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Objective:To explore the effect of sciatic nerve derived exosomes(SN-EXO) on axon regeneration and functional recovery after peripheral nerve injury(PNI).Methods:From March 2021 to October 2022, the Department of Orthopedics of the First Affiliated Hospital of Zhengzhou University studied the effect of SN-EXO on the proliferation of Schwann cells(SCs) through EdU cell proliferation experiment. Twenty-one healthy male SD rats were randomly divided into 3 groups of sham operation, peripheral nerve injury(PNI) and SN-EXO treatment, with 7 rats in each group. The right sciatic nerves of rat models in sham group were exposed without injury. In the rat in PNI group and SN-EXO treatment group, PBS and SN-EXO were injected under the epineurium of right sciatic nerves following sciatic nerve crush. Sciatic nerve function index(SFI) was performed at 28 days after operation, and then sacrificed. Right sciatic nerves were removed for further exploration of nerve regeneration. The histopathological changes and axon arrangement of sciatic nerves were evaluated by HE staining. Regeneration efficiency of neurofilaments and SCs were obserred by NF200 and S100β double staining of sciatic nerve. The data obtained were statistically analyzed, and P<0.05 was statistically significant. Results:It was found that SN-EXO can significantly enhance the proliferation ability of SCs, with statistically significant difference( P<0.05). SFI in SN-EXO treatment group and PNI group were(-27.65±4.36) and(-57.33±7.49), respectively, and the difference was statistically significant( P<0.05). Axons in SN-EXO treatment group were arranged more closely and orderly than those in the PNI group at 28 days after operation, and there were less injury induced axon disintegration and vacuolation. Immunofluorescence assay indicated that NF200 and S100β fluorescence intensity in SN-EXO treatment group was significantly higher than that in the PNI group, and the difference was statistically significant( P<0.05). Conclusion:SN-EXO could enhance the proliferation of SCs to promote axon regeneration following peripheral nerve injury.
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Peripheral nerve injuries, the worldwide difficult and complicated diseases, cause serious dysfunction but without ideal strategies to assist the successful treatment and recovery. The primary strategy to repair the peripheral nerve injuries is to bridge the lesions by promoting axon regeneration. The importance of mechanical factors in the nervous system has been appreciated only recently. It has been demonstrated that the application of external mechanical force is able to direct axonal outgrowth and to stimulate axonal elongation. For this purpose, to direct axonal growth cones in vivo with accurate force appears to be a challenge that must be resolved. Bionanotechnology is promising a new tool that offers the possibility to influence the process of axonal regeneration. The magnetic force generated by the interaction between Magnetic nanoparticles (MNPs) and magnetic fields provides remote, non-invasive, accurate, and controllable lead and control of neuronal axon regeneration.
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Objective To discuss the clinical application of reverse dorsal metatarsal artery perforator flap for reconstruction of forefoot soft tissue defects.Methods Since January,2008 to March,2016,43 patients with forefoot soft tissue defect due to various causes were reconstructed with the flap based on dorsal metatarsal artery perforator.Dorsal pedis was used as a donor site with dorsal metatarsal artery perforator as the donor artery.The flap size varied from 2.0 cm × 4.0 cm to 6.0 cm × 8.0 cm.Among them,27,8,4 and 4 cases were reconstructed with flap based on first,second,third and fourth dorsal metatarsal artery perforator flap respectively.Results All the patients were followed-up which ranged from 3 months to 24 months.Six flaps suffered from post operative venous congestion.Out of 6,4 survived with early emergency management while the remaining 2 suffered epidermal necrosis which survived with regular dressing change.Eventually,all the flaps survived.They had good texture and they were elastic,good-looking and very wear-resisting.Walking function was normal.Conclusion Reverse dorsal metatarsal artery perforator flap is an ideal choice in reconstruction of small to medium sized soft tissue defects of forefoot.
