Objective: Alveolar bone loss is a common adverse effect of intrusion treatment.Mandibular incisors are prone to dehiscence and fenestrations as they suffer from thinner alveolar bone thickness. Methods: Thirty skeletal class II patients treated with mandibular intrusion arch therapy were included in this study. Lateral cephalograms and cone-beam computed tomography images were taken before treatment (T1) and immediately after intrusion arch removal (T2) to evaluate the tooth displacement and the alveolar bone changes. Pearson’s and Spearman’s correlation was used to identify risk factors of alveolar bone loss during the intrusion treatment. Results: Deep overbite was successfully corrected (P < 0.05), accompanied by mandibular incisor proclination (P < 0.05). There were no statistically significant change in the true incisor intrusion (P > 0.05). The labial and lingual vertical alveolar bone levels showed a significant decrease (P < 0.05). The alveolar bone is thinning in the labial crestal area and lingual apical area (P < 0.05); accompanied by thickening in the labial apical area (P < 0.05). Proclined incisors, non-extraction treatment, and increased A point-nasion-B point (ANB) degree were positively correlated with alveolar bone loss. Conclusions While the mandibular intrusion arch effectively corrected the deep overbite, it did cause some unwanted incisor labial tipping/flaring. During the intrusion treatment, the alveolar bone underwent corresponding changes, which was thinning in the labial crestal area and thickening in the labial apical area vice versa. And increased axis change of incisors, non-extraction treatment, and increased ANB were identified as risk factors for alveolar bone loss in patients with mandibular intrusion therapy.

Cryoablation (CRA) and microwave ablation (MWA) are two main local treatments for hepatocellular carcinoma (HCC). However, which one is more curative and suitable for combining with immunotherapy is still controversial. Herein, CRA induced higher tumoral PD-L1 expression and more T cells infiltration, but less PD-L1^highCD11b⁺ myeloid cells infiltration than MWA in HCC. Furthermore, CRA had better curative effect than MWA for anti-PD-L1 combination therapy in mouse models. Mechanistically, anti-PD-L1 antibody facilitated infiltration of CD8⁺ T cells by enhancing the secretion of CXCL9 from cDC1 cells after CRA therapy. On the other hand, anti-PD-L1 antibody promoted the infiltration of NK cells to eliminate PD-L1^highCD11b⁺ myeloid cells by antibody-dependent cell-mediated cytotoxicity (ADCC) effect after CRA therapy. Both aspects relieved the immunosuppressive microenvironment after CRA therapy. Notably, the wild-type PD-L1 Avelumab (Bavencio), compared to the mutant PD-L1 atezolizumab (Tecentriq), was better at inducing the ADCC effect to target PD-L1^highCD11b⁺ myeloid cells. Collectively, our study uncovered the novel insights that CRA showed superior curative effect than MWA in combining with anti-PD-L1 antibody by strengthening CTL/NK cell immune responses, which provided a strong rationale for combining CRA and PD-L1 blockade in the clinical treatment for HCC.

