Objective:To verify the predictive value of the Second Revision of the International Staging System (R2-ISS) in newly diagnosed patients with multiple myeloma (MM) who underwent first-line autologous hematopoietic stem cell transplantation (ASCT) in a new drug era in China.Methods:This multicenter retrospective cohort study enrolled patients with newly diagnosed MM from three centers in China (Beijing Chao-Yang Hospital, Capital Medical University; the First Affiliated Hospital, Sun Yat-Sen University, and the Second Affiliated Hospital of Naval Medical University) from June 2008 to June 2018. A total of 401 newly diagnosed patients with MM who were candidates for ASCT were enrolled in this cohort, all received proteasome inhibitor and/or immunomodulator-based induction chemotherapy followed by ASCT. Baseline and follow-up data were collected. The patients were regrouped using R2-ISS. Progression-free survival (PFS) and overall survival (OS) were analyzed. The Kaplan-Meier method was used to analyze the survival curve and two survival curves were compared using the log-rank test. Cox regression analysis were performed to analyze the relationship between risk factors and survival.Results:The median age of the patients was 53 years (range 25-69 years) and 59.5% (240 cases) were men. Newly diagnosed patients with renal impairment accounted for 11.5% (46 cases). According to Revised-International Staging System (R-ISS), 74 patients (18.5 %) were diagnosed with stage Ⅰ, 259 patients (64.6%) with stage Ⅱ, and 68 patients (17.0%) with stage Ⅲ. According to the R2-ISS, the distribution of patients in each group was as follows: 50 patients (12.5%) in stage Ⅰ, 95 patients (23.7%) in stage Ⅱ, 206 patients (51.4%) in stage Ⅲ, and 50 patients (12.5%) in stage Ⅳ. The median follow-up time was 35.9 months (range, 6-119 months). According to the R2-ISS stage, the median PFS in each group was: 75.3 months for stage Ⅰ; 62.0 months for stage Ⅱ, 39.2 months for stage Ⅲ, and 30.3 months for stage Ⅳ; and the median OS was not reached, 86.6 months, 71.6 months, and 38.5 months, respectively. There were statistically significant differences in PFS and OS between different groups (both P<0.001). Multivariate Cox regression analysis showed that stages Ⅲ and Ⅳ of the R2-ISS were independent prognostic factors for PFS ( HR=2.37, 95% CI 1.30-4.30; HR=4.50, 95% CI 2.35-9.01) and OS ( HR=4.20, 95% CI 1.50-11.80; HR=9.53, 95% CI 3.21-28.29). Conclusions:The R2-ISS has significant predictive value for PFS and OS for transplant-eligible patients with MM in the new drug era. However, the universality of the R2-ISS still needs to be further verified in different populations.

【Objective】 To determine the risk factors of urinary sepsis secondary to minimally invasive percutaneous nephrolithotomy (mPCNL) in patients with negative preoperative urine culture (UC). 【Methods】 A total of 274 patients with negative preoperative UC treated with mPCNL during Jan.2016 and Jun. 2021 were retrospectively analyzed. The incidence of urinary sepsis was observed, and the general data of patients with or without urinary sepsis after mPCNL were compared. logistic regression model was used to analyze the risk factors of urinary sepsis after mPCNL. 【Results】 Urinary sepsis occurred in 11 cases (4.01%). Univariate analysis showed that urinary sepsis was associated with gender, body mass index, stone load, diabetes, urine WBC ≥2+, urinary nitrite, procalcitonin, and operation time. Multivariate logistic regression analysis showed that the independent risk factors of urinary sepsis after mPCNL included diabetes (OR=2.34, 95%CI=1.051-5.43, P=0.037), stone load (OR=7.51, 95%CI=3.17-7.38, P=0.045), urine WBC≥2+ (OR=4.57, 95%CI=6.75-11.38, P=0.032), urinary nitrite positive (OR=6.45, 95%CI=0.93-26.87, P=0.028) and operation time≥120 min (OR=3.53, 95%CI=1.41-8.85, P=0.042). 【Conclusion】 Diabetes, stone load, urinary WBC ≥2+, positive urinary nitrite and operation time ≥120 minutes are the risk factors of urinary sepsis after mPCNL in patients with negative urine culture.

