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

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 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.

Objective To explore the influence of HepG2 cells' proliferation and autophagy by the Nrf2-ARE pathway,and provide the experimental basis for clinical exploring effective liver cancer treatment.Methods Hepatic carcinoma HepG2 cells were cultured,and its proliferation inhibition rates and the change of cell cycle' s in each phase were explored by the MTT assay and flow cytometry.The hepatoma cells' autophagy was qualitative observed by inverted phase contrast microscope and fluorescence microscope.Results Inhibitory rate of HepG2 cells was obviously higher in the Nrf2 inhibitor BML-111 group than control group (P ＜ 0.05),and the control group was aslo obviously higher than the Nrf2 inducer EGb group (P ＜ 0.05).Flow cytometric analysis showed that G1 phase cells in the cell cycle increased,S phase cells reduced and G2/M period cells relatively increased in the Nrf2 inhibitor BML-111 group.But G1 phase cells reduced,S phase cells increased and G2/M period cells relative reduced in the Nrf2 inducer EGb group.Inverted phase contrast microscope and fluorescence microscope checked that ranging from the size of the bubble and autophagosome formed in Hepatoma HepG2 cytoplasmic of the Nrf2 inhibitor BML-111 group.Conclusions The Nrf2-ARE pathway played an reverse inhibition on HepG2 cells' proliferation and autophagy.After the inhibition of Nrf2-ARE pathway,HepG2 cells mostly stayed in the G1 phase of the cell cycle.

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 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.

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 study X-ray and CT findings of retroperitoneal fibrosis and their value for diagnosis of this disease.Methods X-ray and CT findings and clinical data of 5 cases confirmed with retroperitoneal fibrosis by clinicopathology were retrospectively analysed in combination with literature review.Results X-ray and CT manifestations of retroperitoneal fibrosis included diffuse mass at retroperitoneum,the neighboring organs were enveloped by masses,and one or bilateral renal pelvis and the ureter expansion.Conclusion X-ray and CT have vital clinical significance in diagnosing the retroperitoneal fibrosis.

Objective To reproduce an experimental model of blast injury to dog brain simulating the mechanism of primary effect of the blast wave of explosive weapons.Methods A spherical explosive with explosive energy of 1gTNT was used to detonate at different distances(9mm,13mm)from the right temple to produce blast injury to the dog brain.The changes in physiological index before or after detonating and the surviving time after injury were recorded.The changes in the behavior of the wounded animals and characteristics of pathological changes in the brain were observed.Results Respiratory arrest,hypotension,and decreased heart rate were observed after wounding.All animals survived longer than 6 hours after the explosion injury.Obvious subdural hematoma and sub-arachnoid hemorrhage occurred frequently.Traumatic conditions of the brain were different in the two groups.Conclusions The animal model reproduced in this experiment simulates that produced by blast wave of explosive weapons.It is reproducible,easy to handle,and can be used in experimental study of blast injury to the brain.