Objective To investigate the effect of perforator identification before DIEP flap dissection for the patient with abdominal scar.Methods Preoperative multidetector-row computed tomography angiography was used to identify that the dominant perforators of the abdominal wall were not damaged completely.During the second stage breast reconstruction operation,the located dominant perforator and the DIEP flap were dissected.Results The dominant perforator located by MDCTA was identified with the exploration in operation.Follow-up for half a year,the flap survived well and the patient was satisfied with the appearance.Conclusion Abdominal scar was not the definite contraindication for DIEP flap.MDCTA provided a good quality evaluation of the perforator vessels.The located dominant perforator was dissected to confirm the blood supply of the DIEP flap.Identification of perforator can be used as a routine preoperative evaluation for patients with scar on donor site.

Objective:To study the influence of all-trans retinoic acid (atRA)on craniomaxillofacial development of C57 mice. Methods:Pregnant C57BL mice were divided into 4 groups(n =5)at gestation day (GD)1 0.Mice in three atRA-induction groups were given atRA of 60,80 and 1 00 mg/kg,respectively.The mice in control group were given the equivalent volume of corn oil.All pregnant mice were sacrificed at GD1 9 and the embryos were collected.Stereo microscope was used to observe the craniomaxillofacial morphology.Standardized radiographs were taken and cephalometric analysis was performed.Results:The embryonic body length and body mass of control group surpassed those of 80 and 1 00 mg/kg atRA groups(P <0.05,P <0.01 ).atRA induced craniomaxillofacial malformations and maldevelopment.The mice induced by atRA exhibited a shorter mandibular body and more retrusive position of max-illary and mandibular(∠NAK and ∠NBD)when compared with their norm(P <0.01 ).Significant decrease in craniofacial length (Op-Rh)was observed in all atRA-induced groups(P <0.01 ).Decreases in cranial vault height(Fp-Os)and cranial vault length(Pa-Na)dimensions were observed in 80 and 1 00 mg/kg atRA groups(P <0.05,P <0.01 ).Conclusion:Exogenous atRA dose-depend-ently induces retardation of craniomaxillofacial morphology in embryo of C57BL mice by inhibition of the sagital and vertical dimension development of the bone.

OBJECTIVETo investigate the effects of all-trans retinoic acid (atRA) on the function of bone morphogenetic protein receptor 2 (BMPR2) expression in embryonic palate.

METHODSCleft palate mice model was established by atRA. On gestation day (GD) 15 and GD 17, the pregnant mice were killed to obtain the embryos from the uteri. The embryonic palates were stained with hematoxylin-eosin, and the remaining sections were used for the immunohistochemistry of BMPR2 detection. Reverse transcription-polymerase chain reaction was performed to detect the expression levels of Bmpr2 mRNA.

RESULTSIn the atRA-treated group, short extensions and failure to fuse with each other were observed. The positive expression of BMPR2 was detected in developing palatal process from GD 15 to GD 17 in the control group. Compared with those of the control group, BMPR2 protein and Bmpr2 mRNA decreased in the atRA-treated group (P<0.05).

CONCLUSIONThe treatment of pregnant mice with retinoic acid produces small palatal shelves in their fetuses and down-regulates BMPR2 expressions.

Animals ; Bone Morphogenetic Protein 2 ; Cleft Palate ; Disease Models, Animal ; Down-Regulation ; Female ; Mice ; Pregnancy ; RNA, Messenger ; Tretinoin

Objective To investigate the role of hybrid bone grafting using autograft and freezedried allograft bone in restoration of acetabular bone defect,as well as to evaluate the clinical results of this grafting technique combined with acetabular scaffold in dealing with massive acetabular deficiency.Methods Between April 1999 to December 2007,18 patients (19 hips) underwent acetabular revision by using a mixture of autograft and allogenic freeze-dried cancellous bone particles plus acetabular scaffold.There were 8males and 10 females,aged from 33 to 76 years (average,64.7 years).The acetabular defects were caused by aseptic loosening of primary total hip arthroplasty in 17 patients and osteoarthritis secondary to osteotomy in 1 case of acetabular dysplasia.There were 5 cases of Paprosky Ⅱ B defect,2 Paprosky Ⅱ C defect,6 Paprosky ⅢA defect and 6 Paprosky ⅢB defect.Results All patients were followed up for 3.6 to 12.3 years (average,6.5 years).Harris hip score improved from preoperative 38.7±9.6 to 87.6±7.8 at final follow-up.According to X-rays,bone incorporation evidenced by trabecular bridging of the host-donor interface was found at 3to 6 months postoperatively,and effective bone incorporation was achieved in all cases one year postoperatively.Polyethylene wear occurred in one case.Acetabular component loosening was not found at final follow up.Conclusion Impacted bone grafting using a mixture of autograft and freeze-dried allograft bone can efficiently restore acetabular bone defect.Adding autograft bone to freeze-dried allograft bone is a highly effective way of achieving graft incorporation.Hybrid bone grafting technique with acetabulum scaffold is an attractive option for the treatment of extensive acetabular deficiency.

