A comprehensive reconstruction strategy for moderate to severe faciocervical scar contractures

The focus of treatment of faciocervical scar contractures includes cervical reconstruction and elimination of hypertrophic scars. Unfortunately, most previous studies have neglected the esthetic appearance of scars. In this study, we tried to combine surgical therapy and ultrapulse fractional CO₂ laser (UFCL) to eliminate facial scars while restoring neck reconstruction and to establish the optimal conventional management for faciocervical contracture. Thirty-eight individuals were enrolled and divided into two groups. After received cervical release surgeries, comprehensive UFCL therapy group received treatment of UFCL at 3-month intervals, silicone sheets, and pressure garments, while another group only received treatment of silicone sheeting and compression. Twelve months after the termination of therapy, faciocervical scars of both two groups were assessed by two uninvolved physicians according to the Vancouver Scar Scale (VSS), and patients’ satisfaction survey was also recorded by the study participants using a patient four-point satisfaction scale. Thirty-six patients completed the treatment and follow-up. The results show that the VSS scores of both two groups decreased after 12 months, but comprehensive UFCL therapy group dropped more significantly than the conventional treatment group at follow-up session, which was statistically significant (P?<?0.001), and the patient satisfaction was higher than that of the conventional treatment group. This comprehensive treatment combined of surgery, UFCL, silicone sheets, and pressure garments works as an effective and esthetic reconstruction for moderate to severe postburn faciocervical scar contractures.

     

Mechanism of Graft Damage Caused by NTPDase1-activated Macrophages in Acute Antibody-Mediated Rejection

ObjectivesTo investigate the effect and mechanism of macrophage activation and graft damage caused by nucleoside triphosphate diphosphohydrolase 1 (NTPDase1) in acute antibody-mediated rejection (AMR).MethodsAcute AMR was induced in different skin-grafted nude mouse models with wild-type NTPDase1 expression, transgene-enhanced NTPDase1 expression, or NTPDase1 gene knockout. Several methods (eg, real-time fluorescence quantitative polymerase chain reaction, high-performance liquid chromatography [HPLC], immunofluorescence, flow cytometry, and luciferin/luciferase assays) were used to study (at the histologic and molecular levels) the extracellular adenosine diphosphate (ADP) concentration, macrophage proliferation, major histocompatibility complex (MHC) class II antigen expression on the surface of macrophages, B-cell activating factor (BAFF) expression in the peripheral blood serum, and the total number of SmIg-positive B cells during acute AMR. The relative activity of NTPDase1 in B cells and epithelial cells, pathologic changes, and the incidence of positive C4d deposition around the capillaries of skin grafts on the different nude mice were studied.ResultsMacrophages proliferated significantly when acute AMR occurred. The higher the NTPDase1 expression level, the lower the extracellular ADP concentration, the expression of MHC class II antigens on the surface of macrophages, the expression of BAFF in the peripheral blood serum, and the total number of SmIg-positive B cells, indicating negative correlations. The relative activity of NTPDase1 in B cells and epithelial cells of the skin graft was different among the different mice. The higher the NTPDase1 expression level, the lower the degree of pathologic damage to the skin graft.ConclusionsImbalance in extracellular ADP degradation by NTPDase1 may promote macrophage activation, and activated macrophages may be an important cause of graft damage.     

Clinicopathological characteristics,prognosis, and chemosensitivity in patients with metastatic upper tract urothelial carcinoma

PurposeTo investigate the clinical characteristics, chemosensitivity, and outcome of metastatic upper tract urothelial carcinoma (UTUC).Patients and MethodsRecords of patients with metastatic UTUC since January 2005 were retrieved from a database that included clinical and survival data. Statistical analyses including survival and multivariate analyses of factors were respectively performed by the Kaplan-Meier method and Cox proportional hazard model.ResultsA total of 250 consecutive UTUC cases were evaluated. There were 56 patients (22.4%) with initially diagnosed stage IV disease. The most common metastatic sites were lung (39.6%), distant lymph nodes (39.2%), bone (19.6%), liver (18.0%), and adrenal gland (7.2%), respectively, and the local recurrence rate was 10.4%. Two hundred thirteen patients received first-line chemotherapy. The overall response rate was only 28.7% and the median progression-free survival time was only 5.0 months. The overall survival time of the cohort was 18.0 months. Multivariate analyses showed that initially diagnosed stage IV disease, number of metastatic organs ≥3, no response to chemotherapy and cycles of chemotherapy ≤2 were adverse prognosticators for overall survival.ConclusionUTUC presented to be more prone to metastasize than locally recur and thought to have low chemosensitivity. Stage IV disease at initial diagnosis, number of metastatic organs, response and cycles of chemotherapy were independent prognosticators for metastatic UTUC.