Objective To study the CT findings and diagnostic role in morning glory syndrome (MGS). Methods CT study of 7 patients with MGS diagnosed by clinical information was reviewed retrospectively. Results CT findings included: (1) the crater like excavation of the disc in 3 patients; (2) the funnel shaped widening of the retrobulbar optic nerve, a pear shaped deformity of the globe in 2 patients; (3) two patients with cystic expansion of the optic nerve, which was of water density and was continuous with the vitreous humor. Conclusion The CT findings of MGS were particularly striking. CT is the imaging method of choice in the diagnosis of this disorder.

Objective:To investigate the clinical efficacy of robotic navigation and percutaneous internal fixation in the treatment of fresh undisplaced scaphoid lumbar fractures.Methods:From November 2019 to October 2020, 8 patients were treated at Department of Hand Surgery, Xuzhou Renci Hospital for fresh undisplaced scaphoid lumbar fractures. There were 7 males and one female with an average age of 27.5 years (from 18 to 42 years), and 5 left and 3 right cases. Navigation by a Tianji orthopedic robot was conducted to decide the positions for implantation of percutaneous Herbert screws to fixate the fractures. The bone healing was followed up by regular X-ray and CT examinations. The functional recovery was evaluated by Mayo wrist score, grip strength, pinch strength and wrist range of motion, and the wrist pain was evaluated by visual analogue scale (VAS).Results:All the 8 patients were followed up for a mean time of 12.8 months (from 6 to 19 months). All the wounds healed by the first intention without any inflammation or infection. CT examination at 3 months postoperation found that all the fracture ends got united. At the final follow-up, the average active motions of the injured wrist were: 67.9° in flexion, 64.1° in extension, 21.2° in radial deviation and 52.2° in unlar deviation, respectively. The average grip strength was recovered to 31.3 kg, reaching up to 85.2% (from 66.7% to 100.0%) of the contralateral wrist; the average pinch force was recovered to 19.5 kg, reaching up to 89.3% (from 77.8% to 100.0%) of the contralateral wrist. At the last follow-up, the Mayo wrist function scores averaged 97.5 (from 95 to 100) and all the 8 cases were excellent. The VAS pain score of the wrist averaged 0.88 (from 0 to 2).Conclusion:In the treatment of fresh undisplaced scaphoid lumbar fractures, navigation with a Tianji orthopedic robot can be used to visualize percutaneous minimally invasive screw fixation so that accurate positioning and precise screw placement are ensured, leading to rapid rehabilitation.

Objective:To investigate the clinical effect of supermicrosurgery combined with modified anterograde replantation in Yamano Ⅰ zone.Methods:To retrospect and analysis the data of replantation of amputated finger in Yamano Ⅰ in Xuzhou Renci Hospital from March 2016 to October 2019. All patients were treated by supermicrosurgery combined with modified anterograde replantation method. The modified anterograde replantation method was according to proportional anastomosis of arteries and veins, the proceed was artery and nerve → fixation of bone → anastomosis of subcutaneous vein → suturing of skin wound. In the procedure of anastomosis of arteries and nerves, the position of injured finger replantation was modified, the customary horizontal position was altered to vertical position, the severed finger was flipped to the palmar side which was taken as the rotation axis, and the anastomosis was performed through the dorsal approach. Both the proximal and distal sections was completely exposed in the position, so that the visual angle of the surgeon was changed from squint to direct vision, and which suitable for the observation and operation. Follow-up was performed in outpatient department and WeChat after surgery, and functional evaluation was recorded according to the trial standard for functional evaluation of replantation of severed finger of Hand Surgery Society of Chinese Medical Association.Results:All of 38 patients were involved, including 23 males and 15 females. The mean age was 27.3 years (ranged from 1 to 58 years). All of injured fingers were completely severed in Yamano Ⅰ zone by single finger. The causes of injuries included chainsaw injury( n=6), knife cutting injury ( n=5), crush injury ( n=19), and avulsion injury ( n=8). According to the classification of Yamano Ⅰ zone, there were 4 cases of type Ⅰ, 14 cases of type Ⅱ, 11 cases of type Ⅲ, 6 cases of type Ⅳ and 3 cases of type Ⅴ. There were 12 cases of thumb, 9 cases of index finger, 6 cases of middle finger, 7 cases of ring finger and 4 cases of little finger. The ischemia time was 1-12 h. The survival rate was 94.7% (36/38). Thirty-three patients were followed up for 6-12 months. The length and shape of the fingers were similar to the contralateral finger, the nail was intact, and the two-point discrimination was 3-5 mm. The hand function returned to normal. Conclusions:The supermicrosurgery combined with modified anterograde replantation in Yamano Ⅰ zone can be used for the replantation of fingertip with arterial and venous anastomosis. The replantation fingertip has a high survival rate, satisfactory function and appearance. It is an ideal choice for the treatment of amputated finger in Yamano Ⅰ.

