Nonalcoholic steatohepatitis （NASH） is a chronic metabolic disease characterized by hepatocyte fatty degeneration and ballooning degeneration， and it plays an important role in the progression of hepatic steatosis. Recent studies have shown that immune homeostasis imbalance between T helper 17 （Th17） and regulatory T （Treg） cells are closely associated with the pathological process of NASH. Transforming growth factor-β1 （TGF-β1） is a key cytokine for regulating the differentiation and proliferation of Th17/Treg cells， and TGF-β1 binds to its receptor and activates the Smad signaling pathway， thereby regulating the immune balance of Th17/Treg cells and the expression of inflammatory factors and participating in the repair of liver inflammation. This article systematically reviews the molecular mechanism of the TGF-β1/Smad signaling pathway in affecting NASH by regulating the immune balance of Th17/Treg cells， in order to provide a theoretical basis for the research on the pathogenesis of NASH and related treatment strategies.

Objective To analyze the factors affecting the prognosis of soft tissue sarcomas originating from the mediastinum and lung using relevant data from the SEER database. Methods The data of 376 patients were collected from the SEER database, and were randomly divided into the train set (n=263) and validation set (n=113). The relationship between each variable and patient survival and prognosis was analyzed using the Kaplan-Meier method and Cox proportional risk regression to establish a nomogram, to predict the overall survival of patients. The calibration curves, consistency index, and ROC curves were used to evaluate the performance of the nomogram. Results Histological type, surgery, chemotherapy, tumor size, and tumor stage were the factors affecting the prognosis of primary mediastinal and pulmonary soft tissue sarcomas. The established nomogram could predict the 6-month, 1-year, and 2-year overall survival of patients, and the calibration curves showed good prediction accuracy with measured values. C index of the train set and validation set were 0.754 and 0.745, respectively. The areas under the curve of ROC were 0.849 and 0.924. Conclusion The nomogram established in this study can predict 6-month, 1-year, and 2-year overall survival in patients with primary mediastinal and pulmonary soft tissue sarcoma.

Objective:To investigate the optimal treatment modalities and prognostic factors of adenoid cystic carcinoma of the head and neck salivary gland.Methods:From January 2016 to December 2018, clinical data of 166 patients with adenoid cystic carcinoma of the head and neck salivary gland who received postoperative radiotherapy at Department of Radiation Oncology of the Ninth People′s Hospital of Shanghai Jiao Tong University School of Medicine were retrospectively analyzed. The survival analysis was performed by Kaplan-Meier method. Univariate prognostic analysis was conducted by log-rank test. Multivariate prognostic analysis was carried out by Cox proportional hazard regression model.Results:Among 166 enrolled patients, 70 cases were male and 96 female with an average age of 53 years (18 to 71 years). The median follow-up time was 31.2 months (8.6-63.1 months). Sixty-six patients underwent radical surgery (extended resection across the anatomical areas outside the tumor bed, pursuing negative margins of various resections), and the remaining 100 patients underwent conservative surgery (only extended resection of lesions, not pursuing negative nerve resection margins). The median dose of postoperative radiotherapy was 66 Gy (54-70 Gy). Seventy-three patients were treated with TP regime due to positive or close margins and 9 cases of cervical lymph node metastasis. The 3-and 5-year overall survival (OS), locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), progression-free survival (PFS) rates were 95% and 95%, 93% and 93%, 74% and 66%, 73% and 65%, respectively. Seven patients experienced primary lesion recurrence, 5 cases of regional lymph node recurrence and 38 cases of distant metastasis. T 3-T 4 stage, lymph nodes (+ ), stage IV, solid pathologic subtype, Ki-67≥10% and perineural invasion were associated with worse PFS and DMFS. Multivariate analysis demonstrated that only solid pathologic subtype was the independent prognostic factor of OS, LRRFS, PFS and DMFS. Conclusions:The local control rate of salivary gland adenoid cystic carcinoma can be improved by postoperative intensity-modulated radiotherapy (IMRT) with a recommended dose of ≥66 Gy. Solid pathologic subtype is the most important adverse prognostic factor.

Objective To assess the efficacy and safety of post operative adjuvant concurrent chemoradiotherapy for patients with high-risk salivary gland tumors (SGT).Methods Fifty-two patients with moderate or high malignant pathological stage complicated with locally advanced stage Ⅲ/ⅣA±positive margin/close margin admitted to Shanghai Ninth People's Hospital from 2016 to 2018 were enrolled in this study.Among them,35 patients were male and 17 female with a median age of 55.5 years old (range:21-73 years old).All 52 patients were treated with intensity-modulated radiotherapy and concurrent chemotherapy.Patients with adeno carcinoma of the salivary gland receives concurrent chemotherapy with TP regimen.Patients with lympho epithelial cancer and squamous cell carcinoma were treated with cisplatin regimen.Results Forty-seven patients (90％) completed two cycles of concurrent chemotherapy,and five patients (10％) completed one cycle of concurrent chemotherapy.The median follow-up time was 15.7 months (3.2-34.8 months).The 2-year disease-free survival (DFS) and overall survival (OS) rates were 74％ and 98％.Three patients experienced regional lymph recurrence and 6 cases had distant metastasis.Grade Ⅲ oral mucositis was observed in 30 patients.Grade Ⅲ dermatitis occurred in 5 cases.Only one patient experienced Grade Ⅳ neutropenia,and 2 patients developed Grade Ⅲ neutropenia.DFS was positively correlated with the cycle of postoperative adjuvant concurrent chemotherapy (P=0.006).Conclusions Patients with high-risk SGT can obtain higher 2-year DFS and OS rates and tolerable adverse events after postoperative concurrent chemoradiotherapy.Nevertheless,the long-term outcomes remain to be validated by randomized controlled clinical trials.

