Identification of immunological subtypes of hepatocellular carcinoma with expression profiling of immune-modulating genes.

Recent studies demonstrate that immune checkpoint inhibitor (ICI) therapy has achieved success in many types of advanced cancers including advanced hepatocellular carcinoma (HCC). However, ICI therapy is beneficial in only some HCC patients, suggesting that immune-responses are highly variable in HCCs. Therefore, understanding the immune status in HCC microenvironment will facilitate ICI immunotherapy and guide patient selection for the therapy. In this study, we first analyzed the expression profile of immune-modulating genes and their relationship with survival of HCC patients using the data downloaded from The Cancer Genome Atlas - Liver Hepatocellular Carcinoma (TCGA-LIHC) database, and found that the higher expressions of CD276 (B7-H3) and CD47 were significantly associated with poor survival. Then we identified 4 immune subtypes of HCCs with different survivals by using the combination expression of B7-H3 (or CD47) and CD8. Patients with B7-H3low/CD8high or CD47low/CD8high have the best survival while ones with B7-H3high/CD8low or CD47high/CD8low have the worst survival. The 4 immune subtypes were validated in another 72 HCC patients obtained from South China. In conclusion, our findings suggest that HCC patient prognosis is associated with immunophenotypes by T cell infiltration (CD8 expression) and the expression of the adaptive immune resistance gene (B7-H3 or CD47), and this immune classification system will facilitate HCC patient selection for ICI immunotherapy.

µ-TRTX-Ca1a: a novel neurotoxin from Cyriopagopus albostriatus with analgesic effects.

Human genetic and pharmacological studies have demonstrated that voltage-gated sodium channels (VGSCs) are promising therapeutic targets for the treatment of pain. Spider venom contains many toxins that modulate the activity of VGSCs. To date, only 0.01% of such spider toxins has been explored, and thus there is a great potential for discovery of novel VGSC modulators as useful pharmacological tools or potential therapeutics. In the current study, we identified a novel peptide, µ-TRTX-Ca1a (Ca1a), in the venom of the tarantula Cyriopagopus albostriatus. This peptide consisted of 38 residues, including 6 cysteines, i.e. IFECSISCEIEKEGNGKKCKPKKCKGGWKCKFNICVKV. In HEK293T or ND7/23 cells expressing mammalian VGSCs, this peptide exhibited the strongest inhibitory activity on Nav1.7 (IC50 378 nM), followed by Nav1.6 (IC50 547 nM), Nav1.2 (IC50 728 nM), Nav1.3 (IC50 2.2 µM) and Nav1.4 (IC50 3.2 µM), and produced negligible inhibitory effect on Nav1.5, Nav1.8, and Nav1.9, even at high concentrations of up to 10 µM. Furthermore, this peptide did not significantly affect the activation and inactivation of Nav1.7. Using site-directed mutagenesis of Nav1.7 and Nav1.4, we revealed that its binding site was localized to the DIIS3-S4 linker region involving the D816 and E818 residues. In three different mouse models of pain, pretreatment with Cala (100, 200, 500 µg/kg) dose-dependently suppressed the nociceptive responses induced by formalin, acetic acid or heat. These results suggest that Ca1a is a novel neurotoxin against VGSCs and has a potential to be developed as a novel analgesic.

[Discussion on the micro-plastic operative treatment of nasal-septum deviation combined with crooked nose].

OBJECTIVES: To explore the micro-plastic operative treatment of deviated nose combined with nasal septum deviation. METHODS: We designed the incision at the caudal side of the nasal septum. The three-line reduction method for correcting nasal septum deviation was performed. The connection of the caudal nasal septum and the anterior nasal spine was reposited. The micro-plastic surgery with fixed suture was used to correct the deviated nose. RESULTS: After the surgery, the nasal septum deviation was corrected, whose nasal function and symptoms improved without nasal adhesion, nasal septum perforation or other complications. Meanwhile, the nasal tips were in the middle place and nasal dorsums were straight. The aesthetic outcome was satisfactory. CONCLUSIONS: Compared to the traditional orthopedic technique, the micro-shaping technique can be used for the homochromous operation of crooked nose combined with nasal septum deviation with less injury and lower risk. We suggest this micro-shaping technique be used in a rational way.

[Observation of curative effects of musculoskeletal ultrasound-guided needle-knife on the degenerative meniscus disease].

