[A sampling survey of intraoperative facial nerve monitoring in China]

Objective: This study aims to investigate the current application and the level of knowledge of intraoperative facial nerve monitoring among medical staff in China. Methods: A comprehensive online questionnaire was conducted among medical professionals across different regions in China from October 2022 to February 2023. The survey exclusively targeted departments specializing in otolaryngology, head and neck surgery, neurosurgery, and oral and maxillofacial surgery. The questionnaire covered various aspects including general information, intraoperative facial nerve monitoring practices, training history, indications for monitoring, parameters used during monitoring procedures, as well as factors influencing its implementation. Results: A total of 417 participants from 31 provincial, municipal, and autonomous regions were included. Intraoperative facial nerve monitoring was found to be implemented in 227 (54.4%,227/417) repondents of 53 institutions (24.9%, 53/213). The top three indications for implementing this technique were acoustic neuroma, parotid gland surgery, and modified middle ear surgery (mastoidectomy). Herein 81.1%(184/227) medical staff involved in intraoperative facial nerve monitoring had received relevant training, 57.3%(130/227)-92.1%(209/227) reported a lack of clear description regarding recording thresholds, stimulation currents/frequencies/wave widths. Conclusion: The majority of the institutions surveyed have not yet adopted intraoperative facial nerve monitoring. Furthermore, significant gaps concerning the procedure exist. It is imperative to establish standards or guidelines to promote its better development and application.

[Management of the internal carotid artery during lateral skull base surgery: a series of 41 cases]

Objective: To introduce our experience on dealing with the internal carotid artery (ICA) during the resection of lateral skull base tumors, and to explore the reference values for using radiological findings to make a rational surgical plan. Methods: A retrospective study of patients who underwent resection of lateral skull base tumors involving ICA at Peking Union Medical College Hospital from May 2015 to May 2021 was conducted. The demographic information, preoperative examinations, diagnosis, surgical details and follow-ups were collected. A total of 41 patients were enrolled [24 (58.5%] females, 17 (41.5%) males], with an average age of 47.9 years. According to the preoperative imaging findings, the relationships between the tumors and ICA were divided into four types: adjacency, compression, invasion and ICA aneurysm. Results: The ICA was preserved in 32 (78.0%, 32/41) cases and was reconstructed in nine (22.0%, 9/41) cases. All the 27 (65.9%, 27/41) tumors adjacent to ICA were successfully separated from the artery. Among the 11 tumors compressing the ICA, six were resected with the involved ICA segment and vascular reconstruction was conducted. One (2.4%, 1/41) tumor invading ICA and two (4.9%, 2/41) ICA aneurysms required revascularization. The mean follow-up time was (26.1±2.9) months. There was no recurrence, except one case of adenoid cystic carcinoma which had brain metastases one year after surgery. Conclusions: According to the preoperative imaging, lateral skull base tumors adjacent to ICA can be detached from the vascular surface. Separation should be attempted first for tumors compressing ICA, and revascularization should be followed if separation failed. Vascular reconstruction is usually needed in the removal of tumors invading ICA and ICA aneurysms. Preoperative radiology can provide good references for planning a surgery for lateral skull base tumors.

[Effect evaluation of surgical plus radio(chemo)therapy and non-surgery chemoradiotherapy treatment strategies for advanced tonsillar squamous cell carcinoma]

Objective: Using propensity score matching method(PSM) to investigate the clinical effect of surgical plus radio(chemo)therapy and non-surgery chemoradiotherapy treatment strategies for advanced tonsillar squamous cell carcinoma. Methods: A retrospective analysis was conducted on the clinical data of 324 patients diagnosed with advanced tonsillar squamous cell carcinoma and treated in Peking Union Medical College Hospital from 2000 to 2018, confirmed by pathology and without distant metastasis. Survival analysis was performed using Kaplan-Meier estimates, the Cox proportional hazards model, and propensity score matching(PSM). Results: Of the 324 patients, 102 were treated with non-surgery chemoradiotherapy treatment strategies and 222 with surgical plus radio(chemo)therapy treatment. Cox multivariate analysis showed that the non-surgery treatment group had a favorable prognosis than the surgical treatment group, however, these outcomes were not significantly different [overall survival(OS): adjusted Hazard Ratios(aHR): 0.92, 95% confidence interval(CI): 0.60-1.42; disease-specific survival(DSS): aHR: 0.71, 95%CI: 0.43-1.20; disease-free survival(DFS): aHR: 0.82, 95%CI: 0.53-1.28]. The new patient cohort consisted of 102 subpairs after PSM. There were no significant differences between two groups(OS: aHR: 0.85, 95%CI: 0.51-1.40; DSS: aHR: 0.62, 95%CI: 0.35-1.11; DFS: aHR: 0.80, 95%CI: 0.49-1.33). Conclusion: Our findings indicate that patients with non-surgical treatment do not have significantly better survival outcomes compared to surgical treatment group, while non-surgical treatment has advantages in improving the quality of life of patients, so comprehensive treatment based on radiotherapy and chemotherapy may be recommended for advanced tonsillar squamous cell carcinoma.

Dehydrocostus Lactone Attenuates Methicillin-Resistant Staphylococcus aureus-Induced Inflammation and Acute Lung Injury via Modulating Macrophage Polarization

Dehydrocostus lactone (DHL), a natural sesquiterpene lactone isolated from the traditional Chinese herbs Saussurea lappa and Inula helenium L., has important anti-inflammatory properties used for treating colitis, fibrosis, and Gram-negative bacteria-induced acute lung injury (ALI). However, the effects of DHL on Gram-positive bacteria-induced macrophage activation and ALI remains unclear. In this study, we found that DHL inhibited the phosphorylation of p38 MAPK, the degradation of IκBα, and the activation and nuclear translocation of NF-κB p65, but enhanced the phosphorylation of AMP-activated protein kinase (AMPK) and the expression of Nrf2 and HO-1 in lipoteichoic acid (LTA)-stimulated RAW264.7 cells and primary bone-marrow-derived macrophages (BMDMs). Given the critical role of the p38 MAPK/NF-κB and AMPK/Nrf2 signaling pathways in the balance of M1/M2 macrophage polarization and inflammation, we speculated that DHL would also have an effect on macrophage polarization. Further studies verified that DHL promoted M2 macrophage polarization and reduced M1 polarization, then resulted in a decreased inflammatory response. An in vivo study also revealed that DHL exhibited anti-inflammatory effects and ameliorated methicillin-resistant Staphylococcus aureus (MRSA)-induced ALI. In addition, DHL treatment significantly inhibited the p38 MAPK/NF-κB pathway and activated AMPK/Nrf2 signaling, leading to accelerated switching of macrophages from M1 to M2 in the MRSA-induced murine ALI model. Collectively, these data demonstrated that DHL can promote macrophage polarization to an anti-inflammatory M2 phenotype via interfering in p38 MAPK/NF-κB signaling, as well as activating the AMPK/Nrf2 pathway in vitro and in vivo. Our results suggested that DHL might be a novel candidate for treating inflammatory diseases caused by Gram-positive bacteria.

