Objective To evaluate the efficacy of endovenous laser treatment(EVLT) plus punctiform stripping therapy for lower extremity varicose veins.Methods Sixty-eight limbs in fifty patients with varicosed vein underwent EVLT plus punctiform stripping therapy in department of vascular surgery of the first affiliated hospital of Anhui medical university.Results All patients were followed for 2～27 months and all the patients had successful occlusions of varicosed veins with no recurrence were observed.Local skin paresthesia were found in 2 patients.No local recurrence and deep vein thrombosis were found.Conclusion EVLT plus punctiform stripping therapy is a simple and effective treatment for lower extremity varicosed veins with fewer complications and recurrences.

Objective To investigate the dynamic expression of mRNA and protein of surfactant protein C (SPC),E-cadherin (E-cad),N-cadherin (N-cad) and α-smooth muscle actin (α-SMA) and elucidate the significance of epithelial-mesenchymal transition (EMT) in a newborn rat model of Bronchopulmonary dysplasia (BPD).Methods A newborn rat model of BPD in hyperoxia was established,and a control group exposed to air was established.Lung tissue was collected on days 3,7,14,and 21,respectively.Alveolar development was evaluated by radical alveolar counts(RAC),including thickness of alveolar septum,ratio of alveolar and septa.Real-time PCR and Western-blot were used to detect levels of markers of epithelial cells (SPC,E-cad) and interstitial cells (N-cad,α-SMA) in AT2 and protein expression.Results On day 7,14,and 21,compared with the control group,RAC (7.38 ± 0.92,9.25 ± 0.70,9.88 ± 0.99) and alveolar area/pulmonary septal area ratios (A/S) (2.53 ± 0.02,3.34 ± 0.09,3.96 ± 0.13) were all higher in BPD group [RAC (5.88 ± 0.83,5.14 ± 0.83,4.38 ± 0.52) and A/S (1.88 ± 0.03,1.95 ± 0.03,1.89 ± 0.02)] (all P ＜ 0.05) ; the alveolar septum (8.53 ± 0.04,10.75 ± 0.46,13.55 ± 0.84) in BPD group were thicker than those (5.77 ± 0.09,4.40 ± 0.12,3.67 ± 0.18) in the control group (all P ＜ 0.01).The expressions of SPC and α-SMA in BPD group were significantly higher than those in the control group on day 14 and 21 (all P ＜ 0.05).The level of E-cad mRNA (2.43 ± 0.60,2.59 ± 0.48,3.37 ± 0.53) and protein (18.39 ± 1.77,18.29 ± 1.52,11.48 ± 1.72) for E-cad were higher in the control group than those (mRNA:1.48 ± 0.55,1.57 ± 0.48,1.12 ± 0.45 ;protein:9.50 ± 1.38,8.57 ± 1.06,8.22 ± 1.31) in BPD group was lower(P ＜ 0.05),while the level of N-cad was significantly higher(P ＜ 0.05) on day 7,14,and 21.Conclusions In the development of BPD,the markers of lung epithelial cells were down regulation,while the markers of interstitial cells were up-regulation,and these findings suggest that EMT from lung epithelial cells contributes to the occurrence of BPD.

Objective To evaluate the efficacy and safety of reamed interlocking intramedullary nail in the treatment of upper tibial fracture .Methods According to the random number table ,81 patients with tibial fracture were divided into observation group ( reaming intramedullary interlocking nails ) of 41 cases and control group (unreamed intramedullary nails) of 40 cases.The operation time,healing time,fracture of nail lock,fracture union and infection were observed and compared between the two groups .Results The operation time of the observation group [(55.3 ±19.2)min] was significantly longer than that of the control group [(44.7 ±12.4)min].The healing time of the observation group [(16.2 ±4.2) weeks] was significantly shorter than that of the control group [(24.1 ± 5.2)weeks],the differences were statistically significant (t=6.543,8.235,all P<0.05).The fracture of the nail, fracture healing were compared between the two groups,the differences were not statistically significant(χ2=0.086,0.753, 0.633,0.598,all P>0.05).Conclusion Reamed interlocking intramedullary nail in the treatment of upper tibial fracture has reliable curative effect .The internal fixation is more stable and the healing rate of the patients is faster .

