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ABSTRACT: ObjectLiliequist’s membrane (LM) is an important arachnoid structure in the basal cisterns. The relevant anatomic descriptions of
this membrane and how many leaves it has are still controversial. The existing anatomical theories do not satisfy the needs
of minimally invasive neurosurgery. We aimed to establish the three-dimensional configuration of LM.
MethodsFifteen adult formalin-fixed cadaver heads were dissected under a surgical microscope to carefully observe the arachnoid mater
in the suprasellar and post-sellar areas and to investigate the arachnoid structure and its surrounding attachments.
ResultsIt was found that the LM actually consists of three types of membranes. The diencephalic membrane (DM) was usually attached
by the mesencephalic membrane (MM) from underneath, and above DM it was usually a pair of hypothalamic membranes (HMs) extending
superomedially. The pair of HMs was stretched between the DM (or MM) and the hypothalamus and were seldom attached to the
carotid–chiasmatic walls between the carotid cistern and the chiasmatic cistern. These three types of membranes (DM, MM, and
HM) comprised the main arachnoid structure in the anterior incisural space and often presented as four connected leaves. However,
only two thirds of the specimens had all three types of membranes, and there was considerable variation in the characteristics
and shapes of the membranes among the specimens.
ConclusionAll three types of membranes comprising LM serve as important anatomical landmarks and interfaces for surgical procedures
in this area.
KeywordsLiliequist’s membrane–Microanatomy–Subarachnoid cistern–Neurosurgery
Acta Neurochirurgica 04/2012; 153(1):191-200. · 1.52 Impact Factor
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ABSTRACT: Various reconstructive methods have been reported for coverage of soft-tissue defects around the knee; however, there is still no report about the pedicled vastus medialis perforator flap; hence, this article aims to elaborate on this approach for resurfacing of defects around the knee. From January 2010 to December 2010, six patients with defect size ranging from 5.0 × 3.3 to 10.5 × 7.0 cm received soft-tissue coverage with the pedicled vastus medialis perforator flap. Among them, five cases were male, and the other female. The age of patients ranged from 20 to 52 years, with an average of 34.5 years. The injury of one patient was caused by being crushed by a heavy metal object, and the rest sustained injuries in traffic accidents. The defect in one case was located at the inferomedial aspect of the thigh, and the rest around the knee. Five flaps survived completely, while one case suffered marginal necrosis due to infection. The donor sites healed without complication. Postoperative follow-ups of the patients ranged from 1 to 18 months. Through the article, we demonstrate the feasibility of using the pedicled vastus medialis perforator flap for reconstruction of knee injuries, which makes the knowledge of the vastus medialis-related flap series more complete and also enriches the methods of repairing defects around the knee.
Journal of Plastic Reconstructive & Aesthetic Surgery 04/2012; 65(9):1151-7. · 1.49 Impact Factor
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ABSTRACT: There have been limited data on molecular epidemiology of syphilis in China. This study aimed to analyze strain type distribution of Treponema pallidum causing early syphilis across geographic areas in China using an enhanced method.
Genital samples were collected from patients in East, South, and North China. Positive DNA of T. pallidum was analyzed by arp, tpr, and tp0548 genes.
Sufficient DNA for full molecular typing existed in 197 of 324 samples, and 27 strain types were identified. A range of 3 to 20 repeats (except 4, 11, and 19 repeats) and 25 repeats were found for the 60-bp tandem repeats of the arp gene. This was the first time the 9 and 25 repeats were detected. For the RFLP analysis of the tpr genes, patterns a, d, h, j, and l were identified. This was the first time the h, j, and l patterns were observed in China. For the sequence analysis of the tp0548 gene, sequences c, e, and f were identified. Strain type distribution was significantly different across geographic areas (χ² = 20.6, P = 0.006). Overall, 14d/f was most predominant (39% of fully typed samples, 95% CI = 32%-46%); 13d/f, 15d/f, and 16d/f were next most common (each 13% of fully typed samples, 95% CI = 9%-18%).
