Objective·To investigate the efficacy and safety of a dose-reduced,all-oral lenalidomide/melphalan/prednisone acetate(RMP)regimen in elderly and frail patients with newly diagnosed multiple myeloma(NDMM).Methods·Elderly and frail NDMM patients who visited the Department of Hematology of Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,and the Third People's Hospital of Kunshan from April 2018 to March 2024 were retrospectively included.Clinical data and laboratory indicators were collected,and all patients were treated with the RMP regimen.SPSS 27.0 and R software were used for statistical analysis.Independent t-test was applied to normally distributed quantitative data,Mann-Whitney U test to non-normally distributed quantitative data,and x2 test and Fisher's exact probability method to qualitative data.Kaplan-Meier survival curves and Log-rank test were used for survival analysis.Results·Among the 22 elderly and frail NDMM patients treated with RMP,the median age was 76.3(68.4,95.0)years,and the median follow-up time was 25.5 months.The overall response rate(ORR)was 68.2%,and the rate of≥very good partial response(VGPR)was 36.4%.The median progression-free survival(PFS)was 20.53 months.The median PFS in the≤75-year-old group was 25.23(95%CI 12.95?37.52)months,while in the>75-year-old group it was 18.23(95%CI 14.86?21.61)months.There was no significant difference between the two groups.The median PFS in the≥partial response(PR)group was 20.67(95%CI 13.57?27.76)months,and in the

Objective·To investigate the efficacy and safety of a dose-reduced,all-oral lenalidomide/melphalan/prednisone acetate(RMP)regimen in elderly and frail patients with newly diagnosed multiple myeloma(NDMM).Methods·Elderly and frail NDMM patients who visited the Department of Hematology of Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,and the Third People's Hospital of Kunshan from April 2018 to March 2024 were retrospectively included.Clinical data and laboratory indicators were collected,and all patients were treated with the RMP regimen.SPSS 27.0 and R software were used for statistical analysis.Independent t-test was applied to normally distributed quantitative data,Mann-Whitney U test to non-normally distributed quantitative data,and x2 test and Fisher's exact probability method to qualitative data.Kaplan-Meier survival curves and Log-rank test were used for survival analysis.Results·Among the 22 elderly and frail NDMM patients treated with RMP,the median age was 76.3(68.4,95.0)years,and the median follow-up time was 25.5 months.The overall response rate(ORR)was 68.2%,and the rate of≥very good partial response(VGPR)was 36.4%.The median progression-free survival(PFS)was 20.53 months.The median PFS in the≤75-year-old group was 25.23(95%CI 12.95?37.52)months,while in the>75-year-old group it was 18.23(95%CI 14.86?21.61)months.There was no significant difference between the two groups.The median PFS in the≥partial response(PR)group was 20.67(95%CI 13.57?27.76)months,and in the

Objective To investigate the relationship between cognitive impairment and sleep parameters in acute ischemic stroke patients with obstructive sleep apnea(OSA).Methods A total of 343 patients with acute ischemic stroke and OSA were selected.The cognitive function was assessed using the simple mental state examination scale(MMSE).Patients were divided into the stroke with OSA and cognitive impairment group(MMSE＜27 points,n=119)and the stroke with OSA without cognitive impairment group(MMSE≥27 points,n=224).General data,TOAST etiological classification and distribution of cerebral infarction lesions were collected.The intelligent sleep monitoring system was used to calculate apnea hypopnea index(AHI)and evaluate OSA.Objective sleep monitoring parameters were collected at night.Sleep monitoring was conducted within 24 h of admission and continuous monitoring for≥3 nights.Continuous monitoring duration≥7 h every night to obtain night sleep structure parameters.Multifactor Logistics regression was used to analyze the relationship between cognitive impairment and sleep parameters in stroke patients with OSA.Results Compared with the stroke with OSA without cognitive impairment group,the proportion of age,diabetes history and HHcy history,the proportion of patients with infarct lesions located in frontal,temporal,parietal,occipital,thalamus,basal ganglia,brainstem and hemioval center increased in the stroke with OSA and cognitive impairment group,and the number of years of education decreased,the number of waking times,the proportion of light sleep and AHI increased,the nighttime sleep efficiency and deep sleep period decreased(P＜0.05).Logistics regression analysis showed that after controlling for years of education,age and other interference factors,nighttime sleep efficiency and AHI were strongly associated with cognitive impairment in acute ischemic stroke patients with OSA(P＜0.05).The increased nighttime sleep efficiency was protective factor for cognitive impairment,and increased AHI was risk factor for cognitive impairment.Conclusion Cognitive impairment in acute ischemic stroke patients with OSA is closely related to sleep parameters,in which the increased sleep efficiency at night is a protective factor for cognitive impairment,and the increased AHI is a risk factor.

