子宫动脉栓塞术对剖宫产术后瘢痕部位妊娠的治疗价值

目的：随着剖宫产率的不断攀升,剖宫产术后瘢痕部位妊娠的发生率已日趋增多。本研究将探讨子宫动脉栓塞术对剖宫产术后瘢痕部位妊娠的治疗价值。方法：选择我院2009年03月至2013年03月剖宫产术后瘢痕部位妊娠的患者共28例,均行双侧子宫动脉栓塞治疗,收集其主要临床资料,包括术中出血量、血HCG下降情况、住院时间、住院费用、月经复潮时间及不良反应,并进行回顾性分析。结果：28例患者均治疗有效,24例患者栓塞治疗后行清宫术,术中出血量5-200（平均36．5±4．8）mL,另4例栓塞治疗后未行清宫术。平均住院时间为13．6±4．7天。28例血β-HCG于栓塞后7～38天降为正常,超声检查示子宫复旧的平均时间为20—36天,栓塞后28-44天月经复潮。结论：28例患者采用UAE联合MTX灌注化疗治疗后出血量少,恢复快,疗效显著。子宫动脉栓塞术能有效防止和控制出血,保留妇女生育功能,是一种安全、有效的治疗方法。     

面颈部吸脂结合脂肪移植在瘢痕整形中的临床应用观察

目的:探讨与观察面颈部吸脂结合脂肪移植在瘢痕整形中的临床应用效果。方法:采用回顾性研究方法,选择2017年8月到2020年6月在本院诊治的面颈部瘢痕患者78例作为研究对象,根据随机信封抽签原则把患者分为联合组与对照组各39例。对照组给予面颈部吸脂治疗,联合组给予面颈部吸脂结合脂肪移植治疗,治疗观察3个月。结果:联合组治疗后瘢痕部位的疼痛分级与对照组对比差异无统计学意义(P>0.05)。两组治疗后的美容权重评分与瘢痕基底深度都低于治疗前(P<0.05),联合组低于对照组(P<0.05)。治疗后联合组的总有效率为97.4%,高于对照组的82.1%(P<0.05)。联合组治疗期间的感染、栓塞、出血、神经损害等并发症发生率为5.1%,低于对照组的28.2%(P<0.05)。结论:面颈部吸脂结合脂肪移植在瘢痕整形中的临床应用并不会增加患者的疼痛,还能降低瘢痕基底深度与减少并发症的发生,提高患者的美容度与总体治疗效果。     

鼻唇沟瘢痕皮瓣修复烧伤后鼻翼缺损的临床研究

目的:探讨鼻唇沟扩张瘢痕皮瓣或瘢痕皮瓣修复烧伤后鼻翼缺损的临床疗效。方法:回顾性分析我院于2006年6月至2012年6月收治的烧伤后鼻翼缺损患者18例。男性10例,女性8例,年龄6~64岁,平均35.3岁。其中面部深Ⅱ度烧伤12例,Ⅲ度烧伤6例;病程8个月~7年。应用鼻唇沟扩张瘢痕皮瓣修复11例,鼻唇沟瘢痕皮瓣修复7例。缺损面积最大者为1.8×2.5 cm2,最小者为0.7×1.3 cm2。结果:术后皮瓣全部成活,无并发症发生。18例鼻翼缺损患者外观均明显改善,皮瓣外形不臃肿,颜色、质地与周围皮肤相近。术后鼻部瘢痕不明显,供区鼻唇沟无明显瘢痕增生。结论:保留残存鼻翼的解剖结构,利用鼻唇沟扩张瘢痕皮瓣或瘢痕皮瓣重建鼻侧背部结构,是鼻翼缺损修复的良好方法。     

Modulatory effects of connexin-43 expression on gap junction intercellular communications with mast cells and fibroblasts

The influence of mast cells upon aberrant wound repair and excessive fibrosis has supportive evidence, but the mechanism for these mast cell activities is unclear. It is proposed that heterocellular gap junction intercellular communication (GJIC) between fibroblasts and mast cells directs some fibroblast activities. An in vitro model was used employing a rodent derived peritoneal mast cell line (RMC-1) and human dermal derived fibroblasts. The influence of the expression of the gap junction channel structural protein, connexin 43 (Cx-43) on heterocellular GJIC, the expression of microtubule β-tubulin and microfilament α smooth muscle actin (SMA) were investigated. The knockdown of Cx-43 by siRNA in RMC-1 cells completely blocked GJIC between RMC-1 cells. SiRNA knockdown of Cx-43 within fibroblasts only dampened GJIC between fibroblasts. It appears Cx-43 is the only expressed connexin (Cx) in RMC-1 cells. Fibroblasts express other Cxs that participate in GJIC between fibroblasts in the absence of Cx-43 expression. Heterocellular GJIC between RMC-1 cells and fibroblasts transformed fibroblasts into myofibroblasts, expressing α SMA within cytoplasmic stress fibers. The knockdown of Cx-43 in RMC-1 cells increased β-tubulin expression, but its knockdown in fibroblasts reduced β-tubulin expression. Knocking down the expression of Cx-43 in fibroblasts limited αSMA expression. Cx-43 participation is critical for heterocellular GJIC between mast cells and fibroblasts, which may herald a novel direction for controlling fibrosis.     

