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ObjectivesThe present study aimed to investigate the characteristics of salivary microbiota of children with obstructive sleep apnea (OSA) and to assess longitudinal alterations in salivary microbiota before and after adenotonsillectomy.MethodsA set of cross-sectional samples consisted of 36 OSA children (17 boys and 19 girls, 7.47 ± 2.24 years old) and 22 controls (9 boys and 13 girls, 7.55 ± 2.48 years old) were included in the study, among which eight OSA children (five boys and three girls, 8.8 ± 2.0 years old) who underwent treatment of adenotonsillectomy were followed up after 1 year. Saliva samples were collected, and microbial profiles were analyzed by bioinformatics analysis based on 16S rRNA sequencing.ResultsIn cross-sectional samples, the OSA group had higher α-diversity as estimated by Chao1, Shannon, Simpson, Pielou_e, and observed species as compared with the control group (p < 0.05). β-Diversity based on the Bray–Curtis dissimilarities (p = 0.004) and Jaccard distances (p = 0.001) revealed a significant separation between the OSA group and control group. Nested cross-validated random forest classifier identified the 10 most important genera (Lactobacillus, Escherichia, Bifidobacterium, Capnocytophaga, Bacteroidetes_[G-7], Parvimonas, Bacteroides, Klebsiella, Lautropia, and Prevotella) that could differentiate OSA children from controls with an area under the curve (AUC) of 0.94. Linear discriminant analysis effect size (LEfSe) analysis revealed a significantly higher abundance of genera such as Prevotella (p = 0.027), Actinomyces (p = 0.015), Bifidobacterium (p < 0.001), Escherichia (p < 0.001), and Lactobacillus (p < 0.001) in the OSA group, among which Prevotella was further corroborated in longitudinal samples. Prevotella sp_HMT_396 was found to be significantly enriched in the OSA group (p = 0.02) with significantly higher levels as OSA severity increased (p = 0.014), and it had a lower abundance in the post-treatment group (p = 0.003) with a decline in each OSA child 1 year after adenotonsillectomy.ConclusionsA significantly higher microbial diversity and a significant difference in microbial composition and abundance were identified in salivary microbiota of OSA children compared with controls. Meanwhile, some characteristic genera (Prevotella, Actinomyces, Lactobacillus, Escherichia, and Bifidobacterium) were found in OSA children, among which the relationship between Prevotella spp. and OSA is worth further studies.

BACKGROUND Oral breathing (OB) was considered associated with specific craniofacial structures and same for pediatric obstructive sleep apnea (OSA). This study aimed to investigate the differences of craniofacial structures between OB and OSA. METHODS In this retrospective study, 317 children under age 18 years were recruited and divided into OB group, OSA group, and control group. OSA group (15 boys, 4 girls) were referred from qualified sleep center and diagnosed as pediatric OSA with full-night polysomnography. OB group (10 boys, 10 girls) were mostly referral from pediatric or ENT department, some of whom undertook polysomnography and were not OSA. Control group consisted of orthodontic patients within the same period. Lateral cephalograms were obtained in all groups and their parameters were compared with Chinese normal values and each other. RESULTS R-PNS of OB group (18.04 ± 2.49 mm) was greater than OSA group (14.27 ± 4.36 mm) and even control group (16.22 ± 3.91 mm) (P

Background Surgical delay can improve flap viability, leading to vasodilation, neovascularization, and vessel reorganization. Experiments suggest a similar positive effect of botulinum toxin type A on pedicled flap viability. However, whether it may convert choke anastomoses into true anastomoses and how to identify the optimal timing for flap transfer remain unclear. Methods One hundred fifty-four Sprague-Dawley rats were divided into a control group, three saline injection groups, and three botulinum toxin type A injection groups defined by time of injection (2, 3, and 4 weeks before flap harvest). A pedicled 11 × 3-cm flap was marked on the unilateral dorsum of each rat. Before flap harvest, the flap donors were assessed by infrared thermal imaging, postmortem arteriography, immunohistochemical staining of CD31, and enzyme-linked immunosorbent assay. Flap survival area percentage was measured on postoperative day 7. Results In the control and saline groups, infrared thermography showed three independent white hotspots interspaced by red zones over flaps, whereas it presented a continuous white band in the botulinum toxin type A groups. There was a significant increase in flap survival area, flap surface temperatures, numbers of identifiable vessels in the choke zones, microvascular density, and vascular endothelial growth factor concentration in the botulinum toxin type A groups. Conclusions Botulinum toxin type A can convert choke anastomoses into true anastomoses, and its preconditioning effect cannot increase over time; it is appropriate to choose the timing point when the infrared thermal images show a continuous white band existing over flaps for flap transfer.

The quick and efficient perception of facial expressions represents a special and fundamental capacity of humans to engage in social communication. Here, we examined the effects of vasopressin (AVP, a neuropeptide) on the processing of same- and other-gender facial expressions among males and females. After receiving either AVP or placebo (PBO) intranasally in a randomized and double-blind manner, participants were asked to rate their approachability to facial expressions while event-related potentials (ERPs) were recorded. Males rated lower approachability scores to neutral and positive male faces relative to the scores to emotion-matched female faces after AVP but not following PBO administration. These behavioral effects were correlated with the AVP-induced increased P1 and decreased N170 responses to male faces among male participants. Females rated higher approachability scores to negative female faces than the scores to negative male faces after AVP but not following PBO treatment. These results suggest that AVP decreases friendly responses to neutral/positive male faces in males and increases friendly responses to negative female faces in females. Overall, these results demonstrate the gender-specific effects of AVP in response to same- and other-gender facial expressions, indicating there are sex- and context-dependent effects of AVP on socioemotional processes.

Contains fulltext : 203513.pdf (Publisher’s version ) (Open Access) Individuals with high levels of psychopathic tendencies tend to show a lack of guilt, a lack of empathic concern, and a disregard for the impact of their decisions on others. However, how guilt influences social decision-making for those with high psychopathic traits is still unknown. Here, we investigated how psychopathic traits relate to the capacity to acquire knowledge about social expectations, and to what extent guilt aversion affects subsequent decision-making. 63 participants completed self-report measures of psychopathy, and then played a modified Trust Game in the role of the Trustee. Results showed that participants' self-reported beliefs about their partner's expectations were largely predictive of the amount of money they returned to the partner. These decisions were negatively correlated with the PPI-I scores. Furthermore, participants' degree of guilt aversion were negatively correlated with PPI total scores. Our findings suggest that individuals with higher psychopathic traits are indeed capable of understanding the expectations of others, but do not seem to directly utilise this knowledge in their social decision-making, and experience less anticipated guilt about this. The present study provides empirical evidence of intact social knowledge coupled with decreased reciprocity and diminished guilt aversion as levels of psychopathic traits increase. 11 p.

