[Advances in non-invasive treatment of aortic diseases]

The current clinical treatment methods for aortic diseases including aortic aneurysm, aortic dissection,etc.,are open surgery and endovascular surgery. Compared to traditional open surgery, endovascular surgery has the advantages of minimal trauma, fast recovery, fewer complications, and better prognosis, which gradually becomes the main trend in the treatment of aortic diseases. However, with the further development and long-term follow-up of endovascular treatment for aortic diseases, increasing evidence shows that in many cases, there are difficulties in the diagnosis of causes, decision-making of treatment timing, and lack of effective evaluation of treatment prognosis in endovascular treatments. Therefore, it is necessary to conduct in-depth research on non-invasive treatment including prevention, diagnosis, treatment, and prediction of aortic diseases. The non-invasive treatment of aortic disease is mainly applied to high-risk populations with aortic dissection, regulating key targets and mechanisms, and adopting drug intervention in advance to achieve the goal of controlling aortic dilation and preventing the occurrence of dissection. Conducting precise multi omics analysis to determine the optimal intervention timing and treatment strategy and targeting complications related to aortic disease or endovascular treatment for patients with a positive family history of aortic dilation or those who have developed aortic dissection. Precise regulation can be achieved to control the progression of aortic aneurysm and aortic dissection, delay or achieve long-term stable coexistence with aortic disease, and even reverse disease progression and achieve benign aortic remodelingthrough new intervention vectors. Ultimately achieving the ideal state of complete thrombosis and mechanized healing of the aortic aneurysm or aortic dissection false lumen.

[The precision medicine for the treatment of acute respiratory distress syndrome is based on identification of phenotypes]

The acute respiratory distress syndrome (ARDS) is a heterogeneous syndrome characterized by distinct etiologies and complicated pathobiological mechanism. It is difficult to discriminate patients with unique biological features or individual response to specific therapy by traditional definition and subgrouping. Unfortunately, there are few clinical evidences supporting effective drug therapy to ARDS. The sub-phenotype or endotype of ARDS is related to potential mechanism of the syndrome, and is critical to personalized treatment of ARDS. An appropriate sub-phenotype of ARDS may be defined by data-driven assessment of the available data including clinical features, biological biomarkers and respiratory parameters of the patients. Latent class analysis or machine learning has potential to establish new sub-phenotype of ARDS stably, which is helpful to guide precision medicine approach.

Evidence for Band Renormalizations in Strong-Coupling Superconducting Alkali-Fulleride Films

There has been a long-standing debate about the mechanism of the unusual superconductivity in alkali-intercalated fullerides. In this Letter, using high-resolution angle-resolved photoemission spectroscopy, we systematically investigate the electronic structures of superconducting K_{3}C_{60} thin films. We observe a dispersive energy band crossing the Fermi level with the occupied bandwidth of about 130 meV. The measured band structure shows prominent quasiparticle kinks and a replica band involving the Jahn-Teller active phonon modes, which reflects strong electron-phonon coupling in the system. The electron-phonon coupling constant is estimated to be about 1.2, which dominates the quasiparticle mass renormalization. Moreover, we observe an isotropic nodeless superconducting gap beyond the mean-field estimation (2Δ/k_{B}T_{c}≈5). Both the large electron-phonon coupling constant and large reduced superconducting gap suggest a strong-coupling superconductivity in K_{3}C_{60}, while the electronic correlation effect is suggested by the observation of a waterfall-like band dispersion and the small bandwidth compared with the effective Coulomb interaction. Our results not only directly visualize the crucial band structure but also provide important insights into the mechanism of the unusual superconductivity of fulleride compounds.

[A case of acute poisoning with thiamethoxam]

Thiamethoxam belongs to the second generation of neonicotinoid insecticides, and case of acute poisoning with thiamethoxam had never reported in China. This paper reviewed a case of oral poisoning with thiamethoxam pesticides, the patient suffered vomiting, generalized convulsions, confusion, and decreased oxygen saturation. After treated with gastric lavage, ventilator support, and the use of propofol, midazolam, sodium phenobarbital, and sodium valproate, the convulsions could not be controlled. Untill treated with penehyclidine hydrochloride and hemoperfusion combined with hemofiltration, the patient finally recovered and was discharged from the hospital. We suggest that the main treatments for acute severe thiamethoxam poisoning are decontamination and symptomatic support, pentoxifylline hydrochloride and hemoperfusion combined with hemofiltration may improve the patients' prognosis.

Effects of rhBMP-2 on Bone Formation Capacity of Rat Dental Stem/Progenitor Cells from Dental Follicle and Alveolar Bone Marrow

Dental stem/progenitor cells are a promising cell sources for alveolar bone (AB) regeneration because of their same embryonic origin and superior osteogenic potential. However, their molecular processes during osteogenic differentiation remain unclear. The objective of this study was to identify the responsiveness of dental follicle cells (DFCs) and AB marrow-derived mesenchymal stem cells (ABM-MSCs) to recombinant human bone morphogenetic protein-2 (rhBMP-2). These cells expressed vimentin and MSC markers and did not express cytokeratin and hematopoietic stem cell markers and showed multilineage differentiation potential under specific culture conditions. DFCs exhibited higher proliferation and colony-forming unit-fibroblast efficiency than ABM-MSCs; rhBMP-2 induced DFCs to differentiate toward a cementoblast/osteoblast phenotype and ABM-MSCs to differentiate only toward a osteoblast phenotype; and rhBMP-2-induced DFCs exhibited higher osteogenic differentiation potential than ABM-MSCs. These cells adhered, grew, and produced extracellular matrix on nanohydroxyapatite/collagen/poly(l-lactide) (nHAC/PLA). During a 14-day culture on nHAC/PLA, the extracellular alkaline phosphatase (ALP) activity of DFCs decreased gradually and that of ABM-MSCs increased gradually; rhBMP-2 enhanced their extracellular ALP activity, intracellular osteocalcin (OCN), and osteopontin (OPN) protein expression; and DFCs exhibited higher extracellular ALP activity and intracellular OCN protein expression than ABM-MSCs. When implanted subcutaneously in severe combined immunodeficient mice for 3 months, DFCs+nHAC/PLA+rhBMP-2 obtained higher percentage of bone formation area, OCN, and cementum attachment protein expression and lower OPN expression than ABM-MSCs+nHAC/PLA+rhBMP-2. These results showed that DFCs possessed superior proliferation and osteogenic differentiation potential in vitro, and formed higher quantity and quality bones in vivo. It suggested that DFCs might exhibit a more sensitive responsiveness to rhBMP-2, so that DFCs enter a relatively mature stage of osteogenic differentiation earlier than ABM-MSCs after rhBMP-2 induction. The findings imply that these dental stem/progenitor cells are alternative sources for AB engineering in regenerative medicine, and developing dental tissue may provide better source for stem/progenitor cells.

[The importance and limitations of medical imaging diagnosis for temporomandibular disorders]

Temporomandibular disorders (TMDs) have attracted the attention of the clinicians of stomatology and other related disciplines because of the high prevalence and close relationship with multiple disciplines. Medical imaging is of great value in the diagnosis and differential diagnoses for TMDs. Based on the author's clinical practice experience and some related research work, combined with the relevant literatures, the indications, advantages and disadvantages of various commonly used imaging modalities were described. Simultaneously, the importance and limitations of imaging diagnosis for TMDs were discussed and emphasized in the present article.

