The core event of cell proliferation is DNA replication and cell division. DNA topoisomerase type Ⅱ plays an important role in this process.As a cell proliferating marker,DNA topoisomerase type Ⅱis caught great attention. The authors review the recent research of NDA topoisomerase type Ⅱ and its value evaluated as a cell proliferating marker.

[Objective]To analyze the results of distal tibial pilon fractures treated with individual management based on severity of soft tissue injury.[Method]From January 2005 to September 2008,29 Pilon fractures were treated.There were 22 males and 7 females aging from 23 to 63,with an average of 41.4.According to Ruedi-Allgower classification system of Pilon fracture,16 cases were type Ⅱ,13 type Ⅲ.According to Tscherne-Gotzen graduation system of soft tissue injury,22 cases were close fracture,8 grade 0,4 grade 1,8 grade 2,2 grade 3,and 7 cases were open fracture,3 grade 1,2 grade 2,2 grade 3.Individual management was based on severity of soft tissue injury.[Result]All patients were available for follow-up at an average of 28.6 months(range,12 to 56 months) after surgery.There were 10 excellent,13 good,4 fair,and 2 poor results according to the ankle score of Mazur.The complications occurred in 5 patients(17.2%),including wound superficial infection(n=2),skin necrosis(n=1),deep infection(n=1),and pin tract infection(n=1) with external fixation.[Conclusion]Individual management based on severity of soft tissue injury for Pilon fracture has advantages of fewer complications and good function.

Abstract? AIM: To analysis the relation of severity of rhegmatogenous retinal detachment with the levels of amino acids and vascular endothelial growth factor ( VEGF) in the serum and in subretinal fluid.? METHODS: Forty -eight patients ( 52 eyes ) with rhegmatogenous retinal detachment treated in our hospital were selected.According to the degree of retinal detachment, patients were divided into <1/2 quadrant group, 1/2-3/4 quadrant group and>3/4 quadrant group. Fifty-five healthy objects for physical examination in our hospital were selected as the control group, to compare the differences of amino acids and VEGF levels in the serum.Correlation analysis on VEGF levels and amino acids in the serum and in subretinal fluid among patients with different grades of rhegmatogenous retinal detachment was conducted.? RESULTS: In patients with rhegmatogenous retinal detachment, the tryptophan in serum was 28.59±4.46mg/L, phenylalanine 8.95 ±2.55mg/L, methionine 8.15 ±2.17mg/L, valine 28.62 ±5.29mg/L, histidine 18.96 ±1.85mg/L and VEGF 589.92 ±185.34μg/L, which were higher than those in the control group, and the difference was statistically significant(P<0.05).The levels of phenylalanine was 9.85 ±1.21mg/L, histidine 20.63 ±2.07mg/L and VEGF 718.69 ± 283.34μg/L in the subretinal fluid of>3/4 quadrant group, which were significantly higher than those in the <1/2 quadrant group and 1/2-3/4 quadrant group ( P<0.05). VEGF in the subretinal fluid of VEGF in the rhegmatogenous retinal detachment group were positively correlated with phenylalanine (r=0.542, P<0.001), and histidine (r=0.782, P<0.001).?CONCLUSION: The levels of amino acids and VEGF in the subretinal fluid of patients with rhegmatogenous retinal detachment was higher than those in normals and increased with the severity of retinal detachment.

Objective To explore the value of strain rate imaging (SRI) technology in the diagnosis of hypertension patient with re-gional left ventricular early diastolic dysfunction. Methods 50 essential hypertension patients were divided into hypertension Group Ⅰ and Group Ⅱ, including 31 patients with normal left ventricular and 19 patients with left ventricular hypertrophy. 25 healthy people were used as the control group. SRI was done in the six different basal myocardial segments and the parameters of SRI were compared with that of Doppler tissue imaging (DTI) and pulse Doppler (PW). Results In the hypertension group, SRe of the six different basal myocardial segments was lower than that in the control group (P<0.05), but (SRa) of hypertension group was higher (P<0.05). SRe was negatively correlated with the patients'illness development (r=-0.89, P<0.05), but SRa was positively correlated (r=0.97, P<0.05). And the SRe/SRa<1 detection rate of Group Ⅱ was higher than that in Group Ⅰ, and the ratio in the control group was lowest(P<0.05). Total detection rate of SRI (88%) was higher than Em/Am <1 of DTI (79.67%) and E/A < 1 of PW(60%), and these changes were more obvious in Group Ⅰ. SRI was higher than DTT and PW (P<0.05). Conclusion Compared with traditional technology and methods, SRI could pro-vide more accurate diagnoses to hypertension patient with regional left ventricular early diastolic dysfunction.

