Polymalic acid, known as a bioactive material, is completely biodegradable, and has far reaching application potential in medical field. Combined with our own findings, we summarized advances in polymalic acid metabolism, microbial fermentation synthesis, and application research in the medical field. Finally, prospect for further research was addressed.
Fermentation ; Industrial Microbiology ; Malates ; chemistry ; Polymers ; chemistry

Objective:To study the clinical and pathological features of Langerhans cell histiocytosis (LCH), and to provide the reference for its diagnosis and treatment.Methods:The manifestation of one LCH patient was retrospectively analyzed.The features of the LCH patients were explored by analyzing the results of skin biopsy, radiological test and follow-up.The associated literatures were reviewed.Results:The patient presented the typical symptoms gradually,including polycystic lung,skin ulcer,diabetes insipidus,and lactation.The skin pathological findings showed the densely distributed mononuclear cell infiltration in dermis and the immunohistological staining result showed positive CD1a. The patient was follwed up for 7 years and died of heart and lung failure. Conclusion:LHC has various manifestations and should be confirmed by clinical features,pathological features and imaging examination.The adult patients with multisystem and vital organ involvement suggest the poor prognosis.

Objective To evaluate the accuracy of the fetal weight estimation system in terms of estimating the fetal weight.Methods The fetal weight estimation system developed by the Department of Electronic Engineering,Fudan University was applied to estimate the fetal weight in many hospitals,and the differences between the estimated results of the system and the actual weight of newborn fetuses,as well as the accuracy of the estimation system and the traditional estimation methods were compared.Results A total number of 610 cases were employed,with each case including the ultrasound images of fetus before birth,the corresponding measurement data and the newborn weight.The correlation coefficients between the weight of the newborn babies and the fetal parameters,which were measured by the estimation system in terms of the biparietal diameter,the head circumference,the abdomen circumference and the femur length,were higher than those obtained by manual annotations,with improvements of 0.08,0.17,0.09 and 0.05,respectively.The absolute error of the estimated weight of the system with respect to the actual weight was 44 g smaller than those estimated by traditional method,and the variance of the absolute error was 53 g smaller;while the corresponding absolute percentage error was 1.8％ lower,and the corresponding variance percentage was 1.5％ lower.Conclusions The fetal weight estimation system improves the accuracy of the prenatal ultrasound assessment and provides reliable information to clinical diagnosis.

Objective To compare the value of contrast-enhanced ultrasound(CEUS) and contrastenhanced CT(CECT) for the differential diagnosis of the benign and malignant hepatic nodules in BuddChiari syndrome(BCS).Methods Thirty-nine BCS patients with hepatic nodules underwent CEUS and CECT examination separately,through which the perfusion characters of the nodules in different phases were observed.With the pathological result as the golden standard,the sensitivity,specificity and accuracy of CEUS and CECT were compared on diagnosing benign regenerative nodules and hepatocellular carcinoma (HCC) in BCS.Results Of the 66 hepatic lesions in 39 patients,21 were hepatocellular carcinoma(HCC),and the other 45 were regenerative nodules.The sensitivity,specificity and accuracy of CEUS and CECT were 81％,91％,88％ and 71％,84％,80％ respectively.Thus the diagnostic efficiency difference between CEUS and CECT had no statistic significance(P ＞0.05).Conclusions The differential diagnoses of the benign and malignant hepatic nodules in BCS on CEUS and CECT have high consistency.Due to the convenience and safety of CEUS,it can be used as first-line method.

Objective:To compare the effects of stromal cell-derived factor-1 (SDF-1 )and granulocyte colony-stimulating factor (G-CSF)on proliferation,migration,and odontoblastic differentiation of human dental pulp stem cell (DPSC)in vitro.Methods:DPSCs were cultured in vitro and treated with either 1 00 μg/L SDF-1 or 1 00 μg/L G-CSF.Cell counting kit-8 (CCK-8 )and colony-forming unit (CFU ) were used to detect the effect of SDF-1 and G-CSF on the proliferation ability of DPSC.Cell migration of DPSC was determined by wound healing assay and Transwell migration assay.The effects of SDF-1 and G-CSF on odontoblastic differentiation of DPSC were evaluated by alkaline phosphatase (ALP)staining, ALP activity and alizarin red S staining.The expression of odontoblastic-related genes such as dentin ma-trix protein 1 (DMP-1 )and dentin sialophosphoprotein (DSPP)were quantified by real-time RT-PCR. Results:SDF-1 and G-CSF promoted the proliferation of DPSC slightly,but the difference was not statis-tically significant.Wound healing assay showed that SDF-1 and G-CSF promoted cell migration of DPSC significantly (P<0.01 ),but there was no significant difference between the two factors.In Transwell migration assay,the number of migrated cells of the control group was 5 .0 ±1 .4 per sight,while the SDF-1 group was 24.3 ±6.8 per sight and the G-CSF group was 1 1 .8 ±3.3 per sight,suggesting that cell migration of DPSC was improved significantly after being treated with SDF-1 or G-CSF,and SDF-1 was more effective than G-CSF (P<0.05 ).Significantly greater odontoblastic differentiation potential was found in SDF-1 group and G-CSF group based on the ALP staining.Higher ALP activity,more mineralization nodule formation and higher expressions of DMP-1 and DSPP were also found after SDF-1 or G-CSF treatment.Conclusion:SDF-1 had no significant effect on the proliferation of DPSC,but could significantly promote cell migration and odontoblastic differentiation of DPSC.Its effect on DPSC was bet-ter than G-CSF.

