Solitary fibrous tumor (SFT) is a rare spindle cell neoplasm that usually develops in the pleura and peritoneum. The head and the neck region is involved in only 6% of the cases. We described a rare case of large SFT originated from the right neck region in a 32-year-old man. Enhanced CT scan revealed two large completely resected masses in the carotid sheath region and the right thyroid gland. Immunohistochemical studies showed positive CD34, CD99, NSE and bcl-2, and negative Desmin, NF, S-100, CD31, F8, CK, MBP, indicating that the tumor was benign. It showed no evidence of recurrence on the patient during 9 years follow-up.
Adult ; Head and Neck Neoplasms ; diagnosis ; Humans ; Male ; Solitary Fibrous Tumors ; diagnosis ; Tomography, X-Ray Computed

OBJECTIVE:To provide reference for rational prophylactic application of antibiotics in perioperative period of per-manent cardiac pacemaker implantation. METHODS:600 cases performed permanent cardiac pacemaker implantation in 2010(be-fore rectification),2012(during rectification)and 2014(after rectification)were randomly sampled from our hospital,and divided into control group,intervention group one and intervention group two. The prophylactic application of antibiotics was investigated and analyzed in 3 groups. RESULTS:For control group,intervention group one and intervention group two,the rates of rational type selection of antibiotics for prophylactic use were 7.25%,31.00% and 91.96%,respectively. The rates of rational medication timing of antibiotics for prophylactic use were 0,100% and 100%;average duration of prophylactic use decreased from (3.6 ± 1.2)d before intervention to(1.1±0.5)d and(1.0±0.2)d. There was no statistical significance in the incidence of postoperative infection(P>0.05). Compared with control group,average drug cost,antibiotics cost and drug ratio decreased significantly in in-tervention group,with statistical significane (P<0.05). CONCLUSIONS:Antibiotics special rectification is effective and improve the rational application of antibiotics in our hospital.

Objective To observe the availability and safety of ventricular septal defect (VSD) occluder in infants and young children with large patent ductus arteriosus (PDA) associated with severe pulmonary hypertension.Methods Five patients (1 male and 4 fomale) of large PDA aged 5 months to 3 years,weighted from 5.1 to 15 kg,body surface area (BSA) 0.37-0.58 m2 underwent transcathter intervention with concentric VSD occluders from June 2008 to May 2009.Arterial ducta were tube-like and their diameters were 5.7 to 8.5 mm,with ulmonary vascular resistance from 4.8 to 5.7 Wood Unit,Qp/Qs 3.4-4.6.Three patients were given Bosentan after intervention.Results The large PDAs were successfully closed with VSD occluders,including 1 concentric perimembranous VSD occluder and 4 muscular VSD occluders.They all discharged 4 to 5 days with hidrosis and weight improved.Echocardiogram indicated VSD occluder was stable,no residue shunt and no stricture of left pulmonary artery and descending aorta were found.According to tricuspid and pulmonary regurgitation,pulmonary arterial pressure decreased differently and returned to normal after 6 months follow-up.Conclusion VSD occluder is available and effective to close large PDA associated with severe pulmonary hypertension in inrants and young children,but more cases and long-term follow-up are necessary.

