[Investigate of the etiology and prevention status of liver cirrhosis].

Objective: To investigate the etiology, prevention and treatment status, and their corresponding regional differences of the patients with liver cirrhosis in China, in order to provide scientific basis for the development of diagnosis and control strategies in China. Methods: Clinical data of patients diagnosed with liver cirrhosis for the first time through January 1, 2018 to December 31, 2020 from 50 hospitals in seven different regions of China were collected and analyzed retrospectively, and the difference of etiology, treatment, and their differences in various regions were analyzed. Results: A total of 11 861 cases with liver cirrhosis were included in the study. Thereinto, 5 093 cases (42.94%) were diagnosed as compensated cirrhosis, and 6 768 cases (57.06%) had decompensated cirrhosis. Notably, 8 439 cases (71.15%) were determined as chronic hepatitis B-caused cirrhosis, 1 337 cases (11.27%) were alcoholic liver disease, 963 cases (8.12%) were chronic hepatitis C, 698 cases (5.88%) were autoimmune liver disease, 367 cases (3.09%) were schistosomiasis, 177 cases (1.49%) were nonalcoholic fatty liver, and 743 cases (6.26%) of other types of liver disease. There were significant differences in the incidence of chronic hepatitis B, chronic hepatitis C, alcoholic liver disease, fatty liver, schistosomiasis liver disease, and autoimmune liver disease among the seven regions (P<0.001). Only 1 139 cases (9.60%) underwent endoscopic therapy, thereinto, 718 cases (6.05%) underwent surgical therapy, and 456 cases (3.84%) underwent interventional therapy treatment. In patients with compensated liver cirrhosis, 60 cases (0.51%) underwent non-selective ß receptor blockers(NSBB), including 59 cases (0.50%) underwent propranolol and 1 case (0.01%) underwent carvedilol treatment. In patients with decompensated liver cirrhosis, 310 cases (2.61%) underwent NSBB treatment, including 303 cases (2.55%) underwent propranolol treatment and 7 cases (0.06%) underwent carvedilol treatment. Interestingly, there were significant differences in receiving endoscopic therapy, interventional therapy, NSBB therapy, splenectomy and other surgical treatments among the seven regions (P<0.001). Conclusion: Currently, chronic hepatitis B is the main cause (71.15%) of liver cirrhosis in several regions of China, and alcoholic liver disease has become the second cause (11.27%) of liver cirrhosis in China. The three-level prevention and control of cirrhosis in China should be further strengthened.

[Clinical analysis and surgical treatment evaluation of 23 cases with primary parapharyngeal space tumors].

Objective: To analyze the clinical characters and surgical treatment of primary parapharyngeal space (PPS) tumors. Methods: A total of 23 cases of primary PPS tumors which were treated from November 2011 to December 2017 were included for the retrospective analysis in this study. Results: Twenty-three cases of patients with primary PPS tumors were analyzed in this study. Surgical approach was as follows: transcervial approach applied in 7 cases, transparotid approach in 4 cases, transoral approach in 2 cases, transmandibular approach in 4 cases, and the combined approaches on 6 cases. Besides, among 7 cases with upper PPS tumor, we applied the surgical navigation system in the surgery of 3 cases. The mean surgery duration of these cases, 3.5 h, was shorter than unused ones, while the mean maximum size (MMS) of tumors, 5.7 cm, was also larger. So far, 23 cases had no recurrence and metastasis. The most frequent histopathological type of all the cases was pleomorphic adenoma (8 cases), followed by Schwannoma (5 cases). With an 8-to-72-months follow up, 23 cases had no recurrence, metastasis or death. Conclusions: Surgical resection is preferred in the treatment of PPS tumors. In the upper PPS tumor cases, the surgical navigation system could reduce the operative duration significantly and is more suitable for larger tumors.

Postoperative radiotherapy is dispensable for OSCC patients with micrometastases in lymph nodes.

