Dihydrophenanthro[b]furan derivatives from the tubers of Bletilla striata.

Two pairs of new dihydrophenanthro[b]furan enantiomers blephebibnols G-H (1-2), one new dihydrophenanthro[b]furan derivative blephebibnol I (3), along with four known analogues (4-7), were isolated from the tubers of Bletilla striata. Their structures including the absolute configurations were determined by the combination of spectroscopic data analysis, ECD and NMR calculations. Compounds 1a, 1b, and 2b showed inhibition of NO production in LPS-stimulated BV-2 cells, with IC50 values ranging from 4.11 to 14.65 µM. Further mechanistic study revealed that 1a suppressed the phosphorylation of p65 subunit to regulate the NF-κB signaling pathway. In addition, some compounds displayed selective cytotoxic activities against HCT-116, HepG2, A549, or HGC27 cancer cell lines with IC50 values ranging from 0.1 to 8.23 µM.

[Chemical constituents from tuber of Bletilla striata].

Eighteen compounds were isolated from the EtOAc soluble fraction of Bletilla striata by various chromatographic techniques, such as silica gel, ODS, Sephadex LH-20, RP-HPLC. Their structures were identified by spectroscopic methods and physicochemical properties, as 5-hydroxy-2-(p-hydroxybenzyl)- 3- methoxybibenzyl(1), shancigusins B(2), shanciguol(3),arundinan(4), 3',5-dihydroxy-2,4-di(p-hydroxybenzyl)-3-methoxybibenzyl(5), arundin(6), 3,3'-dihydroxy-2-(p-hydroxybenzyl)-5-methoxybibenzyl(7), 3, 3'-dihydroxy-2', 6'-bis(p-hydroxybenzyl)-5-methoxybibenzyl(8), 7-hydroxy-2,4-dimethoxyphenanthrene(9), bleformin B(10),nudol(11), 3,7-dihydroxy-2, 4-dimethoxyphenanthrene(12), 2, 7-dihydroxy-4-methoxy-9,10-dihydrophenathrene(13), bleformin D(14), 4,4'-dimethoxy-9,10-dyhydro-[6,1'-biphenanthrene]-2,2',7,7'-tetraol(15),gymconopin C(16),(2,3-trans)-2-(4-hydroxy-3-methoxyphenyl)-3-hydroxymethyl-10-methoxy-2,3,4,5-tetrahydro-phenanthro[2,1-b]furan-7-ol(17),shanciol(18). Among them, compound 1 was a new compound, Compounds 2-6,9,15-18 were isolated from this genus for the first time.

Platelet-Rich Fibrin in Fat Grafts for Facial Lipofilling: A Randomized, Controlled Split-Face Clinical Trial.

Objective: Previous studies have reported that platelet-rich fibrin (PRF) may enhance the efficacy of fat grafts in facial lipofilling. However, these studies either lacked objective data or were not randomized, controlled trials. Thus, we aimed to objectively evaluate the efficacy of PRF in facial lipofilling. Methods: A controlled, split-face, randomized trial (January 2018 to May 2019) based on 18 patients who underwent fat grafts for bilateral temple lipofilling was performed. Each patient received a combination of an autologous fat graft and PRF on one side and a fat graft combined with an equal volume of saline on the other side. The effects of PRF were evaluated by comparing the remaining bilateral fat graft volumes through a digital three-dimensional reconstruction technique. Improvements in the appearance and recovery time of each temple were assessed by both a surgeon and patients who were blinded to the treatment assignment. Complications were also recorded. Results: Bilateral temple lipofilling showed no evidence of fat embolism, vascular/nerve injury, infection, massive edema, or prolonged bruising. Three-dimensional reconstruction data and the assessments from both the surgeon and patients revealed no significant differences in fat graft retention volume between the PRF-positive and PRF-negative lipofilling groups. However, recovery time in the PRF-positive lipofilling sites was significantly shortened compared with that of the PRF-negative lipofilling sites. Conclusion: Facial filling with autologous fat grafts is effective and safe. Our results show that PRF does not markedly improve fat graft volume retention in the temple but significantly reduces postoperative recovery time. Trial Registration Number: ChiCTR2100053663.

Phenanthrene, 9,10-dihydrophenanthrene and bibenzyl enantiomers from Bletilla striata with their antineuroinflammatory and cytotoxic activities.