Objective To evaluate diagnostic endoscopic submucosal dissection(D-ESD) for gastric intraepithelial neoplasia(GIN).Methods From January 2012 to May 2016,64 patients with biopsy-proven LGIN who accepted magnifying endoscopy combined with digitalchromoendoscopy(ME-DCE) and D-ESD in Gastrointestinal Endoscopy Center of Nanfang Hospital affiliated to Southern Medical University were retrospectively analyzed in this study.The consistency of ME-DCE prediction with D-ESD pathologic outcome was analyzed by using Kappa test.According to D-ESD pathologic outcome,the two groups were analyzed with independent t-test,chi-square test,or Fisher's exact probability test.Results Sixty-four patients with biopsyproven LGIN were enrolled;25 and 39 patients were predicted by ME-DCE as LGIN and HGIN/differentiated adenocarcinoma respectively;27 and 37 patients were diagnosed as LGIN and HGIN/differentiated adenocarcinoma by D-ESD respectively.ME-DCE prediction was well consistent with D-ESD pathologic outcome(k =0.676).According to pathologic outcome of D-ESD,no significant difference was observed in lesion size,biopsy amount,D-ESD sample size,complete resection rate,operation time period,complications,length of hospital stay,or in-hospital cost(P＞0.05).Conclusion ME-DCE can be proposed when the endoscopic biopsy indicates LGIN.And D-ESD should be performed for definitive diagnosis when the MEDCE indicates HGIN/differentiated adenocarcinoma.

Objective:To explore the method of establishing a modified demyelination and myelination regeneration model induced by dicyclohexanone oxalyl dihydrazone (CPZ) in mice with multiple sclerosis (MS), and to analyze the image markers of demyelination and myelination regeneration in mouse MS model.Methods:After the intragastrically administered with sodium carboxymethyl cellulose (CMCNa) for one week, a total of 30 C57BL/6 male mice were randomly divided into the control group ( n=10), the demyelination group ( n=10), and the remyelination group ( n=10). The mice of the control group were immediately performed MR scanning and pathological specimen obtaining; the mice in the demyelination group were administered with intragastrical CPZ-CMCNa once a day for 6 weeks for inducing demyelination, then received MR scanning and specimen obtaining with the same protocols used in control group; the mice in the remyelination group were administered with intragastrical CPZ-CMCNa once a day for six weeks for demyelination, then CPZ was withdrawn and normal diet was given for another four weeks. Then MR scanning and specimen obtaining were performed with the same protocols used in the other two groups. Regions of interest (ROIs) were set at the rostrum of corpus callosum (rCC), the bilateral normal appearing white matters (NAWM) of the rostrum of corpus callosum, and the bilateral cerebral cortex (Cx). The normalized T 2WI (T 2-normalized), fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) values were compared among the three groups by one-way ANOVA. Results:The demyelination and remyelination mice model of MS were successfully established. The T 2-normalized values of rCC in control group, demyelination group and remyelination group were 0.47±0.03, 0.72±0.04, 0.54±0.04, respectively, with statistically significant difference found ( F=90.511, P<0.05). Post-hoc multiple comparisons showed significant differences among those groups ( P<0.05). There was no significant difference of T 2-normalized value in NAWM and Cx among the three groups ( P>0.05). Moreover, there were significant differences in the FA values (0.36±0.04, 0.29±0.03, and 0.32±0.05), the MD values [(0.572±0.015), (0.598±0.034), and (0.626±0.043)×10 -3 mm 2/s], the AD values [(0.79±0.04), (0.77±0.06), and (0.83±0.04)×10 -3 mm 2/s], and the RD values [(0.46±0.02), (0.51±0.03), and (0.53±0.05)×10 -3 mm 2/s] of rCC of the control group, the demyelination group, and the remyelination group (all P<0.05). Significant difference was found in FA values between the demyelination group and the control group ( P<0.05), and in MD values between the remyelination group and the control group ( P<0.05), as well as in AD values between the remyelination group and the demyelination group ( P<0.05). There were also significant differences in RD values between the remyelination group and the control group, and the demyelination group and the control group (all P<0.05). However, no significant difference was found in all diffusion tensor imaging (DTI) metrics of NAWM and Cx among the three groups (all P>0.05). The LFB-eosin staining showed that the myelin sheath of rCC was lost in the demyelination group, and the rCC was partially regenerated and repaired in the remyelination group. Conclusion:The modified CPZ-CMCNa model can selectively induce demyelination and remyelination of rCC, and the changes of demyelination and remyelination of rCC in the modified CPZ-CMCNa model can be quantitatively detected by T 2WI combined with DTI, which might provide related theoretical basis for the study on dynamic changes of MS lesions.

