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Effects and mechanism of cerium-myricetin nanosystem on wound healing in rats with full-thickness burns
Wang Tao, Teng Junfei, Hu Chao, Wan Luyao, Zhang Wei, Bai Xiangyang, Deng Jun, Luo Gaoxing
, Available online  , doi: 10.3760/cma.j.cn501225-20260312-00101
Abstract:
  Objective  To investigate the effects and mechanism of cerium-myricetin nanosystem (Ce-MYR) on wound healing in rats with full-thickness burns.  Methods  This study was an experimental study with a grouped design. Ce-MYR was prepared by coordination self-assembly and characterized. Mouse RAW264.7 cells were divided into control group cultured normally, hydrogen peroxide group treated with hydrogen peroxide, and low Ce-MYR group, medium Ce-MYR group, and high Ce-MYR group treated with hydrogen peroxide followed by Ce-MYR at final mass concentrations of 5, 10, and 20 μg/mL, respectively. After 24 h of culture, intracellular reactive oxygen species (ROS) levels were detected using the fluorescent probe method. Mouse bone marrow-derived macrophages (BMDMs) were divided into control group cultured normally, lipopolysaccharide (LPS) group treated with LPS, and Ce-MYR group treated with LPS combined with Ce-MYR. After 24 h of culture, immunofluorescence staining was performed to detect and calculate the percentages of CD86- and CD206-positive areas. Additional mouse BMDMs were divided into LPS group and Ce-MYR group treated as the described above. After 24 h of culture, the protein expressions of heme oxygenase-1 (HO-1), arginase-1 (Arg-1), inducible nitric oxide synthase (iNOS), and NOD-like receptor family pyrin domain-containing protein 3 (NLRP3) were detected by Western blotting. The sample size in all the above experiments was 4. Ten 6-week-old male Sprague-Dawley rats were used to establish four full-thickness burn wounds on the back of each rat, which were divided into phosphate-buffered saline (PBS) group and Ce-MYR group according to the random number table method, with 5 rats in each group. PBS or Ce-MYR was subcutaneously injected at the wound margin on post-injury days 0 (immediately), 3, and 6, respectively. The percentages of residual wound area were calculated on post-injury days 3, 7, 14, and 21. On post-injury day 21, the wound tissue of rats was collected to evaluate granulation tissue thickness after hematoxylin-eosin staining, to calculate the type Ⅰ/type Ⅲ collagen ratio after Sirius red-acid fuchsin staining, to count CD31-positive blood vessels after immunohistochemical staining, to determine the percentages of CD86-and CD206-positive areas after immunofluorescence staining, and to detect the levels of interleukin-6 (IL-6), IL-1β, and tumor necrosis factor-α (TNF-α) after enzyme-linked immunosrbent assay.  Results  After 24 h of culture, the ROS level in RAW264.7 cells in hydrogen peroxide group was significantly higher than that in control group (P<0.05); the ROS level in RAW264.7 cells in medium Ce-MYR group was significantly lower than that in low Ce-MYR group (P<0.05) and significantly higher than that in high Ce-MYR group (P<0.05). After 24 h of culture, the percentage of CD86-positive area in BMDMs in LPS group was significantly higher than that in control group and Ce-MYR group (with both P values <0.05), while the percentage of CD206-positive area in BMDMs in Ce-MYR group was significantly higher than that in control group and LPS group (with both P values <0.001). Compared with those in LPS group, the protein expressions of HO-1 and Arg-1 in BMDMs in Ce-MYR group were significantly increased (P<0.05), whereas the protein expressions of iNOS and NLRP3 were significantly decreased (P<0.05). On post-injury days 3, 7, 14, and 21, the percentages of residual wound area in rats in Ce-MYR group were (87.1±2.4)%, (65.1±2.2)%, (16.6±1.9)%, and (0.5±0.4)%, respectively, which were significantly lower than (101.5±3.5)%, (79.9±3.2)%, (36.2±3.9)%, and (14.5±1.9)% in PBS group (with t values of 7.604, 8.478, 10.193, and 16.166, respectively; P<0.001). On post-injury day 21, compared with those in PBS group, the granulation tissue thickness, type Ⅰ/type Ⅲ collagen ratio, and number of CD31-positive blood vessels in wound tissue of rats in Ce-MYR group were significantly increased (with t values of 5.179, 6.212, and 3.395, respectively, P<0.05). The percentage of CD86-positive area in wound tissue was significantly decreased (t=4.474, P<0.05), whereas the percentage of CD206-positive area was significantly increased (t=4.713, P<0.05). The levels of IL-1β, IL-6, and TNF-α in wound tissue were significantly decreased (with t values of 3.999, 5.040, and 6.023, respectively, P<0.05).  Conclusions  Ce-MYR may promote macrophage polarization from the M1 phenotype toward the M2 phenotype by reducing ROS levels and enhancing HO-1-related antioxidant responses, in macrophages thereby improving oxidative stress and inflammatory imbalance in rats with full-thickness burn wounds and promoting wound repair.
