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Objective@#To evaluate the stability and aesthetic effect of a xenogeneic collagen matrix (mucograft) on achieving an adequate keratinized mucosa width (KMW) around implants and to provide a reference basis for the clinical application of xenogeneic collagen matrix materials.@*Methods@#The hospital ethics committee approved the study protocol, and the patients provided informed consent. Twenty patients with a KMW<2 mm at the buccal implant site who were treated in Binzhou Medical University Affiliated Yantai Stomatological Hospital from July 2020 to September 2022 were included, and a total of 36 implants were included. The mean age of the patients was (52.0±10.4) years, of which 18 were females and 2 were males. They were divided into a free gingival graft group (FGG, control group) and a xenogeneic collagen matrix group (test group) according to different graft materials. The incremental effect of the KMW on the buccal side of the implant and the mucosal shrinkage rate was measured at 1 month and 3 months after the operation. The mucosal scar index (MSI) was evaluated after the operation.@*Results@#At 3 months postoperatively, the KMW was (3.67 ± 1.06) mm in the control group and (2.96 ± 0.98) mm in the test group, and the difference was statistically significant (t = 2.076, P<0.05). The KMW shrinkage rate was (33.34 ± 16.30) % in the test group and (22.05 ± 15.47) % in the control group at 1 month postoperatively and (51.95 ± 12.60) % in the test group and (37.44 ± 16.30) % in the control group at 3 months postoperatively, with statistically significant differences between the two groups at the same time points (P<0.05). Three months after surgery, the test group showed significantly better outcomes than the control group in terms of the five scar indicators (scar width, scar convexity, scar color, scar trace, and overall appearance), and the difference was statistically significant (P<0.05).@*Conclusion@#Xenogeneic collagen matrix can increase the peri-implant KMW and achieve a more natural and coordinated soft tissue aesthetic effect but with a higher shrinkage rate.
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AIM: To investigate the application of biological amniotic membrane soaked in pirfenidone(PFD)and to evaluate its anti-scarring effect and toxic side effects on glaucoma model of rabbit eyes.METHODS: The right eyes of 72 healthy New Zealand white rabbits were randomly divided into 0.5%PFD+ biological amniotic membrane group, biological amniotic membrane group, mitomycin C(MMC)group and blank control group after the glaucoma model was established by anterior chamber injection of compound carbomer solution, and 18 rabbits in each group underwent trabeculectomy, in which the 0.5% PFD+ biological amniotic membrane group was placed with 0.5% PFD solution-soaked biological amniotic membrane under the scleral flap, and the biological amniotic membrane group was placed with normal saline-soaked rehydrated biological amniotic membrane under the scleral flap. In the MMC group, a cotton pad soaked in MMC was placed under the scleral flap for 3 min and immediately rinsed with normal saline, while the blank control group received no implant after the scleral flap was made. The intraocular pressure(IOP), filtration blebs, toxic side effects and complications were evaluated, and the histopathological changes in the filtration area were observed by hematoxylin-eosin(HE), Masson staining and immunohistochemical staining.RESULTS: The mean IOP at 14, 21 and 28 d after trabeculectomy were 0.5%PFD+ biological amniotic membrane group&#x003C;MMC group&#x003C;biological amniotic membrane group&#x003C;blank control group(all P&#x003C;0.05). At 28 d after trabeculectomy, 0.5%PFD+ biological amniotic membrane group had the best effect of anti-inflammatory hyperplasia and inhibition of collagen formation, the highest survival rate of filtration blebs, and the inflammatory reaction was mild.CONCLUSION: Biological amniotic membrane soaked in pirfenidone has more obvious anti-scarring effect on glaucoma model, with less toxic side effects and good safety.
