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??Objective    To investigate the characteristics of indirect injury of periodontal membrane caused by maxillofacial impact injury. Methods    The study was carried out at the laboratory of oral and maxillofacial trauma in Fourth Military Medical University??from November 2013 to January 2014. Totally 18 dogs were divided equally into six groups with random allocation??the right mandible of each dog was impacted by a cylindroid iron cap whose weight was 0.26kg??but teeth were not injured directly??the animals were killed 6 h??24 h??3 d??7 d??2 wk and 4 wk later??respectively??the histopathologic manifestations of periodontal membrane of the fourth premolar of right mandible??the second premolar of right mandible and the second premolar of left mandible were observed. Results    The injury of periodontal membrane of the fourth premolar of right mandible was relatively obvious??but the pathologic changes were reversible??periodontal membrane of the second premolar of right mandible was injured slightly??yet no obvious histopathologic change could be observed in periodontal membrane of the second premolar of left mandible. Conclusion    Maxillofacial impact injury can cause indirect injuries of periodontal membrane of adjacent teeth??but the pathologic changes are reversible??traumatic severity decreases as the distance of the tooth to the wound area increases.     

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??Correlation between lymph node metastasis of colorectal carcinoma and vascular pattern of inferior mesenteric artery by CTA LIU Huan-ran, HU Xiang, ZHANG Jian, et al. No. 1 Department of General Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
Corresponding author: HU Xiang, E-mail??lhrlhr9050@sina.com
Abstract Objective To study vascular pattern of inferior mesenteric artery (IMA) by CT angiography (CTA) for colorectal operation. Methods Seventy-seven patients with colorectal carcinoma underwent preoperative IMA CTA from January 2011 to April 2013 in the First Affiliated Hospital of Dalian Medical University were selected randomly. IMA and its branches were reconstructed by VR-r AV technique and divided into different categories. Results All the patients’ IMA branched off the abdominal aorta. Four types of branching were confirmed. Type A, where the three arteries branched off from the same point; Type B, where SA branched off from LCA; and Type C, where SA branched off from SRA; Type D, where SA branched off from LCA and SRA respectively. There was no statistical relation between typing and age, gender, invasive depth of tumor, lymph node metastasis, distance from tumor to anus. But lymph node metastasis had significant associated with the distance from tumor to anus (P=0.002). Conclusion Aberrance of IMA is various, metastasis of 242 group lymph nodes was associated with aberrance of SA. Performing preoperative IMA-CTA is helpful to preserve LCA and reduce inadequate lymph node dissection.     

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??Objective:To evaluate the clinical merit of contrast??enhanced ultrasound (CEUS) in the diagnosis of Small hepatocellular carcinoma (HCC) in patients with posthepatitic cirrhosis. Methods:Small hepatocellular carcinoma were examined and observed by CEUS between March 2004 and October 2005,using ultrasound contrast agent??Sonovue.Contrast enhanced CT and or MRI were performed in all cases. Results:The accuracy of diagnosing Small HCC by CEUS were 88.2% (60/68),according to the hypo??enhancement in arterial phase,iso??enhancement or hyo??enhancement in portal phase,hypo??enhancement in delayed phase.The accuracy and false positive rate of diagnosing Small HCC by CEUS were 97.1% (66/68) and 2.9%(2/68) according to the hypo??enhancement in delayed phase. Conclusion:CEUS might increase the diagnosis of small HCC.     

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??Objective??To detect the level of fecal primary and secondary bile acids in infants with infantile cholestatic hepatopathy??ICH??and analyze its clinical value. Methods??Thirty infants with ICH were enrolled in this study??who were diagnosed with infantile cholestatic hepatopathy. Thirty infants with good health condition were enrolled as the healthy control group. The fecal samples were collected respectively in the preparatory treatment phase and treatment phase from infants with ICH and from the healthy infants. Bile acids were extracted from infants’ feces and were quantitatively analyzed by liquid chromatography-mass spectroscopy. Results??Among the fecal primary bile acids??the level of cholic acid??chenodeoxycholic and glycochenodeoxycholic acid both in the ICH preparatory treatment group and ICH treatment group was significantly lower than that in the healthy control group??P??0.016??.The level of fecal cholic acid and chenodeoxycholic acid of ICH treatment group was higher than in the ICH preparatory treatment group??P??0.016??. Among the fecal secondary bile acids??the level of lithocholic acid both in the ICH preparatory treatment group and ICH treatment group was significantly lower than that in the healthy control group??P??0.016????and the level of ursodeoxycholic acid in the ICH preparatory treatment group was lower than that in the ICH treatment group and healthy control group??P??0.016??. Conclusion??In infants with ICH, the changes of fecal primary bile acids and fecal secondary bile acids have their own characteristics at the early stage of treatment, which may be caused by the short-term treatment, the prognosis of the disease itself and the changes of intestinal function, including intestinal bacteria. Clinical attention should be paid to these changes.     

