The congenital sternoclavicular sinus in children: Our experience of 56 cases

OBJECTIVES

The objective of this study is to explore the clinical diagnosis and treatment of the congenital sternoclavicular sinus in the region of sternoclavicular joint, providing valuable insights for clinical practice in children.

METHODOLOGY

A retrospective review of case notes was conducted for all patients treated for congenital sternoclavicular sinus at a tertiary care pediatric otolaryngology practice from January 2022 to September 2023.This review analyzed the clinical presentations, imaging examination, pathological examination, and treatment.

RESULTS

A total of 56 patients with congenital sternoclavicular sinus were included in the study, with a mean age of 4.10 ± 2.57 years old. Among these patients, the sinuses were located on the left side in 43 cases,on the right side in 12 cases,and bilaterally in one case.While two patients never experienced inflammation, 54 patients did, and 45 of them underwent incision and drainage before excision. Imaging examination, including ultrasonography and computerized tomography (CT) scans, revealed characteristics such as thickening of subcutaneous tissue,subcutaneous tubular structures or tubercles in front of the clavicle,and irregularly shaped lesions with clear borders and uneven internal low echo, Pathological examination confirmed that the sinuses were lined by squamous epithelium in all patients.

CONCLUSIONS

The congenital sternoclavicular sinus may be a remnant of the fourth branchial cleft on the skin side.Complete resection of the sinus during the quiescent phase of inflammation is the recommended curative treatment to prevent recurrent infection.

CT-based dosiomics and radiomics model predicts radiation-induced lymphopenia in nasopharyngeal carcinoma patients

Purpose

This study aims to develop and validate a model predictive for the incidence of grade 4 radiation-induced lymphopenia (G4RIL), based on dosiomics features and radiomics features from the planning CT of nasopharyngeal carcinoma (NPC) treated by radiation therapy.

Methods

The dataset of 125 NPC patients treated with radiotherapy from August 2018 to March 2019 was randomly divided into two sets-an 85-sample training set and a 40-sample test set. Dosiomics features and radiomics features of the CT image within the skull bone and cervical vertebrae were extracted. A feature selection process of multiple steps was employed to identify the features that most accurately forecast the data and eliminate superfluous or insignificant ones. A support vector machine learning classifier with correction for imbalanced data was trained on the patient dataset for prediction of RIL (positive classifier for G4RIL, negative otherwise). The model's predictive capability was gauged by gauging its sensitivity (the likelihood of a positive test being administered to patients with G4RIL) and specificity in the test set. The area beneath the ROC curve (AUC) was utilized to explore the association of characteristics with the occurrence of G4RIL.

Results

Three clinical features, three dosiomics features, and three radiomics features exhibited significant correlations with G4RIL. Those features were then used for model construction. The combination model, based on nine robust features, yielded the most impressive results with an ACC value of 0.88 in the test set, while the dosiomics model, with three dosiomics features, had an ACC value of 0.82, the radiomics model, with three radiomics features, had an ACC value of 0.82, and the clinical model, with its initial features, had an ACC value of 0.6 for prediction performance.

Conclusion

The findings show that radiomics and dosiomics features are correlated with the G4RIL of NPC patients. The model incorporating radiomics features and dosiomics features from planning CT can predict the incidence of G4RIL in NPC patients.

A Giant Anaplastic Lymphoma Kinase Positive Anaplastic Large Cell Lymphoma: Case Report

BACKGROUND

Anaplastic lymphoma kinase-positive (ALK+) large cell lymphoma (ALCL) is a systemic lymphoma. The invasion of the head and neck bone and skin by ALK+ ALCL is relatively uncommon in children.

METHODS

We describe a 13-year-old boy diagnosed with ALK+ ALCL.

RESULTS

He went a surgery of sampling biopsy procedure. Then the boy was treated with six cycles of adjuvant chemotherapy with Non-Hodgkin's Lymphoma-Berlin-Frankfurt-Munster (NHL-BFM)-90 K3 arm. Then, he achieved partial remission (PR).

CONCLUSIONS

It is common for children to develop ALCL, which grows rapidly. Therefore, a sampling biopsy procedure and NHL-BFM-90 K3 were necessary for the patient.

Activation of the rostral nucleus accumbens shell by optogenetics induces cataplexy-like behavior in orexin neuron-ablated mice

Cataplexy is one of the symptoms of type 1 narcolepsy, characterized by a sudden loss of muscle tone. It can be seen as a behavioral index of salience, predominantly positive emotion, since it is triggered by laughter in humans and palatable foods in mice. In our previous study using chemogenetic techniques in narcoleptic mice (orexin neuron-ablated mice), we found that the rostral nucleus accumbens (NAc) shell is needed for chocolate-induced cataplexy. In this study, we investigated whether a short-lasting stimulation/inhibition of the NAc by optogenetics led to a similar result. Photo-illumination to the NAc in the channel rhodopsin-expressing mice showed a higher incidence (34.9 ± 5.1%) of cataplexy-like behavior than the control mice (17.8 ± 3.1%, P = 0.0056). Meanwhile, inactivation with archaerhodopsin did not affect incidence. The episode duration of cataplexy-like behavior was not affected by activation or inactivation. Immunohistochemical analysis revealed that photo-illumination activated channel rhodopsin-expressing NAc shell neurons. Thus, activation of the NAc, whether transient (light stimulation) or longer-lasting (chemical stimulation in our previous study), facilitates cataplexy-like behaviors and contributes to the induction but not maintenance in them. On the other hand, our study's result from optogenetic inhibition of the NAc (no effect) was different from chemogenetic inhibition (reduction of cataplexy-like behavior) in our previous study. We propose that the initiation of cataplexy-like behavior is facilitated by activation of the NAc, while NAc-independent mechanisms determine the termination of the behavior.

