Objective:This study investigated the efficacy and safety of denosumab (DENOS) versus zoledronic acid (ZOL) in the bone disease treatment of newly diagnosed multiple myeloma.Methods:The clinical data of 80 patients with myeloma bone disease (MBD) at the Fifth Medical Center of PLA General Hospital between March 1, 2021 and June 30, 2023 were retrospectively reviewed. Eighteen patients with severe renal impairment (SRI, endogenous creatinine clearance rate<30 ml/min) were treated with DENOS, and 62 non-SRI patients were divided into DENOS (30 patients) and ZOL group (32 patients) .Results:Hypocalcemia was observed in 26 (33%) patients, and 22 patients developed hypocalcemia during the first treatment course. The incidence of hypocalcemia in the non-SRI patients of DENOS group was higher than that in the ZOL group [20% (6/30) vs 13% (4/32), P=0.028]. The incidence of hypocalcemia in SRI was 89% (16/18). Multivariate logistic regression analysis revealed that endogenous creatinine clearance rate<30 ml/min was significantly associated with hypocalcemia after DENOS administration ( P<0.001). After 1 month of antiresorptive (AR) drug application, the decrease in the serum β-C-terminal cross-linked carboxy-telopeptide of collagen type I concentrations of SRI and non-SRI patients in the DENOS group were significantly higher than that in the ZOL group (68% vs 59% vs 27%, P<0.001). The increase in serum procollagen type Ⅰ N-terminal propeptide concentrations of patients with or without SRI in the DENOS group were significantly higher than that in the ZOL group (34% vs 20% vs 11%, P<0.05). The level of intact parathyroid hormone in each group increased after AR drug treatment. None of the patients developed osteonecrosis of the jaw and renal adverse events, and no statistically significant differences in the overall response rate, complete remission and stringent complete remission rates were found among the groups ( P>0.05), and the median PFS and OS time were not reached ( P>0.05) . Conclusions:In the treatment of MBD, DENOS minimizes nephrotoxicity and has strong AR effect. Hypocalcemia is a common adverse event but is usually mild or moderate and manageable.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To explore the effect of Manchester pain management model (MPMM) combined with empowerment education nursing intervention on pain and recovery after cesarean section, and to provide reference for promoting recovery after cesarean section.Methods:A quasi-experimental study was conducted. A total of 120 pregnant women who underwent cesarean section in Shanxi Maternal and Child Health Hospital from September 2021 to June 2022 were selected by convenient sampling method and divided into observation group and control group according to the random number table method, with 60 cases in each group. The observation group received nursing intervention based on MPMM combined with empowerment education, while the control group received routine nursing. The degree of pain, postoperative recovery and nursing satisfaction were compared between the two groups.Results:After the intervention, the pain scores of the observation group were (5.13 ± 1.14), (4.17 ± 0.97), (3.56 ± 0.75) and (3.04 ± 0.79) points in the resting state 8, 12, 24 and 48 h after the operation, respectively, which were lower than (6.02 ± 0.81), (5.05 ± 1.08), (4.48 ± 0.82), (3.50 ± 0.95) points of the control group, the differences were statistically significant ( t values were 2.88 to 6.41, all P < 0.05). The pain scores of the observation group at 8, 12, 24 and 48 hours after operation were (6.98 ± 0.72), (6.44 ± 0.76), (5.48 ± 0.91) and (4.50 ± 0.89) points, respectively, which were lower than (7.62 ± 0.69), (7.47 ± 0.94), (6.95 ± 1.23), (6.18 ± 0.93) points of the control group, the differences were statistically significant ( t values were 4.84 to 10.12, all P<0.05). The time of getting out of bed for the first time in the observation group was (24.70 ± 2.53) h, which was lower than (26.32 ± 3.37) h in the control group, and the difference was statistically significant ( t=2.97, P<0.05). The success rate of first breastfeeding in the observation group was 76.7% (46/60), which was higher than 58.3% (35/60) in the control group, and the difference was statistically significant ( χ2=4.60, P<0.05). The overall nursing satisfaction score of the observation group was (8.25 ± 1.39) points, which was higher than (7.73 ± 1.04) points of the control group, and the difference was statistically significant ( t=-2.31, P<0.05). Conclusions:The nursing intervention based on Manchester pain management model combined with empowerment education can effectively reduce the pain after cesarean section, promote postpartum recovery and improve nursing satisfaction, which is worthy of clinical promotion.

