[Objective]To evaluate the efficacy and safety of total oral regimens containing pomalidomide as a second-line treatment strategy in multiple myeloma.[Methods]A total of 22 patients with multiple myeloma placed on total oral regimens containing pomalidomide as a second-line therapy from March 2020 to December 2023 were retrospectively analyzed to evaluate the treatment response,survival and safety.[Results]The median age of the 22 patients was 71.5 years old. The total oral treatment regimens containing pomalidomide included IPD (7 cases),PCD (11 cases),XPD (2 cases),and PD (2 cases). The median number of treatment cycles was 14. Among the 13 patients with prior lenalidomide exposure,ORR was 53.85％,of which 23.08％ was ≥VGPR. In 9 patients without prior lenalidomide exposure,the ORR was 77.78％,and of which 55.56％ was ≥VGPR. There was no significant difference in ORR between these two groups (P=0.38). In 12 patients with high genetic risk,the ORR was 50％,and ≥VGPR was 16.67％. The median follow-up time was 10.6 months. Disease progressed in 10 patients and death occurred in 6 patients of them. The median progression free survival (PFS) was not reached (not reached and 10.6 months in non-lenalidomide-exposure patients or lenalidomide-exposure patients,respectively).The high grade treatment-related adverse events (AEs)(≥3 ) were reported in 18.18％ patients,including granulocytopenia,thrombocytopenia,and pulmonary infection. There was no treatment-related death.[Conclusion]Total oral regimens containing pomalidomide as a second-line therapy is generally effective and safe for multiple myeloma patients.

Objective To investigate the effect of agomelatine on the clinical efficacy in elderly patients with acute cerebral infarction(ACI)and comorbid anxiety-depression disorders by regu-lating serum neurotransmitters and nerve cytokines.Methods A total of 160 elderly ACI patients with anxiety and depression symptoms admitted in Pingxiang Second People's Hospital from June 2020 to December 2023 were enrolled in this study.All of them received thrombolysis or interven-tional therapy,and then were randomly divided into control and observation groups,with 80 patients in each group.The control group received conventional psychological intervention,while the observation group was given additional oral administration of agomelatine.Cognitive function,neurological function,neurotransmitters and neuronal cytokines,anxiety and depression scores,sleep quality,quality of life,daily activity ability and adverse reactions were compared between the two groups.Results After intervention,Mini Mental State Examination(MMSE)scores,levels of neuropeptide Y(NPY),5-hydroxytryptamine(5-HT),norepinephrine(NE),dopamine and brain-derived neurotrophic factor(BDNF),36-item Brief Health Questionnaire(SF-36)score,and Bar-thel index scale score were significantly higher in both 2 groups when compared with above indicators before the intervention(P＜0.01).And the MMSE score,NPY,5-HT,NE,dopamine and BDNF levels,SF-36 score and Barthel index scale score were obviously higher in the observa-tion group than the control group(P＜0.01).Both groups obtained notably lower NIHSS score,S100 calcium binding protein B(S100B)and myelin basic protein(MBP)levels,Hamilton Anxiety Rating Scale(HAMA)score,and Hamilton Depression Rating Scale 17(H AMD-17)score and Pittsburgh Sleep Quality Index(PSQI)score after intervention(P＜0.01).And the NIHSS score,S100B and MBP levels,HAMA score,HAMD-17 score,and PSQI score were statistically lower in the observation group than the control group(P＜0.01).During the treatment process,no signifi-cant difference was observed in the incidence of total adverse reactions between the two groups(3.75％vs 6.25％,x2=0.526,P=0.468).Conclusion When agomelatine tablets are indicated for ACI patients with concomitant anxiety-depression disorders,they can effectively rehabilitate cog-nitive function,enhance neurological function,improve sleep quality and quality of life,optimize activities of daily living,eliminate negative emotions,and correct the expression of neurotransmit-ters and neurotrophic factors.

