Systemic sclerosis-rheumatoid arthritis overlap syndrome complicated with Sweet's syndrome

Herein, we report a case of a 34-year-old woman with systemic sclerosis (SSc)-rheumatoid arthritis (RA) overlap syndrome (OS) complicated with Sweet's syndrome. OS has been defined as entities satisfying classification criteria of at least two connective tissue diseases (CTD) occurring at the same or at different times in the same patient. The CTD include RA, SSc, systemic lupus erythematosus (SLE), polymyositis, and dermatomyositis. Sweet's syndrome also known as acute febrile neutrophilic dermatosis was first described by Robert Sweet in 1964. Sweet's syndrome is characterized by fever, neutrophilia, erythematous skin lesions, and a diffuse dermal infiltrate of mature neutrophils. There are sets of associations that we will discuss in this article between OS and Sweet's syndrome.

[Diagnosis and treatment of basal cell adenoma of parotid gland]

Objective:To investigate the clinical features, diagnosis and treatment experience of basal cell adenoma (BCA).Method:The clinical data of 7 patients with basal cell adenoma of the parotid gland from the Second Affiliated Hospital of Medical University of Anhui from March 2012 to June 2016 were retrospectively analyzed. Combined with literature review, the experience of diagnosis and treatment was discussed.Result:Seven BCA were mostly diagnosed as pleomorphic adenoma and adenomatous lymphoma before operation using parotid ultrasound, fine needle aspiration cytology and parotid enhanced CT, and no patients was diagnosed as BCA prior to the operation. Four cases were diagnosed as BCA, 1 case was diagnosed as adenoma, 1 case was diagnosed as low-grade malignant tumor, and 1 case was not able to identify benign or malignant tumor by intraoperative fast frozen pathological examination. There were no obvious complications after the operation, and only 2 cases of mild facial paralysis returned to normal in 1 month, and no recurrence was found in the follow-up 18-69 months. Conclusion:Basal cell adenoma of the parotid gland is a rare benign tumor of parotid gland, the lack of specific clinical manifestations and signs, preoperative ultrasonography, fine needle aspiration cytology and parotid gland enhanced CT scan can not confirm the diagnosis, although they have some limitations, they are of great value in the localization, qualitative and differential diagnosis of BCA in the parotid gland. The diagnosis mainly depends on intraoperative, postoperative pathology and immunohistochemical examination. The treatment is mainly surgical excision, and the prognosis is better.

[The clinical assessment of regional resection in the benign tumor of parotid gland]

Objective:To evaluate the clinical assessment of regional resection and superficial lobe total resection in the treatment of benign tumors of the parotid gland. Method:One hundred and nighty-five patients operated in the First Hospital of Peking University from January 1998 to March 2017 with benign tumor of the parotid gland were retrospectively analyzed. There were 189 patients with single side tumor and 6 patients with bilateral sides, 157 cases underwent regional resection and the other 44 cases underwent superficial lobe total resection. All the results and complications were recorded and analyzed between the two groups.Result:There were total 195 patients with 201 cases. All the complications were as follows, 4 cases with recurrence, 44 cases with temporal facial paralysis, 13 cases with permanent facial paralysis, 80 cases with earlobe numbness, 49 cases with facial numbness, 44 cases with skin retraction, 26 cases with operated region effusion, 2 cases with sialosyrinx, 55 cases with Frey syndrome. There were no significant differences between the two groups in the incidences of recurrence, temporal facial paralysis, permanent facial paralysis, earlobe numbness, facial numbness, skin retraction. The incidence of Frey syndrome in the superficial lobe total resection group was significantly higher than the regional resection group(45.5%, 22.3%，P<0.05). The incidence of operated region effusion or sialosyrinx in the regional resection group was significantly higher than the superficial lobe total resection group (16.6%, 4.5%,P<0.05),further analysis showed that the operation method and the location of the tumor were the independent risk factors. Conclusion:Regional resection in the parotid gland tumor was less invasive, the incidences in the most complications were in consistent with superficial lobe total resection, and it was helpful in preventing the occurrence of Frey syndrome. Although regional resection conserved more parotid gland tissue so that the more conserved gland function and it also did not increase the incidence of sialosyrinx, the operated region effusion was significantly increased. If the operated region effusion was not discovered and handled, there would be a risk of sialosyrinx.

[Pharyngeal space carcinoma ex pleomorphic adenoma：a case report]

Carcinoma ex pleomorphic adenoma is an epithelial malignant tumor of pleomorphic adenoma. This may be due to the accumulation of genetic instability caused by long-term pleomorphic adenomas. There are few reports of parapharyngeal space carcinoma ex pleomorphic adenoma in the literature study both at home and abroad. This article retrospectively summarized the clinical data of 1 case of pharyngeal space carcinoma ex pleomorphic adenoma and reviewed the literature. We strengthened the understanding of parapharyngeal space carcinoma ex pleomorphic adenoma, improve the accuracy of diagnosis and reduce misdiagnosis and mistreatment.

[The Research on the Anti-glioma Effect and Mechanism of Cinobufagin]

OBJECTIVE

To study the effect of cinobufagin (CB) on the proliferation inhibition and induction of apoptosis in glioblastoma cell lines U87 and its molecular mechanism.

METHODS

A gradient concentration (0-20 μmol/L) of CB was used to treat the U87 glioma cells for 6 h,12 h,24 h and 48 h,respectively. Cell viabilities were determined by CCK-8 assay to discover the effects of different concentrations of CB on the proliferation of glioma cells. Different concentrations (1-20 μmol/L) of CB were used to treat the U87 glioma cells for 12 h and 24 h,hochest33342 staining assay was used to assess the apoptosis levels. Immunofluorescence staining was used to determine the expression of growth related proteins phospho-protein kinase B(T308)[ p-AKT(T308)] in U87 glioma cells after being treated with CB for 24 h. Western blot was used to determine the apoptotic related proteins (BAX,cleaved-caspase 3,cleaved-caspase 9) and growth related proteins [phospho-inositide 3-kinase (p-PI3K),p-AKT(T308),p-AKT(S473),phospho-ribosomal protein S6 kinase (PS6),phospho-4E-binding protein 1 (p-4EBP1)].

RESULTS

A significant effect of CB on the proliferation inhibition and induction of apoptosis in U87 glioma cells in a time- and dose-dependent manner was observed. Treatment with CB induced the expression levels of apoptosis-related protein,cleaved-caspase 3 and BAX,and the PI3K-AKT-4EBP1 signaling pathway related proteins p-AKT(T308) and p-4EBP1 were decreased.

CONCLUSION

CB can inhibit U87 glioma cells growth and induce apoptosis,which may involve the PI3K-AKT-4EBP1 and BAX-caspase signaling pathways.

Transcriptome analysis of Hevea brasiliensis in response to exogenous methyl jasmonate provides novel insights into regulation of jasmonate-elicited rubber biosynthesis

The phytohomorne methyl jasmonate (MeJA) is known to trigger extensive reprogramming of gene expression leading to transcriptional activation of many secondary metabolic pathways. However, natural rubber is a commercially important secondary metabolite and little is known about the genetic and genomic basis of jasmonate-elicited rubber biosynthesis in rubber tree (Hevea brasiliensis). RNA sequencing (RNA-seq) of H. brasiliensis bark treated with 1 g lanolin paste containing 0.02% w/w MeJA for 24 h (M2) and 0.04% w/w MeJA for 24 h (M4) was performed. A total of 2950 and 2850 differentially expressed genes in M2 and M4 compared with control (C) were respectively detected. Key genes involved in 2-C-methyl-D-erythritol 4-phosphate, rubber biosynthesis, glycolysis and carbon fixation (Calvin cycle) pathway were found to be up-regulated by MeJA treatment. Particularly, the expression of 3-hydroxy-3-metylglutaryl coenzyme A reductase in MVA pathway was down-regulated by MeJA treatment, but the expression of farnesyl diphosphate synthase (FPS) and cis-prenyltransferase (CPT, or rubber transferase) in rubber biosynthesis pathway were up-regulated by MeJA treatment. Up-regulation of critical genes in JA biosynthesis in response to MeJA treatment exhibited the self-activation of JA biosynthesis. In addition, up-regulated genes of great regulatory importance in cross-talk between JA and other hormone signaling, and of transcriptional regulation were identified. The increased expression levels of FPS and CPT in rubber biosynthesis pathway possibly resulted in an increased latex production in rubber tree treated with MeJA. The present results provide insights into the mechanism by which MeJA activates the rubber biosynthesis and the transcriptome data can also serve as the foundation for future research into the molecular basis for MeJA regulation of other cellular processes.

