Effect of epalrestat combined with calcium dobesilate on diabetes peripheral neuropathy and oxidative stress / 中华内分泌外科杂志

Objective:To explore the effect of epalrestat combined with calcium dobesilate on cardiovascular and cerebrovascular diseases and oxidative stress in diabetes patients with peripheral neuropathy.Methods:In a retrospective analysis, 92 patients with diabetic peripheral neuropathy were admitted to the Department of Endocrinology and Metabolism Hospital of Bozhou People’s Hospital from Jun. 2018 to Jun. 2021, which were divided into observation group and control group according to the different treatment methods, with 46 cases in each group. The control group were treated with epalrestat. On this basis, the observation group were given calcium dobesilate combined treatment. The two groups were compared in terms of the Michigan diabetes neuropathy score (MDNS) Michigan neuropathy screening instrument (MNSI) score, oxidative stress reaction [serum superoxide dismutase (SOD), reduced glutathione (GSH) ], clinical efficacy, complications and adverse reactions Using t-test and chi square test.Result:After treatment, the MDNS and MNSI scores of both groups decreased, and the observation group [ (23.49±3.73), (8.49±1.97) ] were lower than the control group [ (28.49±3.85), (11.53±2.28) ] ( t=8.337, 6.843, P<0.05) ; After treatment, the levels of SOD and GSH in both groups increased compared to those before treatment, and the observation group [ (38.96±4.89), (89.79±6.92) ] were higher than the control group those [ (36.42±4.61), (86.74±6.20) ] ( t=2.563, 2.226, P=0.012, 0.028) ; The clinical efficacy of the observation group was higher than that of the control group ( Z=1.592, P=0.042) ; The incidence of complications in the observation group after 1 year was significantly lower than that in the control group ( χ2=4.389, P=0.036) ; The incidence of adverse reactions in the observation group was slightly lower than that in the control group ( χ2=0.155, P=0.694) . Conclusion:Epalrestat combined with calcium dobesilate is effective in the treatment of diabetes peripheral neuropathy, can effectively reduce complications, and has high treatment safety, which is worthy of clinical application.

Antibiotic articular cement spacer for shoulder infection in the elderly / 中华创伤骨科杂志

Objective:To investigate the therapeutic effects of antibiotic articular cement spacer on shoulder joint infection in the elderly patients during stage-one operation.Methods:The data of 3 patients were analyzed retrospectively who had been treated at Department of Orthopaedics, The Sixth People's Hospital Affiliated to Shanghai Jiao Tong University for shoulder infection from May 2018 to December 2019. They were one man and 2 women with an average age of 65.3 years (from 64 to 67 years). One case of infection followed shoulder puncture, another proximal humeral fracture and another shoulder prosthesis replacement. All the 3 patients underwent radical debridement and implantation of antibiotic shoulder cement spacer in stage-one operation but no stage-two operation. The therapeutic effects were evaluated by American Shoulder and Elbow Surgeons (ASES) scoring, Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) scoring, Visual Analog Scale (VAS), and range of shoulder motion.Results:The 3 patients were followed up for 18 to 28 months (mean, 22.7 months). There was no recurrence of infection and the spacers were in good position. The microorganisms detected were Bifidobacterium brevis in one case and methicillin-resistant Staphylococcus aureus in 2 cases. At the final follow-up, the ASES scores averaged 54.4 (from 46.3 to 60.0), Quick-DASH scores 45.1 (from 40.8 to 50.0), VAS scores 2.3 (from 2 to 3), ranges of elevation 65.7 °, ranges of abduction 43.8° and ranges of external rotation 21.7°.Conclusion:For the elderly patients with shoulder infection, implantation of antibiotic shoulder cement spacer after radical debridement can well control infection, relieve pain and improve shoulder functions, sparing them secondary operation.