Influence and mechanism of Prussian blue nanoparticles combined with mouse ADSCs on full-thickness skin defect wounds in diabetic mice
Zhang Xiaowei, Xu Shuangyi, Han Yujia, Li Xiaomei, Xu Gang
, Available online  , doi: 10.3760/cma.j.cn501225-20250106-00009
Abstract:
  Objective  To investigate the influence and mechanism of Prussian blue nanoparticles (PBNPs) combined with mouse adipose-derived mesenchymal stem cells (ADSCs) on full-thickness skin defect wounds in diabetic mice.  Methods  This study was an experimental study using a group design and a repeated-measures design. PBNPs were prepared by hydrothermal synthesis, and their morphology was characterized using transmission electron microscopy. ADSCs were isolated from five male 6–8-week-old Institute of Cancer Research (ICR) mice via collagenase digestion. The cells were divided into control group cultured under routine conditions, high-glucose group cultured with glucose in a final molarity of 30.0 mmol/L, and low-PBNP group and high-PBNP group pretreated with 10 or 20 μg/mL PBNP for 12 h, respectively, followed by the same treatment as in high-glucose group. After 24 h of culture, cell viability was assessed using the cell counting kit-8, the proportion of senescent cells in the cells was detected by β-galactosidase staining, and the protein expression levels of senescence-associated proteins p16 and p21 were determined by Western blotting. Twenty-four male 6–8-week-old ICR mice were used to establish the diabetic model. A full-thickness skin defect wound was then created on the back of each mouse. The injured mice were divided into four groups (with 6 mice in each group) according to the random number table method, including control group with wounds treated with normal saline, ADSC group with wounds treated with normal saline containing 5×106 ADSC (the same cell number below), low-PBNP group and high-PBNP group with wounds treated with normal saline containing ADSC pretreated with 10 and 20 μg/mL PBNP for 12 h, respectively. Wound healing was observed at post-injury day (PID) 0 (immediately), 3, 7, 10, and 14. The percentage of remaining wound area was calculated at post-injury day 3, 7, 10, and 14. At PID 7, the protein expression levels of the cell proliferation markers Ki67 and vascular endothelial growth factor (VEGF) in wound tissue were detected by immunofluorescence method. At PID 14, the expression levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), IL-6, and IL-10 in wound tissue were determined by enzyme-linked immunosorbent assay.  Results  PBNP exhibited a dispersed regular cubic structure. After 24 h of culture, compared with those in control group, cells in high-glucose group showed a significantly lower cell viability (P<0.05), a significantly higher proportion of senescent cells (P<0.05), and significantly higher protein expression levels of p16 and p21 (P<0.05). Compared with those in high-glucose group, cells in low-PBNP and high-PBNP groups showed significantly higher cell viability (P<0.05), significantly lower proportions of senescent cells (P<0.05), and significantly lower protein expression levels of p16 and p21 (P<0.05). From PID 0 to 14, the wounds in all four groups healed gradually. At PID 3, 7, 10, and 14, the percentages of remaining wound area of mice in high-PBNP group were (75.3±3.1)%, (46.7±2.5)%, (24.0±5.2)%, and (8.0±1.0)%, respectively, all significantly lower than (85.0±2.0)%, (62.7±3.1)%, (46.7±3.8)%, and (19.3±2.1)% in ADSC group (P<0.05). At PID 7, the percentage of remaining wound area of mice in ADSC group was significantly lower than that in control group ((77.3±3.2)%, P<0.05). At PID 7, the protein expression levels of Ki67 and VEGF of cells in ADSC group were significantly higher than those in control group (P<0.05), the protein expression levels of Ki67 of cells in low-PBNP and high-PBNP groups and the protein expression level of VEGF of cells in high-PBNP group were significantly higher than those in ADSC group (P<0.05). At PID 14, compared with those in control group, wound tissue in ADSC group showed a significantly higher expression level of IL-10 (P<0.05) and significantly lower expression levels of TNF-α, IL-1β, and IL-6 (P<0.05); compared with those in ADSC group, wound tissue in low-PBNP and high-PBNP groups showed significantly higher expression levels of IL-10 (P<0.05) and significantly lower expression levels of TNF-α, IL-1β, and IL-6 (P<0.05).  Conclusions  PBNP can alleviate high glucose-induced senescence of mouse ADSCs. Compared with mouse ADSCs alone, the combination of PBNP and mouse ADSCs more effectively promotes cell proliferation and angiogenesis in full-thickness skin defect wounds of diabetic mice, inhibits the release of inflammatory cytokines, and accelerates wound healing.
Smart responsive materials for diabetic foot ulcer therapy: from passive coverage to active healing
Chen Xulin
, Available online  , doi: 10.3760/cma.j.cn501225-20260409-00146
Abstract:
Diabetic foot ulcers (DFUs) are caught in a vicious cycle of impaired healing driven by hyperglycemia-induced persistent inflammation, reactive oxygen species (ROS) accumulation, tissue hypoxia, and increased susceptibility to infection. This paper reviews the pathological microenvironmental characteristics of DFUs, the design strategies of smart materials, and their integration with artificial intelligence (AI). Given the complex pathological microenvironment of DFUs, traditional passive dressings have been shown to be inadequate, whereas smart responsive materials show great potential by dynamically sensing and actively modulating the wound microenvironment. Furthermore, the paper highlights four key design strategies for smart responsive materials: using glucose-responsive smart materials to alleviate local hyperglycemia at the wound site; using ROS-scavenging smart materials to eliminate ROS and restore redox homeostasis; applying oxygen-generating materials to relieve hypoxia and promote angiogenesis; and utilizing smart antibacterial materials to combat biofilms and achieve potent bactericidal effects. Currently, the development trend of smart materials has shifted from single-function systems to integrated multifunctional systems. The paper further discusses the potential of integrating AI into material design, preparation optimization, and wound monitoring and treatment decision-making. Although most smart materials are still at the experimental stage and face challenges related to cost and manufacturing processes, next-generation smart materials are expected to achieve dynamic monitoring and autonomous treatment through interdisciplinary innovation, significantly improving DFU healing rates and reducing the risk of amputation.