Itaconate ameliorates methicillin-resistant Staphylococcus aureus-induced acute lung injury through the Nrf2/ARE pathway

Background

Methicillin-resistant Staphylococcus aureus (MRSA) are a critical predisposing factor of sepsis in the clinic. As a product of human energy metabolism and immune response, itaconate can effectively reduce inflammation in the body. This research employed 4-octyl itaconate (4-OI) to illustrate that itaconate exerted anti-inflammatory effects to protect the body from acute lung injury (ALI) induced by MRSA.

Methods

HE staining and immunohistochemistry are used to evaluate the MRSA-induced ALI in mice. WB and qPCR were used to verify the effect of 4-OI on inflammation and oxidative stress caused by MRSA. Molecular docking was used to verify the binding sites of 4-OI and Keap1.

Results

We demonstrated that 4-OI treatment increased the survival ratio, attenuated the pathological damage, inhibited neutrophil infiltration, and reduced lung bacterial burden in the mouse MRSA pneumonia model. 4-OI decreased the expression of inflammatory factors by stimulating the Nrf2 in vivo and in vitro. Furthermore, 4-OI exerted its effect by promoting nuclear transport of Nrf2 in vitro. The results of molecular docking indicated that 4-OI bound to the pocket of Keap1 and exerted a stable interaction. Both Nrf2 inhibitors (ML385) and Nrf2^−/− mice abolished the protective effect of 4-OI on MRSA-induced inflammation both in vitro and in vivo.

Conclusions

4-OI prevents lung damage caused by MRSA bacteremia via activating Nrf2/ARE pathway.

Sodium Propionate Enhances Nrf2-Mediated Protective Defense Against Oxidative Stress and Inflammation in Lipopolysaccharide-Induced Neonatal Mice

Background

Alveolar arrest and the impaired angiogenesis caused by chronic inflammation and oxidative stress are two main factors in bronchopulmonary dysplasia (BPD). Short-chain fatty acids (SCFAs), especially propionate, possess anti-oxidant and anti-inflammatory effects. The present study was designed to examine the roles of sodium propionate (SP) on lipopolysaccharide (LPS)-challenged BPD and its potential mechanisms.

Methods

WT, Nrf2^-/- mice and pulmonary microvascular endothelial cells (HPMECs) were used in this study. LPS was performed to mimic BPD model both in vivo and vitro. Lung histopathology, inflammation and oxidative stress-related mRNA expressions in lungs involved in BPD pathogenesis were investigated. In addition, cell viability and angiogenesis were also tested.

Results

The increased nuclear factor erythroid 2-related factor (Nrf2) and decreased Kelch-like ECH-associated protein-1 (Keap-1) expressions were observed after SP treatment in the LPS-induced neonatal mouse model of BPD. In LPS-induced wild-type but not Nrf2^-/- neonatal mice, SP reduced pulmonary inflammation and oxidative stress and exhibited obvious pathological alterations of the alveoli. Moreover, in LPS-evoked HPMECs, SP accelerated Nrf2 nuclear translocation presented and exhibited cytoprotective and pro-angiogenesis effects. In addition, SP diminished the LPS-induced inflammatory response by blocking the activation of nuclear factor-kappa B pathway. Moreover, pretreatment with ML385, an Nrf2 specific inhibitor, offsets the beneficial effects of SP on inflammation, oxidative stress and angiogenesis in LPS-evoked HPMECs.

Conclusion

SP protects against LPS-induced lung alveolar simplification and abnormal angiogenesis in neonatal mice and HPMECs in an Nrf2-dependent manner.

Sophoricoside attenuates lipopolysaccharide-induced acute lung injury by activating the AMPK/Nrf2 signaling axis

Sophoricoside (SOP), an isoflavone glycoside isolated from seed of Sophora japonica L., has been reported to have various pharmacological activities, including anti-cancer, anti-allergy and anti-inflammation. However, the effect of SOP on lipopolysaccharides (LPS)-acute lung injury (ALI) is completely unclear. Here, we found that SOP pretreatment significantly ameliorated LPS-induced pathological damage, tissue permeability, neutrophil infiltration and the production of pro-inflammatory cytokines (TNF-α, IL-1β and IL-6) in a murine model of ALI. Besides, SOP reduced the production of pro-inflammatory mediators such as iNOS, NO and inflammatory cytokines including TNF-α, IL-1β and IL-6 in LPS-stimulated RAW264.7 cells and bone marrow derived macrophages. Interestingly, treatment with SOP exhibited no effect on the activation of NF-κB and MAPKs in macrophages but prominently accelerated the expression and nuclear translocation of Nrf2. By using ML385, a specific Nrf2 inhibitor, we found that inhibition of Nrf2 abolished the inhibitory effect of SOP on LPS-induced iNOS expression, NO production as well as pro-inflammatory cytokine generation. SOP also activated AMPK, an upstream protein of Nrf2, under LPS stimuli. Furthermore, we demonstrated that the accelerated expression of Nrf2 induced by SOP was reversed by interference with the AMPK inhibitor Compound C. Taken together, our results suggested that SOP attenuated LPS-induced ALI in AMPK/Nrf2 dependent manner and indicated that SOP might be a potential therapeutic candidate for treating ALI/ARDS.

