Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery
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|Website||Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi / Chinese Journal of Reparative and Reconstructive Surgery website|
|Other titles||Zhongguo xiufu chongjian waike zazhi, Chinese journal of reparative and reconstructive surgery|
|Material type||Document, Periodical, Internet resource|
|Document type||Internet Resource, Computer File, Journal / Magazine / Newspaper|
Publications in this journal
- [Show abstract] [Hide abstract] ABSTRACT: Objective: To determine the entry point and screw implant technique in posterior pedicle screw fixation by anatomical measurement of adult dry samples of the axis so as to provide a accurate anatomic foundation for clinical application. Methods: A total of 60 dry adult axis specimens were selected for pedicle screws fixation. The entry point was 1-2 mm lateral to the crossing point of two lines: a vertical line through the midpoint of distance from the junction of pedicle medial and lateral border to lateral mass, and a horizontal line through the junction between the lateral border of inferior articular process and the posterior branch of transverse process. The pedicle screw was inserted at the entry point. The measurement of the anatomic parameters included the height and width of pedicle, the maximum length of the screw path, the minimum distance from screw path to spinal canal and transverse foramen, and the angle of pedicle screw. The data above were provided to determine the surgical feasibility and screw safety. Results: The width of upper, middle, and lower parts of the pedicle was (7.35 ± 0.89), (5.50 ± 1.48), and (3.97 ± 1.01) mm respectively. The pedicle height was (9.94 ± 1.16) mm and maximum length of the screw path was (25.91 ± 1.15) mm. The angle between pedicle screw and coronal plane was (26.95 ± 1.88) degrees and the angle between pedicle screw and transverse plane was (22.81 ± 1.61) degrees. The minimum distance from screw path to spinal canal and transverse foramen was (2.72 ± 0.83) mm and (1.98 ± 0.26) mm respectively. Conclusion: According to the anatomic research, a safe entry point for C2 pedicle screw fixation is determined according to the midpoint of distance from the junction of pedicle medial and lateral border to lateral mass, as well as the junction between the lateral border of inferior articular process and the posterior branch of transverse process, which is confirmed to be effectively and safely performed using the entry point and screw angle of the present study.
- [Show abstract] [Hide abstract] ABSTRACT: Objective: To summarize the application status and progress of platelet-rich plasma (PRP) in clinical orthopedics. Methods: The recent related literature concerning the application of PRP in clinical orthopedics was extensively reviewed and analyzed. Results: Recently, a large number of clinical studies on PRP have been carried out, which are applied in bone defects or nonunion, spinal fusion, osteoarthritis and cartilage injuries, ligament reconstruction, muscle strain, tendon terminal diseases, and a variety of acute and chronic soft tissue injuries. Some results show certain effectiveness, while others demonstrate invalid. Conclusion: Easily drawing, achieving autologous transplantation, and the biological repair potential of the musculoskeletal tissues make PRP to be widely used in clinical orthopedics. However, there are still no uniform standards accepted and reliable clinical guidelines about the application of PRP. Furthermore, a variety of PRP products and their respective indications are also different. The clinical evidences with the greater sample size and higher quality are still needed to further support the safety and effectiveness of PRP in clinical orthopedics.
