Multiple myeloma is a more common malignant disease in blood medicine,which is characterized by hyper-proliferation and accumulation of malignant plasma cells in the bone marrow,resulting in a large number of monoclonal immunoglobulins and their fragments,leading to damage to the terminal organs.Of which about 80％ of patients have multiple myeloma bone diseases (MBD),which seriously affected the quality of life and prognosis of patients.We have found that the main cause of MBD are contributed to inhibition of osteoblasts,activation of osteoclast and affecting the occurrence by a variety of cytokines and pathways.This article will review and introduce the occurrence and development of MBD related to the latest factors and treatment.

OBJECTIVE:To analyze the distribution and drug resistance of pyogenic encephalitis in our hospital,and to pro-vide reference for rational use of antibiotics. METHODS:The cerebrospinal fluid pathogen of 4 255 patients with pyogenic encepha-litis in our hospital during Jan. 1st,2011-Dec. 31st,2014 were cultured and identified,and drug sensitivity test was conducted. RE-SULTS:A total of 834 pathogens were isolated with positive detection rate of 19.6%,including 576 strains of gram-positive bacte-ria,accounting for 69.1%;255 strains of gram-negative bacteria,accounting for 30.6%;3 strains of fungi,accounting for 0.4%. Top 3 gram-positive bacteria were Coagulase-negative staphylococci(436 strains),Staphylococcus aureus(56 strains)and Entero-coccus (29 strains). Top 3 gram-negative bacteria were Klebsiella pneumoniae (46 strains),Acinetobacter baumannii (38 strains) and Escherichia coli(31 strains). Top 3 departments were neurosurgery department(506 strains),ICU(169 strains)and severe re-spiratory disease department (64 strains). Results of drug sensitivity test showed that no drug-resistant Staphylococcus and Entero-coccus strains to vancomycin,teicoplanin and miuocycline was found;nonfermenting Gram-negative bacilli showed low resistant to minocycline. CONCLUSIONS:Gram-positive bacteria dominates the detection rate of cerebrospinal fluid of pyogenic encephalitis patients;drug resistance of various pathogens is serious and clinicians should choose antibiotics based on drug sensitivity.

Objective? To?investigate?the?antimicrobial?resistance?and?beta-lactamase?production?profile?in?the?gram-negative?bacilli?isolated from urinary tract infections in the Second People's Hospital of Gansu Province during the period from 2014 to 2015. The results will provided to clinicians for better antimicrobial treatment. Methods? The?bacterial?isolates?were?identified?via?conventional?laboratory?tests?or?automatic?identification?systems?and?subjected?to?antimicrobial?susceptibility?testing?by?using?Kirby-Bauer?method.?Three-dimensional test was used to detect the enzymes conferring antimicrobial resistance. The susceptibility testing results were interpreted according to the CLSI breakpoints issued in 2012. Results A total of 987 gram-negative strains were isolated from urinary tract infections, including E. coli (51.6%, 509/987), Enterobacter (11.0%, 109/987), P. aeruginosa (10.5%, 104/987), K. pneumoniae (9.9%, 98/987), P. mirabilis (9.3%, 92/987), C. freundii (4.7%, 46/987), and other gram-negative bacilli (2.9%, 29/987). ESBLs were produced?in?494?(50.1?%)?of?the?987?strains?of?gram?negative?bacilli.?Preliminary?screening?test?identified?243?AmpC?beta-lactamases?producing?strains,?and?135?(13.7?%)?strains?were?confirmed?by?three-dimensional?test.?Both?ESBLs?and?Amps?beta-lactamases?were?produced in 16 (1.6%) strains. The prevalence of ESBLs-producing strains was 79.6% in E. coli, 34.6% in P. aeruginosa and 37.8% in K. pneumoniae?isolates.?Metallo-β-lactamase?or?KPC?beta-lactamase?was?not?identified.?The?antimicrobial?resistance?was?serious?in?gram-negative bacilli, which showed relatively low resistance rate to imipenem (0.02%), amikacin (10.6%), cefoperazone-sulbactam (23.8 %), and nitrofurantoin (25.2 %). E. coli prevalence of levofloxacin,?ciprofloxacin?resistance?respectively?were?89.8%,?91.8%. The gram-negative bacilli from urinary tract also showed various levels of resistance to cephalosporins. Conclusions The gram-negative bacilli isolated from urinary tract infections are mainly E. coli. The gram-negative isolates show high level antimicrobial resistance and high prevalence of beta-lactamases. Imipenem, amikacin, cefoperazone-sulbactam, and nitrofurantoin still have very high antibacterial activity against these isolates in vitro.

