Objective To assess the clinical application value of phleboplasties combined with microvascular anastomotic device in venous anastomosis with diameter discrepancy in head and neck defects reconstruction.Methods Sixty-six pairs of veins with significant diameter discrepancy were anastomosed in head and neck reconstructive surgeries with free flaps.Forty of them were anastomosed with microvascular anastomotic device (the coupler group) after phleboplasties including lateral incision, Y-T enlargement and wedge excision while the other 26 pairs of veins were conventionally sutured (the sutured group).Diameter of each vein, anastomosis time, post-operative vascular crisis, flap survival and complications related to the microvascular anastomotic device were recorded.Results The average anastomosis time of the coupler group was (4.78 ± 1.14) min for lateral incision, (5.16 ± 2.07) min for Y-T enlargement and (11.09 ± 3.21) min for wedge excision, and all of them were significantly shorter than that of the sutured group.In the sutured group, all flaps survived except for 2 veins with poor blood flow were cut and re-anastomosed during the operation;1 flap with venous crisis within 72 hours after the operations was explored and replaced with the pectoralis major myocutaneous flap.All veins in the coupler group were successfully anastomosed in a single coupling procedure without anastomotic impatency, blood leak, vessel tearing and ring shedding.No vascular crisis occurred postoperatively.One patient underwent cervical haematoma 5 hours after the operation, and the flap blood supply was unaffected after the haematoma was removed.All flaps in the coupler group survived completely.Patients in both two groups were followed up 6 to 18 months.All flaps healed perfectly and no obvious surgical complications or microvascular anastomotic device rejection happened.Conclusion When anastomoses are carried out using microvascular anastomotic device between veins of different size, phleboplasties including lateral incision., Y-T enlargement and wedge excision can not only reduce the size discrepancy and the anastomosis time, but also ease the difficulty level and guarantee the patency of the venous anastomoses.Wedge excision enjoys the advantage of haemodynamics, and obstruction of venous reflux hardly occurred for size reduction.It should be considered preferentially when external jugular veins are used as the anastomotic vein of the recipient sites in head and neck reconstruction.

Objective To study the differences in retinoic acid receptor γ(RARγ) mRNA expression levels in blood leukocytes between antipsychotic-free and antipsychotic-naive schizophrenic patients and healthy control,especially in different genders. Methods Forty-three acute schizophrenic patients who were antipsychotic-naive or antipsychotic-free for at least three months (male = 34, female = 9) and 39 age- and sex-matched healthy subjects (male =25 ,female = 14) were included for blood leukocytes expression of RAR γ mRNA ,using real-time PCR technique. Results Kolmogorov-Smirnov Z analysis showed a significant increase of RARγ mRNA (P =0.041) level in blood leukocytes of pooled schizophrenic patients(0. 027 ± 0. 003) than in the healthy subjects (0. 020 ± 0.002). The elevation was mainly found in the female patients (0. 030 ± 0.003). Within-sex analysis showed that the female schizophrenic patients showed a trend increase (P = 0. 166) of RAR γmRNA expression compared with the male patients (0. 026 ± 0. 001) and exhibited greater RARγ mRNA expression (P = 0. 014)when compared with the female healthy subjects(0. 018 ±0.004). Conclusions The present findings showed an abnormal expression of leukocyte RARγ mRNA level in antipsychotic-free and antipsychotic-naive schizophrenia especially in the female patients. Blood RARγ markers could add to the diagnosis and individualized pharmacotherapy of schizophrenic patients ,especially the female patients.

