Proteomic Analysis of Exudates from Chronic Ulcer of Diabetic Foot Treated with Scorpion Antimicrobial Peptide.

Scorpion peptides have good therapeutic effect on chronic ulcer of diabetic foot, but the related pharmacological mechanism has remained unclear. The different proteins and bacteria present in ulcer exudates from chronic diabetic foot patients, treated with scorpion antimicrobial peptide at different stages, were analyzed using isobaric tags for quantification-labeled proteomics and bacteriological methods. According to the mass spectrometry data, a total of 1865 proteins were identified qualitatively, and the number of the different proteins was 130 (mid/early), 401 (late/early), and 310 (mid, late/early). In addition, functional annotation, cluster analysis of effects and the analysis of signal pathway, transcription regulation, and protein-protein interaction network were carried out. The results showed that the biochemical changes of wound microenvironment during the treatment involved activated biological functions such as protein synthesis, cell proliferation, differentiation, migration, movement, and survival. Inhibited biological functions such as cell death, inflammatory response, immune diseases, and bacterial growth were also involved. Bacteriological analysis showed that Burkholderia cepacia was the main bacteria in the early and middle stage of ulcer exudate and Staphylococcus epidermidis in the late stage. This study provides basic data for further elucidation of the molecular mechanism of diabetic foot.

First known case of successful pressure ulcer treatment in a lung transplant patient with post-COVID-19 pneumonia.

Given the current COVID-19 crisis, multiple clinical manifestations and related complications of COVID-19 disease, especially in lung transplant patients following post-COVID-19 pneumonia, are a major challenge. Herein, we report the therapeutic course of the first reported case of sacrococcyx pressure ulcers (PU) in a 65-year-old male COVID-19 patient who underwent lung transplantation and developed a PU following surgery. We used a combination of regulated negative pressure-assisted wound therapy system (RNPT, six treatment courses, five days per treatment course), a skin tension-relief system (an intraoperative aid in minimising wounds caused by sacrococcygeal PUs) and a gluteus maximus myocutaneous flap to repair sacrococcygeal wounds. This successfully treated case provides a reference point for the treatment of similar cases.

Human α defensins promote the expression of the inflammatory cytokine interleukin-8 under high-glucose conditions: Novel insights into the poor healing of diabetic foot ulcers.

Sustained infection and chronic inflammation are the most common features and complex mechanisms of diabetic foot disease. In this study, we examined the expression and functional roles of human endogenous α defensins in diabetic foot ulcer. The expression levels of human α defensins HNP1, HNP3, and HNP4 were significantly higher in the wound center than the edge of diabetic foot ulcers. And the inflammatory cytokine interleukin IL-8 (IL-8) was also highly expressed in wound exudates. In human foreskin fibroblasts, these human α defensins were found only slightly to affect IL-8 expression directly. hemoglobin A1C (HbA1c) is the main clinical indicator of diabetic foot disease. Advanced glycation end products of bovine serum albumin (AGE-BSA), as HbA1c analogue, was found to promote IL-8 expression. Human α defensins, in the presence of AGE-BSA, further significantly promoted IL-8 expression. These findings showed that human α defensins aggravated the inflammatory response in diabetic foot ulcers patients, providing new insights in to the poor healing of diabetic foot ulcers.

Pulmonary Embolism after Botulinum Toxin Treatment for Leg Muscle Hypertrophy.

Leg muscle hypertrophy is a unique physical symptom in East Asian women. Compared with traditional surgical treatment for calf muscle hypertrophy, botulinum toxin is widely favored by East Asian women because of its minimal trauma and significant effects. We describe the case of a 22-year-old woman with pulmonary embolism because of deep vein thrombosis, who presented with hypertrophy of bilateral calf muscles, and was administered 300 U of botulinum toxin A injection in July 2022. On the third day after the injection, she experienced swelling and pain in her left leg, which gradually worsened and made walking difficult. She underwent an ultrasound examination of lower limbs, which revealed several deep and shallow vein thrombi in the left lower limb. Computed tomography arterial imaging indicated multiple embolisms in pulmonary arteries. This study aimed to explore and analyze the causes of pulmonary embolism after botulinum toxin treatment for calf muscle hypertrophy by reviewing and analyzing the patient's symptoms, diagnosis, and treatment process to provide management strategies for treatment and prevention of this disease.

