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Lin YH, Wei Y, Zeng Q, Wang Y, Pagani CA, Li L, Zhu M, Wang Z, Hsieh MH, Corbitt N, Zhang Y, Sharma T, Wang T, Zhu H. IGFBP2 expressing midlobular hepatocytes preferentially contribute to liver homeostasis and regeneration. Cell Stem Cell 2023; 30:665-676.e4. [PMID: 37146585 PMCID: PMC10580294 DOI: 10.1016/j.stem.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 02/21/2023] [Accepted: 04/10/2023] [Indexed: 05/07/2023]
Abstract
Although midlobular hepatocytes in zone 2 are a recently identified cellular source for liver homeostasis and regeneration, these cells have not been exclusively fate mapped. We generated an Igfbp2-CreER knockin strain that specifically labels midlobular hepatocytes. During homeostasis over 1 year, zone 2 hepatocytes increased in abundance from occupying 21%-41% of the lobular area. After either pericentral injury with carbon tetrachloride or periportal injury with 3,5-diethoxycarbonyl-1,4-dihydrocollidine (DDC), IGFBP2+ cells replenished lost hepatocytes in zones 3 and 1, respectively. IGFBP2+ cells also preferentially contributed to regeneration after 70% partial hepatectomy, as well as liver growth during pregnancy. Because IGFBP2 labeling increased substantially with fasting, we used single nuclear transcriptomics to explore zonation as a function of nutrition, revealing that the zonal division of labor shifts dramatically with fasting. These studies demonstrate the contribution of IGFBP2-labeled zone 2 hepatocytes to liver homeostasis and regeneration.
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Affiliation(s)
- Yu-Hsuan Lin
- Children's Research Institute, Departments of Pediatrics and Internal Medicine, Center for Regenerative Science and Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Yonglong Wei
- Children's Research Institute, Departments of Pediatrics and Internal Medicine, Center for Regenerative Science and Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Qiyu Zeng
- Children's Research Institute, Departments of Pediatrics and Internal Medicine, Center for Regenerative Science and Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Yunguan Wang
- Quantitative Biomedical Research Center, Department of Population and Data Sciences, Center for the Genetics of Host Defense, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Chase A Pagani
- Children's Research Institute, Departments of Pediatrics and Internal Medicine, Center for Regenerative Science and Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Lin Li
- Children's Research Institute, Departments of Pediatrics and Internal Medicine, Center for Regenerative Science and Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Min Zhu
- Children's Research Institute, Departments of Pediatrics and Internal Medicine, Center for Regenerative Science and Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Zixi Wang
- Children's Research Institute, Departments of Pediatrics and Internal Medicine, Center for Regenerative Science and Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Meng-Hsiung Hsieh
- Children's Research Institute, Departments of Pediatrics and Internal Medicine, Center for Regenerative Science and Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Natasha Corbitt
- Children's Research Institute, Departments of Pediatrics and Internal Medicine, Center for Regenerative Science and Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Yu Zhang
- Children's Research Institute, Departments of Pediatrics and Internal Medicine, Center for Regenerative Science and Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Tripti Sharma
- Children's Research Institute, Departments of Pediatrics and Internal Medicine, Center for Regenerative Science and Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Tao Wang
- Quantitative Biomedical Research Center, Department of Population and Data Sciences, Center for the Genetics of Host Defense, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Hao Zhu
- Children's Research Institute, Departments of Pediatrics and Internal Medicine, Center for Regenerative Science and Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
