[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.

Long non-coding RNAs associated with oral squamous cell carcinoma.

Oral squamous cell carcinoma (OSCC) is one of the most common and fatal diseases in the head and neck region worldwide. To better understand the carcinogenesis and to find efficient biomarkers and therapeutic targets are still in urgent need. The studies of expression profile and mechanisms of long non-coding RNAs (lncRNAs) develop fast in recent years. This molecule form is aberrantly expressing and influencing many cellular processes in different cancer types. But its expression pattern and association with oral squamous cell carcinoma are yet to be elucidated. Here we reviewed recently reported OSCC-related lncRNAs and their relationship with the clinical status of patients. Functional mechanisms were also discussed. With the emerging knowledge and techniques in this area, more efficient biomarkers and therapeutic targets are promising in the future.

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.

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.

[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.

[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.

[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.

[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.

[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.

[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.

[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.

[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.

[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.

[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 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.

[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.

[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.