来那度胺联合自体造血干细胞移植治疗POEMS综合征1例及文献复习

POEMS综合征(POEMS syndrome)是一种罕见的克隆性浆细胞病,Bardwick等[1]于1980年根据该疾病主要症状的首字母:多发性神经病(polyneuropathy)、脏器肿大(organmegaly)、内分泌异常(endocrinopathy)、M蛋白(mprotein)、皮肤改变(skin changes),提出了POEMS综合征的命名方式。POEMS综合征的临床表现复杂,涉及多个学科,并且没有特定的检查方法,所以POEMS综合征早期容易漏诊或误诊。该病发病机制尚不清,可能与细胞因子失衡相关。

Morphological and biochemical characteristics associated with autophagy in gastrointestinal diseases

Autophagy is a cellular catabolic process characterized by the formation of double-membrane autophagosomes.Transmission electron microscopy is the most rigorous method to clearly visualize autophagic engulfment and degradation.A large number of studies have shown that autophagy is closely related to the digestion,secretion,and regeneration of gastrointestinal(GI)cells.However,the role of autophagy in GI diseases remains controversial.This article focuses on the morphological and biochemical characteristics of autophagy in GI diseases,in order to provide new ideas for their diagnosis and treatment.

Clinical characteristics of acute non-varicose upper gastrointestinal bleeding and the effect of endoscopic hemostasis

BACKGROUND Acute non-variceal upper gastrointestinal bleeding(ANVUGIB)constitutes a prevalent emergency within Gastroenterology,encompassing 80%-90%of all gastrointestinal hemorrhage incidents.This condition is distinguished by its abrupt onset,swift progression,and notably elevated mortality rate.AIM To gather clinical data from patients with ANVUGIB at our hospital in order to elucidate the clinical characteristics specific to our institution and analyze the therapeutic effectiveness of endoscopic hemostasis.METHODS We retrospectively retrieved the records of 532 patients diagnosed with ANVUGIB by endoscopy at our hospital between March 2021 and March 2023,utilizing our medical record system.Data pertaining to general patient information,etiological factors,disease outcomes,and other relevant variables were meticulously collected and analyzed.RESULTS Among the 532 patients diagnosed with ANVUGIB,the male-to-female ratio was 2.91:1,with a higher prevalence among males.Notably,43.6%of patients presented with black stool as their primary complaint,while 27.4%had hematemesis as their initial symptom.Upon admission,17%of patients exhibited both hematemesis and black stool,while most ANVUGIB patients primarily complained of overt gastrointestinal bleeding.Urgent routine blood examinations at admission revealed that 75.8%of patients had anemia,with 63.4%experiencing moderate to severe anemia,and 1.5%having extremely severe anemia(hemoglobin<30 g/L).With regard to etiology,53.2%of patients experienced bleeding without a definitive trigger,24.2%had a history of using gastric mucosa-irritating medications,24.2%developed bleeding after alcohol consumption,2.8%attributed it to improper diet,1.7%to emotional excitement,and 2.3%to fatigue preceding the bleeding episode.Drug-induced ANVUGIB was more prevalent in the elderly than middle-aged and young individuals,while bleeding due to alcohol consumption showed the opposite trend.Additionally,diet-related bleeding was more common among the young age group compared to the middle-aged group.Gastrointestinal endoscopy identified peptic ulcers as the most frequent cause of ANVUGIB(73.3%),followed by gastrointestinal malignancies(10.9%),acute gastric mucous lesions(9.8%),and androgenic upper gastrointestinal bleeding(1.5%)among inpatients with ANVUGIB.Of the 532 patients with gastrointestinal bleeding,68 underwent endoscopic hemostasis,resulting in an endoscopic treatment rate of 12.8%,with a high immediate hemostasis success rate of 94.1%.

