Clinical Application of Temporary External Fixator for Immediate Mandibular Reconstruction.

Immediate mandibular reconstruction is always necessary for the patients receiving segmental mandibulectomy to recover the facial contour and function of occlusion. When 3D modeling is unavailable, temporary external fixator is necessary to maintain the occlusion relationship and facial contour. In this study, we introduce the clinical application of temporary external fixator for immediate mandibular reconstruction in patients receiving segmental mandibulectomy, which consists of 2 anchor claws, 2 all-round retentive arms, and 1 central locking structure. From August 2016 to September 2017, temporary external fixator was applied in 13 patients. Clinical data of gender, age, surgical procedure, duration of operation, and clinical outcomes were recorded and analyzed. Among the 13 patients, there were 4 men and nine women whose ages ranged from 21 to 64 (mean 47.7) years old. There were 9 benign and 4 malignant lesions. All lesions expended at the buccal side of mandible. 12 fibular flaps and 1 vascularized iliac bone graft were used. The mandibular defect ranged from 6 to 14 (mean 10) cm. The operation duration of surgery ranged from 5 to 10 (mean 7) hours. All flaps survived with primary healing. The occlusion and facial contour were good, without significant changes of the length of mandibular body and width of mandible before and after surgery. No functional sequelae were noted at the donor sites. From these results, the temporary external fixator is easy to operate; the surgical procedure is simple and time-saving for surgeon when 3D modeling is unavailable. The indication for temporary external fixator usage is the mandibular lesion growing outward to cheek soft tissue.

An ectopic meningioma in nasal floor.

OBJECTIVE: Primary ectopic meningioma is a rare tumor and is usually limited to the paravertebral soft tissues. The aim of this study was to assist in the diagnosis and treatment of the tumor. METHODS: A 16-year-old boy presented with a nasal floor mass. The computed tomographic scan suggested a neoplastic mass lesion in the nasal floor region, and primary diagnosis is sebaceous cyst. The patient received a surgical resection, and the histologic examinations showed that the lesion was characterized with spindle cells. Immunohistochemical staining showed that the tumor cells presented intense reactivity for epithelial membrane antigen and vimentin. Histologic examination and immunohistochemical staining confirmed the diagnosis of extracranial ectopic meningioma. RESULTS: The patient received a radical surgical and immediate restoration of adjacent flap, and the patient fully recovered 1 week later. CONCLUSIONS: The case highlights the fact that despite its rarity, ectopic meningioma should be considered as a differential diagnosis of any mass lesion in the head and neck region, especially when spindle cells are histologically observed.

An osteochondroma of the mandibular condyle.

OBJECTIVE: Osteochondroma is rarely seen in the facial region, especially around the condyle. Here, we report a case of condylar osteochondroma, aiming to assist the diagnosis and treatment of the tumor. METHODS: A case of osteochondroma of the left mandibular condyle in a 49-year-old man was presented. Medical records with x-ray, computed tomographic scan, and bone scan of histologically proven osteochondroma of mandibular condyle were obtained. RESULTS: The patient underwent a surgical resection and had fewer functional changes as well as less dysfunction of the temporomandibular joint. CONCLUSIONS: The current study highlights the fact that, despite its rarity in the mandibular condyle, surgical resection is an effective treatment method. The decision, however, depends on how much swing of the mandible is required after surgery for correction of asymmetry and occlusion.

Computationally Guided Synthesis of MXenes by Dry Selective Extraction.

MXenes are a rapidly growing family of 2D transition metal carbides and nitrides that are promising for various applications, including energy storage and conversion, electronics, and healthcare. Hydrofluoric-acid-based etchants are typically used for large-scale and high-throughput synthesis of MXenes, which also leads to a mixture of surface terminations that impede MXene properties. Herein, a computational thermodynamic model with experimental validation is presented to explore the feasibility of fluorine-free synthesis of MXenes with uniform surface terminations by dry selective extraction (DSE) from precursor MAX phases using iodine vapors. A range of MXenes and respective precursor compositions are systematically screened using first-principles calculations to find candidates with high phase stability and low etching energy. A thermodynamic model based on the "CALculation of PHAse Diagrams" (CALPHAD) approach is further demonstrated, using Ti3 C2 I2 as an example, to assess the Gibbs free energy of the DSE reaction and the state of the byproducts as a function of temperature and pressure. Based on the assessment, the optimal synthesis temperature and vapor pressure are predicted and further verified by experiments. This work opens an avenue for scalable, fluorine-free dry synthesis of MXenes with compositions and surface chemistries that are not accessible using wet chemical etching.