Objective To investigate the causes and treatments of severe complications after laparoscopic surgery. Methods Clinical data of 7 cases with severe complications after laparoscopic surgery in the Third People’s Hospital of Shenzhen from January 2008 to January 2013 were analyzed retrospectively. The informed consents of all patients were obtained and local ethical committee approval had been received. There were 3 males and 4 females with the age ranging from 6 to 67 years old and median of 40 years old. The diagnosis, treatments clinical data of the patients were collected, and the causes, treatments and prevention measures of the complications were summarized. Results Five cases underwent laparoscopic cholesystectomy (LC), 4 of which suffered bile duct injury for severe abdominal adhesion and unclear anatomy of the Calot triangle and 1 case suffered strangulated intestinal obstruction after operation because the hepatic falciform ligament was ruptured when puncturing below the xiphoid. One case underwent laparoscopic high ligation of hernial sac for indirect inguinal hernia and suffered strangulated intestinal obstruction after operation because part of the small intestine ran out of the peritoneum through the port site below the umbilicus. One case underwent laparoscopic tension-free repair for indirect inguinal hernia and suffered ischemic necrosis of the left testis possibly because of testicular torsion when stretching the tissue. The 4 cases with bile duct injury received primary drainage, 3 of which underwent secondary Roux-en-Y cholangiojejunostomy for severe biliary stricture and all recovered well after operation, and the other case underwent endoscopic biliary stent implantation 3 months after operation. The 2 cases with strangulated intestinal obstruction underwent emergent partial resection and end-to-end anastomosis of small intestine and recovered well after operation. The case with necrosis of testis underwent testicular excision. Conclusions The main causes of severe complications after laparoscopic surgery probably are the unclear local anatomy and failing to convert surgical procedure timely, etc. Early diagnosis, comprehensive evaluation and proper surgical interventions are the important measures for improving the prognosis of these patients.

Objective To study the expression of clusterin (CLU) and P-glycoprotein (P-gp) in hepatic cell carcinoma (HCC) and its relationship.Methods The expression of CLU gene in the tissue of H CC (41 cases),cirrhosis(10 cases) and normal liver (10 cases) and the expression of P-gp in the tissue of HCC were detected by immunohistochemical method.Results The positive expression rate of CLU was 82.93％(34/41) in HCC,and negative or weak positive were detected in cirrhosis and normal liver tissue.The positive expression rate of CLU was significantly correlated with Edmondson's histological grade (P ＜ 0.05),but had no correlation with patients' age,sex and cirrhosis (P ＞ 0.05).The positive expression rate of P-gp in HCC was 70.73％(29/41).There was significant correlation between the expression of CLU and P-gp (P ＜ 0.05).Conclusions The over expression of CLU is significantly associated with clinical multidrug resistance in HCC.It should be a potential target for treatment of HCC.

