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.

For wild natural medicine, unanticipated biodiversity as species or varieties with similar morphological characteristics and sympatric distribution may co-exist in a single batch of medical materials, which affects the efficacy and safety of clinical medication. DNA barcoding as an effective species identification tool is limited by its low sample throughput nature. In this study, combining DNA mini-barcode, DNA metabarcoding and species delimitation method, a novel biological sources consistency evaluation strategy was proposed, and high level of interspecific and intraspecific variations were observed and validated among 5376 Amynthas samples from 19 sampling points regarded as "Guang Dilong" and 25 batches of proprietary Chinese medicines. Besides Amynthas aspergillum as the authentic source, 8 other Molecular Operational Taxonomic Units (MOTUs) were elucidated. Significantly, even the subgroups within A. aspergillum revealed here differ significantly on chemical compositions and biological activity. Fortunately, this biodiversity could be controlled when the collection was limited to designated areas, as proved by 2796 "decoction pieces" samples. This batch biological identification method should be introduced as a novel concept regarding natural medicine quality control, and to offer guidelines for in-situ conservation and breeding bases construction of wild natural medicine.

Objective To explore the metabolism and chronic complication features of type 2 diabetes mellitus patients with hyperferritemia. Methods:A total of 268 type 2 diabetic patients with a disease course of more than 5 years, who were hospitalized in our hospital between January to December 2019 were included in this retrospective study. Serum ferritin was measured by Chemiluminescence in each participant. Patients with other diseases, which might affect serum ferritin level, were excluded. According to the results of serum ferritin, the patients were divided into hyperferritemia group ( n=115) and normal ferritin group ( n=153). The metabolic indexes, including C-reactive protein, blood glucose, blood lipid, liver and kidney function, were measured. Chronic complications and comorbidities, including diabetic retinopathy, urinary microalbumin excretion, hypertension, coronary heart disease and cerebrovascular disease were evaluated. The correlation between hyperferritemia and various variables was analyzed. Results:Body mass index, the levels of serum urea nitrogen, uric acid, C-reactive protein, alanine aminotransferase and γ-glutamyltranspeptidase, as well as prevalence of diabetic retinopathy, microalbuminuria, hypertension and coronary heart disease, were significantly higher in hyperferritemia group than in normal ferritin group (all P<0.05). Hyperferrinemia was positively correlated with C-reactive protein ( r=0.262, P<0.001), coronary heart disease ( r=0.232, P<0.001), alanine transpeptidase ( r=0.216, P<0.001), urea nitrogen ( r=0.201, P=0.001), diabetic retinopathy ( r=0.169, P=0.008) and microalbuminuria ( r=0.176, P=0.004). Multivariate logistic regression analysis showed that hyperferrinemia was an independent risk factor of coronary heart disease and diabetic retinopathy ( OR=2.246, 95% CI 1.310-3.849, P=0.003; OR=2.232, 95% CI 1.287-3.870, P=0.004, respectively) in this patient cohort. Stepwise linear regression showed that there was a significant correlation between hyperferrinemia and microalbuminuria (β=0.165, P=0.009). Conclusions:Our results show that the level of serum C-reactive protein, alanine aminotransferase, γ-glutamyltranspeptidase, urea nitrogen, uric acid and microalbuminuria are significantly increased and the risk of coronary heart disease and diabetic retinopathy are higher in type 2 diabetic patients with hyperferritemia.

