Objective:To investigate the clinical effect of the repair and reconstruction of severe foot trauma by microsurgical methods.Methods:Patients with severe foot trauma were admitted to Xinhua Hospital (Chongming), Affiliated with Shanghai Jiao Tong University School of Medicine, and Taizhou Hospital, Affiliated with Wenzhou Medical University in Zhejiang Province from November 2008 to October 2019. All patients were treated with orthotopic replantation using microsurgical anastomosis in emergency and precise microsurgical reconstruction in the second stage. A retrospective analysis of the clinical effect of the reconstructed appearance and function was performed. The evaluation and surgical design were carried out according to the characteristics of the injury site, range, plane, degree, etc., and adequate debridement and orthotopic replantation of residual tissue was performed under the microscope in emergency. Then regular follow-up was conducted to evaluate the postoperative efficacy, the degree of foot swelling, and the observation of foot activity and function.Results:A total of 23 patients with severe foot trauma were enrolled, including 15 males and 8 females, aged from 17 to 69 years old, with an average of 38.5 years old. Among them were the left foot in 10 cases and the right foot in 13 cases. 15 of the 23 patients survived orthotopic replantation. 2 cases of medial plantar skin necrosis were treated by skin graft in the second stage, 1 case of heel skin necrosis and 2 cases of anterior plantar skin necrosis with infection were repaired by flaps, and 3 cases of dorsal skin necrosis with infection combined with bone defect were repaired by flaps or osteocutaneous flap. After the operation, 23 patients were followed up for 6 to 48 months, with an average of 18.5 months. The wounds were completely healed, the color and elasticity were close to the surrounding normal skin, and there was no apparent swelling deformity on foot. The sensory function of the foot was all restored to grades S3-S4, with a small scar, and they walked freely without noticeable limping. The efficacy was evaluated according to a survival situation, color elasticity, appearance and morphology, donor scar, skin sensation, infection control, and patient recognition. 16 cases were satisfied with the outcomes, and 7 reported moderate. Skin swelling rating in the early stage was 1st degree in 3 cases, 2nd degree in 10 cases, 3rd degree in 8 cases, 4th degree in 2 cases; in the later stage was 1st degree in 15 cases, 2nd degree in 6 cases, 3rd degree in 2 cases. Foot function is assessed by the degree of postoperative pain, function of flexion and extension, degree of deformity, and walking ability, which is excellent in 3 cases, good in 13 cases, general in 7 cases, with a reasonable rate of about 69.6%(16/23).Conclusions:The microsurgical technique is one of the most effective methods to repair and reconstruct the function and appearance of the foot with severe trauma for now.

Objective:To investigate the clinical effect of the repair and reconstruction of severe foot trauma by microsurgical methods.Methods:Patients with severe foot trauma were admitted to Xinhua Hospital (Chongming), Affiliated with Shanghai Jiao Tong University School of Medicine, and Taizhou Hospital, Affiliated with Wenzhou Medical University in Zhejiang Province from November 2008 to October 2019. All patients were treated with orthotopic replantation using microsurgical anastomosis in emergency and precise microsurgical reconstruction in the second stage. A retrospective analysis of the clinical effect of the reconstructed appearance and function was performed. The evaluation and surgical design were carried out according to the characteristics of the injury site, range, plane, degree, etc., and adequate debridement and orthotopic replantation of residual tissue was performed under the microscope in emergency. Then regular follow-up was conducted to evaluate the postoperative efficacy, the degree of foot swelling, and the observation of foot activity and function.Results:A total of 23 patients with severe foot trauma were enrolled, including 15 males and 8 females, aged from 17 to 69 years old, with an average of 38.5 years old. Among them were the left foot in 10 cases and the right foot in 13 cases. 15 of the 23 patients survived orthotopic replantation. 2 cases of medial plantar skin necrosis were treated by skin graft in the second stage, 1 case of heel skin necrosis and 2 cases of anterior plantar skin necrosis with infection were repaired by flaps, and 3 cases of dorsal skin necrosis with infection combined with bone defect were repaired by flaps or osteocutaneous flap. After the operation, 23 patients were followed up for 6 to 48 months, with an average of 18.5 months. The wounds were completely healed, the color and elasticity were close to the surrounding normal skin, and there was no apparent swelling deformity on foot. The sensory function of the foot was all restored to grades S3-S4, with a small scar, and they walked freely without noticeable limping. The efficacy was evaluated according to a survival situation, color elasticity, appearance and morphology, donor scar, skin sensation, infection control, and patient recognition. 16 cases were satisfied with the outcomes, and 7 reported moderate. Skin swelling rating in the early stage was 1st degree in 3 cases, 2nd degree in 10 cases, 3rd degree in 8 cases, 4th degree in 2 cases; in the later stage was 1st degree in 15 cases, 2nd degree in 6 cases, 3rd degree in 2 cases. Foot function is assessed by the degree of postoperative pain, function of flexion and extension, degree of deformity, and walking ability, which is excellent in 3 cases, good in 13 cases, general in 7 cases, with a reasonable rate of about 69.6%(16/23).Conclusions:The microsurgical technique is one of the most effective methods to repair and reconstruct the function and appearance of the foot with severe trauma for now.

