[Prediction and investigation of the potential risk factors for the upper mediastinal metastasis of papillary thyroid carcinoma]

Objective: To predict and investigate the potential risk factors for the upper mediastinal metastasis of papillary thyroid carcinoma (PTC). Methods: This study was a prospective cohort study. The admission criteria were patients with untreated thyroid cancer diagnosed in Cancer Hospital, Chinese Academy of Medical Sciences from December 2013 to December 2015, and positive lymph node (cN1, including cN1a and cN1b) was diagnosed by ultrasound. All patients underwent neck to thorax enhanced Computed Tomography (CT) examination preoperatively. All patients with suspected upper mediastinal lymph node metastasis experienced suspicious regional dissection, and those who had not undergone surgery and whose postoperative pathology was non-papillary thyroid carcinoma were excluded. Kaplan-Meier method was selected for survival analysis and all the factors were analyzed by multivariate Logistic regression. Results: Of the 248 patients, 54 were prompted by postoperative pathology for upper mediastinal lymph node metastasis, 86 cases were phase T1, 94 cases were phase T2, 17 cases were phase T3 and 51 cases were phase T4, 21 cases were N1a phase and 227cases were N1b phase. There was a statistically significant difference in the T-phase and N-phase between the upper mediastinal lymph node metastasis group and no upper mediastinal lymph node metastasis group(P<0.05). Univariate analysis showed that among the preoperative relevant factors, ultrasound tumor length> 2 cm, ultrasound tumor bilaterally, CT double neck lymph node metastasis, increased thyroglobulin (Tg), and increased anti-thyroglobulin antibody (ATG) were all risk factors for upper mediastinal lymph node metastasis(all P<0.05). Among the postoperative factors, bilateral tumor, double neck lymph node metastasis, tumor invasion of the recurrent laryngeal nerve, trachea, esophagus or larynx, T3 staging, T4 staging, total number of metastatic lymph nodes>10, the number of metastatic lymph nodes in level Ⅵ>3 and >6, the proportion of metastatic lymph nodes in level Ⅵ>1/2, the number of metastatic lymph nodes in level Ⅳ> 5 and metastatic proportion >1/3 are risk factors for metastasis of upper mediastinal lymph node(all P<0.05). Multivariate analysis showed that CT indicated double neck lymph node metastasis, increased Tg, increased ATG, the proportion of metastatic lymph nodes in level Ⅵ >1/2, and in level Ⅳ>1/3 are independent risk factors for upper mediastinum lymph node metastasis(all P<0.05). The 5-year recurrence-free survival rates of the upper mediastinal lymph node metastasis group and the no upper mediastinal lymph node metastasis group were 92.3% and 94.8% respectively, and the difference was not statistically significant(P=0.307). Conclusions: For preoperative ultrasound considering the presence of lymph node metastases, enhanced neck to thorax CT should be performed routinely. When bilateral cervical lymph node metastasis is determined by CT, or endocrine tests suggest abnormally increased antibodies, attention should be paid to the upper mediastinal lymph nodes metastasis. In the course of neck dissection, if more lymph node metastases in level Ⅵ and level Ⅳ were detected, surgeons should be vigilant of the upper mediastinal metastasis. The prognosis of patients underwent complete mediastinal dissection is not significantly different from that of patients without mediastinal metastasis.

[Advances in toxicity and biological monitoring of 2-butoxy ethanol]

2-butoxyethanol is a widely used organic solvent. The United States Toxic and Disease Registry (ATSDR) listed 2-butoxyethanol as a suspected human carcinogen. In this paper, we reviewed the research progress of methylene chloride metabolism and absorption in vivo, toxicity and biological monitoring in recent years.

[Current status and quality analysis of interventional therapy for patients with atrial fibrillation in China]

Objective: To define the current status and analyze the medical quality of interventional therapy for patients with atrial fibrillation (AF) in China. Methods: This survey was performed in all seven large regions of China, one to three regional major medical centers were selected from each region. Medical records of patients underwent interventional therapy for AF in the year 2017 were randomly inspected. CHA2DS2-VASc score, prescribed anticoagulant after ablation, indication of left atrial appendage occlusion (LAAO), and complications in the medical records were analyzed. Results: A total of 10 800 AF catheter ablations and 447 LAAOs were performed in 17 regional medical centers in 2017. There were 10/17 centers performing AF catheter ablation<500 cases and 7/17 centers performing LAAO<20 cases. A total of 1 347 cases of catheter ablation and 160 cases of LAAO were selected for further analysis. Among all selected cases, 15.8% (238/1 505) non-valvar AF cases recorded CHA2DS2-VASc scores. The anticoagulation rate after AF catheter ablation was 98.6% (1 328/1 347), anticoagulation rate was higher than 90% in 16 out of 17 centers. The complication and severe complication rates of AF catheter ablation were 0.9% (12/1 347) and 0.4% (5/1 347), respectively. The differences of complication and severe complication rates in AF catheter ablation were similar between centers performing<500 cases and centers performing ≥500 cases (0.5% (2/413) vs. 1.1% (10/934), P>0.05; 0.5% (2/413) vs. 0.3% (3/934), P>0.05). The coincidence rate of LAAO indication was 81.3% (130/160), and the rate was higher in center performing ≥20 cases than in centers performing<20 cases (84.8% (106/125) vs. 68.6% (24/35), P<0.05). The complication and severe complication rates of LAAO were 3.1% (5/160) and 1.9% (3/160). The rate of complications in LAAO was higher in center performing<20 cases than in centers performing ≥20 cases (8.6% (3/35) vs. 1.6% (2/125), P<0.05), and there was no significant difference in severe complication rate (5.7% (2/35) vs. 0.8% (1/125), P>0.05). Conclusions: Interventional therapy for AF in China is generally standardized and safe. The overall incidence of complications post AF interventional ablation is low, the anticoagulation rate after AF catheter ablation is high, and the adherence rate of LAAO indication is fair. The indicators mentioned above vary widely among centers.

