[The efficiency of total endoscopic surgery with preferential incision of the tendon sheath and traditional open surgery for the treatment of peroneal tendondislocation]

Objective: To compare the outcomes between the patients of peroneal tendon dislocation treated by either total endoscopic surgery with preferential incision of the tendon sheath or traditional open surgery. Methods: This is a retrospective cohort study. The clinical data of 45 patients with peroneal tendon dislocation were operated on Department of Sports Medicine and Joint Surgery, Nanjing First Hospital from July 2016 to June 2020. There were 26 males and 19 females,aged (31.2±9.3) years (range: 17 to 45 years). Among them,23 patients underwent open peroneal tendon groove deepening followed by tendon sheath repair(traditional open group), and the other 22 patients underwent similar operations but all-endoscopically with preferential incision of peroneal tendon sheath(total endoscopic group). The perioperative data of patients were collected, and pain visual analogue score (VAS) was used to evaluate the pain changes before and after surgery and during the follow-up period, and the American Orthopaedic Foot and Ankle Society anklehindfoot scale (AOFAS-AH), range of motion (ROM), the MOS item short form health survey (SF)-36, and the homemade questionnaire of patient satisfaction were used to evaluate the patients' outcomes after the operation, and CT scan was carried out to observe the deepening of the fibular groove and MRI to observe the status of the peroneal tendon and sheath during the follow-up. Independent sample t test, Wilcoxon rank sum test and repeated measure ANOVA were used for comparison of quantitative data between groups. Chi-square test,Mann-whitney U or Fisher exact test was used for comparison of classified data, respectively;and paired sample t test was used for comparison of quantitative data before and after surgery in groups. Results: There was no statistically significant difference between the two groups of patients in terms of gender, age, disease duration, side of injury, and injury typing (all P>0.05). There was no significant difference between the two groups in terms of operation time((47.9±5.4)minutes vs. (47.2±6.3)minutes;t=0.402, P=0.690), but the incision length ((2.17±0.35)cm vs. 5.97±0.42)cm;t=32.892,P<0.01)and hospitalization time ((4.0±1.7)days vs. (7.6±3.6)days;t=4.249,P<0.01) were significantly shorter in the total endoscopic group than those in the traditional open group. All patients were followed up for more than 12 months, and the follow-up time was (19.2±3.9) months (range: 12 to 24 months). The total endoscopic group showed a significant increase in VAS, AOFAS scores, SF-36 scores and patient satisfaction rate at 3 months postoperatively and the last follow-up (all P<0.05). Three months after surgery, the ROM in the total endoscope group was higher than that in the traditional group ((62.14±1.46) ° vs. (53.13±1.52) °;t=20.315, P<0.01), and there was no significant difference between the two groups at the last follow-up ((63.18±1.10) ° vs. (63.48±2.43) °;t=0.531, P=0.599). Conclusion: Total endoscopic surgery with preferential incision of the tendon sheath has the advantages of minimally invasivenessas compared with traditional open surgery with faster recovery and better outcome.

[Minimally invasive intelligent innovative technologies in foot and ankle surgery: development status and prospects]

The rapid development of technology has ushered in a new era of minimally invasive and intelligent surgery.Minimally invasive surgeries, such as small incision, percutaneous surgery, arthroscopic surgery, and endoscopic surgery, have contributed to less invasive surgical trauma, better cosmesis, and faster recovery. Furthermore, the recent adoption of artificial intelligence (AI) has introduced new assistances and tools for minimally invasive foot and ankle surgery. By the help of advanced AI algorithms, surgeons can accurately make diagnose and personalized treatment strategies. The application of computer-assisted navigation systems and robotics has facilitated precise surgical procedures and real-time confirmation of surgical outcomes. Foot and ankle surgery has lagged behind other surgical specialties in adopting these advancements. Currently, the integration of various forms of minimally invasive surgery and AI technology stands as the main trend in the development of foot and ankle surgery. It is believed that in the near future, intelligent minimally invasive surgery will become the mainstream in the domain of foot and ankle.

[Treatment of patent ductus arteriosus in very preterm infants in China]

Objective: To describe the current status and trends in the treatment of patent ductus arteriosus (PDA) among very preterm infants (VPI) admitted to the neonatal intensive care units (NICU) of the Chinese Neonatal Network (CHNN) from 2019 to 2021, and to compare the differences in PDA treatment among these units. Methods: This was a cross-sectional study based on the CHNN VPI cohort, all of 22 525 VPI (gestational age<32 weeks) admitted to 79 tertiary NICU within 3 days of age from 2019 to 2021 were included. The overall PDA treatment rates were calculated, as well as the rates of infants with different gestational ages (≤26, 27-28, 29-31 weeks), and pharmacological and surgical treatments were described. PDA was defined as those diagnosed by echocardiography during hospitalization. The PDA treatment rate was defined as the number of VPI who had received medication treatment and (or) surgical ligation of PDA divided by the number of all VPI. Logistic regression was used to investigate the changes in PDA treatment rates over the 3 years and the differences between gestational age groups. A multivariate Logistic regression model was constructed to compute the standardized ratio (SR) of PDA treatment across different units, to compare the rates after adjusting for population characteristics. Results: A total of 22 525 VPI were included in the study, with a gestational age of 30.0 (28.6, 31.0) weeks and birth weight of 1 310 (1 100, 1 540) g; 56.0% (12 615) of them were male. PDA was diagnosed by echocardiography in 49.7% (11 186/22 525) of all VPI, and the overall PDA treatment rate was 16.8% (3 795/22 525). Of 3 762 VPI who received medication treatment, the main first-line medication used was ibuprofen (93.4% (3 515/3 762)) and the postnatal day of first medication treatment was 6 (4, 10) days of age; 59.3% (2 231/3 762) of the VPI had been weaned from invasive respiratory support during the first medication treatment, and 82.2% (3 092/3 762) of the infants received only one course of medication treatment. A total of 143 VPI underwent surgery, which was conducted on 32 (22, 46) days of age. Over the 3 years from 2019 to 2021, there was no significant change in the PDA treatment rate in these VPI (P=0.650). The PDA treatment rate decreased with increasing gestational age (P<0.001). The PDA treatment rates for VPI with gestational age ≤26, 27-28, and 29-31 weeks were 39.6% (688/1 737), 25.9% (1 319/5 098), and 11.4% (1 788/15 690), respectively. There were 61 units having a total number of VPI≥100 cases, and their rates of PDA treatment were 0 (0/116)-47.4% (376/793). After adjusting for population characteristics, the range of standardized ratios for PDA treatment in the 61 units was 0 (95%CI 0-0.3) to 3.4 (95%CI 3.1-3.8). Conclusions: From 2019 to 2021, compared to the peers in developed countries, VPI in CHNN NICU had a different PDA treatment rate; specifically, the VPI with small birth gestational age had a lower treatment rate, while the VPI with large birth gestational age had a higher rate. There are significant differences in PDA treatment rates among different units.

