OBJECTIVE: To sum up transplantation of free scapular flap to repairing injury of faciocervical region, 103 cases in past 16 years were reviewed. METHODS: The scapular flap contained the ascending, descending, and transverse branches of the circumflex scapular artery. The range of the flap was as following: across the scapular spine to the acromion in upper edge, to the level of anterior iliac spine in lower edge, to the bilateral middle axillary line in both sides. RESULTS: The clinical result was good. Fifty eight cases were followed up for 3 months to 10 years, the function of the faciocervical region was recovered with satisfied contour. In part of the patients, a second-stage operation was performed to make the flap thinner. CONCLUSION: The maximal range of the flap can be 45 cm x 16 cm. For its sufficient blood supply, it should be of no influence on survival of the flap if the window is open in suitable site. Because of its large range of donating region and sufficient blood supply, it is fit for children.
Currently, commercial devices for electrical neural stimulations can only provide fixed stimulation paradigms with preset constant parameters, while the development of new stimulation paradigms with time-varying parameters has emerged as one of the important research directions for expanding clinical applications. To facilitate the performance of electrical stimulation paradigms with time-varying parameters in animal experiments, the present study developed a well-integrated stimulation system to output various pulse sequences by designing a LabVIEW software to control a general data acquisition card and an electrical stimulus isolator. The system was able to generate pulse sequences with inter-pulse-intervals (IPI) randomly varying in real time with specific distributions such as uniform distribution, normal distribution, gamma distribution and Poisson distribution. It was also able to generate pulse sequences with arbitrary time-varying IPIs. In addition, the pulse parameters, including pulse amplitude, pulse width, interphase delay of biphasic pulse and duration of pulse sequence, were adjustable. The results of performance tests of the stimulation system showed that the errors of the parameters of pulse sequences output by the system were all less than 1%. By utilizing the stimulation system, pulse sequences with IPI randomly varying in the range of 5~10 ms were generated and applied in rat hippocampal regions for animal experiments. The experimental results showed that, even with a same mean pulse frequency of ~130 Hz, for neuronal populations, the excitatory effect of stimulations with randomly varying IPIs was significantly greater than the effect of stimulations with fixed IPIs. In conclusion, the stimulation system designed here may provide a useful tool for the researches and the development of new paradigms of neural electrical stimulations.
ObjectiveTo investigate the current situation of orthopedic quality control and management in county-level regional general hospitals in Guangdong, and to provide a scientific basis for further standardizing the procedures of orthopedic quality control and management in county-level regional general hospitals and continuously improving the work of provincial orthopedic quality control center.MethodsFrom June 2019 to July 2020, online and offline questionnaire survey and field survey were used to investigate the quality control and management of orthopedic departments in 22 county-level regional general hospitals in Guangdong.ResultsAmong the overall scores of the surveyed hospitals, the highest score was 96.5, the lowest score was 72.0. There were 6 hospitals with a total score of “excellent” (accounting for 27.3%). The “facilities and equipment” and “medical quality” of the surveyed hospitals were relatively valued. Taking Guangzhou, the capital of Guangdong as the center, the districts and counties were divided into the east, the south, the west and the north regions, and the difference in overall scores of orthopedics among the four regions was statistically significant (F=6.299, P=0.004). The unqualified rates of department setting, key technology development, average hospitalization days of representative diseases, equipment allocation, personnel allocation, department management and building layout were relatively high, which were 77.3%, 63.6%, 45.5%, 40.9%, 40.9%, 36.4% and 36.4%, respectively. Most hospitals had set up special debridement rooms in orthopedic department (95.5%), and the management and monitoring of the use of antibacterial drugs was mostly reasonable (90.9%). In terms of the level of orthopedic medical treatment, only 3 hospitals with sufficient key technologies reached the standard, accounting for 13.6%, and only 7 hospitals reached the standard of scientific research capacity, accounting for 31.8%. In terms of quality control, the numbers of hospitals with qualified medical record sampling (72.7%), perfect management and supervision mechanism (86.4%) and quality management team in departments (77.3%) were the least. In addition, among the investigated hospitals, beds were in short supply in orthopedic departments, with 12 hospitals accounting for 54.5% being deducted; 16 hospitals (72.7%) were deducted for unqualified doctor-patient ratio and 11 hospitals (50.0%) were deducted for unqualified nurse-patient ratio.ConclusionsThe overall level of orthopedics construction and management in the surveyed hospitals is uneven. The medical professional and technical level is insufficient. It is difficult to meet the practical needs, and there is an imbalance in the ratio of medical personnel. In the future, it is necessary to strengthen the quality control of orthopedic medical care, strengthen the medical technology training of county-level regional general hospitals and increase the medical and health resources and capital investment, so as to improve the quality control of county-level regional general hospitals.