Salvinorin A protects against methicillin resistant staphylococcus aureus-induced acute lung injury via Nrf2 pathway

Salvinorin A (SA), a neoclerodane diterpene, is isolated from the dried leaves ofSalvia divinorum. SA has traditionally been used treatments for chronic pain diseases. Recent research has demonstrated that SA possesses the anti-inflammatory property. The present study aim to explore the effects and potentialmechanisms ofSA in protection against Methicillin Resistant Staphylococcus aureus (MRSA)-induced acute lung injury (ALI). Here, we firstly found that verylowdosesof SA (50 μg/kg) could markedly decrease the infiltration of pulmonary neutrophils, mRNA expression of pro-inflammatory cytokines (TNF-α, IL-1β and IL-6) and then attenuated ALI cause by MRSA infection in mice. In vitro findings revealed that SA attenuated lipoteichoicacid-induced apoptosis, inflammation and oxidative stress in RAW264.7 cells. Mechanism research revealed that SA increased both mRNA levels and protein levels of nuclear factor erythroid 2-related factor 2 (Nrf2) and up-regulated mRNA expression of its downstream genes (HO-1, Gclm, Trx-1, SOD1 and SOD2). Additionally, Nrf2 knockout mice abolished the inhibitory effect of SA on neutrophil accumulation and oxidative stress in MRSA-induced ALI. In conclusion, SA attenuates MRSA-induced ALI via Nrf2 signaling pathways.

[Diagnosis and treatment of rare complications of liver cirrhosis]

The rare complications of cirrhosis, such as chylous ascites, hepatic hydrothorax, spontaneous bacterial peritonitis, cirrhotic cardiomyopathy, portopulmonary hypertension, cirrhotic nervous system damage, etc., have not yet been fully understood and/or promptly and effectively diagnosed and treated by clinicians. Therefore, this article aims to introduce the above-mentioned rare complications, clinical features, treatment and prognosis of liver cirrhosis in an attempt to improve the clinicians' understanding and level of diagnosis and treatment.

[Effect of sorafenib and prophylactic TACE for prevention of postoperative relapse in patients with liver cancer combined with microvascular invasion]

Objective: To study the effect of sorafenib and prophylactic transarterial chemoembolization (TACE) for prevention of postoperative relapse in patients with liver cancer combined with microvascular invasion (MVI) after using radical hepatectomy. Methods: A retrospective analysis was performed on 137 cases that underwent radical hepatectomy at the First Affiliated Hospital of Zhengzhou University from August 2015 to January 2018. Clinical data of liver cancer patients with MVI were diagnosed by postoperative pathology. General data of the three groups were analyzed. Kaplan-Meier was used to calculate the tumor-free survival rate. COX proportional hazards-model was used to analyze the independent risk factors for postoperative recurrence of liver cancer with MVI recurrence. Counting data was compared by x(2) test between groups, and log-rank test was used to compare the tumor-free survival rates. Results: A, B, and C groups had 49, 36, and 52 cases, respectively. General clinicopathological data of the three groups were not statistically significant. The postoperative tumor-free survival rates at 1-, 2-, and 3-years were 71.4%, 51.0%, 38.8%, 86.1%, 75.0%, 66.7%, and 82.7%, 75.0%, and 59.6% respectively in A, B, and C groups. Multivariate Cox proportional-hazards regression model showed that patients' age (HR = 0.622, P = 0.046), maximum tumor diameter (HR = 1.661, P = 0.033), prophylactic TACE (HR = 0.544, P = 0.019), and postoperative use of sorafenib (HR = 0.419, 0.222, 0.791, P = 0.007) were independent risk factors for postoperative recurrence of liver cancer with MVI. Conclusion: Sorafenib or prophylactic TACE use can significantly reduce the recurrence rate within 3 years after radical surgery in patients with liver cancer who were confirmed to have MVI by postoperative pathology.

[Preliminary analysis of central paroxysmal positional vertigo]

Objective: To explore the possible pathogenesis of central paroxysmal positional vertigo (CPPV) by analyzing its clinical manifestations and characteristics. Methods: The clinical data of 3 patients with CPPV, including 1 male and 2 females, aged 36, 14 and 70 years old respectively, were collected from the Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences from June 2014 to June 2018. The clinical symptoms, nystagmus, other central ocular motor abnormalities, MRI, PET-CT, and laboratory findings were analyzed retrospectively. Results: All patients showed transient vertigo and nystagmus induced by head changes relative to gravity, but the characteristics of nystagmus did not conform to the typical characteristics of nystagmus in benign paroxysmal positional vertigo. None of patients response to repositioning maneuvers, and all patients presented with the signs of abnormal visual oculomotor system or other symptoms of central system. MRI, PET-CT and blood biochemical tests confirmed that the causes of CPPV in the patients were chronic hemorrhage, inflammation and paraneoplastic cerebellar degeneration. Although the etiology of the three cases is different, the lesion site is involved in the central velocity storage mechanism. Conclusion: The damage of central velocity storage mechanism may lead to the damage of feedback rotation signal correction pathway, and CPPV appears when the head position changes relative to gravity.

Sodium Propionate Attenuates the Lipopolysaccharide-Induced Epithelial-Mesenchymal Transition via the PI3K/Akt/mTOR Signaling Pathway

Short-chain fatty acids (SCFAs), especially propionate, originate from the fermentation of dietary fiber in the gut and play a key role in inhibiting pulmonary inflammation. Chronic inflammation may induce an epithelial-mesenchymal transition (EMT) in alveolar epithelial cells and result in fibrotic disorders. This study was designed to investigate the beneficial effect of sodium propionate (SP) on lipopolysaccharide (LPS)-induced EMT. In cultured BEAS-2B cells, the protein expression levels of E-cadherin, α-smooth muscle actin (SMA), and vimentin were 0.66 ± 0.20, 1.44 ± 0.23, and 1.32 ± 0.21 in the LPS group vs 1.11 ± 0.36 (P < 0.05), 1.04 ± 0.30 (P < 0.05), and 0.96 ± 0.13 (P < 0.01) in the LPS + SP group (mean ± standard deviation), respectively. Meanwhile, LPS-triggered inflammatory cytokines and extracellular proteins were also reduced by SP administration in BEAS-2B cells. Moreover, SP treatment attenuated inflammation, EMT, extracellular matrix (ECM) deposition, and even fibrosis in a mouse EMT model. In terms of mechanism, LPS-treated BEAS-2B cells exhibited a higher level of phosphatidylinositol 3-kinase (PI3K)/AKT/mammalian target of rapamycin (mTOR) phosphorylation, which was interrupted by SP treatment. It is worth noting that the blockade of the PI3K/Akt/mTOR signaling cascade reduced the LPS-evoked EMT process in BEAS-2B cells. These results suggest that SP can block LPS-induced EMT via inhibition of the PI3K/Akt/mTOR signaling cascade, which provides a basis for possible clinical use of SP in airway and lung diseases.

