[Application of retroauricular sulcus incision in the operation of benign tumors in the deep lobe of parotid gland]

Objective: To investigate the application of retroauricular groove incision in the resection of benign tumors in the deep lobe of parotid. Methods: From January 2017 to January 2022, 19 patients (11 males and 8 females, age ranged from 17 to 69 years, with a median age of 48) with benign tumor in the deep lobe of parotid gland underwent parotidectomy through retroauricular sulcus incision in Linyi People's Hospital. Among them, 17 cases with tumor diameter≤4.0 cm underwent simple retroauricular groove incision, and 2 cases were dumbbell type with tumor diameter>4.0 cm on the medial side of mandible protruding into the parapharyngeal space, in which the deep lobe and tumor of parotid gland were resected through retroauricular sulcus incision combined with intraoral incision. Results: Tumors were completely removed through retroauricular sulcus incision in 17 cases, and dumbbell type tumors were removed through retroauricular sulcus incision combined with intraoral incision in 2 cases. Postoperative pathological examinations showed pleomorphic adenoma in 13 cases, basal cell adenoma in 4 cases and Warthin's tumor in 2 cases. Temporary mandibular marginal branch paralysis occurred in 2 patients and returned to normal 3 weeks after operation. All incisions healed in Phase I. By following-up of 1-5 years with a median follow-up time of 3.1 years, none of the patients had Frey syndrome, salivary fistula, other complications and tumor recurrence. The patients and their families were satisfied with the postoperative facial appearances. Conclusion: The retroauricular groove approach can not only preserve the function of parotid superficial lobe and facial nerve, but also has less trauma, less tissue defect and hidden scar. As the advantages of less complication, low recurrence rate and good cosmetic effect, the incision is worthy of clinical application.

Safety and Efficacy Analysis of Patients with Extensive-Stage Small Cell Lung Cancer (ES-SCLC) Treated with SHR-1316 Plus Chemotherapy and Sequential Chest Radiotherapy as First-Line Therapy from a Phase II Trial

PURPOSE/OBJECTIVE(S)

CAPSTONE-1, a phase 3 trial, showed that SHR-1316 (PD-L1 antibody) combined with standard first-line chemotherapy could prolong overall survival (OS) in patients (pts) with ES-SCLC. The CREST trial reported consolidative thoracic radiotherapy (TRT) of 30 Gy in 10 fractions provided a 10% 2-year OS benefit and more intensive TRT should be investigated in ES-SCLC. In the era of immunotherapy, the role of TRT also needs further exploration. Therefore, we designed this clinical trial to investigate the efficacy and safety of SHR-1316 plus first-line chemotherapy followed by TRT combined with SHR-1316.

MATERIALS/METHODS

Key inclusion criteria were pts aged 18-75 years, with previously untreated histologically or cytologically confirmed ES-SCLC, and an ECOG performance status of 0-1. Eligible pts would receive 4∼6 cycles of SHR-1316 (20mg/kg, D1, q3w) combined with EP/EC (etoposide, 100mg/m2, D1-5, q3w and cisplatin, 75mg/m², D1-3, q3w or carboplatin, AUC = 5, D1, q3w), followed by SHR-1316 combined with TRT (≥3 Gy*10 f or ≥2 Gy*25 f, involved-field irradiation), and then the maintenance therapy with SHR-1316 until disease progression or intolerable adverse events (AEs). The main endpoints included ORR, PFS and safety.

RESULTS

From October 2020 to January 2023, 33 pts received SHR-1316 and sequential consolidative TRT. Among them, 19 pts received high-dose TRT (>3 Gy*10 f or ≥2 Gy*25 f) and 14 pts received low-dose TRT (≤3 Gy*10 f or<2 Gy*25 f). The median age was 62 (range: 38-73). Most pts were male (28, 84.8%), former smokers (22, 66.7%) with an ECOG performance status 1 (32, 97%). Ten (30.3%) pts were diagnosed with brain metastasis and 10 (30.3%) pts had liver metastasis at baseline. At the data cutoff date, 9 pts remained on treatment, the average number of treatment cycles was 9.2. 33 pts had at least one 1 post-treatment tumor assessment. The confirmed ORR and DCR were 90.9% (30/33) and 100% (33/33) in all pts, were 89.5% (17/19) and 100% (19/19) in high-dose TRT group, and were 92.9% (13/14) and 100% (14/14) in low-dose TRT group. The median PFS was 10.2(CI: 5.8∼14.7) months in all pts, was 7 (CI: 3.8∼10.2) months in high-dose TRT group and 10.4 (CI: 8.4∼12.3) months in low-dose TRT group. AEs occurred in 27 (81.8%) pts and grade 3 or 4 AEs occurred in 20 (60.6%) pts. The most common grade 3 or 4 AEs included neutropenia (15, 45.5%), leukopenia (8, 24.2%), lymphocytopenia (5, 15.2%), pneumonia (3, 9.1%), anemia (3, 9.1%) and thrombocytopenia (2, 6.1%).

CONCLUSION

SHR-1316 plus chemotherapy and sequential TRT as first-line therapy for ES-SCLC showed promising efficacy and acceptable safety. There is no significant difference between high-dose and low-dose TRT groups in terms of safety and efficacy according to current data.

Study on the Dynamic Changes of Myocardial Injury Markers in Radiotherapy for Esophageal Carcinoma and Its Correlation with Cardiac Dosimetry

PURPOSE/OBJECTIVE(S)

It was hypothesized that radiotherapy for esophageal cancer could cause radiation-induced heart damage. To investigate the dynamic changes of myocardial enzyme, high-sensitive troponin T (hs-TnT), N-terminal pro-brain natriuretic peptide precursors (PRO-BNP) and left ventricular ejection fraction (LVEF) during radiotherapy and six months after radiotherapy for middle and lower thoracic squamous cell carcinoma, and to analyze the correlation between these indicators and dose-volume histogram (DVH) parameters of the heart.

MATERIALS/METHODS

A total of 35 patients with thoracic esophageal squamous cell carcinoma who underwent radical concurrent chemoradiotherapy were enrolled in the study. Radiation therapy was performed for up to 6 weeks. All patients received Intensity modulated radiation therapy (IMRT). Total radiation dose was from 50.4Gy to 60 Gy in each patient with a dose of 1.8-2.0 Gy per fraction. Blood samples to determine creatine kinase (CK), creatine kinase isoenzyme MB (CK-MB), lactic dehydrogenase (LDH), alpha-hydroxybutyric dehydrogenase (α-HBDH), hs-TnT, PRO-BNP and LVEF were measured before radiotherapy, during (10th -20th fraction), at the end of radiotherapy, 1, 3, 6 months after radiotherapy. The dynamic changes of the above indexes were analyzed. The correlation between the above indexes and the mean heart dose (Dmean), V5-V60 (dose-volume histograms data were recorded in discrete 5Gy dose levels) of the heart in the course of radiotherapy was also analyzed.

