The impact of virtual reality on student engagement in the classroom-a critical review of the literature.

Objective: The purpose of this review is to identify the impact of virtual reality (VR) technology on student engagement, specifically cognitive engagement, behavioral engagement, and affective engagement. Methods: A comprehensive search of databases such as Google, Scopus, and Elsevier was conducted to identify English-language articles related to VR and classroom engagement for the period from 2014 to 2023. After systematic screening, 33 articles were finally reviewed. Results: The use of VR in the classroom is expected to improve student engagement and learning outcomes, and is particularly effective for students with learning disabilities. However, introducing VR into middle school education poses several challenges, including difficulties in the education system to keep up with VR developments, increased demands on students' digital literacy, and insufficient proficiency of teachers in using VR. Conclusion: To effectively utilize VR to increase student engagement, we advocate for educational policymakers to provide training and technical support to teachers to ensure that they can fully master and integrate VR to increase student engagement and instructional effectiveness.

Head and neck MRI-based T stage and [18F]FDG PET/CT-based N/M stage improved prognostic stratification in primary nasopharyngeal carcinoma.

OBJECTIVES: To evaluate whether MRI-based T stage (TMRI), [18F]FDG PET/CT-based N (NPET/CT), and M stage (MPET/CT) are superior in NPC patients' prognostic stratification based on long-term survival evidences, and whether TNM staging method involving TMRI + NPET/CT + MPET/CT could improve NPC patients' prognostic stratification. METHODS: From April 2007 to December 2013, 1013 consecutive untreated NPC patients with complete imaging data were enrolled. All patients' initial stages were repeated based on (1) the NCCN guideline recommended "TMRI + NMRI + MPET/CT" ("MMP") staging method; (2) the traditional "TMRI + NMRI + Mconventional work-up (CWU)" ("MMC") staging method; (3) the single-step "TPET/CT + NPET/CT + MPET/CT" ("PPP") staging method; or (4) the "TMRI + NPET/CT + MPET/CT" ("MPP") staging method recommended in present research. Survival curve, ROC curve, and net reclassification improvement (NRI) analysis were used to evaluate the prognosis predicting ability of different staging methods. RESULTS: [18F]FDG PET/CT performed worse on T stage (NRI = - 0.174, p < 0.001) but better on N (NRI = 0.135, p = 0.004) and M stage (NRI = 0.126, p = 0.001). The patients whose N stage upgraded by [18F]FDG PET/CT had worse survival (p = 0.011). The "TMRI + NPET/CT + MPET/CT" ("MPP") method performed better on survival prediction when compared with "MMP" (NRI = 0.079, p = 0.007), "MMC" (NRI = 0.190, p < 0.001), or "PPP" method (NRI = 0.107, p < 0.001). The "TMRI + NPET/CT + MPET/CT" ("MPP") method could reclassify patients' TNM stage to a more appropriate stage. The improvement is significant in patients with more than 2.5-years follow-up according to the time-dependent NRI values. CONCLUSIONS: The MRI is superior to [18F]FDG PET/CT in T stage, and [18F]FDG PET/CT is superior to CWU in N/M stage. The "TMRI + NPET/CT + MPET/CT" ("MPP") staging method could significantly improve NPC patients' long-term prognostic stratification. CLINICAL RELEVANCE STATEMENT: The present research provided long-term follow-up evidence for benefits of MRI and [18F]FDG PET/CT in TNM staging for nasopharyngeal carcinoma, and proposes a new imaging procedure for TNM staging incorporating MRI-based T stage and [18F]FDG PET/CT-based N and M stage, which significantly improves long-term prognostic stratification for patients with NPC. KEY POINTS: • The long-term follow-up evidence of a large-scale cohort was provided to evaluate the advantages of MRI, [18F]FDG PET/CT, and CWU in the TNM staging of nasopharyngeal carcinoma. • A new imaging procedure for TNM stage of nasopharyngeal carcinoma was proposed.

[Environmental Process, Effects and Risks of Emerging Contaminants in the Estuary-Coastal Environment].

Human activities and global climate change have contributed substantially to the input of land-sourced pollutants into the aquatic environment, especially for emerging or newly identified contaminants, such as microplastics, emerging persistent organic pollutants, pharmaceuticals, and personal care products. The prevalence and toxicity of these emerging pollutants has raised continued concern for the health and safety of the public worldwide. A review of sources, distribution, interfacial transport processes of microplastics, per-and polyfluorinated compounds, antibiotics, and endocrine-disrupting chemicals and factors that influence their environmental behavior in the estuary-coastal environment have been included. The adverse ecological effects and health risks of these emerging contaminants to humans were also reviewed. Lastly, the direction of future research was provided regarding the environmental behavior of multiple emerging pollutants in the coastal environment and the health risks resulting from their interactions, supporting the prevention and control of marine pollution and the healthy development of the marine economy.

