Objective:To explore the efficacy and safety of domestic bortezomib in combination with lenalidomide and dexamethasone in the treatment of newly diagnosed multiple myeloma (NDMM) .Methods:This multicenter, prospective, single-arm clinical study included 126 patients with NDMM admitted to seven hospitals between December 2019 and January 2022. All patients received domestic bortezomib in combination with lenalidomide and dexamethasone (BLD regimen), and the efficacy, prognostic factors, and safety were analyzed.Results:Among the 126 patients with NDMM, 118 completed four cycles of treatment, with an overall response rate (ORR) of 93.22% (110/118) and a ≥very good partial response (VGPR) rate of 68.64% (81/118). Ultimately, 114 patients completed at least eight cycles of treatment, with an ORR of 92.98% (106/114) and a ≥VGPR rate of 77.19% (88/114). Eighteen patients underwent autologous hematopoietic stem cell transplantation after completing 6-8 cycles of the BLD regimen, with an ORR of 100% (18/18) and a ≥VGPR rate of 88.9% (16/18). The proportion of patients achieving ≥VGPR increased with the treatment duration, and factors such as staging and age did not significantly affect efficacy. Single-factor analysis showed that R2-ISS stage Ⅲ/Ⅳ, blood calcium >2.27 mmol/L, and failure to achieve VGPR after six cycles were adverse prognostic factors for progression-free survival (PFS) ( P<0.05), whereas failure to achieve VGPR after six cycles was an adverse prognostic factor for overall survival (OS) ( P<0.001). Multifactor analysis demonstrated that failure to achieve VGPR after six cycles is an independent adverse prognostic factor for PFS ( P=0.002). The incidence of hematologic adverse reactions was 16.7% (19/114), and nonhematologic adverse reactions were mainly mild to moderate, with no significant cardiac or renal adverse reactions observed. Conclusion:The BLD regimen is effective in treating NDMM, in which patients with high-risk genetic features are still achieving a high ≥VGPR rate, and the overall safety is good.

It remains unclear whether heart transplantation is still feasible on patients who develop neurological complications before surgery and underwent successful neurological treatment.This article reported the diagnosis and treatment process of a heart failure patient complicating with acute ischemic stroke,who underwent successful heart transplantation after thrombectomy for acute ischemic stroke,aiming to provide clinical evidence and decision-making plan on diagnosis and treatment options for this group of patients with severe neurological complications.

Objective:To investigate the application effect of the Living Lab concept combined with the teaching model of case-based study (CBS) and reference-induced self-education (RISE) in thoracic surgery nursing teaching.Methods:A total of 132 nursing students who participated in 11 rounds of training (12 nursing students per round) in Department of Thoracic Surgery, The Affiliated Hospital of Inner Mongolia Medical University were included in the study, and according to the teaching method, they were divided into control group and observation group, with 66 nursing students in each group. The students in the control group received routine teaching, and those in the observation group received the Living Lab concept combined with CBS-RISE teaching. Assessment results were compared between the two groups, and the critical thinking ability and degree of satisfaction with teaching were evaluated for both groups. SPSS 22.0 was used to perform the t test. Results:Compared with the control group, the observation group had significantly higher objective question score (48.82±4.21 vs. 46.73±4.54, P<0.05), subjective question score (33.12±3.86 vs. 31.59±3.47, P<0.05), and total score (81.02±7.57 vs. 76.34±7.91, P<0.05). After training, compared with the control group, the observation group had significantly higher total score and scores of the dimensions such as truth seeking, open mindedness, analyticity, systematicity, self-confidence, inquisitiveness, and cognitive maturity ( P<0.05). The observation group also had a higher degree of satisfaction with teaching methods, teaching contents, and teachers compared with the control group ( P<0.05). Conclusion:In thoracic surgery nursing teaching, the application of the Living Lab concept and CBS-RISE can improve the assessment results of nursing students and enhance their critical thinking ability, with a high degree of teaching satisfaction among nursing students.

MicroRNA (miRNA) plays an important role in the development of diffuse large B-cell lymphoma (DLBCL) by binding to the 3′ non-coding region of the target gene mRNA to regulate gene expression after transcription. The expression level of miRNA is closely related to the clinical staging, typing, prognosis assessment, and therapeutic effect of DLBCL. miRNA has a great potential as that of DLBCL-related biomarkers, and because of the close link between the two, miRNA-based therapies are expected to lead to new treatment options for DLBCL patients.

