[A multicenter prospective study on early identification of refractory Mycoplasma pneumoniae pneumonia in children].

Objective: To explore potential predictors of refractory Mycoplasma pneumoniae pneumonia (RMPP) in early stage. Methods: The prospective multicenter study was conducted in Zhejiang, China from May 1st, 2019 to January 31st, 2020. A total of 1 428 patients with fever >48 hours to <120 hours were studied. Their clinical data and oral pharyngeal swab samples were collected; Mycoplasma pneumoniae DNA in pharyngeal swab specimens was detected. Patients with positive Mycoplasma pneumoniae DNA results underwent a series of tests, including chest X-ray, complete blood count, C-reactive protein, lactate dehydrogenase (LDH), and procalcitonin. According to the occurrence of RMPP, the patients were divided into two groups, RMPP group and general Mycoplasma pneumoniae pneumonia (GMPP) group. Measurement data between the 2 groups were compared using Mann-Whitney U test. Logistic regression analyses were used to examine the associations between clinical data and RMPP. Receiver operating characteristic (ROC) curves were used to analyse the power of the markers for predicting RMPP. Results: A total of 1 428 patients finished the study, with 801 boys and 627 girls, aged 4.3 (2.7, 6.3) years. Mycoplasma pneumoniae DNA was positive in 534 cases (37.4%), of whom 446 cases (83.5%) were diagnosed with Mycoplasma pneumoniae pneumonia, including 251 boys and 195 girls, aged 5.2 (3.3, 6.9) years. Macrolides-resistant variation was positive in 410 cases (91.9%). Fifty-five cases were with RMPP, 391 cases with GMPP. The peak body temperature before the first visit and LDH levels in RMPP patients were higher than that in GMPP patients (39.6 (39.1, 40.0) vs. 39.2 (38.9, 39.7) ℃, 333 (279, 392) vs. 311 (259, 359) U/L, both P<0.05). Logistic regression showed the prediction probability π=exp (-29.7+0.667×Peak body temperature (℃)+0.004×LDH (U/L))/(1+exp (-29.7+0.667×Peak body temperature (℃)+0.004 × LDH (U/L))), the cut-off value to predict RMPP was 0.12, with a consensus of probability forecast of 0.89, sensitivity of 0.89, and specificity of 0.67; and the area under ROC curve was 0.682 (95%CI 0.593-0.771, P<0.01). Conclusion: In MPP patients with fever over 48 to <120 hours, a prediction probability π of RMPP can be calculated based on the peak body temperature and LDH level before the first visit, which can facilitate early identification of RMPP.

Accuracy of digital templates for guidance of custom-made total temporomandibular joint replacement.

This study evaluated the application of digital templates to guide custom-made total temporomandibular joint (TMJ) replacement. Patients treated with a custom-made total TMJ prosthesis for TMJ osteoarthrosis, ankylosis, or tumours were included prospectively. Before surgery, two types of digital template (articular eminence and condyle neck templates) were designed to guide the bone osteotomy and prosthesis positioning. The reconstructive outcomes were assessed through clinical examinations and accuracy analysis by superimposing the postoperative three-dimensional craniomaxillofacial model onto the preoperative virtual plan. Thirty-seven patients (45 joints) underwent successful TMJ reconstruction with the custom-made TMJ prosthesis guided by the digital templates, without intermaxillary fixation. For all patients, the occlusal relationship was stable in reference to the preoperative state. There were significant improvements in pain and maximum inter-incisal opening. Through merging of the pre- and postoperative craniomaxillofacial models, the maximum implanted error was 1.17 ± 0.23 mm in linear measurement and 1.19 ± 0.14 mm in surface deviation. There was more deviation in the anteromedial part of the fossa and inferior part of the mandibular handle. The digital templates were able to assist in the accurate placement of the TMJ prosthesis without the need for intermaxillary fixation.

[Study of the risk factors for recurrence of early and late stage hepatocellular carcinoma after hepatic artery embolization combined with radiofrequency ablation therapy].