[Clinical characteristics of 91 patients of otorhinolaryngology head and neck malignant tumors in children]

Objective:To analyze the clinical characteristics, treatment and prognosis of the otolaryngology head and neck malignant tumors in children, in order to improve the diagnosis and treatment of the diseases. Methods:The patients of otorhinolaryngology head and neck malignant solid tumors under 14 years old hospitalized in Kunming Children's Hospital and the First Affiliated Hospital of Kunming Medical University from 2014 to 2020 were retrospectively analyzed. All cases were statistically analyzed according to gender, age, location, pathological type and treatment method. Results:The main clinical manifestations of 91 children were mainly facial and neck masses, including nasal congestion, swallowing discomfort, and continuous intermittent fever. CT and MRI examination showed that the diameter of the tumor was 1.2 cm ×2.0 cm to 5.0 cm×12.0 cm, with a mean of 2.8 cm×3.2 cm, and 19 cases had distant metastasis. The main tissue sources were soft tissue （56 cases） and epithelial tissue （35 cases）. There were 6 pathological types, the most common was sarcoma （41 cases）, followed by neuroblastoma （15 cases）, papillary carcinoma （14 cases）, squamous cell carcinoma （10 cases）, mucoepidermoid carcinoma （8 cases）, and adenocarcinoma （3 cases）. According to the classification of tissue origin, the statistical analysis of gender and pathological type showed statistically significant differences in both gender and pathological types（P<0.01）. Conclusion:The age of onset, primary site, tissue origin and pathological type of otolaryngology head and neck malignancy in children have their own characteristics, which should be comprehensively evaluated and treated with multidisciplinary treatment.

[Genotype and phenotype analysis of a family with Waardenburg syndrome type Ⅰcaused by a novel mutation in PAX3 gene]

Objective:To identify gene mutation and analysis the association between clinical characterizes and the mutations in a family of Waardenburg syndrome （WS） type I in Yunnan, China. Methods:With informed consent, the proband with WS phenotype and his family members were given medical history collection, physical examination and audiological evaluation. Peripheral blood was obtained, genomic DNA was extracted, and deafness related genes were detected by high-throughput sequencing. Sanger sequencing was used to verify the mutation sites of proband and his family members. Results:C. 602C>G mutation in exon 5 of PAX3 gene was identified, which is nonsense mutation and may cause a truncated protein. The mutation cause 201 amino acid of the protein changed from serine to stop codon. According to the American College of Medical Genetics and Genomics （ACMG）, it is considered as Pathogenicity（PVS1+PM2+PP3）. This mutation has not been included in the database also not been reported in the literature. Conclusion:Combined with the results of clinical diagnosis and gene diagnosis, this mutation was considered as the cause of the disease. This study enriched mutation spectrum of PAX3 gene.

[Clinical characteristics of localized Langerhans cell histiocytosis in children]

Objective:To explore the clinical features of cephalic and facial limited langerhans cell histiocytosis （LCH） in children for improving its diagnosis and treatment. Methods:Clinical data of 8 children with cephalic and facial limited LCH were retrospectively analyzed, including the onset time of disease, lesion location, imaging data, clinical manifestations and treatment strategies. Results:One case was preliminarily diagnosed as chronic inflammation with nasal back lesions, then conformed by repeated surgical pathology. Six cases were found to have simple cephalic and facial lumps without pain and swelling. One case was found to have temporal lump with suppurate in the lateral auditory canal. Five cases were treated with surgical excision of lesions. Three cases were treated with surgical excision of lesions, and continued with chemotherapy after confirmed pathological diagnosis. All cases were followed up for 2-3 years with good prognosis. Conclusion:Cephalic and facial limited LCH in children was easy to be misdiagnosed and should be regarded as animportant differential diagnosis of cephalic and facial lumps. Good outcome is achieved by treatment with surgical resection combined with adjuvant chemotherapy.

