[Analysis on the characteristics of postural blood pressure changes recorded with continuous non-invasive arterial pressure monitoring system and the correlative factors in elderly hospitalized patients]

Objective: To explore the characteristics of postural blood pressure changes in elderly inpatients and the related factors of orthostatic hypotension (OH). Methods: This study was a clinical case control study. Two hundred and sixty-six elderly patients (≥60 years old), who were hospitalized between April 2016 and November 2017 in Geriatric Department of Peking University First Hospital, were included. They were divided into direct standing group and indirect standing group. Direct standing group involved 102 patients, they changed posture from supine directly to standing position, and the blood pressures at the moments of supine, immediately after standing and the first, second, and third minute after standing were recorded by continuous noninvasive arterial pressure (CNAP) system. Indirect standing group involved 164 patients, and they changed posture from supine to sitting for 3 minutes, and then changed to standing position. Blood pressures at the moments of supine, immediately after sitting, the third minute after sitting, immediately after standing and the third minute after standing was recorded by CNAP. Blood pressure changes after different postural changes mode and the rates of OH were compared. The related factors of OH was analyzed by binary logistic regression analysis. Results: The lowest systolic blood pressures (SBP) mostly occurred immediately after postural change: immediately after standing for direct standing group (86.3%(88/102)), and immediately after sitting for indirect standing group (59.1%(97/164)). The lowest diastolic blood pressures (DBP) mostly occurred immediately after standing in the two groups: 87.3%(89/102) for direct standing group and 43.3% (71/164) for indirect standing group. The maximum SBP drop (SBP of supine minus the lowest SBP during postural changes) of direct standing group was significantly higher than indirect standing group (median 20.5(14.0, 29.3) vs. 18.0(11.0, 26.0) mmHg (1 mmHg=0.133 kPa, P<0.05). The rates of OH occurred immediately and within 3 minutes from supine to standing position were significantly higher in direct standing group than in indirect standing group (65.7% (67/102) vs. 43.9% (72/164), and 70.6% (72/102) vs. 49.4% (81/164), both P<0.05). Binary logistic regression analysis showed that brachial-ankle pulse wave velocity was positively associated with OH after a transition from supine to standing position (immediately and within 3 minutes, OR=1.002 (95%CI 1.000-1.004), 1.003 (95%CI 1.001-1.006), P=0.014, 0.006) in direct standing group. Conclusions: OH is common in elderly hospitalized patients. The most obvious blood pressure changes are likely to occur immediately after position changes. Adding a sitting position during the transition of supine to standing position may decrease the amplitude of SBP drop. Brachial-ankle pulse wave velocity is associated with OH after the transition from the supine to standing position in the elderly inpatients.

[Analysis of distant metastasis and related factors of head and neck mucosal melanoma]

Objective:To analyze the characteristics and related factors of distant metastasis of head and neck mucosal melanoma, so as to provide better help for the treatment and the control of patients' survival. Method:Retrospectively analyze the patients of head and neck mucosal melanoma who were treated in our hospital from January 2004 to December 2016, through follow-up, of which 37 cases of patients with metastatic disease were analyzed which including the incidence of distant metastasis, specific metastasis and prognosis, time, etc.The age and gender of the patients were controlled, and 37 cases of 1∶1 were selected randomly in the patients who had no distant metastasis. χ² test, Kaplan-Meier analysis and multiple factor logistics regression model were used to analyze the related factors of distant metastasis of head and neck mucosal melanoma. Result: The time from hospitalization to distant metastasis was 5-98 months, and the median progression time was 18 months. 27 people died in the 37 cases, 10 people were still alive,which lung metastasis accounted for 32.43%(12/37) , peritoneal metastasis accounted for 16.22% (6/37), bone metastases accounted for 5.41%(2/37), the presence of multiple organ metastasis (lung, liver, brain) patients accounted for 45.95%(17/37).χ² test and Kaplan_Meier analysis showed that no matter whether there was pigmentation or not, postoperative radiotherapy, AJCC staging and operation mode were the significant factors.Finally,multiple factor logistics regression model showed AJCC staging, and the presence of pigment deposition was associated with metastasis. Conclusion: There is a wide variety of multiple organ metastasis when found.Less brain metastases. According to the AJCC stage, patients with advanced stage usually predict poor prognosis and distant metastasis after operation.The patients' lesion without pigmented melanoma have a great chance of distant metastasis..

[Follow-up research on hearing progression of GJB2 mutation associated hearing loss in children]

Objective: To analyze the auditory follow-up alteration of GJB2 associated hearing loss children. Method: Forty three children aged 0-5 years with homozygous or heterozygous mutations of gene attach to the Children' s Hearing Diagnostic Center of our hospital were enrolled in this study. Distortion product otoacoustic emissions and acoustic immittance, auditory brainstem response, auditory steady state response, acoustic impedance, pediatric behavior audiometry and other audiological tests were performed. The subjects had at least two audiology diagnosis results at different time; follow-up time was at least three months. According to the genotype, the subjects were divided into two groups: 23 cases(53.49%) in the truncating mutation/truncating mutation (T/T) group and 20 cases(46.51%) in the nontruncating mutation/truncating mutation (NT/T) group. Hearing levels of the first and last diagnoses and progression rate were compared between the two groups, and the progression value and progression rate were analyzed. Result: The average follow-up time was(19.63 ± 16.76) months. The frequency of c. 235delC (56.98%) in GJB2 gene mutations sites was highest in this group, followed by c. 109G> A (22.09%). The first diagnosis of hearing loss, T/T group was mainly severe(60.87%), NT/T group was mainly mild (50.00%); The degree of final hearing loss in the T/T group was mainly severe(50.00%) while the NT/T group was mainly mild(42.50%), and the T/T group was both heavier than the NT/T group. The difference was both statistically significant. Follow-up research on 43 cases(86 ears) showed that 3 cases(4 ears) developed hearing progression, 1 of them were bilateral progression, two was unilateral progression; the overall rate of progression was 4.65%(4/86), and the rate of progression in the T/T group was 2.17%(1/46) while the NT/T group was 7.50%(3/40). There was no significant difference between the two groups. The average progression of 4 ears was 11.25 dB HL, the average progression speed was 0.5 dB HL/month. Conclusion: This study showed that the degree of hearing loss of associated hearing loss children was mild to profound, and those with truncating mutations/truncating mutations were severer than those with nontruncating mutations/truncating mutations. Hearing progression was seen in both groups, it is suggested that children with GJB2 gene mutations hearing progression may occur during growth and development, therefore, they should be followed up regularly. .

[The anti-cancer effect of ZR30 protein via targeting extracellular signal proteins of different cell subpopulations of glioma]

Objective: To investigate the roles and anti-cancer mechanism of artificially synthesized EGF-containing fibulin-like extracellular matrix protein (EFEMP1) derived tumor suppressor ZR30 protein in glioma (GBM). Methods: ZR30 protein were in vitro expressed using a wheat germ cell-free system. GBM cell lines (U251, U251NS, and U87) were cultured for 2-3 days in the presence or absence of ZR30 treatment. MMP-2 level was detected by gelatin zymography assay, moreover, the expression of EGFR, Notch-1 and p-Akt/Akt levels were determined by western blot. Additionally, MTT assay was used to measure ZR30's effect on the cell proliferation of U251 and U251NS cells. Furthermore, pre-mixed U251-GFP and U251NS-RFP cells (1∶9) were injected into the brain of nude mice, and then ZR30 or PBS was injected into the intra-tumor after 10 and 21 days, respectively. Then DNA was extracted from the right brain of nude mice in each group. Comparative quantitative polymerase chain reaction (CQ-PCR) was used to examine the copy numbers of human gene hSPAG16, mouse gene mSpag16, GFP and RFP. The survival status of each group of nude mice was also observed. Results: The levels of activated MMP-2 in U87 and U251 cells were lower after 10, 50 and 100 ng/ml ZR30 treatment for 2-3 days. Western blot analysis showed that ZR30 treatment reduced the expression of EGFR, Notch-1 and p-Akt/Akt in U251 cells, and inhibited Notch-1 and p-Akt/Akt expression in U251NS cells, and then decreased the response of U251 cells to EGF stimulation. Moreover, ZR30 inhibited the cell proliferation of U251 and U251NS two days after exposure. The in vivo orthotopic GBM xenografts were successfully constructed. CQ-PCR results indicated that the hSPAG16/mSpag16 ratios of mice in PBS group and ZR30 treatment groups at 180, 700, and 1 800 ng dosages were 3.67±2.82, 1.18±0.97, 1.75±1.55 and 1.38±1.17, respectively, and ZR30 treatment groups showed significantly lower ratios than the PBS group (P<0.05 for all). Correspondingly, the ratios of GFP/RFP in each group were 1.97±0.80, 1.97±0.85, 1.48±0.71 and 1.73±0.77, respectively, showing no statistical significance (P>0.05 for all). When treatment was performed 10 d after cell implantation, and the median survival time of mice in PBS group and ZR30 group was 40.5 days and 59.0 days, respectively. When treatment was performed 21 d after cell implantation, the median survival time of mice in PBS group and ZR30 group was extended to 57.0 days and 74.5 days, respectively. The median survival time of ZR30 treatment groups significantly prolonged (P<0.05 for all). Conclusions: ZR30 inhibits in vitro cell growth, invasion, angiogenesis and stemness maintenance in glioma via suppressing activated MMP-2, EGFR, p-Akt/Akt and Notch-1 proteins. In vivo, ZR30 markedly increased survival of mice harboring glioma xenografts, even for only one intra-tumoral injection at the time of early tumor formation. Overall, the in vivo and in vitro experiments supported the therapeutic potential of ZR30 for GBM.

