configuration mode,with high sensitivity and non-invasion.As one of the optimal measures in tumor diagnosis and therapy,abnormally-increased FDG uptake of some subtypes therefore makes an increasing application of PET-CT in lymphoma.The progress of PET-CT in lymphoma will be summarized in this paper based on the reports from the 58th American Society of Hematology Annual Meeting.

Objective To evaluate the clinical effect of the free-hand cervical pedicle screw fixation in treatment of the upper cervical fracture and instability.Methods A retrospective review was performed on 15 patients with upper cervical fracture and instability treated with cervical pedicle screw fixation and fusion from September 2006 to January 2009.There were 11 males and 4 females,at average age of 41.2 years(range,18-60 years).Of all,there were five patients with atlas fracture and dislocation(including three simple anterior arch fractures and two Jefferson fractures),three with axis fracture and dislocation,one with dens fractures plus nonunion,two with C2,3 fracture and dislocation and four with atlantoaxial instability without fracture.The main clinical complaints included local neck pain and/or tetraplegia.Halo traction was recommended to restore the cervical sequence preoperatively in all patients.All 15 patients were treated by cervical pedicle screw-rods internal fixation and bone graft fusion.During the operation,the point and angle of the implanted pedicle screws were determined by preoperative X-ray and CT scan and the bony channel drilled with free-hand before implantation of the Summit or Vertex pedicle screws(22-26 mm long)and posterior interlaminar autologous or allogeneic bone fusion.Patients could get out of bed with neck collar at days 1-2 after operation.Results A total of 64 cervical pedicle screws were implanted in all 15 patients,with no vertebral artery injury,spinal cord injury or cerebrospinal fluid leakage.Postoperative X-ray and CT scan confirmed satisfactory internal fixation.The clinical symptoms were improved significantly.Fourteen patients were followed up for 12-36 months,which showed bony fusion,with no looseness or breakage of the screws.Neurologic impairment was improved in all patients,with no complications associated with the cervical pedicle screw.Conclusions Cervical pedicle screw internal fixation can reestablish the upper cervical vertebrae stability and help to recover the spinal cord and nerve function and hence is a reliable method for upper cervical fracture and/or instability.

Objective The mortality rate of the children after surgical repair of congenital heart disease associated with acute renal injure has been reported to be 30％-79％.Peritoneal dialysis is the common treatment method for those patients,but the optimal time to initiate peritoneal dialysis is still controversial.The aim of this study was to investigate the clinic outcome of early peritoneal dialysis to the children following cardiac surgery.Methods We performed a retrospective chart of children following cardiac surgery from January 2008 to December 2009.The total number was 4561,62 of them were performed PD treatment.Data on the PD treatment children were collected from pre-operation to hospital discharge.Early peritoneal dialysis group was defintes as PD initiated at operation room or the interval between the end of operation to starting peritoneal dialysis less than 3hrs.the others were traditional PD group.Results The whole PD treatment rate was 1.36％,15 patients died.The mortality were 10.71％ (3/28) in early PD and 35.29％ (12/34) in conditional PD group respectively (P =0.036).2 patients were met RIFLE(risk,injury,failure,loss,and end-stage renal disease,RIFLE)classification as failure grade in early PD group while 10 patients in traditional PD group (P =0.001).After PD treatment 24hrs,the Vasoactive-Inotrope Scores and serum creatinine values were much lower in the early PD group children than those in the traditional PD group[(19.00 ±2.39) vs(37.00±5.22),P=0.002;(50.51 ±21.84) vs(130.13±76.09),P=0.001)].Conclusion This study shows that early PD can prevent the children after congenital heart surgery to develop AKI,and reduce the severity of the clinic status.Early intervention with PD is associated with low mortality.

Objective To quantify the concentration of peripheral blood plasma neutrophil gelatinase-associated lipocalin (NGAL) in patients with acute pancreatitis (AP) and to explore its value in assessment of the severity of AP.Methods From June 2011 to March 2012,83 patients with AP were selected,among those 43 cases were mild acute pancreatitis (MAP) and 40 were severe acute pancreatitis (SAP).The control group included 30 healthy individuals.The peripheral blood of patients with AP and healthy controls was collected,and plasma was isolated after centrifuged.The concentration of NGAL in plasma was detected by enzyme-linked immunosorbent assay (ELISA).The t-test was performed for comparison between groups.The correlation between the concentration of NGAL in plasma and clinical parameters of AP was analyzed by Spearman rank order correlation analysis.The diagnosis value of the concentration of NGAL in SAP was evaluated by receiver operating characteristic (ROC) curve and area under the curve (AUC).Results The concentration of plasma NGAL in AP group ((10.30± 5.97)nmol/L) was higher than that in healthy control group ((1.94±1.35) nmol/L) and the difference was statistically significant (t=11.924,P＜0.01).The concentration of plasma NGAL in SAP group ((14.61 ±5.28) nmol/L) was higher than that in MAP group ((6.27±-3.09) nmol/L) and healthy control group,the differences was statistically significant (t=8.677 and 14.539,both P＜0.01).The concentration of plasma NGAL of AP patients was positively correlated with acute physiology and chronic health evaluation-Ⅱ score,Ranson score,bedside index for severity in acute pancreatitis score,computed tomography (CT) severity index,C-reactive protein,white blood cells and the days of hospitalization (r=0.651,0.556,0.514,0.620,0.320,0.458 and 0.346,all P＜0.05).The area under the ROC curve of plasma NGAL concentration in diagnosis of SAP was 0.926 (95％CI:0,870-0.983).The cutoff value of plasma NGAL level in diagnosis of SAP was 8.44 nmol/L.The sensitivity and specificity was 87.5 ％ and 88.9％,respectively.Conclusions Plasma NGAL level is correlated with the severity of patients with AP.NGAL may be one of the markers for the early diagnosis of SAP.

