OBJECTIVETo seek a new method for reconstructing bilateral intemrnal jugular vein invaded by metastasis lymph node in advanced oral cancer patients.

METHODSA combination of microvascular anastomosis and longitudinal constriction suture venoplasty was performed to reconstruct internal jugular vein. We resected the part of the bilateral internal jugular vein of advanced oral cancer patients invaded by metastasis lymph node and used the external carotid vein to reconstruct the internal jugular vein. A part of the vessel wall of the internal jugular vein could also be resected to reconstruct the vein. Longitudinal constriction suture venoplasty could slowly narrow the lumen diameter of the internal jugular vein. Thus, difference in anastomosis diameter should be avoided because it generates eddy currents and subsequently causes blood clots. A total of five advanced cases of oral squamous cell carcinoma were involved in this study. We performed bilateral radical neck dissection on all patients to reconstruct the internal jugular vein and observed their postoperative conditions.

RESULTSPostopera-tive follow-up of 5 months to 19 months was performed on all patients. Doppler or CT angiography and related tests showed no internal jugular vein thrombosis. No patient with facial edema, throat swelling, cerebral edema, and high intracranial pressure or other serious complications caused by blocked venous blood was observed. The one-year survival rate of five patients was 60% (3/5).

CONCLUSIONMicrovascular anastomosis combined with longitudinal constriction suture venoplasty is a new method for reconstructing internal jugular vein. This method was proved successful and clinically feasible.

Carcinoma, Squamous Cell ; Constriction ; Humans ; Jugular Veins ; Lymphatic Metastasis ; Mouth Neoplasms ; Neck Dissection ; Postoperative Period ; Reconstructive Surgical Procedures ; Sutures

Objective To discuss the influence of different antitumor treatments on the survival time of patients with obstructive jaundice caused by cholangiocarcinoma located at middle-low segment of common bile duct after receiving PTCD. Methods During the period from Jan. 2012 to March 2013, a total of 60 patients with pathologically-proved cholangiocarcinoma located at the middle-low segment of common bile duct were admitted to authors’ hospital. According to tumor TNM staging, stage Ⅱ was seen in 9 cases, stage Ⅲ in 39 cases and stage Ⅳ in 12 cases. Based on the degree of cell differentiation, highly differentiated cancer was observed in 9 cases, moderately differentiated cancer in 37 cases, and poorly differentiated cancer in 14 cases. The 60 patients were enrolled in this study. Drainage tube placement and stent implantation were performed in all patients so as to relieve the symptoms of jaundice. According to the antitumor treatment used, the 60 patients were randomly and equally divided into three groups with 20 patients in each group. Draining procedure with subsequent regular arterial infusion chemotherapy was employed in the patients of group A; draining procedure with subsequent particle chain placement in biliary tract was performed in the patients of group B; and draining procedure with subsequent regular arterial infusion chemotherapy together with particle chain placement in biliary tract was carried out in the patients of group C. The results were analyzed using SPSS17.0 statistical software. The death factors of patients were statistically evaluated by using multivariate Cox proportional hazards regression analysis method, P<0.05 was considered that the difference had statistical significance. Results The median survival periods of group A, B and C were (186.0±36.4) days, (183.0±26.5) days and (252.0±43.6) days respectively. The death factors of cancer patients were analyzed by using multivariate Cox proportional hazards regression analysis method, which indicated that tumor stage was a risk factor for death (HR=8.434, 95%CI 3.41-20.090);the treatment mode was a protection factor of death (HR=0.616, 95%CI 0.429-0.884); while the degree of tumor differentiation was unrelated to death(score test,字2=0.197, P=0.657>0.05). The risk of death in group B was not significantly different from that in group A (HR=1.012, 95%CI 0.558-2.179); while the treatment mode of group C was a protection factor of death (HR=0.334, 95%CI 0.148-0.075). Conclusion The TNM stage and treatment mode can influence the survival time of patients with cholangiocarcinoma located at the middle-low segment of common bile duct. Therefore, for the treatment of obstructive jaundice caused by cholangiocarcinoma, combination use of regular arterial infusion chemotherapy and particle chain placement in biliary tract should be employed immediately after draining procedure as this therapeutic mode can effectively prolong patient’s survival time.

