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Objective To study the effect of high frequency repeated transcranial magnetic stimulation (rTMS) on learning and memory in rats with global cerebral ischemia and to investigate its mechanism.Methods Thirty-five male Sprague-Dawley rats (8-10 weeks old) were randomly divided into sham operation group (n=8),model group (n=9),sham-rTMS (s-rTMS) group (n=9) and rTMS group (n=9).The global cerebral ischemia model was established by modified four-vessel occlusion method.The rTMS group received 10 Hz rTMS stimulation for two weeks,whereas the s-rTMS group received sham stimulation.Morris water maze test was used to detect the spatial learning ability,multi-channel recording technique was used to detect the local field potentials in the hippocampus CA1 region of theta and gamma oscillation,and immunohistochemical staining and Western blotting were used to detect the expression of protein kinase A (PKA) and phosphorylated cyclic adenosine monophosphate response element binding protein (p-CREB) of hippocampus.Results The average escape latency in the model group was longer than that in the sham operation group ((35.16±0.80) s vs (16.57±0.74) s,k=3.723,P=0.013),the spanning platform times and the original platform quadrant swimming time in the model group were shorter than that in the sham operation group (1.14±0.42 vs 4.46±0.23,k=3.185,P=0.042;(14.46±0.73) s vs (29.31±0.42) s,k=3.027,P=0.047).Compared with the sham operation group,the mean power spectral density of theta and gamma reduced ((-68.48±2.61) Hz vs (-59.38±2.25) Hz,k=2.958,P=0.048;(-82.23±4.60) Hz vs (-70.50±4.25) Hz,k=3.729,P=0.021),and the expression of PKA and p-CREB protein decreased in the model group (7 184.26±975.12 vs 25 137.35±1 010.62,k=3.588,P=0.027;1 803.73±336.18 vs 20 175.25±727.23,k=2.912,P=0.049).The average escape latency in the rTMS group was shorter than that in the model group ((24.69± 1.01) s vs (35.16±0.80) s,k=4.082,P=0.034),and the spanning platform times and the original platform quadrant swimming time in the rTMS group was longer than that in the model group (2.42±0.31 vs 1.14±0.42,k=3.296,P=0.039;(23.07±0.67) s vs (14.46±0.73) s,k=4.323,P=0.012).Compared with the rTMS group,the power spectral density of theta and gamma reduced ((-63.81±3.12) Hz vs (-68.48±2.61) Hz,k=3.582,P=0.015;(-75.80±4.58) Hz vs (-82.23±4.60) Hz,k=4.051,P=0.026),and the expression of PKA and p-CREB protein decreased in the model group (13 065.32±1 045.18 vs 7 184.26±975.12,k=3.923,P=0.031;11 032.83±562.86 vs 18 03.73±336.18,k=3.178,P=0.038).Conclusion High frequency rTMS could improve learning and memory of global cerebral ischemia rats,the mechanism of which might be that rTMS enhance the hippocampal theta and gamma oscillations and increase the expression of PKA and p-CREB protein in the hippocampus,thus increasing the hippocampus synaptic plasticity.
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Objective@#To investigate the feasibility of repairing soft tissue defects of extremities with the perforator flap based on the first perforating artery of profunda artery.@*Methods@#From January 2015 to December 2018, 9 patients with soft tissue defects of extremities were treated in the Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University. 5 males and 4 females; aged 29-48 years, average 36 years old. The causes of injury were traffic accident injury (4 cases), heavy object crush injury (3 cases) and mechanical injury (2 cases). There were 3 cases of soft tissue defect of upper limb, 6 cases of soft tissue defect of lower extremity, 2 cases of tendon and nerve rupture, 2 cases of fracture, 1 case of tendon and 1 case of bone exposure. All soft tissue defects were repaired with the perforator flap based on the first perforating artery of Profunda artery. After debridement, The range of soft tissue defect was 10 cm×5 cm-16 cm×10 cm. The intraoperative flap area was 12 cm×6 cm-18 cm×11 cm. The vascular anastomosis was performed in the area, the flap covered the wound surface and the donor site directly pulled the suture or grafted skin.@*Results@#All flaps survived completely and there were no complications such as vascular crisis. Follow-ups were performed in various forms for 6 to 12 months. These flaps were satisfactory in appearance and function and had a good texture.@*Conclusions@#The perforator flap based on the first perforating artery of profunda artery can repair the defects of the limbs in the soft group. The donor site of the flap is hidden, the amount of tissue available is relatively large and the repair effect is good.
