果酸配合中药治疗痤疮临床观察

目的：观察果酸配合中药治疗痤疮的疗效及安全性。方法：选取90例痤疮患者,随机分为治疗组（果酸配合中药治疗）和对照组（单纯果酸治疗）,其中以20%浓度的果酸治疗痤疮区域,1次/月,共4次;口服中药每日1剂,随症加减,3个月为1个疗程。结果：治疗组和对照组总有效率分别为84.44%、63.33%,治疗组疗效明显优于对照组。在果酸治疗时或者治疗后可有不同程度的刺痛、红斑、瘙痒、烧灼、紧绷,一般无需处理,1周左右可自行恢复。结论：果酸配合中药治疗痤疮,疗效满意、安全性高,有临床推广价值。     

果酸联合胶原贴敷料治疗寻常性痤疮疗效观察

目的：观察果酸联合胶原贴敷料治疗面部寻常性痤疮的临床疗效。方法：将78例面部寻常性痤疮患者随机分为两组：实验组39例,果酸联合胶原贴敷料治疗;对照组39例,单纯果酸治疗。结果：实验组有效率87．2％、对照组有效率53．8％,实验组有效率明显高于对照组,差异有统计学意义。实验组患者瘢痕及色素沉着的有效率及患者皮肤自我评价的改善情况均高于对照组。结论：果酸联合胶原贴敷料治疗寻常性痤疮,其中胶原贴敷料既可以辅助治疗痤疮皮损,也可以帮助修复皮肤屏障功能,减少不良反应的发生,这种治疗方法行之有效,值得临床推广应用。     

肉毒毒素与透明质酸联合应用对皮肤真皮层成纤维细胞增长和胶原沉积的影响

目的 探讨肉毒毒素与透明质酸联合应用对皮肤真皮层成纤维细胞增长和胶原沉积的影响.方法 实验采用新西兰兔建立动物模型,设立透明质酸(HA实验组)、A型肉毒毒素(BTX-A实验组)及二者联合(联合实验组),注射3个实验组和对照组(生理盐水),于第1、2、4周,通过病理切片HE染色,观察各实验组对真皮层成纤维细胞影响的差异,用Ⅰ、Ⅲ型胶原免疫组织化学染色方法,评估各实验组对真皮层胶原含量影响的差异.结果 联合实验组第2、4周成纤维细胞数目显著高于对照组(P＜0.05),免疫组织化学切片Ⅰ、Ⅲ型胶原平均积分吸光度(A值)与对照组差异无统计学意义(P＞0.05).结论 BTX-A和HA联合局部注射使真皮层成纤维细胞数目增加,且有效缓解BTX-A单独注射引起的对Ⅰ、Ⅲ型胶原沉积的抑制作用,从而提高肉毒毒素和透明质酸单独应用的治疗效果.     

Electron microscopic visualization of proteoglycans and collagen in bovine costal cartilage

Removal of the soluble proteoglycans from slices of bovine costal cartilage by extraction in 4 M guanidinium hydrochloride permitted the visualization of abundant amounts of dispersed and disaggregated collagen in the matrix. Proteoglycans which are resistant to extraction are seen as small granules which are concentrated in the perilacunar regions. Large proteoglycan granules appear to originate in the chondrocyte. As they come to occupy positions in the matrix distant from the chondrocyte, the granules become smaller. A non-granular, amorphous component masks the collagen fibers so that they cannot be readily seen in the intact cartilage.

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Zusammenfassung Die löslichen Proteoglycane wurden mittels Extraktion in 4 M Guanidinhydrochlorid aus Rippenknorpelschnitten des Rindes entfernt. Dies erlaubte die Sichtbarmachung von großen Mengen von verstreuten und auseinandergerissenen Collagen in der Matrix. Die Protoglycane, welche sich nicht extrahieren lassen, erscheinen als kleine, in den perilacunären Regionen konzentrierte Körnchen. Die großen Proteoglycan-Körner scheinen in den Chondrocyten zu entstehen. Sobald sie sich in die Matrix, außerhalb der Chondrocyten, verlagern, werden die Körner kleiner. Ein nicht-granulärer, amorpher Bestandteil verhüllt die Collagenfasern, so daß diese im intakten Knorpel nicht deutlich gesehen werden können.

