胶原膜复合碱性成纤维细胞生长因子修复皮肤缺损的实验研究

目的：观察胶原膜复合碱性成纤维细胞生长因子（bFGF-CM）促进兔颅顶部皮肤创面愈合的作用。方法：建立兔颅顶部全层皮肤缺损模型（2cm×2cm）。将54只新西兰兔随机分为3组：胶原复合bFGF组（bFGFCM）、胶原组（CM）和空白对照组（Control）。分别于术后1、2、4周处死实验动物,采用大体观察、石蜡切片HE染色和Masson染色评价创面愈合状况。结果：术后1周,胶原复合bFGF组创面显著缩小（P〈0.05）,肉芽组织增生及胶原合成明显;胶原组次之;空白对照组无明显肉芽增生及胶原合成。术后2周,胶原复合bFGF组创面愈合率仍较另外两组显著（P〈0.05）,肉芽组织成熟程度较高,胶原合成量大;胶原组次之;空白对照组最小。术后4周,各组实验动物创面基本愈合,胶原复合bFGF组瘢痕挛缩较另两组轻。镜下观,胶原复合bFGF组表皮及真皮层发育较另两组成熟,空白对照组胶原纤维的状态和排列似瘢痕组织。结论：胶原复合bFGF膜比单纯胶原膜能更有效的促进兔皮肤缺损后的再生并减少瘢痕形成。     

骨缝牵张成骨的比较组织学研究

目的:比较HE染色和三联染色中不截骨的缝牵张成骨组织学变化情况.方法:不截骨直接三维牵张羊颧骨缝,固定期1、3、5、8周取材,进行三联染色和HE染色,与对侧空白对照标本比较,观察缝区组织变化、新骨质形成情况.结果:骨缝被牵开后1周,成纤维细胞、成骨细胞、毛细血管增生,大量胶原纤维形成、排列有序,3周时以胶原纤维为主,形成较成熟的骨小梁,5周时编织骨形成,8周时未见网状纤维和弹力纤维,结构成熟完整.结论:三联染色显示固定早期大量胶原纤维形成,HE染色显示新骨形成速度快.     

曲古抑菌素抑制增生性瘢痕形成的实验研究

目的探讨曲古抑菌素(Trichostatin A,TSA)对兔耳增生性瘢痕的作用及对成纤维细胞周期和凋亡的影响。方法建立兔耳腹侧面瘢痕增生模型,一侧兔耳注射TSA(1.0μmol/L),另一侧注射生理盐水作为自身对照。观察不同时间瘢痕外形变化,组织学变化,检测bcl-2的含量的变化,分析各时间点瘢痕组织内细胞周期及细胞凋亡率的变化。结果随着药物作用时间延长,TSA组与对照组相比①瘢痕增生块厚度明显减小(P<0.05),质地变软。②镜下观察见成纤维细胞数目减少,bcl-2阳性细胞逐渐增多,30天时两组bcl-2阳性细胞所占比率都超过50%。③处在S期的细胞所占比例逐渐减少,细胞被抑制在G1/G2期,与对照组相比变化显著(P<0.05)。④凋亡细胞百分率则呈下降趋势,早期时明显高于对照组,30天时两组比较无明显差别。结论兔耳早期增生性瘢痕局部注射曲古抑菌素可抑制瘢痕增殖过程,使瘢痕纤维化程度减轻。     

微针注射纳米脂肪治疗兔耳增生性瘢痕的初步探讨

目的:探究纳米脂肪(Nanofat)用微针注射对增生性瘢痕的治疗效果。方法:制备纳米脂肪,将其分别装载于微针仪器E-Zinjector与1 m L注射器中,自动细胞计数仪检测纳米脂肪中脂肪干细胞的细胞活性。选取8只新西兰大白兔,对每只兔耳构建的4个瘢痕区域随机分别采用以下治疗:E-Zinjector注射生理盐水(0.9%NaCl+E-Zinjector)、1 m L注射器注射生理盐水(0.9%NaCl+Injector)、1 m L注射器注射Nanofat(Nanofat+Injector)和E-Zinjector注射Nanofat(Nanofat+E-Zinjector)。治疗2周后取材,行HE、Masson染色,qRT-PCR检测α-SMA和COL-ⅠmRNA表达。结果:E-Zinjector负载的方式对脂肪干细胞活性没有影响。HE、Masson染色示,Nanofat+Injector和Nanofat+E-Zinjector组瘢痕的胶原密度适中、排列整齐,而0.9%NaCl+E-Zinjector组与0.9%NaCl+Injector组可见大量致密、杂乱的胶原组织。qRT-PCR检...     

