Radiography evaluation of enhanced vascularization of COMP-Ang-1 on acellular nerve / 中华显微外科杂志

Objective To observe the way of vascularization of acellular nerves and evaluate the enhanced vascularization of using COMP-Ang-1 into acellular nerve on bridging sciatic nerve gaps by radiography.Methods From March,2013 to June,2014,acellular nerves were harvested by chemical extraction.Thirty-six female rats weighing 200-250 g were randomly divided into 2 groups:18 animals with 1 cm long sciatic nerve lesions were repaired by nerve grafting (control group),18 animals with 1 cm long sciatic nerve lesions were repaired by nerve grafting and COMP-Ang-1 were administrated after surgery.Grafts were harvested after perfusion of lead oxide (carotid artery) on day 7,day 14 and day 21 postoperatively.Radiography was performed to capture the two dimensional image.The rules of vascularization of acellular nerve and the enhanced effects of COMP-Ang-1 on vascularization were evaluated.Results The density of vessels in COMP-Ang-1 group were higher than control group after 7 days (2701.60 ± 318.93 vs.925.40 ± 106.22,P =0.030),14 days (3309.21 ± 381.31 vs.2832.70 ± 189.23,P =0.210) and 21 days (4787.33 ± 251.09 vs.3469.36 ± 232.10,P =0.030) postoperatively; the area of vessels in COMP-Ang-1 group were higher than control group after 7 days (9231.03 ± 581.91 μm2 vs.4839.01 ± 101.01 μm2,P =0.043) and 14 days (15561.13 ± 697.73 vs.6811.07 ± 250.05,P =0.049) postoperatively.Conclusion COMP-Ang-1 can enhance the vascularization of acellular nerves fairly.

Effect of Schwann cell-derived neurotrophic factor on the biological characteristics of skeletal satellite cells in rats / 中华显微外科杂志

Objective To study the effects of Schwann cell-derived neurotrophic factor(SDNF) on myoblast stem cells(called satellite cells,SCs) in vitro. Methods After setting up SCs culture system in vitro, SCs which treated with various SDNF concentrations culture medium were dynamically evaluated by cell morphology,MTT growth curve and fusion rate. Results The ability of SCs preceding their participation in muscle repair include proliferation and differentiation, 200 ng/ml SDNF stimulated cell proliferation more than the other medium,but 50 ng/ml,100 ng/ml,200 ng/ml,400 ng/ml SDNF made SCs differentiation significantly for their high myotube fusion rate. Conclusion SDNF can regulate the proliferation and differentiation of rat skeletal satellite cellsin vitro,but in differentiation significantly.SDNF might play a role in slowing down denervated muscle atrophy.

The value of MRI in the diagnosis of brachial plexus birth palsy / 中华显微外科杂志

ObjectiveTo evaluate the value of MR imaging(MRI)in diagosing of obstetrical brachial plexus.MethodsBetween September 2006 to September 2011,eighteen cases (12 males and 6 females)of obstetrical brachial plexus injury had being used for investigation,aging from 2 month to 3 years, average of 10.6 month. Eight left side and 10 right side. Tassin Ⅰ was 4 cases,Tassin Ⅱ was 6 eases, Tassin Ⅲwas 5 eases, Tassin Ⅳ was 4 cases. All cases were performed to MRI test before operating and the result compare with finding during operating. ResultsFindings of MRI:pseudomeningocele was in 13 of the 18cases while 10 of the 15 patients had multiple pseudomeningoceles. Displacement of spinal cord was in 6 cases; Normal was 2 cases; thickening of nerve root was in 2 cases.ConclusionMR imaging is an effective tool for demonstrating lesions of the brachial plexus worthy of surgical exploration.

Scientific assessment on the outcome of clinical application with peripheral nerve graft materials / 中华显微外科杂志

