Healing an ischial tuberosity pressure ulcer in a patient with neurogenic heterotopic ossification: a case report.

Neurogenic heterotopic ossification (NHO) is widely recognised as an aberrant bone formation in soft tissue following central nervous system injury. It is most frequently associated with pain and limited movement, especially in the hip. However, it may be neglected in patients with paraplegia with a pressure ulcer (PU). We report the case of an 18-year-old male patient who presented with a hard-to-heal ischial tuberosity PU and who had undergone three operations at other hospitals during the previous six months, which had failed to repair the PU. There was a history of paraplegia as a consequence of spinal cord injury two years previously. Computed tomography and three-dimensional reconstruction showed massive heterotopic ossification (HO) in the wound bed and around the right hip. Histological findings were consistent with a diagnosis of HO. The HO around the wound was completely excised, negative pressure wound therapy was used to promote granulation, and a gluteus maximus musculocutaneous flap was used to cover the wound. We conclude that for patients with paraplegia, with a hard-to-heal PU, it should be determined whether it is associated with NHO. Surgical resection of HO surrounding the wound and improving the microcirculation are critical for repair and reconstruction of these PUs.

Polyphyllin VII induces fibroblasts apoptosis via the ERK/JNK pathway.

Hypertrophic scar (HS) is a pathological scar that often occurs in burn patients. Its histology is characterized by the excessive proliferation of fibroblasts (FB) and excessive accumulation of extracellular matrix (ECM). Inhibition of proliferation and activation of FB is essential for the treatment of HS. The crude extracts of traditional Chinese medicines have beneficial therapeutic effects on HS besides possessing fewer side effects and being easily available. Polyphyllin VII (PP7) is an isoprene saponin isolated from Rhizoma paridis. It has a pro-apoptotic effect on cancer cells. In the present study, we demonstrate that PP7 exerts a significant inhibitory effect on hypertrophic scar fibroblasts (HSFs) in vitro. We also demonstrate that PP7 considerably induces the apoptosis of HSFs and inhibits their activity. Our data show that the PP7-induced HSFs cell apoptosis was mainly due to the enhanced expression of apoptotic genes (Bax, Caspase-3, Caspase-9) and decreased expression of Bcl-2. Moreover, PP7 treatment also enhances the expression of JNK, but that of extracellular protein kinases (ERK) was reduced, and induces apoptosis through ERK/JNK pathways. Thus, PP7 can be used as a drug to prevent the formation of HS.

LncRNA COL1A2-AS1 inhibits the scar fibroblasts proliferation via regulating miR-21/Smad7 pathway.

lncRNA COL1A2-AS1 (COL1A2 antisense RNA 1), a lncRNA overexpressed in hypertrophic scar, has been demonstrated to be involved in the hypertrophic scar formation. However, the mechanisms of lncRNA COL1A2-AS1 inhibiting the scar fibroblasts proliferation remains not well understood. In this study, we demonstrated that lncRNA COL1A2-AS1 was upregulated in hypertrophic scar tissue and fibroblasts, and suppressed fibroblasts proliferation by promoting Smad7 expression. Furthermore, we found that miR-21 was involved in lncRNA COL1A2-AS1-induced expression of Smad7, by which COL1A2-AS1 acted as endogenous sponge to adsorb miR-21 and in turn regulated Smad7 and a cascade of molecular to play a protective role in hypertrophic scar. In addition, overexpression of miR-21 attenuated COL1A2-AS1-mediated proliferation suppression of hypertrophic scar fibroblasts. In conclusion, our study demonstrated that COL1A2-AS1/miR-21/Smad pathway plays an important role in inhibiting hypertrophic scar formation, and suggested this novel pathway may be a new target for hypertrophic scar treatment.

[Experimental study on effect of hirudin in inhibiting hyperplastic scar fibroblasts].

