Establishing a Chinese older hip fracture registry for older patients: a Delphi study to define the focus and key variables for this registry

A national hip fracture registry does not yet exist in China. This is the first to recommend a core variable set for the establishment of a Chinese national hip fracture registry. Thousands of Chinese hospitals will build on this and improve the quality of management for older hip fracture patients. The rapidly ageing population of China already experiences over half a million hip fractures every year. Many countries have developed national hip fracture registries to improve the quality of hip fracture management, but such a registry does not exist in China. The study is aimed at determining the core variables of a national hip fracture registry for older hip fracture patients in China. A rapid literature review was conducted to develop a preliminary pool of variables from existing global hip fracture registries. Two rounds of an e-Delphi survey were conducted with experts. The e-Delphi survey used a Likert 5-point scale and boundary value analysis to filter the preliminary pool of variables. The list of core variables was finalised following an online consensus meeting with the experts. Thirty-one experts participated. Most of the experts have senior titles and have worked in a corresponding area for more than 15 years. The response rate of the e-Delphi was 100% for both rounds. The preliminary pool of 89 variables was established after reviewing 13 national hip fracture registries. With two rounds of the e-Delphi and the expert consensus meeting, 86 core variables were recommended for inclusion in the registry. This study is the first to recommend a core variable set for the establishment of a Chinese national hip fracture registry. The further development of a registry to routinely collect data from thousands of hospitals will build on this work and improve the quality of management for older hip fracture patients in China.

Mariculture affects antibiotic resistome and microbiome in the coastal environment

Antibiotics are increasingly used and released into the marine environment due to the rapid development of mariculture, resulting in spread of antibiotic resistance. The pollution, distribution, and characteristics of antibiotics, antibiotic resistance genes (ARGs) and microbiomes have been investigated in this study. Results showed that 20 antibiotics were detected in Chinese coastal environment, with predominance of erythromycin-H₂O, enrofloxacin and oxytetracycline. In coastal mariculture sites, antibiotic concentrations were significantly higher than in control sites, and more types of antibiotics were detected in the South than in the North of China. Residues of enrofloxacin, ciprofloxacin and sulfadiazine posed high resistance selection risks. β-Lactam, multi-drug and tetracycline resistance genes were frequently detected with significantly higher abundance in the mariculture sites. Of the 262 detected ARGs, 10, 26, and 19 were ranked as high-risk, current-risk, future-risk, respectively. The main bacterial phyla were Proteobacteria and Bacteroidetes, of which 25 genera were zoonotic pathogens, with Arcobacter and Vibrio in particular ranking in the top10. Opportunistic pathogens were more widely distributed in the northern mariculture sites. Phyla of Proteobacteria and Bacteroidetes were the potential hosts of high-risk ARGs, while the conditional pathogens were associated with future-risk ARGs, indicating a potential threat to human health.

[Endoscopic resection of type D trigeminal schwannoma through nasal sinus approach]

Objective: To examine the feasibility and surgical approach of removing type D trigeminal schwannoma through nasal cavity and nasal sinus under endoscope. Methods: Eleven patients with trigeminal schwannoma who were treated in the Department of Otorhinolaryngology, Qilu Hospital of Shandong University from December 2014 to August 2021 were analyzed retrospectively in this study. There were 7 males and 4 females, aged (47.5±13.5) years (range: 12 to 64 years). The neoplasm involved the pterygopalatine fossa, infratemporal fossa, ethmoidal sinus, sphenoid sinus, cavernous sinus, and middle cranial fossa. The size of tumors were between 1.6 cm×2.0 cm×2.0 cm and 5.7 cm×6.0 cm×6.0 cm. Under general anesthesia, the tumors were resected through the transpterygoid approach in 4 cases, through the prelacrimal recess approach in 4 cases, through the extended prelacrimal recess approach in 2 cases, and through the endoscopic medial maxillectomy approach in 1 case. The nasal endoscopy and imaging examination were conducted to detect whether neoplasm recurred or not, and the main clinical symptoms during follow-up. Results: All the surgical procedures were performed under endonasal endoscope, including Gross total resection in 10 patients. The tumor of a 12-year-old patient was not resected completely due to huge tumor size and limited operation space. One patient was accompanied by two other schwannomas located in the occipital region and the ipsilateral parotid gland region originating from the zygomatic branch of the facial nerve, both of which were removed concurrently. After tumor resection, the dura mater of middle cranial fossa was directly exposed in the nasal sinus in 2 cases, including 1 case accompanied by cerebrospinal fluid leakage which was reconstructed by a free mucosal flap obtained from the middle turbinate, the other case was packed by the autologous fat to protect the dura mater. The operation time was (M(IQR)) 180 (160) minutes (range: 120 to 485 minutes). No complications and deaths were observed. No recurrence was observed in the 10 patients with total tumor resection during a 58 (68) months' (range: 10 to 90 months) follow-up. No obvious change was observed in the facial appearance of all patients during the follow-up. Conclusion: Type D trigeminal schwannoma involving pterygopalatine fossa and infratemporal fossa can be removed safely through purely endoscopic endonasal approach by selecting the appropriate approach according to the size and involvement of the tumor.

[Related factors of cervical lymph node metastasis and prognosis of patients with cN0 tongue squamous cell carcinoma]

PURPOSE

To explore the related factors of cervical lymph node metastasis and postoperative quality of life in patients with cN0 tongue squamous cell carcinoma (SCC), and provide a theoretical basis for clinical prediction of occult neck metastasis and improvement of survival rate.

METHODS

A total of 283 patients with cN0 tongue SCC who underwent surgery in Huaian No.1 People's Hospital were collected. Chi-square test and logistic regression were used to analyze the correlation between cervical lymph node metastasis and clinical pathological parameters of patients. Single-factor and multi-factor Cox regression analysis were used to explore independent risk factors for prognosis of patients with tongue SCC. Survival analysis was used to study the correlation between cervical lymph node metastasis and prognosis of patients. SPSS 21.0 software package was used for statistical analysis.

RESULTS

Chi-square test and logistic regression analysis showed that infiltration depth, T stage and pathological grade were closely related to cervical lymph node metastasis(P<0.05), and infiltration depth was the main factor leading to postoperative cervical lymph node metastasis(OR=2.175). The depth of invasion, pathological grade and cervical lymph node metastasis could be regarded as independent risk factor affecting the prognosis of patients with tongue SCC(P<0.05).

