Objective To explore the CT and MR imaging findings of acinic cell carcinoma (ACC)in salivary gland and enhance the diagnosis of this rare disease.Methods The CT and MR imaging characteristics of 20 patients (7 males and 13 females,median age 44 years old) with pathologically proved ACC were retrospectively reviewed.CT and MR images were evaluated in relation to the following: location,size,morphology,margin,CT density/MR signal intensity and enhancement pattern.Results Twelve lesions were located in parotid gland,two lesions in maxillary Sinus,and one lesion in submandibular,parapharyngeal,infratemporal fossa,buccal,nasal cavity,and hard palate respectively.The size of lesions were 0.7～5.8 cm.Sixteen lesions less than 3 cm in size demonstrated round or oval round masses with well defined margin.Four lesions more than 3 cm in size demonstrated irregular masses with unclear margin.Among them,bony destruction of the wall of the maxillary sinus was noted in 3 cases,and the preauricular skin was invaded in 1 case.The densities (signal intensity) were homogeneous in 6 cases and heterogeneous in 14 cases.Lesions were slightly low density in 11 case and isodensity in 3 cases on CT plain scan.Lesions were homogeneous isointense in 2 cases and heterogeneous isointense in 4 cases on T1WI,heterogeneous hyperintense in all cases on T2WI.On post contrast images,lesions demonstrated remarkable enhancement in 14 cases,moderate enhancement in 2 cases and mild enhancement in 3 cases.Conclusions The imaging characteristic of ACC were nonspecific.CT and MR could accurately detect the extent of tumor involvement and was helpful to provide more comprehensive information for the strategy of clinic therapy.

ObjectiveTo explore the characteristic CT features of benign and malignant submandibular gland lesions.Methods CT scans of 75 cases of submandibular gland lesions verified pathologically after surgery were analyzed retrospectively,including 38 cases of pleomorphic adenoma,22 cases of malignant tumors,11 cases of chronic submaxillaritis,2 cases of myoepithelioma,1 case of neurilemoma and 1 case of hemangioma.Results ( 1 ) All 38 cases of submandibular gland pleomorphic adenoma only occupied a part of submandibnlar gland.Thirty five lesions were on the edge of submandibular gland.The edge of 33 lesions were smooth and the density of 30 lesions were even.Thirty three lesions were slightly or moderately enhanced and 10 lesions showed “target sign” on enhanced CT.( 2 ) There were 22 cases of submandibular gland malignant tumors.Three lesions of lymphoma located at the edge of submandibular gland with smooth edge and even density,and showed mild to moderate enhancement.The remaining 19 lesions showed rough edge and uneven density.Eighteen of the 19 lesions showed ill-defined boundary,2 of the 18 lesions invaded most of submandibular gland and 16 of the 18 lesions invaded the whole submandibular gland.Seventeen lesions were unevenly enhanced,thickened,cirvilinear vessels were seen in 12 of the 17 lesions.Nine cases were accompanied with swollen lymph nodes ( minor diameter greater than 1.0 cm) in neck.(3)There were 11 cases of chronic submaxillaritis,which showed enlargement of the whole submandibular gland with relative smooth edge and relative clear boundary.Most of lesions were moderately and evenly enhanced.Six cases were companied with submandibular duct lithiasis and dilatation.All of 11 cases were accompanied with lymph node enlargement in neck.(4) Two cases of myoepithelioma demonstrated irregular ring enhancement on CT;one case of neurilemoma showed obvious cystic changes and slight enhancement on the edge;1 case of hemangioma showed multiple phleboliths and prolonged contrast enhancement.ConclusionsMost of submandibular gland benign and malignant lesions show some degree of characteristic CT findings.It is relatively difficult to discriminate between lymphoma and submandibular gland pleomorphic adenoma.

Breast cancer is the principal cause of death in malig-nancy women , usually treated with the combination of surgery , chemotherapy , radiotherapy and endocrinotherapy .With the de-velopment of cell biology , molecular biology , immunology, im-munotherapy becomes a new field of breast cancer treatment .In this review, we discuss new findings in breast cancer immuno-therapy , including recent successes with bispecific antibodies and immune checkpoint blockade .We also discuss therapeutic cancer vaccines and highlight several additional immunotherapy modalities in early stages of development .

