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Objective:To retrospectively analyse the clinical effect of sensation reconstructed free medial plantar artery perforator flap in repair of digit-tip defects.Methods:From March 2017 to February 2021, 11 cases with digit-tip defect were repaired by medial plantar artery perforator flap in the Department of Hand Surgery of Xuzhou Renci Hospital. The cutaneous sensory nerves were separated when the flap was harvested, and then the sensory nerves were sutured to the palmar nerves of the digits to reconstruct the sensation of the flap. All wounds had exposure of phalangeal bones, the size of the digit-tip defects was 1.2 cm×1.0 cm-2.5 cm×2.2 cm, the size of the flaps was 1.6 cm×1.5 cm-3.0 cm×2.7 cm. Ten donor sites were directly sutured and 1 was repaired by skin grafting. All patients were included in the postoperative follow-up through outpatient clinic and WeChat reviews to collect relevant information, including texture, sweating, stability, sensation, degree of bloating, blood circulation, usage of the flaps and skin and scars at the donor sites.Results:All flaps survived besides 1 case had venous occlusion occurred 12 hours after the operation, and the venous occlusion was relieved by releasing the dressing and removing some of sutures, and the flap survived smoothly. The wounds in the donor sites healed well. The postoperative follow-up period lasted for 6-18 months, with an average of 10.7 months. The flaps were soft, wear-resistant, and stable. The skin texture was restored with a small amount or normal sweating. One flap had mild bloated, and another flap showed a slightly poor colour of the flap together with a lower temperature. The sensory recovery of the flaps was good, reaching S 3+ or above. The TPD had achieved 6.0-8.5 mm, with an average of 7.1 mm. One patient had concerns in using the affected digit and 3 cases were in protective use of the affected digits. There was no wear and ulcer in the foot donor sites. According to Wang Shuhuan's assessment of flap function and Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, the patients in this group were scored excellent in 8 cases and good in 3 cases. Conclusion:The application of free medial plantar artery perforator flap in repair of digit-tip wounds can achieve good repairs. The donor site is hidden without effect on walking. It is one of the ideal donor sites for repairing digit-tip wounds.
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Objective To investigate the efficacy and feasibility of combination of leflunomide and clopi-dogrel in the treatment of IgA nephropathy. Methods 84 patients with primary IgA nephropathy were randomly divided into four groups: Control group (group 1) received valsartan; test group (group 2) received valsartan +clopidogrel; group 3 received valsartan + leflunomide; group 4 received valsartan + clopidogrel + leflunomide. The level of 24 h urinary protein,serum creatinine, glomerular filtration rate and therapeutic efficacy, adverse reactions were detected and recorded during the 48 weeks follow-up. Results The 24 h urinary protein of 84 patients showed a downward trend during the course of treatment , but there were statistical differences between groups since 8 weeks after treatment (P < 0.05). The level of urine protein in group 3 and group 4 decreased significantly to 61.48% and 67.23% respectively in 48 weeks after treatment. At the end of the follow up , the serum creatinine levels in group 1 and group 2 significantly increased while the glomerular filtration rate de-creased obviously (P < 0.05). Conclusion The combination of leflunomide with clopidogrel could reduce the level of urinary proteins and slow renal function deterioration in the treatment of IgA nephropathy with less ad-verse reactions. This study provides a new idea for treatment of IgA nephropathy.
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Objective To investigate the relationship between serum pregnancy associated plasma protein A (PAAA‐A) ex‐pression and gene polymorphism with the severity of coronary lesions in the patients with coronary heart disease (CHD) .Methods Ninety‐eight patients with CHD in the Nanyang Municipal Central Hospital were selected as the observation group and divided into single vessel lesion group and multiple vessel lesion group according to coronary angiographic results .Ninety‐eight individuals un‐dergoing healthy physical examination were selected as the control group .The venous blood was collected at the visiting hospital in the observation group and at the physical examination in the control group for detecting the serum PAPP‐A protein level by ELISA .PAPP‐A gene and IVS6+ 95 polymorphism were analyzed by adopting polymerase chain reaction restriction fragment length polymorphism(PCR‐RELP) .Results Compared with the control group ,peripheral blood PAPP‐A protein level in the obser‐vation group was significantly increased(P<0 .05) ,moreover the PAPP‐A protein level in the multiple vessel lesion group was sig‐nificantly higher than that of the single vessel lesion group (P<0 .05) .The peripheral blood PAPP‐A level was positively correlated with the severity of CHD .Three genotypes existed in PAPP‐A gene IVS6+95 locus ,including CG heterozygous ,homozygous CC and GG homozygous type .The CC homozygous allele frequency in the patients with multiple vessel lesion was higher than that in the patients with single vessel lesion (P<0 .05) .Conclusion The PAPP‐A protein level and IVS6+95 polymorphism have a close relation with the severity of coronary lesions in patients with CHD .CC genotype may be one of genetic susceptibility gene markers in the patients with CHD .
