Objective To gain the best cosmetic result and to avoid the manifest postoperative scar, bleeding and injury of the sensory nerves in the nipple and areola. Methods The gynecomastia was corrected under the endoscope through a small incision (2~3.5 cm) around the areola combined with the tumescent liposuction of the breast to individuals whose breast hyperplasia was mainly because of the fat tissue hyperplasia and the incised tissues were sent for pathological examinations. Results Since March 2000, 16 young men with normal men genitals appearance had undergone this operation, in which 4 cases were breast gland tissue hyperplasia, 3 cases of fat tissue hyperplasia and 9 cases of mixed fat and gland tissue hyperplasia. The results were satisfactory with normal men breast appearance and small areola incisions. No complications happened such as hematoma, abnormal feeling and necrosis in nipple and the breast. The incised tissue of the unilateral breast was 100~320g with average of 130g. The sunction lipectomy volume of the unilateral breast was 20~130ml with average of 68ml. The pathological examination revealed that the incised tissue were fat tissue and breast gland tissue. During 5 months to 3 years following up, no breast hyperplasia recurred. Conclusions The endoscopic operative technique is an ideal option to correct the gynecomastia because it minimizes the areolar incision and avoids the injury of the nipple and areola. It is also helpful to the distal part incision and remoulding of the breast.

Objective To find out the differences of bergenin content in Ardisia crenata from different regions and its different parts,and suggest its medicinal parts. Methods The bergenin content in different parts of Ardisia crenata was identified by TLC and determined by HPLC. Results The difference of bergenin content in different parts of Ardisia crenata was significant,and that in stems was better than in roots,which in the leaves was the lest. Conclusion The stem was regarded as the available medicinal resources and is worth exploiting.

Objective: To investigate the clinical practicability and prognostic value of Helsinki CT score in patients with traumatic brain injury (TBI). Methods: A retrospective case series study was conducted to analyze the clinical data of 124 TBI patients admitted to First Affiliated Hospital of Xinjiang Medical University from September 2016 to October 2018. There were 91 males and 33 females, aged 14-84 years, with an average age of 49 years. Glasgow coma score (GCS) at admission ranged from 3-8 points in 45 patients, 9-12 points in 42 patients, and 13-15 points in 37 patients. According to Glasgow outcome scale (GOS) at 6 months after injury, 26 patients were classified into the poor prognosis group with GOS of 1-3 points and 98 patients were in the good prognosis group with GOS of 4-5 points. The prognosis-related risk factors were analyzed, and the role of Helsinki CT score to predict the adverse prognosis and mortality of TBI patients in the two groups was investigated. The sensitivity and specificity of Helsinki CT Score for 6-month poor prognosis were evaluated by receiver operation characteristic (ROC) curve and area under the curve (AUC). Results: Univariate analysis suggested that there were significant differences in terms of subdural hematoma, intracranial hematoma, extradural hematoma, hematoma volume >25 cm^3, intraventricular hemorrhage and suprasellar cistern pressure between the poor prognosis group and good prognosis group (P<0.05). Multivariate logistic regression analysis showed that the mortality and bad prognosis were related to the hemorrhage of ventricles, the pressure of suprasellar cistern and the disappearance of suprasellar cistern in the poor prognosis group and the good prognosis group (P<0.05), while intracranial hematoma and hematoma volume showed no association with mortality and poor prognosis (P>0.05). The Helsinki CT score could independently predict the adverse prognosis and mortality of TBI patients at 6 months (multivariate logistic regression: OR_death=1.21, OR_{adverse prognosis}=1.14). Helsinki CT score had a better predictive ability of 6-month mortality (AUC=0.85) than that of 6-month adverse prognosis (AUC=0.76), and had a predictive value for 6-month mortality and adverse prognosis. Conclusions Subdural hematoma, extradural hematoma, intraventricular hemorrhage and suprasellar cistern state (compression or disappearance) are the risk factors for the poor prognosis of TBI patients. Intraventricular hemorrhage and suprasellar cistern state are the main risk factors for predicting the mortality of 6 months. Helsinki CT score can independently predict the adverse prognosis and mortality of TBI patients at 6 months, and has relatively better value in predicting the mortality.

The efficacy of decompressive craniectomy (DC) in reducing traumatic brain injury mortality has been affirmed,but there are also many serious complications.Syndrome of the trephined (ST) and paradoxical herniation (PH) are rare complications.ST is characterized by a series of neurological deterioration due to skin flaps subsidence from weeks to months after DC.These neurological impairments are closely related to the subsequent repair of skull defects.PH shows progressive decrease in consciousness on the basis of ST,changes in pupils on the side of skull defects,low touch pressure at the defect window,and obvious midline shift and brain stem compression on CT.ST and PH have common inducements in pathophysiology,including cerebrospinal fluid dynamics,atmospheric pressure,cerebral blood flow and brain material metabolism.There is no consensus on the diagnosis of ST and PH,and early cranioplasty is suggested in terms of treatment.This article reviews the clinical manifestations,pathophysiological changes,diagnosis and treatment of ST and PH after DC operation,so as to provide references for clinicians to further understand ST and PH.

