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Objective:To evaluate the role of histone deacetylase 6 (HDAC6) in the maintanence of neuropathic pain (NP) and the relationship with myeloid differentiation factor 88 (MyD88)/nuclear factor kappa B (NF-κB) signaling pathway in the rats.Methods:Twenty-four clean-grade healthy male Sprague-Dawley rats, aged 6-8 weeks, weighing 200-260 g, were divided into 4 groups ( n=6 each) using a random number table method: control group (group C), sham operation group (group S), NP group and NP plus HDAC6 inhibitor ACY-1215 group (group NP+ ACY). The rat model of NP was established by ligating the L 5 spinal nerve in anesthetized rats.The L 5 spinal nerve was only exposed without ligation in group S. In NP+ ACY group, ACY-1215 25 mg/kg was intraperitoneally injected daily for 21 days after the end of model establishing.The equal volume of solvent was intraperitoneally injected in S and NP groups, and group C was reared normally.The mechanical paw withdrawal threshold (MWT) was measured on 3 days before establishing the model (T 0), the day before establishing the model (T 1) and 1, 3, 7, 10, 14 and 21 days after establishing the model (T 2-7). The rats were sacrificed after measurement of MWT on day 21 after ligation, and the spinal dorsal horn tissues of L 4-6 were removed for determination of the expression of MyD88, NF-κB and phosphorylated NF-κB (p-NF-κB) (by Western blot) and expression of interleukin-1beta (IL-1β) and tumor necrosis factor-alpha (TNF-α) mRNA (by real-time polymerase chain reaction). Results:Compared with C and S groups, the MWT was significantly decreased at T 2-7, and the expression of MyD88, NF-κB, p-NF-κB, TNF-α mRNA and IL-1β mRNA was up-regulated in NP and NP+ ACY groups ( P<0.05). Compared with group NP, the MWT was significantly increased at T 5-7, and the expression of MyD88, NF-κB, p-NF-κB, TNF-α mRNA and IL-1β mRNA was down-regulated in group SNL+ ACY ( P<0.05). Conclusion:HDAC6 activation is involved in the maintanence of NP, which is related to activating MyD88/NF-κB signaling pathway in the rats.
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Objective:To evaluate the effect of valproic acid on the expression of M1/M2 microglia in the prefrontal cortex of rats with neuropathic pain (NP).Methods:Thirty-six clean-grade healthy male Sprague-Dawley rats, aged 6-7 weeks, weighing 200-230 g, were divided into 3 groups ( n=12 each) using a random number table method: sham operation group (group S), group NP, and valproic acid group (group V). The NP model was established by ligation of the L 5 spinal nerve (SNL) of anesthetized rats.Valproic acid 300 mg/kg was intraperitoneally injected immediately after SNL and every day after ligation, once a day, for 3 consecutive days in group V, while the equal volume of normal saline was given instead of valproic acid in S and NP groups.The mechanical paw withdrawal threshold (MWT) was measured before ligation and at 1, 3, 7, 14, 21 and 28 days after ligation.Sucrose preference test and forced-swim test were performed on day 28 after ligation.After the end of the behavior test, the prefrontal cortex was removed for determination of the expression of cluster of differentiation (CD) 16 and CD206 by Western blot.The ratio of CD206/CD16 was calculated. Results:Compared with group S, the MWT at each time point after ligation and rate of preference for sucrose were significantly decreased, the duration of immobility in forced-swim test was prolonged, the expression of CD16 and CD206 was up-regulated, and the ratio of CD206/CD16 was decreased in group NP ( P<0.05). Compared with group NP, the MWT at each time point after ligation and rate of preference for sucrose were significantly increased, the duration of immobility in forced-swim test was shortened, the expression of CD16 was down-regulated, the expression of CD206 was up-regulated, and the ratio of CD206/CD16 was increased in group V ( P<0.05). Conclusion:The mechanism by which valproic acid improves depression may be related to promoting the expression of M2 microglia and inhibiting the expression of M1 microglia in the prefrontal cortex of rats with NP.
