Coping with alpine habitats: genomic insights into the adaptation strategies of Triplostegia glandulifera (Caprifoliaceae).

How plants find a way to thrive in alpine habitats remains largely unknown. Here we present a chromosome-level genome assembly for an alpine medicinal herb, Triplostegia glandulifera (Caprifoliaceae), and 13 transcriptomes from other species of Dipsacales. We detected a whole-genome duplication event in T. glandulifera that occurred prior to the diversification of Dipsacales. Preferential gene retention after whole-genome duplication was found to contribute to increasing cold-related genes in T. glandulifera. A series of genes putatively associated with alpine adaptation (e.g. CBFs, ERF-VIIs, and RAD51C) exhibited higher expression levels in T. glandulifera than in its low-elevation relative, Lonicera japonica. Comparative genomic analysis among five pairs of high- vs low-elevation species, including a comparison of T. glandulifera and L. japonica, indicated that the gene families related to disease resistance experienced a significantly convergent contraction in alpine plants compared with their lowland relatives. The reduction in gene repertory size was largely concentrated in clades of genes for pathogen recognition (e.g. CNLs, prRLPs, and XII RLKs), while the clades for signal transduction and development remained nearly unchanged. This finding reflects an energy-saving strategy for survival in hostile alpine areas, where there is a tradeoff with less challenge from pathogens and limited resources for growth. We also identified candidate genes for alpine adaptation (e.g. RAD1, DMC1, and MSH3) that were under convergent positive selection or that exhibited a convergent acceleration in evolutionary rate in the investigated alpine plants. Overall, our study provides novel insights into the high-elevation adaptation strategies of this and other alpine plants.

Plant-on-chip: Core morphogenesis processes in the tiny plant Wolffia australiana.

A plant can be thought of as a colony comprising numerous growth buds, each developing to its own rhythm. Such lack of synchrony impedes efforts to describe core principles of plant morphogenesis, dissect the underlying mechanisms, and identify regulators. Here, we use the minimalist known angiosperm to overcome this challenge and provide a model system for plant morphogenesis. We present a detailed morphological description of the monocot Wolffia australiana, as well as high-quality genome information. Further, we developed the plant-on-chip culture system and demonstrate the application of advanced technologies such as single-nucleus RNA-sequencing, protein structure prediction, and gene editing. We provide proof-of-concept examples that illustrate how W. australiana can decipher the core regulatory mechanisms of plant morphogenesis.

Benefits of Mindfulness Training on the Mental Health of Women During Pregnancy and Early Motherhood: A Randomized Controlled Trial.

Objective: This study aimed to evaluate the effects of a mindfulness-based psychosomatic intervention on depression, anxiety, fear of childbirth (FOC), and life satisfaction of pregnant women in China. Methods: Women experiencing first-time pregnancy ( n = 104) were randomly allocated to the intervention group or a parallel active control group. We collected data at baseline (T0), post-intervention (T1), 3 days after delivery (T2), and 42 days after delivery (T3). The participants completed questionnaires for the assessment of the levels of depression, anxiety, FOC, life satisfaction, and mindfulness. Differences between the two groups and changes within the same group were analyzed at four time points using repeated-measures analysis of variance. Results: Compared with the active control group, the intervention group reported lower depression levels at T2 ( P = 0.038) and T3 ( P = 0.013); reduced anxiety at T1 ( P = 0.001) and T2 ( P = 0.003); reduced FOC at T1 ( P < 0.001) and T2 ( P = 0.04); increased life satisfaction at T1 ( P < 0.001) and T3 ( P = 0.015); and increased mindfulness at T1 ( P = 0.01) and T2 ( P = 0.006). Conclusion: The mindfulness-based psychosomatic intervention effectively increased life satisfaction and reduced perinatal depression, anxiety, and FOC.

BMP8A promotes survival and drug resistance via Nrf2/TRIM24 signaling pathway in clear cell renal cell carcinoma.

