[Progress and policy considerations on the pilot program of standardized training for public health physicians in China]

The standardized training for public health physicians plays an important role in exploring the cultivation public health professionals and strengthening the construction of public health service providers. In 2018, the National Health Commission of China launched a pilot program of standardized training for public health physicians in 10 provinces. This paper clarifies the definition of the standardized training for public health physicians, systematically analyzes the status quo of the training in China and other countries, articulates the design and progress of the training in the perspective of Centers for Disease Control and Prevention, and makes some suggestions for the priorities of the pilot training program, so as to provide reference and basis for the better development of the standardized training for public health physicians in China in the future.

Artesunate restores mitochondrial fusion-fission dynamics and alleviates neuronal injury in Alzheimer's disease models

Alzheimer's disease (AD) remains a leading cause of dementia and no therapy that reverses underlying neurodegeneration is available. Recent studies suggest the protective role of artemisinin, an antimalarial drug, in neurological disorders. In this study, we investigated the therapeutic potential of artesunate, a water-soluble derivative of artemisinin, on amyloid-beta (Aβ)-treated challenged microglial BV-2, neuronal N2a cells, and the amyloid precursor protein/presenilin (APP/PS1) mice model. We found that Aβ significantly induced multiple AD-related phenotypes, including increased expression/production of pro-inflammatory cytokines from microglial cells, enhanced cellular and mitochondrial production of reactive oxygen species, promoted mitochondrial fission, inhibited mitochondrial fusion, suppressed mitophagy or biogenesis in both cell types, stimulated apoptosis of neuronal cells, and microglia-induced killing of neurons. All these in vitro phenotypes were attenuated by artesunate. In addition, the over-expression of the mitochondrial fission protein Drp-1, or down-regulation of the mitochondrial fusion protein OPA-1 both reduced the therapeutic benefits of artesunate. Artesunate also alleviated AD phenotypes in APP/PS1 mice, reducing Aβ deposition, and reversing deficits in memory and learning. Artesunate protects neuronal and microglial cells from AD pathology, both in vitro and in vivo. Maintaining mitochondrial dynamics and simultaneously targeting multiple AD pathogenic mechanisms are associated with the protective effects of artesunate. Consequently, artesunate may become a promising therapeutic for AD.

[Emergency training need and effect evaluation analysis of novel coronavirus pneumonia in centers of disease control and prevention]

A questionnaire was used to investigate the emergency training needs of novel coronavirus pneumonia of disease prevention and control institutions in provinces, deputy provincial level regions and cities specifically designated in the state plan, and the effect evaluation of emergency training activities conducted by Chinese Center for Disease Control and Prevention (China CDC). The results showed that 67.4% of 47 disease prevention and control institutions (31/46) believed that the emergency training at the initial stage of the epidemic should be conducted as soon as possible, and the form of network training should be given priority. The training should focus on the urgently needed technologies such as epidemiological investigation, formulation and response of prevention and control strategies, laboratory testing, etc. The teaching materials should highlight pertinence and practicability and be presented in the form of electronic video. The average satisfaction score of the video training conducted by China CDC was (8.81±1.125) and the score of audio-video courseware was (8.97±0.893). The needs analysis and evaluation of novel coronavirus pneumonia prevention and control in disease prevention and control institutions could provide reference for the follow-up training and improve the emergency training management.

[Current situation and suggestions of public health personnel training in disease control and prevention institutions]

Under the background that the national health has become the national priority development strategy, it is essential to speed up public health ability among talents. Based on the consulting project of the Chinese Academy of Engineering, "Research on the training strategy of medical and health personnel in China", this paper analyzes the current situation and existing problems of public health personnel training in disease control and prevention institutions. Based on three stages of public health education, this paper puts forward that the public health personnel training should first solve the problem of public health personnel team construction and create programs on college education-post graduate education-continuing education. Through the personnel training system, different training modes are designed for other groups of people to improve the ability of public health personnel in an all-around way.

