Table of Content

25 March 2019 Volume 37 Issue 2

  

Anatomical observation of fascial layer of retroperitoneal autonomic nerve associated with rectal cancer surgery

LIANG Zhi-ping, YANG Yong-yu, WU Tian-tong, CHEN Bi-jun, ZHANG Ce

Chinese Journal Of Clinical Anatomy. 2019, 37(2):  121-126.  doi:10.13418/j.issn.1001-165x.2019.02.001

Abstract ( 944 )  

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Objective    To further elucidate the fascial layer of the pelvic autonomic nerve from the view of anatomy and histology.    Methods    The relationship between autonomic nerve and prerenal fascia-presacral fascia was observed in 7 cadavers and 52 patients undergoing laparoscopic rectal cancer surgery. Histological examination was performed on the retroperitoneal tissue between mesentery of descending sigmoid colon and aortic iliac artery, and between the mesorectal and sacral periosteum.    Results   Anatomical observation showed that abdominal aortic plexus, superior hypogastric plexus, hypogastric nerve and inferior hypogastric plexus were located at the posterolateral side of the prerenal fascia-presacral fascia. Histological examination showed that the nerve fibers were located behind the fascia and some of the finer nerve fibers were located in the fascia.    Conclusion    The autonomic nerve is located in the posterolateral part of the prerenal fascia-presacral fascia. Maintaining the integrity of this fascia is the anatomical basis and basic method of preserving autonomic nerve in rectal cancer surgery.

Anatomical measurement and clinical significance of 38 cases of atlas lateral mass nourishment hole

SU Bao-ke, WANG Wei, CAI Yong-qiang, ZHANG Yun-feng, WANG Li-dong, XU Yang-yang，FENG Hui-mei, HE Yu-jie, WANG Hai-yan, LI Zhi-jun, WANG Xing, WANG Zhi-qiang, LI Xiao-he

Chinese Journal Of Clinical Anatomy. 2019, 37(2):  126-129.  doi:10.13418/j.issn.1001-165x.2019.02.002

Abstract ( 1028 )  

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Objective　To observe and measure the clinical anatomical parameters of atlas lateral mass nutrient foramen, so as to provide a reference for the reduction of vascular injury risk by atlas lateral mass screw fixation.　Methods    Thirty-eight normal dry human atlas specimens were randomly selected to observe the shape, number, location and symmetry of the nutrient foramen in the lateral mass of atlas (defined as those with a diameter greater than or equal to 1.0 mm). The maximum transverse diameter, longitudinal diameter, depth, and the distance between the outer edge of the nutrient foramen and the inner edge of the transverse perforation hole were measured.　Results　 In 38 cases, 95% of atlas had nutrient foramen, 42% were round, 8% were transverse ellipse, 45% were longitudinal ellipse, and 5% had no nutrient foramen. About 79% of the sides were symmetrical, and about 16% of the sides were asymmetrical. The maximum transverse diameter of the nutrient foramen was (2.16±0.86) mm, the maximum longitudinal diameter was (2.82±1.03) mm, and the maximum depth of the nutrient foramen was (1.75±0.71) mm. The outer diameter of the nourishing hole was between the inner diameter of the transverse hole. The distance was (8.61±1.46) mm, and there was no significant difference between the left and right sides of each measurement index.  Conclusion　There are nourishing holes on the left and right sides of 95% of the atlas. The position is located in the middle of the lateral mass of the atlas, which is in the channel of the pedicle screw. When atlas is fixed, the diameter of the screw can be referenced is (8.61±1.46) mm. The screw channel is located at the inner edge of the atlas lateral mass (1.73±0.7) mm.

The postoperative clinicopathological characteristic of ground glass opacity localized by Hook-wire

WANG Bin, ZHANG Hao-nan, GAO Wei, ZHANG Wei-hao, XU Yan, XING Wen-ge, SI Tong-guo

Chinese Journal Of Clinical Anatomy. 2019, 37(2):  130-134.  doi:10.13418/j.issn.1001-165x.2019.02.003

Abstract ( 867 )  

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　Objective　To evaluate the relationship between the clinical and imaging features of the postoperative clinicpathological characteristic of ground glass opacity (GGO) localized by Hook-wire.  Methods　Retrospective analysis was made in 83 cases of GGO patients with a diameter less than 2 cm in clinical data, imaging data and postoperative pathology, analysis of imaging findings of pure ground glass opacity (pGGO) and mixed ground glass opacity (mGGO). The relationship between clinical, imaging features and postoperative pathology of GGO was analyzed.　Results　A total of 83 lesions (36 cases of pGGO and 47 cases of mGGO) were successfully localized by Hook-wire with no severe complications. Comparative analysis found that the proportion of patients with invasive adenocarcinoma (IAC) in mGGO was significantly higher than that of pGGO (21.7% vs 7.2%, P=0.004). The proportion of IAC patients with diameter greater than 1 cm in mGGO group was significantly higher than that with diameter less than 1 cm (29.8% vs 8.4%, P=0.003). There was no significant difference in age, gender, location distribution and pathological type.　Conclusion　The proportion of IAC patients in mGGO is significantly higher than that of pGGO. mGGO patients with opacity diameter ≥1.0 cm need to adopt active therapeutic plan.

