Objective:To study the effects of different Epstein-Barr virus (EBV) DNA load, induction chemotherapy+ radiotherapy and concurrent radiochemotherapy on patients with stage Ⅲ nasopharyngeal carcinoma (NPC).Methods:A total of 178 patients with stage Ⅲ NPC were selected as the study subjects in the Department of Otorhinolaryngology of the First People′s Hospital of Xianning of Hubei Province from January 2012 to March 2019, including 44 patients received adjuvant chemotherapy. According to the pre-treatment EBV DNA load of 1 000 copies/ml, the patients were divided into high viral load group (EBV DNA≥1 000 copies/ml, n=53) and low viral load group (EBV DNA<1 000 copies/ml, n=125), and 14 patients in the high viral load group and 30 patients in the low viral load group received adjuvant chemotherapy. According to treatment method, the patients were divided into induction chemotherapy+ radiotherapy group ( n=105) and concurrent radiochemotherapy group ( n=73). The general clinical data, recurrence rate, 5-year overall survival (OS) rate, disease free survival (DFS) rate, local recurrence free survival (LRFS) rate and disease metastasis-free survival (DMFS) rate of each group were compared. Results:Among 178 patients with stage Ⅲ NPC, 34 cases recurred, accounting for 19.10%, and 29 cases died, accounting for 16.29%. There was a statistically significant difference in N staging between the induction chemotherapy+ radiotherapy group and the concurrent radiochemotherapy group ( χ2=6.40, P=0.01). The tumor recurrence rate in the high viral load group was 33.96% (18/53), and that in the low viral load group was 12.80% (16/125), and there was a statistically significant difference ( χ2=10.79, P<0.01). The recurrence rate of lymph nodes [(9.43% (5/53) vs. 1.60% (2/125), χ2=4.15, P=0.04], the distant metastasis rate [18.87% (10/53) vs. 5.60% (7/125), χ2=7.59, P=0.01] were significantly higher than those in the low viral load group, and there were statistically significant differences. The tumor recurrence rate of patients in the induction chemotherapy+ radiotherapy group was 17.14% (18/105), and that in the concurrent radiochemotherapy group was 21.91% (16/73), and there was no statistically significant difference ( χ2=0.63, P=0.43). The 5-year OS rate, DFS rate, LRFS rate and DMFS rate of 178 patients with stage Ⅲ NPC were 84.68%, 72.80%, 79.68% and 79.54%, respectively. The 5-year OS rate (79.25% vs. 92.80%, χ2=6.86, P<0.01), DFS rate (73.58% vs. 88.00%, χ2=5.67, P=0.01), LRFS rate (73.21% vs. 89.24%, χ2=8.32, P<0.01) and DMFS rate (65.24% vs. 78.00%, χ2=4.15, P=0.02) in the high viral load group were significantly lower than those in the low viral load group, and there were statistically significant differences. The 5-year OS rate (89.52% vs. 87.67%, χ2=0.15, P=0.70), DFS rate (84.76% vs. 82.19%, χ2=0.21, P=0.65), LRFS rate (80.38% vs. 79.84%, χ2=0.00, P=1.00) and DMFS rate (79.52% vs. 81.78%, χ2=0.05, P=0.83) in the induction chemotherapy+ radiotherapy group were not statistically significant compared with those in the concurrent radiochemotherapy group, and there were no statistically significant differences. The 5-year OS rate of 44 patients receiving adjuvant chemotherapy was significantly higher than that of patients who did not receive adjuvant chemotherapy (93.77% vs. 87.49%), and there was a statistically significant difference ( χ2=5.21, P=0.02). In the high viral load group, the 5-year OS rate of patients receiving adjuvant chemotherapy was significantly higher than that of patients who did not receive adjuvant chemotherapy (93.77% vs. 84.13%), and there was a statistically significant difference ( χ2=5.11, P=0.03). Conclusion:Induction chemotherapy+ radiotherapy can achieve the same therapeutic effect as concurrent radiochemotherapy. High viral load is associated with high recurrence rate and poor survival rate. For these patients with high viral load, treatment intensity needs to be strengthened.