Objective:Investigating the efficacy of unilateral adrenalectomy in treatment for primary pigmented nodular adrenocortical disease (PPNAD).Methods:Clinical data of 26 patients with PPNAD treated in our hospital from January 2013 to June 2023 was retrospectively analyzed.There were 11 males and 15 females, with an average age of (19.4±4.7) years. 25 cases presented with typical Cushing's syndrome, and 16 cases were diagnosed with Carney's syndrome. PRKAR1A gene mutation detected in 8 out of 10 cases. CT showed multiple small nodules on bilateral adrenal glands in 14 cases, unilateral small nodules or mild thickening with normal contralateral glands in 8 cases, and no obvious abnormalities in 4 cases. All patients showed autonomous oversecretion of cortisol by endocrine laboratory tests, with a median 24 h-UFC of 408.35 (334.28, 800.78) μg/24 h and decreased level of adrenocorticotropic hormone. All 26 patients underwent laparoscopic unilateral adrenalectomy, with left side adrenalectomy in 8 cases and right side adrenalectomy in 18 cases.Results:The average surgical duration was (85.2±28.7) minutes, with intraoperative blood loss <50 ml in all cases. The median time to drainage tube removal post-operation was 3 (2, 3) days. One patient developed a postoperative pulmonary infection, and 3 patients required postoperative hormone replacement therapy. The median follow-up duration was 64 (31.5, 103.8) months, and all patients showed alleviation of Cushing syndrome clinical manifestations after operations. 19 patients (73.1%) had their 24 h-UFC levels normalized to a median of 42.0 (22.4, 58.3) μg/24 h within 8.5 (5, 46) days post-surgery. 7 patients (26.9%) did not achieve normal 24 h-UFC levels, yet experienced an average reduction of (73.2±10.4)%. 13 patients (50.0%) did not experience recurrence, with a median follow-up of 51 (7, 89.5) months, including two cases without recurrence at 10 years post-surgery. 13 patients showed recurrent increase in postoperative cortisol levels, with a median of 225.6 (188.9, 397.2) μg/24 h. The median time to increased 24 h-UFC post-surgery was 27 (13.5, 50.5) months, with the longest duration reaching 104 months. Among these, 9 cases exhibited clinical signs and symptoms of recurrence, while 4 cases did not. Of the 13 patients with recurrence, 9 underwent contralateral adrenalectomy or subtotal resection, while 4 were observed with follow-up.Conclusions:Unilateral adrenalectomy could be a surgical treatment option for PPNAD. Despite the recurrence in some patients postoperatively, unilateral adrenalectomy could effectively and rapidly reduce cortisol levels in PPNAD patients and alleviate the clinical manifestations of Cushing syndrome.

Objective:To explore the clinical effect of observation and psychological intervention, splint or brace fixation as well as surgical treatment on habitual dislocation of the hip (HDH) and to combine the authors' data with a compilation of the cases from the literature, evaluingating the epidemiological characteristics of HDH and the treatment scheme to maintain the stability of hip joint by systematic literature review in children.Methods:A retrospective analysis of the relevant data of 11 patients (12 hips) with HDH were treated from March 2007 to March 2021, including 2 boys and 9 girls. The age of the first dislocation was 2.25 (1.66, 3.75) years old and 4.33 (3.33, 6.17) years old at the age of diagnosis. At the same time, the relevant literature reports were searched from 1932 to 2022, and 24 HDH patients reports and clinical studies were confirmed to be included in this study according to the inclusion and exclusion criteria. The data of 33 patients (38 hips) with HDH who were obtained in the literature, including 5 boys and 28 girls. The age of the first dislocation was 2.00 (1.50, 2.00) years old and 4.00 (2.55, 5.00) years old at the age of diagnosis. A total of 44 patients (50 hips) with HDH who were analyzed, including gender, age of first dislocation, age of diagnosis, mode of stimulating dislocation, side and direction of dislocation, accompanying symptoms, family history, trauma history and imaging examination. The data of 41 patients with HDH (3 patients were excluded due to lack of treatment description) were treated with observation and psychological intervention in 19 patients, splint or brace fixation in 13 patients, and surgical treatment in 9 patients. The femoral neck-stem angle, acetabular index, central edge angle (CE angle) and Reimers instability index were measured by AutoCAD software, and the hip function was evaluated by Harris standard. Meantime, the disappearance time of dislocation was recorded.Results:The average follow-up time of 44 patients (50 hips) with HDH were 4.05±2.93 years old, and the time of disappearance of dislocation after treatment were 1.28±1.19 years old. Patients were diagnosed as 7 boys and 37 girls, 30 right and 8 left as well as 6 bilateral, the age of the first dislocation was 2.64±1.54 years old and 4.52±2.64 years old at the age of diagnosis. The data of 39 patients took hip flexion, adduction, internal rotation or hip flexion and adduction as the mode of stimulating dislocation. There were 43 patients with posterior dislocation, 41 patients with an audible "click" sound during dislocation, 36 patients with painless dislocation, and 37 patients with "vacuum phenomenon" were captured at the moment of dislocation. All patients with HDH had no specific family history and obvious history of trauma. There was no significant difference in general data between observation and psychological intervention group, splint or brace fixation group as well as surgical treatment group ( P>0.05). Harris standard to evaluate hip function, CE angle and Reimers instability index of the affected side were significantly different from those before and after treatment at the moment of dislocation ( H=127.51, P<0.001; H=55.70, P<0.001; H=54.69, P<0.001). Compared with the immediate disappearance of dislocation in the surgical treatment group, the disappearance time of dislocation in the observation and psychological intervention group and the splint or brace fixation group were significantly longer, and the difference was statistically significant ( H=20.83, P<0.001). Conclusion:Without specific family history and obvious trauma at young girls, painless posterior dislocation of hip with an audible "click" sound and "vacuum phenomenon" at the moment of dislocation are the significant epidemiological characteristics of HDH. Observation and psychological intervention, splint or brace fixation are recommended as the initial treatment scheme. When conservative treatment is ineffective, surgical treatment is needed to stabilize the hip joint quickly.

