Circular RNAs(CircRNAs)are a class of non-coding RNAs with a covalently closed-loop structure,high stability,and tissue specificity,with the production mechanisms different from linear RNAs.Recent studies have discovered that some CircRNAs can encode proteins via cap-independent translation mechanisms such as internal ribosome entry site,N6-methyladenosine,and rolling loop translation.The encoded proteins regulate homologous linear proteins or downstream signaling pathways via protein bait or other mecha-nisms,thereby exerting biological functions.Studies have shown that CircRNAs play a role in various diseases,especially in tumor progression,proliferation,invasion,and metastasis and immune regulation.Therefore,by elucidating the expression and roles of proteins encoded by CircRNAs in tumorigenesis and development,this pa-per is expected to provide new tumor markers and potential targets for tumor diagnosis and treatment.

Objective:To investigate the clinical effect of the anterolateral femoral perforator flap（ALTP）pedicled with the oblique branch of lateral circumflex femoral artery（LCFA）assisted by CT angiography（CTA）examination for repairing soft tissue defects of limbs.Methods:A retrospective case series study was made on 51 patients with soft tissue defects of limbs treated in Ningbo No.6 Hospital from March 2015 to March 2020，including 31 males and 20 females at age of 26-63 years［（42.0±8.9）years］. The defects were located at the forearm in 15 patients，at the hand in 13，at the lower leg in 15 and at the ankle in 8. The size of defects ranged from 9 cm×6 cm to 18 cm×10 cm，with the size of flaps from 10 cm×6 cm to 20 cm×12 cm. A total of 33 patients were examined with CTA scanning and Doppler ultrasound（CTA group）and 18 patients with Doppler ultrasound（Doppler group）. All patients underwent debridement and negative pressure closed drainage（VSD）at stage I and were repaired by ALTP pedicled with the oblique branch of LCFA at stage II. The diameter and length of the vessel pedicle was recorded in CTA group before operationand in both groups during operation. The time of flap harvesting in both groups was recorded during operation. The survival of the flap in both groups was observed one week after operation. Zhang Hao's scoring standard was applied to evaluate the outcome at the last follow-up.Results:All patients were followed up for 6-12 months［（9.1±1.5）months］. In CTA group，the diameter of LCFA vessel pedicle measured before operation had no significant difference from that during operation（ P>0.05），while the length of LCFA vessel pedicle before operation［（12.3±2.1）cm］was longer than（10.9±2.2）cm during operation（ P<0.05）. The two group showed no significant differences in the diameter and length of LCFA vessel pedicle during operation（ P>0.05）. The time of flap harvesting in CTA group was（38.5±6.2）minutes，significantly shorter than（51.4±8.4）minutes in Doppler group（ P<0.05）. One week after operation，all flaps survived. Two patients developed flap arterial congestion in CTA group，among whom one survived after surgical revision and one with partially necrosis was healed after dressing change. One patient was found with flap arterial congestion with partial necrosis in Doppler group，who was healed after dressing change. There was no significant difference in postoperative flap arterial congestion between the two groups（ P>0.05）. The patients' satisfaction score in CTA group was（8.5±1.5）points at the last follow-up，higher than（7.4±2.0）points in Doppler group（ P<0.05）. Conclusion:For repairing soft tissue defects of limbs，free ALTP pedicled with the oblique branch of LCFA assisted by three- dimensional CT angiography can accurately get the information of perforator，shorten the flap harvesting time，and obtain satisfactory clinical results as compared to Doppler ultrasound.

Objective:To analyse clinical outcomes and risk factors of vascular crisis on patients received oral and maxillofacial defect repairations with free tissue flap.Methods:From January, 2013 to July, 2018, 1 049 patients with soft tissue defect of oral and maxillofacial were reconstructed with free tissue flap, in which 64 cases occurred vascular crisis. Among the cases, 28 defect were reconstructed with radial forearm free flap (RFFF), 19 with anterolateral thigh flap (ALTF), and 17 with fibula flap. All patients underwent surgical exploration. The clinical data and surgical outcomes were collected. The univariate analysis and multivariate regression analysis were performed by using SPSS version 22.0 software. The result was supposed to statistically significant when P<0.05. Results:Among 64 patients occurred vascular crisis, 44 flaps were rescued successfully by surgical procedures (68.8%). Univariate analysis revealed that the salvage rate was related to the smoking history, type of tissue flap, time of vascular crisis occurrence, cause of vascular crisis and the time interval between crisis occurrence and surgical exploration ( P<0.05). Multivariate regression analysis revealed that only type of tissue flap, the time of vascular crisis occurrence and the interval time were the independent significant factors for salvage rate ( P<0.05). Conclusion:The salvage rate became higher when the vascular crisis occurred earlier, and the interval time was shorter. The type of tissue flap could affect the outcome of surgical exploration. The success rate decreased with an order of RFFF, ALTF to fibula flaps. The primary principle in the management of vascular crisis was early identification and early surgical exploration.

