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.     

The therapeutic effect of Interleukin-18 on hypertrophic scar through inducing Fas ligand expression

ObjectiveAmong downstream interleukin-18 (IL-18) targets, Fas ligand (FasL) in particular, has been strongly implicated in many conditions. Our study aims to explore the role of IL-18 in hypertrophic scar through enhancing FasL expression.MethodsIL-18 expression in hypertrophic scar tissues and normal tissues were explored by immunohistochemistry, qRT-PCR and Western blotting, and the expression of IL-18 in normal skin fibroblasts and hypertrophic scar fibroblasts by immunofluorescence. Hypertrophic scar fibroblasts treated with recombinant human IL-18 (rhIL-18) were assessed with MTT, Annexin V-FITC/PI, qRT-PCR, ELISA and western blotting. In the hypertrophic scar of rabbit ears, rhIL-18 was injected to determine histological changes with HE and Masson staining. Additionally, the scars were rated based on contour and overall severity using a visual analog scale scores (VAS).ResultsIL-18 was decreased in hypertrophic scar tissues and fibroblasts compared to normal skin tissues and fibroblasts, respectively. Decreased proliferation and increased apoptosis of hypertrophic scar fibroblasts were found after rhIL-18 treatment with enhanced expression of FasL, sFasL FADD, Caspase-8, Caspase-9 and Caspase-3 in a dose-dependent manner. The VAS and thickness of scars in rabbit ears was decreased as time went on after rhIL-18 treatment, with decreases in scar elevation index (SEI) and the increases in FasL expression.ConclusionIL-18 curbs proliferation and promotes apoptosis of hypertrophic scar fibroblasts by enhancing FasL expression. IL-18is a potential target for treatment of hypertrophic scar.     

丹皮酚对增生性瘢痕成纤维细胞的抑制作用

目的探讨丹皮酚对增生性瘢痕成纤维细胞的抑制作用。方法自2018年9月至2020年6月北部战区总医院烧伤整形科提取原代增生性瘢痕成纤维细胞后,将细胞平分为4组,分别采用0μmol/L(对照组)、50μmol/L、100μmol/L的丹皮酚及10μmol/L的5-氟尿嘧啶(5-Fu)处理;CCK-8实验检测细胞处理后第0、3、5、7天的增殖情况。处理3 d后通过ELISA实验检测增生性成纤维细胞中活性氧基团或分子、丙二醛和超氧化物歧化酶的含量;Western blot实验检测丹皮酚对于细胞中TGF-β1、Ⅰ和Ⅲ型胶原的表达情况。结果50、100μmol/L的丹皮酚和10μmol/L的5-FU分别作用于细胞3 d后与对照组相比,对于细胞增殖的抑制率分别为(32.63±3.06)%、(46.41±4.41)%和(45.32±9.26)%,组间比较差异显著,具有统计学意义(P<0.05)。丹皮酚能够显著下调增生性成纤维细胞中ROS和MDA的表达情况,上调SOD的含量,降低TGF-β1、Ⅰ和Ⅲ型胶原的表达。结论丹皮酚能够抑制增生性瘢痕成纤维细胞的生长、减轻氧化应激损伤,下调TGF-β1和胶原的表达。     

The Efficacy of Tc99m Dimercaptosuccinic Acid (Tc-DMSA) Scintigraphy and Ultrasonography in Detecting Renal Scars in Children with Primary Vesicoureteral Reflux (VUR)

Introduction: Pyelonephritis-induced renal scarring in children is a major predisposing factor for proteinuria, hypertension, and ultimate renal failure. The aim of this study was to investigate and compare the efficacy of Tc99m dimercaptosuccinic acid (Tc-DMSA) renal scintigraphy and renal ultrasonography (USG) in detecting renal scars in children with primary vesicoureteral reflux (VUR). Materials and methods: Tc-DMSA scan and USG studies were done in 62 children who were admitted to our clinic between 1997 and 2003 because of documented urinary tract infection (UTI) and diagnosed with primary VUR. Renal scarring detection rates of Tc-DMSA scan and USG were compared according to reflux grades. Results: In the whole group, renal scars were detected by Tc-DMSA scan and USG in 55% and 38% of refluxing units, respectively. Detection rates of Tc-DMSA and USG according to reflux grades were as follows: 47% and 29 % in low-grade VUR (grades 1 and 2), 46 % and 25% in mid-grade VUR (grade 3), 76% and 65% in high-grade VUR (grades 4 and 5), respectively. Conclusion: USG was found to be an inappropriate study in the detection of renal parenchymal scars, irrespective of the reflux grade. In this study, Tc-DMSA scan detected scars in 35% of kidneys reported to be normal on USG.     

