The da Vinci Surgical System has developed and great progress has been made recently in surgery. Despite lack of applications in tumors of head and neck, its advantages, such as minimally invasive procedure and rapid recovery, show great prospects. In this article, we reviewed the surgical method, indication, advantages and prospects of its application in tumors of head and neck.

Objective This study was to systemically evaluate the efficacy of TACE before hepatectomy on resectable primary HCC.Methods The articles focused on preoperative TACE for resectable primary HCC,published from Jan.1,1980 to Jan.1,2008,were selected by computerized search of literatures and manual search of bibliographies.The clinical controlled trials meeting inclusion criteria were reviewed systematically by meta-analysis.The reported data were processed with the statistical techniques of meta analysis.The combinability of the studies was assessed in terms of clinical and statistical criteria.Tumor-free survival rate was calculated.And pooled estimates were computed according to a fixed or random effect model by heterogeneity.Results A total of 1288 patients were included in 8 trials.There was no difference between the two groups in the 1,3-year tumor-free survival rate.Conclusion Preoperative TACE for resectable primary hepatic carcinoma can't improve survival rate.

Objective To compare the effect after endovascular repair (EVAR) or open repair (OR) of ruptured abdominal aortic aneurysm (rAAA) in Department of Vascular Surgery,Beijing Anzhen Hospital.Methods Clinical data of 46 repaired rAAAs patients was retrospectively analyzed from 2005 to 2015.The difference between the EVAR group and the OR group in perioperative mortality,operation time,ICU stay,blood transfused,length of stay (LOS),complication rate were compared by x2 test and t test.Results 18 rAAA patients were repaired by EVAR,aged from 51 to 91 with a mean of (68 ±9).28 were repaired by OR,aged from 41 to 83 with a mean of (70 ± 11).Perioperative mortality was 21.0％ for EVAR and 28.6％ for OR (P ＞0.05).LOS was (15.3 ±9.5) days for EVAR,and (23.9 ± 10.5) days for OR (P ＜0.05).Blood transfused was (3 210 ± 3 780) ml for EVAR and (4 814 ± 3 392) ml for OR (P＜0.05).ICU stay time was (7.7 ±4.2) d for EVAR and (4.2 ±2.5) d for OR (P＜0.05).Conclusion EVAR is a reliable approach for the treatment of acute rAAA.

Objective To evaluate the effectiveness of spatio-temporal image correlation with M-mode display ( STIC-M ) in monitoring fetal left ventricular systolic function in fetuses with congenital heart disease(CHD) . Methods Five hundred and thirty-six normal fetuses and 34 fetuses with CHD( 29 without hydrops and 5 with hydrops) were involved in the study . Left ventricular fractional shortening ( LVFS) was measured using STIC-M . The data of normal fetuses was used to construct reference ranges of LVFS for assessment of fetuses with CHD . Results The LVFS of the normal fetuses [ range :26 .8％ - 42 .9％ , mean :( 34 .9 ± 4 .1) ％ ] was negatively correlated with gestational age ( r = - 0 .16 , P < 0 .001) . Compared with the normal controls ,LVFS was significantly decreased in CHD fetuses with hydrops ( P < 0 .001) . However ,there was no significant difference in LVFS between normal controls and CHD fetuses without hydrops ( P > 0 .05) . Conclusions STIC-M is a new method that can be used to measure LVFS to evaluate fetal ventricular systolic function . The fetal ventricular contractile function of CHD fetuses without hydrops may not be damaged or is in compensation stage . The fetuses with cardiac hydrops generally become lower .

