Impact of body mass index on perioperative mortality of acute stanford type A aortic dissection: a systematic review and meta-analysis

BACKGROUND

Obesity may increase perioperative mortality of acute Stanford type A aortic dissection (ATAAD). However, the available evidence was limited. This study aimed to systematically review published literatures about body mass index (BMI) and perioperative mortality of ATAAD.

METHODS

Electronic literature search was conducted in PubMed, Medline, Embase and Cochrane Library databases. All observational studies that investigated BMI and perioperative mortality of ATAAD were included. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using a random-effects model. Meta-regression analysis was performed to assess the effects of different clinical variables on BMI and perioperative mortality of ATAAD. Sensitivity analysis was performed to determine the sources of heterogeneity. Egger's linear regression method and funnel plot were used to determine the publication bias.

RESULTS

A total of 12 studies with 5,522 patients were eligible and included in this meta-analysis. Pooled analysis showed that perioperative mortality of ATAAD increased by 22% for each 1 kg/m2 increase in BMI (OR = 1.22, 95% CI: 1.10-1.35). Univariable meta-regression analysis indicated that age and female gender significantly modified the association between BMI and perioperative mortality of ATAAD in a positive manner (meta-regression on age: coefficient = 0.04, P = 0.04; meta-regression on female gender: coefficient = 0.02, P = 0.03). Neither significant heterogeneity nor publication bias were found among included studies.

CONCLUSIONS

BMI is closely associated with perioperative mortality of ATAAD. Optimal perioperative management needs to be further explored and individualized for obese patient with ATAAD, especially in elderly and female populations.

TRIAL REGISTRATION

PROSPERO (CRD42022358619). BMI and perioperative mortality of ATAAD.

CHBP induces stronger immunosuppressive CD127+ M-MDSC via erythropoietin receptor

Erythropoietin (EPO) is not only an erythropoiesis hormone but also an immune-regulatory cytokine. The receptors of EPO (EPOR)2 and tissue-protective receptor (TPR), mediate EPO's immune regulation. Our group firstly reported a non-erythropoietic peptide derivant of EPO, cyclic helix B peptide (CHBP), which could inhibit macrophages inflammation and dendritic cells (DCs) maturation. As a kind of innate immune regulatory cell, myeloid-derived suppressor cells (MDSCs) share a common myeloid progenitor with macrophages and DCs. In this study, we investigated the effects on MDSCs differentiation and immunosuppressive function via CHBP induction. CHBP promoted MDSCs differentiate toward M-MDSCs with enhanced immunosuppressive capability. Infusion of CHBP-induced M-MDSCs significantly prolonged murine skin allograft survival compared to its counterpart without CHBP stimulation. In addition, we found CHBP increased the proportion of CD11b+Ly6G-Ly6Chigh CD127+ M-MDSCs, which exerted a stronger immunosuppressive function compared to CD11b+Ly6G-Ly6Chigh CD127- M-MDSCs. In CHBP induced M-MDSCs, we found that EPOR downstream signal proteins Jak2 and STAT3 were upregulated, which had a strong relationship with MDSC function. In addition, CHBP upregulated GATA-binding protein 3 (GATA-3) protein translation level, which was an upstream signal of CD127 and regulator of STAT3. These effects of CHBP could be reversed if Epor was deficient. Our novel findings identified a new subset of M-MDSCs with better immunosuppressive capability, which was induced by the EPOR-mediated Jak2/GATA3/STAT3 pathway. These results are beneficial for CHBP clinical translation and MDSC cell therapy in the future.

Corrigendum: Myeloid-Derived Suppressor Cells Alleviate Renal Fibrosis Progression via Regulation of CCL5-CCR5 Axis

[This corrects the article DOI: 10.3389/fimmu.2021.698894.].

Myeloid-Derived Suppressor Cells Alleviate Renal Fibrosis Progression via Regulation of CCL5-CCR5 Axis

BACKGROUND

Renal fibrosis is inevitable in all progressive chronic kidney diseases (CKDs) and represents a serious public health problem. Immune factors contribute to the progression of renal fibrosis. Thus, it is very possible that immunosuppression cells, such as myeloid-derived suppressor cells (MDSCs), could bring benefits to renal fibrosis. Herein, this study investigated the antifibrotic and reno-protective effect of MDSCs and the possible mechanisms.

METHODS

Murine and cell models of unilateral ureter obstruction (UUO) renal fibrosis were used. Bone marrow-induced MDSCs and granulocyte-macrophage colony-stimulating factor (GM-CSF) were pretreated before surgery. Kidney weight, pathological injury, extracellular matrix deposition, and epithelial-mesenchymal transition progression were examined. Transforming growth factor (TGF)-β1)/Smad/Snail signaling pathway involvement was investigated through Western blotting and quantitative PCR (qPCR). Accumulation of MDSC, CD4+ T cell, regulatory T (Treg), and T helper 1 (T_H1) cell accumulation, and CCL5 and CCR5 expression level in MDSCs and non-MDSCs were evaluated using flow cytometry.

RESULTS

In vitro- and in vivo-induced MDSCs significantly ameliorated UUO-induced tubulointerstitial fibrosis, inhibited the TGF-β1/Smad/Snail signaling pathway, and enhanced MDSC and Treg infiltration in the kidney while downregulating the T_H1 cells. Both in vitro and in vivo experiments confirmed CCL5 elevation in the two MDSC-treated groups.

CONCLUSION

In vitro- and in vivo-induced MDSCs alleviated renal fibrosis similarly through promoting the CCL5-CCR5 axis interaction and TGF-β1/Smad/Snail signaling pathway inhibition. Our results indicate an alternative treatment for renal fibrosis.

Association Between Syndecan-1, Fluid Overload, and Progressive Acute Kidney Injury After Adult Cardiac Surgery

Background: Acute kidney injury (AKI) is a common complication after cardiac surgery and the prognosis of AKI worsens with the increase in AKI severity. Syndecan-1(SDC-1) is a biomarker of endothelial glycocalyx degradation. Fluid overload (FO) is associated with poor outcomes in AKI patients and may be related to the damage of endothelial function. This study aimed at demonstrating the association between elevated SDC-1, FO, and AKI progression. Methods: In this prospective study, we screened patients who underwent cardiac surgery and enrolled patients who experienced an AKI within 48 h after surgery from December 1, 2018 to January 31, 2019. Blood and urine samples were collected at the time of AKI diagnosis for plasma SDC-1 (pSDC-1) and urine SDC-1 (uSDC-1) measurements. Fluid balance (FB) = accumulated [fluid intake (L) - fluid output (L)]/body weight (kg) × 100%. FO was defined as FB > 5%. The primary endpoint was progressive AKI, defined as AKI progression from a lower to a higher stage. The patients were divided into progressive AKI group vs. non-progressive AKI group. Results: The quartiles of pSDC-1 concentration (117.3 [67.4, 242.3] ng/mL) showed a graded association with the incidence of progressive AKI, ranging from 5.0, 11.9, 32.6 to 52.4% (p for trend < 0.001). Multivariate logistic regression showed that increased pSDC-1 was an independent risk factor for progressive AKI. The AUC-ROC area of pSDC-1 concentration in predicting AKI progression was 0.847. Linear regression showed a positive correlation between FB and pSDC-1 concentration (R ² = 0.384, p < 0.001). In patients with FO, the progressive AKI incidence was significantly higher in the high pSDC-1 (≥117.3 ng/mL) subgroup than in the low pSDC-1 subgroup (58.3 vs. 17.6%, OR = 9.167, P = 0.005). In patients without FO, the progressive AKI incidence was also significantly higher in the high pSDC-1 subgroup with a lower odds ratio (30.4 vs. 7.4%, OR = 6.714, P = 0.002). Conclusion: Elevated pSDC-1 concentration was associated with progressive AKI after cardiac surgery and showed good predictive ability for progressive AKI. FB was related to the increase of pSDC-1. The interaction between pSDC-1 and FB may further aggravate the progression of AKI.

