[Research progress in the diagnosis and management of proliferative verrucous leukoplakia]

Proliferative verrucous leukoplakia (PVL) is one of the oral potentially malignant disorders (OPMD) with the highest malignant potential. PVL tends to be easily misdiagnosed owing to the resemblance in clinical manifestations between PVL and other diseases such as oral leukoplakia or oral lichen planus. PVL is considered as a special type of oral leukoplakia by some scholars, which is characterized by its tendency of recurrence and metastasis, along with its high risk of malignant transformation. So far, the accurate clinic diagnosis and management of PVL are still intractable due to the lack of definite histopathological definition, unified diagnostic criteria and effective treatment modalities. This review aims to provide the clinical practitioners with a series of advices on the clinical diagnosis and management of PVL by systematically reviewing the diagnostic logistics, therapeutic strategies, malignant transformation detection based on tremendous relevant data and evidence-based medicine.

[Clinical study on the effects of neoadjuvant chemotherapy on lymph node ratio, prognosis, and survival analysis of stage ⅢA-N2 non-small cell lung cancer]

Objective: To investigate the effect of neoadjuvant chemotherapy (NCT) on the lymph node ratio (LNR) of patients with stage ⅢA-N2 non-small cell lung cancer (NSCLC), and analyze the relationship between LNR and prognosis. Methods: The data of 128 patients with stage ⅢA-N2 NSCLC admitted to the Department of Cardiothoracic Surgery of the First Affiliated Hospital of Hebei North University from January 2013 to December 2018 were retrospectively collected. The patients were divided into two groups according to the treatment method. The patients in the observation group (64 cases) were treated with NCT and surgery, and the patients in the control group (64 cases) were treated with surgery. Lymph node metastasis and survival were observed in the two groups. Subgroups were divided according to LNR and N2 lymph node status, and survival analysis was performed for each subgroup. Univariate and multivariate analysis were conducted for the observation group. Results: The number of metastatic lymph nodes, the proportion of patients with positive lymph nodes, and the rate of lymph node metastasis in the observation group were lower than those in the control group,3.8±2.1 vs 4.9±2.4,92.2% vs 100%,19.1% vs 22.4% respectively (all P<0.05). Progression-free survival (PFS) and overall survival (OS) in the observation group were better than those in the control group (both P<0.05). Both the observation and control subgroups with low LNR had better PFS and OS than the subgroups with high LNR (both P<0.05). Patients in the observation group with non-multi-site N2 lymph node metastasis had better PFS and OS (both P<0.05). Univariate analysis of observation group showed that patients with low LNR had better 2-year PFS and OS(both P<0.05). Multivariate analysis showed that the higher the LNR, the greater the risk of death (HR=2.178,95%CI: 1.025-4.626,P=0.043) and progression (HR=2.130,95%CI: 1.123-4.038,P=0.021). Conclusion: NTC could improve the prognosis and reduce LNR of patients with stage ⅢA-N2 NSCLC, and LNR was expected to be a prognostic indicator.

[Clinical study of cell sheets containing allogeneic keratinocytes and fibroblasts for the treatment of partial-thickness burn wounds]

