Objective To investigate the relationaship between liver cirrhosis patients comibined with infection or death and intestinal permeability (IP)test.Methods 48 patients with liver cirrhois and 16 healthy volunteers were enrolled in the Af-filiated Hospital of Yan’an University during 2 years from 2013 to 2014 in this prospective study.Clinical data of patients were analyzed.LMR (IP index)were caculated and dectected by HPLC differental method.Serum LBP,IL-6 and I-FABP were determined by ELISA.Patients were followed for 1 year and assessed fro survival and the occurrence of infections.Re-lated factors with IP index were analyzed by Spearman’s rho.ROC curve,kaplan-meiser curve,cox regression were used to analyze related factors with the infection-free survival.Results IP index were increased in 40 (83.3%)patients with liver cirrhosis,compared with 4 increased IP index in healthy controls (χ2=19.006,P=0.001).IP index were correlated with al-bumin,IL-6,INR,bilirubin and Child-Pugh (CTP)scores by Spearman’s rho anaylsis (rs=-0.339~0.485,all P<0.05). 20 (41.7%)liver cirrhosis patients developed infection in the one year follow-up.There were signigicant differences in asci-tes (14 vs 18),CTP scores [9(5~14)vs 10(7~14)],MELD scores [12(7~27)vs 17(9~25),IL-6 [40(10~1 200)vs 60 (10~1 800)pg/ml]and I-FABP [1 160(800~8 600)pg/ml vs 4 130(1 520~8 060)pg/ml]between non-infected cirrhosis and infected cirrhosis patients (χ2=8.400,Z=-3.310~-2.160,all P<0.05).It was found that MELD>9,acites,I-FABP>1 728 pg/ml were independent factors of infection-free survial in liver cirrhosis patients by COX regression (all P<0.05).Conclusion Although increased IP was higher in liver cirrhosis,and it failed to predict infection-free survial in liver cirrhosis patients.

Objective To evaluate the value of diffusion weighted imaging in differential diagnosis of endometrial carcinoma stagedⅠa.Methods A retrospective analysis of 18 patients with endometrial carcinoma staged Ⅰ a which was confirmed by pathology. Other 22 patients with benign endometrial diseases were also enrolled in the study including endometrial hyperplasia in 9,endometrial polyp in 8 and degenerative submucous myoma in 5.DWI with b value of 0 s/mm2 and 1 000 s/mm2 was performed with single shot sequence of EPI,and the ADC values were measured.Results The mean ADC values of endometrial carcinoma staged Ⅰa,endome-trial hyperplasia,endometrial polyp and degenerative submucous myoma were (0.89±0.21)×10 -3 mm2/s,(1.45±0.19)×10 -3 mm2/s, (1.29±0.32)×10 -3 mm2/s and (1.32 ±0.29)× 10 -3 mm2/s,respectively.There were statistical significant differences between them (F =48.021,P =0.00).Furthermore,statistically significant differences also existed between endometrial carcinoma and other groups (P <0.05).Conclusion ADC value shows a good value in differential diagnosis of endometrial carcinoma staged Ⅰa.

Objective To evaluate the apphcation of wireless mobile infusion system in the outpatients and emergency patients.Methods A total of 566 outpatients and emergency patients with infusion were divided into the observation group and the control group according to the order of infusion.The observation group with 297 cases was used wireless mobile infusion system,and the control group with 269 cases was used traditional infusion method.The reception time,infusion waiting time and satisfaction for nurses' job of patients between two groups were compared.The satisfaction for job of nurses among different work models were compared,too.Results The reception time,infusion waiting time of patients in the observation group were less than those in the control group:(2.07±0.26) min vs.(3.17±0.26) min,(9.89±0.31) min vs.(13.49± 0.21) min,and there were significant differences,P＜0.01.The satisfaction for nurses' job of patients in the observation group were better than those in the control group,x2=8.921,7.064,5.251,and there were significant differencs,P＜0.05.The satisfaction for job of nurses in the observation group was better than that in the control group,and there was significant difference,P＜0.05.Conclusion Wireless mobile infusion system can improve work efficiency,guarantee the safety of infusion,improve patients and nurses' satisfaction.

Objective To explore a modified technique of perforator flap anatomical study,in an attempt to understand the vascular territory of the specific perforator vessel in flaps,and determined its application in posterior tibial artery perforator flaps.Methods From October,2013 to October,2014,6 corpse were used in this study.A full-thickness posterior tibial artery perforator flap was excised from the crus of a fresh adult corpse.The anatomical measurements were synchronized with the procedure.The isolated skin flaps were fixed in a frame made of silk screen and batten and subsequently photographed.In vitro skin flaps were divided into 3 groups:full-thickness,without deep fascia,and without subcutaneous adipose layer.The skin flaps were perfused with barium sulfate silicone,and photographed using mammography after coagulation of the silicone.The imaging data were processed by digital software system.Results The mean number of posterior tibial artery perforators in the lower medial leg was 4.17 ± 0.94.The projection points of perforated sites were located in the area 2-3 cm lateral to the A-C line.The proximal border was (4.51 ± 1.84)cm distal to the plane of tibial medial condyle;the distal border reached the medial malleolus plane;and the anterior and posterior borders reaching the anterior and posterior midline of the crus respectively.And according to the comparison of the 3 group processed images,vascular territory change could be obtained.And this could provid clinicians with reliable anatomical information,guiding the acquisition and trimming of perforator flaps.Conclusion The modified strategy intuitively indicated the blood vascular areas of different artery perforator flaps of varying thickness and the vascular branches as well as their courses.The approach is profoundly significant in guiding the acquisition of skin flaps and for the trimming and reconstruction of flaps.The deep fascia of posterior tibial artery perforator flaps plays a negligible role in the blood supply of flaps.Furthermore,the subcutaneous adipose tissues in the distal portion of flaps can be thinned appropriately,with limited vascular consequences.

