A comparative study for the efficacies of transaxillary non-inflatable endoscopic surgery versus traditional surgery for papillary thyroid carcinoma / 中华耳鼻咽喉头颈外科杂志

Objective: To compare the efficacies between open surgery and axillary non-inflatable endoscopic surgery in papillary thyroid carcinoma (PTC). Methods: A retrospective analysis was performed on 343 patients with unilateral PTC treated by traditional open surgery (201 cases) and transaxillary non-inflating endoscopic surgery (142 cases) from May 2019 to December 2021 in the Head and Neck Surgery of Sichuan Cancer Hospital. Among them, 97 were males and 246 were females, aged 20-69 years. 1∶1 propensity score matching (PSM) was performed on the enrolled patients, and the basic characteristics, perioperative clinical outcomes, postoperative complications, postoperative quality of life (Thyroid Cancer-Specific Quality of Life), aesthetic satisfaction and other aspects of the two groups were compared after successful matching. SPSS 26.0 software was used for statistical analysis. Results: A total of 190 patients were enrolled after PSM, with 95 cases in open group and 95 cases in endoscopic group. Intraoperative blood losses for endoscopic and open groups were [20 (20) ml vs. 20 (10) ml, M (IQR), Z=-2.22], postoperative drainage volumes [170 (70)ml vs. 101 (55)ml, Z=-7.91], operative time [135 (35)min vs. 95 (35)min, Z=-7.34], hospitalization cost [(28 188.7±2 765.1)yuan vs. (25 643.5±2 610.7)yuan, x¯±s, t=0.73], postoperative hospitalization time [(3.1±0.9)days vs. (2.6±0.9)days, t=-3.24], and drainage tube placement time [(2.5±0.8) days vs. (2.0±1.0)days, t=-4.16], with statistically significant differrences (all P<0.05). There was no significant difference in surgical complications (P>0.05). There were significant diffferences between two groups in the postoperative quality of life scores in neuromuscular, psychological, scar and cold sensation (all P<0.05), while there were no statistically significant differences in other quality of life scores (all P>0.05). In terms of aesthetic satisfaction 6 months after surgery, the endoscopic group was better than the open group, with statistically significant difference (χ2=41.47, P<0.05). Conclusion: Endoscopic thyroidectomy by a gasless unilateral axillary approach is a safe and reliable surgical method, which has remarkable cosmetic effect and can improve the postoperative quality of life of patients compared with the traditional thyroidectomy.

Comparison of three kinds of free flaps used in patients with oral and oropharyngeal tumors / 中华耳鼻咽喉头颈外科杂志

Objective: To compare the recovery and quality of life of patients with oral and oropharyngeal tumors treated with three kinds of free soft tissue flaps. Methods: The clinical data of 103 patients, including 66 males and 37 females, aged 26-74 years, who underwent primary repair of defects after resection of oral and oropharyngeal tumors in Sichuan Tumor Hospital from July 2014 to August 2020 were analyzed. Anterolateral thigh flap (ALTF) was used in 43 patients, radial forearm free flap (RFFF) in 45 patients, and lateral arm free flap (LAFF) in 15 patients. Postoperative qualities of life of patients were evaluated by the university of Washington quality of life questionnaire and oral health impact scale (HIP-14 Chinese edition). SPSS 23.0 software was used for statistical analysis. Results: The T staging of RFFF or LAFF group was significantly lower than that of ALTF group (P<0.05). There was no significant difference in mean flap areas between ALTF group ((55.87±27.38) cm2) and LAFF group ((49.93±19.44) cm2), while RFFF group had smaller mean flap area ((33.18±6.05) cm2) than ALTF group (t=5.311, P<0.001) and LAFF group (t=3.284, P=0.005). In terms of oral functions including swallowing, mastication, taste and spitmouth, there were no significant differences between LAFF group and RFFF group (P>0.05), but both groups had better oral functions than ALTF group (P<0.05). There was no significant difference in appearance scores between LAFF group (75(75, 75)) and ALTF group (75(75,75) vs.75(75,75),Z=-1.532, P=0.126), and both groups had higher scores than RFFF group (50(50, 75),Z values were -3.447 and -3.005 respectively, P<0.05). RFFF group had higher speech score (100(67, 100)) than LAFF group (67(50, 76),Z=-2.480, P<0.05) and ALTF group (67(33, 67),Z=-5.414, P<0.05). ALTF group had lower mean score of quality of life than RFFF group [72(56,77) vs.79(69, 89),Z=-3.070, P<0.05), but there was no statistical difference in the mean scores of qualities of life between ALTF group and LAFF group (Z=1.754, P=0.079). According to the evaluation of oral health impact scale (HIP-14 Chinese version) 1 year after surgery, individual item scores and the average score of all items in ALTF group were lower than those in RFFF and LAFF groups (P<0.05), with no significant difference between RFFF group and LAFF group (P>0.05). Conclusions: RFFF has unique advantages for small tissue defects, while ALTF is suitable for large tissue defects, such as buccal penetrating defect, whole tongue and near whole tongue defect, and LAFF is a compromise choice between ALTF and RFFF. ALTF is inferior to RFFF and LAFF in oral functional reconstruction, including swallowing, chewing, taste and spittle. ALTF and LAFF are superior to RFFF in postoperative appearance.

