With the increasing proportion of human papilloma virus(HPV)infection in the pathogenic factors of oro-pharyngeal cancer,a series of changes have occurred in the surgical treatment.While the treatment mode has been im-proved,there are still many problems,including the inconsistency between diagnosis and treatment modes,the lack of popularization of reconstruction technology,the imperfect post-treatment rehabilitation system,and the lack of effective preventive measures.Especially in terms of treatment mode for early oropharyngeal cancer,there is no unified conclu-sion whether it is surgery alone or radiotherapy alone,and whether robotic minimally invasive surgery has better func-tional protection than radiotherapy.For advanced oropharyngeal cancer,there is greater controversy over the treatment mode.It is still unclear whether to adopt a non-surgical treatment mode of synchronous chemoradiotherapy or induction chemotherapy combined with synchronous chemoradiotherapy,or a treatment mode of surgery combined with postopera-tive chemoradiotherapy.In order to standardize the surgical treatment of oropharyngeal cancer in China and clarify the indications for surgical treatment of oropharyngeal cancer,this expert consensus,based on the characteristics and treat-ment status of oropharyngeal cancer in China and combined with the international latest theories and practices,forms consensus opinions in multiple aspects of preoperative evaluation,surgical indication determination,primary tumor re-section,neck lymph node dissection,postoperative defect repair,postoperative complication management prognosis and follow-up of oropharyngeal cancer patients.The key points include:① Before the treatment of oropharyngeal cancer,the expression of P16 protein should be detected to clarify HPV status;② Perform enhanced magnetic resonance imaging of the maxillofacial region before surgery to evaluate the invasion of oropharyngeal cancer and guide precise surgical resec-tion of oropharyngeal cancer.Evaluating mouth opening and airway status is crucial for surgical approach decisions and postoperative risk prediction;③ For oropharyngeal cancer patients who have to undergo major surgery and cannot eat for one to two months,it is recommended to undergo percutaneous endoscopic gastrostomy before surgery to effectively improve their nutritional intake during treatment;④ Early-stage oropharyngeal cancer patients may opt for either sur-gery alone or radiation therapy alone.For intermediate and advanced stages,HPV-related oropharyngeal cancer general-ly prioritizes radiation therapy,with concurrent chemotherapy considered based on tumor staging.Surgical treatment is recommended as the first choice for HPV unrelated oropharyngeal squamous cell carcinoma(including primary and re-current)and recurrent HPV related oropharyngeal squamous cell carcinoma after radiotherapy and chemotherapy;⑤ For primary exogenous T1-2 oropharyngeal cancer,direct surgery through the oral approach or da Vinci robotic sur-gery is preferred.For T3-4 patients with advanced oropharyngeal cancer,it is recommended to use temporary mandibu-lectomy approach and lateral pharyngotomy approach for surgery as appropriate;⑥ For cT1-2N0 oropharyngeal cancer patients with tumor invasion depth＞3 mm and cT3-4N0 HPV unrelated oropharyngeal cancer patients,selective neck dissection of levels ⅠB to Ⅳ is recommended.For cN+HPV unrelated oropharyngeal cancer patients,therapeutic neck dissection in regions Ⅰ-Ⅴ is advised;⑦ If PET-CT scan at 12 or more weeks after completion of radiation shows intense FDG uptake in any node,or imaging suggests continuous enlargement of lymph nodes,the patient should undergo neck dissection;⑧ For patients with suspected extracapsular invasion preoperatively,lymph node dissection should include removal of surrounding muscle and adipose connective tissue;⑨ The reconstruction of oropharyngeal cancer defects should follow the principle of reconstruction steps,with priority given to adjacent flaps,followed by distal pedicled flaps,and finally free flaps.The anterolateral thigh flap with abundant tissue can be used as the preferred flap for large-scale postoperative defects.

