Objective:To investigate the clinical efficacy of lenalidomide combined with bortezomib and dexamethasone (RVd) regimen in treatment of newly diagnosed multiple myeloma (NDMM) patients and its effect on the levels of regulatory T cells (Treg cells) and natural killer (NK) cells.Methods:Thirty-eight NDMM patients who were admitted to the Second Affiliated Hospital of Bengbu Medical College from September 2019 to May 2022 were selected for a prospective study, and were divided into control group (18 cases) and observation group (20 cases) according to random number table method. The control group was treated with bortezomib+epirubicin+dexamethasone (VAd) regimen, and the observation group was treated with RVd regimen. The efficacy and safety were compared between the two groups. The levels of Treg cells (CD4 + CD25 + FOXP3 +) and NK cells (CD3 - CD56 + CD16 +) before and after treatment in the two groups were detected by flow cytometry, and the results were compared. Results:After 4 courses of treatment, the objective response rate (ORR) of the observation group was 95.0% (19/20), which was higher than that of the control group [77.8% (14/18)], and the difference was statistically significant ( P = 0.016). Before treatment, there was no statistical difference in the levels of Treg cells and NK cells between the two groups ( P values were 0.381 and 0.650). After treatment, the level of Treg cells in the control group increased from (1.5±0.5)% before treatment to (4.7±1.3)% ( P = 0.008), while the level of Treg cells in the observation group increased from (1.4±0.5)% before treatment to (6.8±1.5)% ( P = 0.001), and the level in the observation group was higher than that in the control group ( P = 0.027); the level of NK cells in the control group increased from (16±6)% before treatment to (20±5)% ( P = 0.004), while the level of NK cells in the observation group increased from (16±6)% before treatment to (24±6)% ( P = 0.006), and the level in the observation group was higher than that in the control group ( P = 0.032). The incidence rates of thrombocytopenia and neutropenia in the observation group were higher than those in the control group, and the differences were statistically significant ( P values were 0.012 and 0.027), which was reversible after active treatment. There was no statistical difference in the incidence rates of other adverse reactions (all P>0.05). Conclusions:RVd regimen for NDMM is clinically effective, safe and reliable, and the patients' levels of Treg cells and NK cells elevate after treatment.

Objective:To evaluate the application value of SPECT lung perfusion imaging in guiding radiotherapy path, optimizing the radiotherapy plan for lung cancer and protecting lung function during radiotherapy for locally advanced non-small cell lung cancer.Methods:In this study, 84 patients with stage Ⅲ non-resectable non-small cell lung cancer were randomly divided into the control group ( n=44) and observation group ( n=40). In the control group, radiotherapy plan based on conventional CT images was delivered, and two plans based on the lung function information suggested by conventional CT and SPECT lung perfusion imaging: P1 and P2 were given in the observation group. All patients in the observation group were finally treated according to the P2 plan. The incidence of radiation pneumonitis, and changes in lung function before and after radiotherapy were statistically compared between two groups. The dose-volume parameters of P1 and P2 were statistically compared. Results:After the plan was optimized, the incidence of radiation pneumonitis in the observation group was significantly reduced and the decline of lung function was significantly improved (both P≤0.001). The functional dose parameters were significantly improved in the P2 plans (both P<0.05), whereas the irradiation dose of organs at risk did not significantly change ( P>0.05). Conclusion:SPECT lung perfusion imaging optimizes the intensity-modulated radiotherapy plan, which can reduce the functional lung dose and increase the tumor radiotherapy dose without increasing the irradiation dose of other organs at risk.

Neuromyelitis optica spectrum disorders (NMOSD) are a severe autoimmune inflammatory demyelinating disease of the central nervous system. NMOSD complicated with immune thrombocytopenia (ITP) is rare. This paper reports a case of NMOSD who was misdiagnosed as multiple sclerosis for many years, and then developed thrombocytopenia. ITP was diagnosed by perfect examination. After immunosuppression and thrombopoiesis therapy, the platelets returned to normal. The review of the case and literatures can help to improve the understanding of this kind of disease, timely diagnose and treat patients, and avoid serious complications.

OBJECTIVE: To analyze the clinical characteristics and genetic basis of a child affected with Glass syndrome. METHODS: Clinical manifestations and auxiliary examination results of the child were analyzed. Potential mutation was detected with next generation sequencing and validated by Sanger sequencing. RESULTS: The child has featured growth and mental retardation, delayed speech, cleft palate, crowding of teeth, and downslanting palpebral fissures. DNA sequencing revealed a de novo heterozygous missense mutation c.1166G>A (p.R389H) in exon 8 of the SATB2 gene in the child. CONCLUSION The heterozygous mutation c.1166G>A (p.R389H) of the SATB2 gene probably account for the Glass syndrome in the patient.
Abnormalities, Multiple ; genetics ; Child ; Chromosome Deletion ; Chromosomes, Human, Pair 2 ; Humans ; Intellectual Disability ; genetics ; Matrix Attachment Region Binding Proteins ; genetics ; Mutation ; Transcription Factors ; genetics

Functional imaging plays an important role in lung cancer radiotherapy.Functional imaging techniques include single photon emission computed tomography,positron emission tomography,magnetic resonance imaging,and computed tomography.Using lung function information provided by these techniques for lung cancer radiotherapy can better protect the normal function of lung tissue,optimize the radiotherapy program,and reduce the incidence of radiation pneumonitis.With the development of perfusion and imaging technology,functional imaging technology is expected to be widely used in the precise radiotherapy of lung cancer in the future.

