OBJECTIVETo investigate the effectiveness of microbubble-enhanced ultrasound (MEUS) for detecting perforators preoperatively in supraclavicular flap surgery.

METHODSFrom May 2009 to October 2013, there were 20 patients (26 flaps were involved) who planned to undergo supraclavicular artery based flap surgeries to recover the large-area defects in head and neck. The MEUS together with regular color Doppler ultrasound ( CDUS) were conducted preoperatively to determine the anatomical features of perforators branching from supraclavicular arteries (SCA). The perforator with wider caliber, faster flow speed, longer pedicles and closer pivot point was selected and the flap was designed according to the observed results.

RESULTSThere were 37 perforators of SCA detected by CDUS, whose calibers were ranging from 0.5 to 0.8 mm [Mean: (0.6 ± 0.1) mm]. There were 48 perforators of SCA detected by MEUS. Compared to CDUS, the caliber obtained from MEUS for same vessel is significantly increased [(0.7 ± 0.3) mm vs (0.6 ± 0.1) mm, P < 0.05]. According to the results of MEUS and three-dimensional reconstructive techniques, in at least 65.4% (17/26) of the flaps, thoracic branch of SCA (TBSA) has large caliber and good flow velocity which can be regarded as the predominant vessel and used as the pedicle of flap. The results of the operations confirmed the existences of all the marked vessels. 25 flaps were obtained according to the preoperative plans and one case used perforators of internal mammary artery as free flaps since the perforator of SCA was found improper. The contrast-related complication occurred in one patient which was manifested by gastrointestinal adverse effect like nausea and anorexia. The patient recovered 1 day later without treatment. All the patients have been followed up for 3 to 16 months (Mean: 8 months) with well-survived flaps.

CONCLUSIONSThe perforators of SCA demonstrated significant variations and preoperative mapping was vital for the success of surgery. MEUS is a valuable imaging modality for the preoperative assessment of the vascular supply for supraclavicular artery based flap.

Arteries ; diagnostic imaging ; Humans ; Mammary Arteries ; Microbubbles ; Neck ; surgery ; Perforator Flap ; Reconstructive Surgical Procedures ; Ultrasonography ; methods

BACKGROUND:Large numbers of experimental data have confirmed that bone marrow mesenchymal stem cel s have a positive therapeutic effect on cerebral ischemia-reperfusion injury, but there are few reports about intravenous administration of bone marrow mesenchymal stem cel conditioned medium in the treatment of stroke.
OBJECTIVE:To investigate the effects of the conditioned medium of rat bone marrow mesenchymal stem cel s on the recovery of neurological function in rats after cerebral ischemia-reperfusion injury.
METHODS:The bone marrow mesenchymal stem cel s were isolated from rat bone marrow. When cel s at passage 2 or 3 reached 90%confluence, the original culture medium was removed. Then the cel s were cultured in serum-free DMEM for 18 hours. After that, the culture solution was col ected as the conditioned medium of rat bone marrow mesenchymal stem cel s. Adult rats were subjected to 2 hours of right middle cerebral artery occlusion. Ischemia-reperfusion injury rats were randomly assigned to three groups:control group, simple culture medium group and conditioned medium group, and respectively given injection of normal saline, DMEM, conditioned medium (10 mL/kg) via the tail vein at 2, 24, 48 hours after operation.
RESULTS AND CONCLUSION:There was no difference in the behavioral tests among the three groups at postoperative 2 hours (P>0.05). Compared with the control and simple culture medium group, neurological impairment was significantly improved in the conditioned medium group at postoperative 1, 3, 5 days (P<0.05), but there was no significant difference between the control and simple culture medium groups. At postoperative 5 days, brain edema was significantly eased in the conditioned medium group in comparison to the control and simple culture medium groups (P<0.05), and there was also no difference between the latter two groups (P>0.05). These results suggest that rat bone marrow mesenchymal stem cel s-conditioned medium via intravenous administration can significantly ease brain edema and improve the neurologic function after cerebral ischemia-reperfusion injury.