Objective To explore the effect of security,self-acceptance,self-concept,intemet addiction,anxiety,depression on the suicidal ideation of internet addiction patients.Methods The safety,self-acceptance,self-concept,internet addiction,anxiety and depression of 220 internet addiction patients were assessed using the corresponding scale tools.Suicidal ideation was used as the dependent variable,and each influencing factor was used as the independent variable.Correlation analysis,multiple stepwise regression analysis and path analysis were utilized to analyze the predisposing factors.Results The suicidal ideation (12.65 ±5.72) was positively correlated with internet addiction assessment (73.35± 15.83),depression self-evaluation (56.33± 13.75) and anxiety self-assessment (48.93± 17.20) (r=0.250,0.636,0.531,P＜ 0.01),while negatively correlated with security (50.26± 12.33),self-acceptance (38.29±7.15),and self-concept (56.47± 17.92) (r=-0.390,-0.297,-0.298,P＜ 0.01).Sequentially depression (β =0.571,P＜ 0.01),anxiety (β =0.173,P=0.003) were entered into the multiple regression equation.Path analysis based on the structural equation model showed that suicidal ideation had a direct effect with depression and anxiety,with effect values of 0.583 and 0.176.There were indirect effects of self-concept,self-acceptance,sense of security,and internet addiction assessment.The effect values were-0.137,-0.117,-0.281,and 0.034.The total effect of suicidal ideation and self-concept,self-acceptance,sense of security,internet addiction,depression self-assessment,and anxiety self-assessment were-0.137,-0.117,-0.281,0.034,0.583 and 0.176 respectively.Conclusions The influence of security,self-acceptance,and self-concept on suicidal ideation is produced through the mediating effects of depression and anxiety,and it has a negative predictive effect.There is no direct causal relationship between internet addiction and suicidal ideation.

Objective:To compare the clinical outcomes and complications of oblique lateral interbody fusion combined with bilateral pedicle screw fixation through intermuscular approach and posterior interbody fusion combined with bilateral pedicle screw fixation through intermuscular approach by channel for lumbar spinal stenosis.Methods:A retrospective study was conducted on 73 patients who underwent surgical treatment for lumbar spinal stenosis from Jun 2015 to Jun 2017, including 33 males and 40 females. The average age was 66.8±7.94 years (from 39-85 years). These diseases occured at L 3/4 in 5 patients and L 4/5 in 68 patients. Random according to the time of admission, 38 cases were treated with oblique lateral interbody fusion combined with bilateral pedicle screw fixation through intermuscular approach (oblique lateral fusion group), and 35 cases with posterior interbody fusion combined with bilateral pedicle screw fixation through intermuscular approach by channel (posterior fusion group). The clinical results, image data and complications were compared between the two groups. Results:All patients in both groups had operation performed smoothly. The operation time was 99±8.96 min in the oblique lateral fusion group and 96.8±9.57 min in the posterior fusion group, and there was no significant difference between the two groups. The intraoperative bleeding in the oblique lateral fusion group 80±24.72 ml was significantly less than that in the posterior fusion group 261±52.87 ml ( t=9.621, P<0.05). No incision infection occurred after surgery. The VAS score of lumbar incision 72h after operation in the oblique lateral fusion group 1.21±0.55 was significantly less than that in the posterior fusion group 1.70±0.86 ( t=3.723, P=0.028). The follow-up period lasted for 12-24 months, averagely 17.5±2.58 months. There was statistically significant difference between preoperative and postoperative in the two groups, whether it was the area of the foraminal canal or the area of the spinal canal. There wboth the foraminal area and the spinal canal area were enlarged. The intervertebral space height in the two groups recovered significantly after surgery, the difference was statistically significant. But the intervertebral space height were partly lost at the last follow-up, and there was significant difference compared with postoperative. During the follow-up, no pedicle screw loosening, displacement, rupture, or anterior and lateral displacement of cage occurred. The fusion rate was 97.1% in the posterior fusion group and 100% in the oblique lateral fusion group. There was no statistical difference between the two groups.In terms of ODI index: the posterior fusion group recovered from 48.6±6.1 preoperative to 10.2±2.2 at the last follow-up, and the oblique lateral fusion group recovered from 49.0±5.7 preoperative to 9.3±1.8 at the last follow-up. There was statistically difference between last follow-up and preoperative in the two groups. The incidence of complications in the posterior fusion group was 22.86%, and the incidence in the oblique lateral fusion group was 23.68%. There was no significant difference between the two groups. Conclusion:Both the two decompression and fusion methods have achieved good clinical results in the treatment of lumbar spinal stenosis, with the advantages of less trauma, good stability, fast recovery, and high fusion rate. Compared with posterior decompression and fusion methods, the advantages of OLIF are more obvious, such as less bleeding,lower risk of nerve injury and good indirect decompression of spinal canal. Therefore, the OLIF technique can be a better choice for surgical treatment of lumbar spinal stenosis.