YBX1 Protects against Apoptosis Induced by Oxygen-Glucose Deprivation/Reoxygenation in PC12 Cells via Activation of the AKT/GSK3β Pathway

Reperfusion therapies for ischaemic stroke can induce secondary injury accompanied by neuronal death. The Y-box binding protein 1 (YBX1), an oncoprotein, is critical for regulating tumour cell proliferation and apoptosis. Thus, we wanted to know whether YBX1 could regulate neuronal cell apoptosis caused by cerebral ischaemia/reperfusion (I/R). We established a model of cerebral I/R-induced injury in vitro by oxygen-glucose deprivation/reoxygenation (OGD/R) treatment and determined YBX1 expression using Western blot. Next, the effect of YBX1 on the apoptosis and viability of OGD/R-treated PC12 cells was evaluated by flow cytometry, MTT assay, and Western blot. Besides, the release of lactate dehydrogenase (LDH) and the activity of catalase (CAT) and superoxide dismutase (SOD) were detected to evaluate oxidative stress of PC12 cells induced by OGD/R. The regulatory roles of YBX1 in the AKT/GSK3β pathway were examined by Western blot. As a result, OGD/R treatment down-regulated YBX1 expression in PC12 cells. YBX1 over-expression attenuated the growth inhibition and apoptosis of PC12 cells induced by OGD/R. Besides, the increase of LDH release and the decrease of SOD and CAT activities caused by OGD/R were reversed by YBX1 over-expression. Moreover, YBX1 over-expression could activate the AKT/GSK3β pathway in OGD/ R-treated PC12 cells. Therefore, YBX1 could protect against OGD/R-induced injury in PC12 cells through activating the AKT/GSK3β signalling pathway, and thus YBX1 has the potential to become a therapeutic target for cerebral I/R-induced injury.

[Clinic analysis of cervical lymph node lesions in children]

Objective:Explore the clinical features of cervical lymph node lesions in children with different pathological types, and provide help for the early diagnosis of the disease. Method:The data of 73 children with cervical lymph node disease diagnosed by lymph node biopsy were collected, and the gender composition, age distribution, lymph node characteristics and clinical manifestations of children with different pathological types were analyzed. Result:Among the 73 children with cervical lymph node disease, the incidence of male patients in the benign disease group was less than that of female ones, and the incidence of male patients in the malignant disease group was greater than that of female ones, the difference in gender composition between the two groups was statistically significant（P<0.05）. The benign disease group had the largest proportion in the school-age period（27.4%）, and the malignant disease group had a larger proportion in the preschool period（21.9%） and school-age period（20.5%）, both groups had a relatively smaller proportion in the infant and adolescent period, the difference in age distribution within the group was statistically significant（P<0.01）. Among the various pathological types, the proportion of 73 children with lymph node inflammatory reactive hyperplasia was the largest, 35.6%（26/73）, and was mainly at school age; the second was Hodgkin's lymphoma, accounting for 20.5%（15/73）, mainly in the preschool and school age. The average maximum transverse diameter of lymph nodes in the malignant disease group was greater than that in the benign disease group（P<0.05）. The lymph nodes in the benign disease group were mainly distributed in areas Ⅰ, Ⅱ, and Ⅲ, and the lymph nodes in the malignant disease group were mainly distributed in areas Ⅱ, Ⅲ, Ⅳ, and Ⅴ, there was a statistically significant difference in the distribution of enlarged lymph nodes between the two groups（P<0.01）. Conclusion:Different pathological types of cervical lymph node lesions in children are different in gender composition, age distribution, lymph node size and distribution, and cervical lymph node lesions in children have their own characteristics.

Radiomics features of ascending and descending nasopharyngeal carcinoma

OBJECTIVES

To evaluate the application value of CT-based radiomics features for the ascending and descending types of nasopharyngeal carcinoma (NPC).

METHODS

A total of 217 NPC patients (48 ascending type and 169 descending type), who obtained CT images before radiotherapy in Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University from February 2015 to October 2017, were analyzed retrospectively. All patients were randomly divided into a training set (n=153) and a test set (n=64). Gross tumor volume in the nasopharynx (GTVnx) was selected as regions of interest (ROI) and was analyzed by radiomics. A total of 1 300 radiomics features were extracted via IBEX. The least absolute shrinkage and selection operator (LASSO) logistic regression was performed to choose the significant features. Support vector machine (SVM) and random forest (RF) classifiers were built and verified.

RESULTS

Six features were selected by the LASSO from 1 300 radiomics features. Compared with SVM classifier, RF classifier showed better classification performance. The area under curve (AUC) of the receiver operating characteristic (ROC) curve, accuracy, sensitivity, and specificity were 0.989, 0.941, 1.000, and 0.924, respectively for the training set; 0.994, 0.937, 1.000, and 0.924, respectively for the validation set.

CONCLUSIONS

CT-based radiomics features possess great potential in differentiating ascending and descending NPC. It provides a certain basis for accurate medical treatment of NPC, and may affect the treatment strategy of NPC in the future.

The rates of second lung cancers and the survival of surgically-resected second primary lung cancers in patients undergoing resection of an initial primary lung cancer

BACKGROUND

The Lung Cancer Screening Trial demonstrated improved overall survival (OS) and lung cancer specific survival (LCSS), likely due to finding early-stage NSCLC. The purpose of our investigation is to evaluate whether long-term surveillance strategies (4+ years after surgical resection of the initial lung cancer(1LC)) would be beneficial in NSCLC patients by assessing the rates of second lung cancers(2LC) and the OS/LCSS in patients undergoing definitive surgery in 1LC as compared to 2LC (>48 months after 1LC) populations.

