Objective To investigate the effects and underlying mechanisms of a spray prepared from exosomes derived from M2 macrophages induced by interleukin-4 （IL-4） and tantalum particles （Ta） on the healing of pressure ulcers. Methods Bone marrow-derived macrophages were polarized into M2 macrophages using IL-4 or Ta, and exosomes （Exo-IL-4/Exo-Ta） were extracted. The regulatory effects of Exo-IL-4/Exo-Ta on M1 macrophage phenotypes and fibroblast matrix secretion were evaluated in vitro. Proteomic analysis was conducted to explore the biological processes and regulatory networks associated with Exo-Ta. A rat pressure ulcer model was used to assess the effects of Exo-IL-4/Exo-Ta spray on wound healing rate, inflammatory cell infiltration, and collagen deposition. Results In vitro, Exo-IL-4/Exo-Ta induced the polarization of M1 macrophages to M2 macrophages, reduced the secretion of pro-inflammatory factors, and promoted the expression of anti-inflammatory substances. Additionally, Exo-IL-4/Exo-Ta enhanced the production of collagen and fibronectin in fibroblasts. Proteomic analysis revealed that Exo-Ta primarily participated in biological processes such as energy metabolism and macromolecule biosynthesis. In vivo, Exo-IL-4/Exo-Ta spray accelerated wound healing, reduced inflammatory infiltration, and improved tissue remodeling in the rat pressure ulcer model. Conclusion Exosome sprays derived from M2 macrophages could accelerate pressure ulcer healing by modulating inflammation and promoting tissue regeneration, which demonstrated excellent clinical application potential.

OBJECTIVES: To reprogram human placental fibroblasts (HPFs) into chemically induced epithelioid-like cells (ciEP-Ls) using a combination of small-molecule compounds. METHODS: HPFs cultured under normoxic conditions were identified using immunofluorescence assay, PCR and chromosomal karyotyping. Under hypoxic conditions (37 ℃, 5% O₂), HPFs were cultured in a medium containing small-molecule compounds C6TSEDRVAJZ (CHIR99021, 616452, TTNPB, SAG, EPZ5676, DZNep, Ruxolitinib, VTP50469, Afuresertib, JNK-IN-8, and EZM0414), and the cell morphology was observed daily. The expression levels of epithelial cell markers in the induced cells were detected by immunofluorescence, Western blotting and PCR. Chromosomal karyotyping of the induced cells was performed and the induction efficiency was calculated. RESULTS: Before induction, HPFs showed positive expressions of fibroblast surface markers CD34 and vimentin and were negative for epithelial surface markers. PCR results showed high expressions of fibroblast-specific genes S100A4 and COL1A1 in HPFs with a normal human diploid karyotype. After one day of induction, the HPFs underwent morphological changes from a multinodular spindle shape to a round or polygonal shape, which was morphologically characteristic of ciEP-Ls. On day 4 of induction, the cells exhibited high expressions of the epithelial cell markers E-cadherin and Lin28A. RT-qPCR results also showed that the cells expressed the epithelial markers Smad3, GLi3, PAX8, WT1, KRT19, and KRT18 with significantly down-regulated expressions of all the fibroblast surface markers and a normal human diploid karyotype. The reprogramming efficiency of HPFs into ciEP-Ls ranged from (64.53±2.8)% to (68.10±3.6)%. CONCLUSIONS The small-molecule compound combination C6TSEDRVAJZ is capable of inducing HPFs into ciEP-Ls under hypoxic conditions with a high induction efficiency.
Humans ; Fibroblasts/drug effects* ; Pregnancy ; Female ; Cell Differentiation/drug effects* ; Pyrimidines/pharmacology* ; Placenta/cytology* ; Cells, Cultured ; Pyridines/pharmacology* ; Pyrazoles/pharmacology* ; Epithelial Cells/cytology*

