Therapeutic Outcome of Stereotactic Body Radiotherapy for Small Hepatocellular Carcinoma Lesions - A Systematic Review and Network Meta-analysis.

Surgical resection, stereotactic body radiotherapy (SBRT) and radiofrequency ablation (RFA) have seldom been compared for small hepatocellular carcinoma (HCC). We explored the treatment outcomes of SBRT for small HCC by conducting a network meta-analysis (NMA). We compared the efficacy and safety of surgical resection, RFA and SBRT for liver-confined small HCC (three or fewer lesions with a diameter ≤5 cm). The study endpoint included the odds ratios of the 1-, 3- and 5-year progression/recurrence/disease-free survival (disease progression-free survival; DPFS) and overall survival rates, as well as severe complications. Forty-five studies included 21 468 patients. In the NMA with comparable data, SBRT had comparable 1-, 3- and 5-year DPFS but significantly worse pooled long-term overall survival (3- and 5-year overall survival) than surgical resection (odds ratio 1.39, 95% confidential interval 1.3-1.89; odds ratio 1.33, 95% confidence interval 1.06-1.69, respectively). SBRT was associated with significantly better pooled 1-year DPFS compared with RFA (odds ratio 0.39, 95% confidence interval 0.15-0.97), with the remaining outcomes being comparable. SBRT had significantly less incidence of severe complications compared with surgical resection (odds ratio 0.62, 95% confidence interval 0.42-0.88) and RFA (odds ratio 0.2, 95% confidence interval 0.03-0.94). In conclusion, for small HCCs (≤5 cm) with one to three nodules, SBRT may be favourable to reduce the risks of severe complications. In terms of DPFS, SBRT may be recommended as an alternative first-line therapy for RFA and surgical resection. The results regarding overall survival should be interpreted with caution, considering the potentially uneliminated bias. There is a clear need for well-designed randomised trials to conclusively identify real differences in efficacy between these treatments, especially SBRT and surgical resection.

A 2-bp deletion in intron 1 of TMEM182 is associated with TMEM182 mRNA expression and chicken body weight.

1. Searching for molecular markers related to growth and carcase traits plays a critical role in improvement of the production performance of broilers. Previous studies found that transmembrane protein 182 (TMEM182) inhibits skeletal muscle development, growth, and regeneration, implying that the TMEM182 gene plays an important role during the development process of skeletal muscle.2. A novel 2-bp indel in intron 1 of TMEM182 was detected in a yellow chicken population derived from the cross of White Recessive Rock chickens with Xinghua chickens, and three genotypes II (inserted homozygote), ID (inserted and deleted heterozygote) and DD (deleted homozygote) were observed. Association analyses indicated that the indel was significantly associated with the body weight, muscle fibre area, breast muscle weight and wing weight in the F2 population.3. The expression of TMEM182 in leg muscle of chickens with II genotype was higher than that with DD genotype, with the 2-bp indel located in one of the putative PAX4 binding sites. Further research through luciferase assays revealed that the PAX4 could bind to the putative binding site and increase the TMEM182 transcription, with the 2-bp deletion disrupting the binding of PAX4.4. The present study provides evidence for the association of the novel 2-bp indel in intron 1 of TMEM182 with the growth and carcase traits of chickens. This 2-bp indel could be used as a genetic marker in broiler breeding.

Imaging Features and Pathological Analysis of 43 Parotid Basal Cell Adenomas.

PURPOSE: To investigate the correlation between sonographic and computed tomography and pathological features of basal cell adenomas (BCAs) of the parotid gland. METHODS: This retrospective study included 41 patients (43 tumors) with BCAs. The tumors were divided into three types based on their location in the parotid gland and their imaging features. The features of the tumors were analyzed. RESULTS: Imaging manifestations and corresponding pathological results of most BCAs of the parotid glands resembled those of benign parotid gland tumors. Malignant transformation occurred in membranous BCAs and in those with extensive cribriform structures. Type-II and type-III tumors accounted for 82.93% of the total proportion. Thirteen tumors showed cystic degeneration with 30.23%, among which type-III tumors could easily develop cystic degeneration. These cystic areas might correspond to cystic degeneration or focal necrosis. Cystic change was not dependent on the tumor size. The pathological features of the tumors were correlated to their imaging manifestations. CONCLUSION: Most BCAs of the parotid glands have imaging manifestations similar to those of benign parotid gland tumors. BCAs with extensive cribriform structures and of the membranous type can show malignant transformation and should be treated with caution in clinical practice.

[Safety and short-term efficacy of apatinib combined with oxaliplatin and S-1 in the conversion treatment for gastric cancer with peritoneal metastasis].

