Application of supraclavicular fasciocutaneous island flap for reconstruction after removal of tumors in parotid and auricle area / 中华耳鼻咽喉头颈外科杂志

Objective: To evaluate the efficacy of supraclavicular fasciocutaneous island flap (SIF) for repairing the defect of parotid or auricle regions after tumor resection. Methods: From February 2019 to June 2021, 12 patients (11 males and 1 female, aged 54-77 years old), of whom 4 with parotid adenoid cystic carcinoma and 8 with auricular basal cell carcinoma underwent reconstruction surgery for postoperative defects in the parotid gland area and auricular area with SIF in the Department of Otorhinolaryngology Head and Neck Surgery, the Second Xiangya Hospital of Central South University and their clinical data were retrospectively analyzed. Size of the SIF, time for harvesting SIF, neck lymph node dissection and postoperative complications were recorded. Results: The flap areas were (6-9) cm × (8-13) cm, and the harvesting time for SIF ranged from 40 to 80 min, averaging 51.7 min. The donor sites were directly closed. All patients underwent ipsilateral levels Ⅰ-Ⅲ neck dissection, with 4 cases undergoing additional level Ⅳ neck dissection and 2 cases undergoing level Ⅳ-Ⅴ neck dissection. Of the 12 SIF, 10 were completely survival and 2 had flap arterial crisis with partial flap necrosis, in addition, 1 had donor site wound dehiscence. With follow-up of 10-42 months, there were no tumor recurrences in 10 patients, 1 patient was lost to follow-up at 10 months postoperatively, and 1 patient experienced local tumor recurrence at 11 months after surgery and died 15 months later. Conclusion: SIF is an easily harvested flap with good skin features matching the skin in parotid and auricle regions and less damage to donor site, and this flap has no need for microvascular anastomosis technique. SIF is feasible and effective for repairing defects in parotid and auricle area.

Effects of extracts from Arnebia euchroma (Royle) Johnst on apoptosis of HepG2 and its anti-hepatocellular carcinoma in mice / 中国药理学通报

Aim To study the apoptosis of human hep-atoma cell line ( HepG2 ) induced by different polar parts of Arnebia euchroma ( Royle ) Johnst ( AE ) and to verify its anti-hepatoma effect by a mouse orthotopic liver cancer model so as to explore the anti-cancer effect of AE extract. Methods Firstly, MTT method and Annexin V-FITC/PI double staining method were used to detect the anti-proliferative and pro-apoptotic effects of each polar part of AE on HepG2 cells, and Western blot was used to detect the expression of Bcl-2 apoptosis family proteins incells. Based on the above experimental results, the effective parts with significant pro-apoptotic effect were screened out for anti-in situ liver cancer experiments in mice, and the organ indexes, liver function indexes and tissue sections of mice with orthotopic liver cancer before and after administration were evaluated. Results With the decrease of the polarity of AE extract,the anti-proliferation and pro-apoptotic effects on HepG2 cells were enhanced, and the anti-proliferation and apoptosis-inducing effects of AE petroleum ether fraction ( AEP) were the most significant. When AEP dose was 1.56 (μg • L

Epididymis cell atlas in a patient with a sex development disorder and a novel NR5A1 gene mutation / 亚洲男科学杂志(英文版)

This study aims to characterize the cell atlas of the epididymis derived from a 46,XY disorders of sex development (DSD) patient with a novel heterozygous mutation of the nuclear receptor subfamily 5 group A member 1 (NR5A1) gene. Next-generation sequencing found a heterozygous c.124C>G mutation in NR5A1 that resulted in a p.Q42E missense mutation in the conserved DNA-binding domain of NR5A1. The patient demonstrated feminization of external genitalia and Tanner stage 1 breast development. The surgical procedure revealed a morphologically normal epididymis and vas deferens but a dysplastic testis. Microfluidic-based single-cell RNA sequencing (scRNA-seq) analysis found that the fibroblast cells were significantly increased (approximately 46.5%), whereas the number of main epididymal epithelial cells (approximately 9.2%), such as principal cells and basal cells, was dramatically decreased. Bioinformatics analysis of cell-cell communications and gene regulatory networks at the single-cell level inferred that epididymal epithelial cell loss and fibroblast occupation are associated with the epithelial-to-mesenchymal transition (EMT) process. The present study provides a cell atlas of the epididymis of a patient with 46,XY DSD and serves as an important resource for understanding the pathophysiology of DSD.