[The analysis of the misdiagnosis big data of the otolaryngology during 2004 to 2013 in China]

Objective:The aim of this study is to explore the misdiagnosis status of the otolaryngology in China as well as to provide evidence to reduce misdiagnosis and improve the diagnostic level.Method:The retrieval and management system of the misdiagnosed diseases database developed by Chen Xiaohong was used for searching the literature of the misdiagnosis in otolaryngology.The 10 year' smisdiagnosis literature data of the otolaryngology(from 2004 to 2013) were analyzed including the literature sources, sample size, misdiagnosis rate,misdiagnosis consequences and misdiagnosis reasons.Result:A total of 369 articles were found,including 4211 cases.The average misdiagnosis rate was 25.43% in 51 diagnosed diseases.The top misdiagnosed diseases were nasopharyngeal tuberculosis(84.76%),tuberculous otitis media (75%) and congenital laryngeal cyst(75%).The lowest misdiagnosed disease was nasosinusitis(5.92%).The top three misdiagnosed diseases were tuberculosis of otolaryngology(1216 cases),nasosinusitis(710 cases) and BPPV(697 cases).After statistical analysis,we found that 97.22% of the misdiagnosed patients were grade Ⅲ consequences (that is the misdiagnosis and mistreatment does not cause adverse consequences),but there were still 10 cases caused gradeⅠconsequences(death or sequela).The main causes of the misdiagnosis were lack of diagnosis experience, non detailed interrogation and physical examination and non targeted examinations.Conclusion:The big data of the 10 years reflects the misdiagnosis phenomenon in otolaryngology to some extent.Neurologist, stomatologist and ophthalmologist should be familiar to the main points of the differential diagnosis diseases of the otolaryngology and strive to reduce the clinical misdiagnosis and mistreatment.

Discrete Superconducting Phases in FeSe-Derived Superconductors

A general feature of unconventional superconductors is the existence of a superconducting dome in the phase diagram. Here we report a series of discrete superconducting phases in the simplest iron-based superconductor, FeSe thin flakes, by continuously tuning the carrier concentration through the intercalation of Li and Na ions with a solid ionic gating technique. Such discrete superconducting phases are robust against the substitution of 20% S for Se, but they are vulnerable to the substitution of 2% Cu for Fe, highlighting the importance of the iron site being intact. The superconducting phase diagram for FeSe derivatives is given, which is distinct from that of other unconventional superconductors.

[Clinical significance of low-dose CT performed for three consecutive years in diagnosis of lung nodules in coal mine workers with 20 working years]

Objective: To investigate the clinical significance of low-dose CT (LDCT) in coal mine workers with relatively long working years. Methods: A total of 907 coal mine workers with ≥20 working years were enrolled, among whom there were 863 male and 44 female workers with a mean age of 49.5 years. Digital radiography (DR) was performed for these workers in 2013, and LDCT was performed for three consecutive years from 2014 to 2016. Results: A total of 32 workers were found to have lung nodules by DR in 2013, while in 2014, 269 workers were found to have non-calcified lung nodules by LDCT, and there was a significant difference in the number of workers with lung nodules (χ(2)=233.73, P<0.005) . There was also a significant difference in the detection rate of nodules between the workers with different working years of dust exposure (χ(2)=6.648, P=0.00) . The male workers had a significantly higher detection rate of nodules than the female workers (χ(2)=5.690, P=0.017) . There was no significant difference in the number of nodules between workers with different types of work (χ(2)=16.985, P=0.05) . There were 443 lung nodules in total, among which 71.56% were solid nodules and 55.75% had a size of ≤4mm; malignant nodules were confirmed by surgery in 6 (0.66%) of the 907 workers after baseline LDCT. LDCT reexamination in 2015 and 2016 found new nodules in 8 workers and enlarged nodules in 3 workers, and there was no significant change in the number of nodules with a size of ≤4 mm. Conclusions: It is necessary to perform high-risk population screening for coal mine workers by LDCT. The follow-up strategies for nodules with a size of ≤4mm are the same as those for negative results; annual reexamination is recommended for nodules with a size of >4-8 mm, and clinical treatment should be considered for nodules with a size of >8 mm.

[Clinical characteristic and prognostic analyses of 117 cases of head and neck mucosal melanoma]

Objective: To study the clinical characteristics of mucosal melanoma in the head and neck, including the risk factors affecting distant metastasis, recurrence and survival rate, and to provide the basis for the individualized treatment of mucosal melanoma in the head and neck. Methods: The clinical data of 117 cases of mucosal melanoma in the head and neck treated from January 2004 to June 2016 in Beijing Tongren Hospital were analyzed retrospectively, and the risk factors affecting the prognosis, distant metastasis and local recurrence were analyzed.Kaplan-Meier analysis was used for survival analysis, and Log-Rank test was used for comparison between groups. Results: The follow-up time was 5-139 months, with a median of 32 months, and the median survival time was 34 months.The 3 and 5 year cumulative survival rates were 47.0% and 25.0%, respectively.Local recurrence occurred in 27 patients (23.1%), and distant metastasis in 37 cases (31.6%). After the operation, 50 patients received radiotherapy.Multiple factor Cox regression analysis showed that distant metastasis, AJCC staging, and two operations were risk factors affecting survival (P<0.05), and immunologic/targeted therapy was a protective factor affecting survival prognosis(P=0.008). Postoperative radiotherapy and distant metastasis were important factors affecting recurrence (P<0.05). AJCC staging, pigmentation, and postoperative recurrence were risk factors for distant metastasis (P<0.05). Conclusion: The 3 and 5 year survival rates of primary mucosal melanoma in head and neck are low, and the incidence of local recurrence and distant metastasis are high. Surgery is the first choice and the integrity of the initial operation has an important impact on the prognosis of the patients. Postoperative adjuvant radiotherapy is recommended to improve the local control rate, and immunotherapy and targeted therapy should be applied in time to improve survival.

[Hypoxia inducible factor-1α deSUMOylation reduces the stemness maintenance ability of endometrial cancer stem cell and increases its chemosensitivity]

Objective: To reduce the stemness maintenance ability of endometrial cancer stem cell and increase its sensitivity to chemotherapy by inducing hypoxia inducible factor 1α (HIF-1α) protein deSUMOylation. Methods: Lentiviral plasmid mediated ubiquitin carrier protein 9 (Ubc9) gene silencing was transgened into KLE endometrial carcinoma cells. The expression of Ubc9, small ubiquitin-related modifier 1(SUMO1) and HIF-1α protein was detected by Western blotting. Then tumor stem cells clones were cultured in 96 well plates, and these clone balls diameter were calculated. Cell cycles were determined by flow cytometry. MTT cytotoxicity assay and flow cytometry method were used to test sensitivity of cisplatin to endometrial cancer stem cell. Results: The results of Western blotting showed that Ubc9 gene was silenced well, and the covalent binding state of SUMO-1 and HIF-1α protein levels were significantly decreased (P<0.05). Ubc9 gene silencing in endometrial cancer cells reduced clone formation rate by (31.61±5.29)% down to (11.42±3.07)%, while the cell cycle shift from G1 to G2. IC50 of cisplatin decreased from 44.37 mg/L to 7.39 mg/L, and the rate of cell apoptosis by (41.59±5.37)% down to (26.22±4.03)%. Conclusion: The stemness maintenance ability of endometrial cancer stem cell can be reduced through deSUMOylation of HIF-1α protein by silencing Ubc9 gene expression, and their sensitivity to chemotherapy be enhanced, which provides a new reference for future gene therapy of endometrial carcinoma.