Objective To analyze the clinical characteristics,treatment regimens and influencing factors of prognosis of patients with mantle cell lymphoma(MCL).Methods The clinical data of 41 patients with MCL was collected.These patients were initially diagnosed and treated in the Fifth Medical Center of Chinese PLA General Hospital between August 2004 and December 2019.The clinical features,therapeutic efficacy and prognosis-related factors were clarified.Results The median duration of follow-up was 68(1-165)months.The 3-year progression free survival(PFS)and overall survival(OS)were 37.29%and 62.75%respectively.Based on univariate analysis,B symptoms,Eastern Cooperative Oncology Group(ECOG)scores,the mantle cell lymphoma international prognostic index(MIPI),relapse and refractory state and the therapeutic effect were statistically significant for progression free survival.B symptoms,R-chemotherapy and therapeutic effect were statistically significant for overall survival.In multivariate analysis,B symptoms and the MIPI were statistically significant for progression free survival.B symptoms,R-chemotherapy and therapeutic effect were statistically significant for overall survival.There were statistically significant differences in 3-year OS between patients with different MIPI and MIPI-C scores.Conclusion Mantle cell lymphoma mostly occurs in elder males,and is more likely to be detected in late the stage.B symptoms,R-chemotherapy and therapeutic effect are independent prognostic factors for patients with MCL.The MIPI and MIPI-C scores have clinical guidance significance for patient survival.

Objective:This study aimed to evaluate the efficacy and safety of daratumumab as a maintenance treatment after autologous hematopoietic stem cell transplantation (auto-HSCT) in patients with newly diagnosed multiple myeloma (NDMM) .Methods:The clinical data, hematological and renal response, and safety of 15 post-transplant patients with NDMM who had received daratumumab maintenance between May 1, 2022 and June 30, 2023 were retrospectively analyzed.Results:Fifteen patients (11 males and 4 females) with a median age of 58 (41-72) years were included. Thirteen patients did not receive daratumumab during induction therapy and auto-HSCT, 6 patients had renal impairment, and nine patients had high-risk cytogenetics. The median infusion of daratumumab was 12 (6-17) times, and the median duration of maintenance was 6 (1.5-12) months. The treatment efficacy was evaluated in all 15 patients, and daratumumab maintenance therapy increased the rate of stringent complete response from 40% to 60%. The renal response rate and median estimated glomerular filtration rate of six patients with RI-NDMM were also improved. During daratumumab maintenance therapy, the most common hematological grade 3 adverse event (AE) was lymphopenia [4 of 15 patients (26.67%) ], whereas the most common nonhematologic AEs were infusion-related reactions [7 of 15 patients (46.67%) ] and grade 3 pneumonia [5 of 15 patients (33.33%) ]. The five patients with pneumonia were daratumumab naive [5 of 13 patients (38.46%) ], with a median of 8 (6-10) infusions. Among them, the chest computed tomography of three patients showed interstitial infiltrates, and treatment with methylprednisolone was effective. With a median follow-up of 12 months, the 1-year overall survival rate was 93.33%, and only one patient died (which was not related to daratumumab treatment) .Conclusions:Daratumumab was safe and effective as a maintenance agent for post-auto-HSCT patients with NDMM, and AEs were controllable. The most common nonhematologic AE was grade 3 pneumonia, and a less dose-intense maintenance regimen for the first 8 weeks could reduce the incidence of pneumonia.

