[The correlation and mechanism between chronic kidney disease and periodontitis based on cross-sectional data].

Objective: To explore the correlation between periodontitis (PD) and chronic kidney disease (CKD) in adults, as well as the potential mechanisms involved. Methods: Data on PD and CKD from the National Health and Nutrition Examination Survey (NHANES) database between 1999 and 2014 were downloaded. Weighted univariate and multivariate logistic regression analyses were conducted to investigate the risk factors associated with PD and CKD, considering demographic and clinical indicators. Using publicly available genome-wide association study (GWAS) summary datasets for kidney disease and periodontal disease as outcome variables, as well as 731 immune cell phenotypes and 91 inflammatory proteins as exposure factors from the OPEN GWAS database, a two-sample Mendelian randomization (TSMR) analysis was performed using the inverse-variance weighted (IVW) method. Results: Seven demographic indicators including gender, age, race, education level, marital status, income, and health are related to the incidence of CKD and PD. Among them, the elderly (≥60 years old), poverty (poverty-income ratio <1.3), divorce or widowhood, and male ratio in the comorbidity group of CKD and PD [67.12% (833/1 241), 36.83% (457/1 241), 34.41% (427/1 241), and 57.78% (717/1 241) respectively] were significantly higher than those in the control group [23.71% (4 179/17 623), 29.17% (5 141/17 623), 18.16% (3 200/17 623), and 48.73% (8 587/17 623) respectively] (all P<0.001). Those with high educational level (university and above) and self-rated excellent health accounted for a relatively small proportion in the comorbidity group [14.10% (175/1 241) and 8.22% (102/1 241) respectively]. The prevalence of PD increased among individuals with abnormal renal function indices, including glomerular filtration rate, urine protein/creatinine ratio, serum creatinine, serum uric acid, and blood urea nitrogen. Univariate logistic regression analysis showed a positive correlation between the incidence of PD and CKD (OR=2.14, 95%CI: 1.90-2.42, P<0.001). Multivariate logistic regression analysis also indicated that PD and CKD were potential risk factors for each other (PD for CKD: OR=1.22, 95%CI: 1.07-1.40, P=0.004; CKD for PD: OR=1.19, 95%CI: 1.04-1.37, P=0.012). Furthermore, after adjusting the model based on demographic indicators, there was still a significant correlation between PD and CKD (P=0.01). Mechanistically, the results of the TSMR analysis support the existence of a common risk factor mediated by immune cells between CKD and PD, namely the expression of CD64 on multiple innate immune cells mediates the occurrence of CKD and PD. The absolute count of CD64+ monocytes is associated with an increased risk for both CKD (HR=1.11) and PD (HR=1.07), while same tendency showed in the absolute count of CD64+ neutrophils for CKD (HR=1.22) and PD (HR=1.23). Conclusions: There is a positive correlation between CKD and PD, particularly moderate to severe PD, and the shared pathogenesis involves CD64+ monocytes in the circulatory system. Targeted interventions focusing on CD64 molecules or monocyte subsets may be beneficial.

[Analysis of the efficacy of left subclavian artery laser in situ fenestration combined with hybrid arch debranching surgery for aortic arch reconstruction in patients with Stanford type A aortic dissection].