MMP-3诱导人牙髓成纤维细胞CCN2mRNA的表达及意义

目的：通过观察基质金属蛋白酶-3（MMP-3）对体外培养人牙髓成纤维细胞中结缔组织生长因子（CTGF/CCN2）mRNA的影响,揭示MMP-3促进牙髓损伤愈合的机制。方法：选取年轻患者因正畸或阻生拔除的健康第三磨牙,取出牙髓以常规体外酶消化培养法获得人牙髓成纤维细胞,利用RT-PCR方法检测经MMP-3诱导30min后人牙髓成纤维细胞中CCN2mRNA的表达。结果：正常组和实验组人牙髓成纤维细胞均有CCN2mRNA表达,但是经MMP-3诱导后的人牙髓成纤维细胞CCN2mRNA的表达更强。结论：MMP-3通过诱导CCN2mRNA的合成,从而促进牙髓损伤的愈合。     

乳铁蛋白下调脂多糖激发的人牙周膜细胞Toll样受体4表达的研究

目的 观察乳铁蛋白（LF）对经脂多糖（LPS）刺激的人牙周膜细胞（hPDLCs）表达Toll样受体4（TLR4）的影响。方法 采用组织块酶消化法培养hPDLCs,鉴定后取第4代细胞,分成空白对照组、LPS组、LPS+LF组。空白对照组不加任何刺激,LPS组加入0.1 μg?mL-1 LPS;LPS+LF组在加入0.1 μg?mL-1 LPS 2 h后,加入10 μg?mL-1 LF。以加入LF时开始计算时间,4 h后采用实时定量聚合酶链反应（RT-PCR）法检测hPDLCs中TLR4 mRNA的表达,24 h后采用细胞免疫荧光染色法观察TLR4蛋白的表达。结果 RT-PCR检测显示：LPS+LF组TLR4 mRNA表达较LPS组明显降低（P<0.05）,与空白对照组无明显差异（P>0.05）。细胞免疫荧光染色法显示：LPS+LF组TLR4蛋白的表达强度较LPS组减弱（P<0.05）,与空白对照组无明显差别（P>0.05）。结论 LF可以下调LPS激发的hPDLCs中TLR4的表达,在牙周炎症TLR4信号通路的调控过程中有一定的作用。     

靶向p38丝裂素活化蛋白激酶对兔唇裂术后瘢痕增生的影响

目的研究运用p38丝裂素活化蛋白激酶（p38MAPK）基因重组腺病毒靶向敲低目的基因的表达,通过检测p38MAPK信号通路受到抑制后不同时间段兔上唇瘢痕增生受到的影响,来探讨疗效最佳的基因治疗时间。 方法对90只2.0~2.5 kg的上唇裂新西兰白兔进行唇裂修复术,选取术后第0、1、2周对其瘢痕正中注射重组病毒,将第3周的瘢痕组织制成标本。通过使用蛋白免疫印迹法（Western blot）、实时荧光定量反转录聚合酶链反应（RT-PCR）、免疫组织化学染色等方法分别定性、定量检测p38MAPK及瘢痕形成相关因子与Smad蛋白和mRNA的相对表达水平。使用SPSS 24.0软件对实验结果进行统计学分析。 结果相较于术后第0、2周,术后第1周瘢痕组织中ColⅢ（1.373 ± 0.073,F = 8.027,P = 0.002）、MMP1（1.715 ± 0.028,F = 9.262,P = 0.001）表达明显升高,ColⅠ（0.424 ± 0.015,F = 7.794,P = 0.003）和TIMP1（0.464 ± 0.025,F = 6.196,P = 0.007）表达明显降低,差异均有统计学意义。术后第1周的Smad2蛋白表达水平与mRNA表达水平降低（F = 14.123,P = 0.029）,Smad3蛋白表达水平与mRNA表达水平降低（F = 3.796,P = 0.037）,与其他组相比差异均有统计学意义。 结论抑制p38MAPK表达可能通过Smad依赖型信号通路发挥抑制瘢痕增生的作用,兔上唇唇裂术后第1周瘢痕形成过程中靶向敲低p38MAPK对瘢痕增生影响最大。     

