Objective To investigate the clinical and MR features of fungal encephalopyosis and fungal granuloma.Methods The clinical and MR data of 10 cases with fungal encephalopyosis and fungal granuloma confirmed by surgical pathology or clinical serum were analyzed retrospectively.Then we analyzed the clinical conditions,MR signals,lesion enhancement,DWI and MRS performance characteristics of the 10 cases.Results Six cases were fungal encephalopyosis,among which 2 cases occurred in the sella turcica after surgery which located in and above the sella turcica.2 cases occurred in the frontal lobe after frontal surgery and 1 case of them was multiple encephalopyosis.2 cases of encephalopyosis without operation history were located in the left frontal lobe and right cerebellum respectively.The abscess walls of these cases were thin and showed high tension.Furthermore,it had annular significant signal enhancement and high signal in DWI scan.One case of huge fungal granuloma located in the frontal lobe and into the sinuses which showed uneven signal enhancement. The Cho level was significantly increased.Three cases of cryptococcal granuloma showed multiple lesions located in the bilateral basal ganglia region and 2 out of them accompanied with cephalomeningitis.Conclusion The MR performance of fungal encephalopyosis was quite similar with bacterial brain abscesses,which makes the differential diagnosis difficult.The brain fungal granuloma MRS may display a significant increase of Cho level which might be related with gliosis.It shows certain characteristics of brain MR performance of cryptococcal granuloma which are multiple lesions,preferential distribution of basal ganglia region and accompanying cephalomeningitis.

Objective To explore the anatomical basis for the flexor pollicis brevis branch of median nerve transfer to the deep branch of ulnar nerve.Methods Eight fresh upper limb were dissected and observed.The specimen were dissected under the loup.Observed the number of the flexor pollicis brevis branch and measured the distances from pisiform bone to the flexor pollicis brevis branch.Then the transfer operation on the cadaver were imitated.After the anastomosis was completed,the stumps of the nerves were sectioned and stained with HE.The crossing-sectional area and the density of nerve fiber were obtained by Image-Pro Plus version 6.0,then the number of the nerve fiber were calculated.The data analyzed by SPSS 17.0.Results The flexor pollicis brevis branch constantly appear,there were two branches in 2 specimens,one branch in 6 specimens.The flexor pollicis brevis branch could transfer to the deep branch of ulnar nerve by end-to-end surture without tension.The regeneration distances was (37.3 ± 5.76) mm.The crossing-sectional area were (0.0575 ± 0.0086)mm2 and (0.2039 ± 0.0396)mm2,the number were (492.50± 62.62) and (1651.13± 79.01),the density were (8781.4246 ± 1676.2894)/mm2 and (8371.1592 ± 1677.6509)/mm2 in the flexor pollicis brevis branch and the deep branch of ulnar nerve,respectively.There were no significant differences in the density of the nerve fiber between the donor and recipient nerve (P ＜0.05).But there were differences in the crossing-sectional area and number of the nerve fiber(P ＜ 0.05).Conclusion The flexor pollicis brevis branch transfer to the deep branch of ulnar nerve can provide a short regenerating distance,but can supply a part of recipient nerve to reinnervate.

Objective To discuss the classification and treatment of the degloving hand.Methods All 68 degloving hand treated between January, 2005 and December, 2014 in our department were reviewed.The cases were divided into three types according to the extent of the injury.Type Ⅰ the degloving tissue had enough blood supply which was debrided and stitched.Type Ⅱ the degloving tissue had less or no blood supply which was revascularized with replantation or vein anastomosis, some degloving palm or dorsum resurfaced the wound by the degloving skin graft.Type Ⅲ the degloving tissue had no blood supply or severely damaged,the tissue defect should be resurfaced with other tissue reconstruction.Type Ⅱ and Ⅲ were further divided into subtype A, B and C depending on the degloving scope and location, each subtype has its own surgical procedure.Results The total survival rate was 83.8％.The survival rate decreased with the increasing extent of the injury and the increasing degloving scope.Conclusion Classification of the hand degloving injuries depending on the extent of the injury, the degloving scope and location is useful for the assessment of injury and the selection of proper operation procedures.

OBJECTIVETo study the classification and individualized treatment of the terminal phalanx of thumb duplication.

METHODSFrom Apr. 2003 to Dec. 2012, 76 patients with 77 involved thumbs duplication at the level which is distal to the interphalangeal joint were retrospectively studied. Based on the morphology (the nail width and the thumb circumference) and the deviation of the thumb, we classified the terminal phalanx of thumb duplication into 5 types as Type A (no bony connection called floating thumb), Type B(asymmetry and no deviation), Type C(asymmetry and deviation), Type D (symmetry and no deviation) and Type E(symmetry and deviation). Different surgical procedures were selected according to different types. Simple excision of the smaller thumb was adopted for Type A case. Removement of the smaller thumb (usually the radial) and of the collateral ligament of the interphalangeal joint were selected for Type B. Removement of the smaller thumb (usually the radial) and reconstruction of the collateral ligament of the interphalangeal joint, as well as corrective osteotomies at the neck of the proximal phalanx were performed for Type C. The modified Bilhaut-Cloquet procedure with reconstruction of the collateral ligament of the interphalangeal joint were adopted in Type D. The classical Bilhaut-Cloquet procedure, or the modified Bilhaut-Cloquet procedure with reconstruction of the collateral ligament of the interphalangeal joint and corrective osteotomies at the neck of the proximal phalanx were performed in Type E. The results were assessed by an evaluation form for thumb duplication by the Japanese Society for Surgery of the Hand.

