| Objective1. To observe the effect of grip strength training combined with conventional rehabilitation therapy on patients with tendon adhesion after flexor tendon repair. 2.To investigate the molecular mechanism of flexor tendon adhesion by miRNA microarray analysis.Methods1. More than 10 weeks after flexor tendon repair, 59 patients(108 fingers in total) with stiff phalangeal joints were recruited. They were randomly divided into the test group with grip strength training combined with conventional rehabilitation treatment(n=30,55 fingers in total) and the control group with conventional rehabilitation treatment(n=29, 53 fingers in total),using a random number table. The two groups were treated for 8 weeks. The total active motion(TAM) and the grip strength were evaluated before and at the end of the treatment. 2. The primary fibroblasts were cultured. The microRNA(miRNA) expression profiles between keloid derived fibroblasts and normal fibroblasts(including fetal and adult dermal fibroblasts) were compared by miRNA microarray analysis.Results1. Before treatment, the mean of the TAM of the test group is 123.28±33.24°, and the levels of the TAM are listed as follows: none is excellent, 10 patients are good, 12 patients are poor and 33 patients are bad. The average grip strength is 56.20±19.87 N.The mean of the TAM of the control group is 125.87±24.76°, and the levels of the TAM are listed as follows: none is excellent, 9 patients are good, 14 patients are poor and 30 patients are bad. The average grip strength is 58.90±22.10 N. There were no significant differences between the two groups in these aspects(P>0.05). 2. After 8 weeks of treatment, the mean of the TAM of the test group is increased to 211.13±36.04°, and the levels of the TAM are listed as follows: 10 patients are excellent, 28 patients are good,11 patients are poor and 6 patients are bad. The average grip strength is 85.33±17.05 N.The mean of the TAM of the control group is increased to 189.97±18.33°, and the levels of the TAM are listed as follows: 6 patients are excellent, 19 patients are good,20 patients are poor and 8 patients are bad. The average grip strength is 64.48±21.01 N.After treatment, the TAM and the grip strength of these two groups were improved significantly than before treatment(P<0.05). Moreover, compared with the control group, the TAM of the test group was significantly increased(P<0.05). According to the levels of the TAM after treatment, the rate of fineness of the test group was obviously higher than that of the control group, with 69.09% vs 47.17%. Compared with the control group, the grip strength of the test group after treatment was higher than the control group( P < 0.05). 3. We found that the miRNA profiles in keloid-derived fibroblasts are different with those in normal fibroblasts. Nine miRNAs were differentially expressed, six of which were significantly up-regulated in keloid fibroblasts, including miR-152, miR-23b-3p, miR-31-5p, miR-320 c, miR-30a-5p and hsv1-miR-H7, and three of which were significantly down-regulated, including miR-4328, miR-145-5p, and miR-143-3p. We performed computational predictions of target genes for seven differentially expressed miRNAs. And We found that many targets played significant roles in several important pathways which are closely associated with keloids, including transforming growth factor-b(TGF-b) family and mitogen-activated protein kinase(MAPK) pathways, apoptosis and the cell cycle.Conclusion1. Grip strength training combined with conventional rehabilitation therapy may be more effective in improving the hand function of patients with flexor tendon adhesion.2. Our results demonstrate that the miRNA expression profile is altered in keloid derived fibroblasts compared within fetal and adult dermal fibroblasts, and the expression profile may provide a useful clue for exploring the pathogenesis of tendon adhesion. miRNAs might partially contribute to the etiology of tendon adhesion by affecting several signaling pathways relevant to tendon adhesion. |
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