Objective To compare and analyze the advantages and disadvantages of the forearm skin flap and the lateral femoral skin flap in the repair of oral and maxillofacial defects.Methods Of the 34 patients of oral and maxillofacial tumor resection received postopera-tive reconstruction of maxillofacial defects treatment,18 patients repaired by forearm flap( forearm flap group) ,16 patients repaired by antero-lateral thigh flap ( anterolateral thigh flap group) .The clinical effect and the restoration of two groups after surgery were compared.Results The survival rate of disposable surgical flap in forearm flap group was 94.44%,the survival rate of the anterolateral thigh flap group was 87.50%.The difference between two groups was not statistically significant (P>0.05).The difference of swallowing function in 3 months after surgery between two groups was not statistically significant (P>0.05).The difference of survival quality score between the two groups was not statistically significant (P >0.05) in 6 months after surgery.The scar proliferation rate (27.78%), pigment deposition rate (88.89%), temporary sexual dysfunction rate(66.67%),a permanent disability rate (27.78%) of forearm flap group were significantly higher than those of the femoral anterolateral flap group patients (P<0.05).Conclusion The forearm skin flap and the lateral femoral skin flap have a good clincal effect on the repair of oral and maxillofacial defects,and the incidence of complications of the femoral anterior lateral femoral flap is lower.

Objective To explore the relationships between cholangiocarcinoma and clonorochiasis or hepatolithiasis,and to compare their MRI features.Methods The MRI features in 37 patients with cholangiocarcinoma confirmed by surgery and pathology were retrospectively analyzed,including clonorchiasis with cholangiocarcinoma in 21 (group A)and hepatolithiasis with this tumor in 16 (group B).The analyzed parameters included the location,size,shape,signal intensity and enhancement pattern of the tumor and the characteristics of bile duct dilatation.Results In group A,the tumors were located in the right lobe in 12 (57.2%),left lobe in 4 (19%),and porta hepatic in 5 (23.8%).In group B,those were located in the right lobe in 3 (18.7%),left lobe in 9 (56.3%),and porta hepatic in 4 (25%).There was a significant difference in the left/right lobe between two groups (P<0.05),however,no significant difference was found in porta hepatic (P>0.05).The MRI showed the tumors with low signal on T1 WI and high or heterogeneous signal on T2 WI,and with peripheral enhancement in early stage and delayed centric enhancement in 34 patients.Diffuse saccular dilatations of terminal intrahepatic bile ducts were showed in 1 6 (7 6 .2%)in group A and 1 (6 .2%)in group B,meanwhile the dilatations of bile ducts within tumors were showed in 2 (9.5%)in group A and 13 (81.3%)in group B,exhibiting significant differences between the two groups (P<0.05).Conclusion Clonorochiasis and hepatolithiasis are related with the cholangiocarcinoma.No differences in MRI features of cholangiocarcinoma are found between the two groups,however significant differences in location and the features of bile duct dilatation are observed.

OBJECTIVE: To introduce the immune response of CD4~+ T helper lymphocytes (Th) and their cytokines following liver transplantation. DATA SOURCE: A computer-based online search was conducted in Medline from January 1970 to December 2008, Wanfang Database from January 1998 to December 2008, and China Hospital Knowledge Database from January 1998 to December 2008 with the key words of "liver transplantation, rejection, immune Tolerance, T helper lymphocytes, Th1 cells, Th2 cells" in both Chinese and English. DATA SELECTION: Articles about immune response of Th and their cytokines following liver transplantation were included, but reviews and duplicated studies were excluded. MAIN OUTCOME MEASURES: A total of 36 relative articles about immune response of Th and their cytokines following liver transplantation (n=3), immune effect of Th and cytokines on liver transplantation (n=22), and relationship among Th, cytokines, and transplantation immunity (n=11) were included. RESULTS: T helper lymphocyte was of importance to regulate the immune response, with function of supporting body fluid and cellular immune. Th and their cytokines played a very important role in immune tolerance following liver transplantation. The ration of Th1/Th2 was correlated with the immune response following liver transplantation. The increased Th1 secretion might induce rejection of liver tissue. When the ration turned to Th2, the immune tolerance easily occurred. CONCLUSION: Up to now, the theory of relationship between Th1/Th2 ration and transplantation immunity is not used for clinical application. Therefore, how to determine the immune state of organism by detecting and regulating cytokines, adjust Th1/Th2 ration, and induce specific immunologic tolerance of host become hot topics in the future.

