Objective To investigate the feasibility of reconditioning post-sclerotherapy basifacial depressions for venous malformations with the axis platysma-fascial flap including submental artery.Methods Fifteen cases of post-sclerotherapy depressions of venous malformations were treated from Dec.2008 to Oct.2013.Preoperative color Doppler ultrasonography was routinely performed to localize and mark sublingualissubmental artery.Upper hind neck incision was made to dissociate depressed and donor area,after which reconstruction were performed with axis platysma-fascial flap including submental artery.3 months to 2 years' follow-ups were conducted to observe clinical effects.Results All the flaps were alive in all the 15 cases.Satisfacfory recovery archeived because the depressed area appeared well-stacked wihtout secondary depression in the neck.Conclusions It is recommended that axis platysma-fascial flap should be the first chioce of reconditioning basifacial postsclerotherapy depressions for venous malformations,as the operations can be peformed easily under concealed incision with abundant tissues supply and high survival rate.

OBJECTIVETo explore the factors that affect the curative effect and the best method of treatment for the patients with maxillofacial cavernous hemangiomas.

METHODS102 cases of maxillofacial cavernous hemangiomas were performed DSA examination and taken serial photography. According to the diameter, number and draining speed of efferent veins of the tumor, the cavernous hemangiomas were classified into two types-the high efferent speed and low efferent speed type. For all of them, were randomly performed embolization of efferent veins with absolute ethanol plus bleomycin-A5 intratumor injection (group I) and bleomycin-A5 intratumor injection alone (group II).

RESULTSThe cure rate and general effective rate has significant difference (P < 0.01) between two groups in 70 patients with high efferent speed veins, while no significant difference (P > 0.05) in 32 patients with low efferent speed veins.

CONCLUSIONSThis new classification is beneficial for seeking method of treatment. The embolization of efferent veins is an effective method for cavernous hemangioma with high efferent speed veins; but for the type with low efferent speed veins, bleomycin-A5 intratumor injection alone could acquire a good results.

Adolescent ; Adult ; Child ; Child, Preschool ; Embolization, Therapeutic ; Facial Neoplasms ; classification ; diagnostic imaging ; therapy ; Female ; Hemangioma, Cavernous ; classification ; diagnostic imaging ; therapy ; Humans ; Male ; Maxillary Neoplasms ; classification ; diagnostic imaging ; therapy ; Middle Aged ; Radiography ; Sclerotherapy

Objective: To explore the clinical classification of microcystic lymphatic malformations of tongue and observe the treatment of microcystic lymphatic malformations of tongue by retrospective analysis, in order to provide reference for clinical practice. Methods: From October 2005 to October 2015, the complete data of 220 cases of microcystic lymphatic malformations of tongue (115 males and 105 females) received and treated in Provincial Special Department of Vascular Anomalies, Linyi Tumor Hospital was analyzed retrospectively. The age ranged from 8 months to 52 years old, with a median age of 16 years old. All patients were followed up for 3 years, and according to their clinical manifestations, they were divided into three types: localized type of 23 cases, diffuse type of 161 cases, and megaloglossia type of 36 cases. Injection with pingyangmycin merely was performed on 58 cases, whereas merely surgery on 20 cases, injection with pingyangmycin combined with high frequency electrocoagulation on 55 cases, and surgery combined with injection with pingyangmycin on 87 cases. The therapeutic effect was evaluated according to the grade 4 standard. The χ² test was used for statistical analysis of count data. Rank sum test was used for statistical analysis of ranked data. Results: The percentage of surgery merely of localized type was 87.0% (20/23), significantly higher than that of other types of lesions [0% (0/197)] (χ²=178.060, P<0.001). The percentage of injection with pingyangmycin of diffuse type was 100% (161/161), significantly higher than that of other types of lesions [66.1% (39/59)] (χ²=60.034, P<0.001). The percentage of surgery combined with injection with pingyangmycin of megaloglossia type was 100% (36/36), significantly higher than that of other types of lesions [27.7% (51/184)] (χ²=65.800, P<0.001). After follow-ups for 3 to13 years, there were 0 cases of gradeⅠ, 11 cases of grade Ⅱ, 50 cases of grade Ⅲ, and 159 cases of grade Ⅳ. There were statistically significant differences in clinical efficacy among different clinical types (H=158.668, P<0.001). The percentage of level Ⅳ efficacy of localized type, diffuse type and megaloglossia type were 100% (23/23), 82.6% (133/161) and 8.3% (3/36) respectively. Local mucosa ulcer appeared in 45 cases and was cured through oral care and expectant treatment. Fever occurred in 28 cases and returned to normal within 24 h after expectant treatment. The lingual frenum was shortened in 16 cases. There were 12 cases with mild tongue swelling, 6 cases with influence on eating but without influence on breathing, and recovered spontaneously one week later. Conclusions The choice of different treatment methods of microcystic lymphatic malformations of tongue should be made according their clinical classification. The only surgical resection is recommended for localized protrude lesions. Injection with pingyangmycin in high tension combined with surgical resection or high frequency electrocoagulation is effective for diffuse lesions. Surgical resection combined with injection with pingyangmycin is suitable for the patients with megaloglossia type.

