Clinical Characteristics, Electrophysiology, and Skin Biopsy of 38 Peripheral Neuropathy Cases with Small Fiber Involvement of Various Etiologies / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>In small fiber neuropathy (SFN), thinly myelinated Aδ and unmyelinated C fibers are primarily affected, resulting in sensory and/or autonomic symptoms. Various etiologies have been shown to be associated with SFN. This study was aimed to analyze a variety of features in peripheral neuropathy (PN) with small fiber involvement, and to compare disease severity among patients with idiopathic PN, PN associated with impaired glucose tolerance (IGT), and metabolic syndrome (MS) PN.</p><p><b>METHODS</b>Thirty-eight PN patients with small fiber involvement were enrolled from December 20, 2013 to May 31, 2016. Patients were divided into idiopathic PN, IGT-related PN, and MS-related PN groups. Detailed medical history and small fiber neuropathy were investigated, and symptom inventory questionnaire was conducted, as well as the visual analog scale. Nerve conduction studies and skin biopsies were also performed. The differences among the groups were analyzed using analysis of variance and Kruskal-Wallis test.</p><p><b>RESULTS</b>Eight patients were diagnosed with pure SFN. Intraepidermal nerve fiber density (IENFD) weakly correlated with motor conduction velocity (MCV) (r = 0.372, P = 0.025), and proximal (r = 0.383, P = 0.021) and distal (r = 0.358, P = 0.032) compound muscle action potential (CMAP) of the tibial nerve. IENFD also weakly correlated with MCV of the peroneal nerve (r = 0.399, P = 0.016). IENFD was shown to be significantly different among all groups (χ2 = 9.901, P = 0.007). IENFD was significantly decreased (χ2 = 23.000, P = 0.003) in the MS-related PN group compared to the idiopathic PN group. The MCV of the tibial nerve was significantly different among all groups (χ2 = 8.172, P < 0.017). The proximal (F = 4.336, P = 0.021) and distal (F = 3.262, P = 0.049) CMAP of the tibial nerve was also significantly different among all groups.</p><p><b>CONCLUSIONS</b>IENFD of patients included in the present study weakly correlated with various electrophysiological parameters. Small and large fibers are more involved in patients with MS-related PN than in patients with idiopathic PN.</p>

Effects of Head-down Tilt on Nerve Conduction in Rhesus Monkeys / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Few studies have focused on peripheral nerve conduction during exposure to microgravity. The -6° head-down tilt (HDT) comprises an experimental model used to simulate the space flight environment. This study investigated nerve conduction characteristics of rhesus monkeys before and after prolonged exposure to HDT.</p><p><b>METHODS</b>Six rhesus monkeys (3-4 years old) were tilted backward 6° from the horizontal. Nerve conduction studies (NCSs) were performed on the median, ulnar, tibial, and fibular motor nerves. Analysis of variance with a randomized block design was conducted to compare the differences in the NCS before and 7, 21, and 42 days after the -6° HDT.</p><p><b>RESULTS</b>The proximal amplitude of the CMAP of the median nerve was significantly decreased at 21 and 42 days of HDT compared with the amplitude before HDT (4.38 ± 2.83 vs. 8.40 ± 2.66 mV, F = 4.85, P = 0.013 and 3.30 ± 2.70 vs. 8.40 ± 2.66 mV, F = 5.93, P = 0.004, respectively). The distal amplitude of the CMAP of the median nerve was significantly decreased at 7, 21, and 42 days of HDT compared with the amplitude before HDT (7.28 ± 1.27 vs. 10.25 ± 3.40 mV, F = 4.03, P = 0.039; 5.05 ± 2.01 vs. 10.25 ± 3.40 mV, F = 6.25, P = 0.04; and 3.95 ± 2.79 vs. 10.25 ± 3.40 mV, F = 7.35, P = 0.01; respectively). The proximal amplitude of the CMAP of the tibial nerve was significantly decreased at 42 days of HDT compared with the amplitude before HDT (6.14 ± 1.94 vs. 11.87 ± 3.19 mV, F = 5.02, P = 0.039).</p><p><b>CONCLUSIONS</b>This study demonstrates that the compound muscle action potential amplitudes of nerves are decreased under simulated microgravity in rhesus monkeys. Moreover, rhesus monkeys exposed to HDT might be served as an experimental model for the study of NCS under microgravity.</p>

