Objective To investigate the clinical efficiency of repairing ankle and calf wounds by antegrade or retrograde perforating flap of posterior tibial artery. Methods 13 cases with skin defects of ankle and calf wounds were reviewd. The defects were repaired using antegrade or retrograde perforating flap of posterior tibial artery from January 2011 to February 2013, 8 males and 5 females; aged 19 to 65 years old. Wounds were located in the ankle and calf, area which the tibial artery support contu-sioned slightly;defects were associated with exposed bone or tendon, exposed blood vessels. Of the 13 cases, 5 cases have multiple ankle fracture with blood circulation disorders, internal and external fracture fixation were performed emergency with blood ves-sels and nerves exposed, at the same time emergency line wound repair by posterior tibial artery perforating flap. The other 8 cases have no blood vessels and nerves exposure, and accepted vacuum sealing drainage emergency external fixation and flap surgery. Seven cases accepted V-Y antegrade perforating flap of posterior tibial artery, 6 cases using retrograde tibial artery perforator flap. Whose defects were ranged from 1.5 cm×2.0 cm to 9.0 cm×5.0 cm. Antegrade or retrograde perforating flap of posterior tibial ar-tery with 1.5 cm×3.0 cm to 14.0 cm×7.0 cm was used to repair ankle or lower leg medial defect. Antegrade flap donor site sutured directly, but retrograde flap donor site take full thickness skin graft repair from abdomen. Results Circulations of the all 13 cases were stable, with wound healing well after 2 weeks. The patients were followed up for 6 months to 24 months, average of 13 months. All flap graft survived, pedicle no bloated andcat eardeformity. Flaps were soft, no bloated appearance;color was con-sistent with normal skin. Fracture line in the 5 patients was disappeared. Bone healing time was 3.0 to 4.0 months. At the direct su-ture skin donor sites, postoperative scar was small;skin graft donor sites had no obvious scar. Postoperative ankle dorsiflexion 10° to 25°, plantar flexion 15° to 45°. Patients were extremely satisfied with the results of repair. Conclusion Using antegrade or ret-rograde posterior tibial artery perforator flap without sacrificing the main vessel, it is a simple and effective method to repair the medial malleolus and calf wounds.

OBJECTIVE:To establish a HPLC method for the determination of levofloxacin hydrochloride in the levoflo_ xacin hydrochloride ointment.METHODS:The chromatographic column was C 18 ,the mobile phase was consisted of0.05mol/L citric acid-acetonitrile(85∶15)with detection wavelength at293nm and flow speed at1.0ml/min,the column temperature was40℃and the sample size was10?l.RESULTS:Good linear relation was achieved when the levofloxacin hydrochloride concen-tration was at the range of3.88～37.88ug/ml(r=0.9998);The average recovery was99.4%(n=9).CONCLUSION:This determination method is accurate,reliable and it can act as an effective quality control for levofloxacin hydrochloride ointment.

In recent years, here are many new understandings in the definition, etiology, diagnosis and treatment of transient ischemic attack (TLA).The latest viewpoint considers that TIA is a transient episode of neurological dysfunction caused by brain, spinal cord or focal retinal ischemia, without the evidence of acute infarction. The duration of TIA is no longer the key factor, whether the existence of infarction or not is the key factor in the differentiation of TIA and ischemic stroke. Therefore ,it should emphasize the importance of neuroimaging in the diagnosis of TIA. As a neurological emergency, the risk level of TIA should be stratified and evaluated, and the active interventions should be performed.

The article introduces the advances in the evaluation of transient ischemic stroke (TLA) and reviews them from four aspects, including identifying whether the symptoms accord with the diagnosis of TLA, which blood supply area the ischemia is located in, evaluating the pathogenesis of TIA, and predicting its prognosis.

Transient ischemic attack is an unstable cerehrovascular sign and a neurological emergency. The development of neuroimaging not only provides an important approach for insight into the understanding of transient ischemic attack, but also becomes one of the hotspots in the research of transient ischemic attack.

