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Objective:To explore rational surgical treatment for childhood nail matrix nevi.Methods:A retrospective analysis was conducted on clinical data from 35 children with pathologically confirmed nail matrix nevi, who received surgical treatment in Children′s Hospital of Chongqing Medical University from September 2015 to March 2019. Different surgical approaches were adopted according to the site and width of lesions. For lesions with a width of ≤ 3 mm, the nail bed and nail matrix lesions were directly excised with 1-to-2-mm margins and sutured in 11 cases. For lesions with a width of > 3 mm, one of the following 3 surgical procedures was selected by the children′s parents: (1) shaving of nail bed and nail matrix lesions under a microscope at ×8 magnification (8 cases) ; (2) excision of lesions followed by full-thickness skin grafting on the periosteum of the phalanx (8 cases) ; (3) excision of lesions of the second to fifth fingers followed by transfer of skin flaps from the thenar muscle area and full-thickness skin grafting (5 cases) , or excision of lesions of the thumb followed by abdominal-wall flap transfer (3 cases) . The patients were followed up for 12 months, and clinical efficacy was evaluated.Results:During the follow-up, no recurrence occurred in the 11 cases receiving direct excision and suture, with good appearances and longitudinal linear scars on the nail. Among the 8 cases receiving shaving therapy under a microscope, 4 experienced relapse during the follow-up of 6 - 12 months, and the nail/toenail plates were rough and poor in lustrousness in the other 4 without recurrence. No recurrence was observed in the 8 cases receiving excision of the lesions and full-thickness skin grafting, of whom 1 experienced skin graft necrosis, and skin grafts survived with obvious pigmentation in the other 7 cases. Among cases receiving excision of the lesions combined with transfer of skin flaps from the thenar muscle area or abdominal-wall flap transfer, no recurrence was observed, and all transferred flaps survived; good appearances, nearly normal color and gloss of nails were obtained in the cases after transfer of skin flaps from the thenar muscle area, while the color and gloss of postoperative nails were markedly different from those of normal nails in the cases receiving abdominal-wall flap transfer.Conclusion:For nail matrix nevi with a width of ≤ 3 mm, direct excision and suture with 1-to-2-mm margins are recommended; for those with a width of > 3 mm, excision of lesions combined with full-thickness skin grafting, transfer of skin flaps from the thenar muscle area or abdominal-wall flap transfer is recommended; the shaving procedure under a microscope should be used with caution.
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Objective:To explore the clinical application of peroneal artery pedicled with lateral calf muscle wear skin flap in repair of foot and ankle soft tissue defect.Methods:From February 2017 to May 2019, the peroneal artery pedicled with lateral calf muscle wear foot and ankle soft tissue defect was used with skin flap in 20 cases, which included car accident injuries in 11 cases, 3 cases of heavy injuries, skin ulcer in 4 cases, and 2 cases of bone scars. All of the affected limb wounds presented with the exposure of deep tissue such as bone or tendons. The flap cut ranged from 5.0 cm×4.0 cm~7.0 cm×5.0 cm. The donor area was closely sutured in 5 cases, and inguinal full thickness skin pack was used with skin grafting in 15 cases.Results:20 cases of postoperative skin flap survived of all, healing of wounds and cuts for phase I. After follow-up of 5~18 months, the flap had good shape and wear-resistant quality, without feeling bloated. The two points of flap were different within 3~5 mm; the functional activity of the ankle joint was good in the affected limb, with satisfactory results.Conclusions:It is a convenient and reliable procedure, with smaller surgical trauma, which is an ideal skin flap for repair of soft tissue defect in foot and ankle.
