Chronic Lymphocytic Leukemia Prognostic Index: A New Integrated Scoring System to Predict the Time to First Treatment in Chinese Patients with Chronic Lymphocytic Leukemia / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The established clinical staging systems (Rai/Binet) of chronic lymphocytic leukemia (CLL) cannot accurately predict the appropriate treatment of patients in the earlier stages. In the past two decades, several prognostic factors have been identified to predict the outcome of patients with CLL, but only a few studies investigated more markers together. To predict the time to first treatment (TTFT) in patients of early stages, we evaluated the prognostic role of conventional markers as well as cytogenetic abnormalities and combined them together in a new prognostic scoring system, the CLL prognostic index (CLL-PI).</p><p><b>METHODS</b>Taking advantage of a population of 406 untreated Chinese patients with CLL at early and advanced stage of disease, we identified the strongest prognostic markers of TTFT and, subsequently, in a cohort of 173 patients who had complete data for all 3 variables, we integrated the data of traditional staging system, cytogenetic aberrations, and mutational status of immunoglobulin heavy chain variable region (IGHV) in CLL-PI. The median follow-up time was 45 months and the end point was TTFT.</p><p><b>RESULTS</b>The median TTFT was 38 months and the 5-year overall survival was 80%. According to univariate analysis, patients of advanced Rai stages (P < 0.001) or with 11q- (P = 0.002), 17p- (P < 0.001), unmutated IGHV (P < 0.001), negative 13q- (P = 0.007) and elevated lactate dehydrogenase levels (P = 0.001) tended to have a significantly shorter TTFT. And subsequently, based on multivariate Cox regression analysis, three independent factors for TTFT were identified: advanced clinical stage (P = 0.002), 17p- (P = 0.050) and unmutated IGHV (P = 0.049). Applying weighted grading of these independent factors, a CLL-PI was constructed based on regression parameters, which could categorize four different risk groups (low risk [score 0], intermediate low [score 1], intermediate high [score 2] and high risk [score 3-6]) with significantly different TTFT (median TTFT of not reached (NR), 65.0 months, 36.0 months and 19.0 months, respectively, P < 0.001).</p><p><b>CONCLUSIONS</b>This study developed a weighted, integrated CLL-PI prognostic system of CLL patients which combines the critical genetic prognostic markers with traditional clinical stage. This novel modified PI system could be used to discriminate among groups and may help predict the TTFT and prognosis of patients with CLL.</p>

Three-dimensional finite element analysis on mechanical behavior of the bone remodeling and bone integration between the bone-implant interface after hip replacement / 中国骨伤

<p><b>OBJECTIVE</b>To discuss the primary stability of the fixed interface between the cementless prosthesis and femur, and its influence on bone ingrowth and secondary stability under the roughened surface and press fit of different prostheses by finite element analysis.</p><p><b>METHODS</b>:A three-dimensional finite element module of total hip arthroplasty (THA) was developed with Mimics software. There was a collection of data when simulating hip arthroplasty. The frictional coefficient between the fixed interface was 0,0.15,0.40 and 1.00 representing the roughness of prosthesis surface. The press fit was 0, 0.01,0.05 and 0.10 mm according to the operation. The Vion Mises stress distribution and the contact pressure,friction stress and relative sliding displacement between the interface were analysed and compared when simulating the maneuver of climbing stairs.</p><p><b>RESULTS</b>At a fixed press fit of 0.05 mm,the contact pressure between the interface was 230 , 231, 222 and 275 MN under four different frictional coefficient (0,0. 15,0.40 and 1.00) with little change; the relative sliding displacement was 0.529, 0.129, 0.107 and 0.087 mm with a consistent and obvious decline. As the fixed frictional coefficient was 0.40,the contact pressure between the interface were 56.0,67.7 ,60.4 and 49.6 MN under four different press fit (0, 0.01, 0.05 and 0.10 mm) with a reduction; the relative sliding displacement was 0.064,0.062,0.043 and 0.042 mm with an obvious decline, and there was a maximal friction stress when press fit of 0.01 mm.</p><p><b>CONCLUSION</b>There is a dynamic process of the bone remodeling and bone integration between the interface after hip replacement, determining the long-term outcome. The interface clearance and the frictional coefficient are the key factors of the bone integration.</p>

