[Repairing the bone and skin defect of foot after improved toe-to-finger reconstruction utilizing periosteal perforator bone-skin flap of proximal anterior tibial artery].

Objective: To evaluate the clinical outcome of repairing donor site of foot after improved toe-to-finger reconstruction utilizing periosteal perforator bone-skin flap of proximal anterior tibial artery. Methods: Twelve patients of toe defect after reconstruction were repaired from March, 2015 to June, 2017 utilizing periosteal perforator bone-skin flap of proximal anterior tibial artery in the Department of Hand and Foot Microsurgery of Xin'an Hospital, Dongguan City.Of which, there were 7 cases of great toe defect with fibular side of phalanx ungual and skin, 5 cases of second toe defect with proximal interphalangeal joints and the partial bone accompanied the great toe defect.Double bone flaps of one pedicles were used to repair first and second phalanx defect in 5 cases.The skin injured area: 5.5 cm×2.5 cm to 6.5 cm×10.0 cm. Bone defect size of great and second toe were 1.5 cm×1.0 cm×0.8 cm to 1.7 cm×1.0 cm×1.0 cm and 2.5 cm×1.0 cm×1.0 cm to 4.0 cm×1.0 cm×1.0 cm, respectively.The flap size ranged from 6.0 cm×3.0 cm to 6.5 cm×12.0 cm, and the bone flap size ranged from 1.5 cm×1.0 cm×0.8cm to 1.7 cm×1.0 cm×1.0 cm(great toe) and 2.0 cm×1.0 cm×1.0 cm to 3.5 cm×1.0 cm×1.0 cm(second toe). The wound of donor site of the leg was directly combined or local skin transfer sutured with 8 cases, skin-grafting in 4 cases. Results: All the bone-skin flaps survived.After 6-27 months of follow-up, the great toe flaps were found with normal color, good texture and moderate thickness, the two-point discrimination was 7-10 mm. The donor site of the leg showed little influence with normal function.No pain and discomfort in the foot were recorded, and the patients walked well.The healing time of bone flap was from 1.5 to 4 months, with an average of 2.5 months.Using the Maryland Foot Score, 5 cases of 7 feet got excellent and 2 cases of 2 feet got good result in the great toe group (7 cases of 9 feet), the good rate was 100%.Three cases got excellent and two cases got good result in the combined reconstruction group (5 cases), the good rate was 100%. Conclusion: Repairing donor site of foot after improved toe-to-finger reconstruction utilizing periosteal perforator bone-skin flap of proximal anterior tibial artery can also repair bone and skin defect of the great and the second toe, keep the great and the second toe, and restore the appearance and function of the first and the second toe at utmost.

[Study on antibacterial properties and osteoblast activity of antimicrobial peptide coatings on titanium implants].

Objective: To investigate the antibacterial property and biological activity of Ti dental implant with antimicrobial peptide Pac-525 coatings, and to study the effect of peptide Pac-525 coatings on Porphyromonas gingivalis's antibacterial performance and osteoblast proliferation and adhesion. Methods: After ultrasonic micro arc oxidation, alkali treatment and silane treatment, forty-five pure titanium specimens were exposed to antibacterial peptide Pac-525 in different concentration (0.25, 0.50, 0.75 g/L). The titanium specimens in the control group were only treated with ultrasonic micro arc oxidation, alkali treatment and silane treatment. The morphologies of coatings were observed by scanning electron microscope (SEM), and the element changes were detected by energy spectrum analyzer. Orange acridine-ethidium bromide double staining was used to detect the average percentage of live bacteria and biofilm thickness, after the specimens in each group and Porphyromonas gingivalis were co-cultured for 72 hours. Cell counting Kit-8 method and immunofluorescence staining were used to test the proliferation of osteoblasts, the number and growth morphologies of adherent cells, respectively. Results: SEM and energy spectrum analysis showed that the Pac-525 particles loaded on the surface of the coating, and the C and N elements in the Pac-525 coating group were significantly more than those in the control group. The average percentage of living bacteria in the control group, 0.25, 0.50 and 0.75 g/L antimicrobial peptides were 0.58%, 0.45%, 0.34% and 0.28%, respectively, and the difference between each group was statistically significant (P<0.05). The biofilm thickness of Porphyromonas gingivalis in 0.50 and 0.75 g/L antibacterial peptide group were (98.3±1.2) and (94.5±2.5) µm respectively, which were significantly less than those in control group and 0.25 g/L antibacterial peptide group [(117.6±1.5) and (118.0±1.3) µm] (P<0.05), respectively. The number of bone cell adhesion and proliferation of all antimicrobial peptides were significantly greater than those in the control group (P<0.05), and the cells stretched better. Conclusions: The antibacterial peptide coating of titanium implants could inhibit the formation of bacterial biofilm. It had good antibacterial properties and could promote the adhesion and proliferation of osteoblasts.

Abnormal Activation of RhoA/ROCK-I Signaling in Junctional Zone Smooth Muscle Cells of Patients With Adenomyosis.

Adenomyosis (ADS) is a common estrogen-dependent gynecological disease with unknown etiology. The RhoA/Rho-kinase (ROCK) signaling pathway is involved in various cellular functions, including migration, proliferation, and smooth muscle contraction. Here we examined the potential role of this pathway in junctional zone (JZ) contraction in women with and without ADS. We demonstrated that in the normal JZ, RhoA and ROCK-I messenger RNA (mRNA) and protein expression was significantly higher in the proliferative phase of the menstrual cycle than in the secretory phase. Expression of RhoA and ROCK-I in the JZ from women with ADS was significantly higher than in the control women and showed no significant differences across the menstrual cycle. Treatment of JZ smooth muscle cells (JZSMCs) with estrogen at 0, 1, 10, or 100 nmol/L for 24 hours resulted in increased expression of RhoA, ROCK-I, and myosin light-chain (MLC) phosphorylation (p-MLC) in a dose-dependent manner. In parallel to its effects on p-MLC, estrogen-mediated, dose-dependent contraction responses in JZSMCs. Estrogen-mediated contraction in the ADS group was significantly higher than in the controls and also showed no significant differences across the menstrual cycle. These effects were suppressed in the presence of ICI 182780 or Y27632, supporting an estrogen receptor-dependent and RhoA activation-dependent mechanism. Our results indicate that the level of RhoA and ROCK-I increases in patients with ADS and the cyclic change is lost. Estrogen may affect uterine JZ contraction of ADS by enhancing RhoA/ ROCK-I signaling.