An Uncommon Case of Necrotizing Fasciitis and Septic Shock Caused by Vibrio vulnificus Infection-Related Freshwater Shrimp Stung.

Vibrio vulnificus is a deadly marine pathogen that can cause necrotizing fasciitis, septic shock, and even death in severe cases. The relatively low incidence and atypical early-stage symptoms may hinder many physicians from carrying out surgical intervention effectively, thus leading to an increase of mortality in infected patients. This article reported a patient who developed necrotizing fasciitis and septic shock after the exposure to freshwater shrimp stabbed on the limb. By reviewing and analyzing previous studies, it was found out that the timing of surgery could have a significant impact on the patients for their necrotizing fasciitis caused by Vibrio vulnificus infection. The mortality among patients undergoing early-stage surgical treatment (≤12 hours from the time of admission) was significantly lower than that of patients undergoing late surgical treatment (>12 hours).

Endothelial cells promote the proliferation and migration of Schwann cells.

Background: After peripheral nerve injury, Schwann cells proliferate and migrate to the injured site, thereby promoting peripheral nerve regeneration. The process is regulated by various factors. Endothelial cells participate in the process via angiogenesis. However, the effects of endothelial cells on Schwann cells are not yet known. The present study sought to evaluate whether endothelial cells accelerate Schwann cell proliferation and migration. Methods: We established a co-culture model of rat Schwann cells (RSC96s) and rat aortic endothelial cells (RAOECs), and studied the effects of endothelial cells on Schwann cells by evaluating changes in Schwann cell proliferation and migration and related multiple genes and their protein expressions in the co-culture model. Results: The results showed that increasing the proportion of endothelial cells in the co-culture model enhanced the proliferation. At days 1 and 3 following the co-culturing, the relative growth rates of the co-cultured cells were 122.87% and 127.37%, respectively, which showed a significant increase in the viability compared to that of the RSC96s (P<0.05). In this process, the expression of Ki67 increased. The migration ability of Schwann cells was also enhanced. The migration capacity of Schwann cells was detected by wound-healing and Transwell assays. The results of the group with 15% of endothelial cells was significantly higher than the results of the other groups (P<0.0001 and P<0.05, respectively). Further, neuregulin 1 and glial fibrillary acidic protein increased the process of Schwann cell migration. Conclusions: The results showed that endothelial cells can promote the proliferation and migration of Schwann cells and participate in peripheral nerve regeneration.

Molecular Mechanism of the "Babysitter" Procedure for Nerve Regeneration and Muscle Preservation in Peripheral Nerve Repair in a Rat Model.

OBJECTIVE: To investigate the molecular mechanism of nerve "babysitter" for nerve regeneration and muscle preservation in peripheral nerve repair. METHODS: Eighty rats were equalized into 4 groups: peroneal nerve transected, group A received no treatment; group B underwent end-to-end repair; group C underwent end-to-side "babysitter" with donor epineurial window; group D underwent end-to-side "babysitter" with 40% donor neurectomy. During second-stage procedure, end-to-end neurorrhaphies were executed in groups A, C, and D. Expression of Insulin-like growth factor (IGF)-1 in spinal cord and IGF-1, TNF-like weak inducer of apoptosis (TWEAK), and Fn14 in anterior tibial muscles were evaluated by histopathology at 4-, 8-, 12-, and 24-week timepoints postoperatively. RESULTS: At 4 weeks, group D expressed comparable IGF-1 with group B, and greater value than groups A and C in spinal cord. By 24 weeks, groups B and D showed higher values than groups A and C. Insulin-like growth factor 1 in muscles were greater in groups C and D than in groups A and B at 4 weeks, and comparable in all groups at 24 weeks. At 4 weeks, immunoreactive scores of TWEAK were 9.00 ± 0, 3.00 ± 0, 6.75 ± 0.75, and 6.75 ± 0.75, respectively. No differences were noticed in all groups by 24 weeks. At 4 weeks, Fn14 were similar in groups A, C, and D, but lower in group B. Group D showed comparable Fn14 with groups B and C, but lower value than group A at 24 weeks. CONCLUSIONS: End-to-side nerve "babysitter" in peripheral nerve could promote fiber regeneration and muscle preservation by regulating expression of IGF-1 and TWEAK-Fn14. End-to-side "babysitter" with partial donor neurectomy could achieve comparable effects with end-to-end repair.

