Objective To provide anatomical basis for reconstruction thumb of free bifoltaed bone flap pedicled with the dorsal carpal branch of ulnar artery. Methods After red latex was infused into the arteries of 35 sides of adult cadaveric upper limbs, the origin, course, branches, diameters, skin branches and periosteal branches of dorsal carpal branch of ulnar artery were observed, to initate operation experiment of reconstruction thumb on 1 sides. Results The dorsal carpal branch begins with ulnar artery (4.0?1.0)cm above the pisiform with diameter of (1.3?0.5)mm, its pedicle ranges(1.2?0.5)cm and branches off into ascending and descending branches. There were outer diameter range(0.8?0.3)mm and (1.1?0.2)mm. Skin branches of dorsal carpal branch of ulnar artery nourinshed the forearm ulnar side, carpal and dorso-ulnar aspect of mid-hand, periosteal branches of dorsal carpal branch of ulnar artery nourished the anterior internus side of the ulnar and the fifth metacarpal bone. Conclusion The free bifoltaed bone flap pedicled with the dorsal carpal branch of ulnar artery is available to reconstruction the thumb.

AIM: To investigate the phenomenon that miR-let-7d regulates the proliferation and invasion abilities of the lung cancer cells through nuclear receptor peroxisome proliferator-activated receptors γ (PPARγ).METHODS: The relation between PPARγ and microRNA was analyzed by bioinformatics.The plasmid reporter assay was used to verify that PPARγ was the target of miR-let-7d.The lung cancer cell line with low expression of PPARγ was selected from different lung cancer cell lines by Western blot.The regulatory role of miR-let-7d in the lung cancer cells was determined by dual luciferase labeling and Western blot.The effect of miR-let-7d on the proliferation ability of lung cancer cells was detected by colony formation assay, the effect of miR-let-7d on the invasive ability of lung cancer cells was detected by Transwell invasion assay.RESULTS: The results of bioinformatic analysis showed that miR-let-7d regulated the expression of PPARγ, and the 3'UTR of PPARγ contained 2 functional miR-let-7d binding sites, indicating that PPARγ is a direct target of miR-let-7d.miR-let-7d was able to directly regulate the expression of PPARγ at mRNA and protein levels.Transfection of miR-let-7d inhibitor promoted the proliferation and invasion abilities of lung cancer cells by increasing the expression of PPARγ.CONCLUSION: miR-let-7d increases the expression of tumor suppressor PPARγ to inhibit the proliferation and invasive abilities of lung cancer cells.

Objective To explore the size of access channel that may influence the intrarenal pelvic pressure during percutaneous nephrolithotomy.Methods From April 2014 to July 2015,83 patiens with unilateral renal calculus,ranged from 20 to 40mam were divided into 2 group randomly.40 cases underwent F24 channel PCNL and 43 cases underwent F16 channel PCNL.There was no statistically significant difference between the groups in preoperative variables,such as age,gender,preoperative status of infection,status of hydrpnephrosis,size and location of stone (P ＞ 0.05).We used a 6Fr ureteral catheter positioned into the renal pelvic,and the intrarenal pelvic pressure was measured by anesthesia monitor IBP channel during PCNL in different stages (entrance into the collecting system,calculi fragmentation,and termination)for all patients.Removing calculus time,postoperative hemoglobin changing,fever rate,procalcitonin abnormal rate,white blood cell counts and calculi clearance rate were recorded and compared.Results The intrarenal pelvic pressure in different stages on F24 channel and F16 channel were (7.5 ± 1.3)、(22.5± 4.3)、(14.0 ± 2.7) mmHg and (10.3 ± 1.1)、(34.6 ± 4.1)、(23.0 ± 3.6) mmHg,respectively.There was statistically significant difference between 2 groups (P ＜ 0.05).Compared with F16 channel,F24 channel had significant differences in removing calculus time [(12.8 ± 3.7) min vs.(23.3 ± 3.6) min],fever rate [17.5％ (7/40) vs.39.5％ (17/43)],procalcitonin abnormal rate [15.0％ (6/40) vs.34.9％(15/43)] and white blood cell counts abnormal rate [10.0％ (4/40) vs.27.9％ (12/43)] (P ＜ 0.05).However,no significant difference in postoperative hemoglobin changing [(11.8 ± 4.4)g/L vs.(13.7 ±4.7)g/L] and calculi clearance rate [87.5％ (35/40) vs.81.4％ (35/43)] (P ＞0.05).Conclusions Compared with F16 channel,the F24 channel PCNL maintains lower renal pelvic pressure,which is less than reflux limit,during calculi fragmentation,It might be contributed to reduce the postoperative fever rate.It can short time for removing calculi and achieve the better effect.

