Objective To explore the operative methods and clinical outcomes in emergency or sube- mergency repair for the complicated tissue defects in hand in first stage applying microsurgical technique. Methods From Jan.,2000 to Aug.,2005,49 emergency cases of complicated hand tissue defects were re- paired in the first stage with replantation,reconstruction,free flaps,combined finger reconstruction and flap transplantation,including 21 cases in mini tissue mass replantation or reconstruction,15 cases in replantation combined with free flap transplantation,8 cases in replantation and reconstruction combined with free flap transplantation,5 cases in combined multiple digits reconstruction with free flap transplantation.The free flap transplantation included the anterolateral femoral flap,the latissimus dorsi myocutaneous flap,the dorsalis pe- dis flap,the media pedis flap and the instep flap.Results All the flaps,the replanted and reconstruceted finger survived uneventfully except for one replanted finger necrosis.45 cases healed in the first stage and the other 4 cases healed in the second stage.During a follow-up from 6 months to 3 years postoperatively,a satis- factory appearance and function of the reconstructed hand was achieved.The excellent and good rate was 85.7% assessed with provisional functional assessment criterion for upper limbs issued by Chinese Society of Hand Surgery.Conclusion The emergency or subemergency repair for the complicated tissue defects in hand has the advantage of short-term treatment and desirable functional outcome.The emergency replantation and reconstruction combined with various flaps or tissue mass can be applied to repair tissue defect in hand in the first stage according to the position and area of the defect along with the technique level of the surgeon, having been proved to achieve desirable clinical outcomes.And the key points leading to a successful operation is the correct treatment for the raw surface of the defects,suitable choice for various flaps,logical design of combination pattern and prevention and timely treatment for vessel crisis.

Objective To explore the methods for coverage of the defect of great toe after the wrap-a- round flap transferand decrease the morbidity of donor site in great toes.Methods Twenty-five patients received three kinds of procedure for immediate resurfacing of donor defect of the great toes during wrap-around flap transferAmong them9 cases received the free flaps for coverage of defect in donor great toes12 cases was repaired by local pedieled dorsal or plamarpedis flapsand the other cases were treated by the nail-flap of second toe.Results All the flaps were survivalTwo patients received the flap thinning procedure in 6 months laterall patients were satisfied with cosmetic and functional outcomeThe appearance and sensory function of donor toe repaired by second toe nail-flap was best among three methods.Conclusion Accord- ing the detect situation of great toesthree kinds of flap were selected for immediate coverage of donor site, which can decrease the complication of donor great toe at the most.

OBJECTIVETo compare therapeutic effects of locking plates for the treatment of Neer 3-and 4-part proximal humerus fractures.

METHODSFrom January 2009 to June 2011, 64 patients with Neer 3-and 4-part proximal humerus fractures were treated with locked plate fixation. There were 39 patients in the 3-part group including 16 males and 23 females, with an average age of (55.12 +/- 12.52) years old; and 25 patients in the 4-part fractures group including 9 males and 16 females,with an average age of (57.92 +/- 13.14) years old. The American Shoulder and Elbow Surgeons score (ASES), visual analogue scale (VAS) and complications were documented for analysis before and after treatment.

RESULTSAll the patients had incision healing at the first stage. All the patients were followed up, and the duration ranged from 12 to 30 months, with a mean of 16.5 months. Comparably better shoulder function recovery was achieved in the 3-part fractures group with regard to the ASES (76.14 +/- 14.10 in the 3-part fractures group vs. 65.93 +/- 11.82 in the 4-part fractures group, P < 0.05). Moreover,a statistical difference (P < 0.05) was observed regarding the VAS pain score (2.12 +/- 1.63 in the 3-part fractures group vs. 3.90 +/- 2.21 in the 4-part fractures group). For the complications rate,no statistical difference was noted between 3-part fractures group and 4-part fractures group (20.51% vs. 36.00%).

