Objective:To analyze the clinical characteristics, treatment response, and prognosis of patients newly diagnosed with immunoglobulin A multiple myeloma (IgA MM), and to ascertain whether the IgA isotype remains a poor prognostic factor in the bortezomib era.Methods:This study retrospectively enrolled 155 patients newly diagnosed with IgA MM and 420 with non-IgA MM admitted to the Department of Hematology, the First Affiliated Hospital of Nanchang University from March 2014 to December 2021. We compared the two groups in terms of their clinical characteristics, prognoses, and progression-free survival (PFS) and overall survival (OS) following different treatment regimens.Results:Compared with the non-IgA group, the IgA group presented with more aggressive clinical features, including a higher proportion of patients with hemoglobin<85 g/L (61.3% vs 51.4%, P=0.035), extramedullary manifestations (20.0% vs 11.4%, P=0.008), and gain/amp (1q21) (48.6% vs 36.7%, P=0.032). Efficacy analysis revealed a lower overall response rate (ORR) in the IgA group than in the non-IgA group (83.2% vs 92.4%, P=0.001). Among patients treated with bortezomib-based regimens, the ORR was 91.2% in the IgA group and 94.8% in the non-IgA group, but the difference was nonsignificant ( P=0.146). Survival analysis showed that the median PFS and OS were significantly shorter in the IgA group compared with the non-IgA group[23.5 (95% CI: 17.4-29.5) months and 48.8 (95% CI: 30.1-67.5) months vs 40.7 (95% CI: 33.8 - 47.6) months and not reached, respectively; P<0.001 and P=0.002]. In the subgroup of patients who received bortezomib-based therapy without subsequent autologous hematopoietic stem cell transplantation (auto-HSCT), the PFS and OS were significantly shorter in the IgA group compared with the non-IgA group[25.4 (95% CI: 18.7-32.1) months and 53.5 (95% CI: 35.4-71.6) months vs 41.0 (95% CI: 33.7-48.3) months and not reached; P=0.001 and P=0.011]. In patients who underwent bortezomib-based induction therapy followed by auto-HSCT, the 1-, 3-, and 5-year OS rates for the IgA group were 96%, 81%, and 81%, respectively, compared with 93%, 89%, and 79% for the non-IgA group, but the difference was nonsignificant ( P=0.758) . Conclusion:In the bortezomib era, IgA MM is still associated with a poorer overall prognosis than non-IgA MM, likely due to its inherent high-risk biological characteristics. Although bortezomib-based regimens effectively improve the treatment response, they fail to completely bridge the survival gap between the two disease isotypes. Therefore, bortezomib-based therapy followed by auto-HSCT may be a key strategy to overcome the poor prognosis of IgA MM, potentially enabling these patients to achieve long-term survival comparable to that of their non-IgA counterparts.