Objective Transesophageal echocardiography (TEE) guided, minimally invasive perventricular device occlusion of ventricular septal defects ( VSDs) without cardiopulmonary bypass ( CPB) has been applied in multiple centers. We reported experiences and the mid-term results. Methods Four hundred and thirty-two cases from 4 cardiac centers were involved in the study. There were 235 males and 197 females, aged from 3 months to 15 years, with a body weight varying from 4.0 to 26.0 kg. Three hundred and fifty-one patients had perimembranous VSDs, 57 had intracristal or supracristal VSDs and 24 had muscular VSDs (17 had multiple muscular VSDs). The diameter of the VSD ranged from 3 to 12 (5.3 ±1.6 ) mm.For those with perimembranous or muscular VSDs, a 3 to 5 cm inferior sternotomy was made, but for those with intracristal or supracristal VSDs, a 2 to 3 cm incision was made parastemally through the left third intercostal space. Being monitored and guided with TEE, the device was deployed to occlude the VSD through the puncture at the free wall of the right ventricle. TEE was used for assessing the residual shunting, the left and right ventricular outlet tracts, valvular function and for detecting any arrhythmia, The devices would be released if the heart rhythm was normal, as well as the residual shunting and valvular regurgilalion were not detected. Results The procedure was completed successfully in 417 cases(96.5% ) and converted to traditional surgical closure with CPB in the other 15 cases(3.5% ). Concentric devices were used in 238 cases(57.1% )and eccentric devices were used in 179 patients(42.9% ). Successful procedures finished in less than 90 minutes, and the deployment and evaluation of the devices were completed in 5 to 60 (18. 2 ± 8.6) minutes. No residual shunt and detectable aortic or tricuspid insufficiency and arrhythmia was observed. Patients were extubated within 2 hours and discharged 3 to 5 days after the operation. During fellow-up period from 3 months to 2 years, no clinically significant complications occurred. Conclusion The minimally invasive device closure of VSD under TEE guidance without CPB is proved to be a simple, safe and effective treatment for a considerable number of children with VSD. Its use in the clinical practice should be encouraged.

Objective To analyze the clinical characteristics and prognostic factors of elderly patients with cytogenetically normal acute myeloid leukemia (CN-AML). Methods A total of 104 initial CN-AML patients were enrolled in this retrospective study. The clinical characteristics were collected and analyzed retrospectively. Factors affecting complete remission (CR) were analyzed by using chi square test. Univariate and multivariate analyses of prognostic factors were performed by using Kaplan-Meier and Cox hazard regression model respectively. Results After the first chemotherapy, 72 of 104 patients were able to be evaluated the efficacy, the CR rate was 38.9%(28/72) and total response rate was 55.6%(40/72). The white cell count<100 × 109/L and NPM1 mutation were related to a higher CR rate [59.4%(38/64) vs. 12.5%(1/8), 83.3%(10/12) vs. 36.4%(8/22), P<0.05]. Among 104 patients, the median overall survival (OS) was 6.9 months. Univariate analysis results demonstrated that age≥70 years, secondary AML, white cell count≥100×109/L, FLT3-ITD mutation, CD7 expression, achieving CR beyond 2 cycles of induction therapy and CCI score≥2 were influence factors on OS. In multivariable analysis, FLT3-ITD mutation (HR=7.61, 95%CI 1.80-32.11, P= 0.006) and achieving CR beyond 2 cycles of induction therapy (HR= 10.11, 95 % CI 2.38-43.03, P=0.002) were independent prognostic factors for OS in elderly patients with CN-AML. Conclusion The prognosis of elderly patients with CN-AML is the result of the combined effect of many factors, FLT3-ITD mutation and achieving CR beyond 2 cycles of induction therapy are independent prognostic factors in elderly patients with CN-AML.

