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1.
Microsurgery ; 2021 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-34536298

RESUMO

BACKGROUND: Unintentional swallowing of corrosive agents cause problems in the pediatric population. Swallowing dysfunction can be seen after injuring the pharynx and/or epiglottis which leads to the obstruction of esophagus. An algorithm was established taking into account the injury to the epiglottis and restoring gastrointestinal continuity with isolated or combine free and or supercharged jejunum flap, or supercharged colon transposition flap. METHODS: Seventeen patients between the ages of 3 and 16 (mean age: 7.7) were treated between 1985 and 2019. Three different procedures were performed based on endoscopic findings; for patients with no or minimal damage to epiglottis, pedicled colon transposition was done in 12 cases. For patients with epiglottic scarring or edema, a two-stage reconstruction was performed. In the first stage, free jejunum flap was implemented to the pharynx to facilitate food passage, followed by a pedicled jejunum in two cases, or a pedicled colon transposition in two cases to provide gastrointestinal continuity. For one patient with severe epiglottic scarring, a free jejunal flap was used as a diversion conduit in the first stage, followed by supercharged colon transposition to restore gastrointestinal continuity. RESULTS: Supercharged intestinal flaps were harvested with 3-4 cm of extra intestinal tissue than the measured thoracic portion in each individual in order to reach the hypopharyngeal region. The size of the free jejunal flaps were 10 cm. Oral feeding was initiated on the eighth postoperative day. Partial loss of the anterior wall of the jejunal flap was seen in one case, in which a free anterolateral thigh-vastus lateralis musculocutaneous flap was used for reconstruction. The mean follow-up time was 5.1 years and there was no stricture in the final outcome. CONCLUSION: A competent epiglottis is essential for proper swallowing reflex. Meticulous microsurgical dissection and performing supercharged intestinal flaps provide a complication-free end result.

2.
Int J Mol Sci ; 22(16)2021 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-34445516

RESUMO

In this study, we prepared core-sheath nanofiber membranes (CSNFMs) with silver nanoparticles (Ag NPs) embedding in the polylactic acid (PLA) nanofiber sheath and hyaluronic acid (HA) in the nanofiber core. The PLA/Ag NPs sheath provides mechanical support as well as anti-bacterial and anti-inflammatory properties. The controlled release of HA from the core could exert anti-adhesion effects to promote tendon sliding while reducing fibroblast attachment. From the microfibrous structural nature of CSNFMs, they function as barrier membranes to reduce fibroblast penetration without hampering nutrient transports to prevent post-operative peritendinous adhesion. As the anti-adhesion efficacy will depend on release rate of HA from the core as well as Ag NP from the sheath, we fabricated CSNFMs of comparable fiber diameter, but with thick (Tk) or thin (Tn) sheath. Similar CSNFMs with thick (Tk+) and thin (Tn+) sheath but with embedded Ag NPs in the sheath were also prepared. The physico-chemical properties of the barrier membranes were characterized in details, together with their biological response including cell penetration, cell attachment and proliferation, and cytotoxicity. Peritendinous anti-adhesion models in rabbits were used to test the efficacy of CSNFMs as anti-adhesion barriers, from gross observation, histology, and biomechanical tests. Overall, the CSNFM with thin-sheath and Ag NPs (Tn+) shows antibacterial activity with low cytotoxicity, prevents fibroblast penetration, and exerts the highest efficacy in reducing fibroblast attachment in vitro. From in vivo studies, the Tn+ membrane also shows significant improvement in preventing peritendinous adhesions as well as anti-inflammatory efficacy, compared with Tk and Tn CSNFMs and a commercial adhesion barrier film (SurgiWrap®) made from PLA.