OBJECTIVE To explore risk factors of cervical lymph node metastasis in cN0 papillary thyroid carcinoma. METHODS The clinical data of 537 patients with cN0 papillary thyroid carcinoma were analyzed retrospectively in Beijing Tongren hospital from Jan 2009 to Dec 2015. Patients' gender, age, multifocal lesion, carcinoma complicated with Hashimoto's thyroiditis, capsule breakthrough and tumor size were counted. RESULTS The lymph node metastasis rate of 537 patients with cN0 papillary thyroid carcinoma was 30.9%(166/537). The incidences of lymph node involvement were 24.95%(166/537) at only level VI, 5.21%(28/537) at level VI plus lateral part of neck and 0.74%(4/537) at only skip metastasis, respectively. Chi square test and multivariate logistic regression analysis showed that cervical lymph node metastasis was statistically associated with male, age<45 years, capsule breakthrough and tumor diameter>1 cm (P<0.05). After the operation, there were 17 patients with temporary hoarseness, accompanied with 1 loss to follow-up and 1 failure to return to normal after 1.5 years. There were 61 patients with temporary hypocalcemia, 2 patients failed to follow-up and 2 patients with calcium supplements after respective 1.5 and 4 years. CONCLUSION To stratify the risk of patients with cN0 papillary thyroid carcinoma, male, age<45 years, capsule breakthrough and tumor diameter>1 cm are risk factors for cervical lymph node metastasis. And we suggest that prophylactic central lymph node dissection may be appropriate.

Objective To discuss combined detection of pleural biopsy under medical thoracoscopy and pulmonary serum tumor markers in diagnosis of pleural effusion with unknown reason.Methods 76 patients with pleural effusion caused by unknown reason from January 2014 to March 2016 were retrospectively analyzed. Pleural biopsy was conducted under medical thoracoscopy and sent for pathological examination, and 10 ml venous blood was collected from these patients upon admission for testing serum tumor markers (CEA, SCC-AG, ProGRP and CYFRA21-1).Results Among the 76 patients, there were 32 cases with benign lesions (14 with pulmonary tuberculosis, 9 with inlfammatory lesions, 6 with granulomatous inlfammation, 2 with empyema and 1 with hamartoma) and 44 cases with malignant lesions (18 with adenocarcinoma, 13 with squamous carcinoma, 6 with small cell lung cancer, 3 with adeno-squamous carcinoma, 2 with mesothelioma, 1 with large cell carcinoma and 1 with thymoma). The detection of serum tumor markers showed statistically significant differences in the levels of CEA, SCC-AG, ProGRP and CYFRA21-1 in serum between the malignant pleural effusion group and benign pleural effusion group (P = 0.021,P = 0.006,P = 0.003 andP = 0.010). The levels of various serum tumor markers in the malignant pleural effusion group were obviously higher than those in the benign pleural effusion group. According to the pathological results, patients with pleural effusions not caused by lung cancer (2 with mesothelioma and 1 with thymoma) were eliminated from 44 patients with malignant pleural effusions. The rest 41 patients with pleural effusions caused by lung cancer were divided into non-small cell lung cancer and small cell lung cancer according to the pathological types. The results showed that there were statistically signiifcant differences in the levels of CEA, ProGRP and CYFRA21-1 between non-small cell lung cancer and small cell lung cancer (P = 0.036,P = 0.005 andP = 0.008), while there was no statistically signiifcant difference in the level of SCC-AG (P = 0.811).Conclusions Due to high detection rate and high accuracy in detecting pleural effusions caused by unknown reason, medical thoracoscopy is of great signiifcance, especially for the diagnosis of malignant pleural effusions of pleural metastases. However, serum indicators may provide important reference values for us before the pathological results are available. Thus, it is an important means of diagnosing malignant pleural effusions caused by lung cancer and should be promoted in clinic.