Establishment of preoperative diagnosis of low-grade infectious nonunion / 中华创伤骨科杂志

Objective:To explore the reliability of preoperative diagnosis of low-grade infectious nonunion using haematological testing and radioisotope scanning (bone 3-phase image).Methods:A retrospective study was conducted of the 265 patients with bone nonunion who had been treated at Department of Orthopaedics, The Sixth People’s Hospital Affiliated to Shanghai Jiaotong University and at Department of Orthopaedics, The Eighth People’s Hospital Affiliated to Shanghai Jiaotong University from June 2010 to June 2018.They were 151 males and 114 females, aged from 19 to 64 years (average, 39.7 years).The nonunions occurred mainly at the tibia (113 cases) and the femur (72 cases).The preoperative results of their white blood cell count (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and radioisotope scanning were recorded.Taking the intraoperative pathological observations as the gold standards, the sensitivity, specificity, area under curve (AUC) of receiver operator characteristic (ROC) and Youden index were statistically analyzed respectively for every preoperative haematological tests and radioisotope scanning as well as for different combinations of the radioisotope scanning and one or more haematological tests.Results:Compared with the pathological observations, the radioisotope scanning showed a sensitivity of 80.7%, a specificity of 73.3%, an AUC of 0.770 and a Youden index of 0.540.In the combinations of radioisotope scanning and one haematological test, that of radioisotope scanning and CRP produced the largest AUC of 0.683, a sensitivity of 98.0%, a specificity of 70.3%, and a Youden index of 0.848.In the combinations of radioisotope scanning and 2 haematological tests, that of radioisotope scanning and WBC and ESR produced the largest AUC of 0.895, a sensitivity of 94.3%, a specificity of 67.3%, and a Youden index of 0.616 and all the 3 ones yielded an AUC of more than 0.880.The combination of radioisotope scanning and all the 3 haematological tests produced a sensitivity of 96.5%, a specificity of 79.7%, an AUC of 0.925 and a Youden index of 0.762.Conclusion:Combination of haematological testing and radioisotope scanning can be a reliable preoperative diagnosis of low-grade infection nonunion.

Abnormal metabolism of gut microbiota reveals the possible molecular mechanism of nephropathy induced by hyperuricemia

The progression of hyperuricemia disease is often accompanied by damage to renal function. However, there are few studies on hyperuricemia nephropathy, especially its association with intestinal flora. This study combines metabolomics and gut microbiota diversity analysis to explore metabolic changes using a rat model as well as the changes in intestinal flora composition. The results showed that amino acid metabolism was disturbed with serine, glutamate and glutamine being downregulated whilst glycine, hydroxyproline and alanine being upregulated. The combined glycine, serine and glutamate could predict hyperuricemia nephropathy with an area under the curve of 1.00. Imbalanced intestinal flora was also observed. , , , , and other conditional pathogens increased significantly in the model group, while and , the short-chain fatty acid producing bacteria, declined greatly. At phylum, family and genus levels, disordered nitrogen circulation in gut microbiota was detected. In the model group, the uric acid decomposition pathway was enhanced with reinforced urea liver-intestine circulation. The results implied that the intestinal flora play a vital role in the pathogenesis of hyperuricemia nephropathy. Hence, modulation of gut microbiota or targeting at metabolic enzymes, , urease, could assist the treatment and prevention of this disease.

Clinical application of posterior tibial artery perforator flap within saphenous nerve branch for sensory reconstruction / 中华显微外科杂志

Objective To explore the operative technique and clinical results of posterior tibial artery perforator flap within saphenous nerve branch for sensory reconstruction.Methods From January,2016 to June,2018,9 patients suffered from soft tissue defect were treated by the posterior tibial artery perforator flap containing saphenous nerve branch.Seven patients were males and 2 were females,with age ranged from 31 to 62 years.Soft tissue defects located in hands in 5 patients,plantar in 2 patients,ankle in 1 patient and dorsal foot in 1 patient.The size of soft tissue defects ranged from 8.0 cm×2.5 cm to 21.0 cm×4.0 cm.The regular post-operative followed-up was performed.Results All flaps survived without complications.The size of flap ranged from 10.0 cm×3.5 cm-23.0 cm×5.0 cm.Donor sites were primarily closed in 5 patients and secondary closed in 4 patients.Followed-up ranged from 6 to 15 months with 10 months in average.The contour of flaps were satisfied and the sensory function of the donor sites were normal.At 6 months followed-up,SW test reached 5.07 in all flaps,and 2PD ranged from 14 to 35 mm.Conclusion The novel sensory flap can provide satisfied sensory outcome without sacrificing main artery and saphenous nerve,and is a good candidate for sensory reconstruction of soft tissue defects.

