Objective To investigate the related mechanism of ligamentum flavum (LF) hypertrophy in diabetic pa-tients with lumbar spinal canal stenosis ( LSCS ) .Methods Twenty-four diabetes mellitus patients [ DM (+) ] and twenty normoglycemic patients [ DM (-) ] with LSCS were enrolled in this study .Sorbitol in LF was analyzed using D-Sorbitol/Xylitol test kit .The thickness of LF was measured by CT .The structure of LF was observed after HE and Masson's trichrome staining .The cell cycle and proliferation of fibroblastic cell NIH 3T3 line cultured in high glucose were analyzed .Sorbitol of NIH3T3 was detected under different backgrounds in vitro, normal glucose , high glucose and high glucose burdened with aldose reductase inhibitor ( ARI) , Epalrestat .The expression of inflammatory factors was detected by qPCR and Western blot under above different backgrounds .Results LF of diabetic patients exhibi-ted significantly higher level of sorbitol and pro-inflammatory cytokines , TGF-βand of CD68-positive staining than that of the normoglycemic subjects ( P<0.01 ) .The diabetic LF was significantly thicker than that of the controls , and showed evidence of degeneration .The high glucose-cultured fibroblasts exhibited significantly higher levels of sorbitol , pro-inflammatory factors , and TGF-βcompared to the low glucose-cultured cells , and these levels were dose-dependently reduced by treatment with the aldose reductase inhibitor (P<0.05).Conclusions Sorbitol level of the LF is significantly increased in the DM patients with LSCS .Increased sorbitol recruites inflammatory factors and fibrogenic-related factor TGF-βin LF of DM patients with LSCS which may contributes to the LF hypertrophy .

Objective: To explore the clinical effects of the reconstruction of extensive leg defects using the free anterolateral thigh flap with the contralateral leg vessels as the recipient vessels. Methods: From January 2012 to January 2018, ten patients were treated with severe and extensive leg defects in the department of orthopedics of the First Affiliated Hospital of Nanchang University. There were 7 males and 3 females with an average age of 35, from 17 to 56. There were no main vessels for angiogenesis around the wounds in all cases. The size of defects ranged from 20 cm×13 cm to 29 cm×15 cm. The position of defects were anterior of shank in 5 cases, medial in 3 cases and medial posterior in 2 cases. The various flaps were harvested from the anterolateral thigh region of healthy leg and transferred to repair the leg defects. The healthy vessels of the contralateral leg were chosen as the recipient vessels. The musculocutaneous flap, fascia flap or perforator was removed according to the size of the defect and whether it was necessary to fill the dead space of the wound. The limbs were placed in parallel position and was fixed by external fixator. The pedicle division training was started 1 week after operation, the period of pedicle division and external fixator removing was from 21 days to 32 days. When the pedicle was divided, the vascular end of the limb and the distal end were anastomosed to re-established the continuous vessels. Results: All 10 flaps survived completely after surgery. The size of flaps ranged from 23 cm×14 cm to 32 cm×16 cm. The recipient vessels that were used included the posterior tibial vessels in 5 cases and anterior tibial vessels in the remaining 5 cases. All the vessels in flap pedicle were anastomosed to the recipient vessels in an end-to-end fashion. The anastomotic sites and vascular bundles were covered by using a local flap in 2 cases, skin tension reducer in 1 cases, and free skin graft in the remaining 7 cases. Very mild infection occurred in one case and was controlled by dress changing. A small-sized necrosis of the grafted skin occurred in another patient. All patients were followed up for 6 to 18 months with an average of 12 months. The function of the lower extremities almost recovered. All patients were happy with the final functional and aesthetic outcomes. Conclusions Although there some drawbacks of the technique, such as long-term immobilization of the lower extremities, multiple staged surgeries, for strictly selected patients, the healthy vessels of the contralateral leg could be served as recipients vessels when a free myocutaneous, fasciocutaneous, or perforator flap was used to reconstruct the extensive and severe injury of the leg, particularly in the absence of usable vessels in the ipsilateral leg.