BACKGROUND:Neural stem cells(NSCs)are characterized by widely resources,convenient harvesting,easy culture and prone to import and express exogenous genes,which can be served as carriers of gene therapy for neural system disease.OBJECTIVE:To review the application of NSCs in spinal cord injury.METHODS:Databases of PubMed(http://www.ncbi.nlm.nih.gov/PubMed)and Wanfang(http://www.wanfangdata.com.cn)were searched by the correspondence author using key words of "neural stem cells,spinal cord injury,cellular transplantation" both in English and Chinese to retrieve papers concerning isolation,identification,differentiation of NSCs as well as its application in repairing spinal cord injury.A total of 82 documents were initial obtained by computer,after repetitive studies were excluded,23 papers were included in the final analysis.RESULTS AND CONCLUSION:The NSCs transplantation has been widely used in animal experiments.Currently,the applications of NSCs in repairing spinal cord injury are concentrated on the following aspects:Firstly,cellular replacement therapy,namely,direct transplanting NSCs or activating in vivo NSCs to differentiate into neurons and glial cells,and then integrating transplanted cells with the existed neural cellular structure to cure the disease.Secondly,NSCs were utilized as gene carriers,which carrying target gene to body and reach the aims of cellular replacement and gene therapy.Thirdly,autologous NSCs were induced differentiation for self neural repair via studying growth factors and cytokines.

OBJECTIVETo study the influence of estradiol on histomorphology of skin flaps with ischemia reperfusion injury.

METHODS48 adult male Wistar rats aged 12-14 weeks old, were randomly divided into control group (group I), ischemia-reperfusion group (group II), saline group (group III), estradiol group (group IV). Superficial epigastric artery axial flap, 3 cm x 6 cm in size, was made in the left lower quadrant abdominal of each rat. Flap model with ischemia-reperfusion injury was established by using the nondestructive micro vascular clamp to clamp the superficial epigastric artery. The general condition of the flap was observed after operation. At 7 days after operation, the survival rate of the flap was detected, the flaps were harvested to receive histology and ultrastructural observation. The neutrophils level of the superficial epigastric vein were tested.

RESULTS7 days after operation, the survival rate of the flap in group IV was significantly higher than that in group II, III (P < 0.05). The neutrophils level in group IV was lower than that in group II, III (P < 0.05). The histological observation showed that the degree of tissue swelling and inflammatory exudation in group IV was more slight than that in group II, III. Presence of high neutrophils density were observed in group II, III, while slight inflammation and necrosis were observed in group IV. In group I, collagen fibers in flap are regularly arranged with no significant necrosis. Oganelles structure disappeared and apoptotic bodies were shown in group II and group III, even the lysosome could be seen in the cell. Collagen fibers in flap are regularly arranged with slight swelling and no obvious ultrastructural necrocytosis was seen in the cell of group IV.

CONCLUSIONThe estradiol can significantly increase flap survival rate by inhibiting neutrophils infiltration and improving the pathological changes of organization structure in flap.

Animals ; Epigastric Arteries ; Estradiol ; Leukocyte Count ; Male ; Necrosis ; Neutrophil Infiltration ; drug effects ; Neutrophils ; cytology ; drug effects ; Random Allocation ; Rats ; Rats, Wistar ; Reperfusion Injury ; etiology ; pathology ; Sodium Chloride ; Surgical Flaps ; blood supply ; pathology