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Objective@#To explore the clinical effects of superior gluteal artery perforator island flap in repair of sacral pressure ulcer.@*Methods@#From May 2012 to May 2017, 20 patients with sacral pressure ulcers (14 males and 6 females, aged 27 to 67 years) were admitted to our department. According to the consensus staging system of National Pressure Ulcer Advisory Panel in 2016, 6 cases were in 3 stages, 14 cases were in 4 stages, with the area of pressure ulcers ranging from 5.0 cm×4.0 cm to 10.0 cm×8.0 cm. After debridement and vacuum sealing drainage, the superior gluteal artery perforator island flaps were used to repair the pressure wounds, with the area of flaps ranging from 6 cm×5 cm to 13 cm×8 cm. The donor sites were sutured directly. The survival of flaps after operation, the healing of wounds, and the follow-up of patients were observed.@*Results@#After surgery, flaps of 20 patients survived well without reoperation. The length of hospital stay of patients was 20 to 40 days, with an average of 25 days. Eighteen patients were followed up for 6 to 24 months, with an average of 12.2 months. The flaps were in good shape and elastic recovery. There were no complications such as seroma or hematoma in the donor sites. Both the patients and family members expressed satisfaction with the shape and texture of the flap and shape of hip.@*Conclusions@#The superior gluteal artery perforator island flap is reliable in blood supply and easy to rotate. The flap can carry a little muscle to increase the anti-infective ability. Moreover, the donor site can be directly sutured with slight damage. Thus, it is one of the good methods for repairing sacral pressure ulcers.
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Objective@#To explore the effects of combined transplantation of the rat Schwann cells and fibroblasts (Fbs) on the nerve regeneration of denervated perforator flaps in rats and the mechanism.@*Methods@#(1) Fbs were isolated from the trunk of 2 Sprague-Dawley (SD) rats embryos of 14-16 days′ pregnancy and cultured, and the morphology of the cells was observed. The third passage of cells were used for subsequent experiments. The protein expressions of fibronectin and Ephrin-B2 were observed by immunohistochemical method. The mRNA expression of Ephrin-B2 was detected by real-time fluorescent quantitative reverse transcription polymerase chain reaction (n=3). (2) Schwann cells were isolated from the bilateral sciatic nerves and brachial plexus nerves of 45 SD rats born for 1-3 days and cultured, and the morphology of the cells was observed. The third passage of cells were used for subsequent experiments. The rate of S100 positive cells was detected by immunofluorescence method and flow cytometer, with sample numbers of 9 and 3 respectively. (3) In Dulbecco′s modified Eagle medium (DMEM) high glucose medium, 1 mL Fbs and 1 mL Schwann cells both in the concentration of 1×105 cells/mL were co-cultured as Schwann cells+ Fbs co-culture group, and 2 mL Schwann cells in the concentration of 1×105 cells/mL were cultured alone as Schwann cells alone culture group, with 5 wells in each group. The clusters of Schwann cells in the two groups were observed and counted under inverted phase contrast microscope at post culture hour (PCH) 6 and 24 respectively. The clusters of Schwann cells in Schwann cells+ Fbs co-culture group were observed by immunofluorescence method at PCH 24 too. The protein expressions of EphB2, Sox2, and N-cadherin in Schwann cells of two groups at PCH 24 were detected by Western blotting (n=20). (4) Totally 100 8-week-old male SD rats were selected, and an in situ replanted peritoneal denervated perforator flap was made in each rat. According to the random number table, the rats were divided into simple flap group, Fbs alone transplantation group, Schwann cells alone transplantation group, Schwann cells+ Fbs co-transplantation group, with 25 rats in each group. Flaps of rats in Fbs alone transplantation group and Schwann cells alone transplantation group were injected with 0.4 mL Fb and 0.4 mL Schwann cells respectively (2×106 cells each). Flaps of rats in Schwann cells+ Fbs co-transplantation group were injected with 0.4 mL Fbs and Schwann cells mixed cells (totally 2×106 cells, cell number ratio: 1∶1), and flaps of rats of simple flap group were injected with the same volume of DMEM high glucose medium. On post injection day (PID) 2, 5, 7, 9, and 14, 5 rats in each group were selected respectively according to the random number table. The flap tissue was collected, and the number, diameter, and arrangement of regenerated nerves were observed by immunofluorescence method. Data were processed with completely random designed t test, analysis of variance for repeated measurement, t test, and Bonferroni correction.