Objective:To explore the value of cardiovascular MR (CMR) T 1 mapping in evaluating myocardial injury in patients recovered from COVID-19. Methods:The clinical and image data of 15 patients with COVID-19 (9 with moderate clinical manifestation, 6 with severe clinical manifestation) who underwent CMR screening at 3 months after being discharged from the Second People′s Hospital of Fuyang City during May 2020 to June 2020 were prospective collected. Fifteen COVID-19 patients were selected as case group, and another 11 healthy volunteers were selected as control group. A standardized CMR protocol included cine, native and enhanced T 1 mapping, late gadolinium enhancement (LGE). Cardiac functional parameters, native T 1 value of left ventricular and extracellular volume fraction (ECV) were measured. One way ANOVA was used to assess the difference between CMR parameters among moderate and severe manifestation groups and control group, and LSD- t was used to assess the difference between the three groups. Results:LGE value was negative in all subjects. ECV values were higher in recovered COVID-19 patients with either moderate (27.9%±2.7%) or severe manifestation (30.0%±3.7%) than control group (23.2±1.9%) ( P<0.05); there was no significant difference of ECV values between recovered COVID-19 patients with moderate and severe manifestation ( P=0.100). There was no difference of native T 1 values and other functional and morphologic parameters of left ventricular and right ventricular among recovered COVID-19 patients with moderate and severe manifestation and control group ( P>0.05). Conclusion:CMR myocardial tissue ECV increase in patients who recovered from COVID-19, suggesting subclinical myocardial injury.

OBJECTIVE： To establish a method for simultaneous determination of albiflorin， paeoniflorin， liquiritin， liquiritigenin， cinnamic acid， cinnamaldehyde， ammonium glycyrrhetate and 6-ginger phenol in Guizhijiashaoyao decoction. METHODS： HPLC method was adopted. The determination was performed on Kromasil C18 column with mobile phase consisted of acetonitrile-0.1％ phosphoric acid solution （gradient elution） at the flow rate of 1.0 mL/min. The detection wavelengths were 235 nm（0-35 min，albiflorin， paeoniflorin， liquiritin）、280 nm（35-65 min，liquiritigenin， cinnamic acid， cinnamaldehyde， ammonium glycyrrhetate and 6-ginger phenol）. The column temperature was 25 ℃， and the sample size was 20 μL. RESULTS： The linear range of albiflorin， paeoniflorin， liquiritin， liquiritigenin， cinnamic acid， cinnamaldehyde， ammonium glycyrrhetate and 6-ginger phenol were 2.125-34.000 μg/mL（r＝0.999 9）， 28.700-459.200 μg/mL（r＝0.999 7）， 3.675-58.800 μg/mL（r＝0.999 7）， 1.235-19.760 μg/mL（r＝0.999 8）， 2.300-36.800 μg/mL（r＝0.999 8）， 0.955-15.280 μg/mL（r＝0.999 7）， 36.000-576.000 μg/mL（r＝0.999 7） and 1.500-24.000 μg/mL（r＝0.999 7）， respectively. The quantitative limits were 0.135， 0.102， 0.096， 0.033， 0.013， 0.023， 0.663， 0.198 μg/mL； the detection limits were 0.041， 0.031， 0.029， 0.010， 0.004， 0.007， 0.201， 0.059 μg/mL. RSDs of precision， stability and reproducibility tests were all lower than 3％ （n＝6）. The recovery rates were 97.47％-100.76％（RSD＝1.33％，n＝6）， 98.15％-103.50％（RSD＝1.82％，n＝6）， 95.65％-100.84％（RSD＝2.38％，n＝6）， 96.75％-100.32％（RSD＝1.31％，n＝6）， 95.88％-102.75％（RSD＝2.52％，n＝6）， 95.63％-100.63％（RSD＝2.00％，n＝6）， 96.78％-100.45％（RSD＝1.35％，n＝6）， 95.71％-100.48％（RSD＝1.80％，n＝6）. CONCLUSIONS： The method is accurate， reliable and exclusive， and suitable for simultaneous determination of 8 ingredients in Guizhijiashaoyao decoction.

