Objective To clarify the distribution characteristics of serum pepsinogen (PG ) and gastric cancer related tumor markers in the healthy population ,and analyse their value in health examination .Methods The levels of serum tumor markers ,pep‐sinogenⅠ(PGⅠ ) and pepsinogenⅡ(PGⅡ) were detected in 958 subjects who underwent physical examination by using the Lumi‐nex 200 instrument ,and the ratio of PGⅠ /PGⅡ(PGR) was calculated .Meanwhile ,the C13 breath test was carried out ,and relation‐ships among these clinical indicators were analysed .Results In this population ,The serum level of PGⅠ in male subjects was high‐er than that in female subjects ,there was statistically significant difference(P<0 .05) .The levels of serum PGⅠ ,PGⅡ ,carcinoem‐bryonic antigen(CEA) ,carbohydrate antigen 199(CA199) and carbohydrate antigen 242(CA242) were gradually increased with age ,while the PGR was slowly decreased with age .The positive rate of C13 breath test in male subjects was higher than that in fe‐male subjects ,there was statistically significant difference(P<0 .05) .Compared with subjects whose C13 breath test results were negative ,the serum levels of PGⅠ and PGⅡ were higher ,while the PGR was lower in subjects whose C13 breath test results were positive(P<0 .05) .Conclusion The distribution of serum PG might be correlated with age ,gender and the infection of Helicobact‐er pylori in healthy population .It is shown that the effects of tumor markers on gastric cancer screening are limited .

The distributions and expressions of the T helper 17 (Th17) cells and interleukin 17(IL-17) are found in a verity of tumor tissues.However,their functions in tumorigenesis,which play antitumor or promote tumor roles,have not yet a final conclusion.Therefore,it is necessary to go further study of their functions in tumor microenvirnment.It is wished that in the process of cancer treatment,people would hasten benefit avoids kill and improve the therapeutic effect.

Objective To determine the main predictors of circulatory crisis after replantation in patients with severed distal finger so as to establish the theoretic basis in reducing the morbidity of circulatory crisis. Methods 65 severed distal fingers underwent replantation were respectively reviewed. All the clinical parameters including age, sex, dominant hand or finger, preservation of the severed finger, platelet level, ischemia duration, cause of injury, manner of venous drainage, repair of artery, order of reparation and plane of division were investigated as predictive risk factors for circulatory crisis of finger after replantation. In order to find the risk factors of circulatory crisis, the data was dealt with t test, ?2 test, analysis for variance or multivariate Logistic regression analysis. Results 13 replanted finger suffered from impaired circulation in 65 fingers. Univariate analysis demonstrated that many factors were significantly correlated with the circulatory crisis of finger, such as the manner of venous drainage(?2=6.714,P=0.035), the cause of injury (?2=9.049,P=0.011), the preservation of severed finger(?2=6.452,P=0.040), the age(?2=14.838,P=0.001), the platelet level(uc= 2.961, P=0.003). The multivariate Logistic regression analyses showed that platelet level (OR=1.015, P=0.030), the age(OR=0.349, P=0.031) and the manner of venous drainage(OR=0.278,P=0.036) were the significant independent predictors for circulatory crisis. The incidence of circulatory crisis in patients less than 6 years old was 61.5%, significantly higher than any other age group(P