Objective To quantitatively assess the cardiopulmonary exercise function of spinal cord injury (SCI) patients and observe the effect of aerobic exercise on cardiopulmonary function, motor function and activities of daily living. Methods From December, 2014 to June, 2016, 34 incomplete SCI patients (ASIA C and D) and 23 healthy controls received cardiopulmonary exercise test (CPET). SCI pa-tients were randomly divided into conventional rehabilitation group (n=17) and aerobic exercise group (n=17). The aerobic exercise group received aerobic exercise for four weeks. They were assessed with CPET, motor and sensory function, walking index for spinal cord injury II (WISCI II) and spinal cord independence measure (SCIM) before and four weeks after training. Results Oxygen uptake (VO2)peak, anaerobic threshold (AT), metabolic equivalent of energy (METpeak), VO2/heart rate (HR)peak, respiratory exchange rate (RER)peak, minute ventilation (VE)peak, work rate (WR)peak and systolic blood pressure (SBP)peak were lower in the patients than in the controls (t>2.714, P<0.05). VO2peak、AT、METpeak、VO2/HRpeak、WRpeak increased in the aerobic exercise group after training (t>2.431, P<0.05). METpeak and WRpeak improved in the conventional rehabilitation group after training (t>3.282, P<0.01). The scores of motor in ASIA and SCIM improved in both groups after training (t>2.985, P<0.05). Conclusion The cardiopulmonary function decreased in incomplete SCI patients, which could be improved by moderate intensity aerobic exercise.

ObjectiveTo explore the Apolipoprotein-E （ApoE） gene polymorphism in patients with Alzheimer's disease （AD）, vascular dementia (VD) or mild cognitive impairment (MCI). MethodsPeripheral blood was taken from patient with AD, VD or MCI to determine the ApoE genotypes. ResultsThe most of the patients were ε3/ε3 genotype, while the ε2/ε2 and ε4/ε4 could not be detected. ε3/ε4 genotype （P=0.001） and ApoE ε4 allele （P=0.013） was more frequent in AD than in MCI. ApoE ε4 was more frequent in VD than in MCI （P=0.044）. ConclusionApoE ε4 allele is a risk factor in AD, and may be associated with VD and MCI.

Objective:To investigate the correlations between the bone mineral densities and biomechanical properties on different layers of the cancellous bone in the proximal tibia.Methods:Quantitative CT was conducted of the 15 specimens of adult male tibia. Based on the artificial destruction levels at the trabecular bone on the tibial plateau, the 15 specimens were randomly divided into 3 groups ( n=5): group A (cancellous bone on the 1.5 cm layer below the articular cartilage), group B (cancellous bone on the 3.0 cm layer under the articular cartilage) and group C (cancellous bone on the 0 to 3 cm range of the subchondral bone). After standing positions were simulated in the 3 sets of specimens, they were connected to a biomechanical testing machine. Twenty-four sites were selected and subjected to a vertical load of 600 N. Strain values and overall displacement values of the specimens were recorded before and after trabecular bone destruction. The correlations were analyzed between bone density and displacement values in groups A and B. The strain values before and after trabecular bone destruction, as well as the overall deformation values of the specimens were compared between the 3 groups. Results:The bone densities of specimens in groups A and B were negatively correlated with the displacement values before and after destruction ( P<0.05). Comparisons of strain values at the 24 sites before and after trabecular bone destruction within 3 groups: There were statistically significant differences in the strain values at 8 sites between before and after trabecular bone destruction in group A ( P<0.05). Of the 8 sites, 6 showed increased strains which were mainly concentrated around the insertion point of the anterior cruciate ligament and the medial tibial plateau. There were statistically significant differences in the strain values between before and after trabecular bone destruction at 3 sites in group B ( P<0.05). The strains at all the 3 sites increased, mainly concentrated behind the surface below the level of destruction. There were statistically significant differences in the strain values at 10 sites in group C between before and after trabecular bone destruction ( P<0.05). Of the 10 sites, 5 showed a decrease in the strain which was concentrated above the destruction plane, and 5 showed an increase in the strain which was concentrated below the destruction plane. The overall deformation values of the specimens in groups A, B, and C were (0.033±0.003) mm, (0.015±0.003) mm, and (0.066±0.007) mm, respectively, showing statistically significant differences between the 3 groups ( P<0.05) as well as between any 2 groups ( P<0.05). Conclusions:Bone mineral density in the cancellous bone of the proximal tibia has some value in assessment of the bone strength. Destruction of the proximal tibial cancellous bone can significantly change the strain distribution on the proximal tibia. The proximal cancellous bone of the tibia plays a key role in stress support and load conduction.

