BACKGROUND:Matrix metaloproteinases are now generaly considered to be able to degrade al extracelular matrices. Hypersecretion of matrix metaloproteinases or reduction in tissue inhibitors of matrix metaloproteinases leads to destruction of the dynamic balance of extracelular matrix. OBJECTIVE: To elucidate the role of matrix metaloproteinase-1 and tissue inhibitor of matrix metaloproteinase-1 in the pathogenesis and progression of intervertebral disc degeneration. METHODS:A total of 60 patients with intervertebral disc degeneration were included. Mild, moderate, and severe degeneration signals appeared on MRI imaging of the patients. Meanwhile, 20 patients with vertebral fracture, mainly cervical spine fracture, were selected as the control group. Venous blood samples were colected before the surgery; the intervertebral disc specimens were sequentialy colected. RESULTS AND CONCLUSION: Serum and tissue levels of matrix metaloproteinase-1 in patients with intervertebral disc degeneration were significantly increased compared with the control group (P < 0.05), and furthermore those were significantly increased in patients with severe disc degeneration compared with patients with mild and moderate disc degeneration (P < 0.05). However, serum and tissue levels of tissue inhibitors of matrix metaloproteinases did not differ significantly between the disc degeneration and control groups (P > 0.05). These results indicate that hypersecretion of matrix metaloproteinase-1 occurs in patients with intervertebral disc degeneration; however, the expression of tissue inhibitor of matrix metaloproteinase-1 is not correlated with intervertebral disc degeneration.

BACKGROUND:Stem cels can induce immune tolerance, prolong graft survival time and reduce rejection in organ transplantation, which have become a hot research. OBJECTIVE:To induce immune tolerance to alogenic kidney transplantation with amniotic fluid stem cels in recipient rats and to explore the mechanism underlying immune tolerance. METHODS: Amniotic fluid stem cels were isolated from Wistar rats. Two inbred male rat strains, Wistar rats and Sprague-Dawley rats, were selected as donors and recipients of kidney transplantation. The rat models of renal orthotopic transplantation were divided into the folowing four groups: a sham-operated group (n=10, Sprague-Dawley rats); an isograft group (n=10, Sprague-Dawley to Sprague-Dawley rats); a control group (n=10, Wistar to Sprague-Dawley rats, treated with 1 mL saline); and an experimental group (n=10, Wistar to Sprague-Dawley rats, treated with 1 mL of 3×106/L amniotic fluid stem cels). Serum levels of creatinine, urea nitrogen, interleukin-2, interferon-γ, parameters of oxidative stress were detected at 5 days after operation. Flow cytometry was employed to determine the percentage of CD4+ and CD8+ lymphocytes in the peripheral blood. Kidney transplants were observed pathologicaly. RESULTS AND CONCLUSION:Compared with the control group, the levels of creatinine, urea nitrogen, interleukin-2, interferon-γ, parameters of oxidative stress and proteinuria were lower in the experimental group (P < 0.05). Percentages of CD4+, CD8+ and CD4+/CD8+ ratio were also significantly lower in the experimental group than the control group. However, the rate of cretinemia clearance in the experimental group was significantly higher than that in the control group (P < 0.05). Furthermore, the degree of kidney injury in the experimental group was significantly lower than that in the control group. Our findings demonstrate that the amniotic fluid stem cel transplantation can induce immune tolerance, extenuate oxidative stress, attenuate pathological damage to the kidney transplant and preserve kidney function from acute rejection in rats undergoing kidney transplantation.

Objective To compare the clinical efficacy between simultaneous integrated boost (SIB) and sequential boost (SB) using intensity-modulated radiotherapy (IMRT),and investigate the long-term clinical efficacy and adverse events of SIB-IMRT in combination with chemotherapy in the treatment of esophageal cancer.Methods Clinical data of 330 patients diagnosed with esophageal cancer undergoing radical chemoradiotherapy in Fourth Hospital of Hebei University from January 2006 to December 2015 were respectively analyzed.All patients were assigned into the SIB-IMRT (n=135) and SB-IMRT groups (n=195).All patients received definitive radiotherapy with elective nodal irradiation (ENI).After the propensity score matching (PSM),105 patients were enrolled in each group.Kaplan-Meier method was used to survival analysis.Cox model was used to multivariate prognostic analysis.Results Prior to PSM,the 1-,3-and 5-year local control rates were 80.1％,58.3％,46.7％ and 72.1％,44.9％,40.5％ in the SIB-IMRT and SB-IMRT groups (P=0.050),and the 1-,3-and 5-year OS rates were 81.4％,51.9％,43.5％ and 80.5％,37.9％,22.3％(P=0.014),respectively.After the PSM,the 1-,3-and 5-year LC rates were 80.2％,54.2％,43.9％ and 75.5％,47.2％,41.2％ (P=0.264),and the 1-,3-and 5-year OS rates were 78.9％,49.0％,40.8％ and 83.3％,41.7％,24.8％ (P=0.265),respectively.Multivariate analysis demonstrated that TNM staging was an independent prognostic factor in the SIB-IMRT group,whereas TNM staging and chemotherapy served as the independent prognostic factors in the SB-IMRT group.Stratified analysis revealed that the LC rate in the SIB-IMRT was significantly higher than that in the SB-IMRT group when radiotherapy alone was performed (P =0.018).The OS rate in the SIB-IMRT group was equally higher compared with that in the SBIMRT group.Conclusions The LC and OS rates are almost identical after SB-IMRT and SIB-IMRT in the treatment of esophageal cancer,whereas the prognostic survival in the SIB-IMRT group is significantly longer compared with that in the SB-IMRT group during radiotherapy alone.The findings remain to be validated by multi-center investigations with a large sample size.

