Myasthenia gravis is autoimmune diseases which mediated with acetylcholine receptor antibody.Based on the studies in rencent years,treatment of MG has made great progress.Thisreview will discuss several aspects,such as immune tolerance induced by dendritic cells,blocking monoclonal antibodies,hematopoietic stem cell transplantion,and provide new ideas and methods for the treatment of myasthenia gravis.

Objective To evaluate the clinical value of 16-slice spiral CTA for the diagnosis of lower extremity arterial disease.Methods A total of 103 patients with arterial disease at the lower extremities were submitted to 16-slice spiral CTA.A scanner with a slice thickness of 5 mm,pitch 1.15 mm,increment 1.0 mm,and overlapping 30% was used.Totally 90-100 ml of contrast agent was injected at a rate of 3 ml/s.The scanning was started with a Smartprep auto-trigger and persisted for 20-30 s.The reconstructed images were reformed by means of maximum intensity projection,volume rendering technique,and multiplanar reformation.Results The reconstructed images of the 103 cases were clearly demonstrated by CTA,which showed arteriosclerotic occlusion in 64 patients,arteriostenosis in 32,aneurysm in 4,and normal vessels in 3.Among the 103 patients,40 received surgical treatment,which confirmed the results of CTA.Conclusion Lesions in the lower extremity arteries can be well demonstrated by 16-slice spiral CTA,which can serve as a pre-surgery screening and evaluation.

Objective To explore the method of repairing skin defects in the foot, the ankle and the lower one-third of the lower leg with anterolateral island flaps of the lower leg formed by isolating peroneal artery from the anterior interosseous membrane of the lower leg. Methods 46 adult cadavers' lower legs were anatomized, to observe the blood supply of the anterolateral skin, the lateral anterior malleolar artery anastomoses with anterior perforating branches of the peroneal artery, and the relationship between peroneal vessels and interosseous membrane of the lower legs. Clinically, 8 cases(7 males, 1 female, age ranged from 7 to 48 years) of skin defects of the feet, the ankles and the lower one-third of the lower legs were repaired with anterolateral island flaps of the lower leg by isolating the peroneal vessels from the anterior interosseous membrane of the lower legs from June 1996 to August 2004. The flaps were cut into sizes between 7 cm ? 4 cm and 23 cm ? 12 cm. Results Averaged 3.2 anterior branches stem from the lower one-third of the peroneal artery, extend through the foremina in the interosseous membrane, pass the anterior intermuscular septum of the lower leg, arrive and provide nutrition to the anterolateral skin of the lower leg. The lateral anterior malleolar artery anastomosed with the lowest perforating branch of the peroneal artery to form the lateral malleolar artery arch. The peroneal vessels easily isolated after incision of the interosseous membrane of the lower leg. Eight cases were performed on transposition of the anterolateral island flaps with the artery pedicles of the lower leg. All the patients were followed up from 1 to 8 years, with a mean of 3 years. Only 1 case was necrosis at the distal one-third of the flap. The others totally survived without diabrosis and swelling. The ankle and phalanges had normal movement. The color and texture of the flaps were excellent. The sensation of flaps recovered in 4 cases by suture superficial peroneal nerve. All cases suffered hypoesthesia at the 3rd and 4th toe web. Conclusion Isolating peroneal artery and vein from the anterior interosseous membrane of the lower leg proved easy to perform. Peroneal artery are not main blood vessels and the excision of them affects blood supply to the foot insignificantly. The skin flaps thus formed are ideal for repairing skin defects of the foot, the ankle and the lower one-third of the lower leg.

