[Objective]To explore the feasibility and outcome of posterior single open-door and pedicle screw in treating canal stenosis and instability of cervical vertebrae at one time.[Method]The preoperative radiographs of 15 patients were measured and were diagnosed to be developmental spinal canal stenosis and instability of cervical vertebrae.MRI showed the spinal cords were compressed obviously.Posterior C_(3~7) single open-door decompression and canal-plasty was adopted.Self-designed pedicle screws and intertransverse fusion were used in the unstable segments.[Result]Complications were not found after the operation.The postoperative radiographs showed that the screws were in the right places.The average follow-up time was 13 months,ranging from 7 to 18 months.The short-term radiographs showed firmly fixed screws.[Conclusion]It is a simple and reliable method to treat canal stenosis and instability of cervical vertebrae at one time with posterior single open-door and pedicle screw.Anterior and posterior operations have been avoided and the short-term outcome is satisfied.

Objective To investigate the morphological and immunophenotypic characteristics of phyllodes tumors (PT) and explore their significance in differential diagnosis and evaluation of prognosis.Methods 48 specimens with PT were observed under light microscope with HE and immunohistochemical staining (EnVision method).The antibodies including CD34,CD10,CD117,p53,and Ki-67 were used.10 cases of fibroadenoma were compared and the clinical data and follow-up results were analyzed retrospectively.Results All of 48 cases with PT presented as well-circumscribed masses with typically leaflike structures composed of double-layered epithelial component arranged in clefts and overgrowing hypercellular mesenchymal component.31 benign,12 borderline,and 5 malignant PT were diagnosed based on stromal overgrowth,cellular pleomorphism,mitosis,margins,and others.Focal necrosis was detected in 3 malignant cases and liposarcoma component existed in 1 case.Immunohistochemical staining showed that the positive rates of CD34 were 93.5 ％,58.3 ％,0 in benign,bordline,and malignant PT respectively,there were significant differences between each groups (P ＜ 0.05).The expression of CD10 were 25.8 ％,83.3 ％,80.0 ％,its expression in benign group was significantly different compared with bordline and malignant PT (P ＜ 0.05).p53 was expressed in three groups with no significant difference (P ＞ 0.05).CD117 and Ki-67 had high expression comparatively in malignant PT.All cases were treated surgically with a local recurrence rate of 22.9 ％.Conclusions Reasonable surgery pattern based on accurate histopathological diagnosis is crucial to reduce the local recurrence rate of PT.Immunohistochemistry examination in PT is helpful to the differential diagnosis and evaluation of prognosis.

Objective To report the clinical effect of repair of significant tongue defect after tongue cancer radical resection using anterolateral thigh perforator free flap with CTA three-dimensional reconstruction technique assistance.Methods From January,2012 to November,2015,13 cases were performed using anterolateral thigh perforator free flap in the repair of significant tongue defect after tongue cancer radical resection.Preoperation CT scan of the free flap donor site was done to obtain the three-dimensional images of arterial blood area by Digital Three-dimensional Reconstruction CT Technique to determine the origin of the anterolateral thigh flaps,direction,classification,length,diameter and the position of pedicle perforator.According to the condition of the defect of the tongue,flap of area from10 cm×9 cm to 8 cm×6 cm was design,the flap arteries and veins were anastomosed with the external maxillary artery or the superior thyroid artery,anterior vein,internal jugular vein or external jugular vein respectively.The shape and recovery of function of the reconstructed tongue were observed regularly after operation.Results All the flaps in the 13 cases survived,in the postoperative 4 to 18 months followed up,the appearance of the reconstructed tongue was close to the normal one,the patients were satisfied with the mastication and feeding function.Conclusion CTA three-dimensional reconstruction technique assisted anterolateral thigh perforator free flap technique is useful in obtaining good clinical effect,and it is one of the most best methods for repairing significant tongue defect after tongue cancer radical resection.

