Vitamin D deficiency increases the risk of diabetic peripheral neuropathy in elderly type 2 diabetes mellitus patients by predominantly increasing large-fiber lesions

AIMS

This study explores the link between Vitamin D deficiency (VDD) and diabetic peripheral neuropathy (DPN) in elderly type 2 diabetes mellitus (T2DM) patients.

METHODS

Involving 257 elderly T2DM patients, the study utilized propensity score matching to balance age, sex, and diabetes duration. VDD was defined as serum 25-hydroxyvitamin D [25(OH)D] levels below 20 ng/ml. Large nerve fiber lesions were evaluated by electromyogram, while small nerve fiber lesions were assessed by measuring skin conductance.

RESULTS

DPN patients had notably lower serum 25(OH)D levels than non-DPN patients [15.05 vs. 18.4 ng/ml, P = 0.018]. VDD was identified as an independent risk factor for DPN (odds ratio = 2.488, P = 0.008) in multivariate logistic regression analysis. Spearman's correlation showed negative correlations between serum 25(OH)D levels and specific nerve latencies, and positive correlations with specific nerve velocities and amplitudes. The VDD group exhibited longer median sensory nerve latencies and motor evoked potential latencies compared to the vitamin D-sufficient group. Further, VDD is associated with the prolongation of the median motor nerve latency (odds ratio = 1.362, P = 0.038).

CONCLUSIONS

VDD is independently associated with a higher risk of DPN. VDD may promote the development of DPN by affecting large nerve fibers.

Medications and medical expenditures for diabetic patients with osteoporosis in Beijing, China: A retrospective study

AIMS

This study aimed to clarify the changes in treatment regimens and medical expenditures in diabetic patients with osteoporosis.

METHODS

We recruited 2,853,036 diabetic patients from the Beijing medical insurance database between 2016 and 2018. Among them, 406,221 patients also had osteoporosis. Clinical characteristics, treatment regimens, and medical costs were investigated in diabetic patients with and without osteoporosis.

RESULTS

Diabetes and osteoporosis were most prevalent in participants aged 45---84 years. Compared with diabetic patients without osteoporosis, those with osteoporosis were prone to developing comorbidities and diabetic complications. They often required multiple glucose-lowering drugs and had a higher rate of insulin use. Similarly, osteoporosis leads to an increased number of medications for non-hypoglycemia as well as higher healthcare costs. These medications and costs increased with the number of complications and comorbidities. Interestingly, from 2016 to 2018, although diabetic patients with osteoporosis took more drugs, medical costs were lower year by year.

CONCLUSIONS

Osteoporosis might contribute to a worse condition in diabetic patients, and this population often requires more medications with higher medical costs.

How does diabetic peripheral neuropathy impact patients' burden of illness and the economy? A retrospective study in Beijing, China

Objective

Diabetic peripheral neuropathy (DPN) causes significant illness in patients and has a negative impact on the economy. The objective of this study is to evaluate the cost and quantity of anti-diabetic drugs needed by patients with or without DPN, as well as their variation trends in Beijing between 2016 and 2018.

Methods

This observational cross-sectional study used data on diabetic patients with outpatient medication records obtained from Beijing Medical Insurance from 2016 to 2018. The medications, comorbidities, diabetes-related complications, treatment strategies, and costs of drug treatment were compared between DPN patients and non-DPN patients.

Results

Of the 28,53,036 diabetic patients included in the study, 3,75,216 (13.15%) had DPN and 1,87,710 (50.03%) of the DPN patients were women. Compared with non-DPN patients, DPN patients used more mediations (4.7 ± 2.47 vs. 3.77 ± 2.32, p < 0.0001, in 2018) to treat related complications and comorbidities (2.03 ± 1.2 vs. 1.71 ± 1.05; 2.68 ± 1.93 vs. 2.06 ± 1.86, p < 0.0001, respectively, in 2018). The total annual costs of drug treatment were higher in DPN patients than in non-DPN patients (¥12583.25 ± 10671.48 vs. ¥9810.91 ± 9234.14, p < 0.0001, in 2018). The usage of DDP4i increased from 2.55 to 6.63% in non-DPN patients and from 4.45 to 10.09% in DPN patients from 2017 to 2018.

Conclusions

The number of comorbidities, diabetic complications, medications, and annual drug treatment costs were greater in DPN patients than in non-DPN patients.

