小骨窗经侧裂岛叶显微镜及内窥镜下清除高血压基底节区血肿

[目的]探讨和研究小骨窗经侧裂岛叶入路显微镜及内窥镜辅助下清除高血压性基底节区血肿的手术方法。[方法]选取高血压性基底节区血肿25例病人,出血6h内全麻下行颞部直切口小骨窗经侧裂岛叶入路显微镜及及内窥镜辅助下行血肿清除手术。[结果]术后24h内复查CT血肿清除率均在90%以上,所有病例在7d内GCS到达13分以上,术后10月随访,GOS优9例,中残13例,重残3例,无植物生存状态病例。[结论]小骨窗经侧裂岛叶显微镜及内窥镜下清除高血压基底节区血肿,有利于保护和促进神经功能恢复。

褥式血管吻合在手指钝性离断伤微创再植术中的应用分析

目的:探讨褥式血管吻合在手指钝性离断伤微创再植术中的应用分析。方法:回顾性分析本院2020年4月至2021年4月期间骨科手外显微骨三科收治的112例手指钝性离断伤患者,根据不同手术方法,将其分为单人褥式缝合组58例,双人褥式缝合组54例。比较两组患者手术时间、住院费用,并对所有患者进行术后6个月随访,参照英国医学会标准统计患指感觉、手指屈伸功能恢复情况(TAM)与患指成活率,对比两种缝合方式术后患指功能恢复优良率。结果:双人褥式缝合组患者手术时间短于单人褥式缝合组,住院费用少于单人褥式缝合组,差异有统计学意义(P<0.05);术后断指再植单人褥式缝合组成活55例,成活率94.83%,双人褥式缝合组成活52例,成活率96.30%,差异无统计学意义(P>0.05);术后感觉恢复:单人褥式缝合组优良率为82.76%,双人褥式缝合组优良率为93.34%,无显著差异(χ2=0.141,P=0.707);术后6个月参照TAM标准手指恢复情况中,两种褥式血管吻合方式TAM差异无统计学意义(P>0.05)。结论:在手指钝性离断伤微创再植术采用褥式血管吻合质量可靠,效果良好,尤其适用于双人褥式血管吻合,能缩短手术时间,减少患者住院费用,在手外显微外科或者创伤骨科方面有实际推广意义。

Microstructure, mechanical and bio-corrosion properties of as-extruded Mg-Sn-Ca alloys

The as-extruded Mg？Sn？Ca alloys were prepared and investigated for orthopedic applications via using optical microscopy, scanning electron microscopy, X-ray diffraction, as well as tensile, immersion and electrochemical tests. The results showed that, with the addition of 1% Sn and the Ca content of 0.2%？0.5%, the microstructure of the as-extruded Mg？Sn？Ca alloys became homogenous, which led to increased mechanical properties and improved corrosion resistance. Further increase of Ca content up to 1.5% improved the strength, but deteriorated the ductility and corrosion resistance. For the alloy containing 0.5% Ca, when the Sn content increased from 1% to 3%, the ultimate tensile strength increased with a decreased corrosion resistance, and the lowest yield strength and ductility appeared with the Sn content of 2%. These behaviors were determined by Sn/Ca mass ratio. The analyses showed that as-extruded Mg？1Sn？0.5Ca alloy was promising as a biodegradable orthopedic implant.

Pharmacognostic Research of Thalictrum foeniculaceum

[Objective] The aim was to make pharmacognostic research of Thalictrum foeniculaceum to lay foundation for development of the plant and formulation of re- lated medicinal quality standard. [Method] Based on Thalictrum foeniculaceum plants, morphological characters of the plants, and the paraffin sections and powders of dif- ferent organs were observed with an optical microscope. [Result] Cross-section of roots of Thalictrum foeniculaceum is typical secondary structure of dicotyledon and anticlinal wall of endodermis is curve. What＇s more, vessel type is diversified, in- cluding reticulate vessel, spiral vessel, and bordered pit vessel. In addition, the leaf can be classified into basal leaf and stem leaf, of which the former is ternate vein and bifacial leaf, and the latter is isolateral leaf. The cells in palisade tissue are 2-3 lists and small granules can be found in surface of leaf epidermal cells; pollen grain is round and scattered. [Conclusion] The research laid foundation for development of plant resources and formulation of quality standard for Thalictrum foeniculaceum.

