Objective To explore the clinical application of lesser saphenous-sural nerve adipofascial flap accompanied with a full-thickness skin graft taken from the groin area for reconstruction of the distal one third of anterior tibia,.around the ankle. Methods A distally based lesser saphenous.sural nerve adipofag.cial flap accompanied with a full-thickness skin graft which was taken from the groin area was studied and used to treat 12 patients with soft tissue defects in the distal one third of anterior tibia,3 cases with soft tissue defects and tibia osteomyelitis,2 cases with soft tissue defects and tibia osteomyelitis.The size of the soft tissue defects ranged from 3 cm×5 cm to 9 cm×13 cm,and the biggest donor flap was 13 cm×18 cm.The donor sites at the posterior aspect of the leg and at the groin area were closed primarily. Results All 17 patients were followed up for 6-12 months(average 9 months).All 17 flaps had good perfusion and survived completely,which successfully treated all 17 patients with soft tissue defects or with both soft tissue defects and osteomyelitis.The donor and recipient sites of adipofascial flaps and the groin area healed primarily,and satisfactory appearance and function were achieved.Conclusion Distally based lesser saphenous-sural nerve adipofascial flap accompanied with a full-thickness skin graft which was taken from the groin area can reconstruct the distal one third of anterior tibia,around the ankle,and even treat osetomyelitis successfully,in the same time,which can preserve the function and appearance of the involved limb to the utmost.

Objective To analyze the causes for failed treatments of proximal femoral fractures and to evaluate the curative results of total hip replacement(THR)to salvage the failures.Methods A retrospective study was conducted for 23 consecutive cases of THR to salvage failed treatments of proximal femoral fractures from February 2002 to April 2005.There were 17 cases of femoral neck fracture,five cases of intertrochanteric frac- ture,and one case of femoral head fracture.Results Inadequate reduction after inadequate fixation,incorrect materials or technical errors in internal fixation were the most significant reasons for the failure of early treatment. Twenty-one of the 23 patients were available for fullow-up that ranged from 8 to 46 months(mean,32 months). No such complications as wound infection,hip dislocation,prosthesis breakage or deep venous thrombosis were found.Their mean Harris score increased from 48.3 preoperatively to 87.6 postoperatively.Condusions Re- duction,internal fixation,and fixation technique are very important to treatments of proximal femoral fractures. High energy trauma in young patients and osteoporosis in old patients make treatment of proximal femoral fractures even more difficult.THR is a satisfactory and safe way to salvage a failed treatment of proximal femoral fracture.

BACKGROUND: Under specially physical environment, for example weightlessness, metabolism of bone tissue may have remarkable changes; however, osteoblast is a core of bone metabolism and bone formation, so it is very sensitive to changes of gravity environment.OBJECTIVE: To observe the effects of simulated weightlessness on bone marrow stromal cell count and osteogentic capacity of weight bearing bone in rats so as to reveal the mechanism of bone loss.DESIGN : Randomized pairing and controlled study.SETTING: College of Aerospace Medicine and Department of Pathology of Stomatology College, the Fourth Military Medical University of Chinese PLA.MATERIALS: A total of 20 adult healthy male SD rats were selected in this study. At the beginning of experiment, rats based on their body mass were randomly divided into control group and suspension group with 10 in each group. Alkaline phosphatase kit was provided by Beijing Zhongsheng Bioengineering High-technological Company.METHODS: The experiment was carried out in the Department of Pathology, Collage of Stomatology, the Fourth Military Medical University of Chinese PLA from November 1999 to July 2000. Rats were randomly divided into tail suspension group and control group with 10 in each group. Rats in the tail suspension group were given tail suspension for 28 days. Their heads maintained 30° low position, and their hindlimbs freely suspended and were not given weight loading. While, rats in the control group were fed normally. At the end of experiment, bone marrow stromal cells were obtained from femur for primary and transferring cultures.MAIN OUTCOME MEASURES: Cell counting and methylthianolyldiphenyl-tetrazolium bromide (MTT) assay were used to draw growth curve of cells in primary and transferring cultures and to measure activity of alkaline phosphatase and forming quantity of mineralized nodules in vitro.RESULTS : ① Activity of alkaline phosphatase: Activity of alkaline phosphatase of cells in the primary and transferring cultures in the suspension group was lower than that in the control group, and there was significant difference between them (P＜0.05). ② Forming quantity of mineralized nodules: Forming quantity of mineralized nodules in the suspension group was less than that in the control group, and there was significant difference between them (P＜0.05). ③ Cell growth: Growth curve of femoral stromal cells in primary and transferring culture manifested as S. Doubling time of cells in the suspension group was similar to that in the control group. ④ Amount of bone marrow stromal cells in femur: Amount of bone marrow stromal cells in primary culture in the suspension group was decreased as 50% as that in the control group (P＜0.05).CONCLUSION: Under simulated weightlessness, amount of bone marrow stromal cells decreases obviously; in addition, amount of osteoblast also decreases in weight bearing bone of hindlimbs and osteogentic capacity in vitro decreases simultaneously.

