Objective To report treatment of infectious bone and soft tissue defects caused by tibial shaft fracture of Gustilo type Ⅲ B using free flap and Ilizarov bone transport.Methods Nineteen patients who had suffered from infectious bone and soft tissue defects following tibial shaft fracture of Gustilo type Ⅲ11 B were treated from May 2010 to February 2015.They were 15 men and 4 women,aged from 21 to 58 years (average,45.3 years).Their course of disease ranged from 16 to 21 months,averaging 17.9 months.The area of their infectious defects ranged from 10 cm × 6 cm to 21 cm × 12 cm,and the length of their bone defects from 5 to 11 cm (average,7.4 cm).They were treated with debridement,simple external fixation to reconstruct bony support,coverage of wounds with free flap,and stuffing the dead space with antibiotic concrete beads,followed by Ilizarov bone transport and bone graft after control of infection to reconstruct the defective tibia and function of the affected limb.Results All the flaps survived.Necrosis occurred at the distal margin of one flap but responded to dressing.Pin tract infection occurred in 4 cases but also responded to dressing and antibiotic therapy.Autografts of iliac cancellous bone were implanted into the gliding and traction ends of the bone fragments one month after bone transport had come to rest.All the patients achieved direct bony union.The patients were followed up for an average of 25 months(range,from 19 to 36 months).No secondary fractures or angular deformity was observed.The total treatment time averaged 17.9 months,with no recurrence of infection.According to the Puno score system for functional evaluation at the last follow-up,7 cases were rated as excellent,6 as good and 6 as fair.Conclusion The infectious bone and soft tissue defects caused by tibial shaft fracture of Gustilo type Ⅲ B can be treated by free flap and Ilizarov bone transport,resulting in definitely positive outcomes.

OBJECTIVE To investigate the contribution of the GJB6 gene [encoding connexin 30 (C?30)] mutations in Chinese population with sporadic non-syndromic hearing impairment. METHODS PCR reactions were performed with two pair of primers for the coding sequence of GJB6 gene and for the deletion of GJB6. PCR products bidirectional sequencing was subsequently applied in 214 patients with hearing loss and 86 normal controls. RESULTS A novel heterozygous mutation-233(C→A) was found, which results in amino acid change, A78D. This mutation wasn't detected in the control subjects. The altered valine residue lies within the second conserved transmembrane domain. The large deletion△(GJB6/ D13S1830)] of GJB6 was not found in this group. CONCLUSION The large deletion of GJB6 was not found in the Chinese deafness population. A novel heterozygous mutation of GJB6 was found. These results indicated GJB6 mutations are not a major cause of hearing loss in the Chinese population.

Objective To systematically evaluate the efficacy and safety of amlodipine (A)/hydrochlorothiazide(H) versus val‐sartan(V)/hydrochlorothiazide(H) in treatment of essential hypertension .Methods Literature was retrieved online in Cochrane Li‐brary ,PubMed ,OVID ,MEDLINE ,EMBASE ,CBM ,CNKI ,VIP and Wan fang database up to November 2013 .Relevant magazines were retrieved manually .Quality of the included studies was assessed and Meta‐analysis was performed with RevMan 5 .2 software . Results Seven randomized controlled trials(RCTs) were finally included .Meta‐analyses showed that :in terms of lowering ABP ,V/H group was more effective than A/H group ,the difference was statistically significant (P<0 .05);there was no significant differ‐ence in the decreased value of clinic BP and the control rate of blood pressure between A /H group and V/H group(P>0 .05) .Ad‐verse events occurred less frequently with V/H group compared with A/H group ,the difference was statistically significant (P<0 .05) .Conclusion A/H treatment of essential hypertension is inferior to V/H ,and has more adverse events .

Objective To investigate the clinical effect of harvesting the free anterolateral thigh flap irregularly for the repair of the multiple and complex skin and soft tissue defect at lower limb.Methods From January,2009 to January, 2014, 7 patients with multiple and complex skin and soft tissue defect at lower limb were treated with transplantation of the free anterolateral thigh flap with harvesting irregularly.The parts of wound defect: 2 cases of medial leg andlateral leg, 3 cases of foot back andankle, and 2 cases of medial malleolus and lateral malleolus.All the cases were operated in fracture fixation and wound without obvious infection.The vascular pedicle of free flaps were descending branch of lateral circumflex femoral artery.The types of the harvesting the free anterolateral thigh flap irregularly: 3 cases of the anterolateral thigh flap and terminal branch of lateral femoral circumflex artery muscle flap, 2 cases of the anterolateral thigh flap and transverse branch of lateral circumflex femoral artery muscle flap, and 2 cases of reconstructed lobar femoral anterolateral thigh perforator flap (vascular anastomosis of pedicle of lobulated anterolateral thigh perforator flap with the main stem branch artery of the lateral femoral circumflex vessels).The area of harvesting the free anterolateral thigh flap irregularly were 6 cm × 4 cm to 16 cm × 12 cm;The donor site were closed directly.All the patientsbegined to early rehabilitative exercise under the protection of orthosis after 4 weeks of the operation.Results All cases were followed up for 6 to 14 months, and the average of 8.2 months.All the flaps survived, besides 2 cases with necrosis of small area in distal, and which were healed by dressing, debridement,skin grafting and so on;The healing time were 12 to 34 days, and the average of 17.1 days.The area of flaps without obvious retraction, color were the same as the region, no obvious scar contracture.Conclusion The anterolateral thigh flap feed by the same source vessels for the repair of the multiple and complex skin and soft tissue defect at lower limb is a safe and effective strategy.The flap can be combinated differently to repair multiple and irregular wound one-time, the donor site is small invasive, shorten the treatment cycle, and relieve the suffering.