@*Results@#(1) The third passage of cells isolated and cultured from the rat embryo trunks were uniform in size and shape, long spindle-shaped, with a large proportion of nuclei. Strong positive expressions of fibronectin and Ephrin-B2 protein in cells were observed, and the mRNA expression of Ephrin-B2 was 0.004 1±0.000 8. The cells were identified as Fbs. (2) After 5 days of culture, the primary cells isolated from the sciatic nerves and brachial plexus nerves of neonatal rats were elongated in cell bodies and grew in nest, fence, or vortex-like shape. The third passage of cells were detected by immunofluorescence method and flow cytometer, and the corresponding S100 positive cell rates were (95.9±1.0)% and (95.8±1.1)% respectively. The cells were identified as Schwann cells. (3) At PCH 6 and 24, the cluster numbers of Schwann cells in Schwann cells+ Fbs co-culture group were significantly higher than those of Schwann cells alone culture group (t=6.500, 10.614, P<0.01). At PCH 24, the Schwann cells in Schwann cells+ Fbs co-culture group aggregated into clusters, Fbs dispersed around the Schwann cell clusters, and the protein expressions of EphB2, N-cadherin, and Sox2 in Schwann cells were significantly higher than those in Schwann cells alone culture group (t=2.975, 19.717, 11.159, P<0.05 or P<0.01). (4) On PID 2, a small number of scattered, disordered, short, and thin nerve fibers were observed in the flap tissue of rats in the four groups. From PID 5 to 14, the number of nerve fibers in the flap tissue of rats of Schwann cells+ Fbs co-transplantation group increased gradually, and the nerve fibers were with long diameter and arranged orderly. The number of nerve fibers in the flap tissue of rats of Schwann cells alone transplantation group increased, but the nerve fibers were with short diameter and arranged disorderly, and the number was smaller than that of Schwann cells+ Fbs co-transplantation group. In simple flap group and Fbs alone transplantation group, the nerve fibers in the flap tissue of rats gradually degenerated with gradually decreased number or even disappeared.@*Conclusions@#The combined transplantation of Fbs and Schwann cells in rats can regulate Schwann cells migration and clustering by activating Ephrin/Eph-Sox2-N-cadherin signaling pathway, thus promoting the orderly nerve regeneration of denervated perforator flaps in rats.
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Objective@#To investigate the design of free perforator flap, and the efficacy of utilizing perforator flaps for Ⅳ degree Ischia-sacral ulcer treatment.@*Methods@#From January 2010 to October 2016, 18 patients with Ⅳ degree ischia-sacral ulcer were treated. The surface area of the sacral tail ranged from 4 cm×5 cm to 8 cm ×12 cm.Doppler sonography was used to detect potential perforator.All defects were repaired with free perforator flaps, designed based on the size and shape of the wound. The flap size ranged from 6 cm×11 cm to 9 cm×15 cm.@*Results@#One perforator flap went dehiscence after surgery, repaired by V-Y flap. All the rest of perforator flaps survived well, after 3-24 months follow-up. Flap texture and appearance was good, no ulcer reoccurred.@*Conclusions@#The free perforator flap is a simple technique.It does not need to tracethe trunk of vessels, and it does not cause major morbidities to the buttocks. Therefore, it is one of the ideal ways to repair Ⅳ degree Ischia-sacral ulcer.
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Objective@#To evaluate the clinical effect of the modified nasolabial flap with facial subcutaneous pedicle advanced flap in repairing the defects after midcheek tumor resection.@*Methods@#From June 2012 to June 2017, 27 patients with facial tumors were treated, and according to the nature of the tumor, the tumor tissue was enlarged, frozen pathological examination was performed during the surgery. Once the edge and the base were reported to be negative, the nasolabial flap with facial subcutaneous pedicle advanced flap with a maximum 1 cm wider than the defect width was designed according to the position and size of the wound. The proximal border of the flap was designed at the cured edge of the circular wound. The curved bottom edge of the circular wound was the proximal end of the flap. The defects ranged from 2.0 cm×3.0 cm to 2.5 cm×4.0 cm. The donor site was directly sutured after subcutaneously loosening.@*Results@#The operation was smooth, and the flaps were about 3.0 cm×6.0 cm to 3.5 cm×7.0 cm. The flaps were well transported after surgery, and there was no bruising at the tip. The suture was removed 1 week after surgery. After 6-36 months of follow-up, postoperative scar was not obvious, which were most hidden in the nasolabial folds. There was no ectropion and mouth deformity. The flaps were not swollen, and the color and texture were close to that of normal skin. The appearance was satisfactory. Sensation of skin were well recovered.@*Conclusions@#The modified nasolabial flap with facial subcutaneous pedicle advanced flap is suitable for repairing the facial defects with satisfactory skin sensation and good appearance.
