Guideline for the diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients (version 2023) / 中华创伤杂志

Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.

Guideline for clinical perioperative care of orthopedic trauma patients in the new stage of novel corona virus infection (version 2023) / 中华创伤杂志

As the National Health Commission changes the management of novel corona virus infection, the situation and preventive policies for controlling the epidemic have also entered a new stage in China. Perioperative care strategies for orthopedic trauma such as designated isolation and nucleic acid test screening have also been adjusted in the new stage. Based on the perioperative work experiences in the new stage of epidemic from the frontline anti-epidemic staff of orthopedics in domestic hospitals and combined with the literature and relevant evidence-based medical data in perioperative care of orthopedic trauma patients under the current anti-epidemic policies at home and abroad, Chinese Orthopedic Association and Chinese Society of Traumatology organized relevant experts to formulate the Guideline for clinical perioperative care of orthopedic trauma patients in the new stage of novel corona virus infection ( version 2023). The guideline summarized 16 recommendations from the aspects of preoperative diagnosis and treatment, infection prevention, emergency operation and postoperative management to systematically standardize the perioperative clinical pathways, diagnosis and treatment processes of orthopedic trauma in the new stage of novel corona virus infection, so as to provide a guidance and reference for hospitals at all levels to carry out relevant work in current epidemic control policies.

Anatomic and clinical application of lateral-perineal approach for inferior ramus of pubis-ischium ramus / 中华骨科杂志

Objective:To explore the anatomical and clinical effects of lateral-perineal approach in treating the fracture of inferior ramus of pubis-ischium ramus.Methods:The lateral approach of the perineum was simulated on 10 side of 5 intact wet adult cadavers to determine the surface symbols of incision design and to expose the operative field of the approach and to observe the anatomical characteristics of the perineal branch of the posterior femoral cutaneous nerve and the incision of the surgical approach. Five points were selected at the incision of the approach. The distance (L 1-L 5) between each point and the body surface projection of the perineal branch of the posterior femoral cutaneous nerve was measured. A total of 11 patients, including 5 males and 6 females with an average age of 41.55±14.32 years, ranging from 18 to 62 years, were treated by this approach in clinical practice. All patients had a reduction and fixation to the fracture of inferior ramus of pubis-ischium ramus. The operation duration, incision length, intraoperative blood loss and surgical complications were recorded. The quality of fracture reduction was evaluated according to Matta radiographic criteria. The strength of the adductor was measured. The pelvic function was evaluated according to Majeed Pelvic Score at the last follow-up. Results:Anatomical studies shown that the line between the two points. One point was 4 cm lateral to the level of the apex of the pubic arch. Another point was 4 cm from the ischial tubercle on the line from the ischial tuberosity to the point that 4 cm lateral to the level of the apex of the pubic arch was the axis of the approach lateral of the perineum. Anatomical studies showed that the lateral-perineal approach could expose the range from pubic symphysis to sciatic tuberculum. The distance between the points selected at the incision of the approach and the body surface projection of the perineal branch of the posterior femoral cutaneous nerve: L 1 was 19.40±1.17 mm, ranging from 18 to 21 mm; L 2 was 16.60±2.76 mm, ranging from 10 to 20 mm; L 3 was 18.30±1.89 mm, ranging from 16 to 21 mm; L 4 was 19.20±1.93 mm, ranging from 16 to 22 mm; L 5 was 14.70±1.83 mm, ranging from 13 to 18 mm. All patients were followed up for 17.91±4.09 months, ranging from 13 to 26 months. The incision length was 8.18±0.98 cm, ranging from 7 to 10 cm. The operation duration was 59.64±12.17 min, ranging from 43 to 85 min. The intraoperative blood loss was 100 ml, ranging from 50 to 130 ml. All incisions were healed in all patients. The fractures were healed in 13.36±2.06 weeks, ranging from 10 to 16 weeks. According to Matta radiographic criteria, the quality of fracture reduction was excellent in 6 cases, good in 4 cases and fair in 1 case. At the last follow-up, the adductor muscle strength reached grade 4 in 4 patients and grade 5 in 7 patients. Furthermore, according to the Majeed Pelvic Score, the score of every patient was 86.55±9.59, ranging from 66 to 100, and 8 cases were excellent, 3 cases were good at the last follow-up. The heterotopic ossification occurred in 2 patients, the pain during intercourse occurred in 2 patients. No patient had sensory disturbance or pain in the perineal area. Conclusion:A certain safe distance is between the lateral to the perineum and the perineal branch of the posterior femoral cutaneous nerve with limited risk of injuring posterior femoral cutaneous nerve via the lateral approach of the perineum. The advantages in treating the fracture of inferior ramus of pubis-ischium ramus by this approach have concealed incision, short operation duration and less bleeding with satisfied short-term clinical effects.