Resistance of blended alkali-activated fly ash-OPC mortar to mild-concentration sulfuric and acetic acid attack

The traditional cementitious product is prone to suffer from a high degree of deterioration in the case of exposure to acid solutions because of the decomposition of the binder network. However, the degradation of concrete structures in service by mild concentrations of acid under conditions involving sewage, industrial waters, and acid rain is more common and results in a significant environmental problem. The utilization of alkali-activated materials has been seen to potentially offer an attractive option with regard to acceptable durability and a low carbon footprint. With the aid of visual observation, mass loss, compressive strength tests, X-ray diffraction, Fourier transform infrared spectroscopy, and field-emission scanning electron microscopy with energy-dispersive X-ray spectroscopy, the acid resistance of alkali-activated fly ash mortars in which the precursor was partially replaced (0-30% by mass proportion) with ordinary Portland cement (OPC) was evaluated after 180 days of exposure to mild-concentration sulfuric and acetic solutions (pH = 3). A conventional cement mortar (100% OPC) was used as a reference group. The results demonstrate that the addition of OPC into the alkali-activated system causes a significant increase in compressive strength (around 16.08-36.61%) while showing an opposite influence on durability after acid attack. Based on a linear mean value and nonlinear artificial neural network model simulation, the mass losses of the specimens were evaluated, and the alkali-activated pure-fly ash mortar demonstrated the lowest value (i.e., a maximum of 5.61%) together with the best behavior in the aspect of discreteness at 180 days. The results from microstructure analysis show that the coexistence of the N-A-S-H and C-S-H networks in the blend system occurred by both OPC hydration and FA. However, the formation of the gypsum deposition within the fly ash-OPC blend systems at sulfuric acid was found to impose internal disintegrating stresses, causing a significant area of delamination and cracks. In addition, alkali metal ion leaching, dealumination, as well as the disappearance of some crystalline phases occurred in specimens immersed in both types of acids.

The Effect of SOCS2 Polymorphisms on Type 2 Diabetes Mellitus Susceptibility and Diabetic Complications in the Chinese Han Population

Background

SOCS2 is downregulated in diabetes, which might be related to diabetes. We explored the effect of SOCS2 polymorphisms on the development of type 2 diabetes mellitus (T2DM) and diabetic complications.

Methods

The subjects consisted of 500 patients with T2DM and 501 healthy controls. Five variants in SOCS2 were genotyped by Agena MassARRAY system. RT-qPCR profiling was performed to detect the expression of SOCS2 mRNA. Logistic regression analysis was utilized to calculate odds ratio (OR) and 95% confidence intervals (95% CIs).

Results

Rs3825199 (OR = 1.44, p = 0.007), rs11107116 (OR = 1.39, p = 0.014) and rs10492321 (OR = 1.48, p = 0.004) had an increased T2DM risk of T2DM. Moreover, the contribution of SOCS2 polymorphisms to T2DM risk was associated with age, gender, smoking, drinking, and BMI. SOCS2 variants also had a reduced risk for T2DM patients with diabetic nephropathy, diabetic retinopathy and coronary heart disease. SOCS2 rs10492321 was the best single locus model. SOCS2 mRNA was downregulated in patients with T2DM compared to healthy controls (p = 0.029).

Conclusion

This study firstly reported that rs3825199, rs11107116 and rs10492321 in SOCS2 conferred to an increased risk for the occurrence of T2DM in the Chinese Han population. Moreover, SOCS2 mRNA was downregulated in patients with T2DM, suggesting that SOCS2 might have an important role in the occurrence of T2DM.

PDX1 and MC4R genetic polymorphisms are associated with type 2 diabetes mellitus risk in the Chinese Han population

BACKGROUND

Diabetes mellitus (DM) is a complex metabolic disease that is caused by a complex interplay between genetic and environmental factors. This research aimed to investigate the association of genetic polymorphisms in PDX1 and MC4R with T2DM risk.

METHODS

The genotypes of 10 selected SNPs in PDX1 and MC4R were identified using the Agena MassARRAY platform. We utilized odds ratio (OR) and 95% confidence intervals (CIs) to assess the correlation between genetic polymorphisms and T2DM risk.

RESULTS

We found that PDX1-rs9581943 decreased susceptibility to T2DM among in a Chinese Han population (OR = 0.76, p = 0.045). We also found that selected genetic polymorphisms in PDX1 and MC4R could modify the risk of T2DM, which might also be influenced by age, sex, BMI, smoking status, and drinking status (p < 0.05).

CONCLUSIONS

We concluded that PDX1 and MC4R genetic variants were significantly associated with T2DM risk in a Chinese Han population. These single polymorphic markers may be considered to be new targets in the assessment and prevention of T2DM among Chinese Han people.