Objective:To investigate the significance of clinical factors combined with transvaginal ultrasound and contrast-enhanced ultrasound(CEUS) in guiding the choice of treatment plan for cesarean scar pregnancy(CSP).Methods:The clinical and transvaginal ultrasound and CEUS data of 120 patients with CSP from January 2016 to June 2021 in the First People′s Hospital of Foshan were retrospectively analyzed, and they were divided into ultrasound-guided curettage/ hysteroscopic group (Group A, 91 cases) and laparoscopic group (Group B, 29 cases) according to treatment option, and the differences in clinical and ultrasound factors between the two groups were compared, and to determine the relevant clinical and ultrasound indicators for the choice of treatment option.Results:There were statistical differences between the 2 groups in comparison of whether the gestational sac/mass protruded toward the plasma membrane, gestational sac/mass diameter, the main blood supply site of the gestational sac/mass, the site of the chorion/early placenta and scar thickness (all P<0.05). Logistic regression analysis indicated that CEUS showing major blood supply site of the gestational sac/mass ( OR=6.029, P=0.003) and uterine scar thickness ( OR=12.998, P=0.002) were independent risk factors for minimally invasive surgery for CSP. Conclusions:Ultrasound combined with clinical factors have a certain value in the selection of treatment options for CPS, and the thickness of the uterine scar and the main blood supply site of the gestational sac/mass showed in CEUS may be key factors affecting the minimally invasive surgical treatment of CSP.

Chimeric antigen receptor T cell (CAR-T) is a kind of adoptive cell immunotherapy, in which T cells are genetically modified to exert targeted killing effect on tumors. CAR-T cell therapy has shown remarkable antitumor efficacy for the treatment of tumors, especially for hematological malignancies, but is less effective in solid tumors. Single-target CAR-T is prone to off-target effect during application, and there is a risk of relapse or more refractory treatment. The development of double-target or multi-target CAR-T is expected to extend the antigen coverage of target cells, effectively avoids antigen escape and prevents tumor recurrence, and prolongs the survival time of patients. This article reviews the advances of multi-target chimeric antigen receptor T cell, and discusses the prospect of its development.

Backgrounds::Inadequate sleep duration is associated with a higher risk of type 2 diabetes and the relationship is nonlinear. We aim to assess the curve relationship between night sleep duration and the incidence of type 2 diabetes in China.Methods::A cohort of 11,539 participants from the REACTION study without diabetes at baseline (2011) were followed until 2014 for the development of type 2 diabetes. The average number of hours of sleep per night was grouped. Incidence rates and odds ratios (ORs) were calculated for the development of diabetes in each sleep duration category.Results::Compared to people who sleep for 7 to 8 h/night, people with longer sleep duration (≥9 h/night) had a greater risk of type 2 diabetes (OR: 1.27; 95% CI: 1.01-1.61), while shorter sleep (<6 h/night) had no significant difference in risk of type 2 diabetes. When the dataset was stratified based on selected covariates, the association between type 2 diabetes and long sleep duration became more evident among individuals <65 years of age, male, body mass index <24 kg/m 2 or with hypertension or hyperlipidemia, no interaction effects were observed. Furthermore, compared to people persistently sleeping 7 to 9 h/night, those who persistently slept ≥9 h/night had a higher risk of type 2 diabetes. The optimal sleep duration was 6.3 to 7.5 h/night. Conclusions::Short or long sleep duration was associated with a higher risk of type 2 diabetes. Persistently long sleep duration increased the risk.