Objective:To analyze the clinical characteristics, treatment response, and prognosis of patients newly diagnosed with immunoglobulin A multiple myeloma (IgA MM), and to ascertain whether the IgA isotype remains a poor prognostic factor in the bortezomib era.Methods:This study retrospectively enrolled 155 patients newly diagnosed with IgA MM and 420 with non-IgA MM admitted to the Department of Hematology, the First Affiliated Hospital of Nanchang University from March 2014 to December 2021. We compared the two groups in terms of their clinical characteristics, prognoses, and progression-free survival (PFS) and overall survival (OS) following different treatment regimens.Results:Compared with the non-IgA group, the IgA group presented with more aggressive clinical features, including a higher proportion of patients with hemoglobin<85 g/L (61.3% vs 51.4%, P=0.035), extramedullary manifestations (20.0% vs 11.4%, P=0.008), and gain/amp (1q21) (48.6% vs 36.7%, P=0.032). Efficacy analysis revealed a lower overall response rate (ORR) in the IgA group than in the non-IgA group (83.2% vs 92.4%, P=0.001). Among patients treated with bortezomib-based regimens, the ORR was 91.2% in the IgA group and 94.8% in the non-IgA group, but the difference was nonsignificant ( P=0.146). Survival analysis showed that the median PFS and OS were significantly shorter in the IgA group compared with the non-IgA group[23.5 (95% CI: 17.4-29.5) months and 48.8 (95% CI: 30.1-67.5) months vs 40.7 (95% CI: 33.8 - 47.6) months and not reached, respectively; P<0.001 and P=0.002]. In the subgroup of patients who received bortezomib-based therapy without subsequent autologous hematopoietic stem cell transplantation (auto-HSCT), the PFS and OS were significantly shorter in the IgA group compared with the non-IgA group[25.4 (95% CI: 18.7-32.1) months and 53.5 (95% CI: 35.4-71.6) months vs 41.0 (95% CI: 33.7-48.3) months and not reached; P=0.001 and P=0.011]. In patients who underwent bortezomib-based induction therapy followed by auto-HSCT, the 1-, 3-, and 5-year OS rates for the IgA group were 96%, 81%, and 81%, respectively, compared with 93%, 89%, and 79% for the non-IgA group, but the difference was nonsignificant ( P=0.758) . Conclusion:In the bortezomib era, IgA MM is still associated with a poorer overall prognosis than non-IgA MM, likely due to its inherent high-risk biological characteristics. Although bortezomib-based regimens effectively improve the treatment response, they fail to completely bridge the survival gap between the two disease isotypes. Therefore, bortezomib-based therapy followed by auto-HSCT may be a key strategy to overcome the poor prognosis of IgA MM, potentially enabling these patients to achieve long-term survival comparable to that of their non-IgA counterparts.

Objective:To explore potential predictors of refractory Mycoplasma pneumoniae pneumonia (RMPP) in early stage. Methods:The prospective multicenter study was conducted in Zhejiang, China from May 1 st, 2019 to January 31 st, 2020. A total of 1 428 patients with fever >48 hours to <120 hours were studied. Their clinical data and oral pharyngeal swab samples were collected; Mycoplasma pneumoniae DNA in pharyngeal swab specimens was detected. Patients with positive Mycoplasma pneumoniae DNA results underwent a series of tests, including chest X-ray, complete blood count, C-reactive protein, lactate dehydrogenase (LDH), and procalcitonin. According to the occurrence of RMPP, the patients were divided into two groups, RMPP group and general Mycoplasma pneumoniae pneumonia (GMPP) group. Measurement data between the 2 groups were compared using Mann-Whitney U test. Logistic regression analyses were used to examine the associations between clinical data and RMPP. Receiver operating characteristic (ROC) curves were used to analyse the power of the markers for predicting RMPP. Results:A total of 1 428 patients finished the study, with 801 boys and 627 girls, aged 4.3 (2.7, 6.3) years. Mycoplasma pneumoniae DNA was positive in 534 cases (37.4%), of whom 446 cases (83.5%) were diagnosed with Mycoplasma pneumoniae pneumonia, including 251 boys and 195 girls, aged 5.2 (3.3, 6.9) years. Macrolides-resistant variation was positive in 410 cases (91.9%). Fifty-five cases were with RMPP, 391 cases with GMPP. The peak body temperature before the first visit and LDH levels in RMPP patients were higher than that in GMPP patients (39.6 (39.1, 40.0) vs. 39.2 (38.9, 39.7) ℃, 333 (279, 392) vs. 311 (259, 359) U/L, both P<0.05). Logistic regression showed the prediction probability π=exp (-29.7+0.667×Peak body temperature (℃)+0.004×LDH (U/L))/(1+exp (-29.7+0.667×Peak body temperature (℃)+0.004 × LDH (U/L))), the cut-off value to predict RMPP was 0.12, with a consensus of probability forecast of 0.89, sensitivity of 0.89, and specificity of 0.67; and the area under ROC curve was 0.682 (95% CI 0.593-0.771, P<0.01). Conclusion:In MPP patients with fever over 48 to <120 hours, a prediction probability π of RMPP can be calculated based on the peak body temperature and LDH level before the first visit, which can facilitate early identification of RMPP.

