Clinical application of perforator propeller flaps with anastomosis of superficial veins / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical effect of anastomosis of superficial veins for improving the drainage of perforator propeller flaps.</p><p><b>METHODS</b>From Sept. 2011 to Dec. 2012, 11 cases with soft tissue defects and chronic ulcer wound at extremities were treated with adjacent perforator propeller flaps, which were pedicled by the peroneal artery(5 cases), or the lateral supramalleolar artery(3 cases), or the ulnar artery (2 cases), or the posterior interrosseous artery (1 case). The wound size ranged from from 3.0 cm x 2. 5 cm to 11. 0 cm x 4. 0 cm, and the falps size ranged from 6 cm x 3 cm to 21 em x 5 cm. One superficial vein in all the flaps was anastomosed with superficial vein in the recipient area. The blood supply of the flaps were recorded after operation 1 - 3 months after operation, the fluency of anastomosed vein was detected by color Doppler ultrasound. Flap swelling evaluations were performed in early 3 months and later 3 - 6 months, and the results were classified into 4 grading degrees. 6 months later, Questionnaire of the flap aesthetic satisfactory was performed for seven patients during follow-up period.</p><p><b>RESULTS</b>9 flaps survived completely, two flaps had partial marginal skin necrosis in the distal end, which were both managed with surgical debridement, and both wounds healed in two months. 9 cases were followed up for more than 12 - 19 months. The early rsults of flap swelling evaluations were: I degree 0 case, II degree 8 cases, III degree 3 cases, IV degree 0 case, and the later results were: I degree 7 cases, II degree 4 cases, III degree 0 case, IV degree 0 case. The flaps had ideal appearance, good contour, and high aesthetic satisfactory (100%). The mean flap survival area rate of veins anastomosed was (98. 6 ± 9. 7) %.</p><p><b>CONCLUSIONS</b>Perforator propeller flaps with anastomosis of superficial veins can improve the flap venous drainage, avoid transient venous venous congestion, so as to increase the flap survival. It is an effective way for improving the vein drainage.</p>

Clinical application of lateral leg multi-perforators pedicled propeller flaps for reconstructing the foot and ankle defects / 中华显微外科杂志

Objective To investigate the methods and results of lateral leg propeller pedicled flaps based on multi-perforators for coverage of soft-tissue defects on the foot and ankle.Methods From May,2012 to June,2013,8 patients with soft-tissue defects were treated,including 5 cases by trauma,2 cases by chronic unlcers,1 case by infection on the foot and ankle with exposed osseous and tendinous.Lateral leg propeller pedicled flaps based on multi-perforators were elevated and rotated with the angle from 150° to 180° for coverage of soft-tissue de-fects.Flap size ranged from 15.0 cm × 7.0 cm to 23.0 cm × 9.0 cm.Skin graft was applied to cover the donor sites.After the operation,the blood supplies of flaps were observed severely over 10 days.Questionnaire of the flap aesthetic satisfactory and AOFAS evaluation were performed in 7 patients during fellowed-up periods.Results Seven flaps were all survived well,1 flap had partial marginal skin necrosis on the distal,which was managed with surgical debridement,and wound healed in 1 month.Seven patients had a mean of 10.7 months' fellowed-up periods.The flaps had like-like appearance,good contour,and high aesthetic satisfactor (100％).The mean AOFAS score was 90.5.Conclusion Lateral leg propeller pedicled flaps based on multi-perforators can supply the blood of the larger volume of tissue,which can be safely sustained to repair distal and larger defects on the foot and ankle.

One-staged coverage and revascularisation of traumatised fingers by neighboring digital artery flow-through flaps / 中华显微外科杂志

Objective To investigate the clinical application of neighboring digital artery flow-through flaps for one-staged skin coverage and revascularisation after severe finger injuries.Methods From May 2008 to July 2010,there were ischemic fingers had severe injuries,aged 19 to 52 years old,which were male in 5 cases,female in 2 cases,with skin and arterier defected.One-staged coverage and revascularisation of traumatised fingers were used with neighboring digital artery flow-through flaps.Functional exercise and physical therapy were done 3 weeks later.All cases had more than 12 months' fellowed-up periods.The sensibility testing,Questionnaire of the flap aesthetic satisfactory and TAM evaluations were all performed in all patients.All the results were measured and evaluated.Results All flaps survived completely and digit blood circulations were good in 7 patients.The flaps had good appearance and aesthetic satisfactory (100％).At 12 months after operations,the pain and touch perception reinnervated until 6 months and two-point discrimination testing were 6.1 to 9.6 mm,mean was (7.1 ± 1.3) mm,and the flap sensibility assessment were S3 * and TAM evaluation ratio were 0.81 ±0.16.Conclution Neighboring digital artery flap ideally suited as a thin and pliable flow-through flap in digital replantation/revascularization.It is helpful for salvage of the ischemic fingers after injury with skin and arteries defects.

