[Clinical study of cervical necrotizing fasciitis accompanied with descending necrotizing mediastinitis treated with cervical double parallel incision combined with mediastinoscope or thoracoscope]

Objective: To summarize the experience of applying cervical double parallel incision combined with mediastinoscope or thoracoscope in the treatment of cervical necrotizing fasciitis (CNF) accompanied with descending necrotizing mediastinitis (DNM), so as to provide a reference for clinical practice. Methods: The clinical data of six patients with CNF accompanied with DNM who were admitted to the Department of Stomatology and the Department of Otolaryngology Head and Neck Surgery, The First People's Hospital of Changzhou from September 2014 to September 2018 were retrospectively analyzed. All of the six patients were confirmed by CT of neck and chest, among whom there were two males and four females aged from 48 to 73. Three patients were treated with cervical double parallel incision combined with mediastinoscope to be combined with cervical and thoracic drainage under general anesthesia while the other three with cervical double parallel incision combined with thoracoscope to be combined cervical and thoracic drainage under general anesthesia. The CT of neck and chest as well as infectious indicators including hematology, C-reactive protein (CRP) and procalcitonin (PCT) were reexamined during the postoperative period. Results: The cervical and thoracic combined drainage was unobstructed in all of the six patients, no secondary surgery was performed, and the infectious indicators gradually decreased. All patients had off-bed activities on the first day after the operation, were all cured and discharged after an average of 21 days (16 to 36 days) in hospital and followed up for an average of 18 months (4 to 30 months) after the operation. None of them experienced infection relapse, and they were all satisfied with the appearance of the cervical incision. Conclusions: Cervical double parallel incision combined with mediastinoscope or thoracoscope for the treatment of CNF accompanied with DNM has the advantages of complete drainage, small trauma, excellent efficacy and aesthetic operative area, thus being deserved to be clinically popularized.

MicroRNA-1285 inhibits malignant biological behaviors of human pancreatic cancer cells by negative regulation of YAP1

Pancreatic ductal adenocarcinoma is a most deadly malignancy, with a 5-year survival rate of ~7%. Chemotherapy is the main treatment strategy of this disease. However, the high rate of resistance to chemotherapeutic agent contributes to poor prognosis. MicroRNAs are essential for the initiation, progression and chemoresistance of human malignancies. Previous studies have shown that miRNA-1285 participates in renal cell carcinoma and hepatocellular carcinoma. However, its roles in pancreatic ductal adenocarcinoma are poorly understood. In this study, we confirmed that miR-1285 was significantly down-regulated in gemcitabine-resistant pancreatic cancer cell lines by qRT-PCR. We found that miR-1285 suppressed cell proliferation as well as increased the sensitivity of PDAC cells to gemcitabine by CCK8 assays in vitro. Results from transwell assay indicated that miR-1285 inhibited pancreatic cancer cell migration and invasion. Experiments using different cell lines got identical results. All those results demonstrated that miR-1285 act as tumor suppressor of pancreatic cancer. To our knowledge, this study is the first to elucidate the function of miR-1285 in pancreatic cancer. Western blotting analysis verified that miR-1285 negatively regulated YAP1 protein level, together with EGFR and β-catenin. YAP1 is a known oncoprotein of pancreatic cancer. As silencing of YAP1 activity might be beneficial in cancer prevention and treatment, our results suggest that miR-1285 might serve as a novel therapeutic target for miRNA-based therapy in pancreatic cancer. Further research elucidating the exact mechanisms of miRNA-1285 function and the correlation between miR-1285 levels in tissues or serum and clinical characteristics of pancreatic cancer is needed later.

[Pancreatic ductal adenocarcinoma immune microenvironment and immunotherapy prospects]

The tumor components of pancreatic ductal adenocarcinoma (PDAC) are composed of immune microenvironment of extracellular matrix, fibroblasts, endothelial cells and immune cells together with a minority of malignant cells. The failure of the therapeutic measures, such as chemotherapy, targeted therapy and immunotherapy, has been linked to the specific immune microenvironment of pancreatic cancer. By analyzing the components of immune microenvironment of pancreatic cancer, the mechanism of various components in pancreatic cancer such as highly immunosuppressive, hypoxic and connective tissue hyperplasia can be clarified. New efforts in single-cell profiling will enable a better understanding of the composition of the microenvironment in primary and metastatic PDAC, as well as an understanding of how the microenvironment may respond to novel therapeutic approaches.

