Surgical operation is the main treatment of oral and maxillofacial tumors.Dysphagia is a common postoperative complication.Swal-lowing disorder can not only lead to mis-aspiration,malnutrition,aspiration pneumonia and other serious consequences,but also may cause psychological problems and social communication barriers,affecting the quality of life of the patients.At present,there is no systematic evalua-tion and rehabilitation management plan for the problem of swallowing disorder after oral and maxillofacial tumor surgery in China.Combining the characteristics of postoperative swallowing disorder in patients with oral and maxillofacial tumors,summarizing the clinical experience of ex-perts in the field of tumor and rehabilitation,reviewing and summarizing relevant literature at home and abroad,and through joint discussion and modification,a group of national experts reached this consensus including the core contents of the screening of swallowing disorders,the phased assessment of prognosis and complications,and the implementation plan of comprehensive management such as nutrition management,respiratory management,swallowing function recovery,psychology and nursing during rehabilitation treatment,in order to improve the evalua-tion and rehabilitation of swallowing disorder after oral and maxillofacial tumor surgery in clinic.

Cryoablation therapy with explicit anti-tumor mechanisms and histopathological manifestations has a long history.A large number of clinical practice has shown that cryoablation therapy is safe and effective,making it an ideal tumor treatment method in theory.Previously,its efficacy and clinical application were constrained by the limitations of refrigerants and refrigeration equipment.With the development of the new generation of cryoablation equipment represented by argon helium knives,significant progress has been made in refrigeration efficien-cy,ablation range,and precise temperature measurement,greatly promoting the progression of tumor cryoablation technology.This consensus systematically summarizes the mechanism of cryoablation technology,indications for oral mucosal melanoma(OMM)cryotherapy,clinical treatment process,adverse reactions and management,cryotherapy combination therapy,etc.,aiming to provide reference for carrying out the standardized cryoablation therapy of OMM.

【Objective】 To investigate the clinical features and prognostic factors of elderly patients with localized renal cell carcinoma after operation. 【Methods】 Clinical data of all elderly patients (60-100 years old) with localized renal cell carcinoma who underwent primary tumor resection during 2004 and 2017 in United States National Cancer Institute (SEER) database were collected.The clinical features, surgical methods and prognosis were analyzed.According to the surgical methods, the patients were divided into partial nephrectomy (PN) group and radical nephrectomy (RN) group.The effects of the two surgical methods on the prognosis were compared. 【Results】 A total of 20 348 patients were included.The median survival time was 164 months, and the 3-, 5- and 10-year cumulative overall survival rates were 91.1%, 84.2% and 64.4%, respectively.Multivariate Cox analysis showed that age, sex, race, histological grade, T stage and surgical method were independent prognostic factors for overall survival (P<0.05).Subgroup survival analysis showed that the prognosis of PN was superior to that of RN in all age groups, gender, race, histological grade and T1 stage renal cell carcinoma (P<0.05).For T2 stage renal cell carcinoma, there was no significant difference in the prognosis between patients who received PN or RN (P>0.05). 【Conclusion】 Old age, male, black, non-chromophobe cell carcinoma, low degree of differentiation, high T stage of tumor and RN are independent risk factors for the prognosis of elderly patients with localized renal cell carcinoma.PN is the main treatment method and has remarkable therapeutic effects.

Curettage is the main treatment method for oral maxillofacial cystic lesions,but simple curettage may easily damage surrounding structures such as adjacent teeth and nerves,leading to incomplete removal of the cyst and large jaw defects.The curettage assisted by endoscopy can provide a good surgical field for the surgeons,can clearly identify the important anatomical structure during the operation and can remove the cyst wall tissue as much as possible,thereby reducing the damage and reducing the recurrence rate of the lesion.This article combines the characteristics of maxillofacial surgery with clinical treatment experience,summarizes relevant literature from both domestic and international sources,and engages in discussions with experts in order to provide reference for the clinical treatment of jaw cystic lesions with endo-scope assisted curettage.