Primary vesicoureteral reflux mediated renal scarring after urinary tract infection in Thai children

AIM: To evaluate the association between primary vesicoureteral reflux (VUR) and renal scarring in children using 99 m Technetium-labelled dimercaptosuccinic acid (DMSA). METHODS: Children attending at Songklanagarind Hospital from 1987 to 2002 were evaluated. RESULTS: Ages at diagnosis of VUR in 46 boys and 52 girls were 1.1+/-1.6 and 2.9+/-2.5 years, median 0.6 and 2.3 years, respectively (P<0.001). DMSA scans were performed at 4.1+/-3.6 years. Renal parenchymal damage was detected in 34 kidneys (22%) of 154 demonstrated refluxing ureters, and one kidney (2%) of 42 non-refluxing ureters (P=0.002). Of 79 refluxing ureters in boys and 75 refluxing ureters in girls, there were 25 and nine renal scars, respectively (32% and 12%, P=0.003). Renal scars in VUR grades I-V were 11%, 7%, 12%, 44% and 64%, respectively (P<0.001). Multivariate analysis revealed that high grade VUR (P<0.001), age of diagnosis of VUR greater than 5 years (P=0.001), and male gender (P=0.002) were the most significant risk factors for renal scarring. CONCLUSION: High-grade VUR, age of diagnosis of VUR greater than 5 years and male gender were the most significant risk factors for renal scarring.     

15-脱氧-△12,14-前列腺素J2对兔耳增生性瘢痕Ⅰ型胶原表达的影响

目的 观察过氧化物酶体增殖物激活受体γ(PPARγ)的配体15-脱氧-△12,14-前列腺素J2(15d-PGJ2)对兔耳增生性瘢痕Ⅰ型胶原表达的影响,探讨15d-PGJ2防治增生性瘢痕的可行性.方法 选取新西兰大白兔18只,在兔耳腹侧面制作2 cm×3 cm全层皮肤缺损创面,每耳2个,共计72个,建立兔耳增生性瘢痕动物模型,随机分组,分别用15d-PGJ2及生理盐水行瘢痕内注射,1次/d,共7次.停药后第14、21天两组同时取材;每组每次切取18个组织块.应用免疫组织化学、荧光定量聚合酶链反应(PCR)及Western blot检测Ⅰ型胶原的表达.结果 与对照组比较,15d-PGJ2注射后瘢痕体积缩小,变软变平,色泽轻度变浅.Ⅰ型胶原主要分布于真皮的细胞间质、成纤维细胞胞质中,血管壁上亦见阳性信号,在各个时间点15d-PGJ2组Ⅰ型胶原mRNA和蛋白的表达均较对照组低,且差异有统计学意义(P<0.05).结论 PPAR-γ的配体15d-PGJ2可降低瘢痕内Ⅰ型胶原的含量,引起瘢痕萎缩,从而防治瘢痕.     

肥大细胞类胰蛋白酶在病理性瘢痕中的表达研究

目的 研究肥大细胞类胰蛋白酶(mast cell tryptase,MCT)在病理性瘢痕中的表达及分布情况,探讨MCT基因在瘢痕疙瘩、增生性瘢痕及正常皮肤中是否存在差别.方法 采集未经治疗的瘢痕疙瘩、增生性瘢痕及正常皮肤各20例,应用免疫荧光组化对MCT的表达进行定位,应用实时荧光相对定量PCR进行mRNA基因水平的相对定量分析.结果 MCT主要集中在瘢痕组织的胶原纤维柬之间,以瘢痕组织浅层分布较多;实时荧光PCR相对定量结果显示MCT基因在瘢痕疙瘩中表达高于增生性瘢痕和皮肤(P<0.01),瘢痕疙瘩中MCT基因表达量约为增生性瘢痕的2.5倍,皮肤的5.4倍.结论 MCT在瘢痕的形成中可能起一定的作用.     