Mechanics analysis on knee joint after virtual replacement / 中国组织工程研究

BACKGROUND:Simulative dynamics provides advantages of repeatable and non-invasive to a model. Additional y, structural model of individualism improves the reliability of Finite Elemental Analysis. It is an optimal attempt to analyze mechanics of knee joint after virtual replacement surgery. OBJECTIVE:To achieve dynamic information of contact stress upon knee joint surface by finite element analysis surgery for total knee arthroplasty postoperatively, and to provide objective data for further“surgery plan”. METHODS:After scanning affected knee joint by CT/MR and scanning knee prosthesis by laser instrument, a model composed of prosthesis, knee joint as wel as its ligament was rebuilt computational y;dynamic lines were measured. After prosthesis instal ation&osteotomy performed by facility of Simulation in Mimics according to knee joint replacement standard, this model was imported into ANSYS so as for Meshing, Material assignment, load applied. Stress distribution was analyzed by Finite Element Method. RESULTS AND CONCLUSION:The best finite element model of postoperative TKA 3D knee joint was obtained;dynamic data were tested to be approximately agreeable to those previous studies of direct measurement upon prosthesis. The experiment of analyzing structural deformation, stress distribution&internal energy change benefits to search the best position for prosthesis instal ation, osteotomy and surgical result prediction. Thus, these are indispensable data in surgery plan.

Anatomical observation on surgical spaces related to laparoscopic right hemicolectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore regional anatomy of fasciae and spaces related to laparoscopic right hemicolectomy (LRC).</p><p><b>METHODS</b>Seven cadavers and 49 patients undergoing LRC for cancer were observed. Computed tomography (CT) images of patients and healthy individuals were reviewed.</p><p><b>RESULTS</b>Between ascending mesocolon and prerenal fascia (PRF), there was a right retrocolic space (RRCS), which communicated in all directions. Anterior, posterior, medial, lateral, cranial, and caudal boundaries of the RRCS were ascending mesocolon, PRF, superior mesenteric vein, peritoneal reflexion at right paracolic sulcus, inferior margin of transverse part of duodenum, and inferior margin of the mesentery root, respectively. Between transverse mesocolon and pancreas and duodenum, there was a transverse retrocolic space (TRCS), which was bounded cranially by root of transverse mesocolon. On CT images of healthy individuals, PRF was noted as slender line of middle density, continuing to transverse fascia, and the retrocolic spaces were unidentifiable. For patients with right colon cancer, PRF and right retrocolic space might be easier to be identified.</p><p><b>CONCLUSIONS</b>The RRCS and the TRCS are natural surgical spaces. The PRF is natural surgical plane in LRC for cancer.</p>

Finite element analysis on internal fixation biomechanics for vertical sacrum fractures in the second generation of Chinese digitized human / 医用生物力学

Objective This study aims at comparing and optimizing postoperative stability and biomechanical compatibility in treating different types of vertically unstable sacrum fractures by using percutaneous posterior-ring tension-band steel plate and percutaneous iliosacral screw. MethodUsing CT and MR images of the second generation of Chinese digitized human “male No. 23”, the finite element models were developed respectively for two groups of vertical sacrum fractures of Denis Ⅰ,Ⅱ,Ⅲ zone with ipsilateral superior and inferior pubis ramus fractures treated with percutaneous posterior-ring tension-band steel plate (P-group) vs percutaneous iliosacral screw (S-group). The multi-solution finite element analysis and experiment validations were adopted on the basis of lumbosacral spinal three-column loading modes and sacroiliac joint physiologic behaviour. Results When simulating vertical sacrum fractures of Denis Ⅰ zone, von Mises stresses of internal fixation device of posterior and anterior rings of P-group were significantly increased, while the sacrum displacements were also increased compared to those in S-group. Whereas as simulating vertical sacrum fractures in Denis Ⅱand Ⅲ zones, von Mises stresses of fixator of both rings in P-group were lower than those of S-group, and the sacrum displacements were also remarkably decreased. Conclusions Considering internal fixation stability, mechanical compatibility for fracture healing and surgical procedure security, percutaneous iliosacral screw is more appropriate for the treatment of vertically unstable pelvis fractures with sacrum Ⅰzone injury, whereas percutaneous posterior tension-band steel plate is in favor of the treatment of vertically unstable pelvis fractures with sacrum Ⅱ and Ⅲ zone injuries.

