ObjectiveTo investigate the efficacy and safety of cinobufagin tablets combined with thalidomide/dexamethasone （TD） regimen in the treatment of newly diagnosed multiple myeloma （NDMM） with phlegm and stasis obstruction. MethodsThe clinical data of 50 patients with NDMM of phlegm and stasis obstruction who were hospitalized at the Jiangsu Province Hospital of Chinese Medicine from June 1st， 2015 to July 31th， 2019 were retrospectively analyzed， and they were divided into a control group （bortezomib/dexamethasone-containing regimen， 27 cases） and an observation group （cinobufagin tablets combined with TD regimen， 23 cases）. The clinical efficacy and safety were compared between the two groups after two or three courses of treatment. The primary outcomes were clinical remission rate including overall response rate and deep remission rate， one-year and two-year overall survival rate， and adverse effects. The secondary outcomes were the proportion of plasma cells in bone marrow， hemoglobin， β2-microglobulin， lactate dehydrogenase， serum creatinine， blood urea nitrogen， bone pain score， and KPS functional status score （KPS score） before and after treatment. ResultsIn terms of clinical efficacy， there was no statistically significant difference （P＞0.05） in the overall response rate ［the observation group 69.57%（16/23） vs the control group 70.37% （19/27）］ and deep remission rate ［the observation group 56.52% （13/23） vs the control group 55.56% （15/27）］ between groups after the treatment. The one-year overall survival rates of the observation group and the control group were 90.9% and 92.4%， and the two-year overall survival rates were 81.8% and 80.9% respectively， with no statistically significant differences between groups （P＞0.05）. During the treatment， no renal function injury occurred in both groups. The incidence of peripheral nerve injury in the observation group was 8.70%， which was lower than 48.15% in the control group （P＜0.01）. After the treatment， the proportion of myeloma plasma cells， β2-microglobulin， serum creatinine level， and bone pain score decreased， while the hemoglobin level and KPS score increased in both groups （P＜0.05 or P＜0.01）. Compared between groups after treatment， the bone pain score of the observation group was lower than that of the control group， while the KPS score was higher than that of the control group （P＜0.05）. ConclusionThe clinical efficacy of cinobufagin tablets combined with TD in the treatment of NDMM is equivalent to bortezomib/dexamethasone-containing regimen， but the former is more helpful in relieving the pain and improving the quality of life， and has better safety.

Objective:To investigate the clinical characteristics of influenza A and influenza B pneumonia and the risk factors of severe influenza pneumonia in children.Methods:The epidemiology, clinical characteristics, laboratory tests and pathogens of co-infection in children with pneumonia caused by influenza A virus and influenza B virus, and the risk factors of severe influenza pneumonia were retrospectively analyzed.Results:(1) The cases of influenza A infection accounted for 65.1% and those with influenza B infection accounted for 32.9% among the 711 children with influenza pneumonia.The dominant strain was Influenza B Victoria virus in spring and summer, influenza A(H 3N 2) virus in autumn, and influenza A(H1N1) virus in winter.The dominant strain was influenza A virus at the age of < 1 year and ~3 years, influenza A virus and influenza B virus at the age of ~6 years, and influenza B virus at the age of ≥6 years.(2) The gastrointestinal symptoms were more common in children with influenza B pneumonia compared with those with influenza A pneumonia(53.4% vs 44.7%, χ2=4.728, P=0.030), but crackles and wheezing were more common in children with influenza A pneumonia compared with those with influenza B pneumonia(80.1% vs 70.5%, 36.9% vs 25.6%, χ2=8.945, 8.093, all P<0.05). (3) The percentage of decreased lymphocyte count in children with influenza B pneumonia was higher than those with influenza A pneumonia(5.6% vs 1.9%, χ2=6.633, P=0.010). (4) Mixed Mycoplasma Pneumoniae was more common in children with influenza B pneumonia compared with those with influenza A pneumonia(23.9% vs 10.8%, χ2=20.789, P<0.001), and mixed virus and bacteria were more common in children with influenza A pneumonia compared with those with influenza B pneumonia(15.8% vs 8.1%, 50.1% vs 41.9%, χ2=7.934, 4.221, all P<0.05). (5) Multivariate logistic regression analysis showed that age <2 years( OR=1.886, 95% CI 1.149~3.096, P=0.012), increased LDH( OR=1.736, 95% CI 1.080~2.790, P=0.023), the percentage of lymphocyte decreased( OR=2.762, 95% CI 1.669~4.571, P<0.001) and the percentage of CD3 + decreased ( OR=6.019, 95% CI 3.993~9.331, P<0.001)were risk factors for severe influenza pneumonia. Conclusion:Among hospitalized children with influenza pneumonia, there were some differences in the age of infection, clinical characteristics, laboratory tests and pathogens of co-infection between the cases caused by influenza B and influenza A, and clinicians should remain vigilant for the occurrence of severe influenza pneumonia.

