Objective:To systematically evaluate the effectiveness of manual lymphatic drainage (MLD) in the prevention and treatment of breast cancer-related lymphedema (BCRL).Methods:Randomized controlled trials (RCTs) on the application of MLD for lymphedema after breast cancer surgery were retrieved from PubMed, Embase, Web of Science, CNKI, and Wanfang databases. The search covered studies published in English and Chinese from January 1, 2000 to February 1, 2024. Literature management and screening were conducted using EndNote X9 software based on inclusion and exclusion criteria. Relevant data from the final included studies for the meta-analysis were extracted. The outcome measures included the incidence of BCRL, reduced values in upper limb volume or circumference in BCRL patients, and the incidence of axillary web syndrome (AWS). Meta-analysis was performed using RevMan 5.4 software. The incidence of BCRL and AWS was expressed as relative risk ( RR) with 95% confidence intervals ( CI), and the Mantel-Haenszel method was used to calculate pooled effect sizes. For the reduction in limb volume or circumference in BCRL patients, standard mean difference ( SMD) with 95% CI was used, and the inverse variance method was applied to calculate pooled effect sizes. A P-value of <0.05 was considered statistically significant. The I2statistic was used to assess heterogeneity among studies; a fixed-effect model was applied when I2<50%, and a random-effects model was used when I2≥50%. Results:A total of 760 studies were retrieved, and 12 RCTs involving 2 279 post-breast cancer surgery patients were ultimately included. Among them, 1 132 patients in the control group received conventional treatment or combined compression bandaging, while 1 147 patients in the experimental group received MLD in addition to the control group interventions. Moderate to high heterogeneity was observed among the studies ( I2>50%, P<0.05), and a random-effects model was used for the analysis of all outcome measures between the two groups. The result showed that compared to the control group, the experimental group had a lower incidence of BCRL ( RR=0.35, 95% CI: 0.20-0.64, Z=3.42, P<0.001), the reduction in limb volume or circumference measurements increased( SWD=-1.28, 95% CI: -2.45~-0.10, Z=2.13, P=0.030), and a lower incidence of AWS ( RR=0.20, 95% CI: 0.07-0.55, Z=3.11, P=0.002). Conclusion:MLD can significantly prevent the occurrence of lymphedema and AWS in patients after breast cancer surgery, and for patients who have already developed lymphedema, MLD can also effectively reduces the degree of swelling. However, more high quality clinical studies are still needed for further verification.

The skin is one of the most vital organs in the human body, and skin wounds caused by various factors can severely impact patients’ physical and mental health. Among the therapeutic strategies for skin wound repair, mesenchymal stem cell-derived exosomes (MSC-Exos) have emerged as a promising biological therapy, attracting significant attention in related research. As critical mediators of stem cell biological effects, MSC-Exos fuse with target cells and transfer bioactive proteins and nucleic acids from stem cells into recipient cells. These exosomes modulate inflammatory responses, promote cell proliferation, migration, and angiogenesis, and regulate extracellular matrix remodeling, thereby accelerating wound healing. In recent years, studies on the mechanisms by which exosomes promote skin wound repair have advanced and refined continuously. This article summarized the key signaling pathways through which MSC-Exos participate in skin wound repair, aiming to enhance the understanding of their roles in facilitating wound healing.

Objective:To investigate changes in psychological status before and after sequential therapy in patients with skin circulatory disorders following hyaluronic acid injection.Methods:A retrospective study was conducted on 17 female patients, with a mean age of 28-54 (39.5±1.2) years, admitted to the Fourth Medical Center of PLA General Hospital from December 2021 to July 2022. Patients received ultrasound-guided percutaneous arterial puncture or digital subtraction angiography (DSA) guided catheter intervention for hyaluronidase injection, alongside corticosteroid pulse therapy, diuretic administration, neurotrophic support, wound protection, and laser therapy. Psychological assessments, including the Minnesota multiphasic personality inventory (MMPI) and symptom check list-90 (SCL-90), were performed at admission and 30-45 days post-discharge. Changes in assessment scores and patient satisfaction were analyzed.Results:Two patients failed to complete all assessments, leaving 15 cases for final analysis. Affected anatomical regions included the nose/perinasal area (13 cases), temporal region (3 cases), lips (3 cases), and forehead (7 cases). MMPI scores for hypochondriasis, depression, hysteria, psychopathic deviation, paranoia, psychasthenia, and hypomania showed statistically significant reductions compared to baseline (all P<0.05). SCL-90 scores for somatization, obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, psychoticism, and sleep/appetite disturbances also demonstrated significant decreases (all P<0.05). Among the 15 patients, 7 patients reported being very satisfied, 6 patients were satisfied, and 2 patients were moderately satisfied, with no dissatisfaction reported. Conclusion:Sequential therapy is associated with improved psychological outcomes in patients with skin circulatory disorders secondary to hyaluronic acid injection.

