[Comparison of preoperative planning of radioactive seed implantation for pelvic wall recurrent gynecological malignant tumors between 3D-printing non-coplanar template and 3D-printing coplanar template]

Objective: To compare the difference of preoperative planning parameters between 3D-printing non-coplanar template (3D-PNCT) and 3D-printing coplanar template (3D-PCT) in the treatment of pelvic wall recurrent gynecological malignant tumor with radioactive seeds implantation, and to guide the clinical application. Methods: From January 2016 to March 2018, 33 patients with pelvic wall recurrent gynecological malignant tumor were treated with radioactive seeds implantation assisted by 3D-printing template and in Peking University Third Hospital. All patients underwent 3D-PNCT and 3D-PCT preoperative planning. The D(90) of target remained similar for the same patient. The parameters were compared with Wilcoxon test or Kruskal-Wallis test. Results: D(90) was similar between the two groups (P>0.05). The number of inserting needles through intestine and bone in 3D-PNCT group was less than that in 3D-PCT group (0 (0-13), 0 (0-25), Z=-2.941, P<0.05;0 (0-3), 0 (0-25), Z=-2.232, P<0.05). Conclusion: For patients with gynecological malignancies with pelvic recurrence, both of the two peroperative plans could achieve prescription dose, but 3D-PNCT is more safer.

[Fujian Tulou Family Cohort Study: study design and characteristics of participants and pedigrees in baseline investigation]

Objective: To describe the study design, the characteristics of participants as well as the pedigrees included in the baseline survey of Fujian Tulou Family Cohort Study. Methods: Fujian Tulou Family Cohort Study was a prospective open cohort study with a biological sample bank. A baseline survey was conducted in Tulou areas of Nanjing county in Fujian province from 2015 to 2018, including questionnaire survey, physical and biochemical indicators examinations, and blood sample collection in adults aged ≥18 years. In addition, family relationship of the participants was also recorded. The pedigree information of the juveniles under 18 years old were also collected. Results: The baseline survey included 2 727 individuals in two clans, of whom 2 373 (87.0%) were adults, and 2 126 participants completed questionnaires, physical examinations and biochemical tests. The average age of the 2 126 participants was (57.9±13.3) years, with 39.4% being males. The current smoking rates in male and female participants were 41.2% and 2.1%, respectively. The corresponding rates of current alcohol consumption were 19.0% and 2.6%. For common chronic diseases, the prevalence rates were 51.3% for hypertension, 9.7% for diabetes and 26.7% for hyperlipemia according to the self-reported disease diagnoses, health examination results and biochemical examination results in class Ⅱ or Ⅲ hospitals. Based on the family relationship information and genealogical data, 710 pedigrees were finally identified, consisting of 5 087 family members. The numbers of five, four, three, and two generations pedigrees were 3, 88, 238 and 381, respectively. The pairs of the first to the fifth degree relatives were 12 039, 2 662, 1 511, 202 and 31, respectively. Conclusion: The establishment of Fujian Tulou Family Cohort provides valuable resources for exploring the genetic risk factors, environmental risk factors and gene-environment interactions contributing to the risk of common chronic diseases.

[Comparison of the efficacy of decitabine combined with micro-transplantation or priming regimen as consolidation treatment for older patients with acute myeloid leukemia]

目的

探索老年急性髓系白血病（AML）第1次完全缓解（CR₁）后采用地西他滨联合微移植巩固治疗的疗效与安全性。

方法

回顾性分析2012年11月至2015年9月诊治的37例CR₁老年（≥60岁）AML患者病例资料，比较分析地西他滨联合微移植（微移植组，19例）与地西他滨联合预激方案巩固治疗（化疗组，18例）的疗效和不良反应。

结果

两组患者起病时的年龄、WBC水平、疾病状态差异均无统计学意义（P值均>0.05）。两种巩固治疗方案的耐受性均良好，微移植组与化疗组的CTC 3~4级非血液学不良反应发生率差异无统计学意义[36.8%（7/19）对27.8%（5/18），χ²=0.347，P=0.728]。微移植组与化疗组中性粒细胞恢复的中位时间分别为12和13 d（z=1.599，P=0.110），血小板恢复的中位时间分别为14和12 d（z=−1.314，P=0.189）。微移植组患者均未发生移植物抗宿主病。微移植组与化疗组的2年无白血病生存率分别为50.7%和24.3%（P=0.047），2年总生存率分别为54.9%和30.0%（P=0.071）。

