Objective To determine the anatomical basis of an algorithm to safely elevate the deep circumflex iliac artery osteocutaneous perforator(DCIAP) flap. Methods 1.Six unfixed corpses underwent whole body gelatine/lead oxide injection.Specimens were dissected by layers.Angiography and photography were used to document the precise course,size,location,and type of individual perforators in the lateral lumbar region.The surface areas of cutaneous territories and perforator zones were measured and calculated with Photoshop and Scion Image.2.One specimen also underwent whole body carboxymethylcellulose/lead oxide injection,CT scan and 3D-Reconstrution. Results An average of 1.6 DCIA perforators with a diameter of 0.7mm was present in 92% of specimens.Perforators were located 5～10 cm posterior to the anterior superior iliac spine,12～35mm above the crest,with a perforator zone of 31 cm~2.The DCIA reliably perfused the medial aspect of the iliac crest.Conclusion The DCIA reliably perfused the medial aspect of the iliac crest and lateral lumbar region.It offers a large quantity of bone on a pedicle of large diameter.The mobility of the skin component allows better tissue positioning during complex reconstructions.

Objective To provide anatomical information and clinical application of flaps based on the proximal ulnar artery perforators.Methods Ten fresh cadavers who underwent injected with artery imaging technology and dissected with layer by layer;Eighteen patients who sought surgical treatment with proximal ulnar artery perforator flap for soft tissue defects of the finger and dorsum wrist at our hospital between October 2011 and November 2012 were included in this study.Results The diameter and superficial length of the main perforator respectively were 0.5-0.9 mm and 33.0-47.0 mm in our dissection.There were 5-9 perforators given from the ulnar artery to supply skin over the medial side of the forearm.All of the 18 flaps survived after surgeries.The flap size ranged from 3.0 cm × 2.5 cm to 10.0 cm × 5.5 cm.All of the transplanted flaps presented favourable contours and good functions at 6 to 12 months' followed-up.Conclusion Proximal ulnar arter perforator flap has favourable appearance,constant vascular pedicle,reliable blood supply,and large diameter.The free transplantation of this flap offers a satisfactory alternative for repairing the small and medium-sized area of soft tissue defects of forearm and hand.

Objective To investigate the change of caspase-3 in rabbits after lung ischemia-reperfusion injury(LIRI) and the effect of puerarin(葛根素).Methods Thirty healthy rabbits used for unilateral lung ischemia-reperfusion model were randomly divided into 3 groups(each n=10): control group(C group),lung ischemia-reperfusion group(I/R group) and puerarin group.The activity of serum superoxide dismutase(SOD),the contents of serum malondialdehyde(MDA) and nitric oxide(NO),the wet to dry weight(W/D) ratio of lung tissue and the index of quantitative assessment of histological lung injury(IQA) were measured respectively in different groups;the pneumocyte apoptosis index(AI) was achieved by terminal deoxynucleotidyl transferase mediated dUTP nick end labeling(TUNEL);caspase-3 protein and mRNA expression were studied by using in situ hybridization(ISH) and immunocytochemistry(IHC) techniques in the groups mentioned above.Results The activity of SOD and content of NO were significantly lower in I/R group than those in C group(both P

Purpose:To evaluate the efficacy and safety of combination regimen of Epirubicin, Leucovorin, 5 Fluorouracil and Cisplatin (ECF L) in treatment of patients with unresectable or recurrent gastric carcinoma, a phase IV study was conducted.Methods:Patient who was pathologically confirmed as primary gastric carcinoma or its metastatic foci with at least one measurable focus was enrolled in nine sites. The chemotherapy regimen was composed of Epirubicin 50mg/m 2 d1, Lecuovorin 200mg/m 2 d1～3, 5 Fu 600mg/m 2 d1～3, and Cisplatin 20mg/m 2 d1～3 given intravenously, which was designed to be three cycles (three weeks per cycle) per patient. Supportive treatment is allowed if necessary. Written informed consent form was obtained from each patient.Results:From 2000 March to 2001 August a total of 79 patients (16/79 of stage Ⅲ, 63/79 of stage Ⅳ; 37/79 of initial chemotherapy, 42/79 of secondary chemotherapy, and 53/79 of recurrent after surgical intervention) were enrolled and finally there were 66 evaluable patients. Among them 4 achieved CR and 18 of PR, the overall response rate (RR) was 33.3% (22/66), the RR of initial patient was 36.7% (11/30), secondary patient was 30.6% (11/36), and subject with lymph node and/or soft tissue metastasis achieved 50.0% (15/30). There were 25 patients with NC, 19 of PD, and 13 withdrew during the study. Most common adverse event occurred was bone marrow suppression (WHO standard degree Ⅲ～Ⅳ, 20.1%), alopecia (Ⅲ～Ⅳ, 5.1%), and nausea/vomiting (Ⅲ～Ⅳ, 2.3%).Conclusions:Current data indicated the ECF L regimen was feasible to treat the unresectable gastric carcinoma with tolerable toxicity.