There is increasing evidence that bone morphogenetic proteins (BMP) are involved in the proliferation and drug tolerance of kidney cancer. However, the molecular mechanism of BMP8A in renal cell proliferation and drug tolerance is not clear. Here we showed that BMP8A was highly expressed in renal cell carcinoma, which suggests a poor prognosis of ccRCC. Promotion of cell proliferation and inhibition of apoptosis were detected by CCK-8 assay, Trypan Blue staining, flow cytometry and bioluminescence. BMP8A promoted resistance of As2 O3 by regulating Nrf2 and Wnt pathways in vitro and in vivo. Mechanistically, BMP8A enhanced phosphorylation of Nrf2, which, in turn, inhibited Keap1-mediated Nrf2 ubiquitination and, ultimately, promoted nuclear translocation and transcriptional activity of Nrf2. Nrf2 regulates the transcription of TRIM24 detected by ChIP-qPCR. BMP8A was highly expressed in ccRCC, which suggests a poor prognosis. BMP8A was expected to be an independent prognostic molecule for ccRCC. On the one hand, activated Nrf2 regulated reactive oxygen balance, and on the other hand, by regulating the transcription level of TRIM24, it was involved in the regulation of the Wnt pathway to promote the proliferation, invasion and metastasis of ccRCC and the resistance of As2 O3 . Taken together, our findings describe a regulatory axis where BMP8A promotes Nrf2 phosphorylation and activates TRIM24 to promote survival and drug resistance in ccRCC.

Low power consumption thermo-optic switch formed by an integrated processing method.

In this paper, an integrated processing method was demonstrated to fabricate the polymer-based thermo-optic (TO) switch with low power consumption. The characteristic parameters of the switch were carefully designed and simulated. The air trench structure was exploited to reduce the power consumption, which can be formed with the waveguide simultaneously by the integrated processing method. Moreover, the introduced polymer/silica hybrid waveguide structure can also improve the response time of the device. A typical fabricated switch presented a low switching power of 5.2 mW. The measured switching rise time and fall time are 192.2 and 201.1 µs, respectively.

Novel long noncoding RNA OTUD6B-AS1 indicates poor prognosis and inhibits clear cell renal cell carcinoma proliferation via the Wnt/ß-catenin signaling pathway.

BACKGROUND: The long noncoding RNA (lncRNA) OTUD6B antisense RNA 1 (OTUD6B-AS1) is oriented in an antisense direction to the protein-coding gene OTUD6B on the opposite DNA strand. TCGA database data show that the expression of the lncRNA OTUD6B-AS1 is downregulated and that OTUD6B-AS1 acts as an antioncogene in a variety of tumors. However, the expression and biological functions of the lncRNA OTUD6B-AS1 are still unknown in tumors, including clear cell renal cell carcinoma (ccRCC). METHODS: The expression level of OTUD6B-AS1 was measured in 75 paired human ccRCC tissue and corresponding adjacent normal renal tissue samples. The correlations between the OTUD6B-AS1 expression level and clinicopathological features were evaluated using the chi-square test. The effects of OTUD6B-AS1 on ccRCC cells were determined via MTT assay, clone formation assay, transwell assay, and flow cytometry. Furthermore, the impact of OTUD6B-AS1 overexpression on the activation of the Wnt/ß-catenin signaling pathway was investigated. Finally, ACHN cells with OTUD6B-AS1 overexpression were subcutaneously injected into nude mice to evaluate the influence of OTUD6B-AS1 on tumor growth in vivo. RESULTS: In this study, we found that the expression of the lncRNA OTUD6B-AS1 was downregulated in ccRCC tissue samples and that patients with low OTUD6B-AS1 expression had shorter overall survival than patients with high OTUD6B-AS1 expression, which showed that the different expression level of OTUD6B-AS1 indirectly correlated with survival of patients. Lentivirus-mediated OTUD6B-AS1 overexpression significantly decreased the proliferation of ccRCC cells and promoted the apoptosis of the cells. Furthermore, OTUD6B-AS1 overexpression partly inhibited cell migration and invasion. The overexpression of OTUD6B-AS1 decreased the activity of the Wnt/ß-catenin pathway and suppressed the expression of epithelial-to-mesenchymal transition (EMT)-related proteins (E-cadherin, N-cadherin and Snail) in ccRCC cells. In addition, compared with the parental ACHN cells, OTUD6B-AS1-overexpressing ACHN cells injected into nude mice exhibited decreased tumor growth in vivo. CONCLUSIONS: Taken together, our findings present a road map for targeting the newly identified lncRNA OTUD6B-AS1 to suppress ccRCC progression in cell lines, and these results elucidate a novel potential therapeutic target for ccRCC treatment.