BACKGROUND:Stem cell transplantation and tissue engineering in repairing bone defects is a hotspots of recent study.OBJECTIVE:To observe the therapeutic effect of engineering repair on bone defect by auto-transplantation of bone marrow stromal cells(BMSCs)DESIGN: Left-right comparative studySETTING:Experimental center of the First Affiliated Hospital of Harbin Medical UniversityMATERIALS:Twelve New Zealand rabbits with birth age of 10 days to 2months were selected ,male or female with body mass of 2 to 2.5 kg.METHODS :The experiment was conducted in the Experimental Center of First Clinical Medical College, Harbin Medical University from June 2002to June 2003. Self-BMSCs were separated for subculture. 1.5 cm bone was intercepted at middle of radius in 12 rabbits so as to simulate complete bone defect. Then, the left radius defect was filled with collagen sponge carrying BMSCs ( experimental side),which was replaced by simple collagen sponge in the right side(control side). Twelve weeks later, rabbits were put to death and the outcomes of both sides were compared.X-ray assessment was accorded to the standardized stage of bone defect repair (bone repair was graded into 0 to 5 grades,grade 5 implies that bone defect has been completely replaced by new bone,grade 0 implies that no new bone repair).MAIN OUTCOME MEASURES:The general observations of rabbit radius defects,X-ray scanning, histological and electro-microscopic observations.At week 12, callus became strong and protruded to bone defects in experimental side,well connecting with broken ends. While broken ends in control group were only connected by fibrous tissue and no continuous callus was found continuously crossing through the bone defect of experimental side, marrow cavity was smooth, but molding was incomplete. While in control side, no continuous callus could be observed passing through the broteoblasts and new stroms could be observed in bone defect of experimental side, but only a few of osteocytes appeared in the broken ends of control vations: The osteoblast observed in the experimental side seems normal and was rich in enlarged endoplasmic reticula energetic in ,protein synthesis and abundant in organelle.CONCLUSION :As osteogenetic cells, BMSCs possess better osteogenesis property. They can be used as seed cellsin bone defect repair by using bone-engineering techniques.

Objective To assess the coronary flow reserve in the patients with systemic lupus erythematosus(SLE)by transthroracic echocardiography(TTE).Methods Coronary sinus blood flow of 24 SLE patients and 18 matched healthy controls were assessed by TTE.The coronary flow reserve was calculated as the ratio of hyperemic to baseline blood flow.Hyperemia was induced by intravenous administration of dipyridamole.Results Adequate recordings of blood flow in the coronary sinus under both conditions were obtained by TTE in all study subjects.Patients with SLE were found to have significantly decreased coronary flow reserve comparing with normal SUbiects(1.55±0.21 versus 2.51±0.33.P＜0.01).Conclusions Coronary flow reserve can be measured by TTE in SLE patients,Coronary flow reserve is impaired suggesting that SLE patients may have subclinical coronary artery disease.