This study aimed to compare the long-term efficacy of Kirschner wires and Herbert screw internal fixation in scaphoid fracture. A retrospective chart with radiographic review and functional follow-up was conducted for patients with the scaphoid fracture. 65 patients (40 for K-wire fixation and 25 for Herbert screw) were enrolled. The nonunion rate for K-wire fixation and screw method were indifferent comprehensively and for iliac graft subgroup. Less bone necrosis was found with K-wire fixation (2.5% vs 16%, P=0.049). There's no difference between groups in Mayo scores, post-operation pain and grid strength. Patients with K-wire fixation have larger range of motion on radial/ulnar deviation (35.25±11.32 vs 28.00±8.66, P=0.007). The results support the use of Kirschner wires in the treatment of scaphoid fractures. Advantages such as high union rates and good function recovery of wrist could be expected from minimal invasion, multi-axial stable fixation.

Background Experimental evidence suggests that endogenous vascular endothelial growth factor (VEGF) may play a major role in the surgical delay phenomenon. The purpose of this study was to investigate the effect of endogenous VEGF on flap surgical delay. Methods A total of 82 adult male Sprague-Dawley rats with an average weight of 330 g were used for these experiments. These experiments were then conducted in two parts. In part 1, 32 rats were used to assess the effectiveness of VEGF inhibitor through Western blot assay and enzyme-linked immunosorbent assay. In part 2, 50 rats were used to investigate the effect of VEGF on flap surgical delay by means of arteriography, histologic analysis, and flap viability. Results The VEGF protein inhibition ratio reached the maximum (approximately 91.6 percent) in 5 to 7 days. The number of transverse arteries and the number of vessels greater than 0.1 mm in diameter on the 3-day delay duration and the 6-day delay duration were significantly greater than those of the normal group. The number of transverse arteries and the number of vessels greater than 0.1 mm in diameter on the 6-day inhibition duration were not significantly changed compared with the normal group. Microvascular density on the 6-day delay duration obviously increased, whereas the 6-day inhibition duration was not significantly changed in comparison to the normal group. Conclusion Endogenous VEGF is an initiating factor of the surgical delay effect by controlling choke vessel dilation and neovascularization within the choke zones.

Background Craniofacial skeletal patterns change after orthognathic surgery. The present study aimed to investigate the effects of different craniofacial patterns on nasal respiratory function and the upper airway. Methods Forty-seven healthy subjects were selected and divided into 3 groups according to their mandibular position. Sixteen were in the skeletal Class I group, 15 were in the skeletal Class II group, and 16 were in the skeletal Class III group. Cone beam computed tomography was performed, and nasal airflow and nasal resistance were measured. Differences in nasal respiratory functions and upper airway were compared among the groups. A correlation analysis was conducted for nasal respiratory function, upper airway, and skeletal patterns. Results There were significant differences among the 3 groups regarding dominant-side nasal inspiratory capacity (P = 0.001), bilateral nasal inspiratory capacity (P = 0.005), nasal partitioning ratio-inspiration (P = 0.007), and velopharyngeal minimum cross-sectional area (P = 0.029). The values were significantly higher for the skeletal Class III group than the skeletal Class I and II groups. A correlation analysis showed that the nasal partitioning ratio and nasal airway resistance were mostly negatively correlated with SNA, but the upper airway volume and cross-sectional area were positively correlated with SNB and negatively correlated with ANB. The dominant-side nasal expiratory capacity was mainly negatively correlated with the mean velopharyngeal cross-sectional area (r = -0.324, P = 0.026), mean glossopharyngeal cross-sectional area (Glosso-A mean) (r = -0.293, P = 0.046), and mean total airway cross-sectional area (Total-A mean) (r = -0.307, P = 0.036). Conclusion Craniofacial skeletal morphology may affect nasal respiratory function and the upper airway.

Analysis shows that extending the age limit for grants boosts the number awarded to women, but more must be done to achieve parity, say Ying Ma and colleagues. Analysis shows that extending the age limit for grants boosts the number awarded to women, but more must be done to achieve parity, say Ying Ma and colleagues.

Currently, experimental evidence suggests that the surgical delay can increase flap survival area, but its effect may decrease if the optimal delay period is missed. The aim of this study is to establish a sensitive and objective modality based on the visualized and individualized infrared thermography for identifying the maximal surgical delay effect. A rectangular three-angiosome flap was designed on the unilateral dorsum of the rat. Ninety-six rats were randomly divided into six groups according to the various delay time. Both the relative temperature and the relative temperature ratio were measured by the infrared thermography. Arterial density, number of vessels0.1 mm in diameter, microvessel density, VEGF concentration, and flap viability were measured. Receiving operating characteristic curve with the highest Youden-Index was used to detect and identify an optimal cutoff point of the relative temperature ratio in the maximal surgical delay effect. The criteria for identifying the flap maximum delay effect based on the infrared thermography included the surface of the postdelayed flaps presented white color (higher temperature) instead of the red and white pattern of the normal skin and the optimal cutoff point of the relative temperature ratio was ≥1.17 with a sensitivity of 84.6% and a specificity of 77.3%. Instead, the sensitivity and specificity of the conventional method based on the delay time were 38.5 and 90.9%, respectively. Infrared thermal imaging can accurately identify the maximum delay effect when combined with the relative temperature ratio.

Background The aim of this study was to examine the usefulness of infrared (IR) thermography in visualizing the dilation of the choke vessels in a delayed pedicled perforator flap rat model. Methods A three-territory island flap was designed and harvested on one side of the rat dorsum. The flap was divided into five regions. In the normal group (n = 8), IR thermal imaging was correlated with the postmortem arteriography for the location of angiosomes, linking patterns, perforator diameter, and temperature on each region. The delay group (n = 35) was divided into seven groups according to various delay periods. At different time intervals, the delay group was compared with the normal group according to link pattern and temperature on each region. Results IR thermal imaging showed that a white hotspot existed on the surface of each angiosome; the true anastomotic vessels manifested a continuous white band linking the white hotspots on angiosomes, whereas the choke vessels presented a red zone in between adjacent hotspots. After delay, the dilation of the choke vessels manifested itself as the replacement of the red zone between adjacent hotspots by the white band on IR thermography. In addition, the delayed flap presented a phenomenon of rise and fall in temperature over time. Conclusion IR thermography can accurately visualize the process of the dilation of choke vessels after a surgical delay. The chronological change in the IR thermal imaging combined with the temperature change in the delayed flap might be useful to determine the optimal delay period.

Objective The posterior thigh region has been neglected as a donor site for free perforator flaps, likely due to difficulties in positioning the patient during surgery. This study describes the clinical application of the posterior thigh perforator flap based on the third perforating artery of the profunda femoris artery (PFA). Methods The free posterior thigh perforator flap based on the third perforating artery of the PFA was used for reconstruction of soft tissue defects in nine patients between February 2010 and May 2014. Results Flap sizes ranged from 12 × 7 cm to 20 × 13 cm. The length of the vascular pedicle averaged 10.28 cm, and the mean diameters of the third perforating artery and venae comitantes were 1.68 and 1.14 mm, respectively. All of the perforators originated from the PFA. Of the 9 free flaps used in 9 patients, 7 flaps survived completely. There were no early complications in these flaps. During the follow-up period, no patient experienced cold intolerance, scar contracture, or scar pain. There were no functional impairments at the donor or recipient sites. Conclusions The posterior thigh flap based on the third perforating artery of the PFA is an excellent option for reconstructing soft tissue defects. The anatomical location of the third perforating artery is relatively consistent. The vascular pedicle is relatively longer and has large caliber vessels. The scar at the donor site can be well concealed with low morbidity. The skin color and texture of this flap show satisfactory results.

