[Objective]To provide microsurgery anatomical data for the surgical operation in treating of extreme lateral lumbar dsic herniation through the observations of the regional anatomic structure about the post-median approach tolateral vetebral lamina(PMALVL).[Method]Thicknesses of intertransverse ligament,the distribution of anterior branches of lumbar nerve and vessel were measured at the adult cadavas specimens.Retrospectively analyzed with 12 cases of extreme lateral lumbar disc herniation from January 2004 to January 2006,including 7 cases were treated by the lateral approach to the vertebral lamina,5 cases treated by PMALVL.[Result]The thickness of intertransverse lingament is 0.6~1.3 mm.More than 90 percent of anterior branches of lumbar segmental arteries and the accompanying veins from L_3 to S_1 were located ventrally in the superior portion of the intertransverse ligament.A branch from Lumbar artery permanently locates in the hfiddle of post-lateral intertransverse ligament.The angle between the anterior branch of Lumbar nerve root and midline sagittal plane is 18.9?~39.2?.The distance from the root of the tranverse to the anterior branch of lumbar nerve root and from the lateral margin of the pars interarticul aris to the anterior branch of lumbar nerve root(5.6~8.0)mm and(1.7~3.6)mm respectively.The period of follow up in 12 cases was from 3 months to 24 months,with an average of 10 months.The resultwas excellentin 8 cases,good in 3 cases,total fine rate according the classification of Nakal was 91.67%.[Conclusion]Intertransvarse ligament is a reliable landmark for PMALVL and treating extreme lateral lumbar disc herniation through PMALVL may get microtraumatic and excellent effect.

BACKGROUND: Studies have shown that OCT4, SOX2 and HIWI can express in tumor tissues. OBJECTIVE: To investigate the relationship between the expression of stem cell transcription factors SOX2 and OCT4 in esophageal squamous cell carcinoma and their clinical characteristics and prognosis. METHODS: Expression levels of SOX2 and Oct4 were detected using immunohistochemical SP method in 77 cases of esophageal squamous cell carcinoma and 40 cases of adjacent cancer tissues confirmed by pathological examination, and then the their relationship with prognosis and clinical characteristics of the patients was analyzed. RESULTS AND CONCLUSION: Significantly higher levels of SOX2 and Oct4 were found in the esophageal cancer tissues than the adjacent cancer tissues (P < 0.05). SOX2 and Oct4 were highly expressed in the esophageal cancer tissues isolated from poorly differentiated, lymph node metastasis patients (P < 0.05). During the 2-year follow-up, the median survival of patients positive for SOX2 and Oct4 was only 24 and 21 months, respectively, which was significantly lower than that of negative patients (30 and 33 months, respectively). These findings indicate that the highly expressed SOX2 and Oct4 in esophageal cancer tissues are associated with the differentiation, metastasis and prognosis of the patients with esophageal squamous cell carcinoma.

Surgery is the first choice for the treatment of early non-small cell lung cancer(NSCLC),and lymph node metastasis is the most important factor influencing prognosis of resectable NSCLC.A large number of studies have identified the importance of systematic mediastinal lymph node(N2) dissection,which is also an important basis for the development of NCCN guidelines.But there are few reports about the dissection of intrapulmonary lymph node(N1),especially no detailed study on the dissection of the lymph nodes around the bronchi of non-primary tumor-bearing lobes and segments in lung cancer,and the NCCN guidelines were not detailed elaborate.This article will make a summary of the research on the correlation of intrapulmonary lymph node(N1) dissection.

Objective:To observe the effect and influence of homocysteine and cystatin C in type 2 diabetes patients treated by Shuxuening injection combined with gliclazide. Methods: Type 2 diabetic patients were randomly divided into observation group and control group,and there were 30 cases in each group. The control group was given gliclazide hypoglycemic treatment, on the basis of the observation group to combined with Shuxuening injection. The course of treatment was 2 weeks. Efficacy , adverse drug reactions ,Ho-mocysteine ( Hcy) , Cystatin C ( CysC) and blood glucose ( FBG, PB) level change of two groups patients before and after treatment were compared. Results:The total effective rate of the observation group was 96. 67%, which was significantly higher than that of the control group (P<0. 05). After treatment,blood glucose and Hcy, CysC levels of the two groups of patients were significantly de-creased compared with before treatment (P<0. 05),and those of the observation group was much lower(P<0. 05). The incidence of adverse drug reactions between the two groups had no significant difference(P>0. 05). Conclusion:Shuxuening Injection on patients with type 2 diabetes mellitus has good curative effect, it can effectively reduce homocysteine and cystatin C levels, better control of blood glucose.

