肠系膜下动脉根部自主神经保护的解剖学基础

目的　观察肠系膜下动脉（IMA）根部与其周围自主神经的解剖学关系,为肠系膜下动脉根部自主神经保护提供解剖学证据。 方法　7例10%福尔马林固定标本进行大体解剖及显微解剖;2例新鲜标本模拟腹腔镜下直肠癌D3根治术中肠系膜下动脉根部自主神经的显露和保护。 结果　上腹下丛(SHP)的左、右侧束及束间交通支与肠系膜下动脉根部关系密切。右侧束距离肠系膜下动脉根部较远,位于肾前筋膜下。以左侧束降支为界,其近端,上腹下丛左侧束、肠系膜下丛、腹主动脉丛紧贴肠系膜下动脉根部左侧壁并相互延续,其远端左侧束走行于肾前筋膜下。左侧束降支距离IMA起点的距离不恒定。 结论　在肾前筋膜前平面分离可有效保护上腹下丛右侧束及侧束间交通支;以SHP左侧束降支作为肠系膜下动脉根部离断的解剖学标志可以有效保护左侧束。     

Rare case of right accessory renal artery originating as a common trunk with the inferior mesenteric artery: a case report

Dissection of a male cadaver revealed several vascular abnormalities in the abdominal cavity, notably of the renal circulation. In particular, three renal arteries were observed on the right side and two on the left. On the right side, one accessory renal artery originated as a common trunk with the inferior mesenteric artery. Additional variations included a left inferior phrenic artery originating from the celiac trunk, bilateral testicular veins emptying into renal veins, and the left testicular artery arising from the left renal artery. The possible embryonic development of these branching patterns and their clinical significance are discussed briefly.     

Experience in identifying the venous drainage of the adrenal gland during laparoscopic adrenalectomy

Laparoscopic adrenalectomy (LA) is the procedure of choice for most adrenal tumors. An important part of LA is the early identification and ligation of the adrenal veins. The venous drainage from each adrenal gland is usually via a single vein: the right vein draining into the inferior vena cava (IVC) and the left vein into the left renal vein. Although infrequent, variable venous drainage has been documented. The aim of the study was to clarify if LA identified venous drainage and its variants. Between January 1999 and January 2008, 142 consecutive patients underwent LA. Adrenal vein anatomy was documented on a prospective database. In total, 142 patients underwent 162 LA (right = 62, left = 66, bilateral = 17). All adrenal veins were identified at the time of laparoscopy. For 157 LA, the adrenal venous drainage was constant: right vein drained into the IVC and left vein drained into left renal vein. Five patients had adrenal vein variants: two right veins draining separately into IVC (n = 1), two right veins draining into the IVC and right renal vein (n = 1), and two left veins draining separately into the left renal vein (n = 3). Adrenal vein variants were present in patients with phaeochromocytomas (n = 4) or adrenocortical carcinoma (n = 1). The laparoscopic approach allowed an excellent view of the main adrenal venous anatomy. This has helped confirm the constant nature of the venous drainage and successfully identify variant adrenal veins.     

穿支蒂足背外侧皮神经浅静脉营养血管皮瓣的解剖基础

目的为穿支蒂足背外侧皮神经浅静脉营养血管皮瓣修复前足软组织缺损提供解剖基础。方法在30侧动脉内灌注红色乳胶的成人足标本上解剖观测:1足背外侧皮神经/足外侧缘静脉的走行与分布;2足底外侧动脉足背穿支与足背外侧皮神经浅静脉营养血管间吻合关系。另在1侧新鲜标本上进行摹拟手术设计。结果 1足背外侧皮神经外侧支为主干的延续,伴足外侧缘静脉恒定的沿足外侧缘径直前行,分布于足背外侧缘及第5趾外侧缘皮肤;2足背外侧皮神经/足外侧缘静脉营养血管为多节段、多源性,其中足底外侧动脉在第5跖骨与小趾外侧群肌之间浅出的足背穿支位置相对恒定,并分出众多的细小血管与足外侧缘静脉旁血管链的分支密切吻合。结论可形成以足底外侧动脉足背穿支蒂足背外侧皮神经浅静脉营养血管皮瓣转位修复前足软组织缺损。     

