Objective To evaluate the method of endoscopic band ligation in resecting upper gastrointestinal leiomyoma . Methods We selected 59 patients with 64 small upper gastrointestinal tract leiomyo-mas by endoscopy , EUS and EUS guided fine needle aspiration. Of the 64 leiomyomas, their distribution were in esophagus 50, stomach 12 and duodenum 2. When the endoscope with transparent cap was introduced to reach the lesion, it was sucked into the cap, then released the band to ligate it. Two weeks after operation, endoscopic monitoring of the lesion was performed weekly until the complete healing of the wound. Results In the 64 lesions, 50 esophageal and 2 duodenal leiomyomas were thoroughly resected and the mean concrescence time is 3. 1 weeks and 4. 5 weeks respectively. Nine of 12 gastric leiomyomas were resected thoroughly and the other 3 were partially ligated and resulted in incomplete excision with the mean concrescence time of 4. 5weeks. No perforation occurred. Conclusions Endoscopic band ligation is an ideal method in resecting the small upper gastrointestinal leiomyomas.

Background Nanoemulsions (NEs) is one of the most popular ophthalmic colloidal drug delivery system due to its long-term stability, low toxicity and irritancy, considerable capacity for solubilization of lipophilic drug molecules and great potential in bioavailability improvement.The cornea pathway is the main route of intraocular absorption after topical use of NEs.Though NEs possess numerous physiological and physicochemical advantages,the use of NEs cannot always obtain satisfactory results.Objective This study was to investigate the impacts of epithelium and stroma on the corneal permeation of topical ophthalmic terbinafine hydrochloride nanoemulsions (TH-NEs).Methods TH-NEs was prepared by the self-emulsification method.The size and Zeta potential of the oil droplets in the formulation were analyzed using a dynamic light-scattering particle size analyzer.The high performance liquid chromatography (HPLC) was used for the in vitro release study.Sixty New Zealand albino rabbits were randomly divided into intact cornea group and cornea epithelium debrided group.The cornea epithelium of the left eyes was debrided in the cornea epithelium debrided group.The TH-NEs were instilled into the lower conjunctival sac of left eyes.Six rabbits were executed from each group 15,30,60,120 and 240 minutes after dosing,respectively.The corneas were collected and analyzed by HPLC.The fluorescein diacetate (FDA) was used to label the TH-NEs.Two C57BL/6 mice with left cornea epithelium debrided and 2 normal mice were used for the fluorescence tracing study.The fluorescence distribution of FDA labeled TH-NEs was observed by a two-photon laser confocal scanning microscope 30 minutes and 60 minutes after single instillation.Results The average size and Zeta potential of the oil droplets were 51.37 nm and-0.232 7 mV respectively,and 0.482％ of encapsulated drugs was released from the TH-NEs after 12 hours.The peak concentrations of TH in the intact cornea and epithelium debrided cornea were (17.85 ± 2.79) μg/g and (4.40± 1.75) μg/g respectively, which occurred 15 minutes postdose.The drug concentrations in the intact cornea were significantly higher than that in the debrided cornea 15,30,60 and 120 minutes after dosing, with significant differences between them (t =9.998,8.658,6.903,7.576;all at P=0.000).The fluorescence was observed in the cornea epithelium when the cornea was intact.The fluorescence intensity in the superior layer of corneal epithelium was obviously higher than that in the deep layers of corneal epithelium 30 minutes and 60 minutes after dosing.No fluorescence was observed in the cornea stroma of both eyes.Conclusions The cornea epithelium is the main of absorption and distribution position of TH-NEs.The cornea stroma is the dominating permeation barrier for the intraocular transportation of the TH-NEs.The cornea stroma may stop the permeation of TH-NEs by molecular exclusion mechanism.

Lung cancer is one of the most common malignant tumors. Globally, the incidence and mortality of lung cancer are very high and on the rise. In recent years, immune checkpoint inhibitors (ICIs) have a significant survival advantage in treating advanced NSCLC. However, for NSCLC patients with positive driver genes, ICIs are not effective. But some tumor suppressor genes have varying degrees of impact on immunotherapy through mutations or deletions. Among them, serine/threonine kinase 11 (STK11) gene mutations are closely related to PD-1/PD-L1 ICIs. Studies have found that STK11 mutations are related to reduced immune cell infiltration, low PD-L1 expression and poor response to PD-L1 inhibition. This article reviews the research progress of the correlation between STK11 gene mutation and immunotherapy on NSCLC.

