Autologous stem cell transplantation (ASCT) has been considered as frontline therapy for patients with multiple myeloma (MM) based on the increased rate of response and prolonged progression-free survival compared with conventional chemotherapy.In the recent years,the favorable results shown by newdrug-based multidrug inductions,consolidations,and long-term maintenance approaches have challenged the role of ASCT.Allogeneic hematopoietic stem cell transplantation (allo-HSCT) has shown to be a potentially curative treatment for MM.However,the effectiveness of high-dose conditioning with conventional allo-HSCT is compromised by transplant-related mortality (TRM).Nonmyeloablative transplantation has showed reduced TRM and promising graft-versus-myeloma effects,but rates of acute and chronic graft-versus-host disease remain high.This article provides an overview of clinical trials and aims to define the role of stem cell transplantation in the era of novel agents.

The immunomodulatory drugs (IMiD) thalidomide and lenalidomide,and the proteasome inhibitor (PI) bortezomib have dramatically improved clinical outcomes for patients with relapsed/refractory multiple myeloma(MM).But a part of patients become refractory or intolerant to these agents.Numerous agents are currently in clinical development,including new IMiD (pomalidomide),new PI (eg,carfilzomib,MLN9708,and marizomib),histone deacetylase inhibitors (eg,panobinostat and vorinostat) and signal transduction modulators (eg,perifosine),and have demonstrated promising anti-myeloma activity in patients with relapsed/refractory MM,particularly in those who are refractory to approved novel agents.This article describes antimyeloma agents currently available or in clinical development for relapsed/refractory patients.

Objective To analyze current status of research on pulmonary embolism and changes of its knowledge in domestic academic literatures.Methods Totally,2319 domestic papers on pulmonary embolism were collected by computerized retrieval from CHKD system during the period of 1994 to 2006 with a key word of"pulmonary embolism",and were classified and summarized according to their type,contents,author's affiliation.Results Number of papers on pulmonary embolism increased quickly in recent 13 years,especially in the last five years,from 25 papers in 1994 to 430 in 2006.Most of the papers in the early stage were case reports,and the number and proportion of original articles increased obviously after 1997.Contents of the papers were mainly about clinical manifestation and examinations of pulmonary embolism,but papers on its auxiliary examinations,laboratory examinations,clinical nursing care,animal experiments,and so on were all increased.Authors of the papers were from varied departments of hospitals,mainly in the department of internal medicine,especially in the departments of cardiology and respiratory diseases,followed by the divisions of medical imaging,radiation and nuclear medicine.Papers were mainly submitted by authors from affiliated hospitals of medical schools and hospitals at city-level,and papers submitted by gross-roots hospitals such as county hospital and clinic also increased.Conclusion Significant success in diagnosis and treatment of pulmonary embolism has been achieved domestically in recent 13 years,which has been recognized popularly by Chinese physicians.

BACKGROUND:At present, few studies concerned pulmonary infection after treatment of senile fracture. For special parts of senile patients, there are no studies on complications of pulmonary infection in perioperative period after hip fracture. OBJECTIVE:To study risk factors for pulmonary infection in patients with senile hip fractures in perioperative period. METHODS:The data of 46 senile hip fracture patients with perioperative pulmonary infection were retrospectively analyzed. A matched case-control study was conducted in 46 senile hip fracture patients without pulmonary infection in the same hospital and the same period. The difference in perioperative various clinical indexes was compared between the two groups. Risk factors of pulmonary infection received Logistic regression analysis. RESULTS AND CONCLUSION:Multivariate analysis screened out 14 possible perioperative pulmonary infection factors:chronic obstructive pulmonary disease, smoking, diabetes mel itus, heart disease, mechanical ventilation, intraoperative bleeding amount, erythrocyte infusion, operation time, preoperative low body mass index (body mass index<18.5 kg/m2 ), serum albumin<35 g/L, electrolyte disturbance, time of entering intensive care unit and length of stay. Logistic regression analysis displayed that chronic obstructive pulmonary disease (OR=23.317;95%CI:2.702-60.312;P=0.000), entering intensive care unit (OR=7.890;95%CI:2.624-76.012;P=0.008), mechanical ventilation (OR=35.210;95%CI:8.464-131.203;P=0.017) and operation time (OR=12.122;95%CI:5.154-99.098;P=0.012) were independent risk factors for perioperative pulmonary infection in patients with senile hip fracture. These data indicated that one should be alert to the possible occurrence of pulmonary infection in senile hip fracture patients with the presence of chronic obstructive pulmonary disease, entering intensive care unit and mechanical ventilation.

