Objective To investigate the effect of alteration of CRELD1 gene expression on the related genes in the endocardial cushion development.Methods Over-expression and silence of CRELD1 gene were realized by the construction of lentiviral vector.Afterwards,the lentiviral vectors were used to infect the human fetal lung fibroblasts (HFL)-I.All of the cells were divided into the following 5 groups:the blank control group,the negative control group of interference,the interference group,the negative control group of over-expression,and the over-expression group.Western blot and real-time fluorescent quantitative polymerase chain reaction were applied to examine the mRNA and protein expression of CRELD1,Sox9,Aggrecan,Scleraxis and Tenascin-C.Results The DNA sequences of 2 recombinant plasmids pLV3-shRNA-CRELD1 and pLV4-CRELD1 matched very well with those which were designed according to the DNA sequence analysis.HFL-I was successfully infected with lentiviral vectors and displayed fluorescent green light under inverted fluorescence microscope.The results of real-time PCR detection and Western blot test were consistent:expressions of Sox9 and Aggrecan in the interference group were significantly higher than those in the negative control group of interference,while the expressions of the 2 genes in the over-expression group were significantly lower than those in the negative control group of over-expression.Expressions of Scleraxis increased in both the interference group and the over-expression group when compared with the negative control groups respectively.Compared to the corresponding negative control groups,Tenascin-C expression decreased markedly in the interference group,whereas it increased significantly in over-expression group.Conclusions CRELD1 gene has negative effect on the expression of the related genes Sox9 and Aggrecan in the endocardial cushion development,whereas it has positive effect on the Tenascin-C expression.It serves as a theoretical framework to illustrate the effect of CRELD1 gene on the atrioventricular septal defect.

Objective To find out about the characteristics and prognosis of retinal detachment due to ocular contusion. Methods The clinical data of 36 patients (36 eyes) with retinal detachment due to ocular contusion were retrospectively analyzed. Results There were 3 eyes (8.3%) with huge retinal hole (≥90?), 4 eyes (11.1%) oral tear of ora serrata retinae, 4 eyes (11.1%) with macular hole, 3 eyes (8.3%) with tractive retinal detachment, and 22 eyes (61.2%) with retinal hole (

To investigate the clinical efficacy of distally based myocutaneous flap pedicled with nutrient vessel of cutaneous nerve of leg for the treatment of traumatic chronic osteomyelitis of lower leg. A total of 25 patients with traumatic chronic osteomyelitis of lower legs were from Department of Burn and Plastic Surgery, Beijing Jishuitan Hospital from January 2002 to June 2008. All the patients were treated with distally based myocutaneous flap pedicled with nutrient vessel of cutaneous nerve of leg after thoroughly debridement. Among them, 6 patients were treated with myocutaneous flap with nutrient vessel of saphenous nerve, and 19 patients were treated with myocutaneous flap with nutrient vessel of sural nerve. The sizes of the flaps were 5 cm×3 cm-18 cm× 12 cm, with attached muscles were 3 cm×3 cm-8 cm×5 cm. The lengths of the pedicles were 5-12 cm. All transplanted myocutaneous flaps survived well. A 6-24 months follow-up of all patients was obtained. The shape and texture of the myocutaneous flaps were good. And there was no recurrence of osteomyelitis. Results suggested that the distally based myocutaneous flap pedicled with nutrient vessel of cutaneous nerve of leg had reliable blood supply and satisfied efficacy, which was a good method for repairing traumatic chronic osteomyelitis of lower leg.