Objective:To investigate the clinical effect of different surgical methods in the treatment of bisphosphonate-related osteonecrosis of the jaw (BRONJ).Methods:A total of 20 cases of BRONJ who were treated for surgical treatment from January 2013 to March 2019 were included for the retrospective analysis in this study. There were 14 males and 6 females in this study. The average age of onset was 65.4 years, including 67.4 years for males and 60.7 years for females. There were 9 patients in stage 1, 7 in stage 2, 3 in stage 3, and 1 patient with maxillary lesions in stage 2 and mandibular lesions in stage 3. For patients in stage 1 or stage 2 who had poor systemic conditions and could not tolerate general anesthesia or surgical trauma. Different surgical treatments should be performed according to the results of imaging evaluation. If completely dead bones were formed locally, sequestrectomy under local anesthesia was performed. For patients whose dead bones were not completely separated, partial jaw resection was performed. For stage 3 BRONJ patients with severe symptoms occurring in the mandible, such as the formation of intraoral and external fistulas, pathological fractures, or lesions involving the lower margin of the mandible, segmental osteotomy was usually performed when general conditions were stable.Results:Of the 20 patients, 6 cases (including 1 patient with lesions involving both maxilla and mandible) underwent sequestrectomy, 11 cases partial jaw resection and 4(including 1 patient with lesions involving both maxilla and mandible) mandibular segmental osteotomy. The patients were followed up for 1-67 months (mean 32.8 months). All the patients who underwent mandibular segmental osteotomy were recovered well and discharged. 6 patients were clinically asymptomatic after partial jawbone resection. The symptoms of the rest of the patients were alleviated, showing relieved pain, disappeared dead bone and so on, while the course of disease was significantly slowed down.Conclusions:Sequestrectomy and partial jaw resection can relieve symptoms and improve quality of life of patients, so that some patients can achieve clinical cure. Mandibular segmental osteotomy as a more effective treatment method, can be considered as the preferred treatment for stage 3 patients with lesions in the mandible and with good systemic condition.

Objective:To investigate the effect of mini-retromandibular and transparotid approach in open reduction and internal fixation of middle or low condylar fractures.Methods:A total of 28 condylar fracture cases which were treated with mini-retromandibular approach from January 2016 to January 2019 in Nanjing Stomatological Hospital were included in this study. These cases included 18 males and 10 females with ameanage of 42.5 years. There were 11 cases of left condyle fractures, 13 cases of right condyle fractures and 4 of bilateral condyle fractures. During the operations, incisions of 2-3 cm long were made on the skin and subcutaneous tissue along the posterior margin of the mandible. Then we performed blunt dissections parallel to the facial nerves, directly passing through the parotid gland and masseter muscles, without the facial nerve injuried. After exposing the fracture line, the fracture ends were fixed and restored with two 4-hole titanium miniplates under direct vision.The medical reviews were performed on the third day and 3-6 months after operation by imaging examination and clinical examination. The contents included: postoperative hematoma, postoperative infection, nerve injury, salivary fistula, maximum mouth opening degree, mouth opening type, occlusal relationship, scar condition, etc.Results:All of the 28 patients had good restoration of fracture ends without nerve injury, salivary fistula or other complications. Only one patient suffered with postoperative infection. After 3 months, titanium miniplate was removed by second operation. The mouth opening of patients ranged 1.5-3.8 cm, with an average of 3.1 cm, which was significantly improved compared to the pre-operation (0.5-2.0 cm, average 1.2 cm). One patient’s chin was slightly deviated to the affected side at the time of opening, and the occlusal relationship was recovered well with intermaxillary elastic traction for 3-5 days.The mouth opening type of other patients was nearly normal. Followed up for 6-36 months, all of the patients had no obvious scars after operation.The patients were satisfied with the operation effect. All patients took postoperative CT and 3D reconstruction 3 to 6 months after operation, which showed that the fracture reduction was good.Conclusions:Mini-retromandibular and transparotid approach is effective, simple, efficient and fast in the treatment of condylar middle or low fracture, without facial nerve dissection. It can not only reduce the operation time and the possibility of facial nerve injury, but also make postoperative scar relatively inconspicuous.

