ObjectiveTo explore the expressions of prostaglandin F2α receptor (PTGFR) and cyclooxygenase-2 (COX-2) in tissues of benign bile duct scar and their significances, and investigate the regulating effect of transforming growth factor-β1 (TGF-β1) on the expression of PTGFR in human bile duct fibroblasts cultured in vitro. MethodsThe samples of common bile duct (CBD) scars were collected from 18 patients with benign bile duct scar stricture and 6 cases of normal CBD tissues from liver transplantation donor were collected as control. The expressions of PTGFR and COX-2 were detected by immunohistochemical strept-avidin-biotin complex (SABC) method. Semiquantitative RT-PCR and ELISA methods were used to detect the mRNA and protein levels of PTGFR in bile duct fibroblasts which were effected by TGF-β1 with different concentrations (0, 10, 20, and 30 ng/ml) for 24 h. ResultsThe positive rates of PTGFR and COX-2 were 88.9% (16/18) and 83.3% (15/18) in tissues of benigh CBD scar and 33.3% (2/6) and 0 (0/6) in normal CBD tissues (Plt;0.05). The expressions of the PTGFR mRNA and protein levels became upregulated when the concentrations of the TGF-β1 became higher in human bile duct fibroblasts (Plt;0.05). And the effect was concentration dependant to some extent. ConclusionsThe high expressions of PTGFR and COX-2 play important roles in the process of benign bile duct stricture formation. TGF-β1 is able to induce higher expressions of PTGFR mRNA level and the PTGFR protein level in a concentration dependent manner, and regulate the formation of benign bile duct stricture.
Analysis of hospital cases of cholelithiasis in every four years of the recent 3 decades clearly shows the tendency of changes of cholelithiasis in clinical appearance in Chengdu.Constituent ratio of gallbladder stone was 12.56% in 70’s,47.54% in 80’s and 81.38% in 90’s.Bill duct stones including acute obstructive suppurative cholangitis was 71.01%, 46.08%,and 15.82% respectively. Biliary ascariasis was 11.67%, 2.75% and 0.68% respectively. Age incidence shows right moving, i.e. old patients increased. Urban patients increased.The influencing factors listed are: improvement of diagnostic methods; improvement of livelihood and diet; increased life expectancy; more health follow up examinations; technical improvements in rural areas and etc.
Objective To study the method to inhibit perioperative internal mammary artery (IMA) spasm from the perspective of muscarinic receptor, and research the function of muscarinic cholinergic receptor subtypes of IMA. Methods IMA segments in vitro with intact endothelium were obtained from 30 patients who underwent coronary artery bypass grafting (CABG). According to muscarinic receptor antagonists of different concentrations， They were divided into control group (not using receptor antagonist), atropine group (nonselective M receptor antagonist), pirenzepine group (M1 receptor antagonist) and Methoctramine group(M2 receptor antagonist) by random number table. The effects of antagonists on vasodilatation were analyzed, Scott ratio was used to calculate affinity index (pD2) and Schild plot was used to count rivalry index (pA2). Results Acetylcholine (Ach)induced concentrationdependentrelaxation response of IMA segments with intact endothelium precontracted with potassium chloride (KCl). The pD2 was 6.92±0.05. The effects of atropine, pirenzepine and methoctramine on doseresponse curve induced by Ach with intact endothelium were all concentrationdependent. With the increase of the concentration of antagonists, the Achinduced doseresponse curves had a significant shift to right(Plt;0.05). Atropine, pirenzepine and Methoctramine competitively antagonized the reaction of vessel to Ach. The pA2 were 9.62±0.15,7.70±0.08 and 630±0.08, respectively. Conclusion The Achinduced relaxation response of IMA with intact endothelium is concentrationdependent. According to the affinity of different antagonist, IMA in Vitro Achinduced relaxation response is implemented by acting on nonneuronal muscarinic cholinergic M1 receptor subtype.