- [Show abstract] [Hide abstract] ABSTRACT: To investigate the influences of lactic acid (LA), the final degradation product of polylactic acid (PLA) on the proliferation and osteoblastic phenotype of osteoblast-like cells so as to provide theoretical basis for bone tissue engineering. Ros17/2.8 osteoblast-like cells were harvested and divided into 3 groups. In groups A and B, the cells were cultured with the medium containing 4, 8, 16, 22, and 27 mmol/L L-LA and D, L-LA, respectively. In group C, the cells were cultured with normal medium (pH7.4). The cell proliferation was determined with MTT method after 1, 3, and 5 days. The relative growth ratio (RGR) was calculated, and the cytotoxicity was evaluated according to national standard of China. In addition, the alkaline phosphatase (ALP) activity of cells cultured with medium containing 4 mmol/L L-LA (group A), 4 mmol/L D, L-LA (group B), and normal medium (group C) after 1 and 5 days were detected with ALP kits, and the relative ALP ratio (RAR) was calculated; after 21 days, the calcium nodules were tested with von Kossa staining method, and were quantitatively analyzed. When LA concentration was 4 mmol/L, the mean RGR of both groups A and B were all above 80%, and the cytotoxic grades were grade 0 or 1, which meant non-cytotoxicity. When LA concentration was 8 mmol/L and 16 mmol/L, groups A and B showed cytotoxicity after 5 days and 3 days, respectively. When LA concentration was above 22 mmol/L, cell proliferations of groups A and B were inhibited evidently after 1-day culture. At each LA concentration, RGR of group A was significantly higher than that of group B at the same culture time (P < 0.05) except those at 4 mmol/L after 1-day and 3-day culture. After 1 day, the RAR of group A was significantly higher than that of group B on 1 day (144.1% ± 3.2% vs. 115.2% ± 9.8%, P < 0.05) and on 5 days (129.6% ± 9.8% vs. 78.2% ± 6.9%, P < 0.05). The results of von Kossa staining showed that the black gobbets in group A were obviously more than those of groups B and C. The staining area of group A (91.2% ± 8.2%) was significantly higher than that of groups B (50.3% ± 7.9%) and C (54.2% ± 8.6%) (P < 0.05). The concentration and composition of LA have significant effects on the cell proliferation and osteoblastic phenotype of osteoblast-like cells.
- [Show abstract] [Hide abstract] ABSTRACT: To evaluate the characteristics, treatment, and effectiveness of grade III spoke heel injury in children. Between January 2007 and June 2013, 31 children with grade III spoke heel injuries were treated. There were 19 boys and 12 girls, aged from 3 to 12 years (mean, 5.2 years). The time from trauma to operation was 2 hours to 26 days (mean, 4.4 days). The soft tissue defects of the heels ranged from 3.5 cm x 2.5 cm to 8.0 cm x 4.5 cm, which all complicated with Achilles tendon and calcaneus tuberosity defects. In 16 cases of large Achilles tendon defects which can not be stretched straightly to calcaneus tuberosities, repair with sliding gastrocnemius musculocutaneous flaps (16 cm x 5 cm to 21 cm x 10 cm) and insertion reconstruction of the tendon were performed. In 15 cases of Achilles tendon defects which can be stretched straightly to calcaneus tuberosities, repair with reversed pedicled flap (4.0 cm x 2.5 cm to 8.0 cm x 4.5 cm) and insertion reconstruction of the tendon were given. Nerve anastomosis was not performed. The donor site was covered with split-thickness skin graft. All children were followed up 6 months to 4 years (mean, 13 months). The other flaps survived except 3 cases having partial necrosis. The color and appearance of the flaps were satisfactory, with no impact on wearing shoes and walking. The flaps recovered sensory function. As more follow-up time, the angle of dorsal flexion was gradually improved. Heel raising on one leg was restored. The bone amount of calcaneus tuberosity increased slowly based on X-ray films. Grade III spoke heel injury in children possesses peculiar features, surgical methods should be based on defects of Achilles tendon and soft tissue. Dorsal flexion of the ankle is obviously limited; as follow-up time goes on, the ankle function is progressively improved. However, long-term follow-up is needed.