[Effect of dexmedetomidine alone for postoperative analgesia after laparoscopic cholecystectomy]

Objective: To investigate the effect of dexmedetomidine alone for postoperative analgesia after laparoscopic cholecystectomy. Methods: Forty patients scheduled for elective laparoscopic cholecystectomy in First Hospital of Ninghai County, American Society of Anesthesiologists (ASA) gradeⅠor Ⅱ, were randomly divided into dexmedetomidine group (Group D, n=20) and fentanyl group (Group F, n=20). The patient controlled analgesia (PCA) pumps were used after the operation. In the group D, the intravenous PCA protocol was dexmedetomidine 0.2 μg·kg(-1)·h(-1) diluted to 100 ml in 0.9% saline. In the group F, the PCA protocol was fentanyl 20 μg /kg diluted to 100 ml in 0.9% saline. Mean arterial pressure (MAP) and heart rate (HR) were recorded at the following time points: before induction of anaesthesia, end of operation and 4, 6, 8, 24, 48 hours after the operation. The pain score on a visual analogue scale (VAS) and the Ramsay sedation score were recorded at 4, 6, 8, 24, 48 hours after the operation. The incidences of postoperative nausea and vomiting (PONV), respiratory depression, dizziness, time to recovery of gastrointestinal function (time to first passage of flatus) and satisfaction with pain control were also recorded. Results: There were no significant difference in the general data of patients, duration of surgery, total dose of intraoperative propofol, fentanyl and sevoflurane, and total fluids during the operation (P>0.05). No patients received rescue analgesic. The MAP and HR values at different time points showed no significant difference between the groups (P>0.05). Similarly, the VAS scores and Ramsay sedation scale at 4, 6, 8, 24, 48 hours after the operation were not significantly different between the groups (P>0.05). The incidence of PONV was significantly reduced in group D, rating as 5%, comparing with 40% in Group F (P<0.05). Patients of Group D experienced a faster gastrointestinal function recovery, and the time to the first passage of flatus were (41.3±10.1) h in Group D and (55.6±11.4) h in Group F (t=-4.195, P<0.05), respectively. The pain treatment satisfactory score (PTSS) in Group D was (8.1±1.3) points, higher than that in Group F (6.1±1.5) points (t=4.426, P<0.05). Meanwhile, there was no statistic difference in the incidence of respiratory depression and dizziness in both groups (P>0.05). Conclusion: Intravenous infusion of dexmedetomidine alone at 0.2 μg·kg(-1)·h(-1) after laparoscopic cholecystectomy not only reduces postoperative pain, but also enhances satisfaction with pain control and improves the recovery of gastrointestinal function.

Charge Transfer Effects in Naturally Occurring van der Waals Heterostructures (PbSe)_{1.16}(TiSe_{2})_{m} (m=1, 2)

van der Waals heterostructures (VDWHs) exhibit rich properties and thus has potential for applications, and charge transfer between different layers in a heterostructure often dominates its properties and device performance. It is thus critical to reveal and understand the charge transfer effects in VDWHs, for which electronic structure measurements have proven to be effective. Using angle-resolved photoemission spectroscopy, we studied the electronic structures of (PbSe)_{1.16}(TiSe_{2})_{m} (m=1, 2), which are naturally occurring VDWHs, and discovered several striking charge transfer effects. When the thickness of the TiSe_{2} layers is halved from m=2 to m=1, the amount of charge transferred increases unexpectedly by more than 250%. This is accompanied by a dramatic drop in the electron-phonon interaction strength far beyond the prediction by first-principles calculations and, consequently, superconductivity only exists in the m=2 compound with strong electron-phonon interaction, albeit with lower carrier density. Furthermore, we found that the amount of charge transferred in both compounds is nearly halved when warmed from below 10 K to room temperature, due to the different thermal expansion coefficients of the constituent layers of these misfit compounds. These unprecedentedly large charge transfer effects might widely exist in VDWHs composed of metal-semiconductor contacts; thus, our results provide important insights for further understanding and applications of VDWHs.

Evidence for negative thermal expansion in the superconducting precursor phase SmFeAsO

The fluorine-doped rare-earth iron oxypnictide series SmFeAsO1-x F x (0 [Formula: see text] 0.10) was investigated with high resolution powder x-ray scattering. In agreement with previous studies (Margadonna et al 2009 Phys. Rev. B. 79 014503), the parent compound SmFeAsO exhibits a tetragonal-to-orthorhombic structural distortion at [Formula: see text]  =  130 K which is rapidly suppressed by [Formula: see text] 0.10 deep within the superconducting dome. The change in unit cell symmetry is followed by a previously unreported magnetoelastic distortion at 120 K. The temperature dependence of the thermal expansion coefficient [Formula: see text] reveals a rich phase diagram for SmFeAsO: (i) a global minimum at 125 K corresponds to the opening of a spin-density wave instability as measured by pump-probe femtosecond spectroscopy (Mertelj et al 2010 Phys. Rev. B 81 224504) whilst (ii) a global maximum at 110 K corresponds to magnetic ordering of the Sm and Fe sublattices as measured by magnetic x-ray scattering (Nandi et al 2011 Phys. Rev. B 84 055419). At much lower temperatures than [Formula: see text], SmFeAsO exhibits a significant negative thermal expansion on the order of  -40 ppm · K-1 in contrast to the behaviour of other rare-earth oxypnictides such as PrFeAsO (Kimber et al 2008 Phys. Rev. B 78 140503) and the actinide oxypnictide NpFeAsO (Klimczuk et al 2012 Phys. Rev. B 85 174506) where the onset of [Formula: see text] 0 only appears in the vicinity of magnetic ordering. Correlating this feature with the temperature and doping dependence of the resistivity and the unit cell parameters, we interpret the negative thermal expansion as being indicative of the possible condensation of itinerant electrons accompanying the opening of a SDW gap, consistent with transport measurements (Tropeano et al 2009 Supercond. Sci. Technol. 22 034004).

Antiferromagnetic Order in Epitaxial FeSe Films on SrTiO_{3}

Single monolayer FeSe film grown on a Nb-doped SrTiO_{3}(001) substrate shows the highest superconducting transition temperature (T_{C}∼100  K) among the iron-based superconductors (iron pnictides), while the T_{C} value of bulk FeSe is only ∼8  K. Although bulk FeSe does not show antiferromagnetic order, calculations suggest that the parent FeSe/SrTiO_{3} films are antiferromagnetic. Experimentally, because of a lack of a direct probe, the magnetic state of FeSe/SrTiO_{3} films remains mysterious. Here, we report direct evidence of antiferromagnetic order in the parent FeSe/SrTiO_{3} films by the magnetic exchange bias effect measurements. The magnetic blocking temperature is ∼140  K for a single monolayer film. The antiferromagnetic order disappears after electron doping.

[The related factors of head and neck mocosal melanoma with lymph node metastasis]

Objective:To investigate the related factors of mucosal melanoma of head and neck with lymph node metastasis for early diagnosis and further treatments. Method:A retrospective analysis of 117 cases of head and neck mucosal malignant melanoma patients which received surgical treatment was performed. Eleven cases of patients with pathologically confirmed lymph node metastasis and 33 cases without lymph node metastasis (1∶3) were randomly selected to analyze. The related factors of lymph node metastasis of head and neck mucosal melanoma patients including age, gender, whether the existence of recurrence, bone invasion, lesion location were analyzed. The single factor and logistic regression analysis were performed, P<0.05 difference was statistically significant. Result:The lymph node metastasis rate of head and neck mucosal melanoma was 9.40%(11/117), the single factor analysis showed that there were 3 factors to be associated with lymph node metastasis, which was recurrence (P=0.0000), bone invasion (P=0.001), primary position (P=0.007). Recurrence (P=0.021) was a risk factor for lymph node metastasis according to the Logistic regression analysis, and the impact of bone invasion (P=0.487) and primary location (P=0.367) remained to be further explored. Conclusion:The patients of head and neck mucosal melanoma with the presence of recurrent usually accompanied by a further progression of the disease, such as lymph node metastasis, so for recurrent patients should pay special attention to the situation of lymph node and choose the reasonable treatment.