Lymph node metastasis is a decisive factor for performing postoperative radiotherapy for oral squamous cell carcinoma (OSCC). However, whether OSCC patients with only micrometastasis need postoperative radiotherapy is unclear. In this study, OSCC patients (n = 311) with negative (n = 247), only micrometastasis (n = 44) and macrometastasis (n = 20) were detected and selected by HE staining. Micrometastasis was re-assessed using immunohistochemical staining of cytokeratin (CK) in HE-negative patients to find out the false negative cases. The results indicated that, among the negative lymph node cases (n = 247), the positive rate of CK was 4.94% (n = 12). Besides, the clinical features of the primary tumor in relation to the only micrometastatic status and the value of the postoperative radiotherapy on the only micrometastasis patients were evaluated. Patients with only micrometastasis had higher T stage and inferior worst pattern of invasion (WPOI) than patients without micrometastasis, but they had longer overall survival (OS), metastasis-free survival (MFS), and disease-free survival (DFS) than macrometastasis patients. However, the survival time of only micrometastasis patients with or without postoperative radiotherapy was comparable, even in patients with inferior WPOI. Radiotherapy, however, may only benefit patients with IV/V levels of micrometastasis. These data indicated that postoperative radiotherapy is dispensable for only micrometastasis OSCC patients.

Hyalinizing clear cell carcinoma of salivary gland origin in the head and neck: clinical and histopathological analysis.

Hyalinizing clear cell carcinoma (HCCC) is an extremely rare neoplasm of salivary gland origin with a low-grade indolent nature. It is difficult to distinguish from other malignant salivary gland tumours. Clinical outcomes following surgery are generally reported as good. The aim of this study was to further determine the features of HCCC. This study was approved by Medical ethics review of affiliated hospital of jiangsu university. Fourteen new cases of HCCC are reported. The clinical and histopathological data of these 14 cases were analysed alongside those of 141 cases identified in a systematic review of the literature (up to 2016). Demographic data, histopathological findings, clinical presentation, primary treatment, and outcomes were extracted. Histologically, HCCC tumour cells had a clear cell morphology with hyalinized stroma. Immunohistochemical results were positive for cytokeratins and EMA, but negative for SMA, S100, vimentin, and calponin. Twelve of the 14 patients showed EWSR1 translocation. Local nodal metastasis on presentation was present in 17.3% and the overall recurrence rate was 17.7% in the total population (N=155), compared with 35.7% and 21.4%, respectively, in the new cases alone. Focal necrosis and local metastasis were identified as possibly associated with recurrence. The overall prognosis was good: only 3.8% of patients died of the disease. HCCC is less indolent than was previously thought, but overall the prognosis is good. Risk factors for recurrence may include focal necrosis and local metastasis at presentation. The best treatment for patients with HCCC is wide local excision combined with regional lymph node dissection.

[Evaluation and influencing factors of surgical margin status of oral squamous cell carcinoma].

Surgical resection with adequate margins is an essential component of the treatment for patients with oral squamous cell carcinoma (OSCC). A distance of 5 mm or more between healthy tissue to the tumor front is generally accepted as a safe margin. It is very important for surgeons to precisely evaluate the resection area of tumor both pre- and intra-operatively and try to achieve a safe margin, which will result in a decreased risk of local recurrence. The relationship of surgical margin status to patients' prognosis, and factors which will affect surgical margin distance demand are discussed in this paper. We recommend that adequate margins evaluation should take consideration of many factors such as anatomical location, depth of tumor invasion, pattern of tumor invasion, mucosal dysplasia grade and so on. With the development of molecular biology, surgical margin study at molecular level can give us a new strategy to evaluate its adequacy.

Differential roles of Porphyromonas gingivalis lipopolysaccharide and Escherichia coli lipopolysaccharide in maturation and antigen-presenting functions of dentritic cells.