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Objective To evaluate the effect of activating adenosine A2A receptors on myocardial is-chemia-reperfusion ( I∕R) injury in diabetic rats and the relationship with autophagy. Methods Clean-grade healthy male Sprague-Dawley rats, aged 6 weeks, weighing 200-250 g, were studied. The diabetic rat model was established by intraperitoneal injection of 1％ streptozotocin 60 mg∕kg. Forty diabetic rats were divided into 4 groups ( n=10 each ) using a random number table method: sham operation group ( group Sham) , I∕R group ( group I∕R) , I∕R plus adenosine A2A receptor agonist CGS21680 group ( group CGS) , and I∕R plus CGS21680 plus adenosine A2A receptor antagonist ZM241385 group ( group CGS+ZM) . Myocardial I∕R was produced by occlusion of the left anterior descending branch of the coronary artery for 30 min followed by 120-min reperfusion. Adenosine A2A receptor agonist CGS2168010μg∕100g was in-travenously injected at 10 min before reperfusion in group CGS. CGS2168010 ug∕100g and ZM2413850. 2 mg∕kg were intravenously injected sequentially at 10 min before reperfusion in group CGS+ZM. Blood sam-ples were obtained at the end of reperfusion for determination of concentrations of creatine kinase-MB ( CK-MB), lactate dehydrogenase (LDH) and cardiac troponin I (cTnI) in serum (by enzyme-linked immu-nosorbent assay). The animals were sacrificed, and myocardial tissues were obtained for measurement of the percentage of myocardial infarct volume ( by TTC staining) and for determination of the expression of mi-crotubule-associated protein 1 light chain 3 Ⅰ ( LC3Ⅰ) , LC3 Ⅱ, p62 and Beclin-1 ( by Western blot) . LC3 Ⅱ∕LC3 Ⅰ ratio was calculated. Results Compared with group Sham, the serum CK-MB, LDH and cTnI concentrations and percentage of myocardial infarct volume were significantly increased, the expression of p62 and Beclin-1 was up-regulated, and the LC3Ⅱ∕LC3Ⅰratio was increased in group I∕R ( P<0. 05) . Compared with group I∕R, the concentrations of serum CK-MB, LDH and cTnI and percentage of myocardial infarct volume were significantly decreased, the expression of p62 and Beclin-1 was down-regulated, and the ratio of LC3Ⅱ∕LC3Ⅰwas increased in group CGS ( P<0. 05) , and no significant change was found in the pa-rameters mentioned above in group CGS+ZM (P>0. 05). Compared with group CGS, the concentrations of serum CK-MB, LDH and cTnI and percentage of myocardial infarct volume were significantly increased, the expression of p62 and Beclin-1 was down-regulated, and the ratio of LC3Ⅱ∕LC3Ⅰwas decreased in group CGS+ZM ( P<0. 05) . Conclusion Activating adenosine A2A receptors can mitigate myocardial I∕R injury, and the mechanism may be related to enhancing autophagy in diabetic rats.
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Objective To explore the clinical outcome of free chimeric anterolateral thigh cutaneotendinous flap with rectus femoris muscular flap for repairing the complex tissue defect of dorsum wrist. Methods From June, 2005 to March, 2014, free chimeric anterolateral thigh cutaneotendinous flap with rectus femoris muscular flap was used for repairing the complex tissue defect of dorsum wrist in 15 cases, which were 12 males and 3 females, and aged from 18 to 52 years old. The skin and soft tissue defect ranged from 8.0 cm×5.5 cm to 22.0 cm×12.0 cm. All ac-companied with extensor digitorum tendon loss. The tendon defect ranged from 5.0 cm to 12.0 cm (7.6 cm on average). The flap size ranged from 9.0 cm×6.5 cm to 23.0 cm×13.0 cm. The pedicle length ranged from 4.0 cm to 7.0 cm (5.3 cm on average). Results All flaps survived, and no postoperative complications occurred. The followed-up time ranged from 12 months to 36 months, and the texture of flap was flexible. No bulky was noted, and skin color was similar to the hand skin. The flexor and extensor function of wrist recovered satisfying. The 2-point discrimination of flap ranged from 9 mm to 15 mm (12.5 mm on average). Conclusion Free chimeric anterolateral thigh cutaneo-tendinous flap with rectus femoris muscular flap is a good option for repairing the complex tissue defect of dorsum wrist.