Objective To investigate the efficacy of medial plantar flaps with cutaneous nerves on fixing palm skin defects for patients injured while working.Methods All cases with palm skin defects who received medial plantar flaps grafting from June 2003 to January 2013,were analyzed retrospectively.The data included 13 males and 10 females,with the mean age of 36 years old (range,18-61 years old).There were 16 cases with right hand injury and 7 cases with left,whose skin defects ranged from 3.6 cm×2.8 cm to 7.0 cru×5.5 cm.All cases had skin and soft tissue injury while 5 cases with vascular and nerve injury,3 cases with tendon involvement and being exposed,6 cases with open metacarpal fractures.15 patients were treated with emergency surgery within 8 hours after injury,while 8 patients were treated 10 days after debridement surgery.Results Altogether,23 patients who received medial plantar flaps grafting operations,with palm skin defects,were included in this study.All cases were followed up for 3 to 36 months with a average period of 18 month.The grafted flaps range from 4.6 cm×3.8 cm to 8.0 cm×6.5 cm.Among the patients,19 of them recovered excellently with healing by first intention,with 7-14 d healing time,fully-retained hand functions and palm appearance,and 4-8 mm for between two points distinguish test.Flaps survived fairly well in 3 patients because partial necrosis happened at plantar skin graft donor site.After being debrided and dressed,the wound healed at second phase with a healing time of 12-21 d and 5-9 mm for between two points distinguish test.The operated hands could flex and extend functionally in the follow-up period.Only one patient did not recovered from medial plantar flap grafting and the flap did not survive operationally.The patient recovered after another operation with groin skin grafting later.According to Gu Yudong et al' evaluation criteria,such as improved hand function,19 cases were scored as excellent recovery,3 cases as good,and 1 as poor.The excellent rate was 95.7％ (22/23).Conclusion Medial plantar flaps with cutaneous nerves are ideal flaps for palm skin defects restoration,which characterized by the advantages of fixed anatomical position,high survival rate and being good to the functional recovery and palm appearance.

This study was aimed to find out the optimum parameters to decoction extraction process of Brassicae Radix cream . With methods of integrated score and uniform design , contents of the total extract and the total polysaccharide were set as the target to investigate the optimization process of extraction. The experiment showed that the optimum extraction condition was as follows: ten folds of water, four times decoction at boiling tempera-ture , one hour for each time . It was concluded that the optimum parameters to decoction extraction of Brassicae Radix were stable and feasible, which can be used for the preparation and reference for Brassicae Radix cream in Tibetan clinics .

AIM To study the flavonoids from the leaves of Astragalus membranaceus (Fish.) Bge..METHODS The ethyl acetate and n-butyl alcohol fractions of 75％ ethanol extract from A.membranaceus leaves were isolated and purified by silica,ODS and preparative HPLC column,then the structures of obtained compounds were identified by spectral data.RESULTS Thirteen compounds were isolated and identified as quercetin (1),quercetin-3-O-β-D-glucopyranoside (2),rhamnocitrin-3-O-β-D-glucopyranoside (3),rhamnocitrin-3-O-β-neohesperidoside (4),rhamnocitrin-3-O-3-D-glucopyranoside (1'''→2'')-β-D-apiofuranosyl (5),complanatuside (6),glycitein (7),4',7-dihydroxy-3-methoxy isoflavone (8),genistein (9),calycosin-7-O-β-D-glucopyranoside (10),genistin (11),glycitin (12),tiliroside (13).CONCLUSION Compounds 5,8,13 are isolated from genus Astragalus for the first time,and compound 2 is first isolated from this plant.

The treatment of lower extremity chronic refractory ulcers requires a long time but with poor prognosis. Thus, many patients end up with amputations. The treatment of lower extremity chronic and recalcitrant ulcers and limb salvage has been a challenge worldwide. The Ilizarov technique based on the law of "tension-stress" brings a new hope in treating lower limb chronic and recalcitrant ulcers. The Ilizarov technique and distraction osteogenesis not only induce bone formation but also lead to angiogenesis and improved microcirculation. The Ilizarov technique consists of longitudinal distraction of long bone and tibia trans-verse transport (TTT) (proximal tibial corticotomy followed by transverse distraction). These two techniques have their own advantages and disadvantages with different indications in clinical application. Longitudinal distraction of long bone is mainly used for bone formation, such as large bone defects, osteonecrosis or bone infection (with or without soft tissue loss or ulcers). Because of only a partial osteotomy in TTT, the trauma is minor and their effects on limb instability are limited. Moreover, the procedure is simple with only a few minor complications. Thus, it is ideal in treating lower limb ischemic ulcers, such as diabetic foot ulcers, thromboangiitis obliterans (Buerger's disease), ulcers caused by atherosclerotic occlusion, arterial or venous ulcers, and trauma wounds. Several studies reported that TTT achieved high healing and limb salvage rates in treating severe diabetic foot ulcer. However, TTT could achieve lower recurrent rate. Thus, it is the most successful application in treatment of chronic ulcers. TTT also improves healing and limb salvage in treatment of thromboangiitis obliterans. However, the overall effects are limited than those in treating diabetic foot ulcer. For lower limb atherosclerosis occlusion, TTT induces regeneration of microvessles and consequently leads to ulcer healing. The effects are better than other conventional treatments. A combination therapy with vascularization is emphasized to attain the optimal long-term effects. The effects of TTT on lower limb recalcitrant ulcers still need to be validated in randomized control trial with larger sample size. Further, the mechanism of treatment needs to be explored by pilot studies which could show that this may be related to the formation of pro-angiogenetic factors and a rebalance of the inflammatory microenvironment during TTT.