Flow-through posterior interrosseous artery flaps for repair of digital wounds combined with artery injury / 中华创伤杂志

Objective To investigate the methods and clinical effects of flow-through posterior interrosseous artery flaps for reconstructing digital wounds combined with artery injury.Methods From December 2011 to September 2013,11 patients with traumatic digital defect combined with artery injury were repaired with flow-through posterior interrosseous artery flaps.Flap aesthetic satisfaction was assessed using questionnaires; flaps were tested for pain and touch sensation,temperature perception,and two-point discrimination; finger activity was detect using the total active movement (TAM) ratio of the injured and uninjured side.Results All flaps and injured fingers survived.Wounds healed by the first intension.Nine patients were followed up for 12-24 months.Two-point discrimination of the flaps recovered at postoperative 6 months and averaged (9.7 ± 2.1) mm at postoperative 12 months,with S3 +grade in sensation evaluation.TAM ratio of the injured and uninjured side was 0.85 ±0.17.All patients expressed the satisfaction to flap appearance.Conclusions Flow-through posterior interrosseous artery flaps are safe and effective to cover digital wounds and restore blood circulation.The technique improves the clinical application of perforator flaps.

Flow-through latissimus dorsi musculocutaneous flap transplantation for functional reconstruction of forearm musculus flexor digitorum defects / 中华骨科杂志

Objective To investigate the clinical application of flow-through latissimus dorsi musculocutaneous flaps for functional reconstruction of musculus flexor digitorum defects.Methods 9 forearm traumatic patients were selected admitted from March 2011 to February 2013,aged 22 to 57 years old (average age 39.2),including 5 male and 4 female.All cases were combined injuries.The flexion of the fingers was constrained.The injury areas ranged from 15 cm×6 cm to 21 cm×9 cm while the flaps were 17 cm×7 cm at least and 24 cm×10 cm at most.For traumatic musculus flexor digitorum,skin,soft tissue and radial artery defects were all well repaired with functional flow-through latissimus dorsi musculocutaneous flaps.Functional exercise and physical therapy were done 3 weeks later.Electromyography,grip strength,and pinch strength evaluation were performed at the 6,12months after operating.Enneking evaluation was scored during follow-up periods from 12 to 24 months.All the results were measured and evaluated.Results All flaps survived completely in 9 patients and recipient radial artery were bypassed well.The flaps had good appearance and high aesthetic satisfactory.Seven cases had more than 12 months' follow-up periods.Muscle contraction can be touched 3 months after transplantion.Diagram of EMG tracing showed that the maximum voluntary contraction action potentials presented simple phase at 3 months,intermix phase at 6 months,and interference phase at 12 months.The average grip strength of the second to fifth finger was 8.97±2.91 g/mm2 at 6 months,11.69±3.71 g/mm2 at 12 months.The average pinch strength of thumb and the index finger was 1.39±0.22 g/mm2 at 6 months,1.67±0.34 g/rmm2 at 12 months.For the muscle power recovery and motor nerve function scale,4 cases were M3+,3 cases were M3.The average ratio of Enneking evaluation score with nomal was 65.7％± 15.9％.Conclusion As functional musculocutaneous flaps,flow-through latissimus dorsi musculocutaneous flaps are effective for reconstruction of musculus flexor digitorum and wound defects.The vascular status of the extremities are protected and maintained,which is extremely useful in forearm-salvage procedures from both functional and structural viewpoints.