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Résumé L'élimination de protéoglycans solubles de coupes de cartilage costal de boeuf, par extraction dans une solution de 4M d'hydrochlorure de guanidinium, permet de mettre en évidence des quantités abondantes de collagène dispersé et désagrégé dans la matrice. Les protéoglycanes, résistants à l'extraction, sont visibles sous forme de granules concentrés dans les régions périlacunaires. Les granulations plus importants des protéoglycanes semblent venir du chondrocyte. Dans la matrice, éloignée des chondrocytes, ces granules deviennent plus étroites. Un composant non granulaire amorphe masque les fibres de collagène, de telle sorte qu'elles sont difficilement visibles dans le cartilage intact.

     

果酸产品治疗女性黄褐斑的疗效及安全性

目的:观察果酸产品治疗女性黄褐斑的疗效及安全性。方法:用芯丝翠果酸产品治疗73名女性黄褐斑患者,包括果酸活肤治疗及日常治疗过程。活肤治疗过程每次持续3～5min,每3周1次,浓度从20%递增至35%,共5～10次。治疗前、后应用数码相机摄取面部照片,医生进行MASI评分、患者进行满意度评价。结果:经5次果酸活肤治疗及日常治疗,患者MASI评分从14.97下降至9.11,患者满意率为70%;经6～10次治疗后下降至8.77,患者满意率达到83%。果酸活肤治疗过程仅出现轻度刺痛、瘙痒、皮肤潮红等轻微不良反应,日常治疗过程未出现不良反应。结论:芯丝翠果酸产品能有效治疗女性面部黄褐斑,副作用轻微。     

Currarino syndrome: proposal of a diagnostic and therapeutic protocol

Background/purpose

The Currarino syndrome (CS) is a peculiar form of caudal regression syndrome (CRS) characterized by the association of hemisacrum, anorectal malformation (ARM), and presacral mass. The authors analyzed retrospectively their series, and they propose a multidisciplinary diagnostic and therapuetic protocol that until now has not been introduced.

Methods

A series of 6 patients with CS is presented. Five of them were treated initially in other centers. None of them had an early diagnosis. All presented associated anomalies; in 50%, Hirschsprung’s disease (HD) and other dysganglionoses were present. One patient died of a presacral ectopic nephroblastoma.

Results

Depending on the expressivity, 3 types of CS can be identified, complete, mild, and minimal. Dysganglionoses and HD can be considered part of CS. A multidisciplinary diagnostic and therapeutic protocol is presented. Main points are sacrum x-Ray, molecular genetic diagnosis, radiologic evaluation of every member of CS families, magnetic resonance (MR) evaluation of patient spine and pelvis, suction rectal biopsies, and search for associated anomalies.

Conclusions

This protocol could give a valid contribution to the treatment of CS, allowing an early diagnosis and proposing a rational timing of multidisciplinary surgical procedures. Early diagnosis and treatment are essential to avoid morbidity and mortality from an undiagnosed presacral mass.     

Effects of lactic acid and glycolic acid on human osteoblasts: a way to understand PLGA involvement in PLGA/calcium phosphate composite failure

The use of degradable composite materials in orthopedics remains a field of intense research due to their ability to support new bone formation and degrade in a controlled manner, broadening their use for orthopedic applications. Poly (lactide-co-glycolide) acid (PLGA), a degradable biopolymer, is now a popular material for different orthopedic applications and is proposed for use in tissue engineering scaffolds either alone or combined with bioactive ceramics. Interference screws composed of calcium phosphates and PLGA are readily available in the market. However, some reports highlight problems of screw migration or aseptic cyst formation following screw degradation. In order to understand these phenomena and to help to improve implant formulation, we have evaluated the effects of PLGA degradation products: lactic acid and glycolic acid on human osteoblasts in vitro. Cell proliferation, differentiation, and matrix mineralization, important for bone healing were studied. It was found that the toxicity of polymer degradation products under buffering conditions was limited to high concentrations. However, non-toxic concentrations led to a decrease in cell proliferation, rapid cell differentiation, and mineralization failure. Calcium, whilst stimulating cell proliferation was not able to overcome the negative effects of high concentrations of lactic and glycolic acids on osteoblasts. These effects help to explain recently reported clinical failures of calcium phosphate/PLGA composites, but further in vitro analyses are needed to mimic the dynamic situation which occurs in the body by, for example, culture of osteoblasts with materials that have been pre-degraded to different extents and thus be able to relate these findings to the degradation studies that have been performed previously.     