Objective:To investigate the characteristics and causes of endplate injury in the oblique lateral interbody fusion for the treatment of lumbar diseases, and summarize the precaution of endplate injury.Methods:Thirty-five cases of endplate injury were observed, which were originally treated with oblique lateral interbody fusion with or without pedicle screw fixation from October 2014 to December 2017. There were 7 males and 28 females, and the age ranged from 51 to 78 years old (averagely 62.8±8.13 years). There were 2 cases of lumbar disc degeneration, 10 cases of lumbar canal stenosis, 17 cases of lumbar degenerative spondylolisthesis, 2 cases of lumbar spondylolysis with or without spondylolisthesis, and 4 cases of lumbar degenerative scoliosis. Lesion sites contained L 3,4 in 2 cases, L 4,5 in 21 cases, L 2-4 in 3 cases, L 3-5 in 4 cases, L 2-5 in 3 cases and L 1-5 in 2 cases. Preoperative bone mineral density examination revealed there were 7 cases of T>-1 SD, 24 cases of -2.5 SD

Synovial sarcoma is a soft tissue malignancy of unknown origin which usually occurs around the joints of the extremities, but rarely detected in the kidneys. A case of primary synovial sarcoma of the kidney was reported, which was preoperatively diagnosed as a malignant tumor of the right kidney for intermittent gross hematuria. After the laparoscopic radical nephrectomy, primary renal synovial sarcoma was confirmed by pathological examination. The patient refused further treatment, and there was no recurrence or metastasis during the 13 months of follow-up.

Objective To observe the impacts of acupuncture and moxibustion on kelch like epichlorohydrin related protein 1(Keap1)and nuclear factor E2 related factor 2(Nrf2)signal pathway in kidney tissue of cisplatin(DDP)-induced kidney injury model mice,and to explain the protective mechanism of acupuncture and moxibustion on improving kidney injury caused by DDP.Methods Forty SPF male KM rats were randomly divided into 4 groups,with 10 rats in each group.One day before the start of treatment,the three groups of mice outside the blank group were intraperitoneally injected with cisplatin 10 mg·kg-1 according to their body weight,and the blank group was injected with the same dose of 0.9%NaCl solution.The model was established 24 hours later.Both acupuncture group and moxibustion group selected"Dazhui"(GV14),"Ganshu"(BL18),"Shenshu"(BL23)and"Zusanli(Housanli)"(ST36)for acupuncture and moxibustion respectively,once a day for 5 days.The other two groups were fixed every day without treatment.After fasting for 1 day,the contents of BUN,Scr,CysC and NGAL in serum and Keap1 and Nrf2 in renal tissue were detected by ELISA;Western blot and Real-time PCR were used to detect the protein expression and gene transcription of Keap1 and Nrf2 in the kidney tissue of mice in each group.Results Compared with the blank group,the content of Keap1 protein,protein expression and relative expression of mRNA in the model group increased(P<0.05),the content of Nrf2 protein,protein expression decreased(P<0.05),Nrf2 relative expression of mRNA increased(P<0.05);Compared with the model group,the content of Keap1 protein,the expression of Keap1 protein and the relative expression of Keap1 mRNA in the kidney of mice in the acupuncture and moxibustion groups decreased(P<0.05);Nrf2 protein content,protein expression and relative mRNA expression increased(P<0.05).Conclusion Acupuncture and moxibustion can improve the renal function of DDP renal injury model mice and enhance their antioxidant stress ability,so as to improve the renal injury caused by DDP chemotherapy.Its mechanism may be related to Keap1/Nrf2 signal pathway.

Objective:To investigate the clinical characteristics, pathological features and surgical efficacy of adult gangliogliomas.Methods:Seven patients with gangliogliomas underwent surgical treatment in our hospital from August 2010 to December 2021, were chosen; their clinical data were retrospectively analyzed, and the CT and MRI manifestations and histopathological features of gangliogliomas and surgical efficacy of these patients were concluded.Results:In these 7 patients, solid-mass type was identified in 1 patient, cystic-solid mixed type in 4 patients, and diffuse infiltrating type in 2 patients. The solid part showed slightly low or equal density on CT, and mostly showed slightly low signal on T1, slightly high signal on T2, high or slightly high signal on T2 FLAIR, and equisignal or slightly low signal on DWI of MRI. Immunohistochemical staining showed that in the tumor specimens, glial cell components were positive for glial fibrillary acidic protein, oligodendrocyte transcription factor and S-100 protein, and ganglion cell components were positive for neuronal nuclear antigen and synaptophysin. Gross total resection was achieved in 5 patients, subtotal resection in 1 patient, and partial resection in 1 patient; gangliogliomas without total resection were diffuse infiltrative type. The median Karnofsky performance status scores were 80. There was no death during the follow-up period of 7 months-11 years.Conclusions:Adult gangliogliomas are mostly cystic and solid lesions with clear boundary on imaging, and the histopathological characteristics of mixed neoplastic ganglion cells and glial cells are the main basis for their diagnosis. The surgical efficacy is usually good, but the diffuse infiltrating type is difficult to achieve total resection.