Objective To investigate the predictive value of Rho-associated coiled-coil contai-ning kinase1(ROCK1)and ROCK2 for no reflow in patients with acute ST segment elevation myocar-dial infarction(STEMI)undergoing percutaneous coronary intervention(PCI).Methods A total of 168 STEMI patients who received PCI were selected as study objects,and were divided into no reflow group and normal blood flow group based on whether no reflow occurred,were divided into high ex-pression group and low expression group based on the expression of ROCK1 and ROCK2.Enzyme linked immunosorbent assay was used to detect the levels of serum ROCK1 and ROCK2.The differ-ences in serum levels of ROCK1 and ROCK2 between the no reflow group and the normal blood flow group were analyzed,and the risk factors for no reflow in STEMI patients undergoing PCI treatment were analyzed,the predictive value of ROCK1 and ROCK2 for no reflow in STEMI patients undergoing PCI treatment were analyzed.Results Of 168 STEMI patients,no reflow occurred in 46 cases(27.38％).The Killip grade,time from onset to hospital admission,proportion of patients who did not use proph-ylactic no reflow,serum ROCK1 level and serum ROCK2 level in the no reflow group were higher or longer than those in the normal blood flow group(P＜0.05).The incidence of no reflow in ROCK1 high expression group was higher than that in ROCK1 low expression group,and the incidence of no reflow in ROCK2 high expression group was higher than that in ROCK2 low expression group,the differences were statistically significant(P＜0.05).The incidence rates of no reflow in the ROCK1 high expression group and ROCK2 high expression group were higher than that in the ROCK1 low expression group and ROCK2 low expression group(P＜0.05).Multiple Logistic regression analy-sis showed that Killip grade of Ⅲ to Ⅳ,longer onset to admission time,no using prophylactic no re-flow drugs,and higher serum levels of ROCK1 and ROCK2 were all risk factors for no reflow in STEMI patients undergoing PCI(P＜0.05).Receiver operating characteristic curve showed that ROCK1 and ROCK2 had high predictive value for PCI in STEMI patients without reflow,and the predictive value was increased after the combination of ROCK1 and ROCK2.The area under the curve was 0.789(95％CI,0.711 to 0.867).Conclusion High serum levels of ROCK1 and ROCK2 are both risk factors for no reflow in STEMI patients undergoing PCI,and their combination has high predictive value for no reflow.

Objective To investigate the predictive value of Rho-associated coiled-coil contai-ning kinase1(ROCK1)and ROCK2 for no reflow in patients with acute ST segment elevation myocar-dial infarction(STEMI)undergoing percutaneous coronary intervention(PCI).Methods A total of 168 STEMI patients who received PCI were selected as study objects,and were divided into no reflow group and normal blood flow group based on whether no reflow occurred,were divided into high ex-pression group and low expression group based on the expression of ROCK1 and ROCK2.Enzyme linked immunosorbent assay was used to detect the levels of serum ROCK1 and ROCK2.The differ-ences in serum levels of ROCK1 and ROCK2 between the no reflow group and the normal blood flow group were analyzed,and the risk factors for no reflow in STEMI patients undergoing PCI treatment were analyzed,the predictive value of ROCK1 and ROCK2 for no reflow in STEMI patients undergoing PCI treatment were analyzed.Results Of 168 STEMI patients,no reflow occurred in 46 cases(27.38％).The Killip grade,time from onset to hospital admission,proportion of patients who did not use proph-ylactic no reflow,serum ROCK1 level and serum ROCK2 level in the no reflow group were higher or longer than those in the normal blood flow group(P＜0.05).The incidence of no reflow in ROCK1 high expression group was higher than that in ROCK1 low expression group,and the incidence of no reflow in ROCK2 high expression group was higher than that in ROCK2 low expression group,the differences were statistically significant(P＜0.05).The incidence rates of no reflow in the ROCK1 high expression group and ROCK2 high expression group were higher than that in the ROCK1 low expression group and ROCK2 low expression group(P＜0.05).Multiple Logistic regression analy-sis showed that Killip grade of Ⅲ to Ⅳ,longer onset to admission time,no using prophylactic no re-flow drugs,and higher serum levels of ROCK1 and ROCK2 were all risk factors for no reflow in STEMI patients undergoing PCI(P＜0.05).Receiver operating characteristic curve showed that ROCK1 and ROCK2 had high predictive value for PCI in STEMI patients without reflow,and the predictive value was increased after the combination of ROCK1 and ROCK2.The area under the curve was 0.789(95％CI,0.711 to 0.867).Conclusion High serum levels of ROCK1 and ROCK2 are both risk factors for no reflow in STEMI patients undergoing PCI,and their combination has high predictive value for no reflow.

Stimulator of interferon genes (STING) is a cytosolic DNA sensor which is regarded as a potential target for antitumor immunotherapy. However, clinical trials of STING agonists display limited anti-tumor effects and dose-dependent side-effects like inflammatory damage and cell toxicity. Here, we showed that tetrahedral DNA nanostructures (TDNs) actively enter macrophages to promote STING activation and M1 polarization in a size-dependent manner, and synergized with Mn²⁺ to enhance the expressions of IFN-β and iNOS, as well as the co-stimulatory molecules for antigen presentation. Moreover, to reduce the cytotoxicity of Mn²⁺, we constructed a TDN-MnO₂ complex and found that it displayed a much higher efficacy than TDN plus Mn²⁺ to initiate macrophage activation and anti-tumor response both in vitro and in vivo. Together, our studies explored a novel immune activation effect of TDN in cancer therapy and its synergistic therapeutic outcomes with MnO₂. These findings provide new therapeutic opportunities for cancer therapy.