Efficacy and survival outcomes of dose-dense carboplatin plus paclitaxel as neoadjuvant chemotherapy for triple-negative breast cancer / 中华肿瘤杂志

Objective: To evaluate the efficacy and survival outcomes of dose-dense (biweekly) carboplatin plus paclitaxel (PC) as neoadjuvant chemotherapy (NAC) in triple-negative breast cancer (TNBC), and to explore an optimal neoadjuvant chemotherapy regimen for TNBC. Methods: Patients diagnosed as TNBC(cT1-4N0-3M0) in Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College Between January 2008 and September 2018 who received dose-dense PC and standard 3-weekly PC as NAC were 1∶1 matched using propensity score matching (PSM) to compare the efficacy, safety and survival outcomes. Results: One hundred of TNBC patients were enrolled (50 patients were divided in dose-dense group, 50 patients in standard group). The objective response rate (ORR) of dose-dense group and standard group were both 90.0% (45/50). The grade 3-4 neutropenia in dose-dense group was less than that of standard group (32.7% vs. 68.0%, P=0.001), while the rate of ALT/AST elevation in dose-dense group was higher than that of standard group (57.1% vs. 32.0%, P=0.012). The pathological complete response (pCR) rates were 34.0% (17/50) in dose-dense group and 38.0% (19/50) in standard group, without statistically significance (P=0.677). The median follow-up time was 55 months (3-150 months). The 5-year recurrence-free survival (RFS) in dose-dense group and standard group were 83.5% and 75.2%, respectively the 5-year overall survival (OS) in dose-dense and standard group were 87.9% and 84.5% the difference were not statistically significant (P=0.322 and 0.647, respectively). Patients with residual disease (tumor size≥1 cm or lymph node positive) had poor prognosis, the 5-year RFS and OS were 59.3% and 68.5%, respectively. Conclusions: Dose-dense PC has similar efficacy with standard 3-weekly PC and has a good safety profile. Since dose-dense regimen can shorten the duration of therapy, it can be an alternative in TNBC.

Evaluation of the diagnostic efficiency of three anti-Echinococcus antibody-based assays for the serodiagnosis of echinococcosis / 中国血吸虫病防治杂志

ObjectiveTo evaluate the efficiency of three Chinese commercial anti-Echinococcus antibody-based assays for the serodiagnosis of echinococcosis. MethodsA total of 142 sera from cystic echinococcosis patients, 89 sera from alveolar echinococcosis and 39 sera from healthy controls were sampled, and detected by kits A (ELISA), B (ELISA) and C (colloidal gold immunoassay). The routine blood testing results and biochemical parameters were compared between the cystic and alveolar echinococcosis patients, and the associations of the absorbance (A value) of the serum specific antibody detected by A and B kits with the routine blood testing results and biochemical parameters were examined in echinococcosis patients. In addition, the performance of these three assays for the serodiagnosis of echinococcosis was evaluated. Results There were no significant differences between the cystic and alveolar echinococcosis patients in terms of the median white blood cell count (WBC), neutrophil count (NEU), monocyte count (MONO), basophil count (BASO), alanine aminotransferase concentration (ALT), aspirate aminotransferase concentration (AST), total bilirubin (TBIL), direct bilirubin (DBIL), indirect bilirubin (IBIL) (all P values > 0.05), and higher median lymphocyte count (LYM) and albumin levels (ALB) were detected in cystic echinococcosis patients than in alveolar echinococcosis patients (both P values < 0.05), while the median eosinophil count (EOS) was greater in the alveolar echinococcosis patients than in the cystic echinococcosis patients (P < 0.01). The A value of the serum specific antibody detected by kit A showed a linear positive correlation with WBC (rs = 0.153, P < 0.05) and EOS (rs = 0.174, P < 0.05), and a linear negative correlation with TBIL (rs = -0.134, P < 0.05) and IBIL (rs = -0.146, P < 0.05), while the A value of the serum specific antibody detected by kit B showed a linear positive correlation with WBC (rs = 0.257, P < 0.01), NEU (rs = 0.203, P < 0.01), MONO (rs = 0.159, P < 0.05), EOS (rs = 0.330, P < 0.01), ALT (rs = 0.171, P < 0.01) and AST (rs = 0.160, P < 0.05), and a linear negative correlation with ALB (rs = -0.168, P < 0.05). The overall coincidence rate, sensitivity, specificity, Youden’s index and Kappa value of A, B and C kits were 86.30%, 69.63% and 91.48%; 84.42%, 64.94% and 92.21%; 97.44%, 97.44% and 87.18%; 0.82, 0.62 and 0.79; and 0.600, 0.337 and 0.750 for the diagnosis of echinococcosis, respectively. The overall coincidence rate, sensitivity, specificity and Youden’s index of A, B and C kits were 84.54%, 64.64% and 71.82%; 80.99%, 55.63% and 68.31%; 97.44%, 97.44% and 87.18%; and 0.78, 0.53 and 0.56 for the diagnosis of cystic echinococcosis, respectively, while the overall coincidence rate, sensitivity, specificity and Youden’s index of A, B and C kits were 92.19%, 85.16% and 85.16%; 89.89%, 79.78% and 84.27%; 97.44%, 97.44% and 87.18%; and 0.87, 0.77 and 0.72 for the diagnosis of alveolar echinococcosis, respectively. The C kit showed cross-reactions in the serodiagnosis of cystic echinococcosis and alveolar echinococcosis. There were no significant difference in the area under the receiver operating characteristic curve (ROC) between A and B kits for the diagnosis of echinococcosis (0.970 vs. 0.948, Z = 1.618, P > 0.05), and there was a high agreement between A and B kits in the diagnosis of echinococcosis (Kappa = 0.585, P < 0.01). Conclusions The three commercial anti-Echinococcus antibody-based kits exhibit a higher serodiagnostic efficiency for alveolar echinococcosis than for cystic echinococcosis. The A kit shows a high sensitivity and specificity for the diagnosis of echinococcosis, and has a relatively stable diagnostic performance and fewer influencing factors, which is suitable for the pre-surgical preliminary diagnosis and post-surgical follow-up monitoring of serum anti-Echinococcus antibody, while the C kit shows a high sensitivity and specificity for the diagnosis of echinococcosis, and is easy to perform and high in reporting rate, which is feasible for initial screening of echinococcosis.