[Advances in the research of effects of glutamine on immune function of burn patients]

Glutamine is the most abundant amino acid found in plasma and cells. It is the preferred fuel for enterocytes in the small intestine, macrophages, and lymphocytes. After serious burn, increased requirement of glutamine by the gastrointestinal tract, kidney and lymphocytes, and relatively insufficient self synthesis likely contribute to the rapid decline of glutamine in circulation and cells. Glutamine supplementation can not only protect intestinal mucosa, maintain normal intestinal barrier function, reduce bacterial translocation, and enhance the intestinal immune function, but also increase the number of lymphocytes, enhance the phagocytic function of macrophage, promote the synthesis of immunoglobulin, and reduce the body's inflammatory response, so as to enhance the immune function. Therefore, glutamine supplementation can improve and enhance the immune function, reduce complications and promote the prognosis of severely burned patients.

Effects of traditional Chinese medicine nursing combined with conventional nursing in patients with chronic obstructive pulmonary disease: a meta-analysis

Objective

This meta-analysis aims to evaluate the effects of traditional Chinese medicine (TCM) nursing combined with conventional nursing in patients with chronic obstructive pulmonary disease (COPD).

Methods

Data were collected from the databases of PubMed, Embase, the Cochrane Library, Web of Science, Google Scholar, China National Knowledge Infrastructure (CNKI), WanFang Data (WF) and VIP Database, including literature regarding the effects of TCM nursing combined with conventional nursing in patients with COPD published before January 2017. The Jadad scale was used to assess the quality of the eligible literature. The weighted mean differences and odds ratios were used to analyze St. George’s Respiratory Questionnaire (SGRQ) scores, pulmonary function, hospital stay, and clinical efficacy.

Results

Twenty-three randomized controlled trials comprising 3116 cases (TCM nursing combined with the conventional nursing group: 1559; conventional nursing group: 1557) met the inclusion criteria. TCM nursing combined with conventional nursing was associated with a lower SGRQ score, higher forced expiratory volume in 1 second (FEV1) value, higher FEV1/forced vital capacity (FVC) value, higher FEV1% value, higher FEV1 predicted value, shorter hospital stay, and preferable clinical efficacy.

Conclusions

TCM nursing combined with conventional nursing emphasized that dialectical nursing can be performed preferably in patients with COPD.

Role of academic self-efficacy in the relationship between self-directed learning readiness and problem-solving ability among nursing students

Objective

Problem-solving should be a fundamental component of nursing education because it is a core ability for professional nurses. For more effective learning, nursing students must understand the relationship between self-directed learning readiness and problem-solving ability. The aim of this study was to investigate the relationships among self-directed learning readiness, problem-solving ability, and academic self-efficacy among undergraduate nursing students.

Methods

From November to December 2016, research was conducted among 500 nursing undergraduate students in Tianjin, China, using a self-directed learning readiness scale, an academic self-efficacy scale, a questionnaire related to problem-solving, and self-designed demographics. The response rate was 85.8%.

Results

For Chinese nursing students, self-directed learning readiness and academic self-efficacy reached a medium-to-high level, while problem-solving abilities were at a low level. There were significant positive correlations among the students’ self-directed learning readiness, academic self-efficacy, and problem-solving ability. Furthermore, academic self-efficacy demonstrated a mediating effect on the relationship between the students’ self-directed learning readiness and problem-solving ability.

Conclusions

To enhance students’ problem-solving ability, nursing educators should pay more attention to the positive impact of self-directed learning readiness and self-efficacy in nursing students’ education.

[Expression of βF1 and T cell receptor γ in T lymphoblastic lymphoma/leukemia]

Objective: To evaluate the expression of βF1 and T cell receptor (TCR)γ in T lymphoblastic lymphoma/leukemia(T-LBL/ALL), and investigate the clinicopathological features. Methods: Fifty-one cases of T-LBL/ALL were collected at Guangdong General Hospital from 2010 to 2016, the expression of βF1 and TCRγ was assessed by immunohistochemistry. Results: There were 13 cases of children and adolescents, and 38 cases of adults. The expression rates of βF1 and TCRγ were 27.5%(14/51) and 15.7%(8/51) respectively. The proportion of adults in αβ T-LBL/ALL, TCR-silent T-LBL/ALL and γδ T-LBL/ALL was 7/14, 79.3%(23/29)and 8/8 respectively, and the difference was significant (P=0.023). There was no statistical difference in sex, LDH, bone marrow involvement and Ann arbor stage among these three groups(P>0.05). γδ T-LBL/ALLs included 6 cases of CD4(-)/CD8(-) phenotype, whereas αβ T-LBL/ALL included 7 cases of CD4(+) /CD8(+) phenotype. There was significant difference in CD4/CD8 expression among these three groups(P<0.01). Conclusions: γδ T-LBL/ALL occurred only in adults, with predominantly CD4(-)/CD8(-) phenotype. αβ T-LBL/ALL occurred more common in children and adolescents, with predominantly CD4(+) /CD8(+) phenotype.

A Proposed Set of Metrics to Reduce Patient Safety Risk From Within the Anatomic Pathology Laboratory

Background: Anatomic pathology laboratory workflow consists of 3 major specimen handling processes. Among the workflow are preanalytic, analytic, and postanalytic phases that contain multistep subprocesses with great impact on patient care. A worldwide representation of experts came together to create a system of metrics, as a basis for laboratories worldwide, to help them evaluate and improve specimen handling to reduce patient safety risk.

Method: Members of the Initiative for Anatomic Pathology Laboratory Patient Safety (IAPLPS) pooled their extensive expertise to generate a list of metrics highlighting processes with high and low risk for adverse patient outcomes.

Results: Our group developed a universal, comprehensive list of 47 metrics for patient specimen handling in the anatomic pathology laboratory. Steps within the specimen workflow sequence are categorized as high or low risk. In general, steps associated with the potential for specimen misidentification correspond to the high-risk grouping and merit greater focus within quality management systems. Primarily workflow measures related to operational efficiency can be considered low risk.

Conclusion: Our group intends to advance the widespread use of these metrics in anatomic pathology laboratories to reduce patient safety risk and improve patient care with development of best practices and interlaboratory error reporting programs.

[A prospective pilot study of combined intra-operative radiotherapy for centrally located hepatocellular carcinomas]

Objective: To carry out a prospective cohort study of combined intra-operative radiotherapy for centrally located hepatocellular carcinomas (HCC) and to observe the safety and postoperative complications. Methods: A total of 79 patients with centrally located HCC who underwent hepatectomy were divided into two groups: experimental group (combined with targeted intra-operative radiotherapy, 32 cases) and control group (single surgical operation, 47 cases). Patients in the experimental group received intra-operative electron radiotherapy after tumor resection, while patients in the control group received to intra-operative electron radiotherapy.The haemorrhagia amount and operation time during the operation, intra-operative liver function and the recovery of liver and gastrointestinal tract of patients in these two groups were compared. Results: No postoperative 30-day mortality was observed in all of the patients. The average total operation time of patients in the experimental group was (319±76) min, significantly longer than (233±76) min of the control group (P<0.001). The average aspartate transaminase (AST) level of patients in the experimental group at postoperative day 1 was 562.5 U/L, significantly higher than 347.0 U/L of control group (P=0.031). However, the average prothrombin activity levels of patients in the experimental group at postoperative day 3 and day 7 were (68.3±17.9)% and (73.4±10.2)%, respectively, significantly lower than (78.9±15.9)% and (80.0±10.6)% of control group (both P<0.05). There were no significant differences of tumor volume, differentiation degree, satellite lesion, dorsal membrane invasion, microvascular invasion between these two groups (all P>0.05). There were no significant differences of hospital stay, ventilation time, the incidence of hepatic insufficiency, ascites, pleural effusion, infection, biliary fistula between these two groups (all P>0.05). There were no significant differences of alanine aminotransferase (ALT), albumin, total bilirubin between these two groups at postoperative day 1, 3, 5 and 7 (all of P>0.05). Conclusion: The resection of centrally located HCC combined with intra-operative radiotherapy may increase the total operation time, delay the early postoperative recovery of liver function, but it is still safe and feasible. Trial registration: National Cancer Centre /Cancer Hospital, Chinese Academy of Medical Sciences, ChiCTR-TRC-12002802.