OBJECTIVE:To establish a method for simultaneous determination of 30 kinds of microelements in Mallotus apelta from Guangxi. METHODS:ICP-MS method was adopted. The radio frequency power was 1550 W,the sampling depth was 10 mm,the carrier gas velocity was 1.05 L/min,the atomizing chamber temperature was 2 ℃,and the peristaltic pump was 0.10 rps. The collision mode was He,and the gas flow rate was 4.2 mL/min. RESULTS:The linear ranges of aluminum,vanadium,chromi-um,manganese,iron,nickel,copper,zinc,gallium,arsenic,cadmium,antimony,molybdenum,rubidium,cesium,barium, lanthanum,cerium,praseodymium,neodymium,europium,gadolinium,dysprosium,holmium,erbium,lutetium,mercury,thal-lium,lead and uranium were 10-1000 ng/mL(r=0.9999),0.1-5 ng/mL(r=0.9999),0.1-5 ng/mL(r=0.9999),10-1000 ng/mL (r=0.9999),10-1000 ng/mL(r=0.9999),0.1-5 ng/mL(r=0.9997),0.5-100 ng/mL(r=0.9997),1-500 ng/mL(r=0.9998), 1-100 ng/mL(r=0.9997),0.5-50 ng/mL(r=0.9999),0.5-50 ng/mL(r=0.9999),0.1-10 ng/mL(r=0.9999),0.1-10 ng/mL(r=0.9999),0.1-10 ng/mL(r=0.9999),0.1-10 ng/mL(r=0.9999),1-500 ng/mL(r=0.9999),0.1-10 ng/mL(r=0.9999),0.1-10 ng/mL(r=0.9999),0.1-10 ng/mL(r=0.9999),0.1-10 ng/mL(r=0.9998),0.1-10 ng/mL(r=0.9999),0.1-10 ng/mL(r=0.9999), 0.1-10 ng/mL(r=0.9999),0.1-10 ng/mL(r=0.9999),0.1-10 ng/mL(r=0.9999),0.1-10 ng/mL(r=0.9998),0.1-5 ng/mL(r=0.9984),0.1-10 ng/mL(r=0.9999),0.5-100 ng/mL(r=0.9997),0.1-10 ng/mL(r=0.9999),respectively. The limits of quantita-tion were no higher than 0.44 mg/kg,and the limits of detection were no higher than 0.11 mg/kg. RSDs of precision,stability and reproducibility tests were no more than 10.0%. The recoveries were 80.45%-116.68%(RSD ranged 0.47%-5.83%,n=6). The con-tents of Mn,Ba Fe and Al in samples were the highest. CONCLUSIONS:The method is simple,precise,stable and reproduc-ible,and can be used for simultaneous determination of 30 kinds of microelements in M. apelta from Guangxi. The contents of harmful elements are in line with national standard.

BACKGROUND: Bone marrow mesenchymal stem cells (BMSCs) and bone marrow mononuclear cells(BMMNCs) have been both used to treat spastic cerebral palsy. However, the differences in their therapeutic effects remain unknown. OBJECTIVE: To compare the therapeutic effects of BMMSCs and BMMNCs in cerebral palsy children as well as on fine motor function. METHODS: 105 children with spastic cerebral palsy were enrolled and randomly assigned to three groups: BMMSCs group, BMMNCs group and control group. Patients in the two transplantation groups received four intrathecal cell injections, and those in the control group received Bobath therapy, twice a day, for consecutive 3 weeks. The Gross Motor Function Measure (GMFM) and Fine Motor Function Measure (FMFM) were used to evaluate the therapeutic efficacy at 3, 6 and 12 months after transplantation. RESULTS AND CONCLUSION: At 3 months after cell transplantation, scores in A dimension of GMFM and in A, C dimensions of FMFM in BMMSC group were all superior to those of BMMNC group and control group (P < 0.05). At 6 months after cell transplantation, scores in A, B dimensions of GMFM and in A, B, C, D and E dimensions of FMFM in BMMSC group were better than those of BMMNC group and control group (P< 0.05), and total scores of GMFM and FMFM were also better in the BMMSC group (P < 0.05). At 12 months after cell transplantation, scores in A, B and C dimensions of GMFM and A, B, C, D and E dimensions of FMFM scores in BMMSC group were all superior to those of BMMNC group and control group (P < 0.05) as well as the total GMFM and FMFM scores. There were six cases of low intracranial pressure headache in BMMNC group and six cases of low-grade fever in BMMSC group. In summary, both BMMSCs transplantation and BMMNCs transplantation are safe, effective and feasible for the treatment of spastic cerebral palsy in children, and moreover, BMMSCs transplantation is a better method than BMMNCs transplantation to improve gross and fine motor functions of spastic cerebral palsy children.

