Objective:To evaluate the efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in young patients with high-risk multiple myeloma (HRMM) and analyzed the factors affecting patient prognosis.Methods:In this retrospective study, we analyzed the clinical data of 14 patients with HRMM with cytogenetic abnormalities or high-risk biological factors who underwent allo-HSCT at the Hematopoietic Stem Cell Transplantation Center of the Institute of Hematology & Blood Diseases Hospital between November 2016 and November 2022.Results:There were seven males and seven females included in the study, with a median age of 39.5 (31-50) years at the time of allo-HSCT. The median number of treatment lines before transplantation was 2 (1-6) . Before allo-HSCT, 42.9% (6/14) of the patients did not achieve complete remission, while 35.7% (5/14) of the patients achieved measurable residual disease positivity. After transplantation, all patients were evaluated for their treatment response, and the overall response rate was 100% (14/14) . All 14 patients successfully underwent allo-HSCT, with median engraftment times for neutrophils and platelets of 11 (10-14) days and 13 (9-103) days, respectively. Acute grade Ⅱ-Ⅳ graft-versus-host disease (GVHD) occurred in five patients (35.7%) , and two patients (14.3%) developed moderate-to-severe chronic GVHD. The median follow-up time after allo-HSCT was 18.93 (4.10-72.53) months, with an expected 2-year transplant-related mortality rate of 7.1% (95% CI 0%-21.1%) and an expected 2-year overall survival rate of 92.9% (95% CI 80.3%–100.0%) . Moreover, the expected 1-year and 2-year progression-free survival rates were 92.9% (95% CI 80.3%-100.0%) and 66.0% (95% CI 39.4%-100.0%) , respectively, and the 2-year cumulative incidence of relapse was 28.9% (95% CI 0%-56.7%) . Upfront allo-HSCT following complete remission after induced therapy and the presence of chronic GVHD might be favorable prognostic factors. Conclusion:allo-HSCT is an effective treatment for improving the prognosis of young patients with HRMM.

Objective:To analyze the effects of espO gene knockout on the biological characteristics of enterhemorrhagic Escherichia coli (EHEC). Methods:Two-step methods mediated by the suicide plasmid pCVD442-Δ espO and plasmid pTrc99a were used to construct the espO gene-deleted strain (Δ espO) and the complemented mutant (CΔ espO), respectively. HeLa cells were infected with different EHEC strains to analyze the biological functions and lethal effects of espO gene during infection. Results:PCR, electrophoresis and gene sequencing showed that the Δ espO and CΔ espO mutants were successfully constructed. Compared with the wild-type strain, neither the Δ espO nor CΔ espO mutant showed significant difference in growth rate, indicating that the espO gene had no influence on the growth and replication of EHEC. Furthermore, EspO could activate the tumor necrosis factor receptor (TNF)-induced NF-κB signaling pathway, while the effector protein NleB could inhibit the process. EspO could not inhibit the death of HeLa cells induced by TNF or TNF-related apoptosis-inducing ligand (TRAIL) after EHEC infection. Conclusions:In this study, we successfully constructed the espO gene-deleted and complemented mutants of EHEC and preliminarily analyzed the interaction between espO gene and host cells and the effects of espO gene on cell apoptosis during infection, which provided reference for further research on the in vitro biochemical activity and in vivo pathogenic roles of EspO.

【Objective】 To develop an assay to determine β-lactam antibiotics using microcolumn gels and to study the β-lactam antibiotics present in the blood of patients and their clinical significances. 【Methods】 446 patients with a history of taking β-lactam antibiotics from January 2019 to June 2019 were randomly selected from Trauma Emergency Center, Department of Arthrosis, Department of Spine and Department of Bone Oncology of our hospital, and 4 mL(per capita) venous blood was collected. Irregular antibody screening, anti-globulin detection and drug antibody determination were performed by microcolumn gel method. The data of gender, age, disease, blood transfusion history and medication were collected. The test results and clinical data were retrospective analyzed. 【Results】 The yielding rate of antibody was 0.45%(2/446) in patients with a history of taking β -lactam antibiotics. 16.38%(73/446) of the samples were positive in direct antiglobulin test, and 64.38%(47/73) of them did not agglutinate with RBCs treated with drugs. The yielding rate of specific antibodies against drug was 4.93%(22/446), and the titer ranged from 2 to 128(8). 1 case of auto-IgM antibody, 1 case of blood group related antibody and 2 cases of non-specific protein adsorption were detected. The yielding rate of drug antibody in patients with blood transfusion history reached to 12.10 %(22/124), so it was also high in patients with bone tumor. 【Conclusion】 Direct antiglobulin assay is helpful for the detection of β-lactam antibodies. The negative results of antibody screening cannot completely exclude the presence of drug antibodies. The yielding rate of drug antibody can be greatly improved by specific drug antibody detection, and it was higher in transfused patients relative to non-transfused one.