OBJECTIVE: To observe the curative effect of musculoskeletal ultrasound-guided needle-knife on the degenerative meniscus disease, and to provide a new method in the treatment of degenerative meniscus disease. METHODS: Seventy-seven patients with degenerative meniscus disease treated in the Third Affiliated Hospital of Beijing University of Chinese Medicine from January 2015 to September 2015 were selected, including 30 males and 47 females, aged from 44 to 66 years old, with an average of 57.5 years old. VAS scores, Lysholm scores and distance of meniscal protrusion were analyzed and compared before treatment, 2 weeks and 1 month after treatment. The curative effect was summarized at last. RESULTS: The mean Lysholm scores were 51.63±15.26(before treatment), 77.13±11.82(2 weeks after treatment) and 87.56±8.65(1 month after treatment). The mean VAS scores were 7.080±1.574 (before treatment), 2.630±0.310(2 weeks after treatment) and 0.850±0.177(1 month after treatment). The mean of the distance of meniscal protrusion scores were 0.400±0.156 (before treatment), 0.298±0.140 (2 weeks after treatment) and 0.240±0.110 (1 month after treatment). VAS scores and Lysholm scores were improved significantly compared with preoperative results. The distance of meniscal protrusion showed an obvious improvement after treatment. CONCLUSIONS: The treatment of musculoskeletal ultrasound-guided needle-knife has advantages of high accuracy position and excellent effectiveness for degenerative meniscus disease. The treatment provides safety operation and significantly improves quality of life in patients without any complications.

Transition from control to elimination: impact of the 10-year global fund project on malaria control and elimination in China.

The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) supported a project on the control and elimination of malaria in People's Republic of China which was one of the biggest-scale international cooperation programmes to control malaria in the country during the past 10 years. The project promoted the effective implementation of the Chinese national malaria control programme. On the basis of epidemiologic data, an overview of the project activities and key performance indicators, the overall impact of the GFATM project was evaluated. We also reviewed relevant programme features including technological and management approaches, with a focus on best practice, innovations in implementation and the introduction of international standards. Last, we summarised the multi-stakeholder cooperation mechanism and comments on its sustainability in the post-GFATM period. Recommendations for the future management of the Chinese national malaria elimination programme are put forward after considering the challenges, shortcomings and lessons learnt during the implementation of the GFATM project in China to sustain past achievements and foster the attainment of the ultimate goal of malaria elimination for the country.

[Endoscopic coblation assisted arytenoidectomy in the treatment of bilateral vocal cord paralysis].

OBJECTIVE: To introduce a new surgical technique for the treatment of bilateral vocal cord paralysis. METHODS: Twenty-nine patients with bilateral vocal cord paralysis treated in Dalian Municipal Central Hospital between 2008 and 2012 were retrospectively studied. Coblation assisted arytenoidectomy was performed in all cases. The pre and postoperative glottic measurement and vocal acoustic parameters were analyzed. RESULTS: All patients were decanulated 1 week after operation. Three months later, the mean glottic area increased from (21.9 +/- 4.7) to (40.3 +/- 5.2) mm2 (t = 5.74. P < 0.05); the width of maximal glottic chink increased from (1.47 +/- 0.37) to (4.82 +/- 0.54) mm (t = 6.24, P < 0.05). Twenty-six patients (89.7%) satisfied with the voice quality. Acoustic parameters (F0, jitter, shimmer) were no significant difference (P > 0. 05) , but there was a significant difference in maximum phonation time (P < 0.05). During three months to 3.5 years follow-up, the patients had a stable airway and effective phonation. CONCLUSIONS: Endoscopic coblation assisted arytenoidectomy is a new surgical method for the treatment of patients with bilateral vocal cord paralysis, which is efficient, minimally invasive and safe.

Structure selective complexation of cyclodextrins with five polyphenols investigated by capillary electrokinetic chromatography.

The complexation of five polyphenols, namely trans-resveratrol, astilbin, taxifolin, ferulic acid, and syringic acid (guest molecules) with α-, ß-, and γ-cyclodextrin (host molecules), was investigated by capillary electrokinetic chromatography. The binding constants were calculated based on the effective electrophoretic mobility change of guests with the addition of cyclodextrins into the background electrolyte. Because of cavity size, cyclodextrins showed structure-selective complexation property to different guest. The stability of the trans-resveratrol complexes was in the order of ß- > α- > γ-cyclodextrin. The cavity size of α-cyclodextrin was too small for astilbin and taxifolin molecules, and thus they could not form complexes. The molecular size of syringic acid was too big for all cyclodextrins cavity, and no cyclodextrin could form complexes with it. Temperature studies showed that the binding constants decreased with the rise of temperature. Enthalpy and entropy values were calculated and the negative values of these parameters indicated that the complexation process was enthalpy-controlled. Van der Waals force and release of high-enthalpy water molecules from the cyclodextrins cavity played important roles in the process.

