Senescent thyroid tumor cells promote their migration by inducing the polarization of M2-like macrophages

PURPOSE

An in-depth understanding of the mechanism of thyroid cancer progression will help identify patients with thyroid cancer with a high risk of recurrence and metastasis. Although studies have pointed out that the senescence of thyroid tumor cells may stimulate TAMs and cause a series of changes. However, the role of TAMs in aging thyroid cancer cells is still unknown. The aim of this study was to investigate the function of TAMs in aging thyroid cancer cells.

METHODS

We conducted in vitro model studies based on the K1 cell line to induce tumor cell senescence and study its effect on the differentiation of macrophages, flow cytometry was used to confirm polarization of macrophages, transwell assay was used to confirm changes of invasion and migration of tumor cells.

RESULT

Our data indicate that aging thyroid tumor cell lines trigger the polarization of M2-like macrophages, accompanied by increased expression of CCL17, CCL18, IL-18, and TGFβ1. This event is caused by the activation of the NFκB pathway upregulation of CXCL2 and CXCL3 is related. Further studies have shown that differentiated M2-like macrophages promote tumor cell migration (but have no effect on cell proliferation).

CONCLUSION

Our study indicating that the interaction between tumor and TAMs also occurs in the advanced stages of thyroid tumors and will lead to faster tumors progress.

The carcinogenic complex lncRNA FOXP4-AS1/EZH2/LSD1 accelerates proliferation, migration and invasion of gastric cancer

OBJECTIVE

To clarify the role of lncRNA FOX4-AS1 in the progression of gastric cancer (GC) via interacting with EZH2/LSD1.

PATIENTS AND METHODS

Relative level of FOXP4-AS1 in GC tissues and adjacent normal tissues was determined by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR). The potential influences of FOXP4-AS1 on cellular behaviors of GC cells were evaluated via a series of functional experiments. Bioinformatics prediction, RNA immunoprecipitation (RIP) assay, and Western blot were conducted to verify the potential of EZH2/LSD1 as a target of FOXP4-AS1.

RESULTS

FOXP4-AS1 was upregulated in GC tissues relative to controls. Its level was higher in GC patients with stage III-IV than those with stage I-II. The survival rate was lower in GC patients presenting the high expression of FOXP4-AS1 compared with those presenting low expression. Transfection of sh-FOXP4-AS1 1# or sh-FOXP4-AS1 2# attenuated proliferative, migratory, and invasive abilities of AGS and BGC7901 cells. FOXP4-AS1 could bind to LSD1 and EZH2, and positively regulated their expression levels. Transfection of sh-LSD1 or sh-EZH2 reduced the proliferative ability of GC cells.

CONCLUSIONS

FOXP4-AS1 binds to EZH2/LSD1 to form a carcinogenic complex, thus accelerating GC cells to proliferate, migrate and invade.

[Efficacy and safety of hepatitis B re-vaccination in children after completion of chemotherapy and(or) hematopoietic stem cell transplantation]