OBJECTIVE: The aim of this research is to study the roles of Porphyromonas gingivalis-lipopolysaccharide (P. gingivalis-LPS) and Escherichia coli-lipopolysaccharide (E. coli-LPS) on maturation and antigen-presenting functions of dendritic cells (DCs), and to provide experimental evidences to explore the possible mechanism of DCs in periodontitis. MATERIALS AND METHODS: Flow cytometry was used to detect CD11c, MHC-II, CD80, CD86 and CD40 expression on DCs which were stimulated by P. gingivalis-LPS or E. coli-LPS and ELISA was used to detect IL-12, IFN-γ, IL-10 and IL-13 secreted by DCs. CCK8 was used to assay CD4+T cells proliferation after co-cultured with DCs stimulated by P. gingivalis-LPS or E. coli-LPS and ELISA was used to detect IL-2, IFN-γ, IL-10 and IL-13 secreted by T cells. TLR4 inhibitor (polymyxin B) or TLR2 and TLR4 inhibitor (OxPAPC) was added to P. gingivalis-LPS group and E. coli-LPS group to observe the effects of these two TLR inhibitors on the maturation and antigen-presenting functions of DCs. RESULTS: The capacity of P. gingivalis-LPS to stimulate DCs maturation was similar to that of E. coli-LPS. The amount of IL-12 and IFN-γ secreted by DCs in P. gingivalis-LPS group was significantly lower than that of E. coli-LPS group (p < 0.05), meanwhile, IL-10 and IL-13 secreted by DCs in P. gingivalis-LPS group was significantly higher than that of E. coli-LPS group (p < 0.05). DCs stimulated by both P. gingivalis-LPS and E. coli-LPS could promote the proliferation of CD4+T cells. The amount of IL-2 and IFN-γ secreted by T cells stimulated by DCs in P. gingivalis-LPS group was significantly lower than that of E. coli-LPS group (p < 0.05), meanwhile, IL-10 secreted by T cells stimulated by DCs in P. gingivalis-LPS group was significantly higher than that of E. coli-LPS group (p < 0.05). When TLR4 inhibitor was added to E. coli-LPS group, maturation and antigen-presenting functions of DCs were significantly inhibited. When TLR4 inhibitor was added to P. gingivalis-LPS group, maturation and antigen-presenting functions of DCs were not significantly inhibited. When TLR2 and TLR4 inhibitor was added to P. gingivalis-LPS group, maturation and antigen-presenting functions of DCs were significantly inhibited. CONCLUSIONS: P. gingivalis-LPS could prime DCs maturation and antigen-presenting functions. DCs stimulated by P. gingivalis-LPS are prone to induce a stronger Th2 cell responses while DCs stimulated by E. coli-LPS are prone to induce a stronger Th1 cell responses. P. gingivalis-LPS triggers DCs through TLR2 pathway while E. coli-LPS triggers DCs through TLR4 pathway.

Keratocystoma of the parotid gland: a clinicopathological study and literature review.

The authors investigated the clinicopathological characteristics of keratocystoma of the parotid gland. Two cases of parotid gland keratocystoma in the files of Nanjing Stomatological Hospital were analysed. These slowly growing parotid gland tumours occurred in two women aged 29 and 49 years. The cut surface showed multilocular cystic lesions filled with keratin materials. Histologically, there were multi-cystic spaces and solid epithelium islands, containing keratinized lamellae. Without cytological atypia, the lining stratified squamous epithelium showed apparent keratinization through an orthokeratotic or parakeratotic pathway. No skin appendage formation was observed. Both cases immunoreactively stained positively for AE1/AE3 and CK5/6 but negatively for CK8/18, S-100 and Calponin. There was no evidence of recurrence 3 or 4 years after superficial parotidectomy. The data from these two cases and cases previously published suggest that keratocystoma of the parotid gland is a benign cystic neoplasm. Surgical resection is apparently sufficient for cure.

Peripheral blood dendritic cells and vascular endothelial growth factor in oral squamous cell carcinoma: correlation analysis and in vitro study.

Vascular endothelial growth factor (VEGF) may cause functional deficiency in dendritic cells (DCs) in vitro. The roles of peripheral blood dendritic cells (PBDCs) and VEGF in patients with oral squamous cell carcinoma (OSCC) are not well understood. The authors analysed the correlation between VEGF and PBDC in 81 OSCC patients. They assessed the effect of VEGF on DC function in vitro. VEGF levels were significantly increased in OSCC patients compared with control subjects (P < 0.05), but PBDC levels were significantly lower (P < 0.05). VEGF expression in TNM I-II (67%) and T1-T2 (74%) was significantly lower, compared with TNM III-IV (88%, P < 0.05) and T3-T4 (89%, P < 0.05). Increased VEGF expression in primary tumours was significantly correlated with elevated serum VEGF levels, but reduced PBDC levels. In vitro cultured DC exposed to VEGF showed significantly decreased expression of functional proteins, enhanced endocytosis activity, and elicited weaker proliferation of T cells, compared with that of free VEGF (P < 0.01). These findings suggest that decreased PBDC and elevated VEGF occur in OSCC patients. Higher VEGF levels may affect precursor cells, resulting in decreased numbers of functional DC.

Increased frequency of the mannose-binding lectin LX haplotype in Chinese systemic lupus erythematosus patients.