Purpose The aim of this study was to analyze the differences in perioperative complications for pedicled island flaps in the reconstruction of extremities and to identify the factors contributing to pedicled island flap necrosis. Furthermore, the flap indications based on these outcomes are summarized. Methods Based on the inclusion criteria, 228 skin flaps were included in this study. Univariate and multivariate analyses were used to identify the risk factors for pedicled island flap necrosis. Differences in perioperative complications between upper and lower extremities were analyzed using the chi-square test or Fisher's exact test. Results The average age of the patients was 38 years. The overall complication rate was 21.93%, including partial flap necrosis (10.09%) and total flap necrosis (5.70%). The overall complication rate and flap necrosis rate in upper extremity reconstruction were significantly lower than the rates in lower extremity reconstruction. Flap area and postoperative wound infection were statistically significant risk factors for pedicled island flap necrosis in extremity reconstruction. Preoperative contamination of the wound bed was a statistically significant risk factor for postoperative wound infection. Conclusions The flap area and postoperative wound infection were both independent risk factors for pedicled island flap necrosis in extremity reconstruction. The causes contributing to the differences in perioperative complications between upper and lower extremities reconstruction included preoperative contamination of the wound bed, postoperative wound infection, and the flap area but were also related to anatomical factors of the skin flap. Pedicled island flaps are more suitable for small- and medium-sized soft tissue defects.

OBJECTIVE There are significant differences in the results on disputed thoracic outlet syndrome (TOS) surgery, which reflect that not all patients with disputed TOS are amenable to surgery. It is necessary to find out appropriate indicators for screening of patients who are suitable for surgery. Pain and paresthesia are 2 prominent symptoms of disputed TOS. The purpose of this study was to identify which symptoms could be removed by surgery. METHODS Data for all patients with disputed TOS who were admitted and prepared for surgical treatment between July 2008 and April 2012 were collected. The patients were divided into the surgical group and untreated group. The patients in the untreated group actively gave up surgical treatment due to fear of surgery after admission. The follow-up was obtained by standard visits with the clinician and by telephone interviews. RESULTS There were 10 patients (unilateral TOS) in the surgical group and 5 (3 bilateral TOS) in the untreated group. Statistical analysis showed no significant differences in age, sex, duration of symptoms, the types of symptoms, positive signs and provocative tests on physical exam, and length of follow-up between 2 groups. As for paresthesia, statistically significant difference was detected between the preoperative and postoperative surgical group (P < 0.001) and between the surgical and untreated group (P = 0.002). With regard to pain, there was no statistically significant difference between the preoperative and postoperative surgical group (P = 0.350) and between the surgical and untreated group (P = 0.251). However, the degree of pain was tolerable in both groups. CONCLUSIONS Our preliminary results revealed that the surgery is effective for the paresthesia as the main symptoms of the patients, but is invalid for the pain as the main symptoms.

Tendinopathy is a common clinical pathology found in athletes and workers with mixed treatment results. Piperine, a major alkaloid found in the black and long pepper, has been demonstrated to have variety of pharmacological properties such as analgesic and anti-inflammatory effects. The present study was designed to investigate the effects of piperine on collagenase-induced Achilles tendon injury. Rats were intratendineously injected with collagenase in the right Achilles tendon, followed by intragastrical administration of piperine (100 mg/kg). Morphological structure and biochemical analysis of glycosaminoglycans, hydroxyproline, collagen III, and the activity of matrix metallopeptidases in the tendon tissues were performed. Our results showed that collagenase injection resulted in clear degenerative changes in the tendon. Administration of piperine improved the morphological structure of tendon, increased glycosaminoglycans and hydroxyproline levels, and inhibited the expression and activities of MMP-2 and MMP-9. Furthermore, piperine inhibited the activation of ERK and p38 signaling pathways in injured tendon. These results indicate a beneficial role of piperine against collagenase-induced tendon injury.

Accumulated evidences implicated that microRNAs may be involved in diabetic neuropathy. Here, we investigated miR-29's roles in primary isolated dorsal root ganglion (DRG) neurons from STZ-induced diabetic rats. First, miR-29b was found down-regulated after STZ-injection. Inhibitions were increased with time course. Down-regulation of miR-29b was associated with higher apoptosis rate and more serious axonal swelling. Meanwhile, axonogeneration genes were inhibited, whereas neurodegenerative genes were stimulated. Restoration of miR-29b by mimic experiment could reverse the above neuropathy. Furthermore, western blot analysis disclosed that miR-29b could abolish Smad3 activation. In conclusion, the present study identifies that miR-29b could protect DRG from diabetic rats. This protective effects suggested potential therapeutic application of miR-29b in diabetic neuropathy.

The anatomy of any particular vascular perforator relative to its vascular territory (perforasome) and flow characteristics is unique and complex. This arterial perforasome study with laboratory rabbits was conducted to assess four-dimensional computed tomographic angiography as an imaging tool for the design of individualized tissue transfers. This study offers clinically relevant information that should improve flap survival.Six New Zealand White rabbits weighing 3.0 to 3.25 kg underwent contrast-enhanced four-dimensional computed tomographic angiography in a 128-slice scanner after intraarterial injection of iopromide iodinated contrast material. Based on the image data, the perforasome of the posterior thigh perforator was marked onto the posterior thigh skin. The perforasome size was confirmed by microangiography. Data from four-dimensional computed tomographic angiography and microangiography were statistically compared.Four-dimensional computed tomographic angiography clearly and accurately delineated the perfusion and vascular territories of the perforators. The area of the perforator flap as measured with four-dimensional computed tomographic angiography compared favorably to that obtained by means of microangiography; there was no statistically significant difference in the results from the two methods.This study demonstrated that four-dimensional computed tomographic angiography was capable of accurately characterizing the vascular territory and flow characteristics of the arterial perforator in live rabbits. This technique for determining perforator location, axiality, and optimal perfusion territory will potentially benefit human patients.

Contains fulltext : 170245.pdf (Publisher’s version ) (Open Access) Successful navigation of our complex social world requires the capability to recognize and judge the relative status of others. Hence, social comparison processes are of great importance in our interactions, informing us of our relative standing and in turn potentially motivating our behavior. However, so far few studies have examined in detail how social comparison can influence interpersonal decision-making. One aspect of social decision-making that is of particular importance is cooperative behavior, and identifying means of maintaining and promoting cooperation in the provision of public goods is of vital interest to society. Here, we manipulated social comparison by grading performance rankings on a reaction time task, and then measured cooperative decisions via a modified Public Goods Game (PGG). Findings revealed that individuals ranked highest tended to be more cooperative as compared to those who placed in the bottom rank. Interestingly, this effect was regardless of whether the comparison group members were the subsequent players in the PGG or not, and this effect was stronger in those with higher social orientation. In summary, the present research shows how different social comparison processes (assessed via social rankings) can operate in our daily interaction with others, demonstrating an important effect on cooperative behavior. 14 p.