AIM: To investigate the role of nitric oxide synthase (NOS), soluble guanylyl cyclase (sGC) and protein kinase C (PKC) signaling in tumor necrosis factor-? (TNF-?)-induced cardioprotection against hypoxia/reoxygenation (H/R) injury. METHODS: Neonatal rat ventricular myocytes were pretreated with TNF-? or sodium nitroprusside (SNP) or L-arginine (L-Arg), respectively, for 12 h and then subjected to continuous hypoxia for 12 h, followed by reoxygenation for 6 h. The manganese superoxide dismutase (Mn-SOD) activity of the cells was measured after H/R. Myocyte injury was determined by the release of lactic dehydrogenase (LDH). RESULTS: TNF-? (10~5 (U/L)) significantly increased the Mn-SOD activity and decreased release of LDH from ventricular myocytes. The cardioprotection against H/R injury was induced by the pretreatment with SNP (5 ?mol/L) or L-Arg (5 mmol/L), which was blocked by ODQ (10 ?mol/L), the specific sGC inhibitor, and Chel (5 ?mol/L), the specific PKC inhibitor. Pretreatment with L-NAME (100 ?mol/L), ODQ, Chel, antoxidant 2-MPG (400 ?mol/L) or tyrosine kinase inhibitor genistein (50 ?mol/L) attenuated the increased Mn-SOD activity and reduced LDH level induced by TNF-?. CONCLUSION: The results suggest that NO may play a role in TNF-?-induced cardioprotection, which is mediated by sGC and PKC. [

OBJECTIVE:To provide reference for rational use of antibiotics to treat Pseudomonas aeruginosa (PA) infection in the clinic. METHODS:Resistant rate of PA in our hospital during 2011-2015 were analyzed retrospectively. Antibiotics use densi-ty(AUD)of 10 commonly used antibiotics were analyzed statistically,and the correlation of resistant rate with AUD was investi-gated by Spearman correlation analysis. RESULTS:One thousaud and eleven strains of PA were isolated in our hospital during 2011-2014,detection rate of PA always occupied the top 5 place. Top 3 antibiotics in the list of AUD were levofloxacin,ceftazi-dime,cefoperazone sodium and tazobactam sodium. AUD of piperacillin sodium and tazobactam sodium,levofloxacin,ciprofloxa-cin and meropenem were positively correlated with resistant rate of PA(r were 1.000,0.900,1.000,1.000,P<0.05). AUD of ce-foperazone sodium and tazobactam sodium were negatively correlated with resistant rate of PA(r=-0.900,P<0.05). AUD of imi-penem and cilastatin sodium,ceftazidime,gentamicin,aztreonam and amikacin had no correlation with resistant rate of PA(P>0.05). CONCLUSIONS:There is correlation between AUD of antibiotics and resistant rate of PA. It is of important significance to detect resistant rate of PA and the use of antibiotics regularly. Antibiotics should be selected cautiously in accordance with bacterial monitoring data,results of drug sensitivity tests,the amount and resistant rate of antibiotics,etc,in order to reduce resistant PA.