[Efficacy and safety of Entecavir monotherapy switched from Lamivudine combined Adefovir Dipivoxil for chronic hepatitis B virus-related compensated liver cirrhosis]

Objective: To observe the efficacy and safety of de novo combination of Lamivudine(LAM) and Adefovir Dipivoxil (ADV) therapy counter to Entecavir (ETV) monotherapy in patients with chronic hepatitis B (CHB)- related compensated liver cirrhosis. Methods: Patients with chronic hepatitis B-related compensated cirrhosis who were initially treated with LAM and ADV for more than 1 year were randomly assigned to two groups, one half replaced with ETV monotherapy, and the other half continued LAM and ADV co-therapy. Liver biochemistry, renal biochemistry, estimated glomerular filtration rate, alpha-fetoprotein, HBV serology markers and serum HBV DNA were measured every 3 months. Urine β2-microglobulin was measured every 6 months And retinol binding protein, followed up for 3 years. The mean values of the two groups were compared with t-test, and the rate of comparison was analyzed by x2 test. Results: A total of 580 cases were collected, 290 cases were replaced with ETV monotherapy, the other 290 patients continued to LAM and ADV combination therapy. In the ETV group, the rates of HBV DNA negative conversion at 1 year, 2 years and 3 years were 77.6%, 84.5% and 94.5% respectively, while the HBV DNA negative conversion rates at 1, 2 and 3 years in the LAM and ADV combination groups were 69.3%, 73.4% and 80.3% respectively. Among them, the negative rates of HBV DNA in the second year and the third year were P < 0.05, the difference was statistically significant. The 3-year cumulative gene-resistant rate in the ETV group was 1.4%, while the combined treatment was as high as 8.6%, and the difference was statistically significant in the two groups. The estimated value of serum creatinine and glomerular filtration rate in ETV group was followed by 3 years, and the baseline level was maintained, in the same group, the serum creatinine was higher than baseline, and the estimated value of glomerular filtration rate decreased. The results showed that there were 6.2%, 12.1%, 22.1% and 0, 0.3%, 1%, respectively, in 1, 2 and 3 years for the group of consecutive treatment and the replacement of ETV Group. The estimated glomerular filtration rate decreased by more than 30% compared with the baseline. The difference was statistically significant; the proportion of serum creatinine in the 1 year, 2 years and 3 years of the combined treatment group was 1.7%, 4.5% and 6.6%, compared with the baseline rise of > 50 μmol/l, and the ETV group was replaced in the 1 year, The values of 2 and 3 years were 0,0,0.7%, of which the 2nd and 3rd years were statistically significant; the proportion of microalbuminuria and retinol-binding protein in patients with combined treatment group was also significantly higher than that of Β2-m ETV Group. Conclusion: The initial combination of LAM and ADV therapy is inferior in terms of ETV monotherapy. Single therapy with ETV increase the rate of viral response, reduce the incidence of drug resistance, and also reduce the incidence of renal impairment in patients with chronic hepatitis B -related compensated liver cirrhosis.

miR-25 Mediates Retinal Degeneration Via Inhibiting ITGAV and PEDF in Rat

BACKGROUND

Age-related macular degeneration (AMD) is the main cause of irreversible blindness in the elderly. Oxidative stress in retinal pigment epithelium (RPE) is deemed to play a pivotal role in the pathogenesis of AMD. miR-25 functions as an essential modulator in response to oxidative-stress in several cell types, but its function in RPE cells is poorly understood.

OBJECTIVE

To explore the roles of miR-25 in RPE cells and in the development of AMD.

METHODS

A rat model of retinal degeneration was induced by sodium iodate (SI). Subretinal injection of antagomiR-25 was performed for the intervention while the scramble as control. Visual responses were recorded with Electroretinogram (ERG). TUNEL assay was performed to detect apoptosis. Phagosome quantification in vivo was performed to evaluate RPE cell function. Oxygen-glucose deprivation treatment was performed to mimic in vitro oxidative stress. Gene expression at mRNA level and protein level were performed by quantitative polymerase chain reaction (qPCR) and Western Blot, respectively. The pigment epithelium derived factor (PEDF) level in the cultured medium was measured by Enzyme-linked immunosorbent assay (ELISA). The interaction between miR-25 and integrin αV (IGTAV) / PEDF 3'UTR was examined by dual luciferase assay. Chromatin immunoprecipitation (ChIP) assay was performed to examine its transcriptional regulation of miR-25.

