[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 construct a set of evaluation index system for the core ability of preventive medicine graduates to respond to sudden biological public health events.Methods:Research methods such as in-depth interviews and group discussions were used to determine the core competence structure, the Delphi method was used to conduct two rounds of expert consultation, and the index system and its weights were finally determined based on the consultation results of 21 experts on the system. Excel and SPSS 21.0 were used for data collation and statistical analysis.Results:The positive coefficient of expert consultation was greater than 80%, the authority coefficient was greater than 0.7, and the average was 0.906. The final index system was composed of 4 first-level indicators, 10 second-level indicators, and 39 third-level indicators.Conclusion:The evaluation index system can provide a reference for exploring effective ways to improve the core competence of graduates.

Objective To analyze the cancer mortality and epidemiological characteristics of digestive system cancer in Xianyou County, Fujian Province, and to provide a scientific evidence for formulating preventive measures for digestive system cancer. Methods Excel and SPSS software were used to collect the monitoring data of digestive system cancer death in Xianyou County from 2014 to 2018, and then analyzed the mortality, the standardized rate (according to the Chinese 2000 population census) and the cause of death. Results From 2014 to 2018, the deaths of malignant tumors in Xianyou County accounted for 35.00% of all deaths. Among them, the four common digestive system malignant tumors (gastric cancer, esophageal cancer, liver cancer and colorectal cancer) accounted for 62.44% of malignant tumors. Gastric cancer ranked first and accounted for 27.36%. Average annual rate of crude mortality and standardized mortality of malignant tumor in the digestive system were 108.93/10⁵ and 89.34/10⁵, respectively, and the ratio of male to female was 2.27 to 1. Significant differences were found between town and village, as the terrain gets lower, the death rate goes down gradually. Compared with the data of 2011-2012, the standardized death rate of gastric cancer, esophageal cancer and liver cancer were reduced by 29.71%, 23.92% and 12.06%, respectively, while the rate of colorectal cancer was increased by 28.80% and the average annual growth rate was 7.83%. Conclusion Although the death rates of gastric cancer, esophageal cancer and liver cancer have decreased significantly, the malignant tumor of the digestive system is still the main disease that causes the death of residents in Xianyou County, Putian City. Therefore, it is necessary to strengthen the education of health in order to achieve the early discovery, diagnosis and treatment.

After participating in the student selection training and on-site refereeing of the clinical examination skills competition for college students in Sichuan-Chongqing region twice in succession, the author combined the on-site performance and competition results of the participating students with pre-match training experience and normal teaching experience. A comprehensive analysis found that the students' proficiency in basic testing skills, psychological quality and humanistic quality have an important impact on the results of the competition. Teachers should not only pay attention to the quality of basic skills training and theoretical knowledge teaching in practical teaching, but also pay attention to the cultivation of students' teamwork ability and good working habits. Therefore, the clinical laboratory skills competition has a strong leading role in promoting the education and teaching reform of medical laboratory technology and improving the quality of professional practice teaching. It is hoped that more medical colleges and universities will pay attention to and participate in it, and further promote the development of practical teaching of medical laboratory technology.