[Spatial and temporal distribution and predictive value of chest CT scoring in patients with COVID-19]

Objective: To explore a modified CT scoring system, its feasibility for disease severity evaluation and its predictive value in coronavirus disease 2019 (COVID-19) patients. Methods: This study was a multi-center retrospective cohort study. Patients confirmed with COVID-19 were recruited in three medical centers located in Beijing, Wuhan and Nanchang from January 27, 2020 to March 8, 2020. Demographics, clinical data, and CT images were collected. CT were analyzed by two emergency physicians of more than ten years' work experience independently through a modified scoring system. Final score was determined by average score from the two reviewers if consensus was not reached. The lung was divided into 6 zones (upper, middle, and lower on both sides) by the level of trachea carina and the level of lower pulmonary veins. The target lesion types included ground-glass opacity (GGO), consolidation, overall lung involvement, and crazy-paving pattern. Bronchiectasis, cavity, pleural effusion, etc., were not included in CT reading and analysis because of low incidence. The reviewers evaluated the extent of the targeted patterns (GGO, consolidation) and overall affected lung parenchyma for each zone, using Likert scale, ranging from 0-4 (0=absent; 1=1%-25%; 2=26%-50%; 3=51%-75%; 4=76%-100%). Thus, GGO score, consolidation score, and overall lung involvement score were sum of 6 zones ranging from 0-24. For crazy-paving pattern, it was only coded as absent or present (0 or 1) for each zone and therefore ranging from 0-6. Results: A total of 197 patients from 3 medical centers and 522 CT scans entered final analysis. The median age of the patients was 64 years, and 54.8% were male. There were 76(38.8%) patients had hypertension and 30(15.3%) patients had diabetes mellitus. There were 75 of the patients classified as moderate cases, as well as 95 severe cases and 27 critical cases. As initial symptom, dry cough occurred in 170 patients, 134 patients had fever, and 125 patients had dyspnea. Reparatory rate, oxygen saturation, lymphocyte count and CURB 65 score on admission day varied among patients with different disease severity scale. There were 50 of the patients suffered from deterioration during hospital stay. The median time consumed for each CT by clinicians was 86.5 seconds. Cronbach's alpha for GGO, consolidation, crazy-paving pattern, and overall lung involvement between two clinicians were 0.809, 0.712, 0.678, and 0.906, respectively, showing good or excellent inter-rater correlation. There were 193 (98.0%) patients had GGO, 147 (74.6%) had consolidation, and 126(64.0%) had crazy-paving pattern throughout clinical course. Bilateral lung involvement was observed in 183(92.9%) patients. Median time of interval for CT scan in our study was 7 days so that the whole clinical course was divided into stages by week for further analysis. From the second week on, the CT scores of various types of lesions in severe or critically patients were higher than those of moderate cases. After the fifth week, the course of disease entered the recovery period. The CT score of the upper lung zones was lower than that of other zones in moderate and severe cases. Similar distribution was not observed in critical patients. For moderate cases, the ground glass opacity score at the second week had predictive value for the escalation of the severity classification during hospitalization. The area under the receiver operating characteristic curve was 0.849, the best cut-off value was 5 points, with sensitivity of 84.2% and specificity of 75.0%. Conclusions: It is feasible for clinicians to use the modified semi-quantitative CT scoring system to evaluate patients with COVID-19. Severe/critical patients had higher scores for ground glass opacity, consolidation, crazy-paving pattern, and overall lung involvement than moderate cases. The ground glass opacity score in the second week had an optimal predictive value for escalation of disease severity during hospitalization in moderate patients on admission. The frequency of CT scan should be reduced after entering the recovery stage.

[Research progress of liposome drug delivery system in stomatology]

Liposomes are spherical vesicles with bilayer membrane structure spontaneously formed by phospholipids dispersed in an aqueous medium. Liposomes are excellent drug carrier with amphiphilic properties. Liposomes have good biocompatibility, biodegradability and no immunogenicity. Liposomes can achieve the delivery of the drug, enhance the solubility, improve the stability, reduce the toxic effect of the drug, and improve the therapeutic effect of the loaded drug. In recent years, liposome drug delivery systems have been widely used in dentistry. This article reviews the application of liposome drug delivery systems in caries, dental pulp diseases, periodontitis, implantation, oral anesthesia and oral candidiasis.

