Esophageal squamous cell carcinoma (ESCC) accounts for more than 90% of the confirmed cases of esophageal cancer in Asia, and the degree of malignancy is high. There is a growing number of research on ESCC immunotherapy, particularly programmed death-1 (PD-1) and programmed death-ligand 1 (PD-L1). Among them, the most studied PD-1/PD-L1 inhibitors in ESCC are nivolumab, pembrolizumab, camrelizumab, toripalimab, tislelizumab, atozolizumab, SHR-1316 and durvalumab. Some of the clinical trials of these drugs are still in progress, and some have initially shown good results.

Objective To summarize and analyze the clinical features of Hirayama disease.Methods The authors summarized the clinical data of 29 cases of Hirayama disease in recent 9 years.Resuits All of the 29 cases were male and the age of onset was 12-25 years.22 of the 29 patients only had the symptoms of one upper Jimb and7 of them had symptoms of beth upper limbs.Most of them had symptems on the right or the symptoms were on more severe in the right than left.while only one case had symmetric symptoms of both upper limbs.The arm appeared as a slope,this was due to partial muscular atrophy.EMG indicated that the impairment of spinal anterior cells were limited to the arm relevant segments and both sides were involved.Cervical MRI scan suggested spinal atrophy at the level of C5-7 vertebral bodies.being asymmetric in most of the cases.The atrophy was more obvious on the side with more severe symptoms.There was one patient whose MRI showed high T2 signal in the spinal anterior cells of the C5-6 segments.All the cases used cervical supporter and were followed up for 1-5 years.All of them had good prognosis.Conclusions Hirayama disease is more common in men with hidden onset before 20 years of age.Most of the patients noted the symptoms of hands gradually about 2 years after a period of rapid growth in height in adolescence.The predominant clinical manifestations are as follows:atrophy of lower cervical cord in cervical MRI,asymmetric spinal atrophy in horizontal impaction and the degree of atrophy consistent with the symptoms of limbs.EMG could indicate bilateral spinal anterior impairment in lower cervical cord.Rare case may present the abnormal signal in the spinal cord,but pyramid signs were absent.

Objective To carry out a systematic evaluation for the diagnostic accuracy of Des-γ-carboxy-prothrombin(DCP) in primary hepatocellular cancer(PHC) by Meta-analysis.Methods The published international and domestic studies on DCP in the diagnosis of PHC were searched in multiple databases from its inception until December 2016.A total of seventeen studies were finally selected,among which 1 970 cases of PHC group and 2 588 cases of control group were included.The control group was composed of chronic hepatitis,cirrhosis,tumors in other systems and healthy subjects with physical examination.A meta-analysis was performed using Stata 12.0.Results The overall pooled results of the analysis and the 95％ confidence intervals were as follows:the sensitivity(SEN) was 0.79 (0.74 to 0.83),the specificity (SPE) was 0.90 (0.87 to 0.93),the positive likelihood ratio(PLR) was 8.1 (5.8 to 11.1),the negative likelihood ratio(NLR) was 0.24(0.19 to 0.29),the diagnostic odds ratio(DOR) was 34(21 to 55) and the area under the summary receiver operator characteristic curve (SROC) was 0.91 (0.89 to 0.93).The sensitivity combined the detections of AFP and DCP in the diagnosis of PHC was 0.90 with 0.94 of AUCROC and 56 of DOR.Conclusion The serum DCP may exhibit a relatively higher diagnostic specificity for PHC.The combined detections of AFP and DCP could improve the sensitivity and diagnostic accuracy.

Objective To study acute toxicity of nanometer titanium dioxide to the liver and kidney of mice. Methods 20 KM mice (22-26 g) were randomly divided into two groups, the control group and the experimental group, TiO2 (20-30 nm) suspension (single dose of 5 g/kg body weight) was given to mice by a single oral gavage, the mice in the control group were given the physiologicalsaline. 14 days after the treatment, the mice were sacrificed and the serum were collected to evaluate the levels of ALT(alanine amino transferase), AST(aspartate aminotransferase), ALP(alkaline phosphatase), UA(uric acid), Cr(creatinine),BUN(blood urea nitrogen), CK(creatine kinase), LDH(lactate-dehydrogenase), ?-HBDH(alpha-hydroxybutyrate dehydrogenase), TBIL(total bilirubin levels). The tissues of the liver and kidney were excised and were embedded in paraffin blocks, hematoxylin-eosin (HE) staining for further histopathological diagnosis. Results The serum ALT, ALT/AST, BUN, LDH and ?-HBDH of the TiO2 group were statistically higher than those in the control group (P

