Application of Human Acellular Dermal Matrix with Skin Graft for Lacunar Soft-Tissue Defect of Lateral Heel after Calcaneal Fracture.

OBJECTIVE: To investigate the clinical effect of human acellular dermal matrix (HADM) combined with split-thickness skin graft in repairing lacunar soft tissue defects of the lateral heel after calcaneal fracture. METHODS: From June 2018 to October 2020, providers repaired 11 cases of lacunar soft tissue defects at the lateral part of the heel using HADM combined with split-thickness skin graft. After thorough debridement, the HADM was trimmed and filled into the lacunar defect area. Once the wound was covered, a split-thickness skin graft and negative-pressure wound therapy were applied. Providers evaluated the appearance, scar, ductility of the skin graft site, appearance of the donor site, healing time, and any reoperation at follow-up. RESULTS: Of the 11 cases, 8 patients achieved successful wound healing by primary intention. Three patients showed partial necrosis in the edge of the skin graft, but the wound healed after standard wound care. Evaluation at 6 and 12 months after surgery showed that all patients had wound healing and mild local scarring; there was no obvious pigmentation or scar formation in the donor skin area. The average healing time was 37.5 days (range, 24-43 days). CONCLUSIONS: The HADM combined with split-thickness skin graft is a simple and effective reconstruction method for lacunar soft tissue defect of the lateral heel after calcaneal fracture. In this small sample, the combination demonstrated few infections, minor scar formation, few donor site complications, and relatively short hospital stays.

Results after open lunate excision alone or in combination with palmaris longus tendon ball arthroplasty for the treatment of Kienböck's disease.

PURPOSE: This study aims to compare results after open lunate excision alone and in combination with palmaris longus tendon ball arthroplasty for the treatment of late-staged Kienböck's disease (KD). METHODS: This is a retrospective study using the prospectively collected data, and patients who had a discharge diagnosis of KD (stage IIIB based on Lichtman staging criteria) and underwent surgical treatment by lunate excision alone or in combination with palmaris longus tendon ball arthroplasty between January 2011 and December 2020 were included in this study. Variables of interest involved demographics, disease condition, operative procedure, and the outcomes evaluated at the last follow-up. Within and between comparisons were performed. RESULTS: Thirty-five patients underwent lunate excision alone, and 40 patients underwent the combination procedure. At the final follow-up, patients in both groups exhibited significant improvements compared to pre-operation, such as wrist flexion, wrist extension, carpal height ratio, PRWE score, Cooney score, and grip strength (all P < 0.05). Compared to the excision group, combination procedure group had significantly longer surgical time (P < 0.001), more blood loss (P < 0.001) and exhibited better wrist flexion (P = 0.001), PRWE score (P = 0.001), Cooney score (P = 0.0034), and grip strength (P = 0.017). The excellent or good rate based on Cooney wrist score was not significantly different (87.5% vs 71.4%, P = 0.083). CONCLUSION: Lunate excision in combination with palmaris longus tendon ball arthroplasty is a better option than lunate excision alone for the treatment of stage III KD and can be considered as an operative option.

Shengji solution accelerates the wound angiogenesis of full-thickness skin defect in rats via activation of TGF-ß1/Smad3-VEGF signaling pathway.

Shengji solution is made according to the classic prescription - Shengji prescription. Shengji solution is a external prescription of traditional Chinese medicine with the functions of nourishing blood, relieving pain, producing muscle and shrinking the wound. In the present study, we investigated the therapeutic effects of Shengji solution on dorsal full-thickness skin defects in rats. We also detected the activation of transforming growth factor beta1 (TGF-ß1)/SMAD3/vascular endothelial growth factor (VEGF) signaling pathways in the wound-healing process. The results showed that the wound was cleaned with normal saline followed by bandaging with cotton gauze according to the groups, respectively: (a) control group; (b) Kangfuxin group, the wound was moistened with Kangfuxin solution; (c) Shengji solution group, the wounds were moistened with Shengji solution; (d) Shengji solution+SB431542 inhibitor group, the wound was moistened with Shengji solution, and then SB431542 inhibitor (10 mg/kg) was injected intraperitoneally for 5 days. On the 14th day after operation, the wound-healing rate of Shengji solution group was more than 95% and also greater than that in the control group and Shengji solution+SB431542 inhibitor group. Besides, Shengji solution could inhibit the inflammation and capillary production by enhancing the epithelial regeneration, dermal repair and angiogenesis. Moreover, Shengji solution could also increase CD34 content, the expressions of TGF-ß1, VEGF proteins and the phosphorylation of SMAD3 in wound granulation tissue. In conclusion, Shengji solution can accelerate the dermal cutaneous wound healing in rats, stimulate angiogenesis and collagen synthesis by activating TGF-ß1/SMAD3/VEGF pathway.