Objective:To investigate a surgical method and clinical effect on reconstruction of infective ulcer and soft tissue defects in dorsal fingers of the elderly patients with free perforator flap of peroneal artery.Methods:From March 2016 to June 2022, 13 elderly patients with infective ulcer and soft tissue defects in dorsal fingers were reconstructed with free perforator flaps of peroneal artery. The patients were 65-70 years with an average age of 66.5 years. Cause of infection: 10 ulceration and soft tissue defects were caused by diabetes and 3 by injury. Seven infective ulceration and soft tissue defects were in dorsal index fingers, 3 in dorsal middle fingers and 3 in dorsal ring fingers with the size of soft tissue defects at 2.0 cm×4.5 cm-2.0 cm×5.5 cm with an exposure of tendon and phalange. The donor site of the flaps was of contralateral calf and the flaps were 2.5 cm×5.0 cm-2.5 cm×6.0 cm in size. All donor sites were sutured directly. All patients were included in the postoperative follow-up at outpatient clinic to observe the appearance and sensation of the flap as well as finger movement.Results:All flaps survived and all wounds achieved stage I healing, without recurrence of infection. Twelve patients had the postoperative follow-up for 12 to 27 months, with an average of 21.6 months. There were satisfactory appearance of flaps and the function of fingers. Sensation of flaps recovered to S 2 in 5 patients and S 3 in 7 patients. The recovery of hand function was evaluated according to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, with 8 hands in excellent and 4 in good. Conclusion:The free perforator flap of peroneal artery has advantages of constant vascular anatomy, reliable blood supply, moderate thickness and direct closure of donor site. It is a useful clinical method in reconstruction of infective ulcer and soft tissue defects in dorsal fingers of the elderly patients.

Objective:To investigate a surgical method and clinical effect on reconstruction of infective ulcer and soft tissue defects in dorsal fingers of the elderly patients with free perforator flap of peroneal artery.Methods:From March 2016 to June 2022, 13 elderly patients with infective ulcer and soft tissue defects in dorsal fingers were reconstructed with free perforator flaps of peroneal artery. The patients were 65-70 years with an average age of 66.5 years. Cause of infection: 10 ulceration and soft tissue defects were caused by diabetes and 3 by injury. Seven infective ulceration and soft tissue defects were in dorsal index fingers, 3 in dorsal middle fingers and 3 in dorsal ring fingers with the size of soft tissue defects at 2.0 cm×4.5 cm-2.0 cm×5.5 cm with an exposure of tendon and phalange. The donor site of the flaps was of contralateral calf and the flaps were 2.5 cm×5.0 cm-2.5 cm×6.0 cm in size. All donor sites were sutured directly. All patients were included in the postoperative follow-up at outpatient clinic to observe the appearance and sensation of the flap as well as finger movement.Results:All flaps survived and all wounds achieved stage I healing, without recurrence of infection. Twelve patients had the postoperative follow-up for 12 to 27 months, with an average of 21.6 months. There were satisfactory appearance of flaps and the function of fingers. Sensation of flaps recovered to S 2 in 5 patients and S 3 in 7 patients. The recovery of hand function was evaluated according to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, with 8 hands in excellent and 4 in good. Conclusion:The free perforator flap of peroneal artery has advantages of constant vascular anatomy, reliable blood supply, moderate thickness and direct closure of donor site. It is a useful clinical method in reconstruction of infective ulcer and soft tissue defects in dorsal fingers of the elderly patients.

