Objective To investigate the relationship between the ultrastructural features combined with the expression of connexin ( Cx43 ) protein in uterine junction zone and pathogenesis of adenomyosis.Methods From Nov. 2008 to Nov. 2009, 30 patients with adenomyosis (including 14 cases with proliferative endometrium and 16 cases with secretory endometrium) as study group matched with 30 women with cervical intraepithelial neoplasia (GIN) Ⅲ treated by hysterectomy as control group were enrolled in this study in Affiliated Hospital to Inner Mongolia Medical College. The expression of Cx43 in uterine junction zone of patients with adenomyosis was detected by immunohistochemisty staining. The ultrastucture of eutopic endometrium, uterine junction zone and outer 1/3 myometrium in both groups without history of dilatation and curettage, C-section and uterine surgery were observed by using transmission electron microscopy. Results ( 1 )The expression of Cx43 in proliferative and secretroy uterine junction zone were 0.133 ±0.018 and 0.137 ± 0.021 in study group and 0.154 ±0.016 and 0.141 ±0.018 in control group,which reached statistical difference (P ＜0.05). However, it didn't show significant expression of Cx43 between proliferative and secretory uterine junction zone in study or control group ( P ＞ 0.05 ). The expression of Cx43 in proliferative and secretory of eutopic endometrium of 0.067 ± 0.017 and 0.062 ± 0142 in study group were significantly lower than 0.094 ±0.005 and 0.080 ±0.005 in control group. It didn't show statistical difference of Cx43 expression between proliferative and secretroy eutopic endometrium in both group. The expression Cx43 in outer myometrium of proliferative phase were 0.184 ± 0.022 in study group and 0.188 ± 0.028 in control group, which did not show significant difference (P ＞0.05). It also did not exhibit statistical difference of Cx43 expression in outer myometrium of secretory phase (0.178 ± 0.022,0.191 ± 0.025,P ＞0.05). (2) Morphological changes: the area of uterine smooth muscle cells of the uterine junction zone of (24. 3 ± 1.6) μm2 in study group were significantly increased than (21.8 ±2.0)μm2 in control group (P ＜ 0.01 ). The length of the cell membrane dense plaques of (1.07 ± 0. 17 )μm in study group was significantly increased than (0.71 ±0.07) μm in control group (P ＜0.01 ). The myocytes exhibited cellular hypertrophy and disordered arrangement and fewer caveolae. There was cylindrical and dentate, chromatin margination, more heterochromatin in which muscle cells of nuclear surface of the uterine junction zone. Less cytoplasmic myofilaments and more intermediate filaments. Mitochondria were increased,the volume increased significantly vacuolization. The rough endoplasmic reticulum and Golgi apparatus were more prominent. Otherewise, mast cells and fibroblasts were close and glandular epithelial cells showed desmosome connection which villus thickening and dense. All features were more prominent at the junctional zone. Conclusions The down-regulation of Cx43 expression and ultrastructure changes in the junction zone might play an important role in pathogenesis of adenomyosis.

Objective To study the effect of poly- DL- lactic acid (PDLLA) absorbable membrane on preventing adhesion after repair of peripheral nerve injury. Methods 60 SD rats were divided into 2 groups randomly: the suturing+ PDLLA group (experimental group) and the purely suturing group (contrast group), with 30 rats in each group. Their sciatic nerves were cut off and then sutured microsurgically. In the experimental group, the anastomotic stoma was encapsulated with PDLLA membrane; in the contrast group, there was no such a treatment. We conducted gross observations and histological examinations at 2, 4, 8, 12, and 16 weeks after operation, neural electrophysiological examinations at 12 and 16 weeks after operation, and image analysis by computer at 16 weeks after operation. Results The scar proliferation and adhesion near the anastomotic stoma in the experimental group were less extensive than those in the contrast group; regenerative nerve fibers grew more straight and orderly manner. Electrophysiological examinations and image analyses by computer also showed that the experimental group achieved better results than the contrast group. Conclusion Poly- DL- lactic acid (PDLLA) absorbable membrane can prevent scar proliferation and adhesion after repair of peripheral nerve and promote nerve functional recovery effectively.

Objective To repair and reconstruct severe burn wounds on face,hands and joints with the principles and techniques of plastic and aesthetic surgery.Methods Twenty three burn victims in a single batch were transferred from a remote area to our Burns Institute on post burn day 2,June 28,2006.All the patients were males aged from 17 to 46 years,with a mean of 24.4?6.3 years,the mean total burn area was 15.7%?13.9% TBSA(ranged from 6% to 75%),with moderate to severe inhalation injury,and fourteen of them had received tracheostomy.The burn areas on face ranged from 0.5% to 3% TBSA,and all of them were deep second or third degree burn.The burn areas on hands ranged from 1% to 4% TBSA of deep second or third degree.On post burn day 3,the patients received escharectomy or tangential excision of eschar on hands followed by split thickness skin grafting with the principles and techniques of plastic and aesthetic surgery.During post burn week 2 to 3,the eschar on the faces were peeled off,followed by split-thickness skin grafting according to the principles and techniques of plastic and aesthetic surgery.Results All the wounds on the face and joints were repaired successfully,the configuration and functions were satisfactory.Conclusion It is feasible to repair the burn wounds on face and joints with the principles and techniques of plastic and aesthetic surgery for the burn patients of mass fire catastrophe.