The classification and clinical application of frontal sinus drainage channel and frontal crypt air chamber in CT imaging

LI Xiao-yuan, YUAN Mei, YOU Qin-qin, AI Shu-yue

Chinese Journal Of Clinical Anatomy. 2019, 37(2):  135-138.  doi:10.13418/j.issn.1001-165x.2019.02.004

Abstract ( 980 )  

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Objective　To understand occurrence of frontal sinus inflammation by investigating the imaging of 64 slice spiral CT on the frontal drainage type and anatomy of frontal recess of the distribution channel.　Methods　The CT images of 1355 cases of nasal sinus were anatomically observed and diagnosed of frontal sinusitis. All of them underwent thin-layer scanning and multi-planar reconstruction. The gasification frontal sinus were classified according to uncinate attachment site: attachment to the orbital wall, sieve plate and skull base were frontal sinus drainage type I, II and III. The anatomical characteristics and variation of the frontal recess air chamber were observed. The frontal recess gas room was classified according to the international frontal sinus anatomy classification ( IFAC ).   Results    A total of 1355 patients, 2582 sides of frontal sinus were gasified. There were 456 cases of frontal sinusitis of them. The incidence of inflammation in type II and III frontal sinus drainage channels was higher. Type I was different with type II and III with statistical significance (P<0.05). There was no significant difference between type II and III（P＞0.05）. The agger nasi cell (ANC) and supra bulla cell (SBC) were “permanent air chambers”. The incidence of inflammation was similar to the average incidence of frontal sinus inflammation. The rest of the types of frontal crypt air chamber had statistical significance for the incidence of frontal sinus inflammation（P<0.05）.   Conclusion  Both the variation of frontal sinus drainage channel and the gasification of frontal sinus recess gas room have important impact on the frontal sinus inflammation. High resolution CT scan and multi-planar reconstruction can clearly reflect the frontal sinus drainage around the channel variation and different type of gas room real anatomy.

Application of three-dimensional CT angiography in the anatomy of the right upper pulmonary veins

LIU Yue-yue, SHI Yi-bing

Chinese Journal Of Clinical Anatomy. 2019, 37(2):  139-141.  doi:10.13418/j.issn.1001-165x.2019.02.005

Abstract ( 1600 )  

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Objective　To study the pulmonary veins of the right upper lobe with multi-slice spiral CT angiography (MSCTA) combined with the post-processing technology of volume rendering (VR).  Methods　Totally 95 patients underwent multi-slice CT pulmonary venography. The right upper vein was displayed with VR technology, then the right upper pulmonary veins was  classified and the segmental veins with the VR technology was studied.　Results　(1)There were a total of 268 venous branches with complex shape in the anterior superior lobes of the right lung, mainly draining the anterior segment of the right upper lobe and the tip of the lung in 95 cases; There were 18 branches in the right lung horizontal fissure, draining the right upper lobe and the right lung mid-lobe. The central vein of the right lung had one branch in 95 cases, which was shaped in the middle of the anterior segment of the right upper lobe and the middle of the apical segment of the right lung. The veins in the upper lobe of the right lung appeared scarce, with a total of 14 branches, and with 5 directly into the left atrium. (2)The pulmonary veins of the right upper lobe were mainly classified as “pre+central vein” type in 81 cases (85.2%), and as“pre+middle+posterior vein” type in 14 cases (14.8%), which were described in the previous literature. The lonely “anterior vein” and “central vein” types were not found in this study.　Conclusion　MSCTA combined with post-processing VR technology can truly visualize the branch form of the right upper lobe vein.

Effect of puerarin on relaxation of mesenteric artery in spontaneously hypertensive rats

WU Yun, XU Yun-fei, He Xi-ju, Zhang Wen-jun, He Yun,Jian Meng-chan,LI Wen-chen

Chinese Journal Of Clinical Anatomy. 2019, 37(2):  142-147.  doi:10.13418/j.issn.1001-165x.2019.02.006

Abstract ( 511 )  

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Objective　To investigate the effect of puerarin on the relaxation of mesenteric artery in spontaneously hypertensive rats.　Methods　20 spontaneously hypertensive rats were randomly divided into 5 groups: hypertension group, captopril group, puerarin low, medium and high dose groups, 4 in each group, and 4 WKY as a normal control group. Body weight and blood pressure were measured before administration and 8 weeks after administration，the content of NO in the serum and the content of ET-1 in the plasma were measured，separation of mesenteric tertiary arteries for HE staining , analysis of wall thickness-to-lumen radius ratios(WT/LR) were performed. The relaxation effect of puerarin on endothelium-intact and endothelium-denuded artery rings were measured by pressure myograph. The effect of puerarin on the relaxation of the arterial ring after endothelium-dependent pathway blockers and endothelium-independent pathway blockers after incubation.　Results　The systolic blood pressure difference and diastolic blood pressure difference in the low, medium and high dose groups of puerarin were significantly lower than the hypertension group. Serum NO content decreased and plasma ET-1 levels increased in the high dose group of puerarin. The WT/LR of the mesenteric tertiary arteries in the middle and high dose group of puerarin decreased. Puerarin had a concentration-dependent relaxation effect on endothelium-intact and endothelium-denuded artery rings, but the endothelium-intact arterial ring diastolic effect was stronger. After incubation with endothelium-dependent pathway blockers and endothelium-independent pathway blockers, the relaxation effect of puerarin was significantly attenuated.　Conclusion　The vasodilating effect of puerarin on the mesenteric artery in spontaneously hypertensive rats is both endothelium-dependent and endothelium-independent. The endothelium-dependent pathway is achieved through the NO-sGC-cGMP signaling pathway and is also associated with the promotion of prostatic release. The endothelium-independent pathway of puerarin may be related to the opening of K+ channels on vascular smooth muscle.