An analysis on the relationship between vitamin D levels and related factors among type 2 diabetic patients in Lishui City / 预防医学

Objective To analyze serum vitamin D level in patients with type 2 diabetes mellitus(T2DM),and to provide evidence for the intervention.Methods A total of 270 blood samples from patients with T2DM by multi -stage random sampling in 1 0 streets/towns in Lishui City were collected to test 25 -hydroxyvitamin D level by high performance liquid chromatography - tandem mass spectrometry.Results The average level of 270 case of T2DM patients '25 -hydroxyvitamin D was (22.97 ±8.07)ng/mL.Gender,household registration,BMI stage and 25 -hydroxyvitamin D level were statistically significant,respectively (Z =4.1 3,P <0.05),(Z =2.44,P <0.05),(F =3.21 ,P <0.05).By multiple linear regression analysis,we found that gender,household registration and length of outdoor exercise time was related to vitamin D level,the B value were -5.1 78,2.369,and 2.026,respectively(P <0.05).Conclusion T2DM patients had lower level vitamin D in their blood.Vitamin D had negative correlation with gender,household registration, and outdoor exercise time.T2DMpatients’vitamin D monitoring and outdoor activities should be strengthened.

Morphological and molecular identification of two strains of dermatophytes / 华中科技大学学报（医学）（英德文版）

In this study, we used traditional morphological and molecular identification methods to preliminarily identify two strains of dermatophytes. The two strains were observed under the microscope. And then the dermatophytes were cultured on Sabouraud's dextrose agar (SDA). The 18S rRNA regions of the two dermatophyte strains were amplified by polymerase chain reaction (PCR), and the PCR products were sequenced and compared with GenBank data. BLAST tools and DNAMAN software were used to analyze the sequences. To further determine highly homologous sequences, a phylogenetic tree was constructed using the Neighbor-Joining method. The two strains of dermatophytes were identified by traditional morphological identification as Epidermophyton floccosum and Microsporum ferrugineum. The 18S rRNA sequence analyses showed high similarities to Cladosporium cladosporioides isolate C115LM-UFPR and Ascomycete sp. LB68A1A2. Epidermophyton and Cladosporium belong to dermatophyte, while Microsporum ferrugineum and Ascomycete belong to microsporum. The two novel strains of dermatophytes were therefore identified as Cladosporium cladosporioides isolate C115LM-UFPR (JN650537, Cladosporium) and Ascomycete sp. LB68A1A2 (AY770409, Ascomycete sp).