Objective:To investigate the clinical effect of free medial sural artery perforator flap (MSAP) in repairing skin and soft tissue defects of hand and foot.Methods:The clinical data of patients with soft tissue defects of hand and foot who were treated by the free MSAP in Xuzhou Renci Hospital from January 2017 to December 2019 were analyzed retrospectively. When repairing the wound of the foot, the donor site was harvested from the ipsilateral lower limb; when repairing the wound of the hand, the donor site was harvested from the ipsilateral or contralateral lower limb. Regular follow-up was carried out through outpatient reexamination, WeChat and telephone. The hand scoring criterion was the upper extremity functional evaluation standard set up by the Chinese Society of Hand Surgery of the Chinese Medical Association; the foot scoring criterion was the Maryland score system.Results:All 10 patients were involved, including 5 males and 5 females. The mean age was 44.8 years (ranging from 16 to 56 years). There were 8 cases of hand wounds and 2 cases of and foot wounds. The MSAP size was 4.0 cm×7.0 cm-5.0 cm×14.0 cm. The lower leg donor site was closed primarily. The cutaneous nerves were anastomosed in seven cases. All flaps survived in 10 patients and primary healing after the operation. One flap had a vascular crisis after the operation and survived after the vascular exploratory operation. Nine cases were followed up for 6-12 months; the mean follow-up time was 8 months. the MSAP was in good shape, the sensation of the flap recovered to grade S2-S3, and the two-point discrimination was 7-9 mm. The hand and foot function returned to normal. The flap in the weight-bearing area was not broken. The movement and sensation of the lower limbs in the donor area were normal without dysfunction. At the last follow-up, hand function was evaluated: 6 cases were excellent and 1 case was good; the evaluation of foot function was excellent in 2 cases. One patient was lost to follow-up.Conclusions:The free MSAP does not damage the main blood vessels; the perforating branches are relatively constant, the vascular pedicle is long, and the subcutaneous fat layer is thin. The effect of repairing the wound of hand and foot is good.

Objective:To investigate the clinical effect of supermicrosurgery combined with modified anterograde replantation in Yamano Ⅰ zone.Methods:To retrospect and analysis the data of replantation of amputated finger in Yamano Ⅰ in Xuzhou Renci Hospital from March 2016 to October 2019. All patients were treated by supermicrosurgery combined with modified anterograde replantation method. The modified anterograde replantation method was according to proportional anastomosis of arteries and veins, the proceed was artery and nerve → fixation of bone → anastomosis of subcutaneous vein → suturing of skin wound. In the procedure of anastomosis of arteries and nerves, the position of injured finger replantation was modified, the customary horizontal position was altered to vertical position, the severed finger was flipped to the palmar side which was taken as the rotation axis, and the anastomosis was performed through the dorsal approach. Both the proximal and distal sections was completely exposed in the position, so that the visual angle of the surgeon was changed from squint to direct vision, and which suitable for the observation and operation. Follow-up was performed in outpatient department and WeChat after surgery, and functional evaluation was recorded according to the trial standard for functional evaluation of replantation of severed finger of Hand Surgery Society of Chinese Medical Association.Results:All of 38 patients were involved, including 23 males and 15 females. The mean age was 27.3 years (ranged from 1 to 58 years). All of injured fingers were completely severed in Yamano Ⅰ zone by single finger. The causes of injuries included chainsaw injury( n=6), knife cutting injury ( n=5), crush injury ( n=19), and avulsion injury ( n=8). According to the classification of Yamano Ⅰ zone, there were 4 cases of type Ⅰ, 14 cases of type Ⅱ, 11 cases of type Ⅲ, 6 cases of type Ⅳ and 3 cases of type Ⅴ. There were 12 cases of thumb, 9 cases of index finger, 6 cases of middle finger, 7 cases of ring finger and 4 cases of little finger. The ischemia time was 1-12 h. The survival rate was 94.7% (36/38). Thirty-three patients were followed up for 6-12 months. The length and shape of the fingers were similar to the contralateral finger, the nail was intact, and the two-point discrimination was 3-5 mm. The hand function returned to normal. Conclusions:The supermicrosurgery combined with modified anterograde replantation in Yamano Ⅰ zone can be used for the replantation of fingertip with arterial and venous anastomosis. The replantation fingertip has a high survival rate, satisfactory function and appearance. It is an ideal choice for the treatment of amputated finger in Yamano Ⅰ.