Surgical repair of soft tissue defects of the knee and leg remains challenging. Using a case study approach, the anatomy of the popliteo-posterior intermediate cutaneous artery was examined, and a reverse island flap method was developed and implemented. After obtaining informed consent, 5 patients (1 woman, 4 men, age range 31 to 57 years) underwent the experimental use of a reverse island flap with a posterior thigh flap pedicled on the cutaneous vessels arising from the popliteo-posterior intermediate artery to repair soft-tissue defects of the knee and leg. The defects were caused by burned skin below the knee (n = 1), progressive skin necrosis in the knee after fracture surgery (n = 2), and skin infections associated with diabetes mellitus (n = 2). Skin defect sizes ranged from 15 cm x 5 cm to 30 cm x 12 cm. These large defects did not heal spontaneously; wound duration ranged from 1 week to 1 year, and all patients had refused defect repair with free flaps. Patients received posterior thigh flaps pedicled on the popliteo-posterior intermediate artery with areas ranging from 17 cm x 6 cm to 25 cm x 12 cm. All patients were treated with antibiotics and local dressings (iodoform and alcohol) changed daily post surgery, and blood supply was monitored by assessing the texture and color of the flap and venous regurgitation (ie, vein drainage disturbance). Four (4) of the five flaps survived completely. In 1 patient, partial survival of the flap, which had a good blood supply despite a venous circulation disorder, occurred: in this case, complete survival was achieved after treatment with a retrograde fascial flap and skin grafting. The appearance and texture of all flaps were satisfactory (ie, patients underwent only 1 operation, healing time was approximately 2 weeks, flap quality was close to normal skin, the donor site closed directly, and the shape and function of the knee and leg recovered well). No donor site abnormality was observed, and no postsurgical infection occurred. More research is needed, but the use of a reverse island flap with a posterior thigh flap pedicled on the cutaneous vessels arising from the popliteo-posterior intermediate artery may be a feasible option to repair soft tissue defects of the knee and leg.

Few clinical retrospective studies have reported the risk factors of pedicled flap necrosis in hand soft tissue reconstruction. The aim of this study was to identify non-technical risk factors associated with pedicled flap perioperative necrosis in hand soft tissue reconstruction via a multivariate logistic regression analysis.For patients with hand soft tissue reconstruction, we carefully reviewed hospital records and identified 163 patients who met the inclusion criteria. The characteristics of these patients, flap transfer procedures and postoperative complications were recorded. Eleven predictors were identified. The correlations between pedicled flap necrosis and risk factors were analysed using a logistic regression model.Of 163 skin flaps, 125 flaps survived completely without any complications. The pedicled flap necrosis rate in hands was 11.04%, which included partial flap necrosis (7.36%) and total flap necrosis (3.68%). Soft tissue defects in fingers were noted in 68.10% of all cases. The logistic regression analysis indicated that the soft tissue defect site (P = 0.046, odds ratio (OR) = 0.079, confidence interval (CI) (0.006, 0.959)), flap size (P = 0.020, OR = 1.024, CI (1.004, 1.045)) and postoperative wound infection (P0.001, OR = 17.407, CI (3.821, 79.303)) were statistically significant risk factors for pedicled flap necrosis of the hand.Soft tissue defect site, flap size and postoperative wound infection were risk factors associated with pedicled flap necrosis in hand soft tissue defect reconstruction.

Computed tomography-assisted angiography (CTA) for lower limb vasculature can identify perforators only as small as 1 mm in diameter. The technique does not clearly show the microvascularity in subdermal layers of the skin. This study investigated a novel method of CTA using intrafemoral injection of contrast medium instead of intravenous injection to display the vascular anatomy of small perforators with a diameter less than 1 mm in the lower extremities of rabbits. Posterior thigh perforator surgery was performed for 15 New Zealand rabbits weighing 2.5 to 3.5 kg. Five rabbits underwent anatomic dissection to determine the vascular anatomy of the posterior thigh perforator and its location relative to adjacent structures. Of the remaining 10 rabbits, 5 were subjected to CTA scanning after injection of iodine contrast through a microcatheter inserted into the femoral artery, and 5 were subjected to CTA scanning through venous injection of contrast media. The latter group was designated as the control group (10 extremities). Images were viewed using a dedicated workstation. Postoperative outcomes and complications were monitored for 7 days after the procedure. All the CTA images of intraartery administration clearly showed that the posterior thigh perforators originated from the popliteal artery. Injection of contrast agent through the femoral artery improved resolution of the CTA, enabling visualization of perforator arteries with diameters in the range of 0.3 to 0.4 mm. The images of the control group indicated the course of the perforator in the muscle of only six legs. The images of the remaining four legs did not display the perforator. The CTA-treated animals recovered without any complications. The anatomic dissection matched the CTA mapping. Computed tomography-assisted angiography using intraarterial injection of contrast media enables visualization of vessels smaller than 1 mm in diameter. The described animal model also showed the presence of vascular branches in the subdermis. This imaging technique may help in the preoperative design of perforator flaps for use in clinical practice. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Controversies exist among trials reporting the effects of statins on endothelial dysfunction in patients with diabetes mellitus (DM). Therefore, we performed a meta-analysis to determine whether statin therapy could improve endothelial dysfunction in patients with DM.PubMed, Cochrane and Embase were searched for randomized controlled trials of statins. Only trials reporting changes in flow-mediated dilatation (FMD) were included in this analysis. A meta-analysis was performed to assess the relationship between statin therapy and improvements in endothelial dysfunction. Meta-regression and subgroup analyses were done to identify sources of heterogeneity.Ten statin studies (845 patients) were included in this analysis. Statin therapy significantly improved FMD in patients with DM [weighted mean difference (WMD): 0.94%; 95% CI: 0.38%, 1.5%; P0.001]. Although heterogeneity among trials was found (I(2): 67%), no significant publication bias was detected. Subgroup analyses showed that patients did not benefit from statin therapy if their body mass index (BMI) was27.6 kg/m(2) (four trials; I(2): 0%; WMD: 0.11%; 95% CI: -0.47%, 0.70%; P=0.70). However, FMD was significantly improved among patients with BMI ≤27.6 kg/m(2) (five trials; I(2): 14%; WMD: 1.52%; 95% CI: 1.19%, 1.85%; P0.001). Type 1 diabetes, younger age, lower baseline blood lipid levels and blood pressure were all associated with improvements in FMD. The meta-regression analysis yielded similar results.Statins significantly improved the FMD only in patients with better endothelial functions. The use of FMD in evaluating therapeutic outcomes should be careful in populations at high risk.

