Multiple myeloma (MM) is a hematological malignancy that poses significant treatment challenges due to its heterogeneity and propensity for relapse and progression. In the last two decades, the therapeutic landscape of MM has changed dramatically, but the disease remains largely incurable, with many patients facing treatment resistance. This review evaluates the current status of MM treatments, emphasizing the limitations of traditional therapies and the emerging role of immunotherapy in improving patient outcomes. It highlights the importance of achieving and maintaining minimal residual disease negativity and a balanced immune response as key treatment goals. Furthermore, it discusses the advancements in immunotherapies that are improving the prospects for patients, particularly those with relapsed or refractory disease. Innovative strategies, such as chimeric antigen receptor T-cell therapy, bispecific antibodies, and bispecific T cell engagers, have shown significant promise by targeting the malignant cells and the bone marrow microenvironment, which are essential for disease persistence and resistance to therapy. Future research should focus on refining MM treatment strategies, including the integration of immunotherapy into earlier treatment lines and the development of predictive biomarkers for personalized treatment approaches, ultimately enhancing patient outcomes.

Objective:To investigate the effect of intolerance of uncertainty (IU) on state worry, state anxiety, and galvanic skin response in college students with medium and low trait anxiety.Methods:The trait anxiety inventory (TAI) and the intolerance of uncertainty scale (IUS) were used to investigate 1 378 college students in Beijing. A total of 537 individuals with medium or low trait anxiety (TAI score ≤54) were selected, from which high IU individuals (IUS score ≤58) and low IU individuals (IUS score > 58) were selected and allocated to uncertain group ( n=28) and certain group ( n=28) according to gender, age, education level and IU score. The modified NPU paradigm task, the penn state worry questionnaire(PSWQ)and the brief state anxiety measurement(BSAM) were used to assess the subjects' worry and anxiety.The galvanic skin response of individuals completing the NPU paradigm task was recorded.SPSS 26.0 was used for a two factor analysis of variance (classification: high IU, low IU; group: uncertain group, certain group). Results:The results of the two factor analysis of variance showed that the interaction between individual state anxiety classification and group was not significant( F(1, 55)=0.05, P>0.05, η2=2.16). The main effect of classification was significant( F(1, 55)=24.17, P<0.05, η2=1143.01). The anxiety level of individuals with high IU was significantly lower than that of individuals with low IU( P<0.05). The group main effect was not significant( F(1, 55)=0.03, P>0.05, η2=1.45), and there was no significant difference between the uncertainty group and the certainty group in terms of worry( P>0.05). The interaction between individual state anxiety classification and group was significant ( F(1, 55)=4.38, P<0.05, η2=3.02). The simple analysis results showed that in the uncertain group, the state anxiety of individuals with high IU was significantly lower than that of individuals with low IU ( P<0.05). In the certain group, there was no significant difference in state anxiety between individuals with high and low IU ( P>0.05). The interaction between individual galvanic skin response classification and group was not significant ( F(1, 55)=0.03, P>0.05, η2=0.00). The classification main effect was not significant( F(1, 55)=0.07, P>0.05, η2=0.00), and there was no significant difference in skin electrical activity between individuals with high and low IU ( P>0.05). But the main effect of the group was significant( F(1, 55)=4.86, P<0.05, η2=0.03). The skin electrical activity of the uncertain group was higher than that of the certain group( P<0.05). Conclusion:In the college students with medium and low trait anxiety, IU is an effective predictor of individual state worry and state anxiety under uncertain conditions.

Objective:To evaluate the efficacy and safety of autologous hematopoietic stem cell transplantation(auto-HSCT)for the treatment of multiple myeloma(MM)in elderly patients aged over 65 years.Methods:In this retrospective analysis, the efficacy and safety of auto-HSCT for the treatment of MM was examined in 28 patients aged >65 years diagnosed and treated at Soochow Hopes Hematology Hospital between March 1, 2020 and October 31, 2022.The functions of the major organs of these patients were evaluated before transplantation.Results:The 28 patients had a median age of 67(66-72)at the time of transplantation, a median number of 2.985 × 10 6/kg(2.036-9.5 × 10 6/kg)of collected CD34+ hematopoietic stem cells, and a median number of 2(1-3)days of collection.The median time to neutrophil implantation after hematopoietic stem cell transfusion was 10(9-14)days, and the median platelet implantation time was 11(10-29)days.The median follow-up time was 25 months, but the median progression-free survival time was not reached.The 1-year PFS rate was 89.3% and 2-year PFS rate was 76.3%, with 2 patients' starting point of PFS set at the time of pre-transplantation re-induction therapy because needed salvage auto-HSCT.The overall survival time was not reached, the 1-year overall survival rate was 100.0%, and the 2-year overall survival rate was 90.5%. Conclusions:Auto-HSCT is a safe and effective treatment for elderly MM patients aged over 65 years after screening and assessment.

