An alternative method for reconstructing anterior segmental mandibulectomy defects with a plate and pectoral major muscle flap

Background: Reconstruction of anterior segmental mandibulectomy still remains a challenge. Osteocutaneous free flap remains the ideal choice of reconstruction because it restores cosmesis and function. The use of other locoregional flaps compromises cosmesis and function. Here, we have introduced a unique technique of reconstruction with lingual cortex mandibular plate as an alternate choice for free flap. Method: Six patients aged 12–62 years underwent oncological resection for oral cancer which involved the anterior segment of the mandible. Following resection, they underwent lingual cortex mandibular plating with pectoralis major myocutaneous flap reconstruction. Adjuvant radiotherapy was delivered to all patients. Results: The mean bony defect was 9.2 cm. There were no significant perioperative events related to the surgery. None required tracheostomy and all were safely extubated with no post-surgical complications. The cosmetic and functional outcomes were acceptable. Following the completion of radiotherapy with a median follow-up of 11 months, Plate exposure occurred in one patient. Conclusion: The technique is cheap, quick and simple, and can be effectively applied in resource-constrained and demanding situations. It is possible to consider this as an alternative treatment strategy for osteocutaneous free flap in anterior segmental defects

Influences of structural changes after valgus impacted femoral neck fracture on hip range of motion: a 3D simulation test / 中华创伤骨科杂志

Objective:To determine the influences of structural changes after valgus impacted femoral neck fracture on hip range of motion (ROM) so as to provide evidence for clinical judgment of whether reduction is necessary or not in the internal fixation of such fractures.Methods:1. 3D reconstructions of the CT hip scans were performed for the 73 patients who had been treated at Department of Orthopaedic Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University for valgus impacted femoral neck fractures from January 2019 to April 2019.The femoral neck-shaft angle, anteversion angle, femoral offset, axial alpha angle, lateral center edge angle (LCEA), anterior center edge angle (ACEA) and center displacement were measured and compared between the affected and healthy sides to determine the influences of the fracture on the above indexes. 2. Hip motions (flexion and MIR-90°) were simulated on bilateral sides to determine the influences of structural changes after fracture on hip ROM using stepwise regression and Logistic regression. 3. The distribution of femoral-acetabular contact points on the femoral side was observed in simulation of hip flexion to detect the potential area for femoracetabular impingement (FAI) induced by the fracture displacement.Results:1. The valgus impacted femoral neck fractures had significant influences on femoral neck-shaft angle, anteversion angle, femoral offset and axial alpha angle. Compared with the healthy side, on average, the femoral neck-shaft angle increased by 5.1°, anteversion angle decreased by 6.5°, femoral offset decreased by 8.2 mm and axial alpha angle increased by 9.7° on the affected side, showing significant differences ( P<0.05).The displacements of the femoral head center averaged 9.2 mm. There was no significant difference in LCEA or ACEA between the affected and healthy sides ( P>0.05). 2. Compared with the healthy side, on average, the simulated hip flexion decreased significantly by 27.0° and the hip MIR-90° decreased significantly by 20.3° on the affected side after fracture ( P<0.05). Regression analysis showed that femoral anteversion angle, ACEA and displacement of the femoral head center had a significant influence on hip ROM, especially the anteversion angle. When the anteversion angle decreased by more than 7.1°, the hip flexion would decrease by at least 20%. 3. The points of FAI distributed more widely on the fracture side. Compared with the healthy side, the impact points extended outward and upward in hip flexion and extended inwardly in hip MIR-90° on the affected side. Conclusions:After a valgus impacted femoral neck fracture, if the femoral anteversion angle has been decreased by more than 7.1°, the hip ROM can be greatly influenced and the points of FAI can be distributed more widely. Therefore, reduction should be recommended before internal fixation of the fracture.