RESULTS

The Serum hs-TNT and LVEF show an upward trend during radiotherapy, at the end of radiotherapy and 6 months after radiotherapy for esophageal cancer. The hs-TnT of patients before, during, at the end of radiotherapy and 1, 3, and 6 months after radiotherapy were 7.2pg/ml, 9.1pg/ml, 9.1pg/ml, 9.0pg/ml, 9.4pg/ml, and 8.1pg/ml, respectively (p<0.05). The LVEF were 63.7%, 62.4%, 62.0%, 62.5%, 62.2%, 61.9% respectively (p<0.05). The pro-BNP showed an upward trend during radiotherapy and gradually returned to normal after radiotherapy. The CK and CK-MB showed a downward trend during radiotherapy and 1 month after radiotherapy, and gradually returned to normal 3 months after radiotherapy. Compared with the low dose group (the average dose of heart < 2000cGy), the high dose group (≥2000cGy) had a greater increase in hs-TNT, pro-BNP and LVEF, and a slower recovery time. There was no correlation between the changes of myocardial enzyme, hs-TnT, PRO-BNP, LVEF and the heart mean dose, V5-V60 during radiotherapy (p>0.05).

CONCLUSION

Cardiac injury induced by concurrent chemoradiotherapy for middle and lower thoracic esophageal cancer can lead to the increase of serum hs-TNT and pro-BNP and the increase of LVEF in the early stage of treatment, and this phenomenon is more obvious in the high-dose group. The hs-TnT and PRO-BNP are sensitive parameters to reflect the heart damage in esophageal cancer radiotherapy, which may provide reference for the heart protection during radiotherapy.

Establishment and characterization of an immortalized bovine intestinal epithelial cell line

Primary bovine intestinal epithelial cells (PBIECs) are an important model for studying the molecular and pathogenic mechanisms of diseases affecting the bovine intestine. It is difficult to obtain and grow PBIECs stably, and their short lifespan greatly limits their application. Therefore, the purpose of this study was to create a cell line for exploring the mechanisms of pathogen infection in bovine intestinal epithelial cells in vitro. We isolated and cultured PBIECs and established an immortalized BIEC line by transfecting PBIECs with the pCI-neo-hTERT (human telomerase reverse transcriptase) recombinant plasmid. The immortalized cell line (BIECs-21) retained structure and function similar to that of the PBIECs. The marker proteins characteristic of epithelial cells, cytokeratin 18 (CK18), occludin, zonula occludens protein 1 (ZO-1), E-cadherin and enterokinase, were all positive in the immortalized cell line, and the cell structure, growth rate, karyotype, serum dependence and contact inhibition were normal. The hTERT gene was successfully transferred into BIECs-21 where it remained stable and was highly expressed. The transport of short-chain fatty acids and glucose uptake by the BIECs-21 was consistent with PBIECs, and we showed that they could be infected with the intestinal parasite, Neospora caninum. The immortalized BIECs-21, which have exceeded 80 passages, were structurally and functionally similar to the primary BIECs and thus provide a valuable research tool for investigating the mechanism of pathogen infection of the bovine intestinal epithelium in vitro.

Simultaneous Confidence Band Approach for Comparison of COVID-19 Case Counts

The outbreak of the novel coronavirus (COVID-19) was declared to be a global emergency in January of 2020, and everyday life throughout the world was disrupted. Among many questions about COVID-19 that remain unanswered, it is of interest for society to identify whether there is any significant difference in daily case counts between males and females. The daily case count sequences are correlated due to the nature of a contagious disease, and contain a nonlinear trend owing to several unexpected events, such as vaccinations and the appearance of the delta variant. It is possible that these unexpected events have changed the dynamical system that generates data. The classic t-test is not appropriate to analyze such correlated data with a nonconstant trend. This study applies a simultaneous confidence band approach in an attempt to overcome these difficulties; that is, a simultaneous confidence band for the trend of an autoregressive moving-average time series is constructed using B-spline estimation. The proposed method is applied to the daily case count data of seniors of both genders (at least 60 years old) in the State of Ohio from April 1, 2020 to March 31, 2022, and the result shows that there is a significant difference at the 95% confidence level between the two gender case counts adjusted for the population sizes.

[Risk assessment of internal mammary lymph node metastasis and choice of irradiation of internal mammary lymphatic drainage area in breast cancer patients with negative internal breast lymph nodes on imaging]

Objective: To explore the independent risk factors of internal mammary lymph nodes (IMN) metastasis and the risk assessment method of IMN metastasis preoperatively in breast cancer patients with negative IMN in imaging examination, and guide the radiotherapy of IMN in patients with different risk stratification of IMN metastasis. Methods: The clinical and pathological data of 301 breast cancer patients who underwent internal mammary sentinel node biopsy(IM-SLNB) and/or IMN dissection in Shandong Cancer Hospital with negative IMN on CT and/or MRI from January 2010 to October 2019 were analyzed retrospectively. The independent risk factors were analyzed by univariate and multivariate logistic regression, and the independent risk factors of IMN metastasis were used to risk stratification. Results: Among the 301 patients, 43 patients had IMN metastasis, and the rate of IMN metastasis was 14.3%. Univariate analysis showed that vascular tumor thrombus, progesterone receptor (PR) expression, T stage and N stage were associated with IMN metastasis. Multivariate logistic regression analysis showed that tumor located in medial quadrant, positive PR and axillary lymph node metastasis were independent risk factors for IMN metastasis. The risk of IMN metastasis was assessed according to the independent risk factors of the patients: low-risk group is including 0 risk factor, medium-risk group is including 1 risk factor, and high-risk group is including 2-3 risk factors. According to this evaluation criteria, 301 patients with breast cancer were divided into low-risk group (with 0 risk factors), medium-risk group (with 1 risk factor) and high-risk group (with 2-3 risk factors). The IMN metastasis rates were 0 (0/34), 4.3% (6/140) and 29.1% (37/127), respectively. Conclusions: The risk stratification of IMN metastasis according to three independent risk factors of IMN metastasis including tumor located in medial quadrant, positive PR and axillary lymph node metastasis in breast cancer patients can guide the radiotherapy of IMN in newly diagnosed breast cancer patients. For N1 patients, radiotherapy of IMN is strongly recommended when the primary tumor is located in the medial quadrant and/or PR positive.