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Objective To investigate the surgical indications and repair methods for the treatment of electrical bums in the limbs.Methods Thirty-eight cases since May,1997 to June,2014 who underwent flap treatment in 7-14 days after electrical bums was summarized.Among these patients,4 cases were treated by local flaps,1 case was treated by thenar flap,2 cases were treated by dorsal island skin flap of the index finger,1 case was treated by cross-leg flap,1 case was treated by medial plantar skin flap;2 cases were treated by pedicle latissimus dorsi flaps,4 cases were treated by antebrachial flap with a pedicle of the posterior interosseous artery,4 cases were treated by metacarpal artery reversed island flaps,10 cases were treated by groin flaps;1 case was treated by free radial artery flap,1 case was treated by free latissimus dorsi flap,3 cases were treated by free anterolateral thigh flaps;1 case was treated by reverse island forearm posterior interosseous flap,2 cases were treated by posterior perforator reversed island flaps of the lower leg,1 case was treated by anterolateral perforator reversed island flaps of the lower leg.The area of flap was from 42.0 cm × 13.0 cm to 6.0 cm × 3.0 cm.The survival rate of the flap,the appearance and function of limb were observed.Results All these patients were followed up from 4 months to 3 years 6 months,the mean time was 6 months and 20 days.Thirty-five flaps survived completely,accounting for 92.1％,and 3 cases suffered partial necrosis at the distal end,accounting for 7.9％.Secondary healing was achieved by dress changing.The appearance of the limbs was satisfactory.Among the 28 cases whose bums were on the hands,the total number of excellent and good was 15,medium was 8,and 5 poor cases.The excellent and good rate was 57.1％.Conclusion Early repairing of the electrical burns with flaps is the effective method for protecting the deep structures of the limb,preventing and control the secondary infections and preserve the function of the limbs.
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Objective To demonstrate the clinical outcome of bilateral gluteus maximus musculocutaneous flap in conjunction with continuous postoperative negative pressure wound therapy in reconstruction of sacral soft tissue defects.Methods From January, 2008 to April, 2013, 18 patients (8 males and 10 females, aged from 34 to 78 years old) with full-thickness sacral soft tissue defects were treated.The size of the defects after initial debridement ranged from 3.0 cm × 2.0 cm to 18.0 cm × 14.0 cm, with the exposure of sacrum or ligament.Bilateral gluteus maximus musculocutaneous flap were applied in all the patients.Two drainage tubes were placed on each side of the flaps during the surgery and suck for 10 to 12 consecutive days after the operation.Results The size of the harvested flaps ranged from 12.0 cm × 8.0 cm to 18.0 cm × 12.0 cm, and all the donor sites of the flaps were closed with primary suture.Thirty-five flaps in 17 patients survived without any complication.Partial necrosis of one flap was found in 1 patient and managed successfully with conservative dressing change.Fourteen patients were followed-up ranged from 8 months to 2.5 years (mean follow-up was 18 months).Color and texture of the flaps were satisfactory and no recurrence of sacral defect was noted.Conclusion Bilateral gluteus maximus musculocutaneous flap in conjunction with continuous postoperative negative pressure wound therapy may serve as a useful option for fullthickness sacral soft tissue defects.
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Objective To analysis the clinical diagnosis and treatment of the scaphoid and lunate bone fracture with (or) wrist dislocation.Methods A retrospective analysis of the clinical data included 77 cases,which got admitted according to the inclusion and exclusion criteria and followed up completely from 2005 to 2013.In this group,there were 64 males and 13 females whose age arranged from 15 to 73 with a mean age of 31.9.There were 41 cases of simple fracture,32 cases of bone fracture with dislocation and 4 cases of simple dislocation.Treatment of cases was divided into the conservative treatment group (9 cases) and the surgery group (68 cases).The surgery group was further divided into four subgroups according to surgical method (i.e.compression screw fixation,Kirschner wire fixation,proximal row of carpal resection,and lunate excision head shaped bone transposition).Clinical outcome was evaluated based on modified Mayo wrist score and X-ray.Results All of 77 patients were followed up completely.Follow-up time arranged from 6 months to 8 years,with an average follow-up time of 3 years and 5 months.9 cases were treated conservatively.In the surgical treatment group,there were 36 cases of compression screw fixation,34 cases of Kirschner wire fixation,1 case of proximal row of carpal resection and 1 case of the lunate bone resection heads transposition.The average healing time of compression screw group was 6.1 weeks and the Kirschner group was 7 weeks.According to the modified Mayo wrist score,excellent:51 cases (66.2％),good:11 cases (14.3％),fair:9 cases,and poor:6 cases.The rate of excellent and good was 80.5％.The cure rate of compression screw treatment was 97％,and 85％ of Kirschner.The difference of cure rate was statistically significant.After surgery,there were four cases that got scaphoid malunion.The degree of deformity was not serious with only one case happened in the dominant hand,and the wrist pain got better after symptomatic treatment.1 case of scaphoid fracture with dislocation had the problem of wrist instability.18 weeks later,with ligament tightening surgery,postoperative Mayo score went back to excellent.Conclusion Lateral X-ray film of wrist is a preferred method for the examination of scaphoid and lunate fractures with (or) dislocation.Since it's easy to misdiagnose,films of special position are needed to be added.Surgery is preferred for treatment,and the selecting of surgical methods are based on the situation of fracture and dislocation.The advantages of screw fixation are obvious.
