OBJECTIVETo explore the incidence, degree, and pattern of rib cartilage calcification in congenital microtia patients, in order to provide reference for harvesting the rib cartilage, sculpturing cartilage framework.

METHODSFrom Jun. 2013 to Nov. 2014, 383 patients (age range, 6-45 years) underwent CT scans of the chest. 11 patients with bony diseases or traumatic history were excluded. The remaining 372 patients were divided by age into four groups as 6-15, 16-25, 26-35, 36-45 years old. Twenty patients (10 male and 10 female) were selected by the order of patient identification number in each age group, thus selecting a total of 80 patients (40 male and 40 female). Retrospective study of CT scans of the chest in 80 patients and the incidence, degree, and pattern of cartilage calcification of the sixth to eighth ribs were noted. A chi-square test is conducted to test whether there are significant difference between the variables through the SPSS 19.0 software.

RESULTSOverall, 40.4% (194/480) cartilage was calcified; female patients (47.50%, 114/240) showed higher frequency of calcification than male patients (33.33%, 80/240, P = 0. 025). Calcification rates of all age groups are 1.7% (2/120), 46.7% (56/ 120), 49.2% (59/120), 64.2% (77/120). Calcification rate of 6-15 years group is lowest in all groups (P < 0.05) while other three groups have no statistical significance (P > 0.05). Calcification rates of the sixth and sevent rib cartilage were higher than those of the eighth rib cartilage in all age groups except 6-15 years group, who had a similar rate of all three ribs. Calcification rate of all three rib cartilage was significantly increased with age. Calcification rates of the amle's rib cartilage and the female's in all age groups are 3.3% (2/60) and 0.0% (0/60) (6-15 years): 33.3% (20/60) and 60.0% (36/60) (16-25 years): 40.0% (24/60) and 58.3% (35/60) (26-35 years), 56.7% (34/60) and 71.2% (43/60) (36-45 years). In 6-15 years group calcification rates of male and female had a similar rate, while female's rates were higher than male's rates in other three groups. Male and females mainly had the granular type of calcification [70.0% (56/80), 63.2% (72/114)].

CONCLUSIONSFemales who are over 16 years old should pay more attention to the possibility of middle-severe calcification before harvesting rib cartilage. These patients should take CT examination if necessary. In addition, the patients who had previous operation, or traumatic history, rib deformity, or spine deformity should select the CT examination.

Adolescent ; Adult ; Age Factors ; Calcinosis ; diagnostic imaging ; epidemiology ; Cartilage Diseases ; diagnostic imaging ; epidemiology ; Child ; Congenital Microtia ; Costal Cartilage ; diagnostic imaging ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Retrospective Studies ; Sex Factors ; Tomography, X-Ray Computed

Domestic and overseas studies onthe prominent eartreatment were reviewed and analyzed.Current progress of clinical therapy for prominent ear was summarized.The uniform clinical diagnosis and therapy of prominent earhave not been determined, due to its complicated and various therapeutic methods and unclear etiology. Reported therapies mainly include: (1)surgical therapy, which attains satisfactory therapeutic effect by adopting improved approaches, i. e. the combination of operations or the innovative methods based on Mustarde′s, Sterstrom′s and Converse′s surgical methods. (2)Non-surgical therapy, including ear splinting or molding, and laser-assisted cartilage reshaping(LACR). The non-surgical therapyisa hot research field, and is going to bepopularizedin the future.Research of etiology and non-surgical treatments may be helpful to provide abetter therapy strategy for prominent ear.