This paper aims to utilize the intersecting cortical model (ICM), which imitates the biological neural cells sync pulse, to preliminary research about the contour integration mechanism and the selection of attention. The idea of "Excitement-Inhibition" oscillation is introduced into the ICM, and meanwhile, the target contour chain code is used as the high-level feedback to control the input. Thus, we propose the Excitation-Inhibition-ICM which contains both the BUTTON-UP and the TOP-DOWN mechanism. The experimental results showed that the proposed model could effectively suppress noise to make the smooth edge synchronization issue, thus completing the process of BOTTOM-UP. The introduction of the target contour chain code can obtain consistent target outline with the input target chain code, but other targets cannot form a closed contour since they do not match with the input target chain code, so as to realize the TOP-DOWN mechanism. The results proved that our proposed model could imitate the contour integration mechanism and the selection of attention of the visual cortex V1.
The aim of this paper is to reveal the change of the brain function for nicotine addicts after smoking cessation, and explore the basis of neural physiology for the nicotine addicts in the process of smoking cessation. Fourteen subjects, who have a strong dependence on nicotine, have agreed to give up smoking and insist on completing the test, and 11 volunteers were recruited as the controls. The resting state functional magnetic resonance imaging and the regional homogeneity (ReHo) algorithm have been used to study the neural activity before and after smoking cessation. A two factors mixed design was used to investigate within-group effects and between-group effects. After 2 weeks’ smoking cessation, the increased ReHo value were exhibited in the brain area of supplementary motor area, paracentral lobule, calcarine, cuneus and lingual gyrus. It suggested that the synchronization of neural activity was enhanced in these brain areas. And between-group interaction effects were appeared in supplementary motor area, paracentral lobule, precentral gyrus, postcentral gyrus, and superior frontal gyrus. The results indicate that the brain function in supplementary motor area of smoking addicts would be enhanced significantly after 2 weeks’ smoking cessation.