Objective:To investigate the clinical effect of different surgical methods in the treatment of bisphosphonate-related osteonecrosis of the jaw (BRONJ).Methods:A total of 20 cases of BRONJ who were treated for surgical treatment from January 2013 to March 2019 were included for the retrospective analysis in this study. There were 14 males and 6 females in this study. The average age of onset was 65.4 years, including 67.4 years for males and 60.7 years for females. There were 9 patients in stage 1, 7 in stage 2, 3 in stage 3, and 1 patient with maxillary lesions in stage 2 and mandibular lesions in stage 3. For patients in stage 1 or stage 2 who had poor systemic conditions and could not tolerate general anesthesia or surgical trauma. Different surgical treatments should be performed according to the results of imaging evaluation. If completely dead bones were formed locally, sequestrectomy under local anesthesia was performed. For patients whose dead bones were not completely separated, partial jaw resection was performed. For stage 3 BRONJ patients with severe symptoms occurring in the mandible, such as the formation of intraoral and external fistulas, pathological fractures, or lesions involving the lower margin of the mandible, segmental osteotomy was usually performed when general conditions were stable.Results:Of the 20 patients, 6 cases (including 1 patient with lesions involving both maxilla and mandible) underwent sequestrectomy, 11 cases partial jaw resection and 4(including 1 patient with lesions involving both maxilla and mandible) mandibular segmental osteotomy. The patients were followed up for 1-67 months (mean 32.8 months). All the patients who underwent mandibular segmental osteotomy were recovered well and discharged. 6 patients were clinically asymptomatic after partial jawbone resection. The symptoms of the rest of the patients were alleviated, showing relieved pain, disappeared dead bone and so on, while the course of disease was significantly slowed down.Conclusions:Sequestrectomy and partial jaw resection can relieve symptoms and improve quality of life of patients, so that some patients can achieve clinical cure. Mandibular segmental osteotomy as a more effective treatment method, can be considered as the preferred treatment for stage 3 patients with lesions in the mandible and with good systemic condition.

Objective:To investigate the effect of mini-retromandibular and transparotid approach in open reduction and internal fixation of middle or low condylar fractures.Methods:A total of 28 condylar fracture cases which were treated with mini-retromandibular approach from January 2016 to January 2019 in Nanjing Stomatological Hospital were included in this study. These cases included 18 males and 10 females with ameanage of 42.5 years. There were 11 cases of left condyle fractures, 13 cases of right condyle fractures and 4 of bilateral condyle fractures. During the operations, incisions of 2-3 cm long were made on the skin and subcutaneous tissue along the posterior margin of the mandible. Then we performed blunt dissections parallel to the facial nerves, directly passing through the parotid gland and masseter muscles, without the facial nerve injuried. After exposing the fracture line, the fracture ends were fixed and restored with two 4-hole titanium miniplates under direct vision.The medical reviews were performed on the third day and 3-6 months after operation by imaging examination and clinical examination. The contents included: postoperative hematoma, postoperative infection, nerve injury, salivary fistula, maximum mouth opening degree, mouth opening type, occlusal relationship, scar condition, etc.Results:All of the 28 patients had good restoration of fracture ends without nerve injury, salivary fistula or other complications. Only one patient suffered with postoperative infection. After 3 months, titanium miniplate was removed by second operation. The mouth opening of patients ranged 1.5-3.8 cm, with an average of 3.1 cm, which was significantly improved compared to the pre-operation (0.5-2.0 cm, average 1.2 cm). One patient’s chin was slightly deviated to the affected side at the time of opening, and the occlusal relationship was recovered well with intermaxillary elastic traction for 3-5 days.The mouth opening type of other patients was nearly normal. Followed up for 6-36 months, all of the patients had no obvious scars after operation.The patients were satisfied with the operation effect. All patients took postoperative CT and 3D reconstruction 3 to 6 months after operation, which showed that the fracture reduction was good.Conclusions:Mini-retromandibular and transparotid approach is effective, simple, efficient and fast in the treatment of condylar middle or low fracture, without facial nerve dissection. It can not only reduce the operation time and the possibility of facial nerve injury, but also make postoperative scar relatively inconspicuous.

