[A single-center study on the oncological outcomes of active surveillance of thyroid nodules measuring≤1 cm with highly suspicious ultrasound features]

Objective: To investigate the oncological outcomes of active surveillance (AS) in patients showing thyroid nodules measuring≤1 cm with highly suspicious ultrasound features. Methods: A prospective single-center cohort study. A total of 534 patients with highly suspicious thyroid nodules (2015 American Thyroid Association Nodule Sonographic Patterns and Risk of Malignancy: High Suspicion) were enrolled in this study, the patients received AS at Peking Union Medical College Hospital between January 2017 and November 2022 to assess oncological outcomes (disease progression, recurrence/metastasis rate, etc). The patients were followed up every 6 months for physical examination and neck ultrasound examination. And the value of tumor volume changes in evaluating tumor enlargement was explored too. Results: There were 413 females and 121 males in this cohort, with a mean age of (42.6±11.8) years. During a median follow-up period of 45.6 months (ranged from 3.5 to 176.0 months), disease progression occurred in 26 patients (4.9%) with highly suspicious thyroid nodules, characterized by a minimum 3-mm increase in tumor diameter in 19 patients (3.6%) and lymph node metastases in 7 patients (1.3%). Forty-seven (8.8%) patients opted for delayed surgery, with 29 patients due to a change in preference. There was no significant differences in pathologic and follow-up outcomes between patients with disease progression and preference change. Patients aged≤40 years had a higher cumulative incidence of 5-year disease progression than those aged>40 years (4.9% vs 1.9%, P=0.060). No patients experienced distant metastases or deaths. Among the 595 high-risk thyroid nodules with continuous volume assessment results and an increase in nodule diameter of less than 3 mm (including all high-risk nodules in patients with single or multiple nodules), 184 (30.9%) and 79 (13.3%) nodules exhibited volume increases of more than 50% and 100%, respectively, in multiple measurements. Among the nodules with volume changes exceeding 50% and 100%, the proportion of nodules with a baseline tumor diameter of≤0.5 cm was significantly higher than those with a diameter of>0.5 cm, at 69.0% vs 31.0% (P<0.001) and 77.2% vs 22.8% (P<0.001), respectively. Conclusions: Active surveillance in patients with highly suspicious subcentimeter thyroid nodules has good short-term oncological outcomes and can be considered a safe alternative to surgery. Due to the large variability in the measurement results of tumor volume, it is not suitable as an indicator for evaluating tumor enlargement.

[Application of an occupational health risk assessment method in dioctyl phthalate producing enterprise]

Objective: To find the risk assessment model of [di (2-ethylhexyl) phthalate, DEHP] fitting well for producing companies. Methods: The Cluster Sampling method was used in selecting a DEHP producing company in the occupational health and workplace environment monitoring study conducted between July and August in 2017. Data was collected by site evaluating and workplace environment monitoring. According to GBZ/T 298-2017《Technical Guidelines for Occupational Health Risk Assessment of Chemical Hazards in the Workplace》, a qualitative assessment method and a semi-quantitative comprehensive index method were chosen as the models and were compared. Results: The occupational health risk of the two methods rated 4 (high risk) and 2 (negligible risk) . Conclusion: The semi-quantitative comprehensive index method is more comprehensive and accurate when used to assess the occupational health risk caused by DEHP.

[Comparative study on the EPLAD of profoundly deaf children with hearing aid fittings or cochlear implantations at the same age]

Objective:The purpose of the current study was to provide good clinical values for rehabilitation exercises and counseling of hearing impaired children by comparing the early prelingual auditory development（EPLAD） of children with hearing aid fittings or cochlear implantations at the same age. Method:Longitudinal evaluation of EPLAD, profoundly deaf children, who received hearing aid fittings or cochlear implantations at 2 years of age, were recruited in this study, and would be tested with Infant-toddler meaningful auditory integration scale（IT-MAIS） at 3, 6 and 12 months after intervention. One hundred and four children were recruited in this study and divided into two groups based on the types of devices: Cochlear implant group（CI group） and Hearing aid group（HA group）. Each child could be permitted to miss follow-up one time. Result:The IT-MAIS scores of children in both groups improved with increasing wear time. The scores in CI group showed a statistically significant improvement between each interval after switch-on（P=0.000）. However, there was just a statistical difference between overall scores at 3 and 12 months after fitting in HA group（P=0.042）. In addition, the IT-MAIS scores of the two groups were statistically significant at 6 and 12 months after switch-on/fitting（P=0.026, P=0.005）. Simultaneously, the mean overall score of children in CI group at 12 months after switch-on approached the average level of unaided peers with mild hearing loss. However, the mean score at 12 months after fitting was close to the average level of unaided peers with moderate hearing loss. Conclusion:Both of CI and HA could improve EPLAD of profoundly deaf children. However, the EPLAD of CI children could improve faster in the first year after switch-on. And the results would also provide more comprehensive clinical values for rehabilitation and counseling of hearing impaired children by comparing to normal and unaided hearing impaired children.

