Objective To evaluate the effect and side-effect in patients with multiple myeloma by the treatment of T-VAD.Methods To observe the effect and side-effect in 23 newly diagnosed patients with the treatment of T-VAD,and analyze them.Results Out of 23 patients,9(39%)patients gained complete remission(CR)and 11(49%)achieved partial remission(PR).The median survival time was 46 months.The side-effects consisted of fatigue(100%),somnolence(78%),constipation(69%),infection(48%),secondary diabetes mellitus(30%),numbness(17%),leukopenia(22%)and no one patient experienced deep vein thrombosis(DVT).Disease free survival of three years was 50%.Conclusion The treatment 0f T-VAD on patients with MM is an effective regimen,though there are many side-effcts,such as infection,they are relatively well-tolerated.

Objective To investigate the effect of dexamethasone combined with oridonin on proliferation and apoptosis in multiple myeloma cells U266 and the related molecular mechanism. Methods Exponential phase of growth U266 cells were treated with different concentrations of oridonin combined with dexamethasone or alone. U266 cells treated by DMSO were taken as control group. The proliferation inhibitory ratios were measured by CCK-8 assay followed by 24 h, 48 h and 72 h. Apoptosis induction was assessed by using Annexin V-FITC kit. Real time PCR was used to examine the mRNA changes of Notch1, NF-κB/p65 and bcl-2. Western blot assay was applied to detect the protein expression of Notch1, cleaved Notch1, NF-κB/p65 and bcl-2. Results Compared with that in control group, proliferation in all the experimental groups was inhibited (P<0.05), and the apoptosis was promoted (P<0.05); especially the combination of dexamethasone and oridonin had a synergistic effect on the proliferation and apoptosis of U266 cells (P<0.05). The results of PCR and Western blot showed that after treatment of U266 cells with dexamethasone, the mRNA as well as their protein levels of NF-κB/p65 and bcl-2 were decreased compared with those in the control group (P<0.05). Moreover, the mRNA and protein expression of Notch1, cleaved Notch1, NF-κB/p65 and bcl-2 was obviously down-regulated in oridonin group and the combination group (P<0.05). Conclusion Combination of dexamethasone and oridonin can significantly increase the anti-tumor effect by inhibiting proliferation and inducing apoptosis of U266 cells, which may be related to the inhibition of the Notch1 pathway.

Objective To observe the levels of serum thymidine kinase 1(TK1)and secreted protein Dikkopf-1(DKK1)in patients with advanced non-small cell lung cancer(NSCLC),and analyze the relation-ship between serum TK1,DKK1 and the prognosis of NSCLC.Methods This study adopted a prospective co-hort study method,a total of 91 chemotherapy patients with advanced NSCLC admitted in Jinshan Branch of Shanghai Sixth People's Hospital from January 2020 to June 2021 were enrolled as the research objects.All patients received the detection of serum TK1 and DKK1 on admission,completed 4 chemotherapy cycles in Jinshan Branch of Shanghai Sixth People's Hospital and were followed up for 3 months.The disease remission rate was evaluated according to the relevant standards.The patients with complete remission and partial re-mission were included in the good prognosis group,and those with the stable and progressive lesions were in-cluded in the poor prognosis group.The levels of serum TK1 and DKK1 were compared between the two groups.Logistic regression was used to analyze the relationship between the levels of serum TK1 and DKK1 and the prognosis of patients with advanced NSCLC.Results Among 91 patients with advanced NSCLC who received chemotherapy,threre were 58 cases(63.74％)in the good prognosis group,and 33 cases(36.26％)in the poor prognosis group.The levels of serum carcinoembryonic antigen(CEA),TK1 and DKK1 in the poor prognosis group were higher than those in the good prognosis group(P＜0.05).Logistic regression anal-ysis showed that the high levels of serum TK1 and DKK1 were the influencing factors of poor prognosis in pa-tients with advanced NSCLC(OR＞1,P＜0.05).The receiver operating characteristic curve was drawn,and the results showed that the area under the curve of serum TK1,DKK1 alone and combined for predicting the poor prognosis in patients with advanced NSCLC was＞0.700,all of which had certain predictive value,and the predictive value of the combined detection was the highest.Conclusion The abnormal increase of serum TK1 and DKK1 levels may indicate a high risk of poor prognosis in patients with advanced NSCLC.Early monito-ring of serum TK1 and DKK1 levels in patients has certain positive significance for predicting and evaluating the prognosis of patients.

Scrub typhus is a zoonotic disease caused by Orientia tsutsugamushi. We report here a middle-aged man with 3 days history of mild fever, dysphagia, and anarthria. On examination, he had nystagmus, quadriparesis, and a fresh eschar in the left scrotal region. Cerebrospinal fluid (CSF) and serum samples were positive for tsutsugamushi antibody. The magnetic resonance images (MRIs) showed T2 lesions in the brainstem, basal ganglia, frontal, corona radiate and spinal cord. After treatment with chloramphenicol and prednisolone, the clinical symptoms and signs improved. Our case highlights that encephalomyelitis may be caused by rickettsial disease such as scrub typhus.