Xinglong Chen

Troglitazone suppresses transforming growth factor-β1-induced collagen type I expression in keloid fibroblasts

Background  Peroxisome proliferator‐activated receptor (PPAR)‐γ agonists are increasingly used in patients with diabetes and some studies have suggested a beneficial effect on organ fibrosis. However their effects on dermal fibrosis in keloids are unknown.

Activation of peroxisome proliferator-activated receptor-γ inhibits transforming growth factor-β1 induction of connective tissue growth factor and extracellular matrix in hypertrophic scar fibroblasts in vitro

Peroxisome proliferator-activated receptor-γ (PPAR-γ) ligands have been recently reported to have beneficial effects on organ fibrosis. However, their effects on extracellular matrix (ECM) turnover in hypertrophic scar fibroblasts (HSFs), and the related molecular mechanisms are unknown. HSFs were cultured and exposed to different concentration PPAR-γ ligands in the presence of transforming growth factor-β1 (TGF-β1). In growth-arrested HSFs, a PPAR-γ natural ligand (15-deoxy-D12,14-prostaglandin J2, 15d-PGJ2) and a synthetic ligand (GW7845) dose-dependently attenuated TGFβ1-induced expression of Connective tissue growth factor (CTGF), collagens and fibronectin. Furthermore, the suppression of CTGF mRNA and protein expression are relieved by pretreatment with an antagonist of PPAR-γ (GW9662). Moreover, GW7845 and 15d-PGJ2 partially inhibited the expression and phosphorylation of the TGF-β1/Smad pathway. These results suggest that in TGFβ1-stimulated HSFs, PPAR-γ ligands caused an antiproliferative effect and reduced ECM production through mechanisms that included reducing CTGF expression, and a crosstalk between PPAR-γ and Smad may be involved in the inhibitory effects of PPAR-γ ligands.

Safety and Efficacy of Operative Versus Nonsurgical Management of Distal Radius Fractures in Elderly Patients: A Systematic Review and Meta-analysis

PURPOSE To assess the safety and efficacy of operative versus nonsurgical treatment of distal radius fractures in elderly patients. METHODS We comprehensively searched the PubMed, Web of Science, and Cochrane Library databases for studies that satisfied predetermined inclusion and exclusion criteria. Outcomes of interest included pain level, grip strength, wrist range of motion, wrist functional assessment, radiographic parameters, and complications; we compared these using continuous measurements. We performed a systematic review and meta-analysis to assess operative versus nonsurgical procedures in patients aged 60 years and older. RESULTS Two randomized controlled trials and 6 retrospective studies were included. Meta-analysis did not detect statistically significant differences in pooled data for pain level, functional assessment, and wrist range of motion between the operative and nonsurgical groups. Grip strength was significantly greater in the operative group. The incidence of major complications requiring surgery and that of tendon injury were significantly higher in the operative group. Radiographic outcomes including volar tilt, radial inclination, and ulnar variance were significantly better in the operative group. Considerable heterogeneity was present in all studies and adversely affected the precision of the meta-analysis. CONCLUSIONS The current literature does not support the theory that operative management can provide better clinical outcomes for elderly patients with distal radius fractures. Although operative management can offer better radiographic outcomes and grip strength than can nonsurgical treatment, the risk of complications requiring surgical treatment is greater. Thus, indications for operative fixation should be considered carefully in the treatment of elderly patients. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.

Peroxisome proliferator-activated receptor-γ (PPAR-γ) agonist inhibits transforming growth factor-beta1 and matrix production in human dermal fibroblasts

Peroxisome proliferator-activated receptor-gamma (PPAR-gamma) agonists are increasingly used in patients with diabetes, and some studies have suggested a beneficial effect on organ fibrosis, but their effects on dermal cell growth and extracellular matrix (ECM) turnover are unknown. To investigate the effect of the PPAR-gamma agonist troglitazone on cell growth and matrix production in human dermal fibroblasts (HDF), HDF were cultured and grown in a different concentration of troglitazone. PPAR-gamma expression and matrix production were measured in HDF in the presence of troglitazone. The mRNA expressions of TGF-beta1, collagen I (Col I) and fibronectin (FN) were determined by quantitative real-time reverse transcription polymerase chain reaction (RT-PCR). The protein of transforming growth factor-beta1 (TGF-beta1) was determined by enzyme-linked immunosorbent assay (ELISA) and proteins of Col I and FN were determined by Western blotting. The mRNA expression of TGF-beta1, Col I and FN were significantly decreased in HDF in 15-30 micromol l(-1) troglitazone compared to the control group with Dulbeccos modified Eagles medium (P<0.01). An obvious decrease of TGF-beta1 protein was found in troglitazone-treated groups as compared to the control group (P<0.05). Exposure of HDF to troglitazone reduced col I secretion (P<0.05), and fibronectin secretion (P<0.05). This study suggests that PPAR-gamma agonist will provide a novel approach with therapeutic potential in dermal fibrosis, such as hypertrophic scar, keloid and so on.