Objective To investigate the value of quantitative analysis of the left ventricular longitudinal strain in patients with hypertrophic cardiomyopathy (HCM) and with normal left ventricular ejection fraction (LVEF) by using two-dimensional speckle tracking imaging.Methods Twenty-eight HCM patients with normal LVEF (all of the cases were non obstructive HCM),who were diagnosed by clinical and ultrasound echocardiography between January 1,2015 and January 1,2016 in the First Affiliated Hospital of Dalian Medical University,served as the experimental group.And twenty healthy volunteers served as the healthy control group.The peak longitudinal strain (LPS) of the left ventricle and the systolic peak of the left ventricle were calculated by the STE technique.The indexes such as the transmural gradient (△ LS=LPSEndo-LPSEpi)and the transmural gradient percentage (△ LS％=△ LS/LPSEndo) were calculated.The Peak systolic longitudinal strain of endocardium (LPSEndo),the peak systolic longitudinal strain of mid-cardium (LPSMid),the peak systolic longitudinal strain of epicardium (LPSEpi),the peak systolic longitudinal strain of basal segment (LPSb),the peak systolic longitudinal strain of middle segment (LPSm),the peak systolic longitudinal strain of apical segment (LPSa),the global peak systolic longitudinal strain (GLPS) and other left ventricular myocardial strain,such as △ LS,△ LS％,in both the HCM group and the healthy control group,were analyzed by using independent samples t test comparison.For each layer of the left ventricle and the overall myocardial longitudinal strain,two independent sample t test was used for comparison between groups,and LSD-t test was used for intra-group comparison.Results (1) There was a gradient of LPS among the three layers and the three segments in both of the two groups:LPSEndo and LPSMid [(18.36±4.97)％ vs (13.80±4.23)％,(26.41±2.93)％ vs (22.19±2.49)％],the difference was statistically significant (t=5.550,8.529,P ＜ 0.05);LPSEndo and LPSEpi [(18.36±4.97) ％ vs (11.91 ±3.63)％,(26.41±2.93)％ vs (19.43±2.20)％],the difference was statistically significant (t=5.550,8.529,P ＜ 0.05);There was significant difference between LPSMid and LPSEpi in the healthy control group [(22.19 ± 2.49)％ vs (19.43 ± 2.20)％,t=3.709,P ＜ 0.05)],that was,LPSEndo ＞ LPSMid ＞ LPSEpi.LPSa and LPSm,the difference was statistically significant (t=4.029,6.839,P ＜ 0.05);LPSa and LPSb,the difference was statistically significant (t=5.304,9.887,P ＜ 0.05);There was significant difference between LPSm and LPSb in the healthy control group (t=4.170,P ＜ 0.05);that was,LPSa ＞ LPSm ＞ LPSb.In the HCM group,LPS in the 3 layers,3 segments,and the whole left ventricular wall were lower than that of the the healthy control group,the differences were statistically significant [GLPS:(14.63± 3.75)％ vs (22.68±2.51)％,t=-8.347;LPSEndo to LPSEpi:t=-6.477,-7.909,-8.242;LPSa to LPSb:t=-6.647,-8.790,-7.267;all P ＜ 0.05).(2) Compared with the healthy control group,both the segmental gradient and global transmural gradient in the HCM group were found reduced,but the difference had no statistical significance (all P ＞ 0.05).(3) The transmural gradient percentage both in the healthy control group and the HCM group were reduced from the apical segment to the basal segment,the difference were statistically significant (HCM group:t=9.985,5.969;healthy control group:t=17.513,7.043;all P ＜ 0.05).Compared with the healthy control group,the △ LS％a and the △ LS％m of HCM group were significantly higher [(58.86± 11.32)％ vs (43.70±4.73)％,(28.43± 11.48)％ vs (20.30± 3.66)％],and the difference was statistically significant (t=5.634,3.049,all P ＜ 0.05).Conclusions (1) Using 2D-STI could accurately determine the regional or the global left ventricular systolic function in patients with HCM.(2) The transmural gradient percentage can be more sensitive to reflect the change of the transmural gradient,and more research needed to explore its value for clinical application.

Objective To analyze the misdiagnosed cases of the nodular goiter (NG)in real-time contrast-enhanced ultrasound(CEUS),in order to improve the diagnostic accuracy of NG.Methods Two-hundred and sixty-five cases of NG CEUS images,especially the 48 nodules in 44 misdiagnosis cases,were retrospectively analyzed to find out the main reasons of the misdiagnosis.In addition,the factors which effected the results of CEUS such as size,number and calcification of NG nodules were summarized.Results There were 42 nodules misdiagnosed as thyroid cancer,5 nodules misdiagnosed as thyroid adenoma and 1 nodular goiter misdiagnosed as subacute thyroiditis in 874 nodular goiter cases.The misdiagnosis rate of nodular goiter was 5.49% (48/874)by the diagnostic criterion of homogeneous enhancement in CEUS.The differences size and calcification of nodules had a significant impact on CEUS.The misdiagnosis rate of the NG nodules with major diameter less than 10 mm was much higher than that of more than 10 mm,the misdiagnosis rate of NG nodules with coarse calcification was much higher than the situation of microcalcification(P <0.05).Conclusions Major diameter less than 10mm and coarse calcifications of NG nodular are the main factors which influence the results of CEUS.