FGD5‑AS1 is an oncogenic lncRNA in pancreatic cancer and regulates the Wnt/β‑catenin signaling pathway via miR‑577

The objective of the present study was to clarify the expression characteristics of long non-coding RNA (lncRNA) FGD5 antisense RNA 1 (FGD5-AS1) in pancreatic cancer, as well as its biological function and underlying mechanism. Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) was utilized for the detection of FGD5-AS1 and microRNA (miR)-577 expression levels in pancreatic cancer tissues. Transfection was performed to upregulate or downregulate FGD5-AS1 in pancreatic cancer cell lines. MTT and Transwell assays were then utilized to detect the proliferation, migration and invasion of cancer cells, respectively. Subsequently, dual-luciferase reporter gene assay, RNA immunoprecipitation assay, RNA pull-down assay, RT-qPCR, western blotting, and Pearson's correlation analysis were employed to confirm the regulatory relationships among FGD5-AS1, miR-577, low-density lipoprotein receptor-related protein 6 (LRP6) and β-catenin. Western blotting was employed to determine the expression levels of Axin2, cyclin D1 and c-Myc. The expression level of FGD5-AS1 was upregulated in pancreatic cancer tissues and cell lines. FGD5-AS1 knockdown inhibited pancreatic cancer cell proliferation, migration and invasion. By contrast, miR-577 was significantly inhibited in pancreatic cancer cells and tissues; its downregulation promoted pancreatic cancer cell proliferation, migration and invasion, and reversed the effects of FGD5-AS1 knockdown on pancreatic cancer cells. In addition, it was revealed that miR-577 was a target of FGD5-AS1, and FGD5-AS1 could modulate the expression levels of LRP6, β-catenin, Axin2, cyclin D1 and c-Myc via suppressing miR-577. In conclusion, in pancreatic cancer, highly expressed FGD5-AS1 activated the Wnt/β-catenin signaling and promoted cancer cell proliferation, migration and invasion via suppression of miR-577.

Construction of tissue-engineered skin with rete ridges using co-network hydrogels of gelatin methacrylated and poly(ethylene glycol) diacrylate

Tissue-engineered skin, as a promising skin substitute, can be used for in vitro skin research and skin repair. However, most of research on tissue-engineered skin tend to ignore the rete ridges (RRs) microstructure, which enhances the adhesion between dermis and epidermis and provides a growth environment for epidermal stem cells. Here, we prepared and characterized photocurable gelatin methacrylated (GelMA) and poly(ethylene glycol) diacrylate (PEGDA) co-network hydrogels with different concentrations. Using a UV curing 3D printer, resin molds were designed and fabricated to create three-dimensional micropatterns and replicated onto GelMA-PEGDA scaffolds. Human keratinocytes (HaCaTs) and human skin fibroblasts (HSFs) were co-cultured on the hydrogel scaffold to prepare tissue-engineered skin. The results showed that 10%GelMA-2%PEGDA hydrogel provides the sufficient mechanical properties and biocompatibility to prepare a human skin model with RRs microstructure, that is, it presents excellent structural support, suitable degradation rate, good bioactivity and is suitable for long-term culturing. Digital microscope image analyses showed the micropattern was well-transferred onto the scaffold surface. Both in vitro and in vivo experiments confirmed the formation of the epidermal layer with undulating microstructure. In wound healing experiments, hydrogel can significantly accelerate wound healing. This study provides a simple and powerful way to mimic the structures of human skin and can make a contribution to skin tissue engineering and wound healing.

The Effects of Key Influencing Factors on Unsafe Events in Airport Flight Areas According to Time Series Data

This study applied modern econometric models to analyze the factors affecting the number of unsafe events (NUE) in the airport flight area using time series data from 1993 to 2017. Influencing factors considered in this article include gross domestic product (GDP) per capita (GDPPC), household consumption level (HCL), the civil aviation passenger turnover (CAPT), the number of civil aviation transport aircraft (NCATA), the total population of the whole country, and the number of civil aviation employment (NCAE). First, the Johansen cointegration test results demonstrate that HCL, NCATA, and NCAE have long-term effects on unsafe events-namely, a 1% increase in HCL corresponds to an average 0.262% increase in NUE. In addition, a 1% increase in NCATA correlates to an average 2.339% increase, and a 1% increase in NCAE corresponds to an average 2.202% decrease in NUE with fixed variables. The analysis results based on the vector error correction model suggest that CAPT has short-term effects on unsafe events and positively correlates to unsafe events. The results of the impulse response function also indicate that the impact of NUE in the previous period on the change of NUE gradually weakens and finally tends to be stable. Finally, NCATA is found to promote the change of NUE significantly. Similarly, the results of variance decomposition also indicate that NCATA has the greatest contribution to the change of NUE, followed by NUE in the previous period. The findings reveal the effects of key factors on the change of unsafe events in airport flight areas, thus providing a valuable theoretical basis for preventing the occurrence of unsafe incidents.

Effects of Glycyrrhiza polysaccharide in diet on growth performance, serum antioxidant capacity, and biochemistry of broilers

In the present study, we analyzed the effects of Glycyrrhiza polysaccharide (GCP) on growth performance, serum antioxidant capacity, and biochemistry of broilers. A total of 600, one-day-old AA broilers randomly divided into 5 treatment groups with 6 replicate pens of 20 birds per cage received dietary supplementation with GCP (0, 200, 500, 1,000, and 1,500 mg/kg) for 42 d. The supplementation of GCP linearly decreased (P < 0.05) feed conversion rate on day 22 to 42. Dietary supplementation with GCP reduced (P < 0.05) serum total cholesterol on day 21 and 42 and linearly improved (P < 0.05) albumin and high-density lipoprotein cholesterol. Dietary supplementation with 1,000 or 1,500 mg/kg GCP significantly increased (P < 0.05) serum total superoxide dismutase (T-SOD) activity on day 21 and 42 and reduced (P < 0.05) serum malondialdehyde content on 21 d. Dietary supplementation with 1,000 or 1,500 mg/kg GCP significantly improved (P < 0.05) interleukin-1β (IL-1β) and interferon-γ (IFN-γ) expressions in liver on day 21 and 42. At the end of the experiment, we randomly selected 20 broilers from 3 treatment groups (0, 1,000, and 1,500 mg/kg), respectively, to perform an lipopolysaccharide (LPS)-induced acute stress experiment. The 60 broilers were divided into 6 treatment groups with 10 birds per cage. The experiment was designed as a 3 × 2 factorial arrangement with GCP (0, 1,000, or 1,500 mg/kg) and LPS (injection of saline or 1 mg/kg body weight) levels as treatments. When the grouping was finished, the broilers were immediately intraperitoneally injected with LPS or normal saline. Six hours after challenged, serum antioxidant and liver immunity were analyzed. The results showed that dietary GCP prevented LPS-induced reductions in T-SOD activity and increases in malonaldehyde content (P < 0.05). Also, dietary GCP supplementation mitigated the LPS-induced increase in IL-1β and IFN-γ in the liver. Supplementation with 1,500 mg/kg GCP showed the most optimal effect in broilers. GCP has the potential to be used as feed additive in broilers.

