AIM: To explore the curative effects of various approaches to improve the arterial inflow following flap grafting with various tensions. METHODS: 135 patients with skin defects in limbs, who underwent flap grafting in Department of Orthopedics, Baoan People's Hospital of Southern Medical University between August 2002 and August 2006, were selected, and informed the consent. The wounds of every 45 cases were sutured under the tension of 1.0 kg, 1.5 kg, and 2.0 kg, respectively; meanwhile, all patients were randomly divided into hyperbaric oxygen group, dexamethasone group, and local injection of heparin group with 15 cases in each group, and given the corresponding treatment besides ordinary treatment. Seven days later, the flap survival was observed. RESULTS: 135 patients were all involved in the result analysis without any loss. The flaps of 90 patients recovered completely under the tension of 1.0 kg and 1.5 kg. But under 2.0 kg tension, the flaps of 10 penitents in the hyperbaric oxygen group recovered, 4 survived mostly and 1 necrosed; in the dexamethasone group, 5 flaps recovered, 3 survived mostly, and 7 necrosed; in the local injection of heparin group, 3 flaps recovered, 3 survived mostly, other 9 necrosed completely. CONCLUSION: The suture tension of 1.0 kg to 1.5 kg is feasible in flap grafting, and compared with heparin and dexamethasone, hyperbaric oxygen could better promote the arterial inflow under high tension like 2.0 kg.

Objective To explore the clinical significance of blood serum AFP determination in gravis type viral hepatitis. Methods The level of blood serum AFP was determined by radioimmunoassay in 85 eases of gravis type viral hepatitis, and its change was observed in a dynamic state. Results The abnormality rate of AFP was 83. 6% in the patients of gravis type viral hepatitis. The abnormality rate of AFP in acute gravis type viral hepatitis was significantly lower than that in suhacute severe hepatitis and chronic severe hepatitis(P < 0.01). The survival rate in the team with high level of AFP was significantly higher than that of teams with normal or low level of AFP(P <0.01～0.05) in the patients of gravis type viral hepatitis. The blood serum AFP level in the survivors was significant-ly higher than that of the death in the patients of gravis type viral hepatitis(P <0.01). Conclusions The blood ser-um AFP determination in gravis type viral hepatitis,can be used as a sensitive index for prognosis. A high level of AFP indicates that the hepatic cells regeneration is active and the prognosis is relatively better.

Objective To observe the 3 years or more effects on optical correction,refraction,and orthokeratology with rigid gas permeable contact lens(RGPCL) wearing in patients with keratoconus.Design Retrospective case series.Participant 73 keratoconus patients(136 eyes) fitted with RGPCL.Methods Patients wearing RGPCL for 3 years or more in Peking University Optometry & Ophthalmology Center were observed.Correct visual acuity was determined before and at 1,2 and 3 years of lens wearing,and the refractive power,corneal curvature,corneal astigmatism and corneal morphological changes were measured with auto-refractomer/keratometer and keratoconus screening analysis system of computer-assisted corneal topography at the same time.The changes of base curve and RGPCL power were also compared.All patients were divided into mild keratoconus group(Group A),moderate and severe keratoconus group (Group B).Main Outcome Measures Visual acuity,refractive power,base curve of RGPCL,corneal topography parameters.Results The patients wore RGPCL for 49.3?15.3 months(36-76 months).At the initial visit,uncorrected visual acuity(UVA) was 3.76?0.45, corrected visual acuity with spectacles(SPVA) was 4.57?0.53,and with RGPCL(RGPVA) was 4.89?0.14.RGPVA was improved significantly (F=171.994,P=0.000).RGPVA at last visit(4.95?0.11) was better than that at initial visit(t=-6.733,P=0.000),which was more significant in group B than that in group A.The rate for RGPVA more than 0.8 at the initial,1 year,2 years and 3 years of lens wearing was 85.13%,86.76%,85.60%and 84.62%respectively.At the initial visit and last visit,the myopia diopters and the corneal astigmatism were 7.13?4.01D vs.6.23?3.42D(P=0.014) and 6.23?3.24D vs.4.42?2.34D(P=0.000) respectively.The RGPCL base curve and lens power were 7.38?0.50 mm vs.7.54?0.42 mm(P=0.000),and -6.22?3.59 D vs.-5.33?3.09 D(P=0.000) respectively. The changes of power and base curve of lens in group B were more significant than that in group A.The decrease of 9 corneal topography parameters between initial visit and last visit was significant statistically(all P