TopClosure® tension­relief system improves clinical outcomes of patients with breast cancer undergoing mastectomy.

The present randomized controlled study aimed to investigate the effects of TopClosure® tension-relief system (TRS) on patients with breast cancer undergoing mastectomy. A total of 402 female patients with breast cancer who came to the Renmin Hospital of Wuhan University between March 2014 and June 2018 were involved in the present study. All patients receiving mastectomy were randomly divided into the TRS group (n=201) and the control group (n=201). Serum levels of high-sensitivity C-reactive protein, TNF-α, IL-6 and procalcitonin were measured using ELISA. Vancouver Scar Scale was recorded at 2 weeks and 1-3 and 6 months following the operation. The 36-Item Health Survey Scales were performed for all patients at 1 month after surgery. The TRS reduced the incidence of flap necrosis, infection and the duration of hospital stay. In addition, the TRS was found to attenuate inflammation and improve scar outcomes as well as the quality of life. It was concluded that the TRS could significantly improve the clinical outcomes.

PTEN/Akt Signaling-Mediated Activation of the Mitochondrial Pathway Contributes to the 3,3'-Diindolylmethane-Mediated Antitumor Effect in Malignant Melanoma Cells.

3,3'-diindolylmethane (DIM) has an anticancer activity, but the role DIM plays on malignant melanoma cells and its specific mechanism is unclear. We studied the biological effects of DIM on malignant melanoma cells and the related mechanism and the results showed that DIM significantly suppressed cell proliferation and induced apoptosis in malignant melanoma cells. In addition, the expression levels of phosphatase and tensin homolog deleted on chromosome ten (PTEN), Bax, Bid, cleaved caspase-3, and cleaved caspase-9 were increased after DIM treatment. In A2058 PTENmut cells, DIM-mediated inhibition of proliferation and DIM-induced apoptosis were attenuated. Additionally, the overexpression and knockdown of PTEN could regulate such effects of DIM in malignant melanoma cells. Furthermore, DIM exerted growth-inhibiting and apoptosis-inducing effects in vivo. This study demonstrated that DIM has antitumor effect in human malignant melanoma cells through the mitochondrial apoptotic pathway activated by PTEN/Akt signaling.

Functional restoration of penis with partial defect by scrotal skin flap.

PURPOSE: We investigated a reconstructive method with better sensory and erectile function for partial penile defects and report our long-term results of surgical correction using scrotal skin flaps. MATERIALS AND METHODS: We retrospectively analyzed the records of 18 patients with penile defects referred to us between 1992 and 2007. All cases were treated with a scrotal skin flap initially to repair the secondary defect after penile elongation. RESULTS: Of the 18 cases treated during the 15-year period the mechanism of primary injury was circumcision in 3, animal bite in 9 and penile tumor dissection in 6. Penile elongation, division of the suspensory ligament and scrotal skin flaps achieved penile augmentation and enhancement. Six cases were treated with a bilateral scrotal skin flap supplied by the anterior scrotal artery and 12 were repaired with a total anterior scrotal skin flap supplied by the anterior and posterior scrotal arteries. Penile length in the flaccid and erectile states was obviously increased postoperatively (p <0.05). All patients were followed 1 to 9 years (mean 2.3) postoperatively. Deep and superficial sensation recovered and erectile function was retained. Of the 18 patients 15 reported satisfied sexual intercourse during the 0.5 to 5-year followup. CONCLUSIONS: The method of correcting partial penile defect using scrotal skin flaps is effective and simple according to our long-term experience. This method achieves reasonable cosmesis and penile length in most cases with better sensory and erectile function.

