OBJECTIVETo investigate one-stage repairing upper lip defects with an island flap based on the inferior labial arterial arch.

METHODSAn island flap pedicled with the inferior labial arterial arch was used to repair upper lip defects. The size of the wedge-shaped flap ranged from 1.5 cm x 1.5 cm to 1.5 cm x 2.0 cm. Since 1993, fifteen patients with upper lip defects have been treated with this method.

RESULTSAll the flaps survived with satisfactory function and appearance.

CONCLUSIONSThe island flap of the inferior labial arterial arch is effective and applicable in repairing severe secondary deformities of congenital bilateral cleft lips.

Adolescent ; Adult ; Arteries ; transplantation ; Cleft Lip ; surgery ; Female ; Humans ; Lip ; abnormalities ; blood supply ; Male ; Reconstructive Surgical Procedures ; methods ; Surgical Flaps ; Young Adult

Animals ; Breath Tests ; methods ; Carbon Isotopes ; Carbon Tetrachloride ; Carbon Tetrachloride Poisoning ; Chemical and Drug Induced Liver Injury ; etiology ; physiopathology ; Liver Function Tests ; methods ; Male ; Phenylalanine ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo determine the stress distribution on endplate after lumbar prosthetic disc nucleus (PDN) replacement.

METHODSSix fresh lumbar vertebrae with normal Modic classification were harvested. The specimens were used to establish L4-5 intact, nucleotomy, prosthetic nucleus pulposus replacement models. Vertical compression tests were performed with MTS machine at the rate 50 N per second to maximum load of 1300 N. The stress under the endplate were measured directly with accurate pressure sensors.

RESULTSFor intact specimens, the stress on the endplate maintained higher in the central zone of the endplate, and decreased gradually to the periphery, and was well-distributed. After nucleotomy, the stress on the central zone of endplate was significantly decreased, and increased stress occurred in the periphery of endplate. After PDN replacement, the stress on the central zone of endplate was found more 15.1% higher than that in intact disc (P < 0.05), and the neighboring zone also showed higher stress measurements.

CONCLUSIONSAfter lumbar prosthetic disc nucleus replacement, the stress concentration on endplate may occur in the central zone of prosthetic disc nucleus insertion. Therefore, the prosthetic nucleus pulposus with suitable shape, proper biomechanical functions and updated materials need further study.

Adult ; Arthroplasty, Replacement ; Cartilage, Articular ; physiology ; Humans ; Intervertebral Disc ; surgery ; Joint Prosthesis ; Lumbar Vertebrae ; surgery ; Middle Aged ; Stress, Mechanical

Adult ; Female ; Femoral Fractures ; diagnostic imaging ; physiopathology ; surgery ; Fibula ; transplantation ; Humans ; Male ; Middle Aged ; Time Factors ; Tomography, X-Ray Computed ; Transplantation, Autologous

OBJECTIVETo evaluate the safety and efficacy between endoscopic papillary balloon dilatation (EPBD) and endoscopic sphincteropapillotomy ( EST) for common bile duct stones using meta-analysis method.

METHODSRandomizd controlled trials comparing EPBD with EST for common bile duct stones and published from January 1990 to July 2012 were recruited. This meta-analysis was conducted to estimate short-term and long-term complications. Fixed random effect model or random effect model was established to analyze the data.

RESULTSTwelve randomizd controlled trials were included in this analysis. These studies included 1865 patients, 925 of them were treated with EPBD and 940 were treated with EST. The analysis of basic characteristics of these included studies showed that: compared to EST, patients in the EPBD group were younger (OR = -1.16, 95% CI: -1.49 to -0.84, P = 0.00), while in two groups, there were no significant difference (P > 0.05) in gender proportion, average size of stones, number of gallstones, previous cholecystectomy, the number of merged duodenal diverticulum, common bile duct diameter, the total follow-up time. Also, compared to EST, the overall stone clearance in the EPBD group was lower (OR = 0.64, 95% CI: 0.42 to 0.96, P = 0.03), pancreatitis incidence was higher (OR = 2.67, 95% CI: 1.61 to 4.43, P = 0.00), incidence of bleeding (OR = 0.12, 95% CI: 0.04 to 0.34, P = 0.00), acute cholecystitis (OR= 0.39, 95% CI: 0.18 to 0.84, P = 0.02), total long-term complication rate (OR = 0.53, 95% CI: 0.36 to 0.77, P = 0.01), stone recurrence rate more than a year were lower (OR= 0.48, 95% CI: 0.26 to 0.90, P = 0.02). While in two groups, there were no significant difference (P > 0.05) in the stone removal on 1 '' attempt, the total near-term complications and acute cholangitis.