- [Show abstract] [Hide abstract] ABSTRACT: Objective: To introduce the surgery method to reset and fix tibial plateau fracture without opening joint capsule, and evaluate the safety and effectiveness of this method. Methods: Between July 2011 and July 2013, 51 patients with tibial plateau fracture accorded with the inclusion criteria were included. All of 51 patients, 17 cases underwent open reduction and internal fixation without opening joint capsule in trial group, and 34 cases underwent traditional surgery method in control group. There was no significant difference in gender, age, cause of injury, time from injury to admission, side of injury, and types of fracture between 2 groups (P > 0.05). The operation time, intraoperative blood loss, incision length, incision healing, and fracture healing were compared between 2 groups. The tibial-femoral angle and collapse of joint surface were measured on X-ray film. At last follow-up, joint function was evaluated with Hospital for Special Surgery (HSS) knee function scale. Results: The intraoperative blood loss in trial group was significantly less than that in control group (P < 0.05). The incision length in trial group was significantly shorter than that in control group (P < 0.05). Difference was not significant in operation time and the rate of incision healing between 2 groups (P > 0.05). The patients were followed up 12-30 months (mean, 20.4 months) in trial group and 12-31 months (mean, 18.2 months) in control group. X-ray films indicated that all cases in 2 groups obtained fracture healing; there was no significant difference in the fracture healing time between 2 groups (t=1.382, P=0.173). On X-ray films, difference was not significant in tibial-femoral angle and collapse of joint surface between 2 groups (P > 0.05). HSS score of the knee in trial group was significantly higher than that of control group (t=3.161, P=0.003). Conclusion: It can reduce the intraoperative blood loss and shorten the incision length to use open reduction and internal fixation without opening joint capsule for tibial plateau fracture. Traction of joint capsule is helpful in the reduction and good recovery of joint surface collapse. In addition, the surgery without opening joint capsule can avoid joint stiffness and obtain better joint function.
- [Show abstract] [Hide abstract] ABSTRACT: To review the researches of in vivo kinematics in lumbar degenerative spondylolisthesis (DS). Related literature concerning the in vivo kinematics in patients with lumbar DS was extensively reviewed and comprehensively analyzed in 4 terms of the instability of lumbar DS, vertebral motion pattern, the morphological changes of spinal canal, and intraoperative biomechanical measurement. Whether there is lumbar segmental instability in lumbar DS patients is still controversial, which should be based on degenerative stage of lumbar spine and grade of slip. The hypomobility of the lumbar spinous processes and the facet joint is seen in DS. The diameter, cross-sectional area, and volume of spinal canal in lumbar DS patients are significantly smaller than those of the normal control. Because of its invasive procedure and medical ethics, the use of the intraoperative measurement device is limited. These reported researches of in vivo kinematics in DS are almost on the sagittal plane. However, few data have been reported on the 6-degree-of-freedom (6DOF) kinematics of the diseased levels under physiological loading conditions. The 6DOF kinematics data can accurately reflect the segmental motion characteristics in lumbar DS patients, recent studies have been reported, further studies are still needed.
- [Show abstract] [Hide abstract] ABSTRACT: Objective: To explore the effectiveness of retrograde island neurocutaneous flap pedicled with lateral antebrachial cutaneous nerve in the treatment of soft tissue defect of the hand. Methods: Between October 2011 and December 2013, 17 cases of skin and soft tissue defects of the hands were treated. There were 8 males and 9 females, aged 23-62 years (mean, 44 years). Of them, defect was caused by trauma in 13 cases, by postoperative wound after degloving injury in 2 cases, and by resection of contracture of the first web in 2 cases; 13 cases of traumas had a disease duration of 2-6 hours (mean, 3.5 hours). The defect sites located at the back of the hand in 5 cases, at the radial side of the palm in 4 cases, at the first web in 2 cases, at the palmar side of the thumb in 4 cases, and at the radial dorsal side of the thumb in 2 cases. The bone, tendons, and other deep tissue were exposed in 15 cases. The defect size varied from 3 cm x 3 cm to 12 cm x 8 cm. The size of the flaps ranged from 3.6 cm x 3.6 cm to 13.2 cm x 8.8 cm. The lateral cutaneous nerve of the forearm was anastomosed with the cutaneous nerve of the recipient sites in 9 cases. The donor sites were repaired by free skin graft or were sutured directly. Results: The other flaps survived, and obtained healing by first intention except 2 flaps which had partial necrosis with healing by second intention at 1 month after dressing change. The skin graft at donor site survived, and incisions healed by first intention. All patients were followed up 5-30 months (mean, 12 months). The flaps had good color and texture. Flap sensory recovery, of S2-S3+ was obtained; in 9 cases undergoing cutaneous nerve flap anastomosis, the sensation of the flaps recovered to S3-S3+ and was better than that of 8 cases that the nerves were disconnected (S2-S3). The patients achieved satisfactory recovery of hand function. Only 2 cases had extended limitation of the proximal interphalangeal joint. At last follow-up, according to the Chinese Medical Society of Hand Surgery function evaluation standards, the results were excellent in 15 cases and good in 2 cases. Conclusion: Retrograde island neurocutaneous flap pedicled with lateral antebrachial cutaneous nerve is an effective way to repair skin defects of the hand, with the advantages of reliable blood supply and simple surgical procedure.