Integration of metabolism images into multimodal neuronavigation for frameless stereotaxy / 中华外科杂志

<p><b>OBJECTIVES</b>To evaluate the efficacy of integration of metabolism images into multimodal neuronavigation for frameless stereotactic biopsy.</p><p><b>METHODS</b>From January to December 2012, 32 patients with brain lesions underwent frameless stereotactic biopsy guided by positron emission tomograph (PET) and proton magnetic resonance spectroscopy ((1)H-MRS)-based multimodal neuronavigation and intraoperative magnetic resonance imaging (iMRI). The cohort consisted of 16 male and 16 female patients, with a mean age of 45 years (range: 7 - 62 years). Biopsy targets were identified according to PET and (1)H-MRS. Biopsy was performed with Varioguide frameless biopsy system. Diagnostic yield and complications were assessed.</p><p><b>RESULTS</b>Metabolism images-based multimodal neuronavigation and iMRI were successfully implemented in all cases. iMRI confirmed accuracy of biopsy targets. All the specimens obtained pathological diagnosis, the diagnostic yield was 100%. In 1 patient, iMRI found small hematoma (< 5 ml), surgical evacuation wasn't needed with intraoperative complication rate 3.1%. With the help of multimodal neuronavigation, no patients had new or worsened neurologic deficits.</p><p><b>CONCLUSIONS</b>Integration of metabolism images into multimodal neuronavigation provide not only anatomical, but also metabolic and functional information for frameless stereotaxy, increasing diagnostic yield and avoiding postoperative neurologic deficits.</p>

Application of intraoperative magnetic resonance imaging and multimodal navigation in surgical resection of glioblastoma / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of intraoperative magnetic resonance imaging (iMRI) and multimodal navigation in surgical resection of glioblastoma.</p><p><b>METHODS</b>Between February 2009 and July 2010, 76 glioblastoma patients underwent surgical resection guided by iMRI and multimodal navigation. The cohort consisted of 43 male and 33 female patients, with a mean age of 49 years (range: 14-79 years). Rates of gross total resection (GTR) and extent of resection (EoR) were calculated at first and final iMRI scans.Pearson χ(2) test was used to compare the rates of GTR.</p><p><b>RESULTS</b>iMRI and multimodal navigation were successfully implemented in all cases. Rates of GTR were misestimated by neurosurgeons in 24 cases (31.6%), which were confirmed by first iMRI. Total tumor resection were achieved in 20 cases (26.3%) as a result of iMRI scan, increasing the rates of gross total resection from 52.6% to 78.9% (χ(2) = 11.692, P = 0.001). Extent of resection in 28 patients who underwent further tumor resection were increased from 81.5% to 98.1%, leading to the overall extent of resection improved from 92.3% to 98.4%. At 3-month follow-up, 3 cases (3.9%) developed permanent neurologic deficits. The mean clinical follow-up was 15.6 months (range 3.0-45.0 months). The 2-year overall survival rate was 19.7%. The median progression-free survival of gross total resection group was 12 months (95% CI: 10.1-13.9 months), compared with 9 months (95%CI: 7.9-10.1 months) of the subtotal resection group (χ(2) = 4.756, P = 0.029). The overall survival of gross total resection group was 16 months (95% CI: 13.7-18.3 months), compared with 12 months (95% CI: 9.7-14.3 months) of the subtotal resection group (χ(2) = 7.885, P = 0.005).</p><p><b>CONCLUSION</b>Combined with multimodal navigation, iMRI helps maximize surgical resection of glioblastoma, preserving neurological function while increasing progression-free survival and overall survival.</p>