结论

对于老年AML患者，地西他滨联合微移植可能是一种安全有效的巩固方案。

[Interpretation of updated version of BPPV clinical practice guideline: treatment and patient education]

In 2008, American Academy of Otorhinolaryngology Head and Neck Surgery(AAOHNSF) published the first clinical practice guideline for benign paroxysmal positional vertigo (BPPV), in which 13 key action statements for BPPV diagnosis, treatment, and patient education were proposed. The updated version of guideline was published in 2017. This article aimed at interpreting the updated guideline with particular focus on BPPV treatment and patient education.

[Treatment of children's pharyngeal stenosis following pharyngeal surgery with coblation]

Objective:Pharyngeal stenosis as a postoperative complication following pharyngeal surgery (tonsillectomy/adenoidectomy) with coblation is rare and may be difficult to treat. This report is to explore the causes of pharyngeal stenosis and presents our successful treatment experience. Method:From Jan 2012 to July 2016, 5 children with pharyngeal stenosis (2 nasopharyngeal stenosis and 3 nasopharyngeal stenosis combined with oropharyngeal stenosis) secondary to pharyngeal surgery (tonsillectomy/adenoidectomy) in Peking Union Medical College Hospital were analyzed. Five cases with severe nasopharyngeal stenosis received surgery of scar resection, horizontal-to-vertical pharyngoplasty and local pharyngeal flap rotation; and three of them received free skin transplantation. After stenosis repair surgery, prolonged nasopharyngeal hollow stents were used for more than 6 months. To evaluate the therapeutic effect, pharyngeal cavities and symptoms of difficulty nasal breathing, mouth breathing, difficulty in blowing nose, hyponasal speech, snoring, restless sleep, anosmia, dysphagia were assessed and compared before and after surgery. Result:With 7-46 months follow-up, all symptoms of the 5 cases are ameliorated and the diameters of nasopharyx are more than 1.5 cm. No velopharyngeal insufficiency complication happened. Conclusion:Improper operation with coblation can cause severe pharyngeal stenosis. Flap rotation, horizontal-to-vertical pharyngoplasty and prolonged use nasopharyngeal hollow stents are reliable methods to correct pharyngeal stenosis following children's pharyngeal surgery.

[Effect of serum growth hormone releasing hormone levels on cognitive function in patients with moderate-severe obstructive sleep apnea-hypopnea syndrome]

Objective: To investigate the effect of GHRH on the cognitive function of OSAHS patients by detecting the serum GHRH levels and assessing their cognitive function in patients with OSAHS. Methods: A total of 70 moderate-severe OSAHS patientsand 32 adults with snoring from October 2013 to May 2017 were enrolled for overnight polysomnography(PSG) and cognitive function assessment. Blood samples were taken at the next morning and serum GHRH levels were measured by ELISA. Results: There was no significant difference between OSAHS group (318.73±186.66)pg/ml and control group (291.48±147.36)pg/ml. Compared with control group, the serum GHRH levels were significantly increased in OSAHS patients without cognitive impairment (370.31±197.33)pg/ml, and evidently decreased in those with cognitive impairment (193.63±70.97)pg/ml (both P<0.05). The cognitive function of OSAHS patients was influenced by serum GHRH levels (OR=0.42, 95%CI: 0.24-0.73), body mass index (OR=2.23, 95%CI: 1.03-4.79), and daily sleepiness score (OR=1.80, 95%CI: 1.04-3.09). Conclusion: Serum GHRH levels in patients with moderate-severe OSAHS may play a protective role in patients' cognitive function.