Polymer/glass hybrid DC-MZI thermal optical switch for 3D-integrated chips.

A directional coupler (DC) Mach-Zehnder interferometer (MZI) thermal optical switch based on a polymer and glass waveguide hybrid for three-dimensional (3D)-integrated chips is demonstrated. The proposed thermal optical switch consists of a polymer waveguide and glass waveguide prepared using an ion-exchange technique. The two waveguide cores can achieve coupling in the vertical direction, improving the integration level on 3D-integrated chips, realizing the complementary advantages of polymer and glass materials. Because of the opposite thermal optical coefficients of polymer and glass materials, and the good stability, low transmission loss and large thermal conductivity of glass material, the device with a low power consumption, small dimensions, fast response time and high extinction ratio can be easily obtained. The optical field coupling between the graded refractive index and step refractive index in 3D directions was simulated. The optimized coupling efficiency is 99.82% with an open-window dimension (w) of 3 µm. The refractive index difference between the diffusion surface center and cladding (Δn) is 0.022. The properties of the DC-MZI thermal optical switch were optimized, achieving a switch power consumption of 5.16 mW, a rising time of 128.8 µs, a falling time of 249.5 µs without an air trench structure, and a switch power consumption of 3.74 mW, a rising time of 140.7 µs, a falling time of 256.3 µs after the etching of an air trench structure with a heating electrode width of 8 µm.

Investigation of A Slow-Light Enhanced Near-Infrared Absorption Spectroscopic Gas Sensor, Based on Hollow-Core Photonic Band-Gap Fiber.

Generic modeling and analysis of a slow-light enhanced absorption spectroscopic gas sensor was proposed, using a mode-tuned, hollow-core, photonic band-gap fiber (HC-PBF) as an absorption gas cell. Mode characteristics of the un-infiltrated and infiltrated HC-PBF and gas absorption enhancement of the infiltrated HC-PBF were analyzed. A general rule of microfluidic parameters for targeting different gas species in the near-infrared was obtained. Ammonia (NH3) was used as an example to explore the effects of slow light on gas detection. The second harmonic (2f) signal and Allan deviation were theoretically investigated based on the derived formulations.

Computer-assisted resection and reconstruction of bilateral osteoradionecrosis of the mandible using 2 separate flaps prepared from a single fibula.

OBJECTIVES: Osteoradionecrosis of the mandible is a late radiation-induced complication, which is a major concern in survivors of head and neck cancer. STUDY DESIGN: In this study, we present a case of a patient with nasopharyngeal carcinoma who developed extensive bilateral osteoradionecrosis of the ascending ramus of the mandible. After preoperative virtual surgical planning, the obtained data were used to fabricate patient-specific cutting templates. The bilateral mandibular defects were reconstructed using 2 separate flaps prepared from a single fibula. RESULTS: Both defects were successfully reconstructed, and satisfactory aesthetic and functional results were achieved. CONCLUSIONS: Bilateral mandibular osteoradionecrosis can be managed with virtual surgical planning, and the defects can be reconstructed using 2 separate flaps prepared from a single fibula.

Comparison of outcomes with extensive segmental pectoralis major myocutaneous flap via the anterior axillary line and the conventional technique in oral and oropharyngeal cancer.

