Chronic wound has very complicated pathogenesis and is difficult to treat;the situation has been improving owing to the progress in wound healing research and the clinical application of new techniques.This article focuses on the pathogenesis of chronic wound and introduces progress in various kinds of treatment,such as skin substitute,growth factors,negative pressure treatment,etc.

Objective To investigate the feasibility, safety and efficiency of endovascular treatment for patients with aorto-bilateral-iliac artery total occlusive disease.Methods A total of 35 patients with aorto-bi-iliac artery total occlusive disease treated with endovascular therapy in Peking Union Medical College Hospital and the First Hospital of Shijiazhuang between Jan 2012 and Dec 2013 were retrospectively analyzed.Results There were 33 males and 2 females, mean age (67 ± 6) years treated during the study period.Technical success rate was 100％.129 bare stents and 4 covered stents were implanted.There were no peri-operative death.Postoperative leg ankle brachial index (ABI) improved significantly (0.86 vs.0.28, P ＜ 0.28).Postoperative complications occurred in 2 patients (5.7％), including brachial artery thrombosis and rupture of external iliac artery post-dilation.The mean follow-up period was 16.5 months (2-28 months).Two patients (5.7％) were lost to follow up.Re-intervention was performed in 3 patients (8.6％) due to reocclusion of the stents.Primary patency was 91％ (30/33) Conclusions Endovascular treatment is effective for aorto-bi-iliac artery total occlusive disease with low complications and acceptable mid-term patent rate.

Objective To evaluate therapeutic effects of endovascular therapy for in-stent restenosis of superficial femoral artery,and the risk factors of restenosis of re-intervention therapy.Methods We retrospectively summarized the clinical data of 35 patients(38limbs)who suffered from in-stent restenosis of superficial femoral artery(SFA)stent from 2010 to 2012.Results 35 patients (38 limbs)were enrolled in this study,there were 24 males and 11 females.Mean age was (68 ±8)years.The success rate of endovascular therapy was 89.5％ (34/38),including in-stent angioplasty in 14 limbs,in-stent and beyond-stent angioplasty in 5 limbs,in-stent angioplasty and beyond-stent re-stenting in 15 cases.The primary patency and sencondary patency rate for 6,12 and 24 months was 65.2％,46.5％,46.5％,and 87.5％,80.2％,55.8％ respectively.The independent risk factors for re-obliteration were age ＞ 70 years (P ＜ 0.05) and diabetes mellitus (P ＜ 0.05).Conclusions Endovascular therapy is effective and safe in treatment in-stent restenosis of superficial femoral artery.The long-term in-stent patency is not satisfactory,with age ＞ 70 years and diabetes mellitus as independent risk factors.

Objective To evaluate the relationship between emergence agitation (EA) during recovery from general anesthesia and postoperative cognitive dysfunction (POCD).Methods Two hundred and eighty ASA Ⅰ or Ⅱ patients,aged 18-70 yr,weighing 52-80 kg,undergoing elective surgery,were included.Anesthesia was induced with midazolam,fentanyl,propofol and cisatracurium.The patients were tracheal intubated and mechanically ventilated.Anesthesia was maintained with remifentanil,propofol and cisatracurium.EA was assessed at 15-40 min after extubation by using Post-operative Quality Recovery Scale and the cognitive function was assessed at day 1 before operation and days 1-7 after operation.Patients were divided into POCD or nonPOCD group according to the occurrence of POCD.The general data of patients,preoperative complications and types of surgery were recorded.If there was significant difference between the 2 groups,the factor was analyzed using multi-factor logistic regression to select the risk factor for incidence of POCD.Results The incidence of POCD was 40.7 ％.The results of logistic regression analysis showed that the dangerous degree of the risk factors for POCD in order from high to low were emergence agitation,duration of anesthesia and age.Conclusion EA during recovery from general anesthesia is an independent risk factor for POCD.

Objective To investigate the clinical roles of lysine methyltransferase 5A(KMT5A)in human hepatocellular carcinoma(HCC)and its functions in cell migration and invasion. Methods The expression levels of KMT5A of 60 cases were detected by immunohistochemistry(IHC). KMT5A siRNA was used to down-regulate the expression of KMT5A in SMMC-7721 cells. Cell migration and invasion were measured by wound healing assays and transwell assays,respectively. Immunoblotting was used to detect the expression of MMP-2 after siRNA trans-fection. miR-186 mimics were transfected into SMMC-7721 cells and the mRNA levels of KMT5A was detected by qRT-PCR after transfection. Results High expression of KMT5A was associated with large tumor diameter (>5 cm,P=0.047)and advanced TNM stage(Ⅲ+Ⅳ,P=0.035). The expression of KMT5A was knocked down by siRNA in SMMC-7721 cells. Down-regulation of KMT5A suppressed cell migration(P=0.031,P=0.006)and invasion(P=0.010),and impaired MMP-2 expression(P=0.040). Overexpression of miR-186 could significantly inhibit the expression of KMT5A(P = 0.007). Conclusions Over-expression of KMT5A in HCC tissues associ-ates with poor clinical features. KMT5A knockdown inhibits the migration and invasion on HCC cells.