CONCLUSIONSOn the basis of lower rates of bleeding, EPBD seems to be preferred strategy over EST for endoscopic remove of common bile duct stones in patients who have coagulopathy. Although stone recurrence rate more than a year of EPBD is lower, but the overall stone clearance rate is lower and the risk of pancreatitis is higher than that of EST.

Dilatation ; Gallstones ; surgery ; Humans ; Postoperative Complications ; epidemiology ; Randomized Controlled Trials as Topic ; Sphincterotomy, Endoscopic ; Treatment Outcome

Objective To explore the clinical value of 99Tcm-MIBI G-MPI in patients diagnosed with myocardial bridging(MB) by CTA. Methods Forty-five patients with MB and 17 normal controls diagnosed by CTA(64 slices CT) were included. All patients underwent rest 99Tcm-MIBI G-MPI and 17 MB patients and 9 normal controls also underwent stress 99Tcm-MIBI G-MPI. Myocardial ischemia, function and wall motion were assessed. G-MPI results were compared with CTA results by χ2 test, Fisher exact test and t test. Results In patients with MB, the positive rate of abnormal perfusion by gated stress 99Tcm-MIBI G-MPI was 64.7% (11/17) and 41.2% (7/17) using quantitative analysis and visual evaluation respectively; while the data were 42.2% (19/45) and 22.2% (10/45) by rest G-MPI (P=0.035). The positive rate by rest G-MPI in MB patients was significant different among mural coronary arteries of different depths and different locations. By quantitative analysis of the stress G-MPI, the reversible, fixed, and mixed ischemia patients were 4 (35.3%), 6 (23.5%) and 1 (5.9%) respectively; the reversed, reversible and fixed abnormity of wall motion was found in 4 (23.5%), 4 (23.5%) and 2 (11.8%) patients respectively; the reversed, reversible and fixed wall thickening were found in 6 (35.3%), 5 (29.4%) and 1 (5.9%) patients respectively. There was no significant difference in left ventricular ejection fraction and peak filling rate between MB patients and normal controls in both rest and stress studies (t: from -0.564 to 1.292, all P>0.05). Conclusion The G-MPI may be useful for the evaluation of myocardial ischemia and myocardial function simultaneously in patients with MB.

OBJECTIVETo explore the diagnostic value of MRI in the transient dislocation of the patella.

METHODSThe DR and MRI data of 35 patients with acute patellar transient dislocation from January 2015 to December 2017 were retrospectively analyzed, including 12 males and 23 females, ranging in age from 10 to 23 years old, with an average of 17 years old. The differences between DR and MRI diagnosis and surgical or discharge diagnosis were compared, and the difference between them in diagnosis of knee anatomical position, bone injury, signs and soft tissue injury were compared. The R statistical software WiLcoxon signed rank test (WiLcoxon signed rank test) was used for statistical analysis.

RESULTSAll 35 MRI findings were completely consistent with postoperative or discharge diagnosis. According to MRI, 7 cases of high patella and 7 cases of patella subluxation were diagnosed. According to DR, 7 cases of high patella and 0 cases of patella subluxation were diagnosed. Fourteen dislocations were diagnosed by MRI and 7 dislocations were diagnosed by DR. There was statistically significant difference between the two methods in the diagnosis of abnormal position of patella(=10, <0.05). Total 112 cases of bone injuries were diagnosed by MRI, and 0 was diagnosed by DR. There was statistically significant difference between the two methods in the diagnosis of bone injuries(=16, <0.05). Total 43 cases of soft tissue injuries were diagnosed by MRI, and 0 was diagnosed by DR. There was statistically significant difference between the two methods in the diagnosis of soft tissue injuries (=21, <0.05). Total 35 cases of hydrops of the knee joint were diagnosed by MRI, and 30 were diagnosed by DR. There was statistically significant difference between the two methods in the diagnosis of hydrops of the knee joint(=32, >0.05).