Objective:To analyze the epidemiological and clinical characteristics of imported COVID-19 cases after SARS-CoV-2 vaccination and to provide evidence for the prevention and control of COVID-19.Methods:The imported COVID-19 cases in Chengdu as of April 15, 2021 were divided into the vaccinated group and unvaccinated group according to the history of SARS-CoV-2 vaccination. The epidemiological and clinical data of the cases were collected retrospectively, and the differences in epidemiological and clinical characteristics of the two groups were compared. Laboratory tests consisted of nucleic acid test, clinical index test, serum antibody test and lymphocyte test. Software WPS2019 was used for data management and software R 4.0.3 was used for statistical analysis.Results:A total of 75 COVID-19 cases were included in the analysis, in which 20 had received SARS-CoV-2 vaccination and only 4 with clinical symptoms, 55 patients did not receive SARS-CoV-2 vaccination, and 16 had clinical symptoms. In vaccinated group, the first injection time of vaccination ranged from July to November 2020, and 10 cases received two doses of vaccine simultaneously and 10 cases received two doses of vaccine at intervals of 14-57 days. The intervals between the completion of vaccination and the onset ranged from 87 days to 224 days. The differences in classification and clinical type between the two groups were significant. Significant differences were observed in case classification and clinical type between vaccinated group and unvaccinated group ( P<0.05). The vaccinated group had a relatively high proportion of asymptomatic infections (40.00%, 8/20), while mild infections were mainly observed in the unvaccinated group(76.36%,42/55). The differences in Ct values (ORF1ab gene and N gene) at the diagnosis were not significant between vaccinated group and unvaccinated group ( P>0.05), similar results were also observed in lymphocyte subtypes, procalcitonin and C-reactive protein level comparisons. Serum amyloid A level was higher in unvaccinated group than in vaccinated group ( P<0.05). However, the SARS-CoV-2 related serum antibody of IgM, IgG and total antibody levels were significantly higher in vaccinated group ( P<0.05). Conclusions:Risk of infection still exists with SARS-CoV-2 after vaccination, which can facilitate the production of specific serum antibody of IgM and IgG when people are exposed to the virus. It has a certain protective effect on SARS-CoV-2 infected persons. Vaccination can reduce the clinical symptoms and mitigate disease severity.

Objective:To explore the MRI features of neonatal deep cerebral arterial infarctions.Methods:The medical and MRI datas of 23 neonates with deep cerebral arterial infarctions from January 2011 to December 2018 in Beijing Children′s Hospital, Capital Medical University were retrospectively analyzed. Both 11 males and 12 females with ages between 1-28 d were recruited and MRI were performed within 2-20 d after symptom onset. The MRI featurs including location, morphology, signal characteristics, enhancement features and other accompanied signs were reviewed.Results:A total of 15 cases with arterial infarction and 8 cases with complication of purulent meningitis were identified. The median age at presentation were 2 d and 7 d respectively. The unilateral involvement were demonstrated in all neonates with arterial infarctions. Among them, 11 had deep infarcts and the main branch of the middle cerebral artery was involved in 4 neonates. MRI showed slightly hypo-intensity on T 1WI and slightly hyper-intensity on T 2WI with indistinct boundary and focal punctate hyper-intensity on T 1WI and hypo-intensity on T 2WI. In 8 cases secondary to purulent meningitis, unilateral involvement was found in 5 cases and bilateral involvement in 3 cases. All cases showed hypo-intensity on T 1WI and hyper-intensity on T 2WI with indistinct boundary. Among them, 7 cases were heterogeneous, with small cystic changes which appeared as slightly hyper-intensity on T 1WI and slightly hypo-intensity on T 2WI peripherally, as well as nodular or patchy restricted diffusion. Marked swelling of the lesion was found in 6 cases. Multiple patchy or ring enhancement was revealed in 5 cases. Iso-intensity and restricted diffusion in posterior horn of the lateral ventricle were found in 2 cases. Restricted diffusion in frontotemporal subarachnoid space was found in 5 cases. One case showed subdural effusion. Conclusion:Neonatal deep cerebral arterial infarctions have certain characteristic appearance on MRI. Lesions secondary to purulent meningitis can be bilateral involvement with heterogeneous MRI intensities, and different period of infarction signs could be found concurrently. MRI is beneficial to the differential diagnosis.