Objective To examine survival differences in prognosis and survival between patients with HPV-positive and those with HPV-negative oropharyngeal squamous cell carcinoma (OPSCC).Methods Pubmed,Embase,Web of science and Medline databases were searched from their inception till June 2014.A random-effect meta-analysis was used to pool study estimates evaluating overall (all-cause mortality),disease-specific (death from OPSCC),disease-free (recurrence free),progression-free survival outcomes and local regional control rate in HPV-positive vs HPV-negative OPSCC.After study selection,two reviewers assessed and extracted data independently.Meta-analysis was performed using the STATA 11.0software.Results Thirty-seven studies were included.HPV-positive OPSCC patients had a better overall survival compared to HPV-negative patients (HR 0.39,95％ CI 0.32-0.46).HPV-positive OPSCC patients had a significantly lower disease specific mortality (HR 0.31,95％ CI 0.22-0.39) and were less likely to experience progression or recurrence of their cancers than HPV-negative patients (HR 0.34,95％CI 0.25-0.42).Both disease-free survival and progression-free survival were significantly improved in patients with HPV-positive OPSCC (HR 0.38,95％ CI 0.29-0.47 and HR 0.46,95％ CI 0.29-0.63,respectively).Conclusions HPV infection is an important prognostic factor of OPSCC.Stratified therapies can be applied in OPSCC based on HPV status of tumours.

