Objective:To confirm the reuse of mismatched regenerated motor axons of brachial plexus and explore the effect of target organs on their regeneration in a rat model.Methods:This study was carried out between January 2021 and December 2021 at the research laboratory of the Department of Microsurgery, Orthopaedic Trauma and Hand Surgery, the First Affiliated Hospital of Sun Yat-sen University. Animals were randomly assigned into 2 groups, as a regeneration group (RGen) with 5 subgroups and a reuse group (RUs) with 3 subgroups. There were 6 rats per subgroup with 42 rats in total. It was observed that in the groups of RGen1-4, after the transection and suture of the musculocutaneous nerve, the motor axons of the proximal end could accurately grow into the distal corresponding endoneural tube. It was also observed that in the mismatched regenerated group, motor axons were the axons that grew into the endoneurial tube of the lateral forearm cutaneous nerve (LFCN), and other non-target organ contacts were made to the regenerated nerves after mismatch. It was specifically further divided into RGen1, the group without an organ for nerve to make contact with; RGen2, the group with skin as the target organ with nerves contact by neurorrhaphy; RGen3, the group with skin as the target organ with originally reserved natural nerve contact; RGen4, the group with muscle as the target organ with nerves contact by neurorrhaphy and RGen5, a control group. After 8 weeks, the positive area (PA), mean density (MD) and integral optical density (IOD) were measured, with AChE and ChAT fluorescence staining of the medial branch of LFCN, to evaluate the regenerated nerves after mismatch. Of the RUs group, firstly, the innervating branches of the flexor carpi radialis (FCR) were dissected and exposed, then further assigned according to initially innervated FCR (RUs1), contacted with regenerated nerves after mismatch (RUs2) and denervated (RUs3), respectively. After 8 weeks, compound muscle action potential (CMAP) and wet weight ratio of FCR were taken. Masson staining of FCR was also performed to evaluate muscle reinnervation by the regenerated nerves after mismatch. Data analysis with One-Way ANOVA and Bonferroni 0.05 indicated a statistically significant difference.Results:In the RGen groups, after AChE staining, the PA, MD and IOD of RGen3 and RGen4 were higher than that of RGen1 and RGen5, and PA of RGen4 were higher than that of RGen2, with a statistically significant difference ( P<0.05). After ChAT staining, the values of PA and IOD of RGen3 and RGen4 were higher than that of RGen1 and RGen5, and PA of RGen4 were higher than that of RGen2, with a statistically significant difference ( P<0.05). In the RUs, electrophysiological assessment showed that no CMAP was observed in RUs3, there was no significant difference in Latency of RUs1 and RUs2. The difference was statistically significant ( P<0.05). Wet weight rate of muscle of RUs1 (98.91%±3.86%) was higher than that of RUs3 (86.67%±4.68%) with a statistically significant difference ( P<0.01), but no significant difference when compared with RU2 (92.74%±3.88%). Masson staining showed that the CVF value of RUs2 (8.61%±1.16%) was significantly higher than that of RUs1 (3.17%±0.76%), and statistic significantly lower than that of RUs3 (16.44%±2.26%)( P<0.01). Conclusion:Target organ contact can promote the regenerated nerves after mismatched regeneration, and the muscle target organs exhibit greater facilitation than the cutaneous target organs. Besides, regenerated nerves after mismatch can establish effective innervation with muscle target organs, comfirming their effective reuse.

Objective:To investigate the preoperative risk factors affecting early extremity blood supply after repair of major arterial injury so as to provide clues for prevention of limb ischemia.Methods:The clinical data were retrospectively analyzed of the 139 patients (140 extremities) with major extremity arterial injury who had been admitted to Department of Microsurgery, Orthopaedic Trauma and Hand Surgery, The First Hospital Affiliated to Sun Yat-sen University from January 2003 to December 2019. There were 112 males and 27 females, with a mean age of 30 (20, 44) years. The primary outcome was the early status of blood supply to the injured extremity (48 hours after surgery). Univariate analysis was conducted of such factors as gender, age, ischemia time, injury mechanism, injury site, fracture, soft tissue lesion, and duration of surgery. The significant factors ( P<0.1) were then analyzed by logistic regression, and P<0.05 was considered statistically significant. Results:Ischemia happened in 44 (31.4%, 44/140) extremities within 48 hours after surgery. There were significant differences in injury mechanism, ischemia time, fracture, and soft tissue lesion between patients with and without postoperative extremity ischemia ( P<0.05). Logistic regression analysis indicated that blunt injury ( OR=5.639, 95% CI: 1.068 to 29.761, P=0.042) and soft tissue lesion ( OR=12.568, 95% CI: 3.402 to 46.431, P<0.001) were significant preoperative risk factors affecting the early blood supply after repair of major extremity arterial injury. Conclusion:As blunt injury and soft tissue defect are preoperative risk factors for early extremity ischemia after repair of major extremity arterial injury, surgeons should pay more attention to them when assessing patients and making repair protocols.

