Objective To evaluate the effect of three diamension-digital subtraction angiography (3D-DSA) or computed tomography angiography (CTA) on the patients with ruptured multiple intmcranial aneurysm (MIA). Methods A retrospective study on 21 patients with MIA was performed.After scanning with 3D-DSA or 3D-CTA, three-dimensional reconstruction of MIA was carried out by 3D workstation,then the diagnosis was decided and the treatment plan (endovascular treatment or microsurgery) was selected according to stereoscopic image of MIA. Results (1) 3D-DSA or CTA was performed in 21 patients with subarachnoid hemorrhage (SAH),it was revealed these patients carried with 48 aneurysms,including 35 small aneurysms (25 mm).Not only miero-aneurysms and small aneurysms could be precisely showed,also the size of aneurysmal neck,the relationship of the aneurysm and the parent vessel and contiguous branches by stereoscopic image.(2) According to the standard of classification,9 patients with MIA for gradeⅠ(42.9%),10 for gradeⅡ(47.6%),2 for gradeⅢ(9.5%),0 for gradeⅣ.Endovascular treatment was selected prior to microsargery for those high grade patients.In this group,17 patients with 40 aneurysms underwent endovascular embolotherapy with GDC coils.Twenty four anemysms were completely occlusioned,12 beyond 90%,4 were left without treatment because of their small size.In microsurgery group,3 aneurysrus were totally clipped,1 could not be found during operation.No any treatment was accepted in 2 patients with 4 aneurysms. Conclusions 3D-DSA or CTA,which is very useful for the diagnosis and treatment of MIA,could improve the accuracy of diagnosis of MIA and clearly show the stereoscopic image of MIA,also the relation of sac and parent artery.For those patients with high grade MIA,endovascular treatment was selected prior to microsurgery,pro re nata,used to combine with mierosurgery.

Objective To investigate the surgical techniques and methods of anterolateral thigh (myocutaneous) flap. Methods Two hundred and forty-five consecutive free anterolateral thigh (myocutaneous) flaps for reconstruction of the defects of oral and maxillofacial region following the malignant tumors resection from January 2007 to August 2009 were reviewed. The incision was designed in the upper,middle or lower part 3 cm medial of the iliac-patella line according to the thickness of flaps needed. The perforators with suitable vessel diameter and strong pulse were chosen to make flaps with muscular tissue to fill dead space. More than one perforators were taken when large flaps were harvested. The size of the flaps ranged from 4 cm × 4 cm to 10 cm × 25 cm. Eighteen fat flaps were made thinned. Results Of the 245 flaps harvested, 3 complete necrosis occured, and the survival rate was 98. 8%. Blisters occurred in 8 thinned flaps, but they all survived. All the wounds were closed directly except 5 cases, which needed skin graft because of too large defects of skin. All the skin graft came from the upper part of the wound of donor site. The shape and function were satisfactory after the reconstruction. Conclusions When anterolateral thigh(myocutaneous) flaps are harvested, the incision should be designed 3 cm medial of the iliac-patella line according to the thickness of flaps needed. It is helpful to find the perforators. All of the lower, middle and upper parts of anterolateral thigh region have cutaneous perforators. The skin defects within 8 cm can be closed directly, while the skin defects more than 8 cm often need skin grafting. The skin grafts can be taken from the upper part of donor site wounds.

OBJECTIVETo investigate the clinicopathologic factors related with recurrence and prognosis after surgical resection for anorectal melanoma.

METHODSThe clinicopathologic factors related to recurrence and prognosis of 50 patients with anorectal melanoma after surgical resection were retrospectively analyzed using univariate and multivariate methods.

RESULTSForty-seven patients underwent radical operation, including 31 abdominoperineal resection (APR) and 16 sphincter preserving operation. The local recurrence rates were 16.1%(5/31) and 68.8%(11/16) respectively. chi(2) analysis revealed that operation pattern was associated with local recurrence rate. The 5-year survival rate was 18.2%. Univariate analysis revealed that single tumor, intramural infiltration and operation pattern were related with prognosis. Multivariate analysis revealed that intramural infiltration was the most important prognostic factor for anorectal melanoma.

CONCLUSIONSThe prognosis of anorectal melanoma is poor. Early diagnosis and treatment are important for the improving of curative effect.

Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Lymphatic Metastasis ; Male ; Melanoma ; pathology ; surgery ; Middle Aged ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Prognosis ; Rectal Neoplasms ; pathology ; surgery ; Retrospective Studies ; Survival Rate

The prenatal ethanol exposure induced the alterations of dendritic spine and synapse in visual cortex and their long-term effect would be investigated in mice from P0 to P30. Pregnant mice were intubated ethanol daily from E5 through the pup's birth to establish mode of prenatal alcohol abuse. The dendritic spines of pyramidal cells in visual cortex of pups were labeled with DiI diolistic assay, and the synaptic ultrastructure was observed under transmission electron microscope. Prenatal alcohol exposure was associated with a significant decrease in the number of dendritic spines of pyramidal neurons in the visual cortex and an increase in their mean length; ultrastructural changes were also observed, with decreased numbers of synaptic vesicles, narrowing of the synaptic cleft and thickening of the postsynaptic density compared to controls. Prenatal alcohol exposure is associated with long-term changes in dendritic spines and synaptic ultrastructure. The changes were dose-dependent with long term effect even at postnatal 30.
Animals ; Dendritic Spines ; ultrastructure ; Ethanol ; toxicity ; Female ; Fetal Alcohol Spectrum Disorders ; etiology ; pathology ; Male ; Mice ; Mice, Inbred C57BL ; Microscopy, Confocal ; Microscopy, Electron, Transmission ; Pregnancy ; Prenatal Exposure Delayed Effects ; pathology ; Pyramidal Cells ; ultrastructure ; Synapses ; ultrastructure ; Visual Cortex ; ultrastructure

OBJECTIVETo observe the clinical effect of autologous red bone marrow injection in treating focal bone defect in postoperative nonunion.

METHODSThirteen patients with focal bone defect in postoperative nonunion (7 cases in tibia, 2 cases in femur, 4 cases in humerus), including 8 males and 5 females with the mean age of 32.5-years-old (ranging from 15 to 60 years). The bone defects were treated with autologous red bone marrow injection (1 time per 2 weeks, 5 times in total) and the X-rays of AP and LP were observed.

RESULTSThirteen patients were followed up from 6 to 12 months with an average of 7.5 months. According to results of X-ray pictures, 13 cases obtained bone defect recovered completely, and the average time of union was 4 months.

CONCLUSIONAutologous red bone marrow injection has ascendancy such as less wound and clear clinical effect, which can accelerate bone healing and promotes functional recovery of limb. It is a good method to treat focal bone defect in postoperative nonunion.

Adolescent ; Adult ; Bone Marrow Transplantation ; Bone Regeneration ; Bone and Bones ; physiopathology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; therapy ; Transplantation, Autologous ; Young Adult

OBJECTIVETo study the expression of Smad4 and transforming growth factor-beta(1) (TGFbeta(1)), transforming growth factor-beta receptor II (TGFbetaRII) in cholangiocarcinoma tissue and its relationship with the biological behaviour and prognosis of the disease.

METHODSThe expressions of Smad4, TGFbeta(1) and TGFbetaRII were detected by immunohistochemical technique in 47 specimens of cholangiocarcinoma and the normal bile duct tissue adjacent to the tumor. The expressions of Smad4, TGFbeta(1) and TGFbetaRII were compared with the clinical stages and pathological grades of the patients.

RESULTSThe expression of TGFbeta(1) was positive in 36 cholangiocarcinomas (76.6%), which was higher than that in the normal tissue adjacent to the lesion. The positive expressions of Smad4 and TGFbetaRII were 14 (29.8%) and 28 (59.6%) in the carcinoma tissues, respectively (P < 0.05). The expression of TGFbeta(1) was related to the clinical stage, metastasis of lymph node and liver of the tumor (P < 0.05), but not with the histological grade (P > 0.05). There was positive correlation between TGFbetaRII expression and the clinical stage (P < 0.05), but no correlation between the TGFbetaRII expression and histological grade or metastasis of lymph node and liver (P > 0.05). The expression of Smad4 was associated with the histological grade, clinical stage and metastasis of lymph node and liver (P < 0.05).

CONCLUSIONSThe expressions of Smad4, TGFbeta(1) and TGFbetaRII correlate with the histological grading, clinical staging and metastasis of the lymph node and liver in cholangiocarcinoma. Combined detection of Smad4, TGFbeta(1) and TGFbetaRII may be helpful in the determination of the malignant degree and the prognosis of this disease.

Adult ; Aged ; Bile Duct Neoplasms ; metabolism ; pathology ; Bile Ducts, Intrahepatic ; Biomarkers, Tumor ; biosynthesis ; Cholangiocarcinoma ; metabolism ; secondary ; Female ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Neoplasm Metastasis ; Neoplasm Staging ; Protein-Serine-Threonine Kinases ; Receptors, Transforming Growth Factor beta ; biosynthesis ; Smad4 Protein ; biosynthesis ; Transforming Growth Factor beta1 ; biosynthesis

pair kinds of complicated defects on oromaxillo-facial region.

