Forensic Medicine ; Humans ; Kidney Transplantation ; Polycystic Kidney Diseases

Objective To evaluate the surgical approaches and therapeutic effect of lymphatic malformations located in head and neck in children. Methods Eleven cases of lymphatic malformations in the region of head and neck in children encountered between Jan. 1998 and Dec. 2008 in Peking University First Hospital were retrospectively analyzed. Initial diagnosis was made based on the physical examination and then confirmed by MR and Enhanced CT imaging. Surgical therapy was used for patients with lymphatic malformation which exceeds 4 cm. The operative technique was as follows: mass resection and superficial parotidectomy (4 cases), mass resection and total parotidectomy (2 cases), mass resection with neck dissection (2 cases), mass resection with neck dissection and sternotomy (1 case), marginal mandibular branch of facial nerve dissection and mass resection (2 cases). Dissection outside the false capsule was applied during the operation and facial nerve was dissected from bole to terminal arborization. Results The mass was completely removed in all 11 cases without organ dysfunction and obvious dysfigurement. The cure rate was 100%. Three cases suffered from a branch of facial nerve paralysis because of tension and 1 case had a Homer's syndrome after operation. One ease needed a blood transfusion (150 ml ) during the operation. All cases have been followed up with excellent results from 6 to 121 months, 32 months of the median, no mass recurrence. Conclusions Dissection outside the false capsule of mass and dissection of facial nerve were applied in the surgical treatment of huge lymphatic malformations. These methods are effective in the preservation of function and avoidance of abnormality.

OBJECTIVETo explore why sentinel lymph node biopsies (SLNB) produce false negative results in breast cancer patients by studying the anatomical origin of sentinel lymphatic channels (SLCs), as well as the relationship between SLCs and sentinel lymph node (SLN).

METHODSSixty-two breast cancer patients consenting to modified radical mastectomies were marked by exit angle (theta(e)) preoperatively and were injected with 3 ml of methylene blue (MB) into the inner edge of the areolae under general anesthesia. SLCs were carefully dissected to retain connections between the areolae and SLN to define the direction, route and number of SLCs and their relationship with the SLN.

RESULTSSLCs and SLN were identified in 52 cases (83.87%) successfully. In 49 of these 52 cases (94.23%) the SLCs exited from the areolae and terminated in axilla with an theta(e) = 31 degrees - 90 degrees , and in 36 of 52 cases (69.23%) with an theta(e) = 61 degrees - 90 degrees . The majority of the time, one SLN was identified (92.31%, n = 48) with two identified SLNs occurring only 7.69% (n = 4) of the time. There were three patterns of connectivity: 1) Two SLCs could connect to one SLN separately; 2) One SLC could divide into several branches before or after entering axilla, which ultimately connected to one SLN; or 3) One SLC could divide into two branches before entering axilla, which connected to one SLN separately and these two SLNs could be located in different parts of axilla. No false negative or false positive was demonstrated by pathological analysis of SLN which was identified according to SLCs.

CONCLUSIONSNo evidence showed that the mechanism of axillary lymph node metastasis is skip metastasis. We conclude that false negative results from SLNB seems to be associated with the technique used, which may be caused by the incomplete knowledge of the anatomical relationship between SLCs and SLN.

Adult ; Aged ; Breast Neoplasms ; pathology ; False Negative Reactions ; Female ; Humans ; Lymphatic Metastasis ; Lymphatic System ; pathology ; Methylene Blue ; Middle Aged ; Sentinel Lymph Node Biopsy

OBJECTIVEAn improved water-fat separation method based on region-growing was proposed for use in regions with low signal-noise ratio (SNR).

METHODSRegion-growing method was applied to 4 sub-images acquired by a down- sampling operation on the acquired phasor maps. The spatial smoothing constraint was exploited to calculate 4 error phasor maps to construct the final smooth error phasor map, which was used in two-point Dixon technique for water-fat separation.

RESULTSThe simulation experiment showed that the proposed method produced smaller errors, and for clinical images of the knees, abdomen and lower limbs, the proposed method achieved accurate water-fat separations.

CONCLUSIONThe proposed method is more robust and reliable than the original global region-growing algorithm, and serves as a promising water-fat separation method for clinical applications.