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Objective To discuss the clinical application of free micro-flap based on the superficial palmar branch of radial artery (SPBRA) to repair the palmar soft tissue defect of the finger.Methods From October,2012 to September,2015,this flap was used in 25 patients to repair the palmar soft tissue defect of the finger.The artery,the vein and the never in the flaps was anastomosed respectively with that in the recipient site.The donor area was sutured directly.Results All patients were followed-up for a mean of 11 months (range,6-20 months).All 25 flaps survived.The character of flap was good,the appearance and sensitive function obtained satisfactory resume.At the last follow-up,the two-point discrimination was 5-10mm on the affected side.According to the Standard of Evaluation of Thumb-Finger Reconstruction of the Chinese Medical Association,there were excellent in 17 cases,and good in 8 cases.The wounds of donor site healed by 1st intention with no visible scars.The function of thumb was not damaged.Conclusion The free micro-flap based on the SPBRA is feasible for soft-tissue defects of finger bacause the undamaged major blood vessels of donor site,the inconspicuous scar,and the good appearance and sensitive function of repaired fingers.
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ObjectiveTo investigate the treatment efficacy of traumatic proximal interphalangeal (PIP)joint defects with prosthetic replacement.MethodsFrom September 2007 to November 2010, ten patients with joint defect injuries were treated by joint prosthetic replacement (5 index fingers,4 middle fingers,and 1 ring finger),including a reconstructed middle finger.Joint motion range and postoperative pain of all cases were measured to evaluate the treatment.ResultsAll cases went through a smooth operation with primary wound healing,and with neither intraoperative nor postoperative complications happened.The follow-up period was range from 8 months to 2 years.The active motion arcs of PIP joints ranged from 50° to 80°,and satisfactory appearances as well. According to assessment standard of upper extremity described by Chinese Hand Surgery Association,the treatment outcome were excellent in 6 fingers,good in 3 fingers,general in 1 finger.ConclusionJoint prosthetic replacement is a new effective method to treat traumatic proximal interphalangeal joint defect,which is a simple operation with advantages of little trauma and rapid recovery.
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<p><b>OBJECTIVE</b>To discuss the pathological and clinical characteristics,methods of therapies and perioperative considerations of cervicothoracic spinal fractures and dislocations in patients with ankylosing spondylitis (AS).</p><p><b>METHODS</b>Thirteen patients with ankylosing spondylitis and cervicothoracic spinal fractures and dislocations were treated from January 2001 to March 2009, including 11 males and 2 females,aged varied from 33 to 60 years (mean 46) in 11 males and from 36 to 59 years (mean 47.5) in 2 females respectively. The symptom duration of AS was from 12 to 27 years (means 14.5 years). The chief complains were pain around cervical part and shoulder blades, some accompanied with decrease of motor power and sensation in upper or lower limbs. Spine radiographs revealed a displaced fracture of cervicothoracic spine. Laboratory examination presented positive results of HLA-B27 test. Fusion of fracture and ASIA neurological function grade variation were observed.</p><p><b>RESULT</b>A total of 13 patients, who underwent operation, were followed up for 12 to 43 months(means 35.6 months). There were 6 patients were treated with anterior cervical discectomy and fusion, 4 with anterior cervical corpectomy and fusion, 1 with laminectomy and fusion and 2 with combined anterior and posterior stabilisation. The bone fusion were observed after reduction of fractures and dislocations ultimately. Twelve patients acquired an improved neurological status in different degrees, and only one suffered from persistent neurological impairment loss. The complications occurred in 5 cases during perioperation.</p><p><b>CONCLUSION</b>This study suggests that most cervicothoracic spinal fractures and dislocations in patients with AS are extremely unstable and require operations. If operative method is proper and operative process accurate, either anterior,posterior or combined approach can achieve good spinal myeloid functional recovery with low rates of operative complications occurrence, under the guidence of imaging manifestation.</p>
