A new freshwater species of Pinnularia (Bacillariophyta) from Hunan Province, China.

This study describes a new species of Pinnularia, P.hupingensissp. nov., on the basis of light and scanning electron microscope images. Pinnulariahupingensissp. nov. is characterised by its linear valve outline, extremely divergent striae, and very large hexagonal central area occupying ca. 1/5-1/8 of the valve length. The primary and secondary sides of the valve and the internal proximal raphe fissures are discussed. The new species is compared to similar taxa of the genus Pinnularia.

Artificial intelligence-based analysis of the spatial distribution of abnormal computed tomography patterns in SARS-CoV-2 pneumonia: association with disease severity.

BACKGROUND: The substantial heterogeneity of clinical presentations in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia still requires robust chest computed tomography analysis to identify high-risk patients. While extension of ground-glass opacity and consolidation from peripheral to central lung fields on chest computed tomography (CT) might be associated with severely ill conditions, quantification of the central-peripheral distribution of ground glass opacity and consolidation in assessments of SARS-CoV-2 pneumonia remains unestablished. This study aimed to examine whether the central-peripheral distributions of ground glass opacity and consolidation were associated with severe outcomes in patients with SARS-CoV-2 pneumonia independent of the whole-lung extents of these abnormal shadows. METHODS: This multicenter retrospective cohort included hospitalized patients with SARS-CoV-2 pneumonia between January 2020 and August 2021. An artificial intelligence-based image analysis technology was used to segment abnormal shadows, including ground glass opacity and consolidation. The area ratio of ground glass opacity and consolidation to the whole lung (GGO%, CON%) and the ratio of ground glass opacity and consolidation areas in the central lungs to those in the peripheral lungs (GGO(C/P)) and (CON(C/P)) were automatically calculated. Severe outcome was defined as in-hospital death or requirement for endotracheal intubation. RESULTS: Of 512 enrolled patients, the severe outcome was observed in 77 patients. GGO% and CON% were higher in patients with severe outcomes than in those without. Multivariable logistic models showed that GGO(C/P), but not CON(C/P), was associated with the severe outcome independent of age, sex, comorbidities, GGO%, and CON%. CONCLUSION: In addition to GGO% and CON% in the whole lung, the higher the ratio of ground glass opacity in the central regions to that in the peripheral regions was, the more severe the outcomes in patients with SARS-CoV-2 pneumonia were. The proposed method might be useful to reproducibly quantify the extension of ground glass opacity from peripheral to central lungs and to estimate prognosis.

Current situation and prospect of breast-conserving surgery using oncoplastic surgery technique in breast cancer / 中华内分泌外科杂志

Breast cancer is the most common malignant tumor in the population, and the incidence of young breast cancer patients is gradually increasing. With the increasing requirements of patients for cosmetic effect after tumor resection, the traditional breast conserving surgery can no longer meet the treatment needs of patients. Breast-conserving plastic surgery for breast cancer has been proved to be safe in oncology, but there are still many deficiencies. Therefore, it is very important for surgeons and patients to develop unified and repeatable standard guidelines for breast-conserving plastic surgery of breast cancer.

miRNA Levels as a Biomarker for Anti-VEGF Response in Patients with Diabetic Macular Edema.

BACKGROUND: The aim of this study was to investigate whether miRNA levels in the circulation could serve as a predictive biomarker for responsiveness to anti-vascular endothelial growth factor (VEGF) therapy in patients with diabetic macular edema. METHODS: Whole blood samples were collected at baseline from 135 patients who were included in the BRDME study, a randomized controlled comparative trial of monthly bevacizumab or ranibizumab treatment for 6 months in patients with diabetic macular edema (Trialregister.nl, NTR3247). Best corrected visual acuity letter score (BCVA) and retinal central area thickness (CAT) were measured monthly during the 6-month follow-up. Levels of selected miRNAs were quantified. RESULTS: Following linear regression analysis, the levels of four miRNAs were negatively associated with baseline CAT. Multivariable regression analysis confirmed this association for miR-181a. No associations with changes in CAT after 3 or 6 months of anti-VEGF treatment were found. In addition, no associations with miRNA levels with baseline BCVA or change in BCVA after 3 or 6 months of anti-VEGF treatment were found. CONCLUSIONS: Circulating miR-181a levels were negatively associated with CAT at baseline. However, no associations between miRNA levels and the response to anti-VEGF therapy were found.

The influence of right-left error in the placement of the Cc electrode in tibial nerve somatosensory evoked potentials (SEPs).