CONCLUSIONThe clinical outcomes of the 3-part proximal humerus fractures is better than the 4-part fractures proximal humerus fractures treated with locking plate. Complex proximal humeral fractures treated with locking plates can be achieved a satisfactory outcome when attention is paid to anatomic reduction, stable fixation, proper screws and plate placement, and reasonable functional exercise postoperative.

Adult ; Aged ; Aged, 80 and over ; Bone Plates ; Case-Control Studies ; Female ; Fracture Fixation, Internal ; instrumentation ; methods ; Humans ; Male ; Middle Aged ; Shoulder Fractures ; diagnostic imaging ; surgery ; Tomography, X-Ray Computed ; Treatment Outcome

Animals ; Astragalus Plant ; chemistry ; Coxsackievirus Infections ; physiopathology ; Flavonoids ; pharmacology ; Mice ; Mice, Inbred BALB C ; Myocarditis ; physiopathology ; virology ; Myocytes, Cardiac ; drug effects ; virology

Objective To explore the correlation between plasma Klotho and FGF23 levels with senile hypertension .Methods Totally 180 cases of hypertension aged more than 60 years old were selected as the research group and divided into the grade 1 hypertension group(60 cases) ,grade 2 hypertension group(60 cases) and grade 3 hypertension group(60 cases) .The age and pro‐portion of male to female were basically consistent .60 elderly people without hypertension were selected as the control group .The level of plasma Klotho and FGF23 protein were tested by ELISA .The lipid level was detected by the automatic biochemical analy‐zer .The detection results were compared with those in the control group for analyzing their correlation .Results Plasma Klotho protein level in each hypertension group was lower than that in the control group ,while plasma FGF23 protein level and BMI were significantly higher than those in the control group(P<0 .05) .With the blood pressure level increase ,plasma Klotho protein level was gradually decreased ,while FGF23 protein level was gradually increased .The negative correlation was found between plasma Klotho protein and FGF23 protein (r= -0 .282 ,P=0 .001) .Plasma Klotho protein and FGF23 protein had no obvious correlation with BMI (r= -0 .063 ,-0 .098 ,P>0 .05) .Conclusion Plasma Klotho protein and FGF23 protein levels have obvious correlation with the blood pressure level ,which may jointly participate in the occurrence and development of hypertension .

OBJECTIVETo explore Chinese medical theory of Fei and Dachang being interior-exteriorly correlated by observing changes of inherent immune response and acquired immune response in the lung tissue and the intestinal tissue of ulcerative colitis (UC) model rats and the intervention of Chinese compounds (CM).

METHODSSeventy rats were randomly divided into 5 groups, i.e., the normal control group (n = 10), the model group (n = 15), the treatment 1 group (n = 15, treated from Fei), the treatment 2 group (n = 15, treated from the intestine), and the Western medicine (WM) group [n = 15, treated with Sulfasalazine (SASP). Except those in the normal control group, the UC rat model was prepared by allergizing colon mucosa combined with TNBS-alcohol (50%) enema, and then intervened by medication (treated with CM complex prescription of treatment from lung, CM complex prescription of treatment from intestine, and SASP). After intragastric administration for 4 weeks, rats were sacrificed and samples taken. The expression of tumor necrosis factor α (TNF-α) and IL-8 contents in the lung tissue, the intestinal tissue, and the serum were detected by radioimmunoassay. Serum MedCAM-1 contents were detected using ELISA. Changes of the expression of Toll-like receptor 4 (TLR4), nuclear factor κB (NF-κB), neutrophil migration inhibition factor (MIF), mucosal addressin cell adhesion molecule-1 (MadCAM-1) mRNA in the lung tissue and the intestinal tissue were detected by real time PCR.

