[ABSTRACT]OBJETIVETo analyze the reliability and safety of our simplified microsurgical techniques in head and neck reconstruction.METHODSA total of 3045 consecutive cases of free flap transferred in the head and neck region from May 1999 to May 2015 were reviewed. Data concerning the operation included the date of surgery, defect description and site, stage and histology of tumor, type of free flap, recipient vessel and complications.RESULTSOf the 3045 cases, 1856 were males, and 1189 were females. The age ranged from 5 to 86 years, with the average of 47.8 years. Among the 3045 cases, 2868 were tumor-related defects reconstructions, and 2653 were one stage reconstructions. The overall success rate of free flap was 98.5%. The vessel thrombosis rate was 2.9%, and the flap salvage rate was 48.9%.CONCLUSIONOur microsurgery technique greatly simplified traditional microsurgical technique. Head and neck reconstruction using this technique is very safe and reliable, and needs further clinical applications.

Objective To investigate the mid?term follow?up results of bone grafting pedicled with the femoral quadra?tus augmented with a titanium mesh for alcohol?induced osteonecrosis of the femoral head and to analyze the technical factors affecting the surgical outcome. Methods Twenty cases (24 hips) treated with bone grafting pedicled with the femoral quadratus augmented with a titanium mesh between January 2008 and September 2009 were retrospectively reviewed. Control group includ?ed 18 cases (20 hips) treated with bone grafting pedicled with the femoral quadratus alone in the same period. All the hips were al?cohol?induced femoral head necrosis and were classified as ARCOⅡC or ARCOⅢA stage. The one hundred points method was used for outcome evaluation. Statistical analysis was performed using SPSS statistical package 13.0(SPSS Inc., USA). Results The titanium group has a longer operative time and more estimated blood loss than the bone?grafting group with statistical signifi?cance. For the twenty cases in the titanium group, two cases were lost to follow?up with another one case receiving total hip arthro?plasty due to severe collapse, and the rest were followed for an average of 62.7 (58 to 66) months. For the eighteen cases in bone-grafting group, one case was lost to follow?up with another one case receiving total hip arthroplasty due to severe collapse, and the rest were followed for an average of 61.3 (57 to 64) months. At the last follow?up, the titanium group had a successful rate of 85.7%(excellent in 13, good in 5 and fair in 2) with a five?year survival rate of 95.2%(20 out of 21 hips) and the bone?grafting group had a successful rate of 84.2%(excellent in 13, good in 3 and fair in 2) with a five?year survival rate of 94.7%(18 out of 19 hips). Clini?cal and radiographic outcomes were not statistically significant different between the two groups. Mild collapses were noted radio?graphically in both groups, with 7 out of 20 in titanium group and 5 out of 18 in the bone?grafting group. Among these mildly col?lapsed cases, the cases in titanium group had a relatively better clinical outcome than those in the control group and the cases with a larger mesh supporting area had an even better clinical outcome. Conclusion The mid?term follow?up results of bone grafting pedicled with the femoral quadratus augmented with a titanium mesh for alcohol?induced osteonecrosis of the femoral head were satisfactory. Factors affecting surgical outcomes included the placement of the titanium mesh, and the bone?grafting technique.

Objective To analyze the results of theoretical test and clinical skills examination of standardized resident training gradua-tion exam in Beijing in recent years, to improve the examination standards and assessment models. Methods The results of theoretical test and clinical skills examination from 2011 to 2016 were collected. The difficulty, degree of differentiation, and factors related with the result of clinical skills examination were analyzed. Results The test paper is difficult with good degree of differentiation from 2014 to 2016. Edu-cation degree and year were not related with the clinical skills (P>0.05), while the hospital level was (P<0.05). Conclusion The standardized training and assessment of residents in rehabilitation medicine need continuously attention. Combined with the results of the assessment and the problems exposed in the assessment, a feasible scheme should be put forward, in order to improve the quality of resident training.