Objective:To investigate the surgical technique and the clinical effects of direct posterior approach (DPA) with the fixation of percutaneous tunnel screw and plate for acetabular posterior comminuted fractures.Methods:Thirty-six cases with acetabular posterior comminuted fractures treated by this technique from January 2016 to July 2020 were retrospectively analyzed in this study. There were 28 males and 8 female, aged 42.0±12.1 (range 19-64) years. According to Letournel-Judet classification, there were 28 cases of transverse associated with posterior wall fractures, 6 cases of posterior column with posterior wall fractures and 2 cases of T shape with posterior wall fractures. DPA was adopted in prone position. The anterior and posterior column fractures of the acetabulum were reduced under direct vision and then fixed with percutaneous tunnel screw. Further, the posterior wall fractures of the acetabulum were reduced and fixed with plate and screws. The operation duration, intraoperative blood loss, incision length, fracture union time, fracture reduction quality, postoperative complications and hip function were recorded.Results:The incision was 9.8±1.2 (range 8-12) cm. The operation duration was 102.9±21.4 (range 65-145) min. Intraoperative bleeding was 214.0±116.9 (range 100-640) ml. Postoperative X-ray and CT examinations showed perfect reduction. All the patients were followed up for 20.9±9.2 (range 10-38) months. The fracture healing time was 4.6±1.0 (range 3-6) months. There was no patient with damaged superior gluteal nerve and blood vessel. There were 2 cases of femoral head cystic changes without pain in walking, 1 case of postoperative infection and bacteremia who was cured at 1 month after debridement and anti-infection treatment, 1 case of sciatic nerve injury but recovered at 3 months after operation, and 1 case of heterotopic ossification at 3 months after surgery without affecting hip motion. According to the Matta's criteria, the reduction quality of the acetabular fracture was rated as excellent in 28 cases, good in 6 cases, fair in 2 cases. According to the modified Merle D'Aubigné and Postel scoring system, hip joint function was excellent in 24 cases, good in 10 cases and fair in 2 cases.Conclusion:DPA approach can directly reduce acetabular posterior comminuted fractures through a minimal incision. Combined with the technique of percutaneous tunnel screw, it displays great advantages of less trauma and with good clinical effects.

Objective:To investigate the microsurgical anatomy of thoracodorsal artery perforators, and the clinical effect in repairing the soft tissue defect of hand with the thoracodorsal artery perforator flap (TAP).Methods:From October, 2014 to November, 2014, the axillary arteries in 10 thoracodorsal specimens were perfused with red latex. The number and diameter of the perforators of the thoracodorsal arteries were mearsured. From January, 2015 to February, 2019, 52 cases of soft tissue defects in hand combined with bone and extensor tendon exposure were repaired with TAP. The patients were followed-up in outpatient department to observe the clinical efficacy.Results:The number of perforators of thoracodorsal artery was 2-4 mostly, and 3 perforators was the most. The diameter of perforators was 0.22-0.68 mm, and the distance between the perforating point and the posterior axillary wall was 5.2-11.8 cm. All the operations were completed successfully, and the donor sites were closed directly. In 52 cases, 48 flaps survived, 2 had partially necrosis, and 2 had completely necrosis. The patients were followed-up for 5 to 24 months. The blood supply of the flaps was good with soft texture and good appearance.Conclusion:The TAP is an ideal flap because of its thin in thickness, concealed donor area and no obvious scar after direct suture.

Objective To establish the quality standard of Santeng oral solution.Method Sargentodoxa Caulis and Spatholobi Caulis were identified by thin layer chromatography.Chlorogenic acid was assayed by high performance liquid chromatography.The chromatographic column is Agilent Zorbax SB C18 (4.6 mm×250 mm, 5 μm) with a stable temperature of 35 ℃.The mobile phase in isocratic elution consists of acetonitrile and 0.1% folic acid aqueous solution with a preliminary volume ratio of 9∶91.The flow rate is 1.0 ml/min with an injection volume of 20 μl.Results Thin layer chromatography showed distinct spots of Sargentodoxa Caulis and Spatholobi Caulis with a great specificity.A regression formula Y=60.14X-6.37(r>0.999 9) was obtained with a good linearity in concentration range of 2.70~202.50 μg/ml.Conclusion A simple, stable and repeatable method was established for the quality control of Santeng oral solution.

