Treatment and prognosis analysis of perineural invasion on sinonasal adenoid cystic carcinoma / 中华肿瘤杂志

Objective: To analyze the efficacy of sinonasal adenoid cystic carcinoma (ACC) with perineural invasion (PNI), and explore the prognostic value of PNI on sinonasal adenoid cystic carcinoma. Methods: The clinical data of 105 patients with sinonasal ACC admitted to Cancer Hospital, Chinese Academy of Medical Sciences from January 2000 to December 2016 were retrospectively reviewed. All patients were restaged according to American Joint Committee on Cancer 8th edition. Follow-up visits were conducted to obtain information of treatment failure and survival outcome. The Log rank test was used for univariate analysis of prognostic factors, and Cox regression model was used for multivariate prognostic analysis. Results: The maxillary sinus (n=59) was the most common primary site, followed by the nasal cavity (n=38). There were 93 patients with stage Ⅲ-Ⅳ. The treatment modalities included surgery alone (n=14), radiotherapy alone (n=13), preoperative radiotherapy plus surgery (n=10), and surgery plus postoperative radiotherapy (n=68). The median follow-up time was 91.8 months, the 5-year local control (LC), distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival (OS) rates were 72.6%, 73.0%, 52.9% and 78.0%, respectively. There were 33 patients (31.4%) with PNI-positive. The 5-year DMFS, PFS, and OS rates of PNI-positive group were 53.7%, 29.4% and 56.5%, respectively, which were significantly inferior to those of PNI-negative group (80.8%, 63.0% and 86.8%, respectively, P<0.05), while there was no significant difference in the 5-year LC rate between both groups (64.5% vs 76.5%, P=0.273). The multivariate Cox regression analysis showed PNI was one of the poor prognostic factors of DMFS (HR=3.514, 95%CI: 1.557-7.932), PFS (HR=2.562, 95%CI: 1.349-4.866) and OS (HR=2.605, 95%CI: 1.169-5.806). Among patients with PNI-positive, the 5-year LC, PFS and OS rates of patients received surgery combined with radiotherapy were 84.9%, 41.3% and 72.7%, respectively, which were significantly higher than 23.3%, 10.0% and 26.7% of patients receiving surgery or radiotherapy alone (P<0.05). Conclusion: The presence of PNI increases the risk of distant metastasis in patients with sinonasal ACC. Compared with patients with PNI-negative, the prognosis of patients with PNI-positive is relatively poor, and surgery combined with radiotherapy for PNI-positive sinonasal ACC results in good clinical outcomes.

Simultaneous determination of four constituents in Zizyphi Spinosae Semen by ASE-CAD / 中草药

Objective: To establish an accelerated solvent extraction (ASE)-charged aerosol detector (CAD) method for simultaneous detection of jujuboside A, jujuboside B, spinosin, and betulinic acid in Zizyphi Spinosae Semen. Methods: The orthogonal design was applied to optimize the extraction parameters of the ASE system. The target compounds were detected by HPLC-CAD with the parameters as follow: Thermo Syncronis C18 (100 mm × 3 mm, 3 μm) column, a gradient elution program with acetonitrile-water as mobile phase at a flow rate of 0.5 mL/min, the column temperature was kept at 40℃. Detector was Corona Ultra CAD with 35℃ of nebulization temperature. Results: Optimization of the ASE parameters with orthogonal design greatly improved the extraction efficiency; All the target compounds could be simultaneously determined in a single run. Good linear relationships (0.998 3-0.999 6) and high relative recoveries were 98.46%-102.02%. Conclusion: The method is rapid, simple, accurate, and thus could be used for the quality control of Zizyphi Spinosae Semen.

