OBJECTIVE To observe the clinical efficacy of endoscopic type Ⅰ tympanoplasty in patients with chronic suppurative otitis media accompanied by fungal otitis media.METHODS Based on the symptom characteristics of the external auditory canal and tympanic mucosa,80 patients were divided into four groups:dry ear without fungi group,dry ear with fungi group,wet ear without fungi group,and wet ear with fungi group.Record its clinical characteristics.Patients with fungal otitis externa should receive medication treatment during the perioperative period.Failure to heal the tympanic membrane repaired 6 months after surgery,recurrent perforation of the graft,and/or persistent inability to dry the ear are considered repair failures.RESULTS A total of 80 patients were included in this study,and the overall healing rate of the tympanic membrane in the four groups of patients was 98.8％.There was no significant difference in the postoperative tympanic membrane healing rate among the four groups of patients.The postoperative air bone conduction difference in all four groups of patients decreased compared to preoperative levels,but the difference was not statistically significant.CONCLUSION Patients with chronic suppurative otitis media accompanied by fungal otitis media undergoing type Ⅰ tympanoplasty showed no decrease in tympanic membrane healing rate and no significant improvement in efficacy.

Objective:To evaluate the efficacy and safety profile of ixazomib/lenalidomide/dexamethasone (IRd) in Chinese patients with relapsed/refractory multiple myeloma (MM) .Methods:This study comprising 14 medical centers in China included patients with relapsed/refractory MM who received at least. Ixazomib at an initial oral dose of 4 mg was administered. Seven patients had dose adjustment to 3 mg at the time of first dose. The lenalidomide doses were adjusted according to creatinine clearance rate. The efficacy and safety were evaluated every cycle.Results:In the study cohort of 74 patients, the median age was 65 years and 11 (14.9% ) patients received over three lines of therapy. Overall response rate (ORR) was 54.1% (40/74) , and 7 (9.5% ) , 14 (18.9% ) , and 19 (25.7% ) patients achieved stringent complete response or complete response, very good partial response, and partial response, respectively. The median progression-free survival and overall survival were 9.9 and 20 months, respectively. The median time to response was 1 month. The efficacy and survival outcome were similar to those reported in the Tourmaline-MM1 China Continuous Study. The ORR of patients refractory to bortezomib, lenalidomide, and bortezomib plus lenalidomide were 52.0% (13/25) , 57.1% (4/7) , and 33.3% (6/18) , respectively. The rate of grade 3-4 adverse events was 36.5% (27/74) . Common hematological toxicities were anemia, thrombocytopenia, lymphopenia, and neutropenia. Common non-hematological toxicities were fatigue, gastrointestinal symptoms, and infections. Two cases of grade 3 peripheral neuropathy were reported. The patients eligible for the Tourmaline-MM1 China Continuous Study had a higher ORR than the ineligible patients [77.8% (14/18) vs 46.4% (26/56) , P=0.020]. There was no difference in the rate of grade 3-4 adverse events [33.3% (6/18) vs 37.5% (21/56) , P=0.749]. Conclusion:The IRd regimen had good efficacy and acceptable toxicity in Chinese patients with relapsed/refractory MM.

