Objective To report the functional reconstruction and rehabilitation for a patient who under- went allograft for both of his forearms and hands.Methods One male patient underwent allograft for both of his forearms and hands in October 2002 in our department to reconstruct his hand functions.The allografted hands were intervened with an integrated rehabilitation program,which involved administration of immunosuppressants,post- operative monitoring,postoperative functional training,massage,physiotherapy,orthosis,performance training, sensation training,secondary operation and mental rehabilitation.The patient was followed up for 4 years.Results The forearms and hands of the patient were in good shape and regained nearly normal sensation.The distance of two-point-discrimination was 2.5 cm to 4.0cm.The TAM (total active motion) of fingers was fine.The patient could look after himself well and were healthy in psychology.Conclusion An integrated rehabilitation program can yield satisfactory results in the management of allografted forearms and hands.

Objective To study the relationship between lymph node micrometastasis in early gastric cancer and clinicopathology of tumor,and explore an appropriate operative procedure.Methods A total of 1 004 lymph nodes from 50 patients with early gastric cancer(EGC)were sliced and restained with H.E and immunohistochemical technique,respectively.Immunohistochemical staining was performed by the streptavidin-biotin immunoperoxidase method with cytokeratin-specific monoclonal antibody CAM5.2.The relationship between lymph node micrometastasis and clinicopathological characteristics of primary tumors and prognosis of EGC was analysed.Results The incidence of nodal micro-involvement was significantly increased in diffuse type cancerous lesions(n=11,32.35%)as compared with intestinal type cancerous lesions(n=1,6.25%)(P

OBJECTIVETo explore the differentiation and the variant expression of protein of the bone marrow stromal stem cells (BMSCs) when the BMSCs differentiated into the neuronal cells in the analogous micro-environment of spinal cord injury.

METHODSBMSCs were isolated from bone marrow of Wistar rats and labeled with PKH26 (control group), and then were cocultured with neural cells, which were isolated from the spinal cord of the fetal rats, in the same plate well (co-culture group) or in the two-layer Petri well (two-layer group). Eight days later, the BMSCs were identified by immunofluorescence staining of NSE and GFAP respectively. The apparently changing proteins were analyzed by SELDI-TOF-MS while the BMSCs differentiated into neurons.

RESULTSEight days after co-culturing with neural cells in the same plate well or in the two-layer Petri well, BMSCs appeared more similar with neural cells. The immunofluorescence identification showed that, NSE and GFAP of which the BMSCs of the two-layer group expressed were obviously higher than control group (P < 0.05); and these two proteins of co-culture group were also obviously higher than the other two groups (P < 0.05). Five proteins in the co-culture group changed obviously as followed: TIP39_RAT and CALC_RAT were 5.360 and 2.807 times of that in the control group; INSL6_RAT, PNOC_RAT and PCSK1_RAT were 38.0, 49.9 and 43.8 percent of those in the control group.

CONCLUSIONSBMSCs could differentiate into neural cells in vitro, and the differentiation ratio of BMSCs in the co-culture group is higher than that of the two-layer group. Five proteins, including TIP39_RAT, CALC_RAT, INSL6_RAT, PNOC_RAT and PCSK1_RAT, are correlated closely to the mechanisms of which the BMSCs differentiated into neurons.

Animals ; Bone Marrow Cells ; cytology ; metabolism ; Cell Differentiation ; Cells, Cultured ; Coculture Techniques ; Glial Fibrillary Acidic Protein ; metabolism ; Mesenchymal Stromal Cells ; cytology ; metabolism ; Neurons ; cytology ; Phosphopyruvate Hydratase ; metabolism ; Rats ; Rats, Wistar ; Spinal Cord Injuries ; surgery

BACKGROUNDAfter injury, axonal regeneration of the adult central nervous system (CNS) is inhibited by myelin-derived growth-suppressing proteins. These axonal growth inhibitory proteins are mediated via activation of Rho, a small GTP-binding protein. The activated form of Rho, which is bound to GTP, is the direct activator of Rho kinase (ROCK) through serial downstream effector proteins to inhibit axonal regeneration. The objective of this study was to observe the therapeutic effect of inactivation of the Rho-ROCK signaling pathway to promote neurologic recovery after spinal cord injuries in rats.

METHODSOne hundred and twenty adult female Sprague-Dawley rats were randomly divided into three groups. Laminectomies alone were conducted in 40 rats in the sham group. Laminectomies and spinal cord transections were performed in 40 rats in the control group (treated with normal saline administered intraperitoneally). Laminectomies and spinal cord transections were performed in 40 rats in the fasudil-treated group (treated with fasudil administered intraperitoneally). Neurologic recovery was evaluated before surgery and 3 days, and 1, 2, 3, and 4 weeks after surgery using the Basso-Beattie-Bresnahan (BBB) scale of hind limb movement. At the same time, the expression of RhoA mRNA was determined with RT-PCR. Histopathologic examinations and immunofluorescence staining of NF were performed 1 month after surgery.

