Objective To determine the outcome of the combined use of flaps transfer and ilizarov technique reconstruct the large soft tissue defects and bone lose in the lower leg.Methods Sixteen patients were identified from a retrospective review from July,2008 to July,2013,who suffered the large soft tissue defects and bone lose in the lower leg and underwent single-stage soft tissue and osseous reconstruction using the flap technique and Ilizarov method.There were 12 males and 4 females aged from 22 to 62 years old (average 42.6 years old).The size of soft tissue defect ranged from 8 cm×9 cm to 30 cm×20 cm.The length of the bone discrepancy ranged from 2 to 14 cm.According to the local condition of the lower leg and the size of the composite tissue defects,10 patients received the free flap covering,6 patients repaired by the saphenous neurocutaneous perforator flap (3 cases) and sural nerve neurocutaneous flap (3 cases).Daily monitoring the skin temperature postoperative.Distraction was commenced on postoperative day 10 to 14 at the rate of 1 mm/day and continued in 4 equal increments.Results The follow-up time ranged from 18 to 36 months.Sixteen flaps survived completed,only 1 flap was observed the venous congestion in postoperative day 2.The duration of ilizarov application ranged from 3.5 to 18.0 months.All patients achieved final union.All patients were satisfied with the outcome of the surgery.Conclusion The combined use of neurocutaneous flap and Ilizarov technique for reconstruction of large composite soft tissue defect in the lower leg.Significantly reduce patient treatment time,improving traction osteogenesis of long bones and the ability of resistance to infection.

Objective To study the relationship between microalbuminuria and inflammation media of C-reactive protein(CRP) and interleukin-6(IL-6) in type 2 diabetes mellitus,and to explore the clinical significance.(Methods)Ninety-six patients with type 2 diabetes mellitus were divided into 3 groups according to the urine albumin excretion rate(UAER): normal albuminuria group(NA),microalbuminuria group(MA) and clinical proteinuria group(CP).The serum levels of CRP,IL-6,fasting plasma glucose,creatinine and fasting insulin were measured in all the cases. Results The levels of CRP and IL-6 in MA group were significantly higher than those in NA group(P

Objective To study the anatomy of superficial palmar digital veins in fingertip,and explore the clinical application of superficial palmar digital veins as venous drainage in fingertip replantation.Methods One hundred fingers were studied with three methods: microanatomy,sectional anatomy,and X-ray.According to microanatomical observation,thirteen fingers in 10 cases with fingertip amputations and dorsal veins defect were replanted by anastomosis of palmar digital veins to reconstruct the venous drainage of the amputated digits. Results ( 1 ) 1 to 3 tiny superficial palmar digital veins can be found at the level of the onychorrhiza.The average diameters of the superficial palmar digital veins were 0.2-0.5 mm.(2)In clinical practice,13 replanted fingers were survived.After 3-18 months following-up,the appearance and function were satisfactory. Conclusion The distribution of the palmar digital veins was in some pattern.Anastomosis of the superficial palmar digital veins can not only improve the success rate of the fingertip replantation,but also avoid the complications of the other venous drainage methods.

Objective To evaluate the clinical effect of the reversed saphenous fasciocutaneous island flap combined with the VSD therapy in plate exposure of the distal tibia.Methods From January 2008 to July 2010,seven patients with hardware exposure following internal fixation of the distal tibia fracture were treated by VSD therapy and reversed saphenous fasciocutaneous island flap reconstruction.The VSD therapy was performed from 7 to 26 days after hardware exposure,and the flap transfer was performed 7 to 14 days after the VSD therapy.The size of the soft-tissue defect ranged from 4 cm × 2 cm to 13 cm × 4 cm.The mean follow-up was 10.6 months after the fracture (range,8-14 months).Results The average times of the VSD therapy was 1.3.After VSD was removed,the exposed hardware was covered by healthy granulation tissue in all cases.All flaps were successfully transplanted,and the size of flap ranged from 6 cm × 3 cm to 15 cm × 6 cm.Six of 7 flaps survived completely without further procedures.The necrosis of the distal margin of the flap occurred in 1 patient.A solid bony union was confirmed by the X-ray in all patients after 4-6 months postoperatively.No skin defects or fistulae were observed.Conclusion The combination of the reversed saphenous fasciocutaneous island flap and VSD therapy could save the exposed hardware and cover the soft tissue defects in the distal tibia.