Objective To investigate the effects of DMOG on the microcirculation of the choke-area and the survival of the cross-boundary flap in rats via tail vein injection.Methods Rats with ischemic three-territory perforator flaps on the dorsum were treated with DMOG at a dosage of 40 mg/kg body weight via tail vein injection at 1 day before surgery(day-1),the time of surgery(day 0),1 day after surgery(day 1),2 days after surgery(day 2) and 3 days after surgery(day 3).Control group received sterile saline at the same time points and same dosage via tail vein injection.① Draw materials from the choke-area at day 1,day 3 and day 7,HE stain was used to compare the diameter size of the artery and vein at the same site.② Western blotting to check the expression of PCNA and HIF-1α,ELISA to detect the content of PCNA,HIF-1α,SDF-1α and VEGF at day 7.③At day 7,measure the survival area of the flap and observe the vessel of the flap by lead oxide-gelatine technique.Results ① There was a greater survival rate of (96.3 ± 5.1)％ in the treatment group than in the control group with (73.9 ± 5.8)％ at day 7 (P ＜ 0.05).② The diameter size of the arterioles and venules were dilated in both groups until postoperative days 7.But the treatment group was more expanded than the control group at day 3(2.20 ± 0.26 vs.1.50 ± 0.20,P ＜ 0.05) and day 7(3.67 ± 0.35 vs.2.03 ± 0.15,P ＜ 0.05).③ The skin expression of PCNA and HIF-1α in the treatment group were greater than the control group(P ＜ 0.05) at day 7.④ The content of skin PCNA in the treatment group and control group were(8.95 ± 0.71) ng/mg and (4.15 ± 0.72) ng/mg,HIF-1α were(5.04 ± 0.50)ng/mg and (2.98 ± 0.29) ng/mg,SDF-1α were (2.91 ± 0.61) ng/mg and (1.39 ± 0.62) ng/mg,and VEGF were(2.17 ± 0.41) ng/mg and (0.95 ± 0.44) ng/mg,respectively.The treatment group was greater than the control group (P ＜ 0.05).Conclusion DMOG can improve the microcirculation of the choke area,and then increase the survival of the perforator skin flaps in rats via tail vein injection.

Objective To reduce the misdiagnosis of the inpatients admitted to digest department with abdominal pain through analyzing the consultation undertaken by surgeon.Method The causes and the constituent ratio according to the case records of those inpatients admitted to digest department because of abdominal pain were analyzed.Results The obstruction of hollow viscus was the first cauge(51.07%),and the tumor of digestive tract(17.78%)was the second cause for invitation for consultation to surgeon of the inpatients with abdominal pain in digest department wards.The ultrasound 32.78%,CT 26.67% and gastroenterological endoscope 13.89% were definite diagnosis,and should shorten the time of consultation.Conclusion Whether inpatient or outpatient with abdominal pain should be planned to be examined by ultrasound,CT or gastroenterological endoscope,obgerve the changes of the symptom and sign so that the misdiagnosis can be avoided.

Objective To explore the diagnostic performance of susceptibility weighted imaging (SWI) in distinguishing malignant from benign parotid lesions.Methods We prospectively evaluated preoperative SWI findings of 41 patients with 12 malignant and 29 benign parotid lesions by surgical pathology, and explore the intravenous distribution, the largest diameter of veins (dv-max), the number of veins per unit area (N/Svein) and the graduation of intratumoral susceptibility signal intensity (ITSS).The parameters was analyzed by Chi-square test, Independent t-test, Mann-Whitney U rank test and receiver operating characteristics (ROC) curves with SPSS 16.0 software.Results (1) For intravenous distribution, the benign ones mainly distributed around peripheral areas, accounting for 89.7％ (26/29), while the malignant ones were centrally distributed, making up 10/12.There were significant difference (x2=20.882, P=0.000) between benign and malignant ones.(2) The largest diameter of veins (dv-max) of benign and malignant lesions were (1.1±0.5) mm and (2.5 ± 1.0)mm respectively.There were significant difference (t=4.633, P=0.000) between benign and malignant ones.(3) The N/Svein of benign lesions were (0.80±0.92) per cm2, while that of malignant ones are (1.07±0.69) per cm2.The N/Svein (t=0.9143, P=0.367) was statistically insignificant.(4) For the graduation of ITSS,among benign lesions, there were 3 cases of grade 0, 22 cases of grade 1, 2 cases of grade 2 and 2 cases of grade 3.Meanwhile, there were 2 cases of grade 1, 5 cases of grade 2 and 5 cases of grade 3 among malignant lesions.When the Youden index reached the highest point, the optimal diagnostic threshold of dv-max and ITSS values were 1.75 mm and 1.5 mm, the corresponding area under the ROC curve (AUC) were 0.924 and 0.856 respectively.The sensitivity of d and ITSS ondiagnosis were 10/12 and 10/12, and the specificity of that were 96.6％ and 86.2％ respectively.The table shows that the sensitivity and specificity of intravenous distribution in diagnosis of malignant lesions are 10/12 and 89.7％.Conclusions The results provided evidence that SWI may be helpful in distinguishing malignant from benign parotid lesions, and it is worth to be generalized in clinical medicine.

