[Analysis of risk factors and construction of nomogram model for local lymph node metastasis in salivary gland mucoepidermoid carcinoma].

Objective: To analyze the risk factors affecting regional lymph node metastasis in salivary gland mucoepidermoid carcinoma (MEC) and to establish a nomogram model for individually predicting lymph node metastasis in salivary gland MEC. Methods: The clinical data of 2 152 patients with salivary gland MEC from 1975 to 2020 were collected from the Surveillance, Epidemiology, and End Results (SEER) database of the National Cancer Institute. The collected data were divided into training cohort (1 506 cases) and validation cohort (646 cases) according to the ratio of 7∶3. Single-factor regression and multi-factor logistic regression were used to screen factors related to local lymph node metastasis in salivary gland MEC, with constructing of a nomogram. Calibration curve, receiver operating characteristic (ROC) curve, area under the ROC curve (AUC) and decision curve analysis were used to evaluate model performance in the validation cohort and the total cohort. Statistical tests were performed using SPSS (26.0) and R (4.3.0) software. Results: Multivariate logistic regression results showed that M stage [OR(95%CI):12.360(3.295-46.365), P=0.014], pathological grade Ⅱ、Ⅲ、Ⅳ[OR(95%CI): 1.956(1.329-2.879), 9.654(6.309-14.772), 9.298(6.072-14.238), P<0.001], T staging T2, T3, T4[OR(95%CI): 1.706(0.932-3.124), 3.021(1.790-5.096), 3.311(1.925-5.695), P<0.001], and gender [OR(95%CI):0.759(0.593-0.972), P=0.029] were independent factors affecting local lymph node metastasis in salivary gland MEC. Through verification in the validation cohort and the total cohort, the AUC values were greater than 0.8, and the calibration curve was close to the perfect reference line, proving that the constructed nomogram model had good specificity and sensitivity for predicting local lymph node metastasis in salivary gland MEC. Conclusion: M stage, pathological grade, T stage, and gender are risk factors for predicting regional lymph node metastasis and the established-nomogram has good predictive performance for local lymph node metastasis in salivary gland MEC.

[Application value of folate receptor-positive circulating tumor cells in the diagnosis of head and neck squamous cell carcinoma].

A total of 82 patients and healthy subjects in the First Affiliated Hospital of Sun Yat-sen University from March to August 2023 were recruited. The cohort consisted of 43 patients with head and neck squamous cell carcinoma (HNSCC) and 39 non-cancer patients or healthy subjects. There were 63 males and 19 females, with a median age of 62 (46, 67) years. The levels of folate receptor-positive circulating tumor cells (FR+CTCs) in the blood of HNSCC patients and non-cancer/healthy subjects were 12.4 (8.5, 17.8) floate unit (FU)/3 ml and 5.0 (3.8, 6.6) FU/3 ml, respectively, with a statistically significant difference (P<0.001). The area under the receiver operating characteristic (ROC) curve for FR+CTCs levels was 0.937 (95%CI: 0.888-0.986, P<0.001), with a cut-off value of 7.4 FU/3 ml determined by the maximum Youden index. At this cut-off value, the sensitivity and specificity of FR+CTCs for diagnosing HNSCC were 90.70% and 89.74%, respectively. The current study suggests that FR+CTCs could be used as a liquid biopsy marker for the screening and diagnosis of HNSCC.

[Research progress in anti-reflux reconstructions and mechanism after proximal gastrectomy].

The electrophysiological activity of the gastrointestinal tract and the mechanical anti-reflux structure of the gastroesophageal junction are the basis of the anti-reflux function of the stomach. Proximal gastrectomy destroys the mechanical structure and normal electrophysiological channels of the anti-reflux. Therefore, the residual gastric function is disordered. Moreover, gastroesophageal reflux is one of the most serious complications. The emergence of various types of anti-reflux surgery through the mechanism of reconstructing mechanical anti-reflux barrier and establishing buffer zone, and the preservation of, the pacing area and vagus nerve of the stomach, the continuity of the jejunal bowel, the original gastroenteric electrophysiological activity of the gastrointestinal tract, and the physiological function of the pyloric sphincter, are all important measures for gastric conservative operations. There are many types of reconstructive approaches after proximal gastrectomy. The design based on the anti-reflux mechanism and the functional reconstruction of mechanical barrier, and the protection of gastrointestinal electrophysiological activities are important considerations for the selected of reconstructive approaches after proximal gastrectomy. In clinical practice, we should consider the principle of individualization and the safety of radical resection of tumor to select a rational reconstructive approaches after proximal gastrectomy.

Tertiary Lymphoid Structure Raises Survival and Immunotherapy in HPV- HNSCC.