Objective To study the association between the cerebral infarction and the angiotensin converting enzyme (ACE) gene rs4646994 and rs35397082 polymorphisms in Binhai area ,Tianjin .Methods Gene sequencing and DNA electrophoresis were used for the detection of the ACE gene single nucleotide polymorphisms (SNPs)(rs4646994 and rs35397082) .53 samples from pa‐tients with acute cerebral infarction and 53 samples from healthy volunteers were used in our study .Serum sample were collected from each group and tested by ACE ELISA .Results There were only deletion type of rs35397082 SNP in both of the control and cerebral infarction group .In the control group ,the number of insertion type of rs4646994 was 45(84 .91% ) ,deletion type was 8(15 . 09% ) and in the patients group ,the number of insertion was 47(88 .68% ) and the deletion was 6(11 .32% ) .There was no signifi‐cant difference between the patients group and the healthy donors (P>0 .05) .The concentration of ACE in control group was high‐er than the patients with acute cerebral infraction (P<0 .05) .Conclusion There is no significant association between the ACE gene polymorphisms(rs35397082 and rs4646994) and cerebral infarction in Binhai area ,Tianjin .The different concentration of ACE is not caused by these two SNPs .In this study ,these two SNPs are not the are not the risk factors of the cerebral infarction in Tianjin based on our study .

Objective To assess the correlation between coronary heart disease and common carotid artery and femoral artery atherosclerosis with two-dimensional color Doppler ultrasound (2D-CDUS). Methods Ninety patients with coronary heart disease were divided into three subgroups according to the extent of coronary artery stenosis observed with coronary angiography, and 50 normal subjects were taken as normal group. Ultrasound examination with high-frequency linear array probe was performed to measure IMT of common carotid and femoral artery in order to observe the plaque and extent of stenosis, the formation of blood dynamics, physical characteristics and hemodynamic environmental parameters. Results Among the coronary disease groups, common carotid artery and the femoral artery IMT, atherosclerotic plaque in the number, rate and all points increased along with the degree of coronary artery stenosis increasing. Physical characteristics and its hemodynamic environmental parameters had some changes with the increase of atherosclerosis. Conclusion The atherosclerosis of common carotid artery and the femoral artery are closely related with coronary atherosclerosis.

OBJECTIVETo observe the clinical effects of free musculo-cutaneous flap bridging with contralateral posterior tibial vessel on repair of lower extremity soft tissue defect.

METHODSFrom February 2006 to June 2013, 10 patients with soft tissue defect on lower shank and foot were included. The posterior tibial vessel on healthy lower extremity was chosen as recipient vessel and anastomosed with free latissimus dorsi musculo-cutaneous flap, or free latissimus dorsi musculo-cutaneous flap combined with thoracic-umbilical skin flap or anterolateral femoral musculo-cutaneous flap. The retrograde bridged flap was transposed to repair defect on contralateral lower shank and foot. The wound area ranged from 40 cm x 21 cm to 22 cm x 15 cm, with flap size from 48 cm x 26 cm to 25 cm x 18 cm. Meanwhile the defects on donor sites were covered with skin graft and both lower extremities were fixed with kirschner wires at middle tibia and calcaneus. The kirschner wires were removed at 4 weeks and pedicles were cut off 5-8 weeks postoperatively. Six patients received posterior tibial vessel reanastomosis at the same time of pedicle cutting.

RESULTSAll the 10 flaps survived and 3 patients received thinning of flaps due to excessive thickness. During the follow-up period of 3 months to 2 years follow up, the ambulatory function of injured legs recovered gradually with satisfactory appearance. The reanastomosed posterior tibial vessel on the healthy side was recovered.

CONCLUSIONSAppropriate bridged musculo-cutaneous flaps is suitable for extensive soft tissue defect of lower shank and foot. It is a safe and effective method for limb salvage.