Comparative study on minocycline hydrochloride ointment and iodine glycerol in the treatment of chronic periodontitis / 新乡医学院学报

Objective To explore the clinical effect of minocycline hydrochloride ointment and iodine glycerol in the treatment of chronic periodontitis and the effect on the inflammatory cytokines in gingival crevicular fluid (GCF).Methods A total of 90 patients with chronic periodontitis (115 affected teeth) in Stomatology Hospital of Zhangjiakou from December 2015 to December 2016 were included and randomly divided into observation group(57 affected teeth) and control group (58 effected teeth),with 45 patients in each group.All patients were given routine periodental non-surgical treatment,based on this,the patients in the control group were smeared iodine glycerol (20 g · L-1) in the periodontal pocket with a probe;the patients in the observation group were injected minocycline hydrochloride ointment in the periodontal pocket until the ointment overflowed the gingival margin.The patients in the two groups were treated one time a week for 4 weeks.After 4-week treatment,the gingival index (GI),gingival sulcus bleeding index (SBI),probing depth (PD),plaque index (PLI),periodontal attachment level (AL) and the clinical efficacy were recorded.The levels of hypersensitive C-reactive protein(hs-CRP),interleukin8 (IL-8),interleukin-10 (IL-10),tumor necrosis factor-α (TNF-α),matrix metalloproteinases-8 (MMP-8) and soluble intercellular adhesion molecule-1 (sICAM-1) were detected by enzyme linked immunosorbent assay before and after treatment and compared between the two groups.Results There was no statistic difference in GI,SBI,PD,PLI,and AL between the two groups before treatment (P ＞ 0.05);the GI,SBI,PD,PLI,and AL after treatment were significantly lower than those before treatment (P ＜ 0.05);the GI,SBI,PD,PLI and AL in observation group were significantly lower than those in the control group after treatment (P ＜ 0.05).There was no statistic difference in the levels of hs-CRP,IL-8,IL-10,TNF-α,MMP-8 and sICAM-1 in GCF between the two groups before treatment(P ＞ 0.05);the levels of hs-CRP,IL-8,TNF-α,MMP-8 and sICAM-1 in GCF after treatment were significantly lower than those before treatment (P ＜ 0.05),but the IL-10 level was significantly higher than that before treatment in the two groups(P ＜ 0.05);the levels of hs-CRP,IL-8,MMP-8,TNF-α and sICAM-1 in GCF in observation group were significantly lower than those in the control group after treatment (P ＜ 0.05);the level of IL-10 was significantly higher than that in the control group after treatment (P ＜ 0.05).The total effective rate of affected teeth in observation group(96.49％,55/57) was significantly higher than that in the control group (74.14％,43/58) (x2 =11.40,P ＜ 0.05).Conclusion Minocycline hydrochloride ointment can effectively improve the inflammatory reaction status in patients with chronic periodontitis,and it can control the inflammatory damage of periodontal tissues by inhibiting the inflammatory reaction,and effectively alleviate the clinical symptoms.

Mutation Analysis of Gap Junction Protein Beta 1 and Genotype-Phenotype Correlation in X-linked Charcot-Marie-Tooth Disease in Chinese Patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Among patients with Charcot-Marie-Tooth disease (CMT), the X-linked variant (CMTX) caused by gap junction protein beta 1 (GJB1) gene mutation is the second most frequent type, accounting for approximately 90% of all CMTX. More than 400 mutations have been identified in the GJB1 gene that encodes connexin 32 (CX32). CX32 is thought to form gap junctions that promote the diffusion pathway between cells. GJB1 mutations interfere with the formation of the functional channel and impair the maintenance of peripheral myelin, and novel mutations are continually discovered.</p><p><b>METHODS</b>We included 79 unrelated patients clinically diagnosed with CMT at the Department of Neurology of the Chinese People's Liberation Army General Hospital from December 20, 2012, to December 31, 2015. Clinical examination, nerve conduction studies, and molecular and bioinformatics analyses were performed to identify patients with CMTX1.</p><p><b>RESULTS</b>Nine GJB1 mutations (c.283G>A, c.77C>T, c.643C>T, c.515C>T, c.191G>A, c.610C>T, c.490C>T, c.491G>A, and c.44G>A) were discovered in nine patients. Median motor nerve conduction velocities of all nine patients were < 38 m/s, resembling CMT Type 1. Three novel mutations, c.643C>T, c.191G>A, and c.610C>T, were revealed and bioinformatics analyses indicated high pathogenicity.</p><p><b>CONCLUSIONS</b>The three novel missense mutations within the GJB1 gene broaden the mutational diversity of CMT1X. Molecular analysis of family members and bioinformatics analyses of the afflicted patients confirmed the pathogenicity of these mutations.</p>

