1.Effectiveness of the integrated schistosomiasis control programme in Sichuan Province from 2015 to 2023
Chen PU ; Yu ZHANG ; Jiajia WAN ; Nannan WANG ; Jingye SHANG ; Liang XU ; Ling CHEN ; Lin CHEN ; Zisong WU ; Bo ZHONG ; Yang LIU
Chinese Journal of Schistosomiasis Control 2025;37(3):284-288
Objective To investigate the effectiveness of the integrated schistosomiasis control programme in Sichuan Province during the stage moving from transmission interruption to elimination (2015—2023), so as to provide insights into formulation of the schistosomiasis control measures during the post-elimination stage. Methods Schistosomiasis control data were retrospectively collected from departments of health, agriculture and rural affairs, forestry and grassland, water resources, and natural resources in Sichuan Province from 2015 to 2023, and a database was created to document examinations and treatments of human and livestock schistosomiasis, and snail survey and control, conversion of paddy fields to dry fields, ditch hardening, rivers and lakes management and building of forests for snail control and schistosomiasis prevention. The completion of schistosomiasis control measures was investigated, and the effectiveness was evaluated. Results A total of 20 545 155 person-times received human schistosomiasis examinations in Sichuan Province during the period from 2015 to 2023, and 232 157 person-times were seropositive, with a reduction in the seroprevalence from 2.10% (44 299/2 107 003) in 2015 to 1.12% (9 361/837 896) in 2023 (χ2 = 7.68, P < 0.001). The seroprevalence of human schistosomiasis appeared a tendency towards a decline in Sichuan Province over years from 2015 to 2023 (b = −8.375, t = −10.052, P < 0.001); however, no egg positive individuals were identified during the period from 2018 to 2023, with the prevalence of human Schistosoma japonicum infections maintained at 0. Expanded chemotherapy was administered to 2 754 515 person-times, and medical assistance of advanced schistosomiasis was given to 6 436 persontimes, with the treatment coverage increasing from 46.80% (827/1 767) in 2015 to 64.87% (868/1 338) in 2023. Parasitological tests for livestock schistosomiasis were performed in 35 113 herd-times, and expanded chemotherapy was administered to 513 043 herd-times, while the number of fenced livestock decreased from 121 631 in 2015 to 103 489 in 2023, with a reduction of 14.92%. Snail survey covered 433 621.80 hm2 in Sichuan Province from 2015 to 2023, with 204 602.81 hm2 treated by chemical control and 4 637.74 hm2 by environmental modifications. The area of snail habitats decreased from the peak of 5 029.80 hm2 in 2016 to 3 709.72 hm2 in 2023, and the actual area of snail habitats decreased from the peak of 8 585.48 hm2 in 2016 to 473.09 hm2 in 2023. The mean density of living snails remained low across the study period except in 2017 (0.62 snails/0.1 m2). Schistosomiasis control efforts by departments of agriculture and rural affairs in Sichuan Province included conversion of paddy fields to dry fields covering 153 346.93 hm2, hardening of 6 110.31 km ditches, building of 70 356 biogas digesters, replacement of cattle with 227 161 sets of machines, and captive breeding of 21 161 070 livestock from 2015 to 2023, and the control efforts by departments of water resources included rivers and lakes management measuring 5 676.92 km and renovation of 2 331 irrigation areas, while the control efforts by departments of forestry and grassland included building of forests for snail control and schistosomiasis prevention covering 23 913.33 hm2, renovation of snail control forests covering 8 720 hm2 and newly building of shelterbelts covering 764 686.67 hm2. All 63 endemic counties (cities and districts) had achieved the criterion for schistosomiasis elimination criteria in Sichuan Province by the end of 2023. Conclusion Following the integrated control efforts from 2015 to 2023, remarkable achievements have been obtained in the schistosomiasis control programme in Sichuan Province, with all endemic counties successfully attaining the schistosomiasis elimination target at the county level.
