Objective To explore the relationship between the expression of c fos gene and delayed neuron death in perinatal hypoxia ischamia encephalopathy (HIE). Methods Terminal deo xynuleotidyl transferase mediated dUTP nick end labeling (TUNEL), immuno histochemistry andreverse transcription PCR(RT PCR) were used to detect the apoptosis and transcription and translation of c fos gene in the hippocampus following HIE. Results Positive signal of apoptosis from CA1 to CA4 sections were observed in experimental hippocampi. Marked signal appeared earlier and longer in CA1 section than in the other sections[CA1: 1 h: (14.6?2.3),24 h: (51?6),72 h: (17.4?0.3);CA4:1 h :1.3?1.6),24 h: (47?8),72 h: (21.6?0.6) apoptosis cell number/ mm 2 ],compared with the sham group of CA1 section P

Objective To introduce the improvement of the flap from the dorsal site of the index in the application of treatment in the thumb web contracture. Methods Apply improved first dorsal metacarpal flap for 111 cases of patients of the thumb web contracture releasing. The original island or tongue-shaped flaps was modified to be the local flap transfer to the thumb web. Surgical method simplified. Before thumb web contracture was released, the flap was taken from ulnar aspect to radial aspect on the dorsum of the index. The flap was transferred to cover the soft tissue defect on the first web space following the contracture releasing. Flap donor area was closed by split-thickness skin graft. Results One hundred and eleven cases of flaps survived. After the 3-18 months (mean follow-up of 8.5 months), the local appearance, thumb function recovered well for 94.6 percent. Conclusion Improved first dorsal metacarpal flap is effective methods in thumb web contracture releasing.

ObjectiveTo evaluate the strain of the weight-bearing metatarsal bone. Methods6 fresh-frozen cadaveric lower extremities were dissected to expose the dorsal aspect of metatarsal. Bone segments were clarified for adherence of strain-gauges while feet kept intact. Then vertical downward axial load was exerted to distal tibia at a 2 mm/min velocity, from 0 N to 1200 N with one minute interval of 200 N leveled loading augment each for sampling. Superficial strain of the metatarsal was measured by resistance strainmeter methods. ResultsThe strain increased gradually with axial loading, and compress force was always found at every marked bone. The strain of every marked bone was significantly different at the same loading (P<0.05). As to the strain of the middle of the metatarsal, the sequence was the second metatarsal＞the third metatarsal＞the fourth metatarsal＞the first metatarsal＞the fifth metatarsal. As to the strain of the second metatarsal, the sequence was the middle＞the neck＞the base. ConclusionThe peak strain was found at the middle of the second and third metatarsal with axial loading, which prompts the stress fractures of the second and third metatarsal are most common, especially the middle of the second metatarsal.

ObjectiveTo investigate the technique and clinical results of curved osteotomy under the metatarsal head's cartilage for improving reconstructed metacarpophalangeal joint function of fingers with second toe transplantation. MethodsThere were total 21 cases with 21 digits. During second toe transplantation with the metatarsophalangeal joint, the bottom of the second metatarsal head was incised. Then a curved osteotomy were carried out on about 5.0 mm under the metatarsal head's cartilage until the passive range of motion could be 90°.Longitudinal or cross-Kirschner wires were used to fix the joint.Finally,the conventional methods were used to reconstruct the blood supply, movement and nerves. ResultsAll 21 digits of the 21 cases survived uneventfully.The follow-up time was ranged from 6 to 24 months.Their average passive range of motion of the reconstructed metacarpophalangeal joint was 75°,ranging from 65° to 85°.The average active range of motion was 65°, ranging from 45° to 80°. Postoperative X-ray revealed fracture healed well without joint degeneration. ConclusionCurved osteotomy under the metatarsal head's cartilage is an effective way to improve active and passive activities function of the reconstructed metacarpophalangeal joint with second toe transplantation.

Objective To summarize and investigate the therapeutic effects of reconstruction of contracture of the first web space with snuff-box flap. Methods Eighteen patients with contracture of the first web space were treated by snuff-box flap. The width and the angle of the first web space was 19 mm and 20°on average. According to the first web space skin defects, the flap designed to nasopharyngeal fossa centers as rotation point, the radial line when the forearm in the neutral position as the axis. Results The followedup for 5-26 months revealed that 17 flaps had a success, but 1 case was partly necrosis. The width of the first web space was augmented by an aveage of 45 mm, the angle of the first web space was augmented by an average of 50°. Conclusion It is ralatively simple and reliable to repair the contracture of the first web space using the snuff-box flap.