There is substantial genetic diversity of T. pallidum in China. The broad and ununiform distribution of strain types may reflect differences in regional sexual network patterns. Predominance of few strain types may indicate a linked transmission.
Sexually transmitted diseases 01/2012; 39(1):42-5. · 2.58 Impact Factor
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ABSTRACT: Detailed knowledge of the vasculature of the medial aspect of the foot has rarely been reported, but it is of tremendous importance for harvesting the flap in this area to cover defects of the foot and hand. Repair of soft-tissue defects at the dorsal forefoot remains a challenge in reconstructive surgery. The authors describe the use of the distally based saphenous neurovenofasciocutaneous flap at the medial aspect of the foot to cover this region.
This study was divided into two parts: an anatomical study and clinical application. In the anatomical study, 35 cadaveric feet were injected with red gelatin, five others were made as corrosive vascular casts, and then the main vessels distributed at the medial aspect of the foot were observed. Clinically, six cases of soft-tissue defects at the dorsal forefoot were reconstructed with distally based saphenous neurovenofasciocutaneous flaps.
The anatomical study showed that (1) the vasculature pattern could roughly be classified into three types and (2) there were constant anastomoses between the above-mentioned arteries around the midpoint of the first metatarsal bone. In terms of clinical application, all flaps completely survived, and one patient had partial loss of skin graft.
The blood supply to the medial aspect of the foot has multiple origins, on the basis of which of several flaps can be harvested, either a pedicled or free. Of particular clinical significance is the distally based saphenous neurovenofasciocutaneous flap, which is thin, is in the immediate vicinity of the forefoot, and has a reliable retrograde blood supply. This flap should be considered as a preferential way to reconstruct soft-tissue defects of the dorsal forefoot.
Plastic and reconstructive surgery 05/2011; 127(5):1967-78. · 2.74 Impact Factor
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Joseph D Tucker,
Li-Gang Yang,
Bin Yang, He-Ping Zheng,
Helena Chang,
Cheng Wang,
Song-Ying Shen,
Zheng-Jun Zhu,
Yue-Pin Yin,
S V Subramanian,
Xiang-Sheng Chen,
Myron S Cohen
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ABSTRACT: HIV testing is still stigmatized among many high-risk groups in China, whereas routine syphilis testing has been widely accepted at sexually transmitted infection (STI) clinics. This project used the platform of a rapid syphilis screening test to expand HIV test uptake. The objective of this study was to use multilevel modeling to analyze determinants of syphilis and HIV-testing uptake at STI clinics in China.
2061 STI patients at 6 clinics in Guangdong Province were offered free rapid syphilis and free rapid HIV testing. Test uptake was defined by patient receipt of results and a multilevel model was used to analyze predictors of uptake.
This was the first syphilis or HIV test for the large majority (1388, 77.7%) of participants. Syphilis test uptake and HIV test uptake were high (1681, 81.6%, syphilis test uptake; 1673, 81.2% HIV test uptake). HIV test uptake was significantly concordant with syphilis test uptake (τb = 0.89, P < 0.001). The most parsimonious model of refusing HIV test uptake included the following variables: being married, having a previous HIV test, being unaccompanied, and participating in the last 2 months of the study.
STI clinic-based screening for syphilis and HIV represents an excellent opportunity for scaling up integrated services, especially in South China where syphilis and sexually transmitted HIV cases are both rapidly increasing. Effective integration of HIV testing into routine clinical practice requires an understanding not only of individual test uptake but also of the broader social context of HIV testing.