[Relationship between peripheral blood micronutrients and four kinds of oral mucosal diseases in children: clinical analysis of 217 cases].

PURPOSE: To investigate the relationship between peripheral blood micronutrient levels and 4 kinds of oral mucosal diseases (minor recurrent aphthous ulcer, angular cheilitis, cheilitis and geographic tongue) in children aged 0~14 years. METHODS: One hundred and fifty-two children with oral mucosal lesions (COML) and 65 healthy children (health control group, HC) were included. The clinical data of each group were recorded separately to compare whether there existed differences in the levels of serum water-soluble vitamins (vitamins B1, B2, B3, B5, B6, B7, B9, B12, C), serum fat-soluble vitamins [vitamins A, E, K, 25(OH)D2, 25(OH)D3], zinc and serum calcium. Whether peripheral blood micronutrients were risk factors associated with the onset of COML was analyzed through disorder multiclass logistic regression with SPSS 23.0 software package. RESULTS: Peripheral blood micronutrients differed in children with minor recurrent aphthous ulcers, cheilitis, and geographic tongue (P＜0.05). Compared with HC group, children in minor recurrent aphthous ulcer group had significantly lower levels of vitamin B1, B6, B7, C, A, and 25(OH)D3 (P＜0.05), and relatively higher rates of vitamin B6 (50.00% vs 13.85%), vitamin B7 (36.76% vs 9.23%), 25(OH)D3 (64.71% vs 36.92%) deficiency and vitamin K excess (8.82% vs 0.00%)(P＜0.005). Multiclass logistic regression analysis showed that vitamin B1, vitamin C, vitamin A deficiency, vitamin B5, and vitamin K excess were risk factors for incidence in children with minor recurrent aphthous ulcer, and each element was independent for each other. Compared with HC group, the levels of vitamin B7 and 25(OH)D3 in children with cheilitis were significantly lower(P＜0.05), and the rate of vitamin B7 deficiency was significantly higher (P＜0.005). Multiclass logistic regression analysis showed that vitamin B7 and vitamin A deficiency were risk factors for cheilitis in children, and the two were independent for each other. Compared with the HC group, vitamin K excess rate was significantly higher in children with geographic tongue (7.14% vs 0.00%) (P＜0.005). Multiclass logistic regression analysis showed that vitamin C deficiency and vitamin K excess were risk factors for the incidence of geographic tongue, and the two were independent for each other. Compared with other groups, peripheral blood micronutrients had no correlation with the pathogenesis of angular cheilitis (P＞0.05). CONCLUSIONS: The occurrence of COML is closely related to peripheral blood micronutrient levels, which suggests that children with COML need to monitor vitamin and mineral levels and supplement treatment when necessary.

[Expression of B cell activation factor and correlation analysis in patients of systemic lupus erythematosus and its correlation with periodontitis].

PURPOSE: To detect the level of B cell activating factor (B - cell activating factor of the TNF family, BAFF) in the serum of patientes suffering from systemic lupus erythematosus (SLE) with periodontitis, and analyze the relationship between the expression of BAFF with periodontitis and SLE. METHODS: According to the inclusion criteria, patients visiting the Department of Stomatology and Rheumatology, Shengjing Hospital Affiliated to China Medical University were selected, including 19 patients in the periodontitis group(P group), 22 in the systemic lupus erythematosus group (SLE group), 24 in the systemic lupus erythematosus combined with periodontitis group(SLE+P group), and 20 in the healthy control group(H group). The general information, periodontal probing depth (PD), clinical attachment loss (CAL), gingival sulcus bleeding index(SBI) were collected. Serum samples of patients in each group were collected, and BAFF content was determined by Elisa. Rheumatic and immunological indexes of subjects in SLE group and SLE+P group were determined, and the correlation between BAFF content and periodontal indexes was analyzed. SPSS 20.0 software package was used for statistical analysis. RESULTS: CAL in P+SLE group was significantly higher than that in P group(P＜0.05). Serum BAFF concentrations in SLE+P group, SLE group and P group were significantly higher than those in the healthy control group (P＜0.05). Serum BAFF concentration in SLE+P group was significantly higher than that in SLE group(P＜0.05). ESR, SLEDAI and disease duration in SLE+P group were significantly higher than those in SLE group (P＜0.05). The expression level of BAFF in serum was positively correlated with CAL and SBI(P＜0.01). The expression level of BAFF in serum was positively correlated with PD(P＜0.05). There was significant positive correlation between serum BAFF level and duration of disease and hormone use(P＜0.01). Serum BAFF level was positively correlated with C3 (P＜0.05). CONCLUSIONS: SLE has certain correlation with periodontitis, and serum BAFF in SLE patients with periodontitis is significantly increased.BAFF may be associated with the development of SLE and periodontitis.

WeChat-based remote follow-up management alleviates the home care burden and anxiety of parents of premature infants: Randomized controlled study.