Evaluating the Effects of Bone Marrow Sparing Radiotherapy on Acute Hematologic Toxicity for Patients with Locoregionally Advanced Cervical Cancer: A Prospective Phase II Randomized Controlled Trial

PURPOSE/OBJECTIVE(S)

Bone marrow sparing intensity modulated radiotherapy (BMS-IMRT) can reduce the incidence of acute hematologic toxicity (HT) for locoregionally advanced cervical cancer (LACC) patients receiving concurrent chemoradiotherapy (CCRT), but the norm has been controversial. The purpose of the study was to evaluate the effects of bone marrow (BM) V40 <25% on decreasing the incidence of acute HT in a prospective clinical trial.

MATERIALS/METHODS

A total of 242 LACC patients were recruited from May 2021 to May 2022, who were evenly randomized into BMS-IMRT group and standard IMRT group according to a computer-generated random number list. All patients received pelvic irradiation with concurrent cisplatin (40 mg/m2 weekly), followed by brachytherapy. For patients in BMS-IMRT group, the outer contour of pelvic bone, lumbar spine and left and right femur heads were additionally delineated as a surrogate for BM, and V40 <25% was prescribed. Blood counts were tested weekly, of which nadirs during external beam radiotherapy (EBRT) were graded to assess acute HT as primary observation index. Second observation index were dosimetric parameters of EBRT plan from the dose volume histograms (DVHs). Binary logistic regression model and receiver operating characteristic (ROC) curve were used for predictive value analysis.

RESULTS

Baseline demographic, disease and treatment characteristics were all balanced between BMS-IMRT group and standard IMRT group. BMS-IMRT was associated with a lower incidence of grade ≥2 and grade ≥3 acute HT, leukopenia and neutropenia (72.70% vs 90.90%, P <0.001*; 16.50% vs 65.30%, P <0.001*; 66.10% vs 85.10%, P = 0.001*; 13.20% vs 54.50%, P <0.001*; 37.20% vs 66.10%, P <0.001*; 10.70% vs 43.80%, P <0.001*). Plan target volume (PTV) for all patients satisfied the clinical requirement of V(100%) ≥95%, and conformity and homogeneity were both comparable between 2 groups. BMS also decreased dose delivered to the organs at risk (OARs) including rectum, bladder and left and right femur head. Univariate and multivariate analyses showed that BM V40 was an independent risk factor for grade ≥3 acute HT (odds ratio [OR] = 2.734, 95% confidence interval [CI] = 1.959-3.815, P <0.001*). Cutoff value was 25.036% and area under the curve (AUC) was 0.786. The nomogram was constructed, which was rigorously evaluated and internally cross-validated, showing good predictive performance.

CONCLUSION

BM V40 <25% can reduce the risks of acute HT for LACC patients receiving CCRT while the dose delivery of target volume and other normal tissues were not compromised. With great practicality and applicability, BM V40 <25% is a promising strategy, making BMS-IMRT widespread especially in the area where application of image guided radiotherapy (IGRT) such as 18F-fluorodeoxyglucose positron emission tomography (18FDG-PET)/CT is not popularized. Chinese clinical trial registry (ChiCTR2200066485).

A Comparison of Two Plan Optimization Methods in Three-Dimensional Brachytherapy for Cervical Cancer

PURPOSE/OBJECTIVE(S)

To compare dose distributions created by using two Inverse Planning Simulated Annealing (IPSA) and Hybrid Inverse Planning Optimization (HIPO) in three-dimensional (with CT image guidance) brachytherapy planning for cervical cancer.

MATERIALS/METHODS

Brachytherapy plans for thirty patients with cervical cancer were created using the IPSA and HIPO algorithms (The IPSA algorithm is calculated based on the anatomical structure, and the simulated annealing algorithm is used to optimize the residence time, and the HIPO algorithm is the optimization and replacement for the IPSA). To obtain a HIPO plan, a manually optimized post-loading treatment plan was applied to these 30 patients, and then the treatment plan was reoptimized using the HIPO algorithm based on the original image information. Individual patients will consider interpolation therapy according to the needs of their condition. The types of plans were compared based on a variety of dose volume parameters, including the mean dose covering 90% of high-risk clinical target volume (D90 for HR-CTV), the mean dose to 2 cm3 volume (D2cc) for bladder, rectum, intestine and sigmoid, and average treatment time were compared and analyzed.

RESULTS

Compared with the two groups of plans, mean value of HR-CTV D90 for the HIPO plans was (585 cGy), which was significantly higher than that for the IPSA plans (567 cGy. This difference is statistically significant (P<0.05). The HIPO plans had mean D2cc 422±47 cGy for bladder, 403±38 cGy for rectum, which were lower than those from the SA plans, i.e., 446±42 cGy for bladder and 427±31 cGy for rectum; These differences were statistically significant (t = 5.125, 4.729, P <0.05). There was no statistically significant difference in the sigmoid D2cc doses between the two algorithms. The treatment times for delivering the two types of plans were not significant different.

CONCLUSION

Depending on patient's condition, whether conventional brachytherapy therapy or interpolation therapy is used, the use of the HIPO algorithm to design the treatment regimen without additional treatment time can provide a higher target dose than the manually optimized brachytherapy regimen. Meanwhile, the bladder and rectum doses can be reduced to a certain extent under the premise of ensuring that the target dose met the treatment requirements. There is some increasement for the intestine dose with HIPO planning group, but the dose limits required by the guidelines are still met clinical requirement.

Design of a high counting efficiency sensor for 1.0 cubic feet per minute laser particle counter

Based on the theory of Mie scattering, an optical sensor for a 1.0 cubic feet per minute laser particle counter is developed in this paper. First, an illumination optical path relying on aspherical lens and cylindrical lens for laser shaping was designed, and a narrow optical spot with the illumination in the vertical direction of the photosensitive area approximately distributed as a flat top was obtained. Second, the scattering light path was designed by using the theory of Mie scattering and geometric optics method. Then, the structure of the sampling air path was designed with reference to the principle of Laval nozzle, and the particle flow trajectory was verified by simulation using the fluid dynamics software Ansys Fluent. Finally, the performance of the optical sensor was measured with polystyrene latex (PSL) particles, and the results showed that the counting efficiency of the 0.3 μm particle size channel met the requirement of 50% ± 20% and the 0.5 μm particle size channel met the requirement of 100% ± 10%, which complied with the ISO 21501-4 standard.