OBJECTIVE: To study the effect of hirudin on the function of human hyperplastic scar fibroblasts (HSFBs). METHODS: HSFBs were cultured in vitro. Hirudin solution in the concentration of 1, 10, and 50 kU/L was respectively added into DMEM culture medium to form 1, 10, and 50 kU/L hirudin groups, with 9 wells in each group. HSFBs cultured without hirudin were set up as control group. Cell inhibition rate, secretion level of TGF-beta1 from cells, and expression levels of mRNA of type I and III precollagen were determined at 24, 48, and 72 h after culture. RESULTS: Inhibition rates of HSFBs growth was respectively (29.3 +/- 0.9)%, (30.1 +/- 0.3)%, and (45.2 +/- 1.9)% when cultured with 10 kU/L hirudin for 24, 48, and 72 hs, which were higher than those in control group [(0.0 +/- 0.0)%, P < 0.05]. There was statistically significant difference between control group and 1 and 50 kU/L hirudin groups in the inhibition rates of HSFBs at some time points (P < 0.05). Secretion level of TGF-beta1 of HSFBs in 1, 10, 50 kU/L hirudin groups was respectively (228.5 +/- 1.8), (210.5 +/- 11.1), and (168.5 +/- 14.1) pg/mL when cultured for 48 hs, of which the last 2 figures were significantly lower than that of control group [(265.0 +/- 1.5) pg/mL, P < 0.05]. Hirudin in the concentration of 10 and 50 kU/L could inhibit the expression of mRNA of type I and III precollagen in HSFBs. CONCLUSIONS: Hirudin solution in the concentration of 10 and 50 kU/L can inhibit the proliferation of HSFBs and secretion of TGF-beta1 and collagen in certain degree.

Proliferation hemangiomas formation through dual mechanism of vascular endothelial growth factor mediated endothelial progenitor cells proliferation and mobilization through matrix metalloproteinases 9.

Infantile hemangioma is the most common tumor of infancy and the mechanism leading to proliferation hemangiomas formation is poorly understood and currently no successful treatment modality exists. We hypothesize that EPCs formed during proliferation hemangiomas, as the result of vascular endothelial growth factor (VEGF) stimulation through MMP9, play the major role in the control of cell proliferation and capillary-like vessels production. Accepting the hypothesis to be correct, a therapy that inhibits EPC mobilization and proliferation can be used to prevent the proliferation hemangiomas formation. Current therapies are only partially effective and safe because they could not eliminate all the relative factors of proliferation hemangiomas formation at all, such as: EPCs in the peripheral blood, and at the same time inducing death (apoptosis and necrosis) of other normal cells. A more efficient prevention of proliferation hemangiomas could be achieved using specific drugs or biologic methods that inhibit EPC mobilization and proliferation. Therapy based on gene therapy, capable to specifically inhibit VEGF and MMP9 expression in gene level, can be possibly effective.

[Design of myocutaneous flap with color Doppler flow imaging technique for breast reconstruction in breast cancer after operation and radiotherapy].

OBJECTIVE: To investigate the method and effect of axial pattern myocutaneous flap in reconstructing breast by using color doppler flow imaging (CDFI) technique. METHODS: Suitable axial myocutaneous flaps were selected according to the character of the focus in 26 cases of breast cancer after operation and radiotherapy. All the axial pattern myocutaneous flaps were designed on the basis of traditional design method before operation; then, CDFI with high resolution was used to examine the starting spot, exterior diameter, trail and length of the myocutaneous flaps' major artery. The myocutaneous flaps were redesigned according to the results of CDFI and transferred to reconstruct the breasts. The results of operation and examination were investigated. RESULTS: According to the CDFI, only one thoracodorsal artery's blood current was slow, its wall was rough and presented with arteriosclerosis. The blood flow was fluent and the vessel wall was smooth with other supplying arteries in the flaps. And no embolism, sclerosis or absence of blood vessel was found. The starting spots, exterior diameters, trails and anatomic layers of the major supplying arteries of the flaps were displayed clearly with CDFI, in accordance with the results of operation. Twenty-one cases of latissimus dorsi myocutaneous flap, 4 cases of the contralateral transverse abdominis myocutaneous flap and 1 cases of the bilateral transverse abdominis myocutaneous flap were used in this group. The flaps survived and healed well, the breasts were reconstructed well with perfect appearance, shape and sensation. CONCLUSIONS: CDFI is a simple, visualized and noninvasive method for designing the axial pattern myocutaneous flap in breast reconstruction, it can provide more scientific and accurate evidence for preoperative determination of myocutaneous flap transplantation.