Objective: To assess the anti-hepatitis B surface antibody (HBsAb) titers in children after completion of chemotherapy and (or) hematopoietic stem cell transplantation (HSCT), evaluate the efficacy and safety of the current hepatitis B re-vaccination schedule. Methods: A total of 239 children who completed their chemotherapy and (or) HSCT and visited the vaccination clinic of Shanghai Children's Medical Center from March 2017 to July 2019 were enrolled in this study. According to the previous diseases, patients were divided into leukemia group (85 cases), lymphoma group (30 cases), solid tumor group (49 cases) and non-malignant hematological disease group (75 cases). According to the treatment of previous diseases, the patients were divided into chemotherapy group (126 cases), HSCT group (89 cases) and chemotherapy plus HSCT group (24 cases). HBsAb titers were assessed both at the time of diagnosis and after completion of treatment and some children who were HBsAb seronegative were re-vaccinated with 3 doses of hepatitis B vaccine, the vaccine-related adverse reactions were monitored. HBsAb titers were measured again one month after the completion of inoculation. HBsAb titers were defined as negative at levels <10 U/L and positive at ≥ 10 U/L. Chi-square test or Fisher exact test was used to compare the difference of negative conversion rate of hepatitis B antibody between groups, and Logistic regression was used to explore the risk factors of hepatitis B antibody negative conversion. Results: Among 239 patients, there were 143 males and 96 females. At the time of diagnosis, 179 patients (74.9%) were HBsAb seropositive and 60 patients (25.1%) were HBsAb seronegative. After completion of chemotherapy and (or) HSCT, 133 of 179 children with HBsAb seropositive (74.3%) at diagnosis became HBsAb seronegative. Univariate analysis showed significant differences at the negative conversion rates of HBsAb between different disease groups (χ²=10.211，P=0.015), different treatments groups (χ²=14.899，P<0.01) and different HBsAb titers groups before treatment (χ²=32.117，P<0.01). Logistic regression showed that HSCT (chemotherapy group as the reference, odds ratio (OR）=2.999, 95% confidence interval (CI) 1.276-7.050，P=0.012) and HBsAb titers<328.2 U/L before treatment (HBsAb titers≥328.2 U/L group as the reference, OR=6.397， 95% CI3.159-12.954，P<0.01) were risk factors for negative conversion of HBsAb. Among 48 patients whose HBsAb was seronegative after completion of chemotherapy and (or) HSCT and re-vaccinated with hepatitis B vaccine, 47 (97.9%) cases became HBsAb seropositivie. No serious adverse effects or complications were reported among these patients. Conclusions: After completion of chemotherapy and (or) HSCT, most children completely lose their protective humoral immunity against hepatitis B. Hepatitis B re-vaccination schedule can be efficiently and safely applied in those patients.

Identification of novel monoclonal antibodies targeting the outer membrane protein C and lipopolysaccharides for Escherichia coli O157:H7 detection

AIMS

To identify and evaluate the application of two novel monoclonal antibody (mAb) 2G12 against outer membrane protein (Omp) C and mAb 12B1 targeting the O chain of the lipopolysaccharides (LPS) of Escherichia coli O157:H7 (ECO157).

METHODS AND RESULTS

The sensitivity and specificity of these two antibodies were evaluated with eight ECO157 strains and 68 untargeted strains. mAb 2G12 and 12B1 had no detectable binding with any of the non-O157 strains at 6·0 log₁₀ CFU per ml, while its high specificity and affinity remained with all ECO157 strains. When a higher level (8·0 log₁₀ CFU per ml) was tested, 2G12 and 12B1 did not react with 82·35 and 97·06% of the non-O157 strains respectively. Based on the pair of two antibodies, the sandwich enzyme-linked immunosorbent assay detected 100% (8/8) of ECO157 strains and none of the non-ECO157 strains. The detection limit of ECO157 strains in pure culture were 4·2 ± 0·2 log₁₀ CFU per ml. When the developed test was applied to artificially inoculated beef samples, the detection limit was 6·0 log₁₀ CFU per gram without enrichment and 1·0 log₁₀ CFU per gram after 12 h of enrichment.

CONCLUSIONS

The two novel antibodies identified in this study served as great candidates for the recovery, and detection of ECO157 from different environmental and food samples.

SIGNIFICANCE AND IMPACT OF THE STUDY

ECO157-specific detection was improved by a combination of the novel OmpC mAb and LPS mAb with defined target antigen and good specificity.

Investigation of the spatially varying relationships of PM2.5 with meteorology, topography, and emissions over China in 2015 by using modified geographically weighted regression

PM_2.5 pollution is caused by multiple factors and determining how these factors affect PM_2.5 pollution is important for haze control. In this study, we modified the geographically weighted regression (GWR) model and investigated the relationships between PM_2.5 and its influencing factors. Experiments covering 368 cities and 9 urban agglomerations were conducted in China in 2015 and more than 20 factors were considered. The modified GWR coefficients (MGCs) were calculated for six variables, including two emission factors (SO₂ and NO₂ concentrations), two meteorological factors (relative humidity and lifted index), and two topographical factors (woodland percentage and elevation). Then the spatial distribution of MGCs was analyzed at city, cluster, and region scales. Results showed that the relationships between PM_2.5 and the different factors varied with location. SO₂ emission positively affected PM_2.5, and the impact was the strongest in the Beijing-Tianjin-Hebei (BTH) region. The impact of NO₂ was generally smaller than that of SO₂ and could be important in coastal areas. The impact of meteorological factors on PM_2.5 was complicated in terms of spatial variations, with relative humidity and lifted index exerting a strong positive impact on PM_2.5 in Pearl River Delta and Central China, respectively. Woodland percentage mainly influenced PM_2.5 in regions of or near deserts, and elevation was important in BTH and Sichuan. The findings of this study can improve our understanding of haze formation and provide useful information for policy-making.