Summary Objective To introduce our experiences of using the reverse posterior interosseous flap and its composite flap. Methods In the series of 201 cases, the fasciocutaneous flap was used to cover skin defects over the distal 1/3rd forearm, wrist and hand in 174 cases. The composite flap with the vascularised ulna bone graft was used to reconstruct the thumbs in 11 cases, and with the vascularised tendon graft was used to repair tendon defects with skin defects in 16 cases. The size of the ulna graft was 3–6cm in length and 1–2cm in width. The 4–7cm tendon graft was obtained from the extensor digiti quinti or extensor carpi ulnaris. The size of the flaps ranged from 5cm×4cm to 16cm×10cm. Results One flap failed completely. Of the other 200 flaps which survived 16 cases had venous congestion and had partial necrosis at the distal end. The size of the necrotic area ranged from 1 to 4cm in length. Ninety-three patients were followed up for at least 6 months, and included 10 patients with composite flaps. Generally, the flap matched the surrounding skin. But 10 cases had a lipectomy. The sensibility did not recover or achieved S1 within 6 months. For the extensor tendon defect, the function of finger extension was nearly normal and tenolysis was not required. In contrast, tenolysis was required after the flexor tendon reconstruction. However, these patients refused surgery. The bone grafts were healed in 3 months. The reconstructed thumb looked abnormal and lacked normal sensibility, although the patients used them. The linear scar line was conspicuous over the dorsum of the forearm. Conclusion The reverse posterior interosseous flap is a reliable method to cover skin defects over the distal 1/3rd of the forearm, the wrist and hand. The composite flap with a vascularised tendon graft is an optimal reconstructive option for any extensor tendon loss (III zone) associated with a skin defect. Using the composite flap with a vascularised bone graft or combined with the digital neurovascular flap is another way to reconstruct the thumb.

To evaluate chromosomal damage and cytotoxicity in exfoliated buccal mucosa cells, cells of the tongue and epithelial gingival cells from adults following CBCT scan and to compare the sensitivity of the different exfoliated cells to a same dosage of ionizing radiation.The study included 46 healthy participants (median age 27 years; age range 23-42 years) who had a CBCT scan. Exfoliated mucosa cells were collected immediately before the CBCT scan and 10 days after. Cells were centrifuged, fixed in the fluid of methanol : glacial acetic acid (3 : 1) and stained using the method of Schiff's reagent and fast green. One observer analyzed all the slides. For interobserver variances, a second observer scored 16 slides chosen from all the subjects. The same set of 16 slides were analyzed once again a month later for intraobserver variances.There is no significant differences for micronucleated cells before and after a CBCT scan in exfoliated buccal mucosa cells (p = 0.476), cells of the tongue (p = 0.884) and epithelial gingival cells (p = 0.362). The frequencies of pyknosis cell and karyolysis cell had significantly increased after CBCT scan in the three groups. No significant difference was found among the three kinds of mucosa cells (p = 0.557). The interobserver (p = 0.624) and intraobserver (p = 0.193) variances were not significant.A CBCT scan may induce cytotoxicity but not chromosomal damage in the oral mucosa cells, including buccal mucosa cells, cells of the tongue or epithelial gingival cells. The sensitivity of the different exfoliated cells to the same dosage of radiation had no statistically significant difference.

Background The medial arm is an optimal potential donor site for treating skin defects around the elbow. However, whether a reliable pedicled perforator flap could be harvested from the medial arm remains unanswered. The purpose of this study was to report the technique and our results using the medial arm pedicled perforator flaps. Methods A total of eight flaps in seven patients underwent the medial arm pedicled perforator flaps to treat skin defects around the elbow. The flap was pedicled on one perforator 1.3 ± 0.3 mm in diameter within 3 cm above the medial epicondyle. The flap size varied between 10 and 20 cm in length and between 6 and 10 cm in width. Results Of the eight flaps in seven patients, seven flaps survived uneventfully except that one suffered venous insufficiency. Six patients were followed up for 1 month to 2 years. One patient was lost to follow-up after 7 days. The wounds in all patients healed satisfactorily. No deep wound infection and wound dehiscence developed. No revision surgery was performed in the survived flaps. Conclusions The survival of the medial arm pedicled perforator flap confirms the phenomenon of one perforator perfusing multiple perforator angiosomes in the medial arm, although this study has the retrospective clinical nature and limited number of the patients. The medial arm pedicled perforator flap is a useful tool to treat skin defects around the elbow.

Introduction In this study, we aimed to investigate the dental and skeletal changes associated with long-term use of the Silensor appliance (Erkodent, Cologne, Germany) in patients with obstructive sleep apnea and hypopnea syndrome. Methods The sample included 42 patients with mild-to-severe obstructive sleep apnea and hypopnea syndrome (mean apnea-hypopnea index, 27; range, 5-74) who had been treated with the Silensor appliance for an average of 4 years (range, 1-11 years). A questionnaire was used to assess of the side effects subjectively; the cephalometric analysis was conducted to identify the dental and skeletal changes of different treatment times objectively. Results The Silensor appliance was associated with few subjective side effects. Most subjective side effects decreased after long-term use of the Silensor appliance. Significant changes after long-term use of the Silensor appliance were observed in incisor angulation, overbite, overjet, mandibular plane angle, anterior lower facial height, and anterior facial height. Overbite and skeletal changes at treatment times between 1 year and 3 years were a decrease in overbite and increases in the mandibular plane angle, anterior lower facial height, and anterior facial height. Overjet and other dental changes at treatment times longer than 3 years were a decrease in overjet, retroclination of the maxillary incisors, and proclination of the mandibular incisors. Conclusions The Silensor appliance was well tolerated and preferred by most subjects. Common but mild dental and skeletal changes resulted from using the appliance over a long period of time. The changes after 1 to 3 years of use were skeletal changes predominantly. Both dental and skeletal changes were observed simultaneously at treatment times longer than 3 years.

des-O-methyllasiodiplodin (DML) from Cerbera manghas has shown antagonistic activity against mineralocorticoid receptor (MR). Considering the involvement of MR in the insulin tolerance, we attempted to investigate the potential of DML in the treatment of type 2 diabetes mellitus (T2DM).Surface plasmon resonance (SPR) technology and reporter gene-based assays were used to study protein-small molecule interactions. HepG2 and 3T3-L1 cells were treated with H2O2 (0.2 mmol/L) or aldosterone (10 nmol/L) for 24 h. The expression of MR in the cells was downregulated with siRNA. The anti-inflammatory effect of the compound was evaluated, respectively. db/db mice were administered DML (30 mg·kg(-1)·d(-1)) for 4 weeks. Serum biochemical parameters and insulin sensitivity were examined. The expression levels of pro-inflammatory cytokines (MCP-1, TNF-α and IL-6) and ROS-related genes (NADPH p47 subunit and transcriptional factor PU.1) in adipose tissues and livers were analyzed using real-time RT-PCR.In HepG2 and 3T3-L1 cells, both H2O2 and aldosterone markedly stimulates the expression of MCP-1, TNFα, IL-6, p47 and PU.1 genes. Co-treatment with DML (10 μmol/L) significantly reduced the H2O2- or aldosterone-induced expression of these genes. SPR-based assay confirmed the antagonistic activity of DML against the interaction between SRC-1 and MR-LBD. Furthermore, DML decreased aldosterone-induced MR transcriptional activity in a dose-dependent manner. Downregulation of MR with siRNA in the cells prevented or significantly attenuated aldosterone-stimulated expression of these genes, whereas DML did no longer affect the expression of these genes except that of IL-6. Oral administration of DML effectively reduced the levels of blood glucose and glycosylated hemoglobin (HbA1c) in db/db mice. The treatment also rectified the expression of pro-inflammatory factor and ROS-related genes in db/db mice.DML effectively lowers the blood glucose level in db/db mice possibly via ameliorating the expression of obesity-related pro-inflammatory cytokines, highlighting the potential of the marine natural product as a drug lead for the treatment of metabolic disorders.

