[Research on applying genetic and environmental risk score in risk-adapted colorectal cancer screening].

Objective: To evaluate the effectiveness of a risk-adapted colorectal cancer screening strategy constructed utilizing genetic and environmental risk score (ERS). Methods: A polygenic risk score (PRS) was constructed based on 20 previously published single nucleotide polymorphisms for colorectal cancer in East Asian populations, using 2 160 samples with MassARRAY test results from a multicenter randomized controlled trial of colorectal cancer screening in China. The ERS was calculated using the Asia-Pacific Colorectal Screening Score system. Logistic regression was used to analyze the association between PRS alone and PRS combined with ERS and colorectal neoplasms risk, respectively. We also designed a risk-adapted screening strategy based on PRS and ERS (high-risk participants undergo a single colonoscopy, low-risk participants undergo an annual fecal immunochemical test, and those with positive results undergo further diagnostic colonoscopy) and compared its effectiveness with the all-acceptance colonoscopy strategy. Results: The high PRS group had a 26% increased risk of colorectal neoplasms compared with the low PRS group (OR=1.26, 95%CI: 1.03-1.54, P=0.026). Participants with the highest PRS and ERS were 3.03 times more likely to develop advanced colorectal neoplasms than those with the lowest score (95%CI: 1.87-4.90, P<0.001). As the risk-adapted screening simulation reached the third round, the detection rate of the PRS combined with ERS strategy was not statistically different from the all-acceptance colonoscopy strategy (8.79% vs. 10.46%, P=0.075) and had a higher positive predictive value (14.11% vs. 10.46%, P<0.001) and lower number of colonoscopies per advanced neoplasms detected (7.1 vs. 9.6, P<0.001). Conclusion: The risk-adapted screening strategy combining PRS and ERS helps achieve population risk stratification and better effectiveness than the traditional colonoscopy-based screening strategy.

Low expression of lncRNA MGC27345 is associated with poor prognosis in gastric cancer patients.

OBJECTIVE: A series of evidence showed that long non-coding RNAs (lncRNAs) play an essential regulatory role in the occurrence and development of human cancer, and is a potential biological target in the fight against cancer. PATIENTS AND METHODS: In this research, we investigated the role of lncRNA MGC27345 in gastric cancer (GC), the expression of MGC27345 in GC was detected by quantitative Real-Time PCR in GC tissue from 235 patients. The correlations between MGC27345 expression and clinicopathological variables and survival were evaluated by the Chi-square test. Kaplan-Meier method (log-rank test), univariate and multivariate Cox regression assays were carried out for the identification of the survival and independent risk factors for GC. RESULTS: MGC27345 expression levels were significantly decreased in GC tissues than in adjacent normal specimens. Lower expression of MGC27345 was found in advanced tumor stages. GC patients with low-expression of MGC27345 had a poorer overall survival compare to those with high-expression of MGC27345. Furthermore, MGC27345 was an independent protective prognosis factor in GC development. CONCLUSIONS: Our data indicated that MGC27345 may have a diagnostic and prognostic value for patients with advanced gastric cancer and assist to improve clinical outcomes for GC patients.

The long non-coding RNA DDX11-AS1 facilitates cell progression and oxaliplatin resistance via regulating miR-326/IRS1 axis in gastric cancer.

