Objective To discuss the clinical application and therapeutic effect of repairing deformed thumb in the way of transposition of abandoned polydactyly with neurovascular bundles.Methods From January 2005 to December 2011,six cases of type Ⅳ deformities of thumb duplications were treated with excision of thin and deformed thumb phalangette of trunk,the redundant hyperdactylia,which was well-formed and involved in the first web space,was then transposed with neurovascular bundles to the thumb phalangette of trunk by the first web space and the side of thumb for fixation followed by repairation of form of thumb phalangette.The surplus metacarpal bone and phalanx of duplications were removed and the first web space was reconstructed.Results All 6 cases of heterotopic thumb phalangette transplanted to the deformed thumb phalangette were completely survived.Kirschner wires were removed 4 weeks after operation.Fracture healing occured after 4 to 6 weeks after operation.Postoperative follow-up period ranged from 3 months to 1 year.Transplanted thumbs possessed well-formed appearance with previous sensation on the finger pulp as well as excellent function of grabbing and opposing.Conclusion To repair deformity of trunk thumb in the way of microsurgery by means of transposition of duplicated thumb with neurovascular bundle which should be abandoned,is a simple operation with satisfactory and reliable postoperative effect.It shall be spred and applied.

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.

Objective To investigate the effects, and possible mechanism of action, of vasoactive intestinal peptide (VIP) on acute lung injury in a rodent model of endotoxic shock. Method Endotoxic shock was induced in Sprague-Dawley (SD) rats by intravenous injection of lipopolysacchaiide (LPS) at 10 mg/kg. Three groups (each group with 10 rats), were given injections of either normal saline (Control), LPS 10 mg/kg (LPS group), or LPS 10 mg/kg + VIP 5nmol (VIP). Samples were collected 6 hours after injection. Indices of lung injury including lung wet/dry weight ratio, protein concentration and neutrophil count in bronchoalveolar lavage fluid( BALF) were derived. Assays of TNF-α,IL-1β, IL-10 in serum and BALF were performed using ELISA. Light and electron microscopy were used to detect histopathological changes in lung tissues. Results The lung wet/dry weight ratio, protein concentration and neutrophil count in BALF were significantly raised in the LPS group compared to the Control group (P ＜ 0.05). These indices were significantly lowered in the VIP group compared to the LPS group, though not to the level of the control group. Concentrations of TNF-α, IL-1β, IL-10 in serum and BLAF also increased in the LPS group compared to the control group (P ＜ 0.0S). Levels of TNF-α and IL-1β were significantly lowered in the VTP group compared to the LPS group (P ＜ 0.05), while levels of IL-10 was significantly raised ( P ＜ 0.05). Histopathological changes due to lung injury were not as severe in the VIP group compared to the LPS group. CondusKms VIP plays a protective role during acute lung injury induced by endotoxic shock in rats. Its mechanism of action may be related to down-regulation of proinflammatory cytokines and up-regulation of anti inflammatory cytokines.

Objective To present some revision surgery for correcting short and bulky outward appearance of reconstructed finger pulp in toe-to-hand transfer. Methods Since Sep. 1998 to Dec. 2006,in a series of 33 patients, 39 fingers had been reconstructed with 2nd toe. In order to change the shape of bulbous distal toe segment into a normal tapering fingertip, revisional operations had been designed, i.e. (1)Excision of bulky skin and excessive soft tissue from one or both sides of the finger pulp. (2)Transfer and inlaid the excised lateral soft tissue flap to the central constricting part of the finger pulp. (3)Full thickness skin graft to palmar central narrow part of toe pulp. 4. Rotational transfer of local lateral "L" shape flap. Results All the patients healed by first intention with no skin necrosis occurred. The bulbous rectangular shaped toe pulp were corrected and outward appearance were much improved in most cases. Though the outward appearance in one simple skin graft case was not satisfactory in correcting flexion deformity of distal segment and increased its circumference. Conclusion In toe-to-hand transfer, the distal segment of reconstructed finger often shown to have an bulbous toe pulp appearance, which may bring psychological burden to the patient and their relatives. Simple revisional surgery recommended here may yield favorable improvement.