Efficacy and safety of iguratimod on patients with primary Sjögren's syndrome: a randomized, placebo-controlled clinical trial

Objective: To evaluate the clinical efficacy and safety of iguratimod for the treatment of primary Sjögren's syndrome (pSS) and explore its possible mechanism of action.Method: We conducted a randomized, placebo-controlled clinical trial in 66 pSS patients. Patients were randomized in a 2:1 ratio to receive oral iguratimod for 24 weeks or matching placebo. The primary endpoint was the EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI). Secondary endpoints included mental discomfort visual analogue scale (VAS) score, patient global assessment (PGA), EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI), Schirmer's test values, unstimulated whole salivary flow, erythrocyte sedimentation rate (ESR), and immunoglobulin G (IgG). The proportions of B cells in peripheral blood and levels of serum B-cell activating factor (BAFF) were measured at baseline and week 24 in the iguratimod group. All adverse events were recorded during the trial period.Results:ESSPRI improved more in the iguratimod than in the placebo group (p = 0.016). Mental discomfort VAS score, PGA, Schirmer's test, ESR, and IgG also improved more in the iguratimod than in the placebo group (all p < 0.05). Adverse events were reported 13.6% of the iguratimod group. Levels of BAFF and proportions of plasma cells in patients decreased significantly after iguratimod treatment. The proportions of peripheral plasma cells had positive correlations with both serum IgG and BAFF.Conclusion: Iguratimod improved some dryness symptoms and disease activity in pSS patients, and reduced the level of BAFF and percentage of plasma cells over 24 weeks. Iguratimod seems to be an effective and safe treatment for pSS.

A Bifunctional Coordination Polymer for Al3+ Ion Detection and its Treatment Effect on Nonalcoholic Fatty Liver Disease by Promoting Lipoxygenases and Reducing Intrahepatic Triglyceride Content

In this study, a new Cd(II)-bearing coordination polymer with the chemical formula of {[Cd₄(meda)₃(dpe)₄(H₂O)₄]·(NO₃)₂·2(H₂O)}_n (1, H₂meda = 3,3'-methylenedibenzoic acid, dpe = 1,2-di(pyridin-4-yl)ethane) has been successfully prepared by reaction of Cd(NO₃)·4H₂O with a V-shape carboxyl ligand H₂meda along with the linear dipyridine ligand dpe under the hydrothermal conditions. Due to its intensive luminescence, complex 1 could be utilized as the sensor of detecting Al³⁺ ion, and its detection limit is 4 × 10^-6 M. Firstly, the toxicity of the compound on the normal liver cells was determined with Cell Counting Kit-8 detection kit. The triglyceride in liver cells was detected by detection kit after compound treatment and the relative expression of 15-lox and 12-lox in L02 cells was also measured by RT-PCR after compound treatment. In addition, multiple functional groups that provided by the synthesized Cd(II) complex have been studied by using molecular docking simulation for the confirmation of possible binding modes that formed between ligand and receptor.

Efficacy of surgical treatment on different sizes of hepatitis B virus-related hepatocellular carcinoma and prognostic analysis

PURPOSE

To investigate the efficacy of surgical resection for patients with different sizes of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC), and to analyze the risk factors influencing the prognosis.

METHODS

The clinical data of a total of 138 patients with HBV-related HCC admitted to and treated in our hospital from June 2012 to June 2014 were retrospectively analyzed, and the patients were divided into small HCC (SHCC) group (tumor diameter ≤5 cm, n=69) and solitary large HCC (SLHCC) group (tumor diameter >5 cm, n=69) based on the size of tumors. The differences in operative methods, operation time, intraoperative blood loss, number of intraoperative blood transfusion, time of portal triad clamping and incidence of complications, as well as postoperative liver function and alpha fetoprotein (AFP) indexes, tumor recurrence and survival conditions were compared between the two groups.

RESULTS

Among the 138 HCC patients who underwent hepatectomy, 54 cases had ≥3 resected hepatic segments, and 84 cases had <3 resected hepatic segments. SHCC group exhibited remarkably shorter operation time and notably smaller intraoperative blood loss than SLHCC group. The 1-, 3- and 5-year overall survival rates were 91.3%, 87.0%, 71.0%, 60.9%, 58.0% and 46.4%, respectively, and the 1-, 3- and 5-year disease-free survival rates were 71.0%, 63.8%, 47.8%, 44.9%, 37.7% and 30.4%, respectively, in the two groups. The log-rank test showed that the overall survival rate in SHCC group was distinctly higher than that in SLHCC group (p=0.041), and no statistically significant difference in the disease-free survival rate was detected. According to multivariate analysis, HBV deoxyribonucleic acid (DNA) load ≥104 U/mL, tumor diameter >5 cm and positive microvascular invasion were independent risk factors for the patient's prognosis (p<0.05).

CONCLUSIONS

SLHCC has a similar disease-free survival rate to SHCC but a lower overall survival rate than SHCC. HBV DNA load ≥104 U/mL, tumor diameter >5 cm and positive microvascular invasion are independent risk factors for the patient's prognosis.

Expression and prognostic significance of long noncoding RNA AK001796 in esophageal squamous cell carcinoma

OBJECTIVE

Previous study has reported that long noncoding RNA AK001796 (AK001796) functions as a tumor promoter in esophageal squamous cell carcinoma (ESCC). However, its clinical in ESCC patients remains largely unclear. The purpose of the present study was to evaluate the prognostic value of AK001796 in ESCC patients.

PATIENTS AND METHODS

The expression levels of AK001796 in ESCC tissues and matched normal tissues were detected by RT-PCR. Association between AK001796 levels and clinicopathological factors was also analyzed by chi-square test. Overall survival (OS) and disease-free survival (DFS) were analyzed using the Kaplan-Meier method and log-rank test. The predictors for OS and DFS were assessed by univariate analysis and multivariate analysis using Cox's proportional hazards model.

RESULTS

We found that AK001796 was elevated in human ESCC samples compared with the adjacent normal tissues (p<0.01), and the high level of AK001796 expression was significantly correlated with lymph node metastasis (p=0.032) and advanced UICC stage (p=0.016). Interestingly, Kaplan-Meier analysis indicated that patients with high AK001796 expression had a significantly lower OS (p=0.010) and DFS (p=0.001). Moreover, we showed that AK001796 was an independent poor prognostic factor for OS and DFS in ESCC patients through univariate and multivariate analysis.

CONCLUSIONS

Our data provide important evidence that AK001796 may be a useful biomarker of advanced progression and poor prognosis of ESCC.