[Clinical analysis of 46 rheumatoid arthritis patients with peripheral neuropathy]

Objective: To study clinical features of rheumatoid arthritis (RA) patients with peripheral neuropathy (PN). Methods: The clinical data of 46 RA patients with PN in the First Affiliated Hospital of Zhengzhou University from August 2012 to August 2019 were retrospectively analyzed, including clinical manifestations, laboratory and imaging results, previous treatment, treatment and clinical outcome. The other 92 RA patients without PN at the same period were selected as controls. Results: In RA patients with PN, the male to female ratio was 1∶2.1 with an average age (59.1±11.8) years. The course of RA and PN was 102.0 (19.0-156.0) months and 4.2 (0.7-5.5) months respectively. Numbness (84.8%, 39/46) and muscle weakness (21.7%, 10/46) were the most common symptoms. According to results of electromyography, polyneuropathy (60.0%, 27/46) was the predominant manifestation, followed by mononeuritis multiplex (31.1%, 14/46). Compared to RA patients, rheumatoid factor (RF) (P<0.001) and the percentage of cutaneous vasculitis (P=0.042) were higher in RA patients with PN. Logistic regression analysis revealed significant correlation between RF>178.4 IU/ml (OR＝5.626, 95%CI 2.509-12.618, P<0.001) and development of PN. Paresthesia in 27 patients (58.7%, 27/46) were relieved after treatment of high dose glucocorticoid and immunoglobulins (IVIG). Twelve patients were followed up regularly and the mean duration of follow-up was 17.0(4.8-52.8)months. Paresthesia in 10 (10/12) patients were relieved compared to that at discharge, 1 (1/12) patient achieved complete remission. Conclusion: Numbness and muscle weakness are the common symptoms in RA patients with PN and polyneuropathy is the main type. RF>178.4 IU/ml is correlated with the development of PN in RA patients. Intensive treatment such as high dose glucocorticoid and IVIG are effective.

Hyperlipidemia Impairs Osseointegration via the ROS/Wnt/β-Catenin Pathway

The influence of hyperlipidemia on titanium implant osseointegration and the underlying mechanisms is not well understood. This study investigates the changes in osseointegration and explores the potential mechanisms in hyperlipidemia conditions. In vivo, specialized titanium implants were implanted in the femurs of diet-induced or genetic hyperlipidemia mice. In vitro, primary murine osteoblasts were cultured on the titanium surface in high-fat medium. Results showed that hyperlipidemia led to poor osseointegration in both types of mice in vivo, and high-fat medium impaired the osteogenic differentiation of primary osteoblasts on the titanium surface in vitro. In addition, high-fat medium caused significant overproduction of reactive oxygen species (ROS) and inhibition of the Wnt/β-catenin pathway in osteoblasts. Both N-acetyl-L-cysteine (NAC, an ROS antagonist) and Wnt3a (an activator of the Wnt/β-catenin pathway) attenuated the poor osteogenic ability of osteoblasts. In addition, NAC reactivated the Wnt/β-catenin pathway in osteoblasts under high-fat stimulation. These results demonstrate that hyperlipidemia impairs osseointegration via the ROS/Wnt/β-catenin pathway and provide support for the ROS or Wnt/β-catenin pathway as a promising therapeutic target for the development of novel drugs or implant materials to improve the osseointegration of implants in hyperlipidemic patients.

Determining the 4th limiting amino acid in low crude protein diets for male and female Cobb MV × 500 broilers

1. Four experiments were conducted to determine the 4th limiting amino acid (AA) in maize-soybean meal-based diets. 2. Deletion assay methodology was used to quantify performance and carcase trait responses to potential deficiencies in essential and conditionally essential AA caused by reductions in dietary crude protein of maize-soybean meal-based diets from 202.9 to 186.5 g/kg. 3. The deletion of Val, Phe and Gly + Pro resulted in negative effects on live performance and carcase traits for male broilers, whereas AA deletion only affected wing weights for females with no response on live performance. 4. Further experimentation could not duplicate a response to Phe or Pro in male broilers. 5. Valine was identified as the potential 4th limiting AA in maize-soybean meal-based diets and was not found to be co-limiting with Ile.

[The value of "posterior approach, uncinate process priority, artery first" in laparoscopic pancreatoduodenectomy]

Objective: To explore the value of "posterior approach, uncinate process priority, artery first" in laparoscopic pancreatoduodenectomy. Methods: The clinical data of 200 patients who underwent laparoscopic pancreatoduodenectomy from January 2018 to April 2019 in the Second Department of Hepatobiliary and Pancreatic Surgery, the First Hospital of Jilin University were analyzed retrospectively. Meanwhile, the advantages of "posterior approach, uncinate process priority, artery first" were analyzed. Results: Two hundred patients were treated with "posterior approach, uncinate process priority, artery first". The average total operation time was (260.2±50.1) min, sample cutting time was (86.6±18.7) min, intraoperative bleeding volume was 50 (50-100) ml, average number of lymph node dissection was (19.2±7.4), and average hospitalization time was (17.9±9.9) days. Conclusion: The "posterior approach, uncinate process first, artery first" approach not only protects the variant hepatic artery, but also allows early detection of SMA, clarifies the positional relationship between the tumor and SMA, realizes R0 resection, and reduces the amount of bleeding during operation and shortens the operation time, which is safe and feasible in clinical setting.