[Effects of retroperitoneal laparoscopic ureterolithotomy and flexible-ureteroscopic holmium laser lithotripsy for complex upper ureteral calculi]

Objective: To explore the clinical effects of retroperitoneal laparoscopic ureterolithotomy (RPLU) and flexible-ureteroscopic holmium laser lithotripsy (f-UHLL) for complicated upper ureteral calculi. Methods: A total of 45 cases of complicated upper ureteral calculi between March 2014 and January 2016 in Department of Urology, Affiliated Jiangyin Hospital of Southeast University Medical College were retrospectively analyzed, there were 32 males and 13 females, ranging from 27 to 45 years with an average age of (34.1±9.5) years. Of the 45 patients, 28 had ureteral distortion and 17 had concurrent ureteral stones in the lower or middle ipsilateral ureter. In those patients, 20 cases underwent f-UHLL, and 25 cases received RPLU. The stone size, operation time, hospital stay, stone clearance rates and postoperative fever rates between the two groups were compared with t test and χ(2)test. Results: The operation was successfully performed in all patients, no complications with leakage of urine or ureteral perforation occurred, and no significant difference in renal function between the two methods were founded in postoperative period. There was no significant difference in operation time((78.4±8.5) minuetes vs.(73.3±11.3) minuetes, t=0.61, P=0.67), time of double J tube removed ((33.8±3.4)days vs. (37.6±8.9) d, t=2.37, P=0.08) and ipsilateral renal glomerular filtration rates ((41.3±7.6)ml/minuetes vs.(40.5±7.1) ml/min, t=0.78, P=1.27) between the two groups. However, the hospitalization time ((5.9±1.7)days vs. (4.2±1.6) days, t=1.92, P=0.04), postoperative fever rates (4% vs.30%, χ(2)=5.72, P=0.03) and calculus clearance rates (100% vs. 75%, χ(2)=7.03, P=0.01) in RPLU were significantly higher than f-UHLL. Besides, 5 patients in the f-UHLL group had postoperative stone residue and were treated with extracorpore shock wave lithotripsy. Conclusions: Both RPLU and f-UHLL are safety and validity for complex upper ureteral calculi. RPLU can improve the rate of calculus removal and reduce the rate of postoperative fever.

[Association between ribavirin plasma concentration and sustained virologic response in treatment of patients with genotype 1b chronic hepatitis C with pegylated interferon-α-2b and ribavirin]

OBJECTIVE

To investigate the association between the dose and plasma concentration of ribavirin (RBV) and sustained virologic response (SVR) during the anti-hepatitis C virus (HCV) treatment with pegylated interferon-α-2b (PEG-IFN-α-2b) and RBV.

METHODS

A total of 40 patients with chronic hepatitis C (CHC) who were treated with PEG-IFN-α-2b and RBV as the antiviral treatment were enrolled, and according to the therapeutic effect (SVR was defined as HCV RNA maintained below the lower limit of detection at 24 weeks after drug discontinuation in patients who achieved virologic response at the end of treatment, and recurrence was defined as HCV RNA turning positive), these patients were divided into SVR group (20 patients aged 19-55 years, including 10 male patients) and recurrence group (20 patients aged 21-76 years, including 12 male patients). The HPLC-MS/MS was used to measure the RBV plasma concentration at weeks 4, 12, 24, and 48 of treatment. The t-test and receiver operating characteristic (ROC) curve were used for statistical analysis.

RESULTS

During the antiviral treatment, the dose of RBV showed a significant difference between the two groups (15.01 ± 1.21 mg/kg vs 10.28 ± 2.81 mg/kg,t= 6.908,P= 0.000). The area under the ROC curve reached 0.96 (95%CI0.00-1.00,P= 0.000), suggesting that the dose of RBV had a high value in predicting SVR. When the dose of RBV was higher than 13.05 mg/kg (sensitivity 100%; specificity 85%), the possibility of achieving SVR was also increased. The RBV plasma concentrations in the SVR group at weeks 4,12, 24, and 48 of treatment were 1 894.8 ± 740.7 ng/ml, 2 029.9 ± 547.7 ng/ml, 2 011.8 ± 354.2 ng/ml, and2 093.5 ± 540.3 ng/ml, respectively, and those in the recurrence group were 1 223.1 ± 722.7 ng/ml, 1 286.9±685.4 ng/ml, 1304.7 ± 692.0 ng/ml, and 1 221.3 ± 655.3 ng/ml, respectively. The RBV plasma concentration at each time point showed significant differences between the two groups (t= 2.903,P= 0.006;t= 3.787,P= 0.001;t= 4.068,P= 0.000;t= 4.593,P= 0.000). The results of ROC analysis showed that the areas under the ROC curve at weeks 4, 12, 24, and 48 of treatment were 0.76 (95%CI0.61-0.92,P= 0.005), 0.83 (95%CI0.68-0.97,P= 0.000), 0.83 (95%CI0.69-0.98,P= 0.000), and 0.86 (95%CI0.72-1.00,P= 0.000), respectively, suggesting that the RBV plasma concentration had a high value in predicting SVR. When the cut-off values of RBV plasma concentration at weeks 4, 12, 24, and 48 of treatment were higher than 1262.5 ng/ml (sensitivity 90%; specificity 60%), 1432 ng/ml (sensitivity 100%; specificity 65%), 1427 ng/ml (sensitivity 100%; specificity 65%), and 1610 ng/ml (sensitivity 95%; specificity 80%), respectively, there was a greater possibility of achieving SVR.

CONCLUSION

During the antiviral treatment with PEG-IFN-α-2b and RBV, the dose and plasma concentration of RBV have a high value in predicting the recurrence of CHC and the possibility of SVR.

Predictors of high on-aspirin platelet reactivity in elderly patients with coronary artery disease

Objectives

Previous studies have illustrated the link between high on-aspirin platelet reactivity (HAPR) with increasing thrombotic risks. The aim of our study was to investigate relative risk factors of HAPR in elderly patients with coronary artery disease.

Methods

Elderly, hospitalized coronary artery disease patients on regular aspirin treatment were enrolled from January 2014 to September 2016. Medical records of each patient were collected, including demographic information, cardiovascular risk factors, concomitant drugs and routine biological parameters. Arachidonic acid (AA, 0.5 mg/mL) and adenosine diphosphate (ADP, 5 µmol/L) induced platelet aggregation were measured via light transmission assay (LTA) to evaluate antiplatelet responses, referred as LTA–AA and LTA–ADP.

Results

A total of 275 elderly patients were included, with mean age of 77.2±8.1 years, and males accounted for 81.8%. HAPR was defined as LTA–AA in the upper quartile of the enrolled population. HAPR patients tended to have lower renal function (P=0.052). Higher serum uric acid (SUA) level, as well as lower platelet count, hemoglobin and hematocrit were observed in HAPR patients, with a higher proportion of diuretics use (P<0.05). Multivariate analysis revealed that SUA (OR: 1.004, 95% CI: 1.000–1.007, P=0.048), platelet count (OR: 0.994, 95% CI: 0.989–1.000, P=0.045), hematocrit (OR: 0.921, 95% CI: 0.864–0.981, P=0.011) and concomitant P2Y12 receptor inhibitors use (OR: 1.965, 95% CI: 1.075–3.592, P=0.028) were correlated with HAPR. Spearman’s correlation analysis demonstrated an inverse association of LTA–AA with hematocrit (r=−0.234, P<0.001), hemoglobin (r=−0.209, P<0.001) and estimated glomerular filtration rate (r=−0.132, P=0.031).

Conclusion

SUA, platelet count, hematocrit and P2Y12 receptor inhibitors use were independently correlated with HAPR. These parameters might provide novel therapeutic targets for optimizing antiplatelet therapy.

[Endoscopic transoral resection the tumors of the higher position in parapharyngeal space: a retrospective case-control study]

Objective:To analysis the indication and security of the endoscopic resection of transoarl and pterygoid process approach of neoplasms in elevatus parapharyngeal space.Method:A retrospective case-control study were carried out in 22 patients with parapharyngeal space tumors.In the observation group (11 patients), tumors were endoscopic resected by transoral and pterygoid process approach. Paired with 11 patients (control group) who underwent surgry by traditional approach. We compared the en bloc resection rate, the operation time, blood loss, postoperative hospital stay, complication rate between the two groups.Result:In the observation group, the operation time, the blood loss and the postoperative hospital stay was (122.45±22.2)min, (97.26±13.75)ml, (4.09±1.22)d respectively. While in the control group, the operation time, the blood loss and the hospitalized days was (134.36±20.38)min, (213.64±63.99)ml, (5.10±0.99)d respectively. There were tumors that were block resection in both groups. In the observation group, there were a recurrence. Comparing the operation time, en bloc resection rate and postoperative hospital stay, there were no significant differences. There were differences in bloods loss between the two groups.Conclusion:The endoscopic transoral resection the tumors of the higher position in parapharyngeal space is safe, minimally invasive and feasible in selected cases, with a high local control rate and a low surgical complication rate.