Diabetes mellitus and risk of pancreatic cancer in China: A meta-analysis based on 26 case-control studies

AIMS

The relationship between diabetes mellitus and pancreatic cancer risk from is uncertain based on the results of existing publications. The current report updated and re-evaluated the possible association between diabetes mellitus and pancreatic cancer risk in China.

METHODS

Six databases (PubMed, Embase, Web of Science, the Cochrane Library, the Chinese Biomedical Database, and the Chinese National Knowledge Infrastructure) were used for the literature search up to October 2017.

RESULTS

Twenty-six case-control studies involving 7702 pancreatic cancer cases and 10186 controls were screened out. The overall summary estimate for the relationship between diabetes and pancreatic cancer was 3.69 (95% CI, 3.12-4.37). The subgroup analysis indicated positive associations among northern and southern Chinese, as well as studies with healthy population or hospital controls. In addition, the risk of developing pancreatic cancer was inversely associated with the duration of diabetes, with the highest risk of pancreatic cancer occurring among patients with diabetes <2years. Individuals who had diabetes <2years had a >2-fold higher risk of developing pancreatic cancer than individuals who had diabetes for 2-4years or 5-10years (OR, 4.92; 95% CI, 4.16-5.80 vs. OR, 1.92; 95% CI, 1.30-2.85/OR, 2.14; 95% CI, 1.49-3.09).

CONCLUSIONS

This meta-analysis strongly supports that an association exists between diabetes and an increased risk of pancreatic cancer in China, which should be confirmed with other ethnic groups.

Optimal dilation time for combined small endoscopic sphincterotomy and balloon dilation for common bile duct stones: a multicentre, single-blinded, randomised controlled trial

BACKGROUND

Endoscopic sphincterotomy is the established treatment for common bile duct stones. Balloon dilation offers an alternative. Prolonged dilation (300 s) with a 10 mm diameter balloon decreases the occurrence of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP). We aimed to determine the optimal duration of dilation for combined endoscopic sphincterotomy and balloon dilation for the removal of common bile duct stones.

METHODS

We did a multicentre, single-blinded, randomised controlled trial at 15 tertiary surgical centres in China. Eligible patients (≥18 years) with native papilla and common bile duct stones (≤1·5 cm in size and <2 cm in diameter) undergoing ERCP were randomly assigned (1:1:1:1:1) to receive balloon dilation for 0, 30, 60, 180, or 300 s after deep bile duct cannulation. Randomisation was done by an independent statistician using a computer-generated randomisation list with a block size of ten, stratified by centre. Patients and outcome assessors, but not endoscopists and investigators, were masked to treatment allocation. Balloon dilation was done with controlled radial expansion balloons according to common bile duct stone size. Stones were removed using stone retrieval balloons or baskets. The primary endpoint was overall frequency of post-ERCP pancreatitis. The primary efficacy analysis and safety analyses were done in the modified intention-to-treat population, which included all randomly assigned patients with successful cannulation, but excluded those who withdrew consent after randomisation. This study was registered with ClinicalTrials.gov, number NCT02510495, and is complete.

FINDINGS

Between July 29, 2015, and Dec 1, 2017, 3721 consecutive patients with common bile duct stones were recruited, 1718 of whom were excluded. The remaining 2003 patients underwent a small (3-5 mm) endoscopic sphincterotomy. 83 patients withdrew consent after the ERCP procedure, thus 1920 patients were included in the modified intention-to-treat analysis (0 s [n=371], 30 s [n=384], 60 s [n=388], 180 s [n=390], and 300 s [n=387]). Overall, post-ERCP pancreatitis occurred in 199 (10%) of 1920 patients (44 [12%] patients in the 0 s group, 28 [7%] in the 30 s group, 32 [8%] in the 60 s group, 36 [9%] in the 180 s group, and 59 [15%] in the 300 s group). Prolonged dilation (300 s) significantly increased the occurrence of post-ERCP pancreatitis compared with shorter balloon dilation (p=0·002). The frequency of post-ERCP pancreatitis was significantly lower in the 30, 60, and 180 s groups than in the 300 s group (relative risk [RR] 0·48, 95% CI 0·31-0·73; p=0·0005 vs the 30 s group; 0·54, 0·36-0·81; p=0·003 vs the 60 s group; 0·61, 0·41-0·89; p=0·01 vs the 180 s group). The frequency of post-ERCP pancreatitis was significantly higher in the 0 s group than the 30 s group (RR 1·62, 1·04-2·56; p=0·03). No difference in stone extraction (all ≥90%) was observed between groups. Following ERCP, 90 (5%) of 1920 patients had acute cholangitis, 14 (<1%) had acute cholecystitis, and five (<1%) had gastrointestinal bleeding, with no significant differences between groups. One (<1%) patient had Stapfer II perforation, which resolved spontaneously with conservative treatment.

INTERPRETATION

A balloon dilation time of 30 s for combined endoscopic sphincterotomy and balloon dilation reduced the frequency of post-ERCP pancreatitis and was determined to be the optimum dilation time for the removal of common bile duct stones.

FUNDING

National Natural Science Foundation of China, Gansu Competitive Foundation Projects for Technology Development and Innovation.

Regulatory T cells are an important prognostic factor in breast cancer: a systematic review and meta-analysis

The clinical relevance of regulatory T cell (Treg) infiltration in breast cancer (BC) remains controversial, and no recent meta-analysis has been published on this subject. Our aim was to identify the precise relationship between Tregs and the prognosis and clinic-pathological features of BC. Eligible articles were identified with a MEDLINE database search over a period up to March 2015. Our meta-analysis was performed using STATA software 11.0 and Review Manager 5.3. The correlations between Treg infiltration and clinico-pathological features and BC prognosis were analyzed. Subgroup and sensitivity analyses, as well as meta-regression, were conducted. Eighteen published studies (including 8,562 patients) were eligible. Overall survival (OS) and disease-, recurrence-, and progression-free survival (DFS/RFS/PFS) were correlated with Treg infiltration (OR=2.03 (95% CI, 1.40-2.95; P=0.000) and 1.48 (95% CI, 1.00-2.19; P=0.050), respectively), including 3-, 5-, and 10-year mortality rates. In addition, low Treg infiltration was present in estrogen receptor (ER)-positive tumors (P=0.000), progesterone receptor (PR)-positive tumors (P=0.003), Her2-negative tumors (P=0.000) and histological grade I/II tumors (P=0.001). No publication bias was observed with the exception of OS. Subgroup analysis suggested that the mortality rate of the high Treg infiltration subgroup was increased compared with the low Treg infiltration subgroup among ER-positive patients. Treg infiltration indicated a poorer prognosis for BC and is related to ER, PR, and Her2 status and histological grade. Thus, Treg infiltration could help predict outcomes and guide clinical therapy.