Association between STAT4 gene polymorphism and type 2 diabetes risk in Chinese Han population

Background

Evidence from genetic epidemiology indicates that type 2 diabetes (T2D) has a strong genetic basis. Activated STAT4 has an inflammatory effect, and STAT4 is an important mediator of inflammation in diabetes. Our study aimed to study the association between STAT4 single nucleotide polymorphisms (SNPs) and T2D susceptibility in Chinese Han population.

Methods

We conducted a 'case–control' study among 500 T2D patients and 501 healthy individuals. 5 candidate STAT4 SNPs were successfully genotyped. The association between SNPs and T2D susceptibility under different genetic models was evaluated by logistic regression analysis. ‘SNP-SNP’ interaction was analyzed and completed by multi-factor dimensionality reduction (MDR). Finally, we evaluated the differences of clinical characteristics under different genotypes by one-factor analysis of variance.

Results

The overall results showed that STAT4 rs3821236 was associated with increasing T2D risk under allele (OR 1.23, p = 0.020), homozygous (OR 1.51, p = 0.025), dominant (OR 1.36, p = 0.029), and additive models (OR 1.23, p = 0.020). The results of stratified analysis showed that rs3821236, rs11893432, and rs11889341 were risk factors for T2D among participants ≤ 60 years old. Only rs11893432 was associated with increased T2D risk among female participants. There was also a potential association between rs3821236 and T2D with nephropathy risk. STAT4 rs11893432, rs7574865 and rs897200 were significantly associated with lysophosphatidic acid, cystatin C and thyroxine t4, respectively.

Conclusion

The genetic polymorphisms of STAT4 is potentially associated with T2D susceptibility of Chinese population. In particular, rs3821236 is significantly associated with T2D risk both in the overall and several subgroup analyses. Our study may provide new ideas for T2D individualized diagnosis/protection.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12920-021-01000-2.

Contribution of gestational diabetes mellitus heterogeneity and prepregnancy body mass index to large-for-gestational-age infants-A retrospective case-control study

OBJECTIVE

To study the associations between heterogeneity of gestational diabetes mellitus (GDM) subtype/prepregnancy body mass index (pre-BMI) and large-for-gestational-age (LGA) infants of Chinese women.

METHODS

We performed a retrospective case-control study of 299 women with GDM and 204 women with normal glucose tolerance (NGT), using oral glucose tolerance test-based indices performed at 24-25 weeks of gestation. Women with GDM were classified into the following three physiologic subtypes: GDM with a predominant insulin-secretion defect (GDM-dysfunction), GDM with a predominant insulin-sensitivity defect (GDM-resistance), or GDM with both defects (GDM-mixed). We then used a binary logistic regression model to evaluate the potential associations of GDM subtypes and pre-BMI with newborn macrosomia or LGA.

RESULTS

Women with GDM-resistance had a higher pre-BMI (P < 0.001), whereas women in the GDM-dysfunction and GDM-mixed groups had pre-BMIs comparable to the NGT group. In the logistic regression model, women in the GDM-mixed group exhibited an increased risk of bearing newborns with macrosomia and LGA, and women in the GDM-dysfunction group tended to have newborns with LGA after adjusting for pre-BMI and other potential confounders. Women who were overweight or obese prepregnancy manifested an increased risk of having newborns with macrosomia and LGA relative to normal-weight women, regardless of whether values were unadjusted or adjusted for all potential confounders. There was no significant interaction between GDM subtype and pre-BMI for any of the studied outcomes.

CONCLUSIONS

Heterogeneity of GDM (GDM-dysfunction and GDM-mixed) and prepregnancy overweight/obesity were independently associated with LGA in Chinese women. There was no significant interaction between GDM subtypes and pre-BMI for LGA.

Prospective Comparison of Equations Based on Creatinine and Cystatin C for the Glomerular Filtration Rate Estimation in Chinese Renal Transplant Recipients

BACKGROUND

Currently, there is no dedicated equation to estimate glomerular filtration rate (GFR) for transplanted kidneys. This study aimed to compare the performance of serum creatinine (Scr)- and cystatin C (CysC)-based equations in Chinese renal transplant recipients.

METHODS

A total of 252 stable renal transplant recipients were enrolled in this study. The plasma clearance of ^99mTc-DTPA (rGFR) was used as a reference standard. The Scr, CysC, and rGFR of the patients were measured on the same day. The bias, precision, accuracy (percentage of estimates within 10%, 30%, and 50% of rGFR), and agreements of 8 Scr and 5 CysC eGFR equations were assessed. The factors affecting the accuracy were also evaluated.