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10.3969/j.issn.2095-4344.2013.25.013
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Objective To introduce our experiences of reconstruct the first web space using flaps.Methods One hundred and twelve patients sustained contracture of the first, summarized the indications of different flaps in coverage of the first webspace and their prognosis of these flaps were retrospectively reviewed.Results The local flaps, such as double Z-plasty or Z-plasty, were suitable to cover minor contracture of the first webspace; the dorsal flap arising from the index finger was suitable for the coverage of the medium contracture, and the posterior interosseous artery flap or the reverse antebrachial island flap based on the dorsal branch of the anterior interosseous artery suitable for the severe cases. Conclusion The usage of flaps is important to resume the cosmetic shape and function of the first webspace after release of the contracture of the first webspace.
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Objective To investigate the anti-rejection effect of T cell vaccination combined with FK506 of heterogenic transplantation on rat nerve. Methods SD rats were vaccinated by the spleen cells of BABL/c mice; T cell vaccines were activated and vaccinated in the spleen cells of these SD rats. The SD rats of nerve transplantation recipient were vaccinated with T cells combined with FKS06. The mixture lymphocytes culture, microcytotoxicity assay, histological alteration of nerves, humid weights of tibial anterior muscle were observed to confirm the anti-rejection effect of T cell vaccination combined with FK506 treatment. Results The humid weights of tibial anterior muscle of the vaccinated rats combined with FKS06 treatment were statistically different from those in control group (P ＜ 0.05), and so as the index of rejection (e.g. lymphocytes transformation efficiency) (P ＜ 0.05). Conclusion T cell vaccination combined with FK506 treatment can inhibit the rejection of heterogenic transplantation on rat peripheral nerve.
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Objective To introduce the clinical application of the extended anterolateral leg flap,which is based on the superficial peroneal artery and lateral supramalleolar artery. Methods Through anatomic study on the blood supplies of the skin over the anterolateral portion of the leg.The combined superficial peroneal artery and lateral supramalleolar artery could extend the size of the traditional anterolateral leg flap.In addition,the point of pivot of the extended anterolateral leg flap could locate at the level of the lateral malleolus,which decreases the distance between the flap and recipient site.Clinically,we have used the extended anterolateral leg flaps in 60 patients to cover skin defect over the feet.The flap ranged from 16 cm×10 cm(pedicle length 8.0 cm)to 26 cm×7 cm(pedicle length 6.0 cm). Results In the series, the flap survived in 53 patients(88.3%)unevently,and partial necrosis occurred in 7 patients(11.7%).Conclusion Based on the combined superficial peroneal artery and lateral supramalleolar artery,the size of the traditional anterolateral leg flap could be inceased,which enlarges its value on the coverage of skin defects over the feet.
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Objective To investigate the mechanism of venous reverse-flow flap in the differentperiod after operation.Methods The rabbits wero randomly allocated into 3 groups.In group A,including saphenous artery and venae commutante.In group B,saphenous artery without venae commutante.In group C,surface seeping and saphenous artery and venae commutante.Flap appearance,intravenous pressure,vessel diameter,mierocircular and histological examination were mea8ured.Results The difference of introvenous pressure between group A.B and C was obvious.Reverse flow WaS found in group A and C group through microcirculation observation 2 hours post-operation.Venous valve lose efficacy while the vessel diameter wes at maximum just after the pressure peak.Conclusion Venous retrograde return in reverse-flow island flaps can be achieved more easily through"incompetent valves route"than through "communicating and collaterall by pass route".By pass route is a supplementary way.Surface seeping Can slighfly relieve the venous pressure but can cause infection.
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Objective To analyze the clinical results of surgical treatment of nerve compression of the upper limb.Methods The clinical characterisitcs treatment methods and prognosis of nerve compres sion of the upper Iimbs in 646 padents were analyzed.Results Four hundred and of them were followed up for from 6 months to 3 years.The numbness disappcared and the function five of the nerve innervation area became normal or near normal after operation in 252 cases(62.2%),improved in 124 cases(30.6%),no change or worse in 29 cases(7.2%).The excellent rate of nerve funcfion recovery were 93%after rehabilitation teatment.Conclusions The loss degree of sensorimotor function of the effected limbs provides reference for operating mode and iS closely related to nerve functional restoration.The evaluation of the loss degree of sensorimotor function of the affected limbs before the operation should be taken into account.Rehabilitation teatment after operation can promote functional restoration and prevent teratogencsis.
