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2017 Vol. 33, No. 8

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Expert Forum
Review of the major work and challenge of emergency medical rescue from gas explosion accident in Hangzhou
Zhang Qin
2017, 33(8): 465-468. doi: 10.3760/cma.j.issn.1009-2587.2017.08.001
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In order to ameliorate the prognosis of patients in burn disaster, national emergency medical rescue expert teams are usually dispatched to incident areas. This article discusses the major work and challenges of the medical rescue expert teams using example of rescuing gas explosion accident in Hangzhou in last few days and author′s personal experience of previous mission. The foremost mission of medical rescue expert teams is to provide feasible strategic advice for burn disaster rescue and pivotal critical care support. The medical rescue expert teams always begin their work in hospitals lack of experience in disaster rescue. According to the characteristics of"7·21"Hangzhou gas explosion accident, the medical rescue expert teams focus on reassessment of the severity and hidden injuries of all patients, referral of patients according to the homeostasis status in patients with different severity, developing medical safety strategies, medical-related public safety strategies, and nosocomial infection control measure for rescue work. Furthermore, the medical rescue expert teams join the treatment for some critically ill patients and sudden emergency cases. The main challenges of medical rescue experts faced are accumulation and improvement of personal medical skill and powerful psychological endurance. Psychological counseling can play beneficial role in rescue group. In addition, establishing coordinated relationship among national emergency medical rescue expert teams, local administration, and local medical group shall be beneficial to disaster rescue.
Attaching importance to molecular imaging techniques and promoting precision diagnosis in burns
Yu Yongming, Peng Xi
2017, 33(8): 469-472. doi: 10.3760/cma.j.issn.1009-2587.2017.08.002
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The explosive growth and advancement of computer science in recent decades have prompted the rapid development and wide applications of imaging techniques in life science, which have brought about revolutionary changes in modern medicine. Nowadays, it is possible to visualize multiple physiological and disease processes, precisely and non-invasively, in a living human body. Modern medicine has even started"reading the mind", to diagnose psychology, behavior and degenerative disorders of human brain. The border between the organic and inorganic diseases in old dogma is disappearing because imaging techniques have"visualized"the neurological and tissue changes of inorganic disorders. Severe burn injury is associated with very complicated pathological processes, which are always at the borderline between life and death. Complete recovery of patients with severe burn injury, if possible, may take years of time. Hence, a real-time monitoring of the disease process is of pivotal importance in early recognition and prevention of life-threatening complications and in assessing the therapeutic efficacy for a less-eventful recovery. Here we review and introduce some potential applications of modern imaging techniques in burn care and research, which may benefit burn patients. Some techniques are still in their early or pre-clinical stage and some are mature techniques in other fields of medicine, which are potentially applicable in burn diagnosis and treatment through our research. We intend to bring your interest to this field which may eventually lead to new revenues improving our clinical work on burn victims.
Brief disserting on the balance of internal environment in burn disease
Han Chunmao, Wang Xin′gang
2017, 33(8): 473-475. doi: 10.3760/cma.j.issn.1009-2587.2017.08.003
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The essential internal environment in human being involves water, electrolyte, and acid-base balance, which is the basis of balance and stability of internal environment in other systems. For burn patients, the balance of internal environment, referring to metabolism, nutrition, inflammatory response, and immunoreaction, is one of the most important aspects in burn disease. This paper aims to briefly elaborate the balance of internal environment after burn, with the purpose to promote the basic and clinical research in this field.
2017, 33(8): 475-475. doi: 10.3760/cma.j.issn.1009-2587.2017.08.102
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2017, 33(8): 475-475. doi: 10.3760/cma.j.issn.1009-2587.2017.08.101
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2017, 33(8): 490-490. doi: 10.3760/cma.j.issn.1009-2587.2017.08.104
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2017, 33(8): 490-490. doi: 10.3760/cma.j.issn.1009-2587.2017.08.103
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2017, 33(8): 497-500. doi: 10.3760/cma.j.issn.1009-2587.2017.08.008
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2017, 33(8): 501-503. doi: 10.3760/cma.j.issn.1009-2587.2017.08.009
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2017, 33(8): 504-506. doi: 10.3760/cma.j.issn.1009-2587.2017.08.010
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2017, 33(8): 506-507. doi: 10.3760/cma.j.issn.1009-2587.2017.08.011
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2017, 33(8): 508-509. doi: 10.3760/cma.j.issn.1009-2587.2017.08.012
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2017, 33(8): 510-511. doi: 10.3760/cma.j.issn.1009-2587.2017.08.013
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2017, 33(8): 512-512. doi: 10.3760/cma.j.issn.1009-2587.2017.08.014
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2017, 33(8): 513-513. doi: 10.3760/cma.j.issn.1009-2587.2017.08.015
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2017, 33(8): 526-527. doi: 10.3760/cma.j.issn.1009-2587.2017.08.020
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2017, 33(8): 528-528. doi: 10.3760/cma.j.issn.1009-2587.2017.08.021
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Metabolism and Nutrition and Immunoregulation of Bruns
Effects of ω-3 polyunsaturated fatty acids on damage of intestinal mucosa of rats with severe burn in early stage and the mechanism
Cai Chen, Xia Zhengguo, Xu Qinglian, Li Xingzhao
