Objective: To discuss the diagnosis and managementof traumatic carotid cavernous fistula (TCCF).Methods: In all 15 patients with TCCF confirmed byangiography, 8 patients got early diagnosis and cure. WithSeldinger technique adpoted in the puncture of femoralartery, Magic 3 F-1.8 F BD catheters combining withballoon were used to embolize the fistula or the internalcarotid artery.Results: Early diagnosis and cure were achieved in 8patients within one week and no sequelae occurred. Sevenpatients with delayed diagnosis who were cured beyond oneweek had some sequelae such as hypopsia in 5 cases,incomplete oculomotor paralyses in 3 and incompleteabducent paralyses in 2. Among all the 15 cases, theinternal carotid artery was preserved in 12 cases acountingfor 80%. Occluding the fistula with sacrifice of the internalcarotid artery was performed in 3 cases and no repatency of the fistula occurred by following up beyond three months.Conclusions: The preferred therapy for TCCF is toocclude the fistula using detachable balloon. The diagnosisand treatment for TCCF can significantly reduce occurrencerate of the complications and sequelae.

Objective: To investigate the dynamics of plasmacAMP/Cgmp in patients during cardiac surgery, and itsrelationship to traumatic stress.Methods: Sixteen patients, aged 19.31 years ± 10.4years, who underwent an open heart operation withcardiopulmonary bypass (CPB) and hypothermia wereserved as subjects. The arterial plasma concentrations ofcyclic adenosine monophosphate ( Camp ) and cyclicguanosine monophosphate ( Cgmp ) were measured byradioimmunoassay 2 hours before operation, afterheparinization, 20 minutes following CPB, at the end of theoperation, and 24 and 72 hours postoperatively,respectively. The patients' preoperative blood samples wereheparinized and the venous blood samples of 30 healthyblood donors were taken to measure the levels of Camp andcGMP as heparin and normal controls separately.Results: There were no statistical difference amongthe heparin control, preoperative level and normal control.The peak values of Camp and Cgmp occurred during CPBand plasma Camp levels changed synchronously withintensities of operative stimulus to human body. HowevercGMP level was mainly related to the operative stimulus to the heart and CPB. The Camp value was positivelycorrelated with the Cgmp value ( r = 0.6313, P ＜ 0.001 ).Conclusions: Dynamic variation of plasma cyclicribonucleotide can be considered as a reference parameterfor intensity of traumatic stress.

Objective: To study the curative effect of wilsoniiinjecta on severe head injury (SHI).Methods: A total of 120 patients with SHI weredivided randomly into 2 groups, the patients treated withconventional methods as Group A (n = 60) and the patientstreated with wilsonii injecta as Group B (n = 60). Thechanges of neural function indexes were evaluated withGlasgow Coma Scale (GCS) before treatment and withGlasgow Outcome Scale ( GOS ) after treatment,simultaneously, the paramneters of hemorrheological indexes(HI), brain electrical activity map ( BEAM ) andtranscranial Doppler sonography (TCD) were observedbefore and after treatment.Results: In Group B, the clinical GCS, the HI, theBEAM and the prognosis GOS were improved much morethan those in Group A. And the TCD parameters in GroupB decreased, which had significant difference comparedwith that in Group A (P ＜0.01).Conclusions: Wilsonii injecta can rapidly improve theinjured persons' conscious states, the abnormal BEAM and the surviving quality. It suggests that the improvement of the HI is related to the relief of the vasospasm of thearterial blood vessels in the brain, which may be one of theimportant mechanisms of wilsonii injecta in improving theprognosis.

