Hands are an important organ with which mankind has created his civilizations. Functional reconstruction of hand defects is a difficult clinical problem. The cosmetic artificial hand has no other function than that of decoration. The tool hand and kruckenberg forearm furcate phalangisation have scarcely been utilized now because they have limited functions. The myoelectric artificial hand is the major product on the prosthese market, but its accuracy needs improving. Microsurgery can restore part of the sensory functions of the hand but can not restore its normal contour. Treatment of the lost part of the forearm with an electronic artificial hand, which is controlled by a reconstructed digit transplanted from the second toe to the forearm stump, improves the action accuracy. Wide application of this new technique is recommendable. More than 10 cases treated with allograft hand transplantation have been reported recently. Since these patients have to receive a long term therapy of immunosuppressive agents due to the immunological rejection,this method is not suitable to be a routine clinical operation. If the problems concerning transplantation immunity are solved, allograft hand transplantation will be an optimal method of functional reconstruction of hand defects.

Objective: To explore the therapeutic effects of immediate breast reconstruction after modified radical mastectomy of breast cancer with nipple-areolar complex preservation and partial skin-sparing. Meth- ods- We studied 24 eady stage breast cancer patients who received immediate breast reconstruction after modified radical mastectomy with nipple-areolar complex preservation and partial skin-sparing. Nine patients had silicone prosthesis, 3 patients had transverse rectus abdominis myocutaneous flap (TRAM), and 12 pa-tients had silicone prosthesis combined with part of latissmus dorsi-myocutaneous flap (LDMF). The effects of breast reconstruction were evaluated according to objective and subjective criteria after surgery. Results: All of the 24 patients obtained successful breast reconstruction. The appearance of the reconstructed breast was perfect and the two sides seemed symmetrical. The aesthetic outcome was good in 23 patients and satisfacto-ry rate was up to 95.83%, and the subjective evaluation was up to 100%. Necrosis of part of the nipple was found in only one case. Hematoma appeared in one patient and vanished after 3 months. All patients received adjuvant chemotherapy after surgery. No local recurrence and distant metastasis occurred during the follow up period (5～48 months). One patient died of primary hepatic carcinoma at 2 years after surgery. Conclusion:Immediate breast reconstruction after modified radical mastectomy of breast cancer with preservation of nip-ple-areolar complex and partial skin-sparing is safe and effective for early stage breast cancer patients. The reconstructed breast is satisfactory. Breast reconstruction surgery is economical and can reduce patients' psy-chological pressure due to loss of the breast, and improve quality of life. Immediate breast reconstruction does not affect postoperative adjuvant therapy and long-term therapeutic effect. Breast reconstruction surgery has been gradually accepted by more and more eady stage breast cancer patients.

Objective To explore factors associated with incision infection in elderly patients undergoing general surgery and thus provide a basis for its clinical prevention.Methods Retrospective clinical data of 2985 elderly patients who underwent routine surgical operation after admission to the Department of General Surgery from Feb.2009 to Dec.2013 were analyzed.Patients with incision infection following surgery were assigned into the infection group,while patients without incision infection served as the control group.Single factor analysis and multivariate Logistic regression analysis were conducted to identify factors responsible for incision infection.Results There were 91 cases with incision infection,constituting a rate of 3.0％.Compared with the control group,patients in the infection group showed an older average age [(67.3±5.8) years vs.(63.0± 5.6) years,t=1.906,P＜0.05],a longer average operating time [(2.13±0.26) hours vs.(1.87±0.24) hours,t=10.149,P＜0.001],and a longer average incision length [(8.14±2.62) cm vs.(7.59±2.14) cm,t=2.396,P＜0.01].In addition,compared with the control group,more patients in the infection group received prophylactic antibiotics (74.7％ vs.83.3％,x2 =4.819,P=0.032),exhibited malnutrition (20.9％ vs.10.0％,x2 =11.418,P=0.001),and had diabetes mellitus (11.0％ vs.5.1％,x2 =5.968,P=0.015).Therefore,independent risk factors for incision infection included age (OR=1.89),operating time (OR=3.32),nutritional status (OR=2.08) and diabetes mellitus (OR=3.18).Conclusions A few risk factors may contribute to incision infection.Clinicians should take necessary preventive measures accordingly to minimize its occurrence.

Objective To investigate the predictive value of skull CT angiography (CTA) original image spot in acute stage (3 ～6 h) of hypertensive intracerebral hemorrhage (HICH) hematoma enlargement.Methods A total of 45 cases of HICH patients was analyzed retrospectively,who accepted emergency head CT scan and CTA synchronization within 6 h occurrence.According to the CTA without original image spot,those cases were divided into two groups including patient's clinical symptoms worsen instant or regular 24 h after onset review head CT scan.According to the field the formula,the hematoma volume was calculated.The incidence rate of hematoma expansion was compared between two groups.Results (1) Of 45 cases,emergency skull CTA original image spot positive sign was 11 cases (24.4％),spot sign negative 34 cases (75.6％).The patient's age,gender,admission glasgow coma scale (GCS) score and head CT hematoma volume for the first time had no statistical difference between two groups (P ＞ 0.05).(2) There were 13 patients (28.9％) who occurred the hematoma enlargement,10 cases (10/11,90.9％) with the spot sign positive,and 3 case (3/34,8.8％) with spot sign negative.The hematoma expansion rate had statistical difference between two groups (P ＜ 0.01).Conclusions Cranial CTA original image spot can provides objective for patients with acute phase of HICH hematoma expansion imaging indicator,which helps to select hematoma in patients at high risk of easy to expand.Thus makes the treatment of patients with the class a more timely and accurate.