Hand contracture due to extravasation injury from peripheral intravenous therapy in children / 中华骨科杂志

Objective To investigate the clinical manifestation,therapeutic methods and treatmenteffectiveness of hand contracture due to extravasation injury from peripheral intravenous therapy in children.Methods Data of 6 children who had received treatment for hand contracture in our hospital from March 2004 to September 2011 were retrospectively analyzed.There were 3 boys and 3 girls,aged from 24 to 51 months (average,38 months).Two children underwent extensor tenolysis and dorsal capsular release at the metacarpophalangeal (MCP) joints.The other 4 children received conservative treatment,including physical therapy (ultrasound and medium frequency pulse) to reduce the hand swelling and peritendinous adhesion,active and passive functional exercise of digital joints and night splint protection.Results The MCP joint could be passively flexed to 90° intraoperatively in 2 children who underwent operation; however the contracture recurred at 2 months and 6 months after operation,respectively,and then the MCP joints were fixed at 0° position.For 4 children who received conservative treatment,although the active flexion of their MCP joints ranged from 30° to 45° during the rehabilitative procedure,recurrence of hand contracture was observed after the cessation of the rehabilitation in all children,and the range of active MCP joints flexion varied from 0° to 15°.Conclusion The mechanism underlying hand contracture due to extravasation injury from peripheral intravenous therapy remains elusive.Either simple conservative or surgical management results in poor functional outcomes.Combined therapy based on different indications for conservative and surgical management may improve the outcomes.

The protective effect of EGB761 on vessels of denervated gastrocnemius in rats and its mechanism / 华中科技大学学报（医学）（英德文版）

This study investigated the protective effect of EGB761 on blood vessels of denervated gastrocnemius of rat and its possible mechanism. Fifteen male adult SD rats were randomly divided into three groups: normal control group (n=3), control group (n=6) and EGB761-treated group (n=6). The rats in the control and EGB761-treated group underwent a neurotomy to bilateral sciatic nerves. Then, they were administered EGB761 [100 mg/(kg·d)] and isovolumic normal saline, respectively by gavage everyday. No treatment was given to the rats in the normal control group. Gastrocnemius was harvested at 1 and 3 week(s) postoperatively in each group. Immunohistochemical method was used to detect the ratio of capillary/fiber (CFR) of denervated gastrocnemius and the expression of VEGF, fetal liver kinase -1(Flk-1) receptor and HSP70 in the vascular wall. The results showed that in the normal control group, VEGF, Flk-1 and HSP70 were expressed in the vessel wall of gastrocnemius, with Flk-1 expressed only in the endothelial cell of vessels. CFR in the EGB761-treated group was significantly higher than that in the control group at 1 week and 3 week(s) after neurotomy. The expression of VEGF and Flk-1 in the vessel wall of both control and EGB761-treated group was much lower than that in the normal control group, and the expression of these proteins in the EGB761-treated group was decreased as compared with that in the control group. The expression of HSP70 in the vessel wall of both control and EGB761-treated groups was enhanced when compared with that in the normal control group, and it was substantially augmented in the EGB761-treated group in comparison to the control group. It was concluded that EGB761 has a protective effect on blood vessels of denervated gastrocnemius, which is related to the increased HSP70 expression but not the expression of VEGF and its receptor Flk-1.

Skeletal muscle-derived stem cells exhibit cardiocyte competences / 华中科技大学学报（医学）（英德文版）

Adult stem cells from skeletal muscle cells were induced to differentiate into cardiocytes to see if stem cells from another different but histologically-comparable tissues can differentiate to the target cells. Skeletal muscles-derived stem cells (MDSCs) were isolated from adult skeleton muscle tissues by differential adhesion, and immunocytochemically identified by using Sca-1. In order to induce the proliferation but not differentiation of MDSCs, the cells were cultured in Dulbecco's modified Eagle's medium/F12 (DMEM/F12) supplemented with 1:50 B27, 20 ng/mL basic fibroblast growth factor (bFGF), 20 ng/mL epidermal growth factor (EGF) in a suspension for 6 days. Then these stem cells were treated with 5 mumol/L 5-azacytidine for 24 h in an adherence culture. The characteristics of induced cells were examined by immunocytochemistry, quantitative real time RT-PCR and morphological observation of cell phenotype. Our results showed that the appearance of some cells gradually changed from spindle-shape into polygonal or short-column-shape. Some of these post-treated cells could contract spontaneously and rhythmically. The expression of GATA-4 and cTnT was increased 1 and 2 week(s) after the treatment. And about 16.6% of post-treated cells were cTnT-positive. Therefore, we are led to conclude that skeletal muscle-derived stem cells could differentiate into cardiocyte-like cells, which exhibited some characteristics of cardiocytes.

