Twenty-five patients with traumatic carpitis treated by wrist fusion plate internal fixation in Department of Orthopedics, Commercial Staff Hospital of Wuhan from July 2000 to July 2007 were selected, of which 21 were followed up for more than 6 months. Twelve cases had slight dorsal extension dysfunction of thumb, forefinger and middle finger; 10 had slight initiative dorsal extension dysfunction of thumb interphalangeal articulation; 4 had forearm rotation dysfunction, such as distal radioulnar joint or ulnaris pain. Of 21 followed-up patients, 12 cases had no pain, 5 had bearable wrist pain after intensive physical labor, and 4 had pain in daily life of forearm rotation, which affected their working. Grip strength of 15 cases restored to 75% of the operate side, 5 cases to 50%-75%, and 1 case to 50%. The results suggest that plate implantation relieve joint pain, but partial wrist function is limited. The plate materials are biocompatible to human body with no specific adverse effects.

RNA interference is a newly emerging gene block technology. Exogenous and endogenous double stranded RNA in cells can restrain specific sequence gene expression. RNA interference can block the specific gene expression efficiently, and identify the upper or lower reaches of the relationship of the different genes in the complex signaling pathway. It is a powerful tool to study signal transduction pathway. RNA interference can inhibit targeted gene expression of mRNA and protein products. It could simply, specifically, efficiently and stably reduce targeted gene expression, and it could remove the target gene without affecting other materials. RNAi technology is better than any previous methods in gene function's study and application. But, it is hard to transfect the RNA into mammalian cell lines, and mammalian cells also generate antagonism to the double stranded RNA or small interfering RNA. Thus, we are looking forward that using highly effective and safety small interfering RNA in medical care.

Objective To investigate the effect on differentiation of denervated skeletal muscle-derived stem cells (MDSCs) induced by TGF-β1 in vitro.Methods MDSCs were obtained from the rat denervated skeletal muscle by preplate technique,with TGF-β1 adding on medium.Cultured cells were divided into two groups.A,control group; B,10 ng/ml TGF-β1 group.Cell growth was observed with phase contrast microscope.lmmunocytochemistry,quantitative RT-PCR and Western blot was used to detect the expression of Sca-1,COL-Ⅰ,COL-Ⅲ,α-SMA and vimentin in denervated MDSCs.Results The synthesis of COL-Ⅰ,COL-Ⅲ,α-SMA and vimentin by denervated MDSCs was extremely low at protein level in vitro,while Sca-1 level was really high.Belong to the treatment with TGF-β1,COL-Ⅰ,COL-Ⅲ,oα-SMA and vimentin in the denervated MDSCs had strong expression,but Sca-1 in which had a weak expression.Under the stimulation of TGF-β1,COL-Ⅰ expression reached peak at the 2nd day (12.5591 ± 0.3389),which was about 3 times as control group.COL-Ⅲ reached highest value at the 5th day (0.8956 ± 0.0438),which was about 23 times as control group.α-SMA topped out to 18 times at the 5th day (1.1090 ± 0.0018).Vimentin expression rose by 8.5 times and peaked at the 5th day (0.1794 ± 0.0019).The expression of Sca-1 began to decline at the 2nd day,with a remarkable reduction at the 5th day (0.0636 ± 0.0015).Conclusion TGF-β1 could induce differentiation of the denervated MDSCs to myofibroblasts in vitro,and promote the synthesis and excretion of extracellular matrix.

