Emergency nursing management on prevention of novel coronavirus infection in Department of Microsurgery / 中华显微外科杂志

Objective:To discuss the emergency nursing management procedure in Department of Microsurgery during novel coronavirus pneumonia(COVID-19) and evaluate the effect of the prevention and control procedures.Methods:From January, 20- February 20, 2020, in order to prevent the medical staff and patients from infection of COVID-19, prevention and control measures were put in place which included screening and diagnosis of emergency pa- tients at the Department of Emergency through check body temperature and lung CT scan, monitoring body temperature and finger blood oxygen saturation on all inpatients and their accompanies, confirming the diagnosis and quarantine the patients who were in high temperature with abnormal lung CT scans, disinfecting and summary disinfection of the quaran- tine wards where suspected patients stayed, training medical staff for personal protections, standardizing the use and man- agement of personal protection equipment (PPE), managing medical staff in wards, educating patient about the COVID-19 to relive their nervousness, etc.Results:Of the 4 patients with persistent fever, 2 were diagnosed as new coronavirus infection. Of the 2 COVID-19 patients, 1 had confirmed diagnosis and transferred, the other who with highly suspected COVID-19 was quarantined at home. All medical staffs were trained with COVID-19 prevention and control proce- dures, with a qualification rate at 100%. Fourty-eight medical staffs were put on front-line duty and the rest of 17 were put on standby. Apart from one medical staff had been infected at the early phase of COVID-19, no one was in- fected after the emergency management and protective measures were implemented. All medical devices were used strictly to follow the controlled procedures. All patient wore masks.Conclusion:During the COVID-19 epidemic, emergency management measures were taken to avoid cross infection in hospital, which ensured the safety of medical staff and patients. The COVID-19 prevention and control measures were practical, in time and effective.

Analysis of role change and function of microsurgery staff in fighting against COVID-19 / 中华显微外科杂志

The outbreak of COVID-19 around the world has made more than two millions of confirmed patients and serious shortages of healthcare resources and medical staff in many countries. In the battle of fighting COVID-19 in Wuhan, many microsurgery staff across China were sent to Wuhan and put on duty in the treatment of COVID-19 patients. The purpose of this article is to review the personal experiences of microsurgery staff in fighting against COVID-19 as well as to analyse how to act professionally when facing the challenges and change of roles and meanwhile having to give full play to the professional advantages subject to make contributions to the battle of COVID-19. A reference is hereby provided for the microsurgery staff in dealing with a sudden and major epidemic outbreak in the future.

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.

Perforator pedicled flaps by anastomosis of superficial veins for reconstructing the extremity defects: 14 cases report / 中华显微外科杂志

Objective To investigate the methods and results of perforator pedicled flaps by anastomosis of superficial veins for reconstructing the extremity defects.Methods From February, 2012 to September, 2012, a total of 14 patients with traumatic skin and soft tissue and artery defects in extremities were repaired by perforator pedicled flaps anastomosed superficial veins with the recipient vessels.Fourteen flaps were based on five kinds of perforator arteries, the posterior interrosseous artery in 5 cases, the ulnar artery in 3 cases, the metacarpal artery in 2 cases, the peroneal artery in 3 cases, the lateral supramalleolar artery in 2 cases, the ulnar artery in 2 cases,and the posterior interrosseous artery in 1 case.After the operation, the blood supplies of flaps were observed severely,postoperative flap swelling were evaluated by edema level classification.After 1 month the blood flow of vein anastomosis were examed by color Doppler ultrasound.Questionnaire of the flap aesthetic satisfactory were performed during fellow-up periods.Results Twelve flaps were all survived well, 2 flaps had partial marginal skin necrosis in the distal, which was managed with surgical debridement, and wound healed in 1 month.Flap swelling were light, edema level classification were one degree in 4 cases,two degree in 10 cases postoperation 7 days, one degree in 11 cases and two degree in 3 cases, after 6 months.Color Doppler ultrasound examinations showed 9 vein anastomosises were all bypassed well.Eleven cases had 6-12 months' fellow-up periods.The flaps had like-like appearance, good contour, high aesthetic satisfactory.Conclusion Perforator pedicledr flaps by anastomosis of superficial veins can reduce the flap venous pressure obviously, avoid transientvenous venous congestion, improve the survival quality of the flap.It's a safe and effective method for soft tissue coverage of traumatic extremity wounds.

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.

