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足背逆行岛状皮瓣的临床应用

Digital Subtract CT Angiography Technology of Head and Neck

目的:探讨头颈部数字减影CT血管成像(DSCTA)成像技术的方法。方法:随机选择12例作头颈部脑血管DSCTA病例,通过扫描前训练、缩短扫描时间以减少患者运动,取得增强前后位置一致的横断图像。采用CT机自带的软件进行图像减影处理。采用减影后的图像进行三维后处理。结果:12例患者头颈部血管减影成功,取得了良好血管减影图像。结论:科学的DSCTA检查技术可获得良好的头颈部血管性病变减影图像

Assessment of Laparoscopic Resectablity of Carcinoma of Gallbladder

内皮素受体拮抗剂在围术期治疗6个月以下婴儿肺动脉高压的临床意义

目的 评价非选择性内皮素受体拮抗剂（波生坦）治疗6个月以下婴儿围术期先天性心脏病肺动脉高压的临床效果。 方法 按世界卫生组织（WHO）肺动脉高压分级（FC）将60例年龄小于6个月的先天性心脏病（分流）相关性肺动脉高压患者分为两组，对照组：30例围术期接受常规治疗［包括：地高辛口服0.01 mg/（kg·d），1次/d；安体舒通口服3 mg/(kg·d),3次/d;卡托普利口服1.5 mg/(kg·d)，3/d; 治疗组:30例在常规治疗基础上加用波生坦（术前6.25 mg，2次/d,1周；术后12.5 mg，2次/d，应用1~4周）口服治疗。观察两组患者肺动脉收缩压、运动耐量和机械辅助通气时间的变化，评估药物的临床效果。结果 治疗组用药后1周肺动脉收缩压较对照组明显改善63.43±7.37 mm Hg vs. 69.11±6.35 mm Hg，t=3.197，P=0.002），术后1周治疗组肺动脉压较对照组持续下降（42.42±8.13 mm Hg vs. 58.93±7.79 mm Hg,t= 8.030，P=0.001）；治疗组术后机械辅助通气时间和运动耐量（30 ml奶液喂养时间）均明显优于对照组。 结论 波生坦用于治疗6个月以下的小婴儿是安全的，先天性心脏病（分流）相关的肺动脉高压患者围术期使用波生坦能显著降低肺动脉压，改善心功能及运动耐量，缩短术后机械辅助通气时间。

CONSTRUCTION AND IDENTIFICATION OF RHESUS MONKEY Schwann CELLS MODIFIED WITH HUMAN GLIAL CELL DERIVED NEUROTROPHIC FACTOR GENE

Objective To construct the rhesus monkey Schwann cells (SCs) modified with human glial cell derived neurotrophic factor (hGDNF) gene. Methods The coding sequence of hGDNF amplified by PCR from pUC19-hGDNF was inserted into eukaryotic expression vector pBABE-puro. The recombinant eukaryotic expression vector pBABE-puro-hGDNF was identified with restriction enzyme digestion and DNA sequencing. The SCs were isolated from rhesus monkeys, cultured and purified. The SCs were transfected with the recombinant retrovirus vector containing hGDNF gene. The mRNA and protein expressions of hGDNF were analyzed by real-time fluorescent quantitative PCR and Western blot. Results The PCR product of hGDNF coding sequence was a 596 bp specific segment. The recombinant eukaryotic expression vector was digested into a 596 bp specific segment by specific restriction enzyme and another segment. The 596 bp segment confirmed by DNA sequencing was consistent with hGDNF sequence on GenBank. Restriction enzyme digestion and sequencing results showed that the coding sequence of hGDNF was successfully inserted into the recombinant retrovirus vector and the mRNA and protein expressions of hGDNF were significantly higher in transfected SCs than non-transfected SCs (P lt; 0.05). Conclusion The rhesus monkey SCs modified with hGDNF gene are successfully constructed and hGDNF can be released continuously and stably, which will provide a foundation for the further research about cell therapy of hGDNF-SCs in the repair of injured nerve.

BEST KNEE FLEXION ANGLE THROUGH ANTEROMEDIAL PORTAL DURING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

ObjectiveTo investigate the best knee flexion angle by analyzing the length and orientation of the femoral tunnel through anteromedial portal (AM) at different flexion angles during anterior cruciate ligament (ACL) reconstruction. MethodsTwelve fresh cadaveric knees were selected to locate the center of ACL femoral footprint through AM using the improved hook slot vernier caliper, and to locate the posterior bone cortex using a diameter 3 mm ball at flexion of 90, 100, 110, 120, and 130°. The femoral tunnel length, standard coronal and sagittal plane angles, and the position relation between exit point and the lateral epicondyle were measured; the tunnel orientation on the anteroposterior and lateral X-ray films was also measured. ResultsWith increasing flexion of the knee, the femoral tunnel length showed a first increasing and then stable tendency; significant difference was found between at flexion of 90°and at flexions of 100, 110, 120, and 130°, and between flexions of 100°and 120°(P<0.05). The femoral tunnel showed a trend of decreasing with coronal angle, whereas gradually increasing with sagittal angle. The knee flexion angle had significant difference either among flexions of 90, 110, and 130°or between flexions of 100°and 120°(P<0.05). The exit point of the femoral tunnel located at the lateral epicondyle of the femur proximal to posterior region at flexion of 90°in all knees, and at flexion of 100°in 7 knees, but it located at the lateral epicondyle of the femur proximal to anterior region at flexion of 110, 120, and 130°in all knees. As the knee flexion angle increasing, the angle between femoral tunnel with the tangent of internal-external femoral condyle on anteroposterior X-ray films showed a trend of decreasing gradually, but a trend of increasing gradually on lateral X-ray films. On the anteroposterior X-ray films, significant differences were found in the angle either among flexions of 90, 110, and 130°or between flexions of 100°and 120°(P<0.05). On the lateral X-ray films, there were significant differences in the angle among flexions of 90, 100, 110, 120, and 130°(P<0.05). ConclusionDuring ACL reconstruction by AM, 110°is the best flexion angle, which can get the ideal femoral tunnel.