[Predictive value of serum lactate dehydrogenase on prognosis of patients with paraquat poisoning]

Objective: To investigate the predictive value of serum lactate dehydrogenase (LDH) in the prognosis of patients with paraquat (PQ) poisoning, and to provide evidence for early prognosis assessment. Methods: In February 2022, 50 patients with PQ poisoning who completed serum LDH detection admitted to the Department of Emergency Medicine, the First Affiliated Hospital of Wenzhou Medical University from January 2012 to December 2021 were selected as the observation group, and 50 healthy physical examination personnel were randomly selected as the control group. Patients with PQ poisoning were divided into survival group and death group according to the prognosis, and the differences of blood routine routine, liver and kidney function and other indicators in the first admission between the two groups were compared. Multivariate logisitic regression model was established, ROC curve was drawn, and the influencing factors of prognosis of patients with PQ poisoning were analyzed. Results: Compared with the control group, the white blood cell count (WBC), total bilirubin (TBil), alanine aminotransferase (ALT), aspartate aminotransferase (AST), LDH, glucose (GLU) and creatinine (Cr) in observation group were significantly increased, while albumin (ALB) and total cholesterol (TC) were significantly decreased (P<0.05). Univariate analysis showed that WBC, elevated LDH (>247 U/L), TBil, ALT, AST and Cr were significantly different between PQ poisoning survival group and death group (P<0.05). Multivariate logisitic regression analysis showed that elevated serum LDH was an independent risk factor for the prognosis of PQ poisoning patients (OR=9.95, 95%CI: 1.34-73.82, P=0.025). The area under the ROC curve of LDH was 0.811 (95%CI: 0.692-0.930). When the cut-off value was 340 U/L, the sensitivity was 0.889 and the specificity was 0.719. Log-rank test showed that there was a statistically significant difference in survival rate between the normal LDH group and the elevated LDH group (P=0.001) . Conclusion: Serum LDH has a good predictive value in evaluating the prognosis of patients with PQ poisoning. Elevated LDH is a risk factor for poor prognosis of patients with PQ poisoning.

[Efficacy and outcomes of shunt surgery for secondary hydrocephalus]

Records of secondary hydrocephalus patients undergoing shunt surgery in the Department of Neurosurgery of Peking Union Medical College Hospital from September 2012 to April 2022 and their clinical characteristics and outcomes were retrospectively reviewed and analyzed. Among 121 patients who received first time shunt placement, the most common causes of secondary hydrocephalus were brain hemorrhage (55, 45.5%) and trauma (35, 28.9%). Cognition decline (106, 87.6%), abnormal gait (50, 41.3%) and incontinence (40, 33.1%) were the most prevalent manifestations. Postoperative central nervous system infection (4, 3.3%), shunt obstruction (3, 2.5%) and subdural hematoma/effusion (4, 3.3%) were the most frequent neurological complications. Overall incidence of postoperative complications was 9% (11 cases) in the current cohort. And 50.5% (54/107) of the patients receiving shunting achieved a Glasgow outcome scale (GOS) score of at least 4. Shunt surgery is preferred for secondary hydrocephalus, especially for secondary normal pressure hydrocephalus. Moreover, it is recommended to complete cranioplasty in staged operation or one-stage operation for the patients with decompressive craniectomy.

Restart Expedites Quantum Walk Hitting Times

Classical first-passage times under restart are used in a wide variety of models, yet the quantum version of the problem still misses key concepts. We study the quantum hitting time with restart using a monitored quantum walk. The restart strategy eliminates the problem of dark states, i.e., cases where the particle evades detection, while maintaining the ballistic propagation which is important for a fast search. We find profound effects of quantum oscillations on the restart problem, namely, a type of instability of the mean detection time, and optimal restart times that form staircases, with sudden drops as the rate of sampling is modified. In the absence of restart and in the Zeno limit, the detection of the walker is not possible, and we examine how restart overcomes this well-known problem, showing that the optimal restart time becomes insensitive to the sampling period.

[Characteristics and related factors of viral nucleic acid negative conversion in children infected with Omicron variant strain of SARS-CoV-2]

Objective: To understand the characteristics and associated factors of viral nucleic acid conversion in children infected with Omicron variant strain of SARS-CoV-2 in Shanghai. Methods: The clinical symptoms, laboratory results and other data of 177 children infected with SARS-CoV-2 who were hospitalized in Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University (designated hospital for SARS-CoV-2 infection in Shanghai) from April 25 to June 8, 2022 were retrospectively analyzed. According to the chest imaging findings, the children were divided into mild and common type groups. According to their age, the unvaccinated children were divided into<3 years old group and 3-<18 years old group. According to the vaccination status, the children aged 3-<18 year were divided into non-vaccination group, 1-dose vaccination group and 2-dose vaccination group. Comparison between groups was performed by independent sample t-test and analysis of variance, and multivariate linear regression analysis was used for multivariate analysis. Results: Among the 177 children infected with Omicron variant of SARS-CoV-2, 96 were males and 81 were females, aged 3 (1, 6) years. The time of viral nucleic acid negative conversion was (10.3±3.1) days. The 177 children were 138 cases of mild type and 39 cases of common type. Among the children aged 3-<18 years old, 55 cases were not vaccinated, 5 cases received 1-dose and 36 cases received 2-dose vaccination. Among the 36 children who received 2 doses of vaccination, the time of viral nucleic acid negative conversion was shorter in those vaccinated within 6 months than those over 6 months ((7.1±1.9) vs. (10.8±3.0) d, t=-3.23, P=0.004). Univariate analysis showed that the time of nucleic acid negative conversion of SARS-CoV-2 was associated with age, underlying diseases, gastrointestinal symptoms, white blood cell count, proportion of neutrophils, proportion of lymphocytes, and the number of doses of SARS-CoV-2 vaccine (t=3.87, 2.55, 2.04, 4.24, 3.51, 2.92, F=16.27, all P<0.05). Multiple linear regression analysis showed that older age (β=-0.33, 95% CI -0.485--0.182, P<0.001) and more doses of vaccination (β=-0.79, 95% CI -1.463--0.120, P=0.021) were associated with shortened nucleic acid negative conversion time in children, while lower lymphocyte proportion (β=-0.02, 95% CI -0.044--0.002, P=0.031) and underlying diseases (β=1.52, 95% CI 0.363-2.672, P=0.010) were associated with prolonged nucleic acid negative conversion time in children. Conclusion: The children infected with Omicron variant of SARS-CoV-2 with reduced lymphocyte proportion and underlying diseases may have longer time of viral nucleic acid negative conversion,while children with older age and more doses of vaccination may have shorter time of viral nucleic acid negative conversion.