OBJECTIVE: The purpose of this study was to explore the effect of WeChat-based remote follow-up management on reducing the home care burden and anxiety of parents of premature infants. METHODS: A randomized controlled study was conducted in our hospital, with 150 premature infants enrolled in this study, each with 75 cases in the intervention group and the control group. WeChat-based remote follow-up management was performed in the intervention group after discharge, while traditional outpatient follow-up management was performed in the control group. Zarit Burden Interview (ZBI) scale as the primary outcome was used to compare the parental care burden between the two groups. RESULTS: At the 1-month follow-up, the ZBI (37.1 ± 8.3 vs. 54.2 ± 10.5 [mean ± SD], mean difference: 17.1, the 95% confidence interval for the mean difference: [14.07, 20.13], P = 0.016), Family Caregiver Task Inventory (FCTI) scale (23.1 ± 5.2 vs. 33.4 ± 6.7 [mean ± SD], mean difference: 10.3, the 95% confidence interval for the mean difference: [8.38, 12.22], P = 0.023), Self-Rating Anxiety Scale (SAS) (49.6 ± 8.5 vs. 60.2 ± 10.8 [mean ± SD], mean difference: 10.6, the 95% confidence interval for the mean difference: [7.49,13.71], P = 0.021) and Self-Rating Depression Scale (SDS) (48.2 ± 9.5 vs. 58.8 ± 11.2 [mean ± SD], mean difference: 10.6, the 95% confidence interval for the mean difference: [7.28, 13.92], P = 0.019) scores of the intervention group were lower than those of the control group, and the lower scores indicate better outcomes. CONCLUSION: WeChat-based remote follow-up management of premature infants after discharge can effectively improve parents' ability to care and their psychological state and reduce burden of care.

[Preliminary study on the correlation between IL-6,IL-33, and IL-10 and periodontitis and rheumatoid arthritis].

PURPOSE: To determine the expression levels of interleukin-6(IL-6), interleukin-33 (IL-33) and interleukin-10 (IL-10) in gingival crevicular fluid in patients with periodontitis and rheumatoid arthritis, and to investigate the correlation between IL-6, IL-33, IL-10 and periodontitis and rheumatoid arthritis. METHODS: According to the inclusion criteria, patients who were admitted to the Department of Stomatology and Rheumatology and Immunology of Shengjing Hospital of China Medical University were selected, including 21 patients with periodontitis (PD group), 21 patients with rheumatoid arthritis (RA group), and 24 patients with periodontitis combined with rheumatoid arthritis (PD+RA group), 24 healthy patients (H group). General information for each subject was recorded including periodontal probing depth (PPD), clinical attachment loss (CAL), and gingival sulcus bleeding index (SBI). Samples of gingival crevicular fluid were collected from each group, and the contents of IL-6, IL-33 and IL-10 in gingival crevicular fluid were determined by ELISA, and the correlation between IL-6, IL-33, IL-10 and periodontal clinical indicators was analyzed. SPSS 20.0 software package was used to analyze the date. RESULTS: The expression level of IL-6 in PD+RA group was significantly higher than that in H group, PD group and RA group (P<0.05). The content of IL-33 in PD group, RA group and PD+RA group was significantly higher than that in H group (P<0.05), while the content of IL-33 in PD+RA group was significantly higher than that in RA group (P<0.05). The expression level of IL-10 in the RA group was significantly higher than that in the H group, the PD group and the PD+RA group (P<0.05). PPD in PD group was positively correlated with the contents of IL-6 and IL-33 (r=0.62, 0.43), SBI, PPD and CAL in PD+RA group were positively correlated with the contents of IL-33 (r=0.69, 0.58, 0.55). CONCLUSIONS: The levels of IL-6 and IL-33 in gingival crevicular fluid of patients with periodontitis accompanied by rheumatoid arthritis are significantly increased, while the contents of IL-10 are significantly decreased, suggesting that IL-6, IL-33 and IL-10 play an important role in the occurrence and development of periodontitis and rheumatoid arthritis.

Correlation of Tim-3 expression with chemokine levels for predicting the prognosis of patients with glioblastoma.

Glioblastoma (GBM) immunotherapy, which blocks the checkpoint inhibitor molecule T cell immunoglobulin domain and mucin domain-3 (Tim-3), has potential therapeutic applications. However, not all patients do benefit from the targeted therapy. This study aimed to explore Tim-3 expression correlated chemokine profiles and immune cell infiltration and investigate their potential as prognostic markers of glioblastoma (GBM) immunotherapy. We analyzed transcriptional data of GBM from TCGA database, to measure Tim-3 expression by R package DESeq2 analysis and observed differentially expressed genes in GBM samples with high Tim-3 expression levels. We also probed the relative gene enrichment pathways. Tim-3 expression was evident in biological processes including the recruitment of immune cells. We also identified some chemokines related to Tim-3 expression. The expression levels of CCL18, CXCL13 and CCL7 were significantly higher in GBM tissues with high Tim-3 expression than in GBM tissues with low Tim-3 expression. In addition, exploring the relationship between immune cell infiltration and Tim-3 expression suggested that Tim-3 expression was positively related to significant immune cell infiltration.