糖基化终产物对人牙龈成纤维细胞2种基质金属蛋白酶表达的影响

目的研究糖基化终产物(advanced glycation end products,AGEs)对人牙龈成纤维细胞(human gingivalfibroblasts,HGF)表达基质金属蛋白酶-1(matrix matelloproteinase-1,MMP-1)和基质金属蛋白酶-8(matrix matallo-proteinase-8,MMP-8)的影响,探讨糖尿病加速牙周炎发展的可能机制。方法将培养的HGF随机分成6组:空白对照组只加入培养液;阴性对照组仅加入含50μg/mL人血清白蛋白(human serum albumin,HSA)的培养液;4个含AGE-HSA的实验组分别加入含0.5、5、50、100μg/mL AGE-HSA的培养液。培养24、48、72 h后,分别应用酶联免疫吸附测定法(enzyme-linked immunosorbent assay,ELISA)和实时定量聚合酶链反应(real-time quantitativepolymerase chain reaction,QPCR)检测细胞MMP-1、MMP-8的蛋白和mRNA表达。结果 100μg/mL AGE-HSA组培养24、48和72 h后,MMP-1水平明显高于阴性对照组、空白对照组及0.5μg/mL AGE-HSA组,差异具有统计学意义(P<0.05)。各浓度AGE-HSA组MMP-1 mRNA水平均显著高于阴性对照组,差异有统计学意义(P<0.05)。各浓度AGE-HSA组MMP-8水平与阴性对照组相比差异均无统计学意义(P>0.05),MMP-8 mRNA表达均为阴性。结论 AGEs可能通过促进HGF合成MMP-1,介导胶原降解,从而加重糖尿病患者的牙周组织破坏,尚不能说AGEs影响MMP-8的表达。     

MMP-8在龋病发展过程中的表达及意义

目的：观察MMP-8在不同程度龋损牙齿中的表达，探讨MMP-8与龋病发展的关系。方法：标本选自因龋未经治疗的第三磨牙，按临床及X线诊断为浅龋、中龋、深龋各10颗，无龋坏第三磨牙10颗为对照组。采用免疫组织化学方法观察MMP-8在不同龋损中表达。结果：正常组MMP-8在成牙本质细胞、前期牙本质、成纤维细胞略有着色；浅龋组成牙本质细胞和前期牙本质、成纤维细胞中有比较浅的阳性表达；中龋组成牙本质细胞增生活跃，前期牙本质增厚，染色阳性，牙髓细胞染色加深；深龋组成牙本质细胞呈阳性表达，牙本质基质中呈散在条索性表达。牙髓组织中成纤维细胞、血管内皮细胞强阳性表达，在修复性牙本质中MMP-8表达强阳性。结论：MMP-8参与龋病的进展过程。     

基质金属蛋白酶-9在兔正畸牙周组织中的表达

目的：观察兔实验性正畸牙齿移动过程中基质金属蛋白酶-9(MMP-9)在牙周组织中的表达。方法：选用体重在2．0kg左右的日本大耳白兔35只，分为正常组与实验1、3、5、7、14、21天组。建立兔正畸牙齿移动模型，对实验标本进行MMP-9免疫组化染色。通过组织学观察，计算机图像分析系统对兔牙周组织中MMP-9的表达变化进行平均灰度分析，比较压力区与张力区的表达变化。结果：在施力1d后牙周组织压力区的MMP-9表达增强，5d后表达达高峰，此时破骨细胞、血管内皮细胞胞浆中MMP-9表达呈强阳性；牙周组织的张力区在施力第3天MMP-9表达略增强，第14天表达达高峰，成骨细胞胞浆中MMP-9的表达此时呈强阳性。结论：正常免牙周组织中存在MMP-9；MMP-9参与了兔实验性正畸牙齿移动牙周组织的改建过程。     