Prognostic scoring system for locoregional control among the patients with nasopharyngeal carcinoma treated by intensity-modulated radiotherapy / 癌症

The prognostic value of T category for locoregional control in patients with nasopharyngeal carcinoma (NPC) has decreased with the extensive use of intensity-modulated radiotherapy (IMRT). We aimed to develop a prognostic scoring system (PSS) that incorporated tumor extension and clinical characteristics for locoregional control in NPC patients treated with IMRT. The magnetic resonance imaging scans and medical records of 717 patients with nonmetastatic NPC treated with IMRT at Sun Yat-sen University Cancer Center between January 2003 and January 2008 were reviewed. Age, pathologic classification, primary tumor extension, primary gross tumor volume (GTV-p), T and N categories, and baseline lactate dehydrogenase (LDH) level were analyzed. Hierarchical cluster analysis as well as univariate and multivariate analyses were used to develop the PSS. Independent prognostic factors for locoregional relapse included N2-3 stage, GTV-p ≥26.8 mL, and involvement of one or more structures within cluster 3. We calculated a risk score derived from the regression coefficient of each factor and classified patients into four groups: low risk (score 0), intermediate risk (score >0 and ≤1), high risk (score >1 and ≤2), and extremely high risk (score >2). The 5-year locoregional control rates for these groups were 97.4%, 93.6%, 85.2%, and 78.6%, respectively (P < 0.001). We have developed a PSS that can help identify NPC patients who are at high risk for locoregional relapse and can guide individualized treatments for NPC patients.

Long-term outcome and late toxicities of simultaneous integrated boost-intensity modulated radiotherapy in pediatric and adolescent nasopharyngeal carcinoma / 癌症

The application of simultaneous integrated boost-intensity modulated radiotherapy (SIB-IMRT) in pediatric and adolescent nasopharyngeal carcinoma (NPC) is underevaluated. This study aimed to evaluate long-term outcome and late toxicities in pediatric and adolescent NPC after SIB-IMRT combined with chemotherapy. Thirty-four patients (aged 8-20 years) with histologically proven, non-disseminated NPC treated with SIB-IMRT were enrolled in this retrospective study. The disease stage distribution was as follows: stage I, 1 (2.9%); stage III, 14 (41.2%); and stage IV, 19 (55.9%). All patients underwent SIB-IMRT and 30 patients also underwent cisplatin-based chemotherapy. The prescribed dose of IMRT was 64-68 Gy in 29-31 fractions to the nasopharyngeal gross target volume. Within the median follow-up of 52 months (range, 9-111 months), 1 patient (2.9%) experienced local recurrence and 4 (11.8%) developed distant metastasis (to the lung in 3 cases and to multiple organs in 1 case). Four patients (11.8%) died due to recurrence or metastasis. The 5-year locoregional relapse-free survival, distant metastasis-free survival, disease-free survival, and overall survival rates were 97.1%, 88.2%, 85.3%, and 88.2%, respectively. The most common acute toxicities were grades 3-4 hematologic toxicities and stomatitis. Of the 24 patients who survived for more than 2 years, 16 (66.7%) and 15 (62.5%) developed grades 1-2 xerostomia and ototoxicity, respectively. Two patients (8.3%) developed grade 3 ototoxicity; no grade 4 toxicities were observed. SIB-IMRT combined with chemotherapy achieves excellent long-term locoregional control in pediatric and adolescent NPC, with mild incidence of late toxicities. Distant metastasis is the predominant mode of failure.