2.Epidemiological analyses of 125 cases of paragonimiasis in Sichuan Province from 2020 to 2023
Yu ZHANG ; Yang LIU ; Liang XU ; Xiaohong WU ; Nannan WANG ; Lin CHEN
Shanghai Journal of Preventive Medicine 2025;37(6):511-514
ObjectiveTo analyze the epidemiological and clinical characteristics of paragonimiasis cases in Sichuan Province, and to provide an evidence for the prevention, diagnosis and treatment of paragonimiasis in medical institutions. MethodsData were collected from case reports submitted by cities (prefectures) from 2020 to 2023, including demographic information, epidemiological features, clinical symptoms, laboratory testing indicators, and awareness of paragonimiasis. Epidemiological descriptions and statistical analyses were performed on these variables. ResultsA total of 125 paragonimiasis cases were reported in Sichuan Province from 2020 to 2023, including 53 thoracic/pulmonary cases and 72 extrapulmonary cases. Geographically, cases were distributed in Dazhou City (63 cases, 50.40%), Yibin City (61 cases, 48.80%), and Deyang City(1 case, 0.80%). The male-to-female ratio was 1.66∶1, with 77.60% (97 cases) aged 0‒18 years. Students accounted for the majority of cases (67 cases, 53.60%). Among the patients, 67 cases (53.60%) had a history of consuming raw or undercooked crabs, and 94 cases (75.20%) reported drinking untreated water. The predominant symptoms included migratory subcutaneous nodules (26.40%), cough (24.80%), and abdominal pain/diarrhea (21.60%). Younger patients exhibited a higher proportion of migratory subcutaneous nodules, while older patients more frequently presented with cough and chest pain (χ2=4.060, P=0.044; χ2=9.235, P=0.002). Elevated eosinophil percentages and absolute counts were observed in 99.20% (124 cases) and 93.60% (117 cases) of patients, respectively. Peripheral white blood cell counts were higher in thoracic/pulmonary cases than that in extrapulmonary cases (Z=2.398, P=0.016), but no statistically significant differences were found in eosinophil absolute counts or percentages between the two types (Z=0.609, P=0.542; Z=0.732, P=0.464). In terms of treatment courses, 28 cases had 1 course, 31 cases had 2 courses, 43 cases had 3 courses, 11 cases had 4 courses, and 10 cases had 5 courses or more. Extrapulmonary cases required significantly longer treatment durations than thoracic/pulmonary cases (t=2.299, P=0.023). Only 12.80% (16 cases) of patients were aware of paragonimiasis. ConclusionParagonimiasis in Sichuan Province occurred sporadically, and the patients were mainly children and adolescents. The clinical manifestations of the patients lacked specificity, making it easy to lead to misdiagnosis. During the diagnosis, epidemiological history, migratory subcutaneous nodules and other main symptoms should be fully considered. An increase of the absolute count and proportion of eosinophils served as significant warning indicators for paragonimiasis infection.
3.Effects of peripheral blood-derived exosomes intervened by Naozhenning on injury of neuron induced by microglia
Li GAO ; Le ZHAO ; Liya WU ; Weiyi ZHANG ; Nan LI ; Nannan WEI ; Yonghui WANG
China Pharmacy 2025;36(19):2393-2398
OBJECTIVE To study the effects of peripheral blood-derived exosomes (Exo) intervened by Naozhenning (NZN) on injury of neuron cells HT22 induced by microglia BV-2 cells. METHODS Wistar rats were selected to prepare peripheral blood- derived Exo intervened by NZN (66.83 g/kg), referred to as NZN-Exo; peripheral blood-derived Exo intervened by normal saline and piracetam (PLXT, 1.62 g/kg) were prepared using the same method, denoted as KB-Exo and PLXT-Exo respectively, and all Exo were subsequently identified. Meanwhile, BV-2 cells were stimulated with 1 μg/mL lipopolysaccharide (LPS) to prepare LPS- stimulated supernatant, and non-LPS-stimulated supernatant was prepared following the