Objective:To evaluate the clinical effect of combination of autologous tissue reconstruction of tarsal plate with temporal flap on repair of full-thickness lower eyelid defect.Methods:Eleven patients (11 eyes) underwent hard palate mucosa or ear cartilage combined the emporal flap with the orbicularis oculi muscle to repair full-thickness defect ofpalpebra inferior.Of the 11 patients,6 had more than 75％ eyelid defect area,and 5 had more than 50％ eyelid defect area.Results:All 11 eyes closed completely,with no entropion or ectropion,and returned to normal basically.Postoperative follow-up was performed for 6 months to 5 years,3 years and 4 months on average.The function and form of eyelid remained stable.Infection,leakage or contracture was not found on reconstruction tarsus.Conclusion:Reconstruction of eyelid with autogenous hard palate mucosa or ear cartilage combined the emporal flap with the orbicularis oculi muscle is a simple,convenient and effective method.

Objective To investigate the application of antimicrobial agents in a tertiary first-class hospital before and after implementing special rectification activity on clinical antimicrobial use.Methods Data about antimicrobial use in a hospital in Sichuan Province between January 2011 and December 2013 were collected and analyzed retro-spectively,data included antimicrobial varieties,the ratio of antimicrobial prescription in outpatient department to emergency department,percentage of antimicrobial application expense in the total hospitalization expense,antimi-crobial use rate and use density,antimicrobial use rate and use density of special use antimicrobial agents,microbial detection for patients receiving restricted and special antimicrobials.Results Before implementing rectification of an-timicrobial use,there were 88 kinds of antimicrobial agents in hospital,after implementing rectification,there were 50 kinds of antimicrobial agents.The ratio of antimicrobial prescription in outpatient department to emergency de-partment,and the percentage of antimicrobial expense in the total hospitalization expense were both lower than be-fore rectification (both P <0.05 ).Antimicrobial use rate and antimicrobial use rate of special use antimicrobial agents before and after rectification were all statistically different(all P <0.05).Compared with before rectification, microbial detection rate of specimens from patients receiving restricted and special use antimicrobial agents improved significantly (both P <0.05 ).Perioperative antimicrobial prophylactic use rate in patients with class Ⅰincisional operation after rectification was lower than before rectification,while percentage of antimicrobials used 30 min-2 h before operation was higher than before rectification (both P <0.05).Conclusion After three year special rectifica-
tion,antimicrobial use become more rational,but management still needs further and continuous improvement.

Objective To investigate the changes of geometry and function of left ventricle (LV) and left atrium(LA) in hypertensive male patients with concentric remodeling.Methods Consecutive male patients were divided into two groups: normal control group(NC group,n=146) and concentric remodeling group(CR group,n=274).The whole patients were checked with echocardiogram.Echocardiographic parameters included: thickness of interventricular septum(IVST) and LV posterior wall(PWT),LV end-diastolic diameter(LVIDd),media-lateral diameter(LVID),LV length(LVL),LA anterior-posterior diameter,media-lateral diameter,superior-inferior diameter,LA area,LV end-diastolic volume,end-systolic volume,stoke volume,ejection fraction(EF),early diastolic peak velocity (E) and atrial contraction peak velocity(A) of the mitral valve flow.LV mean diameter(LVMD) and E/A were calculated.Student t test was used to compare the variables between the two groups.Results IVST,PWT,IVST/LVPWT ratio,LA diameters and LA area in CR group were larger than those in NC group.LVIDd was shorter and LVID was larger in CR group than in NC group.LVL in CR group was larger than that in NC group.LVMD/LVL ratio was smaller than that in NC group.There was no significant difference in LVEF between two groups while E/A ratio in CR group was smaller than that in NC group.Conclusions The concentric remodeling in hypertensive patients makes the LV a thin,long but thick-walled cavity.The LV diastolic function is impaired in CR group but the systolic function reserves well.