Objective To discuss how to assess scientifically on the outcome of clinical application with peripheral nerve graft materials. Methods All Pubmed database from 1990 to 2010 were retrieved,and searched the English literatures about the application with peripheral nerve graft materials. The literatures consisted of original clinical research and review excluding animal experiments, repetitive research and irrelevant literatures. The clinical trials data of U.S. was also our target. The information about the safety and effectiveness of peripheral nerve graft materials and related statistical problems were discussed. Results Totally 1578 literatures were identified. Following reading titles and abstracts, we excluded some irrelevant articles. Finally 31 literatures and 2 issue of clinical research from clinical trial data of U.S. were included. After analysis on the literatures, we gained the following results: a remarkable degree of homogeneity among patients can be formed by setting the inclusion and exclusion criteria. For the assessment of proper digital nerve repair, Macknnon- Dellon evaluation is commonly applied, but for the composite nerve, BMRC evaluation is the main method and electromyography can be used as a secondary choice. The safety of peripheral nerve graft materials cannot be evaluated throughout one's life according to the current level of science and technology. It should be evaluated by long-term clinical observation. Randomized clinical trials with random grouping was a gold standard for clinical trials with a good balance and strong comparability. However, non-randomized controlled trials also have an important value. Conclusion It is impossible to make all affected factors homogeneity in a limited timespace conditions of clinical trial. However, we can try our best to keep factors homogeneity to maximum degree by setting the inclusion and exclusion criteria. The scientific assessment of outcome of peripheral nerve repair can be carried out with reasonable and internationally recognized nerve function evaluation methods, strict follow-up time and statistics programme meeting the clinical requirement.

Preliminary research on the clinical classification of the brachial plexus root injury in adult / 中华显微外科杂志

Objective To explore the clinical classification of the brachial plexus root injury in adult.MethodsAll 155 cases of adult brachial plexus root injury in the First Affiliated Hospital of Sun Yat-sen University,were collected and analyzed on their characteristic,operative methods,and clinical outcome so as to find the distribution and incidence of different type of brachial plexus root injury and set up the clinical classification of adult brachial plexus root injury.ResultsBrachial plexus root injuries in adult could be classified into three types and seven subtypes.Type A is upper brachial plexus root injury,including type AⅠ (C5,C6 completely avulsion or rupture injury,with/without phrenic nerve injury),type AⅡ (C5-C7 completely injury),and type AⅢ (C5-C7 completely injury accompanied with C8,T1 incompletely injury).Type B is lower brachial plexus root injury,including type BⅠ[ C8,T1 (with/without C7)completely injury ] and type BⅡ (C8,T1,C7 completely injury,accompanied with C5、6 incompletely injury).Type C is total brachial plexus root injury,including type CⅠ(C5-T1 completely root avulsion) and type CⅡ(C7-T1 root avulsion accompanied with C5、6 root or trunkrupture).For the cases of every type,u pper brachial plexus root injury type A have 86 cases,in which type AⅠ 6 cases,type AⅡ 27 cases and type AⅢ 53 cases; lower brachial plexus root injury type B have 6 cases,in which type BⅠ 2 cases and type BⅡ 4 cases; total brachial plexus root injury type C have 63 cases,in which type CⅠ 51 cases and type CⅡ 12 cases. ConclusionExcept the upper,lower,and total three types,brachial plexus root injuries in adult could be classified further into seven subtypes.The distribution of different type of adult brachial plexus root injury is overbalance:upper type A (55.5％) is more often seen,total type C(40.6％) followed and lower type B(3.9％) is the least seen.In upper brachial plexus root injury,type AⅢ(61.6％) is more often seen,type AⅡ(31.4％) followed and type AⅠ(7％) is less seen.

Applied microanatomical study of availible length of C7 nerve / 中华显微外科杂志

Objective To relatively prolong the length of C7 nerve through microanatomical study and carry out direct anastomosis between the end of avulsed nerve and contralateral C7. Methods Fifteen cadaveric specimens and 30 sides of the adult brachial plexus was dissected. The C7 nerve was confirmed and measured by using electric vernier caliper. Parameters as follow: the length of C7 nerve from root to trunk; the length of C7 nerve from root to division(anterior and posterior division); transverse and longitudinal diameter of C7 nerve in root site, combination site between trunk and division, end site of anterior and posterior division. After dissected the nerve adventitia of binding site between division and cord and cut the distal end of anterior and posterior division, the length of C7 nerve from root to division (anterior and posterior division)was measured again. Results The measured result of the length C7 nerve: the length of C7 from root to trunk: (45.87 ± 10.43)mm; Before micro-dissected, the length of C7 from root to anterior division: (61.14 ±13.44)mm; the length of C7 from root to posterior division: (54.63 ± 11.35)mm after micro-dissected, the length of C7 from root to anterior division: (74.67±12.86)mm; the length of C7 from root to posterior division:(68.73± 11.86)mm; the prolonged length of anterior division: (13.15± 4.26)mm; the prolonged length of posterior division: (14.21 ± 6.98)mm. Conclusion Through dessecting the adventitia of binding site of division (anterior and posterior division) and cord of C7 nerve. The length of C7 nerve can be relatively prolonged.

