[Anatomy of the deep circumflex iliac artery perforators and reconstruction of complex mandibular defects with chimeric deep circumflex iliac artery perforator flap].

OBJECTIVE: To investigate the anatomy of the perforator vessels of the deep circumflex iliac artery (DCIA) and the techniques for repairing mandibular complex defect using chimeric deep circumflex iliac artery perforator flap (DCIAPF). OBJECTIVE: We analyzed the origin, distribution, number and courses of the perforator vessels of the DCIA, and measured the outside diameters of the vessels at the origin in 6 adult cadaveric specimens (12 sides) with latex perfusion. From July, 2018 to September, 2019, based on the results of anatomical study and imaging findings and using the digital surgical guide plate, we harvested DCIAPF from 4 patients for repairing mandibular body or angle defects and oral soft tissue defects. OBJECTIVE: The perforating vessels of the DCIA included abdominal muscular branches, osteomusculocutaneous branches and terminal musculocutaneous branches. The abdominal muscle branches originated from the DCIA inguinal segment in 4 and from both the inguinal and iliac segments in 2 of the specimens. The osteomusculocutaneous branches all originated from the internal iliac crest in 75% and from both the inguinal and internal iliac crest segments in 25% of cases; the inguinal segment gave rise to only one perforating branch. The number of the musculocutaneous perforating branches was 1 (58.3%) or 2 (41.7%). In the 4 patients undergoing mandibular reconstruction, the DCIAPF survived in all cases with good recovery of the donor site wound. Satisfactory facial appearance with good oral morphology and occlusal relationship was achieved at 1 month postoperatively in all the patients. None of the patients experienced obvious functional abnormalities at the donor site, and imaging examination confirmed successful reconstruction of the oromandibular defects in all the cases. OBJECTIVE: A good understanding of the anatomic characteristics of the perforator vessels of the DCIA combined with imaging examinations and digital surgery technology facilitates the harvest of DCIAPF for repairing mandibular body or angle defects complicated by oral soft tissue defects.

let-7i inhibits proliferation and migration of bladder cancer cells by targeting HMGA1.

BACKGROUND: Let-7 is one of the earliest discovered microRNAs(miRNAs) and has been reported to be down-regulated in multiple malignant tumors. The effects and molecular mechanisms of let-7i in bladder cancer are still unclear. This study was to investigate the effects and potential mechanisms of let-7i on bladder cancer cells. METHODS: Total RNA was extracted from bladder cancer cell lines. The expression levels of let-7i and HMGA1 were examined by quantitative real-time PCR. Cell viability was detected using the CCK-8 and colony formation assays, while transwell and wound healing assays were used to evaluate migration ability. Luciferase reporter assay and western blot were used to confirm the target gene of let-7i. RESULTS: Compared with the SV-40 immortalized human uroepithelial cell line (SV-HUC-1), bladder cancer cell lines T24 and 5637 had low levels of let-7i expression, but high levels of high mobility group protein A1 (HMGA1) expression. Transfection of cell lines T24 and 5637 with let-7i mimic suppressed cell proliferation and migration. Luciferase reporter assay confirmed HMGA1 may be one of the target genes of let-7i-5p. Protein and mRNA expression of HMGA1 was significantly downregulated in let-7i mimic transfected cell lines T24 and 5637. CONCLUSIONS: Up-regulation of let-7i suppressed proliferation and migration of the human bladder cancer cell lines T24 and 5637 by targeting HMGA1. These findings suggest that let-7i might be considered as a novel therapeutic target for bladder cancer.

[Clinical Application Value of Peripheral Blood Diagnostic Report].