RESULTS

Among the Scr-based equations, the Japanese Society of Nephrology-Chronic Kidney Disease Initiatives (JSN-CKDI) equation had the best overall performance with a bias of -6.2 mL/min/1.73 m², and 96.1% of its estimates were within 30% of the rGFR. For the CysC-based equations, the Filler equation had the best performance with a bias of -3.9 mL/min/1.73 m², and 93.7% of its estimates were within 30% of the rGFR. Overall, the CysC-based equations showed better performance than the Scr-based equations. In addition, significant differences were observed between bias and gender and between bias and rGFR value in some equations, whereas transplantation time and immunosuppressive regimens were not correlated with the bias.

CONCLUSION

The JSN-CKDI equation provides the best estimation of the GFR equations, and the CysC-based equations performed better than the Scr-based equations in this population.

Metabolite detection of pancreatic carcinoma by in vivo proton MR spectroscopy at 3T: initial results

PURPOSE

The authors sought to identify metabolic features of pancreatic carcinoma by in vivo proton magnetic resonance (MR) spectroscopy at 3 Tesla.

MATERIALS AND METHODS

Forty healthy volunteers and 40 patients with pancreatic carcinoma confirmed by histopathology underwent T2-weighted imaging for localisation of the single voxel. Respiration-triggered (1)H MR spectroscopy was used to detect metabolites in normal pancreas and cancerous tissue. All spectral data were processed with SAGE software. Unsuppressed water at 4.7 ppm was used as an internal reference to determine metabolite concentrations. Each ratio among the different peak areas was statistically evaluated between normal pancreas and pancreatic carcinoma.

RESULTS

The following five groups of spectra were detected: unsaturated fatty acids (-CH = CH-) at 5.4 ppm; residual water at 4.7 ppm; choline metabolites at 3.2 ppm; unsaturated fatty acids (-CH2-CH = CH-) or a combination of N-acetylaspartate (NAA), N-acetylaspartylglutamate (NAAG), glutamine, glutamate, macromolecules and unsaturated fatty acids (-CH2-CH = CH-) at 2.0 ppm and lipids at 1.3 ppm. Ratio of lipids to unsuppressed water in normal pancreas was statistically greater than that in pancreatic cancer (p=0.004). Ratio of choline to unsuppressed water in normal pancreas was statistically greater than that in pancreatic cancer (p=0.0001). Ratio of fatty acids (-CH = CH-) to lipids in normal pancreas was statistically lower than that in pancreatic cancer (p=0.006).

CONCLUSIONS

Compared with normal pancreas, pancreatic carcinoma has a higher ratio of fatty acids (-CH = CH-) to lipids and lower ratios of lipids to unsuppressed water and choline to unsuppressed water at 3T.

Proteomic Analysis of the Genotoxicant Methylazoxymethanol (MAM)-Induced Changes in the Developing Cerebellum

The genotoxicant methylazoxymethanol (MAM) is a widely used developmental neurotoxin, and its glucoside is an etiological factor for western Pacific amyotrophic lateral sclerosis-parkinsonism-dementia complex (ALS/PDC). Identification of global protein expression changes that occur in response to MAM in the developing cerebellum could provide valuable insight into the potential mechanisms involved in the neurodegeneration process. We have utilized fluorescence 2-dimensional differential gel electrophoresis (2D-DIGE), to determine the protein expression changes that occur during normal cerebellar development and in response to MAM. Three day-old postnatal C57BL/6 mice (PND3) received a single injection of MAM, and the cerebella of postnatal day 4 (PND4) and day 22 (PND22) were analyzed. Approximately, 1400 unique spots were matched and quantified in all samples. Comparison of PND4 and PND22 developing cerebellum showed that a significant fraction of the proteome (approximately 68%) changes at this stage. The immediate response of the developing cerebellum to MAM was minimal (approximately 10%). However, significant differences (27%) were noted 14 days after MAM exposure. In contrast, the transcriptome changes were more pronounced at 24 h compared to 14 days. MAM targeted several proteins networks including transport (e.g., alpha-synuclein), cytoskeletal (e.g., beta-tubulin, vimentin), and mitochondrial (e.g., Atp5b) proteins. Immunochemistry confirmed several of the changes in protein expression (alpha-synuclein). Comparison with gene expression changes revealed that the temporal changes observed in the transcriptome and proteome are not correlative. These studies demonstrate for the first time the potential networks involved during neuronal development and neurodegenerative processes that are perturbed by MAM.

[The preliminary research of maxillary sinus cancer on oncogene level]

OBJECTIVE

To determine the oncogene c-myc, bcl-2' product expression in the maxillary sinus cancer and to investigate its clinical significance.