CONCLUSIONS

Invasion depth, T stage and pathological grade can be used as indicators to predict occult cervical lymph node metastasis in patients with cN0 tongue SCC. Invasion depth, pathological grade and cervical lymph node metastasis can be used as independent indicators to predict the prognosis of patients with cN0 tongue SCC.

Preoperative circulating fibrinogen to albumin ratio in predicting 5-year prognosis of oral cancer radical surgery

Accurate prediction of oral cancer (OC) prognosis before surgery is the key to treatment. The prognosis of OC is mainly based on the Tumor-Node-Metastasis (TNM) staging system, but TNM staging cannot accurately predict clinical prognosis. Current research results show that systemic inflammatory and nutritional markers can influence the postoperative prognosis and outcome of malignant tumors. The objectives of this research are to explore the preoperative blood fibrinogen and albumin in OC patients and to determine the predictive validity of the fibrinogen to albumin ratio (FAR) over 5 years of follow-up. This retrospective cohort study queried The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University database and identified 157 cases of OC operations performed between 2014 and 2016. Survival curves were presented by the Kaplan-Meier method. Univariate and multivariate analyses were used to assess clinical value for patients with radical surgery. The FAR revealed a good prediction for 5-year cancer-specific survival (CSS). The optimal cut-off value for FAR was 0.072. Multivariate logistic regression analyses revealed that FAR was an independent risk factor for survival. Increased FAR (> 0.072) is negatively associated with the CSS of patients (log-rank test, p < 0.01). The preoperative FAR may provide a significant predictor of cancer-specific survival in oral cancer patients undergoing radical surgery.

[Effects of moderate dose rosuvastatin on carotid plaque in patients with diabetes mellitus evaluated by magnetic resonance imaging]

Objective: To observe the effect of lipid regulating therapy on carotid atherosclerotic plaque in diabetic patients. Methods: The REACH study, conducted between March 2009 and February 2012, enrolled asymptomatic patients with magnetic resonance imaging (MRI) confirmed carotid atherosclerotic plaque, who had never taken lipid-lowering drugs. Patients were treated with a moderate dose of rosuvastatin for 24 months. Blood lipid levels were measured and carotid MRI was performed at baseline, 3 and 24 months after treatment. The volume of carotid wall and lipid-rich necrotic core (LRNC) were measured by image analysis software. This study retrospectively analyzed patients in the REACH study. Patients were divided into diabetes group and non-diabetic group. The changes of blood lipid level and MRI parameters of carotid atherosclerotic plaque were compared between the two groups and their correlation was analyzed. Results: A total of 38 patients with carotid atherosclerotic plaque were included in this study, including 13 patients (34.2%) in the diabetic group and 25 patients (65.8%) in the non-diabetic group. Baseline parameters were comparable between the two groups, except higher HbA1c level in diabetes group (P<0.05). Compared with baseline, the total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) and triglyceride (TG) levels were significantly decreased at 3 and 24 months in both two groups (P<0.05). The change of high-density lipoprotein cholesterol (HDL-C) in diabetes group was not obvious, while it was significantly increased in non-diabetic group at 24 months ((1.38±0.33) mmol/l vs. (1.26±0.26) mmol/l, P<0.05). MRI results showed that the volume and percentage of LRNC remained unchanged at 3 months, slightly decreased at 24 months (64.86 (45.37, 134.56) mm³ vs. 75.76 (48.20, 115.64) mm³, P>0.05) and (15.84% (11.47%, 24.85%) vs. 16.95% (11.64%, 22.91%), P>0.05) in diabetic group. In non-diabetic group, the volume and percentage of LRNC were significantly decreased at 3 months (63.01 (44.25, 188.64) mm³ vs. 72.49 (51.91, 199.59) mm³, P<0.05) and (13.76% (8.81%, 27.64%) vs. 16.04% (11.18%, 27.05%), P<0.05) respectively. Both parameters further decreased to (55.63 (27.18, 179.40) mm³) and (12.71% (8.39%, 24.41%)) at 24 months (both P<0.05). Wall volume, lumen volume and percent wall volume (PWV) were not affected post therapy in both two groups(P>0.05). There were no correlations between the changes of plaque parameters including volume and percentage of LRNC, wall volume, lumen volume, PWV and the changes of blood lipid parameters (TC, LDL-C, HDL-C and TG) in 3 and 24 months (P>0.05). Conclusion: Lipid-lowering therapy possesses different effects on carotid atherosclerotic plaque in diabetic and non-diabetic patients, and the LRNC improvement is more significant in non-diabetic patients as compared to diabetic patients.

Prognostic role of an inflammation scoring system in radical resection of oral squamous cell carcinoma

Background

Inflammatory markers can influence the postoperative prognosis and outcome of malignant tumors. However, the role of inflammatory factors in oral squamous cell carcinoma (OSCC) are still debatable. The primary objective of this investigation was to detect the preoperative blood fibrinogen and neutrophil–lymphocyte ratio (NLR) in OSCC patients and to determine the predictive validity of F-NLR (combined fibrinogen and NLR score).

Methods

A total of 365 patients with oral cancer after surgery were separated into three classes: F-NLR of 2, with hyperfibrinogenemia (> 250 mg/dL) and high NLR (> 3.2); F-NLR of 1, with only one higher index; and F-NLR of 0, with no higher indices. Univariate and multivariate analyses were used to identify risk factors for the demographic and clinical characteristics of patients in the three F-NLR groups. Kaplan–Meier survival analysis was used to assess the prognosis.

Results

Preoperative F-NLR showed a relatively better predictive role in oral cancer prognosis than fibrinogen and NLR alone. Multivariate analysis revealed that F-NLR has the potential to be an independent predictor for OSCC cancer-specific survival (P < 0.001). Patients with high scores had a relatively poorer prognosis than those with low scores (P < 0.001).

Conclusions

Our findings indicate that blood F-NLR may serve as an independent prognostic factor in OSCC patients.

Unplanned reoperation after radical surgery for oral cancer: an analysis of risk factors and outcomes

Background

Unplanned reoperation (UR) after radical surgery for oral cancer (OC) is a health threat for the patients. The aim of the study was to identify the incidence of and risk factors for unplanned reoperation following oral cancer radical surgery, and to explore a potential role for long-term survival.

Methods

The present study followed a retrospective study design. Univariate and multivariate analyses were used to identify risk factors for demographic and clinical characteristics of patients. Survival analysis was performed by the Kaplan–Meier method. The data was analyzed statistically between November and December 2021.