Reconstrucción mamaria con colgajo musculocutáneo de recto abdominal con isla transversa de piel (TRAM): experiencia de 12 años en Hospital El Pino / Breast reconstruction with musculocutaneous flap of abdominal rectus with transverse skin island (TRAM): 12 years of experience at Hospital El Pino

Objetivos: Analizar los resultados de reconstrucción mamaria con colgajo musculocutáneo de recto abdominal con isla transversa de piel (TRAM) en el Servicio de Cirugía del Hospital El Pino. Materiales y Métodos: Estudio retrospectivo de pacientes sometidas a mastectomía por cáncer de mama y posterior reconstrucción con colgajo TRAM pediculado en los últimos 12 años (2005-2017). Resultados: Se realizaron 12 reconstrucciones mamarias, 6 fueron con colgajo TRAM pediculado. La mayoría de las pacientes recibieron tratamiento adyuvante con radioterapia (1 caso), quimioterapia (1 caso), quimioterapia + radioterapia (2 casos). El tiempo transcurrido entre la mastectomía y reconstrucción mamaria fue en promedio de 2,5 años. Se produjeron 4 complicaciones (66,7%) que necesitaron reintervención: hematoma posoperatorio precoz, infección y necrosis grasas de colgajo, dehiscencia de sutura abdominal, necrosis grasa + fibrosis de colgajo TRAM. La evaluación de los resultados fue subjetiva obteniéndose muy buenos resultados en el 66,7% de los casos. No hubo complicaciones en sitio donante. Discusión: El colgajo TRAM pediculado es el tejido autólogo más utilizado en reconstrucción mamaria. Su tasa de complicación es de 26% muy por debajo a lo obtenido en nuestra experiencia. Las principales complicaciones son fibrosis y necrosis grasa de colgajo, pérdida de colgajo, seroma e infección siendo la necrosis grasa la más frecuente en nuestra serie. El uso de colgajo TRAM otorga mayor satisfacción con apariencia, tamaño y sensación del seno. Debido a los resultados obtenidos creemos que el colgajo TRAM pediculado es una excelente alternativa de reconstrucción mamaria en nuestro hospital.

Objectives: To analyze the results of breast reconstruction with musculocutaneous flap of the rectus abdominis with transverse skin island (TRAM) in the Service of Surgery of El Pino Hospital. Materials and Methods: Retrospective study of patients undergoing mastectomy for breast cancer and subsequent reconstruction with pedicled TRAM flap in the last 12 years (2005-2017). Results: 12 mammary reconstructions were performed, 6 were with pedicled TRAM flap. The majority of patients received adjuvant treatment with radiotherapy (1 case), chemotherapy (1 case), chemotherapy + radiotherapy (2 cases). The time elapsed between the mastectomy and breast reconstruction was on average 2.5 years. There were 4 complications (66.7%) that required reintervention: early postoperative hematoma, infection and flap fat necrosis, abdominal suture dehiscence, fat necrosis + TRAM flap fibrosis. The evaluation of the results was subjective, obtaining very good results in 66.7% of the cases. There were no complications in the donor site. Discussion: The pedicled TRAM flap is the most used autologous tissue in breast reconstruction. Its complication rate is 26%, much lower than that obtained in our experience. The main complications are fibrosis and flap fat necrosis, flap loss, seroma and infection, with fat necrosis being the most frequent in our series. The use of TRAM flap gives greater satisfaction with appearance, size and sensation of the breast. Due to the results obtained, we believe that the pedicled TRAM flap is an excellent alternative for breast reconstruction in our hospital.

