Objective To explore the efficacy of prefabricated expanded cervico-scapulo-dorsal reverse axial flap combined with cervico-thoracic skin flap to repair cicatricial contracture of lateral neck. Methods Ten patients with cicatricial contracture of lateral neck were repaired by prefabricated expanded cervico-scapulo-dorsal reverse axial flap combined with cervico-thoracic skin flap. The flaps were transferred to repair the wound caused by excision of the scar on the lateral side of the neck. Results All the twenty skin flaps survived in first intention. Both the configuration and function were satisfactory after 6 to 18-month follow-up. Conclusion Prefabricated expanded cervico-scapulo-dorsal reverse axial flap combined with cervico-thoracic skin flap is an ideal method to repair the cicatricial contracture of lateral neck.

Objective To analyze the related influencing factors of progressive ischemic stroke, and to investigate the value of serum markers for prediction of progressive ischemic stroke. Methods Three hundred and six patients with acute cerebral infarction were divided into progressive ischemic stroke (PIS) group (n=91) and non-progressive ischemic stroke (NPIS) group (n=215). Data of gender, age, past medical history, personal history and serum markers were collected and compared in two groups. Binary Logistic regression was used to analyze the influencing factors of PIS. The receiver operating characteristic (ROC) curves of neutrophils to lymphocytes ratio (NLR), fibrinogen and fasting blood glucose were analyzed in two groups. Results Positive rates of hypertension history, diabetes history, hypercholesterolemia history, incidence of large artery atherosclerotic (LAA) stroke were significantly higher in PIS group than those in NPIS group ( P<0.05). The levels of neutrophils, NLR, fibrinogen and fasting blood glucose were significantly higher, but the level of lymphocytes was significantly lower in patients with PIS than those in patients with NPIS (P<0.05). Logistic regression analysis confirmed that diabetes, LAA stroke, NLR, fibrinogen and fasting blood glucose were independent risk factors for the PIS ( P<0.05). The areas under ROC curve by NLR, fibrinogen and fasting blood glucose were 0.777, 0.560 and 0.574, respectively. The sensitivities of NLR, fibrinogen and fasting blood glucose were 72.5%, 59.8%and 47.3%, respectively;and the specificities were 76.7%, 51.2% and 69.8%, respectively. Conclusion The occurrence of PIS is related with blood pressure, blood lipids, inflammatory cells in peripheral bolld, fibrinogen and fasting blood glucose. The level of NLR in peripheral blood can predict the occurrence of PIS, which can be used as an important reference index for early diagnosis of PIS.

Objective To study the relationship between serum uric acid (UA) level and cerebrovascular stenosis in acute ischemic stroke (AIS) patients.Methods Five hundred and thirteen patients with AIS or old IS admitted to our hospital from April 2014 to April 2016 were divided into primary IS group (n=236),recurrent IS group (n=136),and old IS group (n=141).Venous blood samples were taken on admission for biochemical testing.The patients were further divided into serum UA≤255 μmol/L group (n=128),serum UA=256-312μmol/L group (n=129),serum UA=313-371 μmol/L group (n=129),and serum UA＞371 μmol/L group (n=127).Their cerebrovascular stenosis was assessed by CT angiography or magnetic resonance angiography after admission.Results The severity of cerebrovascular stenosis,hypertension,diabetes and hyperlipidemia was significantly different in primary IS group,recurrent IS group and old IS group (27.5％ vs 33.8％ vs 12.8％、24.2％ vs 28.7％ vs 46.8％、61.9％ vs 49.3％ vs 40.4％、71.6％ vs 61.8％ vs 46.8％,P=0.000).Logistic regression analysis showed that serum UA≤ 255 μmol/L was an independent risk factor for cerebrovascular stenosis (OR =2.787,95 ％CI:2.209-3.365,P=0.001).The risk of cerebrovascular stenosis decreased gradually with the elevated serum UA level.Conclusion Serum UA level is not directly related with recurrent IS.Low serum UA level is a risk factor for cerebrovascular stenosis in AIS.