Objective To evaluate the value of the differential diagnosis of benign and malignant thyroid nodules under the background of Hashimoto' s thyroiditis (HT) using contrast-enhanced ultrasonography (CEUS).Methods Ninety-three single thyroid nodules with HT confirmed by operations and pathology were given CEUS examination,and time-intensity curves were drawn by using TomTec analyzing software.The parameters as follows:rise time (RT),time to peak (TTP),mean transit time (mTT) and maximum intensity(IMAX) were compared by independent-samples t test,and the diagnostic value of parameters were analyzed by receiver operating characteristic (ROC) curve.Results In 93nodules,there were 56 benign thyroid nodules,and 37 malignant thyroid nodules.(1) After injection of contrast media,the enhancement and wash-out in benign nodules were mostly the same with peripheral gland,as well as the enhance intensity.Malignant nodules presented lower enhancement,with later rise time and earlier wash-out compared to peripheral gland.(2) mTT was longer,while IMAX was higher in benign nodules than those in malignant nodules (P ＜0.05).But there were no significant differences in RT or TTP between the two groups.(3) The cut-off value in diagnosis of benign and malignant thyroid nodules with HT assessed by ROC curve were mTT 21.70 s,IMAX 86.41％.When mTT,IMAX,and combination of the two parameters were used for the diagnosis of malignant thyroid nodules with HT,the sensitivity were 86.5 ％,83.8 ％,97.3 ％ and the specificity were 69.6 ％,75.0 ％,48.2 ％,respectively.Conclusions CEUS is helpful to identify the benign and malignant thyroid nodules under the background of HT.

Objective To investigate the different roles of two-dimensional,color Doppler ultrasound and real-time ultrasound elastography in the diagnosis of Hashimoto's thyroiditis(HT).Methods One hundred and forty-one patients clinically diagnosed as HT underwent traditional ultrasound and elastography.The patients were classified into three groups,the hyperthyroidism group,the hypothyroidism group and the euthyroidism group.One hundred and eight volunteers with normal thyroid functions were enrolled as control group.Ultrasonic characteristics (size,echo,accompanied nodules,blood flow distribution of thyroid) and thyroid elastic parameters were recorded and analyzed.Results ①Focal hypoechoic pattern was mainly seen in the group of HT hyperthyroidim,diffuse hypoechoic pattern was mainly seen in the groups of HT euthyroidism,diffuse hypoechoic pattern with heterogeneous linear hyperechoic and nodular changes were mainly seen in the HT hypothyroidism group.②Blood flow reduced according to the order by the hyperthyroidim group,euthyroidism group and hypothyroidism group.③Patients with HT hyperthyroidism had elastic image pattern Ⅰ.Patients with HT euthyroidism had pattern Ⅰ and pattern Ⅱ.Patients with HT hypothyroidism had pattern Ⅱ and pattern Ⅲ.④There were significant differences (P＜0.05) between the mean elastic strain and the ratio of the blue area in each group.Conclusions Real-time ultrasound elastography is helpful for the diagnosis of HT.

Objective To examine the barbiturate infusion for intractable intracranial hypertension and its effect on brain tissue oxygen ( PbtO2 ). Method 60 patients with intractable intracranial hypertension were divided into tow groups, experimental group and control group. PbtO2 and intracranial pressure (ICP) were continuous monitored. Follow-up was more than 3 months and the prognosis was compared between two groups. Results When pentobarbital administration began, the mean PbtO2 [ 72 h: (26. 7 ±6. 7)mmHg] at 24h, 48h and 72h in experimental group were significantly higher than that of control group [ 72 h: ( 21. 1 ± 7. 2) mmHg ] ( P < 0. 05 ). The mean ICP [ 5 d: (2. 48 ± 1.11 ) kPa ] in the third and fifth day of experimental group were lower than that of control group [ 5 d: (3. 12 ± 1.09 ) kPa ]. Prognosis of pentobarbital group was better than control group( P < 0. 05 ). Conclusions Pentobarbital can effectively reduce intracranial pressure in patients with refractory intracranial hypertension and improve brain tissue oxygen. PbtO2 is an ideal monitoring marker, and it can predict prognosis to a certain extent.