[A reevaluation of diagnostic efficacy of International Society of Thrombosis and Haemostasis and Japanese Association for Acute Medicine criteria for the diagnosis of sepsis disseminated intravascular coagulation]

Objective: To reevaluate the diagnostic efficacy of International Society of Thrombosis and Haemostasis (ISTH) and Japanese Association for Acute Medicine (JAAM) criteria for sepsis disseminated intravascular coagulation (DIC). Methods: A total of 769 patients diagnosed as sepsis were enrolled in our study. Blood samples were collected within the first hour in ICU and the index of coagulation was detected. The correlation between the conventional coagulation index and the acute physiology and chronic health evaluation (APACHE Ⅱ) and sequential organ failure assessment (SOFA) scores was analyzed. The sensitivity and specificity of diagnostic efficacy were analyzed by receiver operating characteristic (ROC) curve. Results: In the 769 cases, 95 cases (12.35%) conformed to the standard of ISTH and 271 cases (35.24%) were in accordance with the standard of JAAM. Prolonged prothrombin time (PT) was seen in 726 cases (94.41%). Activated partial thromboplastin time (APTT) was prolonged in 434 cases (56.44%). Plasma fibrinogen (Fib) was decreased in 94 cases (12.22%) and increased in 365 cases(47.46%). Platelet (PLT) count decreased in 158 cases (20.55%). D-dimer was elevated in 759 cases (98.70%). Fibrin degradation product (FDP) was increased in 724 cases (94.15%). PT, APTT, D-dimer, FDP, PLT were correlated with APACHE Ⅱ(r value were 0.259, 0.348, 0.319, 0.289,-0.275, all P values<0.05) and SOFA score(r values were 0.409, 0.445, 0.407, 0.411,-0.526, respectively, all P values<0.05). The areas under the curve (AUCs) in the ISTH standard from high to low were accordingly PT (0.813), FDP (0.792), PLT (0.746), Fib (0.563). The AUCs from high to low were FDP (0.844), PLT (0.716), and PT (0.660), respectively in the JAAM standard. Under the criteria of ISTH, the diagnostic sensitivities of PT, PLT, Fib and FDP were 92.63%, 67.37%, 9.47%, 98.95%, respectively, and specificities as 53.56%, 86.05%, 99.26% and 33.38%% respectively. As to the JAAM criteria, the diagnostic sensitivities of PT, PLT, and FDP were 74.54%, 52.77%, 91.51% and specificities as 51.61%, 84.94%, 40.76% respectively. Conclusions: According to the ISTH and JAAM diagnostic criteria, the diagnostic efficacy of PT and PLT is relatively high, which is associated with the severity of DIC. D-dimer and FDP have the high sensitivity but the specificity is poor. The diagnostic specificity of Fib is good, yet with low sensitivity and poor overall efficacy.

Expression of IL-17A, E, and F and their receptors in non-small-cell lung cancer

Lung cancer is the leading cause of cancer-related morbidity and mortality worldwide. Interaction of nascent or established lung tumour cells with various cytokines and infiltrating immune cells has been implicated in lung cancer pathogenesis. In this study, we systematically analysed immunoreactivity for IL-17A, IL-17E and IL-17F and their relevant receptors in the lung sections from non-small cell lung cancer (NSCLC) and normal control. Immunoreactivity for IL-17A, IL-17F, IL-17RA and IL- 17RC, but not IL-17RB was significantly elevated in NSCLC compared with controls, while IL-17E was reduced. The median numbers of infiltrating lymphocytes and neutrophils and global macrophage (CD68) immunoreactivity of phagocytes were also elevated in NSCLC compared with control tissue sections. Furthermore, correlation between the expression of IL-17A and its receptors IL-17RA and IL- 17RC varied according to NSCLC histopathological type. These data suggest that IL-17A, E, F and their receptors IL-17RA, RB, RC may be involved in the pathogenesis of NSCLC. Further understanding of the relationship between the IL-17/IL-17R axis and the tumour inflammatory microenvironment may reveal new therapeutic targets.

[Technical specification for clinical application of critical ultrasonography]

Critical ultrasonography(CUS) is different from the traditional diagnostic ultrasound, the examiner and interpreter of the image are critical care medicine physicians. The core content of CUS is to evaluate the pathophysiological changes of organs and systems and etiology changes. With the idea of critical care medicine as the soul, it can integrate the above information and clinical information, bedside real-time diagnosis and titration treatment, and evaluate the therapeutic effect so as to improve the outcome. CUS is a traditional technique which is applied as a new application method. The consensus of experts on critical ultrasonography in China released in 2016 put forward consensus suggestions on the concept, implementation and application of CUS. It should be further emphasized that the accurate and objective assessment and implementation of CUS requires the standardization of ultrasound image acquisition and the need to establish a CUS procedure. At the same time, the standardized training for CUS accepted by critical care medicine physicians requires the application of technical specifications, and the establishment of technical specifications is the basis for the quality control and continuous improvement of CUS. Chinese Critical Ultrasound Study Group and Critical Hemodynamic Therapy Collabration Group, based on the rich experience of clinical practice in critical care and research, combined with the essence of CUS, to learn the traditional ultrasonic essence, established the clinical application technical specifications of CUS, including in five parts: basic view and relevant indicators to obtain in CUS; basic norms for viscera organ assessment and special assessment; standardized processes and systematic inspection programs; examples of CUS applications; CUS training and the application of qualification certification. The establishment of applied technology standard is helpful for standardized training and clinical correct implementation. It is helpful for clinical evaluation and correct guidance treatment, and is also helpful for quality control and continuous improvement of CUS application.

[Association between ADAMTS14 gene polymorphism and the temporomandibular joint osteoarthritis in Chinese Han females]

OBJECTIVE

To investigate the association between single nucleotide polymorphisms (SNP) of ADAMTS14 gene rs4747096 and osteoarthritis of the temporomandibular joint in Chinese Han females.

METHODS

As a case-control study, a total of 213 Chinese Han females were involved in the present study, which contained 103 temporomandibular joint osteoarthritis patients and 110 healthy people who had no symptoms or signs of temporomandibular joint osteoarthritis as control. Peripheral blood samples were collected from each participant. Genomic DNAs of temporomandibular joint osteoarthritis patients and healthy control were extracted from peripheral venous blood, which were stored in -80 °C refrigerator by using DNA extraction kits. The designed primers were used for polymerase chain reaction (PCR) amplification of specific DNA fragments. Genotype was determined by sequencing the PCR products. The software Chromas 2.22 was used to analyze the genotype. The genotype distributions, allele frequencies and genetic models between the patients and controls were compared. The age distribution was checked by t-test. Genotype and allele frequency were detected by Chi-square test.