OBJECTIVE To explore the current status and challenges of informatization construction for clinical trial centralized pharmacy based on the relevant experience of The First Affiliated Hospital, Zhejiang University School of Medicine. METHODS Review the development of clinical trial drug management and informatization process, along with the management experience of the hospital where the author works, and then introduce the framework and specific operation details of the informatization system when conducting centralized management method, summarize the problems encountered at present and propose future prospects. RESULTS Informatization construction played a significant role in the management of central pharmacies in clinical trial, enabling them to adapt to the complex management needs of investigational products and meet the high standards and strict requirements of Good Clinical Practice(GCP) and related regulations. However, the development of the current information system was still not perfect, and there were problems that need to be solved. CONCLUSION Each hospital needs to pay attention to the informatization construction of the central pharmacy of the clinical trial, improve and perfect the centralized management method of the investigational products, and explore modern technologies and equipments, which are of immense importance for the construction of the clinical trial pharmacy management that conforms to the development trend of drug clinical trials and GCP.

Surgery is currently the most appropriate treatment for early-stage non-small cell lung cancer (NSCLC). Increasing unilateral or bilateral multiple primary lung cancer being found, segmentectomy has attracted wide attention for its unique advantages in the treatment for such tumors. Ground glass opacity dominant early-stage NSCLC is associated with a good prognosis and can be cured by segmentectomy, however, the treatment of solid-dominant NSCLC remains controversial owing to the invasive nature. With the in-depth study on the lymph node metastasis pathway, radiological characteristics and molecular biology of NSCLC, a large part of solid nodules with certain characteristics can also be cured by segmentectomy. This paper reviews the research status and progress about the indication of segmentectomy.
.

OBJECTIVE: To explore the genetic basis for a Chinese pedigree affected with inherited afibrinogenemia. METHODS: For the proband and his family members, prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), Fibrin(ogen) degradation products (FDPs), D-dimer (D-D), plasminogen activity (PLG:A) and the TT mixed experiment with protamine sulfate were determined with a STAGO-R automatic coagulation analyzer. The activity and antigen of fibrinogen (Fg) in plasma were measured with the Clauss method and immunonephelometry method, respectively. All exons and flanking regions of the fibrinogen genes (FGA, FGB and FGG) were amplified by PCR and directly sequenced. Human Splicing Finder software was used to predict and score the change of splicing site caused by the mutation. RESULTS: The proband showed normal FDPs and D-D but significantly prolonged TT, PT and APTT. The activity and antigen of fibrinogen in plasma were significantly decreased (<0.1 g/L). His young sister and parents showed slightly prolonged TT (18.20-18.50 s) and decreased fibrinogen activity (1.27-1.54 g/L) and fibrinogen antigenic content (1.34-1.56 g/L). Genetic testing revealed that the proband has carried homozygous IVS7-12A>G (g.4147A>G) mutations of the FGG gene, for which his parents and young sister were heterozygous. As predicted by Human Splicing Finder and Mutation Taster software, the variant may generate a new splicing site which can extend the sequence of exon 7 by 11 bp, with alteration of the coding sequence. PROVEAN suggested the variant to be deleterious. CONCLUSION The afibrinogenemia of the proband may be attributed to the FGG IVS7-12A>G variant, which was unreported previously.
Adult ; Afibrinogenemia/genetics* ; Female ; Fibrinogen/genetics* ; Heterozygote ; Humans ; Male ; Mutation ; Pedigree

