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 discuss the protective effect of ginsenoside Rh1(G-Rh1)on kidney injury in the diabetic mellitus(DM)mice,and to clarify its mechanism.Methods:The diabetic kidney disease(DKD)model was prepared by using the high-fat,high-sugar diet combined with intraperitoneal injection of streptozotocin(STZ).A total of 48 C57/BL6 model mice were randomly divided into model group,nuclear factor erythroid 2-related factor 2(Nrf2)inhibitor ML385 group(ML385 group)(30 mg·kg-1),G-Rh1 group(30 mg·kg-1),and G-Rh1+ML385 group(30 mg·kg-1 G-Rh1+30 mg·kg-1 ML385),and there were 12 mice in each group.Additionally,12 C57/BL6 mice were selected as control group.After treated for 8 weeks,automatic analyzer was used to detect the levels of fasting blood glucose(FBG),blood urea nitrogen(BUN),and serum creatinine(Scr)in serum of the mice in various groups,as well as 24 h urinary protein(24 h UP)levels in urine,and the kidney index was calculated;kits were used to detect the activities of superoxide dismutase(SOD)and lactate dehydrogenase(LDH),and the levels of malondialdehyde(MDA)in kidney tissue of the mice in various groups;Western blotting method was used to detect the expression levels of Nrf2 and heme oxygenase-1(HO-1)proteins in kidney tissue of the mice in various groups.Results:Compared with control group,the levels of FBG and kidney indexes in serum of the mice in model group,ML385 group,and G-Rh1+ML385 group were significantly increased(P<0.01),and the level of FBG in serum of the mice in G-Rh1 group was significantly increased(P<0.01);compared with model group,the kidney index of the mice in ML385 group was significantly increased(P<0.05),while the levels of FBG and kidney index of the mice in G-Rh1 group were significantly decreased(P<0.05 or P<0.01);compared with G-Rh1 group,the level of FBG and kidney index of the mice in G-Rh1+ML385 group were significantly increased(P<0.01).Compared with control group,the levels of BUN and Scr in serum,and 24 h UP in urine of the mice in model group,ML385 group,G-Rh1 group,and G-Rh1+ML385 group were significantly increased(P<0.01);compared with model group,the level of BUN in serum and 24 h UP in urine of the mice in ML385 group were significantly increased(P<0.05),while the levels of BUN and Scr in serum,and 24 h UP in urine of the mice in G-Rh1 group were significantly decreased(P<0.01);compared with G-Rh1 group,the levels of BUN and Scr in serum,and 24 h UP in urine of the mice in G-Rh1+ML385 group were significantly increased(P<0.01).Compared with control group,the activities of SOD in kidney tissue of the mice in model group,ML385 group,G-Rh1 group,and G-Rh1+ML385 group were significantly decreased(P<0.01),while the levels of MDA and LDH activities were significantly increased(P<0.01);compared with model group,the activity of SOD in kidney tissue of the mice in ML385 group was significantly decreased(P<0.05),and the level of MDA was significantly increased(P<0.05);the activity of SOD in kidney tissue of the mice in of G-Rh1 group was significantly increased(P<0.01),and the level of MDA and activity of LDH were significantly decreased(P<0.01);compared with G-Rh1 group,the activity of SOD in kidney tissue of the mice in G-Rh1+ML385 group was significantly decreased(P<0.01),and the level of MDA and activity of LDH were significantly increased(P<0.01).Compared with control group,the expression levels of Nrf2 and HO-1 proteins in kidney tissue of the mice in model group,ML385 group,G-Rh1 group,and G-Rh1+ML385 group were significantly decreased(P<0.05 or P<0.01);compared with model group,the expression levels of Nrf2 and HO-1 proteins in kidney tissue of the mice in ML385 group and G-Rh1+ML385 group were significantly decreased(P<0.05),while the expression levels of Nrf2 and HO-1 proteins in kidney tissue of the mice in G-Rh1 group were significantly increased(P<0.01);compared with G-Rh1 group,the expression levels of Nrf2 and HO-1 proteins in kidney tissue of the mice in G-Rh1+ML385 group were significantly decreased(P<0.01).Conclusion:Ginsenoside Rh1 reduces the oxidative stress and improves the kidney function,providing protective effects on kidney injury in the DM mice,and its mechanism may be related to the activation of the Nrf2/HO-1 signaling pathway.

