Chinese expert group consensus on diagnosis and clinical management of osteoradionecrosis of the mandible

Osteoradionecrosis of the mandible (MORN) is one of the most devastating complications caused by radiation therapy in the head and neck region. It is characterized by infection and chronic necrosis of the mandible as the main manifestation. Clinically, MORN-related symptoms include swelling, pain, dysphagia, trismus, masticatory or speech disorders, refractory orocutaneous fistula, bone exposure, and even pathological fracture. MORN has become a challenging clinical problem for oral and maxillofacial surgeons to deal with, but thus far, this problem has not been solved due to the lack of widely accepted treatment algorithms or guidelines. Because of the nonexistence of standardized treatment criteria, most clinical treatment against MORN nowadays is largely based on controversial empirical understandings, while recommendations on post-therapeutic evaluations are scarce. Therefore, to further unify and standardize the diagnosis and treatment of MORN, to decrease the huge waste of medical resources, and ultimately, to improve the wellbeing of the patients, the Chinese Society of Oral and Maxillofacial Surgery (CSOMS) convened an expert panel specialized in MORN from 16 domestic medical colleges and affiliated hospitals to discuss the spectrum of diagnosis and and formulate treatment. In addition, consensus recommendations were also revised with a comprehensive literature review of the previous treatment experiences and research pearls. This 'expert consensus statement on diagnosis and clinical management of MORN' is for clinical reference.

[Progress on clinical trials of cancer drugs in China, 2019]

Objective: To deliver macro understanding of the latest research progress on clinical trials and approved products of cancer drugs in China in 2019. Methods: The number of clinical trials and related investigational products by domestic and foreign enterprises in 2019 were acquired in the China Food and Drug Administration Registration and Information Disclosure Platform for Drug Clinical Studies, while listed drugs were obtained in the China Food and Drug Administration Query System for Domestic and Imported Drug. Characteristics on stage, scope, indication of those trials, classification and mechanism of involved products, as well as listed anticancer drugs were summarized and depicted. Results: There were 474 cancer drug trials registered in China in 2019, accounting for 21.8% of the total, and 397 (83.8%) were initiated by domestic pharmaceutical enterprises. Overall, international multicenter trials accounted for 13.1%, and phase I trials accounted for 47.3%. Compared with global enterprises, the proportion of international multi-center trials initiated by domestic companies is lower (4.8% vs. 55.8%, P<0.001), and the proportion of phase I clinical trials and bioequivalence trials is higher (51.9% vs. 23.4%, 19.4% vs. 1.3%, P<0.001). An accumulative of 27 cancer types were involved for all the cancer drug trials, and lung cancer, solid tumor, and breast cancer were the most common cancer types, with 103, 95 and 49 trials, respectively. For the three cancer types unique to Chinese population, gastric, liver and esophageal cancer, the total number of initiated trials was 47. For all those trials, there were 335 cancer drug varieties, with 86.0% developed by domestic pharmaceutical enterprises, including 300 therapeutic drugs, 30 adjunctive drugs and 5 preventive drugs. In terms of mechanism, targeted drugs and immune drugs were the most popular, accounting for 74.6% and 20.3%, respectively. In addition, 17 anticancer drugs targeting on 11 cancer types were approved in China in 2019. Conclusions: Clinical trials on cancer drugs in China have ushered a booming era, with large number of innovative agents represented by targeted drugs and immune drugs under clinical development or putting into clinical practice. Those local enterprises are playing more and more critical roles. Strengthening clinical research and development on Chinese unique cancer types is the key direction of future work.

