Volume 88  ·   Issue 15  ·  2008

Objective To discuss the feasibility and method of immediate breast reconstruction right after modified radical mastectomy in early breast carcinoma patients.Methods Deep inferior epigastric artery perforaton flaps were immediately applied on patients to reconstruct the breast after the skin-sparing mastectomy.The breasts were shaped after the deep inferior epigastric artery and vein were anastomosed to the thoraeodorsal artery and vein.Results In 10 cases of breast reconstruction by DIEP flaps since 2005,there were completely survival in 8 flaps,distal skin necrosis in 1 flap,adiponecrosis in 1 flap.With the follow-up of 9-28 months,the reconstructed breasts were well-shaped and there were no abdominal complication in dnor sites.Ninety percent patients were satisfied with the results from the good to the best level.Conclusion Most patients were satisfied with the results of mastectomy reconstruction.

Objective To explore the diagnosis and treatment of partial anomalous pulmonary venous connection(PAPVC).Methods The clinical data of 38 pediatric patients with PAPVC were retrospectively reviewed.All received uhrasonography and part of them received angiography or 64-detector spiral computed tomography.Then the enlarged atrial septal was repaired with patch to separate the pulmonary vein dystopia to left atrium or the vertical vein was anastomosed to left atrium directly or by homograft vessel.The complicating abnormities were corrected.Follow-up was conducted for 3 months to 7years.Results One case died from severe low cardiac output after operation.Two cases were complicated postoperatively with Ⅱ°atrial ventricular block and one with pulmonary hypertensive crisis,and all were cured after treatment.And the other patients recovered after surgery.Follow-up showed that the quality of their postoperative life was good and no relapse to obstruction of pulmonary venous was reported. Conclusion overviewed carefully during uhrasonographic examination.Transesophageal echoeardiography and contrast examination may help.CT and MRI elevate the final diagnosis rate of PAPVC.The result of operation on PAPVC is good.

Objective To evaluate the expressions of epidermal growth factor receptor(EGFR)and phosphorylated Akt(p-Akt)in non-small-cell lung cancer(NSCLC).Methods 189 NSCLC samples were made into tissue microarray and immunohistochemistry was used to detect the expression of EGFR and p-Akt proteins.The association of the expressions of EGFR and p-Akt protein with the survival time was evaluated.Results The EGFR and p-Akt protein positive rates were 54.5%and 51.3%respectively.Univariate analysis showed that the EGFR expression was associated with gender(x2=4.267,P=0.039),histology(x2=14.749,P=0.002),differentiation(x2=6.295,P=0.043),and pathological stage(x2=9.318,P=0.025).Logistic multivariate analysis showed that only the pmhological type was associated with EGFR expression(P=0.047).The p-Akt expression was not related with the above clinieopathological features(P＞0.05)Kaplan-Meire survival analysis showed that neither of the two proteins had an impact on the patients' surval(P=0.972 and P=0.903 respectively).Conclusion Protein expressions of IEGFR and p-Akt have no impact on NSCLC patients' survival,thus so far they can not serve as molecular staging or prognostic indicators.

Objective To assess the value of laparoscopic ultrasonography in laparoscopic hepatectomy.Methods Twenty-two patients with liver diseases underwent laparoscopic ultrasonography.A 10 mm 7.5/10 MHz linear,side viewing laparoseopic ultrasonography probe was used intra-operatively to examine the convergence of intrahepatic biliary ducts and blood vessels,confirm and correct the resection line,guide the laparoscopie resection,examine the tumor margin,and discover the residue of cMeuli.Results One additional tumor was detected in one primary liver tumor case during the laparoscopic hepatectomy.Laparoscopic hepateetomy was accomplished successfully in 21 patients one of which had to be transferred to laporotomy due to severe liver cirrhosis and uncontrollable bleeding.The average operation time was 157 min with the average examining and guiding time of 14 min.The intra-operative bleeding amount was 520 ml.No calculus and tumor residue were found.One case of post-operative liver wound bile leakage and one case of subphrenic hydrops were found and they both recovered after drainage.Conclusion Intra-operative laparoscopic ultraSonography helps evaluate the entire liver and decide the resection line accurately.Under its guiding the laparoseopic hepateetomy can be performed smoothly.

