BACKGROUND:Studies have shown that cytokine inhibitor pirfenidone can inhibit biological activity of fibroblasts by regulating a variety of cytokines. It has made good progress in the research and application of anti-fibrosis of internal organs, but the effect and mechanism for hypertrophic scars and skin fibroblasts are unclear. OBJECTIVE:To investigate the effect of pirfenidone on human hypertrophic scar fibroblasts. METHODS:Human hypertrophic scar fibroblasts were cultured using tissue culture method. Passages 3-6 cel s grew wel in the logarithmic growth phase were col ected. Cel s were divided into the control group (0 g/L pirfenidone), 0.15, 0.3 and 1 g/L pirfenidone groups according to different mass concentrations. Cel s were intervened for 12, 36 and 48 hours. RESULTS AND CONCLUSION:MTT, reverse transcription-polymerase chain reaction and enzyme-linked immunosorbent assay results demonstrated that compared with the control group, cel proliferation, transforming growth factorβ1 mRNA expression, types I and III col agen secretion were decreased in the 0.15, 0.3 and 1 g/L pirfenidone groups (P<0.05), and the decrease was most significant in the 1 g/L pirfenidone group (P<0.05). At 24, 48 and 72 hours after intervention, significant differences in inhibitory rate of cel proliferation and the secretion of types I and III col agen were detected among 0.15, 0.3 and 1 g/L pirfenidone groups (P<0.05). Results confirmed that pirfenidone apparently inhibited the secretion of col agen of hypertrophic scar fibroblasts cultured in vitro, transforming growth factorβ1 expression and cel proliferation and viability.

Objective: To analysis the clinical efficacy of dorsal digital nerves fasciocutaneous pedicle flap (DDNFPF) with superficial vein anastomosis in the treatment of the type III and type IV of fingertip defect, and the relationship between the incidence of vein crisis and superficial vein anastomosis. Methods: A total of 85 patients with 92 fingers, treated by DDNFPF from February, 2017 to December, 2018, were retrospectively analyzed. The superficial veins of 30 patients with 32 fingers were anastomosed, and 55 patients with 60 fingers were not. The difference of the superior rate and the incidence of venous crisis between superficial vein anastomosis and non-superficial vein anastomosis was compared by Chi-square test. The difference was considered as statistically significant when P<0.05. The regular postoperative followed-up was performed. Results: The average followed-up time was (7.0±2.9) months. The incidence of venous crisis in anastomosis group (1/32) was lower than that in non-anastomosis group (13/60). The difference was statistically significant (χ²=4.217, P<0.05) . There was no significant difference in the superior rate between the 2 groups after operation (96.8% and 90.0% respectively, χ²=0.596, P>0.05) . The repaired fingertips of the 2 groups were in good appearance, wear-resistant, stable holders and two-point discrimination was 5 to 8 mm. Conclusion DDNFPF for the type III and IV type of fingertip defect is safe and effective. A anastomosis of superficial veins in recipient area can significantly reduce the incidence of venous crisis.

Objective:To investigate the application value of cannulated screws in the treatment of Hauck type Ⅱ ulnar styloid process fracture.Methods:The clinical data of 93 patients with Hauck type Ⅱ ulnar styloid process fracture who received treatment at Fuzhou Second Hospital Affiliated to Xiamen University from December 2020 to February 2023 were retrospectively analyzed for a case-control study. Among these patients, 38 patients did not undergo surgical fixation and 55 patients underwent surgical fixation. Twenty-seven patients underwent surgical fixation with cannulated screws and twenty-eight patients underwent surgical fixation with Kirschner wires. The fracture healing, postoperative rehabilitation, and functional recovery of the wrist were compared among groups.Results:The fracture healing rate and the incidence of distal radioulnar joint instability in the surgical fixation group were 100.00% (55/55) and 5.45% (3/55), respectively. These were significantly higher and lower respectively compared with the non-surgical fixation group [57.89% (22/38), 50.00% (19/38), χ 2 = 27.66, 24.69, both P < 0.001]. The wrist function recovery in the surgical fixation group was significantly superior to that in the non-surgical fixation group ( Z = -5.18， P < 0.001). There were no statistically significant differences in operative time and intraoperative blood loss between the cannulated screw group and the Kirschner wire group [(21.41 ± 5.15) minutes vs. (20.93 ± 5.71) minutes, (2.11 ± 0.97) mL vs. (2.07 ± 0.90) mL, t = 0.32, 0.15, both P > 0.05]. The fracture healing time and rehabilitation intervention time in the cannulated screw group were shorter than those in the Kirschner wire group [(6.48 ± 1.05) weeks vs. (9.14 ± 1.24) weeks, (2.11 ± 0.32) weeks vs. (3.11 ± 0.57) weeks, t = 8.57, 7.98, both P < 0.001]. The postoperative wrist function scores in the cannulated screw group were superior to those in the Kirschner wire group ( Z = -2.21, P < 0.05). Conclusion:For patients with Hauck type Ⅱ ulnar styloid process fracture, surgical fixation can promote the recovery of wrist function after surgery, and cannulated screw fixation is an effective method for the treatment of Hauck type Ⅱ ulnar styloid process fracture.