A case of bilateral inguinal hernia recurrence in infancy: Investigations on collagen metabolism

Background. Recurrent inguinal hernias in early infancy are rare. We report on a case of a 3-month-old male infant suffering bilateral inguinal hernia recurrence (RINGH). Due to previous observations of an altered collagen metabolism in hernia patients, a severe connective-tissue pathology in the infant was hypothesised. Methods. Hernial sac tissue of the infant was analysed and compared to specimens from five children operated upon one-sided primary inguinal hernias (controls). In paraffin-embedded sections, we determined the distribution of collagen types I and III by crosspolarisation microscopy and the expression of matrix metalloproteinase 2 (MMP-2) by immunohistochemistry. In fibroblast cultures, expression of collagen types I and III and of MMP-2 was investigated by RT-PCR (real-time polymerase chain reaction) and zymography. Electron microscopical investigations were performed exemplarily in two fibroblast cultures to compare cell morphology. Results. No differences in collagen I/III ratios between RINGH and controls were found either on protein or on mRNA level. Immunohistochemical and RT-PCR analysis of MMP-2 showed a lowered expression in the RINGH patient, as compared to controls, whereas the gelatinolytic activity of MMP-2 did not differ between the groups. Electron microscopical investigations showed similar cell arrangement and morphology. Conclusions. To conclude, a marked biochemical correlate to a severe connective-tissue pathology in the infant suffering inguinal hernia recurrence could not be found. With regard to the slight differences in the expression of MMP-2, a possible role in the genesis of inguinal hernia recurrence cannot be ruled out.     

透明质酸、层粘连蛋白及Ⅳ型胶原水平与肾移植急性排斥反应的关系

目的探讨移植肾组织及血清中透明质酸(HA)、层粘连蛋白(LN)及Ⅳ型胶原(C_(-Ⅳ))含量与急性排斥反应的关系。方法以雄性SD大鼠为供者,Wistar大鼠为受者,采用改进的Blom法制作大鼠原位左肾移植模型,设同种移植对照组、同种移植用药组(术后腹腔注射环孢素A 10 mg·kg~(-1)·d~(-1)),另设同系移植组(供、受者均为Wistar大鼠)和假手术组(Wistar大鼠仅切除右肾,不行移植),每组20只大鼠。每组分别于术后3、5、7及9 d各随机选取5只大鼠,从下腔静脉采血2 ml,随后切取移植肾(假手术组切取左侧肾脏),用放射免疫分析法测定肾组织匀浆及血清中HA、LN及C_(-Ⅳ)的含量,并行肾组织切片,根据“Banff 97”标准进行病理诊断。结果从术后5d开始,同种移植对照组的肾组织匀浆及血清中HA、LN及C_(-Ⅳ)的浓度均显著高于同系移植组、假手术组及同种移植用药组(P＜0．01)；血清中HA、LN及C_(-Ⅳ)的浓度与肾组织匀浆中HA、LN及C_(-Ⅳ)的浓度呈正相关(r分别为0．960、0．934和0．847,P值均为0．000)。病理检查证实,同种移植对照组共有17个肾脏发生急性排斥反应,同种移植用药组共有4个肾脏发生急性排斥反应,它们的Banff急性排斥反应指数与移植肾组织匀浆中及血清中HA、LN及C_(-Ⅳ)的浓度均呈正相关(P＜0．01)。结论HA、LN及C_(-Ⅳ)在肾移植急性排斥反应的发生及发展中起重要作用,肾移植术后监测血清中HA、LN及C_(-Ⅳ)的浓度有助于急性排斥反应的诊断。     

Tensile mechanical properties of bovine articular cartilage: variations with growth and relationships to collagen network components.