Grain Yield,Biomass Accumulation,and Leaf Photosynthetic Characteristics of Rice under Combined Salinity-Drought Stress

Simultaneous stresses of salinity and drought often coincide during rice-growing seasons in saline lands,primarily due to insufficient water resources and inadequate irrigation facilities.Consequently,combined salinity-drought stress poses a major threat to rice production.In this study,two salinity levels(NS,non-salinity;HS,high salinity)along with three drought treatments(CC,control condition;DJ,drought stress imposed at jointing;DH,drought stress imposed at heading)were performed to investigate their combined influences on leaf photosynthetic characteristics,biomass accumulation,and rice yield formation.Salinity,drought,and their combination led to a shortened growth period from heading to maturity,resulting in a reduced overall growth duration.Grain yield was reduced under both salinity and drought stress,with a more substantial reduction under the combined salinity-drought stress.The combined stress imposed at heading caused greater yield losses in rice compared with the stress imposed at jointing.Additionally,the combined salinity-drought stress induced greater decreases in shoot biomass accumulation from heading to maturity,as well as in shoot biomass and nonstructural carbohydrate(NSC)content in the stem at heading and maturity.However,it increased the harvest index and NSC remobilization reserve.Salinity and drought reduced the leaf area index and SPAD value of flag leaves and weakened the leaf photosynthetic characteristics as indicated by lower photosynthetic rates,transpiration rates,and stomatal conductance.These reductions were more pronounced under the combined stress.Salinity,drought,and especially their combination,decreased the activities of ascorbate peroxidase,catalase,and superoxide dismutase,while increasing the contents of malondialdehyde,hydrogen peroxide,and superoxide radical.Our results indicated a more significant yield loss in rice when subjected to combined salinity-drought stress.The individual and combined stresses of salinity and drought diminished antioxidant enzyme activities,inhibited leaf photosynthetic functions,accelerated leaf senescence,and subsequently lowered assimilate accumulation and grain yield.

Investigation of hydroxyl-terminated polybutadiene propellant breaking characteristics and mechanism impacted by submerged cavitation water jet

A submerged cavitation water jet(SCWJ)is an effective method to recycle solid propellant from obsolete solid engines by the breaking method.Solid propellant's breaking modes and mechanical process under SCWJ impact are unclear.This study aims to understand those impact breaking mechanisms.The hydroxyl-terminated polybutadiene(HTPB)propellant was chosen as the research material,and a self-designed test system was used to conduct impact tests at four different working pressures.The high-speed camera characterized crack propagation,and the DIC method calculated strain change during the impact process.Besides,micro and macro fracture morphologies were characterized by scanning electron microscope(SEM)and computed tomography(CT)scanning.The results reveal that the compressive strain concentration region locates right below the nozzle,and the shear strain region distributes symmetrically with the jet axis,which increases to 4% at first 16th ms,the compressive strain rises to 2% and 6% in the axial and transverse direction,respectively.The two tensile cracks formed first at the compression strain concentrate region,and there generate many shear cracks around the tensile cracks,and those shear cracks that develop and aggregate cause the cracks to become wider and cut through the tensile cracks,forming the tensile-shear cracks and the impact parts eventually fail.The HTPB propellant forms a breaking hole shaped conical after impact 10 s.The mass loss increases by 17 times at maximum,with the working pressure increasing by three times.Meanwhile,the damage value of the breaking hole remaining on the surface increases by 7.8 times while 2.9 times in the depth of the breaking hole.The breaking efficiency is closely affected by working pressures.The failure modes of HTPB impacted by SCWJ are classified as tensile crack-dominated and tensile-shear crack-dominated damage mechanisms.

Liquefaction susceptibility and deformation characteristics of saturated coral sandy soils subjected to cyclic loadings-a critical review

Coral sandy soils widely exist in coral island reefs and seashores in tropical and subtropical regions.Due to the unique marine depositional environment of coral sandy soils,the engineering characteristics and responses of these soils subjected to monotonic and cyclic loadings have been a subject of intense interest among the geotechnical and earthquake engineering communities.This paper critically reviews the progress of experimental investigations on the undrained behavior of coral sandy soils under monotonic and cyclic loadings over the last three decades.The focus of coverage includes the contractive-dilative behavior,the pattern of excess pore-water pressure(EPWP)generation and the liquefaction mechanism and liquefaction resistance,the small-strain shear modulus and strain-dependent shear modulus and damping,the cyclic softening feature,and the anisotropic characteristics of undrained responses of saturated coral sandy soils.In particular,the advances made in the past decades are reviewed from the following aspects:(1)the characterization of factors that impact the mechanism and patterns of EPWP build-up;(2)the identification of liquefaction triggering in terms of the apparent viscosity and the average flow coefficient;(3)the establishment of the invariable form of strain-based,stress-based,or energy-based EPWP ratio formulas and the unique relationship between the new proxy of liquefaction resistance and the number of cycles required to reach liquefaction;(4)the establishment of the invariable form of the predictive formulas of small strain modulus and strain-dependent shear modulus;and(5)the investigation on the effects of stress-induced anisotropy on liquefaction susceptibility and dynamic deformation characteristics.Insights gained through the critical review of these advances in the past decades offer a perspective for future research to further resolve the fundamental issues concerning the liquefaction mechanism and responses of coral sandy sites subjected to cyclic loadings associated with seismic events in marine environments.