Treatment of talar cartilage injury and bone cyst with modified biplane Chevron osteotomy and autogenous osteochondral transplantation / 中华创伤骨科杂志

Objective:To evaluate the clinical efficacy of the modified biplane Chevron osteotomy and autogenous osteochondral transplantation for the treatment of talar cartilage injury with bone cyst.Methods:From February 2016 to February 2019, 26 patients with talar cartilage injury and bone cyst were treated at Department of Orthopaedics, The First Affiliated Hospital to Guangxi Medical University. They were 16 males and 10 females, aged from 22 to 50 years (average, 36.2 years). According to the Hepple classification, there were 5 cases of type Ⅳ and 21 cases of type Ⅴ. The extent and range of talar cartilage injury were evaluated by arthroscopy, the modified biplane Chevron osteotomy of medial malleolus was performed to expose cartilage defects medial to the talus, unstable cartilage was removed thoroughly, sclerotic wall of the bone cyst was freshly treated, and an osteochondral column taken from the non-weight-bearing area of the ipsilateral femoral medial condyle was implanted into the injured area of talar cartilage. The clinical efficacy was evaluated by comparing the ankle-hindfoot scores of American Orthopedic Foot and Ankle Society (AOFAS), Karlsson ankle scores, visual analogue scale (VAS) and Lysholm ankle scores between preoperation and one year post-operation.Results:All the 26 patients were followed up for an average of 20.6 months (from 12 to 30 months). Follow-up did not observe any postoperative complications like incision infection, cyst recurrence or malunion, or any obvious pain or movement limitation at the donor knee joint. The AOFAS ankle-hindfoot scores were significantly increased from preoperative 64.3±3.9 to 89.5±5.1 one year postoperation, the Karlsson scores were significantly increased from preoperative 60.5±5.5 to 85.2±6.9 one year postoperation, and the VAS scores were significantly decreased from preoperative 6.2±1.1 to 1.8±0.9 one year post-operation (all P<0.05). The Lysholm ankle scores before and after operation were 94.7±1.9 and 94.1±1.8, respectively, showing no significant difference ( P>0.05). Conclusion:In the treatment of talar osteochondral injury and bone cyst, the modified biplane Chevron osteotomy of medial malleolus and autogenous transplantation of osteochondral column can effectively relieve ankle pain and improve ankle function, leading to satisfactory clinical efficacy.

Anterior approach combined with blocking plates and screws in the management of acetabular fracture involving the quadrilateral area / 中华创伤杂志

Objective:To investigate the clinical efficacy of anterior approach combined with blocking plates and screws in the management of acetabular fracture involving the quadrilateral area.Methods:A retrospective case series analysis was performed for 16 patients with acetabular fracture involving the quadrilateral area admitted to First and Second Affiliated Hospital of Guangxi Medical University from January 2017 to January 2019. There were 12 males and 4 females，with the age of 21-66 years［（45.3±10.6）years］. According to Letournel-Judet classification，there were 9 patients with bi-column fracture，6 with anterior and posterior traverse fracture and 1 with anterior column fracture. A total of 9 patients were operated via the ilioinguinal approach and 7 via the lateral-rectus approach. Reduction and fixation of the pelvis and acetabulum were performed，using 3.5 mm cortical bone screws or plates to block the internal displacement of fracture in the quadrilateral body. The incision length，operation time and intraoperative blood loss were recorded. The quality of fracture reduction was assessed according to the Matta reduction criteria at postoperative 2 days and hip function by the modified Merle D'Aubigne-Postel score at postoperative 3 months and 12 months. Postoperative complications were observed.Results:All patients were followed up for 13-24 months［（16.1±2.9）months］. The ilioinguinal approach and lateral-rectus approach showed surgical incision of 12-26 cm［（18.6±4.0）cm］and 8-15 cm［（10.7±2.3）cm］，respectively. The operation time was 107-215 minutes［（159.2±27.8）minutes］and the intraoperative blood loss was 200-2，300 ml［（853.1±489.7）ml］. According to Matta reduction criteria，the results were excellent in 9 patients and good in 7. Three months after operation，the modified Merle D'Aubigne-Postel score was 11-18 points［（15.2±2.2）points］，which showed the results were excellent in 4 patients，good in 7，fair in 4 and poor in 1，with the excellent and good rate of 69%. Twelve months after operation，the modified Merle D'Aubigne-Postel score was 13-18 points［（16.9±1.4）points］，which showed the results were excellent in 7 patients，good in 8 and fair in 1，with the excellent and good rate of 94%. The liquefaction of post-surgical incision was seen in a patient，bladder injury in a patient，lateral femoral cutaneous nerve injury in a patient，and heterotopic ossification in a patient. There was no loosening or breakage of the internal fixation.Conclusion:For acetabular fracture involving the quadrilateral area，anterior approach combined with blocking plates and screws can prevent the displacement of quadrilateral fracture and attain satisfactory reductiongood hip function recovery and few complications.