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Adult , Female , Humans , Male , Middle Aged , Cervical Vertebrae , Wounds and Injuries , General Surgery , Joint Dislocations , Diagnosis , General Surgery , Spinal Fractures , Diagnosis , General Surgery , Spondylitis, Ankylosing , Thoracic Vertebrae , Wounds and Injuries , General SurgeryABSTRACT
Objective To summarize clinical application of the medial sural artery perforator pedicled flap for the coverage of soft tissue defects around the knee and upper one third of lower leg.Methods From May 2003 tO January 2007,16 patients(11 men,5 women)with soft tissue defects around the knee and upper one third of lower leg underwent reconstruction with the medial sural artery perforator pedicled flap.Of them,4 eases recipient site were located on the prepatellar region,2 cases were located on the anterolateral pateflar,1 case was located on the anteromedial patellar,and 9 cases upper one third oflowerleg.They ranged in age from 23 to 52 years(mean,36 years).The donor leg was ipsilateral in all cages. Results One ca8e sustained superficial infection postoperative and the gradual wound healed by daily wound dressings.All the flaps had survived completely without major complication with satisfactory clinical results. Follow-up period ranged from 3.0 months to 3.5 years(mean, 1.7 years)postoperatively.There was no remarkable donor site morbidity.All cases had good appearance and function in recipient site.There was no remarkable donor site morbidity. Conclusion The medial sural artery perforator flap is nourished by the musculocutaneous perforater of the medial sural artery.The flaps seem to has highly vascularize,a constant vascular anatomy and a long vascular pedicle.The flap is thin and suitable for the coverage of soft tissue defects around the knee and upper one third of lower leg.
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From September 2002 to May 2006, five patients ( age range, 24 to 46; mean, 32) with tibial defect underwent transplantation of free latissmus dorsi osteocutaneous flap using bridge-like vascular anastomosis. All the osteocutaneous flaps survived without any serious complications, and tibial defects were improved completely. After 1.5 to 4.5 years' follow-up ( mean, 2.6), no remarkable dysfunction was found at donor sites, and local injury was reduced. This study indicates that transplantation of free latissmus dorsi osteocutaneous flap using bridge-like vascular anastomosis might be useful in leg reconstructive surgery if only one vessel is remained.
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<p><b>OBJECTIVE</b>To summarize clinical application experience of treatment of occluded iliofemoral veins with great saphenous vein cross-over bypasses.</p><p><b>METHODS</b>From September 1998 to December 2005,6 patients(5 men, 1 woman) with occluded iliofemoral veins underwent great saphenous vein cross-over bypasses. They ranged in age from 36 to 52 years (mean, 41 years old). All patients had unilateral thigh and leg edema and swelling with accompanying pain. The normal contralateral great saphenous vein was dissected and it was tunneled across the super-pubic fat pad and anastomosed to the femoral vein or the proximal portion of great saphenous vein in distal to occluded iliofemoral veins.</p><p><b>RESULTS</b>The postoperative course was uneventful. One case sustained superficial infection postoperatively at donor site and the gradual wound healed by daily wound dressings. At 1 to 3.5 years (mean 1.8 years) followed up, all patients had pain disappearance and obvious relief of the edema but some swelling.</p><p><b>CONCLUSION</b>Great saphenous vein cross-over bypasses is effective operative method of treatment of occluded iliofemoral veins. The operation is relatively simple and safe.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Embolism , General Surgery , Femoral Vein , General Surgery , Iliac Vein , General Surgery , Saphenous Vein , TransplantationABSTRACT
<p><b>OBJECTIVE</b>To evaluate the clinical application of microsurgical fascia latae flaps combined with rib and skin graft for reconstruction of the distal phalanx defect.</p><p><b>METHODS</b>The phalanx wounds were sutured together like syndactyly. The autologous rib was revised to repair the bone defect of distal phalanx. The fascia latae flap was used to cover the bone exposure with microvascular anastomoses and resurfaced by a meshed split-thickness skin graft.</p><p><b>RESULTS</b>5 cases were treated successfully. The fascia latae flaps were all survived with only skin graft necrosis at the distal end in one case. It was healed spontaneously.</p><p><b>CONCLUSIONS</b>The fascia latae flap is nourished by the descending branch of the lateral circumflex femoral artery. The flaps has a good blood supply and can be easily obtained with a long vascular pedicle. The flap is ideal for the reconstruction of distal phalanx defect when combined with autologous rib implant and skin graft.</p>