Objective: To investigate the relationship between type 2 diabetes mellitus (T2DM) and the pathogenesis and metastasis of colorectal cancer. Methods: A case-control study was performed to compare 852 colorectal cancer patients with 940 controls (patients without cancer) recruited from 2001 to 2006, with respect to their sex, cancer subsite, the course of T2DM, hepatic metastasis, smoking and drinking. Correlated risk factors were analyzed. Results: The risk of colorectal cancer was increased in patients with T2DM and the relative risk (OR) was 2.466. The OR of male patients was higher than that of female patients, but with no significant difference (2.775 vs 2.070, P=0.394). The incidence of T2DM in patients with left hemicolon cancer was higher than that in those with right hemicolon cancer and rectal cancer, but with no significant difference between them. The colorectal cancer risk in T2DM patients with a DM course of 10 ～ 20 years was the highest, and the OR was 4.696. The rate of hepatic metastasis was higher in T2DM patients with colorectal cancer than that in celorectal cancer patients without T2DM and the OR was 2.888. Conclusion: T2DM may be one of the important pathogenic risk factors for colorectal cancer. The OR is increased with the extension of DM course within 20 years. Colorectal cancer patients with T2DM may be more prone to hepatic metastasis.

Objective To investigate the effects and possible mechanism of action of inhibiting hepatitis B virus X protein (HBx) expression on liver cancer metastasis. Methods The suppression of HBx expression in MHCC97H cells was performed by siRNA interference technique, and the effects of HBx suppression on the metastasis of MHCC97H cells were detected by Matrigel invasion assays and in a lung-metastasis mouse model. The expression levels of related epithelial-mesenchymal transition (EMT) and apoptosis proteins were examined by Western blotting. Results Introduction of HBx-siRNA into MHCC97H cells inhibited the expression of HBx and the ability to metastasize,downregulated the expression of Twist and N-cadherin, and upregulated E-cadherin expression. These changes resulted in inhibiting EMT of MHCC97H cells. Meanwhile, apoptosis involved in the Twist-P53 pathway was also found. Conclusions Inhibiting expression of HBx can decrease the metastatic a-bility of MHCC97H cells by changing EMT and inducing apoptosis.

This paper reports a simple method using the mesentery as a naturai mountingsubstrate for the study of mesenteric free cells under the scanning electron micros-cope.Mouse mesentery was cut into pieces about Ⅰ square centimeter in size andadhered on to neutral filter paper.The specimen were fixed in 5% glutaraldehyde and1% osmium tetroxide for 20 minutes,each step washed lightly with pH 7.4 PBS,dehydrated with ascending series of alcohol,put into amyl acetate,critical pointdried with CO_2,coated with gold and examined in scanning electron microscope.The morphologic features of free cells in the peritoneal lumen,such as polymorpho-nuclear leucocytes,macrophages and lymphocytes could be observed satisfactorily.We studied in particular the relationship between immunoreactive cells and targetcells(fetal liver cell)injected into the peritoneal cavity,Polymorphonuclear leuco-cytes could be seen invading into and eroding the target cells and macrophage cau-sing their swelling and lysis.Cooperative action of immunoreactive cells and anincrease in number of milk spots were also observed.

ObjectiveTo observe the influence of treating course on the lipid-regulating effect of Xuezhikang and Simvastati.MethodsTwo hundred and two patients with unstable angina pectoris(UAP) were randomly enrolled and divided into Simvastatin group(n = 98)and Xuezhikang group(n = 104).The TC, TG,LDL-C, HDL-Clevelsweremeasuredbeforethe treatment and atthe3rd, 6thmonthafter the treatment.According to the suitable threshold of blood lipids in normal Chinese people, the patients who had abnormal blood lipids were picked out from the two groups for the further observation.ResultsThe lipidregulating effects of Simvastatin and Xuezhikang were showed up at the 3rd month, and the effective rate were 40.6％ and 60.9％ for TC regulation,51.2％ and 84.5％ for LDL-C regulation,22.2％ and 61.5％ for HDL-C regulation.We found significantly better effects of Xuezhikang than that of Simvastatin(x2 = 6.38,17.05,4.04;P ＜ 0.05, P ＜ 0.01, P ＜ 0.05) .However, at the 6th month the effective rate of Simvastatin and Xuezhikang were 89.9％ and 95.4％ for TC regulation,89.1％ and 97.2％ for LDL-C regulation,83.3％ and 84.6％ for HDL-C regulation, which showed no significant differences (x2 = 1.81,3.57, 0.01 ; Ps ＞ 0.05).The effective percentages of reduced TG level of Simvastatin and Xuezhikang were 9.5％ and 24.5％ at the 3rd month,51.4％ and 68.4％ at the 6th month, which showed significant differences (x2 = 6.45,5.13 ; Ps ＜ 0.05) between the two groups at both time points.Conclusion The lipid-regulating effects of Xuezhikang and Simvastati were influenced by the treating period.Xuezhikang shows lipid-regulating effect more quickly ,and it is recommended in treating CHD patients,especially for the patients with hypertriglyceridemia.

