Ten percent ethyl acetate oil red dye was injected into the axillary artery of 30adult cadavers.After careful dissection under surgical microscope,the cutaneousarteries in the lateral thoracic region were demonstrated.The skin and subcutaneoustissue in this region is nourished mainly by four axial arteries.In the anterior part,the anterolateral area,accessory lateral thoracic artery is almost always present.It isa direct cutaneous branch of axillary or brachial artery.In the posterior part,thepectoral latissimus dorsi area,direct cutaneous branches,arise from the lateral thoracicartery,subscapulo-dorsal thoracic artery and axillary artery.The distribution of thecutaneous arteries may be monopolized by either one,or one to be the main theother accessory.The diameters of the arteries and accompanying veins,can satisfythe requirment of a cutaneous flap in microvascular surgery.These arteries all possessrich anastomosis between each other and with neighboring arteries.The architactureof the destribution of blood vessels of lateral thoracic region,possibly set up amorphological basis,which may be helpful in cutaneous flap designation.

Based on the related theories of physician behavior analysis, summarize and discuss the incentives mechanism of supplier payment on physician behavior and its inner mechanism, provide theoretical supports and political suggestions for further analysis on payment reform.

Background Blepharitis is an induce factor for multiple ocular surface diseases.Research showed that bacteria play an important role in the pathogenesis of blepharitis.To make sure the pathogenic bacteria and effective antimicrobial agents are of clinical significance for the prevention and treatment of blepharitis.Objective The purpose of this study was 1o investigate the bacterial isolates of conjunctival sac secretion and meibomian secretion in the patients with blepharitis and study their in vitro antimicrobial susceptibility.Methods Forty-five patients with anterior blepharitis and 45 cases with posterior blepharitis were included in Beijing Chaoyang Hospital from December 2006 to December 2012,and 45 patients for laser in situ keratomileusis were enrolled in the same period as control group.The secretions of the conjunctival sac and meibomian were collected with sterile cotton swab,and bacterial isolates were cultured in bouillon culture-medium.The number of eyes with different bacteria was examined and calculated.Then the bacteria were switched to blood agar plates,and antimicrobial susceptibility test to erythromycin,gentamicin,tobramycin,rifampin,levofloxacin were performed by M ueller Hinton (M-H) medium paper method.Results The total germiculture positive rates were 81.1％,76.1％ and 65.0％ in the anterior blepharitis group,posterior blepharitis group and the control group,showing a significant difference among them (x2 =12.80,P=0.00).The germiculture positive rates in meibomian secretion were 84.4％ and 78.8％ in the anterior blepharitis group and the posterior blepharitis group,which were significantly higher than 67.8％ in the control group (x2=7.30,P =0.03).There was no statistically significant difference in the germiculture positive rate of conjunctival sac section among the three groups (77.8％,73.3％ and 62.2％) (x2 =5.60,P=0.06).The main bacteria in conjunctival sac secretion and meibomian secretion were staphylococcus epidermidis,staphylococcus aureus and corynebacterium in all the subjects,but streptococcus pneumoniae and gram-negative bacillus were not detected in the control group.Staphylococcus showed the highest susceptibility to gentamicin,tobramycin and rifampicin,with the sensitive rate ＞70％.Corynebacterium was susceptible to various drugs.Streptococcus pneumoniae had susceptibility to erythromycin and tobramycin.However,Gram-negative bacillus was not susceptible to all the drugs above.Conclusions Bacteria participate in the pathogenesis of blepharitis,but the germiculture positive rate,bacterial species and drug susceptibility of bacteria are obviously different between patients with blepharitis and normal population.Reasonable application of antimicrobial agents is important to blepharitis.

Eosinophilic gastroenteritis (EGE) is a rare disorder characterized by eosinophilic infiltration of the bowel wall with various gastrointestinal manifestations.The etiology of the disease is not clear.EGE can affect the growth and development in children,and can cause a variety of complications.Through the elaborate discussion to the pathogenesis,clinical manifestations,diagnostic criteria and treatment principles of EGE,can strengthen identification to EGE,and improve the level of diagnosis and treatment.