Three-dimensional visualization of the structures related to the anterior cervical segment approach / 南方医科大学学报

<p><b>OBJECTIVE</b>To establish a digital model allowing three-dimensional visualization of the structures involved in the anterior cervical segment approach.</p><p><b>METHODS</b>Based on the imaging data obtained from CT angiography (CTA), magnetic resonance myelography (MRM) and continuous magnetic resonance imaging (MRI) of a healthy volunteer (scanning from the center of the head to the inferior border of the T3 level), image segmentation and reconstruction for the skeleton, arteries, veins, and spinal cord was conducted semi-automatically using the Mimics software according to the different thresholds of the tissues. The cervical plexus, brachial plexus and muscles of the neck were reconstructed with the Nerves pipe editor and the Med CAD module to establishing the three-dimensional model for displaying the structures involved in the anterior cervical segment approach.</p><p><b>RESULTS</b>A three-dimensional digital model of the structures involved in the anterior cervical segment anterior approach was established, which allowed the display of anatomical relations of the skeletal structure, aorta, superior vena cava, thyroid gland, hyoid bone, laryngeal cartilages, trachea, lung, 12 neck muscle groups, as well as the spinal cord, spinal nerves, cervical plexus, brachial plexus, and intervertebral disk of the neck.</p><p><b>CONCLUSION</b>The three-dimensional model established can allow the visualization of the important structures for the anterior cervical segment approach, and provides a medical teaching platform for anatomy and surgical training.</p>

Application of the medical image three-dimensional visualization system of abdomen in diagnosis and evaluating resectability of pancreatic tumors / 中华外科杂志

<p><b>OBJECTIVE</b>To study the value and the clinical application of the Medical Image three-dimensional Visualization System of Abdomen (MI-3DVS) in diagnosis and evaluating resectability of pancreatic tumor.</p><p><b>METHODS</b>Twelve patients with pancreatic tumor were tested with 64-slice helical CT (64-MSCT) angiography, and the CT data was reconstructed with MI-3DVS from November 2008 to August 2009. The 3D findings were adopted in diagnosis and evaluating resectability, and the results were compared with surgical operation and the pathological finding. There were 7 male and 5 female, aged from 14 to 83 years. Within the 12 cases, there were 4 cases with pancreatic carcinoma, 5 cases with pancreatic solid pseudopapillary tumor, 2 cases with pancreatic serous cystadenoma, 1 case with pancreatic cyst (ductal epithelial papillary hyperplasia).</p><p><b>RESULTS</b>Nine tumors which had been regarded as removable pre-operatively with MI-3DVS were removed successfully. Three patients who were considered unresectable by other hospitals with CT were operated successfully with MI-3DVS. The other 3 patients' tumors were actually not able to be removed as pre-operative evaluation.</p><p><b>CONCLUSION</b>MI-3DVS plays an important role in diagnosis and assessment of resectability of pancreatic tumor.</p>

2D/3D registration system based on single X ray image and CT data / 医用生物力学

Objective To build a 2D/3D registration system based on the compute unified device architecture(CUDA) frame with single X-ray image and CT data of knee joints and apply it in the research of knee motion and stability of implanted prosthesis. Method The digital radiography(DR) equipment used in the study was calibrated by the Zhang zhengyou Calibration Method, and then digitally rendered radiographs(DRR) images were generated in the CUDA frame with light tracing algorithm, and the best 2D/3D registration parameters were calculated with a similarity operator of cross correlation; finally, the results were evaluated by using the method of 3D/3D registration with data obtained from a 3D laser scanner. Results With knee specimen X-ray images and CT data, in 6 degrees of freedom, the average errors of transform were below 1 mm, and those of rotation were below 1°. Conclusions The 2D/3D registration system can meet the precision requirement of motion detection and be used to study the knee motion and prosthesis location.