Development of advanced electron tomography in materials science based on TEM and STEM

The recent developments of electron tomography（ET） based on transmission electron microscopy（TEM） and scanning transmission electron microscopy（STEM） in the field of materials science were introduced. The various types of ET based on TEM as well as STEM were described in detail, which included bright-field（BF）-TEM tomography, dark-field（DF）-TEM tomography, weak-beam dark-field（WBDF）-TEM tomography, annular dark-field（ADF）-TEM tomography, energy-filtered transmission electron microscopy（EFTEM） tomography, high-angle annular dark-field（HAADF）-STEM tomography, ADF-STEM tomography, incoherent bright field（IBF）-STEM tomography, electron energy loss spectroscopy（EELS）-STEM tomography and X-ray energy dispersive spectrometry（XEDS）-STEM tomography, and so on. The optimized tilt series such as dual-axis tilt tomography, on-axis tilt tomography, conical tilt tomography and equally-sloped tomography（EST） were reported. The advanced reconstruction algorithms, such as discrete algebraic reconstruction technique（DART）, compressed sensing（CS） algorithm and EST were overviewed. At last, the development tendency of ET in materials science was presented.

The Application of Virtual Reality Technology to Ear Microsurgery

The broad application of virtual reality (VR) to medicine has been of great value. The virtual surgery is one of technically difficult applications. With the expansion of the increasingly fine and complicated ear microsurgery, new methods are required to train the doctors. It is necessary and of practical significance to apply VR to the ear micro-operation, which is a functional operation with high precision and great difficulties. In this article, medical VR applications were reviewed. The application of VR to the ear microsurgery was discussed and the virtual ear microsurgery system was designed.

Biomechanical change of lumbar unilateral graded facetectomy and strategies of its microsurgical reconstruction:report of 23 cases

Objective： To evaluate the lumbar stability and the primary clinical results of unilateral facetectomy, transforaminal lumbar interbody fusion （TLIF） and unilateral pedicle screw fixation by X-Tube system. Methods： Five human lumbar cadaveric functional spine units（FSU） were obtained and graded facetectomy by 0, 1/4, 1/2, 3/4 and 4/4 were performed respectively on the left articular process of them. The stability of these 5 models was evaluated at flexion, extension, lateral bending and axial rotation. After a serial of biomechanical researches, 23 patients from June 2004 to March 2006 in our department underwent unilateral facetectomy, transforaminal lumbar interbody fusion （posterior lumbar interbody fusion） and unilateral pedicle screw instrumentation by X-Tube system. After general anaesthesia, with the guide of fluoroscopy and using X-Tube system, procedures of unilateral endoscopic facetectomy, spinal nerve root decompression, autologus spongy bone transplantation, one cage oblique insertion and unilateral pedicle screw instrumentation were performed. Results： There was no significant difference in flexion, extension, lateral bending and axial rotation of lumbar motion range after unilateral graded facetectomy. The stability of left/right axial direction was greatly affected when the range of graded facetectomy exceed 1/2. According to the Nakai criteria, for the 23 patients, the clinical result was excellent in 15 （65.2%）, good in 6 （26.1%） and fair in 2 （8.7%）. The fusion rate was 95.6% in excellent and good cases. Although partial absorption of bone grafts was observed in 1 case which might indicate a unsuccessful fusion, there was no loosing and replacement of instrument and no clinical symptoms occurred. Conclusion： The lumbar stability will be affected significantly when the range of graded facetectomy exceeds 1/2. Procedures of unilateral facetectomy, transforaminal lumbar interbody fusion and unilateral pedicle screw fixation is an optional strategy for microsurgical reconstruction, though the indications of the procedure should be carefully restricted.

