The purpose of this study was to investigate the arterial supply of the pisiform bone. Fifty upper extremities from adult human cadavers of both sexes were studied. The observations showed that there was a small branch(named the main artery of pisiform) arising from the lower part of the ulnar artery in each cases. The mean value of the length of the main artery of the pisiform was 23.89±8.68mm, the diameter of the artery was 0.79±0.21mm. The length, width and thickness of the pisiform were 11. 61±1.98mm, 11.40±1.87mm and 10.30±1.26mm, respectively. The length and width of the space accupied by the lunate on the X-ray films were measured, they were 16.38±1.96mm and 12.03±1.17mm, respectively.
ObjectiveTo design the channels of parallel screws and cross screws for fixation of symphysis pubis diastasis through a small sample anatomic study on pubic symphysis and its neighbor structures so as to provide anatomical basis for minimally invasive fixation of symphysis pubis diastasis. MethodsEight cadaveric pelvic specimens (6 men and 2 women) were transected along L5 and the proximal 1/3 of bilateral thighs, with intact lumbar spines. The spermatic cord, womb round ligament, and corona mortis were dissected; the distance to the ipsilateral pubic tubercle was measured and subsequently the distance between pubic tubercles, the height of pubic symphysis, the diameter of outer edge of pubic tubercle, the thickness of pubic symphysis and 2 cm outside the pubic symphysis (upper, central, and lower 1/3 thickness of pubic symphysis) were measured to provide anatomical basis for the design of channels of parallel screws and cross screws. ResultsParallel screw fixation: the entry point of first screw was on the outer edge of pubic tubercle, and its exit point was on the outer edge of contralateral pubic tubercle; a cannulated screw with a diameter of 4.5 mm or 6.5 mm can be suitable for this channel. The entry point of second screw was 20 mm outside the pubic symphysis and 23 mm beneath the pubic symphysis, and its exit point was symmetrical with entry point; a cannulated screw with a diameter of 4.5 mm can be appropriate for the second channel. The direction of two screws was perpendicular to the pubic symphysis. Cross screw fixation: the entry point of cross screws was on one side of the pubic tubercle, and its exit point was 20 mm outside the contralateral pubic symphysis and 23 mm beneath the contralateral pubic symphysis; two cannulated screws with a diameter of 4.5 mm can be chosen for cross screws channels. The direction of two cross screws was intersected with the horizontal line of two pubic tubercles at an angle of 25° respectively; besides, two cross screws formed an anteversion angle and retroversion angle of 5-10° with pubic body plane, respectively. ConclusionThe channels of parallel screws and cross screws are feasible for fixation of symphysis pubis diastasis by analyzing the anatomical data of the pubic symphysis and its neighbor structures, but further biomechanical research is need to confirm the stability of two fixation methods.
ObjectiveTo summarize the progress in treatment of pubic symphysis diastasis. MethodsRelated literature concerning treatment of pubic symphysis diastasis was extensively reviewed and comprehensively analyzed in terms of anatomy, biomechanics, and treatment. ResultsThere are many fixation methods for treatment of pubic symphysis diastasis, which aims at restoring the stability of the anterior pelvic ring. External fixator is often used as a temporary fixation; tension band wire has been abandoned due to its poor biomechanical stability; screw loosening and plate breakage often appears when a single reconstruction plate is used; box plate significantly increases the biomechanical stability of anterior pelvic ring but it leads to a considerable surgical trauma; locking plate has been used for pubic symphysis diastasis recently, especially for osteoporotic fractures; percutaneous cannulated screw has the advantages of less trauma, less bleeding, and good stability, so it is good choice for treatment of pubic symphysis diastasis. ConclusionThere is no uniform standards about the treatment of pubic symphysis diastasis, but the minimally invasive treatment is an undeniable trend. Percutaneous cannulated screw has achieved satisfactory effectiveness, however, its biomechanical stability and anatomic channels need to be further studied.
ObjectiveTo determine the prognostic significance of change of systemic immune inflammation index (SII) before and after neoadjuvant chemotherapy (NCT) in advanced pancreatic cancer.MethodsThe patients with advanced pancreatic cancer who received the NCT before pancreatectomy and met the inclusion and exclusion criteria of this study from January 2013 to December 2016 in the Panjin Liao-Oil Gem Flower Hospital were retrospectively collected. The patients were designed into an increased SII group (SII before NCT was lower than after NCT) and decreased SII group (SII before NCT was higher than after NCT) according to the change of SII before and after NCT. The laboratory data before and after NCT were collected to calculate the SII and to analyze the relationship between the change of SII before and after NCT and the clinical outcomes. The clinicopathologic characteristics and postoperative 3-year survival rate of the two groups were compared. The Cox regression was used to evaluate the influencing factors of postoperative survival of advanced pancreatic cancer.ResultsAll of 103 patients were included, 42 of whom in the increased SII group and 61 in the decreased SII group. The proportions of the intraoperative tumor size >3 cm, CA19-9>37 U/mL after NCT, and postoperative complications in the increased SII group were significantly higher than those in the decreased SII group (P<0.05). All 103 patients were followed up from 9 to 81 months with median 13 months, the 3-year cumulative survival rate of patients in the increased SII group was significantly lower than that of patients in the decreased SII group (19.0% versus 42.6%, P=0.012). The results of the multivariate analysis showed that the CA19-9>37 U/mL after NCT [HR=2.084, 95%CI (1.140, 3.809), P=0.017], postoperative complications [HR=1.657, 95%CI (1.009, 2.722), P=0.046], the absent of postoperative adjuvant chemotherapy [HR=1.795, 95%CI (1.085, 2.970), P=0.023], and the elevated SII after NCT [HR=1.849, 95%CI (1.111, 3.075), P=0.018] were the independent risk factors affecting postoperative 3-year survival rate of patients with advanced pancreatic cancer.ConclusionsThe change value of SII before and after NCT is an independent risk factor for the prognosis of patient with advanced pancreatic cancer, the elevated SII after NCT is a poor prognosis index in patient with advanced pancreatic cancer. However, the evaluations of larger controlled trials are necessary at multiple institutions before introduction of SII as a prognostic indicator in clinical practice.