Impact of prosthesis-patient mismatch on the quality of life of elderly patients after aortic valve replacement / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the long-term changes in the quality of life (QOL) scores in elderly patients after aortic valve replacement, and assess the impact of prosthesis-patient mismatch on the QQL of the patients.</p><p><b>METHODS</b>A prospective cohort study was conducted involving 100 consecutive elderly patients above 70 years of age, who underwent isolated aortic valve or simultaneous aortic valve-coronary artery bypass graft (CABG) procedures between August 10, 1995 and August 19, 1998. Patient-prosthesis mismatch (PPM) was defined as a prosthetic aortic valve EOAI of 0.85 cm2/m2 or less. The clinical follow-up examinations were carried out at 4 weeks and 6 months after the operation, and then annually afterwards. Cumulative and comparative analyses of the long-term outcomes and gradient pressure of the prosthetic valve were performed. The QOL of the patients was evaluated using the Short Form 36-Item Health Survey (SF-36) questionnaire.</p><p><b>RESULTS</b>The mean age of the patients at prosthesis implantation was 74.7-/+5.7 years (range 70-87 years). The patients were followed up for a mean of 7.3-/+4.5 years. The thirty-day mortality was 6.3% in the mismatch group, and 3.3% in the matching group. The freedom from death showed no significant difference between the two groups at the first, third and fifth years after the prosthetic implantation, but differed significantly at the seventh year. The echocardiographic data showed significant differences in the mean gradient pressure between the two groups at the first and fifth years postoperatively. At most of the time points for follow-up examination, the general health and energy/vitality of the patients all improved from the preoperative levels, but no significant improvement was found at the third, fifth, and seventh years in the role emotional, social role, or general mental health; at the first postoperative year, however, the role emotional, social role, and particularly mental health, presented with significant improvements in comparison with the preoperative levels. No obvious difference in the QOL was noted between the two groups at the time points of observation.</p><p><b>CONCLUSIONS</b>Aortic vale replacement improves the QOL of the elderly patients, but the degree of improvements do not seem to be influenced by PPM. The interpretation of the impact of PPM on the clinic outcome of the patients still remains controversial.</p>

Image segmentation and three-dimensional reconstruction of the liver based on 64-slice spiral CT scanning data / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the segmentation methods of the liver CT images and the value of 3-dimensional (3D) reconstruction of the liver in the planning of hepatic surgery.</p><p><b>METHODS</b>The 2D Digital Imaging and Communications in Medicine (DICOM) format data of the liver obtained from healthy volunteers were transformed into bmp format image, and the liver image segmentation was performed using Photoshop software. The 3D model was reconstructed using MIMICS software.</p><p><b>RESULTS</b>The DICOM format data of the liver obtained by 64 slice spiral CT included totally 658 slice images. The segmented liver image showed clear profiles and complete intrahepatic duct data were reserved. The segmented liver images were free of discontinuation during continuous observation. The liver surface and internal ductal system, including the hepatic arteries and veins, and the hepatic portal system and their branches, were represented clearly. The reconstructed liver allowed clear identification of the anatomic landmark and matched the actual liver volume. The reconstructed ductal structure were distinct and continuous with natural texture. The reconstructed liver and the hepatic internal duct system were simultaneously displayed by adjusting the transparency of the liver, and the blood vessels were also represented.</p><p><b>CONCLUSION</b>Segmentation of the liver images in different phases using Photoshop can be feasible for liver reconstruction. The reconstructed liver and the intrahepatic ductal structure allow vivid 3D observation of the spatial relationship among the major tracts and accurate estimation of the liver volume.</p>

Study on the three dimensional hepatic virtual operation based on the data of 64-slice helical CT scanning / 中华外科杂志

<p><b>OBJECTIVE</b>To study the surgery plan and simulation effect of the three dimensional (3D) hepatic virtual operation based on the data of 64-slice helical CT scanning and to probe the feasibility of the virtual operation based on the FreeForm Modeling System.</p><p><b>METHODS</b>The volunteer liver was scanned to collect two dimensional (2D) DICOM data of 64-slice helical CT scanning and the 3D hepatic and intrahepatic vessels model were reconstructed by MIMICS software. The reconstructed liver, the intrahepatic vessels model and the artificial tumor models were output into the FreeForm Modeling System in the STL format. The device PHANTOM with the characterization of dynamo-feedback was applied to make the operation on the 3D hepatic.</p><p><b>RESULTS</b>The spatial relationship between the tumour and the intrahepatic vessels were clearly observed by rotation and enlargement of the target. According to the operation principle, the left lobe of liver resection was simulated by manipulating the device PHANToM. Through the liver transparence surface, the intrahepatic vessels were easily distinguished. The operation procedure was accord with the clinic hepatic surgery. Meanwhile, during the operation, by adjusting the incision objective intensity, the dynamo-feedback intensity was definitely touched.</p><p><b>CONCLUSIONS</b>By using the FreeForm Modeling System,the hepatic operation procedure can be simulated ahead of time. The operation complication in the practical surgery can be anticipated and the individualization operation schema can be reasonable instituted.</p>