same protocol. HT22 cells were divided into four groups: KB-Exo group (treated with non-LPS-stimulated supernatant+KB-Exo), model group (treated with LPS-stimulated supernatant+KB-Exo), PLXT-Exo group (treated with LPS-stimulated supernatant+PLXT-Exo), and NZN-Exo group (treated with LPS-stimulated supernatant+NZN-Exo), with the concentration of the corresponding Exo in all groups being 50 μg/mL. After 24 hours of culture, the proliferation of HT22 cells was detected by the CCK-8 assay and EdU assay; the apoptosis of HT22 cells was detected; the microstructure of HT22 cells was observed; the contents of interleukin-1β (IL-1β), IL-10, nuclear factor-κB (NF- κB), and tumor necrosis factor-α (TNF-α) in HT22 cells were measured, as well as the expression levels of TNF-α, NOD-like receptor thermal protein domain associated protein 3 (NLRP3), Caspase-1, B-cell lymphoma-2( Bcl-2), and Bcl-2-associated X protein (Bax). RESULTS KB-Exo, PLXT-Exo and NZN-Exo were successfully prepared, and all Exo exhibited typical cup-shaped contours and membrane-enclosed characteristics. Compared with KB-Exo group, model group showed significantly decreased cell proliferation rates (detected by CCK-8 and EdU), intracellular IL-10 levels, and Bcl-2 protein expression levels (P<0.05); while the cell apoptosis rate, intracellular levels of IL-1β, TNF-α, and NF-κB, as well as the expression levels of NLRP3, TNF-α, Caspase-1, and Bax proteins were significantly increased (P<0.05). Additionally, in the model group, the cells showed volume swelling, incomplete cell membrane, nucleolar rupture, significant swelling and deformation of mitochondria, and severe vacuolization. Compared with model group, the above quantitative indicators in the PLXT-Exo group and NZN-Exo group were significantly reversed (P<0.05), with large and round cell nuclei, intact nuclear membranes, and reduced mitochondrial vacuolization. CONCLUSIONS Peripheral blood-derived Exo intervened by naozhenning can alleviate the injury of neuronal cells HT22 by inhibiting inflammatory responses and cell apoptosis.
4.Molecular characteristics and genetic evolution analysis of CRISPR loci in Listeria monocytogenes
DU Bo ; WU Ying ; CAI Nannan ; REN Yanyan ; XIU Min ; LIU Wenxin
China Tropical Medicine 2025;25(3):343-
Objective To detect clustered regularly interspaced short palindromic repeats (CRISPR) in Listeria monocytogenes, and analyze the structure and homology of CRISPR loci. Methods Totally 34 strains of Listeria monocytogenes isolated in our laboratory were identified, PCR amplified and sequenced. The repeat sequence structure and spacer sequence homology in CRISPR loci were analyzed by bioinformatics software. Results A total of 7 CRISPR loci were detected in 34 strains. The mutation rate of the first 2 and last 2 bases of the Repeat sequence of CRISPR loci was higher, while the mutation rate of the middle part was lower. Seven CRISPR sites form eight CRISPR structural types, among which the Repeat sequences of CRISPR1 and CRISPR2 are relatively conserved, while the Repeat sequences of CRISPR1 and CRISPR5 can form dumbbell shaped secondary structures. The number of Spacer sequences contained in each CRISPR site ranges from 2 to 15, with an average of 2.43. The 136 Spacer sequences detected were not only homologous to Listeria plasmids and bacteriophages, but also homologous to uncultured virus sequences, staphylococcal bacteriophages, and Listeria innocua. The same CRISPR genotype did not show large-scale clustering, but some strains in the same year were in the same evolutionary cluster with close genetic relationships. Conclusion The CRISPR structure of Listeria monocytogenes in this study exhibits high specificity, and its homology with bacteriophages provides a theoretical basis for the application of bacteriophages in the control and prevention of Listeria monocytogenes.