Objective To investigate the replantation methods and outcomes of mini tissue mass of amputated finger. Methods Twenty-six fingers of 20 patients were replanted with multiple vessel anastomosis methods to restore blood supply.The methods include vascular anastomosis,vascular bridge,arteriovenolization,veno-arteriolization,et al. Results Twenty-five replanted tissues were survived completely.Partly necrosis occur in 1 case,and rehabilitation by change dressings.The patients were follow up from 6 to 12 months.The contour and function of the replantation fingers recovered satisfactory. Conclusion By using the rational anastomosis according to the traumatic condition,it could be obtain good outcome of mini tissue mass replantation

Objective To measure stress distribution of the main bone architecture of the normal adult cadaveric foot and discuss the effect of plantar ligament injury on stress distribution. Methods Seven fresh adult cadaveric feet were used and 10 strain gauges attached to the bones of the longitudinal foot arch,including the calcaneus,navicular,medial cuneiform,1-5 metatarsal trunk,the distal part of the tibia and fibular,respectively.After the loading Was added to 700 N by almighty test machine,resistance strainmeter was used to measure surface strain of these bones.The results were processed statistically. Results The strain was varied based on different bone segments attached and increased with loading.Tensile force was always found at the medial part of the navicular,the distal part of the tibia and fibular,while the others showed compression all the time.Peak strain was found at calcaneus.followed by the second and third metatarsal.Strain on the surface of the bone segments changed greatly with different ligament injury(P＜0.05).Conclusion The bone surface stress of the longitudinal foot arch changes significantly when the plantar ligament is injured.

Objective To explore small size toe tissue flap for aesthetic reconstruction of the thumb and / or finger. Methods Six kinds of small size toe tissue transplants had been applied in repairing skin-bone-joint composite tissue defects of the thumb or finger in 74 cases. Results Among 83reconstructed flaps of the 74 patients, 81 flaps survived completely. Follow-up examination made three to forty-eight months postoperatively showed that the outward appearance were excellent in most cases. The function of the thumbs or fingers were good. The donor feet can walk normally with no pain. Conclusion A variable combinations of toe tissues including skin, soft tissue, bone and joint can be harvested to form a lot of small size transplants for refined aesthetic reconstruction of thumb and finger. The functional and aesthetic results are good and the treatment course is shortened.

Objective To introduce the concept of long length finger reconstruction and our corresponding three operative methods. Methods In a series of 10 finger defect cases with one of their long finger amputated at or proximal to proximal phalanx, long finger reconstruction were accomplished with one of the three methods. First method: For emergency patients whose proximal finger segment were demolished, the donor second toe was transplanted intercalatedly with microsurgical technique between the original proximal finger stump and the saved distal finger segment. Second method: Bilateral second toes were harvested and connected together to form a long transplant in order to reconstruct a normal length finger. Third method: From one foot, the donor second toe is harvested with its dorsal and plantar skin flap. From the other foot, the second toe is harvested with its metatarsophalangeal joint and skin flaps from neighbouring sides of great and third toes. The skin covering will be perfect. During transplantation of the proximal transplant, the MPJ should be fixed at 90°plantar rotation position for better flexion. Results Uneventful survival of reconstructed fingers were obtained in all ten cases. Postoperative functional evaluation of the patients with standard set by Chinese Society of Hand Surgery showed to be excellent in 1 case, good in 5 cases and fair in 4 cases. The overall excellent/good rate was 60%. Conclusion By application of these three reconstruction methods, the challenging problem of long length finger can be solved to reasonable extent.

Objective To investigate the efficacy and safety of CT portograph combined with endoscopic ultrasonography for the pricision treatment of esophagogastric varices in patients with cirrhosis. Methods A total of 130 inpatients with cirrhosis complicated with esophagogastric variceal bleeding who received endoscopic treatment from January 2013 to January 2015 were selected. Using prospective randomized controlled design, the patients were divided into two groups, the experimental group and the control group, with 65 cases in each group. The number and degree of esophagogastric varices were assessed by CT portography in the experimental group. Then endoscopic ultrasonography was used to assess the paraesophageal vein and perforator vein before endoscopic treatment. The range and degree of esophagogastric varices were observed and the lesions were treated by endoscopy in the control group. Results A total of 62 patients completed the study in the experimental group, and 63 in the control group. The number of treatment was significantly lower in the experimental group than that in the control group(3. 00±0. 76 VS 5. 63±0. 92, P=0. 000) . The disappearance time of varices was significantly shorter in the experimental group than that in the control group(7. 25±1. 16 months VS 8. 88±1. 64 months, P=0. 039). The variceal recurrence rate of the experimental group was significantly lower than that of the control group [ 1. 6％ ( 1/62 ) VS 12. 7％( 8/63) , P=0. 040] . The incidence of pleural effusion was significantly lower in the experimental group than that in the control group [ 0 ( 0/62 ) VS 9. 5％ ( 6/63 ) , P= 0. 040 ] . The total complication rate was significantly lower in the experimental group than that in the control group [ 27. 4％ ( 17/62 ) VS 58. 7％(37/63), P=0. 003]. Conclusion CT portography combined with endoscopic ultrasonography is safe and effective for esophageal gastric varices in patients with cirrhosis.