Objective To analyze the immunological feature of the multiple myeloma. Methods The serum of 117 cases were detected by serum protein electrophoresis and immunofixation electrophoresis;and analyzed quantitatively immune globulin(IgG、IgA、IgM) ,total protein and albumin. Results Monoclone protein peak was found in 67 patients out of 117 patients tested(57.3%) ,it located mainly at γ border. Immunoglobulin G was found in 62 patients out of 117 patients tested(53.0%). Immunoglobulin A was 19 cases(16.3%) ,Immunoglobulin M was 12 cases(10. 1%) ,DL was 2 cases(1.7%) ,free light chain was 22 cases(18.8%). Homotypic immunoglobulin level increased notably and non-correspond constituent was low in immunoglobulin test. The protein quantified displayed that total protein increased and albumin decreased in different level. Conclusion The seroimmunological index played a crucial role in diagnois,clinical stage and prognosis of MM.

Objective: To investigate the preparation of pulsatile release tablets, the release of the drug in vitro and the pharmacokinetics in vivo . Methods: Dil tiazem hydrochloride（DIL） was used as model drug. The pulsatile release tabl e ts were prepared by dry-coated method with carnauba wax, bee wax and hydrophil i c cellulose as coating materials. The effects of formulation and technology on t he release characteri stic of diltiazem hydrochloride was investigated. The mechanism of pulsatile rel ease of the drug was proved by erosion test. The pharmacokinetic study on four h uman subjects was done by means of HPLC measurement. Results: In vitro ， delayed-release ti me t 10 was 2.1　h, the maximum release time t rm 4.0　h and t he pulsed-releas e time t 10-90 1.7　h. In vivo ， delayed-release time t la g was 5.7　h, the p eak time 8.5　h and the pulsed-release time 2.6　h. Conclusion: The rele ase of drug from pulsatile-released tablets of diltiazem hydrochloride was in a pulsed way both in vitro and in vivo .

Objective To know the postnatal depression and anxiety state and its related factors of parturients from migrant worker family,and then reference to certain nursing counter-measures. Methods Sampled 73 parturients by spontaneous labor from migrant worker family and 45 local matched parturients,interviewed them by SAS and SDS to know their postnatal depression and anxiety state,and then analyzed the datum between them. Results The level of postnatal depression and anxiety in parturients from migrant worker family was significant higher than that in local parturienta.Different level of depression and anxiety was existed in different parturients from migrant worker family by different educational attainments,different family type and different financial state. Conclusions The state of postnatal depression and anxiety in parturients from migrant worker family is severely,related health education should be strengthened,associated social secu-rity and support system should be established to help them release their unhealthy emotion.

Objective To measure the diameter of optic nerve sheath by ultrasonography to evaluate the change of intracranial pressure(ICP)in prone position ventilation,and to provide basis for prone position ventilation in patients with increased intracranial pressure (ICH). Methods A total of 58 patients with mechanical ventilation were treated with prospective clinical study from 2016.05.01 to 2017.05.01. The patients were treated with different PEEP and different positions(supine position and prone position),and detected optic nerve sheath diameter(ONSD)behind 3 mm of eye 3 mm by bedside ultrasound. The cause inducing increase of ICP was studied through the changes of ONSD and the data was analyzed by the paired t test. Results Prone position had a significant effect on patients with increased intracranial pressure. PEEP had a significant effect on MAP,Ppeak, Pplat,but had no effect on increased intracranial pressure. Conclusions Prone position ventilation significantly affect the ONSD. Therefore ,it weighs the pros and cons when patients with intracranial hypertension were received prone position ventilation.