Clinical study on repairing huge soft tissue defect in foot with a extensive reverse peroneal artery flap / 中华显微外科杂志

@#Objective To introduce the clinical application of a extensive revense peroneal artery flap in repairing big soft tissue defect in foot, especially in repairing a big defect in distal foot and the exposure of one or more metatarsophalangeal joint. Methods The skin flaps were used in 11 cases to repair the big soft tissue defect in foot, including the distal part of foot. The flap upper boundary may surpass the capitulum fibulae; The lower boundary may reach the back line between external malleolus and internal malleolus; Lat-eral boundary could overrun anterior margin of fibula about 2 cm; Inboard boundary could get to medial mar-gin of gastrocnemius muscle. In attention: the two branch vessels from peroneal vessel in the site of 11-13 cm and of 5-7 cm above the outer anker would be included in the flap. Results Ten of 11 skin flaps survived satisfactory. A small, marginal portion of one flap in one case presented necrosis. Conclusion The reverse peroneal artery flap is easy to elevate and safety, which is an ideal flap for a huge soft tissue defect in foot, especial in the distal part of foot.

Expression of neural stem cells transfected by neurenergen-3 gene / 中国组织工程研究

BACKGROUND: It is one of hot topics for the application of neurotrophic factors including neurenergen-3 to promote peripheral neural regeneration nowadays; however, clinical application is restricted to safety and effective administration route. Gene transfection brings a novel thinking and pathway for neurotrophic factors used in clinic.OBJECTIVE: To observe the expression of neural stem cells modified by neurenergen-3 gene after transfection.DESIGN: Completely randomized study.SETTING: Department of Traumatic Orthopaedics and Hand Surgery, the First Affiliated Hospital, Guangxi Medical University;Department of Hand Surgery, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology.MATERIALS: Three healthy SD rats of four months old and either gender were selected from Animal Center, Tongji Medical College, Huazhong University of Science and Technology. Recombinant adenoviral expressing vector for transfection of neural stem cells was constructed in Laboratory of Orthopaedics, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, and the concentration was 0.15 g/L.METHODS: The experiment was carried out in the Orthopaedic Laboratory and Central Laboratory, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology from December 2002 to March 2004. Recombinant plasmid pAD-neurenergen-3 containing with green fluorescent protein (GFP) gene was transfectd into primarily cultured neural stem cells by using cationic tiposome interventional method. At 72 hours after transfection, fluorescent inverted microscope was used to observe GFP expression in neural stem cells, and transfection efficiency was measured simultaneously. Expression and transcription of neurenergen-3 gene in neural stem cells were detected at 72 hours, 1 and 5 weeks after transfection by using immunocytochemical stain and reverse transcription polymerase chain reaction (RT-PCR).MAIN OUTCOME MEASURES: Expression of neurenergen-3 gene in transfected neural stem cells.RESULTS: ① Neural stem cells transfected by recombinant plasmid pAD-neurenergen-3: GFP expressed on partial neural stem cells at 72 hours after transfection, and the transfection efficiency was 40%. Five weeks later, GFP expression was still observed. ②Transcription and expression of neurenergen-3 gene in neural stem cells: Transcription of neurenergen-3 mRNA was observed in neural stem cells at 72 hours, 1 and 5 weeks after transfection, and expression of neurenergen-3 mRNA was still observed in 5 weeks after trans fection.CONCLUSION: As the carrier of cationic liposome, neurenergen-3 gene can effectively transfect, culture and long-term express neural stem cells via the introduction of adenoviruses.

The upper limb lateral bone-skin flap combine with the second toe transplant primary repair complex thumb defect / 中华显微外科杂志

@#Objective To introduce a sort of method about thumb reconstruction to complex thumb defect. Methods From January 2003 to December 2006, 13 patients who incur sever thumb defect above5 grade adopt the upper limb lateral bone-skin flap combined with the second toe transplant primary thumb reconstruction, pestop follow-up visit 12 months to 3 years, according to hand surgery society of Chinese Medical Associaition thumb and finger reconstruction functional assessment probation standard to evaluatethe function of reconstituted thumb. Results All of the transplanted upper limb lateral bone-skin flaps and the second toes take, and function well. Conclusion The upper limb lateral bone-skin flap combined with the second toe transplant primary repair complex thumb defect had been tested one good method for thumb reconstruction to above 5 grade thumb defect.