BACKGROUND: This study compared the outcomes of an extensive segmental pectoralis major myocutaneous flap (esPMMF) and a conventional pectoralis major myocutaneous flap (PMMF). METHODS: The study enrolled 91 patients with primary oral and oropharyngeal squamous cell carcinoma (SCC) who underwent radical resection followed by reconstruction of the defect using either an esPMMF via the anterior axillary line or a PMMF. The pedicle lengths of the esPMMF and PMMF were 22-28 and 18-22 cm, respectively. The esPMMF and PMMF had skin paddle dimensions of 5 × 8 to 7 × 14 cm and 6 × 7 to 8 × 17 cm, respectively. RESULTS: The esPMMF pedicle was longer than that of the PMMF. The range of shoulder abduction was significantly greater in the esPMMF group and the donor-site aesthetic results were better. CONCLUSION: The esPMMF has a longer pedicle flap, enables a greater range of shoulder abduction, and has a better aesthetic result than the conventional technique.

Cancer-associated fibroblasts confer cisplatin resistance of tongue cancer via autophagy activation.

Cancer-associated fibroblasts (CAFs) play important roles in carcinogenesis and progression of tongue squamous cell carcinoma (TSCC). However, effect of CAFs on chemotherapy resistance of TSCC remains largely obscure. Here, we cultured the matched primary CAFs and normal fibroblasts (NFs) pairs and detected their roles in cisplatin sensitivity of TSCC, as well as autophagy-related protein LC3 and Beclin1 expressions. During exposure to cisplatin, TSCC with CAFs group exhibited significantly increased cell viability and IC50, but reduced apoptosis than that with NFs group. Meanwhile, cisplatin increased the LC3-II and Beclin1 levels of those TSCC co-cultured with CAFs. Activation of cisplatin-induced autophagic flux was inhibited by CQ, which can accumulate LC3-II protein and increase punctate distribution of LC3 localization. Beclin1 siRNA also decreased the cisplatin-induced autophagy. Both CQ and Beclin1 siRNA increased cisplatin-induced apoptosis but inhibited viability of TSCC co-cultured with CAFs. In vivo, combination of cisplatin and CQ significantly inhibited the growth of xenografted tumors than cisplatin alone. Taken together, our findings highlight the important role of CAFs in cisplatin resistance of tongue cancer via autophagy activation, suggesting that inhibition of autophagy could be an optimal strategy for chemoresistance of TSCC.

Roles of Loss of Chromosome 14q Allele in the Prognosis of Renal Cell Carcinoma with C-reactive Protein Abnormity.

BACKGROUND:: Renal cell carcinoma (RCC) is frequently associated with paraneoplastic inflammatory syndrome (PIS). This study aimed at exploring the connections between the survival rate and specific gene alterations and the potential mechanism. METHODS:: We retrospectively studied 69 surgical RCC cases from August 2014 to February 2016, including 18 cases of clear cell RCC (ccRCC) demonstrating elevated pretreatment serum C-reactive protein (CRP, Group A). Twelve of the 18 cases were symptomized with febrile episode. We also selected 49 cases of ccRCC with normal pretreatment CRP (Group B). Using 22 microsatellite markers, we compared the incidence of loss of heterozygosity (LOH) between Group A and Group B. All statistical tests are two-sided. RESULTS:: The 3p LOH was common in both Group A (89%) and Group B (92%). The frequency of 14q LOH in Group A (16 of 18) was higher than Group B (4 of 49, χ2 = 40.97 P < 0.0001). The 3p and 14q LOH were the characteristics of ccRCC with elevated acute phase reactants, including PIS, regardless of the presence of metastasis. On the contrary, 14q LOH was a rare genomic alternation in advanced-staged ccRCC without PIS. The overall survival of patients with elevated CRP (33.3%) was lower than its counterparts (6.1%, hazard ratio=1.852, P < 0.0001) in Kaplan-Meier curve. CONCLUSIONS:: The results imply that the disruption of a 14q gene(s) might result in not only the inflammatory manifestations in the tumor host but also the poor survival rate as well. The isolation of the gene(s) on 14q might be a vital goal in the treatment of PIS-associated RCC.