Results

The incidence of UR was 15.7%. The primary cause of UR was reconstructed flap complications. Multivariate logistic regression analyses revealed that diabetes, tumor size, type of reconstruction, and nodal metastasis were independent risk factors for UR. Patients undergoing UR had a longer hospitalization, more post-operative complications, and a higher mortality compared with the non-UR group. UR is negatively correlated with the cancer-specific survival rate of patients (Log-rank test, P = 0.024).

Conclusion

Diabetes, tumor size, pedicled flap reconstruction and cervical nodal metastasis (N2) as independent risk factors for UR was discovered. UR was positively correlated with perioperative complications prolong hospital stay, and increased early mortality, but negatively correlated with the cancer-specific survival rate survival rate.

Antibiotics, antibiotic resistance genes and microbial community in grouper mariculture

Increasing use of feed and medicine in mariculture could cause negative environmental impacts such as habitat modification, microbial disease development and antibiotic resistance. Here we investigated contamination of antibiotics and antibiotic resistance genes (ARGs), and composition of microbial community in grouper mariculture systems in Hainan province, China. Results showed detection of various antibiotic residues with the dominance of fluoroquinolones and tetracyclines in the six grouper cultivation systems. The concentrations of the detected antibiotics in the grouper mariculture water were significantly higher than those in the original seawater. Some of the detected antibiotics such as enrofloxacin, ciprofloxacin, ofloxacin, oxytetracycline and erythromycin in the mariculture water and/or sediment would pose high resistance selection risks. Sulfonamides resistance genes sul1 and sul2 were found to be predominant in water and sediment, while tetracycline resistance genes were prevalent in fish gill and gut. The dominant bacterial phyla in water and sediments were Bacteroides, Actinomycetes, and Proteobacteria, while the dominant ones in fish gill and gut were the Proteobacteria. Genera of Vibrio and Mycobacterium in the core microbiota were important zoonotic pathogens, and there was a significant positive correlation between Vibrio and ARGs. Phyla of Proteobacteria, Actinomyces, and Cyanobacteria were positively correlated to ARGs, indicating that these microorganisms are potential hosts of ARGs. The putative functions of microbiome related to antibiotic resistance and human diseases were significantly higher in fish than in the mariculture environment. This study suggests that mariculture system is a reservoir of ARGs, and the use of antibiotics in mariculture could induce the increase of antibiotic resistance and the prevalence of opportunistic pathogens.

Rapid Test Method for Multi-Beam Profile of Phased Array Antennas

The measurement of the phased array antenna (PAA) is completely different from the traditional antenna, due to its multi beam patterns. Usually, each beam pattern of the PAA needs a separate measurement, which makes the overall time extremely long. Thus, the traditional method can no longer meet the efficiency and cost requirements of new PAA measurement. In this paper, a pattern reconstruction method is proposed which significantly reduce the measurement time of multi-beam PAAs. With the known array element patterns (AEP) and theoretical weighted port excitation of the beams, any beam pattern can be predicted by measuring only a certain beam pattern, due to the element excitation coefficient (including the matching, mutual coupling, and manufacturing factors, etc.) of the specific PAA being calculated. The approach has low reconstruction error in term of beam pointing accuracy, side lobe, and co-polar and cross-polar patterns while being validated for large scanning range. Through theoretical derivation and experiments, the effectiveness of the method is verified, and the testing efficiency of the phased array antenna can be improved by 10 times or even more.

[Cross sectional study of familial hypercholesterolemia in dyslipidemia patients receiving lipid-lowering therapy: DYSIS-China subgroup analysis]

Objectives: To analyze the incidence, blood lipid levels and cardiovascular disease of familial hypercholesterolemia (FH) in dyslipidemia patients receiving lipid-lowing therapy from the DYSIS-China. Methods: Dyslipidemia International Study-China (DYSIS-China) database was re-analyzed according to the criteria of "Chinese guidelines for prevention and treatment of dyslipidemia in adults-2016 version". DYSIS-China database included 25 317 dyslipidemia out-patients who received at least one lipid-lowering drug for at least three months. All the patients were divided into three groups: unlikely HF, possible FH and definite FH according to the Dutch Lipid Clinic Network diagnostic criteria. Age, gender, lipids levels, drug use and complications were compared among the three groups. Factors were compared between Possible FH group and definite FH group in terms of age stratification. Results: A total of 23 973 patients with dyslipidemia were included. The average age was (64.8±9.9) years, 11 757 patients were females (49.0%). The proportion of unlikely FH in the total population was 20 561 (85.7%), possible FH was 3294 (13.7%), and the definite FH was 118(0.5%). Patients in the definite FH group (58.3±8.5 years) was younger than in unlikely HF(65.3±9.8 years) and possible FH(61.8±9.9 years) group. LDL-C ((5.6±1.9) mmol/L) levels were significantly higher in definite FH group than in unlikely HF ((2.5±0.9) mmol/L) and possible FH ((4.3±1.0) mmol/L) group. TC ((7.4±1.8) mmol/L) levels were also significantly higher in definite FH group than in unlikely HF ((4.3±1.0) mmol/L) and possible FH ((6.0±1.0) mmol/L) group. Percent of female sex, sedentary lifestyle and systolic blood pressure value were significantly higher in definite FH group than in other two groups (all P<0.05). Statin use was similar among the 3 groups. Prevalence of ischemic cardiomyopathy (70(59.3%)) was significantly higher in the definite FH group than in unlikely FH group7519 (36.6%) and possible FH group1149 (34.9%). The rate of hypertension (82 (69.5%)) was also significantly higher in the definite FH group than in unlikely FH group (2 063 (62.6%) and in possible FH group (13 928 (67.7%)). The possible FH group had the highest proportion of patients aged 55-64 years (1 146 (34.8%)), and the prevalence of hypertension 358 (76.8%), diabetes 189 (40.6%), ischemic heart disease 186 (39.9%), cerebrovascular disease 149 (32.0%) and heart failure 28 (6.0%) was the highest in patients over 75 years old. The definite FH group had the highest proportion of patients aged 55-64 years (49 (41.52%)), and the prevalence of ischemic heart disease (70 (59.3%)) was the highest in patients aged 45-54 years old group, there was no significant difference in the prevalence of diabetes,hypertension,heart failure,peripheral artery disease and cerebrovascular disease among different age groups. Conclusion: The detection rate of FH in Chinese patients with dyslipidemia is not low, the blood lipid level is poorly controlled, and the risk of cardiovascular disease is high in Chinses FH patients.

