[Analysis of the therapeutic efficacy of pars plana vitrectomy without intraocular tamponade in the treatment of high myopic eyes with myopic foveoschisis and central foveal detachment]

Objective: To investigate the efficacy of pars plana vitrectomy (PPV) without intraocular tamponade in the treatment of high myopic eyes with myopic foveoschisis (MF) accompanied by foveal detachment (FD). Methods: A retrospective case series study was conducted. The medical records of patients diagnosed with unilateral MF accompanied by FD at the Eye & ENT Hospital of Fudan University between May 2018 and December 2021 were collected. All patients underwent 23-gauge PPV with posterior vitreous cortex clearance, and no intraocular tamponade was applied. The cases were divided into groups based on whether the internal limiting membrane was peeled during surgery or retained. Follow-up was conducted for at least 12 months. The main outcome measures included postoperative best-corrected visual acuity (BCVA, converted to logarithm of the minimum angle of resolution), central foveal thickness (CFT), MF resolution, and complications. Statistical analyses were performed using t-tests, chi-square tests, Fisher's exact tests, and univariate and multivariate linear regression. Results: A total of 40 patients (40 eyes) with MF and FD were included in the study, with 30.0% being male and 70.0% female. The mean age was (56.9±11.7) years, and the axial length of the eyes was (29.1±1.9) mm. At 12 months postoperatively, BCVA improved from baseline 1.15±0.58 to 0.73±0.39 (t=6.11, P<0.001), and CFT decreased from baseline (610.1±207.2) μm to (155.9±104.1) μm (t=13.47, P<0.001). Complete resolution of MF with foveal reattachment was observed in 80.0% of eyes, with a median time of 6 (5, 8) months. There was no significant difference in BCVA and CFT between the internal limiting membrane peeled group and retained group [0.68±0.39 vs. 0.79±0.40, t=0.85, P=0.403; (148.3±63.8)vs.(164.3±137.2)um,t=0.48, P=0.634]. One eye experienced macular hole and another eye developed retinal detachment postoperatively. Correlation analysis showed a positive correlation between BCVA at 12 months postoperatively and baseline BCVA (β=0.433, P<0.001). Conclusions: Pars plana vitrectomy without intraocular tamponade is effective in treating MF accompanied by FD. The choice between internal limiting membrane peeling and retention does not significantly affect visual prognosis.

[Research on epidemiological characteristics of pneumonia and correlative factors of length of hospitalization in the elderly aged 60 years and older in Ningbo]

Objective: To investigate the epidemiological characteristics of pneumonia and the related factors of the length of hospitalization of pneumonia in the elderly aged 60 years and older in Ningbo in 2019. Methods: Data on hospitalized cases of pneumonia in the elderly aged 60 years and older in Ningbo in 2019 were collected through the regional health information platform, and the population data of Ningbo in 2019 were obtained through the Zhejiang Provincial Bureau of Statistics. A descriptive epidemiological analysis was conducted on hospitalized cases of pneumonia in the elderly population, and factors related to the length of hospitalization were explored. Results: A total of 15 956 hospitalized cases of pneumonia aged 60 years and older were reported in Ningbo in 2019, and the incidence of pneumonia requiring hospitalization was 1.02% (15 956/1 571 431). The incidence was 1.13% (8 613/760 357) in males and 0.83% (6 759/811 074) in females, and the ratio of male to female cases was 1.27∶1. The highest incidence was found in the ≥80 age group (2.52%), and the lowest incidence was found in the 60-69 age group (0.58%). March, February, and January were the peak period of pneumonia hospitalization. The main types of pneumonia diagnosed were not specified (65.12%), followed by bacterial pneumonia (34.60%). The M(Q1, Q3) of hospitalized patients with pneumonia was 9 (7, 13) days. The results of multivariate logistic regression analysis showed that gender (female: OR=0.911, 95%CI: 0.849-0.978) and older age (70-79 years old: OR=1.211, 95%CI: 1.111-1.321; ≥80 years old group: OR=1.486, 95%CI: 1.365-1.617), settlement method (self-payment: OR=0.567, 95%CI: 0.464-0.691), higher level of hospitals (Grade Ⅱ: OR=1.902,95%CI:1.723-2.100; Grade Ⅲ: OR=1.546,95%CI:1.407-1.698) were associated with the length of hospitalization for pneumonia in people aged 60 years and older in Ningbo. Conclusions: Hospitalization with pneumonia in people aged 60 years and older was high in winter and spring, men and older adults were in high-risk groups in Ningbo in 2019. Gender, age, billing method, and level of hospitals may be related factors to the length of hospitalization for pneumonia.

[Epidemiological characteristics and spatiotemporal distribution of schizophrenia in Ningbo, 2018-2022]

Objective: To explore the temporal and spatial distribution characteristics of reported incidence of schizophrenia in Ningbo from 2018 to 2022 and to provide a scientific basis for rational allocation of mental health resources and comprehensive prevention and treatment of schizophrenia. Methods: The reported incidence data of schizophrenia from 2018 to 2022 were collected from Ningbo's mental health information management system, and the reported incidence was calculated by township. The spatial correlation analysis and the spatiotemporal scan analysis were used to study the spatiotemporal distribution of schizophrenia. Results: The reported incidence of schizophrenia decreased from 2018 to 2022, with 4 133 new cases reported, and the annual average reported incidence was 9.76/100 000. Global and local spatial autocorrelation analysis showed positive spatial correlations and hot spots in 2018-2020. The space-time scan analysis showed an incidence cluster in Dongqiao Town, Haishu District, during 2018-2019. The RR was 2.46, and the log-likelihood ratio was 256.89. Conclusions: The reported incidence of schizophrenia in Ningbo has obvious temporal and spatial aggregation, and the high incidence area explored can provide clues for further research on the correlation between environmental factors and the incidence of schizophrenia and has certain guiding significance for the rational allocation of mental health resources in Ningbo.

[Effects of denosumab on bone mineral density around proximal femoral prosthesis after total hip replacement in postmenopausal osteoporotic patients]

OBJECTIVE

To evaluate the effect of denosumab on bone mineral density around proximal femoral prosthesis after total hip arthroplasty(THA) in the postmenopausal osteoporotic patients.

METHODS

Fifty-four consecutive patients underwent unilateral primary THA were included in this retrospective study. Twenty-five patients received denosumab for osteoporosis as the treatment group, and the twenty-nine without denosumab were the control group. At 1 week, 3month, 6 months, and 12 months after THA, bone turnover markers and proximal femoral periprosthetic bone mineral density (BMD) were measured.

RESULTS

At 3, 6 and 12 months after operation, the level of TRACP-5b in the control group was significantly higher than that in the treatment group (P<0.05);the level of bone-specific alkaline phosphatase (BALP) between two groups showed significant difference in 12 months after operation (control group was higher than treatment group, P<0.05). The BMD of Gruen 1 and Gruen 7 decreased at 3, 6 and 12 months after operation compared with 1 week after operation. Comparing the treatment group and the control group, the differences of the the decrease of BMD in Gruen 1 and Gruen 7 were no significant at 3 months after surgery. In Gruen 1, Gruen 7 at 6 months after operation and Gruen 1, Gruen 7 at 12 months after operation, the decrease of BMD in the control group was significantly higher than that in the treatment group(P<0.05). It is suggested that desudumab could inhibit the loss of BMD after 6 months, and continuously show a protective effect on bone mass at 12 months after operation.

CONCLUSION

After THA in postmenopausal patients with osteoporotic femoral neck fracture, Desuzumab can reduce the loss of BMD around the proximal femoral prosthesis and effectively inhibit bone resorption.