ObjectiveTo provide anatomy information for harvesting a pedicle or free posterior interosseous artery cutaneous branches-chain flaps. MethodsFourteen forearms from fresh human cadaver were used to study the anatomy characteristics of the posterior interosseous artery cutaneous branches-chain flaps with the following three methods:latex perfusion for microanatomy,denture materials and vinyl chloride mixed packing for cast,and PVA-bismuth oxide perfusion for molybdenum target X-ray arteriography.The cutaneous perforator with a diameter ≥ 0.2 mm were included for statistical analysis.Results① There were 6.2 cutaneous branches raised from posterior interosseous artery. Measuring from the radial edge of ulnar head to the lateral epicondyle of humerus as the standard distance, the distal cutaneous branch clusters located at 21.24％ relative to the standard distance,while the proximal clusters located at 47.86％.② There were two large cutaneous perforators from the posterior interosseous artery at(5.82 ± 1.22)cm proximal to the ulnar styloid and (10.34 ±0.98)cm distal to the epicondyle of humerus.The diameter and pedicle length of the distal perforators were(0.50± 0.04)mm and (16.79 ± 5.12)mm respectively,while the proximal perforator were (0.60 ± 0.08 )mm in diameter with a pedicle (21.20 ± 12.28)mm in length.③ The vascular chains parallel to the posterior interosseous artery were formed via anastomosis of the adjacent cutaneous perforators. ConclusionThere is clinical significance to use pedicle or free posterior interosseous artery cutaneous branches-chain flaps.

OBJECTIVETo evaluate the value of CT common rail technique for application in intensity-modulated radiotherapy for nasopharyngeal carcinoma (NPC).

METHODSTwenty-seven NPC patients underwent Somatom CT scans using the Siemens CTVision system prior to the commencement of the radiotherapy sessions. The acquired CT images were registered with the planning CT images using the matching function of the system to obtain the linear set-up errors of 3 directions, namely X (left to right), Y (superior to inferior), and Z (anterior to posterior). The errors were then corrected online on the moving couch.

RESULTSThe 27 NPC patients underwent a total of 110 CT scans and the displacement deviations of the X, Y and Z directions were -0.16∓1.68 mm, 0.25∓1.66 mm, and 0.33∓1.09 mm, respectively.

CONCLUSIONCT common rail technique can accurately and rapidly measure the space error between the posture and the target area to improve the set-up precision of intensity-modulated radiotherapy for NPC.

Adult ; Aged ; Aged, 80 and over ; Carcinoma ; Female ; Humans ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; radiotherapy ; Patient Positioning ; Radiotherapy, Intensity-Modulated ; methods ; Tomography, X-Ray Computed ; methods

OBJECTIVESTo study the shape and the structures in the craniocervical junction region (CCJR) and the safety of far lateral approach.

METHODSTen cadaveric heads and 20 skull-base specimens were fixed with 10% formalin, and 4 of the 10 cadaveric heads were sectioned in different plane with the aid of operative microscope. The shape and relation of structures in the CCJR were observed.

RESULTSThe third segment of the vertebral artery(VA) was 21.6(15.3 31.9) mm. An incomplete bony canal was found to be 15% and complete bony canal surrounding the VA to be 5% on the VA groove. The distance of the left and right VA was 14.3a(c)(9.8 15.2) mm on the entry into the dura. The length of the occipital condyle was 26.8(25.1 28.2) mm, with the thickness of its anterior, middle and posterior one-third part was 9.9(9.6 10.6) mm, 11.2(9.2 13.1) mm and 8.6 (8.3 9.0) mm respectively. The distance between the posterior pole of the occipital condyle and the intracranial orifice of the hypoglossal canal was 9.9(8.6 11.4) mm, and between the posterior pole and the extracranial orifice was 16.1(13.5 17.1) mm. The transverse process of the atlas was the most important bony landmark for the approach.

