Since Oct. 1990, the 2nd metatarso-phalangeal joint and big-toe nail composite graft with the neuro-vascular bundle was transplanted to reconstruct the thumb in 4 cases. The transplants were all survived. The follow-up through 5 months, a comparatively good function and appearance were achieved.The applied anatomy, the surgical technique and the matters needing attention were detailed.
【Abstract】 Objective To build nano-biomimetic tissue engineered blood vessel (NBTEBV) with nanotopology by using electrospinning (ELSP) technology. Methods Cony vascular endothel ial cell(VEC) on tubiform tooting in vitro was cultured. NBTEBV was built by use of multi-row nozzle with the suspension of cony vascular smooth muscle cell (VSMC) and mimic ECM (MECM) solution. NBTEBV was cultured with bioreactor in vitro . VEC and VSMC viabil ity and prol iferation were observed with MTT; and HE staining, scanning electron microscopy(SEM) observation and biomechanical test were carried out after 24 hours of static culture and 7 days of dynamic culture. Results After 7 days of culture, the length of NBTEBV was 57 mm, the external diameter was 4 mm and the thickness of wall was 0.4 mm. The NBTEBV’s color was white and the texture was even and flexible. MTT results indicated the viabil ity of cells cultured on NBTEBV for 7 days was normal(8.9 × 106 /mg, 3.5 ×105/mg for 24 hours). SEM and HE staining indicated that the topologic character of NBTEBV was similar to that of the naturalblood vessel. The NBTEBV showed a network scaffolds structure with 100 nm thick fiber and 600 nm aperture. The HE stainingresult showed that the NBTEBV was composed of VEC and VSMC by layer. Vascular mechanical results showed that the NBTEBVultimate hydrostatic pressure was 950 mmHg, the compl iance of the NBTEBV under physio-pressure (110/70 mmHg) was 3.0%; the ultimate tensile strength of 20 mm × 5 mm tissue sl ice was 18.5 MPa. Conclusion The technology of ELSP can use VSMC and MECM scaffold simultaneously to build tissue engineered blood vessel with nanotopology mimic native blood vessel.
From March 1979 to February 1987, 500 cases of firearm wounds of blood vessels were treated. Of them, 465 cases were recovered, 15 cases were disabled, 13 cases had amputation, and 7 cases died. The article presented the clinic materials. The following problems were discussed: (1) The characteristics of firearm wounds of blood vessels. (2) Emergency treatment of injuries of major blood vessels of limbs. (3) Indications of repair of blood vessels. (4) The methods of repair of defect in blood vessel. (5)Factors influencing the survival of extremities, and (6) Active prevention and treatment of complication.
Serum alkaline phosphatase (ALP) has long been used as a biomarker for the liver, kidney, and bone. Currently, increasing evidence suggests a correlation between serum ALP and cardiovascular disease (CVD). Research has shown that serum ALP affects endothelial cell function and induces changes in pyrophosphate through various mechanisms to accelerate vascular calcification and promote cardiac fibrosis. Therefore, this article reviews the potential value of serum ALP in CVD through relevant research, revealing the specific relationship between serum ALP and CVD, in order to provide new ideas for the prevention and treatment of CVD.
From 1979, a total of 5 cases of giant cell tumor of the lower end of radius were treated by segmental resection, and vascularized fibular head transplantation, and reconstruction of the inferior radio-ulnar joint. The bone healed within 2-3 months. The patients were followed for 5-10 years. There was no recurrence, nor distant metastasis, and the functional recovery of extremities was satisfactory.The clinical materials, the operative techniques and the assessment of the long-term results were introduced.
Objective To observe the revascularization process of transplanted nerve after transplantation of long nerve and accompanying peri pheral vessels, to investigate its relationship with nerve regeneration. Methods The mediannerve defect models of the left forelimb (3 cm in length) were made in 60 New Zealand rabbits (aged 6-8 months, weighing 2.0-2.5 kg, and male or female), which were randomly divided into 2 groups (n=30). In situ anastomosis of the median nerves was performed in the control group; in situ anastomosis of the median nerves was made in parallel to the surrounding elbow veins, the transplanted epineurium and the adventitia were sutured with nerve anastomosis l ine in the experimental group. After operation, the gross observation, electrophysiological testing, and histopathology observation was performed at 1, 2, 4, 8, and 12 weeks, and transmission electron microscope at 12 weeks to observe the revascularization of nerve grafts, nerve fiber regeneration, and functional recovery. Results In the experimental group, revascularization was observed at 1 week after operation, and the degree of revascularization was significantly higher than that in the control group at 2, 4, 8, and 12 weeks. At 8 and 12 weeks, the nerve fiber regeneration speed, quality, and quantity in the experimental group were better than those in the control group. At 2, 4, 8, and 12 weeks, the nerve conduction velocities were (10.32 ± 0.94), (13.14 ± 1.22), (22.68 ± 1.16), and (24.09 ± 1.27) m/ s respectively in the experimental group, and were (9.18 ± 1.07), (11.12 ± 1.03), (19.81 ± 1.37), and (20.67 ± 1.19) m/s in the control group, showing significant difference at 12 weeks after operation (t=3.167, P=0.001). At 12 weeks in the experimental group, the myel in sheath had similar size, less sheath plate delamination, normal Schwann cells and rich organelles, in which normal microfilaments, microtubules and axonal mitochondria were observed; axonal mitochondria had clear crestfilm and no swelling and vacuolization, and the neurofibrils basically became normal. The myelinated nerve fibers area, myelin thickness, and axon diameter were (5.93 ± 0.94) mm2, (0.72 ± 0.12) μm, and (3.12 ± 0.12) μm respectively in the experimental group, and were (5.28 ± 0.72) mm2, (0.65 ± 0.09) μm, and (2.98 ± 0.16) μm respectively in the control group, all showing significant differences (t=3.736, P=0.002; t=3.271, P=0.002; t=4.533, P=0.001). Conclusion The transplanted nerves in parallel to large blood vessels can promote angiogenesis of the transplanted nerve, and accelerate the regeneration and functional recovery of the nerves.