Objective:To explore the therapeutic outcome of rat skeletal muscle extracellular matrix(ECM) hydrogels blended with skeletal muscle stem cells for skeletal muscle defects in a rat model.Methods:From May, 2018 to January, 2020, 5 methods were employed to obtain ECM from rat skeletal muscle. The resulting ECM was evaluated using haematoxylin and eosin (HE) staning and 4-6-diamidino-2-phenylindole (DAPI) staining. The components and structure of hydrogel were assessed by Masson staining and scanning electron microscopy (SEM). Skeletal muscle stem cells were then blended in the hydrogel and MTT was used to observe the growth of cells. Rat skeletal muscle defect models were established and HE staining was used to examine the growth of injured skeletal muscle in each group. Expression of Pax7 and MyoD were detected by immunofluorescence in each group. The function of skeletomuscular tissue was evaluated by electrical stimulation in each group. T test and ONE-WAY analysis of variance were used for data analysis.Results:In this study, a method that caused little damage to skeletal muscle structure and completely removed the cell components was found. This method was employed in the preparation of hydrogel. Masson staining and SEM showed that hydrogel retained the basic structure and some biological factors of skeletal muscle. MTT test showed that hydrogel promoted the proliferation of skeletal muscle stem cells. The experiments in rat skeletal muscle defect models showed that the group treated with stem cells [Specific force was (9.00±2.10) N/cm 2 achieved better outcomes than the other groups (4.06±1.12) N/cm 2 and (5.00±1.60) N/cm 2 in unrepaired group and hyclrogel group, respectively] ( P<0.05) . Conclusion:The results indicated that ECM hydrogel has a good biocompatibility. Furthermore, it was observed that rat skeletal muscle ECM hydrogels blended with skeletal muscle stem cells promoted the repair of muscle defect in a rat model, which would offer a promising strategy for functional muscle repair.

Objective:For Bayne and Klug type Ⅲ radial longitudinal deficiency, the aim of the surgical methods is to create a centralized stable wrist and restore the length of the radius. The purpose of the current study was to validate the use of the staged procedures with vascularized proximal fibular epiphyseal transfer, based on a single vascular pedicle of the inferior lateral genicular artery to treat radius defects.Methods:Between June 2007 and June 2012, five children with an averaged age of 4.3 years (range, 3.3 to 5.8 years) who had a type Ⅲ radial longitudinal deficiency were identified. The staged procedures we performed for this patient consisted of: (1) soft tissue distraction of the wrist with an external distraction device to centralize the wrist and create a space for placement of the proximal fibular graft, ulnar osteotomy, and internal fixation to correct the bowing deformity of the ulna if necessary; (2) vascularized proximal fibular epiphysis transferred to repair the radius defect and to reconstruct the wrist; and (3) pollicization or thumb reconstruction to treat thumb deficiency. In all patients, the range of motion of the digits, wrist, forearm, and elbow; the length of the forearm; and the deviation of the wrist were evaluated.Results:The averaged duration of follow-up was 52.6 months (range, 42 to 72 months). All transplants survived and united with the host bone within 3 months postoperatively. An averaged correction of 28 degrees in the hand-forearm angle was obtained. At the final follow-up, the average ulna and radius lengths were 14.4 cm and 12.1 cm, respectively; the percentage length compared with the normal side was 64.0 and 56.3 percent, respectively. The overall range of wrist motion was approximately 56 percent of that of the contralateral extremity. The averaged pronation and supination were 75 and 45 percent of the normal side, respectively. The overall range of elbow motion was similar to the normal side.Conclusions:The results of the present study indicated that vascularized proximal fibular epiphyseal transfer, based on the inferior lateral genicular artery, is a technically feasible method for treatment of Bayne and Klug type Ⅲ deficiency, which restores the length of the radius and stabilized the wrist.

