Does the use of pretreatment MRI change the management of patients with newly diagnosed breast cancer?

Breast MRI plays a critical role in the diagnosis and management of breast cancer. The purpose of this study is to evaluate the effect of preoperative breast MRI on the management of a large cohort of breast cancer patients at our institution. This study is a retrospective chart review of all newly diagnosed breast cancer patients who underwent preoperative breast MRI at our institution between January 1, 2004 and December 31, 2009. 1352 patients comprised the study population. 241 (17.8%) patients underwent a change in surgical management as a result of preoperative MRI. Patients with tumors in the lower inner quadrant and the central breast and those with pathology of invasive lobular carcinoma were significantly more likely to have their management changed by preoperative MRI. There was also a significant trend for larger tumors to be associated with a change in surgical management. No statistically significant association was found between breast density and change in management. This study supports the recommendation for the use of preoperative breast MRI in the majority of newly diagnosed breast cancer patients, especially those with larger tumors, pathology of invasive lobular carcinoma, and tumors in the lower inner quadrant. Preoperative breast MRI is a useful tool for the evaluation of additional disease that led to a change in the surgical management of 17.8% of patients.     

Intrasellar cavernous hemangioma.

Reports of intrasellar cavernous hemangioma are rare. They are usually incidental findings at autopsy, or initially mistaken for pituitary adenoma and treated accordingly. There are no specific symptoms. Cranial nerve palsy has occasionally been reported in patients with cavernous hemangioma, with or without sellar extension. However, intrasellar cavernous hemangioma with extension into the cavernous sinus resulting in oculomotor palsy has not been reported. We present a rare case of intrasellar cavernous hemangioma and discuss the diagnosis and management. Total surgical removal is recommended. However, attempts to resect the parasellar component of the lesion may be associated with high morbidity. Therefore, surgical cranial nerve decompression in the acute stage followed by stereotactic radiosurgery for the residual lesion may be an alternative.     

Endovascular treatment of a huge cervical carotid artery pseudoaneurysm with Wallgraft prosthesis

Traumatic pseudoaneurysm of the internal carotid artery (ICA) is a rare cause of epistaxis, which may be life-threatening if left untreated. We report the case of a massive epistaxis from left ICA pseudoaneurysm. Our patient was a 38 year-old man with the history of a severe traffic accident 13 years ago. The pseudoaneurysm was treated with the placement of a Wallgraft prosthesis inside the carotid artery. After the endovascular treatment, the left ICA remained patent and no recurrent hemorrhage was noted in the 1 year follow up after the procedure.     

应用扩张后皮瓣修复乳房下部瘢痕

目的 探寻乳房下部瘢痕挛缩的较佳治疗方法. 方法 对2000年7月-2007年7月笔者单位收治的9例乳房下部瘢痕挛缩女性患者,行乳房周围皮肤扩张术.扩张器埋置切口多选择在乳房下部瘢痕处,置入部位以乳房周围侧胸部、胸部中央剑突附近为佳,且侧胸部置入时尽量使扩张器位置向上,与乳房上级水平齐平.扩张器埋置层次在深筋膜下及腺体表面.Ⅱ期充分松解挛缩的瘢痕,使腺体及乳房恢复正常解剖位置,将扩张后皮瓣设计成直接推进或易位皮瓣修复缺损,或直接拉拢缝合封闭创面. 结果 除1例患者皮瓣尖端4.0 cm×3.0 cm范围发生血运障碍,经植皮后创面愈合外,其余8例皮瓣均成活,创面愈合;所有患者乳晕、乳头均恢复正常解剖位置.其中3例6个月～2年后复诊,效果满意. 结论 应用扩张后皮瓣修复乳房下部瘢痕挛缩,效果良好.     

应用扩张额部皮瓣修复下睑区缺损

目的探讨下睑区病损的修复方法。方法应用扩张额部皮瓣修复下睑区缺损或病损切除后创面,可采用滑车上血管或颞浅动脉额支为蒂。选择滑车上血管为蒂,以对侧为佳,切口选择在头皮内,使扩张器向一侧倾斜;如以颞浅动脉额支为蒂,切口同样在头皮内,使扩张器长轴平行于额部。扩张充分后,先将下睑病损切除、松解,使下睑恢复到正常解剖位置,据缺损大小设计皮瓣。如以滑车上血管为蒂,采用带蒂转移,3周后断蒂;如以颞浅动脉额支为蒂,采用皮下蒂转移,供区拉拢缝合。结果共10例,6例以滑车上血管为蒂,4例以颞浅动脉额支为蒂,皮瓣均成活,3例6个月后复诊,效果满意。结论应用扩张额部皮瓣修复下睑病损,可以避免眼睑外翻,是目前较好的方法。     

Mechanical Stimulation by Ultrasound Enhances Chondrogenic Differentiation of Mesenchymal Stem Cells in a Fibrin‐Hyaluronic Acid Hydrogel