Detection and treatment of synchronous lesions in colorectal cancer: The clinical implication of perioperative colonoscopy

AIM： To evaluate the clinical significance of preand intra-operative colonoscopy for the detection of synchronous lesions in colon cancer.METHODS： Two hundred and sixty-five pre-operative and 51 intra-operative colonoscopic evaluations were performed in 316 colorectal cancer patients who underwent curative resection from January 2001 to June 2006. The incidence and characteristics of synchronous lesions and their influence on surgery were evaluated.RESULTS： Two hundred and eighty-two synchronous lesions were detected in 124 （39.2%） of 316 patients including all lesions regardless of their histologic type. True adenomatous polyps were found in 91 （28.8%） of 326 patients, and 27 （5.4% of all patients） patients had synchronous colon cancers. The preoperative identification of synchronous lesions altered the planned surgery in 37 （14.0%） of 265 patients. In 18 patients among the surgically removed cases, the lesions were removed by extending the resection range. Further segmental resection or polypectomy through enterotomy was necessary in 29 patients. Nineteen （37.2%） of 52 intraoperative colonoscopy cases had synchronous lesions. Additional surgical procedures including segmental bowel resection and polypectomy with enterotomy were necessary in 7 （23.7%） of 52 intraoperative colonoscopy cases to remove the lesions.CONCLUSION： Synchronous colorectal polyps or cancer are frequent and their preoperative detection is important for optimal surgical planning and treatment. Intraoperative colonoscopy is a useful option in cases where a preoperative colonoscopy is not feasible.

Dermatofibrosarcoma protuberans: from translocation to targeted therapy

Dermatofibrosarcoma protuberans(DFSP), the most common dermal sarcoma, is a low-grade, slow growing fibroblastic malignant neoplasm that most frequently affects middle aged adults and is characterized by a high local recurrence rate and a low propensity for metastasis. Wide surgical resection or Mohs micrographic surgery(MMS) are the preferred approaches for localized disease, while radiation therapy is warranted for inoperable disease or for cases with positive margins where re-excision is not possible. DFSP is generally regarded as refractory to conventional chemotherapy. Treatment options for systemic disease were limited until the discovery of a unique translocation, t(17;22)(q22;q13)(COL1A1;PDGFB) found in a majority of cases. In recent years, imatinib, a PDGFβR, ABL and KIT inhibitor, has revolutionized systemic therapy in DFSP. In this review, we summarize the epidemiological, clinical, histological and genetic characteristics of DFSP and update the readers on its current management.

Solidification of Be-free Ni-based dental alloy

A novel, Nb- and Si-rich and Be-free Ni-based alloy was cast by two methods of investment casting and continuouscasting to study the microstructure evolution during solidification and its mechanical properties. The solidification of the alloy startedwith the primary crystallization of FCC-γ, followed by a binary eutectic reaction, with the formation of a heterogeneous constituent：FCC-γ＋G-phase, which replaced the low-melting eutectic （FCC-γ＋NiBe） in the Be-bearing alloys. AlNi6Si3 and γ′ formed during theterminal stages of solidification by investment casting, while the formation of AlNi6Si3 was suppressed by continuous casting. TheScheil solidification model agreed very well with the experimental results.

The microsurgical treatment of glomus tumor at the nail bed of the finger

Objective： To discuss the diagnosis and treatment of glomus tumor at the nail bed of the finger. Methods： The course and therapeutic outcome of 12 cases of glomus tumor which were resected and confirmed by histology examination were analyzed. Results：All cases were followed up for six months up to 2 years, no recurrences were observed, the shape of the nait was normal. Conclusion： Microsurgical treatment of glomus tumors of the nail bed is effective.