Objective To study the diagnostic value of 3-dimensional CT reconstruction in posterior urethral strictures or ankylurethria.Methods Thirty patients with strictures or ankylurethria of posterior urethra caused by pelvic fracture underwent helical CT scan and 3-dimensional reconstruction of the urethral canal as well as radiographic urethrography before and post open urethral reconstruction to observe the urethral anatomy,the length and position of the urethral strictures,the depth of periurethral scar.Results The mean stricture or ankylurethria length measured by radiographic urethrography was 4.0 cm (range from 1.0 cm to 7.0 cm),and the correlation coefficient of stricture or ankylurethria length was 0.92,21 (70%) patients were diagnosed accurately by radiographic urethrography.The mean stricture or ankylurethria length measured by 3-dimensional CT reconstruction was 4.3 cm (range from 1.2 cm to 7.6 cm),and the correlation coefficient of stricture or ankylurethria length was 0.96,there were 28(93%) patients diagnosed accurately by 3-dimensional CT reconstruction.The mean stricture or ankylurethria length measured by open urethral reconstruction was 4.2 cm (range from 1.5 cm to 7.5 cm).Five patients with urethrorectal fistula were also diagnosed accurately by 3-dimensional CT reconstruction rather than by radiographic urethrography.Conclusions 3-dimensional CT reconstruction of the urethral canal can accurately evaluate the urethral anatomy,the length and position of the urethral strictures,as well as the depth of periurethral scar after crush injury and provide useful information for operation that may not be provided by radiographic urethrography.3-dimensional CT reconstruction may become the most valuable means for detecting posterior urethra strictures or ankylurethria with urethrorectal fistula.

Objective To determinted whether GM1 had a protective effect on injury induced by serum-deprivation and the possible mechanism in PC12 cells. Methods The viability of PC12 cells was quantified by MTT after serum-deprivation.The number of apoptotic cells and necrotic cells were determined by Hoechst 33258/PI staining.And the change of PKC protein expression on PC12 cells' membrane and cytosols was detected by Western blotting. Results 1.The viability of PC12 cells decreased after serum-deprivation and the serum-deprivation for 24 hours was chosen as an injury model in this research.Most of the PC12 cells presented apoptosis 24 hours after serum-deprivation.In addition,the PC12 cells' cytosols PKC protein decreased,while the PC12 cells' membrane PKC protein increased significantly,and this result suggested PKC's translocation to membrane and its activation.2.The viability of PC12 cells preincubated with GM1 in high concentrations(10,1,0.1?mol/L) increased significantly and GM1 protected PC12 cells from apoptosis after serum-deprived injury.GM1 reduced the damage of serum-deprivation on PC12 cells and inhibited PKC protein translocation after injury.3.The repair function of GM1 was effective to neuronal resume after serum-deprived injury.Conclusion Neuroprotective effects of GM1 on serum-deprived injury may be partly mediated through the regulation of PKC pathways and it is helpful for the recovery after injury.

No abstract available.
Infant ; Infant, Newborn ; Lissencephaly* ; Spasms, Infantile*

Objective To investigate the feasibility of using small intestinal submucosa (SIS) graft for the repair of anterior urethral strictures. Methods From June 2009 to August 2010, 18 men (mean age, 38 yrs) with anterior urethral strictures underwent urethroplasty using a four-layer SIS as an onlay patch graft. SIS was used to augment the urethral caliber at the stricture site. The mean stricture length was 4.6 cm (range 3.5 to 7 cm). The pre-operative mean maximal flow rate was 3.8 ml/s (range 1.5 to 5.5 ml/s). The required SIS grafts (4 to 7.5 cm long and 2 cm wide) were positioned into the urethrotomy defect and were spread-fixed to the corpora cavernosa using 5-0 polyglactin interrupted sutures. Two apices of the graft were sutured to the proximal and distal apices of the urethrotomy with 5-0 polyglactin interrupted stitches. The margins of the opened urethra were sutured to the SIS patch with 5-0 polyglactin running sutures. Results The mean follow-up period was 10 mon. (range 6-18 mon.). No postoperative complication, such as infection or rejection related to the use of heterologous graft material was observed. Seventeen patients voided well postoperatively with the mean peak urine flow of 25.4 ml/s (14-44 ml/s). Cystoscopy revealed that at four weeks and six weeks, the SIS graft was well distinguishable from the normal surrounding tissue; and at 16 weeks, the urothelium was regenerated and the biomaterial was not distinguishable from the normal surrounding tissue. The squamosal epithelium was seen in the histological examination of the grafts. The remaining one patient with failed hypospadias developed a slight urethral narrowing at five months post-operatively and needed sound dilatations. Conclusions SIS matrix appears to be a safe and effective reconstructive material in selected urethral reconstructions.