[A review on group 2 innate lymphoid cells and miR-155 in allergic rhinitis]

Allergic rhinitis (AR) is the Th2 inflammatory response that atopic individuals exposure to allergens, mediators released by IgE-mediated, and a variety of immunocompetent cells and cytokines involved .Group 2 innate lymphoid cells (ILC2) are a novel population of native lymphocyte, can secrete large amounts of Th2 cytokines to promote the development of allergic diseases after being activated. MiR-155 plays a vital role in the development of the immune system, the differentiation of immune cells, and the maintenance of immune function.Nasal mucosas from the patients with allergic rhinitis show enrichment for ILC2 and miR-155. Highly expressed miR-155 may enhance the level of IL-4 by promoting ILC2 expression, thereby promoting Th2 inflammatory response.This review focuses on the function and meaning of ILC2 and miR-155 in patients with Allergic rhinitis.

[Effect of CCR3 gene knockout on eosinophils in mice]

Objective:To investigate the effect of CCR3 gene knockout on the proliferation, maturation and apoptosis of eosinophils (EOS) in mice. Method:Bone marrow cells from CCR3 gene knockout mice (experimental group) and wild-type mice (control group) were cultured in vitro and induced differentiation into mature EOS. EOS proliferation was observed by cell counting.Expression of degranulation protein mRNA was detected by qRT-PCR. EOS apoptosis was detected by Annexin V-FITC/PI double staining method. Result:①The number of cells on the 0-14 day of EOS cultured in vitro showed that the number of cells in the experimental group was less than that in the control group at tenth, twelfth, fourteenth days, and the proliferation was slower, the difference was statistically significant (P<0.01). ②The test results of EOS cells apoptosis showed that, under the condition of containing 10 ng/ml IL-5 or no IL-5, the apoptosis rate of EOS cells in experimental group was higher than that in normal control group, the difference between both groups was statistically significant (P<0.01). ③The expression results of ECP, EPO, MBP mRNA in EOS showed that the expression levels of ECP, EPO, MBP mRNA in the experimental group compared with the normal control group were reduced in varying degrees, the difference between both groups was statistically significant (P<0.05). Conclusion:Knockout CCR3 gene can inhibit the proliferation and maturation of EOS and promote its apoptosis, which provides a theoretical basis for CCR3 as a target gene to treat allergic rhinitis.

[Influence of EDC ethanol solution on dentin shear bond strength with a self-etch adhesive system]

OBJECTIVE

To evaluate the bonding ability of one representative self-etch adhesive system by applying the micro-shear bond strength test method with different concentrations of carbodiimide [1-ethyl-3-(3-dimethylaminopropyl) carbodiimide, EDC] ethanol solution pretreatment.

METHODS

Extracted sound human third molars were collected from patients ranging 18 to 40 years. In the study, 80 molars were first sectioned to prepare a flat middle coronal dentin surface and then were randomly divided into 5 groups (n=16) according to without/with different surface treatments [blank control; 80% (volume fraction) ethanol control; EDC ethanol solution of three concentrations (0.01 mol/L, 0.3 mol/L and 0.5 mol/L)]. Each specimen underwent a micro-shear bond strength test and failure mode observation. The data collected were subjected to statistical analysis using one-way ANOVA and post hoc Tukey's test to analyze the difference of the micro-shear bond strength, and chi-square test/Fisher's exact test for the failure mode frequency of the micro-shear bond strength test specimens at a significance level of P=0.05.

RESULTS

The micro-shear bond strength of the three concentration EDC treatments were (35.29±8.97) MPa (0.01 mol/L EDC treatment group), (40.24±9.68) MPa (0.3 mol/L EDC treatment group), (37.38±9.66) MPa (0.5 mol/L EDC treatment group) separately; and that of the 80% ethanol group was (37.49±7.76) MPa. All micro-shear bond strength value of the above four groups was statistically higher than that of the blank control group [(33.81±7.98) MPa]. The immediate micro-shear bond strength and failure mode was of no statistically significant difference among all the groups. It was noticed that the immediate micro-shear bond strength of 0.3 mol/L was higher than that of all the other groups, especially higher than that of the 80% ethanol pretreatment group despite that there was no significant difference among all the groups. And the test of failure mode indicated that the cohesive failure was more common, while the frequency of adhesive failure was rare in each experimental group.

CONCLUSION

EDC pretreatment had no adverse effect on the immediate micro-shear bond strengths of Clearfil SE Bond. Meanwhile, EDC treatment did not cause more adhesive failure in immediate micro-shear test, which had further denoted what was said above. However, it needs more research to illustrate the anti-enzymatic role of EDC in dentin bonding.

Sustained Abdominal Aorta Compression Elevates Coronary Perfusion Pressure after Asphyxia-Induced Cardiac Arrest in a Rabbit Model

Objective

To investigate whether sustained abdominal aorta compression (SAAC) can improve coronary perfusion pressure (CPP) during cardiopulmonary resuscitation (CPR) and improve resuscitation outcomes without causing liver laceration.

Design and Setting

Animal study.

Methods

Cardiac arrest was induced by asphyxia in 28 New Zealand rabbits and maintained for 2 minutes before resuscitation. Animals were resuscitated using either standard CPR (STD-CPR group) or standard CPR and SAAC (SAAC-CPR group). Restoration of spontaneous circulation (ROSC), restoration of spontaneous breathing (ROSB) and cerebral performance category score were determined. CPP, mean arterial pressure (MAP) and ROSC were compared in the two groups.

Results

MAP and CPP in the SAAC-CPR group were significantly higher than in the STD-CPR group. However, MAP and blood gas results showed no significant difference between the two groups during ROSC. ROSC was achieved in seven of fourteen animals in the STD-CPR group and in eleven of fourteen animals in the SAAC-CPR group. Five animals in the STD-CPR group and nine in the SAAC-CPR group survived 24 hours after ROSC. No liver injury occurred in the two groups.

Conclusions

SAAC-CPR produces an increased CPP and MAP than traditional CPR and it does not lead to liver laceration/injury.

Electrophysiological properties of strial pericytes and the effect of aspirin on pericyte K+ channels

The present study was designed to investigate the electrophysiological properties of strial pericytes and the effect of aspirin on pericyte K⁺ channels. Pericytes were identified by determining their morphological characteristics and using pericyte-associated immunofluorescence techniques. The electrophysiological properties of strial pericytes were observed with a whole-cell patch-clamp technique. Alterations in the outward current of cochlear pericytes in the stria vascularis of guinea pigs were examined following the application of K⁺ channel retardants. The effects of aspirin on pericyte K⁺ channels were also evaluated with the whole-cell patch-clamp technique. The results demonstrated that pericytes were desmin positive, and their nuclei were large and surrounded by a small proportion of the cytoplasm. Cytoplasmic processes gradually declined in size as branches grew parallel to the capillary axis. Thus, capillaries were surrounded by tips. The electrophysiological properties of the cochlear pericytes in the stria vascularis of guinea pigs were also determined. The membrane capacitance of the pericytes was 5.9±0.3 pF, while the membrane resistance and resting potential were 2.2±0.3 GΩ and −30.9±1.2 mV, respectively. The current densities of the pericytes (pA/pF) were 3.2±0.7, 10.6±1.0, 15.7±0.9 and 21.3±1.2 at command voltages of 0, +20, +40, and +60 mV, respectively. The K⁺ channels were activated when the pericytes were within the range of −20 mV to +20 mV, particularly at 0 mV. The inhibition rates of the outward current of cochlear pericytes in the stria vascularis of the guinea pigs were determined by administering iberiotoxin (IBTX) and IBTX + 4-aminopyridine. Once the background leakage current was removed, the following inhibition rates were obtained with 3, 10, 30, 300 and 1,000 µmol/l aspirin: 20.8±4.8, 34.1±6.9, 48.2±6.7, 63.6±7.1 and 65.7±8.1%, respectively. The outward current of the cochlear pericytes in the stria vascularis was inhibited by aspirin with a half maximal inhibitory concentration of 24.5±4.5 µmol/l. The membranes of the pericytes in the stria vascularis are characterized by high-conductance calcium-activated K⁺ (BK_Ca) and voltage-dependent K⁺ (K_V) channels. The outward current of the cochlear pericytes in the stria vascularis of guinea pigs was inhibited by aspirin in a concentration-dependent manner. In addition, BK_Ca and K_V channels were inhibited by aspirin.