Objective To investigate the effects of low dose radiation on the level of oxidative damage and antioxidant in population of high background radiation area of Guangdong.Methods A total of 48 male residents who lived in high background radiation area(HBRA) of Guangdong province and 48 male residents who lived in neighboring Enping control area were chosen as the objectives and control respectively.The peripheral venous blood of two groups was collected,and then the levels of 8-OHdG and TrxR were determined by enzyme linked immunosorbent assay (ELISA).Results Compared with the CA group [(315.39 ± 100.59) ng/ml],the level of 8-OHdG [(272.64 ± 96.85) ng/ml] decreased significantly in HBRA (t =2.121,P ＜0.05).Compared with the CA group [(0.467 ±0.056) ng/ml],the level of TrxR [(0.496 ± 0.044) ng/ml] increased significantly in HBRA (t =-2.823,P ＜ 0.05).The results of multiple linear regression analysis demonstrated that the chronic exposure to low dose of radiation had significant effects on the expression level of 8-OHdG and TrxR (t =-2.327,2.367,P ＜ 0.05) after adjustment for confounding factors such as age,drinking,tea drinking,smoking,medical exposure and stressful events.Conclusions Chronic exposure to low dose radiation may decrease the level of oxidative and enhance the level of antioxidant.

BACKGROUND:Though the effects of conservative or traditional open reduction and internal fixation in the treatment of thoracolumbar fractures are reliable and satisfactory for most cases, two methods also have shortages. Minimal-invasive percutaneous pedicle screw system provides a new available method. OBJECTIVE:To investigate the clinical effect of Sextant percutaneous pedicle screw system in the treatment of thoracolumbar fractures. METHODS:A total of 55 patients, who had undergone percutaneous pedicle screw fixation using Sextant system (25 patients) or traditional open internal fixation (30 patients) for single-level vertebral body compression fractures in Department of Orthopedics of Renmin Hospital of Wuhan University from February 2011 to January 2013, were enrol ed in this study. RESULTS AND CONCLUSION:Except two patients in traditional open internal fixation group were lost after discharge, al other patients were fol owed up for 8-14 months. Operative time, intraoperative blood loss, postoperative drainage amount and hospital day were better in percutaneous pedicle screw fixation group than in the traditional open internal fixation group (P<0.05). Compared with preoperation, the sagittal Cobb angle, visual analogue scale and Oswestry disability index after operation were significantly lower (P<0.05), while anterior vertebral body height ratio was significantly higher in each group (P<0.05). No significant difference was found in terms of correction loss and Oswestry disability index between two groups at 8 months after operation (P>0.05). The results show that percutaneous pedicle screw fixation using Sextant system has a satisfactory outcome in the treatment of thoracolumbar fractures. However, obeying indication strictly is very important for clinical application.

Objective To evaluate the clinical value of real-time 3 dimensional echocardiography (RT-3DE) for measurement of right ventricular function in the repaired tetralogy of Fallot (TOF) compared to cine magnetic resonance imaging (c-MRI).Methods Thirty-seven randomly selected patients with repaired TOF from Jan.2000 to Jun.2007 in Children's Hospital,Fudan University underwent both RT-3DE and c-MRI for the data of right ventricular enddiastolic volume (RVEDV),right ventricular end-systolic volume (RVESV),right ventricular ejection fraction (RVEF),which were compared to evaluate the reproducibility and correlation of two ways on right ventricular function.Results All the patients completed both RT-3DE and c-MRI on the same day.The correlation for RVEDV,RVESV,RVEF measured by 2 methods was high (r =0.933,0.943,0.911,P =0.000,0.000,0.105),and it showed that consistency existed in RVEF,as difference was only (1.2 ± 4.5) ％.Comparison with c-MRI,RVEDV and RVESV measured by RT-3DE was underestimated,in which difference was (-17.4 ± 16.9) mL,(-9.3 ± 10.5) mL.Conclusions RVEF with RT-3DE can be assessed with acceptable accuracy,but it is not so good for RVEDV and RVESV.Further study needs to be performed to make sure the value of RT-3DE on the assessment of right ventricular function in repaired TOF.