[Clinical analysis of mediastinal lymph node dissection through sternotomy approach in the treatment of papillary thyroid carcinoma with mediastinal lymph node metastasis]

Objective: To investigate the rule of mediastinal lymph node metastasis of papillary thyroid carcinoma and the application of therapeutic mediastinal lymph node dissection through the sternotomy approach in the treatment of mediastinal lymph node metastasis of papillary thyroid carcinoma. Methods: All cases of papillary thyroid carcinoma with mediastinal lymph node metastasis treated through sternotomy cooperated by thoracic surgeons and head and neck surgeons from January 2006 to January 2017 in Cancer Hospital of Chinese Academy of Medical Sciences were included in this study. The distribution, metastasis rate, metastasis degree, surgical method, surgical complications and postoperative survival of patients with mediastinal lymph node metastasis were retrospectively analyzed. Results: A total of 31 patients (16 males and 15 females) with papillary thyroid cancer with mediastinal lymph node metastasis, with a median age of 46 (19-65) years, were enrolled in the group. Partial upper sternotomy was used in 28 cases, and total sternotomy was used in 3 cases. The mediastinal lymph nodes of papillary thyroid carcinoma metastasized farthest to the station 6, and the lymph node metastasis rate of each group from high to low was: 2R (61%), 1R (39%), 3A (39%), 1L (16%), 2L (10%), 4R (10%), 5 (3%) and 6 (3%). No metastasis was observed in station 3P, 4L and 7. In addition, the degree of lymph node metastasis at station 2R was the highest, reaching 35% (77/219). Extra-nodal invasion of mediastinal metastatic lymph nodes in thyroid papillary carcinoma is common (23%), easily fuses into masses (23%) and invades peripheral vascular nerves (26%). Up to 29% of blood transfusions are required during or after surgery due to oozing or bleeding (9/31). The 1-, 3-, 5-and 10-year survival rates of patients undergoing surgical treatment were 94%, 94%, 87% and 81%, respectively. Conclusion: Papillary thyroid carcinoma can metastasize to almost all mediastinal lymph nodes except station 3P, 4L and 7. Radical mediastinal lymph node dissection through sternotomy is an effective method for the treatment of mediastinal lymph node metastasis of thyroid papillary carcinoma.

[Epidemiological characteristic and current status of surgical treatment for esophageal cancer by analysis of national registry database]

Objective: To investigate the epidemiological characteristics and current status of surgical management for esophageal cancer in China. Methods: A national database was setup through a network platform. The clinical data of esophageal cancer treated by surgery was collected from 70 major hospitals in China between January 2009 and December 2014. Results: Complete data of 8 181 cases of esophageal cancer patients who underwent surgery were recorded in the database and recruited in the analysis. Among them, 6 052 cases were male and 2 129 were female, the average age was 60.5 years.The epidemiological investigation results showed that 148 cases (1.8%) had history of psychological trauma, 7 527 cases (92.0%) were lower social economic status, 5 072 cases (62.0%) were short of fresh vegetables and fruits, 6 544 cases (80.0%) ate rough food frequently, 3 722 cases (45.5%) drank untreated water directly from lake or river or shallow well, 3 436 cases (42.0%) had a unhealthy eating habit, including habits of eating food fast (507 cases, 6.2%), eating hot food or drinking hot tea/soup (998 cases, 12.2%), eating fried food (1 939 cases, 23.7%), 4 410 cases (53.9%) had the habits of smoking cigarettes and 2 822 cases (34.5%) drank white wine frequently.The pathological results showed that 7 813 cases (95.5%) were squamous cell carcinoma, 267 cases were adenocarcinoma (3.3%), 25 cases were adenosquamous cell carcinoma (0.3%) and 50 cases were small cell carcinoma (0.6%). A total of 1 800 cases (22.0%) received preoperative neoadjuvant therapy due to locally advanced disease or difficulty of resection. The esophagectomies were performed through left thoracotomy approach in 5 870 cases (71.8%), through right chest approach in 2 215 cases (27.1%), and the remain 96 cases (1.2%) received surgery though other approaches.A total of 8 001 cases (97.8%) underwent radical resection, the other 180 cases (2.2%) received palliative resection. The 30-day postoperative mortality rate was 0.5%, the overall ≥ grade Ⅱ postoperative complication rate was 11.6% (951 cases). The 1-yr, 3-yr, and 5-yr overall actual survival rates were 82.6%, 61.6%, and 52.9%, respectively. Conclusions: The data analysis of the national database for esophageal cancer shows that bad eating habits or eating rough food without enough nutrients, lower social and economic status, drinking white wine and smoking cigarettes frequently may be correlated with tumorigenesis of esophageal cancer. However, strong evidences produced by prospective observation studies are needed. Overall, the long-term survival of esophageal cancer patients has been improved gradually due to the application of advanced surgical techniques and reasonable multimodality treatment.

