The purpose of this study was to determine the debriding scope of soft tissues in gunshot wound, and to compare the feasibility of one-stage bone graft transfer between nonvascularized and vascularized bone grafts in 16 dogs.The results demonstrated that it was not accurate to excise the soft tissue till bleeding or to excise only 1cm around the trajectory.The major reasons for the failure of bone transplantation were wound infection, oral open wound, and subsequent infectious myelitis and formation of fistula.Both the nonvascularized and vascularized bone grafts survived at the early stage.The transplanted bone served as bone bridge, and induced the formation of new bone.The bone defect was repaired by membranous bone formation.

Objective To introduce and evaluate arthroscopic release technique for treatment of knee stiffness due to arthrofibrosis after total knee arthroplasty (TKA). Methods Five patients with mean age of 56 years (41－ 70 years) underwent knee arthroscopy for a history of arthrofibrosis following TKA. There was no painful stiff total knee or infected total knee in this series. All of 5 cases had good range of motion in the operation room after total knee replaced. The arthroscopy was performed at 6 months (3－ 12 months) after the TKA, and at this time the flexion was limited to 70 degrees (60－ 85 degrees).In 2 cases,the extension was limited to 10 degrees and 30 degrees. With 3 standard portals, we examined the knee joint and found the adhesions and fibrous band formed in the suprapatellar pouch and two gutters. By resection of those fibro- band and passive flexion of the knee, the satisfactory range of motion(ROM)could be achieved. For the 2 cases of extension limited, CR prothesis was replaced. We released the posterior cruciate ligaments through the anterior portals. Continuous passive motion was started immediately postoperatively at the first day. The patients were evaluated at an average time of 20 months (8－ 46 months) after the arthroscopy. Results The mean knee ROM was 116 degrees (100－ 130 degrees) at the end of arthroscopy and was 105 degrees (90－ 115 degrees)at the last review.The mean ROM was improved by 35 degrees (15－ 50 degrees). There were no complications in this series. Conclusion Arthroscopic release for the treatment of knee stiffness due to arthrofibrosis without pain and infection following TKA is a useful, reliable and safe technique, compared with closed or open procedure. The arthrolysis should be done at 3 to 6 months after the TKA in order to obtain better results.

Objective To investigate the cause and management of urethral dehiscence after hypospadias repair. Methods 23 cases of urethral dehiscence after hypospadias repair were reviewed.According to the location of meatus and the status of available skin, urethroplasty was performed by preputial island flap, scrotal island flap or bladder mucosa translocation. Results 23 cases were followed up from 1 to 9 years.15 cases were cured.3 developed urethral fistulae after the secondary repair, which were subsecondary closed up successfully by Thiersch procedure,4 had stricture at the anastomosis site or at the meatal stenosis , which were cured by a silastlic tube stent ( 1.5～5.0 months ). 1 had a mild penile curvature yet erection was satisfactory. Conclusions Preputial or scrotal island flap translocation should be the primary choice of secondary urethral reconstruction, whereas bladder mucosa graft is used in case of local skin deficiency.A secondary surgery should be performed by experceinced uro pediatric surgeons.

Objective To detemine the effect of autografts of in-vitro cultured corneal limbal stem cells for treating pterygium. Methods A total of 11 cases (12 eyes) with pterygium were treated with autograft of in-vitro cultured corneal limbal stem cells and were followed-up for 6-15 months. Results During the follow-up pterygium recurred in 1 eye (8.33 %) . All of the grafts survived well and no immunological rejection or other complication occurred. Conclusion Autograft of in vitro cultured corneal limbal stem cells is an effective and valuable method to treat pterygium.

Objective:To investigate the clinical efficacy and safety of entecavir combined with triple viable bifidobacterium capsules in the treatment of patients with cirrhosis induced by chronic hepatitis B.Methods:Totally 86 chronic hepatitis B patients with cirrhosis were randomly divided into the observation group and the control group with 43 ones in each.The control group was given entecavir treatment,and the observation group was treated with triple viable bifidobacterium capsules additionally.The treatment course was three months.The effect of treatment,changes of liver function(TBiL,AST,ALT,etc.),liver fibrosis level (HA,PCⅢ,LN,etc.)and adverse events were compared between the groups before and after the treatment.Results:The total effective rate of the observation group was higher than that of the control group (P<0.05);the levels of TBiL,AST and ALT decreased in both groups after the treatment (P<0.05),and those in the observation group were lower than those in the control group (P<0.05);the levels of HA,PC III and LN decreased in the two groups after the treatment (P<0.05),and those in the observation group were lower than those in the control group (P<0.05);there were no significant adverse drug reactions in both groups during the treatment course.Conclusion:Entecavir combined with triple viable bifidobacterium capsules in the treatment of patients with cirrhosis induced by chronic hepatitis B exhibits significant clinical efficacy,which can improve liver function and liver fibrosis with promising safety and without significant adverse reactions.