梨状肌上孔内血管损伤致臀内上部坏死的解剖学基础

目的:分析研究髋关节手术损伤臀上血管后并发臀内侧上部坏死的解剖学基础。方法:在40侧经动脉内灌注红色乳胶标本,解剖观察梨状肌上孔、臀上血管神经走行及分支分布,髂内动脉造影观察吻合情况。结果:梨状肌上孔为半圆形,中点高(11.6±2,4)mm,下界宽(22.3±4.2)mm;梨状肌上孔内侧缘骨壁厚(7.5±1.2)mm;臀上动脉外径厚(2.3±1.3、)mm;外径宽(4.8±1.0)mm;臀上动脉深支分布臀中小肌;浅支外径厚(0.9 0.6)mm;外径宽(2.7±0.8)mm,分布臀大肌内侧上部。臀上静脉1支型占30.0％,2支型占70.0％;臀上静脉浅支外径厚(0.6±0.2)mm,外径宽(0.9±0.6)mm。结论:术中将臀大肌向内推臀上动、静脉挤压至梨状肌上孔内侧缘骨壁上,致臀上血管断裂,并发臀内侧上部软组织坏死。     

Fetal development of the retrohepatic inferior vena cava and accessory hepatic veins: Re‐evaluation of the Alexander Barry's hypothesis

The retrohepatic inferior vena cava (IVC) is commonly considered to originate from the right vitelline or omphalomesenteric vein. In contrast, Alexander Barry hypothesized that one of the hepatic veins grows to merge with the subcardinal vein and develops into the retrohepatic IVC. We re‐examined fetal development of the retrohepatic IVC and other related veins using serial histological sections of 20 human fetuses between 6 and 16 weeks of gestation. At 6–7 weeks, when a basic configuration of the portal‐hepatic vein systems had just been established, one of hepatic veins (i.e., the posterocaudal vein in the present study) had grown caudally to reach the posterocaudal surface of the liver, and notably, extended into the primitive right adrenal gland (five of the eight early‐staged fetuses). Because the inferior right hepatic vein (IRHV) and retrohepatic IVC appeared at the same developmental stage, it is likely that any peripheral remnants of the posterocaudal vein would continue to function as primary drainage territory for the IRHV. The caudate vein developed rapidly in accordance with marked caudal and leftward extension of Spiegel's lobe at 12–16 weeks. Thin accessory hepatic veins developed later than the caudate vein and IRHV. The present results supported Barry's hypothesis. Clin. Anat. 23:297–303, 2010. © 2010 Wiley‐Liss, Inc.     

Expression profiles of proliferative and antiapoptotic genes in sporadic and colitis‐related mouse colon cancer models

Elevated levels of survivin, telomerase catalytic subunit (TERT), integrin‐linked kinase (ILK), cyclooxygenase 2 (COX‐2), inducible nitric oxide synthase (iNOS) and the regulatory factors c‐MYB and Tcf‐4 are often found in human cancers including colorectal cancer (CRC) and have been implicated in the development and progression of tumorigenesis. The aim of this study was to determine the expression of these genes in mouse models of sporadic and colitis‐associated CRC. To address these issues, we used qRT‐PCR approach to determine changes in gene expression patterns of neoplastic cells (high‐grade dysplasia/intramucosal carcinoma) and surrounding normal epithelial cells in A/J and ICR mouse strains using laser microdissection. Both strains were injected with azoxymethane and ICR mice were also given drinking water that contained 2% dextran sodium sulphate. In both sporadic (A/J mice) and colitis‐associated (ICR mice) models of CRC, the levels of TERT mRNA, COX‐2 mRNA and Tcf‐4 mRNA were higher in neoplastic cells than in surrounding normal epithelial cells. In contrast, survivin mRNA was upregulated only in neoplastic cells from A/J mice and ILK mRNA was upregulated only in neoplastic cells from ICR mice. However, the expression of iNOS mRNA was similar in normal and neoplastic cells in both models and c‐MYB mRNA was actually downregulated in neoplastic cells compared with normal cells in both models. These findings suggest that the genetic background and/or the molecular mechanisms of tumorigenesis associated with genotoxic insults and colonic inflammation influence the gene expression of mTERT, COX‐2, Tcf‐4, c‐MYB, ILK and survivin in colon epithelial neoplasia.     