Objective: To acknowledge the availability and rates of annual transition of outcomes during the progression and regression stages of colorectal cancer (CRC) and related diseases, by pooling global follow-up studies on the natural history of CRC. Methods: Till March, 2017, data was collected through systematic literature review over multiple databases, including PubMed, Embase, Cochrane and Chinese Biology Medicine (CBM) disc. Information regarding the characteristics, classification system of health states, related outcomes and incidence rates on CRC or high-risk adenoma for the surveillance cohorts of the studies, were extracted and summarized. Both Meta and sensitivity analyses were performed on those outcomes if they appeared in more than 3 studies, using the random effects model. Annual transition rate with 95%CI was used to estimate each of the outcomes, Quality of the studies was assessed, using the Newcastle-Ottawa Scale. Results: A total of 29 cohort studies were included, with the mean follow-up period as 5.7 years. All studies except one, focused on adenoma-carcinoma pathway and reported the outcome parameters of adenomas by different risk, and some reported the findings on different sizes (n=6) of adenomas. These cohorts were divided into three groups (normal status, with low-risk or high-risk adenoma) according to the status of baseline endoscopic pathologic findings. Their available outcome parameters, corresponding number of involved articles, aggregated sample size and pooled annual transition rates were presented. Six parameters were obtained in the normal cohorts, including those from normal to low-risk adenoma (16 articles, 58 235, 0.030: 0.024-0.037), to high-risk adenoma (17 articles, 62 089, 0.003: 0.002-0.004), to diminutive adenoma (<5 mm, 4 articles, 1 277, 0.021: 0.013-0.029), to small adenoma (6-9 mm, 4 articles, 1 277, 0.006: 0.001-0.010), to large adenoma (≥10 mm, 7 articles, 3 531, 0.002: 0.000-0.003) and to CRC (19 articles, 104 836, 0.000 3: 0.000 2-0.000 5). Three parameters were obtained in low-risk adenoma in cohorts with polypectomy findings, including recurrence (9 articles, 4 788, 0.109: 0.062-0.157) from low-risk adenoma after polypectomy to high-risk adenoma (10 articles, 5 736, 0.009: 0.004-0.013) and to CRC (12 articles, 11 347, 0.000 6: 0.000 4-0.000 8). Three parameters were obtained on high-risk adenoma from cohorts with polypectomy findings, including recurrence (12 articles, 7 030, 0.038: 0.028-0.048) from high-risk adenoma after polypectomy to low-risk adenoma (8 articles, 2 489, 0.133: 0.081-0.185) and CRC (14 articles, 14 899, 0.002: 0.001-0.003). Except for normal to low-risk adenomas, results from the sensitivity analysis for the other parameters showed stable. Of the included studies, two presented incidence rates of CRC in different clinical stages and the another two were focusing on the parameters related to serrated pathway. Conclusions Globally, follow-up studies reported data on natural history of colorectal cancer is of paucity. Compared to the "adenoma-carcinoma" pathway, transition parameters of the serrated lesion pathway are more limited. This Meta-analysis provided convincing evidence for optimizing the strategies regarding follow-up program on the disease, using the baseline endoscopic findings from global CRC Screening Program. These results also offered strong data-related support for Chinese population- specific interventional model on colorectal cancer.

Objective: To improve the understanding of idiopathic hypereosinophilic syndrome (HES) and to be aware of its potential of transforming to acute myeloid leukemia (AML). Methods: The clinical data of one patient diagnosed with HES progressed to AML in the 923rd Hospital of the People's Liberation Army Joint Service Support Force were analyzed, and relevant literatures were reviewed. Results: The patient was diagnosed with idiopathic HES that progressed to AML with FIP1-like-1-platelet-derived growth factor receptor α (FIP1L1-PDGFRA) after 2 years. The patients achieved complete remission after the treatment of chemotherapy combined with tyrosine kinase inhibitor and then received hematopoietic stem cell transplantation. The patient had more than 1 year disease-free survival until the deadline. Conclusion Idiopathic HES has the potential to transform to AML with FIP1L1-PDGFRA fusion gene positive, therefore regular follow-up should be emphasized.

Objective To evaluate the effect of compound glycyrrhizin on the prevention and cure of cytarabine syndromes. Methods A total of 130 patients with hematological malignancies treated by moderate or high dose of cytarabine in the 303th Hospital of PLA from July 2010 to July 2016 were included. Patients were randomly divided into the control group and the experiment group by using random number table method, and each group had 65 patients. In the control group, patients were treated with cytarabine alone. In the experiment group, patients were treated with cytarabine plus compound glycyrrhizin. Skin rash and fever in patients of the two groups were also recorded. Results of blood routine tests, liver and kidney function tests were monitored during the treatment. Results Sixty-one patients in the experiment group and 63 patients in the control group were enrolled finally. In experiment group and control group, the differences in the incidence of cytarabine syndromes [8.2 % (5/61) vs. 41.3 % (26/63), χ2＝ 18.1, P < 0.001], skin rash [1.6 % (1/61) vs. 12.7 % (8/63), χ2＝16.3, P <0.001], and fever [6.6 % (4/61) vs. 36.5 % (23/63), χ2＝5.63, P <0.017] were statistically significant. There was no significant difference of the incidence of liver injury and minimum blood cell count between the two groups (P＞ 0.05). Conclusion Compound glycyrrhizin can effectively reduce the incidence of cytarabine syndromes, but the larger size and multiple center studies are needed to further verify the effect.