Internal fixation combined with bone grafting for distal humeral nonunion / 中华创伤骨科杂志

Objective To evaluate the outcomes of internal fixation combined with bone grafting in the treatment of distal humeral nonunion.Methods This retrospective study included 48 patients who had undergone internal fixation combined with iliac bone grafting for distal humeral nonunion between January 2011 and December 2015 at Department of Orthopedic Surgery,The Sixth People's Hospital of Shanghai.They were 31 males and 17 females,with a mean age of 35.4 years (from 22 to 49 years).The outcomes were evaluated by clinical examination,X-ray film,Mayo elbow performance score (MEPS) and visual analogue scale (VAS) during follow-up.Results All the 48 patients were followed up for 18 to 60 months (mean,36 months).No wound-related complications were reported in this cohort.Solid bone union was achieved at 3 to 8 months (mean,4.2 months) after surgery.At the last follow-up,the range of elbow flexion-extension was improved from preoperative 66° to 101°,and the ranges of pronation and supination were enhanced from 65° and 45° preoperatively to 82° and 75°,respectively.The MEPS increased from 54 points preoperatively to 82 points postoperatively.The results were excellent in 26,good in 16 and fair in 6 cases (with an excellent to good rate of 87.5％).The VAS decreased from 4.5 points preoperatively to 1.2 points postoperatively,indicating notable relief of the elbow pain due to distal humeral nonunion.Follow-ups revealed no ulnar nerve injury,nonunion,heterotopic ossification,implant loosening or breakage,or instability of the elbow joint.Conclusion Internal fixation combined with bone grafting is reliable in treatment of distal humeral nonunion,leading to satisfactory outcomes.

Free chimeric vascularized fibular graft and sural flap for reconstruction of composite extremity defects / 中华创伤骨科杂志

Objective To report clinical application of free chimeric vascularized fibular graft combined with sural flap for reconstruction of composite extremity defects after open fracture.Methods From June 2010 to July 2014,free chimeric vascularized fibular grafts and sural flaps were used to treat 4 patients with composite extremity defects at Department of Orthopaedics,The Sixth People's Hospital.They were 3 men and one woman,aged from 39 to 61 years(average,48.5 years).There were 2 cases of soft tissue defects on the forearm complicated with radial defect,one case of soft tissue defects on the forearm complicated with ulnar shaft defect,and one case of soft tissue defects on the leg complicated with tibial defect.The length of bone defect ranged from 8 cm to 18 cm (average,13.0 cm);the size of soft tissue defects ranged from 22 cm × 6cmto23cm × 15 cm (average,22.3cm × 9.7cm).Results The area of flap ranged from 25 cm × 9 cm to 26 cm × 18 cm (average,25 cm × 13 cm);the length of fibular graft ranged from 8 cm to 18 cm (average,13 cm).The 4 patients were followed up for 8 to 42 months (average,20.5 months).All the chimeric flaps survived.All the fractures united after an average of 8.5 months.The last follow-ups revealed no refracture.All the patients were satisfied with the outcomes.Conclusion Free chimeric vascularized fibular graft combined with sural flap is a reliable choice for reconstruction of composite extremity defects after open fracture.

