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 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 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 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 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 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.

BACKGROUND: A large amount of in vivo and in vitro experiments have confirmed that, basic fibroblast growth factor (bFGF) has been widely utilized in various tissues and cells, it can facilitate the wound healing.OBJECTIVE: To observe the efficacy and feasibility of gene gun-mediate delivery of human bFGF on the healing of deep partial thickness bum wounds.DESIGN, TIME AND SETTING: Randomized design,an observational trial was performed at the Military Central Laboratory of Changhai Hospital in the Second Military Medical University of Chinese PLA between December 2007 and October 2008.MATERIALS: SD rats of clean grade, weighing 200-250 g, irrespective of genders, ware involved in this study.METHODS: Natural human bFGF gene was recombined and optimized, then eukaryotic expression vector pCI-neo-bFGF was constructed taking pCI-neo as a vector, and transfeoted with human embryonic kidney cells 293 T cells. Dot blot and Western blot methods were utilized to determine the bFGF expression. Rat model of deep partial thickness burn wounds was processed into transgene process using gene gun technique, pCI-neo-bFGF-transfected ones served as experiment group while pCI-neo-transfected ones served as controls.MAIN OUTCOME MEASURES:Wound healing time was recorded and the efficacy was evaluated. The contents of hydroxyproline and collaganase Ⅰ in burn wound tissues were determined at 24 hours, 48 hours, 96 hours, 7 days, 10 days and 14 days following transgene process.RESULTS: the recombinant pCI-neo-bFGF was transfected with human embryonic kidney 293T cells. Dot blot and Western blot analysis have showed that, the constructed pCI-neo-bFGF expression vector could express human bFGF, and the expression of synthesized gene was remarkably higher than that of natural gene under fluorescence microscope; gene gun-mediated transgene experiment have showed that, the wound healing time was (13.00+1.31) days in the experiment group and (14.75±1.28) days in the control group, with significant differences (P＜0.05). The contents of hydroxyproline and collagenase Ⅰ reached a peak at 5 days after the injury, that is 48 hours after transfection, and then gradually decreased and maintained at a certain level. The experiment group had higher hydroxyproline levels compared with control group at different time points (P＜0.05, P＜0.01); the collagenase Ⅰ in the experiment group was notably higher than that in the control group at 48 hours and 96 hours after transfection (P＜0.01).CONCLUSION: Gene gun-mediated delivery of human bFGF can short the time of wound healing, increase the contents of hydroxyproline and collagenase Ⅰ during the healing period, accelerate the healing of deep partial thickness burn wounds.

Objective To evaluate the extra-anatomic bypass surgery for aorto-iliac occlusive disease in the elderly. Methods From January 2005 to December 2008,33 elderly patients/39 limbs (age ranged from 70 to 87 years, mean 76.0 ± 3.0 years) with aortoiliac occlusive disease were retrospectively analyzed. According to Fontaine classification, there were 5 phase Ⅱ b cases (7 limbs), 22 phase Ⅲ cases (26 limbs), and 6 phase Ⅳ cases (6 limbs), all cases were with TASC C, D lesions. Results These 33 cases/39 limbs were tr eated with a variety of bypass, including axillobifemoral bypass (6 cases/12 limbs) ,axillofemoral bypass ( 20 cases/20 limbs ), femorofemoral bypass ( 7 cases/7 limbs ). Intermittent claudication improved in 5 cases, rest pain disappeared in 22 cases, and ulcers healed in 6 cases after operations. The mean ABI increased from 0.29 ± 0.11 to 0.66 ± 0.13 ( t = 2.69, P ＜ 0.05 ). All limbs were salvaged and there was no perioperative mortality within 30 days after operations. Postoperative complication rate was 9.1%. Patients were followed up for a median of 12 ±5 months (range, 6 to 28 months), primary patency rate was 89.7% (35/39), secondary patency rate was 94.9% (37/39), limb salvage rate was 92.3% (36/39). After dischargement the mortality was 6.1% (2/33) with one dying of myocardial infarction and another one of malignant tumor (gastric cancer). Conclusions Extra-anatomic bypass for aorto-iliac occlusive disease in the elderly is feasible, safe and effective, and the cardiopulmonary dysfunctions are the major risk factors for perioperative complications.

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.