Objective: To observe the short-and mid-term efficacy of left subclavian artery(LSA) laser in situ fenestration combined with arch debranching surgery for aortic arch reconstruction in patients with Stanford type A aortic dissection aged 60 years and above. Methods: This is a retrospective cohort study. A total of 41 Stanford type A aortic dissection patients aged 60 years and above who received combined surgery in Department of Endovascular Surgery, the First Affiliated Hospital of Zhengzhou University from January 2018 to December 2020 were retrospectively analyzed. There were 25 males and 16 females, aged (67.3±5.9)years(range: 60 to 75 years). Among them, 19 patients underwent LSA laser in situ fenestration combined with arch debranching surgery(combined surgery group) and 22 patients underwent hybrid aortic arch debranching surgery(non-combined surgery group). Independent sample t test, χ2 test and Fisher exact probability method were used to compare the clinical characteristics of the two groups. Kaplan-Meier method was used for survival analysis, and the 5-year survival rate of the two groups was compared by Log-rank test. Results: Body mass index in the combined operation group was significantly higher than that in the non-combined operation group ((27.1±1.6)kg/m2 vs.(26.9±1.9)kg/m2; t=2.766,P=0.006), and the difference was statistically significant. There was no statistical significance in the comparison of other general data (all P>0.05). The operation time ((320.9±21.7) minutes vs. (326.7±22.5)minutes; t=14.838, P<0.01)) and LSA reconstruction time ((32.6±3.2)minutes vs. (44.7±6.0)minutes; t=46.913, P<0.01) in the combined operation group were significantly shortened, and the difference was statistically significant. The rate of LSA reconstruction in the combined operation group (100% vs. 72.7%; P=0.023) was significantly higher than that in the non-combined operation group, and the difference was statistically significant. There were no significant differences in the incidence of pulmonary infection, unplanned second operation, continuous renal replacement therapy, neurological complications and the in-hospital mortality between the two groups. Compared with the non-combined surgery group, the total complication rate related to LSA reconstruction was significantly lower in the combined surgery group (0 vs. 27.3%; P=0.023). Kaplan-Meier survival analysis showed that there was no difference in 5-year survival rate between the combined operation group and the non-combined operation group (84.2% vs 77.3%; χ2=0.310, P=0.578). Conclusion: Laser in situ fenestration of the LSA combined with arch debranching surgery to reconstruct the aortic arch can significantly shorten the operation and LSA reconstruction time in patients with Stanford type A aortic dissection, improve the success rate of LSA reconstruction, and reduce the occurrence rate of LSA reconstruction complications.

[Mid- and long-term results of surgical treatment of brachiocephalic Takayasu arteritis].

Objective: To examine the mid - and long-term outcomes of surgical treatment of brachiocephalic Takayasu arteritis. Methods: This is a retrospective case series study. The clinical data of 39 patients,which had been diagnosed as brachiocephalic Takayasu arteritis (244 cases),who underwent surgical treatment,were analyzed between July 2012 to November 2022 at Department of Endoluminal Vascular Surgery, the First Affiliated Hospital of Zhengzhou University. There were 5 males and 34 females, aged (37.9±14.0)years (range:13 to 71 years). Despite medical treatment, the patients suffered severe ischemic symptoms continually and then underwent surgical interventions. Among them, 20 patients underwent endovascular procedures, 11 underwent open surgical procedures, and 8 underwent hybrid procedures. Patients were followed up through outpatient visits at 1, 3, 6 months after surgery and once every year later. Follow-up was conducted until November 2022. Operation status, postoperative complications and re-intervention of patients were recorded and the Kaplan-Meier survival curves were used to analyze postoperative vascular patency rates. Results: All 39 surgeries were successful, with no intraoperative death or serious complications. The follow-up period was (48.8±38.2) months(range:1 to 123 months). Thirty-three patients experienced symptom relief after surgery, and 6 patients required secondary surgical interventions. The patency rates for the endovascular treatment group at 1-, 3-, 5-, and 10-year were 95.0%, 75.2%, 60.2%, and 60.2%, respectively, while the patency rates for open surgery were all 90.9%. In the hybrid surgery group, the patency rates at 1-, 3-, 5-, and 8-year were all 87.5%. Conclusion: For patients with brachiocephalic Takayasu arteritis, choice of an appropriate blood flow revascularization intervention should be based on the patient's condition,and the mid-and long-term outcomes are satisfactory.

[A case of multiple difficult illnesses in a patient with extremely severe burn complicated with type 2 diabetes].

On December 20, 2018, a 40-year-old male patient with extremely severe flame burn was admitted to Guangzhou First People's Hospital. A variety of difficult illnesses occurred simultaneously (refractory hyperglycemia, refractory hypernatremia, and progressive wound deepening) and successively (repeatedly postoperative hypotension, nervous system diseases, and secondary diabetes insipidus). The patient underwent treatments such as anti-shock, reducing blood sugar and blood sodium, scab removing, and gradual skin grafting after admission. Although the hyperglycemia and hypernatremia were basically corrected and the wounds were basically repaired, the patient ultimately died of nervous system diseases and secondary diabetes insipidus 5 months later. Although the cause of the above illnesses can not be fully determined, the targeted treatments to improve clinical symptoms, maintain stable internal environment and physiological function, and accelerate the process of wound repair conducted by the team may provide some experience for the treatment of such severe patients.

[Status of HVPG clinical application in China in 2021].

