For nasotracheal intubation, which nostril results in less epistaxis: right or left?: A systematic review and meta-analysis.

BACKGROUND: Nasotracheal intubation is usually required in patients undergoing oromaxillofacial, otolaryngological or plastic surgery to prevent the airway encroaching into the operating field. Epistaxis is the most common complication, but which nostril is associated with a lower incidence and severity of epistaxis is still unclear. OBJECTIVE: When both nostrils are patent, to determine the preferred nostril for nasotracheal intubation under general anaesthesia. DESIGN: A systematic review and meta-analysis of randomised controlled trials (RCTs). The primary outcome was the incidence of epistaxis and the secondary outcomes included the incidence of severe epistaxis, the time required to pass the tube through the nasal passage and total intubation time. DATA SOURCES: PubMed, Embase and the Cochrane Register of Controlled Trials were searched from database inception to 1 March 2020. ELIGIBILITY CRITERIA: The only studies included were RCTs comparing epistaxis related to nasotracheal intubation via right or left nostril, in adult surgery patients undergoing general anaesthesia. RESULTS: Ten RCTs with 1658 patients were included. Compared with the left nostril, intubation via the right nostril was associated with a significantly lower incidence of epistaxis: risk ratio (RR) and 95% confidence intervals (CI) were 0.78 (0.62 to 0.99), P = 0.04: a lower incidence of severe epistaxis (five studies, n=923), RR 0.40 (0.22 to 0.75), P = 0.004: and a shorter intubation time (three studies, n=345), mean difference -7.28 (-14.40 to -0.16) seconds, P = 0.05. In two studies (n=310), no significant difference between the right and left nostril was observed in the time to pass the tube through the nasal passages, mean difference -0.59 (-1.95 to 0.77) s, P = 0.40. CONCLUSION: On the basis of the current available evidence, when both nostrils are patent, the right nostril is more appropriate for nasotracheal intubation, with a lower incidence and severity of epistaxis and faster intubation time. TRIAL REGISTRATION: The study protocol has been registered in PROSPERO (CRD42020169949).

[Effect of scaling and root planing on serum C-reactive protein levels in patients with moderate to severe chronic periodontitis: a systematic review and Meta-analysis].

OBJECTIVE: To evaluate the effect of scaling and root planing (SRP) on serum C-reactive protein (CRP) levels in patients with moderate to severe chronic periodontitis. METHODS: We searched the PubMed, Web of Science, EMBASE, Cochrane, CNKI, Wanfang, and VIP databases from the inception to July 8th, 2019. Two reviewers independently screened literature, extracted data, and evaluated the bias risk of included studies. Then, a meta-analysis was performed using RevMan 5.3 software. RESULTS: A total of 13 randomized controlled clinical trials and 12 prospective clinical trials were included. Meta-analysis showed that serum CRP levels decreased at 2 and 3 months after SRP (P<0.05), and no significant difference in serum CRP levels was found at 6 months (P=0.49). CONCLUSIONS: SRP can reduce serum CRP levels in systematically healthy patients with moderate to severe chronic periodontitis at 2 and 3 months after SRP.

Tumor-Infiltrating CD1a+ DCs and CD8+/FoxP3+ Ratios Served as Predictors for Clinical Outcomes in Tongue Squamous Cell Carcinoma Patients.

Tumor-infiltrating immune cells engage in an extensive crosstalk with tumors and act as two-edged swords by inhibiting or promoting cancer growth. Therefore, identifying the density and prognostic values of tumor-infiltrating immune cells will provide valuable tips for cancer treatments. In this study, we identified the density of tumor inflammatory infiltrates and the number of tumor-infiltrating immune cells, including CD3+, CD4+, CD8+, FoxP3+ T cells and CD1a+ dendritic cells (DCs) in 153 tongue squamous cell carcinomas (TSCC). High inflammatory cell infiltration was associated with better overall survival (OS) and disease free survival (DFS). Moreover, the number of CD3+, CD4+, FoxP3+ and CD1a+ cells were associated with tumor differentiation (P<0.001) and the number of FoxP3+, CD1a+ cells and CD8+/FoxP3+ ratios were also associated with tumor stage (P<0.01, P<0.01, P<0.05). In addition, patients with higher CD1a+ DCs had better OS and increased CD8+/FoxP3+ ratios were associated with improved OS and DFS (P = 0.037; P = 0.047; P = 0.033). In conclusion, our results indicated that tumor-infiltrating CD1a+ DCs and CD8+/FoxP3+ ratios were associated with favorable clinical outcomes but not independent prognostic factors for TSCC patients.