OBJECTIVETo evaluate the therapeutic effect of hatchet flap for buccal tissue defect.

METHODSThe hatchet flap was designed beside the tissue defect and advanced to cover the defect.

RESULTSSince 2006, 13 cases were treated with primary healing and no flap loss. The size of the flaps ranged from 1.8 cm x 2.0 cm to 2.5 cm x 3.5 cm. All the cases were followed up for 3 months to 1.5 years. The postoperative appearance was satisfactory with inconspicuous scar.

CONCLUSIONSHatchet flap is very suitable for the buccal tissue defect with satisfactory cosmetic result. The facial natural figure is protected very well.

Adult ; Aged ; Aged, 80 and over ; Cheek ; surgery ; Face ; surgery ; Female ; Humans ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; Young Adult

AIM:To investigate whether the association of connexin 43 ( Cx43 ) and L-type calcium channel involved in the pathogenesis of atrial fibrillation ( AF) .METHODS:The biochemical assays and whole-cell patch-clamp technique were used to study the expression of Cx43 in human atrial tissue.The co-localization of Cx43 and L-type calcium channel, and the regulation of L-type calcium current in atrial myocytes were investigated.RESULTS:The expression of Cx43 at mRNA and protein levels was decreased in human atrial tissues of AF patients.In cultured atrium-derived myocytes ( HL-1 cells) , knockdown of Cx43 significantly inhibited the mRNA expression of L-type calcium channelα1c subunit, as well as L-type calcium current.Co-localization of Cx43 with L-type calcium channel α1c subunit in mouse atrial myocytes was observed.CONCLUSION:The decrease in Cx43 is involved in the pathogenesis of AF, probably through reducing the L-type calcium current in atrial myoctyes by co-localization with L-type calcium channel, thus representing the potential pathogenesis in atrial fibrillation.

Objective: Based on coronary artery calciifcation (CAC) distribution in the rural population of Yunnan province, we further explored the relationship between coronary artery calciifcation score (CACS) and the pulse pressure difference (PPD).
Methods: A randomly stratiifed cluster sampling method was used to study the rural population of Yunnan province and 16-MDCT scan was performed in 212 subjects for evaluating their CAC and calculating CACS. The subjects were divided into 2 sets of groups according to the age and CACS value. Age (51-60) years group,n=108 and Age (61-71) years group,n=104; CACS<1 group,n=162, 1≤CACS<100 group,n=33 and CACS≥100 group,n=17. The PPD level and the relationship between CACS and PPD were compared among different groups.
Results: The average PPD level in Age (61-71) years group was (44.67±13.87) mmHg and in Age (61-71) years group was (50.00±17.44) mmHg,P=0.015, PPD was positively related to age, rs=0.202,P=0.003. The average PPD level in CACS≥100 group, CACS<1 group and 1≤CACS<100 group were (55.22±18.79) mmHg, (46.87±15.46) mmHg and (45.20±15.89) mmHg respectively,P<0.05. The patients with increased PPD level in CACS≥100 group was 47.1%, in CACS<1 group was 17.3% and in 1≤CACS<100 group was 15.2%,P<0.05. Spearman rank correlation analysis indicated that PPD level was positively related to CACS, rs=0.282,P=0.047, with adjusted confounding factors such as age and blood cholesterol level, the PPD was still positively related to CACS.
Conclusion: PPD as a risk factor of coronary artery disease is related to CACS in rural population of Yunnan province, the CACS increased accordingly with the elevated PPD level.