[Research progress and future trends of early-onset gastric cancer].

Early onset gastric cancer (EOGC), defined as gastric cancer occurring at a younger age. Early-onset gastric cancer tends to be poorly differentiated and highly malignant. Genetic material and environmental exposure factors may be the main causes of early occurrence of gastric cancer. Prolonging the survival and improving the quality of life of patients with early-onset gastric cancer is our main research goal in the future. This article aims to elaborate on the current research status and progress of EOGC in terms of its clinicopathological characteristics, molecular genetics, microecological environment, prediction methods, treatment plans, and prognosis, while also exploring potential avenues for future research.

[Risk factors of occult lymph node metastasis of levels â ¢ and â £ in papillary thyroid carcinoma].

Objective: To investigate the potential risk factors for occult lateral cervical lymph node metastasis (LNM) to levels Ⅲ and Ⅳ in patients with papillary thyroid carcinoma (PTC) and the necessity of super-selective lateral lymph node dissection for patients harboring these metastases. Methods: This prospective study included PTC patients who were operated by the same surgeon in the Department of Head and Neck Surgery of Cancer Hospital, Chinese Academy of Medical Sciences from October 2015 through October 2019. Preoperative ultrasound and enhanced Computer Tomography (CT) did not denote suspected enlarged lymph nodes in the lateral neck. All patients underwent lymph node dissection in levels Ⅲ and Ⅳ on the basis of original thyroid collar incision after LNM to level Ⅵ was confirmed by preoperative fine needlebiopsy or intraoperative frozen pathology. Results: Of all 143 patients, 74 (51.7%) had occult LNM in levels Ⅲ and Ⅳ confirmed by postoperative pathology. The average number of metastasized lymph nodes in levels Ⅲ and Ⅳ was 2.64±1.80, and that in level Ⅵ was 3.77±3.27. There was a significant linear positive correlation between the number of metastasized lymph nodes in level Ⅵ and that in levels Ⅲ and Ⅳ (r=0.341, P<0.001). That the metastasized lymph nodes in level Ⅵ equals three was the best predictor of occult lateral LNM to levels Ⅲ and Ⅳ. Univariate analysis showed that age <55 years, tumor size ≥2.0 cm, number of metastasized lymph nodes in level Ⅵ ≥3, and percentage of metastasized lymph nodes in the total number of dissected lymph nodes in level Ⅵ >50% were associated with occult LNM in levels Ⅲ and Ⅳ (P<0.05). Multivariate analysis showed that number of metastasized lymph nodes in level Ⅵ≥3 was an independent risk factor for occult LNM in levels Ⅲ and Ⅳ (P=0.006). Conclusions: Age, tumor size and LNM in level Ⅵ were associated with occult lateral LNM in PTC patients. Lymph node dissection in levels Ⅲ and Ⅳ could be considered for selective patients, since it will help to avoid secondary operation for residual tumor or recurrence resulted from insufficient treatment without increasing the incidence of complications or affecting patients' appearances.

[Preliminary study of superselective lymph node dissection in regional lateral cervical lymph node metastasis of papillary thyroid carcinoma].

Objective: To explore the applied value of super-selective cervical lymph node dissection in papillary thyroid carcinoma (PTC) patients with clinically suspicious lateral lymph node metastasis (LNM). Methods: We retrospectively analyzed the clinical data of 232 cN1b PTC patients who underwent surgery from September 2013 to May 2018 in the Department of Head and Neck Surgical Oncology, National Cancer Center. Among them, 90 cases received super-selective neck dissection (level Ⅲ and IV) and 142 cases underwent selective neck dissection (level Ⅱ-Ⅳ). The LNM of two groups were analyzed. Results: Postoperative pathological results showed that 173 cases had LNM in the central compartment. The LNM cases of level Ⅱ-Ⅳ were 47, 147 and 130, respectively. Eight patients of super-selective neck dissection and 6 of selective neck dissection had postoperative lymphatic fistulas (P=0.146). No patients in super-selective neck dissection group while 9 patients in the selective lymph node dissection group had postoperatively permanent impairment of shoulder mobility, the difference was statistically significant (P=0.015). In the super-selective neck dissection group, 2 patients had long-term postoperative incision discomfort, and 5 cases had obvious cicatrix after surgery. In the patients with selective neck dissection, 27 cases experienced long-term incision discomfort after surgery, and 26 patients had apparent scar tissue, the differences were statistically significant (P<0.005). There was no recurrence during the follow-up. Conclusions: Super-selective neck dissection is a feasible, safe and effective treatment for cN1b PTC patients. It can improve the quality of postoperative life and avoid the over treatment for patients.