Expression and role of connective tissue growth factor in the peripheral nerve after chronic compression injury / 中华显微外科杂志

Objective To investigate the effects of connective tissue growth factor (CTGF) on the chronic peripheral nerve compression injury and explore the function of CTGF in peripheral nerve compression injury and repair. Methods From July 2010 to September 2010, fifty aduh male SD rats were randomly divided into group A and B: group A (sham-operated group): only exposed the sciatic nerve; group B (compression group): undergone sciatic nerve entrapment operation on the right hind leg according to the method which Mackinnon adopted when he established the model of chronic sciatic nerve compression.Electron microscopy,immunohistochemistry,RT-PCR and Western-blot were performed to observe the morphological changes of the compressed nerve tissue and to determine the level of CTGF,collagen- Ⅰ,Ⅲ (COL- Ⅰ,Ⅲ),2,4,6,8,10 weeks after the surgery,respectively. Results After sciatic nerve compression,the collagen in nerve increased ; The expression of CTGF and COL- Ⅰ, Ⅲ in sciatic nerve of compressed group increased, which was statistically different compared with the sham-operation group (P ＜ 0.05); In the meanwhile,the contents of CTGF and COL- Ⅰ,Ⅲ were positively correlated in a certain period. Conclusion Peripheral nerve fibrosis can be caused by chronic nerve compression.The expression of COL- Ⅰ,Ⅲ in sciatic nerve increased and CTGF get involved in the pathophysiological process, which suggests that CTGF plays an important role in the process of neural injury and fibrosis.

Effect of TGF-β1 and CTGF on skeletal muscle fibrosis in nerve compression / 中华显微外科杂志

ObjectiveTo investigate expression of TGF-β1,CTGF and collagen deposition in skeletal muscle during chronic entrapment of peripheral nerve. MethodsFifty rats were separated into two groups,control group and experimental group. At different time points after operation, the right gastrocnemius of 5rats from each group were collected for further analysis such as HE, Masson stain, immunohistochemical staining,RT-PCR and Western-blot. Results It was observed that axon degeneration occurred during chronic nerve entrapment,and which was in line with reports from other groups.Moreover,it had been demonstrated that after nerve entrapment,skeletal muscles may form fibrosis and degeneration consequently.Within this pathological procedure,expression of TGF-β1. CTGF and deposition of collagenⅠ changed rapidly when compared with control group.ConclusionOverall,these results indicated that these factors may be important during skeletal muscle degeneration after chronic nerve entrapment.

Role of TGF-β1 in the process of differentiation of denervated skeletal muscle-derived stem cells in vitro / 中华显微外科杂志

Objective To investigate the effect on differentiation of denervated skeletal muscle-derived stem cells (MDSCs) induced by TGF-β1 in vitro.Methods MDSCs were obtained from the rat denervated skeletal muscle by preplate technique,with TGF-β1 adding on medium.Cultured cells were divided into two groups.A,control group; B,10 ng/ml TGF-β1 group.Cell growth was observed with phase contrast microscope.lmmunocytochemistry,quantitative RT-PCR and Western blot was used to detect the expression of Sca-1,COL-Ⅰ,COL-Ⅲ,α-SMA and vimentin in denervated MDSCs.Results The synthesis of COL-Ⅰ,COL-Ⅲ,α-SMA and vimentin by denervated MDSCs was extremely low at protein level in vitro,while Sca-1 level was really high.Belong to the treatment with TGF-β1,COL-Ⅰ,COL-Ⅲ,oα-SMA and vimentin in the denervated MDSCs had strong expression,but Sca-1 in which had a weak expression.Under the stimulation of TGF-β1,COL-Ⅰ expression reached peak at the 2nd day (12.5591 ± 0.3389),which was about 3 times as control group.COL-Ⅲ reached highest value at the 5th day (0.8956 ± 0.0438),which was about 23 times as control group.α-SMA topped out to 18 times at the 5th day (1.1090 ± 0.0018).Vimentin expression rose by 8.5 times and peaked at the 5th day (0.1794 ± 0.0019).The expression of Sca-1 began to decline at the 2nd day,with a remarkable reduction at the 5th day (0.0636 ± 0.0015).Conclusion TGF-β1 could induce differentiation of the denervated MDSCs to myofibroblasts in vitro,and promote the synthesis and excretion of extracellular matrix.