CONCLUSIONSKnowing the shape and relationship of the VA and occipital condyle in the CCJR is helpful in preserving the important structures in far lateral approach to target region.

Humans ; Microsurgery ; Occipital Bone ; anatomy & histology ; Skull ; anatomy & histology ; surgery ; Vertebral Artery ; anatomy & histology

OBJECTIVESTo explore shape and position relationship of the structures with in sinus triangle region, and provide the anatomic foundation for extended presigmoid operative approach.

METHODSTen cadaveric heads and 15 skull-base specimens fixed with 10% formalin, with aid of operative microscope, the shape and relations of structures with in the sinus triangle region were observed and microphotographed. Four cadaveric heads were sectioned in different plane using collodion embedding process.

RESULTSJugular blub (JB) had high -placed jugular blub (HJB), normal jugular blub (NJB) and low-placed jugular blub (LJB). The incidence of HJB was 8% and 18% for the left and right sides (P < 0.01). The JB dome can extend upward the hypotympanic cavity and the posterior wall of the internal acoustic meatus. The incidence of NJB and LJB was 36% and 30%, and 6% and 2% respectively. The level distance between the posterior semicircular canal and petrosal posterior surface was (4.1 +/- 1.1) mm. The distance between the JB and vertical part of the facial nerve was (3.2 +/- 0.5) mm and (2.0 +/- 0.4) mm. The distance between the JB and posterior margin of the internal acoustic port was (7.5 +/- 1.7) mm and (4.0 +/- 1.0) mm.

CONCLUSIONSKnowing the shape and position relationship of structures in the sinus triangle region is favorable for preserving the important structures in extended presigmoid operative approach.

Autopsy ; Cadaver ; Cranial Sinuses ; anatomy & histology ; Glomus Jugulare ; anatomy & histology ; Humans ; Neuroanatomy ; Semicircular Canals ; anatomy & histology

Objective:To investigate the expression of retinoic acid receptor responsive gene 2 (RARRES2), microtubule microfilament cross-linking factor 1 (MACF1), and core protein polysaccharide (DCN) in cerebrospinal fluid (CSF) of patients with neurosyphilis, and their diagnostic value for neurosyphilis.Methods:A total of 64 non neurosyphilis syphilis patients (syphilis group) and 78 neurosyphilis patients (neurosyphilis group) admitted to the Second Hospital of Nanjing between June 2020 and September 2022 were included. Among neurosyphilis patients, there were 48 early neurosyphilis patients (early group) and 30 late neurosyphilis patients (late group). Patients with neurosyphilis are treated with routine symptomatic therapy and antibiotic therapy to expel syphilis. The mRNA levels of RARRES2, MACF1, and DCN in CSF of patients with neurosyphilis before and after treatment were detected by quantitative real-time polymerase chain reaction (qRT-PCR). The National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the neurological function of patients with neurosyphilis before and after treatment. The diagnostic value of various indicators for neurosyphilis was analyzed using receiver operating characteristic (ROC) curves.Results:The mRNA levels of RARRES2, MACF1, and DCN in CSF of patients with neurosyphilis were higher than those in the syphilis group (all P<0.001). The mRNA levels of RARRES2, MACF1, and DCN in the CSF of patients with advanced neurosyphilis were higher than those in the early group (all P<0.001). Compared with before treatment, the NIHSS score and RARRES2, MACF1, and DCN mRNA levels of neurosyphilis patients decreased after treatment (all P<0.001). The area under the curve (AUC), sensitivity, and specificity of the combined diagnosis of RARRES2, MACF1, and DCN mRNA in CSF for neurosyphilis were 0.995%, 100.00%, and 93.75%, respectively. The AUC and sensitivity were higher than those of individual diagnosis. Conclusions:The expression of RARRES2, MACF1, and DCN is elevated in CSF of patients with neurosyphilis, and is associated with disease severity and treatment response. These three genes may be candidate biomarkers for diagnosing neurosyphilis.