[The clinical anatomy of the inferior thyroid arteries and veins and the safety of the modified tracheotomy]

Objective:To evaluated the clinical anatomy of the inferior thyroid arteries and veins and the safety of clinical application of the modified tracheotomy. Method:Sixty patients who need partial resection or full resection of thyroid cancer and 50 patients with laryngeal or hypopharyngeal cancer required tracheotomy were enrolled in this study. The distribution of the inferior thyroid arteries and veins closely related to tracheotomy is further dissected. The inverted "U" type of tracheal flap tracheotomy was further improved based on anatomical findings. Finally, the further modified tracheotomy was used for clinical practice and compared with the conventional tracheotomy and the inverted "U" type of tracheal flap tracheotomy. Result:Of the 110 cases, the lowest thyroid artery was found in 11 cases, with a rate of 10%. The inferior thyroid vein has 2-4 branches, which originates from the lower lobe or isthmus of the thyroid lateral lobe, descending in the anterior tracheal space. According to the characteristics of the static reflux of the thyroid gland, the lower thyroid vessels are classified into four types: intravenous dry type (28 cases); intravenous double dry without traffic type (43 cases); intravenous double trunk with traffic (28 cases); mixed type (11 cases). At present, the further modified tracheotomy can effectively avoid the rebleeding of the lower thyroid arteries and veins. There were no bleeding and other complications in all cases. Conclusion:It provides a basis for the further modified of tracheotomy based on the clinical anatomy of the inferior thyroid artery and vein, which is closely related to tracheotomy. The further modified tracheotomy has certain advantages than the conventional tracheotomy and the inverted "U" type of tracheal flap tracheotomy.

[Preoperative airway management and perioperative period asphyxia prevention in patients with tumors invasion in the cervical tracheal]

Objective:To investigate the effect of preoperative airway treatment and postoperative asphyxiation preventive measures in patients with tumors invasion in the cervical tracheal. Method:The clinical date of 35 patients with different degree of tumors invasion in the cervical tracheal were analyzed retrospectively. Anesthesia including normal endotracheal intubation anesthesia, awake intubation anesthesia with visual laryngoscope assisted after topical anesthesia, intubation anesthesia with preoperative tracheotomy, intubation anesthesia after transection of trachea and anesthesia with extracoporeal circulation was selected according to the patient's situation such as whether exist forced position, or the extent of dyspnea, or the range of recurrent tumor. Preventive tracheotomy or fistulization was performed according to the patients' tracheal involvement and the choice of operation and general condition during the operation. Result:All 35 patients were successfully anesthetized, 17 of whom had no dyspnea or forced position, this kind patients were all anesthesia successfully, and 3 of them underwent prophylactic tracheotomy. Sixteen cases of nonrecurrent tumor with forced position, 15 patients were accepted awake anesthesia successfully with visual laryngoscope assisted after topical anesthesia, 1 patient who cannot be intubated or done tracheotomy is completed with extracorporeal circulation; prophylactic tracheotomy or tracheostomy was performed in this group. Of 2 cases of recurrent tumor with forced posture, preoperative tracheal intubation failed, 1 case was intubated after emergency transection of trachea, 1 case was successfully intubated by emergency tracheotomy before operation and 2 cases received postoperative tracheostomy. In this study, no serious complications such as massive bleeding, asphyxia and cardiovascular accident occurred after the operation. Conclusion:The preoperative airway management of patients whose tumors involves the cervical tracheal and whether tracheotomy or ostomy need to prevent asphyxia or not should be based on the nature of the tumor such as whether is recurrent, the extent of trachea involvement and whether to merge the OSAHS. Only by considering the various factors that affect the airway synthetically, an effective method can be adopted to ensure the safety of the operation.

[Clinical value of spectral CT imaging in preoperative evaluation of pathological grading of esophageal squamous cell carcinoma]

Objective: To investigate the value of spectral computed tomography quantitative parameters in the assessment of pathological grade of esophageal squamous cell carcinoma before operation. Methods: The imaging findings of 52 patients with confirmed esophageal squamous cell carcinoma by surgery and pathology were prospectively analyzed in Henan Provincial People's Hospital from June 2016 to May 2017.There were 43 males and 9 females, aged 49-76 years, with an average age of (66±8) years.All the patients were divided into three groups based on the pathological finding: well-differentiated group (n=12), moderately-differentiated group (n=20), poorly-differentiated group (n=20). All the patients received chest plain scan and double phase enhanced scan of gemstone spectral computed tomography.The enhancement attenuation (HU), the average of the slope of the spectral Hounsfield Unit curve (λ(HU)), normalized iodine concentration (NIC), normalized effective atomic number (Z(eff-a)) were measured and calculated.The difference in HU, λ(HU), NIC, Z(eff-a) among different grades were statistically analyzed.The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficiency of single and combined parameters in the differentiation of poorly-differentiated and well-moderately differentiated esophageal squamous cell carcinoma. Results: There were significant differences in HU, λ(HU), NIC, Z(eff-a) among different pathological grading of the esophageal squamous cell carcinoma in arterial phase and venous phase (F=4.496-9.056, H=23.204, 20.724, all P<0.05). The best single parameter to differentiate poorly-differentiated from well-moderately differentiated esophageal squamous cell carcinoma was NIC in arterial phase with areas under the ROC curve (AUC), the cutoff value, sensitivity, specificity, accuracy of 0.860, 0.197, 65.0%, 96.9%, 84.6%, respectively; the best combination of parameters was HU+ NIC+ λ(HU) in arterial phase with AUC, the threshold of predicted probability, sensitivity, specificity, accuracy of 0.913, 0.380, 85.0%, 81.3%, 82.7%, respectively. Conclusion: Gemstone spectral imaging quantitative parameters can be used to evaluate the pathological grading of esophageal squamous cell carcinoma, the NIC and HU+ NIC+ λ(HU) in arterial phase have the highest differential diagnostic efficiency.

[Exploratory study of circulating tumor DNA detection in early breast cancer: an analysis of 75 next-generation sequencing results]

Objective: To explore the utility of circulating tumor DNA detection in early breast cancer by using next-generation sequencing. Methods: This exploratory study of circulating tumor DNA detection is for early invasive breast cancer patients treated in Breast Disease Center, Peking University First Hospital from December 2015 to July 2016. Plasma samples were collected and were used to isolate plasma cell-free DNA.Exons or hotspots of 247 cancer related genes were sequenced by next-generation sequencing. Mutations and their correlation with clinic-pathological factors were analyzed. The correlation between mutations and clinic-pathological factors was evaluated by χ(2) test or Fisher's exact test. Results: Seventy-five patients were enrolled in this study. All patients were female and aged from 31 to 88 years with median age of 58 years. All patients' clinic-pathological records were complete. Sixty-four mutations in 18 genes (ALK, BCR, ERBB2, ROS1, PDGFRA, EGFR, FGFR2, CYP1B1, CALR, CASP7, BRAF, FGFR1, FGFR3, MET, NRAS, PTEN, KIT, SOD2) were detected in 47 (62.7%) among all 75 patients.Exons were captured in 10 genes, and mutations in 2 of 3 genes analyzed were clustered. Gene mutations were not correlated with menopausal status, histological type, primary tumor (T), regional lymph nodes (N), TNM stage, histological grade, estrogen receptor status, progesterone receptor status, human epidermal growth factor receptor 2 status, Ki-67 and molecular subtype (all P>0.05). Conclusion: Circulating tumor DNA sequencing by next-generation sequencing was useful for detecting breast cancer-related mutations.