Mannose-binding lectin (MBL) is an important complement-activating protein of the human immune system. As a result of one of three structural gene mutations in exon 1 (variants B, C and D) and/or the presence of a low-efficiency promoter polymorphism, MBL deficiency may be associated with increased susceptibility to infectious diseases and to autoimmune disorders, including systemic lupus erythematosus (SLE). Using a combined approach of heteroduplex generator and polymerase chain reaction, a systematic search for mutations in exon 1 and the promoter region of the MBL gene was performed in a Chinese study population comprising 41 SLE patients and 111 healthy controls. Two alleles, a wild-type allele A and a variant allele B (a previously reported mutation of GGC to GAC at codon 54), were identified in MBL exon 1. The frequency of the B allele (0.15) was higher in the SLE patients than in the healthy controls (0.09), but the difference did not attain statistical significance (P > 0.05). However, for two polymorphisms at positions -550 and -221 in the promoter region, the frequency of the low-MBL-producing haplotype (LX) in the patients (0.2073) was significantly higher than that in the controls (0.0855) (P = 0.003, relative risk = 2.79). Our results suggest that the LX haplotype represents a strong risk factor among Chinese SLE patients. Although of lesser importance, the MBL B allele also may be a risk component in the developing process of SLE in Chinese patients.

[Advances of construction of tissue engineered blood vessels].

OBJECTIVE: To discuss the approaches of tissue engineered blood vessels (TEBV) reconstruction. METHODS: The recent literatures about TEBV were widely reviewed. We summarized various types of biomaterials served as scaffold for TEBV and evaluated the construction model of TEBV. And the biological properties of some TEBV were compared. RESULTS: Although the final model of construction of TEBV was not clear, reports in the last two years had shown several important advances in this exciting field. CONCLUSION: Mimicry of some or all of the properties of three layers of natural healthy blood vessels has been the strategy of all TEBV approaches.

[Observation in vivo histological response induced by imlplanted domestic poly-DL-lactic acid plates]

OBJECTIVE:To analyze the histological response and biocompatibility to implanted domestic PDLLA plates in vivo METHODS:Bilateral artificial fractures were created in mandibular bodies in dog and internal fixed with domestic PDLLA plate,TM plate respectively;meanwhile,a domestic PDLLA plate was imlplanted in femur.The interfacial soft tissue around the plates were collected and performed histological study RESULTS:All the skin wound healed well without abscess and fistula formation. From 2 to 4 weeks after the operation,the inflmmatory granulomatous response around the intenal fixation PDLLA plates was more serious than that of the control,in which more macrophages,plasmocytes and less lymphocytes,mononuclear cells infiltrated CONCLUSION:Domestic PDLLA plate is an inert internal fixation material with good biocompatibility, which induced a non-speciflc foreign reaction

[Observation of the biodegradation of domestic poly-DL-lactic acid plates in vivo]

OBJECTIVE:To analyze the degradation and related factors of domestic poly-DL-lactic acid(PDLLA) plates in vivo. METHODS: The artifical transverse fractures in mandibular bodies of dogs were created and internal fixed with domestic PDLLA plates as experimental group,the implanted PDLLA plates in femurs as control.A certain time after the operation,the plates in fractured and implanted regions were collected and undertaken macroscopy and scanning electromicroscopy(SEM),meanwhile the fracture-healing status was evaluated. RESULTS: With time going on,the surface of domestic PDLLA plates y and density of micro-holes among poly-DL-lactic acid molecules in the PDLLA plates increased gradually.16-20 weeks Domestic PDLLA plates can be gradually biodegradation in vivo,in which it is correspondent with and accelerative the fracture-healing process.

[Observation of clinical and pathological responses in short-term following immunochemotherapy for oral squamous cell carcinoma]

24 patients with oral SCC in Stage T3 or T4 were randomly divided into two groups,and treated with two inductive therapies,13 cases of whom received an immumochemotherapy regimen(Sapylin 15 KE+CDDP 70mg/m(2)+VCR 1.4mg/m(2)+PYM 80mg,S-PVP) and 11 cases,a chemotherapy regimen(CDDP 90mg/m(2)+VCR 1.4mg/m(2)+PYM 80mg,PVP) as control.The clinical response and pathological effect after immunochemotherapy or chemotherapy were evaluated through the clinical measurement of tumor size and pathological examination of the specimen.The results showed that the rate of clinical and pathological responses in S-PVP group were 92.3% and 84.6%,respectively;and in PVP group,72.7% and 45.5%.There was a significant difference between two groups in pathological effect(P<0.05),which indicated that the S-PVP regimen in short-term was better than of inductive chemotherapy.It may be relatively objective and accurate in comparison with clinical investigation which could act as an important supplement to the evaluation of clinical response.