Subject(s)
Adolescent , Adult , Female , Humans , Male , Young Adult , Fascia Lata , Transplantation , Finger Injuries , General Surgery , Hand Injuries , General Surgery , Plastic Surgery Procedures , Methods , Ribs , Transplantation , Skin Transplantation , Methods , Surgical FlapsABSTRACT
<p><b>OBJECTIVE</b>To summarize clinical application of one-stage toenail lengthening in free second toe transfer for reconstruction of the thumb (finger).</p><p><b>METHODS</b>Nine patients (male 7, female 2) underwent thumb (finger) reconstruction with second toe transfer were treated by one-stage toenail lengthening technique. Eight were the thumb and 1 was the index finger. Patients aged from 18 to 46 years,with an average of 25 years. A rectangle skin was resected at 0.5 cm away from the eponychium, which was 0.2 cm high and as wide as the toenail. Then stripped U shape flap gently towards proximal end and sutured it. During the operation, the injury of the subcutaneous vascular network should be avoided.</p><p><b>RESULTS</b>Superficial infection at donor area happened in 1 case and was healed by changing dressings. All the reconstruction thumbs (fingers) had survived completely. 2 to 3 mm extending of toenail length was obtained and the appearance of thumb (finger) was improved. There was no growth deformation of toenail. After 7 to 24 months follow up (the average time 13 months), the appearance of the nail was good.</p><p><b>CONCLUSIONS</b>One-stage toenail lengthening in free second toe transfer for reconstruction of the thumb (finger), which can obtain a satisfactory appearance of the nail and have no influence on the motion of the reconstruction thumb (finger), is a simple and an effective operative procedure.</p>
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Adolescent , Adult , Female , Humans , Male , Middle Aged , Nails , Transplantation , Plastic Surgery Procedures , Methods , Thumb , General SurgeryABSTRACT
<p><b>OBJECTIVE</b>To summarize clinical application of the high tibial osteatomy (HTO) with lateral closing-wedge for the treatment of pain of unicompartmental osteoarthritis of the knee.</p><p><b>METHODS</b>From February 2000 to February 2004,9 patients (3 males and 6 females, ranging in age from 52 to 58 years, with an average of 56 years) with unicompartmental osteoarthritis of the knee treated by HTO with lateral closing-wedge. The proximal tibiofibular joint was exposed, the anterior part of the capsule was incised, and to remove a laterally based wedge with saw cuts and osteotomes. Stepped staples were used for the fixation of tibial osteotomies after closing the defect of osteotomy.</p><p><b>RESULTS</b>The operative course was uneventful. There were no complications after operation. The postoperative follow-up period ranged from 2 to 5.5 years (mean, 3.5 years). The results were evaluated with functional assessment criterion of the osteoarthritis of the knee, among the 9 cases, excellent was in 5 cases, good in 3 cases, fair in 1 case.</p><p><b>CONCLUSION</b>HTO with lateral closing-wedge is an effective operative method for the treatment of pain of unicompartmental osteoarthritis of the knee, but except for older patients over 60 years.</p>
Subject(s)
Female , Humans , Male , Middle Aged , Knee Joint , General Surgery , Osteoarthritis, Knee , General Surgery , Osteotomy , Methods , Tibia , General Surgery , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To summarize clinical application of the sural medial gastrocnemius island muscle flap to cover wound of infection on upper region of the tibial.</p><p><b>METHODS</b>Nine patients (7 men, 2 women) with soft tissue defects on the upper region of the tibial underwent reconstruction with the sural medial gastrocnemius island muscle flap. The age ranged from 21 to 60 years old (mean, 34 years). The immediate coverage of the muscle flaps were performed by a meshed split-thickness skin graft. The donor site was closed directly. The donor leg was ipsilateral in all cases.</p><p><b>RESULTS</b>Only one case sustained superficial infection postoperative and the gradual wound healed by daily wound dressings. All the muscle flaps and skin graft had survived completely without major complication with satisfactory clinical results. All patients were followed-up for 13 months to 4 years (mean 21 months), the donor site was healing, there was no remarkable donor site morbidity.</p><p><b>CONCLUSION</b>The sural medial gastrocnemius island muscle flap is nourished by the medial sural artery. The muscle flaps seem to have highly vascularize, a constant vascular anatomy and a long vascular pedicle. The muscle flap is thin and suitable for repairing soft tissue defect on the upper region of the tibial.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Follow-Up Studies , Muscle, Skeletal , Cell Biology , Plastic Surgery Procedures , Methods , Surgical Flaps , Tibia , Wounds and Injuries , Wound Infection , General SurgeryABSTRACT