Objective To explore the clinical manifestations and treatment of pediatric pituitary adenoma.Methods Between January 2001 to January 2015,24 pediatric patients diagnosed with pituitary.adenoma were treated in People's Hospital of Henan Province.The clinical data were retrospectively analyzed,including age,gender,clinical manifestation,therapy and prognosis.Endocrinological levels including all pituitrin and magnetic resonance imaging were analyzed by the follow-up survey.Results The median age was 16.2 years old,ranged from 6.0 to 17.8 years old.Common clinical manifestations were comprised of endocrine-related symptoms (18 cases) and visual deficit (8 cases),and so on.The ratio of male to female was 1.∶ 3.There were 12 cases of prolactin (PRL)-secreting adenoma (50.0％),4 cases of adrenocorticotropic hormone-secreting adenoma (16.7％),3 cases of growth hormone-secreting adenoma (12.5％),3 cases of plurihorminal adenomas (12.5％),and 2 cases of non-functioningadenomas (8.4％).The ratio of micro-adenoma versus macro-adenoma was 15.∶ 9,and there was no invasive macro-adenoma.Transsphenoidal surgery was applied in 14 cases (58.3 ％) with respect to 2 cases (8.3 ％) in transorbital keyhole approach,5 cases (20.8％) through pterional approach,and still 1 case (4.2％) through transsubfrontal approach.Two cases(8.3％) were cured with medications.Eighteen cases were totally resected,while 4 cases were subtotal resected.Six of 18 gross total resection patients recurred within 2 years,while tumors of subtotal resection grew differently.Hypotrophy in patients who received Gamma knife therapy (4/7 cases) was statistically different than that in the patients who did not (7/17 cases) (P =0.002).Conclusion Pediatric pituitary adenomas are usually common in female with endocrine related symptoms,and PRL-secreting adenoma is the most common subtype,and recurrence rate was higher.Individualized therapy is needed for the invalid cases.But any radiotherapy including Gamma knife therapy might induce hypotrophy,which requires special attention.

Objective:To observe the effect of Yi Jin Jing(Sinew-transforming Qigong Exercises)intervention on anxiety in asymptomatic patients with Corona Virus Disease 2019(COVID-19)infection during quarantine.Methods:A total of 160 asymptomatic patients with COVID-19 infection were stratified by gender and divided into an observation group and a control group by the stratified randomization method,with 80 cases in each group.The control group was given basic nursing in the cabin,and the observation group was given additional Yi Jin Jing exercises once a day,20 min each time,and trained continuously until 1 d before leaving the cabin.The Hamilton anxiety scale(HAMA)score was compared between the two groups.Results:A total of 154 cases were included for data analysis in this study,including 74 cases in the observation group and 80 cases in the control group.After intervention,the HAMA scores in both groups increased(P<0.05),while the score in the observation group was lower than that in the control group(P<0.05).In the control group,the HAMA score of females after intervention was higher than that of males.The scores of mental anxiety and somatic anxiety in both groups were higher than those before intervention,while the score of mental anxiety in the observation group was significantly lower than that in the control(P<0.05).However,there was no statistical difference in the somatic score between the two groups(P>0.05).Conclusion:Patients with COVID-19 infection will get anxious during quarantine.Yi Jin Jing exercise can effectively reduce the aggravation of anxiety in asymptomatic patients with COVID-19 infection during concentrated quarantine.

Objective To explore the efficacy of difficult decompression and its influence factors in microvascular decompression for hemifacial spasm.Methods A retrospective analysis of clinical data and follow-up results of 458 patients who underwent microvascular decompression for hemifacial spasm in our hospital from October 2012 to December 2015 was performed.Aecording to whether there was narrow posterior fossa,compression of vertebral artery with perforating branch of brain stem or long vertebral artery,or vessel passing through cranial nerves,all patients were divided into difficult and general decompression groups (n=50,n=408);the effective rate,delayed remission rate and their influencing factors were compared between the two groups.Results All patients were followed up for one to 3 years,averaging 1.6±0.6 years.Among them,46 patients from difficult decompression group were effective (effective rate=92％ [46/50]);and 390 patients from general decompression group were effective (effective rate=95.6％ [390/408]);no statistical difference was noted between the two groups (x2=0.592,P=0.442).But there was statistical difference in delayed remission rate between the two groups (47.8％ vs.25.1％,x2=10.627,P=0.001).Logistic regression analysis was performed among gender,age,course of disease,offending vessels,location,indentation of facial nerve,complex condition of microvacular decompression,efficacy rate and delayed relief rate,and it showed that indentation of facial nerve was related to delayed relief(OR=7.681,P=0.004,95％CI:10.235-31.223).Conclusion The hemifacial spasm patients with difficult decompression are able to achieve as good effect as general decompression if measures are used properly,but the delayed relief rate might be high.

