BACKGROUND:Chronic ankle instability can cause traumatic joint disease and secondary adhesive capsulitis, and even result in permanent dysfunction.
OBJECTIVE: To explicit the forming reason of chronic ankle instability and to investigate the diagnosis and treatment methods of chronic ankle instability based on the biomechanical analysis of the ankle joint.
METHODS: PubMed and Wanfang databases were retrieved for review and basic research papers about the anatomy, biomechanics, diagnosis and treatment of chronic ankle instability published from January 1990 to December 2014. The keywords were “chronic ankle instability, anatomy of ankle joint, biomechanics, therapy, research” in English and Chinese, respectively. After screening, 40 papers were included to summarize the anatomical structure of the ankle joint, mechanism and classification, diagnostic methods, and treatment methods of chronic lateral ankle instability.
RESULTS AND CONCLUSION:Diagnostic methods of chronic ankle instability include ankle varus stress test, ankle anterior drawer test, ultrasonic test, modern imaging detection; and therapeutic methods for chronic ankle instability can be divided into conservative treatment and surgical treatment, and the surgical treatment can be subdivided into non-anatomic reconstruction and anatomical repair of the damaged ligament. Early diagnosis and effective treatment are recommended for patients with chronic ankle instability, and the treatment programs should be determined based on comprehensive analysis of ankle anatomical structure, biomechanical characteristics, pathogenesis, and diagnostic results.

Objective To observe the effect of different ultraviolet on HaCaT and offer experimental evidences for further studies of the pathogenesis of photodermatitis. Methods Using different dose of UVA and UVB to irradiate HaCaT cell line respectively. 12 hours later, the morphology of HaCaT cells was observed and the sum was calculated. Results The cell linkage was loose and the refraction was weak with some dead cells. The effect of large dosage of UVB was more obvious. Conclusions the effects on keratinocyte after UV exposure are different according to the dose of irradiation, which offers experimental evidences for the further study of the pathogenesis of photodermatitis.

Objective To explore the characteristics of nosocomial infection and its related factors among those very low birth weight infant(VLBWI)for coming up with appropriate preventive measures.Methods Fifty-eight infants with birth weight of 1500 g or below in the hospital from January to June in 2012 were studied actively and retrospectively about their nosocomial infection and related risk factors.Results Thirty-five cases of nosocomial infection occurred among the 58 infants with a prevalence of 60.34%. The mainly pathogenic bacteria was Gram-positive bacteria(88.47%)and mostly,infections presented with lung infections(82.90%) within 21 days after birth.The risk factors included mechanical ventilation,PICC,Apga score<7,fluconazole administration and premature rupture of membranes of VLBWI.Conclusion VLBWI are prone to nosocomial infections,mostly lung infection on day 21 after birth.Management should be strengthened within 3 weeks after birth of VLBWI to minimize infections.Reduction of invasive procedures on children and antibiotic use is particularly important.On the other hand,strengthening the health care in the perinatal period and reducing the incidence of preterm birth cannot be ignored.

Objective To study the clinical and pathologic changes in gigantomast.Methods Tissue sections were prepared from 180 cases of breast hypertrophy and 45 cases of normal breast tissues.The morphological changes and the expression and localization of ERRγwere evaluated on the HE and immunohistochemistry stained sections between hypertrophy and normal breast tissues.Results Compared with normal breast,hypertrophic breast showed expended ducts and obvious hyperplasia of the duct epithelial papillary.Hypertrophic breast tissues demonstrated strong expression of ERR-γ in ducts and lobules.Conclusions Upregulated expression of ERRγ is identified in hypertrophic breast tissues that may associate with the development of gigantomastia.

Antithrombin III (AT III) is the most important anti-clotting substance. Recombinant human antithrombin III (rhAT III) expressed in transgenic goat milk attracts more and more attention. Develop an effective purification route for rhAT III is vital to its industrial production. An efficient purification method was developed for the rapid purification of rhAT III by isoelectric precipitation and heparin affinity chromatography. First, casein was effectively removed by isoelectric precipitation. rhAT III was further purified by heparin affinity chromatography. In the process of heparin affinity chromatography, the effects of pH and temperature on the stability of rhAT III were studied, and the effects of operating conditions, elution gradient, flow rate and sample loaded, on the purification efficiency were also studied. Under the optimized conditions, the protein recovery of rhAT III was about 90% with purity over 99%, while its activity recovery was about 50%. Such a purification process is very simple and effective, and it would provide a valuable reference for the further scaling-up of industrial production.
Animals ; Animals, Genetically Modified ; Antithrombin III ; biosynthesis ; Chromatography, Affinity ; Female ; Goats ; Heparin ; Humans ; Mammary Glands, Animal ; metabolism ; Milk ; chemistry ; Recombinant Proteins ; biosynthesis

OBJECTIVETo reconstruct a simpler and reliable composite tissue transplantation model-the femur osteomyocutaneous flap for the replacement of hindlimb transplantation.