Objective:To investigate the detection, epidemiological and clinical characteristics of human rhinovirus(HRV) in hospitalized children with respiratory tract infections.Methods:The study population comprised of 10 514 children with respiratory tract infections admitted to Department of Respiration, the Children′s Hospital of Soochow University, between January 2013 and December 2019.The nasopharyngeal aspirates and medical history were obtained by qualified medical personnel.Reverse transcription-polymerase chain reaction method was used to test HRV.Results:The total positive rate of human rhinovirus was 14.2%(1 493/10 514), and there was no significant difference between male and female( χ2=2.006, P=0.157). The positive rates from 2013 to 2019 were 9.7%, 14.6%, 19.1%, 18.6%, 18.1%, 11.0%, 11.4% respectively, and there were significant differences among these groups( χ2=116.580, P<0.001). HRV distributed throughout the year with a peak in summer and autumn(June to November), followed by spring, and the lowest in winter.The detection rates of HRV infection rates were 14.2%, 15.5%, 13.5% and 9.8% in the age group of 28 d~6 months, ~2 years, ~7 years and>7 years respectively, and there were significant differences among these age groups( χ2=16.124, P<0.001). The detection rate of HRV in children under 2 years was higher( χ2=7.711, P=0.005). The clinical characteristics of HRV infection were fever, cough, wheezing and even dyspnea.Bronchopneumonia had the highest percentage(68.9%), followed by bronchitis(13.2%). Compared with non-coinfection group, patients with coinfection with other viruses were more prone to wheezing and pulmonary rales( χ2=9.483, 10.821, P=0.024, 0.013), and coinfection with mycoplasma was more likely to cause fever and lobar pneumonia( χ2=51.585、96.060, P all<0.001); 57.8% presented leukocytosis, while 15.6% showed a higher CRP(>15 mg/ml). The increase of CRP and leukocytosis were more obvious in children under 2 years of age( χ2=26.097, 55.973, P all<0.001). Conclusion:HRV was a major viral pathogen of RTIs in recent 7 years, distributing throughout the year with a peak in summer and autumn, mainly involving children under 2 years of age.The clinical features were diverse, and the clinical symptoms were severe in childhood coinfections with other pathogens.

Objective:To estimate the hospitalization rate of Haemophilus ( H.) influenzae associated community-acquired pneumonia in children under 5 years in Suzhou. Methods:From 2010 to 2014, medical records and bacteriology results of children under 5 years hospitalized with community-acquired pneumonia in Children's Hospital of Soochow University were collected, retrospectively. Detection rate of H. influenzae was describe. The hospitalization rate of H. influenzae associated community-acquired pneumonia was estimated using the number of local children in urban area of Suzhou, which was obtained from the immunization platform of Suzhou Center for Disease Prevention and Control. Results:A total of 28 043 hospitalized pneumonia cases were included from 2010 to 2014, in which 19 526 (69.63%) had bacteriological examination. The overall detection rate of H. influenzae was 11.06% (2 160/19 526), and children aged 12-23 months had the highest positive rate (14.29%, 550/3 850), and the rate was higher during winter-spring than during summer-autumn ( χ 2=455.11, P<0.01). The average hospitalization rate of H. influenzae associated pneumonia in children under 5 years was 760.36/100 000 (95% CI: 733.70/100 000-787.01/100 000), which was higher in winter and spring (898.79/100 000 and 1 249.52/100 000) than in summer and autumn (514.35/100 000 and 359.04/100 000), and the hospitalization rate was higher in boys (942.12/100 000) than in girls (563.76/100 000), the differences were all significant ( P<0.01). The highest hospitalization rate was observed in children aged 1-5 months (2 478.31/100 000) and the hospitalization rate decreased with age ( χ 2=2 129.80, P<0.01). Conclusion:There was a considerable burden of H. influenzae associated community-acquired pneumonia in children under 5 years in Suzhou, especially in children under 6 months.