[Clinical analysis of abdominal compartment syndrome in patients with serious burn injury].

OBJECTIVE: To summarize the clinical management of abdominal compartment syndrome (ACS) in burn patients with severe burn injury. METHODS: Twelve serious burn patients with abdominal compartment syndrome hospitalized in our center from January 2001 to April 2005 were enrolled in the study. Among them 3 patients were treated with conservative method, 4 with escharectomy of abdominal wall, 5 with laparotomy for decompression. The clinical results were analyzed statistically. Bladder pressure, central venous pressure, systolic blood pressure and arterial blood oxygen partial pressure (PaO2 ) were measured and compared before and after operation. RESULTS: Among these 12 patients, 5 died with the overall mortality of 41.67%. But only 3 died among 9 patients undergone operation. Most of patients were oliguric,with abnormal bladder pressure, central venous pressure, and systolic blood pressure 24 hours before operation. But these parameters were significantly improved after operation ( P <0. 01). CONCLUSION: Early abdominal escharectomy and timely abdominal decompression are vital for the management of ACS in burn patients.

[An investigation of bacterial ecology and analysis of bacterial resistance to antibiotics in a burn ward in Nanning district].

OBJECTIVE: To investigate the changes in the bacterial ecology and to analyze the bacterial resistance to antibiotics in a burn ward in Nanning district during the past 15 years, so as to provide reference to the clinical management of burn infection under subtropical climate. METHODS: Five thousand eight hundred and fifty-five strains of bacteria were isolated from the wounds and blood of 2269 burn patients admitted to our hospital from April of 1989 to March of 2004. Kiry-Bauer method was employed for the detection of antibiotic sensitivity test. The bacterial examination and bacterial resistance were analyzed in spans of every five years. RESULTS: Burn patients in our district were mainly infected by the gram negative bacilli (3559 strains, accounting for 60.79%), among which Pseudomonas aeruginosa, Enterobacter cloacae and Nitrate negative bacilli were major ones in every period. Gram positive cocci accounted for 33.99% (1990 strains), which ranked the second, among which Staphylococcus aureus, Staphylococcus epidermidis, and Coagulase negative staphylococci (MRCNS) were the most predominant ones. The bacterial resistance to multiple antibiotics, such as Gentamicin, third generation of Cephalosporin, and Norfloxacin showed a tendency of increase or maintained at high level while the incidence of resistance to Imipenem and Vancomycin was very low. CONCLUSION: The climate and the way of using antibiotics exerted direct effects on the status of the bacterial ecology and change in bacterial resistance to various antibiotics.

[Design of axial flaps with color Doppler flow imaging technique].

OBJECTIVE: To study the effect of the color doppler flow imaging (CDFI) technique in the design of the axial pattern flap. METHODS: From March 1996 to June 1999, ten patients were included in this study. Among them, there were seven males and three females. Their defects ranged from 6 cm x 8 cm to 15 cm x 20 cm. Before operation, an axial flap was designed by the traditional method. Then CDFI technique of high frequency (5.0-7.5 MHz) was used to examine the major arterial supply of the flap and modify the design accordingly. At last, the modified flap was transferred to cover the defect. RESULTS: All the patients except one underwent the operation successfully. The cosmetic and functional results of the flap were excellent. CONCLUSION: CDFI is a simple, direct and accurate method for detecting the vascular supply of an axial pattern flap. This technique should be popularized to avoid blindness of flap design.