Objective To investigate the causes, diagnosis, treatment and prognosis of misdiagnosing metastatic liver cancer as liver abscess. Methods Clinical data of 4 patients with metastatic liver cancer misdiagnosed as liver abscess in Department of General Surgery, the Third Hospital of Shenzhen from April 2012 to April 2013 were retrospectively analyzed. The informed consents of all patients were obtained and the ethics committee approval was received. There were 1 male and 3 females with age ranging from 44 to 67 years old and a median age of 54 years old. All the patients received tests such as blood routine, liver function, alpha fetoprotein (AFP), carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9) and so on, and examinations of hepatobiliary ultrasonography, computed tomography (CT) scan of the upper abdomen, gastroscope and colonoscope after admission to hospital. Results The mean temperature of patients was (37.8±0.8)℃when admitted in hospital. Two cases got fever and shivering, and 4 cases suffered upper abdominal pain or discomfort. There were 2 cases with increasing white blood cell (WBC) and increasing alkaline phosphatase (ALP), 3 cases with increasing CA19-9, 2 cases with increasing CEA and 1 case with increasing AFP. By ultrasound examination and CT , multiple lesions were observed in 3 cases and single lesion in 1 case, including 2 cases of cystic lesions. Obvious edge enhancement was found in 3 cases by CT scan, heterogeneous internal enhancement in 2 cases, no internal enhancement in 2 cases, and 3 cases were found with lymphadenectasis in the porta hepatis or retroperitoneum. By pathological examination, 2 cases were diagnosed with liver metastasis of colon cancer, 1 case with liver metastasis of gastric cancer. And 1 case was clinically diagnosed with liver metastasis of gastrointestinal tract or extrahepatic bile duct cancer. Two cases received anti-infection treatment after admission to hospital. One case received liver tumor biopsy+catheter drainage of liqueifed necrotic tissues, and 1 case received colon cancer resection for intestinal obstruction. All the 4 patients received chemotherapy. One case died of multiple organ failure 3 months after being diagnosed and 1 case who had undergone colon cancer resection still received chemotherapy and lived well till the date of paper submission. The other 2 cases were in poor condition. Conclusions Some patients with metastatic liver cancer are usually misdiagnosed as liver abscess because of the untypical clinical features. The tumor marker detection is helpful for the differential diagnosis. Comprehensive treatments with the main of surgical resection should be employed in the patients but the prognosis is poor.

Objective To detect the expression of interleukin (IL)-18 of the peripheral blood cells and IL-18 receptor α chain(IL-18Rα) on the surface of CD_3~+ cells in patients newly diagnosed as immune thrombocytopenia (ITP) before medication and to explore the roles of IL-18 and IL-18Rα in the development of ITP. Methods Eighteen out-patients or inpatients with acute ITP accepting treatment in Qilu Hospital were enrolled in this study and 15 matching healthy subjects were taken as control. Plasma IL-18 level was detected with enzyme linked immunosorbent assay (ELISA), the expression of IL-18Rα on CD_3~+ lymphocytes and total lymphoeytes were measured with flow cytometry; T-bet and GATA-3 mRNA were measured with reverse transcriptase polymcrase chain reaction (RT-PCR). Results The expression of IL-18 in acute ITP plasma was (468. 57 ± 141.62) ng/L and IL-18Rα on the surface of CD_3~+ cells and lymphocytes were (8.50 ±3. 16)% and (9. 16±2.98)% respectively. The levels of IL-18 and IL-18Rα were increased in active ITP patients as compared with those in the controls (P <0. 05). The levels of IL-18 mRNA (0. 12 ±0. 02) and T-bet mRNA (0. 07 ±0. 02) were significantly increased in patients with active ITP as compared with those in the controls (P <0.05), while GATA-3 mRNA (0.0039±0.0014) were significantly decreased in patients with active ITP (P < 0. 05). The balance between T-bet and GATA-3 was significantly disturbed in ITP. Conclusions Through the variation of the levels of gene and protein, our study showed that IL-18 and IL-18Rα might upregulate the expression of Th1-cytokines in ITP patients. It is also suggested that IL-18 has potential association with the development of ITP. Especially, it may provide a new treatment method for ITP by regulating the ratio of T-bet and GATA-3 and resuming the balance of Th1/ Th2.

Objective Hepatocyte growth factor (HGF) has been found to stimulate proliferation, mobility and morphological changes of epithelial cells and acts as one of the initiate factors in liver regeneration. Recently, it is found to play an important role in liver cirrhosis(LC) and liver tumorigenesis and development. We mainly discussed the significance of serum HGF in chronic liver diseases. Methods One hundred and Ninety-seven individuals including 80 hepatocellular carcinoma (HCC), 57 LC, 22 chronic hepatitis (CH) and 38 healthy people were tested. Serum HGF levels in HCC, LC and CH patients were each detected by ELISA. The HGF receiver operator characteristic (ROC) curves for LC and HCC patients were drawn to determine the perfect cut off point, respectively. The correlation between serum HGF level and other laboratory findings including ALT, AST, GGT, albumin, total bilirubin, prothrombin time, tumor size and tumor pathological grade was analyzed by Spearman analysis. Results The median serum HGF levels of patients of HCC, LC, CH and normal control were 6.767, 151.200, 7.017, and 3.476 pg/ml, respectively. Serum HGF levels of HCC (P