Vacuum sealing drainage techniqueversus traditional repair in treatment of diabetic foot / 中国组织工程研究

BACKGROUND:Studies have shown that the vacuum sealing drainage technology can effectively promote the wound healing, and it has a wide prospect of clinical application, but there are few reports addressing the treatment of diabetic foot. OBJECTIVE:To discuss the clinical effect of vacuum sealing drainage technology in the treatment of diabetic foot wounds. METHODS: Sixty diabetic foot patients were randomly divided into two groups: traditional treatment group, regulating blood sugar level, dressing and traditional debridement; vacuum sealing drainage group, conventional treatment combined with the vacuum sealing drainage technology. The clinical efficacy of two treatments for diabetic foot was evaluated. RESULTS AND CONCLUSION: Compared with the traditional treatment group, the vacuum sealing drainage showed better outcomes in switching frequency, stable blood sugar control, preparation time, wound healing time and cure rate (P < 0.05). It indicates that the vacuum sealing drainage technology in the treatment of diabetic foot ulcers can resolute wound inflammation, stimulate the growth of granulation, create a favorable surgical condition for secondary skin grafting or flap coverage, significantly shorten the treatment time, and exhibit better curative effects than the traditional treatment.

Improved osteoblast proliferation, differentiation and mineralization on nanophase Ti6Al4V / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Previous studies have demonstrated increased functions of osteoblasts on nanophase materials compared to conventional ceramics or composites. Nanophase materials are unique materials that simulate dimensions of constituent components of bone as they possess particle or grain sizes less than 100 nm. However, to date, interactions of osteoblasts on nanophase materials compared to conventional metals remain to be elucidated. The objective of the present in vitro study was to synthesize nanophase metals (Ti6Al4V), characterize, and evaluate osteoblast functions on Ti6Al4V. Such metals in conventional form are widely used in orthopedic applications.</p><p><b>METHODS</b>In this work, nanophase Ti6Al4V surfaces were processed by the severe plastic deformation (SPD) principle and used to investigate osteoblast long-term functions. Primary cultured osteoblasts from neonatal rat calvaria were cultured on both nanophase and conventional Ti6Al4V substrates. Cell proliferation, total protein content, and alkaline phosphatase (ALP) activity were evaluated after 1, 3, 7, 10 and 14 days. Calcium deposition, gene expression of type I collagen (Col-I), osteocalcin (OC), osteopontin (OP) and the production of insulin-like growth factor-I (IGF-I) and transforming growth factor-beta 1 (TGF-β1) were also investigated after 14 days of culture.</p><p><b>RESULTS</b>Functions of osteoblasts including proliferation, synthesis of protein, and ALP activity were improved on the nanophase compared to the conventional Ti6Al4V. The expression of Col-I, OC and OP mRNA was also increased on nanophase Ti6Al4V after 14 days of culture. Calcium deposition was the same; the average number of the calcified nodules on the two Ti6Al4V surfaces was similar after 14 days of culture; however, highly significant size calcified nodules on the nanophase Ti6Al4V was observed. Of the growth factors examined, only TGF-β1 showed a difference in production on the nanophase surface.</p><p><b>CONCLUSION</b>Nanophase Ti6Al4V surfaces improve proliferation, differentiation and mineralization of osteoblast cells and should be further considered for orthopedic implant applications.</p>

Influence of silencing Polo-like kinase 1 on migration and invasion of colorectal cancer cells / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To examine the role of Polo-like kinase 1(PLK1) in the migration and invasiveness of human colorectal cancer cells.</p><p><b>METHODS</b>Nine colorectal cancer cell lines were cultured. Cell lines with the highest level of PLK1 expression was selected by PCR and Western blot. Three siRNA oligo segments targeting PLK1 were designed and selected cell lines transfected. Successful transfection was confirmed using real-time PCR and Western blot. Changes in migration and invasiveness of the selected cell line were evaluated by Transwell test.</p><p><b>RESULTS</b>Colorectal cancer cell line SW1116 was selected with the highest expression of PLK1 at both mRNA level and protein level. The expression of PLK1 in SW1116 was reduced by the three siRNA oligo segments to varying degrees, and the No.1 siRNA oligo segment was the most efficient. In migration test, the number of cells crossing through chambers in PLK1-siRNA group was 44 ± 14, which was lower than that in the negative control group (242 ± 40) and in blank control group(240 ± 38). In invasion test, the number of cells crossing through chambers in PLK1-siRNA group was 62 ± 3, which was lower than that in negative control group (207 ± 12) and in blank control group (211 ± 15). These differences were statistically significant(P<0.01).</p><p><b>CONCLUSION</b>PLK1 silencing by siRNA may inhibit the migration and invasiveness of colorectal cancer cells, suggesting that PLK1 might play an important role in the infiltration and metastasis of colorectal cancer.</p>