METHODS

SEER13/18 database was reviewed for patients during 1998-2013. Log-rank tests were used to determine the OS/LCSS differences between the 1LC and 2LC in the entire surgical group(EG) and in those having an early-stage resectable tumors (ESR, tumors <4 cm, node negative). Joinpoint analysis was used to determine rates of second cancers 4-10 year after 1LC using SEER-9 during years 1985-2014.

RESULTS

The rate of 2LCs was significantly less than all other second cancers until 2001 when the incidence of 2LCs increased sharply and became significantly greater than all other second cancers in females starting in year 2005 and in men starting in year 2010. OS/LCSS, adjusted for propensity score by using inverse probability weighting, demonstrated similar OS, but worse LCSS for 2LCs in the EG, but similar OS/LCSSs in the ESR group.

CONCLUSION

Because the rate of 2LCs are increasing and because the OS/LCSS of the 1LC and 2LC are similar in early-stage lesions, we feel that continued surveillance of patients in order to find early-stage disease may be beneficial.

Automatic Recognition of Laryngoscopic Images Using a Deep-Learning Technique

OBJECTIVES/HYPOTHESIS

To develop a deep-learning-based computer-aided diagnosis system for distinguishing laryngeal neoplasms (benign, precancerous lesions, and cancer) and improve the clinician-based accuracy of diagnostic assessments of laryngoscopy findings.

STUDY DESIGN

Retrospective study.

METHODS

A total of 24,667 laryngoscopy images (normal, vocal nodule, polyps, leukoplakia and malignancy) were collected to develop and test a convolutional neural network (CNN)-based classifier. A comparison between the proposed CNN-based classifier and the clinical visual assessments (CVAs) by 12 otolaryngologists was conducted.

RESULTS

In the independent testing dataset, an overall accuracy of 96.24% was achieved; for leukoplakia, benign, malignancy, normal, and vocal nodule, the sensitivity and specificity were 92.8% vs. 98.9%, 97% vs. 99.7%, 89% vs. 99.3%, 99.0% vs. 99.4%, and 97.2% vs. 99.1%, respectively. Furthermore, when compared with CVAs on the randomly selected test dataset, the CNN-based classifier outperformed physicians for most laryngeal conditions, with striking improvements in the ability to distinguish nodules (98% vs. 45%, P < .001), polyps (91% vs. 86%, P < .001), leukoplakia (91% vs. 65%, P < .001), and malignancy (90% vs. 54%, P < .001).

CONCLUSIONS

The CNN-based classifier can provide a valuable reference for the diagnosis of laryngeal neoplasms during laryngoscopy, especially for distinguishing benign, precancerous, and cancer lesions.

LEVEL OF EVIDENCE

NA Laryngoscope, 130:E686-E693, 2020.

[Treatment of parotid hemangioma in children]

Objective:To summarize the treatment and effect of children with parotid hemangioma. Method:Thirty-three children with parotid hemangioma were treated with drug in 22 cases, 9 of which received propranolol orally, accounting for 27%; 13 cases underwent B-ultrasound guided bleomycin injection, accounting for 40%; another 11 cases were used. The treatment of surgical removal of hemangioma, accounting for 33%. Result:In 22 children with drug therapy, the evaluation criteria were evaluated by Achauer et al. 12 cases of grade Ⅳ, accounting for 54.5%; 7 cases of grade Ⅲ, accounting for 31.8%; 2 cases of grade Ⅱ, accounting for 9%. For example, accounted for 4.5%; 2 of them（1 in gradeⅠand Ⅱ） were treated with drug therapy for 6 months after surgical resection of hemangioma. Eleven children underwent surgical resection of hemangioma, and 8 patients underwent complete resection of the tumor, accounting for 73%. Among them, 3 patients had residual hemangiomas during operation, and the residual tumor was treated with bleomycin. This group of medications showed that children aged<12 months, after oral propranolol, the tumors were reduced to varying degrees, the most significant change within 1 week after administration, and then the tumor was further reduced until the end of treatment. Conclusion:B-ultrasoun lower bleomycin injection in children with parotid hemangioma is effective, and the incidence of adverse reactions is low, but multiple courses of treatment are required. For patients with poor drug treatment, recurrence or limited range, surgical resection of blood vessels can be selected. Tumor surgery should pay attention to the choice of indications and surgical operation skills, reduce the risk of facial nerve injury and postoperative facial scars. There are many different treatments for infantile hemangioma, but there is still no treatment for all children. The drug treatment of this group showed that after oral propranolol, the tumors were all reduced to varying degrees, the color became lighter, the texture became softer, and the change was most significant within 1 week after administration, and then the tumor was further reduced until the end of treatment. B-ultrasound guided bleomycin injection in children with parotid hemangioma is effective. After 1-2 courses of treatment, the tumor shrinks significantly and the incidence of adverse reactions is low. Drug treatment of parotid hemangioma in children is simple. A safe and effective method. For children with poor drug treatment, recurrence or limited range, surgical treatment of hemangioma can be selected. Surgery should pay attention to the choice of indications and surgical operation skills, reduce the risk of facial nerve injury and postoperative facial scars.