Assuntos
Antibacterianos/administração & dosagem , Ácido Hialurônico/administração & dosagem , Poliésteres/química , Prata/química , Traumatismos dos Tendões/tratamento farmacológico , Células 3T3 , Animais , Antibacterianos/química , Antibacterianos/farmacologia , Proliferação de Células/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Modelos Animais de Doenças , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Positivas/efeitos dos fármacos , Ácido Hialurônico/química , Ácido Hialurônico/farmacologia , Nanopartículas Metálicas , Camundongos , Testes de Sensibilidade Microbiana , Nanofibras/química , Espectroscopia Fotoeletrônica , Coelhos , Traumatismos dos Tendões/cirurgia , Aderências Teciduais/prevenção & controle
3.
Artigo em Inglês | MEDLINE | ID: mdl-34320594

RESUMO

BACKGROUND: Performing ablative surgery using an laparoscope is a common practice. However, its use in the harvest of a segment of intestine for reconstruction has 2 major challenges: risk of damage to the vascular pedicle of the flap as well as to the vessels of other parts of the intestine that remain in the peritoneal cavity and risk of damage to the intestinal flap while pulling it out through a small opening in the abdominal wall. The aim of this study was to report advantages and disadvantages of harvesting free intestinal flaps using the laparoscopic method, explaining the challenges faced and lessons learned from this experience. PATIENTS AND METHODS: Free intestinal flaps were harvested by laparoscopy in 12 patients aged 28 to 63 years. There were 9 free jejunal flaps for the reconstruction of the cervical esophagus and 3 ileocolic flaps for the reconstruction of both the cervical esophagus and voice reconstruction. RESULTS: In 1 patient, laparoscopy was converted to laparotomy due to previous colectomy, which resulted in compromised circulation to the rest of the colon. One jejunal flap had leakage at its pharyngeal end; therefore, a pectoralis major myocutaneous flap was used for closure. In addition, 1 ileocolic flap had partial loss of its anterior wall, and a free anterolateral flap was used as a patch for closure. Furthermore, it was very difficult to harvest 1 free jejunal flap due to the thick and fat mesentery. CONCLUSION: Prolonged operative times, unexpected leakage at the anastomosis sites, partial loss of flaps, possible risk of vascular pedicle damage or venous compromise, demanding pedicle dissection in obese patients, and requirement of conversion to laparotomy are the major drawbacks of harvesting free intestinal flaps by laparoscopy.

5.
Front Immunol ; 12: 638381, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33868265

RESUMO

While oxidative stress has been linked to multiple sclerosis (MS), the role of superoxide-producing phagocyte NADPH oxidase (Nox2) in central nervous system (CNS) pathogenesis remains unclear. This study investigates the impact of Nox2 gene ablation on pro- and anti-inflammatory cytokine and chemokine production in a mouse experimental autoimmune encephalomyelitis (EAE) model. Nox2 deficiency attenuates EAE-induced neural damage and reduces disease severity, pathogenic immune cells infiltration, demyelination, and oxidative stress in the CNS. The number of autoreactive T cells, myeloid cells, and activated microglia, as well as the production of cytokines and chemokines, including GM-CSF, IFNγ, TNFα, IL-6, IL-10, IL-17A, CCL2, CCL5, and CXCL10, were much lower in the Nox2-/- CNS tissues but remained unaltered in the peripheral lymphoid organs. RNA-seq profiling of microglial transcriptome identified a panel of Nox2 dependent proinflammatory genes: Pf4, Tnfrsf9, Tnfsf12, Tnfsf13, Ccl7, Cxcl3, and Cxcl9. Furthermore, gene ontology and pathway enrichment analyses revealed that microglial Nox2 plays a regulatory role in multiple pathways known to be important for MS/EAE pathogenesis, including STAT3, glutathione, leukotriene biosynthesis, IL-8, HMGB1, NRF2, systemic lupus erythematosus in B cells, and T cell exhaustion signaling. Taken together, our results provide new insights into the critical functions performed by microglial Nox2 during the EAE pathogenesis, suggesting that Nox2 inhibition may represent an important therapeutic target for MS.