Objective: The investigation and research on the application status of Hepatic Venous Pressure Gradient (HVPG) is very important to understand the real situation and future development of this technology in China. Methods: This study comprehensively investigated the basic situation of HVPG technology in China, including hospital distribution, hospital level, annual number of cases, catheters used, average cost, indications and existing problems. Results: According to the survey, there were 70 hospitals in China carrying out HVPG technology in 2021, distributed in 28 provinces (autonomous regions and municipalities directly under the central Government). A total of 4 398 cases of HVPG were performed in all the surveyed hospitals in 2021, of which 2 291 cases (52.1%) were tested by HVPG alone. The average cost of HVPG detection was (5 617.2±2 079.4) yuan. 96.3% of the teams completed HVPG detection with balloon method, and most of the teams used thrombectomy balloon catheter (80.3%). Conclusion: Through this investigation, the status of domestic clinical application of HVPG has been clarified, and it has been confirmed that many domestic medical institutions have mastered this technology, but it still needs to continue to promote and popularize HVPG technology in the future.

[Efficacy of Han-uvulopalatopharyngoplasty (HUPPP) combined with radiofrequency ablation of tongue base or HUPPP with traction of tongue base on moderate to severe patients with obstructive sleep apnea hypopnea syndrome (OSAHS):a multicenter randomized controlled trial].

Objective: To compare the therapeutic efficacy of Han-uvulopalatopharyngoplasty (HUPPP) combined with radiofrequency ablation of tongue base or HUPPP with traction of tongue base on moderate to severe patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods: This is a multicenter randomized controlled trial. From March 2017 to July 2019, moderate to severe OSAHS patients from three clinical center in Shanghai who were intolerant to continuous positive airway pressure (CPAP) and with velopharyngeal and glossopharyngeal plane obstruction were enrolled in this study. According to the surgical type, they were 1∶1 randomized to HUPPP plus radiofrequency ablation of tongue base group (Ablation group) or HUPPP plus traction of tongue base group (Traction group). All patients completed over-night standard Polysomnography (PSG), upper-airway assessment (Friedman classification, Müller test, CT and cephalometric examination), preoperative routine examination, Epworth Sleepiness Scale (ESS) and Quebec sleep questionnaire (QSQ). Six to 12 months after operation, all the above-mentioned examinations were repeatedly performed. Changes of aforementioned variables before and after operation were assessed. Results: A total of 43 patients with moderate to severe OSAHS were enrolled in this study. One patient lost to follow-up, the remaining 21 were allocated to Ablation group and 21 were allocated to Traction group. The total therapeutic efficacy of all patients was 69.05% (61.90% in Ablation group and 76.19% in Traction group), but there was no statistical significance between the two groups (P= 0.317). The value of sleep scale score (ESS and QSQ), objective sleep variables (apnea-hypopnea index, oxygen saturation, percentage of time with blood oxygen less than 90% in total sleep time, oxygen desaturation index and micro-arousals) and upper airway cross-sectional area (palatopharyngeal and retrolingual area) of the two groups were improved (P<0.05), but the differences between the two groups were not statistically significant (P>0.05). Conclusion: For moderate to severe OSAHS who had glossopharyngeal plane obstruction, both HUPPP plus radiofrequency ablation of tongue base or HUPPP plus traction of tongue base are effective treatment for OSAHS, and the curative effect is similar. The choice of surgical type could be selected according to patient's or surgical conditions.

[Analysis of diagnosis, treatment and risk classification of blunt thoracic aortic injury].

Objective: Propose a new risk classification system for blunt thoracic aortic injury and explore its treatment strategies. Methods: After the retrospective analysis of clinical data from 68 patients with blunt thoracic aortic injury in the First Affiliated Hospital of Zhengzhou University from November 2016 to October 2020, there were 56 males and 12 females, among these patients, the median age was 45(21-69). According to the degree of aortic injury and the combined injury, the patients were scored for aortic injury, and the risk of the patients were graded into following three types: low-risk group (score ≤ 2 points) 12 cases, intermediate-risk group (3 points ≤ score ≤ 5 points) 41 cases, high-risk group (score ≥ 6 points) 15 cases. Analyzing the effects of treatments received by patients in different grades on the prognosis. Patients were followed up through hospitalization or outpatient clinics at 1, 3, 6, 12 months after surgery and every year thereafter. Results: Of the 68 patients, 21 received non-surgical treatment and 47 received surgical repair, including 6 open surgery and 41 thoracic aortic endovascular repair. There were 16 cases of emergency operation and 31 cases of delayed operation. Twelve low-risk patients were treated with non-surgical treatment, and only 1 patient died of lung infection, with a mortality rate of 8.3% (1/12). There were 8 deaths in 41 moderate-risk patients, with a mortality rate of 19.5% (8/41), and the aortic-related mortality rate was 9.8% (4/41), and the operative mortality rate was 10.8% (4/37). The total mortality of 15 high-risk patients was 40% (6/15), and the aortic-related mortality rate was 30.0% (5/15), and the mortality rate of surgical patients was 10% (1/10). During the follow-up period of 5 to 52 months, no deaths occurred outside the hospital. According to the risk grading, there were significant differences in the aortic-related mortality of each grade (χ²=7.840, P=0.020). During the follow-up of 5-52 months, 1 case had type Ⅰ endoleak, 1 case of cerebral infarction, and 1 case of acute renal failure. Conclusion: According to the patient's degree of aortic injury and combined injury, the risk classification helps to choose the appropriate treatment.