Experimental study on staphylococcal enterotoxin promoting tendon-bone healing after reconstruction of anterior cruciate ligament in rabbits / 中国骨伤

<p><b>OBJECTIVE</b>To explore highly agglutinative staphylococcin (HAS) pomoting on tendon-bone healing after reconstruction of anterior cruciate ligament(ACL) in rabbits.</p><p><b>METHODS</b>Animal model of ACL reconstruction in 24 mature New Zealand white rabbits(3 months, 2.56 kg on average, either gender) were established using autologous digital long extensor tendon and randomly classified into 2 groups(HAS and control group), 12 rabbits for each group. HAS group was separately injected 0.1ml highly agglutinative staphylococcin immediately into tendon-bone interface during the operation and 2 days after operation. Control group was injected with the same dose of physiological saline for 3 days. All animals were sacrificed at 4, 8, and 12 weeks after operation for histological examinations. The specimens were stained with hematoxylin-eosin, picric acid-sirius red, VEGF immunohistochemistry stain, and toluidine blue to histologically analysis the total pathology changes of the tendon-bone healing tissue, the tendon bone interface morphology classification, hyperplasia and arrangement of collagen fiber, vascularization and new bone formation, respectively.</p><p><b>RESULTS</b>The Yamakado morphological interface results showed that the tissue healing at tendon-bone interface of the HAS group was better than that of the control group. The histological examination revealed that on the 4th week after operation, the tendon-bone interface of HAS group was filled with fibrous connective tissue. The proliferated fibroblasts, chondroblasts and the angiogenesis were rich. On the 8th week after operation, the healing tissue at the bone-tendon interface had developed into dense connective tissue, the neo-vessels were very rich, the collagen fibers were formed abundantly, some Sharpey's fibers spanning parts of the tendon-bone interface. On the 12th week after operation, the transition zones were full of Sharpey's fibers;the neo-vessels were not as much as the 8th weeks, but new bone formation was further increased and immature fibrocartilage appeared. For quantitative histological analysis at 4, 8 and 12 weeks after operation, the proportion of neo-vessel area and the area of now bone formation of the HAS group were all significantly higher than those of the control group(<0.05).</p><p><b>CONCLUSIONS</b>Under the synergy of staphylococcal enterotoxin C and other active ingredients, Highly Agglutinative Staphylococcin can significantly improve the tendon-bone healing after ACL reconstruction in rabbit knees, which is expected to be a new method to improve the clinical results of ACL reconstruction.</p>

Serguei Constantinovitch Pankejeff: uma estranha memória sem lembrança do homem dos lobos / Serguei Constantinovitch Pankejeff: a memory with no remembrances from the wolf man

O presente texto visa a fazer uma interlocução com o trabalho História de uma neurose infantil (Freud 1918 [1914]). De forma pontual toma como objeto de reflexão a questão da cena primária e suas repercussões no acontecer do processo onírico. Aborda o tema da memória, buscando sustentar metapsicologicamente a diferença entre o não lembrar por resistência – memória representacional – e não lembrar por não ter como lembrar – memória não representacional. Diante dessa proposição advoga a importância de discriminar construções, vinculadas às origens do inconsciente não recalcado, e reconstrução, vinculadas às origens do inconsciente recalcado. Nesse processo reflexivo indaga e levanta a hipótese que o sentimento de estranhamento, passível de ser capturado pelas imagens do sonho, pode ser um elemento de ligação entre o traumático, do inscrito não transcrito, e as retranscrições enquanto produto do trabalho psíquico.

This paper aims to make a dialogue with the work From the history of an infantile neurosis (Freud 1918 [1914]). In short, it takes the issue of primal scene and its impact on the dream process as object of reflection. It addresses the issue of memory, and it seeks to metapsychologically support the difference between not remembering by resistance - representational memory - and not remembering by lack of means to remember - non-representational memory. This proposition endorses the importance of discriminating constructions linked to the origins of the non-repressed unconscious, and reconstructions, linked to the origins of the repressed unconscious. This reflective process hypothesizes that the feeling of strangeness, which can be captured by the images of dreams, may be a link between the traumatic, the non-transcribed inscriptions, and the retranscriptions as a psychic work product.