[Expressions of MPV, P-LCR and NLR in patients with novel coronavirus disease 2019]

To provide new ideas for clinical diagnosis and treatment of coronavirus disease 2019 (COVID-19), this study explore the expression level and prognostic value of platelet parameters in mild, moderate and severe COVID-19. This is a retrospective analysis. From January to May 2020, a total of 69 patients who were diagnosed with COVID-19 in the Third Central Hospital and the Jinnan Hospital (both situated in Tianjin) were enrolled in the disease group. According to the severity, these patients were divided into mild group (15 cases), moderate group (46 cases), and severe group (8 cases). In the same period, 70 non-infected patients were enrolled in control group. The level of white blood cell count (WBC), absolute neutrophil count (NEU#), absolute lymphocyte count (LY#), neutrophil-lymphocyte ratio (NLR), red blood cell count (RBC), hemoglobin (Hb), platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), and platelet-large contrast ratio (P-LCR) before and after treatment were analyzed. Binary logistic regression analysis is used to establish a mathematical model of the relationship between these indexes and the outcome of severe COVID-19 patients. The receiver operating characteristic(ROC) curve is used to further explore the prognosis value of MPV, P-LCR, NLR separately and jointly in COVID-19 patients. Compare to the control group, WBC and NE# increase (Z=-5.63, P<0.01;Z=-9.19,P<0.01) and LY# decrease (Z=-9.34, P<0.01) in the severe group; NLR increase with the aggravation of the disease, there is significant difference between groups (Z=17.61, P<0.01); PLT, PDW, MPV and P-LCR decrease with the aggravation of the disease, there is significant difference between groups (Z=9.47, P<0.01; Z=11.41, P<0.01; Z =16.76, P<0.01; Z=13.97, P<0.01). Binary logistic regression analysis shows MPV, P-LCR and NLR have predictive value for severe COVID-19 patients. There is a negative correlation between MPV, P-LCR and severe COVID-19 patients (OR=1.004, P=0.034; OR=1.097, P=0.046). There is a positive correlation between NLR and severe COVID-19 patients (OR=1.052, P=0.016). MPV and P-LCR of patients with good prognosis after treatment were significantly higher than those before treatment (Z=-6.47, P<0.01; Z=-5.36, P<0.01). NLR was significantly lower than that before treatment (Z=-8.13, P<0.01). MPV and P-LCR in poor prognosis group were significantly lower than those before treatment (Z=-9.46, P<0.01; Z=-6.81, P<0.01). NLR was significantly higher than that before treatment (Z=-3.24, P<0.01). There were significant differences between good and poor prognosis groups before and after treatment in MPV, P-LCR and NLR (P<0.01). Combination of these three indexes, ROC shows the AUC is 0.931, the sensitivity is 91.5%, the specificity is 94.1%, the positive predictive value is 88.9%, and the negative predictive value is 87.4%, which is better than any of these indexes separately. Changes in these parameters are closely related to clinical stage of COVID-19 patients. MPV, P-LCR and NLR are of great value in the prediction and prognosis of severe COVID-19 patients.

[Survey on provincial disease prevention and control professionals' attitudes and cognition to public health physician standardized training in China]

Objective: To understand the attitudes and cognition of disease control and prevention professionals at provincial level on public health physician standardized training and provide evidence for the improvement of the standardized training and exploration of more effective training mode in China. Methods: By cluster sampling, 2 193 professionals at provincial centers for disease control and prevention (CDC) in 6 provinces, including Jiangsu and Guangdong, Shanxi and Hubei,Sichuan and Xinjiang were selected as the study subjects, the sample size was estimated to be 1 933 persons. Results: A total of 1 716 provincial-level CDC professionals were surveyed, the support rate to the standardized training was 70.7%(1 213/1 716). The level of support was negatively associated with the educational level of professionals and their specialty of public health and preventive medicine. Of 875 public health and preventive medicine professionals, 61.6%(318/516) of those with master's degree or above supported the standard training for public health physicians, which was lower than 73.1%(225/308) of those with bachelor's degree and 86.3%(44/51) of those with college degree or below. There were 14.9%(232/1 555) of the respondents suggested a two year training, and 60.4%(933/1 544) suggesting a field training mode. In terms of training content, 86.6%(1 355/1 564) suggesting "epidemiological survey and public health practice", and 76.7%(1 199/1 564) suggesting "basic theories and methodology". Conclusions: In general, the professionals of provincial CDC showed a relatively low interest in the standardized training for public health physicians and failed to reach a consensus. Besides, they were ill-informed about current training duration, method and content. Thas, the professionals at provincial CDC are suggested to be the key target-population whom should be mobilized during the training pilot period, especially the highly educated ones with relevant specialties of public health. It is suggested that public health physician standardized training should to be implemented in whole CDC system to reach full consensus based on its practical achievements and effects. It is also suggested to establish public health graduate medical education system in China.