Objective To investigate the operative procedure and the short-term therapeutic effects of medial plantar venous flaps for estoration of soft-tissue defects on the volar aspect of fingers. Methods From May 2007 to July 2009, 13 cases (15 fingers) of volar soft tissue defects were treated with medial plantar venous flaps, including 7 males (9 fingers) and 6 females(6 fingers) with an average age of 30 years (range, 17-55 years). Soft tissue defects were caused by electric saws in 4 cases (5 fingers), by crush injury in 6 cases (6 fingers), and by burned scar removal in 3 cases (4 fingers). The size of soft tissue defects ranged from 1.0 cm × 0.9 cm to 5.8 cm × 3.3 cm, included 5 thumbs, 3 index fingers, 3 l ittle fingers, 2 ring fingers, and 2 middle fingers. The emergency surgical treatment was performed in 10 traumatic cases after 2 to 12 hours (4 hours on average); and the elective surgical treatment was performed in the other 3 cases of scar after burn. The 15 medial plantar venous flaps, with size of 1.0 cm × 1.0 cm to 6.0 cm × 3.5 cm, were harvested to restore defects. Of them, 12 venous flaps had 1 superficial vein and the other 3 had 2 veins; and the veins of 13 venous flaps bridged a single digital artery and the veins of the other 2 flaps bridged both arteries. The donor sites were sutured directly or were covered with skin graft. Results All 15 venous flaps survived completely, and the donor and reci pient sites healed by first intention. Eleven cases (11 fingers) were followed up for 2 to 12 months. The texture and color of the flaps were similar to those of adjacent normal skin with a satisfactory appearance. The two-point discrimination was 6-9 mm. According to criterion for joint junction of total active range of motion/total active range of flexion, the results were excellent in 10 cases and good in 1 case; the excellent and good rate was 100%. Conclusion The medial plantar venous flap has advantages of easy-to-operate, rich blood supply and high survival rate. So it is an ideal and rel iable choice for volar soft tissue defects of fingers.
目的 探討孤立性纖維性腫瘤的診斷及外科治療方法。方法 回顧我院10年來經手術切除并行病理檢查確診為孤立性纖維性腫瘤的病例資料，就其診斷和外科治療方法進行總結與分析。結果 共16例次患者，腫瘤分別位于胸腔、腹股溝、后腹膜、外陰、頸部、下肢等部位，無明顯特異的臨床癥狀。所有病例均行手術完全切除腫瘤，術后經病理學檢查和免疫組化染色檢查確診。對患者定期隨訪，其中2例分別于術后5年和7年腫瘤復發，2例分別隨訪3年和5年后失訪，2例患者分別于隨訪的第9個月和16個月因全身多發轉移死亡，其余患者仍在隨訪中。結論 孤立性纖維性腫瘤大多數病例表現為局部緩慢生長的無痛性腫塊，無明顯的臨床癥狀，術前診斷較困難，目前僅能依靠術后免疫組化檢查確診，手術切除是最佳的治療方法。
ObjectiveTo investigate the biological characteristics of bone marrow mesenchymal stem cells (BMSCs) in microenvironment of premature senescence of nucleus pulposus cells (NPCs) so as to lay a foundation for the repair of intervertebral disc degeneration by BMSCs transplantation. MethodsHuman degenerative nucleus pulposus and normal bone marrow were collected, and then NPCs and BMSCs were isolated, cultured, and identified. The 3rd passage BMSCs and the 1st passage NPCs with premature senescence were co-cultured without contact in the Transwell culture system. NPCs to BMSCs ratio was 75%:25% (group A), 50%:50% (group B), and 0:100% (group C). The morphological changes of BMSCs were observed by inverted phase contrast microscopy and transmission electron microscopy. At 3 and 6 days after co-culture, cell counting kit 8 was used to detect cell viability, flow cytometry was used to observe the cell cycle and detect DNA metabolism after BrdU labeling. Cell senescence was also evaluated by detecting senescence associated β-galactosidase (SA-β-gal) activity. ResultsThe typical morphology of cell senescence was seen in groups A and B, especially in group A. At 3 and 6 days after co-culture, the cell survival rate of group A was significantly lower than that of group B (P<0.05). At 3 days after co-culture, the proportion of cells in G1 phase in group A was significantly higher than that in groups B and C (P<0.05), the proportion of cells in S phase in group A was significantly lower than that in groups B and C (P<0.05). At 6 days, the proportion of cells in G1 phase in group A was about 81.0%, and the proportion of cells in S phase and G2 phase decreased, showing significant difference when compared with groups B and C (P<0.05); the proportion of cells in G1 phase in group B was about 74.4%, showing significant difference when compared with group C (P<0.05). BrdU content in group A was significantly lower than that in groups B and C at 3 and 6 days after co-culture (P<0.05), but no significant difference was found between groups B and C at 3 days (P>0.05); Brdu content in group B was also significantly reduced when compared with group C (P<0.05) at 6 days. At 6 days, SA-β-gal activity was significantly increased in groups A and B, and significant difference was shown in SA-β-gal positive cell number between groups (P <0.05). ConclusionPremature senescence of NPCs can down-regulate the proliferation capacity of co-cultured BMSCs by the paracrine effect. The greater proportion of NPCs with premature senescence is, the earlier senescence of BMSCs will be induced.