[Individualized treatment of bilateral carotid body tumor]

Objective: To investigate individualized therapeutic strategy for bilateral carotid body tumors. Methods: Clinical data of 16 patients with bilateral carotid body tumor treated from January 2003 to August 2016 were retrospectively studied. Of the 16 patients, 9 were males and 7 were females; 5 were sporadic and 11 were familial; 8 cases were observed, 1 cases was malignant and treated with chemotherapy, and 7 cases were treated with surgery. The treatment course, perioperative complications and clinical efficacy were assessed. Comprehensive evaluation of bilateral carotid body tumors was performed based on the size of bilateral tumor, clinical manifestations, genetic tests and other indicators. Individual treatment strategies included observation, surgery and observation, bilateral surgery, radiotherapy or chemotherapy. Surgical resection of carotid body tumor was unilateral in 3 cases and bilateral in 3 cases; removal of bilateral carotid body tumors plus unilateral jugular bulb in 1 case; and the internal carotid artery was reconstructed with autologous greater saphenous vein in 1 case. Results: All patients were followed up for 3 months to 12 years. There was no patient death during perioperative period. Superior laryngeal nerve injury occurred in 2 case. Baroreceptor failure syndrome occurred in one patient, but it gradually recoverd with medical treatments. Conlusion: It is important to identify whether bilateral carotid body tumors are hereditary and to make an individualized therapeutic strategy for each patient with bilateral carotid body tumors, focusing on the improvement in the quality of life of patient.

[Clinical treatment of metastatic papillary thyroid carcinoma in cervical lymph nodal with occult primary sites]

Objective:To discuss the diagnosis, treatment and prognosis of metastatic papillary thyroid carcinoma in cervical lymph nodal with occult primary sites. Method:The clinical data of 5 patients involved papillary thyroid carcinoma with cervical lymph nodal metastasis with occult primary sites from 2009 to 2015 were analyzed. Result:According to preoperation examinations, two of them only underwent neck lymph node resection and three patients underwent asubtotal or total thyroidectomy plus neck lymph node dissection. All the pathological results showed that there were metastatic papillary thyroid carcinoma in cervical lymph nodal, but the primary sites of thyroid tissue were normal. After 1 to 7 year follow-up, there was no recurrence. Conclusion:Whether to take the thyroidectomy need to be carefully considered thyroidectomy in patients with metastatic papillary thyroid carcinoma in cervical lymph nodal with occult primary sites.

Narcissus yellow stripe virus and Narcissus mosaic virus detection in Narcissus via multiplex TaqMan-based reverse transcription-PCR assay

AIMS

Development of a multiplex TaqMan RT-qPCR assay to simultaneously detect Narcissus yellow stripe virus (NYSV) and Narcissus mosaic virus (NMV), frequently causing mixed narcissus infection. Feasibility verification was confirmed in natural samples.

METHODS AND RESULTS

Primers and probes were designed based on the conserved CP gene regions of NYSV or NMV and their suitability for singleplex and multiplex TaqMan RT-qPCR assays as well as for conventional RT-PCR. Conventional RT-PCR, singleplex and multiplex TaqMan RT-qPCR assays proved to be NYSV and NMV specific. P-values and coefficients of variation of TaqMan RT-qPCR assays indicated high reproducibility. Significantly increased sensitivity was achieved compared to conventional RT-PCR. The detection limit of both viruses was 10³ copies with superior correlation coefficients and linear standard curve responses between plasmid concentrations and Ct values. NYSV and NMV infection of narcissus leaves, petals and bulbs could successfully be detected via our multiplex RT-qPCR method at 1·25 mg.

CONCLUSION

Our multiplex TaqMan RT-qPCR assay provides rapid, specific, sensitive and reliable testing to simultaneously detect NYSV and NMV, supplying useful routine monitoring for different narcissus samples.

SIGNIFICANCE AND IMPACT OF THE STUDY

Efficient identification and discrimination of the narcissus viruses provides reliable information for scientists and conventional growers. Furthermore, it enriches the information of NYSV, NMV and other narcissus viruses.

[Simultaneous repairing defects of orbital floor and palate with the modified temporalis muscle flap after the maxillectomy]

Objective: To evaluate the outcome of one-stage reconstruction of maxillary and orbital defects with modified temporalis muscle flap (TMF) following the removal of malignant neoplasms. Methods: In this retrospective study, 15 patients underwent the reconstruction of defects of orbital floor and palate after maxillectomy for malignant tumor were included from June 2008 to June 2014. The modified temporalis muscle flap was used to repair the defects after surgery, and functional outcomes were analyzed. Results: All the patients were followed up for 12-81 months. Three cases of them received preoperative radiotherapy and 12 cases underwent postoperative radiotherapy. All flaps were survived. Epithelization of the tissues in oral and nasal cavity was completed in 4-6 weeks. Good functional reconstruction on swallowing and speaking functional results were achieved with maxillary and orbital reconstruction and no secondary deformity of external nose was observed. The eye positions in all cases were normal. Diplopia, diminution and loss of vision were not found. Conclusion: The modified TMF can be used for simultaneous reconstruction for the defects of orbital floor and palate after maxillectomy in patients whom free tissue flap can not be applied to, showing better cosmetic and functional results.

[The comparation of fusion targeting biopsy and systematic biopsy in the clinical diagnosis of prostate cancer: a meta-analysis]

Objective: To systematically compare the differences in the detection rate of prostate cancer with fusion targeting biopsy and systemic biopsy. Methods: A computer-based search of PubMed, Medline, China Biomedical Literature Database and Wanfang database (from the beginning of establishment of library to October 2016) on the detection rate of prostate cancer by fusion targeting biopsy and systemic biopsy was performed manually.The inclusion and exclusion criteria were formulated by 2 reviewers, and the data were extracted and evaluated respectively. RevMan5.3 software was used to analyze the detection rate of prostate cancer by two biopsy methods. Results: A total of 15 related clinical studies were included, 5 337 cases were enrolled in the study, including 2 667 cases of targeted fusion biopsy and 2 670 cases of routine systemic biopsy. The results showed that the overall detection rate of prostate cancer in targeting fusion biopsy was significantly higher than that of conventional systemic biopsy (OR=1.16, 95% CI 1.04-1.30, P=0.007). The detection rates of prostate cancer with different risk grades by two biopsy methods were conducted. We found that targeted fusion biopsy had a significant advantage compared with conventional system biopsy (OR=1.37, 95% CI 1.19-1.58, P<0.05) in middle and high risk prostate cancer with Gleason ≥ 7 points. In low-risk prostate cancer patients with Gleason score <7, the detection rate of prostate cancer by targeted fusion biopsy was lower (OR=0.76, 95% CI 0.65-0.89, P<0.05) than that of conventional systemic biopsy. Conclusions: Targeted fusion biopsy was significantly better than systemic biopsy in the overall detection rate of prostate cancer and the detection rate of the middle and high risk prostate cancer with Gleason ≥7 points. However, systemic biopsy performed better in patients with Gleason<7 points of low-risk prostate cancer.

[Clinical significance of four quadrant localization in the diagnosis and treatment of metastatic carcinoma of the neck with unknown primary]

Objective:The aim of this study is to investigate the clinical significance of four quadrant localization in the diagnosis and treatment of unknown primary cervical metastases. Method:The clinical data with unknown primary cervical metastases, were analyzed retrospectively. All the patients have not been found the original site in the initial treatment. There are four quadrants in the neck, the neck line as the longitudinal axis, and edge of cricoid cartilage as the horizontal axis. When cervical metastasis occurred in the left and right upper quadrant, the primary tumor site and radiotherapy from the skull base to the root of the neck; when appear in left and right lower quadrant, the primary investigation site and radiotherapy from neck to thoracic mediastinum, left lower abdomen also includes following primary search. At the same time, bilateral cervical metastasis cancers, focusing on the central line near the primary focus. Specific treatment strategies include ipsilateral total neck dissection and radical radiotherapy of the above radiotherapy site. Result:Left upper neck in 4 cases, right upper neck in 5 cases, left lower neck in 7 cases, lower right neck in 8 cases and mixed area in 6 cases. Only 10 of 30 patients (33.3%) with primary sites were found in the follow up period. In accordance with the four quadrant localization, the median time was 6 months. Conclusion:Four quadrant localization to locate the primary site is accurate, and individualized comprehensive treatment is the key to improve the curative effect.