Objective: To investigate the risk factors for recurrence of early and late stage hepatocellular carcinoma after receiving hepatic artery embolization combined with radiofrequency ablation therapy. Methods: 246 cases with hepatocellular carcinoma who underwent hepatic artery embolization combined with radiofrequency ablation in Beijing You'an Hospital Affiliated to Capital Medical University from January 2006 to January 2011 were selected. Clinical and follow-up data were collected. Univariate Cox analyses was used to determine the factors influencing recurrence of early and late stage HCC after hepatic artery embolization combined with radiofrequencies ablation. Multivariate Cox regression analysis was used to determine the independent factors. Results: 246 case with hepatocellular carcinoma were treated with hepatic artery embolization combined with radiofrequency ablation, with median follow-up time of 99 months. A total of 179 cases had recurrence and 67 cases had no recurrence. Considering 24 months as the limit, 95 cases had early recurrence and 84 cases had late recurrence. The 1-, 2-, 3-, 5-, and 10-year recurrence rates were 21.3%, 39.0%, 53.0%, 67.3%, and 77.6%, respectively. Multivariate Cox regression analysis showed that the maximum tumor diameter (HR = 2.183, 95% CI: 1.414-3.369, P < 0.01) and tumor number (HR = 1.681, 95% CI: 1.110-2.545, P < 0.05) were independent factor influencing recurrence of early stage HCC after hepatic artery embolization combined with radiofrequency ablation. Liver cirrhosis (HR = 0.421, 95% CI: 0.272-0.651, P < 0.01) was an independent factor influencing recurrence of late stage HCC after hepatic artery embolization combined with radiofrequency ablation. Conclusion: Tumor diameter and number are independent factors influencing recurrence of early stage HCC, while liver cirrhosis is an independent factor influencing recurrence of late stage HCC after hepatic artery embolization combined with radiofrequency ablation therapy.

[A prospective study of the effect and mechanism of autologous platelet-rich plasma combined with Meek microskin grafts in repairing the wounds of limbs in severely burned patients].

Objective: To observe the effect of autologous platelet-rich plasma (PRP) combined with Meek microskin grafts in repairing the wounds of limbs in severely burned patients, and to explore the mechanism. Methods: The prospective controlled research method was used. From September 2016 to January 2020, 16 patients aged 18-69 years, with extensive deep burns, including 9 males and 7 females, who met the selection criteria were admitted to the Department of Burns and Plastic Surgery of the 909th Hospital of the Joint Logistic Support Force of PLA. The bilateral limbs with similar injury in 8 patients were divided into Meek skin grafting+PRP group and Meek skin grafting alone group according to the random number table; in the other 8 patients, the limbs with severer injury were included in Meek skin grafting+PRP group, and the limbs on the other side were included in Meek skin grafting alone group. The wounds of affected limbs in the two groups were treated correspondingly. On post surgery day (PSD) 10, the survival and fusion of Meek microskin grafts were observed and the survival rate and fusion rate were calculated; the histological morphology and the angiogenesis of the basal tissue of Meek microskin graft were observed by hematoxylin-eosin staining and immunohistochemical staining, respectively, with the microvessels being counted. Data were statistically analyzed with paired sample t test. Results: On PSD 10, the wounds of affected limbs in Meek skin grafting+PRP group were dry, and most of the transplanted skin grafts were closely adhered to the basal tissue; while a small amount of exudate could be found in the wounds of affected limbs in Meek skin grafting alone group, and a small part of the transplanted microskin grafts fell off or poorly attached to the basal tissue. On PSD 10, the survival rate and the fusion rate of Meek microskin grafts in the wounds of affected limbs in Meek skin grafting+PRP group were (94±3)% and (86±4)%, which were significantly higher than (89±4)% and (79±4)% of Meek skin grafting alone group, respectively (t=3.633, 4.229, P<0.01). On PSD 10, the basal epidermis was closely connected with dermis of Meek microskin grafts in the wounds of affected limbs in Meek skin grafting+PRP group, with more inflammatory cell infiltration and active microvascular hyperplasia, while the basal epidermis was less closely connected with dermis of Meek microskin grafts in the wounds of affected limbs in Meek skin grafting alone group, with obvious degeneration of collagen fibers under the dermis, less inflammatory cell infiltration, and slightly poor microvascular hyperplasia. On PSD 10, the distribution of microvessels in basal tissue of Meek microskin grafts in the wounds of affected limbs in Meek skin grafting+PRP group were densely clustered, while the distribution of microvessels in Meek skin grafting alone group were scattered, sparse, and dotted. On PSD 10, the number of microvessels in basal tissue of Meek microskin grafts in the wounds of affected limbs in Meek skin grafting+PRP group was 36±6 in each 400-fold visual field, which was significantly more than 29±7 of Meek skin grafting alone group (t=2.671, P<0.05). Conclusions: Autologous PRP can effectively promote the survival rate and fusion rate of Meek microskin grafts in the wounds of limbs after escharectomy in severely burned patients by promoting angiogenesis at the base of Meek microskin grafts.