Objective:To investigate the expression level of bone marrow stromal antigen 2 (BST2) in patients with glioblastoma (GBM) gene and its correlation with DNA methylation level and prognosis.Methods:The datasets of GBM samples from the Cancer Genome Atlas (TCGA) database (35 cases), GSE22891 cohort (50 cases) within Gene Expression Omnibus (GEO) database, and China Glioma Genome Atlas (CGGA) database (105 cases), and non-tumor brains (NTB) (10 cases in TCGA database, 6 cases in GSE22891 cohort, 5 cases in CGGA database were used to make comparisons of gene expression level; 25 cases in GSE63347 cohort, 4 cases in GSE22891 cohort, 8 cases in CGGA database were used to make comparisons of methylation data). Based on gene expression chip and DNA methylation microarray data from public GBM databases, the expression level of BST2 gene in GBM and the association with non-CpG island DNA methylation, GBM molecular subtypes [CpG island methylation phenotype (G-CIMP) and non-G-CIMP proneural, neural, classical, mesenchymal], overall survival (OS) time and functional gene expression profiles were obtained by using intra-group comparison of BST2 gene expression level between GBM and NTB, survival analysis, and bioinformatic analysis.Results:Compared with NTB samples, BST2 mRNA was highly expressed in GBM (mRNA expression data were based on Z-score standardization) (TCGA database vs. GSE63347 cohort: -0.97±1.14 vs. -2.32±0.21, t = 3.74, P < 0.05; GSE22891 cohort: 9.03±1.28 vs. 7.18±0.22, t = 3.42, P < 0.05; CGGA database: -0.43±1.11 vs. -0.62±0.35, t = 2.09, P < 0.05). In TCGA database, BST2 mRNA was highly expressed in different tumor molecular subgroups (G-CIMP: -1.96±0.94; non-G-CIMP proneural: -1.74±0.88; neural: -0.83±0.98; classical: 0.71±1.18; mesenchymal: -0.55±1.01), which were compared with NTB samples (-2.32±0.21), and the differences were statistically significant (all P < 0.05). There were no statistically significant differences in the expressions of BST2 mRNA in the neural, classical, mesenchymal tumors (all P > 0.05), but the expression of BST2 mRNA in above three groups was higher than that in G-CIMP group and non-G-CIMP proneural group (all P < 0.05). Correlation analysis showed that non-CpG island DNA methylation level of BST2 was negatively correlated with the expression of its mRNA (TCGA database: r = -0.30, P < 0.05; GSE22891 cohort: r = -0.54, P < 0.05; CGGA database: r = -0.29, P > 0.05). Survival analysis showed that BST2 mRNA expression level of non-G-CIMP and non-proneural patients was negatively associated with OS ( HR = 1.18, 95% CI 1.00-1.39, P < 0.05); among those tumors with G-CIMP or proneural subtypes, BST2 mRNA expression was not associated with OS ( HR = 1.08, 95% CI 0.84-1.40, P > 0.05). Bioinformatic analysis showed that among non-G-CIMP and non-proneural samples of TCGA database, GBM samples with higher BST2 expression were enriched with functional gene sets related to negative regulation of immune responses and activation of nuclear factor κB (NF-κB) pathway. Conclusions:The upregulated expression of BST2 gene in GBM may be associated with non-CpG island DNA hypomethylation alteration. BST2 gene may become a potential prognostic biomarker for non-G-CIMP and non-proneural GBM.

