AIM: To investigate the volume percentage of infarct and expression of glucose transporter-1 (GLUT1) transcription and protein levels at different ischemic time point and different reperfusion time point in rat focal cerebral ischemic penumbra. METHODS: Focal ischemic models of middle cerebral artery occlusion (MCAO) in rats were made by inserting nylon thread. Brain samples were harvested from ischemic penumbra. Infarct volume were analyzed quantitively by Kontron IBAS 2.5 image auto-analyses system. The expressien of GLUT1 mRNA was assessed by RT-PCR, and the expression of GLUT1 protein was assessed by immunohistochemistry. RESULTS: The infarction volume in MCAO 1 h/reperfusion (R) group was obviously smaller than that in MCAO 3 h/R group. GLUT1 increased at (1 h) MCAO 1 h/R group, climbed to climax at 24 h and remained higher than normal at 1 week. In contrast, in the MCAO 3 h/R group, the corresponding index was at 3 h, 24 h and 1 week, but the increasing degree of GLUT1 was slighter than MCAO 1 h/R. GLUT1 protein began to ascend at 1 h, reached climax at 24 h and was higher than normal at 1 week in MCAO 1 h/R group, while in MCAO 3 h/R group, the corresponding index was at 3 h, 24 h and 1 week. CONCLUSION: GLUT1 expression is notably up-regulated in the penumbra region after focal cerebral ischemia, it may be a protective reaction against ischemic injury. [

AIM: To investigate the volume percentage of infarct and expression level of glucose transporter-3 (GLUT3) transcription and protein at different ischemic time points and different reperfusion time points in rat focal cerebral ischemic penumbra. METHODS: Focal ischemic models of middle cerebral artery occlusion (MCAO) in rats were made by inserting nylon thread. Brain samples were harvested from ischemic penumbra. Infarct volume was analyzed quantitatively by Kontron IBAS 2.5 image auto-analyses system. The change of GLUT3 mRNA was assessed by RT-PCR, and the expression of GLUT3 protein was assessed by immunohistochemistry. RESULTS: The infarction volume in MCAO 1 h/R group was obviously smaller than that in MCAO 3 h/R group. GLUT3 began to ascend at 3 h in MCAO 1 h/R group, reached to climax at 24 h and remained higher than normal at 1 week. In contrast, in the MCAO 3 h/R group, GLUT3 had a descent at 3 h. Later on, it ascended rapidly, and reached climax at 24 h. At 1 week, it approached to normal. The expression level of GLUT3 protein corresponds with that of mRNA. CONCLUSION: GLUT3 expression is up-regulated in the penumbra region after focal cerebral ischemia, it may be a protective reaction against ischemia/reperfusion injury. [

BACKGROUND: Recent researches indicate that ischemia and hypoxia can lead to abnormal brain metabolism and even energy failure, which is an important reason for brain damage and necrosis and identifies energy metabolism disorder as the key event in brain ischemia-reperfusion (IR)injury. Glucose transporter-3 plays the vital role in brain energy metabolism.OBJECTIVE: To observe the changes of cerebral infarct volume and glucose transporter-3 mRNA and protein expressions in cerebral cortical penumbra at different stages of focal cerebral ischemia and reperfusion in rats.DESIGN: Randomized controlled experiment.SETTING: Department of Neurosurgery, Second Hospital Affiliated to Sun Yat-sen University.MATERIALS: This experiment was conducted in the Animal Laboratory of Medical Research Center, Second Hospital Affiliated to Sun Yat-sen University between August and October 2002.Totally 56 SD rats were randomized into 3 groups which were subjected to ① ischemia for 1 hour followed by reperfusion (n=28), ② ischemia for 3 hours followed by reperfusion (n=24), and ③ sham operation (n=4). The rats in the first group were subdivided into 7 subgroups for examination at 1, 3, 6, 12, 24, and 72hours and 1 week after ischemia, with 7 rats in each subgroup; the rats in the second ischemia group were also subdivided in similar manner but without a 1 hour postischemic subgroup. The rats in the sham operation group only received the operation but without arterial occlusion.METHODS: Focal cerebral ischemia-reperfusion (IR) injury model was induced in the rats in the two ischemic groups by means of insertion of suture for arterial occlusion, and the ratio of central ischemic area to cerebral infarct volume in the ischemic penumbra was examined at the specified time points. Reverse transcription-PCR (RT-PCR) was used to detect the expression of glucose transporter-3 mRNA in the cerebral cortex in ischemic penumbra region, and semi-quantitative immunohistochemistry (IHC) employed to detect the level of glucose transporter-3 protein.MAIN OUTCOME MEASURES: Cerebral infarct volume after IR injury, changes of transporter-3 mRNA and protein expressions after IR injury.RESULTS: Totally 56 rats were used in this experiment and all entered result analysis. The post-IR cerebral infarct volume was obviously smaller in 1-hour ischemia group than in 3-hour ischemia group. Glucose transporter-3 mRNA expression began to increase 3 hours after ischemia in 1-hour ischemia group, reaching the peak level at 24 hours and still mainrained higher level than that of the sham operation 1 week; in 3-hour ischemia group, the mRNA expression was slightly decreased at 3 hours but began to increase afterwards till reaching the peak level at 24 hours, followed then by recovery of normal level at 1 week. The changes in glucose transporter-3 protein and mRNA expressions followed almost the same pattern.CONCLUSION: Glucose transporter-3 expression is up-regulated in the ischemic penumbra region, possibly as a protective response to cerebral IR injury.