Immune checkpoint blockade (ICB) targeting PD-1/PD-L1 has been used for the treatment of head and neck squamous cell carcinoma (HNSCC). However, the overall response rate to ICB therapy for HNSCC remains less than 20%. It has recently been reported that the appearance of tertiary lymphoid structures (TLSs) in tumor tissue is correlated with better prognosis and response to ICB treatment. Here, we demonstrated an immune classification for the tumor microenvironment (TME) of HNSCC by analyzing The Cancer Genome Atlas (TCGA)-HNSCC data set and found that immunotype D with TLS enrichment had a better prognosis and response to ICB treatment. Furthermore, we observed that TLSs were present in a part of tumor samples of human papillomavirus (HPV) infection negative HNSCC (HPV- HNSCC) and were associated with the densities of dendritic cell (DC)-LAMP+ DCs, CD4+ T cells, CD8+ T cells, and progenitor T cells in TME. We established an HPV- HNSCC mouse model with TLS-enriched TME by overexpressing LIGHT in a mouse HNSCC cell line. We found that the induction of TLS formation enhanced the response to PD-1 blockade treatment in the HPV- HNSCC mouse model, accompanied by increases in DCs and progenitor exhausted CD8+ T cells in the TME. Elimination of CD20+ B cells attenuated the therapeutic effect of PD-1 pathway blockade in TLS+ HPV- HNSCC mouse models. These results indicate that TLSs contribute to the favorable prognosis and antitumor immunity of HPV- HNSCC. Inducing TLS formation in HPV- HNSCC tumors is a potential therapeutic method for improving the ICB response rate in patients with HPV- HNSCC.

[Recommendations for the diagnosis and treatment of rheumatic diseases-related hemophagocytic syndrome in China].

Hemophagocytic syndrome (HPS), which is currently named as hemophagocytic lymphohistiocytosis (HLH), is a hyperinflammatory syndrome characterized by persistent fever, hepatosplenomegaly, pancytopenia and hemophagocytosis found in bone marrow, liver, spleen and lymph nodes due to excessive activation of macrophages and cytotoxic T cells. Macrophage activation syndrome (MAS) is a specific form of HLH induced by autoinflammatory/autoimmune disorders which can be life-threatening and requires multiple disciplines. In order to improve clinicians' understanding of MAS and standardize the clinical diagnosis and treatment practice of MAS, the rheumatology branch of Chinese Rheumatology Association organized domestic experts to formulate the diagnosis and treatment standard, in order to improve the diagnosis and treatment level of MAS and improve the prognosis of patients.

[History and present situation of seromuscular flap anastomosis in proximal gastrectomy].

With the increasing detection rate of early upper gastric cancer and adenocarcinoma of esophagogastric junction, the safety of proximal gastrectomy with clear indications has been verified, and function-preserving proximal gastrectomy has been widely used. However, proximal gastrectomy destructs the normal anatomical structure of esophagogastric junction, resulting in severe postoperative gastroesophageal reflux symptoms and seriously affecting the quality of life. Among various anti-reflux surgery methods, reconstruction of "cardiac valve" has always been the focus of relevant scholars because its similarity with the mechanism of normal anti-reflux. After years of development, evolution and optimization, the designed seromuscular flap anastomosis includes tunnel muscle flap anastomosis, Hatafuku valvuloplasty, single muscle flap anastomosis and double muscle flap anastomosis. The double muscle flap anastomosis has become a research hotspot because it shows good anti-reflux effect in clinical application. This paper reviews the history, research status and hot issues of seromuscular flap anastomosis of esophageal remnant stomach at home and abroad.

[Epidemiological characteristics and treatment outcome analysis of 229 patients with hydrofluoric acid burns in hands].