[Effect on intratumoral T lymphocyte and its subset in oral squamous cell carcinoma following immumnochemotherapy]

The relative numbers of CD(3)(+),CD(3)(+),CD(8)(+) and HLA-RD(+) cells in the tumor tissue before and after inductive therapy was counted using immunohistochemical technique of Avidin Biotin-Peroxidase Complex(ABC),and then the effect on local immune cell following two different inductive therapies was comparatively analysed.The results showed that S-PVP therapy could result in significant increasing in numbers of CD(3)(+)and CD(4)(+) cells intratumorally as compared with pre-therapy(P<0.05),and in slignt increasing in numbers of CD(8)(+) and HLA-DR(+) cell,which is no significant difference between pre-and post-therapy.In the PVP group,there was no significant difference in numbers of CD(3)(+),CD(4)(+),CD(8)(+) and HLA-DR(+) cells between pre-and post-treatment.The results suggested that T lymphocyte in the tumor site could significantly increase in numbers following the S-PVP therapy,and PVP chemotherapy did not obviously affect the local cellular immunity.

[Yield and cytotoxicity of tumor-infiltrating lymphocyte(TIL) following immunochemotherapy]

Tumor-infiltrating lymphocyte (TIL) in the primary site of oral SCC treated with S-PVP of PVP therapy was collected respectively and its yield,that is calculating the amount of TIL per tumor tissue.The cytotoxicity of TIL against the target,Tca8113 was detected.The results showed that the yield of TIL in S-PVP group was three times over that in PVP group.At the ratio of 5 to 1 (effector to target) the cytotoxicity was 38% in S-PVP group and 32% in PVP group.There was no significant difference in its cytotoxicity between two groups.The results revealed that immunochemotherapy of S-PVP regimen for treating oral SCC had neither direct damage to tumor cell from the agents nor antitumor immune reactivity with BRM stimulating an increasing in numbers of TIL.

[A prospective study evaluating effectiveness of TMJ arthroscopy for particular stages of internal derangement]

The purpose of this prospective study is to evaluate effect on particular stages of internal derangement by TMJ arthroscopy.According to Wilkes-Bronstein classification,the distributions between 81 joints and particular stages of ID were:25 joints in II stage,18 in III,24 in IV,and 14 in V.The total 81 joints were undergone by arthroscopic surgery,the total success rates of different stages of ID were:24/25 joints in II stage,16/18 in III,13/24 in IV,and 7/14 in V particularly.The success rates were no statically significance (P>0.05) between II stage and III stage or between IV and V or V stages.The conclusion is that these cases in II or III stages of ID choose arthroscopic surgery than those cases in IV or V stages.

[A retrospective study evaluating effectiveness of different TMJ arthroscopic techniques for discal displacement with or without reducing]

The three arthroscopic techniques were particularly method I(lysis and lavage),method II(disc repositioning and sclerotherapy plus method I),method III(traction,fixation plus method II) in order to make comparative study.The distributions between the 76 joints and three techniques were:14 joints in method I,31 in II,and,31 in III.The total follow-up was 30m(6-84m),and the total success rate was 73.7%(53/76).The mean follow-ups were particularly:28.6m in method I,38.4m in II.and,74.2%(23/31) in III,particularly.There were no statically significance between I and II.In disc displacement with reducing,there were no statically significance between method II(18/20) or III(14/15) and I(1/40),and no statically significance between II and III.In disc displacement without reducing,there were no statically significance between method I(6/10)and II(8/11) or III(9/16),or between II and III.Conclusions were that II or method III was effective on disc displacement with reducing,and that it don't make clear for any one of three methods to be more effective on disc displacement without reducing.

Treatment of habitual dislocation of the temporomandibular joint with subsynovial injection of sclerosant through arthroscope.

Five patients with habitual dislocation of the temporomandibular joint (TMJ), failing in conservative therapy, were treated with subsynovial injections of sclerosant through an arthroscope, and this treatment was proved to be effective over the short-term. Compared with operation, this method is easily performed and produces less damage and no significant sequelae, but the long-term effects have yet to be observed.