OBJECTIVETo assess the feasibility and safety of using the modified active fixation pacing leads model to pace the right ventricular outflow tract septum.

METHODSA total of 136 patients undergoing artificial heart pacemaker implantation with active fixation pacing leads were randomized into two groups to receive conventional right ventricular outflow tract pacing (CRVOTP) or modified right ventricular outflow tract pacing (MRVOTP). The electrode lead wire core was modeled in a double-curved three-dimensional shape in CRVOTP group and in a J-shaped bend in MRVOTP group before fixation at the right ventricular outflow tract septum.

RESULTSRight ventricular outflow tract septum pacing was achieved successfully in all the patients. None of patients experienced serious complications. No significant differences were found between the two groups in the number of times of electrode fixation, pacing thresholds, impedance, R wave height or QRS wave width during the operation, but MRVOTP was associated with a reduced time of X -ray exposure and operation (P<0.05) due to the convenience in electrode modeling and in passing the leads through the tricuspid annulus and the direct access to the right ventricular outflow tract septum. Postoperative follow-up of the patients showed no incidence of active fixation pacing lead dislocation and comparable pacing thresholds of the ventricular electrodes, impedance, R wave height and QRS wave width between the two groups.

CONCLUTIONSUsing the modified active fixation pacing leads model to pace the right ventricular outflow tract septum can reduce the time of X -ray exposure and operation with a low probability of lead damage.

UNLABELLEDObjective To compare the impact of right ventricular apical (RVA) versus right ventricular outflow tract (RVOT) pacing on left ventricular systolic synchronization.

METHODSSixty patients were prospectively recruited and randomized into RVA group (n=30) with the right ventricle leads placed in the RVA and RVOT group (n=30) with right ventricle leads placed in the septum of the RVOT. Speckle tracking imaging was performed with 100% ventricle pacing to measure the differences in the time to maximum left ventricle (LV) radial strain.

RESULTSIn RVA group, the difference in the time to 6-segment maximum LV radial strain after pacing was 105.27 ± 19.74 ms, significantly greater than that in RVOT group (41.65 ± 12.17 ms, P<0.001). The standard difference of time to 6-segment maximum LV radial strain was also significantly greater in RVA group than in RVOT group (42.71 ± 17.63 vs 17.63 ± 5.62 ms, P<0.001).

CONCLUSIONLeft ventricle systolic synchronizaition after RVOT pacing is superior to RVA pacing.

Objective To assess the changes of white matter microstructure in neuromyelitis optica spectrum disorders (NMOSD) with DTI based on tract-based spatial statistics (TBSS) method.Methods Conventional MR and DTI were performed in 20 NMOSD patients (NMOSD group) and 20 healthy volunteers (control group).DTI data were analyzed with TBSS procedure,which was a part of FSL software packages,and non-parametric statistical analysis was performed on the whole brain.Correlation between FA value of tracts with significant difference in NMOSD group and expanded disability status scale (EDSS) scores was analyzed.Results TBSS analysis revealed significantly (P＜ 0.05,FWE corrected) extensive decrease of FA value in cerebrum and cerebellum white matter fiber bundles,i.e.corpus callosum,fornix,corticospinal tract,unciform fasciculus,cerebellar peduncles etc.in NMOSD group,and decrease of AD value,increase of RD value in cingulum bundle,corpus callosum and fornix,while MD value only increased in fornix and retrolenticular part of the left internal capsule (P＜0.05,FWE corrected).Negative correlations were found between FA value of left uncinate fasciculus,right external capsule,left inferior cerebellar peduncle,bilateral anterior limb of internal capsule,medial lemniscus and EDSS scores (all P＜0.05).Conclusion Widespread white matter damage is observed in cerebrum and cerebellum in NMOSD patients by using TBSS analysis,which may partly correspond to the disabilities of NMOSD patients.However,the other microstructural changes of white matter tracts may suggest complicated pathological mechanism of NMOSD.