Objective To study the effect of the recombinant matrilysin (rMMP-7) and its antisense oligonucleotide transfected by liposome (LIPO-MAON) on the proliferation of lung adenocarcinoma cell line A549 and human umbilical vein endothelial cells (HUVEC). Methods Antisense oligonucleotide of matrilysin was constructed by liposome transfection. The proliferation of HUVEC and A549 was detected by MTT assay in case of rMMP-7 or LIPO-MAON existence. The expression of MMP-7 mRNA in both HUVEC and A549 was examined by semi-quantitative RT-PCR assay. Results The proliferation of both HUVEC and A549 cell line was accelerated by high level of rMMP-7 (0.75, 1.0 ?g/ml), and the inhibited proliferation was only found in A549 cell line treated with high concentration of LIPO-MAON (7.5, 10 nmol/ml), but not in HUVEC. By RT-PCR assay, no expression of MMP-7 mRNA was found in HUVEC; however, enhanced or decreased expression of mRNA were found when A549 cell line was treated respectively with rMMP-7 or LIPO-MAON (P

Objective To detect the difference of cerebral gray matter change in children with different karyotype Turner Syndrome (TS) by using voxel-based morphometry (VBM).Methods Nineteen children with 45XO karyotype TS,21 children with heterozygous TS and 20 age-matched control girls were recruited in this study.Wechsler intelligence scale for children was used to obtain their intelligence quotients (IQ).High-resolution magnetic MR imaging was performed in TS children and control girls to collect the whole brain structural data.The data was analyzed by VBM based on SPM8 to compare the volume of gray matter among the monosomy TS children,heterozygous TS children and normal controls by using covariance analysis.Alphasim method in the software of analysis of functional neuroimages(AFNI) was used for clusterlevel multiple comparison.Results The IQ was 89 ± 16 for the monosomy TS children,and it was 91 ± 13 for heterozygous TS children and 109 ± 15 for the controls.Statistical analysis revealed significant difference of IQ among them (F =10.75,P ＜ 0.05).Compared with normal controls,both monosomy TS children and heterozygous TS children showed significantly decreased volume (voxel numbers in clusters were 4117,1392,1085,t =5.75,5.33 and 5.02 for monosomy TS; voxel numbers in clusters were 4501,2437,591,t =5.40,5.11 and 4.95 for heterozygous TS respectively,P ＜ 0.01,FWE-corrected) in the gray matter of bilateral precuneus lobule,postcentral gyrus,and cingulum cortex.However,the volume of the orbitofrontal lobe,parahippocampal gyrus,cerebellum,temporal pole,corpus striatum and posterior midbrain were increased in the monosomy and heterozygous TS children compared to the controls (voxel numbers in clusters were 1444,1188,791,725,695,431,386,t =5.01,5.96,5.67,5.23,4.85,4.43,4.94 for monosomy TS; voxel numbers in clusters were 6988,2709,2510,2380,1987,1709,1185,t =6.50,7.06,7.26,5.27,5.71,6.02,4.56 for heterozygous TS,P ＜ 0.01,FWE-corrected).Compared with monosomy TS,heterozygous TS showed increased gray matter volume in the left parahippocampal gyrus and corpus striatum (voxel numbers were 1014 and 496,t =4.75,4.53,P ＜0.01,FWE-eorreeted),while they had decreased gray matter volume in the right supramarginal gyrus (voxel number was 350,t =4.28,P ＜ 0.01,FWE-corrected).Conclusions Both monosomy and heterozygous TS show brain atrophy in the parietooccipital lobe,indicating similar abnormality of gray matter development.However,heterozygous TS shows more increased gray matter volume in the prefrontal lobes and the cerebellum than monosomy TS,which may be the compensatory mechanism in this condition.