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Objective@#To summarize the individual design of the perforator flap based on the descending branch of the lateral circumflex femoral artery and ecological protection of the flap.@*Methods@#From June 2013 to June 2017, 33 cases of extremities wound defects were repaired with the descending branch perforator flap of the lateral circumflex femoral artery. According to the chracteristics of extremity wound and the anatomy of the descending branch perforator of the lateral circum flex artery, a medial incision of the flap according to the demarcation line was performed. Through meticulous dissection, two perforator branches were found and traced on the surface of facia lata. The size of the kiss flap was adjusted according to the perforator caliber. The chimeric muscular flap was incised according to muscular penetration point of the perforator and the course of lateral fermoral nerve with cautious protection of muscular branch of femoral nerve. During the incision, fascia lata, nerves and muscles on donor site were protected to reduce the damage to donor site. Meanwhile, ecological structure on donor site was reconstructed. Our series include 22 males, 11 females. The average age ranged from 13 to 71 years (mean: 47years). There were 21 cases of wounds on dorsum manus and wrists and 12 cases of wounds on the dorsum pedis and lower limbs. The wound dimension ranged from 7 cm×8 cm to 13 cm×24 cm. The flap dimension ranged from 6 cm×7 cm to 8 cm×15 cm.There were 22 cases of KISS flaps and 11 cases of chimeric flaps. Wounds on all donor sites were primarily sutured. Course of the disease ranged from 1 week to 2 months.@*Results@#All flaps were harvested uneventfully and survived well. No vascular crisis occurred. Wounds on all donor sites were primarily sutured. Three to 24 (mean 18) months of follow-up was made on 28 cases. The color and texture of flaps was good. Appearance of the flaps was good. Protective sensation recovered. Only linear scar can be seen on donor sites. No muscular hernia and cinesipathy was noticed on donor sites.@*Conclusions@#The size of KISS flaps depends on the caliber of perforator branch estimated intraoperatively. Muscular part of the chimeric flaps was harvested according to the muscular entry points of perforators and the demand of recipient sites. The wound defects were reconstructed individually according to the peculiarity of the defects. Fascialate, nervus cutaneus and muscle was cautiously protected in the course of flap harvest. Ecological structure was reestablished after flap harvest to reduce complications.
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Objective To discuss the therapeutic effect of free perforator flap of the humeral back and the healing of the wound after the removal of the malignant tumor.Methods From January,2012 to June,2016,12 cases were treated as soft tissue tumors on shoulder,including 8 cases of skin juga fibrosarcoma,3 cases of basal cell carcinoma,squamous cell carcinoma of the skin in 1 case.Preoperative using doppler ultrasound probe design perforator flap to expand resection,intraoperative cut edge basal tag frozen pathological examination without taking skin flap after the tumor invasion,according to the wound and wear the appropriate adjustment design of perforator flap.Followed-up to observe recurrence,flaps or ulcers,and the texture of the flap and the feel of the flap.All patients were followed-up regularly.Results All 12 patients were followed-up for 6-48 months.The flaps were all alive.The tumor did not relapse,and the flap was not swollen.The texture was consistent with the surrounding tissue.There was no ulceration of the flap.No obvious depression deformity.The outlook of flaps was satisfied,but the feeling was not.The doror sites were closed directly.Conclusion Adjacent using humeral back free perforators flap to repair the defect after tumor resection on shoulder is an easy operation.It is one of the ideal flaps to repair a malignant tumor on the back of the shoulder.