Sequential expression of miR‐182 and miR‐503 cooperatively targets FBXW7, contributing to the malignant transformation of colon adenoma to adenocarcinoma

Genetic changes in colon cancer are known to parallel the tissue abnormalities associated with the disease, namely adenoma and adenocarcinoma. The role of microRNA dysregulation in dysplastic progression, however, is not well understood. Here, we show that miR‐182 and miR‐503 undergo sequential up‐regulation and drive the progression of colon adenoma to adenocarcinoma by cooperatively down‐regulating the tumour suppressor FBXW7. We identified that increased expression of miR‐182 is a feature of adenomas. A subsequent increase in miR‐503 expression works cooperatively with miR‐182 to induce transformation of an adenoma to adenocarcinoma. We show that introducing miR‐503 into AAC1 cells, which are derived from a benign adenoma, confers tumourigenic potential. We also demonstrated that blocking both miR‐182 and miR‐503 in HCT116 colon cancer cells resulted in increased FBXW7 expression and significantly reduced tumour size in xenograft models. We confirmed relevance of these results in patients by examining the expression levels of miR‐182 and miR‐503 in over 200 colon cancer patients with 12 year survival outcome data. Decreased patient survival was correlated with elevated expression of both miRNAs, suggesting that elevated levels of both miR‐182 and miR‐503 define a novel prognostic biomarker for colon cancer patients. In conclusion, we show that a sequential expression of miR‐182 and miR‐503 in benign adenoma cooperatively regulates the tumour suppressor FBXW7, contributing to the malignant transformation of colon adenoma to adenocarcinoma and miR‐182 and miR‐503 may prove to be novel therapeutic targets. Array data are available at: http://www.oncomir.umn.edu/ Copyright © 2014 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd     

舌瓣设计的解剖学基础

目的：为外科舌瓣的设计提供解剖学基础。方法：解剖剥制２５具（５０例）成人舌动、静脉标本，制作７例（１４侧）舌血管铸型标本，观察舌动脉和静脉分布的规律性。结果：舌主要由２条舌动脉供血；舌的静脉每侧有５个流向，多数静脉不与动脉伴行。结论：根据需要舌瓣的蒂部可设在舌体周围的多个部位，多数舌瓣由动脉网供血，但每个舌瓣可获得一个自然的静脉引流渠道。     

尺动脉腕上皮支降支小鱼际皮瓣的解剖学基础

目的 为尺动脉腕上皮支降支小鱼际皮瓣修复手掌心皮肤缺损提供临床解剖学基础。 方法　自2018年5月至2019年5月,采用42侧上肢新鲜标本,其中28侧经肱动脉灌注红色乳胶并进行解剖,14侧经肱动脉灌注ABS后制作铸型标本,解剖观察尺动脉腕上皮支降支在小鱼际区的分支、走行、分布、交通和吻合形式,测量其外径。 结果 从豌豆骨到环、小指指蹼间画一连线,并将其分成3等份。结果显示每侧尺动脉腕上皮支降支发出14.5条分支,其中在远、中、近1/3段共发出皮支6.8支,交通支7.7支。各皮支在小鱼际浅筋膜内相互吻合,形成1~2级皮支链,皮支长(1.80±0.60)cm,直径(0.23±0.10)mm。交通支分别与深部的尺动脉掌深支、掌浅弓尺侧缘、尺侧指掌侧总动脉或小指尺掌侧动脉吻合,交通支长(1.60±0.50)cm,直径(0.16±0.06)mm。在近、远1/3段各有1~2支较大的交通支,是转位较理想的血管蒂。 结论 小鱼际皮瓣的尺动脉腕上皮支降支血管蒂位置恒定,皮瓣内皮支链丰富,皮肤结构与手掌心部位同源,是修复手掌心小面积皮肤缺损的较理想的供区之一。     