Objective:To analyze the clinical characteristics and diagnosis and treatment experiences of Langerhans cell histocytosis (LCH) in skull.Methods:Sixteen patients with cranial LCH admitted to our hospital from January 2015 to December 2019 were chosen in our study. Their clinical data, diagnosis and treatment procedures and prognoses were retrospectively analyzed.Results:Among the 16 patients, there were 13 males and 3 females, aged from 1 to 31 years. The clinical manifestations included space-occupying lesions of the skull; and imaging showed bone destruction of the skull, with or without involvement of other bones or organs. All patients were pathologically confirmed to have LCH after surgical total resection of the lesions. Routine whole-body bone scanning was performed after surgery: one was found to have local abnormal metabolic activity and received local radiotherapy; 8 were combined with other bone or organ involvement, and received chemotherapy. All the patients were followed up for 1-5 years, and no recurrence was found, and no one died.Conclusion:Good prognosis can be achieved in cranial LCH patients accepted resection by giving additional treatment according to the results of postoperative reexamination and combination use of standardized radiotherapy and chemotherapy.

Objective:Compared with closed reduction and percutaneous pinning (CRPP) treatment, evaluating the clinical observation of utilizing a transolecranon pin joystick technique combined with CRPP in the teatment of multidirectionally unstable supracondylar humeral fractures in children.Methods:From thirty nine pediatric multidirectionally unstable supracondylar humeral fractures hospitalized between January 2012 and January 2019, twenty seven males (69.23%) and twelve females (30.77%) were included in the study, with a average age of 6.68±2.52 years (range, 2.17-13.75 y), twenty three fractures (65.7%) were treated with CRPP (CRPP group) and the remaining Sixteen fractures (41.03%) were treated utilizing a transolecranon pin joystick technique combined with CRPP (joystick group). Both groups were followed over 16 weeks. The paired sample t test or χ2 test and Fisher's exact test were used to compare the surgical time, times of fluoroscopy, quality of reduction and neurological or vascular complications, Baumann angle, carrying angle, lateralcapitellohumeral angle, postoperative range of motion as well as function-al outcomeduringthe Sixteen weeks and the last follow-up appointment. Results:All caseswere followed up for 1.98±1.43 years, and all fractures achieved clinical healing at 4 to 6 weeks postoperation. The surgical time and times of fluoroscopy were significantly shorter for patients in the joystick group (27.17±9.68 min, 24.25±5.92 times) when compared with CRPP group (48.59±15.75 min, 49.65±23.83 times, P<0.05). All cases showed restoration of the normal lateral capitellohumeral angle. Compared with Baumann angle of normal contralateral upper extremity during the sixteen weeks and the last follow-up appointment, the quality of reduction on the anteroposterior radiographic view was significantly better for patients in the joystick group than that of CRPP group ( P<0.05). The Baumann angle of the affected upper extremity was 77.70°±2.16°, and that of the normal contralateral upper extremity was 73.78°±4.04° in the CRPP group, joystick group was 73.06°±1.81° and 72.81°±3.45°, respectively at the sixteen weeks follow-up. The Baumann angle of the affected upper extremity was 77.13°±2.20°, and that of the normal contralateral upper extremity was 74.17°±4.17° in the CRPP group, joystick group was 72.69°±1.70° and 73.38°±3.48°, respectively at the last follow-up. The range of motion and clinical outcomes based on the criteria of Flynn were similar in both groups ( P<0.05). The elbow