A biomechanical study of anterior screw fixation for type II odontoid fracture with anteroinferior-posterosuperior fracture line / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the biomechanical effect of anterior screw fixation on the type II fractured odontoid process.</p><p><b>METHODS</b>Twenty fresh human C1-C2 vertebrae specimens were harvested and randomly divided into three groups. The angle of type II fracture line was 0 degree in group I (n=6), 17 degrees in group II (n=8) and 25 degrees in group III (n=6). The fractures were treated by anterior screw fixation. Insertion torque,maximal axial pullout force and stiffness of the bone-screw were tested.</p><p><b>RESULTS</b>There was no significant difference of screw insertion torque and the pull-out strength between each group. The displacement of the odontoid fragment had an association to the angle of the fracture line,the displacement of the small angle was significantly higher than that of the large one (P < 0.5). No significant difference of structure stiffness of the bone-screw was found between each group.</p><p><b>CONCLUSION</b>Anterior screw fixation is feasible for type II odontoid fracture with certain fracture line extends from anteroinferior to posterosuperior.</p>

Beneficial effects of reciprocating gait orthosis on bladder and bowel functions in paraplegia patients / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the beneficial effects of application of a self-designed reciprocating gait orthosis (RGO) combined with comprehensive rehabilitation training on bladder and bowel function in paraplegic patients sustaining spinal cord injuries (SCI).</p><p><b>METHODS</b>Twelve paraplegic patients with complete spinal cord injury at the levels between T(4) and L(1) received the RGO with a comprehensive rehabilitation exercise program carried out before and after fixing. Cold water and colon excretion tests were performed before and 3 months after application of the RGO, and the bladder volume, residue bladder volume, and bladder and bowel pressures were measured in these patients.</p><p><b>RESULTS</b>The 12 paraplegic patients all showed positive results in cold water test before and after RGO application. Before RGO application, 11 of these patients were positive for urine bacteria and only 1 patient was still positive 3 months after the application. The bladder volume and bowel pressure of the patients were significantly increased (P<0.05), while the residue volume and pressure of the bladder were significantly reduced 3 months after RGO application (P<0.05).</p><p><b>CONCLUSION</b>RGO combined with comprehensive rehabilitation training can effectively improve the bladder and bowel function and the quality of life of patients with complete spinal cord injury, suggesting much clinical value for its extensive application.</p>

Clinical anatomic study of the lower lumbar anterolateral vein: with respect to retroperitoneal endoscopic surgery / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To study the anatomy of veins of the lower lumbar spine and provide the anatomic basement for laparoscopic lumbar surgery.</p><p><b>METHODS</b>A total of 15 formaldehyde-preserved cadavers were studied with special attention to the variety and surrounding structure of ascending lumbar vein (ALV) and iliolumbar veins (ILV), and their relationship with lumbar plexus.</p><p><b>RESULTS</b>ALV and ILV can be found on every sides, which have four variants including separate entry and common entry. The ascending vein and iliolumbar vein separately enter common iliac vein in 18 cases, and as a common stem enter the common iliac vein in 12 cases. Retracting common iliac vein medially both the ascending lumbar and the iliolumbar veins are always at risk of avulsion on exposure of the disc space. The injury of obturator nerve and lumbosacral trunk of lumbar plexus should be avoided.</p><p><b>CONCLUSION</b>Awareness of these anatomic variation can prevent the hemorrhage and be helpful for the surgeon in performing a careful ligation of these veins before medial retraction of the common iliac vein. Our findings emphasize the need for proper dissection of ALV and ILV before ligature during exposure of the lower lumbar spine.</p>

The clinic anatomy of lumbar plexus in the lumbar anterolaterally approach minimally invasive surgery / 中华外科杂志

