[Objective]To compare the effects of topical different concentration mitomycin C(MMC)in preventing postlaminectomy peridural adhesion.[Method]Laminectomies were performed at L1 in 40 rats.Cotton pads soaked either with 0.01 mg / ml(group L),0.05 mg /ml(group M),0.1 mg / ml(group H) MMC or saline(group C) were applied to the operative sites.The rats were killed 4 weeks after surgery.The specimens were prepared for determination of the degree of scar adhesion according to Rydell method,the content of Hydroxyproline(HOP),the area of peridural fibrosis and the count of fibroblasts.[Result]Dense peridural fibrosis with marked peridural adhesion showed in group C.No obvious adhesion formed in group H.In group M and L,peridural adhesion wasn't avoided.The content of HOP,the area of peridural fibrosis and the count of fibroblasts showed various degrees decrease in all MMC-treated groups.[Conclusion]Local application of 0.1 mg/ ml MMC may be a successful method of reducing postlaminectomy peridural fibrosis and completely avoided peridural adhesion.

Objective To construct a RhoA-siRNA expression vector and determine its role on the malig-nant behavior of HepG2 cells.Methods A RhoA-siRNA DNA fragment was synthesized and cloned into the expression vector of pGenesil-1.The constructed Rhon-siRNA DNA plasmid was stably transfected into HerG2 cells by lipofectamine,and then HepG2 cells were divided into the HepG2/RhoA-siRNA group (HepG2 cells were transfected with pGenesil-1-RhoA-siRNA),HepG2/control group(HepG2 cells were transfected with control plasmid) and HepG2 group (without plasmid transfection).The inbibitory effect of RhoA-siRNA on RhoA protein expression was shown by Western blot.The proliferation,migration,growth potentiality and cell cycle of transfected HepG2 cells were evaluated by MTT assay,wounded healing,the plate cloning formation test and flow cytometry,respectively.All data were analyzed by one-way analysis of variance (ANOVA) and chi-square test.Results The expression of RhoA protein in the HepG2/RhoA-siRNA group was,significantly decreased compared with that in the other two groups (F=178.19,P<0.05).Scratched cells were healed within 48 hours in the HepG2/control group and HepG2 group,but not in the HepG2/RhoA-siRNA group.The clone formation rates in the HepG2/RhoA-siRNA group,HepG2 group and HepG2/control group were 39%±3%,67%±5%and 70%±6%,respectively,with a significant difference among the three groups(χ2=33.34,38.69,P<0.05).Flow cytometry showed that the number of cells transfected with RhoA-siRNA was highest in the G0/G1 phase and lowest in the S phase(F=70.46,76.57.P<0.05).Conclusion The RhoA-siRNA expression vector can effectively suppress the proliferation and migration of HepG2 cells,which may provide a novel gene therapy for hepatocellular carcinoma.

Objective To investigate the myocardial protection of intraoperative continuous in-fusion of esmolol in elderly patients undergoing laparoscopic surgery.Methods Sixty patients,thirty-two males and twenty-eight females,aged 65-80 years,weighing 40-80 kg,ASA physical status Ⅰ orⅡ,undergoing selective general anesthesia laparoscopic resection of gastrointestinal cancer were ran-domly divided into 2 groups (n = 30 ):esmolol group (group E)and control group (group NS). Group E was administered esmolol 0.3 mg/kg 3 minutes before intubation,then with a continuously infusing rate of 50 μg · kg-1 · min-1 until extubation.Group NS was administered saline instead. MAP,HR,SpO 2 ,PET CO 2 ,BIS and RPP were recorded before intubation (T0 ),intubation (T1 ), pneumoperitoneum (T2 ),the end of surgery (T3 ),extubation (T4 )and 30 minutes after extubation (T5 ).The serum levels of cTnI,CK,CK-MB and LDH were measured before anesthesia and 6,30 hours after surgery.Adverse cardiovascular event happened during perioperation and 3 months follow-ing up was recorded.Results HR,MAP,RPP at T1 ,T2 ,T4 in group E were obviously lower com-pared with group NS (P <0.05).There were no significant differences in the serum levels of cTnI, CK,CK-MB and LDH between two groups at different time points.No major adverse cardiovascular event happened in two groups during perioperation and 3 months following up.Conclusion Intraoper-ative continuous infusion of esmolol 50 μg· kg-1 · min-1 can not significantly influence the serum level of myocardial injury marker in the elderly patients without myocardial damage undergoing lapa-roscopic resection of gastrointestinal cancer.Howerver,it can effectively reduce the cardiovascular re-sponse caused by stimulation,decrease myocardial oxygen consumption,protect myocardial.