Objective To investigate the clinical effect of the free fibula composite tissue flap transplantation to repair the first metatarsal bone with soft tissue defect on foot.Methods From August, 2008 to August, 2013, 6 patients with the first metatarsal bone and soft tissue defect on foot were treated with transplantation of free fibula composite tissue flap.The causes: 2 cases in traffic accident injury, 4 cases in machine injury;3 cases with traumatic defect, and septic defect in 3 patients.Of the 6 cases, the fibular length with transplantation was 6 cm to 12 cm, and the flap area was 8 cm × 5 cm-18 cm × 16 cm;All the cases were followed-up in 3, 6, 12 months postoperatively to observe the fracture healing, and to assess injured limb function in 1 year postoperatively.Results All cases were followed up 12-24 months, and average of 14 months;All the flaps survived, and the metatarsal bone and fibula healing was good visibly in half a year, The surgery function were assessed according to Maryland's scale, and the excellent were 2 and the good were 4.Conclusion The transplantation of free fibula composite tissue flap to repair the first metatarsal bone with soft tissue defect on foot is a safe and effective strategy, and it has the advantages such as covering the wound at foot approvingly, one-time rebuild repair foot weight bearing area and the surrounding soft tissue defect, shorten the treatment cycle, for small area damage in donor area, and the function postoperative is good, etc.

Objective To investigate the clinical effect of transplantation of the free anterolateral thigh flap and iliotibial band for the repair of soft tissue defects at foot and ankle and functional reconstruction.Methods From January,2008 to January,2013,25 pediatric patients with soft tissue defects at foot and ankle were transplantation of the free anterolateral thigh flap and iliotibial band.Of the 25 cases,there were 12 cases at heel,8 cases at dorsum of foot,3 cases at medial malleolus and 2 cases at external malleolus.All the cases were accompanied with different degree of fracture or dislocation,and with soft tissue defect such as achilles tendon,extensor tendon of dorsal,collateral ligament of ankle.The length of soft tissue defect which were reconstructed with iliotibial band were 3 cm to 16 cm.The causes of injury:19 cases were crushed by motorcycle or bicycle,4 cases were crushed machines,2 cases were injuryed in traffic accidents.The areas of free anterolateral thigh flaps were 8 cm × 5 cm to 18 cm × 12 cm.All the patients begined to early rehabilitative exercise under the protection of orthosis after 2 weeks of the operation.Results All cases were followed up from 6 to 24 months,averaged of 14 months.All the flaps survived,and only 2 cases with necrosis of small area in distal,and which were healed by dressing.The healing time were 12 to 24 days,and the average of 15.1 days; The surgery function were assessed according to Thermann's scale,and the results was 14 cases for excellent,9 cases was good,the general was 2 cases,and the excellent and good rate was 92％.Conclusion The transplantation of the free anterolateral thigh flap and iliotibial band for the repair of soft tissue defect at foot and ankle and functional reconstruction is a safe and effective strategy,and it has the advantages such as covering the wound at foot and ankle approvingly,reconstruction of power device once,the flap and iliotibial band were in the same wound,the trauma of doner site is small invasive,early recovery functional exercise,shorten the treatment cycle,and relieve the suffering of children.

Objective To investigate the clinical effect of primary internal fixation combined with flap transfer for Gustilo Ⅲ B open fracture of lower extremity with severe soft tissue defct.Methods From January,2008 to January,2013,15 patients with Gustilo Ⅲ B open fracture of lower extremity and severe soft tissue defect were treated with primary internal fixation combined with flap transfer.Among them,there were 2 cases of foot and ankle fracture,9 of lower-tibia and fibula,3 of upper-tibia and fibula and 1 of distal femur fracture.The areas of the flaps were 10 cm × 8 cm-28 cm × 16 cm.Three cases were treated by bone grafting because of bone defect.Results All patients were followed up for 6-24 months.All flaps were survived,and only small area of 2 cases with the distal necrosis were cured by changing the dressing; In 1 case,the wound was infection and healed after anti-infective and drainage treatment; 13 cases had bone union in primary stage,and the other 2 cases were achieved delayed union; the average healing time was 7.2 months,and no case of osteomyelitis was noted; the time of wound healing was 12-36 days,with an average of 18.1 days.According to lower extremity function evaluation form,the excellent and good rate was 86.6％.Conclusion It is a safe and effective strategy to treat the Gustilo Ⅲ B open fractures of lower extremity and severe soft tissue defect with primary internal fixation combined with flap transfer,which has advantages of reliable fixation,covering the wounds with satisfaction,recovering exercise early,shorten the treatment period,alleviating the suffering of patients and so on.