JAIDS Journal of Acquired Immune Deficiency Syndromes 04/2011; 57(5):e106-11. · 4.43 Impact Factor
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ABSTRACT: We have developed a high-resolution melting analysis (HRMA) for the genotyping of Chlamydia trachomatis and applied it specifically to the 11 sexually transmitted infection-related genotypes: D through K and L1 through L3. The variable segment 2 (VS2) was selected as the target for HRMA genotype identification. Eleven C. trachomatis genotypes were amplified by a nested real-time polymerase chain reaction (PCR) in the presence of the LCGreen saturating dye and showed no cross-reaction with 10 pathogenic bacteria or commensals from urogenital tract. The detection limit of HRMA method was 100 elementary bodies (EB)/mL. All of the 11 genotypes can be distinguished from each other by following an HRMA workflow. Genotype F, G, H, I, J, K, L2, and L3 could be directly identified from each other, whereas D, E, and L1 could be distinguished from each other by a second analysis with fewer curves or by heteroduplex formation with a known reference strain. In the validation panel of 36 C. trachomatis-positive urogenital samples genotyped by VS1-VS2 sequencing, nested real-time VS2 PCR followed by HRMA was able to discriminate between all samples correctly. This assay requires no fluorescence-labeled probes or separate post-PCR analysis and provides a simple and rapid approach for genotyping the C. trachomatis strains that are the most commonly sexually transmitted.
Diagnostic microbiology and infectious disease 10/2010; 68(4):366-74. · 2.45 Impact Factor
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ABSTRACT: Microanatomical dissection was performed on 14 formalin-fixed human cadaveric head specimens to provide information relevant for surgical procedures involving the cistern of the lamina terminalis (LT). The cistern of the LT was located in the midline of the telencephalon and was tent-shaped. The superior wall was located between the septal areas bilaterally, the lateral walls leaned laterally downwards, the anterior wall was the integrated line of the bilateral leptomeninges, the posterior and the inferoposterior walls were composed of the LT, the inferior margin was the arachnoid membrane between the optic nerves, and the inferoanterior wall usually formed a recess in front of the optic chiasm. In summary, the shape of the cistern of the LT is relatively constant, which is helpful for predicting the direction of hemorrhage of an aneurysm of the anterior communicating artery; in distinguishing its neural, vascular, and fibrous contents; and guiding surgical procedures.
Journal of Clinical Neuroscience 10/2010; 18(2):253-9. · 1.25 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Liliequist's membrane (LM) is an important arachnoid structure in the basal cisterns. The relevant anatomic descriptions of this membrane and how many leaves it has are still controversial. The existing anatomical theories do not satisfy the needs of minimally invasive neurosurgery. We aimed to establish the three-dimensional configuration of LM.
Fifteen adult formalin-fixed cadaver heads were dissected under a surgical microscope to carefully observe the arachnoid mater in the suprasellar and post-sellar areas and to investigate the arachnoid structure and its surrounding attachments.
It was found that the LM actually consists of three types of membranes. The diencephalic membrane (DM) was usually attached by the mesencephalic membrane (MM) from underneath, and above DM it was usually a pair of hypothalamic membranes (HMs) extending superomedially. The pair of HMs was stretched between the DM (or MM) and the hypothalamus and were seldom attached to the carotid-chiasmatic walls between the carotid cistern and the chiasmatic cistern. These three types of membranes (DM, MM, and HM) comprised the main arachnoid structure in the anterior incisural space and often presented as four connected leaves. However, only two thirds of the specimens had all three types of membranes, and there was considerable variation in the characteristics and shapes of the membranes among the specimens.
All three types of membranes comprising LM serve as important anatomical landmarks and interfaces for surgical procedures in this area.
Acta Neurochirurgica 10/2010; 153(1):191-200. · 1.52 Impact Factor
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ABSTRACT: This study was designed to determine the prevalence and distribution of Chlamydia trachomatis genotypes from clinical specimens in Guangzhou, China, obtained in the period 2005-2008. One hundred and ninety-four urogenital C. trachomatis samples were collected from sexually transmitted disease clinic patients, and the VS1-VS2 of OmpA gene was amplified by nested PCR and sequenced using an ABI-prism 3730 sequencer. Clinical C. trachomatis strains were genotyped and analyzed for a mutation with respect to the reference VS1-VS2 sequence. VS1-VS2 fragments with 453 bp were amplified from 194 clinical samples. Upon alignment with the sequences of the reference strains, 189 strains with discernible sequences were typed into 9 genotypes, while 5 with ambiguous sequences were considered to be mixed-serovar samples. The most prevalent genotypes were E (50, 26%), F (46, 24%), J (35, 19%), and D (24, 13%). There was no significant difference in the distribution of any of the genotypes detected during the study period, except for genotype K (P<0.01). A total of 16 (8%, 16/189) genetic variants of the OmpA VS1-VS2 of the reference strains were identified. Mutations occurred frequently for genotypes D (2/24, 8%), E (6/50, 12%), F (2/46, 4%), G (1/8, 13%), H (1/12, 8%), and K (4/11, 36%), with most of these being sense mutations that may result in amino acid substitution. Sequencing the OmpA VS1-VS2 enabled the genotype and sequence variations within each genotype to be analyzed. Genotypes E, F, J, and D continued to dominate among urogenital C. trachomatis, whereas genotype K increased significantly in Guangzhou between 2005 and 2008.