Role of iatrogenic transforming growth factor-β1 antibody in peripheral neural fibrosis after chronic entrapment / 中华创伤杂志

ObjectiveTo investigate the effect of transforming growth factor-β1 (TGF-β1) antibody on peripheral neural fibrosis after chronic entrapment.MethodsA total of 75 rats were randomly divided into three groups, ie, Group A (sham operation, only the sciatic nerve exposed), Group B (compression only, treated with sciatic nerve entrapment) and Group C (compression plus antibody injection).Electron microscopy, immunohistoehemistry, RT-PCR and Western blot were performed to observe the morphological changes of the compressed nerve tissue and to determine the level of TGF-β1 , collagen Ⅰ and collagen Ⅲ at 2, 4, 6, 8, 10 weeks after sciatic nerve compression, respectively.Results The levels of TGF-β1 , types Ⅰ and Ⅲ collagen protein were increased significantly in the Group B compared with that in the Group A, when the expression of TGF-β1 was increased in the early phase of the compression, reached the peak at the 4th week, and then decreased slowly.The expressions of collagenⅠand collagen Ⅲ were increased after compression, reached a peak at the 6th week and then maintained a relatively high level.The number of the fibrous tissues was decreased significantly and the content of types Ⅰ and Ⅲ collagen protein declined in the Group C, with statistical difference compared with the Group B (P ＜ 0.05).ConclusionsPeripheral nerve fibrosis can be caused by chronic nerve compression.TGF-β1 plays an important role in effectively inhibiting the collagen synthesis and ameliorating the nervous fibrosis of the protein following peripheral nervous entrapment.

Role of transforming growth factor-β1 in the process of fibrosis of denervated skeletal muscle / 华中科技大学学报（医学）（英德文版）

In order to investigate the biological function of transforming growth factor-β1 (TGF-β1) during fibrosis in denervated skeletal muscle, we recruited sciatic nerve injury model of SD rats in which denervated gastrocnemius was isolated for analysis. At different time points after operation, denervated muscle was examined by several methods. Masson trichrome staining showed morphological changes of denervated skeletal muscle. Quantitative RT-PCR detected the rapid increase of TGF-β1 expression at mRNA level after nerve injury. It was found that a peak of TGF-β1 mRNA expression appeared one week post-operation. The expression of collagen I (COL I) mRNA was up-regulated in the nerve injury model as well, and reached highest level two weeks post-injury. Immunoblot revealed similar expression pattern of TGF-β1 and COL I in denervated muscles at protein level. In addition, we found that the area of the gastrocnemius muscle fiber was decreased gradually along with increased interstitital fibrosis. Interestingly, this pathological change could be prevented, at least partly, by local injection of TGF-β1 antibodies, which could be contributed to the reduced production of COL I by inhibiting function of TGF-β1. Taken together, in this study, we demonstrated that the expression of TGF-β1 was increased significantly in denervated skeletal muscle, which might play a crucial role during muscle fibrosis after nerve transection.

Mechanism and application of gene interference in cell signal transduction / 中国组织工程研究

RNA interference is a newly emerging gene block technology. Exogenous and endogenous double stranded RNA in cells can restrain specific sequence gene expression. RNA interference can block the specific gene expression efficiently, and identify the upper or lower reaches of the relationship of the different genes in the complex signaling pathway. It is a powerful tool to study signal transduction pathway. RNA interference can inhibit targeted gene expression of mRNA and protein products. It could simply, specifically, efficiently and stably reduce targeted gene expression, and it could remove the target gene without affecting other materials. RNAi technology is better than any previous methods in gene function's study and application. But, it is hard to transfect the RNA into mammalian cell lines, and mammalian cells also generate antagonism to the double stranded RNA or small interfering RNA. Thus, we are looking forward that using highly effective and safety small interfering RNA in medical care.

Wrist arthrodeses with wrist fusion plate in 21 cases: Biocompatibility and function evaluation / 中国组织工程研究

Twenty-five patients with traumatic carpitis treated by wrist fusion plate internal fixation in Department of Orthopedics, Commercial Staff Hospital of Wuhan from July 2000 to July 2007 were selected, of which 21 were followed up for more than 6 months. Twelve cases had slight dorsal extension dysfunction of thumb, forefinger and middle finger; 10 had slight initiative dorsal extension dysfunction of thumb interphalangeal articulation; 4 had forearm rotation dysfunction, such as distal radioulnar joint or ulnaris pain. Of 21 followed-up patients, 12 cases had no pain, 5 had bearable wrist pain after intensive physical labor, and 4 had pain in daily life of forearm rotation, which affected their working. Grip strength of 15 cases restored to 75% of the operate side, 5 cases to 50%-75%, and 1 case to 50%. The results suggest that plate implantation relieve joint pain, but partial wrist function is limited. The plate materials are biocompatible to human body with no specific adverse effects.

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.

