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.

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 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.

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 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.

Objective To analyze the association between the polymorphism of 5509-5511delCAA in exon4 of Tim-1 gene and the susceptibility to rheumatoid arthritis(RA)in a group of Han population from Yunnan province.Methods The PCR-DNA se-quencing analysis was used to detect the polymorphism of 5509-5511delCAA in exon4 of Tim-1 gene in 196 RA Han nationality pa-tients and 190 individuals of healthy physical examination(control).The ELISA method and indirect immunofluorescence assay was adopted to detect the three related aotuantibodies of RA,including the rheumatoid factors(RF)and the anti-cyclic citrullinated pep-tide(Anti-CCP)and the anti-keratin antibodies(AKA).Results There were statistically significant differences in genotype and al-lele frequency of 5509-5511delCAA between the RA group and the control group(P <0.05);the positive rate of RF and the anti-CCP between different genotypes of 5509-5511delCAA in the RA group had no statistically significant differences(P >0.05 ),but the positive rate of AKA between different genotypes of 5509-5511delCAA in the RA group had statistically significant differences (P <0.05).Conclusion The 5509-5511delCAA site of Tim-1 exon4 has the polymorphic variation,the 5509-5511delCAA genotype maybe related with the genetic susceptibility to RA in Han population of Yunnan province,the different genotypes does not affect the expression of RF and the anti-CCP,but affects the expression of AKA.

Objective To explore the function of p53 on regulating the expression of miR-148b in lung cancer cell line PC-9 and its corresponding molecular mechanism and the impact on cell proliferation. Methods Transient transfection of p53 eukaryotic expressing plasmids into lung cancer cell line PC-9 was performed to establish a cell model over-expressing p53. RT-PCR was used to explicit the impact of p53 on the expression of miR-148b. A reporter vector containing miR-148b promoter was used to investigate the function of p53 on regulating the transcription of miR-148b. Low-expressing miR-148b by transfecting its specific inhibitors , a CCK-8 assay was performed to explore the influence of miR-148b on the lung cancer cell proliferation inhibited by p53. Results Over-expression of p53 promoted miR-148b expression in lung cancer cell line PC-9. P53 could increase the luciferase activity driven by miR-148b promoters. Knockdown of miR-148b attenuated the impact of p53 on inhibiting the proliferation of PC-9 cells. Conclusion P53 inhibits the proliferation of lung cancer cell line PC-9 partially depending on miR-148b.

AIM:To observed the protective effect of diminazene aceturate ( DIZE) , an angiotensin-converting enzyme 2 (ACE2) activator, on diabetic nephropathy (DN) rats.METHODS:Male Wistar rats (n=30) were randomly divided into normal control (NC) group, DN group and DIZE group (each group consisted of 10 rats).The rats in DN group and DIZE group were induced by intraperitoneal injection of streptozotocin at dose of 65 mg/kg.After 12 weeks, the rats in DIZE group and DN group received subcutaneous injection of DIZE (15 mg· kg -1 · d-1 ) or vehicle for 4 weeks. The samples of blood and urine were collected at week 16, and ratio of kidney weight to body weight (KW/BW), plasma glucose (GLU), 24 h urinary protein (24UP) and serum creatinine (SCr) were measured.The renal pathological changes in each group were observed by periodic acid-Schiff ( PAS) staining and immunohistochemistry .The levels of AngⅡ and Ang-(1-7) in the plasma, and TGF-β1 and VCAM-1 in the renal tissues were measured by ELISA .The mRNA and protein levels of collagen I and FN were determined by quantification real-time PCR and immunohistochemistry .The effects of DIZE on the expression of ACE2 in DN rats were determined by Western blot .RESULTS:DIZE remarkably increased the expression of ACE2 and Ang-(1-7) in DN rats.Compared with NC group , the GLU, KW/BW, 24UP, SCr, and the ex-pression of collagen I , FN, TGF-β1 and VCAM-1 in DN group and DIZE group were increased .However , after treatment of the DN rats with DIZE, these indicators were decreased except the KW/BW.The GLU showed no significant change . CONCLUSION:DIZE raised the activity of ACE2 and increased the expression of Ang-(1-7), thus alleviating fibrosis and inflammation in the kidney and having therapeutic potential for diabetic nephropathy .