[Effectiveness of minimally invasive surgery in the treatment of pancreatic acinar cell carcinoma]

Objective: To explore the effectiveness of minimally invasive surgical treatment for pancreatic acinar cell carcinoma (PACC). Methods: Six patients with PACC diagnosed in Peking University Third Hospital from January 2010 to September 2022 were retrospectively selected. Preoperative evaluation was performed on whether the lesions were eligible for surgery, including whether radical resection of liver metastases could be performed. Laparoscopic or Da Vinci robot-assisted resection was performed on six patients, and spleen retention was determined according to the original lesions and the relationship with peripheral blood vessels and tissues, while simultaneous resection was performed on cases of peripheral organ tissue invasion. The patients' basic information, preoperative general conditions, preoperative diagnosis and tumor stage, minimally invasive surgery methods, postoperative complications, pathological results, tumor stage and follow-up data were collected and analyzed to explore the effectiveness of minimally invasive surgery. Results: Among the six patients, four were males and two were females, with the age of 25-69 years. Five patients had abdominal pain and distension before surgery, five patients had tumors located at the tail of the pancreatic body, and one patient had tumors located at the head of the pancreas. Preoperative imaging (enhanced CT and MRI) was performed to measure the tumor diameter (2.8-10.0 cm). Tumor markers were elevated in two patients before surgery, and six patients underwent surgery through laparoscopy or robotic platform. No complications such as postoperative pancreatic fistula and bleeding were clinically relevant during and after surgery. There were two cases with concurrent or heterochronous liver metastasis, two cases with lymph node metastasis and nodular metastasis, four cases with tumor invasion of surrounding organs (stomach, spleen or duodenum), and three cases with vascular cancer thrombi. The follow-up time of the six patients was 12 to 165 months, and one patient underwent three operations due to postoperative liver metastasis and residual pancreatic recurrence, and the results were satisfactory. All the six patients survived at the last follow-up. Conclusions: PACC is prone to invade the surrounding organs, and has a large tumor diameter. Radical surgery for PACC can be completed through minimally invasive surgery, and satisfactory oncology prognosis can be obtained. In addition, some PACC patients with recurrence and metastasis can still be treated by surgery.

[Controversies and prospects for surgical treatment of pancreatic neuroendocrine neoplasms with liver metastases]

The incidence of pancreatic neuroendocrine neoplasm(pNEN) increased over the past two decades. Liver metastasis, the most common type of distal metastasis, is also one of the most important prognostic factors. Although several medical treatments, including biotherapy, chemotherapy, targeted therapy, peptide receptor radionuclide therapy and locoregional therapy, are available for pNEN with liver metastases, surgery is still the only possible treatment for cure. Currently, there are several controversies as regards surgical treatment for pNEN with liver metastases. These controversies include, but are not limited to, whether surgical resection is appropriate for pancreatic neuroendocrine tumor G3 with liver metastases, how to classify primary lesion and hepatic metastases comprehensively and accurately, what is the optimal surgical strategy for type Ⅱ liver metastases, who can benefit greatly from cytoreduction, and how to refine the Milan criteria for liver transplantation. This article aims to discuss those main controversies and provide prospects for future clinical trials.

Utilizing Proteomic Approaches to Uncover the Neuroprotective Effects of ACE Inhibitors: Implications for Alzheimer's Disease Treatment

Two types of angiotensin-converting enzyme (ACE) inhibitors, lisinopril and benazepril HCl, were tested in neuroblastoma cells and found to upregulate low-density lipoprotein-receptor-related protein 1B (LRP1B) and 14-3-3 protein zeta/delta. Additionally, benazepril HCl was found to increase the expression of calreticulin. The upregulation of these proteins by ACE inhibitors may contribute to the amelioration of cognitive deficits in Alzheimer's disease/dementia, as well as the clinically observed deceleration of functional decline in Alzheimer's patients. This discovery suggests that the supplementation of ACE inhibitors may promote neuronal cell survival independently of their antihypertensive effect. Overall, these findings indicate that ACE inhibitors may be a promising avenue for developing effective treatments for Alzheimer's disease.

Immune Response Related to Lymphadenopathy Post COVID-19 Vaccination

Mass vaccination against coronavirus disease 2019 (COVID-19) is a global health strategy to control the COVID-19 pandemic. With the increasing number of vaccinations, COVID-19 vaccine-associated lymphadenopathy (C19-VAL) has been frequently reported. Current findings emphasize the characteristics of C19-VAL. The mechanism of C19-VAL is complicated to explore. Accumulated reports separately show that C19-VAL incidence is associated with receiver age and gender, reactive change within lymph nodes (LN), etc. We constructed a systematic review to evaluate the associated elements of C19-VAL and provide the mechanism of C19-VAL. Articles were searched from PubMed, Web of Science and EMBASE by using the processing of PRISMA. The search terms included combinations of the COVID-19 vaccine, COVID-19 vaccination and lymphadenopathy. Finally, sixty-two articles have been included in this study. Our results show that days post-vaccination and B cell germinal center response are negatively correlated with C19-VAL incidence. The reactive change within LN is highly related to C19-VAL development. The study results suggested that strong vaccine immune response may contribute to the C19-VAL development and perhaps through the B cell germinal center response post vaccination. From the perspective of imaging interpretation, it is important to carefully distinguish reactive lymph nodes from metastatic lymph node enlargement through medical history collection or evaluation, especially in patients with underlying malignancy.

