Objective To investigate the cause and nursing of the abdominal incision dehiscence.Methods The clinical data of 18 cases of abdominal incision dehiscence after surgery were analyzed retro-spectively from January 1998 to June 2008 in our hospital.Results Abdominal wound dehiscence was caused by various factors,such as basic disease,anesthesia during operation,suture techniques and postop-erative care.Conclusions We should pay attention to the relevant factors of incision dehiscence and make the appropriate care and treatment when patients are admitted to hospital.Correction of malnutrition,strengthening the treatment of basic disease,attention to suture technique ale helpful for reducing the inci-dence of abdominal incision dehiscence.

Normal cells have limited proliferation ability.After certain cycles of proliferation,they will lose the response ability to growth factors and finally cease division and start the course of aging. In current opinion,lacking of the terminal end of a chromosome(telomere)is the cause for cells to loss the proliferation ability and leads cells to aging and death.The human telomerase catalytic subunit 1(hTERT)can activate telomemse which prolong DNAs of the terminal end of chmmosome and help cells gain genomic stabilization.The discoveries of telomere,telomerase and hTERT provide new idea for studying of cell aging and the findings are also applied in the establishment of immortal cell line. Also they may play an important role in the studv of biological feature of seed cell in tissue engineering and the establishment of cell bank.

[Objective]To explicate whether the telomerase activity is regulated by human telomerase reverse transcriptase (hTERT) in human bone marrow mesenchyme stem cells(hBMSC).[Method]hBMSC were cultured and transfected with eukaryotic expressing plasmid pCIneo-hTERT encoding hTERT. After selection with G418 to stabilize the transfection,expression of hTERT mRNA was detected with TR-PCR, detecting the expression of hTERT protein was detected with Western Bolt, and the telomerase activity in untransfected and transfected cells were detected by RT-PCR.[Result]The hMSCs grew well after transfecting plasmid pCIneo-hTERT.The cells began to suspend and die after the day of the G418 selection. At the tenth day,all the untransfected cells were dead, but the transfected cells began to clone proliferation. So the density of G418 subdued to 100 ?g/ml for maintaining selecting, at the twentieth day,there were obvious anti-G418 cell clones. After stable transfection, hTERT was expressed at mRNA and protein level in these anti-418 cell clones, and meanwhile telomerase activity was positive and obviously raise up in these transfected cells.[Conclusion]In human' bone marrow mesenchyme cells,telomerase could be activated by exogenous hTERT. This is a foundation to establish immortalized human bone marrow mesenchyme stem cell line.

Objective To describe an alternative procedure of arthroscopic double-bundle posterior cruciate ligament (PCL)reconstruction using deep-frozen fresh allogenic achilles tendon and evaluate the follow-up outcome in early stage. Methods The ruptured PCL was reconstructed under arthroscopy using deep frozen fresh allogenic achilles tendon preparing in Y-shaped allografts, one bundle was used for anterolateral bundle, the other for posteromedial bundle. Absorbable screw was used to fix the soft tendon graft and metal screw was used to fix the bone graft. Results From March 2003 to August 2004, the procedure of arthroscopic double-bundle PCL reconstruction using allogenic achilles tendon was applied in 10 cases. The average follow-up period was 13.2 months(6～24 months, among them 6 cases were more than 12 months ). 2 cases with anterior cruciate ligament (ACL) injury were also reconstructed with hamstring tendons (semitendinosus and gracilis). 3 cases with rupture of postolateral horn of knee joint were anatomically reconstructed with hamstring tendons. Clinical results were carefully compared using the Lysholm score system before and after the operation, the average score was 50.3 preoperatively, and 91.2 postoperatively. The objective examination showed that the tibia post-migrating sign, posterior drawer test and Lachman test were positive in all the 10 cases preoperatively; whereas the posterior drawer test and Lachman test were negative postoperatively; the tibia post-migrating sign were weak positive in 3 cases with longer clinical histories(more than 1 year); the flexion range of the knee were slightly restricted (5?～20?) in the 2 cases with simultaneous ACL injury. Conclusions Allogenic achilles tendon is an ideal material for arthroscopic double-bundle PCL reconstruction. Arthroscopic double-bundle reconstructed PCL is in accordance with the anatomy and physiology of natural PCL. The injury and complications caused by the autograft can be alleviated. The allograft can be prepared in advance and the soft end of the implant can pass through the bone tunnel easily, and thus the operaton time under arthroscopy can be saved and the trauma caused by arthroscopy is abated. Arthroscopic double-bundle PCL reconstruction is sample, safe and effective.

Objective To introduce the method of two bundle anatomical reconstruction of the posterolateral corner(PLC) of the knee using auto-harmstring,and to evaluate the short-term clinical outcomes.Methods Using auto-harmstring,23 knees of 21 cases with acute or chronic posterolateral complex injuries were anatomically reconstructed from March 2003 to November 2005.There were 20 male and 1 female patients(mean age:32.3 years,ranging from 17 to 47 years)in this study with follow-up of at least 12 months(average:26.7 months,ranging from 12 to 31 months.Tow cases had isolated PLC injuries,21 knees had multiligamentous injuries,and 5 cases associated with meniscus injuries.The technique used includes:(1)an autogenous semitendinosus placed through trastibial bone tunnel from posterior to anterior and then turned to transfibulur bone tunnel to reconstruct the popliteus and popliteofibular ligament;(2)an autogenous gracilis tendon placed through transfibulur bone tunnel to reconstruct the fibulocolateral ligament(FCL).The transplanted grafts were secured to the femoral insertion of the popliteus and FCL respectively with metal or bioabsorbable interference screw.All patients were followed-up prospectively with clinical examinations and Lysholm knee scores.Results There was no varus knee instability in full extension,and one-grade varus instability with firm endpoint was found in 2 cases at 30? flexion.There was no increased external rotation in all of the 23 knees at 30? flexions(in prone position).Mean Lysholm knee scores were 89.2(range from 88 to 100).Conclusions Two bundle anatomical reconstruction of the PLC of the knee using auto-harmstring yields a stable knee with excellent function,mini-trauma,and reliable fixation of grafts,this technique is an ideal method for the treatment of PLC injuries.