[A study of 16 cases on the island pectoralis major muscle flap in repair for the defects after the laryngeal function reserved operation of hypopharyngeal carcinoma]

Objective:To explore the application about island pectoralis major muscle flap in repair for the defects after the laryngeal function reserved operation of hypopharyngeal carcinoma.Method:A retrospective analysis about 16 patients who underwent hypopharyngeal carcinoma surgery using pedicle island pectoralis major myocutaneous flap to repair, including 14 cases whose primary tumors located in the piriform fossa, and 2 cases in pharynx posterior wall.Result:All 16 cases' pectoralis major muscle flap survived, 2 of patient appeared to have a pharyngeal fistula, but recovered after transition. Of the 16 cases, 14 cases were removed the trachea tube in 1-3 months, 2 cases survive with tube, and all patients were satisfied with their appearance and the function. In 16 cases, 2 of them survived 3 and a half years, died of lung metastasis; 2 cases survived for four years, 1 died of local recurrence of tumor and another died of heart disease; 1 survived for four and a half years and died of lung metastasis; the remaining 11 cases were still in follow-up.Conclusion:The application in the surgical defect repair of pharyngeal carcinoma with pedicle island pectoralis major myocutaneous flap is safe and effective.

The prognostic role of controlling nutritional status scores in patients with solid tumors

BACKGROUND

We conducted a meta-analysis to investigate the association between preoperative controlling nutritional status (CONUT) scores in various solid tumors and clinical outcomes.

METHODS

Relevant studies published up to August 12, 2017 were identified using electronic databases, including PubMed, Embase, and Web of Science. The pooled hazard ratios (HR) and their corresponding 95% confidence intervals (CI) for overall survival (OS) and event-free survival (EFS) were calculated to explore the relationship between preoperative CONUT score and prognosis.

RESULTS

In total, 674 patients with solid tumors from four published studies were included in this meta-analysis. The pooled HR for OS was 1.98 (95% CI, 1.34-2.91, p=0.001), indicating that patients with high CONUT scores had worse OS. The pooled HR for EFS was 1.98 (95% CI, 1.34-2.93, p=0.001), revealing that high CONUT scores were significantly associated with short EFS.

CONCLUSIONS

Our data suggest that high preoperative CONUT scores indicate poor prognosis for patients with solid tumors. Further studies are needed to verify the significance of CONUT scores in clinical practice.

Complex role of connexin 43 in astrocytic tumors and possible promotion of glioma‑associated epileptic discharge (Review)

Connexin (Cx)43 is a multifunction protein which forms gap junction channels and hemi‑channels. It also contains abundant binding domains which possess the ability to interact with certain Cx43‑associated proteins and therefore serve a fundamental role in various physiological and pathological functions. However, the understanding of the association between cancer and Cx43 along with Cx43‑gap junctions (GJ) remains unclear. All available data illustrate that Cx43 and its associated GJ serve important functions in cancers. The expression levels of Cx43 demonstrate a downward trend and an increase in the levels of malignancy, particularly in astrocytomas. The GJ intercellular communication activity in glioma cells can be adjusted via Cx43 phosphorylation and through the combination of Cx43 and its associated protein. Available evidence reveals Cx43 as a tumor‑inhibiting factor that suppresses glioma growth and proliferation. However, its mechanism is also regarded as complicated and ambiguous. Furthermore, it is apparent that Cx43‑GJ and the carboxyl tail may contribute to glioma growth and proliferation too. However, this valuable role could be weakened by its effects on migration and invasiveness. The detailed mechanism remains unclear and full of controversies. Cx43 can enhance the motor ability and invasiveness of astrocytic glioma cells. It is also able to influence glioma cells to detach from the tumor core to the peritumoral neocortex. This peritumoral region has recently been regarded as the basic focus of glioma‑associated seizure. Thus, Cx43 may take part in the onset and development of glioma‑associated epileptic discharge. In addition, change and increase of Cx43 expression in GJs has been observed in seizure perilesional tissue, which is associated with brain tumors. Cx43 or GJ/hemi‑channels exert enduring effects in the promotion of glioma‑associated epileptic release through direct mass effects and change of the tumor microenvironment. However, there are still a number of issues concerning this aspect that require further exploration. Cx43, as a potential treatment target against this incurable disease and its common symptom of epilepsy, requires further investigation.

Impact of repeat HER2 testing after initial equivocal HER2 FISH results using 2013 ASCO/CAP guidelines

PURPOSE

The updated 2013 American Society of Clinical Oncology/College of American Pathologists guideline recommendations for human epidermal growth factor receptor 2 (HER2) testing have made some major changes in HER2 fluorescence in situ hybridization (FISH) interpretation criteria with additional FISH equivocal cases. Repeat HER2 testing is recommended after initial HER2 FISH equivocal results; however, little is known about its impact on final HER2 status. The aim of this study is to investigate whether reflex test clarifies HER2 status, and to characterize clinicopathological features of the newly defined HER2 equivocal group.

METHODS

A total of 886 consecutive cases of primary invasive breast cancer conducted with dual-probe HER2 FISH testing between November 2013 and December 2015 were reviewed. HER2 immunohistochemistry (IHC) and FISH testing were performed on a different tissue block or a new specimen after initial HER2 FISH equivocal results.

RESULTS

Compared to 2007 guideline, 85 (9.6%) cases changed their category by using 2013 guideline. The major change of the 85 cases is that 57 (6.4%) cases in HER2 FISH-negative category changed to equivocal, and the equivocal category cases increased from 36 to 67. HER2 FISH equivocal was significantly associated with HER2 IHC equivocal (2+) and chromosome 17 polysomy (P < 0.01). Repeat testing by IHC and FISH clarified HER2 status in 33 and 42% of HER2 equivocal cases, respectively. Overall 32 (48%) initial HER2 equivocal cases stayed HER2 equivocal after repeat FISH and or IHC testing. These tumors were ER/PR+, with high KI-67 index.

CONCLUSION

New guidelines classify more HER2 FISH equivocal cases. Repeat HER2 testing clarifies HER2 status in about 50% of initial HER2 FISH equivocal cases. In addition, HER2 equivocal cases merit further study as there is limited information about prognosis and optimal treatment strategy for this population.

[Clinical manifestations of 10 cases of imported human Zika virus disease in Jiangmen city of China]

Objective: To study the clinical manifestations and detection method for imported patients of Zika virus disease. Method: The records of symptoms, signs and laboratory results were collected and analyzed. The specimen of blood, saliva and urine from patients were collected. Results: Two of ten patients had mild fever. The visible cutaneous maculopapular rash of the trunk and extremities was observed in all patients. Seven patients were observed congestive conjunctivitis and only one patient gave an account of itching. No patient had symptoms of myalgia or arthralgia. The laboratory results of patients were normal except two patients had mild leucopenia and another one had thrombocytosis. The Zika virus RNA was detected in urine samples for a longest period. The detection rates of Zika virus RNA from the samples of blood, saliva and urine that collected in seventh day after disease onset were 0, 5, 8 cases, respectively. Conclosion: Epidemiology history, maculopapular rash, congestive conjunctivitis and Zika virus RNA being detected in urine can be considered as the important clinical criterion for making a definite diagnosis as Zika virus disease.

[Effects of bioactive glass on reducing the hypersensitivity after full crown preparation]

OBJECTIVE

To evaluate the efficacy of the 45S5 bioactive glass on the reduction of hypersensitivity of teeth prepared for full coverage crowns.

METHODS

In the study, 31 prepared abutment teeth with vital pulp from 18 patients satisfied the inclusion criteria and exclusion criteria. The patients were informed consent and recruited into the study. This was a before and after self-control, single blind clinical trial. The severity of tooth hypersensitivity at baseline was evaluated, after application of the placebo, which was the powder of zinc oxide, and after application of the 45S5 bioactive glass on the same tooth. Tooth hypersensitivity was evaluated by Yeaple probe and visual analogue scale (VAS) when the tooth was stimulated by a fixed value of mechanical pressure and a blast of cold air respectively. And the dentist gave the subjective score, and the Schiff score at the same time. The three methods of measurement were repeated at baseline, after application of placebo and after application of the powder of 45S5 bioactive glass. Student's t test and nonparametric test were used for statistical analysis.