[A survey on therapy strategies for rheumatoid arthritis in Chinese rheumatologists]

To investigate how Chinese rheumatologists treated patients with rheumatoid arthritis (RA). We performed a survey on the choices of first-line and second-line anti-RA therapies, prescription of methotrexate and glucocorticoids, assessment of disease activity and frequencies of follow-up at the Asia Pacific League of Associations for Rheumatology meeting 2016 in Shanghai. The majority (85.1%) of rheumatologists preferred methotrexate as first-line treatment. As alternative agents, 71.0% rheumatologists chose leflunomide or sulfasalazine. If methotrexate was not tolerable, only 8.6% rheumatologists would switch to parenteral administration. After failure of responding to methotrexate, 62.0% rheumatologists recommended to change or combine other conventional synthetic disease modifying anti-rheumatic drugs (DMARDs). Etanercept was the most popular biological option in 65.2% rheumatologists. Almost all (97.3%) rheumatologists prescribed methotrexate at an initial dose of 7.5 to 15 mg/week and 73.8% rheumatologists at a maximum of 10 to 15 mg/week. There were 49.3% rheumatologists prescribing oral glucocorticoids at first-line therapy. Surprisingly, 42.6% rheumatologists never or rarely assessed disease activity in daily work. For patients having achieved remission, 74.2% rheumatologists would follow up them every 1 to 3 months. This study suggests that most Chinese rheumatologists treat RA patients consistent with international guidelines, while the maximum dose of methotrexate, glucocorticoid as first-line treatment, assessment of disease activity and follow-up frequency are locally modified.

[Clinical characteristics of cardiomyopathies complicated with ventricular thrombosis]

Objective: To summarize the clinical characteristics of cardiomyopathy complicated with ventricular thrombosis. Methods: The clinical data of inpatients suffered from cardiomyopathy complicated with ventricular thrombosis in Fuwai Hospital between January 2015 and May 2019 were analyzed retrospectively. Results: A total of 125 cases were reviewed, and 24.8% were female. Dilated cardiomyopathy was the most common disease (62.4%), followed by arrhythmogenic right ventricular cardiomyopathy (ARVC) (13.6%) and hypertrophic cardiomyopathy (11.2%). There were 74.4% thrombosis in left ventricle, 12.8% in right ventricle and 12.8% in biventricle. The proportions of right ventricle thrombosis were higher in ARVC than in other cardiomyopathies (52.9% vs 6.5%, P<0.01). The majority suffered from cardiac function New York Heart Association (NYHA) Class Ⅲ (45.6%) and class Ⅳ (39.2%). The ratio of NYHA Class Ⅳ was higher in female patients than in male ones (25.8% vs 10.6%, P<0.05). In lab detection, positive results of D-Dimer and N terminal-pro B type natriuretic peptide (NT-proBNP) accounted for 72.8% and 97.6%, respectively. There were 2.5% patients died in the hospital or discharged because of the worsening of illness, the chances were higher in female than male patients (9.7% vs 0, P<0.01). Among these patients, one succumbed to massive ischemic stroke caused by ventricular thrombus detachment under standard anticoagulation therapy. Conclusions: Dilated cardiomyopathy is the most common cardiomyopathy complicated with ventricular thrombosis. The most common location of thrombosis is left ventricle. Right ventricle thrombosis is more common in ARVC. The majority suffer from moderate or severe cardiac dysfunction. Higer proportion of female patients suffer from anemia, severe condition and poor prognosis.

[Spatial-temporal cluster of hemorrhagic fever with renal syndrome in Hebei province, 2005-2016]

Objective: To explore the spatial-temporal distribution and epidemic characteristics of hemorrhagic fever with renal syndrome (HFRS) in Hebei province from 2005 to 2016. Methods: Records of HFRS cases reported from each county in Hebei during January 2005 to December 2016 were collected from National Notifiable Disease Surveillance System (NNDSS). Global and local spatial association statistics were used to measure the spatial autocorrelation and software GeoDa 1.2.0. Software SaTScan 9.4.1 was used to analyze spatiotemporal clusters. Software ArcGIS 10.2 was used to visualize the yearly scan results. Results: In Hebei province, a total of 8 437 human HFRS cases reported from 170 counties with an annual incidence rate of 0.99/100 000 population during 2005-2016. The peak incidence season was spring. Global spatial autocorrelation analysis on the incidence of HFRS at county-level showed that the value of Moran's I were all above 0 (P<0.05), indicating that the significant spatial cluster. The result of local indicators on spatial association (LISA) analysis revealed that identified hot spots were mainly in northeastern area, while cold spots were found in some counties of central and southern areas. Spatial-temporal scan detected that the primary cluster of HFRS incidence was mainly distributed in Qinhuangdao city and Tangshan city, including 11 counties (city/district): Beidaihe district, Haigang district, Funing district, Shanhaiguan district, Changli county, Lulong county and Qinglong Manchu autonomous county in Qinhuangdao city, and Qian'an city, Laoting county, Luanzhou city and Luannan county in Tangshan city (RR=39.64, P<0.001), during January-July in 2005. Conclusions: There were significant spatial-temporal cluster of HFRS in Hebei from 2005 to 2016. The cluster areas of HFRS were mainly in northeastern Hebei, it is necessary to strengthen the prevention and control programs of HFRS in these areas.