One approach to repairing articular defects is to regenerate cartilage by recapitulating the changes that occur during fetal and postnatal growth into adulthood, and to thereby restore functional biomechanical properties, especially those of the normally strong superficial region. The objectives of this study were (1) to characterize and compare tensile biomechanical properties of the superficial region of articular cartilage of the patellofemoral groove (PFG) and femoral condyle (FC) from bovine animals over a range of growth stages (third-trimester fetal, 1-3 week-old calf, and adult), and (2) to determine if these properties were correlated with collagen network components. With growth from the fetus to the adult, the equilibrium and dynamic tensile moduli and strength of cartilage samples increased by an average of 391-1060%, while the strain at the failure decreased by 43%. The collagen concentration (per wet weight) increased by 98%, and the pyridinoline cross-link concentration increased by 730%, while the glycosaminoglycan concentration remained unchanged or decreased slightly. Some growth-associated changes were location-specific, with tensile moduli and strength attaining higher values in the PFG than the FC. The growth-associated variation in tensile moduli and strength were associated strongly with variation in the contents of collagen and pyridinoline cross-link, but not sulfated glycosaminoglycan. The marked changes in the tensile properties and collagen network components of articular cartilage with growth suggest that such parameters may be used to evaluate the degrees to which regenerated cartilage recapitulates normal development and growth.     

骨胶原属性与骨强度关系研究进展

骨组织作为一种复杂的生物复合材料,胶原是其重要的有机组成成分,为骨组织提供韧性以维持骨组织良好的生物力学性能。大量的研究表明,骨质疏松症等能导致骨强度降低的疾病发生时,骨组织胶原属性会发生显著改变。在决定骨强度方面,骨胶原属性已经成为独立于骨密度之外的决定性参数。研究骨组织的胶原属性对骨强度的影响,能更好的理解骨质疏松症等疾病的发病机制,并为评估人体骨强度提供重要参考信息。根据文献回顾,骨胶原分子结构、胶原纤维排布走向、胶原分子间的交联等都会对骨强度产生显著影响,同时笔者重点总结了骨质疏松症和糖尿病两种导致骨强度降低的疾病发生时,骨胶原属性会发生如下改变:胶原排布走向改变、基团修饰改变和糖基化改变增加等。     

果酸联合迪维霜治疗毛周角化病疗效观察

目的:评估果酸联合迪维霜治疗毛周角化病的疗效及其安全性。方法:采用果酸联合迪维霜治疗90例毛周角化病患者,每2周1次果酸治疗,每次果酸治疗3天后外用迪维霜,每晚1次,4次果酸治疗为1个疗程。自身前后为对照。结果:基本痊愈16例(17.78%),显效56例(62.22%),有效12例(13.33%),无效或者无明显变化6例(6.67%),总有效率为80%。结论:果酸联合迪维霜治疗毛周角化病效果好,无明显不良反应,值得临床推广。     

依那普利对肝硬化大鼠肝脏Ⅰ型胶原、Ⅲ型胶原表达的影响及与肝纤维化的关系

目的 探讨血管紧张素转换酶抑制剂（ACEI）依那普利是否对CCl4引起的大鼠肝纤维化有阻滞作用。方法 采用CCl4损伤引起的肝硬化门脉高压大鼠模型，随机分为正常对照组、肝硬化模型组、依那普利治疗组。治疗组在用CCl4造模的同时用依那普利灌胃，1次／d，直到造模结束，取部分肝组织用甲醛固定后行苏木素一伊红（HE）染色和Masson染色并进行肝硬化分级；然后根据染色结果制作组织芯片并行免疫组织化学染色，检测Ⅰ、Ⅲ型胶原的蛋白表达并进行半定量分析。取部分肝组织用逆转录（RT—PCR）法检测Ⅰ、Ⅲ型胶原的mRNA表达并进行半定量分析。结果 肝硬化分级和Masson染色胶原半定量结果证实肝硬化模型组、依那普利治疗组大鼠肝纤维化程度明显加重，与对照组比较差异有统计学意义（P〈0．01）；而依那普利治疗组的肝纤维化程度较模型组明显减轻，差异有统计学意义（P〈0．05）。Ⅰ、Ⅲ型胶原免疫组织化学蛋白表达及mRNA表达结果证实肝硬化模型组与对照组、依那普利治疗组比较明显上调（P〈0．05）。结论 ACEI可以有效地下调CCl4引起的肝纤维化大鼠的Ⅰ、Ⅲ型胶原的蛋白表达和mRNA表达，进而抑制大鼠肝纤维化的发展。     