OBJECTIVETo determine the percentage of hypercholesterolemic patients who had met the criteria as total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C), defined by the Chinese National Recommendations for Prevention and Treatment of Dyslipidemia.

METHODSAdult patients with hypercholesterolemia, who had been receiving the same lipid-lowering therapy for at least 2 months, were enrolled. Lipid levels were determined at the time of enrollment, to assess whether the patients' lipid levels had reached the criteria for treatment. Patients' cardiovascular risk factors and lipid-lowering treatments were also collected.

RESULTSOne hundred and eighty patients with mean age of 65.8 were studied. Of these, 6.7% had no risk factors and no definite disease of atherosclerosis (low-risk group), 65.5% had risk factors but no documented atherosclerosis (high-risk group), and 27.8% had established atherosclerosis diseases or diabetes mellitus. Overall, only 44% of patients achieved both TC and LDL-C target levels. The success rates were higher among low and high-risk groups than that among patients with atherosclerosis or diabetes mellitus. The relationship between four different lipid-lowering drug therapies and successful patient outcome was also investigated. The success rates were 51.8% for simvastatin, 42.9% for pravastatin, 31.6% for fluvastatin, 12.5% for other drugs respectively.

CONCLUSIONMore than half of the hypercholesterolemic patients receiving lipid-lowering therapy had not achieved TC and LDL-C target levels. Data from this study indicated that a significant gap still existed between dyslipidemia prevention principles and clinical practices, suggesting that more aggressive treatment of dyslipidemia is needed.

Aged ; Anticholesteremic Agents ; therapeutic use ; Cholesterol ; blood ; Cholesterol, LDL ; blood ; Female ; Humans ; Hypercholesterolemia ; blood ; drug therapy ; Male ; Middle Aged

Objectives:To observe the anatomical location and mechanism of axis ring fractures (ARF) using 3-D CT scans, and propose a new classification for such fractures.Methods:By reviewing prospectively maintained database collecting ARF from 7 medical centers in China, 202 patients were included in this study. According to anatomical location, ARFs were classified into axis arthrosis fracture (AAF) and axis bony damage (ABD). The axis ring was divided into anterior, middle, and posterior rings, based on the border of the pars interarticularis (or pedicle) of axis. According to the features of ARF and previous study, a new classification was proposed based on the anatomical features of different fracture patterns, which was divided into three types and six subtypes (A1, A2, B1, B2, C1 and C2). The incidence of AAF and ABD and their distribution in different location of axis ring and the new classification, were observed.Results:In 202 patients with ARF, 501 anatomical structures were involved. 288 AAFs were found in 178 patients (288/501, 57%), while 213 ABDs were found in 149 patients (213/501, 43%). In anterior ring, 304 structures (304/501, 61%) were involved in injury, with 225 AAF and 79 ABD. In middle ring, 99 structures (99/501, 20%) were involved in injury, and all of them were ABD. In posterior ring, 98 structures (98/501, 19%) were involved in injury, with 63 AAF and 35 ABD. The anterior ring injuries (61%) were more common than middle (20%) or posterior ring (19%). In anterior ring, AAF (84%) were morecommon than ABD (16%); In middle ring, all the injuries were ABD; In posterior ring, AAFs (64%) were more common than ABD (36%). Type A fractures were featured with pedicle fractures and were identified in 30 patients (30/202, 15%). Type A1 fractures were bilateral pedicle fracture lines symmetrically or asymmetrically and identified in 12 (6%) patients; Type A2 fractures were pedicle fracture lineson one side and inferior articular facet injuries or lamina fractures on the otherside and identified in 18 (9%) patients. Type B fractures were featured with superior articular facet injuries or posterior wall of C2 body fractures on one side and identified in 136 patients (67%). Type B1 fractures were superior articular facet injuries or posterior wall of C2 body fractures on one side and pedicle fracture on the other side and identified in 57 (28%) patients; Type B2 fractures were superior articular facet injuries or posterior wall of C2 body fractures on one side and inferior articular facet injuries or lamina fractures on the otherside and identified in 79 (39%) patients. Type C fractures were featured with bilateral superior articular facet injuries or posterior wall of C2 body fractures and identified in 36 patients (18%). Type C1 fractures were bilateral superior articular facet injuries or posterior wall of C2 body fractures symmetrically and identified in 22 (11%) patients; Type C2 fractures were bilateral superior articular facet injuries or posterior wall of C2 body fractures asymmetrically and identified in 14 (7%) patients.Conclusion:ARF could occur in different anatomical locations, and most of these fractures were caused by hyperextension and axial load on superior articular facet on one or two sides. The new CT classification of ARF with three types and six subtypes might provide all fracture patterns, which could be useful for the choice of proper diagnosis and treatment for such fractures.