ObjectiveTo evaluate the safety and efficacy of the intravitreal methotrexate treatment in patients with primary vitreoretinal lymphoma (PVRL). MethodsRetrospective non-comparative interventional case series. Fourteen patients (26 eyes) with biopsy-proven PVRL were included in the study. All patients received examination of Snellen chart visual acuity, fundus color photography and optical coherence tomography (OCT). Among the 24 eyes with recordable visual acuity, 17 eyes has initial visual acuity≥0.1 (0.45±0.20) and 7 eyes with initial visual acuity ranged from light perception to hand movement. The vitreous opacities and (or) subretinal yellowish-white lesions and retinal pigment epitheliumuplift were observed in all eyes. All eyes were treated with intravitreal methotrexate (4000 μg/ml, 0.1 ml) injections according to a induction-consolidation-maintenance regimen. For 26 treated eyes, each received an average of (11.5±6.3) injections. Twenty eyes had finished theintraocular chemotherapy, while 6 eyes had not. Eight of 20 eyes were clinically confirmed free of tumor cells by diagnostic vitrectomy, 12 eyes were still with tumor cell involvement.The follow-up was ranged from 2 to 48 months, the mean time was 18 months. The examination of BCVA, fundus color photography and OCT were performed. No tumor cell was defined as clinical remission. Visual acuity was scored as improved or declined obviously (improved or declined 2 lines) or mild improved or declined (changed within 2 lines). ResultsTwenty eyes achieved clinical remission after (3.5±3.6) injections, 12 eyes of 20 eyes with tumor cell involvement before chemotherapy achieved clinical remission after (5.8±3.0) injections. The mean visual acuity of seventeen eyes with initial visual acuity 0.1 in induction phase and at the end of treatment were 0.36±0.23 and 0.56±0.20, respectively. Compared with before treatment, the visual acuity was mild declined in induction phase (t=1.541, P>0.05), but mild improved at the end of treatment (t=2.639, P<0.05). The visual acuity at the end of treatment in 7 eyes with initial visual acuity<0.1 was ranged from no light perception to 0.1. Of 14 patients, 2 patients have been fatal because of brain lesions progression at 42 and 48 months after diagnosis of primary central nervous system lymphoma. No ocular recurrence was noted during the follow-up in 20 eyes who finished intraocular chemotherapy. ConclusionsPVRL patients can achieve clinical remission after (3.5±3.6) injections by intravitreal chemotherapy of methotrexate, and the visual acuity improved mildly. No ocular recurrence was found during follow-up.
Objective To investigate the effects of combined platelet-rich plasma (PRP) and arterial supercharging technique on the survival rate and functional restoration of cross-body region skin flaps in rabbits. MethodsTwelve healthy 6-month-old New Zealand White rabbits were randomly assigned to 4 groups (n=3): sham group, PRP group, anastomosis group, and combined treatment group. An axial skin flap with an area of 12 cm×6 cm on the inner side of the hind limbs of all animals were prepared, with the saphenous artery as the main blood supply. Following the ligation of both the proximal and distal ends of the saphenous artery across all groups, the sham group received no further intervention, the PRP group was subjected to PRP injection, the anastomosis group underwent in situ end-to-end anastomosis of the distal saphenous artery, and the combined treatment group received both in situ distal saphenous artery anastomosis and PRP administration. Flap survival was evaluated and recorded on postoperative days 1, 3, and 7, with survival rates calculated accordingly. On day 7, flap tissue samples were harvested for HE staining to assess basal tissue morphology. Additionally, immunohistochemical staining was conducted to detect the expression of α-smooth muscle actin (α-SMA), vascular endothelial growth factor (VEGF), and CD31 in the flap tissues. Results At postoperative day 1, no significant difference in flap survival rates were observed among the 4 groups (P>0.05). At day 3, the PRP group showed no significant difference compared to the sham group (P>0.05); however, both the anastomosis and combined treatment groups exhibited significantly higher survival rates than the sham group (P<0.05), the combined treatment group further demonstrated superior survival rates compared to both the PRP and anastomosis groups (P<0.05). At day 7, the combined treatment group maintained significantly higher survival rates than all other groups (P<0.05), while both the PRP and anastomosis groups exceeded the sham group (P<0.05). HE staining at day 7 revealed persistent inflammatory cell infiltration, sheet-like erythrocyte deposition, and disordered collagen fibers in the sham group. The PRP group showed nascent microvessel formation and early collagen reorganization, whereas the anastomosis group displayed mature microvasculature with resolved interstitial edema. The combined treatment group exhibited differentiated microvessels with densely packed collagen bundles. Immunohistochemical analysis at day 7 demonstrated significantly larger relative area percentages of α-SMA, VEGF, and CD31 positive cells in the combined treatment group compared to all other groups (P<0.05). Both the PRP and anastomosis groups also showed significantly higher values than the sham group (P<0.05). Conclusion The combination of PRP and arterial supercharging techniques significantly enhances flap healing, potentially through mechanisms involving augmented angiogenesis and improved blood supply.