BACKGROUND: Limb allograft is a sort of composite tissues allotrans plantation(CTA), some researches showed that the apoptosis of target cell is one of the main mechanism of the dysfunction of allograft.OBJECTIVE: To investigate the characteristic of cell apoptosis in acute rejection of limb allograft in rats based on limb allograft model.DESIGN: A randomized controlled trial using the experimental animals as the objects.SETTING: Experimental animal center Laboratory of a hospital of a medical university MATERIALS: The experiment was done in the Experimental Animal Central Laboratory of the First Affiliated Hospital of Harbin Medical University from November 2003 to May 2004. Totally 56 healthy and male SD rats and 28 Wister rats were involved with body mass of 200 to 250 g. The rats were provided by the Experimental Animal Center of the First Affiliated Hospital of Harbin Medical University. They were randomly divided into two groups:transplantation group with 28 Wistar rats and 28 SD rats and control group with 28 SD rats.INTERVENTIONS: The transplantation group of SD rats underwent limb allotransplantation from allogenetic Wistar. The control group of SD rats underwent limb replantation. The expression of acute rejected in limb allografts was observed. The limb grafts were harvested atday 1, 3, 5 or 7 after transplantation. Histopathological rejection grade of each tissue rejection was performed with hematoxylin-eosin staining. Apoptotic cells were detected by TUNEL (terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling) and apoptotic index(AI) was calculated.MAIN OUTCOME MEASURES: Primary results: ① istopathological grade of acute rejection in limb allografts ② The relationship between apoptosis and acute rejection in limb allograft in rats; Secondary results:General condition of rats in each group.RESULTS: The limb grafts showed edema and erythema and the skin became red at day(3.43 ±0.79) after transplantation. The average survival time was(7.42 ± 1.72) days. The acute rejection in skin was the strongest. On the day 3, 5 and 7 after operation, the histopathological rejection grades of skins in the transplantation group were(1.14±0.38) ,(2.28 ±0.48) and(2.86 ±0.38) grades respectively. They were significantly different from that of muscle and nerve( P ＜ 0.05 ) . The apoptotic cells in allografts were mainly infiltrating lymphocytes in subcutaneous tissues and then the muscle cells. All was positively correlated with acute rejection grade in limb allograft .CONCLUSION: Apoptosis was involved in acute rejection of limb allograft in rat. The apoptotic index can be used as a quantitative index to estimate the injury of grafts.

OBJECTIVE To investigate the distribution and drug resistance status of extended-spectrum ?-lactamases producing(ESBLs) Klebsiella pneumoniae and to provide the basis for clinic anti-infective treatment.METHODS To use ATB-expression analyzer to identify the microbe.The drug susceptibility was tested with the K-B method and the ESBLs producing strains detected by diffusion confirmed test.RESULTS Among 137 strains of identified K.pneumoniae,34.3% of them(47 strains)produced ESBLs,and most had been shown in geriatrics ward.The drug resistance rate of ESBLs producing K.pneumoniae was higher than that in non-producing ESBLs one.So imipenem should be considered to be a preferred antibiotic when used on K.pneumoniae seriously infected cases.CONCLUSIONS The drug resistance of K.pneumoniae is a serious problem,we should pay attention on the status of ESBLs distribution,based on the susceptibility to choose the reasonable antibacterial to avoid the producing ESBLs bacteria spread out.

Objective To explore the effectiveness of the unsaturated disaccharides derived from chondroitin sulfate(CS)in urine using post column derivation fluorometric method of high performance liquid chromatography (HPLC).Methods Urine samples were prepared with the centrifugal flirtation and the routine precipitation methods separately,then digest the sample with CS lyses,use the post column derivation method of HPLC to fluorometric determine the unsaturated disaecharides(△Di-0S,△Di-4S and △Di-6S),compare the recovery differences of the CS standard in the urine pretreated by the two methods.Results The HPLC system ran well,the lowest detection limit of the method was 10 ng.When the urine was pretreated by the centrifugal flirtation method,the recovery of △Di-0S,△Di-4S and △Di-6S produced from the CS standard were 86.93%,87.28%and 85.03%,respectively,while the recovery of the three disaccharides in routine precipitation method were 75.09%,72.96%and 77.70%merely.Conclusions The HPLC post column derivatization fluorometric method is comparatively sensitive,it can be used to determine unsaturated disaccharides decomposed by CS.In the pretreatment procedure of the urine,the centrifugal flirtation method was superior to the routine precipitation method,it can be used as microdetermination for the unsaturated disaccharides.