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Objective@#To explore the effects of lappaconitine (LA) on pain and inflammatory response of severely burned rats and the mechanism.@*Methods@#Forty SD rats were divided into healthy+ normal saline group, sham injury+ normal saline group, pure burn group, burn+ LA group, and healthy+ LA group according to the random number table (the same dividing method below), with 8 rats in each group. Rats in pure burn and burn+ LA groups were inflicted with about 32% total body surface area deep partial-thickness scald (hereinafter referred to as burn) on the back and right hind. Rats in sham injury+ normal saline group were sham injured. Rats in burn+ LA group were intraperitoneally injected with 1 g/L LA solution in the dosage of 4 mL/kg at 2.0 h before injury and post injury hour (PIH) 0 (immediately), 24.0, 48.0, and 72.0. Rats in healthy+ LA group were intraperitoneally injected with LA solution in the same dose at the same time points as above, and rats in healthy+ normal saline and sham injury+ normal saline groups were intraperitoneally injected with normal saline in the dose of 4 mL/kg at the same time points as above. At 1.5 h before injury and PIH 12.5, 24.5, 36.5, 48.5, and 72.5, the paw withdrawal mechanical threshold (PWMT) of injured rats was detected, and their pain behaviors were observed. The same observation and detection were conducted in rats without injury in the two groups at the same time points as above. Another 32 SD rats were divided into normal saline group, trinitrophenyl (TNP)-ATP group, minocyline group, pyridoxal-phosphate-6-azophenyl-2', 4'-disulfonic acid (PPADS) group, with 8 rats in each group, and all the rats were inflicted with the same burn injury as above. At PIH 48.0, rats in normal saline group were intrathecally injected with 10 μL normal saline; rats in TNP-ATP group were intrathecally injected with 10 μL TNP-ATP in the concentration of 30 nmol/μL; rats in minocyline group were intrathecally injected with 10 μL minocyline in the concentration of 5 g/L; rats in PPADS group were intrathecally injected with 10 μL PPADS in the concentration of 10 nmol/μL. The PWMT of rats was detected at 0.5 h before injection and 0.5 h after. At PIH 72.5, the tissue in the dorsal horn of spinal cord of rats in sham injury+ normal saline, pure burn, and burn+ LA groups was harvested to observe the co-expression of P2X4 receptor and OX42 receptor with immunofluorescent staining and to observe the expression of P2X4 receptor and count the positive cells with immunohistochemical staining. The venous blood was harvested for determination of serum content of tumor necrosis factor-alpha (TNF-α) and interleukin-1 beta (IL-1β) with enzyme-linked immunosorbent assay. The same observation and determination were conducted in rats without injury in the two groups at the same time point as above. Data were processed with one-way analysis of variance, analysis of variance for repeated measurement, SNK test, paired t test, and Bonferroni correction.@*Results@#(1) There were no abnormal activity in rats of healthy+ normal saline, sham injury+ normal saline, healthy+ LA groups at all time points. Until PIH 72.5, rats in pure burn group were in poor mental state; red and swollen manifestation and blister were observed in burn wounds on the back and right hind; imbalance in gait, lick, bite, and scratch were observed occasionally. Fewer behaviors such as lick, bite, and limp were observed in rats in burn+ LA group than in pure burn group, and the red and swollen manifestation in wounds of rats in burn+ LA group dissipated faster than that in pure burn group. (2) At 1.5 h before injury, there were no significant differences in the PWMT values of rats in healthy+ normal saline, sham injury+ normal saline, pure burn, burn+ LA, and healthy+ LA groups (F=0.106, P>0.05). PWMT values of rats in pure burn group were significantly lower than those in the other 4 groups at all post injury time points (with P values below 0.05). PWMT values of rats in burn+ LA group were significantly lower than those in healthy+ normal saline, sham injury+ normal saline, and healthy+ LA groups at all post injury time points (with P values below 0.05). (3) At 0.5 h before injection, PWMT values of rats in normal saline, TNP-ATP, PPADS, and minocyline groups were close, respectively 15.3±0.8, 15.1±1.0, 15.3±0.9, and 15.6±1.1 (F=0.343, P>0.05). At 0.5 h after injection, PWMT values of rats in normal saline group and PPADS group were respectively 15.2±1.2 and 14.8±1.0, which were significantly lower than 20.8±1.4 and 26.3±1.0 in TNP-ATP group and minocyline group respectively (with P values below 0.05). PWMT values of rats in normal saline and PPADS groups were similar before and after injection (with t values respectively 0.073 and -0.772, P values above 0.05), while those of rats in TNP-ATP and minocyline groups were higher after injection than before injection (with t values respectively -10.180 and -20.813, P values below 0.01). (4) At PIH 72.5, co-expression of P2X4 receptor and OX42 receptor was observed in a few microglias of rats in healthy+ normal saline, sham injury+ normal saline, and healthy+ LA groups, while co-expression of P2X4 receptor and OX42 receptor was observed in a large number of microglias of rats in pure burn and burn+ LA groups. At PIH 72.5, more P2X4 receptor positive cells were observed in rats in pure burn group than in the other 4 groups (with P values below 0.05), and more P2X4 receptor positive cells were observed in rats in burn+ LA group than in healthy+ normal saline, sham injury+ normal saline, and healthy+ LA groups (with P values below 0.05). (5) At PIH 72.5, the serum content of TNF-α and IL-1β of rats in pure burn group was significantly higher than that in the other 4 groups (with P values below 0.001). The serum content of TNF-α and IL-1β of rats in burn+ LA group was significantly lower than that in healthy+ normal saline, sham injury+ normal saline, and healthy+ LA groups (with P values below 0.001).@*Conclusions@#LA has significant analgesic effects on severely burned rats, and it can ameliorate the excessive inflammational situation. The mechanism may be related to its inhibition of expression of P2X4 receptor in microglias in the dorsal horn of spinal cord and reduction in the release of inflammatory factors TNF-α and IL-1β.
