Prognostic tools for hypertrophic scar formation based on fundamental differences in systemic immunity

Unpredictable hypertrophic scarring (HS) occurs after approximately 35% of all surgical procedures and causes significant physical and psychological complaints. Parallel to the need to understanding the mechanisms underlying HS formation, a prognostic tool is needed. The objective was to determine whether (systemic) immunological differences exist between patients who develop HS and those who develop normotrophic scars (NS) and to assess whether those differences can be used to identify patients prone to developing HS. A prospective cohort study with NS and HS groups in which (a) cytokine release by peripheral blood mononuclear cells (PBMC) and (b) the irritation threshold (IT) after an irritant (sodium lauryl sulphate) patch test was evaluated. Univariate regression analysis of PBMC cytokine secretion showed that low MCP‐1, IL‐8, IL‐18 and IL‐23 levels have a strong correlation with HS (P < .010‐0.004; AUC = 0.790‐0.883). Notably, combinations of two or three cytokines (TNF‐a, MCP‐1 and IL‐23; AUC: 0.942, Nagelkerke R²: 0.727) showed an improved AUC indicating a better correlation with HS than single cytokine analysis. These combination models produce good prognostic results over a broad probability range (sensitivity: 93.8%, specificity 86.7%, accuracy 90,25% between probability 0.3 and 0.7). Furthermore, the HS group had a lower IT than the NS group and an accuracy of 68%. In conclusion, very fundamental immunological differences exist between individuals who develop HS and those who do not, whereas the cytokine assay forms the basis of a predictive prognostic test for HS formation, the less invasive, easily performed irritant skin patch test is more accessible for daily practice.     

A comparison of double single suture-button fixation,suture-button fixation,and screw fixation for ankle syndesmosis injury: A retrospective cohort study

Different methods have been used throughout the years for syndesmotic injury but there is no consensus on the ideal treatment. Some methods are expensive and some have more complications. The aim of this study is to compare single suture endobutton with double suture endobutton and screw fixation for syndesmotic injury.Sixty nine patients with syndesmotic injury with fibular fractures whom were treated with a single interosseous suture endobutton system (ZipTight^TM, Zimmer Biomet), a double interosseous suture endobutton system (ZipTight^TM, Zimmer Biomet) and 1 syndesmotic screw (TST, Istanbul, Turkey) were included in this study. Functional and radiological results from patient records between 2015 and 2018 were retrospectively evaluated.Twenty patients were treated with the double interosseous suture endobutton, 23 were treated with the single interosseous suture endobutton, and 26 were treated with traditional AO screw fixation. Three patients from the screw fixation group (11.5%) required revision surgery (P < .05). All the radiologic and clinical outcomes were statistical similar in all 3 groups.Our findings showed that the interosseous suture endobutton system is at least as safe as the screw fixation technique for treatment of syndesmosis joint injuries and can be used as an alternative to the screw method. The interosseous suture endobutton system eliminates the need for a second surgery to remove the hardware, which minimizes the probability of re-diastasis. Since our results showed no statistical difference between single and double interosseous suture endobutton systems, the less costly single endobutton system may be the better alternative.     

基于SOCS通路探讨糖尿病足溃疡治疗中中药“去腐生新”作用的研究进展

糖尿病足溃疡（DFUs）是糖尿病严重的并发症之一，发病率和截肢率高，目前具体发病机制仍未完全明确。相关研究表明，炎症、感染和营养障碍等多种因素共同影响DFUs的转归及预后。抑制相关炎症通路和细胞因子表达，可促使坏死组织脱落促进愈合。此外，细胞因子信号传导抑制因子家族蛋白（SOCS）可通过激活蛋白酪氨酸激酶（JAK）/信号转导和转录活化因子（STAT）信号通路参与细胞因子信号转导，参与DFUs创面炎症反应以及愈合过程。近年来，大量研究发现具有“去腐生新”功效的单味中药及其活性成分、中药复方对DFUs具有很好的疗效，研究中药治疗DFUs的具体机制已成为近些年来研究的热点之一。文章查阅近年文献，就SOCS通路与DFUs的关系及中医药治疗DFUs作用机制进行综述。     