Objective: To evaluate the efficacy and safety of cell sheets containing allogeneic keratinocytes and fibroblasts in the treatment of partial-thickness burn wounds. Methods: The cell sheets containing allogeneic keratinocytes and fibroblasts were constructed using polyurethane biofilm as carrier. Then gross observation and histological observation were conducted. From April 2016 to December 2017, Changhai Hospital of Naval Medical University recruited patients with acute partial-thickness burn wounds that met the inclusion criteria for this prospective and positively self-controlled clinical trial. Recruitment of 40 acute partial-thickness burn wounds were planned with each selected single wound being not smaller than 10 cm×10 cm and not more than 5% total body surface area (TBSA). Each wound was equally divided into two areas, which were recruited into cell sheet group and conventional treatment group according to the random number table. The wounds in cell sheet group were covered by cell sheet and then sterile gauze as secondary dressings. Depending on the wound healing and exudation, the sterile gauze was replaced every 1 to 3 day (s) after the treatment was started, and the cell sheet was replaced every 7 days (namely dressing changing). The wounds in conventional treatment group were covered by sulfadiazine silver cream gauze and then dressed with sterile gauze, with the dressings changed every 2 to 3 days depending on wound exudation. On treatment day 5, 7, 10, and 14, the wound healing rates in the two groups were calculated. The complete wound healing time, the total number of dressing changes, and the status of wound infection during treatment were recorded. The Visual Analogue Scale was used to score the pain at the first dressing change. Scar formation of patients was followed up for 6 to 12 months after injury. Safety indicators including vital signs, laboratory examination indexes, and adverse reactions during treatment were observed. Data were statistically analysed with Wilcoxon rank sum test and Bonferroni correction. Results: (1) Each prepared cell sheet had a diameter of about 8 cm and was about 49 cm(2) in size, containing 2 or 3 layers of keratinocytes and fibroblasts. (2) A total of 43 patients were enrolled, of whom 3 patients dropped out of the study. Of the 40 patients who completed the treatment, there were 22 males and 18 females who were aged 1 to 57 year (s), with total burn area of 2% to 26% TBSA. (3) On treatment day 5, 7, 10, and 14, the wound healing rates in cell sheet group were significantly higher than those in conventional treatment group (Z=4.205, 4.258, 3.495, 2.521, P<0.05 or P<0.01). The complete wound healing time in cell sheet group was 7 (6, 8) days, which was significantly shorter than 11 (7, 14) days in conventional treatment group (Z=4.219, P<0.01). The total number of wound dressing changes in cell sheet group was 1 (1, 2) times, which was significantly less than 6 (4, 7) times in conventional treatment group (Z=5.464, P<0.01). (4) The wounds in cell sheet group in 31 patients healed before the first dressing change. The pain score of wounds in the first dressing change in cell sheet group of 9 patients was 1 (0, 1) point, while the pain score of wounds in the first dressing change in conventional treatment group of 40 patients was 2 (1, 3) points. There was no obvious infection in the wounds in both groups of 40 patients before the wound healing. Nine patients completed the follow-up after the trial. In 6 patients, no scar formation was observed in cell sheet group or conventional treatment group. The color of wounds in cell sheet group was consistent with normal skin, and there was only a small amount of pigment deposition in the wounds of conventional treatment group. Three patients developed pigment deposition only in the wounds of cell sheet group but obvious scars in conventional treatment group. (5) The abnormal fluctuations of vital signs including body temperature, blood pressure, heart rate, respiratory rate, and laboratory examination indexes of all patients during treatment were alleviated through the process of burn wound healing. No obvious adverse reactions or abnormalities related to the treatment were observed. Conclusions: The cell sheet containing allogeneic keratinocytes and fibroblasts can reduce the number of dressing changes, accelerate wound epithelialization, shorten wound healing time, reduce pain during dressing change in the treatment of partial-thickness burn wounds, and it may reduce scar hyperplasia after wound healing because of accelerating wound epithelization. Its clinical application is simple, safe, and effective.

Magnetic Weyl semimetal phase in a Kagomé crystal

Weyl semimetals are crystalline solids that host emergent relativistic Weyl fermions and have characteristic surface Fermi-arcs in their electronic structure. Weyl semimetals with broken time reversal symmetry are difficult to identify unambiguously. In this work, using angle-resolved photoemission spectroscopy, we visualized the electronic structure of the ferromagnetic crystal Co₃Sn₂S₂ and discovered its characteristic surface Fermi-arcs and linear bulk band dispersions across the Weyl points. These results establish Co₃Sn₂S₂ as a magnetic Weyl semimetal that may serve as a platform for realizing phenomena such as chiral magnetic effects, unusually large anomalous Hall effect and quantum anomalous Hall effect.

Synergism between RIZ1 gene therapy and paclitaxel in SiHa cervical cancer cells

RIZ1 is a tumor suppressor gene. The purpose of the present study was to investigate the inhibitory effect of RIZ1 gene therapy on the growth of SiHa cervical cancer cells and its synergism with paclitaxel. The expression levels of RIZ1 were examined by real-time PCR and western blotting before and after transfection of RIZ1. The effects of paclitaxel or pcDNA3.1(+)-RIZ1 alone or in combination, on the proliferation of SiHa cells were evaluated by MTT method. The inhibitory effect on the proliferation of SiHa cells was more significant in the pcDNA3.1(+)-RIZ1 combined with paclitaxel group than in the pcDNA3.1(+)-RIZ1 or paclitaxel groups (P<0.05). The expression level of RIZ1 in SiHa cells increased after treatment with paclitaxel, which indicated a synergism between them. RIZ1 gene therapy combined with paclitaxel showed stronger cell inhibition than paclitaxel alone, which indicated a synergism between them.

[Incidence and influencing factors of term small for gestational age infants in China]

OBJECTIVE

To investigate the incidence and influencing factors of term small for gestational age infants (SGA ) in China.

METHODS

This study is a multicenter study. Data were collected from Chinese Neonatal Network with term infants, born from May 1st 2010 to February 28th 2014, from 83 nationwide hospitals.