<p><b>OBJECTIVE</b>To provide anatomic data for reducing lumbar plexus nerve injury.</p><p><b>METHODS</b>The applied anatomy of lumbar plexus was studied by 15 formaldehyde-preserved cadavers, two groups of sectional images of lumbar segment and three series of virtual chinese human dataset.</p><p><b>RESULTS</b>Arrangement of the lumbar nerve was regular. From anterior view, lumbar plexus nerve arranged from lateral to medial from L2 to L5; from lateral view, lumbar nerve arrange from ventral to dorsal from L2 to L5. The angle degree between the lumbar nerve and lumbar increased from L1 to L5. The lumbar plexus nerve was revealed to be in close contact with transverse process. By sectional anatomy, all parts of the lumbar plexus nerve were located in the dorsal third of the psoas major. The safety zone of the psoas major to prevent nerve injuries was ventrally 2/3.</p><p><b>CONCLUSIONS</b>Psoas major can be considered as surgery landmark when expose the lateral anterior of lumbar by incising the psoas muscle. Incising the psoas muscle ventral 2/3 can prevent lumbar plexus injury. Transverse process can be considered as landmark for the position of lumbar plexus in operation.</p>

Distribution of neuronal nitric oxide synthase-immunopositive neurons in rat corpus striatum and their ultrastructures / 南方医科大学学报

<p><b>OBJECTIVE</b>To observe the distribution of neuronal nitric oxide synthase (nNOS)-immunopositive neurons in rat corpus striatum and their ultrastructural features.</p><p><b>METHODS</b>Brain tissue specimens were obtained from normal SD rats, in which nNOS-immunopositive neurons were visualized by ABC immunocytochemistry and observed under immunoelectron microscope with pre-embedding staining.</p><p><b>RESULTS</b>Under light microscope, nNOS-immunopositive neurons appeared brown with distinct profiles of the cell body and processes. These neurons, mostly medium-sized and small cells, were located mainly in the lateral region of the corpus striatum. Only a few immunopositive neurons were detected in the medial region of the corpus striatum. Immunohistochemistry and transmission electron microscopy identified the nNOS-immunopositive neurons as interneurons possessing large nuclei with small amount of cytoplasma. The immunopositive granules were visualized as black plaques, and the larger ones distributed mainly in the cell bodies, some with monolayer membrane encapsulation. The small granules did not have the encapsulation, scattering in perinuclear regions and under the cell membrane, but not in the cell body. The immunopositive granules were also found in the axons and dendrites, but not in the vesicles of the synapses. In addition, many immunopositive terminals were found close to the blood vessels.</p><p><b>CONCLUSIONS</b>nNOS-immunopositive neurons in rat corpus striatum are mainly medium-sized and small cells as is typical of the interneurons. The immunopositive granules locate in the cytoplasma, axons and dendrites, and larger granules have membrane coating while small ones do not, possibly in relation to their functions.</p>

Apoptosis induction of rhesus peripheral blood lymphocytes / 南方医科大学学报

<p><b>OBJECTIVE</b>To establish a method for inducing apoptosis of rhesus peripheral blood lymphocytes (PBLs).</p><p><b>METHODS</b>Rhesus PBLs were irradiated with X-ray, (60)Co gamma-rays and ultraviolet (UVC254 nm), respectively, and the cell apoptosis was evaluated with flow cytometry using annexin-V staining and propidium iodide staining.</p><p><b>RESULTS</b>X-ray and (60)Co gamma-ray irradiation induced only low apoptotic rates of the PBLs, and UVC resulted in the highest apoptotic rate of about 60%. UVC irradiation of the PBLs in RPMI supplemented with 10% heat-inactivated fetal calf serum for 60 min at a distance of 20 cm led to an early apoptotic rate of 58.85% and necrotic rate of 11.5%. The apoptotic rate of PBLs increased in a dose- and time-dependent fashion.</p><p><b>CONCLUSION</b>For inducing apoptosis of the rhesus PBLs, UVC can be more effective than X-ray and (60)Co gamma-ray. The highest apoptotic rate can be achieved when the rhesus PBLs in RPMI supplemented with 10% heat-inactivated fetal calf serum are exposed to UVC for 60 min at the distance of 20 cm.</p>