Microlocalization of CD68+ tumor-associated macrophages in tumor stroma correlated with poor clinical outcomes in oral squamous cell carcinoma patients.

CD68 has been widely used as a pan-macrophage marker for tumor-associated macrophages (TAM) which always involve in carcinogenesis. But the correlations between CD68(+) TAMs and prognosis of patients show to be inconsistent, which might due to lack of specific markers of TAMs. We here found that the microlocalization of CD68(+) TAMs also played a unique role in prognosis of patients with oral squamous cell carcinoma (OSCC). CD68(+) TAMs were identified in paraffin-embedded OSCC specimens (n = 91) by using immunohistochemistry. The number of CD68(+) TAMs was remarkably increased from adjacent none-neoplasia tissues (NT) to tumor nest (TN), but tumor stroma (TS) was infiltrated with highest frequency of CD68(+) TAMs (P < 0.0001). Unexpectedly, more CD68(+) TAMs in TS, but not NT or TN, were associated with high tumor grade (P = 0.033), lymph node metastasis (P = 0.034), and shorter 10-year overall survival time, disease free survival. Considering TAMs was derived from monocytes in peripheral blood, we assessed the relationship between leukocytes in peripheral blood and CD68(+) TAMs in OSCC and found that more CD68(+) TAMs in TS were accompanied with decreased monocytes and lymphocytes in peripheral blood (P < 0.05). Although Cox regression analysis revealed that CD68(+) TAMs in TS were not an independent prognostic factor for OSCC patients, we raised a possibility that the microlocalization of CD68(+) TAMs was an indispensable factor for the advance of OSCC.

Effects of postoperative analgesia with the combination of tramadol and lornoxicam on serum inflammatory cytokines in patients with gastric cancer.

OBJECTIVE: To compare the effects of postoperative patient-controlled intravenous analgesia (PCIA) with morphine, tramadol, or tramadol combined with lornoxicam on serum inflammatory cytokine production. METHODS: 60 patients with an American Society of Anesthesiologists (ASA) physical status of I or II, undergoing radical correction of gastric cancer, were equally randomized to receive PCIA with morphine (M group), tramadol (T group), or tramadol combined with lornoxicam (L group). The visual analog scale (VAS) and Bruggemann comfort scale (BCS) scores were used to evaluate the postoperative analgesic efficacy. Serum levels of the interleukins (IL) IL-2, IL-6, and IL-10, and soluble IL-2 receptor (sIL-2R) were measured before anesthesia, 90 min after incision, and 24, 48, and 72 h after surgery. RESULTS: No significant difference was found in the VAS, BCS, or baseline serum IL-2, IL-6, IL-10, or sIL-2R between the groups. At 90 min after incision, only the IL-6 levels increased (p < 0.05). At 24 h after surgery, the IL-2 levels decreased, with the M group having the lowest levels, while IL-6, IL-10, and sIL-2R levels increased, with the M group having the highest level and the L group having the lowest level (p < 0.05). At 48 h after surgery, the cytokine levels were starting to return to the baselines but still had statistical significance (p < 0.05). At 72 h after surgery, only the IL-6 levels had returned to their baseline. CONCLUSION: PCIA using tramadol combined with lornoxicam has less influence on inflammatory cytokines than morphine or tramadol alone in patients undergoing gastric cancer surgery.

[Application of nitrous oxide / oxygen inhalation sedation in tooth extraction of elderly patients with hypertension].