Objective: To culture fibroblast cells from the kneeligaments and to study the biological characteristics of thesecells.Methods: Cells of the anterior cruciate ligament(ACL) and the medial collateral ligament (MCL) fromNew Zealand white rabbit were cultured in vitro. Cellulargrowth and expression of the collagen were analyzed.Moreover, an in vitro wound closure model was establishedand the healing of the ACL and the MCL cells wascompared.Results: Maximal growth for all these cells wereobtained with Dulbecco's modified Eagle's mediumsupplemented with 10% fetal bovine serum, but RPMI 1640and Ham's F12 media were not suitable to maintain thesecells. Morphology of both ACL and MCL cells from NewZealand white rabbit was alike in vitro, but the MCL cellsgrew faster than the ACL cells. Both cell types producedsimilar amount of collagen in culture, but the ratio ofcollage type I to type III produced by ACL cells was higherthan that produced by MCL cells. Wound closure assayshowed that at 36 hours after injury, cell-free zones createdin the ACL cultures were occupied partially by the ACLcells; in contrast, the wounded zone in the MCL cultureswas almost completely covered by the cells.Conclusions: Although the ACL cells and the MCLcells from New Zealand white rabbit show similarappearance in morphology in culture, the cellular growthand the biochemical synthesis of collagen as well as thehealing in vitro were significantly different. Thesedifferences in intrinsic properties of the two types of cells invitro might contribute to the differential healing potentialsof these ligaments in vivo.

Objective: To introduce a safe and specific approachof 13C magnetic resonance spectrum (13C MRS )spectroscopy and investigate the alterations in hepaticanabolism.Methods: Relative anaplerotic, pyruvate recyclingand gluconeogenic fluxes were measured by 13C MRSisotopomer analysis of blood glucose from rats with 40%body surface area burn injury, and from rats exposed tosham injury. A short chain fatty acid, [U-13C] propionatewhich was avidly extracted by the liver, was infusedintravenously to deliver 13C into the citric acid cycle.Proton-decoupled 13C MRS of deproteinized plasma orextracts of the freeze-clamped liver were used to determinethe distribution of 13C in blood or hepatic glucose.Results: There was no difference in the multipletsdetected in the glucose carbon-2 anomer from blood or liverafter 45 or 60 minutes of the infusion of the propionate,indicating that steady-state isotopic conditions wereachieved. Gluconeogenesis relative to citric acid cycle fluxwas not altered by burn injury; in both sham and burngroups the rate of glucose production was about equal toflux through citrate synthase. In the sham group ofanimals, the rate of entry of carbon skeletons into the citricacid cycle was about 4 times than that in the burn group.Similarly, flux through pyruvate kinase (again relative tocitrate synthase) was significantly increased after the burninjury.Conclusions: Since results from analysis of the bloodglucose are the same as that of the hepatic glucose, 13Cdistribution in the glucose and hepatic metabolism can beassessed based on the 13C MRS analysis of the bloodglucose.

Objective: To study the effect of compound injectionof Radix Hedysari on peripheral nerve regeneration in rats.Methods: Seventy-five healthy adult SD male rats,weighing 150 g, were randomized into 5 groups (15 rats ineach group). The bilateral sciatic nerves of the rats wereexposed and clamped with a smooth clamp to make aninjury area of 2 mm. After clamp operation Group 1 wasinjected with compound injection of radix Hedysari (CIRH)1.5 ml/day, Group 2 with CIRH 1.0 md/day, Group 3 withCIRH 0.5 ml/day, Group 4 with nerve growth factor(NGF) 50 U/day, and Group 5 was taken as the controlgroup without any management. The bilateral sciatic nervewas taken out at 3 days, 1, 2 and 4 weeks after clamping,stained with osmic acid and observed microscopically. Themyelinated nerve fibers were counted. The nerveconduction velocity was determined 2 and and 4 weeksbefore sample taking the sciatic nerve function index wasmeasured 4 weeks before sample taking.Results: The results of nerve conduction velocity, themyelinated nerve fiber count and the sciatic functuion indexin the CIRH treated groups were better than those in thecontrol group. The results of the nerve conduction velocityand the myelinated nerve fiber count at 2 weeks and thenerve conduction velocity at 4 weeks in Group 1 were betterthan those of Group 4. Biological observation showed thatdegenerated and necrotic myelin sheath in CIRH treatedGroups at 2 and 4 weeks decreased remarkably compared to the NGF treated group.ConcIusions: CIRH can promote regeneration ofperipheral nerves and absorption of degenerated andnecrotic injured nerves. It has the same effect as NGF.