Investigation and analysis of the quality of life on brachial plexus injury patients / 中华显微外科杂志

Objective To investigate the quality of life on brachial plexus injury patients in crosssectional study method and acquire related data. To analysis the effect factors and try to study on the methods which help to improve the quality of life of these patients. To our knowledge, this is the first study that measures quality of life of the brachial plexus injury patients in China. Methods Research participants completed the Chinese version of the World Health Organization Quality of Life Assessment-Bref (WHOQOL-BREF) and the 5-items version of International Index of Erectile Dysfunction Questionnaire (IIEF-5) for male.Data were typed into computer and analyzed with SPSS version 13.0. Correlations between domain scores and hospital stay, age, and family monthly income variables were analyzed with Spearman non-parameter correlation analysis. Results Fifty-one valid questionnaires were retrieved. The average score of these patients in physical, psychological, environment domains were 11.47 ± 2.36, 12.37 ± 2.28 and 11.62 ± 2.22, respectively. They were significantly lower than the norm groups in national studies which were 15.8 ± 2.9, 14.3 ±2.5 and 13.2 ± 2.4 (P ＜ 0.01 ). The average score of IIEF-5 was ( 17.83 ± 4.65), significantly lower than the normal score of 22 (P ＜ 0.01 ). Significant correlation was found among physical domain and age(P ＜ 0.05),family monthly income (P ＜ 0.05) and IIEF-5 score(P ＜ 0.01). Psychological domain also has significant correlation with IIEF-5 score (P ＜ 0.05) and so does environment domain with family monthly income (P ＜0.05). Conclusion Brachial plexus injury patients showed a reduction in quality of life scores. Even though the physical aspect was the most affected, there is evidence that the psychological, environmental domains and erectile function remained far from the ideal conditions expected for the general population. The effect factors are complex and there still remain much work to do.

A preliminary clinical report on bridging digital nerve defect with human acellular nerve graft / 中华显微外科杂志

Objective To evaluate the safety and efficacy of the human acellular nerve allograft (hANG)for nerve repair in the clinical setting,and report the early outcomes of bridging digital nerve defect with the hANG. Methods Four patients with 5 digital nerve injuries were included in this pilot study.The nerves defect ranged from 10-20 mm and were bridged with the hANG(manufactured by Zhongda Medical Equipment Co.,Ltd,Guangzhou,China).Four digital nerve acute injuries in 3 patients were repaired with hANG primarily,while the nerve in another patient was reconstructed secondarily.The procedure was performed under a 10-manifying operating microscope.The nerve stumps were debrided until the normal fascicles could be seen.hANG was inserted between the proximal and distal stumps and end-to-end neurorrhaphy was performed with 9-0 sutures.Postoperative cares included dressing change and administration of antibiotics.No immunosuppressants had been used.The follow-up time ranged from 1 to 3 months.The wound and blood sample were examined for the safety of hANG.The nerve function Wag evaluated according to the scoring system proposed by the Nerve Injuries Committee of the British Medical Research Council. Results All wounds healed primarily.The adverse effects,such as rejection,allergy,infection,and toxicity to the liver and kidney were absent.The results of blood biochemistry test were within the normal range.The injured nerve achieved good functional recovery.In 2 cages,the 2 point discrimination(2PD)was 8mm(S3~+,excellent). Conclusion Based on the short term follow-up,using hANG to repair digital nerve defect as long as 20mm was safe,and the nerve functional recovery is pretty good.

Treatment of total root avulsion of brachial plexus by contralateral C_7 nerve transfer for directly repairing C_8T_1 via prespinal route combined with functioning gracilis transplantation / 中华显微外科杂志