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AIM: To explore the dynamic expression of high mobility group box 1(HMGB1)in scar tissues after glaucoma drainage valve implantation, and to further reveal the role and possible mechanism of HMGB1 in scarring after glaucoma surgery.METHODS: A total of 60 New Zealand white rabbits were randomly divided into control group(n=20), model group(n=20, silicone implantation under conjunctival sac)and model with drug administration group(n=20, silicone implantation under conjunctival sac combined with 5-fluorouracil injection). The conjunctival tissues were collected at 4 and 8 wk after surgery. HE staining and Masson staining were used to detect the proliferation and distribution of fibroblasts and collagen fibers in conjunctival tissues. Immunohistochemistry was utilized to detect the distribution and changes of HMGB1, transforming growth factor(TGF)-β1, Smad3 and α-smooth muscle actin(SMA)in conjunctival tissues. RT-PCR and Western blot were adopted to detect the mRNA and protein expression of HMGB1, TGF-β1, Smad3 and α-SMA in conjunctival tissues.RESULTS: HE staining and Masson staining showed that the proliferation of inflammatory cells, fibroblasts and collagen fibers in the model group was significantly higher than that in the control group at both 4 and 8 wk. Meanwhile, the proliferation of fibroblasts and collagen fibers in the model with drug administration group was significantly lower than that in the model group. Immunohistochemical staining showed that the expression of HMGB1, TGF-β1, Smad3 and α-SMA protein was observed in the conjunctival tissues of the model group both 4 and 8 wk, with brown and significantly deeper staining of the model group at 8 wk. Meanwhile, the positive staining in the model with drug administration group at both 4 and 8 wk was significantly lower than that in the model group. There was positive correlations between the number of fibroblasts stained with HE and the expression of HMGB1 in the conjunctival tissue of the model group at both 4 and 8 wk(r=0.602, 0.703, all P&#x003C;0.05). RT-PCR and Western blot revealed that the mRNA and protein expression levels of HMGB1, TGF-β1, Smad3 and α-SMA in the model group were significantly higher than those in the control group at both 4 and 8 wk(all P&#x003C;0.05). Meanwhile, the mRNA and protein expression levels of HMGB1, TGF-β1, Smad3 and α-SMA in the model with drug administration group were significantly lower than those in the model group(all P&#x003C;0.05). There was positive correlations between mRNA expressions of HMGB1 and TGF-β1, Smad3 in the model group and the model with drug administration group(all P&#x003C;0.05).CONCLUSION: The expression of HMGB1 increased at a time-dependent manner after glaucoma valve implantation. HMGB1 acts an indispensable role in the initiation and progression of scar formation after glaucoma surgery, which may be involved in the regulation of TGF-β/Smad signaling pathway.
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AIM: To investigate the effect of ALK5 inhibitor EW-7197 on the proliferation and migration of human Tenon fibroblasts(HTFs)induced by transforming growth factor-β1(TGF-β1)and its mechanism.METHODS: The cell proliferation rate was detected by MTS assay, and the optimal concentration and time of EW-7197 were explored. Then HTFs were divided into three groups: normal control group, TGF-β1 induced group and TGF-β1+EW-7197 group. Cell migration was observed by Transwell assay. The protein expression levels of Fibronectin, α-SMA, as well as the phosphorylated Smad2, Smad3(p-Smad2, p-Smad3)were measured by Western blot.RESULTS: MTS assay showed that the proliferation rate of cells treated with 6.0 μmol/L EW-7197 for 24h was the lowest(all P<0.01). Transwell assay showed that the migrated number of HTFs in TGF-β1 induced group was 228.0±17.0/field, which was significantly more than that in normal control group(149.0±15.0/field)and TGF-β1+EW-7197 group(46.0±8.0/field; all P<0.01). Western blot showed that the protein relative expression levels of Fibronectin, α-SMA and p-Smad2, p-Smad3 of HTFs in TGF-β1 induced group were significantly higher than that in normal control group and TGF-β1+EW-7197 group(all P<0.001).CONCLUSION:EW-7197 can suppress the proliferation and migration of TGF-β1-induced HTFs through TGF-β/Smad signaling pathways.
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Introducción: la radiodermitis es uno de los efectos secundarios más frecuentes de la radioterapia y afecta aproximadamente al 95% de los pacientes que la reciben. La radiodermitis aguda se presenta dentro de los 90 días posteriores al inicio del tratamiento, tiene un profundo impacto en la calidad de vida de los pacientes y puede ser la causa de la interrupción prematura de la radioterapia. Su tratamiento es complejo y el papel de los corticoides sistémicos en él aún no ha sido evaluado. Materiales y métodos: estudio descriptivo de 6 pacientes mayores de 18 años con radiodermitis grave, tratados con corticoides sistémicos al no responder a la terapia tópica inicial. Hubo un seguimiento de 6 meses, entre el 1 de junio de 2019 y el 30 de mayo de 2020, en el Servicio de Dermatología de un hospital de alta complejidad. Resultados: se indicó tratamiento con corticoides sistémicos en dosis de meprednisona 40 mg/día o equivalentes, durante 5 días, con resolución completa del cuadro en un período máximo de 15 días. Discusión: en la bibliografía no hemos encontrado trabajos científicos que comuniquen o evalúen la utilidad de los corticoides sistémicos en la radiodermitis grave. Proponemos, entonces, demostrar su utilidad en esta patología. Conclusión: el objetivo de este trabajo es comunicar nuestra experiencia en pacientes con radiodermitis aguda grave, con gran repercusión en el estado general, que evolucionaron con una rápida resolución del cuadro y un adecuado manejo sintomático, mediante el uso de corticoides sistémicos. (AU)
