Objectve To probe the effect of treating the trauma soft tissue defects of the leg by microsurgical technique. Methods Ninety-nine cases of the trauma soft tissue defects of leg were treated by used 12 kinds of microsurgical flaps.Result All cases with soft tissue defects of the leg were repaired successfully.Follow-up 6 months to 10 years,the results were satisfactory and function improvement in 99 cases. Conclusions Accoding to soft tissue defects of size,the section and the technique of the operator to select the different microsurgical flap could be suitable and resolvable problem of soft tissue defects.

Objective To analyze the causes of clinical misdiagnosis of solid pseudopapillary tumor of pancreas (SPTP),and recommend the countermeasures with a combination of pertinent literature.Methods The clinical data of 10 cases of SPTP with misdiagnosis were retrospectively analyzed.There were 9 women and 1 man,and the average age was 29.3 years old.The clinical symptoms were nonspecific.Results All patients received surgical treatment,and the correct diagnosis was made according to the pathology after surgery.All patients were followed up,and no recurrence or metastasis was found.Conclusions SPTP is a rare disease in clinic.Sufficient understanding in the clinical features and imaging characteristics can improve the rate of diagnosis before operation.

Objective To investigate the beneficial effects of cyclosporin A ( CsA) on traumatic hemorrhagic shock in rats. Methods The traumatic hemorrhagic shock model was adopted in 144 SD rats which were divided into 6 groups: sham-operated group,shock control group,lactated Ringer's solution ( LR) group,CsA 1 mg/kg,5 mg/kg and 10 mg/kg group. The effects of three doses of CsA on the animal survival time and 24 h survival rate were observed,and the effects of CsA on hemodynamic parameters,including mean arterial blood pressure ( MAP) ,left intraventricular systolic pressure ( LVSP) ,left ventricular end-diastolic pressure ( LVEDP) ,maximal change rate of left intraven-tricular pressure ( ± dp/dtmax ) and heart rate ( HR) were also observed. Results CsA at the concentration of 5 mg/kg and 10 mg/kg can significantly increase the survival time and 24 h survival rate of shock rats,the survival rate was increased to 56. 3% from 25% of LR group. After shock,the hemodynamic parameters were significantly decreased including MAP,LVSP and ± dp/dtmax ,LR infusion only improved the hemodynamics to some extent,which were significantly lower than those in sham-operated group. CsA (5 mg/kg and 10 mg/kg) can signifi-cantly improve the hemodynamics of shock rats including LVSP and ± dp/dtmax ,which were increased at 2 h after resuscitation as compared to LR group,and return to about normal levels. 1 mg/kg of CsA also restored the hemodynamic parameters, but there were no significant differences between CsA 1 mg/kg group and LR group. Conclusion CsA has good beneficial effect on traumatic hemorrhagic shock,and 5 mg/kg and 10 mg/kg of CsA showed a better effect.

Objective To investigate the effects of calcium sensing receptor (CaSR)on vasorelaxation/vasoconstriction of superior mes-enteric artery (SMA)in rats and its relationship to endothelium.Methods With endothelium-intact and endothelium-denuded SMA rings of rats,the effects of CaSR-specific allosteric modulator cinacalcet on the SMA rings pre-contracted with norepinephrine (NE),and vascular contractile response /relaxation reactivity were observed.Results Cinacalcet had no effects on resting tension of SMA rings with or without endothelium.Cinacalcet caused a significant relaxation in the endothelium-intact SMA rings pre-contraction with NE in a dose-dependent manner.Endothelium denudation abolished cinacalcet-induced vasorelaxation.Pretreatment with cinacalcet for 30 minutes decreased the con-tractile response of endothelium-intact SMA rings to NE,but had no significant influence on relaxation reactivity.In the endothelium-denuded SMA rings,cinacalcet did not affect both vasoconstriction and vasorelaxation.Conclusion CaSR plays an important role in the regulation of the vascular reactivity,and this effect is endothelium-dependent.