Aim To investigate the influence of total fl avones of buckwheat flower (TFBF) on the productivity of the non-enzymatic advanced glycation end products (AGEs) in vivoand vitro. Methods TFBF in different dosages (0.1 g?kg -1?d -1,0.2 g?kg -1?d -1,0.4 g?kg -1?d -1) was taken orally by streptozotocin-induced diabetic rats for 12 wk. After the treatment, blood glucose, fructosamine and AGEs in plasma and kidney were measured. Meanwhile, glucose and bovine serum albumin (BSA) were incubated with TFBF at different concentrations (0.01 mg?L -1,0.05 mg?L -1,0.10 mg?L -1) respectively for 4,8,12 wk.The fluorescence intensity of glycated BSA was detected by a spectrophotometer BSA was detected spectrophotometer.Results TFBF significantly lowered the level of blood glucose in diabetic rats (P

Objective To investigate the diagnostic value of B-mode ultrasonography in detecting middle hepatic vein(MHV)in chronic liver disease patients.Methods 80 chronic liver disease patients were divided into 2 groups(chronic hepatitis and liver cirrhosis).Liver biopsies and the inner diameter(ID)of MHV was detected with B-mode ultrasonography.The ID of MHV was compared in the chronic hepatitis and liver cirrhosis groups,different liver fibrosis stages and compensation/non-compensation liver cirrhosis.The ability of ID of MHV in auxiliary diagnosis liver cirrhosis was analyzed with the receiver operating characteristic curve(ROC).Results The size of ID of MHV in liver cirrhosis(3.82±1.84)mm was smaller than that of chronic hepatitis(6.15±1.67)mm(P＜0.01).The size of ID of MHV in non-compensation liver cirrhosis(2.98±1.15)mm was smaller than that of compensation liver cirrhosis(4.42±2 20)mm(P＜0.05).There was midrange negative correlation with liver fibrosis stages and the ID of MHV(rs=-0.465,P＜0.01).The cutoff point of ID of MHV diagnosis liver cirrhosis was 4.7mm.The area under ROC(AUC)achieved 0.813(P＜0.01).The sensitivity(Se),specificity,(Sp),positive predictive value (PPV),negative predictive value(NPV)and Youden index were 67.5%,90.0%,88.0%,73.5% and 57.5%,respectively.Conclusion There is well clinical value with B-mode ultrasonography detecting ID of MHV for the auxiliary diagnosis of chronic liver disease.

Background:Small intestinal bleeding is difficult to diagnose and treat because of its complex etiology and limit to examination method. Aims:To analyze the etiology,diagnosis,treatment and prognosis of small intestinal bleeding. Methods:The clinical data of 118 consecutive patients with small intestinal bleeding admitted from Oct. 2006 to Oct. 2016 at Daping Hospital,the Third Military Medical University were retrospectively analyzed. Results:Melena was the most common manifestation of small intestinal bleeding (41. 5％),followed by dark bloody stool,positive fecal occult blood test,hematochezia,and anemia with unknown cause. The major causes of bleeding were benign or malignant tumors (43. 2％),vascular lesions (28. 0％)and inflammatory lesions (15. 3％). Diagnosis was made by means of capsule endoscopy,colonoscopy,digital subtraction angiography (DSA),barium meal examination,multi-slice CT (MSCT)and CT enterography (CTE). Forty-one patients were treated by surgical operation,7 by selective arterial embolization,2 by endoscopic therapy,56 by conservative therapy,and all these patients achieved hemostasis. One patient died of massive hemorrhage and 11 were discharged with giving up of treatment. Conclusions:The leading cause of small intestinal bleeding is tumor,followed by vascular and inflammatory lesions. Capsule endoscopy is able to make definite diagnosis with high accuracy,and MSCT is the most widely used diagnostic approach. In addition to conventional treatment,surgical operation,interventional and endoscopic therapies also play important roles in treating small intestinal bleeding.