The article analyzes chief physician SUN Wuquan's empirical characteristics in treating neck-type cervical spondylosis:disease differentiation combined with pattern differentiation,emphasizing the assessment of tendons and bones,with DING's Tuina(Chinese therapeutic massage)manipulations and static Gongfa(Qigong exercise)as the predominant treatment,inherits the academic features of DING's Tuina school,"paying equal attention to tendons and bones,putting function first";thus provides a reference for treating neck-type cervical spondylosis with Tuina therapy.

Objective:To explore the value of morphometric analysis program (MAP) in detecting focus of pediatric epilepsy related to focal cortical dysplasia (FCD) II.Methods:A retrospective analysis was performed; 42 epilepsy children with FCD II and postoperative Engel grading I in Department of Neurosurgery, He'nan Provincial People's Hospital from June 2020 to January 2023 were enrolled. Preoperative MRI data were analyzed by MAP. Difference in general data and focus detection rate by MRI and MAP were compared between the positive MAP group and negative MAP group, and consistency of MAP positive areas (true positive MAP and false positive MAP by postoperative CT) with interictal PET low metabolism positive areas was analyzed.Results:Of the 42 children, 28 had positive MAP and 14 had negative MAP in the epileptogenic focus. Gender was statistically different between positive MAP group and negative MAP group ( P<0.05). MAP had significantly better performance in focus detection compared with MRI (28/42 vs. 19/42, P<0.05). Significant difference was noted between consistency of true positive MAP area with interictal PET low metabolism positive areas (40/43) and that of false positive MAP area with interictal PET low metabolism positive areas (4/33, P<0.05). Conclusion:MAP can improve the focus detection rate of pediatric epilepsy related to FCD II effectively, and PET contributes to rule out false positive results.

Objective:To explore the relation between extended resection and prognosis of primary glioblastoma.Methods:A prospective study was performed. The subjects were from the colony of patients with primary glioblastoma who underwent surgical resection in our hospital from January 2014 from January 2017. Tumor volume and tumor residual volume showed by MR imaging T1 enhanced sequences (Group A and Group B), and tumor volume and tumor residual volume showed by fluid-attenuated inversion recovery (FLAIR) sequences (Group A1 and Group A2) were obtained within one week before surgery and 24 h after surgery, respectively; and the degrees of tumor resection were calculated. Cox proportional hazards regression model was used to determine factors influencing overall survival (OS) in glioblastoma patients. Kaplan-Meier method was used to plot the survival curves of these patients. Log-rank test was used to compare the survival rates of patients from Group A and Group B, and patients from Group A1 and Group A2.Results:A total of 128 patients were included; 71(55.5%) were into Group A, and 17 (13.3%) were into Group A1. Multivariate analysis showed that preoperative Karnofsky performance scale (KPS) scores, promoter methylation status of O-6-methylguanine-DNA methyltransferase (MGMT), tumor residual volume by T1 enhanced sequences, tumor residual volume by FLAIR sequences, and tumor resection degree by FLAIR sequences were independent influencing factors for OS ( P<0.05). Survival rate of patients from Group A was significantly higher than that in Group B( P<0.05); and survival rate of patients from Group A1 was significantly higher than that in Group A2 ( P<0.05). Conclusion:Residual of primary glioblastoma showed by FLAIR sequences is an important factor affecting the prognoses, and extended resection is necessary.