Objective To investigate platelet-derived growth factor ( PDGF ) protection on blood flow and mitochondrial function of hemorrhagic shock rats. Methods Ninety-six SD rats were randomly divided into six groups including shock group, lactated ringer's solution (LR) resuscitation group,PDGF treatment groups(1,3. 5,7,15μg/kg). Laster-Doppler and oxygen concentration determination method were applied to observe the protective effect of PDGF treatment on animal survival,blood flow and mitochondrial function in liver and kidney. Re-sults As compared with LR resuscitation group,PDGF treatment increased animal survival rate and also improved blood fiow of liver and kindy,mitochondrial respiration control ration(RCR),of which the group with 3. 5μg/kg had the best result. Conclusion This finding sug-gests that PDGF may be a potential agent to treat acute critical such as hemorrhagic shock.

Objective To investigate the effects of arginine vasopressin (AVP) combined with norepinephrine (NE) in treatment of uncontrolled hemorrhagic shock (UHS) in rats.Methods UHS models were produced in rats and divided into three groups according to the random number table,which were resuscitated with LR equivalent to 1/2 (17.5 ml/kg) of shed blood,LR equivalent to 1/4 (8.75 mL/kg) of shed blood and without LR respectively.Each group was subdivided into six groups:AVP1 (0.04 U/kg) group,AVP2 (0.4 U/kg) group,NE (3 μg/kg) group,AVP1 + NE group,AVP2 + NE group and LR control group,with 10 rats per group.Effects of single AVP or NE infusion or combined infusion respectively grouped with different doses of LR on survival time and hemodynamics of UHS rats were observed.Results Compared with AVP,NE and AVP + NE groups without LR or with LR equivalent to 1/2 of shed blood respectively,AVP2 + NE group with LR equivalent to 1/4 of shed blood provided better main artery pressure (MAP),prolonged survival time and enhanced 4-hour survival rate in treatment of UHS rats.Moreover,survival time and 24-hour survival rate were increased significantly and hemodynamic parameters like MAP,left intraventricular systolic pressure (LVSP) and maximal change rate of left intraventricular pressure (± dp/dt max) were improved after hemostasis.Conclusion AVP (0.04 U/kg) + NE (3 μg/kg) infusion with LR equivalent to 1/4 of shed blood prior to hematosis can win the time for definitive treatment and improve the treatment outcome.

Objective To systematically evaluate the effect of preoperative transarterial chemoembolization (TACE) on perioperative safety of patients with resectable hepatocellular carcinoma (HCC).Methods Literatures were researched using Chinese Journal Full-text Database,Wanfang database,VIP database,PubMed,Medline from December 1,1994 to May 30,2016 with the key words including “肝细胞癌,肝切除,术前化疗栓塞,经动脉化疗栓塞,liver cancer,hepatocellular carcinoma,liver resection,hepatectomy,transcatheter arterial chemoembolization,transarterial chemoembolization,preoperative” Manual retrieval was also conducted simultaneously.The randomized controlled trials (RCTs) about TACE on perioperative safety of patients with resectable HCC were received and enrolled.Patients undergoing surgery after preoperative TACE were allocated into the case group and patients undergoing first-stage resection were allocated into the control group.Two reviewers independently screened literatures,extracted data and assessed the risk of bias.Count data were described as relative risk (RR) and 95％ confidence interval (CI).Measurement data were represented as standardized mean difference (SMD) and 95％CI.The heterogeneity of the studies was analyzed using the I2 test.Results Five RCTs were enrolled in the Meta analysis,and the total sample size was 430 cases including 212 in the case group and 218 in the control group.Results of Meta analysis showed that there was no statistically significant difference in the hemihepatic resection rate between the 2 groups (RR=0.99,95％CI:0.81～ 1.20,P＞0.05).The combined resection rate of perihepatic organs in the case group was significantly higher than that in the control group (RR=3.42,95％CI:1.91-6.12,P＜0.05).Results of subgroup analysis showed that operation time and incidence of postoperative complications of patients with an average tumor diameter ＞5 cm in the case group were respectively longer and higher than these in the control group (SMD=0.31,RR=1.65,95％CI:0.06-0.57,1.01-2.69,P＜0.05).Conclusion There is no obvious effect of preoperative TACE on resectable HCC,and it can evaluated combined resection rate of perihepatic organs,operation time and incidence of postoperative complications of patients with resectable HCC and an average tumor diameter ＞ 5 cm,and also reduce the perioperative safety.