Objective To determine the risk factors associated with early allograft dysfunction (EAD) after liver transplantation. Methods We retrospectively analyzed the records of 138 patients who underwent liver transplantation from January 2006 to October 2016 in our department. Transplant recipients were divided into two groups:those who met the diagnostic criteria of EAD (EAD group) and those who did not (non-EAD group). We compared blood flow into the transplanted livers and other clinical features between the two groups using univariate and multivariate analysis. Results Intraoperative portal vein flow (PVF) maximum was significantly different between the two groups. Multivariate analysis revealed that intraoperative PVF maximum ＜1 600 mL/min was the only independent risk factor for the occurrence of EAD after liver transplantation in this cohort. Conclusion Intraoperative PVF maximum ＜1 600 mL/min is an independent risk factor for the occurrence of EAD after liver transplantation. Measuring intraoperative blood flow into the transplanted liver in liver transplant recipients may help identify patients at risk for developing EAD.

Objective:To investigate the application value of the diagnostic and surgical method for asymmetric prominent mandibular angle assisted by digital surgical design.Methods:The data of the females in Han nationality with prominent mandibular angle from December 2010 to December 2020 in the Department of Digital Plastic Surgery of Plastic Surgery Hospital, Chinese Academy of Medical Sciences were analyzed retrospectively. ProPlan CMF 3.0 software was used to preoperatively mirror the patient’s three-dimensional(3D) model to obtain a diagnosis. The characteristics of bilateral differences of asymmetry of mandible were evaluated, and the surgical method were analyzed. The effect of surgery was objectively evaluated by indicators such as gonion point width (Go-W), condyle apex height (Co-H), and mandibular angle(Ag). SPSS 18.0 was used for statistical analysis, and the data were tested by Kolmogorov-Smirnov test, and the result were in line with the normal distribution. The data were expressed in Mean±SD, and the paired t-test was used to compare the measurement result of the indicators on both sides of the mandible, and P<0.05 was a statistically significant difference. Results:A total of 30 female patients, aged from 18 to 39 years, were included. Preoperative 3D model measurements showed a longer mandibular ascending branch on one side of the mandible (long side) and a more extrusion of the mandibular angle on the other side (prominent side), which was treated with a modified surgical method of mandibular angle osteotomy. The height of the osteotomy line on the long side was the height of the exuberant osteotomy line + the height difference between the two sides, and the thickness of the outer plate grinding on the protrusion side was the thickness of the outer plate grinding on the long side + the width difference between the two sides. Both the preoperative pogonion and menton points were far from the long side of the mandible and biased towards the prominent side. The height, width and mandibular angle of the marker points on both sides of the mandible were compared, and the differences were statistically significant ( P<0.01). Among them, the asymmetrical difference between Go-W, Co-H and Ag was the largest, which could be used to evaluate the effect of surgery. The differences between Go-W, Co-H and Ag before and after surgery on the long side of the mandible were (1.10±2.05) mm, (12.84±2.96) mm, (-17.75±5.16)°, and the differences between the three indicators on the prominent side were (4.24±1.64) mm, (10.95±3.25) mm, (-14.87±5.14)°, respectively, and the differences between preoperative and postoperative comparisons were statistically significant ( P<0.01). The asymmetric differences between the three indicators on both sides of the mandible after surgery were (-0.32±2.30) mm, (-0.02±0.37) mm, (-0.01±1.87)°, respectively, and the differences were not statistically significant ( P>0.05). All patients had no complications such as hematoma and infection after surgery, and the patients were satisfied with the result of the operation. Conclusions:Asymmetric hypertrophy mandibular angle can be reconstructed by the patient’s preoperative 3D model to accurately measure the differences between the two sides of the mandible. This design can effectively guide the surgical method, improve the symmetry of the patient’s bilateral mandible, and achieve better aesthetic effects on the face.