RESULTS

In the present study, there were no significant differences between the osteoarthritis patients and healthy controls in terms of age. The genotype distribution was in accordance with Hardy-Weinberg equilibrium in the two groups. The genotype frequency of the ADAMTS14 (rs4747096) in the experimental group was 38.8% (AA), 55.4% (AG), and 5.8% (GG), respectively. The genotype frequency in the control group was 40.9% (AA), 43.6% (AG), and 15.5% (GG), respectively. The difference of genotype frequency of the ADAMTS14 (rs4747096) was significant between the experimental group and the control group (P=0.047). There was no significant difference in allele frequency between the two groups (P=0.415). AA and AG genotypes significantly increased the risk of the disease compared with GG in dominant model (OR=1.114, 95% CI: 1.015-1.223, P=0.028).

CONCLUSION

A significant correlationship was found between the ADAMTS14 (rs4747096) SNP and the temporomandibular joint osteoarthritis in Chinese Han females. The distribution of rs4747096 may be different between temporomandibular joint osteoarthritis and healthy population.

[Experts consensus on the management of the right heart function in critically ill patients]

To establish the experts consensus on the right heart function management in critically ill patients. The panel of consensus was composed of 30 experts in critical care medicine who are all members of Critical Hemodynamic Therapy Collaboration Group (CHTC Group). Each statement was assessed based on the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) principle. Then the Delphi method was adopted by 52 experts to reassess all the statements. (1) Right heart function is prone to be affected in critically illness, which will result in a auto-exaggerated vicious cycle. (2) Right heart function management is a key step of the hemodynamic therapy in critically ill patients. (3) Fluid resuscitation means the process of fluid therapy through rapid adjustment of intravascular volume aiming to improve tissue perfusion. Reversed fluid resuscitation means reducing volume. (4) The right ventricle afterload should be taken into consideration when using stroke volume variation (SVV) or pulse pressure variation (PPV) to assess fluid responsiveness.(5)Volume overload alone could lead to septal displacement and damage the diastolic function of the left ventricle. (6) The Starling curve of the right ventricle is not the same as the one applied to the left ventricle,the judgement of the different states for the right ventricle is the key of volume management. (7) The alteration of right heart function has its own characteristics, volume assessment and adjustment is an important part of the treatment of right ventricular dysfunction (8) Right ventricular enlargement is the prerequisite for increased cardiac output during reversed fluid resuscitation; Nonetheless, right heart enlargement does not mandate reversed fluid resuscitation.(9)Increased pulmonary vascular resistance induced by a variety of factors could affect right heart function by obstructing the blood flow. (10) When pulmonary hypertension was detected in clinical scenario, the differentiation of critical care-related pulmonary hypertension should be a priority. (11) Attention should be paid to the change of right heart function before and after implementation of mechanical ventilation and adjustment of ventilator parameter. (12) The pulmonary arterial pressure should be monitored timingly when dealing with critical care-related pulmonary hypertension accompanied with circulatory failure.(13) The elevation of pulmonary aterial pressure should be taken into account in critical patients with acute right heart dysfunction. (14) Prone position ventilation is an important measure to reduce pulmonary vascular resistance when treating acute respiratory distress syndrome patients accompanied with acute cor pulmonale. (15) Attention should be paid to right ventricle-pulmonary artery coupling during the management of right heart function. (16) Right ventricular diastolic function is more prone to be affected in critically ill patients, the application of critical ultrasound is more conducive to quantitative assessment of right ventricular diastolic function. (17) As one of the parameters to assess the filling pressure of right heart, central venous pressure can be used to assess right heart diastolic function. (18). The early and prominent manifestation of non-focal cardiac tamponade is right ventricular diastolic involvement, the elevated right atrial pressure should be noticed. (19) The effect of increased intrathoracic pressure on right heart diastolic function should be valued. (20) Ttricuspid annular plane systolic excursion (TAPSE) is an important parameter that reflects right ventricular systolic function, and it is recommended as a general indicator of critically ill patient. (21) Circulation management with right heart protection as the core strategy is the key point of the treatment of acute respiratory distress syndrome. (22) Right heart function involvement after cardiac surgery is very common and should be highly valued. (23) Right ventricular dysfunction should not be considered as a routine excuse for maintaining higher central venous pressure. (24) When left ventricular dilation, attention should be paid to the effect of left ventricle on right ventricular diastolic function. (25) The impact of left ventricular function should be excluded when the contractility of the right ventricle is decreased. (26) When the right heart load increases acutely, the shunt between the left and right heart should be monitored. (27) Attention should be paid to the increase of central venous pressure caused by right ventricular dysfunction and its influence on microcirculation blood flow. (28) When the vasoactive drugs was used to reduce the pressure of pulmonary circulation, different effects on pulmonary and systemic circulation should be evaluated. (29) Right atrial pressure is an important factor affecting venous return. Attention should be paid to the influence of the pressure composition of the right atrium on the venous return. (30) Attention should be paid to the role of the right ventricle in the acute pulmonary edema. (31) Monitoring the difference between the mean systemic filling pressure and the right atrial pressure is helpful to determine whether the infusion increases the venous return. (32) Venous return resistance is often considered to be a insignificant factor that affects venous return, but attention should be paid to the effect of the specific pathophysiological status, such as intrathoracic hypertension, intra-abdominal hypertension and so on. Consensus can promote right heart function management in critically ill patients, optimize hemodynamic therapy, and even affect prognosis.

[Comparision of risk factors and pathogens in patients with early- and late-onset ventilator-associated pneumonia in intensive care unit]

Objective: To compare risk factors and bacterial etiology in patients with early-onset versus late-onset ventilator-associated pneumonia (VAP) in intensive care unit (ICU). Methods: This prospective cohort study enrolled mechanically ventilated patients hospitalized for more than 48 hours in the first affiliated hospital, China Medical University from Jan 2012 to Jun 2016. Subjects were classified by ventilator status: early-onset VAP (< 5 d ventilation, E-VAP) or late-onset VAP (≥ 5 d ventilation, L-VAP). Potential risk factors and pathogen were evaluated. Results: A total of 4 179 patients in adult ICU were screened, 3 989 (95.5%) of whom were mechanically ventilated, 962 patients with mechanical ventilation time ≥ 48 h. VAP developed in 142 patients. E-VAP and L-VAP had different potential risk factors based on statistical analysis.Independent risk factors for E-VAP included male (OR=1.825, 95%CI 1.006-3.310), chronic obstructive pulmonary disease (COPD; OR=3.746, 95%CI 1.795-7.818), emergency intubation (OR=1.932, 95%CI 1.139-3.276), aspiration (OR=3.324, 95%CI 1.359-8.130). Whereas independent risk factors for L-VAP were coma (OR=2.335, 95%CI 1.300-4.194), renal dysfunction (OR=0.524, 95%CI 0.290-0.947), emergency intubation (OR=2.184, 95%CI 1.334-3.574). Mortality in E-VAP and L-VAP group were both higher than the non-VAP group[30.2%(19/63)vs 19.8%(162/820), P=0.044; 29.1%(23/79) vs 19.8%(162/820), P=0.046]. The pathogens isolated from early-onset versus late-onset VAP were not significantly different between groups, which the most common ones were acinetobacter baumannii, pseudomonas aeruginosa and klebsiella pneumoniae. Conclusion: E-VAP and L-VAP have different risk factors, however related pathogens are similar. Different specific preventive strategies are suggested based on different onset of VAP.

