Objective To report our results of a study of 21 patients who underwent reconstruction of complicated head and neck defects following cancer ablation using microvascular anastomotic anterolateral thigh flap To discuss the advantages and disadvantages of using this flap Methods Twenty one consecutive free anterolateral thigh flaps in 21 patients were transferred for reconstruction of head and neck defects following cancer ablation between May 1990 and April 2001 The success rate was 95 percent (20 of 21),with one flap lost due to a twisted perforator The anterolateral thigh flaps were classified into four types according to the perforator derivation and the direction in which it traversed the vastus lateralis muscle Type I is the most common,in which a vertical musculocutaneous perforators from the descending branch of the lateral circumflex femoral artery were found in 61 9 percent of cases (13 of 21) Reconstruction of one layer facial skin defect was carried out in 3 cases,through and through defect in 15 cases,the skin defects of the anterior cervical region and the mucosa defects of the hypopharynx in 3 cases Results Nineteen of 21 flaps survived One flap was totally lost and another was partially lost after surgery The mean follow up was 46 months (range:6 to 120 months) A total of 9 patients were disease free survival Two patients are alive with persistent tumor 5 patients died of local recurrence 4 patient died of regional lymph node metastasis,brain metastasis,second primary cancer and cerebral vascular accident respectively,1 patient was lost to follow up Conclusion The anterolateral thigh flap provides more tissue than the radial forearm flap,no important artery sacrificed and the donor scar is more easily hidden The anterolateral thigh flap can be successfully used to repair a variety of complicated defects of the head and neck

Aim To explore the mechanism of insulin in combination with selenium preventing myocardial apoptosis in diabetic cardiomyopathy rats .Methods SD rats ( n =50 ) were randomly divided into five groups: control , diabetic cardiomyopathy ( DCM ) , DCM with insulin treatment , DCM with selenium treat-ment, and DCM with insulin and selenium combination treatment .The cell apoptosis was observed by TUNEL . The levels of Bcl-2, caspase-3, PARP, Cbl-b and p38 MAPK were examined by Western blot .The inter-actions of Cbl-b-p38 MAPK and Ku70-Bax were detec-ted by immunoprecipitation .Results Insulin in com-bination with selenium synergistically inhibited apopto-sis, up-regulated Cbl-b, down-regulated p38MAPK ex-pressions and increased the interactions of Cbl-b-p38MAPK and Ku70-Bax.Conclusion Insulin and selenium synergistically inhibit myocardial apoptosis by regulating Cbl-b-inhibited p38 MAPK and preventing Bax translocation .

AIM:To investigate the effect of insulin and selenium in combination on the apoptosis and the ex-pression of Ku70, acetylated Ku70, Bax and cytochrome C in myocardial cells of the rats with diabetic cardiomyopathy (DCM), and to explore the mechanism of insulin and selenium in their synergistic anti-DCM effect.METHODS:SD rats (n=50) were randomly grouped into control, DCM, DCM with insulin treatment (DCM+In) group, DCM with selenium treatment (DCM+Se) group, and DCM with insulin and selenium combination treatment (DCM+In+Se) group.Mito-chondrial membrane potential ( MMP) was measured by flow cytometry .The cell apoptosis was observed by terminal-deoxy-nucleotidyl transferase mediated nick end labeling (TUNEL).The levels of Ku70, Bax and cytochrome C were examined by Western blot .The acetylation status of Ku 70 was detected by co-immunoprecipitation .RESULTS: The rats in DCM group showed marked cell apoptosis compared with the control rats .The levels of Ku70 and acetylated Ku70 declined sig-nificantly compared with control group .Bax significantly translocated from cytoplasm into mitochondria and cytochrome C translocated from mitochondria into cytoplasm compared with control group .Compared with DCM +In group or DCM +Se group, insulin and selenium in combination significantly inhibited the apoptosis , down-regulated Ku70 and acetylated Ku70 levels, and prevented Bax and cytochrome C translocation .CONCLUSION: Insulin and selenium synergistically inhibits myocardial apoptosis by regulating Ku 70 acetylation and inhibiting Bax translocation .

Objective To investigate the predictive value of serum lactate combined with PIRO (Predisposition,Infection,Response and Organ dysfunction) score in the development of multiple organs dysfunction syndrome (MODS) in septic patients and to study procalcitonin (PCT),in order to provide guidelines for clinical care.Methods From April 2015 to July 2016,a total of 752 sepsis patients were enrolled and divided into MODS group (n =488) and non-MODS group (n =264) according to the criteria of MODS.At 28 d after admission,these patients were divided into survival group (n =477) and death group (n =275).PCT and lactate levels in serum were measured,and PIRO score of these patients was calculated.Then the differences in levels of PCT and lactate in serum were compared among patients at different PIRO score categories.ROC was constructed to observe the clinical values of the biomarkers,PIRO score and lactate combined with PIRO score in predicting prognosis.Result PCT,lactate levels in serum and PIRO score were significantly higher in MODS group and death group,showing significant positive correlation.The areas under ROC curves (AUCs) of serum lactate combined with PIRO score for predicting MODS were 0.906,which was significantly higher than that of serum PCT (0.716),serum lactate (0.851) and PIRO score (0.840) alone (all P ＜ 0.05).Serum PCT,serum lactate and PIRO score were the independent predictors of MODS.Conclusions Serum lactate in combination with PIRO score was a valuable indicator in predicting development of MODS in septic patients.