Coexistence of MACC1 and NM23‐H1 dysregulation and tumor budding promise early prognostic evidence for recurrence risk of early‐stage colon cancer

The tumor‐node‐metastasis (TNM) classification, the presence of a mucinous component, and signet ring cells are well‐known criteria for identifying patients at a high risk for recurrence and determining the therapeutic approach for early‐stage colon cancer (eCC). Nevertheless, recurrence can unexpectedly occur in some eCC cases after surgical resection. The aims of the present study were to evaluate the relation of dysregulated MACC1, c‐MET, and NM23‐H1 expression with the histopathological features of tumors in recurrence formation in eCC cases. A total of 100 sporadic eCC patients without poor prognosis factors were evaluated in this study. The relationship between the altered expression of MACC1, c‐MET, and NM23‐H1 and pathological microenvironmental features, including the presence of tumor budding and desmoplasia, were assessed. The primary outcomes, including 5‐year overall survival (OS) and disease‐free survival (DFS), were also measured. Compared with nonrecurrent patients, the expression level of MACC1 was 8.27‐fold higher, and NM23‐H1 was 11.36‐fold lower in patients with recurrence during the 5‐year follow‐up (p = 0.0345 and p = 0.0301, respectively). In addition, the coexistence of high MACC1 and low NM23‐H1 expression and tumor budding was associated with short OS (p < 0.001). We suggest that the combination of reduced NM23‐H1, induced MACC1, and the presence of tumor budding are promising biomarkers for the prediction of recurrence and may aid the stratification of patients with stage II colon cancer for adjuvant chemotherapy.     

Diversity and Determinants of the Three‐dimensional Anatomical Axis of the Heart as Revealed Using Multidetector‐row Computed Tomography

The location of the heart within the thorax varies significantly between individuals. The resultant diversity of the anatomical cardiac long axis, however, and its determinants, have yet to be systematically investigated. We enrolled 100 consecutive patients undergoing coronary arterial computed tomographic angiography, decomposing the vector of the anatomical cardiac long axis by projecting it to horizontal, frontal, and sagittal planes. The projected vectors on each plane were then converted into three rotation angles using coordinate transformation. We then measured the extent of aortic wedging, using the vertical distance between the inferior margins of the non‐adjacent aortic sinus and the epicardium. We took the aortic root rotation angle to be zero when an “en face” view of the right coronary aortic sinus was obtained in the frontal view, defining leftward rotation to be positive. The mean horizontal, frontal, and sagittal rotation angles were 48.7° ± 9.5°, 52.3° ± 12.0°, and 34.0° ± 11.2°, respectively. The mean extent of aortic wedging, and the aortic root rotation angle, were 42.7 ± 9.8 mm, and 5.3° ± 16.4°. Horizontal rotation of the anatomical axis was associated with leftward and ventral rotation, and vice versa. Multivariate analysis showed aortic root rotation to be associated with horizontal cardiac rotation, while aortic wedging is associated with frontal and sagittal cardiac rotation. We have quantified the marked individual variation observed in the anatomical axis of the living heart, identifying the different mechanisms involved in producing the marked three‐dimensional diversity of the living heart. Anat Rec, 300:1083–1092, 2017. © 2017 Wiley Periodicals, Inc.     