Objective To discuss the clinical feature of chronic pain of aged people and strategies and effect of its self-management as well as their relationship.Methods Investigation with questionnaires wag carried out in 243 aged people who were above 65 years old to understand the clinical feature of chronic pain and strategies of its self-management.The results underwent analysis.Results Non-narcotic analgesics,physical exercise,cold and heat therapy and spiritual activity were used most frequently in selfmanagement of pain.No statistical difference existed in the use of self-management strategies between people in different age groups.Effect of self-management strategies was negatively correlated with degree of pain,interrupting with daily life and anxiety,but Wag positively correlated with self-efficacy score.Conclusions Aged people ale willing to attemp various strategies to cope with chronic pain.We should pain attention to the standardization of physical exercise,confrontation of anxiety and improvement of self-efficacy to improve the effect of self-management.

Objective To analyze the surgical treatment options and its results for thoracic and thoracolumbar disc herniation.Methods From June 2004 to December 2009,thirty-one patients of thoracic and thoracolumbar disc herniation with or without ossification of ligament flavum were surgically treated,including 22 males and 9 females,with a mean age of 54 years(range,24 to 71 years).According to Anand and Regan clinical classification,there was type 2 for 1 case,grade 3a for 2,grade 3b for 3,grade 4 for 6,and grade 5 for 19.The neurological status was Frankel B for 2 cases,C for 6,D for 11,and E for 12.Anterior surgeries were performed for 18 patients without ossification of ligament flavum.Anterior decompression was performed through the resection of posterior part of vertebral body,or subtotal resection of vertebral body,followed by strut graft and internal fixation.Posterior surgeries were performed for 13 patients with disc herniation and ossification of ligament flavum.The resection of hemi-articular process and total laminectomy was performed.Results The complications of 18 patients with anterior surgery included laceration of dura mater in 1 case,nerve root sleeve injury in 1 case,intercostal neuralgia in 3 cases,atelectasis in 1 case,and femoroiliac numbness in 2 cases.The complications of 13 patients with posterior surgery included intra-canal hematoma in 1 cases,leakage of cerebrospinal fluid in 2 cases,infection of incision in 1 cases,and pneumonia in 1 case.The patients were followed for 18 months(range,6 to 48 months).At final follow-up,the neurological status and local symptom improved in all patients,with Frankel C for 3 cases,D for 7,and E for 21;and Anand and Regan type 1 for 2 cases,2 for 1,3a for 1,4 for 2,5 for 10 and no symptom for 15.Conclusion For thoracic and thoracolumbar disc herniation,anterior surgery is suitable for patients mainly suffered anterior cord compression.Resection of posterior part of vertebral body or subtotal resection of vertebral body is often needed for sufficient decompression.Posterior surgery is suitable for patients with anterior and posterior cord compression due to ossification of ligament flavum,and the decompression can be obtained by resection of hemi-articular process and total laminectomy.

BACKGROUND:Previous studies have shown that continuous administration of 1×107 of bone marrow mesenchymal stem cel s can induce immune tolerance in rats undergoing kidney transplantation, but it is not yet found clinical y that curcumin exerts an on immunomodulatory effect on kidney transplantation.
OBJECTIVE:To investigate the effects of different concentrations of curcumin on bone marrow mesenchymal stem cel s-induced immune tolerance in rats after kidney transplantation.
METHODS:Rat model of kidney transplantation was made, and rat models were randomly divided into four groups:transplantation group with no treatment;bone marrow mesenchymal stem cel s group (cel group) injected with 1×107/kg bone marrow mesenchymal stem cel s via the left iliac vein (before peritoneal suture) and tail vein (from the 2nd day) for 10 days;bone marrow mesenchymal stem cel s+low/high dosage of curcumin groups (low/high dosage curcumin groups) injected intragastrical y with 2 or 10 mg/kg curcumin combined with injection of bone marrow mesenchymal stem cel s for 10 days. Transforming growth factor-β1 protein expression in the kidney tissues was examined by immunohistochemical staining. The concentrations of interleukin-2 and interleukin-6 in serum were detected by ELISA assay.
RESULTS AND CONCLUSION:After kidney transplantation, the protein expression of transforming growth factor-β1 in renal tubular epithelial cel s and renal interstitial cel s as wel as the concentrations of interleukin-2and interleukin-6 in serum were significantly higher in the transplantation group than the other groups (P<0.05). Compared with the cel transplantation group, the protein expression of transforming growth factor-β1 as wel as the concentrations of interleukin-2 and interleukin-6 reduced significantly in the low/high dosage curcumin groups (P<0.05). These findings indicate that simultaneous administration of curcumin and bone marrow mesenchymal stem cel s can effectively inhibit immune rejection reaction and improve renal function in rats after kidney transplantation.