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.

In order to improve the yield and simplify the operation, the synthesizing process of JAK3 inhibitor tofacitinib citrate was improved based on the analysis of the methods previously published.Using 2, 4-dichloro-7H-pyrrolo [2, 3-d] pyrimidine and (3R, 4R)-1-benzyl-N, 4-dimethylpiperidin-3-amine dihydrochloride as starting materials, tofacitinib citrate was obtained through four steps of nucleophilic substitution, catalytic transfer hydrogenation, cyanide acetylation and citrate salt, and its crystal form was consistent with the original research.After optimization, the yield was better than those reported in literature, and the mild reaction conditions were suitable for industrial production.

Objective: To identify confounding factors associated with dental caries prevention, as the basis for the development of subsequent health management plan for dental caries prevention in young children. Methods: From June to September 2019, a questionnaire survey was conducted among parents of young children enrolled in five kindergartens in the district of Shanggang Steel Community, Pudong New District, Shanghai, using the convenience sampling method. The survey included basic demographic characteristics on parents and children, as well as information factor, motivation factor, behavioral skills, and caries prevention behavior. Results: Among 718 parents surveyed, the median information factor score was 8 (7, 9), the median personal motivation factor score was 20 (19, 20), the median social motivation factor score was 9 (8, 10), the median behavioral skills score was 25 (24, 25), and the median caries prevention behavior score was 7 (5, 8). Motivation factor was positively associated with behavioral skills, both information factor and behavioral skills were positively associated with dental caries prevention (P<0.05). Personal motivation factor had a direct influence factor of 0.80 on behavioral skills and an indirect influence factor of 0.15 on dental caries prevention behavior; behavioral skills and information factor had a direct influence factor of 0.19 and 0.26 respectively on dental caries prevention. Conclusion The finding suggest that in addition to oral hygiene information and education for parents of young children, mental support should be a key component of any community-based dental caries prevention program.

Objective: To investigate the immunohistochemical staining of anaplastic lymphoma kinase (ALK; clone 1A4) in pediatric medulloblastoma (MB). Methods: Molecular subtyping was performed based on the NanoString and sequencing techniques for 44 pediatric MB cases at Children′s Hospital, Zhejiang University School of Medicine from 2014 to 2017. ALK expression was detected with EnVision immunhistochemistry using ALK clone 1A4 on whole section. Statistical analyses were performed to evaluate the correlation of protein expression with molecular subgroups. Results: The age ranged from 0.5 to 13.0 years with an average age of 5.8 years. There were 28 males and 16 females, and 31 classic, 5 desmoplastic nodular, 3 extensive nodular and 5 large cell/anaplastic MBs. Except three cases was unable classified, 41 MBs were classified into the four molecular groups: 5 in WNT group, 12 in SHH group, 9 in Group 3 and 15 in Group 4. Thirteen of 44 MB cases were positive staining for ALK, and the positive rate was 29.5%. Six cases were strong reaction, and 7 cases were weak. The expression of ALK at the protein level was associated with the WNT group (P<0.01). The characteristic perinuclear dot-like staining was only showed in WNT group. Conclusions The ALK immunhistochemistry using antibody clone 1A4 is a useful marker for the molecular subgroup detection of MB. The strong staining and perinuclear dot-like staining indicate as WNT group.

