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Background: Mental health disorders are highly prevalent in polycystic ovary syndrome (PCOS) cases. The etiology for anxiety/depression in women with PCOS still remains unclear, due to conflicting results. Aim: To examine whether an association exists between the mental health of Chinese women with PCOS and various indicators such as their disease characteristics, biochemistry results and sleep status. Methods: During July 2018 and January 2020, our study included a total of 433 women diagnosed with PCOS at Chongqing Hospital of Traditional Chinese Medicine. Sleep-related variables were evaluated by the Pittsburgh Sleep Quality Index (PSQI), anxiety and depression values were quantified by the Hospital Anxiety and Depression Scale (HADS), and biochemistry results were collected from the medical records of the patients. Results: 26.6% patients resulted as positive anxiety and 23.6% as positive depression. We found significant associations between anxiety/depression status and sleep conditions of PCOS patients. More specifically, anxiety significantly associated with sleep quality OR (95%CI) = 1.611 (1.147–2.261), sleep disturbance 2.326 (1.468–3.685) and daytime dysfunction 1.457 (1.122–1.891). Similarly, depression significantly associated with sleep quality 1.467 (1.043–2.063), sleep disturbance 1.624 (1.030–2.561) and daytime dysfunction 1.406 (1.077–1.836). There was no association detected between mental health and disease characteristics, as well as reproductive and metabolic indicators in PCOS. Limitation: Cross-sectional nature of the data prevents causal associations, selection bias of a hospital-based population. Conclusions: Sleep-related disorders might be involved in the etiology and development of the anxiety/depression observed in PCOS cases. We propose that management of sleep disorders should be an integral part of the disease management of women with PCOS.

BACKGROUND: Guidelines recommend mediastinal sampling first for patients with mediastinal lymphadenopathy with suspected lung cancer. The objective of this study was to describe practice patterns and outcomes of diagnostic strategies in patients with lung cancer. METHODS: This study included a retrospective cohort of 15,914 patients with lung cancer with T1-3N1-3M0 disease diagnosed from 2004 to 2013 in the National Cancer Institute’s Surveillance, Epidemiology, and End Results or Texas Cancer Registry Medicare-linked databases. Patients who had mediastinal sampling as their first invasive test were classified as guideline consistent; all others were guideline inconsistent. Propensity matching was used to compare the number of tests performed, and multivariable logistic regression was used to compare the incidence of complications. RESULTS: Guideline-consistent care increased from 23% to 34% of patients from 2004 to 2013 (P < .001). Use of endobronchial ultrasound-guided transbronchial needle aspiration increased from 0.1% to 25% of all patients (P < .001), and mediastinal sampling increased from 54% to 64% (P < .0001). Guideline-consistent care was associated with fewer thoracotomies (38% vs 71%; P < .001) and CT scan-guided biopsies (10% vs 75%; P < .001) than guideline-inconsistent care but more transbronchial needle aspirations (59% vs 12%; P < .001). Guideline-consistent care was associated with fewer pneumothoraxes (5.1% vs 22%; P < .001), chest tubes (0.9% vs 4.4%; P < .001), hemorrhages (3.5% vs 5.8%; P < .001), and respiratory failure events (2.7% vs 3.7%; P = .047) than guideline-inconsistent care. Bronchoscopic mediastinal sampling was associated with fewer complications than surgical mediastinal sampling. CONCLUSIONS: Guideline-consistent care with mediastinal sampling first was associated with fewer tests and complications. Quality gaps decreased with the introduction of endobronchial ultrasound-guided transbronchial needle aspiration but persist. Gaps include failure to sample the mediastinum first, failure to sample the mediastinum at all, and overuse of thoracotomy.

Summary Recent attempts have been made to direct the sensory neurotisation of free superficial circumflex iliac artery (SCIA) flaps. However, donor nerves enabling sensory recovery are limited. We report our findings in fifteen patients who underwent distal limb defect reconstruction using a sensate SCIA flap, including the lateral cutaneous branch of the subcostal nerve (LCSN), between August 2017 and September 2018. The distance from the anterosuperior iliac spine to the point where the LCSN crossed the iliac crest ranged between 6.5 and 10 cm. The diameter ranged between 1.5 and 4.0 mm. The flap size ranged between 8 × 4 and 13 × 10 cm2. All of the flaps survived uneventfully. Tests of sensory modalities, including the Semmes-Weinstein (SW) touch, vibration, pinprick, temperature and static two-point discrimination (s2PD) tests were applied in nine regions of each flap post-operatively. One or more modalities were present in at least one region at 6 months post-operatively, and the recovery of vibration perception was more consistent than that of SW touch and pinprick perception. The recovery of s2PD was noted in 4 cases over a follow-up period of more than 12 months. A reliable sensate flap with the LCSN can be considered as an attractive option for the sensory reconstruction of distal limb defects of moderate size.

Background Studies have demonstrated that liver enzymes are associated with metabolic syndrome (MetS). However, little information is available regarding these relationships in elderly populations. Our present study aimed to explore the associations between liver enzymes and the risk of MetS in elderly populations. Methods This cross-sectional study included 1444 elder participants (970 men and 474 women) who attended annual physical examinations. Univariate and multivariate logistic regressions were performed to estimate the associations between liver enzymes and the risk of MetS and its components according to quartiles of the concentration of each liver enzyme. Results The prevalence of MetS and its components increased remarkably with increasing quartiles of alanine aminotransferase (ALT), gamma-glutamyltransferase (GGT) and alkaline phosphatase (ALP) but not with aspartate aminotransferase (AST) in the elderly. Compared with subjects in the bottom quartile, the adjusted odds ratio for MetS in the highest ALT, GGT and ALP quartiles were 1.78 (95% CI 1.21–2.61), 2.58 (95% CI 1.77–3.78) and 1.85 (95%CI 1.27–2.70) respectively. No statistically significant increases in the odds ratio for MetS according to increased quartiles of AST were found in either the univariate or multivariate logistic regression analyses. Conclusions Elevated liver enzymes levels (mainly ALT, GGT and ALP but not AST) are positively associated with the prevalence of MetS in elderly populations.