Anatomic evaluation the entry point of C2 pedicle screw / 中华外科杂志

<p><b>OBJECTIVE</b>To study the relevant position of C(2) pedicle to C(2) inferior articular process, set up a technique of C(2) pedicle screw placement with the inferior articular process of axis as an anatomic landmark.</p><p><b>METHODS</b>Fifty C(2) bone specimens were used to measure the distance from the sagittal midline to the medial border, the midpoint and the lateral border of C(2) inferior articular process or C(2) pedicle; the width and the height of the C(2) pedicle were also evaluated. The anatomic relation between the measurements data of C(2) pedicle and that of C(2) inferior articular process were analyzed, and the technique of C(2) pedicle screw fixation was established.</p><p><b>RESULTS</b>The medial border of C(2) inferior articular process was averaged (3.67 +/- 0.41) mm lateral to that of C(2) pedicle, and the midpoint C(2) inferior articular process was averaged (1.15 +/- 0.44) mm lateral to the lateral border of C(2) pedicle, respectively. Using the C(2) inferior articular process as landmark, two techniques was established for C(2) pedicle screw placement. The entry point of method A was located in 2 mm medial and superior to the central point of C(2) inferior articular process; the entry point of method B was at the crossing point of the medial border C(2) inferior articular process with the superior quarter of C(2) inferior articular process.</p><p><b>CONCLUSIONS</b>There is a steady anatomic relation between C(2) pedicle and C(2) inferior articular process, the C(2) inferior articular process could be as a convenient key anatomic landmark to determine the location of C(2) pedicle and the position of C(2) pedicle screw entry point.</p>

Preservation of the autonomic nerve in rectal cancer surgery: anatomical factors in ligation of the inferior mesenteric artery / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the regional anatomy between the abdominal autonomic nerves including the abdominal aortic plexus (AAP) and the inferior mesenteric artery (IMA), and explore the safe ligation point on the IMA and the optimal dissection method to avoid autonomic nerve injuries.</p><p><b>METHODS AND RESULTS</b>Dissections and observation were carried out on 16 fixed male cadavers. The AAP located in the thin fascia layer covering the surface of the aorta and its branches. No autonomic nerves were found in the area around the root of the IMA, and the point where the IMA and the left trunk of the AAP intersected was highly variable. The left trunk of the AAP adhered more closely to the IMA than to the aorta.</p><p><b>CONCLUSIONS</b>In view of autonomic nerve preservation, the only safe site for ligation of the IMA is at its origin, and no other such sites are available along the IMA trunk and its branches. The IMA and the posterior fascia layer containing the autonomic nerves constitute the optimal surgical plane for IMA ligation, which should be performed following skeletonization of the IMA with careful preservation of the integrity of the posterior fascia layer.</p>

Modification of the right subclavian vein catheterization and its anatomic basis and techniques / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Several million subclavian-vein catheters are placed in patients each year to enable caregivers to administer chemotherapy, total parenteral nutrition, or long-term antibiotics or to manage preoperative fluids. Subclavian venipuncture requires the position of a deep vein to be identified with only surface landmarks. But the traditional right subclavian vein (RSV) catheterization (primitive procedures) is not the answer for all patients. The precise location of the vein is not known, and it is important to select the most appropriate method to achieve central venous access safely in any given patient. To modify the primitive procedures of the RSV catheterization for greater success and reduce the complications, anatomic studies and ultrasonography were conducted and clinical applications were validated.</p><p><b>METHODS</b>Anatomical observation and measurement of the RSV and its adjacent structures were performed on 20 adult cadavers according to modified procedures. The RSV catheterization of 2900 cases was carried out by the modified procedure, 500 of these cases were observed by ultrasonography after the operation.</p><p><b>RESULTS</b>The anatomical studies and clinical application showed that the insertion point differs from the bodily form of fatness or leptosome. The clinical data revealed that in the 2900 cases which were performed with the modified approach, the success rate was 98.90% (2868 cases), the failure rate was 1.10% (32 cases), and the complication rate is 0.79% (23 cases), and the catheterization time is (31.2 +/- 10.5) minutes. Five hundred and sixty cases of the RSV catheterization were carried out by the recommended insertion procedure; the results were compared with the modified approach and the traditional approach. The successful rate of the traditional approach was 73.0%, of which the complication rate was 6.1%; the two approaches were significantly different (successful rate: chi(2) = 626.642, P < 0.01; complication rate: chi(2) = 80.708, P< 0.01).</p><p><b>CONCLUSIONS</b>The modified RSV catheterization is characterized with a higher success rate and less complications, and the insertion procedure differs from the bodily form of fatness or leptosome.</p>