Object To study the chemical constituents of alkaloids of Amsonia sinensis Tsiang extracted with methanol. Methods Compounds were separated by exchange resin, macroporous resin and silica gel column chromatography. Their structures were elucidated by spectroscopic analysis. Results Three compounds were isolated from total alkaloids of A. sinensis extracted with methanol. They were identified as: rhazidigenine (Ⅰ), amsonic acid (Ⅱ), trans-sinapic acid methylester (Ⅲ). Conclusion Compound Ⅱ is a new one, and compound Ⅰ and Ⅲ are obtained from this plant for the first time.

Objective To investigate the application and clinical result of treatment soft tissue defect in the lower leg after severe trauma by using the reversed descending branch of the lateral circumflex femoral artery of the injured leg as the recipient artery for free flaps.Methods Twenty-three patients with soft tissue defect of the lower leg after severe trauma from February 2007 to October 2012 were retrospectively analyzed.The patients were treated with the free flaps (the latissimus dorsi flap or the anterolateral thigh flap) using the reversed descending branch of the lateral circumflex femoral artery of the injured leg as the recipient artery.There were 14 males and 9 females,with an average age of 31.7 years (range,22-49 years).The causes of injury were traffic accidents in 12 cases,crushing injury in 8 cases,and machinery injury in 3 cases.The defect located at the proximal in 4 cases,the proximal and middle in 12 cases,middle and distal in 7 cases.Sizes of the tissue defect were 14 cm×5 cm to 32cm×12 cm,and the flap sizes were 15 cm×7 cm to 34 cm×13 cm.The donor defect was closed directly or resurfaced with a splitthickness skin graft taken from the thigh.Results Twenty-three flaps survived completely.Partial necrosis at the distal edge of the flap occurred in one case,and was healed by secondary intention.No patient needed urgent operative revision due to postoperative thrombosis of the vessels.All flaps completely survived,without evidence of postoperative insufficiency of the blood supply or venous congestion.The donor skin graft survived and the incision healed by first intention.The mean follow-up period was 12.4 months (range,6-21 months).The appearance,texture,color and thickness of flaps in all cases were good at the last followup.The flap achieved protective sensation with the two-point discrimination ranging between 10-25 mm.Conclusion Due to the advantages of reliable blood supply,short treatment cycle,and without postoperative forced position,the reversed descending branch of the lateral circumflex femoral artery of the injured leg can be an ideal choice as the recipient artery for free flaps in repairing the soft tissue defect in the lower leg after severe trauma.

Objective To evaluate the safety, feasibility and efficacy of treating familial adenoma-tous polyposis (FAP) with cancerization by total colectomy and proctocolectomy under laparoscopv. Methods Perioperative data and surgical outcomes of 3 FAP patients who underwent laparoscopic total colectomy and proctocolectomy were analyzed retrospectively and compared with those of 8 patients performed conventional open surgery between Autumn 2001 and December 2002. Results All of the 3 patients were received laparoscopic total colectomy or proctocolectomy successfully without severe complications. The operative times were longer in the laparoscopic group when compared with the conventional group (243. 33 vs. 168. 75 minutes) , (P= 0.028). The mean operative blood loss, flatus and hospital stay in the laparoscopic group were 146. 66 ml, 1. 33 days and 14 days respectively without significant difference when compared with those of the conventional group. The incision length was significantly shorter in the laparoscopic group (4. 33 vs. 19. 38cm) , ( P

OBJECTIVETo explore the effect of dorsalis pedis parallel flaps in repairing perforating skin and soft tissue defects of the palms.

METHODSEighteen patients with perforating skin and soft tissue defects of the palms were hospitalized from July 2008 to November 2010. The area of skin defect ranged from 2.0 cm x 1.5 cm to 5.0 cm x 2.5 cm. The dorsalis pedis parallel flaps were used to repair these defects, with the area ranging from 2.0 cm x 2.0 cm to 5.5 cm x 3.0 cm. The donor sites were covered with autologous full-thickness skin from inner thigh.

RESULTSAll the 18 flaps and skin grafts of donor sites survived completely. Seventeen patients were followed up for 6 to 23 months, with mean time of 10 months, and one patient was lost to follow-up. The texture, elasticity, and appearance of all the 17 flaps were satisfactory, with no obvious pigmentation or cicatricial contracture. At the last follow-up, the distance of two-point discrimination of flaps ranged from 6 to 9 mm, with mean distance of 7.4 mm, and the sensation of flaps reached S3 in 13 patients who had nerve anastomosis.

CONCLUSIONSThe dorsalis pedis parallel flap, with reliable blood supply and flexible design, is a good choice for repairing perforating skin and soft tissue defects of the palms.