Objective:To analyze the effect of tanreqing injection on the serum levels of transforming growth factor-β (TGF-β) and matrix metalloproteinases-9 (MMP-9) of patients with chronic obstructive pulmonary disease (COPD).Methods:102 patients with COPD were divided into the control group and the observation group according to random number table method,52 cases in each group.The control group was treated with routine therapy,and the observation group was treated with Tanreqing injection based on the control group.The serum TGF-β,MMP-9 levels,forced vital capacity (FVC),1 s forced expiratory volume (FEV1),partial pressure of carbon dioxide (PaCO2),oxygen partial pressure (PaO2),CD4+,CD86,CD4+/CD8+,syndrome integral,clinical efficacy and incidence of side effects were observed and compared between the two groups.Results:After treatment,the serum TGF-β,MMP-9 levels,PaCO2 and syndrome integral of observation group were significantly lower than those of the control group,the PaO2,CD4+,FVC,FEV1,CD4+/CD8+ and the clinical efficacy of observation group were obviously higher than those of the control group (P＜0.05).There was no significant difference in the incidence of side effects between the two groups (P＞0.05).Conclusion:Tanreqing injection could effectively reduce the serum levels of TGF-β and MMP-9,and improve the arterial blood gas,lung function and immune function in treatment of patients with COPD.

Objective To explore the effects of estrogen on oxidative stress of the lung tissue induced by acute paraquat (PQ) poisoning. Methods Thirty-two male adult New Zealand rabbits were randomly divided into model group and estrogen intervention group, 16 rabbits in each group. The model of lung injury induced by PQ poisoning was reproduced by feeding 16 mg/kg of 20% PQ through gastric tube. The rabbits in estrogen intervention group received intravenous infusion of 5 mg/kg estrogen after PQ challenge for 7 days, and the rabbits in model group received an equal volume of normal saline. Three rabbits in each group were sacrificed at 1, 2 and 3 days respectively after exposure. The lung tissue was harvested, the levels of reactive oxygen species (ROS) was determined by 2',7'-dichlorofluorescin diacetate (DCFH-DA), malondialdehyde (MDA) was determined by thiobarbituric acid (TBA), the mRNA expression of manganese-containing superoxide dismutase (MnSOD) was determined by reverse transcription-polymerase chain reaction (RT-PCR), and adenosine triphosphatase (ATP) content in mitochondrion was determined by enzyme linked immunosorbent assay (ELISA). The pathological changes in lung were observed under light microscopy using hematoxylin and eosin (HE) staining, and the lung injury was evaluated with lung injury score. Results The contents of ROS and MDA in lung within 3 days after PQ poisoning were gradually increased, and MnSOD mRNA expression and ATP content were gradually decreased. Estrogen intervention could significantly reduce the production of ROS and MDA after PQ poisoning [3-day ROS (fluorescence intensity): 161.05±30.04 vs. 188.30±31.80, 3-day MDA (mmol/L): 98.71±0.92 vs. 122.12±1.24], up-regulate MnSOD mRNA expression (integral A value: 3.05±0.90 vs. 1.22±0.24), and increase ATP content in mitochondrion (ng/L: 3.75±0.92 vs. 2.28±0.29) with statistically significant differences (all P < 0.01). In lung tissue after PQ poisoning, congestion, edema, focal pulmonary consolidation, pulmonary interstitial and alveolar space were infiltrated by a large number of neutrophil, alveolar interval were thickened obviously and the above phenomenon were most serious at 3 days after poisoning as shown under optical microscope. Estrogen intervention could significantly improve lung injury as compared with that of model group, and the lung injury score at 3 days was significantly lower than that of model group (11.8±0.7 vs. 13.5±1.0, P < 0.01). Conclusions The oxidative stress indicators in the lung tissue after PQ poisoning were obviously abnormal, the pathological damage was serious with time dependence. The administration of estrogen can reduce acute lung injury after PQ poisoning by reducing the oxidative stress.

Objective To establish experimental autoimmune cerebral spinal cord inflammation ( EAE) model rats, and observe the pathological changes and effect of oxymatrine on EAE model.Methods 30 rats were randomly divided into control group,EAE ( model group) group and oxymatrine group.The EAE symptom score was used to evaluate the rats after the model, and to observe the changes of its behavior.By HE staining and Kluver &Barrera myelin dyeing to observe the inflammation of the brain and spinal cord demyelinating changes.Results The animals in control group had no change in behavior and pathological.In model group, all animals occured behavioral changes, accompanied by varying degrees of demyelination and inflammatory infiltration of the brain and spinal cord.In oxymatrine group,6 rats did not appear EAE clinical manifestations and behavioral change, and the myelin structure was intact.Conclusion Oxymatrine can extend the incubation period experimental autoimmune encephalomyelitis in rats of the disease, relieve symptoms and protect nerve.