[Efficacy and dosimetric analysis of (125)I seeds implantation for pelvic recurrent cervical cancer after radiotherapy under CT guidance]

Objective: To evaluate the relationship of dosimetry parameters and efficacy of (125)I seeds implantation for pelvic recurrent cervical cancer (PRCC) after external beam radiotherapy(EBRT) under CT guidance. Methods: A retrospective analysis was made on 30 PRCC patients after EBRT in Peking University Third Hospital with (125)I seeds implantation under CT guidance. Postoperative plans were made to evaluate the dosimetric parameters. Kaplan-Meier method was used to calculate local progression free survival (LPFS) rate and overall survival (OS) rate, and Log-rank test and Cox regression were used for univariate and multivariate analysis. Results: The 1-year and 2-year LPFS rate was 39.4% and 22.5%, respectively. The 1-year and 2-year OS rate was 57.3% and 27.4%, respectively. On postoperative plan, D(90) was (132±47) Gy, D(100) was (51±24) Gy, V(100) was 88%±10%, V(150)was 69%±15%, V(200) was 51%±18%.LPFS time would be longer while D(90) ≥105 Gy or D(100) ≥ 55 Gy or V(100) ≥ 91% (all P<0.05). D(100) was significantly related to LPFS (P<0.05). But these dosimetry parameters got no effect on OS. Conclusions: LPFS time of (125)I seeds implantation for PRCC after EBRT under CT guidance would be longer when D(90)≥105 Gy or D(100)≥ 55 Gy, or V(100)≥ 91%. D(100) is an independent factor related to LPFS.

[Congenital pyriform fistula with acute suppurative thyroiditis as the initial presentation]

Objective: To summarize the clinical characteristics of congenital pyriform fistula with acute suppurative thyroiditis as the initial presentation. Method: A total of 71 patients with congenital pyriform sinus fistula were treated, of which 33 cases had acute suppurative thyroiditis as the first symptom. For the patients with congenital pyriform sinus fistula who have acute suppurative thyroiditis as the first symptom, infection should be controlled first. Full drainage should be done when necessary, and the lesion should be completely excised during the stable period. Result: All the patients were followed up for 6 months to 216 months. No recurrence was found during follow-up. Conclusion: For patients with acute suppurative thyroiditis, the possibility of congenital pyriform sinus fistula should be considered.If the diagnosis of congenital pyriform sinus fistula is clear,the lesion should be completely resected by surgery. .

[Clinical analyses of 263 patients with laryngeal leukoplakia]

Objective: To investigate the etiology, clinical and pathological characteristics of laryngeal leukoplakia and the predictive risk factors of recurrence and malignant transformation. Methods: Clinical data of 263 patients with laryngeal leukoplakia between January 2000 and December 2015 were analyzed retrospectively. Results: The pathological diagnoses included squamous epithelial hyperplasia (54.4%), mild dysplasia (17.9%), moderate dysplasia (12.2%), severe dysplasia and carcinoma in situ (12.5%), and invasive carcinoma (3.0%). Age and the extent of lesion were statistically different among different pathological groups (P<0.05). Gender, smoking and alcohol consumption did not show statistical differences among different pathological groups (P>0.05). Follow-up of 215 patients, excluding 6 cases of invasive carcinoma. The recurrence rate was 20.6%(43/209), and the malignant transformation rate was 5.3%(11/209). Multivariate analysis showed that pathological classification of moderate to severe dysplasia was the independent risk factor for recurrence and malignant transformation of laryngeal leukoplakia (P<0.05). In patients with severe dysplasia and carcinoma in situ, the recurrence proportion of conservative treatment, vocal cords (partial) resection and radiotherapy were 8/10, 0/10 and 2/11 respectively. Conclusions: Laryngeal leukoplakia occurs frequently in elderly men with long-term smoking history. Pathological diagnoses are different. The grade of dysplasia is the predictive risk factor for the recurrence and malignant transformation of laryngeal leukoplakia. More aggressive treatment and closer follow-up should be warranted for patients with moderate dysplasia, severe dysplasia and carcinoma in situ.