Thirteen undescribed phenanthrene and bibenzyl derivatives, named blestanols A-M, including one pair of biphenanthrene enantiomers, two bis 9,10-dihydrophenanthrene ethers, five pairs of 9,10-dihydrophenanthrene/bibenzyl atropisomers, one racemic 9,10-dihydrophenanthrene/bibenzyl dimer, one 9,10-dihydrophenanthrenebibenzyl ether, two pairs of bibenzyl derivatives, and one stilbene, together with 12 known analogues were isolated from the tubers of Bletilla striata. The structures were elucidated via spectroscopic data analysis. 15 compounds were purified to yield enantiomers (a, b) via chiral-phase HPLC, and their configurations were determined by optical rotation values and the comparison of the experimental and calculated electronic circular dichroism (ECD) curves. Blestanols K-L possessed a cycloheptene moiety, which is rarely observed in bibenzyl derivatives. A putative biosynthetic pathway for the identified components is deduced. Among these compounds, 14 compounds showed inhibition of NO production, with IC50 values ranging from 5.0 to 19.0 µM. Eight compounds displayed selective cytotoxic activities against HCT-116, HepG2, BGC-823, A549 or U251 cancer cell lines, with IC50 values ranging from 1.4 to 8.3 µM. In addition, their structure-activity relationships are discussed briefly.

Effect of camptothecin on collagen synthesis in fibroblasts from patients with keloid.

Keloids are distinguished by substantial deposition of collagen in the dermis, resulting in an imbalanced production and aggregation of extra cellular matrix. This study was undertaken to evaluate the effects of the topoisomerase I inhibitor camptothecin (CPT) on collagen synthesis in the activated dermal fibroblasts from healthy donors and patients with keloid. The fibroblasts were cultured in the presence or absence of CPT. Cellular toxicity assay was determined by MTT analysis. The expression of type I collagen and type III collagen was studied both at the transcriptional and post-transcriptional levels, using conventional quantitative real-time reverse transcription PCR and Western blotting. Results showed that there was predominantly a clear and dose-dependent decrease in the synthesis of collagen 1, not collagen 3, in keloid fibroblasts without significantly cellular toxicity. The CPT had an activity on the regulation of the ratio of type I/III collagen in the metabolism of keloid fibroblasts by inhibiting the secretion of type I collagen. The data suggest that the inhibitory effect of CPT, a topoisomerase I inhibitor, on collagen synthesis may be an effective treatment for limiting fibrosis in keloid patients.

[Repair of cervical scar contracture with flaps containing cervical cutaneous branch of the transverse cervical artery].

OBJECTIVE: To observe the therapeutic effect of repairing cervical scar contracture using flaps carrying cervical cutaneous branch of the transverse cervical artery. METHODS: Sixty-six patients with scar contracture after burn in anterior region of neck hospitalized from 1988 to 2011. The scars were excised and repaired with flaps containing the cervical cutaneous branch of transverse cervical artery. They included 55 island flaps (with 9 flaps pre-expanded) and 11 non-island flaps (with 1 flap pre-expanded). After removing the scar and releasing the contracture, flaps with the cervical cutaneous branch of transverse cervical artery were designed and raised in the supraclavicular and infraclavicular regions and the anterior thoracic region. The axial vessel of the flap was the cutaneous artery, which perforated in the crossing area of sternocleidomastoid muscle and omohyoid muscle and originated from the transverse cervical artery. The posterior borderline of the flap reached the anterior border of the trapezius muscle. Its exterior borderline reached the middle part of deltoid muscle, and its interior borderline ended at the midsternal line. The lower borderline was located 3.0-4.0 cm below the nipple. The incisions at the interior, lower, and exterior borders of the flap were first made. Then after sharp dissection to the clavicle, blunt dissection was performed to the pedicle to allow the flaps to be able to cover the wound after rotation without undue tension. The pre-expanded donor sites were sutured directly, while the un-expanded ones were covered with skin graft. RESULTS: Out of the 66 flaps, 64 flaps survived. Two flaps showed partial necrosis at the distal end due to sub-flap hematoma, and they healed after skin grafting. All the donor sites healed. The color and texture of all flaps matched well with the surrounding skin tissue. The flaps regained sensation pertaining to the chest in the early stage, and complete sensation pertaining to the neck appeared 6 months after surgery. CONCLUSIONS: The flap containing cervical cutaneous branch of the transverse cervical artery is a good choice for repairing severe cervical scar contracture for its simple harvest, reliable blood supply, and similar color and texture to the skin of cervical region.

[Repair of inframammary scars with expanded skin flaps].

OBJECTIVE: To investigate suitable treatment method for contracture of inframammary scars. METHODS: Nine female patients with contracture of inframammary sear hospitalized in our hospital from July 2000 to July 2007 were subjected to skin expansion around the breast. The sites of incisions were mainly located on the inframammary scars. The expanders were placed around the breast and middle chest near the sternum. On the lateral side of chest, the expander should be inserted at the site parallel to upper level of the breast. The expanders should be placed under deep fascia and superficial to the gland. At II stage of operation, the scars were excised and the subcutaneous tissues should be thoroughly loosened to assure that the soft tissue and mammary gland would be restored to its anatomical position. Expanded skin was then designed as advancement or transposition flaps to repair the defects, or effects were closed with suturing. RESULTS: Blood circulation disturbance occurred at the tip of a flap in one patient, with the size of 4.0 cm x 3.0 cm, and the resulting wound healed after skin grafting. Flaps in the other 8 patients survived, and the wounds healed satisfactorily. Nipples and mammary areola were successfully restored to the anatomical positions. Three patients were followed up for 6 months to 2 years, and the result was satisfactory. CONCLUSIONS: Expanded flap is feasible for repairing contracture of inframammary scar and with good result.