PURPOSE: To investigate the safety and efficacy of nitrous oxide/oxygen inhalation sedation assisted in elderly hypertensive patients under local anesthesia during tooth extraction. METHODS: Forty elderly patients (age≥70 years) with hypertension who needed tooth extraction with electrocardiographic monitoring were selected, and divided into experimental and control groups randomly, with 20 patients in each group. The experimental group was treated with nitrous oxide/oxygen inhalation sedation and local anesthesia for surgery, the control group underwent tooth extraction under local anesthesia. Heart rate, blood pressure, as well as differences of operative time in all groups before surgery, during operation and after surgery were observed and compared. SPSS 11.0 software package was used for statistical analysis. RESULTS: The intraoperative HR, BP of patients in the control group was significantly higher than those of patients in the experimental group (P<0.05). HR, BP were relatively stable during the whole procedure in the experimental group. Compared with the control group, surgery was significantly longer in the experimental group (P<0.05). The difference was statistically significant. CONCLUSIONS: Nitrous oxide/oxygen inhalation sedation assisted local anesthesia can be a safe and effective anesthetic method in tooth extraction of elderly patients with hypertension. Supported by Medical Science and Technology Progress Project of Nanjing City(YKK11040).

[Specific markers and ultrastructure of lymphatic vessel in healthy human dental pulp].

PURPOSE: To explore the existence of lymphatic vessels in healthy human dental pulp. METHODS: Thirty healthy human dental pulps were obtained from non-carious premolars removed for orthodontic reasons. Immunohistochemistry was performed using the antibodies specific for lymphatic endothelium such as D2-40 and LYVE-1, and for vascular endothelial cell such as CD31 and CD34. The expression of D2-40 was detected by Western blotting and ultrastructure was examined by transmission electron microscopy. RESULTS: In healthy human dental pulps, we failed to detect any reactivity for the lymphatic markers D2-40 and LYVE-1 in the observed vessels. These vessels were positive stained by blood endothelial markers CD34 and CD31. Odontoblasts were weakly stained with D2-40. Western blotting performed on collagenase-treated human dental pulps did not show a band at 40 kDa, corresponding to the molecular weight of the lymphatic marker D2-40. Transmission electron microscopy indicated that vessels in dental pulp consisted of endothelial monolayer surrounded by pericytes and complete basement membrane, which were typical ultrastructural characteristics of blood vessels rather than lymphatic vessel. CONCLUSIONS: Human dental pulp does not contain true lymphatic vessels under healthy conditions. Whether lymphatic system is involved in dental pulp interstitial fluid circulation during inflammation deserved further study. Supported by National Natural Science Foundation of China (81100768) and Key Project Supported by Medical Science and Technology Development Foundation, Department of Health of Nanjing City (YKK11040 and QRX11123).

[Relationship between RNA degradation and postmortem interval in mice].

OBJECTIVE: To investigate the degradation changes of beta-actin mRNA and 18S rRNA in different time points and temperature after death, and to explore the relationship between the changes and postmortem interval (PMI) in the brain of mice. METHODS: Twenty-four health adult C57BL/6 mice were randomly divided into two groups (12 each group). They were sacrificed by cervical dislocation and placed in chamber with two different temperature (4 degrees C and 37 degrees C, humidity was 80%). The mice brains were sampled at 6 different time points(immediately, 0.5h, 2h, 6h, 24h, 48h), and total brain RNA were extracted. Ct value of each sample was obtained using RT-PCR and real-time PCR technology, and beta-actin mRNA and 18S rRNA content ratio was calculated. The correlation between the content ratio and PMI was expressed using statistical regression analysis. RESULTS: At 37 degrees C, RNA degradation rate was faster than 4 degrees C, which showed that there was correlation between temperature and RNA degradation. Comparing with the stability of beta-actin mRNA, 18S rRNA was more stable. CONCLUSION: The study on degradation of beta-actin mRNA and 18S rRNA in mice brain using real time PCR technology could provide a new theoretical basis for estimation of PMI and would be supplementary to the traditional methods.

