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 determine whether proactive molecular risk classifier for endometrial cancer (ProMisE) could be used to assess the prognosis of patients with atypical endometrial hyperplasia (AEH) or early-stage endometrial cancer (EC) treated with levonorgestrelreleasing intrauterine system (LNG-IUS). Methods: A retrospective cohort study was conducted among 93 AEH or early-stage EC patients who received LNG-IUS to preserve fertility . By immunohistochemistry and gene sequencing, 4 subtypes of ProMisE were identified (p53 wild type [p53 wt], mismatch repairdeficient [MMRd], p53-abnormal, and POLE-mutated). The primary outcome was the time to complete response (CR) after LNG-IUS therapy. Secondary outcomes included the recurrence rate after CR and success rate of conception. Results: Among the 93 patients, 15 (16.1%) were classified as MMRd, 6 (6.5%) as POLEmutated, 5 (5.4%) as p53-abnormal, and 67 (72.0%) as p53 wt. Comparison of serum cancer antigen 125, family history of tumor, and positive rates of programmed cell death 1 ligand 1 protein and Ki67 protein in 4 groups showed statistically significant differences (p<0.05).Patients with the p53-abnormal subtype had the lowest overall CR rate (40%) and the highest recurrence rate (2/2). Patients with POLE-mutated subtype had the best prognosis, and all 6 patients achieved CR. When patients achieved complete remission, assisted reproductive technology was more likely to help them conceive than natural conception (p<0.05). Conclusion Patients with early-stage EC or AEH who are more likely to benefit from fertilitysparing treatment can be identified using ProMisE classifier. Patients with POLE-mutated are suitable for fertility-sparing treatment with LNG-IUS.

Objective: To determine whether proactive molecular risk classifier for endometrial cancer (ProMisE) could be used to assess the prognosis of patients with atypical endometrial hyperplasia (AEH) or early-stage endometrial cancer (EC) treated with levonorgestrelreleasing intrauterine system (LNG-IUS). Methods: A retrospective cohort study was conducted among 93 AEH or early-stage EC patients who received LNG-IUS to preserve fertility . By immunohistochemistry and gene sequencing, 4 subtypes of ProMisE were identified (p53 wild type [p53 wt], mismatch repairdeficient [MMRd], p53-abnormal, and POLE-mutated). The primary outcome was the time to complete response (CR) after LNG-IUS therapy. Secondary outcomes included the recurrence rate after CR and success rate of conception. Results: Among the 93 patients, 15 (16.1%) were classified as MMRd, 6 (6.5%) as POLEmutated, 5 (5.4%) as p53-abnormal, and 67 (72.0%) as p53 wt. Comparison of serum cancer antigen 125, family history of tumor, and positive rates of programmed cell death 1 ligand 1 protein and Ki67 protein in 4 groups showed statistically significant differences (p<0.05).Patients with the p53-abnormal subtype had the lowest overall CR rate (40%) and the highest recurrence rate (2/2). Patients with POLE-mutated subtype had the best prognosis, and all 6 patients achieved CR. When patients achieved complete remission, assisted reproductive technology was more likely to help them conceive than natural conception (p<0.05). Conclusion Patients with early-stage EC or AEH who are more likely to benefit from fertilitysparing treatment can be identified using ProMisE classifier. Patients with POLE-mutated are suitable for fertility-sparing treatment with LNG-IUS.

Objective: To determine whether proactive molecular risk classifier for endometrial cancer (ProMisE) could be used to assess the prognosis of patients with atypical endometrial hyperplasia (AEH) or early-stage endometrial cancer (EC) treated with levonorgestrelreleasing intrauterine system (LNG-IUS). Methods: A retrospective cohort study was conducted among 93 AEH or early-stage EC patients who received LNG-IUS to preserve fertility . By immunohistochemistry and gene sequencing, 4 subtypes of ProMisE were identified (p53 wild type [p53 wt], mismatch repairdeficient [MMRd], p53-abnormal, and POLE-mutated). The primary outcome was the time to complete response (CR) after LNG-IUS therapy. Secondary outcomes included the recurrence rate after CR and success rate of conception. Results: Among the 93 patients, 15 (16.1%) were classified as MMRd, 6 (6.5%) as POLEmutated, 5 (5.4%) as p53-abnormal, and 67 (72.0%) as p53 wt. Comparison of serum cancer antigen 125, family history of tumor, and positive rates of programmed cell death 1 ligand 1 protein and Ki67 protein in 4 groups showed statistically significant differences (p<0.05).Patients with the p53-abnormal subtype had the lowest overall CR rate (40%) and the highest recurrence rate (2/2). Patients with POLE-mutated subtype had the best prognosis, and all 6 patients achieved CR. When patients achieved complete remission, assisted reproductive technology was more likely to help them conceive than natural conception (p<0.05). Conclusion Patients with early-stage EC or AEH who are more likely to benefit from fertilitysparing treatment can be identified using ProMisE classifier. Patients with POLE-mutated are suitable for fertility-sparing treatment with LNG-IUS.