Elevation of autophagy rescues spermatogenesis by inhibiting apoptosis of mouse spermatocytes

Autophagy and apoptosis are interlocked in an extensive crosstalk. Our previous study demonstrated that hypotonic hypoxia-induced marked apoptosis of a spermatocyte-derived cell line (GC-2). However, whether hypoxia-induced apoptosis is mediated by inhibition of autophagy under hypoxic conditions remains unclear. In this study, GC-2 cells were cultured in 1% O2 and harvested at different time points. Autophagy was determined by acridine orange staining, cyto-ID staining, mCherry-GFP-LC3B adenovirus transfection and Western blotting for various autophagy markers. Apoptosis was detected by TUNEL staining, flow cytometry, JC-1 staining and Western blotting of apoptosis-related proteins. We found that hypoxia-induced apoptosis of GC-2 cells through mitochondrial and death receptor pathways and inhibited autophagic flux in GC-2 cells in a time-dependent manner. However, while marked autolysosome formation was observed in GC-2 cells before 24-h culture in hypoxic conditions, apparent apoptosis was observed only after 24-h culture in hypoxic conditions. Caspase-8 siRNA treatment induced cell survival, accompanied by induction of the mature autophagosome, acidic vesicular organelle formation and autophagic flux. Furthermore, Beclin-1 overexpression markedly attenuated the impairment of spermatogenesis in mice by inhibiting apoptosis of spermatocytes. The results of this study demonstrate that hypoxia inhibits autophagy, which further enhances hypoxia-induced apoptosis of mouse spermatocytes by promoting caspase-8 activation in a time-dependent manner, suggesting that combined application of apoptosis inhibition and autophagy activation might be a therapeutic strategy for treating hypoxia-induced male infertility.

[Advances of chronic tympanic membrane perforation animal model]

Chronic tympanic membrane perforation in an animal model has been widely used. The ideal model is a lasting and stable perforation without infection. For half a century, several physical modalities have been evolved, such as thermal injury, infolding technique, tympanostomy tube, re-myringotomy, and laser myringotomy. Chemical methods using chemical substance inhibiting growth and repair of cells as well as using gene defect animals are also applied. We have found the success rate is lower when using only one method and it would be better to combine physical and chemical approaches. In this article, we review the research advances in the establishment of chronic tympanic membrane perforation animal model.

[The advance of materials for preventing adhesion in tympanoplasty]

For otitis media patients with severe mucosal lesions, adhesion is the most common poor prognosis of tympanoplasty. We generally consider tympanic cavity adhesion is due to eustachian tube dysfunction and poor middle ear ventilation. The mechanism of adhesion is unclear so far, which we thought is mainly associated with wounded surface and activation of the fibrinolytic system. To solve the problem of adhesion, several materials have been used in the middle ear surgery, such as plastic sheet, silicone sheet and absorbable material. And there are some benefits. The most widely used is silicone sheet, and there are some researches focused on its thickness, shape and components to achieve better anti-adhesion effect. In this article, we will do a review for the research advances of anti-adhesion materials in tympanoplasty.

[A double-blind randomized controlled trial on the efficacy of mixed pure tone sound therapy in chronic tinnitus patients with different hearing loss]

Objective: The effectiveness of two different sound therapies in chronic subjective tinnitus was compared. The effectiveness of different degrees of hearing loss patients on two different sound therapies were analyzed preliminarily and the possible mechanisms were discussed. Methods: This clinical trial was conducted in the Peking Union Medical College Hospital, China from January 2018 to April 2018. Patients were received sound therapy when they were diagnosed as subjective tinnitus. This was a double-blinded randomized controlled trial. In our clinical trial, we included 56 participants who were randomly divided into Groups A and B with different sound therapies by using a computer allocation sequence. Pure tone audiometry, tympanometry and tinnitus matching were performed. The patients were followed up for 2 weeks, 1 month, 2 months and 3 months. Tinnitus handicap inventory (THI) and visual analog scales (VAS) measuring were used to evaluate the handicap, loudness and anxiety of tinnitus. An analysis of variance (ANOVA) of 2×5 repeated-measures was conducted. Results: With the prolongation of the treatment time, both groups showed significantly lower scores after 3 months training compared with baseline which were measured by THI scores. While there was no effect between the two groups. According to the degree of hearing loss, Group A and B were divided into normal to mild hearing loss group (26-40 dB HL, Group A1, Group B1), moderate to profound hearing loss group (41 dB HL group and above, Group A2, Group B2). In the patients with normal hearing and mild hearing loss, the THI (P=0.013), VAS loudness and annoyance scores (P<0.01) after 3 months in Group B1 was significantly lower than those at baseline and the sound therapy in Group B1 was effective. In patients with moderate to profound hearing loss, the THI, VAS loudness and annoyance scores (P<0.01) after 3 months in Group A2 was significantly lower than those at baseline and the sound therapy in Group A2 was effective. Conclusions: Sound therapy may be effective for some patients. Sound therapy for patients with different degrees of hearing loss are different. The tinnitus of most patients could not disappear completely, but reduce or eliminate. Doctors should use appropriate and individualized acoustic parameters for different characteristics of tinnitus. Doing so would provide effective and specific sound therapy for patients and reduce or eliminate tinnitus.

[Design of cross-sectional anatomical model focused on drainage pathways of paranasal sinuses]

Objective:To design and produce cross-sectional anatomical models of paranasal sinuses for the purpose of demonstrating drainage pathways of each nasal sinus for the young doctors. Method:We reconstructed the three-dimensional model of sinuses area based on CT scan data, and divided it into 5 thick cross-sectional anatomy models by 4 coronal plane，which cross middle points of agger nasi cell, ethmoid bulla, posterior ethmoid sinuses and sphenoid sinus respectively. Then a 3D printerwas used to make anatomical cross-sectional anatomical models.Result:Successfully produced a digital 3D printing cross-sectional models of paranasal sinuses. Sinus drainage pathways were observed on the models. Conclusion:The cross-sectional anatomical models made by us can exactly and intuitively demonstrate the ostia of each sinus cell and they can help the young doctors to understand and master the key anatomies and relationships which are important to the endoscopic sinus surgery.