[Objective]To discuss the common complications and the methods of prevention and treatment in the operation of displaced acetabular fracture.[Method]Sixty-six cases with displaced aceuabular fracture were treated operatively from August 2005 to June 2009.Approach included anterior ilioinguinal approach,posterior Kocher-Langenbeck approach,or combined ilioinguinal and Kocher-Langenbeck approach.The functional results and complications were analyzed.[Result]All cases were followed up for an average of 29 months(12-46 months).According to the Matta evaluation,the anatomical reduction of acetabular fracture were in 34 cases,perfect in 25,and unsatisfactory in 7.According to the modified Merle d' Aubigne and Postel clinical evaluation standard,the clinical outcome was graded as being excellent in 23 cases,good in 29,fair in 8,poor in 6.Sciatic nerve injury after operation were noted in 2 hips,osteoarthritis in 14,heterotopic ossification in 10,and avascular necrosis of femoral head in 2.No infection and death were founded in this group.[Conclusion]The important factors to decrease the operative complications of acetabular fracture include correct fracture classification,suitable operative time,good operative approach,proficient technique of reduction and fixation and reasonable perioperative measures.

Objective To study the dynamic changes of serum concentration of soluble cell adhesion molecule (sCAM) in patients with aneurysmal subarachnoid hemorrhage.Methods Serum concentrations of sCAM in 30 patients with aneurysmal subarachnoid hemorrhage were detected using ELISA method before surgery and at 1~3 d, 7~9 d and 11~13 d after surgery. Transcranial Doppler sonography was used to measure the velocity of middle cerebral artery (VMCA). The results were compared with 20 healthy controls.Results Serum concentrations of sCAM at 1~3 d and 7~9 d in patient group were significantly higher than that in control group (all P

Objective To explore the content of peripheral blood T lymphocyte subsets and natural killer (NK) cells in diffuse large B-cell lymphoma (DLBCL) in different clinical stages and analyze their clinical significance.Methods Sixty-two DLBCL patients were divided into 3 groups according to clinical stages:stage Ⅱ group (21 cases),stage Ⅲ group (21 cases ),stage Ⅳ group (20 cases).Thirty healthy examiners were selected as control group.Two ml peripheral blood was taken from every person.Peripheral blood T lymphocyte subsets(CD3+,CD4+,CD8+) and NK cell count were detected by flow cytometry(FCM) and CD4+/CD8+ was calculated.Results CD3+ in stage Ⅱ and Ⅲ groups[(854.6 ± 276.9 ) × 106/L,(823.3 ± 211.5)× 106/L] were lower than those in control group[(1268.8 ±684.0) × 106/L] and stage Ⅳ group [(1332.7 ±571.2) × 106/L](P ＜ 0.05).CD4+ in stage Ⅱ,Ⅲ,Ⅳ groups [(433.5 ± 240.7) × 106/L,(423.8 ± 234.8) ×106/L,(423.0 ± 143.8 ) × 106/L] were lower than those in control group [(751.3 ± 367.4) × 106/L] (P ＜0.05).CD8+ and CD4+/CD8+ in stageⅣ group [(861.2 ±634.1) × 106/L,0.5 ±0.3] were significantly higher than those in control group [(455.9 ± 334.6) × 106/L,2.1 ± 1.3],stage Ⅱ group [(390.6 ± 54.1 ) × 106/L,1.0 ±0.8] and stageⅢ group [(377.4 ±493) × 106/L,0.9 + 0.6](P＜0.05).NK cell in stage Ⅳgroup was obviously lower than that in control group[(210.3 ± 122.0) × 106/L vs.(353.3 ± 284.7) × 106/L,P＜ 0.05].And the higher clinical stage was,the lower NK cell was.Conclusions With the clinical stage increasing,the immunity depression and disorder of DLBCL patients become more and more serious,the more tumor burden is,the worse NK cell activity is.

