颏部透明质酸注射填充术

目的介绍一种应用透明质酸产品进行颏部注射填充的方法。方法本组共30例颏部短小的患者,在表面麻醉下选用30G细针头进行颏部透明质酸注射填充治疗。透明质酸用量为2．0～3．0m1,平均2．4ml。其中1例患者因颏肌紧张,曾预先行颏肌肉毒毒素注射治疗。治疗后评价颏部填充效果及面部轮廓的改善程度。随访至治疗后6个月。结果本组30例患者,颏部填充后的隆起效果明显,面部轮廓改善,符合审美要求,患者对外观满意。注射治疗后颏部肿胀程度较轻,一般在治疗后第3天达到高峰,在4～7d逐渐消退。未发现外形不对称、局部感染、血肿、皮肤坏死及填充剂过敏情况。填充效果可维持6个月以上。结论应用透明质酸产品注射填充矫正颏部短小,是一种安全、有效的治疗方法,易被医师及患者接受,操作简单,便于推广。     

多平面注射透明质酸鼻整形的临床研究

目的 通过在鼻梁不同部位不同层次注射透明质酸,以改善鼻部外观形态,达到满意的鼻整形效果.方法 在鼻骨部于骨膜下或骨膜上,软骨部于软骨膜上,鼻尖部于大翼软骨间注射透明质酸,以垫高鼻背和鼻尖.根据鼻部形态及求美者的审美要求确定注射剂量,遵循宁少勿多的原则,若不足可于首次注射后1周内补充注射,本组病例注射总量为1 ～1.5 ml.结果 2010年1月至2012年1月,共进行透明质酸注射鼻整形60例,未发现患者有特别的不良反应,未出现肿胀外观,术后随访10 ～ 13个月,效果均较满意,42例能维持9个月左右,最长12个月,1例在6个月消失.结论 透明质酸多层次注射隆鼻效果确实,可以达到更真实的鼻整形效果.     

Eosinophiluria from intra-articular hyaluronic acid injection

A 68-year-old male with ischemic heart disease, mild renal impairment, and heart failure was subjected to intra-articular hyaluronic acid treatment by injection for his osteoarthritis. This was followed by worsening renal function associated with eosinophiluria but without any other systemic features of allergy. These urinary abnormalities resolved and the renal functions improved to almost baseline levels after further injections were stopped. Received: October 11, 2001 / Accepted: August 9, 2002 Correspondence to:M. Banerjee     

Soft tissue filling with hyaluronic acid

PHYSIOLOGY AND PHARMACOLOGY: Hyaluronan was discovered by Karl Meyer in 1934 in the vitreous humor of cattle eye. Hyaluronic acid, (AH), is a natural polysaccharide and a ubiquitous component of the extra cellular matrix. It is largely biocompatible and has a short half life. In the early 1990's, preceded by the use of bovine collagen, AH started to be employed in the fields of Dermatology and Plastic Surgery; currently it is a major intervention product in both soft tissue augmentation and facial volume loss treatments. Often well tolerated, AH, has high water retention properties and is an effective tissue volumizer. Industry first attempted to extract AH from rooster comb, then through bacterial fermentation and succeeded in increasing its lifespan by cross linking. However, industrially produced AH can contain residues from the manufacturing process. It thus appears critical to us to be informed of the process used in manufacturing AH including the reticulant utilized. Manufacturers should be legally required to publish this data as well as to conduct physiochemical follow-up studies over the short, mid and long terms. LEGAL CONSIDERATIONS: In Europe, CE marking is a prerequisite to market injectable products. However, a CE marking does not necessarily imply that the product's efficacy and side effects have been assessed objectively in clinical studies. However, this marking is expected to fall into line with the US legislation, where the marketing of any medicinal product is subject to FDA approval, based on comprehensive animal and clinical studies and on more systematic and better centralised side effect reporting. We have examined most of the products used in Europe and internationally in 2004, whether of animal or bacterial origin, reticulated or non-reticulated, and used to restore, increase volume or as a product vector. Before injecting these products, it is essential to have a thorough understanding of their absolute and relative contraindications and anaesthetic requirements, differences between types of wrinkles to fill in and indicated techniques, differences between concerned regions or tissues, and the impact of associated cosmetic treatments. These resorbable injectable products have mild and, more importantly, short-lived side effects. However, in patients with a relative contraindication, a double test is justified, as allergic reactions are known to occur in 1 to 3% of patients. It is also advisable not to inject HA in a site previously injected with a non-resorbable product. More precise statistics on results and side effects based on double-blind randomised studies are still wanting, due to the lack of legal requirement and effective centralisation of data. Therefore, all side effects must be reported to improve our knowledge as well as the safety of injections. CONCLUSION: Although their duration of effect is limited, HA products are the most commonly used fillers, before collagens. Many questions have yet to be answered, but they produce very significant results in filling procedures. Both clinicians and patients praise these products for their tolerance, resorbable nature, and limited side effects.     