Multidisciplinary team model for patients with oral cancer and systemic diseases: an expert consensus / 华西口腔医学杂志

Large general hospitals currently play an increasingly important role in the diagnosis and treatment for acute critical patients and difficult diseases because of the development of dual referral system and hierarchical diagnosis, as well as the formation of medical treatment alliance. Patients with oral cancers are often associated with systemic diseases, which increases the complexity of the condition. Thus, meeting the demand through the traditional single medical model is difficult. As such, a multidisciplinary team (MDT) model has been proposed and has achieved a good clinical effect. To standardize the application of this model, we organized an event in which relevant experts discussed and formulated a consensus to provide standardized suggestions on the MDT process and the diagnosis and treatment of common systemic diseases as reference for clinical practice.

Measurement of the weight and volume of submandibular gland in vitro / 北京大学学报(医学版)

OBJECTIVE@#To measure the weight and volume of normal submandibular gland by in vitro detection of glandular body, to compare with the measurement values of CT volume rendering to evaluate the consistency of the two methods, and to explore the related factors affecting the weight and volume of the submandibular gland.@*METHODS@#The patients who underwent neck dissection due to oral cancer and were confirmed with normal submandibular gland by postoperative histopathology in Peking University School and Hospital of Stomatology from May 2019 to January 2020 were collected in this study and divi-ded into 4 groups according to the age standards raised by the Society of Geriatrics Chinese Medical Association and WHO (2000) age standards. The submandibular gland was carefully dissected along with the capsule immediately after neck dissection. The weight and volume of submandibular gland were accurately measured by an integrated aseptic measuring device. The volume of submandibular gland was measured by CT volume rendering before operation and the consistency of the two methods was evaluated. The 95% confidence interval of the weight and volume of submandibular gland in the different groups of Chinese people, which were divided by gender and age, were calculated, and the correlation with age, gender, height, weight, body mass index (BMI) and other factors was analyzed.@*RESULTS@#The weight and vo-lume of submandibular gland were measured in 220 subjects. The average weight and volume of submandibular gland were (11.69±2.45) g and (11.55±2.41) cm3 respectively. The volume of submandibular gland measured by CT volume rendering ranged from 70% to 82% of that measured by in vitro detection of glandular body, and the correlation coefficient between the two methods was 0.976 (P < 0.05). The gender difference of weight and volume of submandibular gland existed in the groups of youth, middle-aged, young elderly and elderly groups, the values of males were obviously higher than those of females (P < 0.05). There was no gender difference of weight and volume of submandibular gland in the adolescent group (P > 0.05). The weight and volume of submandibular gland had a strong positive correlation with body height (P < 0.05), a weak positive correlation with body weight (P < 0.05), and no correlation with BMI (P > 0.05). The female's weight and volume of submandibular gland in the young elderly and elderly groups were significantly lower than those in the other three groups (P < 0.05).@*CONCLUSION@#The normal reference range of the weight and volume of submandibular gland in vitro were established in different age and gender groups of Chinese people. The volume of submandibular gland mea-sured by CT volume rendering was 70%-82% of that measured by in vitro detection of glandular body. The results of the two methods had a high degree of consistency. The weight and volume of submandibular gland were related to age, gender, body height and body weight.

