Neoadjuvant chemotherapy with capecitabine combined with oxaliplatin for mid-low locally advanced rectal cancer with negative mesorectal fascia:Long-term outcomes of a prospective trial(PKUCH-R03 trial)

Objective:To evaluate the safety and efficacy of neoadjuvant chemotherapy(NCT)in mid-low locally advanced rectal cancer with negative mesorectal fascia(MRF).Methods:This prospective,single-arm phaseⅡtrial was designed and conducted at Peking University Cancer Hospital.The patients who provided consent received 3 months of NCT(capecitabine and oxaliplatin,CapOX)followed by total mesorectal excision(TME).The primary endpoint was the rate of pathological complete response(pCR).Results:From January 2019 through December 2021,a total of 53 patients were enrolled,7.5%of whom experienced grade 3-4 adverse events during NCT.The pCR rate was 17.0%for the entire cohort,and the overall rate of postoperative complications was 37.7%(1.9%of gradeⅢa patients).The 3-year disease-free survival rate was 91.4%,and 23.5%(12/51)of the patients suffered from major low anterior resection syndrome(LARS).Postoperative complications were independently associated with major LARS.Conclusions:For patients with mid-low rectal cancer with negative MRF,3 months of NCT were found to yield a favorable tumor response with acceptable toxicity.With fair long-term survival,the NCT regimen could be associated with low rates of perioperative complications as well as acceptable anal function.

Symmetry of upper eyelid after unilateral blepharoptosis repair with minimally invasive conjoint fascial sheath suspension technique

AIM:To investigate the symmetry of upper eyelid in patients with unilateral mild and moderate blepharoptosis who underwent unilateral minimally invasive combined fascia sheath(CFS)suspension.METHODS:A retrospective study of patients who underwent unilateral minimally invasive CFS suspension surgery between January 2018 and December 2021.Inclusion criteria included unilateral mild and moderate ptosis,good levator muscle function(>9 mm)and follow-up of at least 6mo.Pre-and post-operative symmetry was graded subjectively for marginal reflex distance 1(MRD1),tarsal platform show(TPS)and eyebrow fat span(BFS).A t-test was used to evaluate MRD1,TPS and BFS asymmetry by calculating delta values.The Bézier curve tool of the Image J software was used to extract the upper eyelid contours,where the symmetry was measured by the percentage of overlapping curvatures(POC).RESULTS:Totally 105 patients(105 eyelids)were included(mild group,n=84;moderate group,n=21).Postoperatively,all patients increased MRD1 and decreased TPS in the ptotic eye while maintaining unchanged BFS.The asymmetric delta value for MRD1 was measured to be 1.48±0.86 preoperatively,and it decreased to 0.58±0.67 postoperatively in all cases(P=0.0004).In patients with mild ptosis,the asymmetry value of TPS fell significantly from 1.15±0.62 to 0.68±0.38(P=0.0187).The symmetry of the upper eyelid contour increased in all subgroups of patients,with a POC of 59.39%±13.45%preoperatively and POC of 78.29%±13.80%postoperatively.CONCLUSION:Minimally invasive CFS suspension is proved to be an effective means of improving the symmetry of unilateral ptosis in terms of MRD1(all subgroups),POC(all subgroups)and TPS(only mild group),whereas BFS is unaffected.

A new technique for correction of iatrogenic upper eyelid retraction by using a composite flap of the orbicularis muscle and fascia on the anterior surface of the tarsal plate

Background:Upper eyelid retraction is a challenging complication of cosmetic upper eyelid blepharoplasty.To avoid extra trauma,we developed a new technique for correcting iatrogenic upper eyelid retraction by postmigrating a compound flap of the orbicularis muscle and fascia(OFC)on the anterior surface of the tarsal plate.This method extends the aponeurosis of the levator palpebrae superioris muscle(LPS),which can achieve a good correction for post-blepharoplasty retraction.Methods:We collected data from 15 patients with mild to moderate iatrogenic upper eyelid retraction who were treated at our hospital between February 2017 and December 2019.The OFC was used to replace the missing part of the LPS,and post-migration of the LPS and fixation of the OFC to the tarsal margin were conducted.Postoperative outcome measurements included postoperative binocular symmetry,double eyelid smoothness,eyelid fullness,margin reflex distance(MRD1),degree of eyelid closure,and exposure keratitis.The patients were followed-up at seven days,one month,and six months postoperatively.Results:One patient with moderate eyelid retraction showed undercorrection 6 months postoperatively,with the upper eyelid margin located at the upper edge of the pupil.The remaining patients had the upper eyelid margin stabilized at 1.0–2.0 mm below the upper corneal margin.Other observational indicators were satisfactory,including binocular symmetry,double eyelid fluency,and eyelid fullness.During the follow-up,no exposure keratitis was identified.The MRD1 indexes after the operation were significantly different(P<0.001)from those before the procedure.Conclusions:Extension and post-migration of the LPS using the orbicularis muscle and OFC structure can effectively correct mild iatrogenic eyelid retraction after ptosis with less damage and good postoperative eyelid morphology and closure function.