Since distraction osteogenesis had been used in maxillofacial surgery in the 1990s,it has become an important option for treating maxillary hypoplasia in cleft lip and palate (CLP) patients. Numerous domestic and international studies reported that the prognosis of distraction osteogenesis might be affected by various factors, including the design of osteotomy line, type of distractor, advancement of maxillary bone and the age of patients, etc. Therefore, the present article reviewed possible impact factors that affect the effectiveness and outcomes of maxillary distraction osteogenesis of CLP from three aspects: treatment methods, type of patients and adjuvant therapy, which hopefully might benefit the formulation of treatment strategies in clinical work and improve the prognosis of distraction osteogenesis.

Objective:To explore the clinical effect of nebulized acetylcysteine inhalation combined with bronchoscopy in treating elderly patients with severe ventilator-associated pneumonia (VAP).Methods:From January 2016 to December 2017, 80 elderly patients with severe VAP who were hospitalized in Zhejiang Hospital were divided into acetylcysteine+ bronchoscopy group [24 males and 16 females, aged (78±7) years] and bronchoscopy group [26 males and 14 females, aged (80±7) years]using random number table for a prospective cohort study. Patients in bronchoscopy group were treated with bronchoscopy in addition to conventional supportive care of symptoms. Patients in acetylcysteine+ bronchoscopy group received nebulized acetylcysteine inhalation therapy on the basis of the treatment given to patients in bronchoscopy group. Patients in both groups received treatment continuously for 7 days. The simplified clinical pulmonary infection score (CPIS) in both groups was assessed before and after treatment. Venous blood of 10 mL was collected before and after treatment to detect leukocyte count, serum C-reactive protein, and procalcitonin. Arterial blood of 1 mL was collected before and after treatment to detect partial arterial oxygen pressure (PaO 2), partial arterial carbon dioxide pressure (PaCO 2), oxygenation index. The inhalation platform pressure (Pplat), dynamic lung compliance (Cdyn), airway resistance, work of breathing, time of antibiotic use, and time of mechanical ventilation of patients in two groups were recorded before and after treatment. Data were statistically analyzed with chi-square test and t test. Results:(1) The simplified CPIS, leukocyte count, serum C-reactive protein, and procalcitonin of patients in acetylcysteine+ bronchoscopy group were significantly lower than those in bronchoscopy group after treatment ( t=2.32, 2.15, 6.08, 7.12, P<0.05 or P<0.01). The simplified CPIS, leukocyte count, serum C-reactive protein, and procalcitonin of patients in acetylcysteine+ bronchoscopy group and bronchoscopy group after treatment were significantly lower than those before treatment ( t=13.76, 13.60, 12.70, 8.32, 11.44, 14.28, 9.48, 9.50, P<0.01). (2) Compared with bronchoscopy group, patients in acetylcysteine+ bronchoscopy group had significantly higher PaO 2 and oxygenation index ( t=4.14, 2.55, P<0.05 or P<0.01) but significantly lower PaCO 2 ( t=4.36, P<0.01) after treatment. The PaO 2 and oxygenation index of patients in acetylcysteine+ bronchoscopy group after treatment were significantly higher than those before treatment ( t=10.90, 43.72, P<0.01). The PaO 2 and oxygenation index of patients in bronchoscopy group after treatment were also significantly higher than those before treatment ( t=6.55, 43.03, P<0.01). The PaCO 2 of patients in both groups after treatment were significantly lower than those before treatment ( t=21.54, 21.92, P<0.01). (3) The Cdyn of patients in acetylcysteine+ bronchoscopy group after treatment was significantly higher than that in bronchoscopy group ( t=5.41, P<0.01), and Pplat, airway resistance, and work of breathing were significantly lower than those in bronchoscopy group ( t=2.18, 5.46, 2.49, P<0.05 or P<0.01). The Cdyn of patients in both groups after treatment were significantly higher than those before treatment ( t=16.10, 10.90, P<0.01), and Pplat, airway resistance, and work of breathing were significantly lower than those before treatment ( t=21.18, 11.13, 9.32, 15.50, 5.17, 5.97, P<0.01). (4)The time of mechanical ventilation and antibiotic usage of patients in acetylcysteine+ bronchoscopy group were (6.9±1.9)and (8.7±2.8) d, respectively, which were significantly shorter than (10.1±2.2) and (11.6±3.5) d in bronchoscopy group ( t=6.85, 4.09, P<0.01). Conclusions:Nebulized acetylcysteine inhalation combined with bronchoscopy can significantly control the degree of lung infection in elderly patients with severe VAP, improve patients′ respiratory mechanics parameter and blood gas analysis indicator, and shorten the time for mechanical ventilation and antibiotic usage.