Background This study aimed to evaluate the safety and tolerability for variable dosages of a novel hepatitis E vaccine p179. Methods The randomized open-label parallel control phase 1 clinical trial enrolled 120 eligible participants aged 16–65 years in Jiangsu Province, China. The experimental groups were randomized to receive different dosages of 20 μg, 30 μg, and 40 μg Hepatitis E Virus (HEV) p179 vaccines, with the 30 μg HEV vaccine p239 Hecolin as control, and vaccinated at 0, 1 and 6 month intervals. Participants were observed for solicited local and systemic adverse reactions (ARs) occurring within 7 days after each vaccination, and any serious adverse events (SAEs) occurring within 6 months post-vaccination. Blood samples were collected from participants 3 days before and after each injection, to determine the blood routine and serum biochemical indexes. Results The solicited local ARs incidence in experimental groups were significantly lower than that of the control group (P = 0.027). The difference between solicited total and systemic ARs incidence of experimental groups and the control group were not significant (P > 0.05). Similar patterns were observed when the analyses were performed on the group having ARs of varying grades and symptoms. All changes in blood biochemical indexes and routine blood tests before and after different vaccinations were mild (grade 1) or moderate (grade 2), and the difference in experimental groups and the control group were not statistically significant. No vaccine related SAEs occurred in any of the subjects during the study. Conclusion Three different dosages of HEV p179 vaccine were deemed safe and well tolerated. No vaccine-associated SAEs were identified, and the 30 μg dosage formulation was selected for further investigation for efficacy. Clinical trials registration number: 2012L01657 .

Purpose Head and neck tumors that involve the craniomaxillofacial region are classified as stage IVb disease and are clinically challenging. In this study, the outcomes of craniofacial resection and craniofacial reconstruction in patients with recurrent malignant tumors involving the craniomaxillofacial region were evaluated. Patients and Methods This retrospective observational study was conducted from January 2008 to August 2015. Data collected for each patient included age, gender, tumor site, initial treatment, craniofacial resection, reconstruction flaps and complications after craniofacial resection, adjuvant treatment, and reported outcomes of craniofacial resection and craniofacial reconstruction. The χ2 test in SPSS was used to analyze the data. Results Twenty-four patients with recurrent malignant tumors involving the craniomaxillofacial region were identified who had undergone craniofacial resection at the Center of Craniomaxillofacial Surgery of Sun Yat-sen University (Guangzhou, Guangdong, China). The study population was comprised of 24 patients (15 men and 9 women; age range, 21 to 73 yr) with recurrent tumors (58.3% with squamous cell carcinoma [SCC], 41.7% with sarcoma [SA]) involving the craniomaxillofacial region who underwent craniofacial resection. Craniofacial resection consisted of orbital exenteration and maxillotomy; anterior skull base surgery, facial resection, and mandibulotomy; or ipsilateral radical neck dissection. The resultant craniomaxillofacial defects were reconstructed using extended vertical lower trapezius island myocutaneous flaps (TIMFs), temporalis myofascial flaps, or submental flaps. All patients with recurrent malignant tumor involving the craniomaxillofacial region underwent gross total resection of the tumor; 22 patients underwent craniofacial reconstruction. There were no major surgical complications. Minor flap failure and wound dehiscence in the donor site occurred in 4 patients. The follow-up period ranged from 8 to 36 months. Seven patients in the SCC group and 7 in the SA group were alive with no evidence of disease (AND), 3 in the SCC group and 2 in the SA group were alive with disease (AWD), and 4 in the SCC and 1 in the SA group died of the disease (DOD) after local recurrence or distant metastases at 8 to 18 months. There were no statistical differences among the AND, AWD, and DOD groups. Conclusions Craniofacial resection remains an effective salvage treatment for patients with recurrent SCC and SA involving the craniomaxillofacial region. The extended vertical lower TIMF is a large, simple, and reliable flap for reconstructing major defects after a craniofacial resection.

Cognitive-coping therapy (CCT), integrating cognitive theory with stress-coping theory, is an efficacious therapy for obsessive-compulsive disorder (OCD). However, the potential brain mediation for the effectiveness remains unclear. We sought to investigate differences of resting-state brain function between OCD and healthy controls and if such differences would be changed by a four-week CCT.Thirty-one OCD patients were recruited and randomized into CCT (n=15) and pharmacotherapy plus CCT (pCCT, n=16) groups, together with 25 age-, gender- and education-matched healthy controls. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was scored to evaluate the severity in symptoms. Resting-state functional magnetic resonance imaging was scanned pre- and post-treatment.For patients, Y-BOCS scores were reduced during four-week treatment for CCT and pCCT (P0.001), but no group difference was observed. No differences in amplitude of low-frequency fluctuation (ALFF) values were found between CCT and pCCT either pre- or post-treatment. Compared to controls, ALFF in OCD patients was higher in the left hippocampus, parahippocampus, and temporal lobes, but lower in the right orbitofrontal cortex, rectus, bilateral calcarine, cuneus, lingual, occipital, left parietal, postcentral, precentral, and parietal (corrected P0.05). The ALFF in those regions was not significantly correlated to the severity of OCD symptoms. After a 4-week treatment, the ALFF differences between OCD patients and controls disappeared.The pharmacotherapy group was not included since OCD patients generally do not respond to pharmacotherapy in four weeks.Our data indicated that resting-state brain function was different between OCD and controls; such differences disappeared after OCD symptoms were relieved.

Purpose Outcomes of salvage surgery and carotid artery (CA) management were evaluated in patients with oral and oropharyngeal cancer. Patients and Methods Eighteen patients with recurrent oral and oropharyngeal squamous cell carcinoma involving the CA underwent salvage surgeries consisting of wide resection of the tumor, CA resection without and with reconstruction, and CA subadventitial dissection without and with encapsulation. Major tissue defects were reconstructed using a flap. Results One patient showed postoperative transient hemiplegia, and wound dehiscence occurred at the recipient site in 2 patients. Two patients had carotid blowout. One patient who underwent CA resection and reconstruction had a carotid embolism. After 5 to 42 months of follow-up, 12 patients were free of disease, 2 remained ill, and 4 died of local recurrence or distant metastases. Conclusions Salvage surgery remains an effective treatment modality. CA sacrifice offers a viable treatment strategy. Major defects can be reconstructed with a trapezius flap.

The purpose of this study was to investigate the neural activity and functional connectivity in generalized anxiety disorder (GAD) during resting state, and how these alterations correlate to patients' symptoms. Twenty-eight GAD patients and 28 matched healthy controls underwent resting-state functional magnetic resonance (fMRI) scans. Amplitude of low-frequency fluctuation (ALFF) and seed-based resting-state functional connectivity (RSFC) were computed to explore regional activity and functional integration, and were compared between the two groups using the voxel-based two-sample t test. Pearson's correlation analyses were performed to examine the neural relationships with demographics and clinical symptoms scores. Compared to controls, GAD patients showed functional abnormalities: higher ALFF in the bilateral dorsomedial prefrontal cortex, bilateral dorsolateral prefrontal cortex and left precuneus/posterior cingulate cortex; lower connectivity in prefrontal gyrus; lower in prefrontal-limbic and cingulate RSFC and higher prefrontal-hippocampus RSFC were correlated with clinical symptoms severity, but these associations were unable to withstand correction for multiple testing. These findings may help facilitate further understanding of the potential neural substrate of GAD.