【Abstract】 Objective To summarize the recent progress in related research on transforming growth factor β1 （TGF-β1）/Smad3 signal transduction pathway and post-traumatic scar formation. Methods Recent related literature at home and abroad on TGF-β1/Smad3 signal transduction pathway and post-traumatic scar formation was reviewed and summarized. Results TGF-β1 is an important influence factor of fibrotic diseases, and it plays biological effects by TGF-β1/Smad3 signal transduction pathway. The pathway is regulated by many factors and has crosstalk with other signal pathways at cellular and molecular levels. The pathway is involved in the early post-traumatic inflammatory response, wound healing, and late pathological scar formation. Intervening the transduction pathway at the molecular level can influence the process of fibrosis and extracellular matrix deposition. Conclusion TGF-β1/Smad3 signal transduction pathway is an important way to affect post-traumatic scar formation and extracellular matrix deposition. The further study on the pathway will provide a theoretical basis for promotion of wound healing, as well as prevention and treatment of pathological scar formation.
Objective To identify the effect of β-endorphin in the development of paresthesia in hypertrophic scar by detecting the expression and content of β-endorphin in human normal skin and hypertrophic scar. Methods Hypertrophic scar samples were collected from 42 patients with hypertrophic scar for 1-20 years (mean, 4.5 years), including 15 males and27 females with an average age of 32.6 years (range, 16-50 years). According to the kind of paresthesia, they were divided into 3 gourps: non-pain-pruritus group (n=20), pruritus group (n=14), and pain-pruritus group (n=8). Normal skin samples (normal skin group) were harvested from 5 patients undergoing skin grafting surgery, including 3 males and 2 females with an average age of 24.6 years (range, 15-37 years). The immunofluorescence method was used to observe the expression of β-endorphin and ELISA method to detect the concentrations of β-endorphin in the tissues. Results The β-endorphin expressed in all samples, and it expressed around peri pheral nerve fibers in the dermis, fibroblasts, and monocytoid cells princi pally; and it expressed significantly ber in pruritus group and pain-pruritus group than in non-pain-pruritus group and normal skin group. The β-endorphin content was (617.401 ± 97.518) pg/mL in non-pain-pruritus group, (739.543 ± 94.149) pg/mL in pruritus group, (623.294 ± 149.613) pg/mL in pain-pruritus group, and (319.734 ± 85.301) pg/mL in normal skin group; it was significantly higher in non-pain-pruritus group, pruritus group, and pain-pruritus group than in normal skin group (P lt; 0.05); it was significantly higher in pruritus group than in non-pain-pruritus group and pain-pruritus group (P lt; 0.05); and there was no significant difference between non-pain-pruritus group and pain-pruritus group (P gt; 0.05). Conclusion The expression of β-endorphin is high in hypertrophic scar, it may paly an important role in process of pruritus in these patients.
Objective To discuss the effectiveness of distal palm perforator mini-flap in the treatment of scar contracture of digital web-spaces. Methods Between August 2008 and March 2010, 6 cases of scar contracture of digital web-spaces were treated, including 4 males and 2 females and aging 16-68 years (mean, 45 years). The causes were burn injury, twisting injury, and crush injury in 2 cases, respectively. The disease duration was from 3 months to 3 years. The affected digital web-spaces were from index finger to middle finger in 2 cases, from middle finger to ring finger in 3 cases, and from ring finger to small finger in 1 case. The maximum abduction degree of digital web-spaces was 5-10°. The sizes and the depths of reshape of digital web-spaces disappeared. The defect size ranged from 20 mm × 8 mm to 30 mm × 13 mm after opening digital web-spaces. The size of the distal palm perforator mini-flap ranged from 25 mm × 10 mm to 35 mm × 15 mm. The donor sites were sutured directly. Results All 6 flaps survived and got primary heal ing. Incisions at donor sites healed by first intention. All patients were followed up 6-12 months. The reconstructed digital web-spaces had good appearance and soft texture. The range of motion of metacarpophalangeal joint was normal. The sizes and the depths of reshape of digital web-spaces were similar to normal ones. The maximum abduction degree of digital web-spaces was 40-60°. There was no scar contracture of incision of palm. The shapeof flaps and function of the fingers were satisfactory after 6-12 months of follow-up. Conclusion It is an ideal method to treat scar contracture of digital web-spaces with distal palm perforator mini-flap.
