Objective To observe the change rules of insulin receptor from rat bladders after losing lower cen-tal innervations so as to explore the function of insulin receptor in denervated bladder. Methods From January, 2016 to June, 2017, 40 Sprague-Dawley rats were randomly divided into experimental group and control group,each group was 20. The conus medullaris of rats in experimental group were damaged, and rats in control group received sham opera-tion. The rats in 2 groups were sacrificed at different time after surgery (1 day, 1 week, 1 month, 3 months). Bladder specimens were harvested to perform wet weight measurement and immunohistochemical detection of insulin receptor. Results Corresponding to 1 day, 1 week, 1 month and 3 months after surgery, the bladder wet weight of control group were (0.089±0.022)g, (0.094±0.038)g, (0.106±0.112)g and(0.102±0.048)g, and of experimental group were (0.092± 0.026)g, (0.110 ±0.034)g, (0.538 ±0.098)g and (1.528 ±0.462)g. One month and 3 months after surgery, bladder wet weight of experiment group were significantly increased as compared with those of control group (P<0.05). One day, 1 week, 1 month and 3 months after the operation, the positive rate of insulin receptor expression was 60％, 100％, 100％and 80％. And strongly positive rate was 55％. In control group, the positive rate of insulin receptor expression was 20％, 40％, 40％, and 0％. The expression of insulin receptor in experimental group was significantly higher than that in con-trol group in every stage(P<0.05). Conclusion The expression of insulin receptor is significantly increased after den-ervation of bladder. The defections of insulin receptor might lead to apoptosis and muscle wasting after denervation. Re-store insulin receptor function might be key point to prevent bladder tissue from irreversible damage.

Objective To explore the expressions of Bcl-2 and Bax proteins in the neurons of spinal cord after tibial nerve and common peroneal nerve injuries in rats.Methods A total of 90 male SD rats were randomly divided into three groups, the group A was as control group, group B as suture of tibial nerve cut group, and group C as suture of the common peroneal nerve cut group.The L4-6 segment spinal cord of the rats were removed for HE staining and immumohistochemical staining on 3, 7, 14, 28 days after the operation.The number of motor neurons in the spinal anterior horn were calculated.The expressions differences of Bcl-2 and Bax proteins were detected by immuno-histochemistry, and values of Bcl-2/Bax were calculated.Results The number of motor neurons in the anterior horn of spinal cord in group B were less than that in group C on 1, 3, 7, 14, 28 days after the operation (P< 0.01).The expression of Bcl-2 protein in group B and group C showed an upward and then declining trend.It decreased to the lowest on the postoperative 3 d in group B and 7 d in group C, respectively.The expressions of Bax protein in group B and C showed an upward and then declining trend, and it increased to the highest on the postoperative 3 d in groups B and C.The values of Bcl-2/Bax in groups B and C were showed an decreased and then increased trend and it was lower in group B than group C on the postoperative 3, 7, 14, 28 d(P< 0.01).Conclusion Injuries of tibial nerve and common peroneal nerve of the rats would lead the apoptosis of motor neurons in the spinal cord, but compared with the injury of common peroneal nerve, tibial nerve injury would lead less apoptosis of motor neurons.

Objective To explore the expressions of Bcl-2 and Bax proteins in the neurons of spinal cord after tibial nerve and common peroneal nerve injuries in rats.Methods A total of 90 male SD rats were randomly divided into three groups, the group A was as control group, group B as suture of tibial nerve cut group, and group C as suture of the common peroneal nerve cut group.The L4-6 segment spinal cord of the rats were removed for HE staining and immumohistochemical staining on 3, 7, 14, 28 days after the operation.The number of motor neurons in the spinal anterior horn were calculated.The expressions differences of Bcl-2 and Bax proteins were detected by immuno-histochemistry, and values of Bcl-2/Bax were calculated.Results The number of motor neurons in the anterior horn of spinal cord in group B were less than that in group C on 1, 3, 7, 14, 28 days after the operation (P< 0.01).The expression of Bcl-2 protein in group B and group C showed an upward and then declining trend.It decreased to the lowest on the postoperative 3 d in group B and 7 d in group C, respectively.The expressions of Bax protein in group B and C showed an upward and then declining trend, and it increased to the highest on the postoperative 3 d in groups B and C.The values of Bcl-2/Bax in groups B and C were showed an decreased and then increased trend and it was lower in group B than group C on the postoperative 3, 7, 14, 28 d(P< 0.01).Conclusion Injuries of tibial nerve and common peroneal nerve of the rats would lead the apoptosis of motor neurons in the spinal cord, but compared with the injury of common peroneal nerve, tibial nerve injury would lead less apoptosis of motor neurons.