Expression of vascular endothelial growth factor receptors in rat spinal cord tissue / 中国组织工程研究

BACKGROUND:Vascular endothelial growth factors (VEGF) can promote the division of endothelial cells and accelerate the growth of newborn vessels, whereas the expression and distribution of VEGF receptors (VEGFR) in spinal cord should be observed.OBJECTIVE: To observe the expression and distribution of VEGFR-1 and VEGFR-2 in rat spinal cord.DESIGN: A randomized controlled observation.SETTING: Department of Orthopaedic Surgery, the First Affiliated Hospital of Dalian Medical University; Department of Hand Surgery, Union Hospital affiliated to Tongji Medical College, Huazhong University of Science and Technology.MATERIALS: Ten adult male Wistar rats of clean degree, weighing 180-200 g, were provided by the animal experimental center of Tongji Medical College, Huazhong University of Science and Technology. Immunohistochemical primary antibody was purchased from Santa Cruz Company; the second and third antibodies from Beijing Zhongshan Biotechnology Co., Ltd. Reverse transcription-polymerase chain reaction (RT-PCR) kit was the product of Promega,Trizol reagents were purchased from Invitrogen Company, and the VEGFR-1 and VEGFR-2 primers were designed by Beijing Aoke Company.METHODS: The experiment was carried out in the laboratory of Department of Hand Surgery of Wuhan Union Hospital from March to June in 2004. ① Detection of VEGFR expression in spinal cord anterior horn: The rats were anesthetized by 100 g/L chloral hydrate, spinal cord of lumbar 4-6 (L4-6) was fixed in fixation solution at 4 ℃ for overnight, then routine dehydration, hyalinization and paraffin embedding were performed, and serial sections of about 5 μm were prepared for observing the VEGFR expressions using immuniohistochemical staining. ② Detection of VEGFR mRNA expression in spinal cord: Five rats were selected, L4-6 spinal cord (50 mg) was removed and centrifugated, then the content of total RNA was determined with ultraviolet spectrophotometer. The synthetized cDNA was amplified with PCR, and the PCR products (10 μL) were treated with 20 g/L agarose gel electrophoresis, and stained with 0.1 mg/L ethidium bromide, the results were observed and recorded under ultraviolet lamp and photographed. The products were scanned and quantified with gel imaging analytical system to record the gray value of each band, the gray value of β-actin band was taken as 1,and those of the other objective fragments were compared with it to record the gray value ratio and analyze the expressions of the objective fragments.MAIN OUTCOMEMEASURES: ① Expression and distribution of VEGFR-1 and VEGFR-2 in rat spinal cord anterior horn;② Results of VEGFR mRNA expression in spinal cord.RESULTS: ① Both VEGFR-1 and VEGFR-2 were expressed in the microvessels of normal rat spinal cord tissue.Besides, VEGFR-2 mainly expressed in motor neurons, glial cells and the nerve fibers in surrounding white matter. ②The results of gel imaging analytical system showed that the VEGFR-2 content in normal spinal cord was obviously higher than VEGFR-1 (0.874±0.222, 0.486±0.181, P ＜ 0.05).CONCLUSION: VEGF promote the formation of microvessels through the combined effects of VEGFR-1 and VEGFR-2,and it plays the neurotrophic and neuroprotective role through VEGFR-2.

Favorable effect of local VEGF gene injection on axonal regeneration in the rat sciatic nerve / 华中科技大学学报（医学）（英德文版）

This study is to investigate the effect of local phVEGF(165) injection on sciatic nerve regeneration in the rats and to search for a new way in the further treatment of peripheral nerve injuries. Forty-five adult male Wistar rats received a neurotomy to bilateral sciatic nerves, which were subsequently reconnected with 10/0 epineurial nylon sutures. The injured segments was locally injected with normal saline (group A), or 25 microg of phVEGF(165) (group B) or 50 microg phVEGF(165) (group C). Nerve conduction and regeneration were evaluated in terms of the histological changes, weight of gastrocnemius muscles, electrophysiology and morphometric results. Our study demonstrated that rats of group C showed the best results in terms of nerve regeneration, followed by group B and group A. Our findings suggested that local injection of phVEGF165 can facilitate nerve regeneration and promote functional recovery in a dose-dependent manner.

Favorable Effect of Local VEGF Gene Injection on Axonal Regeneration in the Rat Sciatic Nerve / 华中科技大学学报（医学）（英德文版）

This study is to investigate the effect of local phVEGF165 injection on sciatic nerve regeneration in the rats and to search for a new way in the further treatment of peripheral nerve injuries.Forty-five adult male Wistar rats received a neurotomy to bilateral sciatic nerves, which were subsequently reconnected with 10/0 epineurial nylon sutures. The injured segments was locally injected with normal saline (group A), or 25 μg of phVEGF165 (group B) or 50 μg phVEGF165 (group C).Nerve conduction and regeneration were evaluated in terms of the histological changes, weight of gastrocnemius muscles, electrophysiology and morphometric results. Our study demonstrated that rats of group C showed the best results in terms of nerve regeneration, followed by group B and group A. Our findings suggested that local injection of phVEGF165 can facilitate nerve regeneration and promote functional recovery in a dose-dependent manner.