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Murray E, Challoumas D, Putti A, Millar N. Effectiveness of Sodium Hyaluronate and ADCON-T/N for the Prevention of Adhesions in Hand Flexor Tendon Surgery: A Systematic Review and Meta-Analysis. J Hand Surg Am 2022; 47:896.e1-896.e20. [PMID: 34509314 DOI: 10.1016/j.jhsa.2021.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 05/04/2021] [Accepted: 07/14/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE A common complication after digital flexor tendon repair in the hand is postoperative adhesions that can cause loss of motion and compromise hand function. The aim of this review of relevant published literature was to assess the effectiveness of locally administered sodium hyaluronate or ADCON-T/N for the prevention of adhesions after hand flexor tendon repair. METHODS A literature search was conducted in June 2020 in multiple databases for randomized controlled trials . Our primary outcome was measurement of active finger motion. Follow-up was defined as short-term (< 12 weeks), mid-term (12 weeks to 6 months) and long-term (> 6 months). Mean differences (MD) and standardized mean differences (SMD) of total active motion (TAM) of the interphalangeal joints (IPJs) and active motion of the IPJs separately were calculated where results were meta-analyzed. RESULTS Six randomized controlled trials were included. For ADCON-T/N, no benefits were detected for TAM of the IPJs (MD 1.71 [-21.54, 24.96]) or active motion of the IPJs separately (proximal: MD 4.77 [-4.47, 14]; distal: MD 1.17 [-10.33, 12.66]) in the short-/mid-term. The mid-term benefit in TAM of sodium hyaluronate over standard care (placebo/no treatment) did not reach statistical significance (SMD 0.31 [0, 0.63]); however, a subgroup comparison of repeated administration of sodium hyaluronate versus standard care was both statistically and clinically significant (SMD 0.55 [0.11, 0.98]). CONCLUSIONS Repeated administration of sodium hyaluronate at the tendon repair site may be effective in improving postoperative active finger motion after primary hand flexor tendon repair in the mid-term. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic II.
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Affiliation(s)
- Elspeth Murray
- Department of Trauma & Orthopaedic Surgery, Wishaw General Hospital, Wishaw
| | - Dimitris Challoumas
- Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow; Department of Trauma & Orthopaedic Surgery, Ayr University Hospital, Ayr.
| | - Amit Putti
- Department of Trauma & Orthopaedic Surgery, Forth Valley Royal Hospital, Larbert, UK
| | - Neal Millar
- Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow
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Choudhury RY, Basharat K, Zahra SA, Tran T, Rimmer L, Harky A, Idhrees M, Bashir M. "Proximalization is Advancement"-Zone 3 Frozen Elephant Trunk vs Zone 2 Frozen Elephant Trunk: A Literature Review. Vasc Endovascular Surg 2021; 55:612-618. [PMID: 33754903 DOI: 10.1177/15385744211002493] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Over the decades, the Frozen Elephant Trunk (FET) technique has gained immense popularity allowing simplified treatment of complex aortic pathologies. FET is frequently used to treat aortic conditions involving the distal aortic arch and the proximal descending aorta in a single stage. Surgical preference has recently changed from FET procedures being performed at Zone 3 to Zone 2. There are several advantages of Zone 2 FET over Zone 3 FET including reduction in spinal cord injury, visceral ischemia, neurological and cardiovascular sequelae. In addition, Zone 2 FET is a technically less complicated procedure. Literature on the comparison between Zone 3 and Zone 2 FET is scarce and primarily observational and anecdotal. Therefore, further research is warranted in this paradigm to substantiate current surgical treatment options for complex aortic pathologies. In this review, we explore literature surrounding FET and the reasons for the shift in surgical preference from Zone 3 to Zone 2.