Objective: To explore the epidemiological characteristics and treatment outcomes of patients with hydrofluoric acid burns in hands. Methods: A retrospective observational study was conducted. The medical records of 229 patients with hydrofluoric acid burns in hands who were admitted to Zhejiang Quhua Hospital from January 2008 to December 2020 and met the inclusion criteria were collected. The following statistical data of patients were collected, including gender, age, type of affiliated enterprise, hydrofluoric acid mass fraction, injury site, total burn area, prehospital time, length of hospital stay, length of wound healing, whether hypocalcemia and hypomagnesemia occurred or not on admission, whether surgery intervention was performed or not, and whether scar sequelae occurred or not. Single factor and multivariate logistic regression analysis were used to screen out the risk factors impacting surgery intervention and scar sequelae of all the patients and patients whose hydrofluoric acid mass fraction was known. Single factor and multivariate linear regression analysis were used to screen out the risk factors impacting the length of wound healing of all the patients and patients whose hydrofluoric acid mass fraction was known. Results: The 229 patients included 206 males and 23 females, with the majority aged 30 to 50 years (139 patients). The type of affiliated enterprise of majority patients was non-fluorine chemical enterprise. The hydrofluoric acid mass fraction was known in only 91 patients, mainly medium. The majority injury site was in the middle and end of finger. The total burn area was below or equal to 1% total body surface area. The prehospital time was 19 (9, 29) h. The length of hospital stay was 2 (1, 7) d. The length of wound healing was 12 (8, 18) d. The proportions of hypocalcemia and hypomagnesemia were 0.9% (2/229) and 1.3% (3/229) on admission, respectively. Thirty-six patients had surgeries and 83 patients had scar sequelae. In 229 patients, single factor logistic regression analysis showed that both type of affiliated enterprise and prehospital time were the factors impacting surgery intervention (with odds ratio values of 7.86 and 51.35, respectively, 95% confidence intervals of 1.83-33.76 and 11.89-221.78, respectively, P<0.01) and scar sequelae of patients (with odds ratio values of 3.62 and 27.40, respectively, 95% confidence intervals of 1.76-7.43 and 13.25-56.68, respectively, P<0.01); multivariate logistic regression analysis showed that prehospital time was the independent risks factor impacting surgery intervention and scar sequelae of patients (with odds ratio values of 43.00 and 24.55, respectively, 95% confidence intervals of 9.89-187.03 and 11.78-51.16, respectively, P<0.01); single factor linear regression analysis showed that both type of affiliated enterprise and prehospital time were the factors impacting the length of wound healing of patients (with ß values of 6.16 and 12.83, respectively, 95% confidence intervals of 3.38-8.93 and 10.72-14.93, respectively, P<0.01); multivariate linear regression analysis showed that both type of affiliated enterprise and prehospital time were the independent risk factors impacting the length of wound healing of patients (with ß values of 2.81 and 12.16, respectively, 95% confidence intervals of 0.50-5.13 and 10.00-14.31, respectively, P<0.05 or P<0.01). In 91 patients whose hydrofluoric acid mass fraction was known, single factor logistic regression analysis showed that type of affiliated enterprise, hydrofluoric acid mass fraction (low and high), and prehospital time were all the factors impacting surgery intervention of patients (with odds ratio values of 9.10, 11.25, 10.69, and 0.04, respectively, 95% confidence intervals of 1.15-72.25, 1.39-90.93, 1.32-86.59, and 0.01-0.19, respectively, P<0.05 or P<0.01), type of affiliated enterprise, hydrofluoric acid mass fraction, and prehospital time were all the factors impacting scar sequelae of patients (with odds ratio values of 0.32, 0.21, and 36.80, respectively, 95% confidence intervals of 0.11-0.92, 0.06-0.73, and 11.03-122.79, respectively, P<0.05 or P<0.01); multivariate logistic regression analysis showed that both hydrofluoric acid mass fraction and prehospital time were the independent risk factors impacting surgery intervention of patients (with odds ratio values of 11.51 and 0.04, respectively, 95% confidence intervals of 1.22-108.26 and 0.01-0.25, respectively, P<0.05 or P<0.01), prehospital time was the independent risk factor impacting scar sequelae of patients (odds ratio=37.71, with 95% confidence interval of 9.97-142.69, P<0.01); single factor linear regression analysis showed that type of affiliated enterprise, hydrofluoric acid mass fraction (low and high), and prehospital time were all the factors impacting the length of wound healing of patients (with ß values of 7.12, -5.63, -9.74, and 13.50, respectively, 95% confidence intervals of 2.43-11.81, -10.59--0.68, -14.78--4.70, and 10.14-16.86, respectively, P<0.05 or P<0.01); multivariate linear regression analysis showed that both hydrofluoric acid mass fraction and prehospital time were the independent risk factors impacting the length of wound healing of patients (with ß values of -5.84 and 0.09, respectively, 95% confidence intervals of -10.59--1.08 and 0.05-0.12, respectively, P<0.05 or P<0.01). Conclusions: The majority of patients with hydrofluoric acid burns in hands are young and middle-aged males. Type of affiliated enterprise, hydrofluoric acid mass fraction and prehospital time are the risk factors that affect the treatment outcomes of patients with hydrofluoric acid burns in hands.

GSDME Is Related to Prognosis and Response to Chemotherapy in Oral Cancer.

