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 investigate the short-term efficacy and clinical safety of pharmacomechanical catheter-directed thrombolysis(PCDT)combined with Venovo(Bard)venous stent implantation in treating iliac vein compression syndrome(IVCS)associated with acute lower extremity deep venous thrombosis(DVT).Methods The clinical data of 23 IVCS patients with acute DVT,who received PCDT combined with Venovo venous stent implantation at the Fifth Affiliated Hospital of Zhengzhou University of China between July 2022 and December 2022,were retrospective analyzed.The differences in preoperative and postoperative lower limb circumference and the postoperative thrombus clearance rate were evaluated.Outpatient follow-up was conducted at one,3,and 6 months after treatment,and the patient's venous clinical severity score(VCSS)was recorded and the stent patency was checked.Results Successful surgery was achieved in all 23 patients,and the target lesion thrombus was completely cleared(clearance ratio＞95％).A total 23 Venovo iliac vein stents were implanted during the same period.During the follow-up period of 6 months,neither displacement,fracture or detachment of the stent nor death occurred.In the 23 patients,the circumference differences of thigh and calve between the affected and healthy lower limbs decreased from preoperative(5.59±0.93)cm and(3.52±0.85)cm respectively to postoperative(1.43±0.68)cm and(1.41±0.72)cm respectively,the differences were statistically significant(both P＜0.05).Six months after treatment,the VCSS significantly decreased from preoperative(8.0±1.9)points to postoperative(5.4±1.1)points,the difference was statistically significant(P＜0.05),the primary patency rate was 95.7％(22/23),and the surgical re-intervention rate was 4.3％.Conclusion For the treatment of IVCS complicated by acute lower extremity DVT,combination use of PCDT and Venovo venous stenting is clinically safe and effective,therefore,this technique carries good prospect of clinical application.(J Intervent Radiol,2024,33:627-632)

Objective:To explore the effects of 10Hz repetitive transcranial magnetic stimulation(rTMS)on verbal and spatial working memory with different loads in patients with stroke. Method:Twenty-nine patients with working memory impairments after the left hemisphere stroke were random-ly assigned into the rTMS group(n=14)and control group(n=15).The patients in the rTMS group were treated with 10Hz rTMS while the patients in the control group received sham stimulation.Before and after the intervention,digital/spatial N-back tasks and digit span forward(DSF)and digit span backward(DSB)tests were used to assess work memory.Montreal Cognitive Assessment(MoCA)and the Functional Indepen-dence Measure(FIM)was used to assess cognitive function. Result:There were statistically significant differences before and after the intervention in the scores of DSF,the accuracy rates of 1-back and 2-back tasks of digit and space,the scores of MoCA,attention,memory,executive function,and FIM for the rTMS and control groups,and the scores of DSB in the rTMS group(P＜0.05).Post-intervention differences in DSB,digit 1 and 2-back,spatial 2-back,FIM,MoCA total score,and subtests of memory and executive function were significant between the groups(P＜0.05).The linear mixed-ef-fect analysis showed that improvements in the accuracy rates of digital N-back tasks in the rTMS group were more affected by load compared to the control group(P＜0.05).Controlling for the confounding factors such as age and effects of different content working memory tasks,improvements in the accuracy rates of digital 1-back and 2-back tasks were positively correlated with the improvements in the score on FIM(P＜0.05),and the improvements of the digital 2-back task was positively correlated with the improvement of MoCA scores and executive function(P＜0.05). Conclusions:rTMS can significantly improve verbal and spatial working memory manipulation in stroke pa-tients,with more significant improvement in high cognitive demand working memory(2-back).In addition,the improvement in higher-load verbal working memory brought by rTMS is associated with the improvement in cognition,self-care,and survival ability of patients with stroke.

