Objective Anatomical researches of two long superiror genicular vessels,the descending branch of lateral circumflex femoral artery (LCFA) and the descending genicular artery(DGA),were performed to discuss the feasibility of reconstruction in lower leg's destruction injury by free flaps transplant anastomoses with these two long superior genicular vessels.Methods Thirty embalmed lower limb specimens from adult cadavers perfused with red latex were used for this anatomical study.The superior of patella,anterior inferior iliac spine and adductor tubercle were used as observation landmark.Dissection started along the line that from the middle point of Inguinal Ligament to the middle point of superior line of patella,and dividedly turned over to posterior lateral part and posterior medial part.The followings were focused observed:①The external diameter at the beginning of the D-LCFA ; the 0.5 mm external diameter point of this artery,and its length to the beginning and superior of patella.②The external diameter at the beginning of DGA,the distance between the beginning of DGA and adductor tubercle.③Anastomoses relations of final branches of D-LCFA and DGA with other arteries around the knee.Results The external diameter of the beginning of D-LCFA was (2.73 ± 0.35) mm ; the 0.5 mm external diameter point of this artery's length to the beginning and to the superior of patella were (24.56 ± 0.92) cm and (6.09 ± 0.86) cm; both D-LCFA and DGA had sent out many perforator arteries on their ways; the final branch of D-LCFA and DGA had lots of anastomoses relations in perioseal deep fascia and superficial fascia with other genicular arteries.Conclusion Base on the anatomical researches,in theory,the two long superior genicular vessels (D-LCFA and DGA) have enough lengthes and blood supply to regress and anastomosis with free flaps transplant to repair lower leg's smashed wound.

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10.3969/j.issn.1008-9691.2013.03.017

Objective To explore the roles of Apelin in the development of gastric carcinoma (GC) and interrelation with MVD. Methods Immunohistochemical streptacidin/peroxidase (SP) technique was adopted to examine the expressions of Apelin in 20 cases of normal gastric mucosa, 20 cases of atypical hyperplasia (Dys) and 60 cases of gastric carcinoma, and to examine MVD by CD34 staining. Results With the development of GC, the positive rate of Apelin was increased gradually, namely 5.0 %(1/20) in normal gastric mucosa group, 15.0 %(3/20) in atypical hyperplasia group and 83.3 %(50/60) in gastric carcinoma. Expression of Apelin was correlated with TNM stage and differentiation. MVD in the Apelin positive group (47.01±11.66) was significantly higher than that in the negative group(38.90±10.21); MVD of the Apelin positive group expression was correlated with the histologic stage, serosa infiltration and lymph node metastasis (P < 0.05). Conclusion Apelin may contribute to the development of GC by activating tumour neoangiogenesis.

BACKGROUND:Bone marrow mesenchymal stem cells (BMSCs) have been induced to differentiate into cardiomyocyte-like cells in vitro.OBJECTIVE:To explore the association between GATA-4, Nkx-2.5 and α-myosin heavy chain (α-MHC) expression and cell morphological changes and structure formation in the process of BMSCs differentiation into cardiomyocyte-like cells.METHODS:By using myocardial lysate, BMSCs were induced to differentiate into cardiomyocytes.Immunocytochemistry staining was used to detect cardiac troponin T (cTnT) and connexin43, for the identification of cardiomyocytes. In the process of directional differentiation, RT-PCR was used to detect the expression of GATA-4,Nkx2.5 and α-MHC.RESULTS AND CONCLUSION:During the directional differentiation of BMSCs, the cells were changed from long fusiform to short rod, forming protrusions that were interconnected to form mesh-like, bamboo-like or myotube-like structure. When the cells were interconnected like a bamboo, cTNT and connexin43 positive cells were visible, and then the number of positive cells increased with the presence of myotube-like structure. RT-PCR results showed that during the induced directional differentiation of BMSCs, GATA-4, Nkx2.5 and α-MHC mRNA levels increased continuously. When interconnected cells formed a mesh-like structure, GATA-4 expression reached the peak and then kept a high level. When adjacent cells were fused into a myotube-like structure, α-MHC reached the peak. Additionally, the expression of Nkx2.5presented a time-dependent increase trend. Overall, during the induced differentiation of BMSCs into cardiomyocyte-like cells, the expression of cardiomyocyte specific genes, characterized by temporality and spatiality, is related to the changes of cell morphology and special structure formation.