A consensus remains unsettled yet for basic medical insurance and common protocols on managing patients seeing doctors out of their hometown.This results in such setbacks as difficulty in seeing doctors elsewhere for those covered and in unaffordable financial burden,as well as medical insurance fraud,lack of information sharing among social insurance authorities,and difficulty of supervision.This study described the status quo of seeding doctors elsewhere under China's basic medical insurance system,and analyzed problems found in the management framework.On such basis,authors proposed such recommendations as unified management system for seeding doctors elsewhere,network information sharing for medical insurance information,and networked settlement for medical expenses for basic medical insurance.These measures should be carried out as per general requirements for health reform stage by stage.

Objective:To obtain recombinant Profilin of silkworm,identify its immunogenicity,predict its B cell epitopes and construct the evolutionary trees. Methods: The nucleotide sequence of Profilin was acquired from NCBI,synthesized it and cloned it into pET-28 vector. Then,the recombinant plasimids were transformed to E. coli BL21. After induced by IPTG,recombinant protein was purified by Affinity chromatography. Furtherly,its allergenicity was identified by Western blot,the potential B cell epitopes was analyzed through DNAStar and build the evolutionary trees by MEGA5. 05. Results: The recombinant protein of Profilin was successfully expressed and purified by affinity chromatography. Besides,the protein contains a high IgE-binding activity with IgE existing in serum of patients allergic to silkworm. Conclusion: The recombinant proflilin has IgE-binding activity, and it is meaningful for fundamental research and specific diagnosis studies of allergic diseases caused by silkworm.

Objective To investigate the clinical efficacy of atlantoaxial pedicle screw fixation plus bony fusion in treatment of traumatic upper cervical instability.Methods From October 2009 to August 2013,29 patients with traumatic upper cervical spine instability were treated with posterior atlantoaxial pedicle screws.The patients underwent autografting (n =19) and allografting (n =10) for spinal fusion.Surrcal outcomes were recorded including intraopcrativc blood loss,operation time,with or without nerve,blood vessel and spinal cord injury,wound healing and bone fusion rate.Results All operations were completed smoothly with operation time of 110 minutes (range,85-135 minutes) and blood loss of 150 ml (range,80-500 ml).At the follow-up of 10 months to 5 years (mean 18 months),bony fusion was detected for all the patients.Postoperative radiographs verified all patients were bony fusion with satisfactory cervical spine stability.No complications of reduction loss,fixation failure,and spinal cord or vertebral artery injury were observed except for 1 patient with low viruleut infection and 2 with delayed wound healing.Conclusion Single posterior atlantoaxial pedicle screw fixation provides security and reliable stability in treatment of upper cervical instability,however wound healing problems should be taken seriously.

Objective To discuss the method and surgical technique in treatment of the displaced acetabular fracture.Methods The study involved 66 patients with displaced acetabular fracture treated operatively with reconstruction plates from August 2005 to June 2009.Based on the fracture typing,the surgical techniques including anterior ilioinguinal,posterior Kocher-Langenbeck,combined ilioinguinal and Kocher-Langenbeck and Y shaped approach were performed in 12,30,22 and 2 patients,respectively.Results The operation time was mean 3.4 hours(1.5-6.5 hours),with mean blood loss of 550 ml(range,350-1 200 ml).All patients were followed up for average 29 months(range,12-46 months).According to Matta evaluation standard,the reduction of acetabular fracture was anatomical in 34 patients,imperfect in 25 and unsatisfactory in seven.According to the modified Merled' Aubigne and Postel clinical evaluation standard,the clinical outcome was graded as excellent in 23 patients,good in 29,fair in eight and poor in six.Conclusion The factors key to successful operation include correct fracture classification,good approach anatomy,proficient technique of reduction and fixation,and reasonable perioperation measures.