Gasdermin E (GSDME), as the major executive protein of pyroptosis, has been considered to be linked to antitumor immunity in recent years. However, the role of GSDME in oral squamous cell carcinoma (OSCC) remains to be elucidated. Here, by using a human OSCC tissue microarray, human OSCC tissue, and Tgfbr1/Pten conditional knockout mice, we found that GSDME was strongly expressed in OSCC and that GSDME expression in primary tumors was higher than that in metastatic lymph nodes. In addition, GSDME expression in OSCC was positively related to better prognosis. Moreover, GSDME-mediated pyroptosis occurred upon stimulation with chemotherapy drugs, and functional knockdown of GSDME attenuated the cisplatin-induced antitumor effect. Consistent with these results, bioinformatic analysis indicated that GSDME expression was positively correlated with the sensitivity of a number of antitumor drugs approved by the US Food and Drug Administration. Inhibition of GSDME expression by small interfering RNA in SCC7 cells significantly increased the expression of the cancer stem cell markers, CD44 and ALDH1. Furthermore, multiplexed immunohistochemistry and flow cytometry indicated that the expression of GSDME positively correlated with tumor-infiltrating CD8+ T cells, granzyme B, and M1 phenotype macrophages. Collectively, these findings demonstrated that GSDME is a potential positive prognostic factor of OSCC, and GSDME-mediated pyroptosis induced by chemotherapy plays a role in antitumor response.

[Application of modified Kamikawa anastomosis in digestive tract reconstruction after proximal gastrectomy].

Objective: Traditional Kamikawa anastomosis in digestive tract reconstruction after proximal gastrectomy can greatly decrease the anastomosis-related complications and reduce the incidence of reflux esophagitis, but its complexity limits the wide application. To decrease the complexity of Kamikawa anastomosis, the surgical team of Changzhi People's Hospital of Shanxi Changzhi Medical College improved this technique by using novel notion and reduced surgical procedures. This study aims to evaluate the efficacy and safety of modified Kamikawa anastomosis in digestive tract reconstruction after proximal gastrectomy. Methods: A descriptive cohort study was carried out. Case enrollment criteria: (1) upper gastric carcinoma or esophagogastric junction carcinoma without distant metastasis was confirmed by preoperative gastroscopic biopsy and imaging examination; (2) tumor diameter was less than 4 cm; (3) preoperative clinical staging was cT1-3N1M0. Exclusion criteria: (1) patients received preoperative neoadjuvant chemotherapy; (2) patients had severe heart or lung disease, or poor nutritional status so that they could not tolerate surgery. Clinical data of 25 patients with upper gastric carcinoma or esophagogastric junction carcinoma who underwent modified Kamikawa anastomosis in digestive tract reconstruction in Heji Hospital (8 cases) and Changzhi People's Hospital (17 cases) from April 2019 to December 2020 were retrospectively collected. Of 25 patients, 21 were male and 4 were female, with mean age of 63.0 (49 to 78) years; 3 underwent open surgery and 22 underwent laparoscopic surgery. The modified Kamikawa anastomosis was as follows: (1) the novel notion of total mesangial resection of the esophagogastric junction was applied to facilitate the thorough removal of lymph nodes and facilitate hand-sewn anastomosis and embedding; (2) the diameter of the anastomotic stoma was selected according to the diameter of the esophageal stump, between 2.5 and 3.5 cm, to reduce the occurrence of anastomotic stenosis; (3) an ultrasonic scalpel was used to incise the esophageal stump, which could not only prevent bleeding of the esophageal stump, but also closely seal the esophageal mucosa, muscle layer and serosa to prevent esophageal mucosa retraction; (4) barbed suture was used to suture the remnant stomach fundus and esophagus to fix the stomach fundus in order to reduce the cumbersome and difficult intermittent sutures in a small space; (5) two barbed sutures were used to continuously suture the front and back walls of the anastomosis and complete the suture and fixation of the muscle flap. Relevant indicators of surgical safety, postoperative complications (using the Clavien-Dindo classification), esophageal reflux symptoms and the occurrence of esophagitis (using Los Angeles classification) were analyzed. The gastroesophageal reflux disease (GERD) score, gastroscopy, multi-position digestive tract radiography during postoperative follow-up were used to evaluate the residual gastric motility and anti-reflux efficacy. Results: Modified Kamikawa anastomosis in digestive tract reconstruction after proximal gastrectomy was successfully performed in 25 patients. The surgical time was (5.8±1.8) hours, the intraoperative blood loss was (89.2±11.8) ml, and the average hospital stay was (13.8±2.9) days. Three cases (12.0%) developed postoperative anastomotic stenosis as Clavien-Dindo grade III and were healed after endoscopic dilation treatment. Postoperative upper gastrointestinal radiography showed 1 case (4.0%) with reflux symptoms as Clavien-Dindo grade I. Gastroscopy showed no signs of reflux esophagitis, and its Los Angeles classification was A grade. No anastomotic bleeding, local infection and death were found in all the patients. At postoperative 6-month of follow-up, GERD score showed no significant difference compared to pre-operation (2.7±0.6 vs. 2.4±1.0, t=-1.495, P=0.148). Conclusion: Modified Kamikawa anastomosis in digestive tract reconstruction after proximal gastrectomy is safe and feasible with good anti-reflux efficacy.

[HIV positive rate from different detection methods in medical institutions in China: a Meta analysis].