A comparative study of finger pulp reconstruction using arterialised venous sensate flap and insensate flap from forearm

OBJECTIVE The aim of this study was to investigate the feasibility of finger pulp reconstruction using arterialised venous flaps from forearm and compare the outcomes of arterialised venous sensate flap and insensate flap. METHODS Twenty-seven arterialised venous flaps were reviewed retrospectively in the reconstruction of finger pulp defects in 23 patients, including 15 sensate flaps (sensate group) and 12 insensate flaps (insensate group). Nine flaps in this series were harvested from the dorsal aspect of the forearm and the other 18 were harvested from the volar aspect. Standardised assessment of outcomes in terms of objective sensory recovery, pinch power of the reconstructed digits, cold intolerance and time of returning to work was completed. RESULTS All flaps survived completely. Twenty-six flaps were available for follow-up of more than 9 months (mean, 15.4 months). Almost all the flaps in the sensate group obtained normal sensation, while most cases of the insensate group only achieved protective sensation. Cold intolerance was present in most cases of the insensate group in comparison with the sensate group with only one case suffering from slight cold intolerance. There was no significant difference of pinch power between the two groups. All the patients were contented with the aesthetic outcomes of the surgery. CONCLUSION The arterialised venous sensate flap from forearm is a practical alternative for finger pulp reconstruction with satisfactory functional and aesthetic outcomes. The forearm region can be an acceptable donor site for arterialised venous sensate flap in the reconstruction of larger finger pulp defect.

Reconstruction of Totally Degloved Fingers With a Spiraled Parallelogram Medial Arm Free Flap

PURPOSE To investigate the results of resurfacing completely degloved digits using a parallelogram free flap from the medial arm in a spiral fashion. METHODS We reviewed the reconstruction of 26 digits in 21 patients with a parallelogram free flap from the medial arm in a spiral fashion following a non-replantable degloving injury. RESULTS The sizable perforator was observed consistently in the medial arm with 13 of 21 (62%) originating from the superior ulnar collateral artery, 6 of 21 (29%) directly from the brachial artery, and 2 of 21 (9%) from the superficial brachial artery. All the flaps but one, which sustained partial flap loss, survived uneventfully. Total active motion ranged from 93° to 145° and 112° to 154° in the cases with and without metacarpophalangeal joint involvement, respectively. The static 2-point discrimination test varied from 6 to 13 mm. No scar contracture was recorded in these patients. All the patients were satisfied with the overall results. CONCLUSIONS Resurfacing the defect in a spiral fashion is a valuable and reliable technique for the reconstruction of complete finger degloving injuries. The medial arm flap is a good candidate for this procedure, with satisfactory functional recovery and good aesthetic restoration. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.

Management of Degloving Injuries of the Foot with a Defatted Full-Thickness Skin Graft

BACKGROUND Degloving injuries of the foot with involvement of the heel and sole occur relatively rarely but pose an extreme challenge to the reconstructive surgeon due to the unique anatomy of the foot. Very limited studies are available regarding the outcomes of reattachment of the degloved skin as a full-thickness graft. METHODS Twenty-one patients, including eight children and thirteen adults, were treated for a degloving injury of the foot with an immediate defatted full-thickness skin graft from September 2002 to January 2010. After reattachment to its original anatomical site, the graft was further secured with multiple sutures and was fenestrated to improve skin graft incorporation. Traditional dressings were applied. At the time of follow-up, the clinical outcome was graded with use of the Maryland Foot Score. RESULTS Complete incorporation of the graft occurred in ten of the thirteen adults and seven of the eight children (p > 0.05). Follow-up at an average of 32.8 months (range, twenty-four to sixty months) revealed stable wounds in 81% (seventeen) of the twenty-one patients. All stated that they were satisfied with the cosmetic appearance of the affected foot. At the time of the last follow-up, seventeen of the twenty-one patients had a good to excellent score according to the Maryland Foot Score. Sensation restoration in the pediatric group started earlier and progressed faster than that in the adult group, but all patients obtained at least protective sensation eventually and none complained of cold intolerance in the foot. CONCLUSIONS Degloving injuries can be treated successfully with a defatted full-thickness skin graft followed by conventional dressings in both children and adults. This procedure is relatively simple, without the demands of microsurgical techniques, and can provide good functional and cosmetic results.