Utilizing Proteomic Approach to Analyze Potential Antioxidant Proteins in Plant against Irradiation

Gamma-ray irradiation is an effective and clean method of sterilization by inactivating microorganisms. It can also be applied to induce anti-oxidants for future application. In this study, the mung bean (Vigna radiata) was exposed to gamma-ray irradiation under the dose of 0, 5 or 10 kGy. With increasing irradiation doses, the concentrations of malondiadehyde decreased while the levels of total flavonoids and DPPH (1,1-diphenyl-2-picrylhydrazyl) radical scavenging activity increased. It has been shown that consuming flavonoids can provide protective effects. In addition, proteomic analysis identified several proteins having anti-oxidant activities in the 5 kGy irradiated group. These proteins are Apocytochrome f, Systemin receptor SR 160, DELLA protein DWARF8, DEAD-box ATP-dependent RNA helicase 9, ζ-carotene desaturase (ZDS), and Floral homeotic protein AGAMOUS. Our findings indicate that plants contain a variety of phytochemicals and antioxidant proteins which may effectively prevent oxidative stress caused by irradiated peroxidation.

[Molecular targeted therapy strategy and clinical research progress in pancreatic ductal adenocarcinoma]

The incidence of pancreatic ductal adenocarcinoma(PDAC) is increasing year by year among digestive system tumors.It has a high degree of malignancy and a poor prognosis.Its five-year survival rate is less than 8%.Traditional radiotherapy and chemotherapy are not sensitive to pancreatic cancer,so finding a new drug is the future hope for pancreatic cancer.In recent years,molecular targeted therapy has made obvious progress in diseases such as hematological malignancies,non-small cell lung cancer and melanoma,and a large number of targets have been tried in pancreatic cancer, for example, gene mutation targets, important signaling pathway targets, receptor targets, etc. The use of these targeted drugs alone or in combination has shown good results in preclinical models and some clinical trials, and some treatment have been standardized for patients with pancreatic cancer, while other options that have not yet been tested in large-scale clinical trials also offer a variety of potential possibilities for future targeted treatments for pancreatic cancer.

The Effects of Heterologous Immunization with Prime-Boost COVID-19 Vaccination against SARS-CoV-2

Coronavirus Disease 2019 (COVID-19) pandemic, which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become the global challenge. Reaching global herd immunity will help end the COVID-19 pandemic. However, vaccine shortage and vaccine hesitancy are the obstacles to achieve global herd immunity against SARS-CoV-2. The current homologous vaccine regimen is experimentally switching to heterologous vaccination at several study sites. However, the reactogenicity of heterologous ChAdOx1-S and mRNA vaccination against SARS-CoV-2 is still unclear. We have conducted a systematic review to summarize the current findings on the safety and immunogenicity of this heterologous vaccination and elucidate their implications against SARS-CoV-2. This systematic review was conducted by the guidelines of PRISMA. Articles were searched from PubMed and other sources (MedRixv and Google scholar) starting from 1 January to 5 September 2021. The search term was heterologous ChAdOx1-S and BNT162b2 or mRNA-1273 vaccination. Our review found that participants with ChAdOx1/BNT162b2, ChAdOx1-S/mRNA-1273 or BNT162b2/ChAdOx1-S did not have the serious adverse events seen with homologous vaccination. Participants with the heterologous regimen (ChAdOx1/BNT162b2, ChAdOx1-S/mRNA-1273 or BNT162b2/ChAdOx1-S), compared with those with two doses of ChAdOx1-S, have shown a more robust immune responses against SARS-CoV-2, such as higher levels of responsive antibodies or increased numbers of spike-specific T-cells. Nevertheless, these immune responses were slightly diminished in the recipients of BNT162b2/ChAdOx1-S. Also, the safety study of heterologous ChAdOx1-S/mRNA vaccination was based on small populations. Further studies to enclose diverse categories, such as race/ethnicity or geography, may be necessary. Overall, the heterologous immunization with ChAdOX1-S and the mRNA vaccine may improve the vaccine shortage related slow pace of reaching herd immunity, especially using the heterologous immunization with ChAdOx1-S/BNT162b2.