[Research progress on urogenital function preservation in extralevator abdominoperineal resection]

Extralevator abdominoperineal excision (ELAPE) has been suggested to potentially improve oncological outcomes in advanced low rectal cancer patients. However, the urogenital function impairment as one of the main complications deteriorates the quality of life in these patients. The key point to prevent urogenital function impairment is to avoid autonomic nerve injury, including the superior and inferior hypogastric nerve plexus and neurovascular bundle. Three areas should be especially focused during surgery, including the posterolateral aspect of the prostate during the separation of the rectum from prostate, the lateral wall of ischioanal fossa and the area in front of anal canal. Previous presumption supposed that extended resection, though promoting oncologic outcomes, might lead to enlarged injury to surrounding vessels and nerves that deteriorated patients' urogenital function. But recent studies show that postoperative urogenital function outcomes of rectal cancer patients who underwent ELAPE are not inferior to conventional APE after the induction of minimal invasive approaches including laparoscopic and robotic surgery. Their quality of life can be comparable with patients who underwent conventional APE, and are even better in some particular area. Moreover, as further improvement of ELAPE procedure has been made, the concept of individualized ELAPE addressed the importance of personalized surgical procedure based on tumor stage and location, dedicating to avoid injury to vessels and nerves through preserving more surrounding tissues. Urogenital function outcomes, as part of postoperative outcomes, get more and more attention in recent years. We review current studies on urogenital function after ELAPE from anatomy to clinical research, in order to raise surgeons' attention of nerve preservation technique and to improve their understanding of ELAPE procedure.

[A review of immune-related adverse events associated with immunotherapy]

Immune checkpoint inhibitors have been approved for clinical application in China. However, the increased immune-related adverse event (irAE) needs more attention. This review summarized the incidence, characteristic clinical manifestation and treatment of irAEs associated with programmed cell death protein-1(PD-1) and programmed cell death ligand-1(PD-L1) inhibitors. To have a deep insight into irAE, the potential mechanisms, the different incidences of cancer types, influencing factors and the direction of future research were also discussed here to provide guidance for clinical oncologist to identify and monitor irAE.

Identifying key environmental factors for enhancing the pollutant removal potential at a river confluence

The confluence area of river networks is a hot spot for pollutant removal. As an essential part of the river ecosystem, sediment bacterial communities played a crucial role in the removal of pollutants. However, how the potential of sediment bacterial communities can be enhanced toward the removal of pollutants remains unclear. Therefore, this study provides a new approach for the identification of key environmental factors that enhance the pollutant removal potential at a river confluence, integrating the bacteria-based index of biotic integrity (Ba-IBI), path model, support vector regression (SVR) model, and sensitivity analysis. The developed Ba-IBI could quantitatively evaluate the differences of both structure and function of bacterial communities before and after the confluence, with a range from 1.52 to 2.78. The flow regime, which was represented by the Froude number, exerted an indirect effect on Ba-IBI mediated through water nutrients and sediment nutrients according to path model results. Sediment nutrients and water nutrients were considered as the main environmental factors that directly affected sediment bacterial communities. A function that could predict the response of sediment bacterial communities to environmental factors in the best possible way was found through SVR modeling, with R² = 0.8357. The results of the sensitivity analysis indicated that the total phosphorus in water and ammonia nitrogen in sediments were key environmental factors for enhancing the pollutant removal potential at the river confluence. The established approach aids the improvement of the bioremediation potential of river confluence area, and might provide a theoretical basis for watershed restoration.

Resistive Switching Mechanism of HfO₂ Based Resistance Random Access Memory Devices with Different Electrode Materials

This study investigated the impact of electrode materials on HfO₂-based RRAM devices. The research includes three types of electrode materials: (1) the electrodes with strong ability of oxygen reservoirs; (2) the electrode with poor ability of oxygen reservoirs; (3) the active electrode with injection ability. Through implementing different combinations of electrodes, three types of switching modes were obtained and the relative conduction mechanism was analyzed, as well as conduction model. Those studies may offer ways of using electrodes to control the resistive switching processes and fabricating the RRAM devices with good performance.

Targeted inhibition of β-catenin by miR-320 and decreased MMP-13 expression in suppressing chondrocyte collagen degradation

OBJECTIVE

Wnt/β-catenin pathway plays a critical role in modulating embryonic development, cell growth, and differentiation. The over-expression of β-catenin activates this pathway and up-regulates expression of matrix metalloproteinase-13 (MMP-13), and promotes matrix degradation and occurrence of osteoarthritis (OA). This study aims to explore the effect of miR-320 expression in OA chondrocyte and underlying mechanisms.