Application of transforming growth factor-beta 1 plasmid in local host during frozen nerve allograft / 中国组织工程研究

BACKGROUND: In repair of nerve defect with allogenic nerve graft, to reduce immune rejection is one of the key problems. At present, the main approach is to reduce antigenicity of grafted nerve segment and apply generally immune inhibitor.OBJECTIVE: To observe the effects of freeze/thaw treatment and local application of transforming growth factor beta 1 (TGF-β1) plasmid on frozen nerve allograft.DESIGN: Randomized controlled animal experiment was designed.SETTING: Department of Hand Surgery, Union Hospital, Tongji Medical College Affiliated to Huazhong University of Science and Technology.MATERIALS: The experiment was performed in Tongji Medical College of Huazhong University of Science and Technology from January 2003 to December 2004, in which 40 Wistar healthy and adult rats were employed,from different delivery and were randomized into experimental group and control, 20 rats in each one.METHODS: Transforming growth factor-β1 (TGF-β1) plasmid and frozen allogenic sciatic nerve were prepared. In experimental group and control,sciatic nerve was cut off 2.0 cm in length, in the foramen 0.5 cm beneath piriformis. The nerve defect was repaired with pre-frozen allogenic nerve 2.0 cm in length. In experimental group, TGF-β1 plasmid was injected in local muscle and two broken ends of nerve. In the control group, physiological saline of equal volume was injected. In the 6th and 12th weeks, the samples were collected from 10 rats in each group for sectioning, staining,axonal counting and statistical analysis.RESULTS: No any animal was died in experiment and all of animals entered result analysis. In the 6th weeks, in the control group, mild edema appeared among axons on the grafted segment of nerve and in the experimental group, there was no edema among axons and the regenerated nerve numbers were close to the normal. In the 12th week, in the experimental group, the entire grafted nerve segment was basically filled up by the regenerated axons;myelinated nerve fiber was arranged in order and both axons and myelins were developed well. The regenerated axonal count in experimental group was more significantly than the control, indicating extremely significant difference [(98.6±4.8), (75.8±5.1) counts/μm2, t=2.962, P ＜ 0.01].CONCLUSION: Freeze/thaw treatment can decrease antigenicity of allogenic nerve, which provides the possibility of repair of nerve defect. Local application of TGF-β1 plasmid can provide immune inhibition locally and reduce immune rejection in the host.

An experiment study of target muscle and moter endplate on peripheral nerve end-to-side neurorrhaphy / 中国矫形外科杂志

[Objective]To study the effect of End-to-side neurorrhaphy for protection target muscle.[Method]Twenty-six wistar rats were divided into two groups,with 13 in each group,peroneal nerve was transacted on the right side of all the animals,in one group,the proximal end of peroneal nerve was turned back and ligated,the distal end was sutured to the side of tibial nerve with perineurial window,in another group,both ends of the transacted peroneal nerve were turned back and ligated as contrast,no operation was done on the left side.Three months after operation,the peroneal nerve and the tibial muscle were taken for histologic exmination,and the muscle's wet weight was examed.[Result]Significant difference was seen between the two groups in the muscle wet weight,the muscle fiber cross sectional area,the moter endplate area and color(P

Peripheral nerve regeneration in response to target muscular injection of methyl cobalamin in rats / 中国组织工程研究