Supplemental Digital Content is available in the text, Purpose: Functional reconstruction of mutilating hand injuries poses a challenge to the surgeon. We present our experience with use of multiple composite tissue flaps transplant for functional reconstruction of hand in patients with mutilating hand injuries. The associated merits and demerits of these surgical approaches are briefly discussed. Methods: From August 2004 to October 2014, functional reconstruction of hand with transplantation of multiple composite tissue flaps was performed in 8 patients. These included the toe with dorsal pedis artery flap, the reverse posterior interosseous artery flap, and the anterolateral thigh flap. Mean interval from injury to functional reconstruction was 10.6 days. Results: All transplanted skin flaps and reconstructed neofingers survived completely. Only 1 patient developed wound infection at the recipient site (hand), which resolved without any debridement or revision surgery. At the donor site (foot), partial skin necrosis was observed in 1 patient, which healed with local wound care. In other patients, all wounds healed without any complications. The average range of movement at the neofinger metacarpophalangeal and interphalangeal joints was 38° and 73°, respectively. None of the patients required revision surgery. Conclusion: Use of negative pressure wound therapy and multiple composite tissue flap transplantation appears to be an effective strategy for hand functional reconstruction in patients with mutilating hand injuries. Among the multiple composite tissue flaps, use of toe transplantation combined with reverse posterior interosseous artery flap appears to be the best option.

Nerve injuries causing segmental loss require nerve grafting. However, autografts and allografts have limitations for clinical use. Peripheral nerve xenotransplantation has become an area of great interest in clinical surgery research as an alternative graft strategy. However, xenotransplant rejection is severe with cellular immunity, and Th1 cells play an important role in the process. To better understand the process of rejection, we used peripheral nerve xenografts from rats to mice and found that mononuclear cells expressing IFN-γ and IL-17 infiltrated around the grafts, and IFN-γ and IL-17 producing CD4+ and CD8+ T cells increased during the process of acute rejection. The changes of IL-4 level had no significant difference between xenotransplanted group and sham control group. The rejection of xenograft was significantly prevented after the treatment of IL-17 and IFN-γ neutralizing antibodies. These data suggest that Th17 cells contribute to the acute rejection process of peripheral nerve xenotransplant in addition to Th1 cells.

To investigate dental changes in long-term oral appliance treatment of obstructive sleep apnea and hypopnea syndrome(OSAHS).A total of 7 patients were included in the study. The three-dimensional (3D) model study was used to investigate the delicate changes of dentition.The 7 patients who had been treated with an oral appliance for a mean duration of 8.5 years were recruited. The arch widths increased in the molar area. The distance between the distobuccal cusps of the left and right upper second molar increased (2.11 ± 2.14) mm, P=0.040. The distance between the distobuccal cusps of the left and right upper first molar increased (0.56 ± 0.61) mm, P=0.049. The distance between the distobuccal cusps of the left and right lower first molar increased (1.25 ± 0.93) mm, P=0.040. Several molar and premolar cusps were depressed. Other teeth had no change statistically.The orthodontic side-effects on the teeth are small during the treatment of patients with OSAHS.

Skin defects around the knee remain a challenge for the reconstructive surgeons. Choosing appropriate flaps for coverage is crucial to preserve the knee joint or to restore its function. On the basis of anatomic results in 20 cadaveric specimens, we found a constant supragenicular fasciocutaneous perforator within 3 cm above the adductor tubercle, which arose from the saphenous branch of the descending genicular artery. Based on it, the distally pedicled anteromedial thigh fasciocutaneous flap can be harvested from the anteromedial thigh. Between 2003 and 2009, we performed the distally pedicled anteromedial thigh flaps in 11 patients. The site of skin defects included the popliteal fossa, proximal 1/3 leg, and amputation stump below knee. The size of skin defects ranged from 15 × 6 cm to 27 × 9 cm, and the corresponding size of the flaps ranged from 15 × 10 cm to 32 × 9 cm. Of 11 flaps, 10 flaps survived unevently, except 1 flap which suffered partial necrosis due to venous congestion. The patients were followed up for 3 weeks to 12 months. The donor site healed uneventfully without complications in all patients. Additionally, the skin paddle matched with the recipient in terms of skin color, texture, and thickness. The anteromedial thigh fasciocutaneous flap pedicled on the supragenicular perforator is a reliable and versatile alternative to cover skin defects around the knee.

A series of C7-O- and C20-O-amidated 2,3-dehydrosilybin (DHS) derivatives ((+/-)-1a-f and (+/-)-2), as well as a set of alkenylated DHS analogues ((+/-)-4a-f), were designed and de novo synthesized. A diesteric derivative of DHS ((+/-)-3) and two C23 esterified DHS analogues ((+/-)-5a and (+/-)-5b) were also prepared for comparison. The cell viability of PC12 cells, Fe(2+) chelation, lipid peroxidation (LPO), free radical scavenging, and xanthine oxidase inhibition models were utilized to evaluate their antioxidative and neuron protective properties. The study revealed that the diether at C7-OH and C20-OH as well as the monoether at C7-OH, which possess aliphatic substituted acetamides, demonstrated more potent LPO inhibition and Fe(2+) chelation compared to DHS and quercetin. Conversely, the diallyl ether at C7-OH and C20-OH was more potent in protection of PC12 cells against H(2)O(2)-induced injury than DHS and quercetin. Overall, the more lipophilic alkenylated DHS analogues were better performing neuroprotective agents than the acetamidated derivatives. The results in this study would be beneficial for optimizing the therapeutic potential of lignoflavonoids, especially in neurodegenerative disorders such as Alzheimer's and Parkinson's disease.