Objective: To explore the clinical application value of peripheral blood diagnostic report. Methods: 557 peripheral blood diagnostic reports were collected from Peking University First Hospital, YANDA LU DAOPEI Hospital and Beijing United Family Hospital. The results were analyzed and summarized according to different blood cell morphology character for the first time and review cases, respectively. Results: Two hundred and one samples from first time patients were found abnormal complete blood count or leukocyte differential count, they were summarized as anemia, anemia accompanied with leukopenia or thrombopenia, abnormal white blood cell count or leukocyte differential count and abnormal platelet count. Each condition was further distinguished on the basis of different morphology character. Initial diagnosis or further examination could be proposed if abnormal morphology was specific or typical, when blood cell morphology was atypical or normal, the morphology was described objectively. 22 review cases included many benign and malignant disorders such as acute leukemia, chronic leukemia, myelodysplastic syndrome, multiple myeloma, infectious mononucleosis and so on. Suggestion of therapeutic effect, progression of diseases or further examination could be present according to complete blood cell count and morphology character. Conclusion: Peripheral blood diagnostic report can provide more comprehensive and accurate information for clinic, and propose important advisory opinions for primary diagnosis, differential diagnosis, treatment monitoring and progression assessment.

[Analysis of a Chinese Charcot-Marie-Tooth disease type 2D pedigree].

Objective: To achieve definite diagnosis in a clinically diagnosed Charcot-Marie-Tooth disease (CMT) pedigree and broaden the mutational diversity of CMT-related mutations in Chinese Han population. Methods: Patients clinically diagnosed with CMT were recruited from Department of Neurology, Chinese PLA General Hospital between December, 2012 to June, 2016. Clinical examination, laboratory tests, nerve conduction studies, and molecular and bioinformatics analyses were performed on a clinically diagnosed CMT pedigree. Results: In the pedigree, a GARS mutation (c.794C>T, p. S265F) was identified and CMT2D was diagnosed. Conclusion: The newly identified GARS mutation has broaden the mutational diversity of CMT2D in Chinese Han population.

Long non-coding RNA NEAT1 overexpression is associated with unfavorable prognosis in patients with hepatocellular carcinoma after hepatectomy: A Chinese population-based study.

AIM: To identify the association between the expression of lncRNA NEAT1 and clinicopathological characteristics of patients with HCC, and to explore the prognostic significance of lncRNA NEAT1 in predicting prognosis of HCC. METHODS: We retrospectively reviewed 86 patients with HCC (35 female, 51 male) managed in our institution between 2009 and 2014. The expression level of lncRNA NEAT1 was detected by real-time PCR. Prognostic factors were evaluated using Kaplan-Meier curves and Cox proportional hazards models. RESULTS: For the entire cohort of 86 patients, we showed that the expression level of NEAT1 was significantly higher in HCC tissues compared with non-tumorous tissues and NEAT1 was increased obviously in the HCC cell lines including SMMC-7721, Huh-7 and Hep3B (P < 0.001). MTT assay showed that si-NEAT1 remarkably inhibited the cell proliferation in three HCC cell lines. Moreover, over-expression of lncRNA NEAT1 was closely related to liver cirrhosis (P = 0.026), microvascular invasion (MVI) (P = 0.023), and TNM stage (P = 0.017). After adjusting for competing risk factors, we identified that expression level of lncRNA NEAT1 was an independently risk factor associated with the prognosis of patients with HCC (P = 0.031). CONCLUSIONS: In this study, we found NEAT1 expressed significantly higher in HCC tissues compared with non-tumorous tissues. Overexpression of lncRNA NEAT1 was an independently risk factor associated with the prognosis of patients with HCC.

Humoral Immunity in Bronchiectasis: Finding Good's Syndrome.

We present a case of a 37-year-old man with a past history of a surgically removed thymoma, who presented with recurrent pulmonary infections and bronchiectasis. On further testing, he was found to have low total immunoglobulin levels, a constellation of findings known as Good's syndrome. He responded well to immunoglobulin replacement, in addition to the usual treatments for bronchiectasis. We present this case to emphasize the association of bronchiectasis, low immunoglobulins, and thymomas and the role of immunoglobulin replacement as a treatment option.

The safety and efficacy of laparoscopic donor nephrectomy for renal transplantation: an updated meta-analysis.