Objective:To systematically evaluate the effectiveness of manual lymphatic drainage (MLD) in the prevention and treatment of breast cancer-related lymphedema (BCRL).Methods:Randomized controlled trials (RCTs) on the application of MLD for lymphedema after breast cancer surgery were retrieved from PubMed, Embase, Web of Science, CNKI, and Wanfang databases. The search covered studies published in English and Chinese from January 1, 2000 to February 1, 2024. Literature management and screening were conducted using EndNote X9 software based on inclusion and exclusion criteria. Relevant data from the final included studies for the meta-analysis were extracted. The outcome measures included the incidence of BCRL, reduced values in upper limb volume or circumference in BCRL patients, and the incidence of axillary web syndrome (AWS). Meta-analysis was performed using RevMan 5.4 software. The incidence of BCRL and AWS was expressed as relative risk ( RR) with 95% confidence intervals ( CI), and the Mantel-Haenszel method was used to calculate pooled effect sizes. For the reduction in limb volume or circumference in BCRL patients, standard mean difference ( SMD) with 95% CI was used, and the inverse variance method was applied to calculate pooled effect sizes. A P-value of <0.05 was considered statistically significant. The I2statistic was used to assess heterogeneity among studies; a fixed-effect model was applied when I2<50%, and a random-effects model was used when I2≥50%. Results:A total of 760 studies were retrieved, and 12 RCTs involving 2 279 post-breast cancer surgery patients were ultimately included. Among them, 1 132 patients in the control group received conventional treatment or combined compression bandaging, while 1 147 patients in the experimental group received MLD in addition to the control group interventions. Moderate to high heterogeneity was observed among the studies ( I2>50%, P<0.05), and a random-effects model was used for the analysis of all outcome measures between the two groups. The result showed that compared to the control group, the experimental group had a lower incidence of BCRL ( RR=0.35, 95% CI: 0.20-0.64, Z=3.42, P<0.001), the reduction in limb volume or circumference measurements increased( SWD=-1.28, 95% CI: -2.45~-0.10, Z=2.13, P=0.030), and a lower incidence of AWS ( RR=0.20, 95% CI: 0.07-0.55, Z=3.11, P=0.002). Conclusion:MLD can significantly prevent the occurrence of lymphedema and AWS in patients after breast cancer surgery, and for patients who have already developed lymphedema, MLD can also effectively reduces the degree of swelling. However, more high quality clinical studies are still needed for further verification.

The skin is one of the most vital organs in the human body, and skin wounds caused by various factors can severely impact patients’ physical and mental health. Among the therapeutic strategies for skin wound repair, mesenchymal stem cell-derived exosomes (MSC-Exos) have emerged as a promising biological therapy, attracting significant attention in related research. As critical mediators of stem cell biological effects, MSC-Exos fuse with target cells and transfer bioactive proteins and nucleic acids from stem cells into recipient cells. These exosomes modulate inflammatory responses, promote cell proliferation, migration, and angiogenesis, and regulate extracellular matrix remodeling, thereby accelerating wound healing. In recent years, studies on the mechanisms by which exosomes promote skin wound repair have advanced and refined continuously. This article summarized the key signaling pathways through which MSC-Exos participate in skin wound repair, aiming to enhance the understanding of their roles in facilitating wound healing.

Objective:To investigate changes in psychological status before and after sequential therapy in patients with skin circulatory disorders following hyaluronic acid injection.Methods:A retrospective study was conducted on 17 female patients, with a mean age of 28-54 (39.5±1.2) years, admitted to the Fourth Medical Center of PLA General Hospital from December 2021 to July 2022. Patients received ultrasound-guided percutaneous arterial puncture or digital subtraction angiography (DSA) guided catheter intervention for hyaluronidase injection, alongside corticosteroid pulse therapy, diuretic administration, neurotrophic support, wound protection, and laser therapy. Psychological assessments, including the Minnesota multiphasic personality inventory (MMPI) and symptom check list-90 (SCL-90), were performed at admission and 30-45 days post-discharge. Changes in assessment scores and patient satisfaction were analyzed.Results:Two patients failed to complete all assessments, leaving 15 cases for final analysis. Affected anatomical regions included the nose/perinasal area (13 cases), temporal region (3 cases), lips (3 cases), and forehead (7 cases). MMPI scores for hypochondriasis, depression, hysteria, psychopathic deviation, paranoia, psychasthenia, and hypomania showed statistically significant reductions compared to baseline (all P<0.05). SCL-90 scores for somatization, obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, psychoticism, and sleep/appetite disturbances also demonstrated significant decreases (all P<0.05). Among the 15 patients, 7 patients reported being very satisfied, 6 patients were satisfied, and 2 patients were moderately satisfied, with no dissatisfaction reported. Conclusion:Sequential therapy is associated with improved psychological outcomes in patients with skin circulatory disorders secondary to hyaluronic acid injection.