OBJECTIVE: The purpose of this study was to investigate whether three-dimensional (3D) magnetic resonance imaging could improve diagnostic accuracy for suspected posterior ligamentous complex (PLC) disruption. MATERIALS AND METHODS: We used 20 freshly harvested goat spine samples with 60 segments and intact surrounding soft tissue. The animals were aged 1–1.5 years and consisted of 8 males and 12 females, which were sexually mature but had not reached adult weights. We created a paraspinal contusion model by percutaneously injecting 10 mL saline into each side of the interspinous ligament (ISL). All segments underwent T2-weighted sagittal and coronal short inversion time inversion recovery (STIR) scans as well as coronal and sagittal 3D proton density-weighted spectrally selective inversion recovery (3D-PDW-SPIR) scans acquired at 1.5T. Following scanning, some ISLs were cut and then the segments were re-scanned using the same magnetic resonance (MR) techniques. Two radiologists independently assessed the MR images, and the reliability of ISL tear interpretation was assessed using the kappa coefficient. The chi-square test was used to compare the diagnostic accuracy of images obtained using the different MR techniques. RESULTS: The interobserver reliability for detecting ISL disruption was high for all imaging techniques (0.776–0.949). The sensitivity, specificity, and diagnostic accuracy of the coronal 3D-PDW-SPIR technique for detecting ISL tears were 100, 96.9, and 97.9%, respectively, which were significantly higher than those of the sagittal STIR (p = 0.000), coronal STIR (p = 0.000), and sagittal 3D-PDW-SPIR (p = 0.001) techniques. CONCLUSION: Compared to other MR methods, coronal 3D-PDW-SPIR provides a more accurate diagnosis of ISL disruption. Adding coronal 3D-PDW-SPIR to a routine MR protocol may help to identify PLC disruptions in cases with nearby contusion.
Adult ; Animals ; Contusions ; Diagnosis ; Female ; Goats ; Humans ; Ligaments ; Magnetic Resonance Imaging ; Male ; Models, Animal ; Protons ; Sensitivity and Specificity ; Spine ; Tears ; Weights and Measures

Objective To report the application of C7T1extensive osteotomy and C7pedicle subtraction osteotomy(PSO) in the correction of cervicothoracic deformity secondary to ankylosing spondylitis(AS)and to investigate the efficacy and safety of the techniques.Methods Between April 2006 and August 2017,eight male patients with cervicothoracic deformity undergoing C7T1extensive osteotomy(3 cases)or C7PSO(5 cases)were retrospectively reviewed.The mean age was 31.3±14.9 years(range, 14-60 years).C2-T1kyphosis,C2-T1scoliosis and C2-T1sagittal vertical axis(SVA)were measured on the lateral cervical radio-graphs and chin-brow vertical angle(CBVA)was measured on clinical photographs preoperatively and at the final follow-up.The operative time, blood loss and complications were recorded. Results The average follow-up duration was (11.3 ± 7.9) months (range,3-48 months).In C7T1extensive osteotomy group,the mean operative time was 305 min(300-310 min)and the average blood loss was 1 250 ml(1 000-1 500 ml).Preoperative and postoperative C2-T1kyphosis were 17.0°±16.3°and-13.3°±20.2°,re-spectively.The preoperative CBVA was 20.0°±4.5°,which improved to 4.7°±5.9°at the final follow-up with a mean correction rate of 76.5%.C2-T1SVA was improved from(6.9±4.0)cm preoperatively to(3.5±1.8)cm at the final follow-up with an average correc-tion rate of 49.3%.In C7PSO group,the mean operative time was 536 min(375-730 min)and the average blood loss was 2 450 ml (700-4 200 ml).There were four patients with concomitant scoliosis and kyphosis.Preoperative and postoperative C2-T1kyphosis were 22.8°±10.5°and-13.5°±10.0°,respectively.The preoperative C2-T1scoliosis was 24.8°±12.7°,which improved to 5.0°±3.5° at the final follow-up with a mean correction rate of 79.8%.CBVA was improved from 60.5°±10.2°preoperatively to 14.3°±8.6°at the final follow-up with an average correction rate of 76.4%.C2-T1SVA was corrected to(6.4±2.5)cm at the final follow-up from(10.4 ± 4.3) cm preoperatively. One patient was presented with severe cervicothoracic scoliosis and the C2-T1scoliosis was im-proved to 10°from 33°with a 69.7% correction rate.No neurological complications,infection,or implant-related complications were observed both intraoperatively and during the follow-up period.One patient who underwent C7PSO experienced intraopera-tive subluxation of the osteomized vertebra.Fortunately,there was no neurological deficit.Solid bony fusion was observed after six-month Halo-vest immobilization.Conclusion Both C7T1extensive osteotomy and C7PSO are effective in the correction of cervico-thoracic deformity secondary to AS with acceptable complication rate.C7PSO is particularly suitable for the correction of severe and complicated biplanar cervicothoracic deformity.