Objective To explore the value of synchrotron radiation micro-CT(SR-pCT)and automatic marker watershed image segmentation for quantifying three-dimensional local bone tissue and blood vessels in mouse models of breast cancer tibia metastasis.Methods Mouse models with breast cancer bone metastasis in tibia were established and underwent oral Vatalanib,injection of Bevacizumab,combination of Vatalanib or Bevacizumab,or injection of placebo,respectively.On the 8th day(time point T1)and the 22nd day(time point T2)after injection of tumor cells,the tibia bone was scanned using combined vascular contrast injection and SR-pCT,and high-resolution simultaneous imaging of local bone tissue and vascular network were achieved.Then bone tissue and vessels on images were segmented using automatic marker watershed image-segmentation method,global threshold method and region growing method,respectively,and the quality of segmentations were assessed with Dice similarity coefficient(DSC).The anatomical quantitative parameters of tibia with breast cancer metastasis were obtained,including the fraction of bone volume in total volume(BV/TV),fraction of vessel volume in total volume(VV/TV),the mean thickness of bone(B.Th)and the mean thickness of vessel(V.Th).The anatomical quantitative parameters were compared among different treatments at the same time point,also between different time points under the same treatment.Results DSC for segmentation of local tibia bone tissue and vascular structures based on automatic marker watershed image segmentation method were all greater than 0.95,higher than that of other methods(all P＜0.05).No significant difference of anatomical quantitative parameters was found under different treatments at T1(all P＞0.05),and V.Th under the combined treatment were lower than that under other treatments at T2(all P＜0.05).Compared with T1,BV/TV and B.Th at T2 increased while VV/TV at T2 decreased in tibia metastasis under combination treatment(all P＜0.05),BV/TV,B.Th and V.Th at T2 increased under Vatalanib or Bevacizumab treatment(all P＜0.05),and BV/TV and B.Th at T2 increased under placebo(both P＜0.05).Conclusion The combination of SR-pCT and automatic marker watershed method could be used to initially quantify three-dimensional structures of local bone tissue and blood vessels in mouse models of breast cancer tibia metastasis.

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.

Objective:To investigate the effect and relationship of coronary microvascular dysfunction (CMD) on cardiac mechanical indices in patients with non-obstructive coronary artery disease(NOCAD) in the resting state.Methods:This study was a single-center retrospective study. Seventy-nine NOCAD patients who hospitalized in Qilu Hospital of Shandong University from July 2017 to March 2022 were recruited. All patients underwent conventional echocardiography examination and the examination of coronary flow velocity reserved by transthoracic Doppler echocardiography (TTDE-CFVR). Based on the results of TTDE-CFVR, patients were divided into CMD group (CFVR<2.5, 32 cases) and a control group (CFVR≥2.5, 47 cases). Clinical data, routine echocardiographic parameters, regional mechanical indices including regional myocardial work index(RWI) and regional longitudinal strain(RLS), global mechanical indices including left ventricular global longitudinal strain(GLS), global longitudinal strain in the endocardial layer(GLS-endo), global longitudinal strain in the epicardial layer(GLS-epi), left ventricular global work index(GWI), global contractive work(GCW), global waste work(GWW), global work efficiency(GWE) were compared between two groups. Binary logistic regression was used to analyze the risk factors of CMD. ROC curve was used to construct a prediction model for CMD.Results:There was no significant difference in sex ratio, BMI, smoking history, diabetes, hypertension and dyslipidemia between CMD group and control group. Age was significantly higher in the CMD group than in the control group. RWI, GWI, GCW, GWE and the absolute values of RLS, GLS, GLS-endo and GLS-epi were significantly lower in the CMD group than in the control group. Logistic regression analysis showed that the decrease of absolute value of GLS was an independent risk factor for the CMD( OR=1.335, 95% CI=1.041-1.713, P=0.023). ROC curve showed that myocardial strain-related indexes had a good decrease value for the CMD. Conclusions:For patients with NOCAD, the presence of CMD is associated with the decrease of left ventricular regional and global systolic function.