Objective: To analyze the clinical characters and surgical treatment of primary parapharyngeal space (PPS) tumors. Methods: A total of 23 cases of primary PPS tumors which were treated from November 2011 to December 2017 were included for the retrospective analysis in this study. Results: Twenty-three cases of patients with primary PPS tumors were analyzed in this study. Surgical approach was as follows: transcervial approach applied in 7 cases, transparotid approach in 4 cases, transoral approach in 2 cases, transmandibular approach in 4 cases, and the combined approaches on 6 cases. Besides, among 7 cases with upper PPS tumor, we applied the surgical navigation system in the surgery of 3 cases. The mean surgery duration of these cases, 3.5 h, was shorter than unused ones, while the mean maximum size (MMS) of tumors, 5.7 cm, was also larger. So far, 23 cases had no recurrence and metastasis. The most frequent histopathological type of all the cases was pleomorphic adenoma (8 cases), followed by Schwannoma (5 cases). With an 8-to-72-months follow up, 23 cases had no recurrence, metastasis or death. Conclusions Surgical resection is preferred in the treatment of PPS tumors. In the upper PPS tumor cases, the surgical navigation system could reduce the operative duration significantly and is more suitable for larger tumors.

Objective: To investigate the feasibility and clinic outcome of the turbocharging technique in repairing large defect with free perforator flap. Methods: From January 2017 to December 2018, 6 patients with defect of over length or large size were repaired with free perforator flaps, anterolateral thigh(ALT) flap in 3 cases and deep inferior epigastric artery perforator(DIEP) flap in 3 cases in Department of Hand Surgery, Ningbo No.6 Hospital. There were 4 males and 2 females, aged from 29 to 54 years old, with an average age of 41 years old.It was found that the size of the flap beyond the perforasome, while multiple perforators in the flaps were not from the same pedicle. The turbocharging technique was applied in the operation. The distal perforator of the flap was anastomosed with the proximal pedicle branch. The flap size ranged from 20 cm×8 cm to 25 cm×12 cm. The donor sites were closed directly for 3 cases and skin grafting for 3 cases. Results: All the flaps survived successfully, no distal necrosis occurred. The patients were followed up for 3 to 12 months, with an average of 9 months. All flaps survived well with satisfactory appearance and pliable texture. The healing of skin graft was satisfactory in 3 cases in donor site. No graft skin contracture occurred. The donor sites closed directly in 3 cases had linear scar in donor site, no obvious contracture occurred. The flap sensation returned to S2-S3. Conclusions If the size of the flap is super long or large, beyond the perforasome, while multiple perforators in the flaps were not from the same pedicle, the application of turbocharging technique can avoid partial necrosis of the flap and improve the survival rate of the flap, which is an ideal alternative.

Objective To analyze tumor immune microenvironment and related mechanisms in liver cancer.Methods We included 10 cases of hepatocellular carcinoma,hepatitis B patients and healthy volunteers from January 2015 to December 2017 in Shanxi Grand Hospital.We first detected the peripheral and local GM-CSF level in each group,detected myeloid-derived suppressor cells (MDSCs) GM-CSF and pathway-related protein expression.from liver cancer,tumor margin and normal liver tissue through flow cytometry and immunohistochemistry,Finally,we transfected the CCR4-NOT transcriptional complex subunit 7 (CNOT7) recombinant plasmid in the hepatoma cell line,and then detected the related protein expression.Results There was no significant difference for peripheral blood GM-CSF level between liver cancer group,hepatitis group and control group (P＞0.05).The level of local GM-CSF was (32.2±8.9) ng/L,which was higher than that of hepatocellular carcinoma (9.7±2.7) ng/L and normal liver tissue (11.6±2.9) ng/L.The difference was statistically significant (P＜0.05).The proportion of MDSCs at the edge of the tumor was (9.9 ±3.6) ％,which was higher than that of liver cancer (4.0± 1.5) ％ and normal liver tissue (6.3±2.3) ％,and the difference was statistically significant (P＜0.05).Immunohistochemistrydata was consistent with previous data.Compared with normal liver tissue,CNOT7 and STAT3 were highly expressed in liver cancer tissues,while STAT1 was lowly expressed.HepG2 human hepatoma cells were selected for transfection.Compared with the empty plasmid group,CNOT7 expression was decreased in the knocking out group at the same time STAT1 expression was increased,STAT3 and GM-CSF expression was decreased.Conclusion In hepatocellular carcinoma,the secretion of GM-CSF increased and the number of MDSCs increased.Knocking out CNOT7 reduced GM-CSF secretion and activate the JAK/STAT signaling pathway.