Performance of PHMB-surface mesoporous silica composite material and its effect on full-thickness skin defect infected wounds in rats
Zhu Yimeng, Jin Jian, Wang Weiwei
, Available online  , doi: 10.3760/cma.j.cn501225-20250830-00373
Abstract:
  Objective  To investigate the performance of polyhexamethylene biguanide hydrochloride (PHMB)-surface mesoporous silica composite material (hereinafter referred to as the composite material) and its effect on full-thickness skin defect infected wounds in rats.  Methods  This study was an experimental study including group design, factorial design, and repeated measures design. The composite material with good biocompatibility was prepared by rotary evaporation method. The in vitro release of PHMB from the composite material was detected by continuous quantitative release assay. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of PHMB and the composite material against Staphylococcus aureus and Escherichia coli were detected by broth microdilution method. The continuous bactericidal duration of PHMB and the composite material was detected by continuous bacterial challenge assay. The inducing effect of PHMB and the composite material on the resistance of Staphylococcus aureus and Escherichia coli was detected by sub-lethal concentration induction assay. The sample size for the above experiments was 3. Forty-five female SD rats aged 10-12 weeks were divided into routine dressing change group, PHMB group, and composite material group by random number table method, with 15 rats in each group. After preparing full-thickness skin defect infected wounds on the back of all rats, the wounds of rats in routine dressing change group, PHMB group, and composite material group were rinsed and dressed with normal saline, PHMB solution and composite material dispersion with a final mass fraction of 0.100% PHMB, respectively. The wound healing rate and infection status were calculated at post injury day (PID) 6, 12, and 18 with sample sizes of 15, 10, and 5, respectively. At PID 6, 12, and 18, 5 rats from each group were selected by random number table method before dressing change, and the wound tissue bacterial load was detected by viable plate count method.  Results  The composite material with a mass ratio of PHMB to surface mesoporous silica of 1:1 could continuously release PHMB for ≥ 144 h. For both Staphylococcus aureus and Escherichia coli, the MICs of the composite material were lower than those of PHMB, but the MBCs of both materials were identical. The continuous bactericidal duration of PHMB against Staphylococcus aureus and Escherichia coli was both 3 d, and the continuous bactericidal duration of the composite material against Staphylococcus aureus and Escherichia coli was both 6 d. Staphylococcus aureus and Escherichia coli did not show resistance to the composite material after 60 d of culture, which was significantly later than the resistance to PHMB. The wound healing rates of rats in composite material group at PID 6, 12, and 18 were significantly higher than those in routine dressing change group and PHMB group (P<0.05). At PID 6, 12, and 18, no infection occurred in the wounds of rats in composite material group, whereas all wounds in routine dressing change group continuously showed infection, and some wounds in PHMB group still continuously showed infection. The wound tissue bacterial loads of rats in composite material group at PID 6, 12, and 18 were (4.6±3.1), (3.4±3.4), and (1.6±1.5) CFU/mL, respectively, which were significantly lower than those in routine dressing change group (( 1876.0±241.5), (1 076.0±151.1), and (1 184.0±156.6) CFU/mL) and PHMB group ((824.0±277.6), (800.0±231.0), and (832.0±350.9) CFU/mL, P<0.05). The wound tissue bacterial load of rats in PHMB group at PID 6 and 12 was significantly lower than that in routine dressing change group (P<0.05).  Conclusions  The composite material has the activities of synergistic effect and sustained release of PHMB, thereby delaying the generation of bacterial resistance, reducing the bacterial load of wound tissue, and facilitating wound healing.
Meta-analysis of the effects of pulsed dye laser combined with fractional carbon dioxide laser in the treatment of hypertrophic scars in children
Wu Jie, Zhang Huimin, Liu Rui, Zhang Nanxin, Cui Rongtao
, Available online  , doi: 10.3760/cma.j.cn501225-20241224-00502
Abstract:
  Objective  To evaluate the efficacy of pulsed dye laser (PDL) combined with fractional carbon dioxide laser for the treatment of hypertrophic scars (HSs) in children.  Methods  This study was a meta-analysis study. Databases including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, and VIP Chinese Journal Service Platform were retrieved to obtain the publicly published retrospective and prospective studies on the efficacy of PDL combined with fractional carbon dioxide laser for pediatric HS from the establishment of each database to October 31, 2024. The outcome indexes included the total score of the patient and observer scar assessment scale (POSAS) and laser treatment-related adverse reactions. Stata version 16.0 software was used to conduct a meta-analysis.  Results  A total of 7 studies were included, involving 348 children with HSs, of whom at least 296 had burn-induced HSs. Meta-analysis result showed that PDL combined with fractional carbon dioxide laser significantly reduced the total POSAS score in pediatric HS (with standardized mean difference of -7.76, 95% CI of -10.91 to-4.61, P<0.05). Subgroup analysis results suggested that geographic distribution, scar duration, intervention measures, and fractional carbon dioxide laser energy parameters might be sources of heterogeneity for the total POSAS score. The incidence of adverse reactions of PDL combined with fractional carbon dioxide laser for pediatric HS was low, at 0.04 (with 95% CI of 0.02-0.06, P<0.05). There was no publication bias in total POSAS score or its subgroup analyses (including geographic distribution, scar duration, intervention measures, fractional laser parameters, and assessor) or adverse reactions (P<0.05).  Conclusions  PDL combined with fractional carbon dioxide laser is beneficial for the recovery of pediatric HS, with a low rate of adverse reactions and a favorable safety profile. For pediatric HS, the early intervention window within 3 months after scar formation should be prioritized, and a regimen combining low-energy (≤50 mJ) fractional carbon dioxide laser flexibly with PDL may yield better therapeutic outcomes.