Objective To explore the effects of one time loading of different doses of simvastatin before percutaneous coronary intervention (PCI)on post-PCI inflammation,oxidation stress and the endothelium function in (ACS) patients. Methods Totally 124 cases with ACS were randomly divided into two groups:high dose simvastatin group(40 mg,62 cases),low dose simvastatin group (20 mg,62 cases). Each group was given the same basic treatment. Blood samples were obtained from all the patients before and 12 h after PCI,and endothelin-1 (ET-1),nitric oxide (NO),interleukin-10(IL-10),high sensitive - C reactive protein(hs-CRP),superoxide dismutase (SOD) and malondialdehyde(MDA) were detected. Results The baseline information,distribution of sex,age,and implanted frames had no significant differences between the two groups (P＞0.05).Before PCI,the levels of ET-1,NO,IL-10,hs-CRP,SOD and MDA had no significant differences (P＞0.05) between the two groups.After PCI,ET-1,IL-10 and hs-CRP levels in simvastatin 40 mg group were significant lower while NO level was higher than in simvastatin 20 mg group[(4.4 ± 1.1)ng/L vs.(4.8±1.2)ng/L,t=2.03,P=0.044; (15.0±6.3) ng/L vs.(18.7±9.0)ng/L,t=2.68,P=0.008;(26.9±10.0)ng/L vs.(31.5± 11.7)ng/L,t=2.52,P =0.022;(51.9± 10.9)μmol/L vs.(47.1±11.8)μmol/L,t=2.37,P=0.020].There were no significant differences in MDA and SOD levels between the two groups.For safety,all the patients had no abnormality in liver and kidney function after treatment. Conclusions Compared with 20 mg simvastatin loading before PCI,the 40mg simvastatin loading may decrease the inflammatory cytokines and improve the endothelium function more effectively.

Objective To investigate the efficacy of continuous veno-venuous hemodialysis/filtration(CVVHD/F) for the treatment of multiple organ dysfunction syndrome(MODS)caused by severe infection and to explore the mechanism in children.Method Nineteen cases of pediatric septic shock with MODS were treated with CVVHD/F in Children's Hospital Affiliated to Shanghai Jiaotong University from December 2002 to November 2007.The clinical data were studied including mortality rate,serum electrolytes,arterial partial pressure of oxygen (PO2),artery partial pressure of carbon dioxide(PCO2),FiO2/PO2,urine output,blood pressure,doses of vasoactive agents,Cr,BUN,etc.Results Cannulation and CVVHD/F were well performed in a total of 19 cases,with median age 33.4±36.5 months(from 3 months to 8 years) ,with their gender ratio of male(13 cases)to female (6 cases) to be 68.4% and 31.6%.The mean pediatric crifcal illness score(PCIS) was 69.1±10.4 and Median Pediatric Risk of Mortality score(PRMS Ⅲ)12.66±7.85,respectively.The duration of CWHD/F was 92 hours(ranged from 16 hours to480 hours).FiO2/PO2,PCO2,and PO2 were iraproved significantly after 12 to 24 hours CVVHD/F in patients with acute respiratory distress syndrome(ARDS) or lung edema (P<0.05).The concentrations of serum kalium,natrinm and HCO3- level resumed to well-balanced in 24 hours (P<0.05).The serum Cr and BUN were decreased to normal range(P<0.05).The mortality rate was 63.2%.Conclusions CVVHD/F was effective for treatment of septic shock with MODS in pediatric by improving oxygenation,maintaining normal serum electrolytes,conecting metabolic acidosis,increasing the tissue perfusion and eliminating the serum Cr and BUN.