Objective To evaluate the influence and significance of preoperative design of surgical approach on stem cell transplantation via stereotactic surgery. Methods Six patients with stroke in the basal ganglia region were selected. The transplantation target and transcranial approach point were designed by magnetic resonance examination before stem cell transplantation via stereotacfic surgery to guarantee that the line connecting the transplantation target and transcranial approach point could avoid the important functional areas, the ventricular system and the softening focus. Postoperative magnetic resonance examination was performed to observe whether the practical target and surgical approach coincided with the preoperative design or not. Results The practical transplantation target was coincided with the designed transplantation target, distributed around the softening focus without implanted cells in the softening focus. Surgical approach was coincided with the preoperative design and it successfully avoided the important brain functional area, ventricular system and softening focus.Conelnsion The preoperative design of surgical approach can not only ensure the cells being exactly transplanted into the reservation target and guarantee the curative effect, but also promise the surgical approach successfully avoiding the important brain functional area, ventricular system and softening focus and reduce the operative injury.

OBJECTIVETo study the diagnostic value of diffusion tensor imaging (DTI) in cervical spondylotic myelopathy.

METHODSTwenty healthy volunteers and fifty patients with cervical spondylotic myelopathy underwent DTI in the Affiliated Hospital of Medical College of Ningbo University from January 2014 to April 2015. Healthy volunteers served as controls. Fifty patients were divided into three groups (group A , B, C) according to cervical MRI scan standard. Group A (17 cases) had only the dura mater spinalis compressed; Group B (23 cases) showed the cervical spinal cord compressed, but no high signal in it; Group C (10 cases) had the cervical spinal cord compressed with high signal in the same level. The average apparent diffusion coefficients(ADC) and fractional anisotropy (FA)values in these examinee were analyzed and all subjects were performed fiber tracking.

RESULTSThere was no statistically significant differences in ADC and FA values in C2/C3, C3/C4, C4/C5, C5/C6, C6/C7 of control group (P>0.05). The average ADC and FA values in control group were (0.875 +/- 0.096) x10(3) mm2/s and 0.720 +/- 0.051, respectively; compared with group A,there was no statistically significant difference; compared with group B and C, there was significant difference; comparison among group A, B, C, there was significant differences.

CONCLUSIONDTI can early and accurately quantify the changes of microstructure in cervical spondylotic myelopathy. Fiber tracking can show the damage range of spinal cord lesions.

Adult ; Case-Control Studies ; Cervical Vertebrae ; diagnostic imaging ; Diffusion Tensor Imaging ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Radiography ; Spinal Cord Diseases ; diagnostic imaging ; surgery ; Spondylosis ; diagnostic imaging ; Young Adult

BACKGROUNDMiR-34a dysregulation has been implicated in tumorigenesis and progression of gastric cancer, but its role in prognosis of patients with gastric cancer remains unknown. The aim of this study was to investigate the expression and prognostic significance of miR-34a in gastric cancer patients after radical gastrectomy.

METHODSQuantitative real-time polymerase chain reaction was performed to detect the expression of miR-34a in human gastric cancer cell lines and tissues in 76 patients with gastric adenocarcinoma from China. Results are assessed for association with clinical features and overall survival (OS) using Kaplan-Meier analysis. Prognostic values of miR-34a expression and clinical outcomes were evaluated by Cox regression analysis. A molecular prognostic stratification scheme incorporating miR-34a expression was determined using receiver operating characteristic analysis.

RESULTSThe results show that the expression level of miR-34a was decreased in human gastric cancer cell lines and tissues, and down-regulated expression of miR-34a was associated with Lauren classification (P = 0.034). Decreased miR-34a expression in gastric cancer tissues was positively correlated with poor OS of gastric cancer patients (P = 0.013). Further multivariate Cox regression analysis suggested that miR-34a expression was an independent prognostic indicator for gastric cancer (P = 0.027). Applying the prognostic value of miR-34a expression to tumor node metastasis (TNM) stage system showed a better prognostic value in patients with gastric cancer than miR-34a expression (P = 0.0435) or TNM stage (P = 0.0249) alone.

CONCLUSIONThe results reinforce the critical role for the down-regulated miR-34a expression in gastric cancer and suggest that miR-34a could be a prognostic indicator for this disease.