Objective:To investigate the blood supply pattern and characteristics of bilobate anterolateral thigh flaps, and to summarize the clinical experience.Methods:Date of 102 cases of limb wounds repaired by bilateral anterolateral thigh perforator flaps from March 2014 to July 2019 were retrospectively analyzed. There were 80 males and 22 females with an average age of 40.7 years (range, 9-66 years). All of the patients suffered from limb trauma with complex tissue defects, among which 29 cases had two adjacent and discontinuous wound surfaces on the same limb, and the area ranged from 5 cm×5 cm to 30 cm×18 cm, while the other 73 cases remained a single wound with the area ranged from 12 cm×11 cm to 27 cm×15 cm. Ultrasonic Doppler was used to locate the perforating branches. According to different patterns of blood supply, flaps of different types were designed and applied respectively. For those who with perforating branches of common trunk type or fascial type, the wound surface can be covered by the flap directly; for those who with perforating branches of double trunks type or mixed type, the turbocharging technique was performed after dissection of the pedicles of the flap, while the wound was repaired by reconnection. All the donor sites were sutured directly.Results:Total of 105 bilobed flaps were designed in 102 patients, including 43 flaps of common trunk type, 30 flaps of double trunks type, 24 flaps of fascial type and 8 flaps of mixed type. The single harvested flap area ranged from 6 cm×5 cm to 20 cm×9 cm. One patient's one piece of the bilobed flap repairing two wounds suffered an arterial crisis at 17 h after surgery. The surgery confirmed there was an intractable arterial spasm and the crisis was relieved after a vein trans-plantation. Then about 4 cm×3 cm superficial necrosis appeared in the most distal part of the flap and healed in secondary after dressing changes. Two cases with single wounds suffered from a vein crisis at 48 h after operation. After removing the suture and blood letting, the flaps survived a week later. The average healing time was 19 days (range, 8-83 days). All the thigh donor sites healed by first stage. All the cases were followed-up for an average period of 16 month (range, 6-70 months). The latest follow-up showed that the flaps were of good color and texture, and the sensation of the flaps recovered partially. According to the British Medical Research Council sensory rating scale: 21 cases were grade S2 and 81 cases were grade S3. According to the revascularization assessments of digital replantation standard by Hand Surgery Branch of Chinese Medical Association, the results were excellent in 91 cases, good in 11 cases, with excellent and good rate of 100%. Linear scars were left in most donor sites and the VAS scores were all zero. 5 cases had a large scar area which the width was more than 3 cm, but there was no scar contracture or pain. 9 cases had an abnormal sensation in the donor area in the early stage and recovered gradually 3 months later without any movement disorder.Conclusion:The use of the bilobed anterolateral femoral perforator flap with different blood supply patterns to repair the wounds of extremities could overcome the lack or deficiency of blood supply caused by perforators with different sources. To clarify the blood supply types is conducive to the flap cutting and leaf splitting during the operation, which greatly improves the survival rate of the flap.

Spinal cord injury is a difficult medical problem and need to be solved urgently.Application of tissue engineering to repair spinal cord injury has gradually become a hot spot.It is important to prevent the development of scar tissue while inducing cells' regeneration by using scaffold.Nanotechnology has improved the performance of scaffold because of its superiority.Nanoscaffold has obvious advantages compared with the traditional scaffolds.New scaffold materials can be obtained by nanotechnology.Nanoscaffold can also serve as a good drug carrier,and it may have beneficial effects on biological behaviors of seed cells on its surface,such as differentiation,proliferation and migration,which may promote tissue regeneration and functional recovery and get good results in repairment of spinal cord injury.This article summarized the research progress in recent years in nano spinal cord engineering scaffolds in order to provide a reference for research in related fields.

Objective To explore the new operation method and clinical effect of treating degloving injuries of the whole thumb.Methods Nine cases of the whole thumb degloving injury caused by machine were treated with free wrap-around flap from the big toe and the flap from the opposite foot.The phalanges,joints and tendons of all injured thumbs were integral relatively,except that the interphalangeal joints in 3 cases were destroyed and the flexor and extensor pollicis longus were ruptured.The size of the dorsal tissue defects varied from 4.8 cm × 2.9 cm to 6.2 cm × 3.4 cm,and the volar tissue defects ranged from 4.7 cm × 3.2 cm to 6.1 cm × 4.0 cm.The area of the wraparound flap from the big toe harvested was from 5.0 cm × 3.2 cm to 6.7 cm × 3.9 cm.The flap from the opposite foot was tibial flap with dorsalis pedis flap from the opposite second toe,and the area of the flap was from 5.0 cm × 3.5 cm to 6.6 cm × 4.5 cm.Results All 9 combined flaps survived.The wound healed primarily.Skin grafts in the donor sites of the foot also survived.Postoperative follow-up ranged from 6 to 20 months,with an everage of 9 months.The pulp of the thumb was well-stacked.Sensory recovery ranged from S3 to S3 +.Thumb nail grew well.Thumbs performed good functions as grabbing,grasping and nipping.The range of motion of the MP joints of the reconstructed thumb was normal.The motion of interphalangeal joints were acceptable in 6 cases,but worse than the normal thumb.The interphalangeal joint in 3 cases destroyed was fused.There was no obvious influence on the function of the foot.Conclusion Applying combined wrap-around flap from the big toe with the tibial flap and dorsalis pedis flap from the opposite foot in treating degloving injuries of the whole thumb is a new operation method,which could achieve good appearance and function,but have a small influence on the donor site.It is worthy being used widely in clinical.