Effect of Puerarin on the expression of MMP-9 protein in spinal cord after brachial plexus root avulsion

CHEN Chuan-qi, CHEN Long-ju, WU Tai-ding, TAN Yun-xia, LI Dan, WANG Yu

Chinese Journal Of Clinical Anatomy. 2019, 37(2):  148-152.  doi:10.13418/j.issn.1001-165x.2019.02.007

Abstract ( 526 )  

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Objective    To investigate the expression changes of matrix metalloproteinase-9 (MMP-9) in spinal cord after brachial plexus root avulsion and the effect of Puerarin on its expression.    Methods    A total of 174 adult male SD rats were randomly divided into a normal group, a model group, Puerarin low, medium and high treatment groups. The model group and the Puerarin treatment groups underwent the right C5~C7 anterior nerve root avulsion. The rats were injected intraperitoneally Puerarin every day after the operation. The expression of MMP-9 protein in C5~C7 segment of spinal cord was detected by Western Blot.  Results  Compared with the normal group, the expression of MMP-9 protein peaked at the 1st day after brachial plexus root avulsion, decreased near to normal at the 3rd day and decreased to a lower level after 1 week. The expression of MMP-9 protein in spinal cord tissue of Puerarin treatment group was significantly lower than the model group at the 1st day.    Conclusion    MMP-9 may be involved in the early injury response to brachial plexus root avulsion, and Puerarin may help to alleviate this injury.

The protective effects of diosgenin on hypoxia-induced endoplasmic reticulum stress injury of rat myocardial cell H9c2

MU Qing, ZHANG Zhi-liang, YANG Sheng

Chinese Journal Of Clinical Anatomy. 2019, 37(2):  153-159.  doi:10.13418/j.issn.1001-165x.2019.02.008

Abstract ( 562 )  

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Objective　To investigate the effects and mechanisms of diosgenin (DG) on hypoxia-induced injury of rat myocardial H9c2 cell.　Methods　Cells were divided into H9c2, DG, Hypoxia and Hypoxia + DG group. Cells were treated with hypoxia for inducing injury, and cells were treated with corresponding concentrations of  DG or solvent. Cell proliferation was measured by CCK8 assay, apoptosis was determined by flow cytometry, the expressions of endoplasmic reticulum stress (ERS)-related proteins (CHOP, cleaved caspase-12, GADD34 and BiP) were determined by western blot. The concentrations of SOD and MDA were also measured. The MI/R rat model was produced, rats were treated with DG intragastrically,recorded heart rate (HR) and mean artery pressure (MAP). The concentrations of serum creatine kinase (CK), SOD and MDA were measured, the tissue injury was determined by HE staining, and the related proteins of ERS was measured by Western blot.   Results  Compared with H9c2 group, the proliferation rate was down-regulated and apoptosis rate was increased in Hypoxia group; compared with the Hypoxia group, proliferation rate was up-regulated and apoptosis rate was decreased in Hypoxia + DG group. Meanwhile, the expression levels of CHOP and Caspase-12 in Hypoxia group were increased compared with the H9c2 group, but the expression levels of GADD34 and BiP were decreased. In addition, hypoxia decreased the concentration of MDA, but increased SOD significantly. DG alleviated the effects of hypoxia. Furthermore, DG enhanced cardiac function of model rats of MI/R, alleviated the injury of myocardial tissue, inhibited the expressions of CHOP and Caspase-12, induced the expressions of GADD34 and BiP, down-regulated the concentration of MDA, and increased SOD in serum of rats. Conclusion  DG attenuates hypocia-induced myocardial cell injury and myocardial injury of model rats of MI/R through inhibiting ERS.

Comparison of the effect and mechanism of transplantation of bone marrow mesenchymal stem cells and cardiac sca1-positive stem cells on myocardial infarction

SUN Qi, SHAN Wei

Chinese Journal Of Clinical Anatomy. 2019, 37(2):  160-164.  doi:10.13418/j.issn.1001-165x.2019.02.009

Abstract ( 562 )  

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　Objective　To investigate the therapeutic effect of bone marrow mesenchymal stem cell (MSCs) and cardiac-derived Sca1 positive stem cell on acute myocardial infarction model in mice.　Methods　Bone marrow mesenchymal stem cells were isolated from the femur bone marrow of adult C57BL/C mice, and Sca1 positive stem cells were harvested from the heart by flow cytometry. Twenty-four male C57BL/C mice were divided into four groups: sham group, control group, bone marrow MSCs treated group and Sca1 positive cells treated group. After anesthesia, the mouse thorax was opened and the left anterior descending coronary artery (LAD) was ligated to establish the acute myocardial infarction model. After successful LAD ligation, cells were injected into the infarcted myocardium. Four weeks later, cardiac ultrasound was used to observe heart function: the left ventricular ejection fraction (LVEF) and left ventricular (LV) end dilated volume. In addition, quantitative PCR was used to evaluate the RNA expression of VEGFa and VEGFb in cultured cells.　Results　The cultured bone marrow MSCs adhered to the dish and showed a spindle shape. The positive rate of Sca1 positive stem cells was about 18 %, and they also adhered to the dish while showed a short shuttle-like shape. Compared with Sca1positive stem cell therapy, MSCs treatment increased the survival rate of mice after myocardial infarction. After 4 weeks of cell transplantation therapy, the LVEF of the bone marrow-derived MSCs treatment group was significantly higher than that of the cardiac-derived Sca1 positive stem cell treatment group, while the LV end dilated volume was lower. The expression of VEGFa and VEGFb was significantly higher in bone-derived MSCs. 　Conclusion　Both bone marrow-derived MSCs and Cardiac-derived Sca1positive stem cells are beneficial to the improvement of cardiac function after infarction, and bone marrow-derived MSCs are superior in improving LVEF and inhibiting enlargement of left ventricular after myocardial infarction in mice, which may be caused by the high expression of VEGF in bone marrow derived MSC.