[Epidemiological characteristics of reinfection of 2019-nCoV and influencing factors in Ningbo]

Objective: To analyze the epidemiological characteristics of reinfection of 2019-nCoV and influencing factors, and provide evidence for effective prevention and control of COVID-19 epidemic. Methods: The incidence data of COVID-19 in Ningbo from January 1, 2020 to November 30, 2022 were collected from the infectious disease surveillance system of Chinese information system for disease control and prevention. The incidence of reinfection of 2019-nCoV was investigated by using questionnaire. logistic regression analysis was used to analyze the influences of gender, age, time interval from the first infection, history of underlying disease, 2019-nCoV vaccination dose and disease severity on the reinfection. Results: A total of 897 previous 2019-nCoV infection cases were investigated, of which 115 experienced the reinfection of 2019-nCoV, the reinfection rate was 12.82%. The interval between the two infections M(Q1, Q3) was 1 052 (504, 1 056) days. Univariate analysis showed that age, 2019-nCoV vaccination dose, history of underlying disease, type of 2019-nCoV variant causing the first infection, time interval from the first infection and severity of the first infection were associated with the reinfection rate (all P<0.05). Multivariate logistic regression analysis showed that the risk for reinfection in age group 30- years was higher than that in age group ≥60 years (OR=2.10, 95%CI: 1.11-3.97). No reinfection occurred in those with time interval from the first infection of <6 months, and the risk for reinfection was higher in those with the time interval of ≥12 months than in those with the time interval of 6- months (OR=6.68, 95%CI: 3.46-12.90). The risk for reinfection was higher in the common or mild cases than in the asymptomatic cases (OR=2.64, 95%CI: 1.18-5.88; OR=2.79, 95%CI: 1.27-6.11). Conclusion: The time interval from the first infection was an important influencing factor for the reinfection of 2019-nCoV, and the probability of the reinfection within 6 months was low.

[Epidemiological characteristics of a local cluster epidemic caused by 2019-nCoV Delta variant in Ningbo, 2021]

Objective: To understand the epidemiological characteristics of a local clustered epidemic caused by 2019-nCoV Delta variant in Ningbo and provide reference for the improvement of COVID-19 epidemic prevention and control. Methods: Case finding was conducted based on case definitions, and field epidemiological investigation of COVID-19 cases was carried out. In which Nasal and oropharyngeal swabs of the cases were collected for pathogen testing, and the results were analyzed with descriptive epidemiological methods. Results: A total of 74 COVID-19 cases were reported in this epidemic, and the cases were mainly mild ones, accounting for 87.84% (65/74), and there were no severe or critical cases. The epidemic curve showed a human-to-human transmission mode, indicating that a transmission for at least six generations had occurred. The age of the COVID-19 patients ranged from 2 years to 80 years, and 27.03% (20/74) of the cases were older than 60 years. The cases were mainly workers (55.41%, 41/74) and housework/the unemployed (27.03%, 20/74). The COVID-19 epidemic was limited, and no further spread to other areas occurred. The transmission chain among the cases was clear, and the gene sequencing results confirmed that the current epidemic was caused by 2019-nCoV Delta variant, which was highly homologous to the strains from other province. Conclusion: The local COVID-19 epidemic in Ningbo was caused by imported cases of COVID-19 from other province, and local community spread occurred through daily contacts between cases and contacts.

[Transmission chains of local epidemic of COVID-19 caused by 2019-nCoV Delta variant in Zhenhai district, Ningbo]

Objective: To investigate the local epidemic of COVID-19 caused by 2019-nCoV Delta variant in Zhenhai district of Ningbo, identify the transmission chain and provide reference for the prevention and control of COVID-19 epidemic. Methods: The incidence data of COVID-19 in Zhenhai from 6 to 18 December, 2021 were collected in field investigation. Field epidemiological investigation was conducted to understand the epidemiological characteristics of COVID-19 cases and analyze the transmission chains. Results: The first case might be infected with 2019-nCoV through direct or indirect exposure when passing through a medium-risk area, then a family cluster was caused, and the epidemic spread through close contacts of family members with others such as work, daily life, and moxibustion. The epidemic lasted for 14 days, and 74 confirmed COVID-19 cases were reported. The median incubation period was 4.0(3.0,5.8)d. All the cases were in a chain of transmission for more than 6 generations, and the intergenerational interval was 3.5(2.0,5.3)d. The gene sequencing result indicated that the pathogen was Delta AY.4 variant of 2019-nCoV. Both the epidemiological investigation and the gene sequencing results supported that the local COVID-19 epidemic in Zhenhai was associated with the COVID-19 epidemic in Shanghai. Conclusions: The transmission chain of this epidemic was clear. Delta AY.4 variant has obvious characteristic to cause case clusters in families, places with poor ventilation, and residential communities. It is suggested to strengthen the health management in key areas and key populations, and increase the frequency of nucleic acid testing.

[Effectiveness of precise prevention and control strategies of dynamic zero COVID-19 in Ningbo, Zhejiang province]

Objective: To evaluate effectiveness of the precise prevention and control strategies of dynamic zero COVID-19 in Ningbo, Zhejiang province. Methods: Based on the incidence data of COVID-19 and case epidemiological survey report in Ningbo in December 2021, the incidence curve of COVID-19 was generated and a dynamics model was developed to estimate the case number of under different intervention measures. The basic reproduction number (R₀) and real-time reproduction number (R_t) were calculated to evaluate intervention effect. Results: A total of 74 cases of COVID-19 had been confirmed in Ningbo as of 17 December, 2021. The R₀ was estimated to be 4.3. With the strengthening of prevention and control measures, the R_t showed a gradual downward trend, dropping to below 1.0 on December 11 and 0.4 on December 14. The model fitting results showed that the actual case number was close to the estimated case number (76 cases) when the effectiveness of intervention was 90%. The number of cases decreased by 98.4% compared with that if no intervention was taken. Conclusion: The precise prevention and control strategies of dynamic zero COVID-19 have obvious effect, which can facilitate the rapid control of COVID-19 epidemic in Ningbo.

[Research progress on the relationship between HIV infection, antiretroviral therapy, and diabetes mellitus]

The expectancy and quality of life among people with HIV have improved remarkably with the widespread use of antiretroviral therapy (ART). In the meantime, the risks for HIV-related metabolic diseases have increased significantly, in particular diabetes mellitus. Multi-factors coeffect to increasing the risk of diabetes mellitus among HIV patients. Recently, growing of research has reported an association between HIV infections and ART and the development of diabetes mellitus. In this article, we summarize the recent studies investigating HIV infection and ART in diabetes mellitus to clarify their mechanism on the development of diabetes.