[Comparison of quality of life of hypopharyngeal squamous cell carcinoma patients after laryngeal preservation surgery and total laryngectomy].

Objective: To evaluate and compare the quality of life (QOL) in patients with hypopharyngeal squamous cell carcinoma after laryngeal preservation surgery and total laryngectomy. Methods: We selected parts of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 and the Head and Neck Module (EORTC QLQ-C30 and EORTC QLQ-H&N35) and designed the QOL questionnaire. We investigated 42 patients with hypopharyngeal squamous cell carcinoma underwent laryngeal preservation surgery and 38 patients underwent total laryngectomy by QOL questionnaire and followed up their survival. Results: The somatic function dimension, psychological function dimension, and social function dimension of patients underwent laryngeal preservation surgery were (92.46±15.71), (80.56±22.67) and (90.08±19.50), respectively, which were higher than (79.39±32.75), (68.42±25.05) and (61.84±29.55) of the total laryngectomy group (P<0.05), while the economic dimension was not significantly different between the two groups (P>0.05). The social function dimension (including social support and socialization, family relationship) of laryngeal preservation surgery group were (89.04±25.47) for postoperative time < 70 months and (90.94±13.28) for postoperative time ≥70 months, which were higher than (65.48±29.14) and (57.35±30.32) of the total laryngectomy group (P<0.01). Conclusions: The somatic function dimension, psychological function and social function of patients with hypopharyngeal squamous cell carcinoma underwent laryngeal preservation surgery obtain a better QOL than patients underwent total laryngectomy. Therefore, we should improve the laryngeal function and QOL of patients under the premise of ensuring the survival rate.

[Induction of specific CD8(+) T cells against hepatocellular carcinoma-associated neoantigens].

Objective: To predict the tumor neoantigen peptides in hepatocellular carcinoma (HCC), and examine their specific immune effects against the tumor cells without injury to normal cells. Methods: The data of whole-genome sequencing and exome sequencing of HCC tumor and matched non-tumor liver tissues were analyzed to confirm the HCC-associated somatic mutations. Based on the HLA phenotype of the patients, we used NetMHC software to predict the neoantigen epitopes with high binding affinity to their MHC-I molecules. The predicted peptides with mutation sites included were synthesized. GPL10687 platform was applied to examine the gene expression difference between tumor and normal tissues of the selected genes in GSE25097, one of the GEO databases. The quantitative real-time PCR (qRT-qPCR) and immunohistochemistry were used to confirm the expressions in tumors and normal tissues of the selected genes. By using the predicted peptides, we induced the generation of antigen-specific CD8(+) cytotoxic T lymphocytes (CTLs) and examined their specific effects against tumor cells. Results: The mutation frequency of TP53 (tumor protein p53) was 40%, and LAMA3 (Laminin Subunit Alpha 3) was 8% in the analyzed HCC tissues. In GSE25097 database, TP53 and LAMA3 mRNA levels in tumors were 1.57±0.02 and 1.37±0.10, which were significantly increased than those in matched no-tumor tissue (0.54±0.01 and 0.36±0.01, P<0.05). The differences of expression levels of TP53 and LAMA3 in tumor and no-tumor tissues were validated by using qRT-qPCR and immunohistochemistry in 10 HCC tissues. The mRNA levels of TP53 and LAMA3 in tumors were 0.24±0.03 and 0.13±0.06, which were significantly elevated than those in matched no-tumor tissue (0.11±0.01 and 0.01±0.01, P<0.05). Among the Chinese population, HLA-A2 and HLA-A11 and HLA-A24 accounted for 70%, representing the major MHC-I molecules. The CTLs induced by predicted peptides showed cytotoxicity to the targets pulsed with mutated peptide, with no effect on the target pulsed with normal peptide and on normal cells. Conclusions: TP53 and LAMA3 existed relative higher mutation frequency in HCC, and expressed higher in tumor tissues. The induced CTLs by predicted peptides derived from mutation-associated protein could specific kill the target cells without injury to normal cells.

[An experimental study of Zn/Ca/P-containing coatings on titanium implant surface modified by plasma electrolytic oxidation].

