Objective To observe the expression of chemokine (MCP-1) and chemokine receptor (CCR2) in bone marrow cells,bone marrow stromal cells of multiple myeloma (MM) patients.Methods 15 cases were diagnosed by domestic uniform standard for MM patients,7 cases of male,8 cases of female,age range from 38 to 67 years,mean age 53.7 years old.According to the Durie-Salmon staging system,patients were divided into Ⅰ (2 cases),Ⅱ (5 cases) and Ⅲ period(8 cases).Control group were from 10 cases of non-malignant blood disease patients.MCP-1,CCR2 expression were measured by flow cytometry.Results Almost 14 cases of bone marrow cells expressed MCP-1and CCR2 in MM patients,while in the control group,bone marrow cells almost did not express MCP-1and CCR2.Stromal cells had similar MCP-1and CCR2 expression profile (68.17 ％ vs 4.27 ％. P＜0.05).Tumor cells of MCP-1/CCR2 expression rates were 3.25 ％ and 32.76 ％. Compared MCP-1/ CCR2 expression of stromal cells and tumor cells with different stages of disease, the activated stage and the stable stage had similar level (68.71％ and 32.76 ％ vs 70.12 ％ and 53.39 ％. P＞0.05). Conclusion Most patients with MM bone marrow were expressed MCP-1and CCR2.MCP-1and CCR2 are the major MM cell surface expression of chemokine/receptor, which play important roles in the progress of.

Objective To explore the feasibility to apply case mix index ( CMI) in risk assessment of clinical nursing units. Methods Questionnaire was designed and used to evaluate risk ratings for 43 nursing units with wards, with the survey results subject to expert scoring. The units consisted of 16 in surgical system, 15 in internal medicine, and 7 in traditional Chinese medicine system. Statistical method was used to analyze the correlation of the expert scoring and CMI. Results The CMI of nursing units and expert scoring results had strong correlation (r=0. 69, P<0. 05). Two groups of data in surgical system and internal medicine system were highly correlated (r= 0. 716, P<0. 05; r= 0. 643, P<0. 05 respectively), while the two groups of data in traditional Chinese medicine system had no correlation (r=0. 572, P>0. 05). Conclusions CMI can be used as a reference for dynamic risk assessment of nursing units.

Objective:To compare the clinical characteristics and analyze the prognostic factors between human immunodeficiency virus (HIV)-infected patients and non-HIV-infected immunocompromised patients with pneumocystis pneumonia (PCP) complicated with acute respiratory failure (ARF) in intensive care unit (ICU).Methods:The clinical data of patients with PCP complicated with ARF admitted in ICU of The First Affiliated Hospital of Zhengzhou University and The Sixth People′s Hospital of Zhengzhou City between May 2018 and October 2020 were retrospectively reviewed. All subjects were divided into HIV-infected group and non-HIV-infected immunocompromised group. General characteristics and underlying diseases of patients in the two groups were analyzed. Laboratory parameters, treatment and outcomes between two groups were compared. Independent sample t test, Mann-Whitney U test and chi-square test were used for statistical analysis, and univariate and multivariate logistic regression models were used to identify the risk factors for the clinical outcome. Results:A total of 129 PCP complicated with ARF patients were enrolled, including 75 HIV-infected patients and 54 non-HIV-infected immunocompromised patients. Only 10.7%(8/75) patients of HIV-infected group received anti-retroviral therapy (ART), but none of the patients in either groups had previously received trimethoprim-sulfamethoxazole (TMP-SMX) for PCP prophylaxis. Acute physiology and chronic health evaluation (APACHE) Ⅱ score of HIV-infected group was 18.7±6.0, which was higher than that in non-HIV-infected immunocompromised group (13.1±4.4) when admitted in ICU ( t=-5.45, P<0.001). Hypoproteinemia was common in both groups. Ninety-six percent (72/75) of HIV-infected patients had CD4 + T lymphocyte counts lower than 200/μL and 84.0%(63/75) of patients had CD4 + T lymphocyte counts even lower than 50/μL, while 5.74%(31/54) of patients in non-HIV-infected immunocompromised group had CD4 + T lymphocyte counts lower than 200/μL. The CD4 + /CD8 + T lymphocyte counts ratio was 0.05(0.02, 0.12) in HIV-infected group, which was lower than that in non-HIV-infected immunocompromised group (0.96(0.64, 1.44)), and the difference was statistically significant ( Z=-9.16, P<0.001). The length of ICU stay and hospital stay of non-HIV-infected immunocompromised patients were 10.0(7.0, 14.0) days and 18.0(11.8, 32.5) days, respectively, which were both longer than those in HIV-infected patients (7.0(4.0, 9.0) days and 13.0(7.0, 23.0) days, respectively), and the differences were both statistically significant ( Z=-3.58 and -2.73, respectively, both P<0.050). The hospital mortality of HIV-infected patients was 57.3%(43/75), which was significantly higher than that in non-HIV-infected immunocompromised patients (38.9%, 21/54) ( χ2=4.27, P=0.039). Multivariable logistic regression identified that lactic dehydrogenase (LDH), C-reactive protein (CRP) and APACHE Ⅱ score were the risk factors for the clinical outcome of HIV-infected patients (odds ratio ( OR)= 1.006, 1.015 and 1.736, respectively, all P<0.050). The partial pressure of oxygen in arterial blood/fractional concentration of inspiratory oxygen (PaO 2/FiO 2), LDH and CD4 + T lymphocyte counts were the risk factors for the clinical outcome of non-HIV infected immunocompromised patients ( OR=0.970, 1.008 and 0.989, respectively, all P<0.050). Conclusions:PCP patients with ARF are critically ill with high mortality rate. LDH, CRP and APACHEⅡscore are predictors for prognosis of HIV-infected patients with PCP, while PaO 2/FiO 2, LDH and CD4 + T lymphocyte counts are predictors for prognosis of non-HIV infected immunocompromised patients with PCP.