RESULTS

Oxidative stress up-regulated miR-25 in RPE cells in very early stage, accompanied by decreased phagocytosis and reduced growth factor secretion in those cells. Such changes preceded RPE cell apoptosis and visual impairment in the SItreated rats. Furthermore, antagomiR-25 intervention effectively rescued RPE cells from degeneration in such model. The increased miR-25 was confirmed to mediate RPE degeneration through direct targeting IGTAV and PEDF. On the other hand, upstream, miR-25 was found to be up-regulated by STAT3 signaling under oxidative stress in both in vivo and in vitro models.

CONCLUSION

Our findings demonstrate that, in SI-treated rats, oxidative stress activates STAT3 signaling which up-regulates miR-25 expression, in a very early stage. The increased miR-25 then inhibits ITGAV and PEDF expressions, resulting in RPE phagocytosis dysfunction and then RPE apoptosis and visual impairment as observed in patients with AMD. These findings lead us to a better understanding of AMD pathogenesis, and suggest that miR-25 could be a potential therapeutic target for oxidative stress related RPE diseases, like AMD.

The use of carbon nanoparticles to track occult lingual lymph nodes in early-stage tongue squamous cell carcinoma

The lingual lymph nodes (LLNs) can only be detected with difficulty in early-stage tongue squamous cell carcinomas owing to the small size. Recurrence or metastasis could occur in the floor of the mouth as a result of neglecting the LLNs. The injection of carbon nanoparticles to track occult LLNs in early-stage tongue squamous cell carcinoma is presented and discussed. This technique is simple and easy to use intraoperatively. If LLNs were stained black during the operation, the sublingual gland along with the fatty tissue of the floor of the mouth were removed simultaneously. The LLNs in early-stage tongue squamous cell carcinoma deserve more attention.

Comparison of the subjective satisfaction of the donor site morbidity: Free radial forearm flap versus anterolateral thigh flap for reconstruction in tongue cancer patients

BACKGROUND

The purpose of the study was to compare the differences of the subjective satisfaction of the donor site morbidity between the free radial forearm flap (FRFF) and anterolateral thigh flap (ALTF) for tongue reconstruction.

MATERIAL AND METHODS

One hundred and nineteen patients underwent FRFF or ALTF reconstruction were retrospectively evaluated by a standardized self-established donor site morbidity questionnaire which included 5 domains, sensibility, movement disabilities, cosmetics, social activities and general impacts on the quality of life.

RESULTS

The Cronbach's coefficient alpha of the questionnaire was 0.707. The exploratory factor analysis revealed that the 5 items of the questionnaire might load onto two distinct subscales. Patients with ALTF had higher scores in the sensibility, cosmetics and the composite score (P < 0.05). No significant differences were found in the movement disabilities, social activities and general impacts on the quality of life between the two groups (P > 0.05).

CONCLUSIONS

ALTF has the advantage of better results of donor site morbidity, such as sensibility and cosmetics, over FRFF.

[Study of surgery combined with 125I brachytherapy for adenoid cystic carcinoma of oral and maxillofacial region]

OBJECTIVE

To retrospectively analyze the results of treatment outcome by surgery combined with ₁₂₅I brachytherapy and correlative factors of adenoid cystic carcinoma (ACC).

METHODS

In the study, 75 patients with primary ACC of oral and maxillofacial region were treated by surgery combined with ₁₂₅I seeds brachytherapy. Radical resection or subtotal resection was applied for the tumor. The brachytherapy treatment planning system was used to create implant plans with the prescribed dose of 60 Gy to 120 Gy. The ₁₂₅I seeds were implanted intraoperatively or postoperatively. The regular follow-up was required. The Kaplan-Meier method was used to assess the tumor control rate and the patients' survival rates. Meanwhile, the Cox regression analysis was used to find out the prognostic factors.