To study the functional change of nerve trunk after removing the partial bundles of ulnar nerve, to propose the concept of functional reserve of peripheral nerves and to investigate the functional reserve quantity of peripheral nerves.Two hundred and twenty SD rats (male or female), aging 3 months and weighing 300-350 g, were randomized into the experimental group and the control group (n=110 per group). And the experimental group was subdivided into group 1/8, group 1/4, group 1/3, group 1/2 and group 2/3 according to the resection portion (n=22 per group). In the experimental group, the section of the lowest level on ulnar nerve trunks was exposed, and a certain portion of its bundles was separated and cut, while in the control group the bundles were only separated without resection. The general condition of all rats was observed, and the motoneurons in cornu anterius medullae spinalis were detected at 1 week, 2 weeks and 2 months after operation. The neuro-electrophysiology and the function of dominated muscles were detected at 2 weeks, 2 months, 3 months, and 4 months after operation.All the rats survived without infection and obvious ulcer in the limbs. The number of motoneurons in cornu anterius medullae spinalis in various experimental subgroups witnessed no obvious changes (P0.05). The superstructure changed obviously at the early postoperative stage in group 1/2 and group 2/3, but restored well at 2 months after operation. For the latent period of evoked potential, there was no significant difference between the various experimental subgroups and the control group at each time point (P0.05), but there was a significant difference among the various experimental subgroups when compared the time points of 2, 3 and 4 months to that of 2 weeks (P0.05) and no statistically significant difference at other time points (P0.05). For the wave amplitude of evoked potential of motor nerves, the maximum wave amplitude and the persistence time of the dominate muscle, there were significant differences between the various experimental subgroups and the control group at each time point (P0.05), and there were significant differences among the various experimental subgroups when comparing the time points of 2, 3 and 4 months to that of 2 weeks (P0.05) and no statistical significance at other time points (P0.05).The functional reserve of the ulnar nerve without compromise accounts the 1/3 of the whole trunk diameter.

To explore a suitable repairing method for skin defects of the foot and ankle, and to evaluate the therapeutic effects of the different repairing methods.From January 2000 to October 2005, 36 patients with skin defects of the foot and ankle underwent the repairing treatment, of whom 35 were males and 1 was patients with skin defects of the foot and ankle underwent the repairing treatment, of whom 35 were males and 1 was 2 repaired groups. And the patients in the 2 groups were equally satisfied with the repairing treatments. female, aged 5-62 years, averaged 38 years. Of the 36 patients, 12 had an injury by a machine, 22 had a traffic accident, 1 had an infection, and 1 had a cold injury. And the injuries involved the dorsum of the foot, heel, forefoot, and medial or lateral malleolus. The injuries were respectively treated by 2 different repairing methods, the repair with the coverage by the lateral supramalleolar flaps and the repair with the coverage by the reverse sural neurocutaneous flaps. The skin defects ranged in area from 5 cm x 4 cm to 20 cm x 10 cm. The lateral supramalleolar flap was used in 15 patients (15 flaps) with a flap area of 5 cm x 4 cm-15 cm x 8 cm, and the reverse sural neurocutaneous flap was used in 21 patients (22 flaps) with a flap area of 6 cm x 4 cm-20 cm x 10 cm. We retrospectively observed the therapeutic results and compared the success rates of the two methods.Of the 36 patients, 15 underwent the repair with the coverage by 15 lateral supramalleolar flaps; 10 achieved a complete survival of the flaps, 2 developed an epidermal necrosis over the distal part, and 3 developed a complete necrosis. The other 21 patients underwent the repair with the coverage by 22 reverse sural neurocutaneous flaps. Of the 22 flaps, 21 had a complete survival, and only 1 failed to coverage by 22 reverse sural neurocutaneous flaps. Of the 22 flaps, 21 had a complete survival, and only 1 failed to survive. The comparison revealed that there was no difference in the color, texture, and contour of the flaps between the 2 repaired groups. And the patients in the 2 groups were equally satisfied with the repairing treatments. The sensation of the flaps recovered to S0-S1.The repairing of the foot and ankle skin defects with the coverage by the lateral supramalleolar flaps or by the reverse sural neurocutaneous flaps can achieve a similar good therapeutic result. However, the repair with the lateral supramalleolar flaps is more suitable for the skin defect of a smaller area over the medial or lateral malleolus, or the proximal dorsum of the foot; the repair with the reverse sural neurocutaneous flaps is more suitable for the skin defect of a larger area over the foot and ankle without serious destruction of the malleolar arterial rete.

Based on anatomic study, the vascularized capitate transposition to replace excised necrotic lunate was designed and applied in 40 cases of advanced Kienbock disease. It includes excision of the necrotic lunate and proximal shift of the vascularized capitate. The blood supply of the transposed capitate is provided by the dorsal branch of the anterior interosseous artery. Bone union occurred radiographically, and no postoperative capitate necrosis occurred in all cases after 6 weeks. Twenty-three cases were followed up for 1 year. No residual wrist pain existed in the range of motion, but limited residual wrist pain existed in labor work. The arc of motion ranged on average from 35 degrees of flexion to 45 degrees of extension. The grip power of the affected hand reached on average 70% compared with the contralateral. The authors conclude the vascularized capitate transposition is a reliable alternative for advanced Kienbock disease.

To evaluate the clinical application and discuss the operative indication of the reverse dorsal metacarpal flap and its compound flap on the skin defects of hand.From 1990 to 2003, we applied the reverse dorsal metacarpal flap and its compound flap to repair soft tissue defects of fingers in 122 cases, which included 90 cases of the reverse metacarpal flap and 32 cases of its compound flaps with tendon grafts, nerve grafts or bone grafts. Based on the follow-up observations, we analyzed the indications of the reverse metacarpal flap and its compound flaps, the postoperative contours, flap colors and textures in comparison to contralateral fingers retrospectively.In the series of 122 cases, flaps survived and the donor site defects were closed directly. The follow-up period ranged from 1-12 years. The postoperative contours, colors and textures of the flaps and its compound flaps were similar to those of normal fingers, although linear scar remained. According to standards of sense recovery (British Medical Research Council, BMRC), the sense function of the flaps resumed S3 after operation for 1 year. In 10 cases with the tendon defects treated by the flap with tendon grafts, function of flexion-extension of fingers resumed 50%-75% in comparison to the contralateral fingers using the method of measurement of total active motion. In 7 cases with the phalangeal nonunion or bone defects treated by the flap with bone grafts, union occurred after operation for 3 months.To soft tissue defects on fingers with bone or tendon exposure, the reverse metacarpal flap and its compound flap are a better choice for repairing. The range of repairing is up to the distal interphalangeal joint of fingers. The second dorsal metacarpal artery is more consistent and larger as the choice of vascular pedicle, in comparison with other dorsal metacarpal arteries. Postoperative flap color and texture are similar to normal fingers.