[The clinical application of monitored anesthesia care in percutaneous dilatational tracheostomy].

OBJECTIVE: To investigate the changes in hemodynamics and depth of anesthesia under monitored anesthesia care (MAC) in patients undergoing percutaneous dilatational tracheostomy (PDT). METHODS: Forty-six patients with oral cancer were divided into two groups with 23 cases each: Local anesthesia group (group L) and MAC group (group M). Local and intratracheal surface anesthesia were performed with 2% lidocaine in group L. Midazolam, propofol and fentanyl were added to group M after local and intratracheal surface anesthesia, then PDT was carried out. During the induction, observer's assessment of alertness/sedation(OAA/S) scale was used to assess the depth of sedation. Mean arterial blood pressure (MAP), heart rate (HR), state entropy (SE) and response entropy (RE) were recorded before anesthesia (basal value, T1), after local anesthesia (T2), after intravenous administration/before incision (T3), during incision (T4), during dilating with stretching pliers (T5) and endotracheal intubation (T6). A postoperative follow-up was taken in group M. RESULTS: MAP and HR increased significantly at T4-T6 in group L and decreased at T3 (P < 0.05) with no change at T4-T6 in group M compared with those in T1. MAP and HR at T3-T6 in group M were obviously lower than those in group L. SE and RE at T3-T6 in group M were obviously lower than those at T1 or in group L (P < 0.01) and decreased significantly with the reduction of OAA/S scale (P < 0.05) during the induction. Intraoperative awareness in group M was not found through postoperative follow-up. CONCLUSION: Patients undergoing PDT under MAC has more comfortability, more stable hemodynamics and no memory, so MAC is a better anesthesia for PDT than local anesthesia.

[Expression and clinical significance of kidney injury molecule-1 in renal epithelial neoplasms].

OBJECTIVE: To study the expression and clinical significance of kidney injury molecule-1 (KIM-1) in primary and metastatic renal epithelial neoplasms. METHODS: A total of 136 cases of kidney neoplasms were retrospectively reviewed including 63 primary clear cell renal cell carcinomas (RCCs), 22 papillary RCCs, 13 chromophobe RCCs, 7 oncocytomas, 7 RCCs associated with Xp11.2 translocation/TFE3 gene fusions and 24 metastatic clear cell RCCs. Immunostaining for KIM-1 and kidney-specific-protein (Ksp)-cadherin were performed and the relationship to tumor stage and grade in clear cell RCCs was investigated. RESULTS: Expression of KIM-1 was detected in 77.8% (49/63) of clear cell RCCs, 90.9% (20/22) of papillary RCCs, 1/13 of chromophobe RCCs, 7/7 of RCCs associated with Xp11.2 translocation/TFE3 gene fusions and 87.5%(21/24) of the metastatic RCCs, but not detected in 7 cases of oncocytomas. A diffuse expression of KIM-1 was more frequently observed in Furhman nuclear grade III/IV clear cell RCCs (P = 0.010). Ksp-cadherin expression was mainly observed in chromophobe RCCs and oncocytomas. CONCLUSIONS: KIM-1 is a specific biomarker for injuried kidney proximal tubules and the corresponding neoplasms, and has a high specificity and sensitivity for primary or metastatic clear cell RCCs, papillary RCCs and RCCs associated with Xp11.2 translocation/TFE3 gene fusions. Combination of KIM-1 and Ksp-cadherin immunostaining can lead to a more precise histological classification of primary kidney epithelial neoplasms and improve the diagnostic accuracy of metastatic RCCs.

[Prognostic significance and grading of stromal invasion in pT1 adenocarcinoma of lung].

