Objective To study the expression of transcription factor specificity protein1 and activator protein-2α and the correlation between the two transcription factors in the process of occurrence and development of colorectal cancer. Methods To detect expression of Sp1 and AP-2α mRNA by Real-Time PCR in 60 colon cancer tissues and corresponding normal tissues and the results were compared with the clinical features and pathological characters. The relationship between the expression of Sp1 mRNA and AP-2α mRNA in 60 colon cancer tissues was determined. Results The expression rates of Sp1 mRNA was detectable to highly expressed rates in colon cancer tissues than the matched normal tissues (P ＜0.01),whereas AP-2α mRNA in the colon cancer tissues was significantly lower than that in the matched normal tissues (P ＜0.01). Sp1 mRNA and AP-2α mRNA expression rates had no significant difference between the clinical features (sex, age and tumor areas) respectively. Loss expression or down regulation expression of AP-2α mRNA was detected, whereas Sp1 mRNA was detectable to highly expressed in the different histological grade and Dukes stages. The expression of Spl mRNA and AP-2α mRNA were positively correlated with the histological grade in colon cancer. A significant correlation was found between the expression of Sp1 mRNA and AP-2α mRNA (r =-0.849, P ＜0.001). Conclusion Loss or down regulation expression of AP-2α mRNA,whereas Sp1 was detectable to highly expressed in colon cancer. Negative correlation occurred in Sp1 mRNA and AP-2α mRNA indicated that AP-2α and Sp1 provide the new clues of genetic diagnosis and treatment.

Objective To explore the curative effect of fibular flap with limbs composite soft-tissue.Methods From February,2013 to February,2016,13 cases with body severe trauma patients were treated,which including 5 cases of upper limbs and 8 cases of lower limbs,and all existed bone defect,soft tissue defect and trunk vessel defect.Three cases with limbs distal non blood supply were emergency treated with debridment and flow-through fibular flap transplantation renovation,peroneal artery repairing defective blood vesscls to rcstorc limbs distal blood supply,fibular flap repairing bone defect,skin flap repairing soft tissue defect.The limb blood supply for other 10 cases were in good condition,but one case with main artery defect did the second phase of fibular flap transplantation and repaired defective blood vessels,bone and skin soft tissue synchronously according to wound condition.According to the postoperative observation for flap survival and appearance,X-ray films to observe fracture healing after 6 weeks,three months and 6 months of operation as well as evaluating limb function recovery,then analyzed the results.Results Flaps survived successfully for 11 cases,and flaps for the other 2 cases were partial necrosis.One Case was edge flap necrosis,heal scabby after dressing,and the other case was necrosis for 1/3 of the area,but the deep fascia survival,and the skin graft healing after dressing.One case with forearm rolling was in vascular crisis after operation,but tbe crisis was relieved after detection,and fingers blood supply was recovered.All the patients were followed up for 6 to 36 months(mean,14 months).All flaps were survived,fractures healed well and limbs distal blood supply was good.Bone healing time was 8 to 24 weeks,and patients with lower limbs injury could bear load after 3 to 8 months.Lower limbs restored walking function.Upper limbs and hands restored rotation function.Transplant flapshad good elasticity and satisfactory appearance.Conclusion Using fibular flap to repair defective blood vessels,bone and soft tissue synchronously,not only can rescue the limbs on the verge of amputation,but also can repair defective composite tissue and get a good prognosis.It is an effective method for open injuries severely treatment in clinic.