IncRNA H19 promotes tongue squamous cell carcinoma progression through ß-catenin/GSK3ß/EMT signaling via association with EZH2.

H19 is involved in tumor metastasis and associated with tumor progression. Enhancer of zest homolog 2 (EZH2) is overexpressed in multiple cancer types and correlates with tumor proliferation, epithelial-mesenchymal transition, and poor prognosis. However, the interaction between H19 and EZH2 to promote tongue squamous cell carcinoma (TSCC) progression remains largely uncharacterized. Insitu hybridization and quantitative reverse-transcription PCR (qRT-PCR) were performed to measure H19 expression in primary TSCC and adjacent normal tissues and cell lines. EZH2 expression was determined by immunohistochemistry in matched primary TSCC and adjacent normal tissues. The correlation between H19 and EZH2 expression and clinicopathological characteristics were analyzed. The roles of H19 in cell proliferation, apoptosis, and invasion were analyzed using a H19-targeted lentivirus. Western blot and qRT-PCR were carried out to detect downstream signal pathway changes. Expression levels of downstream signaling proteins in primary TSCC tissues and adjacent normal tissues were analyzed by immunohistochemistry. H19 and EZH2 were upregulated in TSCC tissues compared to matched normal tissues, and significantly correlated with WHO grade, lymph node metastasis, and poor prognosis. H19 silencing attenuated cell proliferation, apoptosis, and invasion in vitro. H19 knockdown inhibited the activation of ß-catenin/GSK-3ß/cyclin D1/c-myc, upregulated E-cadherin and zonula occludens-1 (ZO-1), and inhibited N-cadherin, vimentin, Snail1, Twist1, and ZEB1. Silencing H19 expression also inhibited tumor progression and lung metastasis in an animal model. Our findings indicate that H19 promotes TSCC progression through association with EZH2, and affects downstream ß-Catenin/GSK3ß/EMT signaling, suggesting that H19 inhibition might be a potential target for the treatment of TSCC.

Postoperative immune response and surgical stress in selective neck dissection: Comparison between endoscopically assisted dissection and open techniques in cT1-2N0 oral squamous cell carcinoma.

BACKGROUND: Endoscopically assisted selective neck dissection (SND) has recently been applied in clinical N0 cases of oral squamous cell carcinoma (OSCC). However, nothing is known of the immune response after surgery. METHODS: A total of 60 patients with cT1-2N0 OSCC randomly underwent endoscopically assisted SND and open operations. The serum levels of IL-6, IL-8, IL-10, IL-1b, TNF-a, CRP, cortisol, ACTH, and growth hormone were analyzed before the start of the surgery (T0) and at 2 (T1), 6 (T2), 24 (T3), and 72 h (T4) after surgery. RESULTS: A total of 31 patients were randomized for endoscopic SND, whereas 29 underwent open procedures. The release of IL-6, IL-10 and CRP was significantly lower in the endoscopic group than in the open surgery group (p < 0.05), and cortisol levels were also lower in the endoscopic group (p < 0.05). CONCLUSIONS: Endoscopic SND could effectively provide lower inflammatory responses and surgical stress, reducing peri-operative trauma and accelerating recovery.

Endoscopy-Assisted Resection of Benign Lesions on the Base of the Tongue via the Transoral Approach Using a Harmonic Scalpel.