Modulation of MHC class I antigen decreases pancreatic islet immunogenicity

Pretreatment regimens directed at reducing the immunogenicity of pancreatic islets have emphasized the elimination or alteration of the major histocompatibility complex (MHC) class II-positive dendritic cells within the islet. Unfortunately, the efficacy of such pretreatment regimens has been extremely variable and the relative contribution of the dendritic cells to the overall immunogenicity of pancreatic islets has remained ambiguous. Recent evidence has suggested that the MHC class I antigen present on the endocrine cells within the islets may play an important role in the alloimmune response. This study utilized the in vitro mixed lymphocyte-islet co-culture system to determine if pretreatment of whole islets with an anti-MHC class I monoclonal antibody specific to the donor strain would block the generation of cytotoxic T lymphocytes (CTL) in the in vitro mixed lymphocyte-islet coculture. Pretreatment of B10.BR (H-2k) and DBA/2J (H-2d) islets with an allospecific anti-MHC class I monoclonal antibody blocked the generation of allospecific CTL when the pretreated islets were placed into coculture with C57Bl/6 (H-2b) splenocytes. If such a pretreatment regimen is similarly effective in vivo, it could potentially be used as an antirejection strategy in pancreatic islet allotransplantation.     

Modulation of tissue immunogenicity by organ culture. Comparison of adult islets and fetal pancreas

Uncultured mouse islet allografts (BALB/c to CBA) are rejected 2 to 4 weeks after transplantation. Allografts, cultured in 95% O2 and 5% CO2 for 7 days before transplantation, show no sign of rejection up to 3 months post-transplantation. However, the cultured allografts are rejected if the CBA recipient is given an i.v. injection of 10(5) peritoneal cells at the time of transplantation. Organ culture of BALB/c fetal pancreas (16 to 17 days gestation) under the same conditions failed to prevent allograft rejection. The immunogenicity of fetal pancreas is reduced if this tissue is cultured in 95% O2 and 5% CO2 for 17 days before transplantation.     

Management of detachment of Descemet's membrane caused by injection of hyaluronic acid

We report a case in which, in an attempt to reform a flat anterior chamber, hyaluronic acid inadvertently was injected between Descemet's membrane and the corneal stroma. The surgical repair is described and a way to prevent this complication is recommended.     

透明质酸钠凝胶注射隆鼻的临床应用

目的 评价应用透明质酸(HA)注射隆鼻的临床效果.方法 自2009年6月至2012年6月,对35例求美者行HA注射隆鼻术,并观察注射后的临床效果、疗效保持时间、不良反应等.结果 所有求美者注射后即刻均得到改善.注射后3、6、12个月随访,分别有100%、91.43%、65.65%的注射部位维持了改善的效果,求美者对鼻外形及填充高度满意.注射治疗中未出现急慢性过敏反应及感染、肉芽肿、血管栓塞、皮肤坏死等并发症.结论 HA注射隆鼻术安全,方便,有效,维持时间约6～12个月.     

透明质酸在皮肤科的应用进展

透明质酸是一种由D-葡萄糖醛酸和N-乙酰氨基葡萄糖双糖重复构成的氨基葡聚糖,存在于细胞外基质中,具有保湿、维持细胞外间隙,并促进离子溶质和营养物质运输的功能,在血管发生、炎症、细胞迁移、创伤愈合、免疫反应及肿瘤生物学等方面发挥重要作用。保水作用是透明质酸最重要的生理功能之一,并通过和其他基质分子相互作用,保持细胞外基质的稳定性和弹性。透明质酸在皮肤病发生发展中发挥重要的作用,其在美容及化妆品中的应用亦备受关注。     

医用透明质酸钠在临床中的应用综述

医用透明质酸钠在临床中的应用综述顾其胜王文斌吴萍透明质酸（ｈｙａｌｕｒｏｎｉｃａｃｉｄ，ＨＡ）是一种高分子直链聚糖，由Ｎ乙酰Ｄ葡萄糖胺和Ｄ葡萄糖醛酸构成。ＨＡ属于一种天然降解且具吸收性的生物医学材料［１］。它广泛分布在动物和人体组织和细胞...     