Objective:To analyze the clinical value of indocyanine green (ICC) fluorescence imaging in Mirizzi syndrome type Ⅱ-Ⅲ laparoscopic cholecystectomy (LC).Methods:A retrospective analysis was performed on 80 patients diagnosed with Mirizzi syndrome types Ⅱ-Ⅲ who underdoing LC in Affiliated Hospital of Liaoning University of Traditional Chinese Medicine from October 2018 to February 2022, including 32 males and 48 females, aged (63.5±6.9) years. Patients were divided into two groups based on whether ICG fluorescence imaging technology was used, the control group ( n=38) that patients were treated with conventional LC and the experimental group ( n=42) patients were treated with LC guided by ICG fluorescence imaging. In the experimental group, the extrahepatic bile duct was identified by ICG fluorescence imaging during LC, and ICG was injected intraoperally to determine the reserved blood flow of gallbladder flap for fluorescence imaging and determine the resection line. Operation time, intraoperative blood loss, conversion rate of laparotomy and postoperative complications (bile leakage, incision infection, etc.) were compared between the two groups. Intraoperative fluorescence imaging and determination of the modified resection line of reserved gallbladder were analyzed in the observation group. Results:There was no significant difference in age, male proportion, type of Mirizzi syndrome and conversion rate of laparotomy between the two groups (all P>0.05). In the observation group, the operative time was (208.7±32.0) min, the intraoperative blood loss was (50.5±23.8) ml, and the biliary leakage was 7.1% (3/42), which was lower than that in the control group (228.2±33.9) min, (73.8±31.0) ml, 26.3% (10/38). The differences were statistically significant (all P<0.05). Of 37 cases (88%) showed common hepatic duct and common bile duct successfully in the observation group. In the observation group, ICG fluorescence imaging was used to determine the gallbladder resection line in 8 cases (19.0%). The gallbladder flap without fluorescence imaging was removed. Conclusion:ICG fluorescence imaging in LC for Mirizzi syndrome patients can identify the common bile duct and hepatic duct to guide surgical resection, determine the gallbladder flap resection line, reduce postoperative bile leakage and bleeding, and accelerate the surgical progress.

Objective:To explore the clinical value of indocyanine green (ICG) fluorescence imaging technology in complex laparoscopic cholecystectomy (LC) for real-time imaging of extrahepatic bile ducts to avoid bile duct damage.Methods:The data of 90 patients with complicated gallbladder stones with cholecystitis who underwent LC from November 2018 to May 2019 at Liaoning University of Traditional Chinese Medicine Affiliated Hospital were studied. The patients were divided into the control group and the experimental group based on different imaging methods. The control group underwent conventional LC, and the experimental group underwent LC under guidance of ICG fluorescence imaging technology. ICG 5 mg were injected into a peripheral vein (elbow vein) 12 hours before operation. The pre-LC common bile duct, common hepatic duct and cystic duct recognition rates, time to establish gallbladder triangle, intraoperative blood loss, bile duct injuries and postoperative complications were determined.Results:Of the 45 patients in the experimental group, there were 18 males and 27 females. The age was (60.9±9.3) years. The body mass index (BMI) was (26.2±2.0) kg/m 2. Of the 45 patients in the control group, there were 23 males and 22 females. The age was (57.5±8.7) years. The BMI was (26.7±2.7) kg/m 2. There were no significant differences in the clinical data between the two groups ( P>0.05). In the experimental group, the common bile duct was successfully shown in 40 patients (88.9%) and the cystic duct in 34 patients (75.6%). In the control group, the common bile duct was shown in 13 patients (28.9%) and the cystic duct in 12 patients (26.7%). The time taken for the experimental group to establish the triangle of gallbladder was (33.4±9.0) min. The corresponding time for the control group was (52.7±15.0) min. The intraoperative blood loss was (15.5±5.4) ml in the experimental group and (23.0±15.6) ml in the control group. One patient in the control group, but no patients in the experimental group, had to be converted to laparotomy. The control group had 1 right hepatic duct injury and 1 common bile duct injury. Each group had 1 patient with a sub-xiphoid incision infection. No additional complications were detected after a follow-up of 3 months. The differences in pre-LC common bile duct, common hepatic duct, and cystic duct recognition rates, time to establish the gallbladder triangle, and intraoperative blood loss were significantly different between the two groups ( P<0.05). There were no significant differences in biliary tract injuries and postoperative complications rates ( P>0.05). Conclusion:Early observation of the cystic duct and common bile duct with ICG fluorescence imaging in complex LC can help prevent common bile duct damage and speed up the progress of surgery.