METHOD

In 46 maxillary sinus cancer and 56 normal nasal mucous membrane, immunochemical method was adopted to determine oncogene c-myc and bcl-2' product.

RESULT

In the normal nasal mucous membrane, the positive rates of oncogene c-myc and bcl-2' product were 0; in the maxillary sinus cancer, the positive rates of c-myc and bcl-2' product were 73.91 (34/46), 60.87 (28/46) respectively. The positive rate of c-myc' product in the relapse group(91.67%, 11/12) was significantly higher than that in the non-relapse group(67.65%, 23/34), P < 0.01; the positive rate of bcl-2' product in the relapse group(50%, 6/12) was significantly lower than that in the non-relapse group(64.71%, 22/34), P < 0.05; the positive rate of c-myc' product in the stage IV (88.89%, 8/9) was significantly higher than that in the stage II (63.64%, 7/11), P < 0.05; the positive rate of bcl-2' product in the stage II (72.73%, 8/11) was significantly higher than that in the stage IV (55.56%, 5/9), P < 0.05; the positive rate of bcl-2' product was in the negative correlation to the pathological grade of primary carcinoma.

CONCLUSION

The oncogene c-myc and bcl-2 take part in the genesis and advancing course of maxillary sinus cancer. Their products were the important oncogology indexes, which might be useful to determine illness condition and predict relapse.

[Long-term follow-up result of partial laryngectomy]

OBJECTIVE

To study the long-term follow-up result of partial laryngectomy and reservation of laryngeal function.

METHODS

Three hundred and seventy-nine patients who underwent partial laryngectomy from 1986 to 1995 were summarized (male 290 cases, female 89 cases). Among them, 184 cases were supraglottic carcinomas (T1 8 cases, T2 115, T3 48, T4 13, according to UICC in 1992), 192 cases were glottic carcinomas (T1 115, T2 63, T3 13, T4 1), 3 cases were transglottic carcinomas (T2 1, T3 2). In common 8 kinds of operations were performed: 26 cases underwent cordectomy, 138 vertical laryngectomy, 7 frontolateral laryngectomy, 12 horizontal glottic laryngectomy (middle part of the larynx), 58 supraglottic laryngectomy, 95 horizontovertical (3/4) laryngectomy, 24 subtotal laryngectomy with cricoglossoepiglottic anastomosis, 19 near-total laryngectomy with cricoglossal anastomosis (with reservation of unilateral arytenoid cartilage). 193 cases underwent concurrent neck dissection(121 unilateral, 72 bilateral).

RESULTS

All cases restored their phonation and overcame aspiration with removing nasal feeding from 7 to 23 days after operations. 362 cases were decannulated from 9 days to 3 months after operations. Another 8 cases were decannulated after a secondary plastic operation. Decannulation rate was 97.6%. The three, five and ten year survival rates were 86.8% (329/379), 81.3% (266/327) and 69.4% (120/173) respectively.

CONCLUSION

Partial laryngectomy is a kind of radical operation with reservation of laryngeal function. Mastering indications strictly, correct operation choices, excellent surgical skills and perfect repairing technique are bases of improving life qualities and curative effect.

[The study of p16 gene mutation and methylation in laryngeal squamous cell carcinoma]

OBJECTIVE

To investigate the development and mechanism of the p16 gene inactivation in laryngeal squamous cell carcinoma (LSCC).

METHODS

With PCR-based methylation assay and PCR-SSCP, first and second exon mutation in p16 gene and methylation of endogenase in promoter in 32 cases of LSCC and paracancer tissue were studied.

RESULTS

No mutation were found in first and second exon in the samples; methylation of Cfo I were detected in 6 cases in first exon, methylation of Sac II was found in 4 cases, and methylation of Hpa II in 4 cases. In second exon, methylation of Hpa II was detected in 5 cases and methylation of Cfo I in 6 cases.

CONCLUSION

Methylation of promoter in p16 gene is one of the important mechanisms of the inactivation of the gene. The inactivation of p16 gene has a close relation with the development and progress of LSCC.

[Horizontal-vertical hemilaryngectomy for advanced laryngeal cancer]

OBJECTIVE

To evaluate the adequacy of horizontal-vertical partial laryngectomy in the treatment of advanced laryngeal cancer.

METHODS

We retrospectively reviewed 57 patients with advanced laryngeal cancer (T3 or T4 on the primary site) treated by horizontal-vertical hemilaryngectomy. Fifty-six patients underwent neck dissections.

