BACKGROUND:The pathogenesis of Legg-Calve-Perthes disease (LCPD), a juvenile form of avascular necrosis of the femoral head (ANFH), is not fully understood.OBJECTIVES:The purpose of this work was to study the regulatory effect of R-spondin 1 (Rspo1) on osteoblastic apoptosis and evaluate the pre-clinical efficacy of recombinant human protein Rspo1 (rhRspo1) in treatment of LCPD.MATERIAL AND METHODS:This is an experimental study. In vivo rabbit ANFH model was established. Human osteoblast cell line hFOB1.19 (hFOB) was used to overexpress and silence Rspo1 in vitro. Additionally, hFOB cells were induced with glucocorticoid (GC) and methylprednisolone (MP), and treated with rhRspo1. The expressions of Rspo1, β-catenin, Dkk-1, Bcl-2, and caspase-3, and the apoptosis rate of hFOB cells were examined.RESULTS:The expressions of Rspo1 and β-catenin were lower in ANFH rabbits. The expression of Rspo1 was decreased in GC-induced hFOB cells. Compared to the control group, after 1 μM MP induction for 72 h, the expressions of β-catenin and Bcl-2 were higher, while Dkk-1, caspase-3 and cleaved caspase-3 expressions were lower in Rspo1 overexpression and rhRspo1-treated groups. The apoptosis rate of GC-induced hFOB cells was decreased in Rspo1 overexpression and rhRspo1-treated groups compared to the control group.CONCLUSIONS:R-spondin 1 inhibited GC-induced osteoblast apoptosis via Wnt/β-catenin pathway, which might be associated with the development of ANFH. Moreover, rhRspo1 had a potential pre-clinical therapeutic effect on LCPD.

目的 探讨脱细胞异体真皮联合头刃厚皮修复儿童瘢痕创面的临床效果.方法 52例外伤及烧伤后瘢痕,根据瘢痕切除后创面封闭术式分为复合植皮组和自体植皮组各26例,一次性切除瘢痕后,复合植皮组采用脱细胞异体真皮联合头刃厚皮移植修复创面,自体植皮组采用自体刃厚皮片或薄中厚皮片移植修复创面.比较2组植皮成活率和植皮后创面完全愈合时间,随访10个月,观察创面移植区域的色泽、质地、皮下丰满度、瘢痕增生情况及对关节功能的影响等.结果 复合植皮组创面植皮成活率(92.31％)、创面愈合时间(12.62±3.18)d]与自体植皮组[96.15％、(11.90二2.61)d]比较差异均无统计学意义(P＞0.05);复合植皮组植皮区丰满,瘢痕增生轻,色泽、质地优于自体植皮组(P＜0.05);复合植皮组关节功能受影响5例,自体植皮组关节功能受影响10例,差异有统计学意义(P＜0.05);复合植皮组头皮供皮区均无瘢痕增生,自体植皮组供皮区色素改变1 6例,瘢痕形成10例,其中2种情况均发生者8例,供皮区瘙痒16例,供皮区反复破溃3例,影响睡眠5例.结论 脱细胞异体真皮联合头刃厚皮修复儿童瘢痕丰满度高、瘢痕增生轻,功能恢复好,供皮区损伤小.