Objective To investigate clinical characteristics and outcomes of twin pregnancies complicated with growth discordance.Methods Five hundred and seventy-six twin pregnancies who delivered between January 1,2000 and July 31,2012 in Peking University First Hospital were retrospectively analyzed.Cases with twin-twin transfusion syndrome had been excluded.Fetal weight was estimated by abdominal circumference and femur length; neonatal birth weight was recorded.The weight difference between two babies was divided by the weight of the bigger one to obtain the differential ratio.Twin pregnancy complicated with growth discordance was diagnosed if the ratio was equal or greater than 25％ (discordance group,n=68),and growth concordance was diagnosed if the ratio was less than 25％ (concordance group,n=508).The incidence of twin pregnancies complicated with growth discordance was analyzed.The incidence of maternal complications,premature delivery,perinatal death and neonatal complications were compared between the two groups.Chisquare test and t test were used for statistical analysis.Results The incidence of twin pregnancies complicated with growth discordance was 11.8％ (68/576).The incidence of growth discordance in monochorionic twins was higher than that in dichorionic twins [17.6％ (40/227) vs 8.0％ (28/349),x2=11.40,P＜0.05].The gestational age at delivery in the discordance group was earlier than that in the concordance group [(35.6±4.1) weeks vs (36.6±3.2) weeks,t=-1.66,P＜0.05],and the incidence of premature delivery in the discordance group was higher than that in the concordance group [58.8％ (40/68) vs 47.6％ (242/508),x2=3.85,P＜0.05].The perinatal mortality in discordance group was higher than that in the concordance group [9.6％ (13/136) vs 4.7％ (48/1 016),x2=5.84,P＜0.05].Among babies in discordance group,the incidence of intracranial lesion in monochorionic twins was higher than that in dichorionic twins [20.9％ (14/67) vs 6.8％ (3/44),x2=4.06,P＜0.05].Conclusions Twin pregnancies with growth discordance are prone to adverse pregnancy outcomes.Prenatal care should be strengthened and fetal condition should be assessed timely.It is suggested that neonates should undergo overall checkup and long-term follow-up.

Objective To investigate the different expression of various subtypes of human leukocyte antigen-G(HLA-G)in placenta of patients complicated with severe pre-eclampsia.Methods Ten placental samples from early-onset severe pre-eclamptic pregnancies and ten from late-onset severe preeclamptic pregnancies were collected as study group; ten placental samples from preterm pregnancies and ten from normal pregnancies were collected as control group.The levels of HLA-G protein in the four groups were measured by western blot and immunohistochemistry.Results(1)HLA-G1 protein decreased significantly in both the early-onset(2.4 ± 0.6 versus 2.9 ± 1.1,P ＜ 0.05)and the late-onset pre-eclampsia groups (3.5 ± 2.1 versus 4.2 ± 2.4,P ＜ 0.05).(2)HLA-G5 protein increased in the late-onset pre-eclampsia groups(1.8 ± 1.1 versus 1.1 ± 0.9,P ＜ 0.05); the increase in the early-onset pre-eclampsia group is not obvious(1.6 ± 0.9 versus 1.4 ± 0.7,P ＞ 0.05).(3)The level of HLA-G1 protein in placenta from patients complicated with premature labor is lower(2.9 ± 1.1 versus 4.2 ± 2.4,P ＜ 0.05); HLA-G5 protein does not change significantly(1.4 ± 0.7 versus 1.1 ± 0.9,P ＞ 0.05).(4)HLA-G1 and G5 proteins mainly express in the placenta extravillous cytotrophoblast cells.There is also a high level of expression around the blood vessels and in the extraembryonic mesoderm.Conclusions(1)HLA-G1 decreased significantly in both the early-onset and late-onset pre-eclamptic patients.(2)HLA-G5 increased in both the early-onset and late-onset pre-eclamptic patients,and the increase in the late-onset pre-eclamptic patients is obvious.(3)In late pregnancy,the level of HLA-G1 is lower in patients complicated with premature labor,this may be the result of its earlier pregnancy week; HLA-G5 does not change significantly.(4)HLA-G1 and G5 mainly express in the placenta extravillous cytotrophoblast cells.