BACKGROUND: Currently, the laparoscopic technique is widely used for living donor nephrectomy. Does it provides adequate safety and benefits for the living donor? We performed a meta-analysis to evaluate the safety and efficacy of laparoscopic donor nephrectomy (LDN) as well as an analysis of postoperative quality of life compared with the open donor nephrectomy (ODN). METHODS: Eligible studies were identified from electronic databases: Cochrane CENTRAL, PubMed, and EMBASE as of October 2011. Relevant parameters explored by-using Review Manager V5.0 included operative time, warm ischemia time, intraoperative blood loss, hospital stay and time to return to work. RESULTS: Compared with ODN, LDN showed a shorter hospital stay (days; mean difference [MD]: -1.27, P < .00001) and time to return to work (days; MD: -16.35, P < .00001), less intraoperative blood loss (ml; MD: -101.23, P = .0001) without an increase among donor intraoperative and postoperative complications or compromise of recipient graft function. Hand-assisted laparoscopic donor nephrectomy (HLDN) showed a shorter warm ischemia time (minutes) than the standard laparoscopic donor nephrectomy (MD: -1.02, P < .00001). We also observed that hospital stay (days) significantly favored SLDN compared with HLDN (MD: 0.33, P < .005), but operative times, intraoperative estimated blood loss, and donor postoperative complications were not significantly different between them. Donor postoperative quality of life revealed only physical functioning and bodily pain scores to significantly favor LDN. CONCLUSIONS: LDN is a safe surgical procedure for a living donor.

Prescription of atropine eye drops among children diagnosed with myopia in Taiwan from 2000 to 2007: a nationwide study.

PURPOSE: This study was conducted to examine the atropine eye drop prescription trend for children diagnosed with myopia, and to determine the factors associated with the prescription of atropine eye drops. DESIGN: This was a population-based cross-sectional study. METHODS: This study was conducted using a national representative sample from the National Health Insurance (NHI) claims data. All school children between 4 and 18 years of age who had visited an ophthalmologist and were diagnosed with myopia between 2000 and 2007 were included herein. The main outcome measure was the proportion of subjects who were prescribed atropine eye drops in each year. Logistic regression was used to identify the factors associated with atropine eye drops being prescribed. RESULTS: The prescription of atropine eye drops for children diagnosed with myopia increased significantly from the school years 2000 (36.9%) to 2007 (49.5%). There was also a shift from prescribing high concentrations (0.5 and 1%) of atropine eye drops to lower concentration ones (0.3, 0.25, and 0.1%) within this period. Atropine eye drops were more frequently prescribed to 9-12-year-old children (OR=1.26-1.42, compared with those 7-8 years old), and to children from families with a high socioeconomic status (OR=1.19-1.25); however, they were less prescribed to those living in mid to low urbanized areas (OR=0.65-0.84). CONCLUSIONS: This study revealed an increasing trend of atropine eye drop prescription for children with myopia in Taiwan. Our study provides eye-care professionals worldwide a reference for the potential integration of atropine eye drops into their clinical practice toward children with myopia.

Aerodigestive tract, lung and haematological cancers are risk factors for tuberculosis: an 8-year population-based study.

SETTING: The deterioration of immunity in cancer patients may be associated with a higher incidence of tuberculosis (TB). OBJECTIVE: Despite several previous studies on cancer and TB, no population-based investigation has been published. We performed a nationwide population-based study to investigate the incidence of active TB among cancer patients, and the cancer-type specific risk factors related to TB. DESIGNS: This nationwide population-based retrospective cohort study was based on data obtained from the Taiwan National Health Insurance Database. A total of 16,487 cancer patients and 65,948 controls matched for age and sex were recruited. RESULTS: The incidence of TB per 100,000 person-years was 339 in the cancer patients and 202 in the controls, which gives a crude incidence rate ratio of 1.68 (95%CI 1.42-1.98). The hazard ratio (HR) was 1.67 (95%CI 1.42-1.96) after adjusting for age, sex and comorbidity. Cox regression showed that cancers of the aerodigestive tract, including oral, nasopharyngeal and oesophageal and lung cancer (HR 3.09, 95%CI 2.42-3.94) and haematological cancers, including non-Hodgkin's lymphoma and leukaemia (HR 3.22, 95%CI 1.98-5.22), were significant risk factors for TB. CONCLUSION: Cancer patients have a higher incidence of TB than controls. Patients with aerodigestive tract, lung and haematological cancers are especially vulnerable to TB.