Introduction: radiodermitis is one of the most frequent side effects of radiotherapy and affects approximately 95% of the patients who receive it. Acute radiodermitis occurs within 90 days after the start of treatment, has a profound impact on the quality of life of patients and may be the cause of premature discontinuation of radiotherapy. Its treatment is complex and the role of systemic corticosteroids in it has not yet been evaluated. Materials and methods: descriptive study of 6 patients older than 18 years with severe radiodermatitis, treated with systemic corticosteroids when they did not respond to initial topical therapy. With a 6-month follow-up, between June 1, 2019 and May 30, 2020 at the Dermatology Service of a high complexity hospital. Results: treatment with systemic corticosteroids was indicated at a dose of meprednisone 40 mg/day or equivalent, for 5 days, with complete resolution of the symptoms in a maximum period of 15 days. Discussion: in the literature, we have not found scientific papers that report or evaluate the usefulness of systemic corticosteroids in severe radiodermatitis. We propose to demonstrate their usefulness in this pathology. Conclusion: the objective of this work is to communicate our experience in patients with severe acute radiodermatitis, with great repercussions on the general state, who evolved with rapid resolution of the symptoms and adequate symptomatic management, with the use of systemic corticosteroids. (AU)
Subject(s)
Humans , Male , Female , Adult , Young Adult , Radiation Injuries/drug therapy , Radiodermatitis/drug therapy , Adrenal Cortex Hormones/therapeutic use , Radiotherapy/adverse effects , Prednisone/administration & dosage , Adrenal Cortex Hormones/pharmacologyABSTRACT
O carcinoma basocelular é considerado a neoplasia mais comum do mundo, tem como principal fator de risco a radiação ultravioleta, pode aparecer em todo o corpo incluindo couro cabeludo. A alopecia frontal fibrosante é uma alopecia cicatricial primária, variante do líquen planopilar. A associação entre as duas patologias não tem relato prévio na literatura. Neste caso apresenta-se paciente feminina, pós-menopausa, atendida por queixa de queda de cabelo, com diagnóstico histopatológico de alopecia frontal fibrosante e carcinoma basocelular de couro cabeludo. A distinção das margens tumorais para exérese completa da neoplasia é complexa apenas pela dermatoscopia e exame físico, devido á presença de áreas de atrofia em comum. Então se optou pela cirurgia micrográfica de Mohs para delimitação histopatológica de margens.
BCC is considered the most common neoplasia in the world, it can appear throughout the body including the scalp. Frontal fibrosing alopecia is a primary scarring alopecia, variant of lichen planopilaris. The association between the two pathologies has not been previously reported in the literature. In this case it is presented a brazilian female patient complaining of hair loss, with histopathological diagnosis of AFF and scalp BCC. The distinction of tumor margins for neoplastic excision is complex only by dermoscopy and physical examination, due to areas of common atrophy. So Mohs micrographic surgery was chosen for histopathological delimitation of margins.
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Objective:To investigate the effect of epigallocatechin gallate (EGCG) on the activation of human Tenon fibroblasts (HTFs) and its mechanism.Methods:Tenon capsule tissues from nine eyes of nine advanced primary open angle glaucoma patients during trabeculectomy were obtained for primary cell culture.HTFs harvested were identified by immunofluorescence staining for vimentin and keratin.Cells at passage 4-6 were used for experiment.Viability of HTFs treated with EGCG at 0, 10, 20, 30, 40, 50, 60, 70 and 80 μmol/L was detected by cell counting kit-8 (CCK-8) assay.The cells were divided into blank control group, transforming growth factor (TGF)-β1-induced group, and EGCG-treated group, which were cultured in normal medium, medium containing 10 ng/ml TGF-β, medium containing 10 ng/ml TGF-β+ 50 μmol/L EGCG, respectively.The proliferation rate of HTFs was detected by BrdU labeling assay.Cell migration was observed by scratch wound healing assay.The expression of α-smooth muscle actin (α-SMA) was measured by immunofluorescence staining.The protein relative expression levels of Smad2/3, phosphoinositide-3-kinase (PI3K), protein kinase B (Akt) as well as the phosphorylated Smad2/3 (p-Smad2/3) and phosphorylated Akt (p-Akt) were measured by western blot.This study was approved by the Ethics Committee of Guangdong Provincial People's Hospital (NO.GDREC2019331H[R1]).Results:The HTFs harvested had spindle shape, grew regularly and were vimentin-positive.CCK-8 assay showed that there was no significant difference in the variability of HTFs treated with EGCG at 10, 20, 30, 40 and 50 μmol/L in comparison with 0 μmol/L EGCG treatment (all at P<0.05). BrdU labeling assay showed that cell proliferation in the TGF-β1-induced group was (66.37±12.65)%, which was significantly higher than (14.75±12.33)% in EGCG-treated group ( P<0.05). Three days after scratch, the relative scratch area in the TGF-β1-induced group was (47.33±12.22)%, which was significantly lower than (92.67±4.04)% in the EGCG-treated group ( P<0.05). Immunofluorescence assay showed that α-SMA fluorescence was significantly enhanced in the TGF-β1-induced group in comparison with the blank control group, which was reduced to blank control group level in EGCG-treated group.Western blot analysis showed that there were significant differences in the relative expression levels of p-Smad2/3, PI3K and p-Akt protein among the various groups ( F=58.820, 121.153, 69.289; all at P<0.001). The relative expressions of p-Smad2/3, PI3K and p-Akt in the TGF-β1-induced group were significantly higher than those in the blank control group, 10 μmol/L and 50 μmol/L EGCG-treated groups (all at P<0.05). Conclusions:EGCG can suppress TGF-β1-induced HTFs activation through Smad and PI3K/Akt signaling pathways.