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Objective To study the surgical treatment strategies,techniques and results of laparoscopic surgery for space occupying lesions in pancreatic body and tail.Methods To retrospectively analyze the clinical data of 65 patients with space occupying lesions in pancreatic body and tail.These patients were consecutively treated in Department of Minimally Invasive Surgery,the First Affiliated Hospital of Zhengzhou University from January 2010 to November 2017.Results All operations on the 65 patients were performed laparoscopically.The operations included laparoscopic distal pancreatectomy with splenectomy (n =22),spleen preserving laparoscopic distal pancreatectomy (n =43,with Kimura's method,n =38;and Warshaw's method,n =5).The mean size of the lesions was 5.5 cm (range 1.0 ～ 11.2 cm).The mean intraoperative blood loss was 120 ml (range 30～350 ml).The mean operation time was 230 min (range 160～310 min).Complications developed in 11 patients (16.9％).There were no tumour recurrence on follow-up which ranged from 1 to 81 months.Conclusions For patients with space occupying lesions in pancreatic body and tail,surgical strategies should be planned according to the site of the lesion and its relation to the blood vessels of the spleen.With good surgical techniques,laparoscopic treatment of lesions in pancreatic body and tail can be carried out safely,with a low complication rate and with an increased spleen preservation rate.
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Spinal edema is a very important pathophysiological basis for secondary spinal cord injury,which affects the repair and prognosis of spinal cord injury.Aquaporin-4 is widely distributed in various organs of the body,and is highly expressed in the brain and spinal cord.Inward rectifying potassium channel 4.1 is a protein found in astrocytes of central nervous system.It interacts with aquaporins in function.Aquaporin-4 and inward rectifying potassium channel 4.1 play an important role in the formation and elimination of spinal cord edema,inhibition of glial scar formation and promotion of excitotoxic agents exclusion.The distribution and function of aquaporin-4 and inward rectifying potassium channel 4.1 in the central nervous system and their expression after spinal cord injury have multiple effects on spinal edema.Studies of aquaporin-4 and inward rectifying potassium channel 4.1 in the spinal cord may provide new ideas for the elimination and treatment of spinal edema.
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@#Objective To explore the expression and the changes of microtubule, aquaporin-4 (AQP4) and potassium ion channel 4.1 (Kir4.1) after spinal cord injury in rats.Methods Ninety female adult Sprague-Dawley rats were randomly divided into sham operation group (n=30) and injury group (n=60). The injury group was divided into six hours, one day, three days, five days and seven days subgroups, with twelve rats in each subgroup. Spinal cord injury at T10 was established with modified Allen's method (20 g×25 mm) in the injury group. The water content of spinal cord was measured at each time point after injury. Then, the pathology was observed with HE staining, the expression of α-Tubulin, AQP4 and Kir4.1 was detected and analyzed with immunohistochemical staining and Western blotting.Results The water content of the spinal cord was higher in the injured group than in the sham operation group (P<0.05), and was highest on the fifth day. HE staining showed that the gray matter hemorrhage at six hours after injury; one day after injury, the gray matter bled seriously, and neuron swelling was aggravated; three days after injury, the area of gray matter necrosis increased, and the edema phenomenon was obvious; five days and seven days after injury, the gray matter necrosis and the edema phenomenon were more serious. Western blotting and immunohistochemistry showed that the expression of AQP4 gradually increased after injury, and raised at peak on the fifth day; the expression of α-Tubulin and Kir4.1 was similar, and the expression gradually decreased after injury, especially on the fifth day.Conclusion The expression of α-Tubulin and Kir4.1 is similar after spinal cord injury, and is contrary to the expression of AQP4. α-Tubulin, AQP4 and Kir4.1 may be related after injury and may participate in the formation of spinal cord edema.
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Objective To discuss the diagnosis and laparoscopic treatment for superior mesenteric artery compressing syndrome (SMACS).Methods A retrospective analysis was conducted on 62 SMACS patients who had received total laparoscopy treatment from October 2006 to May 2016.Results All 62 cases received upper gastrointestinal series and definite diagnosis was achieved on 51 cases;Definite diagnosis was made on 31 cases among 44 cases undergoing CTA (CTA,CT angiography) examination,19 cases were diagnosed with the disease among 26 cases who had received ultrasound examination.Total laparoscopic duodenojejunostomy was conducted on 41 cases,total laparoscopic gastrointestinal anastomosis was conducted on 14 cases,total laparoscopic gastroduodenal double shortcut anastomosis was conducted on 7 cases.All patients were cured or alleviated and discharged from hospital.Conclusions Upper GI contrast series made definite diagnosis on most SMACS cases.For patients with relapsing symptoms and poor conservative treatment result a surgery is recommended.Total laparoscopic duodenojejunostomy is the mainstay of treatment and is safe and reliable.
