Multiple myeloma (MM) is malignant plasma cell clonal disease.Autologous stem cell transplantation (ASCT) strengthen the advantages of the high-dose chemotherapy in treatment of MM,which achieves long-term survival in some patients.Even in the era of targeted novel agents,ASCT can still obviously increase the response rate of treatment.To improve the therapeutic efficacy,targeted novel agents were administrated before and after ASCT.However,targeted novel agents still cannot replace ASCT therapy in the treatment of MM.The direction of future research is to find more reasonable,effective and low toxic treatment.

The circle of Willis is the major cerebral collateral circulation.Its anatomical variation is in populations higher.The previous studies showed that anatomical variation in circle of Willis was an independent risk factor for cerebral ischemia.This article reviews the relationship between the various anatomical variation types of the circle of Willis and cerebral ischemia.

Objective To analyze the different clinical effects of colpohysterectomy combined with anterior and posterior wall colporrhaphy with or without biological mesh for uterine prolapse.Methods From January 2010 to May 2015, colpohysterectomy combined with anterior and posterior wall colporrhaphy was performed in 106 cases of uterine prolapse, including 75 cases receiving biological mesh repair (experimental group) and 31 cases of non-biological mesh (control group).Clinical and surgical information of all patients was collected, and satistial analysis was done between the two groups.Results All the operations were accomplished successfully.There were no statistical differences in bleeding amount during operation [(34.5±7.3) ml vs.(32.1±4.9) ml, t=1.973, P=0.051], time to first flatus [(29.2±4.8) d vs.(30.2±5.3) d, t=-0.907, P=0.366], postoperative hospital stay [(6.1±1.5) d vs.(6.0±1.4) d, t=0.328, P=0.744], as well as the operative time [(91.4±3.4) min vs.(95.1±10.2) min, t=-1.970, P=0.051].At one year after surgery, in the experimental group there were 74 patients cured, 1 patient improved, and no invalid or recurrence case, while in the control group there were 27 patients cured, 1 patient improved, 3 cases of recurrence and no invalid case.The treatment effect of the experimental group was significant better than that of the control group (Z=-2.571, P=0.010).Conclusions Colpohysterectomy with anterior and posterior wall colporrhaphy with biological mesh can be selected for uterine prolapse patients without contraindications.The results of surgery are better with biological mesh, with low recurrence rate.

64 patients with severe chronic periodontitis were divided into 2 groups(n =32)randomly.Intramuscular injection of ketorolac tromethamine(KT group)and local block injection of lidocaine(L group)were respectively applied for periodontal subgingival scaling and root planning.The analgesic effect was assessed using VAS,the adverse drug reactions were recorded during and after operation.During op-eration the VAS between the 2 groups was not statistically different(P >0.05).6 and 1 2 h after operation the VAS of KT group was lower than that of L group(P <0.05).During operation minor intraoperative local adverse reactions were observed in all cases in L group,but not any in KT group(P <0.05);after operation minor adverse reactions were observed in 1 case of KT group and in 2 cases of L group(P >0. 05).

Objective:To study the effect ofmetformin combined with insulin aspart on the serum cholesterol(TC),total Bilirubin (TBil),uric Acid(UA),urinary Micro Protein(mAlb) levels and Maternal and Infant Outcomes of gravida with Gestational Diabetes Mellitus.Methods:84 patients ofgestational diabetes mellitus who received therapy from June 2014 to June 2016 in our hospital were selected.According to random number table,those patients were divided into the observation group (n=42) and the control group (n=42),on the basis of routine treatment,The control group was treated with insulin aspart,while the observation group was combined with metformin hydrochloride.The blood glucose index and the levels of TC,TBil,UA,mAlb and maternal and infant outcomes were compared.Results:After treatment,the levels of fasting blood glucose (FBG),postprandial 2h blood glucose (2hPG),glycosylated hemoglobin (HbA1c),TC,TBil,UA and mAlb in the observation group were significantly lower than the control group,the levels of TBil was significantly higher than the control group (P＜0.05);the incidence ofgestational hypertension,hydramnios,premature birth,cesarean section,giant child and neonatal jaundice were significantly lower than the control group (P ＜0.05).Conclusion:Metformin combined with insulin aspart was well for gestational diabetes mellitus,which could effectively improve the blood glucose indicators and TC,TBil,UA,mAlb levels,maternal and infant outcomes.