By means of polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) assay, the association between vitamin D receptor (VDR) genotypes and bone mineral density (BMD) in the patients receiving long-term glucocorticoid therapy was studied. The clinical data and blood of 71 patients with rheumatosis who received long-term glucocorticoid therapy were collected. BMD was measured by dual-energy X-ray absorptimometry. VDR gene fragment (about 185 bp) was amplified by PCR from the extracted genomic DNA, then digested with restriction endonuclease Bsm I. The genotypes were evaluated based on the fragment length following endonuclease digestion and the association between genotypes and BMD or Z-score values was analyzed. Among the 71 cases, the detected genotypes were Bb and bb with the distribution frequency being 11.3% and 88.7% respectively. The distribution frequency of the alleles was in agreement with the Hardy-Weinberg equilibrium. There was no significant difference between the two genotypes in age, gender, body mass index (BMI), disease duration, disease types, time of glucocorticoid administration and cumulative dosage (P > 0.05). Osteoporosis rate of the patients with Bb or bb genotype was 37.5% and 33.3% respectively, with the difference being not significant (chi 2 = 0.05, P = 0.8). The BMD and Z-score values at lumbar spine and femur in two genotypes were not similar, but the difference had no significant (P > 0.05). The distribution frequency of bb type of VDR genotypes in Han populations of China was more prevalent, followed by Bb and bb types in turn. In the patients receiving long-term glucocorticoid therapy, there was no significant difference in BMD between Bb and bb genotypes. The data suggest that the VDR genotypes may not be means of identifying patients at greater risk of glucocorticoid-induced osteoporosis, which await to be further confirmed by a large sample size.
Arthritis, Rheumatoid/drug therapy ; Bone Density ; Genotype ; Lupus Erythematosus, Systemic/drug therapy ; Osteoporosis/chemically induced ; Osteoporosis/*genetics ; *Polymorphism, Restriction Fragment Length ; Prednisolone/*adverse effects ; Prednisolone/therapeutic use ; Receptors, Calcitriol/*genetics

Although burn treatment technology has been greatly improved, the number of patients with hypertrophic scar contracture deformities after burn has not decreased significantly. Some patients still have severe deformities, which not only affect the appearance, but also lead to different degrees of dysfunction. Surgery is still dominant for treating hypertrophic scar contracture deformity. In addition to skin grafting, flaps, especially expanded flaps (perforator flaps), expanded free flaps (perforator flaps), and prefabricated flaps etc. are more frequently used in functional and exposed areas after scar excision, in order to achieve perfect repair and reduce donor site damage. The treatment of scar contracture deformity should take into account the rehabilitation after operation on the basis of active operation, so as to achieve the unity of shape and function.

In the repair of burn wound, high-voltage electrical burn wound is still the most complicated and the most difficult one to deal with. According to the clinical experience of author and the literature at home and abroad, this article systematically discusses the early treatment of high-voltage electrical burn wounds, including limbs escharotomy, fasciotomy, and early debridement, and the repair of high-voltage electrical burn wounds in various parts, especially in some special parts, focusing on the repair of the life-threatening parts and site of large vascular injury. At the same time, this article discusses the feasibility and necessity of functional reconstruction. We should make full use of modern repair technology and innovation, interdisciplinary cooperation, so as to reduce disability rate, amputation rate, and mortality of patients with high-voltage electrical burns as far as possible.

Objective To investigate the effects of aspirin(aspi) on rat cardiac fibroblasts (CFs) proliferation induced by aldosterone(ald) and the underlying molecular mechanisms .Methods Primary CFs from 1-3 day neonatal rats were digested by 0.08%trypsin and then purified by differential adhesion .The rats were divided into four groups:control group, DMEM medium ( free calf serum ) , ald group [ DMEM medium ( free calf serum ) +ald 1 ×10 -8 mol/L ] , aspi group [DMEM medium (free calf serum)+ald 1 ×10 -8 mol/L+aspi 1.11 ×10 -6 mol/L] and spiro group [DMEM medium (free calf serum)+ald 1 ×10 -8 mol/L +spiro 1 ×10 -6 mol/L].The morphology of CFs was assayed by HE staining methods .MTT Methods were used to measure cell proliferation .Western blotting was used to determine protein expression of TGF-β-Smad 2,3,4.Results HE Staining results showed that compared with the control group , ald activated cell proliferation and increased the cell division phase significantly (P<0.01).Compared with ald group, aspi+ald as well as spiro+ald could reduce cell division significantly ( P<0 .05 ) .MTT assay showed that compared with control group , ald could significantly improve the metabolism of MTT in CF (P <0.01).Compared with ald group, aspi +ald as well as spiro+ald could reduce the metabolism of MTT (P<0.01).Western blotting revealed that the expression levels of TGF-β-Smad 2, 3, 4 in CF were significantly increased by the stimulation of ald but were significantly reduced in aspi +ald and spiro+ald groups compared with ald group (P<0.01).Conclusion Aspi can inhibit the proliferation of CFs induced by ald,possibly by down-regulating the expression of Smad 2, Smad3 and Smad4.