Bilobalide alleviates neuroinflammation and promotes autophagy in Alzheimer's disease by upregulating lincRNA-p21

EGb 761 has some protective effects on AD and can improve the cognitive functions of AD mice. However, the underlying molecular mechanisms are unknown. Here, we investigated the function of bilobalide, the effective component of EGb 761, in neuroinflammation and autophagy during AD. LPS-treated BV-2 cells were used as an in vitro model for neuroinflammation. The APP/PS1 AD mouse line was used to examine the function of bilobalide in AD. ELISA and qRT-PCR were used to measure the levels of proinflammatory cytokines, including TNF-α, IL-6 and IL-1β. Western blotting was employed to determine the protein levels of p-p65, iNOS, COX-2, LC3, beclin-1, p62 and p-STAT3. Immunostaining was applied to examine the number of autophagosomes. LPS treatment induced inflammatory responses and inhibited autophagy in BV-2 cells. Bilobalide suppressed LPS-induced neuroinflammation and promoted autophagy. Furthermore, bilobalide treatment increased the lincRNA-p21 levels, which suppressed STAT3 signalling. Knockdown of lincRNA-p21 reversed the effects of bilobalide. Overexpression of lincRNA-p21 promoted autophagy and inhibited neuroinflammation as well while STAT3 inhibitor blocked the effects of si-lincRNA-p21. In vivo experiments revealed that bilobalide improved the learning and memory capabilities of APP/PS1 AD mice. Bilobalide improves the cognitive functions of APP/PS1 AD mice. Mechanistically, bilobalide suppresses inflammatory responses and promotes autophagy possibly by upregulating lincRNA-p21 levels.

Two novel chiral tetranucleate copper-based complexes: crystal structures, nanoparticles, and inhibiting angiogenesis and the growth of human breast cancer by regulating the VEGF/VEGFR2 signal pathway in vitro

The single crystals of two novel copper(ii)-based complexes containing l-methioninol-derived Schiff bases were obtained and characterized. The nanoparticles of these complexes were prepared and their cellular uptake was measured in MDA-MB-231 cells and HUVECs. It was found that these complexes could remarkably induce apoptosis, inhibit proliferation, suppress migration and metastasis, and inhibit angiogenesis and the growth of triple-negative breast cancer derived from MDA-MB-231 cells in vitro. Meanwhile, these complexes exhibit anticancer and antiangiogenic functions by activating the important protein molecules VEGFR2, FAK, AKT and Erk1/2 or their phosphorylated molecules p-VEGFR2, p-FAK, p-AKT, and p-Erk1/2 in the VEGF/VEGFR2 signaling pathway, collapsing the mitochondrial membrane potential, and damaging the level of reactive oxygen species.

Anti-cancer activities of metal-based complexes by regulating the VEGF/VEGFR2 signaling pathway and apoptosis-related factors Bcl-2, Bax, and caspase-9 to inhibit angiogenesis and induce apoptosis

Copper-based complexes exhibited multiple anti-cancer functions by regulating the expressions of Bcl-2, Bax, and caspase-9 and activating the VEGF/VEGFR2 signaling pathway.

[A survey of attitudes to and demands on internship in graduates majoring in preventive medicine in 6 colleges and universities in China]

Objective: To understand the internship of students majoring in preventive medicine in 6 colleges and universities in China, and provide reference suggestions for the improvement of internship arrangement. Methods: By using the method of combined clustering and convenient sampling, the fifth grades students majoring in preventive medicine in six universities in the eastern, central and western China were surveyed by using questionnaires to collect the information of their attitudes (to) and suggestions for clinical and public health internships. Results: A total of 596 students were surveyed. In terms of the benefits of clinical internship and public health internship, students who thought that the internship was fruitful accounted for >88%, and more students thought that reform is needed in clinical internship compared with public health internship. In clinical internship, the students through that the time arrangement was not appropriate enough (95, 39.58%), the content should be more detailed and in-depth (73, 30.42%) and the content did not conform to the professional direction (54, 22.50%). In public health internship, the students thought that the time arrangement was not appropriate (77, 45.56%), the content should be more detailed and standardized (65, 38.46%) and the types of internship bases should be more diversified (20, 11.83%). Conclusions: The undergraduates majoring in preventive medicine felt to be benefited from clinical practice and public health internships and thought they are of necessity. At the same time, there are still many problems which needs to be improved in the two types of internships. It is necessary to make joint efforts from students, teachers, colleges and practice bases to promote the continuous improvement of undergraduate internship.