Objective:To investigate the value of ultrasonography in diagnosis of transposition of great arteries of the fetus at 11-13 + 6 weeks gestation. Methods:A prospective study was conducted on fetuses screened by ultrasound in the first trimester in Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region between January 2015 and March 2022. Fetal heart structure was screened by three-section screening method. Fetuses with suspected transposition of the great arteries at 11-13 + 6 weeks gestation underwent followed-up ultrasound examination, chromosome and gene test results. The ultrasound characteristics and prognosis pregnancy outcomes were summarized. Results:Twenty-one cases of transposition of the great arteries were detected by ultrasonography, including complete transposition of great arteries (20 cases) and congenitaly corrected transposition of the great arteries (1 case). Two cases were miss diagnosed. Twenty-one cases showed parallel signs of two major arteries on grayscale outflow section at 11-13 + 6 weeks gestation. There were 6 cases with aneuploid ultrasonographic soft markers abnormality, 2 cases with extracardiac malformation. Chromosome and microarray analysis were performed in 13 cases. 4 cases with chromosomal abnormality. Four cases of chromosomal abnormalities were associated with ultrasonographic soft markers abnormality, and 1 case with extracardiac malformation.In the 23 cases, 20 cases were induced, 1 miscarried, and 2 delivered to term. Among the fetuses delivered at term, 1 case died before neonatal operation and 1 case survived. Conclusions:Standardized ultrasound scan at 11-13 + 6 weeks has high accuracy in diagnosis of transposition of the great arteries. And the incidence of chromosomal abnormality is high with ultrasonographic soft markers abnormality or extracardiac malformation.

Objective　To explore the mechanism of apolipoprotein E （ApoE） affecting the expression of matrix metalloproteinase-9 （MMP-9） in astrocytes. Methods　（1） Astrocytes in wild-type （WT） and ApoE gene knockout （ApoE-/-） C57BL / 6J suckling mice were cultured in vitro；glial fibrillary acidic protein （GFAP） antibody were employed to identified the astrocytes. （2） Astrocytes from wild type WT and ApoE-/- C57BL/6J suckling mice were divided into blank control group（Control group），negative control group（NC group） and p65 gene knock down group（KD group）. No lentivirus was added to the Control group. The negative control lentivirus was added to the NC group，and the positive lentivirus that silended the p65 gene was added to the KD group. The nuclear factor-κB （NF-κB） p65 gene of astrocytes was silenced with siRNA lentivirus to inhibit NF-κB signal transduction. The expression of p65 protein was detected by Western blot，and MMP-9 and tumor necrosis factor-α（TNF-α） were detected by ELISA. （3）Add TNF-α to stimulate the astrocytes of each group for 24 hours，and the concentration of MMP-9 in each group of astrocytes before and after stimulation was measured by ELISA. Results　（1） The expression of NF-κB p65 protein and the concentrations of MMP-9 and TNF-α in the two astrocytes in the KD group were significantly lower than those in the Control group and the NC group （P<0.05），but those between the Control group and the NC group were no significant different（P>0.05）；（2） The concentration of MMP-9 and TNF-α of ApoE-/- astrocytes were higher than WT astrocytes in the Control group and NC groups （P<0.05），while those was no significant difference between ApoE-/- astrocytes and WT astrocytes in KD group （P>0.05）；（3） The concentrations of MMP-9 of the two types of astrocytes in Control group and NC group was increased after the stimulation of TNF-α（P<0.05），while the concentration of MMP-9 in the KD group had no significant change（P>0.05）. Conclusion　ApoE may affect the expression of MMP-9 in astrocytes through the TNF-α/NF-κB signaling pathway，and then affects the integrity of the blood-brain barrier.

