To explore the molecular mechanisms underlying the immunomodulatory effects of hypertonic sodium chloride and hetastarch 40 injection (HSH) resuscition on the development of lung inflammation in a hemorrhagic shock model, Sprague Dawley rats were subjected to hemorrhagic shock and intratracheal LPS,the so called two hit rodent model.The animals resuscitated by transfusion of either Ringer's lactate(RL) or a 6ml/kg volume of HSH were sacrificed at 1,2,4 hour after resuscitation,respectively. Surface expression of adhesion molecule CD11b on circulating polymorphonuclear (PMN) was measured by flow cytometry. Bronchoalveolar lavage fluid(BALF) neutrophil counts were determined.Lung tissue myeloperoxidase(MPO) activity reflecting total lung neutrophil infiltration was assessed by modified Bradly′ method. The results showed that resuscitation with HSH significantly reduced BALF neutrophil counts( P

Objective To investigate the application and clinical result of treatment soft tissue defect in the lower leg after severe trauma by using the reversed descending branch of the lateral circumflex femoral artery of the injured leg as the recipient artery for free flaps.Methods Twenty-three patients with soft tissue defect of the lower leg after severe trauma from February 2007 to October 2012 were retrospectively analyzed.The patients were treated with the free flaps (the latissimus dorsi flap or the anterolateral thigh flap) using the reversed descending branch of the lateral circumflex femoral artery of the injured leg as the recipient artery.There were 14 males and 9 females,with an average age of 31.7 years (range,22-49 years).The causes of injury were traffic accidents in 12 cases,crushing injury in 8 cases,and machinery injury in 3 cases.The defect located at the proximal in 4 cases,the proximal and middle in 12 cases,middle and distal in 7 cases.Sizes of the tissue defect were 14 cm×5 cm to 32cm×12 cm,and the flap sizes were 15 cm×7 cm to 34 cm×13 cm.The donor defect was closed directly or resurfaced with a splitthickness skin graft taken from the thigh.Results Twenty-three flaps survived completely.Partial necrosis at the distal edge of the flap occurred in one case,and was healed by secondary intention.No patient needed urgent operative revision due to postoperative thrombosis of the vessels.All flaps completely survived,without evidence of postoperative insufficiency of the blood supply or venous congestion.The donor skin graft survived and the incision healed by first intention.The mean follow-up period was 12.4 months (range,6-21 months).The appearance,texture,color and thickness of flaps in all cases were good at the last followup.The flap achieved protective sensation with the two-point discrimination ranging between 10-25 mm.Conclusion Due to the advantages of reliable blood supply,short treatment cycle,and without postoperative forced position,the reversed descending branch of the lateral circumflex femoral artery of the injured leg can be an ideal choice as the recipient artery for free flaps in repairing the soft tissue defect in the lower leg after severe trauma.

Objective To describe the technique and characteristics of simple hand-assisted laparoscopic resection of renal and adrenal. Methods A total of 37 patients (22 males and 15 females) underwent simple hand-assisted laparoscopic resection of renal and adrenal from June 1999 to April 2004.Their mean age was 52 years (range,25～65 years).Renal resection group included 29 cases,including 13 of renal carcinoma and 2 of renal pelvic carcinoma.All these 15 cases were staged as T 1N 0M 0.The average tumor volume of the renal resection group was 3 cm?3 cm?2 cm.8 of hydronephrosis,2 of renal tuberculosis,4 of renal atrophied.Adrenal tumor resection group included 8 cases;the average tumor volume was 4 cm?5 cm?6 cm. Results Simple hand-assisted laparoscopic resection of the tumors was performed successfully in 36 cases without any complication such as injury of intestines and other important abdominal viscera except 1 case who underwent open surgery.The mean operative time of nephrectomy was 145 min,and that of adrenal giant tumor resection was 125 min.The mean blood loss was 110 ml.The patients recovered well and were discharged 7 to 8 days after operation.Follow-up lasted 3 months to 5 years after operation.Of the 37 cases,35 survived healthily;2 with renal carcinoma died (1 died of cerebrovascular accident 2 years after operation and the other died of brain and pulmonary metastasis 3 years after operation). Conclusions Simple hand-assisted laparoscopic resection of renal and adrenal giant tumor has the advantages of easier performance,shortened operative time and faster recovery from operation.Thus,this technique is worthy of popularization.