MicroRNA profiling of medulla oblongata in spontaneous hypertensive rats

WANG Jia-lu, MA Wen-jie, DOU Jian-ping, LI Cai-xia, LIU Ai-jun, LIAO Jia-wan,WANG Jia-you

Chinese Journal Of Clinical Anatomy. 2019, 37(2):  165-168.  doi:10.13418/j.issn.1001-165x.2019.02.010

Abstract ( 557 )  

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Objective　To reveal the microRNA (miRNA) profiling of medulla oblongata in spontaneous hypertensive rat (SHR).　Methods　Spontaneous hypertensive rats were taken as the SHR group, and normal blood pressure SD rats were the control group. Microarray analysis was performed to compare the miRNA expression profiles of medulla between the SHR and control group.　Results　Compared with the control group, the systolic pressure of the tail artery of SHR group increased significantly（P<0.0001）. There were significant differential expression profile in the medulla oblongata miRNAs of SHR group, including 16 miRNAs expression up-regulated and 7 miRNAs expression down-regulated (1.5-fold change cutoff, P<0.05). The qRT-PCR data showed that miR-153, miR-193 and miR-301a were significantly down-regulated in medullas of SHRs, which were consistent with the microarray data. From the miRDB online database, we identified 2775 targets for all differentiated miRNAs (target score was set to≥83). The KEGG pathways for these targets were enriched in 12 pathways, including phosphatidylinositide 3-kinase (PI3K) pathway.    Conclusion    miR-153, miR-193 and miR-301a expression are significantly down-regulated in medulla oblongata of spontaneous hypertensive rats. Bioinformatics analysis suggests that nerve inflammation mediated by PI3K pathway may be the main pathogenic pathway regulated by the differentially expressed miRNAs of  hypertension.

Astragalus polysaccharide inhibits oral squamous cell carcinoma cell line SCC-25 xenograft tumor by suppressing JAK/STAT3 signaling pathway

DENG Li, CAI Ting, WANG Jing-xue, XIA Yu, ZHOU Zhi

Chinese Journal Of Clinical Anatomy. 2019, 37(2):  169-173.  doi:10.13418/j.issn.1001-165x.2019.02.011

Abstract ( 578 )  

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Objective　To elucidate the effect and mechanism of astragalus polysaccharide (AP) on SCC-25 xenograft tumor model mice in oral squamous cell carcinoma (OSCC) cell line.　Methods　The xenograft tumor model was established by subcutaneous injection of oral squamous cell carcinoma cell line SCC-25, and the xenograft tumor BALB/c nude mice models were randomly divided into 4 groups: a control group (cTRL), an AP low-dose group (AP 10 mg), an AP medium-dose group (AP 25 mg) and an AP high-dose group (AP 50 mg) for subsequent experiments. After treatment with AP, the tumor volume and survival rate of mice were measured. The expression of Ki67 and vascular endothelial growth factor (VEGF) were detected by immunohistochemistry. Apoptosis of xenograft tumor cells was detected by TUNEL assay. Protein expression of JAK2/STAT3 pathway members was detected by Western blot.　Results　Compared with the control group, the tumor volume of the low, medium and high-dose groups were decreased significantly (P<0.01), and the survival rate of the mice was increased significantly in AP treated groups (P<0.01). In addition, the expression levels of Ki67 and VEGF were decreased significantly (P<0.01), and the phosphorylation levels of JAK2/STAT3/c-myc were significantly inhibited (P<0.01).　Conclusion　AP inhibits the growth of SCC-25 xenograft tumors in a dose-dependent manner; particularly, AP increases the survival rate of xenograft tumor mice, and down-regulates the expression levels of Ki67 and VEGF and the phosphorylation level of JAK2/STAT3/c-myc. AP may inhibit oral squamous cell line SCC-25 xenograft tumor by inhibiting JAK2/STAT3/c-myc signaling pathway.