The cholinergic anti-inflammatory pathway (CAP) is a neuro-immunomodulatory pathway,in which acetylcholine (ACh) released by the interaction of vagal nerves with α7 nicotinic acetylcholine receptor (α7nAChR),which prevents the synthesis and release of pro-inflammatory cytokines and ultimately regulates the local or systemic inflammatory response in a feedback manner. It has been shown that there are many possible effective treatments for sepsis, including vagus nerve stimulation by physical therapy, drugs such as acetylcholine receptor agonist and ultrasound therapy.
Acetylcholine ; Humans ; Inflammation ; Neuroimmunomodulation ; Sepsis ; Vagus Nerve Stimulation ; alpha7 Nicotinic Acetylcholine Receptor

Objective: To design the self-rating scale on basic ability in graduates of preventive medicine major, and test its reliability and validity, providing a reliable tool for evaluating the basic ability of graduates. Methods: On the basis of constructing the Evaluation Index System on Basic Ability in Graduates of Preventive Medicine Major, the three-level indexes were converted to specific questions. Self-evaluation scale including 58 items, 22 sub-dimensions and 8 main dimensions were finally designed after pre-survey and expert argumentation. A total of 205 graduates of preventive medicine major from a medical college and 9 experts in the field of public health were selected to completed the questionnaire. Scale's reliability was tested by applying internal consistency reliability and composite reliability; it's validity was tested by applying content validity and confirmatory factor analysis. Results: Scale's α coefficient of internal consistency reliability was 0.976; α coefficient and combination reliability of eight main dimensions were both higher than 0.8; the content validity index S-CVI of the scale was 0.94, the content validity index I-CVI of the item level was 0.78 to 1.00; the average variance extraction amount (AVE) of the eight main dimensions was higher than 0.50. Fitting of the structural model with the item used as observation indexes was reasonable (χ²/df=1.749, RMR=0.036, RMSEA=0.061, NFI=0.801, IFI=0.904, TLI=0.904, CFI=0.903), and the sub-dimension as used observation indexes was good(χ²/df=1.876, RMR=0.032, RMSEA=0.066, NFI=0.913, IFI=0.958, TLI=0.945, CFI=0.957). Conclusion This scale is the first self-rating scale on the basic ability in graduates of preventive medicine major on the basis of the National Standards of Teaching Quality on Public Health and Preventive Medicine, with good reliability and validityl. It is able to achieve quantitative evaluation on graduates' basic abilities.

Objective To construct a self management program for patients with ureteral stoma, then validate the proposal. Methods The expert consensus reached an agreement after 2 rounds of Delphi expert consultation of "self management programme", according with the contents of the manual requirements,the intervention patients(41 cases)were given these self management interventions:regular one-on-one ostomy skills training, mental support and motivational interview, recording stoma diary, the control patients were given routine nursing interventions,after 1,3 and 6 months of implementation,their results of self management was evaluated. Results The total score of self-management ability was 99.32±10.41,105.34±13.75,109.18±10.91 in the control group after the intervention of 1,3 and 6 months respectively,and 106.73 ± 13.82,117.65 ± 15.47,129.43 ± 12.37 in the test group,the differences were statistically significant (t=7.847, 9.318, 11.416, P<0.01). The total score of quality of life was 167.18 ± 24.62, 173.36 ± 25.33, 179.48 ± 22.17 in the control group after the intervention of 1, 3 and 6 months respectively,and 178.66 ± 23.47,185.41 ± 22.67,213.17 ± 26.75 in the test group,the differences were statistically significant (t=6.839, 10.241, 13.926, P<0.01). Conclusions The construction of the ureterostomy self-management program, enhance patients'self-management consciousness, and improve the ability of self-management.

Objective The study explored the feasibility of PBL teaching approach and mini-CEX scores evaluation method in hematology probation teaching practice. Methods 54 medical students of eight-year program were selected in the study and they were in hematology department of Sun Yat-sen Memorial Hospital for clinical probation. The study compared PBL teaching approach with traditional training method, and used mini-CEX to evaluate the students' clinical competence. Results The performance of PBL teaching group is better than traditional teaching group in the aspect of inquiry skill, clinical diagnosis, therapy plan and humanistic care (P<0.05). There is no significant difference of basic knowledge, physical examination skill and clinical operational skills between these two groups. More than 85％of the students in PBL group are satisfied with the teacher in the aspect of participation, feedback, guidance, correction and assistance. Conclusion Through this teaching practice, the study provides new methods for improving the teaching of pre-internal clinical practice in hematology department.