Short- and long-term results of open vs laparoscopic multisegmental resection and anastomosis for synchronous colorectal cancer located in separate segments

BACKGROUND

It remains unclear whether laparoscopic multisegmental resection and anastomosis (LMRA) is safe and advantageous over traditional open multisegmental resection and anastomosis (OMRA) for treating synchronous colorectal cancer (SCRC) located in separate segments.

AIM

To compare the short-term efficacy and long-term prognosis of OMRA as well as LMRA for SCRC located in separate segments.

METHODS

Patients with SCRC who underwent surgery between January 2010 and December 2021 at the Cancer Hospital, Chinese Academy of Medical Sciences and the Peking University First Hospital were retrospectively recruited. In accordance with the inclusion and exclusion criteria, 109 patients who received right hemicolectomy together with anterior resection of the rectum or right hemicolectomy and sigmoid colectomy were finally included in the study. Patients were divided into the LMRA and OMRA groups (n = 68 and 41, respectively) according to the surgical method used. The groups were compared regarding the surgical procedure's short-term efficacy and its effect on long-term patient survival.

RESULTS

LMRA patients showed markedly less intraoperative blood loss than OMRA patients (100 vs 200 mL, P = 0.006). Compared to OMRA patients, LMRA patients exhibited markedly shorter postoperative first exhaust time (2 vs 3 d, P = 0.001), postoperative first fluid intake time (3 vs 4 d, P = 0.012), and postoperative hospital stay (9 vs 12 d, P = 0.002). The incidence of total postoperative complications (Clavien-Dindo grade: ≥ II) was 2.9% and 17.1% (P = 0.025) in the LMRA and OMRA groups, respectively, while the incidence of anastomotic leakage was 2.9% and 7.3% (P = 0.558) in the LMRA and OMRA groups, respectively. Furthermore, the LMRA group had a higher mean number of lymph nodes dissected than the OMRA group (45.2 vs 37.3, P = 0.020). The 5-year overall survival (OS) and disease-free survival (DFS) rates in OMRA patients were 82.9% and 78.3%, respectively, while these rates in LMRA patients were 78.2% and 72.8%, respectively. Multivariate prognostic analysis revealed that N stage [OS: HR hazard ratio (HR) = 10.161, P = 0.026; DFS: HR = 13.017, P = 0.013], but not the surgical method (LMRA/OMRA) (OS: HR = 0.834, P = 0.749; DFS: HR = 0.812, P = 0.712), was the independent influencing factor in the OS and DFS of patients with SCRC.

CONCLUSION

LMRA is safe and feasible for patients with SCRC located in separate segments. Compared to OMRA, the LMRA approach has more advantages related to short-term efficacy.

Long-term outcomes and failure patterns after laparoscopic intersphincteric resection in ultralow rectal cancers

BACKGROUND

Intersphincteric resection (ISR), the ultimate anus-preserving technique for ultralow rectal cancers, is an alternative to abdominoperineal resection (APR). The failure patterns and risk factors for local recurrence and distant metastasis remain controversial and require further investigation.

AIM

To investigate the long-term outcomes and failure patterns after laparoscopic ISR in ultralow rectal cancers.

METHODS

Patients who underwent laparoscopic ISR (LsISR) at Peking University First Hospital between January 2012 and December 2020 were retrospectively reviewed. Correlation analysis was performed using the Chi-square or Pearson's correlation test. Prognostic factors for overall survival (OS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were analyzed using Cox regression.

RESULTS

We enrolled 368 patients with a median follow-up of 42 mo. Local recurrence and distant metastasis occurred in 13 (3.5%) and 42 (11.4%) cases, respectively. The 3-year OS, LRFS, and DMFS rates were 91.3%, 97.1%, and 90.1%, respectively. Multivariate analyses revealed that LRFS was associated with positive lymph node status [hazard ratio (HR) = 5.411, 95% confidence interval (CI) = 1.413-20.722, P = 0.014] and poor differentiation (HR = 3.739, 95%CI: 1.171-11.937, P = 0.026), whereas the independent prognostic factors for DMFS were positive lymph node status (HR = 2.445, 95%CI: 1.272-4.698, P = 0.007) and (y)pT3 stage (HR = 2.741, 95%CI: 1.225-6.137, P = 0.014).

CONCLUSION

This study confirmed the oncological safety of LsISR for ultralow rectal cancer. Poor differentiation, (y)pT3 stage, and lymph node metastasis are independent risk factors for treatment failure after LsISR, and thus patients with these factors should be carefully managed with optimal neoadjuvant therapy, and for patients with a high risk of local recurrence (N + or poor differentiation), extended radical resection (such as APR instead of ISR) may be more effective.

[Risk factor and nomogram for predicting the probability of a permanent stoma after laparoscopic intersphincteric resection for ultralow rectal cancer]