Objective To explore the surgical methods and clinical application effects of repairing hand soft tissue defect with free vascularized flaps based on the distal perforator of ulnar artery.Methods From March, 2001 to December, 2012 in our hospital, 90 patients with hand soft tissue defects were repaired by free vascularized flaps based on the distal perforator of ulnar artery, including 74 patients cases were repaired by Phase Ⅰ emergency surgery, 16 patients cases with scar contracture were repaired by Phase Ⅱ surgery.There were 34 cases were rebuild the sensory by repaired the continuity between the dorsal branch of the ulnar nerve and dorsal digital nerve or palmar digital nerve.The free vascularized flaps that used the emerging point of perforator of the ulnar artery as center of the flap was designed, which based on the distal perforator to repairing the hand soft tissue defect.Results All 89 patients postoperative flaps were survived.Necrosis was seen in 1 flap which was repaired by skin grafting.Follow-up ranged from 3 to 36 months with an average of 12 months.The appearance of flap was not clumsy, the quality was good.The sensation was S3-S3+ in 34 cases after nerve reconstruction surgery.The active and passive activity of 16 cases with scar contracture were improved significantly.The incision in 72 cases for direct suture were healed without scar contracture, 18 cases of skin grafts were all survived without contracture.Conclusion The free vascularized flaps based on the distal perforator of ulnar artery has constant perforating point, which can carry sensory nerves and leads to little donor site damage without major vascular injury.The flap serves as a simple approach to repair hand defects, and get satisfied skin flap appearance and texture, the fingers feel and function recovered well.

0.05),but enhanced the expression of CD80,CD86 significantly(P

BACKGROUND: Patellar fracture is a common injury in orthopedics. There is no recognized gold standard for the implants. The improvement of the implants and the progress of the technology are the research hotspot in recent years. OBJECTIVE: To review the new progress of internal fixation for patellar fracture, and to explore the principles and advantages and disadvantages of various surgical treatment methods, so as to guide the clinical choice of the appropriate direction of internal fixators. METHODS: Wanfang and China National Knowledge Infrastructure were searched by the first author. The Chinese key words were “patella fracture, classification, biomechanics, internal fixator, internal fixation, complications, prognosis”. Simultaneously, PubMed was searched with the English search terms of “patellar fracture, classification, biomechanics, implants, internal fixation, tendon reconstruction, complications, prognosis”. The retrieval period was from July 2005 to February 2020. A total of 516 documents were retrieved. According to the inclusion and exclusion criteria, 47 documents were selected and summarized. RESULTS AND CONCLUSION: (1) The patellar fracture with knee extension function damage and articular surface damage should be treated by operation. The operation should not only consider the flatness of articular surface, but also consider the separation and displacement trend caused by the traction of quadriceps femoris tendon and patella ligament. (2) There are many kinds of implants for patella fracture, but there is no unified gold standard. (3) Implants for surgical treatment of patellar fracture include steel wire, Kirschner wire, suture, anchor, and steel plate. All kinds of built-in products are improved and innovated continuously.