Objective: To investigate the safety and short-term efficacy of apatinib combined with oxaliplatin and S-1 in the conversion treatment for gastric cancer with different types of peritoneal metastasis. Methods: A prospective study "one arm exploratory clinical study of conversion therapy of apatinib with S-1 and oxaliplatin in the treatment of advanced gastric cancer" (clinical registration ChiCTR-ONC-17010430) from medical record database was retrospectively analyzed. Patients aged 18-70 years with gastric cancer peritoneal metastasis confirmed by histology and laparoscopic exploration, and had not receive radiotherapy, chemotherapy, targeted therapy or immunotherapy before were enrolled. Before operation, the patients received 6 cycles of S-1 (80-120 mg/d, d1-d14) and oxaliplatin (130 mg/m(2), d1), and 5 cycles of apatinib (500 mg/d, d1-d21) conversion regimen. Three weeks after chemotherapy, whether the operation was performed or not depending on re-evaluation and patient preference. The main outcome were adverse reactions, and the secondary outcome were objective remission rate (ORR), disease control rate (DCR), and overall survival (OS) rate. The follow-up period was up to May 2020. Results: A total of 27 patients with gastric cancer peritoneal metastasis were enrolled in this study. There were 13 males and 14 females, with a median age of 58 (30-68) years old. There were 9 cases of P1a, 5 cases of P1b, and 13 cases of P1c. There were 14 cases with 1-5 scores of PCI (peritoneal cancer index), and 13 cases with 6 scores or above. The incidence of adverse reactions was 100%. The most common adverse reactions were hematological events including leucopenia (70.4%, 19/27) and granulocytopenia (74.1%, 20/27). Non-hematological adverse events included fatigue (51.9%, 14/27) and oral mucositis (37.0%, 10/27). One patient was withdrawn due to grade 4 thrombocytopenia. Among 26 patients with feasible efficacy evaluation, 18 (69.2%) achieved partial remission, 3 (11.5%) achieved stable disease, and 5 (19.2%) disease progression. The objective remission rate was 69.2% (18/26) and the disease control rate was 80.8% (21/26). Fourteen patients underwent surgery, including 6 patients undergoing R0 resection with the R0 resection rate of 42.9% (6/14). The postoperative pathological response rate was 64.3% (9/14). The follow-up time was 12-40 months, and the follow-up rate was 100%. The 1-year OS rate was 65.2% and the survival time was (14.0±1.7) months. The 1-year OS rates of P1a/P1b group and P1c group were 81.8% and 42.0% respectively, whose difference was statistically significant (P=0.041). The 1-year OS rates of PCI 1-5 group and PCI ≥6 group were 67.3% and 38.5% respectively, whose difference was statistically significant (P=0.022). Conclusion: In the conversion treatment of gastric cancer peritoneal metastasis, the safety of apatinib combined with oxaliplatin and S-1 is acceptable, and this regimen shows a good short-term survival efficacy in patients with P1a/P1b and PCI of 1-5.

[Research on mental health status of medical staff during COVID-19 epidemic].

Objective: To explore the psychological status of medical staff during COVID-19 epidemic, so as to provide reference and scientific basis for carrying out further psychological intervention and ensuring the mental health of medical staff. Methods: By using convenient sampling method and the Stresss-Anxiety ubscale of Depression Anxiety Stress (DASS-21) , the mental health status of 615 medical staff was investigated by the way of questionnaire star from February 4 to 16, 2020. A total of 615 questionnaires were distributed and collected, and 615 were valid, with an effective recovery rate of 100%. Results: The detection rates of psychological stress and anxiety of medical staff were 13.82% (85/615) and 25.37% (156/615) , respectively. 31-40 years old and working in key departments were risk factors for psychological stress of medical staff (OR=1.779, 2.127) ; Women, frequently washing hands with soap/hand sanitizer/disinfectant were protective factors for psychological stress (OR=0.520, 0.528) . Medical staff working in designated hospitals and key departments were more likely to have anxiety (OR=2.042, 2.702) ; The high fit of the mask to the face and bridge of the nose was a protective factor for the psychological anxiety of medical staff (OR=0.500) . Conclusion: Medical staff show higher stress and anxiety during the epidemic of COVID-19. Psychological intervention should be carried out early, focusing on men, age 31 to 40, medical staff working in designated hospitals and key departments.

Using Meglumine Diatrizoate to improve the accuracy of diagnosis of cracked teeth on Cone-beam CT images.