[Determination and significance of serum MPO and amylin in adult patients with OSAHS after short-range noninvasive positive pressure ventilation]

Objective:The aim of this study to investigate the determination and significance of serum MPO and amylin in adult patients with OSAHS after short-range noninvasive positive pressure ventilation. Method:Eighty-seven OSAHS patients were divided into severe group (30 cases), moderate group (30 cases) and mild group (27 cases) according to the AHI range. Twenty-seven outpatient health persons were selected as the control group. Serum amylin and myeloperoxidase were measured by ELISA; Amyloid and myeloperoxidase were reassessed in 30 patients with severe OSAHS after 6 months of combined therapy, and the relationship between amylin, myeloperoxidase and PSG was analyzed. Result:①With the severity of OSAHS patients increased, the serum amylin and myeloperoxidase levels gradually increased (F=22.486, 19.755;P<0.01); There was no significant difference in MPO and amylin concentration between the mild group and the control group (P>0.05), and the other groups were significantly different from each other (P<0.01). ②There was no correlation among serum amylin and myeloperoxidase level and BMI and age in OSAHS patients (P>0.05); and a negative correlation with SaO₂, and AHI was positively correlated (P<0.01). ③After 3 months of CPAP treatment, LSaO₂ increased which the AHI and peripheral blood MPO, amylin levels lower than before in 30 patients (P<0.05); The amylin and myeloperoxidase concentrations of blood after 6 months of treatment were significantly lower than those of 3 months after treatment (P<0.05), which still increased compared with the control group. Conclusion:The determination of serum amylin and MPO in patients with OSAHS has a certain reference value in predicting the condition and curative effect of diabetes mellitus and insulin resistance. CPAP treatment can significantly reduce the degree of hypoxiapatients and cardiovascular damage in OSAHS patients, which was significantly correlated with the treatment time.

[Diagnostic value of enhanced CT/MRI for thyroid cartilage invasion by malignant tumor]

Objective: To evaluate the values of enhanced CT and MRI for the diagnosis of thyroid cartilage invasion by laryngeal and hypopharyngeal cancer. Methods: One hundred and ninety-seven patients with primary laryngeal or hypopharyngeal cancer treated with surgery between January 2013 and December 2014 were included in this study. All patients underwent enhanced CT and MRI before surgery. With MRI using the techniques of fast recovery fast spin echo (FRFSE), spin echo echo planar imaging (SE-EPI) and diffusion weighted imaging (DWI), thyroid cartilage invasion was evaluated and the results of postoperative histopathological examination was used as a gold standard for the determination of thyroid cartilage invasion. The sensitivity, specificity, positive predictive value and negative predictive value of enhanced CT or MRI in detecting thyroid cartilage invasion by laryngeal and hypopharyngeal cancer were evaluated. Data were analyzed with SPSS17.0 software. Results: Among 197 patients, there were 35 cases with supraglottic laryngeal cancer, 92 cases with glottic laryngeal cancer, 9 cases with subglottic laryngeal cancer, and 61 cases with hypopharyngeal cancer. Postoperative pathologycal examinations showed that 63 (32.0%) of 197 patients had thyroid cartilage invasion by tumor. Based on TNM classification of AJCC (American Joint Commission for Cancer, 2010), there were 36 cases at T2 stage, 109 cases at T3 and 52 cases at T4; 117 cases with N0, 46 cases with N1 and 34 cases with N2. The sensitivity, specificity, positive predictive value and negative predictive value of CT for the detection of thyroid cartilage invasion were respectively 57%, 86%, 65% and 81%, and those of MRI were respectively 94%, 87%, 78% and 97%. Kappa values were 0.45 for CT and 0.77 for MRI in diagnosis of thyroid cartilage invasion, with statistically significant difference (χ(2)=6.78, P<0.05). Conclusion: MRI (FRFSE and SE-EPI DWI) has more advantages than CT in the diagnosis of thyroid cartilage invasion by laryngeal or hypopharyngeal cancer.

Validation of aspirin response-related transcripts in patients with coronary artery disease and preliminary investigation on CMTM5 function

Aspirin is widely used in the prevention of cardiovascular diseases, but the antiplatelet responses vary from one patient to another. To validate aspirin response related transcripts and illustrate their roles in predicting cardiovascular events, we have quantified the relative expression of 14 transcripts previously identified as related to high on-aspirin platelet reactivity (HAPR) in 223 patients with coronary artery disease (CAD) on regular aspirin treatment. All patients were followed up regularly for cardiovascular events (CVE). The mean age of our enrolled population was 75.80±8.57years. HAPR patients showed no significant differences in terms of co-morbidities and combined drugs. Besides, the relative expression of HLA-DQA1 was significantly lower in low on-aspirin platelet reactivity (LAPR) patients, when compared with HAPR and high normal (HN) group (p=0.028). What's more, the number of arteries involved, HAPR status and the relative expression of CLU, CMTM5 and SPARC were independent risk factors for CVE during follow up (p<0.05). In addition, overexpression of CMTM5 attenuated endothelial cells (ECs) migration and proliferation, with significantly decreased phosphorylated-Akt levels, while its inhibition promoted these processes in vitro (p<0.05).Our study provides evidence that circulating transcripts might be potential biomarkers in predicting cardiovascular events. CMTM5 might exert anti-atherosclerotic effects via suppressing migration and proliferation in the vessel wall. Nevertheless, larger-scale and long-term studies are still needed.

[A new method to orthodontically correct dental occlusal plane canting: wave-shaped arch]

OBJECTIVE

To introduce a technique of second order wave-shaped arch wire to orthodontically treat dental occlusal plane canting (DOPC) with left-right interactive anchorage, and to test its clinical efficacy.

METHODS

Among the permanent dentition malocclusion patients who showed no obvious facial asymmetry, we screened for patients who showed anterior occlusal plane canting (AOPC) after routine orthodontic examination, treatment planning, MBT fixed appliance installation and serial arch wires alignment. Each patient had been clinically appraised in frontal view by 2 orthodontists and the patient him/herself; if all 3 agreed that the AOPC was obvious, the patient was included. By this means, we included 37 patients, including 10 males and 27 females; the average age was (21.9±5.2) years. To correct AOPC, opposite direction equal curvature second order rocking-chair curve was bent on each side of 0.46 mm×0.56 mm stainless steel edgewise wire. With reference to normal occlusal plane, a curve toward the occlusal surface was made to extrude under-erupted teeth on one side while a curve toward the gingiva was made to intrude over-erupted teeth on the other side, so that the arch wire was made into a wave shape in vertical dimension. Before and after application of wave-shaped arch wire, frontal facial photographs were taken when the patient's mouth was open slightly with lips retracted to show anterior occlusal plane (AOP) clearly. An AOP was constructed by connecting the center of the slot in the medial edge of canine bracket on each side in the photograph. The angles between the bipupillary plane(BPP) and the constructed AOP were measured in ImageJ1-48v software and the angle differences before and after treatment were compared with paired Wilcoxon test in SPSS 10.0 software.

RESULTS

The wave-shaped arch could correct AOPC effectively in 3 to 10 months time with an average of 5.5±1.7 months; the angles between AOP and BBP before treatment ranged from 2.90° to 6.12° with a median of 4.01°; after treatment the angles were from -0.17° to 2.57° with a median of 1.87°, the decrease of the angles between AOP and BBP after treatment ranged from 1.08° to 4.15° with a median of 2.21°. Paired Wilcoxon test P was 0.000.

CONCLUSION

The wave-shaped arch can be used independently or in combination with other treatment methods, which can take advantage of left and right interactive anchorage to correct AOPC effectively, so it has certain application value in clinical practice.

[An adolescent with Hashimoto's encephalopathy after surgery and ¹³¹I radiotherapy for papillary thyroid carcinoma: one case report]

Hashimoto's encephalopathy is a rare brain disease. Its etiology is still unknown. In this paper, we reported a 15-year-old female patient underwent total thyroidectomy and lymph node dissection, due to a multifocal papilliferous carcinoma of the right lobus. Forty-two days after surgery, the patient was treated by ¹³¹I radiotherapy in another hospital and begun to have a headache after 48 hours. At last, the patient was diagnosed by HE on the basis of all considerations. She recovered from by i.v. Immunoglobulin. Till now, the patient has not relapsed for more than 4 years follow-up.