Objective To explore the perception and evaluation of patients with somatic symptom disorder about their own diseases and treatment,and to provide theoretical basis for design of illness percep-tion questionnaire for patients with somatic symptoms disorder. Methods A semi-structured interview was conducted among 15 initial and untreated patients with somatic symptom disorder using the descriptive quali-tative study. The data were sorted,encoded,classified,summarized and refined using MAXQDA10 software. Results Three main themes and six sub-themes of illness perception in patients with somatic symptom dis-order were analyzed and sorted out:(1) symptom recognition:including three sub-themes,low understanding of the disease and denial of somatic symptoms as mental illness;(2)drug taking concerns:including two sub-themes worrying about side effects of drugs,drug addiction and having difficulty to stick to the long-term reg-ular medication;(3)emotional reaction:including the obvious negative emotions of depression and helpless-ness sub-theme. Conclusion Patients with somatic symptom disorder have a general bias in illness percep-tion,which has a potential adverse effect on treatment compliance. Therefore,it is necessary for clinical med-ical staff to early estimate patients’illness perception,and carry out mental health education and rational e-motional behavior therapy.

Objective: To explore the perception and evaluation of patients with somatic symptom disorder about their own diseases and treatment, and to provide theoretical basis for design of illness perception questionnaire for patients with somatic symptoms disorder. Methods: A semi-structured interview was conducted among 15 initial and untreated patients with somatic symptom disorder using the descriptive qualitative study. The data were sorted, encoded, classified, summarized and refined using MAXQDA10 software. Results: Three main themes and six sub-themes of illness perception in patients with somatic symptom disorder were analyzed and sorted out: (1) symptom recognition: including three sub-themes, low understanding of the disease and denial of somatic symptoms as mental illness; (2)drug taking concerns: including two sub-themes worrying about side effects of drugs, drug addiction and having difficulty to stick to the long-term regular medication; (3)emotional reaction: including the obvious negative emotions of depression and helplessness sub-theme. Conclusion Patients with somatic symptom disorder have a general bias in illness perception, which has a potential adverse effect on treatment compliance. Therefore, it is necessary for clinical medical staff to early estimate patients’illness perception, and carry out mental health education and rational emotional behavior therapy.

Objective To investigate the effects of apolipoprotein E (ApoE) deficiency on neuromyelitis optica (NMO) model of spinal cord sections induced by NMO-IgG and complement in vitro.Methods NMO-IgG was extracted from the patients with NMO,and complementary serum from healthy people.The spinal cord sections of seven days old C57BL / 6J mice with wild type (WT) or ApoE knockout (ApoE-/-) were cultured for seven days.The spinal cords of the two genotypes were randomly divided into experimental groups (NMO-ApoE-/-group,NMO-WT group) and control groups (C-AopE-/-group,C-WT group),respectively.The experimental groups were treated with NMO-IgG and complementary serum,and the control groups only with complementary serum.Then all the sections were continued incubating for 24 h before harvested.Immunofluorescence staining and modified thick tissue film immunofluorescence were used to detect the expression of aquaporin 4 (AQP4),glial fibrillary acidic protein (GFAP),ionic calcium fibronectin (IBA1),myelin basic protein (MBP) and human neurofilament protein L (NFL) respectively.The lesion score was calculated according to the areas percentage of AQP4 and GFAP deficiency in spinal cord sections.Results Compared with the respective control groups,the expressions of AQP4,GFAP,MBP and NFL were deficient in the experimental groups (The percentages of missing area in the NMO-ApoE-/-group were 83.88％ ± 5.01％,82.44％ ± 6.11％,45.02％ ± 5.11％ and 54.65％ ± 7.66％ respectively,while the percentages of missing area in the C-ApoE-/-group were 10.44％ ± 4.07％,5.73％ ±0.82％,9.12％ ±1.41％ and 5.72％ ±0.81％,t=34.143,37.269,20.300,19.051,allP ＜0.05;The percentages of missing area in the NMO-WT group were 77.74％ ± 6.75％,75.62％ ± 5.76％,37.60％ ± 4.88％ and 46.29％ ± 4.98％,while the percentages of missing area in the C-WT group were 9.31％ ± 2.97％,5.80％ ± 0.82％,9.10％ ± 1.63％,5.80％ ± 0.81％ respectively,t =27.828,35.934,16.613,24.057,all P ＜ 0.05).While IBA1 was up-regulated and the damage scores were higher in both the NMO-ApoE-/-group and the NMO-WT group.The percentages of missing area in the NMO-ApoE-/-group and the NMO-WT group showed statistically significant difference (t =2.194,2.436,3.149,2.746,all P ＜ 0.05).The expression level of IBA1 in the NMO-WT group was higher than that in the C-WT group (19.88 ± 1.11 vs 11.18 ±0.65,t =25.270,P ＜0.05),while the expression level of IBA1 in the NMO-ApoE-/-group was higher than that in the NMO-WT group (25.81 ± 1.61 vs 19.88 ± 1.11,t =9.101,P ＜0.05).The degree of deficiency or up-regulation of above-mentioned proteins was more obvious in the NMO-ApoE-/-group than that in the NMO-WT group.Conclusions NMO-IgG extracted from NMO patients can induce NMO-like damage in isolated tissue at the presence of complement.ApoE deficiency promotes the further activation of microglia,thereby aggravates the injury of astrocyte in the model of NMO.