Kickstand extended external fixation for prevention of pressure sores and swelling in the post-traumatic lower extremity / 中华创伤骨科杂志

The Kickstand technique is an extension added to the basic frame of modern external fixation to elevate an affected extremity. It is an affordable and modified external fixation in orthopedic trauma. Orthopedic physicians use this technique to prevent formation of pressure sores and relieve swelling in lower extremity of patients who require prolonged bed rest, because this technique makes the heel apart from the supporting surface and promotes circulation of venous blood lymph fluid. This paper briefly introduces the development of this technique and its efforts to improve quality of care and solve a clinical problem. To relieve the burden of healthcare for pressure sores and swelling in an affected lower extremity after surgery, this technique should be popularized.

Kickstand extended external fixation for prevention of pressure sores and swelling in the post-traumatic lower extremity / 中华创伤骨科杂志

The Kickstand technique is an extension added to the basic frame of modem external fixation to elevate an affected extremity.It is an affordable and modified external fixation in orthopedic trauma.Orthopedic physicians use this technique to prevent formation of pressure sores and relieve swelling in lower extremity of patients who require prolonged bed rest,because this technique makes the heel apart from the supporting surface and promotes circulation of venous blood lymph fluid.This paper briefly introduces the development of this technique and its efforts to improve quality of care and solve a clinical problem.To relieve the burden of healthcare for pressure sores and swelling in an affected lower extremity after surgery,this technique should be popularized.

Current diagnosis and treatment of acute extremity compartment syndrome / 中华创伤骨科杂志

Extremity compartment syndrome can cause neuromuscular ischemia and deposition of metabolites in the compartment,leading to irreversible lesions which harm limb functions in the end.It is a great challenge for surgeons to make a timely and accurate diagnosis of the syndrome in adults and children.The key is evaluation of the clinical symptoms and intracompartmental pressure.In this paper we summarize the epidemiology,etiology,pathophysiology,and current diagnosis and treatment of acute extremity compartment syndrome of the upper and lower extremities in adults and children.

The therapeutic effects of total hip arthroplasty with combined anteversion angle of femoral neck-acetabu lam in Crowe Ⅳ developmental dysplasia of the hip / 实用医学杂志

