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.

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.

Duodenal varices are an uncommon disease which occurs along the entire gastrointestinal tract outside the esophagus or stomach.Among ectopic varices,duodenal varices are the most common one.Cirrhosis,hepatic portal hypertension,extrahepatic portal vein occlusion and vasculitis contribute to the pathogenesis of ectopic variceal formation.The unusual pathophysiology,location,diversity and uncertain curative effect of DV are associated with its low detection rate and high mortality of patients.Therefore,the diagnosis and treatment of DV is one of the tough problems in clinical practice.This article reviews the current research advances in pathophysiology,diagnosis and treatment of duodenal varices to provide reference for clinical practice.

ObjectiveTo observe whether if intravenous infusion of dexmedetomidine in advance can prevent irritation and cough causing by sufentanil.MethodsNinety patients who performed excision of intracranial tumor were divided into observation group and control group by random digits table with 45 cases each.Patients in observation group were intravenously infused 0.5 μg/kg dexmedetomidine for 10 minutes before induction.Patients in control group were intravenously infused 0.9％ sodium chloride for 10 minutes before induction.All the patients were intravenously infused 0.3 μg/kg sufentanil after taking drugs of load dosage in 3 seconds,and the incidence of irritation and cough in 1 minute was observed.The mean arterial pressure and heart rate were recorded before infusing dexmedetomidine or sodium chloride(T0),at the end of infusing dexmedetomidine or sodium chloride (T1),before intubation (T2),1 minute after intubation (T3).ResultsThe incidence of irritation and cough,moderate-severe irritation and cough in observation group [ 24.4％ ( 11/45 ),11.1％ (5/45) ] were lower than those in control group [ 48.9％ (22/45),22.2％ ( 10/45 ) ]with significant differences(P＜ 0.01 ).The mean arterial pressure in control group at T2 was lower than that in observation group [ (71.2 ± 3.5) mm Hg( 1 mm Hg =0.133 kPa) vs.(84.7 ± 4.1 ) mm Hg] with significant difference (P ＜ 0.05 ).The mean arterial pressure in control group at T3 was higher than that in observation group [(96.7 ± 6.4) mm Hg vs.(83.1 ± 5.2) mm Hg] with significant difference(P＜ 0.05).The heart rate at T1,T2,T3 in observation group was lower than that in control group [ (53.2 ± 4.7 ) beats/min vs.(70.4 ± 6.2 )beats/min,(56.3 ± 3.1 ) beats/min vs. (64.7 ± 3.7) beats/min,(59.1 ± 4.8) beats/min vs. (81.5 ± 6.1 )beats/min],and there were significant differences(P ＜0.05).Conclusions Intravenous infusion of dexmedetomidine (0.5 μg/kg) in advance can effectively prevent irritation and cough causing by sufentanil,and can enhance the stability of circulation during intubation.

Objective To observe the clinical effect of mannatide treatment with burn infection. Methods 100 burn patients admitted to Sichuan Nanchong Central Hospital from May 2009 to July 2012 were randomly divided into control group and treatment group, each group had 50 cases. Both of two groups were given conventional treatment, treatment group were treated with intravenous mannatide,control group were injected recombinant human growth hormone. Results The average length of stay in treatment group was signiifcantly shorter than control group (P=0.042). The clinical total effective rate, serum IgA, IgG, IgM and other indicators of immune function were improved signiifcantly compared with control group (P=0.037). There was no statistical signiifcance in blood protein, transferrin, prealbumin, glucose, insulin, urinary sodium, urinary potassium, chloride and other indicators of patients between two groups. Conclusion Mannatide can effectively enhance immune function, promote wound healing, shorter hospital stay and improve the clinical efifcacy.