The protective effect of carnosine on apoptosis in HBMEC induced by LPS and its mechanism

ZHAO Yan, HU Jing, YANG Wen-qiang, HE Xin, DU Jia-rui, LI Zong-ze, YANG Jing

Chinese Journal Of Clinical Anatomy. 2019, 37(2):  174-178.  doi:10.13418/j.issn.1001-165x.2019.02.012

Abstract ( 528 )  

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Objective　To investigate the protective effect of carnosine on apoptosis in HBMEC induced by LPS and its mechanisms.　Methods　The injury model was established by treating HBMEC cells with LPS in vitro. Inverted microscope was used to observe cell morphology. The cell viability was detected by MTT assay, and the cell apoptosis rates were measured by flow cytometry. The reactive oxygen species (ROS) level in cells was detected by fluorescent probe CDFH-DA. The expressions of NF-κB P65, IL-1β and TNF-α were explored by Western blot.　Results　Compared with control group, the cell viability was slightly decreased in LPS group (P＞0.05). The apoptosis rate, the level of ROS, nuclear NF-κB P65, IL-1β and TNF-α increased obviously (P＜0.01) in LPS group. Compared with LPS group, the apoptosis rate, the level of ROS, nuclear NF-κB P65, IL-1β and TNF-α reduced obviously (P＜0.01) in LPS+carnosine group (10mmol/L,20mmol/L,40 mmol/L).　Conclusions　Carnosine has protective effect on apoptosis of HBMEC cells injury induced by LPS. The mechanism may be related that carnosine inhibited LPS induced ROS production, avoided NF-κB pathway overactivation, and further decreased the secretion of IL-1β and TNF-α.

The absence of the left cephalic vein in the middle and lower part of arm：case report

HUANG Lan, HUANG Jing-ya, CHEN Yu-ji, HUANG Jie-qing, WEI Li

Chinese Journal Of Clinical Anatomy. 2019, 37(2):  178.  doi:10.13418/j.issn.1001-165x.2019.02.028

Abstract ( 595 )  

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Biomechanical analysis in using three different implants for midfoot injury

LI Liang,XU Yong-qing,HE Xiao-qing,LI Chuan

Chinese Journal Of Clinical Anatomy. 2019, 37(2):  179-184.  doi:10.13418/j.issn.1001-165x.2019.02.013

Abstract ( 661 )  

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Objective　To evaluate the stability of new Nickel titanium memory alloy three-corner fixator in treatment of midfoot injury and measure the changes of plantar pressure of the lateral column dislocation by three different implants to provide experimental reference in selecting implants and evaluate the biomechanical properties of those implants．Methods　Six fresh foot specimens were made into the models of the lateral column dislocation，which were fixed with Nickel titanium memory alloy three-corner fixator，the bridge plate and 2mm K-wire in turn. After the loading of 600 N，the changes of the plantar pressure in forefoot were measured by the method of the Tekscan Evolution handle pressure system．During the experiment, axial compression was performed with ElectroForce®3510 series test instruments. The compression stiffness of each bone-fixation combination was calculated and statistically analyzed.   Results   While the tarsometatarsal joint fracture dislocation was fixated by those there different kind of implants, the pressure under the fourth and fifth tarsometatarsal joints would all increased; the peak pressure under the second and third metatarsal head would all decrease, and differences were statistically significant（P＜0.05）．Nickel titanium memory alloy three-corner showed the statistical significant difference compared with the normal state（P>0.05）. There was no statistically significance between the compression stiffness of the three implants before fatigue test. The compression stiffness of K-wire group was decreased with significance.  Conclusion   Nickel titanium memory alloy three-corner fixator would help plantar pressure of the forefoot return to the normal state. The stability of the Nickel titanium memory alloy three-corner fixator is favored to meet the special biomechanical needs, which lays the foundation for its clinical use.

Variations of testicular artery and vein and inferior artery of right suprarenal gland: a case report

ZHANG Da, MA Jian-jun, XU Zi-yue, ZUO Wei-xin, YANG Biao, LI Zhen-qian, YING Yan-min, MA Hui-hui

Chinese Journal Of Clinical Anatomy. 2019, 37(2):  184.  doi:10.13418/j.issn.1001-165x.2019.02.029

Abstract ( 645 )  

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Finite element analysis of the effect of increasing screw cap on internal fixation of tibial fracture in fracture area of steel plate

WU Geng, ZHANG Zhen-wei, ZHANG Mei-chao, LI Zheng

Chinese Journal Of Clinical Anatomy. 2019, 37(2):  185-189.  doi:10.13418/j.issn.1001-165x.2019.02.014

Abstract ( 489 )  

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Objective　To investigate the effect of the placement of the screw cap on the biomechanical properties of the fixed structure in the fracture zone when the fixed tibial fracture was performed.　Methods　Through the CT scan data and 3D image reconstruction, the finite element model of the fixed plate fixation of the comminuted fracture of middle tibia was established by simulated clinical operation. The position of the nail at the 13-hole plate was 1, 2, 4, 5, 9, 10, 12, and 13 holes, and nail holes in the fracture area were 6,7,and 8, and two kinds of plate fixation methods were designed: A (the screw cap placed in the fracture zone) and B (the screw cap not placed in the fracture zone), and model A and model B were tested by 600N compression test and 1000N three-point bending test respectively. The mechanical indexes of each part of the model were calculated and analyzed, and the comparison was made.　Results　In the compression test, the maximum stress of the model A steel plate appeared at the lower end of the steel plate, and the maximum stress of the model B steel plate appeared in the fracture zone. The maximum stress of the model A was significantly smaller than that of the model B. In the three-point bending test, the maximum stress of the two model steel plates appeared in the fracture zone. The maximum stress of model A was significantly smaller than that of model B.　Conclusion　Adding screw cap at the empty screw hole in the fracture zone of the steel plate can significantly reduce the maximum stress of the steel plate and reduce the stress concentration in the fracture zone of the steel plate, thereby reducing the risk of fatigue fracture of the steel plate at the fracture end.