Involvement of the BDNF-TrkB-KCC2 pathway in neuropathic pain after brachial plexus avulsion.

INTRODUCTION: Brachial plexus avulsion significantly increased brain-derived neurotrophic factor (BDNF) release in the spinal cord. Here we investigated the involvement of the BDNF-TrkB-KCC2 pathway in neuropathic pain caused by BPA injury. We hypothesized that activation of BDNF-TrkB may inhibit neuronal excitability by downregulating KCC2 to maintain a high intracellular Cl-concentration. We established a neuropathic pain rat model by avulsion of the lower trunk brachial plexus, and investigated the effects of the TrkB-specific antibody K-252a on the expression of BDNF, TrkB, and KCC2. METHODS: We randomly divided 40 male SD rats into four groups. In the brachial plexus avulsion group, C8-T1 roots were avulsed from the spinal cord at the lower trunk level. In the K252a group, 5uL K252a was applied intrathecally daily for three days after avulsion. In the sham surgery group, expose only and without damage. The control group did not undergo any treatment. Mechanical hyperalgesia and cold allodynia were analyzed by electronic pain measuring instrument and acetone spray method at different time points on days 1, 3, 7, 10, 14, and 21 after surgery. At 21 days after surgery, the expression of BDNF and TrkB in dorsal horn neurons and GFAP in astrocytes were detected by immunohistochemistry at the C5-T1 segment of the spinal cord. The expression levels of BDNF, TrkB, and KCC2 in the C5-T1 spinal cord were measured by Western Blot at 7 and 21 days. RESULTS: Mechanical hyperalgesia and cold allodynia were significantly reduced in the K252a group compared with the brachial plexus avulsion group. Compared with the BPA group, BDNF, TrkB and GFAP were significantly decreased in the K252a group at 21 days after treatment by immunohistochemical test. In the WB test, the expressions of BDNF and TrkB in the K252a group were quantitatively detected to be decreased, while the expression of KCC2 was increased, which was obvious at 7 and 21 days. CONCLUSION: BDNF-TrkB-KCC2 pathway can significantly relieve neuropathic pain after BPA, and is a potential target for the treatment of neuropathic pain.

Cannulated compression screw with versus without two K-wire fixation for treatment of scaphoid waist fracture nonunion.

PURPOSE: This study aims to introduce the "tripod" technique using cannulated compression screw and two anti-rotational K-wires for treatment of unstable scaphoid waist fracture nonunion, and to compare it with the single cannulated screw fixation technique in term of scaphoid union and surgical outcomes. METHODS: It was a retrospective study. From January 2014 to March 2020, 103 consecutive patients with scaphoid waist fracture nonunion treated with the tripod fixation and bone grafting (n = 45) or with single cannulated compression screw and bone grafting (n = 58) were included. All the procedures were performed by the same hand surgery team, and autologous cortico-cancellous radius bone graft was used for bony reconstruction. The minimal follow-up period was 12 months. The union rate and the time to union, range of motion (ROM), grip strength, Visual Analogue Scale (VAS), Quick Disabilities of the Arm, Shoulder and Hand (DASH) score and modified Mayo Scores at the last visit were compared. RESULTS: In tripod fixation group, bony union was achieved in all patients at the mean of 14.8 ± 3.8 weeks, while in the single cannulated screw fixation group the bony union rate was 94.8% (55/58) and the time to union was 17.6 ± 3.6 weeks. The difference of time to union was statistically significant (p = 0.027), but not for bony union rate (p = 0.122). At the last visit, no significant difference was found with respect to any clinical and radiographic outcome measures (all p > 0.05). The overall rate of complications was not significantly different between two groups (15.6% vs 10.3%, p = 0.430). CONCLUSIONS: Tripod fixation technique with headless compression screw and two K-wires is a safe and effective technique for treatment of scaphoid nonunion fixation and can be considered to use in practice, especially for those potentially rotationally unstable cases.