Acute lymphoblastic leukemia is the most common malignant tumor of children.Due to the application of individual chemotherapy,the cure rate of this disease is increasing.Because of the rapid development of brain in childhood,the chemotherapeutic drugs can affect the neurocognitive function of children in varying degrees.The progresses of pathophysiology,neurological function,MRI of acute lymphoblastic leukemia related neurocognitive impairment were reviewed in this article.

Objective:To examine the differences of local functional connectivity in male and female children with autism spectrum disorders (ASD), and analyze the correlation of local functional connectivity with severity of clinical symptoms in ASD children.Methods:In the International Autism Brain Imaging Exchange Database, resting-state functional MR imaging (rs-fMRI) and T1WI data were extracted from 72 children with ASD (36 male and 36 female) and 72 normal controls (36 male and 36 female) who met the inclusion criteria at 5 sites. Regional homogeneity (ReHo) method was used to evaluate the local functional connectivity of the 4 groups. A covariance analysis (gender and diagnosis as factors; age, total intelligence quotient, and head movement parameters as concomitant variables) was used to find out the differences of ReHo in the 4 groups. Pearson correlation analysis was used to examine the correlation between ReHo values with significant differences in covariance analysis and revised autism diagnostic interview (ADI-R) scale scores in children with ASD.Results:(1) Regarding the main effect of diagnosis, significantly decreased ReHo values in the right posterior cerebellar lobe, and significantly increased ReHo values in the left anterior central gyrus and the left precuneus of the ASD children were noted as compared with those in the normal controls (GRF calibration, voxel level: P<0.01, cluster level: P<0.05); regarding the main effect of gender, the male subjects had significantly higher ReHo value in the right middle temporal gyrus, and significantly lower ReHo values in the left inferior frontal gyrus, the left precuneus, the right angular gyrus, and the right supramarginal gyrus than the female subjects (GRF calibration, voxel level: P<0.01, cluster level: P<0.05); interaction effect (diagnosis×gender) results showed that there was significant difference in ReHo values of the left middle frontal gyrus among the 4 groups (GRF calibration, voxel level: P<0.01, cluster level: P<0.05). (2) The results of Pearson correlation analysis showed that the ReHo value in the right middle temporal gyrus was positively correlated with the verbal performance scores measured by ADI-R scale ( r=0.387, P=0.026), and the ReHo value in the right posterior cerebellar lobe was positively correlated with the social dimensionality scores ( r=0.364, P=0.037) in male patients with ASD; the ReHo value in the right supramarginal gyrus was negatively associated with the social dimensionality scores ( r=-0.395, P=0.031), and the ReHo value in the left middle frontal gyrus was negatively associated with the repetitive behavior scores in female patients with ASD ( r=-0.398, P=0.029). Conclusion:There are brain regions with abnormal local functional connectivity in ASD children, and there are differences in local functional connectivity between male and female patients with ASD, which may be the brain functional basis of the differences in the clinical manifestations of male and female patients with ASD, and local functional connectivity in some brain regions is related to the severity of clinical symptoms of the children with ASD.