Neck dissection and post-operative chemotherapy with dimethyl triazeno imidazole carboxamide and cisplatin protocol are useful for oral mucosal melanoma.

BACKGROUND: Oral mucosal melanoma (OMM) is a clinically rare disease with poor prognosis. Various treatment methods have been investigated with the aim of improving the prognosis. This study aimed to analyze the data of a single institution in the management of OMM. METHODS: A total of 78 consecutive OMM patients were included in this retrospective study. The intraoral lesion was treated either by cryotherapy, surgery or both; the neck was treated by neck dissection or observation; post-operative chemotherapy with dimethyl triazeno imidazole carboxamide and cisplatin was performed in some patients. The Kaplan-Meier method was used for statistical analysis. RESULTS: Among the 78 patients, there were 50 males and 28 females with an average age of 53.8 years (ranging from 27 to 85 years). The most common sites of OMM were the hard palate and gingiva. The main cause of death in OMM was distant metastasis. No significant difference was found between the intraoral/cervical lesion recurrence/post-operative distant metastasis and the intraoral lesion site/biopsy method/treatment method. The metastasis rate of cervical lymph node was high in the OMM patients, even in the patients with clinically negative necks. Cervical lesion recurrence was correlated with N stage and intraoral lesion recurrence. The survival period was longer in the patients with T3 staging, clinical stage III disease, with post-operative chemotherapy and without post-operative distant metastasis when compared to those patients with T4a staging, clinical stage IV disease, without post-operative chemotherapy and with post-operative distant metastasis. CONCLUSIONS: Radical surgery including wide intraoral resection and neck dissection is recommended for OMM patients. Post-operative chemotherapy may also be beneficial for both primary and recurrent OMM patients.

Irradiation-Induced Extremes Create Hierarchical Face-/Body-Centered-Cubic Phases in Nanostructured High Entropy Alloys.

A nanoscale hierarchical dual-phase structure is reported to form in a nanocrystalline NiFeCoCrCu high-entropy-alloy (HEA) film via ion irradiation. Under the extreme energy deposition and consequent thermal energy dissipation induced by energetic particles, a fundamentally new phenomenon is revealed, in which the original single-phase face-centered-cubic (FCC) structure partially transforms into alternating nanometer layers of a body-centered-cubic (BCC) structure. The orientation relationship follows the Nishiyama-Wasser-man relationship, that is, (011)BCC || ( 1¯1¯1)FCC and [100]BCC || [ 11¯0]FCC . Simulation results indicate that Cr, as a BCC stabilizing element, exhibits a tendency to segregate to the stacking faults (SFs). Furthermore, the high densities of SFs and twin boundaries in each nanocrystalline grain serve to accelerate the nucleation and growth of the BCC phase during irradiation. By adjusting the irradiation parameters, desired thicknesses of the FCC and BCC phases in the laminates can be achieved. This work demonstrates the controlled formation of an attractive dual-phase nanolaminate structure under ion irradiation and provides a strategy for designing new derivate structures of HEAs.

Cyclin D1 overexpression enhances chemosensitivity to TPF chemotherapeutic agents via the caspase-3 pathway in oral cancer.