Association between MDR1 gene of gastrointestinal tumors, the expression of P-glycoprotein and resistance to chemotherapeutic drugs

The aim of the present study was to examine and discuss the association between multidrug resistance 1 gene (MDR1) of gastrointestinal tumors, the expression of P-glycoprotein and resistance to chemotherapeutic drugs. In this study, 126 cases of patients with gastrointestinal tumors admitted to hospital from February 2013 to February 2015 were selected. The expression levels of MDR1 gene were obsreved in the control population and patients before and after treatment by fluoresecent quantitative PCR. The protein expression level of P-glycoprotein was determined using western blotting and enzyme-linked immunosorbent assay. In addition, drug resistance was assessed by ATP-TCA chemosensitivity experiments. The results showed that before treatment, the expression of mRNA in MDR1 of tissues of gastrointestinal tract of the 126 cases was 108-fold larger than that of the gastrointestinal tract of the controls (p<0.05), P-glycoprotein was 87-fold larger than the expression level of the controls (p<0.05). The sensitivity of 126 tumor tissues to different chemotherapeutic drugs was determined, and the results showed that most of the tumor tissues were sensitive to chemotherapeutic drugs, and the sensitivity rate reached 96.4%. Following chemotherapy, the expression of mRNA in MDR1 of tumor tissues and the expression of P-glycoprotein decreased (p<0.05). In conclusion, the MDR1 gene and P-glycoprotein have a positive correlation with the occurrence of gastrointestinal tumors, and a negative correlation between the MDR1 gene and P-glycoprotein with resistance of chemotherapeutic drugs. Therefore, the MDR1 gene and P-glycoprotein can be used as references in the identification and diagnosis of gastrointestinal tumors.

Prognostic significance of ACP5 expression in patients with lung adenocarcinoma

INTRODUCTION

Tartrate-resistant acid phosphatase 5 (ACP5), which is essential for bone resorption and osteoclast differentiation, promotes cell motility through the modulation of focal adhesion kinase phosphorylation. This study seeks to elucidate the association of ACP5 expression and the clinicopathologic characteristics of patients with lung adenocarcinoma (AD).

METHODS

The expression of ACP5 was measured by Immunohistochemistry and Western blot analysis in lung AD and matched tumor-adjacent tissues, and the χ² test was applied to analyze the correlation between ACP5 expression and clinicopathologic features. Using the Kaplan-Meier method, univariate and multivariate regression analysis was to explore the correlation between ACP5 expression and overall survival (OS).

RESULTS

We found that ACP5 was frequently upregulated in lung AD tissues. The high expression of ACP5 was significantly related to lymph node status, tumor-node-metastasis (TNM) stage, and differentiation. From the results of univariate survival analysis, it indicated that the patients with high expression of ACP5 expression had a significantly lower OS than the patients with low expression of ACP5 expression. As it showed in Multivariate Cox regression analysis, the high expression of ACP5 expression was an independent prognostic factor for OS.

CONCLUSIONS

Our results suggest that high expression of ACP5 correlates with tumor progression and may serve as a potential prognostic biomarker in lung AD.

[Effect of acupuncture at "Zusanli" (ST 36 and "Taichong" (LR 3) on gastrointestinal hormone levels in rats with diarrhea type irritable bowel syndrome]

OBJECTIVE

To observe the effect of acupuncture of "Zusanli" (ST 36) and "Taichong" (LR 3) on gastrointestinal hormone levels in diarrhea type irritable bowel syndrome (IBS-D) rats so as to provide experimental evidence for acupuncture treatment of IBS-D.

METHODS

Forty-eight Wistar rats were randomly divided into control, model, acupuncture and medication groups, with 12 rats in each group. IBS-D model was established by chronic mild restraining stress combined with isolated raising and intragastric administration of Folium Sennae (10 mL/kg). For rats of the acupuncture group, bilateral "Zusanli" (ST 36) and "Taichong" (LR 3) were punctured and stimulated for 30 min, once daily for 14 days. The rats of the medication group were treated by gavage of Pinaverin bromide, once daily for 14 days, and those of the control and model groups were given with equal volume of saline. Somatostatin (SS), substance P (SP) and vasoactive intestinal peptide (VIP) in the rats' plasma and ileum tissues were detected by sandwich enzyme-linked immunosorbent assay (ELISA).