Objective:To compare the effects of different positioning and puncture methods for epidural anesthesia in obese parturients undergoing cesarean section.Methods:In this prospective, randomized, controlled study, 175 obese parturients, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, with a body mass index of > 30 kg/m 2, who underwent elective cesarean section with epidural anesthesia at Henan Provincial People′s Hospital from July 2023 to April 2024, were selected and assigned into 4 groups using a random number table method: palpation positioning + median approach to puncture group (PM group, n=44), body surface marker positioning + paramedian approach to puncture group (BP group, n=43), ultrasound-assisted positioning + paramedian approach to puncture group (UP group, n=45), and ultrasound-assisted positioning + ultrasound-guided in-plane approach to puncture group (UU group, n=43). The procedures were performed by anesthesiology residents skilled in the four different epidural anesthesia positioning and puncture methods. Main observation indicators: success rate of puncture at first attempt and total success rate of puncture. Secondary observation indicators: the number of puncture, changes in puncture interspaces, positioning time, puncture time, anesthesia operation time, postoperative nausea and vomiting, sensory abnormalities at the puncture site, bleeding at the puncture site, maternal satisfaction rates, and occurrence of low back pain at day 7, 1 month, 2 months, and 3 months postoperatively. Results:In this study, 2 cases were excluded from PM group, 2 from BP group, 2 from UP group, and 2 from UU group. The total success rates of puncture were as follows: 95% (40/42) in PM group, 98% (40/41) in BP group, 93% (40/43) in UP group, and 98% (40/41) in UU group. There was no significant difference in the total success rates of puncture among the four groups ( P>0.05). Compared to PM group, the success rate of puncture at first attempt was significantly increased, the rate of changes in puncture interspaces was decreased, the positioning time was shortened, the incidence of nausea and vomiting was decreased, satisfaction rates were increased, and the incidence of low back pain was reduced at 7 days after operation in BP group; the success rate of puncture at first attempt was significantly increased, the number of puncture was reduced, the rate of changes in puncture interspaces was decreased, the positioning time, puncture time and anesthesia operation time were shortened, the satisfaction rates were increased, and the incidence of low back pain was decreased at 7 days after operation in UP group; the rate of changes in puncture interspaces was significantly decreased, and the positioning time was shortened in UU group ( P<0.05). Compared to BP group, the puncture time was significantly shortened in UP group, and the number of puncture was significantly increased, the anesthesia operation time was prolonged, the incidence of nausea and vomiting was increased, and the satisfaction rate was decreased in UU group ( P<0.05). Compared to UP group, the success rate of puncture at first attempt was significantly decreased, the number of puncture was increased, the puncture time and anesthesia operation time were prolonged, the incidence of nausea and vomiting was increased, and the satisfaction rates were decreased in UU group ( P<0.05). Conclusions:Ultrasound-assisted positioning combined with the paramedian approach to puncture can raise the success rate of puncture at first attempt, reduce the development of puncture-related complications, and increase the maternal satisfaction in obese parturients undergoing cesarean section.

Objective:To explore the application effect of preoperative autologous blood localization method in laparoscopic resection of gastric stromal tumors in unfavorable areas of the stomach.Methods:A retrospective analysis was conducted on the case data of 40 patients with gastric stromal tumors in unfavorable locations admitted to Jinjiang Hospital from January 2019 to December 2022. The patients were divided into a control group (intraoperative endoscopic localization method) and an autologous blood localization group according to different intraoperative lesion localization methods, with 20 cases in each group. The surgical time, intraoperative blood loss, hospitalization time, postoperative exhaust time, and adverse reactions were compared between the two groups.Results:The surgery time of the autologous blood localization group was shorter than that of the control group [(92.30±8.80)min vs (108.20±14.87)min, P<0.05]. There was no statistically significant difference in intraoperative bleeding, hospitalization time, and postoperative exhaust time between the two groups (all P>0.05). Two groups of patients did not show an increase in inflammatory indicators such as white blood cells and C-reactive protein on the day after surgery. Both groups of patients did not experience adverse reactions such as fever, abdominal pain, or postoperative complications. Conclusions:The autologous blood injection localization method provides a safe, simple, and effective method for preoperative localization of gastric stromal tumors in unfavorable areas of the stomach under laparoscopy, and is worthy of clinical promotion and use.