Comprehensive Molecular and Cellular Characterization of Acute Kidney Injury Progression to Renal Fibrosis

Acute kidney injury (AKI) and chronic kidney disease (CKD) represent different stages of renal failure; thus, CKD can be regarded as a result of AKI deterioration. Previous studies have demonstrated that immune cell infiltration, oxidative stress, and metabolic mentalism can support renal fibrosis progression in AKI cases. However, the most important triggers and cell types involved in this pathological progression remain unclear. This study was conducted to shed light into the underlying cellular and molecular features of renal fibrosis progression through the analysis of three mouse whole kidney and one human single-cell RNA-sequencing datasets publicly available. According to the different causes of AKI (ischemia reperfusion injury [IRI] or cisplatin), the mouse samples were divided into the CIU [control-IRI-unilateral ureteral obstruction (UUO)] and CCU (control-cisplatin-UUO) groups. Comparisons between groups revealed eight different modules of differentially expressed genes (DEGs). A total of 1,214 genes showed the same expression pattern in both CIU and CCU groups; however, 1,816 and 1,308 genes were expressed specifically in the CCU and CIU groups, respectively. Further assessment of the DEGs according to the Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment pathway and Gene Ontology (GO) showed that T-cell activation, fatty acid metabolic process, and arachidonic acid metabolism were involved in the fibrosis progression in CIU and CCU. Single-cell RNA-sequencing data along with the collected DEGs information also revealed that the T-cell activation mainly happened in immune cells, whereas the fatty acid metabolic process and arachidonic acid metabolism occurred in tubule cells. Taken together, these findings suggest that the fibrosis process differed between the CIU and CCU stages, in which immune and tubule cells have different functions. These identified cellular and molecular features of the different stages of fibrosis progression may pave the way for exploring novel potential therapeutic strategies in the clinic.

Single-cell RNA Sequencing in Immunology

The complex immune system is involved in multiple pathological processes. Single-cell RNA sequencing (scRNA-seq) is able to analyze complex cell mixtures correct to a single cell and single molecule, thus is qualified to analyze immune reactions in several diseases. In recent years, scRNA-seq has been applied in many researching fields and has presented many innovative results. In this review, we intend to provide an overview of single-cell RNA sequencing applications in immunology and a prospect of future directions.

Inflammatory biomarkers to predict adverse outcomes in postoperative patients with acute type A aortic dissection

Objectives. The present study aimed to evaluate prognostic value of inflammatory markers for in-hospital mortality and renal complication in patients undergoing surgery for acute type A aortic dissection (ATAAD). Design. Serum concentration of C-reactive protein, leukocyte counts, procalcitonin (PCT), tumor necrosis factor (TNF)-α, interleukin-2 receptor (IL-2R), IL-6 and IL-8 were measured on the day of admission to the hospital (T0) and on 1st (T1), 2nd (T2), and 7th (T3) day after surgery. Results. 328 patients were included. There were significant differences between survivor group and non-survivor group in PCT, IL-2R, and IL-6 (p = .001, p = .015, and p = .005). There were significant differences between patients with different AKI stage in PCT and IL-2R (p = .001, p < .001). The area under receiver operating characteristics (ROC) curve on 30-day death was 0.686 for PCT, 0.718 for IL-2R, 0.694 for IL-6 and 0.627 for IL-8. The area under ROC curve on stage III AKI was 0.852 for PCT, 0.749 for IL-2R, 0.626 for IL-8, and 0.636 for TNF-α. IL-2 > 1438 U/ml and IL-6 > 45.5 pg/ml were independently associated with 30-day mortality (p = .014 and p < .001). The area under ROC curve was 0.849 on score 2 (using 1 point for PCT > 4.58 ng/ml, 1 point for IL-2R > 1438 U/ml, 1 point for APACHE II score >15.5, and 1 point for IL-6 > 45.5 pg/ml). Conclusions. PCT and cytokines may be considered as predictors for adverse renal outcomes and mortality in patients with ATAAD patients after surgery. They are earlier than traditional biomarkers and combination of these biomarkers will improve the accuracy.

A systematic review of the relationship between the distributions of aggrecan gene VNTR polymorphism and degenerative disc disease/osteoarthritis

Objectives

Degenerative disc disease (DDD) and osteoarthritis (OA) are relatively frequent causes of disability amongst the elderly; they constitute serious socioeconomic costs and significantly impair quality of life. Previous studies to date have found that aggrecan variable number of tandem repeats (VNTR) contributes both to DDD and OA. However, current data are not consistent across studies. The purpose of this study was to evaluate systematically the relationship between aggrecan VNTR, and DDD and/or OA.

Methods

This study used a highly sensitive search strategy to identify all published studies related to the relationship between aggrecan VNTR and both DDD and OA in multiple databases from January 1996 to December 2016. All identified studies were systematically evaluated using specific inclusion and exclusion criteria. Cochrane methodology was also applied to the results of this study.

Results

The final selection of seven studies was comprehensively evaluated and includes results for 2928 alleles. The most frequent allele among all the studies was allele 27. After comparing the distributions of each allele with others, statistically significant differences have been found in the distribution of the alleles by the two groups, with an over-representation of allele (A)21 (disease: 3.22%, control: 0.44%). Thus, carrying A21 increased the risk of DDD. Such an association was not found to be statistically significant when considering the risk of OA.

Conclusions

The findings suggest that VNTR A21 seems to be associated with higher risk to DDD, however, such an association may not be statistically significant regarding the risk of OA.