Objective To explore the effect of the three-dimensional examination application on the education of nursing aesthetics.Methods Totals of 126 students of grade 2006 were considered as experimental group,received the three-dimensional examination,while 120 students of grade 2005 were served as control group that received the traditional examination.Questionnaire and semi-structured procedure method were used to evaluate the examination method.Results The evaluations of students about the examination method such as satisfaction,fairness,learning interest,attention degree,cultivating of originality thinking and team work in experimental group were significantly higher than that in control group ( P ＜ 0.05 ).Average scores about the students'appearance and human sprit of experimental group were ( 3.93 ± 0.19 ),( 3.87 ± 0.19 ) and that of control group were (2.97 ± 0.20),(2.90 ± 0.18),and the difference was statistically significant (t =3.488,3.676,respectively; P ＜ 0.05 ).Conclusions Three-dimensional examination can evaluate completely if students meet the demand of teaching,and it is good at improving comprehensive quality of nurses and promote the teachers' teaching abilities.

Objective To investigate the relationship between volume of fracture fragment and surgical methods in patients with radial head fracture.Methods A retrospective study was conducted of the 60 patients with radial head fracture of Mason type Ⅲ who had been admitted to the Department of Hand Surgery,Wuhan Pu'ai Hospital from January 2013 to December 2016.They were 28 males and 32 females,aged from 26 to 71 years (average,54.5 years).Of them,41 underwent open reduction and internal fixation (incision group) and 19 radial head replacement (replacement group).The volumes of radial head and fracture fragment were measured by CT scan and three-dimensional reconstruction of the elbow joint before operation.A volume-weighted ratio R corresponding to a specific radial head fragment was calculated.Correlation between the volume-weighted ratio R of the radial head fragment and the Broberg-Morrey elbow function score was calculated.At the last follow-up,the Broberg-Morrey elbow function score was used to assess the efficacy and complications were recorded in the 2 groups.Results All the 60 patients were followed up for 20 to 36 months (mean,28.6 months).At the last follow-up,the Broberg-Morrey elbow function score was 86.5 ±1.3 points (from 72 to 91 points) for the incision group and 93.6 ± 1.4 points (from 78 to 95 points) for the replacement group;the complication rate was 17.1％ (7/41) for the former and 15.8％ (3/19) for the latter.There was a linear relationship between the volume-weighted ratio R of the radial head fragment and the Broberg-Morrey elbow function score in the incision group.The linear regression equation between the two was:y=65.63+0.67x (R2=0.85,P=0.0006).There was no linear relationship between the volume-weighted ratio R of the radial head fragment and the Broberg-Morrey elbow function score in the replacement group (P =0.053).When the Broberg-Morrey elbow joint function score (93.6 points) for the replacement group was substituted into the linear regression equation y =65.63 + 0.67x (y =93.6),x =41.7.Conclusions In the patients with radial head fracture of Mason type Ⅲ,open reduction and internal fixation may lead to a better prognosis for those with a volume ratio ≥41.7 between the radial head and fracture fragment while radial head replacement may lead to a better prognosis for those with a volume ratio ＜41.7 between the radial head and fracture fragment and for those elderly ones with osteoporosis.

AIMBLT1 and BLT2 were both recently cloned and identified as two subtypes of leukotrine B4 (LTB4) receptors. With the usage of U-75302 and LY255283, the specific antagonists of BLT1 and BLT2 respectively, the involvement of BLT1 and BLT2 in the inflammatory and immunological responses was in vitro explored.

METHODS(1) To investigate inhibition of U-75302 and LY255283 on the proliferation of rat synovial cells, 3H-TdR incorporation into the cells was quantified. (2) Flow cytometric assay for interferon-gamma (IFN-gamma) and interleukine 4 (IL-4) profiles in CD4+ T lymphocytes from rat spleen was carried out to determine the ratio of Th1/Th2.

RESULTS(1) For inhibition on rat synovial cells proliferation, U-75302 exerted its effect only at a high concentration of 10 micromol/L and LY255283 at the concentrations of 10 micromol/L-10 micromol/L. (2) Both U-75302 and LY255283 could elevate the percentage of Th2, but could not influence that of Th1.

CONCLUSIONBLT1 and BLT2 were involved in the synovial cells proliferation change the ratio of Th1/Th2. Their meaning served as targets for prevention and treatment of infectious diseases should be emphasized.

Animals ; Cell Line ; Cell Proliferation ; drug effects ; Fatty Alcohols ; pharmacology ; Glycols ; pharmacology ; Inflammation ; immunology ; Male ; Rats ; Rats, Wistar ; Receptors, Leukotriene B4 ; antagonists & inhibitors ; physiology ; Synovial Membrane ; cytology ; immunology ; Tetrazoles ; pharmacology ; Th1-Th2 Balance