The fate of sulfonamides in the process of phytoremediation in hydroponics

Phytoremediation has been proven to be an alternative in-situ treatment technique for sulfonamide polluted wastewater. However, the fate of sulfonamides in the phytoremediation process of multiple sulfonamides coexistence is unclear. Therefore, the possibility and mechanism of phytoremediation of ten sulfonamides by different wetland plants through hydroponics were investigated in this study. The phytoremediation rates of Σsulfonamides by different wetland plants were from 44.5% to 56.9%. Mass balance analysis showed that rhizosphere biodegradation (90.2% - 92.2%) dominated the phytoremediation of Σsulfonamides, while hydrolysis (7.63% - 8.95%) and plant uptake (0.05% - 0.17%) accounted for a small proportion. It is worth mentioning that the dissipation of the target sulfonamides in the hydroponic system followed the first-order reaction kinetic model, with half-lives of 13.3 d to 53.3 d, which are close to or even lower than that of aerobic biodegradation in river water, sediment, and piggery wastewater. Six of the ten spiked sulfonamides were detected in plant samples demonstrated that the selective uptake of plants under the coexistence of multiple sulfonamides. The distribution of sulfonamides (concentrations and uptake amounts) in plant tissues followed the sequence of root > stem > leaf in this study, but the distribution in stems and leaves needs further study. The uptake and rhizosphere biodegradation of Cyperus papyrus to sulfonamides are optimally resulting that its phytoremediation rate is significantly higher than other plants (p < 0.05), which indicates that plant species is one of the key factors affecting the phytoremediation efficiency of sulfonamides. These findings verify the feasibility of phytoremediation of sulfonamides, and provide new insights into the fate of sulfonamides in the process of phytoremediation.

[Pollution Characteristics and Removal of Typical Pharmaceuticals in Hospital Wastewater and Municipal Wastewater Treatment Plants]

In this study, solid phase extraction (SPE) coupled with high-performance liquid chromatography-tandem triple quadrupole mass spectrometry (HPLC-MS/MS) was used to track the contamination of 17 benzodiazepines, 14 acidic pharmaceuticals, and 5 neutral pharmaceuticals in 4 hospital wastewater treatment systems and 3 municipal wastewater treatment plants in Guangzhou, Guangdong Province. The results showed that a total of 10 benzodiazepines, 8 acidic, and 3 neutral pharmaceuticals were detected in the hospital wastewater treatment systems with concentrations in the ranges of 0.41-23376 ng·L^-1 and 0.11-22888 ng·L^-1 in the influents and effluents, respectively; The 8 benzodiazepines, 8 acidic, and 4 neutral pharmaceuticals were detected in the municipal wastewater treatment plants with concentrations in the ranges of 0.4-1695 ng·L^-1 (influents) and 0.1-1526 ng·L^-1 (effluents). Among them, high levels of benzodiazepine compounds including lorazepam[(53.1±2.7) ng·L^-1, H1], oxazepam[(39.5±4.1) ng·L^-1, W2] and clozapine[(30.6±4.0) ng·L^-1, W1] were detected. Ibuprofen[(19014±5430) ng·L^-1, H1] and paracetamol[(2600±570) ng·L^-1, H2] were found to have the highest concentrations for the acidic and neutral pharmaceuticals, respectively. Less than 30% of benzodiazepines were removed in hospital wastewater treatment systems and municipal wastewater treatment plants; however, acidic and neutral pharmaceuticals had higher removal rates. The municipal wastewater treatment plants had greater performance in the removal of acidic and neutral pharmaceuticals (mostly 60%-99%) than the hospital wastewater treatment systems (mostly 10%-60%). Finally, the usage and pollution emissions of 20 typical pharmaceuticals in Guangzhou and Guangdong Province were calculated based on the average emission per person. The total amount of usage in Guangzhou and Guangdong was 3942 kg·a^-1 and 30371 kg·a^-1, respectively. Paracetamol and ibuprofen had the greatest values, as did oxazepam and lorazepam benzodiazepines. The emission rate of these 20 pharmaceuticals in Guangzhou reached 1456 g·a^-1 with concentrations ranging from 3.07 (mefenamic acid) to 378 g·a^-1 (oxazepam).

Biodegradation of typical azole fungicides in activated sludge under aerobic conditions

Widespread use of azole fungicides and low removal efficiency in wastewater treatment plants (WWTPs) have led to the elevated concentration of azole fungicides in receiving environment. However, there was limited research about the removal mechanism of azole fungicides in the biological treatment of WWTPs. Imidazole fungicide climbazole and triazole fungicide fluconazole were selected to investigate the biodegradation mechanism of azole fungicides in activated sludge under aerobic conditions. Climbazole was found to be adsorbed to solid sludge and resulted in quick biodegradation. The degradation of climbazole in the aerobic activated sludge system was fitted well by the first-order kinetic model with a half-life of 5.3 days, while fluconazole tended to stay in liquid and had only about 30% of loss within 77 days incubation. Ten biotransformation products of climbazole were identified by high resolution mass spectrometry using suspect and non-target screening method. But no biodegradation products of fluconazole were identified due to its limited removal. The possible biodegradation pathways for climbazole were proposed based on the products identification and pathway prediction system, and involves oxidative dehalogenation, side chain oxidation and azole ring loss. The findings from this study suggest that it should be a concern for the persistence of fluconazole in the environment.

Highly enhanced biodegradation of pharmaceutical and personal care products in a novel tidal flow constructed wetland with baffle and plants

Research on decentralized wastewaters deserves special focus due to the potential abundance of emerging organic pollutants including pharmaceutical and personal care products (PPCPs), which might pose serious threats to the local water bodies and even to human health. Constructed wetland (CW) is a common decentralized wastewater treatment technology, with a certain ability to eliminate PPCPs. Nonetheless, PPCPs removal in common CWs is frequently challenging, besides, the removal mechanism remains elusive. Based on our previous study, tidal flow constructed wetlands (TFCWs) is effective in nitrogen removal. Here, 3 TFCWs with different modifications (baffle, plants, both baffle and plants) were constructed to treat raw domestic sewage and specifically to evaluate the removal efficiencies and mechanism of PPCPs. 24 PPCPs including 7 antibiotics, 8 steroid hormones and 9 biocides were detected in the level of 1.10 ± 0.29 ng/L-799 ± 10.6 ng/L in the influents. Consequently, we found that modification with both baffle and plants significantly influenced the removal of PPCPs. Moreover, the highest removal rates of biocides (97.1 ± 0.29%), steroid hormones (99.8 ± 0.02%), and antibiotics (90.2 ± 1.60%) were achieved via both baffles and plants in TFCWs. Based on the mass balance analysis, microbial degradation dominated the removal of PPCPs with a percentage higher than 85.7%, followed by substrate adsorption (5.22 × 10^-2-14.3%) and plant uptake (1.66 × 10^-3-0.44%). Further, 16S rDNA sequencing analysis revealed that the presence of baffle and plants improve the removal efficiency of PPCPs by means of enhancing microbial diversity and changing dominant microorganisms. Moreover, Thaumarchaeota was potentially the key microorganism in the phylum level for PPCPs elimination by TFCWs through LEfSe (linear discriminant analysis (LDA) effect size) analysis. These findings provide new insights into the removal of PPCPs in CWs.