Cite this article: L. Cong, G. Tu, D. Liang. A systematic review of the relationship between the distributions of aggrecan gene VNTR polymorphism and degenerative disc disease/osteoarthritis. Bone Joint Res 2018;7:308–317. DOI: 10.1302/2046-3758.74.BJR-2017-0207.R1

Myeloid-derived suppressor cells in transplantation: the dawn of cell therapy

Myeloid-derived suppressor cells (MDSCs) are a series of innate cells that play a significant role in inhibiting T cell-related responses. This heterogeneous population of immature cells is involved in tumor immunity. Recently, the function and importance of MDSCs in transplantation have garnered the attention of scientists and have become an important focus of transplantation immunology research because MDSCs play a key role in establishing immune tolerance in transplantation. In this review, we summarize recent studies of MDSCs in different types of transplantation. We also focus on the influence of immunosuppressive drugs on MDSCs as well as future obstacles and research directions in this field.

Tempering-Drying Simulation and Experimental Analysis of Corn Kernel

In order to study the effect of corn kernel composition and physical structure on moisture distribution and transfer process and obtain the optimal tempering-drying parameters of corn kernel, a physical model was constructed with four different components as follows: seed coat, horny endosperm, farinaceous endosperm and embryo. The drying model was established based on the assumption of different diffusion coefficients and same thermal conductivity for the four components. The software of COMSOL Multiphysics was used to simulate the heat and mass transfer process inside the corn kernel during the thin-layer drying. The results showed that the least total drying time and the best drying quality were achieved under the multistage circulating drying of 10 min hot air drying and 60 min tempering, and the tempering degree was up to 0.9207.

A bioinformatic analysis of microRNAs role in osteoarthritis

OBJECTIVE

To evaluate the underlying function of microRNAs (miRNAs) in osteoarthritis (OA).

DESIGN

A bioinformatic analysis of miRNAs-OA studies was completed in multiple databases. All identified articles were assessed using specific inclusion and exclusion criteria (Eligible case-control studies for the present study included those which investigated miRNAs differential expression in cartilage tissues and cells of OA and controls. Abstracts, case reports, conference presentations, editorials, and expert opinions were excluded.). We performed bioinformatic analysis and assessed which miRNAs are commonly elevated or decreased in cartilage of OA, and assessed putative targets of these miRNAs using TargetScan, Database for Annotation, Visualization and Integrated Discovery (DAVID), FunRich and String.

RESULTS

Fifty seven studies were included in this study. Our current review has identified 46 differentially expressed miRNAs involved in autophagy, inflammation, chondrocyte apoptosis, chondrocyte differentiation & homeostasis, chondrocyte metabolism and degradation of the extracellular matrix (ECM). Additionally, our literature search identified a wide range of miRNAs that have been shown to be differentially expressed in OA. The function of up-regulated miRNAs primarily target nucleus, whereas the function of down-regulated miRNAs primarily target transcription.

CONCLUSIONS

Comprehensive analysis of all miRNAs studies reveals cooperation in miRNA signatures and suggests that there may be two biologically synergic classes of miRNAs that are associated with OA. This finding suggests that miRNAs may be useful as diagnostic biomarkers and/or may provide new therapeutic targets in OA. Furthermore, a better understanding of the targets of these miRNAs will accelerate biomedical discoveries and improve clinical care based on new knowledge of OA-related disease mechanisms.

Association of endothelin-1 gene polymorphisms with essential hypertension in a Chinese population

Endothelin-1 (ET-1) is the most potent endogenous vasoconstrictor and is involved in several vascular disorders such as hypertension. Its strong interaction with other vasoactive hormone systems suggests that the ET-1 gene (EDN1) is a potential candidate molecule that influences the risk of developing hypertension. Recently, two single nucleotide polymorphisms in EDN1 have been reported to be associated with hypertension: Lys198Asn and 3A/4A (-134delA) located in the 5'-untranslated region. To determine the association of these two polymorphisms with hypertension, we genotyped patients and controls (N = 537) and compared the allele and genotype frequencies between groups. There was no significant difference in the genotype frequencies of these two polymorphisms between healthy controls and hypertension patients. Although previous reports have revealed a significant interaction between the END1 Lys198Asn (G/T) polymorphism and body mass index in association with hypertension, no such relationship was observed in the present study. Further, we compared blood pressure among hypertensive subjects and observed that neither systolic nor diastolic blood pressure was significantly associated with variations in the genotypes of the two single nucleotide polymorphisms. In summary, these two END1 polymorphisms do not appear to affect the development of hypertension in the Chinese population.

High-flow Nasal Cannula Versus Noninvasive Ventilation for Treatment of Acute Hypoxemic Respiratory Failure in Renal Transplant Recipients

OBJECTIVE

This study aimed to evaluate the outcomes of high-flow nasal cannula (HFNC) oxygen therapy compared with noninvasive ventilation (NIV) for the treatment of acute hypoxemic respiratory failure in renal transplant recipients.

METHODS

Data were retrospectively collected from a tertiary intensive care unit (ICU) from July 1, 2011, to September 31, 2015. All renal recipients who had acute respiratory failure at that period of time were classified into the HFNC or NIV group depending on the initial form of respiratory support.

RESULTS

A total of 38 patients were enrolled in this study. Twenty patients received HFNC and the other 18 received NIV as the initial respiratory support. The ICU mortality in the HFNC group was 5% (1 patient), compared with 22.2% (4 patients) in the NIV group (P = .083). The median length of the ICU stay was 12 days in the HFNC group, compared with 14 days in the NIV group (P = .297). The number of ventilator-free days at day 28 was significantly higher in the HFNC group than in the NIV group (26 ± 3 vs 21 ± 3; P < .001). The incidences of both pneumothorax (0% vs 22.2%; P = .042) and skin breakdown (0% vs 22.2%; P = .042) were significantly lower in the HFNC group.

CONCLUSIONS

In renal transplant recipients with acute hypoxemic respiratory failure secondary to severe pneumonia, HFNC achieved outcomes similar to NIV. In addition, HFNC was associated with an increased number of ventilator-free days at day 28 and fewer complications.

Cytoplasmic GPER translocation in cancer-associated fibroblasts mediates cAMP/PKA/CREB/glycolytic axis to confer tumor cells with multidrug resistance

Multiple drug resistance is a challenging issue in the clinic. There is growing evidence that the G-protein-coupled estrogen receptor (GPER) is a novel mediator in the development of multidrug resistance in both estrogen receptor (ER)-positive and -negative breast cancers, and that cancer-associated fibroblasts (CAFs) in the tumor microenvironment may be a new agent that promotes drug resistance in tumor cells. However, the role of cytoplasmic GPER of CAFs on tumor therapy remains unclear. Here we first show that the breast tumor cell-activated PI3K/AKT (phosphoinositide 3-kinase/AKT) signaling pathway induces the cytoplasmic GPER translocation of CAFs in a CRM1-dependent pattern, and leads to the activation of a novel estrogen/GPER/cAMP/PKA/CREB signaling axis that triggers the aerobic glycolysis switch in CAFs. The glycolytic CAFs feed the extra pyruvate and lactate to tumor cells for augmentation of mitochondrial activity, and this energy metabolically coupled in a 'host-parasite relationship' between catabolic CAFs and anabolic cancer cells confers the tumor cells with multiple drug resistance to several conventional clinical treatments including endocrine therapy (tamoxifen), Her-2-targeted therapy (herceptin) and chemotherapy (epirubicin). Moreover, the clinical data from 18F-fluorodeoxyglucose positron emission tomography/computed tomography further present a strong association between the GPER/cAMP/PKA/CREB pathway of stromal fibroblasts with tumor metabolic activity and clinical treatment, suggesting that targeting cytoplasmic GPER in CAFs may rescue the drug sensitivity in patients with breast cancer. Thus, our data define novel insights into the stromal GPER-mediated multiple drug resistance from the point of reprogramming of tumor energy metabolism and provide the rationale for CAFs as a promising target for clinical therapy.