With the improvement of critical care medical technology, more critically ill children are transferred from Pediatric Intensive Care Unit (PICU) to General Ward, and the transition period of PICU has become a hot spot of clinical research. Paying attention to the relocation stress of parents of children in transition period of PICU is also the focus of clinical nursing practice in critically ill pediatrics. However, the relocation stress of parents of children has adverse effects on their own health and the rehabilitation process of children. This paper reviews the concept, assessment tools, influencing factors and intervention measures of parents of transitional children in the PICU transition period and puts forward the limitations and suggestions of the current research on transitional pressure in parents of children in the PICU transition period, so as to provide references for relocation stress nursing service for parents of children in transition period in PICU.

Objective:This study aimed to evaluate the efficacy and safety of lenalidomide combined with bortezomib and dexamethasone (VRD) in the treatment of newly diagnosed multiple myeloma (MM) .Methods:A total of 150 newly diagnosed patients with MM diagnosed in The First Affiliated Hospital of Soochow University from November 2018 to February 2021 and received VRD as the induction regimen were included to evaluate the safety and efficacy of VRD induction therapy for newly diagnosed MM.Results:The median follow-up was 22 months, two patients (1.3%) died early after treatment, and 148 patients (98.7%) completed induction therapy. 116 patients (77.3%) were mobilized to collect autologous hematopoietic stem cells, 101 cases (87.1%) were qualified in the collection, of which 48 cases (41.4%) were excellent in the collection. The 3-year progression-free survival (PFS) rate was 59%, and the 3-year overall survival (OS) rate was 83%. After induction, complete remission (CR) /stringent CR rate was 54.4%, ≥ very good partial remission rate was 77.3%, overall response rate was 86.0%, and minimal residual disease negative rate was 46.0%. There was no statistically significant difference in the efficacy of cytogenetic high-risk patients compared with standard risk patients ( P=0.456) . The median PFS time of cytogenetic high-risk patients was shorter than that of standard risk patients (not reached vs 33 months, P=0.014) . There was no statistically significant difference in the median OS time (not reached vs not reached, P=0.072) . The highest incidence of hematological adverse events was thrombocytopenia (72%) , followed by neutropenia (42%) and anemia (20%) . The highest incidence of non-hematological adverse events was peripheral neuritis (56.7%) . The main digestive tract symptoms include constipation (30.0%) and diarrhea (17.3%) . Upper respiratory tract infection (23.3%) and lung infection (7.3%) are the main infections. The incidence of adverse thrombocytopenia (90.0% vs 63.7%, P=0.001) , neutropenia (54.2% vs 36.3%, P=0.038) , anemia (33.3% vs 13.7%, P=0.005) , diarrhea (27.1% vs 12.7%, P=0.030) , limb edema (20.8% vs 3.9%, P=0.030) , fever (20.8% vs 4.9%, P=0.006) , thrombosis (8.3% vs 0, P=0.016) , and renal function deterioration (20.8% vs 3.9%, P=0.030) in patients with renal insufficiency was higher than that in patients with normal renal function. Conclusion:The VRD regimen has a significant effect on newly diagnosed MM, does not affect the hematopoietic stem cell collection, and has controllable adverse events; however, the incidence of adverse events was higher in patients with renal insufficiency.

【Objective】 To investigate the related factors of allogeneic blood transfusion (ALBT) in total hip arthroplasty. 【Methods】 Thebasic information, surgical details and laboratory data of 258 patients who underwent total hip arthroplasty in Orthopedics Department of our hospital were collectedfrom the electronic medical record system and laboratorytest system. The factors concerningALBT were obtainedby single factor and multivariate logistic regression analysis. 【Results】 The ALBT rate in this study was 19%, and the differencesin such important factors affecting ALBT as gender, age, intraoperative blood loss, drainage volume, operation duration, preoperative hemoglobin (Hb), preoperative activated partial thromboplastin time (APTT), preoperative prothrombin time (PT) andhypertension between the two groupswere notable (P<0.05). Multivariate regression analysisrevealed that the independent related factors ofALBT were age ≥ 60 years (OR3.577), intraoperative blood loss (OR1.003), drainage volume (OR1.004)and preoperative PT (OR1.888). Preoperative Hb (OR0.94) was a protective factor. 【Conclusion】 Specific and individualized evaluation of ALBT, aimed atreducingunnecessary blood transfusion, can be provided through the analysis of relevant factors.

