Objective To compare lateral orbital keyhole approach(LOK) with conventional keyhole approach including supraorbital keyhole approach (SOK) and pterional approach(PTK) for exposuring the sellar region and oper-ation ability, to provide theoretical and practical basis for the clinic. Methods From January, 2017 to Feburary, 2018, 15 cadaver head specimens of Chinese (30 sides) fixed by formalin were randomly divided into 3 groups, simu-lating SOK, LOK and PTK, application of frameless neuronavigation system, intersection of the posterior margin of the optic chiasma and the lamina terminalis served as the base point. Six different reference points were selected to radi-ate into the parasellar region of the skull base. The direction of the 2 adjacent reference points were connected to the base point to form a triangle. Six triangles constituted the sellar region to represent the total area. The supratentorial area, ipsilateral area, inferior area and contralateral area were calculated by stacking triangle. The comparison was made between groups. The Salma operation exposure scale was used to simulate the aneurysms of the common parts in the brain and the quantitative scores were performed. Results The total parasellar regions by SOK, LOK and PTK respectively were:(1641.6±295.6)mm2, (1782.3±294.6)mm2 and (1552.5±307.4)mm2. There was no statistical differ-ence(P>0.05); To compare the supratentorial region, SOK and LOK were both bigger than PTK ( P<0.05); To compare the ipsilateral and infratentorial area, LOK and PTK were both bigger than SOK respectively ( P<0.05);To compare the contralateral area, SOK, LOK and PTK were increased in turn (P<0.05). Salma operation exposure scale was used to get the scores:the score of SOK was 29.7 (39.08％), LOK was 37.0 (48.68％), and PTK was 36.1 (47.50％). Conclusion Anatomical analysis displayed that the 3 keyhole approaches showed different exposure of each part the parasellar re-gions, the LOK had a good exposure to the parasellar region and so as the higher maneuverability. But the clinical appli-cation should be comprehensive analysis, pay attention to specific lesions and make an appropriate choice. It has impor-tant clinical significance to improve the prognosis of patients.

Objective To investigate the hemodynamic monitoring and clinical significance of transcranial Doppler (TCD) combined with indocyanine green (ICG) fluorescence angiography and FLOW 800 in carotid endarterectomy (CEA).Methods Forty-eight patients with extracranial carotid atherosclerotic stenosis underwent CEA in our hospital from October 2015 to September 2018 were chosen to our study. The mean blood flow velocity (Vm) of the middle cerebral artery (MCA) was monitored by TCD throughout the operation. The intraoperative blood pressures were adjusted according to the monitoring results, and the average blood Vm of the narrowed arteries was measured using TCD probe before and after artery temporary occlusion. ICG fluorescence angiography and FLOW 800 were used to monitor vascular morphology and patency simultaneously.Results One patient, who was observed to have severe stenosis by TCD, ICG fluorescence angiography, and FLOW 800 after arteries temporary occlusion, showed significantly improved by multimodal monitoring after re-suture; one patient showed external carotid artery occlusion by ICG fluorescence angiography and FLOW 800 had noexternal carotid artery occlusion; other 46 patients showed no carotid artery stenosis and good intracranial perfusion by TCD, ICG fluorescence angiography, and FLOW 800 after initial suture. Two patients developed ischemic stroke (IS) after CEA, and both of them were recovered after conservative medical treatment for two weeks without any neurological dysfunction; two patients had cerebral hyperperfusion syndrome (CHS), and both of them relieved after blood pressure control three d after treatment; one patient had subcutaneous hematoma in the operation area, and the hematoma was gradually absorbed after conservative treatment; the rest patients recovered well. All patients were followed up for 4-6 months after CEA, and CT angiography showed that carotid artery stenosis was relieved; CT perfusion imaging and TCD examinations showed that cerebral perfusion was significantly improved as compared with those before operation.Conclusion Intraoperative TCD combined with ICG fluorescence angiography and FLOW 800 can effectively monitor the intracranial and extracranial blood flow of intraoperative carotid artery, which is of great significance in reducing the risk of IS and CHS during carotid endarterectomy.

Objective:To investigate the efficacy and clinical experiences of fluorescein angiography assisted occlusion via lateral-orbital keyhole approach in internal carotid bifurcation aneurysms. Methods:The clinical data of 16 patients with internal carotid artery bifurcation aneurysms admitted to our hospital from January 2016 to December 2020 were retrospectively analyzed. All patients accepted fluorescein angiography assisted occlusion via lateral-orbital keyhole approach. The patients were followed up at one, 3, and 6 months after surgery by medical imaging. The therapeutic efficacy of these patients was assessed by Glasgow outcome scale (GOS). Results:All aneurysms in these 16 patients were clipped at one-stage operation. Intraoperative fluorescein angiography and FLOW 800 showed that the aneurysms were completely clipped without residual, and the blood flow of the parent artery and perforating arteries was unobstructed. Six months after surgery, 14 patients recovered well (GOS scores of 5), and 3 developed limb hemiplegia (GOS scores of 4).Conclusion:Intraoperative fluorescein angiography assisted occlusion via lateral-orbital keyhole approach is safe and effective in internal carotid bifurcation aneurysms.