- [Show abstract] [Hide abstract] ABSTRACT: To review the research progress of induced osteogenesis of bone marrow mesenchymal stem cells (BMSCs) transfected by double-gene. The recent literature concerning the comparative research of induced osteogenesis of BMSCs transfected by double-gene was extensively reviewed. The characteristics of BMSCs, the advantage and effect of synergistic inductive osteogenesis, the application prospect and problems of BMSCs transfected by double-gene were summarized. The effect of induced osteogenesis concerning BMSCs transfected by double-gene is far superior to single gene transfection and the activity of osteoblast is also significantly increased. The research used in bone tissue engineering experiment also obtain good effect. Induced osteogenesis of BMSCs transfected by double-gene is able to make up for the lack of a single gene transfection and has great development prospects in the orthopaedic field.
- [Show abstract] [Hide abstract] ABSTRACT: To summarize the recent development of the magnetic compression anastomosis in surgery. The abroad and domestic relevant literature about magnetic compression anastomosis was extensively reviewed, and comprehensive analyzed. Magnetic compression anastomosis in the reconstruction of the body lumen is a simple and effective way; laparoscopy combined with magnetic compression anastomosis has the advantages of small wound and quick recovery. Magnetic compression anastomosis has been increasingly used in clinical practice. But its mechanism has not been fully revealed, and it is difficulty in expelling out of the magnet for the gastrointestinal and certain large-size lumen, so further research and optimization are still needed. Relative to the traditional manual suture, magnetic anastomosis has great advantage, especially a combination of magnetic compression anastomosis and minimally invasive surgery has bright prospects for development.
- [Show abstract] [Hide abstract] ABSTRACT: To review the mechanism and research progress of signaling pathways which play key roles in the regulation of osteoblast differentiation and bone formation. Recent articles about signaling pathways of osteoblast differentiation and bone formation were reviewed and comprehensively analyzed. At present, multiple signaling pathways have been found to be involved in the regulation of osteoblast differentiation and bone formation, among which bone morphogenetic protein-Smads, Wnt/β-catenin, Notch, Hedgehog, and fibroblast growth factor signaling pathways may play the most important roles. Not only each pathway has a complex regulatory mechanism itself, but also contacts and impacts with each other, thus they formed a more complicated and sophisticated regulatory network, and regulate together osteoblast differentiation and bone formation. However, the mechanisms in detail of those pathways are still not very clear, because the animal experiment techniques are not yet mature as well as the relevant clinical trials were carried out not too much. The complete molecular mechanism of osteoblast differentiation and bone formation should be further investigated, so as to lay a theory foundation for preventing and treating the common bone diseases in clinical which are involve in osteoblast differentiation and bone formation.
