Objective To explore the effect of joint mobilization and quadriceps setting on nitric oxide(NO) and tumor necrosis factor(TNF) of the experimental knee osteoarthritis in rabbits. Methods Rabbits model of knee osteoarthritis was induced by papain. 32 rabbits were divided into 4 groups randomly, 8 in each group. The changes of contents of NO and TNF in synovia were detected.Results Expression of NO and TNF in synovia of all treatment groups decreased compared to the control group(P<0.01).Conclusion Joint mobilization and quadriceps setting can decrease the level of NO and TNF in synovia.

BACKGROUND: Skin transplantation is the most effective conventional method to cure large area full-thickness skin damage caused by empyrosis or some diseases, but present deficiency of skin donator is the largest barrier in front. The most ideal way to solve this problem is to use tissue-engineering skin reconstructed by self-skin cells as seed cells.OBJECTIVE: To investigate the effects of tissue engineered artificial animal skin in animal grafting experiment.DESIGN: A randomized controlled trial SETTING: Institute of frontier medical sciences and department of dermatology in a university.MATERIALS: Study was performed in the Cell-Engineering Institute of Jilin University from September 1998 to July 2001. Totally 20 newborn Wistar rats and 24 8-week old male nude mice were selected into our study.METHODS: Full-thickness wounds(diameter: 20 nn) were made on the backs of twenty-four nude mice to establish full-thickness skin defect animal model for grafting by the tissue-engineered reconstructive artificial skin made by chitosan(CH) as stromal scaffold. Twenty-four 8-week old nude mice were divided into artificial skin (AS) group, chitosan membrane(CH) group and control group (CG). All wounds were covered with AS, CH or petrolatun gauze correspondingly. The wounds of each groups were observed daily,techniques like histology and infrared-ray scan were used for a dynamical surveillance on the 3rd, 7th, 14th and 21st days.MAIN OUTCOME MEASURES: ① general observation; ② blood supply in recipient area under infrared-ray observation; ③ histological observation.RESULTS: Transplanted AS had a favorable fusion between tissue-engineered skin and self-skin on the 3rd day after grafting with a few of ingrowths of capillaries. The color of the AS was closed to self-skin. The capillaries gradually increased in the grafts over time. The new epidermis was clearly consisted of stratum basale, stratum spinosum, stratum granulosum, and stratum corneum. Keratinization enhanced with exfoliation. Cells in dermis increased and the scaffold gradually degraded. The secreted extracellular matrix increased as well. On the 14th day after grafting, the wounds almost recovered.The color of the grafted artificial skin was more similar to the nature skin with very little scaring, which indicated that a second grafting was unnecessary. The scabs did not completely fall off in CH group until the 14th day, and the wound was not healed. The color was darker than that of AS group. The scabs fell off in CG, and the wounds were big and deep with dark red color.CONCLUSION: The new reconstructive tissue-engineered artificial skin with CH as stromal scaffold has good histocompatibility, which can be applied in grafting for full-thickness wounds.

Objective To find T2N0M0 colorectal cancer patients at high risk for relapse or metastasis.Methods From January 1993 to December 2014,339 patients with histologically confirmed stage T2N0M0 primary colorectal cancer treated by radical surgery with complete clinical follow-up data were enrolled into this study.Survival rates were calculated using Kaplan-Meier method,and survival cures were compared using the Log-rank test.Cox proportional hazards model was used to analyze the significant factors defined in univariate test.Results The 5-year and 10-year overall survival rates were 83.0％ and 68.9％,respectively.Male gender,old age,lymphovascular involverment,perineural invasion,poor differentiation and invasive micropapillary carcinoma were associated with low cancer-specific survival rates in Kaplan-Meier analysis.Multivariate analyses revealed male gender,old age,lymphovascular involverment,poor differentiation and invasive micropapillary carcinoma as significant independent factors predicting poor prognosis.Conclusions Male gender,old age,lymphovascular involvement,poor differentiation and invasive micropapillary carcinoma are risk factors predicting poor prognosis for T2N0M0 colorectal patients.