Objective To investigate the prognostic effects and failure patterns of different clinical target volumes of IMRT in definitive chemoradiotherapy for cervical and upper-thoracic esophageal cancer,in order to provide a reference for radiotherapy target area delineation.Methods A retrospective analysis was performed on the clinical data of 132 patients with cervical and upper-thoracic esophageal cancer who received definitive IMRT and concurrent chemotherapy in our hospital from 2010 to 2014.Seventy-one patients received elective nodal irradiation (ENI) and the other 61 patients received involvedfield irradiation (IFI).The Kaplan-Meier method was used to calculate local control (LC),progressionfree survival (PFS) and overall survival (OS) rates.The significant difference was evaluated by the logrank test.The prognostic factors were determined by Cox univariate and multivariate analyses.Results The last follow-up time was December 2017,the median follow-up time was 59.5 (14.2-95.8) months.Follow-up rate was 99.2％.For the ENI and IFI groups,the 1-,3-,5-year LC were 77.5％,58.8％,48.8％ vs.64.3％,29.1％,26.2％ (x2=9.68,P=0.002),PFS were 68.6％,37.7％,25.9％ vs.47.5％,17.2％,3.6％ (x2=11.39,P=0.001),OS were 81.7％,53.9％,31.3％ vs.70.5％,31.9％,16.3％ (x2=7.70,P =0.006),respectively.In multivariate analysis,T stage,N stage,and RT field were independent factors for LC,PFS and OS(P＜0.05).The total failure rates,local-regional recurrent rate in ENI group were lower than those in IFI group (x2 =13.23,5.24,P＜0.05).No significant differences were found in acute radiation esophagitis,pneumonitis and myelosuppression (Grades ≥ 3) between the two groups(P＞0.05).Conclusions Compared with IFI,ENI can significantly reduce local-regional recurrence and distant metastasis and improve the long-term survival for cervical and upper-thoracic esophageal cancer patients who received definitive chemoradiotherapy.

Objective:To analyze whether involved-field irradiation (IFI) was associated with improved survival and reduced treatment-related adverse events compared with elective nodal irradiation (ENI) in Chinese patients with esophageal squamous cell carcinoma receiving radiotherapy.Methods:Literature review was conducted from CNKI, Wanfang Data, PubMed, Embase, Web of Science and Cochrane Central databases (until July 31, 2022). Relevant data were collected according to the inclusion and exclusion criteria. Primary outcomes included overall survival (OS) rate and treatment-related adverse events. Secondary outcomes included progression-free survival (PFS) rate and local control rate (LCR). Risk of bias was assessed using the Cochrane Risk of Bias tool. The quality of the results was assessed by using the meta analysis of Evidence Evaluation and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methods.Results:A total of 7 articles with 918 patients were included of which 465 received IFI and 453 received ENI. The 1-, 2-, 3-and 5-year OS rates in the IFI group were not significantly different from those in the ENI group (1-year OS rate: RR=1.00, 95% CI=0.94-1.07, P=0.97, high certainty; 2-year OS rate: RR=1.01, 95% CI=0.90-1.13, P=0.90, high certainty; 3-year OS rate: RR=0.86, 95% CI=0.71-1.05, P=0.14, high certainty; 5-year OS rate: RR=0.76, 95% CI=0.42-1.37, P=0.36, low certainty). In the IFI group, patients with ≥grade 2 acute radiation esophagitis ( RR=0.71, 95% CI=0.58-0.87, P=0.001, high certainty), ≥grade 3 acute radiation esophagitis ( RR=0.39, 95% CI=0.24-0.64, P<0.001, high certainty) and ≥grade 2 acute radiation pneumonitis ( RR=0.72, 95% CI=0.52-0.99, P=0.04, high certainty) were significantly lower compared with those in the ENI group. However, no significant differences were observed in the incidence of ≥grade 3 late radiation esophagitis, ≥grade 3 acute radiation pneumonitis and ≥grade 3 late radiation pneumonitis between two groups. No significant differences were noted in the 1-, 2-, 3-PFS rates and LCR between two groups. Conclusions:For Chinese patients with esophageal squamous cell carcinoma, IFI and ENI yield similar efficacy in terms of OS, PFS and LCR. However, IFI has a lower incidence of ≥grade 2 acute radiation esophagitis, ≥grade 3 acute radiation esophagitis and ≥grade 2 acute radiation pneumonitis than ENI.