Objective To present our experience of dealing with complete penile amputation.Methods Two cases of penile complete amputation were reported.The first case was a 34-year-old man,suffered amputation of the penis approximately 2.5 cm distal from the pubic area with a sharp knife.3.5hours later,the patient was transferred to our hospital.The urethra mucosa and corpus spongiosum were anastomosed.The cavernous body of the penis was reattached by suturing the tunics albuginea of each corpus cavernosum to the corresponding proximal segment.One dorssl artery,two dorsal veins,and dorsal nerve were anastomosed under a 10 × microscope with interrupted 9-0 nylon nonabsorbable sutures.The second case was a 25-year-old man,presented to the emergency room 15 hours after distal penile amputation,which had 2 wounds as a result of self-mutilation caused by psychiatric problems.The urethra mucosa and corpus spongiosum were anastomosed.The cavernous body of the penis was reattached by suturing the tunics albuginea of each corpus cavemosum to the corresponding proximal segment using 4-0 polyglactic acid sutures.Results In the first case,the tourniquet was released after replantation,and the distal penis appeared to revascularize,as noted by the gradual increase in redness and size.An arterial pulse was detected,and the superficial penile veins displayed normal turgor,and no bleeding was found.On postoperative day 3,the penile skin started to necrotize.On day 12,the necrotic skin was superficially debrided,and a fistula was observed in the corresponding urethral segment.Two weeks later,the fistula was sutured with 4-0 interrupted synthetic absorbable suture,and a transposition flap to embed the whole injured penis shaft was created from the proximal scrotal skin.The glans was exposed.Two months after the second operation,the embedded penis was released from the scrotum.After follow-up of two years,the patient had glans re-epithelialization with normal voiding,sensation,and erections.In the second case,the glans was still pink,but the penile skin started to necrotize on postoperative day 3.On day 14,serious infections were noted,the necrotic skin was superficially debrided,and the amputated penis was relieved.Conclusions Prompt diagnosis and early treatment are essential to avoid the potential complications of ischemic necrosis and autoamputation.Venous outflow is a critical factor for success of replantation.Microsurgical reanastomosing of the dorsal penile vein,penile arteries,and dorsal nerves can be identified as the standard method for penile replantation.The bipedicled scrotal flap can provide adequate skin cover for penis defects.

Objective To evaluate the safety and efficacy of interventional treatment of occlusion of the entire inferior vena cava (IVC).Methods The clinical data of 6 patients with entire IVC occlusion were analyzed retrospectively.All patients were diagnosed by color Doppler ultrasound and DSA.Venography was performed under local anesthesia via internal jugular vein and femoral vein approach.The occlusion of IVC and hepatic vein were treated with balloon dilatation and/or stent placement.Follow-up examination with color Doppler ultrasound was taken 1,3,6,12 months after treatment and annually thereafter to assess the patency of IVC and hepatic vein.The pressure gradient of hepatic vein-right atrium and IVC-right atrium before and after interventional treatment were compared with paired t test.Results In 5 cases,both IVC and 1 hepatic vein were recanalized successfully.In 1 case,recanalization of IVC failed,but the right hepatic vein was recanalized successfully.The mean pressure gradient of hepatic vein-right atrium decreased from (23.2 ± 2.0) cmH2O (1 cmH2O =0.098 kPa) before treatment to (8.7 ± 3.2) cmH2O after treatment in 6 cases (t =21.6,P ＜ 0.05).The mean pressure gradient of IVC-right atrium decreased from (26.6 ± 2.7) cmH2O before treatment to (9.4 ± 1.1) cmH2O after treatment (t =16.1,P ＜ 0.05).Abdominal pains occurred in 3 patients after stent implantation which disappeared in 24 hours.No other complications such as bleeding and death occurred.During a mean follow-up of(42 ± 27)months (16 to 90 months),hepatic vein patency was maintained in 6 cases and IVC patency was maintained in 5 cases.Conclusion Interventional treatment of occlusion of the entire IVC is a safe and effective method.

Lipase of 54/923 cases increased in viral hepatitis group with an abnormal rate of 5.85％.Lipase level of viral hepatitis patients gradually increased with the rising total bilirubin levels,and the difference was statistically significant (P ＜0.0l).Among 54 viral hepatitis cases with elevated lipase,11 died.The sustained abnormal rate of lipase (6/11) of the death group was statistically significant vs.4.65％ (2/43) of the survival group(P ＜0.01).Thus viral hepatitis could be concomitant with elevated lipase and elevated lipase might promote the progression of liver disease.The continuing rise of lipase is correlated with the severity and prognosis of the patients.