Objective To investigate the effect of lead aVR on recent prognosis in patients with non -ST -elevation acutecoronary syndrome(NSTE -ACS).Methods 195 patients with NSTE -ACS were divided into ST segment elevation in lead aVR group(n =54 cases)and non -ST segment elevation in lead aVR group(n =141 ) according to ST segment elevation in lead on admission;clinical data,laboratory index and coronary artery lesion were recorded,and major adverse cardiac (MACE)in hospitalization time were also recorded.Results Compared with non -ST segment elevation in the lead aVR group,the heart rate of ST segment elevation in the lead aVR group was faster[(85.4 ±12.0)beats per minute vs.(79.3 ±13.2)beats per minute,t =2.959,P <0.05],systolic blood pressure and diastolic blood pressure were higher[(145.0 ±20.3)mmHg vs.(136.0 ±19.4)mmHg,t =2.874,P <0.05];NT -proBNP[(743.9 ±125.8)pg/mL vs.(416.4 ±95.3)pg/mL,t =19.625,P <0.05],cTnI[(3.4 ± 1.0)ng/mL vs.(1.2 ±0.4)ng/mL,t =21.994,P <0.05],CK -MB[(31.5 ±9.8)ng/mL vs.(19.8 ±6.5)ng/mL, t =9.682,P <0.05]were higher (P <0.05);LVEF were lower[(50.1 ±5.2)% vs.(53.8 ±5.7)%,t =4.153, P <0.05];the rate and amplitude of low ST segment in outside lead aVR also was higher[(9.5 ±3.8)mm vs. (7.4 ±2.8)mm,t =4.224,P <0.05];the rate of left main and three -vessel disease in ST segment elevation in lead aVR group were higher (P <0.05).Compared with non -MECE group,proportion of ST segment elevation in lead AVR on admission was higher (P <0.05).Logistic regression analysis showed that heart rate(OR =1.472),NT -proBNP(OR =1.732),cTnI(OR =1.893),left main coronary artery(OR =2.478)and three -vessel disease (OR =2.310)were risk for ST segment elevation in lead AVR(P <0.05).Logistic regression analysis also showed that ST segment elevation in lead AVR were risk for MACE(OR =1.474).Conclusion ST segment elevation in lead AVR has close relationship with large area of myocardial ischemia,and patients prognosis is poorer,which may be independ-ent risk factor for the recent outcomes of patients with NSTE -ACS.Early record of the change in the case of aVR lead ECG ST segment NSTE -ACS patients is of important value in evaluation of the condition and prognosis.

Objective To describe the Reverdin technique for treatment of hallux valgus (HV) based on correction of proximal articular set angle (PASA). Methods Thirty-one Reverdin osteotomies (in 31 feet of 17 female patients)were performed between 1992 and 1998. Reverdin operation is unique among the surgical procedures for its ability to correct large PASA with a medial wedge-type osteotomy of the metatarsal head. Results On the follow-up of 1 to 8 years, patients rated outcomes as excellent or good in 96％ (30 feet). There was no complication of delayed union or avascular necrosis of the metatarsal head. Radiographical follow-up: PASA averaged 19 degrees(range 30-12 degrees), had a postoperative averaged value of 1.95 degrees, HV angles averaged 30 degrees(range 41-23 degrees), had a postoperative value of 14.3 degrees. Intermetatarsal angles averaged 10.9 degrees (range 16-4 degrees), had a postoperative value of 5.8 degrees. Conclusion The preoperative PASA value is the most important factor in hallux valgus evaluation, as well as the selection of operative techniques. The normalization of PASA safegurds more successes and less recurrences.

Objective To observe the efficacy of somatostatin on elderly patients with acute suppurative cholecystitis and its impact on the C-reactive protein (CRP), prealbumin (PA) and total bilirubin (TBIL) effects before or after operation. Method 110 elderly patients with acute suppurative cholecystitis, which from January 2011 to June 2013, were randomly divided into observation group and control group, each group had 55 cases, the control group were gave operation, the observation group were treated with somatostatin on basis of control group before and after operation. The operative time, blood loss, postoperative visual analog scale (VAS) score and morbidity were observed. At the same time, the levels of CRP, PA and TBIL were detected before and after operation. Results After treatment, the blood loss, postoperative hospital stay and postoperative complication rate in observation group were significantly lower than those in control group (P<0.01), while the differences in operative time and postoperative VAS score between two groups were not significant . After treatment, the levels of CRP, and TBIL appear significantly lower than those before treatment (P<0.01), while the PA levels appear significantly higher compared with those before treatment (P<0.01), the decreasing or increasing levels in observation group were more obvious compared with control group (P<0.01). Conclusion The adjuvant therapy efficacy of somatostatin were obvious before and after operation, they can significantly reduce the body's inflammatory response, and promote the postoperative recovery.