Optimizing Recovery Following Mihata Superior Capsular Reconstruction Surgery with Tensor Fascia Lata Auto Graft: A Comprehensive Rehabilitation Protocol

Objective: Superior Capsular Reconstruction (SCR) using a Tensor Fascia Lata (TFL) autograft is an evolving technique for treating irreparable rotator cuff tears. The Mihata technique, initially developed in Japan, has shown promising long-term results. However, a standardized post-operative rehabilitation protocol for this procedure in the USA is lacking. Purpose: This study aims to evaluate the outcomes of a comprehensive rehabilitation protocol following SCR with TFL autograft in a cohort of nine patients. Participants and Methods: A prospective observational study was conducted at Concentra Urgent Care, San Francisco. Nine patients, aged 55 - 65 years, underwent SCR with TFL autograft performed by a specialized orthopedic surgeon. Post-operative rehabilitation was managed using a structured protocol, divided into three phases focusing on passive exercises, progressive range of motion, and strengthening. Outcomes were measured using the Visual Analogue Scale (VAS) for pain, forward flexion range of motion (FF-ROM), and Single Assessment Numeric Evaluation (SANE) scores over a six-month period. Results: Significant improvements were observed in pain reduction (mean VAS decrease of −3.67 points, p = 0.01), ROM (mean FF increase of 41.11 degrees, p = 0.014), and SANE scores (mean improvement of 42.11%, p = 0.009), indicating the efficacy of the rehabilitation protocol. Conclusion: The comprehensive rehabilitation protocol following SCR with TFL autograft significantly improved pain, range of motion, and shoulder function in patients, suggesting its potential utility in clinical practice.

OJU Peyronie’s Disease in an Elderly Ghanaian Gentleman—A Case-Report and Literature Review

Background: Peyronie’s disease is characterized by fibrous plaque formation in the tunica albuginea, leading to penile curvature and sexual dysfunction. Surgical correction is often required in cases of severe deformity or significant functional impairment. Aim: To present the case of a patient with severe Peyronie’s disease who underwent surgical correction using an autologous fascia lata graft. Case Presentation: We report the case of a 77-year-old Black-African gentleman with Peyronie’s disease, presenting with a self-reported penile curvature of 70 degrees and significant sexual frustration. He was managed surgically with plaque excision followed by a tunica albuginea patch using a subcutaneously harvested autologous fascia lata graft, all performed in a single surgical session. Conclusion: This case highlights the importance of individualized surgical planning and patient-specific considerations in achieving optimal outcomes in the management of Peyronie’s disease, particularly in cases requiring grafting for severe curvature.

直肠阴道隔的解剖学研究及其临床意义

目的:为直肠癌切除术,阴道塌陷及影像学提供解剖学依据。方法:25例福尔马林固定的成年女性盆腔标本,14例行正中失状切,在体式镜下观察,11例制成250～750μm厚的水平和矢状位火棉胶切片。结果:直肠阴道隔由前后两层组成,前层是Denonvilliers'fascia,后层是直肠固有筋膜。二者紧贴在一起,向上在直肠子宫陷凹处的腹膜折返下方分开,向下在会阴体上方分开,两侧在阴道后外侧分开。Denonvilliers'fascia在不同水平其两侧的止点不同:在宫颈平面止于宫旁组织,在阴道上部止于阴道旁组织,在阴道中部止于盆筋膜腱弓,在阴道下部止于肛提肌出口的外侧。结论:直肠阴道隔由前方的Denonvilliers'fascia和后方的直肠固有筋膜组成。

鼻内镜下自体肌肉筋膜加脂肪组织修补脑脊液鼻漏

2002年6月～2005年8月对35例脑脊液鼻漏患者手术修补时,分别采用了联合肌肉筋膜与脂肪组织以及单独使用肌肉筋膜作为修补材料,前瞻性对比观察修补效果。

颞筋膜修补鼻中隔穿孔

鼻中隔穿孔常由于手术、外伤、炎症、药物或不明原因引起，在临床上较常见。修补手术难度大，我科自2003～2007年间，用颞筋膜及自体骨进行鼻中隔穿孔修补8例，取得较满意效果，报道如下。

