From May 1990 January 1991, 22 patients with recurrent esophageal carcinoma after external radiotherapy were treated by intraluminal brachytherapy of Iridium-192(HDR). Preliminary results showed relief of symptoms and improvment of general condition with gain weight. Barium X-ray films revealed better barium passage and smooth mucosa in 80% patients. 14 cases have survived over 8 months and 2 over 16 months. The average survival was 9.18 months.

The paper introduced the theory of the standard score and its application in instructional supervision and analyzed the difference between the standard score and original score in instructional supervision recording and revealed the reasons behind the difference.Besides,the paper pointed out the advantages which included scientificity and stability,providing information of the grade level,being suitable for longitudinal comparison and the crosswise comparison,and disadvantages such as complex calculation and depending on the distribution of original records.Finally,the paper put forward some recommendations on using standard score in instructional supervision:keeping the stability of the supervision expert team,insurance of supervision times,carrying out classified supervision and viewing the scores in its entirety.

OBJECTIVETo study the expressions of Notch1-4 gene in human keloid-derived mesenchymal-like stem cells, and to explore the Notch signaling pathway's role in the formation of keloid.

METHODSKeloid samples were collected to harvest human keloid-derived mesenchymal-like stem cells through two-step enzymatic dissociation method. By flow cytometry, cell phenotype of primary and P3 generation were analyzed. By immunocytochemistry, the expressions of Oct4, vimentin and CK19 were examined. Keloid-derived mesenchymal-like stem cells were induced into osteoblasts in vitro and calcium deposition was detected by Alizarin red S stain. Realtime polymerase chain reaction (RT-PCR) was used to detect the expressions of Notch1-4 mRNA in keloid-derived mesenchymal-like stem cells.

RESULTSFlow cytometry showed that keloid-derived mesenchymal-like stem cells of primary and P3 generation highly expressed CD29, CD44, CD90 from the typical MSC phenotype marker, but they failed to express HSC phenotype markers, such as CD34 and CD45. The results of immunocytochemistry showed that Oct4 from pluripotent stem cell markers and vimentin from mesenchymal cell markers was positive and CK19 from epithelial cell markers was negative. After induced differentiation into osteoblasts in vitro after 21 day, calcium nodules could be seen clearly; Notch1-4 gene were expressed in keloid-derived mesenchymal-like stem cells through RT-PCR. The relative quantitative of Notch2, Notch3 gene were higher than Notch1, Notch4 gene (P < 0.05).

CONCLUSIONSThe expression difference of different subtypes from Notch gene in human keloid-derived mesenchymal-like stem ceils may be related to self-renewal, proliferation, differentiation, and participate in the formation of keloid.

Adolescent ; Cells, Cultured ; Child ; Female ; Humans ; Keloid ; metabolism ; pathology ; Male ; Mesenchymal Stromal Cells ; metabolism ; Receptors, Notch ; metabolism

OBJECTIVETo explore the clinical effects of relaying reversed perforator flaps in repairing skin and soft tissue defects at distal end of finger and donor site.

METHODSSeventeen patients (17 fingers) with skin and soft tissue defects at distal end of finger were hospitalized from June 2011 to June 2013. The reversed digital artery perforator flap with branch of digital nerve was used to repair the defect. The first donor site was repaired by dorsal metacarpal artery perforator flap; the second donor site was closed by suturing. The area of skin defect at distal end of finger ranged from 2.0 cm x 1.5 cm to 3.0 cm x 2.0 cm, and the area of digital artery perforator flap and dorsal metacarpal artery perforator flap ranged from 2.2 cm x 1.5 cm to 3.6 cm x 2.5 cm and 2.5 cm x 2.0 cm to 4.2 cm x 3.0 cm, respectively.

RESULTSAll the 34 flaps survived completely. Cyanosis and partial necrosis of the epidermis appeared in 1 flap, which was healed after dressing change. All the patients were followed up for 1 to 18 months, with mean time of 8 months. The color, texture and appearance of flaps were satisfactory. There was no depression or breakdown in the first donor sites. Some linear scars appeared in the second donor sites, but they did not affect the general appearance. The donor sites at joint or tendon did not affect the joint activity after healing. The results of function evaluation of range of active movement of the fingers were excellent in 15 cases and good in 2 cases. The results of sensation of the flaps were S3 in 1 finger, S4 in 2 fingers, and S5 in 14 fingers. The distance of two-point discrimination of flaps ranged from 5 to 7 mm, with mean distance of 6 mm.

CONCLUSIONSRelaying reversed perforator flap, with reliable blood supply and both donor sites in the hand, can improve the appearance and function of the first donor site as well as repair skin and soft tissue defects at distal end of finger.