METHODSTen femur osteomyocutaneous flaps from 5 Lewis rats were transplanted into 10 syngeneic recipients' inguinal region. Their nutrient vessels were anastomosed with recipients vessels. The graft of this model was consisted of the groin flap and partial femur. To verify the feasibility of this model, gross and histological appearance were studied after transplantation to evaluate the viability of grafts.

RESULTSThe operative time was (159.0 +/- 8.3) min with the harvesting time of (68.0 +/- 4.8) min and the ischemia time of (55. 8 +/- 6.8) min. The methylene blue injection showed rich blood supply of transplanted femur osteomyocutaneous flap. All the 10 flaps survived completely with pink skin color and hair regrowth. The histologic examination of the flaps also revealed the normal appearance of the viable skin and bone marrow.

CONCLUSIONSThe femur osteomyocutaneous flap is a simple and reliable model for composite tissue transplantation, and its establishment will provide a new tool for the study of composite tissue allografts.

Animals ; Bone Transplantation ; Femur ; transplantation ; Male ; Models, Animal ; Muscle, Skeletal ; transplantation ; Rats ; Rats, Inbred Lew ; Skin Transplantation ; Surgical Flaps ; Tissue Transplantation

BACKGROUND:Mouse pluripotent stem cel s are induced to differentiate into insulin-secreting cel s that can effectively improve blood glucose levels in diabetic mice. OBJECTIVE:To detect mRNA and protein levels of insulin-like cel clusters from induced pluripotent stem cel s and to investigate the function of insulin-secreting cel s in vitro and in vivo. METHODS:Mouse induced pluripotent stem cel s cultured in vitro were induced to differentiate into insulin-secreting cel s using combined inducers through three stages. The morphology of endodermal cel s, islet-derived progenitor cel s and mature islet cel s in each stage was observed and relative gene expression levels were detected by PCR. Mature insulin-like cel clusters underwent dithizone staining and functions of insulin released in vitro were observed by ELISA assay. Final y, the insulin-secreting cel s were transplanted into the subrenal capsule of diabetic mice, and then blood glucose levels were observed. RESULTS AND CONCLUSION:The mature spherical insulin-like cel clusters were successful y obtained in vitro, which were in iron red by dithizone staining, and expression of insulin mRNA was determined by PCR. The insulin-like cel clusters could secrete insulin in response to various blood glucose levels by ELISA assay. In addition, after the cel s clusters were transplanted into the subrenal capsule of mice with type 1 diabetes, the blood glucose levels were marbedly improved.

Objective To investigate the therapeutic effect of the microdissected thin fibular skin flap of the great toe to repair the finger pulp defect,and to discuss the operation and outcome of the flap for finger pulp defect.Methods From September,2012 to January,2016,12 cases of finger pulp defect were treated with the thin fibular skin flap of great toe removed partially subcutaneous fat under the microscope.One case for index finger,3 cases for middle finger,4 cases for ring finger,and 4 cases for little finger.Among them,5 cases were crush injury,6 cases were stamping injury,1 case was avulsion injury.The flap area was 3.0 cm×1.5 cm-3.2 cm×2.2 cm.The donor site was closed directly or covered with flap.Results All the 12 flaps survived completely without blood supply crisis,and the primary healing was achieved in donor site.Ten cases were followed-up from 6 months to 36 months.The blood-supply,texture and elasticity of transferred flaps and the shape of fingers pulp were excellent.Function recovery of the fingers was good.Pain and temperature sense were regained without hypersensitivity,two-point discrimination of finger pulp was 5-8 mm.Conclusion It is a reliable approrach for the repare of the finger pulp defects using the microdissected thin fibular skin flap of the great toe,especillay in repare finger pulp defect of ring and little finger.