OBJECTIVE: At our laboratory, we routinely record tibial nerve somatosensory evoked potentials (SEPs) using 5 channels including the second cervical vertebra (C2S)-contralateral central area (Cc) and Cz' (2 cm posterior to Cz)-Cc derivations. In a man with lumbar spondylotic myelopathy, symptoms improved after surgery, although the N21-P38 interval was markedly prolonged in comparison with that before surgery. We presumed that the Cc electrode was actually placed on the ipsilateral central area (Ci) at the second examination. Inspired by this episode, we investigated the influence of the right-left error in the placement of the Cc electrode. METHODS: Subjects were 20 healthy volunteers. Tibial nerve SEPs were recorded with 8 leads including Cz'-Cc, Cz'-Ci, C2S-Cc and C2S-Ci. RESULTS: For the Cz'-Ci lead, the P38 potential diminished in amplitude, was absent or became negative. For the C2S-Ci lead, a large negative potential corresponding to the phase reversal of P38 was frequently observed. CONCLUSIONS: Tibial nerve SEPs using the Cz'-Cc or C2S-Cc lead are distorted if the Cc electrode is placed on the opposite side. SIGNIFICANCE: When a strange result is obtained in tibial nerve SEPs, we should check for a right-left error in the Cc electrode placement.

Regional lymph nodes distribution pattern in central area of right-sided colon cancer: in-vivo detection and the update on the clinical exploration.

Distribution of regional lymph nodes (LNs) is decisive for the lymphadenectomy boundary in radical resection of right-sided colon cancer (RCC). Currently, the data of LNs in central area remains ambiguous and scarce. Herein we aim to provide a more detailed anatomical research on LNs surrounding the superior mesenteric vessels for RCC and investigated the metastasis rate. In this study, Carbon Nanoparticles (CNs) and Indocyanine Green (ICG) were used for regional LNs mapping by preoperative colonoscopic tattooing (PCT) and we laparoscopically observed the stained LNs distribution pattern. Lastly, 143 RCC patients who received a "superior mesenteric artery (SMA)-oriented" hemicolectomy were included to calculate the probability of LNs metastasis in our target area. 27 patients diagnosed as RCC (mean age 58.04 years, 17 male) were included. 14 patients underwent CNs injection and 13 patients consented to the ICG, while 4 cases suffered from imaging failure. The unequal number of the regional LNs located between SMV and SMA was detected in 22 cases (81.48%), posterior to SMV area in 6 cases (22.22%), and anterior to SMA in 16 cases (59.26%), respectively. The presence of LNs posterior to SMV was associated with the crossing pattern of ileocolic artery (χ2 = 4.24, P = 0.039). The probability of LNs metastasis in the above areas (target areas) was 2.10% (3/143). In conclusion, right-hemi colon-draining lymphatic vessels anteriorly/posteriorly traversed the SMV and arrived at the surface of SMA near the middle colonic artery (MCA) level, which highlights the potential need of removing mesenteric tissue in our target area on lymphatic resection.

From chaos to order: the life history of Hannaea inaequidentata (Lagerstedt) Genkal and Kharitonov (Bacillariophyta), from initial cells to vegetative cells.

This study presents observations on three species of Hannaea and documents and illustrates the life history of H. inaequidentata. We have divided the life history of H. inaequidentata into the following four series of successive stages: auxospore, initial cell, pre-normal vegetative cell, and normal vegetative cell. The initial cell has a cylinder-like and a frequently twisted outline, a longitudinal perizonium wholly covering the valve surface, and a disc-shaped incunabular scale, but lacks any transverse perizonium bands. The pre-normal vegetative cell cannot form ribbon-like colonies, has a wide variety of irregular outlines and is composed of two cell types: one with its epivalve composed of either the initial epivalve or the initial hypovalve, its hypovalve being newly formed, the other with both its epivalve and hypovalve newly formed. The normal vegetative cell has a regular outline and exhibits a significant length reduction so that the largest valve is at least four times longer than the smallest. From initial cell to normal vegetative cell, the developmental sequence goes from 'chaos to order' as happens in many phenomena in the universe. The lack of transverse perizonium bands may be the cause of the initial 'chaos' process during its developing period from the initial cell to the normal vegetative cell. The development of frustule/valve shape, central area, sternum, virga, vimine, rimoportula and ocellulimbus etc. during the life circle is summarised. In the genus Hannaea, some taxa lack the strongly buttressed central area as in H. inaequidentata, which also has almost parallel valve margins.