Objective:To investigate the application value of the diagnostic and surgical method for asymmetric prominent mandibular angle assisted by digital surgical design.Methods:The data of the females in Han nationality with prominent mandibular angle from December 2010 to December 2020 in the Department of Digital Plastic Surgery of Plastic Surgery Hospital, Chinese Academy of Medical Sciences were analyzed retrospectively. ProPlan CMF 3.0 software was used to preoperatively mirror the patient’s three-dimensional(3D) model to obtain a diagnosis. The characteristics of bilateral differences of asymmetry of mandible were evaluated, and the surgical method were analyzed. The effect of surgery was objectively evaluated by indicators such as gonion point width (Go-W), condyle apex height (Co-H), and mandibular angle(Ag). SPSS 18.0 was used for statistical analysis, and the data were tested by Kolmogorov-Smirnov test, and the result were in line with the normal distribution. The data were expressed in Mean±SD, and the paired t-test was used to compare the measurement result of the indicators on both sides of the mandible, and P<0.05 was a statistically significant difference. Results:A total of 30 female patients, aged from 18 to 39 years, were included. Preoperative 3D model measurements showed a longer mandibular ascending branch on one side of the mandible (long side) and a more extrusion of the mandibular angle on the other side (prominent side), which was treated with a modified surgical method of mandibular angle osteotomy. The height of the osteotomy line on the long side was the height of the exuberant osteotomy line + the height difference between the two sides, and the thickness of the outer plate grinding on the protrusion side was the thickness of the outer plate grinding on the long side + the width difference between the two sides. Both the preoperative pogonion and menton points were far from the long side of the mandible and biased towards the prominent side. The height, width and mandibular angle of the marker points on both sides of the mandible were compared, and the differences were statistically significant ( P<0.01). Among them, the asymmetrical difference between Go-W, Co-H and Ag was the largest, which could be used to evaluate the effect of surgery. The differences between Go-W, Co-H and Ag before and after surgery on the long side of the mandible were (1.10±2.05) mm, (12.84±2.96) mm, (-17.75±5.16)°, and the differences between the three indicators on the prominent side were (4.24±1.64) mm, (10.95±3.25) mm, (-14.87±5.14)°, respectively, and the differences between preoperative and postoperative comparisons were statistically significant ( P<0.01). The asymmetric differences between the three indicators on both sides of the mandible after surgery were (-0.32±2.30) mm, (-0.02±0.37) mm, (-0.01±1.87)°, respectively, and the differences were not statistically significant ( P>0.05). All patients had no complications such as hematoma and infection after surgery, and the patients were satisfied with the result of the operation. Conclusions:Asymmetric hypertrophy mandibular angle can be reconstructed by the patient’s preoperative 3D model to accurately measure the differences between the two sides of the mandible. This design can effectively guide the surgical method, improve the symmetry of the patient’s bilateral mandible, and achieve better aesthetic effects on the face.

Objective:To study the clinical and cytogenetic characteristics of patients with multiple myeloma harboring 6q deletion, with the aim to determine the impact of 6q deletion on survival.Methods:This study included the retrospective analysis of 382 newly diagnosed patients with multiple myeloma in our hospital from 2014 to 2017 and compared the clinical and cytogenetic characteristics between patients with and without 6q deletion. The log-rank test and the Cox proportional hazards regression model were used to analyze prognostic factors for progression-free survival (PFS) and overall survival (OS) .Results:Compared to those without 6q, the patients with 6q deletion were older (median age, 63 vs 58 years, P=0.039) , had higher incidence of t (4; 14) (30.4% vs 16.4% , P=0.020) , and higher proportion of complex karyotypes (22.2% vs 5.3% , P=0.001) . Univariate survival analysis using the log-rank test revealed that 6q deletion was associated with shorter PFS. However, by the Cox multivariate proportional hazards regression model, 6q deletion was not an independent prognostic factor and its effect on survival was affected by age, t (4; 14) , and other risk factors. Conclusions:6q deletion was common in elderly patients with multiple myeloma and was often accompanied by t (4;14) and complex karyotypes. However, 6q deletion was not an independent prognostic factor for multiple myeloma.

