Objective To compare the efficacy of the reforming endoscopic minimally invasive releasing(REMIR) with open procedure for treatment of carpal tunnel syndrome.Methods Senventy patients with unilateral carpal tunnel syndrome were randomly divided into REMIR group and open procedure group,with 35 cases in each group.Kelly's standard,two-point discrimination,operation time and complication occurrence were compared between the two groups.Results All patients were followed-up for 12 months.There was no significant difference in the therapeutic results and in the improvement of two-point discrimination between the two groups (P ＞ 0.05 ).The operation time of REMIR group was significantly shorter than the open procedure group ([ 10.03 ± 1.84] min vs [37.63 ±7.18]min,t =22.210,P ＜0.001 ).And there was no cases with scar tenderness in REMIR group while there was 7 cases in open procedure group.Conclusion Compared with the open procedure,the REMIR method has the same clinical efficacy while with the advantages of causing smaller skin scar and being less time consuming.

Objective To examine the contribution of CD4+ CD25+ regulatory T cells to liver transplant tolerance. Methods After injection of anti-CD25 monoclonal antibody (mAb, PC61), mouse orthotopic liver transplantation was performed and survivals were determined. The paraffin-embedded sections of hepatic allografts were cut and stained with hematoxylin and eosin (HE). Furthermore, the effect of CD4+ CD25+ regulatory T cells on proliferative response of CD4+ T cells and cytotoxicity of CD8+ T cells was examined by depleting these regulatory T cells. Results Depletion of these cells in the recipients but not in the donors before liver transplantation caused rejection. Histological analyses of hepatic allografts with PC61 treatment showed extensive leukocyte infiltration and tissue destruction, whereas those in the control group showed minimal changes. Moreover, elimination of CD4+CD25+ T cells resulted in the enhancement of both proliferative response of CD4+ T cells and cytotoxicity of CD8+ T cells against donor-type alloantigen. Conclusions These results suggest that CD4+CD25+ regulatory T cells were important for tolerance induction to hepatic allografts.

Objective To investigate the expression of CXCR6 in allograft rejection and effect of CXCL16/CXCR6 interaction on allograft survival Methods Intra-abdominal heterotopic heart transplantation was performed using wild type (WT) Balb/c mice (H-2d) (allogeneic) as donors or WT C57BL/6 mice (B6, H-2b) (syngeneic) as donors, and using WT B6 mice as recipients. The intragraft expression of CXCR6 and expression of CXCR6 in CD8+ T cells of the spleens from syngeneic and allogeneic recipients were examined. The allogeneic recipients were further divided into the experimental group (n = 5) and control group (n = 6) randomly. The experiment group and control group were injected with anti-CXCL16 mAb or control mAb respectively until rejection occurred. The cardiac allograft survival in experimental group and control group was evaluated. Results Rejected allografts showed higher expression of CXCR6 than syngeneic cardiac grafts. More importantly,expression of CXCR6 in CD8+ T cells was also up-regulated by allograft rejection. However, injection of anti-CXCL16 mAb could not inhibit cytotoxic activity of CD8+ T cells. Moreover, experimental group could not prolong the cardiac graft survival time as compared with control group. Conclusion Expression of CXCR6 in CD8+ T cells is up-regulated in allograft rejection.

Objective:To explore the feasibility and clinical effect of modified tibial transverse transport (TTT) technique in treatment of severe diabetic foot.Methods:The research was carried out from November 2015 to November 2017 at the Department of Hand Microsurgery, Xiangya Hospital of Central South University. Red latex was used to perfuse 10 adult lower limb specimens through femoral artery. The study observed the occurrence rate of osteofascial cutaneous branches from the inner and posterior edge of tibia within 6.0 to 10.0 cm distal from the tibial tubercle, as well as the number, distribution, outer diameter and other indicators of the perforating cutaneous branches and periosteal branches. Combined with findings in the anatomical observation, a chimeric flap with a vessel of posterior medial tibial osteofascial cutaneous branch was designed to improve TTT in the treatment of diabetic foot. From February 2016 to November 2018, 12 patients with Wagner’s Grades Ⅲ and Ⅳ diabetic feet were treated. All the patients were treated with a modified TTT, with a piece of designed tibial bone flap at 10.0 cm × 2.5 cm in size. After surgery, 5 patients with gangrenous toes received various toe stump reconstruction surgery for removal of the external fixator for bone transport. Two patients had arch stone flap reconstructions for the wounds of heel and sole, 3 patients had the wounds self-healed, and 2 patients with Wagner’s Grade IV diabetic feet had proximal calf amputations. Postoperative follow-ups were run through visits of outpatient clinic, and meanwhile the preliminary effects of the surgical procedure were observed and summarised.Results:Among the 10 specimens, it was found that a total of 11 osteofascial cutaneous branches(2 branches in 1 case and 1 branch in 9 cases) branched out from the posterior edge of tibia within 6-10 cm distal to the tibial tubercle. The distance to the tibial tubercle was 9.23 cm± 0.62 cm, with an outer diameter at 1.10 mm ± 0.10 mm. After penetrating the deep fascia, the osteofascial cutaneous branch further branched out a skin branch with an outer diameter of 0.59 mm± 0.09 mm, and delivered blood supply to the medial skin of calf. Meanwhile, it also branched out a periosteal branch with an outer diameter of 0.85 mm ± 0.10 mm, and supplied blood to the medial periosteum of tibia. All surgery went smoothly. A significant increase of temperature in foot skin and a significant decrease in postoperative Visual Analogue Scale(VAS) score were found in comparison with what before the surgery( P<0.05). The follow-up time of 12 patients was 24-36(29.33 months ± 4.36 months). After surgery, the symptoms of pain and numbness in the affected limbs were significantly improved or even disappeared and the wounds in foot were completely healed in 10 patients. The wounds of TTT in the calf were all healed in stage-I. The segments of tibial bone transport were all completely healed with healing time of 6.17 months ± 0.83 months. The wounds of the 2 amputees healed well. Conclusion:Modified TTT bone graft can effectively promote wound healing and reduce complications by covering the wound with a posterior tibial medial fascia flap in the treatment of severe diabetic foot. Further studies are required to confirm the benefits to the patients from this modified surgical procedure.