Related factors of central regional lymph node metastasis in thyroid papillary microcarcinoma / 中华内分泌外科杂志

Objective To investigate the related factors of central regional lymph node metastasis (CLNM) in patients with papillary thyroid microcarcinoma (PTMC).Methods The clinical and pathological fea tures of 550 cases of PTMC with clinical lymph node negative (cN0) were retrospectively analyzed.x2 test and multivariate logistic regression analysis were used to analyze the related factors of CLNM.ROC curve was used to analyze tumor diameter and CLNM of PTMC.Results The CLNM rate was 35.6％.Univariate analysis showed that patients aging less than 45 y(x2=13.983,P＜0.001),with tumor diameter≥7 mm (x2=14.263,P＜0.001),with capsule invasion (x2=7.316,P=0.006),multifocality (x2=14.321,P＜0.05) and bilateral tumors (x2=9.265,P=0.002) were more likely to have CLNM.Multivariate Logistic regression analysis showed that age ＜45 y,tumor diameter ≥7 mm,invasion of capsule and multifocal are all independent risk factors of CLNM for patients with PTMC.The optimal cutoff value of CLNM by diameter was 8 mm.Conclusion The CLNM of PTMC is related to many factors.When the age of the patient is less than 45 y,the diameter of the tumor is more than 7 mm,the invasion of the capsule and the multifocal lesion,the central lymph node dissection should be performed.

Usage of a rotational flap for coverage of a large central forehead defect.

Background: The forehead is a donor site for facial reconstruction but has no generous donor site for its coverage. All options of the reconstructive ladder can be used. A large rotation flap was used to reconstruct a big central forehead defect following failed previous repair in an elderly diabetic patient after a motor car accident. Case presentation: A 64-year-old diabetic man presented with an extensive central forehead defect after failed previous repair following a motor car accident. Coverage of the defect was performed using a flap based around the ear on one side in a rotation movement. An accepted functional and esthetic result was achieved after 3 months of follow-up. Conclusion: A rotation flap based on arteries around the ear can be used for coverage of a difficult lesion in the central forehead. Level of evidence: Level V, therapeutic study.

Central lobe epilepsy surgery - (functional) results and how to evaluate them.

OBJECT: To evaluate whether central lobe epilepsy (CLE) surgery in the pericentral area implies inevitable function loss and to determine how postsurgical functional outcomes are perceived by the patient. METHODS: We included all 22 people with epilepsy (PWE) who received central lobe epilepsy (CLE) surgery in the pre- and postcentral gyri between 1995 and 2015 in the University Medical Center Utrecht. We determined function loss and followed-up on quality of life (AQoL-8D), mobility (Rivermead Mobility Index RMI) and self-evaluation of the surgery. To compare this with the literature, a systematic review was conducted, with specific regard for studies that included functional outcome. RESULTS: Our own cohort showed newly developed functional loss in 54.4% postoperatively. Follow-up questionnaires were returned by 11/19 PWE (the other 3 could not be contacted). The mean AQoL-8d score was 0.74 (SD 0.16) and the mean RMI score was 13.7 (SD 3.0). This mean AQoL-8d was slightly lower than the Western mean population scores (0.86 and 0.87 respectively). RMI scores and postoperative functional deficits were both significantly related to how well PWE scored on the AQoL-8d. 72.7% of the PWE became seizure free after surgery (Engel class 1A). All PWE were happy with the CLE surgery and would recommend this type of surgery to other PWE. Becoming seizure-free, gaining better functioning and having more energy were reported as the most important reasons. The literature provided 475 unique papers, of which 25 were selected for critical appraisal. Six studies were of adequate quality and provided sufficient information to extract results. Prevalence of postoperative neurological deficit varied between 0 and 50%. No information is given on patient's perceptions. CONCLUSIONS: About half of central lobe resections do not result in new neurological deficits. The patient's perspective is important in CLE surgery, but neglected in the literature. PWE may report being satisfied with the results of surgery despite new deficits and impact on quality of life. Counseling in CLE surgery should take these findings into account. Neurologists and neurosurgeons should not by default refrain from CLE surgery and think a PWE will not accept a deficit.

Surgery on motor area metastasis.

The role of surgery on central area metastasis remains unclear, and outcome data are still controversial. The aim of our study is to analyze the predictive value of clinical and surgical data on motor and functional outcome of patients, taking into account new emerging data on boundary irregularity of brain metastasis. We retrospectively analyzed 47 consecutive patients who underwent surgery assisted by neurophysiologic monitoring for a solitary metastasis in central area between 2010 and 2013. Inclusion criteria were as follows: good functional status (Karnofsky Performance Status (KPS) ≥70), controlled systemic disease, and absence of extra-cranial dissemination. At 1-month follow up, motor and functional outcomes were compared with preoperative clinical status, response to corticosteroids, extent of tumor resection, boundary irregularity, and size of tumor. Gross total resection was achieved in 93.6% of cases. In preoperative symptomatic patients, motor outcome (according to Medical Research Council grading scale) improved in 55.5% and worsened in 16.7%, while functional outcome (according to KPS score) improved in 50% and worsened in 14.2% of cases. No worsening occurred in preoperative asymptomatic patients. Motor outcome resulted to be not correlated with preoperative deficits, tumor volume, or preoperative response to corticosteroid treatment. Remarkably, motor outcome and extent of surgical resection appeared strongly correlated with tumor boundary irregularity (p < 0.05). Surgery with neurophysiologic monitoring on motor area metastasis can improve functional and motor condition in selected patients. Tumor volume does not represent a limit in surgery. The high correlation between clinical outcome, resection rate, and tumor boundary irregularity strengthens a new belief on the infiltrative growing pattern of brain metastasis. Motor function was evaluated according to Medical Research Council grading scale (Ott et al. 2014) while functional status was assessed according to KPS score.

