In recent years,considerable progress has been made in the treatment of multiple myeloma(MM).However,despite the current improved prognosis of this malignancy,it always ends in relapse and therefore new therapeutic approaches are urgently needed to overcome it.The chimeric antigen receptor(CAR)-T cells targeting B cell maturation antigen(BCMA),cluster of differentiation 19(CD19),cluster of differentiation 38(CD38) and kappa light chains have been evaluated,and have achieved remarkable results in clinical trials.However,even when MM is treated with CAR-T cell therapy,most patients eventually relapse,which is the greatest limitation of this therapy.This paperreviewedthe research progress,limitations and optimization of CAR-T cell immunotherapy in the treatment of MM.

Gefitinib and erlotinib are the first generation of targeted therapeutic agents approved for the treatment of advanced non-small cell lung cancer. Despite a dramatic initial response, most patients subsequently and ultimately become resistant to the drugs. Recent studies have proposed various mechanisms of such resistance, some of which related to a second mutation in epidermal growth factor receptor, aberrant activation of other tyrosine kinase receptors, bypassing signal pathways and constitutive activation of downstream signal molecules. Other researches also associated the drug resistance to internalization of epidermal growth factor receptor and changes in tumor microenvironment. Furture studies need to focus on overcoming or reversing resistance to the drugs and developing new targeted therapeutic agents.

Objective To interview the work feelings of the Middle youth patients with peritoneal dialysis. Methods Using the purposive sampling method, 11 patients were interviewed, and analyzed the content of the interview. After the interview, data were transcribed and extracted the keywords. Results Eight keywords were extracted, the patients had four positive feelings:self-perceived burden relived;more social support; more glad, negative feelings relived; peritoneal dialysis could be sure. 4 negative themes were extracted:tedious;had economic pressure;lack of self-realization;could not take the family burden. Conclusions Work can improve the living conditions of middle youth patients with peritoneal dialysis. More patients should be encouraged to return to work.

Objective To establish a HPLC method to determine the antiseptics in compound dexamethasone acetate cream and evaluate the usage rationality of antimicrobial preservatives. Methods The content of ethyl hydroxybenzoate was calculated by external standard with HPLC.The effectiveness of antimicrobial preservatives was measured according to the preservative effectiveness test in ChP(2015edition) by inoculating 5 kinds of test microorganisms including Pseudomonas aeruginosa,Escherichia coli,Staphylococcusaureus,Candida albicans and Aspergillusniger.Results The linear ranges of ethyl hydroxybenzoate was 6.63-132.6 μg/mL ( r =0.999 7 ) .The average recoveries was 99.2%.The samples from different batche had different antimicrobial effectiveness due to the content of ethyl hydroxybenzoate.Conclusion The described method can be used in the determination of the preservatives of ethyl hydroxybenzoate in compound dexamethasone acetate cream.At present the use of antibacterial agent is arbitrary, it is necessary to strengthen research and supervision.

A systematic comparative study ou the morphology and histology of the rhizomes of polygonatum including "Huangjing" and "Yuzhu" currently available on the Chinese market werepresented. The differences between this two types of herbal medicines were given.

The role of serotonergic system in vasovagal syncope (VVS) has been more concerned.Serotonin is a kind of neurotransmitter which is widely distributed in central nervous system.There are kinds of serotonergic receptors on postsynaptic membrane,among which 5-HT1A receptors participate in the mechanism of central blood pressure depression and promote the release of hormones such as prolactin and adrenocorticotrophic hormone.Acute administration of selective serotonin reuptake inhibitors (SSRIs) during head-up tilt test (HUT) blocks the reuptake of serotonin in the synapse space and thus increases stimulation of the serotonin receptors,which induces syncope episode.Long-term administration of SSRIs downregulates the postsynaptic serotonergic receptors,thus it weakens the reaction to the rapid change of serotonin concentration, which results in rapid depression of sympathic nerves and prevention of syncope episode.These demonstrate that central serotonergic system may participate in the pathogenesis of VVS and SSRIs are important for the diagnosis and treatment of VVS.

