Evolution of transmaxillary approach to tumors in pterygopalatine fossa and infratemporal fossa: anatomic simulation and clinical practice / 中华医学杂志(英文版)

BACKGROUND@#The endoscopic transnasal approach has been proven to have advantages on the removal of the tumors in pterygopalatine fossa (PPF) and infratemporal fossa (ITF). Herein, this study aimed to describe a modified approach for resection of the tumors in these areas, both in cadaveric specimen and clinical patients.@*METHODS@#The 20 adult cadaveric specimens and five patients with tumors in PPF and ITF were enrolled in this study. For the cadaveric specimens, ten were simulated anterior transmaxillary approach and ten were performed modified endoscopic transnasal transmaxillary approach. The exposure areas were compared between two groups and main anatomic structure were measured. Surgery was operated in the five patients with tumors of PPF and ITF to verify the experience from the anatomy. Perioperative management, intraoperative findings and postoperative complications were recorded and analyzed.@*RESULTS@#The modified endoscopic transnasal transmaxillary approach provided as enough surgical exposure and high operability to the PPF and ITF as the anterior transmaxillary approach did. The diameter of maxillary artery in the PPF was 3.77 ± 0.78 mm (range: 2.06-4.82 mm), the diameter of middle meningeal artery in the ITF was 2.79 ± 0.61 mm (range: 1.54-3.78 mm). Four patients who suffered schwannoma got total removal and one of adenocystic carcinoma got subtotal removal. The main complications were facial numbness and pericoronitis of the wisdom tooth. No permanent complication was found.@*CONCLUSIONS@#With the widespread use of neuroendoscopy, the modified endoscopic transnasal transmaxillary approach is feasible and effective for the resection of tumors located in PPF and ITF, which has significant advantages on less trauma and complications to the patients.

Processing mechanism of social cues in faces / 生理学报

The purpose of the present paper was to review the processing mechanisms of social cues in faces. We summarized researches relative to social cues in faces and discussed the processing mechanism of these cues from the aspects of facial expression, facial attractiveness, gaze and face direction, and lipreading. First, we discussed the general neural mechanism of face information processing and summarized the functions of face areas in the fusiform gyrus, posterior superior temporal sulcus and inferior occipital gyrus. Next, the neural mechanism of emotional face perception was discussed. The processing of emotional faces consists of encodings of perceptual and emotional components. The amygdala plays an important role in the emotional processing of facial expressions. Furthermore, the neural responses to facial expressions may be influenced by multiple factors, such as the type of emotion, the dynamic presentation of the face and the consciousness of facial expressions. With respect to facial attractiveness processing, studies has shown that the reward circuitry is activated by highly attractive faces. However, the influence of facial attractiveness on neural responses remains elusive. It is proposed that the neural responses to facial attractiveness might be modulated by factors such as the task, observer's sex, expectation and other social cues in faces. Eye gaze perception and face view perception are related to visual attention, and the relevant neural circuitry has been found to include attention-related areas, such as the intraparietal sulcus. Finally, research on lipreading reveals its important role in language perception. The auditory cortex and language-related cortex have been shown to be activated by lipreading. In summary, the present evidence may support facial information processing theory. However, the theory could be further improved based on present and future findings. Furthermore, we discussed the deficits in the processing of social cues in individuals with mental disorders and proposed future research directions in this field.

Prospective comparative study of arthroscopic anterior cruciate ligament construction with autograft and allograft / 中华外科杂志