OBJECTIVE: To evaluate the effect of microwave polymerization and water-bath heat polymerization on accuracy and flexural strength of denture base resin. METHODS: Ten maxillary complete dentures were prepared and divided into microwave polymerization and water-bath heat polymerization groups according to random number table, with 5 dentures in each group. In the microwave polymerization group, the dentures were heated for 9 minutes with 40% firepower, natural cooled, the pressure of flasking at 4.5 kg/mm~2. In the water-bath heat polymerization group, the temperature increased from room to 70℃, sustained for 1.5 hours, then rise to 100℃ for 0.5 hour. The dentures were maintained at 25℃ thermostatic water bath for a week. The denture base, as well as standard cast was cut down at posterior border of the second molar. Dimensional accuracy between the posterior border of upper complete denture and standardized cast at five different positions was measured by digital microscope. Specimens with 64 mm× 10 mm×2.5 mm were made for measuring flexural strength.RESULTS: ①The posterior border gaps between the upper complete denture and standardized cast was (141±78) urn and (147±74) μm cured by microwave polymerization and water-bath heat polymerization, which has no statistical difference. The flexural strength of denture base resin cured by the microwave polymerization and water-bath heat polymerization was (81.60±14.04) MPa and (84.24±17.65) MPa, and there was no statistical difference (P > 0.05). CONCLUSION: There is no significantly difference in the accuracy and flexural strength cured by microwave polymerization and by water-bath heat polymerization, but the microwave polymerization takes shorter time than that by water-bath heat polymerization.

BACKGROUND:Studies regarding neural stem cells (NSCs) mainly focus on rodents and human,few of which addressing non-human primate animals.OBJECTIVE:To explore a culture system of cynomolgus monkey NSCs (cmNSCs),additionally,to observe its differential potential.DESIGN,TIME AND SETTING:An in vitro cytology observation was performed at the Canter for Stem Cell Biology and Tissue Engineering,Sun Yat-sen University between July 2008 and April 2009.MATERIALS:Spontaneously aborted cynomolgus monkey fetus with 3-5 months old (gestational age),was provided by Landao Biotechnology Co.,Ltd.METHODS:The subventricular zone and the hippocampus were dissected aseptically from the brain of spontaneously aborted cynomolgus monkey fetus,then triturated with fire-polished glass Pasteur pipettes to single cells,and cultured in 25 cm~2 culture flask with concentration of (2.0-5.0)×10~5.The neurospheres were transferred into polyornithine and fibronectin precoated cell culture dish after 2 weeks when they formed.Each 20 μg/L of epithelium growth factor (EGF) and basic fibroblast growth factor (bFGF) was daily added.The adhesive cells were passagad when they reached about 90% confluency.MAIN OUTCOME MEASURES:The NSCs and its differential potential were identified by surface marker nestin and immunocytochemistry.RESULTS:The neurospheres formed after 1 week culture,and grew with time prolonged.The culture system was changed into adherent culture at 4th week.At 24 hours after plated on the poly-omithine/fibronectin pre-coated dish,neurospheras adhered to the dish and many cells migrated out of neurnshperes and proliferated as monolayer.The immunocytochemistry showed that NSCs which culture medium contain EGF and bFGF preserve neatin positive,and the cmNSCs that without EGF and bFGF differentiated into astrocytes (GFAP positive),neurons (Tuj-1 positive) and oligodendrocytes (O4 positive).CONCLUSION:The culture system which combines suspension culture and adherent culture is fit for the culture of cmNSCs.The cultured cmNSCs has potential to differentiate into astrocytes,neuronal cells and oligodendrocytes.