Objective To analyze the clinical efficacy of Yanshu compound sophora flavescens injection (Yanshu injection) combined with paclitaxel and cisplatin (TP) regimen in the treatment of advanced non-small cell lung cancer (NSCLC). Methods One hundred and sixty-two patients with NSCLC admitted to the Department of Oncology of Danyang Hospital of Traditional Chinese Medicine from May 2014 to June 2018 were enrolled, all of their definite diagnosis was based on pathological or cytological examinations, and they were divided into two groups by the administration type, 81 cases in each group. The western medicine treatment group (western group) was treated with TP regimen alone, 3 weeks constituting 1 therapeutic course, and 3 consecutive courses were treated; based on the treatment of western drug TP regimen, the integrated traditional Chinese and western medicine treatment group (combined group) was additionally and simultaneously given Yanshu injection for consecutive 2 weeks. After treatment, the clinical efficacy and incidence of adverse reactions of the two groups were observed. Results The total effective rate in the combined group was significantly higher than that in western group [60.49% (49/81) vs. 40.74% (33/81), P <0.05]; the incidences of adverse events: alopecia, thrombocytopenia, neurotoxicity, leukopenia, nausea and vomiting, and gastrointestinal reaction in the combined group were obviously lower than those in western group [alopecia: 24.69% (20/81) vs. 60.49% (49/81), thrombocytopenia: 23.45% (19/81) vs. 40.74% (33/81), neurotoxicity: 14.81% (12/81) vs. 34.57% (28/81), leukopenia: 17.28% (14/81) vs. 62.96% (51/81), nausea and vomiting: 14.81% (12/81) vs. 60.49% (49/81), gastrointestinal reaction: 27.16% (22/81) vs. 62.96% (51/81), all P < 0.05]. Conclusion Yanshu injection combined with TP regimen is obviously effective in the treatment of advanced NSCLC, thus it is worthy to be applied clinically.

Objective To investigate the influence of tiotropium bromide on lung function index,quality of life and re-hospitalization risk of patients with bronchial dilation and pulmonary infection.Methods 100 patients with bronchiectasis and lung infection were chosen,and they were randomly divided into control group (50 patients) with BAL used alone and observation group(50 patients) with tiotropium bromide on the basis of control group.The short-term clinical effects,the levels of FVC,FEV1 and FEV1 ％,BODE index scores and QLI scores before and after treatment,and re-hospitalization rate of the two groups were compared.Results The short-term effective rate of the observation group was significantly higher than that of the control group(94.00％ vs.76.00％,x2 =7.81,P ＜ 0.05).The levels of FVC,FEV1 and FEV1％ after treatment of both two groups were significantly higherthan before treatment[(2.78 ±0.57)L vs.(2.15 ± 0.33) L,(3.60 ± 0.71) L vs.(2.20 ± 0.36) L;(2.15 ± 0.42)L vs.(1.23 ±0.32)L,(2.77±0.59)L vs.(1.17 ±0.29)L;(65.25 ±11.45)％ vs.(51.79 ±9.23)％,(77.46 ±15.80) ％ vs.(52.02 ± 9.36) ％,t =2.34,2.97;2.52,3.07;2.47,3.12,all P ＜ 0.05].After treatment,the levels of FVC,FEV1 and FEV1 ％ of the observation group were significantly higher than control group [(3.60 ± 0.71) L vs.(2.78 ±0.57)L;(2.77 ±0.59)L vs.(2.15 ±0.42)L;(77.46±15.80)％ vs.(65.25 ± 11.45)％,t =2.26,2.44,2.30,all P ＜0.05].The QLI score and BODE index scores after treatment of both two groups were significantly better than before treatment[(3.37 ± 0.54) points vs.(3.95 ± 0.65) points,(2.11 ± 0.40) points vs.(3.87 ±0.61)points,(7.28 ±1.18)points vs.(5.04 ± 0.95) points,(8.69 ± 1.54) points vs.(5.13 ±0.98) points,t =2.29,2.81;2.50,2.96,all P ＜ 0.05].After treatment,the QLI score and BODE index scores of the observation group were significantly better than the control group[(2.11 ±0.40) points vs.(3.37 ±0.54) points,(8.69 ± 1.54) points vs.(7.28 ± 1.18)points,t =2.21,2.44,all P ＜ 0.05].The re-hospitalization rate of the observation group was significantly lower than that of the control group (16.00％ vs.2.00％;28.00％ vs.6.00％;x2 =8.02,9.74,all P ＜ 0.05).Conclusion Selective cholinergic receptor blocker combined with BAL in the treatment of patients with bronchial dilation and pulmonary infection can efficiently relieve the respiratory symptoms,improve lung function,improve the quality of life and is helpful to avoid re-hospitalization occurrence.