5.Mechanism of Naozhenning granules in regulating mitochondrial energy metabolism in multiple cerebral concussion rats
Li GAO ; Le ZHAO ; Nannan WEI ; Liya WU ; Tiantian WANG ; Weiyi ZHANG ; Yonghui WANG
China Pharmacy 2024;35(9):1050-1056
OBJECTIVE To explore the mechanism of Naozhenning granules in regulating mitochondrial energy metabolism in hippocampal tissue of multiple cerebral concussion (MCC) model rats. METHODS SPF grade Wistar rats were used to prepare MCC models using the “free fall impact method”. The successfully modeled rats were divided into model group, piracetam group, and Naozhenning granule low-dose, medium-dose and high-dose groups, and a normal group was also set up, with 8 rats in each group. Rats in each treatment group orally administered corresponding drugs at doses of 0.324 g/kg for the piracetam group and 2.25, 4.5 and 9 g/kg for the Naozhenning granule low-dose, medium-dose and high-dose groups; the normal group and model group were given equal volumes of normal saline; once a day, for 14 consecutive days. The motor exploration ability, learning and memory ability of rats were tested; the adenosine triphosphate (ATP) content in the hippocampal tissue of rat was detected; the changes in the mitochondrial structure of hippocampal tissue was observed; the fluorescence intensity of mitochondrial dynamin- related protein 1 (Drp1), mitochondrial fission protein 1 (Fis1), mitochondrial fusion 1 (Mfn1), and optic atrophy protein 1 (Opa1) were detected in the hippocampal tissue of rat; the protein expression levels of peroxisome proliferator activated receptor gamma coactivator-1α(PGC-1α), nuclear respiratory factor-1(NRF-1),mitochondrial transcription factor A(TFAM), Wnt-3a,β-catenin in hippocampal tissue of rat were detected. RESULTS Compared with the normal group, the total exercise distance, number of central grid entries, number of upright positions, new object recognition index, mitochondrial ATP content, fluorescence intensity of Mfn1 and Opa1, the protein expression levels of PGC-1α、NRF-1、TFAM、Wnt-3a、 β-catenin in the model group were significantly reduced (P<0.01), while the rest time and fluorescence intensity of Drp1 and Fis1 in hippocampal tissue were significantly increased (P<0.01). The results of transmission electron microscopy showed that the mitochondria in the hippocampal tissue were significantly swollen, with a large number of broken and reduced cristae, and some mitochondria had myeloid changes in the membrane. Compared with the model group, the levels/contents of the above indicators in rats of each administration group showed varying degrees of reversal, and most of the differences were statistically significant (P<0.05 or P<0.01); the degree of mitochondrial swelling in the hippocampal tissue was reduced, with a small amount of broken and reduced cristae, fuzzy fractures appeared in local areas of the rough endoplasmic reticulum. CONCLUSIONS Naozhenning granules can improve the motor exploration, learning and memory abilities of MCC model rats, repair neuronal damage, and exert neuroprotective effects. Its mechanism may be related to activating Wnt/β-catenin signaling pathway,maintaining the balance of mitochondrial division and fusion,and promoting mitochondrial biosynthesis.
6.Repairment effect of intra-articular adipose stem cell injection on articular cartilage destruction in rabbit model with temporomandibular joint osteoarthritis and its mechanism
Jing HE ; Gao SUN ; Nannan LI ; Palizi ABULIKEMU ; Guomin WU
Journal of Jilin University(Medicine Edition) 2024;50(1):71-78
Objective:To discuss the repairment effect of intra-articular injection of adipose derived stem cells(ADSCs)on articular cartilage destruction in the temporomandibular joint osteoarthritis(TMJOA)model rabbits,and to clarify the possible mechanism.Methods:Twenty-seven rabbits were randomly divided into control group,model group,and ADSCs group.The ADSCs of the rabbits were extracted and cultured.The rabbit TMJOA model was prepared by monosodium-iodoacetate(MIA)injection technique.The temporomandibular joint cavity of the TMJOA model rabbits in ADSCs group was given two continuous intra-articular injections of 1.0×106 mL-1 ADSCs,while the rabbits in control and model group were given sequivalent volume of saline into the temporomandibular joint cavity.After 8 weeks,Micro-CT scan was performed on the temporomandibular joints of the rabbits in various groups;the bone volume fraction(BV/TV),bone surface area/bone volume(BS/BV),trabecular thickness(Tb.Th),trabecular separation(Tb.Sp),and trabecular number(Tb.N)of condyles tissue of the rabbits in various groups were analyzed;HE staining was used to observe the pathomorphology of condyles tissue of the rabbits in various groups;immunohistochemistry was used to detect the localization and expression levels