Cicatrix ; Depression ; Epidermis ; Extremities ; Finger Injuries ; surgery ; Humans ; Perforator Flap ; Reconstructive Surgical Procedures ; methods ; Skin ; Skin Transplantation ; methods ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; blood supply ; Sutures ; Tendons ; Treatment Outcome ; Wound Healing

Objective To explore an anatomical basis for the lateral tarsal artery pedicle flap on front and lateral compartment of leg and the feasibility of repairing skin defects on forepart of feet. Methods The branches, course and anastomosis of the lateral tarsal artery, perforator of peroneal artery up external malleolus, superficial peroneal artery were studied in 20 legs of adult cadavers.The flap was designed on these grounds. 8 cases repaired by lateral tarsal artery pedicle flap on front and lateral compartment of leg, 5 cases of skin defects on dorsum of foots, 3 cases of skin defects on footplates.The area of defect on forepart of foot was 5 cm× 4 cm-cm × 5 cm. The donor sites were resurfaced with skin grafts or sutured directly. The lateral tarsal artery, perforator of peroneal artery up external malleolus, perforator of anterior tibial artery superficial peroneal artery were anastomosed each other, formed single band blood vessel axle on lateral foot, fore external malleolus, front and lateral compartment of leg. The area of flap was 6 cm × 4 cm - 10 cm × 6 cm.Results All of the flaps survived completely. All cases were followed up, followed up 6- 12 months, averaged 8 months. The color, appearance and texture of the flaps were good, without ulcer on the flap. The patients can walk freely. Conclusion The flap on front and lateral compartment of leg should be designed according to the lateral tarsal artery. Blood supply of flap was reliable, little trauma. The flap's vessel pedicle is enough long. It could repair any defect on forepart of foots.

he donor sites of the intermediate dorsal neurocutaneous flap on the foot. Conclusion The donor sites of the dorsal artery flaps can be repaired by the intermediate dorsal neurocutaneous flaps on the foot.The method is simple, applicable, safety.

Objective To explore a novel and highly specific small-molecule TNFβinhibitor by using computer-aid?ed virtual screening and cell-based assays in vitro. Methods Computer-aided drug design and virtual screening were used to design and identify chemical compounds that targeted TNFβbased on the crystal structure of the TNFβ-TNFR1 com?plex. The effect of the small-molecule compound against TNFβ-induced cytotoxicity of L929 cells was detected by MTT as?say, and the efficacy of the compound to inhibit TNFβ-induced apoptosis of L929 cells was determined by flow cytometry as?say. The impact of the compound on L929 cell cycle was examined by Propidium Iodide (PI) staining and flow cytometry, and the influence of the compound on TNFβ-triggered signal pathway was analyzed by Western blot assay and Ultra VIEW VOX 3D Live Cell Imaging System. Results No.35 compound (named as C35 thereafter) could effectively inhibit TNFβ-induced cell death in a dose dependent manner, and the half-maximum inhibition concentration (IC50) was 8.19μmol/L. Furthermore, C35 had lower cytotoxicity and minimal effect on L929 proliferation. Here we further revealed that C35 could affect TNFβ-induced apoptotic pathway by blocking the activation of Caspase 3, and markedly reduce L929 cell apoptosis induced by TNFβ. Conclusion A novel TNFβsmall-molecule inhibitor was identified by combining computer-aided virtual screening with functional assays, and which could block TNFβ-triggered apoptotic pathway and efficiently inhibit the cell death in?duced by TNFβ.

Objective To explore an anatomical basis for the medial plantar skin flaps and its clinical value of repairing heel defects. Methods The origin,branches,course and distribution of the medial plantar artery and the nerve of flaps were studied in 10 adult cadavers(20 legs).8 cases of homonymy and opposite side heel soft tissue defects with medial plantar skin flaps,aged 10-42 years.Free skin transplantation on the donors. Results The length of media plantar artery deep branch was (8.9±0.2)cm,gives off 3-5 cutaneous branches.Medial plantar nerve have 5-8 branches.it inchdes 3～5cutaneous branches distribute plantar skin and 2-4 plantar digital nerves distribute toes skin.The area of flaps was 4.0 cm×3.0 cm-6.0 cm×5.0 cm in the 8 flaps. 6 pedicle skin flaps were transfenrred to repair homonymy side heel soft tissue defects.2 opposite side heel soft tissue defects were repaired by 2 free flaps.All the flaps were survived. All patients were followed up one months to one year,the function and appearance of the flaps were good.Conclusion The flaps have less anatomic variation or sacrificing major vessels but have reliable blood supply and can restore good sensation after operation.They are ideal flaps for repairing heel soft tissue defects.