[Expanded deltopectoral flaps for treatment of cervical cicatricial contracture].

OBJECTIVE: To investigate the application of expanded deltopectoral flaps for treatment of cervical cicatricial contracture. METHODS: The cervical cicatricial contracture was corrected in 18 cases with unilateral expanded deltopectoral flaps and 2 cases with bilateral expanded deltopectoral flaps. The size of scar ranged from 8 cm x 5 cm to 12 cm x 13 cm. The size of the unilateral expanded deltopectoral flaps ranged from 9 cm x 16 cm to 12 cm x 18 cm. The defects in donor sites were closed directly. The infraclavicula incision was designed. The flaps were delayed 3 weeks after flap transfer. The pedicle was cut off 4 weeks later. RESULTS: From 2007 to 2009, 20 cases with cervical cicatricial contracture were treated with expanded deltopectoral flaps. All the flaps were survived. 6 cases were followed up for 6 months with satisfactory results in 5 cases and conspicuous scar in 1 case. CONCLUSIONS: Expanded deltopectoral flap is very suitable for large size of cervical cicatricial contracture.

[Repair of facial and cervical scars with expanded deltopectoral flaps].

OBJECTIVE: To explore the methods for repair of facial and cervical scars after burn. METHODS: One hundred and two patients with facial and cervical scars as a result of burn injury were repaired by unilateral or bilateral deltopectoral flaps after expansion with pedicles. First, facial scars were excised and contractures were released to restore eye, mouth and nose to normal anatomical position. The facial scar flaps were overturned to join with the pedicles of deltopectoral flap for closing the wounds. The residual wounds were repaired by delayed flaps without pedicles 3 weeks later. RESULTS: Among 102 patients, the flaps survived well in 94 cases, and blood supply insufficiency was found in distal end of unilateral flap in 7 cases (depigmentation after primary healing ). Necrosis of unilateral flap occurred in one patient, and it healed after skin grafting. CONCLUSION: Expanded deltopectoral flap is efficacious procedure for repair of massive cervical and facial scars.

[Expanded skin flaps for the treatment of large scalp and face scar].

OBJECTIVE: To explore the method to repair large scalp and face scars. METHODS: 1-3 expanders under the scalp were needed for repair the scalp scar. The expanded deltopectoral flaps were transferred to repair the face scar. RESULTS: 12 cases were treated with satisfactory results. All the flaps survived and the donor sites were closed primarily. 2 cases had expander exposure which didn't affect the treatment results. Atrophic cutaneous striae was occurred because of overexpansion. CONCLUSIONS: Skin expansion is a good method for large scalp and face scar.

[Management of severe postburn scar contracture in the lower extremities].

OBJECTIVE: To summarize the clinical experience in the management of severe postburn scar contracture in the lower extremities. METHODS: The scars in popliteal fossa and ankle joint were excised. Traction and skin grafting were employed in the management of contracture deformity in these areas. RESULTS: Severe postburn scar contracture deformity in sixty postburn patients could be corrected by constant traction and skin grafting. CONCLUSION: Scar excision and lysis with constant traction might be an optimal method in the management of severe postburn scar contracture deformity of joints in the lower extremities and satisfactory results could be obtained without tendon grafting and elongation.

[The design of the expanded flap for the repair of the temporal and cheek area].

OBJECTIVE: To explore the design of an expanded flap at the temporal and cheek area. METHODS: The expanded flap was used for the repair of 619 temporal and cheek defects secondary to scar, nevus or hemangioma excision. In the frontal area, the rotational flap was usually used. For the repair of the cheek, the applied flap included the rotational, advanced, and transposition flap from the neck, as well as the pedicle flap from the thoracic area. RESULTS: Eight thoracic-deltoid flaps had distal necrosis of 1 approximately 5 cm. Of them, 5 flaps were repositioned with subsequent good result; the other 3 flaps underwent skin grafting. The five facial expanded flaps showed distal necrosis of 0.5 approximately 1 cm. Of them, 4 flaps occurred delayed healing, 1 flap underwent skin grafting. Expander extrusion happened in 41 cases (6.62%), which resulted in deficiency of the expanded area. Satisfactory results were achieved in all the other cases. CONCLUSIONS: According to our experience, careful design of the flap is very important for obtainingbetter surgical results and decreasing complications.