RESULTS

The indexes measured at baseline, after the application of the placebo and after the application of the 45S5 bioactive glass were as follows, respectively: Tactile value (29.03±9.44) g, (29.68±9.48) g and (44.19±11.19) g, VAS value (50.79±22.92) mm, (46.63±22.06) mm and (30.90±20.30) mm, Schiff score 2.13±0.67, 1.97±0.66 and 1.42±0.56. After the application of bioactive glass, the values of Tactile, the VAS, and the Schiff score were statistically different from those at baseline or after application of the placebo (P<0.05). The data measured at baseline and after application of the placebo were of no statistical difference (P>0.05). Statistical differences between the Schiff scores of the groups were associated with gender, tooth position, primary or secondary tooth preparation.

CONCLUSION

RESULTS of the clinical trial showed that the powders of 45S5 bioactive glass were significantly effective on reducing the hypersensitivity of teeth with vital pulp after the full crown preparation.

[From traditional population-based approach to individualized precision medicine: the interpretation of update on The AJCC Colorectal Cancer Staging System, Eighth Edition]

The eighth edition of cancer staging system published by AJCC will be implemented all over the world in January 1, 2018. In addition to strengthening the traditional TNM staging system, the introduction of new molecular markers, is a major advance in the eighth edition, and is expected to play a more valuable role in the"individualized" clinical practice. The most important update in the eighth edition of AJCC colorectal cancer staging system is"non-anatomic" prognostic and predictive evaluation system based on the molecular detection. The system is useful for better understanding the pathogenesis of colorectal cancer, and guide clinicians to provide individualized treatment for the patients even in the same stage of colorectal cancer.

[Effect of microRNA-106b on the invasion and proliferation of trophoblasts through targeting MMP-2]

Objective: To investigate the expression of microRNA-106b (miR-106b) in the placentas of patients with pre-eclampsia and its relationship with matrix metallopeptidase (MMP) -2, and its effect on the invasion and proliferation of trophoblasts. Methods: (1) Placental tissues were collected from patients with mild pre-eclampsia (mPE, n=30), severe pre-eclampsia (sPE, n=30) and normal pregnant women (n=40). Human choriocarcinoma cell lines JAR and JEG3 were assigned to the miR-106b mimics group, the mimics negative control group, the miR-106b inhibitor group and the inhibitor negative control group, respectively. (2) The target gene of miR-106b(such as MMP-2) was predicted by bioinformatics. Dual-luciferase reporting system was used to verify the regulation of miR-106b on the expression of MMP-2. (3) The expressions of miR-106b and MMP-2 were measured by quantitative real-time PCR (qRT-PCR) and western blot. (4) Cell proliferation was determined by MTT assay. (5) Invasive activities in each group were assessed by cell transwell invasion assays. Results: (1) Predicting result of bioinformatics indicated that MMP-2 was one of the target genes of miR-106b. Dual-luciferase activity assay demonstrated that MMP-2 was the direct target of miR-106b (P<0.01) .(2) The results of qRT-PCR.①The expression of miR-106b in the placentas of mPE, sPE, normal pregnant women were 2.89±0.04, 1.96±0.03, 1.01±0.03, respectively (P<0.05). And the expression of MMP-2 mRNA in the placentas of mPE, sPE, normal pregnant women were 1.87±0.05, 0.69±0.03, 2.78±0.03, respectively (P<0.05). ②The expression of miR-106b in the JAR cell line in the miR-106b mimics group, the mimics negative control group, the miR-106b inhibitor group and the inhibitor negative control group were 2.39±0.03, 1.03±0.04, 0.73±0.03, 1.11±0.04, respectively (P<0.05). And its expression in the JEG3 cell line were 2.17±0.04, 1.18±0.04, 0.61±0.03 and 1.22±0.03, respectively (P<0.05). ③The expression of MMP-2 mRNA in the JAR cell line in the miR-106b mimics group, the mimics negative control group, the miR-106b inhibitor group and the inhibitor negative control group were 0.45±0.15, 1.02±0.03, 2.28±0.03, 1.11±0.03, respectively (P<0.05). And its expression in the JEG3 cell line were 0.58±0.03, 1.25±0.15, 2.25±0.03, 1.21±0.03, respectively (P<0.05). (3) The results of western blot. ①The expression of MMP-2 protein in the placentas of mPE, sPE, normal pregnant women were 1.63±0.04, 0.55±0.03, 2.82±0.03, respectively (P<0.05). ②The expression of MMP-2 protein in the JAR cell line in the miR-106b mimics group, the mimics negative control group, the miR-106b inhibitor group and the inhibitor negative control group were 0.41±0.03, 0.97±0.03, 2.25±0.03, 1.01±0.03, respectively (P<0.05). And its expression in the JEG3 cell line were 0.53±0.03, 1.20±0.03, 2.31±0.04, 1.19±0.03, respectively (P<0.05). (4) miR-106b could inhibit the proliferation of JAR and JEG3 cells, cell proliferation rates in the miR-106b mimics group were lower than that in the mimics negative control group (P<0.05). And cell proliferation rate in the miR-106b inhibitor group was higher than the inhibitor negative control group (P<0.05). (5) The numbers of JAR cell that passed the membrane in the miR-106b mimics group, the mimics negative control group. The miR-106b inhibitor group and the inhibitor negative control group were 61±15, 79±13, 134±13, 80±12, respectively(P<0.05). And the numbers of JEG3 cell that passed were 57±12, 71±15, 128±15, 70±14, respectively (P<0.05). Conclusion: The miR-106b could inhibit the invasion and proliferation of JAR and JEG3 cells through targeting MMP-2, and have a relationship with the pathogenesis of pre-eclampsia.

[Minor salivary duct carcinoma of the larynx: a case report]

Salivary duct carcinoma SDC is a rare disease, especially in the larynx. From the pathology point of view, SDC histomorphology is very similar to breast ductal carcinoma. From the immunohistochemistry, epithelial antibodies are positive, but the SMA is negative. From the review of papers, total resection is the first choice for the treatment, but the local recurrence and distant metastasis are the main influence factors for survival rate. Now we still lack the clinical experience for such disease.

[Association between the ApoB/A1 ratio and the vulnerability of LMCA plaque in the patients with stable angina pectoris]

Objective: To investigate the relationship between ApoB/A1 ratio and the characteristics of tissue components of their left main coronary artery(LMCA)plaque. Methods: A total of 98 patients with stable angina pectoris who received chronic statin treatment underwentpercutaneous coronary intervention in the People's Hospital of Henan Province from June 2010 to June 2016 were included.We prospectively performed intravascular ultrasound virtualhistology (IVUS-VH) to their LMCA and evaluated the tissue characteristics, and the blood level of total cholesterol (TC) and low-density lipoprotein cholesterol(LDL-C), high-density lipoprotein cholesterol(HDL-C), triglyceride(TG), LDL-C/HDL-C ratio, ApoB, ApoA1, ApoB/A1 ratio were measured, then the association of the tissue characteristics with the aboved lipids values were analyzed. Results: According to the median value of their ApoB/A1ratios (0.80), they were divided into 2 groups [high ApoB/A1 ratio (>0.80) (n=49) and low ApoB/A1 ratio (≤0.80) (n=49)]. The patients with a high ApoB/A1 ratio had alarger fibrolipid volume and a smaller fibrous volume compared to patients with a low ApoB/A1 ratio ( 17.5%±1.2% vs 9.0%±1.0%, P=0.03 and 55.1%±2.1% vs 63.9%±1.8%, P<0.01). Using multivariate linear regression analysis after adjustment for the above-mentioned confounding factors, the ApoB/A1 ratio had a significantly positive correlation with fibrolipid volume (r=0.445, β=0.29, P=0.010)and had a negative correlation with fibrous volume (r=-0.567, β=-0.32, P=0.011), suggesting that the ApoB/A1 ratio was associated with the vulnerability of the LMCA plaque. Conclusion: For the patients with stable angina pectoris and chronic treatment of statins, a high ApoB/A1 ratio is associated with a high percentage of fibrolipid volume and a low percentage of fibrous volume in LMCA lesions, suggesting that the ApoB/A1 ratios could predict the vulnerability of the LMCA plaque.