Objective:To investigate the clinical value immature granulocyte percentage(IG％)and other inflammatory indicators in the severity of acute appendicitis.Methods:A total of 201 pediatric patients undergoing appendicitis surgery admitted to Zhoukou Central Hospital from June 2022 to August 2023 were included.Patients with pathologically confirmed actue appendici-tis were divided two subgroups:actue simple appendicitis(ASA)group and actue complicated ap-pendicitis(ACA)group,The variables that included IG％,white blood cell(WBC)count,absolute neutrophil count(ANC),absolute lymphocyte count(ALC),neutrophil to lymphocyte ratio(NLR),pro-calcitonin(PCT),C-reactive protein(CRP),platelet to lymphocyte(PLR)and other indexes were ana-lyzed between ASA and ACA group.The logistic regression model for diagnosis of ACA was es-tablished,and the diagostic value of this model and other inflammtory indicators for ACA was evaluated by receiver operating characteristic(ROC)curve analysis.Results:The levels of IG％,WBC,ANC,ALC,NLR,PCT and PLR were higher and the level of ALC was lower in ACA group than those in ASA group(all P＜0.05).Logistic regression analysis showed that IG％,NLR and CRP were three diagnostic determinants of ACA(all P＜0.05).The AUC of the established logistic model and IG％,NLR,CRP were 0.868,0.821,0.691 and 0.790(all P＜0.001).The logistic model was vali-dated by independent cohorts,and the AUC was 0.872,the sensitivity was 90.0％and the speci-ficity was 75.6％.Conlusions:The IG％value can early indicator for pediatric ACA,and the es-tablished logistic regression model based on biomarkers including IG％,NLR and CRP has clinical value in diagnosing ACA in children.

OBJECTIVETo compare the efficiency of response evaluation by clinical examination, ultrasonograghy and mammography in neoadjuvant chemotherapy (NAC) for breast cancer.

METHODSA retrospective cohort study was conducted to analyze the data of 141 patients treated with neoadjuvant chemotherapy. Response evaluation was performed by clinical palpation, ultrasound and mammography.

RESULTSOnly 12 (8.5%) among the 141 patients presented with a stage I tumor. The tumor size determined by palpation was often larger than that by ultrasound before therapy (P < 0.01). Among patients with suspicions axillary nodes checked by ultrasound, 88.3% (53/60) of them had positive nodes by pathology before NAC, and 34.5% (10/29) of patients with negative nodes determined by ultrasound had positive nodes by pathology. In all the 141 patients, 21(14.9%) showed pathological complete remission in both the primary tumor and lymph node. For response evaluation, the false complete remission rate judged by clinical examination was 46.8% (22/47), and the false tumor residual rate by ultrasound was 84.0% (21/25). In 53.5% (23/43) of patients the response could not be assessed by mammography due to that the tumors were undistinguishable in size. The range of microcalcification was not reduced in 5 patients with a partial response of the tumor. 25 patients experienced needle puncture during therapy. Among them, in the 9 pathologically negative patients, only 3 achieved pCR, and the other 16 positive patients didn't achieve pCR.

CONCLUSIONUsing the puncture or sentinel lymph node biopsy, clinicians should pay enough emphasis on the pathological determination of the node status before chemotherapy. Clinicians will make a quite of false judgment of the tumor by clinical examination, ultrasound or mammography. They may use needle puncture during therapy to evaluate the response of neoadjuvant chemotherapy, and the result should be analyzed synthetically.

Adult ; Aged ; Aged, 80 and over ; Axilla ; Breast Neoplasms ; diagnostic imaging ; drug therapy ; pathology ; Carcinoma, Ductal, Breast ; diagnostic imaging ; drug therapy ; pathology ; Chemotherapy, Adjuvant ; Cohort Studies ; Female ; Humans ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Mammography ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Staging ; Remission Induction ; methods ; Retrospective Studies ; Sentinel Lymph Node Biopsy ; Ultrasonography

OBJECTIVETo report the application of the chimeric perforator flap pedicled with descending branch of lateral circumflex femoral artery for large and complicated oromaxillary soft tissue defect.

METHODSBased on the anatomic study of descending branches and cutaneous perforators of lateral circumflex femoral artery, the perforator vessels were found and used as flap pedicle. The perforator flap was made as chimeric flap for repairing the oromaxillary soft tissue defect in 8 cases. The chimeric perforator flaps were divided into three types as anterolateral thigh flaps and anteromedial thigh flaps, anterolateral thigh flaps and rectus femoris perforator flaps, and anterolateral thigh flaps and anterolateral thigh flaps.

RESULTSAll the 16 flaps in 8 cases survived completely with no complication. The wounds in donor sites were all primarily closed with no skin graft. The patients were followed up for 1-9 months with good functional and esthetic results. There was no morbidity in donor sites.

CONCLUSIONSThe chimeric perforator flap has a large tissue volume for large and complicated oromaxillary defect. There is no need for extra donor site and extra blood vessel anastomosis.

Adult ; Aged ; Female ; Femoral Artery ; transplantation ; Humans ; Male ; Middle Aged ; Oral Surgical Procedures ; methods ; Reconstructive Surgical Procedures ; methods ; Surgical Flaps ; blood supply