[Effects of low-dose photodynamic therapy on the function of human adipose mesenchymal stem cells and its mechanism]

Objective: To investigate the effects of low-dose photodynamic therapy on the proliferation, regulation, and secretion functions of human adipose mesenchymal stem cells (ADSCs) and the related mechanism, so as to explore a new method for the repair of chronic wounds. Methods: The experimental research methods were adopted. From February to April 2021, 10 patients (5 males and 5 females, aged 23 to 47 years) who underwent cutaneous surgery in the Department of Dermatology of the First Affiliated Hospital of Army Medical University (the Third Military Medical University) donated postoperative waste adipose tissue. The cells were extracted from the adipose tissue and the phenotype was identified. Three batches of ADSCs were taken, with each batch of cells being divided into normal control group with conventional culture only, photosensitizer alone group with conventional culture after being treated with Hemoporfin, irradiation alone group with conventional culture after being treated with red light irradiation, and photosensitizer+irradiation group with conventional culture after being treated with Hemoporfin and red light irradiation, with sample number of 3 in each group. At culture hour of 24 after the treatment of the first and second batches of cells, the ADSC proliferation level was evaluated by 5-ethynyl-2'-deoxyuridine staining method and the migration percentage of HaCaT cells cocultured with ADSCs was detected by Transwell experiment, respectively. On culture day of 7 after the treatment of the third batch of cells, the extracellular matrix protein expression of ADSCs was detected by immunofluorescence method. The ADSCs were divided into 0 min post-photodynamic therapy group, 15 min post-photodynamic therapy group, 30 min post-photodynamic therapy group, and 60 min post-photodynamic therapy group, with 3 wells in each group. Western blotting was used to detect the protein expressions and calculate the phosphorylated mammalian target of rapamycin complex (p-mTOR)/mammalian target of rapamycin (mTOR), phosphorylated p70 ribosomal protein S6 kinase (p-p70 S6K)/p70 ribosomal protein S6 kinase (p70 S6K) ratio at the corresponding time points after photodynamic therapy. Two batches of ADSCs were taken, and each batch was divided into normal control group, photodynamic therapy alone group, and photodynamic therapy+rapamycin group, with 3 wells in each group. At culture minute of 15 after the treatment, p-mTOR/mTOR and p-p70 S6K/p70 S6K ratios of cells from the first batch were calculated and detected as before. On culture day of 7 after the treatment, extracellular matrix protein expression of cells from the second batch was detected as before. Data were statistically analyzed with one-way analysis of variance and least significant difference test. Results: After 12 d of culture, the cells were verified as ADSCs. At culture hour of 24 after the treatment, the ADSC proliferation level ((4.0±1.0)% and (4.1±0.4)%, respectively) and HaCaT cell migration percentages (1.17±0.14 and 1.13±0.12, respectively) in photosensitizer alone group and irradiation alone group were similar to those of normal control group ((3.7±0.6)% and 1.00±0.16, respectively, P>0.05), and were significantly lower than those of photosensitizer+irradiation group ((34.2±7.0)% and 2.55±0.13, respectively, P<0.01). On culture day of 7 after the treatment, compared with those in normal control group, the expression of collagen Ⅲ in ADSCs of photosensitizer alone group was significantly increased (P<0.05), and the expressions of collagen Ⅰ and collagen Ⅲ in ADSCs of irradiation alone group were significantly increased (P<0.01). Compared with those in photosensitizer alone group and irradiation alone group, the expressions of collagen Ⅰ, collagen Ⅲ, and fibronectin of ADSCs in photosensitizer+irradiation group were significantly increased (P<0.01). Compared with those in 0 min post-photodynamic therapy group, the ratios of p-mTOR/mTOR and p-p70 S6K/p70 S6K of ADSCs in 15 min post-photodynamic therapy group were significantly increased (P<0.01), the ratios of p-p70 S6K/p70 S6K of ADSCs in 30 min post-photodynamic therapy group and 60 min post-photodynamic therapy group were both significantly increased (P<0.01). At culture minute of 15 after the treatment, compared with those in normal control group, the ratios of p-mTOR/mTOR and p-p70 S6K/p70 S6K of ADSCs in photodynamic therapy alone group were significantly increased (P<0.05 or P<0.01). Compared with those in photodynamic therapy alone group, the ratios of p-mTOR/mTOR and p-p70 S6K/p70 S6K of ADSCs in photodynamic therapy+rapamycin group were significantly decreased (P<0.05). On culture day of 7 after the treatment, compared with those in normal control group, the expressions of collagen Ⅰ, collagen Ⅲ, and fibronectin of ADSCs in photodynamic therapy alone group were significantly increased (P<0.01). Compared with those in photodynamic therapy alone group, the expressions of collagen Ⅰ, collagen Ⅲ, and fibronectin of ADSCs in photodynamic therapy+rapamycin group were significantly decreased (P<0.01). Conclusions: Low-dose photodynamic therapy can promote the proliferation of ADSCs, improve the ability of ADSCs to regulate the migration of HaCaT cells, and enhance the secretion of extracellular matrix protein by rapidly activating mTOR signaling pathway.