Early diagnosis and treatment for basal ganglia germinomas in children

CHENG Long-fei, WU Jia-ming, ZHANG Mao-ying, XIANG Yong-sheng, WANG Xiang-yu, CHEN Ke-en

Chinese Journal Of Clinical Anatomy. 2019, 37(2):  190-195.  doi:10.13418/j.issn.1001-165x.2019.02.015

Abstract ( 1411 )  

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Objective　To study the early diagnosis and treatment for basal ganglia germinomas in children.　Methods　A total of 21 cases of basal ganglia germinomas (BGG) in children were analyzed according to clinical characteristics, neuroimaging data and tumor markers from November 2006 to January 2017.　Results　BGG was characterized in male adolescents with progressive hemiparesis, intelligent deficiency and high level of serum HCG. The basal ganglia space-occupying lesion oppressed the ventricle with ipsilateral temporal lobe atrophy in brain CT. Tumor parenchyma was shown with isointense or heterogeneous enhancement on MRI T1 weighted images; T2 weighted images showed obvious local occupying effect and the atrophy of temporal lobe with widening of cerebral sulci and cisterns. After diagnostic radiotherapy, the tumor volume reduced obviously, and the patients could be cured completely by further combination of chemotherapy with radiotherapy.　Conclusion　The diagnosis of basal ganglia germinomas should be considered in the male children around 11 years old with progressive hemiparesis, intelligent deficiency, high HCG level of serum or CSF, and the basal ganglia with no obvious boundary space-occupying lesion and the ipsilateral temporal lobe atrophy in neuroimaging. It can be further confirmed by diagnostic radiotherapy and then the patients should receive further chemotherapy with combination of radiotherapy so as to reduce the risk of surgery.

Clinical significance and relationship between the long head of bicep tendon lesions and rotator cuff injury

YI Gang, ZHANG Lei, YANG Jing, GUO Xiao-guang, LIU Yang, QIN Bo, WANG Guo-you, FU Shi-jie

Chinese Journal Of Clinical Anatomy. 2019, 37(2):  196-200.  doi:10.13418/j.issn.1001-165x.2019.02.016

Abstract ( 1698 )  

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Objective　To analyze clinical significance and relationship between the long head of bicep tendon (LHBT) lesions and rotator cuff injury.　Methods　A total of 126 patients with rotator cuff repaired by arthroscopy were analyzed in the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University during 2010~2017. Examination and evaluation of LHBT were performed during the operation. The types of LHBT lesions were recorded and the correlation between the LHBT lesion and the time of rotator cuff tear, the size of the tear and the involvement of the tendon were analyzed.    Results    There were type I lesions of LHBT (tendinitis) 51 cases (40.5%), type II lesion (subluxation) 12 cases (9.5%), type III (total dislocation) 12 cases (9.5%), type IV (partial tear) 15 cases (11.9%), type V (complete rupture) 6 cases (4.8%), remaining 30 cases (23.8%) without obvious pathological changes of LHBT. All patients with chronic rotator cuff tear who had a history of more than 12 weeks were accompanied by LHBT lesions. The patients with the subscapalaris (SSC) injury were more prone to LHBT lesions. And the greater the degree of the tearing of the subscapalaris, the higher the incidence of LHBT lesions；the difference was statistically significant (P<0.05).　Conclusions　The LHBT lesion was closely related to the rotator cuff injury, especially in patients with the tearing of the SSC, which was positively correlated with the size of the tearing of the SSC. When examining rotator cuff injury, especially in the case of combined injury of the SSC, we should pay attention to LHBT to avoid missed diagnosis. Early identification and repair of injured rotator cuff can prevent further deterioration of LHBT lesions.

Minimally invasive treatment of Sanders type Ⅲ calcaneal fractures with mini - plate and internal column screw

ZHANG Xue-quan, LI Hui-jin, XIAO Zhi-qing, XIAO Xin-li, HUANG Chun-xu, ZHANG Huo-lin, ZENG Fen

Chinese Journal Of Clinical Anatomy. 2019, 37(2):  201-205.  doi:10.13418/j.issn.1001-165x.2019.02.017

Abstract ( 790 )  

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Objective　To explore the minimally invasive treatment of Sanders Ⅲ calcaneal fractures with mini-plate and internal column screw.　Methods　The clinical data of 31 cases with Sanders type III calcaneal fracture treated by modified tarsal sinus incision with mini-plate and medial column screw from January 2016 to December 2016 was retrospectively analyzed. Among them, there were 21 males and 10 females, aged 22~43 years, with an average age of 32.4 years. 18 were on the left and 13 on the right. Postoperative complications were counted and differences before and after operation of Bohler's angle, Gissane's angle, calcaneal height and width were compared.  Finally，AOFAS（Ankle and hind foot scoring system）was used to evaluate the clinical efficacy.　Results　All the 31 patients were followed up from 21 to 23.8 months, and the average follow-up time was 22.5 months. All patients achieved bone union, and the mean duration of fracture healing was 5.1 months. At the last follow-up, Bohler angle, Gissane angle, calcaneal height and calcaneal width were significantly different from those before operation (P<0.01). AOFAS score increased from (64.3±1.1) preoperatively to (85.7±3.2) postoperatively, of which 22 were excellent and 5 were good. There were no common complications such as wound infection, skin flap necrosis, peroneal tendon irritation, internal fixation exposure, sural nerve injury and so on.　Conclusions　Modified tarsal sinus incision for Sanders type III calcaneal fracture has the advantage of convenient operation and sufficient exposure of articular surface. Fixation with mini-plate and medial column screw can prevent calcaneal varus and reduce complications after operation.