Objective: To investigate the effect of Meek skin grafting on patients with extensive deep burn at different age groups. Methods: Eighty-four patients with extensive deep burns conforming to the study criteria were hospitalized in our unit from April 2011 to April 2015. Patients were divided into children group (C, with age less than 12 years old), young and middle-aged group (YM, with age more than 18 years and less than 50 years old), and old age group (O, with age more than 55 years old) according to age, with 28 patients in each group. All patients received Meek skin grafting treatment. The use of autologous skin area, operation time, wound healing time, and hospitalization time were recorded. The survival rate of skin graft on post operation day 7, complete wound healing rate in post treatment week 2, and the mortality were calculated. Data were processed with one-way analysis of variance, t test, and χ² test. Results: The use of autologous skin area of patients in group C was (5.1±1.0)% total body surface area (TBSA), significantly less than (8.3±1.0)%TBSA and (8.3±1.4)%TBSA in groups YM and O, respectively (with t values 32.900 and 52.624, respectively, P values below 0.05). The operation time, wound healing time, and hospitalization time of patients in group C were (1.368±0.562) h, (9.6±0.6) and (32±11) d, significantly shorter than those in group YM [(3.235±0.011) h, (16.9±2.6) and (48±12) d, respectively] and group O [(3.692±0.481) h, (17.3±2.6) and (46±13) d, respectively, with t values from 4.350 to 21.160, P values below 0.05]. The survival rate of skin graft of patients on post operation day 7 in group C was (92±15)%, significantly higher than (81±10)% and (72±12)% in groups YM and O, respectively (with t values 5.509 and 3.229, respectively, P values below 0.05). The above indexes in groups YM and O were similar (with t values from 0.576 to 22.958, P values above 0.05). Complete wound healing rate in post treatment week 2 and the mortality of patients in group C were similar to those in groups YM and O (with χ² values 0.365 and 0.122, respectively, P values above 0.05). Conclusions Meek skin grafting can be used in the treatment of patients with extensive deep burns at different age groups, compared with the young and middle-aged and old patients, the effect in children was better.

Objective: To explore the clinical effects of repair of wounds in the fingers after electrical burn with wrist perforator free flaps. Methods: Twelve patients (13 fingers) with electrical burn were hospitalized in our burn ward from January 2016 to January 2017. After radical debridement, the size of wounds ranged from 5.0 cm×2.0 cm to 10.0 cm×7.0 cm. Wounds with size below or equal to 6.0 cm ×2.5 cm were repaired with free flaps based on the superficial palmar branch of radial artery, with flap area ranging from 2.5 cm×2.2 cm to 6.0 cm×4.5 cm. The superficial palmar branch of radial artery, subcutaneous vein, and palmar cutaneous branch of the median nerve underwent end-to-end anastomosis with digital proper artery, dorsal superficial vein, and digital proper nerve in the finger, respectively. The donor sites were sutured directly. Wounds with size larger than 6.0 cm×2.5 cm were repaired with free flaps based on the dorsal carpal branch of ulnar artery, with flap area ranging from 4.5 cm×3.0 cm to 12.0 cm×8.5 cm. The dorsal carpal branch of ulnar artery, subcutaneous vein, and medial antebrachial cutaneous nerve underwent end-to-end anastomosis with digital proper artery, dorsal superficial vein, and digital proper nerve in the finger, respectively. The donor sites were sutured directly or covered by full-thickness skin graft from abdomen. Results: Five free flaps based on the superficial palmar branch of radial artery and 8 free flaps based on the dorsal carpal branch of ulnar artery were used in the patients. In one week after surgery, 12 flaps survived completely, while one free flap based on the dorsal carpal branch of ulnar artery suffered from slight infection, after depressing change, it survived in the end. After the follow-up of half a year, the flaps were full in shape and the distance of two-point discrimination of ranged from 4.0 to 7.0 mm. The fingers showed good functional recovery and no deformity. The grade of function of the fingers was excellent in 10 cases and good in 3 cases. There were small incision scars in donor sites. Conclusions The wrist perforator free flap is safe and reliable for repairing electrical burn wound of finger. The wounded finger shows good appearance and function after operation.