Prognostic Value of the Modified Systemic Inflammation Score in Patients With Extranodal Natural Killer/T-Cell Lymphoma.

BACKGROUND: Extranodal natural killer/T-cell lymphoma (ENKTL) is a rare and extremely malignant tumor. The systemic inflammation score (SIS), which is based on the pretreatment level of lymphocyte-to-monocyte ratio (LMR) and serum albumin (Alb), has been shown to be of prognostic value in a number of cancers. We integrate several other pretreatment serum inflammatory indicators, including the neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), serum C-reactive protein (CRP) and albumin (Alb) level, to establish a modified systemic inflammatory scoring system to predict clinical outcomes of ENKTL. METHODS: A total of 184 patients with newly diagnosed ENKTL was retrospectively investigated. Systemic inflammatory indexes, including NLR, LMR, CRP, and Alb level were reviewed. Receiver operating characteristic (ROC) curve analysis was carried out to obtain the optimal cut-off value. The associations between cutoff values and overall survival (OS) were analyzed by Kaplan-Meier curves and Cox proportional models. RESULTS: The median age of patients was 44.0 years, ranging from 15 to 82 years. There were 129 (70.1%) male patient. About 57.1% of patients had stage III or IV disease. The optimal cut-off values of NLR and LMR in predicting OS were 3.1 and 2.4, respectively. The clinical standard of CRP and Alb levels at 10 and 40 mg/L, respectively, were chosen as the optimal cut-off values. By multivariate analysis, hemophilic syndrome (hazard ratio [HR]: 10.540, 95% confidence interval [CI]: 3.440-32.291, P < 0.001), advanced Ann Arbor stages (III-IV) (HR: 4.606, 95% CI: 1.661-12.774, P = 0.003), paranasal sinus invasion (HR: 2.323, 95% CI: 1.069-5.047, P = 0.033), NLR ≥ 3.1 (HR: 3.019, 95% CI: 1.317-6.923, P = 0.009), Alb level of <40 mg/L (HR: 0.350, 95% CI: 0.134-0.915, P = 0.032), and radiation therapy (HR: 0.430, 95% CI: 0.205-0.901, P = 0.025) were independent protective factors for ENKTL. We combined two inflammatory indexes NLR and Alb level to establish a modified systemic inflammation score (mSIS). These 184 patients were divided into 3 groups: group 1 (mSIS score of 0), group 2 (mSIS score of 1), and group 3 (mSIS score of 2). The mean OS of these three groups were 42 months (95% CI: 31.4-53.12), 77 months (95% CI: 68.5-87.5), and 89 months (95% CI: 71.4-82.7), respectively (P < 0.001). The Harrell's concordance index (C-index) of mSIS is 0.725. The mSIS could be used to discriminate patients categorized in the low-risk group of International Prognostic Index (IPI) (P < 0.001) and the low-risk and intermediate-risk prognostic index of natural killer cell lymphoma (PINK) group (P = 0.019). CONCLUSION: The pretreatment mSIS could be an independent prognostic factor for OS in patients with ENKTL and warrants further research.

Association of body composition with survival and inflammatory responses in patients with non-metastatic nasopharyngeal cancer.

OBJECTIVES: It is unknown whether or not the body composition is correlated with the prognosis and inflammatory response in patients with nasopharyngeal cancer (NPC). MATERIALS AND METHODS: This cohort included 1767 patients with NPC. Visceral, subcutaneous and intra muscular adipose tissues (VAT, SAT and IMAT), and skeletal muscle index were quantified with computed tomography. We used the optimal stratification to select cut points for VAT, SAT and IMAT. We defined sarcopenia according to a widely used cut-point. The primary endpoint was overall survival (OS). The association between body composition and inflammatory response was also examined. RESULTS: Low VAT, SAT, IMAT and sarcopenia were observed in 260 (14.7%), 451 (25.5%), 773 (43.7%) and 683 (38.7%) patients, respectively. Low VAT (P < 0.001, hazard ratio [HR], 1.884; 95% confidence interval [CI], 1.436-2.473,) and SAT (P = 0.022, HR, 1.334, 95%CI, 1.043-1.706) were both associated worse survival. IMAT and sarcopenia were not with prognostic value. In multivariate analysis, we found the prognostic value of the VAT (HR: 1.544, 95% CI: 1.128-2.114; P = 0.007) was independent of T stage, N stage, disease stage, lactic dehydrogenase, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), the systemic immune-inflammation index (SII), EBV-DNA and body mass index. We observed higher NLR (P = 0.028) and PLR (P < 0.001) in patients with low SAT. Both low VAT (P = 0.009) and SAT (P = 0.005) were associated with decreased stromal lymphocyte infiltrating intensity. CONCLUSIONS: Among body composition parameters, VAT was an independent prognostic factor, especially in patients with locally advanced NPC.