El presente texto tiene como objetivo hacer una interlocución con el trabajo De la historia de una neurosis infantil (Freud, 1918 [1914]). De manera puntual, toma como objeto de reflexión el tema de la escena primaria y sus repercusiones en el suceder del proceso onírico. Aborda el tema de la memoria, en la búsqueda de sostener metapsicológicamente la diferencia entre el no recordar por resistencia, – memoria representacional, – e no recordar por no tener como recordar, memoria no representacional. Delante de esta conjetura aboga la importancia de discriminar construcciones, vinculadas a los orígenes del inconsciente reprimido. En este proceso reflexivo, averigua y levanta la hipótesis de que el sentimiento de extrañeza, pasible de ser capturado por las imágenes del sueño, pueda ser un elemento de enlace entre lo traumático, de lo inscripto no transcripto, y las retranscripciones producto del trabajo psíquico.

Research on dynamic three-dimensional reconstruction of tissue doppler ultrasound heart images / 中国医学装备

Objective:To discuss the dynamic three-dimensional reconstruction of tissue Doppler ultrasound cardiac image.Methods: To separate anatomical structure and function parameter information from Doppler ultrasound medical image, and then combines with the three-dimensional distribution to reconstruct it and fuse imaging.Results: Ultimately, it reveals the relationship between function parameter and anatomical structure. The dynamic three-dimensional reconstruction of tissue Doppler ultrasound cardiac image is also expounded in this paper.Conclusion: It scientifically completed the dynamic three-dimensional reconstruction of tissue Doppler ultrasound cardiac image by combining both tissue Doppler imaging and ultrasound medical image reconstruction technique. It is of great significance in clinical medicine.

Predicción a escala genómica de Componentes de Saccharomyces cerevisiae mediante Análisis de Balance de Flujos / Prediction of genome scale of Saccharomyces cerevisiae by flux balance analysis

El microorganismo Saccharomyces cerevisiae cuenta con gran número de modelos biológicos conocidos como reconstrucciones, las cuales pueden ser a escala genómica. De estas reconstrucciones a escala genómica provienen los modelos matemáticos, también llamados modelos estequiométricos. Una de las técnicas más usadas para estudiar estos modelos es el Análisis de Balance de Flujos (FBA). El proposito del FBA es predecir el crecimiento del microorganismo bajo estudio, y la producción y consumo de componentes como el etanol, CO2 glicerol, sucinato, acetato y piruvato. Para determinar si las predicciones obtenidas mediante FBA son únicas se utiliza la técnica de Análisis de Variabilidad Flujos (FVA). El presente trabajo muestra los resultados de aplicar el FBA a la reconstrucción reciente del microorganismo S. cerevisiae, la denominada iMM904 y los compara con un conjunto de datos experimentales presente en la literatura. Este trabajo también estudia la existencia de múltiples predicciones FBA utilizando la técnica FVA. Los resultados ilustran que es posible predecir el crecimiento del microorganimo S. cerevisiae, con errores entre el 11% y 28%; la producción de CO2, con errores entre el 0.3% y 4.5% y la producción de etanol, con errores entre el 11% y 13%.

Several biological models, named reconstructions, are used for the study of the S. cerevisiae microorganism. The reconstructions can be genomic scaled. Mathematical models are generated from the reconstructions and they are called stoichiometric models. The flux balance analysis (FBA) is one of the tools used for the analysis of these models. The FBA attempts to predict the evolution of the microorganism and the consumption and production of components like glucose, ethanol, glycerol, succinate, acetate and pyruvate. A Flux variability analysis (FVA) is used to determine the uniqueness of the FBA predictions. This paper shows the results of applying FBA to the iMM904 reconstruction of S. cerevisiae and compares them with experimental data from literature. The results in this paper show that it is possible to predict the evolution with errors between 11% and 28% ; the production of CO2 with errors between 0.3% and 4.5%; and the production of ethanol with errors between 11% and 13%, using FBA for the iMM904 model.