Objective To clone the vascular endothelial growth factor C gene(VEGF-C),construct its sense and antisense eukaryotic expression vectors,and then to identify and analyze the gene's sequence.Methods Total RNA was isolated from human SGC-7901 cells when the cells were in logarithm growing period.The sense and antisense total length cDNA of VEGF-C gene were then synthesized and amplified from the total RNA by RT-PCR.The plasmid pCI-neo and pcDNA3 were transformed and prepared by Escherichia coli.After being cut with Hind Ⅲ+EcoR I and Xba I+EcoR I respectively,the VEGF-C cDNA was cloned into eukaryotic expression vector pCI-neo and pcDNA3.The recombinant plasmids pcDNA3-sense VEGF-C and pCI-neo-antisense VEGF-C were verified finally by restriction endonuclease analysis and sequencing.Results The positive clone of total length cDNA of VEGF-C gene which had been synthesized and amplified by RT-PCR contained approximately 1.3kb insert.The sense and antisense recombinants were pcDNA3-sense VEGF-C and pCI-neo-antisense VEGF-C.Their positive clone contained an approximately 6.8kb insert.Sequencing of basic radicals confirmed that the sequences of DNA fragments introduced to the recombined plasmids fitted the parameters of the expected design,and the two fragments were complementary with opposite direction.Conclusions The human VEGF-C gene has been cloned and both its sense and antisense eukaryotic expression vectors are constructed successfully,which set up a foundation for the next step of study on the effects of transfected antisense VEGF-C cells on the growth of tumor cells in vitro,and for the further study on the effects of VEGF-C in the formation of lymphatics and metastasis of gastric carcinoma.

Objective To provide suggestions for the safety management of printing inks and the establishment of food safety standard for food contact materials.Methods The laws,regulations and directives related to printing inks from different countries were collected and the differences among different management models were analyzed and compared.Results The safety management models of European Union,Switzerland,Germany,US and Japan were generalized and their experiences in the management measures of printing inks were summarized.Conclusion Safety standard of printing inks for food contact materials should be established on the basis of industry status and the various safety risks of different inks.Management experiences of other countries should be considered and the participation of industry associations should be encouraged.

Objective To compare the clinical diagnoses with autopsy findings and evaluate the frequency of misdiagnosis.Methods The findings of 356 cases who were autopsied in our department due to medical treatment dispute during the period of 1988 to 2007 were retrospectively analyzed.The clinical diagnosis and autopsy findings,sex and age of the death,length of hospitalization,the hospital department,distribution of death disease and the rank of hospital were analyzed.The concordance between diagnosis before death and at autopsy was calculated.Results In 162 cases(45.5%),the autopsy findings confirmed the clinical diagnosis.In 101 cases(28.4%),the clinical diagnosis suggested by clinicians were discordant with the autopsy findings.In 63 cases(17.7%),some diagnoses made by clinicians were proved by autopsy,and in 30 cases(8.4%),the clinical and postmortem diagnosis were beyond comparison.The most frequently misdiagnosed diseases were from cardiovascular and respiratory diseases,and among them,cardiomyopathy,aortic atherosclerosis and pneumonia were most common.Conclusion Autopsy is not only helpful for the management of medical dispute,but also beneficial to reduce the misdiagnosis in clinical practice.