LepR-Expressing Stem Cells Are Essential for Alveolar Bone Regeneration

Stem cells play a critical role in bone regeneration. Multiple populations of skeletal stem cells have been identified in long bone, while their identity and functions in alveolar bone remain unclear. Here, we identified a quiescent leptin receptor–expressing (LepR+) cell population that contributed to intramembranous bone formation. Interestingly, these LepR+ cells became activated in response to tooth extraction and generated the majority of the newly formed bone in extraction sockets. In addition, genetic ablation of LepR+ cells attenuated extraction socket healing. The parabiosis experiments revealed that the LepR+ cells in the healing sockets were derived from resident tissue rather than peripheral blood circulation. Further studies on the mechanism suggested that these LepR+ cells were responsive to parathyroid hormone/parathyroid hormone 1 receptor (PTH/PTH1R) signaling. Collectively, we demonstrate that LepR+ cells, a postnatal skeletal stem cell population, are essential for alveolar bone regeneration of extraction sockets.

Role of PTH1R Signaling in Prx1+ Mesenchymal Progenitors during Eruption

Tooth eruption is a complex process requiring precise interaction between teeth and adjacent tissues. Molecular analysis demonstrates that bone remodeling plays an essential role during eruption, suggesting that a parathyroid hormone 1 receptor (PTH1R) gene mutation is associated with disturbances in bone remodeling and results in primary failure of eruption (PFE). Recent research reveals the function of PTH1R signaling in mesenchymal progenitors, whereas the function of PTH1R in mesenchymal stem cells during tooth eruption remains incompletely understood. We investigated the specific role of PTH1R in Prx1⁺ progenitor expression during eruption. We found that Prx1⁺-progenitors occur in mesenchymal stem cells residing in alveolar bone marrow surrounding incisors, at the base of molars and in the dental follicle and pulp of incisors. Mice with conditional deletion of PTH1R using the Prx1 promoter exhibited arrested mandibular incisor eruption and delayed molar eruption. Micro-computed tomography, histomorphometry, and molecular analyses revealed that mutant mice had significantly reduced alveolar bone formation concomitant with downregulated gene expression of key regulators of osteogenesis in PTH1R-deficient cells. Moreover, culturing orofacial bone-marrow-derived mesenchymal stem cells (OMSCs) from Prx1Cre;PTH1R^fl/fl mice or from transfecting Cre recombinase adenovirus in OMSCs from PTH1R^fl/fl mice suggested that lack of Pth1r expression inhibited osteogenic differentiation in vitro. However, bone resorption was not affected by PTH1R ablation, indicating the observed reduced alveolar bone volume was mainly due to impaired bone formation. Furthermore, we found irregular periodontal ligaments and reduced Periostin expression in mutant incisors, implying loss of PTH1R results in aberrant differentiation of periodontal ligament cells. Collectively, these data suggest that PTH1R signaling in Prx1⁺ progenitors plays a critical role in alveolar bone formation and periodontal ligament development during eruption. These findings have implications for our understanding of the physiologic and pathologic function of PTH1R signaling in tooth eruption and the progression of PFE.

Discriminating between bronchiolar adenoma, adenocarcinoma in situ and minimally invasive adenocarcinoma of the lung with CT

PURPOSE

To identify computed tomography (CT) features that may help distinguish bronchiolar adenoma (BA) from lung adenocarcinomas in situ (AIS) and minimally invasive adenocarcinomas (MIA) among lung lesions presenting as ground-glass nodules (GGNs).

MATERIALS AND METHODS

A total of 140 patients with GGNs confirmed by surgery and pathology, were reviewed retrospectively. There were 68 men and 72 women with a mean age of 64.3±8.9 (SD) years (range: 31 - 85 years). The CT features of BA, AIS, and MIA were analyzed and compared. CT features, including percentage of solid component, maximum diameter of solid component, lesion density, location, margin, shape, pseudo-cavitation, calcification, ill-defined peripheral opacity, and air bronchogram, were analyzed using multivariate logistic regression and receiver operating characteristic curves.

