[Clinical application of perforator propeller flaps with anastomosis of superficial veins].

OBJECTIVE: To investigate the clinical effect of anastomosis of superficial veins for improving the drainage of perforator propeller flaps. METHODS: 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. RESULTS: 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) %. CONCLUSIONS: 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.

Flow-through deep inferior epigastric perforator flaps transplantation for reconstruction of large defects at the extremities / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical application of flow-through deep inferior epigastric perforator flaps for reconstruction of large defects at the extremities.</p><p><b>METHODS</b>The deep inferior and superior epigastric arteries were designed as the axial vessel and the arterial supply to the flap was the paraumbilical perforator artery. Free deep inferior epigastric perforator flaps were harvested in flow- through manners to reconstruct associated arterial defect in the wound. The sensation assessment,Enneking score,and questionnaire of the flap aesthetic were all performed during follow-up period.</p><p><b>RESULTS</b>From December 2011 to September 2012, 5 patients with large defects at extremities were treated. The deep inferior and superior epigastric arteries were designed as the axial vessel and the arterial supply to the flap was the paraumbilical perforator artery. The wound defects ranged form 11 cm x 5 cm to 30 cm x 11 cm. And the flap size ranged from 13 cm x7 cm to 33 cm x 13 cm. All flaps survived completely. The recipient arteries were all bypassed well documented by color Doppler examinations. All cases had 12-24 months' follow-up period. The flaps had good appearance and high aesthetic satisfactory(100%). 12 months after operations, sensation assessment were all S3+, and the Enneking score ratios were 82%-95% ,with 87.2% in average.</p><p><b>CONCLUSIONS</b>Flow-through deep inferior epigastric perforator flaps are reliable and effective for reconstruction of large defects at the extremities with maintenance of the vascular status of the extremities. The flaps can also be designed in transverse or oblique mode for clinical application.</p>

The protective effect of EGB761 on vessels of denervated gastrocnemius in rats and its mechanism.

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

The Protective Effect of EGB761 on Vessels of Denervated Gastrocnemius in Rats and Its Mechanism / 华中科技大学学报（医学）（英德文版）

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

[Effects of mannose-6-phosphate on transforming growth factor beta and transforming growth factor beta receptor expression of flexor tendon cells].

OBJECTIVE: By culturing tendon sheath fibroblasts, epitenon tenocytes and endotenon tenocytes of rabbits' tendon in vitro, to study the effects of mannose-6-phosphate on transforming growth factor beta (TGF-beta) peptide and receptor expression, and to provide the experimental basis for preventing the tendon healing adhesion by mannose-6-phosphate. METHODS: Eight adult New Zealand white rabbits, regardless of their gender and weighing 4.0-4.5 kg, were selected. Tendon sheath fibroblasts, epitenon tenocytes, and endotenon tenocytes were isolated from rabbit flexor tendon and cultured separately. All 3 cells were divided into 2 groups at random after cells were adjusted to a concentration of 4 x 10(4) per well and 1 x 10(4)/mL. The first was the control group without supplementation. The experimental group was supplemented with mannose-6-phosphate. The expressions of TGF-beta and TGF-beta receptor were quantified with enzyme-linked immunosorbent assay. The expression of TGF-beta1 mRNA was also assessed with in situ hybridization and the expression of TGF-beta1 was assessed with immunohistochemistry. RESULTS: The expressions of TGF-beta and TGF-beta receptor in experimental group were significantly lower than that in control group (P < 0.05). The expression levels of TGF-beta1 and TGF-beta2 decreased in descending order of tendon sheath fibroblasts (36.1%, 37.9%), epitenon tenocytes (31.0%, 32.1%), and endotenon tenocytes (31.2%, 27.0%). The expression levels of TGF-beta3 decreased in descending order of endotenon tenocytes (42.5%), tendon sheath fibroblasts (41.2%), and epitenon tenocytes (33.3%). The expression levels of TGF-beta receptor 1 and TGF-beta receptor 2 decreased in descending order of epitenon tenocytes (29.9%, 26.2%), endotenon tenocytes (27.8%, 23.5%), and tendon sheath fibroblasts (23.1%, 20.0%). The expression levels of TGF-beta receptor 3 decreased in descending order of endotenon tenocytes (26.1%), epitenon tenocytes (19.2%), and tendon sheath fibroblasts (15.8%). In experimental group, the positive expression of TGF-beta1 mRNA and the expression level of intracellular TGF-beta1 mRNA in all 3 tendon cells were significantly lower than those in the control group (P < 0.05). Immunohistochemical staining showed the expressions of TGF-beta1 in all 3 tendon cells were significantly lower in the experimental group than in the control group. CONCLUSION: Mannose-6-phosphate can significantly decrease the expressions of TGF-beta peptide, TGF-beta receptor, and TGF-beta1 mRNA. Modulation of mannose-6-phosphate levels may provide a mean of modulating the effects of TGF-beta on adhesion formation in flexor tendon wound healing.