Incoherence-coherence crossover and low-temperature Fermi-liquid-like behavior in AFe2As2 (A = K, Rb, Cs): evidence from electrical transport properties

We study the normal-state transport properties of AFe2As2 (A  =  K, Rb and Cs) single crystals using Hall coefficient, resistivity and magnetoresistance (MR) measurements. In all three materials, the Hall coefficient R H shows a strong temperature dependence, which is typical for multi-band systems. In particular, R H develops an upturn below a characteristic temperature [Formula: see text], which is in agreement with the incoherence-coherence crossover reported in recent nuclear magnetic resonance studies. A Fermi-liquid-like state, characterized by T (2) behavior of the resistivity and a positive orbital MR obeying Kohler's rule, emerges below T FL  ∼0.4 [Formula: see text]. The superconducting transition temperature T c experiences a simultaneous suppression with [Formula: see text] and T FL as the alkali ion's radius increases from A  =  K to A  =  Cs, suggesting that the unconventional superconductivity in the AFe2As2 series is related to the strength of the electronic coherence. A phase diagram, similar to that in the heavy fermion Kondo lattice system, is obtained. Based on all the experimental evidence, we argue that the physical properties of this family of heavily hole-doped Fe-based superconductors are controlled by the hybridization between itinerant carriers and localized orbitals, and the Kondo scenario could be effective in such a case.

Resolving and Tuning Mechanical Anisotropy in Black Phosphorus via Nanomechanical Multimode Resonance Spectromicroscopy

Black phosphorus (P) has emerged as a layered semiconductor with a unique crystal structure featuring corrugated atomic layers and strong in-plane anisotropy in its physical properties. Here, we demonstrate that the crystal orientation and mechanical anisotropy in free-standing black P thin layers can be precisely determined by spatially resolved multimode nanomechanical resonances. This offers a new means for resolving important crystal orientation and anisotropy in black P device platforms in situ beyond conventional optical and electrical calibration techniques. Furthermore, we show that electrostatic-gating-induced straining can continuously tune the mechanical anisotropic effects on multimode resonances in black P electromechanical devices. Combined with finite element modeling (FEM), we also determine the Young's moduli of multilayer black P to be 116.1 and 46.5 GPa in the zigzag and armchair directions, respectively.

[The diagnosis and treatment strategy for patients with severemultispace abscesses in neck]

Objective:To analyze the clinical characteristics of patients with severe deep neck abscess,etiology,imaging,appropriate treatment selection in those patients,to improve the judgement and understanding of the disease.Method:Thirty cases of severe deep neck abscess treated from March 2010 to June 2015 were retrospectively reviewed,including the clinical characteristics,diagnosis and treatment strategy.Result:The sore throat,odynophagia,dysphagia,fever and difficulty breathing were the most common symptoms of severe deep neck abscess.The causes of deep neck abscess were tooth diseases(5 cases),foreign bodies in pharynx or esophagus(4 cases),the second branchial crack cyst with multiply abscess,uncertain cause(20 cases).Six of the above cases complicated with mediastinal abscess.Radiologic evaluation was performed on all of the patients to identify the most probable location of the abscess:parapharyngeal space,retropharyngeal space,masticator space,carotid space,etc.Twenty-five cases were treated by drainage via incising lateral neck and 4 patientsreceived abscess puncture aspiration.Life-threatening complications were developed in all cases,29 cases were cured but one case dead.Conclusion:The treatment of severe deep neck multispace abscesses should be mindful.Once deep neck abscesses are diagnosed,we should timely undertake surgical drainage via incising lateral neck.Emergency tracheostomy should be perform in some case like severe dyspnea,airway obstrucion.Antibiotics should be appropriately applied,and basic diseases and complications should be carefully controlled.

[Frequency and clinical features of ASXL2 gene mutation in acute myeloid leukemia patients with AML1- ETO fusion gene positive]

目的

探讨伴AML1-ETO融合基因的急性髓系白血病（AML）患者ASXL2基因突变情况、突变阳性患者临床特征及ASXL2基因突变与c-kit基因突变的关系。

方法

采用PCR扩增产物片段直接测序分析法，检测59例伴AML1-ETO融合基因初发AML患者ASXL2基因第11、12外显子编码区突变情况，比较ASXL2基因突变阳性和阴性组患者的临床特征、生存及c-kit基因突变情况。

结果

59例患者中7例存在ASXL2突变，突变率为11.9%。ASXL2基因突变阳性组患者初诊时外周血红蛋白浓度中位数为56.2（38.0~72.0）g/L，显著低于ASXL2突变阴性组患者的69.0（37.2~154.0）g/L，差异有统计学意义（P=0.038）；外周血WBC、PLT、嗜酸粒细胞比例、骨髓原始细胞比例与ASXL2突变阴性组相比，差异均无统计学意义（P值均>0.05）。两组均未见肝、脾、中枢神经系统浸润；淋巴结不同程度肿大，但ASXL2基因突变阳性、阴性两组间差异无统计学意义（P=0.859）。免疫表型分析显示：ASXL2基因突变阳性组CD33表达显著低于阴性组（P=0.033）；两组患者均未表达cCD3，CD117、cMPO、HLA-DR、CD34、CD38、CD13、CD44、CD15、CD64、CD11b、CD56、CD19、cCD79a、CD7两组表达差异均无统计学意义（P值均>0.05）。ASXL2基因突变阳性与阴性组患者总缓解率、总生存时间差异均无统计学意义（P值分别为0.577、0.631）。两组c-kit基因突变检出率分别为14.3％和29.4%，差异无统计学意义（P=0.697）。

结论

该组伴AML1-ETO融合基因AML患者ASXL2基因突变率为11.9%。ASXL2突变阳性患者外周血红蛋白浓度、CD33表达方面呈现一定的临床特征。ASXL2基因突变与c-kit基因变突可能没有特定的关联性。

Syphilitic dementia and lipid metabolism

BACKGROUND AND PURPOSE

Chronic syphilitic infection may lead to dementia. It is in general paresis (GP), which is the major late form of neurosyphilis, that cognitive impairment frequently occurs. The association between lipid metabolism and GP is unclear.

METHODS

In this study, serum lipids were studied in 188 GP patients, in 241 syphilitic patients without neurosyphilis and in 539 healthy controls. The Mini-Mental State Examination (MMSE) was tested in all GP patients. Thirty-five GP patients had a follow-up evaluation 3 months after penicillin treatment.

RESULTS

Significantly lower apolipoprotein A-I (apoA-I) levels were found in GP and in syphilitic patients without neurosyphilis compared to controls. In the 25-44-year-old groups, the male syphilitic patients without neurosyphilis had lower serum apoA-I levels and higher apolipoprotein B (apoB)/apoA-I ratios compared with female patients. A follow-up evaluation of 35 GP patients 3 months after penicillin treatment showed a significant positive correlation between increased apoA-I levels and MMSE scores.

CONCLUSION

Abnormal apoA-I metabolism may be associated with the decline of cognitive performance. Long-term decrease of apoA-I level and higher apoB/apoA-I ratio may be contributing factors in syphilitic dementia. These results suggest a similar overlap between syphilitic dementia and lipid metabolism to that occurring in Alzheimer's disease.

Serum uric acid level and left ventricular hypertrophy in elderly male patients with nonvalvular atrial fibrillation

BACKGROUND AND AIMS

Recent studies have suggested that serum uric acid (SUA) induces oxidative stress and inflammation, which are involved in the mechanism of cardiac hypertrophy. In patients with atrial fibrillation (AF), comorbidity of left ventricular hypertrophy (LVH) exacerbates cardiac function. In this study, we investigated the association between SUA and cardiac hypertrophy in AF patients.

METHODS AND RESULTS

Initially, 1296 consecutive elderly patients (age >60) with nonvalvular AF were retrospectively selected from the inpatient clinic between January 2012 and April 2015. Demographic, clinical, and echocardiographic characteristics were carefully recorded. The final study population was 577 patients. The mean SUA level was significantly higher in patients with LVH than those without LVH. Compared with the non-LVH group, the LVH group was older, had a higher percentage of female patients, and had lower hemoglobin levels and estimated glomerular filtration rates. Patients in the LVH group also had a higher rate of coronary heart disease and fewer had history of radiofrequency ablation compared with the non-LVH group. In the hyperuricemia group, B-type natriuretic peptide levels, left atrial diameter, left ventricular mass index, and percentage of NYHA (New York Heart Association) class III/IV were significantly higher than the SUA normal group. Multivariate logistic regression analysis indicated the independent risk factors for LVH in elderly AF patients included SUA, age, male sex, the presence of coronary heart disease, and diuretic therapy. Subgroup analysis identified SUA as a significant risk factor associated with LVH in men.

CONCLUSIONS

SUA was independently associated with LVH in elderly male patients with nonvalvular AF.