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AIM:To investigate the influence of K-115 on the proliferation and migration of human Tenon's fibroblasts(HTFs)and to access the possible mechanism. Furthermore, to provide new ideas for anti-scar treatment after glaucoma surgery.METHODS: The Tenon capsule tissues were collected from patients who underwent glaucoma surgery in Hebei General Hospital from September 2018 to September 2019. Primary culture of HTFs was performed by tissue block method. The transforming growth factor-β1(TGF-β1)was used to induce HTFs activation that can mimic glaucoma filtration surgery. The cells were treated with K-115 and divided into 4 groups: the control group was treated with dimethyl sulfoxide(DMSO); TGF-β1 group was treated with 10μg/L TGF-β1 for 24h; TGF-β1 +5 K-115 group was pretreated with 5μmol/L K-115 for 2h and then treated with 10μg/L TGF-β1 for 24h; TGF-β1+10 K-115 group was pretreated with 10μmol/L K-115 for 2h and then 10μg/L TGF-β1 was added for 24h. Cell proliferation was observed by cell proliferation experiment. The migration ability of cells was detected by scratch test. The formation of autophagosomes was observed by transmission electron microscopy. Apoptosis was visualized by Hoechst 33342/PI staining.RESULTS: Cell proliferation experiment revealed that K-115 could inhibit the proliferation of HTFs induced by TGF-β1. Scratch test suggested that K-115 could inhibit the migration of HTFs induced by TGF-β1. Transmission electron microscope results showed that K-115 could enhance autophagy of HTFs induced by TGF-β1. Hoechst 33342/PI staining suggested that K-115 did not induce apoptosis.CONCLUSIONS: K-115 may regulate the proliferation and migration of HTFs induced by TGF-β1 by increasing autophagy rather than inducing apoptosis.
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@#AIM:To investigate the dynamic expression characteristics of interleukin-10(IL-10)after implantation of glaucoma drainage material, and to reveal the role of IL-10 on scarring formation.METHODS:Totally 75 New Zealand white rabbits were randomly divided into three groups, which were implanted with different types of material-Polymethyl methacrylate coated Parylene C(PMMA group), silicone together with injection of Mitomycin C(MMC)(silicon-MMC group)and silicone(silicone group). Aqueous humor were collected at 1, 3d, 1, 2, 3, 4 and 8wk after operation and enzyme-linked immunosorbent assay(ELISA)were utilized to detect the expression of IL-10 in the aqueous humor. The connective tissue surrounding the material were collected at 1, 2, 3, 4 and 8wk postoperatively. Hematoxylin-eosin(HE)staining was applied to evaluate the proliferation of fibroblasts and the infiltration of inflammatory cells. The protein expression and mRNA of IL-10 in the connective tissue were detected by immunohistochemistry and real-time PCR.RESULTS:Compared with PMMA and silicon-MMC group, silicone group showed significantly increased proliferation of fibroblasts and infiltration of inflammatory cells according to the HE staining result. The result of ELISA showed the expression of IL-10 in the aqueous humor increased significantly at the early stage after surgery, and then decreased gradually,the highest appeared on the third day after operation,and in silicone group there was higher than the other two groups in the early stage postoperatively(1d-3wk)(all <i>P</i><0.05), and there was no significant difference in the late stages(4-8wk). The protein expression and mRNA of IL-10 in connective tissue were the highest in the first week after operation, decreased gradually at 2-3wk after operation, and increased again at 4-8wk after operation by immunohistochemistry and real-time PCR. And the expression was higher in silicone group than in the other two groups at each time point(all <i>P</i><0.05). Furthermore, there was a positive correlation between the expression of IL-10 protein and the proliferation of fibroblasts in the late stages(4-8wk).CONCLUSION: After implantation of glaucoma drainage material, the process of IL-10 increased first, then decreased gradually, and increased again 4wk later, thus IL-10 may be a potential target for inhibiting the scar formation.