Objective To establish a quality control standard for Qingre Baidu granules .Methods Isatidis Radix ,Fruc-tus Forsythiae ,Herba Violae ,and Glycyrrhizae were identified by TLC ,and the concentration of chlorogenic acid was deter-minedbyHPLC.ThismethodwasemployedonanAgilentZORBAXSB-C18column(4.6mm×250mm,5μm)at30℃ witha mobile phase of acetonitrile (A) and 0 .2% formic acid (B) using the gradient elution program shown as follows :0-12 min , 11%-12% A run at the flow rate of 1 .0 ml/min .The injection volume was 20 μl and the detection wavelength was 327 nm . Results Characteristic spots could be detected by TLC and the specificity of the method was satisfactory .As for chlorogenic acid ,the equation of linear regression of chlorogenic acid was Y=60 .239 4X+9 .096 3 (r=0 .999 9) with the linear range of 6.19-396 .00 μg/ml .The average recovery was 99 .66% (RSD=2 .82% ) .Conclusion The established method is simple ,reli-able ,reproducible ,and can be used for the quantitative determination and quality control of Qingre Baidu granules .

OBJECTIVE:To study the inhibitory mechanism of timosaponin B-Ⅱ(TB-Ⅱ) on the proliferation and migration of human lung cancer A549 cells. METHODS:A549 cells were treated with TB-Ⅱ [0(blank control),1,10 and 100 μg/ml] for 48 h,and total RNA and total protein were extracted respectively. Real time fluorescence quantitative-PCR and Western blot were used to detect mRNA and protein levels of IL-18. IL-18 in A549 cells was silenced by transfection;the expression of IL-18 mRNA and protein were compared among untransfection group,negative control group and transfection group;and then human lung can-cer A549 cells with silenced gene were treated with 10 μg/ml TB-Ⅱ for 24,48 and 72 h. The activity of cell proliferation was de-tected with CCK-8,and the change of cell migration ability was observed by streak method. RESULTS:Compared with blank con-trol,the expression of IL-18 mRNA and protein in A549 cells all increased after treated with TB-Ⅱ(P<0.05 or P<0.01),and were positively correlated with concentration. Compared with untransfection group,the expression of IL-18 mRNA and protein de-creased in transfection group(P<0.01). Compared with untransfected cell treated with TB-Ⅱ,the viability and migration ability of A549 cells with transfection gene increased after treated with TB-Ⅱ for 72 h(P<0.01). CONCLUSIONS:TB-Ⅱ can inhibit the proliferation and migration of A549 cells by up-regulating IL-18 gene expression.

OBJECTIVEEssential oil from root of Angelica dahurica cv. Qibaizhi were studied.

METHODEssential oil was extracted by water-steam distillation and analyzed by GC-MS.

RESULTTwo hundreds and ninety chromatographic peaks were detected, among which 111 compounds have been identified. The contents of them made up 90.61% of the total essential oil.

CONCLUSIONThe main compounds in the essential oil were 3-carene (12.70%), beta-elemene (6.20%), beta-terpinene (3.53%), beta-myrcene (1.97%), gamma-elemene (1.82%), beta-phellandrene (1.65%), and beta-maaliene (1.61%), et al. In addition, suberosin (0.16%), a coumarins compound, was also determined.

Angelica ; chemistry ; Drugs, Chinese Herbal ; chemistry ; Gas Chromatography-Mass Spectrometry ; Oils, Volatile ; analysis ; Plant Roots ; chemistry

Objective To investigate the effects of Ulinastatin(UTI)on the function of splenic lymphocytes from rats with severe acute pancreatitis(SAP).Method Twenty-eight Wister rats(clean grade)were randomly divided into control,sham operation,SAP,and ulinastatin group.No operation was performed in control group.And rats with sham-operation received laparotomy and catheterization into choledocho-pancreatic duct without injection of sodium deoxycholic.Rats in ulinastatin group received ulinastatin injection(50000 U/kg)via tail vein 30 minutes after pancreatitis induced with DCA injected into pancreatic duct.Rats ofother groups were given equal volume of saline.At 2,4 hours after operation,all animals were killed by neck dislocation,and splenocytes were isolated and cultured in RPMI 1640 medium containing 10%fetal calf serum.Proliferation of splenecytes was determined with MIT cellular proliferation assay.Levels of Th1 cytokines(IL-2,IFN-γ)and Th2 cytokine(IL-10)in supematants of splenoeytesweremeasured by ELISA.Quantitative data were expressed as mean±SE.Statistical analyses were performed by Student's t test with SPSS software(version 10.0 for Windows).A P value less than 0.05 Was considered statistically significant. Results The concentration of IL-2, IL-10 and IFN-γ and proliferative activity of splenocytes in SAP group were significantly lower than that in sham operation group.In contrast,the proliferative as well as the eytokine-releasing capacities of the solenecms from rats treated with UTI were significantly increased compared with those from rats with SAP.Conclusions The deficiencies in proliferation and cytokine release in response to antigen stimulation inaplys an anergic state of splenocytes during SAP.Treatment with UTI contributed to the recovery of the immune function by improving proliferative responses and cytokine release of splenocytes.