OBJECTIVE: To study the prognostic significance of grading system for stromal invasion in pathologic tumor stage T1 (pT1) adenocarcinoma of lung. METHODS: Eighty-five cases of surgically resected pT1 lung adenocarcinoma with clinicopathologic and follow-up data were retrospectively reviewed. The degree of invasive growth was classified into three grades according to its location in the tumor. The clinicopathologic characteristics and prognostic significance were analyzed. RESULTS: Amongst the 85 cases studied, 17 cases (20%) were in grade 1, 12 (14%) in grade 2 and 56 (66%) in grade 3. The tumor size was smaller and lymphovascular permeation was less frequently encountered in cases with grade 1 stromal invasion than in those with grade 3 (P=0.005 for tumor size and P=0.018 for occurrence of lymphovascular permeation). The rate of lymph node metastasis and pathologic staging in cases with grade 1 and grade 2 were similar and were significantly lower than those with grade 3 (P=0.007 for rate of lymph node metastasis in grade 1 versus grade 3 tumors, P=0.002 for pathologic stage in grade 1 versus grade 3 tumors, P=0.027 for rate of lymph node metastasis in grade 2 versus grade 3 tumors and P=0.021 for pathologic stage in grade 2 versus grade 3 tumors). There was no statistically significant difference with respect to age, gender and smoking history of the patients, amongst cases in different grades. The overall five-year survival rate was 63%. The five-year survival rates for cases with grade 1, grade 2 and grade 3 were 100%, 83.3% and 46.6%, respectively. The difference between cases with grade 2 and grade 3 was statistically significant (P=0.027). The death rate during follow-up for cases with grade 1, grade 2 and grade 3 were 0, 16.7% and 42.9%, respectively. The difference between cases with grade 1 and grade 3 was statistically significant (P=0.001). Univariate analysis showed that grade of stromal invasion (P=0.001), pathologic stage (P<0.001), presence of lymphovascular permeation (P<0.001) and lymph node involvement (P<0.001) represented important prognostic factors. Multivariate analysis also showed that pathologic stage (P<0.001) was an independent prognostic factor. CONCLUSIONS: The grading system of stromal invasion in pulmonary adenocarcinoma correlates with tumor prognosis and other prognostic factors. It represents a useful criterion in prognostic categorization of pT1 adenocarcinoma of lung.

Primary alveolar soft part sarcoma of vertebra: a case report and literature review.

Alveolar soft part sarcoma (ASPS) is a rare malignant soft tissue tumor, which rarely occurs in bone. We present a case of ASPS in a 23-year-old man with a 2-month history of back pain. Computed tomography scanning and magnetic resonance images demonstrated a destructive process in the 12th thoracic vertebra associated with a unilateral soft tissue mass. The tumor showed evidence of hypervascularity on MRI; it obviously was enhanced on T1-weighted images after injection of Gd-GDPA, and signal voids were shown on all pulse sequences which may help to differentiate ASPS from other tumors of the vertebra. We believe that this is the first case of ASPS arising in a vertebra.

Loss of expression of EphB1 protein in gastric carcinoma associated with invasion and metastasis.

OBJECTIVE: EphB1 is a member of the Eph family of receptor tyrosine kinases that is involved in embryonic nervous and vascular system development. Over- or underexpression of certain Eph receptors has been found in some cancer samples compared to normal tissue. Expression of Eph receptors is related to malignant transformation, metastasis, differentiation, and prognosis of cancers. Recently, the EphB subfamily has been shown to be involved in the tumorigenesis of colorectal cancer. In the present study, expression of the EphB1 transcript and protein in gastric carcinoma samples was determined to investigate the roles of EphB1 in development, progress and prognosis of gastric carcinoma. METHODS: Quantitative real-time reverse transcriptase-polymerase chain reaction and immunohistochemical staining were used. RESULTS: The EphB1 transcript was overexpressed in 68.9% (42/61) and underexpressed in 14.8% (9/61) of cases. However, the expression of protein was greatly different from the transcript expression, with overexpression and underexpression being 17.2% (10/58) and 44.8% (26/58), respectively. In addition, we showed that underexpression of EphB1 protein is significantly associated with invasion, stage and metastasis in gastric carcinomas. CONCLUSION: EphB1 may have a tumor-suppressive role in gastric cancer.