Contracture ; Foot ; surgery ; Hand Injuries ; surgery ; Humans ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Skin ; Skin Transplantation ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; blood supply ; Treatment Outcome ; Wound Healing ; Young Adult

Objective Through analyzing the people of attending the continuing medical education in the first affiliated hospital of Xinjiang Medical College from 2000 to 2006 to propose corresponding measures of management. Methods To carry on processing to the data by Excel. Results Among the people who took advanced courses in the first affiliated hospital of Xinjiang Medical College from 2000 to 2006, there were most people in 2004, and there was different percentage of races, and the percentage of the degree and technical titles varied from the South and the North.Conclusions The reform of management system should be strengthened according to the character of the people attending the continuing medical education.

Objective To investigate the clinical efficacy of a novel path of lymph node dissection combined with peripheral vascular occlusion for the treatment of gastric cancer in stage ⅢC.Methods The clinical data of 142 patients with gastric cancer in stage Ⅲ C who were admitted to the 175th Hospital of PLA from January 2006 to December 2009 were retrospectively analyzed.Seventy patients received novel path of lymph node dissection combined with peripheral vascular occlusion (combined group) and 72 patients received simple lymph node dissection via the novel path (simple group).The positive rate of mRNA expression of carcinoembryonic antigen (CEA) and the distal metastatic rate of tumor cells between the 2 groups were compared.Patients were followed up via outpatient examination,phone call and in-patient examination till January 2013.The measurement data and the enumeration data were analyzed using the t test and the chi-square test,respectively.Results The operation time,volume of blood loss and number of lymph nodes dissected were (184 ± 26) minutes,(282 ± 80) mL and 28 ± 5 in the combined group,(180 ± 28)minutes,(355 ± 85)mL and 27 ± 5 in the simple group,with no significant difference between the 2 groups (t =0.882,5.267,0.496,P ＞ 0.05).The positive rates of mRNA expression of CEA of the combined group and the simple group were 10.0％ (7/70) and 9.7％ (7/72),with no significant difference between the 2 groups (x2 =0.003,P ＞ 0.05).The positive rates of mRNA expression of CEA after lymph node dissection of the combined group and the simple group were 2.9％ (2/70) and 16.7％ (12/72),with significant difference between the 2 groups (x2 =8.240,P ＜ 0.05).The positive rates of mRNA expression of CEA after total gastrectomy of the combined group and the simple group were 4.3％ (3/70) and 4.2％ (3/72),with no significant difference between the 2 groups (x2=0.001,P ＞ 0.05).All patients were followed up at postoperative year 1,and 139 patients were followed up at postoperative year 3.The median time of follow-up was 33.5 month (range,12.0-42.0 month).The 1-year distal metastatic rate of the combined group and the simple group were 7.1％ (5/70) and 8.3％ (6/72),with no significant difference between the 2 groups (x2=0.070,P ＞0.05).The 3-year distal metastatic rate of the combined group and the simple group were 33.3％ (23/69) and 51.4％ (36/70),with significant difference between the 2 groups (x2=4.660,P ＜0.05).The distal metastatic rates of distal parenchymatous organs of the combined group and the simple group were 10.1％ (7/69) and 44.3％ (31/70),with significant difference between the 2 groups (x2=20.390,P ＜ 0.05).Conclusions Novel path of lymph node dissection combined with peripheral vascular occlusion can block the lymph node and blood backflow,and thus effectively reduces the distal metastatic rate of gastric cancer in stage ⅢC after operation.

Objective To review our experiences on perioperative anesthetic management for patients who received percutaneous nephroscopic peripancreatic necrectomy for acute necrotizing pancreatitis.Method The clinical data on 18 patients with acute necrotizing pancreatitis who received percutaneous nephroscopic peripancreatic necrectomy in our hospital from August 2008 to January 2011 were retrospectively analyzed.Results There was a marked fluctuation in hemodynamic status of the patients which required the use of vasoactive drugs during perioperative period.PETCO2 significantly increased after pneumoperitoneum.Tracheal extubation was possible in 11 patients immediately after surgery in the operation room,while 7 patients required tracheal intuhation to be transported back to the surgical intensive care unit (SICU).Conclusion Most patients who underwent percutaneous nephroscopic peripancreatic necrectomy had a varying degree of shock and multi-organ injury before operation.Proper anesthetic induction and maintenance,correct use of vasoactive drugs and lung protective ventilation strategy,and active fluid resuscitation are the keys to good perioperative anesthetic management and to improve treatment results.