[Small doses of gentamicin drum indoor injection treatment of intractableMénière disease clinical observation of the impact of the hearing]

Objective:To investigate the history,audiology,imaging,and operative characteristics of tympanosclerosis patients with intact tympanic membranes,and to provide theoretical reference for preoperative diagnosis and treatment.Method:A retrospective study was carried out among 9 tympanosclerosis patients (16 ears) with intact tympanic membranes who underwent exploratory tympanotomy.For different patients,the different reconstruction of ossicular chain are in selection.We compared the pre-operative outcomes of pure tone audiometry and otoscope with the post-operative outcomes,and calculated their air-bone gap and improvement value.Result:At 3 month after operation,otoscope showed that the tympanic membrane of all patiens were integrity.Tinnitus disappeared or improved in 5 cases.The mean thresholds of air conduction,bone conduction and air-bone gap were(40.33±11.48)dB,(27.34±8.46)dB,(13.16±9.85)dB respectively.The air-bone gap in 3 months after the operation was significantly smaller than that before operation(P<0.05).Conclusion:Most of the patients with tympanosclerosis suffer mixed hearing loss.In addition to chronic inflammatory stimulation,tympanic membrane incision catheter may be one of the important pathogenic factors.Morphology and imaging are more useful in differentiation of otosclerosis.Early and active surgery interference would attain good effect.

Bulk Fermi Surface of Charge-Neutral Excitations in SmB_{6} or Not: A Heat-Transport Study

Recently, there have been increasingly hot debates on whether a bulk Fermi surface of charge-neutral excitations exists in the topological Kondo insulator SmB_{6}. To unambiguously resolve this issue, we perform the low-temperature thermal conductivity measurements of a high-quality SmB_{6} single crystal down to 0.1 K and up to 14.5 T. Our experiments show that the residual linear term of thermal conductivity at the zero field is zero, within the experimental accuracy. Furthermore, the thermal conductivity is insensitive to the magnetic field up to 14.5 T. These results demonstrate the absence of fermionic charge-neutral excitations in bulk SmB_{6}, such as scalar Majorana fermions or spinons and, thus, exclude the existence of a bulk Fermi surface suggested by a recent quantum oscillation study of SmB_{6}. This puts a strong constraint on the explanation of the quantum oscillations observed in SmB_{6}.

[Discovery of a novel spliceosome of ABL gene (ABL(Δexon7+35INS)) and its association with TKIs resistance in chronic myeloid leukemia]

OBJECTIVE

To explore whether the ABL(Δexon7) and ABL(35INS) spliceosome contributed to TKIs resistance.

METHODS

Screening ABL(Δexon7) and ABL(35INS) in 74 normal people and 76 CML patients (53 patients in remission and 23 patients with TKIs resistance) by using polyacrylamide gel electrophoresis combined with cloning sequencing.

RESULTS

A novel spliceosome ABL(Δexon7+ 35INS) (ABL(Δexon7) and ABL(3)5INS existed at the same time) was identified and the mutation was detected in 8 (10.8%) of 74 normal people, 4 (7.5%) of 53 remission patients and 2 (8.7%) of 23 resistant patients. While 47 (63.5%) cases expressed ABL(Δexon7) and 8 (10.8% ) cases expressed ABL(35INS) in 74 healthy people, 30 (56.6%) cases expressed ABL(Δexon7) and 5 (9.4% ) cases expressed ABL(35INS) in 53 remission patients, 12 (52.2%) cases expressed ABL(Δexon7) and 3(13.0%) cases expressed ABL(35INS) in 23 resistant patients. Three kinds of spliceosome in all groups had no statistical difference.

CONCLUSION

ABL(Δexon7+ 35INS), ABL(Δexon7) and ABL(35INS) may be not uncommon in ABL gene and were unrelated to resistance in CML with TKIs treatment. ABL(35INS) were often accompanying with exon 7 deletion.

Identification of novel DYNC2H1 mutations associated with short rib-polydactyly syndrome type III using next-generation panel sequencing

Short rib-polydactyly syndrome type III (SRPS3) is a perinatal lethal skeletal disorder with polydactyly and multisystem organ abnormalities. While ultrasound of the fetus can detect skeletal abnormalities characteristic of SRPS3, the syndrome is often difficult to diagnose before birth. As SRPS3 is an autosomal recessive disorder, identification of the gene mutations involved could lead to the development of prenatal genetic testing as an accurate method of diagnosis. In this study, we describe genetic screening approaches to identify potential abnormalities associated with SRPS3. Karyotype analysis, array comparative genomic hybridization (aCGH), and next-generation panel sequencing were each performed on a fetus showing signs of the disorder, as well as on the mother and father. Karyotype and aCGH results revealed no abnormalities. However, next-generation panel sequencing identified novel mutations in the DYNC2H1 gene. The fetus was compound heterozygous for both a missense mutation c.8313A > T and a frameshift mutation c.10711_10714delTTTA in the DYNC2H1 gene, which were inherited from the mother and father, respectively. These variants were further confirmed using Sanger sequencing and have not been previously reported. Our study indicates the utility of using next-generation panel sequencing in screening for novel disease-associated mutations.

Emergent Kondo Lattice Behavior in Iron-Based Superconductors AFe_{2}As_{2} (A=K, Rb, Cs)

Here, we experimentally study the origin of d-electron heavy fermion (HF) behavior in iron-based superconductors (FeSCs) AFe_{2}As_{2} (A=K, Rb, Cs). Nuclear magnetic resonance on ^{75}As reveals a universal coherent-incoherent crossover with a characteristic temperature T^{*}. Below T^{*}, a so-called "Knight shift anomaly" is first observed in FeSCs, which exhibits a scaling behavior similar to f-electron HF materials. Furthermore, the scaling rule also regulates the manifestation of magnetic fluctuation. These results undoubtedly support an emergent Kondo lattice scenario for the d-electron HF behavior, which qualifies the AFe_{2}As_{2} (A=K, Rb, Cs) as d-electron HF superconductors.

Ultralow-Frequency Collective Compression Mode and Strong Interlayer Coupling in Multilayer Black Phosphorus

The recent renaissance of black phosphorus (BP) as a two-dimensional (2D) layered material has generated tremendous interest, but its unique structural characters underlying many of its outstanding properties still need elucidation. Here we report Raman measurements that reveal an ultralow-frequency collective compression mode (CCM) in BP, which is unprecedented among similar 2D layered materials. This novel CCM indicates an unusually strong interlayer coupling, and this result is quantitatively supported by a phonon frequency analysis and first-principles calculations. Moreover, the CCM and another branch of low-frequency Raman modes shift sensitively with changing number of layers, allowing an accurate determination of the thickness up to tens of atomic layers, which is considerably higher than previously achieved by using high-frequency Raman modes. These findings offer fundamental insights and practical tools for further exploration of BP as a highly promising new 2D semiconductor.

Evolution of High-Temperature Superconductivity from a Low-T_{c} Phase Tuned by Carrier Concentration in FeSe Thin Flakes

We report the evolution of superconductivity in an FeSe thin flake with systematically regulated carrier concentrations by the liquid-gating technique. With electron doping tuned by the gate voltage, high-temperature superconductivity with an onset at 48 K can be achieved in an FeSe thin flake with T_{c} less than 10 K. This is the first time such high temperature superconductivity in FeSe is achieved without either an epitaxial interface or external pressure, and it definitely proves that the simple electron-doping process is able to induce high-temperature superconductivity with T_{c}^{onset} as high as 48 K in bulk FeSe. Intriguingly, our data also indicate that the superconductivity is suddenly changed from a low-T_{c} phase to a high-T_{c} phase with a Lifshitz transition at a certain carrier concentration. These results help to build a unified picture to understand the high-temperature superconductivity among all FeSe-derived superconductors and shed light on the further pursuit of a higher T_{c} in these materials.

Angular-Dependent Phase Factor of Shubnikov-de Haas Oscillations in the Dirac Semimetal Cd_{3}As_{2}

We measure the magnetotransport properties of the three-dimensional Dirac semimetal Cd_{3}As_{2} single crystal under magnetic fields up to 36 T. Shubnikov-de Haas (SdH) oscillations are clearly resolved and the n=1 Landau level is reached. A detailed analysis on the intercept of the Landau index plot reveals a significant dependence of the SdH phase factor on the orientation of the applied magnetic field. When the magnetic field is applied in the [001] direction, i.e., along the fourfold screw axis of the tetragonal crystal structure, a nontrivial π Berry phase, as predicted for the Dirac fermions, is observed. However, in a magnetic field tilted away from the [001] direction, the π Berry phase is evidently reduced, and a considerable enhancement of the effective mass is also revealed. Our observations demonstrate that the Dirac dispersion in Cd_{3}As_{2} is effectively modified in a tilted magnetic field, whereas the preserved π Berry phase in a magnetic field along the [001] direction can be related to the realization of the Weyl fermions. The sudden change of the SdH phase also indicates a possible topological phase transition induced by the symmetry-breaking effect.