Objective: A permanent stoma can seriously affect patients' quality of life. Clinicians need to consider the risk of a permanent stoma when making clinical decisions. This study analyzed preoperative predictors of a permanent stoma after laparoscopic intersphincteric resection for low rectal cancer (LISR), and a prediction model was constructed validated. Methods: This was a retrospective study that analyzed clinical data of 331 ultralow rectal cancer patients who were diagnosed with primary rectal adenocarcinoma by endoscopy and pathology, including 218 males and 113 female, (58.8±11.2) years and (23.7±3.1) kg/m². The patients underwent LISR with a preventive stoma from January 2012 to December 2020. Patients with multiple primary colorectal cancers, who underwent emergency surgery for intestinal obstruction or bleeding or perforation, and did not complete 18 months follow up were exclucled. R software was used to randomly select 234 patients as the modeling group with a ratio of approximately 7:3, and the remaining 97 patients comprised the validation group. The stoma site was determined by the surgeon before the operation, and the ileum 30 cm from the ileocecal valve was selected. The rates of a permanent stoma for the entire group and the preoperative clinical factors that may affect the permanency of a stoma in the modeling group were determined. A permanent stoma was defined as failure to close the stoma at 18 months after surgery. Multivariate logistic regression analysis was used to analyze the preoperative independent risk factors for a permanent stoma after LISR. R software was used to create the nomogram model, and the predictive ability of the nomogram model was evaluated by receiver operating characteristic (ROC) curve analysis. Results: Among the 331 patients who underwent LISR, 37 (26 cases in the modeling group and 11 cases in the validation group, 11.2%) developed a permanent stoma for the following reasons: anastomotic stenosis due to leakage (16 cases, 43.2%), distant metastasis (16 cases, 43.2%), intolerant to stoma closure surgery (3 cases, 8.1%), stenosis due to postoperative radiation (1 case, 2.7%), and poor recovery of anorectal function (1 case, 2.7%). Univariate analysis showed that preoperative neoadjuvant chemoradiotherapy, poorly differentiated tumor, cT3 stage, and distant metastasis were associated with a permanent stoma. Multivariate logistic regression analysis showed that neoadjuvant chemoradiotherapy [OR=3.078, 95% confidence interval (CI): 1.326-7.147; P=0.009], cT3 stage (OR=2.257, 95%CI: 1.001-5.091; P=0.049), and stage IV cancer (OR=16.180, 95%CI: 2.753-95.102; P=0.002) were independent risk factors for permanent stoma after LISR. Based on the selected risk factors, a nomogram model for predicting permanent stoma was constructed. The area under the ROC curve of the modeling group was 0.793, the optimal cut-off value was 0.890, the sensitivity was 0.577, and the specificity was 0.885. The area under the ROC curve of the validation group was 0.953. The corrected curves of the modeling group and the validation group showed a good degree of fit. Conclusion: Neoadjuvant chemoradiotherapy, cT3 stage, and distant metastasis are independent predictors of a permanent stoma after LISR, and the nomogram model is helpful to predict the probability of a permanent stoma. Patients with high-risk factors should be adequately informed of the risk of a permanent stoma before colorectal surgery.

Evaluation of Free Flaps Transferred by Microvascular Anastomosis in Oral and Maxillofacial Surgery

The authors discuss indications for the use of microvascular free flaps transferred to the oral and maxillofacial region. A series of 139 cases, involving 145 free flaps, is reported over a three year period. The overall success rate for all types of flaps was 89.3%. Advantages and disadvantages of the use of various flaps are presented and suggestions are offered to avoid complications.

Selection and validation of differentially expressed genes in head and neck cancer

We applied a robust combinatorial (multi-test) approach to microarray data to identify genes consistently up- or down-regulated in head and neck squamous cell carcinoma (HNSCC). RNA was extracted from 22 paired samples of HNSCC and normal tissue from the same donors and hybridized to the Affymetrix U95A chip. Forty-two differentially expressed probe sets (representing 38 genes and one expressed sequence tag) satisfied all statistical tests of significance and were selected for further validation. Selected probe sets were validated by hierarchical clustering, multiple probe set concordance, and target-subunit agreement. In addition, real-time PCR analysis of 8 representative (randomly selected from 38) genes performed on both microarray-tested and independently obtained samples correlated well with the microarray data. The genes identified and validated by this method were in comparatively good agreement with other rigorous HNSCC microarray studies. From this study, we conclude that combinatorial analysis of microarray data is a promising technique for identifying differentially expressed genes with few false positives.

[Reconstruction of the common carotid artery with freeze dried arterial allografts in goats]

OBJECTIVE

To observe the patency rate and histopathologic changes at different times after implantation of freeze dried arterial allografts.

METHODS

4 healthy adult goats were used as the experimental models. A segment of the common carotid artery 2 cm in length was surgically removed and bridged with freeze-dried graft of common carotid artery from another goat. The eight necks of 4 animals were divided into A and B group randomly, each containing 4 arteries. In group A, both cut ends of the carotid artery were anastomosed end to end with the arterial allograft. In group B, the proximal end of the carotid artery was anastomosed end to side with the allograft. The patency of the graft was monitored with Laser Doppler Flowmeter within one week and carotid angiography was performed in selected animal. The allografts with anastomoses were harvested at 1 week, 2 weeks, 3 months and 6 months after implantation, respectively. The surgical fresh specimens were prepared and subject to histopathologic evaluation under light microscope, scanning electron microscope and transmission electron microscope.

RESULTS

In Group A, 2 grafts were patent at 1 week and 2 weeks, respectively. One graft was not patent at 3 months, one was largely occluded at 6 months, only 1/4 part of the graft was patent. In Group B, 3 grafts were patent at 1 week, 2 weeks, 3 months, respectively. One graft was occluded at 6 months. There was no significant difference in patency rate between the two groups. Histopathologic examinations showed that in freezed dried arterial homograft, the endothelial cells were lost but the matrix was complete. One week after implantation, mononuclear macrophages were infiltrated into the wall in large amount and adventitia of loose connective tissues was formed. After 2 weeks of implantation, intimia was noted, intimal hyperplasia was also noted at the anastomotic sites and migrated toward the central portions of the graft. At 3 months, the homograft displayed a complete endothelial cell coverage with only small areas of fresh fibrin and endothelial disruption. The rejection reaction was diminished prominently. The medial matrix was largely substituted by proliferation of smooth muscle cells, the homograft was near normal in structure.

CONCLUSION

Reconstruction of carotid artery defect with freeze dried arterial homografts was feasible. The rejection reaction was not significant. If the endothelial lining does not regenerate within 3 months, long term graft patency is hardly achieved.