[Clinical significance of bedside dynamic visual acuity test]

Objective: Dynamic visual acuity (DVA) is defined as the visual acuity when there are relative movements between subjects and visual targets. The purpose of this study was to discuss the correlation between bedside DVA test and other examinations of vestibular function, and to assess the value of DVA test for clinical diagnosis. Methods: Retrospective analysis of 323 cases with peripheral vestibular disorder, and analyzing the correlation between bedside DVA results and caloric test were performed. Results: Out of these 323 cases, 113 cases showed positive results of DVA.Among these 113 cases with positive DVA test, 109 cases were bilateral or unilateral vestibular function loss according to the results of caloric test or VEMP. The disease with the highest positive rate of DVA was bilateral vestibulopathy(BVP), followed by vestibular neuritis (VN) and profound sudden sensorineural hearing loss (pSSNHL). Conclusions: Bedside DVA is effective to determine the cases with BVP and severe unilateral vestibular function loss.

[Clinical analyses of 263 patients with laryngeal leukoplakia]

Objective: To investigate the etiology, clinical and pathological characteristics of laryngeal leukoplakia and the predictive risk factors of recurrence and malignant transformation. Methods: Clinical data of 263 patients with laryngeal leukoplakia between January 2000 and December 2015 were analyzed retrospectively. Results: The pathological diagnoses included squamous epithelial hyperplasia (54.4%), mild dysplasia (17.9%), moderate dysplasia (12.2%), severe dysplasia and carcinoma in situ (12.5%), and invasive carcinoma (3.0%). Age and the extent of lesion were statistically different among different pathological groups (P<0.05). Gender, smoking and alcohol consumption did not show statistical differences among different pathological groups (P>0.05). Follow-up of 215 patients, excluding 6 cases of invasive carcinoma. The recurrence rate was 20.6%(43/209), and the malignant transformation rate was 5.3%(11/209). Multivariate analysis showed that pathological classification of moderate to severe dysplasia was the independent risk factor for recurrence and malignant transformation of laryngeal leukoplakia (P<0.05). In patients with severe dysplasia and carcinoma in situ, the recurrence proportion of conservative treatment, vocal cords (partial) resection and radiotherapy were 8/10, 0/10 and 2/11 respectively. Conclusions: Laryngeal leukoplakia occurs frequently in elderly men with long-term smoking history. Pathological diagnoses are different. The grade of dysplasia is the predictive risk factor for the recurrence and malignant transformation of laryngeal leukoplakia. More aggressive treatment and closer follow-up should be warranted for patients with moderate dysplasia, severe dysplasia and carcinoma in situ.

[Expression difference of connexins in neural cells of Cx26 deficiency deafness]

Objective:Using induced pluripotent stem cell (iPSC) technology, neural cells from Cx26 deficiency deafness patients were derived, to investigate the influence of Cx26 deficiency on neural development and gene expression.Method:Fibroblasts were taken from profound deaf patients caused by Cx26 deficiency, and were induced to non-integration induced pluripotent stem cell lines, whose morphology, internal and external gene expression were characterized. Then these iPSC lines were differentiated into neural cells, whose expression change of pluripotent genes, neural markers and connexin genes were investigated.Result:Three iPSC lines with Cx26 deficiency were successfully established and differentiated into neural progenitor cells and neurons. The iPSC lines showed similar morphology, proliferation, internal and external gene expression with human embryonic stem cells. In iPSC-derived neurons, expression of Cx32 was up-regulated obviously, expression of Cx36 was up-regulated slightly, and expression of Cx26 showed no obvious change.Conclusion:TNeural differentiation of IPSC is not influenced by Cx26 deficiency, but expression of Cx32 and Cx36 are up-regulated, which may hint compensation from Cx32.

[Laryngeal endoscopic cricopharyngeal myotomy for cricopharyngeal achalasia post stroke]

Objective: To explore the safety and validity of endoscopic cricopharyngeal myotomy in patients with cricopharyngeal achalasia. Methods: A total of 19 patients with cricopharyngeal achalasia suffered from sustained dysphagia were enrolled in this study. The patients were divided into transcervical cricopharyngeal myotomy(CPM) group and endoscopic CPM (ECPM) group. Swallowing function and complications were evaluated.SPSS7.0 software was used to analyze the data. Results: The swallowing function improved significantly in seven patients in ECPM group, and 9 patients improved in CPM group.The video fluoroscopic swallowing study(VFSS)-swallowing score, VFSS-aspiration score and drinking test score were (3.1±1.1), (3.4±0.8) and (2.0±0.6)in post-ECPM, (3.4±1.4), (3.0±0.9) and (2.2±0.6)in post-CPM. No statistical difference was found in validity between CPM group and ECPM group(t=-0.435, t=1.086, t=-0.607, P>0.05). No statistical difference was observed on the occurrence of complication between two groups. Only one patient had subcutaneous emphysema after operation in ECPM. Conclusions: New surgical instruments and endoscopic surgical technique were safe and effective for cricopharyngeal achalasia. Because these instruments are cheaper, laryngeal endoscopic cricopharyngeal myotomy is easier to be popularized more easily than microscopic laser assistted CPM.

[Alarming system in real time and high quality display using volumerendering for otologic surgical navigation: a preclinical study]

Objective:The aim of this study is to design and develop a novel navigation framework that alarms the surgeon with sound during drilling and dynamically renders the high quality medical image data. Method:The accuracy of the proposed system were measured with a skull model using paired point registration and the target registration error (TRE) was computed. We segmented the accurate structure of target and compute the minimum distance between the drill tip and the target. Once the drill tip approached the target structures, the system would alarm the surgeon. We proposed a novelty method that used a mask to render the medical image data in real time. Result:The maximum distance error of 90 target points was 1.016 mm, the minimum was 0.427 mm, and the average distance error was (0.74±0.07) mm. The design and development of the alarming system and dynamically rendering the medical image data of navigation system was accomplished. Conclusion:The results show that the accuracy of the navigation system can meet the clinical needs. It also demonstrates the feasibility of the alarm system and dynamic display system and its application prospects.

Improvement in the Quality of HbA1c Determination by Using Commutable Specimens With IFCC-Assigned Values

Background

To assess the usefulness of commutable secondary reference materials with International Federation of Clinical Chemistry (IFCC)-assigned values, for improving the quality of hemoglobin A1c (HbA 1c ) determination.

Methods

We recalibrated and evaluated 3 point-of-care-test (POCT) devices via 3 different method-specific central laboratory analyzers that were calibrated using commutable specimens with IFCC-assigned values. The staff members who performed POCT were also evaluated before and after training.

Results

HbA 1c levels measured with POCT devices showed significantly lesser bias after external mathematical calibration. The interlaboratory CVs for HbA 1c measurements decreased from 12% to 4% after training of POCT-device-operating personnel in the NycoCard group. The CVs in the DCA Vantage and Afinion groups also improved after training.