Objective To investigate the operative method and efficacy of subcutaneous pedicle scar-band rotation flap in the treatment of cervical postburn scar contracture. Methods Between August 2008 and May 2010, 15 patients with cervical postburn scar contracture were treated with subcutaneous pedicle scar-band rotation flaps, including 9 males and 6 females with an average age of 17.3 years (range, 7-35 years). The disease duration was 1-8 years (mean, 3 years). The locations were the left cervical region in 6 cases, the right cervical region in 8 cases, and mental cervical angle region in 1 case. According to LI Ao’s classification standard for cicartrical contracture, there were 12 cases of grade I and 3 cases of grade II. The area of scar ranged from 8 cm × 5 cm to 25 cm × 12 cm. After scar relaxation, wounds were repaired with the subcutaneous pedicle scar-band rotation flaps of 7 cm × 5 cm to 15 cm × 10 cm at size. In 3 cases of grade II, free split thickness skin grafts (7 cm × 4 cm to 12 cm × 7 cm at size) were used simultaneously. Results After 2 weeks of operation, 2 scar-band flaps had distal partial necrosis and healing was achieved after dressing change with formation of hypertrophic scar; the others survived with healing of incisions by first intention. After 6-12 months of follow-up, all patients possessed good cervical contours, sufficient release of scar contractures, and normal cervico-mandicular or mental cervical angles. The skin’s color and texture were satisfactory. There was no recurrence of cervical scar contracture and other complications. All patients acquired normal cervical movement at last follow-up. Conclusion Subcutaneous pedicle scar-band rotation flap is a simple, efficient, and versatile technique in release of cervical postburn scar contracture. It is an effective method to make use of the lateral excess scar flap to resurface defects caused by scar release.
Objective Col I A1 antisense oligodeoxyneucleotide (ASODN) has inhibitory effect on collagen synthesis in cultured human hypertrophic scar fibroblasts. To investigate the effects of intralesional injection of Col I A1 ASODN on collagen synthesis in human hypertrophic scar transplanted nude mouse model. Methods The animal model of humanhypertrophic scar transplantation was established in the 60 BALB/c-nunu nude mice (specific pathogen free grade, weighing about 20 g, and aged 6-8 weeks) by transplanting hypertrophic scar without epidermis donated by the patients into the interscapular subcutaneous region on the back, with 1 piece each mouse. Fifty-eight succeed models mice were randomly divided into 3 groups in accordance with the contents of injection. In group A (n=20): 5 μL Col I A1 ASODN (3 mmol/L), 3 μL l iposome, and 92 μL Opti-MEM I; in group B (n=20): 3 μL l iposome and 97 μL Opti-MEM I; in group C (n=18): only 100 μL Opti-MEM I. The injection was every day in the first 2 weeks and once every other day thereafter. The scar specimens were harvested at 2, 4, and 6 weeks after injection, respectively and the hardness of the scar tissue was measured. The collagens type I and III in the scar were observed under polarized l ight microscope after sirius red staining. The ultrastructures of the scar tissues were also observed under transmission electronic microscope (TEM). Additionally, the Col I A1 mRNAs expression was determined by RT-PCR and the concentrations of Col I A1 protein were measured with ELISA method. Results Seventeen mice died after intralesional injection. Totally 40 specimens out of 41 mice were suitable for nucleic acid and protein study, including 14 in group A, 13 in group B, and 14 in group C. The hardness of scars showed no significant difference (P gt; 0.05) among 3 groups at 2 weeks after injection, whereas the hardness of scars in group A was significantly lower than those in groups B and C at 4 and 6 weeks (P lt; 0.05), and there was no significant difference between groups B and C (P gt; 0.05). The collagen staining showed the increase of collagentype III in all groups, especially in group A with a regular arrangement of collagen type I fibers. TEM observation indicated that there was degeneration of fibroblasts and better organization of collagen fibers in group A, and the structures of collagen fibers in all groups became orderly with time. The relative expressions of Col I A1 mRNA and the concentrations of Col I A1 protein at 2 and 4 weeks after injection were significant difference among 3 groups (P lt; 0.05), and they were significantly lower in group A than in groups B and C (P lt; 0.05) at 6 weeks after injection, but no significant difference was found between groups B and C (P gt; 0.05). Conclusion Intralesional injection of Col I A1 ASODN in the nude mice model with human hypertrophic scars can inhibit the expression of Col I A1 mRNA and collagen type I, which enhances the mature and softening of the scar tissue. In this process, l iposome shows some assistant effect.