Objective To evaluate the therapeutic effect of poloxamer hydrogel loaded with exosomes derived from human dental pulp stem cells genetically modified with human hepatocyte growth factor against radiation skin injuries.Methods Human dental pulp stem cells derived exosomes(DPSC-Exo)and hepatocyte growth factor modified DPSC-Exo(HGF-DPSC-Exo)were extracted via ultracentrifugation separation,identified in terms of particle size and morphology,and analyzed separately by means of nanoparticle tracking analysis and scanning electron microscopy(SEM),while exosome marker proteins were determined by Western blot.Then,the effect of exosomes on radiation-damaged skin cells was assessed.The poloxamer hydrogel was prepared and its safety was evaluated with CCK-8.A mouse model of injury combined with radiation injury was established,and the therapeutic effect of hydrogel loaded with exosomes was determined based on wound size,HE and Masson staining.Furthermore,the underlining therapeutic mechanism was explored with Tunnel assay,malondialdehyde content and peroxidase activity.Results The diameter exosomes ranged from 30 to 150 nm and their morphology was a disc-shaped vesicle under SEM.Moreover,CD9,CD63 and TSG101 were expressed.The results of cellular experiments showed that exosomes significantly promoted the proliferation and migration of radiation-damaged skin keratinocytes and fibroblasts,and reduced their apoptosis.HGF modification enhanced the healing effect of exosomes.Poloxamer hydrogel showed good temperature-sensitive properties and biocompatibility.The results of animal experiments showed that exosomes significantly accelerated the healing of radiation-combined injuries in mice,inhibited inflammatory infiltration and mitigated collagen deposition in the wound.Interestingly,the healing effect in the group treated with hydrogel loaded with exosomes was the best.The underlining mechanism was possibly related to promotion of cell proliferation and inhibition of apoptosis and oxidative stress.Conclusion A novel poloxamer hydrogel loaded HGF-DPSC-Exo has been prepared and its therapeutic effect against radiation combined injury has been proved,thus providing a new strategy for the treatment of radiation skin injury in clinic.

Objective:To systematically investigate the prevalence, diagnosis and treatment of nontuberculous mycobacteria (NTM) infection following autologous fat grafting.Methods:A comprehensive search and collection of domestic and international literature on NTM infection after autologous fat grafting was conducted based on established inclusion and exclusion criteria. The gender, age, surgical procedure, onset latency, time of diagnosis, NTM strain, clinical manifestations, treatment plan, and follow-up time of each selected patient were collected. Systematic analysis was performed on the collected data. The measurement data of normal distribution was expressed as Mean±SD, the data of skew distribution was expressed as M( Q1, Q3), count data was expressed as frequency and percentage. Results:The data of 72 patients from 31 studies were included in the analysis, with 1 male and 71 females, aged (36.7±11.7) years (ranging from 21 to 67 years). The follow-up period ranged from 2 months to 9 years, with a median time of 12 (6, 36) months. Infection sites after fat grafting included the face (65.3%, n=47), breast (20.8%, n=15), abdomen (9.7%, n=7), buttocks (8.3%, n=6), and limbs (2.8%, n=2). Among them, 65 cases (90.3%) were infected at the injection site, 2 cases (2.8%) were infected at the liposuction site, and 5 cases (6.9%) were infected at both the liposuction and injection sites. The identified strains of NTM were: M. abscessus in 53 cases (73.6%), M. chelonae in 10 cases (13.9%), M. fortuitum in 7 cases (9.7%), M. conceptionense in 1 case (1.4%), and mixed infection of M. abscessus/ M. chelonae in 1 case (1.4%). The average latency period was 25 (10, 30) days, ranged from four days to six months. The time of diagnosis was approximately 120 (68, 195) days (ranged from 30 days to two years). Sixty-nine patients (95.8%) underwent debridement, drainage, and negative pressure aspiration, with an average of more than 3 times of debridement treatments. All patients were treated with two or more antibiotics. Clarithromycin, amikacin, ciprofloxacin, and cefoxitin were the most frequently used antibiotics. The mean duration of treatment was 12 (7, 16) months (ranged 2.5 to 18 months). Conclusion:The most common strains of NTM infection after autologous fat grafting were M. abscessus, M. chelonae, and M. fortuitum, with a higher infection rate observed at the fat injection site compared to the liposuction site. The most common treatment strategy for NTM after diagnosis was early debridement followed by combined antibiotic therapy. However, it is challenging to accurately diagnose NTM infections, leading to a high rate of misdiagnosis and mistreatment. Therefore, healthcare professionals should increase their awareness of NTM infections and acquire knowledge on how to prevent, diagnose, and treat them.