of SRY-related high mobility group box gene 9(SOX9),matrix metalloproteinase-13(MMP-13),and vascular endothelial growth factor(VEGF)proteins in condyles tissue of the rabbits in various groups;Western blotting method was used to detect the expression levels of SOX9,MMP-13,and VEGF proteins in condyles tissue of the rabbits in various groups.Results:The micro-CT scan results showed that compared with control group,the BV/TV,Tb.Th,and Tb.N of condyles tissue of the rabbits in model group were significantly decreased(P<0.05),while the BS/BV and Tb.Sp were significantly increased(P<0.05);compared with model group,the BV/TV,Tb.Th,and Tb.N in condyles tissue of the rabbits in ADSCs group were significantly increased(P<0.05),and the BS/BV and Tb.Sp were significantly decreased(P<0.05).The HE staining results showed that the condylar cartilage surface of the rabbits in control group was smooth with clear layers and intact structure;compared with control group,the surface of condyles tissue of the rabbits in model group was irregular with thickened hypertrophic layer and areas of cell depletion and clustering;compared with model group,the pathological damage of condyles tissue of the rabbits in ADSCs group was significantly decreased.The immunohistochemical staining results showed that compared with control group and ADSCs group,the number of brown granule in condyles tissue of the rabbits in model group was increased,mainly concentrated in the hypertrophic layer,especially in the bone cartilage junction site and the expression levels of SOX9,MMP-13,and VEGF proteins in condyles tissue of the rabbits in model group were significantly increased(P<0.05);compared with model group,the number of brown granule in condyles tissue of the rabbits in ADSCs group was significantly decreased,and the expression levels of SOX9,MMP-13,and VEGF proteins were significantly decreased(P<0.05).The Western blotting results showed that compared with control group,the expression levels of SOX9,MMP-13,and VEGF proteins in condyles tissue of the rabbits in model group were significantly increased(P<0.05);compared with model group,the expression levels of SOX9,MMP-13,and VEGF proteins in condyles tissue of the rabbits in ADSCs group were significantly decreased(P<0.05).Conclusion:Intra-articular injection of ADSCs can effectively repair the cartilage destruction in TMJOA,alleviate the cartilage injury,and mitigate the progression of osteoarthritis.
7.Analysis of the distribution characteristics and antibiotic resistance of pathogen in children with hematological disorders and cancers complicated with sepsis in PICU
Liangliang KANG ; Yuhui WU ; Nannan HE ; Huabao CHEN ; Yucong ZHANG ; Bin YU ; Yizhou PIAN ; Jiayin LIN
Chinese Pediatric Emergency Medicine 2024;31(1):28-34
Objective:To explore the distribution characteristics and antibiotic resistance of pathogen in children with hematological disorders and cancers complicated with sepsis in pediatric intensive care unit (PICU).Methods:The clinical data of children with hematological disorders and cancers complicated with sepsis hospitalized at Shenzhen Children′s Hospital affiliated to China Medical University from January 2016 to August 2023 were retrospectively analyzed. Patients were divided into survival group and death group based on the outcome of sepsis on 28 days after diagnosis.Results:A total of 202 sepsis episodes occurred in 176 children were enrolled in this study. Among all, 144 (71.3%) cases of bloodstream infection, 59 (29.2%) cases of pulmonary infection, 21 (10.4%) cases of abdominal infection, 9 (4.5%) cases of soft tissue infection, 9 (4.5%) cases of nervous system infection, and 3 (1.5%) cases of urinary tract infection. A total of 244 pathogenic strains were identified, in which 74 (30.3%) cases were gram-positive bacteria. The top 3 pathogens isolated were Coagulase negative Staphylococcus (21 strains), Staphylococcus aureus (19 strains) and Streptococcus pneumoniae (13 strains). Gram-negative bacteria accounted for 122 (50.0%) strains, in which top 3 were Klebsiella pneumonia (33 strains), Escherichia coli (25 strains), and Pseudomonas aeruginosa (23 strains). Fungi comprised 48 (19.7%) strains:the top 3 were Candida tropicalis (14 strains), Candida albicans (10 strains), Aspergillus and Pneumocystis jirovecii (7 strains each). The incidence of Acinetobacter baumannii, Stenotrophomonas maltophilia, and Pseudomonas aeruginosa were significantly higher in death group compared to survival group[9.0%(6/67)vs. 2.3%(4/177), χ2=3.971 ,P=0.046; 9.0%(6/67)vs. 1.1%(2/177), χ2=7.080 ,P=0.008;16.4%(11/67)vs. 6.8%(12/177), χ2=5.288 ,P=0.021]. The samples of 57 cases were simultaneously detected by both culture and metagenomic next-generation sequencing (mNGS). Pathogens were detected in 25 cases by both culture and mNGS. In 30 