Twenty-six total intravenous anesthesia was performed in 23 ASAⅡorⅢpatients with various advanced malignancies undergoing whole body hyperthermia (WBH). Their age ranged from 32 to 67 yrs and body weight between 42 and 77 kg. The patients had no hypertension, coronary artery disease or diabetes mellitus. Anesthesia was induced with midazolam 5-10 mg, fentanyl 0.1 mg, propofol 1.5-2.5 mg?kg-1 and vecuronium 0.12 mg?kg-1 and maintained withⅣinfusion of midazolam (0.08-0.16 mg?kg-1?h-1), remifentanil (0.05-0.15?g?kg-1?h-1) and vecuronium (0.08-0.15 mg?kg-1?h-1). The patients were mechanically ventilated (VT = 8-12 ml?kg-1, RR= 10-18 bpm, FiO2 = 1.0) after tracheal intubation. PETCO2 was maintained at 35 mm Hg. ECG, MAP, HR, CVP, SpO2 , PETCO2 , peak airway pressure, VT, RR, minute ventilation (MV), urine output, core temperature (lower esophageal and naso-pharyngeal) and surface temperature were continuously monitored. Swan-Ganz catheter was placed in 15 patients. MPAP, PCWP and cardiac output (CO) were measured and Qs/Qt, cardiac index (CI) and stroke index (SI) were calculated. WBH was induced in an ultra-red radiation hyperthermic cabin (type ET-SpaceTM-1) and was divided into 3 phases:Ⅰwarming phase (lower esophageal temperature increased gradually to 41.8℃) ;Ⅱhyperthermic phase (lower esophageal temperature was maintained at 41.8℃for 1 h) andⅢcooling phase (core temperature was gradually decreased to 38.5℃without any cooling measures). Blood samples were taken from artery and Swan-Ganz catheter 15 min after induction of anesthesia (baseline), at 39℃, 40℃, 41℃and 41.8℃during warming phase, at the late hyperthermic phase and at 40℃and 38.5℃during cooling phase for blood gas analysis, determination of blood electrolytes and sugar. As the temperature was increasing, HR, CI, SI, CVP, MPAP, PCWP, Qs/Qt and peak airway pressure were gradually increased while MAP, PaO2 , pHa, BE and blood glucose and K+ were decreasing during warming phase (Ⅰ). These changes reached the peak levels at the late period of hyperthermic phase (Ⅱ) and then gradually returned to baseline during cooling phase (Ⅲ) . Vasoactive drugs and fluid infusion including crystalloid and colloid were needed to maintain hemodynamic stability in 69% patients. Acidosis had to be corrected in 54% patients. Severe hypotension and pulmonary edema occurred in 4 patients. Continuous hemodynamic monitoring, respiratory support, maintenance of circulatory stability and correction of acidosis and hypokalemia were the key factors in the management of patients during WBH.

Objective:To develop a modified rat laryngeal transplantation model to improve the survival rate of recipients.Methods: Eighty Class Ⅱ isogeneic F344 rats,weighing 250-350 g,were randomly divided into 2 groups(n=40).The control group adopted the Strome model.The allograft used for the experimental group preserved ascending pharyngeal artery,which formed a complex allograft together with tongue base,larynx and pharyngolarynx.End-to-end anastomosis was performed between both allograft common carotid arteries and anterior neck veins.The patency rate and survival rate of the allograft of the 2 groups were compared.Results: The artery,vein patency rate and survival rate were 30%,15%,and 30% in control group,and 75%,65%,and 80% in experimental group,respectively(P

Objective To explore the antibacterial activity of extract of Ginkgo biloba leaves on Porphyromonas gingivalis in vitro ,and to provid pharmacological reference for developing a new type of antibacterial drugs in the treatment of periodontal disease.Methods This experiment was divided into negative control group,imipenem control group and different concentrations and forms of extract of Ginkgo biloba leaves groups.Solvent extraction method was used to extract the extract of Ginkgo biloba leaves, punching method and test tube method were performed to detect the antibacterial activity of extract of Ginkgo biloba leaves in anaerobic environment invitro and compared with Staphylococcusaureus and E.coli.By observing the antibacterial ring diameter and determination of the minimum bacteriostasis concentration (MIC),the antibacterial activities of extract of Ginkgo biloba leaves in vitro were measured.Results In the experiment of bacteriostatic ring,Porphyromonas gingivalis was treated with extract of Ginkgo biloba leaves,Ginkgo biloba leaf tablet and Ginkgo biloba soft capsule concentrate and 1∶4 diluent,the bacteriostatic ring diameters were decreased with the decreasing of the concentration.The maximum bacteriostatic diameter of Ginkgo biloba extract was 1 6.5 mm,and the maximum bacteriostasis diameters of Ginkgo biloba leaf tablet and soft capsule were 15.3 and 14.5 mm,respectively;the bacteriostatic diameter of the exact of Ginkgo biloba leaves was bigger than those of Ginkgo biloba leaf tablet and Ginkgo biloba soft capsule (P < 0.05), but there was no statistical difference of bacteriostatic diameter between Ginkgo biloba leaf tablet and Ginkgo biloba soft capsule (P> 0.05);E.coli and Staphylococcusaureus groups get the same results.When the concentration of extract of Ginkgo biloba leaves was more than 1.95 mg·L-1 ,there was no growth of Porphyromonas gingivalis but E. coli and Staphylococcus aureusa still grew;only the concentrations of exact of Girkgo biloba leaves were more than 6.25 and 12.5 mg· L-1 ,E. coli and Staphylococcus aureus didn’t grow;the bacteriostatic effect of extract of Ginkgo biloba on Porphromonas gingivalis was better than E.coli and Staphylococcus aureus . Conclusion Extract of Ginkgo biloba leaves has antibacterial effect on Porphyromonas gingivalis.