BACKGROUND: Methyl cobalamin, a derivative of vitamin B12, .can promote the metabolism of nucleic acid protein, axoplasmic transport and axonal regeneration.OBJECTIVE: To observe the role of target muscular injection of methyl cobalamin ofdifferent dosages in the regeneration of peripheral nerve injury in rats.DESIGN: A randomized and controlled animal experiment.SETTING: Changzhou Second People's Hospital affiliated to Nanjing Medical University.MATERIALS: The experiment was carried out in March 2003. Thirty healthy Wistar rats were randomly divided into three groups with 10 rats in each group: high-dosage group, low-dosage group and blank control group.METHODS: All the rats were made into models of sciatic nerve injury by epineural suture immediately after transection of left sciatic nerve. Rats in high- and low- dosage groups were injected with methyl cobalamin of 300and 100 μg/kg per day respectively, and those in blank control group were injected with 1 mL normal saline of the same volume, and target muscular injection was given once a day postoperatively. At postoperative 4 and 8weeks, 5 rats were killed at one time; the wet mass of left triceps surae muscle was measured. Morphological observation of sciatic nerve under light and electron microscopes and imaging analysis were made as the detected indexes to analyze the effect of methyl cobalamin of different dosages on sciatic nerve injury in rats.sciatic nerve myelin sheath at postoperative week 8.parison of the wet mass of triceps surae muscle at postoperative 4 weeks: It was higher in high-dosage group than in low-dosage group and blank control group [(1.367±0.012) g, (1.164±0.011) g, (0.950±0.009) g, P ＜ 0.05].week 8: It washigher in high-dosage group than in low-dosage group and blank control group [(2.205±0.015), (1.611±0.013), (1.230±0.014) g, P ＜ 0.05].weeks postoperatively: It was obviously higher in high-dosage group than in low-dosage group and blank control group [(13.30±1.167), (9.453±1.233),atic nerve myelin sheath at 8 weeks postoperatively: It was thicker in highdosage group than in low-dosage group and blank control group [(1.145±0.108),(0.806±0.065), (0.560±0.045) mm, P ＜ 0.05].CONCLUSION: Target muscular injection of methyl cobalamin can promote the regeneration of peripheral nerve, and methyl cobalamin of high dosage can better play its role in nourishing injured nerve.

Dynamic changes in countertraction intensity of the peripheral nerve repaired with the adhesion of fibrin glue / 中国组织工程研究

BACKGROUND: At present, the repair by means of suture is still commonly used to repair the peripheral nerve injury and rupture, while the adhesion of the fibrin glue repairing peripheral nerve injury has been considered as a new topic of study.OBJECTIVE: To study the countertraction intensity of peripheral nerve and its dynamic changes after repaired with the adhesion of fibrin glue.DESIGN: A randomized controlled experimental study.SETTING and MATERIALS: The study was completed in the Laboratory of Biodynamics, Department of Orthopaedics, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology. The healthy adult male Wistar rats weighing 250- 300 g were selected for the experiment.INTERVENTIONS: Totally 96 Wistar rats were completely randomized into the suture group and the adhesion group. Their sciatic nerves were cut, and the incisions were well lined. The fibrin glue was adopted in the adhesion group, while 11 -0 suture was adopted in the suture group. On the very day and 3, 7, 14, 21, 28 days after the operation, 8 rats were respectively taken each from the suture group and the adhesion group. The free sciatic nerves of them were detected immediately by the biodynamic test.MAIN OUTCOME MEASURES: The peak load and the power consumption were measured when the nerves ruptured and the nerve stress-strain curve was described.RESULTS: In normal countertraction intensity curve of the nerve, the elastic peculiarity can be manifested. Between the suture group and the adhesion group, there were no notable significances of the maximal countertraction intensity and power consumption on the very day and 14, 21, 28 days after the operation( P ＞ 0.05). While 3 days after the operation, the maximal countertraction intensity of the two groups was(1.35± 0. 27),( 1.97 ± 023) N/mm2 respectively, the power consumption was (0. 028 ± 0.007), (0.040 ± 0.003) J/mm2 respectively. Seven days after the operation, the maximal countertraction intensity was( 1.93 ± 0.26), (2.74± 0.30) N/mm2 respectively, the power consumption was(0.047±0.009), (0.063±0.007) J/mm2 respectively. The differences both had the notable significance ( P ＜ 0.05).CONCLUSION: The fibrin glue has enough countertraction intensity and can gratify the need of such nerve repairs.

Impacts of ischemic preconditioning on the contractile function of skeletal muscle / 中国组织工程研究