[Development and clinical application of custom-made temporomandibular joint-skull base combined prosthesis].

Objective: To introduce the design, manufacture and clinical application of the custom-made temporomandibular joint (TMJ)-skull base combined prosthesis and evaluate its safety, effectiveness and accuracy. Methods: The patients diagnosed with the TMJ-skull base lesion in Department of Oral Surgery, Shanghai Ninth People's Hospital from October 2016 to November 2020 were recruited in this study. The maxillofacial CT data for all the patients were obtained and transformed into the Mimics 18.0 software preoperatively. The custom-made TMJ-skull base combined prosthesis, included four components, was designed based on the anatomy, stress distribution and movement of the TMJ and skull base, and fabricated by three-dimensional printing and 5-axis milling technologies. The TMJ-skull base lesion was excised completely with the help of digital templates from modified preauricular and/or post and submandibular incisions. The combined prosthesis were implanted and fixed after the lesion resection. The examinations including general situation, cranio-maxillofacial structure and function were taken during and after surgery to assess its using effect. Results: Ten patients [6 females and 4 males, (43.2±13.6) years old] were included and all prostheses were positioned accurately and fixed excellently. After (29.4±17.3) months follow-up, the occlusion relationship was stable and no adverse symptoms such as dizziness, headache, meningeal irritation and permanent facial nerve injury occurred. The pain, diet, mandibular movement function, lateral movement to diseased side and mouth opening had significant improvements. The forward movement and lateral movement to normal side were not improved significantly. There were no prosthesis displacement, loosening and fracture in X-ray and CT postoperatively. With the pre and postoperative craniomaxillofacial model merging, the maximal implanted error was (0.52±0.17) mm for fossa and condyle and (1.62±0.26) mm for skull base and mandibular handle in surface deviation analysis. Conclusions: The custom-made TMJ-skull base combined prosthesis with customized design and 3D printing fabrication is safe, effective and precise in clinical application.

[Lee T'ao: the pioneer of educator and researcher of Chinese medical history].

Lee T'ao(1901-1959),studied at Beijing National Medical Institute in 1921.He worked at the Chinese Department of Concord Medical Institute from 1928-1942. He studied medical history and taught the history of western and Chinese medicines. He finished Medical History Profile in 1940.During this period, he and Concord Medical Institute collaborated to collect Chinese medical books, therefore he became one of Chinese Medical Association. After 1946, he worked at Medical School of Beijing University (later change its name into Beijing Medical Institute), and he was professor, lead of Medical Teaching and Research Office. He also joined the Editorial department of the Chinese Journal of Medical History, and edited the list of western and Chinese medical books. He published many papers of the Chinese medical history, which had broad vision and novel viewpoint. For the teaching and research, he focused on fieldwork, and physical cultural and historical relics. He investigated and surveyed some high valuable historical relics of medicine that belonged to many of Chinese dynasties. In 1954, he also worked as a lead at the office of medical history for Chinese Central Research Institute. In 1956, he collaborated with Chen Bangxian, teaching the advanced classes for the teachers. He trained many medical history researchers and teachers.

Arthroscopic versus open disc repositioning and suturing techniques for the treatment of temporomandibular joint anterior disc displacement: 3-year follow-up study.

The aim of this study was to evaluate the outcomes of temporomandibular joint (TMJ) arthroscopic and open disc repositioning procedures in the management of anterior disc displacement (ADD). All consecutive patients treated with arthroscopic (group I) or open (group II) disc repositioning between April 2014 and August 2018 were included prospectively. The patients were assessed clinically (1, 3, 6, 12, 24, and 36 months postoperative) and with magnetic resonance imaging (MRI). The statistical analysis was performed using IBM SPSS Statistics v.22.0; P < 0.05 was considered significant. A total of 177 patients (227 joints) were included: 104 patients (130 joints) in group I and 73 patients (97 joints) in group II. There were statistically significant improvements in pain score, clicking, quality of life, diet, and maximum inter-incisal opening when comparing pre- and postoperative clinical parameters within the two groups (P < 0.05 at all time-points for all clinical parameters); however, improvements occurred earlier in group I (at 1 month) than in group II (6 months). Postoperative MRI revealed an overall success rate of 98.1% in group I and 97.3% in group II. New bone formation was found in 70.2% in group I and 30.1% in group II. Arthroscopy may be a better choice for ADD patients, with the advantages of faster clinical improvement and recovery, minimal invasiveness, and better condylar remodelling.