Induction chemotherapy has been previously demonstrated to downgrade locally advanced or aggressive cancers and increase the likelihood of primary lesion eradication. Based on our previous phase 3 trial on TPF (docetaxel, cisplatin and fluorouracil) induction chemotherapy in patients with oral squamous cell carcinoma (OSCC), in which short-term prognostic and predictive values of cyclin D1 expression were reported, the present study aimed to determine the long-term predictive value of cyclin D1 expression in the same patients with OSCC who were eligible to receive TPF induction chemotherapy. In addition, the present study investigated the potential association between cyclin D1 expression and chemosensitivity to TPF agents during OSCC cell intervention, and the underlying apoptotic mechanism of action. In total, 232 patients with locally advanced OSCC from our previous trial with a median follow-up of 5 years were included for survival analysis using the Kaplan-Meier method and the log-rank test in the present study, where cyclin D1 expression in their tissues was detected by immunohistochemistry. Cyclin D1 knockdown, cytotoxicity assays assessing the efficacy of the TPF chemotherapeutic agents and measurements of caspase-3 and PARP activity in HB96, CAL27 and HN30 cell lines were performed. Patients with OSCC in the low cyclin D1 expression group exhibited significantly superior long-term clinical outcomes compared with those in patients in the high cyclin D1 expression group [overall survival (OS), P=0.001; disease-free survival, P=0.003; local recurrence-free survival, P=0.004; distant metastasis-free survival (DMFS), P=0.001]. Furthermore, patients with stage clinical nodal stage 2 (cN2) OSCC in the high cyclin D1 expression group benefitted from TPF induction chemotherapy (OS, P=0.024; DMFS, P=0.024), whilst patients with cN2 OSCC in the low cyclin D1 expression group did not benefit from this chemotherapy. Overexpression of cyclin D1 expression was found to enhance chemosensitivity to TPF chemotherapeutic agents in OSCC by mediating caspase-3-dependent apoptosis. Based on these findings, TPF induction chemotherapy can benefit patients with cN2 OSCC and high cyclin D1 expression in terms of long-term survival from compared with standard treatment. In addition, OSCC cell lines overexpressing cyclin D1 are more sensitive to TPF chemotherapeutic agents in a caspase-3-dependent manner (clinical trial. no. NCT01542931; February 2012).

[Evaluation of harmonic scalpel assisted extracapsular dissection for benign parotid tumors].

PURPOSE: To investigate the clinical outcomes and prognosis of harmonic scalpel assisted extracapsular dissection for benign parotid tumors. METHODS: A total of 132 patients with full medical archives who were diagnosed as benign parotid tumors from 3 medical centers were retrospectively analyzed. The included patients were divided into 3 groups according to tumor positions, namely, superficial pre-auricular, superficial tail, and deep lobe. The intra- and peri-operative variables, complications, functional outcomes and recurrence rates were analyzed with SPSS 16.0 software package. RESULTS: The surgical and drainage time were longer and the blood loss and drainage amount were significantly greater in deep lobe group (P<0.01). Facial nerve damage occurred more frequently in deep lobe group (P=0.022), while damages of great auricular nerve and parotid fascia, as well as capsule rupture were similar among 3 groups (P>0.05). More patients with decreased sensation or sialocele were observed in deep lobe group (P=0.004, 0.043, respectively), and no significant differences were found for wound infection and Frey's syndrome among 3 groups (P>0.05).Transient facial nerve paralysis occurred more frequently in deep lobe group (P<0.01), while permanent facial nerve paralysis was similar (P=0.052). No significant difference was observed for tumor recurrence (P=1.000). CONCLUSIONS: HS-ECD displays good outcomes and prognosis for benign tumor of parotid gland, with improved esthetic and functional results as well as fewer complications and recurrence rate postoperatively.

Co-expression of XIAP and CIAP1 Play Synergistic Effect on Patient's Prognosis in Head and Neck Cancer.

To explore the influence of chemotherapy on prognosis of Head and Neck Squamous Cell Carcinoma (HNSCC) and the relationship between XIAP and CIAP1 co-expression and the prognosis in HNSCC. 129 patients were recruited in our study, they were divided into two groups, neoadjuvant group (n = 60) and non-neoadjuvant group (n = 69). Expression level of XIAP and CIAP1 were examed in neoadjuvant group, and was correlated with clinical outcomes of the patients. The unselected patients were not benefit from neoadjuvant chemotherapy. Moreover, the patients whose tumors co-express high level of XIAP and CIAP1 presented poorer overall and disease-free survival rates than those whose tumors co-express low level of XIAP and CIAP1 (overall survival P < 0.001, disease-free survival P < 0.001). Our results validate that individual chemotherapy is important for HNSCC, and co-expression of XIAP and CIAP1 prompted a worse prognosis.