[Treatment and prognosis analysis of perineural invasion on sinonasal adenoid cystic carcinoma]

Objective: To analyze the efficacy of sinonasal adenoid cystic carcinoma (ACC) with perineural invasion (PNI), and explore the prognostic value of PNI on sinonasal adenoid cystic carcinoma. Methods: The clinical data of 105 patients with sinonasal ACC admitted to Cancer Hospital, Chinese Academy of Medical Sciences from January 2000 to December 2016 were retrospectively reviewed. All patients were restaged according to American Joint Committee on Cancer 8th edition. Follow-up visits were conducted to obtain information of treatment failure and survival outcome. The Log rank test was used for univariate analysis of prognostic factors, and Cox regression model was used for multivariate prognostic analysis. Results: The maxillary sinus (n=59) was the most common primary site, followed by the nasal cavity (n=38). There were 93 patients with stage Ⅲ-Ⅳ. The treatment modalities included surgery alone (n=14), radiotherapy alone (n=13), preoperative radiotherapy plus surgery (n=10), and surgery plus postoperative radiotherapy (n=68). The median follow-up time was 91.8 months, the 5-year local control (LC), distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival (OS) rates were 72.6%, 73.0%, 52.9% and 78.0%, respectively. There were 33 patients (31.4%) with PNI-positive. The 5-year DMFS, PFS, and OS rates of PNI-positive group were 53.7%, 29.4% and 56.5%, respectively, which were significantly inferior to those of PNI-negative group (80.8%, 63.0% and 86.8%, respectively, P<0.05), while there was no significant difference in the 5-year LC rate between both groups (64.5% vs 76.5%, P=0.273). The multivariate Cox regression analysis showed PNI was one of the poor prognostic factors of DMFS (HR=3.514, 95%CI: 1.557-7.932), PFS (HR=2.562, 95%CI: 1.349-4.866) and OS (HR=2.605, 95%CI: 1.169-5.806). Among patients with PNI-positive, the 5-year LC, PFS and OS rates of patients received surgery combined with radiotherapy were 84.9%, 41.3% and 72.7%, respectively, which were significantly higher than 23.3%, 10.0% and 26.7% of patients receiving surgery or radiotherapy alone (P<0.05). Conclusion: The presence of PNI increases the risk of distant metastasis in patients with sinonasal ACC. Compared with patients with PNI-negative, the prognosis of patients with PNI-positive is relatively poor, and surgery combined with radiotherapy for PNI-positive sinonasal ACC results in good clinical outcomes.

[Characteristics and influencing factors of newly HIV infection among newly confirmed HIV/AIDS cases in Ningbo city, 2017-2020]

Objective: To identify the characteristics and influencing factors of local HIV infection among newly confirmed cases in Ningbo from 2017 to 2020 to provide evidence for traceability investigations on critical cases and facilitate the detection procedures and reduce new HIV infection. Methods: From January 1, 2017, to December 31, 2020, the newly confirmed HIV/AIDS in Ningbo were recruited. An epidemiological questionnaire was used to collect relevant information, including demography, sexual behaviors, results of HIV antibody tests, and the route of HIV transmission. According to the HIV testing, history of risk behaviors, and the level of CD4⁺ lymphocytes after confirmation, the HIV infection was acquired in the previous year, or the place was in Ningbo. The EpiData 3.1 and SPSS 23.0 software were used for input, sorting database and statistical analysis. Results: A total of 2 044 HIV/AIDS on-site investigations were completed. The average age of the subjects was (40.6±15.3) years old, including 1 684 males (82.4%), 758 unmarrieds (37.1%), 1 072 (52.5%) registered as permanent residents in Ningbo, 1 253 (61.3%) with junior high school education or below, 979 (47.9%) lived in Ningbo for more than five years. The proportion of local, new HIV infections was 34.34% (702/2 044). Multivariate logistic analysis showed that the proportion of local newly HIV infection was higher among those who were confirmed in 2020 (compared with the 2017 confirmed cases, OR=1.422, 95%CI:1.092-1.851), whose occupations were students/teachers/cadres/retirees (compared to commercial service/catering/public place service personnel, OR=1.682, 95%CI: 1.307-2.165), meeting sex partners via male social software locally in the last year (compared with without using related dating software, OR=1.353, 95%CI: 1.073-1.706). Conclusions: The proportion of local HIV infection of newly confirmed HIV/AIDS was relatively high in Ningbo city from 2017 to 2020. Meeting gay sex partners through local male social software appeared a risk factor for local newly HIV infection. Traceability investigations and internet intervention should be carried out for MSM. While male social software should be focused on identifying and controlling the risk of local newly HIV infection.

[Conducting analysis on HIV tracing and molecular network for promoting precise detection,prevention and control of AIDS]

The current sexual transmission of newly infected HIV cases is complicated in China. It is crucial for interrupting HIV transmission by HIV tracing and molecular network analysis,conducting early detection and precise prevention among HIV-positive individuals. The articles in this issue focused on the global situation of HIV tracing, and molecular network analysis in promoting accurate detection and prevention of AIDS started from analyzing the reported epidemiological characteristics of HIV/AIDS in Ningbo city from 2017 to 2020. Relations of HIV transmission between HIV positive individuals and sex partners by tracing investigation were also, analyzed. Data on HIV transmission mode by combining social and molecular networks were gathered to provide evidence for applied research on precise detection, prevention, and control of AIDS.

[HIV infection and related factors of traceability efficiency among sex partners of HIV positive men who have sex with men]

Objective: To investigate the situation related to HIV infection and influencing factors of traceability efficiency among sex partners of HIV positive men who have sex with men (MSM). Methods: A cross-sectional survey was conducted to investigate the traceability among sex partners of HIV-positive MSM in Ningbo from 2018 to 2020. Limiting-antigen avidity enzyme immunoassay determined recent HIV infection. The classified data was evaluated by chi-square test, and factors of traceability efficiency were analyzed by multivariate logistic regression. Results: A total of 374 newly confirmed HIV-positive MSM were recruited to participate in the HIV test in Ningbo from 2018 to 2020.HIV positive rate of sex partner was 15.7% (75/479,95%CI:12.4%-18.9%). HIV positive rates of sex partner of recent HIV infection MSM was 31.8% (21/66,95%CI:20.3%-43.4%). The proportion of newly confirmed HIV-positive sex partners of recent HIV infection MSM (76.2%) was higher than that of long-term HIV infection MSM (48.1%). The difference was statistically significant (P=0.028). Results from the multivariate logistic regression analysis showed that HIV traceability efficiency was higher in the following subpopulations as; HIV positive MSM who were 36-45 years old (compared with 18-25 years old, OR=3.973,95%CI:1.364-11.569), HIV active detection (compared with HIV passive detection, OR=1.896, 95%CI:1.083-3.319), recent HIV infection MSM (compared with long-term HIV infection MSM, OR=3.733, 95%CI:1.844-7.556). Conclusions: HIV positive rate among partners of HIV positive MSM was very high. The traceability efficiency, which was recent HIV infection MSM and HIV active detection, was high. It is suggested to strengthen the traceability and focus on the newly confirmed HIV-positive MSM in VCT clinics.

Effect of chromium methionine supplementation on lactation performance, hepatic respiratory rate and anti-oxidative capacity in early-lactating dairy cows

Chromium may regulate dairy cow metabolism; a chelated formation of chromium methionine (Cr-Met) is available to the feed industry. The objective of this study was to investigate the effect of Cr-Met supplementation on lactation performance, hepatic respiratory rate and anti-oxidative capacity in early-lactating Holstein dairy cows. 64 multiparous cows were assigned to 16 blocks based on parity and milk yield and then the four cows in a block were randomly allocated to four treatment groups with 0, 4, 8 or 16 g/d of Cr-Met per cow supplemented to a basal diet. Cows were moved from an open dry lot to a naturally ventilated tie stall barn 2 weeks before treatment to adapt to this facility, fed and milked at 0630, 1400, and 1930 h every day. The experiment lasted for 12 weeks. Milk yield and composition were recorded weekly. Dry matter intake was measured every 2 weeks for a total of six times throughout the trial. The plasma variables were measured in weeks 4, 8 and 12 of the experiment. Supplementation of Cr-Met did not affect DM intake of cows. As the supplementation of Cr-Met increased, yields of milk, fat, energy corrected milk (P < 0.01) and lactose (P = 0.01) increased in a linear manner. In terms of plasma variables, insulin concentration decreased in a linear manner with Cr-Met supplementation. As for variables relating to hepatic respiration rate, concentrations of pyruvate and NAD in the plasma were increased in quadratic manners, and lactic dehydrogenase activity was linearly increased as Cr-Met feeding levels increased. Moreover, plasma glutathione peroxidase and superoxide dismutase activity were increased in a linear manner. In conclusion, our study suggested that Cr-Met supplementation improved lactation performance of early-lactating dairy cows through enhancing antioxidant capacity and hepatic cellular respiration.