Objective To analyze the risk factors of metastasis and biological characteristics of patients with gastroenteropancreatic neuroendocrine tumor (GEP-NET).Methods One hundred and forty patients with neuroendocrine (NET) confirmed pathologically were collected between Jan.1993 and Mav 2009,and were divided into relative benign tumors or malignant tumors according to WHO prognostic criteria about GEP-NET.The clinicopathological parameters that related with metastasis of NETs were analyzed by univariate and Logistics regression methods,and the biological behavior characteristics was assessed further.Results GEP-NET showed a maximum incidence at age of 45-54 years for man and of 35-44 years for women.The onset of NET varied in age according to location of primary tumors(P<0.01).The onset age of patients with pancreas NET was lowest(42.92 years).The location that demonstrated the greatest incidence of GEP-NET was pancreas.The univariate analysis showed that gender,age,differentiation,location of primary tumors and maximum diameter of NETs were significantly associated with metastasis of GEP-NET(all P values<0.01).Logistic regression analysis revealed that the site,diameter and differentiation of tumor were the most important predictors for metastasis.The mean age of patients with malignant NET (54.78 years)was older than that of patients with relative benign NET (44.12 years,P<0.01).Conclusions The NET are more commonly found in pancrease.The location of primary tumor,diameter and differentiation of NET are important predictors for tumor metastasis.Poorly differetiated NET are common in patients with gastrointestinal NET or elderly NET patients.

The formation and progression of tumor is inseparable from the changes of cell cycle regulatory proteins.The G2-M period block effect of tumor cells is especially important in slowing the growth of tumor and improving the curative effect.DNA damage receptor,signal transduction factor and effectors are the classical pathways to mediate G2 phase arrest of tumor cells,and have the potential to be new targets for tumor therapy.

Objective To study the distribution and drug‐resistance of pathogens isolated from vaginal secretion in the patients with vaginitis in Dalian area so as to provide an evidence for clinical diagnosis and treatment .Methods The statistical analysis was performed on the detection results of pathogens isolated from vaginal secretion in 5 308 patients with vaginitis .Results In 5 308 patients with vaginitis ,the routine detection of vaginal secretion found that 810 cases(15 .3% ) were bacterial vaginosis ,1 110 cases (20 .9% ) were candida positive and 60 cases (1 .1% ) were trichomoniasis positive ,in which 3 526 cases were performed the patho‐gen detection ,2 615 strains of pathogen were isolated ,including 1 948 strains (74 .5% ) of mycoplasma ,136 strains (5 .2% ) of Chlamydia ,17 strains (0 .7% ) of Neisseria gonorrhoeae ,276 strains(10 .6% ) of candida ,140 strains (5 .4% ) of Gram‐positive cocci and 98 strains(3 .7% ) of Gram‐negative bacilli .The susceptibility rates of Ureaplasma urealyticum to ofloxacin ,levofloxacin ,spar‐floxacin and roxithromycin were lower ,which were 7 .8% ,18 .2% ,26 .3% and 27 .2% respectively ,the susceptibility rates to clar‐ithromycin ,doxycycline and minocycline were higher ,which were 89 .4% ,99 .8% and 99 .9% respectively .The drug resistance of Mycoplasma humenis was higher .The more sensitive antibacterial drugs were only josamycin ,doxycycline and minocycline ,the sen‐sitivity rates were 75 .3% ,96 .2% and 97 .3% respectively ,which to other antibacterial drugs were less than 7 .0% .Candida albi‐cans was generally sensitive to antifungal drugs .The susceptibility rates of Staphylococcus aureus to commonly used antibacterial drugs were higher .All of 24 strains of Streptococcus agalactiae were sensitive to penicillin .No Gram‐positive coccus resistant to daptomycin ,linezolid and vancomycin was found .No Gram‐negative bacillus resistant to daptomycin ,linezolid and vancomycin was found .No Gram‐negative bacillus resistant to imipenem and meropenem was found .Conclusion The pathogens causing vaginitis are very complex .In the treatment of female vaginitis ,clinicians should rationally use antibacterial drugs according to the results of pathogens detection and drug susceptibility test .

Objective To investigate the value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of pulmonary cryptococcosis.Methods 15 patients who were diagnosed as pulmonary cryptococcosis were retrospectively studied,all of them were examined by sputum smear,X ray,CT and EBUS-TBNA.Results 15 patients who received EBUS-TBNA were diagnosed pulmonary cryptococcosis by pathological methods and germiculture,during the process no complication was detected.Conclusion EBUS-TBNA is a safe and effective means in the diagnosis of pulmonary cryptococcosis for pulmonary cryptococcosis patients hard to be diagnosed clinically.