RESULTS

There were 11/140 (7.9%) patients with BA (mean age, 67.7±7.5 [SD]; range 45 - 77 years), 63/140 (45.0%) patients with AIS (mean age, 62.5±8.6 [SD]; range 36 - 69 years) and 66/140 (47.1%) patients with MIA (mean age, 63.5±7.9 [SD]; range 35 - 72 years). By comparison with AIS and MIA, significantly different CT features of BA included tumor size, solid component diameters, low CT attenuation of the ground-glass component, irregular shape, ill-defined peripheral opacity, pseudo-cavitation, and abnormal pulmonary vein. Ill-defined peripheral opacity (odds ratio, 1.060; 95% confidence interval [CI]: 1.020 - 1.380) and pseudo-cavitation (odds ratio, 1.236; 95% CI: 1.070 - 1.565) were variables independently associated with the diagnosis of BA.

CONCLUSION

CT provides morphological features that allow differentiating between BA and AIS-MIA among lung lesions presenting as GGNs.

Noninvasive imaging evaluation of tumor immune microenvironment to predict outcomes in gastric cancer

BACKGROUND

The tumor immune microenvironment can provide prognostic and predictive information. A previously validated ImmunoScore of Gastric Cancer (IS_GC) evaluates both lymphoid and myeloid cells in the tumor core and invasive margin with immunohistochemical staining of surgical specimens. We aimed to develop a noninvasive radiomics-based predictor of IS_GC.

PATIENTS AND METHODS

In this retrospective study including four independent cohorts of 1778 patients, we extracted 584 quantitative features from the intratumoral and peritumoral regions on contrast-enhanced computed tomography images. A radiomic signature [radiomics ImmunoScore (RIS)] was constructed to predict IS_GC using regularized logistic regression. We further evaluated its association with prognosis and chemotherapy response.

RESULTS

A 13-feature radiomic signature for IS_GC was developed and validated in three independent cohorts (area under the curve = 0.786, 0.745, and 0.766). The RIS signature was significantly associated with both disease-free and overall survival in the training and all validation cohorts [hazard ratio (HR) range: 0.296-0.487, all P < 0.001]. In multivariable analysis, the RIS remained an independent prognostic factor adjusting for clinicopathologic variables (adjusted HR range: 0.339-0.605, all P < 0.003). For stage II and stage III disease, patients with a high RIS derived survival benefit from adjuvant chemotherapy {HR = 0.436 [95% confidence interval (CI) 0.253-0.753], P = 0.002; HR = 0.591 (95% CI 0.428-0.818), P < 0.001, respectively}, whereas those with a low RIS did not.

CONCLUSION

The RIS is a reliable tool for evaluation of immunoscore and retains the prognostic significance in gastric cancer. Future prospective studies are required to confirm its potential to predict treatment response and select patients who will benefit from chemotherapy.

Stability of fungal biomass continuously fed with tannic acid in a non-sterile moving-packed bed reactor

A number of bacteria and fungi are known to degrade tannins. In this study, the efficiency of the white-rot fungus, Bjerkandera adusta MUT 2295, was evaluated for the treatment of a synthetic solution prepared with tannic acid. Tests were performed in continuously fed, bench-scale, packed-bed reactors, operated under non-sterile conditions with biomass immobilized within PolyUrethane Foam cubes (PUFs). The main parameters monitored to evaluate the process efficiency were: soluble Chemical Oxygen Demand (sCOD), Total Organic Carbon (TOC) removal, and activities. of Tannase and Lignin Peroxidase. At the end of the process, additional parameters were evaluated, including the increase of fungal dry weight and the presence of ergosterol. The reactor was operative for 210 days, with maximum sCOD and TOC removal of 81% and 73%, respectively. The reduction of sCOD and TOC were positively correlated with the detection of Tannase and Lignin Peroxidase (LiP) activities. Increases in biomass within the PUF cubes was associated with increases in ergosterol concentrations. This study proved that the fungal-based system tested was efficient for the degradation of tannic acid over a period of time, and under non-sterile conditions.