Gene Therapy in Kidney Transplantation: Evidence of Efficacy and Future Directions

Allograft loss remains a severe clinical problem after kidney transplantation. The molecular mechanism of graft loss is a complex process involving T and/or B cell activation, inflammation responses, autophagy and apoptosis. Since these pathways are involved in immune responses in kidney transplant rejection, application of genetic interference to inhibit specific pathways could present an effective targeted gene therapy method. Recent studies have successfully attempted to use gene therapy to target the key molecules involved in immune responses during transplantation. This strategy has the potential to silence target genes associated with a variety of diseases, including those that trigger allograft loss following organ transplantation. In this review, we have discussed evidence of the clinical applicability of gene therapy in kidney transplantation based on known associations between kidney diseases and genes participating in the underlying mechanisms. The molecules contributing to immune responses and inflammatory injury are further highlighted as potential targets in future clinical therapy for renal transplantation.

Acute transverse myelitis of the cervical spine secondary to psoas abscess

BACKGROUND

Acute transverse myelitis is uncommon and presumably results from an autoimmune process or a preceding infection. Most cases of bacterial myelitis are due to hematogenous dissemination from urinary or respiratory tract infections or contiguous spreading from a neighboring infected structure. A psoas abscess rarely spreads to higher levels of the spinal cord. No cases of acute cervical myelitis due to a psoas abscess have been previously reported.

CASE PRESENTATION

A 34-year-old man was transferred to our hospital due to progressive muscle weakness, sensory deficits and severe hypotension. Two weeks prior to admission, he had received low back injection to relieve back pain in a healthcare clinic. One day prior to admission, his condition had worsened. On admission, he was tetraplegic with absence of sensation below the level of the suprasternal fossa. A lumbar CT scan demonstrated an abscess in the left psoas, and the magnetic resonance imaging (MRI) scan of the entire spinal suggested a cervical spine infection. A cerebrospinal fluid (CSF) analysis performed before surgery indicated the possibility of bacterial infection. An operation was performed to drain the abscess. Microbiological cultivation revealed a Methicillin-resistant Staphylococcus aureus (MRSA) infection. The patient was administered with vancomycin for 10 days and followed by oral formulations of linezolid for 6 weeks. The patient's general condition improved, and he was successfully discharged. Six months later, a follow-up MRI revealed that the lesion of the cervical spine had been ameliorated, and the sensation and myodynamia of his upper limbs had partially recovered.

CONCLUSION

This was a rare case of a high-level cervical spine pyogenic infection complicating psoas abscess. An invasive paravertebral injection procedure was thought to be the initial damaging event that created a port of entry for MRSA into the psoas muscle and caused a subsequent psoas abscess. This case indicated that evaluation of higher levels of the spine is warranted when a psoas abscess coexists with severe weakness.

Genome-wide analysis of chitinase genes and their varied functions in larval moult, pupation and eclosion in the rice striped stem borer, Chilo suppressalis

Some insect chitinases are required to degrade chitin and ensure successful metamorphosis. Although chitinase genes have been well characterized in several model insects, no reports exist for the rice striped stem borer, Chilo suppressalis, a highly destructive pest that causes huge yield losses in rice production. Here, we conducted a genome-level analysis of chitinase genes in C. suppressalis. After amplification of full-length transcripts with rapid amplification of cDNA ends, we identified 12 chitinase genes in C. suppressalis. All these genes had the conserved domains and motifs of glycoside hydrolase family 18 and grouped phylogenetically into five subgroups. C. suppressalis chitinase 1 (CsCht1) was highly expressed in late pupae, whereas CsCht3 was abundant in early pupae. Both CsCht2 and CsCht4 were highly expressed in larvae. CsCht2 was abundant specifically in the third-instar larvae and CsCht4 showed periodic high expression in 2- to 5-day-old larvae in each instar. Tissue specific expression analysis indicated that CsCht1 and CsCht3 were highly expressed in epidermis whereas CsCht2 and CsCht4 were specifically abundant in the midgut. Knockdown of CsCht1 resulted in adults with curled wings, indicating that CsCht1 might have an important role in wing expansion. Silencing of CsCht2 or CsCht4 arrested moulting, suggesting essential roles in larval development. When the expression of CsCht3 was interfered, defects in pupation occurred. Overall, we provide here the first catalogue of chitinase genes in the rice striped stem borer and have elucidated the functions of four chitinases in metamorphosis.

Early- and late-onset severe pneumonia after renal transplantation

BACKGROUND

The aim of this study was to clarify the distinctions in the clinical characteristics and outcomes between early- and late-onset severe pneumonia after renal transplantation requiring ICU admission.

METHODS

The data were retrospectively collected in consecutive renal recipients with severe pneumonia from January 1, 2009, to December 31, 2013, in a tertiary ICU. We classified the patients according to the time of pneumonia onset as follows: early-onset severe pneumonia (E-SP) corresponded to a pulmonary infection occurring during the first year following the transplantation, and late-onset severe pneumonia (L-SP) corresponded to a pulmonary infection occurring after the first year following the transplantation.

RESULTS

In the E-SP patients, fungi (42.1%) and viruses (31.6%) were the most common pathogens. Twenty-three (71.9%) patients received non-invasive ventilation (NIV), 15 (65.2%) of whom were intubated. The median duration of the ICU and hospital stays was 11 ± 5 and 19 ± 4 days, respectively. In the L-SP patients, bacteria (42.1%) and viruses (26.3%) were the predominant pathogens. Four of 15 (26.7%) patients failed NIV treatment. The median duration of the ICU and hospital stays was 9 ± 3 and 16 ± 3 days, respectively. The ICU mortality among the E-SP patients was 18.8% (6 of 32), compared with 7.1% (2 of 28) in the L-SP group (P = 0.264).

CONCLUSIONS

Early-onset severe pneumonia in renal transplant recipients resulted in a more serious condition, higher rate of NIV failure, longer duration of mechanical ventilation, and increased length of ICU and hospital stays.

The correlation between GPR30 and clinicopathologic variables in breast carcinomas

The G-protein-coupled-receptor 30 (GPR30) is a new membrane estrogen receptor. The aim of the present study was to determine the correlations among GPR30, ERalpha, PR, C-erbB-2, p53, TNM stage, and pathologic grade in breast carcinomas. Two hundred forty-one biopsy specimens were evaluated with immunohistochemical assays, and then correlations were analyzed. Low negative correlations of GPR30 with ERalpha (r = -0.144, P<0.05) and PR (r = -0.214, P<0.01) were observed. Associations of GPR30 with C-erbB-2, p53, TNM stage, and pathologic grade were not confirmed. These findings indicated that GPR30 might be an independent prognostic factor in breast carcinomas.