OBJECTIVE: The long non-coding RNA DDX11 antisense RNA 1 (DDX11-AS1) was found to be highly expressed in gastric cancer (GC). This study was to explore the role and molecular mechanism in oxaliplatin (OXA) resistance. PATIENTS AND METHODS: The levels of DDX11-AS1, microRNA-326 (miR-326) and insulin receptor substrate 1 (IRS1) were measured by quantitative Real-time polymerase chain reaction (qRT-PCR). Cell proliferation, migration, invasion and apoptosis were examined by methylthiazolyldiphenyl-tetrazolium bromide (MTT), transwell and flow cytometry assays, respectively. Levels of all protein were detected using Western blot. The correlation between miR-326 and DDX11-AS1/IRS1 was confirmed by Dual-Luciferase reporter and RNA immunoprecipitation (RIP) assays. The xenograft model was constructed to explore the effect of DDX11-AS1 in vivo. RESULTS: DDX11-AS1 was overexpressed in OXA-resistant GC tissues and cells, and DDX11-AS1 knockdown inhibited cell proliferation, migration, invasion and OXA resistance, and promoted apoptosis in OXA-resistant GC cells. Mechanically, DDX11-AS1 directly targeted miR-326 and miR-326 could bind to IRS1 in OXA-resistant GC cells. Functionally, silencing DDX11-AS1 repressed the progression and OXA resistance in OXA-resistant GC cells by down-modulating IRS1 expression via sponging miR-326 in vitro and in vivo. CONCLUSIONS: DDX11-AS1 accelerated the progression and OXA chemoresistance of GC cells in vitro and in vivo by sponging miR-326, thus increasing the expression of IRS1, suggesting DDX11-AS1 might be a promising prognostic biomarker and therapeutic target in GC.

Overexpression of long noncoding RNA HOXC13-AS and its prognostic significance in hepatocellular carcinoma.

OBJECTIVE: The long noncoding RNA HOXC13 antisense RNA (HOXC13-AS) was overexpressed in several tumor specimens, and its overexpression was correlated with cells metastasis of tumors. However, its effects in other tumors remained largely unclear. In this work, we aimed to identify whether HOXC13-AS was abnormally expressed in hepatocellular carcinoma (HCC) and further explore its prognostic value. PATIENTS AND METHODS: QRT-PCR was applied for the examination of HOXC13-AS levels in 197 paired HCC specimens and matched non-tumor specimens. Chi-square tests were carried out for the verification of the relations between the levels of HOXC13-AS and the clinicopathologic features of HCC patients. The Kaplan-Meier methods were applied for the exploration of the prognostic value of HOXC13-AS. Multivariate analysis was performed using the Cox proportional hazard assays. RESULTS: Up-regulation of HOXC13-AS was observed in HCC tissues compared to matched normal tissues (p < 0.01). Higher levels of HOXC13-AS were associated with TNM stage (p = 0.024) and lymph node metastasis (p = 0.043). Survival assays showed that HCC patients with high-HOXC13-AS expressions had significantly shorter overall survival (p < 0.0106) and disease-free survival (p < 0.0066) compared to their counterparts with low-HOXC13-AS expressions. Multivariate analyses suggested HOXC13-AS as an independent prognostic factor for HCC patients. CONCLUSIONS: We showed that HOXC13-AS might serve as a promising biomarker for prognosis prediction of HCC.

MiR-296-5p inhibits cell invasion and migration of esophageal squamous cell carcinoma by downregulating STAT3 signaling.

OBJECTIVE: Many studies have emphasized the function of microRNA-296 (miR-296) that inhibits tumor formation. To some extent, the role of miR-296 in esophageal squamous cell carcinoma (ESCC) remains misleading. Therefore, the current research was designed to investigate the regulatory mechanisms of miR-296 and signal transducer and activator of transcription 3 (STAT3) in ESCC. PATIENTS AND METHODS: The mRNA expression of miR-296-5p and STAT3 in ESCC tissues or cell lines was measured via quantitative Real Time-Polymerase Chain Reaction (qRT-PCR). The protein level of STAT3 was measured by Western blotting assay. The Luciferase reporter assay was used to verify the binding sites between miR-296-5p and STAT3. The transwell assay was employed to identify cell migration and invasion. RESULTS: Down-regulation of miR-296-5p was detected in ESCC tissues and cell lines (p<0.01). Additionally, miR-296-5p was found to target STAT3 directly. Functionally, up-regulation of miR-296-5p or down-regulation of STAT3 significantly inhibited cell migration and invasion in ESCC. CONCLUSIONS: MiR-296-5p inhibited cell invasion and migration in ESCC by downregulating STAT3. The overexpression of miR-296-5p by targeting STAT3 suppressed tumorigenesis of ESCC cells.