Objective The current meta-analysis was performed to update the evidcnce on anti-melanoma differentiation-associated gene 5 (MDA5) antibody for the diagnosis of rapid progressive interstitial lung disease (RPILD) and chronic ILD in adult or juvenile dermatomyositis (JDM).Methods The electronic search on PubMed,Embase,Cochrane Library,CNKI,WangFang Data,VIP and China Biology Medicine database was conducted from their inception to May,2017.Meta-disc1.4 was used to calculate heterogeneity and obtain the pool sensitivity,specificity,diagnostic odds ratio,positive and negative likelihood ratios and summarized receiver operating characteristic (SROC) curve.Quality assessment and publication bias were determined by QUADAS-2 and STATA 12.0.Results A total of 32 studies with high quality and middle heterogeneity were selected for the final data synthesis.Anti-MDA5 showed a higher diagnostic and prognostic value for RPILD (AUC =0.927,Q * =0.862),compared with chronic ILD (AUC =0.717,Q * =0.667) in adult dermatomyositis patients.For diagnosing RPILD in JDM,the value of MDA5 detection (AUC =0.836,Q * =0.768)was weak.For the prediction of RPILD,the validity of anti-MDA5 detection in clinical amyopathic dermatomyositis (CADM) (AUC =0.942,Q* =0.880) was higher than that in DM (AUC =0.926,Q * =0.860),which was also more applicable to East-Asia populations (AUC =0.960,Q* =0.891),compared with Chinese (AUC =0.925,Q* =0.859) and Western populations (AUC =0.928,Q* =0.863).The methodological assessment for different anti-MDA5 detection implied ELISA (AUC =0.929,Q* =0.864) was superior in performance as immunoprecipitation (AUC =0.927,Q* =0.859),and there was no publication bias according to Deek's plot.Conclusion Anti-MDA5 antibody should be a significant laboratory index for diagnosis and prediction of ILD in adult DM and JDM with high sensitivity and specificity.

Objective To retrospectively analyze the treatment outcomes and failure patterns in patients with head?and?neck cancer of unknown primary head?and?neck cancer of unknown primary, and to compare the efficacy between elective mucosal irradiation and ipsilateral neck treatment. Methods The clinical data of patients with head?and?neck cancer of unknown primary who were admitted from January 2007 to December 2013 were retrospectively collected. Thirty?one patients received elective pharyngeal mucosal irradiation and 61 patients only received ipsilateral neck treatment. The SPSS 19. 0 software was used for comparison of the survival and local control between the two groups. Results In the 92 patients, the median age was 57 years;79. 3% had metastasis to level Ⅱ lymph nodes;the median follow?up time was 36. 5 months;the 3?year overall survival, mucosal control, and neck control rates were 89. 0%, 86. 6%, and 82. 4%, respectively. Primary sites were found in 15 patients, containing nasopharynx in 4 patients, oropharynx in 3 patients, oral cavity in 3 patients, throat and hypopharyngeal part in 3 patients, maxillary sinus in 1 patient, and esophagus in 1 patient. The patients undergoing elective pharyngeal mucosal irradiation had significantly higher 3?year mucosal control and neck control rates than those undergoing ipsilateral neck treatment ( 100% vs. 74. 9%, P= 0. 040;87. 5% vs. 62. 2%, P= 0. 037 ) . There was no difference in the 3?year overall survival rate between the two groups ( 83. 5% vs. 88. 7%, P= 0. 910 ) . Conclusions For patients with head?and?neck cancer of unknown primary, elective pharyngeal mucosal irradiation can reduce the incidence of primary site and increase the neck control rate. A new standard for target volume delineation should be established as soon as possible for elective prophylactic pharyngeal mucosal irradiation.