Objective In order to evaluate the distribution of genetic subtypes and epidemiological feature of HIV-1 circulating strains in Fujian province. Methods Blood samples and epidemiological data were collected from 104 newly infected patients who were distinguished by BED-CEIA methodology,during 2011-2012. Viral sequences (n=81) of HIV-1 gag,env,and pol segments were amplified by nested PCR. Results Subtypes B and four Circulating Recombinant Forms,(CRF01_AE,CRF07_BC,CRF08_BC and CRF55_01B) were found in the samples, CRF01_AE(45.68%)and CRF07_BC(35.80%)were the two main HIV-1 strains in Fujian province. Compared with previous data,the proportion of CRF07_BC rose significantly while it gradually decreased in CRF01_AE. Heterosexual contact was still the principal transmission route in Fujian province, but the number of infection among men-who-have-sex-with- men grew rapidly. Conclusion Results from this study suggested that different subtypes of HIV-1 strain existed in Fujian province. The distribution of subtypes and the mode of transmission were changing with the progress of epidemic. Dynamic monitoring of the molecular epidemiology trends of HIV-1 infection should be enhanced.

Objective:To evaluate the efficacy and prognostic factors of radiotherapy combined with immunotherapy as the first-line treatment for patients with locally advanced or metastatic esophageal squamous cell carcinoma (LA/M ESCC).Methods:A single-center, retrospective analysis was conducted for the recent efficacy, survival, prognostic factors, post-treatment failure modes, and treatment-related adverse reactions of 57 LA/M ESCC patients eligible for enrollment.Results:The entire group of patients had 1-, 2-, and 3-year overall survival (OS) of 86.0%, 57.5%, and 53.9%, respectively and 1-, 2-, and 3-year progression-free survival (PFS) of 61.4%, 31.0%, and 31.0%, respectively. The median OS was not reached, and the median PFS was 15.0 (95% CI: 10.77-19.23) months. These patients had an overall response rate (ORR) of 80.7% (46/57) and a disease control rate (DCR) of 94.7% (54/57). As indicated by the result of the multivariate analysis, the independent prognostic factors affecting the OS of the patients included their age, clinical stage, number of immunotherapy cycles, and recent efficacy ( HR = 0.25, 2.58, 0.35, 4.05, P < 0.05), and the independent factors influencing the PFS of the patients included their clinical stage and recent efficacy ( HR = 2.27, 1.97, P < 0.05). There were no statistically significant differences in the effects of irradiation ranges and the combination modes of immunologic drugs and chemoradiotherapy on both OS and PFS of the patients ( P > 0.05). A total of 32 patients suffered post-treatment failure. After the second treatment, they had 1- and 2-year OS of 55.7% and 25.3%, respectively, with median OS of 14.0 (95% CI: 5.17-22.83) months. A total of 26 cases experienced treatment-associated adverse reactions of grades 2 or higher during and after treatment. Conclusions:The combination of radiotherapy and immunotherapy is effective and safe as the first-line treatment for LA/M ESCC patients. The post-treatment failure modes still include local recurrence and distant metastasis. Therefore, such combination merits further investigation.

OBJECTIVEIn order to evaluate the distribution of genetic subtypes and epidemiological feature of HIV-1 circulating strains in Fujian province.

METHODSBlood samples and epidemiological data were collected from 104 newly infected patients who were distinguished by BED-CEIA methodology, during 2011-2012. Viral sequences(n = 81) of HIV-1 gag, env, and pol segments were amplified by nested PCR.

RESULTSSubtypes B and four Circulating Recombinant Forms, (CRF01_AE, CRF07_BC, CRF08_BC and CRF55_01B) were found in the samples, CRF01_AE(45.68%)and CRF07_BC(35.80%) were the two main HIV-1 strains in Fujian province. Compared with previous data, the proportion of CRF07_BC rose significantly while it gradually decreased in CRF01_AE. Heterosexual contact was still the principal transmission route in Fujian province, but the number of infection among men-who-have-sex-with- men grew rapidly.