可吸收明胶海绵棒在椎弓根内止血的应用

[目的]观察评价可吸收明胶海绵棒在椎弓根置钉过程中的止血效果。[方法]2017年10月~2018年6月,48例胸腰椎骨折即将行后路手术的患者纳入本研究,采用随机数字表法分为明胶海绵组和骨蜡组。明胶海绵组共23例,置钉过程中应用明胶海绵棒填塞至椎弓根孔道止血;骨蜡组共25例,在透视定位时应用骨蜡封闭椎弓根孔道。记录置钉情况;记录术中出血量、自体血回输量、置钉过程中的出血量、输血量;检测术前和术后5 d RBC、HB和HCT。[结果]两组在置钉总数、伤椎置钉数、伤椎位置各椎置钉数量的差异均无统计学意义(P>0.05)。术后两组各出现1例小腿肌间静脉血栓,抗凝治疗后于复查时消失。术后两组均无明胶海绵或骨蜡导致的不良反应。两组在术中出血量、术中自体血回收量、输血量的差异无统计学意义(P>0.05),但明胶海绵组上述指标均小于骨蜡组。每钉置入过程中明胶海绵组的出血量显著少于骨蜡组,差异有统计学意义(P<0.05)。两组术后5 d的RBC、HB和HCT均较术前显著减少,两时间点间差异均有统计学意义(P<0.05)。术前两组在RBC、HB和HCT的差异均无统计学意义(P>0.05),术后5 d两组在RBC、HB和HCT的差异亦均无统计学意义(P>0.05)。[结论]应用明胶海绵棒填塞椎弓根孔道止血可显著减少安置椎弓根螺钉过程中的出血,是一种简单、安全、有效的脊柱外科术中止血方法。     

Vasoactive Intestinal Peptide Immunoregulatory Role at the Periapex: Associative and Mechanistic Evidences from Human and Experimental Periapical Lesions

IntroductionThe balance between the host proinflammatory immune response and the counteracting anti-inflammatory and reparative responses supposedly determine the outcome of periapical lesions. In this scenario, the vasoactive intestinal peptide (VIP) may exert a protective role because of its prominent immunoregulatory capacity. In this study, we investigated (in a cause-and-effect manner) the potential involvement of VIP in the development of human and experimental periapical lesions.MethodsPeriapical granulomas (n = 124) and control samples (n = 48) were comparatively assessed for VIP and multiple immunologic/activity marker expression through real-time polymerase chain reaction. Experimental periapical lesions (C57Bl/6 wild-type mice) were evaluated regarding endogenous VIP expression correlation with lesion development and the effect of recombinant VIP therapy in lesion outcome. CCR4KO and IL4KO strains and anti-glucocorticoid-induced TNFR-related protein inhibition were used to test the involvement of Treg and Th2 cells in VIP-mediated effects.ResultsVIP expression was more prevalent in periapical granulomas than in controls, presenting a positive association with immunoregulatory factors and an inverse association/correlation with proinflammatory mediators and the receptor activator of nuclear factor kappa B ligand/osteoprotegerin ratio. Endogenous VIP expression up-regulation was temporally associated with lesion immunoregulation and a decline of bone loss. VIP therapy in mice prompted the arrest of lesion development, being associated with an anti-inflammatory and proreparative response that limits the proinflammatory, Th1, Th17, and osteoclastogenic response in the periapex. The VIP protective effect was dependent of Treg migration and activity and independent of interleukin 4.ConclusionsOur results show that VIP overexpression in human and experimental periapical lesions is associated with lesion inactivity and that VIP therapy results in the attenuation of experimental lesion progression associated with the immunosuppressive response involving Treg cells.     

海水浸泡爆炸伤延期植皮最佳时机的研究

目的确定海水浸泡爆炸伤延期植皮的最佳时机。方法建立海水浸泡爆炸伤动物模型后，分别于0、3、7、14d切取创面组织作病理切片，镜下观察创面受床的病理改变；同期对创区实施植皮术，通过计算机全自动图像分析系统准确计算出各组的皮片成活率。结果分别于伤后0、3、7、14d，对皮肤缺损区施行植皮术，发现不同时机植皮成活率不同，伤后7d对海水浸泡爆炸伤皮肤缺损区植皮，皮片成活率最高。结论海水浸泡爆炸伤延期7d后植皮是对创面实施植皮术的最佳时机。     

经穹隆结膜入路埋线法重睑成形术应用探讨

目的:通过分析重睑形成原理,综合比较多种重睑成形的方法,讨论埋线法重睑成形术的优点和可行性。方法:对387例患者行经穹隆结膜入路间断缝合埋线法重睑术。其中88例为其他方法埋线后重睑线消失的患者。结果:手术方法可靠,术后所形成的重睑外形良好,重睑维持时间长。最长随访时间38个月。结论:此方法因符合重睑形成原理,可以充分的将较多的上睑提肌腱膜与上睑皮肤结扎固定、故术后所形成的重睑牢固。且在直视下经穹隆结膜入路,降低了对眼球组织损伤的危险性。是埋线法重睑成形术一种可靠的手术方法。