[A new saikosaponin from Bupleurum chinense DC]

Bupleurum chinense DC. is a well-known and very important traditional Chinese drug. It is often used to treat common cold with fever, alternating chill and fever, feeling of fullness and oppression in the chest. A new saikosaponin was isolated from Bupleurum chinense DC. and its structure was identified as 3-O-[beta-D-glucopyranosyl (1-->3)-beta-D-fucopyranosyl]-3 beta, 16 alpha, 23, 28-tetrahydroxy-olean-11, 13 (18)-dien-30-oic acid 30-O-[xylityl(1-->1)]-beta-D-glucopyranosyl-6-ester on the basis of chemical and spectral evidence. In addition, three known saikosaponins were isolated and characterized as saikosaponin 1, 2"-O-acetyl-saikosaponin b2 and 2"-O-acetyl-saikosaponin a. All the compounds were isolated from Bupleurum chinense DC. for the first time.

The value of a hospitalist service: efficient care for the aging population?

BACKGROUND

We studied patients of a hospitalist teaching service and patients receiving routine private care (control subjects). We sought to evaluate whether inpatients cared for by an academic hospitalist service had lower lengths of stay and resource utilization rates.

METHODS

Using monthly hospital census data, 477 hospitalist cases and 1,160 control cases were selected by explicit criteria from the Medicaid population of a large, university-affiliated, community medical center between July 1, 1996, and June 30, 1997. Outcomes in hospitalist faculty patients were compared to those of control patients under the care of private providers.

RESULTS

Median length of stay was 4 days for control subjects and 3 days for the hospitalist service (p < 0.0001). Median total cost per case was $4,853 for control subjects and $4,002 for hospitalist patients (p < 0.0001). Only patients > or = 65 years old showed statistically significant reductions in both length of stay (p < 0.0001) and total cost (p = 0.002). Subspecialty consultation rates were 37.6% for control subjects and 16.6% for hospitalist cases (p < 0.0001). We noted increasing consultations for patients > or = 65 years old, especially in the control group (p = 0.001). No significant differences in mortality, 30-day readmissions, or interfacility transfers were observed.

CONCLUSIONS

Patients cared for by an academic hospitalist service that includes actively participating medical residents appear to have lower lengths of stay, total costs, and consultation rates than patients receiving routine private care. The reductions are largely observed among patients > or = 65 years old.

[IR search through Internet]

In our laboratories, we have almost had the complete Sadtler IR database, about 133,000 spectra. Based on Sadtler IR Search Master software, off-line spectrum search through internet has been set up in this work. Customers e-mail their unknown spectra as attached files to ftir2000@sina.com or ftir@microchem.org.cn. After we download the unknown spectra and search them, we will send the search reports in Microsoft Word format back to the customers within 72 hours. Please visit our web site www.microchem.org.cn to know the policy about our IR search program.

[The status of protein P16 and P53 in the surgical margins of laryngeal carcinoma and the association with local recurrence]

OBJECTIVE

To assess the status of P53 and P16 of surgical margins in laryngeal carcinoma and the association with the local recurrence following surgical treatment

METHODS

The status of P53 and P16 of surgical margins in laryngeal carcinoma was studied using immunohistochemistry (IHC) staining method in 100 cases of laryngeal carcinoma. Fifty-two of them had recurrent tumors while 48 cases were free of local recurrence after 5-year follow up. The original tumor sites and T stages, which bear important influence over the risk of local recurrence, were strictly matched between the two groups, and the ages and preoperative doses of radiation were also considered.

RESULTS

The percentage of local recurrence was 85% in these patients who showed positive staining for P53 and simultaneous negative staining for P16 in both the cancer tissues and the surgical margins. No association was found between the expression of P53 and P16 and the clinical types or T stages.

CONCLUSION

The status of P53 and P16 in combination demonstrated by IHC technique in surgical margins of laryngeal carcinoma may predict the possibility of local recurrence.

Non-replicating Epstein-Barr virus-based plasmids extend gene expression and can improve gene therapy in vivo

To date, no gene transfer vector has produced prolonged gene expression following a single intravenous injection and then efficiently re-expressed the delivered gene following repeated systemic injection into immunocompetent hosts. To overcome these limitations, a gene therapy regimen using non-replicating Epstein-Barr virus (EBV)-based expression plasmids was developed. One plasmid contains the FR (EBV family of repeats) sequence and the expressed gene. The other encodes Epstein-Barr nuclear antigen 1 (EBNA-1), but lacks FR. Although unable to replicate in mice, intravenous co-injection of EBV-based plasmids in cationic liposome-DNA complexes (CLDCs) substantially prolonged luciferase gene expression. The use of a two-vector system limited host exposure to the EBNA-1 gene product. Furthermore, this EBV-based vector system could be intravenously re-injected multiple times into immunocompetent mice without loss of transfection efficiency. Use of this vector system significantly improved the therapeutic efficacy of the biologically important human granulocyte colony-stimulating factor gene. Delivery of the human granulocyte colony-stimulating factor gene in EBV-based plasmids increased circulating white blood counts for at least 2 months following a single CLDC-based intravenous co-injection. Conversely, white blood counts were never elevated following injection of CLDCs lacking EBV-derived elements. Thus, this EBV-based plasmid vector system both markedly prolongs gene expression at therapeutic levels and efficiently and repeatedly re-transfects immunocompetent hosts. These properties of EBV-based plasmid vectors appear to be due, at least in part, to the documented abilities of the EBNA-1 protein both to retain FR-containing DNA intracellularly and within the nucleus and to block anti-EBNA-1 cytotoxic T cell responses.

[Laryngeal function-sparing surgery for pyriform sinus cancer]

OBJECTIVE

To evaluate the oncologic effect of laryngeal function-sparing surgery for the patients with pyriform sinus carcinoma.

METHODS

A retrospective analysis was performed. Forty-four patients with pyriform sinus cancer who underwent operations were included. There were 10 patients in T1, 14 in T2, 18 in T3 and 2 in T4 categories. 42 patients received preoperative radiation and 2 cases, post-operative radiation. Surgery for the local lesions: 36 patients underwent pyriform sinusectomy and 8, partial laryngectomy and pyriform sinusectomy.

RESULTS

Five year survival rate is 50% for the whole series, 80% for stage I, 71.4% for stage II, 52.9% for stage III, 26.7% for stage IV and 45% for all T3 + T4 patients. Local control rate is 81.8% for all patients and 75% for T3, T4 patients.

CONCLUSION

For selected pyriform sinus cancer patient a conservative laryngeal surgery is warranted with the combination of preoperative radiative therapy.