Japanese journal of infectious diseases. 09/2010; 63(5):342-5.
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ABSTRACT: To present a case series of patients with isolated posterior coronal fractures of lateral tibial plateau treated by direct exposure and buttress plate fixation through posterolateral approach.
Between May 2007 and April of 2008, eight middle aged patients were identified that had isolated posterior coronal fractures of the lateral tibial plateau. All eight patients underwent direct fracture exposure, reduction under visualization, and buttress plate fixation through posterolateral approach.
There were 1 case of split, two cases of pure depression and five cases of split-depression fractures. Four were associated fibular head split fractures without common peroneal nerve injuries. Five patients were injured from a simple fall on riding electrical bicycle while the knee was relaxed in 90 degrees position The articular displacement (8 cases) measured in CT scan was 10.5 mm in average (range 8-15 mm). The cortical split length (from the articular rim to the distal tip, 6 cases) was 2.8 cm in average (range 2.4-3.5 cm). The articular reduction was perfect in seven (absolutely no step-off) and imperfect in 1(<2 mm step-off) as measured by X-ray. With a mean follow-up of 10 months (6 cases > 12 months), the average range of motion arc was 119 degrees , four patients have flexion lag 10 degrees -20 degrees . The average SMFA dysfunction score was 15.8, and average HSS score was 98. All eight patients stated they were highly satisfied.
Direct posterolateral approach by dividing lateral border of soleus muscle, provides excellent fracture reduction under visualization and internal buttress plate fixation for posterior coronal fracture of the lateral tibial plateau. Good functional results and recovery can be expected.
Archives of Orthopaedic and Trauma Surgery 02/2009; 129(7):955-62. · 1.37 Impact Factor
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ABSTRACT: All surgical approaches to the anterior skull base involve the olfactory cistern and have the risk of damaging the olfactory nerve. The purpose of this study was to describe the microanatomical features of the olfactory cistern and discuss its surgical relevance. In this study, the olfactory cisterns of 15 formalin-fixed adult cadaveric heads were dissected using a surgical microscope. The results showed that the olfactory cistern was situated in the superficial part of the olfactory sulcus, which separated the gyrus retus from the orbital gyrus. In coronal section, the cistern was triangular in shape; its anterior part enveloped the olfactory bulbs and was high and broad; its posterior part was medial-superior to internal carotid artery and was also much broader. There were one or several openings in the inferior wall of the posterior part in 53.4% of the cisterns. The olfactory cistern communicated with the surrounding subarachnoind cisterns through these openings. The middle part of the olfactory cistern gradually narrowed down posteriorly. Most cisterns were spacious with a few fibrous trabeculas and bands between the olfactory nerves and cistern walls. However 23% of the cisterns were narrow with the cistern walls tightly encasing the olfactory nerve. There were two or three of arterial loops in each olfactory sulcus, from which long, fine olfactory arteries originated. The olfactory arteries coursed along the olfactory nerve and gave off many terminal branches to provide the main blood supply to the olfactory nerve in most cisterns, but the blood supply was in segmental style in a few cisterns. Moreover, the veins of the cistern appeared to be more segmental than the olfactory arteries in most cisterns. These results suggested that most olfactory cisterns are spacious with relatively independent blood supply, and it is reasonable to separate the olfactory tract with its independent blood supply from the frontal lobe by 1-2 cm in the subfrontal approach, the pterional approach, or anterior interhemispheric approach. However, in the minority of cases, separation of the olfactory tract is not safe because of the anterior origin of the olfactory arteries or segmental blood supply. It is difficult to separate the olfactory nerve without any damage to the olfactory nerve, even with very skilled hands.
