血卟啉单甲醚声动力疗法对兔耳增生性瘢痕的疗效

目的观察血卟啉单甲醚声动力疗法对兔耳增生性瘢痕（hyperplastic scar,HS）的疗效。方法成年大耳白兔60只,随机分成5组。在声动力治疗第2、4、6、8周分别切取两组瘢痕组织,进行指标检测。结果治疗组可降低成纤维细胞密度、瘢痕增生指数,与模型对照组比较差异有统计学意义（P〈O．05）,可降低胶原纤维的面密度,从上皮化后第4周开始与模型组比较差异有统计学意义（P〈O．01）。结论声动力效应能够显著降低兔耳HS,可望为HS治疗提供新的手段。     

兔耳病理性瘢痕皮回植术后组织中基质金属蛋白酶－1及金属蛋白酶组织抑制剂－1表达的变化

目的通过建立兔耳模型观察基质金属蛋白酶－1（matrixmetalloproteinase－1,MMP－1）及金属蛋白酶组织抑制剂－1（tissueinh｜bitorofmetalloproteinase1,TIMP1）在病理性瘢痕皮回植术后组织中表达的变化,探讨瘢痕皮回植治疗病理性瘢痕的机制。方法建立兔耳病理性瘢痕模型。共分为3组：正常皮肤组（对照组,A组）、病理性瘢痕组（B组）及瘢痕皮回植组（c组）。切取标本行HE染色和Masson特殊组织化学染色及免疫组织化学染色,观察各组标本MMP－1、TIMP－1的表达情况。结果病理性瘢痕经瘢痕皮回植术后,MMP－1及TIMP－l均较A组明显升高（P〈O．01）．MMP一1的表达较TIMP一1明显增强（P〈O．01）。结论瘢痕皮回植术治疗瘢痕的机制与瘢痕组织内MMP一1和TIMP一1相互作用的失衡有关。     

An intra‐individual surgical wound comparison shows that octenidine‐based hydrogel wound dressing ameliorates scar appearance following abdominoplasty

Hypertrophic scar formation because of surgical procedures is associated with higher levels of pain, a lower quality of life, and poor cosmetic outcome and requires more resources in follow‐up management. An octenidine‐based hydrogel has been shown to modulate immunological function in an in vitro wound model, suggesting an improved scar formation. In this prospective, randomised, observer‐blinded, and intra‐patient‐controlled study, 45 patients who underwent abdominoplasty or mastectomy with transverse rectus abdominis muscle (TRAM) flap reconstruction were given both a standard postoperative wound dressing on one wound side and an octenidine‐based hydrogel with transparent film dressing, covered with standard postoperative dressing on the other side. Four instances of hypertrophia were reported in the gel side versus 12 in the standard dressing side. Visual Analogue Scale (VAS) pain scores taken during postoperative dressing changes showed reduced scores on the gel side at all time points. Vancouver Scar Scale (VSS) scores showed improvement in the gel side at 3, 6, and 12 months postoperatively. Skin distensibility measured using a cutometer showed significantly improved measures in gel‐treated wounds, similar to measures of healthy skin. Trans‐epidermal water loss (TEWL), measured using a tewameter, showed improved values on the gel side soon after surgery, with both the control and the gel side normalising after approximately 6 months. The octenidine‐based wound dressing demonstrates improved wound healing associated with a lower incidence of hypertrophic scar formation.     

Variability of pressure at the pressure garment-scar interface in children after burn: A pilot longitudinal cohort study

Background

Current consensus for the ideal pressure range at the pressure garment to scar interface is 15–25 mmHg. Interface pressure variability has been reported at new pressure garment fitting in children. Pressure reductions up to 25% have been recorded over one month in adults.

The epiphyseal scar joint line distance and age are important factors in determining the optimal screw length for medial malleoli fractures

AimThe screw length is important to achieve a stable fixation for medial malleoli fractures. We aimed to evaluate the optimal screw length for different age groups in surgically treated medial malleoli fractures. The second aim was to identify the utility of the distance of epiphyseal scar to joint line or joint line to medullary space for assessment of screw length.Material method368 X-rays and computed tomography (CT) images of ankle joints were retrospectively evaluated for optimal screw length, epiphyseal scar to joint line distance, joint to medullary space distance. The mean screw length for each decade was calculated. The correlations of screw length with age, screw length with distance of epiphyseal scar to joint line, and screw length with distance of joint line to medullary space were evaluated.ResultsThe optimal screw length was obviously decreased in patients in 61–70 and >70 years old group (p = 0.002). As the distance of epiphyseal scar from joint line was increased, the optimal length of screw was also increased (p = 0.001). The distance of epiphyseal scar from joint line was decreased by age (p = 0.011).ConclusionThe optimal screw length was decreased by age and the epiphyseal scar to joint line distance could be a clue for optimal screw length in medial malleoli fractures.     

