Objective To investigate the selection of surgery and clinical outcomes of upper cervical injuries.Methods 25 upper cervical injury patients were involved in this retrospective study from November 2011 to June 2014.Including 20 males and 5 females with mean age of 37.1 years old (range,14-55 years old).Individual operation methods were based on the comprehensive evaluation of specific situations including the clinical manifestation,the type of the injuries and the imaging data.HaloVest distraction was applicated before operation.The surgery by anterior approach were performed for 7 patients and posterior approach were performed for 18 patients.Preoperative and postoperative American Spinal Injury Association (ASIA) grade and Functional Independence Measurement (FIM) score were studied to evaluate the nerve functional restoration.Imaging data before and after the operation were contrasted to evaluate the reduction of the fracture,the bone union,the fusion of the bone graft and the condition of the internal fixation.Wilcoxon Singed Rank Test was applied to compare the FIM score between pre-operation and last follow-up.Results 15 patients presented neurological function deficit because of cervical spinal cord compromise.All cases were followed up for 6-35 months (mean 18.2 months),showing good clinical and radiological effects.Solid fusion was obtained in all patients among 3-12 months.The ASIA grade improved by an average of 1.1 (6 months after operation) and 1.2 (12 months after operation).There was significant difference in FIM score between pre-operation and last follow-up.One patient got cerebrospinal fluid leakage.Conservative treatment was implemented with the Trendelenburg position,rehydration fluids and so on.Removal of drainage tube 8 days later when the drainage was less than 30 ml/24 h.No incision infection,cerebrospinal fluid leakage,migration or breakage of internal fixation was observed at the last follow-up.Conclusion The type of upper cervical injuries are complicated,the characteristics of fracture,dislocation and nerve injury in different patients are different.The specific situation should be evaluated comprehensively to make individual operation methods.The success of the operation requires the proficiency of the anatomic basis,the biomechanical characteristics,precise entrance point and direction in operation,appropriate diameter of the screw and suitable depth of the screw road.

OBJECTIVETo investigate the hemodynamic changes of primary hepatocellular carcinoma (HCC) evolved from hepatic cirrhosis using CT perfusion imaging.

METHODSThirty-two patients with primary hepatocellular carcinoma evolved from virus-induced fibrosis or cirrhosis underwent dynamic CT scanning of the target slices for 60 min. The perfusion parameters of the hepatic parenchyma and HCC including the blood flow (BF), blood volume (BV), mean transit time (MTT), permeability-surface area product (PS), hepatic arterial fraction (HAF), IRF time of arrival (IRF TO) were obtained. Paired-sample t test was used to determine the differences in the perfusion parameters between the hepatic parenchyma and the primary HCC mass.

RESULTSCompared with hepatic BF (117.13-/+31.05 ml/100 mg/min), BV (14.73-/+3.91 ml/100 mg), PS (31.93-/+5.91 ml/100 mg/min), HAF (25.02-/+8.19%), MTT (12.79-/+3.31 s), IRF TO (3.14-/+1.09 s), the primary HCC mass showed significant increments in the BF (239.69-/+96.07 ml/100 mg/min), BV (20.26-/+6.73 ml/100 mg), PS (37.50-/+9.50 ml/100 mg/min), HAF (68.97-/+15.22%) with decreased MTT (7.17-/+1.38 s) and IRF TO (2.42-/+0.94 s). Significant differences were found in all the perfusion parameters between the hepatic parenchyma and HCC (P<0.05).

CONCLUSIONLiver perfusion parameters can represent the hemodynamic changes in the HCC derived from hepatic cirrhosis.

Adult ; Aged ; Carcinoma, Hepatocellular ; diagnostic imaging ; etiology ; physiopathology ; Female ; Hemodynamics ; Hepatitis ; complications ; Humans ; Image Interpretation, Computer-Assisted ; methods ; Liver Cirrhosis ; complications ; Liver Neoplasms ; diagnostic imaging ; etiology ; physiopathology ; Male ; Middle Aged ; Perfusion ; methods ; Radiographic Image Enhancement ; instrumentation ; methods ; Tomography, X-Ray Computed

OBJECTIVETo investigate the magnetic resonance imaging (MRI) feature of multiple cerebral sclerosis (MS) for better understanding and diagnosis of this disease.