RESULTS

A total of 170 565 neonates were recorded from 83 nationwide hospitals; 144 659 cases were term newborn, and 3 543 neonates were found to be term SGA. The incidence of term SGA was 2.45%. In term SGA, the girl's incidence (2.88%, 1 985/69 003) was higher than boy (2.05%, 1 531/74 707), P<0.001. Furthermore, the incidence of in vitro fertilization (IVF) and artificial fertilization of term SGA was 9.12% (66/724), which was higher than the natural conception (2.42%, 3 465/143 283), P<0.001. The incidence of term SGA in multiple births (30.37%, 741/2 440) was higher than that of single birth (1.97%, 2 787/141 366), P<0.001. The incidence of SGA with maternal age <18 years old was 4.86% (27/556) and was 3.20% (307/9 592) with maternal age > 35 years old, meanwhile both were higher than that with maternal age as 18-35 years old (2.39%, 3 197/133 662). The incidence of SGA with maternal occupation as farmers was 4.67% (854/18 284), which was significantly higher than other professions. The incidence of SGA with maternal education as illiterate and elementary education was 8.65% (187/2 162), 5.17% (397/7 678), respectively, both were significantly higher than those with mother graduated from university (1.72%, 853/49 692). Moreover, the geographical distribution of the main residence of the term SGA mothers showed Northeast Area (1.54%, 30/1 946)and East Area (2.21%, 1 267/57 334) had lower incidence of term SGA than those of Central South Area (2.71%, 493/18 223) and Southwest Area (3.67%, 876/23 852).

CONCLUSIONS

The incidence of term SGA was 2.45% in this study, which was influenced significantly by gender, IVF, multiple births, maternal factors (age, maternal occupation, level of education) and geographical distribution. This multicenter study with large data, to a certain extent, reflected status of the incidence and influencing factors of term SGA in China, which will help prevent and treat term SGA.

[Incidence and influencing factors of term small for gestational age infants in China]

OBJECTIVE

To investigate the incidence and influencing factors of term small for gestational age infants (SGA ) in China.

METHODS

This study is a multicenter study. Data were collected from Chinese Neonatal Network with term infants, born from May 1st 2010 to February 28th 2014, from 83 nationwide hospitals.

RESULTS

A total of 170 565 neonates were recorded from 83 nationwide hospitals; 144 659 cases were term newborn, and 3 543 neonates were found to be term SGA. The incidence of term SGA was 2.45%. In term SGA, the girl's incidence (2.88%, 1 985/69 003) was higher than boy (2.05%, 1 531/74 707), P<0.001. Furthermore, the incidence of in vitro fertilization (IVF) and artificial fertilization of term SGA was 9.12% (66/724), which was higher than the natural conception (2.42%, 3 465/143 283), P<0.001. The incidence of term SGA in multiple births (30.37%, 741/2 440) was higher than that of single birth (1.97%, 2 787/141 366), P<0.001. The incidence of SGA with maternal age <18 years old was 4.86% (27/556) and was 3.20% (307/9 592) with maternal age > 35 years old, meanwhile both were higher than that with maternal age as 18-35 years old (2.39%, 3 197/133 662). The incidence of SGA with maternal occupation as farmers was 4.67% (854/18 284), which was significantly higher than other professions. The incidence of SGA with maternal education as illiterate and elementary education was 8.65% (187/2 162), 5.17% (397/7 678), respectively, both were significantly higher than those with mother graduated from university (1.72%, 853/49 692). Moreover, the geographical distribution of the main residence of the term SGA mothers showed Northeast Area (1.54%, 30/1 946)and East Area (2.21%, 1 267/57 334) had lower incidence of term SGA than those of Central South Area (2.71%, 493/18 223) and Southwest Area (3.67%, 876/23 852).

CONCLUSIONS

The incidence of term SGA was 2.45% in this study, which was influenced significantly by gender, IVF, multiple births, maternal factors (age, maternal occupation, level of education) and geographical distribution. This multicenter study with large data, to a certain extent, reflected status of the incidence and influencing factors of term SGA in China, which will help prevent and treat term SGA.