Objective To investigate the clinical efficacy and safety of carotid endarterectomy (CEA)and carotid artery stenting(CAS)for the treatment of carotid artery stenosis in the elderly.Methods Clinical data of 116 elderly patients aged over 65 years with carotid artery stenosis were retrospectively analyzed.Of 116 patients,73 patients underwent CAS(the CAS group) and 32 received CEA(the CEA group).The success rate,30-day perioperative complications and follow-up results were compared between the two groups.Results There was no significant difference in the success rate (96.8％ vs.100.0％,P ＞ 0.05),30-day perioperative complications,such as bradycardia (6.25％ vs.4.5％,x2 =0.228,P=0.663),acute myocardial infarction(0.0 vs.1.4％,x2 =0.432,P=0.511),transient hypotension(6.3％ vs.8.1％,x2 =0.114,P =0.735),ischemic stroke(6.3％ vs.6.8％,x2 =0.009,P =0.923),and cerebral hyperperfusion syndrome (18.8 ％ vs.10.8％,x2 =0.009,P =0.923),between the CEA and CAS groups.The incidence of persistent hypotension was lower in the CEA group than in the CAS group(3.1％ vs.17.6％,x2 =4.398,P=0.036).No significant difference was found in carotid artery restenosis(moderate:6.3％ vs.8.1％,x2 =0.114,P =0.735;severe:3.1 ％ vs.2.7％,x2=0.014,P=0.905)and ipsilateral stroke(3.1％ vs.5.4％,x2 =0.279,P=0.598)between the CEA and CAS groups at one-year fellow-up.Conclusions Both CEA and CAS have good effieacies in treating carotid artery stenosis in the elderly,while the incidence of persistent hypotension is higher with CAS than with CEA.

Objective To assess whether pregnancy affects the survival of pregnancy-associated breast cancer (PABC), compared with non-PABC. Methods We retrospectively analyzed the data of PABC patients.PABC cases and non-PABC cases were matched with 1:2 according to T stage, molecular classification, age of onset and year of diagnosis.The Kaplan-Meier method was used to estimate DFS and OS, and Log rank test was used for comparison.Cox regression analysis was used to evaluate the risk factors that affect the prognosis of PABC. Results We enrolled 35 patients in the PABC group (pregnancy: 10;postpartum: 25), and 70 patients in the non-PABC group.The median follow-up time was 68.5 and 70.7 months, respectively.The 5-year DFS was 51.6% in the PABC group, and that of the non-PABC group was 72.8%(χ²=4.72, P=0.029);the 5-year OS of the PABC group and the non-PABC group were similar (χ²=1.769, P=0.183).Cox regression analysis showed that pregnancy was an independent risk factor for DFS of PABC patients (P=0.011). Conclusion Patients with breast cancer during pregnancy have a higher risk of recurrence.Further research is necessary to diagnose pregnancy-associated breast cancer earlier and adopt measures to improve the curative effect.

Objective:To investigate the effect of regional cerebral oxygen saturation (rSO 2) combined with neurophysiological blood pressure monitoring on brain protection and myocardial protection during carotid endarterectomy (CEA) in patients with carotid stenosis and coronary heart disease. Methods:One hundred patients with carotid artery stenosis complicated with coronary heart disease treated in Jinhua Central Hospital from June 2021 to June 2022 were randomly divided into control group and experimental group. All patients were scheduled to undergo CEA. Fifty patients in the control group were administered with empirically increasing basic blood pressure by 20% - 30%, and 50 patients in the experimental group were administered with blood pressure under the guidance of rSO 2 combined with motor evoked potentials (MEPs) and somatosensory evoked potentials (EPS). The neurological function indexes of the two groups [neuron specific enolase (NSE), central nerve specific protein (S100-β)], myocardial function indicators [cardiac troponin I (cTnI), B-type natriuretic peptide (BNP)], clinical indicators (eye opening time, extubation time, recovery room stay time, hospital stay) and the incidence of postoperative complications [delirium (POD), cognitive dysfunction (POCD), neurological impairment] were compard between the two groups. Results:Two sets of postoperative NSE and S100-β both increased ( P<0.05), but NSE and S100 in the experimental group after surgery were lower than those in the control group: (0.82 ± 0.14) μg/L vs. (1.18 ± 0.28) μg/L, (290.13 ± 27.25) mg/L vs. (301.98 ± 28.56) mg/L, the differences were statistically significant ( P<0.05). After surgery, cTnI and BNP increased in both groups ( P<0.05), but the cTnI and BNP in the experimental group were lower than those in the control group: (2.87 ± 0.74)] μg/L vs. (3.36 ± 0.83) μg/L, (3.01 ± 0.85) μg/L vs. (3.89 ± 0.92) μg/L, the differences were statistically significant ( P<0.05). The opening time, extubation time, recovery room stay time, and hospitalization time in the experimental group were shorter than those in the control group: (16.79 ± 3.15) min vs. (20.55 ± 3.83) min, (29.38 ± 4.66) min vs. (40.14 ± 4.57) min, (66.82 ± 15.80) min vs. (89.35 ± 24.78) min, (11.24 ± 4.89) d vs. (14.56 ± 6.74) d, there were statistical differences ( P<0.05). The incidence of postoperative complications in the experimental group was lower than that in the control group: 12.00% (6/50) vs. 28.00% (14/50), there was statistical difference ( P<0.05). Conclusions:The application of rSO 2 combined with neurophysiological blood pressure monitoring in CEA of patients with carotid artery stenosis and coronary heart disease has a good effect, which has brain protection and myocardial protection, can shorten the recovery time of anesthesia and hospitalization time, and reduce the incidence of postoperative complications.