Local electronic descriptors for solute-defect interactions in bcc refractory metals.

The interactions between solute atoms and crystalline defects such as vacancies, dislocations, and grain boundaries are essential in determining alloy properties. Here we present a general linear correlation between two descriptors of local electronic structures and the solute-defect interaction energies in binary alloys of body-centered-cubic (bcc) refractory metals (such as W and Ta) with transition-metal substitutional solutes. One electronic descriptor is the bimodality of the d-orbital local density of states for a matrix atom at the substitutional site, and the other is related to the hybridization strength between the valance sp- and d-bands for the same matrix atom. For a particular pair of solute-matrix elements, this linear correlation is valid independent of types of defects and the locations of substitutional sites. These results provide the possibility to apply local electronic descriptors for quantitative and efficient predictions on the solute-defect interactions and defect properties in alloys.

Disorder in Mn+1AXn phases at the atomic scale.

Atomic disordering in materials alters their physical and chemical properties and can subsequently affect their performance. In complex ceramic materials, it is a challenge to understand the nature of structural disordering, due to the difficulty of direct, atomic-scale experimental observations. Here we report the direct imaging of ion irradiation-induced antisite defects in Mn+1AXn phases using double CS-corrected scanning transmission electron microscopy and provide compelling evidence of order-to-disorder phase transformations, overturning the conventional view that irradiation causes phase decomposition to binary fcc-structured Mn+1Xn. With the formation of uniformly distributed cation antisite defects and the rearrangement of X anions, disordered solid solution γ-(Mn+1A)Xn phases are formed at low ion fluences, followed by gradual transitions to solid solution fcc-structured (Mn+1A)Xn phases. This study provides a comprehensive understanding of the order-to-disorder transformations in Mn+1AXn phases and proposes a method for the synthesis of new solid solution (Mn+1A)Xn phases by tailoring the disorder.

[Clinical treatment and prognosis of 52 cases of neurinoma in parotid region].

PURPOSE: To investigate the clinical features, diagnosis, and treatment, as well as prognosis of neurinoma in parotid region, in order to provide references for clinical treatment. METHODS: Fifty-two cases of neurinoma in parotid region treated between June 2000 to December 2013 were retrospectively investigated, including their clinical characteristics, imaging examination, diagnosis, therapies and prognosis. SPSS13.0 software package was used for Fisher's exact test. RESULTS: Nine cases (17.31%) in all had facial paralysis, discomfort and other neural symptoms before operation. Eleven cases(21.15%) was preoperatively diagnosed. All patients were treated with surgery, pathologically diagnosed and followed up for 42 months to 206 months. No recurrence and malignant transformation were found. Twenty-eight cases (53.85%) had symptoms of facial nerve injury postoperatively, but 18 cases (64.29%) were improved functionally. When there was no obvious correlation between the tumor and facial nerve, no facial nerve paralysis was found. When the tumor was located on the facial nerve, the rate of preserving facial nerve function was 22.22%, the rate of intracapsular enucleation of the neurinoma was 85.71%, and the effective rate of excision followed by facial nerve reconstruction was 85.71%. CONCLUSIONS: The diagnosis of neurinoma in parotid region is difficult and needed to be confirmed by postoperative pathology. The preservation of facial nerve function should be the utmost procedure during operation while intracapsular enucleation is the first choice. However, in order to restore the function of facial nerve, nerve reconstruction should be performed as soon as possible.

Elevated growth differentiating factor 15 expression predicts long-term benefit of docetaxel, cisplatin and 5-fluorouracil induction chemotherapy in patients with oral cancer.