[Coblation treatment for laryngeal papilloma in adult].

OBJECTIVE: To evaluate the effect and feasibility of coblation treatment for laryngeal papilloma in adult. METHODS: A total of 18 patients with laryngeal papilloma treated by coblation from April 2008 to June 2010 was retrospectively analysed. There were 4 cases of multiple laryngeal papilloma and 14 cases of single laryngeal papilloma. All of these patients were treated with CoblatorTM Reflex #7070 under general anesthesia without tracheotomy. RESULTS: The volumes of blood loss during surgery varied from 1 ml to 10 ml, 2 ml on average. There was no postoperative bleeding or other complications. Follow-ups ranged from 6 months to 33 months after surgery, median 18 months. Recurrence occurred 4 months and 8 months after surgery in two patients. They were treated with coblation for the second time and followed up for 4 months and 12 months respectively. Recurrence occurred again in one patient. CONCLUSION: Coblation under suspension laryngoscope for laryngeal papilloma in adult was an ideal way due to less bleeding and less damage.

[Preliminary investigation of coblation for early glottic carcinoma].

OBJECTIVE: To establish whether Coblation is a suitable modality for removal of early glottic carcinoma. METHODS: Fourteen patients with early glottic carcinoma (Tis-T2) without lymph node metastasis underwent resection of laryngeal cancer lesions using transoral endoscopic coblation (TEC), without pre- or post-operative radiotherapy and chemotherapy. RESULTS: No severe complication such as bleeding and dyspnea occurred in the cases. Only mild postoperative pain happened to the patients. All patients could eat and pronounce on the surgery day. With following-up of 25 - 37 months, no recurrence was observed in 13 cases. One case, with poorly differentiated squamous cell lesion in the anterior commissure invading subglottic, recurred 3 months postoperatively. The patient received the re-resection of laryngeal lesion by coblation, but another recurrence happened to the patient 6 months postoperatively, and then was cured by partial laryngectomy, with recurrence-free survival 21 months postoperatively. CONCLUSION: The observation suggests that transoral endoscopic coblation is a reliable and safe modality for the resection of early glottic carcinoma.

[Endoscopic surgery using the low-temperature plasma radiofrequency for nasopharyngeal angiofibroma].

OBJECTIVE: To evaluate the feasibility of endoscopic surgery using the low-temperature plasma radiofrequency for nasopharyngeal angiofibroma (NA). METHODS: The clinical data of 4 patients treated between December 2005 and August 2009 were retrospectively analyzed. The tumor in one patient was at stage I and three patients were at stage II, all these patients were treated by endoscopic surgery using the low-temperature plasma radiofrequency under controlled hypotension anesthesia. Preoperative angiography and embolisation were underwent in all patients. Bipolar coagulation was used to help hemostasis during operation. RESULTS: The tumor in all 4 patients was completely removed. The operation time was 60, 80, 110, 90 min respectively. The blood loss was 250, 250, 320, 280 ml respectively. Neither blood transfusion nor complications were encountered perioperatively. Follow-up ranged from 6 months to 4 years, none of the patients recurred. CONCLUSIONS: Endoscopic surgery using low-temperature plasma radiofrequency for nasopharyngeal angiofibroma has many advantages such as less bleeding and total tumor removal. It is a minimally invasive surgical method for nasopharyngeal angiofibroma.

[Endoscopic surgery using the low-temperature plasma radiofrequency for nasal hemangioma].

OBJECTIVE: To evaluate the effect of endoscopic surgery using the low-temperature plasma radiofrequency for nasal hemangioma. METHODS: Clinical data of 15 patients treated between October 2007 and October 2009 under endoscopic surgery using the low-temperature plasma radiofrequency were retrospectively studied. RESULTS: All tumors in 15 patients were completely removed. The blood loss was 1 - 150 ml and the average blood loss was about 15 ml, only gelatin sponge was used to protect the wound after operation. There was no additional packing to stop bleeding. No complications were seen. The patients had mild postoperative pain. All patients were followed-up from 2 months to 2 years, no recurrence was found. CONCLUSIONS: Endoscopic surgery using low-temperature plasma radiofrequency for nasal hemangioma has following advantages such as simplicity, minimal invasion and so on. It is a viable surgical method for the treatment of nasal hemangioma.