Conclusion

Calibration of laboratory devices by specimens with IFCC-assigned values and by external mathematical calibration could improve the accuracy of POCT HbA 1c measurements. Also, standardized training could improve precision in POCT HbA 1c measurements, especially for semiautomated HbA 1c POCT devices.

[Clinical diagnosis of Treacher Collins syndrome and the efficacy of using BAHA]

Objective:To evaluate the efficacy of soft or implanted BAHA in the patients of Treacher Collins syndrome(TCS).Method:Six patients of TCS were studied. The Teber scoring system was used to evaluate the deformity degree. The air and bone auditory thresholds were assessed by auditory brain stem response(ABR). The infant-toddler meaningful auditory integration scale(IT-MAIS) was used to assess the auditory development at three time levels: baseline,3 months and 6 months. The hearing threshold and speech recognition score were measured under unaided and aided conditions. Result:The average score of deformity degree was 14.0±0.6. The TCOF1 gene was tested in two patients. The bone conduction hearing thresholds of patients was（18.0±4.5）dBnHL and the air conduction hearing thresholds was （70.5±7.0）dBnHL. The IT-MAIS total, detection and perception scores were improved significantly after wearing softband BAHA and approached the normal level in the 2 patients under 2 years old. The hearing thresholds of 6 patients in unaided and softband BAHA conditions were（65.8±3.8）dBHL and （30.0±3.2）dBHL (P<0.01) respectively, and 1 implanted BAHA was 15 dBHL. The speech recognition scores of 3 patients in unaided and softband BAHA conditions were（31.7±3.5）% and（86.0±1.7）%(P<0.05) respectively, and 1 implanted BAHA was 96%. Conclusion:Whenever the patient was diagnosed as TCS by the clinical manifestations and genetic testing, BAHA system could help to rehabilitate the hearing to a normal condition.

[Treatment of complicated intra-articular distal radius fractures with extended flexor carpi radialis approach]

OBJECTIVE

To discuss the effect of treatment of complicated intra-articular distal radius fractures with extended flexor carpi radialis approach.

METHODS

A retrospective analysis of 38 cases with fresh complicated intra-articular distal radius fractures treated by using extended flexor carpi radialis approach in our hospital from October 2012 to March 2015, with 25 males and 13 females. The average age was (52.76±8.62) years (32-64 years). The average time to surgery was (5.42±1.91) d (3-10 d), with left wrist 17 cases and right wrist 21 cases. All the patients were with C3 distal radius fractures according to Association for the Study of Internal Fixation (AO/ASIF) classification. The follow-up was conducted 1, 2, 3, 6, and 12 months after operation, including AP and lateral X-ray, wrist extension and flexion, radial deviation and ulnar deviation, forearm pronation and supination, and grip strength. At the end of 6 and 12 months after operation, all the patients were evaluated by using the modified Garland-Werley score and patient rated wrist evaluation (PRWE).

RESULTS

All the patients got good bone union, and their follow-up time was more than 12 months. The average follow-up time was (16.37±2.85) months (12-22 months). The score of modified Garland-Werley evaluation 6 months postoperation was 5.37±2.82, excellent and good rate was 84.21%, the score of modified Garland-Werley evaluation 12 months postoperation was 5.03±2.60, excellent and good rate was 86.84%. The score of PRWE 6 months postoperation was 15.82±8.38, the score of PRWE 12 months postoperation was 12.17±7.58.

CONCLUSION

The extended flexor carpi radialis approach is effective for the treatment of complicated intra-articular distal radius fractures and can avoid the complications of volar and dorsal combination approach.

[Measuring facial paralysis using the three-dimensional dynamic quantitative analysis system of facial motion: correlation with subjective grading systems]

OBJECTIVE

The aim of this study was to measure the facial motion of patients with facial paralysis using a three-dimensional dynamic quantitative analysis system of facial motion (3D ASFM) and analyze its correlation with subjective grading systems.

METHODS

We included 30 healthy volunteers and 50 patients with unilateral facial paralysis. After placing landmarks on the faces, the facial motions of the patients were measured using the 3D ASFM. The regional symmetry ratios(SRs) and gross scores of different parameters were calculated. Then a comparison with four subjective grading systems(House-Brackmann, Sunnybrook, Facial Nerve Grading System 2.0, Fisch) was performed.

RESULTS

The entire test could be completed within five minutes. The normal range of healthy volunteers were obtained, the gross score of which was 91.9±1.5. The SRs of the maximal moving distance(MMD) were most strongly correlated with regional subjective grading systems, followed by the SRs of the maximal moving velocity (MMV). The SRs of the maximal moving acceleration (MMA) were either poorly correlated or uncorrelated with the subjective grading systems. Moreover, the Spearman coefficients with four subjective grading systems were -0.630(House-Brackmann), -0.728(Facial Nerve Grading System 2.0), 0.697(Sunnybrook), and 0.617(Fisch)respectively(P<0.05).

CONCLUSIONS

The 3D ASFM is a convenient method to rapidly assess facial paralysis. It not only overcomes the shortcomings of conventional subjective grading systems, but also correlates well with them.

Association of BCSC-1 with human esophageal squamous cell carcinoma

Breast cancer suppressor candidate-1 (BCSC-1) is a newly identified candidate tumor suppressor gene. BCSC-1 shows decreased levels in a variety of cancer types. In this study, we investigated the association between BCSC-1 and human esophageal squamous cell carcinoma (ESCC). BCSC-1 expression was detected in ESCC and normal tissues adjacent to tumor tissues by Western blot analysis and real-time PCR  as well as immunohistochemistry of paraffin sections. The relationships between BCSC-1 expression and various clinicopathological characteristics were analyzed. Western blot analysis and real-time PCR showed that levels of BCSC-1 protein and mRNA expression in ESCC significantly decreased compared with those in adjacent normal tissues.  Immunohistochemistry exhibited marked reduction of BCSC-1 in 38 of 105 ESCC specimens. Moreover, downregulation of BCSC-1 was associated with the grade of tumor cellular differentiation (P<0.05). These findings indicate that BCSC-1 downregulation in ESCC is associated with carcinogenesis and may play important roles during the process of ESCC cancer development.