[Lateral neck dissection of hypopharyngeal cancer with clinically regional metastasis]

OBJECTIVE

To assess whether lateral neck dissection can control the hypopharyngeal cancer with clinically regional metastasis.

METHODS

A retrospective review of medical chart from 1975 to 1992 was performed. Ninety-three hypopharyngeal squamous cell carcinoma patients who had performed RND were included. The distribution of metastatic neck lymph node was analyzed.

RESULTS

Submandibular triangle lymph node metastasis was occult in only 3 patients. Histological lymph node metastasis to the posterior triangle was found in 5.9% of patients with N0, 7.0% with N1, 37.5% with N2a and 36% with N2b-N3. Histological neck lymph node metastasis to the posterior triangle was found in 4.0% of patients without inferior jugular lymph node metastasis and 34.1% of patients with inferior jugular lymph node metastasis.

CONCLUSIONS

Lateral neck dissection was recommended to treat hypopharyngeal cancers of N0 and N1. N2 and N3 should be treated with neck dissection including II-V group lymph nodes. After lateral neck dissection, frozen section of the inferior jugular lymph node should be performed. If the result of the frozen section is positive, V group dissection should be performed.

Two diastereomeric saponins with cytotoxic activity from Albizia julibrissin

Two diastereomeric saponins, julibrosides J1 (1) and J9 (2), both of which show cytotoxic activity, were obtained from the stem bark of Albizia julibrissin Durazz. On the basis of chemical and spectral evidence [L.B. Ma et al., Carbohydr. Res., 281 (1996) 35-46], the structure of 1 was revised as 3-O-[beta-D-xylopyranosyl-(1-->2)-alpha-L-arabinopyranosyl-(1-->6) -beta-D-glucopyranosyl]-21-O-[(6S)-2-trans-2-hydroxymethyl-6-methyl-6-O- [4-O-((6R)-2-trans-2,6-dimethyl-6-O-(beta-D-quinovopyranosyl)-2,7- octadienoyl)-beta-D-quinovopyranosyl]-2,7-octadienoyl] acacic acid-28-O-beta-D-glucopyranosyl-(1-->3)-[alpha-L-arabinofuranosyl-(1-->4 )]-alpha-L-rhamnopyranosyl-(1-->2)-beta-D-glucopyranosyl ester. The diastereoisomer 2 of 1 was identified as 3-O-[beta-D-xylopyranosyl-(1-->2)-alpha-L-arabinopyranosyl-(1-->6) -beta-D-glucopyranosyl]-21-O-[(6S)-2-trans-2-hydroxymethyl-6-methyl-6-O- [4-O-((6S)-2-trans-2,6-dimethyl-6-O-(beta-D-quinovopyranosyl)-2,7- octadienoyl)-beta-D-quinovopyranosyl]-2,7-octadienoyl] acacic acid-28-O-beta-D-glucopyranosyl-(1-->3)-[alpha-L-arabinofuranosyl-(1-->4 )]-alpha-L-rhamnopyranosyl-(1-->2)-beta-D-glucopyranosyl ester. Saponin 2 is a new saponin named julibroside J9. Both julibrosides J1 and J9 show good inhibitory action against the KB cancer cell line in vitro.

[The treatment of tongue squamous cell with N0]

OBJECTIVE

To evaluate the validity of selective surgery for the N(0) neck in squamous cell carcinoma of the mobile tongue.

METHODS

116 patients with N(0) neck of the mobile tongue cancer who underwent comprehensive RND and 5 patients who had a selective RND were reviewed retrospectively.

RESULTS

According to the suggestion of division of neck level, 7 patients had metastasis at level I; 21, level II; 10, level III, 1 case for level IV or V each. There were 5 cases with level III involvement as a first echelon of metastasis which was peculiar for the neck metastasis of mobile tongue.

CONCLUSIONS

For N(0) neck of the mobile tongue cancer, a neck dissection of level I-III or level I-IV is more than enough.

Fetal gene transfer by transuterine injection of cationic liposome-DNA complexes

In utero injection of cationic liposome-DNA complexes (CLDCs) containing chloramphenicol acetyltransferase, beta-galactosidase (beta-gal), or human granulocyte colony-stimulating factor (hG-CSF) expression plasmids produced high-level gene expression in fetal rats. Tissues adjacent to the injection site exhibited the highest levels of gene expression. Chloramphenicol acetyltransferase expression persisted for at least 14 days and was reexpressed following postnatal reinjection of CLDCs. Intraperitoneal administration of the hG-CSF gene produced high serum hG-CSF levels. X-gal staining demonstrated widespread beta-gal expression in multiple fetal tissues and cell types. No toxic or inflammatory responses were observed, nor was there evidence of fetal-maternal or maternal-fetal gene transfer, suggesting that CLDCs may provide a useful alternative to viral vectors for in utero gene transfer.

Gene expression along the cerebral-spinal axis after regional gene delivery

We demonstrate here that intracerebroventricular or spinal cord (intrathecal) injection of either plasmid DNA alone or cationic liposome: DNA complexes (CLDCs) produces significant levels of expression of both reporter genes and biologically relevant genes in nonparenchymal cells lining both the brain and the spinal cord. Gene expression was identified both within the spinal cord and the brain after intracerebroventricular or intrathecal injection of either CLDCs or plasmid DNA alone. Intracerebroventricular or intrathecal injection of CLDCs containing the beta-galactosidase (beta-Gal) gene produced patchy, widely scattered areas of beta-Gal expression. The chloramphenicol acetyltransferase (CAT) reporter gene product reached peak levels between 24 hr and 1 week postinjection, and was still present at significant levels 3 weeks after a single intracerebroventricular or intrathecal injection. Intrathecal injection of the human granulocyte colony-stimulating factor (G-CSF) gene produced high levels of hG-CSF activity in both the spinal cord and the brain. Intracerebroventricular injection of CLDCs containing the murine nerve growth factor (NGF) gene increased mNGF levels in the hippocampus, a target region for cholinergic neurons in the medial septum, and increased cholinergic neurotransmitter synthetic enzyme choline acetyltransferase (ChAT) activity within the brain, a well-characterized effect of both purified and recombinant NGF protein. These findings indicate that intracerebroventricular or intrathecal injection of CLDCs can produce significant levels of expression of biologically and therapeutically relevant genes within the CNS. Efficient gene transfer into the CNS will facilitate the evaluation of gene function and regulation within the brain and spinal cord. We attempted to transfer and express genes within the brain and spinal cord by direct CNS injection of either DNA alone or CLDCs into the intraventricular and subarachnoid compartments. We show that intracerebroventricular or spinal cord (intrathecal) injection of either plasmid DNA alone or CLDCs produces significant levels of expression of both reporter genes and biologically relevant genes in nonparenchymal cells lining both the brain and the spinal cord. Intrathecal injection of the hG-CSF gene produced high levels of hG-CSF activity in both the spinal cord and the brain. Intracerebroventricular injection of CLDCs containing the murine NGF gene increased mNGF levels in the hippocampus, and increased cholinergic neurotransmitter synthetic enzyme ChAT activity within the brain. Locoregional diffusion of gene products expressed by transfected meningeal lining cells into brain and spinal cord parenchyma could potentially target secreted proteins within brain and spinal cord regions relevant to neuropathological states while limiting peripheral side effects.