Clinical effect on the treatment of multi-level lumbar disc herniation with one hole percutaneous endoscopic technique

SUN Jian-lei，CUI Xin-gang

Chinese Journal Of Clinical Anatomy. 2019, 37(2):  206-209.  doi:10.13418/j.issn.1001-165x.2019.02.018

Abstract ( 825 )  

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Objective    To discuss the clinical curative effect and safety on the treatment for multi-level lumbar disc herniation with one hole percutaneous endoscopic technique.    Methods    26 patients，from January 2014 to July 2018，diagnosed as multi-level lumbar disc herniation，were observed. All patients were treated with the one hole percutaneous endoscopic technique under the local anesthesia. The Oswestry disability index (ODI), visual analogue scale (VAS) and NaKai excellent rate preoperative，6 months after surgery and 1year after surgery were used to analyze clinical curative effect and security.   Results   25 patients got NaKai excellent, 1 patient got relapse, and 0 patient inefficacy. Total NaKai excellent rate was 96.2%. VAS score was（6.18±0.28）preoperatively, (3.24±0.46) 3 months after surgery, and（2.64±1.27）6 months after surgery, and (1.44±1.16) 1 year after surgery. The VAS score was significantly lower than the preoperative score from 3 months to 1 year after surgery. The difference was statistically significant. The difference between preoperative and postoperative ODI was statistically significant（P<0.05）. Postoperative lumbar pain and lower limb numbness and pain were alleviated in 26 patients. Intraoperative small incision, less bleeding, short postoperative hospital stay, early time to go to the ground, and quality of life got improved.  Conclusion  Treatment of multi-segment lumbar disc herniation with one hole percutaneous endoscopic technique shares the advantage of being less traumatic, safe and effective, making it worthy of clinical application and promotion.

Clinical application of dorsal cutaneous branch-chain flaps in repairing dorsal skin defects of the finger

LI Chu-yan，ZHU Xiao-di， LI Wen-qing， ZHANG Guo-lei，WANG Wen-sheng，LI Fang

Chinese Journal Of Clinical Anatomy. 2019, 37(2):  210-212.  doi:10.13418/j.issn.1001-165x.2019.02.019

Abstract ( 659 )  

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Objective　To investigate the surgical method and efficacy of dorsal cutaneous branch-chain flaps in repairing dorsal skin defects of the finger.　Methods　Ten cases of dorsal skin defects of the finger were repaired using dorsal cutaneous branch-chain flaps, with a flap area of 1.0 cm×1.5 cm~2.0 cm× 3.0 cm.　Results　Postoperatively, only 1 case presented effusion at the distal epidermis. After drawing out effusions and wound dressing, all flaps survived. Postoperative follow-up was performed for 3~12 months. After flap repair, fingers showed good appearance. Flaps presented good appearance and color, pliability and no bloating, and all finger joints had good activity function.　Conclusion　The dorsal cutaneous branch-chain flap is characterized by stable blood supply, digital artery preservation, convenient design and simple harvest. Therefore, it is a simple and safe ideal method to repair dorsal skin defects of the finger.

Effects of dexmedetomidine combined with ropivacaine on anesthesia and stress response in children

QIAN Xing-hua, ZHU Zhi-rui, HU Zhi-yong

Chinese Journal Of Clinical Anatomy. 2019, 37(2):  213-216.  doi:10.13418/j.issn.1001-165x.2019.02.020

Abstract ( 581 )  

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Objective　To explore the effect of dexmedetomidine combined with ropivacaine on anesthesia in pediatric foreskin surgery and its effect on children's postoperative stress response.　Methods　A total of 98 cases of pediatric foreskin patients admitted to our hospital from August 2016 to August 2017 were selected as subjects of this study, and randomly divided into two groups with 49 cases each. The control group was treated with ropivacaine anesthesia, and the study group was treated with dexmedetomidine combined with ropivacaine for anesthesia. The analgesic effect, onset time, recovery time, postoperative restlessness rate, stress response and adverse reaction symptoms were compared between the two groups. Results　The analgesic effect of the study group was significantly better than that of the control group (P<0.05). Operation time, onset time of anesthesia and postoperative restlessness rate of the study group were significantly lower than those of the control group (P<0.05). Stress indexes such as blood glucose, cortisol and adrenaline concentration in the study group were significantly lower than those in the control group (P<0.05). The adverse reaction rate of the study group was significantly lower than that of the control group (P<0.05). Conclusion　The application of dexmedetomidine combined with ropivacaine in pediatric foreskin surgery can effectively reduce the stress response of children. In terms of analgesia and sedation, it provides a relatively safe and convenient analgesic method with few complications, which should be further promoted in clinical application.