Endoscopically assisted fixation of the custom-made total temporomandibular joint prosthesis in TMJ Yang's system through a modified preauricular approach.

This article describes the experience with the endoscopically assisted fixation of the customized total temporomandibular joint (TMJ) prosthesis in TMJ Yang's system only through a modified preauricular approach. Twenty patients (23 joints) treated with the custom-made total TMJ prosthesis were retrospectively recruited. An endoscopically assisted technique was used through a modified preauricular approach to fix the mandibular component for all these patients. These reconstructions were evaluated by surgical records, clinical examinations, and radiographic observations. All patients had successful fixation of the prosthesis. No patient had permanent weakness of the facial nerve and malocclusion or any other severe complications. The mean operative time was 111 min per joint (range, 85-133 min). The average surgical bleeding was 195 ml per side. The mean follow-up period was 16.2 months (range, 5-32 months). The mean scores were 8.3 for surgical satisfaction and 9.2 for scar healing evaluation. All patients experienced positive clinical outcomes, with a mean 75.2% reduction in pain and 53.7% increase in mouth opening with significant differences (P<0.05). The endoscopically assisted TMJ reconstruction with the customized prosthesis in TMJ Yang's system through the modified preauricular approach could produce good aesthetic and functional results.

[Effects of autologous platelet-rich plasma in the repair of soft tissue defects of rabbits with free flap].

Objective: To explore the effects of autologous platelet-rich plasma (PRP) in the repair of soft tissue defects of rabbits with free flap. Methods: Thirty 6-month-old New Zealand white rabbits, male and female unlimited, were used to harvest blood from the heart. PRP was prepared by Aghaloo method, then free flap model with size of 5 cm×3 cm was reproduced on each ear of the rabbit. According to the random number table, one ear of each rabbit was recruited to PRP group, and the other ear was recruited to normal saline group. The base of flap on rabbit ear in PRP group was evenly spread with 1.0 mL autologous PRP, and equivalent volume of normal saline was applied to that in normal saline group. Then, the flap was replanted in situ. On post surgery day (PSD) 2, 3, 5, 7, and 14, 6 rabbits in each group were taken. The survival of flap was observed and recorded. The morphology of the basal tissue of flap was observed by hematoxylin-eosin staining. The expressions of CD31 and α smooth muscle actin (α-SMA) in the basal tissue of flap were detected by immunofluorescence method. Another 6-month-old male New Zealand white rabbit without making flap under the same experimental conditions was used for harvesting whole blood and preparing PRP. Then blood platelet count in whole blood and PRP was determined, and the content of vascular endothelial growth factor (VEGF) and transforming growth factor ß (TGF-ß) was detected by double-antibody sandwich enzyme-linked immunosorbent assay. Data were processed with analysis of variance of factorial design, paired sample t test, and Bonferroni correction. Results: (1) On PSD 2, the flaps of wounds of rabbits in PRP group were reddish and adhered well to the basal tissue; the flaps of wounds of rabbits in normal saline group were dark red and poorly attached to the basal tissue. On PSD 3, the flaps of wounds of rabbits in PRP group were ruddy and closely adhered to the basal tissue; the flaps of wounds of rabbits in normal saline group were scattered in the plaque-like dark red and generally attached to the base. On PSD 5, the flaps of wounds of rabbits in PRP group were reddish and closely adhered to the basal tissue, and the flaps were alive; while flaps of wounds of rabbits in normal saline group were rosy and closely adhered to the basal tissue. On PSD 7, the surface of flaps of wounds of rabbits in PRP group was covered with a medium amount of rabbit hair. The color of flap was similar to that of the surrounding skin. The flaps of wounds of rabbits in normal saline group were generally attached to the base, and the surface was only covered with a small amount of fluff. On PSD 14, the incisions were healed well in PRP group, while small wounds in normal saline group were not healed. (2) On PSD 2, inflammatory cell infiltration was observed in flaps of wounds of rabbits in both groups. On PSD 3, the flaps of wounds of rabbits in PRP group showed neovascularization, with less interstitial hemorrhage; while there were less neovascularization in the flaps of wounds of rabbits in normal saline group. On PSD 5, a medium number of inflammatory cell infiltration and a small amount of new microvessels were observed in flaps of wounds of rabbits in normal saline group. Many fibroblasts, a small amount of inflammatory cells, and scattered new microvessels were observed in flaps of wounds of rabbits in PRP group. On PSD 7, the number of new microvessels in normal saline group was significantly lower than that in PRP group. On PSD 14, the new microvessels in the flaps of wounds of rabbits in PRP group gradually matured, and a large number of fibroblasts distributed around them. Some of the newly formed microvessels in the flaps of wounds of rabbits in normal saline group were mature, and the healing was slower than that of PRP group. (3) On PSD 2, 3, 5, 7, and 14, the expressions of CD31 and α-SMA in the basal tissue of flaps of wounds of rabbits in PRP group were significantly higher than those in normal saline group (t=10.133, 5.444, 9.450, 6.986, 8.394, 14.896, 10.328, 9.295, 13.902, 10.814, P<0.01). (4) The platelet count in activated PRP of rabbits was (2 863±962)×10(9)/L, which was significantly higher than (393±49)×10(9)/L in whole blood (t=7.690, P<0.05). (5) The content of VEGF and TGF-ß in activated PRP of rabbits was (564.3±3.2) and (1 143±251) pg/mL, which was significantly higher than (99.7±0.4) and (274±95) pg/mL in whole blood, respectively (t=287.390, 9.648, P<0.05 or P<0.01). Conclusions: PRP of rabbits contains high concentrations of VEGF and TGF-ß. Therefore, PRP can effectively promote microvascular regeneration in free flap tissue and accelerate the survival of free flap.