Objective:To investigate the effect of long-term low dose ionizing radiation on the levels of interleukin (IL) and TGF-β1 in the population in high background radiation area(HBRA).Methods:Appropriate amount of peripheral blood was drawn from 41 and 44 healthy men aged 45-65 years who were randomly selected from Tangkou town of Yangjiang city (HBRA) and Hengpo town of Enping city (control area, CA), respectively. After centrifugation and stratification, the upper plasma of blood was separated to determine IL-2, sIL-2R, IL-4, IL-5 and TGF-β1 by using ELISA. The difference of plasma IL of the residents in those two regions was analyzed. The influence of region, age, smoking, drinking and income on the indexes of ILs and TGF-β1 was evaluated by Covariance analysis.Results:The concentration of IL-2 at HBRA area was slightly higher than those in the control area, but the other indexes were lower than those in CA residents. The differences of IL-5 ( t=7.124, P<0.001) and TGF-β1 ( t=4.900, P<0.001) between two areas were significant statistically. Covariance analysis showed that smoking had a significant effect on IL-2 level ( F=5.283, P<0.05). Conclusions:Under the influence of long-term low-dose ionizing radiation, all kinds of plasma interleukin levels of residents in HBRA were different with that in CA. The immune balance was biased towards Th1 type cytokines, and the immune function in HBRA was slightly stronger than that in CA, suggesting that long-term chronic low-dose ionizing radiation may induce adaptive changes in the immune function, which needs further study.

Objective: To explore the recovery time and risk factors of coagulopathy caused by rodenticide poisoning through analyzing and following up the confirmed cases, and to provide more useful guidance information for the clinic practice. Methods: A total of 96 cases with coagulation dysfunction caused by anticoagulant rodenticide poiso-ning in Children′s Hospital, Chongqing Medical University from January 2014 to December 2016, were analyzed retrospectively.The recovery time of coagulation function and the relationship between recovery time and drug involved way, dysfunction organs and poison concentration were studied respectively. Results: (1) A total of 96 patients were hospitalized because of severe coagulopathy caused by the poisoning of second generation anticoagulant rodenticide.Brodifacoum was detected from 33 blood samples and the median concentration was 364 μg/L (55-4 654 μg/L). Bromadiolone was detected from 7 blood samples and the median concentration was 130 μg/L (18-652 μg/L). Brodifacoum and Bromadiolone were both detected from 8 cases and the median concentration was 741 μg/L (63-6 000 μg/L) and 11 μg/L (3-3 694 μg/L), respectively.(2) A total of 57 cases of the patients were successfully followed up.A total of 18 cases were confirmed with oral poisoning, 16 cases with dermal poisoning, while 23 cases denied any involved ways of poisoning, and 7 cases had organs dysfunction.The follow-up time was 12-54 months.All the hospitalized patients were given specific antidote Vitamin K treatment and recovered successfully without any sequelae.(3) The median recovery time of coagulopathy caused by rodenticide poisoning was 2.5 months.(4) The recovery time of coagulation function was positively correlated with the plasma concentration of Brodifacoum(r=0.619, P<0.01). (5) There was no significant correlation between recovery time and organ dysfunction or drug involved ways of poisoning involvement (all P>0.05). Conclusions The recovery time of coagulation dysfunction caused by anticoagulant rodenticide in children is much longer.The higher the concentration of Brodifacoum poison is, the longer the recovery time.Enough supplementation course of Vitamin K should be given according to the follow-up of coagulation function.