Objective:To investigate the etiology of necrotizing pneumonia (NP) in children and the clinical characteristics of NP caused by different pathogens in China.Methods:A retrospective, case-control study was performed in children with NP who were admitted to 13 hospitals in China from January 2008 to December 2019. The demographic and clinical information, laboratory data, etiological and radiological findings were analyzed. The data were divided into three groups based on the following years: 2008-2011, 2012-2015 and 2016-2019, and the distribution characteristics of the pathogens in different period were compared. Meanwhile, the pathogens of pediatric NP in the southern and northern China were compared. And the clinical characteristics of the Mycoplasma pneumoniae (MP) NP and the bacterial NP were also compared. T-test or Mann-Whitney nonparametric test was used for comparison of numerical variables, and χ 2 test was used for categorical variables. Results:A total of 494 children with NP were enrolled, the median ages were 4.7 (0.1-15.3) years, including 272 boys and 222 girls. Among these patients, pathogens were identified in 347 cases and the pathogen was unclear in the remaining 147 cases. The main pathogens were MP (238 cases), Streptococcus pneumoniae (SP) (61 cases), Staphylococcus aureus (SA) (51 cases), Pseudomonas aeruginosa (13 cases), Haemophilus influenzae (10 cases), adenovirus (10 cases), and influenza virus A (7 cases), respectively. MP was the most common pathogen in all three periods and the proportion increased yearly. The proportion of MP in 2016-2019 was significantly higher than that in 2012-2015 (52.1% (197/378) vs. 36.8% (32/87), χ 2= 6.654, P=0.010), while there was no significant difference in the proportion of MP in 2012-2015 and that in 2008-2011 (36.8% (32/87) vs. 31.0% (9/29), χ2=0.314, P=0.575).Regarding the regional distribution, 342 cases were in the southern China and 152 in the northern China. Also, MP was the most common pathogen in both regions, but the proportion of MP was higher and the proportion of SP was lower in the north than those in the south (60.5% (92/152) vs. 42.7% (146/342), χ 2=13.409, P<0.010; 7.9% (12/152) vs. 14.3% (49/342), χ 2= 4.023, P=0.045). Comparing the clinical characteristics of different pathogens, we found that fever and cough were the common symptoms in both single MP and single bacterial groups, but chest pain was more common (17.0% (34/200) vs. 6.1% (6/98), χ 2=6.697, P=0.010) while shortness of breath and wheezing were less common in MP group (16.0% (32/200) vs. 60.2% (59/98), χ 2=60.688, P<0.01; 4.5% (9/200) vs. 21.4% (21/98), χ 2=20.819, P<0.01, respectively). The white blood cell count, C-reactive protein and procalcitonin in the bacterial group were significantly higher than those in the MP group (14.7 (1.0-67.1)×10 9/L vs. 10.5 (2.5-32.2)×10 9/L, 122.5 (0.5-277.3) mg/L vs. 51.4 (0.5-200.0) g/L, 2.13 (0.05-100.00) μg/L vs. 0.24 (0.01-18.85) μg/L, Z=-3.719, -5.901 and -7.765, all P<0.01). Conclusions:The prevalence of pediatric NP in China shows an increasing trend during the past years. MP, SP and SA are the main pathogens of NP, and the most common clinical symptoms are fever and cough. The WBC count, C-reactive protein and procalcitonin in bacterial NP are significantly higher than those caused by MP.

Objective:To explore effects of feedback education combined with incentive psychological intervention on compliance behavior and psychological state of patients with chronic obstructive pulmonary disease (COPD) .Methods:Using the convenient sampling method, a total of 104 COPD patients who were admitted to Xi'an Central Hospital from January 2016 to January 2019 were selected as the research objects. According to the random number table method, they were divided into the observation group and the control group, with 52 cases in each group. Patients in the control group were given conventional intervention measures, while patients in the observation group were given feedback education and incentive psychological intervention on this basis. The compliance behaviors (reasonable diet, respiratory function exercise, airway inhalation administration, rehabilitation training, disease prevention) were compared between the two group. The changes of self-care ability [Exercise of Self-care Agency Scale (ESCA) ] and mental state [Short Form of the Profile of Mood States (POMS-SF) ]before and after intervention were observed.Results:The scores of compliance with reasonable diet, respiratory function exercise, airway inhalation administration, rehabilitation training and disease prevention of patients in observation group were higher than those in control group (χ 2=4.300, 4.522, 4.833, 4.887, 4.514) . The scores of dimensions of ESCA of patients in the two groups after intervention were all higher than those before the intervention ( t=-7.189, -4.280, -8.404, -5.588, -7.51, -3.228, -8.153, -3.694) , and scores of dimensions of ESCA in the observation group were all higher than those in the control group ( t=4.819, 3.913, 5.228, 4.258) . After intervention, scores of Vigor-Activity (VA) subscale in POMS-SF of patients in the two groups were higher than those before the intervention ( t=-9.830, -8.866) , and score of the VA subscale in POMS-SF of the observation group after the intervention was higher than that of the control group ( t=5.598) . The remaining subscale scores of POMS-SF in the two groups after intervention were lower than those before intervention ( t=6.697, 6.253, 9.233, 6.612, 6.774, 5.307, 6.700, 3.096, 5.228, 2.342) , and the remaining subscale scores of the observation group after intervention were lower than those of the control group ( t=3.327, 2.675, 4.399, 4.201, 4.417) . The above differences were all statistically significant ( P<0.05) . Conclusions:During the treatment of COPD patients, feedback education and incentive psychological intervention can effectively improve compliance behaviors of patients, enhance their self-care ability, reduce their negative emotions and help them to face the disease with a positive attitude.