Multi-Helicopter Search and Rescue Route Planning Based on Strategy Optimization Algorithm

This paper attempts to develop an efficient route planning algorithm to guide the operations of the multi-helicopter search and rescue in emergency. Route planning model of multi-helicopter cooperative search and rescue activity was established first, based on preference ordering of search and rescue objectives, as well as behavioral model of rescue helicopter and on-board detector. Given the route planning model, a multi-helicopter search and rescue route planning general algorithm was developed. The operation mechanism of ant colony algorithm was improved by introducing cooperative modes and the pheromone updating mechanism into existing methods. Furthermore, two cooperative search and rescue modes were studied: one is Overall Cooperative Search and Rescue Mode (OCSARM), in which many ants search and rescue the same region all together; the other is Blocking Cooperative Search and Rescue Mode (BCSARM), which partitions the region into small blocks and appoints helicopter with corresponding performance capabilities. Simulated experiments were developed to test the operability of proposed multi-helicopter search and rescue route planning algorithm. The comparison with existing algorithm shows that the algorithm proposed in this paper reduces computational complexity and evidently enhances algorithm efficiency. Results also indicate that this algorithm not only has the capability of comparing efficiency of two search and rescue modes in different mission requirements but also helps select search and rescue modes before rescue operation.

[Comparation study of incidental irradiation dose to the internal mammary chain during postmastectomy radiotherapy for patients treated with different irradiation techniques]

Objective: To evaluated the unplanned coverage dose to the internal mammary chain (IMC) in patient treated with postmastectomy radiotherapy (PMRT). Methods: One hundred and thirty eight patients with breast cancer receiving radiotherapy (RT) in our hospital were retrospectively analyzed. Patients were divided into three groups: three-dimensional conformal radiotherapy (3D-CRT) group, forward intensity-modulated radiotherapy (F-IMRT) group and inverse IMRT (I-IMRT) group. The IMC were contoured according to Radiation Therapy Oncology Group (RTOG) consensus, and were not include into the planning target volume (PTV). The incidental irradiation dose to IMC among the three groups and the first three intercostal spaces IMC (ICS-IMC 1-3) were all compared, and explored the relationship between the mean doses (Dmean) of IMC and the OARs (ipsilateral lung and heart). Results: The dose delivered to IMC showed no difference in CRT, F-IMRT and I-IMRT(33.80 Gy, 29.65 Gy and 32.95 Gy). And 10.42%, 2.04%, and 9.76% patients achieved ≥45 Gy when treated with CRT, F-IMRT and I-IMRT. For the IMC dose in the first three intercostal spaces (ICS1-3), there was no difference to the three treatment plannings. The Dmean, V(20), V(30), V(40) and V(50) of the ICS-IMC2 and ICS-IMC3 were all obviously superior than ICS-IMC1 for all these three plannings. Moderate positive correlation was founded between Dmean for IMC and Dmean for heart for left breast cancer patients underwent CRT (r=0.338, P=0.01). Whereas for F-IMRT and I-IMRT groups, positive correlation were founded between Dmean for IMC and Dmean and V(20) for ipsilateral lung for all patients (F-IMRT: r=0.366, P=0.010; r=0.318, P=0.026; I-IMRT: r=0.427, P=0.005; r=0.411, P=0.008). Conclusions: In 3D-CRT, F-IMRT and I-IMRT planning methods, partial patients get IMC irradiated doses that could achieve therapeutic doses. Compared with 3D-CRT, F-IMRT and I-IMRT further reduced the dose of irradiated organs. However, there is no difference in the dose coverage of IMC for the three planned approaches when the IMC made an unplanned target.

Evaluation of overall survival rate of different therapies in the treatment of T1-T3 prostate cancer: a network meta-analysis

We performed this network meta-analysis (NMA) in order to compare the overall survival rate of six different therapies of T1-T3 prostate cancer (PC). The therapies include radiotherapy (RT), endocrine therapy (ET), Cryoablation (CRYO), radical prostatectomy (RP), RT+ET and RP+ET. Pubmed, Embase, Cochrane Library, Google Scholar, Web of Science and MEDLINE were searched to collect relevant literature from the inception of the study till February 2017. Cohort studies meeting the inclusion criteria were included in the study. A combination of direct and indirect evidence was performed to evaluate the odds ratio (OR) and draw surface under the cumulative ranking curves (SUCRA). Nine eligible cohort studies were included in this NMA, including 20,644 patients suffering from T1-T3 PC. The pairwise meta-analysis revealed that compared with the ET regimen, the RP and RP+ET regimens exhibited comparatively higher overall survival rates (OR = 2.81, 95%CI = 2.09 ~ 3.78; OR = 3.15，95%CI = 1.80 ~ 5.50, respectively). The results of SUCRA values demonstrated that the RP + ET regimen occupied the first place (89.5%) in terms of overall survival rate, and the RP regimen came second (84.83%). Thus, the RP+ET regimen had better efficacy in the treatment of T1-T3 PC in combined-therapeutic regimens, and the RP regimen presented better efficacy in mono-therapeutic regimen. Our findings indicate that the RP+ET regimen had better efficacy on improving the overall survival rate of T1-T3 PC patients, and the RP regimen ranked second.

Butyrate and retinoic acid imprint mucosal-like dendritic cell development synergistically from bone marrow cells

Accumulating data show that the phenotypes and functions of distinctive mucosal dendritic cells (DCs) in the gut are regulated by retinoic acid (RA). Unfortunately, the exact role of butyrate in RA-mediated mucosal DC differentiation has not been elucidated thoroughly to date. Mucosal-like dendritic cell differentiation was completed in vitro by culturing bone marrow cells with growth factors [granulocyte-macrophage colony-stimulating factor (GM-CSF/interleukin (IL)-4], RA and/or butyrate. The phenotypes, cytokine secretion, immune functions and levels of retinal dehydrogenase of different DCs were detected using quantitative polymerase chain reaction (qPCR), enzyme-linked immunosorbent assay (ELISA) and flow cytometry, respectively. The results showed that RA-induced DCs (RA-DCs) showed mucosal DC properties, including expression of CD103 and gut homing receptor α₄ β₇ , low proinflammatory cytokine secretion and low priming capability to antigen-specific CD4⁺ T cells. Butyrate-treated RA-DCs (Bu-RA-DCs) decreased CD11c, but increased CD103 and α₄ β₇ expression. Moreover, the CD4⁺ T priming capability and the levels of retinal dehydrogenase of RA-DCs were suppressed significantly by butyrate. Thus, butyrate and retinoic acid have different but synergistic regulatory functions on mucosal DC differentiation, indicating that immune homeostasis in the gut depends largely upon RA and butyrate to imprint different mucosal DC subsets, both individually and collectively.