OBJECTIVE: To analyze the correlation of lipoprotein(a) [Lp(a)] with the clinical stability and severity of coronary artery stenosis in patients with coronary artery disease (CAD). METHODS: A total of 531 patients undergoing coronary angiography in Nanfang Hospital between January, 2013 and December, 2016 were enrolled in this study. At the cutoff Lp(a) concentration of 300 mg/L, the patients were divided into high Lp(a) group (=191) and low Lp(a) group (=340). In each group, the patients with an established diagnosis of CAD based on coronary angiography findings were further divided into stable angina pectoris (SAP) group and acute coronary syndrome (ACS) group. The correlation between the severity of coronary artery stenosis and Lp(a) was evaluated. RESULTS: The patients in high and low Lp(a) groups showed no significant differences in age, gender, body mass index, smoking status, hypertension, or diabetes (>0.05). Multivariate logistic regression analysis revealed that age, gender, and serum levels of low-density lipoprotein cholesterol (LDL-C) and Lp(a) were independent risk factors for CAD in these patients. A high Lp(a) level was associated with an increased risk of CAD (OR=2.443, 95%CI: 1.205-4.951, =0.013). The patients with a high Lp(a) level were at a significantly higher risk of CAD than those with a low Lp(a) level irrespective of a low or high level of LDL-C (=0.006 and 0.020). In the patients with CAD, the ACS group had a significantly higher Lp(a) level than the SAP group ( < 0.001); the proportion of the patients with high Gensini scores was significantly greater in high Lp(a) group than in low Lp(a) group (17.3% vs 5.6%, =0.026), and a linear relationship was found between Lp(a) level and Gensini score (R=0.130, =0.006). CONCLUSIONS Serum level of Lp(a) is an independent risk factor for CAD, and an increased Lp(a) is the residual risk for CAD. In patients with CAD, a high Lp(a) level is associated with the clinical instability and severity of coronary artery stenosis.
Acute Coronary Syndrome ; blood ; Angina Pectoris ; blood ; Cholesterol, LDL ; blood ; Coronary Angiography ; Coronary Artery Disease ; blood ; classification ; Coronary Stenosis ; blood ; pathology ; Humans ; Lipoprotein(a) ; blood ; Regression Analysis ; Risk Factors ; Severity of Illness Index

Objective To analyze characteristics and clinical significance of affected and unaffected side plaques in patients with symptomatic middle cerebral artery (MCA) atherosclerosis by three dimensional-sampling perfection with application optimized contrasts using different flip angle evolutions (3D-SPACE) of 3.0 T high-resolution magnetic resonance imaging (MRI).Methods During the period from September 2016 to June 2017,31 patients admitted to the Peking University Aerospace School of Clinical Medicine were enrolled in this study.Routine MRI and high-resolution MRI were performed respectively.Patient's affected and unaffected sides were distinguished based on the conventional MRI on the presence or absence of signs of ischemia.The characteristics of bilateral MCA plaques were studied by high-resolution MRI 3D-SPACE sequences.The stenosis rate,plaque load,eccentricity index were quantitatively analyzed,and the degree of plaque enhancement and remodeling were qualitatively analyzed.Results Thirty-one MCAs in affected and unaffected sides were respectively collected,and 124 MCA plaques and reference plane images were obtained.Among all the patients,tihe MCA in unaffected side was larger in lumen area and had atherosclerotic plaques,and some MCAs had varying degrees of thickening of the wall.The stenosis rate,plaque burden and significantly enhanced plaque proportion of MCA in affected side were significantly higher than those in unaffected side (stenosis rate:76.2％ ± 11.5％ vs 51.7％ ± 13.1％,t =7.801,P＜0.01;plaque burden:81.6％ ±8.0％ vs 56.7％ ±13.9％,t =8.614,P＜0.01;significantly enhanced plaque proportion:50.0％ (13/26) vs 0 (0/26),x2 =17.333,P＜ 0.01).There was no statistically significant difference in plaque distribution between the two sides.Positive remodeling blood vessels had more vessel area than negative remodeling blood vessels ((13.8 ± 2.9) mm2 vs (11.3 ± 2.8)mm2,t =2.389,P =0.024).Conclusion The high resolution MRI 3D-SPACE sequence clearly shows the MCA wall and plague,and can analyze the enhancement degree and morphological features of affected and unaffected side atherosclerotic plaques simultaneously,thus it is beneficial for risk stratification assessment and individualized treatment for stroke Patients in clinical practice.