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Affiliation(s)
| | - Kamran Basharat
- Department of Medicine, St George's University of London, United Kingdom
| | - Syeda Anum Zahra
- Department of Medicine, St George's University of London, United Kingdom
| | - Tien Tran
- Department of Medicine, St George's University of London, United Kingdom
| | - Lara Rimmer
- General Surgery, 171993Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.,Faculty of Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Mohammed Idhrees
- Institute of Cardiac and Aortic disorders, SIMS Hospital, Chennai
| | - Mohamad Bashir
- Vascular & Endovascular Surgery, 155510Royal Blackburn Teaching Hospital, Blackburn, United Kingdom
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El-Shebly A, El Fahar M, Mohammed H, Bahaa Eldin A. Outcomes of repair of the lacerated A2 pulley with extensor retinaculum during primary flexor tendon repair. J Hand Surg Eur Vol 2017; 42:903-908. [PMID: 28604156 DOI: 10.1177/1753193417711596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED We report outcomes of repairing the lacerated A2 pulley with extensor retinaculum graft in ten patients (ten fingers) during primary flexor tendon repair in zone 2. Complete A2 pulley lacerations were found in eight fingers and partial A2 pulley laceration in two. We extended the laceration in the sheath to the middle of the A4 or A1 pulley to allow tendon repair with a four-strand core suture. The A2 pulley was reconstructed with an extensor retinaculum graft. All patients followed the early controlled active mobilization protocol and recovered active range of motion at the interphalangeal joints without major extension deficits. Using the Strickland and Glogovac criteria, there were four excellent, five good and one fair result. One finger was graded excellent, eight good, and one fair according to Tang's criteria. No clinical bowstringing was observed. We conclude that extensive pulley lacerations reconstructed with extensor retinaculum primarily ensure functional recovery after tendon repair. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- A El-Shebly
- 1 Plastic & Reconstructive Surgery Department, Mansoura University, Mansoura, Egypt
| | - M El Fahar
- 1 Plastic & Reconstructive Surgery Department, Mansoura University, Mansoura, Egypt
| | - H Mohammed
- 2 General Surgery Department, Mansoura University, Mansoura, Egypt
| | - A Bahaa Eldin
- 1 Plastic & Reconstructive Surgery Department, Mansoura University, Mansoura, Egypt
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Abstract
UNLABELLED We report on the outcomes of flexor tendon repair in zone 2 subzones with early active mobilization in 102 fingers in 88 consecutive patients. There were 28, 53, 15, and six fingers with repairs in zones 2A to 2D, respectively. Rupture of the repair occurred in four fingers, all in zone 2B. Excluding those with repair ruptures, the mean total active motion was 230° (range 143°-286°). Evaluated with Tang's criteria, the outcomes were ranked excellent in 39 fingers, good in 46, fair in ten, poor in three, and failure in four. The outcomes in zone 2C were significantly inferior to those in zones 2B and 2D ( p = 0.02). Our results suggest that the tendon laceration in the area covered by the A2 pulley (zone 2C) is the most difficult area to obtain satisfactory active digital motion and tendon repair in zone 2B is the area where the risk of rupture is highest. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- K Moriya
- Niigata Hand Surgery Foundation, Niigata, Japan
| | - T Yoshizu
- Niigata Hand Surgery Foundation, Niigata, Japan
| | - N Tsubokawa
- Niigata Hand Surgery Foundation, Niigata, Japan
| | - H Narisawa
- Niigata Hand Surgery Foundation, Niigata, Japan
| | - S Matsuzawa
- Niigata Hand Surgery Foundation, Niigata, Japan
| | - Y Maki
- Niigata Hand Surgery Foundation, Niigata, Japan
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Moriya K, Yoshizu T, Tsubokawa N, Narisawa H, Hara K, Maki Y. Outcomes of release of the entire A4 pulley after flexor tendon repairs in zone 2A followed by early active mobilization. J Hand Surg Eur Vol 2016; 41:400-5. [PMID: 26676484 DOI: 10.1177/1753193415619082] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 10/19/2015] [Indexed: 02/03/2023]
Abstract
We report the outcomes of repair of the flexor digitorum profundus tendon in zone 2a in 22 fingers. The tendon was repaired with a six-strand repair method and the A4 pulley was completely released. Release of the C2 pulley combined with the A4 pulley was necessary in 12 fingers, nine fingers underwent a complete release of the A3, C2, and A4 pulleys, and one finger underwent a release of the C1, A3, C2, and A4 pulleys. The mean total active motion of the three finger joints was 234° at 5 to 12 months of follow-up. No bowstringing was noted in these fingers. The good and excellent recovery of active digital motion was in 20 (91%) out of 22 fingers according to Strickland's criteria or Tang's criteria. Our results suggest that release of the A3, C2, and A4 pulleys makes the repair surgery easier and does not cause tendon bowstringing.