Objective: To explore the clinical efficacy of spine subtle adjusting manipulation for postpartum low back pain (PLBP). Methods: A total of 76 patients with PLBP were randomized into a control group and a treatment group, with 38 cases in each group. The control group was treated with core muscle strengthening exercises, and the treatment group was treated with spine subtle adjusting manipulation. After 3 weeks of treatment, the clinical efficacy was observed, and the visual analog scale (VAS) score and Oswestry disability index (ODI), and the changes of lumbar Cobb angle and pelvic rotation were compared between the two groups. Results: The total effective rate of the treatment group was 92.1％, and that of the control group was 78.9％. The difference between the two groups was statistically significant (P<0.05). After treatment, the VAS score and ODI in both groups decreased, and the intra-group differences were all statistically significant (P<0.05). There were no intra-group statistical differences in the lumbar Cobb angle or pelvic rotation in the two groups (P>0.05). After treatment, there were no statistical differences in the lumbar Cobb angle or pelvic rotation between the two groups (P>0.05); the VAS score and ODI in the treatment group were significantly lower than those in the control group (P<0.05). Conclusion: Spine subtle adjusting manipulation can effectively relieve the pain for patients with PLBP, and improve their daily activity function.

Objective: To design and prepare a novel bi-specific chimeric antigen receptor (CAR)-T cell targeting both CD20 and CD19 antigen on B lymphocyte surface, and to detect its killing effect on B lymphocyte tumors as well as its treatment efficacy on immunodeficiency B-NSG mouse with leukemia. Methods: Bi-specific CAR molecule of CD20 (human originated)/CD19 (murine originated) scFv was constructed and packaged into lentiviral vector in 293 cells, and then transfected into T lymphocytes from healthy donors to prepare BiCAR-T cells. K562-CD19-GFP cells (with positive CD19 expression), K562-CD20-GFP cells (with positive CD20 expression) and Nalm6-Luc-GFP cells expressing luciferase were constructed as target cells. After being co-incubated with above mentioned targets cells, the cytotoxic effects of BiCAR-T cells on target cells were evaluated via LDH release assay, and the secretion of IFN-γ by BiCAR-T cells was evaluated by ELISA. Nalm6-Luc-GFP cells were used to construct the mouse model of leukemia and BiCAR-T cells were transfused via tail veins; the treatment efficacy of BiCAR-T cells on tumor bearing mice was evaluated with small animal imaging method. Results: After 7 days’incubation, the BiCAR-T cells originated from healthy donors amplified about 20-50 times with a positive rate of 10%~92%, indicating successful preparation of BiCAR-T cells. Under an effector∶target ratio of 10∶1, the killing rates of BiCAR-T cells against Nalm-6, K562-CD19-GFP and K562-CD20-GFP cells were significantly higher than that of control cells [(76.7±7.4)% vs (8.7±2.4)%, (93.3±5.2)% vs (46.7±6.2)%, (51.0±0.8) vs (30.7±0.5)%, all P<0.01]. Compared with control group, BiCAR-T cells co-incubated with Nalm-6 cells also secreted significantly more IFN- γ [(872.7±7.7) vs (101.0±5.3) pg/ml, P<0.01). Animal experiment showed that BiCAR-T cells had significant efficacy on B-NSG mice with leukemia; NSG leukemia mice treated with BiCAR-T cells all lived up to 70 days (till they were mercy killed) and leukemia cells disappeared at about 50 days, while the mice in PBS and T lymphocytes group all died at (19±3) d and (20±1) d, respectively. Conclusion: Bi-specific CAR molecules expressing CD19 and CD20 were successfully designed and BiCAR-T cells were successfully prepared. The BiCAR-T cells can effectively kill CD19 and/or CD20 tumor cells and secret large amounts of IFN-γ after co-incubation with target cells, exerting significant treatment efficacy on B-NSG immunodeficiency mouse with leukemia.

