Bilateral triceps tendon approach is flexible and efficient in the treatment of type C distal humerus fractures / 中华创伤杂志(英文版)

PURPOSE@#The purpose of this study was to assess and compare elbow range of motion, triceps extension strength and functional results of type C (AO/OTA) distal humerus fractures treated with bilateral triceps tendon (BTT) approach and olecranon osteotomy (OO). At the same time, we are also trying to know whether BTT approach can provide sufficient vision for comminuted intra-articular fractures of the distal humerus, and whether it is convenient to convert to the treatment to total elbow arthroplasty (TEA) or OO.@*METHODS@#Patients treated with OO and BTT approaches for type C distal humerus fractures between July 2014 and December 2017 were retrospectively reviewed. Inclusion criteria include: (1) patients' age were more than 18 years old, (2) follow-up was no less than 6 months, and (3) patients were diagnosed with type C fractures (based on the AO/OTA classification). Exclusion criteria include: (1) open fractures (Gustillo type 2 or type 3), (2) treated by other approaches, and (3) presented with combined injuries of ipsilateral upper extremities, such as ulnar nerve. Elbow range of motion and triceps extension strength testing were completely valuated, when the fractures had healed. Assessment of functional results using the Mayo elbow performance score and complications were conducted in final follow-up. The data were compared using the two tailed Student's t-test. All data were presented as mean ± standard deviation.@*RESULTS@#Eighty-six patients of type C distal humerus fractures, treated by OO and BTT approach were retrospectively reviewed between July 2014 and December 2017. Fifty-five distal humerus fractures (23 males and 32 females, mean age 52.7 years) treated by BTT approach or OO were included in this study. There were 10 fractures of type C1, 16 type C2 and 29 type C3 according to the AO/OTA classification. Patients were divided into two surgical approach groups chosen by the operators: BTT group (28 patients) and OO group (27 patients). And the mean follow-up time of all patients was 15.6 months (range, 6-36 months). Three cases in BTT group were converted to TEA, and one converted to OO. Only one case in BTT group presented poor articular reduction with a step more than 2 mm. There were not significantly different in functional outcomes according to the Mayo elbow performance score, operation time and extension flexion motion are values between BTT group and OO group (p > 0.05). Complications and reoperation rate were also similar in the two groups. Triceps manual muscle testing were no significant difference in the two groups, even subdivided in elder patients (aged >60 years old).@*CONCLUSION@#BTT is a safe approach to achieve similar functional result comparing with OO. BTT were not suitable for every case with severe comminuted pattern, but it avoids the potential complications related to OO, and has no complications concerning with triceps tendon. It is convenient for open reduction internal fixation and flexible to be converted to OO, as well as available to be converted to TEA in elder patients.

Efficacy and safety of endoscopic and laparoscopic treatment for gastric stromal tumor: a meta-analysis / 中华消化内镜杂志

Objective@#To systematically evaluate the efficacy and safety of endoscopic resection and laparoscopic surgery for gastrointestinal stromal tumors(GIST) (diameter<3.5 cm).@*Methods@#According to the Cocharane system search strategy, Chinese and English literature comparing endoscopic with laparoscopic treatment of GIST published from January 2000 to March 2018 were collected. Ten articles meeting the inclusion criteria were included and analyzed with Revman 5.3.@*Results@#Of the 10 articles, 1 was a prospective randomized controlled trial and 9 were retrospective non-randomized controlled trials. The total number of patients was 1 062. There were 732 cases in the endoscopic treatment group, and 330 cases in the laparoscopic surgery group. The meta-analysis results showed that the endoscopic treatment group had shorter operation time (MD=-30.58 min, 95%CI: -39.31--21.84, P<0.05), less blood loss (MD=-12.99 mL, 95%CI: -16.40--9.57, P<0.05), shorter hospital stay (MD=-3.17 d, 95%CI: -4.76--1.59, P<0.05), and less total cost (MD=-1.63 ten thousand RMB, 95%CI: -2.42--0.84, P<0.05) than those of the laparoscopic group. But there were no significant differences in the positive rate of margin(RR=2.35, 95%CI: 0.52-10.69, P=0.27) or perioperative complications(RR=1.08, 95%CI: 0.48-2.42, P=0.85).@*Conclusion@#Existing studies have shown that endoscopic treatment for GIST is effective, minimally invasive, economical with better prognosis, ensuring complete resection.