Objective To investigate the clinical application of fistulation of artery and vein with self-blood vessel transplantation. Methods Seven patients with renal failure were given antebrachial fistulation of artery and veinwith great saphenous veins of themselves. The ortho- and pachy-great saphenous vein was chosed after it was cut. The great saphenous vein was passed bridge inside forearm in straight line or morpha-U. The method was anastomosis of the radial artery or brachial artery and cephalic vein, basilic vein or median cubital vein. Results The fistulations of artery and vein were successfuland all patients were in hemodialysis regularly. Conclusion The fistulation of artery andvein with selfblood vessel transplantation is a convenient, easy, cheap operation. It can coincide with the clinical demand and be used to make up the failureof fistulation or the fistulation that there is no blood vessel in the forearm.
ObjectiveTo explore the clinical application of variant associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) combined with inferior vena cava reconstruction for end stage hepatic alveolar echinococcosis (HAE).MethodThe clinical data of one case with HAE who treated in Organ Transplantation Center of Sichuan Provincial People’s Hospital in November 2017 was analyzed retrospectively.ResultsComputed tomography revealed that the three hepatic veins and retrohepatic inferior vena cava were invaded by multiple and giant hydatid lesions. Only the segment 6 retained the complete portal vein and hepatic vein return branch. Remnant liver volume/standard liver volume (RLV/SLV) of this patient was 24.9%. Surgical exploration was performed after preoperative examination. In the first stage, ligation of the left portal vein and the right anterior lobe portal vein were performed to increase portal blood supply at S6 while partial split of the liver. The patient recovered well after operation without complications such as bile leakage and infection. Six months after the first stage surgery, the second stage surgery was performed, and RLV/SLV measured before surgery was 48.3%. S1–5/S7–8 were completely removed and the hepatic inferior vena cava was reconstructed with artificial blood vessels. The patient was discharged on 10 days after operation, and there was no complications and relapses occurred during the 18 months follow-up period.ConclusionsVariant ALPPS combined with inferior vena cava reconstruction is an effective attempt to treat end stage HAE with multiple and giant hydatid lesions and insufficient RLV.
Objective To establish a scaffold model from heterogeneoussmall blood vessels. Methods Caudal arteries from 34 Wistar rats( average length 12.08±1.69 cm) were made into acellular blood vessel scaffolds. Some scaffoldswere observed by electron microscope, and others were transplanted to the cut ends of ear central arteries of male Japanese big ear white rabbits. Results Average external diameter was 0.74±0.08 mm in proximal, and 0.55±0.08 mm in distal end of rat caudal arteries. The small blood vessel scaffolds had shin wall whichwas white and soft, composed of fibrous tissues without cells. On the intima surface the fibrous tissues were arrayed densely in a grid-like pattern. After transplantation, the blood flow was reserved, and kept flowing freely in 24 hours. The pulsation of the transplanted artery was accessible and no blood leakage wasfound.Conclusion The natural scaffolds are composed of fibrous tissues, and can sustain the artery pulse pressure for 24 hours. It is better to suture the blood vessels by sleeve anastomosis.
Objective To investigate the feasibil ity of preparing the porous extracellular matrix (ECM) by use of some chemicals and enzymes to decellularize the porcine carotid artery. Methods The porcine carotid artery was procured, and warm ischemia time was less than 30 minunts. The porcine carotid artery was decellularized with 1% sodium dodecyl sulfate (SDS) for 60 hours to prepare common ECM; then common ECM was treated with 0.25% trypsin (for 6 hours) and 0.3 U/ mL collagenase (for 24 hours) to prepare porous ECM. The common ECM and porous ECM were stained with HE,Masson’s trichrome, and Orcein to evaluate the histological features. Then the mechanical property, cytotoxicity, and pore size of ECMs were determined. After 4 weeks of subcutaneous implantation in dogs, the histological examination was used for the study. Results Histological observation confirmed that 2 kinds of ECMs were decellularized completely and more porous structure was observed in porous ECM. Scanning electron microscope showed the pores in porous ECM were greater and the length of shorter axis in porous ECM ranged from 5 to 30 μm, the length of longer axis from 40 to 100 μm. The porosity of porous ECM (99.25%) was greater than that of common ECM (91.50%). The burst pressure of porous ECM decreased when compared with common ECM, showing significant difference [(0.154 3 ± 0.012 7) MPa vs [0.305 2 ± 0.015 7) MPa, P lt; 0.05]. There was no significant difference in suture retention strength between 2 kinds of ECMs (P gt; 0.05). The cytotoxicity test showed no obvious cytotoxicity in 2 kinds of ECMs. In vivo implantation test showed that the deeper host cells infiltration and more neo-microvessels in porous ECM were observed than in common ECM. Conclusion SDS and some enzymes can be used to prepare porous ECM as the scaffold for tissue engineered blood vessels.