Isolation and characterization of L-valine-degrading Candida maltosa DLPU-zpb for D-valine preparation from DL-valine

To develop a practical process for D-valine preparation from DL-valine, L-valine was used as a sole source of carbon and nitrogen in basal minimal medium to isolate L-valine-degrading micro-organisms. A yeast strain DLPU-zpb was obtained, which showed asymmetric degrading activity against DL-valine. Based on the morphology, physiological and biochemical characteristics, and 26S rDNA D1/D2 domain sequence, strain DLPU-zpb was identified as Candida maltosa. The cells of this strain were used as a biocatalyst for eliminating the L-isomer from DL-valine. The L-isomer was completely degraded within 72 h under the conditions of 30°C, pH control at 6·0, 200 rev min(-1) and 50 g l(-1) DL-valine. The strain DLPU-zpb degraded L-valine effectively but not D-valine, and thus D-valine could be easily isolated from the resultant reaction mixture, which provides a new method for D-valine preparation from DL-valine.

SIGNIFICANCE AND IMPACT OF THE STUDY

D-valine is an important raw material for medicines and its demand is increasing year by year. Several approaches for D-valine preparation have been reported, but none of them are likely to provide product at low cost. A newly isolated L-valine-degrading yeast strain Candida maltosa DLPU-zpb was described, which showed asymmetric degrading activity against DL-valine. Thus, a new and practical process for D-valine preparation from DL-valine could be developed. This is the first report of the asymmetric degrading ability of C. maltosa against DL-valine and D-valine preparation from DL-valine.

Downregulation of PLK1 by RNAi attenuates the tumorigenicity of esophageal squamous cell carcinoma cells via promoting apoptosis and inhibiting angiogenesis

Polo-like kinase 1(PLK1) is essential for the maintenance of genomic stability during mitosis. PLK1 has been reported to be upregulated in several solid tumors, including esophageal squamous cell carcinoma (ESCC). However, the role of PLK1 in tumorigenesis of ESCC remains undetermined. We used siRNA and lentivirus-mediated PLK1 RNA interference to investigate the tumor suppressor function of PLK1 reduction in ESCC cells. Flow cytometry and Terminal deoxynuleotidyl transferase-mediated nick-end labeling assay in vitro, as well as immunohistochemitry analysis of Caspase-3 and CD31 in s.c. tumor tissue section, were performed. Knock down of PLK1 expression significantly suppressed the ability of ESCC cells to form colonies in plastic and soft agar. PLK1 reduction mediated by lentivirus caused growth suppression of ESCC in nude mice. Caspase-3 upregulation further indicated that dysregulated apoptosis might contribute to reduced tumorigenecity. In particular, downregulation of CD31 suggested that PLK1 reduction-induced angiogenesis inhibition may also contribute, at least in part, to attenuated tumorigenecity. These findings indicate that PLK1 might play roles in tumorigenesis of ESCC and that PLK1 might be a potential gene therapy target in ESCC. Apoptosis induction together with decreased angiogenesis might be involved in the mechanism of tumor suppressor function of RNA interference targeting PLK1.

XBP1 promoter polymorphism modulates platinum-based chemotherapy gastrointestinal toxicity for advanced non-small cell lung cancer patients

BACKGROUND

The X-box binding protein 1 (XBP1) is a critical transcription factor in the endoplasmic reticulum stress response, which is essential for the maintenance of cellular homeostasis. Here, we investigated whether the regulatory variant rs2269577 of the XBP1 gene influences clinical outcome in advanced non-small cell lung cancer (NSCLC) patients undergoing platinum-based chemotherapy.

PATIENTS AND METHODS

We recruited 663 Chinese patients with advanced NSCLC treated with platinum-based regimens and assessed the association between rs2269577 and clinical outcome. Subsequent functional analyses, including real-time quantitative PCR and dual-luciferase assays, were performed to explore possible molecular mechanisms.

RESULTS

The G/G genotype of rs2269577 was significantly associated with severe gastrointestinal toxicity compared with the homozygous C/C genotype (P=0.012, odds ratio=2.755), particularly in the female, performance status 0-1, and adenocarcinoma subgroups. No significant relevance was found between rs2269577 and treatment efficacy. In gastric epithelial cells, in vitro molecular analyses demonstrated that XBP1 mRNA expression levels decreased after treatment with cisplatin and the G allele of rs2269577 weakened the transcriptional activity of the XBP1 promoter.

CONCLUSION

This is the first study to evaluate the effect of XBP1 polymorphism on severe chemotherapy-related adverse outcomes in platinum-treated advanced NSCLC patients using both pharmacogenomics and functional molecular analyses.

RAGE upregulation and nuclear factor-kappaB activation associated with ageing rat cardiomyocyte dysfunction

Evidence suggests that ageing is a major risk factor for cardiac dysfunction. Interactions between advanced glycation endproducts (AGEs) and the receptor for AGEs (RAGE) are known to cause chronic cellular activation, including activation of nuclear factor-kappaB (NF-kappaB), which has been implicated as a causal factor in the ageing process. To assess whether cardiomyocyte contractile function and the interaction of AGEs with RAGE in the heart are altered in ageing, 25- and 2-month-old male rats were compared. Mechanical properties were assessed in ventricular myocytes using an edge-detection system, including peak twitch amplitude (PTA), time-to-PTA (TPS), time-to-75% relengthening (TR75) and maximal velocity of shortening/relengthening (+/-dL/dt) in ventricular myocytes. AGEs were detected by using a fluorescence assay. The expression of RAGE and NF-kappaB was assessed through a Western blot analysis. Compared with young myocytes, aged myocytes displayed a prolonged TR75 at 1 Hz. With increasing stimulus frequency (from 2 to 4 Hz), aged myocytes' PTA was significantly reduced relative to young myocytes. Aged rat hearts displayed high level of AGEs, RAGE upregulation and NF-kappaB activation. These findings demonstrate impaired cardiomyocyte relaxation and reduced tolerance to increased stimulus frequency in aged rats, which might be associated with enhanced AGEs, RAGE expression, and NF-kappaB activation.