Objective To investigate the clinical effect of distal radioulnar ligament reconstruction by autologous tendon pal‐maris longus transplantation under arthroscopic assistance in treating chronic instability of the distal radioulnar joint .Methods Seven patients with chronic instability of the distal radioulnar joint after failure of conservation therapy were definitely diagnosed by the wrist joint exploration .Then the autologous tendon palmaris longus was taken for conducting the anatomical reconstruction of distal radioulnar ligament ;the average follow up was 12 months .The preoperative and postoperative grip strength and the motion of wrist joint were recorded ;the pain status of the wrist joint was evaluated by using the visual analogue scale (VAS) ,and the wrist function status was evaluated by using the Disabilities of the Arm ,Shoulder and Hand(DASH) and the Modified Mayo Wrist Score (MMWS) .Results The average VAS score of the rist joint motion was recovered from (7 ± 2) points before operation to (3 ± 3) points after operation ,the MMWS score was improved from preoperative (50 ± 9) points to postoperative (83 ± 11) points ,the DASH score was decreased significantly from preoperative (37 ± 15) points to postoperative (16 ± 10) points ,the grip strength was improved from preoperative 84 .5 ± 16 .0 to postoperative 93 .4 ± 11 .0 ,the differences were statistically significant .The mean range of motion(ROM ) in flexion/extension of the wrist was increased from preoperative 93 .5% ± 6 .0% to postoperative 96 .4% ± 3 .0% ,the ROM in pronation/supination of the forearm was increased from preoperative 92 .6% ± 7 .0% to postoperative 97 .2% ± 5 .0% ,but the differences were not statistically significant .Conclusion Under arthroscopic assistance ,the anatomical reconstruc‐tion of the distal radioulnar ligaments is an effective treatment method for treating chronic distal radioulnar joint instability ,its short term follow up has satisfactory effect .

Objective: To analyze the causes of equinus deformity caused by intramuscular venous malformation onset posterior muscles of leg, and discuss the corresponding treatment methods. Methods: A retrospective study was conducted on 69 cases of intramuscular venous malformations with equinus deformity from January 2012 to December 2017. Based on patient's main complain, physical examination and imaging data, the causes were divided into two categories: pain disorder and contracture disorder. Classification was on the basis of definite diagnosis of MRI. When the main complaint of medical history and physical examination indicated pain relief or passivity of the affected limb, and when the back extension of ankle joint was greater than 75 degrees, it was a pain disorder; when the medical history and physical examination indicated pain relief or passivity of the affected limb, the back extension of ankle joint was less than 15 degrees, it was a contracture disorder. Therapeutic methods included drug conservative treatment and surgical treatment. For the patients with pain disorder, the first choice was drug conservative treatment, and for the patients with contracture disorder, the first choice was surgery. Operative methods include simple venous malformation resection, venous malformation resection and Z-type Achilles tendon anastomosis lengthening. After operation patients received systematic functional rehabilitation exercise and calculated the satisfaction rate. Results: 13 cases of painful disorders were firstly treated by conservative medicine, but 4 cases were treated by operation after series of conservative treatments, satisfaction rate was 69.2%(9/13). 56 contracture cases were treated by operation, including 11 cases of simple venous malformation resection, 45 cases resection and Z-type anastomosis lengthening of Achilles tendon. All the patients were followed up for 6 months to 2 years after operation. 53 patients recovered to normal walking after operation, and 3 patients had mild limp, satisfaction rate was 94.6%(53/56). Patient satisfaction was 100%. Conclusions The equinus deformity caused by intramuscular venous malformation onset posterior muscles of leg affect the quality of life. Muscle/tendon contracture was the main cause. Correct surgical treatment combined with early rehabilitation exercise post operation can restore normal walking posture.

Objective To observe the alterations in brain gray matter volume(GMV)in idiopathic generalized epilepsy(IGE)patients with typical absence seizure. Methods Nine IGE patients with typical absence seizure and 16 healthy volunteers were prospectively recruited from People's Hospital of Zhengzhou University from September 2012 to January 2014. By using a 3. 0T magnetic resonance imaging(MRI)and voxel - based morphometry(VBM)method, their whole brain structures and their brain GMV were scanned and analyzed,respectively,then the changes in GMV were observed. Results Compared with healthy control group,brain GMV extensively decreased in IGE patients with typical absence seizure. Thirteen regions with significant differences were as follows:the right rectal gyrus(t = 3. 13,P ﹤0. 01),the left rectal gyrus(t = 4. 82,P ﹤ 0. 01),the right calcarine/ cuneus/ gyrus lingualis/ occipital gyrus/ inferior oc-cipital gyrus(t = 6. 86,P ﹤ 0. 01),right gyrus lingualis(t = 4. 01,P ﹤ 0. 01),the left gyrus lingualis/ inferior occipital gyrus(t = 3. 73,P ﹤ 0. 01),the left inferior occipital gyrus/ gyrus lingualis(t = 5. 42,P ﹤ 0. 01),the left middle occipi-tal gyrus(t = 3. 76,P ﹤ 0. 01),the right middle occipital gyrus/ superior occipital gyrus/ middle temporal gyrus( t =3. 85,P ﹤ 0. 01),left middle temporal gyrus/ superior temporal gyrus(t = 5. 06,P ﹤ 0. 01),the right precuneus/ cuneus (t = 3. 33,P ﹤ 0. 01),and the right superior parietal lo-bule(t = 3. 66,P ﹤ 0. 01),right precentral gyrus(t = 3. 44,P ﹤0. 01),right superior frontal gyrus/ paracentral lobule/ supplementary motor area(t = 3. 50,P ﹤ 0. 01). However,GMV increase was not found. Conclusions Brain GMV extensively decreased in 13 brain regions of IGE patients with typical absence seizure,and among them occipital lobe is the most significant.