Objective To detect the relations of Wnt/β-catenin signal pathway and avascular necrosis femoral head of steroid-induced juvenile rabbits.Methods Thirty-five 8-week-old healthy New Zealand rabbits weighing 1.1-1.9 kg were randomly divided into steroid injection group (SIG,n =25) and control group (CG,n =10) according to a random number table.Prednisolone acetate of 7.5 mg/kg was injected into each SIG rabbit and an equal volume of saline for CG twice weekly for 8 weeks.Radiography and computed tomography (CT) were performed at Weeks 4,8 post-injection.All experimental animals were sacrificed at Week 8 and bilateral femoral heads harvested.According to imaging findings,SIG was further divided into disease group (DG) and non-disease group (NDG).Reverse transcription-polymerase chain reaction (RT-PCR) was employed for detecting the expressions of caspase-3,adipoq,β-catenin,LRP5 and BMP-2 mRNA in femoral heads of DG,NDG and CG.And the differences were compared among three groups.Results In SIG (n =25),only 22 rabbits survived and 6 experimental animals had positive avascular necrosis (DG) at an incidence of 27.3％ (6/22).The expression levels of β-catenin were 0.22 ± 0.01,0.35 ± 0.09 and 1.07 ± 0.41 in DG,NDG and CG respectively.Significant differences existed between CG and two other groups (t =4.94,10.60,P＜0.05).The expression levels of LRP5 were 0.22 ± 0.05,0.35 ± 0.12 and 1.12 ± 0.36 in DG,NDG and CG respectively.Significant differences existed between CG and two other groups (t =4.39,9.93,P＜0.05).The expression levels of Adipoq were 17.84 ± 5.51,3.33 ± 1.26 and 1.11 ± 0.27 in DG,NDG and CG respectively.Significant differences existed between CG and two other groups (t =5.88,12.01,P＜0.05).The expression levels of caspase-3 were 3.10 ± 0.90,1.29 ± 0.35 and 1.06 ± 0.24 in DG,NDG and CG respectively.Significant differences existed between CG and two other groups (t =7.15,7.75,P＜0.05).The expression levels of BMP-2 were 0.08 ± 0.05,0.31 ± 0.21 and 1.12 ± 0.32 in DG,NDG and CG respectively.Significant differences existed between CG and two other groups (t =2.93,8.08,P＜0.05).In DG,NDG and CG,the expression levels of β-catenin were positively correlated with LRP5 (r =0.779,0.914,0.885,P =0.008,0.020,0.019);the expression levels of caspase-3 negatively correlated with β-catenin,the expression levels of caspase-3 negatively correlated with LRP5,the expression levels of adipoq negatively correlated with β-catenin,the expression levels of adipoq negatively correlated with LRP5,the expression levels of BMP-2 positively correlated with β-catenin and the expression levels of BMP-2 positively correlated with LRP5.Conclusions Inhibitory effects of glucocorticoids on Wnt/β-catenin signal pathway may contribute to the apoptosis of osteoblasts and chondrocytes of femoral head,promote the formation of adipocytes and inhibit osteogenesis.

目的：对比观察增生期和退化期小儿毛细血管瘤组织中磷酸腺苷活化蛋白激酶（AMPK）、哺乳动物雷帕霉素靶蛋白（mTOR）表达，探讨AMPK／mTOR通路在小儿毛细血管瘤消退过程中的作用。方法收集50例小儿毛细血管瘤患者的瘤组织标本，按照Mulliken分类法24例患儿瘤组织处于增生期（增生期组），26例患儿瘤组织处于退化期（退化期组），采用免疫组织化学法检测其中 AMPK、mTOR的积分光密度。结果增生期组 AMPK、mTOR的积分光密度分别为33．94±12．78、182．43±47．10，退化期组分别为85．87±19．53、47．22±44．52。两组毛细血管瘤组织AMPK、mTOR积分光密度相比，P均＜0．01。50例小儿毛细血管瘤患者瘤组织AMPK、mTOR积分光密度值呈负相关（r＝－0．78，P＜0．01）。结论与增生期小儿毛细血管瘤组织相比，消退期小儿血管瘤组织中AMPK表达升高，mTOR表达降低。AMPK／mTOR信号通路参与小儿毛细血管瘤的消退过程。

Objective To systematically evaluate the association between protein C and Legg -Calve -Perthes disease.Methods A literature research was performed through PubMed,Embase,Cochrane library,Web of Science,Chinese Biomedical Literature Database(CBM),China National Knowledge Infrastructure(CNKI)and Wan-fang Database from inception to February 201 6 on the association between protein C and Legg -Calve -Perthes disease.According to the Newcastle -Ottawa Scale(NOS)criteria,the quality of studies was evaluated and data were extracted.Meta -analysis was performed with Stata 1 1 .0 software.Results A total of 1 4 articles were included.Twelve articles on protein C and Legg -Calve -Perthes disease in the study group and the control group were compared.The results of Meta -analysis showed that there was no significant difference in protein C levels between the study group and the control group[odds radio(OR)=1 .41 ,95% confidence interval(CI)(0.87,2.28),P =0.1 47];five articles on protein C and the white race of Legg -Calve -Perthes disease between the study group and the control group were com-pared,The results of Meta -analysis showed that there was no significant difference in protein C levels between the whiteskin patients′group and the control group[OR =0.61 2,95%CI(1 .83,7.29),P =0.61 2];three articles on pro-tein C and the yellow race of Legg -Calve -Perthes disease between the study group and the control group were com-pared,and the results of Meta -analysis showed that there was no significant difference in protein C levels between the yellow skin patients group and the control group[OR =0.59,95%CI(0.05,6.72),P =0.080].Conclusion There is no significant correlation between protein C and Legg -Calve -Perthes disease.

Avascular necrosis of the femoral head in children is also known as aseptic necrosis of the femoral head or Legg-Calve-Perthes disease.At present,generally acknowledged that it is a self-limited disease,its etiology is unclear,therapeutic methods are multiformity,and improper handling can lead to severe sequelae.The followings are the bases and clinics about avascular necrosis of the femoral head according to the recent reports and the author's research.