Objective:To investigate the effect of pulmonary vascular dysfunction in the prognosis of patients with acute lung injury (ALI).Methods:Patients with ALI who underwent pulmonary artery catheterization in the department of critical care medicine of Wuhan NO.1 Hospital from June 2017 to June 2019 were enrolled. The general information, clinical and hemodynamic indexes [central venous pressure (CVP), pulmonary artery wedge pressure (PAWP), pulmonary artery systolic pressure (sPAP), pulmonary artery diastolic pressure (dPAP), mean pulmonary artery pressure (mPAP), cardiac index (CI)], acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, arterial blood gas parameters [pH, partial pressure of oxygen (PO 2), partial pressure of carbon dioxide (PCO 2), oxygenation index (PaO 2/FiO 2)], whether there was shock or not; ventilator parameters [platform pressure (Plat), positive end-expiratory pressure (PEEP)], etc. were recorded. Pulmonary artery oxygen saturation, pulmonary vascular function indexes [transpulmonary potential gradient (TPG) and pulmonary vascular resistance index (PVRi)] were calculated. The relationship between TPG, PVRi and mechanical ventilation time, the length of intensive care unit (ICU) stay, cardiovascular days and 60-day mortality were analyzed in patients with different prognosis of 60-day and whether the TPG increased (≥12 mmHg was defined as elevated TPG, 1 mmHg = 0.133 kPa). Results:A total of 65 patients were included in the study, including 30 males and 35 females; aged (48.9±15.2) years old. Forty-eight cases survived in 60-days, 17 died, and the 60-day mortality was 26.2%. At the baseline, there were no significant differences in cardiopulmonary function measurements, such as CVP, sPAP, dPAP, PAWP, CI, etc. between the two groups of patients with different prognosis. The APACHEⅡ score, shock ratio, TPG and PVRi of the death group were significant higher than those of the survival group [APACHEⅡ: 34±9 vs. 28±11, shock: 52.9% vs. 25.0%, TPG (mmHg): 16.2±1.9 vs. 14.6±2.1, PVRi (kPa·s·L -1): 31.8±4.2 vs. 29.7±3.5, all P < 0.05]. The 60-day mortality of 47 patients with TPG ≥ 12 mmHg was significantly higher than that of 18 patients with TPG < 12 mmHg (34.0% vs. 5.6%), and the mechanical ventilation time and the length of ICU stay were also significantly longer (days: 17±9 vs. 11±8, 16±5 vs. 12±5), and the cardiovascular days also increased significantly (days: 23±7 vs. 18±6), and the differences were statistically significant (all P < 0.05). Pearson correlation analysis showed that PVRi was significantly correlated with mechanical ventilation time, the length of ICU stay and cardiovascular days ( r1 = 0.317, P1 = 0.030; r2 = 0.277, P2 = 0.005; r3 = 0.285, P3 = 0.002). In the individual multivariate Logistic regression model, the highest PVRi was an independent risk factor for the 60-day mortality [odds ratio ( OR) = 30.5, 95% confidence interval was 20.4-43.1, P = 0.023]. Conclusion:Pulmonary vascular dysfunction is common in ALI patients and is independently associated with adverse outcomes.

Objective To observe the effects of moderate intensity exercise training combined with Xianlinggubao capsule on bone mineral density (BMD), bone metabolism and femoral biomechanics of ovariectomized rats, so as to provide lab references for osteoporosis prevention. Methods Fifty female SD rats were randomly divided into 5 groups, 10 rats in each group. Group A was the normal control; Group B was given 1 mL normal saline by gavage after ovariectomy for one week; Group C was given moderate intensity exercise training (exercise speed was 20 m/min, lasting for 60 min per day, continuous 5 days per week); Group D was given 1 mL Xianlinggubao capsule ［0.4 g/(kg · d)］ after 1-week ovariectomy; Group E was was given both 1 mL Xianlinggubao capsule and moderate intensity exercise training after 1-week ovariectomy. After 8 weeks of continuous treatment, blood biochemical indexes, BMD, micro CT and biomechanics of the femur and L5 vertebral body were detected. Results Compared with group B, the blood biochemical indexes of Group C-E were improved in varying degrees, the BMD of L5 vertebral body and femur were increased, the bone volume fraction, trabecular number and trabecular thickness of femur (or L5 vertebral body) were increased, the trabecular space and structural model index were decreased, the maximum load, maximum deflection and maximum stress of L5 vertebral body were increased, and the maximum stress of femur was increased. The maximum load, elastic load, elastic deflection, elastic modulus, elastic stress, maximum stress and elastic deflection increased, and the effect of Group E was the most obvious. Conclusions Moderate intensity exercise training combined with Xianlinggubao capsule can improve BMD, bone metabolism and bone microstructure, and improve bone mechanical properties of ovariectomized rats.