Spinal cord injury is a difficult medical problem and need to be solved urgently.Application of tissue engineering to repair spinal cord injury has gradually become a hot spot.It is important to prevent the development of scar tissue while inducing cells' regeneration by using scaffold.Nanotechnology has improved the performance of scaffold because of its superiority.Nanoscaffold has obvious advantages compared with the traditional scaffolds.New scaffold materials can be obtained by nanotechnology.Nanoscaffold can also serve as a good drug carrier,and it may have beneficial effects on biological behaviors of seed cells on its surface,such as differentiation,proliferation and migration,which may promote tissue regeneration and functional recovery and get good results in repairment of spinal cord injury.This article summarized the research progress in recent years in nano spinal cord engineering scaffolds in order to provide a reference for research in related fields.

Objective:To investigate the feasibility and clinical efficacy of the bilobed anterolateral femoral perforator flap pidicled with the oblique branch of lateral femoral circumflex artery in repair of the wounds in extremities.Methods:A study was conducted on 36 patients with complex limb wounds from December, 2014 to May, 2020. Thirty patients had single-wound sized from 10.0 cm×10.0 cm to 23.0 cm×17.0 cm, and 6 patients had 2 adjacent and discontinuous wounds sized from 4.0 cm×5.0 cm to 11.0 cm×9.0 cm. A total of 78 perforators were identified in routine preoperative CDU examination, and 67 perforators were confirmed. According to the actual requirement of the perforator confirmed in surgery, 19 flaps were designed with completely split up into bilobed flaps and 17 bilobed fascial flaps were designed with segmented skin and deep fascia. The blood supply of flaps relies on the anastomosis of oblique branch with the recipient vessels, therefore bridged blood Flow-through anastomosis was performed in 8 flaps. All thigh donor sites were sutured directly. Regular follow-up were made after surgery.Results:In this group, 35 cases of bilobed flaps survived successfully. Venous crisis was found in 1 case of flap repairing 2 wounds after the operation and was relieved 7 days later by remove some stitches and bloodletting. The donor sites healed by first intension, and the wound healing time was 11-83 days. All patients were followed-up for 6-39 months. The flaps had good colour and texture with S 2-S 3 sensory. All the donor sites left linear scars except 1 where left with a large scar without contracture and pain. Conclusion:The repair of the wounds in extremities by bilobed anterolateral thigh perforator flaps pedicled with the oblique branch of the lateral femoral circumflex artery could obtain a more concealed donor site. It acts as a beneficial supplement when a bilobed flap cannot be harvested on the descending branch of the lateral femoral circumflex artery.

Objective To study the therapeutic effects of Bioenterics Intragastric Balloon (BIB) on obesity under gastroscopy.Methods Data of 47 patients treated with Bioenterics Intragastric Balloon under gastrscopy were reviewed from July,2010 to May,2011.Results Weight loss ( mean 15.4 kg ) was successfully achieved in all the patients during 6 months.BMI decreased by 3.2-6.4 kg/m2 ( mean 4.7 kg/m2 ).There was no serious side effect with a better result for obesity according to the follow-up.Conclusion BIB is effective for obesity for noninvasiveness,stable speed of weight loss and less pain.