Multicenter study of wound healing in neurofibromatosis and neurofibroma

Based on clinical experience, the senior author has become convinced that wounds produced to correct the deformities of patients with neurofibromatosis (NF-1) have produced remarkably good scars, the interesting feature being that progression to keloid or hypertrophic scar is rare. The other point noted was that this situation did not change, no matter the patient's race or skin color. There have been few reports describing or discussing this hypothesis. The purpose of this study was to investigate whether wounds produced in the patients with NF-1 produce keloid or hypertrophic scars. The patients with solitary neurofibroma were also included in this study; these were compared with the NF-1 group. This was conducted as a multicenter study. Patients with neurofibromatosis/solitary neurofibroma, who were operated on from 1990 to 2000, were evaluated by reviewing their medical charts and photographs retrospectively. The patients were treated in centers from five different countries. The analysis was undertaken based on the following points: 1) age and sex at surgery; 2) race of the patients; 3) past and family histories of hypertrophic scar and keloid; 4) surgical site(s); 5) diagnosis, NF1 or solitary neurofibroma; 6) surgical complications; 7) number of reoperations to manage the complications; 8) adjuvant therapy for the tumor; 9) depth of the tumors; and 10) incidence of malignant degeneration. A total of 101 cases with neurofibromatosis or solitary neurofibroma was analyzed. The age at surgery ranged from 1 year 6 months to 74 years; sex ratio was 47 males and 54 females. The racial distribution of the patients was 13 white, 13 black, 3 Hispanic, and 58 Asian. There was no past or family history of hypertrophic scar or keloid. The surgical sites were head and neck in 70 cases, trunk in 20 cases, upper extremities in 22 cases, and lower extremities in 20 cases. The clinical diagnosis was NF-1 in 57 cases, solitary neurofibroma in 35 cases, plexiform neurofibroma in four cases, and no distinct clinical diagnosis in five cases. There were no other types of neurofibromatosis. Hematoma and white wide scar were the main postoperative complications found in six cases of NF-1. Infection was also noted in four cases. However, no patient developed hypertrophic scar or keloid in the neurofibromatosis group, whereas two cases showed hypertrophic scar in the solitary neurofibroma group. The outcome showed that the patients with NF-1 and plexiform neurofibroma, no matter the racial group, produce good scars without keloid or hypertrophic changes, whereas solitary neurofibroma has a potential to cause hypertrophic scar.     

Dermatography as an adjunctive treatment of uni- and bilateral scars in combination with pseudo-hair formation after craniosurgery

This article describes the use of dermatography as a method to reduce large cosmetically unacceptable scars in the temporo-occipital region after craniosurgery. Over a period of 15 years, 17 patients were treated in two to five 1-hour sessions without local anesthesia. The results show that dermatography is effective in providing a lasting cosmetically satisfactory effect, with subtle pseudo-hair formation and color pigments stably deposited. At the same time, the hypertrophic scars themselves are reduced and flattened, with their tissue made supple.     

Incidence of hypertrophic and keloid scars after N-butyl 2-cyanoacrylate tissue adhesive had been used to close parotidectomy wounds: A prospective study of 100 consecutive patients

Suturing is the usual technique for cutaneous wound closure after parotidectomy and gives a satisfactory aesthetic appearance for most patients. Late complications include the development of hypertrophic and keloid scars, the incidence of which ranges from 5% to16% in elective cases.     

改良头皮冠状切口在颅颌面骨折手术中的应用

目的 探讨一种新的改良头皮冠状切口在颅颌面骨折手术中的应用价值。方法 对37例颅颌面骨折患者采用改良头皮冠状切口进行颅颌面骨折的修复重建。术后对患者面神经功能状况、耳颞区形态、面形恢复、骨折复位、术区瘢痕等方面进行评价。结果 术后随访6~36个月,37例患者均未出现面神经功能损伤和耳颞区凹陷,面形恢复良好,骨折端均实现解剖复位。切口瘢痕隐蔽,1例出现增生性瘢痕。结论 改良头皮冠状切口可有效降低传统冠状切口所导致的颞区凹陷及面神经颞支损伤的发生,切口更隐蔽,未增加其他并发症的发生,值得临床推广。     

Prevention and management of hypertrophic scars and keloids after burns in children

Hypertrophic scars and keloids are challenging to manage, particularly as sequelae of burns in children in whom the psychologic burden and skin characteristics differ substantially from adults. Prevention of hypertrophic scars and keloids after burns is currently the best strategy in their management to avoid permanent functional and aesthetical alterations. Several actions can be taken to prevent their occurrence, including parental and children education regarding handling sources of fire and flammable materials, among others. Combination of therapies is the mainstay of current burn scar management, including surgical reconstruction, pressure therapy, silicon gels and sheets, and temporary garments. Other adjuvant therapies such as topical imiquimod, tacrolimus, and retinoids, as well as intralesional corticosteroids, 5-fluorouracil, interferons, and bleomycin, have been used with relative success. Cryosurgery and lasers have also been reported as alternatives. Newer treatments aimed at molecular targets such as cytokines, growth factors, and gene therapy, currently in developing stages, are considered the future of the treatment of postburn hypertrophic scars and keloids in children.     