Objective: To analyze the HIV positive detection rate from different detection channels in Chinese medical institutions. Methods: A Meta-analysis was conducted. First of all, the literature on HIV testing of medical institutions in China was systematically searched on China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, VIP Information Chinese journal Service platform and PubMed. Secondly, a self-made information table was used to collect the basic information, HIV positive number and test number of the literature. Finally, R 4.0.2 software was used to calculate the pooled HIV detection rate and 95%CI of the whole population, detection approaches subgroups and regions subgroups, and then the forest map was drawn. Funnel plot was used to analyze publication bias. Results: A total of 45 studies which covered 22 provinces. Meta analysis showed that the pooled HIV positive rate was 0.82‰ (95%CI: 0.62‰-1.04‰). Subgroup analysis showed that the HIV positive rate of STD outpatient was the highest (3.01‰ (95%CI: 1.76‰-4.58‰), followed by other patients (1.43‰ (95%CI: 1.00‰-1.93‰)). The HIV positive rate of western China was the highest (1.14‰ (95%CI: 0.72‰-1.63‰)). The HIV positive rate in 2008-2017 was higher than in 2000-2007. The Egger test indicated no publication bias (t=-0.737, P=0.465). Conclusion: The HIV positive detection rate of patients in medical institutions in China was at a low level, but the positive rate of patients in STD clinics was relatively high. Therefore, the HIV testing should be further expanded in this population. Secondly, HIV screening should be strengthened for other patients.

[Associations of impaired glucose metabolism with chronic peridontitis in pre-diabetes patients].

OBJECTIVE: To investigate the associations of impaired glucose metabolism and insulin resistance with chronic periodontitis in pre-diabetes patients. METHODS: A cross-sectional analysis was conducted and we included a total of 171 pre-diabetes patients aged 30-65 years, free of diabetes. pre-diabetes was defined as impaired fasting glucose (IFG) [fasting glucose (FG): 6.1-7.0 mmol/L] and/or impaired glucose tolerance (IGT) [oral glucose tolerance test (OGTT): 7.8-11.0 mmol/L]. Chronic periodontitis was defined according to Centers for Disease Control and Prevention (CDC)/American Academy of Periodontology (AAP) definition and the patients were divided into mild, moderate, and severe chronic periodontitis groups [mild: at least two interproximal sites with clinical attachment loss (CAL) ≥3 mm and at least two interproxima sites with probing depth (PD) ≥4 mm or 1 site with PD≥5 mm; moderate: at least two interproximal sites with CAL ≥4 mm and at least two interproxima sites with at least two interproximal sites with PD ≥5 mm; severe: at least two interproximal sites with CAL ≥6 mm and at least one interproxima site with at least two interproximal sites with PD≥5 mm]. A periodontal examination indexes [plaque index (PLI), PD, CAL, and bleeding on probing (BOP)] and glucose metabolism indexes [FG, OGTT, hemoglobinA1c (HbA1c), fasting insulin and homeostasis model assessments of insulin resistance (HOMA-IR)] were measured. The association of glucose metabolism and chronic periodontitis was investigated by multivariable logistic regression analysis. RESULTS: FG in the moderate and severe chronic periodontitis groups was significantly higher compared with mild chronic periodontitis group, HOMA-IR in the moderate and severe chronic periodontitis groups was significantly higher compared with mild chronic periodontitis group, OGTT in the severe chronic periodntitis group was significantly higher compared with mild chronic peridontitis group and moderate chronic periodontitis groups, and there was no significant difference between moderate and mild chronic periodontitis groups. For the insulin and HbA1c, there was no significant difference among mild, moderate and severe chronic periodontitis groups. After multivariable adjustment of age, gender, smoking status, hypertension and body mass index, IFG (OR=1.39, 95%CI: 1.01-1.98) and HOMA-IR (OR=1.36, 95%CI: 1.04-1.76) were associated with moderate periodontitis; IFG (OR=1.64, 95%CI: 1.17-2.40), IGT (OR=1.65, 95%CI: 1.21-2.26), and HOMA-IR (OR=1.72, 95%CI: 1.23-2.41) were significantly associated with severe periodontitis. CONCLUSION: Our data provided evidences that impaired glucose metabolism were associated with chronic periodontitis among pre-diabetes patients.

[Efficacy and safety of Anlotinib as a third-line chemotherapy for metastatic colorectal cancer].