Objective To evaluate the clinical efficacy of combined anteversion angle of femoral neck-acetabulam in Crowe Ⅳ developmental dysplasia of the hip (DDH) with Wagner Cone total hip arthroplasty. Methods From June 2013 to February 2016,45 cases of CroweⅣDDH were treated with no femoral shortening osteotomy in THA ,including 25 females and 20 males. The outcomes of anteversion angle of femoral neck and acetabulam were measured in CT scan of hip jiont. The outcomes of abduction angle ,hip center were measured radiologically in X-ray of pelvis. Postoperative function was scored by Harris scoring system. Results The mean follow-up time of the 45 patients was(3.2 ± 0.8)years. Using loosening or revision as the end point ,the survival rate was 100%. The outcomes of preoperative anteversion angle of acetabulam,femoral neck,acetabulam-femoral neck was(27.70 ± 5.35)°,(47.76 ± 7.25)°,and(74.90 ± 8.43)° in CroweⅣgroup,and those of postoperative anteversion angle was(19.82 ± 2.41)° ,(23.35 ± 3.84)° and(44.90 ± 5.18)° ,respectively. There was significant difference between the two groups(P < 0.05). The average height of preoperative dislocation in femoral head was (5.8 ± 1.2)cm and the postoperative average displacement of femoral lesser trochanter was (3.6 ± 0.8)cm. The Harris hip score was improved from preoperative(46.66 ± 7.28)to(90.36 ± 4.72). For most patients,hip pain were significantly relieved ,range of motion of the hip was improved ,and the gait returned to normal. Femoral nerve injury occurred in 2 cases and the case recovered after 3 months respectively. Conclusions The deformity of hip and the stability and matching degree of the prosthesis was evaluated with the combined anteversion angle of femoral neck-acetabulam in CroweⅣDDH. The Wagner Cone can effectively maintain the stability of the hip joint in the non-amputated total hip replacement.

Guangxi cobra venom-derived NGF promotes the osteogenic and therapeutic effects of porous BCP ceramic

Neuro-osteological interactions have an important role in the regulation of bone metabolism and regeneration. Neuropeptides combined with porous biphasic calcium phosphates (BCP) using protein adsorption may contribute to the acceleration of bone formation. In the present study, we investigated the effect of BCP combined with nerve growth factor (NGF) on the growth of osteoblasts in vitro and the combinational therapeutic effect on the repair of calvarial defects in vivo. NGF was separated and purified from Chinese cobra venom using a simplified three-step chromatography method. BCP combined with NGF exerted a potent effect on osteoblast differentiation, as evidenced by enhanced cell proliferation, increased ALP activity and the up-regulated expression of osteogenesis-related genes and proteins. Further, combinational therapy with BCP and NGF improved calvarial regeneration, which was superior to treatment with therapy alone, as observed using imageological and morphological examination and histological and immunohistochemical staining. The results confirmed the effect of neuro-osteological interactions through combinatorial treatment with NGF and BCP to promote osteogenesis and bone formation, which may provide an effective and economical strategy for clinical application.

Ilizarov bone transport for repair of diabetic foot：a functional and imaging evaluation / 中国组织工程研究

BACKGROUND:Previous therapies for diabetic foot are not ideal with large cost, and moreover, amputation is often required. OBJECTIVE: To perform the Ilizarov bone transport in the treatment of patients with diabetic foot (Wanger grades 3-4), and to observe the limb salvage conditions. METHODS: Eighteen patients with diabetic foot, Wanger grades 3-4, admitted in the Department of Bone and Joint Surgery, First Affiliated Hospital of Guangxi Medical University from December 2013 to June 2015 were enroled in this trial. Al of patients were subjected to Ilizarov bone transport. RESULTS AND CONCLUSION: Al the 18 patients were folowed up for 3 to 20 months, and presented with ulcer healing. Scores on ankle-brachial index and 10-g nylon line test were both increased significantly in the patients after treatment, but the visual analog scale scores were reduced. These findings indicate that the Ilizarov bone transport is an effective method for treating ulcer of diabetic foot at Wanger grades 3-4.

Application of 3D printing technology in the repair of pelvic fracture / 中国组织工程研究

BACKGROUND:3D printing technology for preoperative planning has been a trend at present. Moreover, this technology has been extensively used in bone tumor resection and maxilofacial surgery, but seldom used in fracture repair. OBJECTIVE: To explore the value of 3D printing technology application in preoperative evaluation of pelvic fracture, planning and during surgery. METHODS:Pelvic fracture patients underwent preoperative CT scan. Pelvic models of the patients were printed using 3D printing technology at 1:1. Preoperative processing was conducted, including choice of approach, design of incision exposure range, design of fracture reduction, pre-implantation position of the steel plate, optimal plastic design of steel plate, measurement of screw length and design of screw direction. Matta score of pelvic fracture reduction and Majeed score of pelvic function after repair were measured during folow-up. RESULTS AND CONCLUSION:The operation time was 55-130 minutes, averagely (84.75±20.15) minutes. Intraoperative blood loss was 200-800 mL, averagely (417.00±173.58) mL. After operation, no incision infection, fracture nonunion, fixator loosening or breakage appeared. Al patients were folowed up for 8-24 months. The fracture healing time was 10-16 weeks, averagely 12.5 weeks. Fracture reduction was assessed according to Matta scoring: excelent in 15 cases, good in 3 cases, average in 2 cases, and poor in 0 case, with an excelent and good rate of 90%. Postoperative function was assessed according to Majeed scoring: excelent in 13 cases, good in 5 cases, average in 2 cases, and poor in 0 case, with an excelent and good rate of 90%. These findings showed that the application of 3D printing technology in pelvic fracture can determine the fracture’s displacement, is helpful for accurate reduction and plate modeling, reduces surgery duration and intraoperative blood loss and complication, finaly achieves better surgical result. 3D printing technology can better evaluate and plan the pelvic fracture before repair, and can be used as a routine project preparation of pelvic fracture repair.