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Hypertrophic scars are unfavorable skin diseases characterized by excessive collagen deposition. Although systemic treatments exist in clinic to manage hypertrophic scars, they pose significant side effects and tend to lose efficacy over prolonged applications. Traditional Chinese medicine (TCM) offers as a promising candidate to treat pathological scars. A large number of TCMs have been studied to show anti-scarring effect, however, the natural barrier of the skin impedes their penetration, lowering its therapeutic efficacy. Herein, we reported the use of dissolvable hyaluronic acid (HA) microneedles (MNs) as a vehicle to aid the transdermal delivery of therapeutic agent, a model TCM called shikonin for the treatment of hypertrophic scars. Here, shikonin was mixed with HA to make MNs with adequate mechanical strength for skin penetration, making its dosage controllable during the fabrication process. The therapeutic effect of the shikonin HA MNs was studied
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Objective:To investigate the expression of integrin ανβ3 in conjunctival scar after glaucoma filtration surgery and to explore its role in the formation of filtering scar in rats.Methods:Fifty-five SPF male SD rats aged 6-8 weeks were selected to establish the model of glaucoma filtration surgery, and 15 unsuccessful modeling rats were excluded.The remaining rats were divided into control group, transforming growth factor (TGF) group, integrin ανβ3 receptor antagonist LM609 group and TGF+ LM609 group, with 10 rats in each group.The conjunctival flap of different groups was treated with cotton piece containing 0.9% sodium chloride, TGF-β2 (2 mg/ml), LM609 (40 μg/ml), TGF-β2 (2 mg/ml)+ LM609 (40 μg/ml) solution for two minutes, respectively, according to grouping.The intraocular pressure (IOP) was monitored with an iCARE tonometer before operation and at 3 days, 1 week, 2 weeks after operation, and the average IOP ratio ([postoperative IOP/preoperative IOP]×100%) was calculated.At 3 days, 1 week and 2 weeks after operation, slit lamp microscopy was used to observe the morphological changes of filtering blebs and calculate the survival rate of filtering blebs.Two weeks after operation, the operative eyeball tissues were removed and made into paraffin section.The inflammatory changes, fibrosis and collagen deposition of bulbar conjunctiva in the operation area were observed by hematoxylin-eosin staining and picric acid-sirius red staining, respectively.Western blot was used to detect the expression of integrin αν and β3.Immunohistochemical staining was used to detect the expression of integrin ανβ3 in the conjunctival tissue of operation area.The use and care of the rats complied with the Instruction Notions with Respect to Care for Laboratory by State Ministry of Science and Technology.The study protocol was approved by an Ethics Committee of The Daping Hospital, Army Medical University (No.2017-06).Results:The IOP of rats in each group was significantly decreased on the third day after operation compared with before operation, and gradually recovered to the preoperative level in the first to second week after operation.The mean IOP ratios of the control group, TGF group, LM609 group and TGF+ LM609 group were (101.80±4.44)%, (103.90±5.65)%, (94.10±7.45)% and (100.60±4.61)%, respectively, showing a statistically significant difference among them ( F=4.571, P=0.010). The mean IOP ratio of LM609 group was lower than that of the control group, TGF group and TGF+ LM609 group (all at P<0.05). Two weeks after operation, the filter blebs became flat and the bulbar conjunctival tissue was slightly thickened in the control group and TGF+ LM609 group, and bulbar conjunctival tissue was significantly thickened with a large number of blood vessels growing in the TGF group, and localized small filter blebs as well as less vascularization were seen in the LM609 group.The survival rate of filtering bleb in the TGF group was significantly lower than that in the control group, LM609 group and TGF+ LM609 group, and the survival rate of filtering bleb in the LM609 group was significantly higher than that in the control group and TGF+ LM609 group (all at P<0.05). Two weeks after operation, there were fewer infiltrated inflammatory cells and looser collagen fiber deposition in the conjunctival tissue in the LM609 group and TGF+ LM609 group compared with the TGF group.The relative expression levels of integrin αν and β3 under conjunctival tissue in the TGF group were significantly higher than those in the control group, LM609 group and TGF+ LM609 group (all at P<0.05). Immunohistochemical staining showed that integrin ανβ3-positive cells were mainly in the conjunctival tissue around the operation area and microtubules.The number of integrin ανβ3-positive cells in the conjunctival tissue of the operation area in the TGF group were significantly greater than those of other groups. Conclusions:Integrin ανβ3 is highly expressed in the scar of conjunctival tissue after filtering surgery in rats.The inhibition of integrin ανβ3 can reduce the deposition of fibers and prolong the survival of filtering blebs, suggesting that integrin ανβ3 may be involved in the formation of conjunctival scar.