The Management of Lower Extremity Multilevel Arterial Injuries: A 10-Year Experience

Background Limb amputation due to lower extremity arterial injury is not uncommon and multilevel arterial injury is even more limb-threatening and easily missed with potentially devastating consequences. There is limited information on multilevel arterial injuries. Purpose We undertook a review of our experience to gain insight on multilevel arterial injury patterns associated with lower extremity trauma and to analyze the results of management of such injuries with a special focus on the influence of initial diagnosis on limb salvage. Patients and Methods Between August 2002 and September 2012, 38 patients with lower extremity multilevel arterial injuries were reviewed, retrospectively. The injury patterns and amputation rates associated with initial diagnosis or misdiagnosis were analyzed. Results According to their injury levels, three multilevel arterial injury patterns were seen in this series: arterial injuries with the involvement of femoral artery and popliteal artery (pattern A), femoral artery and anterior or (and) posterior artery (pattern B), and popliteal artery and anterior or (and) posterior artery (pattern C). The general missed diagnosis rate was 31.6%. Pattern B had a much higher missed diagnosis rate than the other two patterns. The missed diagnosis rate was significantly correlated with the amputation rates (Odds Ratio =10.7, 95% CI: 2.04-56.61). The definite diagnosis rate was only 14.8% using duplex ultrasonography examination. Conclusions Diagnosis of pattern B injury is more prone to be missed. DUS has low specificity in the detection of multilevel arterial injuries. Aggressive intraoperative exploration is considered to be valuable in the definitive diagnosis of highly suspected cases when other diagnostic tools are unavailable.

Nail Fusion Plasty: Nail Cosmetic Results and Assessment Criteria of Nail Reconstruction.

PurposeThis study aimed to develop a scoring system for evaluating the nail appearance after nail fusion plasty of the duplicated thumb, and to investigate the operation indication of the combination procedure and its effect on the postoperative nail appearance. MethodsThe nail fusion plasty technique was carried out in 20 patients with congenital thumb duplication. The patients were followed up to observe the appearance of nail, and the results were assessed by our nail appearance evaluation criteria. ResultsTwenty patients were followed up for 18 to 92 months (48 months on average). According to our criteria, we achieved excellent results in 12 cases, good in 6 cases, fair in 1 case, and poor in 1 case. ConclusionsThe combination procedure is recommended when the size of the thumb is less than 80% of the size of the normal side or the width of the nail is less than 80% of that of the normal side. Satisfactory results can be obtained by careful operation. The newly devised scoring system assesses the nail appearance in a very comprehensive manner.

The management and surgical intervention timing of enchondromas: A 10-year experience

Abstract Enchondroma, reportedly the most common primary tumor of the long bones of the hand, usually develops during the first till fourth decades of life. However, there has no consensus been reached regarding the surgical intervention timing for these patients. We aim to evaluate the optimal surgical intervention timing for the patients with fractures due to enchondromas, investigate the impact of pathological fractures on the treatment and outcomes in these patients. Medical records and X-rays of patients treated for enchondroma of the hand from 2005 to 2015 were retrospectively reviewed. We collected 148 cases in total and 92 of them had complete information including X-rays, medical records, and files of follow up. There were no significant differences in terms of consolidation time after surgery, recurrence rate, and DASH scores between the groups with and without fractures; the treatment costs were higher in the group with fractures than those without fractures; however, patients without fractures were able to resume work earlier than those with fractures. The pathological fractures associated with enchondromas have no significant impact on the treatment outcomes compared to those with simple nonfractured enchondromas. Although the cost was more expensive for patients treated primarily with pathological fractures due to enchondromas, these patients could resume their work normally much earlier than those treated by delayed surgery. Early surgical intervention is recommended for better results and no increased risks for patients with pathological fractures caused by enchondromas.