RESULTSCompared with the normal control group, the expression levels of TNF-α, TLR4 mRNA, IL-8, MIF mR- NA, and MadCAM-1 mRNA obviously increased in the model group (P < 0.01). Compared with the model group, the expression levels of TNF-α, TLR4 mRNA, IL-8, MIF mRNA, and MadCAM-1 mRNA obviously decreased in the treatment 1 and 2 groups (P < 0.01). The expression of MadCAM-1 mRNA in the intestinal tissue was obviously higher in the model group than in the normal control group (P < 0.01), while the expressions of TNF-α and NF-κB mRNA was obviously lower in the model group than in the normal control group (P < 0.05, P < 0.01). Compared with the model group, the expression of MadCAM-1 mRNA all significantly deceased in each treatment group (P < 0.05, P < 0.01). Serum TNF-α contents were higher in the model group than in the normal control group (P < 0.05). Compared with the model group, serum TNF-α contents could be lowered in the treatment 1 and 2 groups (P < 0.05, P < 0.01).

CONCLUSIONSThe main mechanisms of the intestinal injury in this UC model might be related with activation of acquired immune response, accompanied with lowered functions of inherent immune response. The main mechanisms of the lung injury in this UC model might be related acquired immune response and inherent immune response. Treatment from Fei and treatment from Dachang both could obviously improve the immunodissonance of Fei and Dachang, indicating the special relation between the lung tissue and the intestinal tissue, thus providing experimental evidence for Chinese medical theory of Fei and Dachang being interior-exteriorly correlated.

Aleurites ; Animals ; Colitis, Ulcerative ; drug therapy ; immunology ; Drugs, Chinese Herbal ; therapeutic use ; Enema ; Interleukin-8 ; metabolism ; Intestinal Mucosa ; immunology ; Intestines ; immunology ; Lung ; immunology ; Lung Injury ; NF-kappa B ; metabolism ; RNA, Messenger ; Rats ; Tumor Necrosis Factor-alpha ; metabolism

OBJECTIVETo assess the clinical feasibility of diagnosing and staging liver fibrosis by apparent diffusion coefficient (ADC).

METHODSTotally, 43 patients (mean age 29.3 years) with chronic hepatitis by liver biopsy and 7 healthy controls (mean age 39.9 years) underwent liver diffusion weighted imaging (DWI) with four b values: 0, 200, 500, and 1000 s/mm2 respectively. The liver fibrosis was staged according to Ishak fibrosis stage. The ADC value of liver fibrosis patients and healthy controls was compared. The correlation of ADC value and liver fibrosis staging was analyzed.

RESULTThe histological staging showed 8 stage 1 patients, 10 stage 2 patients, 6 stage 3 patients, 9 stage 4 patients, 8 stage 5 patients and 2 stage 6 patients. The mean ADC value of liver fibrosis patients was significantly lower than that of healthy controls except for stage 1 group (P < 0.05). There was a negative correlation between liver fibrosis staging and ADC value (r = -0.697 with b=500 s/mm2, P < 0.01). Receiver operating characteristic (ROC) curve of ADC value of advanced liver fibrosis (Ishak stage F3 and higher) showed that area under curve = 0.913, 0.825, and 0.794 with b = 500, 1000, and 200 s/mm2, respectively (95% confidence interval: 83.6%-99.0%, 70.7%-94.3%, 66.5%-92.4%; P < 0.05). When b value was 500 s/mm2, the sensitivity (84%) and specificity (80%) of DWI for diagnosis of advanced liver fibrosis were the highest.

CONCLUSIONDWI is proved to be a useful clinical tool in the quantitative evaluation of liver fibrosis and in the prediction of the process of liver fibrosis with the recommendable b value (500 s/mm2).