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ABSTRACT The authors present a case of lupus miliaris disseminatus faciei , a rare skin disease of unknown etiology, which may cause unaesthetic scarring due to its difficult treatment. The histopathological examination of epithelioid granulomas with caseating necrosis, together with the clinical features, are important for diagnosis and early treatment with better results. Despite difficult and unsatisfactory treatment, there are ongoing studies on therapy to improve aesthetic and social impairment. This case report describes an initial misdiagnosis delaying appropriate treatment, and highlights the value of physical examination and clinical judgment for another pathological examination, whenever necessary, aiming at better treatment outcomes in daily practice.
RESUMO Os autores apresentam um caso de lupus miliaris disseminatus faciei , uma dermatose rara, de etiologia desconhecida, que pode deixar cicatrizes não estéticas, pela dificuldade de tratamento. O exame histopatológico de granulomas compostos por células epitelioides, com necrose caseosa, e as características clínicas, são importantes para o diagnóstico e tratamento precoce, com melhores resultados. Apesar do tratamento difícil e insatisfatório, há estudos em andamento sobre terapias para melhorar o comprometimento estético e social. Este relato de caso descreve um diagnóstico inicial errôneo, que atrasou o tratamento adequado, e destaca o valor do exame físico e raciocínio clínico para solicitar outro exame anatomopatológico, quando necessário, de forma a obter melhores desfechos com o tratamento, na prática diária.
Subject(s)
Humans , Female , Adult , Eyelid Diseases/pathology , Eyelid Diseases/drug therapy , Facial Dermatoses/pathology , Facial Dermatoses/drug therapy , Tetracycline/therapeutic use , Prednisone/therapeutic use , Isotretinoin/therapeutic use , Cicatrix , Tacrolimus/therapeutic use , Rosacea/pathology , Rosacea/drug therapy , Dapsone/therapeutic use , Granuloma/pathology , Granuloma/drug therapy , Lupus Vulgaris/pathology , Lupus Vulgaris/drug therapy , Minocycline/therapeutic useABSTRACT
Las lesiones digitales distales han fomentado un gran debate referente a su tratamiento, que puede ser: quirúrgico o conservador. El tratamiento, en definitiva, siempre se encamina a lograr cubrir los tejidos expuestos y epitelizar el pulpejo del dedo afectado. Durante muchas décadas, ha existido la evidencia de que la cicatrización secundaria puede ser beneficiosa y logra resultados favorables; sin embargo, por diferentes motivos ha quedado rezagada frente a la opción quirúrgica. Presentamos el caso de un paciente con amputación traumática del extremo distal del 3er dedo de la mano derecha, que fue tratado de forma conservadora, y se logró buenos resultados estéticos y funcionales. Revisamos en la literatura la validez y equivalencia entre el resultado conservador y el quirúrgico
Distal digital injuries have presented a great debate regarding its treatment, it could be: Surgical and conservative. The treatment is always aimed at achieving coverage of exposed tissues and epithelialization of the affected finger pulp. There has been evidence for many decades that secondary healing can be beneficial for the patient with favorable results, however, due to different aspects, it has lagged behind the surgical option. We present a case of a patient with traumatic amputation of the distal end of the 3rd finger of the right hand, which was treated conservatively, finding good aesthetic and functional results over time. We review in the literature the validity and equivalence in the conservative and surgical result.Keywords: digital amputation, hand, pulp injury, conservative treatment, secondary scarring.
Subject(s)
Humans , Male , Adult , Fingers , Hand , Amputation, Traumatic , Therapeutics , Wounds and Injuries , Conservative TreatmentABSTRACT
La cicatrización de la piel es un proceso complejo y organizado que involucra tres fases: inflamatoria, proliferativa y de remodelación. Es indispensable el análisis de este proceso biomolecularmente para investigar y proponer nuevas estrategias terapéuticas que mejoren la cicatrización o promuevan la regeneración. El objetivo de este proyecto fue analizar histológica y biomolecularmente mediante microespectroscopía infrarroja por transformada de Fourier (MFTIR) y su función de mapeo bioquímico, muestras de lesiones excisionales de piel, comparando los cambios morfológicos y espectroscópicos entre piel sana y piel cicatrizada. Se estandarizó un modelo de lesión excisional de piel en ratones hembra de la cepa NIH de 8 semanas de edad (n=16), provocando una herida excisional de 1 cm2. Se analizó piel sana (día 0) y cicatrizada (día 15 post-lesión) morfométrica, histológica y biomolecularmente mediante análisis fotográfico, técnica histológica y MFTIR con su función de mapeo. El análisis morfométrico demostró una reducción del área de la herida en un 87,6 % al día 15 post-lesión. Histológicamente, en la piel cicatrizada se evidenció un adelgazamiento de la epidermis y menor celularidad en la dermis, observándose la formación de tejido de granulación y fibras de colágena desorganizadas. Espectroscópicamente, se apreciaron cambios entre los dos grupos de estudio, principalmente en las bandas de lípidos y en la región de proteínas. El cálculo de las áreas bajo la curva y el mapeo bioquímico mostraron menor concentración de queratina y colágena en la piel cicatrizada, así como desorganización de las fibras de colágena. Se demostró la capacidad de la MFTIR para caracterizar de forma precisa los cambios biomoleculares en la cicatrización, entre ellos la cantidad de queratina, colágena, y el depósito y ordenamiento de las fibras de colágena asociadas a su maduración.
