Multiple myloma represents the second most common blood cancer.Although new drugs emerge rapidly,multiple myeloma is still incurable.Drug resistance is one of the main causes of myeloma recurrence and relapse.In this paper,advances about the drug resistance mechanisms reported in the 55th ASH annual meeting are summarized.

One hundred and fifty eight post-stroke patients in the recovering period were divided into intervention group (78 cases) and control group (80 cases).Patients in intervention group received home rehabilitation service provided by general practitioners (GP) for 6 months,while patients in control group received routine rehabilitation.After 6-months,the scores of self-rated health measurement scale (SRHMS) in intervention group were significantly higher than those of control group (P ＜0.01);the visiting time and frequency,medical costs and time of caregiving were decreased (P ＜ 0.01);and the satisfaction score of the patients in intervention group was 97％.The results show that home rehabilitation service can improve effectiveness of rehabilitation for post-stroke patient in recovering period.

OBJECTIVE:To provide reference for the rational clinical prophylactic use of antibiotics. METHODS:The cases in whom the clinical prophylactic use of antibiotics between 2006 and 2007 in our hospital showed failure in efficacy were monitored to analyze the cause of failure,meanwhile the clinical samples were sent for culture,isolation,identification and drug susceptibility tests as well as drug resistance analysis. RESULTS:Cephalosporins,Quinolones,Penicillins,Cefhalosporins + enzyme inhibitor were more commonly used antibiotics in our hospital,with drug resistance rates at 57.21%,65.14%,68.63%,and 18.81% respectively. Among the total 240 cases monitored,the prophylactic use of antibiotics totaled 877 times,of which,388 (44.24%) were non-indicated drug use,459 (52.34%) showed drug resistance,286 (32.61%) involved improper drug choice,and 42 (17.50%) showed dual infection. CONCLUSION:The clinical prophylactic use of antibiotics in our hospital is far from perfect; therefore,it is urgent to tighten control on the standard prophylactic use of antibiotics.

Objective To establish case database of critical illness and explore the effect of critical case-based learning in the anesthesia teaching program as well as its influence on clinical thinking ability of students. Methods Case database of critical illness was built with foxtable software and ASAⅢ~Ⅴpatients undergoing anesthesia were included in the case database. Patients' information were recorded according to the sequence of pre-operative evaluation,intra-operative management and post-operative recovery. We designed a student questionnaire to investigate the effect of critical case-based learning. And we also compared the effect of critical case-based learning and traditional teaching on undergraduate interns, residents, and graduate students by scores of case analysis test. Data analysis used t test. Results The critical cases database is characterized by authenticity, hierarchy and for-wardness. Survey result of questionnaire shows that the proportions of students who believe critical case-based learning helps to strengthen the links of theory and clinical practice, to improve expression skills, and to promote active classroom atmosphere, solidarity and cooperation are 80%, 71.6% and 68.3%respectively. Compared with those who received traditional teaching, the residents and graduate students who received critical case-based learning get significantly higher scores in case analysis test. However, the difference of scores between undergraduate interns receiving traditional teaching or criti-cal case-based learning has no significance. Conclusion The establishment of critical cases database and its application in anesthesia teaching program have effectively improved clinical thinking ability of anesthesia residents and graduate students.

Objective To compare the adverse reactions of intranasal and intravenous dexmedetomidine on tracheal extubation during wake up of general anesthesia.Methods One hundred and twenty patients who ASA Ⅰ or Ⅱ grade were divided into four groups (each 30 patients) by random digits table method.The patients in intravenous group were given 0.5 μ g/kg intravenous dexmedetomidine (diluted to 10 ml by 0.9％ sodium chloride,intravenous injection slowly,≥30 s).The patients in intranasal group 1 were given 0.5 μg/kg intranasal dexmedetomidine.The patients in intranasal group 2 were given 0.8 μg/kg intranasal dexmedetomidine.The patients in control group were given intravenous 0.9％ sodium chloride.The systolic blood pressure(SBP),mean arterial blood pressure (MAP),heart rate were compared among groups.Eyes open time and extubation time,the rate of cough and the degree during extubation were compared too.Results The SBP,MAP,heart rate in intravenous group,intranasal group 1 were significantly higher than those in basal state (P ＜ 0.05).The SBP,MAP,heart rate at different time in intranasal group 2 had no significant difference (P ＞ 0.05).The SBP,MAP,heart rate before extubation and after extubation for 3 min in control group were significantly higher than those in intravenous group,intranasal group 1 and intranasal group 2 (P ＜ 0.05).Eyes open time and extubation time among four groups had no significant difference(P ＞0.05).The rate of cough,restlessness and 3 scores of degree before extubation in intravenous group,intranasal group 1 and intranasal group 2 were significandy lower than those in control group [43％ (13/30),50％(15/30),47％(14/30) vs.70％ (21/30); 17％(5/30),23％(7/30),20％(6/30) vs.43％(13/30);53％ (16/30),60％ (18/30),50％ (15/30) vs.80％ (24/30)] (P ＜ 0.05).Conclusions Either intravenous or intranasal dexmedetomidine can effectively prevent the stress reaction during extubation,decrease the degree of restlessness and cough.Intranasal dexmedetomidine(0.8 μ g/kg) is more effective and safe.