Objective: To evaluate the efficacy and feasibility of radiofrequency ablation(RFA) for complicated diffuse arteriovenous malformations. Methods: From Dec. 2014 to Dec. 2016, 12 cases with complicated diffuse arterioveneous malformations were treated by RFA in our hospital. The clinical records were retrospectively reviewed. The lesion size ranged from 10 cm×7 cm to 28 cm×30 cm. Ablation procedures with " high power and long time" technique were performed under real time color Doppler monitoring. The impedance model were used and ablation needles were punctured into core lesions with the most abundant blood flow. Power was set as 90 to 110 W for central core lesions, and 60 to 80 W for superficial or surrounding lesions. The average ablation time was from 60 to 90 min (average, 75 min). Next treatment would be performed 3 months later when neccessary. The therapeutic efficacy was evaluated on a 4-level scale. Results: Hyperpyrexia occurred in 1 patients during first and second treatments. Transient postoperative hemoglobinuria occurred in 2 patient. Full thickness defects induced by tissue necrosis in the original ulcer area of cheek occurred in 1 patient, which was reconstructed with pedicle Trapezius muscle myocutaneous flap. Bleeding symptom in 7 cases stopped after only 1 treatment. After a follow-up period of 1-3 years, the efficacy was graded as Ⅳ in 8 case, as Ⅲ in 4 cases. Conclusions For complicated diffuse arteriovenous malformations, radio frequency ablation with "high power and long time" technique under real time color Doppler monitoring can completely damage the deep core soft lesions, and control the life-threatening hemorrhage effectively, which can be recommended as the alternative therapy when surgery, interventional embolizationor or sclerosant injection can not control the lesions.

Data of patients with maxillofacial and jugular venous malformations involving isthmus faucium area from January 2012 to July 2016 were collected. Patients were questioned about the medical history before operation, and the airway was adequately evaluated. The patients diagnosed as having non-difficult airways were endotracheally tubed using fast induction of anesthesia. Tracheal intubation was per-formed using fast induction of anesthesia combined with topical anesthesia after visual laryngoscopy in the patients assessed as having difficult airways. Endotracheal intubation was guided with a visual hard endo-scope or a fibrobronchoscope in the patients with difficulty in opening mouth after multiple treatments. Post-operative airway management was as follows: the tracheal tube was removed after extubation, the tracheal tube was retained for 24-48 h, or preventive tracheotomy was performed. Oxygen was inhaled by mask. A total of 157 patients were included in this study, 55 patients diagnosed as having difficult airways, and a-mong the 55 patients, 87％ cases were intubated after visual laryngoscopy and 13％ cases received tracheot-omy. There were 10 patients with difficulty in opening mouth after multiple treatments and 5 cases under-went tracheotomy in the outer hospital. Sixteen patients presented with a transient increase in airway pres-sure during intraoperative injection of anhydrous ethanol. There were 106 cases in whom the tracheal tube was removed immediately after emergence, and among them, 32. 1％ cases needed tongue traction and 2. 8％ cases underwent emergency tracheotomy after extubation. Thirty-eight patients needed to retain the tracheal tube for 24-48 h after operation, and among them, 37％ cases needed tongue traction and 3％ ca-ses required emergency tracheotomy after extubation. Thirteen cases underwent preventive tracheotomy. The preoperative visit and assessment are especially important, appropriate airway management strategies should be developed, vital signs should be closely observed during operation, and the timing of extubation should be grasped for this type of patients, and the SpO2 and airway pressure should be mainly observed during op-eration especially for the patients who underwent anhydrous ethanol injection.