Assuntos
Encefalomielite Autoimune Experimental/metabolismo , Microglia/metabolismo , NADPH Oxidase 2/metabolismo , Estresse Oxidativo/fisiologia , Animais , Encefalomielite Autoimune Experimental/imunologia , Encefalomielite Autoimune Experimental/patologia , Camundongos , Camundongos Endogâmicos C57BL , NADPH Oxidase 2/imunologia
7.
Proc Natl Acad Sci U S A ; 118(11)2021 03 16.
Artigo em Inglês | MEDLINE | ID: mdl-33688047

RESUMO

The mosquito protein AEG12 is up-regulated in response to blood meals and flavivirus infection though its function remained elusive. Here, we determine the three-dimensional structure of AEG12 and describe the binding specificity of acyl-chain ligands within its large central hydrophobic cavity. We show that AEG12 displays hemolytic and cytolytic activity by selectively delivering unsaturated fatty acid cargoes into phosphatidylcholine-rich lipid bilayers. This property of AEG12 also enables it to inhibit replication of enveloped viruses such as Dengue and Zika viruses at low micromolar concentrations. Weaker inhibition was observed against more distantly related coronaviruses and lentivirus, while no inhibition was observed against the nonenveloped virus adeno-associated virus. Together, our results uncover the mechanistic understanding of AEG12 function and provide the necessary implications for its use as a broad-spectrum therapeutic against cellular and viral targets.


Assuntos
Antivirais/metabolismo , Hemolíticos/metabolismo , Proteínas de Insetos/metabolismo , Lipídeos , Animais , Antivirais/química , Antivirais/farmacologia , Linhagem Celular , Membrana Celular/metabolismo , Culicidae , Eritrócitos/efeitos dos fármacos , Ácidos Graxos Insaturados/metabolismo , Hemolíticos/química , Hemolíticos/farmacologia , Humanos , Interações Hidrofóbicas e Hidrofílicas , Proteínas de Insetos/química , Proteínas de Insetos/farmacologia , Ligantes , Lipídeos/química , Ligação Proteica , Estrutura Terciária de Proteína , Envelope Viral/metabolismo , Vírus/efeitos dos fármacos , Vírus/metabolismo
8.
Microsurgery ; 41(3): 223-232, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33624866

RESUMO

BACKGROUND: Fibula osteocutaneous flap is associated with a higher rate of reexploration in mandible reconstruction due to limited space for the fixation of various tissue components on multiple segments of the fibula flap. To maintain optimal circulation to the flap and to prevent negative outcomes because of partial or total flap loss, we shared our experiences on salvaging the free fibula flap with vascular compromise in the first reexploration and we developed an algorithm. METHODS: From 1992 to 2018, 12 patients between the ages of 48 to 63 (mean: 52.5) who had presented with oral squamous cell carcinoma (n = 10) followed by osteoradionecrosis of the mandible (n = 2) were explored. The operative findings were; (1) occlusions of vein (3 cases); (2) occlusions of artery (4 cases); and (3) occlusions of both artery and vein (5 cases). After correcting the kinking or evacuating the hematoma, the arterial inflow was initially reestablished by anterograde flow. If this was nonfunctional, retrograde flow from the distal end of the peroneal artery was provided. For the vein, anterograde venous drainage was reestablished. If the thrombus extended deep into the peroneal vein, regular venous return was blocked on the anterograde side, and the flap remained congested therefore retrograde venous drainage was performed regardless of the valves in the vein. However, the two ends of the peroneal artery were anastomosed to prevent thrombosis of the artery. RESULTS: The success rate of revised cases was 75% (9/12). All failed cases had presented with both artery and vein occlusion (three cases). Pectoralis major musculocutaneous flap and anterolateral thigh flap were needed for the external surface in two cases. Skin graft was required for seven cases to restore intraoral lining. Six patients underwent dental rehabilitation with prosthetic implants. CONCLUSION: Immediate reexploration is mandatory to salvage the flap.