[The expression of long non-coding RNA LINC00261 in laryngeal carcinoma tissue and their clinical significance]

Objective:To investigate the expression of LINC00261 in laryngeal carcinoma and to discuss their relevance and the roles in carcinogenesis and development of laryngeal carcinoma. Method:The expressions of LINC00261 in laryngeal carcinoma tissue and paired adjacent normal tissue was determined by real-time PCR. The relationship between the expressions of LINC00261 and the clinic pathological characteristics including clinical stage, pathological type, histological grade and lymph node metastasis in LSCC was analysed according to the clinical data. Result:①The expression of LINC00261 was significantly decreased in the LSCC tissue compared with the normal laryngeal tissue(P<0.01).②In clinical stage grouping, there were no statistical differences of the quantity of LINC00261 expression among supraglottic, glottic and subglottic LSCC(P>0.05).In histological differentiation grouping, LINC00261 had no significant changes in poorly differentiated LSCC compared with the well and moderately differentiated LSCC(P>0.05). In histological grade grouping, the expression of LINC00261 in T1+T2 stages was significantly higher than T3+T4 stages(P<0.05). Moreover, the expression of LINC00261 in LSCC with lymph node metastasis was significantly lower than that without of lymph node metastasis(P<0.05). Conclusion:Down regulation of LINC00261 in laryngeal carcinoma may contribute to the carcinogenesis and development of laryngeal carcinoma. The decreased expression of LINC00261 maybe relative to T term degree and lymphamatic metastasis of laryngeal carcinoma.

[Interpretation of updated version of BPPV clinical practice guideline: diagnosis and examination]

In 2008, American Academy of Otolaryngology-Head and Neck Surgery Foundation（AAO-HNSF）published the first clinical practice guideline for Benign Paroxysmal Positional Vertigo (BPPV) based on evidence-based methodology. The primary purposes of this guideline were to improve quality of care and outcomes for BPPV by enhancing the accuracy and efficacy of diagnosis of BPPV, reduce the inappropriate use of vestibular suppressant, and decrease the inappropriate use of ancillary examinations. The guideline was updated in 2017. This paper aimed at interpreting the updated guideline with a focus on diagnosis and ancillary tests section. Changes from the prior guideline include removal of the "no recommendation" for audiometric; expansion of the recommendations with respect to radiographic and vestibular testing, and broadening out the overall framework of differential diagnosis regarding BPPV.

Spirometra erinaceieuropaei severely infect frogs and snakes from food markets in Guangdong, China: implications a highly risk for zoonotic sparganosis

Sparganosis is a parasitic disease caused by plerocercoid larvae of the genus Spirometra. In China, the main source of sparganosis is from Guangdong, 16.1% of the country's human sparganosis cases occur in this province. Frequent international trade of amphibians and reptiles in Guangdong may introduce new species of Spirometra into the local market. In this study, a large-scale, high-intensity sampling survey was conducted to find out the causative species and epidemic situation of Sparganosis in Guangdong. The prevalence of sparganum infection in five species of frogs (Boulengerana guentheri, Fejervarya multistriata, Hoplobatrachus chinensis, Pelophylax nigromaculatus and Quasipaa spinosa) and nine species of snakes (Elaphe carinata, Lycodon rufozonatum, Hypsiscopus plumbea, Ptyas dhumnades, P. korros, P. mucosa, Naja atra, Sinonatrix annularis and Xenochrophis piscator) was investigated in Guangdong, Southern China from May 2014 to August 2015. The results showed that 9.8% (50/511) of the frogs and 40.8% (141/ 346) of snakes were found to be infected by plerocercoids (spargana). To identify the species of the collected spargana, a partial sequence of the mitochondrial cytochrome c oxidase subunit1 gene (cox1) was amplified and sequenced. Phylogenetic analysis identified all the spargana specimens as Spirometra erinaceieuropaei. Our study indicated that S. erinaceieuropaei, a highly pathogenic parasite, is the only causative agent of sparganosis in Guangdong, China. This study suggests that the large numbers of frogs and snakes in food markets in Guangdong may impact public health in China by transmitting S. erinaceieuropaei sparganum. Additional steps should be considered by the governments and public health agencies to prevent the risk of food-associated Spirometra infections in humans in China.