Objective: To explore the therapeutic feasibility of uterus transplantation for uterine infertility. Methods: Retrospective analysis was performed for the diagnosis, treatment and pregnancy course of the first domestic case of uterus transplantation and the relevant literature reviewed. The recipient was a 22-year-old woman with a congenital absence of uterus and vagina. Previously she underwent vaginal reconstruction and the donor was her mother. The specific procedures included donor/recipient screening, ethical argumentation, assisted reproductive technology of obtaining frozen embryos, Vinci robot-assisted uterine procurement, orthotopic replacement & fixation of retrieved uterus, revascularization; immunoregulation & monitoring of transplanted uterine recipient, assisted reproductive technology after transplantation and gestational management. Results: The durations of donor and recipient surgeries were 360 and 530 min respectively. No complications of recipient or donor occurred during the perioperative period. First menstruation occurred at 40 days post-transplantation and regularly thereafter. Pregnancy occurred after embryo transfer at 31 months post-transplantation. No rejection episodes occurred after transplantation or during gestation. Caesarean delivery occurred near gestational week 34. The boy weighed 2000 grams at birth and the mother remained well. Conclusions In conjunctions with literature review, uterine infertility may be treated by modified uterus transplantation. And a new path is paved for healthy pregnancy of women with uterine infertility.

Objective To analyze the application value of high risk human papillomavirus (HR HPV) DNA and thinprep cytolo-gy test(TCT ) detection in screening cervical cancer and to evaluate the clinical significance of their combined detection .Methods A total of 402 cases conducting cervical cancer screening in our hospital from March to May 2016 were selected and performed the HR HPV DNA and TCT detection .Those of suspected cervical lesions were performed the histopathological examination .Then the effects of HR HPV DNA and TCT combined detection were compared according to the pathological results .Results The detection positive rate of female HR HPV DNA was 27 .1% (109/402);abnormal and benign inflammation reaction were detected out in 46 cases of female TCT ,the positive rate was 11 .4% (46/402);in 123 cases of suspected cervical malignant lesion ,32 .5% females(40/123) appeared CIN Ⅰgrade or more lesions by histopathological examination ;the sensitivity of HR HPV DNA and TCT combined detection was higher than that of single detection ,the difference was statistically significant (P<0 .05);the specificity of HR HPV DNA and TCT combined detection was higher than that of HR HPV DNA single detection ,the difference was statistically signifi-cant(P<0 .05) ,but the difference was not statistically significant compared with TCT single detection (P>0 .05) .Conclusion The detection of HR HPV DNA and TCT is a good method for screening of cervical cancer ,the combined detection of HR HPV DNA and TCT can improve the detection rate of cervical precancerous lesion .

Objective To investigate the effect of impulse noise expose on the expression of growth associated protein 43(Gap-43) in inferior colliculus in rat.Methods SPF grade Male SD rats were randomly divided into 5 groups.The normal control group received noise exposure.The model groups received an averange impulse noise exposure of 156 dB SPL with a pulse duration of 0.23 ms, once for 6 s, for 50 times.Auditory brainstem responses (ABRs) were measured before and 3,7,14, and 28 d after noise exposure with tone pips of 2,4,8,16, and 32 kHz, from 20 to 110 dB SPL.Bilateral inferior colliculus of rats in the model groups was collected and treated by immunohistochemical staining.Gap-43 expression of rats in different groups was measured by determining the gray value of inferior immunohistochemical images.Results After noise exposure, ABRs threshold in the model groups were significantly higher than those of in the normal group (P<0.05 or P<0.01).ABRs threshold at 14 and 28 days after noise exposure were significantly lower than 3 days after impulse exposure (P<0.05).Expression of Gap-43 in inferior colliculus was significantly up-regulated in the noise exposed groups compared with the normal group (P<0.05 or P<0.01).Expression of Gap-43 was significantly down-regulated 28 days after noise expose compared with 3 days after noise expose(P<0.05).Conclusion Impulse noise exposure leads to significant elevation of ABR thresholds and up-regulation of Gap-43 expression in inferior colliculus.Impulse noise exposure may induce auditory cortex prominent remodeling.