Postoperative position change of fibular bone after reconstruction of maxillary defect using free fibular flap / 北京大学学报(医学版)

OBJECTIVE@#To investigate the position change of the fibular bone after maxillary reconstruction by free fibular flap and to analyze the factors affecting the position change.@*METHODS@#Patients who underwent maxillary reconstruction by free fibular flap in the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from November 2012 to November 2016 were enrolled in this study. CT scans 1 week and 1 year postoperatively were collected and stored in DICOM format. The ProPlan CMF software was used to reconstruct the CT scans and separate the maxilla and each segment of the fibular flap. The Geomagic Control software was used to measure the long axis direction vector of each fibular segment. And the position change direction was recorded. The patients were divided into groups according to the use of the fibula or titanium plate to reconstruct the zygomaticmaxillary buttress.@*RESULTS@#A total of 32 patients were enrolled. Among them, 21 were in the titanium plate group and 11 in the fibula bone group. The angle between the long axis of the fibular segment and the X axis in the X-Y plane was 95.65°±53.49° and 95.53°±52.77°, 1 week and 1 year postoperatively, and there was no statistical difference (P>0.05). The angle between the long axis of the fibular segment and the X axis in the X-Z plane was 96.88°±69.76° and 95.33°±67.42°, respectively, with statistical difference (P=0.0497). The angular changes of the long axis of the fibular segment in the titanium plate group and the fibular bone group were 3.23°±3.93° and 1.94°±1.78°, respectively, and the angular changes in the X-Z plane were 6.02°±9.89° and 3.27°±2.31°, respectively. There was no significant difference between the groups (P>0.05). The long axis changes of the fibular segment in the X-Y plane for reconstruction of the anterior alveolar, posterior alveolar, and buttress were 3.13°±3.78°, 2.56°±3.17°, and 5.51°±4.39°, respectively. There was a statistical difference (P = 0.023) between the posterior and buttress. In the X-Z plane, theses were 4.94°±4.75°, 5.26°±10.25°, 6.69°±6.52°, respectively. There was no statistical difference among the three groups (P>0.05). The main positional deviation directions of the titanium plate group and the fibular bone group were interior and superior sides, and there was no statistical difference between the two groups (P>0.05).@*CONCLUSION@#One year postoperatively, the position of the free fibular flap was changed compared with 1 week postoperatively. The position of the free fibular flap was mainly changed to the interior and superior sides.

Dosimetric study of cardioulmonary volume dose of internal mammary node irradiation under inverse-planned intensity-modulated radiation therapy / 中华放射肿瘤学杂志

Objective:To explore whether internal mammary node irradiation (IMNI) can control the normal tissue volume dose within a reasonable range under inverse-planned intensity-modulated radiation therapy (IP-IMRT).Methods:The patients with breast cancer received postmastectomy combined with radiotherapy from January 2015 to July 2016 in Department of Radiation Oncology in Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine were retrospectively screened and sampled. The prescription dose was 50 Gy/25 times. The whole heart and ipsilateral lung were outlined on CT scan, and the dose-volume histogram parameters were quantified in the RT planning system (ADAC Pinnacle).Results:For the left breast cancer patients ( n=67) who received IMNI, the total heart dose-volume histogram parameters in 2016 were significantly decreased compared with those in 2015. The D mean in 2015 was (976.65±411.16) cGy, significantly larger than (687.47±134.65) cGy in 2016( P=0.008). Among the same sampled population, the percentage of whole heart D mean at the doses of 12 Gy, 10 Gy, 8 Gy was 33.3%, 33.3%, and 66.7% in 2015, and 0%, 3.8%, and 11.5% in 2016, respectively. For the right breast cancer patients ( n=65) , D mean, V 2Gy, V 10Gy, V 15Gy and V 20Gy of the heart in the IMNI group were significantly higher than those in the non-IMNI group in 2016(all P<0.05). For the ipsilateral lung, D mean, V 10Gy, V 20Gy, and V 30Gy in the IMNI group were remarkably higher than those in the non-IMNI group (all P<0.05). Conclusions:IMNⅡs found to be associated with increased cardiopulmonary dose volume with IP-IMRT technique. Nevertheless, with the practical experience of IMRT and the increasing awareness of cardiac dose limitation, it is feasible to control the cardiac dose increment within a limited range.

Role and mechanism of muscarinic acetylcholine receptor in the regulation of submandibular gland secretion / 北京大学学报(医学版)