Objective: To explore the osteogenic activity of Zn/Ca/P-containing coatings on titanium implant surface modified by plasma electrolytic oxidation (PEO). Methods: Three groups implants including Zn/Ca/P-containing surface treated by PEO in experimental groups and Ca/P-containing and TiO(2) sandblasted surface in control group were randomly inserted in the bilateral mandibular of rabbits. Mechanical testing and implant-bone interface observation were performed at 4, 6, 8, 10 and 12 weeks after implantion. Results: Zn/Ca/P-containing coating presented a microporous structure. The push-out value indicated the statistical differences among the three groups at each observed time point (P<0.05), and implant-bone bonding power reached a maximum value at 12 weeks, those in the Zn/Ca/P-containing group [(1.57±0.26) MPa] was higher than those in the group with sandblasted surface [(0.83±0.24) MPa] (P<0.05). Histological examination and implant-bone interface observation using field scaning electron microscope (FSEM) showed that the new bone of implant-bone interface increased with healing time and the result from Zn/Ca/P-containing group was superior to that from the control groups at each observed time point. Conclusions: Zn/Ca/P-containing coatings by PEO can accelerate bone formation and remodeling, and enhance bone-implant bonding force.

[Association between sleep and leukocyte telomere length in middle-aged and older adults].

Objective: To understand the association between peripheral leukocytes telomere length (TL) and sleep in middle-aged and old adults. Methods: A total of 176 middle-aged and old adults were investigated by using the Pittsburgh Sleep Quality Index and questionnaire. TL was measured by fluorescence quantitative PCR. The correlation and regression analysis between sleep and telomere length was performed. Results: TL had a mean T/S ratio of 0.995±0.23. There was a negative correlation between TL and age (r=-0.241, P=0.003). With increasing age, sleep quality became worse (r=-0.230, P<0.01), the time to fall asleep became longer (r=0.227, P<0.01), sleep duration was shorter (r=-0.486, P<0.01), sleep efficiency became worse (r=-0.226, P<0.01). After controlling for the effects of gender, age, marital status, income level, residence, smoking, drinking, physical exercise and disease status, multiple linear regression analysis indicated that sleep quality (ß=0.057, P<0.01), time to fall asleep (ß=-0.046, P<0.01), sleep duration (ß=0.086, P<0.01) were independent influencing factors of telomere length, suggesting that the people who had better sleep quality, the shorter time to fall asleep, the longer sleep time would have longer telomere length. Conclusions: Sleep is a relevant factor affecting TL in middle-aged and elderly population. Good sleep may delay aging by slowing TL. We encourage to conduct health education about the importance of sleep quality in community.

[Levels of dichlorodiphenyltrichloroethane internal exposure levels in pregnant women of Xiamen and influencing factors].

Objective: To investigate the level of and factors influencing internal exposure to dichlorodiphenyltrichloroethane (DDT) in pregnant women. Methods: In all, 1 064 pregnant women were recruited in a hospital of Xiamen. Participants were asked to complete a questionnaire to obtain data on sociodemographic characteristics and lifestyle. Peripheral venous blood and cord blood samples were collected. Of the 1 064 pregnant women, 600 were enrolled in this study after completing the questionnaire and providing peripheral venous blood and cord blood. Among those women, 150 were selected randomly using a systematic sampling method. A gas chromatography coupled electron capture detector was used to determine the concentration of six DDT homologues: p,p'-dichlorodiphenyltrichloroethane (p,p'-DDT), o,p'-dichlorodiphenyltrichloroethane (o,p'-DDT), p,p'-dichlorodiphenyldichloroethane (p,p'-DDD), o,p'-dichlorodiphenyldichloroethane (o,p'-DDD), p,p'-dichlorodiphenylethylene (p,p'-DDE), and o,p'-dichlorodiphenylethylene (o,p'-DDE) . Pregnant women were divided into two groups according to DDT concentration: a low concentration group (detection value≤P50) and a high concentration group (detection value>P50). multivariate logistic regression was used to analyze the association between the DDT levels and potential influencing factors which investigated in the questionnaire. Results: The detection rates of p,p'-DDT, o,p'-DDT, p,p'-DDD, o,p'-DDD, p,p'-DDE and o,p'-DDE in the peripheral venous blood samples from the 150 pregnant women were 83.3% (125), 29.3% (44), 58.0% (87), 24.0% (36), 82.0% (123), and 34.7% (52), respectively. The median concentrations were 1.56, 0.03, 0.07, 0.03, 0.93 and 0.03 µg/ml, respectively. The detection rates of p,p'-DDT, o,p'-DDT, p,p'-DDD, o,p'-DDD, p,p'-DDE and o,p'-DDE in the cord blood samples were 69.3% (104), 10.7% (16), 29.3% (44), 20.7% (31), 81.3% (122) and 45.3% (68), and the median concentrations were 0.41, 0.03, 0.03, 0.03, 0.42 and 0.03 µg/ml, respectively. The concentration ranges in the low and high DDT concentration groups which contained 75 respondents respectively were 0-3.69 and 3.74-82.09 µg/ml, respectively. In the single-factor analysis, the number (percentage) of those who consumed seafood " rarely" , "less than twice a week" , and " twice a week or more" was 15 (20.3%), 22 (29.7%), and 37 (50.0%), respectively, in the low concentration group, and 4(5.3%), 20(26.7% ), and 51(68.0% ) in the high concentration group (χ2=8.69, P=0.013). The results of the multivariate logistic regression analysis indicate that pregnant women who consume seafood less than twice a week, twice a week or more have higher peripheral blood DDT concentrations compared with those who rarely consume seafood. The OR (95% CI) values were 1.14 (1.08-1.21), 2.11 (1.55-2.85), respectively. Conclusion: The exposure level of pregnant women to DDTs in the Xiamen area is higher than that of women in other regions. High seafood intake is a risk factor for internal exposure to DDTs.