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AIM:To explore the time-dependent change of Ski protein expression in normal and activated astrocytes in rats.METHODS:The astrocytes were obtained from rat cerebral cortex and cultured in vitro.The astrocytes were treated with LPS and scratch injury for activation.Western blot analysis was used to determine glial fibrillary acidic protein (GFAP) and Ski protein levels in activated astrocytes at a series of time points.The indirect immunofluorescence staining method was performed to detect the location of Ski protein in the astrocytes.RESULTS:The protein of GFAP was naturally expressed in the astrocytes, beginning to increase after treated with LPS and scratch injury.Little protein expression of Ski in the normal astrocytes was observed.The Ski protein expression began to increase after treated with 1 mg/L LPS, peaked at 4 d (P<0.05) and then deceased, but was stills higher than that in the normal cells.The protein expression level of Ski after scratch injury was highly consistent with above mentioned.Ski was mainly observed in the nucleus of the normal cells and the cells treated with LPS for 6 d, while it was observed in the cytoplasm 2 and 4 d after treated with LPS.CONCLUSION:The protein of Ski is expressed in the astrocytes, and the expression level is increased in activated astrocytes,mainly located in the nucelus.Ski may plays an essential roles in the processes of activation and proliferation of astrocytes.
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Objective To explore how and where ski expresses under lipopolysaccharide (LPS) in rats' astrocytes. Methods Astrocytes were obtained from cerebral cortex of a newborn (within 3 days) Sprague-Dawley rat and cultured in vitro. Astrocytes were cultured with LPS in concentration of 0μg/ml, 0.001μg/ml, 0.01μg/ml, 0.1μg/ml, 1μg/ml, 10μg/ml and 100μg/ml for six hours;and cultured with LPS in concentration of 0.1μg/ml for 0 day, 2 days, 4 days, 6 days and 8 days. The level of ski was determined with Western blotting, and the lo-cation of ski was detected with indirect immunofluorescent staining. Results The expression of ski was induced by LPS, especially in the concentration of 0.1μg/ml. The expression of ski induced with 0.1μg/ml LPS peaked at 4 days of inducement and then decreased. Ski was mainly observed in nuclear in the normal astrocytes and the astrocytes induced with 0.1μg/ml LPS for 6 days. However, it was observed in cytoplasm 2 and 4 days of inducement. Conclusion LPS could induce the expression of ski in rats' astrocytes, which may participate in in-flammation.
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Objective To investigate the role of ski in proliferation of astrocytes and the molecular mechanisms in rats. Methods Astro-cytes were obtained from cerebral cortex of a three-day old rat and cultured in vitro. siRNA targeted to ski and negative control sequences were prepared. The astrocytes were divided into ski-siRNA group, siRNA negative control group and untreated control group, while the spe-cific siRNA targeting ski negative control sequences were transfected into astrocytes with Lipofectamine? RNAiMAX Reagent. The protein levels of ski, glial fibrillary acidic protein (GFAP) and Cyclin D1 were determined with Western blotting. The proliferation of astrocytes were measured with CCK8 assay. The cell-cycle of astrocytes were analyzed with flow cytometer. Results The protein level of ski (F=38.611, P30.507, P48.425, P<0.01), compared with the control groups. Conclusion ski knocking down by siRNA significantly inhibits the proliferation of astro-cytes, which may associate with the down-regulation of Cyclin D1 expression.
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@#Amyotrophic lateral sclerosis (ALS), including the familial and the sporadic, accounts for the most proportion of motor neuron disease. The pathogenesis of ALS covers gene mutation, oxidative stress, excitotoxicity, mitochondrial dysfunction, immune and inflammatory, and so on. With interplay and interrelation, these mechanisms, finally, caused multisystem lesion especially motor neural system.