ObjectiveTo investigate the effect of transforming growth factor-β1 (TGF-β1) antibody on peripheral neural fibrosis after chronic entrapment.MethodsA total of 75 rats were randomly divided into three groups, ie, Group A (sham operation, only the sciatic nerve exposed), Group B (compression only, treated with sciatic nerve entrapment) and Group C (compression plus antibody injection).Electron microscopy, immunohistoehemistry, RT-PCR and Western blot were performed to observe the morphological changes of the compressed nerve tissue and to determine the level of TGF-β1 , collagen Ⅰ and collagen Ⅲ at 2, 4, 6, 8, 10 weeks after sciatic nerve compression, respectively.Results The levels of TGF-β1 , types Ⅰ and Ⅲ collagen protein were increased significantly in the Group B compared with that in the Group A, when the expression of TGF-β1 was increased in the early phase of the compression, reached the peak at the 4th week, and then decreased slowly.The expressions of collagenⅠand collagen Ⅲ were increased after compression, reached a peak at the 6th week and then maintained a relatively high level.The number of the fibrous tissues was decreased significantly and the content of types Ⅰ and Ⅲ collagen protein declined in the Group C, with statistical difference compared with the Group B (P ＜ 0.05).ConclusionsPeripheral nerve fibrosis can be caused by chronic nerve compression.TGF-β1 plays an important role in effectively inhibiting the collagen synthesis and ameliorating the nervous fibrosis of the protein following peripheral nervous entrapment.

ObjectiveTo study MRI features and pathologic basis of various periosteal changes in rabbit VX2 bone tumor and to evaluate the role of MRI in the change of periosteum in bone tumor. MethodsBone tumor models were induced by injection of VX2 carcinoma cell suspension into the medullary cavitv of right tibias in 32 rabbits.Thirty-six positive contrast cases and 4 negative contrast cases were established.Serial plain films and MRI examinations were performed at an interval of 5 days foliowing the implantation.Every 4 rabbits were sacrificed immediately after imaging. The findings of periosteal changes were compared between imaging features and pathologic Results . ResultsFrom the 5th to 15th day after implantation of VX2 carcinoma,periosteal edema was demonstrated in 32 tibias. On the 20th day,periosteal thickening Was revealed in 19 tibias. On the 25th day,periosteal new bone with the thickened periosteum attaching to its outer Surface was found in 12 tibias. On the 30th day,periosteal new bone with the thickened Deriosteum were elevated by the tumor in 11 tibias.On the 35th to 40th day,destruction of periosteal bone and periosteum were revealed.ConclusionsThe progress of periosteal changes in rabbit VX2 bone tumor included periosteal edema,periosteal thickening,periosteal new bone,destruction of periosteal new bone and destruction of periosteum. Various periosteal changes could be demonstrated on MRI and MRI is useful in evaluating periosteal changes.

Objective To study the effects of biofeedback combined with the fixed functional appliance in the modification of mandible in patients with Angle Class Ⅱ malocclusion and retruded mandible.Methods A Iotal of 30 orthodontic patients were divided into two groups,all patients with retruded mandible and normal maxilla,ANB>6°,aged from 9 years and three months to 14 years and 11 months.All patients were treated with Forsus fixed functional appliance combined with MBT straight-wire appliance.Muscular activity of the superficial masseter muscle before,during,and after treatment.was evaluated by assessing the average integrated eleetromyogram (EMG) .The biofeedback was performed during functional treatment in the study group,the muscular activity of the superficial masseter muscle was turned into the signal which can be read and seen by patients,and the patient can control the muscular activity of the superficial masseter muscle in a certain extent under the help of instrument.After 6 weeks fixed functional appliance treatment,the biofeedback treatment was performed in the study group with the help of instrument and trained for 10 times,and the patients could trained by themselves for 20 minutes everyday.Results The biofeedback treatment was able to regulate the muscular activity of the masseter muscle and prevent the return of muscle function and the tendency to seat the condyle back toward the fossa,maintain the treatment effect;after biofeedback treatment the decreased postural EMG activity in the masseter muscle was steady,but without statistical significance (P>0.05).Conclusion The biofeedback treatment can maintain the muscular activity of the masseter muscle effectively,enhance the effect of functional treatment and keep the stability of the mandibular position.