Trans-extradural approach to resect trigeminal schwannomas involving the cavernous sinus region / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the techniques and effect of extradural approach for the resection of trigeminal schwannomas involving the cavernous sinus.</p><p><b>METHODS</b>Twenty-three patients (range 26-63 years, mean age 46.2 years) with trigeminal schwannomas involving the cavernous sinus treated by middle fossa extradural approach were retrospectively analyzed. Frontotemporal orbitozygomatic extradural approach was performed in 2 patients. Frontotemporal zygomatic extradural approach was carried out in 21 patients. The first follow-up visit was on the 3rd month after surgery, and if residual was observed on enhanced MRI, then the patient was followed up every 6 months; otherwise, the patient was followed up every 8-12 months.</p><p><b>RESULTS</b>The length of hospital stay after surgery was 7-13 days (mean 8.5 days). Two tumors originated from the ophthalmic branch, 2 from the maxillary branch, 5 from the mandibular branch and 14 from the gasserian ganglion. Total resection was achieved in 21 of the 23 patients (91.3%) and subtotal resection in the other 2 patients. All the patients were followed up from 3 months to 4 years. Median follow-up time was 19 months. The most common symptom was facial hypoesthesia, occurring in 18 patients. This symptom improved in 10 patients and worsened in 8 patients after surgery. New postoperative facial hypoesthesia was observed in 2 patients. Facial pain was observed in 3 patients and subsided after surgery. Two patients had loss of hearing, this symptom improved in 1 patient and worsened in 1 patient after surgery. Diplopia was observed in 6 patients. In 1 of these 6 patients, diplopia resulted from palsy of the oculomotor nerve. In the other 5 patients, diplopia resulted from palsy of the abducens nerve. This symptom improved postoperatively in all these 6 patients. New postoperative atrophy of the temporalis muscle was observed in 3 patients. There was no operation-related mortality. Tumor recurrence was only found in 1 patient after 24 months and was treated by Gamma knife.</p><p><b>CONCLUSIONS</b>The middle fossa extradural approach may be an ideal option for the resection of trigeminal schwannomas involving the cavernous sinus. This approach produces no further impairment, less complication, and is less likely to injured the trigeminal nerve, abducens nerve, trochlear nerve and internal carotid artery.</p>

Morphological and molecular identification of two strains of dermatophytes / 华中科技大学学报（医学）（英德文版）

In this study, we used traditional morphological and molecular identification methods to preliminarily identify two strains of dermatophytes. The two strains were observed under the microscope. And then the dermatophytes were cultured on Sabouraud's dextrose agar (SDA). The 18S rRNA regions of the two dermatophyte strains were amplified by polymerase chain reaction (PCR), and the PCR products were sequenced and compared with GenBank data. BLAST tools and DNAMAN software were used to analyze the sequences. To further determine highly homologous sequences, a phylogenetic tree was constructed using the Neighbor-Joining method. The two strains of dermatophytes were identified by traditional morphological identification as Epidermophyton floccosum and Microsporum ferrugineum. The 18S rRNA sequence analyses showed high similarities to Cladosporium cladosporioides isolate C115LM-UFPR and Ascomycete sp. LB68A1A2. Epidermophyton and Cladosporium belong to dermatophyte, while Microsporum ferrugineum and Ascomycete belong to microsporum. The two novel strains of dermatophytes were therefore identified as Cladosporium cladosporioides isolate C115LM-UFPR (JN650537, Cladosporium) and Ascomycete sp. LB68A1A2 (AY770409, Ascomycete sp).

Application of diffusion tensor imaging-based arcuate fasciculus tractography and intraoperative arcuate fasciculus navigation / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the feasibility of applying diffusion tensor imaging (DTI)-based arcuate fasciculus tractography and intraoperative arcuate fasciculus navigation for neurosurgery.</p><p><b>METHODS</b>Totally 85 patients with interhemispheric tumors who had undergone intra-operative magnetic resonance imaging (MRI) and neuronavigation were divided into sinistrocerebral tumor (SCT) group (n = 55) and sham group (n = 30). All patients accepted routine MRI and DTI preoperatively. The results from both DTI-based arcuate fasciculus tractography and neuronavigation were applied to guide the surgery. All patients were followed up at 2-4 weeks and 3-6 months postoperatively.</p><p><b>RESULTS</b>All patients smoothly received the pre-operative DTI-based arcuate fasciculus tractography. The three dimensional arcuate fasciculus was successfully integrated with the neuronavigation and achieved microscope heads-up display. Long-term follow-up showed that there were only 4 patients suffered from persistent language dysfunction.</p><p><b>CONCLUSIONS</b>The combined application of DTI-based arcuate fasciculus tractography and intraoperative arcuate fasciculus navigation is feasible for guiding brain surgery. It can improve the surgical outcomes of intracranial tumor involving language functional area. The technology also maximizes the retention of language function and improves the post-operative quality of life.</p>