[A primary study on the relationship between condyle position and anterior distraction for cross bite caused by cleft lip and palate]

OBJECTIVE

To evaluate the changes of the position of the mandibular condyle in cleft lip and palate patients with secondary bony cross-bite deformity after early orthodontic treatment with extraoral bow and facial mask.

METHODS

The TMJ topograph 6 months before and after treatment was investigated in 8 patients. The width of the anterior,superior and posterior space of the TMJ was compared prior to and post treatment.

RESULTS

The results showed that there was no significant difference in the width of the three spaces of the TMJ before and after treatment.

CONCLUSION

The position of the mandibular condyle had no significant change after maxillary anterior distraction with extraoral bow and facial mask.

Osteoid osteoma of the eminence of the temporomandibular joint

We describe an osteoid osteoma in the articular eminence of the left temporomandibular joint of a 24-year-old woman. This is an uncommon tumour of the jaws, and has not previously been reported in this location. The mass was removed, she made a good recovery, and there are not signs of recurrence four years later.

[An experimental study on arthroscopic chondrocytes transplantation for repair of osteochondral defects in TMJ]

OBJECTIVE

To certify the feasibility of arthroscopic chondrocytes transplantation in temporomandibular joint (TMJ) and the nature of repaired tissue with autologous chondrocytes transplantation in osteochondral defects.

METHODS

The animal models of osteochondral defects in TMJ were established in 12 rhesus monkeys. Autologous auricular chondrocytes were transplanted to the defects by arthroscope. Healing of the defects was assessed by gross examination, light microscope, immunohistochemical staining.

RESULTS

The repaired tissues with chondrocytes transplantation were fibrocartilages.

CONCLUSION

The technique of arthroscopic chondrocytes transplantation is feasible and the nature of repaired tissue is closest to the normal cartilage, compared with those of subchondral drilling and cartilage transplantation.

[A experimental study on arthroscopic auricular cartilage transplantation for repair of osteochondral defect of temporomandibular joint(TMJ)]

OBJECTIVE

To study the feasibility and resurfacing ability of auricular cartilage transplantation for osteochondral defect of TMJ.

METHODS

Arthroscopic auricular cartilage transplantations were undertaken in 12 rhesus monkeys(24 joints) to repair the osteochondral defects in TMJs. The repaired tissues were examined by gross examination, light microscope and immunohistochemistry(IHC) 4 weeks,8 weeks,12 weeks and 24 weeks postoperatively.

RESULTS

The defects were repaired 8 weeks after operation. As time goes on, the chondrocytes in defects declined and fibroblast increased at the same time. The IHC showed slight positive stain of type II collagen.

CONCLUSION

The osteochondral defects of TMJ can be restored by autologous auricular cartilage. The nature of repaired tissue was fibrocartilage like tissue at first and then fibrotic tissue.

[A experimental study on arthroscopic subchondral drilling for repair of osteochondral defect of temporomandibular joint (TMJ)]

OBJECTIVE

To investigate the resurfacing ability of TMJ cartilage of rhesus monkeys with osteochondral defect.

METHODS

3-millimeter-diameter, 5-millimeter-depth, cylindrical full-thickness drilled osteochondral defect of articular cartilage on the functional slope of TMJ were made on 12 rhesus monkeys(24 joints) by arthroscope. Every 3 monkeys were sacrificed at 4, 8, 12 and 24 weeks postoperatively and the repaired tissue were studied by gross observation, histology and immunohistochemical staining (IHC).

RESULTS

The repaired tissues after subchondral drilling were dominated with fibrous tissues and IHC showed that Type II collagen stain was negative and Type I collagen stain was positive.

CONCLUSION

The osteochondral defect in TMJ can be repaired by arthroscopic subchondral drilling. The nature of repaired tissue is fibrous connective tissue, something different from normal cartilage. Subchondral drilling can be regarded as one of the treatments for articular cartilage defect.

[Establishment of an animal model of osteochondral defect by arthroscope in TMJ]

OBJECTIVE

To create an animal model of osteochondral defect in temporomandibular joint (TMJ) by arthroscope to minimize the surgical injury.

METHODS

Subchondral drilling on the anterior slope of condyle and posterior slope of eminence were performed on 12 rhesus monkeys (24 joints) by arthroscope.

RESULTS

The osteochondral defect models of TMJ were successfully made on 12 monkeys (24 joints).

CONCLUSION

There are fewer injuries and bias in the animal models of TMJ osteochondral defect by arthroscope than by open surgery.

[Experimental study of the effect of TNP-470 on human salivary adenoid cystic carcinoma cell in vitro]

OBJECTIVE

To investigate the effects of TNP-470 on human salivary adenoid cystic carcinoma cell line ACC M in vitro.

METHODS

Cell proliferation was assessed by MTT assays and dye exclusion counting. Morphological changes of apoptosis were observed with fluorescent microscope. DNA ladder, apoptosis rate and cell cycle were examined by DNA agarose gel electronphores and fluorescence flow cytometry (FCM), respectively.

RESULTS

The 50% inhibitory concentrations (IC50) of TNP-470 on ACC-M cells proliferation by MTT assays and dye exclusion counting were 40.68microg/ml and 46.38microg/ml. Apoptosis were observed by fluorescent microscope. DNA electrophoresis for the cells treated with TNP-470 showed brighter DNA ladder; Sub-G1 peak and G2/M arrest were also determined by FCM (P<0.01).

CONCLUSION

TNP-470 has the effect of inducing apoptosis in ACC-M cells in vitro, which may be one of its antitumor mechanisms.

[The DSA features of AVM of jaws]

OBJECTIVE

To evaluate the vascular architecture of AVM of jaws on DSA.