Objective:To explore the efficacy of apatinib combined with S-1 capsule in the treatment of patients with advanced recurrent and metastatic esophageal cancer.Methods:A total of 140 patients with advanced esophageal cancer were selected as test subjects from January 2017 to January 2019 in Shandong Tai′an Cancer Prophylaction-Therapeutic Hospital. These patients were randomly divided into observation group (72 cases) and control group (68 cases) using random number table method. The patients in the observation group were treated with oral apatinib combined with S-1 chemotherapy, and the patients in the control group was only given S-1 chemotherapy. The short-term and long-term efficacy and adverse reactions of the two groups were observed.Results:The objective remission rates of the observation group was 38.9% (28/72), higher than that in the control group (22.1%, 15/68), with a statistically significant difference ( χ2=4.655, P=0.031). The disease control rate of the observation group was 88.9% (64/72), higher than that in the control group (61.8%, 42/68), and there was a significant difference between the two groups ( χ2=13.993, P<0.001). The median progression-free survival of the observation group and the control group was 5.9 months and 2.7 months respectively, the median overall survival was 14.8 months and 7.9 months respectively, and there were significant differences between the two groups ( χ2=5.477, P=0.026; χ2=6.083, P=0.014). The adverse reactions of the two groups were mild, grade 1-2, mainly including fatigue, leukopenia, hand-foot syndrome, hypertension and proteinuria, with incidences of 59.7% (43/72), 50.0% (36/72), 8.3% (6/72), 12.5% (9/72), 9.7% (7/72) in the observation group, and 51.5% (35/68), 57.4% (39/68), 17.6% (12/68), 4.4% (3/68), 4.4% (3/68) in the control group, there were no significant differences between the two groups ( χ2=0.965, P=0.326; χ2=0.760, P=0.383; χ2=2.708, P=0.100; χ2=2.919, P=0.088; χ2=0.794, P=0.373). Conclusion:Apatinib combined with S-1 is effective, safe and tolerable in the treatment of recurrent and metastatic esophageal cancer.

Objective:To investigate the blood flow change status in early stage tumor-related areas of hepatocellular carcinoma and its clinical significance after radiofrequency ablation using multi-slice spiral CT whole-liver perfusion imaging technology.Methods:21 cases of primary liver cancer that underwent CT-guided radiofrequency ablation were included. CT perfusion scans were divided into four groups according to the time points of CT scans (before surgery, immediately after surgery and 1 and 3 month after surgery), and then blood perfusion parameters of the corresponding areas of the tumor were measured. Statistical analysis was performed using two independent samples of non-parametric Wilcoxon rank-sum test. The differences of blood perfusion parameters between tumor or ablation lesion and background liver parenchyma, paratumor tissue or inflammatory response zone were compared before, immediately and 1 and 3 months after surgery, respectively.Results:(1) The hepatic arterial perfusion (HAP) and hepatic arterial perfusion index (HPI) of cancerous liver tumors and background liver parenchyma was significantly increased ( P < 0.01). The total liver perfusion (TLP) was higher than the background liver parenchyma ( P = 0.01 < 0.05). The time to peak (TTP) was significantly lower than background liver parenchyma ( P < 0.01); (2) The perfusion parameters of HAP, PVP and TLP were lower than the background liver parenchyma in the complete ablation lesions immediately after radiofrequency ablation and 1 and 3 months after surgery, and the difference was statistically significant ( P < 0.05); (3) The inflammatory response zone of ablation lesions of HAP, HPI, and TLP were gradually decreased with the extended postoperative time and TTP was gradually increased, while PVP did not change significantly; (4) HAP, HPI, and TTP were compared between the tumor and the tumor inflammatory response zone immediately after surgery, and 1 and 3 months after surgery, and the difference was statistically significant ( P < 0.01). However, there was no statistically significant difference between PVP and TLP ( P > 0.05). Conclusion:CT whole-liver perfusion imaging can precisely evaluate the early stage blood flow change status in peritumor and tumors before and after radiofrequency ablation and then objectively evaluate tumor’s blood supply and therapeutic effect on hepatocellular carcinoma.