变异型POEMS综合征1例并文献复习

POEMS综合征是一种罕见的综合征,1980年由Bardwick及其同事首次提出。近期,青海大学附属医院血液科诊断变异型POEMS综合征1例,现报告如下1病例资料患者,男,53岁,于1年前无明显诱因发现双侧乳房大小略增,体毛增多变硬,性功能减退.

不典型POEMS综合征1例报告并文献复习

POEMS综合征是一种罕见的由单克隆浆细胞异常增殖导致的副肿瘤综合征,主要表现为脱髓鞘性周围神经病及多系统受累。Bardwick等于1980年根据该疾病主要症状的首字母:多发性神经病、脏器肿大、内分泌异常、M蛋白、皮肤改变,提出了POEMS综合征的命名方式[1-2]。日本在2003年的全国范围调查,其发病率大约为0.3/100000[3]。其发病率低,已被列入我国首批罕见病目录。由于其罕见性、多系统受累和临床高度异质性,有着较高的误诊率和漏诊率,从发病至诊断中位时间约为12个月[4-5]。POEMS综合征患者临床症状不典型国内少有相关文献报道,本研究报道1例POEMS综合征患者资料(患者及家属表示知情同意),同时对该病文献进行复习学习,以期为POEMS综合征患者的治疗提供临床指导和参考。

Low-temperature characteristicsof rubbers and performance testsof type 120 emergencyvalve diaphragms

Purpose–The type 120 emergency valve is an essential braking component of railway freight trains,butcorresponding diaphragms consisting of natural rubber(NR)and chloroprene rubber(CR)exhibit insufficientaging resistance and low-temperature resistance,respectively.In order to develop type 120 emergency valverubber diaphragms with long-life and high-performance,low-temperatureresistant CR and NR were processed.Design/methodology/approach–The physical properties of the low-temperature-resistant CR and NRwere tested by low-temperature stretching,dynamic mechanical analysis,differential scanning calorimetryand thermogravimetric analysis.Single-valve and single-vehicle tests of type 120 emergency valves werecarried out for emergency diaphragms consisting of NR and CR.Findings–The low-temperature-resistant CR and NR exhibited excellent physical properties.The elasticityand low-temperature resistance of NR were superior to those of CR,whereas the mechanical properties of thetwo rubbers were similar in the temperature range of 0℃–150℃.The NR and CR emergency diaphragms metthe requirements of the single-valve test.In the low-temperature single-vehicle test,only the low-temperaturesensitivity test of the NR emergency diaphragm met the requirements.Originality/value–The innovation of this study is that it provides valuable data and experience for futuredevelopment of type 120 valve rubber diaphragms.

达雷妥尤单抗联合方案治疗POEMS综合征1例并文献复习

POEMS(polyneuropathy,organomegaly,endocrinopathy,M-protein and skin changes)综合征是一种单克隆浆细胞异常增殖的副肿瘤综合征,患病率约为0.3/10万[1]。该病累积神经、内分泌、骨骼、免疫及造血等系统,临床上诊断需要2个基本要素:多发性周围神经病和单克隆浆细胞病[2]。周围神经病变是超过60%的POEMS综合征患者的首发症状,不少患者早期就诊于神经内科并被误诊为慢性炎性脱髓鞘性多发性神经根神经病(chronic inflammatory demyelinating polyneuropathy,CIDP)等原发性神经系统疾病[3]。由于神经病变进展缓慢、致残率高,多数患者就诊时症状严重且已造成神经不可逆性损伤,给患者生活带来极大不便,因此早识别、早诊断、及时治疗至关重要。本文报告1例采用达雷妥尤单抗(Daratumumab,Dara)联合方案治疗伴有严重周围神经病变的POEMS综合征,分析了神经病变的发病机制,并强调了POEMS综合征诊断的复杂性以及Daratumumab作为新一代药物在治疗中的潜在优势。