ß-Elemene suppresses the proliferation of human airway granulation fibroblasts via attenuation of TGF-ß/Smad signaling pathway.

BACKGROUND: Benign airway stenosis is easily to recur as a result of hyperplastic airway granulation tissues. Our previous study proved that a Chinese drug, ß-elemene, could inhibit the proliferation of fibroblasts cultured from these tissues, which could decrease the recurrence rate of this disease. METHODS: To find out the mechanism for this effect, we first cultured normal human airway fibroblasts and human airway granulation fibroblasts with different concentrations of ß-elemene for the same time or the same dose of ß-elemene for different times to explore the dose/time-effect relationship between the drug and these cells. Then we used gene microarray to screen out the most important pathway by which the drug influenced human airway granulation fibroblasts. At last, we assessed the condition of this pathway in human airway granulation fibroblasts and verified the effect of this drug on this pathway. RESULTS: ß-Elemene inhibited the proliferation of human airway granulation fibroblasts in a dose but no time-dependent manner and did not affect normal human airway fibroblasts. Affecting the expression of transforming growth factor ß (TGF-ß)/Smad pathway may be the key mechanism for this effect. This pathway was activated in human airway granulation fibroblasts and ß-elemene inhibited it in a dose-dependent manner. This effect was similar to the pathway inhibitor, SB431542, and exogenous TGF-ß could attenuate this effect. CONCLUSION: These results indicated that suppressing TGF-ß/Smad pathway was possibly the key mechanism by which ß-elemene inhibits the proliferation of human airway granulation fibroblasts. This pathway may be a promising target to treat benign airway stenosis.

Predictors for reactive thymic hyperplasia and its prognostic value in children and adolescents with lymphoma.

BACKGROUND: Reactive thymic hyperplasia (RTH) is seen in children and adolescents receiving chemotherapy for various malignancies. However, it is not clear why this occurs only in some patients. The aim of this study was to identify the predictors for RTH in children and adolescents receiving chemotherapy for lymphoma and to determine the effect of RTH on prognosis. METHODS: We reviewed the medical records of 126 lymphoma patients (October 2007-October 2012). The patients were divided into two groups according to different criteria, i.e., age at initial diagnosis (2-12 years vs. 13-18 years); presence of thymic infiltration at baseline (yes vs. no); and receipt of mediastinal radiotherapy (yes vs. no). The Kaplan-Meier method and multivariate Cox regression model analysis were used to analyze predictors for RTH. Further, patients were divided into two groups according to the occurrence of RTH during follow-up, and Kaplan-Meier survival analysis was used to analyze the prognostic value of RTH. RESULTS: The 2-12-year-old group had a shorter duration from the end of therapy to RTH than the 13-18-year-old group (median: 3 months vs. 16 months) and a higher rate of RTH (97.1% vs. 60.3%, P < 0.001). The lymphoma thymic non-infiltration group had a shorter duration from the end of therapy to RTH than the lymphoma infiltration group (median: 4 months vs. 22 months), and a higher rate of RTH (88.2% vs. 57.6%, P < 0.001). The non-mediastinal radiotherapy group had higher rate of RTH than the mediastinal radiotherapy group (84.7% vs. 12.5%, P < 0.001). Low age, absence of thymic infiltration by lymphoma at baseline, and absence of mediastinal radiation were predictors for RTH by multivariate Cox regression analysis (P < 0.05). The RTH group had a lower recurrence rate than the non-RTH group (13.9% vs. 40%), and a longer duration from the end of therapy to recurrence (median: 10 months vs. 5 months, P < 0.001). CONCLUSIONS: Younger age, absence of thymic infiltration by lymphoma at baseline and absence of mediastinal radiotherapy are predictors for RTH in children and adolescents. RTH may be a positive prognostic factor.

Curcumin Inhibits Lipopolysaccharide-Induced Mucin 5AC Hypersecretion and Airway Inflammation via Nuclear Factor Erythroid 2-Related Factor 2.