[Partial superficial parotidectomy versus superficial parotidectomy for treatment of parotid benign tumors: evidence-based medicine analysis]

Objective:The aim of this study is to systematically assess the postoperative outcomes of partial superficial parotidectomy（PSP） and superficial parotidectomy（SP） by systematic literature review and Meta-analysis, and to provide a theoretical basis for the selection of the appropriate surgical approach in clinical process. Method:Relevant studies that compared the outcomes of PSP and SP for the parotid benign tumors were searched in Pubmed, CNKI and Wanfangdata databases, and Meta-analysis was performed using software RevMan 5.0. Result:24 studies were selected for the Meta-analysis. A total of 2 795 participants were included in those studies, of whom 1 301 underwent PSP and 1 494 underwent SP. The recurrence rates for PSP and SP were 1.14%（10 of 874） and 0.6%（6 of 993）, respectively. There were no statistically significant difference in recurrence rate between PSP and SP. The rates of transient facial nerve paresis for PSP and SP were 11.60%（122 of 1 052） and 27.37%（350 of 1 279）, respectively. The rates of permanent facial nerve paralysis for PSP and SP were 1.04%（6 of 579） and 4.46%（31 of 695）, respectively. The incidences of Frey's syndrome in PSP group and SP group were 9.20%（95 of 1 033） and 30.32%（409 of 1 349）, respectively. The rate of salivary fistulafor PSP and SP were 5.38%（37 of 688） and 11.25%（65 of 578）. PSP could reduce the risk for complications compared with SP. Conclusion:This systematic review with meta-analysis suggests that PSP has a similar recurrence rate as SP, but PSP can significantly reduce the postoperativecomplications.

[Long-term outcome of patients with pyriform sinus squamous cell carcinoma treated with planned preoperative (chemo-) radiotherapy plus laryngeal function sparing surgery]

Objective: To analyze the long-term outcome of patients with pyriform sinus squamous cell carcinoma treated with planned preoperative (chemo-) radiotherapy plus laryngeal function sparing surgery. Methods: Patients with stage Ⅲ/Ⅳ pyriform sinus squamous cell carcinoma treated with planned preoperative (chemo-) radiotherapy plus laryngeal function sparing surgery during 1999 to 2000 were retrospectively analyzed. Data including concurrent chemotherapy or not, postoperative pathological diagnosis, postoperative complications, recurrence and survival were collected. Twenty patients were treated with preoperative radiotherapy while 14 patients with preoperative chemo-radiotherapy. Results: Among 31 cases of postoperative pathological diagnosed as pyriform sinus, 12 (38.7%) cases without tumor residue, 7 (22.5%) cases with severe radiation response and 12 (38.7%) cases with tumor residue. The 5-year cumulative local recurrence rate, regional recurrence rate and distant metastasis rate was 14.5%, 13.7% and 23.5%, respectively. Five-year cumulative overall survival rate and recurrence-free survival rate were 69.6% and 65.4%, respectively. Nine deaths were attributed to distant metastasis (8 cases) and regional recurrence (1 case). Conclusion: Most patients with pyriform sinus squamous cell carcinoma acquire long-term survival after treated with planned preoperative (chemo-) radiotherapy plus laryngeal function sparing surgery, and distant metastasis is the main cause of death.

Prognostic significance of preoperative radiotherapy in stage II and III rectal cancer patients: A Strobe-compliant study of SEER 18 registries database (1988-2011)

Preoperative radiation therapy has been regarded as the optional neoadjuvant treatment to decrease local recurrence of rectal cancer in addition to surgery. However, its benefit in survival remained obscure. This study was aimed to measure the efficacy of preoperative radiation therapy for survival in stage II and III rectal cancer patients. Retrospective cohort study used the database of Surveillance, Epidemiology and End Results program of the National Cancer Institute in the United States from 1988 to 2011. A total of 49439 patients diagnosed with primary rectal cancer who underwent surgery were included. Clinicopathological characteristics and rectal cancer-specific survival between surgery alone group and surgery plus preoperative radiation therapy group were compared. Rectal cancer patients in surgery plus preoperative radiation therapy group had significantly better survival than those in surgery alone group (72.70% vs. 66.61%, P < 0.001), as well as stratified by stages (stage II: 77.4% vs. 74.3%, P < 0.001; stage III: 68.3% vs. 58.6%, P < 0.001). However, this beneficial impact was only observed after 2000s (P < 0.001). Multivariate survival analysis revealed that preoperative radiation therapy was an independent predictor for better survival in stage III (hazard ratio, 0.795; 95% CI, 0.753-0.840; P < 0.001), but not in stage II (P = 0.70). Preoperative radiation therapy might bring a better survival in stage II and III rectal cancer patients, but only as an independent predictor for stage III patients. As time progressed, preoperative radiation therapy might yield more profit for stage II and III rectal cancer patients.