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Objective@#To investigate the therapeutic effect of propeller flap with low peroneal artery perforator for defects at ankle and heel.@*Methods@#From January 2009 to March 2016, 28 cases with skin defects at ankle and heel were treated with propeller flap pedicled by low peroneal artery perforator, including 15 cases of car accidents, 8 cases of pressure injury, 3 cases of wring injury and 2 cases of electricity shock injury. Defects size ranged from 3 cm×3 cm to 4 cm×6 cm. The fibular was divided into 9 segments from head to external ankle. Doppler ultrasound was used to locate the low peroneal artery perforator from the lower 6-9 segments. The flap pivot point was at perforator point at skin surface, with the peroneal artery as flap axis. The length of big blade was the distance from rotate point to distal end of defects. The flap width was half of the length. The ratio of big blade length to width should not exceed 2∶1. The flaps size was from 3 cm×5 cm to 4 cm×10 cm, based on the defect size. The defects at donor site could be closed with small blade directly.@*Results@#Partial necrosis happened in 1 case due to veneous crisis, which healed after dressing. All the other 27 flaps survived completely. During the follow-up period, the flaps had good match in color and thickness. No secondary operation was needed.@*Conclusions@#The optimization of propeller flap with low peroneal artery perforator is an idealmethod for defects at ankle and heel, which can avoid the necrosis at distal end of flap.
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Objective@#To investigate the feasibility and efficacy of free lobulated lateral circumflex femoral artery perforator flap for foot and ankle defect at non-weight bearing area.@*Methods@#From January 2008 to June 2016, 28 cases with foot and ankle skin and soft tissue defects at non-weight bearing area were treated, including 16 cases with traffic accident, 8 cases with machine injury, and 4 cases with falling injury. There were 10 cases with Achilles tendon exposure, 16 cases with dorsalis pedis tendons exposure and 12 cases with bone exposure. The defect size ranged from 10 cm×8 cm to 16 cm×13 cm. Doppler ultrasound detector was used to select two perforators of lateral femoral circumflex artery. The lobulated perforator flap was designed and harvested as one flap. After clip test was performed to make sure the blood supply of flap, the flap was segmented and repositioned to cover the wound. The width of lobulated flaps was less than 8cm, in order to close the defect at donor sites directly. Postoperative rountine anti-inflammatory, anticoagulant, anticonvulsive treatment and function exercise were adopted. The patients were followed up for 6-28 months.@*Results@#The flap size ranged from 9.0 cm×4.5 cm to 17.0 cm×7.0 cm. Partial necrosis happened at the end of one flap lobe due to pressure, which healed after dressing. All the other 27 flaps survived completely with satisfactory cosmetic and functional result. The wounds at donor sites all healed primarily.@*Conclusions@#Free lobulated lateral circumflex femoral artery perforator flap is one of the ideal flaps with high survival rate and low complication for foot and ankle defect at non-weight bearing area.
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Objective@#To investigate the feasibility and effectiveness of the superficial temporal artery frontal branch flap combine with the retrograde retroauricular artery flap in repairing the preauricular defects.@*Methods@#The superficial temporal artery frontal branch flap with hair is designed for sideburns reconstruction, and the hairless retrograde retroauricular artery flap for repair the hairless area which is between the tragus and the temples. The donor sites were closed directly.@*Results@#From September 2012 to September 2015, 9 cases were treated. All flaps survived completely. Surgical incisions and wounds at donor sites and recipient sites healed primarily. All cases were followed up for 6-18 months (10 months on average) and cosmetic results were satisfactory without visible scar.@*Conclusions@#The method of the superficial temporal artery frontal branch flap combined with the retrograde retroauricular artery flap for the repair of preauricular a large skin defect is simple with less and inconspicious auxiliary incision. The sidebums and hairless area can be simultaneously reconstructed with satisfactory appearance.
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Objective To summarize the individualized design of perforating branches in the KISS flap of the descending branch of lateral femoral circumflex artery and improve the survival rate of flap. Methods From September, 2012 to June, 2016, the individualized design KISS flap of perforating branches of lateral femoral circum-flex artery was used to repair the soft defect in arms and legs in 20 cases, which contained 12 males and 8 females aged from 23 to 71 years old with an average of 48 years. The wounds in upper limb and wrist were 16 cases, and in instep and lower extremity wounds were 4 cases. The areas of tissue defect were ranged from 8.5 cm ×12.0 cm to 12.0 cm×23.0 cm. The area of flap ranged from 5.0 cm×8.0 cm to 8.0 cm×14.0 cm. Donor sites were sutured directly. Post-operative follow-up was done termly. Results All flaps survived without vascular crisis. The wounds and incisions at donor sites were the primary healing. Seventeen cases were followed-up 6 to 24 months (average, 18 months). The color and texture of the flaps were good, and the appearance was satisfactory. The donor site of the flap only left linear scar. Conclusion Designed KISS flap according to diameter of the perforator artery in the operation can improve the survival rate of the flap. The design of the KISS flap is more flexible and reliable, which is worthy of promotion.