<p><b>OBJECTIVE</b>To study the clinical effect of arthroscopic anterior cruciate ligament (ACL) construction with different transplants.</p><p><b>METHODS</b>From March 2006 to April 2009, 86 patients including 60 male and 26 female undergoing arthroscopic ACL reconstruction were prospectively randomized consecutively into autograft group (44 patients, using autogeneic hamstring tendons) and allograft group (42 patients, using allogenic lower extremity tendons). The age of those patients were 22 - 56 years, averaging (32 ± 7) years. The operations were made by the same doctor with the standard technology. The postoperative effects were assessed by the range of motion and tibia forward distance, Lachman test, pivot shift test, Daniel test, IKDC scores systems, Lysholm-Tegner scores.</p><p><b>RESULTS</b>Seventy-nine patients were followed up, 41 patients in autograft groups averaged 39.6 months and 38 patients in allograft group averaged 37.4 months. The operation time of autograft group was (87 ± 11) minutes, that of allograft group was (55 ± 10) minutes (t = 15.732, P < 0.05). The time of postoperative fever of autograft group was (3.2 ± 1.4) days, that of allograft groups was (7.6 ± 5.3) days (t = 5.740, P < 0.05). The Lysholm scores of autograft group was 42 ± 7 before operation, and 89 ± 8 at final follow-up. The Lysholm scores of allograft group was 44 ± 6 before operation, and 87 ± 9 at final follow-up. There was statistic difference in both groups between before operation and final follow-up (t = 13.534 and 17.768, P < 0.05).But no statistic difference existed between the two groups (P > 0.05). The Tegner scores of autograft group was 2.9 ± 2.1 before operation, and 7.7 ± 1.2 at final follow-up. The Tegner scores of allograft group was 2.7 ± 1.4 before operation, and 7.1 ± 1.6 at final follow-up. There was statistic difference in both groups between before operation and final follow-up (t = 16.004 and 12.338, P < 0.05).No statistic difference existed between the two groups (P > 0.05). The KT2000 results showed that the anterior displacement of autograft groups was (10.7 ± 3.5) mm before operation and (5.0 ± 2.7) mm at final follow-up, the anterior displacement of allograft groups was (10.9 ± 2.9) mm before operation and (6.5 ± 2.4) mm at final follow-up, there was statistic difference between before and after operation in anterior displacement in two groups (t = 16.354 and 13.296 P < 0.05). There was no difference between two groups before operation and at final follow-up. Compared to before operation, the IKDC scores were improved greatly after operation (P < 0.05).</p><p><b>CONCLUSION</b>The clinical effect of arthroscopic ACL construction with allograft transplants is near to autograft.</p>

Primary nasal clear cell carcinoma:a case report and literature review / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the clinical and pathological characteristics of the primary nasal-sinonasal clear cell carcinoma, and then summarize the diagnosis and treatment.@*METHOD@#The clinical, imaging and pathological data were analyzed in one patient with primary nasal-sinonasal clear cell carcinoma. The domestic and foreign related literatures from 1992 were reviewed and summarized.@*RESULT@#In 12 cases of primary nasal-sinonasal clear cell carcinoma, 8 cases (66.7%) mainly presented with nasal bleeding, 4 cases (33.3%) with destroyed bone. CT scan showed the sheet shadow similar to soft tissue density in the nasal cavity and paranasal sinuses. Three cases (25.0%) were only treated by surgical resection, 7 cases (58.3%) were treated by surgical resection combined with radiotherapy and chemotherapy, 2 cases (16.7%) were treated by radiotherapy alone. During the 6 months to 10 years follow up, only one patient died of lung metastasis.@*CONCLUSION@#Primary nasal-sinonasal clear cell carcinoma is rare. Nasal bleeding is commonly one of the early symptoms. It must be differentiated from metastatic clear cell carcinoma and a variety of salivary gland tumors with clear cell in pathology. Surgery combined with radiotherapy and chemotherapy is effective treatment. Short-term prognosis is good. Endoscopic surgery can be used to the tumor with a base limited in the nasal cavity and sinuses in early time. The regular check after surgery should be taken to the patients every half a year.