Skeletal muscle-derived stem cells exhibit cardiocyte competences.

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

[Effects of neurotrophic factor 3 gene modified SC on sciatic nerve regeneration in rats].

OBJECTIVE: To investgate the effects of neurotrophic factor 3 (NT-3) genes modified SC on facilitating nerve regeneration and protecting neuronal survival after the sciatic nerve transection in rats. METHODS: The double sciatic nerves were harvested from 3-day-old Wistar rats and the SCs were separated, cultured and purified with double enzyme digestion and adherent culture. The third generation purified SCs were used. The NT-3 cDNA gene was transfected into cultured SCs by using cationic liposome. The NT-3 expression were identified by ELISA after 1, 2, 4 and 8 weeks. The plasmids expressing NT-3 genes were transfected into SCs with lipofectamine. The purity of SCs were detecting before and after modified with NT-3. The nerve-grafting complexes were constructed by SCs (3 x 10(7)/mL) modified NT-3, third generation SCs (3 x 10(7)/mL), NT-3 gene, respectively. And the nerve-grafting complexes were combined with ECM gel and PLGA conduit. Forty-eight adult SD rats were made the models of the right sciatic nerve defect (10 mm). According to the nerve-grafting complexes which were repaired the sciatic nerve defects, the models were divided into 4 groups randomly (n=12): group A (ECM gel and PLGA conduits), group B (SC, ECM gel and PLGA conduits), group C (NT-3 gene, ECM gel and PLGA conduits) and group D (NT-3 modified SC, ECM gel and PLGA conduits). At 2, 4, 6, 8 and 12 weeks after operation, the nerve gross were observed. Electrophysiological examination, histological observation and transmission electron microscope observation were performed at 12 weeks after operation. RESULTS: The concentrations of NT-3 protein were 0.39 +/- 0.25, 0.76 +/- 0.22, 1.06 +/- 0.38 and 1.61 +/- 0.35 at 1, 2, 4 and 8 weeks after operation; showing statistically significant differences (P < 0.05). The purity of SCs was 94.7% +/- 2.1% and 95.6% +/- 2.5% before and after modified with NT-3, respectively; showing a statistically significant difference (P < 0.05). The feet of injury rats began inflammation and ulcer, which healed at 12 weeks in group D, followed by groups C and B, but which was serious in group A gradually. The observations of gross, sections under microscope and transmission electron microscope at 12 weeks showed the regeneration of defect nerve was best in group D, followed by groups C and B, and group A was worst. There were statistically significant differences (P < 0.05) in latent period, amplitude, motor nerve conduction velocity, the number and thickness of axon, the diameter of nerve fiber, the percentage of the nerve tissue area between group A and groups B, C, D, between groups B, C and group D at 12 weeks. At 12 weeks after operation, the transmission electron microscope showed observation the maturation of medullary sheath was best in group D, followed by groups C and B, and group A was worst. CONCLUSION: The nerve-grafting complex of NT-3 genes modified SCs could repair injured nerve. The competence is superior to SCs and neurotrophic factors.

[Effects of platelet-rich plasma on BMSCs differentiation into SC in vitro].

