Computer-Aided Design ; Head ; pathology ; surgery ; Humans ; Neck ; pathology ; surgery ; Printing, Three-Dimensional ; Reconstructive Surgical Procedures

Objective To evaluate the changes of brain metabolism with 18F-fluorodeoxyglucose (FDG) PET/CT in patients with disorders of consciousness (DOC).Methods This retrospective study,from January 2007 to October 2016,included 40 patients (26 males,14 females,age range:17-73 years)in the vegetative state (VS),12 patients (11 males,1 female,age range:25-53 years) in the minimally conscious state (MCS),and 11 patients (10 males,1 female,age range:12-68 years) in the state of recovering from DOC.All patients underwent 18F-FDG PET/CT imaging.The standardized uptake value (SUV) of multiple brain areas among 3 groups of patients was calculated and compared.One-way analysis of variance was used for data analysis.Results The SUV in different encephalic regions among 3 groups were significantly different (F values:6.214-13.642,all P＜0.01) except for mesencephalon.Compared with MCS group,the SUV of cerebral cortex of VS group was lower (t values:2.263-3.548,all P＜0.05).Compared with the recovered group,the SUV of cerebral cortex and cerebellum of VS group was lower (t values:1.299-5.136,all P＜0.05).Compared with the recovered group,the SUV of parietal lobe,temporal lobe,occipital lobe,thalamus and cerebellum of MCS group was lower (t values:1.962-2.841,all P＜0.05).Conclusion 18F-FDG PET/CT may be significant in evaluating brain function of DOC patients.

Objective: To investigate the expression of H3.3 G34W mutant-specific antibody in giant cell tumors of bone (GCTB), and its value in the diagnosis of GCTB. Methods: Immunohistochemical (IHC) EnVision method was used to detect the expression of H3.3 G34W mutant-specific antibody and p63 in 83 GCTBs, 18 aneurysmal bone cysts, 23 chondroblastomas and 28 osteosarcomas diagnosed at Nanjing Jinling Hospital from June 2001 to April 2019. Results: Among the 83 cases of GCTB, 69 cases (69/83, 83.1%) expressed H3.3 G34W. H3.3 G34W expression was found exclusively in the mononuclear cell population with strong and diffuse nuclear staining. H3.3 G34W was expressed in 55 of 57 (96.5%) cases of GCTB in long bones, but only 14 of 26 (53.8%) cases of non-long bone GCTB. All recurrent (9/9)/metastatic GCTB (2/2), post-denosumab GCTB (3/3), primary malignant GCTB (3/3) and secondary malignant GCTB (5/5) also expressed H3.3 G34W. H3.3 G34W was negative in all aneurysmal bone cysts and chondroblastomas. H3.3 G34W was positive in 3 of 28(10.7%) cases of osteosarcomas, and giant cell-rich osteosarcoma(GCRO) was the only histological subtype of osteosarcoma that expressed H3.3 G34W. p63 was expressed in 71.1%(59/83) of GCTB, while the positive rates of p63 in aneurysmal bone cysts,chondroblastomas and osteosarcomas were 3/18, 43.5% (10/23) and 21.4% (6/28) respectively. The sensitivity and specificity of H3.3 G34W mutant-specific antibody in the diagnosis of GCTB were 83.1% and 95.7%. Conclusions H3.3 G34W mutant-specific antibody is a highly sensitive and specific marker for GCTB and helpful for the diagnosis of GCTB and its variants. The limitation of this antibody is that as a mall number of GCTB harbor G34 mutation other than G34W, and thus that cannot be detected. The incidental expression of H3.3 G34W mutant protein in osteosarcoma could be a potential diagnostic dilemma, and the results of H3.3 G34W IHC staining needs careful interpretation.

Thyroid cancer is a common head and neck malignant tumor,it has become a malignant tumor of the highest incidence in young women in China.The treatment of thyroid cancer is a surgery-based comprehensive therapy,and the protection of the parathyroid gland during surgery has always been a major problem for clinicians.The methods for protection of parathyroid glands are in situ preservation or immediate parathyroid autotransplantation according to whether or not the blood supply can be maintained.To identify the parathyroid gland is the key issue of the protection during thryoidectomy.This article reviews the recent progress of the identification and protection of parathyroid glands at home and abroad.