Reservoir characteristics and formation model of Upper Carboniferous bauxite series in eastern Ordos Basin,NW China

Through core observation,thin section identification,X-ray diffraction analysis,scanning electron microscopy,and low-temperature nitrogen adsorption and isothermal adsorption experiments,the lithology and pore characteristics of the Upper Carboniferous bauxite series in eastern Ordos Basin were analyzed to reveal the formation and evolution process of the bauxite reservoirs.A petrological nomenclature and classification scheme for bauxitic rocks based on three units(aluminum hydroxides,iron minerals and clay minerals)is proposed.It is found that bauxitic mudstone is in the form of dense massive and clastic structures,while the(clayey)bauxite is of dense massive,pisolite,oolite,porous soil and clastic structures.Both bauxitic mudstone and bauxite reservoirs develop dissolution pores,intercrystalline pores,and microfractures as the dominant gas storage space,with the porosity less than 10% and mesopores in dominance.The bauxite series in the North China Craton can be divided into five sections,i.e.,ferrilite(Shanxi-style iron ore,section A),bauxitic mudstone(section B),bauxite(section C),bauxite mudstone(debris-containing,section D)and dark mudstone-coal section(section E).The burrow/funnel filling,lenticular,layered/massive bauxite deposits occur separately in the karst platforms,gentle slopes and low-lying areas.The karst platforms and gentle slopes are conducive to surface water leaching,with strong karstification,well-developed pores,large reservoir thickness and good physical properties,but poor strata continuity.The low-lying areas have poor physical properties but relatively continuous and stable reservoirs.The gas enrichment in bauxites is jointly controlled by source rock,reservoir rock and fractures.This recognition provides geological basis for the exploration and development of natural gas in the Upper Carboniferous in the study area and similar bauxite systems.

以肾上腺功能减退为首发表现的POEMS综合征1例报道并文献复习

老年男性患者,无明显诱因出现乏力、纳差,并进行性加重,伴双下肢水肿,入院检查存在多发性神经病,缺乏单克隆浆细胞证据,存在Castleman病及VEGF升高,有淋巴结增大、皮肤色素沉积、浆膜腔积液及肾上腺皮质功能减退,可诊断为变异型POEMS综合征。这个患者以肾上腺皮质功能减退为首发及突出表现,较少见,故对POEMS综合征的内分泌病变发病机制进行文献复习。

POEMS综合征1例报道并文献复习

目的对POEMS综合征的临床特征及治疗进行总结,以提高临床对该病的诊疗能力。方法对广东医科大学附属医院收治的1例POEMS综合征患者的临床表现、相关辅助检查结合既往文献复习进行分析。结果本例患者以四肢麻木、无力起病,逐渐出现肢体水肿、器官肿大、皮肤色素沉着等症状,曾查M蛋白阴性,历时5 a方确诊。结论POEMS综合征临床表现多样,早期极易误诊,临床应提高对该病的认识,从而降低误诊率及漏诊率。

Adsorption,in vitro digestion and human gut microbiota regulation characteristics of three Poria cocos polysaccharides