我们采用 Aquacel-Ag亲水性敷料覆盖深Ⅱ度烧伤患者磨痂后创面，创面愈合效果满意，报告如下。<br>　　1病例与方法<br>　　1.1一般资料2011年8月-2013年8月在武警后勤学院附属医院烧伤整形科治疗且既往无糖尿病、低蛋白血症、结缔组织病等基础病的烧伤患者58例，烧伤深度和面积判定均由本科室2名烧伤专科副主任医师根据“三度四分法”得出一致结论确定。按随机数字表法将患者随机分为治疗组和对照组，每组29例。两组一般资料比较，差异无显著性(P>0.05)，具有可比性(见表1)。

目的:研究小面积深Ⅱ°与Ⅲ°酸烧伤临床切削痂后进行延期植皮手术的效果.方法:2000年1月--2010年1月收住院的经手术植皮的小面积深Ⅱ°与Ⅲ°酸烧伤患者98例,随机分为2组,切削痂后直接植皮为对照组44例,延期植皮术处理为千预组54例.经治疗后对两组手术时间、皮下血肿率、创面细菌量、植皮成活率、创面愈合时间等进行比较分析.结果:手术时间比较2组差异无统计学意义(P>0.05);干预组皮下血肿率低于对照组(P<0.05);干预组创面细菌量与对照组比较无明显增加(P>0.05);干预组植皮成活率高于对照组(P<0.05);干预组创面愈合时间短于对照组(P<0.01).结论:小面积深Ⅱ°与Ⅲ°酸烧伤削痂后延期植皮术具有皮下血肿少,植皮成活率高,感染率低,愈合时间短等优点,是一种比较好的手术选择,综合效果优于立即植皮.

Objective: To evaluate the effect of combined suspl SD-Ag and SD-Ag-Zn-Azone cream on the wound healing in extensively burned patients.Methods: 174 burned patients admitted from January 2008 to December 2010,with burn size exceeding 35% TBSA,were randomly allocated into two groups:combined suspl SD-Ag and SD-Ag-Zn-Azone cream group was applied in 98 patients;while in other 76 patients povidone-iodine was used as control.Results: There was no significant difference between the two groups in mean age,burn size,and treatment.Wound infections,days of antibiotics administration,times of grafting,healing times and degree of scar hyperplasia were remarkably reduced in combined suspl SD-Ag and SD-Ag-Zn-Azone cream group.Conclusion: Combination of SD-Ag Suspension with SD-Ag-Zn-Azone Cream in wound healing of extensively burned patients can significantly increase resistance to infection compared with Iodophor,which is suitable for topical use in the self-healing of extensively burned patients.

目的:观察早期应用人工真皮修复大面积烧伤患者手部创面的效果.方法:选取2009年1月-2010年9月就诊于北京市右安门医院的大面积烧伤患者38例,采用随机分组方法分为两组.人工真皮组19例在早期修复手部创面手术中用人工真皮覆盖创面,2周后用自体刃厚皮片覆盖.对照组19例创面早期切痂、行自体微粒+异体皮移植,后期肉芽组织再行植皮手术.两组术后均行换药、抗感染、加强营养、维护脏器功能等综合治疗,创面愈合后进行功能锻炼.两组均随访0.5～1年,比较两组患者手部功能恢复和皮片挛缩情况.结果:人工真皮组19例38只手于第1次术后3周创面愈合.术后随访观察,术区愈合好,手部伸展、握拳功能良好,复合皮具备较好的弹性,且术区愈后色素及瘢痕轻.对照组1例入院后2周死于重度感染及多脏器功能衰竭,余18例36只手于术后1个月余创面封闭;术后随访观察,术区均有不同程度的瘢痕挛缩、掌指关节背伸畸形、手指间蹼状瘢痕增生,功能活动受限.结论:人工真皮更好地解决了早期无自体皮源时有效封闭创面的问题,是大面积烧伤早期修复手部创面、减轻创伤瘢痕的良好覆盖材料.

Objective To observe the clinical application effect of allogeneic ddermis in plastic surgery of scars after burn.Methods Out of the 8 burn cases receiving plastic surgery of scars,the composite graft with allogeneic dermis plus razor thin autoskin was performed in burn wound coverage in 4 cases,and the graft with razor thin autoskin only was performed in burn wound coverage in the other 4 cases;the follow-up lasted for 1 year;the function recovery and contraction of the patients in the 2 groups were compared.Result 1 year after surgery,the patients having composite graft showed out less skin contraction and smoother and softer skin surfaces than the patients having graft with razor thin autoskin only.Conclusions The composite graft with allogeneic dermis plus razor thin autoskin is superior to the graft with razor thin autoskin only in late function recovery and surface appearance,and allogeneic dermis is a good covering material in plastic surgery of burn scars.