BACKGROUND: Excess mucus production is an important pathophysiological feature of chronic inflammatory airway diseases. Effective therapies are currently lacking. The aim of the study was to evaluate the effects of curcumin (CUR) on lipopolysaccharide (LPS)-induced mucus secretion and inflammation, and explored the underlying mechanism in vivo and in vitro. METHODS: For the in vitro study, human bronchial epithelial (NCI-H292) cells were pretreated with CUR or vehicle for 30 min, and then exposed to LPS for 24 h. Next, nuclear factor erythroid 2-related factor 2 (Nrf2) was knocked down with Nrf2 small interfering RNA (siRNA) to confirm the specific role of Nrf2 in mucin regulation of CUR in NCI-H292 cells. In vivo, C57BL/6 mice were randomly assigned to three groups (n = 7 for each group): control group, LPS group, and LPS + CUR group. Mice in LPS and LPS + CUR group were injected with saline or CUR (50 mg/kg) intraperitoneally 2 h before intratracheal instillation with LPS (100 µg/ml) for 7 days. Cell lysate and lung tissue were obtained to measured Mucin 5AC (MUC5AC) and Nrf2 mRNA and protein expression by a real-time polymerase chain reaction and Western blotting. Bronchoalveolar lavage fluid (BALF) was collected to enumerate total cells and neutrophils. Histopathological changes of the lung were observed. Data were analyzed by one-way analysis of variance. Student's t-test was used when two groups were compared. RESULTS: CUR significantly decreased the expression of MUC5AC mRNA and protein in NCI-H292 cells exposed to LPS. This effect was dose dependent (2.424 ± 0.318 vs. 7.169 ± 1.785, t = 4.534, and 1.060 ± 0.197 vs. 2.340 ± 0.209, t = 7.716; both P < 0.05, respectively) and accompanied by increased mRNA and protein expression of Nrf2 (1.952 ± 0.340 vs. 1.142 ± 0.176, t = -3.661, and 2.010 ± 0.209 vs. 1.089 ± 0.132, t = -6.453; both P < 0.05, respectively). Furthermore, knockdown of Nrf2 with siRNA increased MUC5AC mRNA expression by 47.7%, compared with levels observed in the siRNA-negative group (6.845 ± 1.478 vs. 3.391 ± 0.517, t = -3.821, P < 0.05). Knockdown of Nrf2 with siRNA also markedly increased MUC5AC protein expression in NCI-H292 cells. CUR also significantly decreased LPS-induced mRNA and protein expression of MUC5AC in mouse lung (1.672 ± 0.721 vs. 5.961 ± 2.452, t = 2.906, and 0.480 ± 0.191 vs. 2.290 ± 0.834, t = 3.665, respectively; both P < 0.05). Alcian blue/periodic acid-Schiff staining also showed that CUR suppressed mucin production. Compared with the LPS group, the numbers of inflammatory cells (247 ± 30 vs. 334 ± 24, t = 3.901, P < 0.05) and neutrophils (185 ± 22 vs. 246 ± 20, t = 3.566, P < 0.05) in BALF decreased in the LPS + CUR group, as well as reduced inflammatory cell infiltration in lung tissue. CONCLUSION: CUR inhibits LPS-induced airway mucus hypersecretion and inflammation through activation of Nrf2 possibly.

[Detection and significance of IL-6 and TNF-α in patients with Graves disease and periodontitis].

PURPOSE: To investigate the expression of IL-6 and TNF-α in gingival crevicular fluid (GCF) and serum of patients with Graves' disease(GD) and periodontitis (CP), and to analyze the correlation between Graves' disease and periodontitis. METHODS: One hundred and twenty subjects were selected and divided into 4 groups: 30 healthy participants as the control group, 30 patients with CP, 30 patients with GD, and 30 patients with GD and CP. The serum and GCF level of IL-6 and TNF-α were measured by enzyme-linked immunosorbent assay (ELISA), and clinical periodontal parameters including probing depth (PD), clinical attachment level (CAL) and sulcus bleeding indexes (SBI) were examined. The date was analyzed with SPSS19.0 software package. RESULTS: The concentration of IL-6 and TNF-α in serum and GCF of patients with GD+CP group was significantly higher than that in CP group and GD group (P<0.05). The level of IL-6 and TNF-α in serum and GCF of patients in GD+CP group and GD group was positively correlated with FT3 and FT4 (P<0.05), and the correlation between GD+CP group was significantly higher than that in GD group. CONCLUSIONS: The level of IL-6 and TNF-α in GD+CP group were significantly higher than those in CP group and GD group, indicating that there is an interaction between periodontitis and Graves' disease in immune mechanism.

ß-Elemene inhibits the proliferation of primary human airway granulation fibroblasts by down-regulating canonical Wnt/ß-catenin pathway.

Benign airway stenosis is a clinical challenge because of recurrent granulation tissues. Our previous study proved that a Chinese drug, ß-elemene, could effectively inhibit the growth of fibroblasts cultured from hyperplastic human airway granulation tissues, which could slow down the progression of this disease. The purpose of the present study is to find out the mechanism for this effect. We cultured fibroblasts from normal human airway tissues and human airway granulation tissues. These cells were cultured with 160 µg/ml normal saline (NS), different doses of ß-elemene, or 10 ng/ml canonical Wnt/ß-catenin pathway inhibitor (Dickkopf-1, DKK-1). The proliferation rate of cells and the expression of six molecules involved in canonical Wnt/ß-catenin pathway, Wnt3a, glycogen synthase kinase-3ß (GSK-3ß), ß-catenin, α-smooth muscle actin (α-SMA), transforming growth factor-ß (TGF-ß), and Collagen I (Col-I), were measured. At last, we used canonical Wnt/ß-catenin pathway activator (LiCl) to further ascertain the mechanism of ß-elemene. Canonical Wnt/ß-catenin pathway is activated in human airway granulation fibroblasts. ß-Elemene didn't affect normal human airway fibroblasts; however, it had a dose-responsive inhibitive effect on the proliferation and expression of Wnt3a, non-active GSK-3ß, ß-catenin, α-SMA, TGF-ß, and Col-I of human airway granulation fibroblasts. More importantly, it had the same effect on the expression and nuclear translocation of active ß-catenin. All these effects were similar to 10 ng/ml DKK-1 and could be attenuated by 10 mM LiCl. Thus, ß-elemene inhibits the proliferation of primary human airway granulation fibroblasts by down-regulating canonical Wnt/ß-catenin pathway. This pathway is possibly a promising target to treat benign tracheobronchial stenosis.