Objective:To measure the overall and lobulated volume of the liver with different degrees of liver fibrosis and to further observe pathological changes such as liver microvasculature, hepatocyte apoptosis, and regeneration in order to understand the macroscopic volume changes of the liver during liver fibrosis and its relationship with liver tissue microscopic pathology in patients with chronic liver disease.Methods:53 patients with chronic hepatitis B, alcoholic fatty liver disease, autoimmune liver disease, nonalcoholic fatty liver disease, and drug-induced chronic liver disease who underwent both liver biopsy tissue and abdominal magnetic resonance imaging were collected. Patients were divided into early (F1-2), middle (F3-4), and late (F5-6) in accordance with the Ishak fibrosis stage and Masson stain. The liver and spleen volumes were measured using ITK-SNAP software. CD31 immunohistochemical staining was used to reflect intrahepatic angiogenesis. Ki67 and HNF-4α multiplex immunohistochemical staining were used to reflect hepatocyte regeneration. GS staining was used to determine parenchymal extinction lesions. TUNEL staining was used to observe hepatocyte apoptosis. Spearman correlation analysis was used to analyze the relationship between liver volume changes and liver histopathological changes.Results:As liver fibrosis progressed, the total liver volume and right lobe liver volume gradually decreased ( P<0.05), while the spleen volume gradually increased ( P<0.05). The expression of CD31 and GS gradually increased ( P<0.05), and the expression of Ki67 first increased and then decreased ( P<0.05). The positivity rate of CD31 was negatively correlated with the right lobe liver volume ( r=-0.609, P<0.001) and the total liver volume ( r=-0.363, P=0.017). The positivity rate of Ki67 was positively correlated with the right lobe liver volume ( r=0.423, P=0.018), while the positivity rate of apoptotic cells was significantly negatively correlated with the total liver volume ( r=-0.860, P<0.001). The positivity rate of GS was negatively correlated with the right lobe liver volume ( r=-0.440, P=0.002), and the number of PELs was negatively correlated with RV ( r=-0.476, P=0.013). The CD31 positive staining area was negatively correlated with the Ki67 positive staining area( r=-0.511, P=0.009). Conclusion:As liver fibrosis progresses, patients with chronic liver disease have a depletion in total liver volume and right lobe liver volume, and this is mainly in correlation with fewer liver cells and liver tissue microvasculature disorders.

Objective To assess the predictive value of bedside diaphragmatic ultrasound in predicting pulmonary complications(PPCs)after thoracoscopic lobectomy.Methods The patients who had undergone elective thoracoscopic lobectomy in Henan Provincial People's Hospital were collected.General information and perioperative indicators were recorded.Diaphragmatic motility was detected by bedside ultrasound preoperatively and on postopera-tive days 1,3,and 5.The patients were divided into two groups(PPCs group and non-PPCs group).Statistically different parameters in univariate analysis were included in multivariate logistic regression analysis to screen inde-pendent influencing factors of PPCs.Receiver operating curve(ROC)was drawn,and the performance of diaphragm ultrasound for predicting PPCs was evaluated by the area under the curve(AUC).Results 949 patients were included in this study.PPCs occurred in 537 patients(57.5% ).Univariate analysis showed that as compared with the non-PPCs group,the proportion of diabetic patients and postoperative VAS score in the PPCs group increased,time to chest tube removal and one-lung ventilation,and postoperative hospital stay were longer.PPCs group had a lower DE value on the operative side and healthy side on postoperative days 1 and 3 and on the operative side alone on day 5(P<0.05).Multivariate logistic regression analysis showed that prolonged one-lung ventilation time,diabetes mellitus,DE values on the operative side and unoperative side on postoperative days 1 and 3,and decreased DE value on the operative side on day 5 were independent risk factors for PPCs.The ROC curve shows that the efficacy of DE for pre-dicting PPCs on the operative and healthy sides on postoperative days 1 and 3 was relatively high(AUC of 0.797,0.821,0.933,and 0.929;respectively).The efficacy of DE for predicting PPCs on the operative side was poor on postoperative day 5(AUC of 0.703 and 0.512,respectively).Conclusions A decrease in postoperative DE,prolonged one-lung ventilation time,and diabetes are independent risk factors for PPCs after thoracoscopic lobectomy.Bedside ultrasound evaluation of DE has a higher value in predicting PPCs three days after surgery.