Objective To evaluate the recent and mid-term results of aortic valve replacement for aortic valve insufficiency with large left ventricle.Methods From DCC 1999 to Jan 2006,31 patients with aorta insufficiency with the left ventricle larger than 80 mm,30 males and 1 female,aged(36 ±11),underwent aortic valve replacement and were followed up after discharge by mail and/or telephone call for(46±23)months(3-85 months),and followed up by ultrasonography for(25±24)months(3-70months).The ultrasound cardiographic data were analyzed.Groups were divided according to heart function and LVED to analyze risk factors after operation.Results One case died before discharge from the hospital and 3 eases died during the follow-up.The left ventricular end-diastolic diameter(LVEDD)after operation was(69±11)mm,significantly smaller than that before operation [(86±8)mm,P=0.001 ].The LVEDD continued to decrease during the follow-up and became(55±10)mm.The ejection fraction early during the follow-up Was(58±15),significantly higher than that before operation[(48 ±13)%,P=0.001].The heart function and LVEDD before operation had litile effects on the long term mortality and left ventricle funotion.Conclusion The patients with aortic valve insufficiency and large left ventricle still have indication for surgical treatment and most of such patients have good results in mid-term follow-up.

Objective To offer anatomical supports to the approach of lateral par interarticularis for far lateral lumbar discectomy.nethods In 30 lumber spine specimens taken from adult cadavers the relevant osseous distances of posterolateral region of lumbar vertebrae and its changing regularity with the sequences of lumbar spine were measured:(1)width of isthmus;(2)distance from midline to lateral border of vertebral body;(3)distance from lateral margin of isthmus to lateral border of vertebral body;(4)distance from inferior border of transverse process to superior rim of superior facet;(5)distance from accessory process to superior rim of superior facet;and(6)distance from central plane of lumbar disc to superior rim of superior facet.Results From L1-L2 towards L5-S1,the operative window representing the operating area of the approach of lateral par interarticularis for far lateral lumbar discectomy became progressively smaller in its longitudinal,transverse direction and outer exit.The distance from lmeral margin of isthmus to lateral border of vertebral body representing the transverse diameter of the operative window was reduced to 0.32 cm(P＜0.05).While the distance from inferior border of transverse process to superior rim of superior facet and distance from accessory process to superior rim of superior facet representing the longitudinal diameter of operative window were reduced to 0.17 am and 0.46 cm respectively(both P＜0.05).The distance from central plane of lumbar disc to superior rim of superior facet increased gradually from-0.20 cm in L1-2 t0 0.86 cm in L5-S1 (P＜0.05).The articular process extended upward and covered more lumbar disc plane.Conclusion At the level L1-L2 to L4-L5,the lateral par interarticularis approach is an easy,convenient,and anatomically favorable way to reach the far lateral lumbar disc herniation,but the progressive diminution of operative window increases the bony excision in lateral par interarticularis,root of transverse process,inferior portion of pedicle and superior portion of zygapophysial joint.At the level of L5-S1,the operative window becomes very tight. The excess of bone removal and expected instability of lumbar spine make the lateral par interarticularis approach tough to be done.