Objective: To investigate the clinical outcome of expanded frontotemporal flap pedicled with bilateral superficial temporal vessels, in repairing facial and cervical scar contracture deformity. Methods: From January 2012 to December 2017, 12 male patients with severe facial and cervical scar hyperplasia and contracture deformity, ranging from preauricular region, cheek, chin to neck, were treated in the Burn Department of the First People′s Hospital in Zhengzhou. The patients were aged at 15-58 years, with the mean age of 29.3 years. The frontotemporal scalp flaps were simultaneously expanded to prefabricate a flap pedicled with bilateral superficial temporal arteries and veins. The operations were carried out in 3 stages. Stage Ⅰ: A 400-600 ml cylindrical expander was placed in the frontal region, underneath of galea aponeurosis and frontal muscle, meanwhile, a 50-100 ml cylindrical expander was placed in the temporal region on each side, between the deep temporal fascia and temporal muscle. Stage Ⅱ: The expanded flap pedicled with bilateral superficial temporal vessels were received, to repair the secondary wound after scar resection and contracture release. The neck curve was reshaped. The donor area was directly sutured. Stage Ⅲ: The flap pedicle was repaired, and residual scar was removed. Laser hair removal was performed on the skin flaps about 3 weeks after operation. Results: Seven patients underwent simultaneously cervical and thoracic tissue expansion. The expansion time was 5-6 months (average 5.2 months). The expanded flap was 40 cm×9 cm to 45 cm×15 cm in size. All flaps survived. The venous reflux disorder after the second stage operation occurred in 1 patient. The affected area was purple and swollen. It was recovered after acupuncture and compression bandage for 1 week. Laser hair removal was performed in 8 flaps. Flap thinning was performed in 5 flaps. All 12 patients were followed up for 4 to 24 months. The flaps have good appearance, without bloating. The transferred flaps have similar color and texture with adjacent the facial skin. The cervical mobility was significantly improved. The hairline of the head was normal, and the suture scar was slight and concealed. Conclusions The expanded frontal and temporal flaps provide considerable amount of tissue with thin skin and reliable blood supply. It is an alternative method to repair facial and cervical scar contracture.

Objective: To explore application effects of CT angiography (CTA) and three-dimensional reconstruction technique in repairing scar around the mouth and chin with expanded forehead axial flap. Methods: From June 2013 to October 2017, 9 patients with hyperplastic scar around the mouth and chin after deep burns on face were admitted to our unit. The sizes of scars of patients ranged from 8 cm×7 cm to 13 cm×8 cm. One cylindrical skin soft-tissue dilator with nominal volume of 400 to 500 mL was implanted in forehead area of each patient. Five to six months after the dilator was implanted, scar around the mouth and chin was resected, and the dilator was removed. The secondary wound after scar resection was repaired by expanded forehead axial flap with bilateral superficial temporal vessel pedicles. Three of the nine patients received microstomia diorthosis at the same time. Before the operation, CTA and three-dimensional reconstruction were applied to obtain three-dimensional images of superficial temporal arteries and the branches in the donor site, which could identify the travel, adjacent location, and vascular anastomosis of the above-mentioned vessels to guide flap design. The sizes of flaps of patients ranged from 25 cm×9 cm to 30 cm×8 cm. Two to three weeks after the operation, flap pedicles were cut off, restored, and trimmed. The donor site was sutured directly. Ten to twelve days after the flap repair operation, the flap site received depilation treatment with semiconductor freezing point laser once a month for 4 to 6 times. Results: Flaps of all patients survived well, with no blood circulation disorder. The flaps of three patients were slightly bulky, while they were with natural appearance after flap thinning operation in 3 months post flap repair operation. During follow-up of 6 months to 2 years after the operation, color, texture, and thickness of the flaps were close to normal skin around scars. The appearance of perioral and mental region, and opening function of mouth improved significantly, with no recurrence of scar. Frontotemporal incision was hidden, hair on head grew normally, and reconstructed hairline was natural. Conclusions Scar around the mouth and chin repaired with expanded forehead axial flap were with good appearance and function in operation area and good shape in donor site. CTA and three-dimensional reconstruction technique can provide clear three-dimensional images of superficial temporal arteries and the branches in expanded forehead axial flaps, which can provide reliable basis for preoperative designing of flap, reduce operative risk, and improve survival rate of flap, thus having clinical application value.