Curative effect of wide pedicled double-vessel flap of posterolateral calf in repair of soft tissue defect in hind foot / 中华显微外科杂志

Objective:To explore the curative effect of wide pedicled with double-vessel flap of posterior lateral calf in repair of soft tissue defect in hind foot.Methods:From January 2018 to June 2021, 12 patients with soft tissue defects on hind foot were reconstructed with double-vessel flaps pedicled perforator of peroneal artery and sural nerve nutrient vessels in the Department of Trauma Orthopaedics, No.940 Hospital of Chinese People's Liberation Army Joint Service Support Force. The patients were 8 males and 4 females, aged 9-45(27.17±12.14) years old. Time after injury to admission was 6-24(10.17±4.80) hours. Six patients were with simple soft tissue defects, 2 with tendon defects, 3 with bone defects and 1 with postoperative infection due to an open fracture. The sizes of soft tissue defect ranged from 4 cm×5 cm-8 cm×12 cm. Soft tissue defects were reconstructed by transfer of posterolateral calf flaps, and the bone defects were repaired by phase I or phase II bone grafts or antibiotic cement and membrane induction according to the wound surface. For larger bone defects, stage-II bone transport was carried out to restore the length of the hind foot. Defects of Achilles tendon were reconstructed by direct suture or tendon transposition. Foot functions were evaluated by American Orthopaedic Foot and Ankle Surgery(AOFAS) ankle-posterior sufficient scale, visual analogue scale(VSA) score and flap healing. All patients were included in postoperative follow-up regularly through outpatient clinic or via WeChat.Results:All 12 patients had postoperative follow-up that lasted for 6-24(12.92±6.22) months. One flap developed dark purple colour with swelling at the distal end of the flap 3 days after surgery. It eventually healed after removed some sutures from the pedicle together with blood-letting on the flap surface. Three flaps developed local infection, and they were cured after debridement, dressing change and the use of sensitive antibiotics. The remaining 8 patients had achieved good appearance of flaps and normal ankle function. According to AOFAS, scores of ankle-posterior sufficiency scale increased from 14-45(25.25±5.42) before surgery up to 65-96(75.92±7.73) at the final follow-up. Of the 12 patients, 8 were in excellent, 2 in good and 2 in fair. The VAS scores decreased from 5-8(6.55±1.13) before surgery down to 0-4(1.55±1.37) at the final follow-up. The difference had statistics significance( P<0.01). All patients had satisfactory recovery of ankle function, with the extension at 15-20 degrees and plantar flexion of 30-40 degrees. The donor site healed well and all skin grafts survived. Conclusion:The double-vessel flap pedicled with perforating branch of peroneal artery and nutrient vessels of sural nerve can be used for reconstruction of soft tissue defect of hind foot. It achieved good surgical effects with reliable blood supply, smooth venous return, strong anti-infection ability, satisfactory appearance at donor site and flap itself, as well as a good recovery of foot function.

Preparation of the inactivated Newcastle disease vaccine by plasma activated water and evaluation of its protection efficacy.

Vaccination has been regarded as the most effective way to reduce death and morbidity caused by infectious diseases in the livestock industry. In this study, plasma activated water (PAW) was introduced to prepare the inactivated Newcastle disease vaccine. Humoral immune response was tested by hemagglutination inhibition (HI) assay and enzyme-linked immunosorbent assay (ELISA). In addition, cell-mediated immune response was evaluated by lymphocyte proliferation assay and flow cytometry. The results demonstrated that the vaccine prepared by PAW at appropriate volume ratio could induce similar antibody titers in specific pathogen-free (SPF) chickens compared with the formaldehyde-inactivated vaccine. The challenge experiment further confirmed that the vaccine prepared by PAW conferred solid protection against virulent NDV. Moreover, it was found that the vaccine could promote the proliferation of lymphocytes and stimulate cell-mediated immunity of SPF chickens. Furthermore, analysis of electron spin resonance (ESR) spectroscopy and physicochemical properties of PAW suggested reactive oxygen and nitrogen species (RONS) played an essential role in the virus inactivation. Therefore, this study indicated that NDV treated by PAW in an appropriate ratio retained immunogenicity on the premise of virus inactivation. PAW as a promising strategy could be used to prepare inactivated vaccine for Newcastle disease.

Mechanism of hypoxia-induced factor 1alpha expression in endothelial cells of the human umbilical vein and its induction of apoptosis.

OBJECTIVES: Approach to mechanism of hypoxia-induced factor 1alpha expression in endothelial cells of human umbilical vein and its induction of apoptosis METHODS: In vitro models, and such techniques as transmission electron microscopy, flow cytometry, RT-PCR and Western blot, were applied to investigate the transcription and protein expression of HIF-1alpha mRNA in ECV 304 cells and the action of HIF-1alpha on cell cycle blocking, proliferation inhibition and induction of apoptosis. Cells were divided into two groups: normal oxygen and hypoxic for various time periods (2, 4, 8, 12, 24 and 48 h). RESULTS: We observed that the expression level of HIF-1alpha mRNA and its protein were correlated with the degree of hypoxia. The expression of HIF-1alpha mRNA notably increased after 4, 8, 12, 24 and 48 h of hypoxia, particularly at 24 and 48 h with a gray scale of (71 +/- 1.81) and (70 +/- 2.02) respectively, differing significantly from the control group (P < 0.01), The protein expression of HIF-1alpha also increased 4, 8, 12, 24 and 48 h after hypoxia, particularly at 24 and 48 h, with gray scale (83 +/- 0.15) and (98 +/- 0.10) respectively (P < 0.01), indicating an increase of HIF-1alpha protein expression significantly different from the other groups (P < 0.01). In the control group, there was slight transcription and protein expression of HIF-1alpha at 0 h after hypoxia. Meanwhile, each phase of the cell cycle was detected to have increased expression of HIF-1alpha in response to oxygen-deficient treatment. At times of 24 and 48 h, the number percentage of cells in G1 significantly increased with values of 66.335 +/- 2.144 and 58.890 +/- 5.128; however, the number cells in S phase decreased to 36.215 +/- 1.582 and 39.826 +/- 5.097, significantly different compared to the control group at 0 h with values of 43.903 +/- 6.506 and 60.571 +/- 24.026-(P < 0.05). When the cell cycle was blocked in the G2/S phase, the cell apoptosis ratio significantly increased by 9.24 +/- 1.828 and 30.735 +/- 11.38, compared to each control group-(P < 0.01). CONCLUSIONS: By induction of hypoxia, the cell cycle was dramatically blocked in G1/S phase, and the expression of HIF-1alpha also increased Therefore, sustained expression of HIF-1alpha can inhibit cell hyperplasia, and the apoptosis promotion of injured cells as well as provide protection of endothelial cells.