Objective: To evaluate the efficacy and safety of Anlotinib as a third-line therapy in patients with metastatic colorectal cancer. Methods: Anlotinib was administered to patients with advanced colorectal cancer who had received ≥ second-line standardized treatment, with 12 mg daily lasting for 2 weeks and withdrawal of drugs for a week. The relevant clinical information and treatment protocols were recorded.The efficacy and safety of anlotinib were followed up. Results: A total of 26 patients were enrolled in the study group, and 24 patients could be evaluated, including 2 cases of partial response (PR) and 16 cases of stable disease (SD).The object response rate (ORR) and disease control rate (DCR) were 8.3% and 75%, respectively. The median progression-free survival (PFS) and overall survival (OS) was 4.3 months (95% CI: 2.9-5.7 months) and 14.7 months (95% CI: 10.0-19.4 months), respectively. The most common adverse reactions were fatigue in 17 cases (17/26) and hand-foot skin reactions in 16 cases (16/26). Analysis of Kaplan-Meier revealed that without liver metastasis (95% CI: 11.7-32.3, P=0.011) and left-sided colonic cancer (95% CI: 11.7-46.1, P=0.014) were related to longer OS. Conclusion: Anlotinib as a third-line therapy for advanced colorectal cancer is feasible with high disease control rate and minor side effects.

[Investigation and analysis of protein and energy intake in adult patients with severe burns].

Objective: To investigate and analyze the actual intake of protein and energy in adult patients with severe burns during post burn days (PBDs) 3 to 14. Methods: Records of 52 adult patients with severe burns [37 males and 15 females, (37±9) years old], admitted to the Department of Plastic Surgery and Burns of Tianjin First Central Hospital from January 1st 2011 to December 31st 2017 and meeting the study inclusion criteria, were retrospectively analyzed. Nutrition intake from routes of oral diet, enteral nutrition preparations, and parenteral nutrition preparations of patients during PBDs 3 to 14 were obtained from critical care records. During PBDs 3 to 7 and PBDs 8 to 14, the personal daily total energy intake and the ratio of it to energy target of patients were calculated and compared; the personal daily intake of carbohydrate, fat, and protein and calorigenic percentages of carbohydrate, fat, and protein accounted for total energy intake, and the ratios of non-protein calories to total nitrogen of patients were calculated and compared; the personal daily energy and protein intake of patients from routes of oral diet, enteral nutrition preparations, and parenteral nutrition preparations were analyzed; the percentages of energy intake from routes of oral diet, enteral nutrition preparations, and parenteral nutrition preparations accounted for total energy intake, and the percentages of protein intake from routes of oral diet, enteral nutrition preparations, and parenteral nutrition preparations accounted for total protein intake of patients were calculated. Vomiting and diarrhea of patients during PBDs 3 to 7 and PBDs 8 to 14 were recorded. Levels of serum albumin, prealbumin, blood glucose, and triglycerides, 24-hour excretion of urinary nitrogen, nitrogen balance values of patients on PBDs 7 and 14 were recorded or calculated. Data were processed with paired t test and chi-square test. Results: (1) The personal daily total energy intake of patients during PBDs 3 to 7 and PBDs 8 to 14 were (8 696±573) and (11 980±1 259) kJ respectively, and ratios of them to energy target [(13 290±1 561) kJ] were 65.4% and 90.1% respectively. The personal daily total energy intake of patients during PBDs 3 to 7 was obviously lower than that during PBDs 8 to 14 (t=18.172, P<0.01). (2) The personal daily intake of carbohydrate, fat, and protein of patients during PBDs 8 to 14 were obviously higher than those during PBDs 3 to 7 (t=15.628, 22.231, 10.403, P<0.01). The personal daily calorigenic percentages of carbohydrate, fat, and protein accounted for total energy intake of patients were 56.8%, 25.1%, and 18.3% respectively during PBDs 3 to 7 and 54.2%, 27.0%, and 18.7% respectively during PBDs 8 to 14. The calorigenic constituent ratio of personal daily intake of carbohydrate, fat, and protein accounted for total energy intake of patients during PBDs 3 to 7 was close to that during PBDs 8 to 14 (χ(2)=0.185, P>0.05). The ratios of non-protein calories to total nitrogen (kJ∶g) of patients during PBDs 3 to 7 and PBDs 8 to 14 were 469∶ 1 and 456∶ 1 respectively. (3) The personal daily energy intake of patients from routes of oral diet and parenteral nutrition preparations during PBDs 8 to 14 [(4 394±978), (5 723±898) kJ] were obviously higher than those during PBDs 3 to 7 [(2 137±453), (4 855±825) kJ, t=26.516, 6.583, P<0.01], while the personal daily energy intake of patients from routes of enteral nutrition preparations during PBDs 8 to 14 was close to that during PBDs 3 to 7 (t=1.922, P>0.05). The constituent ratio of personal daily energy during PBDs 3 to 7 was close to that during PBDs 8 to 14 (χ(2)=4.100, P>0.05). The personal daily protein intake of patients from route of oral diet during PBDs 8 to 14 was (58±22) g, obviously higher than (25±6) g during PBDs 3 to 7 (t=14.514, P<0.01). The personal daily protein intake of patients from routes of enteral nutrition preparations and parenteral nutrition preparations during PBDs 8 to 14 was close to those during PBDs 3 to 7 (t=1.924, 1.110, P>0.05). The constituent ratio of personal daily protein intake from routes of oral diet, enteral nutrition preparations, and parenteral nutrition preparations accounted for total protein intake during PBDs 8 to 14 was close to that during PBDs 3 to 7 (χ(2)=5.634, P>0.05). (4) There were 3 patients with vomiting and 4 patients with diarrhea during PBDs 3 to 7, and 1 patient experienced both of them during PBDs 8 to 14. The levels of serum albumin, prealbumin, blood glucose, and triglycerides, 24-hour excretion of urinary nitrogen, and nitrogen balance values of patients on PBDs 7 and 14 were (29±4) and (30±4) g/L, (132±42) and (171±48) mg/L, (7.4±2.8) and (6.7±2.8) mmol/L, (1.5±0.7) and (1.4±0.7) mmol/L, (30.5±4.3) and (34.5±2.2) g, -(25.1±2.6) and -(23.7±3.9) g, respectively. Conclusions: The personal daily total energy intake of patients during PBDs 3 to 7 was lower than that during PBDs 8 to 14. The calorigenic constituent ratio of personal daily intake of carbohydrate, fat, and protein accounted for total energy of patients during PBDs 3 to 7 was close to that during PBDs 8 to 14. Energy and protein intake were mostly derived from parenteral nutrition preparations during PBDs 3 to 7, while those during PBDs 8 to 14 were mainly derived from parenteral nutrition preparations and oral diet.