[Advances in indocyanine green fluorescence imaging during hepatectomy]

While surgical operation is the preferred treatment for liver malignancies,the postoperative recurrence rate remains high. In the early 21^st century,Japanese scientists first reported the use of indocyanine green(ICG) in liver resection. Follow-up studies also found its potential applications such as identifying tumors,determining surgical margins,delineating segmental boundaries,and preventing bile leakage. At present,ICG fluorescence imaging is applied to some types of hepatectomy with excellent effect and is expected to assist in generating surgical strategies for liver malignancies. However,its safety and efficacy still need further studies to evaluate.

Clinical significance of olfactory dysfunction in patients of COVID-19

BACKGROUND

Currently, as the coronavirus disease (COVID-19) has become a pandemic, rapidly obtaining accurate information of patient symptoms and their progression is crucial and vital. Although the early studies in China have illustrated that the representative symptoms of COVID-19 include (dry) cough, fever, headache, fatigue, gastrointestinal discomfort, dyspnea, and muscle pain, there is increasing evidence to suggest that olfactory and taste disorder are related to the COVID-19 pandemic. Therefore, we conduct this study to review the present literature about the correlation between anosmia or dysgeusia and COVID-19.

METHODS

A comprehensive literature search in 2020 of the electronic journal databases, mainly PubMed or Web of Science, was performed using the keywords COVID-19 or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with hyposmia, anosmia, dysgeusia, olfactory disorder, or olfactory dysfunction. The country, study period, case number, inpatient or outpatient medical visit, evaluation method (subjective complaints of dysfunction or objective evaluation), and occurrence rate of olfactory or gustatory function were reviewed.

RESULTS

Many studies reported that the recoverable olfactory or gustatory dysfunction may play an important role as the early clinical symptom of COVID-19. It is associated with better prognosis, although further investigation and validation should be carried out.

CONCLUSION

Studies have shown that smell and taste disturbances may represent an early symptom of COVID-19 and healthcare professionals must be very vigilant when managing patients with these symptoms. In the pandemic era, this implies testing for COVID-19 by healthcare workers with full personal protective equipment.

[The Chinese guidelines for the diagnosis and treatment of pancreatic neuroendocrine neoplasms (2020)]

Pancreatic neuroendocrine neoplasms (pNENs) are highly heterogeneous, and the management of pNENs patients can be intractable. To address this challenge, an expert committee was established on behalf of the Group of Pancreatic Surgery, Chinese Society of Surgery, Chinese Medical Association, which consisted of surgical oncologists, gastroenterologists, medical oncologists, endocrinologists, radiologists, pathologists, and nuclear medicine specialists. By reviewing the important issues regarding the diagnosis and treatment of pNENs, the committee concluded evidence-based statements and recommendations in this article, in order to further improve the management of pNENs patients in China.

Utilizing an Animal Model to Identify Brain Neurodegeneration-Related Biomarkers in Aging

Glycine N-methyltransferase (GNMT) regulates S-adenosylmethionine (SAMe), a methyl donor in methylation. Over-expressed SAMe may cause neurogenic capacity reduction and memory impairment. GNMT knockout mice (GNMT-KO) was applied as an experimental model to evaluate its effect on neurons. In this study, proteins from brain tissues were studied using proteomic approaches, Haemotoxylin and Eosin staining, immunohistochemistry, Western blotting, and ingenuity pathway analysis. The expression of Receptor-interacting protein 1(RIPK1) and Caspase 3 were up-regulated and activity-dependent neuroprotective protein (ADNP) was down-regulated in GNMT-KO mice regardless of the age. Besides, proteins related to neuropathology, such as excitatory amino acid transporter 2, calcium/calmodulin-dependent protein kinase type II subunit alpha, and Cu-Zn superoxide dismutase were found only in the group of aged wild-type mice; 4-aminobutyrate amino transferase, limbic system-associated membrane protein, sodium- and chloride-dependent GABA transporter 3 and ProSAAS were found only in the group of young GNMT-KO mice and are related to function of neurons; serum albumin and Rho GDP dissociation inhibitor 1 were found only in the group of aged GNMT-KO mice and are connected to neurodegenerative disorders. With proteomic analyses, a pathway involving Gonadotropin-releasing hormone (GnRH) signal was found to be associated with aging. The GnRH pathway could provide additional information on the mechanism of aging and non-aging related neurodegeneration, and these protein markers may be served in developing future therapeutic treatments to ameliorate aging and prevent diseases.

Chloroquine and Hydroxychloroquine: Efficacy in the Treatment of the COVID-19

Chloroquine (CQ) and its derivative, hydroxychloroquine (HCQ), have attracted wide attention for treating coronavirus disease 2019 (COVID-19). However, conflicting outcomes have been found in COVID-19 clinical trials after treatment with CQ or HCQ. To date, it remains uncertain whether CQ and HCQ are beneficial antiviral drugs for combating COVID-19. We performed a systematic review to depict the efficacy of CQ or HCQ for the treatment of COVID-19. The guidelines of PRISMA were used to conduct this systematic review. We searched through articles from PubMed, Web of Science and other sources that were published from 1 January 2020 to 31 October 2020. The search terms included combinations of human COVID-19, CQ, and HCQ. Eleven qualitative articles comprising of four clinical trials and seven observation studies were utilized in our systematic review. The analysis shows that CQ and HCQ do not have efficacy in treatment of patients with severe COVID-19. In addition, CQ and HCQ have caused life-threatening adverse reactions which included cardiac arrest, electrocardiogram modification, and QTc prolongation, particularly during the treatment of patients with severe COVID-19. Our systematic review suggested that CQ and HCQ are not beneficial antiviral drugs for curing patients with severe COVID-19. The treatment effect of CQ and HCQ is not only null but also causes serious side effects, which may cause potential cardiotoxicity in severe COVID-19 patients.

