Objective:To observe the ultrastructure of biological living skin equivalent in vitro.Methods:Keratinocytes and fibroblasts were sourced from the back skin of legally aborted human foetus.Fibroblasts were seeded into bovine type I collagen gel and cultured for 3 days.Keratinocytes were seeded on the surface of collagen gel and cultured for another 2 days,then the equivalent skin was exposed to air-liquid interface to form a protective cornified layer.Histological structure and ultrastructure of the equivalent skin were observed by light microscope and transmission electron microscope.Results:The morphogy of equivalent skin of full thickness consisted of epithlium and dermis.Epithelium was made up of stratum basale,stratum spinosum,stratum granulosum and stratum corneum.lntercellular bridge existed within the cells of different layers.Some ultrastructures in epithelium such as desmosome,Lamelle,tonofibrils and lipid droplet were found in the equivalent skin.Conclusion:Tissue-engineered skin may have the features of natural skin.

In the elderly, patient who suffered from hip fracture need to stay in bed for a long time and has a higher prevalence of complications and mortality. Considering the factors of patients in the intraoperative death and postoperative re?habilitation, we take appropriate treatment measures during preoperative, intraoperative and postoperative period respective?ly based on the concept of Enhanced Recovery. Patient will benefit from rapid rehabilitation and reduction of incidence of complications and mortality. ERAS includes preoperative fasting, preventive anagelsia, intraoperative temperature control, anesthesia and surgical approach, postoperative intravenous restriction, nutritional support and painless early motion. This ar?ticle intends to review the security , reliability and clinic efficacy of ERAS.

[Objective]To develop a mini-pressure-sensor(MPS)for measurement of plantar pressure(PP)and to evaluate its clinical application.[Method]The MPS was installed in the shoes,and computer was used to accumulate and analyze the change of PP in whole walking stage.Pathologic changes of PP in clinical patients were also analyzed by MPS.[Result]In normal walking,the PP of forefoot was 49% of body weight(BW)and of midfoot and heel was totally 51% of BW,but at pathologic state,the equilibrium of walking was dynamically disrapted inducing a pathologic changes of foot bearing.[Conclusion]Self-developed MPS for measuring PP is help for dynamic analysis of normal PP and is valuable to recognize the pathologic distribution of PP in pathological state and to provide a guide for treatment.

[Objective]To investigate the treatment of nonunion after Pilon fracture with fibula approach fixation of tibia and ankle joint fixation and its clinical efficacy.[Method]Six cases of nonunion after Pilon fracture were collected from 1999 to 2004,which included 4 males and 2 females,with the average age of 34.7 years(21~53 years).All fractures were found invasion to the tibia-fibula joint and ankle malformation.Fibula and tibia were opened from posterolateral approach and reconstruction plate was placed laterally on the fibula,with screws crossing the fibula into the tibia directly.Autogenous bone graft was used in fracture position and area between tibia and fibula to gain tibia-fibula fusion.[Result]All cases were followed up from 8 months to 4 years with the average of 22 months.Bone fusion were gained in 5 cases with the average time of 3.5 months.Plate broken was found in 1 case for too early weight bearing.[Conclusion]Fibula approach fixation of tibia and ankle joint fixation has advantages of promoting fracture healing,preventing complications,and correction joint malformation.It is a convenient and reliable method for clinical surgeons.

[Objective]To summarize the experience about treatment of segmental and comminuted femoral fractures with intramedullary nail in multiple injuries.[Method]From March 2002 to July 2006,28 patients with segmental and comminuted femoral fractures were treated surgically,13 with AO type C1,9 with C2 and 6 with C3.All of the fractures were treated with close reduction static intramedullary nail fixation.[Result]The postoperative follow-up ranged from 11 to 34 months with an average of 21 months.All of the fractures were healed.Limit load was required for 5 patients who had delayed union without special treatment.After 18-30 months the patients healed up.There were no fat embolisms.No complications such as infection,intramedullary bending or break occurred.[Conclusion]Treatment of femoral fractures with intramedullary nail is a standard method.However,to achieve satisfactory results,comprehensive treatment,careful planning and procedure should be taken for segmental and comminuted femoral fractures in multiple injuries.