Muscarinic acetylcholine receptors (mAChRs), including M1-M5 subtypes, are classic receptors in regulating water, ion, and solute transport in salivary gland. Our work focuses on the studies on the expression pattern and function of mAChR in the submandibular gland (SMG), and the underlying mechanism involved in the mAChR-regulated secretion, together with the effect of parasympathectomy on the salivary secretion. Microvascular autotransplantation of SMG into the temporal fossa provides a continuous and endogenous source of fluids, and is currently an effective method for treating severe keratoconjunctivitis sicca. By using RT-PCR, Western blotting, and immunofluorescence, our data demonstrated that the expression of M1 and M3 subtypes were decreased in latent period in rabbit SMG autotransplantation model, whereas carbachol stimulation promoted the salivary secretion, as well as M1 and M3 expressions. By contrast, mAChRs were hypersensitive in epiphora SMGs, whereas atropine gel and botulinum toxin A application significantly inhibited the hypersecretion in both animal models and patients. Furthermore, the possible intracellular signal molecules involved in the mAChR-modulated salivary secretion were explored. Activation of mAChR upregulated the expression of aquaporin 5 (AQP5), the main transporter that mediated water secretion through transcellular pathway, and led to AQP5 trafficking from lipid rafts to non-lipid microdomain. Extracellular signal-regulated kinase 1/2 (ERK1/2) was involved in the mAChR-regulated AQP5 content. mAChR activation also modulated the expression, distribution, and function of tight junction proteins, and increased paracellular permeability. ERK1/2/β-arrestin2/clathrin/ubiquitin signaling pathway was responsible for the mAChR-regulated downregulation of tight junction molecule claudin-4. Cytoskeleton filamentous actin (F-actin) was also involved in the distribution and barrier function of epithelial tight junctions. Besides, endothelial tight junctions were opened by mAChR agonist-evoked salivation in the mice. Furthermore, parasympathetic denervation increased resting salivary secretion in the long terminrats and minipigs. Taken together, our work demonstrated that mAChR regulated saliva secretion via transcellular and paracellular pathways in SMG epithelium as well as tight junction opening in SMG endothelium. Modulation of mAChR might be a promising strategy to ameliorate SMG dysfunction.

Significance of increased IL-17-producing Foxp3+ Treg in peripheral blood of patients with active systemic lupus erythematosus / 中华微生物学和免疫学杂志

Objective To investigate the expression of IL-17-producing regulatory T cells ( Treg) in patients with systemic lupus erythematosus ( SLE) and to analyze their clinical significance. Methods This study recruited 32 patients with SLE ( including 14 with active SLE and 18 with inactive SLE) and 13 healthy subjects matched for age and sex. Flow cytometry was performed to detect the expression of Foxp3 and IL-17 in CD4 T lymphocytes and the phenotypic characteristics of IL-17-producing Treg. Correlations between these cells and clinical indicators of SLE were analyzed. Peripheral CD4+CD25+ T cells were isola-ted from five healthy subjects and then stimulated with IL-6 and IL-1βalone or in combination. An in vitro T cell polarization assay was performed to investigate the role of cytokines in the polarization and regulation of IL-17-producing Treg. Results Compared with the healthy subjects and patients with inactive SLE, the pa-tients with active SLE had a higher percentage of IL-17-producing Treg in peripheral blood. Moreover, the expression of Foxp3 and CD45RA by IL-17-producing Treg in the active SLE group was down-regulated, while that of IL-2, granzyme B (GramB), programmed cell death protein 1 (PD-1) and glucocorticoid-in-duced tumor necrosis factor receptor ( GITR) was up-regulated. Inflammatory cytokines such as IL-6 and IL-1 could induce Treg to produce IL-17. Conclusions This study suggested that increased inflammatory cytokines might correlate with higher percentages of IL-17-producing Treg in patients with active SLE. These cells were a subset of pathogenic Treg failing to prevent autoimmune.

Study on the molecular phylogeny of Echinococcus multilocularis in Qinghai Province / 中国血吸虫病防治杂志

Objective To amplify and sequence Coxl and Nadl genes in Echinococcus multilocularis isolates from Qinghai Province, and to create phylogenetic trees and molecular clocks, so as to provide evidence for estimating the evolutionary relationships and origins of E. multilocularis in Qinghai Province. Methods Twenty-two post-surgical specimens of patients with hepatic alveolar echinococcosis were sampled from Qinghai Provincial People’s Hospital in 2017. The Coxl and Nadl genes were amplified from E. multilocularis samples and sequenced. Then, the gene sequences were aligned to the Coxl and Nadl genes of Echinococcus species in GenBank database. The intra-species variation was observed, and the phylogenetic tree and molecular clock were created. Results All E. multilocularis samples shared more than 99% genetic homology with the sequences of Coxl and Nadl genes from the E. multilocularis Asian strain in the GenBank database. A total of 6 genotypes were identified, including 2 isolates that had no 100% homology with the sequences of known genes in the GenBank database. Phylogenetic tree analysis revealed remarkable clustering of the E. multilocularis samples with the E. multilocularis Asian strain, and the E. multilocularis isolates from Qinghai Province were estimated to date back to 94 000 years ago by the molecular clock. Conclusions The present study characterizes 6 E. multilocularis genotypes in Qinghai Province, including 2 novel genotypes. Asian strain is the predominant strain of E. multilocularis in Qinghai Province, and the E. multilocularis isolates from Qinghai Province date back to 94 000 years ago.