[Progress in next-generation sequencing research of non-syndromic oral clefts]

Non-syndromic oral clefts (NSOC) are among the most common birth defects. The prevalence of NSOC is 1.13-1.30 per 1 000 live births in China, which is higher than those in other major ethnic groups. The etiology of NSOC is complex and heterogeneous, which involves both genetic and environmental risk factors. Although genome-wide association studies have identified a number of risk loci, these loci can only account for a small proportion of the heritability of NSOC. The next-generation sequencing research provides new ideas for further exploring the genetic risk factors of NSOC. This paper summaries the progress in the next-generation sequencing research of NSOC.

Case report about a successful full robotic radical gastric cancer surgery with intracorporeal robot-sewn anastomosis in a patient with situs inversus totalis and a two-and-a-half-year follow-up study

Background

During the last decade, total laparoscopic and laparoscopic-assisted distal gastrectomy for gastric cancer patients has been developed as alternatives to open resection. In recent years, this minimally invasive surgery has been extended using robotic-assisted surgery.

Case presentation

Here, we report a surgical intervention using a Da Vinci surgical robot in which a lower two-third stomach resection with subsequent Billroth II gastrojejunostomy was performed. The patient was a 53-year-old male with complete situs inversus gastric cancer who had received 2 cycles of neo-adjuvant oxaliplatin combined with S-1 medication. The operation took 3 h in total without complications. The amount of bleeding was about 50 mL, and on day 5 after the operation, the patient was discharged.

Conclusions

This is the first report of a successful robot-assisted gastric cancer resection of advanced gastric cancer in a patient with the anatomical abnormality of situs inversus totalis.

Glucocorticoids in combination with ursodesoxycholic acid in the treatment of autoimmune hepatitis

Autoimmune hepatitis (AH) is usually manifested as chronic hepatitis in clinics; it may evolve to liver cirrhosis, hepatic failure, and even death if treatment is delayed. To investigate the clinical efficacy of glucocorticoids in combination with ursodesoxycholic acid in the treatment of glucocorticoids in combination with ursodesoxycholic acid, one hundred and twenty patients with AH who were admitted to the hospital from February 2014 and February 2016 were selected and randomly divided into an observation group and a control group using random number table. Patients in the control group were treated by glucocorticoids only, while patients in the observation group were treated by ursodesoxycholic acid and glucocorticoids. Patients in both groups were treated for six months. The clinical efficacy of the two groups was evaluated after treatment. The levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), direct bilirubin (DBIL) and total bilirubin (TBIL) of the two groups both decreased after treatment (P less than 0.05), the improvement of the level of liver function of the observation group was superior to that of the control group, and the difference was statistically significant (P less than 0.05); after treatment, the levels of serum immunoglobulin G (IgG) and immunoglobulin m (IgM) of both groups significantly reduced after treatment, and the difference within groups before and after treatment had no statistical significance (P less than 0.05). The reduction of the immunological indicators of the observation group was more remarkable after treatment, and the difference between the two groups had statistical significance (P>0.05). The complete remission rate of the observation group was significantly higher than that of the control group; the incidence of adverse reactions was lower than that of the control group, and the difference had statistical significance (P less than 0.05). Thus it can be concluded that glucocorticoids in combination with ursodesoxycholic acid has favorable efficacy in treating AH as it can promote the improvement of liver function and effectively reduce the dose of glucocorticoids and the incidence of adverse reactions. The therapy is of great clinical values.

Turbulent mass transfer caused by vortex induced reconnection in collisionless magnetospheric plasmas

Magnetic reconnection is believed to be the main driver to transport solar wind into the Earth's magnetosphere when the magnetopause features a large magnetic shear. However, even when the magnetic shear is too small for spontaneous reconnection, the Kelvin-Helmholtz instability driven by a super-Alfvénic velocity shear is expected to facilitate the transport. Although previous kinetic simulations have demonstrated that the non-linear vortex flows from the Kelvin-Helmholtz instability gives rise to vortex-induced reconnection and resulting plasma transport, the system sizes of these simulations were too small to allow the reconnection to evolve much beyond the electron scale as recently observed by the Magnetospheric Multiscale (MMS) spacecraft. Here, based on a large-scale kinetic simulation and its comparison with MMS observations, we show for the first time that ion-scale jets from vortex-induced reconnection rapidly decay through self-generated turbulence, leading to a mass transfer rate nearly one order higher than previous expectations for the Kelvin-Helmholtz instability.