Objective To compare the outcomes between conservative treatment and reconstruction with LARS in patients over 50 years old with chronic forward instability of knee joint.Methods Forty patients with chronic forward instability of knee joint from May,2005 to September,2013 in Shengjing Hospital of China Medical University were included in this study and were divided into conservative treatment group(16 cases) and LARS group(19 cases) besides that were ineligible according to different treatment methods.All patients were followed up for two years.The evaluation indicators included Lysholm,IKDC,Tegner,ROM,Kneelax and Kellgren-Lawrence rating.Results At the end of two-year follow-up,the knee joint function score of conservative treatment group was significantly higher than that before treatment (Lysholm score after treatment (83.4± 12.5) points,before treatment (69.6 ± 10.4) points,t =-11.502,P =0.00;IKDC after treatment,abnormal 2 cases,and before treatment,abnormal 10 cases,P =0.00;Tegner after treatment 6 (1,9) points,before treatment 3 (1,5) points,Z =-3.471,P =0.01).The knee joint function score and Kneelax measurement in the LARS ligament reconstruction group were significantly improved after operation(Lysholm score after treatment (80.0±14.2) points,before treatment (68.7±9.6) points,t =-7.875,P =0.00;IKDC score after treatment,abnormal 2 cases,and before treatment,abnormal 13 cases,P =0.00;Tegener score after treatment 8 (1,9) points,before treatment 3 (1,5) points,Z =-3.879,P=0.00;Kneelax score after treatment (1.5 ± 0.8) mm,before treatment (4.2 ± 0.8) mm,t =9.955,P =0.00).At the end of two-year follow-up,kneelax and Tegner scores in LARS ligament reconstruction group were significantly higher than those in conservative treatment group (Z =6.109,P=0.00;Z =2.672,P =0.01).Conclusion Compared with conservative treatment,LARS ligament reconstruction is more conducive to the stability and functional recovery of knee joint in patients over 50 years old with chronic anterior instability of knee joint.

Objective To compare the effect of whether rotator cuff pathological tissue cleaning and tendon insertion reconstruction or not under shoulder arthroscopy on the surgical treatment of rotator cuff tendinopathy. Methods From September 2015 to January 2017,the clinical data of forty-one patients with rotator cuff tendinopathy treated by surgical medicine ward in Shengjing Hospital of China Medical University were retrospectively analyzed. According to different surgical methods,41 patients were divided into A group and B group. In group A,21 patients were treated with shoulder arthroscopic bursa debridement combined with selective acromioplasty. In group B,20 patients were treated with cleanup of pathological changes tissue and reconstruction of tendon insertion on the basis of A. All patients were followed up for one year. Constant-Murley shoulder function score,visual analog scale (VAS),University of California Los Angeles (UCLA) and Hawkins sign,arc of pain sign and infraspinatus muscle test were used as the evaluation indexes. The shoulder joint function was evaluated so as to compare the efficacy of two surgical methods for rotator cuff disease. Results Compared with the preoperative,the postoperative VAS score,UCLA score and Constant-Murley score in both groups were significantly improved. In group A,the preoperative in group A (5. 0±1. 3) points,(15.5±1.4) points,(65.1±5.7) points) were increased to (0.7±0.4) points,(33.0±1.7) points,(90. 9±3. 1) points. The preoperative scores of group B were (5. 2±1. 0)points,(15. 6±2. 0) points, (65. 4±5. 9) points, and increased to ( 0. 4 ± 0. 5) points, ( 34. 3 ± 0. 9) points, ( 93. 3 ± 2. 3) points respectively,and the differences were statistically significant (group A: t＝14. 77,P＜0. 001; t＝－ 74. 44,P＜0. 001; t＝－ 29. 19,P＜0. 001; group B: t＝23. 13,P＜0. 001; t＝－ 61. 52,P＜0. 001; t＝－ 26. 38,P＜0. 001). The UCLA score and Constant-Murley score of shoulder joint in group B were higher than those in group A (t＝－3. 27,P＝0. 003; t＝－2. 90,P＝0. 007). Postoperative positive rates of Hawkins sign,pain arc sign and infraspinatus muscle test in group A decreased from 90%(18/20),90%(18/20),95%(19/20) to 15%( 3/20),10%( 2/20) and 15%( 3/20) respectively. There was a significant difference between preoperative and postoperative (χ2＝13. 067,P＜0. 001) . χ2＝14. 063,P＜0. 001; χ2＝14. 063,P＜0. 001), group B decreased from 90. 5%( 19/21), 85. 6%( 18/21), 90. 5%( 19/21) to 9. 5%( 2/21), 4. 8%(1/21),9.5%(2/21).There were significant differences between preoperative and postoperative (χ2＝15. 059,P＜0. 001;χ2＝12. 500,P＜0. 001;χ2＝15. 059,P＜0. 001) . Conclusion Both group A and group B are effective in the treatment of rotator cuff tendon disease,and group B is more effective than group A in the treatment of rotator cuff tendon disease.

