Scurvy in a young man: a rare case report.

Scurvy, resulting from vitamin C deficiency, has nonspecific constitutional symptoms, including weakness, malaise, and fatigue. It is frequently misdiagnosed due to the lack of specific clinical manifestations. Although there are sporadic cases of scurvy currently reported in children, scurvy in young people is seldom encountered. Here, we report on a 25-year-old male patient without any underlying conditions who presented with severe pain and ecchymoses of both lower extremities. He was diagnosed with scurvy due to a long history of staying indoors and inadequate intake of fruits or vegetables.

Clinical significance of anti-rheumatoid arthritis 33 antibody in patients with systemic lupus erythematosus.

Although anti-rheumatoid arthritis (RA) 33 antibodies have been reported to be present in various connective tissue diseases (CTDs), the clinical significance of anti-RA33 in CTDs is still obscure. This study was performed to explore the clinical significance of anti-RA33 in CTDs, especially systemic lupus erythematosus (SLE). A total of 565 patients with positive anti-nuclear antibodies who had been tested for anti-RA33 were included in this study and were further classified into RA33-positive and RA33-negative groups. The association between anti-RA33 and the clinical features of CTDs was examined. Receiver operating characteristic (ROC) analysis was performed to explore the diagnostic value of anti-RA33 in SLE and SLE-related organ involvement. The results showed that SLE was the most common disease in CTD patients positive for anti-RA33 (48.8%). Compared with the RA33-negative group, higher proportions of SLE-associated antibodies and SLE patients with a high disease activity as well as lower levels of serum complement components were observed in the RA33-positive group (all p < 0.05). Furthermore, CTD patients with positive anti-RA33 were more likely to suffer from mucocutaneous and hematological involvement as well as interstitial lung disease (all p < 0.05). ROC analysis revealed an area under the curve value of 0.634 (95% confidence interval: 0.587-0.681) for anti-RA33 in the diagnosis of SLE, with a specificity and sensitivity of 92.9% and 13.5%, respectively. Taken together, this study reveals a significant association between anti-RA33 and the clinical features of CTDs, especially SLE, indicating a potential clinical significance of anti-RA33 in the management of SLE.

Case Report: IgA Nephropathy in a Patient With Anti-Transcription Intermediary Factor-1γ Antibody-Positive Dermatomyositis.

Immunoglobulin A nephropathy (IgAN) is the most common primary glomerulonephritis characterized by IgA deposits in the mesangial area of glomeruli. Connective tissue disorders are some of the most frequent causes of secondary IgAN. Nevertheless, IgAN rarely occurs in systemic autoimmune myopathies (SAMs). The present case study reports on a 58-year-old patient with dermatomyositis with positive anti-transcription intermediary factor (TIF)-1γ antibodies who was diagnosed with IgAN during standard immunosuppressive therapy. Moreover, we have made a systematic review regarding the association of SAMs and IgAN. To the best of the authors' knowledge, this is the first case study describing a patient with anti-TIF1γ antibody-positive dermatomyositis who developed IgAN, which demonstrates a potential relationship between anti-TIF1γ-positive dermatomyositis and IgAN. It is important for clinicians to be aware of the possibility of renal involvement in patients with SAMs, even in those with anti-TIF1γ-positive dermatomyositis.

[Effect of acupuncture combined with repetitive transcranial magnetic stimulation on motor function and cerebral hemodynamics in children with spastic cerebral palsy with spleen-kidney deficiency].