PATIENTS AND METHODS

Chondrocyte tissues from OA patients and normal individuals were collected for the detection of expression levels of miR-320, β-catenin, MMP-13, and alpha-1 chain of type II collagen (COL2A1). Dual luciferase reporter assay was performed to test targeted regulation between miR-320 and β-catenin. IL-1β was used to simulate in vitro cultured chondrocytes, which were transfected with miR-320 mimic and/or si-β-catenin, followed by quantification of miR-320, β-catenin, MMP-13, and COL2A1.

RESULTS

In chondrocytes of OA patients, expression of microRNA (miR)-320 is decreased. Bioinformatics analysis revealed complementary binding sites between miR-320 and β-catenin. Compared to control group, increasing levels of β-catenin and MMP-13 expression with reduction of miR-320 and COL2A1 expressions were observed in OA chondrocytes. Transfection of miR-320 mimic and/or si-β-catenin depressed expression of β-catenin and MMP-13 inside chondrocytes, accompanied with elevation of COL2A1 expression.

CONCLUSIONS

MiR-320 expression in OA chondrocyte is decreased, accompanied with up regulation of β-catenin and MMP-13. MiR-320 can inhibit β-catenin and MMP-13 expressions, elevates COL2A1 expression, which provides novel insights for the treatment of osteoarthritis.

Demonstration of Machine Learning-Based Model-Independent Stabilization of Source Properties in Synchrotron Light Sources

Synchrotron light sources, arguably among the most powerful tools of modern scientific discovery, are presently undergoing a major transformation to provide orders of magnitude higher brightness and transverse coherence enabling the most demanding experiments. In these experiments, overall source stability will soon be limited by achievable levels of electron beam size stability, presently on the order of several microns, which is still 1-2 orders of magnitude larger than already demonstrated stability of source position and current. Until now source size stabilization has been achieved through corrections based on a combination of static predetermined physics models and lengthy calibration measurements, periodically repeated to counteract drift in the accelerator and instrumentation. We now demonstrate for the first time how the application of machine learning allows for a physics- and model-independent stabilization of source size relying only on previously existing instrumentation. Such feed-forward correction based on a neural network that can be continuously online retrained achieves source size stability as low as 0.2  μm (0.4%) rms, which results in overall source stability approaching the subpercent noise floor of the most sensitive experiments.

[Comparison of antibiotics and saline irrigation with tube drainage in the treatment of postoperative abdominal and pelvic infectious effusion]

Objective: To compare the efficiency of saline irrigation, antibiotics irrigation and high-concentration antibiotics perfusion with tube drainage in the treatment of infectious effusion. Methods: Clinical and sonographic features of abdominal and pelvic infectious effusion of 64 patients with malignant tumor collected from September 2013 to September 2017 were retrospectively analyzed. The changes of effusion size and temperature, catheterization time were evaluated in saline irrigation group and antibiotics irrigation group. The catheterization time was compared between antibiotics irrigation group and high-concentration antibiotics perfusion group. Results: The effective rates of the saline irrigation group and the antibiotics irrigation group were 68.6% and 86.8%, respectively, and the times of catheterization were 11.9±8.4 days and 7.8±4.8 days, respectively, with significantly statistical difference (both P<0.05). However, the effective rates of the antibiotics irrigation group and the high concentration antibiotic perfusion group were 86.8% and 100.0%, respectively (P=0.067), while the times of catheterization were 7.8±4.8 days and 3.6±3.1 days, respectively (P<0.001). Conclusion: The antibiotic irrigation with tube drainage, especially the high concentration perfusion is more effective than saline in the treatment of abdominal and pelvic infection effusion.