Assuntos
Carcinoma de Células Escamosas , Retalhos de Tecido Biológico , Neoplasias Bucais , Procedimentos Cirúrgicos Reconstrutivos , Algoritmos , Carcinoma de Células Escamosas/cirurgia , Fíbula/cirurgia , Humanos , Mandíbula/cirurgia , Pessoa de Meia-Idade , Neoplasias Bucais/cirurgia
9.
Ann Plast Surg ; 86(2S Suppl 1): S102-S107, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33438959

RESUMO

BACKGROUND: The prognosis of high ulnar nerve injury is poor despite nerve repair or grafting. Anterior interosseous nerve (AIN) transfers provide a satisfactory recovery. However, the efficacy of end-to-side (ETS) AIN transfer and optimal timing in Sunderland grade IV/V of high ulnar nerve injury is lacking. OBJECTIVE: The goals were to compare the outcomes of high ulnar nerve injury managed with ETS AIN transfers with those managed with conventional procedures (nerve repair or graft only) and identify differences between early and delayed transfers. METHODS: Patients with isolated high ulnar nerve injury (Sunderland grade IV/V) from 2010 to 2017 were recruited. Patients with conventional treatments and AIN transfers were designated as the control and AIN groups, respectively. Early transfer was defined as the AIN transfer performed within 8 weeks postinjury. Outcomes were measured and analyzed by the British Medical Research Council (BMRC) score, grip strength, and pinch strength. RESULTS: A total of 24 patients with high ulnar nerve injury (Sunderland grade IV/V) were included. There were 11 and 13 patients in the control and AIN groups, respectively. In univariate analysis, both early and delayed AIN transfers demonstrated significantly better motor recovery among BMRC score and strength of grip and pinch at 12 months (P < 0.05). No statistical significance was found between early and delayed transfer. In multivariate analysis, both early and delayed transfers were regarded as strong and independent factors for motor recovery of ulnar nerve. Compared with the control, early [odds ratio (OR), 1.83; P < 0.001] and delayed (OR, 1.59; P < 0.001) transfers showed significant improvement with regard to BMRC scores. The pinch strength in early (OR, 31.68; P < 0.001) and delayed (OR, 26.45; P < 0.001) transfers was also significantly better. CONCLUSION: The ETS AIN transfer, in either early or delayed fashion, significantly improved intrinsic motor recovery in high ulnar nerve injuries classified as Sunderland grade IV/V. The early transfer group demonstrated a trend toward better functional recovery with less downtime.


Assuntos
Transferência de Nervo , Neuropatias Ulnares , Antebraço , Força da Mão , Humanos , Nervo Ulnar/cirurgia , Neuropatias Ulnares/etiologia , Neuropatias Ulnares/cirurgia
10.
Ann Plast Surg ; 86(3S Suppl 2): S299-S311, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33443882

RESUMO

BACKGROUND: Sonoelastography (SEL) is widely used for assessing tissue stiffness and pathophysiology. It has also been used to diagnose carpal tunnel syndrome (CTS). However, the current criteria to diagnose CTS in SEL are diverse. The aim of this study was to systematically review the literature and assess the diagnostic value of SEL for CTS. METHODS: A literature review was performed using MEDLINE (PubMed), EMBASE, and the Cochrane Collaboration Library for primary research articles using the keywords sonoelastography and carpal tunnel syndrome. Data related to diagnostic and cutoff value were extracted. Bias assessment was performed. RESULTS: A total of 121 publications were reviewed. Nineteen primary case series met the inclusion criteria and were selected for full analysis. Different diagnostic approaches were identified, with units/expressions including kilopascals, conduct velocity, and strain ratio. The kilopascals and conduct velocity were measured using shear wave elastography, whereas strain ratio was calculated by relative compression quantification. A mean shear modulus cutoff value from 38.25 to 86 kPa and an acoustic radiation force impulse cutoff value of 3.0 to 3.23 m/s were used to diagnose CTS. Eight articles reported strain ratio between the median nerve and nearby tissues with diverse results due to different reference points. The other 3 additional diagnostic values were reported. CONCLUSIONS: Sonoelastography is a useful noninvasive and promising modality to diagnose CTS. It may reflect both the condition of soft tissue scarring and quantitative values for CTS and median nerve stiffness. A diversity of examination values was found in different modalities. A high level of evidence was absent.