The ranked importance of dietary factors influencing the performance of broiler chickens offered phytase-supplemented diets by the Plackett-Burman screening design

1.The objective of the present study was to rank the importance of the following dietary factors; canola meal, wheat, whole barley, digestible lysine, phytate-P, calcium, available P, sodium and three NSP-degrading feed enzymes. Their influence on growth performance, gastro-intestinal tract parameters, energy utilisation, ileal N digestibility and disappearance rates were determined via the Plackett-Burman design in broiler chickens offered phytase-supplemented diets. 2. The eleven dietary factors were assigned two levels in the Plackett-Burman design matrix. The resulting twelve dietary treatments were offered to six replicates per treatment (six birds per cage) with a total of 468 male Ross 308 broiler chicks from 7 to 28 d post-hatch. 3. Increasing digestible lysine levels improved weight gain by 15.6% (P < 0.001) and gain:feed by 9.36% (P < 0.001). Increasing calcium levels reduced weight gain by 6.36% (P < 0.001) and gain:feed by 2.60% (P < 0.001). The high calcium level increased gizzard pH from 2.78 to 3.01 (P < 0.005). Whole barley significantly increased relative gizzard weights and contents, pancreas weights and both ileal N digestibility coefficients (0.774 versus 0.803; P < 0.001) and ileal N disappearance rates (23. 3 versus 24.5 g/bird/day; P < 0.001). 4. Overall, digestible lysine level and calcium level were identified as the most influential dietary factors to influence growth performance of broilers offered phytase-supplemented diets, which hold implications for practical diet formulations.

[Effect of long-term deep slow-wave sleep deprivation on the reproductive system in male rats]

Objective: To investigate the effect of long-term deep slow-wave sleep deprivation on the gonad axis, sperm abnormality rate, and structure of the testis in male rats and possible mechanisms. Methods: A total of 30 specific pathogen-free male Wistar rats aged 5 weeks were randomly divided into slow-wave sleep deprivation group 1 (SD1 group) , slow-wave sleep and sleep time deprivation group 2 (SD2 group) , and control group, with 10 rats in each group. The flower pot method was used to establish a model of sleep deprivation. In addition to 12-hour sleep deprivation at night, the rats in the SD1 group were given interference once every 24 minutes, and those in the SD2 group were deprived of sleep for 8 minutes every 24 minutes; the rats in the control group were given 12-hour light illumination and then placed in dark environment for 12 hours. All rats were sacrificed by exsanguination from the femoral artery, and the testis, the epididymis, and blood were collected for analysis. Sperm abnormality rate and sperm motility rate were measured, and cauda epididymal sperm counting was performed. ELISA was used to measure the serum levels of testosterone (T) , follicle-stimulating hormone (FSH) , and luteinizing hormone (LH) . Results: Compared with the control group, the SD2 group had a significant increase in organ coefficient of the epididymis (P<0.05) and a significant reduction in sperm motility rate (P<0.05) . There were significant differences between the SD1 group and the SD2 group in the increase in sperm abnormality rate (P<0.05) and the reduction in cauda epididymal sperm count (P<0.05) . The levels of FSH and T tended to increase, and the level of LH tended to decrease. Pathological examination showed degeneration and vacuolization of a small amount of spermatogenic cells in the SD1 group; in the SD2 group, there were significant degeneration, edema, and vacuolization of most spermatogenic cells, some spermatogenic cells were observed in the lumen, and there were no sperms in the lumen. Conclusion: Long-term deep slow-wave sleep deprivation impairs the structure of the testis, affects sperm motility rate and sex hormones, and increases the risk of sperm abnormality.

[Influence of TNF-α on the immunomodulatory property of laryngeal mucosa mesenchymal stromal cells']