Efficacy and safety of endoscopic and laparoscopic treatment for gastric stromal tumor:a meta-analysis / 中华消化内镜杂志

Objective To systematically evaluate the efficacy and safety of endoscopic resection and laparoscopic surgery for gastrointestinal stromal tumors(GIST)(diameter<3. 5 cm). Methods According to the Cocharane system search strategy,Chinese and English literature comparing endoscopic with laparoscopic treatment of GIST published from January 2000 to March 2018 were collected. Ten articles meeting the inclusion criteria were included and analyzed with Revman 5. 3. Results Of the 10 articles,1 was a prospective randomized controlled trial and 9 were retrospective non-randomized controlled trials. The total number of patients was 1062. There were 732 cases in the endoscopic treatment group,and 330 cases in the laparoscopic surgery group. The meta-analysis results showed that the endoscopic treatment group had shorter operation time (MD= -30. 58 min,95％CI:-39. 31--21. 84,P<0. 05),less blood loss (MD= -12. 99 mL, 95％CI:- 16. 40-- 9. 57,P < 0. 05),shorter hospital stay (MD = - 3. 17 d,95％CI:-4. 76--1. 59,P <0. 05),and less total cost (MD= -1. 63 ten thousand RMB,95％CI:-2. 42--0. 84,P<0. 05)than those of the laparoscopic group. But there were no significant differences in the positive rate of margin(RR = 2. 35, 95％CI:0. 52-10. 69,P= 0. 27)or perioperative complications(RR= 1. 08,95％CI:0. 48-2. 42,P= 0. 85). Conclusion Existing studies have shown that endoscopic treatment for GIST is effective,minimally invasive,economical with better prognosis,ensuring complete resection.

Hemodynamic detection of posterior cerebral artery dysplasia with transcranial Doppler ultrasonography / 中国脑血管病杂志

Objectives: To analyze the hemodynamic characteristics of dysplastic posterior cerebral artery with transcranial Doppler ultrasonography (TCD) and to investigate the diagnostic value of TCD. Methods: Fifty-two patients with posterior cerebral artery P1 segment (PCA-P1) dysplasia screened by MRA and TCD were selected. The hemodynamic changes before and after the carotid compression test were observed, and compared with 52 healthy subjects without abnormal blood vessels (control group). Results: Circled digit oneThe blood flow velocity of 52 patients with PCA-P1 dysplasia on the dysplasia was 55 ± 8 cm/s on the dysplastic side, which was significantly lower than that of 60 ± 6 cm/s in the control group (P < 0.01). After compressing the ipsilateral common carotid arteries (CCAs) respectively, the velocity of PCA-P1 on the dysplastic sides was 192 ± 25 cm/s, and it was significantly higher than 96 ± 14 cm/s in the control group (P < 0.01). The ratio of velocity in patients with dysplasia before and after the compression test (after Vp/before Vp) was 3.52 ± 0.53, and it was significantly higher than 1.60 ± 0.17 in the control group (P < 0.01). Circled digit twoAfter compressing the ipsilateral CCAs respectively, the end-diastolic flow velocity and the ratio before compression (after Vp/before Vp) was 4.48 ± 1.28, and it was significantly higher than 1.61 ± 0.25 in the control group (P < 0.01). Circled digit threePCA-P1 pulsatility index (PI) on the dysplastic sides was 1.00 ± 0.22, and it was significantly higher than 0.78 ± 0.09 in the control group (P < 0.01). There was significant difference (P < 0.01). Circled digit fourOf the 52 patients, the flow spectrum of 28 patients showed high-resistance changes and the flow spectrum of 24 patients was normal. Before and after compressing the ipsilateral CCAs, the ratio of high-resistance spectrum group compared to that before compressing (after Vd/before Vd) was 5.3 ± 1.1, and it was significantly higher than 3.5 ± 0.6 in normal blood flow spectrum group. There was significant difference (P < 0.01). However, there was no significant difference between after VP/before VP and the normal blood flow spectrum group. ©Dysplasia in PCA-P1 was suspected in 39 cases by TCD, and 32 of them were confirmed with MRA. The positive coincidence rate was 82.1%, 17 of them showed high-resistance flow spectrum, and 16 had dysplasia in PCA-P1 confirmed by MRA. The positive coincidence rate was 94.1%. Conclusion: TCD in combination with blood flow spectrum shape may initially diagnose the dysplasia in PCA-P1 according to the changes of hemodynamic parameters of PCA-P1 before and after the CCA compression test.

