BACKGROUND: Denervated muscular atrophy is refractory in clinical treatment. To date, there is still no effective treatment for this disease. OBJECTIVE: To observe the influence of two-division muscular transplantation with the pedicle of blood vessels and nerves on denervated muscular atrophy so as to explore a new thought for denervated muscular atrophy. DESIGN, TIME AND SETTING: Controlled animal trial was performed at the Department of Hand Surgery, Drum Tower Hospital of Nanjing University of Medical College between July 2006 and December 2007. MATERIALS: Thirty clean-grade healthy Wistar rats, weighing 250 g, irrespective of gender, were selected. METHODS: Gastrocnemius muscle denervation models were established in both lower extremities. At the experimental side, two incisions were made in 1/3 gastrocnemius muscle of the right side, and the pedicle of the blood vessels and nerves was transplanted into the lateral head of gastrocnemius. While in the control side (left side), gastrocnemius muscle was only disconnected. Samples were harvested at 4, 8, and 12 weeks postoperatively. MAIN OUTCOME MEASURES: Muscular appearance and ultrastructure were observed; muscle fiber circumference and cross-section area and collagen fiber content were measured. RESULTS: The gastrocnemius muscle at the experimental side appeared plump and elastic with acceptable color, while the muscle became atrophy with pale appearance at the control side. Circumference and cross-section area of the muscle fibers at the experimental side were significantly larger than the control side (P

Objective To evaluate the clinical results of limited Smith-Petersen approach in the treatment of posterior dislocation of hip with femoral head fracture (Pipkin fracture of types Ⅰ and Ⅱ).Methods From February 2008 to July 2013,21 patients with Pipkin fracture of types Ⅰ and Ⅱ were treated at our department.They were 16 men and 5 women,with an average age of 39.2 years (range,from 19 to 56 years).The left hip joint was affected in 8 cases and the right in the other 13.The interval between injury and surgery varied from 2 to 7 days (mean,4 days).According to the Pipkin classification,there were 11 cases in type Ⅰ and 10 in type Ⅱ.All the fractures were fixated via the limited Smith-Petersen approach.Results The patients were followed up for 11 to 29 months (mean,17.4 months).All the fractures healed after an average of 15 weeks (from 12 to 19 weeks).According to their Thompson-Epstein scores of clinical and radiological outcomes at the final follow-ups,7 cases were excellent,9 good and 5 fair,giving a rate of excellent to good of 76.2％.Avascular necrosis of the femoral head occurred in 3 cases and osteoarthritis in 2.No infection or limb deep vein thrombosis was observed.Conclusion For Pipkin fractures of types Ⅰ and Ⅱof,limited Smith-Petersen approach can provide satisfactory exposure which leads to reduced soft tissue injury,better reduction and fixation,and fewer complications as well.

Objective To observe the effect of hyperglycemia on intracranial pressure (ICP) and neurological outcome following severe brain injury. Methods A retrospective review was done on 79 cases with severe traumatic brain injury (with no history of diabetes or important extracranial complications) who underwent craniotomy for evacuation of intracranial hematoma and were divided into two groups based on Glasgow outcome scales (GOS) score, ie, favorable group with GOS of 5 or 4 and unfavorable group with GOS less than 3. Statistical analysis of data was accomplished by using SPSS 11.5 software. The outcome was assessed at the 6th month after injury. Results A significant correlation was found between ICP levels and admission or postoperative glucose values. The unfavorable group had significantly higher glucose levels both on admission and after operation compared with the favorable group, with statistical difference (P

Polybrominated diphenyl ethers (PBDEs) is a kind of important industrial flame retardants,which widely exists in the environment and biosomes.Some researches have indicated that PBDEs is toxic to the nervous system of animals through affecting the release of neuroendocrine hormone,the signal transduction pathways,the transmission of neurotransmitters,the expression of key proteins in the nervous system,and the apoptosis of neuronal cells.Data from environmental monitoring indicated that environmental exposure to PBDEs in China exists,but the research on the effect of PBDEs on nervous system is very limited,which calls for attention.This article summarized researches on the mechanism of neurotoxic effects induced by polybrominated diphenyl ethers from the aspects such as the release of neuroendocrinal hormone,the signal transduction pathways,the transmission of neurotransmitters,the expression of key proteins in the nervous system,and the apoptosis of neuronal cells,and some ideas about the direction of related researches were presented.