Paleoclima de La Guajira, Colombia; según los anillos de crecimiento de Capparis odoratissima (Capparidaceae)

Paleoclimate of La Guajira, Colombia; by the growth rings of Capparis odoratissima (Capparidaceae). There is great concern about the effect of climate change in arid and subarid areas of the tropics. Climate change combined with other anthropogenic activities such as deforestation, fires and overgrazing can accelerate their degradation and, consequently, the increases in losses of biological and economic productivity. Climate models, both local and global, predict that rainfall in the arid Peninsula of La Guajira in the Colombian Caribbean would be reduced and temperature would be increased as a result of climate change. However, as there are only suitable climate records since 1972, it is not possible to verify if, indeed, this is happening. To try to verify the hypothesis of reducing rainfall and rising temperatures we developed a growth ring chronology of Capparis odoratissima in the Middle Peninsula of La Guajira with 17 trees and 45 series which attain 48 years back. We use standard dendrochronological methods that showed statistically significant linear relationship with local climatic variables such as air temperature, sea surface temperature (SST), annual precipitation and wind speed; we also reach to successful relationship of the chronology with global climatic variables as the indices SOI and MEI of the ENSO phenomenon. The transfer functions estimated with the time series (1955 and 2003) do not showed statistically significant trends, indicating that during this period of time the annual precipitation or temperatures have not changed. The annual nature of C. odoratissima growth rings, the possibility of cross-dated among the samples of this species, and the high correlation with local and global climatic variables indicate a high potential of this species for dendrochronological studies in this part of the American continent. Rev. Biol. Trop. 59 (3): 1389-1405. Epub 2011 September 01.

gran preocupación por el efecto del cambio climático en las regiones áridas y semi-áridas tropicales. Los modelos climáticos tanto locales como globales predicen que la precipitación pluvial de la árida Península de La Guajira en el Caribe colombiano se reduciría, y las temperaturas tanto del aire como superficial del mar aumentarían como consecuencia del cambio climático. Para tratar de verificar estas hipótesis construimos una cronología del ancho de los anillos de crecimiento de Capparis odoratissima en la Media Península de La Guajira. La cronología mostró relaciones lineales estadísticamente significativas con las variables climáticas locales: temperatura del aire, temperatura superficial del mar (TSM), precipitación anual, velocidad del viento y variables climáticas del fenómeno ENSO (índices SOI y MEI). Las series de tiempo que calculamos mediante la función de transferencia entre 1955 y 2003, no mostraron tendencias estadísticamente significativas que demostraran que en ese período de tiempo la precipitación anual o las temperaturas han cambiado. La naturaleza anual de los anillos de crecimiento de C. odoratissima, la posibilidad de realizar datación cruzada entre muestras de esta especie y la alta correlación con las variables climáticas locales y globales, señalan un alto potencial de esta especie para realizar estudios dendrocronológicos en esta parte del continente americano.

Photoacoustic Tomography and Applications in The Medical Clinic Diagnosis / 生物化学与生物物理进展

Photoacoustic tomography is a developing, promising,non-invasive imaging method in the medical clinic diagnosis. It is an ultrasound-mediated biophotonic imaging method based on the intrinsic optical absorption properties of tissue and ultrasonic detection, and combines the merits of both high contrast advantage of pure optical imaging and high resolution advantage of pure ultrasound imaging. Photoacoustic tomography can be performed by detecting photoacoustic waves instead of detecting photons. In photoacoustic tomography, imaging contrast is based primarily on the optical properties of biological tissues, and imaging resolution is based primarily on the ultrasonic waves. It can avoid the influence of optical scattering on imaging resolution in principle, and can provide tomography of tissues with high contrast and high spatial resolution at medium depths. Photoacoustic tomography can provide an effective approach to studying the structures, physiological properties, metabolisms, pathological properties of biological tissues. It has important potential clinical applications in the early non-invasive detection of cancers, structural and functional in vivo imaging. A brief introduction of photoacoustic imaging mechanisms is gives, and the imaging methods, the image reconstruction algorithm and the potential biomedical applications of photoacoustic tomography are reveiewed.