Objective To investigate rheumatic disease manifestations in patients with myelodysplastic syndromes and explore possible causes.Methods Nine myelodysplastic syndromes(MDS)inpatients with rheumatic disease manifestations were reviewed retrospectively.Results Nine patients with the diagnosis of MDS had active rheumatic disease manifestations with various degree of hypergammaglobulinemia and positive autoantibodies.Two patients had rheumatoid arthritis(RA)and RA+anti-phospholipid syndrome(APS),four systemic lupus erythematosus(SLE)and SLE+polymyositis(PM),one patients had adult onset Still's disease, one with acute arthritis and cutaneous vassulitis,one had lupus-like manifestations including polyserositis,al- buminuria,hypocomplementemia and positive Commb's test.Conclusion The rheumatic disease manifesta- tions in patients with myelodysplastic syndromes are characterized by various active rheumatic disease manifes- tation.Immunological abnormalities and ineffective hematopoiesis are persistent.Immunologic abnormalities in MDS such as impaired function of T and B cells,hypergammaglobulinemia,positive autoantibodies,may be the causes of various rheumatic manifestations.We suggest that there is a significant association between myeludys- plastic syndrome and rheumatic diseases.

Objective To discuss the donor site complications and the treatments of the anterolateral thiIgh flap transfer. Methods From July 1988 to July 2007,427 patients treated by anterolateral thish flap surgery were followed up.The donor sites were treated by several methods,including direct closure(49 cases),skin graft transfer(258 cases),anterolateral fascial flap transfer(27 cases),musculocutaneous flap and skin sraft transfer(65 cases), superficial epigastric artery flap transfer(28cases).The area of these flaps ranged from 30 cm×10 cm to 18 cm×7 cm.and the average follow-up was 21 months(ranged from 8 months to 54 months). All the data was analyzed by SPSS for Windows,Version 11.0.1. Results Short-term complications(within 4 weeks)and long-term complications (over 6months)were observed.The former included skin necrosis(5.4%),wound infection(4.0%),and necrosis of rectus femoris(0.5%); and the latter included chronic ulcer(4.9%), aerious scar(6.6%), serious discomfortable(5.9%),and quadriceps femoris disfunction(3.7%).The statistical results showed that there was a close correlation between the donor site morbidity and the surgical methods. Conclusion The complications of the donor site cannot be ignored.Protect the soft-tissue of the donor site carefully,design all appropriate operation plan.Careful preoperative examination and local flap transplantation can effectively decrease the rate of complications.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; classification ; genetics ; Leukemia, Myeloid, Acute ; classification ; genetics ; Male ; Middle Aged ; RNA, Messenger ; genetics ; TNF-Related Apoptosis-Inducing Ligand ; genetics ; Young Adult

Background Glucocorticoid is a common drug for treatment of thyroid-associated ophthalmopathy (TAO) with good effectiveness.But some adverse reactions of glucocorticoid are inevitable.At recent years,99technetium-methylene bisphosphonate(99Tc-MDP) is being paid more and more attentions in the treatment of TAO,but its effectiveness and safety is worthy of comparison to traditional treatment methods.Objective This study was to evaluate the efficacy of treatment with intravenous injection of 99Tc-MDP for TAO.Methods The Cochrane Library,CNKI,PubMed,Wanfang database,Weipu net were searched in computer and Google Scholar was searched manually.The randomized controlled trail (RCT) of intravenous injection of 99Tc-MDP for TAO were collected from establishment of database through April,2012.The quality of included literature was assessed based on the methodology of the study.The evaluating indexes included the primary treating outcomes,such as total efficacy,exophthalmic extent and recurrence rate as well as secondary outcomes such as adverse effect.RevMan 5.1 software was used for Mate analysis.Results A total of 11 RCTs were identified with 706 patients.Subgroup analysis was carried out based on the outcome measures and intervention.No significant difference was found in the overall effective rate between intravenous injection of 99Tc-MDP and immunosuppressive treatment (RR =0.96,95 ％ CI:0.76 to 1.22,P=0.740).However,the effective rate was significant different between intravenous injection of 99Tc-MDP and oral prednisone (RR =1.25,95 ％ CI:1.06-1.46,P =0.007) or between intravenous injection of 99 Tc-M DP and the blank control group (RR =2.53,95 ％ CI:1.68-3.81,P =0.000).Significant difference also was found in the total effective rate between intravenous injection of 99Tc-MDP with methyprednisone and methyprednisone alone (RR =1.27,95％ CI:1.05-1.53,P =0.010).There were significant differences in the effective rate of proptosis between intravenous injection of 99Tc-MDP and oral prednisone (RR=2.02,95％ CI:1.44-3.56,P=0.020).The recurrence rate of TAO was significant different between intravenous injection of 99Tc-MDP and oral prednisone (RR =0.51,95％ CI:0.33-0.78,P=0.002).Less adverse responses were seen in the intravenous injection of 99Tc-MDP group than the oral prednisone group and immunosuppressive treatment group.Conclusions Intravenous injection of 99Tc-MDP for TAO appears to be of a similar effectiveness to immunosuppressive method.The combination of intravenous injection of 99Tc-MDP with methyprednisone seems to be more effective than methyprednisone alone,with little systemic adverse effect after application.