cases, pathogen detection were mNGS positive but culture negative. Two cases showed positive results only with culture. A total of 79 (46.8%) strains were multi-drug resistant bacteria, including 27 (34.2%) strains of gram-positive bacteria and 52 (65.8%) strains of gram-negative bacteria. A total of 174 (86.1%) children with sepsis received empirical anti-infective drugs within 24 hours of fever onset. A total of 124 (61.4%) cases were appropriately covered by the initial empirical antibiotics, while 40 (19.8%) cases were not adequately covered and 10 (5.0%) cases had incomplete coverage. Despite the inclusion of pathogenic in the coverage, resistance to initial antibiotics was observed in 22 (10.9%) cases. Fifty-one patients died. Conclusion:The predominant pathogens responsible for sepsis in PICU with hematological disorders and cancers is gram-negative bacteria, followed by gram-positive bacteria and fungi. In comparison to healthy children with sepsis, there is a higher incidence of fungal infections among hematological disorders and cancers. The proportion of multi-drug resistant bacteria infection is high. Early identification and combination of local etiological distribution and drug resistance, along with the empirical selection of appropriate anti-infection treatment strategies, can greatly enhance survival rate.
8.Effect of Naozhenning Granules on Energy Metabolism of Cortical Mitochondria in Rat Model of Post-concussion Syndrome
Nannan WEI ; Liya WU ; Tiantian WANG ; Qizhao LIU ; Weiyi ZHANG ; Yonghui WANG ; Li GAO ; Le ZHAO
Chinese Journal of Experimental Traditional Medical Formulae 2024;30(14):107-113
ObjectiveTo explore the effects of Naozhenning granules on the memory function and neuron cells in the rat model of post-concussion syndrome based on mitochondrial biosynthesis. MethodSPF-grade Wistar rats were used to establish the multiple cerebral concussion (MCC) model by the weight-drop method. The successfully modeled rats were assigned into model, piracetam (0.324 g·kg-1), and low-, medium-, and high-dose (2.25, 4.5, and 9 g·kg-1, respectively) Naozhenning groups. The rats were administrated with corresponding drugs by gavage and those in the blank group and model group were administrated the same volume of normal saline once a day for 14 days. The general state of rats was observed before and after treatment. The open field test and new object recognition test were conducted to examine the motor and memory abilities of rats. Hematoxylin-eosin staining was employed to observe the pathological changes of cortical neurons in rats. Western blot and real-time polymerase chain reaction were employed to determine the protein and mRNA levels, respectively, of peroxisome proliferator-activated receptor γ-coactivator-1α (PGC-1α), nuclear respiratory factor-1 (NRF-1), and transcription factor A mitochondrial (TFAM) in rat cortex. ResultCompared with the blank group, the model group showed anxious and manic mental status, yellow and messy fur, and reduced food intake. In the open field experiment, the model group showed reduced total movement distance, times of entering the central grid, and times of rearing decreased and increased resting time compared with the blank group (P<0.01). The model group had lower recognition index of new objects than the blank group (P<0.01). In addition, the modeling caused reduced neurons with sparse distribution and deformed, broken, and irregular nucleoli and down-regulated the mRNA and protein levels of PGC-1α, NRF-1, and TFAM in the cortex (P<0.01). Compared with the model group, piracetam and Naozhenning improved the mental state, coat color, food intake, and activities of rats. In the open field test, piracetam and Naozhenning increased the total movement distance, the times of entering the central grid, and the times of rearing and shortened the resting time (P<0.05, P<0.01). The piracetam and Naozhenning groups had higher recognition index of new objects than the model group (P<0.05, P<0.01). Compared with the model group, the piracetam and Naozhenning groups showed increased neurons with tight arrangement and large and round nuclei, and some cells with irregular morphology and turbid cytoplasm. Furthermore, piracetam and medium-dose Naozhenning upregulated the protein levels of PGC-1α, NRF-1, and TFAM (P<0.01). Low-dose Naozhenning upregulated the protein levels of NRF-1 and TFAM (P<0.01), and high-dose Naozhenning upregulated the protein levels of PGC-1α and TFAM in the cortex (P<0.01). The mRNA levels of PGC-1α, NRF-1, and TFAM in the cortex were upregulated in the piracetam group and Naozhenning groups (P<0.05, P<0.01). ConclusionNaozhenning granules can improve the motor, memory, and learning, repair the neuronal damage, and protect the nerve function in the rat model of MCC by promoting mitochondrial biosynthesis.