Objective:To introduce a new surgical procedure for harvesting an iliac bone flap with deep iliac circumflex vessels—"retrograde anatomical method", and report the effect of preliminary application with this procedure.Methods:From June 2018 to May 2021, 15 patients who admitted in the Department of Hand and Microsurgery, Xiangya Hospital of Central South University received surgeries of iliac bone flap with deep iliac circumflex artery by "retrograde anatomical method". During the surgery, appropriate cutaneous perforators or muscular branches were found near the medial side of the iliac bone of iliac tubercle. The branches were dissected from surface inwards to the starting point of deep circumflex iliac blood vessel with microsurgery and micro Schlieren forceps. The iliac bone flap was chiselled out, inserted into femoral head, and then anastomosed with the transverse branches of deep circumflex iliac blood vessel and lateral circumflex femoral blood vessel. All patients were included in the postoperative follow-up at the outpatient clinic to evaluate the preliminary effect of this procedure. Harris scores before and after surgery were assessed with paired t test. P<0.05 was considered statistically significant. Results:The length of iliac bone flap was at 3.0-5.0(4.0±0.5) cm, and the length of vascular pedicle was at 4.0-7.0(5.3±1.0) cm. The time of iliac bone flap harvest was 35-55(45.0±6.1) minutes. During the operation, the success rate of harvesting iliac bone flap with deep iliac circumflex artery was 100%, and blood had oozed out of bone surface before the pedicle of all iliac bone flaps was cut-off. The volume of intraoperative autologous blood transfusion was 100-400(226.7±78.2) ml. One patient suffered from traction injury of lateral femoral cutaneous nerve in the operation. The numbness of anterolateral thigh area occurred on the 1st day after the surgery, and relieved 4 months later. Other 14 patients did not suffer from postoperative numbness in the area of anterolateral thigh. The amount of drainage from donor site for the iliac bone flap was 50-70 ml[(62.7±7.5) ml in average] after surgery. Incisions at the donor sites of iliac bone flap healed in stage I. Postoperative follow-up lasted between 3 months and 3 years. There was no incision hernia and other complication in the donor sites of the iliac bone flap. There was a significant difference in Harris scores between at 9, 12 and 18 months after surgery and that before the surgery, respectively( P<0.05). After 18 months, Harris score were at a better level. Conclusion:The "retrograde anatomical method" can quickly determine the nutrient vessels of an iliac bone flap with deep circumflex iliac vessels. The surgical procedure is relatively simple with safe and reliable anatomy. Donor site damage and postoperative complications are greatly minimised. This surgical technique can be considered to be applied clinically.

Objective To review the clinical characteristics of urethral prolapse in female children and summarize our experience of treatment.Methods A retrospective analysis of the clinical characteristics of 102 patients with urethral prolapse from January 2007 to December 2017 was conducted at The Children's Hospital of Zhejiang University School of Medicine.The age of the patients ranged from 8-156 months with an median of 80 months.The presenting symptoms in the 102 girls were:bleeding in 57 patients (55.9％),mass in 31 patients (30.4％),and dysuria/urinary frequency,urgent and pain in 14 patients (13.4％).In all,58 patients were managed conservatively with Sitz baths as their masses were small,39 underwent prolapse reduction under topical anesthesia and Sitz baths because their mass were large,and 5 patients were treated by excision of the prolapsed urethral mucosa with four-quadrant excisional technique because thrombosed urethral prolapse at first visit.Results A total of 89 patients were cured after conservative treatment (87.3％),8 patients were converted to surgical treatment because frequent recurrence with conservative treatment.No urethral stricture,active hemorrhage and recurrent were found in 13 patients after operation.Conclusions The most common clinical manifestations of urethral prolapse are urethral mass and bleeding.Most patients can be cured by conservative treatment.The patients whose symptoms were severe or suffered from frequent recurrence of urethral prolapse should be managed with surgical excision.