Identifying differentially expressed genes and pathways in two types of non-small cell lung cancer: adenocarcinoma and squamous cell carcinoma

Non-small cell lung carcinoma, NSCLC, accounts for 80-85% of lung cancers. NSCLC can be mainly divided into two types: adenocarcinoma (ADC) and squamous cell carcinoma (SCC). The purpose of our study was to identify and differentiate the pathogenesis of ADC and SCC at the molecular level. The gene expression profiles of ADC and SCC were downloaded from Gene Expression Omnibus under accession No. GSE10245. Accordingly, differentially expressed genes (DEGs) were identified by the limma package in R language. In addition, DEGs were functionally analyzed by Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment. A total of 4124 DEGs were identified, including CDK1, CDK2, CDK4, and SKP2. The DEGs were mainly involved in 16 pathways related to cell proliferation, cell signal transduction and metabolism. We conclude that the molecular mechanisms of ADC and SCC are considerably different, and that they are involved in immune response, cell signal transduction, metabolism, cell division, and cell proliferation. Therefore, the two diseases should be treated differently. This study offers new insight into the diagnosis and therapy of these two types of lung cancer.

Immunomodulation of inducible co-stimulator (ICOS) in human cytokine-induced killer cells against cholangiocarcinoma through ICOS/ICOS ligand interaction

OBJECTIVE

To evaluate the immunomodulation of inducible co-stimulator (ICOS) in cytokine-induced killer (CIK) cells against cholangiocarcinoma.

METHODS

CIK cells were generated from normal peripheral blood mononuclear cells. Methyl thiazolyl tetrazolium assay was performed to assess proliferation of CIK-ICOS and controlled CIK cells; ELISA was used to analyze the expression of cytokines. Reverse transcription-polymerase chain reaction and immunohistochemistry were performed to evaluate the expression of ICOS ligand (ICOSL) in CIK cells and human cholangiocarcinoma cell line QBC939 cells. The cytotoxicity of CIK cells was determined either by lactate dehydrogenase-releasing assay in vivo or alteration of tumor size prior to and after the treatment of CIK cells in vivo.

RESULTS

CIK-ICOS cells proliferated more and expressed higher secretion a level of interferon-γ than the controlled CIK. These cells exhibited higher cytotoxicity against cholangiocarcinoma cell lines at all efficacy: toxicity (E:T) ratios tested than the controlled CIK cells. More importantly, the anti-ICOSL antibody was able to attenuate the elevated cytotoxicity mediated by ICOS overexpression. When injected into cholangiocarcinoma xenografts in severe combined immunodeficiency mice, CIK-ICOS cells survived better than the controlled CIK cells around xenografts and significantly reduced the growth rate of cholangiocarcinoma, with least volume increase and more severe necrosis of the xenografts than controlled mice treated with saline, CIK or CIK-enhanced green fluorescent protein.

CONCLUSION

ICOS can enhance the cytotoxic effect of CIK cells against cholangiocarcinoma both in vitro and in vivo. This effect is mediated by ICOS-augmented cytokine secretion and cell proliferation, and in part through ICOS-ICOSL interaction.

A prospective study of the efficacy of endoscopic biliary stenting on common bile duct stones

OBJECTIVE

To investigate the efficacy of endoscopic biliary stenting on common bile duct stones.

METHODS

Fifty patients with choledocholithiasis were treated with endoscopic biliary stenting and followed. The early and late outcome was assessed.

RESULTS

The procedure was successful in all patients and there was only one patient with mild pancreatitis. The patency rates of stent at 6 months, 12 months and 24 months after biliary stenting were 94%, 79% and 58%, respectively. The rate of reduction in size of stone was 60%.

CONCLUSION

Endoscopic biliary stenting was not a definitive treatment of choledocholithiasis. It may be an option for patients clinically unfit for definitive treatment.

Laparoscopic treatment of choledocholithiasis with novel self-releasing biliary stent

OBJECTIVES

The aim of this study was to evaluate the effect of a self-releasing biliary stent antegradely placed during laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis.

MATERIALS AND METHODS

The soft biliary stent, made of polyurethane, was designed as a J-umbrella form with a pigtailed duodenal part and an umbrella-like biliary anchoring part shaped with the rapidly absorbable suture. After the clearance of stones during LCBDE, a guide wire was inserted into the duodenum through the choledochoscope. The stent was advanced over the guide wire until the pigtail of the stent entered the duodenum. The choledochotomy was primarily closed.

RESULTS

This technique has been performed on 33 patients with choledocholithiasis. The median length of postoperative hospital stay was 4.3 (3-8) days. All the stents were eliminated from the bile ducts and discharged out of the body. The median time of the stent stay in the body was 13.6 (+/- 2.55) days. Transient hyperamylasemia occurred in 4 of the 33 (12.1%) patients, and stent occlusion occurred in 1 patient who recovered soon after treatment. No bile leak, biliary infection, or stent dislocation was observed. During the follow-up of 12 months, no biliary infection, residual calculi, or stricture occurred.

CONCLUSION

This novel self-releasing stent is safe and effective in the laparoscopic treatment of choledocholithiasis, and the subsequent removal of the stent can be avoided.