OBJECTIVE: Neoadjuvant chemotherapy (NACT) for the treatment of epithelial ovarian cancer (EOC) has remained controversial. This meta-analysis was performed to systematically assess the efficacy and safety of NACT versus primary debulking surgery (PDS) in patients with EOC.METHODS: PubMed, Embase, ClinicalTrials.gov, and Cochrane Library were queried to assess the therapeutic value of NACT versus PDS in EOC. Electronic databases were queried by using the keywords “ovarian cancer/neoplasms”, “primary debulking surgery”, and “neoadjuvant chemotherapy”.RESULTS: The available trials were pooled, and hazard ratios (HRs), relative risk ratios (RRs) and associated 95% confidence intervals (95% CIs) were determined. Sixteen trials involving 57,450 participants with EOC (NACT, 9,475; PDS, 47,975) were evaluated. We found that NACT resulted in markedly decreased overall survival than PDS in patients with EOC (HR=1.30; 95% CI=1.13–1.49; heterogeneity: p<0.001, ²=82.7%). Furthermore, our results demonstrated that the NACT group displayed increased completeness of debulking removal (RR=1.69, 95% CI=1.32–2.17; heterogeneity: p<0.001, ²=81.9%), and reduced risk of postsurgical death (RR=0.18, 95% CI=0.06–0.51; heterogeneity: p=0.698, ²=0%) and major infection (RR=0.29, 95% CI=0.17–0.51; heterogeneity: p=0.777, ²=0%) compared with patients administered PDS.CONCLUSIONS: This meta-analysis indicated that NACT results in increased completeness of debulking removal, and reduced risk of postsurgical death and major infection compared with PDS, while PDS is associated with improved survival in comparison with NACT in EOC patients.TRIAL REGISTRATION: PROSPERO Identifier: CRD42019120625
Cytoreduction Surgical Procedures ; Drug Therapy ; Humans ; Neoadjuvant Therapy ; Odds Ratio ; Ovarian Neoplasms ; Population Characteristics

OBJECTIVE: Neoadjuvant chemotherapy (NACT) for the treatment of epithelial ovarian cancer (EOC) has remained controversial. This meta-analysis was performed to systematically assess the efficacy and safety of NACT versus primary debulking surgery (PDS) in patients with EOC. METHODS: PubMed, Embase, ClinicalTrials.gov, and Cochrane Library were queried to assess the therapeutic value of NACT versus PDS in EOC. Electronic databases were queried by using the keywords “ovarian cancereoplasms”, “primary debulking surgery”, and “neoadjuvant chemotherapy”. RESULTS: The available trials were pooled, and hazard ratios (HRs), relative risk ratios (RRs) and associated 95% confidence intervals (95% CIs) were determined. Sixteen trials involving 57,450 participants with EOC (NACT, 9,475; PDS, 47,975) were evaluated. We found that NACT resulted in markedly decreased overall survival than PDS in patients with EOC (HR=1.30; 95% CI=1.13–1.49; heterogeneity: p<0.001, ²=82.7%). Furthermore, our results demonstrated that the NACT group displayed increased completeness of debulking removal (RR=1.69, 95% CI=1.32–2.17; heterogeneity: p<0.001, ²=81.9%), and reduced risk of postsurgical death (RR=0.18, 95% CI=0.06–0.51; heterogeneity: p=0.698, ²=0%) and major infection (RR=0.29, 95% CI=0.17–0.51; heterogeneity: p=0.777, ²=0%) compared with patients administered PDS. CONCLUSIONS This meta-analysis indicated that NACT results in increased completeness of debulking removal, and reduced risk of postsurgical death and major infection compared with PDS, while PDS is associated with improved survival in comparison with NACT in EOC patients.TRIAL REGISTRATION: PROSPERO Identifier: CRD42019120625