Assuntos
Síndrome do Túnel Carpal , Técnicas de Imagem por Elasticidade , Síndrome do Túnel Carpal/diagnóstico por imagem , Humanos , Nervo Mediano
12.
Microsurgery ; 41(1): 34-43, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32845534

RESUMO

BACKGROUND: There is no consensus on the appropriate treatment of lymphedema. Proposed techniques include lymphaticovenous anastomosis (LVA), vascularized lymph nodes transfer (VLNT), and suction lipectomy (SL). The benefit of combined procedures has also been postulated. In this prospective study, a combined protocol is proposed as an alternative to single-procedure strategies. METHODS: Between January 2016 and October 2018, we enrolled patients with secondary lymphedema of lower limbs, stage II-III according to the International Society of Lymphology, progressive swelling and skin tonicity >60. Thirty-seven consecutive patients were dichotomized into group I, undergoing VLNT, and group II undergoing VLNT and LVA. Gastroepiploic lymphnode flap was harvested through laparoscopy, and in the same operation, LVAs were performed in group II on the basis of indocyanine green lymphography and patent blue findings. Two weeks later, SL was performed in all the patients. Patients were prospectively evaluated through clinical examination, circumference measurement, and skin tonicity. RESULTS: The average follow-up was 2 ± 0.8 years. The first consecutive 21 patients were treated with VLNT followed by SL. The next 16 patients underwent combined VLNT and LVA, followed by SL. A mean of 2.4 LVAs were performed. A significant difference in the postoperative circumference measurements was found overall (p < .05): 52.6 ± 18.9 above the knee, 42.9 ± 25 below the knee, 36.2 ± 37 at foot. The postoperative tonicity dropped by 12.7 ± 6.3% (p < .05). The episodes of cellulitis significantly decreased to 0.1 ± 0.3 (p < .05). CONCLUSIONS: LVA, VLNT, and SL can be integrated together in a combined approach, in synergy to enhance the outcomes.

13.
J Plast Reconstr Aesthet Surg ; 74(1): 101-107, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32873529

RESUMO

BACKGROUND: Colon interposition for total esophageal replacement cases represents one of the most challenging procedures in surgery. A retrospective study has been conducted and suggestions are proposed according to the analysis of 268 patients who underwent colon interposition for esophageal replacement. Complication rates and the duration of hospital stay were retrospectively analyzed. METHODS: A total of 268 patients were operated between 1984 and 2018. In group 1, 164 patients underwent colon interposition without supercharging with neck vessels and in group 2, 104 patients underwent colon interposition with supercharging. Data regarding flap loss, anastomotic leakage, the duration of hospital stay, and stricture formation in the long-term were statistically analyzed and compared between two groups. RESULTS: The success rate of reconstruction was 98,1% (161 of 164 patients) and 99% (103 of 104 patients) for group 1 and 2, respectively. Early complication (anastomotic leakage) rate was 4,9% in group 1 and 1% in group 2. The differences between two groups regarding flap loss and anastomotic leakage rates were not statistically significant (p = 0,495 and p = 0,077, respectively). The hospital stay was 26,3 days for patients without supercharging (group1) and 20,5 days for patients with supercharging (group 2). In group 1, 6,7% (11/164) of patients had narrowing at the junction of the pharynx and colon; however, in group 2, proximal anastomotic stricture formation was observed in only 1% (1/104) of the patients. The stricture rate was significantly lower in group 2 when compared to group 1 (p = 0,021). CONCLUSION: The careful dissection of the marginal artery and supercharging with neck vessels provide lower complication rates in colon interposition for esophageal reconstruction.