Background:In the pathogenesis of chronic gastritis,the changes of biological factors can affect the physiological barrier of gastric mucosa,increase the risk of injury of intercellular junctions,leading to disruption of mucosal barrier. Aims:To investigate the expressions of occludin and zonula occluden-1 (ZO-1)in chronic gastritis and their significance. Methods:A total of 82 patients with chronic gastritis from October 2014 to October 2017 at the First People's Hospital of Xiaochang were enrolled and divided into chronic non-atrophic gastritis (CNAG)group and chronic atrophic gastritis (CAG)group according to the endoscopic biopsy pathology. Forty healthy subjects were served as normal controls. Expressions of occludin and ZO-1 were examined by immunohistochemistry. Patients positive for Helicobacter pylori (Hp) infection received eradication therapy,and expressions of occludin and ZO-1 were reexamined after Hp eradication. Results:The positivity rates of occludin and ZO-1 proteins in CNAG and CAG groups were significantly lower than those in normal control group (P＜0.05). The positivity rates of occludin and ZO-1 proteins in CNAG group were significantly higher than those in CAG group (P＜0.05). The positivity rates of occludin and ZO-1 proteins in Hp-positive CNAG patients were significantly lower than those in Hp-negative CNAG patients (P＜0.05). The positivity rate of ZO-1 protein in Hp-positive CAG patients was significantly lower than that in Hp-negative CAG patients (P＜0.05). Expressions of occludin and ZO-1 proteins showed a linear trend correlation with activity of gastric inflammation (P ＜0.05);their expressions decreased significantly with the increase in activity of inflammation. The positivity rates of occludin and ZO-1 proteins in CNAG patients increased significantly after Hp eradication (P＜0.05). Conclusions:Expressions of occludin and ZO-1 are decreased in chronic gastritis,especially in CAG,and are correlated with Hp infection and activity of gastric inflammation.

With the development of science and technology,medical simulation has been applied extensively.The application of simulation technique in teaching hospitals has become a new choice in modern medical education.As the most basic and important clinical ability,airway management has become a popular training program in China's teaching hospitals.This paper summarizes the current situation of the simulation training of airway management in teaching hospitals at home and abroad,concludesthe existing problems in the simulation teaching of airway management of teaching hospitals in China,such as narrow range of training objects,lack of professional teaching staff,unscientific curriculum design and outdated training model,etc.Then puts forward the countermeasures of expanding the training coverage,establishing the professional teaching team,designing the curriculum design of science,and introducing advanced simulation equipment to improve the quality of simulated teaching.

Objective To investigate the effects of quercetin on glial scar formation and axonal regeneration after spinal cord injury (SCI) and its association with the p38 mitogen activated protein kinase (MAPK) signal pathway.Methods 128 female Sprague-Dawley (SD) rats were randomly divided into a control group (SCI + saline),an intervention group (SCI + quercetin + anisomycin),a treatment group (SCI + quercetin) and a sham-operation group (n =32).Basso Beattie Bresnahan (BBB) assessment and footprint analysis of the hind limb were performed on days 1,3,7,14,21 and 28 postoperation in each group.The expression levels of p38MAPK,phosphorylation p38MAPK,glial fibrillary acidic protein (GFAP) and neurofilament protein-200 (NF-200) were detected by Western blot.The numbers of GFAP and NF-200 positive staining cells in the injured spinal cord in each group were detected by immunohistochemistry.Results The BBB scores in the treatment group were significantly higher than in the intervention and control groups at each time point after SCI except on day 3 postoperation (P ＜ 0.05).The expression levels of phosphorylation p38MAPK protein in each SCI group were significantly higher than in the sham-operation group on days 3 and 7 postoperation (P ＜ 0.05).The expression levels of phosphorylation p38MAPK protein in the treatment group were significantly lower than in the control and intervention groups on days 3,7 and 14 postoperation (P ＜ 0.05),but there was no significant difference on day 28 postoperation among all the groups (P ＞ 0.05).The numbers of NF-200 and GFAP positive staining cells were significantly greater than in the sham-operation group at each time point postoperation (P ＜ 0.05);the NF-200 positive staining cells in the treatment group were significantly increased in comparison with the control and intervention groups (P ＜ 0.05);the GFAP positive staining cells in the treatment group were significandy fewer than in the control and intervention groups on days 7,14 and 28 postoperation (P ＜ 0.05).Conclusions Quercetin may have protective effects against acute SCI by decreasing glial scar formation,increasing axonal regeneration and promoting recovery of locomotor and nerve function in rats.The effects may be correlated with inhibition of the p38MAPK signal pathway.

The immune system is a complex system involving multiple organs,and it is vulnerable to age,gender,environment and other factors.For a variation normal physiological range,it is a great challenge to evaluate drug-induced immunotoxicity in preclinical safety study.Histomorphologic assessment of the immune system is a recognized cornerstone in the identification of immunotoxicity at present.In this paper,the principles of pathological evaluation for immune system,and pathological evaluation for important immune organs including thymus,spleen,lymph nodes are discussed briefly,so that it is intended to assist toxicity pathologists in the accurate and consistent characterization of intended and unintended drug-induced alterations of the immune system.