Resurfacing of the donor defect after wrap-around toe transfer using the Y-V vascular pedicle lengthening technique / 中华显微外科杂志

Objective To explore the methods of Y-V vascular pedicle lengthening technique for cover-age of the defect of great toe after wrap-around flap transfer, and decrease the morbidity of donor site in great toes. Methods Fifteen patients received three kinds of flap for immediate resurfacing of donor defect of the great toes during wrap-around flap transfer, all flaps were harvested with Y-V vascular pedicle lengthening technique. Among them, 9 cases received the free lateral tarsal flaps transplantation for coverage of defect in donor great toes, 5 cases was repaired by medial tarsal flaps, and only one was treated by the medial plantar flap. Results All the flaps survived postoperatively. The medial plantar flap encountered the venous crisis in postoperative 3 days, and regained the normal blood supply after continuous bleeding for 2 days. All patients were satisfied with cosmetic and functional outcome in average 10- month follow-up. The appearance and sensory function of donor toe repaired by medial tarsal flaps was best among three ones. Conclusion Depending on the Y-V vascular pedicle lengthening technique, the local pedical flaps of foots are enlarged scope for coverage of great toe after wrap-around flap harvest, which can decrease the complication of donor site at the most.

Salvianolic acid B alleviate the disruption of blood-brain barrier in rats after cerebral ischemia-reperfusion by inhibiting MAPK pathway / 药学学报

The aim of the study is to investigate the effect of salvianolic acid B (SalB) on blood-brain barrier (BBB) in rats after cerebral ischemia-reperfusion, and to illustrate its possible mechanisms. Cerebral ischemia-reperfusion was induced by middle cerebral artery occlusion in rats. The break-down of BBB was indicated by extravasations of immunoglobulin (IgG) monitored with immunohistochemistry. The expression of MMP-9 and NOS2 in the brain was determined by immunohistochemistry, and the expression of p-p38 and p-ERK1/2 was detected by Western blotting. It was shown that on day 2 after ischemia-reperfusion the IgG accumulated around the vascular boundary zone, suggesting the break-down of BBB, and the expression of MMP-9 and NOS2 up-regulated at the same time. The result of Western blotting suggested that the expression of p-p38 and p-ERK1/2 increased. On day 7 after ischemia-reperfusion the. expression of MMP-9 and NOS2 was about the same level as day 2, the expression of p-p38 was higher than that on day 2 and the expression of p-ERK1/2 was slightly lower than that on day 2. SalB (1 and 10 mg x kg(-1)) significantly alleviated the extravasations of immunoglobulin induced by cerebral ischemia-reperfusion (P < 0.05). On day 2 and day 7 SalB attenuated the expression of MMP-9 and NOS2 (P < 0.05). SalB (10 mg x kg(-1)) reduced the expression of p-p38 and p-ERK1/2 apparently on day 2 and 7 after ischemia-reperfusion (P < 0.05). SalB (1 mg x kg(-1)) inhibited the expression of p-p38 on day 7 after ischemia-reperfusion (P < 0.05). The results indicate that SalB protects blood-brain barrier in rats after cerebral ischemia-reperfusion by inhibiting the MAPK pathway.

Vessel anastomosis for repairing in site of skin avulsion injury in hand / 中华显微外科杂志

@#Objective To identify the practical microsurgical procedure for repairing in site of skin avulsion injury in hand, and evaluate the long-term following-up results. Methods From January 2001 to May 2005, 21 cases of skin avulsion injury in hand were treated in our department. The surgical procedures thumb skin was revascularized with vein graft from forearm, and the other part of injuried hand was resuffaced by the thickness skin graft taken from the original degloved skin, which was suitable for degloving injury in-graft, the dorsum and palm of hand was skin grafted by the original skin thinned, which was suitable for complete degloved injury at the proximal interphalangeal level. Results All the repaired skin were survival in 16 patients, partial necrosis occurred in 4 cases, which was severely crushed, required debridement and skin graft on the residual defect. Whole failure in 1 case, which underwent secondary amputation. Follow-up at 10-28 months shows acceptable cosmetic and sensible results, slight scarring was present on the volar as-pects of hand. The range of motion of the thumb and fingers was almost complete. All patients regained new jobs. Conclusion Individualization of mierosurgical methods for repairing in site of skin avulsion injury in hand does represent the best solution.