[Comparative results of non-operative and operative treatment of humeral shaft fractures]

OBJECTIVE

To compare the difference between non-operative and operative treatment of humeral shaft fractures.

METHODS

From March 2005 to October 2012, 252 cases of humeral shaft fractures were treated and were adequately followed up. According to the treatment methods, the patients were divided into 2 groups: the non-operative group and the operative group. In the non-operative group, there were 76 cases treated with plaster/small splint fixation,meanwhile there were 176 cases treated with internal fixation either by plating or by nailing in the operative group. The follow-up parameters included: fracture healing rate, fracture union time, complications rate, Constant- Murley shoulder score and Mayo elbow score.

RESULTS

The mean follow-up period was (31.24±20.06) months (ranging 6 to 103 months). There were no statistical differences in age, open fracture number, fracture site and Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification between the non-operative group and the operative group. The fracture healing rate: the non-operative group: 96.1%(72/76), the operative group: 97.7%(172/176), P=0.46; the fracture union time: the non-operative group: (10.24±2.93) weeks, the operative group: (10.69±2.51) weeks, P=0.22; the complication rate: the non-operative group: 5.3%(4/76),the operative group: 15.3%(27/176), P=0.03. The complications included: nonunion: the non-operative group: 3.95%(3/76), the operative group: 2.3%(4/176), P=0.434; radial nerve palsies: the non-operative group: 0%(0/76), the operative group: 5.7%(10/176), P=0.035; bone split: the non-operative group: 0%(0/76), the operative group: 1.7%(3/176), P=0.556; elbow stiffness: the non-operative group:1.3%(1/76), the operative group: 0.6%(1/176), P=1.000; shoulder pain: the non-operative group:0%(0/76), the operative group: 5.1%(9/176), P=0.061. The Constant-Murley shoulder score: the non-operative group: 97.37±4.94, the operative group: 96.34±6.88, P=0.244. The Mayo elbow score: the non-operative group: 99.80±1.72, the operative group: 99.49±2.73,P=0.923.

CONCLUSION

The results of non-operative treatment of humeral shaft fractures appeared with excellent results with lower complications rate compared with that of the operative treatment.

[Laryngeal endoscopic cricopharyngeal myotomy for cricopharyngeal achalasia post stroke]

Objective: To explore the safety and validity of endoscopic cricopharyngeal myotomy in patients with cricopharyngeal achalasia. Methods: A total of 19 patients with cricopharyngeal achalasia suffered from sustained dysphagia were enrolled in this study. The patients were divided into transcervical cricopharyngeal myotomy(CPM) group and endoscopic CPM (ECPM) group. Swallowing function and complications were evaluated.SPSS7.0 software was used to analyze the data. Results: The swallowing function improved significantly in seven patients in ECPM group, and 9 patients improved in CPM group.The video fluoroscopic swallowing study(VFSS)-swallowing score, VFSS-aspiration score and drinking test score were (3.1±1.1), (3.4±0.8) and (2.0±0.6)in post-ECPM, (3.4±1.4), (3.0±0.9) and (2.2±0.6)in post-CPM. No statistical difference was found in validity between CPM group and ECPM group(t=-0.435, t=1.086, t=-0.607, P>0.05). No statistical difference was observed on the occurrence of complication between two groups. Only one patient had subcutaneous emphysema after operation in ECPM. Conclusions: New surgical instruments and endoscopic surgical technique were safe and effective for cricopharyngeal achalasia. Because these instruments are cheaper, laryngeal endoscopic cricopharyngeal myotomy is easier to be popularized more easily than microscopic laser assistted CPM.