[Giant angioleiomyoma of the neck: a rare tumor case and literature review].

Summary The patient was admitted of the chief complain "progressive snoring for two years, gradual enlargement of the neck neoplasm for six months". Specific examination indicated that bilateral cervical-mandibular margin to cervical root diffuse apophysis, most notably in the right thyroid plane.Posterior pharyngeal wall underwent an apophysis while no related vein engorgement was noticed. Ultrasound examination indicated that multiple hypoechoic nodules with calcification from posterior thyroid to submandibular. MRI examination indicated bilateral posterior pharyngeal plexus malformation. The patient was first treated with angiography and embolization in the department of interventional and followed by "cervical mass resection" in the department of otorhinolaryngology head and neck surgery. The tumor size was 11 cm×8 cm×3 cm. Histology of the tumor was angioleiomyoma with immunohistochemical results Desmin（+），SMA（+），CD31（-），CD34（+），Ki67（+，1%），Vimentin（+），D-240（-），p53（-）.

[Organizing an assembly to eliminate hepatitis B virus through a project zero mother-to-child transmission of hepatitis B virus].

The China Foundation of Hepatitis Prevention and Control (CFHPC) initiated a project named, "getting to zero mother-to-child transmission of Hepatitis B," in July 2015, which aims to further reduce the incidence of mother-to-child transmission through standardized follow-up management of pregnant women and their infants with chronic hepatitis B virus infection by means of mobile medical application. Over the past three years, the project has established a nationwide collaborative network for interruption of mother-to-child transmission of hepatitis B virus, with 123 hospitals as project members. In addition, it has formulated a technical guidance document (Clinical Management Algorithm for Interrupting Mother-to-Child Transmission of HBV), which is designed and developed as a mobile medical application (SHIELD APP), and was released in an international conference on the theme to eliminate viral hepatitis. Following the measures mentioned above, the public's awareness rate of hepatitis B have been raised, and a good social atmosphere has been formed, which has played a positive role in promoting the prevention and control of viral hepatitis in China.

[Clinical features and short-term prognosis of Holmes' tremor].

Objective: To explore the clinical characteristics and short-term prognosis of Holmes' tremor (HT) patients. Methods: The clinical and imaging data of HT patients in 5 teaching hospitals between January 2014 and January 2018 were retrospectively analyzed, and Fahn-Tolosa-Marin Tremor Rating Scale (TRS) was used to compare the clinical severity and short-term prognosis between the different subtypes. Results: (1) The time from primary disease to tremor onset was 2 days to 20 months (median time 29 d) in 23 patients with HT enrolled, and the most common cause of HT was cerebrovascular disease (78.3%). (2) The most common involved locations were midbrain (65.2%), thalamus (47.8%) and cerebellum (30.4%). No significant difference in total TRS scores between the isolated lesion group (12 cases) and multiple lesions group (11 cases) (P=0.57), while the scores of the mesencephalic group (15 cases) was significantly higher than the non-mesencephalic group (8 cases) (P=0.00). (3) One case was treated with deep brain stimulation (DBS), while 22 cases were treated with medical therapy. Levodopa combined with clonazepam (7/12) and single levodopa (9/20) were partially effective. (4) At the 3-month follow-up after discharge, patients received DBS had good prognosis. Among the 22 patients treated with medicine, only 8 (36.4%) patients had good outcomes. The short-term prognosis was not significantly different between the isolated and multiple lesion groups (P=0.40), while it was worse in the mesencephalic group than the non-mesencephalic group (P=0.02). Conclusion: The most common cause of HT is cerebrovascular disease, and primary lesions are midbrain, thalamus, and cerebellum. The pharmacologic agents are partially valid for disease control of HT and the short-term prognosis is poor, while the patients with mesencephalic involvement have more severe tremor and worse prognosis.

[Effects of short-term intervention of walking on body mass index, waist circumference, and related indicators of working population].