Objective To investigate the effect of atorvastatin on expression of ABCA1(mRNA,protein) and LXR? mRNA in THP-1 macrophages induced by PMA.Methods Cultured THP-1 cells were induced to differentiate into macrophages by PMA for 48 hours.The macrophages were incubated with atorvastatin in different concentions for 24 or 48 hours.We determined the changes of ABCA1 mRNA,protein and LXR? mRNA by reverse trancriptase polymerase chain reaction(RT-PCR) and immuno-histochemistry.Results The expression level of ABCA1 mRNA(ratio of relative expression 1.21 vs 1.48) and protein as well as LXR? mRNA(0.87 vs1.12) were decreased in THP-1macrophages when cultured with atorvastatin(10 ?mol/L) for 24 h.Conclusion Atorvastatin inhibits the expression of ABCA1 mRNA and protein as well as LXR? mRNA of THP-1macrophages in vitro.

Objective To explore the HEART risk score in predicting 30-day major adverse cardiovascu-lar events (MACE)for the patients presenting to Emergency Department (ED) with acute chest pain. Methods Patients presented in our ED with acute chest pain were enrolled from January,2016 to April,2016. All cause MACE of each patient were followed up at 30 days by Health insurance information management System and call . Results Total 209 patients were enrolled(mean age 65.28 ± 16.85 years;52.63%male). The age,hypertension, ratio of ACS,SpO2,in-patient number HEART score in MACE subject were significantly higher than that in non MACE patients(P<0.05). The blood pressure at admission of MACE patients was significantly decrease than that in non MACE patients(P<0.05). The MACE within 30 days was 5.74%. The respective areas under the curve (AUC)for 30-day MACE(95% CI)was 0.908(0.846 ~ 0.974). The percent of patients with 30-day MACE with HEART scores between 0% and 3,4 ~ 6,and 7 ~ 10 was 0%,2.5%,and 27%,respectively. Conclusion HEART score can be simple,rapid and accurate prediction of emergency department of patients with acute chest pain within 30 days of MACE,effective elimination of low-risk patients with MACE,it plays a very important role for disease assessment and diagnosis and treatment process in emergency department.

ObjectiveTo investigate the clinical characteristics of the inpatients suffering from dengue fever in order to provide references for better diagnosis and treatment.Methods The clinical data of 158 dengue fever patients admitted to the First Affiliated Hospital of Sun Yat-Sen University from July 23rd to October 31st, 2014 during the 2014 epidemic in Guangzhou area were retrospectively analyzed, including general clinical manifestations, conventional examinations, pathogenesis, and prognosis.Results The mean age of the 158 patients was (56±20) years, with half of them over 60 years old (79 cases). Among them, 94 (59.49%) were male.① The common manifestations included fever (100%), headache (70.89%), myalgia/bone soreness (62.03%), and skin rash (54.43%). Bleeding and plasma leakage were found in 25.95% and 14.56% of the patients respectively.② Laboratory examination:leucopenia (75.32%) and thrombocytopenia (77.85%) were found, and alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were elevated in 57.59% and 77.85% of the patients respectively. However, elevation of blood hematocrit was rare (1.27%).③ It was found that in the acute phase (0 - 5 days of the onset), serum dengue virus antibody IgM (DF-IgM) was positive in 63.54% of the patients (61/96), and 92.62% (113/122) of patients were dengue virus RNA (DENA-RNA) positive.④ The rate of comorbidity in this study was 55.06% (87/158), including hypertension (27.22%) and type 2 diabetes (15.82%), which were the two most common co-morbidities.⑤ All the patients were given supportive therapy to prevent complications. They were also isolated for more than 5 days after onset, and at least for 24 hours after subsidence of fever in addition.⑥ The criteria for the diagnosis of severe dengue were fulfilled in 18 patients (11.39%). One patient died of massive hemorrhage from gastro-intestinal tract, and 1 patient voluntarily left hospital with untreated multiple organ dysfunction syndrome (MODS). Another 2 patients of dengue fever died from primary cardio-cerebrovascular disease, and the remaining 154 patients (97.47%) fully recovered with supportive therapy and complication prevention measures.Conclusions The clinical manifestations of inpatients with dengue fever in this study were typical, and they manifested a higher incidence of severe illness. DENA-RNA could be a sensitive indicator for early pathogenic diagnosis. With symptomatic and supportive therapy, most patients had a good outcome. However, early diagnosis and clinical interventions of severe dengue still need further studies.