Objective To explore the clinical design and therapeutic effect of total root avulsion of brachial plexus by contralateral C_7 nerve transfer for directly repairing C_8T_1 via prespinal route combined with functioning gracilis transplantation. Methods Twelve cases of total roots avulsion of brachial plexus were operated at 1 month to 3 months after injury.The contralateral C_7 nerve was successfully transferred to directly repair avulsed C_8T_1 roots or lower trunk via prespinal route.At 2nd operation stage after 4 to 8 months,the functioning gracills transplantation was preformed to reconstruct the elbow flexion and fingers extension. Results Follow-ups were carried out in all 12 cases who had been discharged for 9 to 36 months after the first operation.The positive Tinel signs of ulnar or median nerves were located in the proximal arm at 3 months after 1st operation,in the elbow or proximal forarm at 6 months,and in the wrist or distal forarm at 9 months.At 12 months the positive Tinel signs were found in the plam or fingers in 9 cases.The contraction of sternocostal part of pectoralis major was found at 9 mooths in 7 cases.There were the restoration of the taction-pain sensation in the palm, finger, and medial side of forearm and the contraction of flexor carpi ulnaris and flexor digitorum(M_3)in 5 cases at 15 to 18 months after 1st operation.In 7 patients the flexion of elbow and extension of fingers and thumb restored at 9 to 12 months after the 2nd operation.Their elbow flexion was 90°-120°and M_3(Highet's method),and their finger and thumb extension M_3. Conclusion There is the possibility of the operative design and clinical application of total root avulsion of brachial plexus by contralateral C_7 nerve transfer for directly repairing C_8T_1 via prespinal route combined with functioning gracilis transplantation.There are not only the restoration of sensation and flexion of wrist and fingers,but also the restoration of elbow flexion and fingers extension.

Analytical study of human allogenic acellular peripheral nerve in standard preparation methods / 中华显微外科杂志

@#Objective To analyze five kinds of allogenic acellular peripheral nerve by different meth-ods and try to establish a standard method for preparing nerve materials. Methods Five kinds of nerve ma-terial prepared by different chemical extractions according to nowaday articles were examined by HE staining. Irmnunohistochemistry and protein ratio was studied by allogenic nerves by virtue of Kjeldahl method in order to know the efficiency of these methods in removal of SCs axons and integrality of the basilar membrane. Results Myelin sheath and cytoblast in group 2 that nerves were extracted by Triton X-100 and Sodium de-oxycholate consecutively twice were completely removed, which was well demonstrated in HE staining. Per-ineurium in red staining were arranged wave-like longitudinally, axons and myelin sheath were replaced by column-like spacing. Col I staining were positive in all groups, structure of basilar membrane became loose slightly in the first and second group, and the structure of the other groups were relatively regular. Group 1 and 2 were negative in S-100 staining. There was no difference between group 2 and group 1,3,4 and 5 in sheath removal demonstrated by TEM. Protein ratio in group 2 was the lowest in the measurement with Kjel-dahl method. Conclusion The method used in group 2 that nerves were extracted by Triton X-100 and Sodium deoxycholate consecutively twice was the best in allogenic acellular peripheral nerve preparations.

Study on repair of sciatic nerve lesions using acellular nerves implanted with adipose tissue-derived stromal cells / 中华显微外科杂志

Objective To evaluate the effectiveness of using adipose-derived stromal cells (ADSCs)into a tissue-engineered peripheral nerve on bridging sciatic nerve gaps.Methods Forty-eight F344 female rats weighing 200 - 220 g were randomly divided into 6 groups of nerve grafting to repair 15 mm long asiatic nerve lesions,with 8 mrs in each group.Group A:ADSCs-laden acellular nerves;group B:differentiated ADSCs-laden acellular nerves;group C:Schwann cells-laden acellular nerves;group D:acellular nerves without cells;group E:autografts;group F:nonimplanted grafts.The effects were evaluated in terms of electrophysiulogy,Fluorogold retrograde tracing,histology and tracking studies.Results At 12 weeks after surgery,there was no graft bridging nerve gap in nonimplanted grafts.All the examinations of group A and B were better than group D,respectively (P＜0.05 or P＜0.01).But there were no statistically significant differences among group A,B,C,and D (P＞0.05).Conclusion ADSCs and differentiated ADSCs could promote nerve regeneration when used as seed cells to build tissue-engineered peripheral nerves with acellular nerve scaffolds.

