Objective To provide the anatomic basis of flap which was anatomized to the ankle by Anatomy study of vascular net around ankle joint.Methods 32 lower limbs were infiltrated into red emulsion;4 perfusions of lower limbs,artery;2 cases of radiography;1 lower limb was infiltrated into black ink.Application anatomy was observed the origin,track-way,branches and configuration in ankle and foot.Results The blood provision in ankle includes three parts;All the patients recovered well after treatment by careful flap-design.Conclusion The vascular net around anatomy of the ankle can provide help for the design,the choice and the operation of ankle's,tissue flap,and the function's,recovery after surgery.

Aim To explore the role of progesterone re-ceptor B ( PRB ) in regulation of medroxyprogesterone acetate ( MPA) sensitivity in endometrial cancer cells, and to investigate the effect of MPA on the biological character in Ishikawa cells infected with shRNA targe-ting PRB gene. Methods Ishikawa cells were stably transfected with PRB shRNA using lentivirus to knock-down endogenous PRB expression. Real-time fluores-cent quantitative PCR was applied to confirm the knockdown effect. MTT assay, flow cytometry and cell invasion assay were applied to detect the influence of MPA on endometrial cancer cell proliferation, apopto-sis and invasion. We also used Western blot assay to detect the effect of MPA induced the activation of ERK/MAPK signal pathway. Results Recombinant lentiviral vector expressing shRNA targeting PRB gene was successfully established, results of real-time PCR and Western blot showed that compared with control group, PRB expression in Ishikawa cells infected with shRNA decreased obviously ( P <0.01 ); MPA could repress endometrial cancer cells proliferation and inva-sion, meanwhile promoted its apoptosis ( P <0.01 ) . However, the effect was almost reverse in Ishikawa cells infected with shRNA. Furthermore, MPA induced ERK/MAPK activation in Ishikawa cells infected with shRNA. Conclusions PRB plays a role in regulating therapeutic sensitivity of MPA in endometrial cancer cells;and for Ishikawa cells infected with shRNA tar-geting PRB gene, MPA has effects on the biological character via pERK1/2-MAPK signal pathway.

Objective To evaluate the predictive value of MRI features in the diagnosis of placenta increta/percreta preoperative-ly.Methods We retrospectively reviewed MRI of 39 pregnant women who were suspected to have placenta increta/percreta by the ultrasound previously.1 7 patients were defined as placenta increta/percreta according to the surgical-pathological results,while 22 patients were defined without abnormal placentation.We assessed the presence or absence of the specialized MRI features of placenta increta/percreta.The binary logistic regression analysis was used to determine the valuable MRI findings for predictive of placenta increta/percreta.Results The tenting of the superior wall of bladder or the infiltration of adjacent organs were the most useful signs to predict placenta percreta,with the highest odds ratio (OR)value of 70,P =0.008.The low signal intensity bands on T2 WI and focally interrupted interface of placenta/myometrial were valuable signs to the predictive of placenta increta,with the OR value of 6.4 and 5.6 respectively according to the univariate analysis.On multivariate regression analysis,the low signal intensity bands on T2WI was independent predictive factor for placenta increta(OR 6.6,P =0.02),while the focally interrupted interface of placen-ta/myometrial was not independent factor (OR 3.1 6,P =0.1 75).Conclusion The most useful predictive MRI features for placenta increta/percreta are tenting of the superior wall of bladder and the infiltration of adjacent organs,followed by the low signal intensity on T2 WI.The focally interrupted interface of placenta/myometrial is useful factor.

During the process of China’s healthcare reform, the concept of “costly access to health care” has been discussed for quite a long time. However, big data indicates that a small number of patients (5%) account for disproportionate costs ( approximately 50%) . “Costly access to health care” may not be a ubiquitous perceived prob-lem for all residents. In this paper, the concept“high-need patient” will be introduced and the characteristics of the population will be analyzed. According to the healthcare reform experience from the international perspective, this paper proposed healthcare strategy for Chinese high-need patients and policy recommendations for China’s healthcare reform.