Computer Three‐Dimensional Anatomical Reconstruction of the Human Sinus Node and a Novel Paranodal Area

We have previously shown in rabbit that the pacemaker of the heart (the sinus node) is widespread and matches the wide distribution of the leading pacemaker site within the right atrium. There is, however, uncertainty about the precise location of the pacemaker in human heart, and its spatial relationships with the surrounding right atrial muscle. Therefore, the aim of the current study was to investigate the distribution of the sinus node tissue in a series of healthy human hearts and, for one of the hearts to construct a computer three‐dimensional anatomical model of the sinus node, including the likely orientation of myocytes. A combination of experimental techniques—diffusion tensor magnetic resonance imaging (DT‐MRI), histology, immunohistochemistry, image processing and computer modelling—was used. Our data show that the sinus node was larger than in previous studies and, most importantly, we identified a previously unknown area running alongside the sinus node (the “paranodal area”), which is even more extensive than the sinus node. This area possesses properties of both nodal and atrial tissues and may have a role in pacemaking. For example, it could explain the wide spread distribution of the leading pacemaker site in human right atrium, a phenomenon known as the wandering pacemaker observed in clinics. In summary, a novel 3D anatomical reconstruction presents a new picture of the distribution of nodal cells within the human right atrium. Anat Rec, , 2011. © 2011 Wiley‐Liss, Inc.     

Deciphering the colon cancer genes--report of the InSiGHT-Human Variome Project Workshop, UNESCO, Paris 2010

The Human Variome Project (HVP) has established a pilot program with the International Society for Gastrointestinal Hereditary Tumours (InSiGHT) to compile all inherited variation affecting colon cancer susceptibility genes. An HVP-InSiGHT Workshop was held on May 10, 2010, prior to the HVP Integration and Implementation Meeting at UNESCO in Paris, to review the progress of this pilot program. A wide range of topics were covered, including issues relating to genotype-phenotype data submission to the InSiGHT Colon Cancer Gene Variant Databases (chromium.liacs.nl/LOVD2/colon_cancer/home.php). The meeting also canvassed the recent exciting developments in models to evaluate the pathogenicity of unclassified variants using in silico data, tumor pathology information, and functional assays, and made further plans for the future progress and sustainability of the pilot program.     

High nitric oxide production,secondary to inducible nitric oxide synthase expression,is essential for regulation of the tumour‐initiating properties of colon cancer stem cells

Chronic inflammation is a leading cause of neoplastic transformation in many human cancers and especially in colon cancer (CC), in part due to tumour promotion by nitric oxide (NO) generated at inflammatory sites. It has also been suggested that high NO synthesis, secondary to inducible NO synthase (iNOS) expression, is a distinctive feature of cancer stem cells (CSCs), a small subset of tumour cells with self‐renewal capacity. In this study we explored the contribution of NO to the development of colon CSC features and evaluated potential strategies to treat CC by modulating NO production. Our data show an integral role for endogenous NO and iNOS activity in the biology of colon CSCs. Indeed, colon CSCs with high endogenous NO production (NO^high) displayed higher tumourigenic abilities than NO^low fractions. The blockade of endogenous NO availability, using either a specific iNOS inhibitor or a genetic knock‐down of iNOS, resulted in a significant reduction of colon CSC tumourigenic capacities in vitro and in vivo. Interestingly, analysis of genes altered by iNOS‐directed shRNA showed that the knockdown of iNOS expression was associated with a significant down‐regulation of signalling pathways involved in stemness and tumour progression in colon CSCs. These findings confirm that endogenous NO plays an important role in defining the stemness properties of colon CSCs through cross‐regulation of several cellular signalling pathways. This discovery could shed light on the mechanisms by which NO induces the growth and invasiveness of CC, providing new insights into the link between inflammation and colon tumourigenesis. Copyright © 2015 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.