Objective: To quantify the effects of short-term walking intervention on body mass index (BMI), waist circumference, and related indicators of working population. Methods: The China Motivational Healthy Walking Program in 2016 recruited 29 224 individuals from 139 demonstration areas for comprehensive prevention and control of chronic and non-communicable diseases at the national level and 70 areas at the provincial level. All subjects volunteered to participate into this program. The intervention lasted 100 days from June to September 2016. The walking behavior, height, weight and waist circumference of subjects were measured using a uniform pedometer, body composition tester, height tester and waist-to-hip caliper before and after the intervention. Daily average steps, daily average effective steps, and the percent of fulfilling continuous walking per day were used as main indicators in this study. Self-administered questionnaires were used to collect demographic characteristics, behaviors and chronic diseases. With the adjustment of potential confounding factors, multilevel regression was used to quantify the effect of walking on BMI and waist circumference, and multilevel logistic regression was used to quantify the effect on overweight or obesity and central obesity. Results: A total of 12 368 subjects completed walking interventions and all measurements included in this study. The mean±SD age of all subjects was (41.19±8.99) years, and 5 155 (59.17%) of them were women. After 100-day intervention, all outcome variables decreased significantly. For every additional 1 000 steps per day, subjects would have extra decrease in BMI of 0.023 kg/m(2) [ß (95%CI): -0.023 (-0.030, -0.017)], in waist circumference of 0.046 cm [ß (95%CI): -0.046 (-0.071, -0.020)], and the likelihood for becoming overweight or obesity was 0.97 times [OR (95%CI): 0.97 (0.95, 0.98)] that of before intervention. With additional 1 000 effective steps per day, the difference between baseline and endpoint increased by 0.028 kg/m(2) [ß (95%CI): -0.028 (-0.035, -0.020)] in BMI and 0.062 cm [ß (95%CI): -0.062 (-0.091, -0.033)] in waist circumference. The likelihood of progressing into overweight or obesity was 0.97 times [OR (95%CI): 0.97(0.95, 0.98)] that of before-intervention, and the likelihood of becoming central obesity was 0.98 times [OR (95%CI): 0.98(0.96, 0.99)] that of before-intervention. Compared to subjects with low level percent of fulfilling continuous walking per day, those with high level would have an extra decrease in BMI by 0.150 kg/m(2) [ß (95%CI): -0.150 (-0.22, -0.079)], in waist circumference by 0.340 cm [ß (95%CI): -0.340 (-0.620, -0.064)], and the likelihood of becoming overweight or obesity decreased to 0.74 times that of the low level group [OR (95%CI): 0.74(0.62, 0.89)] and the likelihood of becoming central obesity decreased to 0.78 times that of the low level group [OR (95%CI): 0.78 (0.68, 0.91)]. Conclusion: Strengthening walking exercise in the short term has a positive effect on promoting working population to reduce BMI and waist circumference, and prevent overweight, obesity and central obesity.

Long noncoding RNA LINC01510 is highly expressed in colorectal cancer and predicts favorable prognosis.

OBJECTIVE: Long noncoding RNAs (lncRNAs) have recently emerged as important regulators in governing fundamental biological processes, as well as in tumorigenesis. LncRNA LINC01510 (LINC01510) was recently shown to be involved in colorectal cancer (CRC); however, its role in CRC remains unknown. The objective of this study was to evaluate LINC01510 expression and its relevance to the prognosis of CRC. PATIENTS AND METHODS: LINC01510 expression was detected in CRC tissues and cell lines by using quantitative real-time PCR (qRT-PCR). The correction between LINC01510 expression and clinical characteristics was evaluated with x2-test. Survival curves and log-rank test were used to analyze patients' survival. A Cox proportional hazard model was constructed to evaluate the association of LINC01510 expression with overall survival and disease-free survival, respectively. RESULTS: Here, we found that the levels of LINC01510 in CRC tissues were significantly higher than those in matched tumor-adjacent tissues. Moreover, high LINC01510 expression was observed to be closely correlated with histology/differentiation (p = 0.001), depth of invasion (p = 0.004) and TNM stage (p = 0.003). From the Kaplan-Meier survival curves, it was observed that patients with high expression of LINC01510 had shorter overall survival (p = 0.004) and disease-free survival (p = 0.000) as compared with the LINC01510-low group. In the multivariate analysis, high LINC01510 expression was an independent prognostic factor for both overall survival (p = 0.001) and disease-free survival (p = 0.001). CONCLUSIONS: We demonstrated that low LINC01510 expression was associated with the progression of CRC and could serve as a potential independent prognostic biomarker for patients with CRC.