Objective:To document any effect of a pulsed electromagnetic field (PEMF) on the regulation of neuropeptide Y (NPY) in nucleus pulposus (NP) tissue, NP cell apoptosis and matrix degradation using rats with intervertebral disc degeneration (IDD).Methods:Eighteen Sprague-Dawley rats were randomly divided into a control group, an IDD model group (the model group), and a PEMF group. IDD was induced in both the model and PEMF groups. Right after the modeling, the PEMF group received 14 days of PEMF treatment, while the control group and model group were given no special treatment. Meanwhile, the primary rat nucleus pulposus cells (NPCs) were cultured using Dulbecco′s Modified Eagle Medium at 37℃ and 5% CO 2. When the fusion rate reached 90% after passage, the NPCs were divided into a control group, a TNF-α model group (referred to as model group) and TNF-α + PEMF group (referred to as PEMF group) and treated accordingly. Eight weeks after the modeling, safranin-o/fast green staining was used to assess any pathological morphology changes. The expression of NPY, neuropeptide Y receptor Y2 (NPY2R), bcl-2-associated X protein (Bax), B-cell lymphoma 2 (Bcl-2), collagen type II (Col-II) and matrix metalloproteinase-3 (MMP3) in the intervertebral disc and the cultivated nucleus pulposus cells of the 3 groups were determined. Results:The intervertebral disc cells in the model group were ruptured and folded, with significantly increased polysaccharide and protein components, and significantly increased bone fibers. In the PEMF group the cell boundaries were clearer, with less fibrin fracture and increased cartilage tissue. NPY was expressed in the fibrous annulus and the nucleus pulposus of the intervertebral disc in the model group. The average expression levels of NPY and NPY2R were significantly higher than in the control group and the model group. Compared with the control group, there was a significant increase in the level of Bax and a significant decrease in the expression of Bcl-2 in the model group, and there was a significant decrease in the level of Bax in the PEMF group. Compared with the control group, there was a significant decrease in the Col-II level but a significant increase in the MMP3 protein expression in the model group. The average Col-II mRNA expression was significantly higher in the PEMF group compared with the model group, but the average MMP3 protein expression was significantly less. Those results are consistent with observations in vivo.Conclusion:PEMF may reverse the imbalance of ECM metabolism and delay IDD degeneration by up-regulating the expression of NPY and Bcl-2, as well as blocking the Bax/Bcl-2 signaling pathway to inhibit apoptosis of nucleus pulposus cells.

Objective To analyze the incidence of preterm delivery among single live neonates and the association between maternal reproductive history and preterm birth.Methods A questionnaire survey was conducted on reproductive history among women at childbearing age who were selected through multi-stage stratified random sampling method in Shaanxi,during 2010-2013.Samples would include women at childbearing age and in pregnancy or having had definite pregnancy outcomes.Results A total of 29 608 women at childbearing age with their infants,were studied.The overall incidence of premature delivery among the single live birth neonates under this study,was 2.7％ during 2010-2013.Results from the logistic regression model showed that factors as:having had history with preterm delivery (OR=7.99,95％CI:5.59-11.43),age of the mothers,older than 35 (OR=2.03,95％CI:1.59-2.59) and with history of birth defects (OR=1.54,95％CI:1.01-2.34) were at higher risks for premature delivery in neonates.Intervals on pregnancies between 3-4 years (compared with ≤2 years,OR=0.74,95％CI:0.58-0.93),between 5-6 years (compared with ≤2 years,OR=0.66,95％CI:0.52-0.82),or ＞6 years (compared with ≤2 years,OR=0.48,95％CI:0.37-0.61)together with numbers of parity as 1 (compared with primiparas,OR=0.80;95％CI:0.67-0.95),as ≥2 (compared with primiparas,OR=0.62,95％ CI:0.39-0.97) etc.were protective factors to preterm delivery.Factors as:history of preterm delivery,mothers age (older than 35 years) and intervals of pregnancy,appeared influential to the age of gestation,under the ordinal polytomous logistic regression analysis.Conclusion The incidence of preterm births among single live birth neonates in Shaanxi was lower than the average national level.Programs related to health care services prior to conception and during pregnancy,together with increasing the self-care consciousness of childbearing aged women etc,should all be strengthened in order to reduce the occurrence of preterm birth,in Shaanxi province.