Objective To discuss our drug clinical trial institution's experience and findings during the process of establishing drug clinical trial central pharmacy.Methods Analyze the previous key issues identified during the drug management under different modes,discuss the necessity and feasibility of establishing drug clinical trial central pharmacy.Meanwhile,discuss the planning and construction of hardware including location site of the central pharmacy,equipment and facilities,staff,as well as software such as electronic management system and standard operation procedures.Results After the adoption of central trial pharmacy,space and energy are saved,manpower and material resources are saved,the quality of clinical trials also improved.Conclusions Standardized and unified management of investigational drugs through establishing drug clinical trial central pharmacy,is the strong guarantee for the drug safety of human subject,as well as the accuracy and scientificity of trial results.

Objective To explore the effect of security,self-acceptance,self-concept,intemet addiction,anxiety,depression on the suicidal ideation of internet addiction patients.Methods The safety,self-acceptance,self-concept,internet addiction,anxiety and depression of 220 internet addiction patients were assessed using the corresponding scale tools.Suicidal ideation was used as the dependent variable,and each influencing factor was used as the independent variable.Correlation analysis,multiple stepwise regression analysis and path analysis were utilized to analyze the predisposing factors.Results The suicidal ideation (12.65 ±5.72) was positively correlated with internet addiction assessment (73.35± 15.83),depression self-evaluation (56.33± 13.75) and anxiety self-assessment (48.93± 17.20) (r=0.250,0.636,0.531,P＜ 0.01),while negatively correlated with security (50.26± 12.33),self-acceptance (38.29±7.15),and self-concept (56.47± 17.92) (r=-0.390,-0.297,-0.298,P＜ 0.01).Sequentially depression (β =0.571,P＜ 0.01),anxiety (β =0.173,P=0.003) were entered into the multiple regression equation.Path analysis based on the structural equation model showed that suicidal ideation had a direct effect with depression and anxiety,with effect values of 0.583 and 0.176.There were indirect effects of self-concept,self-acceptance,sense of security,and internet addiction assessment.The effect values were-0.137,-0.117,-0.281,and 0.034.The total effect of suicidal ideation and self-concept,self-acceptance,sense of security,internet addiction,depression self-assessment,and anxiety self-assessment were-0.137,-0.117,-0.281,0.034,0.583 and 0.176 respectively.Conclusions The influence of security,self-acceptance,and self-concept on suicidal ideation is produced through the mediating effects of depression and anxiety,and it has a negative predictive effect.There is no direct causal relationship between internet addiction and suicidal ideation.