Guidelines in pulmonary medicine: a 25-year profile

OBJECTIVE

We attempted to identify clinical practice guideline and pathway articles in the area of pulmonary medicine published in peer-reviewed journals since 1974.

DESIGN

Review.

DATA SOURCES

MEDLINE, the Cochrane Database, Best Evidence, and Abstracts of Clinical Care Guidelines from January 1974 to December 1998.

STUDY SELECTION

All articles contained relevant search terms for pulmonary topics and were included irrespective of setting (primary or specialty, inpatient or outpatient). Controlled and uncontrolled trials as well as observational studies and consensus opinion/statements were all identified. The articles were stratified by design as well as by pulmonary topic.

DATA EXTRACTION

Limited data on study type, study focus, year of publication, and results of study were abstracted.

RESULTS

Our criteria yielded 271 articles, including 115 consensus statements and expert opinion guidelines; 30 controlled studies, meta-analyses, or systematic reviews; and 126 uncontrolled trials and observational studies. Of these, 82 articles (30.3%) related to asthma, 46 articles (17.0%) related to COPD, and 36 articles (13.3%) related to pneumonia. In addition, we tracked the increasing publication of all guideline-related pulmonary articles; randomized, controlled trials (RCTs); systematic reviews; and consensus statements by year for the past 25 years.

CONCLUSION

Pulmonary guidelines are increasingly published in peer-reviewed journals, but few are tested clinically in RCTs. There is continued reliance on consensus statements and expert opinion. Pulmonary guideline publications have continued to dramatically increase in number and in importance since 1974, both on the local level and internationally.

Squamous cell carcinoma of temporal bone: reported on 33 patients

BACKGROUND

This study assessed the treatment results of a series of 33 patients with squamous cell carcinoma (SCC) of the temporal bone and evaluated the efficacy of mastoidectomy combined with perioperative radiation therapy protocol.

METHODS

Thirty-three patients with biopsy-proven SCC invaded to the temporal bone were reviewed retrospectively and staged into three subgroups according to the University of Pittsburgh TNM Staging System. There were 3 patients with Stage I and II disease(tumor confined to auditory canal), 17 patients with Stage III (tumor involving the middle ear or mastoid), and 13 patients with Stage IV(more extensive disease). Two patients were treated by surgery alone. Eleven patients received irradiation only, and the remaining 20 patients underwent combined surgery and perioperative radiotherapy. The surgical intervention included sleeve resection for patients with Stage I and II lesions and mastoidectomy for all patients with Stage III and IV lesions except 1 who had subtotal temporal bone resection. The radiation dose delivered was in the range of 3500 approximately 10 000 cGy, with an average dose of 6560 cGy.

RESULTS

The five-year survival rate for the whole series was 51.7% by the life-table analysis. After being staged into three subgroups (ie, Stage I + II, Stage III, and Stage IV), the estimated five-year survival rates were 100%, 68. 8%, and 19.6%, respectively (p = 0.04). Radiation alone yielded a 28. 7% five-year survival, while combined surgery and irradiation gave a result of 59.6% (p = 0.80). For patients treated with planned combined therapy, the actuarial five-year survival rates were 72.7% (8/11) for Stage III disease and 12.5% (1/8) for Stage IV disease (p = 0.02). Twelve patients who died of disease did so of local recurrence (10 cases), cervical metastases (1 case), and liver metastases (1 case), with 70% of succumbing to their diseases within two years. Complications include osteonecrosis (n = 1), osteitis (n = 3), radiation dermatitis (n = 2), facial nerve palsy (n = 2), and delayed healing (n = 2). Data on clinical presentation and treatment modality were also analyzed.

CONCLUSION

The results of mastoidectomy with removal of all gross tumor, combined with planned perioperative irradiation therapy, seems to be a useful approach for SCC of the temporal bone. This gives at least as good, and possibly better, five-year survival than temporal bone resection. The mastoidectomy procedure creates less operative morbidity and mortality. To facilitate the development of more effective means of treating advanced disease, an accepted staging system and cooperative group investigation is necessary.

[Cervical management in the N0 squamous cell carcinoma of the tongue]

OBJECTIVE

To assess whether the elective neck dissection would be beneficial as a routine management in the N0 squamous cell carcinoma of the tongue.

METHODS

Cox regression model was used for analysis of tongue cancer cases treated by our hospital in a period from 1958 to 1996.

RESULTS

Size of primary tumor and preoperative radiation showed significant difference in relation to cervical lymph node recurrence or metastasis. Neck dissection in the series was not a factor to influence the rate of cervical recurrence or survival. 5-years survival was 73.5% versus 69.3% in patients who underwent elective neck dissection and those without neck dissection (difference not statistically significant).

CONCLUSION

We suggest that elective neck dissection would be avoided in T1 or T2 patients who have no neck node metastases.

Systemic gene delivery expands the repertoire of effective antiangiogenic agents

Cationic liposome-DNA complex (CLDC)-based intravenous gene delivery targets gene expression to vascular endothelial cells, macrophages and tumor cells. We used systemic gene delivery to identify anti-angiogenic gene products effective against metastatic spread in tumor-bearing mice. Specifically, CLDC-based intravenous delivery of the p53 and GM-CSF genes were each as effective as the potent antiangiogenic gene, angiostatin, in reducing both tumor metastasis and tumor angiogenesis. Combined delivery of these genes did not increase anti-tumor activity, further suggesting that each gene appeared to produce its antimetastatic activity through a common antiangiogenic pathway. CLDC-based intravenous delivery of the human wild type p53 gene transfected up to 80% of tumor cells metastatic to lung. Furthermore, it specifically induced the expression of the potent antiangiogenic gene, thrombospondin-1, indicating that p53 gene delivery in vivo may inhibit angiogenesis by inducing endogenous thrombospondin-1 expression. CLDC-based delivery also identified a novel anti-tumor activity for the metastasis suppressor gene CC3. Thus, CLDC-based intravenous gene delivery can produce systemic antiangiogenic gene therapy using a variety of different genes and may be used to assess potential synergy of combined anti-tumor gene delivery and to identify novel activities for existing anti-tumor genes.

[Selective neck dissection in the treatment of supraglottic carcinoma]

OBJECTIVE

To study the effectiveness of selective neck dissection (upper neck dissection, UND) in the treatment of N0 neck of supraglottic carcinoma.

METHOD

The upper neck dissection was designed according to the lymphatic drainage of the supraglottic larynx for the management of N0 neck. The records of the supraglottic carcinoma of T1-4 N0-1 M0 cases (168 patients), who were treated in 1976-1990 at this hospital, were analysed retrospectively.