Adult ; Diffusion Magnetic Resonance Imaging ; methods ; Female ; Humans ; Liver Cirrhosis ; diagnosis ; pathology ; Male ; Middle Aged ; ROC Curve ; Young Adult

Optimization of cultivation condition of recombinant E. coli DH5 alpha/pDH-B2m and the condition suitable for expression of recombinant mature peptide of human bone morphogenetic protein-2 was carried out in 500 mL shaking flasks and then transferred to NBS Bioflo IV, a 20 L DO feed-back fed-batch culture system, to obtain rhBMP-2. The results indicate that keeping dissolved oxygen at 40% and controlling nutrient feeding rate with DO feed back strategy can obtain theoretically 3.59 g recombinant mature peptide of hBMP-2 per liter of broth, the final cell density OD600 reaches 57(22.8 g dry cell weight/L), and the expression of rhBMP-2 amounts to 30% of the total protein in E. coli.
Bone Morphogenetic Protein 2 ; Bone Morphogenetic Proteins ; biosynthesis ; genetics ; Culture Media ; Escherichia coli ; genetics ; Fermentation ; Glycerol ; pharmacology ; Recombinant Proteins ; biosynthesis ; Time Factors ; Transforming Growth Factor beta

OBJECTIVETo report the operative technique and clinical application of the neurocutaneous flap with anterior cutaneous branch of the femoral nerve supplied by the perforator of saphenous artery.

METHODSThe reverse neurocutaneous flap with anterior cutaneous branch of the femoral nerve supplied by the perforator of saphenous artery was used for repairing the defect around knee or at the upper pad of leg. Since Oct. 2005, 16 cases were treated. The flap size ranged from 15 cm x 7 cm to 30 cm x 15 cm. Flap rotation angle ranged from l00 degrees to 180 degrees.

RESULTS13 flaps survived completely. Flap necrosis happened at the 1/7 - 1/5 distal end of the 3 flaps, which healed with dressing or local flap advancement. The patients were followed up for 6 to 24 months with satisfactory functional and cosmetic results. There was no morbidity at the donor site.

CONCLUSIONThe flap has the advantages of both the perforator flap and the neurocutaneous flap. The size of the neurocutaneous flap with the anterior cutaneous branch of the femoral nerve can be enlarged for the large defect at lower extremity.

Adolescent ; Adult ; Arteries ; surgery ; Female ; Femoral Nerve ; surgery ; Humans ; Male ; Middle Aged ; Skin Transplantation ; methods ; Surgical Flaps ; blood supply ; innervation ; Young Adult

AIM:To investigate the clinical significance of stathmin 1 (STMN1) expression in cervical cancer and the influence of its expression on the viability and apoptosis of cervical cancer cells. METHODS:Western blot was used to detect the protein expression of STMN1 in cervical cancer tissues, and the relationship between the expression and clinical characteristics of cervical cancer was analyzed. STMN1-siRNA was transfected into cervical squamous-cell carcino-ma SiHa cells. The protein levels of STMN1, STAT3, p-STAT3 and survivin were determined by Western blot after trans-fection for 48 h. The cell viability was measured by MTT assay. The apoptosis was analyzed by flow cytometry. DCFH-DA probe was used to detect the level of reactive oxygen species (ROS). RESULTS:The protein expression of STMN1 in cer-vical cancer tissues was significantly higher than that in paracancerous tissues (P<0.01). The STMN1 protein expression level was not correlated with age and histological types of cervical cancer patients, but was related to clinical stage, histo-logical differentiation and lymph node metastasis ( P<0.01). Transfection with STMN1-siRNA significantly reduced the expression of STMN1 in SiHa cells. Compared with control group, the cell viability in STMN1-siRNA group was significant-ly decreased, the apoptotic rate and ROS content were increased, and the protein levels of p-STAT3 and survivin were down-regulated (P<0.01). However, no significant difference of the STAT3 protein level was observed between STMN1- siRNA group and control group. CONCLUSION:STMN1 is highly expressed in cervical cancer, and its expression is re-lated to clinical stage, histological differentiation and lymph node metastasis. Inhibition of STMN1 expression reduces the viability and promotes apoptosis of cancer cells by down-regulating STAT3 signaling pathway.