The incidence of osteoporotic thoracolumbar vertebral fracture (OTLVF) in the elderly is gradually increasing. The kyphotic deformity caused by various factors has become an important characteristic of OTLVF and has received increasing attention. Its clinical manifestations include pain, delayed nerve damage, sagittal imbalance, etc. Currently, the definition and diagnosis of OTLVF with kyphotic deformity in the elderly are still unclear. Although there are many treatment options, they are controversial. Existing guidelines or consensuses pay little attention to this type of fracture with kyphotic deformity. To this end, the Lumbar Education Working Group of the Spine Branch of the Chinese Medicine Education Association and Editorial Committee of Chinese Journal of Trauma organized the experts in the relevant fields to jointly develop Clinical guidelines for the diagnosis and treatment of osteoporotic thoracolumbar vertebral fractures with kyphotic deformity in the elderly ( version 2024), based on evidence-based medical advancements and the principles of scientificity, practicality, and advanced nature, which provided 18 recommendations to standardize the clinical diagnosis and treatment.

Osteoporotic thoracolumbar fracture in the elderly will seriously reduce their quality of life and life expectancy. For osteoporotic thoracolumbar fracture in the elderly, spinal reconstruction is necessary, which should comprehensively consider factors such as the physical condition, fracture type, clinical characteristics and osteoporosis degree. While there lacks relevant clinical norms or guidelines on selection of spinal reconstruction strategies. In order to standardize the concept of spinal reconstruction for osteoporotic thoracolumbar fracture in the elderly, based on the principles of scientificity, practicality and progressiveness, the authors formulated the Clinical guideline for spinal reconstruction of osteoporotic thoracolumbar fracture in elderly patients ( version 2022), in which suggestions based on evidence of evidence-based medicine were put forward upon 10 important issues related to the fracture classification, non-operative treatment strategies and surgical treatment strategies in spinal reconstruction after osteoporosis thoracolumbar fracture in the elderly, hoping to provide a reference for clinical treatment.

Objective:To evaluate the clinical efficacy of human-like collagen scar repair gel in the treatment of proliferative hypertrophic scar.Methods:The clinical effect of smear-like silicone ointment on patients with hypertrophic scars after prolonged injury or 4-6 months after surgery, the difference of curative effects between 3-18 years old juvenile group and 19-45 years old adult group, were analyzed by multicenter randomized controlled clinical study. Among them, 58 cases were treated with human-like collagen scar repair gel, 39 cases in adult group and 19 cases in minor group; 30 cases were using Silicone Gel, 20 cases in adult group and 10 cases in minor group. The differences in scar color, thickness, blood vessel distribution, softness, patient's self-conscious symptoms, clinical efficacy scores and adverse reactions were analyzed before and after application of the products at 4, 8, 12 and 24 weeks.Results:The scores of the two groups before treatment were slightly higher than those of the control group except the softness and thickness score test group ( P<0.05). There was no significant difference in the remaining parameters ( P>0.05). The efficacy scores at the 4th, 8th, 12th and the 24th week after application of the two groups showed that there were significant differences in the therapeutic indicators after treatment for different time ( P<0.05) and age grouping. There was no significant difference between juvenile group and adult group ( P>0.05). There was a statistically significant difference in the time points of different clinical evaluation scores ( P<0.05). There was no interaction between the evaluation time and the experimental control group and age group ( P>0.05); and not affected by group or age grouping ( P>0.05), no adverse reactions occurred in either group. Conclusions:Human-like collagen scar repair gel is safe and effective in the treatment of proliferative hypertrophic scar, and the clinical efficacy is not inferior to Silicone gel.