[Problems and strategies in clinical application of associating liver partition and portal vein ligation for staged hepatectomy]

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) can speed up the regeneration of future liver remnant (FLR) in short period of time, and offer a chance for surgical resection for patients without sufficient FLR. However, ALPPS still remains controversy due to its high perioperative morbidity and mortality, as well as the uncertain long-term oncological benefits. How to solve these problems is the key to ensure the safety of surgery.This article focus on the indication selection, liver function reserve evaluation and timing to perform the second stage surgery, surgical mode evolution and comparison with portal venous embolization/portal venous ligation+two-stage hepatectomy.

Quantitative analysis of progesterone using isotope dilution-matrix-assisted laser desorption ionization-time of flight mass spectrometry as a reference procedure for radioimmunoassay

BACKGROUND

Progesterone is one of the female steroid hormones and plays an important role in the menstrual cycle and during pregnancy. It is especially important in preparing the uterus for the implantation of the blastocyst and maintaining pregnancy. The concentration in human serum is measured to determine the ovarian function retroactively and the cause of abortion in early pregnancy.

METHODS

A quantification assay based on isotope dilution mass spectrometry to determine the concentration of progesterone in human serum is reported. Incorporated with ¹³C₃-progesterone, serum samples were subjected to progesterone extraction and clean-up by C4 solid-phase-extraction columns and hexane-based liquid/liquid extraction, respectively. The cleaned-up serum samples were then subjected to MALDI-TOF mass spectrometry for the quantification of progesterone.

RESULTS

Progesterone and the internal standard, ¹³C₃-progesterone, were measured in the selected reaction monitoring mode for the transitions m/z 315.4 to 108.9 and m/z 318.4 to 111.9, respectively. We calculated the peak area ratio of progesterone to ¹³C₃-progesterone. The progesterone concentration in human serum was calculated by substituting the peak area ratio into an isotope dilution calibration curve, and then compared with the radioimmunoassay.

CONCLUSIONS

In the study, the concentrations of serum progesterone were measured, and the recovered progesterone concentration determined by the assay showed good robustness and consistency in comparison to the conventional radioimmunologic assay. We concluded that the ¹³C₃-progesterone-based quantification assay is a robust method for the measurement of serum progesterone.

[Gastroenteropancreatic neuroendocrine tumor microenvironment and related therapy]

Neuroendocrine tumor(NET) is a kind of highly heterogeneous and ubiquitous tumor, frequently localized in the gastrointestinal tract and pancreas. Surgery combined with regional ablation, endocrine therapy,chemotherapy and targeted therapy presents a favorable prognosis when treated with G1 or G2 gastroenteropancreatic neuroendocrine tumor(GEP-NET). However, there are only limited therapeutic strategies for metastatic unresectable tumors and poorly differentiated NEC,which are closely related to the special tumor microenvironment of neuroendocrine tumors.Targeting tumor microenvironment therapy is an important method in current systematic therapy, but till now the knowledge of neuroendocrine tumor microenvironment and its related treatment are limited. This article will specifically introduce the characteristics of tumor microenvironment in GEP-NET from the following aspects: the formation of enrichment vascular supply in TME,the role of tumor stroma,immune cells and cancer associacted fibroblast, and immune checkpoint and future trend of immunotherapy.

[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.

Does the addition of hyperbaric oxygen therapy to conventional treatment modalities influence the outcome of soldiers with idiopathic sudden sensorineural hearing loss?

BACKGROUND

Idiopathic sudden sensorineural hearing loss (ISSNHL) is defined as a 30-decibel (dB) loss in hearing over three contiguous frequencies within 3 days. The cause remains unknown, and there is currently no consensus in the literature as to how it is best treated. Conventional treatment in our unit comprises steroids, pentoxyphiline and dextran, with the potential addition of hyperbaric oxygen therapy (HBOT).

METHODS

A prospective randomised trial was performed on all soldiers diagnosed with ISSNHL in our institution from 1 January 2007 to 31 December 2016. Participants were randomly allocated to one of two groups. Group A was treated with conventional treatment plus HBOT. Group B was treated with conventional treatment only. Data collection included age, gender, clinical symptoms, pure-tone audiometry results and treatment outcome.