Poria cocos(PC)is a famous traditional Chinese medicine(TCM)and a widely used healthcare ingredient,which has antiobesity,enhancing immunity and improving sleep effects.Traditionally,only water-soluble poria polysaccharide(WSP)is extracted and applied for clinical application,while insoluble polysaccharide(alkali-soluble poria polysaccharide,ASP)is discarded as herb residue.However,the whole PC has also been historically utilized as functional herbal food.Considering the beneficial role of dietary fiber and the traditional use of PC,ASP may also contribute substantially to the therapy function of PC.Compared to WSP,little attention has been paid to ASP and ASP modified product carboxymethyl poria polysaccharide(CMP)which has been used as an antitumor adjuvant drug.In this study,the oil,cholesterol,metal ions and polyphenols adsorption ability,in vitro simulated digestive and the gut microbiota fermentation characteristics of WSP,ASP and CMP were studied to evaluate the functional values of three P.cocos polysaccharides(PCPs).The results showed that all three PCPs had good adsorption capacity on cholesterol,polyphenols and metal ions(Cd^(2+)/Zn^(2+)/Mg^(2+)),among which ASP showed the highest capacity than WSP and CMP.The adsorption capacity of all three PCPs on heavy metal ions(Cd^(2+)/Zn^(2+))was stronger than that of non-heavy metal ions(Mg^(2+));The in vitro digestibility of all three PCPs was very low,but WSP was slightly higher than ASP and CMP;Moreover,the indigestible residue of all three PCPs could improve the richness and diversity of gut microbiota,among which ASP had the greatest influence.In general,ASP and CMP could significantly promote the proliferation of some probiotics and inhibit the growth of some harmful bacteria.The gut microbiota diversity of CMP was reduced,but the richness of probiotics,especially Parabacteroides distasonis was significantly enhanced compared with the ASP group,and the growth of harmful bacteria Klebsiella pneumoniae was inhibited after CMP treatment.The short-chain fatty acids(SCFAs)analysis results showed that all three PCPs could significantly promote the production of acetic acid,propionic acid and the total acid content compared with blank control group,and SCFAs producing activity was positively correlated with the proliferative capacity of probiotics.Taken together,the good adsorption characteristics and gut microbiota regulatory activity of ASP may lay foundation for its lipid-lowering and immune-improving function.Additionally,the probiotic effect of CMP and ASP indicated that except for only use the water extract of PC in clinic,CMP and ASP also can be used in healthcare to take full advantage of this valuable medicine.

Gravel hardness effect on compaction characteristics of gravelly soil

The compaction characteristics of gravelly soil are affected by gravel hardness.To investigate the evolution and influencing mechanism of different gravel hardness on the compaction characteristics of gravelly soil,heavy compaction tests and crushing tests were conducted on gravelly soils with gravels originated from hard,soft and extremely soft rocks.According to orthogonal experiments and variance analysis,it was found that hardness has a significant impact on the maximum dry density of gravelly soil,followed by gravel content,and lastly,moisture content.For gravel compositions with an average saturated uniaxial compressive strength less than 60 MPa,the order of compacted maximum dry density is soft gravels>hard gravels>extremely soft gravels.Each type of gravelly soil has a threshold for gravel content,with 60%for hard and soft gravels and 50%for extremely soft gravels.Beyond these thresholds,the compacted dry density decreases significantly.There is a certain interaction between hardness,gravel content,and moisture content.Higher hardness increases the influence of gravel content,whereas lower hardness increases the influence of moisture content.Gravelly soils with the coarse aggregate(CA)between 0.7 and 0.8 typically achieve higher dry densities after compaction.In addition,the prediction equations for the particle breakage rate and CA ratio in the Bailey method were proposed to estimate the compaction performance of gravelly soil preliminarily.The results further revealed the compaction mechanism of different gravelly soils and can provide reference for subgrade filling construction.

Molecular Epidemiology and Clinical Characteristics of Hand, Foot and Mouth Disease in North Sichuan Region, China, 2018-2023: A Descriptive Study

Background: Hand, foot and mouth disease (HFMD) remains an important public health problem in China. Many studies on the epidemiological characteristics of HFMD have been reported, but studies in North Sichuan region have been neglected. Methods: HFMD-related enterovirus infected cases were clinically confirmed and underwent real-time RT-PCR (rRT-PCR) from May 2018 to October 2023 in Guangyuan Central Hospital. Results: During 2018-2023, other EV (437 cases, 81.08%) was the most predominant serotype followed by CV-A16 (94 cases, 17.44%), EV-A71 (8 cases, 1.48%) was the least predominant serotype. Peak infections occurred in July and October. There were no significant differences in gender, age and serotypes. HFMD was concentrated in children under 47 months of age, with the highest incidence in children aged 12 - 23 months and the highest proportion of other EV infections in the whole age group. COVID-19 did not cause significant changes in gender, age and serotype. Overall, there was a significant increase in the proportion of children aged 12 - 23 months infected with CV-A16, and an increase in the proportion of children aged over 36 months infected with other EVs. Conclusions: The incidence of HFMD caused by EV-A71 has decreased significantly, and other EVs have become the main pathogens of HFMD in North Sichuan region in recent years. In the prevention and control of CV-A16, more attention should be paid to children aged 12 - 23 months and the dominant serotype should be closely monitored. Our study highlights the importance of developing of new diagnostic reagents and vaccines for the prevention and control of enterovirus infection. This study for the first time provides insights into district interventions to local conditions.