Blockage of the lysosome-dependent autophagic pathway contributes to complement membrane attack complex-induced podocyte injury in idiopathic membranous nephropathy

Dysregulation of autophagy-mediated podocyte homeostasis is proposed to play a role in idiopathic membranous nephropathy (IMN). In the present study, autophagic activity and lysosomal alterations were investigated in podocytes of IMN patients and in cultured podocytes exposed to sublytic terminal complement complex, C5b-9. C5b-9 upregulated the number of LC3 positive puncta and the expression of p62 in patient podocytes and in C5b-9 injuried podocyte model. The lysosomal turnover of LC3-II was not influenced, although the BECN1 expression level was upregulated after exposure of podocytes to C5b-9. C5b-9 also caused a significant increase in the number of autophagosomes but not autolysosomes, suggesting that C5b-9 impairs the lysosomal degration of autophagosomes. Moreover, C5b-9 exacerbated the apoptosis of podocytes, which could be mimicked by chloroquine treatment, indicating that C5b-9 triggered podocyte injury, at least partially through inhibiting autophagy. Subsequent studies revealed that C5b-9 triggered lysosomal membrane permeabilization, which likely caused the decrease in enzymatic activity, defective acidification of lysosomes, and suppression of DQ-ovalbumin degradation. Taken together, our results suggest that the lysosomal-dependent autophagic pathway is blocked by C5b-9, which may play a key role in podocyte injury during the development of IMN.

[The expressions and correlations of IL-10, CD14 and CD68 in laryngal squamous cell carcinoma]

Objective:The aim of this study is to investigate the distribution of IL-10, CD14 and CD68 in the tumor microenvironment of LSCC with the clinicopathologic factors. Method:We detected the expressions of IL-10, CD14 and CD68 in 46 primary LSCC tumor tissues by immunohistochemistry staining and explore the relationship between them and clinicopathologic factors. Result:We found that the expressions of IL-10, CD14 and CD68 were significantly correlated with clinical stage and T stage (P<0.01). IL-10 and CD14 were correlated with lymph node metastasis (P<0.01), and CD68 was correlated with pathological differentiation (P<0.05). There is a positive correlation trend between the expression of IL-10 and CD14 (P<0.01). Conclusion:We confirm that the high level expressions of IL-10, monocytes and TAMs contribute to the tumor development of LSCC and there is a positive correlation between the expression of IL-10 and monocytes.

[Two families of X-linked lymphoproliferative disease type 1 characterized by agammaglobulinemia]

Objective: To investigate the clinical and immunological laboratory features, mutations in SH2D1A gene and SAP protein expression in four children of two families with X-linked lymphoproliferative disease type 1(XLP-1). Method: Four patients (Family A including Patient 1 and Patient 2, Family B including Patient 3 and Patient 4) and their maternal relatives were enrolled in this study. The clinical manifestation, EBV infection status and chest CT scan were analyzed. The absolute and relative numbers of lymphocyte subsets, T lymphocyte proliferative response, SAP protein expression were assessed by flow cytometry. Quantification of signal joint TCR rearrangementexcision circle (sjTRECs), CDR3 spectratyping of TCRvβ and gene mutation of SH2D1A were detected by PCR based on genomic DNA or cDNA. Result: Four male patients from two families were diagnosed with XLP-1. The ages of disease onset were more than 1 year, more than 1 year, more than 1 month and 6 months. The ages at diagnosis were nine years and ten months, sixteen years and eight months, fourteen years and ten months, four years and nine months. All patients had recurrent infections and EBV infection. Patients 1, 2, and 3 had agammaglobulinemia and Patient 4 had hypogammaglobulinemia. Chest CT scan showed all patients had atelectasis and pneumonia, and Patient 3 had bronchiectasis. Patient 3 was diagnosised as Burkitt lymphoma. For immunological function, all patients exhibited reduced CD4/CD8 ratios, increased numbers of exhausted T lymphocyte, decreased number of NK cell. The numbers of total B lymphocyte and naïve B lymphocyte were normal, but the number of memory B lymphocyte declined in all cases. Four patients' copy numbers of sjTRECs were low and CDR3 spectratypings of TCRvβ showed mildly skewed. But their T lymphocyte proliferative response was normal. SAP protein expression in four cases were measured by flow cytometry. Two patients from Family A were absent and two patients from Family B showed decreased values. SH2D1A gene sequence analysis showed that the patients of Family A harbored a nonsense mutation (c.163 C>T; p.R55X) in exon 2. Their mother and two sisters were carriers. A missense mutation of SH2D1A gene (c.278 G>A; p.G93D) in exon 3 was found in the patients of Family B. The mother was carrier. Four patients remain survived, Patient 3 gave up treatment, other three patients received IVIG therapy. Conclusion: Four patients with XLP-1 from two families characterized by agammaglobulinemia have an extreme vulnerability to Epstein-Barr virus (EBV) infection. The functions of T cell, B cell and NK cell are impaired at different stages. The detection of SAP protein and SH2D1A gene are the key methods for diagnosis of XLP-1.