Objective To analyze the clinicopathological features and lymph node metastases characteristics of intrahepatic cholangiocarcinoma (ICC).Methods The retrospective case-control study was conducted.The clinicopathological data of 1 321 ICC patients who were admitted to 12 hospitals from April 2007 to November 2017 were collected,including 182 in the Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University,173 in the First Affiliated Hospital of Xi'an Jiaotong University,156 in the First Hospital Affiliated to Army Medical University (Third Military Medical University),139 in the Cancer Center of Sun Yatsen University,128 in the Zhongshan Hospital of Fudan University,113 in the Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine,109 in the First Affiliated Hospital of Dalian Medical University,84 in the Tianjin Medical University Cancer Institute and Hospital,65 in the First Affiliated Hospital of Zhengzhou University,62 in the Affiliated Hospital of North Sichuan Medical College,58 in the Affiliated Drum Tower Hospital of Nanjing University Medical School and 52 in the Second Affiliated Hospital of Zhejiang University School of Medicine.Treatment planning was respectively determined by comprehensive hospitals according to clinical features and results of related examinations.Surgical procedures were performed based on the results of intraoperative examinations and patients' conditions.Observation indicators:(1) laboratory examination and treatment situations;(2) relationship between clinicopathological features and primary tumor location and diameter;(3) diagnosis of lymph node dissection and metastases;(4) relationship between clinicopathological features and lymph node metastases.Measurement data with normal distribution were represented as x±s,and comparison between groups was done by the t test.Measurement data with skewed distribution were described as M (range).Comparison of count data were analyzed using the chi-square test.Results (1) Laboratory examination and treatment situations:of 1 321 patients,cases and percentages of positive hepatitis B virus (HBV),positive serum alpha-fetoprotein (AFP) (＞ 20 μg/L),positive serum carcinoembryonic antigen (CEA) (＞ 5 μg/L),positive serum alanine transaminase (ALT) (＞75 U/L),positive serum CA19-9 (＞37 U/mL) and positive serum total bilirubin (TBil) (＞20 μmol/L) were respectively 202,80,329,207,590,300 and 15.586％ (202/1 296),7.339％(80/1 090),26.299％ (329/1 251),16.587％ (207/1 248),49.789％(590/1 185),24.000％ (300/1 250).Of 1 321 patients,1 206 underwent surgery,including 904 with hepatectomy,193 with transcatheter arterial chemoembolization (TACE),72 with percutaneous transhepatic biliary drainage (PTBD),3 with endoscopic retrograde cholangiopancreatography (ERCP),3 with PTBD + ERCP and 31 with other treatments;115 had missing registration of surgical procedures.(2) Relationship between clinicopathological features and primary tumor location and diameter:① Relationship between clinicopathological features and primary tumor location:cases with CA19-9 level ≤ 37 U/mL,38-200 U/mL and ＞ 200 U/mL were respectively 227,91,146 with primary tumor located in left liver and 282,134,137 with primary tumor located in right liver.Cases combined with hepatitis and intrahepatic bile duct stone were respectively 67,73 with primary tumor in left liver and 111,47 with primary tumor in right liver,with statistically significant differences in above indictors (x2 =6.710,5.656,12.534,P＜0.05).The results of further analysis showed that incidence age of ICC was (63± 10)years old in patients with hepatitis and (59± 10) years old in patients without hepatitis,with statistically significant differences (t =4.840,P＜0.05).② Relationship between clinicopathological features and primary tumor diameter:cases with primary tumor diameter ≤ 3 cm,with 3 cm ＜ primary tumor diameter ≤ 5 cm and with primary tumor diameter ＞ 5 cm were respectively 159,250,229 with CEA level ≤ 5 pg/L and 40,65,95 with CEA level ＞ 5 μg/L and 165,258,286 with ALT level ≤ 75 U/L and 34,57,36 with ALT level ＞ 75 U/L and 148,242,281 with TBil level ≤ 20 μmol/L and 51,73,43 with TBil level ＞ 20 μmol/L,and 37,70 and 131 patients had satellite loci of tumor,with statistically significant differences in above indictors (x2=8.669,6.637,15.129,34.746,P＜0.05).(3) Diagnosis of lymph node dissection and metastases:of 904 patients with hepatectomy,346 received lymph node dissection,total number,number in each patient and median number of lymph node dissected were respectively 1 894.0,5.5 and 4.0 (range,1.0-26.0);157 had lymph node metastases,with a rate of lymph node metastasis of 45.376％ (157/346),number and number in each patient of positive lymph node were respectively 393.0 and 2.5.Of 346 patients with lymph node dissection,114 had lymph node metastasis by preoperative imaging examination,postoperative pathological examinations confirmed 64 with lymph node metastasis and 50 without lymph node metastasis;232 didn't have lymph node metastasis by preoperative imaging examination,postoperative pathological examinations confirmed 93 with lymph node metastasis and 139 without lymph node metastasis.The sensitivity,specificity and diagnostic accuracy by imaging examination were respectively 40.8％,73.5％ and 58.7％.(4) Relationship between clinicopathological characteristics and lymph node metastases:lymph node metastasis rate was respectively 51.397％ (92/179) in patients with primary tumor located in left liver,39.103％ (61/156) in patients with primary tumor located in right liver,34.615％(18/52) in patients with primary tumor diameter ≤ 3 cm,42.500％(51/120) in patients with 3 cm ＜ primary tumor diameter ≤ 5 cm,52.980％(80/151) in patients with primary tumor diameter ＞ 5 cm,48.790％(121/248) in patients with CEA ≤ 5 μg/L,59.302％ (51/86) in patients with CEA ＞ 5 μg/L,40.234％ (103/256) in patients with TBil ≤ 20 μmol/L,35.106％ (33/94) in patients with TBil ＞ 20 μmol/L,with statistically significant differences in above indictors (x2 =5.078,6.262,9.456,5.156,P ＜ 0.05).Conclusions The related etiological factors may be different due to different primary location of ICC.Primary tumor in left liver is significantly associated with intrahepatic bile duct stone of left liver,and primary tumor in right liver is associated with combined hepatitis,while combined hepatitis could lead early occurrence of ICC.At present,there is a low rate of lymph node dissection in ICC patients and a high lymph node metastasis rate in patients receiving lymph node dissection.Lymph node metastasis is associated with primary tumor location and diameter,levels of CEA and TBil.Lymph node metastasis rate in left liver is higher than that in right liver,and is getting higher with increased primary tumor diameter.