Objective: To explore the cause and type of pigmentation in the livers and kidneys of rats caused by a compound Chinese medicine preparation. Methods: The experiment consist of low, medium, and high dose groups and a control group, the Sprague-Dawley rats in these groups were orally given 1.0, 2.0 and 4.0 g/kgbw of a compound Chinese medicine preparation of gardenia and distilled water for 30 days, respectively. The body weight, diet, hematology and histopathology of the rats in each group were observed for changes in pigment metabolism. Results: In the first and second weeks of the experiment, the rats in the low, medium, high dose groups and the control group showed no abnormal symptoms or signs. From the third weekend, the urine of the rats in the high dose group turned thick yellow and green, and the stool color became light. During the experiment, no rats died. There were statistically significant differences in body weights and weight gains among these groups ( P<0.05 ) . There were statistically significant differences in total food utilization, direct bilirubin, r-glutamyl transferase, alkaline phosphatase, and liver/body ratios among these groups ( P<0.05 ). Gross examination revealed that the livers and kidneys of rats in the high dose group were dull and green. Microscopic examination revealed changes in dark pigment particles in the livers and kidneys of rats in the high dose group. Histochemical staining confirmed that pigments in the livers and kidneys were bile pigments. Conclusions At a dosage of 4.0 g/kgbw, a compound Chinese medicine preparation of gardenia can lead to bile pigment deposition in the livers and kidneys of rats due to cholestasis.

Objective:To investigate the risk factors of non-obstructive gastric retention before endoscopic retrograde cholangiopancreatography (ERCP) in patients with biliopancreatic disease.Methods:The matched case-control study included 109 patients with non-obstructive gastric retention before ERCP as the case group, and 218 patients without gastric retention as the control group. The patients′ medical records including comorbidities, preoperative medication and laboratory indicators were compared between the two groups. Multivariate conditional logistic regression models were subsequently used to determine the risk factors for non-obstructive gastric retention before ERCP.Results:Logistic regression revealed that the jaundice ( OR=12.359, P<0.001), opiates use ( OR=3.009, P=0.001), somatostatin use ( OR=2.445, P=0.033), fasting hyperglycemia ( OR=1.513, P=0.045), hypokalemia ( OR=4.634, P=0.001) and hyponatremia ( OR=1.805, P=0.023) were independent risk factors for non-obstructive gastric retention before ERCP in patients with biliopancreatic disease. Conclusion:Except for gastrointestinal obstruction, jaundice, opiates use, somatostatin use, fasting hyperglycemia, hypokalemia and hyponatremia are all risk factors for gastric retention in patients with biliopancreatic disease. Comprehensive evaluation and early intervention for patients showing these risk factors are needed.

OBJECTIVE: To explore the genetic and clinical characteristics of near-tetraploidy/tetraploidy karyotype (NT/T) in patients with myelodysplastic syndrome (MDS). METHODS: Cytogenetic findings of 1576 inpatients with primary MDS were retrospective analyzed, among which 9 were diagnosed with NT/T. Clinical data including gender, age, morphology, genetic feature and prognosis were analyzed. RESULTS: The prevalence of MDS patients with NT/T (NT/T-MDS) among all cases was 0.57%. Karyotyping analysis suggested that eight MDS patients had sole NT/T, while the remainder one had a complex karyotype. In addition to the typical morphology of MDS, NT/T-MDS had unique morphology including huge blast, double-nuclear cell and irregular nuclear membrane. One NT/T-MDS patient gave up therapy, and the remaining eight underwent the first course of treatment, albeit with poor prognosis. Only one patient had complete remission, one had partial remission, three had no remission; and three had converted to acute myeloid leukemia. CONCLUSION NT/T-MDS is rare and has unique morphology. Generally, NT/T-MDS patients have poor prognosis. However, NT/T cannot be simply classified as high-risk group, but with consideration whether they have affected particular chromosomal structures as well as other clinical data.
Humans ; Karyotype ; Leukemia, Myeloid, Acute/complications* ; Myelodysplastic Syndromes/pathology* ; Prognosis ; Retrospective Studies ; Tetraploidy

Objective To evaluate a new multiple nucleic acid detection technology-dual amplification assay,for the clinical value in diagnosis of children with upper respiratory tract infection.Methods Samples from 43 patients were tested by dual amplification assay and direct immunofluorescence assay in nasopharyngeal and throat swabs.Seven respiratory tract pathogens were analyzed,included influenzavirus A (FluA),influenzavirus B (FluB),respiratory syncytial virus (RSV),parainfluenzavirus (PIV),adenovirus (Adv),Mycoplasma pneumoniae (Mp) and Chlamydiae pneumoniae (Cpn).In addition,the samples with different result were confirmed by reverse transcription (RT)-nest PCR assay.Results The positive rate of double amplification assay were 53.3％,with 8.8％ multiple infection.Excluding the detection of Mp and Cpn,the positive rate and mulitple infection rate of dual amplification was higher than direct immunofluorescence by 11.1％ and 4.5％ respectively.Eight samples with different result were confirmed the same as the dual amplification result by RT-nest PCR assay.Conclusions The RNA of seven pathogens can be detected simultaneously by dual amplification assay with higher sensitivity and specificity.The dual amplification technology with high clinical application value can provide comprehensive etiological diagnosis information assisting the diagnosis of upper respiratory tract infectious diseases.