Advance in mechanism research of the interaction between bone plant on osteoblast / 国际生物医学工程杂志

The conformity between bone implant and bone tissue plays an important role in osseointegration.Protein molecules such as extracellular matrix proteins,cytoskeletal proteins,and attachment proteins,which produced by osteoblasts,promote the attachment of osteoblasts to bone implant and the surrounding ceils.In vitro studies show that nano-plated implant material bears excellent biocompatibility and superior physical and chemical features.Nano-scale material has the advantage of high surface roughness,wettability and electrochemistry features which erdaance the adherence and interaction of extracellular matrix proteins and promotes the attachmerit,proliferation and differentiation of osteoblasts.The expression of cytokines,such as prostaglandin E2(PGE2)and transforming growth factor-β(TGF-β)are also increased in nano-structured bone implants which in turn promote the new bone formation.Further studies need to be done to explain the mechanism of the effect of nano-tructured bone implant on osteoblasts.

Upregulating the expression of angiogenesis-related genes by transplanting autologous mononuclear bone marrow cells into myocardial infarction scar and the periphery / 中华心血管病杂志

<p><b>OBJECTIVE</b>To detect the regulation of angiogenic genes involved in the processes of collateral development.</p><p><b>METHODS</b>Myocardial infarction (MI) scar was induced by cryoinjury in New Zealand rabbits. Four weeks after MI, 24 hours before cell transplantation, bone marrow was aspirated from the right thigh bone and mononuclear bone marrow cells (BMCs) were isolated by Ficoll density gradient centrifugation. Then the mononuclear BMCs (n = 8) or IMDM culture medium (n = 8) were transplanted into infarction scar and the periphery. Four weeks after mononuclear BMCs transplantation, DNA microarray analysis was performed to detect the regulation of angiogenesis-related genes in infarction scar and the periphery. And the differences of angiogenic genes expression were compared among several important growth factors by Western blot.</p><p><b>RESULTS</b>DNA microarray analysis showed the detail regulation of genes involved in the angiogenic processes. There were 15 genes upregulated over 3 times in the infarction scar. In addition, we also found more genes are involved in the process of angiogenesis in its periphery than in the infarction scar (40 genes vs. 15 genes). Western bolt analysis further demonstrated that mononuclear BMCs transplantation was capable of increasing the levels of VEGF, FGF and Angiopoietin-I expression in the infarction scar and its periphery, compared with the control group, P < 0.05.</p><p><b>CONCLUSION</b>These findings indicate that the natural angiogenic processes leading to collateral development are extremely complex, since many kinds of bone marrow-derived growth factors involved in the processes after mononuclear BMCs transplantation into infarction sites.</p>

How to cover the defect of great toe after the wrap-around flap transfer / 中华显微外科杂志

Objective To explore the methods for coverage of the defect of great toe after the wrap-a- round flap transferand decrease the morbidity of donor site in great toes.Methods Twenty-five patients received three kinds of procedure for immediate resurfacing of donor defect of the great toes during wrap-around flap transferAmong them9 cases received the free flaps for coverage of defect in donor great toes12 cases was repaired by local pedieled dorsal or plamarpedis flapsand the other cases were treated by the nail-flap of second toe.Results All the flaps were survivalTwo patients received the flap thinning procedure in 6 months laterall patients were satisfied with cosmetic and functional outcomeThe appearance and sensory function of donor toe repaired by second toe nail-flap was best among three methods.Conclusion Accord- ing the detect situation of great toesthree kinds of flap were selected for immediate coverage of donor site, which can decrease the complication of donor great toe at the most.