[Textual research on the medical books of Liao Dynasty with extant titles].

There are only 3 extant medical book titles from 2 authors of the Liao Dynasty, from which almost no medical books were handed down; these include Zhi lu gu mai jue (Zhilugu's Pulse Study in Verse), Zhi lu gu zhen jiu shu (Zhilugu's Book of Acu-moxibustion) and Medical Book on Pulse and Prescriptions Translated by Yelü Shucheng. The former two books are written by Zhilugu during the reign of Taizong Emperor (927-947) of the Liao Dynasty, and the last one, by Yelü Shucheng during the reign of Xingzong Emperor (1031-1055) of the Liao Dynasty.

[Evaluation of training course of hepatic disease in grass roots clinical hepatic physicians in some poverty-stricken counties in Shanxi and Shaanxi provinces].

Objective: To understand the awareness of hepatic disease related knowledge among hepatic physicians in poverty-stricken counties in China, assess the effectiveness of training and provide a reference for the training in the future. Methods: The training was conducted in 90 clinical hepatic physicians selected from county hospitals in poverty-stricken counties (or cities) in Shanxi and Shaanxi provinces. An examination was conducted before the training, immediately after the training and at 5(th) month after the training, respectively. One-way analysis of variance and χ(2) test were conducted to evaluate the score and the correct rate. Results: The knowledge score was (42.96±14.02) before the training, (62.86±13.28) immediately after the training and (59.03±17.92) at 5(t)h month after the training, and the differences were significant. After the training, the awareness of all aspects of related knowledge was improved, the difference was significant compared to knowledge score before training, and at 5(th) month after the training, the difference was still significant. Conclusion: After the training, the awareness of liver disease related knowledge of clinical hepatic physicians in poverty-stricken counties (cities) in Shanxi and Shaanxi provinces was improved, and the improvement could be maintained for nearly half a year.

[Effects and the associated factors of the 2016 China Motivational Healthy Walking Program among occupational population].

Objective: To examine the effects and associated factors of the China Motivational Healthy Walking Program among occupational population. Methods: The 2016 China Motivational Healthy Walking Program recruited 29 224 participants from 139 demonstration areas for comprehensive prevention and control of chronic and non-communicable disease at national level and 70 at provincial level. Intervention on walking was carried out by adopting group and individual motivating measures. Walking steps were recorded by electronic pedometer. We used percent of days achieving 10 000 steps (P10 000), percent of days fulfilling continuous walking (PCW), and proportion of valid walking (PVW) steps to reflect walking quantity, pattern and quality of participants. Motivation intensity was measured by summing up scores of each motivating activity. Questionnaire-based online survey collected information about demographic characteristics, lifestyle risk factors and chronic diseases. This study finally included 12 368 individuals in the analysis. Multilevel logistic regression model was used to assess the effect of group and individual motivating measures on walking activity and corresponding associated factors. Results: Age of the study sample was (41.2±8.99) years, and 58.17% (7 194) of them were female. After 100-day intervention, the P10 000, PCW and PVW of all participants were 93.89%±14.42%,92.01%±15.97% and 81.00%±7.45%, respectively. The mean P10 000 and PCW increased with rising group-motivated scores, self-motivated scores and individual-activity scores (P<0.001 for all). The mean PVW decreased with both higher group-motivated scores and self-motivated scores (both P<0.05), and varied little among groups with different level individual-activity scores (P=0.525). According to the results from the multilevel model, those who had greater group-motivated scores and self-motivated scores tended to have more likelihood of high-level of P10 000 and PCW. Age, sex, smoking status, education attainment and alcohol drinking were associated with P10 000 and PCW (P<0.05 for all). Conclusion: The Motivational Healthy Walking Program had positive effect on promoting healthy walking among occupational population. Group-motivated and self-motivated activities were associated with healthy walking.