Objective To study the effect of Xiaoqinglong Decoction on the expression of TSLP in airway epithelial cells of asthmatic model mice.Methods Thirty healthy female BALB/C mice were divided into the blank control group,asthma model group and Xiaoqinglong Decoction group,10 cases in each group.The each group adopted corresponding intervention measures. Then the bronchial and lung tissues were taken.The expression level of bronchial TSLP was detected by immunofluorescence,and the expression level of TSLP mRNA and protein in lung tissue was detected by qRT-PCR and Western Blot.Results The mouse bronchial epithelial cell membrane TSLP staining was strongly positive in the asthma model group,which was weakly positive in the Xiaoqinglong Decoction group and negative in the blank control group.Compared with the asthma model group,mice lung tissue TSLP mRNA expression level in the Xiaoqinglong Decoction group and blank control group was decreased(P<0.05),the Xiaoqin-glong Decoction group was slightly higher than the blank control group,but the inter-group difference was not statistically signifi-cant(P>0.05).The expression level of lung tissue TSLP protein in the Xiaoqinglong Decoction group and blank control group was lower than that in the asthma model group(P<0.05),the Xiaoqinglong Decoction group was slightly higher than the blank control group,but the inter-group difference was not statistically significant(P>0.05).Conclusion Xiaoqinglong decoction has obvious inhibiting effect on the expression of TSLP in airway epithelial cells of asthmatic model mice.

Objective: To investigate the effect and mechanism of brain-derived neurotrophic factor (BDNF) pretreatment for reducing myocardial ischemia/reperfusion (I/R) injury in experiment rats.
Methods: Rat’s myocardial I/R model was established by left anterior descending artery ligation for 30min followed-by reperfusion for 180 min. The rats were divided into 5 groups:Sham operation group, I/R group and IR with BDNF pretreatment (1, 10, 100) nmol/(kg·ml) groups respectively. The LVSP, LVEDP, ±dp/dtmax were recorded after I/R;serum levels of LDH, CK and the cardiac tissue levels of MDA, SOD were examined;the ratios of left ventricular myocardial infarction area in different groups were observed by by Evans blue staining;cell apoptosis rates were evaluated by Tunel staining;the total-TrkB and p-TrkB in myocardium were detected by Western-blot analysis.
Result: Compared with I/R group, in 3 IR with BDNF pretreatment groups, LVSP, ±dp/dtmax were gradually increasing and LVEDP were gradually decreasing, all P<0.05;the leaking levels of LDH, CK and the content of MDA were gradually decreasing and the SOD activity was gradually increasing, all P<0.05;the average ratios of MI area/ischemic area were decreased from (47.54 ± 6.35)%to (28.68 ± 4.56)%, the apoptosis rates decreased from (37.89 ± 5.46)%to (10.24 ± 3.05)%, the level of p-trkB/Total-TrkB increased from (0.16 ± 0.03) to (0.42 ± 0.03), P<0.05.
Conclusion: BDNF pretreatment could maintain the cardiac function in experiment rats after I/R injury, it may reduce MI area, decrease oxidative damage and apoptosis, therefore, protect myocardial cells for reducing IR injury.

Objective To investigate the relationshipbetween glucose fluctuation and the degree of nervous dysfunction of the acute cerebral infarction in patients with type 2 diabetes mellitus.Methods 30 patients with ACI and T2DM were chosen as observation group and 30 patients with T2DM without ACI as the control group.Glucose fluctuation in all patients were monitored for 72h with the continuous glucose monitoring system(CGMS).High frequency ultrasound was used to detect the carotid intima-media thickness (IMT).The levels of blood lipids,glycosylated hemoglobin (HbA1c),homocysteinemia(Hcy) and C-reactive protein(C-RP) were detected in all the patients.The national institute of health stroke scale(NIHSS) was performed.The correlation between NIHSS and other observed factors were analyzed.Results (1)The mean amplitude of glycemic excursions (MAGE),blood glucose standard deviation(SDBG),absolute means of daily differences(MODD),the largest amplitude of glycemic excursions(LAGE),blood lipids,HbA1c,Hcy,C-RP and IMT were statistically significant different between the two groups (all P＜0.05); (2)The MAGE,SDBG,IMT,Hey,C-RP,low-density lipoprotein cholesterol-C (LDL-C),and systolic blood pressure(SBP) were correlated with the NIHSS score (all P＜0.05) ;(3)With NIHSS score as the dependent variable and the indicators above as the independent variables,the multiple stepwise regression analysis showed that the MAGE,IMT,Hcy came into the final equation.Conclusions The blood glucose fluctuation is probably the influential factor on the development of acute cerebral infarction in T2DM patients.Therapy for lowering blood glucose smoothly should be established as soon as possible to recover the nerve function after cerebral infarction and reduce the incidence of stroke recurrence.

Teaching urinary system diseases by problem-based learning method for eight-year program medical students was applied in nephrology department in affiliated Tongji hospital of Huazhong university of science and technology since 2008.They had accumulated experiences in compiling teaching plan,fostering teachers,practicing teaching and evaluating teaching.These steps may future intensify education reform on long schooling system and improve teaching quality of eight-year program.