Objective: To examine the association of greenness exposure with waist circumference (WC) and central obesity in older adults in China. Methods: Based on the cross-sectional data from the Chinese Longitudinal Healthy Longevity Survey in 2017-2018, 14 056 participants aged 65 years and over were included. Demographic characteristics, lifestyle, WC, and other information were collected through a questionnaire and physical examination. Based on the satellite monitoring data of moderate-resolution imaging spectroradiometer (MODIS) provided by NASA, the annual mean of normalized difference vegetation index (NDVI) within a radius of 1 000 meters was obtained as the measurement value of greenness exposure. Multivariate linear regression model, multivariate logistic regression model, and restricted cubic splines (RCS) model were used to analyze the association and dose-response relationship between greenness exposure and WC and central obesity in older adults in China. Results: A total of 14 056 participants were enrolled with a median age of 84.0 years [IQR: 75.0-94.0 years]. About 45.0% (6 330) of them were male and 48.6% (5 853) were illiterate. There were 10 964 (78.0%) participants from rural. The mean of WC was (84.4±10.8) cm. Central obesity accounted for 60.2% (8 465), and the NDVI range was (-0.06, 0.78). After adjusting for confounding factors, the multivariate linear regression model showed that the change value of WC in the urban group [β (95%CI):-0.49 (-0.93, -0.06)] was smaller than that in the rural [-0.78 (-0.98, -0.58)] for every 0.1 unit increase in NDVI (P_interaction=0.022). Compared with the Q₁ group in NDVI, WC of Q₂ and Q₃ groups in rural decreased, and the β (95%CI) values were-1.74 (-2.5, -0.98) and-2.78 (-3.55, -2.00), respectively. The multivariate logistic regression model showed that after adjusting for confounding factors, the risk of central obesity decreased for urban and rural older adults with an increase of 0.1 unit in NDVI, and the OR (95%CI) values were 0.87 (0.80, 0.95) and 0.86 (0.82, 0.89), respectively (P_interaction=0.284). Compared with the Q₁ group in NDVI, the risk of central obesity in the Q₂ and Q₃ groups in rural was lower, and the OR (95%CI) values were 0.68 (0.58, 0.80) and 0.57 (0.49, 0.68), respectively. The results of the multivariate regression model with RCS showed that there was a non-linear association of NDVI with WC (P_nonlinear=0.006) and central obesity (P_nonlinear=0.025). Conclusion: Greenness exposure is negatively associated with WC and central obesity in older adults in China.

Multidrug resistance (MDR) is the main cause of clinical treatment failure and poor prognosis in cancer. Targeting P-glycoprotein (P-gp) has been regarded as an effective strategy to overcome MDR. In this work, we reported our preclinical studies of the triazolo[1,5-a]pyrimidine-based compound WS-716 as a highly potent, specific, and orally active P-gp inhibitor. Through direct binding to P-gp, WS-716 inhibited efflux function of P-gp and specifically reversed P-gp-mediated MDR to paclitaxel (PTX) in multiple resistant cell lines, without changing its expression or subcellular localization. WS-716 and PTX synergistically inhibited formation of colony and 3D spheroid, induced apoptosis and cell cycle arrest at G2/M phase in resistant SW620/Ad300 cells. In addition, WS-716 displayed minimal effect on the drug-metabolizing enzyme cytochrome P4503A4 (CYP3A4). Importantly, WS-716 increased sensitivity of both pre-clinically and clinically derived MDR tumors to PTX in vivo with the T/C value of 29.7% in patient-derived xenograft (PDX) models. Relative to PTX treatment alone, combination of WS-716 and PTX caused no obvious adverse reactions. Taken together, our preclinical studies revealed therapeutic promise of WS-716 against MDR cancer, the promising data warrant its further development for cancer therapy.