Occurrence, fate and mass loading of benzodiazepines and their transformation products in eleven wastewater treatment plants in Guangdong province, China

Benzodiazepines (BZDs) are one of the most widely prescribed psychoactive drugs, however their persistence in the receiving environment has raised great concerns about their potential ecological risks. Here we investigated the occurrence, fate and mass loading of 17 BZDs and their 3 transformation products in 11 wastewater treatment plants (WWTPs) in Guangdong province, China. A total of 10 BZDs and 1 transformation product were found in the WWTPs influents, effluents and excess sludge, with concentrations reaching up to 44.5 ng/L (clozapine), 27.1 ng/L (oxazepam) and 62.9 ng/g (clozapine), respectively. The overall removal efficiency varied widely from negative to complete removal in these 11 WWTPs. Mass balance analysis of two representative WWTPs (WWTP_A and WWTP_B) with different treatment processes showed that their removals were mainly attributed to the sludge adsorption and biodegradation/biotransformation. The total usage of detected BZDs was estimated to be 185 kg/y in Guangdong province, China, while the total emission was 143 kg/y. Based on sewage epidemiology method, the total back-estimated consumption and emissions of BZDs and their transformation products in one district of Guangzhou (WWTP_C service area) were 1012 mg/d/1000 people and 10.1 mg/d/1000 people, respectively. The findings from this study demonstrate the persistence of BZDs in WWTPs and also provide basis for further investigation into the potential ecological risks from this group of chemicals.

Primary intraosseous squamous cell carcinoma arising from an odontogenic keratocyst: case series and literature review

Background

The aim of this study was to investigate the clinicopathologic features of primary intraosseous squamous cell carcinoma arising from an odontogenic keratocyst (PIOSCC ex OKC) and comprehensively improve the understanding of this disease.

Material and Methods

We retrospectively investigated five cases of PIOSCC ex OKC at Peking University School and Hospital of Stomatology. We also conducted a systematic review of studies on PIOSCC ex OKC by using online databases from their inception until February 2020.

Results

In our series of five cases, all lesions were located in the mandible. Three cases (60%) showed recurrent OKCs and two cases (40%) showed primary OKCs. During the follow-up period, one patient died of local relapse. No patients developed metastasis. On the basis of our literature survey, we selected 22 articles reporting 29 patients with PIOSCC ex OKC. Seven of these patients (24.1%) showed local recurrence, three patients (10.3%) developed cervical metastasis, three patients (10.3%) developed distant metastasis (in the pleura in one case and in the lung in two cases), and seven patients died from the disease during the follow-up period. The disease-specific 5-year survival rate in the study group was 53.2%. Through univariate and multivariate analysis, local recurrence was identified as the only significant independent prognostic factor for survival (P < 0.05).

Conclusions

The results suggest that PIOSCC ex OKC is a rare intermediate-grade malignancy. Although elective neck dissection is typically unnecessary, adequate therapy should be applied to achieve the lowest local recurrence rate possible to ensure a favorable survival rate.

Key words:Primary intraosseous squamous cell carcinoma, odontogenic keratocyst, prognosis.

Association of Frailty Status with Risk of Fall among Middle-Aged and Older Adults in China: A Nationally Representative Cohort Study

OBJECTIVES

To investigate the association between frailty status and risk of fall among middle-aged and older Chinese people.

DESIGN

A nationally representative prospective cohort study.

SETTING AND PARTICIPANTS

The study included 13,877 community-dwelling participants aged 45 years and above from the China Health and Retirement Longitudinal Study.

METHODS

Frailty status was identified by the frailty index of health deficit accumulation. 34 variables at baseline were selected to calculate the frailty index. We excluded participants with incomplete information in construction of the frailty index at baseline. Falls were measured based on the respondents' self-report. We used a logistic regression model to estimate the associations between the frailty status and risk of fall, and subgroup analyses and sensitivity analyses were further conducted.

RESULTS

Of 13,877 participants, 2310 (16.6%) had falls during the observation period. 9027 (65.0%) participants were classified as robust, 4019 (29.0%) participants were classified as pre-frail, and 831 (6.0%) participants were classified as frail. Our results indicated per 0.01 increment in the frailty index was significantly associated with an increased risk of fall among middle-aged and older participants (OR: 1.52, 95%CI: 1.45-1.60). Such association was stronger when frailty was presented as a categorical variable, with an OR of 1.75 (95%CI: 1.59-1.93) for pre-frail and 3.04 (95%CI: 2.60-3.56) for frail. The area under the curve of the logistic model was 0.612 (95%CI: 0.600-0.625). Each 0.01 increment of the frailty index was association with a higher risk of fall among middle-aged (45-59years) participants (OR: 1.44, 95%CI: 1.29-1.60) than among older (≥60 years) participants (OR: 1.28, 95%CI: 1.16-1.41) at baseline (p=0.015 for interaction).

CONCLUSION

Frailty was significantly associated with an increased risk of fall among community-dwelling middle-aged and older people in China. It is necessary to screen and recognize frailty status to prevent falls among middle-aged and older adults.