SMARCA4 promotes benign skin malignant transformation into melanoma through Adherens junction signal transduction

Purpose Melanoma is a malignant skin tumor, and its incidence is rising. To explore the specific differences in benign and malignant melanoma at the genetic level, we performed a series of bioinformatics analyses, including differential gene analysis, co-expression analysis, enrichment analysis, and regulatory prediction. Methods The microarray data of benign and malignant melanocytes were downloaded from GEO, and 1917 differential genes were obtained by differential analysis (p < 0.05). Weighted gene co-expression network analysis obtained three functional barrier modules. The essential genes of each module are SMARTA4, HECA, and C1R. Results The results of the enrichment analysis showed that the dysfunctional module gene was mainly associated with RNA splicing and Adherens junction. Through the pivotal analysis of ncRNA, it was found that miR-448, miR-152-3p, and miR-302b-3p essentially regulate three modules, which we consider to be critical regulators. In the pivot analysis of TF, more control modules include ARID3A, E2F1, E2F3, and E2F8. Conclusions We believe that the regulator (miR-448, miR-152-3p, miR-302b-3p) regulates the expression of the core gene SMARCA4, which in turn affects the signal transduction of the Adherens junction. It eventually leads to the deterioration of benign skin spasms into melanoma (AU)

SMARCA4 promotes benign skin malignant transformation into melanoma through Adherens junction signal transduction.

PURPOSE: Melanoma is a malignant skin tumor, and its incidence is rising. To explore the specific differences in benign and malignant melanoma at the genetic level, we performed a series of bioinformatics analyses, including differential gene analysis, co-expression analysis, enrichment analysis, and regulatory prediction. METHODS: The microarray data of benign and malignant melanocytes were downloaded from GEO, and 1917 differential genes were obtained by differential analysis (p < 0.05). Weighted gene co-expression network analysis obtained three functional barrier modules. The essential genes of each module are SMARTA4, HECA, and C1R. RESULTS: The results of the enrichment analysis showed that the dysfunctional module gene was mainly associated with RNA splicing and Adherens junction. Through the pivotal analysis of ncRNA, it was found that miR-448, miR-152-3p, and miR-302b-3p essentially regulate three modules, which we consider to be critical regulators. In the pivot analysis of TF, more control modules include ARID3A, E2F1, E2F3, and E2F8. CONCLUSIONS: We believe that the regulator (miR-448, miR-152-3p, miR-302b-3p) regulates the expression of the core gene SMARCA4, which in turn affects the signal transduction of the Adherens junction. It eventually leads to the deterioration of benign skin spasms into melanoma.

[Relationship between smoking and the severity of OSA].