9.Expert consensus on surgical treatment of oropharyngeal cancer
China Anti-Cancer Association Head and Neck Oncology Committee ; China Anti-Cancer Association Holistic Integrative Oral Cancer on Preventing and Screen-ing Committee ; Min RUAN ; Nannan HAN ; Changming AN ; Chao CHEN ; Chuanjun CHEN ; Minjun DONG ; Wei HAN ; Jinsong HOU ; Jun HOU ; Zhiquan HUANG ; Chao LI ; Siyi LI ; Bing LIU ; Fayu LIU ; Xiaozhi LV ; Zheng-Hua LV ; Guoxin REN ; Xiaofeng SHAN ; Zhengjun SHANG ; Shuyang SUN ; Tong JI ; Chuanzheng SUN ; Guowen SUN ; Hao TIAN ; Yuanyin WANG ; Yueping WANG ; Shuxin WEN ; Wei WU ; Jinhai YE ; Di YU ; Chunye ZHANG ; Kai ZHANG ; Ming ZHANG ; Sheng ZHANG ; Jiawei ZHENG ; Xuan ZHOU ; Yu ZHOU ; Guopei ZHU ; Ling ZHU ; Susheng MIAO ; Yue HE ; Jugao FANG ; Chenping ZHANG ; Zhiyuan ZHANG
Journal of Prevention and Treatment for Stomatological Diseases 2024;32(11):821-833
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.
10.Evaluation of reaction inhibition among military university students by multitasking operation based on Go/No-Go paradigm
Qian ZHANG ; Kejia WU ; Hongqi ZHAO ; Shuo FAN ; Nannan JIANG ; Chuanrui YANG ; Lulu TANG ; Hao YU
Academic Journal of Naval Medical University 2024;45(9):1185-1189
Objective To explore the characteristics of response inhibition of military university students during multitasking operation. Methods Repeated measures of ANOVA as well as distribution test were employed to explore how the performance of 127 military university students in Go/No-Go test was affected by simulated driving task. Results The test results of 127 participants showed that there was a interaction between the interference task and the Go trial proportion on the hit rate and false alarm rate,that is,no significant difference was observed between the 60% and 40% of trial proportion without interference task (both P>0.05),but the hit rate and false alarm rate in the 60% trial proportion condition were significantly higher than those in the 40% trial proportion condition under interference task (both P<0.01).In addition,significant main effects of interference task were observed on hit rate,false alarm rate,and discrimination index d' (all P<0.01),that is,the interference task reduced the hit rate and discrimination,but increased the false alarm rate.Moreover,individual differences existed in the discrimination index d' changes,and the participants were divided into easily disturbed group (n=23,18.11%),undisturbed group (n=20,15.75%),and intermediate group (n=84,66.14%) by adding or subtracting 1 standard deviation from the mean of the difference. Conclusion The interference tasks increase the psychological load of military university students during multitasking operation,and impair the response inhibition;and individual differences exist in response inhibition.


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