Purpose Although negative-pressure wound therapy (NPWT) for complicated wounds has been extensively studied, it is rarely used in cases involving a submandibular fistula due to radiation-induced osteoradionecrosis of the mandible. This study aimed to investigate the efficacy of NPWT for submandibular fistulas after reconstruction for osteoradionecrosis. Patients and Methods Nine patients with submandibular fistulas after reconstruction for osteoradionecrosis treated with NPWT between 2011 and 2014 were included in the study. The wound healing was documented. Results The NPWT device was removed postoperatively between days 7 and 12 (mean duration, 9.6 days). The wound bed was filled with healthy granulation tissue, and successful healing by second intention was observed in all patients within 2 weeks. No complications were observed. The follow-up ranged from 4 to 27 months (mean, 18 months); the fistulas exhibited excellent healing, and no recurrence or infection was observed. Conclusions NPWT is a safe, effective technique for managing submandibular fistulas after reconstruction for osteoradionecrosis.

Objective : In this study three different stimulation parameters of repetitive transcranial magnetic stimulation (rTMS) were tested to compare the efficacy of continuous theta burst stimulation (continuous TBS) for rehabilitation of unilateral spatial neglect (USN) in stroke patients. Methods : Carefully selected cohort of thirty-eight stroke patients were randomly assigned to three treatment groups (1 Hz group, 10 Hz group and continuous TBS group) and sham group. Intervention in patients in the treatment group consisted of rTMS, while patients in the sham group received pseudo-stimulation for two weeks. All patients were administered star cancellation and line bisection tests at 4 different time points of the study. Further, all study subjects in the three treatment groups and sham group underwent diffusion-tensor imaging (DTI) at the beginning and at the end of treatment to calculate fractional anisotropy (FA) and mean diffusivity (MD). Results : Among the three stimulation parameters, star cancellation and line bisection tests revealed significant differences in outcomes at the end of treatments and one month after the end of treatments, compared to beginning of the treatments. Importantly, continuous TBS group patients displayed the best curative effect, based on behavioral scoring, at one month after end of the treatments, followed by the 1 Hz group and 10 Hz group. DTI results showed a significant increase in FA and MD in superior longitudinal fasciculus, superior occipitofrontal fascicle and inferior fronto-occipital fasciculus on the left side, as well as the capsula external and inferior fronto-occipital fasciculus on the right side, in patients after continuous TBS. In addition, compared to the sham group, patients stimulated with continuous TBS exhibited a dramatic increase in FA in the left external capsule. Conclusion : Our study presents strong evidence that rTMS significantly improves neurocognitive functions in USN, with continuous TBS showing the best curative effect. Enhanced connections in the white matter tract network related to visual attention, as assessed by DTI, might be the potential mechanism for the observed recovery in USN using continuous TBS.

To assess the diagnostic value of dual-energy (DE) computed tomography pulmonary angiography (CTPA) for acute pulmonary embolism (PE) using a helical DE scan mode with rapid kVp switching.Seventy-six patients with suspected acute PE underwent DE CTPA. Two readers independently assessed and measured the iodine maps. CTPA images were assessed for the presence, location, and degree of PE as the standard of reference. Iodine maps were used to identify the perfusion defect (PD), and the diagnostic accuracy of iodine maps was calculated. The iodine concentrations of PDs and normal lung parenchyma were also measured and compared.A per-patient analysis showed the 84.6% sensitivity and 96.0% specificity of iodine map for PE, and on per-segment analysis, the sensitivity and specificity for PE were 82.9% and 99.6%, respectively. Intraobserver and interobserver variability correlations were excellent, with k values from 0.806 to 1.000. Quantitative analysis showed there was a significant difference for iodine concentration between circumscribed/patchy PDs or wedge-shaped PDs consistent with PE and normal lung parenchyma (P.05). The intraobserver reliability of reader 1 was from 0.928 to 0.997, and reader 2 was from 0.912 to 0.995. And, the interobserver reliability between two readers was from 0.967 to 0.999.CTPA based on DE scanning with rapid kVp switching can provide both morphologic analysis and quantitative evaluation of PD related to acute PE in addition to standard CTPA data. Quantification of iodine concentration may be helpful for identifying the presence or absence of PE.

Background The intraatrial conduit (IAC) Fontan procedure is one of the Fontan modifications and is usually not considered the first choice. In this large series, we report our experience of the IAC Fontan procedure for the treatment of a functional single ventricle and review its indications, techniques, and clinical outcomes. Methods Between 2009 and 2013, 101 patients with a functional single ventricle underwent an IAC Fontan procedure. The median surgical age was 44 months and weight was 15 kg. The cardiac malformations included tricuspid atresia in 10, double-inlet left ventricle in 8, double-inlet right ventricle in 15, double-outlet right ventricle in 18, congenitally corrected transposition of the great arteries in 11, complete atrioventricular septal defect in 8; criss-cross in 1, pulmonary atresia with intact ventricular septum in 3, Ebstein anomaly in 3, and others in 3. Heterotaxy syndrome was found in 21 patients. An intraatrial polytetrafluoroethylene conduit was implanted to construct the Fontan pathway. In 75 patients, a 2.7-mm to 4.5-mm fenestration was made to reduce the intraconduit pressure. Eighty-three patients had previously undergone a Glenn operation. Median follow-up was 29 months (range, 2 to 60 months). Doppler echocardiography, electrocardiography, and Holter monitoring were used to evaluate hemodynamic performance and arrhythmias. Results There were 2 hospital deaths, 1 Fontan takedown, and 3 midterm deaths. Conduit thrombosis developed in 1 patient. Atrial flutter developed in 2 patients, who underwent electrical cardioversion. Junctional bradycardia developed in 2 patients, but they did not require permanent pacemakers. Overall survival was 97.0% at 1 year and 94.1% at 5 years. Conclusions The IAC modification provides excellent operative and midterm outcomes in most patients with a functional single ventricle. However, a longer follow-up time is required to demonstrate its real advantages.

Objective To evaluate the long-term clinical and radiologic outcomes of treating severely dislocated fractures of condylar neck and base with the comminuted fractures of parasymphysis or mental foramen, specially with crown fracture of deciduous molar and permanent molar or dislocation of the teeth sustained in childhood using bioabsorbable miniplate with open reduction and internal fixation (ORIF). Methods Five children (age ranged from 3 to 11 years old averaged 8.2 years; 3 boys and 2 girls) with severely (the condyle dislocated from the glenoid fossa) dislocated fractures of condylar neck or base with the comminuted fractures of parasymphysis or mental foramen, specially with crown fracture of deciduous molar and permanent molar or dislocation of the teeth were treated with ORIF using 1 or 2 bioabsorbable miniplates (through preauricular approach and an oral vestibular approach). All patients have been followed-up clinically and radiographically for a mean of 5.6 years (range, 3–10 years). Results All patients were cured satisfactorily with excellent occluding relation without restricted mandibular movement, facial asymmetry, retrognathism and ankylosis. 3–10 years follow-up study did not occur any mandibular development disorder. Conclusion The results suggested that ORIF using bioabsorbable miniplate was a reliable fixation technique for use in the treatment of severely dislocated fractures of the condylar neck and base with the comminuted fractures of parasymphysis or mental foramen, specially with crown fracture of deciduous molar and permanent molar or dislocation of the teeth in children when the non-invasive or occlusal therapies were ineffective.