RESULTS

60 participants were enrolled (53 male, 7 female) with ages ranging from 18 to 65 years (mean age of 30.3). No significant differences were observed in the baseline characteristics between the two groups, including gender, age, site, associated symptoms, duration of symptoms and severity of hearing loss. Hearing recovery using Siegel's criteria on days 8 and 13 showed no significant differences between treatment groups. However, the hearing recovery on day 180 was significantly better in those who received the conventional treatment plus HBOT (P<0.05). Additionally, no significant side effects were observed in either group.

CONCLUSIONS

HBOT plus existing conventional treatment was associated with a better outcome than conventional treatment alone. We would recommend the addition of HBOT is recommended as a first-line treatment modality for all soldiers presenting with ISSNHL.

Utilizing glycine N-methyltransferasegene knockout mice as a model for identification of missing proteins in hepatocellular carcinoma

Glycine N-methyltransferase is a tumor suppressor gene for hepatocellular carcinoma, which can activate DNA methylation by inducing the S-adenosylmethionine to S-adenosylhomocystine. Previous studies have indicated that the expression of Glycine N-methyltransferase is inhibited in hepatocellular carcinoma. To confirm and identify missing proteins, the pathologic analysis of the tumor-bearing mice will provide critical histologic information. Such a mouse model is applied as a screening tool for hepatocellular carcinoma as well as a strategy for missing protein discovery. In this study we designed an analysis platform using the human proteome atlas to compare the possible missing proteins to human whole chromosomes. This will integrate the information from animal studies to establish an optimal technique in the missing protein biomarker discovery.

[The treatment options of pancreatic neuroendocrine neoplasm with liver metastasis]

Liver metastasis is the one of the main prognostic factors of pancreatic neuroendocrine neoplasm (PNEN). With the development of multidisciplinary collaboration among surgical oncology, medical oncology, and intervention treatment, the treatment of PNEN with liver metastasis gradually tends to become diversification. Surgery is still the only way for curing the patients with pancreatic neuroendocrine tumor with liver metastasis when the histological types are G1 and G2. Medical oncology and intervention treatment could be selected for those having PNEN with diffuse liver metastasis or those cannot tolerate surgery. Liver transplantation only suits for a small number of selected patients. The present article explored the relationship between histological classifications and the treatment options of PNEN with liver metastasis, and discussed the specific treatments from perspectives of surgical treatment, medical treatment and intervention treatment.

Proteomic Profiling of Neuroblastoma Cells Adhesion on Hyaluronic Acid-Based Surface for Neural Tissue Engineering

The microenvironment of neuron cells plays a crucial role in regulating neural development and regeneration. Hyaluronic acid (HA) biomaterial has been applied in a wide range of medical and biological fields and plays important roles in neural regeneration. PC12 cells have been reported to be capable of endogenous NGF synthesis and secretion. The purpose of this research was to assess the effect of HA biomaterial combining with PC12 cells conditioned media (PC12 CM) in neural regeneration. Using SH-SY5Y cells as an experimental model, we found that supporting with PC12 CM enhanced HA function in SH-SY5Y cell proliferation and adhesion. Through RP-nano-UPLC-ESI-MS/MS analyses, we identified increased expression of HSP60 and RanBP2 in SH-SY5Y cells grown on HA-modified surface with cotreatment of PC12 CM. Moreover, we also identified factors that were secreted from PC12 cells and may promote SH-SY5Y cell proliferation and adhesion. Here, we proposed a biomaterial surface enriched with neurotrophic factors for nerve regeneration application.

Influence of facets and heterojunctions in photoactive bismuth oxyiodide

An investigation into the influence of facets versus heterojunctions in the photoactivity of bismuth oxyiodide composites.

Screening for Oral Cavity Cancer: A 1-year Experience of a Regional Hospital in Taiwan

INTRODUCTION

The purpose of this study was to analyze the risk factors affecting precancerous lesions, and cancer of oral cavity, and to assess efficacy of visual screening for oral mucosal lesions.

METHODS

The medical records of patients older than 30 years of age with history of habitual cigarette smoking or betel quid chewing that received screening for oral mucosal lesions between January 2012 and December 2012 were retrospectively reviewed. The patients' age, gender, risk factors, screening findings, and histopathology results of biopsy were included for further analysis.

RESULTS

A total of 1341 patients were enrolled in this study. There were 1080 males and 261 females ranging from 30 to 96 years of age, with a mean age of 53.9±13.6 years. After screening, 226 (16.9%) were found to be positive of oral lesions. Among these 226 patients, 69 (30.5%) underwent biopsy under local anesthesia, and the histopathology showed malignancy in 13 (5.8%). All of the confirmed malignant cases were squamous cell carcinoma. Among them, 12 received further staging examination and one was lost to follow-up resulting in unknown stage. The early stage oral cavity cancer (stage I and II) accounted for 84.6% (11/13).

CONCLUSIONS

The detection rate of early stage oral cavity cancer in our study was reasonable. Therefore, visual screening for oral cavity cancer is recommended for patients with habitual cigarette smoking or betel quid chewing.