- [Show abstract] [Hide abstract] ABSTRACT: To investigate the efficiency of total knee arthroplasty (TKA) for varus osteoarthritic knees with tibial bone resection determined by lateral tibiofemoral joint 90° flexional gap measurement. Between March and June 2013, 60 patients (60 knees) with varus osteoarthritic knees underwent TKA. All patients were randomly divided into traditional osteotomy group (control group, 30 cases) and lateral tibiofemoral joint 90° flexional gap measurement resection group (trial group, 30 cases). There was no significant difference in gender, age, affected side, body mass index and preoperative knee society score (KSS), range of motion (ROM) of the knee, anatomic tibiofemoral angle (ATFA), patellar tilt angle, posterior condylar offset (PCO), and joint line height between 2 groups (P > 0.05). The bone resection thickness of the distal femoral lateral condyle, femoral posterior lateral condyle, and lateral tibial plateau were measured; and the X-ray films were taken to measure and compare ATFA, patellar tilt angle, PCO, and joint line height after TKA. The knee function recovery was evaluated with KSS score and ROM of the knee. The bone resection thickness of the lateral tibial plateau and distal femoral lateral condyle in trial group was significantly smaller than that in control group (P < 0.05); while the bone resection thickness of the femoral posterior lateral condyle was significantly bigger than that in control group (P < 0.05). The 10 mm polyethylene insert was used in 19 cases of the trial group and in 8 cases of the control group, showing significant difference (Z= -4.040, P=0.003). All the patients were followed up 13-16 months (mean, 14.5 months). Radiography at 6 weeks after TKA indicated that the ATFA, patellar tilt angle, and joint line height had no significant difference between 2 groups (P > 0.05); the PCO of trial group was significantly lower than that of control group (P < 0.05). The KSS score and ROM of the knee at 12 months after operation were significantly improved when compared with preoperative ones in 2 groups (P < 0.05), and trial group was significantly better than control group (P < 0.05). It was an effective method to determine bone resection thickness using lateral tibiofemoral joint 90° flexional gap measurement in TKA for varus osteoarthritic knees, which can reduce the bone resection thickness of the tibial plateau and distal femoral lateral condyle and restore the joint line and PCO with better early recovery of the knee function.
- [Show abstract] [Hide abstract] ABSTRACT: To review the current status and advances of in vivo nucleic acid delivery mediated by poly(ethylenimine) (PEI). The related home and abroad literature about nucleic acid delivery with applications in cancer treatments and tissue engineering was extensively reviewed and analyzed. A variety of in vivo study on the potential of PEI-mediated nucleic acid delivery has been carried out and made certain effects in the animal model, ranging from cancer treatments to rectification of physiological defects (eg. cranial defect and corneal epithelium defect). Tail vein injection is the most commonly adopted route of administration in vivo, followed by pulmonary administration and intralesional injection. However, transfection and expression in vivo have some shortcomings, such as low transfection efficiency and short expression time, so there are some limitation in the clinical application. PEI mediated nucleic acid delivery provides a good method for cancer treatments and rectification of physiological defects. For future research, not only should more in vivo animal testing be done, but the procedures of experimentation also need to be standardized.
- [Show abstract] [Hide abstract] ABSTRACT: To investigate the effect of power-assisted intravascular shunt in replantation of amputated limbs of rabbits. Eighty rabbits weighing 1.8-2.5 kg (male or female) were selected to establish the model of circular amputation at the hind groin, only femoral arteries and veins were completely preserved. After the femoral artery was clamped in 60 rabbits, the rabbits underwent power-assisted intravascular shunt with high-flow rate (group A, n=20), power-assisted intravascular shunt with low-flow rate (group B, n=20), and no power-assisted intravascular shunt (group C, n=20) to reconstruct blood supply; the femoral artery was not clamped in another 20 rabbits of sham group (group D). Before and after intravascular shunt (1, 3, 6, and 12 hours), the malondialdehyde (MDA), lactate dehydrogenase (LDH), and creatine kinase (CK) of the serum were determined. The myeloperoxidase (MPO), MDA, and wet to dry weight ratio (W/D ratio) of the gastrocnemius muscle were measured, and the thrombogenesis and survival rate of limb were observed. Before intravascular shunt, MDA, LDH, and CK of the serum and MPO, MDA, and W/D ratio of the muscle showed no significant difference among 4 groups (P > 0.05). At each time point after intravascular shunt, no significant difference was found in all indexes between groups A and D (P > 0.05); the indexes of groups B and C were significantly higher than those of groups A and D (P < 0.05); the values were the highest in group C (P < 0.05), and reached the peak at 12 hours. All limbs of group A survived with low thrombosis rate, and less limbs could survive with high thrombosis rate in group C. The power-assisted intravascular shunt with high-flow rate can effective ensure the blood supply of the amputated limbs of rabbits with lower limb injury and higher survival rate of amputated limbs after replantation.
