Objective To investigate the expression of COX-2 in multiple myeloma(MM)and the relationship between myeloma cells proliferation and apoptosis.To provide a new prognosis factor and therapeutic target.Methods COX-2 from the 22 newly diagnosed MM,14 relapsed MM and PCNA,HSP70 of the newly diagnosed patients were detected by immunohistochemistry method.Results All the newly diagnosed MM exhibited positive COX-2 immunoreactivity.50% had strong COX-2 and 50% showed weak COX-2.Relapsed MM exhibited strong COX-2.COX-2 was related with serum β2 microglobulin,marrow plasma cells,hemoglobin,PCNA,HSP70(P=0.019,0.003,0.048,0.006,0.034).Conclusion COX-2 was overexpressed in MM.Prognosis of patients with strong COX-2 is poorer than those with weak COX-2.COX-2 may promote the proliferation and inhibit the apoptosis of myeloma cells.

Objective To analyze the efficacy of using da Vinci S robot system to complete the robotassisted laparoscopic radical cystectomy (RARC) orthotopic neobladder and explore the peri-operative nursing care.Methods December 2008 February 2010,four cases of male patients RARC + orthotopic neobladder.Procedure was successful. Focusing on the psychological care before surgery, bowel preparation, and postoperative care focuses on the monitoring of vital signs,drainage tube care,exercise and the new bladder,while actively preventing complications.Results All patients recovered well,without serious complications and with satisfactory effect.Conclusions Robot-assisted laparoscopic radical cystectomy (RARC) + orthotopic bladder was less trauma, safer, reliable, rapid postoperative rehabilitation, scars less, and worthy of application,but subjected to strict nursing process.

Objective To investigate the efficacy and toxicity of bortezomib in combination with ifosfamide, methylprednisolone, thalidomide (V-CMPT) for the treatment of multiple myeloma (MM). Methods Twenty-four patients with newly diagnosed or relapsed/refractory MM were treated with V-CMPT. This regimen was repeated every three weeks as one cycle, and each case received two cycles. We adopted the examination of bone marrow and M protein and other hematological markers to evaluate the condition of disease and the therapeutic response. Results Of the nine patients with newly diagnosed MM, three achieved a complete remission (CR), five of a partial response (PR), and 1 of a minor response (MR). Of the patients with relapsed/refractory MM, two achieved a CR, two had a near CR (nCR), three had a PR, six had a MR, and two were no chang (NC). There was no obvious difference in the two groups (P = 0.511, P = 1.000). The overall response rate (ORR) was 91.7 %, and the CR/nCR rate was 29.2 %. After two cycles, the levels of hemoglobin, the serum albumin and the serum β2-microglobulin were obviously improved. The main adverse events were transient, including gastrointestinal reaction, thrombocytopenia, neuropathy, which could be controlled during the interval of chemotherapy or by symptomatic treatment and had no influence on the chemotherapy.Conclusion V-CMPT regiman was effective against the newly diagnosed and relapsed/refractory MM and could improve the related hematological markers with high response rate and tolerable toxicities.

Objective To obserue that bortezomib lead to hepatic impairment and even hepatic insufficiency. Methods Four multiple myeloma patients with hepatic impairment in velcade therapy were analyzed. All of 4 patients ranged from 46 to 60-year-old were relapsed and refractory, including 3 cases of male and 1 of female; 2 of K light chain type, 1 of non secretion type and 1 of IgGλλ biclonal type; 3 in stage ⅢB and 1 in stage ⅢA. Results Four patients had normal hepatic function before bortezomib therapy, but all appeared hepatic impairment during therapy. ALT and aspartate aminotransferase were increased by 2-80 and 1.5-70 times compared with before the chemotherapy, respectively, and bilirubin and alkaline phosphatase in 2 patients and glutamyltranspeptidase in 1 patient were increased. Hepatic function restored normally after patients were given liver securing drug and discontinued bortezomib therapy. Conclusion It isn't rare that bortezomib causing hepatic impairment in the patients with multiple myeloma.

AIM: To assess the efficacy and safety of prophylactic laser photocoagulation for retinal breaks before laser in situ keratomileusis (LASIK) in myopic eyes.METHODS: From April 2000 to April 2004, totally 1 845 eyes ( 1 233 patients ) requesting LASIK had a fundus examination with indirect ophthalmoscopy before the surgery. They were divided into two groups according to the presence (Group 1) or absence of retinal breaks (Group 2). All patients with retinal breaks, though they were asymptomatic, underwent prophylactic laser photocoagulation to seal the breaks before LASIK.RESULTS: Patient age ranged from 18 to 43 ( 25.3±5.7) yaers old. Mean preoperative spherical equivalent refraction (PSER) was -7.44± 2.13 D (range, -1.50 to -14.50 D). Retinal breaks were identified and treated in 37eyes (2.05%) of 32 patients;1 808 eyes of 1 201 patients had no retinal breaks. No statistical difference was found in age ( P ＞0.05) or gender (P ＞0.05) between the two groups. Significant difference of PSER was noted between Group 1 (-9.41± 4.15D) and Group 2 (-7.52±3.71D) (P＜0.05). During a mean 14mo follow-up, none of the patients developed retinal detachment.CONCLUSION: The efficacy and safety of prophylactic laser photocoagulation for retinal breaks was confirmed.Retinal breaks should be identified and treated by photocoagulation in eyes before LASIK for myopia.