Objective To evaluate clinic pharmacodynamics of ropivacine hydrochloride,a new long-acting amide type local anaesthetic,in Chinese patients undergoing neurolysis and tendolysis of forearm through axillary brachial plexus block.Methods Two hundred ASAI-Ⅱ persons,aged 18-65,weighing 60～75 kg,undergoing neurolysis and tendolysis of forearm under axillary brachial plexus block were randomly assigned to 4 equal groups to received ropivacine of the doses of 1.00 mg/kg(Group Ⅰ),1.25 mg/kg(Group Ⅱ),1.50 mg/kg(Group Ⅲ),and 2.00 mg/kg(Group Ⅳ).Each group was subdivided into 5equal subgroups according to the concentrations(0.15%,0.20%,0.25%,0.30%,and 0.35%).The effects were analyzed.Resuits There was no significant diffefence in starting time,consummating time,and persisting time of sensory and motor nerve block between Group Ⅰ and Group Ⅱ(all P＞0.05).The starting time and consummating time of Group Ⅲ and Group Ⅳ were all significantly shorter than those of Group Ⅰ(all P＜0.05),and the persisting times of Groups Ⅲ and Ⅳ were all significantly longer than those of Group Ⅰ(P＜0.05).90 minutes after brachial plexus block the degrees of muscle strength Groups Ⅰ andⅡwere M1 and M2 respectively,hence,the sensory and motor nerves block was in dissociation.When motor never block was above M3 and M4 the interval of brachial plexus block was 55 min and 27 min in Group Ⅲ and Group Ⅳ respectively.Conclusion Sensory and motor never can be blocked perfectly when the dose of ropivacaine is between 1.5 mg/kg and 2.0 mg/kg and the concentration is between 0.30%-0.35%.When the doses of ropivacaine is 1.25 mg/kg and the concentration is 0.20%-0.25% the starting and consummating time are longer and persisting time is shorter.When the doses of ropivacaine is 1.00mg/kg and the concentration is 0.15%-0.20%the starting and consummating time are longer and only satisfies external debridement and suture without tourniquets.

Objective To investigate the roles of risk assessment and Ki-67 index in judging prognostic of gastrointestinal stromal tumors(GISTs).Methods The clinical data of 102 patients of GIST,60 with gastric stromal tumor and 42 with small intestinal stromal tumor were collected.The relations of disease free survival rate and disease specific overall survival rate to Ki-67 index and risk assessment were analyzed.Results Risk assessment showed that 2 Cases were at very low risk,14 at low risk,16 at intermediate risk,and 28 at high risk.As classified by the Ki-67 index system,13 cases were in the group of Ki-67 index≥5%,and the other 47 cases were in the group of Ki-67 index＜5%.The patients with high risk or Ki-67 index≥5%had significantly lower disease-free survival rates(Pki-67=0.001,Prisk assessment=0.044)and disease specific overall survival rates(Pki-67=0.001,Prisk assessment=0.007).The hish-risk patients had significantly lower survival rate than the patients of other grades(Pdisease-free=0.044,Pover all=0.012).In the 42 patients with small intestinal stromal tumor 9 were at low risk,11 at intermediate risk,and 22 at high risk:and there were 12 cases with Ki-67 index≥5%and 30 cases with Ki-67 index＜5%.Risk assessment had no relationship with disease specific overall survival rate.The overall survival rate of the intestinal stromal tumor patients with the Ki-67 index≥5%was significantly lower than that of those with the K-67 index＜5%(P=0.039),however,Ki-67 index was not related to disease free survival rate.Four of the gastric stromal tumor patients at low and jntermediate risk and with Kj-67 jndex≥5%suffered recurrence or metastasis:and 2 similar cases were found in the small intestinal stromal tumor cases.Conelusion Risk assessment and Ki-67 index are good prognostic indicators for gastric stromal tumors.In small intestinal stromal tumors,risk assessment is only related to disease free survival rate,and Ki-67 index is related to disease specific overall survival rate.In the GIST patients at low and intermediate risk,Ki-67 can be a good complimentary indicator to predict the recurrence or metastasis.