Serum hepatitis B surface antigen correlates with fibrosis and necroinflammation: A multicentre perspective in China.

The kinetics of serum hepatitis B surface antigen (HBsAg) during the natural history of hepatitis B virus (HBV) infection has been studied, but the factors affecting them remain unclear. We aimed to investigate the factors affecting HBsAg titres, using data from multicentre, large-sized clinical trials in China. The baseline data of 1795 patients in 3 multicentre trials were studied, and the patients were classified into 3 groups: hepatitis B early antigen (HBeAg)-positive chronic HBV infection (n = 588), HBeAg-positive chronic hepatitis B (n = 596), and HBeAg-negative chronic hepatitis B (n = 611). HBsAg titres in the different phases were compared, and multiple linear progression analyses were performed to investigate the implicated factors. HBsAg titres varied significantly in different phases (P = .000), with the highest (4.60 log10 IU/mL [10%-90% confidence interval: 3.52 log10 IU/mL-4.99 log10 IU/mL]) in patients with HBeAg-positive chronic HBV infection. In all phases, age and HBV DNA were correlated with serum HBsAg level. In HBeAg-positive chronic hepatitis B patients, a negative correlation between HBsAg titres and fibrosis stage was observed. Alanine amonitransferase or necroinflammatory activity was also correlated with HBsAg titres in HBeAg-negative chronic hepatitis B patients. In conclusion, decreased HBsAg titres may be associated with advancing fibrosis in HBeAg-positive chronic hepatitis B patients or increased necroinflammation in those with HBeAg-negative chronic hepatitis B. Our findings may help clinicians better understand the kinetics of HBsAg and provide useful insights into the management of this disease.

Diagnostic value of various noninvasive indexes in the diagnosis of chronic hepatic fibrosis.

OBJECTIVE: Hepatic fibrosis is a repair response to chronic liver injury. This study evaluated the diagnostic value of various noninvasive indicators for hepatic fibrosis in patients with chronic liver disease. PATIENTS AND METHODS: 95 patients with liver biopsy were enrolled in this study. Routine clinical and laboratory examinations were collected, including age, sex, blood routine, biochemistry, serum fibrosis, and FibroTouch. APRI and FIB4 scores were calculated. The patients were grouped according to liver pathological staging to analyze the correlation between the fibrosis with serum fibrosis, APRI, FIB4 score, and FibroTouch. The receiver operator characteristics of S2, S3, and S4 were analyzed to calculate the area under the curve (AUC). RESULTS: No statistical difference was found on age, ALT, AST, GGT, BMI, TG, CHOL, and Glu (p > 0.05). Liver stiffness measurement (LSM), APRI, FIB4, PCIII, CIV, LN, and HA exhibited statistical significance (p < 0.05). Further correlation analysis showed that PCIII, IV-C, LN, APRI, LSM, and FIB4 were positively correlated with the stage of hepatic fibrosis (p < 0.05). ROC curve analysis demonstrated that LSM and FIB4 revealed good predictions of various stages of fibrosis in chronic liver disease with AUC greater than 0.7. The AUC of LSM in the diagnosis of liver cirrhosis (S4) reached 0.908. Its accuracy was influenced by liver inflammation. CONCLUSIONS: The LSM value in FibroTouch showed high coincidence rate with hepatic fibrosis staging. It is a valuable noninvasive method for assessing the progression of hepatic fibrosis in chronic liver disease.

Predictive values of FAP and HGF for tumor angiogenesis and metastasis in colorectal cancer.

