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BACKGROUND:In recent years,it has been found that some traditional Chinese medicine monomers can alleviate oxidative stress and apoptosis of the skin flap,promote vascular regeneration of the skin flap and prevent skin flap necrosis by activating autophagy. OBJECTIVE:To review the research progress of traditional Chinese medicine monomer regulating autophagy in preventing flap necrosis. METHODS:The Chinese and English key words were"traditional Chinese medicine(TCM),autophagy,skin flaps".The first author searched the relevant articles published in CNKI and PubMed databases from January 2010 to October 2022.A total of 196 articles were retrieved in the preliminary screening and then screened according to the inclusion and exclusion criteria.The quality assessment was conducted by reading the literature titles and abstracts.Finally,55 articles were summarized. RESULTS AND CONCLUSION:(1)The regulation of autophagy is mediated by AMPK/mTOR,PI3K/AKT and other signaling pathways.Activation of autophagy can alleviate the oxidative stress and apoptosis of the flap,promote the regeneration of blood vessels in the flap,and prevent flap necrosis.(2)Terpenoids(Betulinic acid,Andrographolide,Notoginseng Triterpenes,Catalpa),phenolic compounds(Resveratrol,Curcumin,Gastrodin),phenolic acids(Salvianolic acid B)and steroid compounds(Pseudoginsenoside F11)in traditional Chinese medicine monomers can alleviate oxidative stress and apoptosis of skin flap by regulating related signaling pathways to activate autophagy,promote skin flap angiogenesis and promote skin flap survival.(3)Studying the research progress of traditional Chinese medicine monomer to prevent flap necrosis by regulating autophagy can provide a reference and theoretical basis for traditional Chinese medicine to prevent flap necrosis and promote flap healing in the clinic.
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Diabetic ulcer （DU） wound is one of the chronic and serious complications of diabetes characterized by prolonged wound healing， and it is more common in foot and lower extremity ulcers. DU has brought great economic and psychological pressure to patients and seriously affected the quality of life of patients because of its great difficulty in treatment， long treatment process， and high morbidity and mortality. Therefore， how to help the rapid healing of DU wounds， reduce the disability rate and mortality rate， protect limb function， and improve the quality of life is an important topic and hot spot in the field of medical research. The pathogenesis of DU is complex， mainly including microcirculation disorder， peripheral neuropathy， inflammation and infection， and excessive apoptosis of cells， involving physiological processes such as wound inflammation， granulation tissue hyperplasia and re-epithelialization. A large number of previous studies have found that Chinese medicine can regulate phosphatidylinositol 3-kinase/protein kinase B （PI3K/Akt）， Wnt/β-catenin， nuclear factor-κB （NF-κB）， Notch， nuclear factor E2-related factor 2 （Nrf2）， transforming growth factor-β （TGF-β）/Smad， and other signaling pathways， regulate abnormal glucose metabolism， improve microcirculation， inhibit inflammation and oxidative stress， regulate cell proliferation and excessive apoptosis， and promote wound tissue growth to promote the rapid healing of DU wounds under the guidance of treatment based on traditional Chinese medicine （TCM） syndrome differentiation and internal and external treatment. Therefore， this paper reviewed Chinese medicinal monomers or Chinese medicinal compounds in recent years in regulating the above signaling pathways and the expression of key protein molecules and promoting the rapid healing of DU wounds， aiming to provide ideas and a theoretical basis for the in-depth study and clinical application of Chinese medicine in promoting the healing of DU wounds.
