Objective To increase the recognition and diagnostic rate of multiple myeloma.Methods 43 patients with multiple myeloma confirmed by medula needle biopsy and/or pathology were reviewed.Results Misdiagnosis rate reached 65%.Bone abnormality was not found on X-ray and CT films in 8 cases,the remained 35 cases showed bone destructions in varied degrees and types.Conclusion It's main way for improving diagnostic rate of multiple myeloma that deepen recognition of multiple myeloma.Clinical diagnosis must be combined with imageology,laboratory and pathology.

AIM:In this study, the rat lung injury model was induced by ammonium chloride for studying the effect of imidapril on blood gas, serum TNF-α, IL-6 and MDA concentrations, and AngⅡand CD54 protein expression in rat lung tissue.METHODS:Male rats were randomly divided into 3 groups:control group, lung injury model group and drug group.The rats in control group were given saline (2 mL/kg), while the rats in lung injury model group were given 6% ammonium chloride (2 mL/kg).In drug group, imidapril (3 mg· kg-1· d-1) was given to the rats once daily for 1 week by intragastric gavage after given 6%ammonium chloride.On the 7th day, the rats were anesthetized with 2% so-dium pentobarbital.Abdominal aorta blood, venous blood and lung tissue were collected.The blood gas indexes and serum TNF-α, IL-6 and MDA concentrations were determined.The lung tissues were fixed and sliced, and the expression of AngⅡ and CD54 proteins was detected by immunohistochemistry.RESULTS: The PaCO2 increased in lung injury model group compared with control group and drug group (P<0.05).The expression of AngⅡand CD54, and the concentrations of TNF-α, IL-6 and MDA also increased significantly ( P<0.01) in model group.Pulmonary edema, inflammation, alveo-lus congestion, hemorrhage and hyperplasia in model group were obvious compared with control group and drug group. CONCLUSION:Imidapril improves blood gas indexes, and reduces lipid peroxidation and inflammatory responses in the rats with lung injury induced by ammonium chloride.

Objective:To evaluate the safety and feasibility of endovascular recanalization for non-acute internal carotid artery occlusion (NA-ICAO), and to propose a new angiographic classification.Methods:From April 2015 to October 2019, 95 consecutive patients with symptomatic NA-ICAO who received endovascular recanalization were retrospectively analyzed in Beijing Tiantan Hospital, Capital Medical University. All the patients were divided into four groups according to DSA: type Ⅰ, petrous segments were distally reconstituted by collateral vessels; type Ⅱ, cavernous segments were distally reconstituted by collateral vessels; type Ⅲ, ophthalmic segments were distally reconstituted by collateral vessels; type Ⅳ, communicating segments were distally reconstituted by collateral vessels. Study data including clinical characteristics, surgical details, lesion classification, recanalization rate and perioperative complications. For the counting data, the χ 2 test was used to compare between groups. For the quantitative data, the ANOVA was used for the normal distribution data, otherwise the Kruskal-Wallis H test was used. The primary safety outcome was any stroke or death within 30 days. Results:Among the 95 patients, 67 (70.53%) had successful recanalization. The recanalization rates of type Ⅰ－Ⅳ were 92.31% (36/39), 81.82% (18/22), 47.83% (11/23) and 18.18% (2/11) respectively (χ2=29.557, P<0.001). And the complication rates of the four types were 5.13% (2/39), 13.64% (3/22), 21.74% (5/23) and 9.10% (1/11) respectively. The incidence of perioperative ischemic stroke was 2.11% (2/95). No other serious stroke and death occurred. Conclusions:Endovascular recanalization may be feasible and safe for carefully selected patients with NA-ICAO and therefore represents an alternative treatment. The patients with type Ⅰ and Ⅱ lesions had higher recanalization rates, while the patients with type Ⅳ lesions had significantly lower recalculation rate. The new angiographic classification is conducive to the selection of suitable patients and difficulty in grading.