Barriers to tuberculosis care for drug users in two provinces of China: a qualitative study

SETTING

Two compulsory drug rehabilitation centres in Yunnan and Sichuan Provinces, Southwest China.

OBJECTIVE

To understand barriers to tuberculosis (TB) care among drug users in China, and to provide policy recommendations to improve TB control in the drug-using population.

DESIGN

A qualitative study was designed using in-depth interviews with 147 drug users with TB and 12 key informants. Drug users were purposively selected from two compulsory drug rehabilitation centres and key informants from national and provincial justice administration, local TB control dispensaries and compulsory drug rehabilitation centres.

RESULTS

Lack of health awareness and knowledge was reported as one barrier to TB care among drug users. The majority of the respondents lacked social support and perceived fear and stigma when seeking TB care. More than half of the respondents who had discontinued their anti-tuberculosis treatment reported that this was due to drug use. Limited provision of TB care in the compulsory drug rehabilitation centres and local TB control dispensaries was also reported as one of the barriers to TB care among drug users.

CONCLUSIONS

These findings suggest that barriers to TB care for drug users are associated not only with the drug users themselves, but also with the providers and societal factors. Health professionals and policy makers should be aware of these barriers in China.

Parotid abscess: a retrospective study of 14 cases at a regional hospital in Taiwan

PROBLEM/OBJECTIVE

Acute suppurative sialadenitis commonly affects the parotid gland. However, acute suppurative parotitis with abscess formation is less common and possibly complicated by deep neck space infection and sepsis. Our aim was to analyze the clinical features, radiological findings, treatment modalities, and microbiology of parotid abscesses treated at a regional hospital in Taiwan over a 15-year period.

METHODS

Records from patients diagnosed with acute suppurative parotitis or parotid abscesses between January 1998 and December 2012 were retrospectively reviewed. Parotid abscesses were confirmed by computed tomography (CT) examinations.

RESULTS

Fourteen patients (9 males; mean age+standard deviation, 49.6 +/- 14.4 [range, 22-75] years) with parotid abscesses were included. Painful swelling at the angle of the jaw was the most common symptom. All patients sustained unilateral parotid abscesses, with left-sided lesions in 10 patients, and right-sided ones in 4 patients. Radiographically, 13 of 14 abscess lesions were located in the superficial lobe, and 1 was in the deep lobe of the parotid gland. Besides sufficient fluid hydration, maintenance of good oral hygiene, and administration of parenteral antibiotics, all patients were treated with surgical incision and drainage. Klebsiella pneumoniae was the organism most commonly isolated from abscess cultures.

CONCLUSIONS

Parotid abscesses were found in about one fifth of patients with acute infectious parotid disease. Parenteral antibiotics plus surgical incision and drainage was the treatment of choice.

Ambient ionization mass spectrometry

Mass spectrometric ionization methods that operate under ambient conditions and require minimal or no sample pretreatment have attracted much attention in such fields as biomedicine, food safety, antiterrorism, pharmaceuticals, and environmental pollution. These technologies usually involve separate ionization and sample-introduction events, allowing independent control over each set of conditions. Ionization is typically performed under ambient conditions through use of existing electrospray ionization (ESI) or atmospheric pressure chemical ionization (APCI) techniques. Rapid analyses of gas, liquid, and solid samples are possible with the adoption of various sample-introduction methods. This review sorts different ambient ionization techniques into two main subcategories, primarily on the basis of the ionization processes, that are further differentiated in terms of the approach used for sampling.

Electrospray-assisted laser desorption/ionization mass spectrometry for direct ambient analysis of solids

A new method of electrospray-assisted laser desorption/ionization (ELDI) mass spectrometry, which combines laser desorption with post-ionization by electrospray, was applied to rapid analysis of solid materials under ambient conditions. Analytes were desorbed from solid metallic and insulating substrata using a pulsed nitrogen laser. Post-ionization produced high-quality mass spectra characteristic of electrospray, including protein multiple charging. For the first time, mass spectra of intact proteins were obtained using laser desorption without adding a matrix. Bovine cytochrome c and an illicit drug containing methaqualone were chosen in this study to demonstrate the applicability of ELDI to the analysis of proteins and synthetic organic compounds.

Interfaces to connect thin-layer chromatography with electrospray ionization mass spectrometry

This study has developed two interfaces to connect small-size thin-layer chromatography (TLC) with electrospray ionization mass spectrometry (ES-MS) for the continuous analysis of organic mixtures. The interfaces are (1) two bound optical fibers inserted into the C18-bonded particles at the exit of a small TLC channel and (2) a small commercial TLC strip with a sharpened tip. A reservoir continuously supplied a makeup solution to the tip of the TLC channel. The high voltage required for electrospray ionization was introduced into the makeup solution or mobile phase through a Pt wire, and electrospray was generated at the tip of the bonded optical fibers and at the sharp end of the TLC strip. Since small-size TLC channels were used, the elution time was short and less than 0.2 microL of the sample solution and 200 microL of the eluting solvent were required. Organic mixtures were separated successfully and detected on-line using the TLC/ES-MS techniques.