Objective To explore the role of severity of limb ischemic injury in the treatment of popliteal artery injury.Methods A retrospective analysis was conducted of 259 patients with popliteal artery injury who had been treated from January 2002 to December 2014.They were 187 males and 72 females with a median age of 37.6 years (range,from 14 to 68 years).The time from injury to revascularization was from 4 hours to 29 days.According to the Rutherford classification system,the limb ischemic injury was categorized into 4 grades:grade Ⅰ:presence of sense and motion;grade Ⅱ:presence of sense but loss of active motion;grade m:loss of sense or motion;grade Ⅳ:stiffness.For all the patients with injury of grades Ⅰ and Ⅱ,limb salvage was adopted and opening decompression to osteofascial compartment was performed depending on the intraoperative and postoperative limb swelling.For the patients with grade Ⅲ injury,opening decompression to osteofascial compartment was performed to explore the activity of muscles in those with a strong will to preserve their limbs.When the muscle activity was poor but bright red bleeding was found at the broken muscle ends and there were no fish-like changes in muscles,limb salvage was suggested;otherwise amputation was chosen.For all the patients with grade Ⅳ injury,amputation was suggested.Results Of the 146 cases of limb salvages,142 were successful and 4 failed due to uncontrollable infection,giving a total success rate of 54.83％ (142/259).Complete rupture of the popliteal artery occurred in 23 cases,incomplete rupture or tear in 17,contusion and thrombosis in 219.No patient died due to popliteal artery injury or its complications.The patients with injury of grades Ⅰ,Ⅱ,Ⅲ and Ⅳ were respectively 51,88,67 and 53;their success rates of limb salvage were respectively 100.00％ (51/51),96.59％ (85/88),8.96％ (6/ 67) and 0.For the patients whose time from injury to revascularization was ＜ 6 h,6 h to 12 h,13 h to 24 h,25 h to 1 w,and ＞ 1 w,the success rates of limb salvage were respectively 80.77％ (42/52),54.58％ (73/134),20.51％ (8/39),33.33％ (6/18),and 81.25％ (13/16).The 142 patients whose limbs had been salvaged obtained an average follow-up of 31.4 months (range,from 6 months to 8 years).Of them,those with grade Ⅰ injury obtained normal plantar sensation and active ankle flexion and extension.Of the 85 patients with grade Ⅱ injury,all recovered normal or nearly normal plantar sensation,29 achieved partial recovery of active ankle and digital flexion and extension,but the other 56 obtained no recovery of active ankle motion.Of the 6 patients with grade l injury,none obtained recovery of motion function,4 achieved partial recovery of plantar sensation but the other 2 had no recovery.Conclusion The classification of popliteal artery injury into 4 grades according to its severity of ischemic injury can provide helpful guidance to the treatment and prognosis assessment of the popliteal artery injury.

Objective To investigate the most important risk factors leading to failure of replantation of severed distal fingers so as to provide theoretic foundation for an improvement of survival rate. Methods Medical records of 65 amputated distal fingers underwent replantation were retrospectively studied to determine the independent risk factor for failure by using univariate and multivariate statistical analyses. Results Of 65 fingers treated with replantation, 8 (12%) failed. Univariate analysis showed that the increase of platelet level was the risk factor leading to failure of replantation (P= 0.041) . Manner of venous drainage (? 2=12.483, P=0.002), injury cause (? 2= 7.992, P= 0.018) , reconstruction of arteries (? 2=4.158, P=0.041) and preservation of the severed finger (? 2=6.240, P=0.044) were significantly correlated with the failure of replantation. However, multivariate logistic regression analyses showed that platelet level (OR=1.020, P=0.046) and manner of venous drainage (OR=0.154, P=0.040) were the significant independent predictors for failure of replantation. Six (38%) out of 16 amputated fingers replantation by means of single venous anastomosis resulted in failure. Of 26 amputated fingers treated with single venous drainage by bloodletting of finger tip, one (4%) failed. However, only one finger (4%) failed when 23 amputated fingers were treated with venous reflux by a combination of these two ways. Conclusions High level of platelet and venous reflux through anastomosis are the independent predictors affecting replantation of the severed fingers. Augmentation of anticoagulation as well as venous drainage determined by concrete lesion condition contribute to a higher clinical survival rate of replantation.