[A comparison of dosimetric variance for external-beam partial breast irradiation using three-dimensional and four-dimensional computed tomography]

Objective: To investigate the potential dosimetric benefits of four-dimensional computed tomography (4DCT) compared to three-dimensional CT (3DCT) in the planning of radiotherapy for external-beam partial breast irradiation (EB-PBI). Methods: Three-DCT and 4DCT scan sets were acquired for 20 patients who underwent EB-PBI. For each patient a conventional 3D conformal plan (3D-CRT) was generated based on end-inhalation phase (EI). The treatment plan based on the 4DCT EI phase images was copied and applied to the end-exhalation phase (EE) and 3DCT images (defined as EB-PBI(EI), EB-PBI(EE), EB-PBI(3D), respectively). Results: The median volumes of the tumour bed based on 3DCT, EI and EE were 20.99 cm(3,) 19.28 cm(3,) and 18.78 cm(3,) respectively. The tumour bed volume based on 3DCT was significantly greater than that of EI and EE volumes (P<0.05). The planning target volumes (PTV) coverage of EB-PBI(3D), EB-PBI(EI) and EB-PBI(EE) were 96.85%, 97.51%, 97.03%, respectively. The planning target volume (PTV) coverage of EB-PBI(3D) was significantly less than that of EB-PBI(EI) and EB-PBI(EE) (P<0.05). The median homogeneity indexs (HI) based on 3DCT, EI and EE were 0.13, 0.13, 0.13, respectively. The median conformal indexs (CI) based on 3DCT, EI and EE were 0.68, 0.69, 0.68, respectively. The median mean doses (D(mean)) based on 3DCT, EI and EE were 36.20 Gy, 36.20 Gy, 36.22 Gy, respectively. However there were no significant differences in the homogeneity index, conformity index and the mean dose of PTV between the three treatment plans (P>0.05). The EB-PBI(3D) plan resulted in the largest organs at risk dose (P<0.05). Conclusion: There was a significant benefit when using 4DCT to plan 3D-CRT for EB-PBI with regard to reduced non-target organ exposure, and might result in poor dose coverage when the PTV is determined using 3DCT.

[Value of low-dose multi-slice spiral CT chest scan in diagnosis of coal workers' pneumoconiosis]

Objective: To investigate the value of low-dose multi-slice CT (MSCT) chest scan in the diagnosis of coal workers' pneumoconiosis. Methods: A total of 90 patients with a confirmed diagnosis of coal workers' pneumoconiosis were enrolled, and under the conditions of fixed tube voltage, pitch, and slice thickness, they underwent CT scan with a normal dose (150 mA) and a low dose (30-50 mA). The quality of images obtained from two scans was compared, and the imaging findings, opacity profusion, stage, and radiation doses were also compared. Results: Compared with the normal-dose scan, low-dose scan increased the image noise, and the images obtained from scans with doses of 30, 40, and 50 mA did not show significant reductions in signal-to-noise ratio or contrast-to-noise ratio (P>0.05). There was no significant difference in the percentage of image quality between low-dose and normal-dose scans (P>0.05). There were no significant differences in the percentage of various imaging findings, opacity profusion, or percentage of different stages between low-dose (30, 40, and 50 mA) and normal-dose (150 mA) scans (P>0.05). Conclusion: There are no significant differences between low-dose MSCT chest scan and normal-dose CT in image quality, imaging findings of coal workers' pneumoconiosis, opacity profusion, and stage. Meanwhile, low-dose MSCT chest scan greatly reduces the radiation dose and can be used to assist the diagnosis and follow-up reexamination of coal workers' pneumoconiosis and cover the shortage of high-kilovoltage chest X-ray.

[Cone beam CT-derived adaptive radiotherapy for setup error assessment and correction in whole breast intensity modulated radiotherapy]

OBJECTIVE

To quantify the setup error (SE) in breast cancer patients treated with intensity modulated radiotherapy (IMRT) based on cone beam CT (CBCT), and to explore the feasibility of using several CBCT scans to presume and correct SE in the treatment for breast cancer patients.

METHODS

Eighteen breast cancer patients after breast conserving surgery who underwent whole breast IMRT were included in this study. Three dimensional interfraction motion before and after on-line CBCT-based corrections were quantified. The on-line CBCT-based corrections were performed using automated greyscale match. The system SE (Σ) and random error (σ) were calculated for each patient based on the consecutive multiple online scanning based on CBCT (≥5). The trends in magnitudes of Σ and σwere assessed during the treatment.

RESULTS

The magnitude variation of Σ was less than 1 mm before and after on-line CBCT-based corrections. As the CBCT scanning times increase (before 10 times), the Σ in anteroposterior (AP) direction was increased significantly, and σin three dimensional directions was also increased after 7 times of CBCT scanning. After on-line CBCT-based corrections, the Σ showed a steady trend by variation near zero for the first 20 times irradiation; but after 20 times, the Σ in AP and superoinferior (SI) directions was increased slightly (less than 0.5 mm), and σdecreased in three-dimensional directions. There were no significant differences for Σ, σand setup margin (SM) before and after on-line CBCT-based corrections in all three directions (P>0.05).

CONCLUSIONS

For breast cancer patients who underwent IMRT after breast conserving surgery, the setup error is relatively stable during the whole irradiation. The first 5 CBCT scans are suitable to presume and correct SE, and also can be used as the right time for adaptive radiotherapy planning revision.

Hyaluronic acid functionalized nitrogen-doped carbon quantum dots for targeted specific bioimaging

Schematic illustration of the preparation of HA-CQDs (A) and the following bioimaging application (B).

Efficacy comparison between minimally invasive and conventional surgery for lumbar disc herniation in Chinese Han population: a meta-analysis

This corrects the article DOI: 10.1038/sc.2014.98.

Cardiovascular and heart failure safety profile of vildagliptin: a meta-analysis of 17 000 patients

AIMS

To report the cardiovascular (CV) safety profile and heart failure (HF) risk of vildagliptin from a large pool of studies, including trials in high-risk patients with type 2 diabetes mellitus (T2DM), such as those with congestive HF and/or moderate/severe renal impairment.

METHODS

We conducted a retrospective meta-analysis of prospectively adjudicated CV events. Patient-level data were pooled from 40 double-blind, randomized controlled phase III and IV vildagliptin studies. The primary endpoint was occurrence of major adverse CV events (MACEs; myocardial infarction, stroke and CV death). Assessments of the individual MACE components and HF events (requiring hospitalization or new onset) were secondary endpoints. The risk ratio (RR) of vildagliptin (50 mg once- and twice-daily combined) versus comparators (placebo and all non-vildagliptin treatments) was calculated using the Mantel-Haenszel (M-H) method.