Chromatographic fingerprint and multi-components quantitative analysis of Verbena officinalis by HPLC-CAD / 中草药

Objective: To establish a high performance liquid chromatography-charged aerosol detector (HPLC-CAD) method in order to obtain fingerprint profile and achieve the amount of isomer, oleanolic acid, and ursolic acid from Verbena officinalis. Methods: The method was developed by a C30 (150 mm × 2.1 mm, 3 μm) column and a linear gradient elution. Acenitrile-0.2% acetic acid was used as mobile phase. The flow rate was 0.3 mL/min; The injection volume was 10 μL and the column temperature was maintained at 20 ℃. Detector was Corona Ultra CAD with 40 oC of nebulization temperature. Results: Seventeen common peaks were observed from the fingerprint profiles of five different area samples. The relative standard divisions (RSDs) of retention time were less than 0.35%. The relative peak areas of the common peaks were in the range of 3.3%-44.0%. The contents of oleanolic acid were ranging from 0.097% to 0.136%, the contents of ursolic acid were ranging from 0.257% to 0.478%, the total contents were ranging from 0.354% to 0.478%. Conclusion: The fingerprint and simultaneous determination of oleanolic acid and ursolic acid in V. officinalis is firstly studied by HPLC-CAD. This method is simple and with good repeatability, which can be used for the quality control of V. officinalis.

Dominant perforator neurocutaneous flaps for one-staged reconstruction of defects caused by high energy at lower legs, ankles and feet / 中华整形外科杂志

<p><b>OBJECTIVE</b>To evaluate the therapeutic effect of dominant perforator neurocutaneous flaps for one-staged reconstruction of defects caused by high energy at lower legs, ankles and feet.</p><p><b>METHODS</b>From July 2003 to Feb. 2011, 39 cases, with defects caused by high energy at lower legs, ankles and feet, were retrospectively studied. The defects were covered primarily by one or two perforator neurocutaneous flaps (free or pedicled) which were based on a dominant perforator arising from the posterior tibial or peroneal artery (including the lateral supramalleolar perforating artery which is also from the peroneal vessel) respectively through sural, saphenous and superficial peroneal neurocutaneous vascular axis.</p><p><b>RESULTS</b>39 cases with 44 defects were treated by 32 sural neurocutaneous flaps based on the peroneal perforator (5 free and 27 pedicled), 6 saphenous neurocutaneous flaps on the posterior tibial perforator (1 free and 5 pedicled) and 6 superficial peroneal ones on the lateral supramalleolar perforating artery. The largest flap size was 22 cm x 10 cm. All flaps were survived successfully without necrosis. The average in-hospital time was 23 days ( ranged from 12-36 days).</p><p><b>CONCLUSIONS</b>The three kinds of dominant perforator neurocutaneous flaps have reliable blood supply with a relatively large size. They can be chosen and designed individually for all kinds of defects over the lower leg, ankle and foot. There are many advantages in a primary procedure, such as easier dissection, better vessel status in or around recipient areas, less secondary necrosis and lower risk of chronic infection. Moreover, the reduction of granulation and scar tissues benefit functional rehabilitation.</p>

Superficial peroneal neurocutaneous vascular axial adipofascial-cutaneous flap pedicled with lateral supramalleolar perforator for coverage of donor site defects at foot dorsum / 中华整形外科杂志

<p><b>OBJECTIVE</b>To report the operative techniques and clinical results of modified superficial peroneal neurocutaneous propeller adipofascial-cutaneous flap for reconstruction of donor site defects at foot dorsum.</p><p><b>METHODS</b>A propeller adipofascial flap with a skin pedicle (4-6 cm in width) based on the lateral superamalleolar perforating artery which vascularized the flap through the nutrient vessel chain of the superficial peroneal nerve was designed to repair defects after harvesting of foot pedicled dorsal flap. The defects at donor site of the leg was closed directly and split-thickness skin grafting was performed on the adipofascial surface of the flap primarily or secondarily.</p><p><b>RESULTS</b>From May 2007 to Oct. 2011, 7 cases were treated. All flaps were transplanted successfully with satisfactory cosmetic and functional results. The flaps size ranged from 19 cm x 8 cm to 30 cm x 11 cm.</p><p><b>CONCLUSIONS</b>The flap has reliable blood supply with a relatively large vascularized area, long rotation are and minimum donor-site cosmetic morbidity. It' s a simple and safe procedure which is suitable for covering donor sites defects after harvesting foot pedicled dorsal flap.</p>