Objective:To evaluate the clinical significance of patent accessory hepatic vein (AHV) in treatment of Budd-Chiari syndrome (BCS) with hepatic vein occlusion.Methods:The clinical data of 21 BCS patients treated from Jan 2010 to June 2019 were retrospectively analyzed. All patients underwent AHV and IVC venography.Results:Angiography showed that the diameter of AHV was 6-13mm after the procedure, the angle between AHV and the distal end of IVC was (106.9±27.7)°, and 57.1% of the AHV were opened at the right side of IVC, 9.5% at the front, and 1.4% at the left side, respectively. The technical success rate was 100%. Thirteen patients with AHV disease underwent balloon dilatation angioplasty, and their preoperative AHV pressure dropped from (41.6±6.4) cm H 2O to (22.2±5.5) cm H 2O ( t=11.966, P<0.01). The preoperative AHV and intrahepatic IVC pressure decreased from (29.1±3.3) cm H 2O to (19.1±8.8) cm H 2O ( t=8.136, P<0.01) and from (25.5±6.1) cm H 2O to (13.8±4.0) cm H 2O ( t=5.536, P<0.01), respectively. All patients were of no symptom during follow up for 6 months and ultrasound showed that the patency rate of original lesion was 100%. Conclusion:A patent AHV helps alleviate the symptoms and blood congestion of BCS patients with hepatic vein obstruction.

OBJECTIVETo summarize the treatment status of gastric gastrointestinal stromal tumor (GIST) in Shandong province,by analyzing the clinicopathological features and prognostic factors.

METHODSClinicopathological and follow-up data of 1 165 patients with gastric GIST between January 2000 and December 2013 from 23 tertiary referral hospitals in Shandong Province were collected to establish a database. The risk stratification of all cases was performed according to the National Institutes of Health(NIH) criteria proposed in 2008. Kaplan-Meier method was used to calculate the survival rate. Log-rank test and Cox regression model were used for univariate and multivariate prognostic analyses.

RESULTSAmong 1 165 cases of gastric GIST, 557 were male and 608 were female. The median age of onset was 60 (range 15-89) years. Primary tumors were located in the gastric fundus and cardia in 623 cases(53.5%), gastric body in 346 cases(29.7%), gastric antrum in 196 cases(16.8%). All the cases underwent resection of tumors, including endoscopic resection (n=106), local resection (n=589), subtotal gastrectomy(n=399), and total gastrectomy(n=72). Based on the NIH risk stratification, there were 256 cases (22.0%) at very low risk, 435 (37.3%) at low risk, 251 cases (21.5%) at intermediate risk, and 223 cases (19.1%) at high risk. A total of 1 116 cases(95.8%) were followed up and the median follow-up period was 40 (range, 1-60) months. During the period, 337 patients relapsed and the median time to recurrence was 34 (range 1-60) months. The 1-, 3-, and 5-year survival rates were 98.6%, 86.1% and 73.4%, respectively. The 5-year survival rates of patients at very low, low, intermediate, and high risk were 93.1%, 85.8%, 63.0% and 42.3% respectively, with a statistically significant difference (P=0.000). Multivariate analysis showed that primary tumor site (RR=0.580, 95%CI:0.402-0.835), tumor size (RR=0.450, 95%CI:0.266-0.760), intraoperative tumor rupture(RR=0.557, 95%CI:0.336-0.924), risk classification (RR=0.309, 95%CI:0.164-0.580) and the use of imatinib after surgery (RR=1.993, 95%CI:1.350-2.922) were independent prognostic factors.

CONCLUSIONSThe choice of surgical procedure for gastric GIST patients should be based on tumor size. All the routine procedures including endoscopic resection, local excision, subtotal gastrectomy and total gastrectomy can obtain satisfactory curative outcomes. NIH classification has a high value for the prediction of prognosis. Primary tumor site, tumor size, intraoperative tumor rupture, risk stratification and postoperative use of imatinib are independent prognostic factors in gastric GIST patients.