OBJECTIVE: To investigate the clinical effect of acupuncture combined with repetitive transcranial magnetic stimulation in the treatment of children with spastic cerebral palsy with spleen-kidney deficiency, as well as its effect in improving cerebral hemodynamics. METHODS: A total of 220 children with spastic cerebral palsy were divided into observation group and control group using a random number table, with 110 children in each group. The children in the control group were given rehabilitation training and repetitive transcranial magnetic stimulation, and those in the observation group were given acupuncture in addition to the treatment in the control group. Acupuncture was performed at Zusanli (ST36), Xuanzhong (GB39), Sanyinjiao (SP6), Pishu (BL20), Shenshu (BL23), Qihai (CV6), Quchi (LI11), Neiguan (PC6), Hegu (LI4) and Tianshu (ST25) once every other day, three times a week for 3 consecutive months. The two groups were compared in terms of Gross Motor Function Measure (GMFM), Fine Motor Function Measure (FMFM), comprehensive function score for children with cerebral palsy, clinical outcome, and related cerebral hemodynamic parameters (mean blood flow velocity [Vm], systolic peak velocity [Vs], and resistance index [RI] of the cerebral artery). RESULTS: After treatment, both groups had significant increases in the scores of GMFM, FMFM and comprehensive function (cognitive function, speech function, motor ability, self-care, and social adaptability,P<0.01), and the observation group had significantly better improvements in the scores of GMFM (domains A, B and C), FMFM (domains B, C, D and E), and comprehensive function than those of the control group (P<0.01). The therapeutic effect of the observation group (93/110, 84.55%)was superior to that of the control group (80/110, 72.73%, P<0.05). The observation group had significantly higher Vs and Vm and a significantly lower RI than the control group (P<0.01). CONCLUSION: In the treatment of children with spasmodic cerebral palsy with spleen-kidney deficiency, acupuncture combined with repeated transcranial magnetic stimulation can significantly improve their motor function, comprehensive function, and clinical outcome, which may be associated with the regulation of cerebral hemodynamics.

[Biomechanical research of different polypropylene meshes in breast ptosis correction].

OBJECTIVE: To investigate the biomechanical properties of different polypropylene meshes, so as to select the proper mesh for breast ptosis correction as inner bra. METHODS: Mini-pigs were used as animal model. Four different polypropylene meshes were implanted subcutaneously at abdomen. 90 d later, the specimens were taken out for biomechanical study. RESULTS: The tensile strength, stress, relaxation and creep of the four meshes were different. The material and the knitting of the four meshes were different. CONCLUSIONS: The biomechanical properties of relaxation and creep are important in maintaining the postoperative breast figure. Premilene Mesh LP is a new and light polypropylene mesh with mini-pores. Its biomechanical properties are superior to the others.

[Therapeutic effect of scalp-acupuncture combined with exercise therapy on spastic cerebral palsy of the child].

OBJECTIVE: To observe clinical therapeutic effect of scalp-acupuncture combined with exercise therapy on spastic cerebral palsy. METHODS: Eighty children of spastic cerebral palsy were randomly divided into a scalp-acupuncture plus exercise therapy group and a exercise therapy group, 40 cases in each group. The scalp-acupuncture plus exercise therapy group were treated with scalp-acupuncture and exercise therapy, with Yundongqu (the motor area), Pinghengqu (the balance area), Ganjuequ (the sensory area), etc. selected for scalp-acupuncture, and puncture at main points Baihui (GV 20) and Sishencong (EX-HN 1) and exercise therapy. The exercise therapy group were treated by exercise therapy. Changes of GMFM scores and WeeFIM scores before and after treatment were compared. RESULTS: There were significant differences in GMFM scores and WeeFIM scores before and treatment in the scalp-acupuncture plus exercise therapy group (P < 0.001) and in the exercise therapy group (P < 0.05), the former being better than the later (P < 0.05); the total effective rate was 92.5% in the scalp-acupuncture plus exercise therapy group and 72.5% in the exercise therapy group with a significant difference between the two groups (P < 0.05), the former being significantly higher than the later. CONCLUSION: The scalp-acupuncture combined with exercise therapy can improve motor function of limits of children with spastic cerebral palsy, with therapeutic effect better than that of simple exercise therapy.

[Application of abdominoplasty and polypropylene to repair the abdominal defect].