Stimulating Effect of a Novel Synthesized Sulfonamido-Based Gallate ZXHA-TC on Primary Osteoblasts

PURPOSE: This study is intended to investigate the effects of plants or plant-derived antioxidants on prevention of osteoporosis through the maintenance of reactive oxygen species (ROS) at a favorable level. MATERIALS AND METHODS: In this study, a novel antioxidant, namely 3,4,5-Trihydroxy-N-[4-(5-hydroxy-6-methoxy-pyrimidin-4-ylsulfamoyl)-phenyl]-benzamide (ZXHA-TC) was synthesized from gallic acid and sulfadimoxine. Its effect on osteoblast metabolism was investigated via the detection of cell proliferation, cell viability, production of ROS, and expression of osteogenic-specific genes including runt-related transcription factor 2 (RUNX2), bone sialoprotein (BSP), osteocalcin (OCN), alpha-1 type I collagen (COL1A1), and osteogenic-related proteins after treatment for 2, 4, and 6 days respectively. RESULTS: The results showed that ZXHA-TC has a stimulating effect on the proliferation and osteogenic differentiation of primary osteoblasts by promoting cell proliferation, cell viability, and the expression of genes BSP and OCN. Productions of bone matrix and mineralization were also increased by ZXHA-TC treatment as a result of up-regulation of COL1A1 and alkaline phosphatase (ALP) at the early stage and down-regulation of both genes subsequently. A range of 6.25x10(-3) microg/mL to 6.25x10(-1) microg/mL is the recommended dose for ZXHA-TC, within which 6.25x10(-2) microg/mL showed the best performance. CONCLUSION: This study may hold promise for the development of a novel agent for the treatment of osteoporosis.

Risk factors of perioperative blood loss in elderly patients receiving proximal femur locking compression plate fixation for intertrochanteric fractures / 南方医科大学学报

<p><b>OBJECTIVE</b>To analyze the risk factors of perioperative blood loss in elderly patients with intertrochanteric fractures treated with proximal femur locking compression plate (PFLCP) fixation.</p><p><b>METHODS</b>A retrospective analysis was carried out in an cohort of 178 elderly patients undergoing PFLCP fixation for intertrochanteric fractures between February 2010 and December 2014. The preoperative and postoperative blood biochemistry, intraoperative and postoperative of blood loss and blood transfusion were analyzed, and the impact of the factors including age, height, body weight, complications, and operation time was evaluated on perioperative blood loss.</p><p><b>RESULTS</b>The average volume of perioperative blood loss was 637.67 ± 251.57 mL, mean operating time was 130.93 ± 31.02 min, and recessive blood loss was 240.51 ± 195.92 mL in these patients. The volume of perioperative blood loss was associated with the patients' age and the operating time but not with body weight, height, gender, or hypertension.</p><p><b>CONCLUSION</b>Large volume of blood loss may occur in elderly patients undergoing PFLCP fixation for intertrochanteric fractures in close relation with the patient's age and the duration of operation.</p>

Impact of nano-structured porous polycaprolactone combined with bone marrow stromal cells on CTGF expression in rabbit impaired articular cartilage / 实用医学杂志