Objective To investigate the feature of the microorganisms colonization of the thoracic catheter-related infection and evaluate the clinical significance of prophylactic antibiotics administration in patients with pneumothorax treated with closed thoracic drainage. Method A total of 120 patients with pneumothorax treated with closed thoracic dramage in emergency department wore enrolled. The patients were randomized (random number) into group A (n =60) and group B (n =60). In group A, the patients received levofloxacin mesylate injection and in group B, patients received physiological saline injection instead after closed thoracic drainage. The tip of catheter was cut off to get a 2-cm long segment after catheter removal and this segment was dipped into a bottle filled with liquid culture medium for microorganism culture. Statistical analysis carried out by using χ2 test or Fisher exact test. Results Of all 120 patients, microorganisms were found in 49 segments of catheter and 57 strains of microorganisms were found. The four most common microorganisms were Coagulase-negative staphylococci (57.9%), Candida albicans (10. 5%),Staphylococcus aureus (7%) and Acinetobacter baumanii (7%). All of them were highly drug-resistant to β-1actam antibiotics. The difference in the positive rate of microorganism culture was distinct in pneumothorax patients with underlying diseases (50%) in comparison to the patients without underlying diseases (31%) (P ＜ 0.05). The positive rate of microorganism culture increased significantly as the duration of drainage was longer than 14 days (P ＜ 0.01). The positive rate of culture in group A was lower than that in group B if the duration of drainage was less than 7 days (8.3% vs 52.9%, P ＜ 0.01). The positive rate of culture after drainage for 7 days was 21.4% in group A and 68.8% in group B (P ＜0.05), and that after drainage for over 14 days was 70% in both groups (P ＞ 0.05). There were no significant differences in outcome and days of hospital stay between two groups (P ＞ 0. 05). Conclusions The common colonized microorganisms of thoracic catheter-related infection are conditional pathogens and highly resistant to antibiotics. Lengthening the duration of drainage and having underlying diseases increase the risk of infection. Although prophylactic antibiotics administration is beneficial to decrease the risk of thoracic catheter-related infection, it has no effects on shortening hospital stay and outcome of disease.

Objective To summarize the perioperative characters of femoral neck fractures in patients aged at over 80 years by analyzing the surgical treatment procedures. Methods A retrospective study was done on data of patients with femoral neck fractures treated surgically from June 2000 and June 2008. There were 25 males and 36 females, at average age of 83.4 years (80-94 years). Of all, there were 53 patients with fresh fractures including six with type Garden Ⅰ or Ⅱ fractures and 47 with type Garden Ⅲ or Ⅳ fractures, eight with old fractures ( all type Garden Ⅳ). Fifty-one patients (84%) were accompanied with preexisted internal medical or neurological diseases. Six patients with type Garden Ⅰ or Ⅱ fractures were treated with cannulated screw fixation (CSF). Among 55 patients with type Garden Ⅲ or Ⅳ fractures inclu-ding 47 fresh fractures and 8 old ones, 53 patients were treated by hip hemiarthroplasty (HHA) but the other two by cemented total hip arthroplasty (THA) because of preexisting hip osteoarthritis. Results The average operation duration and blood loss were 51 minutes and 50 ml in CSF group, 81 minutes and 180 ml in HHA group, 105 minutes and 350 ml in THA group. Fifteen patients (25%) had postoperative com-plications, mostly hypotension, cardiac insufficiency and atrial fibrillation, accounting for 12%. Postoperative hemoglobin was decreased by 11.9%, 17.1% and 18. 1% on average respectively in CSF group, HHA group and THA group, and postoperative albumin decreased by 10.8%, 18. 1% and 20.2% on average respectively in CSF group, HHA group and THA group. There were 17 patients (28%) with hemoglobin below 100 g/L and four (7%) with albumin below 30 g/L after operation. Conclusions The patients aged ≥80 years with femoral neck fractures are usually accompanied with preexisted internal medical or neurological diseases and have high risk in operation. Adequate preoperative preparation and active prevention and treatment of perioperative complications are important for successful operation and good postoperative results.

Objective To evaluate the clinical efficacy of pingyangmycin (PYM) injection on infantile hemangioma located in the parotid gland region. Methods Twelve patients were treated by intralesional injection of PYM. When necessary, the injections were repeated at an interval of one week, but not more than 3-4 sessions within a therapeutic period. Normally, the secondary therapeutic period was performed 1 month later. The general and local adverse responses were recorded and the clinical outcomes were assessed with a follow-up of 1 to 3 years. Results Complete clinical resolutions were achieved in 10 patients. 2 patients received one injection, 3 patients received 2 injections, 3 patients received 3 injections, and 2 patients received 4 injections. The remaining 2 patients with partial resolution received 6 and 7 injections respectively. No clinical recurrence was observed during the follow-up of 1 to 3 years. No ulcerations or postoperative sears in injection regions were presented. The function of facial nerve was remained normality in all patients. The systematic side effects included transient pyrexia and poor appetite appeared in partial patients. No allergy cases were found. Conclusion Treatment of infantile hemangioma located in parotid gland region with PYM injection reveals a high rate of complete clinical resolution, with fair cosmetic results and short treatment time, and it does not damage the facial nerve or form local scar.The treatment time of PYM injection seems to be positively related to size of the lesions.