joint function of excellent and good rate of the criteria of Flynn was 82.61%, elbow flexion was 134.13°±8.61°, elbow extension was -3.48°±6.47° in the CRPP group, joystick group was 81.25%, 132.19°±9.48° and -3.44°± 4.37°, respectively at the sixteen weeks follow-up. The elbow joint function of excellent and good rate of the criteria of Flynn was 91.30%, elbow flexion was 140.14°±5.76°, elbow extension was -0.65±3.79° in the CRPP group, joystick group was 93.75%, 141.88°±5.12° and -0.31°±3.86°, respectivelyat the last follow-up. No immediate postoperative complications were observed. Conclusion:A transolecranon pin joystick technique combined with CRPP is a safe and effective method, can decrease surgical time and times of fluoroscopy and improve quality of reduction with no increasing risk of complications for closed reduction of multidirectionally unstable supracondylar humeral fractures in children.

Objective: To construct influenza B virus Vero cell adapted strain by genetic recombination technology by using the influenza B virus Vero cell adapted strain as the parent strain. Methods: The chick embryo and Vero cell were co-infected with influenza virus Vero cell adapted strain B/Malaysia/2506/2004 Va (Bv) and the vaccine strain B/massachusetts/2/2012 (BX-51B) recommended by WHO. The reassortants were screened with the anti-Bv serum. Plaque-purified reassortants were used to screen for Vero cell-adapted influenza B virus strains containing the surface antigen of the epidemic strain. Results: A Vero cell-adapted influenza B virus strain was obtained with successive passage in Vero cells. The hemagglutination inhibition test and the one-way immunogold agar diffusion test both showed that the reassortant virus was homologous to NYMC BX-51B, and sequence analysis result showed that the reassortment virus has the same HA and NA gene with the vaccine strain. Conclusion B/Malaysia/2506/2004Va (Bv) can be used as a parent strain to prepare Vero cell vaccine against influenza B virus.

The clinical and urodynamic data of 37 patients with benign prostate hyperplasia (BPH) and 30 diabetic patients complicated with BPH (BPH+DM) admitted between Jan 2014 and July 2017 were analyzed retrospectively. The International Prostate Symptom Score (IPSS), maximal flow rate (Qmax), post-voiding residual urine volume (PVR), maximum cystometric capacity (MCC), first desire to void (FDV), pressure of detrusor maximum (Pdet, max), bladder outlet obstruction index (BOOI), bladder contraction index (BCI) were compared between BPH group and BPH+DM group. According to BOOI-BCI linear regression, 22 cases (group A) and 15 cases (group B) of BPH patients were above and below the linear curve; while there were 14 cases (group C) and 16 cases(group D)of BPH+DM patients above and below the curve, respectively. The mean±SD FDV, MCC, Pdet, max, PVR, BOOI, BCI were (172.7±93.0)ml vs. (300.5±118.4)ml (P<0.05), (311.9±147.1)ml vs. (509.3±98.6)ml (P<0.05), (84.7±51.5)cmH2O(1 cm H2O=0.098 kPa) vs. (49.7± 32.9)cmH2O vs (P<0.05), 10.0 ml(0—200 ml) vs. 41.5 ml(0—450 ml), 69.7 ± 53.7 vs. 35.9 ± 32.3 (P<0.05), 122.3±50.2 vs 84.2±43.3 (P<0.05) in BPH and BPH+DM groups, respectively. In BPH group and BPH+DM group, the regression coefficients of BOOI-BCI were 0.889 and 0.724, respectively. In group A and group B, the difference value of IPSS and Qmax pre and post operation were 7.6±3.5 and 7.3±4.1 (P>0.05), (2.6±1.1)ml/s and (3.7±1.3) ml/s (P<0.05), respectively. In group C and group D, the difference value of IPSS and Qmax pre and post operation were 5.3 ± 2.4 and 6.0 ± 3.3 (P>0.05), (2.4 ± 1.0)ml/s and (3.8 ± 1.4)ml/s (P<0.05), respectively. The study indicates that the therapeutic effect is better for the patients blow BOOI-BCI regression linear curve compared to the patients above the linear curve.