Background Many kindof cells,cytokineand extracellulamatrix components,such aconnective tissue growth facto(CTGF) and fibronectin (FN),can regulate and controll the formation and developmenof epiretinal membrane.Iiimportanto investigate the morphology and pathology of epiretinal membrane fothe prevention of relevanretinopathies.Objective Thistudy wato investigate the expression of CTGF and FN in differentypeand stageof epiretinal membranes.MethodEpiretinal membranewere collected during vitrectomy and silicon oil removal surgery from 24 eyeof 24 casewith rhegmatogenouretinal detachment(RRD) (including 14 eyewith courses＜90 dayand 10 eyewith course≥ 90 days),20 eyeof 20 casewith diabetiretinopathy (DR)associated with vitreouhemorrhage and tractional RD (course≥ 90 days)and 7 eyeof 7 casewith silicon oil tamponade (course≥ 90 days).The grading of the proliferative vitroretinopathy (PVR) wa＞C2 in all the eyes.Histopathological examination waperformed to assesthe pathological elemenin the differentypeand stageof epiretinal membrane,and the differential expressionof CTGF and FN in the varioutypeof epiretinal membranewere detected by immunochemistry.The amounof cellpositive foCTGF and FN wacompared using the FisheExacProbability method.ResultHistopathological examination showed thaincrease in the numbeof RPE celland inflammatory cellwaprimary characteristiin the epithelial membrane of RRD with courses＜90 days,buthere were loof neurogliocyteand fibroblastin the RRD group with course≥ 90 days.In addition,the infiltration of inflammatory cellwapredominanin the RRD and Dgroups,bufibroplasiwaobviouin the silicon oil tamponade group.When the course wa≥ 90 days,7 eye(70.0％)in the RRD group wapositive foCTGF,and 18 eyes(90.0％)in the Dgroup and 2 eyes(28.6％)in the silicon oil tamponade group were positive foCTGF,with significandifference among them(P=0.037).In regardto FN,9 eyeshowed expression in the RRD group(90.0％),18 eyein the Dgroup(90.0％)and 7 eyein the silicon oil tamponade group(100.0％),withousignificandifference among them (P =0.379).In the RRD group,7 eyewith course≥ 90 dayand 13 eyewith courses＜90 days(92.9％)were positive foCTGF,showing significandifference between them(P =0.032).AfoFN,9 eye(90.0％)with course≥ 90 dayshowed positivity,which wasignificantly highethan the 7 eyewith courses＜90 day(50.0％) (P =0.019).ConclusionThe expression of CTGF in epiretinal membranevariewith the disease type and course duration,buthe expression of FN in epiretinal membrane varieonly with the course duration.

Objective To report the anatomical study and clinical application of the free peroneal perforator-based sural neurofasciocutaneous flap. Methods Latex injection studies were performed on 10 adult cadaveric lower limbs. The presence, prevalence, and location of the peronel perforators that were suitable for vascular anastomosis were documented. From April 2007 to January 2010, 6 patients with large soft tissue defects in the upper limb underwent the reconstructive procedures with the free peroneal perforatorbased sural neurofasciocutaneous flap transfers. 4 patients were men and 2 were women, with the age ranging from 19 to 60 years. The causes of the injury included 4 motor vehicle accidents, and 2 massive machinery trauma. The area of the flap ranged from 16 cm × 8 cm to 30 cm × 10 cm, and the length of the perforator pedicle was 4 cm to 6 cm. Results A mean of 5.3 perforating vessels of the peroneal artery was noted in the specimen. The peroneal perforator that located at the junction of the middle and lower thirds of the fibula was found suitable for microsurgery, with the external diameter and the length being (1.21 ± 0.13)mm and (4.6 ± 0.8)cm respectively. All the 6 flaps survived completely without necrosis. No severe venous congestion was observed. All the patients were satisfied with the aesthetic outcome postoperatively at 3 to 12 months'follow-up. There were no major donor site complications. Conclusion The free sural neurofasciocutaneous flap based on a single peroneal perforator is an excellent tool for reconstruction of extensive soft tissue defects in the upper limb.