The Long Non-Coding RNA TP73-AS1 Interacted With miR-142 to Modulate Brain Glioma Growth Through HMGB1/RAGE Pathway

P73 antisense RNA 1T (non-protein coding), also known as TP73-AS1 or PDAM, is a long non-coding RNA which may regulate apoptosis via regulation of p53-dependent anti-apoptotic genes. An abnormal change of TP73-AS1 expression was noticed in cancers. The effects of TP73-AS1 in brain glioma growth and the underlying mechanism remain unclear so far. In the present study, TP73-AS1 was specifically upregulated in brain glioma tissues and cell lines, and was associated with poorer prognosis in patients with glioma. TP73-AS1 knocking down suppressed human brain glioma cell proliferation and invasion in vitro, as well as HMGB1 protein. MiR-142 has been reported to play a pivotal role in cancers; here we observed that TP73-AS1 and miR-142 could negatively regulate each other. Results from luciferase assays suggested that TP73-AS1 might compete with HMGB1 for miR-142 binding. Further, HMGB1/RAGE was involved in TP73-AS1/miR-142 regulation of glioma cell proliferation and invasion. In glioma tissues, TP73-AS1 and HMGB1 expression was up-regulated, whereas miR-142 expression was down-regulated. Data from the present study revealed that TP73-AS1 promoted the brain glioma growth and invasion through acting as a competing endogenous RNA (ceRNA) to promote HMGB1 expression by sponging miR-142. In conclusion, we regarded TP73-AS1 as an oncogenic lncRNA promoting brain glioma proliferation and invasion, and a potential target for human brain glioma treatment. J. Cell. Biochem. 119: 3007-3016, 2018. © 2017 Wiley Periodicals, Inc.

Peripheral immune tolerance alleviates the intracranial lipopolysaccharide injection-induced neuroinflammation and protects the dopaminergic neurons from neuroinflammation-related neurotoxicity

BACKGROUND

Neuroinflammation plays a critical role in the onset and development of neurodegeneration disorders such as Parkinson's disease. The immune activities of the central nervous system are profoundly affected by peripheral immune activities. Immune tolerance refers to the unresponsiveness of the immune system to continuous or repeated stimulation to avoid excessive inflammation and unnecessary by-stander injury in the face of continuous antigen threat. It has been proved that the immune tolerance could suppress the development of various peripheral inflammation-related diseases. However, the role of immune tolerance in neuroinflammation and neurodegenerative diseases was not clear.

METHODS

Rats were injected with repeated low-dose lipopolysaccharide (LPS, 0.3 mg/kg) intraperitoneally for 4 days to induce peripheral immune tolerance. Neuroinflammation was produced using intracranial LPS (15 μg) injection. Inflammation cytokines were measured using enzyme-linked immunosorbent assay (ELISA) and quantitative real-time polymerase chain reaction (qRT-PCR). Microglial activation were measured using immunostaining of Iba-1 and ED-1. Dopaminergic neuronal damage was evaluated using immunochemistry staining and stereological counting of TH-positive neurons. Behavioral impairment was evaluated using amphetamine-induced rotational behavioral assessment.

RESULTS

Compared with the non-immune tolerated animals, pre-treatment of peripheral immune tolerance significantly decreased the production of inflammatory cytokines, suppressed the microglial activation, and increased the number of dopaminergic neuronal survival in the substantia nigra.

CONCLUSIONS

Our results indicated that peripheral immune tolerance attenuated neuroinflammation and inhibited neuroinflammation-induced dopaminergic neuronal death.

A large-scale retrospective study of the overall survival outcome in nasopharyngeal carcinoma with hypertension in Chinese population

BACKGROUND

It is known that hypertension is associated with high levels of vascular endothelial growth factor (VEGF) expression which is, in turn, highly connected to the prognosis of a wide array of cancers. The purpose of this study was to evaluate the relationship between hypertension and prognosis of nasopharyngeal carcinoma (NPC) with definitive radiotherapy in a Chinese population.

PATIENTS AND METHODS

We retrospectively reviewed 4493 patients with NPC who received definitive radiotherapy from 1995 to 2006, with a minimum follow-up of 5 years. Kaplan-Meier survival analysis and Cox proportional hazard model were utilized to determine the association between hypertension and overall survival (OS).

RESULTS

A total of 802 patients with NPC suffered from hypertension as compared to 3691 patients with no associated hypertension. Kaplan-Meier analysis revealed median overall survival of 101.1 and 110.0 months, respectively (p<0.05). In univariate survival analysis, patients with hypertension had worse OS (p<0.05) than non-hypertension patients. Patients with higher grade hypertension also had worse OS (p<0.05) compare to patients with grade 1 hypertension. In multivariate survival analysis, patients with hypertension had significantly worse OS (p<0.05) than non-hypertension patients, as well as M stage (p<0.001), after adjustment for related clinical confounding factors.

CONCLUSION

Our findings provide evidence that hypertension is an independent factor and result in poorer survival outcomes in patients with NPC, the mechanism is still unclear, and it worth further research.