Objective:To conduct a network meta-analysis comparing the efficacy and safety of various drug injections for treating keloids.Methods:The search terms of "triamcinolone acetonide, 5-fluorouracil, verapamil, botulinum toxin, platelet rich plasma, keloid, scar, drug injection" were retrieved in PubMed, Embase, Web of Science, CNKI and Wanfang database to obtain the publicly published randomized controlled trials comparing single or combined drug injection for treating keloid from January 2010 to February 2023. The outcome index was the effective proportion of treatment, incidence proportion of adverse reactions, and recurrence proportion. NoteExpress, RevMan 5.4, and Stata 16.0 statistical software were utilized to perform a network meta-analysis of eligible studies that met the inclusion and exclusion criteria.Results:A total of 1 679 patients were enrolled in 21 studies that evaluated nine treatment modalities: triamcinolone (TAC), 5-fluorouracil (5-FU), botulinum toxin type A (BTA), platelet-rich plasma (PRP), Verapamil, BTA+ 5-FU, TAC+ 5-FU, TAC+ BTA, and TAC+ PRP. The network diagram revealed that there were 36 pairwise comparisons among the 9 treatment measures, with direct comparisons in 13 of them. The funnel plot demonstrated a symmetrical distribution of effect size points, and both Beggs test and Eggers test yielded P values greater than 0.05, indicating a low likelihood of publication bias. Nine treatment measures formed five closed loops with good consistency. The result of the network meta-analysis indicated that BTA+ 5-FU was more effective than TAC, 5-FU, or PRP alone; TAC+ 5-FU was more effective than TAC, 5-FU, or PRP alone; TAC+ BTA was more effective than TAC, 5-FU, BTA, or PRP alone; Verapamil was more effective than 5-FU and BTA was more effective than 5-FU. All result were found to be statistically significant ( P<0.05). A surface under the cumulative ranking area (SUCRA) map was generated, displaying the efficacy ranking and corresponding SUCRA values for each treatment: BTA+ 5-FU (85.6%)>TAC+ 5-FU (84.8%)>BTA+ TAC (76.7%)>Verapamil (48.9%)>BTA (45.0%)>TAC+ PRP (43.8%)>PRP (32.1%)>TAC (24.7%)>5-FU(8.3%). In terms of recurrence rate, the incidence of recurrence was higher with 5-FU compared to BTA or TAC+ 5-FU, and the incidence of recurrence was higher with TAC compared to TAC+ 5-FU; these differences were statistically significant ( P<0.05). A SUCRA map was generated with the ranking and SUCRA value for each treatment as follows: 5-FU (80.4%)>TAC (73.5%)>Verapamil (65.7%)>TAC+ BTA (52.5%)>PRP (34.8%)>BTA+ 5-FU (33.7%)>TAC+ 5-FU (30.2%)>BTA (29.3%). The qualitative analysis revealed a significantly lower incidence of systemic and local adverse reactions following combined drug injection compared to single drug injection. Conclusion:In the treatment of keloids using drug injection, combination therapy utilizing multiple drugs has demonstrated superior efficacy, lower recurrence rates, and fewer adverse reactions in comparison to single-drug therapy. Notably, the utilization of BAT, 5-FU, and TAC in combination may yield the most favorable outcomes.

Telephone follow-up is one of the important ways to follow up patients. High-quality follow-up can benefit both doctors and patients. However, clinical research-related follow-up is often faced with problems such as time-consuming, laborious and poor patient compliance. The authors belong to a team that has been committed to the study of patient-reported outcomes for a long time. The team has carried out long-term follow-up of symptoms, daily function and postoperative complications of more than 1 000 patients after lung cancer surgery, and accumulated certain experience. In this paper, the experience of telephone follow-up was summarized and discussed with relevant literatures from the aspects of clarifying the purpose of clinical research follow-up, understanding the needs of patients in follow-up, and using follow-up skills.