Early postoperative care of liver transplantation for infants with biliary atresia during pediatric intensive care unit stay.

SUBJECT: The aim of this study was to present our institutional experience with the pediatric intensive care unit (PICU) stays of liver recipients to understand prevention of complications. METHODS: This retrospective review included 22 infants who weighed 8.8 kg or less and underwent 23 transplantations. No grafts were from executed prisoners. We summarized the diagnosis, evaluation, medicine usage, and therapeutic intervention associated with subjects experiencing complications of rejection episodes, surgery, or infection during their ICU stay. RESULTS: There was one perioperative death from primary graft nonfunction. The most common postoperative complications were infections, gastrointestinal bleeding, and vascular complications. Rejection episodes occurred among 25% of patients. The most common isolated pathogenic bacteria was Staphylococcus epidermidis. Median initial ICU stay was 10 days. Mean requirement for artificial ventilation was 37.6 hour. Mean times of use of dobutamine, prostaglandin E1, and dopamine was 3.3, 7.5, and 8.8 days, respectively. Parenteral nutrition was started at a mean of 12 hours and oral food intake at a mean of 72 hours. CONCLUSIONS: Although challenging, orthotopic liver transplantation (OLT) in small infants can be successfully performed with meticulous surgical technique and keen postoperative surveillance.

The determinants of traditional Chinese medicine and acupuncture utilization for cancer patients with simultaneous conventional treatment.

This paper investigates the determinants of traditional Chinese medicine (TCM) and acupuncture utilization for cancer patients who are simultaneously having conventional Western medical treatments. This study used five leading cancers in Taiwan, namely cervical, breast, lung, liver and colorectal cancers. A total of 2499 cancer patients were interviewed, of which 2034 had full information and were analysed. Logistic regressions were used for both TCM and acupuncture. The results showed that type of cancer and cancer duration determine the utilization for alternative treatments. While socio-economic factors also affect choice of alternative medicine, the magnitude differs by types of alternative treatment and cancer. Compared with men and older patients, women and younger patients tend to prefer alternative medicine, and patients from south have higher preference for alternative medicine, which could be a reflection of local culture. Our results are useful for the government to determine higher users of TCM and acupuncture among cancer patients, and make policies to suit these patients' needs.

A case of an elderly adult presenting with obstructive hydrocephalus secondary to a rare hemorrhagic suprasellar pilocytic astrocytoma.

In this report, we present a 65-year-old man who presented with signs and symptoms consistent with impending brain herniation. Emergent imaging revealed a hyperdense mass in the suprasellar region. Urgent surgery was performed and final pathology eventuated a pilocytic astrocytoma. Although rare cases of suprasellar pilocytic astrocytoma in children and adults have been reported, we report an interesting case of a hemorrhagic suprasellar pilocytic astrocytoma in an elderly adult (without prior anticoagulant use) causing impending brain herniation secondary to obstructive hydrocephalus.

Clinical application of artificial dura mater to avoid cerebrospinal fluid leaks after microvascular decompression surgery.