METHODS

12 cases of AVM of jaws comprised this study group, and 5 cases in maxilla and 7 cases in mandible, respectively. Seldinger technique was applied to carry out carotid angiography under the guidance of DSA machine (PHILIPS V3000).

RESULTS

The DSA features of AVM of jaws included varix into the posterior area of jaws. The varix of the maxilla was supplied by the posterior superior alveolar artery and transversal facial artery when the soft tissue was involved, and the varix of the mandible was supplied by the inferior alveolar artery, maxillary and facial artery.

CONCLUSION

Angiography is considered necessary for the diagnosis and embolization of AVM of jaws, and the varix is the center of lesion.

[Assessment of velopharyngeal function in normal speech by CT]

OBJECTIVE

To find an objective method to assess velopharyngeal function by CT.

METHODS

Three dimensional conformation of the velopharyngeal orifice of 30 subjects with normal speech at rest and /i:/ position were observed and analyzed. The linear distance and area of velopharyngeal orifice were measured and analyzed statistically.

RESULTS

The average minimal area of velopharyngeal orifice at/i:/ position was 11.92+/-11.73 mm(2). The physical RVPI was 4.03+/-4.03%. Coronary closure was the most common type of velopharyngeal contraction which accounted for 50%, semi-ring type being 30%, and ring type being 20%. No sagittal closure were seen in this study. There were 70% subjects whose position of velopharyngeal closure was at the level of the first cervical vertebra, 26.7% above the level and 3.3% below it. The arrange of velopharyngeal closure was 9-12 mm in 83.4% subjects, and 3-6mm in 16.6%.

CONCLUSION

As a method of assessing velopharyngeal function, CT can not only observe the conformation of velopharyngeal orifice in three dimensions, but also quantitatively analyze the velopharyngeal function.

[A retrospective investigation of shoulder function after RND]

OBJECTIVE

This study was designed to investigate shoulder syndrome and its influence on daily life and employment, and to seek scientific rational standard for evaluating shoulder syndrome.

METHODS

Retrospective investigation of shoulder function were carried out in 50 cases after RND through objective evaluation and subjective examination.

RESULTS

68% cases complained obvious handicap in their daily life and work, impaired shoulder function after RND can be seen in almost every case.

CONCLUSION

RND can cause variable degree of disability in the shoulder which influences patients quality of life directly,self evaluation and abducting arm beyond 90 degrees are good standards for evaluating shoulder syndrome.

[Embolization of AVM of jaws]

OBJECTIVE

To report our experience to embolize the AVM of jaws by direct percutaneous puncture. in conjunction with endovascular therapy.

METHODS

3 cases of AVM of mandible and 3 cases of AVM of maxilla comprised this study group. The patients were embolized with fibered coils, PVA and NBCA. The coils were placed directly into the center of the intraosseous lesion. The procedure was under the guidance of DSA machine (PHILIPS V3000).

RESULTS

The acute arterial bleeding in 4 patients was controllable. The other two cases with oozing bleeding and a warm soft mass on the left face with a palpable pulse respectively, their symptoms and signs got improved a lot. The pericoronal oozing of blood in all patients disappeared during a 3 to 24 months follow-up and new bone formation was found in the follow-up radiography.

CONCLUSION

The embolization of the AVM of jaws by direct percutaneous puncture in conjunction with endovascular therapy is effective and safe, however the longer follow-up is expected.

[The diagnostic value of CT for arteriovenous malformations of jaws]

OBJECTIVE

To evaluate the diagnostic value of CT for arteriovenous malformations (AVM) of jaws.

METHODS

12 cases of central vascular malformations of jaws comprised this study group, 5 cases in maxilla and 7cases in mandible, respectively. The X-ray projection included panoramic radiography, Water's position and posterioanterior and lateral oblique view of mandible. The CT scans were obtained on Somatom ART and the axial and coronal scanning modalities were applied.

RESULTS

Radiographically different signs of the AVM of jaws were demonstrated, X plain film has no pathognomic features. The CT features included lytic expansion of bone, expanded space of marrow, obliteration of trabeculae and intact cortex of jaws. These signs were demonstrated very well in bone window setting. There were three forms of demonstrations of AVM of jaws as following: (1) local unilocular, (2) diffused unilocular, (3) multilocular.

CONCLUSION

CT is helpful for early diagnosis of AVM of jaws, and can provide the guidance for the direct puncture embolization.

[Reconstruction of the common carotid artery with autogenous external jugular vein graft in goats]

OBJECTIVE

To establish a method for reconstruction of carotid artery defect with autogenous graft of external jugular vein, to investigate the patency rate and histopathologic changes at different times after implantation.

METHODS

3 healthy adult goats were used as the experimental models. A segment of 2 cm autogenous external jugular vein was used to bridge a surgical defect of the common carotid artery (2 cm long). The six necks of the three animals were divided into A and B group randomly. In Group A, both cut ends of the artery were anastomosed end to end with the venous graft. In Group B, the proximal end of the artery was anastomosed end to side with the venous graft. The patency rate was recorded at different times. The venous grafts with anastomotic sites were harvested at 2 weeks, 3 months and 6 months after implantation, respectively, for histopathologic examinations.

RESULTS

The grafts in Group A were patent at 2 weeks and 3 months, but occluded at 6 months. The grafts in Group B were patent at 2 weeks and 6 months, but not patent at 3 months. Chi-square test demonstrated insignificant difference in patency rate between Group A and Group B. Histopathologic examinations showed intimal hyperplasia and venous arterialization in venous autografts. The venous wall was loose and edematous, intimal and subintimal hyperplasia was prominent at 2 weeks. Proliferation and migration of smooth muscle cell was found at 3 months after implantation. At 6 months, the venous media was predominantly composed of smooth muscle. Intimal hyperplasia was most prominent adjacent to the anastomosis.