Objective:To evaluate the clinical efficacy of human-like collagen scar repair gel in the treatment of proliferative hypertrophic scar.Methods:The clinical effect of smear-like silicone ointment on patients with hypertrophic scars after prolonged injury or 4-6 months after surgery, the difference of curative effects between 3-18 years old juvenile group and 19-45 years old adult group, were analyzed by multicenter randomized controlled clinical study. Among them, 58 cases were treated with human-like collagen scar repair gel, 39 cases in adult group and 19 cases in minor group; 30 cases were using Silicone Gel, 20 cases in adult group and 10 cases in minor group. The differences in scar color, thickness, blood vessel distribution, softness, patient's self-conscious symptoms, clinical efficacy scores and adverse reactions were analyzed before and after application of the products at 4, 8, 12 and 24 weeks.Results:The scores of the two groups before treatment were slightly higher than those of the control group except the softness and thickness score test group ( P<0.05). There was no significant difference in the remaining parameters ( P>0.05). The efficacy scores at the 4th, 8th, 12th and the 24th week after application of the two groups showed that there were significant differences in the therapeutic indicators after treatment for different time ( P<0.05) and age grouping. There was no significant difference between juvenile group and adult group ( P>0.05). There was a statistically significant difference in the time points of different clinical evaluation scores ( P<0.05). There was no interaction between the evaluation time and the experimental control group and age group ( P>0.05); and not affected by group or age grouping ( P>0.05), no adverse reactions occurred in either group. Conclusions:Human-like collagen scar repair gel is safe and effective in the treatment of proliferative hypertrophic scar, and the clinical efficacy is not inferior to Silicone gel.

Objective: To identify the special biomarkers and the differentially expressed proteins in keloid tissue and to explore the pathogenesis characteristics of familial keloid by comparing the protein expression differences among familial keloid(FK), sporadic keloid(SK), hypertrophy scar (HS), normal scar (NS). Methods: The tissue specimens of FK, SK, HS and NS(6 specimens in each group), were digested, taged and analysed using quantitative proteomic isobaric tags for relative and absolute quantitation (iTRAQ) labeling technology. A difference greater than 1.2 folds and P<0.05 were selection criteria for differencial expression proteins. Then bioinformatics analysis was applied.The expressions of 2 differential proteins were validated using Western Blot analysis. Results: A total of 2 450 differentially expressed proteins were identified. Compared with NS, 250 up-regulated and 281 down-regulated proteins were identified in FK; 281 up-regulated and 232 down-regulated proteins were identified in SK; 199 up-regulated and 233 down-regulated proteins were identified in HS.Compared with SK, 64 up-regulated and 164 down-regulated proteins were identified in FK; 79 up-regulated and 169 down-regulated proteins were identified in HS.Compared with HS, 124 up-regulated and 115 down-regulated proteins were identified in FK.These different proteins were concentrated in several vital signal pathways such as the extracellular matrix protein, cell adhesion and biological metabolism pathways. The variation trend of 2 differentially expressed proteins (P3H1 and RCN-3) were validated by Western Blot. Conclusions Proteomic analysis can identify the proteins with variance of keloid, hypertrophy scar and normal skin. Further investigations of these differential proteins may reveal the pathogenesis of keloid and provide new treatments for it.

OBJECTIVETo investigate the effect of epidermal stem cells from human hypertrophic scar (HS-ESCs) on the skin wound healing in nude mice.

METHODS40 mice were randomly divided into two groups as experimental group (n = 20) and control group (n = 20). Wounds, 1 cm in diameters, were made on every mouse back. The wounds were treated with HS-ESCs and erythromycin ointment in experimental group, or only with erythromycin ointment in control group. The wound healing was observed during the following 14 days. The expression of collagen-I, collagen-III, epidermal growth factor (EGF), fibroblast growth factor (FGF2) , transforming growth factor (TGFbeta1, and TGFbeta2) were studied.

RESULTSThe wound healing time in the experimental group was (20.8 +/- 0.84) d, which was (25.6 +/- 0.89) d in the control group. HE staining revealed that the extent of vascularization in the experimental group was 11.60 +/- 0.55, while it was 8.04 +/- 0.33 in the control group. Immunochemistry analysis showed the expression of collagen-I, collagen-III, EGF, FGF2, TGFbeta1, and TGFbeta2 in the experimental group were significantly higher, compared with those in control group (P < 0.05).

CONCLUSIONHS-ESCs may promote wound healing through enhancement of the vascularization of the wound tissue and the expression of growth factors.