Objective To investigate the feasibility and accuracy of transperineal real‐time three‐dimensional ultrasound combined with clinical factors in predicting the risk of female stress urinary incontinence( SUI ) . Methods T hree hundred and forty‐eight female patients with SUI diagnosed were selected as the case group ,and 102 healthy people in the same period were selected as the control group . All subjects underwent transperineal real‐time three‐dimensional ultrasound . T he ultrasonic parameters of resting state ,contraction and Valsalva were measured ,and the clinical parameters such as age ,height , weight ,history of pregnancy and childbirth were collected . According to the time sequence ,all the subjcets were divided into derivation cohort and verification cohort inproportion to 2∶1 ,single factor screening and logistic multiple regression analysis were carried out on 24 factors ,and the risk model was established . T he cut‐off value of the disease probability P was determined by the ROC curve of the subjects ,and then the accuracy of the cut‐off value in predicting SUI was verified in the verification group . Results Single factor analysis showed that 13 parameters were associated with SUI( all P ＜0 .05) . Logit P＝2 .014+1 .870× Z1 was established by multivariate logistic regression analysis . T he cut‐off value of the disease probability P determined by ROC curve was 0 .823 . T he predictive sensitivity of the model was 68 .1% ( 95% CI : 59 .6% －76 .6% ) ,specificity was 91 .2% ( 95% CI :86 .0% －96 .4% ) ,positive predictive value was 64 .3%( 95% CI : 55 .6% － 73 .0% ) and negative predictive value was 92 .5% ( 95% CI : 86 .2% － 98 .8% ) . Conclusions It is feasible to predict the risk of female stress urinary incontinence by transperineal real‐time three‐dimensional ultrasound combined with clinical factors . Although ,some limitations with the prediction model ,it has accuracy in predicting SUI with obvious symptoms .

Objective: To investigate the feasibility and accuracy of transperineal real-time three-dimensional ultrasound combined with clinical factors in predicting the risk of female stress urinary incontinence(SUI). Methods: Three hundred and forty-eight female patients with SUI diagnosed were selected as the case group, and 102 healthy people in the same period were selected as the control group. All subjects underwent transperineal real-time three-dimensional ultrasound. The ultrasonic parameters of resting state, contraction and Valsalva were measured, and the clinical parameters such as age, height, weight, history of pregnancy and childbirth were collected. According to the time sequence, all the subjcets were divided into derivation cohort and verification cohort inproportion to 2∶1, single factor screening and logistic multiple regression analysis were carried out on 24 factors, and the risk model was established. The cut-off value of the disease probability P was determined by the ROC curve of the subjects, and then the accuracy of the cut-off value in predicting SUI was verified in the verification group. Results: Single factor analysis showed that 13 parameters were associated with SUI(all P<0.05). Logit P=2.014+ 1.870×Z₁ was established by multivariate logistic regression analysis. The cut-off value of the disease probability P determined by ROC curve was 0.823. The predictive sensitivity of the model was 68.1% (95%CI: 59.6%-76.6%), specificity was 91.2% (95%CI: 86.0%-96.4%), positive predictive value was 64.3% (95%CI: 55.6%-73.0%) and negative predictive value was 92.5% (95%CI: 86.2%-98.8%). Conclusions It is feasible to predict the risk of female stress urinary incontinence by transperineal real-time three-dimensional ultrasound combined with clinical factors. Although, some limitations with the prediction model, it has accuracy in predicting SUI with obvious symptoms.

Prostate cancer is one of the most common malignant tumors in men and related studies have achieved great breakthrough in recent years.But because of the lack of effective in vivo animal models, the process to translate basic research into clinical application has been severely hampered.Patient derived prostate tumor xenograft ( PDPTX) model is an ideal animal model in which freshly isolated tumor tissues from patients were inoculated into immunodeficient mice.This model can duplicate the heterogeneity of primary tumor in a better way and keep the tumor complexity at molecular, genetic and pathological levels.Particularly, the PDPTX model, in which the isolated tumor tissue is inoculated under the renal capsule, is even better, because it solves the clrawbacks of traditional subcutaneous inoculation model.In traditional mod-els, the success rate is low, it’s not easy for lower grade tumor to form xenograft, and it’s not easy to reconstruct metasta-sis, etc.PDPTX provides a more ideal in vivo model for prostate cancer studies.It has irreplaceable advantages, especially in target therapy, new drug screening and individualized tumor treatment.