- [Show abstract] [Hide abstract] ABSTRACT: To evaluate the effect of bone cement filling on articular cartilage injury after curettage of giant cell tumor around the knee. Fifty-three patients with giant cell tumor who accorded with the inclusion criteria were treated between January 2000 and December 2011, and the clinical data were retrospectively analyzed. There were 30 males and 23 females, aged 16-69 years (mean, 34.2 years). The lesion located at the distal femur in 28 cases and at the proximal tibia in 25 cases. According to Campanacci grade, there were 6 patients at grade I, 38 at grade II, and 9 at grade III. Of 53 patients, 42 underwent curettage followed by bone cement filling, and 11 received curettage followed by bone grafts in the subchondral bony area and bone cement filling. Two groups were divided according to whether secondary osteoarthritis occurred or not during postoperative follow-up. The gender, age, lesion site, the subchondral residual bone thickness, tumor cross section, preoperative Campanacci grade, subchondral bone graft, and Enneking function score were compared between 2 groups, and multivariate logistic regression analysis was done. All incisions healed by first intention. The average follow-up time was 65 months (range, 23-158 months). Of 53 cases, 37 (69.8%) had no osteoarthritis, and 16 (30.2%) had secondary osteoarthritis. Three cases (5.7%) recurred during the follow-up period. Univariate logistic regression analysis showed no significant difference in gender, age, lesion site, and Campanacci grade between 2 groups (P > 0.1); difference was significant in the subchondral residual bone thickness, tumor cross section, Enneking function score, and subchondral bone graft (P < 0.1). The multivariate logistic regression analysis showed that the decreased subchondral residual bone thickness, the increased tumor cross section, and no subchondral bone graft are the risk factors of postoperative secondary osteoarthritis (P < 0.05). Curettage of giant cell tumor around the knee followed by bone cement filling can increase the damage of cartilage, and subchondral bone graft can delay or reduce cartilage injury.
- [Show abstract] [Hide abstract] ABSTRACT: To evaluate the effectiveness of transforaminal lumbar interbody fusion (TLIF) via Luxor retractor associated with Mantis pedicle screw for the treatment of moderate or severe lumbar spondylolisthesis (LSL). A retrospective analysis was made on the clinical data of 32 patients with LSL treated with TLIF via Luxor retractor associated with Mantis pedicle screw between June 2010 and June 2012. There were 20 males and 12 females, with the mean age of 48 years (range, 36-69 years). LSL occurred at the L4,5 in 17 patients and at the L5, S1 in 15 patients. Of them, 18 cases were rated as Meyerding grade II, and 14 cases as grade III. The disease duration was 8 months to 6 years (mean, 3.5 years). The operation time, intraoperative blood loss, and preoperative and postoperative (1 week and 1 year) intervertebral height and slipping angle were recorded, and the slipping rate was calculated; Japanese Orthopaedic Association (JOA) score was used for clinical efficacy assessment. The operation time was 90-130 minutes (mean, 110 minutes); intraoperative blood loss was 120-300 mL (mean, 210 mL). Incisions healed by first intention. All patients were followed up 24-36 months (mean, 28 months), and no complications of leakage of cerebrospinal fluid and nerve root injury occurred; X-ray films showed satisfactory reduction of spondylolisthesis and good position of pedicle screw and interbody fusion cage. The mean bone fusion time was 4.0 months (range, 3.8-6.0 months). The JOA score, slipping rate, slipping angle, and intervertebral height at 1 week and 1 year after operation were significantly improved when compared with preoperative ones (P < 0.05), but no significant difference was found between at 1 week and at 1 year after operation (P > 0.05). TLIF via Luxor retractor associated with Mantis pedicle screw fixation is a safe and effective minimally invasive technique in treating moderate or severe LSL.