Objective In order to improve the teaching effectiveness of anatomy in nursing, this article made an exploration on the experimental teaching reform combined with the characteristics of nursing profession. Methods The nursing students of class 1and 2 of 2013were set as the research object. The class 1 (110) as experimental class, class 2 (110) for the control group. In the experimental class, the reform of teaching method and teaching quality was improved by adjusting the teaching syl-labus and teaching contents. The control class used the traditional experimental teaching method. The experiment class' teaching reform research of the human anatomy carried on the 1 semester. Exam achievement evaluation and the questionnaire survey were adopted to assess the teaching effect. SPSS 13.0 software was used to do statistical analysis and t test was used to compare two groups of students test scores, experiment grades, test scores and total scores. Results Experimental theory examination results [(47.80±7.30) vs. (44.85±8.38)], experiment grades [(15.48±1.76) vs. (14.55±2.19)], ex-periment test scores [(15.52±2.22) vs. (14.35±2.64)], total score [(78.80±8.99) vs. (73.75±10.53)] were better than control group (P<0.05). In questionnaire survey,more than 80% of the students think that the reformed teaching method can help to improve the teaching effect. Conclusion In human anatomy experiment teaching reform, the reformed experiment teaching method can significantly improve students' scores and the teaching effect. It is better than the traditional method, and is worth publicizing.

Objective To research the clinical outcomes of repairing donor site of abdomen flap by V-Y flap pedicled with deep circumflex iliac artery perforator musculocutaneous.Methods Nine cases with skin defects of hand were treated with lower abdomen flap from December, 2011 to March, 2013, abdominal donor sites could not be directly sutured, and pedicled with deep circumflex iliac artery perforator musculocutaneous.The flap was 8 cm × 16 cm-12 cm × 24 cm in size.Results The average healing time of the V-Y flap pedicled with deep circumflex iliac artery perforator musculocutaneous was 17 days.The patients were followed-up for 3 months to 18 months, averaged of 9 months.The appearance and the texture of the flaps were good.Abdominal wound healing was flat, with no significant depression and navel no significant skew.Patients were satisfied with function and appearance.Conclusion This procedure is easy and effective.The treatment result is satisfactory.It is improvement for repairing donor site of tradition abdomen flap.

Objective To introduce the surgical method of reverse radial side of dorsal artery the fascial pedicle island bone flap for the treatment of thumb composite tissue defects,and to evaluate its short term clinical outcome.Methods From May 2010 to March 2012,9 cases with composite tissue defects at thumb were treated with reverse radial side of dorsal artery the fascial pedicle island bone flap,including 5 males and 4 female with an average age of 38 years (range,13-68).All injuries were caused by planer.The time of injury to operation was 3-8 hours,all patients showed in both thumb root plane beyond volar or dorsal,skin and soft tissue defect accompanied by distal phalanx defect.Skin and soft tissue of thumb defect size was 1.0 cm ×1.8 cm to 2.0 cm × 2.2 cm.Preoperative hands anteroposterior and lateral X-ray were routine taken.Imaging findings were associated with the thumb base beyond the distal phalanx fractures,bone defect length was 0.4-0.7 cm.We cut thumb radial side of the dorsal artery fascia flap during surgery operation according to the thumb side wound defect case.The size of the bone flap was 0.2 cm× 0.6 cm to 0.4 cm × 0.8 cm,properly inserting intramedullary distal phalanx fixed base,9-0 line will flap inside the dorsal nerve and a nerve suture flap reconstruction feeling.Results All bone flaps were survived completely,no case occur venous disorders,flap blood circulation was stable,donor skin graft was survival in stage Ⅰ.This group of patients incision were healing 2 weeks after surgery.All the patients were followed up as scheduled,and the follow-up time was 6-12 months.All flaps survived,and the colors,texture,contour of the flaps were good.The two-points discrimination distance was 7.0-10.0 mm on the flap,Thumb distal phalanx healing time was 1.0-1.5 months.Bone absorption was not observed in graft.The thumb function was assessed as excellent in 7 fingers,good in 2 fingers,no complication occurred in donor site.Conclusion The main artery and nerve will not be sacrifice,when the bone flap is used.There are blood into the backbone of the first metacarpal nearly 1/3 of the bone to reconstruct thumb bone defect,the operative procedures is available and easy to be performed,which is a new method for the treatment of thumb composite tissue defects.