[Higher lint percent and drought tolerant cotton line selected by radiation breeding]

The Gossypium hirsutum cv. Liaomian No. 9 were mutagenized by 60Co gamma ray, from which the mutant line Zhonghuzhi PI 935 (be called "PI 935" for short) was bred by family selection method. The PI 935 not only has some good traits (growing period, drought tolerance, lint color and fiber quality) similar to the original cultivar, but also has higher lint outturn and lint yield than that of the Liaomian No. 9. The PI 935 has been identified and regional tested in nine places times for four years in the southern Xinjiang Weiwuer autonomous region. It was shown that the PI 935 had the higher lint outtrn for the average 47.3% was ten-point percentage more than that of the check cultivars (Junmian No. 1 or Xinluzhong No. 5), the similar lint yield by and large and the growing period by five days later than that of the checks. The PI 935 was collected in the National Bank of Crop Germplasm (unified No. ZM 114274 and named "Zhonghuzhi PI 935").

Analysis and compensation of the measurement error in a lock-in amplifier used for wavelength shift measurements in optical sensing application

The phase measurement error in an interferometric wavelength shift measurement scheme, such as that used in association with in-fiber Bragg grating sensors, has been investigated experimentally with appropriate underpinning analytical theory. It has been shown that when a lock-in amplifier is used to detect the phase shift generated by the Bragg wavelength shift, a pseudoperiodical measurement error can be introduced owing to the difference between the amplitude of the optical path difference ramp and the value of the Bragg wavelength. If the initial ramp deviation equals 20 nm, the measurement error may be as large as +/-2.5% of the total measurement range. With a double-phase lock-in amplifier approach to measure the ac strain, the measurement error can be decreased to 0.4% of the total measurement range. With the real-time measured period that corresponds to the Bragg wavelength with the distorted carrier signal of the interferometer as the reference period of a digital lock-in amplifier, the effect of the initial ramp deviation can be principally avoided, and the measurement error can be kept to an acceptably low level, about 0.1% of the total measurement range.

Phase II study of hepatic arterial floxuridine, leucovorin, and dexamethasone for unresectable liver metastases from colorectal carcinoma

PURPOSE

To determine the toxicity, response rate, and survival of a regimen of hepatic arterial floxuridine (FUDR) with leucovorin (LV) and dexamethasone (Dec) for the treatment of unresectable hepatic metastases from colorectal carcinoma.

PATIENTS AND METHODS

Sixty-two patients with hepatic metastases (33 previously untreated with chemotherapy) were treated with FUDR (0.30 mg/kg/d) and LV (15 mg/m2/d) and Dec (20 mg total dose) as a 14-day hepatic arterial infusion via an implantable pump alternating with 2 weeks of saline.

RESULTS

The complete response (CR) plus partial response (PR) rate was 78% in previously untreated patients, with a median survival duration of 24.8 months; 1- and 2-year survival rates were 91% and 57%, respectively. In the previously treated group, the response rate was 52%, with a median survival duration of 13.5 months. Only 3% of patients (two of 62) developed biliary sclerosis; this was significantly lower than the 21% biliary sclerosis rate observed in our previous trial of hepatic arterial FUDR and LV without Dec (P = .002).

CONCLUSION

The addition of Dec to hepatic arterial FUDR and LV reduces biliary toxicity while maintaining an excellent response rate and survival. We recommend that this treatment be studied further.

Rhodotorula septicemia: report of a case

With the increased use of central venous catheters in cancer patients, there has been an increase in the recovery of environmental and skin organisms from blood cultures. A red yeast, Rhodotorula, an infrequent cause of infection in humans, was isolated from a patient with acute myeloblastic leukemia undergoing bone marrow transplant while he received parenteral nutritional fluids by an indwelling catheter. The patient was clinically ill, as manifested by fever and chills. The patient was treated with amphotericin B and the catheter was removed. He survived the fungemic episode with no recurrence of fungal infection.

New concepts in severe presacral hemorrhage during proctectomy

In the past, surgeons thought that severe presacral hemorrhage during proctectomy was caused by damage of the presacral venous plexus. By studying the anatomy and clinical data, we found that injury of the sacral basivertebral vein also caused this serious complication. Presacral hemorrhage is seen as massive bleeding from the distal pelvic surface of sacrum or from one to several large-caliber foramina of sacral basivertebral veins in that area. This type of presacral hemorrhage is more dangerous than that from simple injury of presacral venous plexus and sometimes it is fatal. We describe the anatomic features of the vertebral venous system and its close relationship with severe presacral hemorrhage. We also propose some new concepts about cause, hemostatic measures, and principles of prevention.