Study on the molecular phylogeny of Echinococcus multilocularis in Qinghai Province / 中国血吸虫病防治杂志

Objective To amplify and sequence Coxl and Nadl genes in Echinococcus multilocularis isolates from Qinghai Province, and to create phylogenetic trees and molecular clocks, so as to provide evidence for estimating the evolutionary relationships and origins of E. multilocularis in Qinghai Province. Methods Twenty-two post-surgical specimens of patients with hepatic alveolar echinococcosis were sampled from Qinghai Provincial People’s Hospital in 2017. The Coxl and Nadl genes were amplified from E. multilocularis samples and sequenced. Then, the gene sequences were aligned to the Coxl and Nadl genes of Echinococcus species in GenBank database. The intra-species variation was observed, and the phylogenetic tree and molecular clock were created. Results All E. multilocularis samples shared more than 99% genetic homology with the sequences of Coxl and Nadl genes from the E. multilocularis Asian strain in the GenBank database. A total of 6 genotypes were identified, including 2 isolates that had no 100% homology with the sequences of known genes in the GenBank database. Phylogenetic tree analysis revealed remarkable clustering of the E. multilocularis samples with the E. multilocularis Asian strain, and the E. multilocularis isolates from Qinghai Province were estimated to date back to 94 000 years ago by the molecular clock. Conclusions The present study characterizes 6 E. multilocularis genotypes in Qinghai Province, including 2 novel genotypes. Asian strain is the predominant strain of E. multilocularis in Qinghai Province, and the E. multilocularis isolates from Qinghai Province date back to 94 000 years ago.

Delayed diagnosis of oral squamous cell neoplasms at different sites / 北京大学学报(医学版)

OBJECTIVE@#To investigate the diagnostic delay of patients with oral squamous cell carcinoma by self-designed questionnaire to find out the significant influencing factors, so as to identify the influencing factors of the patient's delay and the risk of oral cancer.@*METHODS@#A total of 514 patients with primary oral squamous cell carcinoma were enrolled at Peking University School and Hospital of Stomatology from January 2014 to April 2016, including 334 men and 180 women, with a male to female ratio of 1.85:1. The youngest participant was 21 years old, with a maximum of 89 years and a median age of 57.6 years. The position of the disease according to International Classification of Diseases-10 (ICD-10) was divided into lip, buccal, gingival, retromolar, palate, floor of the mouth, tongue, and oropharynx. The age group is divided into 10 years. The level of education was divided into illiteracy, primary education level and advanced education level. Body mass index (BMI) was divided into three levels by 18 kg/m2 and 25 kg/m2. Visual analog scale (VAS) method was to evaluate the patient's preoperative pain. At the same time, the patients were examined by detailed questionnaire to understand the delay factors and delay characteristics, and use SPSS 18.0 software, analysis of variance and chi-square test to explore correlation.@*RESULTS@#Among all patients, the proportion of patients developed in the tongue was the highest (43.3%). Delay was defined by a span of three months or longer from the onset of symptoms until treatment. The delays to diagnosis according to location were as follows (in months and in descending order): lip (6.1 months), buccal (4.1 months), floor of the mouth (3.9 months), tongue (3.6 months), oropharyngeal (2.9 months), retromolar (2.7 months), palatine (2.4 months), and gingival (2.4 months). Different sites and delayed diagnosis were statistically significant (P=0.048). There were no statistically significant differences in gender, education, pain, smoking, drinking and VAS score.@*CONCLUSION@#The study has found that tumor positions and delay have a significant correlation. The position of the tumor is an obvious factor associated with the findings. The lip is the most likely to delay the diagnosis of oral positions. For the lip of the lesion, more than three months' obvious mass is recommended for timely treatment, while at admission, physicians should take the appropriate diagnostic method as soon as possible.

Systematic Evaluation of Shenmai Injection for Prevention and Treatment of Cardiotoxicity Induced by Chemotherapy of Malignant Tumor / 中国中医药信息杂志

Objective To systematically evaluate the clinical efficacy of Shenmai Injection for the prevention and treatment of cardiotoxicity induced by chemotherapy of malignant tumor. Methods Literature about RCTs of Shenmai Injection for the prevention and treatment of cardiotoxicity induced by chemotherapy of malignant tumor in CNKI, Wanfang Database, CBM, VIP, Pub Med, Cochrane Library, Embase, and Web of Science was retrieved by computer from the establishment of database to March 2017. Two investigators independently conducted literature screening, data extraction, and literature quality evaluation. Rev Man 5.3 software was used for Meta-analysis. Results 14 articles were included in the study, involving 1105 patients. The results of Meta-analysis showed that the incidence of abnormal electrocardiogram in Shenmai Injection group was significantly lower than that in control group [RR=0.36, 95％CI (0.29, 0.44), P＜0.000 01]. CK-MB elevation value [SMD=-0.29, 95％CI (-0.58, 0.00), P=0.05]and c Tn T elevation value [SMD=-1.28, 95％CI (-2.48, -0.09), P=0.04]in Shenmai Injection group were less than control group, with statistical significance. Conclusion Shenmai Injection is beneficial to the prevention and treatment of early acute cardiac toxicity and myocardial injury induced by chemotherapy of malignant tumor. However, more large-scale, multi-center, and high-quality clinical RCTs are needed for further verification