Significant value of 18F-FDG-PET/CT in diagnosing small cervical lymph node metastases in patients with nasopharyngeal carcinoma treated with intensity-modulated radiotherapy.

BACKGROUND: Little is known about the nature of metastasis to small cervical lymph nodes (SCLNs) in the patients with nasopharyngeal carcinoma (NPC) examined by using 18-fluoro-2-deoxy-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT). The present study aimed to evaluate the diagnostic values of PET/CT in identifying metastasis in SCLNs in NPC patients. METHODS: Magnetic resonance images (MRI) and PET/CT scans for 470 patients with newly diagnosed, non-distant metastatic NPC were analyzed. Metastatic rates of SCLNs were defined by the positive number of SCLNs on PET/CT scans and total number of SCLNs on MRI scans. Receiver operating characteristic curve was applied to compare PET/CT-determined stage with MRI-determined stage. RESULTS: In total, 2082 SCLNs were identified, with 808 (38.8%) ≥ 5 and < 6 mm in diameter (group A), 526 (25.3%) ≥ 6 and < 7 mm in diameter (group B), 374 (18.0%) ≥ 7 and < 8 mm in diameter (group C), 237 (11.4%) ≥ 8 and < 9 mm in diameter (group D), and 137 (6.5%) ≥ 9 and < 10 mm in diameter (group E). The overall metastatic rates examined by using PET/CT for groups A, B, C, D, and E were 3.5%, 8.0%, 31.3%, 60.0%, and 83.9%, respectively (P < 0.001). In level IV/Vb, the metastatic rate for nodes ≥ 8 mm was 84.6%. PET/CT examination resulted in modification of N category and overall stage for 135 (28.7%) and 46 (9.8%) patients, respectively. The areas under curve of MRI-determined and PET/CT-determined overall stage were 0.659 and 0.704 for predicting overall survival, 0.661 and 0.711 for predicting distant metastasis-free survival, and 0.636 and 0.663 for predicting disease-free survival. CONCLUSIONS: PET/CT was more effective than MRI in identifying metastatic SCLNs, and the radiologic diagnostic criteria for metastatic lymph nodes in level IV/Vb should be re-defined.

Advantage of PET/CT in Target Delineation of MRI-negative Cervical Lymph Nodes In Intensity-Modulated Radiation Therapy Planning for Nasopharyngeal Carcinoma.

Introduction: In intensity-modulated radiation therapy (IMRT) planning for nasopharyngeal carcinoma (NPC), cervical lymph nodes (CLNs) that appear negative on magnetic resonance imaging (MRI) scans can be difficult to target. The purpose of this study was to assess the advantage of 18F-fluorodeoxyglucose positron emission tomography with computed tomography (18F-FDG PET/CT) for distinguishing MRI-negative CLNs and the effect of 18F-FDG PET/CT on diagnosis, target delineation, and dose prescription in IMRT planning for NPC. Methods: Thirty-five NPC patients with 37 MRI-negative CLNs underwent 18F-FDG PET/CT imaging before treatment. Ultrasonography-guided fine-needle aspiration cytology (USgFNAC) was performed to examine the pathology of CLNs. The 18F-FDG PET/CT and cytopathological results were compared, and the diagnostic accuracy of 18F-FDG PET/CT was calculated. The cytopathologically confirmed CLNs were delineated and treated as the gross tumor volume of lymph nodes (denoted as GTVnd). Results: Nineteen of the 37 MRI-negative CLNs were positive on 18F-FDG PET/CT, and metastasis was confirmed by USgFNAC in 16 CLNs. Of the remaining 18 18F-FDG PET/CT-negative lymph nodes, metastasis was confirmed in one. The diagnostic accuracy, sensitivity, and specificity of 18F-FDG PET/CT were 89.2%, 94.1%, and 85.0%, respectively. The positive and negative predictive values were 84.2% and 94.4%, respectively. With a median follow-up of 48.3 months, no relapse was observed among the 18F-FDG PET/CT-positive CLNs with metastasis confirmed by USgFNAC and treated as GTVnd. Conclusion:18F-FDG PET/CT had high accuracy, sensitivity, and specificity for distinguishing MRI-negative CLNs. 18F-FDG PET/CT-positive CLNs could reasonably be categorized as high-risk clinical tumor volume in IMRT planning for NPC.