The Microscopic Surgical Treatment for Tumor of Posterior Cranial Fossa in Children

OBJECTIVE To analyze and discuss about the clinicalcharacteristics, pathological types, surgical modalities andtechniques, and postoperative complications in children withtumor of posterior cranial fossa .METHODS Retrospective study was conducted on 102 cases ofpediatric tumor of posterior cranial fossa, admitted and treated inour hospital during the period of January 1996 to January 2007.All patients underwent microscopic surgical treatment. Fifty-eight were male and 44 cases were female. The age ranged from 9months to 14 years old, with an average of 6.1 ± 0.5 of age. CranialCT or MRI examination was conducted before and after thesurgery on all patients.RESULTS The primary manifestations for this group of patientswere increased intracranial pressure and/or ataxia. Postoperativepathological diagnoses showed: 46 cases of medulloblastoma, 43cases of astrocytoma, 11 cases of ependymoma (including 1 caseof degenerative ependymoma), 1 case of dermoid cyst, and 1 caseof teratoma. In this group of the patients, radical surgery wasused in 68 cases and subtotal surgical removal used in 31 cases,while surgical removal of large section was performed on 3 cases.There were no deaths from surgery reported. Ninety-one casesshowed significant symptomatic improvement when comparedwith preoperative conditions, while 11 cases showed either noimprovement or more severely affected afterward. For 6 cases,postoperative ventriculoperitoneal shunt was performed within7 days to 2 months after the surgery. Sixty-three patients gainedfollow-up for 3 to 60 months in duration. Thirty-nine patientsregained normal life and were able to learn well, while there were7 patients who could not live normally on their own. During thefollow-up period, there were 17 cases of recurrence and 7 casesof death. In 23 cases of medulloblastoma in children with age of3 years old or above, 2 cases who underwent surgical removal ofintracranial ependymoma received small dosage of postoperativeX-ray radiotherapy on the the brain and spinal cord. Nine casesof medulloblastoma in children under age of 3 and 17 cases ofastrocytoma diagnosed after the surgery received chemotherapyof Carmustine.CONCLUSION Medulloblastomas and astrocytomas werethe most common types of pediatric tumor of posterior cranialfossa, right followed by ependymoma, and dermoid cysts andteratomas were rare. Early correct diagnosis, proper selection ofappropriate surgical modality and the surgical margin, propertreatment of postoperative complications, and the selecting rightradiotherapy or chemotherapy were the key factors in influencingthe prognostic outcome of children with tumor of posterior cranialfossa.

THE EFFECTS OF INJURIES IN THE EXTREMITIES ON HUMAN COAGULATION STATUS

Objective To investigate the changes of blood coagulation status and the safety of emergency microsurgery in patients with acute trauma to their extremities. Methods Forty seven patients with open injuries to the extremities were divided into 3 groups: in Group Ia (n=20), the patients presented with open injury to a single limb without traumatic shock and chest or head injuries, and they did not undergo microsurgery; while in Group Ib (n=13), an emergency microsurgery was done. In Group Ⅱ , the patients suffered from multiple compound fractures of the extremities with traumatic shock and chest or head injuries. The blood coagulation status of all the patients was evaluated by testing platelet count (PLC), platelet adhesiveness (PadT), serum antithrombin Ⅲ (AT- Ⅲ ), and D-dimer (D-Di) level. Results In Groups Ia and Ib, only PadT was increased and AT- Ⅲ declined preoperatively, then they returned to normal 24h postoperatively. In Group Ⅱ, at different periods after trauma, there was significant evidence of Pg and AT-Ⅲ decline accompanied by high increase of PadT and D-Di level; at 24h postoperatively, the mean values were 49.3% (PadT), 2.7mg/L (D-Di), 1..1g/L (Pg), and 69.1% (AT-Ⅲ), respectively. All these changes got significant difference (P<0.05) when compared with the normal value and those of Groups Ia and Ib, and did not completely return to normal even 72h after operation. Conclusion An emergency microsurgery could be safely performed in patients with ordinary open injuries to their limbs without traumatic shock, however it should be done with caution in cases of severe injuries with traumatic shock, because hypercoagulation status would follow in several hours after injuries. D-Di measurement may be used as a screening test to predict and assess hypercoagulation status more early after trauma.