BACKGROUND:Previous studies have shown that bone marrow mesenchymal stem cels in the treatment of neurological diseases have achieved some success, which can promote neurological alterations; however, there is no breakthrough on gene and drug regulation. OBJECTIVE:To investigate the influence of ginsenosides-induced differentiation of bone marrow mesenchymal stem cels on nerve regeneration after traumatic brain injury. METHODS: A traumatic brain injury model was built in rats using hydraulic shock method, and then rat models were randomly divided into model group (traumatic brain injury group), bone marrow mesenchymal stem cel group, ginsenosides group (ginsenosides induced differentiation of bone marrow mesenchymal stem cels). At 2 weeks after transplantation, western blot assay was used to detect protein expression levels of nerve growth factor and brain-derived neurotrophic factor, immunohistochemistry assay used to detect the number of BrdU-positive cels. At 1, 3 days and 1, 2 weeks after transplantation, modified neurological severity scores were recorded. RESULTS AND CONCLUSION: The expression levels of nerve growth factor and brain-derived neurotrophic factor protein were significantly higher in the ginsenosides group than the bone marrow mesenchymal stem cel group and model group (P < 0.05). The number of BrdU positive nerve cels was also higher in the ginsenosides group than the bone marrow mesenchymal stem cel group and model group (P < 0.05). At 3 days and 1, 2 weeks after transplantation, the modified neurological severity scores in the ginsenosides group were lower than those in the bone marrow mesenchymal stem cel group and model group (P< 0.05). These findings indicate that ginsenoside-induced bone marrow mesenchymal stem cel transplantation can promote nerve regeneration in rats with traumatic brain injury, which has better outcomes than bone marrow mesenchymal stem cel transplantation alone.

BACKGROUND:Bone marrow mesenchymal stem cels (BMSCs) can promote nerve regeneration, but there are no better results because of the limitations of treatment methods. BMSC transplantation alone is not enough to achieve desired therapeutic effects. OBJECTIVE:To investigate the effect of fibroblast growth factor (FGF)-modified BMSC transplantation on functional recovery and expression of glial fibrilary acidic protein after traumatic brain injury. METHODS:Animal models of traumatic brain injury were established in Sprague-Dawley rats using hydraulic shock method, and then randomized into control group (traumatic brain injury group), BMSC group and FGF-BMSC group (FGF-modified BMSC group). After isolation and culture, BMSCs were modified by adenovirus vector-mediated FGF gene. Western blot assay was used to detect transfection efficiency and glial fibrilary acidic protein expression; immunohistochemical detection was used to detect distribution and number of BrdU positive cels in the brain; Longa score was used to evaluate the neurologic function of rats at 1, 3 days, 1, 2 weeks after transplantation; TUNEL assay was used to detect cel apoptosis in the brain. RESULTS AND CONCLUSION:Western blot results showed that FGF gene was successfuly transferred to the adenovirus vector, and capable of expressing in BMSCs; moreover, the glial fibrilary acidic protein expression of FGF-BMSC group was significantly higher than that in the other two groups (P < 0.05). The number of BrdU positive cels in the brain was significantly higher in the FGF-BMSC group than the other two groups (P < 0.05). Two weeks after transplantation, the Longa scores in the FGF-BMSC group were significantly lower than those in the other two groups (P < 0.05). TUNEL results showed that the number of apoptotic cels in the FGF-BMSC group was significantly lower than that in the other two groups (P < 0.05). These findings indicate that FGF-modified BMSCs transplantation is able to improve neurological damage after traumatic brain injury and promote neurological recovery, which is better than BMSC transplantation alone.