This study aims to explore the correlation of hepatocyte growth factor (HGF) and fibroblast activation protein (FAP) expressions with the angiogenesis and metastasis in colorectal cancer (CRC). The immunohistochemical SABC method was used to detect HGF and FAP expressions in 127 CRC tissues, 51 colorectal polyp tissues and 28 normal tissues. HGF and FAP expressions in liver metastasis were detected using western blot to analyze the correlation of their expressions with lymph node metastasis and liver metastasis. Micro-vessel density (MVD) and clinic-pathologic information of CRC patients were recorded and analyzed. In CRC group, HGF and FAP expressions were greatly higher than those in normal group and colorectal polyps group (P < 0.05). Moreover, the positive rates of HGF and FAP expressions in lymph node metastasis were evidently higher than those in non-lymph node metastasis (P < 0.05). In liver metastasis group, HGF and FAP expressions were obviously higher than non-liver metastasis group (P < 0.05). CRC group had much more MVD in comparison with normal group and colorectal polyps group (P < 0.05).When compared with negative group, MVD was significantly higher than that in CRC tissue with positive HGF and FAP (P < 0.05). Spearman rank correlation analysis showed that HGF and FAP were in positive correlation with MVD (r = 0.542, P < 0.001; r = 0.753, P < 0.001). These results indicate that FAP and HGF play an important role in CRC angiogenesis, and their expression levels are valuable to predict CRC liver metastasis and lymph node metastasis.

Analysis of potential dynamic concealed factors in the difficulty of lower third molar extraction.

BACKGROUND: The purpose of this study was to identify potential concealed variables associated with the difficulty of lower third molar (M3) extractions. MATERIAL AND METHODS: To address the research purpose, we implemented a prospective study and enrolled a sample of subjects presenting for M3 removal. Predictor variables were categorized into Group-I and Group-II, based on predetermined criteria. The primary outcome variable was the difficulty of extraction, measured as extraction time. Appropriate univariate and multivariate statistics were computed using ordinal logistic regression. RESULTS: The sample comprised of 1235 subjects with a mean age of 29.49 +/- 8.92 years in Group-I and 26.20 +/- 11.55 years in Group-II subjects. The mean operating time per M3 extraction was 21.24 +/- 12.80 and 20.24 +/- 12.50 minutes for Group-I and Group-II subjects respectively. Three linear parameters including B-M2 height (distance between imaginary point B on the inferior border of mandibular body, and M2), lingual cortical thickness, bone density and one angular parameter including Rc-Cs angle (angle between ramus curvature and curve of spee), in addition to patient's age, profile type, facial type, cant of occlusal plane, and decreased overbite, were found to be statistically associated ( p < or = 0.05) with extraction difficulty under regression models. CONCLUSIONS: In conclusion, our study indicates that the difficulty of lower M3 extractions is possibly governed by morphological and biomechanical factors with substantial influence of myofunctional factors. PRACTICAL IMPLICATIONS: Preoperative evaluation of dynamic concealed factors may not only help in envisaging the difficulty and planning of surgical approach but might also help in better time management in clinical practice.

[The effect of liraglutide in combination with human umbilical cord mesenchymal stem cells treatment on glucose metabolism and ß cell function in type 2 diabetes mellitus].