Value of shear wave elastography in the early diagnosis of DPN in patients with type 2 diabetes mellitus
Zhang Yanji, Tang Mingyuan, Jian Yang, Wu Xiuping, Ma Lihong, Cai Silang, Deng Chengliang, Wei Zairong
, Available online  , doi: 10.3760/cma.j.cn501225-20241230-00513
Abstract:
  Objective  To investigate the value of shear wave elastography (SWE) in the early diagnosis of diabetic peripheral neuropathy (DPN) in patients with type 2 diabetes mellitus.  Methods  This study was a diagnostic case-control study. From May 2021 to October 2022, 68 patients with type 2 diabetes mellitus who met the inclusion criteria were admitted to the Affiliated Hospital of Zunyi Medical University, including 45 males and 23 females, aged (57±10) years. According to the presence or absence of DPN, the patients were divided into DPN group (38 patients) and non-DPN group (30 patients). During the same period, 30 healthy volunteers who underwent physical examinations at the health examination center of the hospital were recruited as healthy control group, including 19 males and 11 females, aged (56±10) years. Cross-sectional areas of the bilateral common peroneal nerves and tibial nerves measured using a color Doppler ultrasonography system in two-dimensional ultrasonography mode, and the stiffness of the bilateral common peroneal nerves and tibial nerves measured in SWE mode were compared among volunteers in healthy control group and two groups of patients at admission. Independent risk factors for the development of DPN were screened among the participants in the three groups. Among the two groups of patients, receiver operating characteristic curves were used to evaluate the diagnostic value of common peroneal nerve stiffness, common peroneal nerve cross-sectional area, tibial nerve stiffness, and tibial nerve cross-sectional area for DPN. The correlations of common peroneal nerve stiffness and common peroneal nerve cross-sectional area with the Toronto clinical scoring system (TCSS) score were analyzed in DPN group of patients.  Results  At admission, the cross-sectional areas of the bilateral common peroneal nerves of patients in DPN group were significantly larger than those of patients in non-DPN group and volunteers in healthy control group (P<0.05); the cross-sectional area of the right tibial nerve of patients was also significantly greater in DPN group than in non-DPN group (P<0.05). The stiffness of the bilateral tibial nerves and common peroneal nerves of patients in both non-DPN group and DPN group was significantly greater than that of volunteers in healthy control group (P<0.05). The stiffness of the left tibial nerve and the bilateral common peroneal nerves of patients was significantly greater in DPN group than in non-DPN group (P<0.05). The results of multivariable ordinal logistic regression analysis showed that common peroneal nerve stiffness, tibial nerve stiffness, and common peroneal nerve cross-sectional area were independent risk factors for the development of DPN among the participants in the three groups (with OR of 0.91, 0.93, and 0.75, respectively, 95%CI of 0.89 to 0.95, 0.89 to 0.97, and 0.58 to 0.96, respectively, P<0.05). Among the two groups of patients, common peroneal nerve stiffness yielded the largest area under the curve for diagnosing DPN, which was 0.85 (with 95%CI of 0.74 to 0.92). The optimal cutoff value was 75.29 kPa, with a sensitivity of 76.32% and a specificity of 90.00% at the optimal cutoff value. In DPN group, common peroneal nerve stiffness and common peroneal nerve cross-sectional area of patients were significantly positively correlated with the TCSS score (with rs values of 0.83 and 0.89, respectively, P<0.05).  Conclusions  SWE performs well in assessing peripheral nerve stiffness in patients with type 2 diabetes mellitus. In particular, common peroneal nerve stiffness measured using SWE has relatively high diagnostic value for complication of DPN in patients and is correlated with clinical severity. It may serve as an auxiliary imaging marker for the early screening and severity assessment of DPN.