Objective:To explore the effect of intervention of E-cadherin (E-cad) and B-lymphoma Moloney murine leukemia virus insertion region-1 (Bmi-1) mediated by transcription activator-like effector nuclease (TALEN) on the biological behaviors ofnasopharyngeal carcinoma cells.Methods:Multi-locus gene targeting vectors pUC-DS1-CMV-E-cad-2A-Neo-DS2 and pUC-DS1-Bmi-1 shRNA-Zeo-DS2 were constructed,and the E-cad and Bmi-1 targeting vectors were transferred with TALEN plasmids to CNE-2 cells individually or simultaneously.The integration of target genes were detected by PCR,the expressions of E-cad and Bmi-1 were detected by Western blot.The changes of cell proliferation were detected by cell counting kit-8 (CCK-8) assay.T-he cell cycle and apoptosis were detected by flow cytometry.The cell migration and invasion were detected by Transwell assay.Results:The E-cad and Bmi-1 shRNA expression elements were successfully integrated into the genome of CNE-2 cells,the protein expression level of E-cad was up-regulated,and the protein expression level of Bmi-1 was down-regulated.The intervention of E-cad and Bmi-1 didn't affect the proliferation,cell cycle and apoptosis of CNE-2 cells,but it significantly inhibited the migration and invasion ability of CNE-2 cells.Furthermore,the intervention of E-cad and Bmi-1 together significantly inhibited the migration ability of nasopharyngeal carcinoma cells compared with the intervention of E-cad or Bmi-1 alone (all P＜0.01).Conclusion:The joint intervention of E-cad and Bmi-1 mediated by TALEN can effectively inhibit the migration and invasion of nasopharyngeal carcinoma cells in vitro,which may lay the preliminary experimental basis for gene therapy of human cancer.

Objective To study the clinical characteristics of Japanese encephalitis (JE) in 34 adult patients and to improve the level of diagnosis of this disease.Methods The clinical manifestations,laboratory results and radiological features of 34 adult patients with JE in our hospital from July 2017 to September 2017 were summarized and the progonsis was observed.The modified Rankin Scale (mRS) was used to evaluate the progonsis.Results Eighteen patients were males and 16 patients were females with the average age of (45.39 ± 16.34) years in 34 patients who were diagnosed as JE.The major clinical features of JE patients included fever (34,100％) with the average temperature of (39.4 ± 1.1) ℃ on admission,headache (26,76％),seizures (7,21％),decreased consciousness (25,74％) on day 2.6 ± 1.4 after the onset,respiratory failure (9,26％) on day 3.8 ± 1.6 after the onset.The major features of laboratory results included white blood cells increase (15,44％),blood hematocrit decrease (25,74％),eosinophil absolute value decrease (29,85％),cerebrospinal fluid pressure increase (12,35％),cerebrospinal fluid protein increase (27,79％),cerebrospinal fluid white blood cells increase (30,88％).Brain MRI scan of abnormal signal was found abnormal in up to 54％patients (14/26),involving the thalamus,basal ganglia,mesencephalon,temporal lobe,hippocampus and occipital lobe,especially in the area of bilateral thalamus and mesencephalon.The follow-up showed three cases were dead;mRS score was 0 in twenty-one cases,1 or 2 in five cases,3 or 4 in three cases,5 in two cases five-six months after onset;the sequelaes were cognitive impairment in nine patients and movement disorder in five patients.Conclusions The clinical symptoms of JE in adults are severe.The main clinical manifestations of JE are hyperthermia,disturbance of consciousness,seizures and respiratory failure,with characteristic imaging findings on brain MRI.JE is a disease with high mortality and severe long-term sequelae.