BACKGROUND:Human umbilical cord mesenchymal stem cells (hUC-MSCs) may be mutated duringin vitro culture based on the spontaneous malignant transformation of adult stem cells and tumor stem cell theory, and there may be a risk of tumorigenesis after in vivo transplantation. Therefore, to establish and perfect the in vitro safety testing procedures will actively promote the clinical application of stem cells. OBJECTIVE:To investigate the tumorigenic mechanism of hUC-MSCs and the expression level of DNA methyltransferase (DNMTs) in hUC-MSCs. METHODS:Primary hUC-MSCs were isolated and expanded by tissue adherent culture. 3-Methycholanthrene was used to cause the malignant transformation in hUC-MSCs (experimental group), followed by morphological observation and tumorigenesis experiment in nude mice. Then, the tumor tissues were obtained and identified by pathological examination and primary cell culture, and the levels of DNMTs mRNA in hUC-MSCs treated with 3-methycholanthrene and dimethyl sulfoxide (control group) were detected by real-time RT-PCR and compared. RESULTS AND CONCLUSION:hUC-MSCs treated with 3-methycholanthrene led to malignant transformation, which showed malignant growth and non-integer ploidy changes in the cell nuclei, and formed a malignant tumor in immune-deficient mice after injection. Compared with the control group, the cells in the experimental group showed higher expression of DNMTs mRNA as detected by real-time RT-PCR. To conclude, hUC-MSCs can trigger malignant transformation in the morphology and the epigenetics under certain conditions. DNMTs can be a candidate for prevention against malignant transformation of transplanted stem cells.

Objective: To understand the clinical manifestation, imaging characteristics and outcomes of pulmonary malignant tumors in children. Method: We retrospectively collected information about seven cases of pulmonary malignant tumors in children in our hospital from Jan 2010 to Dec 2016. The information included clinical manifestation, imaging characteristics, pathologic results, and treatment. Result: (1) All the seven patients firstly visited pediatric internal medicine departments. Symptoms included cough (n=6), dyspnea (n=4), fever (n=2), anorexia (n=2), chest tightness (n=1), chest pain (n=1), lameness (n=1), abdominal distension and constipation (n=1). We did not find hemoptysis, wheezing or weight loss in those patients. Physical examinations revealed unilateral reduced breath sounds (n=5), moist rales and wheezes (n=1), and normal (n=1). Extrapulmonary signs included abdominal distension (n=2), left hip tenderness (n=1), and mass in left scrotum. We did not identify clubbing finger, anemic appearance, lymph node enlargement, or hepatosplenomegaly etc. (2) Laboratory examination results: complete blood count showed white blood cells in normal range except one case (17.44×10⁹/L). Neutrophil percentage ranged from 0.348 to 0.767. C reactive protein ranged between<1 and 162 mg/L. Hemoglobin was normal. Three out of four cases had abnormal blood tumor markers.(3) Imaging results showed multiple nodes (n=3), multiple cystic lesions in lungs (n=2) (both with pleuropulmonary blastoma), endobronchial soft tissue mass (n=1), pulmonary round-shaped mass (n=1), and mediastinal mass (n=1). Imaging results also found atelectasis (n=3), pneumonia (n=2), pneumothorax (n=2), longitudinal diaphragmatic hernia (n=2), pleural effusion (n=1), subcutaneous emphysema (n=1). (4) All the patients underwent tumor puncture biopsy or tumor resection. Pathology revealed the final diagnosis of pleuropulmonary blastoma (n=3), endodermal sinus tumors (n=2), squamous cell carcinoma of lung (n=1), and thyroid papillary carcinoma (n=1). All of them were malignant tumors. We followed up them. Two patients died (both with pleuropulmonary blastoma) after their parents refused any medical help. Two cases were lost to follow-up. Three patients survived (followed up for 19 months, 11 months and tow months, respectively). One case with thyroid papillary carcinoma pulmonary metastasis underwent right thyroid cancer radical plus left thyroid lobe resection plus modified selective central lymph node dissection, then iodine ¹³¹ treatment. One case with endodermal sinus tumor pulmonary metastasis underwent three times of chemotherapies, resection of left retroperitoneal tumor and left testicular tumor, and six additional chemotherapies. Another one case of endodermal sinus tumor pulmonary metastasis underwent three times of chemotherapies and was discharged. Conclusion Pulmonary malignant tumors are rare diseases in children. Clinical signs are often non-specific. For those with chest CT showing multiple cystic lesions, endobronchial soft tissue mass or multiple nodes, but no significant infection manifestation or no response to anti-infection therapy, pulmonary malignant tumors should be considered. Biopsy may be needed to confirm the final diagnosis.