Objective To investigate the correlation between apparent diffusion coefficient (ADC)value of MR diffusion weighted imaging (DWI)and Ki-67 expression in rectal cancer.Methods The data of 47 patients with rectal cancer confirmed by pathology were retrospectively analyzed.Pelvic MRI,rectum DWI and enhanced examination were performed preoperatively.According to the Ki-67 index,the patients were divided into A-D four Groups:Group A with Ki-67 <10% (-),Group B with Ki-67 10%-25%(+),Group C with Ki-67 26%-50%(++);and Group D Ki-67 > 50%(+++).ADC values were calculated in each group to analyze the correlation with the Ki-67 expression levels.Results The mean ADC value were (1.280 ± 0.200 )× 10 -3 mm2/s in Group A (13 cases),(1.044±0.046)×10 -3 mm2/s in Group B (14 cases),(0.987 ±0.256)×10 -3 mm2/s in Group C (9 cases), and (0.85 1±0.099)×10 -3 mm2/s in Group D (1 1 cases).The mean ADC values were significantly different in the different groups with different levels of Ki-67 expression (P =0.001).ADC value and Ki-67 expression were moderate negatively correlated (r = -0.577, P=0.000).Conclusion DWI and ADC measurement can evaluate indirectly the cell proliferation and prognosis of rectal tumor to some extent.

OBJECTIVETo investigate the vascular supply of intrinsic muscles of foot and anatomic basis for muscular flap design.

METHODSA radiopaque injectate (lead oxide-gelatin mixtures, 26 ml/kg) was injected into 10 fresh cadavers. The dissected regions were photographed and each intrinsic muscles on the foot was removed and radiographed. The number, type, diameter of vascular branches of muscles and their distributions were observed. The area of the vascular territory supplied by each source vessel was calculated using Scion Image for Windows software.

RESULTSThere were significant architectural differences among the intrinsic muscles. The muscles length varied from 22.5mm to 116.2mm [average, (66.1 +/- 23.2)mm]. The measured fiber length were relatively consistent, ranging from 14.2 mm to 27.5 mm [average, (20.2 +/- 4.5)mm]. There are 63 vascular branches into the 23 foot muscles, each muscle having average branches of 3.2 +/- 0.8. The average diameter of branches, the length and width of each vascular territorial area is (0.8 +/- 0.3) mm, (2.2 +/- 0.8) cm, and (0.9 +/- 0.4) cm, respectively. Other findings included that some muscles were not present in some cadavers.

CONCLUSIONSThe blood supply of intrinsic muscles of foot is abundant with different diameter and distributions of branches. There is an anatomic basis for muscular or musculoosseous flap design. There are 7 intrinsic muscles with large and reliable vascular supply which can be chosen as muscular flaps.

Objective To investigate the association of MRI features with HER-2 expression in non-mass-like breast carcinoma. Methods 74 patients with breast cancers diagnosed by pathology underwent MRI prior to surgery,and all lesions were non-mass-like enhancement on dynamic contrast-enhanced MRI.The expression of HER-2 in tumor tissue was detected by immunohistochemical staining.Chi-square test,Fisher’s exact test and spearman rank correlation were used to evaluate the correlations between the morphological characteristics, dynamic enhanced MR parameters,ADC value and HER-2 expression.Results The tumor size was correlated positively with the expression degree of HER-2 (r=0.341,P =0.003).The ADC value was also correlated positively with the positive expression degree of HER-2 (r=0.31 7,P =0.006).However,the time to peak was correlated negatively with that (r =-0.244,P =0.036).No significant correlations between the distribution/internal enhancement manner,the type of time signal intensity curve and HER-2 expression were found (all P >0.05).Conclusion Tumor size,time to peak and ADC value are correlated with the expression of HER-2 in non-mass-like breast carcinoma,which is helpful for the treatment plan and prognosis evaluation for this cancer.