Objective To explore the effect of preoperative platelet (PLT) count on the prognosis of patients with laryngeal squamous cell carcinoma.Methods The clinical data of 286 patients with laryngeal squamous cell carcinoma were retrospectively analyzed to determine the optimal critical value of PLT count for end point of recurrence and death.The effects of preoperative PLT count on the recurrence and 5-year survival rates of patients with laryngeal squamous cell carcinoma after surgery were analyzed.Results The optimal critical value of PLT count for end point of recurrence was 242.5 × 109/L.The patients were divided into PLT ≥242.5 × 109/L group (n =115) and PLT ＜242.5 × 109/L group (n =171).Single factor analysis indicated that the recurrence was not related to age (x2 =0.005,P =0.942),gender (x2 =0.309,P =0.579) and pathological differentiation (Z =2.858,P =0.240),and was related to T staging (x2 =10.509,P =0.001),lymph node metastasis (x2 =7.297,P =0.007),primary tumor site (x2 =16.797,P ＜ 0.001) and preoperative PLT count (x2=12.081,P =0.001).Multivariate analysis indicated that T staging (OR =0.518,95 ％ CI:0.281-0.954,P =0.035),primary tumor site (OR =2.371,95 ％ CI:1.283-4.382,P =0.006),and PLT count (OR =2.885,95％ CI:1.607-5.179,P ＜ 0.001) were the independent factors affecting the recurrence of laryngeal squamous cell carcinoma.The optimal critical value of PLT count for end point of death was 251.5 × 109/L.The patients were divided into PLT≥251.5 × 109/L group (n =94) and PLT ＜ 251.5 ×109/L group (n =192).Single factor analysis indicated that the 5-year survival rate was not related to age (x2 =0.030,P =0.863),gender (x2 =0.000,P =0.945) and pathological differentiation (x2 =4.050,P=0.133),and was related to T staging (x2 =41.630,P ＜ 0.001),lymph node metastasis (x2 =58.110,P ＜0.001),primary tumor site (x2 =36.250,P ＜ 0.001) and preoperative PLT count (x2 =4.790,P =0.029).Multivariate analysis indicated that T staging (HR =0.353,95％ CI:0.193-0.645,P =0.001),primary tumor site (HR =2.151,95 ％ CI:1.312-3.526,P =0.002),lymph node metastasis (HR =2.819,95 ％ CI:1.633-4.867,P＜0.001),and PLT count (HR=1.853,95％CI:1.160-2.960,P=0.010) were the independent factors affecting 5-year survival rates of laryngeal squamous cell carcinoma.Kaplan-Meier survival analysis indicated that the 5-year survival rate of PLT≥251.5 × 109/L group and PLT ＜ 251.5 × 109/L group were 58.23％,67.87％,with significant difference (x2 =4.79,P =0.029).Conclusion Preoperative PLT count is the influence factor of recurrence and 5-year survival rate of laryngeal squamous cell carcinoma patients,which has important significance to the prognosis of laryngeal squamous cell carcinoma patients.

By compiling the practice set of "brief problem examples", we continue to advance case-oriented teaching in the "3+2" assistant general practitioner training "clinical comprehensive course". However, we have found that 10.7% of the questions provided by the instructors are still concerned with large-scale equipment, and operation methods etc., suggesting that parts of the teachers' consciousness in general medicine is still urgent to be enhanced. According to the analysis of the graduation test results of the students of Grade 2015, it is obvious that the average scores of the students after the examination reform have not been significantly affected. The questionnaire survey shows that most of the teachers and students think that it is of positive significance to adopt a "brief medical record problem", and 91.5% of the teachers and 81.7% of the students do not affect the examination paper form and do not affect the answers. As for the compiled 1 exercises, 86.6% of the teachers and 67.8% of the students agreed. In view of the supple-mental effect of the form of "brief medical record problem" to case introduction teaching, it is necessary to compile the exercise set suitable for this course and apply it to specific teaching activities.