曲安奈德抑制兔耳瘢痕增生与氧自由基作用的初步研究

目的 了解曲安奈德局部注射对兔耳增生性瘢痕组织中丙二醛含量的影响,并探讨曲安奈德抑制兔耳增生性瘢痕的作用与氧自由基的关系. 方法 新西兰兔共18只,随机选取其中的14只制作兔耳增生性瘢痕模型,4只作为正常兔耳皮肤组织标本,共8例;兔耳增生性瘢痕组织标本28例,随机分为曲安奈德组(10例)、生理盐水组(10例)、空白对照组(8例).制模术后6周予曲安奈德原液(1 ml:40 mg)分点注射于瘢痕样组织内,每处2～3点,总量0.3～0.4 ml,每周1次,3次为一疗程.制模术后9周取材,显微镜下记数成纤维细胞,并用测微尺测量瘢痕的相对增生厚度,以计算瘢痕增生指数,采用分光光度法测定丙二醛含量变化. 结果 ①大体形态学变化:曲安奈德局部治疗3周后,瘢痕颜色接近兔耳的正常肤色,略高出皮面,表面平整,触之质软.②组织学变化:与空白对照组、生理盐水组比较,曲安奈德组胶原纤维多为平行排列,数量减少.③成纤维细胞密度与瘢痕增生指数变化:与正常皮肤组比较,空白对照组以及生理盐水组成纤维细胞密度增高(P＜0.05),而曲安奈德组则无显著性差异(P＞0.05);生理盐水组与空白对照组间成纤维细胞密度及瘢痕增生指数比较差异无统计学意义(P＞0.05),与此两组比较,曲安奈德组则显著降低(P＜0.05).④丙二醛含量变化:与空白对照组、生理盐水组、正常皮肤组比较,曲安奈德组丙二醛含量明显增高(P＜0.05);生理盐水组与空白对照组间比较差异无统计学意义(P＞0.05);与正常皮肤组比较,空白对照组和生理盐水组丙二醛含量增高(P＜0.05). 结论 曲安奈德局部注射引起兔耳增生性瘢痕组织中氧自由基水平进一步升高.     

内质网分子伴侣GRP94、GRP78和XBP1在病理性瘢痕中的表达初探

目的：检测内质网应激反应的关键分子葡萄糖调节蛋白94（GRP94）、葡萄糖调节蛋白78（GRP78）和X-盒结合蛋白1（XBP1）mRNA在病理性瘢痕的表达,探讨其基因表达及内质网应激反应与病理性瘢痕形成及转归的关系。方法：用RT-PCR法检测GRP94、GRP78和XBP1mRNA在：①瘢痕疙瘩（13例）、增生性瘢痕（17例）和正常皮肤（15例）组织以及体外培养的瘢痕疙瘩（5例）、增生性瘢痕（5例）和正常皮肤（6例）成纤维细胞中的表达;②体外培养瘢痕疙瘩和增生性瘢痕成纤维细胞（各5例）中经0.1mg/ml氢化可的松作用前后的表达。结果：①GRP94、GRP78和XBP1mRNA在瘢痕疙瘩、增生性瘢痕和正常皮肤组织及其成纤维细胞中的表达均无显著性差异（P〉0.05）;②0.1mg/ml氢化可的松作用后,GRP94mRNA在瘢痕疙瘩和增生性瘢痕来源的成纤维细胞中的表达量均显著下降,具有统计学意义（P〈0.01）;而GRP78和XBP1mRNA在瘢痕疙瘩和增生性瘢痕来源的成纤维细胞中的表达量改变均无显著性差异（P〉0.05）。结论：内质网分子伴侣GRP94、GRP78和XBP1在瘢痕疙瘩和增生性瘢痕组织及其成纤维细胞中基因转录与正常皮肤组织及其成纤维细胞中基因转录水平一致;GRP94mRNA的表达量显著下降可能是糖皮质激素治疗病理性瘢痕的机制之一。