Diagnosis and surgical treatment of cervical macrocystic lymphatic malformations in infants

The treatment of lymphatic malformations (LMs) represents a great clinical challenge. The present study reported on the treatment of 68 infants with cervical macrocystic LMs using surgical resection. The cases were retrospectively analyzed. All patients underwent pre-operative ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) examinations. The surgery was performed under general anesthesia with endotracheal intubation. Ultrasonograms showed that 24 cases were monolocular, 44 were multilocular, 16 had no echo, 20 had a uniform low-level echo and 32 had a non-uniform low-level echo. CT showed non-enhancing low-attenuating cystic lesions and attenuation values of 10–45 HU. The magnetic resonance images of the LMs showed a low signal intensity on T1-weighted imaging (WI) and a high signal intensity on T2-WI. Complete resection was achieved in 56 patients, subtotal resection in eight and partial resection in four. Two complications were noted, including reversible paresis of the marginal mandibular branch of the facial nerve and a surgical-site infection. One patient in whom partial resection was achieved had recurrence at ~2 months after the surgery. Ultrasonography, CT and MRI clearly demonstrated the size, shape, extent and adjacent structures of LMs, which aided in surgical planning and assessment of potential risks. Surgical excision increased the chances of cure and was relatively safe for infants aged <1 year. Location and extent, rather than age, were determined to be the most important factors for successful surgical treatment.

Analysis of the correlation among hypertension, the intake of β-blockers, and overall survival outcome in patients undergoing chemoradiotherapy with inoperable stage III non-small cell lung cancer

It is known that hypertension could increase the plasma levels of VEGF and that β-blockers propranolol could counteract the effect. Our aim was to explore the possibility of improving survival outcomes for patients with and patients without hypertension. In addition, we also compared the efficacy of the usage of β-blockers in inoperable non-small cell lung cancer (NSCLC) patients. We retrospectively reviewed 1753 NSCLC patients who underwent concurrence/sequential chemoradiotherapy in our hospital from 1994 to 2005. A total of 606 inoperable patients with stage III were enrolled in this study. Fifty-five patients survived until the follow-up date of May 2011. From the 606 patients, 123 of them had hypertension. We identified 11 of them who took β-blockers orally. Kaplan-Meier methods and Cox proportional hazard model were utilized to analyze the overall survival (OS) outcome among patients with hypertension and patients without hypertension. After that, we compared the patients who took β-blockers with patients who did not take β-blockers in the whole stage III cohort using the same approaches. The Kaplan-Meier analysis revealed that there were no significant survival outcomes between hypertension and non-hypertention groups (P>0.05). No significant difference was found between using β-blockers and not using them in the hypertention group (P>0.05). We also found no statistical significance between using β-blockers and not using them in the whole cohort of 606 NSCLC patients (P>0.05). The results from both univariate or multivariate analysis using the Cox proportional hazards regression model indicated that there was no statistical difference between hypertension and non-hypertension group. There was also no difference between using β-blockers and not using them in the whole stage III cohort (P>0.05). For the patients with hypertension, the usage of β-blockers did not influence the overall survival in stage III inoperable NSCLC. Further randomized clinical trials will be warranted to validate this finding.

Monocytes, microglia, and CD200-CD200R1 signaling are essential in the transmission of inflammation from the periphery to the central nervous system

Peripheral inflammation is known to trigger neuroinflammation and neurodegenerative disease. However, the key components during the propagation of inflammation from the periphery to the central nervous system (CNS) remain unclear. Lipopolysaccharide (LPS) was administered to Sprague-Dawley rats to induce peripheral inflammation. An intravenous injection and an intranigral injection of clodronate liposomes were given to deplete monocytes and microglia, respectively. Recombinant CD200 fusion protein (CD200Fc) or an anti-CD200R1 antibody was injected into the substantia nigra to manipulate the involvement of CD200 and CD200R1. Immunohistochemistry and immunofluorescence staining were used to measure microglial activation and dopaminergic neuronal loss. The expression of brain pro-inflammatory cytokines (i.e., tumor necrosis factor alpha, IL-1β) and CD200-CD200R1 signaling were measured by quantitative RT-PCR. Our data showed that the peripheral LPS injection activated the microglia and induced an increase in the levels of pro-inflammatory cytokines (i.e., tumor necrosis factor alpha, IL-1β). The depletion of either monocytes or microglia suppressed these inflammatory effects that were induced by peripheral LPS administration. The peripheral LPS injection increased the expression of CD200 and CD200R1 in the substantia nigra. Dopaminergic neuronal loss induced by the peripheral LPS injection was accelerated by the blockade of CD200-CD200R1 signaling with an anti-CD200R1 antibody and attenuated by intensifying the signaling with CD200Fc. These results highlight the importance of monocytes, microglia, and CD200-CD200R1 signaling in the transmission of inflammation from the periphery to the CNS.