Objective:To observe the expression of miR-30c-5p and Toll-like receptor 4(TLR4) in colon cancer tissues and cells, and to explore their relationship with clinicopathological features.Methods:As a prospective study, 30 cases of colon cancer surgical specimens and matched normal tissue samples were selected from the Cancer Hospital of China Medical University from May 2016 to may 2017.The expression of miR-30c-5p mRNA was detected by quantitative real-time polymerase chain reaction(qRT-PCR), and the expression of TLR4 Protein was detected by western blot (WC). The expression differences of miR-30c-5p mRNA and TLR4 protein in different TNM stages, differentiation degrees and diameters were observed.The correlation between the expression of miR-30c-5p and TLR4 Protein was analyzed by Pearson Rank method.Results:The expression of miR-30c-5p was lower in colon cancer tissues(0.311±0.147) than in adjacent normal colon tissues(0.881±0.266)( t=10.613, P<0.001). TLR4 protein was higher in colon cancer tissues(0.729±0.274) than in adjacent normal colon tissues(0.361±0.168)( t=6.310, P<0.001). Expression of miR-30c-5p was lower in colon cancer cell lines(0.394±0.045, 0.435±0.098, 0.533±0.092, 0.272±0.069) than in normal colon epithelial cell line(1.371±0.101)( t value were 6.744, 6.432, 6.865 and 6.201, respectively; P<0.001). The expression of TLR4 protein was higher in colon cancer cell lines(1.108±0.169, 1.035±0.177, 1.114±0.253, 1.116±0.157) than in normal colon epithelial tissues(0.358±0.094)( t value were 5.789, 4.799, 5.311 and 5.292, respectively; P<0.001). Pearson rank correlation showed that miR-30c-5p was negatively correlated with TLR4 protein expression( r=-0.487, 95% CI: -0.721--0.154, P<0.01). MiR-30c-5p was decreased with TNM stage increasing( F=31.406, P<0.001), pathological differentiation degree decreasing( F=9.960, P<0.001), tumor diameter increasing( F=10.267, P<0.001). TLR4 was increasing with TNM stage increasing( F=37.634, P<0.001). TLR4 increased with the decrease of tumor differentiation( F=38.027.35, P<0.001). TLR4 increased with tumor diameter ( F=20.717, P<0.001). Conclusion:The low expression of mir-30c-5p and high expression of TLR4 in colon cancer were correlated with TNM stage and tumor volume.

Objective:To study Clinical Effect of Anterolateral Approach ofor the Patients with Hip Arthroplasty and the effect on the serum CRP,IL-6,D-Dimer in levels.Methods:102 Patients with Hip Arthroplasty who received therapy from February 2013 to January 2015 in our hospital,Patients were asked to be divided into observation group and control group.Among them,the control group of 54 cases,through the conventional approach to hip arthroplasty;48 cases of observation group.Serum CRP,IL-6 and D-dimer levels were compared between the two groups before and after surgery,and the efficacy of the two groups was compared by follow-up.Results:After treatment,the total effective rate of the observation group was significantly higher than that of the control group (P＜0.05),Serum CRP,IL-6 and D-dimers increased in both groups at 12 h after surgery and decreased gradually at 7 and 14 days.The levels of serum CRP,IL-6 and D-dimer in the observation group were significantly lower than those in the control group at 12 h,7 d and 14d(P＜0.05).Conclusion:The clinical effect of the anterolateral approach on hip arthroplasty is more significant than that of conventional approach,and can effectively reduce the levels of serum CRP,IL-6 and D-dimer,and is more favorable for postoperative recovery.