Cell Line, Tumor ; Gastrectomy ; Gene Expression Regulation, Neoplastic ; genetics ; Humans ; In Vitro Techniques ; Kaplan-Meier Estimate ; MicroRNAs ; genetics ; Multivariate Analysis ; Prognosis ; Real-Time Polymerase Chain Reaction ; Stomach Neoplasms ; genetics ; surgery

Objective:To clarify the influence and influence paths of stigma on the time of the healthcare-seeking decision in caregivers of elderly patients with dementia, and to provide a theoretical basis for the construction of corresponding humanistic care strategies.Methods:A total of 176 caregivers of elderly patients with dementia who visited the Affiliated Hospital of Xuzhou Medical University and Xuzhou Oriental People ′s Hospital from February 2021 to February 2022 were selected as the study subjects. The General Information Questionnaire, self-designed Scale of Stigma for Caregivers of Senile dementia patients, Multidimensional Scale of Perceived Social Support, self-designed Elderly Dementia Caregivers′ Perceived Barriers Scale for Healthcare-seeking Decision, and self-designed Scale of the Intention to Seek Healthcare for caregivers of senile dementia patients were used in the survey. AMOS 20.0 was used to establish a structural equation model for path analysis. Results:The higher the stigma of caregivers, the longer the time of the healthcare-seeking decision ( β=0.05, P<0.05). Social support, perceived barriers to the healthcare-seeking decision, and the intention to seek healthcare were the mediating variables of caregivers ′ stigma affecting the time of the healthcare-seeking decision, with a total effect of -0.04, 0.14, and 0.36, respectively, and all P<0.05. Conclusions:The stigma in caregivers of senile dementia patients is an important factor affecting the time of the healthcare-seeking decision. By improving mediating factors including social support, perceived barriers to the healthcare-seeking decision, and the intention to seek healthcare, the implementations of targeted humanistic care strategies are expected to help shorten the time of the healthcare-seeking decision.

In order to investigate the effect of antioxidants on human blood, vitamin C was selected and added into plastic blood storage bags with CPD, and stored at 25 degrees C. During 6 days of storage, some indexes as ATP, SOD, MDA, K(+) concentration and superoxide radicals were detected and were compared with control group, The results showed that ATP and SOD activity in whole blood with vitamin C during 6 days of storage was higher then that in control group (P < 0.05, P < 0.01), the MDA and plasma K(+) concentrations in stored whole blood with vitamin C during 6 days of storage were lower than that in control group (P < 0.05, P < 0.01), the superoxide radical concentrations in stored whole blood with vitamin C decreased lower than that in control group (30%). The conclusion was made that vitamin C increases activities of ATP and SOD, decreases concentrations of MDA, plasma K(+) and superoxide radicals during blood preservation.
Adenosine Triphosphate ; blood ; Antioxidants ; pharmacology ; Ascorbic Acid ; pharmacology ; Blood Preservation ; methods ; Erythrocytes ; cytology ; drug effects ; metabolism ; Humans ; Malondialdehyde ; blood ; Potassium ; blood ; Superoxide Dismutase ; blood ; Time Factors

OBJECTIVETo introduce a new prefabricated flap with matched colour, texture, thin enough thickness, large enough dimension and reliability for reconstruction of massive defect of face and neck.

METHODSThe patients with massive scar of face and neck were selected for treatment with prefabricated flap. Flap prefabrication involved two stages. The "sandwich" structure including the descending branch of the lateral femoral circumflex vessels and surrounding muscle fascia was harvested from the thigh and anastomosed to superior thyroid artery or facial vessels. Flap prefabrication was performed by inserting the fascia flap between the cervicothoracic skin and the tissue expander placed beneath the skin. After a period of expansion, the flap was transferred to the recipient site based on the implanted vessels. The results including complications were examined during follow-up.

RESULTSNine patients received this treatment. The average dimensions of fascia flap harvested was 6.3 cm x 11.2 cm. After mean interval of 16.7 weeks, the expanders were filled to a mean volume of 1670cc. The size of prefabricated flap ranged from 12 cm x 15 cm to 15 cm x 32 cm. In all cases, the flap efficiently covered the entire defect of the face and neck, and the donor site of the flap is closed primarily. All of the flaps developed venous congestion in some degree after the second operation. Partial flap necrosis occurred in two cases. Three flap was thinned to contour the bulky pedicle. During follow-up, the transferred flap was matched well to the adjacent skin. The reconstructed face restored nature contour and expression. Muscle weakness or paraesthesia was not found in the donor thigh.

CONCLUSIONSCervicothoracic Prefabricated Flap, is reliable and versatile in the reconstruction of massive soft tissue deficits with restoration nature surface and expression of the face and neck.

Adolescent ; Adult ; Child ; Face ; surgery ; Female ; Humans ; Male ; Middle Aged ; Neck ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; methods ; Surgical Flaps ; Thorax ; Tissue Expansion ; Young Adult