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Objective To investigate the effect of ski gene in migration process of astrocytes in rats. Methods Astrocytes were obtained from rats' cerebral cortex and cultured in vitro. siRNA targeting ski gene and negative control sequences were prepared. The ski-siRNA group, siRNA negative control group and untreated group were set in this experiment. The specific siRNA targeting ski gene was transfected into astrocytes with Lipofectamine?RNAiMAX Reagent. Then the ski protein levels were determined with Western blotting. After transfec-tion, the changes in migration of astrocytes were measured with wound scratch assay and Transwell migration assay. Results Western blot-ting showed that the expression of ski protein was significantly lower in the ski-siRNA group than in the siRNA negative control group and untreated group (F=132.957, P47.197, P69.187, P<0.001). Conclusion Ski knocked down by siRNA could inhibit the migration ability of astrocytes. It is a reminding that ski may take part in the migration process of astrocytes, and moreover, ski may play an important role in the formation of glial scar.
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Objective To explore the expression and change of ski-interacting protein (SKIP) in rats after spinal cord injury. Methods A total of 60 adult female Sprague-Dawley rats were randomly divided into sham group (n=30) and spinal cord injury (SCI) group (n=30), each group was further divided into five time points including one day, three days, five days, seven days, and 14 days with six rats in each time points. The model was established at T10 with modified Allen's technique, and the sham group only bit the lamina of rats. The hindlimbs behavior was assessed with Basso-Beattie-Bresnahan (BBB) score at each time point. The pathological changes of spinal cord neurons were detected with Nissl staining. The expression of SKIP were observed with immunofluorescence staining. Results The BBB scores were signif-icantly lower in each time point in SCI group than in the sham group (t>48.267, P<0.001). Compared with the sham group, Nissl bodies in the cytoplasm of spinal cord neurons began to disintegrate, coalesce and irregularly distribute, the neurons began to degenerate and die on the fifth day, and the damage deteriorated on the 14th day. Immunofluorescence staining showed that SKIP expression was mainly expressed in the gray matter of the spinal cord and little expressed in the white matter. The expression of SKIP gradually increased after SCI, and reached a peak on the fifth day (t=-17.035, P<0.001) and decreased significantly on the 14th day (t=3.853, P<0.05). Conclusion SKIP may be a new signaling molecule, which play an important role in neuronal apoptosis after SCI.
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Objective To discuss the diagnosis and laparoscopic treatment for superior mesenteric artery compressing syndrome (SMACS).Methods A retrospective analysis was conducted on 62 SMACS patients who had received total laparoscopy treatment from October 2006 to May 2016.Results All 62 cases received upper gastrointestinal series and definite diagnosis was achieved on 51 cases;Definite diagnosis was made on 31 cases among 44 cases undergoing CTA (CTA,CT angiography) examination,19 cases were diagnosed with the disease among 26 cases who had received ultrasound examination.Total laparoscopic duodenojejunostomy was conducted on 41 cases,total laparoscopic gastrointestinal anastomosis was conducted on 14 cases,total laparoscopic gastroduodenal double shortcut anastomosis was conducted on 7 cases.All patients were cured or alleviated and discharged from hospital.Conclusions Upper GI contrast series made definite diagnosis on most SMACS cases.For patients with relapsing symptoms and poor conservative treatment result a surgery is recommended.Total laparoscopic duodenojejunostomy is the mainstay of treatment and is safe and reliable.
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Objective To explore the expression and the changes of ski with time in the injured spinal cord in rats. Methods Sixty adult female Sprague-Dawley rats were randomly divided into sham group (n=30) and injury group (n=30), each group were further divided into 1 week, 2 weeks, 4 weeks, 8 weeks and 12 weeks subgroups, with 6 rats in each subgroup. Spinal cord injury at T10 was established with modi-fied Allen's technique (10 g × 25 mm) in the injury group. The hindlimbs behavior of rats was rated with Basso-Beattie-Bresnahan (BBB) scores 1 day, 3 days, 1 week, 2 weeks, 4 weeks, 8 weeks and 12 weeks after spinal cord injury. Three rats in each subgroup were stained with HE staining to observe the pathological changes of the spinal cord and the formation of cavity. The other 3 rats were analyzed with im-munofluorescence staining of ski and semi quantitative analysis. Results The BBB scores of each time point were less in the injury group than in the sham group (P<0.05). Necrosis was the major pathological change in the injury groups 1 and 2 weeks after injury;cystic cavity completely formed 4 weeks after injury, with dense scar tissue around it;there was no significant change in the cavity and scar 8 and 12 weeks after injury, however, the adjacent spinal cord was obviously thinner. Ski expressed little in the normal spinal cord, and expressed more and more after injury, peaked at 8 weeks and decreased then. Ski was mainly observed in white matter in the sham group and 12 weeks injury subgroup, which was in gray matter 2, 4 and 8 weeks after injury. Ski was highly expressed around the cavity in injury center and formed high expression band. Conclusion Ski expresses after spinal cord injury in rats, that may be associated with the activation and prolif-eration of astrocytes and the formation of glial scar.