Objective:For Bayne and Klug type Ⅲ radial longitudinal deficiency, the aim of the surgical methods is to create a centralized stable wrist and restore the length of the radius. The purpose of the current study was to validate the use of the staged procedures with vascularized proximal fibular epiphyseal transfer, based on a single vascular pedicle of the inferior lateral genicular artery to treat radius defects.Methods:Between June 2007 and June 2012, five children with an averaged age of 4.3 years (range, 3.3 to 5.8 years) who had a type Ⅲ radial longitudinal deficiency were identified. The staged procedures we performed for this patient consisted of: (1) soft tissue distraction of the wrist with an external distraction device to centralize the wrist and create a space for placement of the proximal fibular graft, ulnar osteotomy, and internal fixation to correct the bowing deformity of the ulna if necessary; (2) vascularized proximal fibular epiphysis transferred to repair the radius defect and to reconstruct the wrist; and (3) pollicization or thumb reconstruction to treat thumb deficiency. In all patients, the range of motion of the digits, wrist, forearm, and elbow; the length of the forearm; and the deviation of the wrist were evaluated.Results:The averaged duration of follow-up was 52.6 months (range, 42 to 72 months). All transplants survived and united with the host bone within 3 months postoperatively. An averaged correction of 28 degrees in the hand-forearm angle was obtained. At the final follow-up, the average ulna and radius lengths were 14.4 cm and 12.1 cm, respectively; the percentage length compared with the normal side was 64.0 and 56.3 percent, respectively. The overall range of wrist motion was approximately 56 percent of that of the contralateral extremity. The averaged pronation and supination were 75 and 45 percent of the normal side, respectively. The overall range of elbow motion was similar to the normal side.Conclusions:The results of the present study indicated that vascularized proximal fibular epiphyseal transfer, based on the inferior lateral genicular artery, is a technically feasible method for treatment of Bayne and Klug type Ⅲ deficiency, which restores the length of the radius and stabilized the wrist.

Objective To investigate the expression pattern of skeletal muscle specific miR-206,myogenesis related myoD which change with time in dcnervated muscle atrophy rats.Methods From June,2015 to January,2016,40 SPF sprague-dawley rats were equally classified into 5 groups randomly according to standard settled before,5 groups were separately defined as denervated 0d group,denervated 1d group,denervated 7d group,denervated 14d group,and denervated 28d group.Each group contained 8 rats.The rats atrophy models were established by cutting sciatic never on left side.According to the different denervated time,the gastrocnemii on both sides were obtained under anesthesia,respectively.The wet weight ratio of two compared gastrocnemii were measured,and the gastrocnemii transection was observed by HE stain,measured the expression of myoD protein by western blot,obtained the expression of miR-206,myoD mRNA by qPCR.Results According to our study on rats denervated atrophy models,the wet ratio of compared gastrocnemius would decrease rapidly,by HE stain,decease of cross sectional area in muscle fiber was observed as well as degeneration.Collagen fibers hyperplasia appeared and increased with time change.Wet ratio and transaction aera ratio of group Od,1d,7d,14d,28d were 0.99±0.04,0.92±0.07,0.68±0.11,0.39±0.06,0.27±0.07 and 0.99±0.02,0.96±0.04,0.51±0.09,0.34±0.08,0.23±０.03 respectively,difference between experimental groups and control group were statistically significant (P＜ 0.05),the differences between each experimental groups were also statistically significant (P＜ 0.05).After qPCR test of miR-206,myoD mRNA expression,it was found that their expression patterns were similar,miR-206,myoD mRNA increased at first and would reach the expression peak at the 7 th day,after that their contents decreased but still higher at the 14th day when compared with that at the 1 st day.Their expression of group 0d,1 d,7d,14d,28d were 0.24±0.06,0.34±0.04,0.68±0.04,0.49± 0.07,0.25±0.03 and 0.41 ±0.06,0.49±0.09,0.93±0.06,0.66±0.03,0.39±0.04,respectively.All experimental groups were statistically significant different when compared with 0d group except 1d group (P＜ 0.05),the differences between each experimental groups were also statistically significant(P＜ 0.05).The protein expression of myoD was also measured by western blot test,which showed nearly the same expression pattern as the mRNA expression pattern.After injury,the protein expression increased and reached the expression peak at the 7th day.The relative expression of myoD of group 0d,1d,7d,14d,28d measured by grey ratio were 1.03±0.05,1.06±0.06,1.42±0.10,0.66±0.13,0.24±0.07,respectively.The difference between experimental groups and control group were statistically significant (P ＜ 0.05),the differences between each experimental groups were statistically significant (P ＜ 0.05) as well.Conclusion The degree of muscle denervation atrophy was related to the denervated duration in rats.The expression regulation of miR-206 and myoD in gastrocnemius was similar during the muscle denervation atrophy,which suggesting having internal relationship between miR-206 and myoD.