OBJECTIVE: To introduce a operation method of repairing the abdominal defect with abdominoplasty and polypropylene. METHODS: 27 patients were treated with abdominoplasty and polypropylene. RESULTS: Follow up 3 - 20 months, the focus in inferior abdominal wall were removed thoroughly. The incision is cure with A level. No weakness, bulk, hernia and complication occur in the abdominal wall. CONCLUSIONS: The method of repairing the abdominal defect with abdominoplasty and polypropylene is a good method. It is a simple method. Its' result is relied.

[Vulvar form reconstruction in extended radical vulvectomy of vulvar carcinoma].

OBJECTIVE: To evaluate the method of vulvar reconstruction after extended vulvectomy. METHODS: Retrospectively, fourteen cases of vulva carcinoma were treated by radical wide local excision, and the defects were repaired with anterolateral thigh flap and inferior pedicle rectus abdominal myocutaneous flap. After the flap was harvested, it was put on the defect through the tunnel between the donor and the recipient site and the vulvae was reconstructed. RESULTS: All the flaps were survived except 1 anterolateral thigh flap with partial necrosis. One patient was infected at the groin incision but the flap and the grafted skin were survived. The patients were treated with change of the dressing and recovered after skin grafting. All other incisions were healed with first intention. The partial necrosis area was about 4 cm x 6 cm, it healed at 36 postoperative days after free skin grafting. The reconstructed vulvae were plump and elastic. It appeared like the normal vulvae and there was no contraction of the vagina. CONCLUSIONS: Vulvar reconstruction with the anterolateral thigh flap and rectus abdominal flaps after the radical vulvectomy could make the patients recover easily. It produces almost normal appearance and function of the vulvae, reduces the time of wound healing. The patient could have the next therapy more quickly and the quality of life improves. It has wide application value in clinics.

[The periareolar approach management of postoperative complications of breast augmentation by injected polyacrylamide hydrogel].

OBJECTIVE: To analysis various complications of 30 patients of breast augmentation by injected polyacrylamide hydrogel and discuss the treatment through periareolar incision. METHODS: All patients were classified according to the different complications. Open suction technique and partial mastectomies via periareolar incisions were performed in all patients, Only one patient had immediately breast reconstruction with prosthesis, five patients received secondarily breast prostheses implantation via a axillary incision. RESULT: All the symptoms were relieved after remove of polyacrylamide hydrogel. CONCLUSIONS: Polyacrylamide hydrogel should be prohibited for injected breast augmentation at present. A double-blinded randomized clinical study, controlled animal experiments and a large sample questionnaire survey for complications are necessary. The periareolar approach is valuable technique and can remove polyacrylamide hydrogel as completely as possible.

[Preventive effect of chitosan on capsular contracture after implantation of silicone gel-filled mammary implants in rats].

OBJECTIVE: To study the preventive effect of chitosan on capsular contracture after implantation of silicone gel-filled mammary implants in rats. METHODS: 18 SD female rats were divided into three groups randomly. Small silicone gel-filled mammary implants were implanted under each side of latissimus dorsi muscle. Chitosan was injected into left cavities as experimental sides, and nothing was injected into right cavities as control sides. 4, 8 and 12 weeks postoperation, specimens were dissected and observed using light microscope, and area density of collagen both type I and type III were also detected. RESULTS: Fibrous capsules around implants consist of two layers: dense layer and loose layer. 4 weeks postoperation, total thickness of the experimental sides was less than that of the control sides (P < 0.01). Area density of collagen either type I or type III of the experimental sides was lower than that of the control sides (P < 0.01). Both 8 and 12 weeks postoperation, total thickness of the experimental sides was less than that of the control sides (P < 0.05). Area density of collagen type I of the experimental sides was lower than that of the control sides (P < 0.05). Area density of collagen type III was of no statistical difference between the experimental sides and the control sides (P > 0.05). CONCLUSIONS: Chitosan can remarkably prevent capsule contracture during the early period after implantation of silicone gel-filled mammary implants.

[Twice delaying of the expanded flap].

