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.

Clavicle ; injuries ; Fractures, Bone ; therapy ; Humans

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

Objective To establish the reference range of serum human serum insulin levels in our laboratory and investigate measurement stability, Methods The automated Architect i2000 chemiluminescence immunoassay, calibrator and quality control materials were used to measure concentration of serum insulin. Totally 413 cases of healthy adults were enrolled. The physiologic characteristics and the influence of laboratory markers on insulin levels were analyzed. Then the reference range in our laboratory was established. The thermal stability of insulin at different temperatures was investigated. Results Within-run imprecision and between-day imprecision of the automated Architect i2000 insulin assay were 1.67% and 2. 6%, which indicated that this system had good analytical performance. The subjects were classified into 4 groups according to age range ( 10 years). There was no significant difference among four age groups (the median is 5. 6, 5.2, 5.3 and 5. 7 mU/L) (X<'2> = 1. 929,P >0.05). However, the insulin levels were higher in female ( median = 5.7 mU/L) than male ( median = 5.0 mU/L) ( Z = 3.696, P < 0.01 ). The reference range was established based on the 2. 5 and 97.5 percentile values. The reference range of insulin for female was 2. 6-11.8 mU/L and 2. 3-11.6 mU/L for men, which differed from that of other insulin assay. Insulin had a positive correlation with BMI (r =0. 115 ,P =0. 019) and triglyeeride (r =0.143 ,P = 0. 004), and a negative correlation with high density lipoprotein (r = -0.179, P = 0.000). Insulin was stable at 25 ℃ for at least 4 hours or 4 ℃ for 24 hours or could be extended to at least 7 days when stored at -20 ℃. Conclusion Gender is an important physiologic characteristic which has an impact on human serum insuhn level. Insulin reference range should be established according to gender. Insulin immunoreactivity was not very stable at different temperatures.

Objective To explore the pancreatic kininogenase enteric-coated tablets in the treatment of diabetic retinopathy (DR) patients and its effect on the optic disc and macula retinal hemodynamics. Methods 86 cases (140 eyes) of DR patients were randomly divided into pancreatic kininogenase group and normal group with 43 cases in each group, two groups were treated with basic therapy, pancreatic kininogenase group were combined with pancreatic kininogenase treatment. The best corrected visual acuity and the clinical effect of optic disc and macula retinal hemodynamic changes were compared between two groups. Results After treatment, the best corrected visual acuity (BCVA) in pancreatic kininogenase group was greater than the normal group (P<0.05), the retinal neovascularization and fluorescein leakage area in pancreatic kininogenase group was less than the normal group (P<0.05). The disc vascular and macular retinal blood flow volume (VOL), blood flow velocity (FLW)values in pancreatic kininogenase group were larger than those of normal group, and the clinical curative effect of pancreatic kininogenase group was better than that of normal group (P<0.05). Conclusion Pancreatic kininogenase enteric-coated tablets in the treatment of DR patients can improve the optic disc and macular retinal hemodynamic parameters, improve visual acuity and reduce the retinal neovascularization and fluorescein leakage area, so as to improve the clinical treatment effect.

Objective To make a summary of radiation-induced changes in ocular lens and retinal lesions based on dynamic follow-up of a patient exposed to a radiation exposure from 192 Ir source accident,in order to provide the information and experience for the clinical diagnosis and treatment of such injury in emergency of a nuclear or radiation accident.Methods The examination methods included eye lens and visual acuity,slit-lamp examination,fundus examination,automated perimetry,optical coherence tomography (OCT) examination,fundus photography,and fundus fluorescein angiography (FFA).The patient was followed-up for 20 months.Comparative analyses were made of the follow-up results.Results One month after 192Ir radiation exposure,the visual acuities in both eyes were 1.0.Mild age-related opacities were observed in peripheral cortex,but the fundus looked normal.Twenty months later,the patient was followed-up.The visual acuities reduced to about 0.6,evident powder-and punctuate-like opacities could be observed in the cortex of the right lens,and mild turbid foci in the posterior polar and capsule.Multiple scotomata appeared in the superior temporal and inferior nasal in the right eye.The macular fovea thickness was not changed significantly in the right eye.Examination with fundus photography demonstrated mild optical nerve atrophy,drusens,and pale optic discs,while FFA examination showed punctuate or flocculent leakages in both eyes.Conclusions The lens opacity could be induced or accelerated by radiation exposure.In addition to the posterior capsule and pole cataracts,punctuate opacity within cortical layer may also occur.It also suggests that cataract and fundus injuries may occur later during long-term follow-up,even though the eyes may look normal during early examination after the patient exposed to the radiation.

AIM: To investigate the details of age-related changes of T lymphocytes in order to seek for sensitive biomarker for immunosenesence. METHODS: Heparin anticoagulated venous blood was collected freshly from young (20-35 years) and elderly (50-75 years) volunteers and three or four color immunofluorescence staining was performed. The nucleated cells were acquired and the phenotypes of T lymphocyte subpopulations were analyzed with flow cytometry. RESULTS: There was no significant difference in percentages of pan-T (CD3 +), helper T (CD4 +) and cytotoxic (CD8 +) T subsets between young and elderly, whereas the density of CD3 molecule (MFI) on T cells in elderly group decreased significantly. It was also found that the rates of CD44 + and CD62L + T cell subsets in young group did not have statistical difference from elderly. However,the rates of CD95 + pan-T, helper T and cytotoxic T subsets of elderly group were all markedly higher than that in young group. CONCLUSIONS: The relative rates of T cell and its subsets displayed no age-related changes while the density of CD3 was down-regulated during aging in these groups investigated. Moreover, the expression percentage of CD95 (Fas) on T cells increased as aging, suggesting that it is a potential biomarker for evaluating immunosenescence.