Objective To study the effect of using different tibial nerve proximal muscle branchs to repair deep peroneal nerve injury in animal experiment, and to screen out the most optimal donor nerve branch. Methods From June, 2016 to August, 2016, 64 adult female SD rats were randomly divided into 4 groups, which were LHG (using lateral head of gastrocnemius to repair peroneal nerve), MHG(using medial head of gastrocnemius to repair peroneal nerve), SNB (using soleus nerve branch to repair peroneal nerve), and blank. There were16 rats in each group. At 4 and 8 weeks after surgery, each group were tested on behavior, electrophysiology, muscle tension, muscle wet weight and histology, to evaluate function recovery of the muscles controlled by deep peroneal nerve in each group, and to compare recovery of the deep peroneal nerve repaired by different tibial nerve branches. Results Eight weeks after surgery,right foot of the rats in LHG,MHG and SNB group can be extended,toes can be completely opened. Rats in blank group showed limping gait, whose right foot can not be extended, right toe can not be opened, and muscle atrophied. At 4 and 8 weeks after the operation, the recovery rate of LHG, MHG, SNB group (at 4th weeks, 33.60 ±2.22)%, 33.07 ±2.38% and 35.91 ±2.02%; at 8th weeks, 67.16 ±5.74)%, 66.56 ±3.18% and 73.17 ± 5.33%, respectively)was higher than blank group(7.71±1.05% and 7.84±0.78%, respectively)on CMAP amplitude, tibialis anterior muscle contractility, tibialis anterior muscle cell area, muscle cell area. SNB group was superior to the LHG group and LHG group.And the difference was statistically significant(P<0.05). Conclusion All the proxi-mal tibial nerve muscle branchs can be used to repair the deep peroneal nerve injury, and the soleus nerve branch is the preferred donor nerve.

A patient suffered a sustained soft tissue necrosis and infection at the radial interphalangeal joint of left thumb after laser nevus removal. He was treated in the Department of Orthopaedics, No. 920 Hospital of Joint Logistic Support Force of Chinese People's Liberation Army in February 2020. CTA combined with digital technology of Mimics software was used to accurately locate the perforator of posterior tibial artery septal perforator flap at the appropriate part of the calf and the super flap (1.20 cm×0.80 cm×0.46 cm) for the repair was designed. After 1 year of follow-up, the left thumb flap had no swelling with a satisfactory texture and appearance. The sensory recovered to S 3, and the left thumb movement was completely normal. Only a linear scar remained at the donor site of the calf.

Objective:To establish and identify a SD rat model with reconstruction of bladder sensory and motor innervation , so as to lay the foundation for further study of micturition center remodeling and its mechanisms .Methods:A total of 45 female SD rats were randomly divided into control group(n=10) ,rhizotomy group(n=15) and nerve root anastomosis group(n=20) . All the ventral and dorsal roots of spinal nerve below L4 level of rats in rhizotomy group were cut off .In nerve root anastomosis group ,the bilateral ventral and dorsal roots of L4 nerve ,were anastomosed with those of S1 nerve ,after the spinal nerve roots had been cut off .Rats in control group were not treated with surgery . At Six months after surgery ,rats in each group underwent urodynamic test ,nerve root stimulation ,toluidine blue staining at nerve anastomosis site ,pelvic ganglia fluorescence gold tracer staining and bladder wet weight measurements .Results:Bladder maximum capacity ,residual urine volume ,bladder compliance and bladder wet weight in nerve root anastomosis group was less than those in rhizotomy group ,however ,larger than those in control group(P<0 .05) .There was no statistically significant difference in maximum voiding pressure between nerve root anastomosis group and control group(P> 0 .05) ,however ,maximum voiding pressure in nerve root anastomosis group was larger than that in rhizotomy group(P<0 .05) .Intravesical pressure increased after nerve root stimulation in nerve root anastomosis group ,but it was still lower than that in control group(P<0 .05) .Nerve passing rate was (53 .4 ± 6 .7)% in nerve root anastomosis group ,under toluidine blue staining at nerve anastomosis site .After injection of fluorescent gold in pelvic ganglia ,fluorescence gold staining was visible in the L4 spinal cord gray matter in nerve root anastomosis group , however ,not visible in rhizotomy group and control group .Conclusions:SD rat model with reconstruction of bladder sensory and motor innervation is successfully established .It lays the foundation for further study of micturition center remodeling and its mechanism .