ObjectiveTo investigate the effect of acup point injection and rehabilitation techniques on recovery of upper limb function and activities of daily life (ADL) in patients with shoulder-hand syndrome (SHS) after cerebral infarction.Methods Ninety-six patients with SHS after cerebral infarction admitted to Jiuquan City Traditional Chinese Medicine Hospital and Jiuquan City People's Hospital from January 2014 to February 2016 were enrolled, and they were randomly assigned to observation group (56 cases) and control group (40 cases). The patients in the two groups were given the same routine comprehensive cerebral infarction treatments and rehabilitation technological training. In the control group, additionally intermediate frequency physiotherapy was used, while in the observation group, acupuncture and acupoint injection of salvia miltiorrhiza and ligustrazine were added. The patients in two groups were treated consecutively for one month, afterwards, the upper limb motor function, ADL, shoulder joint pain, degree of swelling and range of motion were assessed, and the clinical effects were observed.Results After treatment, the modified Fugl-Meyer motor function score (FMA), modified barthel index (MBI) and the ranges of voluntary activities of shoulder abduction, adduction, flexion, extension, internal rotation and external rotation in patients of two groups were significantly increased than those before treatment; the pain visual analog scale (VAS) and the edema volume difference in observation group were lower than those in the control group, and after treatment, the changes of above indexes were more significant in the observation group than those in the control group [FMA: 70.10±6.38 vs. 41.76±18.69, VAS: 2.00±1.37 vs. 5.00±1.25, MBI: 75.17±3.51 vs. 51.56±2.12, edema volume difference (cm3): 2.13±2.05 vs. 5.75±1.17, flexion: (153.1±6.7)° vs. (56.0±10.9)°, extension: (39.6±5.8)° vs. (17.2±6.7)°, abduction:(168.1±9.6)° vs. (52.1±8.9)°, adduction: (52.1±3.6)° vs. (21.8±4.3)°, external rotation: (49.8±7.6)° vs. (23.2±5.2)°, internal rotation: (107.0±8.5)° vs. (51.2±6.1)°], the total effect in observation group was significantly higher than that in the control group [91.1% (52/56) vs. 70.0% (28/40),P < 0.05].Conclusions Acupuncture and acupoint injection combined with three-level therapeutic regimen of rehabilitation technological training for treatment of shoulder-hand syndrome after cerebral infarction can reduce the patient's pain and edema, and improve upper limb motor function and activities of daily living.

Background and purpose: ERCC2 gene silence by siRNA interference was observed in esophageal cancer cell line and it could change cell sensitivity to taxol. This study was to investigate the biological mechanism of paclitaxel-resistance in esophageal cancer cells. Methods: ERCC2 targeting siRNA (si-ERCC2) has been synthesized. The constructor were transfected into ERCC2 cell lines high-KYSE150(bigh expression of ERCC2) through lipofectamine. RT-PCR and flow cytometry (FCM) were used to detect the ERCC2 mRNA and protein expression levels. MTr assay was used to estimate the paclitaxel sensitivity of the cells. Results: In si-ERCC2 group, ERCC2 could not be detected and ERCC2 protein expression were reduced by 31.2%, 51.6% and 60.0%, respectively, 24,48,72 b after transfection. Paclitaxel IC_(50) value for si-ERCC2 group was 6.32±0.87 μg/mL, lower than the control group(49%). Conclusion: siRNA could successfully silence the target gene ERCC2 at the level of transcription and translation of the gene, the reduction of ERCC2 expression may reverse taxol resistance of the cells.

Objective:To silence ERCC2 (excision repair cross-complementing rodent repair deficiency,complementatin group 2,ERCC2) expression in esophageal cancer KYSE150 cells by small interfering RNA (siRNA) and observe the altered sensitivity of KYSE150 cells to paclitaxel (PTX) and elucidate the mechanism underlying the reversion of the PTX resistance of KYSE150 cells. Methods:ERCC2-targeted siRNA was synthesized in vitro and transiently transfected into ERCC2 overexpressing KYSE150 cells via Lipofectamine mediation. The mRNA and protein expression levels of ERCC2 were determined by using RT-PCR and FCM method, respectively. The sensitivity of KYSE150 cells to PTX was measured by MTT assay before and after siRNA transfection. Results:RT-PCR results suggested that the specific bands of ERCC2 mRNA were not detected in si-ERCC2 group at 24, 48 and 72 h post transfection. FCM results indicated that the expression levels of ERCC2 protein gradually decreased by 31.2%, 51.6% and 60.0% at 24, 48 and 72 h respectively(P<0.01). The IC_(50) value of PTX for ERCC2-silencing KYSE150 cells was (6.32±0.87) μg/mL, lower than that for control cells (P<0.01). Conclusion:siRNA successfully silenced the expressions of target gene ERCC2 at both the transcription and translation levels. Silencing ERCC2 expression partly reversed the resistance of KYSE150 cells to PTX.