[Long-term observation of morphological changes of the inner retinal after internal limiting membrane peeling in macular hole surgery]

Objective: To investigate the characteristics of morphological changes of inner retinal layer after internal limiting membrane peeling in macular hole surgery. Methods: Retrospective case study. Patients with idiopathic macular hole from 2015 to 2018 underwent vitrectomy+internal limiting membrane peeling (inverting)+ gas tamponade in China-Japan Friendship Hospital were investigated. A total of 19 eyes (17 patients) were enrolled, including 4 males (4 eyes) and 13 females (15 eyes). The average age was 62.74±5.25 years. Optical coherence tomography (OCT) was used to obtain the topographic maps of retinal thickness, the thickness of retinal ganglion cell complex and probability maps, and the Angio/en-face maps of macular retina. The characteristics of the morphological changes of the inner retinal were comprehensively analyzed. Results: Among 19 eyes, 9 eyes had internal limiting membrane peeling, 8 eyes had lotus-like internal limiting membrane inverting, and 2 eyes had the uper180 degrees internal limiting membrane inverting. The minimum diameter of macular hole was (543.06+220.17) μm and the maximum diameter was (947.18+319.12) μm. The follow-up time was (21.05+9.66) months, and the visual acuity was 0.45+0.35 at the last follow-up. In the 19 eyes, all the macular holes were closed postoperatively and dissociated optic nerve fiber layer appearance (DONFL) and concentric macular dark spots (CMDS) all showed, as well as mGCC thinning. The changes of CMDS and mGCC in 2 eyes in the uper180 degrees internal limiting membrane inverting group were mainly seen in the upper retina and in the remaining 17 eyes were seen diffused around the macula, which roughly corresponded to the extent of internal limiting membrane peeling. Two eyes showed clear decrease of retinal capillary density on Angio/map. Conclusions: Long-term morphological changes of the inner retinal after internal limiting membrane peeling in macular hole surgery are obvious. In addition to the appearance changes like DONFL and CMDS, the macular ganglion cell complex (mGCC) is also involved. (Chin J Ophthalmol, 2019, 55:747-756).

P1801Multiple members with an isolated atrial septal defect phenomenon presented in a family with Holt-Oram syndrome

Background

Holt-Oram syndrome (HOS), characterized by upper limb malformations, congenital heart diseases (CHD) and/or cardiac conduction abnormalities, is an autosomal dominant disease. Almost all the HOS patients suffer from cardiac and limb abnormalities at the same time. Among them, atrial septal defect (ASD) is the most common cardiac anomaly. The unusual phenotype in a pedigree including multiple members with isolated ASD and a few with isolated limb deformity attracted attention.

Aim

To detect mutant genes of ASD in this pedigree and make a definitive diagnosis. To investigate the mutant type of the gene and illustrate the possible mechanism of heterogeneous phenotype.

Methods

Echocardiography, electrocardiography and physical examination were given to a four-generation Chinese HOS family. Of all 11 patients in this pedigree, eight patients had isolated ASD and one patient had isolated finger deformity. In addition, two patients suffered from both diseases (Figure. 1). Whole Exome Sequencing was performed on the proband and his relatives including three with ASD only, one with finger deformity only and one normal person. Sanger sequencing was performed on biological relatives in this pedigree to valid rare variants. Single nucleotide polymorphisms and insertions/deletions were identified using the GATK program. Pathogenicity was predicted in software like SIFT, Ployphen-2, MutationTaster and CADD_phred.

Results

An exon site mutation (c.100dupG:p.Ala34fs) of TBX5 was detected in all the patients of this pedigree. This mutation site is located in front of T-box and most probably leads to haploinsufficiency of TBX5 protein. In addition, only 42 variants (1 splicing single nucleotide variants (SNV), 15 insertions/deletions, 24 nonsynonymous SNVs, 1 stopgain SNVs and 1 unknown) were found in 29 genes, which are related to cardiac disease.

Figure 1

Conclusions

Our study revealed a mutation (c.100dupG:p.Ala34fs) of TBX5 and further demonstrated the possibility of HOS-related TBX5 mutation in patients with congenital ASD only. This study clarified the diagnosis of this pedigree, provided genetic counseling and promoted the prevention and treatment of HOS. Further research is needed on mechanisms that may lead to phenotypic variation between and within families, such as random monoallelic expression.