Objective To observe the effects of carotid artery stenting (CAS) on ophthalmic artery blood flow in patients with ischemic ophthalmopathy (IOP).Methods A prospective case-control study.Sixty IOP patients (60 eyes) who met inclusive criteria for CAS were enrolled in this study.There was 50％ stenosis of internal carotid artery on one side at least confirmed by color doppler flow imaging (CDFI).Among 60 eyes,there were 3 eyes with central retinal artery occlusion,15 eyes with retinal vein occlusion,37 eyes with ischemic optic neuropathy,5 eyes with ocular ischemia syndrome.The patients were randomly divided into CAS group (32 eyes of 32 patients) and medicine therapy group (28 eyes of 28 patients).The difference of age (t=1.804) and sex (x2=1.975) between two groups was not significant (P＞0.05).The examinations of fundus fluorescein angiography (FFA),CDFI and digital substraction angiography (DSA) were performed before,1 week and 6 months after treatment.The following parameters were recorded:arm-retinal circulation time (A-Rct),peak systolic velocity (PSV),end-diastolic velocity (EDV),and resistance index (RI) in the ophthalmic artery (OA) and central retinal artery (CRA),and the best corrected visual acuity (BCVA).Results There was no significant differences in A-Rct (t=1.354) and BCVA (t=0.376) between the two groups before treatment (P＞0.05).Also,there was no significant differences in PSV (t=-0.294,-2.446),EDV (t=0.141,-0.305),and RI (t=-0.222,-0.694) of OA and CRA between the two groups before treatment before treatment (P＞0.05).Compared with the medicine therapy group,the lower A-Rct was found in the CAS group at different time points after the treatment.The difference was significant on 1 week after treatment (t=-3.205,P＜0.05),but not on 6 months after treatment (t=1.345,P＞0.05).The BCVA of eyes in the two groups were increasing with the extending of time of therapy.Compared with the medicine therapy group,the better BCVA was found in the CAS group at different time points after the treatment (t=0.800,1.527;P＜0.05).Compared with the medicine therapy group,the higher PSV,EDV and lower RI of OA and CRA were found in the CAS group at different time points after the treatment.(P＜0.05).Conclusion Compared with conventional medicine therapy,CAS shows earlier effects in improving ocular hemodynamics for IOP patients with carotid artery stenosis,which benefits visual function improvement of the patients.