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[Objective]To study the influence of VAP(velvet antler polypeptide)-chitosan-honey suspension on decubitus ulcer.[Method]Swines'pressure ulcers were used as decubitus ulcer model.Honey was used as solvent carrier.VAP and chitosan were put into the honey in different proportion.The suspension was applied to the ulcer once a day for seven days.The dressings were changed once every other day.The healing state of the ulcer was observed and the area of the ulcer was calculated.The changes of the ulcer histopathology were observed.[Result]In the group of the suspension proportion of the VAP to the chitosan was 4:1,the wounds had little effusion and the granulation tissues grew fast with the scars falling off early and Absolutely.Pathology results indicated that in the group of the suspension proportion of the VAP to chitosan was 4:1,none necrosis was found,the epithelization was apparent,and the inflammatory cells were fewer.There was no edema,but more newly born blood vessles.[Conclusion]The VAP-chitosan-honey suspension could apparently promote the healing of decubitus ulcer,but the possible mechanism needs to be further studied.
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Objective To investigate the effects of ginsenoside Rg3 (GS-Rg3) on the hypertrophic scars of rabbit ears and provide experimental foundation for study on its inhibition on the hypertrophic scars. Methods Hypertrophic scars were proved on 24 white rabbits,of which the whole level of the skin was excised for 2 cm?2 cm,4-6 points for each ear,controlled by itself. GS-Rg3 0.1 mL(concentration 3 g?L-1) was injected into experimental group and the same volume of saline solution into control group,once every three days regionally. The scar tissues were collected 2,4 and 6 weeks after the injection respectively,the thickness of the scar,structure under the microscope,and the expressions of PCNA,Bcl-2 and Bax were observed. Results In control group,three weeks after the epithelization of the wound,the thickness of the hypertrophic tissue was 3-4 times of ventro ear skin. Under microscope,the dermis was hyperplasia and got thicker,consisted with amount of fibroblast cells,collagen and vessels,the collagen was untidy,nodule or vortex,and the cartilage could be observed in some region.In experimental group, six weeks after the injection,the skin got thinner,the collagen became neath and the quantity of the vessels decreased. In the hypertrophic scars,there was high expression of PCNA,the percent of positive cells was higher (39.55%?6.07%) compared normal tissue (11.18%?1.71%).In GS-Rg3 group,the expression of Bcl-2 was gradually decreased two weeks after injection and obviously decreased six weeks later,there was significant difference compared with before injection (P
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Objective To make a comprehensive evaluation of nano-composite of poly(L-lactide) and surface grafted hydroxyapatite(PLLA/PLLA-gHA) as a new material.Methods According to the evaluated critera of medical implanted materials biology and animal trial recommended in GB/T 16886 and IS0 10993 criterion,the new material was carried out on acute systemic toxicity test,haemolysis test,muscular implantation test and subcutaneous injection test.The extract liquid of new material was injected into mice by vena caudalis to test common station,toxic reaction of it at different time,the results were used to evaluate the acute systemic toxicity.Fresh anticoagulant cony blood was mixed with extract liquid of new material with density of 100 g?L-1 to measure each absorbance with spectrophotometer and work out the corresponding rate of haemolysis.The red punctuation and hydropsia of rabbits were observed at different time by subcuntaneous injecting extract liquid into the back of rabbits.PLLA/PLLA-gHA composite plates were implanted into the sacrospinal muscle of rabbits.Cony venous blood was extracted to detect indicatrix of hematology at diferrent time.The material and surrounded tissues were taken out from animals at the 14th,30th,60th,90th,180th,360th day to examine anatomic and pathological changes.Results Rabbits with PLLA/PLLA-gHA composite had good general condition.There was no any acute systemic toxicity in vivo.Data of AST and Scr had no significant difference between experimental group and control group.The hemolysis rate of extrac liquid was 1.22%,which was under the standard criteria(5%).No red punctuation and light hydropsia were observed at different time in the subcutaneous injection test.The inflammation cytochange of PLLA/PLLA-gHA composite group was similar with that of control group in early days,which was met with the general regularity of inflammatory outcome.The fibrosis membrane surrounding the PLLA/PLLA-gHA composite became thinner gradually with the elongation of implantation time.The fibrosis membrane grew into the material at the 360th day.The degree of the fibrosis membrane was below class Ⅰ.Conclusion The new absorbable type PLLA/PLLA-gHA composite has excellent biocompatibility and security.