Can the Babysitter Procedure Improve Nerve Regeneration and Denervated Muscle Atrophy in the Treatment of Peripheral Nerve Injury?

BACKGROUND: The authors evaluated the long-term efficacy of the "babysitter" procedure in improving nerve regeneration and denervated muscle atrophy for peripheral nerve repair. METHODS: Eighty Lewis rats were allocated equally into four groups. The peroneal nerves of all animals were divided. In group A, the peroneal nerve stumps were anchored into adjacent muscles. Rats in group B underwent end-to-end neurorrhaphy. Rats in group C underwent end-to-side neurorrhaphy of the distal peroneal nerve stump to an epineurial window on the tibial nerve. Rats in group D underwent end-to-side neurorrhaphy of the distal stump to the tibial nerve with 40 percent neurectomy. After 8 weeks, end-to-end neurorrhaphy of the peroneal nerve stumps was performed in group A, C, and D during a second-stage procedure. Electrophysiology, myelinated fiber counts, muscle force and weight, and muscle histomorphometry were analyzed at 4, 8, 12, and 24 weeks postoperatively. RESULTS: At 4 weeks, the end-to-end group showed predominant advantages in nerve regeneration and muscle preservation. No differences were observed in the latency delaying rate, tetanic tension, myelinated fiber number, or muscle weight between groups B and D by 24 weeks (p > 0.05). At 24 weeks, the results revealed superior latency delaying rate, myelinated axon regeneration, and size of muscle fibers in group D as compared with group C. CONCLUSIONS: Peripheral nerve repair with an initial motor nerve babysitter with 40 percent neurectomy of the donor nerve can achieve high efficacy in functional and structural recovery of the recipient system. Nerve babysitter by motor nerve with an epineural window was less effective.

[Nerve classification with hyperspectral imaging technology].

In surgical nerve repair surgery, the identification of nerve fascicles is a key to a good repair of their broken end. Some of the existing nerve fascicles identification method are not ideal. Hyperspectral imaging (HSI) technology provides information of images and spectra of biological tissue at the same time. It can supply a qualitative, quantitative and positioning description of the test objectives, and identify different biological tissues by biochemical characteristic difference, and classify and position these tissues in the image. Compared to other medical imaging technology, this techriology has unique advantages. In this study, the hyperspectral imaging technology is used in the identification and classification of the nerve fascicles by the spectral characteristics of different nerve fascicles, and in determining the orientation of the nerve fascicles in the image by the image spectral information in order to better help surgical personnel to carry out the nerve repair surgery. The significance of this paper is: the first to propose a new method of identification and location of the nerve fascicles and assist surgical staff to improve the efficacy of nerve repair; the second to reserve hyperspectral imaging techniques used in qualitative and quantitative and orientation research combined with biological organization, and speed up the molecular hyperspectral imaging technology to the practical stage.

Mefloquine inhibits chondrocytic proliferation by arresting cell cycle in G2/M phase.

Mefloquine (MQ), an analog of chloroquine, exhibits a promising cytotoxic activity against carcinoma cell lines and for the treatment of glioblastoma patients. The present study demonstrates the effect of mefloquine on proliferation and cell cycle in chondrocytes. MTT assay and propidium iodide staining were used for the analysis of proliferation and cell cycle distribution, respectively. Western blot analysis was used to examine the expression levels of cyclin B1/cdc2, cdc25c, p21WAF1/CIP1 and p53. The results revealed that mefloquine inhibited the proliferation of chondrocytes and caused cell cycle arrests in the G2/M phase. The proliferation of chondrocytes was reduced to 27% at 40 µM concentration of mefloquine after 48 h. The population of chondrocytes in G2/M phase was found to be 15.7 and 48.4%, respectively at 10 and 40 µM concentration of mefloquine at 48 h following treatment. The expression of the cell cycle regulatory proteins including, cyclin B1/cdc2 and cdc25c was inhibited. On the other hand, mefloquine treatment promoted the expression of p21WAF1/CIP1 and p53 at 40 µM concentration after 48 h. Therefore, mefloquine inhibits proliferation and induces cell cycle arrest in chondrocytes.