Introduction Although several techniques have been described for the repair of soft palate defects, soft palate reconstruction remains challenging. This study was performed to evaluate swallowing and speech functions in patients undergoing placement of folded reverse facial-submental artery submental island flaps (FRFF) to reconstruct soft palate defects following cancer ablation. Materials and methods FRFFs were designed for eight patients with soft palate defects resulting from soft palatal squamous cell carcinoma ablation. The clinical stages of tumours were I in two patients, II in four patients, and III in two patients. FRFFs were created to reconstruct soft palate defects. Swallowing and speech functions were evaluated 3 months postoperatively. Results One minor flap failure occurred, but all flaps survived. No donor-site problem occurred. Five patients managed ingestion of a solid diet, two managed a soft diet, and one remained on a liquid diet. Six patients achieved normal speech, one achieved intelligible speech, and one retained slurred speech. The patients were followed for 8–48 months; seven patients were living with no evidence of disease, and one was living with disease. Conclusions The FRFF is reliable for soft palate defect reconstruction following cancer ablation and can achieve satisfactory swallowing and speech functions.

Background We retrospectively analyzed electromyogram (EMG), laboratory and clinical data of 93 patients with polymyositis (PM) to help improve early diagnostic accuracy. Methods Data were collected from hospitalized patients who were diagnosed with PM between January 1, 2006 and April 1, 2010 at Chinese People’s Liberation Army General Hospital. Results Eighty-six (92.47%) patients exhibited an isolated myopathic EMG pattern, 3 (3.23%) showed myopathy combined with neuropathy and 1 (1.08%) had diabetes mellitus. Among the 4 without myopathic EMG, 1 had inflammatory myopathy, and 3 had prior corticosteroid treatment with clinical improvement before EMG examination. Muscle biopsy, performed in 40 cases, inclusive of the 7 cases that did not show an isolated myopathic EMG patterns, revealed that 80% exhibited typical pathological features of PM, 17.5% showed nonspecific muscle fiber necrosis and 2.5% were normal. EMG showed that tibialis anterior and biceps brachii exhibited more abnormal EMG results than abductor pollicis brevis. Patients with disease duration > 3 months had significantly higher alanine aminotransferase and reduced motor unit potential (MUP) amplitudes compared to patients with shorter disease duration. statistical analysis revealed a significant association between disease duration and MUP amplitude reduction. Patients without interstitial lung disease showed significantly longer disease duration and higher creatine kinase and lactate dehydrogenase levels than patients with interstitial lung disease. Conclusions our results show that MUP is a sensitive yardstick for diagnosis of PM and is inversely related to disease duration. our study also highlights that selecting specific muscles for EMG may improve diagnostic accuracy in PM.

article i nfo Background: Accumulating data suggest that hyperhomocysteinemia is associated with the risk of ischemic stroke (IS) and coronary heart disease (CHD) in the general population, but the relationship remains unclear in hypertensive patients. We examined the association of total homocysteine (tHcy) with IS and CHD in hyper- tensive patients. Methods: A total of 5935 Chinese hypertensive patients were recruited in a community-based cross-sectional study from 60 communities in Shenzhen, China. Plasma tHcy was quantitatively measured using the enzyme cycle method. Conventional risk factors for IS and CHD were obtained through questionnaire interviews and physicalexaminations. We includedcerebralinfarction, embolismandsmall-vesseldiseaseasIS; and myocardial infarction,anginapectoris,coronary revascularization, and cardiac arrestas CHD. ISand CHD wereretrospective- ly adjudicated by specialists via interviews, hospital records or relevant tests. Results: Significantly higher values of tHcy were observed in IS patients than in non-IS controls among both men and women.GreatertHcy level wasdosedependentlyassociatedwith anincreasedrisk of ISpresenceinwomen, men and them combined (p-trend: 0.002, 3.8 × 10 −4 and 0.001). The odds ratios (95% CI) of IS for tHcy ≥30 (vs. b15) μmol/L were 2.84 (1.73-4.34) in men, 4.41 (1.62-9.15) in women, and 2.86 (1.72-4.75) in their combination after adjusting for other main risk factors of IS. We did not find any significant association be- tween tHcy and presence of CHD after the adjustment for covariates. Conclusions:Plasma homocysteine level is positively associated with the presence of IS, but not CHD, in Chi- nese hypertensive patients.

Purpose The present meta-analysis illustrates the accuracy of myocardial perfusion SPECT (MPS) to diagnose functional stenotic coronary artery disease (CAD) with fractional flow reserve (FFR) as standard reference. Methods All investigators screened and selected studies that compared MPS with FFR in symptomatic patients with suspected CAD. Patients and study characteristics were independently extracted by two investigators; differences were resolved by consensus. Results 13 articles, including 1,017 patients, 699 vessels were included in the study. No significant publication bias was detected (P = 0.65). At the patient level, the summary sensitivity and specificity were 77% (95% confidence interval [CI], 70–83%) and 77% (95%CI, 67–84%) for MPS. Vessel-level pooled sensitivity was 66% (95%CI, 57–74%) and specificity was 81% (95%CI, 70–89%). The overall diagnostic performance of MPS was moderate. [The area under the summary receiver operating characteristic (sROC) curve was 0.83]. No study influenced the pooled results larger than 0.03. Conclusions The accuracy between FFR and MPS SPECT was moderate.

The aim of the present study was to prepare and evaluate a paclitaxel nanocrystal-based formulation stabilized by serum protein transferrin in a non-covalent manner. The pure paclitaxel nanocrystals were first prepared using an antisolvent precipitation method augmented by sonication. The serum protein transferrin was selected for use after evaluating the stabilizing effect of several serum proteins including albumin and immunoglobulin G. The formulation contained approximately 55-60% drug and was stable for at least 3months at 4°C. In vivo antitumor efficacy studies using mice inoculated with KB cells demonstrate significantly higher tumor inhibition rate of 45.1% for paclitaxel-transferrin formulation compared to 28.8% for paclitaxel nanosuspension treatment alone. Interestingly, the Taxol(®) formulation showed higher antitumor activity than the paclitaxel-transferrin formulation, achieving a 93.3% tumor inhibition rate 12days post initial dosing. However, the paclitaxel-transferrin formulation showed a lower level of toxicity, which is indicated by a steady increase in body weight of mice over the treatment period. In comparison, treatment with Taxol(®) resulted in toxicity issues as body weight decreased. These results suggest the potential benefit of using a serum protein in a non-covalent manner in conjunction with paclitaxel nanocrystals as a promising drug delivery model for anticancer therapy.