Trace analysis of 28 antibiotics in plant tissues (root, stem, leaf and seed) by optimized QuEChERS pretreatment with UHPLC-MS/MS detection

Phytoremediation has proven to be an effective in-situ treatment technique for antibiotic contamination. Due to the immature methods of extracting multi-antibiotics in different plant tissues, the antibiotic absorption and transportation mechanism in the phytoremediation process has yet to be resolved. Therefore, an improved Quick, Easy, Cheap, Effective, Rugged and Safe (QuEChERS) pretreatment with ultra-high-performance liquid chromatography tandem mass spectrometry (UHPLC-MS/MS) detection method for 28 antibiotics in different plant tissues (root, stem, leaf and seed) was developed in this study. The optimized method showed satisfactory performance with recoveries for most antibiotics ranging from 70% to 130% (except sulfadoxine with 138 ± 8.84% in root, sulfameter with 68.9 ± 1.87% and sulfadoxine with 141 ± 10.0% in seed). The limits of detection (LODs) of the target compounds in root, stem, leaf and seed were 0.04 ± 0.02 ~ 2.50 ± 1.14 ng/g, 0.05 ± 0.02 ~ 1.78 ± 0.42 ng/g, 0.06 ± 0.01 ~ 2.50 ± 0.14 ng/g and 0.13 ± 0.10 ~ 3.64 ± 0.74 ng/g, respectively. This developed method was successfully applied to the determination of antibiotics in different tissues of hydroponic wetland plants exposed to antibiotics-spiked water for one-month. Sixteen of 28 spiked antibiotics were detected in plant tissue samples. Overall, of these 16 antibiotics, all were detected in root samples (from < LOQ to 1478 ± 353 ng/g), eleven in stem samples (from < LOQ to 425 ± 47.0 ng/g), and nine in leaf samples (from < LOQ to 429 ± 84.5 ng/g). This developed analytical method provided a robust tool for the simultaneous screening and determination of antibiotics in different plant tissues.

Distributions of time, place, and population of novel coronavirus disease 2019 (COVID-19) from January 20 to February 10, 2020, in China

Background and objective

Since December 2019, increasing cases of novel coronavirus disease 2019 (COVID-19) are being detected worldwide. The purpose of this paper is to provide a scientific reference for the global prevention and control of COVID-19.

Methods

General demographic characteristics, epidemiological history, and clinical symptoms of COVID-19 were collected that had been reported on the websites of multiple Municipal Health Commissions in China. We herein describe distributions in time, place, and population of COVID-19.

Results

As of midnight on February 10, 2020, the number of confirmed cases of COVID-19 in China was 42,638, and the province with the largest number of confirmed cases was Hubei (31,728), followed by Guangdong (1177), Zhejiang (1117), and Henan (1105) province. The number of cases and the speed of confirmed cases in provinces other than Hubei were more moderate than those of the Hubei province. The median (interquartile range) age of 1740 patients with COVID-19 was 44 (33, 54) years, with a range of 10 months to 89 years.

Conclusions

The COVID-19 epidemic should be considered a global threat and the steps for control include early diagnosis and treatment, as well as isolation.

[Distributions of time, place, and population of novel coronavirus disease 2019 (COVID-19) from January 20 to February 10, 2020, in China]

Background and objective

Since December 2019, increasing cases of novel coronavirus disease 2019 (COVID-19) are being detected worldwide. The purpose of this paper is to provide a scientific reference for the global prevention and control of COVID-19.

Methods

General demographic characteristics, epidemiological history, and clinical symptoms of COVID-19 were collected that had been reported on the websites of multiple Municipal Health Commissions in China. We herein describe distributions in time, place, and population of COVID-19.

Results

As of midnight on February 10, 2020, the number of confirmed cases of COVID-19 in China was 42,638, and the province with the largest number of confirmed cases was Hubei (31728), followed by Guangdong (1177), Zhejiang (1117), and Henan (1105) province. The number of cases and the speed of confirmed cases in provinces other than Hubei were more moderate than those of the Hubei province. The median (interquartile range) age of patients with COVID-19 was 44 (33, 54) years, with a range of 10 months to 89 years.

Conclusions

The COVID-19 epidemic should be considered a global threat and the steps for control include early diagnosis and treatment, as well as isolation.

[Establishment of clinical features and prognostic scoring model in early-stage hepatitis B-related acute-on-chronic liver failure]

Objective: To explore the clinical characteristics and establish a corresponding prognostic scoring model in patients with early-stage clinical features of hepatitis B-induced acute-on-chronic liver failure (HBV-ACLF). Methods: Clinical characteristics of 725 cases with hepatitis B-related acute-on-chronic hepatic dysfunction (HBV-ACHD) were retrospectively analyzed using Chinese group on the study of severe hepatitis B (COSSH). The independent risk factors associated with 90-day prognosis to establish a prognostic scoring model was analyzed by multivariate Cox regression, and was validated by 500 internal and 390 external HBV-ACHD patients. Results: Among 725 cases with HBV-ACHD, 76.8% were male, 96.8% had cirrhosis base,66.5% had complications of ascites, 4.1% had coagulation failure in respect to organ failure, and 9.2% had 90-day mortality rate. Multivariate Cox regression analysis showed that TBil, WBC and ALP were the best predictors of 90-day mortality rate in HBV-ACHD patients. The established scoring model was COSS-HACHADs = 0.75 × ln(WBC) + 0.57 × ln(TBil)-0.94 × ln(ALP) +10. The area under the receiver operating characteristic curve (AUROC) of subjects was significantly higher than MELD, MELD-Na, CTP and CLIF-C ADs(P < 0.05). An analysis of 500 and 390 cases of internal random selection group and external group had similar verified results. Conclusion: HBV-ACHD patients are a group of people with decompensated cirrhosis combined with small number of organ failure, and the 90-day mortality rate is 9.2%. COSSH-ACHDs have a higher predictive effect on HBV-ACHD patients' 90-day prognosis, and thus provide evidence-based medicine for early clinical diagnosis and treatment.

Size-dependent influence of NOx on the growth rates of organic aerosol particles

Atmospheric new-particle formation (NPF) affects climate by contributing to a large fraction of the cloud condensation nuclei (CCN). Highly oxygenated organic molecules (HOMs) drive the early particle growth and therefore substantially influence the survival of newly formed particles to CCN. Nitrogen oxide (NOx) is known to suppress the NPF driven by HOMs, but the underlying mechanism remains largely unclear. Here, we examine the response of particle growth to the changes of HOM formation caused by NOx. We show that NOx suppresses particle growth in general, but the suppression is rather nonuniform and size dependent, which can be quantitatively explained by the shifted HOM volatility after adding NOx. By illustrating how NOx affects the early growth of new particles, a critical step of CCN formation, our results help provide a refined assessment of the potential climatic effects caused by the diverse changes of NOx level in forest regions around the globe.