PARAPETROSAL PRESIGMOID APPROACH FOR PETROCLIVAL TUMORS

Objective To discuss the operative technique of parapetrosal presigmoid approach for patients with petroclival tumors and its outcome. Methods 16 petroclival tumors have been microsurgical treated with parapetrosal presigmoid approach and the clinical data were analysed retrospectively. Results In all patients, 9 had meningiomas, 3 epidermoid cysts, 2 pontine gliomas, and 2 schwannomas. Total resection was performed in 12 patients, subtotal resection in 3, and near subtotal resection in 1. Temporary post-operative cranial nerve paresis occurred in 3 patients but no CSF leakage and mortality ever occurred. Conclusion This approach is simpler and safer than other more extensive transpetrosal approaches. It can expose sufficiently the petroclival regions and facilitate tumor removal and provides good clinical outcome.

EXPERIMENTAL TREATMENT FOR OBSTRUCTIVE LYMPHEDEMA BY TRANSPLANTATION OF FASCIAL FLAP RICHED IN LYMPH VESSELS

Objective To provide a more effective microsurgical treatment for obstructive lymphedema.Methods Sixty models of rabbits with lymphedema in right hindlimb were devided into three groups: 20 for fascial flap transplantation (group A), 20 for no treatment (group B) and 20 for anastomosis of lymph vessels and vein (group C) as control. For group A, the posterior branch of medial vein in the normal hindlimb was cut down together with the fascial strip (about 3 cm wide) around it and concomitant lymph vessels, then transferred through the block region of the affected limb. The two broken tips of the vein were anastomosed respectively to normal veins beside the block region. Subcutaneous tissue and skin were sutured at last. For group B, no treatment was carried out. But traditional anastomosis of lymph vessels and vein was used for group C. Postoperative variation of volume was observed and lymphoscintigraphy was made. Results The volume curve of the affected limb in group A kept declining after 2 weeks and nearing to that of the normal hindlimb in group B but away from that of the affected limb in group B. The curve of donor limb in group A was similar to that of the normal limb of group B, which meant no secondary lymphedema occurred in donor limb. The volume of the affected limb of group A had significant difference to that of group C at postoperative 24 weeks, which meant the effect of group A was better than C. The lymphatic drainage of the affected limb of group A was obviously better than B and C in lymphoscintigraphic image. Deposit of nuclein was lessened. Conclusion It was verified that the transplantation of vein-lymph vessels-fatty fascial flap had following advantages: decreased technical difficulty, better long-term effect, almost no chronic lymphedema occurred in donor site, extensive adaptation.

Pathogenicity of Septoria carvi Syd. towards Caraway Carum carvi L, （Apiaceae）

Septoria carvi belong to the fungi recently detected on caraway plants in the Polish climatic conditions. In many European countries, this fungus causes significant losses in caraway cultivation and decreases the quality and quantity of the herb material. The aim of the present work was to study the fungus harmfulness towards the sowing materials, stems, leaves and umbels of caraway. The pathogenicity tests according to Koch＇s postulates were carried out for isolates ofS. carvi using post-culture liquids and a water suspension of conidia to inoculate the plants＇ parts. The studies were conducted in the laboratory, the climatic chamber and in field conditions. S. carvi caused disease symptoms in the form of spots and necrosis on all tested plants organs. The infection was followed by natural openings what was shown by scanning electron microscope （SEM） microscopic observations. The efficiency of inoculation increased injuries and anatomical dipping of plant epidermal tissue. The study showed the ability for asymptomatic S. carvi colonization of inoculated plants＇ parts. The performed pathogenicity tests and microscopic observations SEM showed that the tested isolates of S. carvi were occasional pathogens of caraway.