Objective The purpose of the current study is to demonstrate possible involvement of CD4+CD25+Treg cells and TGF-β in immune activation in patients with myasthema gravis(MG).If so,how does CD4+CD25+Treg cells and TGF-β,collaborate to impact on the production of pathogenic antiAChR antibodies(Ab)?Methods 40 MG in-patients with recent onset or deterioration and age and gender-matched 38 healthy subjects were consecutively enrolled.Flow cytometry was employed to detect circulating CD4+CD25+Treg cells.Levels of AChR-Abs and TGF-β1 in serum were detected by radioimmunoassay and enzyme-linked immunoabsorbance assay respectively.Resets Numbers of CD4+CD25+Treg cells were significanfly decreased in MG patients(3.0%±2.5%)compared with healthy controls(4.6%±3.7%,P=0.03).Decreased production of CD4+CD25+Treg cells was associated with late-onset,longer-duration,positive-MG sera for AChR-Abs,normal or atrophic thymus,and nonthymectomy treatment et al,respectively.Although CD4+CD25+Treg cells were not linear-correlated with serum anti-AChR Ab fiters,but were conversely correlated with each other in MG patients without thymona(non-MGT)(r=-0.37,P=0.02).Likewise,levels of TGF-β1 in 31 non-MGT patients(112 ng/L±83ng/L)were decreased compared with those of healthy subjects(215 ng/L ±134 ng/L,P=0.00),and was conversely correlated with titers of anti-AChR Abs(r=-0.37,P=0.02).The titer of anti-AChR Abs were correlated with Osserman classification and MGFA grade(r=0.34,P=0.03).Conclusion Nambers of CD4+CD25+Treg cells and levels of TGF-β1 in MG patients were significantly decreased compared with healthy controls,and may thus contribute to the pathogenesis of MG.Numbers of CD4+CD25+Treg cells were conversely correlated with levels of anti-AChR Abs in non-MGT patients.

Objective To evaluate the association between the susceptibility of endometriosis(EMS)and the gene polymorphism of tumor necrosis factor(TNF)in Chinese Han population.Methods Peripheral blood samples were collected from 76 EMS patients and 87 normal controls.PCR-RFLP was used to detect the single base change polymorphism in both TNFα gene and TNFβ gene.Results The allele frequencies of the TNFα pdymorphism were 0.9474 and 0.9253 in the EMS patients and the control group respectively,and the TNFβ polymorphism were 0.0526 and 0.0747 respectively.The allele frequencies of the TNFβ1polymorphism were 0.4605 and 0.5115 in the EMS patients and the control group,and the TNFβ2polymorphism were 0.5395 and 0.4885.No difference in the gene and genotype frequencies of TNFα and TNFβ was noted in the EMS patients and normal controls(all P＞0.05).Conclusion TNF gene polymorphism has no effect on EMS in Chinese Han population.Ethnic difference may exist in TNF allele frequency.

Objective To study the developmental electrophysiological properties of delayed rectifier outward K+currents(IDR)in undifferentIA ted NSC and NSC-derived neurons at various time points of adult SD rat hippocampus in vitro.Methods Neural stem cells were isolated from the hippocampus of adult SD rats with serum-free incubation and single-cell cloning technique.Electrophysiological recordings of IDR were performed using whole-cell patch clamp.Results The current density of IDR increased in NSC-derived neurons DIV 0-6 d whereas remained constant in DIV＞6 d.The current density of IDR at+50 mVwas 45 pA/pF±4 pA/pF and 56 pA/pF±10 pA/pF in undifferentIA ted NSCs and NSC-derived neurons DIV 0-6 d respectively(n=9).The activation process of IDR was also ahered in DIV 0-6 d whereas remained constant in DIV＞6 d.The positive shift in steady-state activation curve of IDR revealed an increase 0f V1/2,however the slope factors K remained unchanged.V1/2 Was 9 mV±3 mV and 12 mV±3 mV in undifierentIA ted NSCs and NSC-derived netrrons DIV 0-6 d respectively(n=9,P＜0.05)The inaetivation properties of IDR were not altered before and after differentIA tion.Conclusion Electrophysiological characteristics of IDR were all altered in DIV 0-6 d,suggesting the essentIA l role of IDR in neurogenesis and early stage of differentIA tion/development process is very important for the functional mature of neuron.

psychosurgery is a branch of neurosurgery, which uses surgical techniques to destroy some commissures and commissural fibers in the brain; In 1976, the World Health Organization (WHO) defined it as a surgical operation for the purpose of selectively removing or destroying nerve conduction pathways to influence the behavior of mental patients [1]. This is a very controversial discipline, which has aroused great interest in psychiatry, neurosurgery, ethics and even politics since its birth.

January 2005<Chinese medical journal became the first and only medical academic weekly in China. Major domestic media have reported this milestone progress in Chinese science and technology journals. After three years' efforts, this century-old journal, with the help and support of medical colleagues, not only took the first step to ensure its publication, but also took the lead in establishing a medical science and technology news release system originating from papers in China in January 2007.