[Objective]To evaluate the prognostic value of skull-base invasion of nasopharyngeal carcinoma(NPC)based on magnetic resonance imaging(MRI).[Methods]A total of 924 patients who were diagnosed with NPC between 2003 and 2004,had undergone MRI scan and received mdiothempy as their primary treatment,and had no distant metastasis were included in this study.MRI images and medical records were analyzed retrospectively.All the 924 eases.patients who developed skull-base invasions based on MRI,315 patients with T3 disease and 227 patients with T2 disease were selected for analysis.The staging was according to the sixth edition of the American Joint Commission on Cancer(AJCC)staging system.[Results]Incidence of skullbase invasion according to MRI was 55.4%.Of 924 cases.skull-base invasion on MRI was not an independent prognostic factor for overall survival(OS)and distant metastasis-free survival(DMFS),but was a marginally significant independent prognostic factor for local relapse-free survival(LRFS),P=0.068.Grading of MRI-detected skull-base erosion according to the site of invasion was an independent prognostic factor for OS(P=0.002 and P=0.005)and DMFS(P=0.001 for both)in the 512 patients with skull-base invasions and 315 patients with T3 disease.Severe-grade of skull-base invasion on MRI was an independent prognostic factor for OS and DMFS in the 924 patients(P ＜ 0.001 for both).No significant differences were observed on OS,LRFS,and DMFS between T2a patients and T3 patients with low-grade of MRI-deteeted skull-base involvement.[Conclusions]Skull-base invasion based on MRI is not an independent prognostic factor for NPC.However,severe-grade of invasion according to the site of involvement has positive prognostic value.

A comparative observation about histological and histochemical study were made onthe preservating methods of local ischemic kidney of dogs.The methods of this exp-eriment were divided into five groups:A.Local hypothermia;B.Hypothermic perfu-sion solution 500ml,4℃,containing Procaine 450 mg and Heparin 100 mg,infusedinto renal artery;C.Hypothermic perfusion solution 500ml,4℃,containing 20% Ma-nniton 32ml,25% MgSO_4 0.36 ml,Heparin 100 ml,infused into renal artery;D.Localhypothermia and heparin 30 mg injected into the same vessel.E.Local room tem-perature.The specimens were taken from the kidneys of the experimental dogs atvarious period after treated with every method.The results were as follows;A,D and E group presented irreversible histological changes within 4 hoursaftertreatment.Four hours later,the reaction of SDH,ATPase,AlPase werenegative.It suggested that the kidney damage was serious,as well as expressed thatthe effect of these preservating methods for ischemic kidney are not satisfactory.In B group,the histological and histochemical alteration is very light and almostreversible,during 60 days after treatment.In C group,hypothermic perfusionsolution containing Mannitol,MgSO_4 etc either during experiment or follow observa-tion for 60 days,no histological and histochemical alterations were found.It indica-ted that this method is an ideal perservating technique for ischemic kidney.

Objective:To explore the predictive value of systemic immune inflammation index (SII) for the risk of hospital death in critically ill patients.Methods:The basic information and clinical data of critically ill patients were extracted from the Medical Information Mart for Intensive Care database-Ⅳ (MIMIC-IV) database, including demographic data, vital signs, blood routine, Logistic organ dysfunction score (Lods), Oxford acute severity of illness score (Oasis), simplified acute physiology score (Saps-Ⅱ), acute physiology score Ⅲ (APS-Ⅲ), sequential organ failure score (SOFA) and outcome. The main outcome was hospital death, and the secondary outcomes were length of hospital stay, continuous renal replacement therapy (CRRT), invasive ventilation and 1-year mortality. Patients were divided into two groups according to in-hospital death, and the differences between the groups were compared. According to the SII tripartite for inter-group comparison, the patients were further divided into three groups for comparison, and Logistic regression model was used to analyze the odd ratio ( OR) of the three groups. Results:A total of 32 450 critically ill patients were included in the study, of which 3765 died in hospital, with a mortality rate of 11.6%. ① Compared with the survival group, the SII in the death group were significantly higher ( P < 0.05). ② The mortality for the SII tripartite grouping (<817; 817~2 151; >2 151) were 8.4%, 10.2% and 16.3%, respectively, and the differences between groups were statistically significant. ③ Further, Logistic regression model analysis showed that the risk of death increased gradually with the increase of groups (the first group was the reference group, OR of the second group was 1.38, 95% CI 1.24-1.54, and OR of the third group was 2.03, 95% CI 1.83-2.24 ( P < 0.05). Conclusions:SII has a certain value in predicting hospital death in critically ill patients. It is easy to obtain and can be used for risk stratification of critically ill patients.