Objective To investigate the efficacy of real-time visual feedback on improving the quality of manual chest compression in ambulance.Methods Ten pre-hospital doctors with cardiopulmonary resuscitation experience,aged under 40 years,were recruited to this randomized,crossover,manikin research and randomly assigned into control group (n=5) and feedback group (n=5) by the sealed envelope method.The setting place was a moving ambulance with the velocity of 25～50 km/ h.The whole process consisted of two sessions.In control group,which received feedback in the second session,chest compressions were performed without interruption during each of the three 2 min phases per session,resting for 2 min between phases and for 5 min between sessions.In feedback group,which received feedback in the first session,chest compressions were performed without interruption during each of the three 2 min phases per session,resting for 2 min between phases and for 5 min between sessions.Data of compression rate,compression depth,compression detention and compression accuracy rate were collected.Results In control group,the compressions rate was lower and compression detention was shorter during the second session compared with those during the first session [(109.8±±4.7) r/min vs.(121.2± 10.1) r/min,(6.5±2.1) r/min vs.(10.4±2.8) r/min,all P＜0.05],while the compression accuracy rate during the second session was higher than that during the first session [(28.2±±14.3) ％ vs.(16.8±9.9) ％,P＜0.05].There was no significant difference in compression rate between the two sessions in control group;Compression frequency,compression depth,compression detention and compression accuracy rate did not significantly change between the two sessions in feedback group (all P＞0.05).In the whole process,the compression rate was lower and compression detention was shorter in the feedback group compared with the control group [(111.1±5.1) r/min vs.(115.5±9.7) r/min,(6.5±1.8) vs.(8.4±4.6) r/min,all P＜0.05],and the compression accuracy rate in the feedback group was higher than that in the control group[(22.5±13.4) ％ vs.(26.7±16) ％,P＜0.05].There was no significant difference in compression rate between the two groups during whole process (P＞0.05).Conclusions Although real-time visual feed back improved the quality of manual chest compression in ambulances,which demonstrated more reasonable compression rate,less compression detention and higher compression accuracy,the overall quality of reuscitation was still not enough to achieve effective treatment.This implies that more optimal methods are required to transfer the patients suffering cardiac arrest.

Objective To explore the influence of LPS treatment on related molecules in Smads and ERK1/2 signal pathway in pancreatic stellate cell line LTC-14.Methods LTC-14 cells were cultured in vitro, and were treated with LPS at different dose in different time points.Protein expressions of related molecules in Smads pathway and ERK1/2 pathway and α-SMA in LTC-14 Cells were examined by Western blot.Results On Treated LTC-14 cells by 0, 1, 5, 10, 20 and 50 mg/L LPS,protein expressions of Smad3 were 0.15±0.02, 0.37±0.02, 0.44±0.01, 0.46±0.02, 0.372±0.01 and 0.24±0.03;expressions of Smad7 were 0.79±0.05, 0.84±0.02, 0.55±0.03, 0.45±0.03, 0.34±0.02 and 0.92±0.07;p-ERK1/2 levels were 0.48±0.05, 0.74±0.03, 0.72±0.04, 0.89±0.02, 0.81±0.02 and 0.72±0.03;p-cPLA2 levels were 0.15±0.03, 0.30±0.01, 0.31±0.01, 0.30±0.02, 0.28±0.03 and 0.32±0.02;α-SMA levels were 0.56±0.06, 0.62±0.06, 0.54±0.04, 1.03±0.11, 1.39±0.08 and 1.28±0.10.The changes of protein expressions before and after LPS treatment were obvious (all P<0.01).The protein expressions of ERK1/2 were 0.56±0.03, 0.57±0.02, 0.53±0.02, 0.58±0.02, 0.59±0.05 and 0.55±0.04, which did not change obviously along with increased LPS dosages.LTC-14 cells treated with 10 mg/L LPS for 0, 1, 3, 6 and 9 h,the expressions of Smad3 were 0.69±0.05, 0.68±0.07, 1.02±0.14, 1.82±0.0 and 2.04±0.11,those of Smad7 were 2.77±0.10, 1.37±0.08, 1.45±0.14, 0.78±0.09 and 0.63±0.06,those of p-ERK1/2 were 0.16±0.03, 0.32±0.05, 0.79±0.03, 1.50±0.07 and 1.77±0.04,those of p-cPLA2 were 0.15±0.04, 0.32±0.06, 0.63±0.04, 0.95±0.04 and 1.49±0.10,those of α-SMA were 0.84±0.03, 1.26±0.21, 1.81±0.19, 4.28±0.26 and 4.37±0.15, all of which changed obviously as the treatment time increased (P<0.05 or 0.01).The expressions of ERK1/2 were 0.75±0.03, 0.72±0.02, 0.80±0.04, 0.74±0.03 and 0.85±0.09, which did not change obviously as the treatment time increased.Conclusions LPS could upregulate the expression of α-SMA in a time-and dose-dependent way, and activate intracellular Smads and ERK1/2 inflammatory pathways, which may be the potential molecular mechanism of the development of chronic pancreatitis.