Objective To observe the effect of acupuncture at Tianzhu (BL10) on Blood Stasis Type lumbar disc herniation (LDH). Methods From October, 2013 to October, 2015, 108 LDH cases were randomized into observation group (n=53) and control group (n=55) in accordance with the order of visiting. The observation group received Tuina and acupuncture mainly at Tianzhu, while the control group only received Tuina, for four weeks. The clinical efficacy and improvement of Japanese Orthopaedic Association (JOA) scores were record-ed, and the Visual Analogue Scale (VAS) and serum levels of interleukin-6 (IL-6) were measured before and after treatment. Results The VAS score and IL-6 content decreased in both groups after treatment (t>4.220, P<0.001), and decreased more in the observation group than in the control group (t>3.745, P<0.001). The total effective rate was 94.34% in the observation group, more than 81.82% in the control group (χ2=3.997, P=0.046). The incidence of impromvement of JOA scores was 90.57%in the observation group, more than 76.36%in the control group (χ2=3.920, P=0.048). Conclusion Acupuncture at Tianzhu based on Tuina is more effective on Blood Stasis Type lumbar disc herniation, in term of pain and function, which may relate with decrease of the level of IL-6.

Object To study the chemical constituents of alkaloids of Amsonia sinensis Tsiang extracted with methanol. Methods Compounds were separated by exchange resin, macroporous resin and silica gel column chromatography. Their structures were elucidated by spectroscopic analysis. Results Three compounds were isolated from total alkaloids of A. sinensis extracted with methanol. They were identified as: rhazidigenine (Ⅰ), amsonic acid (Ⅱ), trans-sinapic acid methylester (Ⅲ). Conclusion Compound Ⅱ is a new one, and compound Ⅰ and Ⅲ are obtained from this plant for the first time.

Objective To investigate the anatomical characteristics and clinical application of the distal musculocutaneous perforators derived from the descending branch of lateral circumflex femoral artery in the anterolateral thigh flap transplantation. Methods From July 2007 to December 2009, the anatomic variations of musculocutaneous perforator were investigated in 96 cases who received anterolateral thigh flap and 10 preserved cadavers. Thirty-five cases who received the anterolateral thigh flap using the distal musculocutaneous perforators were included in the study. There were 19 males and 16 females. The age ranged from 28-55 years old, with an average of 38.5 years old. Single flap was used in 20 cases while lobulated flap in 15 cases. Single flap area ranged from 7 cm×15 cm to 9 cm×25 cm, lobulated flap ranged from 5 cm×7 cm to 8 cm×20 cm. Results The cadaver study found that the most musculocutaneous perforators were concentrated in the far fourth of the anterolateral thigh region. The musculocutaneous perforators commonly arose from the the lateral femoral circumflex artery. The perforator arose directly from the femoral artery or the deep femoral artery in one case separately. In the clinical study, 2-5 musculocutaneous perforators were found in 94 cases but not in the other 2 cases. The descending branch of lateral circumflex femoral artery became the direct m musculocutaneous perforator. The proximal intermuscularseptum perforator was found in 2 cases. Postoperative follow-up time ranged from 6-11 months. All flaps survived in the follow-up.Marginal necrosis was found in 3 cases. Only 1 case had complained of knee joint instability. Conclusion The results of this study suggest that the vascular anatomy of the distal musculocutaneous perforator was reliable. The perforator may serve as an option for proximal one in anterolateral thigh flap transplantation.

Objective To investigate the application and clinical result of treatment soft tissue defect in the lower leg after severe trauma by using the reversed descending branch of the lateral circumflex femoral artery of the injured leg as the recipient artery for free flaps.Methods Twenty-three patients with soft tissue defect of the lower leg after severe trauma from February 2007 to October 2012 were retrospectively analyzed.The patients were treated with the free flaps (the latissimus dorsi flap or the anterolateral thigh flap) using the reversed descending branch of the lateral circumflex femoral artery of the injured leg as the recipient artery.There were 14 males and 9 females,with an average age of 31.7 years (range,22-49 years).The causes of injury were traffic accidents in 12 cases,crushing injury in 8 cases,and machinery injury in 3 cases.The defect located at the proximal in 4 cases,the proximal and middle in 12 cases,middle and distal in 7 cases.Sizes of the tissue defect were 14 cm×5 cm to 32cm×12 cm,and the flap sizes were 15 cm×7 cm to 34 cm×13 cm.The donor defect was closed directly or resurfaced with a splitthickness skin graft taken from the thigh.Results Twenty-three flaps survived completely.Partial necrosis at the distal edge of the flap occurred in one case,and was healed by secondary intention.No patient needed urgent operative revision due to postoperative thrombosis of the vessels.All flaps completely survived,without evidence of postoperative insufficiency of the blood supply or venous congestion.The donor skin graft survived and the incision healed by first intention.The mean follow-up period was 12.4 months (range,6-21 months).The appearance,texture,color and thickness of flaps in all cases were good at the last followup.The flap achieved protective sensation with the two-point discrimination ranging between 10-25 mm.Conclusion Due to the advantages of reliable blood supply,short treatment cycle,and without postoperative forced position,the reversed descending branch of the lateral circumflex femoral artery of the injured leg can be an ideal choice as the recipient artery for free flaps in repairing the soft tissue defect in the lower leg after severe trauma.