OBJECTIVE: To observe the effect of liraglutide (LIRA) in combination of umbilical cord mesenchymal stem cells (hUC-MSCs) in treating type 2 diabetes mellitus. METHODS: Eligibility criteria for subjects includes: type 2 diabetes mellitus with more than 10 years duration; having been treated with secretagogues, metformin and insulin in combination with LIRA for at least 6 months; poor glycemic control [glycosylated hemoglobin A1c(HbA1c) 7%-10%]. Totally, twelve patients were enrolled and randomly divided into two groups: the group A (LIRA group, n=6) and the group B (LIRA+ hUC-MSCs group, n=6). The hUC-MSCs were transplanted through infusing of 1×10(6) cells /kg via pancreatic artery directed by interventional radiology on the first day, and followed by infusing 1×10(6) cells /kg through peripheral vein on the eighth, the fifteenth and the twenty-second day sequentially. The control subjects were infused with saline. Both groups were treated with LIRA for 24 weeks at the same period. Fasting plasma glucose(FPG), 2h postprandial plasma glucose(2hPG) and HbA1c were measured. A 75 g oral glucose tolerance test(OGTT)was performed. The early phase of C peptide(CP) secretion function(ΔCP30/ΔG30), the total amount of C peptide secretion function(AUCCP180)and Homeostasis model assessment of insulin resistance (HOMA-IR) were calculated. RESULTS: (1) The baseline FPG, 2hPG, HbA1c, ΔCP30/ΔG30, AUCCP180 and HOMA-IR were comparable between the two groups(P>0.05). (2) Compared with subjects in group A, FPG, 2hPG and HbA1c levels were significantly decreased in subjects in group B [(8.33±0.99) mmol/L vs (6.64±0.79)mmol/L, (13.85±0.86) mmol/L vs (8.65±1.12) mmol/L, (7.82±0.31)% vs (6.82±0.53)%, P<0.05]. (3) Compared with group A, ΔCP30/ΔG30 and AUCCP180 were significantly increased, and HOMA-IR was significantly decreased in group B(0.22±0.13 vs 0.70±0.38, 12.52±5.30 vs 21.16±3.17, 9.46±4.88 vs 4.30±2.68, P<0.05). CONCLUSION: LIRA treatment in combination with hUC-MSCs improves glucose metabolism and the ß cell function in type 2 diabetic patients. (ClinicalTrials.gov NCT01954147).

[Immunotherapy strategy for 35 cases of severe anti-N-methyl-D-aspartate receptor encephalitis].

OBJECTIVE: To provide evidence for establishing standardized treatment strategy of severe anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis in China, by demonstrating the clinical characteristics and comparing the treatment strategy with that adopted in foreign countries. METHODS: A total of 35 hospitalized cases who met the diagnostic criteria for severe anti-NMDAR encephalitis were retrospectively analyzed. Demographic data, clinical history, past medical history, laboratory tests, imaging studies, treatment and the follow-up information were recorded using unified forms. RESULTS: Mental and behavioral abnormalities, seizures and consciousness disturbance occurred in all cases; involuntary movements, speech disorders, memory loss, central hypoventilation and autonomic dysfunction happened in 45%-65% of cases. Sixteen patients (45.71%) required mechanical ventilation. Modified Rankin score (mRS ) arranged 4-5 (mean mRS 4.86). The percentage of patients with elevated intracranial pressure, white blood cell and protein in cerebrospinal fluid were 42.86%, 60.00%, and 14.29%, respectively. Abnormal findings in brain magnetic resonance imaging scan happened in 31.43% cases, located in frontal lobe, temporal lobe, insular lobe, hippocampus, cingulate gyrus, corpus callosum, brain stem, and cerebellum. All cases received intravenous immunoglobulin, for one to maximum seven cycles, with an average of three cycles. 91.43% of cases received glucocorticoid therapy, including 54.29% of cases received high-dose methylprednisolone. Two patients (5.71%) received plasma exchange. Five patients(14.29%) received second-line therapy including rituximab for 4 patients and intravenous cyclophosphamide (CTX) for one. Fifteen patients(42.86%) received long-term immunosuppression therapy. All cases acquired improvement after immunotherapy and were transferred out from ICU, the median ICU time was 46 days and median hospitalized duration was 72 days. The mRS were 5 for 2 cases, 1-4 for the rest patients, and no patient died during hospitalization. During a median follow-up period of 17.6 months, 30 of 35 patients (85.71%) achieved complete recovery or a good outcome (mRS 0-2). Eleven patients (31.43%) relapsed. One patient(2.90%) died 2 years after discharge. CONCLUSION: Intravenous immunoglobulin combined with high-dose methylprednisolone therapy is effective for severe anti-NMDAR encephalitis. Retrial of the first-line immunotherapy is an option for initially unresponsive cases.