ObjectiveTo improve the recognition of lichen sclerosus (LS) involving the anterior urethral strictures and to investigate the outcome of urethroplasty using free mucosal grafts for the treatment of urethral strictures caused by LS. MethodsFrom January 2007 to December 2010,36 patients with anterior urethral strictures caused by LS were treated using oral mucosal grafts or colonic urethroplasty.The mean age was 41 years (range,27 -75) and the mean anterior urethral stricture length was 11.5 cm (range,5.0 -20.0 cm).Of the 36 patients,27 patients underwent dorsal lingual mucosal graft or combined buccal mucosal graft urethrography.Eight patients underwent colonic mucosal urethrography according to the length and seriousness of urethral strictures,and the remaining patient underwent anterior urethral split.Biopsies were taken from the glans,urethral meatus and urethra before urethroplasty. ResultsThe urethral silicone stent was removed 21 d post-operatively and all the patients voided well.An epithelial-stromal lesion characterized by hyperkeratosis,thinned epithelium and diffuse perivascular lymphocyte infiltrate was seen upon histological examination of the biopsied areas.The mean follow-up was 22 ( range,6 - 50) months post-operatively.Meatal stenosis developed in 2 patients undergoing oral mucosas urethroplasty and 1 patient with colonic urethroplasty,the patients voided very well after re-operation.The other patients voided well and the urinary peak flow rates ranged from 17.2 to 47.0 mL/s ( mean,23.4). ConclusionsFree mucosal grafts urethroplasty can obtain good results for the treatment of urethral strictures caused by LS.But there is a risk of recurrence of urethral stricture and closing follow-up is required,especially for meatal stenosis.

ObjectiveTo investigate the long-term outcome of urethral reconstruction using colonic mucosa grafts for the treatment of long-segment,complex urethral strictures and to identify clinical factors that impact long-term outcomes. MethodsForty-six patients underwent colonic mucosal graft urethroplasty from October 2000 to September 2009 were retrospectively reviewed.The mean age was 39 years ( range,17 -70).The patients underwent an average of 2.7 prior unsuccessful repairs and the mean length of urethral strictures was 15.2 cm (range,10.0 to 20.0).The voiding status of all patients was evaluated postoperatively.Some of the paitents underwent uroflowmetry.urethrography and urethroscopy.Successful repair was defined as voiding well with urinary peak flow greater than 15 ml/s without the need for any post-operative procedures,such as dilatation. ResultsUrethral reconstruction was done with colonic mucosa grafts 11.0 -21.0 cm long (mean 15.4).One patient was lost to follow-up.Mean follow-up in the remaining cases was 62 months ( range 20 - 120 ).Complications related to urethroplasty developed in four patients (8.9％).Of these patients,meatal stenosis developed in three patients at 3,8 and 24 months respectively.Anastomotic site stricture occurred at the neourethra and proximal urethra in one patient at 29 months.In another two patients,recurrent strictures unrelated to urethroplasty were found. ConclusionsColonic mucosa graft urethroplasty could be an effective technique for the treatment of complex urethral strictures or panurethral strictures.The factors that impact long-term outcomes are meatal stenosis and stenosis at the anastomosis.

BACKGROUND:Ankle fracture combined with deltoid ligament injury can disorders the anatomical structure of ankle joint. Improper treatment can cause more serious complication, such as walking disorders.
OBJECTIVE:To evaluate the clinical effect of anchor repair plus open reduction internal fixation in the treatment of ankle fracture combined with deltoid ligament injury.
METHODS:Thirty-five patients with ankle fracture combined with deltoid ligament injury were selected from the Department of Orthopedics, the Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University between May 2009 and January 2011, including 24 males and 11 females, and al the patients were treated with anchor repair plus open reduction internal fixation. The age of the patients was 22-61 years, averaged 35.7 years, and al the patients were closed injury without other fractures. The treatment time was 2-10 days, average 4.6 days. According to Lauge-Hansen classification, 26 patients had supination-eversion ankle fracture and nine patients had pronation-eversion. According to Danis-Weber classification, 26 patients were C type and nine patients were B type. After al the three patients were treated with anchor repair, the treatment effect of anchor repair was evaluated through assessing the improvement of clinical symptoms and signs, as wel as the imaging examination of repair and healing.
RESULTS AND CONCLUSION:Al the 35 patients were fol owed-up for 9-26 months, average 13.8 months. Al the patients got Ⅰ stage healing without complications of infection and screw loosening. Fol ow-up X-ray film showed al the 35 patients with ankle fracture achieved bone union, the healing time was 10-21 weeks, average 13.6 weeks. Modified Baird-Jackson score system showed excel ent in 11 cases, good in nine cases, average in four cases, poor in one case, and the excel ent and good rate was 85.7%. At 6 months after internal fixation, the stress X-ray film examination showed the mal eolus gap of the affect side was (3.49±0.36) mm, the mal eolus gap of the healthy side was (3.37±0.41) mm, and there was no significant difference (P>0.05). The results indicate anchor in the repair of deltoid ligament injury during the treatment of ankle fracture with open reduction internal fixation can achieve satisfactory therapeutic effect.