Objective: To determine the role of hemoglobin(HB) -induced heme oxygenase- 1 ( HO- 1 ) in injured lungscaused by limb ischemia-reperfusion (I/R) in rats.Methods: A rat model of ischemia in the hind limbswas made by clamping the infrarenal aorta with amicrovascular clip, and lung injury occurred afterreperfusion. To induce the expression of HO-1 in the lungs,Hb was administrated intraperitoneally at 16 hours beforereperfusion. Northern blotting and Western blotting wereused to detect the expression of HO-1 in the lungs, and thecarboxyhemoglobin (COHb) level in arterial blood wasassayed. The effect of hemoglobin (Hb) on the injuredlungs after limb I/R was determined by measuring thechanges of lung histology, polymorphonuclear (PMN)count, malondialdehyde (MDA) content and wet-to-dryweight ratio (W/D). Zinc protoporphyrin (ZnPP), aninhibitor of HO, was used to determine whether HO-1 wasinduced by Hb after lung injury.Results: Hb led to a significant increase in HO-1mRNA and protein expression in the lungs, accompanied bythe increase of COHb level in arterial blood. Comparedwith the sham controls, the lung PMN count, MDA contentand W/D significantly increased at 4 hours after limb I/R,which reversed by the pretreatment with Hb at 16 hoursbefore reperfusion. ZnPP blocked this protective role of Hbin the injured lungs.Conclusions: Hb can induce the lung HO-1expression, which plays an important role in the defenseagainst I/R-induced lung injury in rats.

Objective: To study the sequential changes of HIF-1α(hypoxia-inducible factor 1 alpha) in experimental spinalcord injury in rats and to analyze its potential effects inSCI.Methods: A static compression model of SCI wasemployed in this study. Expressions of HIF-1α weremeasured with immunohistochemical staining, while flowcytometry was used to determine the apoptotic ratio andbcl-2 expressions.Results: HIF-1α began to increase 1 day after injury,and reached the peak at 3-7 days. Two weeks later, itdeclined significantly. The sequential changes of HIF-1αcoincided well with the alterations of apoptotic ratio andcontents of bel-2.Conclusions: HIF-1α possibly participates in thesecondary ischemic and hypoxic procedures after spinalcord injury, and may mediate the traumatic apoptosis.Further understanding of HIF-1α may provide newtherapeutic regimens for SCI.

Objective: To study the biomechanical properties of the new bone generated by mandibular distractionosteogenesis (DO).Methods: A total of 11 healthy adult goats wererandomly divided into 2 groups, the experimental group (n=9) and the control group (n = 2). For the goats in theexperimental group, the bilateral mandibles were graduallylengthened for 10 mm with distraction appliances. Threegoats were sacrificed respectively at 2, 4 and 8 weeks aftercompletion of distraction. Compressive, three-pointbending and shearing tests were conducted on the standardregenerated bone samples and the whole unilateralmandibular specimens. For the goats in the control group,no operation was made and the whole unilateral mandiblewas taken as the test specimen.Results: The compressive strength and bendingstiffness of the new bone reached the normal level at 4 and 8weeks after completion of distraction, respectively. But theshearing strength remained significantly weaker than that of the controls at 8 weeks after distraction.Conclusions: The distraction appliance can beremoved and the lengthened mandible should be exposed toadaptive functional exercise at 8 weeks after completion ofdistraction.