[The relationship between periodontitis and arterial sclerosis without genetic confounding].

PURPOSE: The aim of this study was to evaluate periodontitis as a significant risk factor related to arterial sclerosis after eliminating genetic confounding. METHODS: Fifty two monozygotic twin pairs, 104 patients, were divided into 3 groups. group A: 24 pairs, 48 healthy people, as the blank group; group B: 28 patients with periodontitis, as the control group; group C: 28 patients with periodontitis, as the treatment group. The sample in group B and C had the same gene type. The index of CRP, IL-6, TNF-αand IMT were detected before treatment, 6 and 12 week after treatment. The data were analyzed using SPSS 17.0 software package. RESULTS: The index of CRP, IL-6, TNF-α and IMT decreased after treatment in group C, there was no significant change in group A and B at each check point. CONCLUSIONS: Periodontitis can promote the development of sclerosis without the intervening of gene.

Optimal Modality for Detecting Distant Metastasis in Primary Nasopharyngeal Carcinoma during Initial Staging: A Systemic Review and Meta-analysis of 1774 Patients.

Purpose: To compare the diagnostic performance of two modalities commonly used for detecting distant metastasis in primary nasopharyngeal carcinoma (NPC): 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) and conventional work-ups (CWUs). Methods: All topic-related studies were comprehensively searched and included. We determined sensitivities and specificities across studies, calculated negative and positive likelihood ratios (LR- and LR+, respectively), and constructed summary receiver operating characteristic curves. Moreover, we compared the diagnostic performance of PET/CT and CWUs by analyzing studies that reported the results of these diagnostic methods on the same patients. Results: The pooled sensitivity and specificity were 85.7% and 98.1% for PET/CT (1474 patients), and 38.0% and 97.6% for CWUs (1329 patients). In the head-to-head comparison of PET/CT and CWUs (1029 patients), PET/CT showed a significantly higher sensitivity (83.7% vs. 40.1%, P < 0.001) and lower LR- (0.169 vs. 0.633, P < 0.001) than CWUs on a per-patient basis; no significant difference was observed in pooled specificity (97.7% vs. 97.8%, P = 0.892) or LR+ (36.416 vs. 16.845, P = 0.149). The superiority of PET/CT over CWUs was due mainly to the better diagnostic performance on bone metastasis. However, suboptimal sensitivity of PET/CT was reported in the aspect of detection of liver metastasis. Sensitivity analyses showed relatively poor sensitivity and LR- of PET/CT compared to the original analysis. Conclusions: PET/CT was superior to CWUs in detecting distant metastasis in primary NPC. However, the efficacy of PET/CT in detecting liver metastasis still requires further optimization.

Knockdown of PKM2 and GLS1 expression can significantly reverse oxaliplatin-resistance in colorectal cancer cells.

Clinical treatment for colorectal cancer (CRC) thus far encounters a huge challenge due to oxaliplatin-resistance. As crucial rate-limiting enzymes in aerobic glycolysis and glutaminolysis, pyruvate kinase M2 type (PKM2) and kidney-type glutaminase (GLS1) are proposed to carry important implications in colorectal carcinogenesis and drug-resistance. This study aimed to explore the possible association of oxaliplatin-resistance with aerobic glycolysis/glutaminolysis indexed by PKM2/GLS1 expression. PKM2 and GLS1 expression was quantified by polymerase chain reaction (PCR) and Western blot techniques in CRC cell lines. The abilities of cell formation, kinetics, migration, invasion, survival and apoptosis, as well as permeability glycoprotein (Pgp) expression were inspected before and after knocking-down PKM2/GLS1 expression. In addition, the influence of knocking-down PKM2/GLS1 expression was evaluated in vivo. Differentiated PKM2 and GLS1 expression in both THC8307 and THC8307/Oxa cell lines was identified. In the THC8307 cell line, PKM2 and GLS1 can accelerate malignant behaviors, increase oxaliplatin-resistance, upregulate Pgp expression, and inhibit cell apoptosis. Contrastingly in the THC8307/Oxa cell line, knockdown of PKM2/GLS1 expression can restrain malignant behaviors, reestablish oxaliplatin-sensitivity, downregulate Pgp expression, and induce cell apoptosis. In xenograft, knockdown of PKM2/GLS1 expression can significantly inhibit tumor growth, reduce Pgp expression, and increase tumor apoptosis. Taken together, the present findings enriched our knowledge by demonstrating a significant association of PKM2 and GLS1 with oxaliplatin-resistance in CRC. We further propose that knockdown of PKM2/GLS1 expression may constitute a novel therapeutic strategy toward effective treatment for CRC.