Multiple myeloma is one of the common hematological malignant disease,but the treatment response was not very promising with conventional and high-dose chemotherapy.There are many new medicines or new therapies having been developed in recent years,such as thalidomide and its derivant,proteasome inhibitors,arsenic trioxide etc,they are more effective than conventional chemotherapy,such as oral melphalan and prednisone(MP);vincristine,doxorubicin,and dexamethasone(VAD).This paper summarize the recent advances in the new options for the treatment of multiple myeloma

0.05).The stimulative index(SI)tested by MTT in MLR at stimulator-to-reactor cell ratio 1∶1,1∶10,1∶20,1∶40 and 1∶80 was 2.7,4.1,3.1,2.5 and 1.6,respectively.The proliferation of T cells stimulated by DCs could be detected at all stimulator-to-reactor ratio.Conclusion DCs could be successfully induced from peripheral blood monocyte in the patients with colorectal cancer by AIM-V serum-free media or by traditional FBS-contained media.AIM-V is more suitable for clinical immunotherapy because it can avoid the risk of allergic reaction for clinical purpose.AIM-V might take the place of serum-contained media to culture DCs.According to the results of MLR,DCs could stimulate allogenetic T cells proliferation at all stimulator-to-effector ratio,furthmore the optimal ratio is 1∶10 .

Objective:To explore the correlation among morning blood pressure surge (MBPS) ,ambulatory arterial stiffness index (AASI) and carotid artery intima‐media thickness (IMT) .Methods :A total of 212 hypertension pa‐tients received 24h ambulatory blood pressure monitoring and carotid artery ultrasonography to measure carotid IMT .According to IMT thickened or not ,they were divided into normal IMT group (n=84) and thickened IMT group (n = 128) ,then MBPS and AASI were calculated .According to MBPS existed or not ,patients were divided into MBPS group (n = 120) and no MBPS group (n = 92) ,then the correlation among MBPS ,AASI and carotid IMT were observed .Results : Compared with normal IMT group ,there were significant rise in AASI [ (0.42 ± 0.13) vs .(0.68 ± 0.14)] and MBPS value [ (25.94 ± 4.57) mmHg vs .(36.57 ± 8.41) mmHg] in thickened IMT group , P < 0.05 both ;compared with no MBPS group ,there were significant rise in AASI [ (0.43 ± 0.13) vs .(0.71 ± 0.14)] and IMT [(1.01 ± 0.20) mm vs .(1.25 ± 0.17) mm] in MBPS group ,P < 0.05 both ;Linear correlation analysis indicated that MBPS and AASI were positively correlated with carotid IMT ( r = 1.22 ,0.51 , P < 0.05 both) .Conclusion : Morning blood pressure surge and ambulatory arterial stiffness index are independent risk factors for carotid artery intima‐media thickness ,and they possess predictive value .

Background and purpose:The role of urine N-telopeptides of type Ⅰ collagen(uNTX) and serum bone spesifi c alkaline phosphatase(sBAP)was confi rmed in osseous metastasis of solid tumors. The aim of this article was to study their role in multiple myeloma (MM). Methods:Thirty eight MM patients (22 new diagnosed, 12 relapsed or refractory, 4 plateau patients ) were examined. Ten age-matched healthy volunteers were used as controls. Urine and serum samples were taken from all patients and controls before therapy, after 3 months and 6 months chemotherapy. Urine samples of NTX, serum samples of BAP were measured with enzyme-linked immunosorbent assays (ELISA). Results:Urine NTX concentrations were signifi cantly higher in newly diagnosed and relapsed or refractory patients than that in plateau patients and controls. Serum BAP concentrations were signifi cantly lower than that in plateau patients and controls. In newly diagnosed patients, urine NTX values were signifi cantly higher in stage Ⅲ disease than in stage Ⅰ/Ⅱdisease, serum BAP values were signifi cantly higher in stage Ⅰ/Ⅱ disease than stage Ⅲ disease. At the third month, urine NTX were signifi cantly lower and serum BAP were signifi cantly higher as well as at the sixth month. But osteolytic lesions in X–ray had no change at the sixth month. Conclusions:Bone turnover markers uNTX, sBAP and bone destruction are closely interrelated in multiple myeloma, they change much earlier than X-ray. They are useful in monitoring progression and the therapeutic effect of myeloma.

0.05).CONCLUSION:There is no evidence of impaired JPS in weight-bearing positions in subjects with ACL reconstruction at a mean follow-up of 12 months after surgery compared with subjects with healthy knees.