Objective To analyze the outcome of the flow-through anterolateral thigh flap for reconstruction in the Gustilo type Ⅲ C traumatized extremities.Methods From June 2008 to June 2011,sixteen flow-through anterolateral thigh flaps were used for limb salvage.All in this series suffered from Gustilo type Ⅲ C open fractures in upper (4 cases) or lower extremities (12 cases).All patients had the presence of wide segmental soft tissue defects and segmental artery defects with compromised circulation.Four patients received primary operations and 12 patients received debridement combined with vacuum sealing drainage and secondary operations.Results All patients were followed up from 12 months to 40 months (average of 22 months).The mean age was 37.5 years old (from 18 to 62 years).The mean timing of free flap transfer was 6.7 days after injury (from 5 hours to 16 days).The mean artery defect was 12 cm in length (from 6 to 16 cm).All the flaps survived completely with a soft tissue texture.After operation,infection occurred in one patient,venous thrombosis occurred 1 day post-operatively in one patient,local flap necrosis occurred in two patients.No donor site morbidity was noted.In the last follow-up,according to Johner-Wruhs and Berton scores,the overall excellent/good rate for lower and upper extremities were 83.3％ and 75.0％ respectively.Conclusion Flow-through anterolateral thigh flaps provide for reconstruction of both the vessels and soft tissue simultaneously.Because of avoiding sacrificing one of the major vessels,it particularly indicates for only one major artery survival in the extremity.The clinical results show that the above reconstruction technique is useful for upper and lower extremities salvage.

BACKGROUND:Bone cement containing antibiotics for repair of bone defects can achieve sustained release of a higher concentration of sensitive drugs, which wil help kil bacteria and provide the necessary bone grafting bed and space to reduce massive bleeding due to removal of the granulation at bone defects during the second phase. OBJECTIVE:To analyze the clinical efficacy of antibiotic bone cement combined with autologous bone transplantation and Ilizarov external fixator on tibial bone defects after traumatic osteomyelitis. METHODS:A total of 31 patients with tibial bone defects after chronic osteomyelitis, including 19 males and 12 females, aged 17-40 years old. After positive debridement of necrotic tissues at bone stump, Ilizarov external fixator was used for fracture fixation, and autogenous iliac bone grafting combined with bone cement containing antibiotics was performed to repair bone defects. Fracture healing time, knee and ankle scoring were fol owed up. RESULTS AND CONCLUSION:The 31 patients were fol owed up for 6 months to 3.5 years. Tibial fractures were healed without infection recurrence in al patients. The bony union time was 3-6 months, the fixation time was 3-6 months, and the limb extended length was (7.50±1.01) cm. No adverse reactions related to bone cement and bone graft occurred. At 3 months after bone grafting, the scores on the knee and ankle joints were improve significantly. These findings indicate that the antibiotic bone cement combined with autologous bone transplantation and Ilizarov external fixator for repair of post-osteomyelitis posterior tibial bone defects can control infection, promote fracture healing, and restore joint functions.

Objective To investigate the clinical results of the anterolateral thigh free flaps for the soft tissue coverage of Gustilo grade-Ⅲ B open bone fractures in lower extremities.Methods The anterolateral thigh free flaps were applied to treat 42 Gustilo grade-11Ⅲ B open fractures.Ten flaps were performed through an emergency procedure.Sixteen were performed at early stage and the other 16 were performed at later stage .The results of the therapy were analyzed after long time follow up. Results All limbs were salvaged and all the flaps survived without protracted course to obtain soft tissue coverage.The follow up ranged 11 to 47 months.The healing time of the bones were significant prolonged in the later stage therapy group compared with the emergency therapy group and the early stage therapy group.In the later stage therapy group,the incidences of the bone infection and nonunion were also higher than the other two groups,and the second stage bone transplantation to repair bone defect and nonunion were needed in 76% patients in this group.The lower limb functions of the later stage treated group were worse than those of the other two groups.Compared to the early stage treated group,better lower limb functions could be obtained in the emergency treated group. Conclusion Delayed soft tissue coverage resulted in higher incidence of complications.The immediate soft tissue coverage of severely injured limbs complicated by Gustilo grade-Ⅲ B open fractures and massive soft tissue defects had the advantages over traditional methods.Hard work though it was,one-stage soft tissue coverage using anterolateral thigh free flaps could obtain better lower limb function.