PURPOSE: Surgical removal of lesions from the base of the tongue can be challenging for head and neck surgeons. This study evaluated the clinical outcomes of patients with benign lesions at the base of the tongue who underwent endoscopy-assisted resection through the transoral approach using an ultrasonic harmonic scalpel. PATIENTS AND METHODS: This retrospective observational study was conducted from May 2013 to January 2016. Data collected for each patient included age, gender, chief complaints, clinical symptoms, diagnostic imaging, complications after resection, and reported outcomes of resection. Diagnoses were made based on patient complaints, clinical symptoms, and computed tomography or magnetic resonance imaging. Diagnoses were confirmed by permanent pathologic sections. RESULTS: Twelve patients with benign lesions on the base of the tongue were identified who had undergone endoscopy-assisted resection through the transoral approach using an ultrasonic harmonic scalpel. The patients had a mean age of 38.9 years. The benign lingual lesions consisted of lingual thyroid masses, squamous papillomas, schwannomas, pleomorphic adenomas, myoepithelioma, and lymphoid hyperplasia. Tumor size varied from 2.0 × 1.8 to 3.0 × 2.8 cm. All tumors were completely removed, and no complications occurred during or after surgery. The patients were followed for 6 to 30 months; 1 recurrence was found and was treated using a second endoscopy-assisted transoral resection. CONCLUSIONS: Under endoscopic assistance, use of the harmonic scalpel through the transoral approach is a safe and feasible surgical technique for the removal of benign lesions at the base of the tongue.

Endoscopy-Assisted Transoral Versus Endoscopy-Assisted Transcervical Minimal Incision Plus Mandibular Osteotomy Approach in Resection of Large Parapharyngeal Space Tumors.

BACKGROUND: Resection of the parapharyngeal space is often challenging. This study aims to evaluate the outcome of the endoscopy-assisted transoral approach for resection of the parapharyngeal space tumors compared with the endoscopy-assisted transcervical approach. METHODS: Twenty-three consecutive patients (15 males, 8 females) who underwent resection of large parapharyngeal space tumors via endoscopy-assisted transoral (ETO) approach or endoscopy-assisted transcervical minimal incision plus osteotomy of the vertical ramus outside the mandibular foramen (ETC + MO) approach were analyzed retrospectively. RESULTS: The tumors in ETO group are benign; there are 2 patients with adenoid cystic carcinoma and 1 patient with recurrent pleomorphic adenoma in ETC + MO group. All of the tumors were removed completely and without rupture. No major complications developed in any patient. Temporary facial paresis occurred in 1 patient in the ETC + MO group, which resolved spontaneously within 8 weeks. The cosmetic effects of all patients in ETO groups and 10 patients in ETC + MO groups were excellent. Patients were followed up for 7 to 26 months, no recurrence was encountered. CONCLUSION: ETO and ETC + MO approach in resection of large parapharyngeal space tumors are feasible and safe technique that achieve excellent aesthetic and functional results. Endoscopy-assisted transoral approach can shorten hospitalized time and avoid the risk of marginal mandibular nerve injury and ETC + MO approach may be used in malignant or recurrent parapharyngeal space tumors.

A comparative study of the endoscopy-assisted transoral approach versus external approaches for the resection of large benign parapharyngeal space tumors.

OBJECTIVE: The advantages and limitations of the endoscopy-assisted transoral approach (EATA) and external approaches (EAs) in resection of parapharyngeal space tumors (PSTs) remain unclear. In our study, we compared the use of the EATA and the EAs for the resection of large, benign PSTs. STUDY DESIGN: Forty-four patients with PSTs were divided into the EATA and EA groups. The perioperative and postoperative outcomes of the patients were evaluated. RESULTS: All of the tumors were completely removed. However, the procedure was converted to an open procedure for four patients in the EATA group and for six patients in the EA group who required endoscopic assistance. The intraoperative blood loss, amount and duration of drainage, postoperative pain, total hospital stay, and cosmetic outcomes were superior in the EATA group (P < .05). CONCLUSIONS: Use of the EATA for resection of large, benign PSTs decreased the surgical invasiveness of the procedure and resulted in better aesthetic outcomes. However, use of the combined surgical approach allowed for improved access for the resection of PSTs.

Craniofacial Resection and Reconstruction in Patients With Recurrent Cancer Involving the Craniomaxillofacial Region.

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.

Endoscope-assisted extracapsular dissection of benign parotid tumors through a single cephaloauricular furrow incision versus a conventional approach.