Objective:To investigate the tumor-specific neoantigen for primary plasma cell leukemia (PCL) using gene sequencing technology combined with bioinformatic analysis. Methods: Peripheral blood samples of one patient with primary PCL during relapse and remission periods were collected. HLA molecular typing was performed using polymerase chain reaction with sequencing-based typing; whole-exome and transcriptome were sequenced by next-generation sequencing method; and bioinformatics software NetMHCpan was used to predict neoantigens. Results: Six tumor-specific missense mutations were found in the patient's peripheral blood during relapse period, located in genes FRG1, MLL3, SVIL, MYOM1, ZDHHC11 and RFPL4A.Considering patient's HLA sub-types, 43 neoantigens were predicted via bioinformatics. Considering that FRG1 and MLL3 had relatively high gene expression levels, 20 neoantigens derived from mutations of the two genes were preferentially selected, among which four neoantigens had high affinity with the patient's HLA molecules and thus had potential clinical application value. Conclusion: The study has completed a tumor neoantigen screen and prediction for primary PCL. This practice demonstrates that predicting neoantigen based on tumor-specific somatic mutation is feasible for primary PCL.

Objective: To investigate the incidence of post-bronchiolitis recurrent wheezing and its risk factors in children. Methods: This study was conducted on patients with bronchiolitis admitted to the Department of Respiratory Disease, Children′s Hospital of Soochow University between November 2016 and March 2017.Nasopharyngeal secretions were taken from all patients and assessed for respiratory pathogens.After discharge, the patients were followed up every 3 months by outpatient visit or telephone call for 1 year. Results: Eighty-nine patients with bronchiolitis were enrolled in this study.Among those 89 patients, respiratory syncytial virus(RSV) infection accounted for 46.1%(41/89 cases), Mycoplasma pneumonia(MP) for 5.6%(5/89 cases), rhinovirus(RV) for 4.5%(4/89 cases), and human bocavirus(hBoV) for 2.2%(2/89 cases). Eighty-three patients were successfully followed up.At the 3, 6, 9, and 12 months of follow-up, the occurrence of wheezing episodes for only once happened in 20 cases(24.1%), 27 cases(32.5%), 35 cases (42.2%), and 38 cases(45.8%), respectively.At 12 months after initial bronchiolitis, the occurrence of wheezing episodes for only once happened in 21 cases(25.3%), 2 episodes of wheezing in 10 cases(12.0%), and 7 cases (8.4%) had more than 3 episodes of wheezing, and 6 cases lost follow-up.The proportion of eczema and milk-protein allergy in post-bronchiolitis recurrent wheezing group was significantly higher than that of the group with not post-bronchiolitis recurrent wheezing patients (χ²=6.219, 4.855, all P<0.05). Logistic regression analysis showed eczema was the independent risk factor for post-bronchiolitis recurrent wheezing(OR=0.189, 95%CI: 0.047-0.765). There were no significant difference in gender, age, premature birth, birth weight, feeding pa-tterns, family history of asthma, pet contact history, severity of disease, course of disease, total immunoglobulin E of serum and the species of virus infected between 2 groups(all P>0.05). Conclusions The incidence of recurrent wheezing among post-bronchiolitis patients is higher during one-year follow-up period.Eczema is the independent risk factor for post-bronchiolitis recurrent wheezing.The specific pathogens and severity of disease have no correlation with post-bronchiolitis wheezing.