Objective To study the influence of sequential and contemporaneous revascularizations of portal vein and hepatic artery during liver transplantation with retrograde reperfusion on the ultra-structural changes in intrahepatic cholangiocytes of the graft with liver ischernia reperfusion injury,and the recovery of short-term liver function after operation.Methods The clinical data of 97 patients who underwent orthotopic liver transplantation (OLT) using retrograde reperfusion via the vena cava (IVC) in our hospital from January,2009 to June,2013 were retrospectively analyzed.Using to the different sequences of revascularization,97 digible patients were divided into three groups:group R-IPR:the initial arterial revascularization group (35 patients);group R-IAR:the initial portal revascularization group (30 patients);group R-SAPR:simultaneous reperfusion group (32 patients).Liver function,coagulation function and other related parameters were continuously monitored for the transplant recipients at the following time points:1 day before operation,2 hours after reperfusion and on postoperative Day 1,2,5 and 7.The ultra-structure of intrahepatic bile duct epithelial cells at 2 hours after reperfusion were studied by transmission electron microscopy and morphometric analysis of mitochondria was performed by the computer image analysis system.Results The levels of ALT,GGT and TB in group R-IAR were significantly lower than those in group R-IPR and group R-SAPR (P＜0.05).There were no significant differences among the three groups in other parameters that reflected liver function at any time point (P＞0.05).In group R-IAR and group R-IPR,mitochondrial swelling of bile duct epithelial cells was more severe than that in group R-SAPR.There were significant differences among the three groups in the mitochondrial average area and the average perimeter (P＜0.05).Mild swelling of mitochondria in hepatic cells was observed in group R-IAR and group R-IPR.There was no significant difference in the mitochondrial average area and average perimeter between the two groups (P＞0.05).Mitochondrial swelling of hepatic cells was most severe in group R-SAPR.There were significant differences in the average area and average perimeter of hepatic cell mitochondria between group R-SAPR and the other two groups (P＜0.05).Conclusion During liver transplantation with retrograde reperfusion,initial arterial revascularization reduced the short-term levels of transaminases,improved early liver function after operation and protected the intrahepatic bile duct against the second ischemia reperfusion injury.

OBJECTIVETo investigate the application value of extracorporeal shock wave to repair and reconstruct osseous tissue for the treatment of avascular necrosis of the femoral head (ANFH).

METHODSA total of 42 hips of 36 patients with ANFH were treated with extracorporeal shock waves included 29 males and 7 females,aged from 21 to 66 during March 2006 to March 2008. The course of disease was 6 months to 3 years (means 1.3 years). According to Ficat classification 8 hips were in stages I, 25 were in stage II, and 9 were in stage III. The energy density of ESWT was from 0.18 to 0.25 mJ/mm2. The treatment focusing points of avascular necrosis of the femoral on the surface projection were marked with X-ray fluoroscopy, and 1 to 2 points were selected for one treatment with 400 to 500 pulses in each point. Generally 3 to 5 treatments were performed, once per 7 days. The CR, CT or MRI and the hip Harris score were obtained to investigate the clinical effects of extracorporeal shock wave for repair and reconstruct osseous tissue framework and improve the hip function before treatment and at 3, 12 months after treatment.

RESULTSThe X-ray,CT or MR were performed of 42 hips,35 hips were treated successfully after extracorporeal shock wave therapy, cure occurred in 6 cases, marked effect in 13 cases, effectiveness in 16 cases and ineffectiveness in 7 case. After one years of followed-up, no relapse was found, the femoral head further collapse did not occur. The Harris hip score of stage I, II, III ere respectivey (90.1 +/- .4), (81.2 +/- .5), (66.9 +/- .6) at 3 months and (91.6 +/- .4), (91.1 +/- .5), (79.0 +/- .1) at 12 months after treatment. The scores after treatment were increased significantly than that of before treatment (P < 0.01).

CONCLUSIONExtracorporeal shock wave therapy has obviously therapeutic effect in the repairing and reconstructing osseous tissue and improve the hip Harris score and improve the hip function. It is a effect significantly, non-invasion, less complications, simple-accurate therapy method for ischemic necrosis of the femoral head.

Adult ; Aged ; Female ; Femur Head Necrosis ; diagnosis ; physiopathology ; radiotherapy ; therapy ; High-Energy Shock Waves ; Hip Joint ; physiopathology ; radiation effects ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Young Adult

The etiology of constricted ear malformation is unknown, while the clinical manifestations are diverse and the classification is complex. At present, there is no estabolished standard for the management of constricted ear. In addition to the conventional operations, some new surgical procedures have achieved ideal clinical outcomes. In this review, current surgical method for the correction of constricted ear were summarized according to the different clinical characteristics. The author hopes it provides reference for the optimal selection of surgical procedures.

The etiology of constricted ear malformation is unknown, while the clinical manifestations are diverse and the classification is complex. At present, there is no estabolished standard for the management of constricted ear. In addition to the conventional operations, some new surgical procedures have achieved ideal clinical outcomes. In this review, current surgical method for the correction of constricted ear were summarized according to the different clinical characteristics. The author hopes it provides reference for the optimal selection of surgical procedures.