Animals ; Cicatrix, Hypertrophic ; pathology ; Epidermis ; cytology ; Female ; Humans ; Male ; Mice ; Mice, Nude ; Skin ; injuries ; Stem Cell Transplantation ; Stem Cells ; Wound Healing

Objective To lay a foundation for the clinical application and tissue engineering research of hypertrophic scar (HS)-derived DMSCs by comparing the biological characteristics of dermis mesenchymal stem cells (DMSCs) from human maturing-phase HS and normal skin.Methods Twenty maturing-phase HS specimens (scar group) and 20 normal skin specimens (control group) were selected to extract and sort DMSCs by two-step enzyme digestion.When cells in both groups were subcultured to 3rd generation,cell morphology and growth curve were observed; expressions of cell surface proteins CD29,CD49 and vimentin were tested by immunocytochemistry; cells with positively expressed surface proteins CD34,CD73,CD90,and CD105 were examined by flow cytometry; expressions of genes Oct4 and Nanog were tested by RT-PCR; cell potential to differentiate into lipoblasts,osteoblasts,and chondroblasts was assayed in inductive medium.Results DMSCs in both groups showed similar shape and growth curve.Cell markers CD29,CD49 and vimentin expressed positively.Of scar and control groups,expressions of CD34,CD73,CD90,and CD105 were (0.60±0.03)％ vs (0.61 ±0.02)％,(98.90±0.80)％vs (99.00±0.70)％,(98.30±0.30)％vs (98.20±0.40)％,and (93.10± 0.40) ％ vs (93.00 ± 0.20) ％ respectively (P ＞ 0.05) ; expressions of genes Oct4 and Nanog were 0.506±0.024 vs0.512±0.024 and 0.496 ±0.018 vs 0.494 ±0.023 (P＞0.05).Both types of DMSCs were able to differentiate in vitro into lipoblasts,osteoblasts,and chondroblasts in invitro conductive medium.Conclusion DMSCs exist in maturing-phase HS and present biomechanical characteristics basically similar with those of normal human skin.

Objective To investigate the value of combined therapy for hand post-burn scars.Methods We retrospectively analyzed 78 hands post-burn scars in 46 cases from 2007 to 2011.A mong them,scar contracture releasing,scar excision,free skin grafting and fixation with Kirschner's pins were performed in 38 hands,scar excision and regional flat transfer were performed in 18 hands,scar excision and skin grafting were performed in 18 hands,abdominal expanded flap transplantation and scar excision were performed in 4 hands.All patients received elastic sleeve pressure therapy,sili cone gel for external application and function training.Within six months after the operation,52 hands received drug delivery by wax therapy,16 hands incision with scar proliferation received drug injection into scar.We followed up all patients from half a year to three years after the treatment to observe the recovery of the appearance and function of the hands.Results We mainly chose surgery,elastic sleeve pressure therapy,silicone gel for external application,drug injection into scar,wax therapy,function training and so on treating the hand post-burn scars and found that the joins deformities caused by scar contracture were largely or totally corrected.The function and appearance were satisfying.Conclusions It is a good method to treat hand scars by surgery and post-surgery combined physical rehabilitation therapy,which deserves to popularization.

Objective To evaluate the efficacy of the combined saphenous nerve-great saphenous vein flap and cutaneous branches of posterior tibial artery flap in repairing refractory wounds. Methods Eighteen cases of pedal chronic ulcers were treated with the combinedsaphenous nervegreat Saphenous vein flap and cutaneous branches of posterior tibial artery flap, in which the wounds were treated with vacuum suction techniques before the operation in 6 cases. Wounds were from 8 cm× 13 cm to 1 cm× 17 cm in zine after debricement, and the designed size of the flaps was from 8 cm× 14 cm to 11 cm× 18 cm. Results After the treatment, 18 cases were evaluated as excellent in 10 cases, and good in 8 cases, in which the primary sealing of the wounds was achieved in 17 cases, but one case presented with focal necrosis of smaal size owing to vein drainage disturbance in a distallypedicled flap, and was healed after flap transplantation. Follow-up for 6 months to 2 years showed that all the patients were satisfied with the results. Conclusions The combined flap has reliable blood supply, skin pedicle of the flap is longer, superior texture and satisfied appearance, and incisive area of the flap is larger. It is particularly useful in repairing refractory wound in foot.

Objective To detect the expression of a novo tumor suppressor gene PTEN and DNA direct repair enzyme MGMT in gynecomastia. Methods Immunohistochemical SP method was used to detect expression of PTEN and MGMT protein in 68 cases of gynecomastia(experiment group) and 24 cases of mammary gland of control group. The selected examples were divided into three different age groups and three different histological types. Results The PTEN and MGMT protein were all expressed in nucleusr of ductal cellula epithelialis. The expression level of PTEN and MGMT proteins in gynecomastia was significantly lower than that of mammary gland of control(P