ObjectiveTo investigate the role and clinical significance of interferon regulatory factor 7 (IRF7) and Toll-like receptor 9 (TLR9) in the development of condyloma acuminatum (CA).MethodsReverse transcription-PCR was performed to analyze the mRNA expressions of IRF7 and TLR9 in peripheral blood mononuclear cells(PBMCs) of 25 patients with CA and 20 normal human controls.ResultsThe expression levels of IRF7 and TLR9 mRNA in PBMCs were significantly higher in the patients with CA than in the controls(both P ＜ 0.01 ).Conclusion There is a significant increase in the expression of IRF7 and TLR9 in the PBMCs of patients with CA.

Objective To explore the expression of nitric oxide synthases including neuronal nitric oxide synthases(nNOS), inducible nitric oxide synthases(iNOS), endothelial nitric oxide synthases (eNOS) in neurogenic bladder tissues, and analyze it's producing feature and significance. Methods There were 30 cases with neurogenic bladder(18 males, 12 females). The average age was 6.3±3.1 years. All patients appeared with myelodysplasia, urinary and fecal incontinence in different degree. Twenty-six cases were manifested with hyperreflexia bladders, and all patients were treated with surgical procedures. During operation, collected bladder tissue samples including tissues of apex vesicae and tissues of bladder neck, and all tissues were enveloped with mineral wax. All tissues were detected for nNOS, iNOS, and eNOS respectively in tissues of apex vesicae and tissues of bladder neck,and with normal bladder tissues as control group (bladder tissues of hypospadia, 10 cases), and according to clinical features, to explore the expression of NOS, and to analyze the relationship among them. Results In normal apex vesicae tissues, all cases stained with nNOS, and distributed among bundles of smooth muscles, and surface of smooth muscles and interstitial tissue, histochemica;score (HS) 2.8-4.0 and 1.2-2.7. There were no stained cells in bladder tissues of iNOS, and HS was very low, HS:0-0. 4 and 0-0.1 ;eNOS mainly distributed in interstitial tissues in rarefaction manners, and mainly in vascular endothelial cell (VEC), and smooth muscles had no stainings the most expression among them was nNOS, and mainly distributed in bladder neck tissues. In neurogenic bladder tissues, the main expression of NOS type was iNOS, and nNOS decreased significantly. eNOS mainly expressed in VEC among interstitial tissues, and had no staining in smooth muscle cells and collagenoblast and rarefaction of microvessel in bladder tissues, and microvessel density decreased significantly than normal bladder tissues. Microvessal density(MVD) in bladder tisssus (6. 8± 3.2/100per square) was less than that in normal tissues (16.7±6.3/100 per square). Conclusions In normal bladder tissues, nNOS mainly distributes in bladder neck and urethra, and nitric oxide mainly derives from nNOS. Much more matrix fibers, fewer nitrogenergic nerves, and less nNOS expression are seen in neurogenic bladder interstitial tissue. There are more iNOS expressions in bladder tissues,and NO is mainly derived from iNOS, and it may play an important role in pathological bladder tissues, especially in fibrosis of bladder wall. eNOS may be considered as angiopoietic labeling, and may evaluate the blood supply of bladder.

Objective To evaluate the urodynamic outcome after bladder augmentation using double de-epithelialized segment of small intestine lined with urothelium. Methods Twenty-five children with neurogenical bladder (age range,4 to 14 years;16 males and 9 females) underwent bladder augmentation using de-epithelialized segment of small intestine lined with urothelium.Pre- and post-operative voiding cystoureterography,urodynamic and clinical evaluation were performed on them.Of them 21 cases were followed up for 6 to 24 months after operation. Results Bladder volume was increased from pre-operative (142.14?45.88)ml to post-operative (242.62?60.04) ml,compliance from (3.26?1.57) ml/cmH 2O (1 cmH 2O=0.098 kPa) to(8.10?3.00)ml/cmH 2O,and maximum urine flow rate from (3.00?1.00) ml/s to (7.60?2.90)ml/s,respectively(P