Objective To compare and explore the morphological characteristics of mast cells in different tissues of 6 types of common laboratory animals.Methods Ten healthy adult SPF Kunming mice, 10 SD rats, 10 Hartley guinea pigs, 10 New Zealand rabbits, 6 beagle dogs and 6 Macaca mulata ( male:female=1:1, for all) were used in this study. The animals were sacrificed by euthanasia, samples of the skin, lung, spleen and sigmoid colon were taken from mouse, rat, guinea pig, rabbit, dog and monkey, and fixed in formalin and Bouin’ s solution.Paraffin sections were stained with toluidine blue and Alcian blue-safranin O, respectively.The mouse skin and dog spleen were immunohistochemically stained for substance P.A color pathological image analysis system was used to conduct the analysis of morphometric pa-rameters of mast cells.Samples of the skin of these animals were also fixed in glutaraldehyde for the electron microscopic observation and comparison of the mast cells.Results Mast cells in different types of animals were distinctive in distribu-tion, morphology, size, metachromasia and staining properties.Density and morphometric parameters of the mast cells had significant differences among the 6 types of animals ( P＜0.05 ) .Characteristic granules were contained in the skin mast cells of guinea pig, dog and monkey.Mast cells in the mouse skin, dog spleen and nerves in the mouse skin showed immu-noreactive substance P.Conclusions Mast cells in the 6 types of laboratory animals showed histochemical and morphologi-cal heterogeneity, which have important reference values in animal experimental research on mast cell function.

Objective To explore the reconstructive methods of benign bone tumor defects in proximal joint. Methods Operative treatment was performed in 11 cases with benign bone tumor defects in proximal joint, a-mong whom 4 cases were treated by curettage,cauterization of wall and bone grafting,3 cases were treated by filling branch through segment fibula transplantation with vascular,2 cases were treated by fibula head transplantation with vascular to reconstruct the glenohumeral joint and rediocarpal joint, and 2 cases were treated by artificial joint re-placement. Results The follow-up ranged from 1.5 to 6 years. All of cases got excellent bone unioned without re-lapse and 2 cases of them developed with little limitation in joint function. Conclusion The importance and recon-structive achievement of fibula transplantation in treating the benign bone tumor defects in proximal joint should be thought fully. The indication of artificial tumor prosthesis replacement should be strictly mastered.

Objective:To estimate the clinical effect of integrated Xinjia Shashen Maidong Decoction and radiotherapy on advanced non-small-cell lung cancer (NSCLC) patients.Methods:30 NSCLC patients were treated with Xinjia Shashen Maidong Decoction after radiotherapy for more than two months,then the clinical effect were evaluated by tumor-mass stable rate,symptoms,Karnofsky score and survival period.Results:Response Evaluation Criteria in Solid Tumor (RECIST) evaluation results showed that the effective rate on relieving tumor mass was 53.3%,stable rate was 86.7%.The symptom of cough was much relieved,with 56.7% effective rate and 93.3% stable rate.And effect on Karnofsky score was good,that effective rate was 56.7% and stable rate was 86.7%. Fortunately,the patients had a median survival period of 11 months.Conclusion:Xinjia Shashen Maidong Decoction enhanced the efficacy of radiotherapy and reduced its side-effects in the treatment of advanced NSCLC patients.

Objective To study the effect of cortisol and dehydroepiandrosterone sulfate(DHEA S)in fetal umbilical cord blood on term labor. Methods Cortisol and DHEA S concentrations were measured By radioimmunoassay in 100 term fetal umbilical cord blood. They were divided into four groups. Group A selective cesarean section without any birth pain ( n =18),Group B cesarean section in latent phase( n =10),Group C cesarean section in active phase( n =12),Group D spontaneous vaginal deliver( n =60). Results The concentrations of fetal umbilical cord cortisol in spontaneous vaginal deliver group was gradually increased with gestational week. The peak level was in the 39th gestation week,by the 42th gestation week,the concentration of cortisol declined to the 37th gestation week. DHEA S changed paralleled with cortisol ( r =0.46, P

The reconstructive method and layout of medical train is studied,especially in reconstruction of the sick and wounded ward,medical room and train carriage.Safe protection for the wounded and methods for equipment constancy are introduced.It is expected to serve as a reference for enhancing medical treatment efficiency and quality.