Effects and mechanisms of PIT on wound healing of full-thickness skin defects in diabetic mice
Zong Yuange, Huang Wanqi, Zhang Ze, Peng Yuan
, Available online  , doi: 10.3760/cma.j.cn501225-20260127-00049
Abstract:
  Objective  To investigate the effects and mechanisms of polyvinyl alcohol/ionic liquid-tannic acid composite hydrogel (PIT) on wound healing of full-thickness skin defects in diabetic mice.  Methods  This study adopted a grouped design and repeated measurement design for experimental research. An ionic hydrogel matrix crosslinked by polyvinyl alcohol-4-(1H)-vinylimidazole-1-methylene benzoic acid and oxidized hyaluronic acid was prepared, and tannic acid was loaded via Cu2+ chelation to construct PIT. A 1,1-diphenyl-2-picrylhydrazyl (DPPH) solution was prepared, which was reacted with tannic acid and PIT respectively for 24 hours. An ultraviolet spectrophotometer was used to detect the DPPH radical scavenging rate. According to the random number table method (the same grouping method below), mouse macrophage RAW264.7 cells were divided into a phosphate buffered saline (PBS) group cultured with PBS, as well as a hydrogen peroxide group and a PIT group, in which cells were first treated with hydrogen peroxide for 12 hours and then respectively cultured under routine condition and with PIT. After 24 hours of culture, the 2',7'-dichlorodihydrofluorescein diacetate fluorescent probe method was adopted to detect the intracellular reactive oxygen species (ROS) level. Escherichia coli ATCC 25922, Staphylococcus aureus ATCC 25923, methicillin-resistant Staphylococcus aureus (MRSA) BNCC 337371, and human umbilical vein endothelial cells (HUVEC) were collected, and all of them were divided into PBS group, tannic acid (TA) group, and PIT group, which were cultured with PBS, TA solution, and PIT, respectively. After 12 hours of bacterial culture, the plate colony counting method was used to count bacterial colonies; after 24 hours of cell culture, the tube formation assay was performed to measure the total tube length, the number of branching nodes, and the number of branches. The sample size of all the above experiments was 3. Eighteen 8-week-old male Kunming mice were selected and divided into PBS group, TA group, and PIT group (with 6 mice in each group) to build a full-thickness skin defect wound model of diabetes. At post injury day (PID) 0 (immediately), the wounds of mice in PBS group, TA group, and PIT group were treated with PBS, TA solution, and PIT by dropping, respectively, and then the dressing was changed every day. The wound healing status was observed at PID 0, 4, 8, and 12, and the wound healing rates at PID 4, 8, and 12 were calculated. At PID 12, wound tissue was harvested. Hematoxylin-eosin staining was performed to observe the status of wound re-epithelialization and measure the thickness of newborn epithelium. Masson staining was conducted to observe the deposition of collagen fibers in wounds and calculate the proportion of collagen fiber-positive area.  Results  After 24 hours of reaction, the DPPH radical scavenging rate of PIT was significantly higher than that of TA (t=16.35, P<0.05). After 24 hours of culture, the ROS level of RAW264.7 cells in hydrogen peroxide group was significantly higher than that in PBS group (P<0.05), and the ROS level of RAW264.7 cells in PIT group was significantly lower than that in hydrogen peroxide group (P<0.05). After 12 hours of culture, the bacterial colony counts of Escherichia coli, Staphylococcus aureus, and MRSA in PIT group were significantly less than those in PBS group and TA group (P<0.05). After 24 hours of culture, compared with those in PBS group and TA group, the total tube length of HUVECs in PIT group was significantly prolonged, and the number of branching nodes and the number of branches increased significantly (P<0.05). From PID 0 to 12, the wounds of mice in all three groups healed gradually. At PID 4, 8, and 12, the wound healing rates of mice in PIT group were (31.6±2.0)%, (51.8±2.5)%, and (97.9±1.5)%, respectively, which were significantly higher than (18.6±0.6)%, (39.5±2.0)%, and (74.6±2.0)% in PBS group and (21.5±1.1)%, (40.7±0.8)%, and (85.3±2.1)% in TA group (P<0.05). At PID 12, the