Objective:To explore the relationship between smoking and the severity of OSA. Method:There were 719 patients included in the study, who were accompanied by snoring, daytime sleepiness and other symptoms. Laboratory-based polysomnographic variables （including AHI, oxygen desaturation index and microarousal index, etc.）, and anthropometric measurements （including weight, neck circumference, waist circumference, hip circumference etc.） were collected for all participants. The severity of OSA was determined by AHI. No OSA was defined as AHI<5, mild OSA as AHI of 5 to 15，moderate OSA as AHI of >15 to 30, and severe OSA as AHI of >30. Smoking severity was determined by the smoking index （SI）. Light smoke was defined as SI<200, moderate smoke was as SI 200 to 400, and severe smoke as SI>400. Result:There were 138 cases of non-OSA and 581 cases of OSA. There were 381 non-smokers, 279 smokers and 59 quit smokers. The smoking rate of OSA group was significantly higher than that of non-OSA group （41.5% vs. 27.5%,P<0.01）. After excluding 59 quit smokers, the remaining 660 subjects were divided into four groups according to the severity of smoking, then each group was further divided into four groups according to OSA severity. Unadjusted analysis showed that OSA severity positively correlated with smoking severity （r=0.203,P<0.01）. The positive correlation remained significant after further adjustment for age, BMI and waist-hip ratio. In addition, logistic regression analysis showed that compared to non-smokers, the odd ratios for OSA in moderate smokers were 1.72 （95%CI 1.08-2.75） and in severe smokers were 2.68 （95%CI 1.61-4.46）, after adjustment for age, BMI and waist-hip ratio. Conclusion:The severity of smoking significantly correlated with the severity of OSA. There was increased risk of OSA in patients with severe smoke. The correlation was independent of some confounders such as age and obesity.

[Clinical characteristics and management of cervical necrotizing fasciitis].

Objective:To investigate the clinical characteristics and treatment of cervical necrotizing fasciitis. Method:Clinical data of 61 patients were analyzed retrospectively. All patients were underwent surgical debridement and treated with broad-spectrum antibiotics after diagnose. Result:Complications occurred in 14 patients. Fifty-nine patients were cured while 2 patients died. After 3 months or more follow-up, 3 patients accompanied with sequelae of vocal hoarseness, and no patient recurred or died. Conclusion:Early surgical debridement and the use of antibiotics should be taken as soon as possible after diagnosis of cervical necrotizing fasciitis, as well as control of comorbidities and systemic support treatment in order to prevent complications and deaths.

Association of serum uric acid change with mortality, renal function and diuretic dose administered in treatment of acute heart failure.

BACKGROUND AND AIMS: Hyperuricemia is reportedly associated with poor outcome in acute heart failure (AHF). The association between changes in Uric acid (UA) levels with renal function change, diuretic doses, and mortality in patients with AHF were studied. METHODS AND RESULTS: Consecutive patients hospitalized with AHF were reviewed (n = 535). UA levels were measured at admission and either at discharge or on approximately the seventh day of admission. Patients with an UA change in the top tertile were defined as having an increase (UA-increase) and were compared to those outside the top tertile (non-UA-increase). The endpoint was all-cause mortality, with a mean follow-up duration of 22.2 months. Patients in the UA-increase group presented with greater creatine increase (P < 0.001), and were administered a higher average daily dose of loop diuretic (P = 0.016) compared with the non-UA-increase group. In-hospital UA-increase was associated with higher risk of mortality even after adjusting for confounding variables including creatine change and diuretic dosage [harzard ratio (HR) 1.53, 95% confidence interval (CI) 1.02-2.30, P = 0.042]. In patients with hyperuricemia on admission, UA-increase was associated with increased mortality (adjusted HR 2.21, 95% CI 1.38-3.52, P = 0.001). Whereas, in those without admission hyperuricemia, UA-increase had no significant association with mortality. CONCLUSIONS: An increase in UA during in-hospital treatment is associated with an increase in creatine levels and daily diuretic dose. Mortality associated with increased UA is restricted to patients who already have hyperuricemia at admission. A combination of UA levels at admission and UA changes on serial assessment during hospitalization may be additional value in the risk stratification of AHF patients.

miR-34a targets the inhibin beta B gene, promoting granulosa cell apoptosis in the porcine ovary.

During ovarian follicular growth and development, only a few follicles actually ovulate. Recently, it was found that follicular atresia is triggered by granulosa cell apoptosis, but the molecular mechanism of follicular atresia was not understood. Using flow cytometry, we found that miR-34a promotes granulosa cell apoptosis in pig ovarian follicles. In addition, inhibin beta B was found to be a miR-34a target gene, based on luciferase reporter assays, quantitative RT-PCR and Western blotting. Taken together, our data indicate that miR-34a plays an important role in granulosa cell apoptosis by targeting the INHBB gene in the porcine ovary.

Association between CASP-8 gene polymorphisms and cancer risk in some Asian population based on a HuGE review and meta-analysis.