Objective: To investigate the role of inflammatory biomarkers in the relationship between blood lead levels and blood pressure changes. Methods: A total of 9 910 people aged 18-79 years who participated in the China National Human Biomonitoring in 2017-2018 were included in this study. A self-made questionnaire was used to collect demographic characteristics, lifestyle and other information, and the data including height, weight and blood pressure were determined through physical examination. Blood and urinary samples were collected for the detection of blood lead and cadmium levels, urinary arsenic levels, white blood cells, neutrophils, lymphocytes, and hypersensitive C-reactive protein (hs-CRP). Weighted linear regression models were used to evaluate the associations between blood lead, inflammatory biomarkers and blood pressure. Mediation analysis was performed to investigate the role of inflammation in the relationship between blood lead levels and blood pressure changes. Results: The median (Q₁, Q₃) age of all participants was 45.4 (33.8, 58.4)years, including 4 984 males accounting for 50.3%. Multivariate logistic regression model analysis showed that after adjusting for age, gender, residence area, BMI, education level, smoking and drinking status, family history of hypertension, consumption frequency of rice, vegetables, and red meat, fasting blood glucose, total cholesterol, triglycerides, blood cadmium and urinary arsenic levels, there was a positive association between blood lead levels, inflammatory biomarkers and blood pressure (P<0.05). Each 2.71 μg/L (log-transformed) increase of the lead was associated with a 2.05 (95%CI: 0.58, 3.53) mmHg elevation in systolic blood pressure (SBP), 2.24 (95%CI: 1.34, 3.14) mmHg elevation in diastolic blood pressure (DBP), 0.25 (95%CI: 0.05, 0.46) mg/L elevation in hs-CRP, 0.16 (95%CI: 0.03, 0.29)×10⁹/L elevation in white blood cells, and 0.11 (95%CI: 0.02, 0.21)×10⁹/L elevation in lymphocytes, respectively. Mediation analysis showed that the levels of hs-CRP significantly mediated the association of blood lead with SBP, with a proportion about 3.88% (95%CI: 0.45%, 7.32%). The analysis also found that the levels of hs-CRP and neutrophils significantly mediated the association of blood lead with SBP, with a proportion about 4.10% (95%CI: 1.11%, 7.10%) and 2.42% (95%CI: 0.07%, 4.76%), respectively. Conclusion: This study suggests that inflammatory biomarkers could significantly mediate the association of blood lead levels and blood pressure changes.
Adult ; Male ; Humans ; Blood Pressure/physiology* ; C-Reactive Protein/analysis* ; Lead ; Arsenic/analysis* ; Cadmium ; Biomarkers ; Hypertension/epidemiology* ; China/epidemiology*

Purpose: The aim of this study was to compare the efficacy of liver transplantation (LT) and liver resection (LR) for hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) and to investigate risk factors affecting prognosis. Materials and Methods: A total of 94 HCC patients with PVTT type I (segmental PVTT) and PVTT type II (lobar PVTT) were involved and divided into LR (n=47) and LT groups (n=47). Recurrence-free survival (RFS) and overall survival (OS) were compared before and after inverse probability of treatment weighting (IPTW). Prognostic factors for RFS and OS were explored. Results: Two treatment groups were well-balanced using IPTW. In the entire cohort, LT provided a better prognosis than LR. Among patients with PVTT type I, RFS was better with LT (p=0.039); OS was not different significantly between LT and LR (p=0.093). In subgroup analysis of PVTT type I patients with α-fetoprotein (AFP) levels >200 ng/mL, LT elicited significantly longer median RFS (18.0 months vs. 2.1 months, p=0.022) and relatively longer median OS time (23.6 months vs. 9.8 months, p=0.065). Among patients with PVTT type II, no significant differences in RFS and OS were found between LT and LR (p=0.115 and 0.335, respectively). Multivariate analyses showed treatment allocation (LR), tumor size (>5 cm), AFP and aspartate aminotransferase (AST) levels to be risk factors of RFS and treatment allocation (LR), AFP and AST as risk factors for OS. Conclusion LT appeared to afford a better prognosis for HCC with PVTT type I than LR, especially in patients with AFP levels >200 ng/mL.

Objective To deveplope construct and validate a novel multiplex PCR system comprised of 30 Y-STR markers only with low and moderate mutation rates. Methods 30 Y-STRs characterized by low/moderate mutation rate and middle/high polymorphic was amplified simultaneously in a multiplex PCR system using the six color labeling fluorescence. PCR product was analyzed in a ABI 3500XL Genetic Analyzer. The accuracy, specifity, sensitivity and stability of the system and its validation on the mixtures were evaluated. Results The validation studies demonstrated that the system is a stable, accurate, and sensitive multiplex PCR system. The sensitivity was 0.0625ng DNA. Y-STR could be detection in a male/female DNA mixture ratio of 1:4. Conclusion The primary study demonstrates that this multiplex PCR system is effective and reliable for forensic routine DNA analysis. It will be very helpful for constructing Chinese forensic Y-STR database and population genetic research.