BACKGROUND: Ischemic preconditioning (IPC) can effectively improve the ischemic resistance of skeletal muscle and reduce the necrotic areas during ischemia-reperfusion; However, the impacts of IPC on contractile function of skeletal muscle during ischemia-reperfusion is unclear.OBJECTIVE: To investigate the effect of IPC on contractile function of skeletal muscle during ischemia-reperfusion.DESIGN: A randomized controlled study by employing experimental animals as subjects.SETTING: Tongji Medical College, Huazhong University of Science and Technology and the 252 Hospital of Chinese PLA.MATERIALS: The experiment was completed in the 252 hospital of Chinese PLA. Totally 14 healthy SD rats were involved.METHODS: A rat right hindlimb ischemic model was utilized, 14 SD rats were randomly divided into control group and experimental group. Control group: sustained ischemia for 4 hours and reperfusion of 1 hour. Experimental group: ischemia for 5 minutes and reperfusion for 5 minutes, after 3 cycles, ischemia for 4 hours and reperfusion for 1 hour continuously of IPC.The isometric twitch contractile force of the right gastrocnemius muscle was measured as a parameter indicating the muscle functional status during is chemia reperfusion. The changes of creatine kinase (CK), malondialdehyde (MDA) in blood sample and the uptake of 99Tcm-methylene diphosphonate (99TcmMDP) in skeletal muscle were measured after 1 hour of reperfusion.MAIN OUTCOME MEASURES: The impacts of IPC on contractile force of gastroenemius and serous CK, MDA and the uptake of 99TcmMDP.RESULTS: The muscle contractile force in the experimental group after four hours of ischemia was (14.32 ± 5.05) g or (25.71 ± 7.58) g after one-hour reperfusion, which was significantly higher than 0 g or (4. 73 ± 2.05) g of control group(P ＜0. 05). The serous levelsofCK [(104.85 ±9. 84) nkat/L], MDA [ (3 988.60 ± 455.92) nmol/L] and the uptake of 99TcmMDP [ (56.0± 8.1 ) mBq/g per minute] were significantly lower in the experimental group than control group [CK(136.36 ± 14.50) nkat/L, MDA (6 542.90±536.72)nmol/L, and 99TcmMDP (97.3 ±5.8) mBq/g per minute, P＜0.05, P ＜0.01].CONCLUSION: IPC can effectively ameliorate the contractile force of skeletal muscle and reduce the necrotic degree of skeletal muscle. Therefore, IPC has a protective effect on the contractile force of ischemic skeletal muscle.

Repair of bone defect with implantation of complex of marrow stromal stem cell and calcium phosphates artificial bone / 中国组织工程研究

BACKGROUND: Bone defect is commonly treated in clinic with auto graft, allograft and artificial bone graft, but with the disadvantages to various extents. Therefore, how to better repair bone tissue in bone defect becomes the hot spot in surgical field.OBJECTIVE: The complex of marrow stromal stem cell (MSC) and calcium-phosphates artificial bone (CPAB) was prepared and the repair of bone defect was observed in animal experiment.DESIGN: Randomized controlled experiment was designed.SETTING: Department of Traumatic Surgery, Affiliated Hospital of Qingdao University Medical College.MATERIALS: The experiment was performed in Animal Experimental Center of Affiliated Hospital of Qingdao University Medical College from May 2002 to September 2003, in which, 24 New Zealand health normal big white adult rabbits were employed, aged varied from 6 to 14 months, mass weighted from 9 to 3.5 kg, of either sex.METHODS: (① Rabbit MSCs were differentiated and proliferated and CPAB was taken as carrier to prepare the complex of CPAB and MSCs. ②24 rabbits (48 laterals) were prepared as model of bone defect, divided into 3 groups, named complex group (24 laterals), in which, unilateral bone defect of 24 rabbits were implanted with cell + carrier complex; The rtificial bone group (12 laterals), in which, CPAB was implanted contralaterally;and blank control (12 laterals), in which, no any management was done contralaterally in bone defect of 12 rabbits. In 8, 16 and 24 weeks after surgery, 4 animals were collected at each time spot in each group for radionuclide monitoring; and the animals were sacrificed under anesthesia for X-ray picturing and histological staining analysis.MAIN OUTCOME MEASURES: ① Gross observation of bone defect in each group. ② Results of X-ray examination. ③ Results of histomorphologic observation. ④ Results of radionuclide monitoring.RESULTS: 24 rabbits all entered result analysis. ① Gross observation of bone defect in each group and results of X-ray examination: In complex group of 24 hours, the fractutred ends were connected partially, the bounder was not clear between the regenerated bone and material and reopened medullary cavity was not visible. In simple artificial bone group, the implanted material was integrated with the cross end and material volume did not change obviously compared with the initial implanting stage. In bland control, ununion fracture presented and medullary cavity was closed. ②Results of histomorphological observation: In 24 hours, the bone defect was smaller in size and the union happened on the defect area in complex group. In artificial bone group, the regenerated bone was integrated tightly with the material and grew inside partially. In blank control group,medullary cavity was closed and bones were not connected. ③ Results of radionuclide monitoring: It was remarkably distinguished with naked eye that radioactive concentration was in tendency of obvious increasing in both complex group and artificial bone group in 8-24 weeks.CONCLUSION: The complex of CPAB and MSCs regenerates bone tissue and repair radial defect in whole. In addition, the repair ability is superior remarkably to simple CPAB.