[A retrospective clinical study of sixty-three cases with persistent inflammation immunosuppression and catabolism syndrome]

Objective: To study the clinical characteristics and prognosis of patients with persistent inflammation immunosuppression and catabolism syndrome (PICS) in ICU. Methods: A total of 126 patients admitted to ICU (ICU stay of more than 10 days, age≥18 years) between January 2014 to December 2014 were retrospectively studied.Data were collected from electronic medical records including demographics, underlying disease, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) score, Sequential Organ Failure Assessment (SOFA) score, laboratory parameters, ICU acquired infections and clinical outcome. Results: The overall incidence of PICS in ICU patients (ICU stay of more than 10 days) was 50.0%(63/126). There were no significant differences in baseline data such as gender, age, APACHEⅡscore, SOFA score and underlying diseases between the two groups(all P>0.05). Compared with the non-PICS group, there were more patients with gastrointestinal perforation in the PICS group (P=0.042), however, the medical or surgical admission did not differ between the two groups(P>0.05). During the stay in ICU, the PICS group showed a higher risk of developing acquired infections compared with the non-PICS group[PICS 63.5%(40/63) vs non-PICS 23.8%(15/63); P<0.001]. The infections were more caused by Candida in the PICS group than the non-PICS group [PICS 22.4%(11/49) vs non-PICS 2/17; P=0.003]. Moreover, the PICS group experienced longer stay in ICU[PICS(31.6±28.8) days vs non-PICS (20.4±11.3) days; P=0.0046] and higher ICU mortality [PICS 28.6%(18/63) vs non-PICS 6.3%(4/63), P=0.001]. Conclusion: PICS is a common manifestation of patients who stay in ICU more than 10 days, which is associated with high risk of ICU acquired infections, prolonged length of stay and high mortality.

[Understanding and treatment strategy for disc displacement of temporomandibular disorders]

Understanding and treatment strategy for disc displacement of temporomandibular disorders (TMD) were discussed in the present review. It has been strongly recommended by the author that the treatment strategy for disc displacement, one subtype of TMD, should be mainly the reversible conservative treatment methods. The most important goal of treatment for disc displacement is to recover the mobility and function of the joint in order to improve the quality of the patient's life. Comprehensive assessments both from somatic and psychological aspects for each TMD patient are necessary, especially for the patients with chronic pain. Although the role of surgical operative treatments is very limited in the general treatment strategy for TMD, it is still important for a few patients who had definite diagnosis of intra-articular disorders, severe symptoms affecting the quality of patient's life and failed to response to the correct conservative treatments. It should be very careful to treat the TMD patients by surgical operation or irreversible occlusion treatments changing the natural denture of the patient, such as full mouth occlusional reconstruction and extensive adjustment of occlusion.

[Accuracy of computer aided measurement for detecting dental proximal caries lesions in images of cone-beam computed tomography]

Objective: To establish and validate a computer program used to aid the detection of dental proximal caries in the images cone beam computed tomography (CBCT) images. Methods: According to the characteristics of caries lesions in X-ray images, a computer aided detection program for proximal caries was established with Matlab and Visual C++. The whole process for caries lesion detection included image import and preprocessing, measuring average gray value of air area, choosing region of interest and calculating gray value, defining the caries areas. The program was used to examine 90 proximal surfaces from 45 extracted human teeth collected from Peking University School and Hospital of Stomatology. The teeth were then scanned with a CBCT scanner (Promax 3D). The proximal surfaces of the teeth were respectively detected by caries detection program and scored by human observer for the extent of lesions with 6-level-scale. With histologic examination serving as the reference standard, the caries detection program and the human observer performances were assessed with receiver operating characteristic (ROC) curves. Student t-test was used to analyze the areas under the ROC curves (AUC) for the differences between caries detection program and human observer. Spearman correlation coefficient was used to analyze the detection accuracy of caries depth. Results: For the diagnosis of proximal caries in CBCT images, the AUC values of human observers and caries detection program were 0.632 and 0.703, respectively. There was a statistically significant difference between the AUC values (P=0.023). The correlation between program performance and gold standard (correlation coefficient r(s)=0.525) was higher than that of observer performance and gold standard (r(s)=0.457) and there was a statistically significant difference between the correlation coefficients (P=0.000). Conclusions: The program that automatically detects dental proximal caries lesions could improve the diagnostic value of CBCT images.

[Diagnosis and treatment of diffuse tenosynovial giant cell tumor arising from temporomandibular joints]

OBJECTIVE

To retrospectively analyze the clinical features, treatment and prognosis to the diffuse tenosynovial giant cell tumor (D-TSGCT) arising from the temporomandibular joint (TMJ), and to give a reference for the early diagnosis and treatment of this disease.

METHODS

In this study, 15 patients finally diagnosed as D-TSGCT of TMJ histopathologically at the Peking University Hospital of Stomatology from October 2003 to August 2015 were selected and reviewed. Their clinical manifestations, imaging and histological features, diagnoses and differential diagnoses, treatments and follow-ups were summarized and discussed.

RESULTS

D-TSGCT of TMJ showed obvious female predominance (12/15), the main symptoms included painful preauricular swelling or mass, limited mouth-opening and mandibular deviation with movement. D-TSGCT on computed tomography (CT) scan often showed ill-defined soft tissue masses around TMJ, enhancement after contrast administration, usually with widening of the joint spaces and with bone destruction of the condyle, the fossa and even the skull base. On magnetic resonance images (MRI), the majority of lesions on T1 weighted images and T2 weighted images both showed the characteristics of low signals (6/11). The lesions could extend beyond the joints (9/11) and into the infratemporal fossa (4/11) and the middle cranial fossa (4/11). Surgical resection was performed in 14 cases and biopsy in 1 case. Postoperative radiotherapy was performed in 3 cases. In follow-ups, 3 cases showed recurrence postoperatively.

CONCLUSION

D-TSGCT arising from TMJ should be differentiated with TMJ disorders, other tumors and tumor-like lesions of TMJ and parotid neoplasms, etc. CT and MRI examinations have important values in the diagnosis and treatment design of D-TSGCT. Because of the local aggressive and extensive behavior, complete resection should be performed as soon as possible. Postoperative radiotherapy was helpful for the extensive lesions including destruction of skull base and may be a good supplementary therapy. Because of the possibility of recurrence and malignancy, long-term follow-up was suggested.

[Cone-beam computed tomography was used for study of root and canal morphology of maxillary first and second molars]

OBJECTIVE

To investigate the root and canal morphology of maxillary first and second molars by using Cone-beam computed tomography (CBCT).

METHODS

The data of patients who underwent the CBCT scan for dental or periodontal diseases between May and September 2012 were analyzed retrospectively. In the study, 630 maxillary first molars, 519 maxillary second molars which were well-developed and without treatment were included. The number of roots, the number of root canals, and the canal configuration according to Vertucci's classification were determined. The vertucci type I was regarded as the conventional form. Other types were the variation forms and the mutation rate was calculated.