Objective:To investigate the expression of MMP-1 and PTEN protein in basal cell papilloma (BCP), as well as their correlation with skin photoaging. Methods:Immunohistochemistry technique via Elivison method was employed to measure the expres-sion of MMP-1 and PTEN protein in lesions from 50 cases of BCP on exposed areas, 50 cases on non-exposed areas, and 30 normal controls. We compared the differences among the three groups and analyzed the result. A total of 90 BCP cases on exposed areas were randomly divided into three groups. Titanium dioxide cream and placebo were respectively applied in the trial groups twice daily for 12 weeks, whereas the control group was non-administered. After 12 weeks, the MMP-1 in the lesions of the three groups was measured and compared. Results:The expression scores of MMP-1 on exposed areas were significantly higher than those in the control group (P<0.01). No significant difference was found between non-exposed areas and the control group (P>0.05). The expression scores of PTEN protein on exposed areas and on non-exposed areas were significantly lower than that in control group (P<0.01). The expression scores of MMP-1 in the group that used titanium dioxide were evidently lower than those in control group after 12 weeks (P<0.05). Conclu-sion:MMP-1 is overexpressed in BCP on exposed areas. PTEN protein is underexpressed in BCP of exposed areas and non-exposed ar-eas. Skin photoaging is a possible cause of BCP on exposed areas.

Objective To analyze the independent risk factors associated with acute kidney injury(AKI)after Sun’s pro-cedure in the patients with acute aortic dissection .Methods Clinical data of 400 patients who underwent Sun ’ s procedure from February 2009 to August 2013 were collected.Data included preoperative GFR, Cleveland values, CPB time and fluid balance of 24 h intra and after operation were gathered .The patients were divided into the group of AKI and the group of non-AKI accounting to the changing of serum creatinine.Results AKI was occurred in 150(37.5%) patients.Hospital mortality in AKI group was significant higher than that in the non-AKI group(11.3% vs.2.4%, P<0.05).Univariable analysis re-vealed male, BWI, hypertension, preoperative MAP,WBC, eGFR, Cleveland value, cardiopulmonary bypass time, intra and postoperative fluid balance for 24 h have significant difference between 2 groups.Multivariate logistic regression analysis showed hypertension, Cleveland value, cardiopulmonary bypass time and fluid balance were independent risk factors for AKI .Conclu-sion AKI after acute aortic dissection was a severe complication .Hypertension, Cleveland value, cardiopulmonary time and fluid balance were associated with AKI.

Objective To analyze the short-term results of endovascular aortic repair (EVAR)for patients with acute type B aortic dissection and chronic renal insufficiency (CRI ).Methods Between February 2009 and December 2012,EVAR was performed in 30 patients with acute type B aortic dissection and CRI (CRI group).Consecutive 30 patients with acute type B aortic dissection whose renal function was normal during the same period was chosen as the control group (non-CRI group).All patients were within 14 days after onset,in which Marfan syndrome was excluded and diagnosis made by computed tomographic angiography (CTA) before the procedure.In 57 patients,EVAR was performed under looal anesthesia and associated procedures included insertion of a chimney stent in the left subclavian artery in 2 case and a bare metal stent in the renl artery in 2,In 3 patients,EVAR was done following right axillary artery-to-left axillary and left subclavian artery bypass with a Y-shaped graft under general anesthesia.Follow-up regimen included renal function and CTA at I month and 1 year postoperatively.Results Compared to the non-CRI group,patients in the CRI grup was significantly younger [ (44.7±13.2) years versus (53.7±16.2)years,P ＜0.05)and had a higher rate of perioperative complications (cerebrospinal ischemia,deterioration of renal dysfunction,and gastroenteral dysfunction) (16.7％ versus 3.3％,P ＜0.05 ),all of which resolved after surgical or medical treatment.One patient in CRI group was readmitted at 6 months for a redo EVAR to treat a new tear distal to the stent.At 1 month and I year postoperatively,no patients suffered from deterioration ofthe renal function,and their CTAs detected no apparent device deformation,alteration and endoleak,with remsrkable improvement in the blood supply of the aortic trie lumen and branches.Conchusion Satisfactory short-term results can be achieved with EVAR for patients with acute type B aortic dissection and CRI.At I month and 1 year postoperatively,no mortality or morbidity occumed such as endoleak,aortic rupture,neurologic and abdominal ischermia.