RESULTS

Local control rates at the end of 3 and 5 years were as follows: T1-T2, 92.2% and 82.0%; T3-T4, 82.6% and 82.6%; and overall, 90.0% and 78.8%. The disease-free survival rates were 74.9% and 54.3%, respectively. The overall survival rates for all the patients were 86.0% and 79.6%, respectively at the end of 3 and 5 years and were 91.3% and 91.3% for T1-T2 patients vs. 73.9% and 59.7% for T3-T4 patients. Distant metastasis-free survival rates at the end of 3 and 5 years were 84.4% and 76.7%, respectively. The distant metastasis-free survival rates at the end of 3 and 5 years were 83.4% and 79.6% with T1-T2 lesion compared with 86.0% and 67.8% with T3-T4 lesion. According to the COX univariate analysis and multivariate analysis, the risk of local recurrence would be raised by the age. Tumor stage and tumor site were the prognostic factors of the overall survival rates.

CONCLUSION

₁₂₅I brachytherapy conducted as an adjuvant therapy postoperatively of ACC of oral and maxillofacial region can acquire satisfactory localregional control, distant metastasis-free survival, disease-free survival and overall survival. Tumors are prone to recur on the older patients. Patients having advanced tumor stage or tumor located in the nasal cavity or sinuses will suffer lower survival rates.

Abstract P4-01-25: Blood-based DNA methylation as epigenetic biomarkers for non-invasive detection of breast cancer

Background: DNA methylation significantly contributes to all hallmarks of cancer. In particular, promoter hypermethylation has been identified as a potential marker for early detection of cancer, therapy monitoring, assessment of prognosis or prediction of therapy response. Here, we identified and validated breast cancer-specific methylation markers for diagnosis of the disease with high sensitivity and specificity.

Methods: 151 bio-banked samples were obtained for a randomized blind study; 65 subjects diagnosed with breast cancer (Stage I to IV), 15 subjects with benign breast disease, 32 subjects diagnosed with other cancer types (11 colorectal, 9 liver and 12 lung cancer), and 39 healthy donor samples. Cell-free DNA was then extracted from the samples, bisulfite converted, and DNA methylation was quantified by using the IvyGene Platform. Finally, the raw data were collected and analyzed to evaluate the test performance.

Results: A total of 53 of the 65 breast cancer samples were correctly identified for an overall calculated sensitivity of 89% with little difference between the sensitivity of detecting Stage I to Stage IV breast cancer (range 88% to 94%). The breast cancer subjects were correctly identified with 96% specificity. Additionally, 28 of 32 samples drawn from healthy donor subjects (specificity 95%) and all 15 samples drawn from subjects diagnosed with benign breast disease (specificity 100%) were also correctly identified. Of the samples drawn from subjects with cancer other than breast cancer, over 96% of lung cancer, colorectal cancer and liver cancer samples were correctly identified as not breast cancer.

Conclusion: The results demonstrate the high diagnostic potential of ctDNA methylation markers in the blood for the detection of breast cancer. In addition, a quantitative analysis of ctDNA provides an opportunity for non-invasive detection of cancer and it's benefits can be anticipated to improve patient management and healthcare quality.

References:

1. Brooks, J.; Cairns, P.; and Zeleniuch-Jacquotte, A. (2009) Promoter Methylation and the Detection of Breast Cancer. Cancer Causes Control. 20(9), 1539–1550.

2. Xu, R. H.; Wei, W.; Krawczyk, M.; Wang, W.; Luo, H.; Flagg, K.; Yi, S.; Shi, W.; Quan, Q.; Li, K.; Zheng, L.; Zhang, H.; Caughey, B. A.; Zhao, Q.; Hou, J.; Zhang, R.; Xu, Y.; Cai, H.; Li, G.; Hou, R.; Zhong, Z.; Lin, D.; Fu, X.; Zhu, J.; Duan, Y.; Yu, M.; Ying, B.; Zhang, W.; Wang, J.; Zhang, E.; Zhang, C.; Li, O.; Guo, R.; Carter, H.; Zhu, J. K.; Hao, X.; and Zhang, K. (2017) Circulating tumour DNA methylation markers for diagnosis and prognosis of hepatocellular carcinoma. Nature materials 16, 1155-1161.