BACKGROUND: Medialis pedis flaps have been widely used in the clinical practice due to their good color and luster,texture as well as the restoration of protective sensation. But little is known about the precise anatomic data of innervation of medialis pedis flaps.OBJECTIVE: Based on identification of local anatomic relationship, this study was designed to repair tissue defects adjacent to Achilles tendon using medialis pedis flaps with saphenous nerve and observe the repairing effects.DESIGN: A single-sample study.SETTING: Department of Plastic Surgery, Affiliated Hospital of Zunyi Medical College & Department of Anatomy, Zunyi Medical and Pharmaceutical College.PARTICIPANTS: Eleven patients with defects at Achilles tendon and/or local skin, who received treatment in the Department of Plastic Surgery, Affiliated Hospital of Zunyi Medical College between January 2004 and June 2007, were recruited into the present study. These patients, composed of 7 males and 4 females, were aged 15-40 years.METHODS: This experiment was performed at the Department of Anatomy, Zunyi Medical and Pharmaceutical College between January 2004 and June 2007. Twenty specimens of lower limb were from 12 cadavers obtained in the Department of Anatomy, Zunyi Medical and Pharmaceutical College and from 8 amputated extremities in the Department of Plastic Surgery,Affiliated Hospital of Zunyi Medical College (Informed consents for the application of amputated extremities have been acquired from the patients). The 20 specimens of adult lower limb were perfused with red emulsion to anatomically study the origin, course, number, size and distribution of the medial plantar artery and the number and distribution of the saphenous nerve in the medial malleolus. Concurrently, repair of tissue defects adjacent to Achilles tendon using medialis pedis flaps with saphenous nerve was performed in 11 patients in the Department of Plastic Surgery, Affiliated Hospital of Zunyi Medical College. Pedicle skin flaps were used in the 11 patients by transplantation.The Hospital's Ethics Committee approved the following protocol. After surgery, 1 24-month follow-up observation was performed by further consultation to study the color and luster, and the texture of the flaps, as well as the two-point discrimination difference compared with the opposite medial plantar area.MAIN OUTCOME MEASURES: Vascular nerves, which dominate medialis pedis flaps with saphenous nerve, as well as the appearance and function of these flaps after repairing tissue defects adjacent to Achilles tendon.RESULTS: Anatomic observation results: 1.0- 2.0 cm after its origin, the medial plantar artery divided into a superficial and a deep branch. The superficial branch of the medial plantar artery passed through the abductor muscle of great toe and originated around the tuberosity of navicular bone with an outer diameter of (1.0± 0.2) mm (adult). The deep branch was the direct continuation of the medial plantar artery, with an outer diameter of (1.5±0.3) mm (adult). 2.5-5.0 cm away from the medial plantar artery, the deep branch divided into a medial deep and a lateral deep branch. The medial deep branch passed through the abductor muscle of great toe deeply and sub-divided into the medial branch (cutaneous branch) and the lateral branch at the branching point of the medial and lateral deep branches. Clinical application: Altogether 11 flaps were used in the present study. All flaps were successfully transplanted without early vascular risk or flap necrosis. Among 7 patients followed up, 2 were followed up for I month, 3 for 6 months, 1 for I year, and I for 2 years. Follow up results showed that the transplanted flaps had good color and luster, texture, and appearance. There was no difference in two-point discrimination between the flap and the opposite medial plantar area.CONCLUSION: Medialis pedis flaps is blood-supplied by the superficial branch of the medial plantar artery that is an absolutely dominated area of the saphenous nerve. Medialis pedis flaps with saphenous nerve can repair Achilles tendon and adjacent tissue defects, possessing the advantages of less anatomic variation, easy resection, and good repair effects.

Objective To investigate the clinical effect of inherent artery dorsal perforator flaps of thumb radial palmar for coverage of ipsilateral thumb degree Ⅰ and Ⅱ oblique defect of the fingertip.Methods The study included 6 males and 6 females,aged 10-40 years (mean 30 years),with thumb fingertip Ⅰ and Ⅱ degree defect treated between October 2009 and October 2013.Injury resulted from machinery cutting injury in 4 patients,machinery twist injury in 3,cutting by sharp weapons in 3,and crush injury in 2.There were 6 patients with Ⅰ degree defect and 6 patients with Ⅱ degree defect.Defects were all oblique involving more in the radial side rather than in the ulnar side and reconstructed with thumb radial palmar artery perforator flaps.Flap ranged in size from 1 cm × 2 cm to 1.5 cm × 2.5 cm.Donor site was covered with skin grafts.Observation indexes were wound healing condition,flap color,flap swelling degree,and flap temperature.Finger function was measured with upper extremity scoring system formulated by Hand Surgery Branch of Chinese Medical Association.Results All flaps survived and achieved good protective sensation.Wound healed primarily.Color,temperature and texture of the flap returned to almost normal.Moderate swelling of the flaps was detected and subsided around one week.All patients were followed up for 1-36 months (mean 20 months).At the final follow-up,two-point discrimination was 9-11 mm (mean 10 mm).Two patients developed distal interphalangeal joint stiffness and recovered after rehabilitation exercise.Finger function was rated as excellent in 10 cases and good in 2.Conclusion Inherent artery dorsal perforator flap of thumb radial palmar has affirmative effect and allows maximum preservation of finger length and function when applied to repair ipsilateral thumb degree Ⅰ and Ⅱ oblique defect of the fingertip.