[Study on themisprints of the primary version of the Compendium of Materia Medica].

The Jinling version of the Compendium of Materia Medica was the primary version.It accurately represented the ideas of LI Shizhen, therefore it was valued by the scholars.There were many defects in misprint (knife carving) and proofreading.The main errors were some Chinese character's strokes missing and wrong characters printed.The authors collected some statistics data andmade some statistical analysis. They found that total misprints were 376 and emerge 615 times.Those misprints can divide into two categories: lack of some parts of Chinese characters; lack of some strokes of Chinese characters.Four tables which list the misprints was made.It is helpful for scholars to examine Compendium of Materia Medica or the study of other similar ancient literatures.

Customized skull base-temporomandibular joint combined prosthesis with 3D-printing fabrication for craniomaxillofacial reconstruction: a preliminary study.

Temporomandibular joint (TMJ) lesions, when large and extensive, will often involve skull base destruction and result in extensive resections, requiring a challenging reconstruction. This study introduces a special type of craniomaxillofacial prosthesis for massive combined skull base-TMJ lesions. Patients who presented with combined skull base-TMJ lesions were recruited. Enhanced computed tomography (CT) data were obtained for all patients and transformed into three-dimensional (3D) reconstruction models. The combined skull base-TMJ prosthesis was designed and fabricated with a customized principle by 3D-printing technology. Clinical follow-up and radiographic evaluations were performed to assess the feasibility of the combined prosthesis in clinical application. A series of five consecutive patients were included in this study. No severe complications occurred after surgery. Based on a mean follow-up period of 13.8 months, the preliminary results suggest that the combined prosthesis has a positive impact on clinical outcomes: there was a mean 75.0% reduction in pain, 55.6% improvement in diet, 54.5% improvement in mandibular function, and 33.6% increase in mouth opening, with significant differences when compared with the preoperative state (all P<0.05). This study suggests that the combined prosthesis represents a safe and reliable implantable reconstruction method for combined skull base-TMJ lesions.

Digital cutting guide and endoscopically-assisted vertical ramus osteotomy to treat condylar osteochondroma: a long-term study.