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Objective:To study the neuro-protective effects of Shenfu injection on Nrf 2 signaling pathway affected by cerebral ischemia reperfusion.Methods: A total of 68 adult male Sprague-Dawley rats were randomly divided into sham group , cerebral ischemia-reperfusion group,and(8 mg/kg)Shenfu injection treatment group.Shenfu injection was injected intraperitoneally in the rats after MCAO.Neurologic deficit was evaluated after 24 hours of reperfusion.All the rats were sacrificed after 24 h of ischemia-reoerfusion for biochemical analysis or Nissl staining.Results:Shenfu injection treatment significantly increased the expression of Nrf 2,HO-1 and NQO-1(P<0.05).Furthermore,Shenfu injection treatment significantly reduced the expression of cleaved -caspase-3 and attenuated neurological deficits after cerebral ischemia reperfusion ( P<0.05 ).Lastly, Shenfu injection could evidently alleviate the severity of neuronal degeneration ( P<0.05 ).Conclusion:Shenfu injection could confer neuroprotection after cerebral ischemia reperfusion through modulating the Nrf2 signaling pathway.
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<p><b>OBJECTIVE</b>To explore the clinical effects of relaying reversed perforator flaps in repairing skin and soft tissue defects at distal end of finger and donor site.</p><p><b>METHODS</b>Seventeen patients (17 fingers) with skin and soft tissue defects at distal end of finger were hospitalized from June 2011 to June 2013. The reversed digital artery perforator flap with branch of digital nerve was used to repair the defect. The first donor site was repaired by dorsal metacarpal artery perforator flap; the second donor site was closed by suturing. The area of skin defect at distal end of finger ranged from 2.0 cm x 1.5 cm to 3.0 cm x 2.0 cm, and the area of digital artery perforator flap and dorsal metacarpal artery perforator flap ranged from 2.2 cm x 1.5 cm to 3.6 cm x 2.5 cm and 2.5 cm x 2.0 cm to 4.2 cm x 3.0 cm, respectively.</p><p><b>RESULTS</b>All the 34 flaps survived completely. Cyanosis and partial necrosis of the epidermis appeared in 1 flap, which was healed after dressing change. All the patients were followed up for 1 to 18 months, with mean time of 8 months. The color, texture and appearance of flaps were satisfactory. There was no depression or breakdown in the first donor sites. Some linear scars appeared in the second donor sites, but they did not affect the general appearance. The donor sites at joint or tendon did not affect the joint activity after healing. The results of function evaluation of range of active movement of the fingers were excellent in 15 cases and good in 2 cases. The results of sensation of the flaps were S3 in 1 finger, S4 in 2 fingers, and S5 in 14 fingers. The distance of two-point discrimination of flaps ranged from 5 to 7 mm, with mean distance of 6 mm.</p><p><b>CONCLUSIONS</b>Relaying reversed perforator flap, with reliable blood supply and both donor sites in the hand, can improve the appearance and function of the first donor site as well as repair skin and soft tissue defects at distal end of finger.</p>
Subject(s)
Humans , Cicatrix , Depression , Epidermis , Extremities , Finger Injuries , General Surgery , Perforator Flap , Plastic Surgery Procedures , Methods , Skin , Skin Transplantation , Methods , Soft Tissue Injuries , General Surgery , Surgical Flaps , Sutures , Tendons , Treatment Outcome , Wound HealingABSTRACT
Objective To observe the protective effect of aprotinin on the cerebral ischemia-reperfusion injury. Methods Rat model of cerebral ischemia-reperfusion injury was created by the middle cerebral artery embolization. The changes of IL-1β,IL-6 and IL-8 content in the brain tissue were measured by ELISA. The neurological scores were made on Zea Longa 5-point scale. Results In model group, the IL-1β,IL-6 and IL-8 protein content began to increase slightly at 3 hours compared with sham group, reached the peal[at 12 hours. In the aprotinin treated group, aprotinin reduced the protein content. It showed no significant difference between model group and aprotinin treated group at 3 hours, however and there was greatly difference at 6,12 and 24 hours between these two groups. Conclusion The present study provides in vivo evidence that aprotinin protects brain against cerebral ischemia-reperfusion injury. The mechanism is related to the decrease of cerebral levels of IL-1β,IL-6 and IL-8.