Summary Objective To discuss the clinical implication of scaphoid ring sign in Lichtman's X-ray III B stage of the lunate avascular necrosis. Methods In a series of 17 cases of advanced Kienbock's diseases, carpal height (CH) and carpal height ratio (CHO) were measured in posteroanterior X-ray view (PA) preoperatively, which included seven cases in stage III A and 10 cases in stage III B . Radioscaphoid angles were also measured in the lateral X-ray view. All these measurements above were to study what were the differences between stages III A and III B . In addition, five fresh normal wrist specimens were dissected to observe the ligaments stabilizing the proximal pole of scaphoid. Results The results of CH and CHR between stages III A and III B were similar, which illustrated no significant difference in carpal collapse between two substages, however, the results of RSA were significantly different between two substages, which implied the position of the proximal pole of scaphoid changed in two substages. Based on the results of anatomical observation, three ligaments were important to stabilize the proximal pole of scaphoid, namely the radioscaphocapitate (RSC) ligament, long radiolunate (LRL) ligament and scapholunate interosseous ligament (SLIL). The function of RSC ligament was to restrict palmar subluxation of the proximal pole of scaphoid; LRL and SLIL were to restrict dorsal transposition of the proximal pole of scaphoid. Conclusion Based on the results, we suppose the scaphoid ring sign is the implication of rotary scaphoid subluxation in stage III B , which was caused by destructions of LRL and SLIL ligaments. All procedures aimed at stage III B must account for this important factor.

To investigate the procedure and applications of antegrade and retrograde dorsal metacarpal flaps with cutaneous branches as pedicles in repairing soft tissue defects of wrist and fingers.From 1995 to 2003, we observed that the proximal and distal branches, deriving from the dorsal metacarpal artery, formed a consistent anastomosis arc subdermally. The anastomosis arc was paralleled to the dorsal metacarpal artery. Antegrade and retrograde dorsal metacarpal flaps could be designed using proximal and distal branches as pedicles. Twenty-seven cases of soft tissue defects were treated by use of dorsal metacarpal flaps with cutaneous branches as pedicles, including 3 cases of defects on dorsum of hand with antegrade flaps, and 24 cases of defects on fingers with retrograde flaps (index finger: 12 cases; middle finger: 6 cases; ring finger: 4 cases; and little finger: 2 cases). The dimensions of the antegrade flaps were 2.0 cm x 4.0 cm - 4.0 cm x 6.0 cm, and the dimensions of the retrograde flaps were 2.5 cm x 3.5 cm - 3.0 cm x 7.0 cm. The incision of the donor site was closed directly.All flaps survived. After a follow-up of 1-3 years, the texture and color of the flaps were good, and the shape and function of the donors were normal.The antegrade or retrograde flap pedicled with the distal or proximal cutaneous branches of the dorsal metacarpal artery, is an optimal flap in repairing finger or wrist soft tissue defects.

To investigate the clinical application of capitate transposition with a pedicle in 30 cases of Kienbock's disease.The external diameter and curvature of the capitate head and proximal facet of the lunate were observed and measured in 100 specimens. The vascularity of the capitate was also investigated. Capitate transposition with a vascular pedicle was designed to treat 30 patients with advanced Kienbock's disease who were followed up for 2 to 16 years and then analyzed according to Evans's scoring system.Aseptic necrosis did not occur in the transposed capitate because the pedicle fascia including the dorsal branch of the anterior interosseous artery ensured the vascularity of proximal two thirds of the capitate. The transposed capitate reestablished a relatively pain-free radiocarpal joint. Follow-up results showed that grip strength and motion arc were up to 70% of contralateral side.Capitate transposition with a pedicle is a reliable treatment method for advanced Kienbock's disease, with favorable prognosis for at least five years postoperatively.

To pay attention to the diagnosis and treatment of the complications associated with closed multi-fractures in metacarpals.From 1997 to 2000, out of 382 patients with closed multi-fractures in metacarpals, 12 had complications. In 7 cases of fractures at the second, third, fourth and fifth metacarpal shaft, complicated by acute compartment syndrome in hand, compartmental fascia were incised for decompress; open reduction and internal fixation were performed. In 4 cases of fractures at the metacarpal base, complicated by acute carpal tunnel syndrome, the fracture was reduced and fixed without transection of the transverse carpal ligament. In 1 case of fracture at metacarpal base, complicated by direct contusion of the median nerve, the fracture was reduced without treatment of the median nerve.All patients were followed up for 3 months. Fracture healed 4-6 weeks postoperatively. No claw deformity and dysfunction of the median nerve occurred. The arc of motion of the proximal interphalangeal and distal interphalangeal joints were normal.During fracture reduction, we should pay attention to the complications associated with closed multi-fractures at metacarpal to decrease hand malfunction.

To analyze the long-term outcomes of antebrachial flap using a pedicle of the dorsal interosseous artery.Ninety cases were followed up for 1-16 years, in which the indications, long-term outcomes and dorsal aspect of the forearm were assessed retrospectively.Eighty-nine cases survived with satisfactory contour of the forearm and hand.Antebrachial flap using a pedicle of the dorsal interosseous artery is an optimal method for repair of soft tissue defects in the hand.

To discuss the diagnosis and treatment of tarsal tunnel syndrome.From 1998 to 1999, 10 cases of tarsal tunnel syndrome were reviewed, and the outcomes of operation were analyzed according to Pefeiffer's method. Out of 10 cases, 6 were examined using electromyography preoperatively.After 1 to 2 year follow-up, postoperative outcomes were excellent in 5 cases, good in 4 cases, and poor in 1 case according Pefiffer's methods.A combination of symptoms and physical signs, and electromyography may increase the diagnosis rate; and early operation will improve the therapy results.

To explore the diagnosis and operative treatment of radiation-induced brachial plexopathy.Nine cases of radiation-induced brachial plexopathy were divided into two groups, 4 cases undergoing neurolysis of brachial plexus as Group A and 5 cases undergoing transfer of myocutaneous flaps after neurolysis as Group B. In Group B, 4 cases were treated with latissimus dorsi myocutaneous flaps (about 20 cm x 20 cm) and 1 case with pectoralis major myocutaneous flap (about 8 cm x 6 cm).All the 9 cases of radiation-induced brachial plexopathy were followed up for a period of 2 to 5 years, with an average of 2.3 years. As far as pain relief and function recovery were concerned, the results of Group B were better than those of Group A.Based on the results of Group B in the series, we suggest that the procedure of covering the wounds with transferred myocutaneous flaps after neurolysis of the brachial plexus should be performed to those advanced patients. The procedure may improve the blood supply of the fibrotic brachial plexus by reestablishing a good nerve bed.

We report our experiences of 90 cases of the reverse antebrachial flap based on the posterior interosseous artery. In 1985, we found a consistent anastomosis (96%) between the posterior interosseous artery and the anterior interosseous artery at the dorsal side of the ulnar head in an anatomical study. From 1985 to 2000, we used this antebrachial flap to repair soft tissue defects of the hands or wrists, the first web space, or to reconstruct thumbs in 90 cases. Only one case suffered flap necrosis. The reverse antebrachial flap on the posterior interosseous artery pedicle has the advantages of good texture and colour, and appropriate thickness compared to the hand. The anastomotic arch which determines the point of rotation is consistent, and the pedicle is long. This flap is reliable for repairing soft tissue defects with or without defects of the nerve, tendon and bone, and also for reconstruction of the first web and thumb. Donor site morbidity is acceptable.