Objective To investigate the efficacy of precise hemihepatectomy guided by middle hepatic vein(MHV),and to study the value of preoperative hepatic vein evaluation.Methods The clinical data of 68 patients who received hemihepatectomy at the Nanjing Drum Tower Hospital from October 2007 to September 2009were prospectively studied.Of the 68 patients,30 received precise hemihepatectomy guided by MHV(precise group)and 38 received anatomical hemihepatectomy(traditional group).The types of hepatic vein in the precise group were evaluated and classified preoperatively.The operation time,operative blood loss,volume of blood transfusion,liver function,morbidity and length of hospital stay of the 2 groups were compared.All data were analyzed using the t test,rank sum test,chi-square test and Fisher exact probability.Results According to the Nakamura's classification,there were 17(57%)patients with type Ⅰ,8(27%)with type Ⅱ and 5(16%)with type Ⅲ;according to the Kawasaki's classification,there were 11 patients with type Ⅰ(37%)and 19 with type Ⅱ(63%).There were 13 patients received right hepatectomy with MHV preservation,15 received left hepatectomy with MHV preservation,1 received right hepatectomy without MHV preservation and 1 received left hepatectomy without MHV preservation.There were no significant difference in the volume of operative blood loss and blood transfusion,level of alanine transaminase,total bilirubin,cholinesterase at postoperative day 3,total length of hospital stay and length of postoperative hospital stay between the 2 groups(t = 1.07,0.92,0.07,0.21,0.63,0.63,0.75,P ＞ 0.05).The operation time,levels of albumin at postoperative day 3 and complication rate were (342 ± 113)minutes,(35 ±3)g/L and 40%(12/30)in the precise group,and(270 ±73)minutes,(33 ±3)g/Land 66%(25/38)in the traditional group,respectively,with significant differences between the 2 groups(t =2.79,2.19;x2 =4.49,P＜0.05).The positive rates of the resection margin were 5%(1/19)in the precise group and 35%(8/23)in the traditional group,there was a significant difference between the 2 groups(P ＜0.05).ConclusionPreoperative hepatic vein evaluation and precise hemihepateetomy guided by MHV can preserve the functional liver tissues with venous drainage,achieve adequate tumor-free resection margin and reduce the postoperative complication rate.

Objective To evaluate the role of different imaging examinations in diagnosis and minimally invasive surgery of intercondylar eminence fracture of the tibia. Methods Different imaging examinations and minimally invasive surgery were done on 43 patients with intercondylar eminence frac-ture of the tibia admitted from July 2004 to December 2007. Preoperative and postoperative imaging data were collected for comparative analysis of functional score. Results Fracture detection rate of X-ray was 95%, that of CT three-dimensional reconstruction 100% and that of MRI 90%. All fractures were healed at one stage, with sound knee function. Conclusions The traditional X-ray examination is the first choice for diagnosis of the intercondylar eminence fracture of the tibia. In the meantime, three-di-mensional reconstruction of CT can help enhance accuracy of diagnosis and MRI can help diagnose cruci-ate ligament injury. Arthroscopic and minimally invasive surgery is rather complex but good to recovery of knee joint function. Compared with other methods, tension band is simple but reliable, for it can avoid breakage of the fractured bone and is suitable for all types of fractures.

Objective:To explore the role and mechanism of Talin-1 in mouse aortic dissection.Methods:Sixty male FVB mice were evenly divided into groups of blank, model, Talin-1 up-regulation, Talin-1 up-regulation control, Talin-1 down-regulation, and Talin-1 down-regulation control. Except mice in the blank group, mice were treated with β-aminopropionitrile (BAPN) combined with angiotensin to construct a mouse aortic dissection model. Hematoxylin-eosin and vascular elastic fiber staining (EVG) were used to observe the aorta and elastic fiber morphology and structure. Western blot was used to detect the phosphorylation levels of FAK and ERK1 / 2 in mouse aortic tissue.Results:The success rate of aortic dissection in model mice was 70%, and there was no aortic dissection appeared in the blank group.No mice died during the experiment. The incidence of aortic dissection in the Talin-1 down-regulated group was 100%, which was significantly higher than that in the Talin-1 down-regulated control group( P<0.05). The incidence of aortic dissection in the Talin-1 up-regulated group was 20%, significantly lower than that in the Talin-1 up-regulated control group. The wall thickness of the aorta of mice in the Talin-1 down-regulated group was accompanied by hematoma or pseudocavity formation. The median elastic fiber content was higher than that in the Talin-1 downregulation control group( P<0.05). The content of elastic fibers in the blood vessel wall of mice in the Talin-1 up-regulation group was significantly higher than that in the Talin-1 up-regulation control group.The down-regulation of Talin-1 significantly inhibited FAK phosphorylation, and instead promoted ERK1/2 phosphorylation( P<0.05). Conclusions:Down-regulation of Talin-1 may reduce the elastic fiber content in the aorta of mice by activating the ERK1/2 signaling pathway, leading to vascular remodeling of the aortic wall and promoting the occurrence of aortic dissection.