Scorpion Venom Active Polypeptide May Be a New External Drug of Diabetic Ulcer.

BACKGROUND: The epidermal growth factor (EGF) is recognized medicine of therapy in ulcer. However, its efficacy has been challenged. We compared scorpion venom active polypeptide and EGF of therapeutic effects in diabetic ulcer. METHODS: The scorpion venom active polypeptide is made into gel. Fourteen diabetic SD rats were randomly divided into scorpion peptide gel group (SPG group) and EGF group. Before treatment, the rat model of diabetic ulcer was created. The levels of IL-1, IL-6, IL-8, and TNF-α in the wound tissue were measured at different time points during the treatment, secretions of wound were collected for bacterial culture, and the wound healing was recorded. RESULTS: Wound healing was faster in SPG group compared to EGF group (3 weeks versus 5 weeks, t-test, p = 0.032). The levels of IL-1, IL-6, IL-8, and TNF-α were not statistically different when the wounds were formed but showed significant differences from the 2nd to the 5th week between two groups. The infection rate was higher in the EGF group (42.86% versus 0, Chi-square test, p = 0.025). CONCLUSIONS: Scorpion venom active polypeptide shortens wound healing with a stronger anti-inflammation and antibacterial effect and may be a new and effective topical drug for the treatment of diabetic ulcers.

Homeobox B9 facilitates hypertrophic scar formation via activating the mitogen-activated protein kinase signaling pathway.

The functions and underlying mechanisms of homeobox B9 (HOXB9) in scar formation remain unclear; therefore, the present study aimed to investigate whether HOXB9 is highly expressed in hypertrophic scar formation. Immunohistochemistry was performed to examine the expression levels of laminin, fibronectin (FN), collagen type I (Col1) and HOXB9 in hypertrophic scar and healthy skin tissues, and in lentivirus­constructed HOXB9­overexpressed or ­silenced fibroblasts (FBs). Reverse transcription­quantitative polymerase chain reaction and western blotting were performed to evaluate the mRNA and protein expression levels of HOXB9, laminin, FN, Col1, extracellular signal­regulated kinase (ERK), c­Jun N­terminal kinase (JNK), p38, p­c­Jun N­terminal kinase (JNK), p­ERK and p­p38. A gel contraction assay was used to evaluate the effect of HOXB9 on FB contraction. Co­immunoprecipitation assays were performed to verify the reciprocal interactions between HOXB9 and ERK, JNK and p38. It was demonstrated that HOXB9, laminin, FN and Col1 were upregulated in hypertrophic scar tissues, and HOXB9 upregulated laminin, FN, Col1, p­ERK, p­JNK and p38, potentially by interacting directly with p38. Furthermore, FBs overexpressing HOXB9 exhibited enhanced contractile capacity. In conclusion, the present study demonstrated that HOXB9 may facilitate hypertrophic scar formation via activating the mitogen­activated protein kinase signaling pathway.

[Reconstruction of the remnant penis: a 52-case report].

OBJECTIVE: To explore the effects of the combined method of abdominal axial flap transposition and penile elongation for the treatment of the remnant penis. METHODS: Fifty-two cases of the remnant penis treated with the combined method from 1984 April to February 2004 were analyzed retrospectively. Follow-up ranged from 0.5 to 20 years postoperatively. RESULTS: The lengths (both in normal and erectile conditions) and the circumferences of the penis gained after operation were (5.6 +/- 1.4) cm, (6.8 +/- 2.5 cm and (6.9 +/- 2.3) cm respectively. The recovery rates of the sensory function were 94.2% and 100% in the glans (immediately and 3 months after operation) and 32.7%, 51.9% and 75% in the flap area (3, 6 and 12 months postoperatively). The two-point distinguishing sense in the glans and the flap area was (5.1 +/- 0.9) mm and(7.9 +/- 1.3) mm 5 years after operation. Early complications included distant flap necrosis (3 cases), disruption of the wound (2 cases), part necrosis of the skin graft in the abdominal wall (2 cases) and poor contours occurred in 4 cases in the later period because of the thickness of the flaps. All of them were corrected with satisfactory results. CONCLUSION: The combined method of abdominal axial flap transposition and penile elongation was recommendable for the treatment of the remnant penis because of its positive effects and less complications.