CONCLUSION

Reconstruction of the common carotid artery with autogenous graft of external jugular vein had a higher patency rate. The main histopathologic changes after implantation is intimal hyperplasia and venous arterialization. Intimal hyperplasia is the result of proliferation and migration of host arterial smooth muscle cell, which passes through the anastomosis to the intima of the vein graft.

[The MRI of the occult cervical metastasis with malignant tumor of the head and neck]

OBJECTIVE

To detect the occult cervical metastasis with MRI so as to find out its diagnostic accurate rate.

METHODS

41 lateral necks(negative by clinical palpation) with malignant tumor of head and neck were examined by MRI before operation and correlated with postoperative pathologic finding.

RESULTS

With MRI evaluation occult cervical metastasis has higher accurate rate(75%), nine of 12 lateral metastatic positive necks were detected on MRI, other three false negative necks were not found, owing to no change of the shape of the metastatic nodes.

CONCLUSION

At present, MRI is one of the effective methods evaluating occult cervical metastasis with malignant tumor of head and neck, but it has still a certain limitation.

Hydroxy-dibenzo crown ether stationary phase for capillary gas chromatography using sol-gel technology

A new kind of crown ether, OH-dibenzo-14-crown-4 (OH-DB14C4), is prepared and coated onto the fused silica capillary by sol-gel process. Chromatographic characteristics including column efficiency (> 3,000 plates/m), thermal stability (to 330 degrees C) and ability of deactivation are studied. The selectivity of new stationary phase is superior to sol-gel OH-terminal silicone oil (OH-TSO) for positional isomers of some aromatic compounds such as xylene, dichlorobenzene, nitrotoluene, nitrochlorobenzene. The new stationary phase has high sample capacity for separation of small molecular mass compounds: low-molecular-mass alcohols, ethers and ketones, short-chain fatty acids and volatile amines.

[Anatomical and histologic study of the cervical vessels in goats]

OBJECTIVE:To investigate the normal anatomic relations and histologic features of the cervical arteries and veins of goat, with the aim of providing a basis for resection and reconstruction of the common carotid artery.MATERIALS AND METHODS: Surgical dissection was performed on 15 healthy adult goats under general anaesthesia. The external diameters of the common carotid artery (CCA) and external jugular vein(EJV) were measured at their midpoints. 1 cm of the CCA and EJV was subject to light microscopic examination. Direct carotid angiography was performed on 2 selected goats to observe the course and branches of the carotid artery and normal blood flow mapping of the CCA was recorded using Laser Doppler Flowmeter. RESULTS:The average external diameter of the EJV was 5.4 mm for the left side and 5.3 mm for the right side. The average external diameter of the CCA was 3.8 mm for the left side and 3.6 mm for the right side. Histologic examinations found that the media of the carotid artery had 10-15 layers of smooth muscles. The EJV had valvulae, its wall was thin, only 1-2 layers of smooth muscle were contained in its medium. CONCLUSION:The CCA and EJV of the goat had a longer course in the neck, and a larger diameter (3-5 mm). Their histologic structures were similar to that of the human being, which makes it advantageous to be more often used as an animal model in experimental surgery.

[The Inhibitory Study of TNP 470 Combined CDDP on the Tumor Growth and Lung Metastasis of Adenoid Cystic Carcinoma ACC M in Nude Mice]

OBJECTIVE:To study the effect of TNP-470 combined CDDP on the tumor growth and lung metastasis of cell strain ACC-M in vivo. METHODS:High potential lung metastatic adenoid cystic carcinoma cell strains (ACC-M) 5x10(5) were injected simultaneously to 18 nude mice subcutaneously and enously. The animals were randomly divided into 3 groups. In group 1, TNP-470 was administered subcutaneously at the dose of 30mg/kg every other day for 2 weeks from the beginning of 3(rd) week to the end of 4(th) week. In group 2, 5mg/kg CDDP were injected into peritoneal cavity at the beginning of 3(rd) week and 4(th) week and TNP-470 in the same manner as group 1 additionally. In group 3, the same volume of 0.97% NaCl was injected in the manner of group 1. The mice were sacrificed by dislocating the neck at the end of 4 weeks. The tumor size and weights were recorded. The vascular density was measured by rabbit-anti-human factor VIII antibody stain. The results were analyzed by Student t and X(2) test. RESULTS:Group 1 and group 2 had fewer tumor weight and lung metastasis than the 3(rd) group. There was significant difference in the tumor weight and lung metastasis between group 1 and group 2. But the vascular density had no difference among three groups. CONCLUSION:TNP-470 combined CDDP has stronger inhibition on both the tumor growth and lung metastasis of human adenoid cystic carcinoma ACC-M than used alone.

Evaluation of the treatment for micromandibular deformity by distraction osteogenesis with submerged intraoral device

OBJECTIVE

To evaluate the results of distraction osteogenesis for correcting the micromandible with an intraoral device.

MATERIALS AND METHODS

Eight cases of micromandible resulting from temporomandibular joint (TMJ) ankylosis and first and second branchial arch syndrome received treatment by distraction osteogenesis. Subjects included 5 females and 3 males, ranging in age from 10 to 43 years (avg 20.25). Five micromandibles were associated with obvious mandibular asymmetry. An osteotomy was performed on bilateral mandibular bodies by intraoral approach. Elongation was started on the 5th or 6th day postoperation at a rate of 0.8 to 1 mm per day. The distractors were removed after a consolidation period from 71 to 139 days.