Assuntos
Autoenxertos/irrigação sanguínea , Colo/transplante , Esofagoplastia/efeitos adversos , Esofagoplastia/métodos , Esôfago/cirurgia , Adolescente , Adulto , Idoso , Fístula Anastomótica/etiologia , Autoenxertos/patologia , Constrição Patológica/etiologia , Dissecação/métodos , Feminino , Sobrevivência de Enxerto , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pescoço/irrigação sanguínea , Estudos Retrospectivos , Transplante Autólogo/efeitos adversos , Transplante Autólogo/métodos , Adulto Jovem
14.
Asian J Surg ; 44(1): 169-173, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32513633

RESUMO

OBJECTIVE: In the conventional Charles' procedure for lower-limb lymphedema, full-thickness skin grafts (FTSGs) or flaps are the preferred treatment for areas around the knee and ankle because of the belief that FTSGs or flaps result in slighter contracture relative to split-thickness skin grafts (STSGs). However, the use of FTSGs or flaps prolongs operation and increases the risk of partial graft loss; should partial graft loss occur, additional grafting is required for remnant defects to avoid significant scarring after secondary healing. The senior author (HCC) thus modified the Charles' procedure and used STSGs around the knee and ankle. The aim of this study was to elucidate the long-term outcomes of STSGs in HCC-modified Charles' procedure, including its attendant complications, such as joint contracture, range-of-motion limitations, and the presence of hypertrophic scars. METHODS: Participants were patients (n = 142) who underwent HCC-modified Charles' procedure and STSGs between 1990 and 2016 for advanced lymphedema; the follow-up was at least 3 years. We detail our modification for improving the take of STSGs in the first operation and the rehabilitation protocol. RESULTS: The active flexion of knee was >90° in 89.4% and 70°-90° in 10.6% of patients. The active plantar flexion of ankle was 30° in 90.8% and 20°-30° in 9.2% of patients. In Stiefel Grading System, 85.9% were "Excellent," 12.0% were "Good," 2.1% were "Fair," and 0 were "Poor." CONCLUSION: STSGs in HCC-modified Charles' procedure yield satisfactory outcomes without joint contracture. Early physiotherapy and the primary take of STSGs are crucial to good functional outcomes.


Assuntos
Articulação do Tornozelo/cirurgia , Articulação do Joelho/cirurgia , Linfedema/cirurgia , Transplante de Pele/métodos , Adolescente , Adulto , Idoso , Cicatriz Hipertrófica/epidemiologia , Cicatriz Hipertrófica/etiologia , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Linfedema/fisiopatologia , Linfedema/reabilitação , Masculino , Pessoa de Meia-Idade , Modalidades de Fisioterapia , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Transplante de Pele/efeitos adversos , Retalhos Cirúrgicos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
15.
J Plast Reconstr Aesthet Surg ; 74(1): 168-173, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32900654

RESUMO

The aim of this study was to compare the incidence of infection and verrucous hyperkeratosis in patients who underwent surgery for advanced lymphedema according to the algorithm designed by the senior author, and were treated concurrently with/without toe treatment. A case series (Between 2004-2015) of 46 patients with unilateral advanced lower limb lymphedema was reviewed. Lymphoscintigraphy was used for evaluation of lymphedema severity. The ICG lymphography was used for staging. Fibrosis and skin induration were reflected by the tonicity. They were divided into two groups: (1) patients who underwent further treatment of toes according to the algorithm, and (2) patients who did not have toe-related treatment. Infection episodes and verrucous hyperkeratosis were recorded. There were 21 and 25 patients in Groups 1 and 2, respectively. All lymphoscintigrams showed severe dermal backflow with severe stagnation by 2.5 h after injection of Tc-99 colloid. All patients were stage IV or V. Tonicity values of skin were <60. Group 1 was reduced to an average of 0.6 episodes per year in the past year of follow-up, and Group 2 was reduced to an average of 1.5 episodes per year in the past year of follow-up (p <0.001). The average frequency of preoperative cellulitis was 3.6 episodes per year. The occurrence of verrucous hyperkeratosis was observed in 14.3% and 32% of Groups 1 and 2, respectively. The incidences of cellulitis and verrucous hyperkeratosis were significantly lower in Group 1 than in Group 2 (p <0.001). To achieve successful control of infection, they should be treated carefully according to the strategy described above.