Objective To explore the clinical characteristics of Waldenstrom macroglobulinemia (WM) and enhance the level of diagnosis and treatment. Method The data of 15 patients with WM in our 68.5(60-79) years, male/female =2.75/1. Main clinical manifestations were fatigue, loss of weight, splenomegaly and lymphadenopathy. All the patients accepted the treatment of alkylating agents, purine nucleoside analogs, bortezomib or thalidomide respectively. The follow-up period for the patients was 4 months to 10 years and the median follow-up time was 82 months. Conclusion WM may often be seen in old male patients with varied clinical manifestations. The primary treatment is chemotherapy, but the disease is incurable. Bortezomib and thalidomide may improve the therapeutic effect.

Objective To investigate the clinical characteristics, prognosis and treatment of pleural effusion of multiple myeloma. Methods From Jun 2005 to March 2010, of 162 patients with multiple myeloma treated in our department were complicated with pleural effusion, whose the proportion male to female was 8:7 and the median age was 56.8 (37-68) years. The diagnosis of malignant pleural effusion was dependent on physical examination, chest X ray, pleural aspiration and pleural fluid cytology. According to internatinal system stages and Durie-Salmon stages, the patients were staged. Results The results of pleural fluid cytology showed that the myeloma cells were positive in 13 patients and was negative in the other 2 patients. All patients received the chemotherapy regimen including bortezomib, large dose of glucocorticoids and cisplatin, cyclophosphamide, etoposide or prednisone (DECP). Although pleural effusion was controlled in some degrees, but were quickly relapsed. Eleven patients died, 2 of steady disease and 2 follow-up. Conclusion Multiple myeloma with myelomatous pleural effusion was very poor in the prognosis. Myelomatous pleural effusion was taken as a late manifestation in multiple myeloma or prediction of the aggressive behavior of the disease.

Objective To study the effect of recombinant interlukin-2 plus chemotherapy in treatment of multiple myeloma. Methods We divided into two groups: chemotherapy plus rIL-2 group and simple chemotherapy group. The patients were given at dose of rIL-2 1×l06 IU/d, iH, qd, for 4 weeks and 4cycles. After 4 cycles the changes of T-cell subsets of their peripheral blood were determined. Response was evaluated according to Blad criteria. Adverse events were graded according to the National Cancer Institute Common Toxicity Criteria,version 3.0. Results The positive percentages of CD_3, CD_4 NK, CD_(69) and CD_4/CD_8ratio after chemotherapy in chemotherapy plus rIL-2 group were significantly higher than those before chemotherapy in the same group and those after chemotherapy in the other group. The overall response rate and complete response rate were 66.7 % and 25.0 % vs 50.0 % and 8.3 % respectively. The side effects of rIL-2 were predictable and manageable. Conclusion Recombinant interlukin-2 plus chemotherapy could increase immune function of patients with multiple myeloma and has a higher response rate as compared with simple chemotherapy.

Objective: To investigate the characteristics of newly reported HIV/AIDS cases aged 15 years and older in Shangcheng District, Hangzhou City from 2006 to 2022, so as to provide the basis for improving AIDS prevention and control strategies. Methods: Data of newly reported HIV/AIDS cases aged 15 years and older in Shangcheng District from 2006 to 2022 were collected through HIV/AIDS Comprehensive Control System of Chinese Disease Prevention and Control Information System. Population distribution and transmission routes were analyzed, and changing trends in case number were analyzed using average annual percent change (AAPC) and annual percent change (APC). Results: A total of 4 409 HIV/AIDS cases aged 15 years and older were newly reported in Shangcheng District from 2006 to 2022, including 3 932 males (89.18%). There were 3 447 cases (78.18%) under 50 years old and 962 cases (21.82%) being 50 years and older. Sexual contact was a predominant transmission route, with 4 326 cases accounting for 98.12%, including 2 626 cases (59.56%) with homosexual contact and 1 700 cases (38.56%) with heterosexual contact. The number of HIV/AIDS cases showed an overall upward trend from 2006 to 2022 (AAPC=13.038%, P<0.05), with an upward trend from 2006 to 2015 (APC=42.578%, P<0.05) and a downward trend from 2015 to 2022 (APC=-19.713%, P<0.05). The increase in the number of cases aged 50 years and older group was faster than that of cases aged under 50 years (AAPC=22.641% vs. 11.162%, both P<0.05). The increase in the number of cases with homosexual contact transmission was faster than that of cases with heterosexual contact transmission (AAPC=20.417% vs. 7.455%, both P<0.05). Conclusions The number of newly reported HIV/AIDS cases aged 15 years and older in Shangcheng District performed an overall upward trend from 2006 to 2022. The cases aged 50 years and older and transmitted through homosexual contact increased rapidly, which should be taken seriously.

Objective To investigate the nursing informatics competencies of nurses from grade A class 3 hospital and explore the importance of nursing informatics competencies training.Methods Questionnaire survey was conducted in 300 nurses from six grade A class 3 hospitals on nursing informatics competencies.Results 63.3％ nurses had clinical nursing informatics training within 1month; 47％ nurses were unfamiliar with the operational approach of Personal Digital Assistant and mobile rounds carts and other terminal nursing equipments; 53.67％ nurses were proficient in using the Nursing Informatics System of Hospital Informatics System( HIS); only 11.33％ nurses can make nursing decision by means of collecting,arrangements and analyzing nursing data via NIS.Conclusions Based on current status of clinical nursing informatics,nursing educators and managers need to enhance the ability for cultivating the awareness of nursing informatics competencies,more attention should be paid to perform nursing informatics training,thereby to improve nursing informatics progress and development.