OBJECTIVE To investigate the cause and prevention experience of acquired lung infection(ALI) in neurological medicine department for patients with indwelling stomach tube.METHODS Retrospective analysis proceeded for all patients with indwelling stomach tube in recently two years.RESULTS Among 113 patients,87 patients developed hospital infection in which 57 patients with indwelling stomach tube developed ALI,that occupied 65.52% of total patients developing hospital infection.CONCLUSIONS For the patients with indwelling stomach tube,inspiration and increasing incidence of retrograde infection from stomach to pharynx and lower respiratory tract in sequence are the main causes developing ALI.In addition,the use of anti-acid drugs,the unreasonable use of antibiotics,and the patients immunity status are the related factors developing ALI.Enhancement of prevention of respiratory tract infection in neurological medicine department for patients with indwelling stomach tube would effectively decrease the incidence of infection and enhance rehabilitation.

Objective To explore the expression of plasminogen activator inhibitor-3 (PAI-3) in normal adult skin. Methods Immunohistochemistry and RT-PCR were used to detect the expressions of PAI-3 and uPA. Results mRNA of PAI-3 and uPA were detected. PAI-3 was mainly expressed in stratum basale, stratum spinosum and stratum granulosum, and its expression enhanced in the well differentiated keratinocytes of the epidermis. uPA was located in basal layer. Conclusion PAI-3 exists in normal adult skin and is related with the differentiation of epidermal keratinocytes.

Objective To report our clinical outcomes of treating tibial defects combined with soft tissue defects using Ilizarov technique.Methods From May 2010 to February 2015,52 patients with combined bone and soft tissue defects of the tibia were treated at our department.They were 41 males and 11 females,aged from 19 to 65 years (average,37.7 years).By Gustilo classification,49 cases were type ⅢB and 3 type ⅢC.The areas of soft tissue defect ranged from 7 cm ×3 cm to 28 cm × 15 cm,and the tibial defects ranged from 5 cm to 15 cm in length (average,12.6 cm).The schemes of Ilizarov technique depended on the location and size of the tibial defects.Open wound dressing combined with bone transport was adopted in 21 cases,limb shortening followed by bone lengthening with compression at the fracture ends in 12 cases,and tissue flap transplantation combined with bone transport or lengthening in 19 cases.Results The follow-up time of the 52 patients ranged from 13 to 61 months (average,27.1 months).The distance of bone transport or lengthening ranged from 5.0 cm to 13.6 cm (average,10.8 cm);the bone transport speed averaged 0.81 mm/day.The tibiae united in all the 52 patients;the time for external fixation ranged from 13 to 21 months (average,15.3 months);the external fixation index was 2.3 months/cm.According to the Paley functional criteria,23 cases were excellent,19 good,9 fair,and one poor,yielding an excellent to good rate of 80.7％.Conclusion According to the location and size of the bone and soft tissue defects of the tibia,the 3 schemes of Ilizarov technique can be rationally chosen to obtain fine clinical outcomes.

Idiopathic macular hole after the internal limiting membrane (ILM) is removed during surgery, the intraoperative optical coherence tomography can be used to observe the presence of debris tissue (RF) protruding into the vitreous cavity at the edge of the hole. Current studies suggest that RF may be caused by epiretinal proliferation and vitreomacular traction, but it is still controversial, and the influence of postoperative anatomical and functional recovery is not clear. Common points can still be found, some of the studies suggest that RF is not conducive to postoperative anatomical and functional recovery during the operation, ILM fragments remain on RF tissues after ILM peeling and re-staining. However, in some studies suggest that RF is beneficial to postoperative anatomical and functional recovery, and ILM fragments on RF are removed. This suggests that whether ILM is removed on RF lead to a certain influence on the postoperative efficacy. There are few researches on RF at present, so it is necessary to understand RF from its essence and assist judgment through histological analysis.

AIM: To analyze the subcellular localization of Arnt2 in rat cerebellar granule neurons (CGNs). METHODS: Based on the amino acids sequence of Arnt2 (LOCUS:NP_036913), the subcellular localization of Arnt2 in eukaryotic cells and the nuclear export signals (NES) of Arnt2 were predicted in CBS bioinformatics database. The subcellular localization of Arnt2 in rat cerebellar granule neurons was detected by the method of laser scanning confocal microscopy (LSM) analysis. RESULTS: It was predicted that Arnt2 located in nuclei of eukaryotic cells with the most probability, while located in cytoplasmic mitochondria with a slight possibility. A nuclear export signal was found in Arnt2 amino acids sequence, it was identified to be the leucine of No.143 that located in N-terminal of Arnt2 amino acids sequence. Finally, the result of LSM analysis shows nuclear localization of Arnt2 in rat CGNs. CONCLUSION: Arnt2 is located in nuclei of normal rat CGNs, it suggests that Arnt2 has the tendency to translocate into mitochondria after induced by some of inducible factors, for both the possibility of mitochondria localization and NES exist in Arnt2 amino acids sequence.