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Objective To study how design and harvest perforating artery free flaps in posterior region of thigh based on research of the anatomical features and distribution regularities of those perforating artery.Methods Using 8 fresh bodies specimen with latex leaded perfusion of inferior gluteal area to study perforator artery anatomy structure and distribution of rear thigh.Screen the fitting perforator arteries for perforator free flap both in caliber and length.Total 7 cases were performed with perforator free flap in posterior thigh,the flap size:from 3 cm × 8 cm-8 cm × 16 cm,and the first perforating artery flap carried out in 4 cases,the second perforating artery flap in 2 cases,the third perforating artery flap in Ⅰ case.Results Anatomic study showed that perforating artery suitable for free flap in this area were in teams of 4 to 5,the average diameter were in range of 0.4 to 2.8 mm,the average length was 2.2-9.0 cm.Seven cases had been applied with perforator flap and all survived.Followed-up from 5 to 11 months,the wounds repaired by the perforator flap of posterior thigh presented fine elasticity,thin flap,beautiful appearance.Conclusion The distribution,length and diameter of perforating artery in posterior region of thigh are suitable for perforator free flap.Being hidden,direct close the posterior region of thigh expected to acchive satisfactory clinical effects.
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Objective Evaluate data of 1270 cases with free flap transplant,to find the problems in the process of operation,and then to analyse its causes and how to prevent and solve it,as well as providing reference for clinical colleagues. Methods To study 1270 cases of free flaps,musculocutaneous flap and perforator flap who was treated in our hospital from October 2000 to October 2010 retrospectively. A total of 722 cases of the group were followed-up 6 months to 5 years. To detective and search the problems and imperfection from designing,harvesting,tranfer,to the management and function of donor site after free flap transplantion.And also to analysis the couse of problems and operation failure,discuss the conclude of and to provide advisable measure. Results Total 1270 free flaps were transplanted successfully except 64 can-celled or failured for some reason, the success rate was 95.0％, the postopertive necrosis rate was 3.8％.Seventy-six cases were encountered vascular complications venous crisis in 42,arterial crisis in 38.Fifty-five cases were saved successfully without surgery,and 15 cases survived completely by vessel explorative operation. Five cases were partial necrosis and 7 cases necrosis. The rate of postoperative infection of emergency cases and chronic one were 4.7％ (682 cases)and 8.8％(588 cases) which show the infective incidence of latter was higher than former. In addition, there were many other problems were found such as distal flaps necrosis,contracture,deformation,impairment function of doner site,etc. Conclusion Preventing and management timely to vessle crisis is the key to flap suvive. The principle of dissecting flap should be followed strictly,and control the indications of modified processing during flap harvest,keep the proper flap tension were technical requirements in flap transplantion. Right way of donor site closed and management of insufficient timely were equally important to prevent and solve to complications and dysfunction.