Objective To investigate the application value of high-resolution magnetic resonance imaging (HR-MRI) as an auxiliary means to evaluate the atherosclerotic stenosis of middle cerebral artery (MCA) before endovascular intervention.Methods Patients with the new infarction or transient ischemic attack in the MCA territories were examined with HR-MRI and digital subtraction angiography (DSA).HR-MRI was used to study the characteristics of atherosclerotic plaques of MCA,qualitatively analyze vascular stenosis rate and plaque load,and qualitatively analyze the plaque location,enhancement degree,and remodeling pattern.The results of HR-MRI examination were used to guide the selection of treatment methods,and the perioperative complications and 3-month outcome of patients treated with intravascular interventional therapy were statistically analyzed.Correlation analysis and consistent evaluation of MCA stenosis rate and stenosis degree measured by DSA and HR-MRI were conducted.Results Atherosclerotic plaques and luminal stenosis in the MCA were found in 25 patients.Among them,13 (52.0％) had positive remodeling,10 (40.0％) had negative remodeling,and 8 (32.0％) had plaques on the sides of perforator arteries.Of the 17 patients who underwent enhanced scan,11 (64.7％) had mild enhancement and 6 (36.3％) had obvious enhancement.Six patients (24％) were treated with endovascular treatment without perioperative complications.Five patients had good outcome and 1 had poor outcome.The stenosis rates of MCA measured by DSA and HR-MRI were 68.05％ ± 21.65％ and 70.9％ ± 20.7％,respectively (t =1.673,P=0.107).The two methods had good correlation (r=0.917,P＜ 0.001).In addition,in the diagnosis of mild (P =0.500),moderate (P =0.063) and severe (P =0.250) stenoses,DSA and HR-MRI also had good consistency.Conclusion HR-MRI can clearly show the characteristics of the middle cerebral artery lumen and plaque.As a preoperative evaluation means for assisted endovascular treatment of atherosclerotic stenosis,it has an important application value.

Objective To investigate the species composition and quantitative dynamic state of rodent and parasitic flea in Huairou District of Beijing City,and to carry out serologic monitoring of animal plague.Methods Rodent density was investigated at different habitats in eight villages and towns between 2009 and 2011.Serum samples from captured rodents were detected by indirect hemagglutination test,and genotypes of collected parasitic fleas were identified.Results A total of 709 rodents which belong to eight different kinds were captured with a rodent density of 2.52％ (83/3 300),and Rattus niviventer and Apodemus peninsulae were dominant species,acounted for 46.4％ (329/709) and 18.1％(128/709),respctively.Five hundred and sixty-three serum samples of rodents were tested by plague indirect hemagglutination,and all of them were plague antibody negative.Two hundred fleas were checked with a flea infected rate of 29.63％ (48/162),and a flea index of 1.23; Paraceras crispus and Leptopsylla pavlovskii were dominant flea species,a total of 30 and 27,respectively.Conclusion Some environment conditions are suitable for rodents survival,even though there is no sign of animal plague epidemic.