Objective To investigate clinical manifestations,histopathological features and treatment of ulcerative colitis (UC) complicated by pyoderma gangrenosum (PG).Methods Data on clinical manifestations,auxiliary examination findings,treatment and prognosis were collected from 8 inpatients with UC complicated by PG in Peking Union Medical College Hospital between July 2009 and July 2016,and analyzed retrospectively.Results Of the 8 cases,5 were male,and 3 were female.Theaverage age of onset was 30.6 years and 35.1 years in males and females respectively.All the patients developed intestinal symptoms of UC before the onset of PG with an average time interval of 5 years.Moreover,all the patients had active total colonic type UC at the onset of PG,including 6 with moderately active UC and 2 with mildly active UC.PG manifested as painful ulcers in 8 patients,and affected lower limbs in 7 patients.Histopathological examination of skin lesions showed typical characteristics of vasculitis in 5 patients.Five patients were complicated by arthralgia.All the patients were treated with glucocorticoids and 5-aminosalicylic acid agents as the basic therapy,3 patients received extra treatment with immunosuppressive agents or minocycline,and 2 with infliximab.Conclusions PG is a severe skin manifestation of UC,commonly occurs in patients with total colonic type UC in the active stage,and mostly affects the lower limbs,with typical histopathological features of vasculitis.

Objective To investigate the clinical value of computer-assisted operation planning system for precise hepatectomy.Methods The clinical data of 45 patients who had undergone precise hepatectomy at General Hospital of PLA from November 2006 to November 2009 were retrospectively analyzed.The 3-dimensional imaging of liver was constructed by computer-assisted operation planning system,and the anatomic relationship between hepatic vasculature and tumor Was analyzed.Volume of hepatic segments,total liver volume,tumor volume,predicted resection volume and the remnant liver volume were calculated before operation.Virtual liver resection was performed in order to select the best operative procedure.The predicted resection volume Was compared with the hepatic segment resected.All data were analyzed by t test,Pearson rank correlation analysis and chi-square test.Results The predicted resection volume calculated based on the 2-dimensional imaging was similar to that calculated based on the 3-dimensional imaging(t=2.125,P>0.05).The three-grade branches of the hepatic artery,portal vein and hepatic vein were clearly shown in the computer-assisted operation planning system.The anatomic relationship between tumor and adjacent vessels was quantitatively analyzed.There was a positive correlation between the predicted resection volume and the resected liver volume(r=0.999,P<0.05),and the error rate Was 5.1%.All patients received anatomical hepatectomy,and the incidence of postoperative complications was 20%(9/45).No liver failure or perioperative mortality was observed.Conclusion Computer-assisted operation planning system may facilitate and promote precise hepatectomy.

Objective To determine the genotypes and their epidermiology of microlide, lincosamide and streptogramin B(MLS_B)resistant S.epidermidis isolates causing nosocomial infection.Method 126 isolates were collected from inpatients in three hospitals in Beijing from 2003-2004 for testing the antibiotic susceptibility to the macrolide erythromycin,the lincosamide clindamycin.The resistance phenotypes of erythromycin-resistant isolates were determined by the double-disc test with erythromycin and clindamycin.The presence of the relative genes(ermA,ermB,ermC and msrA)to MLS_B resistance was identified by PCR and the similarity of the isolates was analyzed by PFGE.Result The isolates were mostly resistant to macrolide and lincosamide.In the constitutive phenotype cMLS_B isolates,the methicillin resistant S.epidermidis(MRSE)proportion appeared high(78.5%),whereas high methicillin susceptible S.epidermidis(MSSE)proportion was found in the inducible MLS_B phenotype(iMLS_B) (69.2%).ermC was shown as the most frequent determinant to the resistance,not only in MRSE and MSSE (70.8% and 6.8%),but also in iMLS_B and cMLS_B(76.9% and 90.3%).No specific endemic strain was found by PFGE analysis.The same resistance phenotype pattern was not clustered together and distributed into type A～F at the similarity of 60%.Among the phenotypes(cMLS_B,iMLS_B and MS phenotype),no significant difference was shown in the PFGE genotype distribution.Conclusion Our results indicate that the MLS_B resistance in S.epidermidis causing nosocomial infection is prevalent in the hospital and MLS_B antibiotics should be used iudiciously,ermC was shown as the most frequent determinant to the resistance.