[Characteristics of the alveolar bone defects evaluated by cone-beam CT in periodontitis patients with orthodontic treatment history of Angle class Ⅱ malocclusion]

Objective: To evaluate the levels of alveolar bone defects by using cone-beam CT in periodontitis patients with history of orthodontic treatment and to find the special tooth positions, sites and periodontitis stages of alveolar bone defects, so as to provide reference for the formulation of clinical personalized diagnosis and treatment plans. Methods: Thirty patients who were diagnosed as Angle class Ⅱ malocclusion, treated by using labial fixed orthodontic appliances and also diagnosed as periodontitis (orthodontic group) were recuited from January 2009 to June 2019 at the School and Hospital of Stomatology, China Medical University in the present study. They were aged (27.0±5.4) years old (ranged 18-41 years old). Another 60 periodontitis patients without a history of orthodontic treatment matched according to age, gender and severity of periodontitis were selected as control group (non-orthodontic group). They were aged (26.7±5.2) years old (ranged 18-41 years old). Cone-beam CT images were used to measure the heights of the alveolar bone defects at each tooth position of the patients. The difference in the heights of the alveolar bone defects between the orthodontic group and the non-orthodontic group at the same position of the maxillary and mandibular alveolar bones were compared. The specificities of the defect heights in different positions of the maxillary and mandibular alveolar bones and different sites of the same tooth position were analyzed among orthodontic group. The specificities of the different tooth positions of the maxillary and mandibular alveolar bones of the different periodontitis stages among orthodontic group were compared. Results: The heights of the alveolar bone defects in the maxillary canine area and molar area, the mandibular incisor area, the canine area and the premolar area in the orthodontic group were higher than that in the non-orthodontic group, and the differences were statistically significant (P<0.05). In orthodontic group, the most severe teeth in the maxillary and mandibular alveolar bone defects were the canine areas [(3.75±1.00), (3.83±1.10) mm]. Secondly, the more severe tooth positions of the maxillary alveolar bone height defects were the molar area [(3.67±0.84) mm] and the incisor area [(3.39±0.83) mm] and the more severe tooth positions of the mandibular alveolar bone defects were the incisor area [(3.73±1.42) mm] and the molar area [(3.54±0.81) mm]. The height of the alveolar bone defect in the mandibular incisor area was greater than that in the maxillary (P<0.05). The bone defect in the maxillary molar area was severer than that of the mandibular area (P<0.05). The alveolar bone defects in the buccal and lingual sides were mostly larger than that of the mesial and distal sides both in maxillary and mandibular positions except for the maxillary incisor area(P<0.05). The most severe alveolar bone defect position changed with the periodontitis stage. The most severe tooth position of the maxillary in stage Ⅰ periodontitis was in the molar area [(3.26±0.63) mm], whereas the incisor area was the most severe tooth of the mandible [(3.14±1.04) mm]. In addition, among maxillary incisor area, canine area, premolar area, molar area, the most severe alveolar bone defect height was the canine area in stage Ⅱ, Ⅲ, Ⅳ mandibular (P<0.05). Conclusions: In periodontitis patients with a history of orthodontic treatment, the height of the alveolar bone defect was specific to the tooth positions and sites. With the periodontitis stage changing, the most severe defect position changed in both maxillary and mandibular alveolar bones. It is recommended to pay more attention to the alteration of alveolar bone in periodontitis patients with a history of orthodontic treatment and give timely targeted treatment plans.

Activity and bioavailability of food protein-derived angiotensin-I-converting enzyme-inhibitory peptides

Angiotensin-I-converting enzyme (ACE) inhibitory peptides are able to inhibit the activity of ACE, which is the key enzymatic factor mediating systemic hypertension. ACE-inhibitory peptides can be obtained from edible proteins and have the function of antihypertension. The amino acid sequences and the secondary structures of ACE-inhibitory peptides determine the inhibitory activities and stability. The resistance of ACE-inhibitory peptides to digestive enzymes and peptidase affect their antihypertensive bioactivity in vivo. In this paper, the mechanism of ACE-inhibition, sources of the inhibitory peptides, structure-activity relationships, stability during digestion, absorption and transportation of ACE-inhibitory peptides, and consumption of ACE-inhibitory peptides are reviewed, which provide guidance to the development of new functional foods and production of antihypertensive nutraceuticals and pharmaceuticals.

Late-Stage Diversification through Manganese-Catalyzed C-H Activation: Access to Acyclic, Hybrid, and Stapled Peptides

Bioorthogonal C-H allylation with ample scope was accomplished through a versatile manganese(I)-catalyzed C-H activation for the late-stage diversification of structurally complex peptides. The unique robustness of the manganese(I) catalysis manifold was reflected by full tolerance of sensitive functional groups, such as iodides, esters, amides, and OH-free hydroxy groups, thereby setting the stage for the racemization-free synthesis of C-H fused peptide hybrids featuring steroids, drug molecules, natural products, nucleobases, and saccharides.

Coexistence of Eph receptor B1 and ephrin B2 in port-wine stain endothelial progenitor cells contributes to clinicopathological vasculature dilatation

BACKGROUND

Port-wine stain (PWS) is a vascular malformation characterized by progressive dilatation of postcapillary venules, but the molecular pathogenesis remains obscure.

OBJECTIVES

To illustrate that PWS endothelial cells (ECs) present a unique molecular phenotype that leads to pathoanatomical PWS vasculatures.

METHODS

Immunohistochemistry and transmission electron microscopy were used to characterize the ultrastructure and molecular phenotypes of PWS blood vessels. Primary culture of human dermal microvascular endothelial cells and in vitro tube formation assay were used for confirmative functional studies.

RESULTS

Multiple clinicopathological features of PWS blood vessels during the development and progression of the disease were shown. There were no normal arterioles and venules observed phenotypically and morphologically in PWS skin; arterioles and venules both showed differentiation impairments, resulting in a reduction of arteriole-like vasculatures and defects in capillary loop formation in PWS lesions. PWS ECs showed stemness properties with expression of endothelial progenitor cell markers CD133 and CD166 in non-nodular lesions. They also expressed dual venous/arterial identities, Eph receptor B1 (EphB1) and ephrin B2 (EfnB2). Co-expression of EphB1 and EfnB2 in normal human dermal microvascular ECs led to the formation of PWS-like vasculatures in vitro, for example larger-diameter and thick-walled capillaries.

CONCLUSIONS

PWS ECs are differentiation-impaired, late-stage endothelial progenitor cells with a specific phenotype of CD133⁺ /CD166⁺ /EphB1⁺ /EfnB2⁺ , which form immature venule-like pathoanatomical vasculatures. The disruption of normal EC-EC interactions by coexistence of EphB1 and EfnB2 contributes to progressive dilatation of PWS vasculatures.

Abstract P5-10-06: Race associated disparities in an urban population of adolescent and young adult (AYA) women with breast cancer

Introduction: Although only about 5-7% of breast cancers occur in women under 40 years of age, multiple studies have shown that these cancers are more aggressive. In addition issues related to genetic testing and fertility preservation are of particular importance for AYA patients with breast cancer. This retrospective analysis aims to describe various biologic and treatment related factors of an urban AYA population with breast cancer and the differences amongst these factors stratified by African American (AA) versus non-AA race. We will look at factors including stage at diagnosis, hormone receptor status, prevalence of BRCA1/2 mutations, time from diagnosis to treatment, enrollment in clinical trials, and fertility preservation.