Emerging evidence suggests that down-regulated miRNAs play an important role in the carcinogenesis of colorectal cancer (CRC). Single nucleotide polymorphisms (SNPs) in the promoter region of miRNAs may disturb miRNAs processing, alter their expression, and ultimately affect an individual’s susceptibility to CRC. We conducted a case-control study and analyzed twelve SNPs in the promoter region of miR-143/145 of 525 subjects including 242 cases with CRC and 283 controls using polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP) assay. The mutant genotypes or alleles of rs41291957, rs353292, rs353293, and rs4705341 were significantly associated with an increased risk of CRC compared with the wild genotypes or alleles, while rs4705343, rs17796757, rs3733845, and rs3733846 were significantly associated with a decreased risk of CRC. When stratification analysis was done by different variables, such as tumor size, tumor site, differentiated status, clinical stage, and metastasis status, we found that patients with the mutant allele of rs41291957 had an increased risk to develop a tumor size larger than 5 cm. These findings suggest that SNPs in the promoter region of miR-143/145 may be related to the etiology of CRC. However, further larger studies with different ethnic origins are needed to confirm our results due to limited sample sizes in the study.

To evaluate the feasibility of transthoracic Doppler echocardiography to determine the optimal pulsing windows for CT coronary angiography to narrow the pulsing windows further, especially in higher heart rate.Doppler was performed on 135 patients before CT scanning. For Doppler, the intervals with minimal motion were evaluated during both systole and diastole integrating electrocardiogram (ECG) intervals. For CT scanning, the retrospective ECG-gating was applied and the optimal reconstruction intervals were determined. The accuracy of Doppler analysis to predict the optimal reconstruction intervals was tested. The predicted length of pulsing windows was compared between Doppler analysis and traditional prospective ECG-gating protocol (heart rate≦65 bpm, 60-76%; 66-79 bpm, 30-77%; ≧80 bpm, 31-47%).According to Doppler analysis, the mean length of intervals with minimal motion in systole was 106.4±39.2 ms and 125.2±92.0 ms in diastole. When the intervals with minimal motion during diastole90 ms, the optimal reconstruction intervals were located at diastole; otherwise, at systole (P0.001). The optimal reconstruction intervals in 93.8% (132/135) patients could be predicted accurately by Doppler analysis. If the optimal reconstruction intervals predicted by Doppler were applied as the exposure windows, the mean length of pulsing windows should has been 105.2±69.4 ms (range: 26.9-510.3 ms), which was significantly shorter than that of traditional prospective ECG-gating protocol (232.0±120.2 ms, range: 93.2-427.3 ms, P0.001).Doppler can help detecting the optimal pulsing windows accurately. Prospective ECG-gating incorporating Doppler analysis may narrow pulsing windows significantly while maintaining image quality.

Objectives to examine the rate of periconceptional and optimal folic acid supplementation, and to characterise their patterns and determinants among antenatal women in central China. Design data from 4290 women in the Anhui Birth Defects and Child Development Cohort Study recruited between October 2008 and September 2009 were analysed. Setting seven Maternal and Child Health Centres of two cities (Hefei and Maanshan) in Anhui province of central China. Participants women initiating prenatal care were included and asked to complete a structured questionnaire regarding folic acid supplementation. Findings sixty-eight per cent (2905/4290) of pregnant women reported taking folic acid supplementation periconceptionally (i.e. at some point before or during early pregnancy), and 32.8% (1405/4290) and 65.2% (2797/4290) had taken it before or during early pregnancy, respectively. However, only 16.1% (690/4290) used it optimally (i.e. regularly from four weeks before pregnancy throughout four weeks after pregnancy). Use of periconceptional folic acid was significantly associated with educational level, household income, registered residence, age, gestational age at recruitment, and planning of pregnancy. Conclusion optimal folic acid supplementation was relatively low. Implications for practice further efforts are needed to inform the population and promote the use of folic acid supplementation.

Objectives To study the underlying alteration in the expression of epithelial markers involved in epithelial-mesenchymal transition (EMT), and elucidate the potential mechanism(s) for Tβ4-induced EMT-like phenotypic changes in bladder cancer cells. Materials and methods All tissue samples in this study were obtained from clinical patients of the Union Hospital of Tongji Medical College, and were confirmed by surgery and pathology. Of these, normal bladder tissues (control), primary urothelial carcinoma of different grades (Stage pTa, Stage pT3), bladder paracancerous tissues, accompanied with 2 bladder cancer cell lines (BIU-87 and T24), were divided into 6 groups. Quantitative RT-PCR, Western blotting, and immunohistochemical study of adhesion molecules Tβ4, ILK, E-cadherin, and β-catenin involved in EMT were carried out. A lentiviral gene transferring vector containing the RNA polymerase III-dependent U6 promoter to express short hairpin RNA (shRNA) directed against Tβ4 was also applied. In the present study, all agents were evaluated using commercial kits. Results A strong correlation between the expression levels of Tβ4, ILK, E-cadherin, and β-catenin was found in the bladder transitional cell carcinoma (TCC) patients. In the BIU-87 and T24 bladder cancer cells overexpressing Tβ4, which were accompanied by a loss of E-cadherin as well as a cytosolic accumulation of β-catenin, up-regulation of ILK was also revealed. The inhibition of the Tβ4 expression with lentiviral shRNA vector could raise EMT-like phenotypic changes, significantly depressed motility, and subsequent invasiveness of bladder cancer cells. Conclusions Our results imply that the Tβ4 is likely to play a crucial role in EMT progression, and that inhibition of the Tβ4 expression or interactions with other genes should be novel therapeutic targets for bladder cancers with high invasive and metastatic potential.

Purpose This clinical study assessed the reverse facial artery–submental artery mandibular osteomuscular flap with titanium dental implants for the functional reconstruction of maxillary defects. Patients and Methods Class 2a defects in 5 patients were repaired with a reverse facial artery–submental artery mandibular osteomuscular flap with titanium dental implants (n = 21). All patients received a fixed partial denture after a 3- to 6-month healing period. Results All lesions were widely excised in an area extending to the maxilla. Of the implants, 20 (95.2%) were loaded and 1 was lost before loading. Reconstruction with a fixed partial denture was successful in all patients. The patients were followed up for 12 to 20 months (mean, 15.8 months), and no recurrence was observed. Conclusion The reverse facial artery–submental artery mandibular osteomuscular flap with titanium dental implants is safe, quick, and simple to elevate and is reliable for the functional reconstruction of maxillary defects.