The end stage of chronic renal diseases is characterized by glomerular sclerosis and interstitial fibrosis. Studies have revealed that effective amelioration of renal fibrosis can significantly delay the progression of chronic renal diseases. Peroxisome proliferator activated receptors (PPARs) are ligand-activated nuclear transcriptional factors of the nuclear hormone receptor superfamily, and PPAR-γ is one of the phenotypes of PPARs. The effect of PPAR-γ on inhibiting renal fibrosis has become a hot spot. In this article the research advances of PPAR-γ in amelioration of renal fibrosis are reviewed.

Objective To study traditional Chinese herb fumigation and steaming in treating AA model rats and the change of IL-1? in serum and joint, and explore its mechanism. Method Fifty Wistar rats were randomly divided into normal group, model group, aqua group, high dose group, low dose group. Except normal group and the right foot of rats were injected CFA 0.1 mL to make AA model. Aqua group, high dose group and low dose group received steam treatment for 10 days. In the 21st day, the content of IL-1? in serum and the expression level in joint were detected. Results Traditional Chinese herb fumigation and steaming group had notable reduction the IL-1? content in serum and strong positive expression of IL-1? in joint than model group. Conclusion Traditional Chinese herb fumigation and steaming can down-regulate the level of IL-1? in serum and restrain IL-1? expression in joint.

Objective In this study,we measured the levels of urinary monocyte chemoattractant (MCP)-1 and interferon-γ-inducible protein (IP-10) and further analyzed their associations with clinical and pathological data in lupus nephritis patients in order to find the non-invasive biomarkers which canpredict disease activity.Methods MCP-1,IP-10,VEGF levels were measured in urine samples from 64 lupus nephritis patients and 20 healthy volunteers.Clinical disease activity was determined by SLEDAI and BILAG scores.The lupus nephritis patients were divided into two groups:active disease group (SLEDAI scores ≥ 10points,n=36) and non-active group (SLEDAI score＜10 points,n=28).Of all patients enrolled,37 patients had a concomitant kidney biopsy performed at the time of urine collection.The predictive performance of uri-nary MCP-1 and IP-10 for renal flare,the Student's t test,Mann-Whitney U test,Chi-square test,and re-ceiver operating characteristic (ROC) curves were constructed for analysis.Results The urinary MCP-1 and urinary IP-10 levels of the active group was significantly higher than that of the non-active group [MCP-1672.39(318.05,2 554.23)pg/ml vs 152.52,(55.61,330.44)pg/ml,Z=-4.717,P＜0.01; IP-10 (38±19) pg/ml vs (22±16) pg/ml,t=3.576 P＜0.01].The level of urinary MCP-1 was positively correlated with the levels of hematuria and 24 hours protein quan-tification,as well as the scores of SLEDAI and BILAG (rbemahuria=0.570,P=0.000; r24hpro=0.569,P=0.000; rSLEDAI=0.600,P=0.000; rBILAG=0.606,P=0.000),and it was also positively correlated with the scores of cellular crescent,wire loop,and AI (rCC=0.405,P=0.015; rwire loop=0.430,P=0.014; rAI=0.352,P=0.003),while nega-tively correlated with the level of C3 and plasma albumin (rc3=-0.564,P=0.000; ralb=-0.587,P=0.000).It had no correlation with the scores of wire loop and CI (P＞ 0.05).The level of uIP-10 was positively correlated with the protein quantification in 24 hours and the scores of SLEDAI and BILAG (r24hpro=0.305,P=0.018; rSLEDAI=0.334,P=0.009; rSILAG=0.496,P=0.000),while negatively correlated with the level of C4 (rC4=-0.301,P=0.016).The R0C curve of uMCP-1 to predict the activity of SLE showed that its specificity was 75.0％,sensitivity was 83.3％,and the area under the ROC curve was 0.85±0.05.The ROC curve of urinary IP-10 to predict the activity of SLE showed that its specificity was 50.0％,sensitivity was 97.2％,its area under the ROC curve was 0.74±0.06.The ROC curve of urinary MCP-1 to predict renal flare shows that its specificity was 45.5％,its sensitivity was 100％,and the area under the ROC curve was 0.74±0.80.The ROC curve of urinary IP-10 to predict renal flare showed that its specificitywas 36.4％,its sensitivity was 73.3％,and its area under the ROC curve was 0.49 ±0.10.Conclusion Urinary MCP-1 and urinary IP-10 predict renal flare in patients with lupus nephritis.Furthermore,urinary MCP-1 is a more specific and sensitive forecaster of renal flare in patients with a history of lupus nephritis than urinary IP-10.