Phenotypic and functional properties of in vitro-induced Helios+regulatory T cells / 中华微生物学和免疫学杂志

Objective To investigate the phenotypic and functional properties of in vitro-induced He-lios+regulatory T cells(Helios+iTreg) and to analyze the differences between Helios+iTreg and Helios+thymic-derived natural Treg (Helios+nTreg). Methods CD4+CD25- effector T cells (CD4+CD25- Teff) that were separated from healthy subjects were cultured with anti-CD3 and anti-CD28 antibodies and stimulated with IL-2 and TGF-β to induce the generation of Helios+iTreg. Flow cytometry and real-time PCR were respectively used to analyze the differences in phenotype and CpG methylation in Treg-specific demethylated region (TSDR) be-tween Helios+iTreg and Helios+nTreg derived from the same donor. Results CD45RA was highly expressed on Helios+iTreg, but not on Helios+nTreg. Additionally, Helios+iTreg expressed significantly higher levels of CD127,ICOS and PD-1,but lower levels of CXCR3,CCR4 and CD25 than Helios+nTreg did. IFN-γ and IL-2 that expressed by Helios+iTreg were more than those by Helios+nTreg. It was also found that the level of CpG methylation in TSDR was much higher in Helios+iTreg than in Helios+nTreg. Conclusion Both nTreg and iTreg expressed Helios,but the phenotypic and functional properties of the two Treg subsets were different. It was suggested that Helios+iTreg and Helios+nTreg might play different roles in the immune system.

Radiological features of non-small-cell lung cancer with brain metastases in a single center: an implication for the HA-WBRT approach / 中华放射肿瘤学杂志

Objective Whole brain radiotherapy ( WBRT) remains the primary treatment for patients with multiple brain metastases ( BM). Hippocampal avoidance WBRT ( HA-WBRT) offers the feasibility of less cognitive function impairment than conventional WBRT.WBRT yields better control rate of intracranial distant progression than stereotatic body radiotherapy (SBRT).This study aims to understand the distribution characteristics of BM within the cranial structures by analyzing imaging features and define the safe margin during HA-WBRT. Methods Clinical data of patients diagnosed with BM by enhanced MRI in Ruijin Hospital from July 2011 to July 2016 were retrospectively analyzed. The distance between the intracranial lesion closest to the hippocampus and the hippocampus was measured. Results A total of 146 patients (90 male and 56 female) with 630 BM lesions were reviewed. Sixty-four patients were diagnosed with non-small-cell lung cancer complicated with BM during the initial admission. In the other 82 patients, the average time from the initial diagnosis to the diagnosis of BM was (14.5±14. 3) months. In total,486 (77. 1％) BM lesions were situated beyond the tentorium. The average diameter of the largest intracranial lesion was (12.5± 10. 3) mm (95％CI:10. 8-14. 2). All 630 BM lesions were distributed as follows:138 (21. 9％) in the cerebellum, 182 ( 28. 9％) in the frontal lobe, 114 ( 18. 1％) in the temporal lobe, 78 (12. 4％) in the parietal lobe,87(12. 7％) in the occipital lobe,28(4. 4％) in the thalamus and 10(1. 6％) in the brainstem. The frequency of hippocampal involvement was 3. 4％(5 mm),4. 8％(10 mm) and 8. 2％(20 mm). The univariate and multivariate logistic analyses indicated that with the risk of hippocampal involvement in patients aged> 60 years was significantly increased (OR= 11. 576 P= 0. 042). Conclusions The probability of brain metastasis within 10 mm around the hippocampus is low. HA-WBRT can control the intracranial lesions and reduce cognitive impairment,which is a safe and feasible treatment method.

A 20-year study on microvascular autologous transplantation of submandibular gland for treatment of severe dry eye / 北京大学学报(医学版)

Severe dry eye is a refractory ophthalmologic disease. Our multidisciplinary research group treated severe dry eye by microvascular autologous transplantation of submandibular gland (SMG) during the past 20 years. The SMG, with its blood vessels and Wharton's duct, was harvested from the submandibular triangle and transferred to the temporal area. The blood vessels in the SMG were anastomosed with the temporal blood vessels using a microsurgical technique. Then, the distal end of Wharton's duct was sutured to form an opening in the upper lateral conjunctival fold. The tear was replaced by the secretion of the transplanted SMG to lubricate the ocular surface. In our study, the surgical techniques of blood vessel management were continuously modified to increase the survival rate of the transplanted SMG. A novel surgical modality of partial transplantation of SMG was established to prevent postoperative epiphora. A clinical study with the largest case number in the world was conducted and the effectiveness of transplantation of SMG for severe dry eye was fully confirmed. In order to resolve two main clinical problems including ductal obstruction resulted from low secretion rate during the latent period, and epiphora due to over secretion of the transplanted SMG in the later term of transplantation, the regulation of the secretion mechanism of the normal and transplanted SMG were investigated. New opinions on mechanisms of saliva secretion were provided. Based on the priniciple of translational medicine, the results of related basic research were applied in the clinic. The clinical guidelines for secretion regulation of transplanted SMG were established. A concept of chronic obstructive sialadenitis of transplanted SMG was provided and its diagnostic criteria, diagnostic technique of sialography, and therapeutic regimen were established. As a result, the surgical success rate was obviously elevated, the surgical complications were decreased, and life quality of the patients was greatly improved.