Objective The aim of this study was to investigate the relationship between membrane cytoskeleton linker protein Ezrin and CD44v6, iNOS, Ki-67, and clinicopathologic characteristics, and the prognostic significance of Ezrin expression in salivary gland adenoid cystic carcinoma (SACC). Study design Immunohistochemistry and reverse-transcription polymerase chain reaction were used to quantify the expression of Ezrin, CD44v6, inducible nitric oxide synthase (iNOS), and Ki-67 in 75 primary SACCs, 25 tumor-free salivary tissues, and 2 SACC cell lines (ACC-M and ACC-2). Survival analysis was performed to find the prognostic significance of Ezrin expression. Results Expressions of Ezrin, CD44v6, iNOS, and Ki-67 in SACC tissues, especially with distant metastasis, were significantly higher than in tumor-free tissues. Ezrin mRNA and protein levels in ACC-M cells were significantly higher than in ACC-2 cells. Ezrin, CD44v6, iNOS, and Ki-67 expressions were significantly higher in solid pattern than in cribriform and tubular patterns. Ezrin and its partners, CD44v6, iNOS, and Ki-67, were significantly related to tumor size, clinical stage, perineural and vascular invasion, and recurrence. Furthermore, Ezrin had an independent prognostic effect on overall survival. Conclusions The increased expression of Ezrin and its partners, CD44v6, iNOS, and Ki-67, in SACC correlated with histologic patterns, may play a role in distant metastasis, and might indicate poor clinical outcome.

Introduction The α V β 3 integrin is a well-known transmembrane receptor involved in tumor invasion, angiogenesis and metastasis. Our aim was to evaluate a novel positron emission tomography (PET) probe, 64 Cu-cyclam-RAFT-c(-RGDfK-) 4 , for noninvasive visualization and quantification of α V β 3 integrin expression. Methods RAFT-c(-RGDfK-) 4 , a tetrameric cyclic Arg-Gly-Asp (RGD)-based peptide, was conjugated with a bifunctional chelator, 1,4,8,11-tetraazacyclotetradecane (cyclam), radiolabeled with the positron emitter 64 Cu and evaluated in vitro by cell binding and competitive inhibition assays and in vivo by biodistribution and receptor blocking studies, and PET imaging. The following cell lines, human embryonic kidney HEK293(β 1 ) [α V β 3 -negative] and HEK293(β 3 ) [α V β 3 -overexpressing] and human glioblastoma U87MG [naturally expressing α V β 3 ], together with their subcutaneous xenografts in athymic nude mice, were used for the present study. The expression levels of α V β 3 on these cell lines and tumor xenografts were analyzed by flow cytometry and sodium dodecyl sulfate–polyacrylamide gel electrophoresis/autoradiography, respectively. Results 64 Cu-cyclam-RAFT-c(-RGDfK-) 4 demonstrated the in vitro and in vivo specificity for the α V β 3 integrin and displayed rapid blood clearance, predominantly renal excretion and low uptake in nontumor tissues. Tumor uptake of 64 Cu-cyclam-RAFT-c(-RGDfK-) 4 (3 h postinjection) in HEK293(β 3 ) (high levels of α V β 3 ), U87MG (moderate levels of α V β 3 ) and HEK293(β 1 ) (undetectable levels of α V β 3 ) tumors was 9.35%±1.19%, 3.46%±0.45% and 1.18%±0.30% injected dose per gram, respectively, with a strong and positive correlation with the tumor α V β 3 expression levels (correlation coefficient=0.967; P V β 3 -positive tumors were clearly visualized with high tumor-to-background contrast, and agreed well with the biodistribution results. Conclusion 64 Cu-cyclam-RAFT-c(-RGDfK-) 4 exhibits potential for noninvasively quantifying α V β 3 expression.

To assess the reliability of the reverse facial-submental artery island flap for reconstruction of oropharyngeal defects after resection of intermediate stage and advanced carcinomas, we studied 13 patients with stage III and IV squamous cell carcinoma (SCC) of the oropharynx. They had all had their tumours excised followed by reconstruction of the oropharyngeal defect using a facial-submental artery island flap. There was no major failure of a flap, but two minor ones. The marginal mandibular branch of the facial nerve remained intact and undamaged. All donor sites healed well and scars were well-hidden. The functional results of speech and swallowing after 10-28 months' follow-up were satisfactory. One patient developed lung metastases. The facial-submental artery island flap is a simple, reliable flap that can be used for reconstructing oropharyngeal defects after resection of medium and advanced carcinomas of the oropharynx.

Summary This article describes the extended vertical lower trapezius island myocutaneous flap for reconstructing large defects of the neck. A total of 11 patients with neck recurrence of oral carcinoma were treated using salvage surgery and an extended vertical lower trapezius island myocutaneous flap based on the transverse cervical artery was used to repair the large defect in the neck. No major flap failure occurred. No disabilities were observed in terms of shoulder motion. The patients were followed up for 6–22 months. Four patients developed local recurrence: two of them are still alive with the disease and two have died. The extended vertical lower trapezius island myocutaneous flap is a large, simple and reliable flap, which is a salvage flap preferred for reconstructing large defects of the neck following the ablation of neck recurrence of oral carcinoma.

The epigenetic changes of tumor suppressor genes are now recognized as an alternative mechanism contributing to the development of myelodysplastic syndrome (MDS). The expression of DNA-damage-inducible transcript 3 (DDIT3) gene has been found down-regulated in myeloid malignancies including MDS. In this study, we performed methylation-specific PCR (MSP) to investigate the methylation status of the CpG island of DDIT3 promoter region in MDS. Aberrant methylation of DDIT3 was detected in 31.8% (21/66) of the cases analyzed. No correlation was found between DDIT3 promoter methylation and clinical parameters and MDS subtypes. Although the estimated 50% survival time of the methylated DDIT3 group was shorter than that of unmethylated group (12.0 months vs. 23.0 months), the difference was not statistically significant (P=0.137). These findings suggest that the hypermethylation of DDIT3 promoter might be one of early events in the development of MDS.