[Determination of relative elements of hard metal in workplace air and urine by inductive coupled plama]

Objective: To establish a rapid detection method regarding the air conditions of workplace and the workers' urine included Tungsten, Cobalt, Nickel, Titanium, Cadmium, Manganese, Lead and its compounds based on inductively coupled plasma mass spectrometry (ICP-MS) . Methods: The experiment adopts ICP-MS to deter-mine those metals in workshop air and workers urine, evaluate the detection's limitation, the precision and accuracy of the method. Using the membrane filter and urine freeze - dried metal standard material to verify this method. Results: Each element of correlation coefficient was greater than 0.999. The recovery rate of air samples was 91.6%~104.6%, within-batch RSD precision was 1.41%~3.50%, between-run precision was 1.28%~4.31%, urine samples recovery rate was 93.0%~102.6%, within - batch RSD precision was 1.25%~3.56%, between - run precision was 1.58%~4.67%, According to the method every element was within the scope of the standard reference, it was also showed that the established method is accurate and reliable. Conclusion: ICP-MS is an effective and feasible method to detect the workshop air and the workers' urine which included Tungsten, Cobalt, Nickel, Titanium, Cadmium, Manganese, Lead and its compounds.

[Sclerotherapy for faciocervical lymphatic malformations under digital subtraction angiography in children]

Objective:To investigate the efficacy and advantages of fluoroscopy sclerotherapy treatment for the faciocervical lymphatic malformations (LMs) under digital subtraction angiography (DSA) in children. Method:Retrospective analysis of 48 cases of lymphatic malfromations who were treated with intratumoral injection of Pingyangmycin and iohexol under DSA and fluoroscopy, and followed up in Kunming children's hospital. Result:Forty-eight cases of children were treated 1 to 5 intratumoral injection of Pingyangmycin and iohexol that carried out under DSA and fluoroscopy. Follow up ranged from 6 to 18 months, 22 cases (45.83%) were cured, 19 cases (39.85%) were markedly effective, 5 cases (10.42%) were effective and 2 cases (4.17%) were ineffective. The total effective rate was 95.83% with no scarring, pigmentation and significant postoperative complications. Conclusion:Intratumoral injection of Pingyangmycin under DSA is an effective and safe method for treatment of lymphatic malformations in children and has the advantages of positioning accuracy, less damage, fewer complication and no influence on apperarence and function.

[Diagnosis and surgical resection of faciocervical lipomas in children]

OBJECTIVE

To discuss the clinical characteristics, imaging findings, surgical treatment and effectiveness of faciocervical lipomas in children.

METHOD

Twenty children with lipomas who were performed surgical resection under the tracheal intubation anesthesia, of which 3 cases located in face and 17 cases located in neck were retrospectively analyzed. Computed tomography (CT) was used in 8 cases and magnetic resonance imaging (MRI) in 6 cases for differential diagnosis. CT and MRI were used to diagnose 6 patients pre-operatively.

RESULT

The image of computed tomography (CT) revealed that 15 cases showed oval and flat circular area and 5 cases showed lobulated lesion. The CT value was negative typically. The signal was inhomogeneous in MRI. The patients' magnetic resonance imaging (MRI) presented a high signal intensity on T1 and T2WI. The hyperintense signal can be suppressed in fat-suppression T2WI sequence. The hypointense of tumor signals fell in tandem surrounding adipose tissue. All the patients got satisfied curative effect after operation. There were no complications such as trachyphonia, bucking and dyspnea. Following up for 6 months to 2 years,no recurrence case occurred.

CONCLUSION

Lipomas generally occur in adult patients, quite rare in children. Imaging examination is helpful in the differential diagnosis of lipoma. Surgical resection is the only effective treatment for lipomas at present.

Low molecular weight polyethylenimine as a transgenic vector for tumor gene therapy

We constructed a polymer composed of a series of small molecule polyethylenimine (PEI) using 4-arm polyethylenimine (PEG) as a core for tumor gene therapy. N,N'-carbonyldiimidazole and N-succinimidyl-3-(2-pyridyldithio) propionate were used as chemical connecting reagents to synthesize 4-arm PEG-PEI2000 and 4-arm PEG-PEI2000-MC11. Chemical characterization was performed using (1)H-NMR. The retardation effect of polymers on plasmid DNA was observed using electrophoretic mobility shift and MTT assays to test the toxicity of the polymers. The gene delivery capability of 4-arm PEG-PEI2000 and 4-arm PEG-PEI2000-MC11, and the effect of MC11 were determined by an in vitro gene delivery experiment with human hepatoma HepG2 cells. At a N:P ratio of 3, the 4-arm PEG-PEI2000 could retard successfully plasmid DNA with low toxicity. In experiments in vitro, when the N:P ratio was 30, the gene delivery efficiency of 4-arm PEG-PEI2000 in HepG2 cells was five times that of PEI2000; After connecting ligand MC11, however, the gene delivery efficiency was twice as great. Free MC11 effectively inhibited the gene delivery efficiency of the 4-arm PEG-PEI2000-MC11. Four-arm PEG-PEI2000 has low toxicity and high gene delivery efficiency, and is an effective gene delivery vector after linking ligand MC11.

[Diagnosis and treatment of faciocervical lymphatic malformations in infant]

OBJECTIVE

To discuss the treatment effect of infant lymphatic malformations (LMs) located in the head and neck.