Optical coherence tomography-based angiography (OCTA) is a novel non-invasive technique for quantitatively evaluating retinal microvascular perfusion. Due to the similar embryonic origin, anatomical characteristics, and physiological characteristics of the retina and cerebral small vessels, changes in retinal microvasculature may provide a new perspective for studying the mechanisms of cerebral small vessel diseases. This article summarizes the application of OCTA in cerebrovascular diseases, aiming to evaluate whether OCTA can become an effective tool for early prediction of the occurrence of cerebrovascular disease and monitoring disease changes.

ObjectiveTo identify factors related to the occurrence of choking and coughing while eating in the disabled elderly and conduct importance matrix analysis to provide a reference basis for controlling choking on food in the disabled elderly. MethodsA convenience sampling method was used to select 80 disabled elderly individuals in a hospital between October 2019 and April 2022 as the study population. The occurrence of choking and coughing while eating was recorded， and a questionnaire was administered to collect general information. Additionally， assessments were conducted using the intelligent mental status examination scale （MMSE）， oral health checklist （BOHSE）， eating assessment tool⁃10 （EAT-10）， and chewing function evaluations. Univariate and multifactorial analyses were conducted to analyze the influencing factors of choking and coughing while eating in the elderly with disabilities. ResultsThe incidence of choking and coughing while eating was 52.50% （42/80） among the 80 disabled elderly. The degree of disability （OR=2.895， 95%CI： 1.352‒6.201）， age （OR=4.040， 95%CI： 1.121‒14.562）， BOHSE score （OR=2.473， 95%CI： 1.002‒6.102）， EAT-10 score （OR=5.345， 95%CI： 2.112‒13.527）， and chewing function score （OR=3.453， 95%CI： 1.247‒9.562） were identified as risk factors for choking and coughing while eating in the disabled elderly. The MMSE score （OR=0.343， 95%CI： 0.135‒0.869） was identified as a protective factor. The importance matrix analysis indicated that EAT-10 score， MMSE score， and chewing function had high importance with slightly lower difficulty in improvement， and were thus listed as items in the priority improvement area. Age and degree of disability had high importance and high difficulty in improvement， and therefore belonged to the suboptimal improvement area. BOHS score was slightly lower both in importance and difficulty of improvement， entering the alternative improvement area. ConclusionAge， degree of disability， BOHSE score， EAT-10 score， and chewing function score are risk factors for the occurrence of choking and coughing while eating， while the MMSE score is a protective factor. The importance matrix analysis can provide a basis for targeted intervention in clinical practice.

Objective:Nuclear magnetic resonance spectroscopy (NMR) was used to detect the species and content of metabolites in urine of patients with inherited metabolic diseases, and to explore the application value of NMR technology in the diagnosis of inherited metabolic diseases.Methods:Urine samples were collected from 20 patients with inherited metabolic diseases diagnosed in Xinhua Hospital, Shanghai Jiaotong University School of Medicine from March to June 2019, including 9 cases of methylmalonic acidemia (MMA). NMR pulse length-based concentration determination and Gas chromatography mass spectrometry (GC/MS) semi-quantitative method were used to detect the composition of metabolites in urine samples of patients with inherited metabolic diseases, and the levels of abnormal metabolites in the two methods were analyzed.Results:NMR technology can detect the levels of characteristic metabolites significantly increased in the urine of patients with MMA, isovalerinemia, glutaric acidemia, propionic acidemia, 3-methylcrotonyl-CoA carboxylase deficiency, ornithine carbamyltransferase deficiency, Citrin deficiency, Canavan disease, tyrosinemia and lysinuria protein intolerance. The average is 8 times of the upper limit of the reference value, and the highest is 545 times. Compared to GC/MS, NMR technology can detect the levels of various metabolites such as organic acids, amino acids and sugars. In 9 cases of untreated MMA,the median levels of methylmalonic acid and 3-hydroxypropionic acid in NMR [1 800 (180-12 000) and 50 (0-270) mmol/mol Cr] were higher than the reference values (0-31, 0-35). The median levels of methylmalonic acid and methylmalonic acid in GC/MS [136.56 (43.79-518.67) and 4.87 (1.52-7.52)] were higher than the reference values (0-4 and 0-0.7).Conclusions:NMR and GC/MS technologies are specific for the diagnosis of organic acidemia. The primary component detected by GC/MS is organic acid. NMR technology can break through this limitation and measure the level of various metabolites in urine, which provides a more theoretical basis for the diagnosis and research of inherited metabolic disease.