Objective To investigate the biological effects of human gastric carcinoma cell line SGC-7901 transinfected by antisence vascular endothelial growth factor-C (anti VEGF-C) gene on the tumorigenicity and vascular generation,and explore the role of VEGF-C gene in metastasis and vascular generation of gastric cancer.MethodsThirty nude mice were randomly divided into three groups (10 each):transgenic anti VEGF-C group,transgenic pure liposome group and non-transgenic group.0.2ml (1?107/ml) of SGC-7901 suspension,either transinfected by anti VEGF-C gene,or by pure liposome,or transinfected nil,was respectively subcutaneously injected into the three groups of mice,once every 2 days for 3 consecutive days.After injection,the size and growth velocity of the neoplasm were measured.The microlymphatic vessel density (MLVD) and microvessel density (MVD) of tumor were also determined.ResultsThe neoplasm grew more slowly and was smaller in the mice of transgenic anti VEGF-C group than in non-transgenic ones.At the end of the 1st,2nd and 3rd week,the MLVD in the mice of transgenic anti VEGF-C group was 4.0?2.2,6.0?3.1 and 9.0?2.7/high field (/HF),respectively.In the transgenic pure liposome group,the MLVD was 6.0?8.7,9.0?3.5 and 18.0?7.2/HF,respectively.In the non-transgenic group,the MLVD was 7.0?4.9,9.0?6.4 and 19.0?6.5/HF,respectively.The MVD in the transgenic anti VEGF-C group was 3.0?2.4,5.0?2.1 and 8.0?1.7/HF,respectively.In the transgenic pure liposome group was 4.0?1.8,6.0?2.7 and 10.0?1.3/HF,respectively,and in non-transgenic group was 4.0?1.5,6.0?1.3 and 9.0?1.2/HF,respectively.There existed significant difference in lymphangiogenesis of the tumor (P0.05).ConclusionsThe anti VEGF-C gene may suppress the tumorigenicity and lymphangiogenesis of human SGC-7901 gastric carcinoma cells,but have little effect on angiogenesis of the tumor.VEGF-C might participate in the lymphangiogenesis of gastric tumor.

Objective To investigate the alteration of NKT cells number in patients with systemic lupus erythematosus (SLE) and its correlation with SLE disease activity.Methods Blood samples were obtained from 30 patients with SLE and 30 healthy control subiects.The number of NKT cells from peripherial blood mononuclear cells (PBMC) were detect by flow cytometry (FCM).Two independent samples t-test and Pearson correlation was used to evaluated the relationship between SLE disease activity and NKT cells.Results Compared with healthy controls [(4.16±0.22)%],lower number of NKT cells were found in SLE group[(2.53±0.33)%](P<0.05).An inverse correlation was observed between the frequency of NKT cells and IgG,anti-dsDNA,SLE disease activity index.Conclusion Reduced proportions of NKT cells observed in patients with SLE and is associated with high SLE disease activity.

Objective To observe the curative effect of methylprednisolone combined with entecavir in treatment of hepatitis B virus (HBV) related early stage liver failure.Methods One hundred and twenty-six patients with HBV related early stage liver failure were divided into treatment group (68 cases) and control group (58 cases) by random digits table method.The patients in 2 groups were given conventional hepatinica treatment and entecavir antiviral treatment,but the patients in treatment group were added methylprednisolone and pantoprazole.The alanine aminotransferase (ALT),total bilirubin (TBil),albumin,prothrombin time (PT),HBV-DNA,tumor necrosis factor (TNF)-α,interleukin (IL)-6 levels were compared between 2 groups,and the adverse reaction of methylprednisolone was observed.Results The ALT,TBil,PT and albumin levels after the first,second,fourth,sixth and eighth week of treatment in treatment group were significantly better than those in control group,and there were statistical differences (P ＜ 0.05).There was no statistical difference in HBV-DNA between 2 groups (P ＞ 0.05).The TNF-α and IL-6 levels after the first and second week of treatment in treatment group were (4.13 ± 1.25) and (1.98 ± 0.67) p g/L,(3.21 ± 0.75)and (1.23 ± 0.29) μ g/L,and in control groups were (5.89 ± 1.78) and (3.67 ± 0.87)μ g/L,(4.12 ± 0.88) and (2.68 ± 0.81) μ g/L.The TNF-α and IL-6 levels in treatment group were significantly lower than those in control group,and there were statistical differences (P ＜ 0.05).The effective rate in treatment group (79.41％,54168) was significantly higher than that in control group (51.72％,30/58),the fatality rate in treatment group (2.94％,2/68) was significantly lower than that in control group (24.14％,14/58),and there were statistical differences (P ＜ 0.05).The adverse reaction of methylprednisolone in treatment group was not found.Conclusion The methylprednisolone combined with entecavir can improve liver function and survival rate in patients with HBV related early stage liver failure,and adverse reaction of methylprednisolone is rare.