The short-term effects of particulate matter on lung function of college students in autumn and winter in Wuhan / 中华预防医学杂志

<p><b>OBJECTIVE</b>To evaluate the effects of indoor and outdoor PM2.5 (fine particulate matter, particulate matter with an aerodynamic diameter ≤ 2.5 µm) on lung function of college students in autumn and winter in Wuhan.</p><p><b>METHODS</b>In this panel study, 37 college students (excluded subject of respiratory disease and smoking history) aged 19 - 21 were investigated by cluster sampling in a university in Wuhan. The follow-up study lasted for 28 days in total, including two study periods, Oct. 29 to Nov. 11, 2009 (autumn) and Dec. 23, 2009 to Jan.5, 2010 (winter), the peak expiratory flow (PEF) of the college students were measured daily in the morning and evening in the university. PM10 and PM2.5 were monitored indoors and outdoors. The effects of PM on lung function of college students were analyzed by using generalized estimating equation (GEE).</p><p><b>RESULTS</b>Average daily concentrations of indoor, outdoor PM2.5 in autumn were (91.3 ± 43.7) and (104.2 ± 49.4) µg/m(3) respectively, while in winter the concentrations of indoor and outdoor PM2.5 were (110.6 ± 42.3) and (143.5 ± 51.2) µg/m(3). The single pollutant model showed that in winter, the evening PEF decrement was significantly associated with increasing outdoor PM2.5. With an increase of 10 µg/m(3) outdoor PM2.5, the PEF measured in the evening decreased 1.27 L/min (95%CI: 0.02 - 2.52 L/min, respectively). Meanwhile, the results showed that 2-days lagged outdoor PM2.5 was also significantly associated with morning PEF. An increase of 10 µg/m(3) 2-days lagged outdoor PM2.5 caused the decrease of 1.82 L/min (95%CI: -3.53 - -0.11 L/min) of PEF measured in the morning. Controlling the influence of gaseous pollutants and building the two pollutants models, the results indicated that no significant changes of PEF of students being exposed to PM2.5 on same day (lag 0) were observed. However, under consideration of SO2 effect, significant association between an increase of 10 µg/m(3) 2-days lagged outdoor PM2.5 and changes of morning PEF (-1.81 L/min, 95%CI: -3.51 - -0.11 L/min, P = 0.037) was found. The relationship between changes of concentrations and PEF was not observed in autumn in this study.</p><p><b>CONCLUSION</b>In our panel study, exposure to outdoor PM2.5 is significantly associated with PEF among college students in winter, but not in autumn.</p>

Imaging and clinical features of nasopharyngeal adenoid cystic carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the spreading patterns nasopharyngeal carcinoma and nasopharyngeal adenoid cystic carcinoma.</p><p><b>METHODS</b>Eighteen pathologically confirmed consecutive cases of adenoid cystic carcinomas (ACC) and 182 cases of untreated nasopharyngeal carcinomas (NPC) were reviewed.</p><p><b>RESULTS</b>Compared with NPC, ACC had higher rates of T4 disease (14.3% vs 38.9%,χ(2) = 7.197, P = 0.007) and paralyzed cranial nerve (6.0% vs 38.9%,χ(2) = 37.936, P < 0.001) . There was no significant difference in skull base invasion rates between 2 groups (53.3% vs 66.7%,χ(2) = 1.181, P = 0.277) . ACC had higher rates of MRI-detected cranial nerve canal invasion (32.4% vs 55.6%,χ(2) = 3.881, P = 0.049) and cavernous sinus invasion (13.7% vs 33.3%,χ(2) = 7.710, P = 0.028) than NPC. Lymph node metastasis occurred in 64.8% of ACC, and 11.1% of NPC (χ(2) = 19.699, P < 0.001) .</p><p><b>CONCLUSION</b>ACC has a higher rate of cranial nerve invasion and NPC has a higher rate of lymphatic metastasis.</p>

Locoregional extension patterns of nasopharyngeal carcinoma and suggestions for clinical target volume delineation / 癌症