RESULTS

The distractions were fulfilled with a range of 8.5 to 24.4 mm. Pain appeared in osteotomy region when the 1 mm distraction was carried out once a day and disappeared when it was divided into twice a day. Mandibular lengthening was successful. Micromandible and facial asymmetries were corrected satisfactorily. The follow-up period ranged from a minimum of 1 month to a maximum of 10 months. There was no recurrence. One case of soft tissue infection and one case of lower lip numbness were reported. There were no cases of infection or other disturbance of wound healing or pseudarthrosis.

CONCLUSIONS

Because of its advantage in little injury, avoiding bone grafting, and few complications, intraoral distraction osteogenesis is a valuable approach to correct mandibular agenesis. However, in the management of mandibular deformities, distraction osteogenesis achieves better results when combined with other orthognathic operations. How to control the direction of distraction is a problem that needs further study.

[Early face mask treatment for maxillary hyperplasia in patients with cleft lip and Palate]

OBJECTIVE: Early interfering orthodontics were used to treat maxillary hyperplasia by face mask and extra-oral bow technique in teenages.The position changes of maxilla after orthodontic treatment were evaluated.METHODS:The cephlometric variables before and after treatment were measured.Variables after treatment were compared with normal values in children with same ages,and changes of the maxillary position was determind.RESULTS:The position of the maxilla after orthopedics was significantly advanced (P<0.001),but there was still difference from normal values.CONCLUSION:In the peroid of mixed dentition of patients with cleft lip and palate,early orthodontics on maxillary hyperplasia could stimulate maxillary development and growth,remove or improve crossbite,extra-oral bow and face mask were efficient tools for this kind of patients.

[The changes of chewing ability after orthognathic therapy: electromyographic analysis]

OBJECTIVE:The maxillo-facial skeletal deformity can only be corrected through orthognathics that consists of orthodontics and operation.There are various changes in aspect of the bite relationship between upper and lower dentition after orthognathic surgery.The change feature of the chewing efficiency of oral maxillary system can be detected through comparing studying of the contracti on force of chewing muscles before and after surgical operation.METHODS:All 6 patients in this research were diagnosed to be skeletal crossbite.Electromyogram was used to test the change of activity of superficial masseter,temporalis and digastrics.The examination was carried out 1 week before operation and 3 months after the operation. RESULTS:When mandibular is in its rest status,there is no significant difference in the change of muscular activities.when it is active,there is significant difference. CONCLUSION:The chewing ability of masticatory muscles is reduced after orthognathic surgery.The result indicated that there is a negative bite relationship between the upper and lower dentition,the occlusion relationship needs accurate adjustment for gaining stability of oral maxillary system.Therefore,orthodontics after operation is of vital importance.

[A preliminary cephalometric study on characters of facial soft tissue in mandibular asymmetry cases]

OBJECTIVE: To study the alterations of facial soft tissue in mandibular asymmetry cases.METHODS:The asymmetric rates of the bone were compared with that of soft tissue by cephalometric analysis in 20 mandibular asymmetry cases by study on the thickness of the soft tissue in special position.RESULTS:It showed that the soft tissue is more symmetric than the bones.CONCLUSION:It can be concluded that the facial soft tissue is not as asymmetric as the bone.This suggests that the reconstrction of the bony deformities and the soft tissue deformities should not be performed at same time.

[The in vitro comparison of platelet induced ACC-M cell adhesion with and without Aspirin]

ObJECTIVE:Observation the affection of aspirin to adhesion of highly metastatic salivary adenoid cystic carcinoma(ACC-M) cell induced by platelet.METHODS:Adhesive ratios of ACC-M cell induced by platelet with or without aspirin were measured.RESULTS:After the addition of platelet rich plasma(PRP),adhesive ratio of ACC-M cell increased significantly (P<0.01). The treatment with aspirin after addition of PRP led to a nonsignificant increase of adhesive ratio (P>0.05).The reduction of adhesive ratio by aspirin was found dosage independent within concentration range of 0.01-0.25g/L of aspirin. CONCLUSION:Adhesion of ACC-M cell was raised by added platelet.Addition of aspirin,platelet induced adhesion of ACC-M cell was inhibited significantly.

[Evaluation of cryosurgery for the management of oral malignant mucomembranous melanoma-A survey of 107 cases reports]

OBJECTIVE:There were 13 cases underwent operation.24 cases underwent cryosurgery only and 70 cases received comprehensive management,which as cryosurgery,operation,chemotherapy and immuno-therapy.RESULTS:The 3'and 5' year survival rate of three groups were 0.0%,0.0%,37.50%,31.25% and 57.14%,36.07%.There are significant differences between operation group and cryosurgery group and between operation group and comprehensive treatment group.Although the third group got the better result,but the difference between late two groups was not statistical significant.CONCLUSION:It is suggested that comprehensive treatment be the routine regime of melanoma in head and neck. Our experience with review of literature covered the classification, surgical principle and complication was presented.

[Presurgical infant orthopedics in complete bilateral cleft lip and palate reconstruction]

OBJECTIVE:This study want to effects on using intraoral-appliance treatment of complete bilateral left lip and Palate in clinic.METHODS:Using Lisson's method preliminary evaluated to effect of presurgical infant orthopedics complete bilateral cleft lip and palate.A sample of 4 cases of 18 weeks infant complete bilateral cleft lip and palate.2 of they are males, others are females.All of they had received presurgical infant orthopedics,Using intraoral appliance. comparison of before and after cast analysis.Evaluate anteiro posteior I, tranverse,oblique degree of the lateral segment, pretrusion premaxilla position change.RESULTS:Every patients after orthopedics treatment had retracted premaxilla come back,corrected of oblique of premaxilla,had lateral segments growth equally on both side,their inclination should be similar.CONCLUSION:Intraoral-appliance can successfully improved malarrangement maxilla of bilateral cleft lip and palate.