Objective To explore the clinical effect of anteromedial thigh perforator flap for repairing soft tissue defect in lower extremity.Methods From January 2009 to December 2012,12 patients with soft tissue defect of lower extremity were treated with free anteromedial thigh perforator flap.Among them,there were 5 cases of wound in front of tibia,4 cases of dorsal foot wound,3 cases of heel wound;the wound size was 3.0 cm ×3.5 cm-7.0 cm × 9.5 cm;3 cases were repaired with free perforator flap of descending genicular artery,2 cases with free anteromedial thigh perforator flap,and 7 cases with medial vastus muscle perforator flap.Results All the transplants survived.Among them,1 case of anteromedial thigh perforator flap and 1 case of descending genicular artery perforator flap appeared vascular crisis postoperative.After anticoagulation and antispasmodic treatment aggressively,the flaps survived.One case of descending genicular artery perforator flap necrosis in edge,and then were cured by changing dressing.Twelve cases were followed up 6-12 months after operation (average 8.6 months),and the texture of flaps were good,the appearance appropriate ;7 sensation of 5 free flaps after nerve anastomosis came back to S; the donor sites in all cases were sutured directly and healed,leaving only the linear scar,and no effect on function.Conclusion The anatomy of anteromedial thigh perforator flap is constant,and the operation is convenient.The clinical result of repairing soft tissue defect of lower extremity is satisfying.

Objective To investigate the clinical effect of transplantation of the free anterolateral thigh flap and iliotibial band for the repair of soft tissue defects at foot and ankle and functional reconstruction.Methods From January,2008 to January,2013,25 pediatric patients with soft tissue defects at foot and ankle were transplantation of the free anterolateral thigh flap and iliotibial band.Of the 25 cases,there were 12 cases at heel,8 cases at dorsum of foot,3 cases at medial malleolus and 2 cases at external malleolus.All the cases were accompanied with different degree of fracture or dislocation,and with soft tissue defect such as achilles tendon,extensor tendon of dorsal,collateral ligament of ankle.The length of soft tissue defect which were reconstructed with iliotibial band were 3 cm to 16 cm.The causes of injury:19 cases were crushed by motorcycle or bicycle,4 cases were crushed machines,2 cases were injuryed in traffic accidents.The areas of free anterolateral thigh flaps were 8 cm × 5 cm to 18 cm × 12 cm.All the patients begined to early rehabilitative exercise under the protection of orthosis after 2 weeks of the operation.Results All cases were followed up from 6 to 24 months,averaged of 14 months.All the flaps survived,and only 2 cases with necrosis of small area in distal,and which were healed by dressing.The healing time were 12 to 24 days,and the average of 15.1 days; The surgery function were assessed according to Thermann's scale,and the results was 14 cases for excellent,9 cases was good,the general was 2 cases,and the excellent and good rate was 92％.Conclusion The transplantation of the free anterolateral thigh flap and iliotibial band for the repair of soft tissue defect at foot and ankle and functional reconstruction is a safe and effective strategy,and it has the advantages such as covering the wound at foot and ankle approvingly,reconstruction of power device once,the flap and iliotibial band were in the same wound,the trauma of doner site is small invasive,early recovery functional exercise,shorten the treatment cycle,and relieve the suffering of children.

Objective To investigate the value of Habib 4X in hepatic resection. Methods The clinical outcome of 21 patients with liver disease who received liver resection at the Tianjin Third Central Hospital from November 2009 to April 2010 were retrospectively evaluated. All the operations were carried out by using Habib 4X. Results All patients received hepatectomy, including right hepatectomy in three patients, left hepatectomy in one patient, multiple segmentectomy in nine patients, single segmentectomy in seven patients and partial liver resection in one patient. All tumors were reseeted completely. The mean operation time was (50±25) minutes and the mean blood loss was(129±117)ml. No patient was transferred to ICU. Three patients were complicated with bile leakage, one with lymphatic leakage and four with pleural effusion, and they were cured by non-surgical treatment. There were no patients with postoperative hemorrhage, incision infection or hepatic failure. No mortality was observed. The mean postoperative hospital stay was(19±14)days. Conclusions Radiofrequency energy was applied along the margins of the tumor to create zones of necrosis before resection with a scalpel, offering hepatobiliary surgeons an additional method for performing liver resections with minimal blood loss, low morbidity and mortality rates. As for malignant tumors, minor or major liver resection assisted by Habib 4X is safe, and it can reduce the chance of positive incisal margin.

Objective To summarize the susceptible factors and the experience of the surgical treatment of ruptured aneurysm of the sinus of Valsalva combined with infective endecarditis.Methods From January 2000 to March 2008,30 cases with raptured aneurysm of the sinus of Valsalva were admitted, clinical data of 10 cases combined with infective endocarditis were retrospectively reviewed.Nine cases underwent the surgical treatment,including 6 cases accepted aortic valve replacement (AVR).Results Nine eases underwent the surgical treatment followed up for 2 months to 8 years,cardiac function of the survivors recovered to Class Ⅰ-Ⅱ in NYHA,7 cases were Ⅰ grade,2 cases were Ⅱ grade.One case was dead for MSOF not underwent the surgical treatment.Conclusions Associated with ventricular septal defect is one of the susceptible factors.Following diagnosis of ruptured aneurysm of sinus of Valsalva combined with infective endocarditis,sufficiently and validly antibiotic and surgical treatment should be pedormed as quickly as possible,and AVR to the moderate and severe aortic insufficiency.

Objective:　To explore the importance of mechanic al ventilation (MV) in treating multiple trauma mainly accompanied with cerebral injury and improve the treatment level. 　　Methods:　All 116 patients who suffered from multiple trauma acc ompanied with mainly cerebral injury were analyzed. Rank correlation and Chi-sq uare test were made between MV with GCS, ISS, and whether shock or not. 　　Results:　The MV was correlated with GCS, ISS scores, and whethe r shock or not markedly. Furthermore, when GCS≤8, the ratio of MV was about 70% . When ISS≥35, the ratio of MV was about 85%. 　　Conclusions:　During the treatment of multiple trauma accompanie d with cerebral injury, the principle of “early MV, early withdraw” and “indi vidualism” should be insisted on. For patients accompanied with shock, the opti mum PEEP is very important. Proper and active MV is of great importance and can improve the treatment level markedly.