Objective To analysis the modified Gleason scoring system for predicting the prognosis after radical prostatectomy.Methods A total of 242 patients who received radical prostatectomy from April,2006 to October 2011 were recruited.The patients who lost follow-up or had adjuvant radiation or hormonal therapy or had visceral or bone metastasis were excluded,the remaining 168 patients were evaluated in the present study.The patients' age ranged from 53 to 85 years old (mean age 69 years old).The mean PSA level was 13.31ng/ml (ranging from 4.59 to 36.12 ng/ml).According to the traditional Gleason scoring system,there were 50 patients in Gleason ≤ 6 group,86 patients in Gleason 7 group and 32 patients in Gleason≥8 group.Patients were divided in five groups according to the modified Gleason scoring system.There were 50 patients in Gleason ≤6 group,67 in Gleason 3 + 4 group,19 in Gleason 4 + 3 group,15 in Gleason 8 group and 17 in Gleason 9-10 group.The biochemical-free-survival curve was drawn by Kaplan-Meier method and the multivariate Cox regression models were used to evaluate the clinical and pathological variables for the development of biochemical recurrence.ROC curve analysis was used to determine the predicted value for 5-year BCR of modified and traditional Gleason scoring.Results Significant differences were noted between the modified Gleason scoring groups and traditional Gleason scoring groups in PSA value (P =0.005),pathological stage (P =0.002),extraprostatic extension (P =0.003),seminal vesicle invasion (P =0.004),lymph node involvement (P =0.049) and positive surgical margin (P =0.006).With a median follow-up of 68 months(ranging from 7 to 98 months),5-year BFS rates for men with Gleason grade ≤6,3 + 4,4 + 3,8 and 9-10 tumours on RP pathology were 84.0％ (42/50),76.1％ (51/67),57.9％(11/19),40.0％ (9/15),29.4％ (5/17),respectively.On multivariate analysis,the HR value of Gleason 3 + 4 group and Gleason 4 + 3 group were 1.736 and 2.075 (P ＜ 0.05).The area under the curve in modified and traditional Gleason scoring were 0.698 (95％ CI 0.609-0.788) and 0.674 (95％ CI O.584-0.764),respectively.Conclusions The modified Gleason scoring system is related to the prostate cancer grade and its survival rate.Therefore,it can predict prognosis accurately in patients with prostate cancer.It can potential to reduce overtreatment in patients with Gleason 3 +4 prostate cancer.

Objective To research the influences of massive hemorrhage on spatial learning and memory ability in elderly SD rats .Methods Fifty six aged SD rats were randomly divided into 3 groups:blank group (B group ,n=8) ,control group (C group , n=24) ,and hemorrhage group (H group ,n=24) .B group was not given any intervention .C group received femoral artery ligation and was sutured under general anesthesia .H group underwent femoral artery puncture phlebotomy ,and then the rats were sutured . Morris water maze was used to test the spatial working ability .Results The escape latency of H group on postoperative day 1 ,3 and 7 were(29 .93 ± 7 .93)s ,(34 .56 ± 6 .74)s and (15 .47 ± 6 .42)s respectively .Compared with B group(12 .56 ± 3 .08)s ,these re‐sults indicated the spatial learning and memory of H group was destroyed after surgery 1 d and 3 d (P<0 .05) ,but no significant difference between H group and B group on postoperative day 7 (P>0 .05) .The escape latent periods to platform observed in C group rats on day1 ,3 and 7 after operation were(15 .74 ± 5 .86)s ,(15 .61 ± 2 .56)s and (13 .56 ± 4 .61)s .Compared with B group [(12 .56 ± 3 .08)s] ,these results indicated that there was no significant difference 7 (P>0 .05) .Conclusion The findings of this study indicate that massive hemorrhage of old rats may destroy the spatial learning and memory .