[Seroepidemiology of pertussis in healthy population in Ningbo, 2019]

Objective: To understand the seroepidemiological characteristics of pertussis in healthy population in Ningbo, and estimate the overall incidence of pertussis. Methods: A cross-sectional survey method was used in this study. A total of 1 206 healthy residents in 9 age groups were stratified randomly selected from 3 counties of Ningbo. Serum samples were collected from the subjects, and the pertussis toxin immunoglobulin G antibody (PT-IgG) levels were measured quantitatively by enzyme-linked immunosorbent assay (ELISA). Results: The mean PT-IgG seropositive rate in the subjects was 0.91% (95%CI:0.45%-1.63%) with a geometric mean titer (GMT) of 3.10 (95%CI:2.86-3.36) IU/ml. The seropositive rates ranged from 0.00% to 1.68%, and the GMTs ranged from 2.08 IU/ml to 5.28 IU/ml in 9 age groups. The incidence rate of pertussis was estimated to be 4 572.81 per 100 000 in age group ≥5 years (95%CI:1 807.30 per 100 000-9 348.12 per 100 000), and the peak of estimated incidence rates were found in age group 5- years (9 301.62 per 100 000, 95%CI:1 121.77 per 100 000-33 154.68 per 100 000) and age group ≥50 years old (8 967.02 per 100 000, 95%CI: 1 059.45 per 100 000-31 845.94 per 100 000). Conclusions: The actual incidence of pertussis was high in Ningbo in 2019. As a result of waning immunity after vaccination, pertussis can occur in adolescents and adults. The pertussis surveillance should be strengthened and the pertussis vaccination strategy should be improved.

[Study on transmission dynamic of 15 clusters of COVID-2019 cases in Ningbo]

Objective: To describe the basic characteristics of clusters of coronavirus diseases 2019 (COVID-19) cases in Ningbo, Zhejiang province, and evaluate the generation time (Tg) and basic reproduction number (R(0)) of COVID-19. Methods: The basic information and onset times of the clusters of COVID-19 cases in Ningbo were investigated, the inter-generational interval of the cases were fitted by using gamma distribution, and the R(0) was calculated based on the SEIR model. Results: In the 15 clusters of COVID-19 cases, a total of 52 confirmed cases, 5 cases of nucleic acid-positive asymptomatic cases. The cases occurred from January 23 to February 4, the cases were mainly women. The incubation period was (6.11±3.38) days, and the median was 5 days. The Tg was (6.93±3.70) days. There were no significant differences in Tg between age group<60 years and age group 60 years and above, and between men and women (P=0.551). According to the Tg calculated in this paper, the R(0) of COVID-19 in Ningbo was 3.06 (95%CI: 2.64- 3.51); according to the reported case transmission interval of 7.5 days in the literature, the R(0) was 3.32 (95%CI: 2.51-9.38). Conclusion: There is no age and gender specific differences in the Tg of clusters of COVID-19 cases in Ningbo, and COVID-19 has high infectivity and spreading power in early phase.

[Epidemic dynamic model based evaluation of effectiveness of prevention and control strategies for COVID-19 in Ningbo]

Objective: To evaluate effectiveness of prevention and control strategies for COVID-19 in Ningbo by using an epidemic dynamic model. Methods: The incidence data and epidemic information of COVID-19 reported in Ningbo as of 9 March, 2020 were collected, and based on the implementation of prevention and control strategies, we developed a SEIR epidemic dynamics model. The basic and real-time reproduction numbers were calculated to evaluate effectiveness of prevention and control. Results: A total of 157 cases of COVID-19 were confirmed, without death, in Ningbo. The proportion of severe cases was 12.1%. The mean incubation period was estimated to be (5.7±2.9) days. The mean interval from illness onset to diagnosis was (5.4±3.7) days. The mean duration from diagnosis to hospital discharge was (16.6±6.5) days. A total of 105 339 contacts had been under medical observation. The infection rates in contacts with home quarantine and centralized quarantine were 0.1% and 0.3%, respectively. In the confirmed cases, those who had been under medical observation before diagnoses accounted for 63.1%. The basic reproduction number was estimated to be 4.8. With the strengthening of prevention and control measures, real-time reproduction number showed a gradual downward trend, dropping to below 1.0 on 4 February, and then continued to drop to 0.2 in mid-February. Conclusion: The effectiveness of the prevention and control measures for COVID-19 in Ningbo can be evaluated by using epidemic dynamic model to provide scientific evidence for the development of the prevention and control strategies.

The knockdown of SNHG3 inhibits the progression of laryngeal squamous cell carcinoma by miR-340-5p/YAP1 axis and Wnt/β-catenin pathway

Laryngeal squamous cell carcinoma (LSCC) is a common malignancy of the head and neck. Long noncoding RNAs (lncRNAs) play essential roles in the development and treatment of LSCC. However, the role and regulatory mechanism of lncRNA small nucleolar RNA host gene 3 (SNHG3) in LSCC progression remain largely unknown. Twenty-five paired LSCC tissues and normal samples were collected. The expression levels of SNHG3, Yes-associated protein 1 (YAP1), and microRNA-340-5p (miR-340-5p) were measured via quantitative real-time polymerase chain reaction or western blot. Cell viability, apoptosis, and glycolysis were investigated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-tetrazolium bromide, flow cytometry, and specific assay kit, respectively. The association between SNHG3 and miR-340-5p or miR-340-5p and YAP1 was assessed by dual-luciferase reporter assay. The expression of a protein involved in the Wnt/β-catenin pathway was detected by western blot. The xenograft model was established to assess the anti-cancer role of SNHG3 inhibition in vivo. We found that the levels of SNHG3 and YAP1 were increased but the miR-340-5p expression was decreased in LSCC tissues and cells. The knockdown of SNHG3 or YAP1 inhibited cell viability and glycolysis but induced apoptosis in LSCC cells. Overexpression of YAP1 reversed the effect of SNHG3 knockdown on LSCC progression. SNHG3 could regulate YAP1 expression by competitively binding with miR-340-5p. Overexpression of miR-340-5p suppressed cell viability and glycolysis but promoted apoptosis in LSCC cells. Knockdown of SNHG3 repressed Wnt/β-catenin pathway by regulating miR-340-5p and YAP1. The silencing of SNHG3 reduced LSCC xenograft tumor growth. In conclusion, knockdown of SNHG3 inhibited LSCC progression via inactivating Wnt/β-catenin pathway by regulating the miR-340-5p/YAP1 axis.

[MIPPO and ORIF for the treatment of elderly proximal humerus fractures of type Neer II:a case control study]

OBJECTIVE

To compare the clinical efficacy of minimally invasive percutaneous plate osteosynthesis(MIPPO)and open reduction and internal fixation (ORIF) in treating senile NEER IIproximal humerus fractures.

METHODS

From March 2014 to March 2016, 46 elderly patients with Neer II proximal humerus fractures were retrospectively reviewed. Among them, 20 patients in MIPPO group included 9 males and 11 females with an average age of (70.4±4.4) years old; while 26 patients in ORIF group included 11 males and 15 females with an average age of (70.9±4.0) years old. The length of hospital stay, times of fluoroscopy, beginning time of function rehabilitation, healing time of fracture, Constant Murley score of the shoulder joint at 3, 6, 12 months after operation and complications were observed and compared.