RESULTSCompared with the control group, the BBB scores of the fasudil-treated group were significantly increased and the expression of RhoA mRNA was significantly decreased. In the fasudil-treated group, a large number of NF-positive regenerating fibers was observed; some fibers crossed the slit of the lesion.

CONCLUSIONInactivation of the Rho-ROCK signaling pathway promotes CNS axonal regeneration and neurologic recovery after spinal cord injuries in rats.

Animals ; Female ; Fluorescent Antibody Technique ; Nerve Regeneration ; Rats ; Rats, Sprague-Dawley ; Signal Transduction ; physiology ; Spinal Cord Injuries ; pathology ; physiopathology ; psychology ; therapy ; rho-Associated Kinases ; antagonists & inhibitors ; physiology ; rhoA GTP-Binding Protein ; antagonists & inhibitors ; physiology

Objective To observe the effect of inducible costimulator(ICOS) costimulation pathway blockade in rat limb allografts acute rejection by RNA interference. Methods Twenty-seven cases of modified hind llmb allotransplantation were performed from Wistar to SD rats. The rats were divided into 3 gronps(each n=9): the rejection group not given a special disposal; the control group, consisting of SD rats that received injection of pSilencer 4.1 and Sofast complex by vein post transplantation; and the interference group that received injection of pSilencer 4.1-ICOSshRNA and Sofast complex. On the eighth day posttransplantation, 3 rats were killed to study the pathological changes in each group. The expressions of ICOS gene in vivo were detected by flow cytometry and RT-PCR. The mixed lymphocyte reaction (MLR) was performed and eytokines in blood were measured by ELISA. The rest rats were used to record limb survival time. Results The mean survival time in rats of the rejection and the control groups were(11.34±1.21) and (11.14±1.32) days respectively. In the interference group, the mean survival time of limb allografts was (16.85±1.73) days(P<0.05). The rats in the rejection and the control groups experienced moderate to serious acute rejections with skin epidermal necrosis, a large quantity of lymphocyte infdtration, muscle cell necrosis and interstitial edema, while the pathological changes in rats of the interference group were mild. The splenocyte ICOS mRNA expression level in the interference group(18.75%) was significantly lower than that of the rejection group(100%) and the control group(98.51%). ICOS cell surface expression level as judged by the fluorescence intensity was 45.59±12.87 in the interference group, 103.72±21.76 in the rejection group, and 93.47±29.55 in the control group(F=6.89, P<0.05). In stimulation assays, a one-way mixed lymphocyte reaction stimulation index(SI), with spleen cells from Wistar and Lewis rats, respectively, the rejection group (5.26±0.42,5.18±0.29) and the control group (5.37±0.27,4.93±0.44) had significantly greater reactions than the interference group(2.37±0.35, 4.87±0.36), respectivily(F=7.29, P<0.05; F=6.19, P0.05). In the IFN-γ and IL-4 expression assays, reactions of the interference group (230.17±38.47,160.32±59.13) were lower than those of the rejection group(490.73±51.48,230.67±45.21) and the control group(480.15±43.96, 240.53± 47.36), (F=7.23,6.75, all P<0.01). Conclusions In vivo transfection of pSilencer 4.1-ICOS shRNA interference plasmid can effectively block T-cell co-stimulation pathway, suppress acute rejection, and prolong limb allografts survival.

Finite element analysis (FEA) is broadly used in engineering, it was initially applied to simulate and solve a variety of engineering mechanics, thermal, electromagnetics, and other physical problems. The principle is a collective to be composed by an infinite number of particles, and an unlimited number of degrees of freedom from the continuum approximation. Brekelmas and Ryblcki firstly applied the finite element method to orthopedic biomechanics research in 1972. The first cervical vertebra finite element model was established in 1982 by Hosey. With the computer and software technology advances in the past 20 years, finite element method in cervical spine biomechanics studies is increased and widespread.
Biomechanical Phenomena ; Cervical Vertebrae ; anatomy & histology ; physiology ; Finite Element Analysis ; Humans ; Models, Anatomic ; Models, Biological ; Movement

Objective:To explore the effect of Wnt/β-catenin signaling pathway on growth plate development of tibial growth plate in young chronic renal failure (CRF) rats.Methods:Four-week-old male SD rats were randomly divided into control group and CRF group ( n=20/per group). Control group was intragastric administration with distilled water, and CRF group was given adenine suspension (150 mg·kg -1·d -1). All the young rats were sacrificed after continuous gavages for 6 weeks. The full length of tibia was compared between the two groups. The width of tibia proximal growth plates was measured by micro-CT scanning, and the width of the growth plate was also measured in histological sections. Chondrocytes isolated from growth plate in two groups were cultured in vitro to P3 generation. Immunohistochemical staining was used to detect the expression of collagen Ⅱ, matrix metalloproteinase 13 (MMP-13) and β-catenin in chondrocytes. Western blotting was used to detect the protein expressions of collagen Ⅱ, MMP-13 and β-catenin. Results:Compared with the control group, the tibial length of rats in the CRF group was shorter [(27.32±5.81) mm vs (35.43±3.61) mm, t=5.226, P<0.001], the width of growth plate in micro-CT picture was more narrow [(0.72±0.22) mm vs (1.13±0.27) mm, t=5.096, P<0.001], and the relative width of the growth plate was also more narrow ( t=6.744, P<0.001) in histological sections. The results of immunohistochemistry and Western blotting showed the expressions of collagen Ⅱ in the CRF group decreased significantly ( t=8.212, P<0.001), MMP-13 ( t=13.091, P<0.001) and β-catenin ( t=7.534, P<0.001) increased significantly compared the control group in chondrocytes. Conclusion:The Wnt/β-catenin signaling pathway is highly expressed in the tibial growth plate of young rats with chronic renal failure, which leads to accelerated degeneration and differentiation of chondrocytes and a closure tendency of growth plate.