Measurement of the cosmic ray proton spectrum from 40 GeV to 100 TeV with the DAMPE satellite

The precise measurement of the spectrum of protons, the most abundant component of the cosmic radiation, is necessary to understand the source and acceleration of cosmic rays in the Milky Way. This work reports the measurement of the cosmic ray proton fluxes with kinetic energies from 40 GeV to 100 TeV, with 2 ¹/₂ years of data recorded by the DArk Matter Particle Explorer (DAMPE). This is the first time that an experiment directly measures the cosmic ray protons up to ~100 TeV with high statistics. The measured spectrum confirms the spectral hardening at ~300 GeV found by previous experiments and reveals a softening at ~13.6 TeV, with the spectral index changing from ~2.60 to ~2.85. Our result suggests the existence of a new spectral feature of cosmic rays at energies lower than the so-called knee and sheds new light on the origin of Galactic cosmic rays.

β4GalT1 promotes inflammation in human osteoarthritic fibroblast-like synoviocytes by enhancing autocrine TNF-α activity

OBJECTIVE

Synovial inflammation plays an important role in the pathogenesis of osteoarthritis (OA), and β4GalT1 has been reported to be involved in the inflammatory process. The aim of our study was to investigate the role of β4GalT1 in the progression of inflammation and analyze the association between β4GalT1 and tumor necrosis factor (TNF)-α in human OA fibroblast-like synoviocytes (FLS).

PATIENTS AND METHODS

Primary cultured FLS isolated from OA synovial tissues were cultured, and the levels of β4GalT1, TNF-α, MMP-3, p/t-ERK, p/t-JNK, and p/t-P38 were analyzed by Western blotting. An enzyme-linked immunosorbent assay (ELISA) was performed to measure the secretion of TNF-α, interleukin (IL)-1β, and IL-6 in OA-FLS. Immunofluorescence staining was used to examine the co-localization of β4GalT1 and TNF-α or THY1. RT-PCR was used to detect the transfection efficiency of β4GalT1.

RESULTS

The expression of β4GalT1 was increased in OA-FLS. β4GalT1 promoted cell invasion, MMP-3 production, and the secretion of TNF-α, IL-1β, and IL-6. si-TNF-α attenuated the β4GalT1-enhanced cell invasion and inflammatory factor secretion in OA-FLS. Furthermore, β4GalT1 increased autocrine TNF-α signaling in OA-FLS. β4GalT1 knockdown successfully decreased autocrine TNF-α activity, while β4GalT1 overexpression increased autocrine TNF-α activity in OA-FLS. Moreover, β4GalT1 enhanced the ERK, JNK, and P38 MAPK signaling pathways through the induction of autocrine TNF-α signaling in OA-FLS.

CONCLUSIONS

β4GalT1 may promote the inflammatory progression of OA-FLS by enhancing autocrine TNF-α signaling.

The relationships between PM2.5 and aerosol optical depth (AOD) in mainland China: About and behind the spatio-temporal variations

Satellite aerosol products have been widely used to retrieve ground PM_2.5 concentration because of their wide coverage and continuous spatial distribution. While more and more studies have focused on the retrieval algorithms, the foundation for the retrieval-relationship between PM_2.5 and satellite aerosol optical depth (AOD) has not been fully investigated. In this study, the relationships between PM_2.5 and AOD were investigated in 368 cities in mainland China from February 2013 to December 2017, at different temporal and regional scales. Pearson correlation coefficients and the PM_2.5/AOD ratio were used as indicators. Firstly, we established the relationship between PM_2.5 and AOD in terms of the spatio-temporal variations, and discuss the impact of some potential factors for a better understanding of the spatio-temporal variations. Spatially, we found that the correlation is higher in the Beijing-Tianjin-Hebei and Chengyu regions and weaker in coastal areas. The PM_2.5/AOD ratio shows an obvious north-south difference, with the ratio in North China higher than South China. Temporally, the correlation coefficient tends to be higher in May and September, with the PM_2.5/AOD ratio higher in winter and lower in summer. As for interannual variations, we detected a decreasing tendency for the PM_2.5-AOD correlation and PM_2.5/AOD ratio for recent years. Then, to determine the impact of the weakening of the PM_2.5-AOD relationship on PM_2.5 remote sensing retrieval performance, a geographically weighted regression (GWR) retrieval experiment was conducted. The results showed that the performance of retrievals is also decreasing while PM_2.5-AOD relationship getting weaker. Our study investigated the PM_2.5-AOD relationship over a large extent at the city scale, and investigated the temporal variations in terms of interannual variations. The results will be useful for the satellite retrieval of PM_2.5 concentration and will help us to further understand the PM_2.5 pollution situation in mainland China.