Objective To discuss the clinical characteristics and management principles of com-posite pheochromoeytoma of adrenal gland (pheochromocytoma-ganglioneuroma). Methods Four cases of composite tumor of adrenal gland diagnosed pathologically were reviewed. All the cases were male, aged 37 to 62 years;three of them had the history of hypertension, one of them accompanied with paroxysmal palpitation, while one case was asymptomatic. Computerized tomography and ultra-sonography showed single tumor in adrenal, the diameter was about 2.5、3.8、6.3、15cm respectively. Two cases showed positive results in 131Ⅰ-metaiodobenzylguanidine (MIBG) scintigraphy. One case showed positive result in 99Tcm-hydrazinonicotinamide-3trysinoctreotide (HTOC) scintigraphy. Twenty-four hours urinary catecholamine examination revealed the average of norepinephrine, epi-nephrine and dopamine were (196.1±92.2)nmol/24 h, (26.6±8.9)nmol/24 h, (1957.9±913.5) nmol/24 h respectively. Two cases were at a little elevated level and the others with normal. All cases were managed with α-adrenergic receptor blocker preoperatively for 2-4 weeks. Results Tumor re-section was performed in all 4 cases, and 3 cases by retroperitoneal laparoscopy, one by open surgery. All 4 cases were diagnosed as composite pheochromocytoma of adrenal (Pheochromocytoma-gangli-oneuroma) by pathology. All patients had no evidence of recurrence or metastasis during follow-up from 15 to 38 months. Two of three cases with hypertension reverted to normotensive. Conclusions Composite pheochromocytoma of adrenal is rare, difficult to be diagnosed preoperatively. Except mild in eatecholamine secretion, which clinical manifestations are similar to pheochromocytoma. Pheochro-mocytoma-ganglioneuroma is no apparent tendency for aggressive behaviors, the results of surgical management are favorable.

Objective To investigate the effect of ultrasound- guided percutaneous injection of lauromacrogol in treating hepatic hemangiomas. Methods During the period from June 2010 to Jan. 2013 at authors’ hospital, a total of 32 patients with hepatic hemangiomas were treated with ultrasound-guided percutaneous injection of lauromacrogol. The largest lesion was 6.0 cm × 5.6 cm in size, and the smallest lesion was 3.0 cm × 2.6 cm in size. Before and after the treatment ultrasonography, hepatic functions and measurement of tumor size were performed, and the results were evaluated. Results A total of 54 times of puncturing were carried out for the 32 patients. Three times of puncturing were made in 2 cases , two times of puncturing in 18 cases, and single time of puncturing in 12 cases. Complete cure was achieved in 25 cases (78.1%) and effective result was obtained in 7 cases, with an effective rate of 100%. After the treatment, all patients complained of different degrees of pain at hepatic region, which were relieved spontaneously. Two patients developed fever (37.5 - 38.5℃), and after physical cooling the body temperature fell to normal within two days. One patient developed mild nausea and vomiting, which disappeared after symptomatic treatment. No severe complications occurred. Conclusion Ultrasound- guided percutaneous injection of lauromacrogol is a simple, safe and effective treatment for hepatic hemangiomas. Besides, this technique has no serious complications.

Chinese Society of Medical Science Research Administration Association has been established for 28 years.In order to make Chinese Society of Medical Science Research Administration Association better play the role,strengthen communication and guidance,the author made an investigation and analysis on Local Medical Association Medical Research Management special committee of current situation.With the increasing research investment from government,efficient research outputs need science research personnel and higher comprehensive quality of research and management personnel.Establish and improve local medical science research management special committee by means of positive organizational building and rich academic exchange and professional training to promote medical research management team construction.

To meet the requirements for the development of marine resources and military operations, divers usually dive deeper than the depth at which narcosis is present during air diving.Under this condition, heliox is required for this div-ing.Sofar, some countries have developed their own decompression tables for routine heliox diving.The best-known is tables from USA and France.In the preceding century, tables of Former Soviet Union and France used for routine heliox diving were introduced into China.On the basis of both types of tables,Chinese Navy developed their own tables for this purpose. In this paper, we summarized the characteristics of these tables from 5 countries and compared them in terms of structure, oxygen use, total decompression time, first stop and other features.This may provide a basis for future modification of ta-bles used in China and the development of new tables for routine heliox diving.

Objective To detect the expression levels of vascular endothelial growth factor D ( VEGF-D) , D2-40 and MMP-7 in papillary thyroid carcinoma ( PTC) and to explore their relationship with micro lymphat-ic density, distribution,and cervical lymph node metastasis .Methods SP immunohistochemistry was used to study the expression of VEGF-D, D2-40 and MMP-7 in 38 cases of PTC with cervical lymph node metastasis , 45 cases of PTC without cervical lymph node metastasis , and 22 cases of normal thyroid tissues .Micro lymphatic density ( MLD) was counted .Results The expression level of VEGF-D in PTC with cervical lymph node metasta-sis and normal thyroid tissues had significant difference (χ2 =13.074, P=0.000, P<0.0167).The expression level of D2-40 in PTC with and without cervical lymph node metastasis had significant difference ( P<0.05 ) . MMP-7 expression in PTC with and without cervical lymph node metastasis had statistical significance ( 91.67%vs 73.33%, P<0.05).MLD in PTC with and without cervical lymph node metastasis and in normal thyroid tis-sues had statistical difference (11.7 ±3.5 vs 8.9 ±3.1 vs 3.9 ±2.7, P<0.05).Conclusion VEGF-D, D2-40 and MMP-7 are highly expressed in PTC and they are possibly related with cervical lymph node metastasis of PTC.