Citation Format: Roy D, Zheng L, Liu D, Li G, Li M, Zhang K, Van Etten RA. Blood-based DNA methylation as epigenetic biomarkers for non-invasive detection of breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-01-25.

The influence of therapeutic vaccine candidate against HBeAg pEGFP-N1-C (472-507)-ecdCD40L on dendritic cells

Hepatitis B virus (HBV) infection is a major public health problem and immune tolerance is responsible for persistent HBV infection. HBV therapeutic vaccines targeting HBV e antigen (HBeAg) may have an excellent effect in overcoming HBV immune tolerance. Thus, there is urgency for designing therapeutic vaccine candidates that target HBeAg. In this research, we fused the C (472-507) gene sequence of HBV with the extracellular domain of human CD40 ligand sequence and ligated this fused sequence into the pEGFP-N1 vector to construct the recombinant plasmid pEGFP-N1-C (472-507)-ecdCD40L. Then, the dendritic cells (DCs) generated from human peripheral blood were transfected with this recombinant plasmid. After this, the phenotype and function of DCs were assessed. Compared with the three control groups of pEGFP-N1-C (472-507), pEGFP-N1 and phosphate buffered saline (PBS), we found that DCs transfected with the recombinant plasmid pEGFP-N1-C (472-507)-ecdCD40L enhanced the expression of costimulatory molecules (CD80, CD86 and HLA-DR) and secretion of cytokine IL-12p70. Furthermore, the capacity of inducing the proliferation of allogeneic lymphocytes was also improved. Our study validated that transfecting DCs with recombinant plasmid pEGFP-N1-C (472-507)-ecdCD40L could activate DCs and enhance their functions. Therefore, C (472-507)-ecdCD40L fusion sequence may be a promising vaccine candidate for chronic hepatitis B therapythat targets HBeAg.

[Increased serum soluble-endoglin level and its clinical significance in antiphospholipid syndrome]

OBJECTIVE

To detect the serum levels of soluble endothelial glycoprotein endoglin (s-Eng) in patients with antiphospholipid syndrome (APS) and to evaluate the correlation between s-Eng levels and clinical features and laboratory parameters.

METHODS

The levels of serum s-Eng were measured by enzyme linked immunosorbent assay (ELISA) in 139 patients with APS, 44 patients with SLE but no APS, 37 patients with primary Sjögren's syndrome (pSS), 23 patients with Bechet's disease (BD), 22 patients with systemic sclerosis (SSc) and 22 persistent anticardiolipin antibody (aCL) positive individuals without SLE or APS (simply aCL positive group) and 87 health controls (HC) without any auto-immune diseases. These APS patients included 64 primary APS patients and 75 APS patients secondary to SLE.The correlation between the clinical data, laboratory parameters, and serum s-Eng levels were analyzed.Independent samples t test, paired t test, Chi-square Test, Mann-Whitney U test, Pearson's χ² test were used for statistical analyses.

RESULTS

(1) The serum levels of s-Eng were significantly higher in the patients with APS whether primary or secondary to SLE than in the health controls and simply aCL positive group and the patients with other autoimmune diseases, including SLE, pSS, BD and SSc (P<0.001). There was no significant difference in the serum s-Eng levels between simply aCL positive group and health controls [(5.17±2.00) mg/L vs. (5.04±1.11) mg/L, P>0.05]. (2) The best cut-off value for the diagnosis of APS was no less than 8.37 mg/L as mean ± 3SD value, with the sensitivity at 0.772 and the specificity at 0.928. The Youden index was 0.700. These results indicated good validity of s-Eng as a diagnostic marker for APS. (3) The proportions of artery thrombosis and pathological pregnancy were higher in the group of s-Eng-positive APS patients than that in s-Eng-negative group (46/81 vs. 19/58, 29/65 vs. 10/44, respectively, all P<0.05). The levels of PLT were lower in the group of s-Eng-positive APS patients (72.00×10⁹/L vs. 119.00×10⁹/L, P<0.001). (4) The proportions of the presence (93.83% vs. 37.93%, P<0.001) and titer (61.70 U/mL vs. 15.45 U/mL, P<0.001) of aCL were both higher in the group of s-Eng-positive APS patients than in s-Eng-negative group. The proportions of the presence (61.73% vs. 43.10%, P<0.05) and titer (33.48 U/mL vs.17.40 U/mL, P<0.05) of anti-β2-glycoprotein I antibody were both higher in the group of s-Eng-positive APS patients than in s-Eng-negative group too.