AIDS antiviral therapy (ART) has achieved great success.Originaly,AIDS had been regarded as a fatal disease,but it has become a kind of infectious disease that could be cured and administrated.Global HIV / AIDS cases were still up to about 38 million,but more than half have been effectively treated.In addition to drug treatment,at present,some new technologies and new methods,such as genome editing,have also been involved in the treatment of AIDS,and in the humanized animal experiment has shown very good results.There is no doubt that AIDS will eventually be stopped its epidemic.However,with the continuous development of AIDS antiviral treatment,the most fundamental problem is that HIV latent library has become increasingly prominent one,whether molecular therapy and hybrid cure have being developed for AIDS treatment,there are still such problem existence.Great efforts shoud be made to continuously search for new markers of latent viral cells and to reduce the latent pool.In addition,despite the prevention and treatment of AIDS has made great achievements,but the world still produces nearly 6000 cases of HIV/AIDS every day.Therefore,the development of safe and effective vaccine,whether in the field of prevention,or in clinical treatment,has its positive significance.

Objective: To evaluate the effects on the apical sealing ability of iRoot SP used for straight root canals. Methods: 73 extracted human teeth with straight roots were randomly assigned to 8 groups. The root canals in groups A3 was obturated with single gutta-percha cone. The others were obturated with thermoplasticized gutta-percha cones. The canals were filled with AH Plus (group A1 and B1), iRoot SP (group A2, A3 and B2) and ZOE (group A4) . The post space was prepared either immediately after obturation (A1-A4) or 7 days later group (B1 and B2) . The extent of dye penetration was measured by transparent dental technology. Results:There were no significant differences among A1-A3 groups, between group A1 and B1, A2 and B2, P＞ 0. 05. The dye penetration extent of group A4 and C was greater than that of group A2 (P ＜ 0. 05) . Conclusion: iRoot SP and AH Plus have same performance on root canal seal. There was no significant difference between iRoot SP + thermoplasticized gutta-percha and iRoot SP + single gutta-percha cone for apical sealing.

OBJECTIVEPsoriasis is an autoimmune-related chronic inflammatory skin disease strongly associated with the dysfunction of Th17 cells. Retinoic acid-related orphan nuclear receptor γt (RORγt) plays a critical role in the differentiation and maturation of Th17 cells and in cell-derived immunologic derangement. We conducted this study to investigate potential mechanism by which the derivative of digoxin selectively antagonizes RORγt transcriptional activity.

METHODUsing molecular docking in combination with molecular electrostatic potential (MEP), we detected the interaction between the derivative of digoxin (Dhd) and ROR transcription factor (RORα,RORβ and RORγt), and the results were further confirmed by bioluminescent assay.

RESULTMolecular docking demonstrated that Dhd could exclusively inhibit the conformation of RORγt; bioluminescent assay further indicated that RORγt was selectively antagonized by Dhd in a dose- and time-dependent manner.

CONCLUSIONDhd can selectively suppress RORγt transcriptional activity.

Digoxin ; analogs & derivatives ; pharmacology ; Humans ; Models, Chemical ; Molecular Docking Simulation ; Nuclear Receptor Subfamily 1, Group F, Member 1 ; antagonists & inhibitors ; genetics ; Transcription, Genetic

Objective To evaluate the effect of different kind of intravenous immunoglobulin (IVIG) therapy in treating Kawasaki disease (KD) and preventing cardiac consequences (coronary artery lesion, CAL). Methods A questionnaire form and guideline for KD diagnosis were sent to 50 hospitals providing pediatric medical care in Shanghai. The data from a total of 1 682 KD patients were collected. It included 1 064 males and 618 females from 1998 through 2008 in Shanghai. The average age of the KD patients was (2.57±2.33) years old (0.1-18.8 years).The patients had been divided into 6 groups for different IVIG therapy, which included 1 g/kg once, 2 g/kg once, 0.4-0.5 g/kg five times, 1 g/kg twice, 2 g/kg twice and others. SAS 6.12 software was used for statistical analysis. Results In all KD patients, the patients treated with IV1G in 5th-10th day of illness has the least cardiac complication and CAL incidence and the group with IVIG therapy of 1 g/kg twice also has the least cardiac complication and CAL incidence. Conclusions The best doses of IVIG in treating KD is 1 g/kg twice and the IVIG therapy should be used in 5th-10th day of KD illness.

Objective: Subthreshold attention-deficit/hyperactivity disorder (ADHD) has been suggested to be a “morbid condition” which also needs medical attention. Methods: The present study recruited 89 children with subthreshold ADHD (sADHD), 115 children with diagnosed ADHD (cADHD), and 79 healthy controls (HC) to explore the clinical manifestation, executive functions (EFs) of sADHD, and the caregiver strain. The clinical manifestation was evaluated through clinical interviews and parent-reports. Executive functions were assessed both experimentally and ecologically. Caregiver strain was measured by a parent-reported questionnaire. Results: For the clinical manifestation, both sADHD and cADHD indicated impairments when compared with HC. The comorbidities and the scaled symptoms indicated that the externalizing behaviors were relatively less serious in sADHD than cADHD, whereas the internalizing behaviors between two groups were comparable. For ecological EFs, sADHD scored between cADHD and HC in inhibition and working memory. For experimental EFs, sADHD was comparable to cADHD in inhibition, shifting, and was worse than cADHD in verbal working memory. For the caregiver strain, all scores of sADHD were between that in cADHD and that in HC. Conclusion Our present findings supported the suggestion of subthreshold ADHD as “morbid condition,” which should be treated with caution in clinical practice, especially for the internalizing behaviors and some key components of EFs.