To evaluate the effects of contrast-enhanced ultrasound (CEU) on the permeability of placental barrier primarily.A total of 60 pregnant Sprague Dawley (SD) rats were divided into 10 groups, including six groups of microbubbles-enhanced ultrasound (varied mechanical index (MI) of 0.13, 1.0 and 1.4 with continuous and intermittent insonation respectively) (US+MB), two groups of ultrasound insonation only (continuous and intermittent insonation respectively) (US), the group of microbubbles only (MB) and the control group. Evans blue (EB), as the tracer, was intravenously injected before treatment. The EB in placenta and fetus was observed under fluorescence microscope and analyzed quantitatively. The EB amount was compared between groups and between placenta and fetus. Lanthanum nitrate-tracing transmission electron microscope examination was performed to observe the distribution of lanthanum in the placenta and fetus.Observed by naked eye, the plancenta was dyed into deep blue while there was no sign of dyeing to the fetus in all groups. Under fluorescence microscope, the red fluorescence radiated by EB was observed in placenta but not in fetus. The EB amount in placenta, insonated by microbubbles-enhanced ultrasound of varied MI, was higher significantly than that in MB, US and control group (all P0.01) while there was no difference between the latter three groups. And in each group, EB amount was much higher in placenta than that in fetus (P0.01). The lanthanum particles deposited in the intercellular space in the syntrophoblast while there was no lanthanum presented in the cytotrophoblast in all groups.Our findings suggest that diagnostic CEU with SonoVue will not increase the permeability of placenta to the macromolecules larger than albumin, although it may affect placenta.

Tumors of the oropharynx are often diagnosed at advanced stages but nonetheless may be treated surgically. Oropharyngeal reconstruction presents a challenge. Several methods of reconstruction have been used, including primary closure, free skin grafts, tongue flaps, buccal fat pads, cheek flaps, myocutaneous flaps, free tissue transfer, and masseter muscle flaps. 1 Advanced tumors and extensive oropharyngeal defects call for alternative approaches to reconstruction. In 1979, Demergasso and Piazza 2 described the trapezius myocutaneous flap, in which the transverse cervical artery and paraspinous attachment of the trapezius were left intact. In 1980, Baek et al 3 first described the lower trapezius island myocutaneous flap (LTIMF) for reconstructing cutaneous defects or performing subcutaneous augmentation of the face. In 2000, Tan and Tan 4 reported the vascular anatomy and clinical use of the extended LTIMF based solely on the dorsal scapular artery system. In 2004, Ugurlu et al 5 proposed using the extended vertical trapezius myocutaneous flap based solely on the transverse cervical artery in a salvage procedure for failed previous flap procedures and tumor recurrence. Because that flap is not an island flap, a second operation is necessary. Here we present our experience with the extended vertical LTIMF for reconstructing larger oropharyngeal defects after the ablation of advanced oropharyngeal squamous cell carcinomas.

Neuroimaging studies on brain responses to acupuncture stimulations have received considerable attention recently. The majority of these studies are centered on healthy controls (HC) and neuropathy, while little work has addressed other disorders. This study aimed to investigate the influence of acupuncture stimulations on brain activities in functional dyspepsia (FD) patients. Eight FD patients and eight healthy controls (HC) were involved in this study. Each HC received an 18F-FDG PET-CT scan at baseline, while each patient received scans at baseline and after acupuncture stimulations. Manual acupuncture stimulations were performed at ST34 (Liangqiu), ST36 (Zusanli), ST40 (Fenglong) and ST42 (Chongyang) in FD patients. The images were analyzed with the Statistical Parametric Mapping software 2.0. Compared to HC, the FD patients showed a lower glycometabolism in the right orbital gyrus, the left caudate tail and the cingulate gyrus, and a higher glycometabolism in the left inferior temporal gyrus (p < 0.005). After acupuncture stimulations, the FD patients showed a glycometabolism decrease in the postcentral gyrus and the cerebella, and an increase in the visual-related cortices(p < 0.005). The results suggest that the anterior cingulate cortex, the prefrontal cortices and the caudate tail involve in processing gastric perceptions in FD patients and that the deactivation of the primary somatosensory area and the cerebella is contributable to acupuncture stimulation, while activation of the visual-related cortex is a response to pain or acupoint actions. (C) 2009 Elsevier Ireland Ltd. All rights reserved.

Venous malformations of the face and neck involve multiple anatomical spaces and encase critical neuromuscular structures, making surgical treatment difficult; high recurrence rates and high morbidity are well documented. The purpose of this study was to evaluate the clinical curative effect of combination compartmentalisation and sclerotherapy for the treatment of massive venous malformations of the face and neck. Sixteen patients with massive venous malformations of the face and neck region (12 males and four females; mean age: 14.9 years, range: 6-22 years) were treated with compartmentalisation using silk sutures followed by injections of 0.1 mg OK-432 and 8 mg pingyangmycin into each small compartment. The injections were performed every two weeks. All lesions received three to six treatments. All the patients had significant swelling and mild pain postoperatively for a period of one to two weeks with no major complications. One patient had transient facial paresis, which resolved spontaneously within two weeks. The follow-up period ranged from three to 14 months (median: 7.1 months). The treatments resulted in the following: four of the lesions were completely involuted, six were mostly involuted, five were partially involuted, and one experienced a small involution. All of the patients had normal liver and kidney functions and normal lung fields on chest X-ray. Compartmentalisation followed by injection of OK-432 and pingyangmycin into each compartment provided a simple, safe, and reliable alternative treatment for massive venous malformations of the face and neck.

Deletions at 8p are frequent in many human cancers and represent a genetic marker associated with a more aggressive tumor phenotype. Previous mutational analysis of DBC2 (deleted in breast cancer 2), a tumor suppressor gene located in the region of loss of heterozygosity (LOH) on 8p21, failed to show a high frequency of mutation linked to low expression in bladder cancer. Promoter hypermethylation may be an alternative mechanism of inactivation of the second allele. We detected the methylation status and expression of the DBC2 gene in 75 bladder cancer samples and 57 corresponding normal tissues. Aberrant methylation and down-regulation of DBC2 were observed preferentially in tumor samples (P < 0.05), and the expression changes were associated with methylation (P < 0.05). These findings, together with the previously mutation reports, suggest that aberrant methylation in DBC2 promoter may be responsible for the expression loss of DBC2 expression in bladder cancer and this hypermethylation event could play a crucial role in the early stage of bladder tumorigenesis.

The growth of parotid haemangiomas during the proliferative phase may be rapid and unpredictable. Involution often takes many years, with attendant psychological sequelae to the child. Although conservative management is usually proposed for parotid haemangiomas occurring in infancy, this may not be particularly helpful and the haemangioma difficult to conceal. The purpose of this study was to evaluate the reliable and aesthetic benefit of using a superficial musculoaponeurotic system (SMAS) fold flap and allograft dermal matrix (ADM) repair of the parotid bed following parotid haemangiomas via pre- and retroauricular incision. Forty-three paediatric patients (33 boys and 10 girls) with haemangiomas involving the parotid gland underwent total parotidectomy using a pre- and retroauricular approach with intraoperative placement of ADM within the parotid bed. They further underwent repair of the parotid bed with SMAS fold flaps. A panel of three plastic surgeons assessed the cosmetic outcomes. All of the patients were evaluated using a short questionnaire; postoperative gustatory sweating was assessed using a modification of Minor's starch-iodine test.