Attenuation of AD‐like neuropathology by harnessing peripheral immune cells: local elevation of IL‐10 and MMP‐9

Immunization with an altered myelin‐derived peptide (MOG45D) improves recovery from acute CNS insults, partially via recruitment of monocyte‐derived macrophages that locally display a regulatory activity. Here, we investigated the local alterations in the cellular and molecular immunological milieu associated with attenuation of Alzheimer’s disease‐like pathology following immunotherapy. We found that immunization of amyloid precursor protein/presenilin 1 double‐transgenic mice with MOG45D peptide, loaded on dendritic cells, led to a substantial reduction of parenchymal and perivascular amyloid beta (Aβ)‐plaque burden and soluble Aβ_(1–42) peptide levels as well as reduced astrogliosis and levels of a key glial scar protein (chondroitin sulphate proteoglycan). These changes were associated with a shift in the local innate immune response, manifested by increased Iba1⁺/CD45^high macrophages that engulfed Aβ, reduced pro‐inflammatory (tumor necrosis factor‐α) and increased anti‐inflammatory (interleukin‐10) cytokines, as well as a significant increase in growth factors (IGF‐1 and TGFβ) in the brain. Furthermore, the levels of matrix metalloproteinase‐9, an enzyme shown to degrade Aβ and is associated with glial scar formation, were significantly elevated in the brain following immunization. Altogether, these results indicate that boosting systemic immune cells leads to a local immunomodulation manifested by elevated levels of anti‐inflammatory cytokines and metalloproteinases that contribute to ameliorating Alzheimer’s disease pathology.     

微等离子体射频技术治疗成熟瘢痕50例临床观察

目的:研究新型微等离子体射频技术治疗瘢痕的效果。方法:50例成熟瘢痕患者,包括31例痤疮疤痕,19例外伤或手术疤痕。均采用微等离子体射频技术进行功率为70～90Watt的滑动式或定点式治疗,每4周治疗一次,共治疗2～5次,通过治疗前及治疗后3个月统一衡量标准对比来进行疗效评估。结果:成熟瘢痕表现为身体各部位分布形状不规则形状皮肤组织凹陷或轻度增生。通过临床指标评分,50例患者总有效率为82%。疗效显著18例(36%),有效22例(44%),轻微改善11例(22%),无效9例(18%)。结论:微等离子体射频技术能显著改善成熟瘢痕的色泽、质地和凸凹程度,不良反应少,是治疗成熟瘢痕的有效方法。     

Gene therapy for pathological scar with hepatocyte growth factor mediated by recombinant adenovirus vector

A complementary DNA (cDNA) encoding human hepatocyte growth factor was introduced into a replication-defective type 5 adenovirus (lacking E1, E3 domains) vector by homologous recombination of intracellular plasmid DNA, thus a recombinant vector containing HGF (Ad-HGF) was obtained. Ad-HGF and Ad-GFP (adenovirus vector carrying green fluorescence protein gene) were expanded in 293 cells and purified by cesium chloride gradient centrifugation for large-scale preparation, then were infected to the primarily cultured scar fibroblast of rabbit ear to observe the transfer efficiency and expression level of HGF in vitro. To evaluate the effect of Ad-HGF on established scar Ad-HGF solution was injected into excessively formed scar, which bears some clinical and histologic similarities to human hypertrophic scars. The results showed that: (i) the transfer efficiency was 36.8% ±14.1% on day 3 in primarily cultured scar fibroblasts treated with Ad-GFP and lasted more than 20 d; (ii) high-level expression of HGF protein was detected by means of ELISA in supernatant of scar fibroblasts treated with Ad-HGF, the amount of expression was 76 ng/4.0 x 10⁵ cells on day 3; (iii) on day 32 after a single intradermal injection of Ad-HGF at different doses (8.6 x 10⁹ pfu, 8.6 x 10⁸ pfu, 8.6 x 10⁷ pfu, 8.6 x 10⁶ pfu) per scar, most of the scars in the former two dose groups were dramatically flattened, some were even similar to that of the normal skin. The value of Hl (hypertrophie index) showed that there was a therapeutic effect of Ad-HGF on scars at the dose of 10⁹ pfu and 10⁸ pfu. Whereas no therapeutic effects were seen at lower dose (10⁷ pfu and 10⁶ pfu of Ad-HGF) groups. In addition, clusters of hair were observed to different extent on healed wound treated with Ad-HGF. Histopathologic examination revealed that in most healed wounds of Ad-HGF treated group, the dermal layer was thinner, the amount of fibrous tissue was much fewer, and hair follicles growth and sebaceous glands were observed. In Sirius red-stained sections the amount of type I collagen in the Ad-HGF-treated scars was diminished markedly, compared to that in Ad-GFP group, in which a huge amount of type I collagen was still observed; (iv) immune response against HGF was absent. Antibody against HGF was not detectable by ELISA in serum from rabbit treated with Ad-HGF; (v) no local or systemic side-effects and toxicity associated with the gene transfer were found. These results demonstrated the potential use of treating pathologic scar by Ad-HGF, an alterative strategy of gene therapy for scar in clinical practice.