Objective To discuss the strategies of prevention and treatment for complications of endovascular therapy in aortoiliac artery occlusive disease.Methods 220 cases who received endovascular interventions with aortoiliac artery occlusive disease were retrospectively reviewed from June 2012 to June 2014.Among these patients,189 cases were males.The age was between 46 to 85yrs and the average age was 64yrs.Results The overall technique success rate was 97.2％.Nine procedure-related major complications requiring additional endovascular or surgical treatment were encountered in 7 patients including 2 acute in-stent thrombosis,1 iliac artery rupture,1 distal embolism,and 5 puncture associated complications (2 acute artery thrombosis,1 arteriovenous fistula,1 hematoma,1 artery dissection).8 cases improved after second endovascular or remedial open surgery,among those 4 cases were managed by endovascular interventions including 2 catheter directed thrombolysis,1 cover-stent implantation and 1 balloon-based angioplasty,4 patients received open surgery including 3 thrombectomies,1 hematoma cleating.After 22 months follow-up,the primary patency,assistant-primary patency and secondary patency was respectively 90.8％,92.1％ and 99.2％.Conclusions More attentions should be paid to the complications of endovascular therapy in aortoiliac artery occlusive disease.Helpful to prevent these complications are a comprehensive evaluation of the lesions,and individualized surgical plan prior to the operations,and a careful intraoperative management.

Objective To review the experience of the surgical treatment of adult patients with anomalous left coronary artery from the pulmonary artery(ALCAPA).Methods A retrospective,single institution review was conducted on nineteen adult patients with ALCAPA surgical treatment from February 2006 to October 2012.Of these patients,five were males and fourteen were females.The age was(35.3 ± 11.7) years.The weight was (61.2 ± 9.4) kg.Most patients showed some evidence of myocardial infarction or ischemia with either abnormal Q waves (4) or ST-T abnormality (13).Twelve patients with coronary angiography and four patients with coronary CT scan showed good coronary collateralization.The preoperative UCG showed the mean left ventricular ejection fraction(LVEF) was 0.60 ± 0.07,and the mean left ventricular end-diastolic dimension(LVEDD) was(52.4 ± 4.4) mm.Severe mitral regurgitation(MR) was seen in two patients,moderate in three patients and mild in four patients.The operative procedures included Takeuchi operation in seven patients,ligation of left coronary artery concomitant with coronary artery bypass graft in two patients,coronary artery re-implantation in ten patients.Of the ten patients with coronary artery re-implantation,two patients underwent mitral valve repair.Results There was no operative mortality.The mean cardiopulmonary bypass time was (144.5 ± 66.9) min and cross-clamp time was (96.4 ± 38.8) min,respectively.The mean mechanical ventilation time was(12.9 ± 3.7) h and intensive care unit time was(39.2 ± 12.5) h,respectively.The mean postoperative LVEF was 0.62 ± 0.04.No significant reduction in LVEDD (45.8 ± 5.5) mm,P ＞ 0.05.Mild and trivial MR were observed in one and four patients,respectively.Sixteen patients(84.2％) completed the follow up with a mean time of 19.2 months.All the patients survived with New York Heart Association class Ⅰ or Ⅱ.During the follow up period,no patient required reoperation or readmission.At the latest echocardiography,the mean LVEF of 0.63 ± 0.05 and mean LVEDD of(49.2 ± 4.6) mm did not significantly improved compared with the data preoperatively or postoperatively.Mild MR was detected in six patients,trivial in three patients during the follow-up period.Conclusion The adult patients with ALCAPA have a dormant disease process.Surgical treatment has been recommended at the time of diagnosis and the coronary re-implantation could be the first choice.As for the concomitant MR,the guideline for the adult MR should be followed.

Objective To study the treatment of a or toiliac occlusive disease and prevention and management of early complications. Methods From Mar 1998 to Mar 2005, 83 aortoiliac arterial occlusion patients were treated with embolectom y by Forgaty catheter as the main therapy for acute occlusion. In cases of chron ic occlusion percutaneous transluminal angioplasty and stenting, prosthesis graf t bypass surgery as well as proximal endovascular procedure combining with dista l arterial reconstructions were adopted on case to case basis. Results There was acute aortoiliac occlus ion in 14 cases, 6 cases (42.9%) suffered from early complications after embole ctomy, with mortality of 7.1%. In chronic aortoiliac occlusion of 69 cases,va rious complications developed in 16 cases(23.2%),of which aortoiliac arteri al stent placement in 17 cases with complications of 23.5%;prosthesis bypass in 23 cases, with complications of 30.4%, and mortality of 4.3%;aortoili ac stenting combining with femoral-popliteal bypass in 29 cases(58 legs)with complications in 5 cases(17.2%). Conclusion The expansion and development of minimally invasive tech niques along with minimal invasive surgery may reduce surgical risks,decrease m obidity and mortality rate.