METHODSThe MRI data of 32 patients with MS were reviewed. Conventional scanning with T1WI, T2WI, Flair sequence was performed, and 26 patients underwent Gd-DTPA enhanced scanning. The MS plaques were analyzed for their locations, sizes, shapes, MR signals and enhanced features, space-occupying signs, and the related corpus callosum changes and brain atrophy. Descriptive statistical method was used for all the data.

RESULTSMRI identified MS lesions in the brain in 30 cases, with the sensitivity of 93.75%. All the MS patients had multiple lesions with predilection sites of the cortical/juxtacortical and periventricle areas, the centrum semiovale, and the corpus callosum. Most of the MS plaques were round or oval of different sizes. Bilateral lesions were almost symmetrical in distribution. Twenty patients had "rectangular demyelination" and 12 had "dirty white matter" signs, and 11 had both manifestations. The lesions were isointense, slightly hypointense or hypointense on T1WI, and hyperintense on T2WI and Flair sequences. Most of the MS plaques presented no enhancement, with occasional nodular or circular enhancement. No or slight space-occupying effect was found in the plaques. Of the 28 MS patients undergoing sagittal scanning of the corpus callosum, 17 presented with abnormal signals, with the sensitivity of 60.71% (17/28). Five patients had corpus callosum atrophy, and 10 had brain atrophy of different degrees.

CONCLUSIONThese results suggest that the corpus callosum is often compromised by the MS lesions to present diffusive, nodular, radiating signal abnormalities and irregular ependymal thickening, which can be most obvious with sagittal FLAIR imaging.

Adolescent ; Adult ; Brain ; pathology ; Corpus Callosum ; pathology ; Female ; Humans ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Multiple Sclerosis ; diagnosis ; Retrospective Studies ; Young Adult

OBJECTIVETo evaluate the feasibility of optimal surgery for breast cancer in elderly patients.

METHODSThe clinical data of 481 patients aged 70 years and above who were treated in our hospital from 1995 to 2009 were retrospectively analyzed.

RESULTSBased on their general conditions and clinical stages, 481 patients were divided into three groups to received different surgical procedures including modified radical mastectomy (MRM group, n=256), tumor extended resection (ER group, n=173), and simple mastectomy (SM group, n=52). The overall 5-and 10-year survival rates were 63.77%and 46.71%, respectively, and the 5-year (p=0.956) and 10-year (p=0.977) survival rates were not significantly among these three groups. However, patients in the ER group had significantly shorter hospital stay, smaller surgical wound, earlier recovery and less complications.

CONCLUSIONIt is feasible for female breast cancer patients over 70 years old choose the optimal surgical procedures according to their general conditions and clinical stages.

Aged ; Aged, 80 and over ; Breast Neoplasms ; surgery ; Female ; Follow-Up Studies ; Humans ; Mastectomy ; methods ; Mastectomy, Modified Radical ; Mastectomy, Simple ; Retrospective Studies

OBJECTIVETo evaluate the dosimetric advantages of postmastectomy electron-beam chest-wall irradiation after left mastectomy in patients with breast cancer.

METHODSElectron-beam chest-wall irradiation and tangential field irradiation were planned using Pinnacle7.4f planning systems for 42 patients with left breast cancer after mastectomy. The total prescribed dose for both plans was 5000 cGy/25 fractions. The dose volume histogram was used to compare the dosimetry of the clinical target volume (CTV) and the organs at risk such as the heart and ipsilateral lung.

RESULTSThe maximum dose (Dmax) of the CTV of electron beam chest-wall irradiation plans was significantly higher than that of tangential field irradiation plans (5562±61 vs 5402±82 cGy, t=6.10, P<0.05). The CTV of the electron beam chest-wall irradiation plans showed better heterogeneity than that of the tangential field irradiation plans, with heterogeneity index of 1.18±0.03 and 1.13±0.18, respectively (t=6.50, P<0.05). Electron beam chest-wall irradiation plans had also a better conformal index of the CTV than tangential field irradiation plans (0.77±0.17 vs 0.57±0.17, t=3.49, P<0.05). The V40 of the ipsilateral lung, the maximum dose of the heart, V30 and V40 of the heart in the electron beam chest-wall irradiation plans were smaller than those of the tangential field irradiation plans [(5.86±3.68)% vs (8.73±3.26)%, t=-2.27, P<0.05; 4839±388 cGy vs 5095±176 cGy, t=-2.32, P<0.05; (2.58±1.50)% vs (7.20±2.62)%, t=-4.70, P<0.05; (1.74±1.23)% vs (4.20±2.51)%, t=-3.50, P<0.05].