Objective To investigate the possible mechanism of Nrf2 in sepsis development and its effect in the septic acute liver injury ,and derive the effect of curcumin on Nrf2 expression ,which provide theoretical basis for clinical prevention and treatment of sepsis .Methods Divided putting 72 male Sprague-Dawley rats into 3 groups:control group ,experimental group and intervention group .After operation ,3 groups were further divided into subgroups 6 hours later ,12 hours later ,24 hours later and 48 hours later respectively .The septic rats model with acute liver injury was reproduced by method of cecal ligation and puncture (CLP) .The ex-perimental group and the intervention group took CLP .The rats in the intervention group were rejected with curcumin in the abdo-men at a dosage of 100 mg/kg an hour after operation .Detected the expression of Nrf2 in the livers of each group used Western blot and measure alanine aminotransferase(ALT ) in serum by drawing the rats′heart blood ;observed the pathological changes in the liver with HE coloration .Results ALT :the values of ALT in the experimental group was significantly increased compared with the control group(P<0 .05);while in the intervention group ,it was markedly improved compared with the experimental group (P<0 . 05) .The expression of Nrf2 :Nrf2 exists in control group rat′s hepatic tissue .In the experimental group ,it was progressively in-creased since the 6 h time point and decreased after the 12 h time point which shown significant decreased compared with the control group(P<0 .05) .In the intervention group ,it was gradually increased since the 6 h time point and decreased after the 24 h time point which was obviously higher than the experimental group(P<0 .05) .Pathological changes :There was no obvious abnormalities in the control group rats′liver structure ,while a lot of inflammatory cells gather and liver cells swell in the experimental group .It was obvious improved after curcumin intervention .Conclusion As Nrf2 is generally lower in the experimental group than in the comparative group ,it shows that Nrf2 directly participates in the occurrence and development of sepsis ,while severe infection blow damages the endogenou s protection system .Decreased activity of Nrf2 causes ignificantly inhibition of anti-oxidative stress and nat-ural immune response ,which may exacerbate acute liver injury by oxidative stress in sepsis .In case of sepsis ,curcumin may increase the level of Nrf2 and the antioxidant enzyme′s activity in the hepatic tissues ,enhancing the general antioxidant ability and alleviating the oxidative stress which points out that curcumin prevents the septic acute liver injury .

Objective To discuss the anticancer role of arsenic trioxide (ATO) with cisplatin on human oral carcinoma HSQ-89 cells. Methods The human oral epidermoid HSQ-89 cells were chosen as the subjects. Different concentrations of ATO were added into Cisplatin(DDP)-treated cells. The inhibition rate of tumor cells was detected by MTT assay. Results Different concentrations of ATO (0,2.5,5,7.5,10,12.5 μmol/mL) were added into oral cancer HSQ-89 cells which have been treated with DDP (15 μg/mL). The inhibition rate of tumor cells were 26.9%, 67.5%, 73.0%, 88.5%, 90.4%, 98.7%respectively; The combined application of ATO with cisplatin could improve the inhibition rate of HSQ-89 cells in a dose-dependent relation. Conclusion The combined application of ATO and DDP can produce a synergistic action of inhibition on oral cancer cell.

AIM: To find one kind of peptide that will conjugate with ouabain and inhibit its biological function, and provide a new treatment strategy for primary hypertension. METHODS: In this study, ouabain was used as a target to screen ouabain conjugated peptide (OCP) from Ph. D. -7 phage display peptide library. After 3 rounds of bio-panning, the products were identified by ELISA and DNA electrophoresis analysis and sequencing. Peptide was synthesized and analyzed the activity by radioligand binding assay. The inhibitory ratio of cell proliferation was measured by MTT and the cell morphology changing was measured by Hoechst 33342/PI staining. The expression of Na~+-K~+-ATPase α1-subunit and β1-subunit were detected by RT-PCR and immunocytochemistry. The levels of the free intracellular Na~+ in EAhy926 cells were measured by laser confocal microscope. RESULTS: The ouabain conjugated peptide was found out, and it was occupied in 0.64(9/14). The analysis of protein showed that the obtained peptides had no homology with Na~+-K~+-ATPase. The amino acid sequence of synthesized peptide was Arg-Cys-Met-Thr-Ser-Arg-Ser. There was binding activity between OCP and ~3H-ouabain. The MTT assay showed that OCP could reverse the inhibition action of ouabain on vascular endothelial EAhy926 cells in a dose and time-dependent manner. The number of apoptotic cells had significantly decreased detected by Hoechst 33342/PI staining. The results of RT-PCR and immunocytochemistry showed that OCP could inhibit the up-regulated expression of Na~+-K~+-ATPase α1-subunit and down-regulated expression of Na~+-K~+-ATPase β1-subunit induced by ouabain in EAhy926 cells. CONCLUSION: The OCP could reverse the growth inhibition and death induction of ouabain in EAhy926 cells, which would provide the basis for studying the interaction between ouabain and Na~+-K~+-ATPase and explore novel anti-ouabain agents.