- [Show abstract] [Hide abstract] ABSTRACT: To review the research progress focused on the effects of strontium ranelate (SR) on osteoarthritis. The relevant literature about the effects and mechanism of SR intervening osteoarthritis in recent years was extensively reviewed and comprehensively analyzed. SR not only could improve the microenvironment of bone metabolism in articular cartilage with osteoarthritis, promote activity of osteoblasts, and inhibit activity of osteoclasts, but also could adjust the expression of key proteases which affect cartilage formation, and therefore it has a potential protective effect on subchondral bone during the progression of osteoarthritis cartilage. SR is expected to become a drug of osteoarthritis disease remission, but further studies are needed to clarify the mechanism of SR in osteoarthritis, and finally confirm the best application dosage of SR in osteoarthritis treatment.
- [Show abstract] [Hide abstract] ABSTRACT: To investigate the expression of p16INK4a in nucleus pulposus (NP) and to clarify its relationship with intervertebral disc degeneration so as to provide evidence for biological repair of intervertebral disc. The NP specimens were obtained from 17 patients with intervertebral disc degeneration undergoing discectomy, who aged 40-50 years (mean, 45.4 years). Based on the preoperative MRI, there were 10 cases of grade III degeneration, and 7 cases of grade IV degeneration. Cell senescence was evaluated by detecting senescence-associated β-galactosidase (SA-β-gal) activity. Senescence marker (p16INK4a) and disc degeneration markers [A disintegrin and metalloproteinase with thrombospondin motifs 5 (ADAMTS 5), Aggrecan, and Sry-related HMG box transcription factor 9 (Sox-9)] were determined in the NP specimens with immunohistochemistry and Western blot. The correlation between ADAMTS 5 and p16INK4a was analyzed. Clustered distribution of green SA-β-gal-positive cells was seen in the NP with grade III and IV degeneration. A few single round SA-β-gal-positive NP cells (NPCs) wrapped by the layered extracellular matrix were also seen in the NP with grade III degeneration. It was difficult to see single distribution of NPCs in the NP with grade IV degeneration. The percentage of SA-β-gal-positive cells was 22.7% ± 5.4% and 37.1% ± 7.6% in the NP with grade III and IV degeneration respectively, showing significant difference (t=-9.666, P=0.000). The percentages of p16INK4a-positive and ADAMTS 5-positive NPCs in the NP with grade IV degeneration were significantly higher than those with grade III degeneration (P < 0.05). The percentages of Aggrecan-positive and Sox-9-positive NPCs in the NP with grade IV degeneration were significantly lower than those in the NP with grade III degeneration (P < 0.05). The protein expressions of Aggrecan and Sox-9 in the NP with grade IV degeneration were significantly lower than those in the NP with grade III degeneration (P < 0.05). The NP with grade IV degeneration showed significantly higher protein expressions of p16INK4a and ADAMTS 5 (P < 0.05). Importantly, there was a good correlation between p16INK4a and ADAMTS 5 protein expressions (r=0.908, P=0.000). Premature senescent NPCs increase in the NP with the advancing disc degeneration. The expression of p16INK4a and its association with degeneration grades suggest that the p16INK4a may play a significant role in the pathogenesis of intervertebral disc degeneration.