RESULTS

Compared with the control group, the body weight and food intake quantity were reduced significantly, while the diarrhea index was increased significantly in the model group (P < 0.05, P < 0.01). In comparison with the model group, the body weight and food intake volume in both acupuncture and medication groups were increased remarkably after the treatment (P < 0.05, P < 0.01) whereas the diarrhea index in the latter two groups was reduced obviously (P < 0.01). Compared with the control group, plasma VIP level was increased significantly in the model group (P < 0.01), while those in both acupuncture and medication groups were decreased remarkably compared with the model group (P < 0.05). No significant changes of plasma SP and SS levels were found after modeling and after both acupuncture and medication treatments. In comparison with the control group, ileum SP, VIP and SS levels in the model group were up-regulated significantly (P < 0.01), while those in both acupuncture and medication groups were down-regulated considerably compared with the model group (P < 0.01). No significant differences were found between acupuncture and medication groups in the levels of ileum SP, VIP and SS (P > 0.05).

CONCLUSION

Acupuncture of ST 36 and LR 3 can effectively down-regulate ileum SP, VIP and SS levels in IBS-D rats, which may contribute to its effect in relieving IBS-D.

[Efficacy observation on osteoarthritis of the knee treated with the ultrastructural acupotomy therapy at the counter-Ashi points]

OBJECTIVE

To compare the difference in the efficacy on osteoarthritis of the knee between the ultrastructural acupotomy therapy at the counter-Ashi points and the conventional acupuncture-moxibustion therapy.

METHODS

Sixty cases were randomly devided into an ultrastructural acupotomy therapy group (group A) and a conventional acupuncture-moxibustion group (group B), 30 cases in each one. In the group A, the ultrastructural acupotomy therapy was applied to the counter-Ashi points in which pain was alleviated or disappeared on pressure. The treatment was given once a week, lasting for 1 month. In the group B, the acupuncture-moxibustion therapy was applied to Dubi (ST 35), Neixiyan (EX-LE 4), Zusanli (ST 36), Yanglingquan (GB 34), etc. The treatment was given once daily, lasting for 1 month. Before and after treatment, the Visual Analogue Scale (VAS), Lysholm knee joint scale and the affected knee joint flexion angle were observed in the two groups. The clinical efficacy was compared between the two groups.

RESULTS

After treatment, the scores of VAS, Lysholm knee joint scale and the affected knee joint flexion angle were improved obviously as compared with those before treatment in either group (P < 0.01, P < 0.05). The results of them in the group A were superior apparently to those in the group B (all P < 0.05). The total effective rate in the group A was superior to that in the group B [80.0% (24/30) vs 60.0% (18/30), P < 0.05].

CONCLUSION

The ultrastructural acupotomy therapy at the counter-Ashi points achieves the superior clinical efficacy on osteoarthritis of the knee as compared with the conventional acupuncture therapy. It relieves pain and improves the motion range of knee joint effectively. It is simple in operation and less in treatment frequency.

Effects of selenium and light wavelengths on liquid culture of Cordyceps militaris Link

To investigate the effects of selenium and light wavelengths on the growth of liquid-cultured Cordyceps militaris and the main active components' accumulation, culture conditions as selenium selenite concentrations and light of different wavelengths were studied. The results are: adenosine accumulation proved to be significantly selenium dependent (R(2) = 0.9403) and cordycepin contents were determined to be not significantly selenium dependent (R(2) = 0.3845) but significantly enhanced by selenium except for 20 ppm; there were significant differences in cordycepin contents, adenosine contents, and mycelium growth caused by light wavelengths: cordycepin, blue light > pink light > daylight, darkness, red light; adenosine, red light > pink light, darkness, daylight, blue light; and mycelium growth, red light > pink light, darkness, daylight > blue light. In conclusion, light wavelength had a significant influence on production of mycelia, adenosine, and cordycepin, so lightening wavelength should be changed according to target products in the liquid culture of C. militaris.