ObjectiveTo investigate the technique and clinical results of curved osteotomy under the metatarsal head's cartilage for improving reconstructed metacarpophalangeal joint function of fingers with second toe transplantation. MethodsThere were total 21 cases with 21 digits. During second toe transplantation with the metatarsophalangeal joint, the bottom of the second metatarsal head was incised. Then a curved osteotomy were carried out on about 5.0 mm under the metatarsal head's cartilage until the passive range of motion could be 90°.Longitudinal or cross-Kirschner wires were used to fix the joint.Finally,the conventional methods were used to reconstruct the blood supply, movement and nerves. ResultsAll 21 digits of the 21 cases survived uneventfully.The follow-up time was ranged from 6 to 24 months.Their average passive range of motion of the reconstructed metacarpophalangeal joint was 75°,ranging from 65° to 85°.The average active range of motion was 65°, ranging from 45° to 80°. Postoperative X-ray revealed fracture healed well without joint degeneration. ConclusionCurved osteotomy under the metatarsal head's cartilage is an effective way to improve active and passive activities function of the reconstructed metacarpophalangeal joint with second toe transplantation.

Objective To investigate the replantation methods and outcomes of mini tissue mass of amputated finger. Methods Twenty-six fingers of 20 patients were replanted with multiple vessel anastomosis methods to restore blood supply.The methods include vascular anastomosis,vascular bridge,arteriovenolization,veno-arteriolization,et al. Results Twenty-five replanted tissues were survived completely.Partly necrosis occur in 1 case,and rehabilitation by change dressings.The patients were follow up from 6 to 12 months.The contour and function of the replantation fingers recovered satisfactory. Conclusion By using the rational anastomosis according to the traumatic condition,it could be obtain good outcome of mini tissue mass replantation

Objective To investigate the replantation of complete severed fingertip when vein can't be repaired and only artery be repaired. Methods All 13 cases complete severed fingertips were replantated with only artery anastomosis but vein cannot be repaired.Low molecular weight heparin was applied to prevent blood clotting postoperation. Blood-letting by nail extraction or latero-incision were done in some cases.The survival fingers were observed. Results After 3-12 months followed-up,12 cases survived with satisfactory appearance and locomotion,2-PD of 2-7 mm,but 1 case was failed. Conclusion The replanted fingertip may survival with only artery anastomosis because of fewer tissue and faster recontruction of venous return.It would raise the survival rate of replanted fingertip by blood-letting by nail extraction or latero-incision according to the traumatic condition.

Objective To introduce the improvement of the flap from the dorsal site of the index in the application of treatment in the thumb web contracture. Methods Apply improved first dorsal metacarpal flap for 111 cases of patients of the thumb web contracture releasing. The original island or tongue-shaped flaps was modified to be the local flap transfer to the thumb web. Surgical method simplified. Before thumb web contracture was released, the flap was taken from ulnar aspect to radial aspect on the dorsum of the index. The flap was transferred to cover the soft tissue defect on the first web space following the contracture releasing. Flap donor area was closed by split-thickness skin graft. Results One hundred and eleven cases of flaps survived. After the 3-18 months (mean follow-up of 8.5 months), the local appearance, thumb function recovered well for 94.6 percent. Conclusion Improved first dorsal metacarpal flap is effective methods in thumb web contracture releasing.

Objective To summarize and investigate the therapeutic effects of reconstruction of contracture of the first web space with snuff-box flap. Methods Eighteen patients with contracture of the first web space were treated by snuff-box flap. The width and the angle of the first web space was 19 mm and 20°on average. According to the first web space skin defects, the flap designed to nasopharyngeal fossa centers as rotation point, the radial line when the forearm in the neutral position as the axis. Results The followedup for 5-26 months revealed that 17 flaps had a success, but 1 case was partly necrosis. The width of the first web space was augmented by an aveage of 45 mm, the angle of the first web space was augmented by an average of 50°. Conclusion It is ralatively simple and reliable to repair the contracture of the first web space using the snuff-box flap.

Objective To evaluate the safety and efficacy of the human acellular nerve allograft (hANG)for nerve repair in the clinical setting,and report the early outcomes of bridging digital nerve defect with the hANG. Methods Four patients with 5 digital nerve injuries were included in this pilot study.The nerves defect ranged from 10-20 mm and were bridged with the hANG(manufactured by Zhongda Medical Equipment Co.,Ltd,Guangzhou,China).Four digital nerve acute injuries in 3 patients were repaired with hANG primarily,while the nerve in another patient was reconstructed secondarily.The procedure was performed under a 10-manifying operating microscope.The nerve stumps were debrided until the normal fascicles could be seen.hANG was inserted between the proximal and distal stumps and end-to-end neurorrhaphy was performed with 9-0 sutures.Postoperative cares included dressing change and administration of antibiotics.No immunosuppressants had been used.The follow-up time ranged from 1 to 3 months.The wound and blood sample were examined for the safety of hANG.The nerve function Wag evaluated according to the scoring system proposed by the Nerve Injuries Committee of the British Medical Research Council. Results All wounds healed primarily.The adverse effects,such as rejection,allergy,infection,and toxicity to the liver and kidney were absent.The results of blood biochemistry test were within the normal range.The injured nerve achieved good functional recovery.In 2 cages,the 2 point discrimination(2PD)was 8mm(S3~+,excellent). Conclusion Based on the short term follow-up,using hANG to repair digital nerve defect as long as 20mm was safe,and the nerve functional recovery is pretty good.