Isolation and characterization of photosystem II from the filamentous sporophyte of Porphyra yezoensis

Thylakoid membranes were isolated and purified from diploid filamentous sporophytes of Porphyra yezoensis Ueda using sucrose density gradient ultracentrifugation (SDGUC). After thylakoid membranes were solubilized with SDS, the phtosystem II (PSII) particles with high 2, 6-dichloroindophenol (DCIP) photoreduction activity were isolated by SDGUC. The absorption and fluorescence spectra, DCIP photoreduction activity and oxygen evolution activity of the thylakoid membranes and PSII particles were determined. The polypeptide composition of purified PSII particles was distinguished by SDS-PAGE. Results showed that PSII particles of sporophytes differed from the gametophytes in spectral properties and polypeptide composition. Apart from 55 kDa D1-D2 heterodimer, CP47, CP43, 33 kDa protein, D1, D2, cyt b559 and 12 kDa protein were identified from PSII particles from sporophytes; a new 102 kDa protein was also detected. However, cyt c-550, 20 kDa, 14 kDa and 16 kDa proteins found in PSII particles from gametophytes were not detected in the sporophytes.

Correlative study of angiogenesis and dynamic contrast-enhanced magnetic resonance imaging features of hepatocellular carcinoma

PURPOSE

To explore the correlation between contrast-enhancement patterns on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and angiogenesis by analyzing microvessel density (MVD), vascular endothelial growth factor (VEGF), and P53 protein expression in hepatocellular carcinoma (HCC).

MATERIAL AND METHODS

MRI was performed with a GE Signa 1.5T MR scanner using SE and FMPSPGR sequences in 30 patients (38 lesions) during the period October 1998 to March 2000. All had histopathologically proven HCC. MR images were reviewed/ analyzed retrospectively. The 30 patients were between 35 and 65 years of age (average age 58; 18 M and 12 F). SE T1WI, PDWI, and T2WI were acquired initially. The FMPSPGR sequence was acquired in the same position. The DCE-MRI was performed in the arterial, portal vein, and delay phase after a bolus injection of Gd-DTPA. The specimens were stained immunohistochemically for CD34, VEGF, and P53. MVD was highlighted by anti-CD34 antibody staining. The enhancement features of HCC lesions were studied correlatively with the tumor MVD, VEGF, and P53 expression at protein level.

RESULTS

In the arterial phase, the results showed that MVD of HCC in the high-enhancement group (229.76 +/- 80.96) was higher than that in the equal-enhancement (173.09 +/- 61.38) and low-enhancement groups (153.00 +/- 108.58) (P < 0.01, respectively). VEGF expression of HCC in the high-enhancement group (68.42%) was higher than that in the equal-enhancement (36.36%) and low-enhancement groups (38.89%) (P < 0.05, respectively). In the portal vein phase, MVD of HCC in the enhancement group (259.80 +/- 93.30) was higher than that in the non-enhancement group (178.64 +/- 92.65) (P < 0.05). No significant correlation was found between VEGF expression and the enhancement feature in the portal vein phase. In the delay phase, MVD of HCC in the ring-enhancement group (269.06 +/- 57.89) was significantly higher than that in the non-ring-enhancement group (144.10 +/- 88.90) (P < 0.01). There was a significant difference in VEGF expression between the ring-enhancement group (76.47%) and the non-ring-enhancement group (42.86%) (P < 0.05). No significant correlation was detected between P53 protein expression and the enhancement feature. Relative enhancement (RE) correlated with MVD, but not with VEGF and P53 protein expression.

CONCLUSION

The contrast-enhancement patterns on DCE-MRI are influenced by tumor angiogenesis, as reflected by elevated VEGF expression, and are therefore valuable indicators for accessing tumor angiogenic activity and tumor neovascularization in vivo in HCC patients.

An improved method for isolation of photosystem II from marine alga Porphyra yezoensis Udea

An improved method for isolation and characterization of photosystem (PS)II particles from thylakoid membranes of gametophytes of a marine alga Porphyra yezoensis Udea is reported. Thylakoid membranes were isolated using ultracentrifugation and differential speeds centrifugation and were further purified by the first sucrose density gradient centrifugation (SDGC). PSII particles with high 2, 6-dichloroindophenol (DCIP) photo-reduction activity were isolated by the second SDGC from the thylakoid membranes. Absorption and fluorescence spectra of the thylakoid membranes and PSII particles were recorded and their polypeptides composition was studied. Thylakoid membranes obtained by the above two methods showed similar spectral properties and polypeptides composition. PSII particles, in addition to common extrinsic proteins found in PSII of other plants, contained cyt c-550, a 20 kDa protein, along with two new proteins (14 kDa and 16 kDa).

Genomic characterization of two Chinese isolates of porcine respiratory and reproductive syndrome virus

The genomes of two isolates of porcine respiratory and reproductive syndrome virus (PRRSV) from China, designated HB-1(sh)/2002 and HB-2(sh)/2002, were sequenced and analyzed. The size of the genomes of HB-1(sh)/2002 and HB-2(sh)/2002 were 15,411 and 15,373 nucleotides respectively, excluding the poly(A) tails. Comparative analysis with the genomic sequences of another Chinese isolate (BJ-4) and North American (VR2332) and European (Lelystad virus, LV) viruses revealed that HB-1(sh)/2002 shared 89.8% identity with BJ-4 and VR2332, but only 54.7% with LV; while HB-2(sh)/2002 shared 89.4% and 89.5% identity with BJ-4 and VR2332 respectively and 54.3% with LV, indicating that the two new Chinese isolates were related to the North American PRRSV genotype. Phylogenetic analysis based on the nucleotide sequence of the structural protein ORF's showed that the two new Chinese isolates belong to same genetic subgroup. HB-2(sh)/2002 additionally exhibited variations in the NSP2 nonstructural protein encoded by ORF1 and the structural protein GP3 encoded by ORF3 in comparison with other North American PRRSV isolates, namely a 12 amino acids deletion in Nsp2 and one amino acid deletion in GP3 were found in HB-2(sh)/2002. Therefore, HB-2(sh)/2002 was a novel strain with unique deletions.

[Analysis of mutation types of p53 gene and possible carcinogenic factors in lung cancer]

Mutational spectrum of p53 gene was analyzed by polymerase chain reaction (PCR)-single strand conformational polymorphism (SSCP) and direct DNA sequencing technique in tissue specimens of primary non-small cell lung cancer (NSCLC) to study the action of p53 gene, its type of mutations and its possible relation to different carcinogens. Results revealed that mutation of p53 gene was found in 94 of 128 resected specimens of NSCLC, including point mutations in 86 cases, deletion and insertion in seven and mutation of the linking site in one, and 63.9 percent of point mutations were G-T and T-G substitution and 25.6 percent G-A and A-G. It suggested that p53 gene mutation correlated closely to the occurrence of NSCLC. Possible environmental carcinogens were discussed in the paper based on the characteristics of the p53 gene mutation.