RESULT

In this seires of 168 patients with no neck metastases pathologically a follow-up of five years after an upper neck dissection revealed a neck recurrence rate of 10.1% (17/168), which is comparable with those reported in the literature after selective neck dissection. Five year survival rate was 72.6% (122/168).

CONCLUSION

Long-termed observation after UND for supraglottic carcinoma (T1-4 N0-1) resulted in satisfactory survival rates and regional control. It seems justifiable to do a selective neck dissection for N0 and selected N1 patients in order that more patients were exempted from enduring the morbidity following a comprehensive neck dissection.

Saikosaponins from roots of Bupleurum scorzonerifolium

Saikosaponin u and saikosaponin v, were isolated from the roots of Bupleurum scorzonerifolium and these saponins were identified as 3-O-[beta-D-glucopyranosyl-(1-->2)-beta-D-glucopyranosyl- (1-->3)-beta-D-fucopyranosyl]-3 beta,16 alpha,23,28-tetrahydroxy-olean- 11,13(18)-dien-30-oic acid-30-O-[pentito(1-->1)-beta-D-glucopyranosyl-(6-->)] ester and 3-O-[beta-D-glucopyranosyl-(1-->3)-beta-D-fucopyranosyl]-3 beta,16 alpha,23,28-tetrahydroxy-olean-11,13(18)-dien-30-oic acid-30-O-[pentito(1-->1)-beta-D-glucopyranosyl(6-->)] ester, respectively.

[Visceral voice training for laryngectomy after hypopharyngectomy and visceral transplant]

OBJECTIVE

To establish a way to visceral voice after stomach or colon transplantation for patients with hypopharyngeal or cervical esophageal cancer.

METHODS

Esophageal voice training was used and modified according to the compliance of the patients. Twenty laryngectomies with replacement of the hypopharynx and esophagus by stomach(13 cases), colon(6 cases) and jejunum (1 case) were trained for voice rehabilitation at the Department of Head and Neck Surgery.

RESULTS

The patients with an artificial esophagus from vicera were easy to gain an influx of certain volume of gas into their artificial esophagus (stomach or colon) and to learn to speak. But on the whole the quality of voice was not so satisfactory. In this series nineteen out of 20 patients (95%) could express their idea by speech after a training course of three weeks.

CONCLUSION

The literature has emphasized role of cricopharyngeus muscle in the training of esophageal voice. Owing to the fact that this series of patients who had had their cricopharyngeus removed, could easily get their voice rehabilitated, it seems this muscle played no major role in the voice rehabilitation.

[Preoperative radiation plus surgery vs. operation alone for laryngeal carcinoma]

OBJECTIVE

To study the validity of preoperative radiation in improving the survival rate of laryngocarcinoma.

METHODS

A prospective randomized clinical trial was conducted with preoperative radiation plus surgery (RS) as one group and surgery alone (SA) as the other group. The ages of the patients were less than 75 years, and the operative types were decided after clinical examination. The patients were divided into SA or RS group by random. Doses of preoperative irradiation was 40 Gy. Three hundred and seventy patients with laryngocarcinoma were treated, 215 in the SA group; 155 in the RS group. All patients were followed up over three years.

RESULTS

In SA group, 3 years survival rate was 83.3%, 5-year survival rate 82.6%, 10-year survival rate 80.3%. In RS group, 3-year survival rate was 78.9%, 5-year survival rate 76.4%, 10-year survival rate 68.6%. There is no statistically significant difference in survival rates between the groups (P = 0.1); but, the 10-year survival rate in SA group was better than that in RS group for the stage III and IV supraglottic carcinomas, the former was 73.6% and the latter 63.5% (P = 0.003). The 10-year survival rate for the patients with T3 and T4 supraglottic carcinomas who underwent total laryngectomy in SA group was better than that in RS group. The former was 68% and the latter 50% (P = 0.0001).

CONCLUSION

Preoperative radiotherapy with 40 Gy didn't increase the survival rate of laryngeal carcinoma. The 10-year survival of stages III and IV supraglottic carcinoma in combined treatment group was lower than that in the surgery alone group.

Replicative efficiency and pathogenicity of hepatitis B virus e-minus precore variant

To study the replicative efficiency and pathogenicity of hepatitis B virus precore variant (A1896), anti-hepatitis B virus e antigen (HBe) titre was studied in naturally occurring wild-type virus infection, A1896 variant infection and dual infection. Higher titre of anti-HBe was found in patients with no virus replication and in patients coinfected with the wild-type virus and A1896 variant, which suggest that anti-HBe may either act as an inhibitor of virus replication or as selective pressure for the A1896 variant. Three site-directed mutants were constructed in the duck hepatitis B virus (DHBV) precore region. A frame shift in the encapsidation signal region abolished replication of DHBV; mutation in the initiation codon of the precore and mutation to generate a termination codon at the distal region of the precore resulted in decreased replication in the duck model. More significant pathological changes were found in the liver tissues of ducks infected with the mutant which mimicked the HBV A1896 variant.

[Squamous cell carcinoma of temporal bone: an analysis of long-term treatment results in 33 patients]

OBJECTIVE

To evaluate the long-term results in patients with squamous cell carcinoma of the temporal bone and treated by of mastoidectomy combined with perioperative radiation therapy.

METHODS

Thirty-three patients with squamous cell carcinoma invading the temporal bone were reviewed retrospectively. According to the tumor extent, the patients were staged into three subgroups, 3 with lesions confined to the auditory canal(Group I), 17 with involvement of the middle ear or mastoid(Group II) and 13 with more extensive disease(Group III). Two patients were treated by surgery, 11 by irradiation and the remaining 20 by the combined surgery and perioperative radiotherapy. The surgical procedures included sleeve resection for group I patients, mastoidectomy for all other patients except one who had subtotal temporal bone resection. The radiation doses were in the range of 3,500 to 10,000 cGy, with an average dose of 6,560 cGy.

RESULTS

The 5-year survival rate for the whole series was 51.7% by the life table analysis. The estimated 5-year survival rates for 3 subgroups were 100%, 68.8%, and 19.6%, respectively (P = 0.012). Radiation alone had a 28.7% survival rate and combined therapy 59.6% (P = 0.80). For patients treated with planned combined therapy, the actual 5-year survival rates were 72.7% (8/11) for Group II and 12.5% (1/8) for Group III (P = 0.02). Twelve patients died of local recurrence (10 cases), cervical metastases(1 case) and liver metastases (1 case) with 67.0% (8/12) succumbed to their diseases within two years. Complications included osteonecrosis (n = 1), osteitis (n = 3), radiation dermatitis (n = 2), facial palsy (n = 2), and delayed healing (n = 2).

CONCLUSION

The 5-year survival rates in patients with mastoidectomy with removal of gross tumor, combined with planned perioperative irradiation therapy, are similar or higher than those from literature. This protocol can be used in patients with squamous cell carcinoma confined to the middle ear or the mastoid.