Chondrogenic differentiation and cartilage tissue formation derived from stem cells are highly dependent on both biological and mechanical factors. This study investigated whether or not fibrin‐hyaluronic acid (HA) coupled with low‐intensity ultrasound (LIUS), a mechanical stimulation, produces an additive or synergistic effect on the chondrogenesis of rabbit mesenchymal stem cells (MSCs) derived from bone marrow. For the purpose of comparison, rabbit MSCs were first cultured in fibrin‐HA or alginate hydrogels, and then subjected to chondrogenic differentiation in chondrogenic‐defined medium for 4 weeks in the presence of either transforming growth factor‐beta3 (TGF‐β3) (10 ng/mL) or LIUS treatment (1.0 MHz and 200 mW/cm²). The resulting samples were evaluated at 1 and 4 weeks by histological observation, chemical assays, and mechanical analysis. The fibrin‐HA hydrogel was found to be more efficient than alginate in promoting chondrogenesis of the MSCs by producing a larger amount of sulfated glycosaminoglycans (GAGs) and collagen, and engineered constructs made with the hydrogel demonstrated higher mechanical strength. At 4 weeks of tissue culture, the chondrogenesis of the MSCs in fibrin‐HA were shown to be further enhanced by treatment with LIUS, as observed by analyses for the amounts of GAGs and collagen, and mechanical strength testing. In contrast, TGF‐β3, a well‐known chondrogenic inducer, showed a marginal additive effect in the amount of collagen only. These results revealed that LIUS further enhanced chondrogenesis of the MSCs cultured in fibrin‐HA, in vitro, and suggested that the combination of fibrin‐HA and LIUS is a useful tool in constructing high‐quality cartilage tissues from MSCs.     

纳米二氧化钛与葡萄糖亚慢性联合经口暴露对幼年大鼠血清叶酸和维生素B12水平的影响

目的 探讨纳米二氧化钛与葡萄糖亚慢性联合暴露对幼年大鼠血清叶酸和维生素B₁₂的影响。方法 对实验所用纳米二氧化钛的粒径、形状、晶型和溶液体系中的团聚程度等物理化学性质进行详细表征。80只4周龄清洁级SD大鼠按体质量随机分为8组(每组10只,雌雄各半)。每天灌胃给予0、2、10、50 mg/kg纳米二氧化钛,分别加或不加1.8 g/kg葡萄糖。染毒90 d后进行血清叶酸和维生素B₁₂含量检测。结果 纳米二氧化钛晶型为锐钛矿,近球形,平均粒径为(24±5) nm。在雄性幼年大鼠中,与对照组相比,纳米二氧化钛(10 mg/kg)加葡萄糖染毒可导致血清叶酸浓度明显增加,差异具有统计学意义(P<0.05)。在雌性和雄性幼年大鼠中,与单纯葡萄糖(1.8 g/kg)染毒组相比,高剂量纳米二氧化钛(50 mg/kg)加葡萄糖可导致血清叶酸浓度明显降低,差异具有统计学意义(P<0.05)。经过联合作用分析,纳米二氧化钛与葡萄糖联合暴露对雌性幼年SD大鼠血清叶酸浓度的影响存在明显拮抗作用。纳米二氧化钛与葡萄糖联合暴露对幼年SD大鼠血清维生素B₁₂浓度的影响较小,未见明显交互作用。仅发现与单纯葡萄糖(1.8 g/kg)染毒组相比,雄性大鼠低剂量(2 mg/kg)纳米二氧化钛加葡萄糖染毒组血清维生素B₁₂浓度明显上升,差异具有统计学意义(P<0.05)。结论 纳米二氧化钛和葡萄糖亚慢性联合经口暴露可以对幼年SD大鼠血清叶酸浓度产生影响,两者存在拮抗作用。     

组织工程人工血管支架的预构

目的：探讨具有血管平滑肌细胞（vascular smooth muscle cells,VSMCs）活性的组织工程人工血管支架的构建方法。方法：①将聚羟基乙酸（polyglycolic acid,PGA）纤维无纺网支架材料、血管平滑肌细胞和胶原纤维相混合，构建组织工程血管。②将VSMCs置入胶原凝胶中，观察VSMCs的生长状况。③观察VSMCs胶原悬液滴入该支架材料中的生长。结果：①VSMCs在胶原凝胶中的位置固定，分布于不同层次，约3－4h逐渐形成多个胞质突起。随时间推移，胞质突起继续伸展，部分细胞呈梭形、纺锤形。②VSMCs胶原悬液滴入胶原包埋处理的PGA支架中后，大部分细胞随胶原凝胶状态的形成，滞留于支架材料网孔中，细胞可沿PGA纤维表面生长。结论：胶原包埋处理的PGA纤维无纺网是良好的携带VSMCs的多孔生物降解材料。     

常德职院新生形态发育和营养状况分析

目的了解本校专科2006级新生主要形态发育指标及其营养现状。方法以整群抽样法抽取1184名学生，测量身高、体重，计算克托菜指数、体重指数（BMI）和劳雷尔指数，并用BMI法对大学新生营养状况进行分析。结果被调查的学生66．72％营养正常；29．22％体重偏低；3．63％超重；0．42％肥胖：女生的体重偏低率略高于男生，而体重正常率、超重肥胖率低于男生。结论我校2006级新生体型以消瘦和正常为主，肥胖体型少。男女生营养状况差异显著，农村学生与城市学生的身高体重和营养状况无统计学意义。