Efficacy of the end-to-side neurorrhaphies with epineural window and partial donor neurectomy in peripheral nerve repair: an experimental study in rats.

BACKGROUND: End-to-side (ETS) neurorrhaphy was a useful tool in peripheral nerve repair and "baby-sitter" procedure. The study was designed to evaluate the long-term efficacy of ETS with epineurial window and 40% partial donor neurectomy in rats. MATERIALS AND METHODS: A total of 60 Lewis rats were divided into three groups (n = 20, each group): following peroneal nerve transection, rats in Group A underwent end-to-end neurorrhaphy; rats in Group B underwent ETS neurorrhaphy of the distal peroneal nerve stump to an epineurial window on the tibial nerve; and rats in Group C underwent ETS neurorrhaphy of the distal peroneal nerve stump to the tibial nerve with 40% partial neurectomy. At 6, 12, 18, and 24 weeks after surgery, electrophysiology, muscle tension, myelinated fiber regeneration, cross-sectional area of muscular fiber, and muscle weight were analyzed. RESULTS: Histology exhibited apparently increased number and size of myelinated fibers in peroneal nerves in Group C, compared with those in Group B. More superior recovery was demonstrated in the electrophysiology and axon regeneration of the peroneal nerves, as well as the maintenance of muscle force, wet weight, and fiber size of the anterior tibial muscles in Group C than those in Group B. CONCLUSION: ETS neurorrhaphy with partial donor neurectomy can achieve higher efficacy in functional and structural recovery of the recipient system. This study provides the evidence of long-term follow-up for the further investigation of ETS neurorrhaphies with different modalities in peripheral nerve repair and in "baby-sitter" procedure.

Changes of the donor nerve in end-to-side neurorrhaphies with epineurial window and partial neurectomy: a long-term evaluation in the rat model.

End-to-side (ETS) neurorrhaphy has been applied in the repair of peripheral nerve injuries and in babysitter procedures. However, the long-term changes of donor nerve and muscle after ETS remain unknown. This study was designed to investigate long-term changes in donor nerve and muscle in a rat model. Sixty Lewis rats were equally allocated into three groups of 20 rats. The peroneal nerve was divided. In Group A, end-to-end (ETE) neurorrhaphy was performed. In Group B, ETS was performed to an epineurial window on the tibial nerve. In Group C, ETS was performed to the tibial nerve with 40% partial neurectomy. The following data were obtained at 6, 12, 18, and 24 weeks postoperatively: latency delaying rate (LDR), amplitude recovery rate (ARR), myelinated fiber counts, muscle force and weight, and cross-sectional area of gastrocnemius muscle fibers. The results showed no significant changes of the donor nerve and muscle in Group B. Nerve regeneration was found in the peroneal nerve, and myelinated fiber number was significantly decreased when compared to the nerve with ETE. In Group C, the myelinated axon number in the peroneal nerve was equivalent to the level in ETE repair. However, function and structure of the donor nerve and muscle were significantly impaired in the early postoperative period. Nonetheless, full recovery was observed 24 weeks after surgery. Both ETS with epineurial window and 40% donor nerve neurectomy showed reinnervation of the recipient nerve without structural and functional changes of the donor system in a long-term follow-up. Partial neurectomy may promote recipient nerve regeneration, but at the cost of donor neuromuscular compromises in the early postoperative period. This study provides long-term evidence for further investigation of ETS in peripheral nerve repair and in babysitter procedures.

Peroneal artery perforator chimeric flap for reconstruction of composite defects in extremities.