Objective To investigate the effects of CSK-conjugated PLGA nanoparticles on oral delivery of insulin in vitro and in vivo.Method CSK-INS-NPs were prepared by double-emulsion. Nanoparticle size、zeta potential and entrapment efficiency were measured. The efficiency of cellular uptake on Caco-2 cells in vitro was evaluated. The hypoglycemic effects were evaluated by monitoring the glucose levels in diabetic rats. Results The average sizes was(134. 4 ± 15)nm and their PDI values were less than 0.3.The insulin entrapment efifciency was around 71%. The cellular uptake of CSK-INS-NPs by Caco-2 cells was 2.8 times higher than INS-NPs. The CSK-INS-NPs transferred more insulin across the Caco-2 cell monolayer than INS-NPs and insulin solution did. In vivo experiments,the CSK-INS-NPs could reduce the blood glucose level of diabetic rats after oral administration in 10 h.Conclusion Compared with insulin solution,CSK-INS-NPs enhanced the insulin through Caco-2 cell monolayer by transcellular pathway and may be a potential delivery system for Oral Delivery of Insulin.

BACKGROUND:The effects of both conservative and traditional open reduction and internal fixation are dissatisfactory in the treatment of thoracolumbar fractures, however, minimal-invasive percutaneous pedicle screw-rod systems provide a new available method.
OBJECTIVE:To investigate the clinical effect of percutaneous pedicle screw fixation using Sextant minimal-invasive system in the treatment of thoracolumbar fractures.
METHODS:A total of 55 patients, who had undergone percutaneous pedicle screw fixation using Sextant system (25 patients) or open pedicle screw fixation (30 patients) for single-level vertebral body compression fractures in Department of Orthopedics, Renmin Hospital of Wuhan University from February 2011 to January 2013, were enrol ed in this study. They showed no neurological signs and symptoms. The operative time, intraoperablood loss, postoperative drainage amount, length of hospital stay, pre-and post-operative Cobb angle and anterior vertebral body height ratio were recorded and compared between two groups.
RESULTS AND CONCLUSION:Except two patients in open pedicle screw fixation group were lost after discharge, al other patients were fol owed up for 8-14 months. There were significant differences in operative time, intraoperative blood loss, postoperative drainage amount and length of hospital stay between two groups (P=0.000 0). The post-operative Cobb angle was significantly lower while anterior vertebral body height ratio was significantly higher at one week than those before fixation in two groups (P=0.000 0). No significant difference was found in correction loss between two groups at 8 months after operation. Experimental findings indicate that, percutaneous pedicle screw fixation using Sextant system has a satisfactory outcome in the treatment of thoracolumbar fractures. However, understanding the correct indications is very important for clinical application.

Objective To investigate the variations of polysomnography of the patients with retardative depression and non-retardative depression. Methods Twenty-eight patients with depression without any medicine at least for 1 month and fifteen normal controls were assessed in this study. Based on the scores of retardation of Hamilton Depression Scale( HAMD), the patients were divided into the group of retardative depression and the group of non-retardative depression. Polysomnography was given to all the subjects. Results Compared with the normal controls, the depressive patients both in the retardative depression group and in the non-retardative depression group showed significant differences of lower total sleep time (TST), sleep efficiency (SE), SWS% , rapid eye movement ) sleep time ( RT), REM sleep latency (RL) ( all P ＜ 0. 05 ), and higher sleep latency (SL) , awakening time( AT), awakening number( AN ), the percentage of AT( A/TST% ), the percentage of 1 sleep( S1 % ), the percentage of RT( RT% ), REM activity ( RA), and REM intensity (RI). REM density (RD) in the retardative depression group was significantly higher than both the non-retardative depression group and the control group ( t =2.36, P＜ 0. 05; t = 2.75, P＜ 0. 05 ). Conclusion Abnormalities of PSG in depression are proved, and RD may be relative to retardation. The differences of PSG do not existed between different kinds of depression such as retardative depression and non-retardative depression.

Objective To explore the application range of expand er s and its clinical efficacy in repair and reconstruction after burn. Methods Two hundred and eighty-six expanders were implanted in 80 burned patients. Volume of the smallest expander was 80cc, and that of the bi ggest one was 800cc. The expansive time ranged from 3 weeks to 2 months. In the second operation, expansive flaps were created and used in the de fected lesion where the scar was removed. Results 7 5 patients were followed up for at least one year with satisfactory results and only 3 patients showed complications that expanders exposed during expan sion. Conclusion Reasonable application of expanders coul d get satisfactory results in repair and reconstruction of severe scar, especia lly for scar at extremities and special sites after burn.