OBJECTIVE To investigate the effect and related mechanism of all￣trans retinoic acid (atRA) exposure on osteogenic differentiation of mouse embryonic palate masenchymal cells MEPM. METHODS MEPM were cultured in osteogenic medium (OM) with atRA 0.1 and 1.0 μmol??L-1 for 1, 3,5, 7 and 9 d. MTT assay was performed to measure the cell viability. The alkaline phosphatase (ALP) activity was measured by chemical colorimetry. The cells were stained using the Von￣Kossa technique to detect the formation of mineralization nodules after 21 d of culture. RT￣PCR was performed to determine expression Runx2, osteopontin, bone morphogenetic protein receptor ( Bmpr) 1b, Bmpr2 and Smad5 mRNA. RESULTS The result of MTT on 9 d showed that, compared with normal control group, the cell viability of OM, OM+atRA 0.1 and 1.0 μmol??L-1 groups decreased significantly(P<0.01). Compared with normal control group, ALP activity of OM group increased significantly(P<0.05), while the ALP activity of OM+atRA 0.1 and 1.0 μmol??L-1 groups was lower than OM group(P<0.05). On 21 d, the Von￣Kossa stai￣ning results showed that the percentage of mineralization nodules formation of OM+atRA 1.0 μmol??L-1 group was (3.65±1.24)%, which was significantly lower than that of OM group(10.33±2.29)%(P<0. 05). On 9 d, the relative Run expression of OM group was the highest one in the four groups, while at￣RA 1.0 μmol??L-1 treatment negatively regulated 20% in comparsion with OM group(P<0.05). Compared with normal control group, the mRNA expression of osteopontin of OM, OM+atRA 0.1 and 1.0 μmol??L-1 groups increased significantly(P<0.05); BDNF mRNA expression of OM group was 2.6￣fold to normal control group, while that of OM+atRA 1.0 μmol??L-1 group was 33% to OM group(P<0.05) . The level of Smad5 mRNA of OM+atRA 1.0 μmol??L-1 group was significantly lower than that of OM group(P<0.05). CONCLUSION atRA Might inhibit osteogenic differentiation of MEPM by down￣regulated the expression of Bmpr1b.

Objective To evaluate the results and complications of hip arthroplasty performed as a salvage procedure after the failed treatment of intertrochanteric hip fractures in elderly patients. Methods Between 2004 and 2009,10 patients were treated with hip arthroplasty after the failed treatment of intertrochanteric fracture.There were six females and four males,at mean age of 75.7 years ( range,68-84 years).The initial treatment of fractures included dynamic hip screw (DHS) fixation in three cases,dynamic condyle screw (DCS) fixation in one,proximal femur fixation with reconstruction interlocking nail in three and conservative treatment without internal fixation in three.The failed procedures included avascular necrosis in four cases,cephalic implant cutting in three,nonunion in two and malunion associated with osteoarthritis in one.Joint hip replacement was performed except for pre-operative infection.Harris score at follow-up was recorded and prosthesis position was evaluated by imaging. Results Six patients were treated with total hip arthroplasty with a cemented cup (three patients) and an uncemented cup ( three patients) and four with a bipolar hemiarthroplasty.A long-stem implant was used in 5 of the 10 hips.The average duration of follow-up was 4.6 years (2-7 years).The mean duration of surgery was 128 minutes and mean blood loss was 764 ml.The mean Harris hip score increased from 37 preoperatively to 85 postoperatively.The functional results were satisfactory.One 84-year-old patient with the implant intact died 2 years postoperatively from a brain hemorrhage. Conclusions Hip arthroplasty is an effective salvage procedure after the failed treatment of intertrochanteric fractures in elderly patient.Most patients have better pain relief and functional improvements in spite of technical difficulties than primary arthroplasty.In the meantime,attention should be paid to patients with poor bone quality,bone loss,or articular cartilage damage.

ObjectiveTo analyze the influencing factors and clinical results of radial shortening after operation of intra-articular fractures. MethodsA total of 54 patients with intra-articular fractures of the distal radius treated surgically from January 2003 to January 2008 were followed up and divided into radial shortening group ( ＞ 4 mm) and control group ( ＜ 4 mm) by whether radial shortening was more than 4 mm. Fracture types, comminution and defection degree, age, surgical approach and internal fixation method, whether bone implant in operation, post-operative volar tilting angle and ulnar inclination angle, and wrist function score were investigated and compared between the two groups. ResultsThe incidence of radial shortening in post-operation of intra-articular fractures of the distal radius was 30％.Age and whether bone implant in operation were significantly different between the two groups. Type C fractures were more liable to radial shortening than type B fractures. Operation approach and internal fixation method have no significant influence on the radial shortening. Volar tilting angle and ulnar inclination angle were not significantly different between the two groups and the excellent and good rate of function score was lower in the radial shortening group. ConclusionThere is a high incidence of radial shortening after operation for the intra-articular fractures of the distal radius, which affects the clinical results of operation. Therefore, we should pay more attention to the influencing factors and take corresponding precaution methods during operation.