Objective Based on the objective test (A type) results of the 2014 comprehensive clinical course graduation test of 3+2 assistant general practitioners training,this article analyzed the differences between different teaching units,so as to provide objective basis for improving the teaching level of each unit.Method We established a database with EXCEL 2000,and put each question's ID and points,and the score of each student into the computer,so we could get the difficulty coefficient,distinction degree and reliability of the test paper,and calculate the difficulty coefficient and difference of each question.Then we analyzed the difficulty coefficient,the difference and the reliability of the 122 students' testing results,and compared the accuracy to the same question of the 6 teaching units.Result The objective test's (A type) difficulty coefficient is 0.77,distinction degree is 0.19,and reliability is 0.99.The highest score of the 122 students is 47 points,and the lowest score is 28 points,the average score is (38.5 ± 3.9) points.In the 50 questions,3 questions' difficulty coefficient is less than 0.4,14 questions' difficulty coefficient is between 0.4-0.7,33 questions' difficulty coefficient is above 0.7,so the difficulty degree of the paper is relatively low.In the 50 questions,23 questions' distinction degree is less than 0.15,17 questions' distinction degree is between 0.15-0.30,10 questions' distinction degree is above 0.30,so the distinction degree of the paper is relatively high.In the 50 questions,20 questions' accuracy appears larger differences between each unit:9 questions' accuracy has decreased significantly among 1-2 units,4 questions' accuracy decreased significantly among 3 units,3 questions' accuracy decreased significantly among 4 units,only 1 unit has high accuracy among 2 questions,and 2 questions' accuracy decreased significantly among all units.These problems are related to the teachers' teaching ability,the difficulty in mastering the key points of the curriculum,the lack of the concept of the general practitioners training.Conclusion The design of the examination paper is basically in line with the study purpose and the objectives of the training course.This examination paper was highly reliable,and suitable for the professional theory and ability test.There are site differences between each unit,which can provide an objective basis for improving the teaching level of different teaching unit,and we will solve the problems in the form of collective preparation next step.

AIM:To investigate the role of microRNA-132 (miR-132) on alveolar macrophage inflammation. METHODS: Rat alveolar macrophage cell line NR8383 was transfected with miR-132 mimic, mimic negative control ( NC) , miR-132 inhibitor, or inhibitor NC.The cells were divided into transfection group, transfection +lipopolysaccha-ride ( LPS) group, and transfection +LPS +acetylcholine ( ACh) group.The mRNA expression of acetylcholinesterase ( AChE) was detected by real-time PCR.The protein levels of AChE, signal transducer and activator of transcription 3 (STAT3) and phosphorylated STAT3 (p-STAT3) in the cells, and nuclear factor-κB (NF-κB) in the cytoplasm and nu-cleus were analyzed by Western blot.The activity of AChE in the culture supernatant was measured by AChE activity assay kit.The nuclear translocation of NF-κB was detected by immunofluorescence assay.RESULTS: Up-regulation or down-regulation of miR-132 had no effect on the mRNA expression of AChE.However, up-regulation of miR-132 decreased the protein level of AChE compared with mimic NC group (P<0.05).Transfection with miR-132 inhibitor increased the pro-tein expression of AChE compared with inhibitor NC group ( P<0.05 ) .In the alveolar macrophages treated with LPS+ACh, the inhibition of nuclear translocation of NF-κB p65 in miR-132 mimic group was more effective than that in mimic NC group ( P<0.05) .The inhibitory effect in miR-132 inhibitor group was weaker than that in inhibitor NC group ( P<0.05 ) .The inhibitory effect of miR-132 mimic on the protein levels of STAT3 and p-STAT3 was stronger than that of mimic NC (P<0.05).CONCLUSION:miR-132 in LPS-stimulated alveolar macrophages reinforced ACh-mediated anti-inflam-matory reaction by targeting AChE to suppress ACh hydrolyzation, which was related to the suppression of NF-κB and STAT3 activation.

OBJECTIVE To report on the phenotype of an infant with central hypoventilation syndrome (CCHS) and result of PHOX2B gene mutation analysis for the purpose of genetic counseling and prenatal diagnosis. METHODS Clinical data of an infant with CCHS was collected and analyzed. Potential mutation of PHOX2B gene was analyzed by amplified fragment length polymorphism (amp-FLP) and DNA sequencing. RESULTS The patient had typical clinical features of CCHS including frequent hypoventilation during sleeping, hypoxemia and hypercapnia which could be corrected by continuous ventilatory support. She also had repeated bruising and was difficult-to-wean, but without any cardiac, pulmonary, neuromuscular or brainstem lesions. DNA sequencing and amp-FLP of the PHOX2B gene showed that the patient has carried a polyalanine expansion repeat mutation (PARM) in exon 3. A 27 bp duplication was confirmed in the repeat sequence of 20 alanines by cloned and sequenced. This has led to an expansion of the repeat tract to 29 alanines. The genotype was therefore 20/29. CONCLUSION A patient with CCHS has been described. Mutation screening of PHOX2B gene can be used as an important support for diagnosis and genetic counseling for such patients.
Female ; Homeodomain Proteins ; genetics ; Humans ; Hypoventilation ; congenital ; genetics ; Infant, Newborn ; Mutation ; Sleep Apnea, Central ; genetics ; Transcription Factors ; genetics