[Construction of latent membrane protein 2A chimeric antigen receptor-T cells and their lethal effects on nasopharyngeal carcinoma cells].

Objective: To produce latent membrane protein 2A (LMP2A) chimeric antigen receptor (CAR)-T cells and detect the lethal effect of LMP2A CAR-T cells on nasopharyngeal carcinoma (NPC) cells. Methods: The study was conducted from September 2016 to December 2017.Genetic engineering technology was used to construct anti-LMP2A CAR lentiviral expression vector and sequencing was identified. The expression of anti-LMP2A CAR in the 293T cells was confirmed by western blot. CCK8 assay was used to evaluate the cytotoxicity of LMP2A CAR-T cells to NPC cells. ELISA assay was performed to test IL-2 and IFN-γ releasing of activated LMP2A CAR-T cells. The inhibition effect of LMP2A CAR-T cells on NPC xenograft tumor was observed in vivo. Statistical analysis was performed by statistical software SPSS 21.0. Results: The results of PCR and sequencing showed that anti-LMP2A CAR lentiviral expression vector was constructed successfully. The result of western blot indicated the expression of anti-LMP2A CAR in the 293T cells effectively. The results of CCK-8 assay showed that the killing activities of LMP2A CAR-T cells to LV-LMP2A-CNE1 cells were (72.11±9.75)%, (54.65 ±5.42)% and (36.68±3.80)% at 20∶1, 10∶1 and 5∶1 ratio of effective cells to target cells, and had a statistical difference compared to CD19 CAR-T cells and T cells (P<0.05). There was no significant difference in the killing activities of LMP2A CAR-T cells to CNE1 cells compared with CD19 CAR-T cells and T cells. The results of ELISA showed that the content of IL-2 and IFN-γ in the co-culture supernatant of LMP2A CAR-T cells and LV-LMP2A-CNE1 cells was significantly higher than that of LMP2A CAR-T cells and CNE1 cells which had statistical difference (P<0.05); In vivo experiment, the volume of LMP2A CAR-T cell group was (80.3±10.0) mm(3) which was significantly lower than that of the control groups, and the difference was statistically significant (P<0.05). Conclusion: LMP2A CAR-T cells are successfully prepared and have an obvious targeting cytotoxicity on LMP2A-positive NPC cells.

[Characteristics analysis of patients with benign paroxysmal positional vertigo-spontaneously cured].

Objective:To analyze the characteristics of patients with benign paroxysmal positional vertigo which were spontaneously cured. Method: A total of 1 257 patients with chief complaint of positional vertigo were included and analyzed retrospectively, in which 921 cases were diagnosed as BPPV with the diagnosis standard of Guiyang meeting, and the other 336 cases were negative in the positional test diagnosed as BPPV-spontaneously cured. The age，gender and history course of the two groups were analyzed respectively.Result:①Among the 1 257 cases of BPPV, 336 (111 male and 225 female) were diagnosed as BPPV-spontaneously cured, with total self remission rate of 26.7%. And the female self remission rate is lower than men slightly（25.9% vs 28.5%）.②The ratio of male to female was 1∶2 in patients with BPPV-spontaneously cured and 1∶2.3 in patients with BPPV. Patients of the two groups were mostly female, and there was no significant difference in gender distribution. ③There was no significant difference in age distribution between patients of BPPV-spontaneously cured and BPPV, and patients of ＞50-70 years old were common in both groups.④The history course of patients in BPPV-spontaneously cured and BPPV both were mostly within 2 weeks at their first visit to hospital,each accounting for 75.3% and 69.3%.But the ratio of patients with BPPV-spontaneously cured for 1-2 weeks was higher than that of the BPPV (20.5% vs 15.1%), and the difference was statistically significant.Conclusion:Whether patients with BPPV can cure spontaneously is not related to age or gender, while women may have a tendency of lower self remission rate. The natural course of patients with BPPV-spontaneously cured is mostly within 2-4 weeks. The duration of natural course may be related to the type of semicircular canal involved.