Objective To establish the acquired tamoxifen (TAM)-resistant human breast cancer cell line T47D-TamR,compare the 18F-FDG uptake rate between T47D-TamR and its parental cell line T47D,and study the mechanism.Methods Long-term step-wise drug stimulation was used for cell line T47D-TamR establishment and then the cell proliferation and resistance index (RI) were determined by MTT assay.The 18F-FDG uptake rates of T47D-TamR and T47D cells were measured in the setting of different cell counts,reaction time,18F-FDG dosages and glucose concentrations.The LDH activity,cellular ATP level and lactic acid concentration in cell supernatant of T47D-TamR and T47D cells were detected.Western blot was used to examine the expression of ERα,Glut-1,phosphorylated AMPK (p-AMPK) and phosphorylated mTOR (p-mTOR).Two-sample t test and two-way analysis of variance were used to analyze the data.Results T47D-TamR cell line was successfully established and its drug RI was 1.97±0.08,with a significantly decreased cell proliferation efficacy (F =230.10,P＜ 0.05).Significant differences of 18 FFDG uptake rates were found between T47D-TamR cell and T47D cell when changing the cell count,reaction time,and 18F-FDG dosage (F values:419.00-1 116.00,all P＜0.05).The LDH activities of T47D cell and T47D-TamR cell were (0.42±0.04) and (0.32±0.02) U/mg protein,cellular ATP levels were (19.99±0.32) and (14.01±0.70) nmol/mg protein,lactic acid concentrations in cell supematant were (2.95±0.05) and (2.02±0.07) mmol/L,respectively.The differences of above parameters between the two groups were significant (t values:4.39-18.80,all P＜0.05).The relative expressions of ERα,p-AMPK,pmTOR,Glut-1 were 0.26±0.03,0.36±0.06,0.75±0.11,0.35±0.07 in T47D cell,and 0.17±0.02,0.61±0.09,0.52±0.08,0.21±0.04 in T47D-TamR cell,and there were significant differences (t values:12.20-16.45,all P＜0.05) between the two groups.Conclusions Compared with parental cells,T47D-TamR cells have lower 18F-FDG uptake rate,LDH activity,cellular ATP level and lactic acid concentration,increased p-AMPK expression and decreased ERα,p-mTOR,Glut-1 expression,indicating the decreased glycolysis ability in TAM-resistant breast cancer cells.

Objective:The morphological characteristics of the oblique branch of lateral circumflex femoral artery (LCFA) were observed by digital subtraction angiography (DSA) in order to provide imaging basis in the application of the ALTF pedicled with the oblique branch of LCFA.Methods:Between February, 2020 and December,2020, for the patients who were requested to repair the wound with ALTF, a DSA radiography was performed before operation. A total of 197 sides of selective DSA were analysed in 113 patients. The occurrence rate, origin and course of the oblique branch of LCFA were observed. Relationships between the oblique branch of LCFA and the upper cutaneous branch, descending branch and transverse branch were analysed. In addition, in order to verify the accuracy of conventional DSA data in describing the morphological characteristics of oblique branches, 10 sites of 10 patients were randomly selected to perform rotational DSA three-dimensional imaging.Results:Femoral artery, deep femoral artery, LCFA and the branches of LCFA were clearly identified on DSA images. The oblique branch appeared in 190 sites, with a occurence rate of 96%. Among them, 1 oblique branch originated from the femoral artery, 2 from the deep femoral artery, and other 187 from LCFA. The oblique branches were found in 10 sites from rotational DSA three-dimensional imaging, which was consistent with conventional DSA imaging.Conclusion:The occurrence rate and morphological characteristics of the oblique branch of LCFA can be directly analysed by DSA. The oblique branch is not a variant branch as reported in the literatures, as it always appears. It may serve the main blood supply artery of the anterolateral thigh flap.

Objective:To investigate the feasibility and clinical outcome of anterolateral thigh flaps (ALTF) based on the transverse branch of the lateral circumflex femoral artery (LCFA) as the source artery in the repair of soft tissue defects of the extremities.Methods:A retrospective analysis was conducted to analyze the clinical data from patients who received the ALTF pedicled with the transverse branch of the LCFA to repair the wounds of the extremities from April 2020 to March 2021 at Ruihua Affiliated Hospital of Soochow University. Preoperative Doppler ultrasound was applied to locate the perforators in the anterolateral thigh area. The ALTF was prepared based on the traditional method, and the perforators were found to be too thin to meet the requirements of vascular anastomosis. The incision was extended superiorly, and the designated perforators were found in the upper segment; thus, the flap was harvested accordingly. The ALTF pedicled with the transverse branch of the LCFA was finally harvested for wound reconstruction. The donor site was directly drawn and sutured. The wound healing of the donor site and the survival rate of the flap were recorded. The comprehensive evaluation scale was used to evaluate the repair effect, which was classified as excellent (90-100 points), good (75-89 points), fair (60-74 points), and poor (<60 points).Results:Thirteen patients with extremity trauma were enrolled in the study, which consisted of nine males and four females. The age range was between 20 and 65 years old. There were 4 cases of hand/forearm wounds and 9 cases of foot/ankle wounds among the patients. The area of soft tissue defects was approximately 7 cm×4 cm to 31 cm×8 cm. Eighteen perforators from the transverse branches of the LCFA, including ten septocutaneous perforators and eight direct cutaneous perforators, were observed in thirteen surgeries. The area of flaps ranged 8 cm×6 cm to 32 cm×10 cm. One flap exhibited arterial crisis, which was relieved after thrombectomy and re-anastomosis of the injured segment; the flap survived. Other flaps survived completely. Thirteen patients were followed up for 6-20 months, and both flaps were soft in texture and good in appearance. In addition, there were no serious complications at the donor site. Finally, the curative effects of the ALTF pedicled with the transverse branch of the LCFA were estimated according to the flap comprehensive evaluation scale. Four cases obtained excellent curative effects, seven cases had good prognoses, and the effects of the remaining two cases were acceptable.Conclusions:The ALTF pedicled with the transverse branch of the LCFA can be used to repair soft tissue defects of the extremities, with a good prognosis obtained; meanwhile, the anatomy of the perforators is simple, and the donor area is relatively inconspicuous. The flap can be a useful supplement to the conventional ALTF.