Tissue Clearing and Its Application to Bone and Dental Tissues

Opaqueness of animal tissue can be attributed mostly to light absorption and light scattering. In most noncleared tissue samples, confocal images can be acquired at no more than a 100-µm depth. Tissue-clearing techniques have emerged in recent years in the neuroscience field. Many tissue-clearing methods have been developed, and they all follow similar working principles. During the tissue-clearing process, chemical or physical treatments are applied to remove components blocking or scattering the light. Finally, samples are immersed in a designated clearing medium to achieve a uniform refractive index and to gain transparency. Once the transparency is reached, images can be acquired even at several millimeters of depth with high resolution. Tissue clearing has become an essential tool for neuroscientists to investigate the neural connectome or to analyze spatial information of various types of brain cells. Other than neural science research, tissue-clearing techniques also have applications for bone research. Several methods have been developed for clearing bones. Clearing treatment enables 3-dimensional imaging of bones without sectioning and provides important new insights that are difficult or impossible to acquire with conventional approaches. Application of tissue-clearing technique on dental research remains limited. This review will provide an overview of the recent literature related to the methods and application of various tissue-clearing methods. The following aspects will be covered: general principles for the tissue-clearing technique, current available methods for clearing bones and teeth, general principles of 3-dimensional imaging acquisition and data processing, applications of tissue clearing on studying biological processes within bones and teeth, and future directions for 3-dimensional imaging.

Spatio⁻Temporal Relationship and Evolvement of Socioeconomic Factors and PM2.5 in China During 1998⁻2016

A comprehensive understanding of the relationships between PM2.5 concentration and socioeconomic factors provides new insight into environmental management decision-making for sustainable development. In order to identify the contributions of socioeconomic development to PM2.5, their spatial interaction and temporal variation of long time series are analyzed in this paper. Unary linear regression method, Spearman's rank and bivariate Moran's I methods were used to investigate spatio⁻temporal variations and relationships of socioeconomic factors and PM2.5 concentration in 31 provinces of China during the period of 1998⁻2016. Spatial spillover effect of PM2.5 concentration and the impact of socioeconomic factors on PM2.5 concentration were analyzed by spatial lag model. Results demonstrated that PM2.5 concentration in most provinces of China increased rapidly along with the increase of socioeconomic factors, while PM2.5 presented a slow growth trend in Southwest China and a descending trend in Northwest China along with the increase of socioeconomic factors. Long time series analysis revealed the relationships between PM2.5 concentration and four socioeconomic factors. PM2.5 concentration was significantly positive spatial correlated with GDP per capita, industrial added value and private car ownership, while urban population density appeared a negative spatial correlation since 2006. GDP per capita and industrial added values were the most important factors to increase PM2.5, followed by private car ownership and urban population density. The findings of the study revealed spatial spillover effects of PM2.5 between different provinces, and can provide a theoretical basis for sustainable development and environmental protection.

[Clinical significance of quantitative level of hepatitis B core antibody]

Hepatitis B core antibody (anti-HBc) targets viral core protein and is produced in patients with hepatitis B virus (HBV) infection, and seroconversion occurs in the early stage of infection and often lasts for a lifetime. Qualitative detection of anti-HBc has been used in clinical practice for many years, while the clinical significance of its quantitative level remains unclear. A novel anti-HBc immunoassay based on double-antigen sandwich ELISA has been developed in recent years and lays a foundation for illustrating the change in the quantitative level of anti-HBc (qAnti-HBc) in HBV infection and its clinical significance. Several recent studies have revealed that qAnti-HBc is associated with the degree of hepatitis activity and response to pharmacotherapy and may become an important basis for selecting antiviral drugs, optimizing therapeutic regimen, and predicting treatment outcome.