BACKGROUND: Injured nerve can regenerate through end-to-side anastomosis and obtain partial physiological function in animal experiment. As an immuno-suppressivedrug, FK506, which is characterized by promoting neural growth and functional recovery, is paid widely attention to.OBJECTIVE: To investigate the effect of FK506 on functional recovery of peripheral nerve after end-to-side anastomosis.DESIGN: Randomized controlled animal study.SETTING: Department of Operation Surgery, Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology.MATERIALS: The experiment was completed in the Department of Operation Surgery, Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology in March 2005. Totally 26female Wistar rats were selected and divided into experimental group and control group with 13 in each group.METHODS: Peroneal nerve was transacted on the right side of all the animals, the proximal end of peronieal nerve was turned back and ligated, and the distal end was sutured to the side of tibial nerve with perineurial window. No operation was done on the left side. FK506 was injected in the right tibial muscle (2 mg/kg· d), once a day within two weeks in the experimental group, and saline was used in another group as contrast.MAIN OUTCOME MEASURES: Three months afteroperation, the bilateral common peroneal nerve and the tibial muscle were taken for electrophysiological and histological examination, and the number of common peroneal nerve fiber, area of tibialis anterior muscle fiber of transverse section and muscle wet weight of tibialis anterior muscle were measured. The results were expressed with the ratio between right side and left side (i.e.recovery rate).RESULTS: Totally 26 rats entered the final analysis. ① Results of histological examination: Both ratio of number of nerve fiber and ratio of area of muscle fiber in the experimental group were higher than those in the control group (0.734±0.143, 0.412±0.119; 0.628±0.125, 0.432±0.135; P ＜ 0.01,0.05). ② Results of electrophysiological examination: Recovery rate of action potential, recovery rate of single muscular contractility and recovery rate of tetanus contractility in the experimental group were higher that those in the control group (P ＜ 0.05). ③ Ratio of wet weight in the experimental group was higher than that in the control group (0.765±0.101,0.513±0.116, P ＜ 0.05).CONCLUSION: FK506 injected into targeted muscle can promote growth and functional recovery of peripheral nerve in end-to-side anastomosis.

Objective To investigate the effects of connective tissue growth factor (CTGF) on the chronic peripheral nerve compression injury and explore the function of CTGF in peripheral nerve compression injury and repair. Methods From July 2010 to September 2010, fifty aduh male SD rats were randomly divided into group A and B: group A (sham-operated group): only exposed the sciatic nerve; group B (compression group): undergone sciatic nerve entrapment operation on the right hind leg according to the method which Mackinnon adopted when he established the model of chronic sciatic nerve compression.Electron microscopy,immunohistochemistry,RT-PCR and Western-blot were performed to observe the morphological changes of the compressed nerve tissue and to determine the level of CTGF,collagen- Ⅰ,Ⅲ (COL- Ⅰ,Ⅲ),2,4,6,8,10 weeks after the surgery,respectively. Results After sciatic nerve compression,the collagen in nerve increased ; The expression of CTGF and COL- Ⅰ, Ⅲ in sciatic nerve of compressed group increased, which was statistically different compared with the sham-operation group (P ＜ 0.05); In the meanwhile,the contents of CTGF and COL- Ⅰ,Ⅲ were positively correlated in a certain period. Conclusion Peripheral nerve fibrosis can be caused by chronic nerve compression.The expression of COL- Ⅰ,Ⅲ in sciatic nerve increased and CTGF get involved in the pathophysiological process, which suggests that CTGF plays an important role in the process of neural injury and fibrosis.

ObjectiveTo investigate the effect of transforming growth factor-β1 (TGF-β1) antibody on peripheral neural fibrosis after chronic entrapment.MethodsA total of 75 rats were randomly divided into three groups, ie, Group A (sham operation, only the sciatic nerve exposed), Group B (compression only, treated with sciatic nerve entrapment) and Group C (compression plus antibody injection).Electron microscopy, immunohistoehemistry, RT-PCR and Western blot were performed to observe the morphological changes of the compressed nerve tissue and to determine the level of TGF-β1 , collagen Ⅰ and collagen Ⅲ at 2, 4, 6, 8, 10 weeks after sciatic nerve compression, respectively.Results The levels of TGF-β1 , types Ⅰ and Ⅲ collagen protein were increased significantly in the Group B compared with that in the Group A, when the expression of TGF-β1 was increased in the early phase of the compression, reached the peak at the 4th week, and then decreased slowly.The expressions of collagenⅠand collagen Ⅲ were increased after compression, reached a peak at the 6th week and then maintained a relatively high level.The number of the fibrous tissues was decreased significantly and the content of types Ⅰ and Ⅲ collagen protein declined in the Group C, with statistical difference compared with the Group B (P ＜ 0.05).ConclusionsPeripheral nerve fibrosis can be caused by chronic nerve compression.TGF-β1 plays an important role in effectively inhibiting the collagen synthesis and ameliorating the nervous fibrosis of the protein following peripheral nervous entrapment.