Objective To investigate the changes aad possible role of estrogen and its receptor ERα、ERβ、GPR30 in the pathogenesis of asymptomatic hyperuricemia.Methods The peripheral blood of 62 asymptomatic hyperuricemia patients (AH) and 68 healthy controls (HC) were collected.The expression of estradial (E2) in serum was detected by the chemilluminescent microparticle immunoassay (CMIA).The expression of ERα,ERβ,GPR30 mRNA in peripheral blood mononuclear cells (PBMCs) was measured using Real time quantitative polymerase chain reaction (RT-qPCR).Statistical Package form Soci-science (SPSS) 17.0 statistical software was used for data analysis.The measurement data were compared by t test,rank sum test or one factor analysis of variance test.The correlation between variables was used by Spearman correlation analysis.Results ① The expression of E2 in serum of the HC group was higher than that in the AH group [(38.7±10.2) pg/ml vs (33.7±8.6) pg/ml,Z=-0.356,P＜0.05].② The expression of ERα,GPR30 mRNA in PBMCs of HC group was increased,compared with that in the AH group (0.000 17±0.000 23 vs 0.000 12± 0.000 12,0.002 0±0.002 1 vs 0.001 5±0.000 8,Z=-2.112,-2.147,P＜0.05,respectively).No significant difference in PBMCs ERβ mRNA levels was found between HC group and AH group,while a slight but not significant increase was observed in HC group.③ The Spearman correlation analysis found that the expression of ERα and ERβ mRNA,E2 and GR,ERβ and GLU in the AH group were positively related (r=0.259,0.251,0.260,P＜0.05,respectively).Conclusion The expression of E2,ERα,ERβ,GPR30 mRNA in the peripheral blood of patients with AH is decreased,suggesting that the estrogen and its receptor may be involved in the patho-genesis of hyperuricemia.

OBJECTIVETo evaluate the colorectal cancer (CRC) prevention effect of metformin in comparison with that of other T2DM medications from a Markov model perspective.

METHODSLiterature concerning CRC morbidity of T2DM patients with metformin or other diabetes medications treatment was reviewed in PubMed and Cochrane Library database from September 2010 to December 2016.

INCLUSION CRITERIA(1)enrolled population was adult patients with T2DM but without CRC; (2) any of the parameters applied in our model was reported; (3) randomized clinical trials (RCTs), quasi-randomized trials, prospective or retrospective cohort studies. With CRC morbidity as endpoint, parameters were extracted to construct Markov model to assess CRC morbidity and cumulative tumor-free survival in each group over 11 years' follow-up period. Finally, Monte Carlo analysis was performed to evaluate the influence of parameter instability on the model.

RESULTSSeven literatures were recruited and 10 000 patients were virtually allocated for each arm. In contrast with non-metformin group, T2DM patients treated with metformin had a lower rate of CRC(1.670% vs. 2.146%, P=0.016). Moreover, cumulative tumor-free survival of metformin group was, slightly but significantly, better than that of non-metformin group (10.908 years vs. 10.882 years, P=0.000).

CONCLUSIONST2DM patients treated with metformin have a lower morbidity of CRC and a better cumulative tumor-free survival than those of non-metformin group. Large scale RCTs are needed to illustrate the role of metformin in the prevention of CRC.

Objective The objectives of this study were to analyze the results of lung cancer screening from 9265 urban residents in Urumqi from year 2014 to 2016,and to evaluate the significance of early diagnosis and treatment of cancer for the lung cancer prevention.Methods A total of 31,177 people with high risk of lung cancer were assessed by cancer risk questionnaire surveyed from 40 to 69 years old residents in Urumqi.High-risk groups were assigned to low-dose spiral CT scan in Affiliated Tumor Hospital of Xinjiang Medical University.Results 9,265 people were scanned with low dose spiral CT and overall completion rate was 29.7％.There had 11.9％ detection rate in 1,005 people who were scanned positive pulmonary nodules.The detection rate was 31.9％ for 2,955 people who were scanned solid nodules(＜5 mm) and 2.5％ for 236 people who had the non solid nodules(＜ 8 mm).After screening,14 patients were diagnosed by pathology and the detection rate was 0.2％.The emphysema,pulnonary cysts,pulmonary bullae and other related lung disease were detected in 4,095 people and the detection rate was 44.2％.Conclusion The lung health status of Urumqi residents was found by a wide range of lung cancer screening,and the awareness of lung cancer prevention and control was greatly improved.It provided the basis for the establishment of effective prevention and treatment system,which was helpful to improve the early diagnosis and treatment rate of lung cancer.