Our previous phase 3 trial (NCT01542931) failed to demonstrate improved survival when docetaxel, cisplatin and 5-fluorouracil (TPF) induction chemotherapy was introduced prior to surgery and postoperative radiotherapy in patients with locally advanced oral squamous cell carcinoma (OSCC). The aim of the present study was to investigate the long-term predictive value of GDF15 expression for potential personalized treatment strategies in OSCC. A total of 256 patients with stage III/IVA OSCC from our phase 3 trial were enrolled in the present study. Immunohistochemical staining against GDF15 was performed in the biopsy samples from 230/256 patients. Kaplan-Meier analysis, followed by the log-rank test, and the Cox proportional hazards model were used for outcome analysis using the statistical SPSS 18.0 software package for Windows. Among the 230 patients, low GDF15 expression was detected in 68 patients and high GDF15 expression was detected in 162 patients. With a median follow-up period of 67 months, the patients with low GDF15 expression exhibited a higher survival rate than those with high GDF15 expression, including 5-year overall survival (73.4 vs. 57.7%; P=0.059), 5-year disease-free survival (64.5 vs. 49.2%; P=0.033), 5-year locoregional recurrence-free survival (66.0 vs. 51.5%; P=0.043) and 5-year distant metastasis-free survival (73.4 vs. 56.6%; P=0.038) rates. Furthermore, the cT3/4N0M0 patients with high GDF15 expression benefited significantly from TPF induction chemotherapy, including overall survival (HR=0.233; P=0.02), disease-free survival (HR=0.296; P=0.014), locoregional recurrence-free survival (HR=0.347; P=0.035) and distant metastasis-free survival (HR=0.212; P=0.013) rates. The results of the present study suggested that elevated GDF15 expression may be used as a long-term prognostic biomarker for poor clinical outcomes in patients with locally advanced OSCC. Elevated GDF15 expression in cT3/4N0M0 patients predicts significant long-term benefit of survival from TPF induction chemotherapy.

[Changes of endogenous ouabain in rat serum and certain tissues after exposure to simulated weightlessness].

OBJECTIVE: To investigate the changes of endogenous ouabain (EO) in rat serum and some tissues after exposure to simulated weightlessness and to investigate its possible pathophysiology. METHOD: Male Wistar rats were randomly divided into control group (Con) and 1 week tail-suspension group (TS). Enzyme-linked immunosorbent assay (ELISA) was used to detect the content of EO in serum, hypothalamus, pituitary, adrenal gland, kidney, heart and liver. RESULT: Compared with Con, EO increased significantly in serum, hypothalamus, adrenal gland and kidney after tail suspension (P<0.05). CONCLUSION: Simulated weightlessness induced changes of EO in serum and some tissues, which may have some effects on the regulation of hydro-electrolyte metabolism and cardiovascular functions.

[Clinical and pathological analysis of jaw ameloblastomas in 890 patients].

PURPOSE: To investigate the clinical and pathological features of jaw ameloblastomas in 890 patients, in order to provide reference for clinical diagnosis and treatment. METHODS: Eight hundred and ninty cases with jaw ameloblastomas treated in our department from January 2003 to June 2014 were retrospectively analyzed, including their gender, age, primary sites, pathological subtypes and therapies. RESULTS: The age of patients ranged from 6 to 101 years old, with a mean age of 40.15 years. The distribution between males and females were 61.91% (551/890) males to 38.08% (339/890) females (1.62:1). 724 (81.35%) were located in the mandible, 166 (18.65%) were located in the maxilla. The occurrence of jaw ameloblastomas in this series of 890 patients was same in both sides of the jaw. Jaw ameloblastomas occurred in any parts of the jaw. Solid (378/890) and unicystic ameloblastoma (427/890) were the most common pathological subtypes. 414 cases underwent curettage, 212 cases underwent decompression, and 264 cases underwent mandibulectomy or maxillectomy. CONCLUSIONS: Jaw ameloblastoma mainly happens in mandible and young people. Men are more vulnerable to suffer from than women. The most common sites are mandibular molar region and ramus. Curettage is the most commonly used treatment for ameloblastomas. Supported by Scientific Research Fund of Oromaxillofacial Head and Neck Surgery of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine.

Nano-sized Superlattice Clusters Created by Oxygen Ordering in Mechanically Alloyed Fe Alloys.