Assuntos
Celulite (Flegmão)/etiologia , Ceratose/etiologia , Linfedema/cirurgia , Unhas/cirurgia , Dedos do Pé/cirurgia , Adulto , Idoso , Algoritmos , Celulite (Flegmão)/prevenção & controle , Feminino , Fibrose , Humanos , Ceratose/prevenção & controle , Vasos Linfáticos/cirurgia , Linfedema/complicações , Linfedema/diagnóstico por imagem , Linfografia , Linfocintigrafia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Pele/patologia , Dedos do Pé/patologia , Adulto Jovem
16.
Polymers (Basel) ; 12(11)2020 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-33139654

RESUMO

Tendon healing after injury is relatively slow, mainly because of the weak activity and metabolic properties of tendon cells (tenocytes). Bletilla striata polysaccharide (BSP) has been reported to enhance cell proliferation. Here, we aimed to increase tendon cell proliferation by BSP treatment. We isolated tenocytes from the flexor tendon of human origin. Moreover, we improved the process of extracting BSP. When human tenocytes (HTs) were treated with 100 µg/mL BSP, the MEK/ERK1/2 and PI3K/Akt signaling pathways were activated, thereby enhancing the proliferation ability of tenocytes. BSP treatment also increased the migration of HTs and their ability to secrete the extracellular matrix (Col-I and Col-III). In conclusion, BSP was successfully extracted from a natural Chinese herbal extract and was shown to enhance tenocytes proliferation, migration and collagen release ability. This study is the first to demonstrate improved healing of tendons using BSP.

17.
Carbohydr Polym ; 250: 116981, 2020 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-33049868

RESUMO

Peripheral nerve injuries mainly occur in the extremities and result in functional deficits, and recovery after microsurgical repair is slow (<1 mm/day) and frustrating. To improve the results of nerve repair, it is crucial to promote local Schwann cell (SC) function, neurite outgrowth, and to reduce perineural adhesion. In this study, a nerve wrap electrospun with Bletilla striata polysaccharide (BSP) and waterborne polyurethane (WPU) was designed to wrap around the repaired nerve to achieve the goal. In SC proliferation/migration tests and neurite outgrowth assay, BSP/WPU revealed considerable improvement. In rabbit sciatic nerve repair model, BSP/WPU exhibited significantly higher compound muscle action potential, muscle contraction force, and reduced perineural adhesion. The downstream fascicles of the BSP/WPU group exhibited a 50 % increase in diameter and 100 % increase in myelin thickness compared with the control group. In vitro and in vivo experiments indicated the positive effect of BSP/WPU nerve wrap on nerve regeneration.


Assuntos
Cicatriz/prevenção & controle , Nanofibras/química , Regeneração Nervosa , Orchidaceae/química , Polissacarídeos/farmacologia , Nervo Isquiático/citologia , Animais , Eletricidade , Masculino , Coelhos , Ratos , Ratos Sprague-Dawley
18.
Microsurgery ; 40(6): 630-638, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32767616