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OBJECTIVE:To explore the effect of tiopronin on the expression of cytochrome P4502E1(CYP2E1)in liver of rats with alcoholic fatty liver.METHODS:30 Wistar rats were randomly divided into 3 groups:group A(blank control group),group B(model group)and group C(tiopronin group).Group B and group C were given 50% alcohol intragastrically to establish alcoholic fatty liver model,while group C were intervened with tiopronin(0.15 g?kg-1?d-1 administered at 1 hour after alcohol administration)for 5 consecutive weeks.Then all the rats were sacrificed with AST and ALT levels in serum determined.The CYP2E1 expression was detected by RT-PCR;and the pathologic changes of the liver tissues were observed.RESULTS:In group B compared with group A,serum levels of AST,ALT and CYP2E1 expression were significantly higher(P
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BACKGROUND: Changes of physiological structure, changes of phenotype and first basic excision are all the changes of gene expression. The technique of DNA microarray is a new method to filtrate target genes fleetly and largely by using the theory of base-partnershin, which can holistically and magnificently study the expression and function of organics genes. OBJECTIVE: To study early differential expression genes of rats with cerebral hemorrhage with DNA microarray and establish academic foundation for exploring mechanism of cerebral hemorrhage.DESIGN: Randomized controlled research.SETTING: Department of Neurology, Affiliated Hospital of North Sichuan Medical College. MATERIALS: The experiment was conducted at the Affiliated Hospital of North Sichuan Medical College from October 2002 to December 2003. Twenty Wistar rats, of either gender, with body mass of 220-260 g, without special pathogen, provided by Experimental Animal Center of Chongqing University of Medical Sciences, were selected and randomly divided into control group and cerebral hemorrhage group, with 10 in each group. METHODS: Animal models with cute cerebral hemorrhage of rats were established with type Ⅶ collagenase tridimensional localization method,and 4 hours later tissues around hematom and normal cerebral tissue at the same part were detected with gene chip. Fluorescent signal was scanned with scanning apparatus and analyzed with computer. Result of genic expressive pattern was researched with reverse transcriptase-polymerase chain reaction (RT-PCR). MAIN OUTCOME MEASURES: Result of gene chip in cerebral tissue of rats and result of RT-PCR.RESULTS: Four hours after acute cerebral hemorrhage, 129 differential expression genes were screened out, in which there were 114 up-regnlation genes and 15 down-regulation genes. Those genes were mostly related to the following aspects: stress, immunological response, apoptosis, energy metabolism and signal transmitting. Genes related with inflammatory impairment were mostly obvious. The result of RT-PCR suggested that the level of genic expression was as the same as the result of Cdna chip, which indicated that genic expressive pattern based on gene chip had great reliability.CONCLUSION: Early cerebral hemorrhage has many differential expression genes, which can play an important role in hemorrhagic brain damage.
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OBJECTIVE: To study protection effect of trasylol on cerebral injury resulting from cerebral ischemia-reperfusion in the interference of immunological response.METHODS: 105 SD rats were randomly assigned into sham operation group,model group and trasylol group (n=35).Focal ischemia-reperfusion model were established by occluding middle cerebral artery.24 h before ischemia and at the 0 h,24 h,4 d,6 d,8 d,10 d,12 d and 14 d of reperfusion,trasylol group were given trasylol via tail vein and other two groups were given normal saline.The infiltration of CD4+ and CD8+ T lymphocytes was observed using immunohistochemistry at different stages of cerebral ischemia-reperfusion.RESULTS: As compared with sham operation group,CD4+and CD8+ T lymphocytes count in model group were increased significantly after cerebral ischemia-reperfusion injury and obtained maximum value at 10th day.CD4+ and CD8+ T lymphocytes count in trasylol group were lower than in model group after cerebral ischemia-reperfusion injury and obtained maximum value at 8th day (P
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OBJECTIVE:To observe the clinical efficacy of Danhong injection and its impact on plsma levels of TNF-? and IL-6 in patients with acute cerebral infarction.METHODS:80 patients with acute cerebral infarction were randomly divided into two groups: 40 in control group were treated with conventional therapy, while the other 40 in treatment group with conventional therapy in combination with Danhong injection.The changes of neurologic function score(NIHSS), clinical effect and the plasma levels of TNF-? and IL-6 after 2-week treatment were compared between the two groups. RESULTS: There were signficnant differences in neurologic impairment score(NIHSS), clinical effect and the plasma levels of TNF-? and IL-6 between the treatment group and the control group after treatment (P