Modified sural neurocutaneous vascular flap based on single dominant perforator arising from peroneal artery for coverage of defects over Achilles tendon / 中华整形外科杂志

<p><b>OBJECTIVE</b>To report the operative techniques and clinical results of specially designed sural neurocutaneous vascular flap pedicled on a dominant perforator (the diameter > or = 0.8 mm) of the peroneal artery for coverage of soft tissue defects overlying the Achilles tendon.</p><p><b>METHODS</b>An approximately rectangular sural neurocutaneous vascular flap pedicled on the lowest dominant perforator arising from the peroneal artery was designed and harvested to repair defects over the Achilles tendon. The pedicle was located at a certain part of the flap, which divided the flap into the distal and the proximal parts. After the tendon was repaired, the flap was rotated 180 degrees based on the perforator and the position of the distal and proximal parts of the flap was changed to cover the defects and part of the donor site respectively. In most cases, skin graft was not needed.</p><p><b>RESULTS</b>The modified flaps were applied in 15 cases. All flaps (ranged from 13 cm x 15 cm - 18 cm x 9 cm ) were transplanted successfully without necrosis, and no vascular problems occurred. Following up for 10-17 months showed both satisfactory functional and cosmetic results.</p><p><b>CONCLUSIONS</b>The modified flap has reliable blood supply and the special design provides nearly normal outline of the ankle which favorites shoe wearing. It' s an excellent option for covering defects overlying the Achilles tendon.</p>

Modified superficial peroneal neurocutaneous flap pedicled with lateral supramalleolar artery arising from peroneal artery for forefoot defect / 中华整形外科杂志

<p><b>OBJECTIVE</b>To report the operative techniques and clinical results of modified distally based superficial peroneal neurocutaneous flap for skin defect of the forefoot.</p><p><b>METHODS</b>A reversed superficial peroneal neurocutaneous flap pedicled with the lateral superamalleolar perforating artery or its descending branch, which vascularized the flap through the nutrient vessel chain of the nerve, which linked vascular territories of superamalleolar perforating artery, cutaneous branches of the anterior tibial artery and superficial peroneal artery, was designed to repair skin defects in the forefoot.</p><p><b>RESULTS</b>The modified flaps were applied in 17 cases. All flaps were survived successfully with no complication. The largest size of the flap was 20 cm x 8 cm. The flap could reach as far as the proximal end of the second and third toes or weight-bearing areas under the fifth metatarsal caput.</p><p><b>CONCLUSIONS</b>The modified flap has reliable blood supply with a relatively large size and long rotation arc. It is a simple and safe for covering medium to large defects in the forefoot.</p>

Study of distribution of dominant perforators arising from peroneal artery with color Doppler flow imaging and its clinical significance for sural neurocutaneous flap / 中华整形外科杂志