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Affiliation(s)
- K Moriya
- Niigata Hand Surgery Foundation, Niigata, Japan
| | - T Yoshizu
- Niigata Hand Surgery Foundation, Niigata, Japan
| | - N Tsubokawa
- Niigata Hand Surgery Foundation, Niigata, Japan
| | - H Narisawa
- Niigata Hand Surgery Foundation, Niigata, Japan
| | - K Hara
- Niigata Hand Surgery Foundation, Niigata, Japan
| | - Y Maki
- Niigata Hand Surgery Foundation, Niigata, Japan
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Frueh FS, Kunz VS, Gravestock IJ, Held L, Haefeli M, Giovanoli P, Calcagni M. Primary flexor tendon repair in zones 1 and 2: early passive mobilization versus controlled active motion. J Hand Surg Am 2014; 39:1344-50. [PMID: 24799144 DOI: 10.1016/j.jhsa.2014.03.025] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 03/19/2014] [Accepted: 03/20/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare early passive mobilization (EPM) with controlled active motion (CAM) after flexor tendon surgery in zones 1 and 2. METHODS We performed a retrospective analysis of collected data of all patients receiving primary flexor tendon repair in zones 1 and 2 from 2006 to 2011, during which time 228 patients were treated, and 191 patients with 231 injured digits were eligible for study. Exclusion criteria were replantation, finger revascularization, age younger than 16 years, rehabilitation by means other than EPM or CAM, and missing information regarding postoperative rehabilitation. This left 132 patients with 159 injured fingers for analysis. The primary endpoint was the comparison of total active motion (TAM) values 4 and 12 weeks after surgery between the EPM and the CAM protocols. The analysis of TAM measurements under the rehabilitation protocols was conducted using t-tests and further linear modeling. We defined rupture rate and the assessment of adhesion/infection as secondary endpoints. RESULTS There was a statistically significant difference between the TAM values of the EPM and the CAM protocols 4 weeks after surgery. At 12 weeks, however, there was no significant difference between the 2 protocols. Older age and injuries with finger fractures were associated with lower TAM values. Rupture rates were 5% (CAM) and 7% (EPM), which were not statistically different. CONCLUSIONS This study showed a favorable effect of CAM protocol on TAM 4 weeks after surgery. The percent rupture rate was slightly lower in the patients with CAM than in the patients with EPM regime. Further studies are required to confirm our results and to investigate whether faster recovery of TAM is associated with shorter time out of work. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.
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Fufa DT, Osei DA, Calfee RP, Silva MJ, Thomopoulos S, Gelberman RH. The effect of core and epitendinous suture modifications on repair of intrasynovial flexor tendons in an in vivo canine model. J Hand Surg Am 2012; 37:2526-31. [PMID: 23174065 PMCID: PMC3513918 DOI: 10.1016/j.jhsa.2012.09.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 09/15/2012] [Accepted: 09/18/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine in vivo effects of modifications to core and epitendinous suture techniques in a canine intrasynovial flexor tendon repair model using clinically relevant rehabilitation. Our null hypothesis was that gap formation and rupture rates would remain consistent across repair techniques. METHODS We evaluated gap formation and rupture in 75 adult mongrel dogs that underwent repair of intrasynovial flexor tendon lacerations followed by standardized postoperative therapy. The current suture technique was a 4-0, 8-strand core suture with a purchase of 1.2 cm and a 5-0, epitendinous suture repair with a 2-mm purchase length and depth. We compared gap and failure by chi-square analysis to a historical group of in vivo repairs (n = 76) from the same canine model using 8-strand core suture repair with purchase of 0.75 cm and 6-0 epitendinous suture with a 1-mm purchase length and depth. RESULTS A total of 93% of tendons (n = 70) demonstrated gapping of less than 3 mm using the current suture technique. Five percent of tendons (n = 4) had a gap of 3 mm or greater, and there was 1 repair site failure. This was significantly improved over the comparison group of historical 8-strand core repair technique, which resulted in 82% (n = 62) of repairs with a gap of less than 3 mm and 7 failures (9%). CONCLUSIONS In an in vivo model, current modifications to suture techniques for intrasynovial flexor tendon repair demonstrated significant improvements in gap formation and rupture compared with a similar technique using shorter purchase lengths and shallower purchase depth. CLINICAL RELEVANCE Suggested repair modifications for the treatment of zone II flexor tendon transections demonstrate improvements in gap formation and tendon rupture in vivo.
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