Objective:To investigate the hemodynamic changes of the main arteries and veins of the extremities and the heart in patients with hypertrophic scar secondary to extensive burns after pressure treatment, and to analyze the relevant mechanisms.Methods:A retrospective before-after self-control study was conducted. From January 2017 to February 2022, 37 patients with hypertrophic scar secondary to extensive burns who met the inclusion criteria were hospitalized in the Burn Rehabilitation Department of Guangdong Industrial Injury Rehabilitation Hospital, including 25 males and 12 females, aged 23-52 years. The patients were admitted to the hospital within 12 weeks after wound healing, and within one week after admission, rehabilitation therapists, occupational therapists, and tailors custom-made pressure products such as full-body pressure garment, pressure pants, vests, split finger gloves, split finger socks, hoods, and plastic collars, with the pressure at each part maintained at 2.67-4.00 kPa when wearing. Before the first treatment with pressure products (hereinafter referred to as before pressure treatment) and at 1 h of the first treatment with pressure products (hereinafter referred to as 1 h of pressure treatment), color Doppler ultrasonography was performed to check the pulse rate of the axillary artery, the lumen diameter, peak systolic velocity (PSV), and resistance index of the axillary artery and femoral artery on the left side, the lumen diameter, cross-sectional area, and average blood flow velocity of the axillary vein and femoral vein, and the mitral valve E peak, mitral valve A peak, tricuspid valve E peak, aortic valve PSV, and pulmonary valve PSV of the heart; an optical chromatographic skin detector was used to detect the red color, red pigment, and surface brightness of the scar on the back of the hand to reflect the filling and distribution of the scar microvessels. Data were statistically analyzed with paired sample t test. Results:Compared with those before pressure treatment, the PSV of the axillary artery of patients was significantly slowed down at 1 h of pressure treatment ( t=55.42, P<0.01); the average blood flow velocity of the axillary vein was significantly accelerated ( t=-60.50, P<0.01); the pulse rate, lumen diameter, and resistance index of the axillary artery, as well as the lumen diameter and cross-sectional area of the axillary vein did not change obviously ( P>0.05); the average blood flow velocity of the femoral vein was significantly accelerated ( t=-80.52, P<0.01); the lumen diameter, PSV, and resistance index of the femoral artery, as well as the lumen diameter and cross-sectional area of the femoral vein had no significant change ( P>0.05); the mitral valve E peak and mitral valve A peak of the heart decreased significantly (with t values of 10.71 and 21.96, respectively, P<0.01); the tricuspid valve E peak of the heart increased significantly ( t=7.57, P<0.01); the PSV of the aortic valve and pulmonary valve of the heart did not change obviously ( P>0.05). At 1 h of pressure treatment, the red color and red pigment values of the scar on the back of the hand of patients were 15.3±1.1 and 16.8±1.2, respectively, which were significantly lower than 24.5±1.3 and 23.8±1.2 before pressure treatment (with t values of 8.32 and 8.04, respectively, P<0.01). The brightness value of the scar surface on the back of the hand of patients at 1 h of pressure treatment was similar to that before pressure treatment ( P>0.05). Conclusions:After pressure treatment for the hypertrophic scar in patients secondary to extensive burn, the average blood flow velocity of the axillary vein and femoral vein in patients are obviously accelerated, the PSV of the axillary artery is significantly slowed down, the peak values of mitral valve E and mitral valve A of the heart are significantly decreased, and the tricuspid valve E peak is significantly increased. These hemodynamic changes may be related to the reduction of microvascular blood flow in the local area of scar after systemic pressure treatment.