Objective:To compare the effects of different positioning and puncture methods for epidural anesthesia in obese parturients undergoing cesarean section.Methods:In this prospective, randomized, controlled study, 175 obese parturients, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, with a body mass index of > 30 kg/m 2, who underwent elective cesarean section with epidural anesthesia at Henan Provincial People′s Hospital from July 2023 to April 2024, were selected and assigned into 4 groups using a random number table method: palpation positioning + median approach to puncture group (PM group, n=44), body surface marker positioning + paramedian approach to puncture group (BP group, n=43), ultrasound-assisted positioning + paramedian approach to puncture group (UP group, n=45), and ultrasound-assisted positioning + ultrasound-guided in-plane approach to puncture group (UU group, n=43). The procedures were performed by anesthesiology residents skilled in the four different epidural anesthesia positioning and puncture methods. Main observation indicators: success rate of puncture at first attempt and total success rate of puncture. Secondary observation indicators: the number of puncture, changes in puncture interspaces, positioning time, puncture time, anesthesia operation time, postoperative nausea and vomiting, sensory abnormalities at the puncture site, bleeding at the puncture site, maternal satisfaction rates, and occurrence of low back pain at day 7, 1 month, 2 months, and 3 months postoperatively. Results:In this study, 2 cases were excluded from PM group, 2 from BP group, 2 from UP group, and 2 from UU group. The total success rates of puncture were as follows: 95% (40/42) in PM group, 98% (40/41) in BP group, 93% (40/43) in UP group, and 98% (40/41) in UU group. There was no significant difference in the total success rates of puncture among the four groups ( P>0.05). Compared to PM group, the success rate of puncture at first attempt was significantly increased, the rate of changes in puncture interspaces was decreased, the positioning time was shortened, the incidence of nausea and vomiting was decreased, satisfaction rates were increased, and the incidence of low back pain was reduced at 7 days after operation in BP group; the success rate of puncture at first attempt was significantly increased, the number of puncture was reduced, the rate of changes in puncture interspaces was decreased, the positioning time, puncture time and anesthesia operation time were shortened, the satisfaction rates were increased, and the incidence of low back pain was decreased at 7 days after operation in UP group; the rate of changes in puncture interspaces was significantly decreased, and the positioning time was shortened in UU group ( P<0.05). Compared to BP group, the puncture time was significantly shortened in UP group, and the number of puncture was significantly increased, the anesthesia operation time was prolonged, the incidence of nausea and vomiting was increased, and the satisfaction rate was decreased in UU group ( P<0.05). Compared to UP group, the success rate of puncture at first attempt was significantly decreased, the number of puncture was increased, the puncture time and anesthesia operation time were prolonged, the incidence of nausea and vomiting was increased, and the satisfaction rates were decreased in UU group ( P<0.05). Conclusions:Ultrasound-assisted positioning combined with the paramedian approach to puncture can raise the success rate of puncture at first attempt, reduce the development of puncture-related complications, and increase the maternal satisfaction in obese parturients undergoing cesarean section.

OBJECTIVE: To investigate the effectiveness of dorsal perforator flap of cross-finger proper digital artery in the treatment of finger soft tissue defect caused by high-pressure injection injury. METHODS: Between July 2011 and June 2020, 14 cases of finger soft tissue defect caused by high-pressure injection injury were repaired with dorsal perforator flap of cross-finger proper digital artery. All patients were male, with a mean age of 36 years (range, 22-56 years). The defects were located on the index finger in 8 cases, middle finger in 4 cases, and ring finger in 2 cases. The causes of injury include 8 cases of emulsion paint injection, 4 cases of oil paint injection, and 2 cases of cement injection. The time from injury to debridement was 2-8 hours, with a mean time of 4.5 hours. The soft tissue defects sized from 4.0 cm×1.2 cm to 6.0 cm×2.0 cm. The flaps sized from 4.5 cm×1.5 cm to 6.5 cm×2.5 cm. The donor site of the flap was repaired with skin graft. The pedicle was cut off at 3 weeks after operation, and followed by functional exercise. RESULTS: All flaps and skin grafts at donor sites survived, and the wounds healed by first intention. Twelve patients were followed-up 16-38 months (mean, 22.6 months). The texture and appearance of all flaps were satisfactory. The color and texture of the flaps were similar to those of the surrounding tissues. The two-point discrimination of the flap was 10-12 mm, with a mean of 11.5 mm. There were different degrees of cold intolerance at the end of the affected fingers. At last follow-up, the finger function was evaluated according to the Upper Extremity Functional Evaluation Standard set up by Hand Surgery Branch of Chinese Medical Association, 3 cases were excellent, 8 cases were good, and 1 case was poor. CONCLUSION The dorsal perforator flap of cross-finger proper digital artery can effectively repair finger soft tissue defect caused by high-pressure injection injury. The operation was simple, and the appearance and function of the finger recover well.
Humans ; Male ; Adult ; Female ; Perforator Flap ; Upper Extremity ; Fingers/surgery* ; Ulnar Artery ; Skin Transplantation