Radiation-Induced Synthesis of Polyvinylpyrrolidone （PVP） Nanogels

Nanogels-particles of polymer gels having the dimensions in the order of nanometers-are gaining attention for their wide application as biomaterials. Mainly, the nanogels are promising novel pharmaceutical carriers for small biologically active agents, bin macromolecules and can be chemically modified to incorporate various ligands for targeted drug delivery. This important factor has stimulated research on dissimilar science field such as nanotechnology and biotechnology, polymer and materials sciences, biochemistry, radiation chemistry and pharmaceutical sciences. A multitude of techniques have been described for the synthesis of this nanomaterial from polymers. However, the use of ionizing radiation （γ, e-） has demonstrated to be especially suitable for obtaining polymeric nanogels with a high degree of purity for biomedical applications, although the gamma radiation has not been widely utilized for these purposes. The aim of this paper is to develop the synthesis of PVP （polyvynilpyrrolidone） nanogels by gamma irradiation, for their evaluation as potential pharmaceutical carriers. Experiments were performed using argon saturated solution of PVP （0.1-1%）. Crosstinking reactions were carried out in a gamma irradiation chamber with a 60Co source （ISOGAMMA LLCo）, at room temperature. The PVP concentration influence was evaluated in PVP solutions （0.1% and 0.25%） at 15 kGy. The SEM （scanning electron microscopy）, ATR （attenuate total reflection spectroscopy）, DLS （dynamic light scattering）, and viscosimetry were used as characterization techniques.

Efficacy of Photogem（Hematoporphyrin Derivative） as a Photoactivatable Larvicide against Aedes aegypti （Diptera： Culicidae） Larvae

Dengue vector is responsible for millions of deaths every year and has caused disastrous impacts on health systems. The continuous use of chemical insecticides, such as carbamates, pyrethroids and organophosphates generates resistant populations of the mosquito, therefore, new control methods must be investigated. The joint action of the population and guidelines for preventing the reproduction of the mosquito associated with the use of photoactivatable insecticides can be the alternative for the control of epidemiological outbreaks in affected regions. In this study, the photo-larvicidal activity of Photogem^（PG）, a derivative of hematoporphyrin, was investigated against 2nd-early 3rd instar of Aedes aegypti larvae （Diptera： Culicidae） under different lighting conditions （artificial lighting system and sunlight）. The dynamics of PG accumulation was characterized by CLSM （confocal laser scanning microscopy） and total time PG eliminationin solution was investigated by ultraviolet-visible spectrophotometry. The maximum photo-activity of PG was observed in 0.5 h under sunlight exposure which achieved 100% larval mortality. Fluorescence images showed a uniform distribution of PG along the digestive tract. PG remained stable in the sunlight for 48 h and in an artificial lighting system for longer periods, therefore, it can be used for the control ofAedes aegypti larvae as a new alternative to chemical insecticides. The method is considered environmentally friendly due to its rapid degradation in the presence of light. Further studies are required, so that the potential of the technique can be explored in real breeding places.

轴型皮瓣再造阴道126例经验体会

目的 总结 6种皮瓣再造阴道的临床经验。 方法 应用下腹部皮瓣、脐旁皮瓣、小阴唇皮瓣、阴囊皮瓣、阴茎皮瓣和阴股沟皮瓣再造阴道 12 6例。 结果 下腹部皮瓣坏死 1例 ,其余皮瓣全部成活 ,阴茎皮瓣法发生阴道口狭窄 1例 ,阴股沟皮瓣法有 3例阴道变浅。 结论 阴股沟皮瓣法距受区最近 ,转移方便 ,皮瓣薄 ,血管神经分布丰富 ,再造的阴道柔软 ,弹性好 ,有会阴部感觉 ,供区极隐蔽并可直接缝合 。