Genetic variation in the CASP-8 gene reportedly can increase cancer susceptibility by regulating tumor cell proliferation and apoptosis. Several studies have investigated this possibility; however, the conclusions remain controversial. We made a Human Genome Epidemiology (HuGE) review and did a meta-analysis to explore the association between CASP-8 gene polymorphisms and cancer risk in Asian populations. Based on the inclusion criteria, 12 case-control studies comprising 7720 cancer cases and 9404 healthy controls were retrieved. Meta-analysis results showed that the rs3834129*del allele/carrier were associated with decreased risk of cancer in Asian populations [del allele: odd ratio (OR) = 0.79, 95% confidence interval (95%CI) = 0.75-0.83, P < 0.001; del carrier: OR = 0.77, 95%CI = 0.72-0.82, P < 0.001]. Subgroup analysis showed that the rs3834129*del allele/carrier are protective factors for cancer risk in Chinese populations (del allele: OR = 0.77, 95%CI = 0.73-0.81, P < 0.001; del carrier: OR = 0.75, 95%CI = 0.70-0.80, P < 0.001), but not in Indian and Korean populations. Furthermore, the rs6704688*T allele/carrier, rs3769827*C allele/carrier, rs3769825*C allele/carrier were associated with decreased risk of cancer in Asian populations (all P < 0.05). While the rs7608692*A allele was associated with increased risk of cancer risk in Asian populations (OR = 1.35, 95%CI = 1.02-1.78, P = 0.03). There was also no significant association between rs3769818, rs13030042, rs13030042, rs1045494, rs1045494, rs2823, or rs113686495, and cancer risk in Asian populations (all P > 0.05). This meta-analysis suggests that the rs3834129*del allele/ carrier, rs6704688*T allele/carrier, rs3769827*C allele/carrier, and rs3769825*C allele/carrier might be protective factors for cancer risk in Asian populations, while the rs7608692*A allele might be a risk factor for cancer risk in Asian populations.

CT-guided percutaneous chemoablation using an ethanol-ethiodol-doxorubicin emulsion for the treatment of metastatic lymph node carcinoma: a comparative study.

Current therapies for metastatic lymph node (LN) are a major burden on health-care systems. Alternative such as percutaneous chemoablation using interstitial injection of ethanol or ethanol-ethiodol-drug(s) mixture (EEM) has been successfully applied to solid tumor ablation of the liver, adrenal glands, lymph nodes and others. However, EEM chemoablation efficacy on two most frequent clinical lymph node presentation, isolated or confluent, has not yet been determined. This study was designed to compare the therapeutic effects of CT-guided percutaneous EEM injection (PEEMI) on patients presenting with single or multiple confluent metastatic LN localizations from various carcinoma. Thirty six patients with metastatic LN carcinoma at various anatomical regions were enrolled from 2009 to 2010 over a nine month period. They were separated into two groups: group A includes 24 single isolated metastatic lymph nodes and group B includes 12 multiple and confluent nodes. The primary end point was the ablative efficacy of PEEMI. The intratumoral (IT) EEM distribution and the occurrence of reflux were recorded. Adjuvant systemic chemotherapy was administered after the procedure. Contrast-enhanced CT scans were performed during procedure and follow-up. Six patients were tested for Fluorodeoxyglucose (FDG) fixation before and after the procedure. For group A the EEM IT distribution-to-tumor ratio was 100% vs. 50% to 80% for group B (t = 11.5, p < 0.05). The reflux frequency was 80% for group A versus 30% for group B. For group A, a complete response (CR) rates of 45.8%, 70.8%, 91.7% and a partial response (PR) rates of 54.2%, 29.2%, 8.3% were obtained at 3, 6 and 12 months after therapy. Regarding group B, a CR rate of 0%, 0%, 0% and PR rate of 16.7%, 50%, 58.3% were observed at similar period of time. Standardized rate by direct method was performed and the CR rate (74.5%) for group A was higher than for group B. The tumor FDG uptake was lower 6 months after PEEMII compared with the preoperative images. Five patients presenting with concomitant lung metastasis, had a good local response-node size reduction on postoperative CT scanning, but no response on lung nodules that were progressing. No serious adverse events were observed. A few patients had mild pain during the procedure, which resolved with peritumor injection of local anesthetic. No needle tract seeding or infection occurred. CT-guided PEEMI treatment is a simple, fast and predictable procedure that has better effectiveness on single, well circumscribed metastatic lymph node than on multiple and confluent ones. Technical improvements are expected to bring better results on large nodes that should be confirmed on larger group of patients.

Changes in facial appearance after maxillomandibular advancement for severe obstructive sleep apnoea hypopnoea syndrome in Chinese patients: a subjective and objective evaluation.