BACKGROUND: A few modified approaches have been reported for performing endoscope-assisted dissections of benign parotid tumors, but none that use incisions totally hidden in a natural furrow. This study evaluated the feasibility of performing endoscope-assisted extracapsular dissections of benign parotid tumors using a single cephaloauricular furrow incision. METHODS: Forty-six patients with benign parotid superficial lobe tumors were randomly divided into two groups: an endoscope-assisted (21 patients) group or a conventional (25 patients) surgery group. Perioperative and postoperative outcomes of the patients were evaluated, including the maximum diameter of the tumors, length of the incision, operating time, estimated blood loss during the operation, amount and duration of drainage, satisfaction scores based on the cosmetic results, perioperative complications, and follow-up information. RESULTS: The diameters of the tumors were comparable between the groups, and all operations were successfully performed as planned. The mean length of the incision in the endoscope-assisted group (3.6 ± 0.5 cm) was significantly shorter than that in the conventional group (9.1 ± 1.9). Meanwhile, the intraoperative blood loss, amount of drainage, perioperative complications, and cosmetic outcomes were all improved in the endoscope-assisted group. No tumor recurrence was found during 11-40 months of follow-up. CONCLUSIONS: Cephaloauricular furrow incisions were totally and naturally hidden in this procedure. Endoscope-assisted extracapsular dissections of benign parotid tumors via a small cephaloauricular furrow incision were found to be feasible and reliable, providing a minimally invasive approach and a satisfactory appearance.

Determinants of Detection of Stones and Calcifications in the Hepatobiliary System on Virtual Nonenhanced Dual-energy CT.

Objective To retrospectively determine the features of stones and calcifications in hepatobiliary system on virtual nonenhanced (VNE) dual-energy computed tomography (CT), and to evaluate the possibility of VNE images in diagnosis for those lesions.Methods A total of 128 gall stones and calcifications of the liver found in 110 patients were examined with triple phase abdominal CT scan from July 2007 to December 2011, in which true nonenhanced (TNE) phase and arterial phase were performed with single-energy CT (120 kVp) and portal venous phase was performed with dual-energy CT (100 kVp and 140 kVp). VNE images were generated from the portal venous phase dual-energy CT data sets by using commercially VNC software. The mean CT values for the stone, liver, bile and paraspinal muscle, mean lesion density and size in area dimension, contrast-to-noise ratio (CNR) of lesion to the liver or bile, and image noise were assessed and compared between VNE and TNE images. The effective dose and size-specific dose estimate (SSDE) were also calculated.Results The mean CT values of the lesions measured on VNE images declined significantly compared with those measured on TNE images (164.51±102.13 vs. 290.72±197.80 HU, P<0.001), so did the lesion-to-liver CNR (10.80±11.82 vs.18.81±17.06, P<0.001) and the lesion-to-bile CNR (17.24±14.41 vs. 21.32±17.31, P<0.001). There was no significant difference in size of lesions area between VNE and TNE images (0.69±0.88 vs. 0.72±0.85 cm2, P=0.062). Compared to the 128 lesions found in TNE images, VNE images showed the same density in 30 (23.4%) lesions, lighter density in 88 (68.8%) lesions, while failed to show 10 (7.8%) lesions, and showed the same size in 61 (47.7%) lesions and smaller size in 57 (44.5%) lesions. The CT cutoff values of lesion and size were 229.21 HU and 0.15 cm2, respectively. The total effective dose for triple phase scan protocol with TNE images was 19.51±7.03 mSv, and the SSDE was 39.84±11.10 mGy. The effective dose for dual phase scan protocol with VNE images instead of TNE images was 13.29±4.89 mSv, and the SSDE was 27.83±9.99 mGy. Compared with TNE images, the effective dose and SSDE of VNE images were down by 32.05%±3.69 % and 30.63%±2.34 %, respectively.Conclusions Although the CT values and CNR of the lesions decreased in VNE images, the lesions of which attenuation greater than 229.21 HU and size larger than 0.15 cm2 could be detected with good reliability and obvious dose reduction. There was good consistency in the size of stones and calcifications in hepatobiliary system between VNE images and TNE images, which ensured the possibility of the clinical application of VNE images.