OBJECTIVE: To explore effect of platelet-rich plasma (PRP) on rabbit BMSCs differentiation into SC in vitro and to detect secretory function of the differentiated cells. METHODS: BMSCs isolated from 5 mL bone marrow of 2-month-old New Zealand white rabbit were cultured using density gradient centrifugation and adherence screening methods. A total of 5 mL femoral vein blood was obtained from rabbits to prepare PRP using modified Appel method. The BMSCs at passage 3 were divided into three groups: the combined induction group, in which the cells were cultured with complete medium containing PRP after beta-mercaptoethanol and retinoic acid inductions; the simple induction group, in which the cells were cultured with L-DMEM complete medium without PRP after beta -mercaptoethanol and retinoic acid induction; the control group, in which the cells were cultured with L-DMEM complete medium. Growth condition of the cells in each group was observed using inverted microscope. cell identification was conducted at 4, 7, 9, and 11 days after culture using immunofluorescence staining method, and NGF content was detected by ELISA method. NGF mRNA expression was assayed by RT-PCR 11 days after culture. RESULTS: Most cells in the combined induction and the simple induction group were out of BMSCs typical cell morphology 4 days after culture; cells in the combined induction group were out of BMSCs typical cell morphology and changed into cells resembling SC in terms of morphology and contour 9 days after culture. The cells in the control group showed no obvious morphological changes. S-100 protein expression in the cells was evident in the combined induction and the simple induction group at each time point after induced culture; the positive expression rate of cell in each group was increased over time, and significant differences were evident between the combined induction group and the simple induction group 7, 9, and 11 days after culture (P < 0.05). Control group was negative for the expression. There were significant differences when comparing the control group with the combined induction group or the simple induction group in terms of NGF content at each time point (P < 0.01). Significant difference was evident between the combined induction group and the simple induction group 7, 9, and 11 days after culture (P < 0.05), and no significant difference was noted 4 days after culture (P > 0.05). Relative intensity of NGF mRNA expression in the combined induction group was greater than that of the simple induction group 11 days after culture (P < 0.05). CONCLUSION: Rabbit BMSCs can differentiate into SC excreting NGF under certain induction condition in vitro. PRP can remarkably promote BMSCs differentiation into SC.

[Effects of TGF-beta1 neutralizing antibody on collagen production and adhesion formation of flexor tendon].

OBJECTIVE: To investigate the preventive effect of TGF-beta1 neutralizing antibody on collagen production and adhesion formation of flexor tendon. METHODS: Tendon fibroblasts, epitenon tenocytes, and endotenon tenocytes were obtained from 6 New Zealand rabbit flexor tendons. Each cell culture was supplemented with 1 ng/mL of TGF-beta along with increasing dose of TGF-beta1 neutralizing antibody. Col I production was measured by enzyme-linked immunoabsorbent assay after 3 days. Eighty-four adult New Zealand White rabbits forepaws underwent sharp transection of middle digit flexor digitorum profundus and immediate repair. Then the rabbits were divided into three groups: the normal saline (NS group, n = 36), 1.0 microg/mL TGF-beta1 neutralizing antibody (1.0 microg/mL TGF-beta1 group, n = 36) and 2.0 microg/mL TGF-beta1 neutralizing antibody (2.0 microg/mL TGF-beta1 group, n = 12) were injected in tendon sheath respectively. Tendons were harvested at 4 and 8 weeks for biomechanics testing, histological evaluation and scanning electron microscope observation. Tendons were harvested at 1, 2, 4 and 8 weeks to determine the mRNA expression of TGF-beta1 and Col I by in situ hybridization. RESULTS: ELISA exhibed that TGF-beta1 enhanced Col I production and the neutralizing antibody significantly inhibited TGF-beta1-induced Col I production in all 3 cell cultures with a dose-dependent. At 4 and 8 weeks after operation the gliding excursion of the tendon and the simulated active flexion in NS group were less than that of 1.0 microg/mL TGF-beta1 group and 2.0 microg/mL TGF-beta1 group. There was significant difference between NS group and 1.0 microg/mL TGF-beta1 group, 2.0 microg/mL TGF-beta1 group (P < 0.05). The tendon anastomosis breaking strength showed no significant differences among three groups (P > 0.05). Scanning electron microscope and histological observation showed that collagen fibers arranged irregularly in NS group, but arranged regularly in 1.0 microg/mL TGF-beta1 group and 2.0 microg/mL TGF-beta1 group at 4 and 8 weeks after operation. The in situ hybridization results revealed that TGF-beta1 and Col I mRNA expression in 1.0 microg/mL TGF-beta1 group was lower than that in NS group at each time. There was significant difference between two groups (P < 0.05). CONCLUSION: TGF-beta1 neutralizing antibody can inhibit the function of the TGF-beta1 effectively and prevent adhesion formation after the flexor tendon injured and repaired.

[Effect of exogenous erythropoietin on denervated muscle atrophy].