Objective To evaluate the incidence, prognosis and influencing factors of lower cranial nerve palsy after microvascular decompression (MVD) in patients with hemifacial spasm (HFS). Methods Clinical data of 1033 patients with HFS, admitted to our hospital from May 2014 to August 2016, were retrospectively analyzed. The incidence of lower cranial nerve palsy after procedure and prognosis of these patients were summarized; and influencing factors were analyzed by statistical method. Results In 1033 patients with HFS, 10 patients (0.97％) had lower cranial nerve palsy after procedure: 6 patients suffered hoarseness, 2 patients suffered dysphasia, and 2 patients were with both symptoms; the symptoms in 6 patients completely recovered within one month, 2 patients within one-3 months, and 2 patients within 3-6 months. No permanent low cranial nerve palsy occurred. There were no statistical significances in age, gender, clinical course, sides, or the types of offending vessels between the lower cranial nerve palsy patients (n=10) and the non-palsy patients (n=1023)(P>0.05). Conclusion Lower cranial nerve palsy is a rare complication after MVD, and type of responsible vessels is not a influencing factor in this complication

Objective To investigate the operative efficacy of pellucid septostomy in patients with septum pellucidum cysts and refractory epilepsy.Methods Nine patients with septum pellucidurn cysts and refractory epilepsy,admitted to our hospital from January 2012 to September 2017,chosen;diagnosis by MR imaging was performed in all patients and no other obvious epilepsy lesions were noted.All patients underwent bilateral endoscopic fenestration (pellucid septostomy) by right frontal approach.Follow-up was performed for 6-72 months.Results All patients took antiepileptic regularly.No overall tonic-clonic seizure was noted in 6-72 months of follow-up.Shrunk septum pellucidum cysts were noted in MR imaging.Conclusion Patients with septum pellucidum cysts and refractory epilepsy could be cured by pellucid septostomy.

Objective To evaluate the clinical application of preoperative multi-slice computed tomography (MSCT) and multi-slice computed tomography portography (MSCTP) in performing transjugular intrahepatic portosystemic stent shunt (TIPSS) combined with gastric coronary vein embolization (GCVE). Methods A total of 126 patients with cirrhosis complicated by upper gastrointestinal bleeding or massive ascites due to portal hypertension were enrolled in this study. The patients were arranged to receive TIPSS together with GCVE. Before the treatment, MSCT and MSCTP were performed in all patients. By using post-processing techniques, including maximum intensity projection (MIP), multiplanar reformation (MPR), volume rendering (VR) and surface shade display (SSD), the anatomy of liver was comprehensively evaluated. Results Both MSCT and MSCTP could clearly display morphologic changes of liver , the spatial relationship of the portal and hepatic veins , the degree and extent of portal collateral circulation , and the severity of ascites, which provided important anatomical information for preoperative evaluation of TIPSS and GCVE. Conclusion MSCT and MSCTP are non-invasive and reliable examinations for the diagnosis of cirrhosis with portal hypertension, it can further clarify the diagnosis and guide the performance of TIPSS and GCVE.