RESULTS

2.38% of the maxillary first molars and 15.22% of the maxillary second molars had 2 separated roots; 97.14% of the maxillary first molars and 73.60% of the maxillary second molars had 3 roots; 10.41% of the maxillary second molars had one single root; 0.77% of the maxillary second molars had 4 roots. In 612 3-rooted maxillary first molars, additional canals were found in 30.88% of the mesiobuccal (MB) roots. In 519 3-rooted maxillary second molars, additional canals were found in 13.87% of the MB roots.

CONCLUSION

CBCT scans show the root and canal anatomy accurately, with the potential of improving the outcome of endodontic treatment.

Development of indirect ELISAs for differential serodiagnosis of classical and highly pathogenic porcine reproductive and respiratory syndrome virus

The objective of this study was to develop two indirect enzyme-linked immunosorbent assays (iELISAs) for detection of serum antibodies against classical vaccine strain of porcine reproductive and respiratory syndrome virus (PRRSV) and highly pathogenic PRRSV (HP-PRRSV). To detect the common antibodies against classical and HP-PRRSV, the coating antigen used in the iELISA (designated iELISA-180) was the antigen of Nsp2-180, the 180aa at amino terminal of Nsp2. To detect the different antibodies against classical and HP-PRRSV, the coating antigen in the second iELISA (designated iELISA-D29) was Nsp2-D29, the deleted 29aa in Nsp2 of HP-PRRSV. The antigen concentration and serum dilutions were optimized using a draughtboard titration. The cut-off values of 0.361 at OD(450nm) for the iELISA-180 and 0.27 at OD(450nm) for the iELISA-D29 were determined by testing a panel of 120 classical PRRSV positive and 198 PRRSV negative pig serum samples, which generated the specificity of 97.1% and 96.7%, the sensitivity of 96.9% and 96.3% for iELISA-180 and iELISA-D29, respectively. The agreements between the Western blot and iELISA-180 and iELISA-D29 were 98%, 96.7%, respectively. The developed iELISAs can be used to differentiate serologically HP-PRRSV from the vaccinated or classical PRRSV in clinical serum samples.

Dose reduction of cone beam CT scanning for the entire oral and maxillofacial regions with thyroid collars

OBJECTIVE

The aim of this study was to evaluate the influence of thyroid collars on radiation dose during cone beam CT (CBCT) scanning.

METHODS

Average tissue-absorbed dose for a NewTom 9000 CBCT scanner (Quantitative Radiology, Verona, Italy) was measured using thermoluminescent dosemeter chips in a phantom. The scans were carried out with and without thyroid collars. Effective organ dose and total effective dose were derived using International Commission on Radiological Protection 2007 recommendations.

RESULTS

The effective organ doses for the thyroid gland and oesophagus were 31.0 µSv and 2.4 µSv, respectively, during CBCT scanning without a collar around the neck. When the thyroid collars were used loosely around the neck, no effective organ dose reduction was observed. When one thyroid collar was used tightly on the front of the neck, the effective organ dose for the thyroid gland and oesophagus were reduced to 15.9 µSv (48.7% reduction) and 1.4 µSv (41.7% reduction), respectively. Similar organ dose reduction (46.5% and 41.7%) was achieved when CBCT scanning was performed with two collars tightly on the front and back of the neck. However, the differences to the total effective dose were not significant among the scans with and without collars around the neck (p = 0.775).

CONCLUSIONS

Thyroid collars can effectively reduce the radiation dose to the thyroid and oesophagus if used appropriately.

Detection of dental root fractures by using cone-beam computed tomography

OBJECTIVES

The purpose of this study was to compare the diagnostic accuracy of cone beam CT (CBCT) with that of conventional dental radiography in the detection of root fractures and to evaluate the influence of root canal fillings on root fracture detection.

METHODS

We investigated 128 patients with clinically suspected root fractures in 135 teeth. These patients underwent conventional dental radiography, CBCT and eventually surgical exploration. Among the 135 teeth, 86 were non-endodontically treated teeth and 49 were endodontically treated teeth. Two oral radiologists independently analysed the dental radiographs and CBCT images of each patient and reached a consensus. The CBCT findings of root fractures were set as the detection of a separation of the adjacent root segments on at least two contiguous sections and on at least two of the three-dimensional (3D) planes.

RESULTS

Root fracture was intraoperatively detected in 95 of the 135 teeth. The sensitivity and specificity of root fractures diagnosed on the basis of the consensus between the 2 evaluators were 26.3% and 100%, respectively, for dental radiography and 89.5% and 97.5%, respectively, for CBCT. CBCT was significantly more accurate than dental radiography in detecting root fractures (P < 0.001). The sensitivity of CBCT was reduced in the presence of root canal fillings but its specificity remained unaffected. Both the sensitivity and specificity of dental radiography were not influenced by the presence of root canal fillings.

CONCLUSIONS

CBCT appears to be more accurate than conventional dental radiography in the detection of root fractures.

UV light emitting transparent conducting tin-doped indium oxide (ITO) nanowires

Multifunctional single crystalline tin-doped indium oxide (ITO) nanowires with tuned Sn doping levels are synthesized via a vapor transport method. The Sn concentration in the nanowires can reach 6.4 at.% at a synthesis temperature of 840 °C, significantly exceeding the Sn solubility in ITO bulks grown at comparable temperatures, which we attribute to the unique feature of the vapor-liquid-solid growth. As a promising transparent conducting oxide nanomaterial, layers of these ITO nanowires exhibit a sheet resistance as low as 6.4 Ω/[Symbol: see text] and measurements on individual nanowires give a resistivity of 2.4 × 10(-4) Ω cm with an electron density up to 2.6 × 10(20) cm(-3), while the optical transmittance in the visible regime can reach ∼ 80%. Under the ultraviolet excitation the ITO nanowire samples emit blue light, which can be ascribed to transitions related to defect levels. Furthermore, a room temperature ultraviolet light emission is observed in these ITO nanowires for the first time, and the exciton-related radiative process is identified by using temperature-dependent photoluminescence measurements.

Vortex properties of two-dimensional superconducting Pb films

Using low temperature scanning tunnelling microscopy/spectroscopy (STM/STS) we have investigated the vortex behaviours of two-dimensional superconducting Pb films at different thicknesses. STS at the vortex core shows an evolution of electronic states with film thickness. Transition from the clean limit to the dirty limit of superconductivity is identified, which can be ascribed to the decreased electronic mean free path induced by stronger scattering from the disordered interface at smaller thicknesses. A magnetic field dependent vortex core size is observed even for such a low- κ superconductor. The weak pinning induced by surface defects leads to the formation of a distorted hexagonal vortex lattice.

[Relationship between coronary angiography and syndrome differentiation type of TCM]

OBJECTIVE

To understand the relationship between the coronary Angiography (CA) reflected degree of coronary artery lesion and the TCM Syndrome Differentiation-type (TCM-SDT).

METHODS

Patients TCM-SDT were differentiated adopting the standard of Syndrome Differentiation for coronary artery diseases revised in 1990, and the comparison of TCM-SDT with the findings in CA was carried out.