[Determination of nitrogen oxides in the air of workplace by ion chromatography]

Objective: Improvement the method of nitrogen oxide sampling, analysis and detection in workplace air. Methods: Absorption and collection with sodium carbonate-sodium bicarbonate buffer solution, analysised by ion chromatography, anion column AS23, column temperature 30 ℃. Results: The linearity of the nitrite ion in the corresponding mass concentration range 0~90.0 μg/ml was good (Nitrogen dioxide in 0~120.0 mg/m(3)) , correlation coefficient>0.999 5. The detection limit was 0.16 μg/ml, The minimum detection concentration was 0.11 mg/m(3) with the sampling volume 7.5 L. Conclusion: The method has good accuracy, high sensitivity, with directing injection and no pre-treatment, and can popularize in general laboratories, and can satisfy the determination of nitrogen oxides in the air of workplace.

[Comparison of flow conditions of adhesives and retention force of restorations among four cement-retained methods of implant-supported fixed prostheses]

Objective: To compare the effect on the flow conditions of adhesives and the retention force of restorations among different cement-retained methods of implant-supported fixed prostheses. Methods: Four common cement-retained methods were selected, including the occlusal hole for screw access (OH), the lingual hole for adhesives overflow (LH), the resin replica for titanium abutment (RR), and the traditional cement-retained method (the control group). The adhesive used in this study was resin-modified glass ionomer cement. The two-dimensional analysis models of computational fluid dynamics (CFD) were established. The flow conditions of adhesives in the adhesion process was analyzed by the CFD analysis. The internal filling ratio and the amount of neck overflow of adhesives below the edge of the prosthesis were calculated. Ten zirconia prostheses in each group were processed and cemented. The retention force was examined by mechanical tensile experiments in vitro. Results: The CFD analysis showed the internal filling ratio of adhesives from high to low was the LH group, the OH group, the RR group and the control group. The amount of neck overflow of adhesives below the edge of the prosthesis from less to more was the RR group, the OH group, the LH group and the control group. The retention force was (240.7±33.9) N in the control group, (278.2±59.1) N in the OH group, (292.9±47.9) N in the LH group, and (262.8±59.4) N in the RR group. There was a statistically significant difference in the retention force between the LH group and the control group (P=0.029). There was no significant difference among the other groups (P>0.05). Conclusions: The modified cement-retained methods can effectively reduce the amount of neck overflow of adhesives, and improve the filling condition of adhesive in the adhesive clearance to ensure the retention force of the prostheses. Clinically, the appropriate modified cement-retained method should be selected according to the three-dimensional position of the implant and the position of prosthetic margin.

Reconstruction of large segmental bone defects in rabbit using the Masquelet technique with α-calcium sulfate hemihydrate

Background

Large segmental bone defects can be repaired using the Masquelet technique in conjunction with autologous cancellous bone (ACB). However, ACB harvesting is severely restricted. α-calcium sulfate hemihydrate (α-CSH) is an outstanding bone substitute due to its easy availability, excellent biocompatibility, biodegradability, and osteoconductivity. However, the resorption rate of α-CSH is too fast to match the rate of new bone formation. The objective of this study was to investigate the bone repair capacity of the Masquelet technique in conjunction with isolated α-CSH or an α-CSH/ACB mix in a rabbit critical-sized defect model.

Methods

The rabbits (n = 28) were randomized into four groups: sham, isolated α-CSH, α-CSH/ACB mix, and isolated ACB group. A 15-mm critical-sized defect was established in the left radius, followed by filling with polymethyl methacrylate spacer. Six weeks after the first operation, the spacers were removed and the membranous tubes were grafted with isolated α-CSH, isolated ACB, α-CSH/ACB mix, or none. Twelve weeks later, the outcomes were evaluated by manual assessment, radiography, and spiral-CT. The histopathological and morphological changes were examined by H&E staining. The levels of alkaline phosphatase and osteocalcin were analyzed by immunohistochemistry and immunofluorescence staining.

Results

Our results suggest that the bone repair capacity of the α-CSH/ACB mix group was similar to the isolated ACB group, while the isolated α-CSH group was significantly decreased compared to the isolated ACB group.

Conclusion

These results highlighted a promising strategy in the healing of large segmental bone defect with the Masquelet technique in conjunction with an α-CSH/ACB mix (1:1, w/w) as they possessed the combined effects of sufficient supply and low resorption.