re-epithelialization of wounds in mice of PBS group was incomplete, and collagen fibers were sparsely distributed with disordered arrangement; the degree of wound re-epithelialization of mice in TA group was higher than that in PBS group, and collagen fibers were distributed in bundles with loose arrangement; the degree of wound re-epithelialization of mice in PIT group was higher than that in TA group, and collagen fibers were densely and orderly arranged in layers. At PID 12, compared with those in PBS group and TA group, the thickness of newborn epithelium in wounds of mice in PIT group increased significantly, and the proportion of collagen fiber-positive area enlarged significantly (P<0.05).  Conclusions  PIT relies on multiple metal ion chelation-mediated mechanisms, including antibacterial activity, antioxidant activity, and angiogenesis promotion. It significantly accelerates the wound healing of full-thickness skin defects in diabetic mice, and improves the quality of tissue repair.
Clinical efficacy of pedicled double perforator deep inferior epigastric artery perforator flap in reconstructing defects following resection of cutaneous malignant tumors
Zhou Shuping, Zhang Dong, Wei Haili, Li Shimin, Chen Junjie, Li Sen, Shi Pancheng, Xing Xinfeng, Shi Yingguang, Chang Chaonan, Zheng Liwu, Wang Huanpeng, Gai Yuning
, Available online  , doi: 10.3760/cma.j.cn501225-20250227-00096
Abstract:
  Objective  To investigate the clinical efficacy of pedicled double perforator deep inferior epigastric artery perforator flap in reconstructing soft tissue defects following resection of cutaneous malignant tumors in the groin or thigh with adjacent major vessels and/or nerves.  Methods  This was a retrospective case series study. From June 2016 to June 2023, 12 patients with cutaneous malignant tumors in the groin or thigh who met the inclusion criteria were admitted to the Department of Burns and Plastic Surgery of the 988th Hospital of the Joint Logistics Support Force of PLA. The cohort included 8 males and 4 females, aged 58 to 76 years. In all patients, tumor invasion depth approached the major vessels and/or nerves. Radical extended resection was performed for the tumors, resulting in postoperative skin and soft tissue defects ranging from 16 cm × 13 cm to 37 cm × 17 cm. A pedicled double perforator deep inferior epigastric artery perforator flap based on the paraumbilical and thoracic paraumbilical perforators was designed and harvested, with flap dimensions ranging from 15 cm × 14 cm to 38 cm × 18 cm. The flaps were transferred to the recipient site through a subcutaneous tunnel and sutured in place. Primary closure of the donor site was achieved in 8 patients; in the remaining 4 patients, the donor site wound was first reduced by approximation sutures, then covered with vacuum sealing drainage (VSD) dressing, with secondary closure performed at a later stage. Postoperative observations included flap blood supply, flap survival, occurrence of vascular crisis, and healing of donor and recipient sites. Operative duration and length of hospital stay were recorded. During follow-up, tumor recurrence, flap contour, donor site scar, and abdominal wall function were assessed.  Results  All 12 patients achieved good flap blood supply and uneventful survival, with no vascular crisis. Both donor and recipient sites healed successfully. Operative duration ranged from 2 to 3 hours, and hospital stay ranged from 15 to 24 days, with a mean of 18.6 days. During a follow-up period of 1 to 6 years, no local tumor recurrence was observed. The flaps were slightly bulky but demonstrated good elasticity and no significant difference in texture from the surrounding tissue. The donor site only exhibited a linear scar, with no significant impact on abdominal wall function.  Conclusions  For extensive soft tissue defects following radical resection of cutaneous malignant tumors in the groin or thigh adjacent to major vessels and/or nerves, the pedicled double perforator deep inferior epigastric artery perforator flap is a viable reconstructive option. This flap provides a large surface area for effective reconstruction while minimizing the impact on donor site aesthetics and function.