Objective To summarize our clinical experience and results of intraoperative stented elephant trunk technique on Stanford type B dissection.Methods From March 2009 to December 2011,24 patients of Stanford type B aortic dissection with insufficient anchored zone or the left subclavian artery involvement underwent intraoperative stented elephant trunk technique in Beijing AnZhen Hospital.Of these patients,20 were male and 4 female,with a mean age of (50.6 ± 9.8) years,(36-77 years).Associated with hypertension in 20 cases,aortic root aneurysm in 1 case,aortic insufficiency in 2 cases,mitral insufficiency in 1 case,coarctation of the aorta in 1 case; 14 cases had a history of smoking.The postoperative internal fistula after descending thoracic aortic stent-graft occurred in 4 cases.Results 24 patients of Stanford type B aortic dissection with insufficient anchored zone or the left subclavian artery involvement underwent intraoperative stented elephant trunk technique.Concomitant procedures included the bypass from the left subclavian artery to the left common carotid artery in 5 cases,aortic valve replacement and ascending aortic plasty in 3 cases,left subclavian artery reconstruction in 2 cases,double valve replacement in 1 cases,the bypass from ascending aorta to descending aorta each in one.The times of cardiopulmonary bypass and selective cerebral perfusion averaged (163.1 ±48.6) min and (29.1 ± 12.4) min,respectively.There was no in-hospital mortality.Complications occurred in 2 patients (2/24,8.3％),including respiratory insufficiency and mediastinal bleeding requiring reoperation,each in one.No paraplegia or stroke occurred postoperatively.Follow-up was available in 23 patients (23/24,95.8％).During the follow-up,type Ⅰ endoleak occurred in 2 patient and needed surgical repair.One patient underwent endovascular aortic repair due to pseudoaneurysm of the distal end of the stent.The complete thrombosis ratio of the false lumen was 86.4％ (20/24).Conclusion The intraoperative stented elephant trunk technique was safe and feasible for Stanford type B aortic dissection with insufficient anchored zone or the left subclavian.artery involvement,a low rate of morbidity and mortality were achieved.The long-term results need the further follow-up.

Objective This study aims to analyze midterm survival and to assess the midterm mortality following acute kidney failure (AKF) of patients undergoing surgical treatment of acute type A aortic dissection.Methods Clinical data of the patients who underwent Sun's procedure from February 2009 to March 2015 were collected.Patients with preoperative dialysis were excluded.Data including preoperative cardiovascular diseases,serum creatinine leve1 and CPB time were gathered.The patients were divided into the group of AKF and the group of non-AKF accounting to require dialysis.The group of AKF was follow-up by phone.Midterm mortality was studied with Cox analysis and midterm survival was estimated by Kaplan-Meier analysis.Results 524 patients underwent aortic surgeries which AKF was occurred in 51 (51/524,9.7％) patients.Hospital mortality was 23.5％ (12/51) in AKF group which seven death were strokes,three death were lower-extremity ischemia and two death were low cardio output.There were 2 patients dead with multi organ failure and paraplegia in first year.One reoperation patient because of anastomotic fistula was dead in fifth year.Only diabetes was independently associated with midterm mortality.Midterm survival for patients with AKF was 56％ during a median follow-up of 30.5 months.Survival was equal between the subgroups of Cr ＞ 200 mol/L and Cr ＜ 200 mol/L(P =0.741).Conclusion AKF after acute aortic dissection was a severe complication and the incidence was 9.7％.In patients with AKF,diabetes was associated with increased mortality across follow-up.Five years survival was 56％ not effected by preoperative Cr.