<p><b>OBJECTIVE</b>To study the distribution of the dominant perforators (the diameter > or = 0.8 mm) of the peroneal artery with color Doppler flow imaging (CDFI) for the purpose of anatomical preparations for the perforator sural neurocutaneous flap.</p><p><b>METHODS</b>The dominant perforators of the peroneal artery (DPPA) were studied with CDFI on bilateral legs of 20 healthy volunteers. The numbers, diameters and locations of the perforators were recorded for a statistical analysis. From Jan. 2005 to Jan. 2009, 51 free or pedicled sural neurocutaneous flaps supplied by a single DPPA were designed and harvested to repair the defects near the ankle (n=22), at the leg (n=15) and the forefoot or hand dorsum (n=14). The perforators were located preoperatively with CDFI and accuracy of CDFI was evaluated intraoperatively. The causes of false results were analysed to improve examining techniques.</p><p><b>RESULTS</b>The average number of DPPA was 4.2 with the average diameter of (1.13 +/- 0.24) mm (0.80-1.90 mm). They were located in the second to ninth segment of the line from the fibular caput to the tip of lateral malleolus which was equally divided into nine segments. The largest DPPA was (1.43 +/- 0.29) mm (1.00-1.90 mm) in diameter and most of them were located in the third to fifth segment (80.4%). The average diameter of the lowest DPPA was (1.02 +/- 0.16) mm( 0.80-1.30 mm) and they were located between the sixth to ninth segment. The total 169 DPPA as well as the largest ones mostly appeared in the middle third of the leg. All of the 51 flaps were transplanted successfully without necrosis, and no vascular problems occurred. Preoperative CDFI examination had a 93.6% true-positive rate and an 88.0% positive predictive value. What should be demonstrated was that if just considered the cases after Dec. 2007, the true-positive rate was 97%, and the positive predictive value was 93.9%.</p><p><b>CONCLUSIONS</b>According to the distribution characteristics of DPPA, a sural neurocutaneous flap pedicled with one of this relatively large perforator can be designed and harvested to repair skin defects of leg and around ankle, but can not be utilized for that of forefoot. With anastomosis of the perforator, the flap based on the largest DPPA can be used as a free flap to cover defect anywhere. CDFI is reliable in preoperative location of DPPA, which makes the surgical procedures easier.</p>

Free peroneal artery perforator sural neurocutaneous flap for hand and foot defects / 中华整形外科杂志

<p><b>OBJECTIVE</b>To report the operative techniques and clinical results of the free peroneal artery perforator sural neurocutaneous flaps.</p><p><b>METHODS</b>Free sural neurocutaneous flap with a single unit of perforating veins and artery arising from the peroneal artery was designed to repair skin defects of hand or from the ankle to distal end of the foot. After the flap was transposed to the defect, the perforating artery was anastomosed with a branch of a nearby artery, and the small saphenous vein was anastomosed with the cephalic vein or the great saphenous vein to establish the flap's circulation. An alternative way was to anastomose the perforating vessels only. The sural nerve was anastomosed to innervate the flap.</p><p><b>RESULTS</b>From Jan 2005 to Dec 2007, 12 cases were treated with the flaps with no flap necrosis. The size of the flaps ranged from 12 cm x 7 cm to 18 cm x 11 cm. The follow-up period was 7 to 27 months. Both the cosmetic and functional results were satisfactory. Two point discrimination was 7 to approximately 12 mm.</p><p><b>CONCLUSIONS</b>The flap has all the advantages of the free flap, the perforator flap and the neurocutaneous flap. It is easily performed with reliable blood supply. It's a good choice for repairing the skin defects of hands and feet.</p>

DDP-sensitivity-related genes in 10 lung cancer cell lines / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To search for genes related to cisplatin (DDP) sensitivity in small-cell lung cancer (SCLC) and non-small-cell lung cancer (NSCLC) cell lines.</p><p><b>METHODS</b>The sensitivity of 4 SCLC lines and 6 NSCLC lines to DDP was evaluated by MTT assay. The expression of 1291 genes related to DDP-sensitivity in the 10 cell lines was measured by cDNA macroarray and the relationship between genes and DDP-sensitivity was analyzed.</p><p><b>RESULTS</b>20 genes were negatively related to DDP-sensitivity in the SCLC and NSCLC cell lines, including Metallothionein, Cathepsin B, TIMP1, TNF-R1, TGF beta-induced 68 000, Cathepsin L, Galectin-1, Annexin 11, PAI-1, IGFBP4, UPAR, Jagged, CD13, alpha 1 A-AR, EphA2 (Eck), APC, RhoC, Fibromodulin, GATA-6 and HSC 70, while only procoagula and MDM2 were positively related to DDP-sensitivity in the SCLC and NSCLC cell lines. 10 genes were negatively related to DDP-sensitivity in the SCLC cell lines, including VHL, MMP-7, Elongin A, GSK-3 beta, SLC, Galectin-3, integrin beta 5, moesin, IKK beta, and ETV 1, while only AT2 was positively related to DDP-sensitivity in the SCLC cell lines. 10 genes were negatively related to DDP-sensitivity in the NSCLC cell lines, including Clusterin, FG FR-2, Thrombospondin 1, HSP 32, Lactate dehydrogenase A, P300, Thymosin beta l0, CD81, C/EBP gamma, Rak, while only CaMKK and TPA were positively related to DDP-sensitivity in the NSCLC cell lines.</p><p><b>CONCLUSION</b>There were 45 genes related to DDP-sensitivity in 10 lung cancer cell lines. There were 22 co-expressed genes in both SCLC and NSCLC cell lines, and only 11 and 12 genes expressed in the SCLC and NSCLC cell lines, respectively.</p>