Objective To investigate the relationship between serum levels of alanine aminotransferase (ALT)or aspartate aminotransferase (AST)apportioned by the same hepatic parenchyma cell volume and liver histological necroinflammation grades in HBeAg-negative chronic hepatitis B (CHB)patients.Methods A total of 145 CHB patients were divided into four groups:Gl,G2,G3 and G4 based on the liver histological necroinflammation grade.The serum ALT and AST levels were determined by automatic biochemical instrument in these four groups.Furthermore,serum ALT and AST levels were then apportioned by the same hepatic parenchyma cell volume.The data were analyzed by ANOVA.Results Mean serum ALT levels in G1,G2,G3 and G4 groups were (35.3±29.1),(91.6±120.4),(111.6± 116.1)and (118.0±122.1)U/L,respectively,and the serum ALT levels apportioned by same hepatic parenchyma cell volume were ( 54.0 ± 45.1 ),( 144.2 ± 184.9 ),(191.3± 204.8)and (215.1 ± 226.5)U/L,respectively.The pairwise comparison between G1 and other three groups all showed statistically significant difference (P＜0.05).Meanwhile,AST levels in G1 to G4 groups were (35.5± 29.0),(64.9±71.7),(96.0±81.9)and (102.8±77.0)U/L,respectively and the serum AST levels apportioned by the same hepatic parenchyma cell volume were (54.3±44.6),(102.3± 107.9),(165.2±148.7)and (189.4±145.4)U/L,respectively.The pairwise comparison between G1 and G3,G1 and G4,G2 and G3,G2 and G4 all showed statistically significant difference (P＜0.05).Conclusion Both AST and ALT levels are sensitive indicators for liver inflammation grading in HBeAg-negative CHB patients during the natural history of the disease.

Objective To explore the association between interleukin (IL)-28B variation and spontaneous clearance of hepatitis C virus (HCV) infection.MethodsA total of 280 HCV infected patients including 200 chronic hepatitis C (CHC) patients and 80 spontaneous clearance patients of HCV infection were enrolled in the study.The rs8099917 single nucleotide polymorphyism (SNP) of IL-28B gene was detected and the association between IL-28B variation and spontaneous clearance of HCV infection was analyzed.The data were compared using chi square test.ResultsThe genotype frequencies of TT and non TT (TG and GG) of IL-28B rs8099917 between CHC patients and spontaneous clearance patients were not significantly different ( x2 =15.874,P ＜ 0.01 ). The prevalence of TT genotype in the spontaneous clearance group was 86.2％,which was higher than that in CHC group (62.0％).T and G allele frequencies in CHC group were 78.0％ and 22.0％,respectively,and those in spontaneous clearance group were 92.5％ and 7.5％,respectively,which indicated that T allele was dominant in spontaneous clearance patients. The allele frequency of rs8099917 was statistically different between the two groups (P＜0.01).The spontaneous HCV clear rate in rs8099917 TT patients was 2.84 folds of non-TT patients,while the risk of chronicity of non-TT (TG+GG) patients was 1.36 folds of TT patients.Conclusion The IL-28B (rs8099917) TT genotype is associated with spontaneous clearance of HCV infection,which can be an important factor to predict the spontaneous clearance of HCV.