OBJECTIVETo identify the pathogenic mutation in a Chinese family with Alport syndrome.

METHODSBlood samples were collected from the members of the family. Direct DNA sequence analysis of the entire coding region and exon-intron boundaries of the COL4A5 gene was performed, and restriction fragment length polymorphism (RFLP) analysis was used to confirm the sequencing results and to test the mutation in all the family members and 200 controls.

RESULTSA novel splicing mutation of c.1517-1G to T in the COL4A5 gene was identified in all patients in the family. RFLP analysis did not detect this mutation in all the unaffected family members and the 200 controls.

CONCLUSIONThis data revealed a novel splicing mutation of c.1517-1G to T in the COL4A5 gene causing Alport syndrome in a Chinese family. Author's study enriched the spectrum of COL4A5 mutation associated with Alport syndrome.

Adult ; Asian Continental Ancestry Group ; genetics ; Base Sequence ; Case-Control Studies ; Chromosomes, Human, X ; genetics ; Collagen Type IV ; genetics ; DNA Mutational Analysis ; Female ; Genetic Linkage ; Humans ; Male ; Mutation ; Nephritis, Hereditary ; genetics ; Pedigree ; Polymorphism, Restriction Fragment Length ; RNA Splicing ; genetics

BACKGROUNDThe spread of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic in the worldwide trend is not contained effectively. The pregnant women infected HIV seriously in the high HIV epidemic areas in China. The transmission of HIV to child may be cut off if HIV positive mother was found early by HIV testing. Pregnant women mandatorily received the HIV counseling and testing services. Most of them did not know the knowledge about HIV prevention and were not willing to receive HIV testing actively. Willingness for HIV testing among pregnant women was investigated, which can help to promote them to take up HIV testing actively. This study assessed the prevalence of the willingness for HIV testing and cognitive factors associated with it.

METHODSA cross-sectional survey was conducted to 500 pregnant women via face-to-face interviews with anonymous structured questionnaire guided by the Health Belief Model (HBM).

RESULTSThe prevalence of the willingness for HIV testing was 58.60%. Perceived higher susceptibility to HIV (multivariate-adjusted odds ratio (ORm) = 2.02, 95% confidence interval (CI): 1.40-5.06), more knowledge for HIV (ORm = 1.92, 95% CI: 1.11-3.87) and perceived less social stigma (ORm = 0.80, 95% CI: 0.34-0.91) were associated with higher willingness for HIV testing among pregnant women.

CONCLUSIONTo prevent HIV mother to children transmission, it is necessary to enhance knowledge for HIV, change cognitive factors and increase willingness for HIV testing among pregnant women.

Adult ; China ; Cross-Sectional Studies ; Female ; HIV ; pathogenicity ; HIV Infections ; diagnosis ; Humans ; Infectious Disease Transmission, Vertical ; Middle Aged ; Multivariate Analysis ; Patient Acceptance of Health Care ; psychology ; Pregnancy ; Pregnancy Complications, Infectious ; diagnosis ; Surveys and Questionnaires ; Young Adult

Cashmere, also known as soft gold, is produced from the secondary hair follicles (SHFs) of cashmere goats. The number of SHFs determines the yield and quality of cashmere; therefore, it is of interest to investigate the transcriptional profiles present during cashmere goat hair follicle development. However, mechanisms underlying this development process remain largely unexplored, and studies regarding hair follicle development mostly use a murine research model. In this study, to provide a comprehensive understanding of cellular heterogeneity and cell fate decisions, single-cell RNA sequencing was performed on 19,705 single cells of the dorsal skin from cashmere goat fetuses at induction (embryonic day 60; E60), organogenesis (E90), and cytodifferentiation (E120) stages. For the first time, unsupervised clustering analysis identified 16 cell clusters, and their corresponding cell types were also characterized. Based on lineage inference, a detailed molecular landscape was revealed along the dermal and epidermal cell lineage developmental pathways. Notably, our current data also confirmed the heterogeneity of dermal papillae from different hair follicle types, which was further validated by immunofluorescence analysis. The current study identifies different biomarkers during cashmere goat hair follicle development and has implications for cashmere goat breeding in the future.