This article was to discuss the effectiveness of medial sural artery perforator pedicled flap or muscle flap in the treatment of soft tissue defect. Since 2002, 21 patients(14 males and 7 females)with prepatellar(n=7)or pretibial(n=14)defect had underwent soft tissue reconstruction. Ten of them obtained medial sural artery perforator pedicled flap and the rest received muscle flap. All the medial sural artery perforator pedicled flaps and muscle flaps survived well and the clinical outcomes were satisfactory. No remarkable donor site morbidity was found. According to our data. medial sural artery perforator pedicled flap or muscle flap may seem to be highly vascularized and have constant vascular anatomy and long vascular pedicle. They could be useful in the treatment of prepatellar or pretibial soft tissue defect.
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The article presents a method improvement of the medial plantar pedicled flap transplantation to cover the defect of the foot heel.Since 2002,6 patients with soft tissue defects on the foot heel underwent reconstruction with the medial plantar pedicled flap transplantation of excluding the plantar fascia and 3 patients used conventional flap of the medial plantar pedicled flap transplantation.They ranged in age from 18 to 52 years(mean,32 years).All the flaps had survived completely without major complication with satisfactory clinical results.Follow-up period ranged from 1.5 to 6 years(mean,3.8years)postoperatively.There was no remarkable donor site morbidity.Patients with flap of excluding the plantar fascia had good appearance in recipient site.Injury to donor site was reduced.Skin of the instep area can be raised as an island fasciocutaneous flap based on medial plantar vessels,with the branch of medial plantar nerve supplying the instep skin to provide the sensation.The flap is thin and suitable for repairment of soft tissue defect on the foot heel.
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Objective To summarize clinical experience in application of nail-bed lengthening operation for fingertip injuries.Methods From September 2003 to May 2007,36 patients (25 men and 11 women) aged 16 -45 years (26 in average) with nail defect by fingertip injuries underwent reconstruction operation using nail-bed lengthening at Orthopaedics and Traumatology Hospital of Taizhou,with the thumb involved in 15 cases,the index finger in 10 cases,the middle finger in eight eases and the ring finger in three case.A skin rectangle with thickness of 2 - 3 mm and width as that of the nail was resected at the skin edge 5 -6 mm distant from the epenychium,without damage to underlying subcutaneous vascular network, and U-shape skin flap was delicately slid proximally with its ends sutured.Results All surgical operations for nail lengthening were uneventful and clinically satisfactory,and the appearance of the thumb or other fingers was good during follow-up for six months to three years (19 months in average).Conclusions Nail lengthening for fingertip injuries with nail defect is a simple and effective surgical operation which could improve the appearance of the thumb and other fingers.
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<p><b>OBJECTIVE</b>To report the clinical results of scalp defect using V-Y-S rotation flap.</p><p><b>METHODS</b>From March 2003 to October 2005, 5 cases scalp defect (4 male, 1 female) were reconstructed with the technique. The age ranged from 26 to 52 years (mean 32 years). The scalp defect ranged from 3 cmx3.5 cm to 4 cmx5 cm. Four cases were reconstructed with bilateral flap and one case was reconstructed with unilateral flaps.</p><p><b>RESULTS</b>All patients were followed-up from 10 to 42 months (mean, 28 months). All the flaps survived completely and showed good hair growth and had satisfactory clinical results.</p><p><b>CONCLUSION</b>Repair of scalp defect using V-Y-S rotation flap technique is simple with no need for a skin graft and can be performed quickly, there is minimal morbidity and the outcome is highly successful.</p>