BACKGROUND: Traumatic dislocation of sternoclavicular joint is a rare disease in orthopedics, which can cause misdiagnosis and improper treatment. Its operation technology is constantly improving, mainly because of the improvement of the internal objects. OBJECTIVE: To explore the new progress in the diagnosis and treatment of traumatic dislocation of sternoclavicular joint, and to summarize the key points and the advantages and disadvantages of operation with various implants. METHODS: The Chinese database of Wanfang and China National Knowledge Infrastructure was searched by the first author. The key words were “dislocation of sternoclavicular joint; biomechanics; implants; internal fixation; tendon reconstruction; complications; prognosis”. Simultaneously, the English database of PubMed was searched, with the search term of “dislocation of sternoclavicular joint; biomechanics; implant; internal fixation; tendon reconstruction; complications; prognosis”. The retrieval period was from July 2010 to February 2020. RESULTS AND CONCLUSION: (1) Traumatic dislocation of sternoclavicular joint is a kind of trauma which is easy to be missed and may be fatal. Computed tomograhy and B-ultrasound can be used to confirm the diagnosis. Magnetic resonance imaging can show the damage of mediastinum structure. (2) Surgical treatment methods include Kirschner wire tension band internal fixation, hook plate internal fixation, locking plate internal fixation, ligament strengthening and reconstruction technology, joint replacement and so on. The fixation strength of Kirschner wires and steel wires is unsatisfactory and its complication rate is high, but they can be used in juvenile patients. The cross joint steel plate does not meet the biomechanical requirements of the fretting joint, so it is difficult to achieve firm fixation. The hook steel plate belongs to the built-in object of elastic fixation, and the disadvantage lies in the abrasion and stimulation of the bone caused by the tail hook structure. More and more attention has been paid to ligament reconstruction technology, which not only meets the needs of strength, but also conforms to the characteristics of biomechanics.

BACKGROUND: The application of tissue engineering in the repair of spinal cord injury is a focus of research in recent years, and most of the studies are still in vitro stage. OBJECTIVE: To explore the effect of repairing spinal cord injury with tissue-engineered spinal cord that was composed of new collagen nanofiber membrane and neural stem cells. METHODS: Collagen was used as raw material, and the nanofiber membrane with parallel arrangement and staggered arrangement of fibers was prepared by electronic spinning technology. The spinal cord derived neural stem cells of neonate rats were cultured on two kinds of nanofibers for 7 days to construct the tissue-engineered spinal cord. Sprague-Dawley rat models of spinal cord hemisection were randomly divided into five groups. In the blank control group, any material was not used. In the parallel tissue engineering group and cross tissue engineering group, corresponding tissue-engineered spinal cord was used. In the parallel group and cross group, corresponding nanofiber membrane was used. At 1-8 weeks after the operation, modified BBB scores of the rats were recorded. At 8 weeks after operation, the spinal cord was taken and stained with hematoxylin and eosin and received immunohistochemistry. The experiments were approved by experimental animal welfare and Ethics Management Committee of Harbin Medical University. RESULTS AND CONCLUSION: (1) The BBB scores in the parallel tissue engineering group were higher than those in the other four groups (P < 0.05). The BBB scores in the staggered tissue engineering group, the parallel group and the staggered group were all higher than those in the blank control group (P < 0.05). The BBB scores in the staggered tissue engineering group were higher than those in the parallel group and the staggered group at 2-8 weeks after operation (P < 0.05). The BBB scores in the parallel group were higher than those in the staggered group at 1 and 2 weeks after operation (P < 0.05). (2) Hematoxylin-eosin staining showed that there was almost no cell structure in the injury area of the blank control, and a large number of scar tissue formation was seen. The formation of scar tissue was inhibited in the parallel group and the staggered group, and the tissue repair was not obvious; the scar formation in the adjacent tissue and no cell connection was established between the injury area and the surrounding area. There were a large number of cell components in the scaffold degradation area of the two tissue engineering groups, and there were obvious tissue regeneration, more cells distributed along the direction of the scaffold; connections were built among the cells and with normal tissues. (3) Immunohistochemistry staining showed that neurons were seen in the two tissue engineering groups. (4) The results showed that the effect of nano tissue engineering on the repair of spinal cord injury was good, and the effect of parallel nano fiber membrane was better.