Methods: A retrospective study of a population of AYA women with breast cancer seen at two hospitals in Washington D.C. from 2006 to 2015 was performed. Data was collected on age, BRCA1/2 test results, stage at diagnosis, hormone receptor status, time from diagnosis to treatment, enrollment in clinical trial, fertility preservation, and pregnant or breastfeeding status at time of diagnosis. Fisher exact test was used to test the association between two categorical variables. Wilcoxon rank sum test was used to compare time to treatment and stage at presentation between AA and non-AA patients.

Results: A total of 161 AYA patients were evaluated. 54 were identified as AA and 107 as non-AA (88 Caucasians, 13 Asian, 6 Hispanics). Median age was 32 years (20-39) overall; 32 years (23-39) for AA and 33 years (20-39) for non-AA. While the rate of genetic testing was high, significantly fewer AA AYA underwent testing compared to non-AA (74% versus 87% respectively, (p=0.050)) and 10% of AA versus 22% of non-AA were found to have a BRCA1/2 deleterious mutation (p=NS). Clinical trial participation was lower for AA compared to non-AA (57% vs. 76%, p=NS) for those where clinical trials were discussed/offered. Fertility preservation was pursued by 10% of AA vs. 35% of non-AA (p=0.001). Of note, 61% of AA and 34% of non-AA had children at the time of diagnosis (p=0.001). While AA (31%) presented more often with advanced stages of cancer compared to non-AA (19%) this was not statistically significant. Triple negativity was similar in AA AYA (25%) vs. non-AA (22%). The median time to treatment initiation did not vary between AA and non-AA (37 days vs. 36 days, p=NS).

Conclusion: In this retrospective study of an urban population of AYA women with breast cancer, there were no delays in treatment initiation or significant differences between AA and non-AA. When compared to non-AA, AA had a statistically significant lower rate of genetic testing and fertility preservation, although the latest could have been affected by a higher number of nulliparous in non-AA. . Encouragingly, the clinical trial participation of AYA who had previously discussed clinical trials with their physician was very high.

Citation Format: Chitalia AA, Aqbal D, Yin R, Cai L, Isaacs CJ, Lynce FC. Race associated disparities in an urban population of adolescent and young adult (AYA) women with breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-10-06.

Effectiveness of telephone-based interventions on health-related quality of life and prognostic outcomes in breast cancer patients and survivors-A meta-analysis

The aim of this meta-analysis was to evaluate the effect of telephone-based interventions on prognostic outcomes and health-related quality of life (HRQoL) in breast cancer patients and survivors. A systematic search of the Cochrane Library, Web of science, Medline, EMBASE, CNKI and CBM database was carried out. Randomised, controlled trials (RCTs) examining the effects of telephone-based intervention versus a control group receiving no telephone intervention, on prognostic outcomes and HRQoL with breast cancer were included. A meta-analysis was conducted to quantify the effects of telephone-based interventions on anxiety, depression, fatigue, self-efficiency, physiological function, social-domestic function and quality of life. In total, 14 studies involving 2002 participants were included. Due to the effect of telephone-based interventions, statistically significant results were found on anxiety (standard mean difference [SMD] = -0.16, 95% confidence intervals [CI] [0.01, 0.30], p = .04), self-efficiency (SMD = 0.22, 95% CI [-0.34, -0.10], p = .0004), social-domestic function (SMD = 0.19, 95% CI [-0.35, -0.03], p = .02) and quality of life (SMD = 0.54, 95% CI [-1.00, -0.08], p = .02). Although the effects on depression, fatigue and physiological function were in the expected direction, these effects were not statistically significant (p > .05) based on the insufficient evidence.

Long noncoding RNA, tissue differentiation-inducing nonprotein coding RNA is upregulated and promotes development of esophageal squamous cell carcinoma

Esophageal squamous cell carcinoma (ESCC) is one of the major causes of cancer death worldwide, especially in Eastern Asia. Due to the poor prognosis, it is necessary to further dissect the underlying mechanisms and explore therapeutic targets of ESCC. Recently, studies show that long noncoding RNAs (lncRNAs) have critical roles in diverse biological processes, including tumorigenesis. Increasing evidence indicates that some lncRNAs are widely involved in the development and progression of ESCC, such as HOTAIR, SPRY4-IT1 and POU3F3. An emerging lncRNA, tissue differentiation-inducing nonprotein coding RNA (TINCR), has been studied in human cutaneous squamous cell carcinoma and has critical biological function, but its role in ESCC remains unknown. Here, we evaluated the expression profile of TINCR and its biological function in ESCC. In a cohort of 56 patients, TINCR was significantly overexpressed in ESCC tissues compared with paired adjacent normal tissues. Further, in vitro silencing TINCR via small interfering RNA (siRNA) inhibited the proliferation, migration and invasion of ESCC cells. Meantime, siRNA treatment induced apoptosis and blocked the progression of cell cycle. Taken together, our study suggests that TINCR promotes proliferation, migration and invasion of ESCC cells, acting as a potential oncogene of ESCC.

Endovascular Coiling of Wide-Neck and Wide-Neck Bifurcation Aneurysms: A Systematic Review and Meta-Analysis

BACKGROUND AND PURPOSE

We present the results of a systematic review and meta-analysis examining outcomes of endovascular coiling of wide-neck and wide-neck bifurcation aneurysms with and without stent assistance. The aim of our study was to assess angiographic and clinical outcomes.

MATERIALS AND METHODS

We performed a comprehensive literature search for all articles on the endovascular coiling of wide-neck and wide-neck bifurcation aneurysms. Studies meeting our inclusion criteria and abstracted data were selected by 2 independent reviewers. Primary outcomes were >6-month complete or near-complete angiographic occlusion, aneurysm recanalization, and aneurysm retreatment. Secondary outcomes included initial complete or near-complete occlusion, long-term good neurologic outcome, procedure-related morbidity, and procedure-related mortality. Data were analyzed by using random-effects meta-analysis.

