Objective To explore effective methods of diagnosis and treatment for delayed rupture of the spleen (DRS) through retrospective analysis of 32 cases. Methods A retrospective study was done in 32 cases with DRS. The effects of CT, ultrasound and diagnostic peritoneal lavage on diagnosis of DRS was observed and compared. Results Splenectomy was performed in 26 cases, among which one died four days after splenectomy because of complicated brain injury and six given conservative treatment under continuous monitoring discharged. The mean hospitalization duration was 18.5 days. Conclusions Diagnostic peritoneal lavage can improve the positive rate of peritoneal puncture. Ultrasound is an important method for diagnosing DRS and closely monitoring the patients receiving conservative treatment.

Objective To investigate the effect of mixed-skin grafting with autologous microskin and allogenetic acellular dermal matrix microskin on wound healing in rats,and to make a further study on the related mechanism.Methods Wistar rats were served as a allogenetic acellular dermal matrix donor rats,and SD rats as acceptors with mould of full thickness skin defects on their back.The ninety SD rats were divided into 5 groups with 18 rats in each group.Group 1 was transplanted with autologous microskin,and group 2 with allogenetic acellular dermal matrix microskin.Groups 3,4 and 5 were grafted with mixed-skin ratio between autologous microskin and allogenetic acellular dermal matrix microskin 1 ∶ 1,1 ∶ 0.5 and 1 ∶ 0.25,repectively.The rate of wound healing was measured,wound samples collected,hematoxylin and eosin stain carried out,fibronectin (FN) and laminin (LN)detected,and intergroup comparison made,respectively,2,3 and 4 weeks after skin grafting.Results The wound healing rates and FN and LN expression of mixed-skin grafting groups were higher than those of the group with autologous microskin grafting.The group of 1 ∶ 0.25 obviously increased (P＜0.05 or P＜0.01).Conclusions The wound healing rate with mixed-skin grafting is higher than that with autologous microskin grafting.The best effect is achieved when the skin ratio between autologous microskin and allogenetic acellular dermal matrix microskin is 1 ∶ 0.25.It is possibly due to the increase of FN and LN on wound skin surface.

Objective To investigate the roles of Xenon-CT cerebral blood flow perfusion imaging in cerebral revascularization before surgery and efficacy evaluation.Methods The clinical data of 15 patients with symptomatic cerebral artery stenosis/occlusion of anterior circulation were analyzed retrospectively.Eight patients were treated with endovascular stenting,1 was treated with internal carotid endarterectomy,and 6 were treated with superficial temporal artery-middle cerebral artery bypass grafting.The regional cerebral blood flow (rCBF) detected by Xenon CT within 2 weeks before and after procedure and the modified Ranking scale (mRS) scores at 6 months after procedure were compared.Results (1) The mean rCBF value of 12 patients with abnormal blood perfusion of target vessels before procedure was 30±10 ml/(100 g·min) and that was 32±14 ml/(100 g·min) after procedure.Compared with before procedure,the difference was statistically significant (P<0.05).The mean rCBF value of 3 patients with normal blood perfusion of target vessels before procedure was 48±6 ml/(100 g·min) and that was 50±7 ml/(100 g·min) after procedure.Compared with before procedure,the difference was not statistically significant (P>0.05).(2) The postoperative mRS score was decreased in 8 cases and stable in 7 cases.Compared with before procedure,there were significant differences in mRS scores after procedure in 15 cases (P<0.05).During the follow-up period,none of the patients had new neurological impairment.Conclusion Revascularization can improve the presence of hemodynamic disorders in patients with symptomatic anterior circulation cerebral artery stenosis or occlusion of the target blood vessels in the distal local cerebral perfusion and neurological deficit symptoms.The patients with abnormal perfusion of preoperative Xenon-CT cerebral blood flow perfusion imaging may be more beneficial than those with normal perfusion.