Pain perception and utility: a comparison of the syringe and computerized local injection techniques

Thirty patients received maxillary infiltration and mandibular inferior alveolar nerve block injections with both a traditional syringe and a computerized system, the Wand. Patients noted their preference for either system and rated their injection pain and postoperative discomfort on a ten-point scale for each type of injection. Mean injection discomfort ratings with the Wand were lower than with the syringe but were not statistically significant. Reduced postoperative discomfort using the Wand for the inferior alveolar nerve block was significant. Both of the dentists in the study and those patients who stated a preference favored the Wand system.

Near-UV, circular dichroism, and fluorescence spectra of a rigid rodlike helical polysilane bearing trietheral moiety in ethanol/water

An optically active, rigid rodlike helical polysilane with 6, 9, 12-trioxatetradecyl and (S)-2-methylbutyl substituents (1) was newly obtained as a very high molecular weight polymer of several million. Due to the presence of trietheral substituent, 1 was readily soluble in a polar solvent such as ethanol and a mixture of ethanol and water, but was insoluble in pure water. Polysilane 1 in pure ethanol at room temperature exhibited an intense and narrow ultraviolet (UV) and circular dichroism (CD) absorptions at 323 nm, associated with an almost mirror imaged fluorescence (FL) at 328 nm, that are characteristics of rigid rodlike, single-screw-sense helical polysilanes reported previously. When solution temperature was changed from 60 degrees C to -104 degrees C, a global shape of 1 expanded associated with an increase of segment length, whereas a screw pitch tended to be wound tightly. On the other hand, as a solvent polarity became poor, a global shape of 1 shrunk associated with an decrease of segment length and formed a chiral motif with an M-helicity between two helical segments with a kink. At a ratio of 50% of ethanol/water of 50:50 (v/v), 1 became insoluble and formed aggregates.

Generation of electrospray from a solution predeposited on optical fibers coiled with a platinum wire

This study examines the feasibility of generating electrospray directly from the tip of two optical fibers bound together with Teflon tape. This approach does not require a capillary and syringe pump. The electrospray source is simply constructed by coiling the two optical fibers with a platinum (Pt) wire. The optical fibers extend beyond the Pt coil for approximately 1 cm. The sample solution is predeposited on the Pt coil by a micropipette. As the high voltage required for electrospray is applied to the coil, the sample solution moves along the grooves between the two optical fibers. A stable electrospray is subsequently generated at the tip of the fibers. The mass spectra of insulin, lysozyme, and ubiquitin are exactly the same as those obtained by conventional electrospray using a capillary and syringe pump. Rapid determination of the active ingredient in a tablet by this technique is demonstrated.

The San Antonio Biethnic Children's Blood Pressure Study: auscultatory findings

INTRODUCTION

The purpose of this study were to: (a) examine for possible ethnicity-related and gender-related differences in blood pressure (BP) in Mexican American and non-Hispanic White schoolchildren; (b) compare auscultatory and oscillometric BP levels; and (c) establish auscultatory BP standards using the width of the BP cuff based on the circumference of the arm in schoolchildren in K-12.

METHODS

Participants were 6259 schoolchildren in kindergarten through 12th grade in the San Antonio, Texas, area. Auscultatory and oscillometric BP readings were obtained in random sequence, using BP cuff width 40% to 50% of the circumference of the upper arm. Averages of 3 readings were used for statistical analyses.

RESULTS

Auscultatory systolic pressures (SPs) in preadolescent Mexican American boys and girls were higher (1 to 3 mm Hg) auscultatory (SP) than in their White counterparts, but the difference was clinically not important. Diastolic pressures (DP) showed no important differences. Auscultatory SPs in 13- to 18-year-old boys of both ethnic groups were significantly (P < .05) higher (3 to 12 mm Hg) than they were for girls, with no ethnic differences. Oscillometric SP was higher than auscultatory SP in children of all ages studied. Oscillometric (DP) was slightly lower (0 to 5 mm Hg) than was auscultatory K4 and higher (4 to 5 mm Hg) than was auscultatory K5 DP.

DISCUSSION

No important ethnicity-related difference was found for auscultatory BP, but significant gender-related differences (boys greater than girls) were found in SP in subjects ages 13 to 18 years. Differences in BP readings by oscillometric and auscultatory methods do not allow interchange of readings. This study provides, for the first time, auscultatory BP standards using BP cuff width 40% to 50% of the arm circumference.