Objective To investigate the clinical efficacy of three-dimensional (3D) and two-dimensional (2D) laparoscopic surgeries in the treatment of Todani type Ⅰ choledochal cyst.Methods The retrospective cohort study was conducted.The clinical data of 59 patients with Todani type Ⅰ choledochal cyst who were admitted to the People's Hospital of Hunan Province between January 2013 and January 2016 were collected.Thirty patients undergoing 2D laparoscopic surgery between January 2013 and June 2014 were allocated into the 2D group and 29 patients undergoing 3D laparoscopic surgery between July 2014 and January 2016 were allocated into the 3D group.There were the same Trocar placement and surgical procedure in the 2 groups,and surgical procedure completely followed the treatment principle of Todani type Ⅰ choledochal cyst.Observation indicators included (Ⅰ) surgical situations:conversion to open surgery,operation time,volume of intraoperative blood loss,(2) postoperative situations:postoperative complications,(3) follow-up.Patients were followed up by outpatient examination or telephone interview to detect postoperative recovery up to April 30,2016.Measurement data with skewed distribution were presented as M (range) and analyzed using the Mann-Whitney U test.Count data were compared by Fisher exact probability.Results (1) Surgical situations:patients in the 2 groups underwent laparoscopic choledochal cystectomy + Roux-en-Y hepaticojejunostomy.Two patients in the 2D group received conversion to open surgery and patients in the 3D group received the successful surgery without conversion to open surgery.Rate of conversion to open surgery in the 2D and 3D groups were 6.7％ (2/30) and 0,respectively,with no statistically significant difference (P ＞ 0.05).Operation time in the 2D and 3D groups were 285 minutes (range,240-390 minutes) and 190 minutes (range,140-215 minutes),with a statistically significant difference (U =40.0,P ＜ 0.05).Volume of intraoperative blood loss in the 2D and 3D groups were 50 mL (range,10-300mL) and 45 mL (range,20-250 mL),with no statistically significant difference (U =1 018.5,P ＞ 0.05).(2)Postoperative situations:patients in the 2 groups had good recovery,without occurrence of severe complications in Clavien-Dindo≥ Ⅲ stage.Four and 1 patients in the 2D and 3D groups were complicated with bile leakage (in Ⅱ stage of Clavien-Dindo) and 1 and 1 were complicated with upper gastrointestinal hemorrhage (in]][stage of Clavien-Dindo),respectively,with no statistically significant difference (P ＞ 0.05).Overall incidence of complications in the 2D and 3D groups were 16.7％ (5/30) and 10.3％ (3/29),with no statistically significant difference (P ＞ 0.05).All the patients were cured by conservative treatment.(3) Follow-up:59 patients were followed up for 5-36 months,with good recovery and without occurrence of reflux cholangitis,hepatic and intestinal anastomosis stenosis and reoperation.Conclusions 3D and 2D laparoscopic surgeries are safe and effective for Todani type Ⅰ choledochal cyst.Compared with 2D laparoscopic surgery,3D laparoscopic surgery can reduce the operation time and not increase the complications,and it should be discreetly promoted based on the experiences of surgeons.

Objectives:To investigate the association and the prognostic significance of the expression of telomerase activity (TA) and apoptosis (APO) in tissues of primary breast cancer.Methods:TRAP-PCR and ELISA were developed to detect the expression of TA,and make quantitative and qualitative analysis respectively.TUNEL was also used to evaluate apoptosis cells in cancer lesions and count apoptosis index (AI).The expression levels of proteins of oncogene Bcl-2 and p53 were measured by means of S-P immunohistochemistry.Results:The mean TA positive expression rate was 89.8%,and its mean optic density was (A) 0.63±0.29,which were significantly higher than those of normal tissues and benign breast lesions (P<0.05).The 5 years survival rate of patients with positive TA expression was lower (60.3%) than those of negative expression (77.4%).There were no relations between TA expression and patients ages,TNM staging,lymph nodes metastasis,size,locations and pathological types of cancer.But TA was positively correlated with APO (r=0.733 1,P<0.05) and the protein expression of oncogene Bcl-2 (r=0.781 4,P<0.05) and negatively correlated with that of p53 (r=-0.625 5,P<0.05).Moreover,in patients receiving preoperative chemotherapy,the levels of TA expression were much lower than those without chemotherapy (64.7% vs 85.1%),and the former had higher AI than the latter (7.19±3.75% vs 3.23±2.04%),intraarterial chemotherapy group were superior significantly to adjuvant group (P<0.05).Multivariate Cox Regression Analysis showed that only TA and AI influenced the survival time of primary breast cancer patients,and patients with higher positive TA expression and AI>4.0% had shorter survival time than those of negative TA expression and AI<4.0% patients.Conclusions:There was a significant correlation between TA and APO and its related oncogene Bcl-2,p53.TA and APO are of great diagnostic values,therapeutic helps and prognostic significance in the formation and the development of primary breast cancer.

Objective To evaluate the clinical effectiveness of perioperative fast-track surgery(FTS)program and nutrition support in the elderly patients with gastric cancer.Methods Totally 42 patients were equally randomized into FTS group(receiving perioperative FTS program)and control group(receiving a conventional therapy).The postoperative first defecation time,postoperative hospital stay,hospitahzation expenditure,and postoperative complications were compared between these two groups.Results The postoperative first defecation time and postoperative hospital stay were(75.4±24.3)hours and(11.2±3.2)days in FIS group and(98.0±22.6)hours and(14.4±4.6)days in control group(P=0.0165,P=0.0004;respectively).The hospitalization expenditure was significantly lower in FTS group than in control group[(3.66±0.48)×104 vs.(4.56±0.78)×104 RMB yuan;P=0.0001].The incidence of postoperative complications in FTS group was also significantly lower than that in control group(9.5% vs.28.6%,P=0.0422).Conclusion Perioperative FTS program can accelerate postoperative rehabilitation,shorten hospital stay,lower hospitalization expenditure,and reduce the incidence of postoperative complications.