Objective To study nano-structured porous polycaprolactone combined with bone marrow stromal cells on CTGF expression in rabbit impaired cartilage. Methods 50 rabbits were randomly divided into normal group, model group, NSP-PCL group, BMSCs group, or NSP-PCL + BMSCs group. A model of rabbit impaired cartilage was surgically established. Then NSP-PCL, BMSCs, and NSP-PCL + BMSCs were separately administered to the latter three groups once a week from the 2nd week to the 5th week after the procedure. The impaired cartilage tissues were collected 24 h after the last administration. The cartilage tissues were pathologically examined by H & E staining. Number of surviving BMSCs was detected by Hoeehst33342 Markers 1 week and 3 weeks after transplantation. Levels of CTGF protein in cartilage were determined by immunohistochemistry and Western blotting. Results In the model group, cartilage layer became thinner, with proliferation of fibroblast cells and a obvious cartilage surface hollow; New cartilage cells appeared in the surface hollow of the impaired cartilage in each treatemnt group, with a thicker layer. The number of transplanted BMSCs after 3 weeks was significantly increased in BMSCs group and NSP-PCL + BMSCs group. As compared with the model group, levels of CTGF protein were increased in each treatment group, with significant differences (P < 0.05). Conclusions Nano-porous polycaprolactone combined with bone marrow mesenchymal stem cells can repair cartilage damage by enhancing the expression of CTGF protein.

Mangiferin protects bone marrow mesenchymal stem cells against hypoxia / 中国组织工程研究

BACKGROUND:Bone marrow mesenchymal stem cells have particularly applied prospects in tissue engineering. However, the death of transplanted cells limits the tissue regeneration. To search a new drug of anti-free radicals and protecting bone marrow mesenchymal stem cells is of great significance. OBJECTIVE:To investigate the protective effects of mangiferin on bone marrow mesenchymal stem cells against hypoxia. METHODS:Rat bone marrow mesenchymal stem cells were cultured in vitro and hypoxia cellmodel was established by cobalt chloride. cells were divided into normal control group, hypoxia group (treated with cobalt chloride), and mangiferin groups (cobalt chloride+20, 40, 80, 160 μmol/L mangiferin). After 12 and 24 hours of hypoxia, superoxide dismutase, malondialdehyde, and catalase levels in the cellsupernatant were determined. After 3, 6, 12, 24 hours of hypoxia, reactive oxygen species change was detected in each group. RESULTS AND CONCLUSION:Mangiferin significantly improved the survival rate of bone marrow mesenchymal stem cells exposed to hypoxia, increased the intracellular superoxide dismutase and catalase activities, decreased intracellular malondialdehyde and reactive oxygen species levels, thereby effectively protecting bone marrow mesenchymal stem cells against hypoxia. These findings indicate that mangiferin has effective protection against hypoxia and strong antioxidant ability, and can significantly reduce oxidative damage.

Upper limb free mini-flap transplantation for repair of finger wounds / 中国组织工程研究

BACKGROUND:Recently, the clinical repair methods of irregular wound on fingers primarily include local pedicled flap and free mini-flap of upper extremities or lower extremities. OBJECTIVE:To discuss the application of free mini-flap derived from upper limb in repairing the wound on fingers. METHODS:From December 2010 to February 2014, 12 patients with irregular wounds on 12 fingers were selected from Department of Traumatic Orthopaedics and Hand Surgery, First Affiliated Hospital of Guangxi Medical University, China. The size of wounds ranged from 1.5 cm × 2.0 cm to 3.0 cm × 4.5 cm with different degrees of bone or tendon exposure. After the debridement, 12 patients were treated by free mini-flaps of upper limb. The donor sites were directly sutured. RESULTS AND CONCLUSION:Among the 12 patients, al the wounds at recipient and donor sites were healed at stage I, and the free mini-flags survival completely. Al of patients were fol owed up for 3-6 months (average 4.5 months). Free mini-flags had good appearance and needn’t undergo secondary trimming. The active motion of fingers was improved dominantly. According to the criteria of Hand Surgery Association Society of Chinese Medical Association Society for the function evaluation of upper limb, three cases were excellent, eight were good, and only one was bad. The excellent and good rate was 91%. Free mini-flaps of upper limb are an ideal method for repair of wounds on fingers. It has no injury to normal tissue in hands, donor site is very secluded, and the short-term curative effect is good.