Objective To investigate the efficacy and safety of Tripterygium wilfordii Hook F (TwHF) combined with renin-angiotensin system (RAS) blockers in chronic kidney disease (CKD) stages 2~3 of IgA nephropathy. Methods 109 patients were randomized into the observation group and the control group. On the basis of taking RAS blockers, patients in the observation group received TwHF, and patients in the control group received methylprednisolone. The proteinuria, renal function and adverse effect were observed during treatment. Results At 3, 6, 9 and 12 months of treatment, proteinuria in the two groups was lower than the baseline(P <0.05). During follow-ups, there was no significant difference of eGFR between the two groups and baseline (P >0.05). Besides, there was no significant difference in terms of proteinuria, eGFR and effective rate in the two groups. The occurrence rate of adverse effects was 9.8% vs 27.4% and there was significant difference in the two groups (P < 0.05). Conclusions TwHF combined with RAS blockers can decrease proteinuria, protect renal function and have less adverse effects, and it is a useful therapeutic options for CKD stages 2 ~ 3 of IgAN.

ObjectiveTo evaluate the value of MR imaging(MRI)in diagosing of obstetrical brachial plexus.MethodsBetween September 2006 to September 2011,eighteen cases (12 males and 6 females)of obstetrical brachial plexus injury had being used for investigation,aging from 2 month to 3 years, average of 10.6 month. Eight left side and 10 right side. Tassin Ⅰ was 4 cases,Tassin Ⅱ was 6 eases, Tassin Ⅲwas 5 eases, Tassin Ⅳ was 4 cases. All cases were performed to MRI test before operating and the result compare with finding during operating. ResultsFindings of MRI:pseudomeningocele was in 13 of the 18cases while 10 of the 15 patients had multiple pseudomeningoceles. Displacement of spinal cord was in 6 cases; Normal was 2 cases; thickening of nerve root was in 2 cases.ConclusionMR imaging is an effective tool for demonstrating lesions of the brachial plexus worthy of surgical exploration.

Objective To observe the clinical therapial value of functional reconstruction with Botulinum Toxin A (BTA) on spasitic cerebral palsy. Methods Thirty-two patients were treated by Achilles tendon lengthening and anterior transfer of posterior tibial tendon.According to the spasticity of triceps surae muscle,all cases were arranged by BTA injection 2 months later after operation.Results From Jan.2000 to Jan.2009,thirty-two cases with equinovarus foot of spasticitical cerebral palsy were collected,the muscle strength of ankle dorsal extensor increased from 0-2 grades to 4-5 grades,there was significant difference between preoperational muscle strength and postoperational one.There was also significant improvement to adjust yarus degrees of ankle joint.the musclar tension of triceps muscle of calf decreased from Ⅱ-Ⅳ grades to Ⅰ-Ⅱ grades. Conclusion Anterior transfer of posterior tibial tendon corresponding with Botulinum Toxin A injection not only release muscle spasticity but also improve dorsal extending strength of ankle joint.The clinical effect of these methods was reliable on cerebral palsy.

Objective To explore the clinical classification of the brachial plexus root injury in adult.MethodsAll 155 cases of adult brachial plexus root injury in the First Affiliated Hospital of Sun Yat-sen University,were collected and analyzed on their characteristic,operative methods,and clinical outcome so as to find the distribution and incidence of different type of brachial plexus root injury and set up the clinical classification of adult brachial plexus root injury.ResultsBrachial plexus root injuries in adult could be classified into three types and seven subtypes.Type A is upper brachial plexus root injury,including type AⅠ (C5,C6 completely avulsion or rupture injury,with/without phrenic nerve injury),type AⅡ (C5-C7 completely injury),and type AⅢ (C5-C7 completely injury accompanied with C8,T1 incompletely injury).Type B is lower brachial plexus root injury,including type BⅠ[ C8,T1 (with/without C7)completely injury ] and type BⅡ (C8,T1,C7 completely injury,accompanied with C5、6 incompletely injury).Type C is total brachial plexus root injury,including type CⅠ(C5-T1 completely root avulsion) and type CⅡ(C7-T1 root avulsion accompanied with C5、6 root or trunkrupture).For the cases of every type,u pper brachial plexus root injury type A have 86 cases,in which type AⅠ 6 cases,type AⅡ 27 cases and type AⅢ 53 cases; lower brachial plexus root injury type B have 6 cases,in which type BⅠ 2 cases and type BⅡ 4 cases; total brachial plexus root injury type C have 63 cases,in which type CⅠ 51 cases and type CⅡ 12 cases. ConclusionExcept the upper,lower,and total three types,brachial plexus root injuries in adult could be classified further into seven subtypes.The distribution of different type of adult brachial plexus root injury is overbalance:upper type A (55.5％) is more often seen,total type C(40.6％) followed and lower type B(3.9％) is the least seen.In upper brachial plexus root injury,type AⅢ(61.6％) is more often seen,type AⅡ(31.4％) followed and type AⅠ(7％) is less seen.