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Objective Tandem Mass Tag(TMT)in vitro quantitative proteomics technology was used to study the mechanism of Xiaozhongzhitong Mixture in the treatment of rat skin flap ischemia-reperfusion injury(FIRI).Methods Thirty SD rats were randomly divided into a normal group,a model group,and a Xiaozhongzhitong mixture group(Xiaozhong group),with 10 rats in each group.After intraperitoneal anesthesia,the model group and Xiaozhong group were completely freed with a pedicled skin flap of about 5 cm*6 cm in size on the back to simulate FIRI;the Xiaozhong group was given Xiaozhongzhitong Mixture(1.8 mL·kg-1)by gavage,once a day,the normal group and the model group were given normal saline(1.8 mL·kg-1)by gavage,once a day,and the rats in the three groups were continuously gavaged for 7 days;after 7 days,the dorsal skin flaps of the rats were collected for TMT proteomics analysis,screen out the differential proteins,perform Gene Ontology(GO)enrichment analysis,pathway enrichment(KEGG)analysis,common differential protein analysis,and establish Protein-Protein Interaction(PPI)network analysis.Results In this experiment,a total of 5005 proteins were screened by protein quantification,of which 4996 proteins were identified,and 141 up-regulated and 132 down-regulated differentially expressed proteins were screened out between the detumescence group/model group.GO enrichment analysis found that the differentially expressed proteins were mainly involved in molecular mechanisms such as organism cell metabolism,occurrence and combination of cellular components,catabolism,organelle formation,mitochondria formation,intracellular substance catalysis,molecular binding,hydrolase activation,and nucleotide regulation.KEGG pathway analysis found that the differentially expressed proteins were mainly involved in signaling pathways such as organismal cell metabolism,ribosome transcription and translation,proteasome system,and cell cycle.PPI analysis found that the differentially expressed co-expressed proteins Mrpl32,Psma2,Mrpl34,Psma4,Psmb1,and Srp9 were located at key nodes of the interaction network.Conclusion The treatment of FIRI with Xiaozhongzhitong Mixture may be related to the mitochondrial ribosome-related signaling pathway and the 20S proteasome system signaling pathway,among which the differential proteins Mrpl32,Psma2,Mrpl34,Psma4 and Psmb1 may be the key targets of treatment.
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【Objective】 To observe the effect of Xiaozhongzhitong Mixture on ischemia-reperfusion injury of rat skin flaps and p38MAPK-PPARγ/NF-κB signaling pathway. 【Methods】 After flap operation, the survival of rat back flaps and flap survival rate were observed. HE staining, TUNEL staining, and qRT-PCR were used to detect the degree of nuclear destruction, as well as the distribution characteristics and mRNA expression levels of p38MAPK, PPARγ, and Nf-κB in vascular endothelial cells of rat flaps, respectively. 【Results】 The flap survival area in sham operation group was the largest, and it was the smallest in model control group and PPARγ inhibitor group. HE staining and TUNEL staining results showed that the flap tissue cells of rats in model control group and PPARγ inhibitor group were severely damaged and obvious apoptotic cells were seen. In model group, rats’ skin flap tissue cells were arranged in a single layer, and the nucleus was intact and clear. qRT-PCR experiment results showed that compared with model group, the expressions of p38MAPK and Nf-κb in the flap tissue of rats in Xiaozhong Zhicong Mixture group were inhibited (P<0.05), while the expression of PPARγ was increased (P<0.05). When the blocker was added, the expressions of p38MAPK, NF-κB and PPARγ in the flap tissue were further suppressed. 【Conclusion】 Xiaozhongzhitong Mixture can alleviate the infiltration of inflammatory cells in the rat model of skin flap ischemia-reperfusion injury, reduce inflammation and the production of apoptotic cells, thereby alleviating the ischemia-reperfusion injury of skin flaps and promoting the survival of the flaps. The mechanism may be related to the inhibition of p38MAPK-PPARγ/NF-κB signaling pathway.
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Objective To observe the OCT image characteristics of the posterior cortical anterior vitreous capsular bag (PPVP) in human eyes.Methods A retrospective clinical study.From May 2012 to February 2017,107 PPVP patients (173 eyes) diagnosed by OCT in Ophthalmology Department of The Third People's Hospital of Chengdu were included in the study.One hundred and three eyes underwent examination of frequency-domain OCT (SD-OCT) and 70 eyes underwent examination of frequency-scanning light source OCT (SS-OCT),respectively.SD-OCT the German Heidelberg Spectralis OCT instrument.SS-OCT was performed by the vitreous enhancement scan mode of Japan's Topcon DRI OCT instrument.The differences of different types of PPVP OCT imaging and image characteristics were observed.Results SD-OCT and SS-OCT showed that the PPVP structure was clear and manifested as macular weakly reflective in the shape of a boat-shaped cavity,the front boundary was vitreous collagen,and the rear boundary was vitreous cortex.There was a weakly reflective Martegiani area on the nasal side of PPVP,and there was a connection channels between them.The two examinations showed a similar pattern,but SS-OCT with the clearer imaging of PPVP.Conclusions The OCT image of PPVP in the human eye is characterized by an anterior weakly reflecting boat-shaped cavity in the macula,with anterior border of vitreous collagen and posterior border of vitreous cortex.Martegiani area is located on the nasal side.