[Combination of CT mulitplane 3D reconstruction, radial endobronchial ultrasound and rapid on-site evaluation for diagnosing peripheral solitary pulmonary nodules]

Objective: To evaluate the diagnostic efficiency of combination of CT multiplane 3D reconstruction (CT-3DR), radial endobronchial ultrasound (R-EBUS), and rapid on-site evaluation (ROSE) for peripheral solitary pulmonary nodules (SPN). Methods: A total of 176 patients with peripheral solitary pulmonary nodule were included from the Nanjing Chest Hospital from March 2016 to March 2017. According to different methods, all the patients were divided into four groups: EG (i.e. R-EBUS+Guiding sheath (GS))group, CTE (i.e. CT-3DR+R-EBUS) group, RE (i.e. ROSE+R-EBUS) group, and triad (i.e. CT-3DR+ROSE+R-EBUS) group. Sampling was performed by transbronchial lung biopsy. The diagnostic yield and complications, procedure time and influencing factors in these four groups were retrospectively analyzed. The value of ROSE and combination of CT-3DR+ROSE+R-EBUS in diagnosis for SPN also was evaluated. Results: The diagnostic yield for total SPNs among four groups were 70.5% in EG group, 70.0% in CTE group, 69.0% in RE group and 74.0% in triad group, respectively. There was no significant difference among four groups (all P>0.05). The procedure time of EG group, CTE group, RE group and triad group were (34.0±6.3), (26.6±6.8), (27.2±7.8) and (19.4±5.4) min, respectively. The procedure time was the shortest in triad group compared with the other three groups (all P<0.001) and the time of CTE and RE groups were significantly shorter than the EG group (both P<0.001). The coincidence rates of CT-3DR navigation position with target bronchus were 87.5% in CTE group and 90.0% in triad group with no significant difference between these two groups (P>0.05). The diagnostic yield was higher for SPNs with their major diameter ≥2 cm than those with their major diameter<2 cm in all four groups (all P<0.05). The positive diagnostic yield was higher with ultrasonic probe located within SPN lesion than the probe adjacent to or deviated the lesion in all four groups (all P<0.05). In EG and RE groups, for those SPNs with the distance between the lesion and pleura≥2 cm, the diagnostic yield were higher than those withe the distance<2 cm (P<0.05) but no similar phenomenon was observed in CTE and triad groups. No significant correlation was detected between the diagnostic yield and the density of SPN lesions among four groups (all P>0.05). ROSE was used in RE and triad groups. The coincidence rate of ROSE with histopathology was 82.6% and the value of Kappa was 0.608. The diagnostic sensitivity, specificity, positive predictive value and negative predictive value of ROSE were 0.818, 0.846, 0.931 and 0.647, respectively. Conclusions: CT-3DR navigation and ROSE help to improve the diagnostic efficiency of R-EBUS for SPN. Combination of CT-3DR, R-EBUS and ROSE is of diagnostic value for peripheral SPN and with significant shortening of procedure time.

[Flunarizine in the prophylaxis of vestibular migraine:a randomized controlled trial]

Objective:To evaluate the efficacy and safety of flunarizine in patients with vestibular migraine（VM）as a prophylactic medication. Method:This randomized control trial was undertaken in patients with definite VM. Behavior changes were advocated to all the patients to avoide certain foods and beverages, as well as changes in lifestyle and habits.Patients in arm A received 10-mg flunarizine daily for 3 months along with betahistine 12 mg Tid for 48 h during episodes, and arm B received only betahistine for 48 h during episodes. Frequency. duration and intensity of vertiginous episodes and the main sideeffects were noted at the start of the study and at the end of 3 months.Result:A total of 23 patients who were diagnosed with definitive migrainous vertigo completed the study. The frequency,duration and intensity of vertiginous episodes showed a significan improvement in both group(P <0.05).Analysis of the frequency, duration and intensity between arm A and arm B showed that frequency improved to a significant degree(P <0.05),but the duration and intensity of vertigo between the two groups did not improve to a significant degree(P >0.05). Severe adverse events were not found. Conclusion:Flunarizine is safe and effective for the prophylaxis treatment of VM.