Detection of cerebral hemodynamics of anterior cerebral artery and anterior communicating artery variations with transcranial Doppler ultrasonography / 中国脑血管病杂志

Objective: To analyze the hemodynamic characteristics in detecting of anatomic variations of anterior cerebral artery (ACA) and anterior communicating artery (ACoA) with transcranial Doppler (TCD). Methods: Sixty-two patients with anatomic variations of ACA or ACoA (patient group) and 48 healthy subjects without variation (control group) diagnosed by magnetic resonance imaging (MRA) and TCD were selected. The hemodynamic changes in extracranial and intracranial vessels in both groups were detected by TCD. Results: Circled digit oneForty-eight patients with unilateral hypogenesis of ACA-A1 in the patient group. The blood flow velocity of ACA-A1 on the hypogenetic sides was 61±16 cm/s, it was significantly lower than 86±15 cm/s in the control group; the blood flow velocity of ACA-A1 on the thick sides was 125±12 cm/s, and it was significantly higher than that in the control group (all P <0.01). The blood flow velocity on the thin sides was about 1/2 of that on the thick sides. Circled digit twoAfter pressing the contralateral CCA, the blood flow velocity of bilateral ACA-A1 increased to various degrees. The ratio of peak systolic blood flow velocity on the thin sides was 3.10±0.50, and it was significantly higher than 1.93± 0.24 in the control group. The ratio on the thick sides was 1.33 + 0.11. It was significantly lower than that in the control group. There was significant difference (P < 0.01). The ratio on the thin sides was more than two times of that on the thick sides. Circled digit threeNine patients with unilateral absence of ACA-A1, the blood flow velocity of contralateral ACA-A1 was 131±17 cm/s, and it was significantly higher than that of the control group and the ipsilateral MCA blood flow velocity. The blood flow velocity of the extracranial internal carotid artery in 57 patients on the thin or absence sides of ACA-A1 was 47±11 cm/s, and it was significantly lower than 60±13 cm/s on the contralateral sides (P < 0.01). Circled digit fourThe blood flow signals in 5 patients with the absence of ACoA were disappeared after compressing the ipsilateral CCA and ACA respectively. Conclusion: According to the hemodynamic changes before and after the bilateral ACA Queckenstedts test, and in combination with the assistant indices such as blood flow velocity of extracranial internal carotid artery, blood flow signal intensity, and blood flow distribution, TCD may primarily detect the significant variation of ACA or ACoA.

Analysis of the relationship between expression of caveolin-1 and prognosis in bladder transitional cell carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyze the relationship between expressions of caveolin-1 and prognosis in bladder transitional cell carcinoma (BTCC).</p><p><b>METHODS</b>The expression of caveolin-1 was detected in 85 cases of BTCC. 64 cases of primary BTCC were followed-up after operation. The tumor-free survival time in recurrent BTCC patients was observed.</p><p><b>RESULTS</b>The positive expression rates of caveolin-1 in primary and recurrent BTCC were 32.8% and 61.9%, respectively, with a significant difference (P < 0.05). There was a significant difference (P < 0.05) between the tumor-free survival times in the groups with positive and negative expressions of caveolin-1. The half-, 1-, 2- and 3-year tumor-free survival rates in the group with positive expression of caveolin-1 were 90.4%, 80.9%, 66.3% and 56.1%, respectively. The half-, 1-, 2-, and 3-year tumor-free survival rates in the group with negative expression of caveolin-1 were 97.7%, 95.4%, 81.4% and 79.0%, respectively. The tumor-free survival rate in the group with positive expression of caveolin-1 was significantly lower than that in the group with negative expression of caveolin-1 (P < 0.05).</p><p><b>CONCLUSION</b>Positive expression of caveolin-1 in BTCC can be regarded as a high risk factor of recurrence of BTCC. Positive expression of caveolin-1 in BTCC is correlated with the prognosis of BTCC, and BTCC patients with positive expression of caveolin-1 should be followed-up after operation.</p>