胎儿皮肤中透明质酸的分布

目的通过研究不同胎龄胎儿皮肤中透明质酸的分布,观察其变化规律,从而探讨其分布与无瘢痕愈合之间的关系,为临床上瘢痕的预防及治疗提供理论依据。方法自4所医院妇产科取3~8个月龄的引产胎儿32例,取颌面部、背部、腹部及大腿内侧4处皮肤,进行免疫组织化学染色,观察透明质酸在皮肤中的分布。结果3个月龄胎儿皮肤中表皮层透明质酸染色阳性,4、5个月龄胎儿皮肤表皮上层染色阳性,真皮染色弱阳性,6~8个月龄胎儿皮肤中透明质酸染色表皮为阴性,真皮层阳性,随胎儿成熟度的提高透明质酸分布发生了明显的变化。不同部位皮肤之间透明质酸分布无明显差别。结论透明质酸分布随胎龄增长由表皮层向真皮层转移,透明质酸分布与无瘢痕愈合之间可能存在一定联系。     

肢体淋巴水肿和透明质酸代谢

目的　探讨淋巴水肿组织中透明质酸的代谢。方法　用埋线法和针刺法收集 39例肢体淋巴水肿皮肤组织液 ,采用放免法检测肢体淋巴水肿透明质酸的含量以及蛋白质的含量。结果　淋巴水肿组织液中透明质酸的含量显著增高 [(2 1× 10 3± 10× 10 3)ng ml直接吸取法 ,(30× 10 3± 4× 10 3)ng ml埋线法 ],是未患病肢体的近 4倍。两组间蛋白质的含量没有明显差异。结论　淋巴循环障碍影响透明质酸的分解代谢 ,使其在皮肤组织中滞留。     

Hylaform: a new hyaluronic acid filler

Hylaform is a new facial filler composed of hyaluronic acid. Hylaform is derived from an avian source, and is a clear gel substance. Skin testing is not necessary, although rare allergic reactions can occur form the avian protein content. Hylaform is injected into the dermis to add volume and provide a rapid correction of facial contour defects. It works particularly well in wrinkles, grooves, and thin lips deflated from aging changes.     

Tetrodotoxin-induced conduction blockade is prolonged by hyaluronic acid with and without bupivacaine

BACKGROUND: In isolated nerves, tetrodotoxin (TTX) blocks nerve conduction longer than bupivacaine. In vivo, however, both substances block nerve conduction to an equal duration, presumably because the hydrophilic TTX binds only weakly to the perineural tissue. High molecular weight hyaluronic acid (HA) prolongs the action of local anaesthetics several-fold. We tested whether admixture of HA enhances the binding of TTX to the perineural tissue and thus induces an ultra-long conduction block after a single application. METHODS: In 12 anaesthetized rabbits, the minimal blocking concentrations of TTX, TTX and HA (TTX/HA) and bupivacaine with HA (bupivacaine/HA) were determined by blocking the natural spike activity of the aortic nerve. In 18 other animals, equipotent concentrations of either TTX, TTX/HA or TTX/bupivacaine/HA were applied topically to the aortic nerve. After disappearance of the spike activity, the wound was closed to simulate the clinical situation of a single shot nerve block. The time until recovery of spike activity was determined. The nerves were examined for signs of neurotoxicity 24 h after the application of the drugs. Data are presented as means +/- SD and compared by ANOVA and Student's t-test for unpaired data. RESULTS: The conduction block by TTX/bupivacaine/HA (10.1 +/- 1.9 h) or TTX/HA (9.3 +/- 1.0 h) was significantly longer than that of plain TTX (7.9 +/- 1.0 h). Neurotoxicity was not observed. CONCLUSIONS: Both HA and HA/bupivacaine prolong the TTX-induced conduction blockade of the aortic nerve of rabbits in vivo. No signs of neurotoxicity were observed.     