RESULTS

The overall 3- and 5-year survival rates were 70% (40/57) and 64% (32/50), respectively. All patients had good phonation and resumed mouth-feeding after surgery. Among all the deaths, 4 died of recurrence of laryngeal cancer, 4 cervical metastasis, 4 distant metastasis, 2 intercurrent disease and 3 unknown. Of 36 patients with N0 neck, fifteen cases (15/36, 41.6%) had lymph node metastases pathologically.

CONCLUSION

Horizontal-vertical hemilaryngectomy is satisfactory for the treatment of selected advanced laryngeal cancers. It also preserves laryngeal functions in most cases.

[Supraglottic horizontal partial laryngectomy]

OBJECTIVE

To evaluate the long-term result of supraglottic horizontal partial laryngectomy.

METHODS

Fifty-five patients with supraglottic laryngeal carcinoma were treated surgically by supraglottic horizontal partial laryngectomy from 1986 to 1995. There were 32 males and 23 females with an average age of 56. Eleven cases were staged I, 26 staged II, 11 staged III and 7 staged IV. Closure of the surgical defect begins by covering the thyroid cartilage with mucosa of the medial wall of the pyriform sinus. The outer perichondrium of thyroid cartilage was approximated with the mucosa of laryngeal ventricle. The hyoid cartilage was excised. The base of tongue was sutured to the reserved thyroid cartilage to take the place of epiglottic cartilage.

RESULTS

The 3- and 5-year survival rates were 85% (47/55) and 77% (37/48) respectively. The decannulation rate was 96%. Most cases had acquired good speech and swallow function after 8-30 days. Complications included granulation and polyp formation at the base of tongue or at the anterior commissure in 4 cases.

CONCLUSIONS

Supraglottic horizontal partial laryngectomy is very effective both in eradicating disease and in preserving laryngeal function.

Interaction of paratropomyosin with beta-connectin and its 400-kilodalton fragment from chicken skeletal muscle as influenced by the calcium ion concentration

The binding of paratropomyosin to beta-connectin, which has been suggested to interact at the A-I junction of a sarcomere, was confirmed by measuring the changes in turbidity of a mixture with changing NaCl concentration, pH and free calcium ions, and by morphological observation and a coprecipitation assay of the aggregates formed in the mixture. Paratropomyosin also bound to the 400-kDa fragment which is the N-terminal portion of beta-connectin and contains the A-I junction region. Moreover, the interaction of paratropomyosin with the 400-kDa fragment was enhanced by a calcium ion concentration from 10(-7) M to 10(-5) M and markedly suppressed above 10(-4) M calcium ions. We conclude that paratropomyosin probably binds to the 400-kDa fragment of beta-connectin in the A-I junction region in living and pre-rigor skeletal muscle. In postmortem skeletal muscle paratropomyosin may be released from the 400-kDa portion of the connectin filament by increased calcium ion concentration and translocated on to thin filaments to induce meat tenderization.

[The histopathological observation and the clinical significance of invasion of pyriform sinus apex in pyriform sinus carcinoma]

OBJECTIVE

To approach the clinical significance of pyriform sinus carcinoma invading to pyriform sinus apex.

METHOD

Forty-three cases of surgical specimens from total laryngectomy and partial hypopharyngectomy of pyriform sinus carcinoma were made with the organ subserial sectioning and pathological study.

RESULT

Pyriform sinus apex is the inferior 1/3 region of pyriform sinus. If pyriform sinus carcinoma invades its apex, the cancerous tissue easely infiltrated the adjacent structure and organs.

CONCLUSION

The invasion of pyriform sinus apex is the beginning position and the most important sign of invading downward the tissue and surrounding organs in the inferior position of hypopharynx. When surgery treatment is performed, the total laryngectomy and hypopharyngectomy of ill hypopharynx is appropriate and necessary.

[Long-term follow-up result of partial laryngectomy in senile patients with laryngeal carcinoma]

OBJECTIVE

To study the long-term follow-up result of laryngectomy with reservation of laryngeal function in senile patients.

METHODS

Ninety-nine patients who were above 65 years old and underwent partial laryngectomies from 1986 to 1990 were summarized. Among them, 14 cases underwent vocal cord resection, 31 vertical hemilaryngectomy, 15 horizontal supraglottic hemilaryngectomy, 2 horizontal glottic laryngectomy, 22 horizontovertical (3/4) laryngectomy, 5 subtotal laryngectomy, 10 total laryngectomy with cricopharyngeal anastomosis.

RESULTS

All patients had their phonation and respiration restored. Decannulation rate was 91.9%. No death occurred during the operation. No severe postoperative complications were found. 3.5-year survival rates were 76.7% and 75.5% respectively.