Objective To evaluate the correlation between cerebral blood flow perfusion and memory impairment in patients with severe stenosis of vertebral basilar artery (VBA).Methods 62 cases of patients with VBA stenosis diagnosed by digital subtraction angiography(DSA) in Beijing Tiantan Hospital from September 2016 to March 2017 were enrolled.Mental State Examination (MMSE),Clinical Memory Scale (CMS) test and CT perfusion(CTP) was performed.All patients were divided into memory normal group(n=24,including 1 excellent case,6 above normal cases,and 14 normal cases) and memory impairment group(n =38,including 18 below normal cases,12 periphery cases,8 impaired cases) according to CMS.The ratios of side-to-side period were compared between bilateral mesial temporal lobe and anterior circulation area.The relative time to peak (rTTP),relative mean transit time(rMTY),relative cerebral blood flow(rCBF) and relative cerebral blood volume (rCBV) were calculate.Results The incidence of CTP decompensation in the medial temporal lobe was higher than that in the patients with memory impairment(P＜0.05).The difference of rTTP and rMTT value between the two groups in the bilateral medial temporal lobes was statistically significant (rTFP:(1.131 ±0.037),(1.437±0.139),t=10.520,P＜ 0.05);rMTT:(1.081 ±0.059),(1.281 ±0.174),t=5.423,P＜0.05).Conclusion The patients with VBA severe stenosis are more likely to get memory impairment due to cerebral hypoperfusion.

Objective:To compare the safety and therapeutic effect of bridging therapy versus direct endovascular treatment in patients with acute ischemic stroke(AIS)aged 80 years and over, who received the therapy within 4.5 h of onset.Methods:A total of 89 AIS patients aged 80 years and over receiving the endovascular therapy at our hospital from January 2016 to June 2019 were studied with versus without intravenous thrombolysis before endovascular therapy(the former as bridging therapy group, n=49; the latter as the direct endovascular treatment group, n=40). Baseline information including gender, the modified Rankin scale(mRS)score, medical history, smoking history, preoperative national institute of health stroke scale(NIHSS)score were collected.Clinical data related to the operation including the times from onset to hospital, door-to-puncture and door-to-recanalization, complications(symptomatic cerebral hemorrhage, mortality)and mRS at 90 d after treatment were compared between the two groups.Multiple logistic regression analysis was used to determine whether or not bridging therapy with intravenous thrombolysis was a prognostic factor.Results:There was no significant difference in baseline information between the two groups( P>0.05). The times from onset to hospital, door-to-puncture, door-to-recanalization had no significant difference between the two groups( P>0.05). There was no significant difference in the incidence of symptomatic cerebral hemorrhage and mortality within 90 d between the two groups(26.5% or 13 cases vs. 17.5% or 7 cases, 14.3% or 7 cases vs.7.5% or 3 cases, χ2=1.031 and 1.017, P=0.310 and 0.313). With different clinical outcomes as dependent variables, after adjusting factors such as gender, admission NIHSS and medical history, Logistic regression analysis showed that the bridging therapy with intravenous thrombolysis was not a prognostic factor( OR=0.795, 95% CI: 0.280~2.258, P=0.666). Conclusions:The bridging therapy is as safe and effective as the direct intravascular therapy for AIS patients aged 80 and over within 4.5 hours of onset.The intravenous thrombolysis should be given as soon as possible within time window.

Objective To evaluate the safety and therapeutic effects of stent retriever-based thrombectomy (SRT) on acute ischemic stroke (AIS) in patients aged 80 years and older.Methods A cohort of 157 AIS patients hospitalized in Capital Medical University Affiliated Beijing Tiantan Hospital were selected for SRT from January 2016 to May 2017.Based on the age,all patients were divided into two groups:groups aged ＜ 80 years and ≥ 80 years.Baseline information including gender,the Modified Rankin Scale (mRS) score,past medical history,smoking history,preoperative National Institutes of Health Stroke Scale (NIHSS),the Alberta Stroke Program Early CT Scores (ASPECTS),intravenous thrombolysis and clinical outcomes were compared between two groups.The informations related to the operation,including time from onset to hospital,door-to-needle puncture time,door-to-recanalization time,SRT complications (symptomatic cerebral hemorrhage,mortality) and good outcome,were compared between two groups.Logistic regression analysis was used to determine whether the age of 80 years and over was a risk factor for adverse prognosis after SRT.Results There were 130 patients in the group ＜ 80 years of age,and 27 patients in the group ≥80 years.No significant differences were found in baseline information between the two groups (all P＞ 0.05).In addition,there were no significant differences in the proportions of the operative information,complications of SRT and the good outcome (all P＞0.05).Furthermore,advanced age (≥80 years) was not a risk factor for adverse outcome after SRT (OR =0.738,95％ CI:0.300-1.813).Conclusions Stent retriever-based thrombectomy is safe and beneficial for patients with acute ischemic stroke,even in patients aged 80 years and over.