Objective To assess the efficacy of the extra long scapular-lateral thoracic-il ioinguinal siamese flap to repair the contracture deformity of perineal scar caused by burn and to discuss its characteristics. Methods From January2008 to August 2009, 9 patients with contracture deformity of perineal scar after deep II degree to III degree burn were treated. There were 7 males and 2 females aged from 22 to 54 years (35.4 years on average). The course of disease ranged from 8 months to 5 years. All cases had central type of perineal scar. Among the cases, 3 cases were compl icated by abdominal scar, 4 cases by legs scar, and 2 cases by abdominal and legs scar. Scar ulcer was observed in 2 cases. The opening-closing angle of bilateral lower extremities was (29.4 ± 8.8)°. And anus could not expose entirely so that squatting and rel ieving the bowels were difficult in 6 cases. Defect areas after scar resection ranged from 20 cm × 6 cm to 28 cm × 8 cm. The size of extra long scapular-lateral thoracic-il ioinguinal siamese flap ranged from 35 cm × 12 cm to 58 cm × 15 cm. The donor sites were sutured directly. Results Bl ister and necrosis occurred in 1 case and was cured after dressing changed, and others flaps survived with wounds primary heal ing. Incision at donor site healed by first intention. All cases were followed up 6-12 months. The perineal function improved and the partial deformities were corrected. The opening-closing angle of bilateral lower extremities increased to (75.6 ± 11.3)°, showing significant difference between pre- and post-operation (P lt; 0.05). The functions of squatting and rel ieving the bowels recovered well. The perineal scar adhesion recurred in 2 cases after 6 months of operation and were cured after scar resectionand expanding flaps transposition. Conclusion In view of large donating region, great facil ity for transposition, stableand sufficient blood supply, reutil ization as expanded flap, it was an effective treatment and a beneficial trial by applying the transposition of the extra long scapular-lateral thoracic-il ioinguinal siamese flap for contracture deformity of perineal scar caused by burn.
Objective To evaluate the cl inical effect and the pathological characteristics of acellular allogeneic dermal matrix in repairing unstable burn scar. Methods From January 2007 to June 2008, 19 cases of unstable burn scars (24 parts) were treated, including 16 males (20 parts) and 3 females (4 parts) with a median age of 27 years (range, 3-58 years). Theinjury was caused by flame (14 cases, 18 parts), electricity (4 cases, 5 parts), and hot water (1 case, 1 part). The unstable burn scars located on hands (8 cases), forearms (2 cases), thighs (3 cases), legs (2 cases), feet (2 cases), chest (1 case), and abdomen (1 case). Scar formed for 3 months to 1 year. The area of defect varied from 7 cm × 5 cm to 22 cm × 15 cm after scar removal. Defects were covered with acellular allogeneic dermal matrix and autogenous spl it-thickness skin graft. At 6-18 months after operation, the pathological observations of the epidermis, the basal membrane, and structural components of the dermis were done. Results All wounds healed by first intention. Scar ulcer disappeared completely in 18 cases and the composite skin grafts all survived. Some bl isters occurred in 1 case and were cured after dressing changing. All patients were followed up 10 months to 2 years (18 months on average). The grafted-skin was excellent in the appearance, texture, and elasticity. The function recovered well. Only superficial scar was observed at skin donor sites. Pathological observation showed that the epidermis and the basal membrane of the skin grafts were similar to that of normal skin, and no significant difference was found in newly capillaries between them. Collagen fibers arranged regularly, and there were few inflammatory cells in the matrix. Conclusion Acellular allogeneic dermal matrix with autogenous spl it-thickness skin graft may effectivly repair the wound after removing the unstable burn scar, and its structure is similar to that of normal skin.