Abdomen ; diagnostic imaging ; Adipose Tissue ; diagnostic imaging ; Algorithms ; Body Water ; Humans ; Image Enhancement ; Image Processing, Computer-Assisted ; Knee ; diagnostic imaging ; Magnetic Resonance Imaging

Objective To study the correlation between fractional anisotropy(FA)and tumor microarchitecture(MVD,VEGF and celluarity).Methods Fouteen gliomas(5 grade Ⅰ and Ⅱ,4 grade Ⅲ, 5 grade Ⅳ)confirmed histo-pathologically were performed on diffusion tensor imaging(DTI)using a GE Signa Excite Ⅱ 3.0 T MR scanner(8-channel head coil,SE echo planner imaging(EPI),thickness:5 mm, spacing:0,directions:25,B values:0 and 1000 s/mm~2,TR 6000 ms,TE minimum,FOV:240 mm? 240 mm,image matrix 128?128,NEX 2).Postprocessing was done using a DTI specific software to gain FA image.ROIs were drqwn in tumor parenchyma and the value of FA was recorded.The positive expression of VEGF and CD34 was shown using immuno-histochemistry method.The VEGF,MVD,and cellularity of every slices were recorded.Pearson correlation analysis was used.Results FA(which is 0.102?0.080 in grade Ⅰ and Ⅱ,0.171?0.037 in grade Ⅲ,0.200?0.021 in grade Ⅳ)has the trend to raise with the increasing grade of astrocytomas.FA has significant positive correlation to MVD(40/HP in grade Ⅰ and Ⅱ, 86/HP in grade Ⅲ,101/HP in grade Ⅳ),VEGF(8% in grade Ⅰ and Ⅱ,47% in grade Ⅲ,55% in grade Ⅳ),and cellularity(104/HP in grade Ⅰ and Ⅱ,160/HP in grade Ⅲ,265/HP in grade Ⅳ).The correlation coefficients between FA and VEGF,MVD,and cellularity were 0.748,0.668,0.625 respectively.Conclusion As a new imaging method,DTI can reveal the microarchitecture in gliomas and be value of distinguishing gliomas of different grade.DTI provides a new method of precise diagnosis to glioma preoperatively.

OBJECTIVETo explore therapeutic effects of emergency medial malleolus osteotomy for the treatment of fractures of talar neck and dislocation of talar body.

METHODSFrom 1995. 6 to 2007. 10, among 24 patients with fractures of talar neck and dislocation of talar body, 18 patients were male and 6 patients were female, ranging in age from 28 to 58 years (mean 35.4 years). The duration from injury to the emergency ward ranged from 0.5 to 12 h. All the patients were treated in 5 hours after hospitalization with emergency medial malleolus osteotomy and internal fixation. Firstly, osteotomy was made above the medial malleolus tip; Secondly, the medial malleolus was turned over downward to uncover the talus; Then, the fracture of talus can be reduced in direct visidn.

RESULTSAll the patients were followed up ranged from 6 to 60 months. According to Kenwright evaluation standards, 18 patients obtained an excellent results, 4 good and 2 fair.

CONCLUSIONIt is easy and clearly to perform medial malleolus osteotomy. The blood circulation of talus is preserved. So it is an effective method to treat the fractures of talar neck and dislocation of talar body.

Adult ; Bone Screws ; Female ; Fracture Fixation, Internal ; Fractures, Bone ; surgery ; Humans ; Male ; Middle Aged ; Osteotomy ; methods ; Talus ; injuries ; surgery ; Treatment Outcome

OBJECTIVETo observe the differentiation and distribution of epidermal stem cell (ESC) after skin soft tissue expansion, and to initially probe into the growth mechanism of expanded skin tissue.

METHODSSamples of normal skin and expanded skin (mean effusion period 45 days) were harvested from head and cervical region in 15 patients who underwent II stage surgery after skin expansion. Samples were divided into scalp adjacent to the center of expander group (expanded scalp, 3 cm from the vertical axis of the expander), scalp from lateral part of the expander group (expanded scalp, 5 - 7 cm lateral to the vertical axis of the expander), cervical skin expansion group, un-expanded scalp control group, and un-expanded cervical skin control group, according to the position of skin harvested. The tissue structure of skin in each group was observed with HE staining, and the differentiation and distribution characteristics of cytokeratin 19 (CK19) positive cells were observed with immunohistochemical staining.

RESULTSCompared with those in the un-expanded control groups, uneven, relatively thickened and obviously folded epidermis with more cell layers and cells with obvious aggregation close to the basal layer were observed in the expanded groups, but those cells were not well-arranged and the transition of polarity was not obvious. The continuity of CK19 positive cells in the basal layer of skin was observed in each of the expanded group with immunohistochemical staining, and positive cells increased obviously and arranged in multilayer in certain parts of basal layer. Clustered or dispersed CK19 positive cells were also observed outside the basal layer. No above-mentioned phenomenon was observed in the un-expanded control group.

CONCLUSIONSThe proliferation and differentiation of ESC with ectopic distribution may enhance the repair process after skin soft tissue expansion.