Objective To understand the anatomical features of the mine wound and provide anatomical basis for the treatment through anatomical observation of the mine wound amputation stump. Methods Three mine wound amputation stumps were dissected. The nerves, arteries and veins were separated and the length of the muscle,nerves,blood vessels and bleeding area were measured,respectively. The sec-tions of muscle tissue were observed by microscope. Results Most of the muscle tissues,nerves and blood vessels were torn and the fractures were comminuted. Observed by the microscope found that the distal muscle tissue was broken,the muscle fiber was contracted,ruptured and mortified. The muscle tissues of proximal part showed edema,most of the muscle fiber was normal and light stain,their texture was fuzzy. Conclusion The mine wound has remote effect. The shock wave of mine explosion may spread along the limbs,which leads to the tissues ruptured and hemorrhage.

ObjectiveTo observe the effect of acetylcholine (ACh) on lipopolysaccharide (LPS) induced inflammatory model of rat alveolar macrophages, and to observe the effect of the acetylcholinesterase inhibitor physostigmine (Phy) on the anti-inflammatory effect of ACh.Methods The rat alveolar macrophages NR8383 were cultured in vitro, which were divided into five groups: blank control group, LPS group (stimulated with 1 mg/L LPS for 12 hours), LPS+ ACh group (0.01, 0.1, 1, 10, 100μmol/L of ACh were added for 5 minutes before LPS stimulation), LPS+ Phy group (1 mmol/L Phy was added for 5 minutes before LPS stimulation), and LPS+ ACh+ Phy group (1 mmol/L Phy and 10μmol/L ACh were added for 5 minutes before LPS stimulation). The supernatants were collected in each group, the enzyme-linked immunosorbent assay (ELISA) was used to assay the contents of tumor necrosis factor-α (TNF-α), interleukins (IL-1β, and IL-6). The activity of acetylcholine esterase (AChE ) in the supernatant was also determined.Results① The contents of TNF-α (ng/L: 605.09±57.13 vs. 34.07±8.62), IL-1β (ng/L: 377.09±28.55 vs. 32.33±10.62) and IL-6 (ng/L: 558.04±77.45 vs. 42.62±11.21) in the LPS group were significantly higher than those in the blank control group (allP< 0.05). These results indicated that the inflammatory model of rat alveolar macrophages was constructed successfully.② ACh with the final concentrations of 0.01, 0.1, and 1μmol/L had less influence on the production of TNF-α, IL-1β and IL-6 in the culture supernatants of alveolar macrophages stimulated with LPS compared with LPS group (allP> 0.05). Nevertheless, 10μmol/L and 100μmol/L ACh notably reduced the production of TNF-α (ng/L: 451.19±30.67, 332.19±32.19 vs. 604.96±22.56), IL-1β(ng/L: 261.08±24.78, 143.98±28.39 vs. 367.06±10.44) and IL-6 (ng/L: 342.75±54.60, 235.48±29.75 vs. 562.69±63.34) in the culture supernatants compared with the LPS group (allP< 0.05).③ The activity of AChE in the LPS group was significantly higher than that in the blank control group (kU/L: 5.21±0.63 vs. 3.09±0.10,P< 0.05). The activity of AChE was successfully inhibited by 1 mmol/L acetylcholinesterase inhibitor Phy pretreatment compared with that in the LPS group (1.51±0.12 vs. 5.21±0.63,P< 0.05).④ The level of TNF-α (ng/L: 183.17±35.44 vs. 451.19±30.67), IL-1β (ng/L: 91.49±12.27 vs. 261.08±24.78) and IL-6 (ng/L: 108.17±22.82 vs. 342.75±54.60) in the culture supernatants of LPS+ ACh+ Phy group was significantly decreased as compared with LPS+ ACh group (allP< 0.05).Conclusions ACh with the final concentrations of 10μmol/L and 100μmol/L can inhibit the LPS induced inflammatory reaction in alveolar macrophages. The acetylcholinesterase inhibitor Phy can reinforce the ACh-mediated anti-inflammatory effect on alveolar macrophages inflammatory model.