Biophysical and microstructural changes of swelling cornea caused by endothelial cells damage

Biophysical properties and microstructural changes of swelling cornea which caused by endothelial cells damage will be evaluated. Swelling cornea models were established by endothelial cells damage in 114 Sprague Dawley rats. Relative gray value, swelling rate and light transmittance were measured to evaluated the biophysical properties and microstructure changes were observed by transmission electron microscopy. Relative gray value decreased while swelling rate rose along with time and both of them reached relative stability after 7 days. Light transmittance showed a decline trend with time even after corneal thickness had reached stable stage. Observed by transmission electron microscopy, interfibrillar distance increased, fewer proteoglycans coating appeared and remnants proteoglycan branches became thinner and longer in 7 days. Diameter of fibrils didn't change obviously with time. In cornea edema models caused by endothelial cells damage, the changes of biophysical property and microstructure can help us evaluate corneal edema accurately and objectively.

Hybrid capture-based genomic profiling of circulating tumor DNA from patients with estrogen receptor-positive metastatic breast cancer

BACKGROUND

Genomic changes that occur in breast cancer during the course of disease have been informed by sequencing of primary and metastatic tumor tissue. For patients with relapsed and metastatic disease, evolution of the breast cancer genome highlights the importance of using a recent sample for genomic profiling to guide clinical decision-making. Obtaining a metastatic tissue biopsy can be challenging, and analysis of circulating tumor DNA (ctDNA) from blood may provide a minimally invasive alternative.

PATIENTS AND METHODS

Hybrid capture-based genomic profiling was carried out on ctDNA from 254 female patients with estrogen receptor-positive breast cancer. Peripheral blood samples were submitted by clinicians in the course of routine clinical care between May 2016 and March 2017. Sequencing of 62 genes was carried out to a median unique coverage depth of 7503×. Genomic alterations (GAs) in ctDNA were evaluated and compared with matched tissue samples and genomic datasets of tissue from breast cancer.

RESULTS

At least 1 GA was reported in 78% of samples. Frequently altered genes were TP53 (38%), ESR1 (31%) and PIK3CA (31%). Temporally matched ctDNA and tissue samples were available for 14 patients; 89% of mutations detected in tissue were also detected in ctDNA. Diverse ESR1 GAs including mutation, rearrangement and amplification, were observed. Multiple concurrent ESR1 GAs were observed in 40% of ESR1-altered cases, suggesting polyclonal origin; ESR1 compound mutations were also observed in two cases. ESR1-altered cases harbored co-occurring GAs in PIK3CA (35%), FGFR1 (16%), ERBB2 (8%), BRCA1/2 (5%), and AKT1 (4%).

CONCLUSIONS

GAs relevant to relapsed/metastatic breast cancer management were identified, including diverse ESR1 GAs. Genomic profiling of ctDNA demonstrated sensitive detection of mutations found in tissue. Detection of amplifications was associated with ctDNA fraction. Genomic profiling of ctDNA may provide a complementary and possibly alternative approach to tissue-based genomic testing for patients with estrogen receptor-positive metastatic breast cancer.

Xuezhikang reduced arterial stiffness in patients with essential hypertension: a preliminary study

This study aimed to test the effects of xuezhikang, a cholestin extract that contains statin-like components, on arterial stiffness in patients with essential hypertension. One hundred hypertensive patients from the Chinese PLA General Hospital were randomly allocated to receive xuezhikang (1200 mg/day, orally) or placebo (same capsules containing only pharmaceutical excipients). Physical examination outcomes, lipid profile, high sensitivity C-reactive protein (hs-CRP) levels, matrix metalloproteinases-9 (MMP-9) levels, and arterial outcomes, including stiffness parameter (β), pressure-strain elasticity modulus (Ep), arterial compliance (AC), augmentation index (AI), and one-point pulse wave velocity (PWVβ) were obtained at baseline and after 6 months of the intervention. Xuezhikang significantly reduced β (8.4±3.1 vs 6.8±2.1, P=0.007), Ep (122.8±43.9 vs 100.7±33.2, P=0.009), PWVβ (6.7±1.2 vs 6.1±1.0, P=0.013), low-density lipoprotein cholesterol (3.4±0.6 vs 2.9±0.5, P=0.001), hs-CRP [2.1 (0.4-10.0) vs 1.4 (0.3-4.1), P=0.020], and MMP-9 (17.2±2.4 vs 12.7±3.8, P <0.001) compared to baseline. The placebo had no effect on these parameters. The changes of PWVβ in the xuezhikang group was significantly associated with the changes of hs-CRP and MMP-9 (r=0.144, P=0.043; r=0.278, P=0.030, respectively) but not with lipid profile changes. Our research showed xuezhikang can improve the parameters of arterial stiffness in hypertensive patients, and its effect was independent of lipid lowering.

Direct loop gain and bandwidth measurement of phase-locked loop

A simple and robust technique for directly measuring the loop gain and bandwidth of a phase-locked loop (PLL) is proposed. This technique can be used for the real-time measurement of the real loop gain in a closed PLL without breaking its locking state. The agreement of the measured loop gain and theoretical calculations proves the validity of the proposed measurement technique. This technique with a simple configuration can be easily expanded to other phase-locking systems whose loop gain and bandwidth should be measured precisely.

L-Tetrahydropalmatine Induces Apoptosis in EU-4 Leukemia Cells by Down-Regulating X-Linked Inhibitor of Apoptosis Protein and Increases the Sensitivity Towards Doxorubicin

BACKGROUND

L-Tetrahydropalmatine (L-THP) is a tetra-hydro protoberberine isoquinoline alkaloid. The phyto-compounds bearing isoquinoline alkaloids have been reported to show a potential effect against a number of human cancers cell lines including leukemia. We hypothesized that L-THP, being an isoquinoline alkaloid, could be a potential molecule against acute lymphoblastic leukemia (ALL), in this study, we evaluate L-THP against p53 deficient leukemia EU-4 cell lines in vitro.

METHODS

For the study, p53 null leukemia EU-4 cells were used and treated with LTHP. The extent of apoptosis and viability of cells were determined. Expression of apoptosis related proteins such as XIAP and MDM2 was done by western blot and PCR studies. The expression of MDM2 and XIAP was knocked down by small interfering RNA (siRNA).

RESULTS

Outcomes of the study suggested that L-THP caused p53-indipendent apoptosis mediated by XIAP in EU-4 cells. The treatment of L-THP caused a decrease in the levels of XIAP protein with increasing dose and time. L-THP caused down-regulation of XIAP protein via inhibiting the expression of MDM2 and involving proteasomedependent pathway. Also, the outcomes of experiments suggested increased sensitivity of leukemia cells towards doxorubicin due to the inhibition of XIAP by L-THP or by siRNA.