Preservation of Parotid Masseter Fascia in Preventing Frey's Syndrome

Objective: To compare the functional outcomes of patients who had parotid masseter fascia reserved and unreserved flap elevating scheme in parotidectomy, especially the morbidity of Frey's syndrome. Methods: Twenty-three patients (group A) had parotid masseter fascia reserved in the parotidectomy, 32 patients (group B) had parotid masseter fascia unreserved in the operation. Compare the morbidity of gustatory sweating syndrome of the two groups. Results: Follow-up after 6 months to 2.5 years, gustatory sweating syndrome occurred in 4 patients of group A (17%), 17 patients in group B (57%). Conclusion: Reservation technic of the parotid masseter fascial in parotidectomy could prevent regeneration of parasympathetic nerve and thus prevent Frey's syndrome post-operation.

侧颅底骨及硬脑膜缺损修复材料组织学研究

通过手术造成狗侧颅底骨及硬脑膜大面积缺损,用阔筋膜、浅筋膜修复,交对阔膜及硬脑膜进行了拉力测试,结果显示阔筋膜单位宽度承受拉力大于硬脑膜,阀筋膜体外组织培养可以存活3个月以上,并有大量成纤维细胞生长,其修复硬脑膜缺损不是起支架作用,而是其本身成活,通过1～15周连续组织学观察,修复之阔筋膜等细胞结构正常存活,有大量毛细血管及成纤维细胞增生,阔筋膜暴露组(骨缺损直径为3.0cm×4.0cm左右)肉芽组织表面可见鳞状上皮形成,与阔筋膜连于一体,逐渐向修复中心爬行,无骨移植或植皮未见脑膜脑膨出现象。

胸腰筋膜解剖结构的研究进展

近年来,对胸腰筋膜（thoracolumbar fascia,TLF）的关注日渐提高。TLF是背部的深筋膜,由多层筋膜和腱膜层复杂排列而形成的结构,位于脊柱的胸椎和腰椎段。TLF可参与形成不同的结构,如椎旁韧带鞘（paraspinal retinacular sheath,PRS）、侧线（lateral raphe,LR）、胸腰椎复合物（thoracolumbar composite,TLC）。研究发现,如对肌肉及筋膜进行收缩或牵张，会使负荷在不同的纤维中传递，对脊柱产生一定作用。

喉部分切除及成形术

介绍3种喉部分切除及成形术的适应症,手术特点及用皮瓣、肌/筋膜、软骨膜作为成形组织的优点,并谈了自己的几点体会。

Assessment of T staging and mesorectal fascia status using high-resolution MRI in rectal cancer with rectal distention

AIM： To determine the accuracy of high-resolution magnetic resonance imaging （MRI） using phasedarray coil for preoperative assessment of T staging and mesorectal fascia infiltration in rectal cancer with rectal distention.METHODS： In a prospective study of 67 patients with primary rectal cancer, high-resolution magnetic resonance imaging （in-plane resolution, 0.66 × 0.56） with phased-array coil were performed for T-staging and measurement of distance between the tumor and the mesorectal fascia. The assessment of MRI was compared with postoperative histopathologic findings. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were evaluated.RESULTS： The overall magnetic resonance accuracy was 85.1% for Tstaging and 88% for predicting mesorectal fascia involvement. Magnetic resonance sensitivity, specificity, accuracy, positive predictive value, and negative predictive value was 70%, 97.9%, 89.6%, 93.3% and 88.5% for ≤ T2 tumors, 90.5% , 76% , 85.1%, 86.4% and 82.6% for T3 tumors, 100%, 95.2%, 95.5% , 62.5% and 100% for T4 tumors, and 80% , 90.4%, 88%, 70.6% and 9d% for predicting mesorectal fascia involvement, respectively.CONCLUSION： High-resolution MRI enables accurate preoperative assessment for T staging and mesorectal fascia infiltration in rectal cancer with rectal distention.

Anatomy of the lateral ligaments of the rectum: A controversial point of view

The existence and composition of the lateral ligaments of the rectum (LLR) are still the subjects of anatomical confusion and surgical misconception up to now. Since Miles proposed abdominoperineal excision as radical surgery for rectal cancer, the identification by "hooking them on the finger" has been accepted by many surgeons with no doubt; clamping, dividing and ligating are considered to be essential procedures in mobilization of the rectum in many surgical textbooks. But in cadaveric studies, many anatomists could not find LLR described by the textbooks, and more and more surgeons also failed to find LLR during the proctectomy according to the principle of total mesorectal excision. The anatomy of LLR has diverse descriptions in literatures. According to our clinical observations, the traditional anatomical structures of LLR do exist; LLR are constant dense connective bundles which are located in either lateral side of the lower part of the rectum, run between rectal visceral fascia and pelvic parietal fascia above the levator ani, and covered by superior fascia of pelvic diaphragm. They are pathways of blood vessels and nerve fibers toward the rectum and lymphatic vessels from the lower rectum toward the iliac lymph nodes.

Spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein

PreservaUon of the spleen at distal pancreatectomy has recently attracted considerable attention. Since our first successful trial, spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein for tumors of the pancreas and chronic pancreatitis has been performed more frequently. The technique for spleenpreserving distal pancreatectomy with conservation of the splenic artery and vein are outlined. The splenic vein is identified behind the pancreas and within the thin connective tissue membrane. The connective tissue membrane is cut longitudinally above the splenic vein. An important issue is to remove the splenic vein from the body of the pancreas toward the spleen, since a different approach may be very difficult. The pancreas is preferably removed from the splenic artery toward the head of the pancreas itself. This procedure is much easier than removing the pancreas from the vein side. One patient had undergone distal gastrectomy for duodenal ulcer, with reconstruction by Billroth Ⅱ tehcnique. If distal pancreatectomy with splenectomy had been performed for the lesion of the distal pancreas at the time, the residual stomach would also have to be resected. The potential damage done to the patient by reconstruction of the gastrointestinal tract in combination with distal pancreatectomy and splenectomy would have been much greater than with distal pancreatectomy only with preservation of the spleen and residual stomach. Benign lesions as well as low-grade malignancy of the body and tail of the pancreas may be a possible indication for this procedure.

Laparoscopic lateral lymph node dissection in two fascial spaces for locally advanced lower rectal cancer

BACKGROUND The procedure for lateral lymph node(LLN)dissection(LLND)is complicated and can result in complications.We developed a technique for laparoscopic LLND based on two fascial spaces to simplify the procedure.AIM To clarify the anatomical basis of laparoscopic LLND in two fascial spaces and to evaluate its efficacy and safety in treating locally advanced low rectal cancer(LALRC).METHODS Cadaveric dissection was performed on 24 pelvises,and the fascial composition related to LLND was observed and described.Three dimensional-laparoscopic total mesorectal excision with LLND was performed in 20 patients with LALRC,and their clinical data were analyzed.RESULTS The cadaver study showed that the fascia propria of the rectum,urogenital fascia,vesicohypogastric fascia and parietal fascia lie side by side in a medial-lateral direction constituting the dissection plane for curative rectal cancer surgery,and the last three fasciae formed two spaces(Latzko's pararectal space and paravesical space)which were the surgical area for LLND.Laparoscopic LLND in two fascial spaces was performed successfully in all 20 patients.The median operating time,blood loss and postoperative hospitalization were 178(152-243)min,55(25-150)mL and 10(7-20)d,respectively.The median number of harvested LLNs was 8.6(6-12),and pathologically positive LLN metastasis was confirmed in 7(35.0%)cases.Postoperative complications included lower limb pain in 1 case and lymph leakage in 1 case.CONCLUSION Our preliminary surgical experience suggests that laparoscopic LLND based on fascial spaces is a feasible,effective and safe procedure for treating LALRC.

Complete mesocolic excision: Lessons from anatomy translating to better oncologic outcome

Since the introduction of complete mesocolic excision(CME) for colon cancer, the oncologic outcome of patients has been greatly improved, which has led to a longer survival and a lower recurrence, just like the total mesorectum excision for rectal cancer. Despite the fact that the exact anatomy of the organ is one of the most vital things for surgeons to conduct surgery, no team has really studied the exact structure of the mesocolon and related attachments for CME, until the mesocolonic anatomy was first formally characterized in 2012. Therefore, this article mainly focuses on the anatomy development of the mesocolon and the achievement in this field. Meanwhile, we introduce the latest progress in laparoscopic surgery for colon cancer achieved by our team.