Bidirectional two-sample MR analysis of causal relationships between human inflammatory proteins and HS and keloids
Wang Sisi, Xiao Kui, Xiao Hongtao, Han Dawei, Zhang Jian, Wang Lei, Li Yancang
, Available online  , doi: 10.3760/cma.j.cn501225-20250117-00025
Abstract:
  Objective  To explore the causal relationships between human inflammatory proteins and hypertrophic scars (HS) and keloids.  Methods  This study was conducted based on bidirectional two-sample Mendelian randomization (MR) analysis. Data of human inflammatory proteins, HS, and keloids were acquired from genome-wide association study database. The inverse variance weighted (IVW) method was adopted to evaluate the causal relationships between 91 kinds of human inflammatory proteins and HS and keloids, i.e., forward MR analysis. For the above associations, Cochran's Q test was used to assess heterogeneity, MR-Egger regression and MR-PRESSO outlier tests were performed to evaluate horizontal pleiotropy, and the leave-one-out method was applied to analyze the robustness of the results. The IVW method was also used to evaluate whether there was a reverse causal relationship between HS, keloids and inflammatory proteins screened out by aforementioned forward MR analysis.  Results  CD6, leukemia inhibitory factor (LIF), tumor necrosis factor ligand superfamily member 12 (TNFSF12), programmed death-ligand 1 (PD-L1), interleukin-17C (IL-17C), LIF receptor (LIFR), osteoprotegerin (OPG), and fibroblast growth factor 23 (FGF23) had significant causal relationships with HS (with ORs of 1.365, 0.506, 1.567, 1.683, 0.621, 1.375, 0.623, and 0.553, respectively, 95%CIs of 1.100-1.693, 0.289-0.887, 1.081-2.273, 1.090-2.599, 0.408-0.947, 1.025-1.845, 0.402-0.966, and 0.315-0.971, respectively, P<0.05). Among them, CD6, TNFSF12, PD-L1, and LIFR were risk factors for HS, while LIF, IL-17C, OPG, and FGF23 were protective factors for HS. CD5, IL-10 receptor subunit alpha (IL-10RA), IL-5, LIF, and OPG had significant causal relationships with keloids (with ORs of 0.744, 1.303, 0.686, 0.603, and 0.715, respectively, 95%CIs of 0.573-0.965, 1.024-1.660, 0.472-0.996, 0.431-0.842, and 0.553-0.924, respectively, P<0.05). Among them, IL-10RA was a risk factor for keloids, whereas CD5, IL-5, LIF, and OPG were protective factors for keloids. No significant heterogeneity or horizontal pleiotropy was observed in the above associations (P>0.05), and the robustness of the results was not driven by any single nucleotide polymorphism. Significant reverse causal relationships existed between HS and TNFSF12 and LIFR of the 8 inflammatory proteins screened out by aforementioned forward MR analysis (with ORs of 0.972 and 0.968, respectively, 95%CIs of 0.949-0.997 and 0.942-0.994, respectively, P<0.05). No reverse causal relationship was found between keloids and the 5 inflammatory proteins screened out by aforementioned forward MR analysis (P>0.05).  Conclusions  CD6, TNFSF12, PD-L1, and LIFR may increase the risk of HS, while OPG and FGF23 may decrease the risk of HS. IL-10RA may increase the risk of keloids, while CD5, IL-5, LIF, and OPG may decrease the risk of keloids.