CONCLUSION

Senility is not a contraindication for laryngectomy with reservation of laryngeal function. The key points are that surgeons should master indications correctly and improve surgical skill to decrease postoperative complications.

Binding of paratropomyosin to beta-connectin from chicken skeletal muscle

We found that paratropomyosin bound to beta-connectin, in examining binding of paratropomyosin at the junction of A- and I-bands of sarcomeres. The turbidity of a mixture of beta-connectin and paratropomyosin was greater with more paratropomyosin added, but high concentrations of Ca2+ suppress this increase. These results suggest that paratropomyosin is released from connectin filaments at the A-I junction region by increased concentrations of calcium ions in postmortem skeletal muscles.

[Detection of human papillomavirus in Chinese laryngeal carcinoma with digoxigenin labelled probe prepared by PCR]

The studies described here detect HPV DNA in 124 cases of fresh tissue samples with different lesions of larynx using a nonradioactive Digoxigenin Labelled Probe prepared by polymerase chain reaction (PCR). The labelled probe of HPV consensus primers was obtained, which can detect nine types of HPVs DNAs such as HPV 6, 11, 16, 18, 31, 33, 35, 42 and 58. The results showed that the rate of positive cases with HPV infection was 45.6% (31/68) in the group of laryngeal carcinoma, 20.0% (3/15) for the group of neck metastatic lymph node, 11.8% (2/17) for precarcinous lesions group and 6.3% (1/16) for the group of vocal cord polypus, respectively. Fifteen cases of normal laryngeal tissue adjacent to the carcinoma and 15 cases adjacent to the carcinoma were HPV DNA negative. The carcinogenic action of HPV in laryngeal carcinoma and the sensitivity and specificity of the probe prepared by PCR are discussed in this paper.

[Loss of heterozygosity on chromosome RB1.20 locus and p110RB1 protein state in squmous cell carcinomas of larynx]

OBJECTIVE

To study the RB1 gene in squamous cell carcinoma of larynx(ISCC) and to find clue for discovering and locating new suppressor gene.

METHODS

Loss of heterozygosity (LOH) of microsatellite polymorphic sequence on chromosomes 13 at RB1.20 locus of 58 LSCC patients were analyzed. The p110RB1 protein state was detected by immunohistochemical staining using the polyclonal antibody to the RB1 products.

RESULTS

It showed that 3 cases in the preinvasive stage (i.e. carcinoma in situ) had no any LOH on chromosome 13. Forty percent of the 55 invasive LSCC showed LOH at RB1.20 locus. By immunohistochemical staining p110RB1 protein negative reaction was observed in 8 LSCCs in which 6 cases associated with LOH at RB1.20 locus.

CONCLUSIONS

RB1 gene was inactivated in some LSCCs. It is putative that there is another tumor suppressor gene on chromosome 13 near by RB1.20 locas. The inactivation of the genes at the chromosome 13q region including RB1 involved genesis and development of invasive LSCC.

[Transglottic carcinoma and transglottic invasion of laryngeal carcinoma]

OBJECTIVE

To explore the definition of transglottic carcinoma and its pathological characteristics of local invasion, and to determine the distinction between transglottic carcinoma and transglottic invasion of laryngeal carcinoma.

METHODS

Fifty total laryngectomy specimens of transglottic carcinoma were subject to whole-organ serial section, HE staining and microscopic observation.

RESULTS

The ventricles of 50 cases were all invaded, the main lesion of carcinoma was in the ventricle, or the ventricle was the center of the lesion. The rate of invasion to paraglottic space(PGS) was 82%(41/50). Submucosal invasion was seen in 52%(26/50) and that with superficial mucosal invasion was seen in 38%(19/50). Superficial mucosal invasion rate was 10%(5/50). Deep submucosal invasion was the major way of tumor spread in transglottic carcinoma which equally involved the supraglottic and glottic regions.

CONCLUSION

Transglottic carcinoma originates from the center of ventricle where it spreads to transglottic region. Submucosal extension is characteristic of local invasion. There are fundamental differences between transglottic carcinoma and transglottic invasion of laryngeal carcinoma in the late stage of the lesion.

[Relationship between voice spectrum analysis and psychoacoustic evaluation in patients with vocal cords polyps]

The purpose of this paper is to investigate the significance of selected acoustic parameters, to determine their usfulness in monitoring effects of treatments, to correlate them to other clinical voice tests (such as aerodynamic measurements, stroboscopic examination, psychoacoustic evaluation), and to determin if there were correlations among the acoustic parameters. The results showed that pitch perturbation quotient (PPQ), amplitude perturbation quotient (APQ), normalized noise energy a and b (NNEa and NNEb) were positively related to the regularity (REG) in the vocal cord polyp. In the present study, psychoacoustic rough (R), breathy (B) were correlated to the regularity (REG), glottic closure (GLO) and the mean airflow rate. The integrated voice analysis was a simple and effective method for acoustic evaluation of pathologic voice.