BACKGROUND:At present,using membrane materials to separate spinal dura mater and scar tissue or using semiliquid materials to surround the dimension of operation are very common after laminectomy.However,therapeutic eflfects ale not satisfactory.Inhibition to the proliferation of fibroblasts,which are the main components of repairing cells,and regulating collagen metabolism have become a hot spot for preventing and treating pathological scar by a biological method.OBJECTIVE:To compare the therapeutic effects of topical application of different concentrations of mitomycin C (MMC)on preventing pefidural adhesion in rats after laminectomy by a qualitative and quantitative combined method.DESIGN:A completely randomized grouping.controlled animal experiment.SETTING:Department of Orthopaedics,Second People's Hospital of Lianyungang City.MATERIALS:Forty healthy adult male SD rats,weighing 200-220 g,were provided by the Animal Experimental Center,Nanjing Medical University.MMC was produced in Union Fermentation Co.,Ltd(Batch No.425ACI,Import drugs registration No.H20020163,Japan).METHODS:The study was performed at the Animal Laboratory Center,Nanjing Medical University,and the Basic Experimental Center,Medical College,Jiangsu University from June 2004 to October 2006.The 40 SD rats were ralndomly divided into 4 groups with 10 rats in each group:MMC high-,medium-,and low-concentration groups,and a control group.After anesthesia,each rat was removal of L1 vertebral plate.A defect(0.2 cm×0.5 cm)was created to expose duml mater.After hemostasia,cotton Pads soaked either with various concentrations ofMMC(0.1,0.05,0.01 g/L)or saline were covered on the laminectomy defects in the three MMC-treated groups and the control group for 5 minutes respeetively.The protocol was carried out in accordance with ethical guidelines for the use and care of animals.MAIN OUTCOME MEASURES:After the operation,4 rats were randomly selected from all anesthetized rats in each group,separately.The peridural scar tissue in the laminectomy segment was cut for calculating the contents of hydroxyproline.Spine columns in the laminectomy segment including Surrounding muscle tissue were resected for measuring irregular sear transverse area and counting the number 0ffibroblasts.The degree of peridural scar adhesion was evaluated by the light microscope.RESULTS:Forty rats were included in the final analysis.In the control group,peridural scar tissue was dense and closely adhered to dura mater.In the MMC high-concentration group.no noticeable peridural adhesion was found.and contents of hydroxyproline,collagen tissue area and the amount of fibroblasts in the scartissue were significantly reduced compared to control group(all P＜0.05).In the MMC medium-and low-concentration groups,contents of hydroxyproline,collagen tissue area and the amount of fibroblasts had reduced to different extents compared to control group.There was significant difference only in the amount of fibroblasts between the MMC mediumconcentration group and the control group(P＜0.05).Incontinuous adhesion between scar tissue and dura mater was found in the MMC medium-and low-concentration groups.CONCLUSION:Topical application of 0.1 g/L MMC can effectively reduce peridural scar tissue hyperplasia and avoid peridural scartissue adhesion afterlaminectomy.

Objective:To explore the effect of free transplantation of composite tissue flap from the anterior lateral aspect of the femur in repairing head skin defects with artificial dural exposure infection.Methods:A retrospective study was conducted on 13 patients admitted to the First Affiliated Hospital of Air Force Military Medical University from April 2018 to August 2020 with craniotomy complications, including craniotomy skin and soft tissue defects combined with artificial dural exposure and infection. After preoperative anti infection treatment, the neurosurgery department participated in debridement and removed the artificial dura mater as much as possible during the operation. A composite tissue flap carrying the fascia lata was designed for the anterior lateral aspect of the thigh, and the flap artery and vein were anastomosed with the superficial temporal artery and superficial temporal vein/middle temporal vein respectively. The defect of the dura mater was repaired with the fascia lata with blood supply. The flap was used to seal the wound, and the donor site was directly sutured or transplanted with autologous medium thick skin graft. The postoperative blood supply and survival of the flap, the presence of cerebrospinal fluid leakage, and the healing of the donor site were observed; The observation of dural integrity and postoperative effects of skull reconstruction using cranial magnetic resonance imaging was followed up.Results:Among the 13 patients in this group, 11 patients had their artificial dura mater completely removed, while 2 patients were not completely removed due to severe adhesion. Among them, 1 patient had a residual area of 0.8 cm×1 cm, and the other had 3 residual areas, with a maximum area of 0.5 cm×0.7 cm; All transplanted skin flaps survived, with 12 cases achieving primary healing and 1 case of partial wound rupture after suture removal, which healed after conservative dressing change; All patients had no cerebrospinal fluid leakage; There was one case of partial necrosis of the graft in the donor site, which healed after supplementing the graft; Thirteen patients underwent cranial magnetic resonance imaging at 3-6 months postoperatively, all of which showed intact dura mater; Among them, 8 patients have completed skull reconstruction surgery, and all of them have healed well after reconstruction, with a good appearance of the surgical area.Conclusions:For wounds with head skin defects and exposed artificial dura mater infection, free transplantation of the anterior lateral composite tissue flap carrying the fascia lata can effectively cover the wound and repair the dura mater defect, achieve good function and appearance, and create favorable conditions for later skull reconstruction.