AIM: To explore in a laboratory setting the feasibility of using Meglumine Diatrizoate (MD) to improve the accuracy of diagnosis of cracked teeth on cone-beam CT (CBCT) images. METHODOLOGY: Twenty-four teeth were cracked artificially by soaking them cyclically in liquid nitrogen and hot water. The number and position of crack lines were evaluated with a dental operating microscope and used as the gold standard. The artificially cracked teeth were then examined using routine scanning (RS) and enhanced scanning (ES) modes, respectively. For the ES mode, MD was painted on the surface of the crack lines, and then, CBCT scanning with the same parameters was performed after 10 min. A radiological graduate student and an experienced radiologist evaluated the presence or absence of crack lines, respectively. The differences between the RS and ES modes were determined and assessed using McNemar's test. Inter-examiner agreement and intra-examiner agreement were assessed using kappa analysis. RESULTS: Fifty-seven crack lines were found in the 24 cracked teeth. In the RS mode, the accuracy of detection of crack lines was 23% (radiological graduate student) and 32% (experienced radiologist), whereas in the ES mode, the accuracy was 61% (radiological graduate student) and 65% (experienced radiologist). The inter-examiner agreement was 0.693 in RS mode and 0.849 in ES mode. The intra-examiner agreement was 0.872 and 0.949 for the radiological graduate student in RS and ES mode respectively; and one for the experienced radiologist both in RS and ES mode. CONCLUSIONS: Compared with routine scanning mode, more crack lines could be detected in enhanced scanning mode using Meglumine Diatrizoate as a contrast medium. MD could be a potential contrast medium to improve the accuracy of detection of crack lines on CBCT images.

[The management for pediatric chronic rhinosinusitis with upper respiratory tract concomitant diseases].

Objective:To analyze the clinical impact of upper respiratory tract concomitant diseases in pediatrics chronic rhinosinusitis(CRS) and treatment methods, efficacy and timing of the concomitant diseases.Method:Two hundred and sixty-seven cases with CRS at a tertiary children's medical center from March 2013 to March 2015 were included in this study. The cases were divided into two groups according to the concomitant diseases. 66 cases without concomitant diseases were allocated into group A；201 cases with concomitant diseases were classified into group B. Group B was further divided into two subgroups according to treatment methods: subgroup B1(97 cases) and subgroup B2(104 cases). Group A and B1 were given the same basic treatment for 3 months，while Group B2 was given the basic plus targeted treatment for the same duration. Comprehensive evaluation was conducted at 3, 6 and 15-months after commencement of treatment. Result:The therapeutic effect of Group A was significantly superior to Group B1 in 3 months（P<0.05）.The clinical efficacy of Group A decreased slightly while Group B1 showed significantly reduced efficacy at 6 and 15-months （all P<0.05）. Comparing Group B1 and B2, the comprehensive effect of Group B2 was considerably better than Group B1 at 3 months（P<0.05）. Furthermore, Group B2 showed no decrease in efficacy while Group B1 decreased significantly at 6 and 15-month. Conclusion:Recurrent upper respiratory tract infections, allergic rhinitis, adenoid hypertrophy and chronic tonsillitis, were common the upper respiratory tract accompanying diseases in children with CRS, and they had significant influence on the efficacy and recurrence of CRS. The basic plus targeted treatment can improve the efficacy and reduce recurrence.

[Clinical effect and airway changes of adjustable oral appliance in the treatment of adult obstructive sleep apnea hypopnea syndrome].

Objective:To investigate the effect of adjustable oral appliance on airway changes and clinical effect in obstructive sleepApnea hypopnea syndrome,and to observe the effect of jaw joints.Method:Forty adult cases diagnosed as OSAHS by polysomnography(PSG), were treated with adjustable oral appliance.After six months,the sleep apnea hypoventilation index(AHI)and the lowest oxygen saturation (LSaO2) by PSG were evaluated. And three-dimensional cone beam computed tomography(CBCT) reconstruction was used to analyze the morphological changes of the upper airway,and the gap of jaw joint preliminarily.Result:After such treatment, LSaO2 level of all cases increased, and AHI reduced(P< 0.01).The total volume and area of the upper airway increased significantly(P< 0.01), There was no obvious anomalies found in jaw joints.Conclusion:The adjustable oral appliance applied to in adult OSAHS can increase the shape and size of the airway,improve the airway ventilation effectively, and have no affection to the jaw joints in initial observation.

Differential roles of Porphyromonas gingivalis lipopolysaccharide and Escherichia coli lipopolysaccharide in maturation and antigen-presenting functions of dentritic cells.