[Primary research of development of a mouse model for non-bacterial sialoadenitis]

OBJECTIVE: To develope a mouse model for non-bacterial sialoadenitis similar to SS.The model of organ-specific to the submandibular gland of mouse has developed for this study. METHODS: Several of the mouse strains were used to the development of non-bacterial sialoadenitis.The injection of syngeneic salivary gland tissue with CFA induced inflammation in submandibular gland in mice.Not all mice had a predictable response. RESULTS: C(57) mice (500microg/ml and 750microg/ml group )appear histologically to be more prove to develop sialoadenitis. CONCLUSION: An animal model of non-bacterial sialoadenitis had been set up,the non-bacterial sialoadentitis may be similar to the autoimmune process in human SS.

[Observation of the biodegradation of domestic poly-DL-lactic acid plates in vivo]

OBJECTIVE:To analyze the degradation and related factors of domestic poly-DL-lactic acid(PDLLA) plates in vivo. METHODS: The artifical transverse fractures in mandibular bodies of dogs were created and internal fixed with domestic PDLLA plates as experimental group,the implanted PDLLA plates in femurs as control.A certain time after the operation,the plates in fractured and implanted regions were collected and undertaken macroscopy and scanning electromicroscopy(SEM),meanwhile the fracture-healing status was evaluated. RESULTS: With time going on,the surface of domestic PDLLA plates y and density of micro-holes among poly-DL-lactic acid molecules in the PDLLA plates increased gradually.16-20 weeks Domestic PDLLA plates can be gradually biodegradation in vivo,in which it is correspondent with and accelerative the fracture-healing process.

[Observation in vivo histological response induced by imlplanted domestic poly-DL-lactic acid plates]

OBJECTIVE:To analyze the histological response and biocompatibility to implanted domestic PDLLA plates in vivo METHODS:Bilateral artificial fractures were created in mandibular bodies in dog and internal fixed with domestic PDLLA plate,TM plate respectively;meanwhile,a domestic PDLLA plate was imlplanted in femur.The interfacial soft tissue around the plates were collected and performed histological study RESULTS:All the skin wound healed well without abscess and fistula formation. From 2 to 4 weeks after the operation,the inflmmatory granulomatous response around the intenal fixation PDLLA plates was more serious than that of the control,in which more macrophages,plasmocytes and less lymphocytes,mononuclear cells infiltrated CONCLUSION:Domestic PDLLA plate is an inert internal fixation material with good biocompatibility, which induced a non-speciflc foreign reaction

[Experimental research on animal model and treatment of Sjogren's syndrome by traditional chinese medicine (TCM)]

OBJECTIVE:To confirm the function of SS Syrup used in our department. METHODS: Under the basis of TCM and differentiation symptoms of SS,the animal model was established and applied to test the function of SS syrup.There are three indices to be observed,weight change,volume of drinking water daily,cAMP change. RESULTS: The three observed indices of dificiency symptom model had been rectified by SS syrup. CONCLUSION: SS syrup has two main functions:(1)reinforcing of the spleen and tonifying qi;(2)nourishing liver-yin and kidney-yin as well as removing pathogentic heat and fire.

[Detection of clinical diagnosis and different symptoms of Sjogren's syndrome by traditional chinese medicine (TCM)]

OBJECTIVE:To search for the appropriate diagnostic criteria of SS and confirm the differentiation of SS.METHODS:The European di agnostic criteria has been used in clinic work for about two years,and differentiated the symptoms of SS by TCM. The specialty and relationship between them was made an inquiry.RESULTS:The European criteria set for SS offers the clinic work a practical method to correctly classify the patients suspected of having this disorder. It refers to the signs and symptoms caused by the insufficiency of spleen-qi with deficiency of liver-yin and kidney-yin.CONCLUSION:It has been further proved for easy to make up the diagnostic of SS and its treatment using traditional chinese medicine.

[A comparison of the effects of 180kv X-ray radiation and cobalt-60 radiation on the jaws of the guinea pigs]

OBJECTIVE: Study of the effects of 180kv x-ray and cobalt-60 radiation on jaws and enhance the understanding of pathology of osteroradionecrosis of jaws(ORNJ).METHODS: 128 guinea pigs were grouped according to different irradiation sources and doses.Fractioned radiation from both sources was delivered in right mandible.The teeth extractions were conducted one week prior to radiation and 1,3,5 months after radiation respectively.Following radiation,the guinea pigs were examined by gross observation, x-ray film and histopathological examination at regular interval. RESULTS: Bone resorption occured within 1 month after irradiation as result of osteoblast inhibition and osteoclast activation.From 2 to 4 month afterwards,the number of osteocytes reduced and pyknosis, empty lacunae as well as obliteration of small vessels in periodontal membrane were commonly seen.The teeth extractions conducted at 3 months,5 months after radiation lead to ORNJ in 7 amimals (14.6%).CONCLUSION: 180kv x-ray radiation was far more damaging to jaws than cobalt-60 radiation.The dental extraction is an important factor inducint the development of ORNJ.

Experimental study of radiation effect on the mandibular microvasculature of the guinea pig

OBJECTIVE

This experimental study was performed to explore the intraosseous microvascular alterations in the irradiated mandible and to increase understanding of the pathogenesis of osteoradionecrosis.

METHODS

One hundred twenty-eight guinea pigs were grouped according to different radiation sources and dosages. Fractioned radiation was delivered to the right mandibles. Dental extractions were conducted at 1, 3, and 5 months respectively, after radiation. One month later, the animals were examined by means of gross observation, histopathology, and microvascular corrosion castings.