[Histopathological study of local invasion and cervical lymph node metastasis in transglottic carcinoma]

To study the histopathological characteristics of local invasion and cervical lymph node metastasis in transglottic carcinoma and provide theoretical guide to clinical practice, 30 laryngectomy and 35 neck dissection specimens were studied by serial section, HE staining and observation under light microscope. The results showed that transglottic carcinomas originated from the ventricle invaded supraglottic and glottic areas equally. The metastatic rate of cervical lymph nodes was 43.3%; the latent metastatic rate was 30%. The metastatic and extracapsular perforation rates as well as the number of the aggregated fusion lymphnodes increased with the increase in the size of the lymphonodes. It was concluded that the transglottic carcinoma should be defined as one with the main lesion locates in the ventricle, or the ventricle being the center with transglottic spread. Since the barrier of ventricle was weak, partial laryngectomy should be performed with care, and ipsilateral neck dissection shoud be included during operation.

[Laser assisted uvulopalptoplasty treatment for obstructive sleep apnea syndrome]

71 patients of obstructive sleep apnea symdrome (OSAS) were treated by Nd:YAG laser assisted uvulopalptoplasty (LAUP). According to the atonamic features of every patient, and type of operation which should be selected, the success rate of surgery would increase, and complications would be reduced. The effect rate is 97.2% by clinic, 90.0% by polysimnograph (PSG).

[On the mechanism of hemilaryngeal fixation in pyriform sinus carcinoma and its clinical significance]

To approach the mechanism of hemilaryngeal fixation in pyriform sinus carcinoma (PSC), surgical specimens from total laryngectomy and partial hypopharyngectomy in 43 cases of pyriform sinus carcinoma were studied using organ subserial sections. Invasion of intralaryngeal muscles and the upper and outer aspects of arytenoid cartilage via paraglottic space was found to be the main cause of hemilaryngeal fixation in these cases. Presence of tumor on the medial wall of the pyriform sinus makes involvement of intralaryngeal structures easy, and thus is more frequently seen with hemilaryngeal fixation. Clinical T3 lesion of the sinus may infiltrate laryngeal cartilages and adjacent soft tissue to become pathologic T4 lesion. For PSC appearing hemilaryngeal fixation, total laryngectomy is safer to thoroughly remove cancer.

[A report of 50 cases of transglottic carcinoma]

50 cases of transglottic carcinoma were chosen and the collodion-embedded specimens of whole-organ serial section were observed. We found that: 1. Transglottic carcinoma was of laryngeal ventricle origin; 2. There were 1 case in T1 and 2 cases in T2 category; 3. Deep infiltration was the main local growth pattern (90%, 45/50), and paraglottic space and thyroid cartilage were easily involved (82%, 41/50 and 65%, 32/50 respectively), clinical stage was not parallel to pathological stage (48%, 24/50).

[Unstable Jefferson variant atlas fractures: an unrecognized cervical injury]

Nine cases of unstable Jefferson variant atlas fractures were treated with nonoperative external immobilization between 1989 and 1993. All of them were studied by plain films and CT scans. Seven cases had three breaks of the atlas ring. One case had unilateral anterior arch fracture, associated transverse ligament tear and quadriplegia. The other case had Jefferson, Hangman, C3pedicle burst fractures and C3,4dislocation. All of the fractures were unstable or potentially unstable. Despite the abnormal open month view in all cases, the plain films showed minimal abnormalities, requiring CT for definite diagnosis. Follow-up for average of 16 months showed the 7 cases showed the fractures healed with good bone bunion, complete mobility and no residual pain.

A case-control study of the etiology of laryngeal cancer in Liaoning Province

A case-control study of laryngeal cancer was conducted in Liaoning Province between January 1991 and April 1992 among 100 subjects with newly diagnosed cancer and 100 controls. The results of one factor analysis, odd ratio (OR), and conditional logistic regression indicated that smoking was the first significant risk factor for laryngeal cancer with an OR value of 16.8. Tobacco smoking ranked the first with an OR value of 30.4. Other factors such as alcoholic indulgence, insufficient intake of vegetable and fruits in winter and spring, air pollution in room and working environment, and fatigue of vocal cords were closely associated with the occurrence of laryngeal cancer.