Through two years of experimental trials,a species of fresh snail rich in protein containing 0. 45mg/kg selenium was obtained

BACKGROUND:Traumatic soft tissue defects of the limbs are usual y accompanied with the exposure of tendon, joint capsule, bone or internal fixator, which can be reconstructed by skin flap. Previous research has shown that it is an important method to repair traumatic tissue defects with flaps. However, rarely research reports perioperative management about flap bed so far. OBJECTIVE:To explore the perioperative strategy for repairing traumatic soft tissue defects with revascularized flaps. METHODS:Total y 94 cases undergoing secondary skin flap repair were enrol ed. Intraoperative debridement using tourniquet was performed, and the wound was washed with mass of physiological saline. Whether the tissues, including bone, tendon, joint capsule and internal fixator, were reserved or not depended on their viability, and then the flaps were harvested to repair defects, and drainage was placed properly at last. RESULTS AND CONCLUSION:The flaps survived in al cases. Exudation occurred in 5 cases with the exposure of bone, and 28 cases with the exposure of tendon or joint capsule healed normal y. No complications were associated with the reservation of the internal fixators, but delayed-union occurred in three cases and nonunion in one case. These findings indicate that the perioperative treatment of the application of skin flap is worthy of attention. Careful debridement, advisable choice of the flap, efficient drainage and using antibiotic normatively are al keys. Treatment of the bone, tendon, joint capsule and internal fixator which are exposed should not only weigh the advantage and disadvantage, but also relax the indication of reserving them.

Stereotactic body radiation therapy (SBRT) adopts different tumor-killing mechanisms from the conventional fractionated radiotherapy.In SBRT,a single high-dose radiation can destroy the membrane of tumor cells and induce the release of tumor-associated antigen,also named in situ tumor vaccine,which stimulates the immune system to kill the residual tumor;a single-fraction radiation with a dose larger than 8-10 Gy can induce rapid apoptosis of vascular endothelial cells via the acid sphingomyelinase pathway at 1-6 hours after radiation,which causes tumor vascular occlusion and secondary tumor-killing effects.In order to understand whether SBRT improves the clinical treatment outcomes via the above mechanisms,this paper reviews the clinical research advances in SBRT for primary liver cancer.

BACKGROUND: Absorbable materials for internal fixation have some advantages such as simple surgery, rapid recovery and no need to second surgery, and have been accepted in the circle of orthopaedics, and had been applied in the clinic. However, the system experiment evidences are not reliable.OBJECTIVE: To investigate whether the absorbable material (the absorbable tension band, absorbable stick or screw) is an acceptable alternative to stainless steel wire with Kirschner wire by comparing their biomechanical properties in the fixation of patella transverse fractures.DESIGN, TIME AND SETTING: The randomized controlled study of biomechanical analysis was performed at the Laboratory of Institute of Biomechanics, Shanghai University from March 2007 to January 2008.MATERIALS: Eight fresh patellae specimens were collected, with the complete patella, articular capsule and patellar ligament (3.0-4.0 cm) and quadriceps femoris (4.0-5.0 cm), and then divided into two groups at random, AO steel wire group (n = 2) and absorbable tension band group (n = 6).METHODS: Eight fresh patellae specimens were divided into two groups at random, AO steel wire group (n = 2) and absorbable tension band group (n = 6) to create models of transverse fractures, which were separately fixed by absorbable tension band,steel wire tension band + Kirschner wire to measure their biomechanics function. If fracture gap reached 1.0 mm, the fixation failed.MAIN OUTCOME MEASURES: The changes in patellar ligament tensile force, quadriceps femoris tensile force, patellar displacement, quadriceps femoris displacement, patellar ligament displacement and patella tensile strain were measured under external load.RESULTS: Under external load, no significant difference was determined in total displacement between the absorbable tension band group and AO steel wire group (9%-10% difference). No significant difference was detected in patellar strain between absorbable tension band group and AO steel wire group (9%-10% difference). The patellofemoral joint force was similar between the absorbable tension band group and AO steel wire group. When internal fixation displaced 1 mm, the load was 587 N in the absorbable tension band group, and 650 N in the AO steel wire group (P > 0.05).CONCLUSION: The absorbable material is an acceptable alternative to stainless steel wire with Kirschner wire in the fixation of patella transverse fractures, with the advantages of good biological function and good stability at the broken ends of fractured bone.

Objective To investigate the apathy and neuropsychological characteristics of newly diagnosed Parkinson's disease (PD) patients.Methods Eighty-two newly diagnosed PD patients and 30 matched healthy controls by age,sex and education level were recruited in the present study.Apathy was assessed using Apathy Evaluation Scale (AES) and related factors,including age,sex,education level and disease duration were simultaneously evaluated.Unified Parkinson's Disease Rating Scale (UPDRS),Hamilton Depression Rating Scale (HAMD),as well as Montreal Cognitive Assessment (MoCA) were employed in order to respectively evaluate the motor function,depression and cognition.Results The AES scores in the PD patients were significantly higher when compared to the healthy controls.The prevalence of apathy and depression in the PD patients was 51.2％ (42/82) and 19.5％ (16/82),respectively.There were no statistically significant differences in age,sex,education level,UPDRS-Ⅱ/Ⅲ scores and MoCA scores between apathy (n =42) and no-apathy (n =40) PD patients (P ＞ 0.05),while the statistically significant difference in HAMD scores between apathy (n =42) and no-apathy (n =40) PD patients was shown (the HAMD scores of apathy PD patients were 10.61 ± 3.30,the HAMD scores of no-apathy PD patients were 5.96 ± 1.90,t =7.87,P ＜ 0.05).The correlation analysis indicated that there were no correlations between AES scores and the related factors,including age,education level,disease duration and UPDRS-Ⅱ / Ⅲ scores,but AES scores were positively correlated with HAMD scores.Conclusion In newly diagnosed PD patients,the apathy is independent of depression,motor dysfunction,as well as cognitive impairment,which may be an early signal for PD.