Objective To observe the influence of human umbilical cord wharton′s jelly‐mesenchymal stem cells(WJ‐MHCs) on the tumor necrosis factorα (TNF‐α) and N‐terminal pro‐brain natriuretic peptide(NT‐proBNP) in rats with heart failure of a‐cute myocardial infarction .Methods Totally 80 male rat models of heart failure of acute myocardial infarction were made by isopre‐naline(ISO) 200 mg/kg injected subcutaneously twice at an interval of 24 hours .After one week ,24 survival rats were randomly di‐vided into WJ‐M HCs transplantation group and normal control group .Sham group was made of 12 health rats ,and then each of the three groups was subdivided into pre‐transplantation group and post‐transplantation group 4 weeks later .WJ‐MHCs transplantation group was transplanted with WJ‐MHCs with DAPI labeled after ISO injected one week .Sham group and normal group were un‐treated and normally bred .The left ventricular ejection fraction(LVEF) measured by before transplantation and post‐transplantation 4 weeks later .The injected cells and the expression of TNF‐αwas measured .Results Compared to pre‐transplantation group ,WJ‐M HCs transplantation group increased the LVEF(P<0 .05);compared to pre‐transplantation and normal control ,WJ‐M HCs trans‐plantation group reduced the TNF‐αand NT‐proBNP in the serum(P<0 .05)and the expression of TNF‐α from the heart tissue (P<0 .05);compared to normal transplantation ,WJ‐M HCs transplantation group reduced the mortality from 33 .3% to 16 .7% ;immunofluorescence demonstrated that transplanted cells were still found alive in the heart after transplantation 4 weeks later .Con‐clusion Transplantation of WJ‐MHCS down‐regulates TNF‐α and NT‐proBNP in the serum in the serum and the expression of TNF‐αfrom the heart tissue and up‐regulates the LVEF in rats with heart failure of acute myocardial infarction .

OBJECTIVE: To analyze the related factors of difficult laryngeal exposure under retaining laryngoscope. METHOD: We did a retrospective analysis of 287 retaining laryngoscope surgery patients' clinical datas to observe the relationship between difficult glottis exposure and patients' gender, degree of mouth opening, BMI, neck circumference, head and neck flexion, TMD, HMD and SMD. RESULT: By ROC curve analysis, we determine the optimal threshold for TMD was 7.35 cm, HMD was 6.33 cm, SMD was 14.75 cm. Univariate analysis showed that gender, and glottis exposure had no significant correlation with difficult laryngeal exposure under retaining laryngoscope. Degree of mouth opening, BMI, neck circumference, head and neck flexion, TMD, HMD and SMD had correlation with difficult laryngeal exposure. Multivariate analysis showed that neck circumference, head and neck flexion, TMD, SMD were independent factors of difficult laryngeal exposure under retaining laryngoscope. CONCLUSION Measurement of neck circumference, head and neck flexion, TMD, SMD before the operation is important for the prediction of difficult laryngeal exposure under retaining laryngoscope.
Glottis ; Head ; Humans ; Laryngoscopes ; Laryngoscopy ; adverse effects ; methods ; Larynx ; Neck ; Posture ; ROC Curve ; Retrospective Studies

OBJECTIVE: To analyze the correlated factors of cervical lymphatic metastasis of T3 and T4 glottic carcinoma. METHOD: We did a retrospective analysis of 91 glottic carcinoma patients' clinical data to analyze cervical lymph node metastasis on different T stage, pathologic degree and the tumor sites. RESULT: The cervical lymph node metastasis rate of 91 cases of T3 and T4 glottic carcinoma was 21.98%. T3 group's metastasis rate was 18.06% (13/72), T4 group's metastasis rate was 36.84% (7/19), P > 0.05. Grouped according to the degree of pathological differentiation, well-differentiated squamous cell carcinoma metastasis rate is 13.89% (5/36), middle-differentiated squamous cell carcinoma metastasis rate is 26.00% (13/50), and poorly-differentiated squamous cell carcinoma metastasis rate is 40.00% (2/5), P > 0.05. Cervical lymph node metastasis rate was 16.22%, when the tumor invading supraglottic region. Cervical lymph node metastasis rate was 15.38%, when the tumor invading subraglottic region. Cervical lymph node metastasis rate was 46.15%, when the tumor invading supraglottic and subraglottic region (P < 0.01). CONCLUSION Cervical lymph node metastasis in cN0 patient with supraglottic carcinoma is effected by T classification, cervical lymphatic metastasis of T3 and T4 glottic carcinoma is not entirely effected by T stage and pathologic degree. When the tumor invades supraglottic and subraglottic region, cervical lymph node metastasis is significantly higher. Therefore, the area of tumor invasion is an important factor for lymph node metastasis.
Humans ; Laryngeal Neoplasms ; pathology ; Lymph Nodes ; Lymphatic Metastasis ; Lymphatic Vessels ; Neck ; Neck Dissection ; Neoplasm Staging ; Retrospective Studies