Early Surgical Management of Large Scalp Infantile Hemangioma Using the TopClosure® Tension-Relief System.

Infantile hemangiomas (IHs) are the most common benign vascular neoplasms of infancy and childhood. The majority do not need medical intervention. However, large ulcerated scalp IHs may lead to fatal bleeding as well as severe cosmetic disfigurement that indicate early surgical excision, inflicting substantial surgical risks, with short- and long-term morbidity.The TopClosure Tension-Relief System (TRS) is an innovative skin stretching and wound closure-secure system that facilitates primary closure of relatively large skin defects. This system has been shown as a substitute for skin grafts, flaps, or tissue expanders.We describe a case of a giant IH of the scalp usually requiring a complex surgical approach, which was immediately primarily closed applying the TRS.A 3-day-old female infant presented with a giant scalp hemangioma at birth that rapidly grew in the neonatal period with early signs of ulceration. The patient underwent surgical resection of the giant scalp hemangioma with immediate primary closure of the defect using the TRS. Surgical procedure and postoperative period were uneventful.Early surgical resections of IHs at infancy carry substantial surgical risks and morbidity. This is the first reported case of early resection of a scalp hemangioma in the neonatal period, with successful immediate primary closure by application of stress-relaxation technique through the TRS. The application of the TopClosure TRS in this age group has significant advantages. It reduces the complexity and length of surgery, reducing blood loss, eliminating donor site morbidity, improving wound aesthetics, and minimizing the need for future reconstructive procedures.

Sleeve Gastrectomy with Modified Jejunoileal Bypass Model in Goto - Kakizaki Rats.

PURPOSE: To develop a non-obese diabetic rat model for sleeve gastrectomy with modified jejunoileal bypass (SG/MJIB) and to investigate its effectiveness and safety for inducing diabetic control. MATERIALS AND METHODS: Thirty-five 13-week-old male Goto-Kakizaki rats were randomly assigned to the pair-fed to sham-operated SG/MJIB (PFSO-SG/MJIB), SG/MJIB, PFSO-SG, SG, and control groups. The experimental period was 16 weeks post-operatively. Body weight; food intake; glycemic control outcomes; and ghrelin, glucagon-like peptide 1 (GLP-1), glucose-dependent insulinotropic peptide (GIP), and insulin levels were measured. RESULTS: The operated and PFSO groups showed significant weight loss 4 weeks post-operatively compared to the control. The SG/MJIB and SG groups exhibited a significant improvement in oral glucose tolerance and insulin tolerance compared to the PFSO and control groups. The improved effects in the SG/MJIB group were better than those in the SG group. The SG/MJIB and SG groups showed decreased fasting ghrelin levels and increased levels of GLP-1 secretion 2 and 16 weeks post-operatively. Compared to the SG group, only the SG/MJIB group showed higher glucose-stimulated GLP-1 levels and significantly improved insulin secretion. CONCLUSION: SG/MJIB may be an effective, steady hypoglycemic surgical model, showing better diabetic control than SG. The hindgut may play a direct role in ameliorating glucose homeostasis.

[Repair and reconstruction of penile defects due to devastating deep burn].