Objective To observe the efficacy and safety of different initial doses of nebulized budesonide inhalation (BI) in infants and young children with moderate to severe asthma exacerbations.Methods A multi-center,parallel controlled clinical trial was performed during Sep 2008 to Apr 2010 in three hospitals,which were Department of Pediatrics,Shanghai Jiaotong University Affiliated Shanghai First People's Hospital,Department of Pediatrics,Shanghai Jiaotong University School of Medicine Affiliated Xinhua Hospital,and Department of Respiratory,Fudan University Affiliated Children's Hospital.One hundred and fifty children aged 6 to 36 month with moderate to severe asthma exacerbations were randomly divided into two groups.The high-starting-dose group was treated with a dose of 1 mg nebulized BI every 8 h for 2 days,while the conventional-starting-dose group was treated with a dose of 0.5 mg cvcry 8 h for 4 days.The terbutaline sulfate aerosol liquid was administered with a dose of 2.5 mg each time as needed.The primary outcome measures were severity scores,which were assessed at admission (0 h),and 8 h,16 h,24 h,48 h,72 h after treatment separately.The secondary outcome measures included the use of β2 receptor agonist,the systemic use of corticosteroids,average length of hospital stay and total cost.The data was analyzed with SPSS 13.0.Results (1) The clinical severity scores were significantly decreased at all time points after treatment in both groups (P ＜ 0.05).Compared with conventional starting-dose of BI,high starting-dose of 3.25 ± 1.82,P ＜ 0.01).(2) The terbutaline doses and the systemic corticosteroids do-ses were significantly reduced in high-starting-dose group compared with conventional-starting-dose group [(16.27 ± 12.99) mg vs (22.90 ± 18.27) mg,P ＜ 0.05 ; (4.54 ± 18.18) mg vs (11.16 ± 21.34) mg,P ＜ 0.05).The average length of hospital stay and the total cost of the two groups showed no significant differences (P ＞ 0.05).(3) There were no side effects associated with BI.Conclusion Compared with conventional treatment,high-starting-dose of BI can control symptoms fast and reduce the use of systemic corticosteroid without any side effects.BI improved symptoms more quickly at 8 h (2.87 ± 1.60 vs 4.48 ± 2.24,P ＜ 0.01) and 16 h (2.48 ± 1.56 vs

Objective To evaluate the respiratory movement of the both lungs with four-dimensional CT(4DCT), and determine the optimal respiratory phase series CT images for radiation dose calculation. Methods From November 2005 to November 2006,thirty patients with lung cancer who received 4DCT scan were enrolled,including 15 left and 15 right lung cancer cases,25 men and 5 women. The media age was 55 (35-78) years old. After 4DCT scanning, the image was treated with Advantage 4D workstation,and then transmitted into Pinnacle station( Adac 7.4). The both lungs were automatically outlined using Pinnacle station with CT recognition value of-900 to-200 Hu. Then-the same physician examined the unreasonable parts and revised them. After the delineation was completed,the volume of 10 respiratory phases of lung was obtained. Results The average respiratory phase in inspiratory and expiratory phases was 78.87%±2.71% and 26.32%±3.17% in the tumor located lung,77.55%±2.81% and 24.73%±2.55% in the healthy lung. The maximum and minimum mean volume was 106.48%±3.00% and 94.23%±2.78% in the tumor located lung,107.47%±2.43% and 93.65%±2.32% in the healthy lung. The volume at the end of inspiratory and expiratory was 106.43%±3.07% and 94.63%±2.71% in the tumor located lung, 107.37%±4.62% and 93.98%±2.34% in the healthy lung. Conclusions The series CT images scan on 20% ,30% and 80% respiratory phases are reasonable for radiation dose calculation. The maximum and minimum average lung volumes are almost equal to those at the end of inspiratory and expiratory.

Objective To observe the application effect of the risk of ovarian malignancy algorithm(ROMA)in screening ovarian cancer among high risk population.Methods The human epididymis protein 4(HE4)and carbohydrate antigen 125 (CA125 )were detected in 1 753 cases of high risk for overian cancer,56 cases of ovarian cancer(positive control)and 60 healthy people,patients. Then the ROMA value was calculated in combination with the subject′s menstruation status.The detection results were analyzed and compared among groups.The high risk group for ovarian cancer devided according to the ROMA value was further performed the confirmatory test and the low risk group was monitored by follow up.The detection rates of ovarian cancer were compared be-tween the two subgroups.Results In the high risk population,the diagnostic performance of the ROMA value for ovarian cancer was superior to that of the single HE4 or CA125;the ROMA value had statistically significant difference between the high risk sub-group in the high-risk population with ovarian cancer or the healthy control group(P <0.05);in 1 753 cases of high risk popula-tion,37 cases were included in the high risk subgroup,in which 3 cases of ovarian cancer were screened out and in clinical early stage.The detection rate of ovarian cancer in the high risk subgroup was 8.1%.No case of ovarian cancer was detected out in the low risk subgroup.Conclusion The ROMA value is conducive to early screening for ovarian cancer in the high risk population, which can save the medical cost and increase the detection rate.