CONCLUSION

Findings of the study confirm that L-THP resulted in p53 independent apoptosis via down-regulating XIAP protein by inhibiting MDM2 associated with proteasome-dependent pathway and increased sensitivity of EU-4 cells against doxorubicin. L-THP caused activation of caspase and resulted in apoptosis, L-THP may be a novel molecule for inducing apoptosis specifically in p53 null leukemia EU-4 cells.

[Status of cholesterol goal attainment for the primary and secondary prevention of atherosclerotic cardiovascular disease in dyslipidemia patients receiving lipid-lowering therapy: DYSIS-China subgroup analysis]

OBJECTIVE

To analyze the current status of cholesterol goal attainment for the primary and secondary prevention of cardiovascular disease in dyslipidemia patients using data from the DYSIS-China study.

METHODS

Based on criteria defined in the 2014 China Cholesterol Education Program (CCEP) and the 2007 Chinese guidelines for the prevention and treatment of dyslipidemia in adults, 25 317 dyslipidemia patients enrolled in the DYSIS-China study (from March 2012 to October 2012) were stratified to the atherosclerotic cardiovascular disease(ASCVD) primary prevention and secondary prevention groups. The total cholesterol (TC) target goals were <3.11, 4.14, 5.18, and 6.22 mmol/L, respectively, and the low-density lipoprotein cholesterol (LDL-C) therapeutic goals were less than 1.8, 2.6, 3.4, and 4.1 mmol/L, respectively, for the very high-risk, high-risk, moderate-risk, and low-risk patients in the primary prevention group. The TC targets for the very high-risk and high-risk patients were <3.11 and <4.14 mmol/L, respectively, and the LDL-C targets were <1.8 and <2.6 mmol/L, respectively, in the secondary prevention group. The TC and LDL-C goal attainment rates were calculated for the different risk groups according to the targets values.

RESULTS

Totally, 71.09% (n=18 000) of the dyslipidemia patients were grouped into very high and high risk groups, 51.76% (n=13 104) and 48.24% (n=12 213) patients were stratified to primary and secondary prevention of ASCVD. The LDL-C and TC goal attainment rates for the secondary prevention group were 33.09%(4 041 cases) and 21.05% (2 571 cases), respectively. The LDL-C and TC goal attainment rates for the primary prevention group were 52.40% (6 866 cases) and 42.06% (5 511 cases), respectively. Multivariate logistic regression analysis showed that diabetes mellitus(OR=5.75, 4.15, P<0.05), coronary heart disease(OR=5.70, 3.58, P<0.001), and peripheral arterial disease(OR=2.42, 1.49, P<0.05) were risk factors for failure to achieve TC and LDL-C goals, respectively.

CONCLUSIONS

Despite the widespread application of the 2014 CCEP and 2007 Chinese dyslipidemia guidelines, LDL-C goal attainment among secondary and primary prevention patients remains suboptimal in China. More rigorous guideline adherence is therefore required to increase the LDL-C and TC goal attainment rates and improve the long-term cardiovascular outcomes in Chinese dyslipidemia patients.

The predictive value of baseline LDL-TG level on major adverse cardiovascular events in a followed up cohort population

OBJECTIVE

We aimed at identifying the predictive roles of Low-Density Lipoprotein Triglycerides (LDL-TG) for major adverse cardiovascular events (MACEs).

PATIENTS AND METHODS

A longitudinal study in a routine health check-up population was performed with an average follow-up of 4.8 years. The participants involved in this study were 1680, from 2007 to 2009, and all had followed-up for all-cause mortality, cardiovascular disease mortality, and the development of MACEs. The demographic information and anthropometric parameters at baseline were recorded. The baseline and follow-up conventional lipid parameters were measured. We also examined the level LDL-TG, as well as the relationship between its level and MACEs.

RESULTS

MACEs individuals were characterized by statistically higher baseline LDL-TG (17.22 ± 8.05 vs. 16.39 ±7.35 nmol/l, p = 0.017). The univariate regression for MACEs group indicated that the LDL-TG (b = 0.813, HR = 2.254, 95% CI: 1.454-3.494, p < 0.001), older age, sex and other factors were a significant risk for MACEs. Furthermore, in the adjusted Cox model showed that only higher baseline LDL-TG (b =0.512, HR = 1.669, 95% CI: 1.013-2.748, p = 0.044) and older age (b = 0.062, HR = 1.064, 95% CI: 1.034-1.094, p < 0.001, Table IV) were still predictors for MACEs.

CONCLUSIONS

Higher baseline LDL-TG closely associated with MACEs and it is a moderate and independent predictive factor for MACEs.

Measurement of sulfur L2,3 and carbon K edge XANES in a polythiophene film using a high harmonic supercontinuum

We use a high harmonic generated supercontinuum in the soft X-ray region to measure X-ray absorption near edge structure (XANES) spectra in polythiophene (poly(3-hexylthiophene)) films at multiple absorption edges. A few-cycle carrier-envelope phase-stable laser pulse centered at 1800 nm was used to generate a stable soft X-ray supercontinuum, with amplitude gating limiting the generated pulse duration to a single optical half-cycle. We report a quantitative transmission measurement of the sulfur L_2,3 edge over the range 160-200 eV and the carbon K edge from 280 to 330 eV. These spectra show all the features previously reported in the XANES spectra of polythiophene, but for the first time they are measured with a source that has an approximately 1 fs pulse duration. This study opens the door to measurements that can fully time-resolve the photoexcited electronic dynamics in these systems.

Comparison of the efficacy of different treatment modalities for Kimura's disease

The objective of this study was to investigate the clinical features of Kimura's disease in the head and neck region and to compare the local recurrence rate between three therapies used for the treatment of this disease. The clinicopathological information of 46 hospitalized patients suffering from Kimura's disease in the head and neck region over a 10-year period was reviewed retrospectively. All lesions were clinically observed in the head and neck region. These 46 patients underwent a total of 58 treatments; nine patients underwent multiple treatments due to local recurrence. Of the 58 treatments, 32 involved surgical excision alone, 24 involved surgical excision and postoperative low-dose radiotherapy (20-40Gy), one was a combination of ultrasound-guided core needle biopsy and radiotherapy, and one was a combination of incisional biopsy and subsequent radiotherapy. During the follow-up period, nine patients suffered 16 local recurrences. The recurrence rate of surgical excision combined with low-dose radiotherapy was much lower than that of surgical excision alone or radiotherapy alone (both P<0.05). It is concluded that Kimura's disease is a benign condition with a good prognosis, and surgical excision combined with postoperative low-dose radiotherapy is associated with the lowest local recurrence rate in the treatment of this disease.