[Comparative analysis of polysomnography and micro-sensitive mattress-sleep monitor used for obstructive sleep apnea hypopnea syndrome].

OBJECTIVE: To assess the efficiency of mattress-type micro sensitive monitor (MMSM) in sleep monitoring. METHODS: Forty patients diagnosed as obstructive sleep apnea-hypopnea syndrome (OSAHS) by polysomnography (PSG) were randomly chosen, then received MMSM examination within 2 - 5 days. The results of both methods were compared, using the respiratory disturbance index, sleep efficiency, and obstructive factors as indicators. RESULTS: All 40 patients were diagnosed as OSAHS, which were consistent with the results of PSG. There was no statistical difference when comparing the apnea hypopnea index (AHI, x(-) ± s, 35.6 ± 21.3 and 37.6 ± 18.8, respectively) and the ratio of rapid eyes movement (REM) stage (15.0 ± 4.5)% and (15.8 ± 6.3)%, respectively (t were 1.867 and 1.014, P > 0.01). Some statistical sense was found when patients'deep sleep, shallow sleep and sleep efficiency were compared (P < 0.01). According to the severity diagnosed by PSG, patients with mild, moderate and severe OSAHS were 11, 7 and 22 cases, respectively, Comparing by MMSM, 2, 19 and 19 cases, respectively. Among seventeen volunteers diagnosed by PSG as normal subjects, 2 of them were diagnosed as mild OSAHS. The sensitivity of MMSM was 100.0% and the specificity was 88.2%. CONCLUSIONS: With regard to the diagnosis of OSAHS, MMSM is well consistent with PSG. The MMSM can be applied clinically as a monitor technique.

[Endoscopic surgery using the low-temperature plasma radiofrequency for nasal inverted papilloma].

OBJECTIVE: To evaluate the effect of endoscopic surgery using the low-temperature plasma radiofrequency for nasal inverted papilloma. Methods In a retrospective study, clinical data of 8 patients underwent endoscopic surgery were analyzed since July 2008. Tumor stage according to Krouse was T1:1, T2:6, T3:1, T4:0, respectively. T1 and T2 lesions were completed excised using the low-temperature plasma radiofrequency, T3 lesions were excised using microdebrider combined with plasma radiofrequency. RESULTS: The average blood loss was about 20 ml, with the exception of one patients with recurrent nasal inverted papilloma about 200 ml. Shorter operative time, minimal postoperative pain, epithelization of nasal cavity was seen 2 months postoperatively. There were no complications. All patients were followed-up for 2-6 months, with no recurrence. CONCLUSIONS: Surgical treatment of nasal inverted papilloma using low-temperature plasma radiofrequency had following advantages: less blood loss, complete en bloc tumor resection, mild injury, short surgery time, mild postoperative pain. In summary, low-temperature plasma radiofrequency is a minimally invasive treatment for nasal inverted papilloma.

[Coblation for benign hyperplasia of tongue base under endoscope].

OBJECTIVE: To investigate the feasibility and efficacy of coblation on benign hyperplasia of tongue base under endoscopy. METHOD: Fifty cases with benign hyperplasia at tongue root including tonsillar hypertrophy, lymphangioma and papillary epithelioma were treated with coblation under endoscopy and analyzed retrospectively. The post-operative Hemorrhage and pain and therapeutic effect were observed. And the follow-up was 16 to 32 months. RESULT: All the tumors were resected completely. The postoperative pain was mild. The patients could eat on the day of surgery without dysfunction of pronunciation and respiratory. The VAS score of foreign body sensation in pharynx was decreased from 81.5 +/- 9.6 to 13.5 +/- 3.9 after surgery (P < 0.01). The recovery rate was 96%, excellence rate was 4% and total effective rate was 100%. Besides, there was no recurrence. CONCLUSION: Coblation is a safe, effective and minimally invasive way to treat benign hyperplasia of tongue base under endoscopy.

[Investigation of reoperation after failure of UPPP].