METHODS

Fourty-six LMs located in the head and neck between 2009 and 2013 were retrospectively analyzed. There were 26 males and 20 females, aged from 9 months to 4 years, with a median age of 1.8 years.

RESULTS

Phase Isurgical resection was performed in 28 cases. The low concentrations of pingyangmycin was injected in 18 cases, and Phase II surgical resection was performed in 6 cases after 6 months, because of the large tumors and a wide range of invasion. Two post-operative complications were found, one was minor paralyses of mandibular branch of facial nerve, manifestied as mouth askew. Another was injured accessory nerve, manifestied as right upper limb lifting weakness, which improved after rehabilitation treatment.

CONCLUSIONS

Surgical treatment is effective to LMs. In order to avoid serious complications, the huge LMs and microcystic LMs may be given local injection of pingyangmycin after puncture fluid, and phase II surgical resection secondly if necessary.

Two polymorphisms of CD44 3'UTR weaken the binding of miRNAs and associate with naso-pharyngeal carcinoma in a Chinese population

OBJECTIVE

CD44 is a member of adhesion molecule families whose function is closely associated with cancer cell metastatic spread and drug resistance. CD44 is expressed as a wide variety of isoforms but 3' untranslated region (3'UTR) is conserved relatively and it is confirmed that more than ten miRNAs regulate the expression of CD44. The aim of this paper is to investigate the association between polymorphisms existed in CD44 3'UTR and nasopharyngeal carcinoma (NPC).

PATIENTS AND METHODS

We scanned 1.5kb of CD44 3'UTR in a 287 patients and 507 controls Chinese Han population. After statistical analysis we found that the minor alleles of rs13347 C/T and rs115214213 T/C are associated with NPC (OR = 1.94 95% CI = 1.44-2.62; OR = 2.07 95% CI = 1.65-2.60). By using bioinformatics tools, we found that rs115214213 may exist in the target region of miR-590-3p. Subsequently, we confirmed that miR-590-3p can repress CD44 expression and promote the apoptosis of CNE2 cells induced by cisplatin in vitro. After that, our transient transfection focusing on reporter gene expression modulated by CD44 3'UTR demonstrated that the presence of an rs13347T allele and rs115214213C allele led to greater transcriptional activity than the rs13347C allele and rs115214213T allele. Similarly, more CD44 expression was shown in minor allele carriers in our western blotting results.

CONCLUSIONS

All these findings suggest that CD44 rs13347C>T and rs115214213T>C polymorphisms may affect NPC development by improving CD44 expression.

Autophagy and chemotherapy resistance: a promising therapeutic target for cancer treatment

Induction of cell death and inhibition of cell survival are the main principles of cancer therapy. Resistance to chemotherapeutic agents is a major problem in oncology, which limits the effectiveness of anticancer drugs. A variety of factors contribute to drug resistance, including host factors, specific genetic or epigenetic alterations in the cancer cells and so on. Although various mechanisms by which cancer cells become resistant to anticancer drugs in the microenvironment have been well elucidated, how to circumvent this resistance to improve anticancer efficacy remains to be defined. Autophagy, an important homeostatic cellular recycling mechanism, is now emerging as a crucial player in response to metabolic and therapeutic stresses, which attempts to maintain/restore metabolic homeostasis through the catabolic lysis of excessive or unnecessary proteins and injured or aged organelles. Recently, several studies have shown that autophagy constitutes a potential target for cancer therapy and the induction of autophagy in response to therapeutics can be viewed as having a prodeath or a prosurvival role, which contributes to the anticancer efficacy of these drugs as well as drug resistance. Thus, understanding the novel function of autophagy may allow us to develop a promising therapeutic strategy to enhance the effects of chemotherapy and improve clinical outcomes in the treatment of cancer patients.

Sustained performance by red and white muscle fibres from the dogfish Scyliorhinus canicula

The mechanical performance of red and white muscle fibres from dogfish was compared during a long series of contractions with sinusoidal movement or under isometric conditions at 12°C (normal in vivo temperature). Power output was measured during sinusoidal movement at 0.75 Hz and peak-to-peak amplitude about 12% L0. Tetanus duty cycle was 33% (0.44 s) at phase −8% (first stimulus at 0.107 s before shortening started). Initially, the red fibres produced only about one third as much power as the white fibres, 6.57±0.63 W kg−1 wet mass (mean ± s.e.m.) and 18.3±2.3, respectively. Red fibres were better at sustaining power output; it declined rapidly to about 60% of its initial value and then remained relatively steady for up to 450 cycles of movement. Force during shortening declined, but force during stretch did not increase: force always relaxed to a low value before stretch started. By contrast, net power output by white fibres declined rapidly to zero within about 50 cycles. Two changes contributed: decline in force during shortening and an increase in force during stretch because relaxation became progressively less complete during the series of contractions. In isometric series (0.44 s stimulation every 1.33 s, cycle frequency 0.75 Hz), red and white fibres sustained peak isometric force similarly; in the 50th cycle force was 59±3% and 56±4% of initial values. The time required for force to relax to 10% of its maximum value decreased during the series for red fibres and increased for white fibres.