CONCLUSIONResults from this study suggested that different subtypes of HIV-1 strain existed in Fujian province. The distribution of subtypes and the mode of transmission were changing with the progress of epidemic. Dynamic monitoring of the molecular epidemiology trends of HIV-1 infection should be enhanced.

Adult ; China ; epidemiology ; Female ; Genotype ; HIV Infections ; epidemiology ; HIV-1 ; classification ; genetics ; Humans ; Male ; Molecular Epidemiology ; Young Adult

Objective:To evaluate the efficacy of target area of radical radiotherapy for inoperable esophageal carcinoma patients treated with intensity-modulated radiotherapy (IMRT).Methods:A retrospective analysis was performed on the clinical data of 564 Ⅰ-Ⅳ non-surgical esophageal cancer who received definitive intensity-modulated radiotherapy alone in our hospital from 2006 to 2015. Propensity score matching (PSM) was used to identify well-balanced patients for comparison. The Kaplan-Meier method was used to calculate local-regional failure-free survival (LRFFS), progression-free survival (PFS), overall survival (OS) rates and univariate analysis. The multivariate analysis of prognostic factors were tested by COX proportional hazard model.Results:The last follow-up time was December 2018, the median follow-up time was 99.7 (95% CI: 77.5-122.1) months. Follow-up rate was 95.9%. For the 564 patients, the 1-, 3-, 5- year LRFFS were 61.5%, 26.5%, 14.3%, PFS were 56.7%, 25.0%, 13.4%, OS were 73.0%, 31.1%, 16.8%. After PSM, for the elective-nodal irradiation (ENI) ( n=141) and involved-nodal irradiation (IFI) ( n=141) groups, the 1-, 3-, 5- year LRFFS were 68.8%, 34.2%, 19.1% vs. 65.2%, 32.1%, 17.9% ( P>0.05), PFS were 63.1%, 31.0%, 16.6% vs. 60.3%, 29.3%, 16.6% ( P>0.05), OS were 80.9%, 41.5%, 23.3% vs. 80.1%, 35.0%, 20.2% ( P>0.05). In multivariate analysis, tumor volume≤37 cm 3 and Ⅰ+ Ⅱ stage were independent factors for LRFFS, PFS and OS. Subgroup analysis showed that there were no significant differences in the survival rates between the ENI group and IFI group ( P>0.05). Comparing to the IFI group, ENI reduced the local-regional failure rate ( P=0.048). Conclusions:Using intensity-modulated radiation therapy alone for inoperable esophageal carcinoma, ENI can significantly reduce the local-regional failure rate, but not improve survival rates compared to the IFI.

Objective:To evaluate the effects of different irradiation ranges in definitive intensity-modulated radiotherapy (IMRT) combined with chemotherapy on the survival of esophageal cancer patients.Methods:Clinical data of 360 esophageal cancer patients who received definitive chemoradiotherapy in the Fourth Hospital of Hebei Medical University from 2006 to 2015 were retrospectively analyzed. Among them, 131 patients received elective nodal irradiation (ENI) and 229 patients underwent involved-field irradiation (IFI). Platinum-based chemotherapy was adopted. The overall survival (OS) rate was analyzed by Kaplan- Meier method and Logrank test. Results:Until the final follow-up at the end of December 2018, the follow-up rate was 96%. The median follow-up time was 64 months (95% CI: 53-76). The median survival time was 24 months (95% CI: 20-28). The 1-, 3-, 5-year OS rates were 76.1%, 38.7% and 21.0%, respectively. After propensity score matching, the 1-, 3-, 5-year OS rates were 83.9%, 48.6%, 26.8% vs. 74.0%, 33.8%, 17.5% between the ENI ( n=131) and IFI groups ( n=131)( P=0.011), respectively. Subgroup analysis showed that patients with male, aged≤66 years, cervical and upper-thoracic location, tumor length≤7 cm, tumor volume≤50 cm 3, T 1-3 stage, dosage>60 Gy and concurrent chemoradiotherapy obtained better OS rates in the ENI group than their counterparts in the IFI group (all P<0.05). In the ENI group, the total failure rate, locoregional failure rate and distant metastasis rate were significantly lower, whereas the incidence of ≥Grade Ⅲ myelosuppression was remarkably higher than those in the IFI group (all P<0.05). Conclusion:Compared with IFI, ENI can significantly improve the survival for patients with early-stage and cervical and upper-thoracic esophageal cancer receiving definitive IMRT combined with chemotherapy.