OBJECTIVE: To investigate the effect of exogenous erythropoietin (EPO) on the denervated muscle atrophy. METHODS: Twenty-four SD male rats, weighting 200-220 g were made the models of denervated gastrocnemius muscle after sciatic nerves were transected under the piriform muscle at the right lower leg, and were randomly divided into two groups (n=12). rhEPO (2500 U/kg) was injected daily into the denervated gastrocnemius muscle in EPO group, and normal saline was injected into the denervated gastrocnemius muscle in control group. To observe the general state of health of the experimental animal, the muscle wet weight, the muscle cell diameter, the cross section area, the protein amount, the percentage of the apoptotic muscle cells, and the Na+-K -ATPase and Ca2+ -ATPase activities were measured 2 and 4 weeks after operation. RESULTS: All experimental animals were survived during experiment without cut infection, and all animals could walk with pulling the right knee. At 4 weeks after operation, 7 cases showed ulcer in the right heel, including 5 in the control group and 2 in the EPO group. At 2 and 4 weeks after operation, the muscle wet weight in EPO group was (885.59 +/- 112.35) and (697.62 +/- 94.74) g, respectively; in control group, it was (760.63 +/- 109.05) and (458.71 +/- 58.76) g, respectively; indicating significant differences between two groups (P < 0.01). The protein amount in EPO group was (77.37 +/- 5.24) and (66.37 +/- 4.87) mg/mL, respectively; in control group, it was (65.39 +/- 4.97) and (54.62 +/- 6.32) mg/mL: indicating significant differences between two groups (P < 0.01). At 2 and 4 weeks after operation, the myofibrillar shapes were nearly normal in EPO group while there were muscle fiber atrophy, some collapse and obviously hyperelastosis between muscle bundle. There were significant differences in the muscle cell diameter and the cross section between two groups (P < 0.01). However, the percentage of the apoptotic muscle cells was 11.80% +/- 1.74% and 28.47% +/- 1.81% in control group, respectively, which was significantly smaller than that in EPO group (21.48% +/- 2.21% and 55.89% +/- 2.88%, P < 0.01). At 2 and 4 weeks after operation, Na+-K+ -ATPase and Ca2+ -ATPase activities in EPO group were higher than those in control group (P < 0.01). CONCLUSION: EPO can delay the denervated muscle atrophy.

Clinical study of treatment for recalcitrant ingrown toenail by partial distal phalanx removal.

The aim of this study was to identify putative aetiological factors of recalcitrant ingrown toenail and then to introduce a new surgical technique for its treatment on the basis of this identification. We found that many of our patients had an upturned morphology on the distal phalanx beneath the recalcitrant ingrown toenail. We thereby designed a new operative technique to treat this problem. From October 1997 to May 2006, 31 patients (38 toes), who were operated on using the new technique, were assigned to the experimental group. Another 38 patients, who were randomly selected from the population without an ingrown toenail, were assigned to the control group. Briefly, the operation is performed as follows: make an elliptical skin incision distal to the hyponychium. Remove the wedge of tissue through incision, together with the periosteum on the lateral side of the distal phalanx. Expose and then transect the distal part of the distal phalanx. Twenty-nine patients (36 toes) were included in the follow up which varied in length from 8 to 29 months. None of them had recurrent symptoms. In conclusion, an upturned abnormality of the distal phalanx may contribute, at least partly, to the formation of recalcitrant ingrown toenail. The partial distal phalanx removal could be considered as an effective technique in recalcitrant ingrown toenail therapy.

Skeletal Muscle-derived Stem Cells Exhibit Cardiocyte Competences / 华中科技大学学报（医学）（英德文版）

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

[Gene expression of transforming growth factor beta1 in zone II flexor tendon wound healing of rabbit].

OBJECTIVE: To research the gene expression of transforming growth factor beta1 (TGF-beta1) in zone II flexor tendon wound healing of rabbit. METHODS: Sixty New Zealand white rabbits forepaws (left side) underwent complete transection and the middle digit flexor digitorum profundus tendon in zone II were repaired by Kessler methods as the experimental group. The normal right forepaws served as the control group. The tendons and tendon sheaths were harvested at 1, 7, 14, 21, 28 and 56 days after repair (n = 10). The expression patterns of TGF-beta1 were analyzed by in situ hybridization and immunohistochemistry staining methods. RESULTS: The in situ hybridization examination revealed that TGF-beta1 mRNA expression up-regulated at 1 day, reached the peak levels at 14-21 days and remained high levels up to 56 days in the experimental group. The expression of TGF-beta1 mRNA in control group was lower than that in the experimental group, showing statistically significant difference (P < 0.05). The results of immunohistochemical staining was similar to that of in situ hybridization. CONCLUSION: The normal tendon and tendon sheath cells are capable of TGF-beta1 production. The cytokine is activated in tendon wound condition. The up-regulation of this cytokine in both tendon and tendon sheath cells are coincidence with both extrinsic and intrinsic mechanisms for tendon repair.