[Centronuclear myopathy: clinical characteristics and MRI image features of oral and maxillofacial region]

Objective: To provide biomechnical basis for orthodontics of centronuclear myopathy (CNM) patients, we studied the oral and maxillofacial clinical features and MRI image manifestations to explore application of MRI to objective evaluation the affected facial muscles. Methods: The study consisted of 8 patients who were diagnosed as CNM (CNM group) and 20 healthy volunteers (control group). Their medical information were gathered and then we examined the ptosis situation and the facial index calculation of them. To measure the maximal hight of palate and the width of palate, patients and volunteers were made impressions. We also checked their maximum bite force with occlusion pressure tester. And they took lateral cephalometric radiographs to measure mandibular plane-Frankfort horizontal plane angle (MP-FH). At last, they were taken oral and maxillofacial region MRI to observe the affected situation of masseter muscle, medial pterygoid muscle and lateral pterygoid muscle. Results: Six patients were ptosis; 6 patients had inverse V-shaped mouth; 3 patients were difficulty in swallowing; 4 patients were anterior open bites; 4 patients were mouth breathing; 7 patients liked to eat soft foods. Morphological facial index ([91.3±0.5]%), MP-FH (34.9°±2.0°) of CNM group were greater than the control group, male maximal hight of palate ([19.0±0.2] mm), female maximal hight of palate ([18.0±0.6] mm) of CNM group were greater than the control group (P<0.05). Male width of palate ([34.5±0.8] mm), female width of palate ([33.4±1.0] mm), male maximum bite force ([464.3±78.2] N), female maximum bite force ([320.7±13.8] N), maximal opening of mouth ([3.4±0.3] cm) of CNM group were less than the control group (P<0.05). And these had significant difference compared with the control group (P<0.05). In MRI examination, there were 7 patients' masseter muscles, 4 patients' medial pterygoid muscles and 6 patients' lateral pterygoid muscles to atrophy asymmetrically. These three pieces of muscular fatty infiltration were inordinately, focused on Grade 0 to 4 and the both sides were similar. Conclusions: CNM patients with long and thin face, high palatine arches and low bite force together were the biomechanical basis of the maxillofacial deformities. MRI can clearly show the affected masseter muscle, medial pterygoid muscle, lateral pterygoid muscle, and can serve as an objective examination method for the evaluation of facial muscles. It can be worth of clinical popularization and application.

[The role of CTLA-4 in the pathogenesis of chronic tonsillitis]

Objective:The purposes of the present study were to explore the role of CTLA-4 in the pathogenesis on development of chronic tonsillitis, and to provide new possibilities and theoretical basis for the drug therapy of chronic tonsillitis and, from soft regulation of the inflammatory immune response point of view. Method:Tonsil tissues were obtained by tonsillectomy and classified into two groups according to clinical forms of tonsillitis, CT (chronic tonsillitis) group (n=21) and TH (hypertrophy of tonsil) group (n=15). We used HE staining to observe the pathological changes in the structure of tonsil tissue in different groups. We used immunofluorescence (IF) method to determine the differences in expression of CTLA-4 between two groups and their distribution characteristics , and used Real-time fluorescent quantitative PCR technique (qRT-PCR) to detect CTLA-4 mRNA expression in the two groups. Result:①HE staining showed the pathogeny structure mainly characterized as the follicular hyperplasia and germinal center in CT group, and obvious "star" phenomenons in TH group. ②Immunofluorescence results showed that the average fluorescence intensity and density of CTLA-4 protein in CT group was significantly higher than in TH group (P<0.05), the difference was statistically significant. ③The qRT-PCR experiment results showed that the expression level of CTLA-4 mRNA in CT group were obviously higher than in HT group (t=6.294, P<0.01), and the differences were statistically significant too. Conclusion:We found CTLA-4 played an important role in the development of chronic tonsillitis disease, suggesting that the mechanism of immunosuppression may exist in the process of chronic tonsil inflammation. Tonsil lymphoid tissue immune suppression provided a new explanation for recurrent tonsillitis, and provides a possibility for the development of new drugs for the treatment of chronic tonsillitis with the exception of surgery recurrent tonsillitis, at the same time for the clinical treatment of chronic tonsillitis in addition to surgery, but the possibility of researching new drugs from the perspective of immunology.

Significance of Pretreatment Red Blood Cell Distribution Width in Patients with Newly Diagnosed Glioblastoma

BACKGROUND Red blood cell distribution width (RDW) is a parameter of the complete blood count (CBC) test. Recent evidence suggests that pretreatment RDW is associated with patient survival in various malignant tumors. We explored the association of pretreatment RDW and other red blood cell (RBC) parameters with clinical parameters and assessed their prognostic impact on overall survival (OS) in patients with glioblastoma (GBM). MATERIAL AND METHODS In total, 109 patients with newly diagnosed GBM were retrospectively reviewed. The Cox proportional hazards regression model and Kaplan-Meier method were used to examine the survival function of pretreatment RDW, mean cell volume (MCV), hemoglobin (HGB), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), RBC count, and hematocrit (HCT) values in patients with newly diagnosed GBM. RESULTS Univariate analysis showed that MCV, MCHC, and RDW were associated with overall survival (OS). However, only RDW remained significant in multivariate analysis. The Kaplan-Meier survival curves showed that patients belonging to the high-RDW group had a worse median OS (293 days versus 375 days, P=0.023) than those belonging to the low-RDW group. CONCLUSIONS The present study showed that pretreatment RDW was superior to MCV and MCHC as a prognostic predictor of clinical outcome in patients newly diagnosed with GBM. Pretreatment RDW was derived directly from the CBC test, which can be easily performed in clinical practice. Therefore, pretreatment RDW values can provide additional prognostic information for patients with GBM. Further larger and prospective studies are needed to confirm these findings and to investigate the mechanism by which of RDW is associated with prognosis in patients with GBM.

[Diagnosis and treatment strategy for clinical complete responders after chemoradiotherapy for rectal cancer: is watch-and-wait policy safe?]

Neo-adjuvant chemoradiotherapy (NACRT) combined with total mesorectal excision (TME) surgery is the main treatment for locally advanced middle-low rectal cancer, and NACRT significantly improves the local control rate of rectal cancer. According to the current guidelines, patients who receive clinical complete response (cCR) after NACRT are recommended for treatment with TME surgery. A few studies have shown that the watch-and-wait (WAW) policy is safe and could ensure anorectal function and quality of life in patients with cCR. In addition, such patients must be closely observed and followed up so as to enable salvage surgery for long periods of tumor re-growth. However, there is not enough evidence to provide a clear answer to the oncological effect of the WAW policy. As a result, WAW policy is not widely available in clinical practice, and further prospective studies are needed to assess its risk and benefit for the patients.

Investigation of correlation between mutational status in key EGFR signaling genes and prognosis of stage II colorectal cancer

Aim: To investigate the relationship between mutations of key genes in the EGFR signaling pathway and the prognosis of stage II colorectal cancer patients without chemotherapy. Materials & methods: The incidence of KRAS, NRAS, BRAF, PIK3CA mutations and deficient DNA mismatch repair were assessed in 160 stage II colorectal cancer patients who had been treated by radical operation without adjuvant chemotherapy. Results: Mutations in KRAS, BRAF or PIK3CA were associated with poor prognosis, while the deficient DNA mismatch repair status was not associated with the prognosis. Combining these three markers, the sensitivity of the predicted value for poor progression-free survival and overall survival reached 0.645 (p = 0.002) and 0.709 (p = 0.001), respectively. Conclusion: Knowing the mutation status of KRAS, BRAF or PIK3CA in stage II colorectal cancer can significantly improve the accuracy of prognoses.

[A cross-section study of severe asthma in eight provinces of China]

Objective: To analyze the prevalence of severe asthmain China. Methods: The epidemiological data was collected from 2 034 asthmatics who were diagnosed in the last epidemiological survey from 2009 to 2010 in 8 provinces. Results: According to the questionnaire survey, among the 2 034 patients, the previously diagnosed patients accounted for 72.47% (1 474/2 034) and the percentage of newly-diagnosed patients was 27.53% (560/2 034). In those 1 474 previously diagnosed asthmatics, 122 (8.28%) were classified into severe asthma, while 6.00% (122/2 034) of all asthmatics and 0.07% (122/164 215) of total respondents presented as severe cases. Statistically, there was no difference in the prevalence of severe patients between men and women. The morbidity rate of severe asthma was the lowest in the 21-30 year old group and the highest in 61-70 year old group (0.85% and 8.31% respectively). The difference among ages was statistically significant (χ²=18.791, P=0.005). In addition, the prevalence rates of severe asthma were also significantly diverged among patients with different education background(χ²=24.639, P<0.000 1). A negative relation was found between education level and the proportion of severe cases. Moreover, the morbidity of severe asthma in smoking patients and non-smoking patients were significantly different as well (χ²=7.447, P<0.05). Compared with asthma patients who do not smoke, smokers were more likely to suffer severe asthma (OR=1.663, 95% CI 1.150-2.404). Conclusions: The prevalence rate of severe asthma in China is similar to that in other countries.Elderly patients have higher risk of severe asthma. Smoking is considered as a risk factor for severe asthma.