Animal experimental study of fracture fixation with PDLLA mixed with chitosan / 中国矫形外科杂志

[Objective]To explore the effect of fracture healing with intramedullary nail of poly-DL-lactic acid(PDLLA) mixed with chitosan and basic fibroblast growth factor(b-FGF),and provides the basis for clinical application.[Method]Middle tibia fracture model of 120 healthy adult rabbits of New Zealand were established and randomly divided into 6 groups as follows:experimental(A):30 rabbits with PDLLA+CHS+ b-FGF;control:5 groups(18 animals for each group):control(B) with PDLLA+CHS,control(C) with PDLLA,control(D) with PDLLA+b-FGF,control(E) with Kirschner's wire,and control(F) with Kirschner's wire+b-FGF.Radiological and histological follow-up was performed in 4,8,12 weeks postoperatively.[Result]All animals were survival.There was no significant difference(P

Protective effect of Schwann cell-derived neurotrophic factor on sensory neurons in spinal dorsal root ganglia / 中国组织工程研究

BACKGROUND: Schwann cell-derived neurotrophic factor is a bioactive protein isolated and purified from the kytoplasm of Schwann cell. It can obviously maintain the survival of spinal cord anterior horn motor neuron and promote the regeneration of peripheral nerve.OBJECTIVE: To observe the protective effect of Schwann cell-derived neurotrophic factor on the high injury of peripheral nerve-induced apoptosis of sensory neurons in spinal dorsal root ganglia.DESIGN: Randomized and controlled animal experiment.SETTING: Shenzhen Second People's Hospital.MATERIALS: Totally 30 3-week-old SD infant rats, of clean grade and either gender, were used in this experiment. They were randomly divided into neurotrophic factor group and control group with 15 rats in each one.Left sides of the animals in both two groups were set as normal sides and right sides as injured sides.METHODS: This experiment was carried out at the Experimental Animal Center, Medical College of Sun Yat-sen University from May 2003 to July 2003. ① L4.5 nerve root high-mutilation animal models were developed on the rats in two groups. Proximal nerve stump was connected with silicone tube. According to grouping, 60 mg/L Schwann cell-derived neurotrophic factors and 20 μL normal saline were injected into the silicone tubes respectively. Two ends of silicone tube were enveloped with vaseline.② Sample collecting was conducted at postoperative 4 weeks, survival rate and morphological change of sensory neurons in dorsal root ganglia of injured nerve was observed.MAIN OUTCOME MEASURES: ① Gross observation of sciatic nerve regeneration at injured side of the rats in two groups ② Survival of sensory neurons in dorsal root ganglia ③ Morphological change of sensory neurons in dorsal root ganglia.RESULTS: All the 30 rats entered the stage of result analysis. ① Gross observation of sciatic nerve regeneration: In the neurotrophic factor group,nerve new born axon grew along silicone tube, with 1cm in length; there were few and thin newborn axons in control group with 0.8 cm in length.② Survival of neuron in dorsal root ganglia of the rats in two groups: There was little fibrous tissue proliferation in the dorsal root ganglion in neurotrophic factor group. The loss of neurons was not obvious and the survival rate was 91.8%. Obvious fibrous tissue proliferation appeared in the dorsal root ganglia in control group, and a great many neurons were lost with the survival rate of 58.6%. Survival rate of neurons was 33.2% higher in neurotrophic factor group than in control group (P ＜ 0.01 ). ③ Morphological change of neurons in dorsal root ganglia: The diameter and area of neurons in dorsal root ganglia were significantly lower in control group than in neu rotrophic factor group and normal side [(21.8±1.4) μm,(373.1±50.9) μm2 vs (24.8±1.1) μm, (482.8±42.2) μm2 and (24.5±1.3) μm, (471.5±51.4) μm2,P ＜ 0.01], while there were no significant difference in diameter and area of neurons between neurotrophic factor group and normal side(P ＞ 0.05).CONCLUSION: Schwann cell-derived neurotrophic factors have obvious neurotrophic bioactivity for sensory neurons in the injured dorsal root ganglia.

Protection of motoneurons from spinal root avulsion induced cell death by Schwann cell derived neurotrophic factor / 中国组织工程研究