Objective To investigate the adverse reactions and survival rate of low dose of Oxaliplatin combined with transcatheter arterial chemoembolization in treatment of elderly patients with primary hepatic carcinoma.Methods A total of 84 patients with primary liver cancer were enrolled and randomly divided into low dose group and high dose group.Patients received 40 mg/m2 and 80 mg/m2 of Oxaliplatin respectively,and adverse reactions and survival rate were compared between the two groups.Results Incidence of nausea and vomiting was obviously lower and the number of patients with pain scale above 6 was significantly smaller in low dose group than in high dose group,with statistically significant differences (11.9％ vs.21.4％ and 28.6％ vs.78.6％,x2 =9.910,20.056,both P ＜ 0.05).White blood cell count was significantly higher and alanine aminotransferase (ALT) was significantly lower in low dose group than in high dose group after treatment (t =13.447,6.774,both P＜0.05).1 year and 3 year survival rate was 69.05％ and 30.95％ in low dose group and 61.9％ and 21.43％ in high dose group,respectively,with no statistically significant difference (x2 =0.474 and 0.985,P=0.491 and 0.321).Conclusions Low dose of Oxaliplatin combined with transcatheter arterial chemoembolization in the treatment of elderly patients with primary hepatocellular carcinoma is worth to be promoted in clinical application because it does not affect the patient survival rate and the toxic effects of the chemotherapy are very little.

A 21-year-old male was hospitalized for recurrent swelling of lower limbs (lymphedema) for 1 year and worsening of it for 1 week.Physical examination revealed several smooth,firm enlarged lymph nodes of the neck,groin without apparent tenderness measuring about 1 cm in diameter.Cardiac and pulmonary auscultation showed no obvious abnormality.The abdomen was soft on palpation without tenderness or rebound tenderness.Skin examination revealed swelling of both lower limbs,especially the left lower limb,as well as scattered irregularly sized,dark erythematous patches with a wood-like consistency on the swollen lower limbs,with high temperature but no tenderness.Elevated peripheral eosinophil count was observed before and after admission,with the eosinophil percentage higher than 70％.Vascular ultrasonography showed thrombosis in the right anterior tibial artery,left dorsal artery of foot and lower portion of the left great saphenous vein.Multiple enlarged lymph nodes were found by computed tomography in the mediastinal,bilateral axillary,retroperitoneal regions and around the abdominal aorta.Lymph node and bone marrow biopsies showed eosinophilia.Histopathology of lesions on the extensor aspect of the left medial thigh and left lateral malleolus showed massive eosinophilic infiltration and lymphatic dilation in the dermis,as well as eosinophil emboli in some lumens.The FIP1L1-PDGFRA fusion gene was undetected.A diagnosis of idiopathic hypereosinophilic syndrome was finally made.The symptoms rapidly regressed after glucocorticoid treatment.

BACKGROUND:Due to limitations of the physicochemical properties of soft denture liner material itself, whisker has been added in the soft lining material in recent years, so as to enhance its mechanical properties. OBJECTIVE:To investigate the effect of different additive amount of anhydrous calcium sulfate whisker on the mechanical function of self-curing soft denture liner. METHODS: There were six groups in this experiment. Anhydrous calcium sulfate whisker at the mass fraction of 0 (control), 1%, 2%, 3%, 4%, 5% was respectively added into self-curing soft liner materials, 10 test specimens in each group, a total of 60 test specimens. The shear bond strength, Shore hardness and tensile strength were detected. RESULTS AND CONCLUSION: With the increasing amount of the anhydrous calcium sulfate whisker, the Shore hardness of the soft lining material was increased continuously, and the tensile strength was increased firstly and then reduced. When 3% anhydrous calcium sulfate whisker was added, the bond strength and tensile strength of soft lining material reached the peak. Taken together, the mechanical properties of the soft lining materials became perfect when 3% anhydrous calcium sulfate whisker was added. These results demonstrate that anhydrous calcium sulfate whisker may affect the mechanical properties of self-curing soft liner.