OBJECTIVE: To explore the surgical ways of reoperation of the UPPP. METHOD: Fifteen failed cases of OSAHS after UPPP were reviewed and analyzed. The reoperations were performed with modified laser assistant, ablation assistant UPPP combining ablation of tongue base. The follow-up was done after 1 year. RESULT: The AHI decreased from (38.56 +/- 11.23)/h to (4.87 +/- 1.59)/h and the lowest SpO2 increased from (61.5 +/- 8.5)% to (79.9 +/- 9.7)% of the patients. The statistical difference was significant (P<0.01) in 1 year after the reoperation. The total validity ratio was 100% and the recovery rate was 96%. No complications happened. CONCLUSION: The shortcomings of UPPP could be made up with ablation, and the ablation could help the UPPP more minimal damage and effective therapy.

[Modified laparoscopic transabdominal preperitoneal repair of groin hernias].

OBJECTIVE: To assess the clinical value of modified transabdominal preperitoneal (TAPP) repair of groin hernias in adult patients. METHOD: From May 2006 to April 2008, modified TAPP repair for hernia was performed in 403 adult patients with groin hernia and 22 with femoral hernia. Indirect hernia sac was treated by high ligation of the hernia sac in similar fashion with the management in children, while direct or femoral hernia was treated by dissecting the hernia sac. An incision was made on the lateral umbilical ligament, and the mesh was stapled and covered completely by the peritoneum of the lateral umbilical ligament, followed by fixation of the mesh with stapling and absorbable sutures. RESULTS: All the operations were accomplished successfully with the operating time from 20 to 30 min for unilateral hemioplasty and the blood loss volume was 4-5 ml. Two patients developed scrotal edema and three showed scrotal seroma. No hernia recurrence was found in follow-up for 2-22 months. The patients complained of no intestinal obstruction symptoms including traction pain, abdominal pain, or nausea or urinary bladder stimulation symptoms. CONCLUSIONS: Modified TAPP repair of groin hernias requires simple operation and produces reliable effect, and is therefore of clinical values for wide application.

[Effect of snoring on facial growth in children].

OBJECTIVE: To evaluate the effect of snoring on facial growth in children and the changes after surgery. METHODS: Observations on facial growth were taken by X-ray 1.5 - 2 years before and after surgery on 40 children snorers aged between 2 - 5 years old, whose tonsils and (or) adenoids were completely removed. The data collected before surgery in the 2 - 3 years old snorers and in the 4 - 5 years old ones were compared with the data from healthy children at the same age respectively. RESULTS: The comparison of data between 21 children snorers aged from 2 - 3 and 17 healthy children of the same ages showed that there was no significant difference in the diameter of pharyngeal cavity at tongue base (PAS), the diameter of nasopharyngeal cavity (UPW-PNS) and the angle between mandibular plane and frankfort horizontal plane (FH-MP) within 2 - 3 years group by statistically (P > 0.05). There is no significance in UPW-PNS and FH-MP angle within 4 - 5 years group by statistics (P > 0.05). Others results is significance in all groups (P < 0.05 or P < 0.01). There was no significant difference in all groups expect Y-axis Angle 1.5 - 2 years after surgery (P > 0.05). CONCLUSIONS: Abnormal facial growth was caused by the consistent force from the changed way of breathing due to the increasing narrowness of upper airway obstruction and the long-existing obstructive sleep. Surgery done as soon as possible is helpful to reduce the force caused by the obstruction and helpful to the normal facial growth.

[Surgical treatment of tumors in anterior and middle skull base by modified maxillary bone disassembly procedures].

OBJECTIVE: To explore the therapeutic effect of the modified maxillary bone disassembly procedures on patients with tumors in the anterior and middle skull base. METHODS: Retrospective analysis was made of patients treated with the modified maxillary bone disassembly procedures. Ten tumors in the anterior and middle skull base were resected according to the pathology, size and site of the skull base tumors including 9 benign tumors and 1 malignant tumor. RESULTS: All tumors were resected completely. All patients were followed up from 12 months to 5 years postoperatively. The complications were less and the life quality was increased. The patients with benign tumors showed no recurrence . Two patients with cerebrospinal rhinorrhea cured spontaneously after 7 days. One patient with melanoma died of brain metastase. CONCLUSIONS: It is necessary to estimate the tumors thoroughly before surgery. According to the location of the tumor, the modified maxillary bone disassembly is the nearest and harmless approach, through which the tumors can be completely excised with minimal invasiveness. The life quality is thus increased.