CONCLUSION

s-Eng serum levels were significantly increased in the patients with APS, and it may play a role as acomplementary serological marker for the diagnosis and risk prediction of APS.

Effect of night light regimen on growth performance, antioxidant status and health of broiler chickens from 1 to 21 days of age

Objective

The study was conducted to evaluate the effects of night light regimen on growth performance, antioxidant status and health of Lingnan Yellow broiler chickens from 1 to 21 days of age.

Methods

A completely randomized factorial design involved 2 photoperiods (constant lighting [CL], 24 L:0 D and intermittent lighting [INL], 17 L:3 D:1 L:3 D)×2 light intensities (10 lx and 30 lx). A total of one thousand six hundred and eighty 1-d-old Lingnan Yellow broiler chicks were randomly divided into 4 treatments with 6 replicates (70 birds per replicate). The experiment lasted for 21 d.

Results

Photoperiods and light intensities had no effect on average daily gain, feed conversion ratio, and mortality of the broiler chickens (p>0.05). The INL had a significant effect on average daily feed intake (p<0.05) of broiler chickens compared with CL. Photoperiod and light intensity had an interactive effect on melatonin (MT) concentration (p<0.05). At CL, reducing light intensity increased MT concentration; INL birds had higher MT but MT concentration was not affected by light intensity. There was an interactive effect on glutathione peroxidase (GPx) and catalase (CAT) in serum and total antioxidant capability (T-AOC) in liver between photoperiod and light intensity. With the decrease of light intensity, the activities of GPx and CAT in serum and T-AOC in liver increased in CL group (p<0.05). Broiler chickens reared under INL had better antioxidant status and 10 lx treatments had higher activities of CAT in serum than 30 lx (p<0.05). Different photoperiods and light intensities had no effect on malondialdehyde. There was an interaction between photoperiod and light intensity on serum creatine kinase (CK) concentration (p<0.05). At CL, the elevated light intensity resulted in an increase in CK content; INL birds had lower CK concentration especially in low light intensity group. Besides, INL and low light intensity significantly reduced the concentration of serum corticosterone and heat shock protein 70 (p<0.05). Serum immunoglobulin M contents were increased in broiler chickens reared under the INL compared with CL group (p<0.05).

Conclusion

Results above suggest that the night light regimen of INL and 10 lx could be beneficial to the broiler chickens from 1 to 21 days of age due to the better health status and electricity savings.

Use of Oral Sildenafil in Treatment of Pediatric Head and Neck Lymphatic Malformations

Background: Lymphatic malformation (LMs) is a low flow vascular malformation, with a morbidity rate of 1/2000 in neonates. Most of the LMs were found in the head and neck. Compared with the macrocrystic ones, the microcrystic LMs show stronger invasiveness and wider involved range, which leads to higher treatment difficulty and recurrence rate as well as a serious impact on patients´ health and quality of life. Aim: To evaluate the efficacy and safety of oral sildenafil in treatment of pediatric head and neck LMs. Methods: In total, 21 children diagnosed with LMs were given oral sildenafil and stopped at week 24. Therapeutic outcome was evaluated by comparing lesions' volume change with baseline. In addition, symptoms improvement and adverse effects were also recorded during the follow-up period. Results: Eight patients (38.0%) showed excellent improvement (>75%-100%), 1 patient (4.8%) had good (>50%-75%), 2 patients (9.6%) had fair (>25%-50%), 3 patients (14.3%) had minimal (0%-25%), and 7 patients (33.3%) had no improvement. The snoring or stridor completely disappeared in 2 subjects, although there was no apparent decrease in LMs size. Moreover, all 3 patients with macrocystic lesions displayed a positive response to sildenafil treatment, followed by mixed type (9/12, 75%). Only 2 out of 6 patients with microcystic lesions had minimal clearance. Only 4 patients showed transient mild diarrhea, there was no other adverse effect in this series. Conclusion: Our study showed that low-dose oral sildenafil citrate tablets are safe and effective to decrease the lesions volume in some LMs children, especially with macrocystic lesion or mixed type.