Application of intraoperative magnetic resonance imaging and functional neuronavigation in microsurgery for lesions near language-related brain regions / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the clinical value of intraoperative magnetic resonance imaging (MRI) and functional neuronavigation in the preservation of the language function during microsurgery for lesions near language-related brain regions.</p><p><b>METHODS</b>Sixty-one right-handed patients underwent microsurgical resection of the lesions near the language-related brain regions with the assistance of intraoperative MRI and blood oxygen level- and diffusion tensor imaging-based functional neuronavigation. The patients were divided into 2 groups according to the location of the lesions, namely group A with lesions near the left posterior inferior frontal gyrus and group B with lesions near the left posterior superior temporal gyrus. The aphasia quotient (AQ) of all patients were obtained using Western Aphasia Battery (WAB) before and 2 weeks after the operation.</p><p><b>RESULTS</b>In the 33 patients with a normal AQ score (≥93.8) before the operation, the AQ score underwent no significant changes after the operation (P>0.05). Twenty-eight patients had lowered AQ scores (〈93.8) preoperatively, which were improved significantly after the operation (P<0.01). At 2 weeks after the operation, the language function worsened in 14 patients (23.0%), and only 2 (3.2%) showed a persistent language deficit at 6 months. Of the 61 patients, radical resection of the lesions was achieved in 41 and subtotal resection in 20 patients. The variation of AQ scores after the operation was not found to correlate to the degree of lesion resection, and the patients in group A showed a greater AQ variation than those in group B.</p><p><b>CONCLUSIONS</b>Intraoperative MRI and functional neuronavigation can well demonstrate the structural relations between the lesions, the cortical areas and the fasciculi related to language functions, thus helping to better preserve the language function during microsurgical lesion resection in patients with lesions near language-related brain regions.</p>

Functional neuro-navigation and intraoperative magnetic resonance imaging for the resection of gliomas involving eloquent language structures / 中华外科杂志

<p><b>OBJECTIVES</b>To explore the clinical value of functional neuro-navigation and high-field-strength intraoperative magnetic resonance imaging (iMRI) for the resection of intracerebral gliomas involving eloquent language structures.</p><p><b>METHODS</b>From April 2009 to April 2010, 48 patients with intracerebral gliomas involving eloquent language structures, were operated with functional neuro-navigation and iMRI. Blood oxygen level dependent functional MRI (BOLD-fMRI) was used to depict both Broca and Wernicke cortex, while diffusion tensor imaging (DTI) based fiber tracking was used to delineate arcuate fasciculus. The reconstructed language structures were integrated into a navigation system, so that intra-operative microscopic-based functional neuro-navigation could be achieved. iMRI was used to update the images for both language structures and residual tumors. All patients were evaluated for language function pre-operatively and post-operatively upon short-term and long-term follow-up.</p><p><b>RESULTS</b>In all patients, functional neuro-navigation and iMRI were successfully achieved. In 38 cases (79.2%), gross total resection was accomplished, while in the rest 10 cases (20.8%), subtotal resection was achieved. Only 1 case (2.1%) developed long-term (more than 3 months) new language function deficits at post-operative follow-up. No peri-operative mortality was recorded.</p><p><b>CONCLUSIONS</b>With functional neuro-navigation and iMRI, the eloquent structures for language can be precisely located, while the resection size can be accurately evaluated intra-operatively. This technique is safe and helpful for preservation of language function.</p>

Implementation and preliminary experience of high-field intraoperative magnetic resonance imaging in the endoscopic chordoma operation with transsphenoidal or transoral approach / 中华外科杂志