Carcinoma de mama em homem: biópsia de linfonodo sentinela e reconstrução do complexo aréolo-papilar / Male breast cancer: sentinel lymph node niopsy and reconstruction of nipple-areolar complex

O câncer de mama no homem é doença rara e, como na mulher, a dissecção axilar é uma parte essencial da terapêutica cirúrgica. Sabe-se que homens tratados com esvaziamento axilar têm o mesmo risco que mulheres de desenvolver morbidades associadas a este procedimento e que a biópsia do linfonodo sentinela tem emergido como uma alternativa eficaz. A proporção da positividade dos receptores hormonais é maior que a observada nas mulheres, ampliando-se, assim, o papel da endocrinoterapia. Os autores relatam caso de câncer de mama inicial em homem tratado com mastectomia simples, biópsia do linfonodo sentinela, endocrinoterapia com tamoxifeno e reconstrução tardia do complexo aréolo-papilar. A biópsia do linfonodo sentinela poderia ser considerada para a avaliação linfonodal de homem com carcinoma de mama com axila clinicamente negativa.

Male breast cancer (MBC) is a rare disease and, as in women, axillary dissection is an essential part of surgical therapy. It is well know that men treated by axillary dissection have the same risk as women of developing the morbidities associated with this procedure and that the sentinel lymph node biopsy is emerging as an efficacious alternative. The rate of hormone receptor positivity is higher than that observed in women, enhancing the role of endocrinotherapy. The authors describe a case of male early breast cancer treated by simple mastectomy, sentinel lymph node biopsy, endocrinotherapy with tamoxifen and lately nipple-areolar complex reconstruction. The sentinel lymph node biopsy should be considered for axillary staging in male breast cancer patients with clinically negative axilla.

Bronquio traqueal derecho y persistencia de conducto arterioso diagnosticados por tomografía axial computarizada en un enfermo con síntomas sugestivos de asma / Computerized axial tomography in the diagnosis of a right tracheal bronchus and patent ductus arteriosus in a patient with an asthma-like syndrome

Un varón de 12 años, con sintomatología respiratoria desde los tres meses de vida fue manejado como asmático desde los cinco años, con esteroides y agentes beta dos inhalados, además de inmunoterapia específica durante 18 meses, sin mejoría. La tomografía computada de tórax reveló disminución de calibre de la tráquea con emergencia, por debajo de la misma, de un bronquio traqueal (BT) en la pared lateral derecha de la tráquea, independizando el lóbulo superior derecho del árbol bronquial. Se observó también la persistencia del conducto arterioso (PCA) y una variante anatómica hepática. Estudios de reconstrucción multiplanar, broncoscopía virtual, cateterismo hemodinámico y broncoscopía confirmaron los diagnósticos. No se encontró Tetralogía de Fallot como defecto cardiaco congénito más comúnmente asociado a la variante del BT para lóbulo superior derecho. Posteriormente al cierre programado de PCA, egresó por mejoría clínica.

A 12 year old male had symptoms suggesting asthma since the third month of age; he was managed with inhaled steroids and bronchodilatadors and specific immunotherapy for 18 months, without improvement. Conventional computed tomography (CT) showed tracheai narrowing and a bronchi emerging from the right lateral wall of the trachea, separating the right upper lobe from the tracheobronchial tree. The CT also revealed a patent ductus arteriosus and an anatomic variant of the liver. Helical CT scans, virtual bronchoscopy, cardiac catherization and bronchoscopy confirmed the diagnoses. In this case, Fallot's tetralogy, the commonest cardiac anomaly associated with tracheai bronchi to the right upper lobe, was not found. Symptoms improved after surgical division of the patent ductus arteriosus.