OBJECTIVE: Although technological advances combined with many surgical innovations have helped to minimize its occurrence, cerebrospinal fluid (CSF) leak still remains to be one of the most common postoperative complications following microvascular decompression (MVD) surgeries. The objectives of this study are 1) to detail our experience with the clinical application of artificial dura mater for the avoidance of CSF leaks in a group of 103 patients who underwent MVD surgeries and 2) to compare the results of CSF leak and deep wound infection between the group with and one without using artificial dura mater. METHODS: From July, 2002 to June, 2004 217 consecutive patients who underwent MVD surgeries for hemifacial spasm or trigeminal neuralgia in our center were enrolled into this study. Among them, 103 patients underwent the application of artificial dura mater (Neuro-patch) in the surgical closure procedure to prevent postoperative CSF leak. The handling techniques were detailed and the postoperative results were evaluated. The follow-up period was at least 6 months. RESULTS: No postoperative CSF leak occurred in the group of patients receiving artificial dura mater whereas 6 cases of CSF leak (2 otorrhea, 2 rhinorrea and 2 CSF wound leak) were found in the group not receiving artificial dura mater. There was no statistical difference of wound infection rates found between these two groups, 1.9 % vs. 2.6 %. CONCLUSIONS: The use of the artificial dura mater in the closure procedure of MVD surgery seems to be a safe and effective way to prevent CSF leaks. However, further investigations on a larger number of cases still need to be done to substantiate its validity.

[Extensive transbasal approach for removal of tumours in the nasal, sphenoid and clival regions].

OBJECTIVE: To improve operative results of removal of the tumors in midline cranial base and the reconstruction of defect at frontal base through modification of the operative approach and techniques. METHODS: Extensive transbasal approach was used in 15 patients with tumours in the nasal, sphenoid and clival regions. RESULTS: The tumor was removed in 10 patients, near totally removed in 4 and partial removed in 1. The operative results of all patients were excellent except an elderly patient with mild operative morbidity. CONCLUSIONS: The procedure we used expand the operative indications for the tumors situated at the midline cranial base and improve the operative results. The procedure has advantages such as wide operative space, reliable reconstruction of the frontal base, and no severe complications.

Serotonergic neurons in the alcohol preferring rats.

Previously, we have shown that the serotonin (5-HT) content and fiber density in a number of terminal brain regions have been found to be decreased in the selectively bred, alcohol preferring (P) rats than in the alcohol nonpreferring (NP) rats. In this study, we further report that, compared with NP rats, there were fewer 5-HT-immunostained (5-HT-IM) neurons in the major ascending raphe nuclei of the P rats. Among the three major groups of 5-HT neurons responsible for the majority of ascending projections to forebrain, dorsal raphe (B7), median raphe (B8), and B9, there were fewer 5-HT-IM neurons in the median and dorsal raphe (not including nucleus oralis) of P rats, compared with NP rats (unpaired Student's test). No difference was observed in the B9 group. When the animals were treated with pargyline and L-tryptophan to enhance the 5-HT in the neurons, the number of 5-HT-IM neurons increased in both lines of rats. However, the difference in the number of 5-HT neurons between the rat lines remained. The intensity of 5-HT-IM was also found to be lower in the dorsal raphe neurons of the untreated P than in the untreated NP rats. The decreased 5-HT-IM was supported by high performance liquid chromatography measurement of 5-HT content, which also indicated that 5-HT content of the dorsal raphe was lower in the P than in the NP rats.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of radix Salviae miltiorrhizae on vasoactive intestinal peptide in cerebral ischemia: an animal experiment.

The levels of vasoactive intestinal peptide (VIP) in three regions of rat brain were assayed in 62 rats. Bilateral common carotid artery ligation was done in 50 rats. Half an hour before ligation 26 rats were given 10 g/kg of Radix Salviae Miltiorrhizae (RSM); 24 rats were given same volume of normal saline as controls. A sham operation was done in 12 rats. Half an hour (n = 30) and 3 hours (n = 32) after operation, the rats were quickly decapitated. VIP levels were assayed in cerebral cortex, hippocampus and caudate nucleus. In salin-treated animals, VIP levels of cerebral cortex and caudate nucleus at 3 hour group were significantly decreased compared with the sham-operated group. No significant difference was found between RSM-treated and sham-operated groups. The preliminary results suggest that VIP may be involved in the pathophysiological procedures of cerebral ischemia and RSM may attenuate the dysfunction of VIP during cerebral ischemia.