Acknowledgement/Funding

None

Nurse and midwife researcher collaboration in eastern sub-Saharan Africa: a social network analysis

AIM

To investigate the collaborative networks among expert clinical nurse and midwifery researchers in eastern and southern Africa.

METHODS

Thirty-eight clinical nurse and midwifery researchers completed an online survey to analyse collaboration between respondents. Data were analysed using social network analysis, generating a network map and associated measurements.

RESULTS

Regional collaboration was poor. Those links that did exist centred on geographic proximity and participation in regional and international organizations.

CONCLUSION

These results help us to understand better ways to strengthen and support nursing and midwifery clinical research in eastern and southern Africa.

IMPLICATIONS FOR NURSING POLICY

Clinical nursing and midwifery research capacity building efforts should focus on supporting collaboration networks among individuals and institutions in the region.

Comparison of dysregulated long noncoding RNAs in lung adenocarcinoma and spinal metastasis: A genome-wide analysis

Long noncoding RNAs (lncRNAs) have been shown to play crucial roles in cancer metastasis, yet the lncRNAs landscape of lung adenocarcinoma has not been completely characterized. The aim of this study was to assess the expression profile and potential function of lncRNA in lung adenocarcinoma and in spinal metastasis (SM). A genome-wide microarray analysis was conducted on lung adenocarcinoma and SM tissue from ten Chinese patients. A total of 3,345 differentially expressed lncRNAs were detected. Of those, 761 lncRNAs were upregulated and 2,584 were downregulated (fold-change >2.0, p<0.05). These differentially expressed lncRNAs were not evenly distributed among the chromosomes of human genome. Volcano plots of these differentially expressed lncRNAs revealed large variability in lncRNAs expression among 12 patients, indicating that certain lncRNAs may play a positive role in SM of lung adenocarcinoma. Gene Ontology enrichment and pathway analysis identified several remarkably dysregulated biological pathways that affect cell adhesion and the interaction of cytokines and cytokine receptors. Co-expression network analysis showed that 9,458 lncRNAs had verified cis- and trans- target genes. All 2,317 cis targeted genes were confirmed to be differentially expressed and influenced by dysregulated lncRNAs in SM of lung adenocarcinoma. Top ten markedly dysregulated lncRNAs and mRNAs were verified from the co-expression network. In conclusion, this study was a genome-wide survey of dysregulated lncRNAs and corresponding mRNAs that comprise co-regulation networks for SM and lung adenocarcinoma tissues. These dysregulated lncRNAs and mRNA networks could be used as therapeutic gene targets to prevent SM of lung adenocarcinoma and to predictively evaluate treatment efficacy.

MiR-223-3p inhibits proliferation and metastasis of oral squamous cell carcinoma by targeting SHOX2

OBJECTIVE

The aim of this study was to explore the role of microRNA-233-3p (miR-233-3p) in the development of oral squamous cell carcinoma (OSCC), and to elucidate the underlying mechanism.

PATIENTS AND METHODS

The expression of miR-233-3p in OSCC tissues and cell lines was detected by quantitative real-time polymerase chain reaction (qRT-PCR). The target of miR-233-3p was detected and evaluated by L-test and Western blot assays, respectively. Furthermore, the effects of miR-233-3p on cell proliferation, migration and apoptosis were discussed by cell counting kit-8 (CCK-8), scratch-wound and flow cytometry test.

RESULTS

MiR-233-3p was lowly expressed in OSCC tissues and cells. Short stature homeobox 2 (SHOX2) was predicted and verified as the downstream target gene of miR-233-3p. Inhibiting the expression of SHOX2 could significantly reduce the malignant behaviors of OSCC cells. The proliferation, migration and anti-apoptotic abilities of miR-233-3p overexpressed cells were obviously limited. However, the recovery of SHOX2 counteracted the beneficial effect of miR-233-3p.

CONCLUSIONS

MiR-223-3p acted as a tumor suppressor gene in OSCC by targeting SHOX2. Our findings revealed that miR-223-3p/SHOX2 axis could be a potential therapeutic target for OSCC.