Creating and maintaining precipitates coherent with the host matrix, under service conditions is one of the most effective approaches for successful development of alloys for high temperature applications; prominent examples include Ni- and Co-based superalloys and Al alloys. While ferritic alloys are among the most important structural engineering alloys in our society, no reliable coherent precipitates stable at high temperatures have been found for these alloys. Here we report discovery of a new, nano-sized superlattice (NSS) phase in ball-milled Fe alloys, which maintains coherency with the BCC matrix up to at least 913 °C. Different from other precipitates in ferritic alloys, this NSS phase is created by oxygen-ordering in the BCC Fe matrix. It is proposed that this phase has a chemistry of Fe3O and a D03 crystal structure and becomes more stable with the addition of Zr. These nano-sized coherent precipitates effectively double the strength of the BCC matrix above that provided by grain size reduction alone. This discovery provides a new opportunity for developing high-strength ferritic alloys for high temperature applications.

Long-term results of a randomized phase III trial of TPF induction chemotherapy followed by surgery and radiation in locally advanced oral squamous cell carcinoma.

Previously, we conducted a randomized phase III trial of TPF (docetaxel, cisplatin, and 5-fluorouracil) induction chemotherapy in surgically managed locally advanced oral squamous cell carcinoma (OSCC) and found no improvement in overall survival. This study reports long-term follow-up results from our initial trial. All patients had clinical stage III or IVA locally advanced OSCC. In the experimental group, patients received two cycles of TPF induction chemotherapy (75mg/m2 docetaxel d1, 75mg/m2 cisplatin d1, and 750mg/m2/day 5-fluorouracil d1-5) followed by radical surgery and post-operative radiotherapy; in the control group, patients received upfront radical surgery and post-operative radiotherapy. The primary endpoint was overall survival. Among 256 enrolled patients with a median follow-up of 70 months, estimated 5-year overall survival, disease-free survival, locoregional recurrence-free survival, and distant metastasis-free survival rates were 61.1%, 52.7%, 55.2%, and 60.4%, respectively. There were no significant differences in survival rates between experimental and control groups. However, patients with favorable pathologic responses had improved outcomes compared to those with unfavorable pathologic responses and to those in the control group. Although TPF induction chemotherapy did not improve long-term survival compared to surgery upfront in patients with stage III and IVA OSCC, a favorable pathologic response after induction chemotherapy may be used as a major endpoint and prognosticator in future studies. Furthermore, the negative results observed in this trial may be represent type II error from an underpowered study. Future larger scale phase III trials are warranted to investigate whether a significant benefit exists for TPF induction chemotherapy in surgically managed OSCC.

Randomized phase III trial of induction chemotherapy with docetaxel, cisplatin, and fluorouracil followed by surgery versus up-front surgery in locally advanced resectable oral squamous cell carcinoma.

PURPOSE: To evaluate induction chemotherapy with docetaxel, cisplatin, and fluorouracil (TPF) followed by surgery and postoperative radiotherapy versus up-front surgery and postoperative radiotherapy in patients with locally advanced resectable oral squamous cell carcinoma (OSCC). PATIENTS AND METHODS: A prospective open-label phase III trial was conducted. Eligibility criteria included untreated stage III or IVA locally advanced resectable OSCC. Patients received two cycles of TPF induction chemotherapy (docetaxel 75 mg/m(2) on day 1, cisplatin 75 mg/m(2) on day 1, and fluorouracil 750 mg/m(2) on days 1 to 5) followed by radical surgery and postoperative radiotherapy (54 to 66 Gy) versus up-front radical surgery and postoperative radiotherapy. The primary end point was overall survival (OS). Secondary end points included local control and safety. RESULTS: Of the 256 patients enrolled onto this trial, 222 completed the full treatment protocol. There were no unexpected toxicities, and induction chemotherapy did not increase perioperative morbidity. The clinical response rate to induction chemotherapy was 80.6%. After a median follow-up of 30 months, there was no significant difference in OS (hazard ratio [HR], 0.977; 95% CI, 0.634 to 1.507; P = .918) or disease-free survival (HR, 0.974; 95% CI, 0.654 to 1.45; P = .897) between patients treated with and without TPF induction. Patients in the induction chemotherapy arm with a clinical response or favorable pathologic response (≤ 10% viable tumor cells) had superior OS and locoregional and distant control. CONCLUSION: Our study failed to demonstrate that TPF induction chemotherapy improves survival compared with up-front surgery in patients with resectable stage III or IVA OSCC.