A preliminary comparative study on two different methods of region of interest selection on the pyramidal tract tracking in the surgery of central area lesions / 中国神经精神疾病杂志

Objective To validate and compare the pyramidal tracts traced by functional magnetic resonance mo?tion activated area as the region of interest method (fMRI guided DTI-FT) and by the anatomy of primary motor cortex as region of interest method(traditional DTI-FT)using subcortical electrical stimulation (DsCS). Methods A prospective study was conducted in 12 cases of patients with central lesions involving the motor area. The pyramidal tracts were traced by fMRI guided DTI-FT method and traditional DTI-FT method. The lesions were resected with the assistance of neuronavigation. The distances between same stimulation positive point and pyramidal tracts traced by the fMRI DTI-FT or traditional DTI-FT were recorded. The coincidence rates between pyramidal tract imaging and DsCS were analyzed in order to verify the accuracy and reliability of these two methods. Results Two cases were excluded:one due to the failure of the fMRI activation caused by movement dysfunction and one case due to negative electrical stimulation.,The pyrami?dal tracts were successfully reconstructed in the rest 10 patients using these two methods which were further applied to assist surgery. The coincidence rates between DsCS and pyramidal tracts were 77%in fMRI DTI-FT and 70%in tradition?al DTI-FT. The shortest distances were 4.3mm±2.8mm and 5.5mm±3.4mm in fMRI DTI-FT and in traditional DTI-FT in 16 DsCS positive sites and the difference was statistically significant (P<0.05). Five cases had temporary postoperative pa?ralysis. Among them, four cases had upper limb paralysis and one case had hemiplegia. The motor function was improved in four cases and remained unchanged in two cases two weeks after the operation. The motor function in the rest six cases did not have any change before and after operation. Conclusion The fMRI guided DTI-FT can be helpful to deal with le?sions and effectively protect the brain function area in patients with the central area lesions involved motor area.

Expression of cathepsin D in the central, peripheral and edematous areas of human astrocytomas / 中华神经医学杂志

Objective To study the expression of cathepsin D (CathD) in the central, peripheral and edematous areas of human astrocytomas and its clinical implications. Methods Forty-one patients with astrocytomas showing clear boundaries between the tumor area and the edematous area but without tumor necrosis or cystic degeneration as shown by magnetic resonance imaging (MRI) were divided into recurrent group (13 patients) and non-recurrent group (28 patients). Surgical specimens of the tissues in the central, peripheral and edematous areas of the tumor were obtained according to MR images using FLAIR sequence for detecting CathD expression with immunohistochemistry Results Normal brain tissues had virtually no or low CathD expression. Positive CathD expression was found in the central, peripheral and edematous areas of the astrocytomas, and the expression was significantly higher in the peripheral area (2.610±0.945) than in the central area (10.780±1.557) of the tumor (P<0.05). Patients in the recurrent group had more intense CathD expression in the peripheral area of the tumor than those in the non-recurrent group (11.539±1.127 vs 10.429±1.620, P<0.05), but in the central area of the tumor, the expression was comparable between the two groups (P>0.05). Conclusion Obvious CathD expression in the peripheral and edematous areas of the astrocytomas may suggest the likeliness of potential astrocytoma infiltration in these areas. The relative low CathD expression of CathD in the central area of the tumor indicates almost total degradation of the extracellular matrix as a result of early tumor invasion. CathD expression in the peripheral and edematous areas of the astrocytomas may serve as an indicator of tumor recurrence.

Anatomicophysiologic Monitoring in the Surgery of Central Area

In the surgery of central area, identifying the motor cortex in front of central sulcus is imperative to prevent loss of motor function. Twenty five patients with tumors or intractable epilepsy near the central sulcus were operated on at the Department of Neurosurgery of Chonbuk National University Hospital, from September. 1991 to December 1993. An estimated localization of lesions was performed with Callosal Grid System, which is a methodolgy made available by the development of high quality of magnetic resonance imaging, digital subtraction angiography and high resolution computerized tomography. This system allowed us to be oriented to the motor cortex as well as permitted assessment of the extent of resection. This was further delineated by direct electrical stimulation, which confirmed the functional motor cortex and made it possible to maximized the tumor resection near and in the motor cortex. The combination of direct cortical stimulation(functional mapping) and the use of the Callosal Grid System(anatomical mapping) allowed us to identify the spatial relationship between them as well as to maximize the tumor resection in most cases without injury to the central area, so that the better outcome is guaranted.