CONCLUSIONSMRI is superior to DR in the diagnosis of acute temporal bone dislocation. MRI should be used as the first choice for imaging diagnosis of acute temporal bone dislocation. It can avoid missed diagnosis and misdiagnosis.

Objective To evaluate the clinical features and the strategy for the diagnosis and treat- ment of bilateral testicular tumor.Methods The clinical data (including the signs and symptoms,imaging studies,tumor markers,treatment modalities and histopatbologic diagnoses) of 10 cases of bilateral testicular tumor from January 1980 to December 2004 were reviewed.Their age ranged from 19 to 58 years(mean,34 years).Of the 10 cases,8 with metachronous and 2 with synchronous testicular tumors were identified.The clinical stages at the primary and secondary tumor diagnosis were:5 cases of stageⅠ,3 of stageⅡ;and 6 cases of stageⅠ,1 of stageⅡ,and 1 of stageⅢ,respectively,in 8 metachronous tumor patients.Two syn- chronous tumor patients were both identified as stageⅠdisease.Histological examination showed the primary tumor (seminoma) in 4 cases and the secondary contralateral tumor (seminoma) in 3.Results Two syn- chronous tumor patients underwent bilateral radical orchiectomy simultaneously,and 8 underwent orchiectomy successively.Retroperitoneal lymph node dissection was performed in 3 cases.Postoperatively,hypogonadism occurred in 10 patients,and 7 of them received androgen replacement therapy.Follow-up ranged from 9 month to 23 years with a mean of 10.5 years.Two patients died of the disease;2 had metastasis (1 of them was alive with metastasis);2 had recurrences and underwent local resection.Conclusions Metachronous bilateral testicular cancers are more common than synchronous bilateral testicular cancers.Seminoma was the most common histopathologic type.Testis-sparing surgery can be performed in selected cases.

Objective To explore the epileptogenic focus locating methods before and during operation and the curative effect of surgical treatment on the basis of localization. Methods Epileptogenic foci in 621 cases of intractable epilepsy were localized according to clinical manifestations and imaging findings by routine EEG (REEG), ambulatory EEG (AEEG) or video-EEG (VEEG).Different types of operations were performed based on the categories of epilepsy, the preoperatively localized foci and electrocorticogram (ECoG) monitoring results during operations. Results The follow-up ranging 0.5-4 years revealed, according to the criteria of International Antiepileptic Association,that 340 cases(54%)were completely recovered(no postoperative seizure),223 cases(36%)were improved obviously (seizure frequency was decreased by more than 75%), 37 cases (6%) were improved a little(seizure frequency was decreased by 50%-75%)and 21(3%)were not improved(seizure frequency was decreased by less than 50%): the effective rdte was 97%.No case worsened.Conclusions Preoperative integrated localization by EEG principally and intraoperative ECoG monitoring can effectively confirm the site and size of epileptogenic foci to instruct the operation and prevent complications so that the satisfactory treatment efficacy can be achieved.

The purpose of the present study was to investigate whether the antipyretic effect of dexamethasone (DEX) delivered by intravenous injection (iv) on intracerebroventricularly (icv) administered egtazic acid-induced febrile response is relevant to the changes in cytosolic free calcium concentration of the hypothalamus. The colon temperatures were measured by a thermistor and the cytosolic free calcium concentration ([Ca2+]i) in dissociated brain cells was measured by Fura 2-AM. The results demonstrated that the pyretic action of egtazic acid (0.6 μmol, icv) was markedly inhibited by DEX (5 mg/kg,iv), but DEX (60～120 μmol/L) did′t affect [Ca2+]i in dissociated hypothalamus cells. Actinomycin D, which interferes with gene transcription (3 nmol, icv), completely abolished the antipyretic action of DEX on egtazic acid-induced fever. These findings suggest that the antipyretic action of DEX on egtazic acid-induced fever is related to the activation of certain gene expression in the brain,but not to the changes of transmembrane calcium ion current in hypothalamus neurons.