Microsurgery 02/2008; 28(1):65-70. · 1.61 Impact Factor
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ABSTRACT: An oligonucleotide array technology was established for rapidly detecting and genotyping Chlamydia trachomatis in urogenital infections. The VS1-VS2 region of the omp1 gene was used to design oligonucleotide probes. Eleven serovar-specific probes to serovars A, B, C, D, E, F, G, H, I, J, and K, and 3 group-specific probes to group B (B, Ba, D, E, L1, and L2), group C (A, C, H, I, J, K, and L3), and an intermediate group (F and G) were synthesized and spotted onto the nylon membrane. Two pairs of universal primers were designed for the nested polymerase chain reaction (PCR) amplification of the VS1-VS2 gene. Digoxigenin-labeled amplicons of the VS1-VS2 gene of C. trachomatis were hybridized to the membrane array. Hybridization signals were read by the nitroblue tetrazolium/5-bromo-4-chloro-3-indolylphosphate color development. The assay developed was tested with reference strains of C. trachomatis serovars and clinical samples. The sensitivity was evaluated for 57 samples previously found to be positive for C. trachomatis by using plasmid PCR, and 98.2% (56/57) concordance was obtained. Fourteen oligonucleotide probes were optimized by trying different reaction conditions, showing specific hybridization with the corresponding reference strains, but no cross-reactions with other urogenital microorganisms. Using this procedure, a total of 59 strains were detected from 56 chlamydial samples. Eight genotypes were found, and type D, E, F, and H were the most frequently observed types (77.9%). Three cases (5.4%) had multiple infections with serovars: 1.D/E, 2.D/F, and 3.F/K. To validate the reference strains and confirm the genotype identity as determined by the oligonucleotide array technology, we sequenced all reference strains and 10 selected specimens across variable sequence VS1 and VS2. No discrepancies were found between the array typing and the genotype identity confirmed by nucleotide sequencing of the PCR product. The findings from this study indicated that the oligonucleotide array is a simple, fast, and specific assay for directly detecting and genotyping C. trachomatis from clinical samples.
Diagnostic Microbiology and Infectious Disease 02/2007; 57(1):1-6. · 2.53 Impact Factor
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ABSTRACT: The purpose of this study was to describe the anatomic basis for a distally based neurovenovascular pedicle compound flap, with nutrient vessels of the cutaneous nerves and superficial veins of the forearm. In this study, the origins, branches, and anastomoses of nutrient vessels of the cutaneous nerves and superficial veins of the forearm and their relationships with the blood supply of adjacent muscle, bone, and skin were assessed in 96 adult cadavers by perfusion of red gelatin into the superior limb arteries. The results showed that the nutrient vessels of cutaneous nerves and superficial veins of the forearm were found to have multiple origins, consisting of six longitudinal vascular plexuses and one transverse vascular plexus of the forearm, as follows: 1) the anterior-lateral vascular plexus from cutaneous branches of the radial artery; 2) the anterior-medialis vascular plexus from cutaneous branches of the ulnar artery; 3) the dorso-lateral vascular plexus from radial osteal and cutaneous branches; 4) the dorso-medialis vascular plexus from ulnar osteal and cutaneous branches; 5) the radial vascular plexus from osteal and cutaneous branches of the radial artery, cutaneous branches of the radial artery in the upper wrist, recurrent branches of the styloid process of the radius, and the radialis vascular plexus of cutaneous branches of the tabatière anatomique (anatomical snuffbox); and 6) the ulnar lateral vascular plexus from cutaneous branches of the ulnar artery in the upper wrist and osteal and cutaneous branches. The transverse vascular plexus is composed of dorsal branches of the ulnar and radial arteries. These perforating branches give fascial branches, cutaneous branches, periosteal branches, and nutrient vessels of cutaneous nerves and superficial veins. These results suggest that nutrient vessels of the cutaneous nerves and superficial veins of the forearm have the same origins as those of the nutrient vessels of adjacent muscles, bones, and skin of the forearm, which can be designated as five types of distally based pedicle flaps with nutrient vessels of cutaneous nerves and superficial veins of the forearm, whose rotation point is at the wrist joint. This flap can be applied to repair tissues of distal parts of the hand.