[The surgical management of upper parapharyngeal regions].

Objective: To find proper the surgical approval and evaluate clinical efficacy to treat the tumor of upper parapharyngeal space involving the base of skull and intracranial skull. Method: The data of 9 cases from June 2013 and June 2018 were analyzed retrospectively including schwannoma in 6 cases, pleomorphic adenoma in 2 cases and hemangioma in 1 case. All cases received preoperative high resolution CT and MRI, some cases also did the DSA examination. Tumor invaded top of nasopharyngeal in 4 cases, the base of skull in 3 cases, and intraskull in 2 cases. 9 cases were treated with surgery alone. Surgical approach: transcervical approach (n=1), transcervical approach and mandibular fracture surgery(n=2), transoral approach(n=3), transnasal transpterygoid approach(n=2), transparotid gland approach(n=1). Result: Tumors in 8 cases were completely removed, and 1 case was performed by partial excision. Hemorrhage(>500 ml) occurred in 2 cases, tongue deflection and cerebrospinal fluid leakage occurred in 1 case. No death, tumor recurrence and wound infection was found. Conclusion: The position of benign upper parapharyngeal space tumors is deep and tumor often invade in the base of the skull and brain tissue. It is close to the important nerve, vessels of the skull base and meninges. The appropriate surgical approach should be selected according to the individual situation. The main point of the operation is complete the tumor resection with preserving or reconstructing the important function of the blood vessel and nerve.

[Etiological characteristics analysis of 3 137 outpatients with vertigo or dizziness in ENT department].

Objective: To analyze the etiological characteristics of patients in department of ENT with chief complaint of vertigo or dizziness in order to reduce the rate of misdiagnosis and wrong treatment. Method: A total of 3 137 patients in department of ENT with chief complaint of vertigo or dizziness from Sep 2015 to Sep 2017 were included and the etiologies were clarified retrospectively. And in which with any of the 8 kinds of disease including benign paroxysmal positional vertigo(BPPV), vestibular neuritis, vestibular migraine (VM), Meiniére disease, recurrent vestibular disease, sudden deafness with vertigo, psychogenic vertigo, posterior circulation ischemia (PCI) together 2 138 patients were further stratified analyzed by gender and age. Result: ①Etiological characteristics of patients with vertigo or dizziness：among the 3 137 patients with vertigo or dizziness in ENT department in our hosipital, the peripheral diseases of vestibular were the most common disease with a total of 1 607 cases, accounting for 51.23%. And there were 506 cases of the central diseases of vestibular accounting for 16.13%, 382 cases of other systemic diseases accounting for 12.18%, 85 cases（2.71%）of psychogenic vertigo, 557 cases （17.76%）of unknown etiology. ②Analysis of the frequent and serious causing of patients with vertigo or dizziness: among the 2 138(68.15%) patients with vertigo or dizziness, BPPV with a total of 827 cases (26.36%) was the most prevalent,while 215(25.99%) of them were diagnosed as self-cured BPPV,vestibular neuritis and VM were the second prevalent with 420 cases (13.39%) and 329 cases (10.49%) respectively, Meiniére disease, recurrent vestibular disease, sudden deafness with vertigo were the third prevalent with 209 cases (6.66%), 144 cases (4.59%), 102 cases (3.25%), respectively; well psychogenic vertigo and PCI were relatively rare, with respectively 85 cases (2.71%) and 22 cases (0.70%). Eotiology analysis stratified by age: The causes of vertigo or dizziness were ranged with age, and patients of 50-70 years old were most common with a total of 1 011 cases, accounting for 49.6%. Etiology analysis stratified by gender: There was gender difference in patients with vertigo or dizziness,such as BPPV, VM, recurrent vestibular disease, sudden deafness with vertigo and psychogenic vertigo were common in female, while PCI in male insteadly. Conclusion: ①Among the patients with vertigo or dizziness, the pheripheral diseases of vestibular are the most prevalent, in which BPPV takes the highest accidence. ②Patients ranging from 50 to 70 years old take the main parts in patients with vertigo or dizziness. And there is an obvious gender difference in patients with BPPV, VM, recurrent vestibular disease, sudden deafness with vertigo, psychogenic vertigo and PCI.