RESULTS

All patients were followed up for 12 to 24 months with an average of 16.8±3.7. The healing time of fracture, beginning time of function rehabilitation in MIPPO group were(13.0±0.8) weeks, (3.0±0.9) days respectively and shorter than those in ORIF group which were (13.8±1.4) weeks and(6.8±1.3) days. The times of fluoroscopy in MIPPO group was 19.2±3.7 and more than that in ORIF group which was 12.1±3.4. At 3 and 6 months after operation, Constant Murley score in MIPPO group were 81.3±3.9, 86.6±5.4 and more than that in ORIF group which were 69.5±6.6, 80.5±6.7. There were no differences between two groups in the length of hospital stay, Constant Murley score at 12 months after operation and grading at the final follow-up. There was one fracture redisplacement in each group. And 1 case of axillary nerve injury in MIPPO group, 2 cases of delayed union in ORIF group. No incision infection, screw loosening or plate break was found.

CONCLUSIONS

MIPPO and ORIF are both effective in treating Neer II proximal humeral fractures. MIPPO technique has the advantages of faster recovery, earlier rehabilitative exercise and better shoulder function. The disadvantages are more exposure to radiationd and the possibility of axillary nerve injure.

[Relationship between particulate matters and cardio-cerebrovascular mortality in Ningbo: a time-series study]

OBJECTIVE

To explore the short-term effect of particulate matters with an aerodynamic diameter of less than or equal to 10 μg (PM10) and aerodynamic diameter of less than or equal to 2.5 μg (PM2.5) on cardio-cerebrovascular mortality in Ningbo city.

METHODS

Daily cardio-cerebrovascular mortality data from 2011 to 2014 in Ningbo city were collected and the time series study using a semi-parametric generalized additive model were used to evaluate the relationship between the mortality of cardio-cerebrovascular disease and particulate matters after adjustment for the long-term trend of death,weather conditions, "days of the week" and other confounding factors.

RESULTS

In single-pollutant model, the short-term effects of particulate matter on cardio-cerebrovascular mortality was strongest in lagged 2 days in Ningbo city, and an increase of 10 μg/m(3) in moving average concentrations (lagged 2-3 days and lagged 2-4 days) of PM2.5 and PM10 could increase the cardio-cerebrovascular mortality by 0.55% (0.23%-0.87%) and 0.53% (0.28%-0.78%), respectively. In multi-pollutant models, PM10 did remain robust after being adjusted for PM2.5 with 0.58% (0.09%-1.07%) increase in cardio-cerebrovascular mortality. The effect of PM2.5 had no statistical significantce after being adjusted for other co-pollutants.

CONCLUSION

These findings suggested that the concentrations of ambient particulate matters were associated with an increased risk of daily cardio-cerebrovascular mortality in Ningbo city.

[Acute effect of air pollutants (carbon monoxide and ozone) on myocardial infarction mortality in Ningbo]

Objective: To explore the effect of carbon monoxide (CO) and ozone (O(3)) in the air on the myocardial infarction mortality in Ningbo, Zhejiang province, from 2011 to 2015. Methods: The data of daily air quality surveillance and the causes of deaths in Ningbo from January 1, 2011 to December 31, 2015 were collected and the time series study using a generalized additive model was conducted to evaluate the relationship between the mortality of myocardial infarction and the air pollutants after adjustment for the long-term trend of death, weather conditions," days of the week" and other confounding factors. Results: The daily average concentrations of CO and O(3) in Ningbo during 2011-2015 were 0.90 (0.02-3.31) mg/m(3) and 82.78 (4-236) μg/m(3), respectively. A total of 5 388 myocardial infarction deaths occurred, with a daily average of 3 deaths. In single-pollutant model, an increase of 0.1 mg/m(3) in average concentration of CO could increase the risk of myocardial infarction mortality by 1.06% (95% CI: 0.29%-1.93%) in general population, and by 1.26% (95% CI:0.28%-2.24%) in aged people aged ≥65 years in lagged 6 days, but the influence was not significant in people aged <65 years. The influence had no significant difference in males, but it increased the risk of myocardial infarction mortality by 1.77% in females (95% CI: 0.44%-3.13%). In multi-pollutant model, CO did remain robust after adjusting for other co-pollutants. Whereas the effect of O(3) had no significant influence. Conclusion: These findings suggested that the increased risk of daily myocardial infarction mortality was associated with the increase of CO concentration, but no such association was found for O(3) in Ningbo.

[Relationship between weather factors and heat stroke in Ningbo city]

OBJECTIVE

To explore the main effects of weather factors on heat stroke.

METHODS

Data from case report on heat stroke was collected in Ningbo city during 2011 to 2014. Temperature threshold, lag effects and interaction of weather factors on heat stroke had been analyzed, using the piecewise regression model, distributed lag non-linear model, response surface model and other methods.

RESULTS

RESULTS showed that temperature and humidity were more correlated with heat stroke than other weather-related factors. Through different models, daily average temperature always presented a better role in predicting the heat stroke, rather than maximum or minimum temperature. Positive association between daily average temperature and heat stroke was obvious, especially at lag 0-1 days, with its threshold as 29.1 (95% CI: 28.7-29.5) ℃ . The cumulative RR of heat stroke at 90(th) percentile of daily average temperature versus 10(th) percentile was 14.05 (95% CI: 7.23-27.31) in lag 0-1 days. The effects of daily relative humidity on heat stroke appeared nonlinear, with low humidity showing a negative effect on heat stroke and could lag for 1-4 days. However, the effect of high humidity was not significant, with the cumulative RR of low humidity and high humidity as 2.35 (95%CI: 1.27-4.33) and 0.86 (95%CI: 0.40-1.85) in lag of 0-4 days, respectively. We also noticed that there was an interactive effect of both temperature and humidity on heat stroke. Under high temperature and low humidity, the risk of heat stroke showed the highest.

CONCLUSIONS

Temperature and humidity showed obvious relationship with heat stroke in Ningbo city, with the threshold temperature as 29.1 ℃. Under high temperature and low humidity, the risk of heat stroke became the highest.

The Effects of Dietary Phosphorus on the Growth Performance and Phosphorus Excretion of Dairy Heifers

The objective of this study was to investigate the effects of reducing dietary phosphorus (P) on the frame size, udder traits, blood parameters and nutrient digestibility coefficient in 8- to 10-month-old Holstein heifers. Forty-five heifers were divided into 15 blocks according to the mo of age and were randomly assigned one of three dietary treatments: 0.26% (low P [LP]), 0.36% (medium P [MP]), or 0.42% (high P [HP]) (dry matter basis). Samples were collected at the wk 1, 4, 8. The results show that low dietary P had no effect on body measurement. The blood P concentration decreased with decreasing dietary P (p<0.05), while the blood calcium content of LP was higher than that of the MP and HP groups (p<0.05), though still in the normal range. The serum contents of alkalinephosphatase, potassium, and magnesium were similar among the treatments. No differences were found in all nutrients' apparent digestibility coefficients with varied dietary P. However, with P diet decreased from HP to LP, the total fecal P and urine P concentration declined significantly, as did fecal water soluble P (p<0.05). In conclusion, reducing the dietary P from 0.42% to 0.26% did not negatively affect the heifers' growth performance but did significantly lessen manure P excretion into the environment.

Biochemical kinetics of cell proliferation regulated by extremely low frequency electromagnetic field

To study the mechanism of cells subjected to external electromagnetic fields, the expression of cyclin kinase inhibitor p27 is analyzed in the four cell cycle phases. The regulatory functions are investigated in gap phase1 to synthesis, gap phase 2 to mitotic phase and post mitotic phase transition in the mammalian cell cycle processes. A mathematical model is developed to meet the general cell cycle regulatory network based on the molecular dynamics method. Phase plane analysis results show that the p27 over-expression can lead to the hysteresis effect of cell cycle processes and phase transition delay. It is an universal approach to predict the key regulatory gene in signal transduction pathway.