To determine the relationship between the intercellular adhesion operon (ica) and the biofilm production in Staphylococcus epidennidis isolates from nosocomial infection, and the affection of ica on the antibiotic susceptibility of the isolates, we collected 106 strains, epidermidis isolates from nosocomial infection specimen to detect their biofilm production by quantitative and qualitative method and investigate the existence of ica operon by PCR. The minimal inhibitory concentration (MIC) to erythromycin, ampicillin, cefoxitin, ceftriaxone, teco-planin, ciprofloxacin, tetracycline, trimethoprim-sulfamethoxazole and vancomycin were tested. Among the isolates, 33 (31. 1% ) of them were detected out carrying ica operon. The rate of biofilm production of the ica-posi-tive isolates was higher than that of the ica-negative (P =0. 001) . By adding glucose and NaCl into the culture the detection rate of biofilm production could be increased. The antibiotic susceptibility of the plankton cells of ica-positive isolates to erythromycin, cefoxitin and ceftriaxone , except ampicillin, ciprofloxacin, tetracycline and tremethoprim-sulfamethoxazole, were lower than those of ica-negative isolates. This study showed that the existence of ica operon was close related to the biofilm formation in 5. epidermidis isolates from nosocomial infection. However, the mechanism of antibiotic resistance of the strains inside the biofilm still needed to be illustrated.

Objective To investigate the acute side effect of 3D printing individual non-coplanar template for 125I seed implantation in head and neck recurrent/ metastatic carcinoma.Methods Between January 2016 and December 2016,42 patients of local recurrent malignant tumor of head and neck received 3D printing guide plate assist radioactive seeds implantations,and included in the study.The tumor volume ranged from 2.4 to 102.8 cm3 (median 28.6 cm3).The prescribed dose is 110-160 Gy,and the seeds activity were 0.34 to 0.70 mCi (1 Ci =3.7 × 1010 Bq).All patients carried out preoperative planning design,individual guide plate production,seed implantation,postoperative dose assessment,and followup.The side effects of skin,mucous membrane,blood and spinal cord were statistically analyzed.Results All patients were operated successfully.The follow-up time was 4-14 months (median 8.5 months).There were no adverse reactions at grade three or above.Three patients had grade one skin reaction.One patient experienced grade one mucosal reaction,two experienced grade two mucosal reactions.The skin response was correlated with the dose of the skin (x2 =7.067,P =0.032).No hematologic toxicity or radiation myelopathy was observed and no seed displacement was found.Conclusions 3D-printing guide plate can provide good accuracy for positioning and direction.For local recurrent malignant tumor of head and neck,there were no obvious adverse reactions and the operation was simple and the dosage was accurate.

Objective To report the clinical effect of free transplanting for soft tissue defects pedieled with high site cutaneous branches of the transverse branch of lateral cirumflex femoral artery.Methods Cu- taneous branches of the descending branch of lateral circumflex femoral artery were found small or abscent in 7 patients.The anterolateral femoral skin flap was pedicled with high site cutaneous branches of the transverse branch to repair the soft tissue defects of the arm,hand,leg and foot,rather than with the descending ones. The size of the flap ranged from 15 cm?6 cm to 28 cm?13 cm,with part muscle valve,iliotibal tract and lat- eral femoral cutaneous nerve.The fractures were performed with internal or external fixation.Results All of the anterolateral femoral skin flap survived well postoperatively in the 7 cases and had good appearance and sensation at one stage.The function of the repaired extremities recovered well.Conclusion The anterolat- eral femoral skin flap pedicled with high site cutaneous branches of the transuvrse branch of lateral circumflex femoral artery has many advantages of good blood supply and large size.The flap was secluding,and can be taken with some muscle and lateral femoral cutaneous nerve.When cutaneous branches of the descending branch of lateral circumflex femoral artery is small or abscent,the anterolateral femoral skin flap with high site cutaneous branches of the transverse branch of lateral circumflex femoral artery is an optimal alternative.