OBJECTIVETo investigate the effect of reverse saphenous nerve neurocutaneous flaps for skin defects of forefoot.

METHODSIn the anatomic study, 50 cadaveric feet were injected with red latex and the anastomosis, distribution and external diameters of medialtarsal artery, medial anterior malleolus artery, medial plantar artery, the superficial branch of the medial basal hallucal artery and saphenousnerve nutritional vessels were observed. Based on anatomic research results, we designed the reverse saphenous nerve neurocutaneous flaps for repairing skin defects of forefoot.

RESULTSThe blood supply of reverse saphenous nerve neurocutaneous flaps were based on the vasoganglion, which consist of arterial arch at the superior border of abductor hallucis and arterial network on the surface of abductor hallucis around the saphenous nerve and medial pedis flap. From Oct. 2006 to Oct. 2011, the reverse saphenous nerve neurocutaneous flaps were used to repair skin defects of forefoot in 11 cases. The flap size ranged from 2.5 cm x 3.5 cm to 7.5 cm x 8.5 cm. The wounds at donor site were covered with full-thickness skin graft. All flaps survived completely with no ulcer at the donor site. 11 cases were followed up for 6 to 18 months( mean, 10 months). The skin color and texture were satisfactory. The patients could walk very well.

CONCLUSIONSIt is reliable to repair the skin defects of forefoot with reverse saphenous nerve neurocutaneous flaps. It is easily performed with less morbidity. This flap should be considered as a preferential way to reconstruct skin defects of forefoot.

Arteries ; anatomy & histology ; Cadaver ; Female ; Foot ; blood supply ; innervation ; Forefoot, Human ; injuries ; surgery ; Humans ; Male ; Muscle, Skeletal ; anatomy & histology ; Reconstructive Surgical Procedures ; Skin Transplantation ; methods ; Surgical Flaps ; blood supply ; innervation ; Transplant Donor Site ; surgery

Objective To test amyloid beta protein(Aβ)40 and Aβ42 levels in CSF and apolipoprotein E (ApoE) genotype in patients with Alzheimer's disease(AD) and study whether or not the Aβ is related to the severity of dementia and the genotypes of ApoE.Methods 48 AD patients including 27 cases of mild type and 21 cases of serious type and 35 normal controls were selected.Aβ40 and Aβ42 in CSF and ApoE genotype were analyzed.Results Aβ40 levels were ( 12.3 ±4.6) μg/L,( 11.7 ±4.1 ) μg/L,( 12.6 ±4.9) μg/L and ( 11.0 ±3.7) μg/L(t = 1.377,0.705 and 1.385 ,all the p values were greater than 0.05) and Aβ42 levels were ( 105.3 ±25.4) ng/L,(110.7 ±21.7) ng/L,(96.9 ±23.9) ng/L and (123.5 ±29.6) ng/L(t=3.006,2.832,and 3.488,all the p values less than 0.01 ),in AD group,mild AD group,moderate to serious AD group and normal controls,respectively.Aβ40 levels were (11.9 ± 5.2) μg/L vs.(10.5 ± 3.8) μg/L in AD and controls with ApoEε4(t=0.696,P＞0.05) and (12.6 ±4.5) μg/L vs.(11.4 ±3.4) μg/L without ApoEε4(t = 1.008,P＞0.05).Aβ42 levels were (99.7 ± 23.8) ng/L vs.( 129.6 ± 31.0) ng/L in AD and controls with ApoEε4( t =1.632,P ＞ 0.05 ) and ( 110.4 ± 28.4) ng/L vs.( 129.6 ± 31.0) ng/L in those without ApoEε4 ( t = 2.110,P ＜0.05 ).Conclusions The CSF level of Aβ is abnormal in AD,and it is related to the severity of the disease and the ApoE genotypes.