Purpose The purpose of this study was to assess the reliability of 2 patterns of submental island flaps—the facial-submental artery island flap and the reverse facial-submental artery island flap—used for reconstruction of oral and maxillofacial defects following cancer ablation. Patients and Methods Thirty-eight soft tissue defects were repaired with facial-submental artery island flaps and reverse facial-submental artery island flaps following cancer surgery. The ages of the patients ranged from 28 to 90 years; 24 were male and 14 were female. The primary lesions included squamous cell carcinoma of the tongue (8 cases), buccal mucosa (16), floor of the mouth (4), lower gingiva (3), oropharynx (2); recurrent squamous cell carcinoma of the palate (3); and basal cell carcinoma of the facial skin (2). The clinical stage of the tumors was stage I in 5 cases, stage II in 25, and stage III in 8. Facial-submental artery island flaps were used in 20 cases, reverse facial-submental artery island flaps in 18. The size of the skin paddle varied from a minimum of 4 cm × 8 cm to a maximum of 5 cm × 15 cm. Direct closure was achieved at all donor sites. Results The postoperative outcome for 2 patterns of submental flaps was 36 cases surviving, 2 of complete necrosis, and one other of temporary palsy of the marginal mandibular branch of the facial nerve. The success rate was 95% and 94.4% for the facial-submental artery island flap and the reverse facial-submental artery island flap, respectively. The form and function of recipient sites were well recovered. The donor site leaves a well-hidden scar. The follow-up period was 3 to 24 months, 1 patient died of tumor local recurrences and 2 cases of cervical recurrence were observed. Conclusion Two patterns of submental island flaps are safe, rapid, and simple to elevate. The facial-submental artery island flap can reliably be used for reconstruction of the lower and middle thirds of the medium-sized oral and maxillofacial defects and the reverse pattern for reconstruction of the middle and upper thirds of the medium-sized oral and maxillofacial defects.

DNA sequencing analysis was used to scan the genes in a Chinese family with clinically diagnosed autosomal genetic hypercholesterolemia. Two mutations were identified in exon 4 of the low-density lipoprotein receptor gene, which is the possible molecular mechanism of etiology of the family. The proband's extremely high level of serum cholesterol and the related manifestations suggested that he was a familial hypercholesterolemia homozygote and that his parents were in a relatively milder condition. DNA sequencing revealed that the proband had an abnormal pattern of exon 4 of the low-density lipoprotein receptor gene due to a heterozygosity (A/G) at nucleotide 386 and a heterozygous single-base deletion (A) at 685. Nucleotide 386 is the second base of codon 129, and A→G mutation (D129G) changed this codon from Asp GAC to Gly GGC . The single-base deletion of A at 685 (685del 1) is a frameshift mutation. It changes the phase of triplets, so that all codons are misread after this site of mutation; consequently, the protein expressed by the gene must be abnormal in structure and function. DNA analysis of the other family members showed that the 2 mutations should be respectively located in different alleles of the proband. Both of the 2 mutations have not been reported previously.

Purpose The purpose of this study was to explore an effective repair method for oral and maxillofacial soft-tissue defects after salvage surgery for patients with recurrent oral carcinoma. Patients and Methods Eight patients (6 females and 2 males, mean age, 56.9 years) with recurrent oral squamous cell carcinoma of the tongue (n = 4), oral cavity floor (n = 2), and buccal (n = 2) were treated with salvage surgery, and the oral and maxillofacial soft-tissue defects were reconstructed primarily by extended vertical lower trapezius island myocutaneous flap. Results No flap failure occurred. The donor sites were closed primarily. There were no disabilities with regard to shoulder motion. Followed up after the operation, the survival period of the patients was 6 to 30 months and the average survival period was 13.1 months. There was 1 recurrent case. All of the patients survived. Conclusion The extended vertical lower trapezius island myocutaneous flap, which is a simple, reliable and large flap, can be preferred as a salvage procedure for oral and maxillofacial soft-tissue defects after salvage surgery for patients with recurrent oral squamous cell carcinoma.

In the absence of efficient systemic chemotherapy, immunotherapy is considered a hopeful treatment for controlling recurrence of hepatocellular carcinoma (HCC). The identification of proper antigenic peptides presented by MHC class I molecules is a critical step for the development of therapeutic vaccines against tumors. Currently, the "reverse immunology" approach is the most commonly used technique in the identification of the tumor-associated T cell epitopes. However, it is based on T cell dependent approach and cannot fully reflect the actual presentation of epitope in tumor in vivo. In the present study, we managed to identify the naturally presented MAGE epitopes of HCC directly by epitope prediction, HPLC differential analysis and MS detection. We successfully detected a naturally processed peptide FLWGPRALV (MAGE-3(271-279), HLA-A2-restricted) with an estimated number of 38-39 copies/cell in HCC. To our knowledge, this is the first evidence that the naturally processed MAGE-3(271-279) can be isolated and identified from the tumor tissue of HCC patient. Furthermore, specific CD8(+) T cell responses to this epitope were also found after tumor relapse by IFN-gamma release Cytospot and tetramer assay indicating that MAGE-3(271-279) was indeed presented by HCC cells in vivo. In addition, another new antigen peptide was found, which may be derived from MAGE-1. Our findings demonstrate the potential of the direct approach for identification of tumor-associated epitopes. This approach may become a useful tool for the development of vaccine against cancer in the future.

The immune spectrum of severe acute respiratory syndrome (SARS) is poorly understood. To define the dynamics of the immune spectrum in SARS, serum levels of cytokines, chemokines, immunoglobulins, complement and specific antibodies against SARS-associated coronavirus (SARS-CoV) were assayed by enzyme-linked immunosorbent assay (ELISA), and phenotypes of peripheral lymphocytes were analyzed by flow cytometry in 95 SARS-infected patients. Results showed that interleukin (IL)-10 and transforming growth factor β (TGF-β) were continuously up-regulated during the entirety of SARS. Regulated on activation normally T cell-expressed and secreted (RANTES) levels were decreased, while monocyte chemoattractant protein-1 (MCP-1) was elevated in acute patients. Immunoglobulins and complement were elevated during the first month of SARS. Both serum-positive rates and titers of specific IgM and IgG antibodies responding to SARS-CoV peaked at days 41–60 from the onset of SARS. CD4+ and CD8+ T lymphocytes decreased significantly in acute-phase. CD3+CD8+CD45RO+ T lymphocytes were decreased by 36.78% in the convalescent patients. Conclusion: SARS-CoV seemed to elicit effective humoral immunity but inhibited cellular immunity, especially CD8+ memory T lymphocytes over time. Prolonged overproduction of IL-10 and TGF-β may play an important role in the disease.