BACKGROUND:Unicompartmental knee arthroplasty has become mainstream operation for treatment of unicompartmental osteoarthritis of the knee, but unicompartmental knee arthroplastystil has some problems, such as excessive bleeding-induced postoperative blood transfusion, increased blood transfusion rate, hospitalization expense and complication of blood transfusion. As tranexamic acid for total knee arthroplasty has achieved good effects. It is significant to investigate whether local application of tranexamic acid can effectively reduce blood loss in unicompartmental arthroplasty.
OBJECTIVE:To investigate the efficacy and safety of the intra-articular tranexamic acid injection in treating perioperative blood loss in patients undergoing unicompartmental knee arthroplasty.
METHODS:122 patients with knee osteoarthritis undergoing unicompartmental knee arthroplastyinthe Department of Orthopedics, the Second Affiliated Hospital ofDalian Medical University from January 2014 to August 2015wereenroled in this study. Al patients were randomly divided into two groups. Patients in the tranexamic acid group were injected with 10 mL of tranexamic acid (containing 1000 mg) + 10 mL of sodium chloride injection in the articular cavity before loosening the tourniquet. Patients in the control group received 20 mL of sodium chloride injection in the articular cavity. In both groups, the drainage tube was clipped for 3 hours after injection.At 48 hours after replacement, the drainage tube was puled out. We compared and analyzed hemoglobin levels and hematocrit at 2 days and 1 month postoperatively, total blood loss and drainage volume at 2 days postoperatively, the number of patients receiving blood transfusion, Hospital for Special Surgery scores of knee function at 1 week and 1 month postoperatively, and thrombosis at 1 week postoperatively, and evaluated effects of tranexamic acid on blood loss after unicompartmental knee arthroplasty.
RESULTS AND CONCLUSION:(1) Hemoglobin levels and hematocrit were significantly higher in the tranexamic acid group than in the control group at 2 days postoperatively (P< 0.05). No significant difference in hemoglobin levels and hematocrit was detected at 1 month postoperatively in both groups (P> 0.05). (2) Drainage volume and total blood loss were significantly less in the tranexamic acid group than in the control group at 2 days postoperatively (P< 0.05). (3) The number of patients receiving blood transfusion was significantly less in the tranexamic acid group (0 case) than in the control group (6 cases) (P< 0.05). (4) Scores of Hospital for Special Surgery were significantly higher in the tranexamic acid group than in the control group at 1 week postoperatively (P< 0.05). No significant difference in above socres was identified between the two groups at 1 month postoperatively. (5) No venous thrombosis was found at 1 week postoperatively in both groups. (6) These results confirm that during knee medial unicompartmental arthroplasty, intra-articular injection of tranexamic acid combined with 3 hours of blood occlusion can effectively reduce drainage volume, perioperative blood loss, blood transfusion, is beneficial to the early recovery of knee jointfunction after replacement, and does not increase the risk of lower extremity deep venous thrombosis.

Objective To understand the cognitive level of urban and rural general practitioners in the concept, diagnosis and treatment of chronic obstructive pulmonary disease and to provide the basis for continuing medical education in basic level hospital for all general practitioners. Methods General practitioners from 21 urban community health service centers (group A) and 27 of the rural community health service centers (group B) were surveyed on chronic obstructive pulmonary disease knowledge through a anonymous questionnaire, the survey contents included five aspects of chronic obstructive pulmonary disease such as basic concept, diagnosis, grouping diagnosis, treatment on stable phase and acute exacerbation. Results The correct rates of five questions in group A were 25.89%, 17.26%, 5.58%, 4.06%, 18.78 and in group B were 8.97%, 8.55%, 5.13%, 4.27%, 17.52%. In chronic obstructive pulmonary disease concept and diagnosis, there was significant difference between two groups(χ2=21.99, P<0.05 and χ2=7.41, P<0.05) . Conclusion The level of the cognitive of COPD (chronic obstructive pulmonary disease) among the general practitioners is very poor, and is strong against to the management work of chronic obstructive pulmonary disease. We need more continuing medical ed-ucation on "the guidelines on diagnosis and treatment of chronic obstructive pulmonary disease " among the urban and rural general practitioners.