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ObjectiveTo study the anatomy of the soleus muscle perforator flap and its clinical application.MethodsIn 6 cadavers specimen with 12 lower limbs,the cutaneous branches and soleus muscle perforator artery were dissected and their measurements were recorded.Fourteen patients with skin and soft tissue defects from July 2002 to October 2010 were repaired by the soleus muscle perforator flap.Of the 14 patients,eight for dorsal and anterior defects of foot,two for anterior defects of malleolus,two for hand defects,two for elbow defects.The size of the flaps was 5 cm × 6 cm - 12 cm × 20 cm.Flap success rates and postoperative course were evaluated. ResultsThe soleus musclocutaneous perforators mostly appeared within 5 - 24 cm length below the head of fibula.The diameter of the artery cutaneous perforator was( 1.08 ±0.22)mm,vena concomitants was (1.20 ± 0.32)mm.All flaps were survived completely and the wounds got primary closure in 14 cases.The flaps were not overstaffed,and their shape,texture and color were similar to normal.All of the 14 cases were evaluated as satisfactory after 6 months to 12 months follow-up. ConclusionThe free soleus muscle perforator flap is an ideal flap for repairing skin and soft tissue defects with the merit of simple procedure,minimal trauma and more physiological circulation established.
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ObjectiveTo investigate the method of osteo-periosteal turned over orthotopically for treating chondromalacia patellae disease and observe the mid-long term efficacy postoperatively.Methods From April 1996 to June 2000,21 patients with chondromalacia patellae were treated in our hospital.Amone them,13 cases were performed osteo-periosteal turned over orthotopically,including 3 males,10 females; with the mean age of 59 years(range,47-65 years).HSS and Lysholm knee rating scale were employed to analysis the results.ResultsThe patients were followed up from 114 to 162 months(mean,133.2 months).One of the patients lost follow-up due to death.Before operation the HSS knee score was 20-58 (34.2±3.8),and 1 year,3 year,5 year,7 year,and 9 year after operation the HSS knee score were 55-70(60.0±7.0),55-82 (64.1±5.9),60-90 (70.1±3.2),50-85 (63.1±4.1),and 50-75 (57.3±2.9) respectively.And Lysholm knee rating scale also showed similar results.The chondromalacia patellae patients before and after operation were significant different.Bone periosteum transplant tissue and surrounding defective tissue healed perfectly,functions recovered perfectly.ConclusionThe method of osteo-periosteal turned over orthotopically has the capabilities to form cartilage.The therapeutic effect and facies articularis patellar is satisfactory.But it only can restore articular cartilage of patellar and does not help for genual malformation.
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Objective To study the method of solving the complications of large allograft including resorption, nonunion and refracture by means of vascularization and the way of improving bone healing. Methods The bone defect longer than 10 cm of limbs were found in 21 cases, plate or external fixator were used to fix allograft bone, and then vascularied autologous bone or periosteum were transplanted or inserted to the massive allograft In order to vascularizate allograft, improve bone healing and prevent complications of bone resorption and osteolysis. 4 cases were implanted by local vascular bondle in one end. 4 cases were transplanted vascular iliac bone into middle part the allograft bone, 2 cases were into one end. 2 cases were transplanted by vascular fibular bone. 6 cases were used vascular periosteum. 3 cases were used combined methods. Results Twenty-one cases with 10 cm or more bone defect in this group were treated by the method above. 14 cases were achieved primary healing, 6 were healing by farther operation, 1 failure. Complications were found in 7 cases, 4 occur infection in all. All were achieved satisfactory function and outlook by follow-up. Conclusion The method of vascularied autologous bone or periosteum combined with massive allograft are effective to improve bone union, reduce the complication of bone resorption and osteolysis,which proved usefull to treat large bone defect.
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Objective To explore reconstructive methods for defects uf bone and soft tissue in traumatic injury uf medial malleolus.Methods A vascular iliac bone with a piece of faacial strip is used together with a local island flap or a free flap to reconstruct the defects of bone,triangular ligament and skin in medial malleolus al one or two stages.Results Follow-ups of 11 to 24 months proved that the stability and walking and weight loading functions uf ankle joint of the patients were restored satisfactorily and their normal varus range without abnormal articular motion was restored.Slight varus occurred during walking in one case,and pain appeared after fatigue in two cases.The X-grams showed no obvious absorption or areosis in the free iliac bone implanted.Conclusion In repair of defects of medial malleolus,combined transplantation of iliac bone and flap is rceommendable because it can keep the essential integrity of malleolus and achieve good Stability and functional recovery of ankle joint.