Cell Proliferation ; Dermis ; cytology ; Epidermis ; cytology ; Humans ; Stem Cells ; cytology ; Tissue Expansion ; Wound Healing

Objective:To evaluate the effects of different interaction modes on the rehabilitation outcomes of stroke patients, and to provide reference for caregivers to choose the best interaction mode according to the rehabilitation goals.Methods:Computerized search of Web of Science, PubMed, Cochrane Library, EMbase, CNKI, Wanfang Database, VIP Database, and China Biomedical Literature Database for randomized controlled trials (RCTs) of interaction modes to improve rehabilitation outcomes of stroke patients was performed from the year of database construction to January 8, 2024. Two researchers independently screened the literature according to inclusion and exclusion criteria, evaluated the risk of bias in the included studies, and extracted data from them. Stata16.0 was used for a network meta-analysis.Results:A total of 22 articles were included that met the inclusion and exclusion criteria, involving 2 404 patients and 5 interaction modes, namely Cox health behavior interaction mode, doctor-patient interaction mode, King interaction compliance mode, dual track interaction mode, and online interaction mode. The results of the network Meta-analysis showed that in terms of improving self-care ability, the King interaction model [ SMD(95% CI)=0.25(0.05-0.45)], the network interaction model [ SMD(95% CI)=0.27(0.07-0.48)], and the Cox health behavior interaction model [ SMD(95% CI)=0.37(0.07-0.67)] were all superior to conventional nursing (all P<0.05). In terms of improving motor function, except for the dual track interactive mode, all other modes were superior to conventional nursing ( SMD values were -0.52--0.30, all P<0.05). There was no statistically significant difference in the application effects of different modes in improving the quality of life (all P>0.05). The ranking results of the area under the cumulative ranking probability curve (SUCRA) for improving self-care ability, motor fuction and quality of life were Cox health behavior interaction mode (SUCRA=83.7%), doctor-patient interaction mode (SUCRA=89.5%) and King interaction standard mode (SUCRA=78.2%). Conclusions:The Cox health behavior interaction model can improve the self-care ability of stroke patients, the doctor-patient interaction model can improve the motor function of stroke patients, and the King interaction standard model may have more advantages in improving the quality of life of stroke patients. It is suggested to combine the advantages of the three to maximize the rehabilitation effect of stroke patients.

A simple, reliable and sensitive liquid chromatography-isotope dilution mass spectrometry (LC-ID/MS) was developed and validated for quantification of olanzapine in human plasma. Plasma samples (50 microL) were extracted with tert-butyl methyl ether and isotope-labeled internal standard (olanzapine-D3) was used. The chromatographic separation was performed on XBridge Shield RP 18 (100 mm x 2.1 mm, 3.5 microm, Waters). An isocratic program was used at a flow rate of 0.4 m x min(-1) with mobile phase consisting of acetonitrile and ammonium buffer (pH 8). The protonated ions of analytes were detected in positive ionization by multiple reactions monitoring (MRM) mode. The plasma method, with a lower limit of quantification (LLOQ) of 0.1 ng x mL(-1), demonstrated good linearity over a range of 0.1 - 30 ng x mL(-1) of olanzapine. Specificity, linearity, accuracy, precision, recovery, matrix effect and stability were evaluated during method validation. The validated method was successfully applied to analyzing human plasma samples in bioavailability study.
Antipsychotic Agents ; blood ; pharmacokinetics ; Benzodiazepines ; blood ; pharmacokinetics ; Biological Availability ; Chromatography, Liquid ; methods ; Humans ; Indicator Dilution Techniques ; Isotope Labeling ; Reproducibility of Results ; Sensitivity and Specificity ; Tandem Mass Spectrometry ; methods

Objective To investigate the iodine nutrition status of the target population living in the areas with low coverage rate of iodized salt and to provide a basis to prevent and control iodine deficiency. Methods The investigation was carried out in the areas with coverage rate of iodized salt lower than 80%, including 7 counties (city, district). Three townships(sub-district office) were sampled in each county and two elementary schools in each township(sub-district office). Urinary iodine level was measured for 40 children aged from 8 to 10 years old in each elementary school. Drinking water iodine was collected and determined in their living villages. Twenty salt samples were tested for iodine in salt from 20 house which had fertile women, and urine iodine of 10 fertile women were tested in each village. Results Sixty-two water samples were determined and the water iodine was ranged from 5.8 to 272.7 μg/L, of which 3 water samples were equal and more than 150 μg/L. Eight hundred and seventy-two salt samples were collected. The coverage rate of iodized salt was 70.74%(585/827) and the coverage rates were below than 80% in 5 counties (city, district). A total of 1660 children' urine samples were collected, the content of urine iodine ranged from 10.0 to 1088.0 μg/L and the urine iodine median was 173.7 μg/L. Four hundred and thirty-seven urine samples were collected from the fertile women and the urine iodine median was 179.1 μg/L. The iodine level of children and women was the highest in Dongguang County(251.8,273.8 μg/L) while that of Hejian County (130.8,118.7 μg/L) was the lowest. Conclusions Although the iodine nutrition of children and fertile women is appropriate in areas with low coverage rate of iodized salt, we presume from the results that the possibility of iodine deficiency in pregnant and lactating women exists in Hejian and Anping.