OBJECTIVE:To establish a method for the concentration determination of vitamin A(VitA)in human serum,and apply it in healthy volunteers and hepatocirrhosis patients. METHODS:After liquid-liquid extraction,serum sample was deter-mined by HPLC. Using VitA acetic ester as internal standard,the separation was performed on Kromasil C18 column with mobile phase consisted of methanol-water (98∶2,V/V) at the flow rate of 1 ml/min. The wavelength was set at 325 nm,and the column temperature was room temperature. The sample size was 20 μl. RESULTS:The linear range of VitA were 0.012 4-3.210 μg/ml(r=0.997 2,n=5),and the limit of quantification was 0.012 4 μg/ml. Inter-day and intra-day RSD ranged 1.66%-2.97%;sample re-coveries were 98.18%-99.56%;extraction recoveries were 89.59%-91.38%. Average blood concentration of VitA were(0.71±0.08)μg/ml in 24 healthy volunteers and (0.28 ± 0.06)μg/ml in 24 hepatocirrhosis patients. There was statistical significance in average blood concentration of VitA between healthy volunteers and hepatocirrhosis patients in different age groups (P<0.05). CONCLU-SIONS:The method is simple,rapid,sensitive and accurate,and can be used for the concentration determination of VitA in serum of healthy volunteers and hepatocirrhosis patients.

Objective To explore the work experiences of intensive care unit ( ICU) charge nurses in a tertiary hospital of Soochow.Methods Phenomenology method was used to survey 10 ICU nurses of a tertiary hospital by non-structured interview. The data was analyzed by phenomenological analysis. Results Five main themes were found by category analysis, which included: enduring stress, suffering losses, bear negative feedback, upgrade oneself constantly, and achieve self ICU; charge nurse; work experience; qualitative researchvalue in professional nursing care. Conclusions The work experiences of ICU nurses contains the positive aspect and the negative aspect. The research results reveals the development of ICU nurses′ work experience and they expect an improvement of the whole social environment.

Background and purpose:Gestational trophoblastic neoplasm (GTN) is a spectrum of disease arising from trophoblastic cells, and the majority of patients with GTN have favorable outcome because of the sensi-tivity to chemotherapy. While the cure rate for high-risk patients is still 70% to 80% as a result of drug resistance and disease recurrence. This study aimed to evaluate the clinical characteristics and outcome of patients with high-risk GTN.Methods:The clinical records of patients with high-risk GTN treated in Obstetrics and Gynecology Hospital of Fudan University from Jan. 2003 to Jan. 2013 were analyzed and reviewed retrospectively from the aspect of different treatment.Results:Fifty-one patients with high-risk GTN were admitted to this hospital. Among 51 high-risk GTN patients, 46 patients were evaluated retrospectively and 5 patients were excluded for incomplete treatments. Of the 46 patients with high-risk GTN, 27 patients were treated by chemotherapy alone, 19 patients received chemotherapy and adjuvant surgical therapy. Forty-four patients received EMA-CO (VP-16+Act-D+MTX/VCR+CTX) as a ifrst-line chemotherapy, 81.82% (36/44) had complete remission and 8 patients developed resistance to EMA-CO. EMA-EP (VP-16+Act-D+MTX/VP-16+cisplatin) was used as second-line chemotherapy for the 8 patients resistant to EMA-CO, 6 patients (2 underwent adjuvant surgical therapy) achieved remission and 2 patients died as a result of drug-resistance and disease progression. For the remaining 2 patients, one was treated by 5-FU+KSM and pulmonary resection, and the other was treated by MTX for misdiagnosis as ectopic pregnancy and then converted to EMA-CO for the pathological diagnosis of choriocarcinoma after surgery. Both of them achieved complete remission. Ultimately, 95.65% (44/46)patients achieved complete remission. Among the 19 patients who underwent adjuvant surgical therapy, 94.70% (18/19) patients achieved complete remission after chemotherapy and adjuvant surgery, and the remaining one patient died of disease progression.Conclusion:Standard combination chemotherapy is crucial in the treatment of high-risk GTN. The role of adjuvant surgery in the management of high-risk GTN should not be underestimated.