Free peroneal perforator-based sural neurofasciocutaneous flaps for reconstruction of hand and forearm / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Sural neurofasciocutaneous flap has been popularly used as an excellent option for the coverage of soft tissue defects in the lower third of leg, ankle and foot, but its free transplantation has been rarely reported. The objective of our work was to investigate the operative technique and clinical results of repairing the soft tissue defects of hand and forearm with free peroneal perforator-based sural neurofasciocutaneous flap.</p><p><b>METHODS</b>Between May 2006 and March 2007, 10 patients including 7 men and 3 women were treated. Their ages ranged from 22 to 51 years. They presented to emergency with large soft tissue defects of 16 cm x 7 cm to 24 cm x 10 cm in size in hand and forearm after injured by motor vehicle accidents (2 cases) or crushed by machine (8 cases). Thorough debridements and primary treatments to associated tendon ruptures or bone fractures were performed on emergency. And free peroneal perforator-based sural neurofasciocutaneous flaps were transplanted when the wound areas were stable at 5 to 7 days after emergency treatment. The flaps were designed along the axis of the sural nerve according to the shape and size of the soft tissue defects, with the peroneal perforator above the lateral malleolus as the pedicle and along with a part of the peroneal artery for vascular anastomosis. Then the flaps were harvested to repair the recipient sites with the peroneal artery anastomosed to the radial (or ulnar) artery and the peroneal veins to one of the radial (or ulnar) veins and the cephalic vein respectively. The flap sizes ranged from 18 cm x 8 cm to 25 cm x 12 cm. The donor areas were closed by skin grafts.</p><p><b>RESULTS</b>All of the 10 flaps survived after surgeries. Marginal necrosis occurred in only 2 cases. The skin grafts survived entirely in the donor sites, and no obvious influence on the donor legs was observed. All of the transplanted flaps presented favourable contours and good functions at 9 to 12 months' follow-up.</p><p><b>CONCLUSIONS</b>Peroneal perforator-based sural neurofasciocutaneous flap has favourable appearance, constant vascular pedicle, reliable blood supply, large size of elevation, and minimal influence on the donor site. The free transplantation of this flap offers a satisfactory alternative for repairing the large soft tissue defects of forearm and hand.</p>

Unilateral hypogenesis of anterior cerebral artery: Transcranial doppler ultrasonography and analysis / 中国脑血管病杂志

Objectives: To analyze the hemodynamic characteristics in patients with unilateral hypogenesis of anterior cerebral artery (ACA) using transcranial Doppler ultrasonography (TCD) and to discuss the diagnostic value of it. Methods: Twenty-eight patients with unilateral hypogenesis of ACA were confirmed by TCD and magnetic resonance angiography (MRA). The characteristics of hemodynamic changes were observed in hypogenetic side and contralateral anterior cerebral artery A1 segment (ACA-A1) before and after compression of the common carotid artery. They were also compared with 28 normal controls. Results: The blood flow velocity of the hypogenetic side ACA-A1 (62 ± 17) cm/s of the 28 patients was significantly lower than that of the control group [(87 ± 15) cm/s; P < 0. 01]; the blood flow velocity of the contralateral ACA-A1 (123 ± 13) cm/s was significantly higher than that of the control group (P < 0.01). The average blood flow velocity of the hypogenetic side ACA-A1 was almost half of the contralateral ACA-A1. After compressing the common carotid arteries respectively, the blood flow velocity of the hypogenetic side ACA-A1 increased for several times (3.0.8 ± 0.51), and it was significantly higher than that of the control group (1.97 ± 0.25; P < 0.01); the blood flow velocity of the contralateral side ACA-A1 increased for several times (1.35 ± 0.11), and it was significantly lower than that of the control group (P < 0.01); the average blood flow velocity of the hypogenetic side ACA-A1 was more than 2 times of the contralateral ACA-A1. Conclusion: Accordin g to hemodynamic changes before and after compression of the common carotid artery, together with the signal strength of blood flow, and the distribution of blood flow, TCD may defect unilateral hypogenesis of ACA.