Microsurgery 02/2006; 26(5):373-85. · 1.61 Impact Factor
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ABSTRACT: The distally based sural neuro-veno-fasciocutaneous flap has been used widely for reconstruction of foot and ankle soft-tissue defects. The distal pivot point of the flap is designed at the lowest septocutaneous perforator from the peroneal artery of the posterolateral septum, which is, on average, 5 cm (4-7 cm) above the lateral malleolus. A longer neuro-veno-adipofascial pedicle would be needed to reversely reach the distal foot defect when the flap is dissected based on this perforating branch, which may result in more trauma in flap elevation and morbidity of the donor site. In this article, we explored new pivot points for this distally based flap in an anatomic study of 30 fresh cadavers. The results showed that the peroneal artery terminates into two branches: the posterior lateral malleolus artery and lateral calcaneal artery. These two branches also send off cutaneous perforators at about 3 and 1 cm above the tip of lateral malleolus, respectively, which can be used as arterial pivot points for the flap. A communicating branch between the lesser saphenous vein and the peroneal venae comitantes was found, accompanied by the perforator of the posterior lateral malleolus artery. This modified, distally based sural flap with lower pivot points was successfully transferred for repair of soft-tissue defects in 21 patients. The size of flaps ranged from 4 x 3 cm to 18 x 12 cm. All flaps survived without complications. Neither arterial ischemia nor venous congestion was noted. In conclusion, the vascular pivot point of a distally based sural flap can be safely designed at 1.5 cm proximal to the tip of the lateral malleolus. This modified flap provides a valuable tool for repair of foot and ankle soft-tissue defects.
Microsurgery 02/2005; 25(7):543-50. · 1.61 Impact Factor
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ABSTRACT: To provide an anatomical basis for selecting optimal retrograde cardioplegia technique therefore to improve the effect of the operation.
Fifty formalin-fixed adult human cadaveric hearts were collected in this study, and special attention was given to the observation of the coronary sinus tributary drainage and the anatomical relationship between the orifice of the coronary sinus and the atrioventricular nodal artery.
Although the majority of the tributaries drained into the coronary sinus, it was identified in 15 cases that the posterior vein of the left ventricle and in another 2 cases the small cardiac vein (SCV) made their way into the middle cardiac vein (MCV) respectively. In 6 cases MCV solely joined the right atrium, which was joined by SCV only in 1 case. Draining into the coronary sinus as seen in 44 cases, MCV had an opening 3.4+/-1.5 mm away from the orifice of the coronary sinus. In the direction perpendicular to the long axis of the coronary sinus orifice, the anterior and posterior extreme points were 4.9+/-2.5 mm and 9.9+/-4.2 mm respectively, away from the atrioventricular nodal artery, which crossed the long axis of the coronary sinus orifice at an angle of 21.2+/-15.6 degrees. The right atrial wall on both sides of the coronary sinus orifice was of a uniform thickness of 1.1+/-0.2 mm.
Direct-vision non-balloon-tipped cannulation conforms better to the anatomical features described above. In purse-string suture, however, sufficient care should be taken of the dangerously thin inferior atrial wall and the close relationship between the coronary sinus orifice and the atrioventricular nodal artery. For better cardioprotective effect of retrograde cardioplegia, non-balloon-tipped cannula under direct vision should be adopted with the assistance of antegrade perfusion and, when necessary, additional transfusion via the exotic MCV opening may be used when the opening appears relatively wide.
Di 1 jun yi da xue xue bao = Academic journal of the first medical college of PLA 05/2003; 23(4):358-60, 363.