Objective:To investigate the clinical value of the free fibula flap transplantation in repair of the defect of tibia and soft tissue with the help of augmented reality (AR) technology.Methods:From May, 2017 to May, 2019, 9 patients with tibial and soft tissue defects were treated. Before operation, CTA scan was performed on both shanks to obtain DICOM data of tibial bone defect. Images of the designed fibular flap and its blood supply model were imported into Sina software through computer virtual surgery assistant technology. With the AR technology, information of virtual fibula flap were projected onto the body surface at the donor site, and the operation was carried out under the precise positioning. In this group, the free fibular flap was harvested with an area of 6.0 cm×4.0 cm-12.0 cm×6.0 cm and the length of fibula was 6.0-13.5 cm. The free fibula flap were used to repair the tibial defect with 5.0-12.0 cm in length and soft tissue defect area at 5.0 cm×3.0 cm-10.0 cm×4.5 cm. Patients were followed-up to observe the survival of fibular flap and the functional recovery of the repaired lower limb, and evaluate the clinical effect.Results:All the fibular flaps survived without vascular crisis and without serious complications occurred at both of donor and recipient sites. After 8-12 months of follow-up, the flap was soft in texture and good in blood supply. The appearance of the repair site was not bloated. Callus began to form at the junction of fibula and tibia at 3-5 months and healed well in 8-12 months. No bone resorption, nonunion, loosening or falling off of screws were found. There was no pain in the shank of the recipient area. Patients could stand and walk freely, and the weight-bearing function was close to normal. According to Enneking system, the average score was 27 points; 7 cases were excellent and 2 cases were good.Conclusion:Application of AR technology in the repair of tibial bone defect with fibular flap transplantation has good clinical effect and has certain practical value.

To establish a UPLC method for simultaneous determination of seven chemical markers (gallic acid, catechin, alphitonin, taxifolin, kaempferol-3-O-beta-D-glucoside, quercetin-3-O-alpha-L-rhamnoside, and kaempferol-3-O-alpha-L-rhamnoside) of the flowers of Polygonum Oriental collected from Guizhou province. Separation was performed at 45 degrees on a ACQUITY UPLC BEH C18 column (2.1 mm x 150 mm, 1.7 microm) with a gradient solvent system of 0.1% formic acid in acetonitrile-0.1% aqueous formic acid as the mobile phase. The flow rate was 0.3 mL x min(-1), the detection wavelength was 280 nm, and the sample injection volume was 1 microL. In the selected linear range, all calibration curves of the seven chemical markers showed good linearity. The recoveries (n = 6) were in the range of 97.90% -101.4% and RSD were less than 3.8%. The results showed that the seven compounds contained in all the samples of the flowers of P. orientale can be chosen as their chemical markers and that this UPLC-PAD method is simple, reliable and suitable for the quality control of the flowers of P. orientale. However, the chemical markers may be present at different levels for samples collected in different areas and at different times. A collection time of mid-to-late August with relatively high content of the chemical markers was suggested for the flowers of P. orientale.
Chromatography, Liquid ; instrumentation ; methods ; Flowers ; chemistry ; Lasers, Semiconductor ; Polygonum ; chemistry

OBJECTIVETo investigate the feasibility of the composite transplantation of 1:3 meshed split-thickness autograft and acellular heterologous (porcine) dermal matrix.

METHODS9 inpatients with full thickness skin burn or hypertrophic scar were selected in this study. After the eschar or scar was excised, the wound was covered with acellular heterologous dermal matrix. Then the meshed (1:3) split-thickness autologous skin sheet was grafted on the dermal matrix. Before dressing up, the radiated pigskin was placed on the composite transplants.

RESULTSThe composite transplantation was successfully used in 9 cases. The meshed split-thickness autograft was expanded 3 times and covered the dermal matrix tightly. The clinical results of the composite transplantation were similar to that of intermediate split thickness skin graft or full thickness skin graft.

CONCLUSIONThe composite transplantation of meshed (1:3) split-thickness autograft and acellular heterologous (porcine) dermal matrix allowed the expansion of the autologous skin sheet to 3 times. The clinical results were similar to that of intermediate split thickness skin graft or full thickness skin graft.