Berberine Ameliorates Periodontal Bone Loss by Regulating Gut Microbiota

Postmenopausal osteoporosis (PMO) is a risk factor for periodontitis, and current therapeutics against PMO prevent the aggravated alveolar bone loss of periodontitis in estrogen-deficient women. Gut microbiota is recognized as a promising therapeutic target for PMO. Berberine extracted from Chinese medicinal plants has shown its effectiveness in the treatment of metabolic diseases such as obesity and diabetes via regulating gut microbiota. Here, we hypothesize that berberine ameliorates periodontal bone loss by improving the intestinal barriers by regulating gut microbiota under an estrogen-deficient condition. Experimental periodontitis was established in ovariectomized (OVX) rats, and the OVX-periodontitis rats were treated with berberine for 7 wk before sacrifice for analyses. Micro–computed tomography and histologic analyses showed that berberine treatment significantly reduced alveolar bone loss and improved bone metabolism of OVX-periodontitis rats as compared with the vehicle-treated OVX-periodontitis rats. In parallel, berberine-treated OVX-periodontitis rats harbored a higher abundance of butyrate-producing gut microbiota with elevated butyrate generation, as demonstrated by 16S rRNA sequencing and high-performance liquid chromatography analysis. Berberine-treated OVX-periodontitis rats consistently showed improved intestinal barrier integrity and decreased intestinal paracellular permeability with a lower level of serum endotoxin. In parallel, IL-17A-related immune responses were attenuated in berberine-treated OVX-periodontitis rats with a lower serum level of proinflammatory cytokines and reduced IL-17A+ cells in alveolar bone as compared with vehicle-treated OVX-periodontitis rats. Our data indicate that gut microbiota is a potential target for the treatment of estrogen deficiency–aggravated periodontal bone loss, and berberine represents a promising adjuvant therapeutic by modulating gut microbiota.

Comparison of glide paths created with K-files, PathFiles, and the ProGlider file, and their effects on subsequent WaveOne preparation in curved canals

BACKGROUND

The root canal glide path has been recommended as the foundation for a safer root canal preparation. The aim of this study was to compare glide paths created with K-files, PathFiles, and the ProGlider file, and their effects on subsequent WaveOne preparation regarding canal transportation, canal volume increase, apical extruded debris, and working time in curved canals.

METHODS

Sixty mesial canals of extracted human mandibular first molars were randomly assigned to the K-file (KF), PathFile (PF) and ProGlider file (PG) groups for glide path preparation. Then, canals were prepared using WaveOne files. Specimens were scanned (voxel size: 18 μm) three times using micro-computed tomography: pre-glide path, post-glide path, and post-root canal preparation. Canal transportations were measured at 1, 3, and 5 mm levels from the apical foramen, and canal volume increases were also accounted. Apical extruded debris during preparation was collected for measurement. Meanwhile,working time was recorded. Data were analyzed statistically using one-way analysis of variance and Tukey's post hoc tests (p < 0.05).

RESULTS

After glide path preparation, the PG and PF groups showed significantly less canal transportation than the KF group at all levels (P < 0.05), while the PG group exhibited a significantly larger canal volume increase than the PF and KF groups (P < 0.05). After the subsequent canal preparation with WaveOne, the PG and PF groups showed significantly less canal transportation than the KF group at 3 and 5 mm levels, and the PG group showed significantly less canal transportation than the PF group at 5 mm level (P < 0.05). However, statistically similar canal volume increases occurred among the three groups. Additionally, the PG and PF groups produced less apical extruded debris compared to the KF group (P < 0.05). The working time of the PG group was the shortest, while that of the KF group was the longest.

CONCLUSION

Compared with the PathFiles and K-files, the ProGlider file combined with the WaveOne file showed reduced canal transportation and working time.

[The treatment of Lemierre syndrome associated with cervical necrotizing fascitis]

Lemierre syndrome is a rare, potentially fatal condition characterized by internal jugular vein thrombosis following an acute oropharyngeal infection, often accompanied with cervical necrotizing fasciitis. This paper reviews 5 cases of Lemierre syndrome with cervical necrotizing fasciitis, extensive cervical drainage and sufficient antibiotics is crucial treatment for Lemierre syndrome, anticoagulation combined with antibiotics is safe and effective for propagation or nonresolution of the thrombus.