[Clinical and experimental study on the ovulation promoting effect of yangjing decoction]

OBJECTIVE

To observe the effect of Yangjing Decoction (YJD) to promote ovulation and to explore its mechanism.

METHODS

The clinical effect of YJD in treating patients of functional non-ovulation and changes of gonadotropic hormone, sex hormone and diameter of main follicle before and after treatment were observed. In experimental study, the influence of YJD on monoamine neurotransmitter of hypothalamus, endorphin (beta-EOP), serum sex hormone, trace element, endometrium and histomorphology of ovary were observed.

RESULTS

In the 36 patients observed clinically, the ovulation rate was 61.1%, the serum contents of follicular stimulation hormone (FSH), luteinizing hormone (LH) and estradiol (E2) increased and the diameter of main follicle enlarged significantly after treatment (P < 0.01, P < 0.001). The experimental study showed that the totals of follicle at different levels, the corpus luteum and the proportion of superior follicle in ovary were improved obviously in the YJD group as compared with those in the control group. After YJD treatment the hypothalamus contents of monoamine neurotransmitter, including norepinephrine (NE) and dopamine (DA) increased, the 5-hydroxytryptamine (5-HT) 5-hydroxyindoleaceticacid (5-HIAA) and beta-EOP decreased significantly, and the NE/DA ratio and NE/5-HT ratio elevated obviously (P < 0.05, P < 0.001). The serum levels of E2, P and trace elements, including Zn, Cu and Fe increased significantly (P < 0.05, P < 0.01).

CONCLUSION

YJD is an effective recipe in promoting ovulation, the effect may be achieved through the multi-linked, multi-systemetic synthetic effect of hypothalamus, hypophysis and ovary, etc.

Binding affinity and selectivity of opioids at mu, delta and kappa receptors in monkey brain membranes

The binding parameters of radiolabeled DAMGO (mu), DPDPE and pCl-DPDPE (delta) and 5 alpha, 7 alpha, 8 beta-N-methyl-N-[7-(1- pyrrolidinyl)-1-oxaspiro(4,5)dec-8-yl]benzeneacetamide (also known as U69593, kappa) and the affinity and selectivity profiles of various opioid agonists and antagonists at the three opioid receptor types were determined in membranes from brain cortex of rhesus monkey. Among the 10 opioids with established mu-selective actions, etonitazene inhibited the binding of [3H]DAMGO with a Ki of 0.02 nM (0.01 nM without sodium) and exhibited mu/delta and mu/kappa selectivities of 8800 and 11,650, respectively. DAMGO had a Ki of 1.23 nM and was about 500-fold more selective at mu receptors compared with delta and kappa sites. Other mu opioids with higher than 100-fold binding selectivity were fentanil and sufentanil. Highly selective delta opioids were DPDPE, deltorphin II and naltrindole. With the exception of N,N-diallyl-Tyr-Aib-Aib-Phe-Leu-OH, all investigated putative delta opioids bound to delta sites with low Kis, i.e., 0.04 nM, 0.13 nM and 1.4 nM for naltrindole, (+/-)-4-[(alpha-R*)-alpha-((2S*,5R*)-4-allyl-2,5-dimethyl-1-piperazinyl) -3- hydroxybenzyl]-N,N-diethylbenzamide and DPDPE, respectively. In this series, the displacement of [3H]pCl-DPDPE yielded results similar to those obtained with [3H]DPDPE. With nanomolar Kis of 0.70, 0.89, 0.25 and 0.06, respectively, the highest kappa selectivity was displayed by (trans)-(+/-)-3,4-dichloro-N-methyl- N-[2-(1-pyrrolidinyl)-cyclohexyl]benzeneacetamide and U69593, followed by dynorphin 1-13 and norbinaltorphimine.(ABSTRACT TRUNCATED AT 250 WORDS)

Longitudinal growth after replantation of immature extremities on rats

Replantation of right hindlimbs in 76 immature rats was performed to study the factors affecting longitudinal growth of replanted extremities. There was a significant difference in tibia length between the replanted limb and the contralateral normal limb. The difference was significantly influenced by the ischemic interval (2 vs 4 hours), but not by suture method (intact vessels, vascular anastomosis with 10-0 nylon or 11-0 nylon). The replantation of immature extremities should be promptly undertaken because of the vulnerability of the epiphysis to ischemic insult.