Sleep quality and characteristics of older adults with acute cardiovascular disease

Sleep plays a vital role in restoring the physical and mental health of people with cardiovascular disease.However,the hospital setting is not a conducive environment for sleep.Sleep interruptions by members of the care team,including vital sign checks,medication delivery,and blood draws for laboratory investigations,are routinely done in many hospitals.Frequent interruptions by staff and noise by other patients have been cited as barriers to restorative sleep in the hospital.

Some of the Chemical and Physical Characteristics of the Graff River in Kut City, Iraq

Some of the chemical and physical water qualities of the Graff River in the city of Kut were studied, and for two sites of the river, One was at the Crimea site, the other in the Jihad district, and for the period from October/2018 to March/2019, Seven variables of river water have been analyzed: temperature PH, electrical conductivity, TDS, turbidity, alkaline, and chloride. The results showed that most of the chemical and physical water properties of the river were in normal proportions and did not rise, except for the turbidity, which was at a very high level, and that the pH values were close to the basal side. The results of the statistical analysis revealed positive significant relationships between the pH and (chloride and TDS). On the other hand, between electrical conductivity and both previous variables as well. And a negative significant connection between temperature and alkaline.

Characteristics and Preliminary Causes of Tropical Cyclone Remote Precipitation over China

In this study,the characteristics and preliminary causes of tropical cyclone remote precipitation(TRP)over China during the period from 1979 to 2020 are investigated.Results indicated that approximately 72.42%of tropical cyclones(TCs)in the Western Pacific produce TRP over China.The peak months for TRP are July and August.The four key regions of TRP are the adjacent areas between the Sichuan and Shaanxi Provinces,the northern coast of the Bohai Sea,the coast of the Yellow Sea,and the southern coast area.The typical distance between the station with TRP and the TC center ranges from 1500 to 2500 km.Most of these stations are situated north to 60°west of north of the TC.The south–west water vapor transportation on the west side of the TC is crucial to TRP.TRP has a decreasing trend because of the decrease in the number of TCs that generate TRP.From the perspective of large-scale environmental conditions,a decrease in the integrated horizontal water vapor transport in China' Mainland,the weakening of upward motion at approximately 25°–35°N,which is inconducive to convection,and an increase in low-level vertical wind shear,which is unfavorable for the development of TC in areas with high frequencies of TRP-related TCs,are the factors that result in the decreasing trend of TRP.

The Influence of Acid on the RockMechanical Characteristics of Deep Shale in theWujiaping Formation

The microscopic characteristics and mechanical properties of rocks change after the action of acid on deep shale,which affects the fracturing effect.Accordingly,we designed and conducted indoor experiments related to the changes in macro and microscopic characteristics after the interaction of acid with the shale of Wujiaping Formation,based on which the characteristic law of fracture volume modification after acid fracturing was studied using numerical simulation.The results demonstrate that the pores and fractures are enlarged and the structure is significantly loosened after the acid immersion.And a 15%concentration of hydrochloric acid can effectively dissolve shale.Furthermore,the degree of acid-etching reaction is highly variable because of the different carbonate content,which reveals the strong inhomogeneity of the shale system in the Wujiaping Group reservoir section.After the acid interacted with the shale rock samples,the triaxial compressive strength,elastic modulus,and Poisson’s ratio of shale decreased.Moreover,the evaluation of the effect after acid fracturing simulated by fracturing software revealed that the smaller the value of elastic modulus in shale-based reservoirs,the more favorable the fracture volume modification.This discovery not only provides a theoretical basis for the expansion and extension patterns of acid-fracturing in carbonaceous shale formations but also offers research methods and theoretical insights for the fundamental exploration of other deep-seated oil and gas resources.