OBJECTIVE: The aim of this research is to study the roles of Porphyromonas gingivalis-lipopolysaccharide (P. gingivalis-LPS) and Escherichia coli-lipopolysaccharide (E. coli-LPS) on maturation and antigen-presenting functions of dendritic cells (DCs), and to provide experimental evidences to explore the possible mechanism of DCs in periodontitis. MATERIALS AND METHODS: Flow cytometry was used to detect CD11c, MHC-II, CD80, CD86 and CD40 expression on DCs which were stimulated by P. gingivalis-LPS or E. coli-LPS and ELISA was used to detect IL-12, IFN-γ, IL-10 and IL-13 secreted by DCs. CCK8 was used to assay CD4+T cells proliferation after co-cultured with DCs stimulated by P. gingivalis-LPS or E. coli-LPS and ELISA was used to detect IL-2, IFN-γ, IL-10 and IL-13 secreted by T cells. TLR4 inhibitor (polymyxin B) or TLR2 and TLR4 inhibitor (OxPAPC) was added to P. gingivalis-LPS group and E. coli-LPS group to observe the effects of these two TLR inhibitors on the maturation and antigen-presenting functions of DCs. RESULTS: The capacity of P. gingivalis-LPS to stimulate DCs maturation was similar to that of E. coli-LPS. The amount of IL-12 and IFN-γ secreted by DCs in P. gingivalis-LPS group was significantly lower than that of E. coli-LPS group (p < 0.05), meanwhile, IL-10 and IL-13 secreted by DCs in P. gingivalis-LPS group was significantly higher than that of E. coli-LPS group (p < 0.05). DCs stimulated by both P. gingivalis-LPS and E. coli-LPS could promote the proliferation of CD4+T cells. The amount of IL-2 and IFN-γ secreted by T cells stimulated by DCs in P. gingivalis-LPS group was significantly lower than that of E. coli-LPS group (p < 0.05), meanwhile, IL-10 secreted by T cells stimulated by DCs in P. gingivalis-LPS group was significantly higher than that of E. coli-LPS group (p < 0.05). When TLR4 inhibitor was added to E. coli-LPS group, maturation and antigen-presenting functions of DCs were significantly inhibited. When TLR4 inhibitor was added to P. gingivalis-LPS group, maturation and antigen-presenting functions of DCs were not significantly inhibited. When TLR2 and TLR4 inhibitor was added to P. gingivalis-LPS group, maturation and antigen-presenting functions of DCs were significantly inhibited. CONCLUSIONS: P. gingivalis-LPS could prime DCs maturation and antigen-presenting functions. DCs stimulated by P. gingivalis-LPS are prone to induce a stronger Th2 cell responses while DCs stimulated by E. coli-LPS are prone to induce a stronger Th1 cell responses. P. gingivalis-LPS triggers DCs through TLR2 pathway while E. coli-LPS triggers DCs through TLR4 pathway.

Vaccine effect of granulocyte-macrophage colony-stimulating factor or CD80 gene-transduced murine hematopoietic tumor cells and their cooperative enhancement of antitumor immunity.

To develop immunogene therapy targeting minimal residual hematopoietic tumor cells in patients, we transduced murine GM-CSF or CD80 gene into murine WEHI 3B myelomonocytic leukemia and EL-4 thymic lymphoma cells using retroviral vectors and evaluated their effects on inducing antitumor responses in syngeneic host mice. Subcutaneously injected GM-CSF- and CD80 gene-transduced WEHI 3B (GMCSF/WEHI/3.2 or CD80/WEHI/1.8, respectively) cells lost their original tumorigenicity in immunocompetent syngeneic mice. Results from tumor inoculation experiments using athymic nude mice suggested that the rejection of GMCSF/WEHI/3.2 in immunocompetent mice depended fully on T cells and that of CD80/WEHI 1.8 depended partly on T cells and partly on NK cells. In both WEHI 3B and EL-4 models, irradiated GM-CSF gene-transduced cells provided strong immuno-protection against wild-type cells, but irradiated CD80 gene-transduced cells did not. A remarkably high cooperative effect was obtained when irradiated GMCSF/EL-4 and CD80/EL-4 were inoculated together. These results suggested that the tumor vaccine effect is efficiently enhanced by GM-CSF gene transduction and CD80 gene transduction induces some protective antitumor immunity in co-operation with GM-CSF gene transduction.

[Clinical study on effect of kang' aibao oral liquid in treating 103 malignant tumor patients].

OBJECTIVE: To observe the clinical efficacy of Kangaibao oral liquid(KABOL), a Chinese herbal preparation in treating malignant turmor of middle or advanced stage. METHODS: A comparative study was done by observing the effect of 103 patients treated with KABOL, and another 90 patients treated with chemotherapy in the same period were taken as a control group for comparison. RESULTS: The immunologic function, short-term effective rate (complete relieved rate and partial relieved rate), survival quality, 1-, 2- and 3-year survival rate, median suvival time, and the CEA declining rate of the KABOL group were significantly higher than those of the control group. CONCLUSIONS: KABOL has the effects of inhibiting tumor growth, prolonging the survival time and improving the quality of survival of tumor patient.