The correlation of the high expression of ETV4 gene with prognosis of patients with ovarian cancer

YU Peng, YANG Yue, LU Jin,LAI Gui-hua, ZHANG Hao-xuan

Chinese Journal Of Clinical Anatomy. 2019, 37(2):  217-222.  doi:10.13418/j.issn.1001-165x.2019.02.021

Abstract ( 1362 )  

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Objective　To investigate the correlation of the high expression of ETS Translocation Variant(ETV4) gene with prognosis of patients with ovarian cancer.   Methods　The expression levels of ETV4 gene in normal human tissue and ovarian cancer tissue, and patients survival were analyzed using the BioGPS database, Oncomine database, Encyclopedia(CCLE) and Kaplan-Meier Plotter database. The relationship between the gene mutation of ETV4 in ovarian cancer and prognosis of patients was analyzed using the cBioPortal database.　Results   The analysis results of BioGPS database showed that the expression of ETV4 gene was low in normal ovarian tissue. Among 340 items searched from Oncomine database, 32 items showed that the expression levels of ETV4 increased, and 2 items showed that the expression levels of ETV4 decreased. Meta-analysis of two studies showed that the ETV4 gene was highly expressed in ovarian cancer tissues (P<0.05). CCLE analysis showed that the ETV4 gene was highly expressed in ovarian cancer cells. Kaplan-Meier Plotter database showed that the Overall Survival (OS) and Disease Free Survival (DFS) in ovarian cancer patients with high expression levels of ETV4 gene were significantly prolonged compared with ovarian cancer patients with low expression levels of ETV4 gene (P<0.05). The results of the cBioPortal database showed that the gene mutation rate of ETV4 in ovarian cancer was 2.5%, which had no significant effect on OS and DFS in patients with ovarian cancer (P>0.05).　Conclusions　The ETV4 gene is highly expressed in ovarian cancer tissue, which  has a significant prolongation of OS and DFS in patients with ovarian cancer, and can be used as a candidate for assessment of clinical prognosis of patients ovarian cancer. The mutation of ETV4 gene has no significant effects on the OS and DFS of ovarian cancer patients.

Establishment of acquired tracheoesophageal fistula by ultra-minimally invasive magnetic compression technique in rabbits

GAO Hui-min1,2,3, QIU Ming-long2,3, ZHANGg Yan-chao2,3, LIU Hao2,3, MA Si-jie2,3, FU Shan 2,3, LV Yi1,2, YAN Xiao-peng1,2

Chinese Journal Of Clinical Anatomy. 2019, 37(2):  223-227.  doi:10.13418/j.issn.1001-165x.2019.02.022

Abstract ( 628 )  

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Objective　To explore the feasibility of establishing ultra-invasive magnetic compression technology to establish a rabbit model of tracheal esophageal fistula(TEF).　Methods　Ten New Zealand rabbits were anesthetized and inserted into the parent magnet and daughter magnet in the cervical trachea and esophagus, respectively. X-ray was taken the following day to observe the location of the mother and daughter magnets. When the parent and daughter magnets were found to be out of the original position and entered the digestive tract, the animals were sacrificed three days later. The general specimens of tracheal esophagus were taken, and the tissue of the fistula was taken for HE and Masson staining for pathological observation.　Results　The average operation time of magnetic compression ultra-invasive technique to establish a TEF was (3.20 ± 0.81) min.  (6.90 ± 1.14) d after operation the magnets fell into the digestive tract, while TEF formatted. There was a slight adhesion between the tracheal membrane and the anterior wall of the esophagus, and the tissue around the fistula was observed. Histopathological observation showed that the stenosis was connected to the anterior wall of the esophagus, which was closely related to the pathological features of the clinically acquired tracheoesophageal fistula.　Conclusions　Establishment of rabbit TEF using magnetic compression ultra-minimally invasive technology is a simple, minimally invasive, and feasible method for animal model of TEF. It can be used as an ideal animal modeling method for obtaining TEF.

Research progress on facial fat compartments

YUAN Rong,LUO Sheng-kang

Chinese Journal Of Clinical Anatomy. 2019, 37(2):  228-230.  doi:10.13418/j.issn.1001-165x.2019.02.023

Abstract ( 501 )  

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Anatomy and clinical application of the cavenous sinus segment of the intarnal corotid artery

ZENG Xing, HUANG Li-zhen, JIANG Ying, ZUO Chan, ZHANG Hui

Chinese Journal Of Clinical Anatomy. 2019, 37(2):  231-233.  doi:10.13418/j.issn.1001-165x.2019.02.024

Abstract ( 1118 )  

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Advances in clinical research on the anterolateral ligament of knee

YU Qiu-jin, RAN Hai-tao，NIE Mao

Chinese Journal Of Clinical Anatomy. 2019, 37(2):  234-235.  doi:10.13418/j.issn.1001-165x.2019.02.025

Abstract ( 572 )  

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Improve the rate of tumor treatment by promoting the regulated cell death

YANG Song-hua，SHI Ying-rui

Chinese Journal Of Clinical Anatomy. 2019, 37(2):  236-238.  doi:10.13418/j.issn.1001-165x.2019.02.026

Abstract ( 621 )  

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Prenatal ultrasound diagnosis of bilateral infant polycystic kidney：report of one case

ZENG He，AN Peng，ZHANG Jia-qi，FENG Wei，WANG Qi-ran，WANG Yu

Chinese Journal Of Clinical Anatomy. 2019, 37(2):  239.  doi:10.13418/j.issn.1001-165x.2019.02.027

Abstract ( 528 )  

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