Tetrodotoxin-induced conduction blockade is prolonged by hyaluronic acid with and without bupivacaine

BACKGROUND: In isolated nerves, tetrodotoxin (TTX) blocks nerve conduction longer than bupivacaine. In vivo, however, both substances block nerve conduction to an equal duration, presumably because the hydrophilic TTX binds only weakly to the perineural tissue. High molecular weight hyaluronic acid (HA) prolongs the action of local anaesthetics several-fold. We tested whether admixture of HA enhances the binding of TTX to the perineural tissue and thus induces an ultra-long conduction block after a single application. METHODS: In 12 anaesthetized rabbits, the minimal blocking concentrations of TTX, TTX and HA (TTX/HA) and bupivacaine with HA (bupivacaine/HA) were determined by blocking the natural spike activity of the aortic nerve. In 18 other animals, equipotent concentrations of either TTX, TTX/HA or TTX/bupivacaine/HA were applied topically to the aortic nerve. After disappearance of the spike activity, the wound was closed to simulate the clinical situation of a single shot nerve block. The time until recovery of spike activity was determined. The nerves were examined for signs of neurotoxicity 24 h after the application of the drugs. Data are presented as means +/- SD and compared by ANOVA and Student's t-test for unpaired data. RESULTS: The conduction block by TTX/bupivacaine/HA (10.1 +/- 1.9 h) or TTX/HA (9.3 +/- 1.0 h) was significantly longer than that of plain TTX (7.9 +/- 1.0 h). Neurotoxicity was not observed. CONCLUSIONS: Both HA and HA/bupivacaine prolong the TTX-induced conduction blockade of the aortic nerve of rabbits in vivo. No signs of neurotoxicity were observed.     

Management of injected hyaluronic acid induced Tyndall effects

BACKGROUND AND OBJECTIVES: Soft tissue augmentation represents a cosmetic procedure performed with increasing frequency. STUDY DESIGN/MATERIALS AND METHODS: Correct utilization permits precise correction of facial rhytids and scars. Novice injectors occasionally inject too superficially in tissue with the resultant appearance of discoloration secondary to the Tyndall effect. RESULTS AND CONCLUSION: In this article, we will review the Tyndall effect in the skin and management options for this growing problem in aesthetic dermatology.     

A new antibacterial carrier of hyaluronic acid gel

Background Postoperative infection following total joint arthroplasty is thought to be one of the most serious and devastating complications. To develop an effective treatment for this complication, we tested a bioabsorbable antibacterial carrier that is made from novel cross-linked hyaluronic acid (HA) gel and gentamicin (GM). Methods Antibacterial activity of the carrier was evaluated by the agar diffusion test, direct contact test, in vivo mouse model, and in vivo rabbit osteomyelitis model. Results GM-containing HA gel suppressed bacterial growth both in vitro and in vivo. In the rabbit osteomyelitis model, beads coated with HA gel containing GM did not disturb bone ongrowth in the femoral stem. Conclusions Our bioabsorbable carrier of antibiotic-containing HA gel is effective for prophylactic treatment or treatment of an actual deep infection following total joint arthroplasty.     

The effects of hyaluronic acid on articular chondrocytes

The purpose of this study was to examine the effects of hyaluronic acid supplementation on chondrocyte metabolism in vitro. The clinical benefits of intra-articular hyaluronic acid injections are thought to occur through improved joint lubrication. Recent findings have shown that exogenous hyaluronic acid is incorporated into articular cartilage where it may have a direct biological effect on chondrocytes through CD44 receptors.Bovine articular chondrocytes were isolated and seeded into alginate constructs. These were cultured in medium containing hyaluronic acid at varying concentrations. Samples were assayed for biochemical and histological changes.There was a dose-dependent response to the exposure of hyaluronic acid to bovine articular chondrocytes in vitro. Low concentrations of hyaluronic acid (0.1 mg/mL and 1 mg/mL) significantly increase DNA, sulphated glycosaminoglycan and hydroxyproline synthesis. Immunohistology confirmed the maintenance of cell phenotype with increased matrix deposition of chondroitin-6-sulphate and collagen type II. These findings confirm a stimulatory effect of hyaluronic acid on chondrocyte metabolism.