[Objective] To explore the risk factors for mortality of bloodstream infections in the patients with hematologic diseases,so as to provide evidence for reasonable and effective application of treatments.[Methods] The clinical data of 242 cases of bloodstream infections who were hospitalized from Jan 2012 to Jun 2016 were analyzed retrospectively,then the analysis was performed for risk factors.The statistical analysis was processed by SPSS 19.0.[Results] A total of 266 strains of pathogens were isolated,including 99 strains of gram-positive bacteria,accounting for 37.2％,and 164 strains of gram-negative bacteria,accounting for 61.7％.Multivariate analysis showed that the significant independent risk factors for mortality were active states of hematologic diseases (P =0.007,OR =5.622,95％ CI 1.586 ～ 19.924),presentation with septic shock(P =0.007,OR =4.978,95％ CI 1.560 ～15.884),cardiac insufficiency (P =0.001,OR =11.878,95％ CI 2.760 ～ 51.120),level of albumin less than 35 g/L (P =0.036,OR =3.468,95％ CI 1.087 ～ 11.066),polymicrobial infection (P =0.010,OR =6.024,95％ CI 1.540 ～ 23.563),and Staphylococcus haemolyticus (P =0.001,OR =19.308,95％ CI 3.392 ～ 109.888)/Enterococcus (P =0.002,OR =15.266,95％ CI 2.817 ～82.728) infection.The survival curves show that the inappropriate initial antimicrobial therapy group or presentation with any one of the independent risk factors had a lower probability of survival than the control group.[Conclusions] Bloodstream infections in patients may cause high mortality rate,so it is necessary that we use antibiotic reasonably and spare no effort to reduce the mortality rate by appropriate application of antimicrobial therapy and effective intervention of the risk factors.

Objective To explore the changes of type H vessel during the low bone mineral density caused by iron accumulation and discuss its clinical meaning.Methods Ten 8-week old male C57BL/6J mice were used for experiments,and randomly divided into two groups:control group and iron group,and 5 mice in each group.In the iron group,0.1 g/kg of iron dextran was injected intraperitoneally once a week for 8 weeks.The control group was injected with the same amount of saline.The femoral and tibial specimens were examined by microscopic CT scan and bone tissue type H vessel immunohistochemical staining.Liver tissue from the two groups were collected for the content of iron by atomic absorption spectroscopy.All experimental data were analyzed with t-test.Results The content of hepatic iron in mice was significantly higher than that in the control group,which indicating that the model was successfully established.The tibia specimens were collected for immunostaining.The vascular area of type H at metaphyseal regions is 11.24％± 1.76％ in iron group and 30.69％±2.78％ in control group,respectively.There is significant difference between the two groups (P＜0.005).The femur specimens were collected for Micro-CT scan,the value of bone mineral density (BMD),bone volume/tissue volume (BV/TV),trabecular thickness (Tb.Th),trabecular number (Tb.N) and trabecular separation (Tb.Sp) was (0.19±0.013) g/cm3,11.92％±1.199％,(35.66±2.684) μm,(2.36±0.429)/mm and (284.41±23.197) μm in iron group and (0.37±0.023) g/cm3,35.76％± 1.336％,(62.05±2.238) μm,(5.68± 1.039)/mm and (163.23± 13.203) μm in control group,respectively.The differences between the two groups were statistically significant (P＜0.05).Conclusion Iron accumulation can lead to low BMD and suppress type H vessel formation in bone,which might provide a new experimental value for mechanism research on osteoporosis caused by iron accumulation.