We have introduced an effective treatment for mandibular condylar osteochondroma with a digital cutting guide and endoscopically-assisted vertical ramus osteotomy (VRO). Eleven patients with unilateral condylar osteochondroma, who did not require orthognathic surgery or had less than 3mm deviation of the chin and a stable occlusion, were treated during the period April 2013-January 2017 with a digital cutting guide and endoscopically-assisted VRO. Clinical data collected included the occlusion, facial contour, and maximum mouth opening (MMO). Computed tomographic (CT) scans were taken before and after operation. Two patients also had additional shaping of the mandibular contour. The pathological diagnosis was confirmed to be osteochondroma in all cases. A mean (range) 19 (12-40) months of follow-up for all 11 cases showed stable postoperative occlusion and facial aesthetics. There were no functional disturbances, recurrence, or condylar absorption. VRO is an alternative to orthognathic surgery for patients with osteochondroma who do not have severe malocclusions. The digital cutting guide and endoscopically-assisted VRO make it possible to achieve precise resection of the tumour and maintain the occlusion with minimal invasion.

Select antibiotics in leachate from closed and active landfills exceed thresholds for antibiotic resistance development.

Though antibiotic resistance (ABR) represents a major global health threat, contributions of landfill leachate to the life cycle of antibiotics and ABR development are poorly understood in rapidly urbanizing regions of developing countries. We selected one of the largest active landfills in Asia and two landfills that have been closed for 20 years to examine antibiotic occurrences in leachates and associated hazards during wet and dry season sampling events. We focused on some of the most commonly used human antibiotics in Hong Kong, one of the most populous Asian cities and the fourth most densely populated cities in the world. Seven antibiotics (cephalexin [CLX], chloramphenicol [CAP], ciprofloxacin [CIP], erythromycin [ERY], roxithromycin [ROX], trimethoprim [TMP], sulfamethoxazole [SMX]) were quantitated using HPLC-MS/MS generally following previously reported methods. Whereas CLX, CAP, ROX and SMX in leachates did not exceed ABR predicted no effect concentrations (PNECs), exceedances were observed for CIP, ERY and TMP in some study locations and on some dates. In fact, an ABR PNEC for CIP was exceeded in leachates during both sampling periods from all study locations, including leachates that are directly discharged to coastal systems. These findings highlight the importance of developing an advanced understanding of pharmaceutical access, usage and disposal practices, effectiveness of intervention strategies (e.g., leachate treatment technologies, drug take-back schemes), and contributions of landfill leachates to the life cycle of antibiotics and ABR development, particularly in rapidly urbanizing coastal regions with less advanced waste management systems than Hong Kong.

At the Intersection of Urbanization, Water, and Food Security: Determination of Select Contaminants of Emerging Concern in Mussels and Oysters from Hong Kong.

Aquaculture, which is growing 3-5 times faster than terrestrial agriculture, will play an important role to meet future global food production needs. However, over 80% of global sewage production is returned to the environment untreated or poorly treated. In developing nations, these nontraditional waters of diverse quality are being recycled for aquaculture, yet chemical residues are differentially studied. Here, we examined pharmaceuticals, pesticides, polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs), polycyclic aromatic hydrocarbons (PAHs), and flame retardants in marine bivalves using isotope dilution liquid chromatography-tandem mass spectrometry (LC-MS/MS) and low-pressure gas chromatography-tandem mass spectrometry (LP GC-MS/MS). Green-lipped mussels from the field and oysters from aquaculture net pens, which are harvested as food products, were collected adjacent to point source municipal wastewater and landfill leachate effluent discharges, respectively, in Hong Kong, the fourth most densely populated country in the world. Multiple classes of pharmaceutical, pesticides, PAHs, and phosphorus-based flame retardants were detected at low µg/kg levels. Acceptable servings per week indicated minimal risk for a number of chemicals; however, such calculations could not be performed for other contaminants of emerging concern. Future efforts are needed to better understand contaminant influences on marine bivalve populations and aquaculture product safety, particularly in rapidly urbanizing regions of developing countries with limited wastewater infrastructure.

Parasitic infections in the East Asian finless porpoise Neophocaena asiaeorientalis sunameri living off the Chinese Yellow/Bohai Sea coast.