BACKGROUND: Schwann cell derived neurotrophic factor, which is isolated and purified from the kytoplasm of Schwann cell with the relative molecular mass of 58000, is a kind of neurotrophic substance possessing obvious neurotrophic activity. It can be against neurovirulent substance of nitrogen monoxidum.OBJECTIVE:To create root avulsion animal models and observe the protective effects of Schwann cell derived neurotrophic factor (SDNF) on motoneurons of spinal anterior horn from spinal root avulsion induced cell death.DESIGN: Repeated observation and measure.SETTING: Third Department of Orthopaedics, Second People's Hospital of Shenzhen; Department of Micro-surgery , First Hospital Affiliated to Sun Yat-sen University.MATERIALS: This experiment was conducted at the Experimental Animal Center of Medical College of Sun Yat-sen University from March to May 2003. Twenty Sprague-Dawley rats with the age of 3-4 months, of clean degree, were selected and divided randomly into experimental group of Schwann cell derived neurotrophic factor and control group of normal saline with 10 rats in each group. The right side was injured, and the left side was intact served as normal control side.METHODS : ①A rat model of C6,7 spinal root avulsion induced motoneuron degeneration was established. ② A small piece of gelfoam presoaked in 40 μL SDNF solutions (1 g/L) was placed in contact with the injured spinal cord in the animals of the experimental group. Normal saline was added as the same way as above in the animals of the control group. ③ A silica pipe was put on the surface of gleform, one end of the silica was sutured to the glefoam , and the other end wasfixed subcutaneously with vaselinum. Local intramuscular injection of penicillinum was performed on the wound following closing the incision. All rats received an injection (20 μL) of either SDNF or normal saline solution at the lesion site through the silica pipe sutured to the glefoam once a week after the surgery. All the animals were killed by the end of the third weeks. ④The spinal region of C6,7 level was dissected out for observing survival rate and morphological change of motoneurons of spinal anterior horn as well as the expression of nitricoxide synthase(NOS).MAIN OUTCOME MEASURES: ① Survival and morphological change of spinal motor neurons. ②Change of nitricoxide synthase expression of spinal motor neurons.RESULTS: Totally 20 rats were enrolled in the experiment, and all of them entered the stage of result analysis. ① Survival and morphological changeof spinal motor neurons: 68.6% motoneurons of injured side of the control group died at 3 weeks after surgery. The survival rate was 31.4%,which was significantly lower than that of the intact side (P ＜ 0.01), and the survived neurons was shrinked significantly; the death rate of spinal motor neurons of injured side of experimental group was decreased by 35%as compared with control group (P＞ 0.05). The survival rate was 66.4%,and the survived neuron body was increased, similar to the intact side (P ＞ 0.05). ② Change of nitricoxide synthase expression of spinal motor neurons: In normal spinal cord, NOS positive neurons were shown in dorsal horn, surrounding the central canal and in the intermediolateral column.NOS was not seen in the anterior horn motonurons. At the end of the third week after C6,7 spinal root avulsion, increased NOS expression was not found at the injured side in the Schwann cell derived neurotrophic factor group and the intact side in the control side, while the significantly increased NOS expression of spinal motoneurons was found at the injured side of the control group.CONCLUSION: Degeneration of spinal motoneuron and increased expression of NOS can be induced by spinal root avulsion. SDNF has a significant effect in protecting spinal motoneurons from spinal root avulsion induced cell death and inhibiting the expression of NOS. These results suggest that the effects .of SDNF on motoneuron survival may be achieved by modifying the expression of certain cellular molecule such as NOS.

Experimental study of suture of core long-distance buried for repair of flexor tendon rupture / 中国康复理论与实践

@# ObjectiveTo adopt a new suture technique the core long-distance buried for repair of flexor tendon rupture which was designed by author and could lessen adhesion.Methods60 human cadaver flexor digitorum tendons were divided into 3 groups and sewed by core long-distance buried suture, Kessler's technique and Bunnell's technique respectively. Instron-testing machine was used to test gap formation force, 2 mm gap formation force and maximum load. 30 hen second and third toe flexor profundus tendons were divided into 2 groups, each group of tendons were transected and repaired by core long-distance buired suture and Kessler's technique respectively. Information of tendon healing and tendon adhesion was observed in the 3rd, 4th and 6th weeks after operation.ResultsIn the group of using core long-distance buried suture technique, the gap formation, 2 mm gap formation and maximum load in were higher than that using Kessler's technique and Bunnell's technique, the effects of lessening adhesion and promoting tendon healing were better than that in the Kessler's technique group.ConclusionCore long-distance buried suture can offer great tensile strength needed by clinic, and allow early motion and lessen adhesion after operation.