BACKGROUND:Travoprost can increase human ciliary muscle cell interspace, decrease uveoscleral outflow resistance and then decrease intraocular pressure. But whether this action pathway is conducted by enhancing the expression of matrix metalloproteinase (MMP) in the ciliary muscle cells remains unclear.OBJECTIVE:To observe the effect of travoprost on the expression of MMP-2 in the human ciliary muscle cells.DESIGN:Controlled observation analysis.SETTING:Zhongshan Ophthalmic Center,Sun Yat-sen University.MATERIALS:This study was Carried out in the Zhongshan Ophthalmic Center,Sun Yat-sen University between August 2005 and April 2006.Donor was from the unilateral eyeball of a youth patient,who was dead within one hour,had no any disease (informed consent was obtained from the relatives) in the Zhongshan Ophthalmic Center, Sun Yat-sen University.Rabbit anti.human MMP-2 polyclonal antibody (Boster Bioengineering Co.,Ltd,Wuhan),and travoprost (86610F,0.004% solution,ALCON company.USA) were used in this study.METHODS: Experimental intervention: 1μmol/L travoprost was added into bovine serum-free medium of human ciliary muscle cell, serving as experimental group,and meanwhile,the cells which were not interfered by drugs were taken as control group.In the experimental group,cells were harvested 6, 12,and 24 hours after travoprost being added.Experimental evaluation:MMP-2 gene and protein expressions in the human ciliary muscle cells in each group were detected by RT-PCR and ELISA methods.The activity of MMP-2 in each group was detected by Zymography technique.MAIN OUTCOME MEASURES:MMP-2 mRNA expression in the human ciliary muscle cell,MMP-2 protein expression and MMP-2 activity in the extracellular fluid.RESULTS:①In the experimental group, at 6,12 and 24 hours after travoprost being added,the relative expression of MMP-2 mRNA was gradually increased (F=236.959,P＜0.01).②In the experimental group,at 6,12 and 24 hours after travoprost being added,MMP-2 protein was also gradually increased with time (F=38.110,P＜0.01).③Zymography technique detection showed that in the experimental group,at 6,12 and 24 hours after travoprost adding,MMP-2 activity was gradually enhanced with time (F=74.348,P＜0.01).CONCLUSION:After human ciliary muscle cell cultured in vitro being subjected to the intervention of travoprost.MMP-2 expression is gradually increased with action time of travoprost, and meanwhile MMP-2 activity is also gradually enhanced.

Objective To measure the setup errors of patients with esophageal carcinoma during the treatment of three dimensional conformal radiotherapy (3DCRT), and to analyze the impact of setup errors on dose distribution of GTV,CTV and normal tissues around. Methods Forty-two patients with esophageal cancer treated by 3DCRT were included. The setup errors of each patient were measured once a week for 6 times by electronic portal imaging device (EPID). The setup errors were integrated into the treatment plan-ning system by moving the isocenter. Then the dose distribution of GTV, CTV and normal tissues were recal-culated. Results The systematic setup errors of the 42 patients were - 2.31 mm, - 0.55 mm and - 0.16 mm, and the random errors were 4.42 mm, 4.35 mm and 4.48 mm in the directions of lef-fight, anterior-posterior,and superior-inferior, respectively. The dose covered 95% GTV( D95 ) was reduced by 32 cGy and by 88 cGy for CTV D95. The lung V20 in the original plan and the integrated plan was 22.49% and 22.02%, respectively. The average dose of the heart in the two plans was 2077.62 cGy and 2036.23 cGy, respectively. In the original plan, no patient had maximum dose of spinal cord over 4500 cGy; While in the intergrated plan there were 18 patients had the spinal cord dose more than 4500 cGy, with a maximum dose of 5503.90 cGy. Conclusions The setup errors cause significant dose reduction of GTV and CTV, but not of the lung and heart . The maximum dose of the spinal cord may exceed 4500 cGy due to the setup errors.

Objective To evaluate the variance and the concordance between the tumor length measured by CT scans and that measured by surgical specimens in esophageal carcinoma. Methods Fiftytwo surgical specimens of the esophageal carcinoma were made into pathological giant section.The shrinkage ratio of tumor was calculated by comparing the length of the specimen fixed by formalin for 24 h and that measured during the operation.One hundred and thirty-seven patients with esophageal carcinoma underwent spiral CT scan before the surgery,and the length of the gross tumor volume was obtained.After the tumor length of the fixed specimen had been measured,the real tumor length in situ was calculated using the shrinkage ratio.Then the variance and the concordance between the tumor length in CT scans and that in situ were compared.Results The mean shrinkage ratio was 90%±10%.The mean tumor length in CT scans was longer than that in situ(5.8 am±2.4 cm vs 4.1 cm±1.8 cm,P=9.68,P=0.000).The concordance of the length measured by the two methods was 40.9%(56/137). Conclusions A certain variance existed between the tumor length in CT images and that computed from surgical specimen in esophageal carcinoma.The results of esophagography and endoscopy should also be referred to delineate the gross tumor volume of esophageal carcinoma.