[Studies on chemical constituents in fruit of Lycium barbarum L].

OBJECTIVE: To study the chemical constituents in the fruit of Lycium barbarum. METHOD: The chemical constituents were isolated by column chromatography and identified by spectral data. RESULT: The compounds obtained were identified as scopoletin(I), beta-sitosterol(II), p-coumaric acid(III), glucose(IV), daucosterol(V) and betaine(VI). CONCLUSION: Compounds III, IV and V were isolated from Lycium barbarum for the first time.

[Cloning and expression of ScFv gene against alpha-toxin of Clostridium perfringens type A].

The VH and VL genes from a hybridoma cell line producing mouse McAb against alpha-toxin of Clostridium perfringens type A were amplified by RT-PCR. The VH and VL genes were connected thought a flexible linker (Gly4Ser)3 and the VH-linker-VL (ScFv) gene was cloned into a vector pGEM-T. The ScFv gene consists of 726 bp encoding 242 amino acid residues. Both VH and VL genes were confirmed as functionally rearranged mouse immunoglobulin variable region. According to kabat classed method, the VH and VL gene segments belong to mouse Ig heavy chain subgroup II (B) and kappa light chain subgroup III respectively. The ScFv gene was amplified inserted the expression vector pHOG21 and transformed into E coli XL1-BLUE. The ScFv protein was highly expressed in recombinant strain XL1-BLUE (pHOG-2E3) and the expression level of the ScFv was about 25% of total bacteria protein by SDS-PAGE. The neutralization assay showed that the expressed ScFv protein could neutralize the phospholipase C activities of alpha-toxin.

International comparison of baccalaureate nursing degrees: collaboration in qualitative analysis.

This paper describes a study which investigated the perceived similarities and differences of a selection of baccalaureate nursing degrees from different continents. An international research team was formed, and by using a modified version of the Delphi process and nominal group techniques the group undertook a qualitative analysis of curriculum documents. The major areas analysis were: aims, content, methods and assessment. Under these headings the group produced a list of key issues supported by a number of indicative statements by collating the independent analyses undertaken by each of the team members. Examples of findings are that critical thinking and personal development are most obvious in aims but that the progression of curricula may not achieve this, there are differences in 'western' and 'asian' orientations to the concept of personal autonomy. Sciences are valued more than arts or humanities. The lecture method as well as practice placement dominate the teaching methods. Transcultural nursing is not significant except where there are two therapeutic ideologies in existence. Assessment methods are largely summative. The findings have application in the development of credit transfer and international exchange schemes. The conclusions highlight areas of special considerations when designing such schemes.

Primary ovarian pregnancy. Report of fifteen cases.

From June 1973 through November 1988, fifteen cases of ovarian pregnancy were admitted to the Shanghai First People's Hospital. All these cases met the four criteria for the diagnosis as listed by Spiegelberg. The incidence of ovarian pregnancy as compared to those of normal and ectopic pregnancy are 1:3 179 and 1:28.1, respectively, which are higher than foreign data reported. Ovarian pregnancy is quite similar to tubal pregnancy in clinical manifestations. Etiological analysis does not reveal any close relationship with inflammation of the female genital tract. However, application of IUD increases the risk of ovarian pregnancy. The principle of management is wedge resection of the diseased ovary.