RESULTS

CA examination showed that 29 patients (39.73%) were of one-artery lesion, 9 patients (12.33%) two-artery lesion and 35 patients (47.95%) three-artery lesion; the stenosis degree of them were: 54 arteries were mild stenosis, 38 moderate stenosis and 31 severe stenosis; 29 arteries were completely occluded, the sum total of affected artery was 152 (69.41%), and the other 67 arteries (30.59%) had no lesion. TCM-SDT showed that all the 73 patients had secondary Excess Syndrome, among them 73 patients (100%) with blood stasis Syndrome, 39 patients (53.4%) with Phlegm-Turbid Syndrome, 16 (21.0%) with Qi-stagnation Syndrome and 7 (9.6%) with Cold condensation Syndrome. 63 patients (86.3%) with obvious primary Deficiency Syndrome, among them, 57 (78.1%) were Qi-Deficiency, 18 (24.7%) Yang-Deficiency, 28 (38.4%) Yin-Deficiency and 5 (6.8%) Yang collapse. All patients had blood stasis of various degrees, manifesting on tongue proper prominently. In the 80.8% patients who had angina pectoris, 74.0% had their mouth, lips and gum dark red, dark purple or light dark in color. The comparison between TCM-SDT and Blood-Stasis score revealed that patients of Cold condensation-blood stasis Syndrome and Yang collapse-blood stasis Syndrome were serious. Patients of Qi stagnation-blood stasis Syndrome and Yin Deficiency-blood stasis Syndrome were mild cases, while patients of Phlegm Turbid-blood stasis Syndrome and Qi Deficiency-blood stasis Syndrome were moderate severity cases. The number of affected artery in Cold condensation patients was the most, and in Yin-Deficiency patients was the least. The coronary artery stenosis degree in patients of Qi-stagnation and Yin-Deficiency were milder than in those of Yang-collapse and Yang-Deficiency patients.

CONCLUSION

The more the number of arterial lesion, the severer the degree of stenosis and the higher the blood stasis score, then the more serious the degree of stasis.

Clinical study of embolization of arteriovenous malformation in the oral and maxillofacial region

OBJECTIVE

To evaluate the value of embolization on arteriovenous malformations (AVM) in the oral and maxillofacial region and to investigate the efficacy of several different embolic materials.

CLINICAL MATERIALS AND METHODS

10 cases with AVMs, including 5 AVMs mainly in the soft tissue and 5 intraosseous lesions, were embolized. Clinical and angiographic effects were analyzed during the 3 to 16 months follow-up.

RESULTS

In the 5 cases embolized without other treatment, 1 case was embolized 3 times, 3 cases twice, and 1 case once. In these cases, postembolization angiograms revealed complete or nearly complete disappearance of the lesions. In the other 5 cases, embolized before surgery, intraoperative bleeding was significantly decreased. All these patients were free of recurrence during follow-up. Among the materials employed, NBCA seemed to offer a better result.

CONCLUSIONS

Embolization may serve as the primary therapy for some AVMs in the oral and maxillofacial region, or as a routine preoperative adjunct for patients with severe intraosseous or disfiguring AVMs.

Moclobemide-induced gynecomastia in rats

AIM

To study the toxic effect of moclobemide on male breast and to elucidate its mechanism of action.

METHODS

Routine histopathological analysis was used to diagnose the effect of moclobemide on male breast in rats. Plasma concentrations of estrogen, androgen, and prolactin were measured by a ratioimmunometer and relative receptors of mammary gland tissue were detected immunohistochemically.

RESULTS

After 180-d moclobemide treatment, the presence of gynecomastia was 0, 5, 5, 7/10 rats in 0, 60, 240, and 600 mg/kg groups, respectively. After 30-d convalescence, only one rat in 600 mg/kg group got the incidence of gynecomastia. Serum prolactin concentration had a trend to decrease with increasing dose and prolactin receptors in mammary gland were up-regulated.

CONCLUSION

Long-term treatment with moclobemide causes gynecomastia in rats, which is reversible. The mechanism of moclobemide-induced gynecomastia may be related to the increase in prolactin receptors in mammary glands.

Cytokine and adrenal axis responses to endotoxin

The push-pull cannula (PPC) technique was applied to examine the kinetics of in vivo concentration changes in male rat brain extracellular fluid (ECF) of endogenous interleukin-1beta (IL-1beta) and corticotrophin releasing hormone (CRH) after a peripheral injection of lipopolysaccharide (LPS) (25 microg/100 g b.wt. intravenously). In addition, IL-1beta, adrenocorticotropin hormone (ACTH) and corticosterone concentrations in plasma were also measured at selected intervals after LPS challenge. Administration of LPS resulted in a progressive increase in the concentrations of IL-1beta in brain hypothalamic ECF. A significant increase from the zero time mean value of 77+/-10 to 393+/-88 pg/ml at the 15-min interval was recorded. The increase in IL-1beta concentration in hypothalamic ECF reached a peak of 883+/-237 pg/ml at 30 min post-LPS. CRH concentration in the same hypothalamic ECF was 41+/-17 pg/ml at time zero, 97+/-15 pg/ml at 15 min and at 30 min was significantly increased (215+/-56 pg/ml). A time course of significant increases at 30 min in plasma concentrations of IL-1beta, ACTH and corticosterone was also recorded in the same animals described above. The data show that a peripherally administered LPS bolus elicited an early (over 15 min post-injection) increase in brain ECF IL-1beta concentration; additional significant increases in hormones released from the hypothalamic-pituitary-adrenal (HPA) axis were recorded at 30 min post-LPS injection. These observations support the concept of an early change in hypothalamic ECF concentration of IL-1beta preceding LPS-induced activation of the HPA axis.

Studies on contributing factors in temporomandibular disorders

OBJECTIVE

To better understand the pathogenesis of TMD by studying microtrauma of the temporomandibular joint (TMJ), immune responses within TMJ, and psychosocial factors of the past ten years.

METHODS

Condyle and disc movements from 38 patients with temporomandibular disorders (TMD) were observed with the use of videotape recording and soundtape recording techniques after TMJ arthrography. Pathological changes following occlusal trauma were examined using an animal model. Immune complexes in condyle cartilage; antibody to collagen II; and cytokines such as interleukin 1, tumor necrosis factor, and interleukin 6 were detected in synovial fluid of TMD. Psychosocial characteristics were analyzed with the Minnesota Multiphasic Personality Inventory (MMPI) of 80 TMD patients and the Life Events Experience Survey (LEES) of 42 TMD patients.

RESULTS

Persistent and recurrent microtrauma did exist within joints of TMD patients, caused by occlusal trauma and occlusal interference. Occlusal trauma in animals could induce condyle and disc degenerative changes that are similar to the findings in TMJ osteoarthrosis patients. Sequestered antigens within cartilage could be exposed to the immune system after joint degeneration. Humoral and cellular immune responses did exist within TMJ and played an important role in the pathogenesis of TMD. Forty percent of TMD patients suffered from psychosomatic disorders, significantly more than in the healthy control.