Volume changes and histological response to injected dextranomer/hyaluronic acid copolymer (Zuidex™) and collagen (Contigen®) in rats

The objective of this study was to investigate the stability in terms of volume changes and local tissue reactions of dextranomer (Dx)/hyaluronic acid (HA) and collagen implants. A total of 57 rats were included in this study: the control group (nine rats), collagen-injected group (24 rats), and Dx/HA copolymer-injected group (24 rats). Under anesthesia, 0.35 ml of bulking agents was injected subcutaneously in the abdominal area. At 1, 6, and12 months, eight animals of the two implant groups and three animals of the control group were killed. The area of the injected material and surrounding tissue were carefully resected for histopathological examination. Mean volume changes in the Dx/HA copolymer group were 0.56 ± 0.12, 0.43 ± 0.08, and 0.28 ± 0.02 ml at 1, 6, and 12 months, respectively. Mean volume changes in the collagen group were 0.25 ± 0.03, 0.21 ± 0.08, and 0.21 ± 0.01 at 1, 6, and 12 months, respectively. The degree of tissue reaction and fibrosis are more pronounced in the Dx/HA copolymer group at each measurement period after injection. Conflict of interest and source of funding: none.     

Further characterization of interaction between bone sialoprotein (BSP) and collagen

Bone sialoprotein (BSP) has an affinity to collagen fibrils [25]. A role of carbohydrate chains in the affinity was examined by removing sialic acids of BSP. Neuraminidase treatment of the BSP increased the binding to collagen. Binding sites of BSP on collagen were examined by biochemical and electron-microscopic methods. Purified bovine BSP was labeled with biotin. Collagen chains or CNBr peptides were separated by electrophoresis and transfered to nitrocellulose membranes. The membranes were incubated with the biotin-labeled BSP, and the bound BSP was visualized with avidin conjugated with alkaline phosphatase. The labeled BSP was preferentially bound to the 2 chain, and peptides derived from 2 chain. In another experiment, the labeled BSP was incubated with reconstituted native collagen fibrils. The mixture was put on a copper grid, reacted with avidin conjugated with gold particles, and observed with an electron microscope. The gold particles were seen mainly within hole zones of the fibrils. BSP bound to the 2 chain within the hole zones may regulate the onset of calcification at hole zones and the cell binding to collagen fibrils.     

The dissolution of bovine and chicken bone collagens in concentrated formic acid

Bovine and chicken bone collagens have been solubilized and presumably denatured (gelatin) by treatment of demineralized, powdered tissue with 70% formic acid. Short periods of extraction such as four hours at 30°, conditions commonly used during cyanogen bromide cleavage of collagen, solubilized 50% and 15% of the chicken and bovine bone collagens respectively. Treatment of the tissues with sodium borohydride partially inhibited the extraction of collagen from chicken bone, but had little effect on the extraction of calf bone collagen. The heterogeneity of the bone gelatin from both species on disc electrophoretic analysis suggested that peptide bonds had been cleaved in some of the collagen chains during exposure to formic acid, thus facilitating the solubilization of the bone collagen as the gelatin. Analysis of the collagen extracted from chicken bone for reducible crosslinks indicated that a large proportion of these bonds had remained intact, in contrast to a previous finding that most of these crosslinks were destroyed in bone gelatin extracted by 4 M CaCl₂, at pH 7.0. The stability of the major reducible crosslinks in bone collagen to severe acid conditions may explain in part some of its unique properties, such as its failure to swell or be solubilized in dilute acid, which distinguish it from soft tissue collagens.     