Objective:To analyze the disease spectrum of lysosomal storage disorders(LSDs) and explore the prevalent distributions of different LSD types in one center in Shanghai.Methods:A retrospective analysis was made.A total of 5 476 suspected LSD patients, including 3 415 males and 2 061 females, with a median age of 4 years(1 day to 72 years), were collected from Xinhua Hospital, Shanghai Jiaotong University School of Medicine from August 2008 to May 2022.The activity of different lysosomal enzymes was detected by fluorescent and biochemical methods.Results:A total of 1 520 patients were diagnosed with LSDs, including 972 males and 548 females, with a median age of 4 years(1 day to 59 years), involving 19 different subtypes.Mucopolysaccharidosis(MPS) was the most common type among LSDs, with a frequency of 45.46%(691/1 520), followed by sphingolipidoses [33.88%(515/1 520)] and glycogen storage disease type Ⅱ [16.05%(244/1 520)] successively.MPS Ⅱ was the most common type in MPS, with a frequency of 45.73%(316/691), followed by MPS ⅣA [22.87%(158/691)]. Niemann-Pick A/B, Gaucher, and Krabbe diseases were common in Sphingolipidoses patients, with frequencies of 37.09%(191/515), 34.37%(177/515), and 10.29%(53/515), respectively.Conclusions:LSDs are common genetic metabolic diseases, especially MPS and sphingolipidoses.Newborn screening for LSDs should be carried out timely so that the patients can be treated early and their prognosis can be improved.

Objective:To investigate the feasibility of individualized primary clinical target volume (CTV) delineation in intensity-modulated radiotherapy for nasopharyngeal carcinoma (NPC).Methods:Clinical data of 87 consecutive patients newly diagnosed with lateralized NPC in Jiangsu Cancer Hospital between October 2016 and February 2018 were retrospectively analyzed. Lateralized NPC is defined as tumor invasion not exceeding the contralateral wall. According to the tumor spread, the primary CTV was optimized as follows: CTV2 only covered the medial part of the contralateral pterygopalatine fossa, whereas the contralateral foramen oval was not included; on the level of parapharyngeal space, the contralateral side of CTV only covered the posterior lateral lymph nodes, whereas the contralateral internal jugular vein was not regularly covered. Failure patterns and 5-year survival [local control rate (LCR), progression-free survival (PFS) and overall survival (OS)] were evaluated by Kaplan-Meier method. Paired t-test and rank-sum test were used to analyze the dose variation in the optimized region and adverse reactions. Results:The median follow-up time was 59.5 months. The 5-year LCR, PFS, and OS were 98.9%, 86.5% and 92.1%, respectively. There was no local recurrence in the optimized area of CTV. Dosimetric comparison results showed that the doses of parotid gland, temporal lobe, cochlea and middle ear on the contralateral side were reduced by 13.45%, 9.14%, 38.83%, and 29.36%, respectively. Four cases (4.6%) developed grade 3 hearing loss, all on the ipsilateral side. The optimized scheme significantly alleviated the hearing loss on the contralateral side compared to that on the ipsilateral side ( P<0.001). Other grade 3 late adverse reactions included cranial nerve injury, subcutaneous fibrosis in the neck and visual impairment, with 1 case each. Conclusion:Individualized primary CTV for lateralized NPC is feasible and safe, with obvious dosimetric advantages and reduced adverse reaction rate, which is worthy of clinical promotion.