Objective To investigate a anatomy research and clinic application of defect of thumb by reverse dorsoradial thumb flap of different rotation point.Methods The origin,course,distribution and vascular chain of the first metacarpal dorsoradial artery of thumb from 11 adult cadaveric hand specimens perfused by red latex were explored from September,2012 to December,2016.There were 3 different rotation points:the proximal of the metacarpophalangeal joint,proximal basal of the first proximal phalanx and distal of the first proximal phalanx.Each could be used as reverse flow flap to repair the defect of thumb.Results The first metacarpal dorsoradial artery of thumb originated from the radial artery and the initial diameter was (0.68±0.26) mm,diagonally across the extensor pollicis brevis tendon and then along the radialis part and terminated in the proximal of the first proximal phalanx of the vascular chain.There was a constant communicating branch among the proximal metacarpophalangeal joint,proximal basal of the first proximal phalanx and digital arterial dorsal branch.All the proximal of the metacarpophalangeal joint 4.3 mm to 10.2 mm and proximal basal of the first proximal phalanx 4.9 mm to 7.2 mm could be used as the rotation point of the flap.The flap of the first promixal phalanx blood supply was based on the vascular chain of neurocutaneous.There was a constant dorsal branch of the pollical artery,which was 8.6 mm to 10.3 mm far from the interphalangeal joint,could be used as the rotation point of the flap.Twenty-four cases with soft tissue defects of thumb were repaired by reverse dorsoradial flap.The flap size ranged from 2.0 cm×1.5 cm to 3.5 cm×2.8 cm.The follow-up period was 3 months to 12 months,protective sensations were restored,and skin flap two-point discrimination were 9.0 mm to 12.0 mm.The appearance of the thumbs was satisfactory.Conclusion Different rotation point of reverse dorsoradial flap can successfully repair the defect of thumb.The operation has advantages of simple,reliable blood supply,high success rate and is an ideal option for reconstruction the defect of thumb.

Objective To explore the anatomic basis of the thinning of the free posterior tibial artery perforator flaps and the clinical effect of repairing wound on hand or foot due to trauma.Methods From November,2016 to December,2017,10 cases of lower extremity cadaver specimens perfused with red ralex were dissected,which were perfused through the amputated femoral artery.Five of them were left and the rest were right.All cases were males.The number,diameter,branches and distribution of the perforator was observed.From September,2012 to September,2017,there were 13 cases of clinical application,which were 5 cases of hand wound and 8 cases of foot wound.The size of the wound was 3.0 cm × 2.0 cm to 6.0 cm × 4.0 cm,and the flap area was 3.5 cm × 2.2 cm to 6.5 cm × 4.5 cm.The repairing procedure was suitable for the wound associated with tendon,bone,joint capsule exposure.Results The number of posterior tibial artery perforating branches that more than 0.50 mm in diameter was 4 to 6,and the mean diameter was (0.87±0.26) mm.The perforating branch penetrated into the fat layer and was divided into 3 layers of vascular network:deep fat vascular network,superficial fat vascular network and subdermal vascular network.The perforating branch was located according to the positional relationship from deep to shallow,and vessel diameter become smaller step by step.The perforating branch trunk gave off branches to the deep vascular network,and the superficial vascular network had the same origin or shared with the deep blood vessels.The subdermal vascular network issued from the superficial vascular network or directly from the perforating branch trunk.There was no or few communicating branch between the deep vascular network and superficial ones,besides the vessel pedicle.So trimming deep fat layer will not affect the blood supply of superficial vascular network and neither will affect the flap blood supply.Most of the deep fat tissue was trimmed in 13 cases.The superficial and subdermal fat vascular network was preserved,and the same to the trunk and branches of the pedicle.All the flaps survived.Of which,1 appeared arterial crisis on the 2nd day after operation,and relieved by the local injection of papaverine.There was 1 case of venous crisis on the 3rd day,and improved by stitches,local release of congestion.Followed-up time was ranged from 2 to 12 months.All flaps were soft with good blood supply and good appearance,and did not need a second thinning surgery.Flaps restored the protective feeling 6 months later.Conclusion The microdissection of perforator flap of posterior tibial artery provides a theoretical basis for the perforator flap thinning,and the thinning of perforator flap is a good method to repair the appearance and function of the wound after foot and hand injuries.