Objective: To study transforming growth factor-β1(TGF-β1) autoproduction in keloid fibroblasts and theregulation effect of blocking TGF-β intracellular signalingon rhTGF-β1 autoproduction.Methods: Keloid fibroblasts cultured in vitro weretreated with either rhTGF-β1 (5 ng/ml ) or recombinantadenovirus containing a truncated type II TGF-β receptorgene (50 pfu/cell ). Their effects of regulating geneexpression of TGF-β1 and its receptor I and II wereobserved with Northern blot.Results: rhTGF-β1 up-regulated the gene expressionof TGF-β1 and receptor I, but not receptor II. Over-expression of the truncated receptor II down-regulated thegene expression of TGF-β1 and its receptor I, but notreceptor II.Conclusions: TGF-β1 autoproduction was observed inkeloid fibroblasts. Over-expression of the truncated TGF-βreceptor H decreased TGF-β1 autoproduction via blockingTGF-β receptor signaling.

Objective: To provide a highly efficient adenoviralvector Ad-CMV-hTGFβ1 for the study of gene therapy forreversion of the intervertebral disc degeneration.Methods: A newly developed recombinant adenoviralvector construction system was used in the study. ThecDNA of hTGFβ1 was first subcloned into a shuttle plasmidpShuttle-CMV. The resultant plasmid was linearized bydigesting with restriction endonuclease PmeI, andsubsequently transformed into E.coll. BJ5183 cells with anadenoviral backbone plasmid pAdEasy-1. Recombinantswere selected by kanamycin resistance and confirmed byrestriction endonuclease analysis. Finally, the recombinantplasmid linearized by PmeI was transfected into 293 cells.Recombinant adenoviruses were generated within 2 weeks.Results: The recombinant adenoviral plasmids werecut by BamHI and PacI respectively, and the diagnosticfragments appeared in 0.8% agarose electrophoresis. Theinfected 293 cells showed evident cytopathlc effect (CPE).The productions of PCR confirmed the presence ofrecombinant adenovirus. The expression of hTGFβ1 wasverified by immunohistochemical staining.Conclusions: The successful generation of theadenoviral vector Ad-CMV-hTGFβ1 and the confirmationof the interest gene expression make it possible for theexperimental study of the reversion of the intervertebraldisc degeneration by gene therapy.

Objective: To detect superoxide anion (O-2) signalsin the heart, liver, lung and kidney tissues after burns.Methods: Twenty-four male rats were randomizedinto 4 groups. The rats of experimental groups wereimmersed in 100℃ water for 15 seconds and 25% third-degree burn was created. Thoracotomy or laparotomy wasperformed at 5, 10, 15, 20 and 30 minutes after burn, andspecimens of the heart, lung, liver kidney were obtained forburned rats. The specimens were then preserved in liquidnitrogen for cryo-preservation and detected immediatelyusing EPR.Results: The signals of superoxide O radicalappeared in the heart, lung, liver and kidney specimens10-15 minutes after burn.Conclusions: There is a direct evidence of oxygen freeradicals (OFRs) injury to viscera of burned rats between10-15 minutes after burn.

Free tissue autograft is an effective means to repairmajor soft tissue defects of extremities. Emergentflap coverage by microsurgery will curtail theduration of the treatment and facilitate early functionrecovery. 1,2 However, trauma could inducehypercoagulability which could be fatal to emergent freeflap transplantation.3-8 To correlate the severity oftrauma and the tendency to hypercoagulability, wechose the patients who suffered from open injuries tothe extremities, including those who needed emergencyreconstruction with microsurgery, and studied the serialchanges in coagulation and anti-coagulation system atdifferent posttraumatic stages.

From 1990 to 2000, we used Hansson pin, AOhollow-pulling screw, and bendable screw to treat150 cases of fresh femoral neck fracture and theresult was analysed to compare the efficacy of the threemethods of internal fixation.

Cerebral atrophy is one of the serious sequelae ofsevere head injury. 1 Neuropathologicalinvestigation has revealed that cerebral atrophy iscaused by either diffuse axonal injury or cerebralhypoxia and ischemia. Secondary ipsilateral cerebralatrophy caused by acute subdural hematomas in infantshas been reported recently, but this unilateral cerebralatrophy after head injury in adult patients has rarelybeen reported.