Intermediate and long-term follow-up evaluation of posterior dynamic lumbar stabilization in lumbar degenerative disease / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the intermediate and long-term follow-up effect of posterior dynamic lumbar stabilization in lumbar degenerative disease.</p><p><b>METHODS</b>The clinical outcomes of 96 patients (male 51, female 45, age from 21 to 68 years, mean 41.5 years) whose follow-up time were more than 2 years with lumbar degenerative disease treated by posterior decompression with Wallis posterior dynamic lumbar stabilization implant or combined with posterior lumbar fusion from August 2007 to January 2010 were retrospectively studied, and assessed with visual analogue scale (VAS) and spinal operative standard of Chinese Medical Association. The early and long-term follow-up effect and complications associated with Wallis posterior dynamic lumbar stabilization were recorded. The height of intervertebral space at the treated level in lateral plain film were measured at preoperatively, 3 month postoperatively and last follow-up, respectively. The finds of MRI obtained at over 6 month postoperative were recorded.</p><p><b>RESULTS</b>The operative procedure of Wallis posterior dynamic lumbar stabilization implant was easy and less invasive. The VAS scores were 78 ± 24, 28 ± 16 and 14 ± 12 preoperatively, 3 month postoperatively and last follow-up, respectively. The good or excellent result was 91.7% at the last follow-up. No complication related with Wallis posterior dynamic lumbar stabilization was found. The rate of patient's satisfaction with the Wallis implant operation was 95.8%. The disc height at the treated level in lateral plain film were (8.2 ± 3.7), (10.4 ± 2.6) and (10.1 ± 1.9) mm at preoperatively, 3 month postoperatively and last follow-up, respectively. There is no further degenerative change found in MRI obtained at over 6 month postoperative. MRI 1 year after Wallis procedure showed rehydration of the formerly black disc at the treated level.</p><p><b>CONCLUSIONS</b>It is easy and safe to use Wallis posterior dynamic lumbar stabilization in treatment of degenerative lumbar disease, and the effect of the intermediate and long-term follow-up more than 2 years is good. The Wallis system provides an alternative for treatment of lumbar degenerative disease.</p>

Experimental study of peripheral nerve grafts for repairing of chronic spinal cord injury in adult rats / 中国骨伤

<p><b>OBJECTIVE</b>To explore the pathological mechanism in the repair of chronic spinal cord injury with free grafting of autoperipheral nerve tissues in rats.</p><p><b>METHODS</b>The SD rats were used to establish SCI model with modified Allen method. The rats were divided into two groups at 12 weeks after the injury, each group had 20 rats. In the experimental group, the sural nerves were removed epineurium and transplanted into SCI lesion by using microsurgical technique; and in the control group, the rats were treated without any operation. The survival and differentiation of the grafts, and the ability of repairing host spinal cord were observed under the light microscope at the postoperative 4th and 12th week. Regeneration rates of nerve tracts in spinal cord were evaluated by using HRP tracing technique at the postoperative 4th and 12th week. The morphological changes were observed at section of spinal cord and the motor functions of both hind legs of rats were detected.</p><p><b>RESULTS</b>In the control group, spinal cord exhibited degeneration with cicatrices and cavitates. In the experimental group, peripheral nerve was almost survived, fused with the spinal tissue and axons could regrow into or span the place of injured spinal cord. Higher number of labeled nerve tracts in spinal cord were observed in experimental group, there was significant difference when compared with the control group. Motor function of hind legs of rats recovered significantly in the treatment group.</p><p><b>CONCLUSION</b>Autoperipheral nerve graft tissues transplantation could survive and integrate with the host and have repairing effects on chronic spinal cord injury in rats.</p>

The characteristics of sympathetic skin response in patients with depression / 中华物理医学与康复杂志