Objective To study the radiosensitizing effect of nano-gold nano-silver particles in hepatocellular carcinoma cells (HepG2) in vitro and the possible mechanisms.Methods MTT assay and clonogenic assay were performed to determine the killing effect of nano-gold and nano-silver particles in HepG2 cells.Flow-cytometry was used to measure cell apoptosis and cell cycle distribution.Western blotting was used to measure the expression of Caspase-3,Bax and Bcl-2.ELIASA was used to determine the content of catalase (CAT),superoxide dismutase (SOD),and total glutathione (GSH).Results Nano-gold and nano-silver particles inhibited the proliferation of HepG2 cells with IC50 of 6.51 μg/ml and 2.47 μg/ml,respectively.Nano-gold and nano-silver particles significantly enhanced the radiosensitivity of HepG2 cells.Obtained by Dq,the SER of 1/5 IC50 nano-gold and nano-silver particles were 1.37 and 1.48,and 1/10IC50 with 1.11 and 1.09.Nano-gold and nano-silver particles increased the expression of Caspase-3 and Bax and reduced the exprcssion of Bcl-2.CAT,SOD and total GSH were significantly reduced.Conclusions Nano-gold and nano-silver particles can enhance the radiation sensitivity of HepG2 cells.Specific sensitizing mechanism may be the activation of the mitochondrial apoptosis pathway and the induction of reactive oxygen species in apoptotic pathways,which ultimately induces apoptosis.

Objective To study clinical outcomes of cross-leg fibula flap for difficult reconstruction of an extensive injury in the lower extremity,which included large soft-tissue defects and long infected bone and tibia defects combined with vascular injury.Methods From September 2004 to September 2008,8 cases with an extensive injury in the lower extremity,which included large soft-tissue defects and long infected bone and tibia defects with vascular injury,were retrospectively analyzed,including 6 males and 2 females with an average age of 36 years (range,19-55 years).The course of disease ranged from 2 weeks to 3 months (average,2 months).The bone defect length ranged from 8 to 20 cm (average,13 cm),and the skin defect area varied from 10 cm×7 cm to 22 cm×12 cm.After thorough debridement,cross-leg fibula flap was used to repair the tibial defect and concomitant soft tissue defect.The pedicles were divided at 4-6 weeks after the initial surgery.The important technical considerations were outlined.Results All 8 patients were followed up for 6 to 36 months (average,24 months).The flaps survived in all 8 patients,and no infection and osteomyelitis happened.The flap transplantations healed at two weeks after operation with good shape.The fractures healed in all of patients with an average period of 11 months (range,6-15 months).All of patients recovered to walk without aid.According to Edwards classification of tibial fractures,4 cases were classified as good,2 as acceptable,and 2 as poor.Conclusion The cross-leg fibula flap is relatively simple,liable for the treatment of an extensive injury in the lower extremity.

Objective The anterior-lateral defect of foot that lost one of the three supporting point of foot can lead to collapse of the lateral longitudinal arch, overload of the first metatarsal heads, and painful callus formation. It is meaningful to investigate the effect of reconstructing the lateral forefoot defect with pedical fibular osteoseptocutaneous flap. Methods From March 1989 to June 2008, there were 38 patients with anterior-lateral defect of foot were constructed. The supporting point with the local distal based pedical fibular osteoseptocutaneous flap was constracted. Results All the 38 flaps survived. All 38 patients had been followed up from 6 months to 10 years (mean 23.5 months) postoperatively. The constructed supporting point of the foot was functional. The patients could walk freely with no pain, and was satisfied with the operation. Assessed with the rating system for foot and ankle established by the American Orthopaedic Foot And Anke Society, 8 patients got a score above 85, 23 patients between 75 to 85, 7 patients between 60 to 75. Conclusion It is effective that transferring local distal based pedical fibular osteoseptocutaneous flap to repair the anterior-lateral defect of foot.

Objective To investigate the analgesic efficacy and safety of parecoxib-sodium in patients undergoing laparoscopic cholecystectomy. Methods Ninety patients received laparoscopic cholecystectomy were divided into parecoxib-sodium group,flurbiprofen group and control group by random digits table, 30 cases in each group, all patients received the drug by vein 30 minutes before surgery. The postoperative pain intensity (VAS score), satisfaction of patients, changes of blood coagulation function and maximum agglutination rate (MAR) of platelet agglutination test before and after treatment and the incidence of postoperative adverse reaction were observed and compared. Results Pestoperative VAS scores and psychiatric symptoms at different time in parecoxib-sodium group and flurbiprofen group were significantly lower than those in control group (P ＜ 0.05), analgesic satisfaction rate were 93.3% (28/30) in parecoxibsodium group and 90.0% (27/30) in flurbiprofen group, which were significantly higher than that in control group [20.0%(6/30)] (P＜0.05). There were no significant difference in blood coagulation function and MAR before and after treatment among three groups (P ＞ 0.05). Conclusion Parecoxib-sodium displays significant analgesic effects and low rate of adverse events for the patients undergoing laparoscopic cholecystectomy, it is worthy of clinical application.