剖宫产术后子宫瘢痕妊娠动脉血管网数字化三维重建及测量

目的:探讨利用数字化三维重建技术及Mimics10.01、UGNX11.0软件建立剖宫产术后子宫瘢痕妊娠(CSP)动脉血管网并测量相关数据的可行性。方法:选取2016年10月至2018年10月就诊于乌鲁木齐市妇幼保健院、新疆维吾尔自治区人民医院、深圳市宝安区沙井人民医院的20例CSP患者,利用CT薄层扫描及CT血管成像技术采集断层图像数据集,借助相关软件重建患者骨盆、盆腔动脉血管网,并测量腹主动脉分叉角度、髂总动脉长度、髂内动脉长度、子宫动脉开口角度,并进行描述性分析。结果:测量的20例CSP患者其腹主动脉分叉角度为45.29°±10.22°,左侧子宫动脉开口角度为64.97°±24.52°,右侧子宫动脉开口角度为58.07°±27.84°;左侧髂总动脉长度为(44.47±15.68)mm,右侧髂总动脉长度为(43.89±15.78)mm,左侧髂内动脉长度为(46.18±13.98)mm,右侧髂内动脉长度为(47.45±13.95)mm。结论:借助数字化三维重建技术结合适当软件可以重建CSP数字化三维模型,并精确测量相关数据,为该疾病的个体化治疗尤其是血管性介入治疗提供了解剖学依据及相关数据支撑。     

三维超声与MRI对剖宫产术后子宫瘢痕妊娠的早期预测价值对比研究

目的：研究三维超声与MRI对剖宫产术后子宫瘢痕妊娠（CSP）的早期预测价值对比。方法：回顾性分析我院2018年2月至2019年2月收治的43例疑似CSP患者临床资料,比较分析三维超声和MRI对剖宫产术后子宫CSP的早期诊断效果。结果：43例术后患者病理证实39例子宫瘢痕患者。采用三维超声正确诊断30例,假阳性4例,诊断敏感度为85.71%,特异度为50.00%,阳性预测值为88.24%,阴性预测值为44.44%,准确率为76.92%;MRI的诊断结果分别为29例、5例、93.54%、58.33%、85.29%、77.79%、74.36%,两者差异均无统计学意义（P＞0.05）。MRI对卵黄囊数量、胚芽数量、原始心管搏动数的检查效果优于三维超声,而三维超声对孕囊内出血情况、局部瘢痕浸润情况、宫腔内积血情况的检查效果则优于MRI（P＜0.05）。结论：三维超声和MRI诊断子宫瘢痕的准确率均较高,MRI显示妊娠囊内出血、宫腔积血、孕囊与切口及周围组织关系优于三维超声,而三维超声在查出卵黄囊、胚芽和原始心管搏动等方面优于MRI,二者联合对诊治子宫瘢痕有重要价值。     

+Gz重复暴露对大鼠脑胶质细胞酸性蛋白表达的影响

目的 探讨＋Gz重复暴露对星形胶质细胞中胶质原纤维酸性蛋白（GFAP）表达的影响。方法 SD大鼠40只，随机分为4组，即对照组（5只）、＋4Gz锻炼组（15只）、＋4Gz锻炼后再暴露于 10Gz组（15只）及单次＋10Gz暴露组（5只）。各组暴露后2d处死取脑，做冰冻切片，免疫组织化学染色观察GFAP的表达情况。结果 4Gz/3min暴露1次、3次和5次后（两次之间间隔24h)，GFAP阳性细胞数由少至多，以细小型为主；单次＋10Gz暴露后，GFAP阳性反应较强，肥大型在梨状皮层和丘脑下部最多，在顶叶皮层和海马较少；＋4Gz分别暴露1次、3次和5次后再暴露于＋10Gz，肥大型在各脑区逐渐减少，在顶叶皮层和海马逐渐消失，代之以细小型。结论 低G值反复暴露后再暴露于高G值对脑的保护作用，与其能减少肥大、肿胀和损伤的GFAP阳性细胞有一定的相关性。     

体外培养人增生性瘢痕成纤维细胞胶原合成及结缔组织生长因子的表达

目的　探讨结缔组织生长因子在人增生性瘢痕发病机制中的作用。方法　体外培养人正常皮肤和增生性瘢痕成纤维细胞 ,通过H3 脯氨酸掺入法检测细胞胶原合成 ,通过免疫细胞化学染色和逆转录聚合酶链反应检测细胞结缔组织生长因子蛋白质和mRNA的表达。结果　和正常皮肤成纤维细胞相比 ,增生性瘢痕成纤维细胞的胶原合成和结缔组织生长因子蛋白质及mRNA的表达均显著增高 (P <0 0 1)。结论　结缔组织生长因子可能在增生性瘢痕纤维化过程中发挥重要促进作用。