Objective To investigate the features of variation of sympathetic skin response(SSR)in depression patients and to clarify the correlation between SSR and the effect of antidepressant therapy in first episode depression.Methods The sample comprised 50 first visit patients,who fulfilled the ICD-10 criteria in a structured interview for depressive disorder.These 50 patients received antidepressant therapy for 6 weeks.Clinical response was defined as ≥50%reduction in total 17-item Hamilton depression rating scale(HAMD).Remission was defined as HAMD score ≤7 at week 6.SSR waveforms were classified into three patterns based on the amplitudes of positive and negative components:P pattern,N pattern and M pattern.Another 50 healthy subjects were involved in this study as controls.Results (1)SSR could be obtained in all normal subjects but couldn't be recorded in 5 of 50 patients whose HAMD scores>28.SSR waveforul patterns were analyzed in these 45 patients P pattern in 7 cases,N pattern 21,M pattern 17.(2)Depression patients had longer latency and lower amplitude than the controls(P<0.01).P pattern had shorter latency and higher amplitude than N pattern.There were no difference in age,course and HAMD scores among the patients with 3 different SSR patterns.(3)Nine of 21 patients of N pattern treated with fluoxetine were remitters.6 patients were clinical responders.These 15 patients had shorter latency and higher amplitude after treatment than that at the initial stage,but there were still differences in latency and amplitude compared with the controls.Conclusion There were significant damages on sympathetic function of depression patients.N pattern was the most SSR pattern among 45 patients recorded SSR.P pattern had shorter latency and higher amplitude than N pattern.SSR is a sensitive and feasible measure inder for neurocardiac electrophysiologic autonomic regulation examination,which could be used to measure clinical therapeutic efficacy for antideppressant in depression patients.

Effect of removed epineurium of peripheral nerve and transplanted into spinal cord injury in rats / 中华显微外科杂志

Objective To investigate the nerve recanalization and the motor function of hind legs after transplantation of peripheral nerve grafts treated with microsurgical technique at chronic spinal cord injury (SCI) in rats.Methods The SD rats were established into SCI model with improved Allen method.The rats were divided into two parts 12 weeks after the injury.In experimental group:by microsurgieal technique. the sural nerves were removed epineufium and transplanted into SCI lesion,control group rats were treated without any operation.Retrograde HRP tracing through sciatic nerve were practiced at 1 month,2 month,3 month after transplantation of peripheral nerve grafts.The morphological changes were observed at section of spinal cord and the motor functions of both hind legs of rat were detected.Results The morphology of the injured spinal cord sections turned better.Retrograde HRP tracing through sciatic nerve showed some HRP positive markers at the site of near rostral end of the nearly injured part at one month after transplantation and increased with the time going by.Motor function of hind legs of rats recovered significantly in transplantation groups.Conclusion Peripheral nerve grafts treated with mierosurgical technique have repairing effect on chronic spinal cord injury in rats.

Association of 4G/5G polymorphism in PAI1 promoter with PAI1 level in deep vein thrombosis / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To reveal the association of 4G/5G polymorphism in the promoter region of the plasminogen activator inhibitor 1 gene (PAI1) with plasma PAI1 level in deep vein thrombosis (DVT) in Chinese Han ethnic group.</p><p><b>METHODS</b>One hundred and twenty Chinese DVT patients and 120 healthy controls were recruited. The PAI1 promoter 4G/5G polymorphism was detected using polymerase chain reaction (PCR). The antigen of tissue-type plasminogen activator (tPA) or PAI1 was quantified by a commercially available enzyme-linked immunosorbent assay (ELISA) in DVT cases and health controlsì respectively.</p><p><b>RESULTS</b>Neither in the distribution of PAI1 promoter 4G/5G polymorphism nor in the frequencies of 4G and 5G allele was there a difference between two groups. The levels of PAI1 antigen in the carriers of the 4G/4G genotype were significantly higher than those either in the 4G/5G genotype or in the 5G/5G genotype; In the 4G/5G genotype or in the 5G/5G genotype the TG levels are an independently determinant factor of PAI1 antigen levels.</p><p><b>CONCLUSION</b>There is a close relationship of the PAI1 4G/5G polymorphism to its plasma level in deep vein thrombosis in Chinese Han ethnic group, although lack of association between this genetic variation and risk of DVT suggest no major cause-effect pathogenic role of this polymorphism by itself.</p>