Objective:To evaluate the results of repairing furcation and root perforation using Mineral Trioxide Aggregate(MTA).Methods:Cases with furcation perforations were divided into two groups randomly,MTA and IRM(control group)methods were adopted in present study.Cases that had root perforations were treated with MTA.Pretreatment,immediate posttreatment,and 1year follow-up radiographs were evaluated in a double-blind manner to determine the presence or absence of any pathologic changes adjacent to the perforation site.Results:21 cases were involved.The healing rate of furcation perforation in MTA group was higher(80%)when compared with that in IRM group(75%).However,statistical analysis showed no significant difference in success rates between both groups(P=0.722).The healing rate of root perforation using MTA was 100%.Conclusion:MTA provides an effective seal of furcation /root perforations,and promises in improving the prognosis of perforated teeth.

Objective To study X-ray and CT findings of retroperitoneal fibrosis and their value for diagnosis of this disease.Methods X-ray and CT findings and clinical data of 5 cases confirmed with retroperitoneal fibrosis by clinicopathology were retrospectively analysed in combination with literature review.Results X-ray and CT manifestations of retroperitoneal fibrosis included diffuse mass at retroperitoneum,the neighboring organs were enveloped by masses,and one or bilateral renal pelvis and the ureter expansion.Conclusion X-ray and CT have vital clinical significance in diagnosing the retroperitoneal fibrosis.

Objective To determine the effects of isoflurane on the amino acid neurotransmitter contents in rat cerebral cortex, hippocampus and spinal cord. Methods Sixteen male SD rats weighting 220-280g were randomly divided into two groups: isoflurane group (A) and control group (B). Animals in group A were killed after 30min inhalation of 1.3% isoflurane and cerebral cortex, hippocampus and spinal cord were removed immediately for determination of glutamic acid (Glu), aspartic acid (ASP), glutamine (Gln), GABA and glycine (Gly) levels by high-performance liquid chromatography (HPLC), whereas in group B O2 was inhaled instead of isoflurane. Results As compared with control group, Asp and Glu levels in cerebral cortex and hippocampus decreased markedly while Gly level increased significantly in hippocampus and spinal cord in isoflurane group. Conclusions The inhibition of excitatory amino acid synapse transmission and augmentation of inhibitory amino acid synapse transmission may be involved in the mechanism of isoflurane anesthesia.

Objective To investigate the expression of NF-κB and epithelial-mesenchymal transition (EMT) related markers E-cadherin and Vimentin proteins in human pancreatic cancer tissues and its relation with the malignant features. Methods The expression of NF-κB、E-cadherin and Vimentin proteins in 62 cases of pancreatic cancer tissues were detected by using immunohistochemistry and compared with the clinicopathological data of pancreatic cancer. Results The positive expression rate of NF-κB was 81% (50/62), Vimentin protein increased of expression was 61% (38/62), and E-cadherin protein loss of expression was 55 % (34/62) in pancreatic cancer. The positive expression rate of NF-κB was significantly related with the lymph node metastasis (x2=11.761, P＜0.05), distant metastasis (x2=9.225, P＜0.05), the absent expression of epithelial marker E-cadherin protein (r =0.352, P ＜0.05) and the positive expression of mesenchymal marker Vimentin protein (r=0.343, P ＜0.05), but there was no relation with the patients gender,age, tumor location, tumor type and tumor differentiation (P ＞0.05). In addition, the significant correlation of E-cadherin expression loss and Vimentin expression with tumor lymph node metastasis and distant metastasis was found (x 2= 6.914, 4.984, 7.753, 5.144, P ＜0.05). Conclusion The overexpression of NF-κB in pancreatic cancer may accelerate invasion and metastasis of pancreatic cancer through inducing EMT.

OBJECTIVETo explore the effect of dorsalis pedis parallel flaps in repairing perforating skin and soft tissue defects of the palms.

METHODSEighteen patients with perforating skin and soft tissue defects of the palms were hospitalized from July 2008 to November 2010. The area of skin defect ranged from 2.0 cm x 1.5 cm to 5.0 cm x 2.5 cm. The dorsalis pedis parallel flaps were used to repair these defects, with the area ranging from 2.0 cm x 2.0 cm to 5.5 cm x 3.0 cm. The donor sites were covered with autologous full-thickness skin from inner thigh.