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??Robot-assisted resection of choledochal cysts and Roux-en-Y bilioenterostomy??A report of 2 patients PENG Cheng-hong, LIU Fei. Department of General Surgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Surgery, Shanghai200025,China
Corresponding author: PENG Cheng-hong, E-mail: chhpeng@188.com
Abstract Objective To investigate the feasibility and security of robot surgical system in resection of choledochal cysts and Roux-en-Y bilioenterostomy. Methods The clinical data of 2 patients who underwent choledochal cysts resection and Roux-en-Y bilioenterostomy with robotic system from July 2012 to July 2013 in Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine were analyzed retrospectively. Results All the operations by robot were performed successfully and none was converted to laparotomy. The operation time was range 140 to 170 mins. The intraoperative blood loss was 50 ml. No transfusion was needed during and after the operation. The follow up of 23 months and 14 months were done postoperatively. Conclusion Robot-assisted resection of choledochal cysts and Roux-en-Y bilioenterostomy are secure, feasible and mini-invasive. The superiority remains to be confirmed by more cases and long-term follow-up.     

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??OBJECTIVE To analyze the structure and growth pattern of the biomass, root number, and age class of Asarum sieboldii f.seoulense. METHODS A large sample, random sampling investigation and determination method were used. RESULTS The biomass and root number of Asarum sieboldii f.seoulense were correlated with the growth speed; the correlation coefficient was high. There existed allometric relationship between the age class and the number of roots of Asarum sieboldii f.seoulense; the age class and biomass had allometric relationship. CONCLUSION The increase of the biomass of Asarum sieboldii f.seoulense depends on the root number; with the increase of the age class, the biomass and root number of Asarum sieboldii f.seoulense increase, but the relative growth speeds are not equal.     

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??Canted occlusal plane is the main feature of mandibular deviation. The causes of occlusal plane canting are very complicated and inconclusive. A large number of studies have shown that it is related to bite force??bite contact area??chewing movement and even head or neck position. CBCT is the best diagnostic method for assessing occlusal plane canting at present. Canted occlusal plane and mandibular deviation are mainly ipsilateral??and a small number reveals contralateral. It can also have adverse effects on temporomandibular joint and mastication??and it has been difficult to be corrected with non-surgical methods. Based on the existing literature??we summarized the canted occlusal plane features??adverse effects and the commonly used non-surgical treatment methods.     

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??Application of single layer pancreaticojejunostomy with external drainage of the pancreatic duct in patients with soft pancreas during pancreaticoduodenectomy??A report of 64 cases YANG Feng??JIN Chen??LI Ji??et al. Department of Pancreatic Surgery??Huashan Hospital??Pancreatic Disease Institute??Shanghai Medical College of Fudan University??Shanghai 200040, China
Corresponding author??FU De-liang??E-mail??surgeonfu@163.com
Abstract Objective To investigate the application value of single layer pancreaticojejunostomy with external drainage of the pancreatic duct in patients with soft pancreas during pancreaticoduodenectomy. Methods The clinical data of 64 patients with soft pancreas who received single layer pancreaticojejunostomy with external drainage of the pancreatic duct during pancreaticoduodenectomy between February 2011 and November 2012 in Department of Pancreatic Surgery??Huashan Hospital??Shanghai Medical College of Fudan University were analyzed retrospectively. Intraoperative condition and postoperative therapeutic effect were observed. Results The operation time of the 64 patients was 6.2??4.0-9.5??h??with intraoperative blood loss of 400??50-2900??mL??anastomosis time of 15.6??11-25??min??and postoperative hospital stay of 14.2 (8-43) d. A total of 35 cases (54.7%) had postoperative complications??including 30 cases of pancreatic fistula ??46.9%??composed of 23 cases of grade A and 7 cases of grade B. There were 3 cases ??4.7%??of delayed gastric emptying??4 cases ??6.3%??of intra-abdominal abscess??1 case ??1.6%??of intra-abdominal hemorrhage and 3 cases ??4.7%?? of incision infection. All the complications were cured after corresponding treatment and none had reoperation or perioperative death. The Clavien-Dindo classification of surgical complications: level ?? in 3 cases??4.7%????level ?? in 27 cases ??42.2%????and level ??a in 5 cases ??7.8%??. Conclusion Single layer pancreaticojejunostomy with external drainage of the pancreatic duct during pancreaticoduodenectomy can obviously reduce clinically significant pancreatic fistula??B/C grade????is especially appropriate for those with soft pancreas. It is worthy of further clinical promotion.