Rapid screening for diuretic doping agents in urine by C60-assisted laser-desorption-ionization-time-of-flight mass spectrometry

This study describes a matrix-assisted laser-desorption-ionization (MALDI) mass spectrometry for rapid screening of 12 diuretics in spiked urine. C60 is used as the matrix for MALDI. Diuretics are directly analyzed by C60-MALDI without previous derivatization. The fact that most diuretic molecules contain sulfate groups accounts for why anions of the molecules can be easily desorbed and ionized in MALDI. Using C60 as the matrix is advantageous because of the low background in the low mass range on the negative MALDI mass spectrum. A clear mass window between m/z 200 and 600 in negative ion mode is also obtained. Only a minimum amount of the sample (< 1 microL) is necessary to perform the analysis. The detection limit of diuretics is approximately 0.1-1 microg/mL.

Variability of the midfacial muscles: analysis of 50 hemifacial cadaver dissections

The region of the midface represents a challenging area to both reconstructive and aesthetic surgeons. An anatomic study was performed that attempted to identify patterns and variations of the muscular anatomy. The goals of this study were twofold: to identify patterns and variability of the midfacial muscles that might impact on reconstructive efforts and to attempt to correlate this anatomy with features of the overlying soft tissues, specifically the nasolabial crease. Fifty hemifacial cadaver dissections were performed. The information collected was assembled into a large data base, and statistical significance was analyzed using Fisher's exact probability test. Results demonstrated that, although a great degree of variability exists with respect to the midfacial muscles, seven distinct patterns of these muscles did emerge. The most common pattern was the presence of a levator alae nasi, levator labii superioris, and zygomaticus major, which occurred in 44 percent of specimens. Specimens that possessed a risorius, zygomaticus minor, or both, were relatively uncommon. The consistent presence of the levators suggests adding a superior vector to recreate a smile in facial reanimation surgery. Two important anatomic variations were noted. A bifid zygomaticus major was found to be present in 34 percent of individuals. Because the inferior bundle had a dermocutaneous insertion, this anomaly may represent the anatomic correlate of a cheek "dimple." A second anomaly noted was the lateral cheek crease, which appeared to be associated with a cutaneous attachment from the underlying platysma muscle. However, no correlation could be found for facial muscle pattern and the overlying nasolabial crease structure. This lack of correlation may indicate that the facial muscles alone do not dictate the structure of the nasolabial crease and that other dynamic factors are involved in determining this feature of the aging face.

Clinical comparison of two panoramic modalities and posterior bite-wing radiography in the detection of proximal dental caries

A clinical study was designed to examine whether the Philips OrthOralix SD (Gendex Dental Systems, Monza, Italy) orthogonal panoramic projection could improve diagnostic accuracy over standard projections in the detection of proximal surface caries. Thirty-five sets of radiographs that demonstrated optimal image characteristics were selected. Using a five-point scale, 18 viewers evaluated whether specified lesions were present or absent. Viewer data was then compared with a consensus radiographic assessment of the state of the proximal areas. Receiver operating characteristic curves were generated with the use of a maximum-likelihood method of fit. The area under the receiver operating characteristic curve was used as the index of diagnostic accuracy. The mean receiver operating characteristic areas for orthogonal and standard projection panoramic and bite-wing radiography to detect the presence of proximal dental caries were 0.68 +/- 0.03, 0.69 +/- 0.03, and 0.79 +/- 0.03 respectively. Critical ratio analysis was used to compare the means for all possible pairings of imaging modalities. In overall performance, conventional bite-wing radiographs gave a significantly greater diagnostic yield for proximal caries than the Philips OrthOralix SD orthogonal or standard panoramic modalities (p > 0.05). The orthogonal projection did not improve diagnostic accuracy in the detection of proximal carious lesions compared with the standard projection.

The relationship between probing attachment loss and computerized radiographic analysis in monitoring progression of periodontitis

This study attempted to evaluate quantitative changes in radiographic density as an indicator of progression of periodontitis. Twenty-one subjects with a history of periodontitis were monitored at baseline, 3, 6, and 9 months using duplicate probing attachment level (PAL) measurements from stents and computer assisted densitometric image analysis (CADIA) of standardized radiographs. Results indicate that the majority of sites exhibited no PAL change during the 9-month period; however, the percentage of sites with loss increased with time. A mean of 6.1% of the sites/patient exhibited probing attachment loss during the study, as compared to a mean of 38.3% of the sites/patient that exhibited a loss of radiographic density. Due to the two dimensional nature of radiographs, density analysis was calculated in terms of radiographic "complexes" of multiple probing sites. There was significantly more density loss at complexes with greater than or equal to 2 mm of attachment loss than at sites with no change in PAL at 9 months; there was no such difference noted at 3 and 6 months. Also, density loss tended to increase as more sites within each complex experienced PAL. Although there was a significant correlation between mean density and PAL changes during the same time interval, there were wide variations at individual sites. This study suggests that there is a complex relationship between density change on radiographs and PAL change. The difficulties inherent in comparing highly sensitive new technologies to relatively imprecise clinical measurements of the attachment level are discussed.(ABSTRACT TRUNCATED AT 250 WORDS)