Objective To determine the modality of Leptospira interrogans invading human and murine mononuclear-macrophages and diversity of leptospiral phagocytotic vesicle formation. Methods Transmission electron microscopy was applied to observe the invasion of L. interrogans serogroup Icterohaemorrhagiae serovar Lai strain Lai into murine mononuclear-macrophage-like cell line J774A. 1 and PMA-activated human monocyte line THP-1 and the formation of leptospiral phagocytotic vesicles. By using immunofluorescence plus either laser confocal microscopy or fluorescence spectrophotometry, the changes of intracellular leptospiral numbers in J774A. 1 and PMA-activated THP-1 cells before and after block with endocytosis inhibitors monodansylcadaverin (MDC), phenylarsine oxide (PAO) and clathrin antibody were investigated. Results The leptospires in J774A. 1 cells were located in phagocytotic vesicles while the leptospires in THP-1 cells had no package with phagocytotic vesicle membrane. Both MDC and PAO presented the effect inhibiting endocytosis of L. interrogans into J774A. 1 and THP-1 cells in dose-dependent manner. The numbers of leptospires in J774A. 1 and THP-1 cells that pre-blocked with 10 μmol/L or above MDC and 1 μmol/L or above PAO were significantly less than that in the two cells untreated with MDC and PAO (P＜0.05＝. After J774A. 1 and THP-1 cells were blocked with clathrin antibody, the numbers of intracellular leptospires were also remarkbly decreased ( P<0.05 ).Conclusion Leptospira interrogans can invade into both human and murine mononuclear-macrophages through the way of clathrin-dependent endocytosis. There is an opposite diversity of leptospiral phagocytotic vesicle formations in human and murine mononuclear-macrophages, which may result in the difference of pathogenesis in human and mice after infected with L. interrogans.

Objective To study the diagnosis, pathomorphological and immunohistochemical features of gastrointestinal stromal tumor (GIST) and to explore the reference parameters for malignancy. Methods Light microscopy was used to study the morphologic characteristics in 54 cases of gastrointestinal mesenchymal tumors, and the expression of CD117,CD34 and S 100 was detected by EnVision immunohistochemical method. ResultsMost borderline and malignant tumors were found in male. CD117 showed diffuse strong expression, CD34 mostly showed diffuse strong expression, S 100 incidentally showed focal expression, and the positive rates were 100%, 59% and 16% respectively. Conclusions CD117 is a sensitive and specific marker for the diagnosis of GIST. Tumor necrosis, high tumor cellularity and intestinal tumor mitotic activity over 1/50HPF were helpful parameters for judgement of malignancy, tumors are most often seen in male.

Objective:To evaluate the role of esophagogastric junction contractile index (EGJ-CI) in distinguishing patients with refractory gastroesophageal reflux disease (RGERD) from functional heartburn (FH).Methods:From March 2014 to January 2018, 82 patients with proton pump inhibitor (PPI) refractory heartburn and/or regurgitation, who visited the Outpatient Department of Gastroenterology at The First Affiliated Hospital with Nanjing Medical University were enrolled, among them 50 patients with RGERD (RGERD group) and 32 patients with FH (FH group). EGJ-CI of RGERD group and FH group were compared. The sensitivity and specificity of EGJ-CI to distinguish RGERD from FH patients. The correlation between EGJ-CI and high resolution esophageal manometry parameters, baseline impedance level and 24 h impedance-pH monitoring parameters were analyzed. Mann-Whitney U test, receiver operator characteristic curve analysis and Spearman correlation analysis were used for statistical analysis. Results:The EGJ-CI of RGERD group was lower than that of FH group (25.8 mmHg·cm (14.1 mmHg·cm, 35.9 mmHg·cm)(1 mmHg=0.133 kPa) vs. 39.2 mmHg·cm (23.0 mmHg·cm, 60.8 mmHg·cm)), and the difference was statistically significant ( Z=-2.833, P=0.005). When the cut-off value of EGJ-CI was 35.8 mmHg·cm, the sensitivity and specificity to distinguish RGERD from FH were 76.0% and 62.5%, respectively; area under the curve was 0.69 (95% CI 0.57 to 0.81). EGJ-CI was positively correlated with lower sphincter resting pressure, integrated relaxation pressure, distal contractile integral, distal esophageal pressure, and mean nocturnal baseline impedance ( r=0.812, 0.631, 0.451, 0.490 and 0.401, all P<0.01). EGJ-CI was negatively correlated with DeMeester score, acid exposure time, total reflux episodes, acid reflux episodes, long reflux episodes and longest reflux time ( r=-0.363, -0.372, -0.346, -0.318, -0.300 and -0.291, all P<0.01). Conclusions:EGJ-CI can help to distinguish patients with FH from RGERD.

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