The skin cicatrization is a complex and organized process that involves three phases: inflammatory, proliferative, and remodeling. It is essential to analyze this process biomolecularly, in order to investigate and propose new therapeutic strategies that improve the healing or promote regeneration. The objective of this project was to analyze histological and biomolecularly through Fourier Transform infrared microspectroscopy (FTIRM) and its biochemical mapping function, samples of an excisional skin wound, comparing the morphological and spectroscopic changes between healthy skin and scarred skin. An excisional skin wound healing model was standardized using female, NIH strain 8-week-old mice (n = 16), provoking an excisional wound of 1 cm2. Healthy skin (day 0) and scarring skin (day 15 post-injury) were morphometrical, histological, and biomolecularly analyzed by digital picture analysis, histological technique, and FTIRM with its mapping function. The morphometric analysis showed a reduction of the wound area of 87.6 % at day 15 after wound. Histologically, in the scarred skin a thinning of the epidermis was evidenced, besides reduced cellularity in the dermis, granulation tissue formation, and disorganized collagen fibers were observed. Spectroscopically, changes between the study groups were appreciated, mainly in the lipid bands and in the protein region. The calculation of the areas under the curve and the biochemical mapping showed a lower concentration of keratin and collagen in the scarred skin, as well as collagen fibers disorganization. The ability of the FTIRM to accurately characterize biomolecular changes in cicatrization process was demonstrated, such as the amount of keratin, collagen, and the deposition and ordering of the collagen fibers associated with their maturation.
Subject(s)
Animals , Female , Mice , Skin/injuries , Wound Healing/physiology , Spectroscopy, Fourier Transform Infrared , Skin/pathology , Skin Physiological Phenomena , Disease Models, AnimalABSTRACT
Aims:To determine the incidence of renal scarring among patients with primary vesicoureteral reflux (VUR) and the possible risk factor(s), we studied 69 children (42 girls and 27boys) with VUR attending the Pediatric opd.Study Design:Prospective Observational study.Place and duration of Study:Department of pediatrics,Sher I Kashmir Institute of Medical Sciences,Srinagar, Kashmir between June 2017 to June 2018.Methodology:All the patients were assessed for VUR grade by voiding cystoureterography and for presence of renal scarring by (99 m) technetium dimercapto–succinic acid scintigraphy. Results:Grade of reflux and number of urinary tract infection (UTI) episodes (≥3) were found to be statistically significant risk factors for renal scarring (P <0.05). However,there was no significant association with gender,familial history and laterality of the disease (P >0.05). Similarly, there was no statistically significant difference of frequency of renal scarring among the different age groups (P >0.05).Conclusions:It was concluded that recurrences of UTI and VUR severity are significant risk factors for renal scarring in children with VUR. Therefore,identification of VUR at an early age may offer the opportunity to prevent episodes of UTI and possible formation of renal scars that may result in end-stage renal failure
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@#AIM: To observe the effects on four effective components of Qingguang'an on collagen fibers, α-smooth muscle actin(α-SMA)and fibronectin(FN)in rabbits after glaucoma surgery.<p>METHODS: Apply four kinds of effective components of Qingguang'an and Qingguang'an Chinese medicine suspension to D, E, F, G, H groups after filtration surgery, and pass with group A(blank control group)and group B(model group)Compared with group C(Mitomycin C group), the effects of four effective components of Qingguang'an and Qingguang'an traditional Chinese medicine suspension on collagen fibers, α-SMA and FN in the scar tissue of glaucoma after filtration were observed.<p>RESULTS: Compare to B group, the ratio of collagen fiber area to E, F, H group, the expressions of α-SMA and the expressions of FN were different(<i>P</i><0.05). <p>CONCLUSION: Qingguang'an effective components 2, Qingguang'an effective components 3, mitomycin C and Qingguang'an suspension reduce the proliferation of myofibroblasts and fibroblasts by inhibiting the expression of collagen fibers, α-SMA and FN, and showed obvious anti-glaucoma staining scar after surgery.