RESULTS

Of the 17 446 patients, 9599 received vildagliptin (9251.4 subject-years of exposure) and 7847 received comparators (7317.0 subject-years of exposure). The mean age of the patients was 57 years, body mass index 30.5 kg/m(2) (nearly 50% obese), glycated haemoglobin concentration 8.1% and T2DM duration 5.5 years. A MACE occurred in 83 (0.86%) vildagliptin-treated patients and 85 (1.20%) comparator-treated patients, with an M-H RR of 0.82 [95% confidence interval (CI) 0.61-1.11]. Similar RRs were observed for the individual events. Confirmed HF events were reported in 41 (0.43%) vildagliptin-treated patients and 32 (0.45%) comparator-treated patients, with an M-H RR 1.08 (95% CI 0.68-1.70).

CONCLUSIONS

This large meta-analysis indicates that vildagliptin is not associated with an increased risk of adjudicated MACEs relative to comparators. Moreover, this analysis did not find a significant increased risk of HF in vildagliptin-treated patients.

Influences on influenza transmission within terminal based on hierarchical structure of personal contact network

BACKGROUND

Since the outbreak of pandemics, influenza has caused extensive attention in the field of public health. It is actually hard to distinguish what is the most effective method to control the influenza transmission within airport terminal. The purpose of this study was to quantitatively evaluate the influences of passenger source, immunity difference and social relation structure on the influenza transmission in terminal.

METHODS

A method combining hierarchical structure of personal contact network with agent-based SEIR model was proposed to analyze the characteristics of influenza diffusion within terminal. Based on the spatial distance between individuals, the hierarchical structure of personal contact network was defined to construct a complex relationship of passengers in the real world. Moreover, the agent-based SEIR model was improved by considering the individual level of influenza spread characteristics. To evaluate the method, this process was fused in simulation based on the constructed personal contact network.

RESULTS

In the terminal we investigated, personal contact network was defined by following four layers: social relation structure, procedure partition, procedure area, and the whole terminal. With the growing of layer, the degree distribution curves move right. The value of degree distribution p(k) reached a peak at a specific value, and then back down. Besides, with the increase of layer α, the clustering coefficients presented a tendency to exponential decay. Based on the influenza transmission experiments, the main infected areas were concluded when considering different factors. Moreover, partition of passenger sources was found to impact a lot in departure, while social relation structure imposed a great influence in arrival. Besides, immunity difference exerted no obvious effect on the spread of influenza in the transmission process both in departure and arrival.

CONCLUSIONS

The proposed method is efficient to reproduce the evolution process of influenza transmission, and exhibits various roles of each factor in different processes, also better reflects the effect of passenger topological character on influenza spread. It contributes to proposing effective influenza measures by airport relevant department and improving the efficiency and ability of epidemic prevention on the public health.

Giant negative magnetoresistance in Manganese-substituted Zinc Oxide

We report a large negative magnetoresistance in Manganese-substituted Zinc Oxide thin films. This anomalous effect was found to appear in oxygen-deficient films and to increase with the concentration of Manganese. By combining magnetoresistive measurements with magneto-photoluminescence, we demonstrate that the effect can be explained as the result of a magnetically induced transition from hopping to band conduction where the activation energy is caused by the sp-d exchange interaction.

Coordinated interaction of Down syndrome cell adhesion molecule and deleted in colorectal cancer with dynamic TUBB3 mediates Netrin-1-induced axon branching

Modulation of actin and microtubule (MT) dynamics in neurons is implicated in guidance cue-dependent axon outgrowth, branching and pathfinding. Although the role of MTs in axon guidance has been well known, how extracellular guidance signals engage MT behavior in axon branching remains unclear. Previously, we have shown that TUBB3, the most dynamic β-tubulin isoform in neurons, directly binds to deleted in colorectal cancer (DCC) to regulate MT dynamics in Netrin-1-mediated axon guidance. Here, we report that TUBB3 directly interacted with another Netrin-1 receptor Down syndrome cell adhesion molecule (DSCAM) and Netrin-1 increased this interaction in primary neurons. MT dynamics were required for Netrin-1-promoted association of DSCAM with TUBB3. Knockdown of either DSCAM or DCC or addition of a function blocking anti-DCC antibody mutually blocked Netrin-1-induced interactions, suggesting that DSCAM interdependently coordinated with DCC in Netrin-1-induced binding to TUBB3. Both DSCAM and DCC were partially colocalized with TUBB3 in the axon branch and the axon branching point of primary neurons and Netrin-1 increased these colocalizations. Netrin-1 induced the interaction of endogenous DSCAM with polymerized TUBB3 in primary neurons and Src family kinases (SFKs) were required for regulating this binding. Knockdown of DSCAM only, DCC only or both was sufficient to block Netrin-1-induced axon branching of E15 mouse cortical neurons. Knocking down TUBB3 inhibited Netrin-1 induced axon branching as well. These results suggest that DSCAM collaborates with DCC to regulate MT dynamics via direct binding to dynamic TUBB3 in Netrin-1-induced axon branching.

Efficacy comparison between minimally invasive and conventional surgery for lumbar disc herniation in Chinese Han population: a meta-analysis

STUDY DESIGN

The pooled data were analyzed using RevMan 5.2 software.

OBJECTIVES

The aim was to compare the efficacy of minimally invasive and conventional surgery for lumbar disc herniation (LDH) in Chinese Han population.

SETTING

China.

METHODS

An electronic search up to November 2013 was performed to retrieve all relevant articles. The overall standardized mean difference (SMD) for continuous outcomes and odds ratio (OR) for dichotomous variables as well as their 95% confidence intervals (CIs) were calculated to compare the efficacy of minimally invasive and conventional surgery.

RESULTS

A total of 23 studies involving 1913 patients treated by minimally invasive surgery and 2295 patients treated by conversational surgery were included in this meta-analysis. The overall estimate indicated that minimally invasive surgery could significantly decrease the hospitalization time (SMD = -2.03, 95% CI, -2.49 to 1.56, P < 0.0001), blood loss (SMD = -2.65, 95% CI -3.33 to 1.97, P < 0.0001), incision length (SMD = -3.57, 95% CI, -4.39 to 2.75, P < 0.0001), recurrence rate (odds ratio (OR) = 0.22, 95 CI: 0.08-0.60, P = 0.003) and complications (OR = 0.47, 95% CI: 0.25-0.92, P = 0.03) and increase the postoperative excellent rate (OR = 1.82, 95% CI, 1.44-2.31, P < 0.0001) compared with conventional surgery. In addition, the pooled data showed that there was no statistically significant difference in the operative time (SMD = -0.58, 95% CI, -1.32 to 0.15, P = 0.12) between LDH patients treated by minimally invasive and conventional surgery.

CONCLUSION

In conclusion, minimally invasive surgery was a more safe and effective treatment for treating LDH in Chinese Han population when compared with conventional surgery.