The temperature during the brain tumor therapy using high-intensity focused ultrasound (HIFU) should be controlled strictly. This research aimed at realizing uniform temperature distribution in the focal region by adjusting driving signals of phased array transducer. The three-dimensional simulation model imitating craniotomy HIFU brain tumor treatment was established based on an 82-element transducer and the computed tomography (CT) data of a volunteer's head was used to calculate and modulate the temperature distributions using the finite difference in time domain (FDTD) method. Two signals which focus at two preset targets with a certain distance were superimposed to emit each transducer element. Then the temperature distribution was modulated by changing the triggering time delay and amplitudes of the two signals. The results showed that when the distance between the two targets was within a certain range, a focal region with uniform temperature distribution could be created. And also the volume of focal region formed by one irradiation could be adjusted. The simulation results would provide theoretical method and reference for HIFU applying in clinical brain tumor treatment safely and effectively.
ObjectiveTo investigate the effectiveness of cervical pedicle screw implantation technique under regional method.MethodsThe clinical data of 85 patients who met the selection criteria between April 2010 and May 2018 were retrospectively analyzed. There were 57 males and 28 females, aged 35-68 years, with an average of 57.6 years. Among them, there were 10 cases of ossification of posterior longitudinal ligament, 68 cases of cervical spondylosis with multilevel stenosis, 3 cases of cervical tumor, 1 case of congenital malformation, and 3 cases of cervical trauma; the lower cervical spine lesions involved C3-C7. Preoperative Frankel spinal cord injury grading: 2 cases of grade C, 51 cases of grade D, and 32 cases of grade E. Cervical pedicle screw implantation technique under regional method was performed with a total of 618 pedicle screws. Postoperative changes in neurological symptoms were observed; cervical mouth opening anteroposterior and lateral X-ray films and cervical CT examinations were performed to evaluate the pedicle screws position.ResultsThe operation time was 2.5-4.0 hours, with an average of 3.0 hours. The intraoperative blood loss was 180-550 mL, with an average of 345 mL. No intraoperative vascular or nerve injury occurred. The patients with neurological symptoms were relieved to varying degrees. There were 2 cases of superficial incision infection after operation, the wound healed after enhanced dressing change. The postoperative hospital stay was 5-14 days, with an average of 8.4 days. At discharge, Frankel neurological grading was grade D in 26 patients and grade E in 59 patients. All the patients were followed up 6-24 months, with an average of 13 months. At last follow-up, cervical X-ray films showed the good pedicle screw fixation without loosening. Cervical CT evaluated the position of pedicle screws: 523 pedicle screws (84.7%) in grade Ⅰ, 80 (12.9%) in grade Ⅱ, and 15 (2.4%) in grade Ⅲ; the accuracy rate of the screw position was 97.6%.ConclusionCervical pedicle screw implantation technique under regional method can significantly improve the success rate of screw implantation. It is easy to operate, does not destroy the bone cortex, and has stable fixation.
OBJECTIVE: To evaluate the clinical efficacy of fasciocutaneous flap in the repair of the III degree burn wound in the facio-cervical region. METHODS: From January 1997 to October 2001, 11 cases of III degree burn wounds in the facio-cervical region were repaired with the cervical-thoracic fasciocutaneous flap ranging from 18 cm x 8 cm to 13 cm x 5 cm. Donor sites were covered with "Z" plasty or skin grafting. RESULTS: Except for partial necrosis of distal end of the flap in 1 case, the flaps in the other 10 cases all survived and presented satisfactory appearance and function during the following up. CONCLUSION: The fasciocutaneous flap in the cervical-thoracic region may provide a large area of flap, and can be easily transferred. It’s an ideal flap for the repair of skin defect in the facio-cervical region, especially for the repair of the wounds with infection or exposure of vessel, nerve and tendon.