The characteristics and purpose of treatment of tibiofibular comminuted fracture is reviewed in this paper.The present points of view is that tibiofibular comminuted fracture is a kind of smash fracture,that is valuable for restoring its tubular structures.The appearance of a series of new type plates and external fixations represents the trend of researching.The combination of internal/external-fixation and sequential treatment is waited for more research.

Literatures about patella fracture fixation in recent years are analyzed retrospectively in this paper.Its characteristics and therapeutic purpose are investigated.A series of new type of internal fixations and external fixations are emphasized.

Objective To evaluate the efficacy of Cypher and Taxus drug eluting stent (DES)in the treatment of coronary artery diease. Methods A total 162 patients underwent coronary artery stenting with eigher the Cypher (n=93) or the Taxus (n=69) drug eluting stent. All patients received follow up angiography. Results The angiographic restenosis rate and TLR rate were 10.8% and 5.4% in the Cypher group whereas 11.6% and 5.8% in the Taxus group. There were no statistical differences between the two groups. In-Stent Late Loss and In-Lesion Late Loss were found less in the Cypher group than in the Taxus group. Conclusion Both the Cypher DES and the Taxus DES decreased the restenosis and TLR rates but the Cypher stent has a lower late loss rate than the Taxus stent.

Objective To discuss the reasons of death in the in-patients with percutaneous coronary intervention(PCI).Methods Retrospective analysis was done in 33 cases who died in or after the procedures among 3 252 in-patients with PCI.Results 4 patients died in procedures and the others died after procedures.The major reasons of death in order were:cardiogenic shock,ventricular fibrillation,acute left heart failure,multiple organ failure,heart rupture and acute renal failure.The in-hospital mortality rate was 1.01%.Conclusion The major reasons of death of patients with PCI are cardiogenic shock,ventricular fibrillation and acute left heart failure.Taking some measures will reduce the in-hospital mortality rate.

Objective Risk factor of radial and horizontal tear for posterior horn of medial meniscus is analyzed in present study.Methods A total of 390 patients diagnosed with medial meniscus tear received during January 2011 to December 2012 were of retrospective analysis.94 cases with radial tear of medial meniscus posterior horn and 95 horizontal cases were chosen as research objects.Age,gender,duration of symptoms,body weight index,trauma history,posterior slop of tibia plateau,knee valgus angle and Outerbridge cartilage classification of patients with radial or horizontal tear were recorded and analyzed.Multifactor unconditioned Logistic regression analysis was employed to analyze risk factor of meniscus radial tear.Results Significant difference could be spotted in the analysis of gender (x2=9.059,P=0.003),body weight index (t=2.549,P=0.012),knee valgus angle (t=-5.609,P=0.000) and Outerbridge cartilage classification (x2=42.300,P=0.000) between patients with radial or horizontal tear.Meanwhile,no significant difference could be spotted in the analysis of trauma history (x2=0.368,P=0.544),posterior slop of tibia plateau (x2=1.021,P=0.312),age (t=-1.228,P=0.221) and symptom duration (t=0.272,P=0.786).According to the results of multi-factor analysis,valgus angle (OR=12.581,P=0.001),age (OR=0.875,P=0.026) and Outerbridge cartilage classification (OR=33.790,P=0.000; OR=15.558,P=0.000; OR=39.891,P=0.000; OR=91.041,P=0.000) were risk factors of meniscus radial tear.Conclusion High incidence of posterior horn of medial meniscus tear was found in patients with senile osteoarthritis.The incidence of radial tear of medial meniscus posterior horn in elderly patients with knee varus or serious articular cartilage was higher than that of horizontal tear.