To explore the molecular mechanisms underlying the immunomodulatory effects of hypertonic sodium chloride and hetastarch 40 injection (HSH) resuscition on the development of lung inflammation in a hemorrhagic shock model, Sprague Dawley rats were subjected to hemorrhagic shock and intratracheal LPS,the so called two hit rodent model.The animals resuscitated by transfusion of either Ringer's lactate(RL) or a 6ml/kg volume of HSH were sacrificed at 1,2,4 hour after resuscitation,respectively. Surface expression of adhesion molecule CD11b on circulating polymorphonuclear (PMN) was measured by flow cytometry. Bronchoalveolar lavage fluid(BALF) neutrophil counts were determined.Lung tissue myeloperoxidase(MPO) activity reflecting total lung neutrophil infiltration was assessed by modified Bradly′ method. The results showed that resuscitation with HSH significantly reduced BALF neutrophil counts( P

Hepatic carcinoma is one of the most common malignant tumors in China.Autophagy activity and the change of Nrf2-ARE pathway play an important role in the process of liver tumors.Nrf2 which is an important regulator to liver cancer belongs to the CNC family.Research discovered that after the inhibition of autophagy,Nrf2-ARE pathway activation contributes to the progression of hepatocellular carcinoma.This article summarizes the relationship between autophagy and the Nrf2-ARE pathway and its impact on the hepatic carcinoma.

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 methods and effects of modified surgical treatment for Amold-Chiari Ⅰ malformation complicated with syringomyelia.Methods Twelve patients with ArnoldChiari Ⅰ malformation complicated with syringomyelia,underwent a modified surgical treatment,effects were observed.Results During the first follow-up,sensation and motion function were significantly improved in 10 cases,unchanged in 2 cases.During the second follow-up,2 cases previously unchanged were improved,while the other were with no change.During the first follow-up,lesion showed on MRI disappeared in 5 cases,reduced in 4 cases,no significant change in 3 cases,no case extend,3 cases with hydrocephalus ventricle was significantly reduced.The second follow-up,MRI showed that there was no change compared with the first follow-up.Conclusion The remove of the pia mater of tonsillar hernia + reconstruction the cisterna magna have good effect on surgical therapies for Arnold-Chiari I malformation complicated with syringomyelia.

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 To describe the technique and characteristics of simple hand-assisted laparoscopic resection of renal and adrenal. Methods A total of 37 patients (22 males and 15 females) underwent simple hand-assisted laparoscopic resection of renal and adrenal from June 1999 to April 2004.Their mean age was 52 years (range,25～65 years).Renal resection group included 29 cases,including 13 of renal carcinoma and 2 of renal pelvic carcinoma.All these 15 cases were staged as T 1N 0M 0.The average tumor volume of the renal resection group was 3 cm?3 cm?2 cm.8 of hydronephrosis,2 of renal tuberculosis,4 of renal atrophied.Adrenal tumor resection group included 8 cases;the average tumor volume was 4 cm?5 cm?6 cm. Results Simple hand-assisted laparoscopic resection of the tumors was performed successfully in 36 cases without any complication such as injury of intestines and other important abdominal viscera except 1 case who underwent open surgery.The mean operative time of nephrectomy was 145 min,and that of adrenal giant tumor resection was 125 min.The mean blood loss was 110 ml.The patients recovered well and were discharged 7 to 8 days after operation.Follow-up lasted 3 months to 5 years after operation.Of the 37 cases,35 survived healthily;2 with renal carcinoma died (1 died of cerebrovascular accident 2 years after operation and the other died of brain and pulmonary metastasis 3 years after operation). Conclusions Simple hand-assisted laparoscopic resection of renal and adrenal giant tumor has the advantages of easier performance,shortened operative time and faster recovery from operation.Thus,this technique is worthy of popularization.

Objective:To evaluate the results of repairing furcation and root perforation using Mineral Trioxide Aggregate(MTA).Methods:Cases with furcation perforations were divided into two groups randomly,MTA and IRM(control group)methods were adopted in present study.Cases that had root perforations were treated with MTA.Pretreatment,immediate posttreatment,and 1year follow-up radiographs were evaluated in a double-blind manner to determine the presence or absence of any pathologic changes adjacent to the perforation site.Results:21 cases were involved.The healing rate of furcation perforation in MTA group was higher(80%)when compared with that in IRM group(75%).However,statistical analysis showed no significant difference in success rates between both groups(P=0.722).The healing rate of root perforation using MTA was 100%.Conclusion:MTA provides an effective seal of furcation /root perforations,and promises in improving the prognosis of perforated teeth.

Objective To study the out come of coblation arytenoidectomy combined with true and false pos-terior cordectomy for treatment of bilateral vocal cord paralysis (BVFP) .Methods The group included 17 patients (8 incomplete BVFP and 9 complete BVFP) .All the patients had waited more than 6 months before surgery with no spontaneous recovery .The patients underwent arytenoidectomy combined with true and false posterior cordecto-my using coblation under video suspension laryngoscope .Electric fibrolaryngoscope was performed before and after operation to evaluate the size of the glottis .The patients'voices were recorded before and after operation and evalua-ted by 3 laryngologists through GRBAS .Results Preoperational laryngoscope showed that in the incomplete BVFP ,the vocal folds were close to the middle line with limited abduction .In the complete BVFP ,the vocal folds failed in adduction and abduction and the size of the glottis was 2 -3mm .3 of the patients had underwent tracheotomy . Post operational electric fibrolaryngoscope showed proximate triangulate breathing space which was more than 4mm in the posterior glottis .The patients were followed up 6 to 44months .15 of the 17 were allowed for decannulation . One patient among them underwent posterior cordectomy and arytenoidectomy on the contralateral side respectively after the first operation because of dyspnea owing to scar diathesis .Two patients bunged up the canula but did not de-cannulate .Among them one was a 8-year old boy diagnosed as congenital heart disease .One was thyroid cancer with stiff neck due to radiology .The only postoperative complication was the appearance of granulations in the operation region in 2 patients ,which were disappeared spontaneously .Quality of the voice improved in 2 patients ,unchanged in 10 and worsened in 5 .Conclusion This study demonstrates that arytenoidectomy associated with posterior cord-ectomy is a satisfactory surgical treatment of bilateral vocal fold paralysis because it leads to a considerable and stable enlargement of the breathing space and preserved the voice quality .

Objective To determine the effects of isoflurane on the amino acid neurotransmitter contents in rat cerebral cortex, hippocampus and spinal cord. Methods Sixteen male SD rats weighting 220-280g were randomly divided into two groups: isoflurane group (A) and control group (B). Animals in group A were killed after 30min inhalation of 1.3% isoflurane and cerebral cortex, hippocampus and spinal cord were removed immediately for determination of glutamic acid (Glu), aspartic acid (ASP), glutamine (Gln), GABA and glycine (Gly) levels by high-performance liquid chromatography (HPLC), whereas in group B O2 was inhaled instead of isoflurane. Results As compared with control group, Asp and Glu levels in cerebral cortex and hippocampus decreased markedly while Gly level increased significantly in hippocampus and spinal cord in isoflurane group. Conclusions The inhibition of excitatory amino acid synapse transmission and augmentation of inhibitory amino acid synapse transmission may be involved in the mechanism of isoflurane anesthesia.