Expression of vascular endothelial growth factor and metastin in colorectal carcinoma / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the expression of vascular endothelial growth factor (VEGF) and metastin in colorectal carcinoma and their association with the clinicopathological features of the malignancy.</p><p><b>METHODS</b>VEGF and metastin expressions were examined immunohistochemically with SP method in 70 specimens of human colorectal carcinoma tissues and adjacent normal tissues.</p><p><b>RESULTS</b>VEGF protein overexpression was detected in 48.6% (34/70)of the colorectal carcinoma tissues but in none of the adjacent normal tissues (P<0.01), and for metastin, the overexpression rate was 28.6% (20/70) in the colorectal carcinoma tissues and 70.0% (49/70) in the normal tissues (P<0.01). The expression of both VEGF and metastin was related to the histological grades, infiltration depth, TNM stage and lymph node metastasis of the tumor (P<0.01 and P<0.05, respectively).</p><p><b>CONCLUSION</b>Immunohistochemical detection of VEGF and metastin can be of value in assessment of the malignancy and in prognostic evaluation of colorectal carcinoma.</p>

The effect of PGI2 on formation and development of hyperdynamic circulatory state in portal hypertensive rats / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the effects of prostacyclin (PGI(2)) and nitric oxide (NO) in the development of hyperdynamic circulatory state on chronic portal hypertensive rats.</p><p><b>METHODS</b>Sixty-six male SD rats were divided into three groups, namely intrahepatic portal hypertension (IHPH) by injection of CCl(4), prehepatic portal hypertension (PHPH) by partial stenosis of the portal vein for 2 weeks and sham-operated controls (SO). Animals in each group were divided further into 3 subgroups and received N(omega)-nitro-L-arginine (L-NNA), indomethacin and saline (as control), respectively. Splanchnic and systemic hemodynamics was measured using radioactive microsphere techniques. The NO concentration in serum was determined by nitrates-nitrites which were measured using a colorimetric method, and concentration of PGI(2) was determined using specific radioimmunoassay for its stable hydrolytic product, 6-keto-PGF(1 alpha).</p><p><b>RESULTS</b>The concentrations of plasma 6-keto-PGF(1 alpha) and serum nitrates + nitrites in IHPH rats (1 123.85 +/- 153.64; 73.34 +/- 4.31) and in PHPH rats (891.88 +/- 83.11; 75.21 +/- 6.89) were significantly higher than those of SO rats (725.53 +/- 105.54;58.79 +/- 8.47). L-NNA and indomethacin could decrease the concentrations of plasma 6-keto-PGF(1 alpha) and serum nitrates + nitrites in IHPH and PHPH rats (P < 0.05). At the same time, CI, FPP and PVI were lowered while MAP, TPR and SVR were increased (P < 0.05). After deduction of NO action, there were no significant correlation between plasma PGI(2) level and hemodynamic parameters such as CI, TPR, PVI and SVR. However, after deduction of PGI(2) action, NO was still correlated highly with those hemodynamic parameters.</p><p><b>CONCLUSION</b>It is NO rather then PGI(2) that is a mediator in the formation and development of hyperdynamic circulatory state in chronic portal hypertensive rats.</p>