RESULTSAccording to our new classification standard, there were 3 cases with Type A duplicated thumbs, 36 with Type B, 13 with Type C, 15 with Type D, 10 with Type E. All the 76 patients underwent the individualized surgical treatment. The patients were followed up for 6-60 months. According to the evaluation form, excellent results were achieved in 66 thumbs, good in 9 thumbs and fair in 2 thumbs.

CONCLUSIONSThe new classification could comprehensively describe the clinical features of the terminal phalanx of congenital thumb duplication. Individualized therapy, including basic and repeated surgical procedure could be adopted for each type with satisfactory results.

Child ; Collateral Ligaments ; surgery ; Finger Phalanges ; surgery ; Humans ; Orthopedic Procedures ; methods ; Osteotomy ; methods ; Polydactyly ; classification ; surgery ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Thumb ; abnormalities

Objective To evaluate ultrasound-guided methylene blue dyeing for radical liver segmental resection.Methods Liver segmental resection with uhrasound-guide methylene blue dyeing (UMD-SR) was performed in 16 cases, results were compared with 16 conventional liver segmental resection (CSR) retrospectively.Results All the operations under uhrasound-guided methylene blue dyeing were successfully carried out, among them, reverse dyeing was used in cases with segment Ⅳ, Ⅴ, Ⅷ resection.The blood loss in UMD-SR group was much less than CSR group(t =3.011 ,P =0.009) , at the cost of a longer operation time (t =5.423,P =0.000 07).There was no difference in the mortality and morbidity rates between two groups.Tumor recurrence rate was 6.25％ in UMD-SR group and 18.75％ in CSR group (x2 =0.133,P =0.285).Conclusions Ultrasound-guided methylene blue dyeing liver segmental resection can reduce the blood loss during operation, improve the safety of hepatectomy in case of hepatic carcinoma.

Objective To study the MR features and differential diagnosis of oligodendroglioma.Methods Clinical and MR data of 34 pathology-diagnosed oligodendroglioma cases were analyzed retrospectively, which included tumor location,signal,size,enhanced and MRS features.Results 22 cases were diagnosed as WHOⅡoligodendroglioma and 12 cases WHOⅢ anaplastic oligodendroglioma.22 tumors located in the frontal lobes,4 tumors in the temporal lobes, 7 tumors in both frontal and temporal lobes,1 tumor located at the optic chiasma.25 tumors located in the superficial areas of the brain.For anaplastic oligodendrogliomas,tumor necrosis and cystic degenerations were showed in 11 cases,and hemorrhage or calcification in 6 cases.For oligodendroglioma,tumor necrosis and cystic degenerations were showed in 6 cases,hemorrhage in 2 cases,calcification in 8 cases.The average tumor diameter was 35 mm for oligodendroglioma and 58 mm for anaplastic oligodendroglioma.For anaplastic oligodendroglioma,obvious irregular or ring enhancements were showed in 11 cases.For oligodendroglioma, mild enhancement was showed in 6 cases,no enhancement in 6 cases and mild or moderate irregular ring-type enhancements in 4 cases.MRS was performed in 6 anaplastic oligodendrogliomas the Cho/Cr ratio was over 4 in 5 cases.MRS was performed in 12 oligodendrogliomas the Cho/Cr ratio was between 2.3 to 3.3 in 10 cases and below 2 in 2 cases.Conclusion The main MR feature of anaplastic oligodendroglioma is that tumor is located in the frontal lobe and superficial area of the brainwith irregular or ring-type enhancement,and the Cho/Cr ratio over 4.

Objective To analyze the clinical features and pathogenic gene mutation in a Chinese family with cerebro-oculo-facio-skeletal(COFS)syndrome,in order to summarize the relationship between phenotype and genotype.Methods The clinical data of the proband and his family members were collected.Genomic DNA from the proband and his parents were extracted by using standard procedures from the peripheral blood leukocytes.Next-generation sequencing was used to detect gene mutation in the patient with COFS syndrome.Sanger sequencing was applied to confirm the results.Results The proband,male,1 year and 3 months old,presented with microcephaly nystagmus,large ears,prominent nose,high arched palate,overhanging upper lip,micrognathia,widely set nipples,flexion contractures(especially involving the elbows and knees),failure to thrive,developmental retardation and feeding difficulty.His parents were normal phenotype.Two different heterozygous mutations c.1843G>T(P.G615W)and c.1996 C> T(P.R666W)were identified in the ERCC2 gene.The proband's father had the heterozygous mutation c.1843G>T(P.G615W)and his mother had the heterozygous mutation c.1996 C> T(P.R666W).Meanwhile,this heterozygous mutation c.1996 C> T(P.R666W)had been reported as a pathogenic gene mutation.Conclusions COFS syndrome is characterized by microcephaly,prominent nose,arthrogryposis and severe developmental delay.This is the first report on COFS syndrome patient in the mainland of China.The pathogenic gene mutations and gene status were identified through genetic studies.The result has laid the foundation for accurate genetic counseling and further prenatal diagnosis.