Application of oxaliplatin in combination with epirubicin in transcatheter arterial chemoembolization in the treatment of primary liver carcinoma

Many cases of liver carcinoma miss the opportunity of surgical treatment because of hidden onset and delayed diagnosis. In recent years, interventional treatment has gradually become a non-surgical method for treating liver carcinoma. To discuss the effects of oxaliplatin in combination with epirubicin in the treatment and its influence on prognosis, this study randomly selected 218 advanced primary liver carcinoma patients from Binzhou People’s Hospital, Binzhou, China and divided them into a control group (n=109) and an observation group (n=109). Patients in both groups were given interventional treatment. Patients in the control group were perfused with oxaliplatin, while patients in the observation group were perfused with oxaliplatin and epirubicin. The effectsat 6-month and 12-month survival rates were compared between the two groups. The results demonstrated that the overall effective rate and clinical benefit rate of the observation group were much higher than those of the control group (30.3% vs 11.9%; 79.8%; vs 44.3%) (P less than 0.05). The serum Alpha Fetal Protein (AFP) and Carcino Embryonie Antigen (CEA) levels of the observation group were much lower than those of the control group; the Karnofsky performance score of the observation group was much lower than that of the control group; the two differences had statistical significance (P less than 0.05). The 6-month survival rate of the observation group was 91.67%, higher than that of the control group (86.11%) (P>0.05). The 12-month survival rate of the observation group was 83.33%, much higher than that of the control group (61.11%) (P less than 0.05). The difference of the incidence of adverse reactions between the two groups had no statistical significance (P>0.05). Thus, it can be concluded that oxaliplatin in combination with epirubicin can improve survival quality, extend survival time, and decrease the serum AFP and CEA levels in the treatment of primary liver carcinoma, with definite effects but without aggravating toxic and side effects. Therefore, the therapy has important clinical value.

Protective effects of Garcinol against neuropathic pain - Evidence from in vivo and in vitro studies

Neuroinflammatory processes have a vital role in the pathogenesis of neuropathic pain. Garcinol, harvested from Garcinia indica, is known to exert potent anti-inflammatory properties. Recent studies have indicated that Garcinol may inhibit activation of nuclear factor-κB (NF-κB) by inhibiting NF-κB/p65 acetylation. These findings prompted us to evaluate the protective effects of Garcinol in the lumbar fifth spinal nerve ligation (SNL)-induced rat model of neuropathic pain and Lipopolysaccharide(LPS)-stimulated primary cultured microglia. In the present study, we found that intrathecal administration of Garcinol significantly attenuated SNL-induced nociceptive behaviors. Garcinol suppressed microglial activation as well as the expression of interleukin (IL)-1β, IL-6, inducible nitric oxide synthase (iNOS)/nitric oxide (NO), and cyclooxygenase-2 (COX-2)/prostaglandin E2 (PGE2) in the spinal cord of SNL rats. It also reduced the nuclear translocation of NF-κB by decreasing acetyl-p65 protein expression. Similarly, in the in vitro study, Garcinol decreased the production of NO/iNOS, PGE2/COX-2, and proinflammatory cytokines in LPS-exposed microglia. Likewise, Garcinol inhibited the NF-κB signaling pathway by downregulating acetyl-p65 levels in LPS-challenged microglia. Our findings suggest that Garcinol may have protective effects against neuropathic pain that are associated with the inhibition of neuroinflammation in microglia. Therefore, Garcinol could be a promising agent in the treatment of neuropathic pain.