Rectal cancer staging: Multidetector-row computed tomography diagnostic accuracy in assessment of mesorectal fascia invasion

AIM: To assess the diagnostic accuracy of multidetectorrow computed tomography(MDCT) as compared with conventional magnetic resonance imaging(MRI), in identifying mesorectal fascia(MRF) invasion in rectal cancer patients.METHODS: Ninety-one patients with biopsy proven rectal adenocarcinoma referred for thoracic and abdominal CT staging were enrolled in this study. The contrast-enhanced MDCT scans were performed on a 256 row scanner(ICT, Philips) with the following acquisition parameters: tube voltage 120 KV, tube current 150-300 m As. Imaging data were reviewed as axial and as multiplanar reconstructions(MPRs) images along the rectal tumor axis. MRI study, performed on 1.5 T with dedicated phased array multicoil, included multiplanar T2 and axial T1 sequences and diffusion weighted images(DWI). Axial and MPR CT images independently were compared to MRI and MRF involvement was determined. Diagnostic accuracy of both modalities was compared and statistically analyzed.RESULTS: According to MRI, the MRF was involved in 51 patients and not involved in 40 patients. DWI allowed to recognize the tumor as a focal mass with high signal intensity on high b-value images, compared with the signal of the normal adjacent rectal wall or with the lower tissue signal intensity background. The number of patients correctly staged by the native axial CT images was 71 out of 91(41 with involved MRF; 30 with not involved MRF), while by using the MPR 80 patients were correctly staged(45 with involved MRF; 35 with not involved MRF). Local tumor staging suggested by MDCT agreed with those of MRI, obtaining for CT axial images sensitivity and specificity of 80.4% and 75%, positive predictive value(PPV) 80.4%, negative predictive value(NPV) 75% and accuracy 78%; while performing MPR the sensitivity and specificity increased to 88% and 87.5%, PPV was 90%, NPV 85.36% and accuracy 88%. MPR images showed higher diagnostic accuracy, in terms of MRF involvement, than native axial images, as compared to the reference magnetic resonance images. The difference in accuracy was statistically significant(P = 0.02). CONCLUSION: New generation CT scanner, using high resolution MPR images, represents a reliable diagnostic tool in assessment of loco-regional and whole body staging of advanced rectal cancer, especially in patients with MRI contraindications.

In situ staining of the primo vascular system in the ventricles and subarachnoid space of the brain by trypan blue injection into the lateral ventricle

We examined a new method for visualization of the primo vascular system in the rat brain involving lateral ventricle injection of trypan blue. Results showed that the primo vascular system in the lateral ventricles and arachnoid mater of the brain were preferentially stained relative to blood vessels and fascia. The primo-vessels along blood vessels in the brain were clearly exhibited. In addition, the primo vascular system was evident between the fourth ventricle and the quadrigeminal cistern. Our experimental findings indicate that this new technique of lateral ventricle injection of trypan blue can visualize the primo vascular system in lateral ventricles and arachnoid mater of rats in situ.

Efficacy of fascia iliaca compartment nerve block as part of multimodal analgesia after surgery for femoral bone fracture

BACKGROUND: Fascia iliaca compartment nerve block(FICNB) has been an established technique for postoperative analgesia after surgery for femoral bone fracture. FICNB is technically easy, effective for postoperative pain control after operation for femoral bone fracture and decreases the complications induced by systemic analgesic drugs. The severity of postoperative pain is affected by genetics, cultural and social factors across the world. In this study we assessed the efficacy of fascia iliaca compartment nerve block when it is used as part of multimodal analgesia after surgery for femoral bone fracture.METHODS: An institution-based case control study was conducted from September, 2013 to May, 2014. All patients who had been operated on under spinal anesthesia for femoral bone fracture were included. The patients divided into a FICNB group(n=20) and a control group(n=20). The FICNB group was given 30 mL of 0.25% bupivacaine at the end of the operation. Postoperative pain was assessed within the f irst 24 hours, i.e. at 15 minutes, 2 hours, 6 hours, 12 hours and 24 hours using 100 mm visual analogue scale(VAS), total analgesic consumption, and the time for the f irst analgesic request.RESULTS: VAS pain scores were reduced within the f irst 24 hours after operation in the FICNB group compared wtih the control group. VAS scores at 2 hours were taken as median values(IQR) 0.00(0.00) vs.18.00(30.00), P=0.001; at 6 hours 0.00(0.00) vs. 34.00(20.75), P=0.000; at 24 hours 12.50(10.00) vs. 31.50(20.75), P=0.004; and at 12 hours(17.80±12.45) vs.(29.95±12.40), P=0.004, respectively. The total analgesic consumption of diclofenac at 12 and 24 hours was reduced in the FICNB group, and the time for the fi rst analgesic request was signifi cantly prolonged(417.50 vs. 139.25 minutes, P=0.000).CONCLUSIONS: A single injection for FICNB could lead to postoperative pain relief, reduction of total analgesic consumption and prolonged time for the fi rst analgesic request in the FICNB group after surgery for femoral bone fracture. We recommend FICNB for analgesia after surgery for femoral bone fracture and for patients with femoral bone fracture at the emergency department.