Objective:To explore the possibility and methods of surgical treatment(ST) for huge primary liver cancer(HPLC).Methods:The clinical data of 86 HPLC were analyzed retrospectively and the main challenges as well as their counter measures during ST are concluded.Results:Among the 86 cases,there were 10 cases which complicated with portal vein(PV),and 5 cases with IVC thrombus respectively;there were 76 cases with HBV cirrhosis,2 HCV cirrhosis,there were 60 and 26 cases of primary and secondary hepatectomy in which included regular right(9 cases),left hemihepatectomy(8 cases)and combined hepatectomy(69 cases).Six cases received PV embolism before surgery.There were 10 and 5 cases of cancer thrombus extraction from PV and IVC respectively.In this group,81 patients were cured,and the perioperative mortality was 5.8%(5/86).The postoperative one—year survival rate for the patients was 77.9%.Conclusions:ST for HPLC is safe and acceptable.Full of preoperative assessment,careful intraoperative exploration,and surgical skill played a key roles.

Objective:To determine the inflammatory factor levels and inflammatory cell percentages in the patients with cough variant asthma (CVA ), and to clarify their potential role in the pathogenesis of CVA unresponsive to bronchodilator treatment.Methods:60 patients with CVA were randomly selected and divided into CVA unresponsive to bronchodilator treatment group (n=30)and CVA responsive to bronchodilator treatment group (n=30).As the same time 30 cases of healthy persons were used as normal control group.The levels of interluekin-8 (IL-8)and esoinophil cationic protein (ECP)in their induced sputum were detected,the classification of inflammatory cells in their induced sputum were observed, and their scores of cough symptom were recorded. Results:The IL-8 level in the induced sputum of the patients in CVA unresponsive to bronchodilator treatment group was higher than that in CVA responsive to bronchodilator treatment group and normal control group (P<0.05).The ECP level in the induced sputum of the patients in CVA unresponsive to bronchodilator treatment group was lower than that in CVA responsive to bronchodilator treatment group (P<0.05),but it was similar to the level in normal control group (P>0.05).The neutrophil percentages in the induced sputum of the patients in CVA unresponsive to bronchodilator treatment group were higher than those in CVA responsive to bronchodilator treatment group and normal control group (P<0.05).The scores of cough symptom of the patients in CVA unresponsive to bronchodilator treatment group was positively correlated with IL-8 level (r=0.764,P<0.01), and the scores of cough symptom of the patients in CVA unresponsive to bronchodilator treatment group was positively correlated with the neutrophil percentage in induced sputum (r=0.889,P<0.01).Conclusion:IL-8 and neutrophil may be associated with the incidence of CVA unresponsive to bronchodilator treatment. They can aggravate the inflammation and hypersensitivity of airway and cough symptom. The determination of IL-8 and neutrophil can be used as an accessory method in the diagnosis and j udgement of severity degree and curative effect of CVA in clinic.

[ABSTRACT]OBJECTIVETo evaluate the clinical value of ultrasound guided fine-needle aspiration (US-FNA) in the diagnosis of thyroid nodules with different size.METHODSThe clinical data of 122 thyroid nodules of 109 cases referred to FNAC for diagnosis were retrospectively reviewed. The final operating histological results of 122 nodules were considered gold standard. RESULTSNon-diagnostic FNAC results occurred in 17 nodules (13.9%). FNAC achieved a sensitivity of 78.6%, a specificity of 93.9%, a positive predictive value of 93.6%, a negative predictive value of 78.3%, and a total accuracy of 85.7%. There was no significant difference between the diameter of the nodule≤1 cm group and>1 cm group, except negative predictive value. The non-diagnostic results rate was no significant difference between groups of different nodule size, benign or malignant nodules, and different operators. CONCLUSIONFNAC is a sensitive, specific and accurate method for differential diagnosis of thyroid nodules.

Objective To introduce 13 clinical cases of reconstructing traumatic defect on skin of thumb and first web using nail skin flap of big toe connectedwith tibial flap of second toe.Methods From May 2003 to April 2007,a series of 13 case8 of traumatic thumb and first web defect were treated by transplantation of nail skin flap of big toe connecting with tibial skin flap of second toe.Among which two total hand degloving injury cages were included too.Two kind of way according the Gilbert type of the Ist metatarsus dorsal artery were used.Results All the cases were successful and healed by first intention.The contour of reconstructed thumbs showed to be normal or approximately normal.Follow-up examination were obtained in nine cases for 3-17 postoperative months(average 7 months).Sensations of pain,touch and temperature recovered.The two-point-discrimination sensation were found to be 7-17 mm respectively.Opposition measured were 60°-85°(average 75°).All the patients can be back to work and restored activities of daily living.Conclusion In treating soft tissue defect of thumb and first web,transplantation of the nail skin flap of big toe connecting with tibial lateral skin flap Can yield ideal skin covering and exceHent motor function.