<p><b>OBJECTIVE</b>To review the preliminary clinical experience with high-field-strength intra-operative magnetic resonance imaging (iMRI) in the endoscopic chordoma operation with transsphenoidal or transoral approach.</p><p><b>METHODS</b>From January 2009 to December 2010, 23 patients [range, 29 - 64 years, mean age (42 ± 3) years] of chordoma were operated with endoscopic transsphenoidal or transoral approach and examined intraoperatively with a movable 1.5 T iMRI magnet. Tumor size range was 2.0 - 5.7 cm, mean (3.5 ± 0.8) cm. A navigation system based on iMRI was used in 20 cases.</p><p><b>RESULTS</b>iMRI scan were performed in each operation from 1 time to 5 times. Neuronavigation system were used in 20 operations and the data renewed in 12 cases by the information from iMRI. In 15 of 23 patients, iMRI had revealed residual lesions and resulted in 12 cases further treatment, eventually, 9 tumors were totally removed and 3 tumors were further removed. The ratio of total removal tumor was enhanced to 73.9% (17/23) from 34.8% (8/23). Among 15 cases of partial chordoma removal detected by scanning in operation, 9 were huge chordoma. The residual of huge chordoma detected by scanning in operation was 9/11, and other chordoma contributed to 6/12. There were no iMRI related safety issue or accident recorded in this study.</p><p><b>CONCLUSIONS</b>High-field-strength iMRI provide high-quality images of tumor resection that allows intraoperative modification of the surgical strategy. Combined with the navigation system, iMRI is helpful to maximize the resection of the chordoma and benefit for the safety of endoscopic operation.</p>

High-field intraoperative magnetic resonance imaging suite with neuronavigation system: implementation and preliminary experience in the pituitary adenoma operation with transsphenoidal approach / 中华外科杂志

<p><b>OBJECTIVES</b>To review the preliminary clinical experience with high-field-strength intraoperative magnetic resonance imaging (iMRI) suite with neuronavigation system in the pituitary adenoma operation with transsphenoidal approach.</p><p><b>METHODS</b>From March 2009 to December 2010, 31 patients [range, 29 - 76 years, mean age (47 ± 11) years]of pituitary adenoma were operated with transsphenoidal approach and intraoperatively with a movable 1.5 T high-field-strength iMRI suite in combination with neuronavigation system. Tumor size was 1.8 - 7.3 cm, mean (3.5 ± 1.2) cm. Twenty-five cases were non-functional pituitary adenoma, 4 cases were prolactin-secreting pituitary adenoma, 2 cases were growth hormone-secreting pituitary adenoma. Thirty patients' resection with transnasal transsphenoidal approach were performed, one patient with transoral transsphenoidal approach was performed.</p><p><b>RESULTS</b>In 12 cases of 30 patients who planed to totally remove tumor, iMRI had revealed residual lesions and resulted in the change of the surgical strategy, 2 invasive cavernous sinus cases no further resection of the tumor because of internal carotid artery encasement, the other 10 cases resected further, eventually. Finally, 8 cases were totally removed. The ratio of total removal tumor was enhanced to 86.7% (26/30) from 60.0% (18/30). There was no perioperative mortality.</p><p><b>CONCLUSIONS</b>High-field-strength iMRI suite with neuronavigation system provides valuable information of tumor resection that allows intraoperative modification of the surgical strategy. It could be very helpful to maximize the resection of the pituitary adenoma and minimize the injury to neurological function.</p>

The PRVEPs evoked by different fields stimulation / 法医学杂志

OBJECTIVE@#To study the character of the PRVEPs evoked by different stimulation fields in normal-vision subjects and its value in forensic medicine.@*METHODS@#The PRVEPs were evoked by full-field, central-field and peripheral-field respectively in 30 subjects (60 eyes) and the latency and amplitude of N1 and P1 were analyzed.@*RESULTS@#There was no statistically significant difference in the latency and amplitude of PRVEPs between right and left eyes. The appearance probability of all the waves was 100% at the different stimulations but that of N1 was 36.77% at the central-field. There was statistically significant difference in the latency of N1 at the full field and peripheral field stimulations and there was no statistically significant difference in the amplitude. There was statistically significant difference in the latency and amplitude of P1 at the full field, central field and peripheral field stimulation.@*CONCLUSION@#The PRVEPs evoked by different field stimulations can be used to evaluate the functions of the different area retina and can be used to identify the exaggerated or pretended visual dysfunction.