Objective To explore the prognostic value of arterial blood lactate (Lac) levels and lactate clearance rate (LCR) in the patients with septic shock.Methods A retrospective study was conducted.Clinical data of 94 septic patients admitted in the Department of Critical Care Medicine in Subei People's Hospital from January 2011 to June 2014 were analyzed.The arterial blood Lac levels at the moment of diagnosis of septic shock (incipient value,0 hour) and early-stage after treatment (3,6 and 24 hours) were reviewed,and individual LCR was calculated at 3,6,24 hours for each patient.According to the outcome in intensive care unit (ICU),patients were divided into survival group (n =48) and death group (n =46).The Lac and LCR at different time points in two groups were analyzed,and the relationships between them and outcome were analyzed.The receiver-operating characteristic (ROC) curve was plotted to assess the value of Lac and LCR at different time points for predicting the outcome.Results Lac level after treatment in survival group was significantly lower than incipient value,but there was no obvious change in death group.Compared with death group,early Lac levels (mmol/L) in survival group were significantly reduced (0 hour:3.80 ± 2.14 vs.5.75±3.21,3 hours:2.05± 1.04 vs.5.03±2.53,6 hours:1.80±0.77 vs.4.40±2.02,24 hours:1.35±0.43 vs.4.90 ± 2.72,P ＜ 0.05 or P ＜ 0.01),the LCR was significantly increased [3 hours:50.00 (72.35)％ vs.13.51 (20.67)％,6 hours:41.43 (58.42)％ vs.22.00 (22.31)％,24 hours:58.73 (29.94)％ vs.18.92 (47.28)％,P ＜ 0.05 or P ＜ 0.01].The Lac levels at all time points were positively correlated with the outcome,and 6-hour and 24-hour LCR were negatively correlated with the outcome.According to the incipient Lac level,patients were divided into low Lac group (Lac ＜ 2 mmol/L),mild Lac group (Lac 2-3 mmol/L) and high Lac group (Lac ≥ 4 mmol/L).The mortality in low Lac group,mild Lac group,high Lac group was gradually increased [23.07％ (6/26),50.00％ (8/16),61.54％ (32/52),x2=10.270,P =0.006].ROC curves demonstrated that the area under ROC curve (AUC) of 24-hour Lac was the largest,0.944,and it was more sensitive and specific in the prognosis evaluation (100％ and 78.3％,respectively).According to the cut-off value of 24-hour Lac as 2.35 mmol/L,patients were divided into high Lac and low Lac groups,and mortality rate in high Lac group was significantly higher than that in low Lac group [100.0％ (36/36) vs.17.24％ (10/58),x2=30.441,P =0.000].The AUC of 24-hour LCR was the largest,0.865,and it was more sensitive and specific for the prognosis evaluation (83.3％ and 91.3％,respectively).According to the cut-off value of 24-hour LCR as 36.8％,patients were divided into high LCR group and low LCR group,and mortality rate in low LCR group was significantly higher than that in high LCR group [84.00％ (42/50) vs.9.09％ (4/44),x2=26.278,P =0.000].Conclusion Early high Lac in patients with septic shock prompts a poor prognosis,and 24-hour Lac levels and LCR are indicators of assessment of clinical therapeutic effect and prognosis of patients with septic shock.

Objective:To observe the clinical effect of apical barrier and perforation repair with mineral trioxide aggregate.Methods:Selected 23 samples from out-patients of the department of conservative dentistry of oral disease treatment center of 306 Hospital of PLA.Among them,7 samples were with unshaped root apical,6 samples were with lateral perforation from root canal internal absorption or root fracture,10 samples were iatrogenic lateral perforation.The course of the disease was 0.5-24 months.The images of dental films showed that there was shadow around the root or apical area in all the samples.All the samples received regular root canal treatment.Under root canal microscope,the open sites were sealed with MTA.After the barrier formed,filled the root canal with warm gutta-percha vertical compaction technique.Patients were ordered to re-check on 6 months and 12 months respectively.Results:1 sample dropped out.On 6 months visit,1 sample showed enlarged shadow at the apical area,20 samples showed shrinked shadow,1 sample showed no significant change.On 12 months visit,the shadow vanished in 9 samples;the shadow decreased in 5 samples,and there were 2 samples showed no significant changes.Conclusion:The treatment with MTA on apical barrier and perforation shows acceptable effect in short term observation.The use of microscope helps to enhance the accuracy and leak tightness of MTA filling.