Objective: To observe the effects of the method of combining free superficial temporal fascia flaps with skin grafts in repairing deep wounds in posterior ankle region of extensively burned patients. Methods: From September 2013 to February 2017, 11 extensively burned patients with deep tissue defects in posterior ankle region were treated in our unit. Two patients had tissue defects in bilateral posterior ankle regions. The wound sizes ranged from 5.8 cm×4.6 cm to 11.7 cm×5.2 cm. Free superficial temporal fascia flaps with the same sizes as the wounds were designed and resected to repair wounds in posterior ankle regions after debridement. The proximal end of superficial temporal veins and posterior tibial veins were performed with end-to-end anastomosis, and superficial temporal arteries and posterior tibial arteries were performed with end-to-side anastomosis. Skin grafts were resected to cover the superficial temporal fascia flaps according to patients′ condition of donor sites. The donor sites were sutured directly. Results: All fascial flaps in 11 patients survived, while 2 skin grafts had partial necrosis, and they healed after secondary skin graft. All patients were followed up for 6 to 13 months, and the shape and function of the operation sites in all patients recovered well. Conclusions The method of combining free superficial temporal fascia flaps with skin grafts can repair deep wounds in posterior ankle regions of extensively burned patients. It has the advantages of good appearances in the recipient sites, strong resistances to infection of fascia flaps, minimal damages to the donor sites, short course of disease, and good prognosis of patients.

Objective: Strategy for wound repair of skin and soft tissue defect and systematic rehabilitation treatment for functional reconstruction of patients with severe burn or trauma on knees. Methods: From January 2015 to October 2016, 26 patients with skin and soft tissue defect on knees after severe burn or trauma were hospitalized in our unit. Among these patients, 14 patients had patellar ligament defect, and 16 patients had knee joint capsule defect. Wound debridement was operated on 1 to 3 days after admission. After debridement, the area of skin and soft tissue defect ranged from 10 cm×7 cm to 42 cm×18 cm. Vacuum sealing drainage (VSD) treatment was performed after debridement, and flap transplantation operation was performed after VSD treatment for 5 to 7 days. Defects of nine patients were treated with local rotation flaps. Seven patients with skin and soft tissue defects on knees and knee joint capsule defects of 5 cm×3 cm to 9 cm×7 cm were treated with free anterolateral femoral flaps combined with fascia lata. Ten patients with skin and soft tissue defects on knees and patellar ligament defects of 6 cm×3 cm to 12 cm×4 cm were treated with free anterolateral femoral flaps combined with iliotibial tract. The area of flaps ranged from 11 cm×9 cm to 22 cm×15 cm. After flap transplantation operation, functional reconstruction of knee joint was carried out according to early, continuous, and sequential systematic rehabilitation treatment strategy. The pain degree and function of knee joint of patients were scored by the International Knee Documentation Committee (IKDC) Knee Evaluation Form before operation and 12 months after operation. The knee joint flexion and extension degrees of patients were measured by joint protractor in 2 weeks and 12 months after operation. The color Doppler ultrasound was used to evaluate integrity of knee joint capsule and continuity of patellar ligament of patients in 6 and 12 months after operation. Results: All flaps of 26 patients survived well, and wounds healed completely after the operation. Distal parts of flaps of 2 patients treated with free anterolateral femoral flaps had local necrosis after the operation, and their wounds healed after debridement and transplantation of autologous intermediate split-thickness skin graft of thigh. The IKDC Knee Evaluation Form score of patients was (79±8) points in 12 months after operation, which was significantly higher than (64±7) points before operation (t=7.20, P<0.05). The flexion degree of knee joint of patients was (117±10)° in 12 months after operation, which was significantly larger than (35±8)° in 2 weeks after operation (t=32.65, P<0.05). The extension degree of knee joint of patients was (12±9)° in 12 months after operation, which was significantly smaller than (61±9)° in 2 weeks after operation (t=19.63, P<0.05). In 6 and 12 months after operation, 9 patients treated with local rotation flaps had good integrity of knee joint capsule and continuity of patellar ligament; 7 patients treated with free anterolateral femoral flaps and fascia lata had good integrity of knee joint capsule; 10 patients treated with free anterolateral femoral flaps and iliotibial tract had good continuity of patellar ligament. During follow-up of 12 months, all flaps survived well; knees of all patients had good appearance; knee joints functioned normally. Conclusions Good appearance and function of knees can be achieved by repairing wound of skin and soft tissue defect on knees after severe burn or trauma with local rotation flaps or free anterolateral femoral flaps with fascia lata or iliotibial tract plus systematic rehabilitation treatment of knee joint in early stage after flap transplantation operation.