Adolescent ; Adult ; Animals ; Burns ; pathology ; surgery ; Child ; Dermatologic Surgical Procedures ; Dermis ; transplantation ; Female ; Graft Survival ; physiology ; Humans ; Male ; Middle Aged ; Skin ; pathology ; Skin Transplantation ; methods ; Swine ; Transplantation, Autologous ; Transplantation, Heterologous ; Wound Healing ; physiology

OBJECTIVE: To investigate the involvement of transcription factor Foxa2 in cardiac differentiation in P19 embryonal carcinoma cells and its molecular mechanism. METHODS: P19 cells were induced to differentiate into cardiomyocytes by adding dimethyl sulfoxide (DMSO) into the culture medium of their embryoid bodies (EBs). The mRNA levels of pluripotency markers of embryonic pluripotent stem cells, cardiac differentiation related genes, and Foxa2 in the cell samples at different time points of cardiac differentiation were detected by reverse transcription PCR (RT-PCR). Differentiated and mature cardiomyocytes were identified by immunofluorescence. Eukaryotic expression plasmid pCMV-rFoxa2 (rat Foxa2) was transfected into P19 cells, and clonal populations of P19 cells that stably expressed green fluorescence protein (GFP)-rFoxa2 were isolated to enhance the expression levels of Foxa2 in P19 cells. The mRNA and protein levels of pluripotency markers and cardiac differentiation related genes in the above cell samples were detected by RT-PCR and Western blot. The mRNA levels of cardiac differentiation related genes in EBs differentiation system were also examined. RESULTS: P19 cells differentiated into cardiomyocytes in the presence of DMSO, accompanied by stimulated expression of Foxa2. Transfection of pCMV-rFoxa2 plasmids into P19 cells upregulated rFoxa2 expression transiently and activated the transcription of its downstream cardiac inducer Cerberus1 (Cer1). The expression of pluripotency marker Nanog was suppressed and the expression of cardiac inducer Sonic Hedgehog (Shh) was elevated in GFP-rFoxa2 P19 cells. The expression of Cer1 and cardiac muscle marker actin, alpha cardiac muscle 1 (Actc1) was upregulated in EBs of GFP-rFoxa2 P19 cells. CONCLUSION Foxa2 participates in cardiac differentiation in P19 embryonal carcinoma cells. Foxa2 may inhibit Nanog expression and stimulate the expression of Cer1 and Shh directly during cardiac differentiation in P19 cells in the presence of DMSO.
Animals ; Cell Differentiation ; drug effects ; Cell Line ; Cytokines ; Dimethyl Sulfoxide ; pharmacology ; Embryonal Carcinoma Stem Cells ; pathology ; Hedgehog Proteins ; metabolism ; Hepatocyte Nuclear Factor 3-beta ; physiology ; Homeodomain Proteins ; metabolism ; Mice ; Myocytes, Cardiac ; cytology ; Nanog Homeobox Protein ; Proteins ; metabolism ; Transfection

BACKGROUND AND PURPOSE: It is unclear whether postthrombolytic antiplatelet (AP) therapy after thrombolytic-related hemorrhage without extensive parenchymal involvement (THEPI) affects the clinical outcome. This study explored whether AP administration in patients with THEPI affects short- and long-term outcomes. METHODS: All of the data for this study were collected from the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS-China) registry. Patients with THEPI were assigned to either the AP (AP therapy should be commenced 24 h after intravenous thrombolysis) or AP-naive groups. THEPI was defined according to European-Australasian Acute Stroke Study II criteria. The 90-day functional outcome, 7-day National Institutes of Health Stroke Scale (NIHSS) score, and 7-day and 90-day mortalities were compared between the AP and AP-naive groups. Logistic regression analysis was used to evaluate the effects of AP therapy on the short- and long-term clinical outcomes. RESULTS: Of the 928 patients enrolled from those in the TIMS-China registry (n=1,440), 89 (9.6%) had nonsymptomatic intracerebral hemorrhage (ICH) within 24-36 h after thrombolysis; 33 (37%) of these patients were given AP therapy (AP group) and 56 (63%) were not (AP-naive group). No significant differences were found for the risk of 7-day aggravated ICH (p=0.998), 7-day NIHSS score (p=0.5491), 7-day mortality [odds ratio (OR)=3.427; 95% confidence interval (95% CI)=0.344-34.160; p=0.294], 90-day mortality (OR=0.788, 95% CI=0.154-4.040, p=0.775), or modified Rankin score 5 or 6 at 90-days (OR=1.108, 95% CI=0.249-4.928, p=0.893) between the AP and AP-naive groups after THEPI. CONCLUSIONS: Early administration of postthrombolytic AP therapy after THEPI does not worsen either the short- or long-term outcome. AP therapy may be a reasonable treatment option for patients with THEPI to reduce the risk of ischemic stroke recurrence.
Cerebral Hemorrhage ; China ; Hemorrhage* ; Humans ; Logistic Models ; Mortality ; National Institutes of Health (U.S.) ; Recurrence ; Stroke