Objective:To explore the effect of midwife-led specialist outpatient weight management on the delivery outcomes of pregnant women with scarred uterus.Methods:From January 2020 to January 2021, convenience sampling was used to select 120 pregnant women with singleton scarred uterus in the First Affiliated Hospital of Wenzhou Medical University as the research object. Pregnant women were divided into the control group and the observation group by random number table method, 60 cases in each group. The control group received routine antenatal outpatient examination and guidance, while the observation group received midwife-led specialist outpatient weight management on the basis of the control group. The vaginal delivery rate, cesarean section rate, 24-hour postpartum hemorrhage, anxiety and newborn birth weight were compared between the two groups.Results:The vaginal delivery rate of pregnant women in the observation group was higher than that in the control group, and the cesarean section rate, 24-hour postpartum hemorrhage, anxiety and newborn birth weight were lower than those in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Midwife-led specialist outpatient weight management can effectively control the weight gain of pregnant women with scarred uterus during pregnancy, improve delivery outcomes, reduce postpartum hemorrhage and maternal anxiety, and help control the birth weight of newborns within the ideal range, which is worthy of clinical application.

Chemical cleaning and disinfection are crucial steps for eliminating infection in root canal treatment.However,irrigant selection or irrigation procedures are far from clear.The vapor lock effect in the apical region has yet to be solved,impeding irrigation efficacy and resulting in residual infections and compromised treatment outcomes.Additionally,ambiguous clinical indications for root canal medication and non-standardized dressing protocols must be clarified.Inappropriate intracanal medication may present side effects and jeopardize the therapeutic outcomes.Indeed,clinicians have been aware of these concerns for years.Based on the current evidence of studies,this article reviews the properties of various irrigants and intracanal medicaments and elucidates their effectiveness and interactions.The evolution of different kinetic irrigation methods,their effects,limitations,the paradigm shift,current indications,and effective operational procedures regarding intracanal medication are also discussed.This expert consensus aims to establish the clinical operation guidelines for root canal irrigation and a position statement on intracanal medication,thus facilitating a better understanding of infection control,standardizing clinical practice,and ultimately improving the success of endodontic therapy.

Objective:To systematically evaluate the relationship between growth and thyroid volume (Tvol).Methods:Chinese and English papers were searched in CNKI, Wanfang Data, VIP Database, PubMed, EMbase, Springerlink, Medline database, articles on the correlation between Tvol and growth in children published from the establishment of these databases to October 2021 were collected. Meta-analysis was conducted with R language 4.0. I2 and Q test were used for heterogeneity test. According to the heterogeneity test results, the fixed effect model or random effect model was selected, and sensitivity analysis was conducted. Egger's method was used to test publication bias. Results:A total of 17 papers were incorporated in this study, including 11 Chinese papers and 6 English papers. The correlation between body surface area (BSA) and Tvol was the strongest[estimated effect value ( COR) = 0.44, 95% confidence interval ( CI): 0.39 - 0.50], followed by weight ( COR = 0.39), height ( COR = 0.37) and age ( COR = 0.29). Sensitivity analysis showed that the estimated effects COR were all within 95% CI of the total effects after deleting any paper, which indicated that the results of Meta-analysis were reliable. Egger's method result showed P > 0.05, indicating that there was no obvious publication bias in this study. Conclusion:Age, height, weight and BSA all have effects on Tvol, among which BSA has the greatest effect.

【Objective】 To establish a blood quality monitoring indicator system, in order to continuously improve blood quality and standardized management. 【Methods】 Based on the research of literature and standards, and guided by the key control points of blood collection and supply process, the blood quality monitoring indicator system was developed. Through two rounds of Delphi expert consultation, the indicator content was further revised and improved according to expert opinions after six months of trial implementation. The indicator weight was calculated by questionnaire and analytic hierarchy process. 【Results】 A blood quality monitoring indicator system covering the whole process of blood collection and supply was constructed, including five primary indicators, namely blood donation service, blood component preparation, blood testing, blood supply and quality control, as well as 72 secondary indicators, including definitions, calculation formulas, etc. Two rounds of expert consultation and two rounds of feasibility study meeting were held to revise 17 items and the weight of each indicator was obtained through the analytic hierarchy process. After partial adjustments, a blood quality monitoring indicator system was formed. 【Conclusion】 A blood quality monitoring indicator system covering the whole process of blood collection and supply has been established for the first time, which can effectively evaluate the quality management level of blood banks and coordinate blood quality control activities of blood banks in Shandong like pieces in a chess game, thus improving the standardized management level