Objective To assay the clinical effect of proximal dorsal digital artery pedicled island flap in treatment and sensory reconstruction of adjacent finger soft-tissue defect.Methods The study enrolled 21 cases of soft-tissue defect in 21 fingers treated from January 2013 to January 2014.All the defects were covered with the proximal dorsal artery pedicled island flaps raised from the adjacent finger.Index finger was injured in 7 patients,middle finger in 9 patients,ring finger in 4 patients,and little finger in 4 patients.Defect and flap dimensions varied from 1.9 cm × 1.5 cm to 4.3 cm × 2.3 cm and from 2.0 cm × 1.7 cm to 4.5 cm × 2.5 cm respectively.Donor site was resurfaced with a fullthickness skin harvested from medial side of the upper arm.Postoperative flap appearance and two-point discrimination were evaluated.Total active motion (TAM) of the finger was evaluated after operation.Results All the flaps and skin grafts survived after operation.Duration of the follow-up was 6-18 months (mean,14.7 months).Through the final follow-up,appearance and function of the flap were satisfactory,donor site healed well,and two-point discrimination was 5-9 mm (mean,6.3 mm).TAM evaluation was excellent in 19 patients and good in 2 patients with the excellent-good rate of 100％.Conclusion The proximal dorsal artery pedicled island flap raised from the adjacent finger is an ideal choice in finger soft-tissue reconstruction,for the technique has advantages of high survival rate,satisfactory appearance and sensory function as well as few complications.

BACKGROUND:Poor implant anchorage in osteoporotic bone impacts its stability and requires the new solutions for the treatment. The augmentation technique with bone cements or bone substitutes is one strategy for the solutions. OBJECTIVE:To evaluate the transient stability of pedicle screw augmented using calcium sulfate cement in osteoporotic vertebral body. METHODS:Fresh calf lumbar vertebrae were selected to measure bone density, and then classified into four groups:the group by pedicle screw in normal vertebral body;the group by pedicle screw augmented using calcium sulfate cement in normal vertebral body;the group by pedicle screw in osteoporotic vertebral body;the group by pedicle screw augmented using calcium sulfate cement in osteoporotic vertebral body. Pedicle screw of equal specification was twisted into the tested pedicle of vertebral arch. The maximum axial screw pul-out strength and the maximum energy required to failure were recorded so as to assess the transient stability of pedicle screw augmented using calcium sulfate cement. RESULTS AND CONCLUSION:The maximum screw pul-out strength and the maximum energy required to failure were significantly less in osteoporotic vertebral body compared with normal vertebral body (P<0.05). The maximum screw pul-out strength and the maximum energy required to failure after augmentation using calcium sulfate cement were significantly increased (P<0.05). The maximum screw pul-out strength and the maximum energy required to failure after augmentation using calcium sulfate cement were identical between normal group and osteoporosis group. These results suggested that calcium sulfate cement could effectively increase the transient stability of pedicle screw. Calcium sulfate cement is effective in augmenting fixation in osteoporotic bone, and has potential in clinical application.

Objective To investigate the clinical outcomes of using modified antegrade digital artery island flap for the treatment of the severely flexion contracture of the burned finger.Methods Between August,2013 to August,2015,21 patients (21 fingers) with severely flexion contracture of the burned finger were hospitalized for treatment.According to the Stren classification standard for the interphalangeal joint flexion contracture,all the patients were rated as type Ⅲ.The volar soft-tissue defect with exposed tendons,nerves,vessels or bone ranged from 1.0 cm × 2.0 cm to 2.5 cm × 4.0 cm after scar relaxation.The artery and the nerve defect were 1.5 to 4.5 cm and 2.0 to 4.2 cm,respectively.The wound were reconstructed with the modified antegrade digital artery island flap.The dorsal branches of the proper digital nerve of the flap were anastomosised with the proper digital nerve of the wound.The flap donor site was resurfaced with full-thickness skin grafting from inner aspect of the forearm.All the cases were called back for postoperative follow-up.Results All the reconstructed fingers and flaps survived completely without vascular problems.The donor skin graft survived and wound healed by first intention.All the patients were followed up with 11.5 months (range,6-22 months).The finger appearance was satisfactory.The texture and color of flaps in all cases were good.There was no pigmentation and contraction relapse.The contracted fingers received no cold intolerance.At the final examination,the average values of static 2-point discrimination were 5.2 mm (range,4.3-6.5 mm) of the flap.In the series,based on the Michigan Hand Outcome Questionnaire,18 patients were strongly satisfied with the injured finger appearance and 3 patients satisfied with the appearance.Conclusion The modified antegrade digital artery island flap,which is easy to raise with large flap size and can result with the good finger appearance and function,is an ideal technique for reconstruction of the severe flexion contracture of the burned finger.