Antigens, CD ; metabolism ; Antigens, Differentiation, T-Lymphocyte ; metabolism ; CD3 Complex ; metabolism ; Cells, Cultured ; Humans ; Kinetics ; Lectins, C-Type ; metabolism ; Lymphocyte Activation ; T-Lymphocyte Subsets ; drug effects ; immunology ; metabolism

Objective To investigate the status of the rehabilitation service and rehabilitation medical professionals in Tianjin. Methods130 hospitals and Disabled Persons' Federations in Tianjin selected by stratified random cluster sampling were surveyed by questionnaires.Results About 49.2% institutions had carried out the rehabilitation services; there were 842 rehabilitation medical professionals in total, including237 rehabilitation physicians and 3 prosthetic orthopaedic technicians, with a gap of nearly 3000 people; most of them were in loweducation. Conclusion The rehabilitation service should be developed; the quantities and quality of the rehabilitation medical professionalsshould be improved, the classified structure and the service objects are unbalanced.

Objective To assess value of serum level of ischemia modified albumin (IMA) in diagnosis for myocardial ischemia of coronary artery disease (CAD). Methods Seventy-two patients with clinically suspected myocardial ischemia of CAD admitted to The First People's Hospital of Hangzhou during November 2009 to May 2010 ready for undergoing coronary angiography, the gold standard for diagnosis of CAD, were randomly selected for the study. The patients were divided into CAD and non-CAD groups based on their coronary angiography. Serum level of IMA was determined with cobalt-albumin binding ( ACB) assay before coronary angiography, which served as diagnostic standard for CAD. Logistic regression analysis method was used to evaluate varied levels of IMA with area under the receiver operating characteristic curve (AUCROC) in diagnosis for myocardial ischemia of CAD. Results Mean level of IMA was (97 ±24) U/ml and (81 ±15) U/ml for CAD group (n =51) and non-CAD group (n =21), respectively. Sensitivity and specificity of a cut-off value of IMA 83.69 U/ml in diagnosis for myocardial ischemia of CAD was 80 percent and 57 percent, respectively, with a predictive value of a positive test 82 percent and that of a negative test 55 percent, respectively, from AUCROC. Logistic regression analysis demonstrated that both hypertension (P=0. 022, 6 = 1.421, OR=4. 141) and level of IMA (P=0.003, b= 1.780, OR=5.928) were independent predictors for CAD. Conclusions Sensitivity, specificity and predictive value of a positive test of the level of IMA are relatively high in diagnosis for myocardial ischemia of CAD, which is an independent predictor of it.

BACKGROUND:The non-steroidal antiinflammatory drugs (NSAIDs) were widely used to prevent heterotopic bone formation following total hip arthroplasty (THA),however,its efficacy and safety is poorly understood.OBJECTIVE:To determine the efficacy and safety of postoperative NSAIDs therapy in patients undergoing THA using Meta analysis.METHODS:The databases of PubMed,Embase,Cochrane Library,Chinese biomedical literature,CNKI,VIP as well as bibliographies of retrieved articles were researched for randomized controlled trials comparing NSAID versus control after THA,and the data were analyzed using Review Manager 5.0.RESULTS AND CONCLUSION:A total of 13 randomized controlled trials totaling 4706 participants were included.The result of meta analysis showed that low dose aspirin did not significantly affect the incidence of heterotopic bone formation (HBF) [RR=0.99,95% CI (0.87,1.14) rather than medium to high dose NSAIDs [RR=0.44,95% CI(0.30,0.64),there was no significant difference between two group in hip pain and physical function,the incidence of HBF was 16.0% in NSAID-group and 11.1% in 7 Gy group.Apart from low dose aspirin,medium to high doses of postoperative NSAIDs produce a substantial reduction in the incidence of HBF at the cost of minor high gastrointestinal side effect.Limited evidence showed there were no significant differences between the groups for improvements in hip pain and physical function,7 Gy fraction is more effective than use of NSAID.