Objective: To investigate the effect of tumor necrosis factor-alpha(TNF-α)on the immunoregulatory capacity of laryngeal mucosal mesenchymal stromal cells (LM-MSCs) and its potential molecular mechanism, and provide a theoretical basis for the study of chronic laryngitis. Methods: LM-MSCs were separated from epiglottal mucosa. The LM-MSCs cells were directly co-cultured with T cells in vitro to detect the immunomodulatory property of LM-MSCs. After long-term stimulation with inflammatory factors TNF-α in vitro, the differences were compared in the immunomodulatory ability of LM-MSCs between normal LM-MSCs and TNF-α stimulated LM-MSCs. The expression of general control non-repressed protein5(GCN5), FAS, FASL in normal LM-MSCs and TNF-α stimulated LM-MSCs was detected by Western blot and quantitative real-time RT-PCR(RT-qPCR). Results: After chronic stimulation of TNF-α, the RNA relative expression of GCN5 was 0.31±0.03 (3 days) and 0.53±0.06 (7 days) compared with control group, showing significant difference (F=13.45, P<0.05). The percentage of LM-MSC-induced T cell apoptosis was 6.27%±0.81% (3 days) and 4.99%±0.52% (7 days) in chronic stimulation group compared with control group 10.02%±1.02%. There is a significant difference among these groups (F=11.13, P<0.05). Moreover, the ability of LM-MSCs to induce T cell apoptosis is regulated by GCN5. Conclusion: With the chronic stimulation of TNF-α, the expression of GCN5 in LM-MSCs is decreased, thus impairing its immunoregulatory capacity.

[Progress in research of relationship between ambient air PM(2.5) and lung diseases]

Fine Particulate Matter (PM(2.5)-particles with an aerodynamic diameter ≤2.5 μm) can penetrate deeply into the lung, deposit in the alveoli, and consequently impair lung function. Both short term and long term exposures to PM(2.5) are associated with the incidence of respiratory diseases (e.g. asthma, chronic obstructive pulmonary disease, lung cancer). This paper summarizes the effects of ambient air PM(2.5) exposure on human respiratory system revealed by epidemiological studies.

[Normalization in axillary lymph node management after neoadjuvant therapy for breast cancer]

Downstaging of breast cancer primary lesions and metastatic axillary lymph nodes among patients who underwent neoadjuvant chemotherapy (NAC) has raised the new challenges and opportunities on individualized breast cancer surgical treatment. Downstaging of the primary lesion has given patients that were previously deemed inoperable or not suitable for surgery a second chance. While downstaging of the lymph nodes has made it possible for sentinel lymph node biopsy (SLNB) to safely replace axillary lymph node dissection. However, the detection rate and false negative rate of early breast cancer SLNB technique in post-NAC patients barely meet the standard of clinical practice. Therefore, it is required that SLNB in post-NAC patients to be carried out by a medical team with advanced imaging equipments and extensive experiences in SLNB. Furthermore, they should be able to precisely evaluate axillary lymph node status before and after NAC as well as mark metastatic lymph node before NAC. Indications of SLNB should be restricted to patients that are downstaged from cN0 to ycN0 or from cN1 to ycN0. Particularly, it is only safe for patients whose axillary lymph node status become negative after NAC to receive SLNB when dual tracer (blue dye and radionuclide), removing more than 2 sentinel lymph nodes and targeted axillary dissection technique are used.

[Physical and chemical properties of pulp capping materials based on bioactive glass]

OBJECTIVE

To investigate the physical and chemical properties of pulp capping materials based on bioactive glass (BG).

METHODS

Novel BG pulp capping materials were composed of powder and fluid. The powder was BG (82.36% SiO₂, 15.36% CaO, and 2.28% P₂O₅) synthesized by using the sol-gel method combined with template technology. Two kinds of fluid were provided: (1) phosphate buffer (PB) solution and (2) phosphate buffer solution with 1% sodium alginate (SA) addition. After mixing the powder and fluid, BG-PB and BG-PB-SA were prepared. Setting time and compressive strength of the BG pulp capping materials were tested by setting time loading system and mechanical testing machine. Statistical analysis was performed using the independent sample t-test, with the significance set at 0.05. pH meters was used to test the pH of the BG pulp capping materials and mineral trioxide aggregate (MTA). The sealing ability of the BG pulp capping materials and MTA was tested by methylene blue dye leakage model. Statistical analysis was performed using one-way ANOVA analysis and LSD multiple comparison, with the significance set at 0.05.

RESULTS

(1) Setting time: the initial and final setting time of BG-PB were (7.2±0.3) min and (12.7±0.9) min, respectively. And the initial and final setting time of BG-PB-SA was (7.5±0.3) min and (13.6±1.6) min. There was no significant difference between BG-PB and BG-PB-SA groups (P>0.05). (2) Compressive strength: the compressive strength of BG-PB was (16.5±1.8) MPa at 1 day and (14.1±3.7) MPa at the end of 28 days. However, the compressive strength of BG-PB-SA was (26.6±6.3) MPa on day 1 and (21.6±5.6) MPa on day 28, which was significantly higher than that of BG-PB (P<0.05). (3) pH: the pH of BG pulp capping materials' bulk immersed in simulated body fluid (SBF) went up to 8.06, and the highest pH of MTA was 8.47. Significant difference was observed between the BG pulp capping materials and MTA (P<0.05). (4) Sealing ability: the optical density (D) in positive control group was significantly higher than ln BG-PB, BG-PB-SA and MTA groups (P<0.05). And BG-PB and BG-PB-SA showed the similar favorable sealing ability with MTA, and no significant difference was observed among the three groups (P>0.05).

CONCLUSION

The novel BG pulp capping materials showed good physical properties, especially BG's setting time was short; BG pulp capping materials are promising.