Detection of Driver and Resistance Mutations in Leptomeningeal Metastases of NSCLC by Next-Generation Sequencing of Cerebrospinal Fluid Circulating Tumor Cells

Purpose: Leptomeningeal metastases are more common in non-small cell lung cancer (NSCLC) with EGFR mutations. The diagnosis is difficult by traditional imaging only, and leads to poor understanding of resistance mechanisms of leptomeningeal metastases.Experimental Design: We compared the CellSearch Assay, the Thinprep cytologic test (TCT), and brain magnetic resonance imaging (MRI) in 21 NSCLC patients with suspected leptomeningeal metastases. Next-generation sequencing that included 416 cancer-associated genes was also performed on cerebrospinal fluid circulating tumor cells (CSFCTC) of 19 patients.Results: Twenty-one patients were diagnosed with leptomeningeal metastases, and CSFCTCs were captured by CellSearch in 20 patients (median, 969 CSFCTCs/7.5 mL; range, 27-14,888). CellSearch had a sensitivity of 95.2% for leptomeningeal metastases diagnosis, which was higher than that of TCT (12/21, 57.1%), MRI (10/21, 47.6%), and MRI plus TCT (19/21, 90.5%), respectively. CTCs were found only in 5 of 14 patients (median, 2 CTCs/7.5 mL; range, 2-4), which was a much lower ratio than CSFCTCs. Genetic profiles of CSFCTCs were highly concordant with molecular mutations identified in the primary tumor (17/19, 89.5%). The resistance gene EGFR T790M was detected in 7 of 9 patients with extracranial lesions, but was detected in only 1 of 14 CSFCTC samples. Other potential resistant mutations, such as MET amplification and ERBB2 mutation, were also identified in CSFCTCs.Conclusions: CSFCTCs captured by CellSearch may be a more sensitive and effective way to diagnose leptomeningeal metastases, and may serve as a liquid biopsy medium for gene profiles in NSCLC patients with leptomeningeal metastases. Clin Cancer Res; 23(18); 5480-8. ©2017 AACR.

[Treatment of intractable aspiration after partial laryngectomy by cuffed tracheostomy tube with inner cannula]

Objective: To evaluate the efficacy of cuffed tracheostomy tube with inner cannula for the treatment of intractable aspiration after partial laryngectomy. Methods: From May 2010 to June 2015, 15 patients with intractable aspiration after partial laryngectomy of laryngeal and hypopharyngeal carcinoma were enrolled. Cuffed tracheostomy tube with inner cannula was used in the 15 patients for treatment of intractable aspiration. The patients and their family were trained to manage the cuffed tracheostomy tube with inner cannula and to eat since the 14th day after surgery. Cuff was initially inflated with 10 ml air and then deflated of 0.5 ml air every 2-3 days. Until the inflation of cuff was no longer required, the cuffed tracheostomy tube was replaced by metal tracheostomy tube. The patients' swallowing function and aspiration were evaluated 6 months after treatment. Results: The 15 cases with intractable aspiration were treated with cuffed tracheostomy tube with inner cannula and after 2-3 months, 14 of them replaced the cuffed tracheostomy tubes with inner cannula by metal tracheostomy tubes and recovered oral eating, and tracheostomy tubes were no longer required for 12 of 14 patients in following 3-6 months, showing a total decannulation rate of 80% in the patients with refractory aspiration. Conclusion: It was safe and effective to treat aspiration after laryngeal and hypopharyngeal surgery with cuffed tracheostomy tube with inner cannula.

Characterization of a novel modification of a CHO-produced mAb: Evidence for the presence of tyrosine sulfation

Herein we describe the investigation of a Chinese hamster ovary (CHO)-expressed human mAb molecule found partially modified by a +80 Da adduct. This mass difference, suggestive of a single sulfation or phosphorylation addition, was observed by mass analysis of the intact and reduced molecule by mass spectrometry (MS). The modification was located on tyrosine 31 (Y31) of the light chain in the complementarity-determining region 1 by liquid chromatography (LC)-MS peptide mapping and electron transfer dissociation fragmentation. The complete loss of the 80 Da modification moiety during collision induced dissociation fragmentation suggested this modification could not be a tyrosine phosphorylation. Treatment of the mAb with alkaline phosphatase confirmed our hypothesis. Western blot experiment using anti-tyrosine sulfation antibody and LC retention time correlation with corresponding synthetic sulfated peptides further confirmed the identification of tyrosine sulfation on the light chain. The unique sequence motif with neighboring acidic amino acids and local secondary structure might play a role to make Y31 a substrate residue for sulfation. This type of modification, to our knowledge, has not been previously reported for CHO-produced human IgG antibodies.

[Analysis of clinicopathological features and prognosis of 98 cases of small hepatocellular carcinoma]

Objective: To analyze the clinicopathological features and prognosis of patients with small hepatocellular carcinoma. Methods: The clinicopathological and follow-up data of 98 patients with small hepatocellular carcinoma who underwent R0 resection from January 2009 to December 2013 were analyzed retrospectively. Results: All of the patients were followed up. Their postoperative 1-year, 3-year and 5-year overall survival rates were 99.0%, 91.7%, and 76.3%, respectively. Their postoperative median overall survival (OS) period was 52 months. The postoperative progression-free survival rates were 86.7%, 66.2% and 55.0%, respectively, and the median progression-free survival (PFS) period was 43.5 months. The univariate analysis showed that satellite nodules, liver capsule invasion and postoperative recurrence time were associated with OS (P<0.05), and long-term heavy drinking, satellite nodules and liver capsule invasion with PFS (P<0.05). The multivariate analysis indicated that long-term heavy drinking was an independent factor influencing the progression-free survival period of patients with small hepatocellular carcinoma (P=0.003) and postoperative recurrence time and liver capsule invasion were independent factors affecting their overall survival period (P<0.05). Conclusions: The treatment of small hepatocellular carcinoma still concentrates on the active treatment of surgery. It is beneficial to patients to minimize the resection scope of normal liver under the premise of R0 removal of tumor. Postoperative recurrence time of ≤2 years suggests poor prognosis of small hepatocellular carcinoma. Long-term heavy drinking can accelerate the recurrence of small hepatocellular carcinoma.

[The adhesion separation operation with CO₂ laser combined withtriamcinolone acetonide vocal cord submucosal injection for the treatment to vocal cord adhesion]

Objective:To investigate the effect of adhesion separation operation with CO₂ laser via prop-up laryngoscope combine with triamcinolone acetonide submucosal injection via electrolaryngoscope to vocal cords adhesion.Method:Sixteen cases of vocal cord adhesion patients(2 cases of children,14 cases of adult) were enrolled in the study. Fourteen patients had the history of surgery(Reinke edema,vocal polyp,pediatric laryngeal papilloma,laryngeal cancer),2 cases were diagnosed as laryngeal tuberculosis. Adhesion separation operation and triamcinolone acetonide submucosal injection(once a week,three weeks) were conducted. All patients were examined with electronic laryngoscope every month for six monthes.Result:Fourteen patients had good triangle shape of glottis vocalis and good sound voice. One cases of laryngeal cancer and 1 cases of laryngeal tuberculosis patients still had adhesion in the anterior commissure of the vocal cords,but with the improvement in breathing and pronunciation.Conclusion:Adhesion separation operation with CO₂ laser via prop-up laryngoscope combine with triamcinolone acetonide submucosal injection via electrolaryngoscope were effective for treatment to vocal cord adhesion,whichimprove the patient's breathing and voice with little trauma and few complications.