Epidemiological characteristics of malaria in Ningbo City, China 2000-2011

The objective of this study was to explore the trend and the epidemiological characteristics of malaria in Ningbo from 2000 through 2011 and provide scientific evidence for the prevention and control. Using the retrospective study, data relating to malaria epidemics during 2000-2011 in Ningbo were collected through the questionnaires of the cases and other important surveillance data. Adult mosquitoes were collected using CDC light traps baited with CO2. Results showed that Plasmodium vivax was the main species, and Anopheles sinensis was the only vector species of malaria. The annual incidence rates (per 100000) ranged from 0.156 to 3.224, and about 95.41% of the cases were imported. The cases occurred mainly between May and November and the incidence showed two peaks, and the local transmission of malaria was determined by vector density. Considering the vast majority of these infections were imported vivax malaria cases from domestic endemic areas (particularly Anhui province), and may lead to limited local transmission, strengthening the routine monitoring of imported malaria, ensuring timely diagnosis, improving case detection rate, giving a standardized treatment to patients and intensifying public health education on malaria prevention are extremely important to malaria prevention and control activities.

Sustained-release bupropion for smoking cessation in a Chinese sample: a double-blind, placebo-controlled, randomized trial

INTRODUCTION

Bupropion is a first-line pharmacological aid for smoking cessation; however, no clinical trials have been conducted in a Chinese population.

METHODS

We enrolled 248 smokers in a hospital-based, randomized, smoking cessation trial conducted at four outpatient centers in Beijing. A total of 123 participants received an 8-week course of sustained-release bupropion (Bup-SR) and 125 participants received 8 weeks of placebo. All participants received brief education and counseling on smoking cessation. We determined rates of abstinence and smoking reduction based on chemical verification and self-report at 8 and 12 weeks.

RESULTS

At the end of the medication treatment (8 weeks) and at the end of the trial (12 weeks), the abstinence rates for Bup-SR were 29.3% and 39.8%, respectively, and 10.4% and 8.0% for placebo, respectively (both p < .001). Bup-SR was also superior to placebo in reducing cigarettes per day and urinary cotinine levels.

CONCLUSION

Bup-SR is efficacious for smoking cessation in healthy Chinese patients treated in the outpatient setting. It is well tolerated with a few mild side effects.

A comparative clinical study of the effects of the traditional Chinese medicine Jinniu capsules and lofexidine on acute heroin withdrawal symptoms

OBJECTIVE

Jinniu capsules, comprised of herbs and marine product extracts, are traditionally used in Chinese medicine. In this randomized multicenter clinical trial we evaluated the efficacy and safety of Jinniu capsules used to treat the symptoms of heroin withdrawal, as compared with lofexidine.

METHODS

Two hundred and twelve patients with heroin dependence were randomly assigned to the Jinniu capsule or lofexidine treatment groups during a 10-day double-blind clinical trial. The severity of their opiate withdrawal symptoms was measured daily for 10 days. Anxiety was measured on days 0, 5, and 10. Safety assessment of the drugs included measurement of vital signs and side effects, as well as laboratory tests.

RESULTS

Withdrawal symptom and anxiety scores decreased gradually over the treatment period, and no significant differences were found between two groups. No severe adverse events occurred during the treatment.

CONCLUSION

Jinniu capsules may be an effective and safe agent in the management of opiate withdrawal.

[Cloning, sequence analysis of deacetoxycephalosporin C synthetase/hydroxylase gene cefEF]

Chromosomal DNA preparations were made form the fungi C. acremonium and A. chrysogenum respectively by a method using 1-Chloro methyl benzene solution. Then the cefEF gene of deacetoxycephalosporin C synthetase/hydroxylase was amplified by polymerase chain reaction. The cefEF gene could only be amplified from the chromosomal DNA of A. chrysogenum. This fragment about 1.0 kb was cloned into pGME-T vector and then sequenced. The sequence indicates that the cloned cefEF gene contains 999 nucleotides encoding for 333 amino acids and there are three bases and two amino acids different from those that have been reported. Both of the two amino acids are not in active site. The result also indicates that the reported C. acremonium or A. chrysogenum generating deacetoxycephalosporin C synthetase/hydroxylase corresponds with A. chrysogenum but not C. acremonium in China.

Apoptosis in human retinal degenerations

PURPOSE

This paper examined the role of apoptosis in human retinal degenerations including pathologic myopia, age-related macular degeneration, serous retinal detachment, retinal lattice, and paving stone degenerations.

METHOD

Thirty-seven enucleated human eyes with 1 of the above-mentioned retinal degenerations were studied by histopathology and by TdT-mediated biotin-dUTP nicked-end labelling (TUNEL) technique.

RESULTS

Tunnel labelling characteristic DNA fragmentation of apoptosis was observed in photoreceptor cells in 2 of the 4 eyes with pathologic myopia and in 4 of 16 eyes with age-related macular degeneration, 2 of which were exudative and 2 of which were atrophic. However, only a few scattered photoreceptor cells were labelled in 4 of 8 eyes with serous retinal detachment secondary to malignant melanoma of the choroid. Moreover, none of the photoreceptors cells in the 4 eyes with retinal lattice degeneration and 6 eyes with retinal paving stone degeneration were labelled.

CONCLUSIONS

Apoptosis is 1 of the important pathways of photoreceptor cell degeneration in pathologic myopia and age-related macular degeneration.

Transoral anterior decompression and fusion of chronic irreducible atlantoaxial dislocation with spinal cord compression

STUDY DESIGN

In this study, 10 patients with chronic irreducible atlantoaxial dislocation were treated by transoral anterior decompression and fusion.

OBJECTIVES

To examine the benefits of the transoral approach, the patients treated with this procedure were compared with the historical control subjects after 2 years of follow-up.

SUMMARY AND BACKGROUND DATA

Chronic irreducible atlantoaxial dislocation with cord compression is difficult to treat because the cord is compressed posteriorly by the posterior arch of the atlas as well as anteriorly by the posterior-superior portion of the axial body and nonunited dens. Its irreducibility, as a result of the bony scarring between the dens and the anterior body of the axis, and the locking of the lateral joints of C1-C2, makes reduction more complex. Posterior surgical approaches have been associated with high morbidity and mortality.

METHODS

Ten patients were diagnosed and followed up by clinical symptoms, radiography, pantopaque myelography, and computed tomography. They were treated surgically by transoral decompression and fusion. During the surgery the nonunited dens as well as callus, granulation, and scar tissue were removed; the cartilage of the articular surfaces of the atlantoaxial joint was excised. Postoperative treatment included skull-cervical biaxial traction, tracheostomy care, nasal feeding, and Minerva cast.

RESULTS

The 2- to 6-year follow-up showed that four out of 10 patients recovered completely and returned to work, three recovered to a great degree and ambulated, two partially recovered, and one recovered poorly.

CONCLUSION

Transoral decompression and fusion offered satisfactory results in a series of patients with chronic irreducible atlantoaxial dislocation. None of the patients showed serious complications of stability, even though only one had a secondary posterior fusion. Therefore, anterior decompression associated with subtotal obliteration of the atlantoaxial joints without bone grafts is a feasible therapy for irreducible atlantoaxial dislocation using a multifunctional bed and biaxial traction.

[Serum apolipoproteins in uremic patients]

Serum Apolipoproteins (Apo) and lipids were determined in 20 patients with uremia. The results were compared with those obtained in sex and age matched controls. The patients had significantly reduced level of Apo AI and ratio of Apo AI/Apo B100, and increased levels of Apo CII, Apo CIII. It was also found that the patients had normal levels of TC, TG and significant decrease of HDL-C, HDL2-C. These findings suggested that Chinese uremic patients had wide extensive Apo abnormalities which could induce disturbances of lipid metabolism and development of atherosclerosis although serum lipid levels were normal, and that Apo might be better predicators of cardiovascular complications than lipids in Chinese patients with uremia.