Objective To investigate the effect of open nursing management on hospital rehabilitation of patients with schizophrenia.MethodsThe outcome of group A,which included 113 patients in open nursing management,and group B,which included 141 patients in close nursing management at the same time,were evaluated with the Brief Psychiatric Rating Scale(BPRS)and the Nurses' Observation Scale for Impatient Evaluation(NOSIE),etc.ResultsThe difference between the two groups in such as the time of symptoms improved,drugs administration,effective rates were not significant(P>0.05).The compliance of medicine,social capability and personal sanitation of group A were improved compared with those in group B(P<0.05),while the time stay in hospital obviously shortened(P<0.01).ConclusionThe open nursing management is helpful to improve the rehabilitation and shorten the time stay in hospital of patients with schizophrenia.

OBJECTIVETo investigate the possibility of using melanoma antigen-1 (MAGE-1) peptide as a tumor vaccine to treat hepatocellular carcinoma (HCC).

METHODSThe expressions of MAGE-1 in 8 HCC cell lines and in liver cancer tissue from a patient were detected using RT-PCR. The type of human leucocyte antigen I(HLA I) of both 8 HCC cell lines and peripheral blood mononuclear cells of the patient was detected using a microcytotoxicity method to screen out target cell lines for the cytotoxicity assay. Peripheral blood mononuclear cells from the HCC patient pulsed with an MAGE-1 peptide (NYKCRFPEI) were used as antigen presenting cells. Autogenous peripheral blood mononuclear cells were stimulated with antigen presenting cells every 7 days for 4 times to elicit cytotoxic T lymphocytes. The phenotype of effector cells was analyzed using flow cytometry. The cytotoxicity of effector cells was detected with a lactate dehydrogenase releasing assay.

RESULTSThe expressions of both MAGE-1 and HLA-A24 were detected in BEL7405 cell line which were used as the positive target cell line in the cytotoxicity assay. The expression of MAGE-1 alone was detected in HLE, BEL7402, BEL7404, QGY7703 and SMMC7721 cell lines, and the expression of neither MAGE-1 nor HLA-A24 was shown in QGY 7701 and HpG2 cell lines. The last 7 cell lines could be used as negative target cell lines in the cytotoxicity assay. Peripheral blood mononuclear cells expanded 32 folds during 28-day culture. The ratio of CD3(+) T cells increased by 16% (from 54% to 70%), and the ratio of CD8(+) T cells increased by 20% (from 36% to 56%) during 28-day culture. When the ratio of effector cells to target cells was 10:1, effector cells exhibited 62.5% cytotoxicity against autogenous lymphoblasts pulsed with the peptide (NYKCRFPEI) of MAGE-1 antigen, 40.25% cytotoxicity against BEL7405 cells, compared with 17.88% cytolysis observed against autogenous lymphoblasts, 19.55% against HLE cells, and 1.6% against QGY7701 cells. When the ratio of effector cells to target cells was 3.3:1, the cytotoxicity of effector cells against the peptide pulsed autogenous lymphoblasts was 53.6%, which was much higher against autogenous lymphoblasts, HLE cells and QGY7701 cells at 15.6%, 13% and 1%, respectively.

CONCLUSIONThe results demonstrate that cytotoxic T lymphocytes with the ability to specifically lyse target cells expressing both MAGE-1 and HLA-A24 could be successfully induced by the MAGE-1 peptide NYKCRFPEI in vitro. This indicates that a good result might be anticipated if this peptide is used as a tumor vaccine to treat HLA-A24 HCC patients.

Adult ; Antigens, Neoplasm ; Cancer Vaccines ; immunology ; Carcinoma, Hepatocellular ; immunology ; HLA-A Antigens ; analysis ; HLA-A24 Antigen ; Humans ; Liver Neoplasms ; immunology ; Male ; Melanoma-Specific Antigens ; Neoplasm Proteins ; genetics ; immunology ; RNA, Messenger ; analysis ; T-Lymphocytes, Cytotoxic ; immunology ; Tumor Cells, Cultured