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Objective To investigate the effect of rosiglitazone on renal interstitial fibrosis in chronic cyclosporine nephropathy (CCN) rats.Methods Twenty-eight rats were randomly assigned to control group,rosiglitazone (RGZ,5 mg·kg-1·d-1) group,cyclosporine A(CsA,15 mg·kg-1·d-1) group,rosiglitazone (5 mg·kg-1·d-1) +CsA group.Real-time PCR and RT-PCR methods were used to investigate the expressions of OPN,RANTES on the 14th day and MMP-9,TIMP-1 on the 35th day in kidney of CCN respectively.Results In comparison with control group,the expressions of OPN,RANTES,MMP-9,TIMP-1 in CsA and RGZ+CsA groups were increased (P＜0.05).In comparison with the CsA group,the expressions of OPN,RANTES,MMP-9,TIMP-1 in CsA+RGZ group significantly decreased (P＜0.05).Conclusion Rosiglitazone may protect renal tissue after CCN by decreasing expressions of OPN,RANTES,MMP-9,TIPM-1.
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Objective To investigate the effects of rosiglitazone on the expression of peroxisome proliferator-activated receptor-γ (PPARγ) and matrix metalloproteinase-9 (MMP-9) in renal interstitial fibroblasts induced by cyclosporine A, and discuss renal protective effect of rosiglitazone on renal toxicity of cyclosporine A. Methods Construction, screening and amplification of the target siRNA vector for PPARγ were carried out.The inhibitory effect of siRNA on the expression of PPARγ in normal rat kidney (NRK) cells was evaluated.NRK cells were cultured in the routine way.Experimental groups: (1)control group:single NRK cells without treatment; (2)RGZ group:NRK cells with RGZ (10 μmol/L); (3)CsA group:NRK cells with CsA (1.0 mg/L); (4)CsA+RGZ group:NRK cells with CsA (1.0 mg/L) plus RGZ (10 μ mol/L); (5)CsA+RGZ+siRNA group:pRNAT-U6.2/Lenti-PPARγ-236 plasmid transfected into NRK cells,then CsA (1.0 mg/L) plus RGZ (10 μmol/L).The mRNA expression of PPARγ was detected by real-time RCR.The mRNA expressions of MMP-9 and TIMP-1 were detected by RT-RCR.The protein expression of FN was detected by Western blotting. Results CsA up-regulated the mRNA level of PPARγ,MMP-9 and TIMP-1 (P＜0.05),and the up-regulation was inhibited by RGZ significantly (P＜0.05).The application of PPARγ siRNA resulted in the decreasing of PPARγ mRNA (P＜0.05),and partly reversed the inhibition effect of RGZ on MMP-9 and TIMP-1 mRNA (all P＜0.05).CsA up-regulated the protein level of FN (P＜0.05),and this effect was significantly inhibited by RGZ (P＜0.05).The application of PPARγ siRNA could reverse the inhibition effect of RGZ on FN protein expression (P＜0.05). Conclusion RGZ can inhibit the expressions of FN,MMP-9 and TIMP-1 induced by CsA which may be the mechanism of the protective effect of RGZ on renal interstitial fibrosis induced by CsA.
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Objective To analyze the disorder status of calcium-phosphorus metablism in maintenance hemodialysis patients. Methods Serum calcium, serum phosphorus, calcium-phosphorus product and PTH were detected in 70 patients with maintenance hemodialysis ,and compared with the indicators of K/DOQI guidelines. Results There were 36 cases over 50 years age and 34 cases less than 50 years age in 70 cases, and there were no significant differences in serum calcium, serum phosphorus, calcium-phosphorus product and PTH between two groups (P ＞0.05). The longer the dialysis, the more obvious changes of serum phosphorus and PTH levels, and there were significant differences(P ＜0.05). In 70 cases ,46 cases(65. 7%) serum calcium,34 cases(48.6%) serum phosphorus ,40 cases(57. 1%) calcium and phosphorus product,28 cases(40%) PTH met the requirement of K/DOQI guidelines,only 18 cases (25.7%) of all indicators reached the K/DOQI requirements. Conclusion The calcium-phosphorus metablism in most hemodialytic patients still cannot reach the K/DOQI guidelines.
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Objective To investigate into the protective effects of rosiglitazone on rat kidney fibroblasts(NRK)damaged by high glucose.Methods From Jan.2005 to Sep.2005,the NRK cells were cultured in vitro,and were divided into five groups:normal glucose group(NG,1 000 mg/L D-glucose),high glucose group(HG,4 500 mg/L D-glucose),HG+RGZ(5 ?mol/L),HG+RGZ(10 ?mol/L)and HG+RGZ(15 ?mol/L).The mRNA expressions of T MMP-1、TIMP-1 and Collagen Ⅲ were measured with RT-PCR.Results Compared with NG group,the mRNA expression of MMP-1 decreased markedly in HG group(P
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Objective To investigate the protective effects of rosiglitazone (RSG) on normal rat kidney cells (NRK) damaged by cyclosporine A(CsA). Methods The NRK cells were cultured with CsA or with CsA plus rosiglitazone. The cellular proliferation was determined by MTT colorimetry. The mRNA expression of TGF-?1 and PPAR? was detected by RT-RCR. Protein levels of PPAR?, p-ERK,FN and AT1R were examined by Western blotting. The level of TGF-?1 in the supernatants was measured by enzyme-linked immunosorbant assay (ELISA). Results CsA inhibited the proliferation of NRK cells in dose and time dependent manner (P