Objective:To investigate the inhibitory effect and the related mechanism of Yiqi Jianpi Fang on aberrant crypt focus (ACF) in Wister rat colorectal cancer model.Methods:50 Wistar rats were randomly divided into 5 groups:TCM low dose group(TCM solution diluted 3 times,5 mL/kg daily gastric volume),TCM middle dose group (5 mL/kg daily gastric volume),TCM high dose group (15 mL/kg daily gastric volume),model group,normal group.With 10 rats in each group.The colorectal tissues were observed under microscope after methylene blue staining by immunohistochemistry method.Results:Compared with the model group,the number of ACF and large ACF in each TCM group were decreased (P＜0.05),and the number of ACF in the TCM middle dose group reduced most obvious,and the difference was statistically significant (P＜0.05).The proliferation indexs of PCNA in intestinal gland cells 24 h and 48 h after modeling in the TCM groups were higher than those in the model group,and the difference was statistically significant(P＜0.05).The apoptosis index of intestinal gland cells 24 h and 48 h after modeling in the TCM groups were higher than those in the model group,and the difference was statistically significant(P＜0.05).The ectopic expression of β-catenin in TCM groups were lower than that in the model group,and it was highest in the high dose group,than was the low dose group,and the middle group was lowest(P＜0.05).The expression of MMP-7 in TCM groups were lower than that in the model group,and it was highest in the low dose group,than was the high dose group,and the middle dose group was lowest (P＜0.05).Conclusion:Yiqi Jianpi Fang can significantly reduce the number of ACF in Wister rats,inhibit the activation of Wnt signaling in colorectal cancer,reduce the incidence of colorectal cancer,and have a certain preventive effect.

BACKGROUND: Transforming growth factor-β(TGF-β) is an essential factor for pathological scar formation. Smad protein group is the signal protein of lower reaches of TGF-β receptor. Asiaticoside can inhibit proliferation of fibroblasts and synthesis of collagen to reduce TGF-β expression in the scar.OBJECTIVE: To study the mechanism of asiaticoside on proliferation of scar fibroblasts and phosphorylated Smad2 and Smad7.DESIGN: Controlled study with observation, in which cell was taken as the object.SETTING: Department of burn and plastic surgery of a hospital affiliated to a university.PARTICIPANTS: The experiment was performed in Surgical Laboratory in Sun Yat-sen University from April 2002 to March 2003. The specimens were selected from 6 inpatients receiving plastic operation due to hyperplasic scar including 3 male and 3 female cases aged varied from 1 to 35 years. The hyperplasic scar fibroblasts were obtained generated from original culture in laboratory of surgical department.INTERVENTIONS: In the research, the experiment group and the control group were divided. In the experiment group, asiaticoside was applied on fibroblasts; in the control group, asiaticoside was not prescribed. The changes of every index were observed before and after medication.MAIN OUTCOME MEASURES: ① Effect of asiaticoside on expression of phosphorylated Smad2 and Smad7; ② Effect of asiaticoside on cell cycle and apoptosis.RESULTS: Asiaticoside inhibited scar fibroblasts entering M phrase from S phrase and reduced the content of phosphorylated Smad2 in fibroblasts, which did not present significant difference in two groups ( t = 1.53, P =0.08).The content of Smad7 in the cells was (50. 80 ± 22.40)% in the experiment group and (32.18 ± 17.84)% in the control group, which indicated significant difference ( t = 2. 17, P = 0. 024).CONCLUSION: Asiaticoside inhibits scar formation by Smad passage.

AIM: to establish an animals model of pulmonary embolism caused by echinococcus granulosus (E.g)cyst fluid. METHODS: Cyst fluid were isolated from sheep liver . Twenty-one rabbits were randomized into 3 groups: group Ⅰ(saline group), group Ⅱ(clear cyst fluid group), group Ⅲ (sand-contained cyst fluid group). Operation was performed on each animal to place a femoral artery catheter and a femoral vein catheter. Saline, clear cyst fluid or sand-contained cyst fluid were given to rabbits at a dose of 3 mL/kg body weigh . Observations were then made at 10, 30, 60 minutes to determine the changes of MAP, blood gas and vaso-active substance. Then ECT scanning image was obtained .After observation, all animals were killed and the lungs were harvested for histological examination by light microscopy. RESULTS: Remarkable decline of PaO 2 , MAP and rise of TXB 2, 6-keto-PGF 1? were observed in group Ⅲ and group Ⅱ(P

