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 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 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 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.

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.

Objective To observe the variation of mortality and discharge against medical advice in major trauma patients admitted to the ICU and thus to improve the level of trauma care.Methods A retrospective analysis was performed on major trauma patients who died or discharged against medical advice in the emergency 1CU from 2003 to 2011.Patients were categorized as the dying,worse,and improved according to their situation at discharge.The dying was included into the death group.Annual variation of mortality and discharge against medical advice were analyzed in these 9 years.These parameters were also compared among three diverse periods (2003-2005,2006-2008 and 2009-2011).Results Ultimately,452 patients were recruited from the 3,343 major trauma patients admitted to the emergency ICU from 2003 to 2011.There were 231 deaths occupying 6.91％ (135 patients died in hospital and 96 patients were dying at discharge) and 221 discharges against medical advance occupying 6.61％ (175 patients deteriorated and 46 patients improved).Within the 9 years,a significant decrease was found in the annual rate of inhospital death,dying at discharge,and total death.Meanwhile,there was an increase in the rate of deterioration at discharge (x2 =15.305,P ＞0.05).However,no significant difference was found in the rate of total death plus deterioration at discharge.During the three periods of 2003 to 2005,2006 to 2008,and 2009 to 2011,number of patients admitted to the emergency ICU was 687,1,143,and 1,513 respectively.Age and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) of the dead,the patients with deterioration at discharge,and the dead plus the patients with deterioration were gradually higher through the three periods; on the contrary,GCS lowered.Total mortality decreased from 11.06％ to 4.63％ (x2 =31.174,P ＜0.01) ; rate of deterioration at discharge increased continuously from 2.77％ to 6.35％ (x2 =12.203,P ＜0.01) ; rate of death plus deterioration at discharge was declined from 13.83％ to 10.97％ (x2 =4.09,P ＞ 0.05).Conclusions From 2003 to 2011,the level of severe trauma care in emergent ICU is obviously improved.Ratio of deterioration at discharge increases with more aged patients.Discharge against medical advance interferes with the accurate assessment of trauma care and should be paid more attention.

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 determine the optimal sequences and scan parameters of Brachial Plexus MRI.Methods Eighteen volunteers were underwent conventional MRI and echo planar imaging scanning. The images acquired were compared with the standard anatomical pictures. Results Ventral rami, ganglion, trunks, cords and some peripheral nerves of brachial plexus were demonstrated very well by echo planar imaging with the post-processing techniques such as MIP, thin slice MIP and MPR.In 18/18 cases the postganglions on both sides and 17/18 cases the preganglions of brachial plexus on both sides could be visualized in EPI pre-processed and post-processed images.Conclusion Echo planar imaging is an effective technique of accurately displaying brachial plexus and adjacent structures. It has potential value in the diagnosis and treatment of brachial plexus diseases. It is also a potential technique to demonstrate other peripheral nerves accurately.