RESULTS

In total, 38 studies including 2446 patients with 2556 aneurysms were included. For all wide-neck aneurysms, immediate complete or near-complete occlusion rate was 57.4% (95% CI, 48.1%-66.8%). Follow-up near-complete occlusion rate was 74.5% (95% CI, 68.0%-81.0%). Recanalization and retreatment rates were 9.4% (95% CI, 7.1%-11.7%) and 5.8% (95% CI, 4.1%-7.5%), respectively. Long-term good neurologic outcome was 91.4% (95% CI, 88.5%-94.2%). For wide-neck bifurcation aneurysms, initial complete or near-complete occlusion rate was 60.0% (95% CI, 42.7%-77.3%), long-term complete or near-complete occlusion rate was 71.9% (95% CI, 52.6%-91.1%), and the recanalization and retreatment rates were 9.8% (95% CI, 7.1%-12.5%) and 5.2% (95% CI, 1.9%-8.4%), respectively.

CONCLUSIONS

Our study of angiographic and clinical outcomes for patients with wide-neck aneurysms demonstrates that endovascular coiling with or without stent-assisted coiling is safe, with low rates of perioperative morbidity and mortality. Initial and long-term angiographic outcomes were generally satisfactory, but not ideal. These data provide some baseline comparisons against which emergent technologies can be assessed.

[The significance of prophylactic migraine therapy in controlling familial Meniere's disease, a preliminary study]

Objective:To investigate the effect of prophylactic migraine therapy in controlling vertigo episode of Meniere's disease. Method:We prospectively collected 16 cases of familial Meniere' disease diagnosed in our vertigo outpatient. The patients were divide into without migraine group (WOM) and with migraine group (WM). Give WM group a prophylactic therapy for migraine and compare within groups about the follow-up results of vertigo episodes. Result:WOM group had better results in controlling vertigo, then the controlling effect equaled after we added a prophylactic therapy for migraine. Conclusion:Combined with prophylactic migraine therapy may have better effect in accompanying migraine patients when controlling familial Meniere's disease.

A novel lncRNA, LUADT1, promotes lung adenocarcinoma proliferation via the epigenetic suppression of p27

Long noncoding RNAs (lncRNAs) are known to regulate the development and progression of various cancers. However, few lncRNAs have been well characterized in lung adenocarcinoma (LUAD). Here, we identified the expression profile of lncRNAs and protein-coding genes via microarrays analysis of paired LUAD tissues and adjacent non-tumor tissues from five female non-smokes with LUAD. A total of 498 lncRNAs and 1691 protein-coding genes were differentially expressed between LUAD tissues and paired adjacent normal tissues. A novel lncRNA, LUAD transcript 1 (LUADT1), which is highly expressed in LUAD and correlates with T stage, was characterized. Both in vitro and in vivo data showed that LUADT1 knockdown significantly inhibited proliferation of LUAD cells and induced cell cycle arrest at the G0–G1 phase. Further analysis indicated that LUADT1 may regulate cell cycle progression by epigenetically inhibiting the expression of p27. RNA immunoprecipitation and chromatin immunoprecipitation assays confirmed that LUADT1 binds to SUZ12, a core component of polycomb repressive complex 2, and mediates the trimethylation of H3K27 at the promoter region of p27. The negative correlation between LUADT1 and p27 expression was confirmed in LUAD tissue samples. These data suggested that a set of lncRNAs and protein-coding genes were differentially expressed in LUAD. LUADT1 is an oncogenic lncRNA that regulates LUAD progression, suggesting that dysregulated lncRNAs may serve as key regulatory factors in LUAD progression.

Hepatitis C virus-related mixed cryoglobulinemic endocapillary proliferative glomerulonephritis and B-cell non-Hodgkin lymphoma: a case report and literature review

OBJECTIVE

Chronic HCV (hepatitis C virus) infection is recognized as the major cause of mixed cryoglobulinemia. Cryoglobulins continually precipitate and form deposits on the vascular endothelium of small to medium-sized blood vessels, which may progress to vasculitic syndrome.

CASE REPORT

A 44-year-old female patient with chronic HCV infection presented with purpuras, edema and proteinuria. Her renal findings included microscopic hematuria, moderate proteinuria and endocapillary proliferative glomerulonephritis (EnPGN) on renal biopsy. Serum cryoglobulins comprised mixed monoclonal cryoglobulins characterized by IgM kappa. The serum protein electrophoresis revealed a monoclonal M protein (9.0%). CD19 and CD20-positive B-cell oligo-monoclonal expansion in the bone marrow was revealed. Rapid relief of the clinical symptoms, the disappearance of proteinuria and a sharp decrease in the HCV viral load were observed in our case after one year of interferon therapy.

CONCLUSIONS

HCV infection-associated extrahepatic manifestations are diverse, which may lead to misdiagnosis. This is the first report of HCV-associated cryoglobulinemic EnPGN and B-NHL, which rapidly responded to interferon.

Genome-wide association study of myelosuppression in non-small-cell lung cancer patients with platinum-based chemotherapy

Platinum-induced myelosuppression severely impedes successful chemotherapy in non-small-cell lung cancer (NSCLC) patients. Hence, it is clinically important to identify the patients who are at high risk for severe toxicity to certain chemotherapy. We first carried out a genome-wide scan of 906 703 single-nucleotide polymorphisms (SNPs) to identify genetic variants associated with platinum-induced myelosuppression risk in 333 NSCLC patients with chemotherapy. Then, we replicated 24 SNPs that had P<1 × 10(-4) in another independent cohort of 876 NSCLC patients. With P<0.05 as the criterion of statistical significance, we found that rs13014982 at 2q24.3 and rs9909179 at 17p12 exhibited consistently significant associations with myelosuppression risk in both the genome-wide association studies (GWAS) scan and the replication stage (rs13014982: odds ratio (OR)=0.55, 95% confidence intervals (CIs): 0.41-0.74, P=7.29 × 10(-5) for GWAS scan and OR=0.77, 95% CI: 0.65-0.93, P=0.006 for replication stage; rs9909179: OR=0.51, 95% CI: 0.37-0.70, P=4.60 × 10(-5) for GWAS scan and OR=0.82, 95% CI: 0.68-0.99, P=0.040 for replication stage; both in additive model). In combined samples of genome-wide scan and replication samples, the minor alleles of rs13014982 and rs9909179 remained significant associations with the decreased risk of myelosuppression (rs13014982: OR=0.71, 95% CI: 0.61-0.83, P =1.36 × 10(-5); rs9909179: OR=0.76, 95% CI: 0.65-0.89, P=0.001). Rs13014982 at 2q24.3 and rs9909179 at 17p12 might be independent susceptibility markers for platinum-induced myelosuppression risk in NSCLC patients.