Dysphagia lusoria: proposal of a new treatment

Summary Recent observation of one patient suffering from dysphagia lusoria has suggested critical review of treatment of the symptomatic aberrant right subclavian artery. Surgical correction of such an anomaly is difficult and may produce serious complications, and is not always successful. Endoscopic dilatation of the oesophageal stricture, even though it might only produce temporary relief of dysphagia, represents a valid therapeutical alternative because of its favourable cost/benefit ratio, low incidence of complications and patient acceptability.     

A “safe and effective” protocol for management of post-thyroidectomy hypocalcemia

Background

This study evaluates the outcomes of a protocol to manage hypocalcemia after thyroidectomy (TTX).

Methods

A review of prospectively collected data was performed in 130 patients who underwent TTX after the introduction of a specific protocol. These patients were compared with a control group of 195 patients who underwent TTX the year prior when routine calcium supplementation was utilized and no specific protocol was used.

Results

Of the 120 patients in whom the protocol was followed, 44 (37%) patients were classified as high risk, 15 (13%) intermediate risk, and 61 (51%) low risk. The protocol had a sensitivity of 85% and a negative predictive value of 92% for predicting subsequent hypocalcemia. With the implementation of the protocol, there was significant reduction in temporary hypocalcemia events (P = .008) and intravenous calcium drip (P = .49). Also, calcium supplementation was significantly lower in the protocol group (P ≤ .001).

Conclusions

This hypocalcemia protocol identifies patients who do not require additional supplementation and additional monitoring. At the same time, it identifies those who will benefit from supplementation after TTX.     

Development of a cultured dermal substitute composed of a spongy matrix of hyaluronic acid and atelo-collagen combined with fibroblasts: cryopreservation

An allogeneic cultured dermal substitute (CDS) was prepared by cultivating fibroblasts on a two-layered spongy matrix of hyaluronic acid (HA) and atelo-collagen (Col). The ability of fibroblasts to secrete cytokines is dependent on the conditions of freezing and thawing. The first experiment was designed to investigate the effects of supplements in a cryoprotective medium, that is, dimethylsulfoxide (DMSO), glycerol, and fetal bovine serum (FBS). In each experiment we measured the cell viability after thawing and the cell growth in CDS recultured after thawing. In addition, the amount of vascular endothelial growth factor (VEGF) released from the CDS recultured for one week after thawing was measured. The highest values of cell viability, cell growth, and the amount of VEGF released were obtained when CDS was frozen in Dulbecco's modified Eagle's medium (DMEM) supplemented with 10% DMSO and 40% FBS, and then thawed quickly in a water bath at 37 degrees C. However, due to the high cost of FBS, in clinical applications CDS is usually frozen in DMEM supplemented with 10% DMSO and 20% FBS. In practice, however, physicians often cannot use CDS immediately after thawing, depending on clinical conditions. Therefore, in the second experiment we investigated cell viability at different time points after thawing. In addition, we investigated cell growth and the amount of VEGF released from fibroblasts in CDS at different time points after thawing under different conditions, and after further reculturing for one week. We recommend that CDS be rinsed with lactated Ringer's solution immediately after thawing, and that it be used within 4 h after thawing.     

The organization of collagen in cryofractured rabbit articular cartilage: a scanning electron microscopic study

Adult rabbit articular cartilage was prepared for scanning electron microscopy using, in order, glutaraldehyde fixation, enzymatic removal of proteoglycan, dehydration in ethanol, cryofracture in liquid nitrogen, and critical-point drying. Enzymes were effective in fixed material. Fixation, cryofracture, alignment of fracture surfaces with "split lines," and retention of subchondral bone were found to be necessary steps for the preservation of collagen detail. The fibrous framework was found to be similar to that proposed by Benninghoff and favored by more recent phase-contrast microscopic studies. Vertical fibers extending from subchondral bone and a network of tangentially oriented superficial fibrils converge in the transitional zone. No random layer is seen. Pericellular capsules interdigitate with the vertical fibers. When cartilage is prepared in a manner that minimizes tissue damage, scanning electron microscopy provides useful, unique information.