RESUMO

BACKGROUND: A diversion loop provides an alternative pathway for food intake from the bucco-gingival sulcus into the thoracic esophagus. Therefore, the bolus does not pass via pharynx where choking may occur in case of severe dysphagia. The data about outcomes and complications of the diversionary procedure are short and they refer to small cohort with brief follow-up. METHODS: This retrospective study analyzed data of 48 patients, mean aged 34.3 years (range, 22-58 years), undergoing the creation of a diversion loop in two stages. Patients complained of aspiration, choking, and dysphagia. Swallowing disorders were caused by corrosive injury, radiation damage, or neurologic injury, and were investigated through laryngoscopy and esophagography. A diversion loop was created in 45 cases with free jejunal flap and in 3 cases with radial forearm flap. Complications, functional outcomes, and revision rate were reviewed. The mean follow-up was 26.3 months. RESULTS: We reported one failure (2%) and one partial necrosis of the free flaps. The most frequent complication was hematoma (8%). One case of esophagocutaneous fistula (2%) and two cases of stricture (4%) were also observed. Forty-two patients (87%) took all of the daily diet from their mouths through the diversionary conduit. A poor functional outcome was significantly associated with pre-operative radiotherapy (p < .0001). CONCLUSIONS: The diversion loop offers an alternative route for alimentation. Patients are freed from their choking obsession; moreover, they are rehabilitated into society without the drawbacks of permanent jejunostomy feeding. The technique was upgraded with caudal marginal mandibulectomy to improve the outcomes. Patients undergoing a diversionary procedure due to radiation damage should be carefully informed about the expected functional results.

20.
Cell Commun Signal ; 18(1): 117, 2020 07 29.
Artigo em Inglês | MEDLINE | ID: mdl-32727504

RESUMO

BACKGROUND: Estrogen receptor α (ERα) has been suggested to regulate anti-inflammatory signaling in brain microglia, the only resident immune cells in the brain. ERα conserves the phosphorylation motif at Ser216 within the DNA binding domain. Previously, Ser216 was found to be phosphorylated in neutrophils infiltrating into the mouse uterus and to enable ERα to regulate migration. Given the implication of this phosphorylation in immune regulation, ERα was examined in mouse microglia to determine if Ser216 is phosphorylated and regulates microglia's inflammation. It was found that Ser216 was constitutively phosphorylated in microglia and demonstrated that in the absence of phosphorylated ERα in ERα KI brains microglia inflamed, confirming that phosphorylation confers ERα with anti-inflammatory capability. ERα KI mice were obese and weakened motor ability. METHODS: Mixed glia cells were prepared from brains of 2-days-old neonates and cultured to mature and isolate microglia. An antibody against an anti-phospho-S216 peptide of ERα (αP-S216) was used to detect phosphorylated ERα in double immunofluorescence staining with ERα antibodies and a microglia maker Iba-1 antibody. A knock-in (KI) mouse line bearing the phosphorylation-blocked ERα S216A mutation (ERα KI) was generated to examine inflammation-regulating functions of phosphorylated ERα in microglia. RT-PCR, antibody array, ELISA and FACS assays were employed to measure expressions of pro- or anti-inflammatory cytokines at their mRNA and protein levels. Rotarod tests were performed to examine motor connection ability. RESULTS: Double immune staining of mixed glia cells showed that ERα is phosphorylated at Ser216 in microglia, but not astrocytes. Immunohistochemistry with an anti-Iba-1 antibody showed that microglia cells were swollen and shortened branches in the substantial nigra (SN) of ERα KI brains, indicating the spontaneous activation of microglia as observed with those of lipopolysaccharide (LPS)-treated ERα WT brains. Pro-inflammatory cytokines were up-regulated in the brain of ERα KI brains as well as cultured microglia, whereas anti-inflammatory cytokines were down-regulated. FACS analysis showed that the number of IL-6 producing and apoptotic microglia increased in those prepared from ERα KI brains. Times of ERα KI mice on rod were shortened in Rotarod tests. CONCLUSIONS: Blocking of Ser216 phosphorylation aggravated microglia activation and inflammation of mouse brain, thus confirming that phosphorylated ERα exerts anti-inflammatory functions. ERα KI mice enable us to further investigate the mechanism by which phosphorylated ERα regulates brain immunity and inflammation and brain diseases. Video abstract.

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