Occupational exposure to diesel engine exhaust and serum cytokine levels

The International Agency for Research on Cancer has classified diesel engine exhaust (DEE) as a human lung carcinogen. Given that inflammation is suspected to be an important underlying mechanism of lung carcinogenesis, we evaluated the relationship between DEE exposure and the inflammatory response using data from a cross‐sectional molecular epidemiology study of 41 diesel engine testing workers and 46 unexposed controls. Repeated personal exposure measurements of PM_2.5 and other DEE constituents were taken for the diesel engine testing workers before blood collection. Serum levels of six inflammatory biomarkers including interleukin (IL)‐1, IL‐6, IL‐8, tumor necrosis factor (TNF)‐α, macrophage inflammatory protein (MIP)‐1β, and monocyte chemotactic protein (MCP)‐1 were analyzed in all subjects. Compared to unexposed controls, concentrations of MIP‐1β were significantly reduced by ～37% in DEE exposed workers (P < 0.001) and showed a strong decreasing trend with increasing PM_2.5 concentrations in all subjects (P_trend < 0.001) as well as in exposed subjects only (P_trend = 0.001). Levels of IL‐8 and MIP‐1β were significantly lower in workers in the highest exposure tertile of PM_2.5 (>397 µg/m³) compared to unexposed controls. Further, significant inverse exposure‐response relationships for IL‐8 and MCP‐1 were also found in relation to increasing PM_2.5 levels among the DEE exposed workers. Given that IL‐8, MIP‐1β, and MCP‐1 are chemokines that play important roles in recruitment of immunocompetent cells for immune defense and tumor cell clearance, the observed lower levels of these markers with increasing PM_2.5 exposure may provide insight into the mechanism by which DEE promotes lung cancer. Environ. Mol. Mutagen. 59:144–150, 2018. © 2017 Wiley Periodicals, Inc.     

Physiological effects of anterior repositioning splint on temporomandibular joint disc displacement: a quantitative analysis

Anterior repositioning splints (ARS) are used primarily for the management of temporomandibular joint (TMJ) anterior disc displacement with reduction (ADDwR). However, the exact physiological effects of ARS are still unclear. This study investigated the short and long‐term effects of ARS on disc and condyle angles/positions by metric analysis. Twenty‐two subjects diagnosed with ADDwR were recruited. Maxillary full‐coverage ARS were fabricated, and MRI of TMJs was obtained before splint treatment, immediate post‐insertion and 6 months after splint treatment. Disc–condyle relationship was determined by disc–condyle angle measurement. Disc and condyle positions were described as X‐Y coordinates with the summit of glenoid fossa as the origin of the coordinates. Thirty‐two TMJs were classified as ADDwR and 12 were normal. Upon ARS insertion, all TMJs with ADDwR got normal disc–condyle relationships. The condyles moved significantly forward and downward, while the discs moved significantly backward and upward. MRI at 6 months after treatment (without ARS insertion) indicated that only 40·6% (13/32) of the joints were maintained in the normal disc–condyle relationship. The majority of condyles returned to their pre‐treatment positions, while the discs generally moved anteriorly again. The use of ARS resulted in forward and downward condyle movement, and a concurrent backward movement of the disc resulting in ideal spatial disc–condyle relationship. The stability of this relationship, however, could not be maintained in the majority of TMJs upon ARS removal. Findings explain the good short‐term clinical outcomes with ARS and their relatively lower efficacy in the long term.     

长疗程利妥昔单抗治疗难治性幼年型特发性炎症性肌病3例

特发性炎症性肌病是一组具有临床表现异质性的自身免疫性疾病,以骨骼肌无力和肌肉炎症病变为特征.临床分型包括皮肌炎、多发性肌炎、散发的包涵体肌炎、免疫介导的坏死性肌病和抗合成酶抗体综合征等[1-3].在儿童期,皮肌炎为最常见的临床类型,约占80％[4].特发性炎症性肌病为临床罕见病,年发病率约为每年每百万人1 ～ 19例[5].美国儿童皮肌炎的发病率约为每年每百万人2.5～4.1例[6],国内尚未见流行病学资料.特发性炎症性肌病的治疗一直非常具有临床挑战性,尤其是一线治疗药物失败的病例[7].近年来,对难治性病例的精准治疗成为特发性炎症性肌病领域的研究重点[8].自20世纪初期开始,利妥昔单抗在国外就被尝试用于难治性特发性炎症性肌病的治疗,但关于利妥昔单抗的应用剂量和疗程,目前尚无统一认识[9],国内也尚未见相关临床研究报道.本文分享了3例传统药物治疗反应欠佳、经长疗程(2年7个月至3年2个月)利妥昔单抗联合治疗后获得临床缓解的特发性炎症性肌病患者的治疗过程,以期为该疾病的治疗提供参考.本观察研究开始前获北京大学第一医院生物医学研究伦理委员会审查批准(批准号:2021科研263).     

Prenatal diagnosis of Berry syndrome by fetal echocardiography: A report of four cases

Berry syndrome is a rare congenital cardiac malformation. We describe 4 cases of Berry syndrome diagnosed by fetal echocardiography. Based on our experience, the three‐vessel view is important for diagnosing the aortopulmonary window and aortic origin of the right pulmonary artery. Furthermore, the true cross‐sectional and sagittal views obtained by continuously scanning from the three‐vessel‐trachea view to the long‐axis view of the aortic arch are required to image the interruption or coarctation of the aortic arch. An early and accurate prenatal diagnosis of Berry syndrome is feasible and helps to improve patient outcomes.     

放射治疗参与的食管癌多学科综合治疗的进展

早期食管癌以手术治疗为主,然而进展期和局部晚期患者,最佳综合治疗策略尚不明确.本文综述了近年来食管癌综合治疗新的临床证据,就早期食管癌的食管保存生活质量提高,新辅助治疗和术后辅助放疗的临床价值,以手术为基础的多学科综合治疗和以放疗为基础的多学科综合治疗疗效差异性,放疗技术研究进展以及靶向药物的临床价值进行了总结,为进一步临床研究提供参考.     

深圳地区成年汉族人群数字全颌曲面断层片的同一认定

背景：目前已经形成了法医牙科影像同”。认定的共同原则，即主要根据牙齿、颁骨及其毗邻结构的生理解剖特自1；、病理变化和牙齿的各种治疗情况等进行个体识别。然而随着人们口腔保健意识不断增强、牙科治疗手段的不断进步，牙齿发生病变的情况正在逐渐地减少，因此单纯依靠牙齿病变和治疗特征进行同。认定方法已不能适应当前的形势。目的：针对口腔无病变和创伤的深圳地区成年汉族人群数字全颌曲面断层片，认识下颌牙齿及下颌骨观测指标测量值在分段赋值区段里的分布频率，评估其进行法医学同一认定的价值。方法：运用E娟Imworkstation2．12软件对200例深圳地区成年人群的数字全颌曲面断层片进行精确测最，测馈值运用MicrosoftOfficeExcel2003和SPSS16．0软件进行统计分析。结果与结论：各观测指标的测量值在分段赋值区段里分布频率不尽相同，最大为96．5％。两张同源数宁全颌曲面断层片之间的分段赋值匹配率最高为77．53％，最低为69。66％；两张非同源数字全颌曲面断层片之间的分段赋值匹配率墩高为42．70％。结果可见数字全颌曲面断层片中牙齿测量指标和下颌骨各观测指标测嚣值分段赋值的分命频牢具仃多样性，可用于同一认定。