Objective To summarize our clinical experience and results of Stanford type B dissection,and analyzed the risk factors of reoperation.Methods From February 2009 to December 2011,81 patients (54 male and 27 female) of Stanford type B aortic dissection underwent surgical procedure in Beijing Anzhen Hospital The mean age was 19 -77 years,averaged (41.6±11.7)years.Associated with hypeftension in 48 cases,Marfan syndrome in 15 case,aortic root aneurysm in 7cases,dilation of aortic sinus and ascending aorta each in one,coarctation of the aorta in 1 case.Reoperation was done in 22cases and 4 of 22 needed the third operation.The risk factors of reoperation were analyzed with Logistic regression analysis.Results Sun (s) procedure was operated on 16 cases,concomitant procedures included Bentall in 7 cases,David in 1,replacement of the ascending aorta in 2 cases,CABG in 1 case.The thoracoabdominal aortic replacement in 31 cases,the descending thoracic aortic replacement in 9 cases,the stented elephant trunk procedure in 24 cases.Concomitant procedures included the bypass from the left subclavian artery to the left common carotid artery in 5 cases,aortic valve replacement and ascending aortic plasty in 3 cases,left subclavian artery reconstruction in 2 cases,double valve replacement in 1 cases,and the bypass from ascending aorta to descending aorta each in one,repair of internal leakage in 1 case.2 patients underwent thoracoabdominal aorta replacement died after surgery due to multiple organ failure caused by postoperative bleeding.The hospital mortality was 2.5％(2/81 cases).Complications occurred in 6 patients (6/81 cases,7.4.％ ),including diastinal bleeding requiring reoperation in 3 cases,respiratory insufficiency and hoarseness each in one,postoperative esophageal fistula needed reoperation and jejunal fistulization in I case.No paraplegia or stroke occurred postoperatively.Logistic regression analysis shows Marfan syndrome is the risk factor of reoperation.Conclusion The surgery on Stanford B aortic dissection can achieve satisfactory clinical results and Marfan syndrome is the risk factor of reoperation.The mid- and long-term results need the further follow-up.

Objective To discuss the timing and procedures of reoperations on the residual aortic dissection after initial ascending aortic operations on Stanford type A aortic dissection.Methods From March 2009 to November 2011,16 consecutive patients(13 males,3 females) underwent reoperations on the residual aortic dissection.The mean age was 44 years(23-61 years),8 cases was associated with Marfan syndrome.The right axillary artery or femoral artery cannulation was used for cardiopulmonary bypass,cerebral protection was achieved by unilateral antegrade brain perfusion and nasopharyngeal temperature was dropped to 20℃-25℃.The Sun's procedure (total arch replacement with stented elephant trunk implantation) was performed in all patients,concomitant procedure include aortic root replacement (Bentall procedune) in 3 patients,aortic root replacement and coronary artery bypass grafting (Bentall + CABG) in 1 patient,the coronary artery anastomotic leakage repair in 1 patient,mitral valve replacement (MVR) in 1 patient.Results The interval between two operations averaged(66 ±40)months.The means of cardiopulmonary bypass,cross clamp and selective cerebral perfusion times were(193 ± 49)minutes,(90 ±28) minutes and(22 ± 10) minutes,respectively.The mean time to tracheal extubation was(17 ± 10) hours.All patients survived from the operation.One patient suffered from temporary left lower limb paralysis and recovered after treatment during follow-up.Computed tomography angiography (CTA)of aorta was performed on each patient before discharged from the hospital:descending aortic true lumen was significantly expanded,thrombosis of false lumen was found near stent graft.The average follow-up time was 17 (3-42) months,one patient died of aortic rupture 3 months later,one patient underwent total thoracoabdominal aorta replacement 6 months later,one patient with descending thoracic aortic dilatation combined with endometrial tear underwent thoracic endovascular aortic repair.Conclusion Reoperation should be performed as the following condition:the annual growth rate of residual aortic diameter exceeds 0.5 cm/year,the maximal aortic diameter exceeds 5 cm.The Sun's procedure (total arch replacement with the elephant trunk implantation) is safe and effective in the treatment of residual aortic dissection,low mortality and complications was achieved by it,the mid-and long-term results need the further follow-up.