CONCLUSIONCompared with the tangential field irradiation plans, electron-beam chest-wall irradiation has better coverage index of the CTV and can decrease the high-dose volume of the normal tissue, but shows a poorer habituation index of the CTV.

Adult ; Breast Neoplasms ; radiotherapy ; surgery ; Female ; Humans ; Mastectomy ; Middle Aged ; Postoperative Period ; Radiometry ; Radiotherapy Dosage ; Thoracic Wall ; radiation effects

BACKGROUND AND OBJECTIVEThe role of postmastectomy radiotherapy (PMRT) in breast cancer patients with T1-T2 tumors and 1-3 positive axillary nodes is still uncertain. This study investigated the value of PMRT for these patients.

METHODSIn the retrospective data of 488 eligible patients, survival analysis was performed using the Kaplan-Meier method. Univariate and multivariate analyses were performed using a log-rank test and the Cox proportional hazards model, respectively.

RESULTSThe median observation time was 54 months. The 5- and 10-year locoregional recurrence-free survival (LRFS) rates were 90.8% and 86.9%, respectively. The 5- and 10-year disease-free survival (DFS) rates were 82.0% and 74.3%, respectively. The 5- and 10-year overall survival (OS) rates were 90.7% and 82.7%, respectively. For the 412 patients without PMRT, T2 classification, 2-3 positive nodes, and hormone (estrogen and progesterone) receptor-negative were risk factors for locoregional recurrence in the multivariate analysis. On the basis of these 3 risk factors, the group with 2-3 factors had a 10-year LRFS rate of 63.1% compared with 96.1% for the group with 0-1 factors (P < 0.001). For the group with 2-3 risk factors, LRFS and DFS were significantly improved by PMRT, with the 5- and 10-year LRFS rates without PMRT of 82.4% and 63.1%, respectively, and, with PMRT, of 98.1% at both 5 years and 10 years (P = 0.002). The 5- and 10-year DFS rates without PMRT were 72.0% and 57.6%, respectively, and, with PMRT, the 5- and 10-year DFS rates were 89.4% and 81.7%, respectively (P = 0.007). There was no significant difference in the 10-year OS rates between patients with and without PMRT. However, there is the potential benefit of 15.3% (87.1% vs. 71.8%, P = 0.072). Conversely, the group with 0-1 factors of PMRT had no effect on prognosis.

CONCLUSIONSIn patients receiving mastectomy with T1-T2 breast cancer with 1-3 positive nodes, for the group with 2-3 risk factors, PMRT significantly improved LRFS and DFS and has potential benefit in OS.

Adult ; Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Breast Neoplasms ; drug therapy ; pathology ; radiotherapy ; surgery ; Carcinoma, Ductal, Breast ; drug therapy ; pathology ; radiotherapy ; surgery ; Carcinoma, Lobular ; drug therapy ; pathology ; radiotherapy ; surgery ; Chemotherapy, Adjuvant ; Disease-Free Survival ; Female ; Humans ; Lymphatic Metastasis ; Mastectomy ; Middle Aged ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Radiotherapy, Adjuvant ; Radiotherapy, High-Energy ; Receptors, Estrogen ; metabolism ; Receptors, Progesterone ; metabolism ; Retrospective Studies ; Risk Factors ; Survival Rate ; Young Adult

OBJECTIVETo study the feasibility and clinical efficacy of a minimally invasive sinus tarsi approach in the treatment of Sanders II calcaneus fractures.