Background Sclera remodeling process in axial elongation is one of the main pathological mechanisms of axial myopia progression.Studies confirmed that transforming growth factor-β1(TGF-β1) participates in the sclera remodeling process,and Smad3 is one of TGF-β1 downstream signal gene transcriptive factors,so to explore its role in sclera remodeling process of myopic eyes is of great significance for pathogenesis and prevention research of myopia.Objective This study was to investigate the expressions of type Ⅰ collagen and Smad3,a TGF-31 downstream target,in sclera of form deprivation myopic (FDM) eyes and explore the impact of TGF-β1-Smad3-type Ⅰ collagen signaling pathway on collagen remodeling in myopic sclera.Methods Seventy-five 1-week-old guinea pigs were randomly divided into normal control group (25 guinea pigs) and FDM group (50 guinea pigs).Monocular FDM was induced by occluding the left eyes of guinea pigs in FDM group with translucent latex balloons for 2,4,6 weeks,respectively,and consecutive occluding for 4 weeks followed by uncovering for 1 week (4/-1 weeks).The refractive power was detected by retinoscopy and axial length was measured with A-type ultrasound.Immunohistochemistry and reverse transcription-PCR were employed to detect the dynamic expressions of type Ⅰ collagen and Smad3 protein ad mRNA in the sclera of guinea pigs with emmetropia and experimental myopia,ard the relationship between collagen Ⅰ and Smad3 levels was analyzed.Results The refraction was hypermetropic in both normal control group and FDM group before occluding of eyes (P＞0.05),and the hypermetropic power was gradually reduced over time in the normal control group.In the FDM group,the refractive power was gradually changed from (+2.09 ± 0.31)D before occluding to (-1.23±0.69),(-4.17±0.59),(-7.07±0.56) and (-4.30±0.58)D,and the axial length was increased from (5.93-±0.39)mm to (6.62±0.36),(7.30±0.34),(7.99--0.32),and (7.21 ±0.36) mm at weeks 2,4,6,and 4/-1 after occluding,respectively,indicating significant differences in refractive power and axial length over time in the FDM group from normal control group and self-control group (all at P＜0.05).The expressions of Smad3 and type Ⅰ collagen protein and mRNA in the sclera of the FDM group was significantly lower than those of the control group and self-control group in various time points (all at P＜0.05).The positive correlation were found in the expression of Smad3 on the myopic sclera with that of type Ⅰ collagen in both protein and mRNA levels (protein:r=0.993,P＜0.05;mRNA:r=0.954,P＜0.05).Conclusions The myopic power and ocular axis increase dependent upon occluding time,and the expressions of Smad3 and type Ⅰ collagen in the sclera are correspondingly weakened in FDM eyes.A consistent expression trend is found between Smad3 and type Ⅰ collage,suggesting Smad3 and type Ⅰ collagen participate in the regulation of sclera remodeling in myopia by TGF-β1-Smad3-Collagen Ⅰ signaling pathway.

AIM:To compare the synthesis efficiency of n3 and n6 very long chain polyunsaturated fatty acid ( VLC-PUFA ) by overexpressing ELOVL4 protein, providing guidance for treating Stargardt-like macular dystrophy (STGD3).
METHODS:To establish recombinant adenovirus with the ELOVL4 protein and green fluorescent protein, transferred into cultured PC12 cells. The cells were divided into 3 groups: PC12, PC12 + Ad- GFP and PC12 + Ad-ELOVL4, former two groups serve as controls. ELOVL4 gene expression was quantified by qRT-PCRs. ELOVL4 protein was analyzed by Western - Blot ( WB ) . The transduced cells were treated with both EPA and AA (1:1). After 48h of incubation, cells were collected, total lipids extracted and fatty acid methyl esters prepared and analyzed by gas chromatography-mass spectrometry ( GC-MS) .
RESULTS:When supplemented together, 20:5n3 (EPA) and 20:4n6 ( AA) were efficiently taken up at almost the same amounts in the PC12 cells regardless of ELOVL4 expression. The ELOVL4-expressing cells elongated both EPA and AA to a series of n3 and n6 VLC-PUFAs. From 20:5n3/EPA, 34:5n3 and 36:5n3 account for 0. 71% and 1.6%, respectively. From 20:4n6/DHA, 34:4n6 and 36:4n6 were only 0. 46% and 0. 61%, respectively. The total relative mol% of n3 VLC-PUFAs synthesized from EPA was almost two times that of n6 VLC-PUFAs synthesized from AA.
CONCLUSION: ELOVL4 protein preferentially elongates n3 PUFA to VLC - PUFAs over n6 PUFA. Dietary supplementation of appropriate n3/n6 PUFAs may provide STGD3 patients with some therapeutic benefits.