Objective To investigate the effects of “patient-family-community”health promotion mode on patients with impaired glucose regulation(IGR).Methods Using the function of random case samples in SPSS,we randomly chose an experimental village and a control village respectively from all villages in Zhuqiao of Pudong New Area.Altogether 75 IGR patients who met the requirement were filtered in the two villages. According to the villages they belonging to,39 of them were divided into experimental group and 36 to control group.From March 201 4 to August 201 4, subjects in the experimental group were intervened by“patient-family-community”health promotion mode,while participants in the control group used the regular health guidance.We compared the test score of knowledge-attitude-practice (KAP) questionnaire,family APGAR questionnaire and blood glucose between two groups.Results Relevant indexes of the two groups before intervention showed no difference (P >0.05).After intervention,the knowledge(K),attitude(A)and practice (P)test scores of the experimental group were (8.85 ±1 .31 ),(8.87 ±1 .77)and (6.92 ±2.67),higher than (5.86 ±2.37),(6.78 ±2.92)and (3.89 ±3.02)of the control group(Z =-5.1 89,-3.299,-4.042;P <0.05).The APGAR test scores of the experimental group(7.56 ±1 .90)was higher than(6.47 ±1 .77)of the control group(t =2.571 ,P <0.05).The FPG,2hPG and HbA1 c of the experimental group were (5.86 ± 0.50)mmol/L,(8.02 ±0.72)mmol/L and(5.73 ±0.42)%,which were lower than (6.1 1 ±0.45)mmol/L, (8.60 ±0.97)mmol/L and(5.97 ±0.53)% of the control group (t =-2.293,-2.383,-2.1 70;P <0.05).Conclusions Applying “patient-family-community”health promotion mode can improve the KAP, family function of IGR patients,control their blood glucose better and prevent diabetes.

Objective To analyzed distribution characteristics of gene mutation and gene carrying rate of thalassaemia in Shenzhen.Methods 2 500 cases with adult,neonatal umbilical cord blood of 2 500 cases for alpha thalassaemia,beta thalas-saemia,gene types and carry frequency were analyzed.Results 8 types of alpha thalassemia gene 128 cases,rate of detection was 5.12% (128/2 500),and the main genetic types were-SEA/αα(54 cases,42.19%),-SEA/-α3.7 (32 cases,25%)respec-tively.2 500 cases of adult samples were checked out 7 types of gene mutation 101 cases,and detection rate was 4.04%(101/2 500).Main gene mutation type were CD41-42 (39 cases,38.61%),IVS-2-654 (20,21 cases,79%),CD17 (18 cases, 17.82%)and-28 (13 cases,12.87%)respectively.Conclusion Shenzhen thalassaemia mutation type and frequency had ob-vious regional characteristics and times characteristics,health authorities should strengthen epidemiology study,formulate corresponding prevention and intervention measures.