- [Show abstract] [Hide abstract] ABSTRACT: Objective: To investigate the protective effects of carboxymethylated chitosan (CMCS) on oxidative stress induced apoptosis of Schwann cells (SCs), and the expressions of brain derived neurotrophic factor (BDNF) and glial cell line derived neurotrophic factor (GDNF) in oxidative stress induced SCs. Methods: Twenty-four 3-5 days old Sprague Dawley rats (weighing 25-30 g, male or female) were involved in this study. The bilateral sciatic nerves of rats were harvested and SCs were isolated and cultured in vitro. The purity of SCs was identified by immunofluorescence staining of S-100. SCs were treated with different concentrations of hydrogen peroxide (H2O2, 0.01, 0.10, and 1.00 mmol/L) for 3, 6, 12, and 24 hours to establish the apoptotic model. The cell counting kit 8 (CCK-8) and flow cytometry analysis were used to detect the cell viability and apoptosis induced by H2O2, and the optimal concentration and time for the apoptotic model of SCs were determined. The 2nd passage SCs were divided into 5 groups and were treated with PBS (control), with 1.00 mmol/L H2O2, with 1.00 mmol/L H2O2 + 50 μg/mL CMCS, with 1.00 mmol/L H2O2 + 100 μg/mL CMCS, and with 1.00 mmol/L H2O2 + 200 μg/mL CMCS, respectively. After cultured for 24 hours, the cell viability was assessed by CCK-8, cell apoptosis was detected by flow cytometry analysis, the expressions of mRNA and protein of BDNF and GDNF were detected by real-time quantitative PCR and Western blot. Results: The immunofluorescence staining of S-100 indicated the positive rate was more than 95%. CCK-8 and flow cytometry results showed that H2O2 can inhibit the proliferation of SCs and induce the SCs apoptosis with dose dependent manner, the effect was the most significant at 1.00 mmol/L H2O2 for 24 hours; after addition of CMCS, SCs exhibited the increased proliferation and decreased apoptosis in a dose dependent manner. Real-time quantitative PCR and Western blot analysis showed that 1.00 mmol/L H2O2 can significantly inhibit BDNF and GDNF expression in SCs when compared with control group (P < 0.05), 50-200 μg/mL CMCS can reverse the oxidative stress-induced BDNF and GDNF expression in SCs in a dose dependent manner, showing significant difference compared with control group and 1.00 mmol/L H2O2 induced group (P < 0.05). There were significant differences among different CMCS treated groups (P < 0.05). Conclusion: CMCS has the protective stress on oxidative stress induced apoptosis of SCs, and may promote the BDNF and GDNF expressions of neurotrophic factors in oxidative stress induced SCs.
- [Show abstract] [Hide abstract] ABSTRACT: To assess the effectiveness of the sural fasciomyocutaneous perforator flap in repair of soft tissue defect in weight-bearing area of the foot. Between January 2007 and September 2010, 19 patients with soft tissue defects in the weight-bearing area of the foot were treated with sural fasciomyocutaneous perforator flaps. The etiology was traffic accident in 16 patients and crush injury in 3 patients. The interval of injury and admission was 2 hours to 14 days. The size of defect ranged from 8 cm x 6 cm to 26 cm x 16 cm; the size of flap ranged from 7 cm x 7 cm to 25 cm x 12 cm. The donor sites were repaired by free skin graft. The flap survival was observed after operation, and the pain score and sensory recovery at the recipient site were used to assess the effectiveness. The flaps survived with satisfactory aesthetic and functional results in 18 cases. Partial flap necrosis was noted and second healing was achieved after split thickness skingrafting in 1 case. One case of delayed ulceration was also noted after 5 weeks, ulceration was successfully cured after wound care and avoidance of weight-bearing for 2 weeks. All patients were followed up 9-25 months (mean, 14.1 months). The flaps had good appearance, without bulky pedicle. Superficial sensation and deep sensation were restored in 17 cases (89.4%) and 18 cases (94.7%) respectively at last follow-up. Sural fasciomyocutaneous perforator flap is a reliable modality in heel reconstruction, having the advantages of low ulceration rate, good wear resistance, and good sensation recovery.
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