Sequential therapy for kidney-tonifying via traditional Chinese medicine effectively improves the reproductive potential and quality of life of women with decreased ovarian reserve: a randomized controlled study.

OBJECTIVE: To investigate the effect of sequential therapy for kidney-tonifying via traditional Chinese medicine (TCM) on improving the fecundity and quality of life (QOL) of women with decreased ovarian reserve (DOR). METHODS: A prospective and randomized controlled study was conducted, in which 80 infertile patients with DOR were selected in our hospital and randomly divided into the test group (n=40) and the control group (n=40). The control group was given sequential therapy of artificial menstrual cycle via administration of estrogen and progesterone, and the test group received sequential therapy for kidney-tonifying via TCM. Then, Kupperman indices, hormone levels, ovarian reserve functions, menopause specific quality of life questionnaire (MENQOL) scores, as well as the pregnancy rates within one year before and after treatment were compared between the two groups. RESULTS: Compared with the control group, the levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and resistance index (RI) of ovarian stroma were significantly decreased in the test group (all P<0.001), while the levels of estradiol (E2), anti-Mullerian hormone (AMH), mid-luteal phase E2, progesterone, antral follicular count (AFC), and ovarian diameter (OVD) of patients were notably increased in the test group (all P<0.001). After treatment, the Kupperman indices and MENQOL scores of the test group were considerably lower than those of the control group (P<0.001). No adverse effects were observed in the test group, whereas the incidence of adverse effects in the control group was 12.50%, although without significant difference between the two groups (P>0.05). The pregnancy rate within one year in the test group was significantly higher than that of the control group (47.50% vs. 25.00%) (P<0.05). CONCLUSION: Sequential therapy for kidney-tonifying via TCM could effectively improve the clinical symptoms, hormone levels, and ovarian function, increase ovulation quality and pregnancy rate, and improve the QOL of DOR patients.

PSAT1 Upregulation Contributes to Cell Growth and Cisplatin Resistance in Cervical Cancer Cells via Regulating PI3K/AKT Signaling Pathway.

Standard therapy strategies for cervical cancer (CC) typically are centered on cisplatin (DDP)-based chemotherapy, while the effects of PSAT1 on cisplatin resistance in CC have not been elucidated. Cisplatin-resistant CC cell line of SiHa (SiHa-R) was established and short hairpin RNA (shRNA) targeting PSAT1 was generated to evaluate the effect of PSAT1 knockdown on CC progression. Cell viability and apoptosis were examined by using CCK-8 and flow cytometry assays. The protein levels of p-Akt, t-Akt, PCNA, cleaved caspase-3, P-glycoprotein (P-gp), and multidrug resistance related protein (MRP)-1 were assessed by western blotting. Cisplatin-resistant CC cells (SiHa-R) exhibited higher expression level of PSAT1 rather than parental SiHa cells. PSAT1 knockdown lowered the IC50 of cisplatin, inhibited the colony formation numbers, and facilitated the apoptosis ability in SiHa-R cells. PSAT1 knockdown also suppressed the protein levels of phospho-Akt, proteins involved in proliferation (PCNA) and drug resistance (P-gp and MRP-1), increased apoptosis related protein (cleaved caspase-3), while the PI3K/Akt agonist, 740 Y-P, markedly reversed these above effects. Inhibition of PSAT1 reduced cisplatin resistance in SiHa-R cells through suppressing proliferation and inducing apoptosis by blocking PI3K/Akt signaling pathway. PSAT1 may be a potential therapeutic target to reverse chemoresistance in cisplatin-resistant CC.