Objective To introduce ramified anterolateral femoral flaps pedicled with different musculocutaneous branches used for primary repair of soft-tissue defects at different regions of extremities. Methods From January 2008 to April 2009, 15 patients, 10 males and 5 females, were treated with an-terolateral thigh flaps for their soft-tissue defects at limbs which involved 4 hands, 6 feet and 5 legs and an-kles. Different shapes of anterolateral thigh flap were designed according to clinical anatomy and particular conditions of blood vessels and musculocutaneous branches in different cases. The flaps were ramified into 2 independent free flaps to repair 2 independent defects. The maximum distance between 2 defects was 8 cm. The area of defect ranged from 3.0 cm×3.5 cm to 8.0 cm×11.5 cm, and the flap area from 5.0 cm×5.0 cm to 9.0 cm×15.0 cm. Results According to clinical anatomy, the presence of sarco-cutaneous branches was 100%. The source blood vessel of the flaps was quadriceps artery of femur. The 15 patients were followed up from 3 to 8 months. The tissue grafts all survived and the flaps primarily healed at the recipient site. Revisions were done 3 weeks to 3 months after the primary operation to thin down the clumsy skin flaps in 6 cases, The shape and texture of the flaps were satisfactory. Conclusion Ramified anterolateral femoral flaps pedicled with different musculocutaneous branches provide an ideal way of repairing severe and complex soft-tissue defects at extremities.

BACKGROUND:Different methods of internal fixation can be selected during the repair of femoral shaft fractures in the clinic, including bridging combined internal fixation and metal locking plate screw fixation.
OBJECTIVE: To compare the biomechanical properties of bridging combined internal fixation and metal locking plate screw fixation for femoral shaft fracture.
METHODS:Eighteen femoral samples were colected and randomly divided to three groups, with six in each group. In the normal control group, no treatment was given. In the other groups, models of femoral shaft fracture were established. In the bridging combination group, samples underwent bridging combined internal fixation. In the locking plate screw group, samples underwent metal locking plate screw fixation. Biomechanical test was conducted in samples of the three groups. In the femoral compression experiments, we recorded the maximum displacement under the maximal load 500 N. In the femoral flexion experiment, we recorded the maximum displacement under the maximal load of 100 N. In the femoral retroversion experiment, we recorded the maximum displacement under the maximal load of 100 N.
RESULTS AND CONCLUSION: (1) Compression experiment at different loads: the maximum displacement was larger in the bridging combination group and locking plate screw group than in the normal control group. Under the maximum load of 500 N, the maximum displacement was significantly larger in the bridging combination group and locking plate screw group than in the normal control group (P < 0.05). Moreover, the maximum displacement was significantly less in the bridging combination group than in the locking plate screw group (P< 0.05). (2) Flexion experiment under different loads: the maximum displacement was larger in the bridging combination group and locking plate screw group than in the normal control group. Under the maximal load of 100 N, the maximum displacement was significantly larger in the bridging combination group and locking plate screw group than in the normal control group (P< 0.05). Moreover, the maximum displacement was significantly smaler in the bridging combination group than in the locking plate screw group (P < 0.05). (3) Retroflexion experiment under different loads: the maximum displacement was larger in the bridging combination group and locking plate screw group than in the normal control group. Under the maximal load of 100 N, the maximum displacement was significantly larger in the bridging combination group and locking plate screw group than in the normal control group (P < 0.05). Moreover, the maximum displacement was significantly smaler in the bridging combination group than in the locking plate screw group (P < 0.05). (4) These results suggested thatin vitro simulated femoral shaft fracture bridging combination fixation and metal locking plate screw system can obtain good fixation effect; the design meets the principle of biomechanics. Among them, bridging combined internal fixation can maintain a smaler displacement, suggesting good deformation resistance under compressive stress, anteflexion and retroflexion stress.