Objective To analyze our clinical results of head and neck reconstruction using microsur- gical free flap transfer techniques.Methods The free flap donor sites with long vascular pedicle and large diameter of vessel were routinely chosed,and chose receipt vessels with large diameter and proper position, and perform vessel ananstomosis under surgical loups instead of microscope.The un-buried free flap with a mo- nitoring window were harvest,and do double venous anastomoses in some flaps to ensure adequate venous out- flow.Results From May 1999 to March 2005,1066 consecutive free flap transfers were used to reconstruct head and neck defects.The overall success rate of free flap was 98.3%.The vessel thrombosis rate was 3.1%,and the flap salvage rate was 45.5%.Conclusion Head and neck reconstruetion using microsurgi- cal free flap transfer technique is safe and reliable,and good clinical results can be obtained.

Objective To discuss the relationships between qi-arrival and mind-control, qi-arrival and qi-regulation, and to define qi-arrival by tracing the relevant records in Nei Jing (Classic of Internal Medicine) and Nan Jing (Classic of Difficult Issues). Method Thirty-seven relevant ancient books of the two classics were reviewed and the notes by WANG Bing, MA Shi, and YANG Shang-shan were referred. Result Mind-control requires the spirits of the practitioner, patient and environment, as well as observing and waiting for the arrival of qi. Regarding qi-regulation, theories involve that qi-arrival achieves same reinforcing and reducing effect as qi-regulation, qi-regulation is elucidated from the correct location of acupoint, proper needling depth and direction, and to regulate qi by observing the arrival of qi. Besides, the changes of internal and external environments also influence qi-arrival via qi-regulation and mind-control. Conclusion Qi-arrival is closely related to mind-control and qi-regulation in obtaining, differentiation, and adjustment. Mind-control and qi-regulation assist each other through the whole acupuncture process, which is the core of qi-arrival.

OBJECTIVETo study the effect of progesterone on interleukin-6 (IL-6) release from human umbilic vein endothelial cells (HUVECs) induced by high mobility group box-1 protein (HMGB1).

METHODThe recombinant expression plasmid pET14b-HMGB1 was constructed and transformed into competent E.coli BL21 cells to obtain HMGB1 protein, which was purified with chromatography on Ni-NTA Sepharose column. Cultured HUVECs were treated with purified HMGB1 protein alone at the concentrations 0, 10, 100, 500, and 1000 ng/ml, progesterone alone at the concentrations of 0, 0.1, 1, 10, 100 mmol/L, or with both HMGB1 protein (500 ng/ml) and progesterone at the terminal concentrations of 0, 0.1, 1, 10, and 100 mmol/L. Twenty-four hours later, the supernatant of the cell culture medium was collected to detect the levels of IL-6 using enzyme-linked immunosorbent assay (ELISA).

RESULTSThe IL-6 levels in HUVEC culture medium was slightly decreased after treatment with low-concentration HMGB1 but increased obviously following treatment with high-concentration HMGB1, and these effects could be dose-dependently inhibited by progesterone. Progesterone alone did not result in any noticeable changes of IL-6 levels in the cell culture medium.

CONCLUSIONSProgesterone can dose-dependently inhibit HMGB1-induced IL-6 release from HUVECs, suggesting the protective role of progesterone in endotoxemia.

Cells, Cultured ; Dose-Response Relationship, Drug ; Endothelial Cells ; cytology ; metabolism ; HMG-Box Domains ; HMGB1 Protein ; pharmacology ; Humans ; Interleukin-6 ; biosynthesis ; Progesterone ; pharmacology ; Umbilical Veins ; cytology ; metabolism

Objective To investigate the expression of caspase-10 in differentiated thyroid carcinoma and association with its development and metastasis. Methods Thyroid samples from 37 patients in a period from January 2006 to December 2007, with differentiated thyroid carcinoma were retrospectively analyzed for caspase-10 by immunohistocbemistry(streptavidin-perosidase, S-P), compared to control group of 46 cases with nodtdar goiter. The relationship between the expression of caspase-10 and the clinical pathologic characteristics of thyroid carcinoma were also explored simultaneously. Results caspase-10 were observed as brown or yellow particles located in the cytoplasm or cell membrane of nodular goiter but there were no significant evidence for its positive expression in thyroid carcinoma, caspase-10 expression was markedly down-regulated in differentiated thyroid carcinoma(29.73%,11/37) compared with benign nodules(71.74%,33/46, χ2=14.528, P<0.01). The positive expression in 18 cases with lymph node metastasis(11.11%,2/18) was significantly lower than those in 19 patients without lymph node metastasis(47.37%,9/19; χ2=4.210, P<0.01). There was no significant correlation(P> 0.05) between the expression of caspase-10 and the clinical pathologic characteristics including male, age, TNM stage and pathologic type. Conclusion Down-regulation of caspase-10 may play a critical role in carcinogenesis and development of differentiated thyroid carcinoma.