[Mid-term multi-center outcomes of bilateral radial artery as conduits in coronary artery bypass grafting]

Objective: To evaluate the mid-term outcomes of bilateral radial artery (BRA) grafts in coronary artery bypass grafting (CABG). Methods: All perioperative medical records and follow-up results of CABG with BRA grafts in multi-centers of China were analyzed retrospectively. Results: A total of 211 patients (170 males and 41 females) underwent CABG grafting with BRA conduits between August 2013 and September 2018, with a mean age of (56.5±9.7) years old (rang 41 to 73 years). There were 161 cases of triple-vessel disease and 50 cases of two-vessel disease. Ninety patients had diabetes mellitus (DM), 35 patients with peripheral vascular disease, 4 patients with chronic obstructive pulmonary disease and 11 with heart valve disease. Two patients underwent off-pump CABG and 209 patients accepted on-pump CABG with commitment valve surgery. There were 210 cases of total arterial revascularization and 161 cases using left thoracic artery conduits, with a graft number of 2-4 (2.7±0.9). No operation-related death occurred, atrial fibrillation happened in 12 patients, hemothorax in 7 cases, and forearm hematoma in one case, hypoxemia in 13 cases and pneumonia in one case. The duration of mechanical ventilation was (8.3±4.7) hours and the mean hospital length of stay was (7.1±2.9) days. Follow-up was completed in 191 patients (90.52%) with a duration of 3-59 (35.5±9.3) months. The mean left ventricular ejection fraction at 3 months after operation was significantly improved, compared to that of the pre-operation (61.0%±7.2% vs 47.1%±5.3%, P=0.017). All patients survived, except that one died from brain injury. No major cardiac events occurred, with a cumulative survival rate of 100% at 1 year and 99.53% at 3 year after operation, respectively. It was showed in coronary CT angiography (CTA) examination that all grafts in 132 patients were patent at the mean follow-up duration of (21.5±6.4) months. Conclusions: BRA grafts as arterial conduit in CABG are proved to be safe, easy for total arterial revascularization and have good mid-term clinical results.

[Longitudinal study of the early prelingual auditory development of children with cochlear implants]

Objective:To explore the early prelingual auditory development (EPLAD) of children with cochlear implants.Method:Children with cochlear implants switched on at 1 and 2 years old in our center were recruited in this longitudinal study, and the EPLAD of them would be tested with the ITMAIS at 3months, 6months, and 12months after switch on. Each children could be permitted to miss follow-up one time.Result:Seventy-five children with unilateral cochlear implants were recruited in the study, and divided into 2 age groups according to the age at switch on,1 year group (32 children) and 2 years group (43 children). The EPLAD of children in both groups improved as the time they wore the cochlear implants increased. The speeds of improvement in both groups were similar to that of normal children and faster than those of children with different hearing impairments and without any interventions. The mean total score at 12 months after switch on in 1 year groups could achieve the average level of mild hearing impaired peer without interventions. In addition, the total scores in both groups were significantly different at 3 months after switch on(P<0.05),and nosignificantly different at 6 and 12 months after switch on(P>0.05).Conclusion:Cochlear implant could help the children with profound sensorineural hearing loss to improve the abilities of EPLAD, and the speed of improvement in the 12 months after switch on was similar to that of normal children. And the results also indicated that the mean total scores at 12 months after switch on in both groups could be close to or achieve the average level of mild hearing impaired peer without interventions, it provided evidences to us for counseling and rehabilitation exercise. In addition, the result, total scores in both groups were just significantly different at 3 months after switch on, emphasized the importance of early intervention as well.

[Timing changes of apoptosis and proliferating cells nuclear antigen after intra-arteiral infusion chemotherapy for nasopharyngeal carcinoma]

OBJECTIVE

To investigate the timing changes of apoptosis (APO) and PCNA after intra-arterial infusion chemotherapy for nasopharyngeal carcinoma.

METHOD

Ten patients were subjected to percutaneous superficial temporal artery catheterization and infusion of anticancer drugs: 5-Fu, DDp, BLM, nicotinamide. The biopsy of nasopharyngeal tumor tissues was performed before chemotherapy and 7 days after chemotherapy. Apoptotic cells were examined by TOT-mediated DUTP-fluorescein and labeling. The expression of proliferating cells nuclear antigen (PCNA) was detected with immunohistochemical staining.

RESULT

AI of nasopharyngeal cancer cells before chemotherapy and 7 days after chemotherapy was 0.52% and 1.42%, PI was 42.4% and 51.2%.

CONCLUSION

Intra-arterial infusion chemotherapy not only induced apoptosis effectively, but also inhibited temporarily tumor cells proliferation in patients. The curative surgical treatment should be performed as soon as possible after chemotherapy.

[Studies on the health standard for room temperature in cold regions]

The microclimate of 205 rooms of single storey houses in four new rural residential districts in coastal and inland Shandong was monitored and studied the blood circulation of the finger, skin temperature, sweating function and other physiological indexes among 2,401 peasants. We interrogated their personal sensation to cold and warmth. The count was done by the application of thermal equilibrium index (TEI), predicted 4-hour Sweat Rate (P4SR) and the uncomfortable index. The standard room temperature is recommended as follows. In rural area in winter the appropriate room temperature is 14-16 degrees C, the comfortable room temperature is 16-20 degrees C, the lowest room temperature must not be below 14 degrees C. In summer the appropriate room temperature is 25-28 degrees C, the comfortable room temperature is 26-27 degrees C, the highest temperature must not be above 28 degrees C.