Preliminary experience in HDR brachytherapy for 72 nasopharyngeal carcinoma patients

From April 1989 to July 1991, 72 patients with residual or recurrent nasopharyngeal carcinoma (NPC) were treated by MSH Ir-192 brachytherapy or combined external radiation therapy. All were proven histologically. 39 patients with residual disease and 6 with recurrent lesion at the primary site were identified after one or more courses of radical external radiation. Eleven patients had received brachytherapy for boost therapy after one or more courses of external radiation. Sixteen were treated with a planned protocol of external irradiation combined with intracavitary brachytherapy. The overall local control rate was 93.3%; the local control rate for residual and recurrent disease was 100% and 50%, respectively. Soft palate perforation was observed in 3 patients. Brachytherapy is believed to be a useful treatment for residual or recurrent NPC following radical external radiation.

Protection by salvianolic acid A against adriamycin toxicity on rat heart mitochondria

It was found that salvianolic acid A (Sai A) has potent antioxidant activity. The effects of Sai A on adriamycin-induced heart mitochondrial toxicity of rats in vitro and on adriamycin antitumor activity are investigated in this article. Malondialdehyde (MDA) formation and membrane rigidification of rat heart mitochondria intoxicated with adriamycin were significantly reduced by Sai A. In the electron spin resonance (ESR) studies, Sai A has no significant effect on the formation of adriamycin semiquinone radicals (AQ.), while hydroxyl radicals generated by electron transfer from AQ. to H2O2 were scavenged by Sai A dose-dependently. On the other hand, Sai A was shown to have no effects on the antitumor activity of adriamycin in cultured L1210 ascitic tumor cells and in mice with P388 ascite tumor. These results indicate that Sai A protects against adriamycin induced heart mitochondrial toxicity of rats, while Sai A has no antagonizing effect on the antitumor activity of adriamycin.

Protection by schisanhenol against adriamycin toxicity in rat heart mitochondria

The effects of schisanhenol (Sal) on Adriamycin (ADM)-induced rat heart mitochondrial toxicity in vitro were investigated. Malondialdehyde formation, lysis, disintegration and membrane rigidification in mitochondria treated with ADM were reduced significantly by Sal. In the electron spin resonance studies, Sal did not affect significantly the formation of ADM semiquinone radicals (AQ.), whereas hydroxyl radicals generated by electron transfer from AQ.to H2O2 were scavenged by Sal dose dependently. These results indicate that Sal could protect against ADM-induced rat heart mitochondrial toxicity.

[Effect of hyperthermal environment on urinary excretion of beta 2-microglobulin and hydrogen ion]

By randomized sampling, 1387 cases working in various circumstances in Chengdu Seamless Steel Tube Plant had their urine net acid clearance (NAC) and osmotic pressure (OSMP) measured, of whom 407 took urine beta 2m examination in addition. Results show that both NAC and OSMP are much higher in the hyperthermal group than in the non-hyperthermal group. There is no significant difference in beta 2m level between the two groups, which demonstrates that the function of proximal renal tubules of the workers in this plant has not been affected, as their working condition conforms to the standards for the prevention of workers made by the government. However, the beta 2m level in the male workers is obviously higher than that in the female. There exists the possibility that the males have contacted the toxic dust at a longer duration, which may be a factor involved in the tubular disorder. The rise of beta 2m together with age is regarded as due to senile decay. This study has provided available data for the set up of worker's prevention system.

Management of local residual primary lesion of nasopharyngeal carcinoma: II. Results of prospective randomized trial on booster dose

Although the question of booster dose for residual primary lesion arises in only 5% of nasopharyngeal carcinoma patients receiving radiotherapy, it poses a difficult problem for clinicians and should be followed. Hence, to test the validity of booster dose for residual primary lesion of nasopharyngeal carcinoma, a prospective randomized trial has been designed and carried out since January 1980. All patients who had a residual lesion in the nasopharynx at 70 Gy were biopsied. Those pathologically positive for cancer were randomized into two groups: (a) positive radiation group (PRG): patients were given further irradiation to a total dose of 90 Gy by the cone-down and assault technique, and (b) positive observation group (POG): patients were given no more irradiation but were followed periodically together with those who were pathology negative (NOG). A total of 78 patients were entered. The validity of booster dose was shown by the 5-year survival rates of the PRG, POG and NOG groups: 75% (3/4), 33% (1/3), and 58% (14/24), respectively. The total local recurrence rates of these groups were 6% (1/16), 36% (5/14), and 4% (2/48), respectively. The authors believe that booster dose for pathology positive residual lesion in the nasopharynx is necessary. The four factors leading to the development of a local recurrence are: (a) residual primary lesion proved positive by pathology but left unboosted, (b) well differentiated squamous cell carcinoma in the original primary lesion, (c) mild radio-response in the cancer parenchyma, and (d) mild radio-response in the interstitial tissue.

Management of local residual primary lesion of nasopharyngeal carcinoma (NPC): are higher doses beneficial?

One hundred and eighty-two nasopharyngeal carcinoma (NPC) patients, treated from March 1958 through 1978, received 70 Gy or more and were left with gross residual lesion in the nasopharynx, were retrospectively analyzed. Ninety-two patients were given a boost by reduced portals to a total of 90-120 Gy (boost group) whereas for the other non-randomized 90 patients, the treatment was stopped at 70 Gy (observation group). The local recurrence, distant metastasis and 5-year survival rates of the two groups are: 35% (32/92) vs. 58% (52/90), 20% (18/92) vs. 43% (39/90), and 54% (50/92) vs. 21% (19/90), respectively. The benefit of boost is more apparent in patients with T1-2 than T3-4 lesions (p less than 0.001), at increased risk of radiation encephalo-myelitis from 5.5% to 17%. The authors believe that boost be given to patients with early Stage T or small residual lesion at the primary site of NPC.

Chinese herb "destagnation" series I: Combination of radiation with destagnation in the treatment of nasopharyngeal carcinoma (NPC): a prospective randomized trial on 188 cases

The results of a prospective randomized trial on 188 patients with NPC is reported to evaluate the validity of Chinese herbal medicine-Destagnation combined with radiotherapy. Ninety patients were allotted to the Destagnation group (radiation plus Destagnation) and 98, to the control group (radiation only). The 5-year success rate (number surviving minus number recurred but salvaged by re-treatment) of the Destagnation group is 53% (48/90) in comparison to 37% (36/98) of the control group (p less than 0.05). Minor complications of Destagnation included occasional anorexia and frequency of bowel movement. The reduced rate of local recurrence at the primary site in the Destagnation group (14%-13/90) as compared to that of the control group (29%-28/98) (p less than 0.05) suggests that Destagnation may be a radiosensitizer. The similar metastatic rates in both groups; 21% (19/90) in the Destagnation group and 21% (21/98) in the control group may refute the belief that Destagnation enhances hematogenous spread.