[Clinical study on treatment of obstinate ingrown nail with distal phalanx of great toe and soft tissue orthopaedics].

OBJECTIVE: To investigate the clinical curative effect of distal phalanx of great toe and soft tissue orthopaedics for treatment of obstinate ingrown nail. METHODS: From October 1997 to May 2006, 31 patients (38 nails) suffering from obstinate ingrown nail were treated by the distal phalanx of great toe and soft tissue orthopaedics. There were 23 males (27 nails) and 8 females (11 nails) with an average age of 17.5 years (12-28 years). The disease course was 2 years and 1 month to 14 years (average, 31.6 months). At the same time, thirty-eight patients with diseases of feet were selected randomly as controls. The depth of the nail groove was measured. The X-ray films were taken to calculate the rate of upward projection of tuberosity (r). RESULTS: The depth of the nail and r value of 31 patients were 2.87 +/- 0.31 mm and 0.149 +/- 0.013, respectively. There were statistically significant differences when compared with control group (1.06 +/- 0.10 mm and 0.060 +/- 0.019) (P < 0.01). Thirty patients (37 nails) had a primary healing; 1 patient (1 nail) had a delayed healing. Twenty-nine patients (36 nails) were followed up for 8 to 29 months (average, 21 months). The appearance of the nail was satisfactory. No relapse occurred in all patients. CONCLUSION: The upward projection of tuberosity of distal phalanx of great toe and deepened nail groove are the most important anatomical causes for ingrown nail. The distal phalanx of great toe and soft tissue orthopaedics is an effective treatment for obstinate ingrown nail.

Favorable effect of local VEGF gene injection on axonal regeneration in the rat sciatic nerve.

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

99Tcm-DISIDA hepatobiliary imaging in evaluating gallbladder function in patients with spinal cord injury.

BACKGROUND: Spinal cord injury (SCI) is associated with increased prevalence of gallstones and acute acalculous cholecystitis. A possible explanation for the increased prevalence of gallstones in SCI patients is decreased gallbladder motility causing gallbladder stasis. In this study, we investigated gallbladder function in patients with SCI. METHODS: Eighteen normal controls, 16 trauma controls and 46 SCI patients were included in this study. Gallbladder function was measured by technium 99m-labeled imino-diacetic acid analogue ((99)Tc(m)-DISIDA) hepatobiliary imaging and represented by filling fraction (FF) and ejection fraction (EF). The data from SCI patients were analyzed according to old versus young, female versus male, heavy versus light body weight, ASIA A & B versus ASIA C & D classification, high- versus low-level injury, and long versus short injury duration. RESULTS: Fifty-two percent of SCI patients had abnormal FF and 59% had abnormal EF. Significantly decreased FF and EF values were found in SCI patients, especially in female patients with severe and high-level injuries. CONCLUSION: Quantitative (99)Tc(m)-DISIDA cholescintigraphy showed that SCI can significantly impair gallbladder function.

Reconstruction of finger pulp defect with reversed fasciocutaneous island flap from same finger.

OBJECTIVE: To investigate the clinical curative effect of reconstruction of finger pulp defect by anastomosis of reversed fasciocutaneous island flap with dorsal branch of the digital nerve of the same finger. METHODS: The restoration of finger pulp defect with fasciocutaneous island flap from the same finger was conducted in 25 cases (30 fingers) from January 2002 to June 2003. Nine patients (11 fingers) whose flaps with dorsal branch of the digital nerve anastomosed with the digital inherent nerve around the surface of the wound were Group A and the others were Group B. The follow-up was carried out at 3 and 9 months after the operation to observe the shape of finger pulp and the sense restoration between two groups. RESULTS: All flaps of 25 cases (30 fingers) survived. Three months after operation, the patients had fully grown finger pulps and recovered the superficial sensation and tactile sense of finger pulps. The two point discrimination on average was 5.00 mm+/-0.23 mm in Group A and 6.00 mm+/-0.30 mm in Group B. The difference between two groups was highly significant. Nine months later, their senses of finger pulps between two groups were recovered basically. CONCLUSIONS: The reversed fasciocutaneous island flap from the same finger is the first choice to reconstruct the finger pulp defect, and the anastomosis of dorsal branch of the digital nerve shall be determined according to the specific condition.