RESULTS

Histologic evaluation showed bone absorption within 2 months following radiation. Four months later, the number of osteocytes decreased and pyknosis and empty lacunae were commonly seen. The casting specimens revealed under scanning electron microscopy that capillary disconnection and obliteration with subsequent vein shrinkage aggravated over time. In the nonhealing dental extraction site, a large-scale vascular network defect presented with focal capillary proliferation around.

CONCLUSIONS

The capillary is the part most vulnerable to the damage caused by radiation in the vascular system of the mandible. On the basis of "hypovascular, hypoxic, hypocellular" structure, local microcirculation failure induced by the trauma-repairing process leads to occurrence of osteoradionecrosis of jaws.

[The advanced studies on surgical treatment about the patients of TMJ ankylosis and OSAS]

OBJECTIVE: Through the treatment on the 10 patients suffered TMJ ankylosis and OSAS,by means of the TMJ reconstruction combining orthognathic surgery,it is demonstrated that the treatment on the patients must include relieve the TMJ anklosis,correct the maxillofacial deformitis and specially enlarge upper airway space.

[The pre-postoperative polysomnographic evaluation on the patients of TMJ ankylosis with OSAS]

Passing by the comparative studies on the polysomnogram of the patients of TMJ ankylosis with OSAS pre-and-postoperation,the result showed the patients' AI (Apnea Index;AI) has been decreasing,SaO(2) during sleep get to rise,and the method combining TMJ reconstruction and orthognathic surgery is effective to the patients.

[Yield and cytotoxicity of tumor-infiltrating lymphocyte(TIL) following immunochemotherapy]

Tumor-infiltrating lymphocyte (TIL) in the primary site of oral SCC treated with S-PVP of PVP therapy was collected respectively and its yield,that is calculating the amount of TIL per tumor tissue.The cytotoxicity of TIL against the target,Tca8113 was detected.The results showed that the yield of TIL in S-PVP group was three times over that in PVP group.At the ratio of 5 to 1 (effector to target) the cytotoxicity was 38% in S-PVP group and 32% in PVP group.There was no significant difference in its cytotoxicity between two groups.The results revealed that immunochemotherapy of S-PVP regimen for treating oral SCC had neither direct damage to tumor cell from the agents nor antitumor immune reactivity with BRM stimulating an increasing in numbers of TIL.

[Effect on intratumoral T lymphocyte and its subset in oral squamous cell carcinoma following immumnochemotherapy]

The relative numbers of CD(3)(+),CD(3)(+),CD(8)(+) and HLA-RD(+) cells in the tumor tissue before and after inductive therapy was counted using immunohistochemical technique of Avidin Biotin-Peroxidase Complex(ABC),and then the effect on local immune cell following two different inductive therapies was comparatively analysed.The results showed that S-PVP therapy could result in significant increasing in numbers of CD(3)(+)and CD(4)(+) cells intratumorally as compared with pre-therapy(P<0.05),and in slignt increasing in numbers of CD(8)(+) and HLA-DR(+) cell,which is no significant difference between pre-and post-therapy.In the PVP group,there was no significant difference in numbers of CD(3)(+),CD(4)(+),CD(8)(+) and HLA-DR(+) cells between pre-and post-treatment.The results suggested that T lymphocyte in the tumor site could significantly increase in numbers following the S-PVP therapy,and PVP chemotherapy did not obviously affect the local cellular immunity.

[Observation of clinical and pathological responses in short-term following immunochemotherapy for oral squamous cell carcinoma]

24 patients with oral SCC in Stage T3 or T4 were randomly divided into two groups,and treated with two inductive therapies,13 cases of whom received an immumochemotherapy regimen(Sapylin 15 KE+CDDP 70mg/m(2)+VCR 1.4mg/m(2)+PYM 80mg,S-PVP) and 11 cases,a chemotherapy regimen(CDDP 90mg/m(2)+VCR 1.4mg/m(2)+PYM 80mg,PVP) as control.The clinical response and pathological effect after immunochemotherapy or chemotherapy were evaluated through the clinical measurement of tumor size and pathological examination of the specimen.The results showed that the rate of clinical and pathological responses in S-PVP group were 92.3% and 84.6%,respectively;and in PVP group,72.7% and 45.5%.There was a significant difference between two groups in pathological effect(P<0.05),which indicated that the S-PVP regimen in short-term was better than of inductive chemotherapy.It may be relatively objective and accurate in comparison with clinical investigation which could act as an important supplement to the evaluation of clinical response.

[Cephalometric analysis in the patients of TMJ ankylosis with OSAS: Skeletal morphology]

By cephalometric analysis of 18 normal men and 12 men who got TMJ ankylosis with obstructive sleep apnea syndrome(OSAS),the authors reported that there were cephalometric characteristics in the patients:the craniomaxillofacial bones displacement posteriorly and superiorly,and demonstrated that it is key to advance the patients' jaws and enlarge the upper airway space.

[Cephalometric analysis in the patients of TMJ ankylosis with OSAS: Soft tissue morphology]

By cephalometric analysis of 18 normal men and 12 men who got TMJ ankylosis with obstructive sleep apnea syndrome(OSAS),the authors reported that there were cephalometric characteristics in the patients:the posterior airway space(PAS) decreased(P<0.001),and the rate of (TA+SPA)/OPA remarkably increased(P<0.001),so the two parameters are significant for the diagnosis and treatment of the patients.

[The pre-and-postoperative cephalometric evaluation on the patients of TMJ ankylosis with OSAS]

After taken the comparative studies on the cephalometric analysis of the patients of TMJ ankyolsis with OSAS pre-and-post operation,the authors demonstrated the method combining TMJ reconstruction and orthognathic surgery is responsible to the patients.