CONCLUSION

Microtrauma of TMJ, immune responses within TMJ, psychosocial factors, and anatomical structures of the TMJ itself are the four main contributing factors of TMD. Possible mechanisms of the interactions of the four factors are presented, and principles of preventing and treating TMD are also suggested.

CD36 peptides that block cytoadherence define the CD36 binding region for Plasmodium falciparum-infected erythrocytes

Mature Plasmodium falciparum parasitized erythrocytes (PE) sequester from the circulation by adhering to microvascular endothelial cells. PE sequestration contributes directly to the virulence and severe pathology of falciparum malaria. The scavenger receptor, CD36, is a major host receptor for PE adherence. PE adhesion to CD36 is mediated by the malarial variant antigen, P. falciparum erythrocyte membrane protein 1 (PfEMP1), and particularly by its cysteine-rich interdomain region 1 (CIDR-1). Several peptides from the extended immunodominant domain of CD36 (residues 139-184), including CD36 139-155, CD36 145-171, CD36 146-164, and CD36 156-184 interfered with the CD36-PfEMP1 interaction. Each of these peptides affected binding at the low micromolar range in 2 independent assays. Two peptides, CD36 145-171 and CD36 156-184, specifically blocked PE adhesion to CD36 without affecting binding to the host receptor intercellular adhesion molecule-1 (ICAM-1). Moreover, an adhesion blocking peptide from the ICAM-1 sequence inhibits the PfEMP1-ICAM-1 interaction without affecting adhesion to CD36. These results confirm earlier observations that PfEMP1 is also a receptor for ICAM-1. Thus, the region 139-184 and particularly the 146-164 or the 145-171 regions of CD36 form the adhesion region for P. falciparum PE. Adherence blocking peptides from this region may be useful for modeling the PE/PfEMP1 interaction with CD36 and for development of potential anti-adhesion therapeutics.

Determination of interleukin-1 receptor antagonist, interleukin-10, and transforming growth factor-beta1 in synovial fluid aspirates of patients with temporomandibular disorders

PURPOSE

This study was undertaken to examine the presence of interleukin-1 receptor antagonist (IL-1ra), IL-10, and transforming growth factor-beta1 (TGF-beta1) in the synovial fluid (SF) lavage specimens of patients with temporomandibular disorders (TMDs).

PATIENTS AND METHODS

Synovial fluid lavage specimens were obtained from 14 temporomandibular joints (TMJs) of 12 patients with TMJ internal derangement (ID) and 17 TMJs of 15 patients with TMJ osteoarthritis (OA). Seven synovial fluid lavage samples of TMJs of four asymptomatic donors served as normal controls. The concentrations of IL-1ra, IL-10, and TGF-beta1 were detected with sensitive and specific sandwich enzyme-linked immunosorbent assay (sandwich-ELISA).

RESULTS

IL-1ra, IL-10, and TGF-beta1 in all the normal controls were undetectable. IL-1ra concentrations were 175.78 +/- 52.43 pg/mL in the patients with TMJ ID and 187.85 +/- 59.51 pg/mL in those with TMJ OA. IL-10 was undetectable in all the TMJ ID and OA samples. The concentration of TGF-beta1 in TMJ ID patients (47.93 +/- 88.25 pg/mL) was significantly less than in patients with TMJ OA (143.61 +/- 108.00 pg/mL) (P < .01).

CONCLUSION

The results suggest that deficiencies of IL-1ra, IL-10, and TGF-beta1 probably play an important role in the cause and pathogenesis of TMJ ID and OA.

Identification of a region of PfEMP1 that mediates adherence of Plasmodium falciparum infected erythrocytes to CD36: conserved function with variant sequence

Adherence of mature parasitized erythrocytes (PE) of Plasmodium falciparum to microvascular endothelial cells contributes directly to the virulence and pathology of this human malaria. The malarial variant antigen, P falciparum erythrocyte membrane protein 1 (PfEMP1), has been implicated as the PE receptor for CD36 on endothelial cells. We identified the region of PfEMP1 that mediates adherence of PE to CD36 and showed that a recombinant protein fragment from this region blocked and reversed adherence of antigenically different parasites. Sequence variation was evident in the CD36 binding domain of different PfEMP1 genes, yet many highly conserved residues, particularly cysteine residues, are evident. This suggests a highly conserved shape that mediates adherence to CD36. Immunization with the CD36-binding domain elicited sera that are cross-reactive with the different recombinant proteins but are strain-specific for the PE surface. Novel anti-adherence therapeutics and a malaria vaccine may derived from exploitation of the structure of the CD36 binding domain of PfEMP1.

Cloning the P. falciparum gene encoding PfEMP1, a malarial variant antigen and adherence receptor on the surface of parasitized human erythrocytes

Plasmodium falciparum-infected human erythrocytes evade host immunity by expression of a cell-surface variant antigen and receptors for adherence to endothelial cells. These properties have been ascribed to P. falciparum erythrocyte membrane protein 1 (PfEMP1), an antigenically diverse malarial protein of 200-350 kDa on the surface of parasitized erythrocytes (PEs). We describe the cloning of two related PfEMP1 genes from the Malayan Camp (MC) parasite strain. Antibodies generated against recombinant protein fragments of the genes were specific for MC strain PfEMP1 protein. These antibodies reacted only with the surface of MC strain PEs and blocked adherence of these cells to CD36 but without effect on adherence to thrombospondin. Multiple forms of the PfEMP1 gene are apparent in MC parasites. The molecular basis for antigenic variation in malaria and adherence of infected erythrocytes to host cells can now be pursued.

Percutaneous internal maxillary arterial embolization with ethylcellulose microspheres. Results in an animal model

RATIONALE AND OBJECTIVES

To investigate the use of ethylcellulose microspheres as long-term and peripheral emboli for percutaneous maxillofacial arterial embolization.

METHODS

Eight mongrel dogs were selected randomly for internal maxillary artery embolization with ethylcellulose microspheres. After embolization, angiographic, microangiographic, and histologic examinations were performed.

RESULTS

Ethylcellulose microspheres were trapped in the peripheral arterioles from 24 hours to 6 months after embolization. Degenerative changes of maxilla, mandible, and dental pulp occurred after the embolization of the internal maxillary artery with the microspheres. No evidence of whole or focal necrosis of the bones and surrounding soft tissues was found between 24 hours and 6 months after embolization.

CONCLUSION

Ethylcellulose microspheres can be used as an alternative long-term and peripheral embolic agent, with potential for percutaneous maxillofacial arterial embolization.

Experimental maxillofacial arterial chemoembolization with encased-cisplatin ethylcellulose microspheres

PURPOSE

To compare chemoembolization with conventional chemotherapy and explore the possibility of chemoembolization in the oral and maxillofacial region using encased-anticancer-drug microspheres.

METHOD

Six mongrel dogs were divided into two equal groups, an experimental group undergoing maxillofacial arterial chemoembolization with cisplatin encased in ethylcellulose microspheres, and a control group undergoing the conventional chemotherapy with cisplatin. The peripheral venous cisplatin concentration and the cisplatin concentration at the local tissue were determined.