EZH2-mediated epigenetic suppression of long noncoding RNA SPRY4-IT1 promotes NSCLC cell proliferation and metastasis by affecting the epithelial-mesenchymal transition

Recent evidence indicates that long noncoding RNAs (lncRNAs) have a critical role in the regulation of cellular processes such as differentiation, proliferation, and metastasis. These lncRNAs are dysregulated in a variety of cancers and many function as tumor suppressors; however, the regulatory factors involved in silencing lncRNA transcription are poorly understood. In this study, we showed that epigenetic silencing of lncRNA SPRY4 intronic transcript 1 (SPRY4-IT1) occurs in non-small-cell lung cancer (NSCLC) cells through direct transcriptional repression mediated by the Polycomb group protein enhancer of zeste homolog 2 (EZH2). SPRY4-IT1 is derived from an intron within SPRY4, and is upregulated in melanoma cells; knockdown of its expression leads to cell growth arrest, invasion inhibition, and elevated rates of apoptosis. Upon depletion of EZH2 by RNA interference, SPRY4-IT1 expression was restored, and transfection of SPRY4-IT1 into NSCLC cells resulted in a significant antitumoral effect, both in culture and in xenografted nude mice. Moreover, overexpression of SPRY4-IT1 was found to have a key role in the epithelial-mesenchymal transition through the regulation of E-cadherin and vimentin expression. In EZH2-knockdown cells, which characteristically showed impaired cell proliferation and metastasis, the induction of SPRY4-IT1 depletion partially rescued the oncogenic phenotype, suggesting that SPRY4-IT1 repression has an important role in EZH2 oncogenesis. Of most relevance, translation of these findings into human NSCLC tissue samples demonstrated that patients with low levels of SPRY4-IT1 expression had a shorter overall survival time, suggesting that SPRY4-IT1 could be a biomarker for poor prognosis of NSCLC.

Amplitude reduction in brainstem auditory response in term infants under neonatal intensive care

OBJECTIVE

To examine brainstem auditory electrophysiology in term neonates under intensive care due to perinatal conditions other than hypoxia-ischemia.

METHODS

Maximum length sequence brainstem auditory evoked response was studied in term neonates in an intensive care unit. The amplitudes of wave components of the response were analysed to assess brainstem auditory electrophysiology.

RESULTS

The amplitudes of all wave components in the neonates under intensive care tended to be smaller than in those in normal term controls. Wave I amplitude was significantly reduced at all 91-910/s clicks (p < 0.05-0.01). The amplitudes of waves III and V were also reduced, respectively, at 227-910/s (all p < 0.05) and at 455 and 910/s (both p < 0.01). The amplitude reduction was slightly more significant at higher than lower click rates, but there were no significant differences in the slopes of wave I, III and V amplitude-rate functions between the neonates under intensive care and the controls.

CONCLUSIONS

Wave amplitudes of maximum length sequence brainstem auditory evoked response were reduced in term neonates under intensive care due to perinatal conditions other than hypoxia-ischemia.

SIGNIFICANCE

Brainstem auditory electrophysiology is depressed in term neonates under intensive care, possibly due to collective adverse effects of perinatal conditions. The impairment to the neonatal, particularly rostral, brainstem due to other perinatal conditions is less severe than that due to hypoxia-ischemia previously reported.

Treatment of intrathoracic anastomotic leak by nose fistula tube drainage after esophagectomy for cancer

Esophageal anastomotic leak remains a lethal complication after esophagectomy for cancer. The aim of the present study is to describe an effective new management, nose fistula tube drainage (NFTD), to treat postoperative intrathoracic leaks. From July 2003 to August 2009, 41 of 4132 patients (0.99%) requiring transthoracic esophagectomy for esophageal and cardiac carcinoma had developed an intrathoracic esophageal anastomotic leak in our hospital as well as another three patients with similar conditions from other hospitals, excluding three patients with gastric necrosis (two) and tracheo-esophageal fistula (one); 23 patients were treated by NFTD, and the remaining 18 patients were treated by conventional chest tube drainage (CCTD). Clinical records of these patients were reviewed and analyzed, including the healing of the leak, mortality, and morbidity. In the NFTD group, 4 patients (17.4%) died, 1 patient (4.3%) required reoperation, and 18 patients (78.3%) healed. However, in the CCTD group, 3 patients (16.7%) died, 1 patient (5.5%) required reoperation, and 14 patients (77.8%) healed. As compared with the CCTD group, patients of the NFTD group had a shorter intensive care course (11.95 vs 33.62 days, P= 0.01) and hospital stay (39.74 vs 77.54 days, P= 0.02). Although this novel NFTD management did not significantly decrease mortality when compared with CCTD, it could gain more effective drainage than CCTD and eventually shorten hospital stay.

Investigation of optimal aminolaevulinic acid concentration applied in topical aminolaevulinic acid-photodynamic therapy for treatment of moderate to severe acne: a pilot study in Chinese subjects

BACKGROUND

Aminolaevulinic acid-photodynamic therapy (ALA-PDT) is a novel and effective treatment in acne. However, little is known about the effect of different concentrations of ALA in the treatment of acne in Chinese patients with Fitzpatrick skin type III and IV.

OBJECTIVES

To investigate the efficacy and safety of ALA-PDT in the treatment of moderate to severe acne in Chinese patients and to identify the suitable concentration of topical ALA.

METHODS

One hundred and eighty patients with moderate to severe facial acne were recruited and randomly divided into four groups. Each group was treated with a different concentration (5%, 10%, 15% and 20%) of ALA to the facial lesions on the right side and placebo agent on the left side as control. Each patient was treated once every 10 days for four sessions. The numbers of inflammatory and noninflammatory acne lesions were counted at baseline and at weeks 2, 4, 12 and 24 after the last treatment. Adverse effects were recorded at each follow-up visit.

RESULTS

After 24 weeks, each side treated by ALA-PDT showed clinical improvement compared with the control side treated by red light alone (P < 0·01). Statistically significantly more patients treated with 20% ALA than with 15% or 10% ALA achieved complete clearance. Regarding side-effects, a trend towards more serious erythema and pigmentation was observed with increasing ALA concentration.

CONCLUSIONS

Increasing the concentration of ALA seems to be beneficial for improving the results. Considering effectiveness and safety, ALA-PDT using 10% or 15% ALA is suggested to the ideal treatment for moderate to severe acne in Chinese patients with Fitzpatrick skin type III and IV.