OBJECTIVE: To introduce a new method for enlarging the survival area of an expanded flap. METHODS: After the skin expander was inflated with enough injection, the first delaying was performed. In the operation, two incisions were made in the skin and subcutaneous tissue superficial to the expander capsule on both sides of the long axis of the expanded flap. After 10 to 14 days, the second delaying followed, in which one pedicle was divided to form a unilateral-pedicled, super-long random flap. When the flap was transferred to the recipient Since 2000,this technique has been used in 16 patients. All the area, the door site was closed directly. RESULTS: flaps survived completely. CONCLUSIONS: The technique of twice delaying can enlarge the survival area of the expanded skin flap.

[The neuro-vascular anatomical study of breast and it's signification in reduction mammaplasty].

OBJECTIVE: to investigate the pattern of the blood supply and the nerve distribution of breast, in order to find a way for short-scar reduction mammaplasty. METHODS: Twelve adult women cadavers were investigated for the vascularture of the anterior thorax and the nerve distribution of the breasts by using the blood vessel casting, specimen transparency technique and the autopsy. Based on the anatomical study, a modified double-circle reduction mammaplasty technique was designed to treat 28 patients with hypertrophical breasts. RESULTS: There existed two- or three-layers vasculature in the anterior thorax. The extensive vertical vascular anastomoses were found among the three layers. The cutaneous perforators, penetrated out of the pectoralis major muscle, were formed a dense vessel network in the retromammary space. The vertical vessels thereafter emerged from the network, passed through gland and linked to the subcutaneous vessels. These vertical vessels were smaller and denser above the fourth intercostal space, but they were larger and sparser below the fourth intercostal space. The innervation of the nipple-areola mainly came from the lateral deep branches of the 4th intercostal nerve. It appeared S-shape running into the dropped breasts. The 28 patients were successfully treated with the modified technique, except one case with the loss of the nipple-areola sense. CONCLUSION: The modified double-circle reduction mammaplasty could maximally fulfill the blood supply to the remained gland and the innervations to the nipple-areola, by keeping the advantages of the traditional technique such as invisible scar, good projection and the long lasting results. It could also be a safe and reliable technique.

[Treatment of the complications of polyacrylamide hydrogel injection for augmentation mammaplasty].

OBJECTIVE: The purpose of this study was to search for a perfect treatment for the complications after polyacrylamide hydrogel injection for augmentation mammaplasty. METHODS: 48 patients who accepted polyacrylamide hydrogel injection for augmentation mammaplasty were included in this study. Operations were performed for the complications of polyacrylamide hydrogel injection. The clinical data were analyzed and the experience in the treatment of the complications was summarized. RESULTS: All patients were satisfied with the result of the operation. The B-ultrasonic examination showed that no visible polyacrylamide hydrogel remained in the cavity. CONCLUSION: The best therapy for the complications of polyacrylamide hydrogel injection was removing of the polyacrylamide hydrogel and the pathologic tissue and irrigation of the cavity.

Long-term correction of glycogen storage disease type II with a hybrid Ad-AAV vector.

We administered an adenovirus-adeno-associated virus (Ad-AAV) vector encoding human acid alpha-glucosidase (hGAA) to acid alpha-glucosidase-knockout (GAA-KO) mice on day 3 of life by gastrocnemius injection. In contrast to previous results for muscle-targeted Ad vector in adult GAA-KO mice, the muscles of the hindlimb showed reduced glycogen content and persistent hGAA for as long as 6 months after neonatal Ad-AAV vector administration. Not only the injected gastrocnemius muscles, but also the hamstrings and quadriceps muscles produced therapeutic levels of hGAA as a result of widespread transduction with the Ad-AAV vector; moreover, hGAA activity was 50-fold elevated as compared to normal mice. Vector RNA was detected in the hindlimb muscles, the hearts, and the livers by northern blot analysis and/or by RT-PCR for as long as 6 months. The low levels of hGAA detected in the heart were attributable to transduction with the Ad-AAV vector, not to secretion of hGAA by the injected muscle and uptake by the heart. Finally, although an antibody response to hGAA was present, it did not prevent the correction of glycogen storage in the skeletal muscle of GAA-KO mice.