Objective:To study the changes and imaging features of arachnoid granulation (AG) in patients with cerebral venous sinus thrombosis (CVST).Methods:The clinical and imaging data of 35 patients with idiopathic CVST confirmed by MR imaging combined with CE-MRV or DSA in our hospital from January 2013 to December 2018, and 35 healthy controls collected at the physical examination center at the same time period were detected. The sizes and numbers of AG were compared between the two groups, and the MR imaging features of CVST and AG in patients with CVST at different courses were compared.Results:(1) In 35 patients with CVST, AG was found in 14 patients, and the average diameter was (5.19±2.40) mm, ranged from 1.83-11.77 mm; in the control group, AG was found in 23 patients, and the average diameter was (4.45±2.03) mm, ranged from 1.45-9.87 mm; no statistical difference was noted in diameter between the two groups ( t=2.121, P=0.221), and the number of AG showed statistical difference between the two groups (χ 2=4.644, P=0.031). (2) In 8 patients with CVST at acute phase, CVST showed hypointense on T2WI and FLAIR; in 20 patients with CVST at subacute phase, CVST showed hyperintense on T2WI and FLAIR; in 7 patients with CVST at chronic phase, CVST showed hyperintense on T2WI and FLAIR. At any stage of venous sinus thrombosis, AG showed high signal on T2WI and low signal on FLAIR. Conclusion:AG detection rate in CVST patients is lower than that in normal controls; MR imaging T2WI and FLAIR sequences could effectively distinguish CVST with AG.

Objective:To establish a nomogram to predict overall survival of patients with stage Ⅰ-Ⅲ gastric cancer (GC) based on preoperative inflammatory markers.Methods:Clinicopathological and follow-up data of 1 035 patients with stage Ⅰ-Ⅲ gastric cancer operated at He'nan Cancer Hospital between May 2015 and Oct 2016 were retrospectively collected. A nomogram was established based on prognostic factors. Harrell's concordance index (C-index), receiver operating characteristic (ROC) curve, calibration curve and decision curve analysis (DCA) were used to verify the performance of the model according to differentiation, calibration and clinical utility.Results:A total of 1 035 patients were enrolled . The median follow-up time was 41.9 months; According to the optimal cutoff value, 170 were with elevated neutrophil-to-lymphocyte ratio (NLR) and 865 with a reduced　ratio; 562 in elevated platelet-to-lymphocyte ratio (PLR) vs. 473 in the reduced group; fibrinogen/albumin ratio (FAR) elevated in 108 group vs. 972 in the reduced group; 180 in the prognostic nutritional index score (PNI) elevated group and 855 in the reduced group. Two hundred and sixty-seven patients were categorized at stage Ⅰ, 334 at stage Ⅱ ,434 at stage Ⅲ. Multivariate regression analysis showed tumor location, vascular tumor thrombus, pTNM stage, FAR, PNI and NLR were independent prognostic factors (all P<0.05). The C-index of the nomogram was 0.723 (95% CI: 0.710 -0.736) and had better clinical utility than the American Joint Committee on Cancer (AJCC) 8th TNM staging system 0.693 (95% CI, 0.681 -0.705). The calibration curve of the nomogram showed that the predicted survival rate was consistent with the actual survival rate in GC patients. Compared to AJCC 8th pTNM staging system, the DCA curve indicate that the nomogram has a higher net income. Conclusion:The nomogram predicting overall survival of patients with stage Ⅰ-Ⅲ gastric cancer is established and verified , which provides better individual prediction than TNM staging system.