Large bone defects of extremities, especially those associated with soft tissue defects, represent difficult reconstructive problems. Chimeric flap is a suitable option for reconstruction of complex bone and soft-tissue defects. In this report, we present the experience on use of the peroneal artery perforator chimeric flap for the reconstruction of complex bone and soft tissue defects in the extremities in 16 patients. The bone defects were located in the tibia in 8 patients, in both tibia and fibula in 1 patient, in the ulna in 2 patients, in both ulna and radius in 2 patients, and the metatarsal bone in 3 patients. The flap was created with skin paddle and fibula bone segments based on independent perforators. The sizes of flap ranged from 8 x 6 to 20 x 11 cm(2), and the length of fibular grafts ranged from 6 to 22 cm. All flaps survived completely. Bone union was ultimately obtained in all cases at 5 to 11 months, while two cases suffered from stress fractures in 12 month and 18 month after operation, respectively, which eventually healed with external fixation treatment. The follow-up time ranged from 12 to 37 months. The definite bone hypertrophy was observed from X-ray at 18 months after operation. In conclusion, our results show that the peroneal artery perforator chimeric flap is a good option for reconstruction of complex bone and soft-tissue defects of extremities, particularly for those with three-dimensional defects and bone defects exceeding 6 cm in length.

[Allografted olfactory mucosa gliacytes repair Wistar rats' sciatic nerve long defect].

OBJECTIVE: To investigate whether or not allografted olfactory mucosa gliacytes could repair peripheral nerve injure. METHODS: Olfactory mucosa gliacytes had been cultured in vitro for 2 weeks, then purified and condensed for later transplantation.Sixty adult female Wistar rats were randomized into 2 groups of 30 rats each, A (control) and B (test). Rats' left sciatic nerves were excised 25 mm long axons and retained epineurium lumen anastomosed to proximal ends. Culture mediums, and olfactory mucosa gliacytes were transplanted into epineurium lumen of A and B groups respectively. At 3 months postoperatively, the regenerations of injured sciatic nerves were evaluated by methods of macroscopy, photomicroscopy, transmission electron microscopy, retro-marked fluorescence red, the condensation of glial fibre acid protein (GFAP) and nerve growth factors (NF) assayed by immunofluorescence, and the concentration of myelin basic protein (MBP) and neurofilament protein (NF) assayed by enzyme linked immunosorbent assay. RESULTS: The regenerations of injured sciatic nerves were superior in B group to in A group; the transportation distance of retro-marked fluorescence red were longer in B group than in A group (P < 0.01). The condensations of GFAP and NGF were more dense in B group than in A group. The concentrations of MBP and NF were more high in B group than in A group (P < 0.01). The function scores of injured limbs were superior in B group to in A group (P < 0.01). The quantifications of nerve fibers and myelin fibers of injured sciatic nerve were larger in B group than in A group (P < 0.01). CONCLUSION: Allografted olfactory mucosa gliacytes could repair injured nerve defect.

Vascular endothelial growth factor upregulates inducible nitric oxide synthase expression in the muscle flap ischemia model in the rat.

The purpose of this investigation was to elucidate the regulation of inducible nitric oxide synthase (iNOS) expression by vascular endothelial growth factor (VEGF) in a muscle flap ischemia model in rats. The gracilis muscle flap model was chosen. Sixty adult male Sprague Dawley rats were randomly divided into two groups (n = 30). After 4 hours ischemia, the experimental group received VEGF treatment, and the control group was given saline in the same fashion. At time intervals of 0, 2, 6, 12, and 18 hours (n = 6 for each time interval) after injection, tissue samples were biopsied for reverse transcriptase polymerase chain reaction, routine hematoxylin-eosin staining, and CD31 immunohistochemical staining. The result showed that iNOS expression is increased in the gracilis muscle flap ischemia model in rats compared with the control group within 6 hours after ischemia (p < 0.05). In the VEGF group, iNOS expression increased rapidly over the first 2 hours, but no statistically significant difference was observed at 12 and 18 hours between the two groups (p > 0.05). We concluded that the application of VEGF could maintain the structure of capillaries and upregulate iNOS expression during the first 6 hours after ischemia in the ischemic muscle flap of a rat model. These findings may provide the evidence to study the mechanism of VEGF in improving flap survival.