BACKGROUND:It is the key point to choose the right size of the prosthesis, and grasp the direction and thickness for osteotomy during total knee arthroplasty. In order to achieve the goal, accurate preoperative planning is very important.
OBJECTIVE:To compare the accuracy of preoperative templating in total knee arthroplasty using conventional two-dimensional (2D) and computed tomography (CT)-based three-dimensional (3D) procedures (templating on 3D image&surgical rehearsing on rapid prototype technology-models), and to confirm the necessity of 3D evaluation for preoperative planning.
METHODS:A total of 25 patients undergoing primary total knee arthroplasty were randomly selected, including 10 males and 15 females, at the age of 58 and 79 years old. 2D and 3D images were col ected from al patients. Preoperative templating was performed for each total knee arthroplasty using both conventional 2D radiographs and a CT-based 3D image model. Accuracies with regard to the predicted and actual implant sizes were determined for each procedure.
RESULTS AND CONCLUSION:The 3D procedure was found to be more accurate in predicting implant size of 80%femoral and 72%tibial components than those of the 2D procedure (4%femoral and 12%tibial components). Significant differences in the consistent rate of femoral and tibial prosthesis models were detected significantly (P<0.05). Kappa coefficient statistics demonstrated that goodness of fit of prosthesis model was good in 3D preoperative templating. Results confirmed that the superiority of 3D preoperative templating over 2D conventional evaluation is in predicting implant size, and provides more comprehensive information on skeletal anatomy.

Objective To investigate the perioperative risk of deep vein thrombosis (DVT) in patients with hepatic cirrhosis that underwent total hip arthroplasty (THA), and to evaluate the safety and feasibility of individualized anti-coagulation treatment.Methods There were 25 patients complicating hepatic cirrhosis that underwent THA (from Jan.to Dec.2014), including 17 males and 8 females, aged 57.9t9.2 years.The primary causes of THA were avascular necrosis of the femoral head (eighteen cases) and osteoarthritis of the hip (seven cases).Low molecular weight heparin (LMWH) was applied for anti-coagulation treatment.Parameters of hepatic function and coagulation function of THA cases (randomized thirty cases, from Jan.2008 to Dec.2008) without hepatic cirrhosis were used as reference for monitoring.For the cases of massive blood loss or upper gastrointestinal hemorrhage, a LMWH administration pause and an administration of fresh frozen plasma and clotting factors were performed in order to maintain a hemorrage/coagulation balance.The clinical outcome of the hip joint was evaluated and complications were treated.A subsequent follow-up was also carried out after perioperative period.Results All cases received successful surgeries and followed up.The follow-up duration was 34± 15.7 months.The preoperative Harris hip score was 32.4± 10.2 points, while the most recent follow-up score was 82.9±6.1 points, which was statistically significant.Dislocation, periprosthetic fracture and periprosthetic infection were absent.All cases received individualized anti-coagulation treatments during peripoerative period.A hemorrage/coagulation balance was achieved.The dynamic parameter curves did not present excessive deviation from reference.One case encountered intermuscular hematoma of the lower limbs 48 hours postoperatively, which was solved by a LMWH pause and administration of fresh frozen plasma and clotting factors.One case suffered upper gastrointestinal hemorrhage five days postoperatively, which was controlled by a LMWH pause and the administration of somatostatin and proton pump inhibitor.Jaundic got worse in one case three days postoperatively but got relieved after treatment.Overt blood loss was 686t141.8 ml.Perioperative death, hepatic failure, hepatic encephalopath, hepatorenal syndrome were absent.No DVT was observed.Conclusion There are risks of DVT in patients of hepatic cirrhosis.Individualized anti-coagulation treatment is needed during perioperative period of THA.

Sal-like 4 (SALL4) plays an important role in promoting the cellular proliferation and maintaining the pluripotency of embryonic stem cells and tumor cells.In fully differentiated cells,the expression of SALL4 is silenced or down-regulated.However,the expression of SALL4 is found to be restored or up-regulated in a variety of non-germ cell tumors.Besides,the expression of SALL4 is often associated with disease progression,treatment effect and prognosis.Therefore,examining the expression level of SALL4 will be of great importance in the diagnosis of disease and monitoring the disease progression for non-germ cell tumors.

AIM: To evaluate the effect of glycine on the changes of TNF-?, IL-1?, IL-6, IL-8 and IL-10 in rat serum and pancreas tissue with acute necrotizing pancreatitis (ANP). METHODS: 150 Wistar rats were randomly divided into sham operation group (SO), ANP group and ANP+glycine group (ANP+Gly). The ANP model was established by retrograde injection of sodium taurocholate into cholangiopancreatic duct. The glycine (1 g/kg) was injected intravenously 10 min before sodium taurocholate injection. The changes of ET, TNF-?, IL-1?, IL-6, IL-8 and IL-10 in serum and pancreas tissue were determined and the pathological study was performed as well. RESULTS: The levels of ET, TNF-?, IL-1?, IL-6, IL-8 and IL-10 in serum and pancreas tissue (except IL-10 at 0 h and 12 h in ANP group) in ANP and ANP+Gly groups were significantly higher than those in SO (except at 0 h) (P