Objective To investigate the relationship between MRI signal,pathological changes and neurological function after sciatic nerve injury in rabbits.Methods Twenty New Zealand white rabbits were randomly and evenly divided into 5 groups,and the right sciatic nerve crush models were established.T2 fat suppression fast recovery spin echo (T2 fs FRFSE) sequence scanning was performed 3 days,7 days,2 weeks,3 weeks and 4 weeks after injury,and TE was set as 30,60 and 90 ms,respectively.Signal intensity ratio (SIR) and relative signal intensity (△S) of proximal and distal part of injured nerve and control side nerve were measured.The relationship between SIR,△S,pathology and rabbit lower limb nerve function were analyzed.Results In the distal part of injured nerve,SIR and △S increased 3-7 days after injury,pathological results showed vacuolar degeneration,and basic toe function lost was found.SIR and △S reached the peak 2 weeks after injury,with most serious disintegration of myelin and toe function disable.SIR,△S and toe function disable gradually recovered,and the nerve regenerated at 3-4 weeks after injury.The injure display rate of T2 fs FRFSE images with TE=90 and 60 ms,SIR of both distal and proximal part of injured nerve were higher than those on images with TE=30 ms (all P＜0.05).Conclusion SIR and △S changes on T2 fs FRFSE imaging can be used to predict rabbit nerve injury.

Objective: To explore the application of extensive pterional approach combined with cutting of the zygomatic arch for the resection of large sphenoid ridge meningioma. Methods: Thirty-three patients with large sphenoid ridge meningioma underwent operation using the extensive pterional approach combined with cutting of the zygomatic arch. Twenty patients with large sphenoid ridge meningioma received operation with the traditional pterional approach as the control. The resection rate, operative time, intraoperative blood loss, and postoperative complications were compared between the groups. Results: Two groups of patients underwent craniotomy under microscope. The Simpon grade I resection and grade Ⅱ resection rate was 93.9％ in the cutting of the zygomatic arch approach group and 60.0％ in the control group (P<0.01). The operative time was (325.2±121.3) min in the cutting of the zygomatic arch approach group, which was significantly shorter than that in the control group with (406.4±182.9) min (P<0.05). The intraoperative blood loss was (502.5±101.8) mL and (697.7±115.4) mL in the two groups (P<0.05). In addition, postoperative complication rate was 15.2％ and 45.0％ in the cutting the zygomatic arch approach group and the control group, respectively (P<0.05). No death was reported in both groups. Conclusion: Extensive pterional approach combined with cutting of the zygomatic arch can fully expose the anatomical structures of the skull base and the sellar region to eliminate the influence of temporal muscle in the exposure of the surgical area. The operative field is exposed to reduce the stretch injury to only the frontotemporal brain tissue, which might be helpful for the complete resection of large sphenoid ridge meningioma, and is more conducive to neurovascular anatomy and relevant functional protection.