OBJECTIVE: To summarize the experience of repair and reconstruction of penile defects as a result of devastating deep burn. METHODS: Twenty-four patients with penile defects in early or late (a half year after wound healed, the same below) stage after burn were involved. Their suspensory ligaments of penis were dissected to lengthen the penis after escharotomy with the necrotic distal part removed. The wounds formed after lengthening were covered with lower abdominal skin flap, scrotal or internal pudendal artery flap. Ten patients underwent surgery within 30 days after burn; the other 14 patients underwent surgery in the late stage. The condition of flaps and complications after surgery were observed. The lengths of penis of patients in flaccid and erection state were measured before surgery and at follow-up period. The sensory function of penile skin, the erectile function of the penis, and sexual intercourse activity of patients were followed up. RESULTS: All the flaps survived except two, in whom areas of 1.0 cm x 0.5 cm and 1.5 cm x 1.0 cm of necrosis at distal parts were found, and they healed after dressing changes. Patients were followed up for 2 to 5 years. The length of penis in flaccid state was (7.4 +/- 1.6) cm, which was (5.3 +/- 1.4) cm longer than that before surgery (P < 0.01). The length of penis in erection state was (9.7 +/- 1.2) cm. The sensory function of penis recovered gradually about half year after surgery with well preserved erectile function. Except one who did not try to have sexual intercourse again, all the other married patients and their spouses were satisfied or quite satisfied with sexual intercourse activity. CONCLUSIONS: Penis elongation combined with skin flap grafting is a good method for the treatment of penile defects due to devastating deep burn. Suitable length and erectile function of penis can be preserved with this method.

Protective effect of a nuclear factor-kappaB inhibitor on ischemia-reperfusion injury in a rat epigastric flap model.

We examined whether nuclear factor-kappa B (NF-kappaB) activation was involved in the ischemia-reperfusion (I/R) injury in a rat skin flap model and whether administration of pyrrolidine dithiocarbamate (PDTC), a NF-kappaB inhibitor, could improve flap viability. Eighty-four Sprague-Dawley rats were divided into control group (n = 28), I/R group (n = 28), and PDTC-treated group (n = 28). An abdominal skin flap (4 x 5 cm) was elevated and subjected to 10 hours of ischemia in both the I/R group and the PDTC-treated group. A bolus of PDTC (300 mg/kg) was infused 5 minutes before reperfusion, followed by a second dose during the first 30 minutes of reperfusion in the PDTC-treated group. Flap tissues were assessed by electrophoretic mobility shift assay at 1, 2, 3, and 6 hours of reperfusion, and myeloperoxidase activity and neutrophil infiltration were assessed at 12 hours of reperfusion. The viability of flaps was assessed 7 days postoperatively. NF-kappaB was activated after reperfusion in the I/R group and displayed peak activity at 1 and 3 hours of reperfusion. In the PDTC-treated group, NF-kappaB activity was significantly reduced at 1, 2, and 6 hours of reperfusion. Myeloperoxidase activity was significantly decreased, and little neutrophil infiltration could be observed. In the PDTC-treated group, the survival of flaps was 86.88 +/- 13.63%, which was significantly greater than the I/R group, in which only 19.20 +/- 7.52% of the flap survived. NF-kappaB is activated during reperfusion in a rat skin flap I/R model. Administration of PDTC can significantly improve flap survival by regulating the early activation of NF-kappaB and suppressing neutrophil infiltration within the flap.

[Suspending of M. temporal, temporal fascia and parietal periosteum to correct late facial palsy].

OBJECTIVE: To explore a simply, effective dynamical method to correct late facial palsy. METHODS: The method of suspending of M. temporalis, temporal fascia was reformed below: (1) To prolong flap of M. temporalis, temporal fascia by parietal periosteum. (2) To elevate the reversal level of compound flap. (3) To fill depressed temporal area by silica gel piece. RESULTS: The compound flap is united structurally and long enough to transfer. Temporal defect is recontoured. And zygomatic area is no longer protruded. CONCLUSIONS: The reformative method resists defect of the old one and obtains a dynamical result.