Mangiferin protects bone marrow-derived mesenchymal stem cells against hypoxia-induced apoptosis / 中国组织工程研究

BACKGROUND:Hypoxic death limits application of cells in transplantation and tissue regeneration. OBJECTIVE:To investigate the protective effects of mangiferin on bone marrow-derived mesenchymal stem cells against hypoxia injury-induced apoptosis resulted from cobalt chloride. METHODS:Rat bone marrow-derived mesenchymal stem cells were in vitro cultured and hypoxia cellmodel was established by cobalt chloride. Model cells were treated with mangiferin. Protective effects of mangiferin were detected using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide;cellapoptosis and mitochondrial membrane potential were detected using flow cytometry. RESULTS AND CONCLUSION:Cobalt chloride significantly inhibited growth of bone marrow-derived mesenchymal stem cells in a dose-dependent manner. The apoptosis rate of cells was (42.49±3.96)%after treated with 200μmol/L cobalt chloride for 12 hours, (46.37±4.49)%after treated for 24 hours. With increasing concentration of mangiferin, apoptosis of bone marrow-derived mesenchymal stem cells in hypoxic model was gradual y reduced (P<0.01), indicating that mangiferin has a protective effect in a concentration-dependent manner on rat bone marrow-derived mesenchymal stem cells in hypoxic injury. Cobalt chloride can induce hypoxic model successful y in bone marrow-derived mesenchymal stem cells. There are some advantages of accurate dose control, no special equipment requirements, and easy operation. Mangiferin can effectively inhibit bone marrow-derived mesenchymal stem cells apoptosis under hypoxic injury.

Interaction among a three-dimensional scaffold, vessels and cells in the culture of tumor cells / 中国组织工程研究

BACKGROUND:The tumor tissue engineering can build an integrated culture model to ful y simulate the in vivo microenvironment of tumor growth, which can be used to study tumor developmental dynamics and related treatment strategies. OBJECTIVE:To review the three-dimensional culture of tumor cells using tumor engineering technology. METHODS:PubMed database was retrieved for articles related to tumor engineering, three-dimensional culture of tumor cells, biological scaffold materials and tumor microenvironment published from January 1992 to March 2013. RESULTS AND CONCLUSION:Three-dimensional culture, because of its reproducible tissue and cellgrowth in vivo, has become an important platform for study of tumor resistance, invasiveness and tumor microenvironment. The three-dimensional culture has showed a trend to gradual y replace the flat culture technique in many fields, and provides a research platform which is very close to in vivo environment. In recent years, with the development of tumor engineering, a variety of new polymer materials have been used in the three-dimensional culture of tumor cells. Three-dimensional culture technology is becoming a hotspot in the field of tumor biology, in which, using a variety of methods and materials, the cells show a growth in the spatial manner to form a biological support or matrix similar to in vivo growth environment. Biomaterials have become the soil on which seed cells can grow wel , and plays an alternative to the extracellular matrix or the matrix of tissues and organs in the tumor engineering. Therefore, the three-dimensional cellculture has been widely used in cancer research, which has become a powerful tool to tumor drug resistance, angiogenesis, cel-cellinteraction, signal transduction, stem cells and other research.

Systematic evaluation on endoscopic operation versus open operation for treating carpal tunnel syndrome / 重庆医学

Objective To systematically assess the efficacy of endoscopic operation and open operation for treating carpal tunnel syndrome .Methods The computer retrieval from MEDLINE ,EMBASE ,Cochrane August ,CNKI ,VIP ,Wanfang databases were conducted for collecting all related randomized controlled trials (RCT ) from February 1989 to February 2012 .The included litera-tures were performed the data extraction ,assessment of bias risk and the quality evaluation .Mata analysis was performed by the RevMan 5 .1 .6 software .Results 21 RCTs including 1 863 operations ,982 cases endoscopic carpal tunnel release (ECTR) and 881 cases of open carpal tunnel release(OCTR) ,met the inclusion criteria .Meta analysis showed that the differences in terms of postop-erative grip strength ,two points discrimination ,incidence of complications ,satisfaction rate ,postoperative symptom relief rate and operation time between the ECTR group and the OCTR group had no statistical significance .The ECTR group was better than the OCTR in the aspects of the time returnning to work ,pinch strength ,postoperative pain rate .Conclusion The ECTR group is supe-rior to the OCTR group in terms of the time returnning to work ,pinch strength ,postoperative pain rate .The other related indexes have no obvious differences between the two kinds of operation procedures .Due to the poor quality of some RCTs ,the above conclu-sion needs more high-quality ,large-sample clinical researches to confirm .