[Inhibitor of nitric oxide synthase on the denervated muscle atrophy].

OBJECTIVE: To study the effect of the competitive inhibitor of nitric oxide synthase N(G)-nitro-L-arginine methyl ester (L-NAME) on the denervated muscle atrophy. METHODS: A model of the denervated gastrocnemius at the right lower limb was established in 36 SD adult rats. The rats were randomly divided into two groups: the L-NAME group (Group A) and the control group (Group B). L-NAME 10 mg/kg daily was injected into the denervated gastrocnemius in Group A, and normal saline was injected into the denervated gastrocnemius in Group B. At 2, 4 and 8 weeks after operation, the rate of the muscle wet weight preservation, the cross section area of the myocyte, the protein amount, and the percentage of the apoptotic muscle cells were measured respectively and the ultramicrostructure of the myocyte was observed. RESULTS: At 2 and 4 weeks after operation, the rate of the muscle wet weight preservation, the cross section area of the myocyte, and the protein amount were significantly greater in Group A than in Group B; however, the percentage of the apoptotic muscle cells was significantly smaller in Group A than in Group B. The observation of the ultramicrostructure of the myocyte showed that an injection of L-NAME could protect the ultramicrostructure of the myocyte. At 8 weeks after operation, there was no significant difference between the two groups in the above-mentioned parameters. CONCLUSION: The nitric oxide synthase inhibition can delay the denervated muscle atrophy.

[Therapeutic effect evaluation of ulnar neurolysis and nerve anterior transposition with an immediate range of motion in the aged].

OBJECTIVE: To investigate the clinical therapeutic effect of the ulnar neurolysis and nerve anterior transposition with an immediate range of motion for the cubital tunnel syndrome in the aged. METHODS: Forty-three patients (24 males and 19 females, aged 60-81 years, averaged 67) admitted for the cubital tunnel syndrome from January 1999 to December 2004 were randomly divided into 2 groups: Group A (n=20) and Group B (n=23), with an illness course of 2-10 months. All the patients underwent the ulnar neurolysis and the nerve anterior transposition. After operation the patients' elbows in group A were immobilized with the plaster slab for an external fixation for 3 weeks; the patients' elbows in group B did not use the external fixation, but began an immediate range of motion on the 2nd day after operation. The Bishop scoring system was used to evaluate the patients' functional recovery in the 2 groups. RESULTS: The follow-up for 1-5 years showed that the ulnar nerve function of all the patients were improved but no significant differences were found between the 2 groups (P > 0.05). The patients in Group A returned to daily activities or work at 45.2 +/- 5.1 days, but the patients in Group B required 15.5 +/- 3.8 days, with a significant difference between the 2 groups (P < 0.05). According to Bishop scoring system, the results were excellent in 14 cases, good in 4 cases, fair in 1 case and poor in 1 case in Group A, and 16, 4, 2 and 1 respectively in Group B. There was no significant difference between the two groups (P > 0.05). CONCLUSION: The ulnar neurolysis and nerve anterior transposition with an immediate range of motion for the cubital tunnel syndrome can promote the ulnar function recovery of the old-aged patients. They can return to their daily activities or work at a more rapid speed when their elbows are mobilized immediately after operation.

Effects of chitosan on cell proliferation and collagen production of tendon sheath fibroblasts, epitenon tenocytes, and endotenon tenocytes.

OBJECTIVE: To study the proliferation and collagen production of tendon sheath fibroblasts, epitenon tenocytes, and endotenon tenocytes; and the effects of chitosan on cell proliferation and collagen production in the 3 cell types of rabbit flexor tendon. METHODS: Three cell lines of tendon sheath, epitenon, and endotenon were isolated from rabbit flexor tendon and cultured. Cell culture media was added with chitosan. The cell number and production of collagens I, II, and III were measured and compared with those cultured without chitosan. The expression of type I collagen in tendon sheath fibroblasts was determined by quantitative analysis of reverse-transcription polymerase chain reaction. RESULTS: All 3 cell lines produced collagens I, II, and III. Adding chitosan to cell media resulted in a significant decrease in cell number in all 3 cell lines. In addition, there was a significant decrease in collagens I, II, and III production in all 3 cell lines as well as the expression levels of type I collagen in tendon sheath fibroblasts (P<0.05). CONCLUSIONS: Chitosan can inhibit cell proliferation and collagen production of the tendon sheath, epitenon, and endotenon, and may provide a promising approach to obviating tendon adhesion formation clinically.