Analysis of setup errors in lung stereotactic body radiotherapy with cone-beam CT-based image guidance / 中国癌症杂志

Background and purpose:Correct target positioning is an important factor affecting the precision of stereotactic body radiotherapy (SBRT) in patients with lung tumors. This study investigated the setup errors in patients with malignant lung tumors receiving SBRT with cone-beam CT (CBCT) and analyzed the factors influencing setup errors.Methods:Twenty-nine patients with solitary malignant lung tumors were enrolled in the study. Each patient underwent SBRT with CBCT before each treatment. Setup errors in CBCT were obtained according to the matched and planned CT images in anterior-posterior (AP), superior-inferior (SI) and left-right (LR) directions. The expanding margins of clinical target volume (CTV) to planning target volume (PTV) according to the analyzed setup errors were then calculated. And the influencing factors of setup errors were analyzed.Results:A total of 155 CBCT images from 29 patients were obtained during the treatment. The setup errors were (-1.68±3.62), (-1.34±3.90) and (0.36±2.15) mm in the AP, SI and LR directions, respectively. The absolute setup errors were (3.16±2.42), (3.29±2.48) and (1.74±1.30) mm in the AP, SI and LR directions, respectively. The suggested expanding margins of CTV to PTV were 9.6, 10.0 and 5.3 mm in the AP, SI and LR directions according to the setup errors. The setup errors in the AP direction of peripheral lesions and in the SI direction of inferior, right and metastatic lesions were relatively larger(P=0.007, 0.008, 0.000 and 0.000)..Conclusion:In patients with malignant lung tumors receiving SBRT, the setup errors were more obvious in the SI and AP directions. Tumor motion management techniques including CBCT, breath-holding technique are required to reduce the setup error in patients with lung tumors receiving SBRT.

Influences of Wuqinxi Bird Exercises Combined with Simple Breath Exercises on Quality of Life and Immune Function of Patients with Chronic Obstructive Pulmonary Disease / 广州中医药大学学报

Objective To evaluate the effect of the bird exercises of Wuqinxi bird exercises combined with simple breath exercises on the quality of life and immune function in patients with chronic obstructive pulmonary disease (COPD). Methods Sixty-eight COPD patients were allocated into observation group (N=32) and control group (N=36)according to the intention of the patients. The control group was given conventional inhalation of Seretide and Tiotropium Bromide,and the observation group did Wuqinxi bird exercises and simple breath exercises plus the conventional inhalation therapy. Before and after treatment,we compared the BODE indexes such as body mass index (BMI), air flow obstruction index of forced expiratory volume in one second (FEV1%), dyspnea scores,exercise capacity (6-min walking distance)as well as COPD assessment test (CAT)scores between the two groups before and after treatment. Meanwhile, the changes of T lymphocyte subtype CD3, CD4, CD8, CD4/CD8 levels and serum immunoglobulin M (IgM),IgA,IgG levels were also monitored. Results(1)After intervention, dyspnea scores of the observation group were obviously improved (P < 0.01), while the control group showed no obvious changes in dyspnea scores (P > 0.05). The observation group had better effect on improving dyspnea scores and 6-min walking distance than the control group (P < 0.05 or P <0.01).(2)After intervention,BODE index and CAT scores were improved in the observation group(P<0.01),BODE index was improved in the control group (P < 0.05), and the improvement of BODE index and CAT scores in the observation group was superior to that in the control group (P < 0.05 or P < 0.01). (3)After intervention, T lymphocyte subtype CD3 and CD4 levels as well as the serum IgM, IgA, IgG levels in the observation group were increased (P < 0.05 or P < 0.01),and IgA level in the control group was also increased (P < 0.05). The observation group had stronger effect on increasing T lymphocyte subtype CD3 and CD4 levels than the control group(P < 0.05 or P < 0.01).(4)The difference of adverse reaction incidence was insignificant between the two groups (P > 0.05). Conclusion Application of Wuqinxi bird exercises and simple breath exercises based on conventional inhalation therapy is effective on improving dyspnea, 6-min walking distance, BODE index and CAT scores, and on increasing T lymphocyte subtype CD3 and CD4 levels as well as the serum IgM and IgG levels of COPD patients.