[Radiotherapy of nasopharyngeal carcinoma--analysis of 1379 patients]

This paper presents 1379 patients with nasopharyngeal carcinoma treated in our hospital from March 1958 to December 1978. The stage I and II lesions comprised 22% and stage III and IV lesions, 78%. 220 KV X-ray was used before 1960 and 60Co was predominant from 1961 through 1978. The overall 5 year survival rate was 41.4% (571/1379). Young adults and female patients gave better results. The 5 year survival rate was, according to pathological type, 45.1% for poorly differentiated squamous cell carcinoma and 13% for adenocarcinoma; according to clinical stage, 85.7% for stage I lesion, 59.5% for stage II, 45.8% and 29.2% for stages III and IV; according to period of treatment, 31.3% in the sixties and 48.6% in the seventies; according to tumor dose at the primary focus, 48.2% for 40-49 Gy, 55.6% for 60-69 Gy and 67.3% for 90 Gy or more; according to with or without prophylactic radiation in the neck region, 53.8% for the former and 23% for the latter. It implies that prophylactic radiation of the neck is necessary regardless of the presence of cervical lymph node metastasis or not. For those who had residual tumor at 70 Gy, the total dose may be boosted to more than 90 Gy with the cone down technic or the dose, at which the primary lesion disappears grossly, is added with 20 Gy. The common complications are radiation myelitis, trismus and otitis media. As in certain patients, the lesion would still recur 5 years after radiotherapy, the authors believe that the nasopharyngeal cancer patients should be followed for ten years at least.

Analysis of 1379 patients with nasopharyngeal carcinoma treated by radiation

One thousand three hundred seventy-nine nasopharyngeal carcinoma (NPC) patients were treated from March 1958 to December 1978. Twenty-two percent had stage I or II and 78% Stage III or IV had lesions. Two hundred twenty-Kv radiographs were used before 1960; and telecobalt was used from 1961 to 1978. Factors influencing the 5-year survival rate favorably are youth of patient, being female, pathologic condition (poorly differentiated carcinoma, 45.1% versus adenocarcinoma, 13%), stage (Stage I, 86%, Stage II, 59.5%; Stage III, 45.8%; Stage IV, 29.2%), decade admitted for treatment in the past (31% in the 1950s, 48.6% in the 1970s), total dose delivered to the nasopharynx (40 to 49 Gy, 46%; 70 to 79 Gy, 54.1%; 90 Gy or more, 64%) and prophylactic radiation to the neck regions (with prophylactic irradiation, 53.8%, without prophylactic irradiation, 23%). This implies that prophylactic radiation of the neck is crucial even without positive clinical metastasis. For those who have a residual tumor in the primary site when 70 Gy has been delivered, the total dose may be boosted to more than 90 Gy with the cone-down technique or on basis of adding 20 Gy to the dose at which the primary lesion disappeared grossly. The common postirradiation complications are: radiation myelitis, trismus, and otitis media. Because disease recurred in some patients after the fifth year, NPC patients should be followed for at least 10 years.

Salvage surgery for nasopharyngeal carcinoma

Nasopharyngeal carcinoma is not a disease to be treated primarily by surgery. Radiation is the first choice of treatment. But, once it recurs, a second course of radiation controls only a small portion of the patients, with a high risk of accumulated radiation injury. We discuss the outcome of salvage surgery in nine cases of nasopharyngeal recurrence and 69 cases of neck metastasis that was uncontrolled or had recurred after irradiation was evaluated. A five-year survival rate of 44% for the primary lesions and 49% for the neck node metastases justifies the rationale of surgery on selected cases of radiation failure.

Value of postoperative radiotherapy for thyroid cancer

A series of 405 patients with thyroid cancer treated by surgery with or without postoperative radiotherapy from February 1958 through 1979 is reported. The immediate evaluation of the operation was that it was either incomplete or complete. Incomplete surgery implied that there was (1) possible residual tumor in the operative field, the result of difficult dissection of the tumor off the neighboring organs or tissues, as assessed by the surgeon; (2) multiple (more than five) lymph nodes involved; (3) positive border of the removed lesions; or (4) microscopic evidence of tumor in the operative field. Complete surgery implied through extirpation of cancer grossly and microscopically. In 297 patients who had complete surgery, 238 patients treated by surgery alone had a 5-year survival rate of 92% (218/238), while 59 patients who received postoperative radiotherapy had a 5-year survival rate of 78% (46/59). The optimum dose of postoperative radiotherapy was 50-70 Gy in 5 to 8 weeks, with the spinal dose kept under 40 Gy. Our experience shows that postoperative radiotherapy did not improve the survival of patients who had had complete surgery. Yet, in 108 patients who had incomplete surgery, surgery alone yielded a 5-year survival rate of 33% (19/57), while surgery plus radiotherapy yielded a 5-year survival of 71% (36/51). Our observation shows a remarkable benefit with postoperative radiotherapy in patients who have had incomplete surgery (P less than 0.05). According to pathologic criteria, postoperative radiotherapy was more effective in well-differentiated cancers than in poorly differentiated ones. It was equally effective in untreated as well as recurrent lesions. The prognosis for younger patients was better, but the sex of the patients did not affect prognosis.

Channel-closing activity of porins from Escherichia coli in bilayer lipid membranes

The opening and closing of the ompF porin from Escherichia coli JF 701 was investigated by reconstituting the purified protein into planar bilayer membranes. The electrical conductance changes across the membranes at constant potential were used to analyze the size and aggregate nature of the porin channel complexes and the relative number of opening and closing events. We found that, when measured at pH 5.5, the channel conductance diminished and the number of closing events increased when the voltage was greater than 100 mV. The results suggest that the number of smaller sized conductance channels increases above this potential. There was also an increase in the smaller subunits and in the closing events when the pH was lowered to 3.5, and these changes were further enhanced by increasing the voltage. We propose that both lowering the pH and elevating the potential across the membrane stabilize the porin in a conformation in which the subunits are less tightly associated and the subunits open in a non-cooperative manner. These same conditions also appear to stabilize the closed state of the pore.

Value of computed tomography in staging the primary lesion (T-staging) of nasopharyngeal carcinoma (NPC): an analysis of 54 patients with special reference to the parapharyngeal space

CT scans of the nasopharynx and the base of skull were performed in 54 patients with histologically proven NPC. The CT findings are compared to those obtained by routine clinical examination. In this series, involvement of the parapharyngeal spaces was found by CT scan in 61% (33/54) of patients, which is impossible to assess by clinical means. Intracranial invasion was demonstrated by CT scan with intravenous contrast enhancement in five patients. CT is more sensitive in showing the erosion of skull base than X ray film. CT scans demonstrated 17% (5/30) of bony invasion in X ray negative patients. Clinical examination showed one involved wall in nine patients; CT scan discovered involvement of two or more walls in five (55%) of these nine. Routine clinical examination discovered extra-nasopharyngeal extensions in 34 locations, whereas CT scans discovered 106, a ratio of 1:3.1. The common sites of extra-nasopharyngeal extension detected by CT scan are: parapharyngeal space, intracranial invasion, sphenoidal sinus, orbit, ethmoidal sinus, maxillary antrum, oropharynx and the nasal cavity. In T-staging of NPC, 55% (6/11) of clinical T2 lesions are up-staged by CT. Thirty-six percent (4/11) of clinical T3 lesions were also up-staged. However, 94% (17/18) of clinical T4 lesions remained unchanged. Only 6% (1/18) of clinical T4 lesions were down-staged.

Lymph node metastases in the neck from an unknown primary. Report on 113 patients

A series of 113 patients with cervical lymph node metastases from an unknown primary tumour is reported. The 5-year survival was 5 per cent after chemotherapy and 37 per cent after irradiation. The factors relevant to the prognosis after irradiation were the location of the mass and the total dose given. The prognosis was better if the mass was located in the neck than in the supraclavicular fossa. It is recommended that most patients with metastases in the upper or middle part of the neck from an unknown primary be radically irradiated with extended fields including nasopharynx, oropharynx, hypopharynx, and the opposite upper part of the neck in addition to the side with metastases. The tumour dose should preferably be higher than 50 Gy. With this policy it was possible to obtain a 5-year survival in about 50 per cent in a series of Chinese patients, which is quite comparable with the result of surgery. In the series reported, the primary lesions were detected during follow-up in only 6 per cent of the cases.