Objective To investigate the clinical application of neighboring digital artery flow-through flaps for one-staged skin coverage and revascularisation after severe finger injuries.Methods From May 2008 to July 2010,there were ischemic fingers had severe injuries,aged 19 to 52 years old,which were male in 5 cases,female in 2 cases,with skin and arterier defected.One-staged coverage and revascularisation of traumatised fingers were used with neighboring digital artery flow-through flaps.Functional exercise and physical therapy were done 3 weeks later.All cases had more than 12 months' fellowed-up periods.The sensibility testing,Questionnaire of the flap aesthetic satisfactory and TAM evaluations were all performed in all patients.All the results were measured and evaluated.Results All flaps survived completely and digit blood circulations were good in 7 patients.The flaps had good appearance and aesthetic satisfactory (100％).At 12 months after operations,the pain and touch perception reinnervated until 6 months and two-point discrimination testing were 6.1 to 9.6 mm,mean was (7.1 ± 1.3) mm,and the flap sensibility assessment were S3 * and TAM evaluation ratio were 0.81 ±0.16.Conclution Neighboring digital artery flap ideally suited as a thin and pliable flow-through flap in digital replantation/revascularization.It is helpful for salvage of the ischemic fingers after injury with skin and arteries defects.

ObjectiveTo investigate expression of TGF-β1,CTGF and collagen deposition in skeletal muscle during chronic entrapment of peripheral nerve. MethodsFifty rats were separated into two groups,control group and experimental group. At different time points after operation, the right gastrocnemius of 5rats from each group were collected for further analysis such as HE, Masson stain, immunohistochemical staining,RT-PCR and Western-blot. Results It was observed that axon degeneration occurred during chronic nerve entrapment,and which was in line with reports from other groups.Moreover,it had been demonstrated that after nerve entrapment,skeletal muscles may form fibrosis and degeneration consequently.Within this pathological procedure,expression of TGF-β1. CTGF and deposition of collagenⅠ changed rapidly when compared with control group.ConclusionOverall,these results indicated that these factors may be important during skeletal muscle degeneration after chronic nerve entrapment.

In order to investigate the biological function of transforming growth factor-β1 (TGF-β1) during fibrosis in denervated skeletal muscle, we recruited sciatic nerve injury model of SD rats in which denervated gastrocnemius was isolated for analysis. At different time points after operation, denervated muscle was examined by several methods. Masson trichrome staining showed morphological changes of denervated skeletal muscle. Quantitative RT-PCR detected the rapid increase of TGF-β1 expression at mRNA level after nerve injury. It was found that a peak of TGF-β1 mRNA expression appeared one week post-operation. The expression of collagen I (COL I) mRNA was up-regulated in the nerve injury model as well, and reached highest level two weeks post-injury. Immunoblot revealed similar expression pattern of TGF-β1 and COL I in denervated muscles at protein level. In addition, we found that the area of the gastrocnemius muscle fiber was decreased gradually along with increased interstitital fibrosis. Interestingly, this pathological change could be prevented, at least partly, by local injection of TGF-β1 antibodies, which could be contributed to the reduced production of COL I by inhibiting function of TGF-β1. Taken together, in this study, we demonstrated that the expression of TGF-β1 was increased significantly in denervated skeletal muscle, which might play a crucial role during muscle fibrosis after nerve transection.

OBJECTIVETo investigate the clinical application of flow-through deep inferior epigastric perforator flaps for reconstruction of large defects at the extremities.

METHODSThe deep inferior and superior epigastric arteries were designed as the axial vessel and the arterial supply to the flap was the paraumbilical perforator artery. Free deep inferior epigastric perforator flaps were harvested in flow- through manners to reconstruct associated arterial defect in the wound. The sensation assessment,Enneking score,and questionnaire of the flap aesthetic were all performed during follow-up period.

RESULTSFrom December 2011 to September 2012, 5 patients with large defects at extremities were treated. The deep inferior and superior epigastric arteries were designed as the axial vessel and the arterial supply to the flap was the paraumbilical perforator artery. The wound defects ranged form 11 cm x 5 cm to 30 cm x 11 cm. And the flap size ranged from 13 cm x7 cm to 33 cm x 13 cm. All flaps survived completely. The recipient arteries were all bypassed well documented by color Doppler examinations. All cases had 12-24 months' follow-up period. The flaps had good appearance and high aesthetic satisfactory(100%). 12 months after operations, sensation assessment were all S3+, and the Enneking score ratios were 82%-95% ,with 87.2% in average.

CONCLUSIONSFlow-through deep inferior epigastric perforator flaps are reliable and effective for reconstruction of large defects at the extremities with maintenance of the vascular status of the extremities. The flaps can also be designed in transverse or oblique mode for clinical application.

Aged ; Arteries ; Epigastric Arteries ; Esthetics ; Extremities ; blood supply ; surgery ; Humans ; Leg Injuries ; surgery ; Perforator Flap ; blood supply ; Reconstructive Surgical Procedures