Objective:To explore the distribution characteristics of the perforators of the oblique branch of the lateral circumflex femoral artery, and to report the clinical effect of the anterolateral thigh flap pedicled with the oblique branch in repairing the wounds of the extremities.Methods:The clinical data of the patients with anterolateral thigh flap pedicled with oblique branch of lateral circumflex femoral artery in Suzhou Ruihua Orthopaedic Hospital from December 2020 to April 2021 were analyzed retrospectively. High frequency color Doppler ultrasound was used to detect the large perforators of the oblique branch of the lateral circumflex femoral artery near the midpoint of the line between the anterior superior iliac spine and the lateral margin of the patella. With reference to the location of the perforators, according to the size and shape of the defect in the recipient area, the anterolateral thigh flap pedicled with oblique branch was designed and dissected to repair the wound. During the operation, the distance between the emitting point of the main oblique branch, the skin entry point of the perforators and the anterior superior iliac spine was measured with a steel ruler, the diameter of the perforators was measured with a microscale, and the number of perforators was counted. The survival and complications of the flap were observed and followed up after operation. In the last follow-up, the comprehensive evaluation scale was used to evaluate the repair effect: 90 to 100 points is excellent, 75 to 89 points is good, 60 to 74 points is average, and less than 60 points is poor.Results:A total of 84 patients were included, including 62 males and 22 females, aged from 14 to 82 years (mean 46.9 years), including 32 cases of hand wounds, 6 cases of forearm wounds, 3 cases of upper arm wounds, 10 cases of calves and 33 cases of foot and ankle wounds. The wound area was 6 cm × 4 cm-20 cm × 45 cm. A total of 88 flaps were removed in 84 patients (skin flaps on both thighs were removed in 4 patients). The size of the skin flap of 88 thighs was 7 cm × 5 cm-37 cm × 11 cm, of which 85 sides of 82 cases survived completely. One case of diabetes had complete necrosis 1 month after operation, and 1 case of 34 cm had necrosis of the distal end of 3 cm × 3 cm skin flap. Necrotic skin flaps were repaired with skin grafting. Four patients developed arterial crisis within 24 hours after operation, and those flaps survived after surgical exploration. All donor areas healed. During the follow-up of 6 to 9 months, the shape of the recipient area was normal in all patients, and there was no deep tissue infection such as osteomyelitis. The color and texture of all flaps were good. The sensation returned to S1-S2 after operation. The skin flap comprehensive evaluation scale was used to evaluate the repair effect. The patients’ score ranged from 73 to 94 points, with an average of 88.1 points. Including 33 excellent cases, 46 good cases and 5 average cases, the excellent and good rate was 94.0%(79/84). A total of 215 perforators were marked with 88 flaps before operation, and 208 perforators were found during the operation(the diameter of the perforators was 0.4-1.5 mm), of which 130 were sent out by oblique branches. There were perforators of the oblique branch in all flaps, with an average of 1.5 on each side, including 84(64.6%) septocutaneous perforators and 46(35.4%) musculocutaneous perforators. Most of the oblique branches originate from the lateral circumflex femoral artery, which runs in the intermuscular septum between the rectus femoris and the intermediate femoris muscle. It is divided into deep branches and superficial branches at the middle and upper 1/3 junction of the line between the anterior superior iliac spine and the lateral margin of the patella. The skin perforators of the oblique branch of the lateral circumflex femoral artery is mostly sent out from the superficial branch, and there are 118 perforators located at the midpoint and proximal end of the line between the anterior superior iliac spine and the lateral margin of the patella, accounting for 90.8% (118/130), reaching a peak at 0.4 (there are 37 perforators).Conclusion:The oblique branch of the lateral circumflex femoral artery is relatively constant, and most of the perforators are located near the midpoint of the line between the anterior superior iliac spine and the lateral margin of the patella, and the proportion of septocutaneous perforator is high. The distribution of perforator is regular, the blood supply is reliable, the application mode is flexible, and the donor site position is more concealed while the blood supply of the flap is secured.