DAZL, a member of the DAZ family, plays a key role in human spermatogenesis. It regulates the promoter via genetic modification, especially DNA methylation, promoting the transcription of DAZL. Besides, the relation of DAZL SNPs with male infertility has been a hot spot of research for many years. It is deduced that local and ethnic factors may be associated with the failure of spermatogenesis. This article presents an overview on the results of recent studies, changes in the DNA methylation of DAZL in spermatogenesis, and the association of DAZL SNPs with male infertility, aiming to provide a new theoretical basis and clinical strategy for the treatment of male infertility.
DNA Methylation ; Humans ; Infertility, Male ; genetics ; Male ; Polymorphism, Single Nucleotide ; RNA-Binding Proteins ; genetics ; Spermatogenesis

Clavicle ; injuries ; Fractures, Bone ; therapy ; Humans

Objective To investigate the serum procalcitonin (PCT) levels in sepsis caused by the bacteria,virus and mycoplasma and explore the role of PCT in etiology diagnosis of sepsis in children.Methods Three hundreds and thirty critically ill children with sepsis caused by bacteria,virus and mycoplasma admitted in PICU of Hunan Children' s Hospital from Feb 1,2011 to Sep 1,2012 were reviewed and analyzed.The PCT levels were measured at admission and day 3.The differences in accidence of sepsis caused by bacteria,viruses and mycoplasma according to different serum PCT levels were analyzed.The differences of PCT levels at admission and day 3 in sepsic children caused by bacteria,viruses and mycoplasma were analyzed.Results The level of serum PCT in sepsis caused by bacterial infection were distinctly increased,caused by virus and mycoplasma infections was not obvious but the increases of serum PCT [0.71 (8.14)ng/ml,0.15 (1.68) ng/ml,0.28 (1.89) ng/ml].According to various PCT levels(0.05 ～ ng/ml,0.5 ～ng/ml,2 ～ ng/ml,10 ～ 300 ng/ml),the differences of accidence of sepsis caused by bacteria,virus and mycoplasma were also statistically significant(x2 =84.50,P ＜ 0.01).The PCT level of septic children caused by bacterial infection in day 3 was significantly decreased compared with that at admission [0.32 (5.68) ng/ml vs 0.71 (8.14) ng/ml] (U =19.34,P ＜0.05).Conclusion PCT plays a certain role in etiology diagnosis of sepsis in children.The increased PCT levels which can be reduced by anti-inflammatory treatment indicate the likelihood of bacterial infection and sepsis.The increase of PCT induced by viral and mycoplasma infections is not obvious,but bacterial infection can not be completely ruled out.

Objective To study the effect of traditional Chinese medicine ointment ironing in alleviating the local reaction caused by intravenous infusion of 20%and sum up nursing experience. Methods Fifty eight patients of acute lumbar disc patients with intravenous infusion of 20% mannitol were randomly divided into the observation group and the control group according to the simple random method with 29 cases in each group. In the course of intravenous infusion of 20%mannitol, local hot dressing was done in the observation group using traditional Chinese medicine ointment ironing properly along the direction of the blood vessel from the 2 cm puncture needle until 30 min after intravenous infusion of mannitol was finished. The control group use the concentration of 330 g/L (33%) magnesium for hot and wet dressing until 30 min after intravenous infusion of mannitol was finished. The two groups were compared in terms of pain degree and the level of phlebitis. Result The pain degree and phlebitis level in the observation group were significantly lower than those in the control group (all P<0.01). Conclusion The traditional Chinese medicine ointment ironing can effectively alleviate local pain and reduce the severity of phlebitis caused by intravenous infusion of 20%mannitol , with curative effect better than that of magnesium sulfate.

Objective To evaluate the application of 3D DSA in diagnosis of intracranial aneurysm. Methods Conventional DSA and 3D DSA were performed in 15 cases with subarachnoid hemorrhage. Results Of 15 cases, by 3D DSA, 12 ones were diagnosed as intracranial aneurysm, and the remaining 3 ones were suspected, while 7 ones could be diagnosed by conventional DSA. Conclusion 3D DSA can improve the diagnosis of intracranial aneurysm.

The purpose of this study was to investigate the changes of protein kinase Calpha (PKCalpha) and cyclin D1 expressions in pulmonary arteries from smokers with normal lung function and smokers with mild to moderate chronic obstructive pulmonary disease (COPD). The peripheral lung tissues were obtained from 10 non-smokers with normal lung function (non-smoker group), 14 smokers with normal lung function (smoker group), 11 smokers with mild to moderate COPD (COPD group). The morphological changes of pulmonary arteries were observed by HE-staining. The expressions of alpha-smooth muscle actin (alpha-SMA), proliferating cell nuclear antigen (PCNA), PKCalpha and cyclin D1 proteins in pulmonary artery smooth muscle cells (PASMCs) were immunohistochemically determined. The percentages of PCNA-positive cells were taken as the smooth muscle cells proliferation index (PI). The mRNA expressions of PKCalpha and cyclin D1 in PASMCs were evaluated by real-time fluorescence PCR. Morphometrical analysis showed that the ratio of pulmonary artery wall area to total area (WA%) in smoker group and COPD group was significantly greater than that in non-smoker group (P<0.01). The PASMCs proliferation index in smoker group and COPD group was significantly higher than that in nonsmoker group (P<0.01). The protein levels of PKCalpha and cyclin D1 in PASMCs were significantly increased in smoker group and COPD group as compared with non-smoker group (P<0.01). The mRNA expressions of PKCalpha and cyclin D1 in PASMCs were significantly elevated in smoker group and COPD group as compared with non-smoker group (P<0.01). Significant correlations were found between PKCalpha protein and WA% or PI (P<0.01). Correlations between cyclin D1 protein and WA% or PI also existed (P<0.01). The expression of PKCalpha was positively correlated with the expression of cyclin D1 at both protein and mRNA levels (P<0.01). In conclusion, increased expressions of PKCalpha and cyclin D1 might be involved in the pathogenesis of abnormal proliferation of PASMCs in smokers with normal lung function and smokers with mild to moderate COPD.