Progress in Diagnosis and Treatment of Double Primary Lung Cancer

With the continuous development of living standards, medical imageology, pathology and the technique of cell biology, the morbidity of double primary lung cancer (DPLC) grows rapidly in recent years. The thoracic surgeons have constantly improved its standard of diagnosis and treatment. At the present, union diagnosis of multiple indexes, defining clinical stage based on a single leision, and the early surgery have been accepted by most of the thoracic surgeons. The video-assisted thoracoscopic surgery (VATS), for its advantage of small trauma, has been accepted by thoracic surgeons and been widely used now. It's a promising treatment for DPLC and other chest diseases. In addition, it has been proved that there was no statistical diffence in prognosis between the simple radiotherapy and surgical treatment. The traditional concept of thoracic surgery is facing severe challenges. Therefore, we review the clinical diagnosis and treatment progress of DPLC as follows.

Efficacy and safety of Yangyinqingfei decoction in the treatment of chronic cough and chronic obstructive pulmonary disease: a meta-analysis

ObjectiveTo systematically review the efficacy and safety of Yangyinqingfei decoction for chronic cough and chronic obstructive pulmonary disease (COPD) patients.MethodsWe electronically searched databases including PubMed, Web of Science, CBM, CNKI, VIP and WanFang Data for randomized controlled trials (RCTs) of Yangyinqingfei decoction for chronic cough and COPD patients from inception to August 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, RevMan 5.3 software was used for meta-analysis.ResultsTwenty-four RCTs involving 2 268 patients with COPD and chronic cough were included. The results of meta-analysis showed that compared with the control group, Yangyinqingfei decoction combined with the conventional medicine could significantly improve clinical effective rate (RR=1.21, 95%CI 1.16 to 1.27, P<0.000 01) and lung function (SMD=0.76, 95%CI 0.59 to 0.94, P<0.000 01) in patients with COPD. Yangyinqingfei decoction combined with the conventional medicine group was superior to the control group (RR=1.41, 95%CI 1.22 to 1.64, P<0.000 01) in clinical efficacy for adults patients with chronic cough. In terms of safety, seven cases occurred adverse reactions in the Yangyinqingfei decoction group, while 13 were found in the control group, the types and degree of adverse reactions in both groups were almost the same.ConclusionThe combination of Yangyinqingfei plus conventional medicine may significantly improve the clinical efficacy for chronic cough and COPD with reliable safety. However, due to the limited quality and quantity of included studies, the above conclusions are needed to verify by more high quality studies.

Advances in study of colorectal mucinous adenocarcinoma

ObjectiveTo summarize the research progress of colorectal mucinous adenocarcinoma.MethodThe articles about colorectal mucinous adenocarcinoma in recent years were reviewed.ResultsThe colorectal mucinous adenocarcinoma was a pathological subtype of colorectal cancer, which had unique clinicopathologic characteristics, relatively low incidence, and poor prognosis. The current studies suggested that the BRAF mutation, microsatellite instability, CpG island methylation, and mucin expression were related to the occurrence and development of colorectal mucinous adenocarcinoma, but its molecular mechanism was still unclear. The colorectal mucinous adenocarcinoma was more common in the proximal colon and female patients. The multiple metastases, extrahepatic and peritoneal metastases were also common. The preoperative MRI examination was very valuable. The main treatment was surgery, and the multidisciplinary discussions were still needed to determine the best treatment for patients in the advanced stage. Compared with other types of colorectal adenocarcinoma, patients with colorectal mucinous adenocarcinoma had a poor prognosis.ConclusionsAlthough we have a certain understanding of colorectal mucinous adenocarcinoma, the study results are limited due to the small sample size of many related articles and the lack of prospective randomized controlled studies. Therefore, more studies are needed in the future to improve the cognition of colorectal mucinous adenocarcinoma. Future research should focus on the molecular mechanism and treatment of colorectal mucinous adenocarcinoma.

腹腔镜十二指肠-空肠手工侧侧吻合治疗肠系膜上动脉压迫综合征4例报道

目的 探讨腹腔镜十二指肠-空肠手工侧侧吻合术治疗肠系膜上动脉压迫综合征的安全性及可行性。 方法 回顾性分析4例接受腹腔镜十二指肠-空肠手工侧侧吻合术治疗的肠系膜上动脉压迫综合征患者的临床资料。 结果 本组4例患者均确诊为肠系膜上动脉压迫综合征，均顺利完成腹腔镜十二指肠-空肠手工侧侧吻合术，无中转开腹或死亡病例。手术时间分别为95、118、103和89 min，术中出血量分别为35、45、30和25 mL，术后肛门排气时间分别为2、3、3和2 d，术后住院时间分别为8、7、9和6 d。术后造影见造影剂顺利通过吻合口，近端小肠显影，未见逆蠕动和造影剂反流情况。术后患者腹痛、腹胀症状消失，无吻合口出血、吻合口漏等严重并发症发生。 结论 腹腔镜十二指肠-空肠手工侧侧吻合术治疗肠系膜上动脉压迫综合征安全、有效。