The TNM staging system is an essential standard for cancer treatment and evaluation, and is used to assess a patient''s prog-nosis. Therefore, every update made to the system is of great significance. According to the recently released edition of the American Joint Committee on Cancer (AJCC) Staging Manual, several major changes to head and neck cancer staging have been made. In this pa-per, we analyze the advantages and disadvantages of these amendments and offer a direction for making future amendments. Our goal is to provide a brief introduction of recent research on head and neck cancers, which can be used as a reference by clinicians.

Objective: To investigate the application of virtual reality technology in the preoperative evaluation of complex head and neck carcinoma and he value of virtual reality technology in surgical treatment of head and neck carcinoma. Methods: The image data of eight patients with complex head and neck carcinoma treated from December 2016 to May 2017 was acquired. The data were put into virtual reality system to built the three-dimensional anatomical model of carcinoma and to created the surgical scene. The process of surgery was stimulated by recognizing the relationship between tumor and surrounding important structures. Finally all patients were treated with surgery. And two typical cases were reported. Results: With the help of virtual reality, surgeons could adequately assess the condition of carcinoma and the security of operation and ensured the safety of operations. Conclusions Virtual reality can provide the surgeons with the sensory experience in virtual surgery scenes and achieve the man-computer cooperation and stereoscopic assessment, which will ensure the safety of surgery. Virtual reality has a huge impact on guiding the traditional surgical procedure of head and neck carcinoma.

Extrathyroidal extension of thyroid cancer has been an important adverse factor affecting the prognosis of patients. According to the latest NCCN (National Comprehensive Cancer Network) guidelines, extrathyroidal extension is the surgical guide fortotal thyroidectomy in newly diagnosed patients, and its incidence in differentiated thyroid cancer is 5%-34%, belonging to T3-T4 stage.In the eighth edition of thyroid cancer AJCC staging, the T3 stage was first divided into T3a (tumor>4 cm and limited to the thyroid) and T3b (gross extrathyroidal extension invading only strap muscles from a tumor of any size), and the "minimal extrathyroidal extension(tumor invasion intoperithyroidal soft tissue or strap muscle invasion)"of the seventh edition was removed from the T stage and changed to the gross extrathyroidal extension invading only strap muscles, but there is still much controversy. It can be seen that different degrees of "extrathyroidal extension" have significant differences in the survival and prognosis of thyroid cancer. This article reviews the latest research progress of extrathyroidal extension, and discusses the significance and clinical research progress of it.

Adult ; Aged ; Coma ; physiopathology ; Consciousness ; physiology ; Consciousness Disorders ; physiopathology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Persistent Vegetative State ; physiopathology ; Photic Stimulation ; methods ; Recovery of Function ; physiology ; Treatment Outcome