Objective To study the effects of ibuprofen on the growth and development of oligodendrocytes. Methods A total of 6 clean and healthy adult female SD (Sprague Dawley) rats were used for extracting and culturing of oligodendrocytes(OLs).Lysophosphatidic acid(LPA)was then added,and the morphological changes of OLs pre-treatment and post-treatment were observed. Then 6 newborn rats (born 24-48 h) were used for mixed glial cell extraction from the cortex, then the OPCs were inoculated into the culture plates and randomly divided into control group, ibuprofen group, lysophosphatidic acid(LPA)group and LPA+ibuprofen group.After the adhering of the cells in each group for three days, cell morphology was observed,and the drugs were added as interventions.The control group was treated with normal saline, and the other 3 groups were added with saline solution of ibuprofen(100 μmol/L),LPA(1.0 μmol/L)and the mixture of them. The cell morphological changes were observed after 7-day intervention.The morphology of OPCs and OLs were observed by immunofluorescence staining through OPCs'specific immune markers (platelet-derived growth factor receptor alpha, PDGFR-α)and OLs'specific immune markers(myelin basic protein,MBP)along with cell count of mature OLs.Western blot assay was used to detect the relative expression level of MBP in each group. Results After the treatment with LPA to the mature OLs,protrusions were shrinking and became very sparse.The morphology of cells developed well in each group after cell adhering for 3 days. After drug intervention for 7 days, more cell protrusions and branches were observed in ibuprofen group and LPA+ibuprofen group than those of the control group and LPA group.The results of cell count showed that the number of MBP positive cells was significantly higher in the ibuprofen group and LPA+ibuprofen group than that in the control group and LPA group(P<0.01).The results of Western blot assay showed that the MBP protein expression was significantly less in LPA group than the other three groups (P<0.01), and the expression was significantly higher in the ibuprofen group than that of LPA+ibuprofen group (P<0.01). Conclusion LPA has a toxic effect on the growth and development of OPCs, and it has an inhibitory effect on the normal growth of mature OLs. A certain concentration of ibuprofen can significantly inhibit the cytotoxicity of LPA on OPCs and OLs,and promote the formation and maintenance of mature OLs.

BACKGROUNDThe expanded endonasal approach (EEA) is used sparingly by surgeons for resection of lesions in the ventrocranial base. Herein, we examined the anatomy of the ventrocranial base by endoscopy and comment on the use of EEA in clinical practice.

METHODSTwenty artery-injected adult cadaveric heads were studied under surgical conditions using the endoscopic EEA. The extent of the surgical exposure, the endoscopic anatomic view and the maneuverability of surgical instruments about the suprasellar region were studied by the endoscopic EEA.

RESULTSThe EEA by endoscope can reach the suprasellar region. In this approach, the optocarotid recess, supra and infra-optic chiasm interspace, the ophthalmic artery and others were important anatomical landmarks for identification of the suprasellar region.

CONCLUSIONSThe endoscopic EEA can be used to remove many types of lesions in the ventrocranial base. The microanatomy observed using the endoscope provides important anatomical information on the suprasellar region for neurosurgeons.

Endoscopy ; Humans ; Nasal Cavity ; anatomy & histology ; Sphenoid Sinus ; anatomy & histology

Aged ; Female ; Humans ; Hypertriglyceridemia ; blood ; epidemiology ; Male ; Middle Aged ; Prevalence ; Uric Acid ; blood

OBJECTIVETo demonstrate the ablation of segmental glissonian pedicle by ultrasound-guided radiofrequency in precision liver resection in porcine model.

METHODSThe study was carried out on 6 Bama miniature pigs. Coagulative desiccation of the vessels feeding the segment to be resected was induced by introduction of a "cooled-tip" radiofrequency electrode under intraoperative ultrasound guidance at the level of the vessels. Then, an area of marked discoloration on the surface of the liver became obvious. Liver parenchymal transection followed without any form of hepatic inflow occlusion. Three segments (segment 3, 5, and 6) were resected on each pig. The criteria studied the local and general tolerance, the change of blood flow parameters of each segmental arterial and portal branches, and the microscopic appearance of the segmental arterial, portal and biliary tract branches. Using t test as the statistical methods.

RESULTSPostoperative mortality and morbidity were 0 and all serum parameters had normalized by 14 days. Demarcation area was obtained in 15 segments. The flow rate of the resected segmental portal branches was 0 cm/s after radiofrequency and the value of the arterial branches was (28 ± 18) cm/s which was significantly lower than pre-radiofrequency, which were (10.2 ± 3.0) cm/s and (60 ± 17) cm/s (t = 14.439, 5.502; P = 0.000). There was no significant difference in the flow rate of the remnant segmental arterial and portal branches among pre-radiofrequency, post-radiofrequency and 14 days after operation. On microscopic observation, the mean ablated length of segmental portal, arterial and biliary tract branches were (1.6 ± 0.4) cm, (1.2 ± 0.4) cm, and (1.7 ± 0.3) cm respectively.

CONCLUSIONSThe ablation of the segmental glissonian pedicle by ultrasound-guided radiofrequency is quick, safe and effective. The probe needs to be away from vessels feeding segments 1.5 cm at least to avoid thermal injuries.

Animals ; Catheter Ablation ; methods ; Female ; Hepatectomy ; methods ; Male ; Swine ; Swine, Miniature ; Ultrasonography