BACKGROUNDThe use of a free, vascularized fibular graft is an important technique for the reconstruction of large defects in long bones. The technique has many advantages in strong, tubular bones; a more reliable vascular anatomy with a large vascular diameter and long pedicle is used, minimizing donor-site morbidity. Due to limitations in both fibular anatomy and mechanics, they cannot effectively be used to treat large limb bone defects due to their volume and strength.

METHODSFrom 1990 to 2001, 16 clinical cases of large bone defects were treated using vascularized double-barrel fibular grafts. Patients were evaluated for an average of 10 months after surgery.

RESULTSAll the patients achieved bony union; the average bone union took 10 months post surgery, and no stress fractures occurred. Compared with single fibular grafts, the vascularized double-barrel fibular grafts greatly facilitate bony union and are associated with fewer complications, suggesting that the vascularized double-barrel fibular graft is a valuable procedure for the correction of large bone defects in large, long bones in addition to enhancing bone intensity.

CONCLUSIONSThe vascularized double-barrel fibular graft is superior to the single fibular graft in stimulating osteogenous activity and biological mechanics for the correction of very large bone defects in large, long bones. Free vascularized folded double-barrel fibular grafts can not only fill up large bone defects, but also improve the intensity margin. Therefore, this study also widens its application and enlarges the treatment targets. However, in the case of bone deformability, special attention should be paid to bone fixation and protection of donor and recipient sites.

Adolescent ; Adult ; Bone Diseases ; pathology ; surgery ; Bone Transplantation ; methods ; Female ; Fibula ; pathology ; surgery ; Humans ; Lower Extremity ; pathology ; surgery ; Male ; Middle Aged ; Models, Biological ; Reconstructive Surgical Procedures ; methods ; Reproducibility of Results

BACKGROUNDTargeted tumor therapies have been making rapid progress in recent years, and the erbB-2 oncogene is a suitable target. There was much discussion about the level of erbB-2 in osteosarcoma. The aim of this study was to investigate the erbB-2 amplification or expression status in osteosarcoma.

METHODSFluorescence in situ hybridization (FISH) and DNA probes for erbB-2 and centromere 17 were used to examine the erbB-2 gene amplification status in 32 osteosarcoma samples, and expression of erbB-2 was analyzed by immunohistochemistry (IHC) and reverse transcription-polymerase chain reaction (RT-PCR).

RESULTSNone of the 32 osteosarcomas was observed by FISH to have the erbB-2 gene amplified, and no distinguishable membrane staining was seen in any case yet, nevertheless, erbB-2 overexpression was present in 6 tumor samples by RT-PCR.

CONCLUSIONSThe status of erbB-2 gene amplification and membrane overexpression is rare in osteosarcomas, and might suggest that the erbB-2 target agent should not be applied to osteosarcomas as single treatment.

Adolescent ; Bone Neoplasms ; genetics ; therapy ; Child ; Dimerization ; Female ; Gene Amplification ; Genes, erbB-2 ; Humans ; In Situ Hybridization, Fluorescence ; Male ; Osteosarcoma ; genetics ; therapy ; Receptor, ErbB-2 ; analysis ; antagonists & inhibitors ; Reverse Transcriptase Polymerase Chain Reaction

OBJECTIVETo investigate the clinical usage of percutanious retrograde acetabular anterior horn screw fixation.

METHODSFrom June 2006 to November 2011,27 patients with anterior horn accetabular fractures were treated with percutaneous retrograde screw. There were 20 males and 7 females with an average age of 35 years (ranged,20 to 61). According to Tile classification,type A was in 5 cases,type B was in 18 cases and type C was in 4 cases. The intra-operative blood loss volume, fractured reduction and screw location were observed.

RESULTSPostoperative X-ray and CT scan showed good reduction. According to the standard of Matta, 10 cases got excellent results, 15 good and 2 poor. All fractures healed and no complications such as neurovascular injuries and femoral head necrosis were found.

CONCLUSIONPercutanious retrograde acetabular anterior horn screw technique have advantages of little trauma, less blood loss volume, reliable fixation, which can be effectively used in clinic.

Acetabulum ; diagnostic imaging ; injuries ; surgery ; Adult ; Bone Screws ; Female ; Fracture Fixation, Internal ; methods ; Fractures, Bone ; diagnostic imaging ; surgery ; Humans ; Male ; Middle Aged ; Radiography