RESULT

The experiment showed a significant difference in the peripheral venous cisplatin concentration between the two groups and between the time period. There was also a significant interaction between groups and time. The peak concentration in the experimental group appeared 12 to 24 hours after chemoembolization. The peak concentration in the control group appeared immediately after the anticancer drug was infused. There was a significant difference in the concentration in the local tissue between the two groups, when all time periods were aggregated.

CONCLUSION

Compared with conventional chemotherapy, the maxillofacial arterial chemoembolization with cisplatin encased in ethylcellulose microspheres significantly decreases the cisplatin concentration in the peripheral venous circulation and increases the concentration in the local tissues, allowing for the possibility of target cancer therapy.

[Magnetic resonance imaging of lateral pterygoid muscle in temporomandibular joint dysfunction syndrome]

Fifteen TMJS of fifteen normal controls and thirty TMJs of thirty patients with TMJDS were studied with head-coil MR imaging. T1 weighted oblique sagittal scanning in closed and opened mouth and T2 weighted oblique sagittal scanning in closed mouth were used to evaluate the lateral pterygoid muscle of the controls and the patients. The upper head of lateral pterygoid muscle was found shorter and straighter in opened mouth than that in closed mouth. It is suggested that the upper head is in the state of contraction in opened mouth. The same finding was also found in the patients with TMJDS in opened mouth. Edema and effusion in lateral pterygoid muscle were found in 80% patients with TMJDS on T2 weighted image.

[Tumor necrosis factor in synovial fluids of temporomandibular joint dysfunction syndrome]

With the MTT tetrazolium WEHI 164 clone 13 cell cytotoxicity assay, we measured TNF alpha (tumor necrosis factor) activity in synovial fluids of TMJDS (Temporomandibular joint dysfunction syndrome). We found no detected TNF alpha level from 5 patients with muscle dysfunction, raised TNF alpha levels from 5 of 11 patients with internal derangement and from 9 of 11 patients with organic destruction (osteoarthritis). The findings of biologically active TNF alpha in synovial fluids of TMJDS suggest that TNF alpha may play a role in the pathogenesis of TMJDS.

[Operative and pathological observations on secondary synovitis of temporomandibular joint dysfunction syndrome]

14 cases (16 joints) with temporomandibular joint dysfunction syndrome (TMJDS) were included in the present study. All the patients had severe pain of the joint for a long time and the conventional therapy was not effective. The operative and pathological findings of the 14 cases showed that synovitis secondary to microtrauma of the joint really existed and might be one of the reasons causing the severe pain of the joint in some patients with TMJDS.

Expression of HLA-class II antigen in gastric carcinomas. Its relationship to histopathological grade, lymphocyte infiltration and five-year survival rate

To investigate whether the expression of HLA-DR antigen in gastric carcinomas is associated with the survival rate, we studied 70 cases of gastric carcinoma using a monoclonal antibody. Forty-seven cases (67%) stained positively, including 31 differentiated carcinomas, and 16 undifferentiated carcinomas. A close correlation was found between expression of HLA-DR antigen and differentiation of the tumor cells. Marked lymphocyte infiltration was seen in the HLA-DR antigen positive cancers. In advanced gastric cancers, the 5-year survival rate of patients with HLA-DR antigen positive cancers was significantly higher (67.5%) than that of patients with HLA-DR antigen negative cancers (40%). The data suggest that the expression of HLA-DR antigen in gastric carcinomas may reflect the degree of tumor cell differentiation, and influence the host immune response and prognosis.

Recurrent parotitis in adults. Report of 35 cases

Clinical, laboratory and sialographic findings were studied in 35 adult patients with recurrent parotitis. The patients were followed up for 0.5-23 years. The results showed that sialographic recovery occurred 3-5 years after disappearance of clinical symptoms. Recurrent parotitis is not a autoimmune disease, and remission may take place spontaneously, including clinical and sialographic healing. However, marked degeneration of the parotid gland or chronic obstructive parotitis may develop consequently. The differential diagnosis of recurrent parotitis in adults is also discussed.

Expression of sialyl-Tn antigen is correlated with survival time of patients with gastric carcinomas

Expression of sialyl-Tn antigen (STN) was examined by an immunohistochemical method in 85 primary gastric carcinomas. The STN expression occurred in 53 (62.4%) cancers, and the positive staining was correlated with degree of gastric wall and lymph vessel invasion, lymph node metastasis, and stage of tumour. Five-year survival rates of patients with STN-positive cancers (47.2%) were significantly lower than those with STN-negative cancers (84.4%) (P < 0.01), and patients with STN-positive cancers at stage III and stage IV had a worse prognosis. In the cancers with serosal invasion, patients with STN-positive cancer disclosed a significantly poorer prognosis than those with STN-negative cancers (P < 0.01). Therefore, it is suggested that a careful follow-up study and intensive postoperative therapy are needed for patients with advanced gastric cancers with positive STN expression.

[Evaluation of digital subtraction arthrography on the diagnosis of temporomandibular joint dysfunction syndrome]

Digital subtraction arthrography of temporomandibular joint superior cavity (TMJSC-DSA) was performed for 70 cases with TMJ dysfunction syndrome. A comparative observation between the operative findings and the findings of TMJSC-DSA examination was carried out for 11 cases who underwent TMJ operation. The results showed that TMJSC-DSA could overcome the disadvantages of conventional arthrography and make exact diagnoses for the anterior displacement of the disc and the disc perforation.

[Analysis of erroneous diagnosis on temporomandibular joint arthrography]

In the present study, 433 arthrographic cases with temporomandibular joint dysfunction syndrome were included. 30 cases of them underwent operation and 22 cases underwent digital subtraction arthrographic examination after conventional arthrography. It has been found that arthrographic erroneous diagnosis could be made because the artificial manifestations caused by over-dose of contrast medium into the joint cavity, repeated puncture, anterior displacement of the condyle after injecting contrast medium and so on. In addition, the arthrographic manifestations of dis-clock were also analysed.

Efficient Multistep Photoinitiated Electron Transfer in a Molecular Pentad

A synthetic five-part molecular device has been prepared that uses a multistep electron transfer strategy similar to that of photosynthetic organisms to capture light energy and convert it to chemical potential in the form of long-lived charge separation. It consists of two covalently linked porphyrin moieties, one containing a zinc ion (P(Zn)) and the other present as the free base (P). The metailated porphyrin bears a carotenoid polyene (C) and the other a diquinone species (Q(A)-Q(B)). Excitation of the free-base porphyrin in a chloroform solution of the pentad yields an initial charge-separated state, C-P(Zn)-P(.+).-Q(A)(-)-Q(B), with a quantum yield of 0.85. Subsequent electron transfer steps lead to a final charge-separated state, C(.+)-P(Zn)-P-Q(A)-Q(B)(.-), which is formed with an overall quantum yield of 0.83 and has a lifetime of 55 microseconds. Irradiation of the free-base form of the pentad, C-P-P-Q(A)-Q(B), gives a similar charge-separated state with a lower quantum yield (0.15 in dichloromethane), although the lifetime is increased to approximately 340 microseconds. The artificial photosynthetic system preserves a significant fraction ( approximately 1.0 electron volt) of the initial excitation energy (1.9 electron volts) in the long-lived, charge-separated state.