RESULTSAll the 18 flaps and skin grafts of donor sites survived completely. Seventeen patients were followed up for 6 to 23 months, with mean time of 10 months, and one patient was lost to follow-up. The texture, elasticity, and appearance of all the 17 flaps were satisfactory, with no obvious pigmentation or cicatricial contracture. At the last follow-up, the distance of two-point discrimination of flaps ranged from 6 to 9 mm, with mean distance of 7.4 mm, and the sensation of flaps reached S3 in 13 patients who had nerve anastomosis.

CONCLUSIONSThe dorsalis pedis parallel flap, with reliable blood supply and flexible design, is a good choice for repairing perforating skin and soft tissue defects of the palms.

Contracture ; Foot ; surgery ; Hand Injuries ; surgery ; Humans ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Skin ; Skin Transplantation ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; blood supply ; Treatment Outcome ; Wound Healing ; Young Adult

Objective To explore the influence of HepG2 cells' proliferation and autophagy by the Nrf2-ARE pathway,and provide the experimental basis for clinical exploring effective liver cancer treatment.Methods Hepatic carcinoma HepG2 cells were cultured,and its proliferation inhibition rates and the change of cell cycle' s in each phase were explored by the MTT assay and flow cytometry.The hepatoma cells' autophagy was qualitative observed by inverted phase contrast microscope and fluorescence microscope.Results Inhibitory rate of HepG2 cells was obviously higher in the Nrf2 inhibitor BML-111 group than control group (P ＜ 0.05),and the control group was aslo obviously higher than the Nrf2 inducer EGb group (P ＜ 0.05).Flow cytometric analysis showed that G1 phase cells in the cell cycle increased,S phase cells reduced and G2/M period cells relatively increased in the Nrf2 inhibitor BML-111 group.But G1 phase cells reduced,S phase cells increased and G2/M period cells relative reduced in the Nrf2 inducer EGb group.Inverted phase contrast microscope and fluorescence microscope checked that ranging from the size of the bubble and autophagosome formed in Hepatoma HepG2 cytoplasmic of the Nrf2 inhibitor BML-111 group.Conclusions The Nrf2-ARE pathway played an reverse inhibition on HepG2 cells' proliferation and autophagy.After the inhibition of Nrf2-ARE pathway,HepG2 cells mostly stayed in the G1 phase of the cell cycle.

Objective To study the out come of coblation arytenoidectomy combined with true and false pos-terior cordectomy for treatment of bilateral vocal cord paralysis (BVFP) .Methods The group included 17 patients (8 incomplete BVFP and 9 complete BVFP) .All the patients had waited more than 6 months before surgery with no spontaneous recovery .The patients underwent arytenoidectomy combined with true and false posterior cordecto-my using coblation under video suspension laryngoscope .Electric fibrolaryngoscope was performed before and after operation to evaluate the size of the glottis .The patients'voices were recorded before and after operation and evalua-ted by 3 laryngologists through GRBAS .Results Preoperational laryngoscope showed that in the incomplete BVFP ,the vocal folds were close to the middle line with limited abduction .In the complete BVFP ,the vocal folds failed in adduction and abduction and the size of the glottis was 2 -3mm .3 of the patients had underwent tracheotomy . Post operational electric fibrolaryngoscope showed proximate triangulate breathing space which was more than 4mm in the posterior glottis .The patients were followed up 6 to 44months .15 of the 17 were allowed for decannulation . One patient among them underwent posterior cordectomy and arytenoidectomy on the contralateral side respectively after the first operation because of dyspnea owing to scar diathesis .Two patients bunged up the canula but did not de-cannulate .Among them one was a 8-year old boy diagnosed as congenital heart disease .One was thyroid cancer with stiff neck due to radiology .The only postoperative complication was the appearance of granulations in the operation region in 2 patients ,which were disappeared spontaneously .Quality of the voice improved in 2 patients ,unchanged in 10 and worsened in 5 .Conclusion This study demonstrates that arytenoidectomy associated with posterior cord-ectomy is a satisfactory surgical treatment of bilateral vocal fold paralysis because it leads to a considerable and stable enlargement of the breathing space and preserved the voice quality .