Some advances in management of peripheral nerve injury / 中华创伤骨科杂志

The reports on the peripheral nerve injury in the internati onal journals in 2003 included the anatomical study on surface landmarks to loca te the thenar branch of the median nerve (Wilhelmi etc.) and management of iatro genic injury to the spinal accessory nerve (Chandawarkar etc.). Gu, Kim, and Tun g, etc. reported the nerve transfers, which were effective in repairing the uppe r brachial plexus injury. The partial bundles transfer of ulnar nerve (Oberlin s method) was one of the nerve transfer operations. The functions of both biceps and brachial muscles were reported to be repaired simultaneously for elbow flex ion reconstruction in the management of brachial plexus injury. Bertellis, etc. reported that the brachial plexus avulsion injury was repaired with nerve transf ers and nerve grafts which were directly implanted into the spinal cord and part ial recovery of shoulder and elbow movements were achieved. The incidence rate o f birth-related brachial plexus injury was 0.06% to 0.26%. 85% to 90% of the patients could spontaneously restore their function (Richter etc.), but a f ew patients who could not should be evaluated 6 months after the birth to decide whether they needed microsurgical nerve repair or not. The suitable time for op eration was reported to be 6 months to 9 months after birth. The patients must b e examined thoroughly and their follow-up information must be recorded, and the y could accept the hyperbaric oxygen therapy.

Study in vitro of populating autogenous Schwann cells into chemical extracted allogenous nerve / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To look for an ideal substance to repair large gap of nerve defect after injury by culture of Schwann cells (Scs) and preparation of acellular allogenous nerve grafts (ANG) with chemical extraction.</p><p><b>METHODS</b>The double adhesion culture and Arab-c to prohibit the fibroblast growth were used to achieve high-purified Scs. Triton-x-100 and sodium deoxycholate were used to achieve ANG. Finally the Scs were microinjected into the acellural nerve grafts and cultured in vitro. The consequence was analysed.</p><p><b>RESULTS</b>High purified Scs and ANG were acquired, which could integrate each other well. Scs could survive and transfer to aline in vitro.</p><p><b>CONCLUSIONS</b>Populating Scs into chemical extracted ANG may be an ideal substance to repair the large gap of nerve defect after injury.</p>

Expression of Schwann cell derived n euro trophic factor after injuried of sciatic nerve of rats / 中华显微外科杂志

Objective To investig ate the expression of Schwann cell derived fa ctor （SDNF） in normal or under the condi tion of different injuries on the sciati c nerves of rats. Methods Sevent y-five S D rats were divided into three groups ac cording to different injuri es including transection， transection fo llowed by epineurial suture， and crush. Ten normal rats were treated as control. T he immunohistochemistry of both sciatic nerve and spinal cord were performed at 5，7，14，30，60 days after operation respec tively. Result （1）lower levels o f SDNF were detected in normal sciatic nerve， t he whole white matter and the laminae Ⅲ～ Ⅴ of dorsal horn of spinal cord. （2）In g roup transection， the SDNF levels reache d a maxium at 14 days after operation in proxi mal segment， at 7 days in distal segment ， and at 5 days in spinal cord. There ap peared a highest expression in related t issue of both group crushing and group s uturing at 60 days after operation. （3）SD N F staining of dorsal horn ipsilateral to the nerve lesion was stronger than that of contralateral. There was a transient expression in spinal motor neurons ipsi lateral to nerve lesion at 5 days in gro up crushing and group transection and at 30 days in group suturing. Conclusi on （1）There is a weaker expression i n norma l sciatic nerve and spinal cord. （2）The expression of SDNF varies with the diffe rent nerve lesions. （3）Significant quant ities of SDNF are released from Schwann cells after nerve lesion， and SDNF is then available to the axon of the lesioned neurons which may promote neuro n repair.

Experimental study on inducing bone marrow stromal cells into Schwann-liked cells in vitro by modified method / 中华显微外科杂志

Objective To search for a more efficient method to induce bone marrow stromal cells (BMSCs) into Schwann-liked cells (SLCs) in vitro. Methods On the base of the method which was used by Dezawa (it was looked as the traditional inducing method),some steps were modified,namely,to use all the reagents in half dose in the same time and two times intervally,this method was looked as the modified inducing method.After induced by the two methods,the cells morphologic characteristic,the positive ratio of immunocytochemical dye with anti-S-100 and anti-GFAP,the cells activity measured by MTT method and the DNA percentage in S period measured by flow cytometry were compared with each other respectively to evaluate the methods'effects. Results Compared with the traditional method,the cells induced by the modified method were more similar to the primary Schwann cells in morphology,more positive proportion in immunocytochemic dye with anti-S-100 and anti-GFAP,less damage in the activity and more percentage in S period. Conclusion The modified method had more advantages such as less damage on cells and more efficiency in inducing BMSCs into SLCs.