Objective To study the analgesic effect of repeated hyperbaric oxygen (HBO) exposures and explore the mechanism involving neural nitric oxide synthase ( nNOS), nitric oxide ( NO) and γ-aminobutyric acid (GABA).Methods The animal pain model was established and the animals were randomly divided into the HBO group, the hyperbaric air ( HBA) group, the normobaric air (NBA) group and the normobaric oxygen ( NBO) group, and were exposed repeatedly to either HBO or air .The chamber was ventilated with 100％ O2 for 5 min, then, the chamber was pressurized to 0.35 MPa at a rate of 0.10 MPa/min.At the pressure of 0.35 MPa, the chamber was again ventilated with oxygen /air for 60 minutes, and then, was decompressed at a rate of 0.10 MPa/min.The animals were exposed in the chamber one session a day for a succession of 4 days.Analgesic effect was evaluated by abdominal contraction test , and nitrate reductase assay was used to determine the expression levels of NO and NOS in the brain tissue and the spinal cord.NOS inhibitors were given by i.c.v injection to measure the effect of NOS on the analgesic effect of HBO.The nNOS + neurons and glatamic acid decarboxylase ( GAD) positive ( GAD +) neurons in the periaqueductal gray ( PAG) were labeled by fluorescopy.Results Repeated HBO treatment induced a biphasic analgesic effect, including: (1) early analgesia which was displayed an hour after HBO exposure and lasted for about 8 hours; (2) late analgesia which was displayed one day after HBO exposure , reached peak one week later and lasted for about 3 weeks.Three hours after the termination of last HBO exposure , medication of the non-specific NOS inhibitor N′-Nitro-L-arginine-methyl ester hydrochloride ( L-NAME ) and nNOS inhibitor S-methyl-L-thiocitrulline (SMTC) could obviously inhibit early analgesic effect .L-NAME and SMTC could significantly inhibit late analgesia .One hour after HBO exposure, the levels of NO and nNOS in the brain tissue and spinal cord were considerably elevated .The late analgesic effect of HBO significantly decreased , when CGP35348 was injected in the lateral ventricle 7 days after HBO treatment.Immunofluorescence indicated that there was a co-localization between nNOS + neurons and GAD + neurons in the PAG.Conclusions Repeated 4 HBO exposures induced a double -phased analgesia.Initial analgesic effect displayed one hour after HBO treatment, involving activation of nNOS, while late analgesic effect emerged one day after HBO exposure , with the interaction between nNOS and GABA B receptors.

Objective To study the analgesic effect of repeated hyperbaric oxygen (HBO) exposures and explore the mechanism involving neural nitric oxide synthase ( nNOS), nitric oxide ( NO) and γ-aminobutyric acid (GABA).Methods The animal pain model was established and the animals were randomly divided into the HBO group, the hyperbaric air ( HBA) group, the normobaric air (NBA) group and the normobaric oxygen ( NBO) group, and were exposed repeatedly to either HBO or air .The chamber was ventilated with 100％ O2 for 5 min, then, the chamber was pressurized to 0.35 MPa at a rate of 0.10 MPa/min.At the pressure of 0.35 MPa, the chamber was again ventilated with oxygen /air for 60 minutes, and then, was decompressed at a rate of 0.10 MPa/min.The animals were exposed in the chamber one session a day for a succession of 4 days.Analgesic effect was evaluated by abdominal contraction test , and nitrate reductase assay was used to determine the expression levels of NO and NOS in the brain tissue and the spinal cord.NOS inhibitors were given by i.c.v injection to measure the effect of NOS on the analgesic effect of HBO.The nNOS + neurons and glatamic acid decarboxylase ( GAD) positive ( GAD +) neurons in the periaqueductal gray ( PAG) were labeled by fluorescopy.Results Repeated HBO treatment induced a biphasic analgesic effect, including: (1) early analgesia which was displayed an hour after HBO exposure and lasted for about 8 hours; (2) late analgesia which was displayed one day after HBO exposure , reached peak one week later and lasted for about 3 weeks.Three hours after the termination of last HBO exposure , medication of the non-specific NOS inhibitor N′-Nitro-L-arginine-methyl ester hydrochloride ( L-NAME ) and nNOS inhibitor S-methyl-L-thiocitrulline (SMTC) could obviously inhibit early analgesic effect .L-NAME and SMTC could significantly inhibit late analgesia .One hour after HBO exposure, the levels of NO and nNOS in the brain tissue and spinal cord were considerably elevated .The late analgesic effect of HBO significantly decreased , when CGP35348 was injected in the lateral ventricle 7 days after HBO treatment.Immunofluorescence indicated that there was a co-localization between nNOS + neurons and GAD + neurons in the PAG.Conclusions Repeated 4 HBO exposures induced a double -phased analgesia.Initial analgesic effect displayed one hour after HBO treatment, involving activation of nNOS, while late analgesic effect emerged one day after HBO exposure , with the interaction between nNOS and GABA B receptors.