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Objective To develop a new system of computer-aided design(CAD) for individual metacarpophalangeal joint prosthesis based on rapid prototyping technique. Methods A hand of cadaver was scanned with PLUS-4 spiral computed tomography (CT).Then the transaxial 2D image data of digitus metacarpophalangeal joint were reconstructed into 3D digitized contour data by 3DMSR that was designed by ourselves. Then,the intramedullary stem was designed in software of Surface 9.0. Results The 3D contour image of metacarpophalangeal joint presented was reconstructed by 3DMSR and edited by Surface 9.0 easily for CAD of individual metacarpophalangeal joint.The intramedullary cavity was like choanoid. The intramedullary stem longitude of articular head and fossa were 47.31 and 35.20 mm.The intramedullary stem fit cavity.The model fit anatomical shape. Conclusion The 3D contour image of metacarpophalangeal joint can be obtained by spiral CT scanning,and the digitized data can be applied directly to CAD of individual artificial joint and subsequently rapid prototyping fabricating.In addition,the reconstruction method is simple and can be applied widely to clinical implant fabricating practice of orthopaedics.
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0.05).Conclusion The long-term curative effects of one end-to-side and double end-to-side neurorrhaphy are the same.The proximal end of the transected nerve can be reconnected with the distal end by double end-to-side neurorrhaphy,but the connected fibers have only partial effects on the recovery of the nerve.
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Objective To study the rehabilitative effect of velvet antler polypeptides-PLGA compound membrane on peripheral nerve injury.Methods Two doses(3 and 15 mg?g~(-1)) of velvet antler polypeptides-PLGA compound membrane(thickness 50 ?m) were used to wrap the sutures of severed sciatic nerves,which were compared with nerve sutures only.2,4 and 6 weeks post-operation,general morphological,electrophysiological,histological and electron microscopic observations and examinations were investigated.Results There were no ulcers in the nars and toes in the treatment group,light conglutination appeared in nerve anastomosis and around tissues.At 6th week post-operation,conglutination was alleviated obviously than 2 weeks post-operation;findings from latency inducing potentials of calf triceps dominated by sciatic nerves showed that recover ratios(%) in treatment group((2 weeks:)9.07?1.44,8.02?1.41;6 weeks: 49.87?9.69,50.11?6.11) were better than those in control group((2 weeks:)2.52?1.83;6 weeks:30.31?6.32) obviously in each time(P
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@#ObjectiveTo detect specific antigens of neural cells in amniotic epithelial cells(AECs) in rats. MethodsAECs were dissociated and purified from the amnion of pregnancy 12—14 d rats. The expression of specific markers of neural stem cells (Nestin, Musashi) and differentiated cells (MAP-2,NSE,GFAP) and ChAT, NT-3 in the AECs were detected by immunocytochemistry. ResultsThe cultured AECs displayed positive immunoreactivity to MAP-2, NSE, GFAP, Nestin and Musashi. In addition, the cells also demonstrated immunoreactivity to ChAT and NT-3. ConclusionAECs are similar with neural cells and it may be useful as a sustained source to improve outcome of neural stem cells transplantation.
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<p><b>OBJECTIVE</b>To investigate the clinical application of capitate transposition with a pedicle in 30 cases of Kienbock's disease.</p><p><b>METHODS</b>The external diameter and curvature of the capitate head and proximal facet of the lunate were observed and measured in 100 specimens. The vascularity of the capitate was also investigated. Capitate transposition with a vascular pedicle was designed to treat 30 patients with advanced Kienbock's disease who were followed up for 2 to 16 years and then analyzed according to Evans's scoring system.</p><p><b>RESULTS</b>Aseptic necrosis did not occur in the transposed capitate because the pedicle fascia including the dorsal branch of the anterior interosseous artery ensured the vascularity of proximal two thirds of the capitate. The transposed capitate reestablished a relatively pain-free radiocarpal joint. Follow-up results showed that grip strength and motion arc were up to 70% of contralateral side.</p><p><b>CONCLUSIONS</b>Capitate transposition with a pedicle is a reliable treatment method for advanced Kienbock's disease, with favorable prognosis for at least five years postoperatively.</p>