Effect of FK506 on functional recovery of peripheral nerve after end-to-side anastomosis / 中国组织工程研究

BACKGROUND: Injured nerve can regenerate through end-to-side anastomosis and obtain partial physiological function in animal experiment. As an immuno-suppressivedrug, FK506, which is characterized by promoting neural growth and functional recovery, is paid widely attention to.OBJECTIVE: To investigate the effect of FK506 on functional recovery of peripheral nerve after end-to-side anastomosis.DESIGN: Randomized controlled animal study.SETTING: Department of Operation Surgery, Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology.MATERIALS: The experiment was completed in the Department of Operation Surgery, Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology in March 2005. Totally 26female Wistar rats were selected and divided into experimental group and control group with 13 in each group.METHODS: Peroneal nerve was transacted on the right side of all the animals, the proximal end of peronieal nerve was turned back and ligated, and the distal end was sutured to the side of tibial nerve with perineurial window. No operation was done on the left side. FK506 was injected in the right tibial muscle (2 mg/kg· d), once a day within two weeks in the experimental group, and saline was used in another group as contrast.MAIN OUTCOME MEASURES: Three months afteroperation, the bilateral common peroneal nerve and the tibial muscle were taken for electrophysiological and histological examination, and the number of common peroneal nerve fiber, area of tibialis anterior muscle fiber of transverse section and muscle wet weight of tibialis anterior muscle were measured. The results were expressed with the ratio between right side and left side (i.e.recovery rate).RESULTS: Totally 26 rats entered the final analysis. ① Results of histological examination: Both ratio of number of nerve fiber and ratio of area of muscle fiber in the experimental group were higher than those in the control group (0.734±0.143, 0.412±0.119; 0.628±0.125, 0.432±0.135; P ＜ 0.01,0.05). ② Results of electrophysiological examination: Recovery rate of action potential, recovery rate of single muscular contractility and recovery rate of tetanus contractility in the experimental group were higher that those in the control group (P ＜ 0.05). ③ Ratio of wet weight in the experimental group was higher than that in the control group (0.765±0.101,0.513±0.116, P ＜ 0.05).CONCLUSION: FK506 injected into targeted muscle can promote growth and functional recovery of peripheral nerve in end-to-side anastomosis.

The characteristics of acute rejection after limb allotransplantation in rats--an experimental study / 华中科技大学学报（医学）（英德文版）

To study the characteristics of acute rejection after limb allotransplantation, 29 male Sprague-Dawley rats were randomly divided into 2 groups, with 15 rats in control group and 14 rats in experimental group. Each rat in control group underwent limb replantation. Each rat in experimental group received limb transplantation from Wistar rat. No immunosuppressive drugs were used after operation. The circulation of the transplanted limb, time and signs of rejection, histopathological changes in the tissues of the limb graft when rejected and survival time of limb grafts were evaluated. In the control group, no signs of rejection were observed, the circulation of each replanted limb was normal, it could survive for a longer time. The experimental group showed clinical signs of rejection (sub dermal edema and erythema) after a mean time of 3.36+/-1.15 days, and the mean survival time of the allografts was only 7+/-0.78 days. Histopathological examination showed most violent rejection reaction in skin. It is concluded that with Wistar-to-SD limb transplantation without use of immunosuppression, rejection of the grafts would occur after a mean time of 3.36+/-1.15 days; the earliest signs of rejection were edema and erythema of the skin, skin being the most representative component of limb graft rejection.

The characteristics of acute rejection after limb allotransplantation in rats--an experimental study / 华中科技大学学报（医学）（英德文版）

To study the characteristics of acute rejection after limb allotransplantation, 29 male Sprague-Dawley rats were randomly divided into 2 groups, with 15 rats in control group and 14 rats in experimental group. Each rat in control group underwent limb replantation. Each rat in experimental group received limb transplantation from Wistar rat. No immunosuppressive drugs were used after operation. The circulation of the transplanted limb, time and signs of rejection, histopathological changes in the tissues of the limb graft when rejected and survival time of limb grafts were evaluated. In the control group, no signs of rejection were observed, the circulation of each replanted limb was normal, it could survive for a longer time. The experimental group showed clinical signs of rejection (sub dermal edema and erythema) after a mean time of 3.36+/-1.15 days, and the mean survival time of the allografts was only 7+/-0.78 days. Histopathological examination showed most violent rejection reaction in skin. It is concluded that with Wistar-to-SD limb transplantation without use of immunosuppression, rejection of the grafts would occur after a mean time of 3.36+/-1.15 days; the earliest signs of rejection were edema and erythema of the skin, skin being the most representative component of limb graft rejection.