Objective:To discusses effectiveness of CTA in the classification of first plantar metatarsal artery and its application value in thumb reconstruction.Methods:Thirty-six cases who underwent thumb reconstruction with free second toe or hallucis flap between December, 2015 and December, 2018 were retrospectively analyzed. Among these cases, 22 cases were injured by machine stranding, 7 cases by heavy objects, and 7 cases were injured by rolling. Exact first plantar metatarsal arteries of all these cases were evaluated by using CTA preoperatively. And compared with intraoperative findings at the donor sites. Free first or second toe flap for thumb reconstruction were designed preoperatively based on branching pattern of first plantar metatarsal arteries.Results:The origin, course, 3-dimensional (3D) anatomical relationship with surrounding tissues and branching pattern of all these feet first plantar metatarsal arteries of 35 cases (70 feet)were well displayed in CTA images, and 1 case (2 feet) were showed poor vascular continuity and artifacts in CTA (2.78%). According to the branching pattern of first plantar metatarsal arteries, 29 cases (58 feet, 80.56%) were ramifying type, 5 cases (10 feet, 13.88%) were main trunk type, and 1 case (2 feet, 2.78%) were tiny branch type. Preoperative CTA images and intraoperative findings at the donor site of 35 cases were remarkably consistent. According to CTA images, 27 cases underwent thumb reconstruction with hallucis flap, 8 cases underwent thumb reconstruction with second toe, and 1 case of poor vascular continuity and artifacts in CTA underwent thumb reconstruction with hallucis flap eventually. All these cases were followed-up for 6-24 (average 12) months, and all reconstructed thumbs survived. The clinical outcomes of all these reconstructed thumbs were good with satisfactory appearance, sensory recovery, excellent motion. The donor feet of all cases recovered well.Conclusion:High-quality 3D images of first plantar metatarsal arteries could be obtained by CTA, allowing preoperative assessment of blood supply and planning of donor site. Therefore, success rate of reconstructed operation could be improved with low disability rate of donor site.

Objective To evaluate the value of 3D printing technology to assist in the repair of severe damage to the radial side hand.Methods From March,2014 to September,2016,there were 9 cases suffered from varying degrees of metacarpal and phalangeal bones injuries with soft tissue destruction at the radial side of the hand.The donor and recipient areas were scanned by 64 row spiral CT before operation.Three dimensional images were obtained by CTA 3D reconstruction technology.Preoperative plan was designed by using Mirror image technology and Virtual surgery aided design technique of Mimics software virtual surgery aided design system.Nine cases were treated with first toe toenail flap with dorsal foot flap combined with second phalangeal bone transplantation to reconstruct thumb and anterolateral thigh perforator flap to repair the wound.The cutting area of the dorsalis pedis flap and anterolateral thigh perforator flaps ranged from 4.0 cm × 5.5 cm to 6.5 cm × 9.5 cm and from 9.5 cm ×17.0 cm to 12.0 cm × 25.5 cm,respectively.Postoperative followed-up was performed to evaluate the effect of the operation.Results All 9 thumbs and flaps survived after the operation.Postoperative followed-up time ranged from 8 to 16 months.The appearance of reconstructed thumb was close to normal,and the two-point discrimination was from 8.0 to 11.0 mm.According to the evaluation criteria of upper limb function of the Chinese Academy of Medical Sciences,7 cases were excellent and 2 cases were good.The survival flaps had soft texture,good blood circulation and satisfactory appearance at the repaired site.Conclusion 3D printing technology assists thumb reconstruction and wound repair for severe damage to the radial side of the hand with good clinical results.