Objective To probe into the effect of sitagliptin on blood glucose fluctuation of the patients with type 2 diabetes mellitus(T2DM) and poor control by insulin aspart 30.Methods Ninety cases of T2DM and poor control by insulin aspart 30 in affiliated Zhongshan hospital from January 1,2014 to December 31,2014 were selected and randomly divided into three groups:simply continuous subcutaneous insulin injection(CSII),acarbose combined CSII group(CSII + Aca) and sitagliptincombined CSII group (CSII + Sig),30 cases in each group.Three groups received the intensive treatment for 2 weeks,and72-h continuous glucose monitoring was performed on last 3 d.The 24 h mean blood glucose(24 hMBG),largest amplitude of glycemic fluctuation(LAGE),mean amplitude of glycemic excursion(MAGE) within 1 d,postprandial blood glucose spike(PGS),postprandial glucose peak time(△t),postprandial glucose excursion(PPGE) and total T were observed within 24 h.The difference of insulin dose(△ insulin),hypoglycemia incidence,glucose-target rate,blood glucose profiles were compared at the end of treatment.Results After two-week treatment,intraday blood glucose variation indicators(24 hMBG,LAGE and MAGE) and postprandial blood glucose variation indicators (PGS,△t,PPGE and total T) in the CSII+Sig and CSII+-Aca groups were significantly lower than those in the CSII group(P＜ 0.05),while the differences in blood glucose variation indicators between the CSII+Sig group and CSII+-Aca group were not statistical significant(P＞ 0.05).In the comparison after treatment,△ insulin,hypoglycemia incidence and glucose-target rate in the CSI + Sig group were lower(P＜0.05).Conclusion The combined application of short-term CSII and sitagliptin will achieve a better effect than the combination with acarbose,can smoothly and steadily reduces the blood glucose level,relieves the whole day glucose fluctuations,effectively reduces △ insulin,and has lower hypoglycemia occurrence rate.

Objective To evaluate the relationship between post-stroke urinary incontinence(UI)and 1 year stroke outcomes.Methods One hundred and thirty consecutive cerebral stroke survivors were classified into 2 groups according to their incontinence status at 1 to 10 d after onset.The patients'baseline characteristics,1 year mortality rate,abilities in the activities of daily living(ADL)and Modified Rankin Scale(mRS)scores were compared.Multivariate analysis was applied to highlight UI risk factors and correlations between UI and 1 year outcomes.Results Total anterior circulation syndrome(TACS)numbers and National Institutes of Health stroke assessment (NIHSS)scores in the UI group exceeded significantly those in the non-UI group,and both were significantly associated with initial UI.The 1 year mortality rate,patients'ADL dependence and mRS scores in the UI group exceeded those in the non-UI group significantly.Initial UI was also significantly associated with the 1 year outcome independently,as well as with age＞75 years,Oxfordshire Community Stroke Project(OCSP)classification and initial NIHSS score.Conclusion UI is common in the patients with TACS and higher initial NIHSS scores.Initial UI predicts a poor 1 year outcome,SO treatment should be strengthened.

Objective To develop and optimize a new method to extract miRNAs from plasma.Methods miRNAs were extracted from plasma by mixing it with the extraction solution that contained surfactant and by heating .Then the ribonuclease inhibitor was added into the extraction to prevent RNAs from degradation .The expression level of each miRNA was detected by real-time quantitative PCR in oder to evaluate the feasibility of this method .Results A method which extracted miRNAs from plamsa in just one step was established .The specificity , reproducibility and stability of this method have been demonstrated by real-time quantitative PCR .Conclusion The one-step method is simple , inexpensive , and plasma-saving.It seems like a new method for clinical examination of miRNAs from plasma .

Objective To investigate the clinicopathological characteristics of HBV recurrence after liver transplantation. Methods The retrospective analysis of the clinicopathological changes was performed on 17 patients who had HBV recurrence after liver transplantation in our medical department. Results HBV recurrence happened from 4 to 48 months. Twelve of them which were identified to be YMDD mutation switched to entecavir or added adefovir. Three of them receiving chemotherapy when liver cancer recurred switched to entecavir. Two of them with withdrawal of lamivudine were given lamivudine continuously. Liver function returned to the normal level and HBVDNA was ＜ 102 U/ml after anti-hepatitis B virus. The histological changes in the transplanted livers included hepatocellular degeneration, necrosis and apoptosis, portal infiltrations and fibrosis.With time after recurrence, it was easier to see hepatitis B virus replication in liver cells, incidence of acute rejection, increases of liver fibrosis and the formation of fibrous septa, even pseudolobule.Conclusion In native HBV infection livers, fibrosis occurs more early and develops rapidly. The number of virus is closely related to liver necrosis and inflammation. Early discovery and change to quick and effective treatment of anti-hepatitis B virus in time can improve greatly the prognosis of the patients.