不同能量密度激光照射家兔耳静脉后的温度变化

目的：观察不同波长激光和不同激光能量密度照射家兔耳静脉后的温度改变。方法：采用立体数码体视显微镜,定量测量10只家兔（0只耳朵、80个区域）的静脉主干和I级分支的平均管径大小。采用PDL585nm脉冲染料激光和长脉宽1064nm Nd：YAG激光,分别对5只家兔（10只耳朵、40个区域）的静脉进行激光照射。PDL585nm激光能量密度分别为6、7、8、9、10J/cm^2,1064nm Nd：YAG激光能量密度分别为14、160、180、200、220J/cm^2。利用数码热敏温度仪测量激光照射后的兔耳皮肤温度改变。结果：家兔耳静脉的主干静脉管径为（1.0120±0.1900）mm,I级分支静脉管径为（0.4523±0.1074）mm。PDL585nm激光照射后,兔耳皮肤温度即刻升高至39.9℃～46.0℃;1064nm Nd：YAG激光照射后,兔耳皮肤温度即刻升高至38.6℃～45.4℃。结论：脉冲染料激光PDL585nm、1064nmNd：YAG激光照射均致兔耳皮肤温度升高,并与能量密度呈正比。     

Nd：YAG激光联合平阳霉素对兔耳静脉作用效应的研究

目的：探讨Nd：YAG激光联合平阳霉素（PYM）对兔耳静脉血管的作用效应。方法：健康新西兰白兔37只（74侧耳）随机分为A、B、C、D4组,A、B、C每组各12只,其中A组（实验组）每只兔耳注射PYM溶液0．3ml（浓度：4mg／ml）,第7d后于注射段行Nd：YAG激光扫描照射（能量密度为2547．8J／cm^2）;B、C组（对照组）分别给予PYM注射、Nd：YAG激光扫描照射;D组（空白组）1只。A、B、C组于第1d、3d、7d、14d、21d、28d各取4只兔耳静脉组织行光镜观察,取第14d、28d组织行透射电镜观察。结果：①光镜下：A组与B组比较,14d、21d、28d的静脉损伤程度有显著性差异（P〈0．05）：A组与C组比较,7d、14d、21d、28d的静脉损伤程度有显著性差异（p〈0．05）。②电镜下：A组与B、C组比较,28d时仍可见内皮细胞水肿,内膜肿胀及附壁血栓。结论：Nd：YAG激光联合平阳霉素较单一处理对兔耳静脉的损伤程度重、损伤作用时间长。     

Silicone Thermoplastic Sheeting for Treatment of Facial Scars: An Improved Technique

Silicone thermoplastic sheeting has been used successfully in the management of hypertrophic and keloid scars resulting from thermal burn injuries. A technique is described that incorporates silicone thermoplastic sheeting for fabrication of a compression face mask. This technique combines the moldability of thermoplastic splinting materials with the therapeutic surface of silicone, yielding the advantages of both in a one-step process.     

Experimental reimplantation utilizing microvascular anastomosis in animals.

The use of the operating microscope and special microsurgical instruments make it possible to achieve successful anastomosis of blood vessels of less than 1 mm in diameter. Microvascular surgery offers newer possibilities in the transplantation of dermisfat grafts, and has led to an unusually high degree of success in the reimplantation of tissues. This paper describes a technique for microvascular anastomosis in animal experiment, using as a model the reimplantation of a completely amputated rabbit ear. In 10 amputated rabbit ears, the central auricular artery with a diameter of 0.5 mm and the two marginal auricular veins with diameter of 0.5-1.0 mm were microsurgically anastomosed. Of the 10 reimplanted ears, 8 survived. The postoperative angiogram showed an unrestricted patency of all the vessels.     

Scar modification. Techniques for revision and camouflage

The surgery and management of scars is a protracted and staged process that includes preparation of the skin through hygienic measures, scar softening (if indicated) with steroids, massage and pressure dressings, skilled execution of the surgical plan, and thorough postoperative wound care. This process generally covers a 1-year period for the various stages mentioned. Many general host and local skin factors will directly affect the final revision result. The two most important indirect factors that the surgeon must endeavor to control are optimal patient preparation and cutaneous health, and patient compliance with, and an ability to carry out, those wound care measures that the surgeon prescribes. Keloid and burn contracture scars represent two entities that are complicated and challenging to treat owing to their abnormal morphophysiologic features. Management of these scars is prolonged, and the patient must understand that the ultimate result will usually be a compromise. New grafting techniques, such as cultured autodermal grafts, offer improved initial management of burn wounds that may subsequently optimize scar revision in these patients. Keloids, and to a lesser extent hypertrophic scars, require steroid injections, pressure treatment, careful surgery, and protracted wound support and pressure treatment (exceeding 6 months) after surgery.