Objective To synthetically evaluate the relationship between miR-31 and the prognosis of carcinoma and to investi-gate its related mechanism.Methods The correlative literatures of tumor prognosis were retrieved from the electronic databases PubMed,EMBASE and ISI Web of Science.The pooled hazard ratios (HRs)and 95% confidence interval(95%CI )were extracted. The prognostic data were performed the synthesis analysis.Results A total of 7 trials conformed to the inclusion criteria including accumulated 2 012 cases of carcinoma.Meta-analysis revealed that the decrease of miR-31 expression in the tumor patients had the poor prognosis (HR=0.784,95%CI :0.630-0.974);in the subgroup analysis,the synthesis results adopting the multivariable a-nalysis and China subjects were 3.512 (95%CI :1.797-6.865)and 1.574 (95%CI :1.062-2.333),which indicating that the in-crease of miR-31 expression predicted the poor prognosis;miR-31 had no statistical significance in the digestive system (P >0.05). Conclusion The prognostic role of miR-31 may possess the histological and regional specificity and has the potential as a novel marker.

Background Bevacizumab and triamcinolone acetonide (TA) has been widely used in the treatment of diabetic macular edema (DME) clinically,but the effectiveness of both treatment has disadvantage.Therefore,some researchers try to combine bevacizumab with TA for the management of DME,but its efficacy is controversial.Objective This study was to evaluate the efficacy and safety of intraovitreal injection of bevacizumab combined with TA versus bevacizumab for DME.Methods The randomized controlled trials (RCTs) of bevacizumab combined with TA versus bevacizumab via intraovitreal injection for DME were searched from Pubmed,EMbase,Cochrane Library,CNKI.The methodological quality of the literature was evaluated according to evidencebased medicine (EBM),and the quality of the RCTs was appraised based on the Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.The outcome indicators including the change values of central macular thickness (CMT) and best-corrected visual acuity (BCVA) as well as the safety indicators including topical and system adverse response of RCTs were analyzed with Cochrane Collaboration' s software RevMan 5.0.Results Nine RCTs were included with 665 eyes.The decrease value of CMT was more remarkable in the bevacizumab combined with TA group than that of the only bevacizumab group 12 weeks and 18 weeks after intravitreal injection (WMD =-44.69,95％ CI:25.27-64.11,P ＜ 0.000 001 ; WMD =-66.86,95％ CI:40.67-93.05,P ＜ 0.000 001).However,no significant differences were found in the change value of CMT in 6 weeks and 6 months after injection between the two groups (WMD =-15.40,95％ CI:-4.04-34.85,P =0.12 ; WMD =-2.57,95％ CI:-19.62-24.75,P =0.82).The improvement value of BCVA (LogMAR) in the bevacizumab combined with TA group was superior to that of the only bevacizumab group 6 weeks after injection (WMD =-0.04,95 ％ CI:-0.08--0.00,P =0.05),but there were no significant differences between the two groups at 12weeks,18 weeks and 6 months after treatment (WMD =-0.04,95％ CI:-0.12-0.05,P=0.36;WMD =-0.04,95％ CI:-0.11-0.03,P=0.28; WMD =0.03,95％ CI:-0.05-0.12,P=0.45).The incidence rate of transient anterior response after injection was not significantly different between the two groups (RR =0.89,95％ CI:0.49-1.60,P =0.70).Secondary ocular hypertension after injection occurred in 30 eyes in the bevacizumab combined with TA group,but no hypertension was seen in the only bevacizumab group.Conclusions Compared with only bevacizumab,intravitreal injection of bevacizumab combined with TA has a better efficacy in improving CMT but no obvious dominant in increasing BCVA for early DME.Intravitreal injection of bevacizumab combined with TA seemingly has a higher risk of inducing controllable ocular hypertension than administration of only bevacizumab.

Problem-based learning(PBL) is a method of the self-study primarily and teacher' s guiding.By using the PBL in the clinical teaching application,we discuss our experience gained in carrying,out PBL and the existing problems.