This study evaluates the outcome and change in facial appearance after maxillomandibular advancement (MMA) in Chinese adults with severe obstructive sleep apnoea hypopnoea syndrome (OSAHS). Twelve patients underwent MMA with adjunctive procedures for severe OSAHS. All underwent physical examination, Epworth Sleepiness Scale evaluation, cephalometry, polysomnography, and facial photographic assessment before and 6 months after MMA. The aesthetic plane (relationship of nose, lips, and chin) was used to judge soft tissue facial profile change after MMA. Postoperative cephalometric data were compared with normal occlusive standards and aesthetic norms. Pre- and postoperative aesthetic appearance was evaluated by 100 lay people using a 10-point visual analogue scale. The maxillomandibular complex (MMC) was advanced 5-10 mm (mean 7.4 mm). The success rate was 83%. All patients were satisfied with the functional and aesthetic results. Postoperative SNA, SNB, and posterior airway space increased and mandibular plane-to-hyoid distance decreased significantly in all patients. The lower lip was closer to EP than the preoperative and normal occlusive standard. In 11 of 12 patients, the lay aesthetic scores were significantly higher postoperatively. MMA is effective for Chinese adults with severe OSAHS. In most patients, facial appearance was more attractive after MMC advancement of 5-10 mm.

Characterisation of a novel cell line (CSQT-2) with high metastatic activity derived from portal vein tumour thrombus of hepatocellular carcinoma.

BACKGROUND: Portal vein tumour thrombus (PVTT) is highly associated with the progression and metastasis of hepatocellular carcinoma (HCC). However, there are no appropriate cell models of PVTT with which to study the biological and physiological characteristics of PVTT. METHODS: Primary cell culture was performed by the use of a successive xenograft line called PVTT-#1, which was obtained from a 60-year-old male HCC patient accompanied by PVTT. RESULTS: A successive cell line named CSQT-2 was established. The cell line showed aggressive phenotypes in terms of cell growth, survival, migration, xenograft and metastasis. Moreover, an orthotopic transplantation assay showed that PVTT can be generated in nude mice when CSQT-2 cells were inoculated in the liver and that it shows a typical migratory tendency in the vascular branches of portal vein. Moreover, the established CSQT-2 cells also showed varied expression of tumour-initiating cell (TIC) markers such as CD133, CD90 and EpCAM. CONCLUSION: Establishment of CSQT-2 may provide a suitable model with which to investigate the molecular mechanisms of PVTT-related HCC.

Neonatal intrahepatic cholestasis caused by citrin deficiency: clinical and laboratory investigation of 13 subjects in mainland of China.

BACKGROUND: Neonatal intrahepatic cholestasis caused by citrin deficiency (NICCD) is a novel inborn error of metabolism due to dysfunction of citrin protein, and much more information about this new disease is still needed for its clinical management. AIMS: To investigate in detail the clinical and laboratory features of NICCD. PATIENTS: 13 NICCD subjects in mainland of China diagnosed in our department since 2006. METHODS: The anthropometric parameters of the patients at birth were compared with controls, representative biochemical changes and metabolome findings were investigated cross-sectionally, and mutations in the causative gene SLC25A13 were analyzed by protocols established previously. RESULTS: The patients showed reduced birth weight, length and ponderal index. Main clinical manifestations consisted of jaundice, hepato/hepatosplenomegaly and steatohepatosis on ultrasonography. Biochemical analysis revealed intrahepatic cholestasis, delayed switch of AFP to albumin, and elevated triglyceride, total cholesterol and LDL-cholesterol together with reduced HDL-cholesterol. Metabolome findings included co-existence of markers for galactosemia and tyrosinemia in urine, and elevated Cit, Met, Thr, Tyr, Lys, Arg and Orn in blood. Mutations of 851-854del, IVS6+5G>A, 1638-1660dup, A541D, IVS16ins3kb, R319X and G333D were detected in the gene SLC25A13. CONCLUSIONS: The diagnosis of NICCD cannot be established based just on the numerous but non-specific clinical manifestations and biochemical changes. The relatively specific metabolome features provide valuable tools for its screening and diagnosis, while SLC25A13 mutation analysis should be taken as one of the reliable tools for the definitive diagnosis. The body proportionality at birth, steatohepatosis on ultrasonography, delayed switch of AFP to albumin, dyslipidemia pattern, urinary metabolome features and the novel mutation G333D expanded the clinical spectrum of NICCD.