Objective:To investigate the clinical effect of free medial sural artery perforator flap (MSAP) in repairing skin and soft tissue defects of hand and foot.Methods:The clinical data of patients with soft tissue defects of hand and foot who were treated by the free MSAP in Xuzhou Renci Hospital from January 2017 to December 2019 were analyzed retrospectively. When repairing the wound of the foot, the donor site was harvested from the ipsilateral lower limb; when repairing the wound of the hand, the donor site was harvested from the ipsilateral or contralateral lower limb. Regular follow-up was carried out through outpatient reexamination, WeChat and telephone. The hand scoring criterion was the upper extremity functional evaluation standard set up by the Chinese Society of Hand Surgery of the Chinese Medical Association; the foot scoring criterion was the Maryland score system.Results:All 10 patients were involved, including 5 males and 5 females. The mean age was 44.8 years (ranging from 16 to 56 years). There were 8 cases of hand wounds and 2 cases of and foot wounds. The MSAP size was 4.0 cm×7.0 cm-5.0 cm×14.0 cm. The lower leg donor site was closed primarily. The cutaneous nerves were anastomosed in seven cases. All flaps survived in 10 patients and primary healing after the operation. One flap had a vascular crisis after the operation and survived after the vascular exploratory operation. Nine cases were followed up for 6-12 months; the mean follow-up time was 8 months. the MSAP was in good shape, the sensation of the flap recovered to grade S2-S3, and the two-point discrimination was 7-9 mm. The hand and foot function returned to normal. The flap in the weight-bearing area was not broken. The movement and sensation of the lower limbs in the donor area were normal without dysfunction. At the last follow-up, hand function was evaluated: 6 cases were excellent and 1 case was good; the evaluation of foot function was excellent in 2 cases. One patient was lost to follow-up.Conclusions:The free MSAP does not damage the main blood vessels; the perforating branches are relatively constant, the vascular pedicle is long, and the subcutaneous fat layer is thin. The effect of repairing the wound of hand and foot is good.

Objective To investigate the effect of leflunomide(LEF)on the expression of associated autophagy genes in synoviocytes of rheumatoid arthritis(RA)by regulating HIF-1α signal pathway.Methods Three genera-tions of RA synovial cells were divided into blank control group,LEF group and Tripterygium wilfordii polyglyco-sides group.The blank control group was added with the same volume of DMEM culture medium.The drug group was treated with LEF(concentration 0.2 mg/ml)and Tripterygium wilfordii polyglycosides(concentration 0.03 mg/ml),the proliferation and apoptosis of synovial cells were detected by flow cytometry,the expression of IL-1 β,TNF-α,ANGPTL-4 and VEGF was detected by ELISA,the expression of HIF-1α mRNA was detected by qRT-PCR,and the expression of HIF-1 α,Beclin-1 and BNIP3 protein was detected by Western blot.Results Com-pared with Tripterygium wilfordii polyglycosides group,the expression of IL-1 α,TNF-α,ANGPTL-4 and VEGF in synovial supernatant of LEF group decreased;compared with the blank control group,the expression of HIF-1αmRNA in synovial cells of LEF group and Tripterygium wilfordii polyglycosides group decreased,and the effect of LEF group was the most obvious;compared with the blank control group,the protein expressions of HIF-1α,Bec-lin-1 and BNIP3 in synovial cells of LEF group and Tripterygium wilfordii polyglycosides group decreased,and the effect of LEF group was the most obvious.Conclusion LEF can inhibit the expression of inflammatory factors in RA synovial cells,inhibit HIF-1α signaling pathway,inhibit the expression of autophagy-related genes Beclin-1 and BNIP3,and improve the pathological state of synovitis.

OBJECTIVETo observe the clinical features of Langerhans cell histiocytosis (LCH), and to improve its early diagnosis and treatment.

METHODSRetrospective analysis of 160 cases of adult LCH from pathology department, West China Hospital of Sichuan University and Union Hospital of Tongji Medical College of Huazhong University of Science and Technology from January 1992 to December 2013 were performed, and their clinical features were analyzed.

RESULTSOf 160 cases, there were 110 male and 50 female, the male to female ratio was 2.2:1. The mean age was 35(18-73) years. There were total 222 lesion sites, including 172(77.5%) osteal lesions, followed by 13(5.8%) lymph nodes and 8(3.6%) oral cavity lesions. The other involved organs were skin(5, 2.2%), liver(5, 2.2%), fossa orbitalis(4, 1.8%), lungs(4, 1.8%), sternoclavicular joint(3, 1.4%), gastrointestinal(2, 0.9%), ear(2, 0.9%), and thyroid (2, 0.9%), adrenal gland (1, 0.5%) and sublingual gland (1, 0.5%). Of 160 cases, 150 (93.8%) had one organ involved while 10 (6.2%) had two or more organs involved. Clinically, 77 cases (48.1%) were misdiagnosed as bone tumors (28 cases, including giant cell tumor, fibrous dysplasia, chondroblastoma, osteoblastoma and osteosarcoma), bone tuberculosis (13 cases), meningioma(9 cases), bone cysts (5 cases), chronic osteomyelitis (5 cases) and diabetes insipidus (5 cases) , skin (4 cases) diseases malignant lymphoma (4 cases), chronic skin ulcers (4 cases), chronic otitis media (1 case), lung (1 case) and oral cancer (1 case).

CONCLUSIONIn this group of the adult cases, the ratio of the male patients is higher. Adult LCH occurs predominantly in bone and presents mainly as unisystem single-focal disease, but multi-organ lesion and skin involvement are lower than that reported in the literatures. Just as LCH in children, adult LCH is also easy to be misdiagnosed. We should raise awareness of the disease and pathological examination is helpful for early diagnosis.

Adolescent ; Adult ; Aged ; China ; Diagnostic Errors ; Female ; Histiocytosis, Langerhans-Cell ; Humans ; Liver ; Lymph Nodes ; Male ; Middle Aged ; Retrospective Studies ; Skin ; Thyroid Gland ; Young Adult