Objective To observe the clinical effects and complications of percutaneous radio frequency ablation.Methods Clinical records from 24 patients with complex venous malformations that underwent percutaneous radiofrequency ablation (RFA) from Dec.2014 to Dec.2015 at a singleinstitution were reviewed.There were 14 males and 10 females.The median age was 11 years ranging from 1.5 to 42 years.There were 13 cases with extensive lesions and 11 cases with deep localized lesions.Coagulopathy occurred in 4 patients with extensive lesions.Ablation procedures were performed under real-time color Doppler monitoring by percataneous radiofrequency dynamic ablation with low power,and the therapeutic efficacy was evaluated on a 4-level scale.Results There were 12 grade Ⅳ cases,9 grade Ⅲ cases,3 grade Ⅱ cases and 0 grade Ⅰ case after 15 to 28 months' follow-up.All 4 patients had improvement in coagulopathy.There were 9 cases with grade Ⅳ therapeutic efficacy in patients with deep localized lesions,compared to 3 in patients with extensive lesions,which indicated a significant differences between these two groups (P＜0.05).Conclusions Moving radiofrequency ablation with low power is feasible and safe in venous malformations treatment,which can be recommended as the replacement for surgery or sclerotreatment,being especially indicated in those with deep lesions.Obvious improvement in coagulopathy and pathogenetic condition can be achieved after ahlation in those with extensive lesions.

Objective:To explore the clinical application of autologous freezing fat granule injection grafting in facial rejuvenation.Methods:A total of 64 cases of facial skin soft tissues ageing atrophy were treated by transplantation of autologous purification freezing lipochondria. Autologous fat was obtained from patient＇s abdomen or thighs, centrifugated at low velocity and low pressure to remove the oil and fluid, then stored the lipochondria in -20℃. Rewarming the fat under 37 ℃ for 1 hour, we observed the integrity of the adipocyte and detected the vitality of the fat. Then the purified autologous fat was injected into the recipient site of the face.Results:The fat cell membrane and cell nucleus were clear and integrity after stored in -20℃ for 24 weeks, and the vitality of the fat was (88.89±1.23)%. 21 cases gained satisfactory clinical results by injecting once and 35 cases with 2 times injections, 8 cases with 3 times injections, the effects were satisfactory and there was no complication by follow-up from 6 to 24 months. 82.81% patients and doctors were satisfactory with the curative effect, and 1.56% patients and doctors were unsatisfactory.Conclusions:The effects are satisfactory of autologous purified freezing microparticle fat injected transplant. It has low absorptivity, can duplicate injection, and accept easily by people. It is a good method for facial rejuvenation and worth to spread in the clinical practice.

Objective:To explore the diagnostic values of MRI T2WI and 3D contrast enhanced magnetic resonance venography (3D CE-MRV) in transverse sinus arachnoid granulations (AGs).Methods:Clinical data were obtained from 811 patients who were subjected to non-contrast MR imaging and 3D CE-MRV between January 2016 and April 2019 in our hospital. And the number of patients whose transverse sinus AGs could be shown by T2WI and MRV, the number, size, and shape of AGs, and the number of AGs-related veins were recorded.Results:MRI T2WI showed 242 AGs in 184 patients (22.7%), and 3D CE-MRV showed 138 AGs in 119 patients (14.7%); MRI T2WI had a significantly higher percentage in showing AGs patients as compared with 3D CE-MRV ( P<0.05). Two hundred and forty-two AGs showed by MRI T2WI were divided into 3D CE-MRV observation group ( n=138) and 3D CE-MRV non-observation group ( n=104); the diameter of AGs in the 3D CE-MRV non-observation group ([5.30±2.10] mm) was significantly smaller than that in the 3D CE-MRV observation group ([6.14±2.03] mm, P<0.05). MR T2WI showed that 231 AGs were like circles or ellipses and 11 AGs were like fractal; while 3D CE-MRV showed that 138 AGs were like circles or ellipses and 0 AG were like fractal. MRI T2WI showed that 289 veins were closely related to AGs, and 3D CE-MRV showed that 97 veins were closely related to AGs. MRI T2WI could demonstrate significantly higher proportion of non-labbe veins which were closely related to AGs than 3D CE-MRV ( P<0.05). Conclusion:As compared with 3D CE-MRV, T2WI can find larger number of AGs in the transverse sinus, and better display the shape of AGs and the vein adjacent to them.