METHODSFrom August of 2015 to July of 2016, 13 patients(totally 13 feet) with Sanders II intra-articular calcaneus fractures were treated via the minimally invasive sinus tarsi approach. The Böhler angle, Gissane angle and the length, width and height of calcaneus were compared between pre-operation and post-operation. The AOFAS ankle and foot scoring system of the orthopaedic ankle foot Association was used to evaluate the efficacy.

RESULTSAll the patients were followed up, and the duration ranged from 6 to 15 months, with an average of 9.5 months. No incision complications occurred. The Böhler angle was increased from preoperative (18.82±5.11)° to postoperative(26.63±4.45)°(=-4.16,=0.000). The Gissane angle was increased from preoperative(111.07±15.36)° to postoperative (124.56±8.71)° (=-2.75,=0.011). The length, width, height of calcaneus were absolutely improved from preoperative(69.82±5.95) mm, (42.07±3.68) mm, (41.20±3.90) mm to preoperatively(72.61±5.46) mm, (39.10±4.02) mm, (44.03±3.33) mm. According to the AOFAS, 8 patients got an excellent result, 4 good and 1 poor, and the postoperative mean score was 88.2±5.9.

CONCLUSIONSThe limited open sinus tarsi approach could be used successfully to treat displaced Sanders II fractures with less injury and effectively restored the surface of subtalar joint, however the method is not fit for the patients with comminuted fracture in lateral wall and great change in the length, width, height, varus and valgus of calcaneus.

Biopsy, Fine-Needle ; Female ; Humans ; Hypercalcemia ; etiology ; Mediastinal Cyst ; diagnosis ; diagnostic imaging ; pathology ; Middle Aged ; Parathyroid Diseases ; diagnosis ; diagnostic imaging ; pathology ; Ultrasonography

The scrap management of the level Ⅱ biosafety cabinet in some institution from 2019 to 2021 was introduced.The level l[biosafety cabinet was analyzed in terms of the causes for the failures,service length and the correlation between them.Some suggestions were put forward including standardizing the utilization,maintenance and scrap management of the biosafety cabinet.References were provided for ensuring the biosafety and operation of the laboratory.[Chinese Medical Equipment Journal,2023,44(10):91-94]

Objective:To analyze the incidence and epidemiological characteristics of traumatic spinal cord injury in China in 2018.Methods:Multi-stage stratified cluster sampling was used to randomly select hospitals capable of treating patients with spinal cord injury from 3 regions，9 provinces and 27 cities in China to retrospectively investigate eligible patients with traumatic spinal cord injury admitted in 2018. National and regional incidence rates were calculated. The data of cause of injury，injury level，severity of injury，segment and type of fracture，complications，death and other data were collected by medical record questionnaire，and analyzed according to geographical region，age and gender.Results:Medical records of 4，134 patients were included in this study，with a male-to-female ratio of 2.99∶1. The incidence of traumatic spinal cord injury in China in 2018 was 50.484 / 1 million （95% CI 50.122-50.846）. The highest incidence in the Eastern region was 53.791 / 1 million （95% CI 53.217-54.365）. In the whole country，the main causes of injury were high falls （29.58%），as well as in the Western region （40.68%），while the main causes of injury in the Eastern and Central regions were traffic injuries （31.22%，30.10%）. The main injury level was cervical spinal cord in the whole country （64.49%），and the proportion of cervical spinal cord injury in the Central region was the highest （74.68%），and the proportion of lumbosacral spinal cord injury in the Western region was the highest （32.30%）. The highest proportion of degree of injury was incomplete quadriplegia （55.20%），and the distribution pattern was the same in each region. A total of 65.87% of the patients were complicated with fracture or dislocation，77.95% in the Western region and only 54.77% in the Central region. In the whole country，the head was the main combined injury （37.87%），as well as in the Eastern and Central regions，while the proportion of chest combined injury in the Western region was the highest （38.57%）. A total of 32.90% of the patients were complicated with respiratory complications. There were 23 patients （0.56%） died in hospital，of which 17（73.91%） died of respiratory dysfunction. Conclusions:The Eastern region of China has a high incidence of traumatic spinal cord injury. Other epidemiological features include high fall as the main cause of injury cervical spinal cord injury as the main injury level，incomplete quadriplegia as the main degree of injury，head as the main combined injury，and respiratory complications as the main complication.