OBJECTIVE: To investigate the expression of RNA methyltransferase METTL14 in hepatocellular carcinoma (HCC) and its clinical significance. METHODS: Immunohistochemical staining was used to detect the expression of METTL14 in 147 pairs of HCC and adjacent hepatic tissues. According to the scores rated by pathologists, the 147 cases of HCC were divided into high and low METTL14 expression groups. The correlation between the expression of METTL14 and clinicopathological parameters was analyzed, and Kaplan-Meier method was used to analyze the relationship between the expression of METTL14 and the prognosis and survival (including the overall survival and disease-free survival) of the patients with HCC after operation. Univariate analysis and multivariate analysis were carried out to assess the impact of METTL14 expression level on the overall survival and tumor-free survival of the patients after operation using a COX regression model and explore whether METTL14 expression level is an independent prognostic risk factor of the postoperative patients. RESULTS: The expression of METTL14 was significantly lower in HCC tissues than in the adjacent tissues ( < 0.001). METTL14 expression in HCC tissues was significantly correlated with the tumor size (=0.044) and TNM stage (=0.046). A low expression of METTL14 in HCC tissues was significantly correlated with a poor prognosis and a significantly shortened overall survival time and disease-free survival time of the patients ( < 0.05), and was an independent risk factor affecting the overall survival and disease-free survival of HCC patients. CONCLUSIONS METTL14 may be a new prognostic marker for patients with HCC after hepatectomy.
Biomarkers, Tumor ; Carcinoma, Hepatocellular ; Disease-Free Survival ; Hepatectomy ; Humans ; Kaplan-Meier Estimate ; Liver Neoplasms ; Methyltransferases ; Prognosis

Objective:To explore the degradation property of novel magnesium alloy stents in Bama mini-pig models of carotid artery stenosis, and evaluate the feasibility of observing their dynamic and continuous process by high-resolution C-arm CT.Methods:Twelve Bama mini-pigs were selected; carotid artery stenosis models were established by large balloon over-dilation and high-fat and high-salt diet in Bama pigs; 24 weeks after that, self-made braided degradable magnesium alloy stents were inserted into the carotid artery stenosis models (confirmed by DSA) by balloon dilation. Degrees of stent patency and in-stent restenosis were examined by DSA immediately after procedure and on the 30 th, 60 th and 90 th d of procedure. Four experimental pigs were sacrificed on the 30 th, 60 th and 90 th d of procedure, respectively; the degradation property of the novel magnesium alloy stents was observed according to results of high-resolution C-arm CT in the inserted-stent areas and staining results of specimens in the stenosis areas, and stent imaging features during degradation were summarized. Results:Twelve Bama mini-pig models of carotid artery stenosis were established and 12 magnesium alloy stents were successfully inserted with a technical success rate of 100%. Both immediate postoperative and follow-up angiography showed patency of the vascular lumens without obvious in-stent restenosis. High-resolution C-arm CT and pathological examination showed homogeneous stent lumens and clear delineation of the stent meshes, with slightly degraded stent on the 30 th d of procedure; the stent lumen was blurred and some magnesium alloy wires were fractured with developed degradation of the stent on the 60 th d of procedure; and the stent meshes and stent strut could not be visualized due to severe degradation of the stent on the 90 th d of procedure. Conclusion:Magnesium alloy degradable stent is almost completely degraded within 90 th d of procedure in Bama mini-pig models of carotid artery stenosis, and high-resolution C-arm CT can be used to dynamically monitor the degradation of the stent in vivo.

Glioblastoma is the most common and aggressive primary tumor in the central nervous system, accounting for 12%-15% of all brain tumors. 3--Acetyl-11-keto--boswellic acid (AKBA), one of the most active ingredients of gum resin from Birdw., was reported to inhibit the growth of glioblastoma cells and subcutaneous glioblastoma. However, whether AKBA has antitumor effects on orthotopic glioblastoma and the underlying mechanisms are still unclear. An orthotopic mouse model was used to evaluate the anti-glioblastoma effects of AKBA. The effects of AKBA on tumor growth were evaluated using MRI. The effects on the alteration of metabolic landscape were detected by MALDI-MSI. The underlying mechanisms of autophagy reducing by AKBA treatment were determined by immunoblotting and immunofluorescence, respectively. Transmission electron microscope was used to check morphology of cells treated by AKBA. Our results showed that AKBA (100 mg/kg) significantly inhibited the growth of orthotopic U87-MG gliomas. Results from MALDI-MSI showed that AKBA improved the metabolic profile of mice with glioblastoma, while immunoblot assays revealed that AKBA suppressed the expression of ATG5, p62, LC3B, p-ERK/ERK, and P53, and increased the ratio of p-mTOR/mTOR. Taken together, these results suggested that the antitumor effects of AKBA were related to the normalization of aberrant metabolism in the glioblastoma and the inhibition of autophagy. AKBA could be a promising chemotherapy drug for glioblastoma.

Glioblastoma multiforme (GBM) in the central nervous system is the most lethal advanced glioma and currently there is no effective treatment for it. Studies of sinomenine, an alkaloid from the Chinese medicinal plant,