Objective To summarize the perioperative outcomes of patients undergoing endovascular repair,and to screen out related preoperative risk factors in order to provide reference for the promotion of postoperative rehabilitation of patients.Methods The clinical data of 2 896 patients undergoing elective endovascular repair in the Department of Vascular Surgery,Zhongshan Hospital,Fudan University from Jan.2013 to Dec.2014 were analyzed to screen out related preoperative risk factors of postoperative complications retrospectively.Results A total of 148 patients had postoperative complications,including 2 cases of death during hospitalization.The incidence of complications in the patients older than 75 years old,with hypertension,diabetic mellitus,renal dysfunction,chronic obstructive pulmonary disease (COPD) or ASA physical status more than grade Ⅱ is 9.7％,8.1 ％,14.3 ％,8.0 ％,29.7 ％,6.3 ％,respectively.The multivariate Logistic regression analysis identified that patients older than 75 years old (P =0.000,OR =43.29,95％CI:22.51-83.28),with hypertension (P=0.000,OR=3.822,95 ％CI:2.37-6.16),diabetic mellitus (P=0.025,OR=1.714,95％CI:1.07 -2.75),renal dysfunction (P =0.017,OR =2.692,95 ％ CI:1.19-6.07) or COPD (P =0.000,OR =7.158,95％CI:3.83-13.37) and ASA physical status more than grade Ⅱ (P =0.000,OR =27.77,95％CI:13.79-55.93) were the independent risk factors with postoperative complications of endovascular repair surgery.Conclusions The patients older than 75 years old,with hypertension,diabetic mellitus,renal dysfunction or COPD and ASA physical status more than grade Ⅱ were the independent risk factors for endovascular repair surgery.

Objective To study the effect of preoperative blood pressure control on postoperative cardiovascular events in patients with hypertension and gastrointestinal surgery. Methods A total of 238 hypertensive patients who underwent gastrointestinal surgery were selected and divided into control group (n =118)and non-control group (n =120)according to thehypotensor treatment.During the operation,the same anesthetic regimen was used.The use of vasoactive drugs was recorded during anesthesia.Bladder chalone C (Cys C)and cardiac troponin T (cTnT)were de-tected in blood before and after the operation,and so were N-terminal B type natriuretic peptide (NT-proBNP)level on the 1st and 5th day after the operation.The postoperative hospitalization time,fol-low-up of cardiovascular events 28 and 90 days after discharge were recorded.Results Compared with the non-control group,the total dosage of ephedrine in the control group was significantly re-duced [(3.41±1.04)mg vs (7.46 ± 3.29)mg,P <0.05 ],total dose of phenylephrinewas signifi-cantly reduced [(0.17±0.10)mg vs (0.46 ±0.16)mg,P <0.05],postoperative hospital stay was significantly shorter [(5.92±1.15)d vs (9.65±1.61)d,P <0.05],NT-proBNP level in the control group on the 1st day after the operation [(108.00 ± 47.11 )pg/L vs (250.38 ± 62.92 )pg/L,P <0.01]and 5 days after the operation [(62.07 ±25.31)pg/L vs (199.02 ± 60.32)pg/L,P <0.01 ] was obviously reduced.There was no statistical difference in Cys C andcTnT between the two group-safter operation.The incidence of cardiovascular adverse events in the control group was significantly lower than that in the non-control group (28 d:13.6% vs 62.7%,90 d:23.3% vs 23.3%,P <0.05).Conclusion Strict control of preoperative blood pressure control in patients with hypertension can significantly reduce the incidence of cardiovascular events.

Objective:To compare the clinical efficacy and safety between spleen total resection splenectomy and spleen partial splenectomy in the treatment of patients with traumatic spleen rupture.Methods:84 cases of patients with traumatic spleen rupture from March 2013 to March 2016 were selected and divided into two groups.42 cases in the spleen total resection group were treated with spleen total resection,while the other 42 cases in the spleen partial nephrectomy group were treated with spleen partial splenectomy.The operative effect,the levels of platelet count,serum IgA,IgG,IgM,CD3 +,CD4 +,CD8 +,CD4 + / CD8 + levels before and after treatment,the incidence of complications were compared between two groups.Results:The intraoperative blood loss,exhaust time,length of hospital stay of spleen partial nephrectomy group were shorter than those of the spleen total resection group,but the operation time of research group was longer than that of the spleen total resection group (P＜0.05).The platelet count,CD8+ of spleen partial nephrectomy group were lower than those of the spleen total resection group (P＜0.05).The IgA,IgG,IgM,CD3+,CD4+,CD8+,CD4+/CD8+ of spleen partial nephrectomy group were significantly higher than those of the spleen total resection group (P＜0.05).The incidence rate of complications in the spleen partial nephrectomy group was lower than that of the spleen total resection group (P＜0.05).Conclusion:Spleen partial splenectomy was more effective than spleen total resection in the treatment of traumatic splenic rupture,which had little effect on the platelet and immune function.

Objective To investigate the effect of myeloid differentiation factor 88 inhibitor ST2825 on the autophagy of THP?1 cells infected by re?combinant mycobacterium smegmatis. Methods The myeloid differentiation factor 88 inhibitor ST2825 was applied on the THP?1 cells infected by recombinant mycobacterium smegmatis,and three groups were defined:the test group with ST2825 treatment,the control group without ST2825 treatment,and the blank group. Autophagosomes were observed under the fluorescence microscope,and the mRNA expression of Beclin?1 gene and Bcl?2gene was analyzed by RT?PCR. Results Compared with the control group,the number of autophagy fluorescent dots in the test group was ob?viously reduced(P<0. 05),and the expression levels of Beclin 1 gene and Bcl?2 gene were declined as indicated by the RT?PCR detection. Con?clusion The myeloid differentiation factor 88 inhibitor ST2825 might inhibit the autophagy of THP?1 cells through interfering the separation of Be?clin?1 and Bcl?2.