Clinical target volume (CTV) delineation is crucial for tumor control and normal tissue protection. This study aimed to define the locoregional extension patterns of nasopharyngeal carcinoma (NPC) and to improve CTV delineation. Magnetic resonance imaging scans of 2366 newly diagnosed NPC patients were reviewed. According to incidence rates of tumor invasion, the anatomic sites surrounding the nasopharynx were classified into high-risk (>30%), medium-risk (5%-30%), and low-risk (<5%) groups. The lymph node (LN) level was determined according to the Radiation Therapy Oncology Group guidelines, which were further categorized into the upper neck (retropharyngeal region and level II), middle neck (levels III and Va), and lower neck (levels IV and Vb and the supraclavicular fossa). The high-risk anatomic sites were adjacent to the nasopharynx, whereas those at medium-or low-risk were separated from the nasopharynx. If the high-risk anatomic sites were involved, the rates of tumor invasion into the adjacent medium-risk sites increased; if not, the rates were significantly lower (P<0.01). Among the 1920 (81.1%) patients with positive LN, the incidence rates of LN metastasis in the upper, middle, and lower neck were 99.6%, 30.2%, and 7.2%, respectively, and skip metastasis happened in only 1.2% of patients. In the 929 patients who had unilateral upper neck involvement, the rates of contralateral middle neck and lower neck involvement were 1.8% and 0.4%, respectively. Thus, local disease spreads stepwise from proximal sites to distal sites, and LN metastasis spreads from the upper neck to the lower neck. Individualized CTV delineation for NPC may be feasible.

MRI in exploring the spread pattern of retropharyngeal lymp node metastases in nasopharyngeal carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>The purpose of this study is to investigate the incidence, distribution and spread pattern of retropharyngeal lymph node (RLN) metastasis in the patient with nasopharyngeal carcinoma (NPC) using magnetic resonance imaging (MRI).</p><p><b>METHODS</b>MRI data of 294 patients with newly diagnosed NPC were reviewed retrospectively. Criteria for RLN metastasis were the minimal axial dimension of > or = 6 mm, or the presence of nodal necrosis.</p><p><b>RESULTS</b>RLN involvement was detected in 165 (56.1%) patients. The incidence of metastatic lateral RLN decreased gradually from C1 to C3 level. A significantly higher incidence of metastatic RLN was observed in the patients with cancerous involvement of oropharynx, nasal cavity, pre-styloid parapharyngeal space, post-styloid parapharyngeal space or with cervical lymph node metastasis. Thirty-one patients (10.5%) had metastatic RLN only, and 54 (18.4%) showed metastatic cervical lymph nodes only, but 134 (45.6%) exhibited an involvement of both the RLN and cervical lymph node. A significantly lower incidence of metastatic RLN was found in T1, N0, and stage I disease.</p><p><b>CONCLUSION</b>The incidence of metastatic lateral retropharyngeal lymph node decreases gradually from C1 to C3 level. Metastatic retropharyngeal lymph node is associated with cancerous involvement of surrounding tissue by primary tumor or with cervical lymph node metastasis. Retropharyngeal lymph node or cervical level II node can be considered equally as the first station of nodal metastasis in nasopharyngeal carcinoma.</p>

Comparison between PET/CT and MRI in diagnosing lymph node metastasis and N staging of nasopharyngeal carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To compare the clinical significance of PET/CT and MRI in diagnosing lymph node metastasis and N staging of nasopharyngeal carcinoma (NPC).</p><p><b>METHODS</b>116 NPC patients had undergone PET/CT and MRI before therapy. The findings of PET/CT and MRI in diagnosing lymph node metastasis and N staging were compared according to the results of follow-up.</p><p><b>RESULTS</b>A total of 614 lymph nodes in 116 patients were analyzed. 340 positive nodes and 274 negative nodes interpreted by image findings were verified during follow-up. The sensitivity, specificity and accuracy of PET/CT in diagnosing node metastasis was 93.2%, 98.2% and 95.4%, while that of MRI was 88.8%, 91.2% and 89.9%, respectively, with statistically significant difference in each between PET/CT and MRI (P < 0.05). Based on Fuzhou Staging System, 109 patients (94.0%) were correctly staged by PET/CT, and 103 patients (88.8%) by MRI, while according to UICC Staging System, 108 patients (93.1%) were correctly staged by PET/CT, and 100 patients (86.2%) by MRI.</p><p><b>CONCLUSION</b>PET/CT is superior to MRI in diagnosing lymph node metastasis and N staging of nasopharyngeal carcinoma. The false-positive and false-negative assessment based on PET-CT scan findings may be caused by: (1) inflammatory hyperplastic node; (2) node with large areas of necrosis; (3) node in diameter less than spatial resolution limitation of PET.</p>