Objective To investigate the effectiveness and safety in patients with largeartery occlusive acute cerebral infarction who received multi-interventional modes mainly with mechanical thrombectomy and its related factors affecting prognosis. Methods The clinical data of 56 patients with large artery occlusive acute cerebral infarction were analyzed retrospectively. The clinical characteristics (gender,age,and underlying diseases),timing of treatment (time from ictus to puncture,time from puncture to recanalization), multi-interventional mode therapies (intra-arterial thrombolysis,thrombectomy,balloon dilation,and stenting, etc. ),and distribution of offending vessels were observed. The modified Thrombolysis in Cerebral Ischemia Scale (mTICI)grade was used to evaluate revascularization. The National Institute of Health Stroke Scale (NIHSS)score was used to observe the neurological function at 24 h before and after procedures. The modified Rankin scale (mRS)was used to evaluate the prognosis at 3 months after procedure. The safety of the treatment was evaluated with operative complications (mainly symptomatic intracranial hemorrhage)and mortality. The patients were divided into either a good prognosis group (n = 34;mRS≤2)or a poor prognosis group (n =22;mRS≥3)according to the prognosis at 3 months after procedure. They were analyzed with univariate analysis. The factors influencing the prognosis were further analyzed with multivariate logistic regression analysis. Results (1)The recanalization rate in 56 patients was 78. 6%(n = 44),in which basilar artery was the highest,reaching 93. 8% (15 / 16),middle cerebral artery was 87. 0% (20 / 23). The NIHSS score at 24 hours was 10 ± 7,it was lower than 16 ± 6 on admission. There was significant difference (t =6. 401,P <0. 01). At 3 months,34 patients (60. 7%)had good prognosis,4 (7. 1%)died,and 8 (14. 3%) had symptomatic intracranial hemorrhage. (2)Multiple factor analysis showed that the high level of recanalization was a protective factor for good prognosis (OR,0. 465,95% CI 0. 267 -0. 809,P =0. 007). Diabetes was an independent risk factor for poor prognosis (OR,5. 535,95% CI 1. 101 -27. 835, P = 0. 038). Conclusion Acute large artery occlusive cerebral infarction treated with the intra-arterial multi-interventional modes may quickly and effectively restore intracranial blood flow. It has the characteris-tics of high recanalization rate and good prognosis,and the higher the level of recanalization,the better the prognosis. Diabetes is an independent risk factor for poor prognosis.

Objective:To compare the effects of 3 different crystalloid fluids at different osmotic concentrations on blood-brain barrier(BBB) and brain edema in severe hemorrhagic shock rats.Methods: A total of 150 male SD rats were equally randomized into a lactated Ringers(LR) group,a 7.2% hypertonic saline(HS) group and a plasmalyte A(PA) group.LR,PA and HS were administered after an hour of severe hemorrhagic shock induced by drawing out about 40% of total blood and maintaining MAP at 35-45 mmHg.Serum S100B,cerebra1 Evans Blue(EB) and water content were determined before(T_0) and 1 h after bleeding(T_1) and immediately(T_2),1 h(T_3) and 2 h(T_4) after administration.The changes of BBB in the hippocampus CA1 area were observed by electron microscopy.Results: The serum S100B level was obviously higher at T_1,T_2,T_3 and T_4than at T_0 in all groups(P0.05).The cerebra1 water content was significantly increased at T_1,T_2,T_3 and T_4in the LR group,at T_1in the HS and at T_1,T_2 and T_3 in the PA as compared with T_0(P

To identify the regulatory region that are responsible for the expression of mPC-1, we have isolated and characterized the mPC-1 gene promoter. Sequence analysis of the mPC-1 5' -flanking region and a series of truncated constructs were performed, which were transiently transfected into the prostate cancer cell lines and non-prostate cancer cell lines and analyzed through Dual-luciferase reporter assay system. The relative activity of mPC-1 gene promoter was by far higher than pGL3-control containing SV40 promoter and enhancer and p61-PSA containing hPSA 6 kb promoter in AR (androgen receptor, AR ) -positive prostate cancer cell lines. The region from 599 bp to 449 bp of mPC-1 promoter might contain a negative regulatory element. The expression of mPC-1 1.1 kb fragment is mainly restricted into prostate cancer cell lines. The relative activity of mPC-1 1.1 kb 5'-flanking region was regulated by androgen. The results demonstrated that the 1.1 kb fragment of mPC-1 5' -flanking region was relatively strong and prostate cancer cell specific promoter region.The 1.1 kb promoter of mPC-1 gene might be well suited to prostate cancer gene therapy if the promoter was properly modified.