BACKGROUND: Genetically engineered cells have been used in the replacement therapy and gene therapy. However, how to select proper donor cells, target cells, and corresponding viral vectors is the most difficult in the therapy.OBJECTIVE: To compare the transduction efficiency of recombinant adenovirus Ad5 and AdSF35, adeno-associated virus rAAV1/2 and rAAV2, and lentivirus LV in bone marrow mesenchymal stem cells (BMSCs) and exogenous gene expression level so as to select the vectors, which can efficiently transduce BMSCs.DESIGN, TIME AND SETTING: Gene engineering controlled observation, performed in the Central Laboratory, Shanghai First People's Hospital between October 2006 and March 2007.MATERIALS: Ten Sprague Dawley rats of clean grade were used to prepare BMSCs. All recombinant viral vectors carded enhanced green fluorescent protein (EGFP) report gene. Ad5 was prepared by the Central Laboratory, Shanghai First People's Hospital. Ad5F35 was gifted by professor Qian Qi-jun from the Second Military Medical University of Chinese PLA. rAAV2 and rAAVI/2 were the products of Benyuan Zhengyang Gene Technique Co.,Ltd. LV was gifted by professor Cuo Li-be from Shanghai Institute of Biochemistry and Cytobiology, Chinese Academy of Sciences.METHODS: Rat BMSCs were in vitro isolated and cultured by density gradient centrifugation. BMSCs of passage 4 were inoculated into 24-well plate at lxlO5/well. One day later, ceils adhered to the wall and allocated to 5 groups. Ad5-EGFP [10, 100,1 000 multiplicity of infection (MOI)], Ad5F35-EGFP (10,10, 1 000 MOI), rAAVI/2-EGFP (1×104,1x10× vg), rAAV2-EGFP(1×104, 1x105vg), and LV-EGFP (30 TU) were respectively added into the 5 groups. BMSCs were transduced for 2 days with Ad virus and separately for 6 days with rAAV and LV virus.MAIN OUTCOME MEASURES: EGFP-positive expression and fluorescence intensity.RESULTS: After twenty-four hours of Ad5-EGFP transduction, EGFP-positive cells were visible under the microscope. With virus dose increasing, EGFP-positive cells increased and fluorescence intensity strengthened. Twelve days later, EGFP-positive cells gradually reduced and fluorescence intensity weakened. For Ad5F35-EGFP, its transduction was basically similar to Ad5-EGFP, but EGFP-positive cell number and fluorescence intensity were increased. After 6 days of rAAV1/2-EGFP or rAAV2-EGFP transduction, EGFP-posidve cell number and fluorescence intensity were decreased. For LV-EGFP transduction, a small amount of EGFP-positive cells could be visible on the second day, and then EGFP-positive ceils and fluorescence intensity were gradually increased until the sixth day.CONCLUSION: Ad5, Ad5F35 and LV could effectively transduce BMSCs cultured in vitro and express exogenous gene.Furthermore, transduction efficiency was correlated with virus dose in dose-dependent manner, rAAVI/2 and rAAV2 had poor/in vitro transduction efficiency.

AIM:Increasing evidence indicates that inflammation contributes to the initiation and perpetuation of atrial fibrillation ( AF) .Al-though tumor necrosis factor ( TNF)-αlevels are increased in patients with AF , the role of TNF-αin the pathogenesis of AF remains unclear.Recent research has revealed that T-type Ca2+currents ( ICa,T ) play an important role in the pathogenesis of AF .METH-ODS:In this study , we used the whole-cell voltage-clamp technique and biochemical assays to explore the role of TNF-αin the regula-tion of ICa,T in atrial myocytes.RESULTS:We found that compared with sinus rhythm (SR) controls, T-type calcium channel (TCC) subunit mRNA levels were decreased , while TNF-αexpression levels were increased , in human atrial tissue from patients with AF .In murine atrial myocyte HL-1 cells, after cultured for 24 h, 12.5, 25 and 50 μg/L TNF-αsignificantly reduced the protein expression levels of the TCC α1G subunit in a concentration-dependent manner .The peak current was reduced by the application of 12.5 or 25μg/L TNF-αin a concentration-dependent manner [from ( -15.08 ±1.11) pA/pF in controls to ( -11.89 ±0.83) pA/pF and (-8.54 ±1.55) pA/pF in 12.5 and 25 μg/L TNF-αgroups, respectively].TNF-αapplication also inhibited voltage-dependent inactivation of ICa,T shifted the inactivation curve to the left .CONCLUSION:These results suggest that TNF-αis involved in the path-ogenesis of AF, probably via decreasing ICa,T function in atrium-derived myocytes through impaired channel function and down -regula-tion of channel protein expression .This pathway thus represents a potential pathogenic mechanism in AF .