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Filtering bleb scarring is the main cause of glaucoma filtration surgery failure. Subconjunctival injection of antimetabolites, such as mitomycin and 5-fluorouracil, is widely used clinically to reduce the incidence of scarring, which improves the success rate of the surgery. However, accompanied side effects such as cytotoxicity should not be ignored. Secreted protein acidic and rich in cysteine (SPARC) as a matricellular protein is widely distributed in the eyes, which plays an important role in the process of wound repairing and tissue remodeling. The expression of SPARC is significantly elevated in the mouse model of subconjunctival scarring. Researches suggest that SPARC participates in and regulate the formation of bleb scarring through multiple pathways, therefore it may become a specific new target in the anti-scarring therapy.
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Acute pyelonephritis (APN) should be detected and treated as soon as possible to reduce the risk of the development of acquired renal scarring. However, in the medical field, urine culture results are not available or considered when the prompt discrimination of APN is necessary and empirical treatment is started. Furthermore, urine culture cannot discriminate APN among children with febrile urinary tract infection (UTI) (pyelitis, lower UTI with other fever focus). Therefore, the usefulness of urine culture for diagnostic purposes is small and the sampling procedure is invasive. Congenital hypoplastic kidney is the most common cause of chronic kidney injury in children. Thus, it is desirable that a main target be detected as early as possible when imaging studies are performed in children with APN. However, if APN does not recur, no medical or surgical treatment or imaging studies would be needed because the acquired renal scar would not progress further. Therefore, the long-term prognosis of APN in young children, particularly infants, depends on the number of recurrent APN, not other febrile UTI. New methods that enable prompt, practical, and comfortable APN diagnosis in children are needed as alternatives to urinary catheterization for urine culture sampling.
Subject(s)
Child , Humans , Infant , Cicatrix , Diagnosis , Discrimination, Psychological , Fever , Kidney , Methods , Prognosis , Pyelitis , Pyelonephritis , Urinary Catheterization , Urinary Catheters , Urinary Tract InfectionsABSTRACT
Objective To study the effect and mechanisms of chloride channel blocker 5-Nitro-2-(3-phenylpropylamino) benzoic acid (NPPB) on thansforming growth factor β1 (TGF-β1) induced human conjunctival fibroblasts (HConF) fibrosis.Methods Cell counting kit (CCK-8) was used to screen out the optimal TGF-β1 treatment time and the optimal NPPB concentration.The cells were divided into control group,TGF-β1 treatment group and TGF-β1+NPPB group.Cell proliferation and cell cycle were detected by CCK-8 and flow cytometer,respectively.Cell migration ability were observed by scratch and transwell migration assays.Western blot and Real time-PCR were used to detect the expression of collagen Ⅰ (COL-Ⅰ),fibronectin (FN) and α-smooth muscle actin (α-SMA).The phosphorylation level of PI3K and Akt were measured by Western blot.Results TGF-β1 promotes cell proliferation in a time-dependent manner.There was no statistically significant difference in A values between 48 hours and 72 hours after TGF-β1 treatment (P =0.064).Forty-eight hours was selected as the most appropriate time for TGF-β1 treatment.NPPB inhibited HConF cell proliferation in a concentration-dependent manner.Compared with the control group,the proliferation A values of cells in the 50 mol/L and 100 mol/L NPPB groups were significantly reduced (P =0.020,0.000),and 100 mol/L was selected as the optimal concentration of NPPB.The cell proliferation A value,migration area and migration cell number of TGF-β1 +NPPB group were significantly lower than those of TGF-β1 treatment group (all at P＜0.05).Compared with the control group and TGF-β1 +NPPB group,the proportion of G1 phase cells in the TGF-β1 treatment group was reduced,and the proportion of cells in the S phase and G2/M phase were increased,with statistically significant differences between them (all at P ＜ 0.05).The protein and mRNA expression of α-SMA,COL-Ⅰ and FN in the TGF-β1 treatment group were higher than those in the control group and TGF-β1+NPPB group,with statistically significant differences between them(all at P＜0.05);the ratios of p-PI3K/PI3K and p-Akt/Akt in the TGF-β1 treatment group were significantly higher than those in the control group and TGF-β1 +NPPB group,with statistically significant differences between them (all at P＜0.05).Conclusions NPPB may inhibit TGF-β1 induced HConF fibrosis process by inhibiting phosphorylation of PI3K and Akt.
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@#Filtering channels carring and subsequent obstruction are the main cause of operation failure after glaucoma filtration surgery. During the process of scarring, human Tenon fibroblasts are transformed into myofibroblasts and secrete a large amount of extracellular matrixproteins. The derangement of the collagen fiber is also observed. A large number of studies have been carried out by domestic and foreign researchers on the treatment of postoperative filtering channel scarring. In this review we summarize the mechanisms of scar formation after glaucoma filtration surgery and corresponding research progress in recent years.