Parasitic disease is among the major causes of health problems in marine mammals. However, little information on parasitic species composition and infection levels in finless porpoises (Neophocaena spp.) is available. In this study, we report the first systematic survey on parasitic infections in the East Asian finless porpoise N. asiaeorientalis sunameri (EAFP) living off the Chinese Yellow/Bohai Sea coast. Using both morphological and molecular methods, 5 parasitic helminths were identified: Campula oblonga in the liver and pancreas; Synthesium seymouri in the pyloric stomach and duodenum ampulla; Anisakis pegreffii in the forestomach, main stomach, and esophagus; Halocercus sp. in the lungs; and Crassicauda magna in the mammary glands and muscle. Among these helminths, C. oblonga (80.7%), S. seymouri (80.7%), A. pegreffii (80.7%), and Halocercus sp. (77.4%) were the most prevalent, whereas C. magna (6.5%) were only observed in 2 EAFP individuals. All juvenile and adult EAFPs were parasitized by at least 3 parasites species (C. oblonga, S. seymouri, and A. pegreffii), whereas in neonates, only Halocercus sp. were detected. We observed no significant difference in parasite prevalence between males and females. In addition, A. pegreffii and C. magna represented new infection records in Neophocaena. A pathological examination associated with parasitic lesions in EAFPs showed damage or destruction of cells or tissues to some extent. This study represents the first systematic survey on parasitic infections in EAFPs, providing important and valuable parasitological information for the research and conservation of this coastal marine mammal.

Prevention of adhesions in the temporomandibular joint by the use of chitosan membrane in goats.

We evaluated the effects of chitosan membrane, a highly absorbable and viscous material, in the prevention of intra-articular adhesions after anchoring of the disc in the temporomandibular joints (TMJ) of six adult goats (12 joints). To simulate anterior displacement of the disc and TMJ trauma, we cut off the retrodiscal attachment and damaged the surface of the condylar bone, then randomly divided the goats into two groups: the control group (n=2) and the experimental group (n=4). In the experimental group we covered the condylar surfaces on both sides of the animals with chitosan membranes. Those in the control group had operations and no special treatment. We took magnetic resonance images (MRI) of all the animals before the operation and at three and six months postoperatively, and measured the interincisal opening and strength at the same time. We counted the number of adhesions macroscopically, and evaluated the adhesive tissues, cartilage, and subchondral bony changes histologically and immunohistochemically. Measurements of the interincisal opening and strength were significantly better in the experimental group than in the controls (p<0.05). Macroscopic evaluation (using a specific adhesion scoring system) showed a significant difference in the formation of adhesions between the groups (p<0.05). Although MRI showed no significant difference between the groups, the histological and immunohistochemical observations supported the hypothesis that chitosan membrane could prevent intra-articular adhesions. It seems to inhibit the formation of adhesions effectively and promote repair of the cartilage. It may therefore be considered a promising absorbable biomaterial to prevent adhesions after operations on the TMJ.

[Efficacy evaluation and exploration of TACE combined with CT-guided precision microwave ablation treatment for primary liver cancer].

OBJECTIVE: To analyze the clinical therapeutic efficacy of transcatheter arterial chemoembolization combined with CT-guided percutaneous precision microwave ablation for the treatment of primary liver cancer and its influencing factors. METHODS: A total of 126 patients with primary liver cancer were treated by transcatheter arterial chemoembolization combined with CT-guided percutaneous precision microwave ablation from Mar 2010 to Oct 2014 in our center. The treatment effect, postoperative complications and recurrence rates were observed, and the factors related to recurrence and survival time were analyzed. RESULTS: All 126 primary liver cancer patients with 201 tumors were ablated for 177 times, and 113 cases with 185 tumors were completed ablated, the complete ablation rate was 92.0%. In all patients, 4 cases had serious complications, the incidence rate was 3.2%. 37 cases had recurrence, with a recurrence rate of 29.4%. All patients were followed up for 10 to 65 months, 17 patients died, and the 1-, 2-, and 3-year cumulative survival rates were 95.2%, 88.1%, and 84.1%, respectively, and the 1-, 2-, and 3-year progression-free-survival rates were 81.5%, 62.7% and 49.2%, respectively .Univariate analysis showed that preoperative AFP level, Child-Pugh score, BCLC stage and the largest tumor size were associated with the survival of patients who received TACE combined with CT-guided precision MWA, and the preoperative AFP level, internal medicine therapy, tumor number and the largest tumor size were associated with the progression-free-survival after the treatment (P<0.05). Multivariate analysis showed that Child-Pugh score and BCLC stage were independent factors affecting the survival of patients with primary liver cancer patients treated with TACE combined with CT guided percutaneous MWA, and the tumor number and the maximum tumor size were independent factors affecting the progression-free-survival of the patients (P<0.05). CONCLUSION: TACE combined with CT-guided percutaneous precision microwave ablation therapy for primary liver cancer has reliable safety and efficacy.