2017, 33(8): 476-480. doi: 10.3760/cma.j.issn.1009-2587.2017.08.004
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Objective To observe the effects of ω-3 polyunsaturated fatty acids (PUFA) on damage of intestinal mucosa of rats with severe burn in early stage and to explore the mechanism. Methods One hundred and twenty SD rats were divided into sham injury group, pure burn group, and ω-3 PUFA group according to the random number table, with 40 rats in each group. Rats in sham injury group were sham injured, while rats in pure burn group and ω-3 PUFA group were inflicted with 30% total body surface area full-thickness scald (hereinafter referred to as burn) on the back. Rats in sham injury group and pure burn group were injected with normal saline solution (1 mL/kg) by tail vein, while rats in ω-3 PUFA group were injected with ω-3 PUFA solution (1 mL/kg) by the same way at 5 minutes post injury. At post injury hour (PIH) 3, 6, 12, 24, and 48, abdominal aorta blood and intestinal mucosa were collected from 8 rats in each group, respectively. Serum content of diamine oxidase (DAO) was detected by spectrophotography. Serum content of tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6) was determined by enzyme-linked immunosorbent assay. Protein expression of NF-κB-p65 in intestinal mucosa was determined by Western blotting. Data were processed with analysis of variance of factorial design, one-way analysis of variance, chi-square test, LSD test, and Bonferroni correction. Results (1) At all time points post injury, serum content of DAO of rats in pure burn group and ω-3 PUFA group was significantly higher than that in sham injury group (with P values below 0.01), and serum content of DAO of rats in ω-3 PUFA group was significantly lower than that in pure burn group (with P values below 0.01). (2) At all time points post injury, serum content of TNF-α and IL-6 of rats in pure burn group and ω-3 PUFA group was significantly higher than that in sham injury group (with P values below 0.01), and serum content of TNF-α and IL-6 of rats in ω-3 PUFA group was obviously lower than that in pure burn group (with P values below 0.01). (3) At all time points post injury, protein expressions of NF-κB-p65 in intestinal mucosa of rats in pure burn group and ω-3 PUFA group were significantly higher than those in sham injury group (with P values below 0.01). At PIH 3, 6, 12, 24, and 48, protein expressions of NF-κB-p65 in intestinal mucosa of rats in ω-3 PUFA group were 1.398±0.016, 1.999±0.948, 2.803±0.065, 1.739±0.602, and 1.484±0.645, obviously lower than 2.096±0.113, 3.402±0.189, 4.183±0.558, 3.618±0.408, and 2.614±0.775 in pure burn group (with P values below 0.01). Conclusions The ω-3 PUFA may alleviate intestinal mucosa injury of rats with severe burn in early stage through reducing protein expression of NF-κB-p65 of intestinal mucosa, serum content of DAO, TNF-α, and IL-6, and inhibiting inflammatory response.
Changes of content and mRNA expression of gelsolin and proliferation activity of T-lymphocyte in spleen of mice with severe burn injury
Chen Qi, Yang Hongming
2017, 33(8): 481-485. doi: 10.3760/cma.j.issn.1009-2587.2017.08.005
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Objective To investigate the changes of content and mRNA expression of gelsolin and proliferation activity of T-lymphocyte in spleen of mice with severe burn injury, so as to determine the optimum intervention time of gelsolin. Methods Eighty male BALB/c mice were divided into sham injury group and burn group according to the random number table, with 40 mice in each group. Mice in burn group were inflicted with 15% total body surface area full-thickness scald (hereinafter referred to as burn) on the back. Immediately after injury, mice in burn group were hypodermic injected with 1 mL normal saline, with iodophor smeared on back once a day to prevent infection. Mice in sham injury group were sham injured without fluid infusion and smearing iodophor. At post injury hour (PIH) 0 (immediately), 8, 24, 48, and 72, spleen of 8 mice of each group were harvested aseptically, respectively. Proliferation activity of T-lymphocyte was determined with methyl-thiazolyl-tetrazolium colorimetry method; gelsolin content of spleen was determined with enzyme-linked immunosorbent assay; mRNA expression of gelsolin of spleen was determined with real-time fluorescent quantitative reverse transcription polymerase chain reaction. Data were processed with analysis of variance of factorial design, one-way analysis of variance, LSD test and Bonferroni correction. Results (1) There was no significant difference in proliferation activity of T-lymphocyte in spleen of mice in two groups at PIH 0 (P>0.05). Proliferation activity of T-lymphocyte in spleen of mice in sham injury group was significantly higher than that in burn group at PIH 8, 24, 48, and 72 (with P values below 0.05). There was no significant difference in proliferation activity of T-lymphocyte in spleen of mice in sham injury group at each time point post injury (F=0.756, P>0.05). Proliferation activity of T-lymphocyte in spleen of mice in burn group at PIH 8 was 0.12±0.04, significantly lower than that at PIH 0, 24, 48, and 72 in the same group (0.73±0.07, 0.56±0.07, 0.51±0.09, and 0.59±0.07, respectively, with P values below 0.05). (2) There was no significant difference in gelsolin content of spleen of mice in two groups at PIH 0 (P>0.05). Gelsolin content of spleen of mice in sham injury group was significantly higher than that in burn group at PIH 8, 24, 48, and 72 (with P values below 0.05). There was no significant difference in gelsolin content of spleen of mice in sham injury group at each time point post injury (F=1.083, P>0.05). Gelsolin content of spleen of mice in burn group at PIH 8 was (11.9±2.6) pg/mg, significantly lower than that at PIH 0, 24, 48, and 72 in the same group [(37.7±2.9), (19.9±4.0), (24.1±4.1), and (24.6±4.0) pg/mg, respectively, with P values below 0.05]. (3) There was no significant difference in mRNA expression of gelsolin of spleen of mice in two groups at PIH 0 (P>0.05). The mRNA expressions of gelsolin of spleen of mice in sham injury group were significantly higher than those in burn group at PIH 8, 24, 48, and 72 (with P values below 0.05). There was no significant difference in mRNA expression of gelsolin of spleen of mice in sham injury group at each time point post injury (F=0.413, P>0.05). The mRNA expression of gelsolin of spleen of mice in burn group at PIH 8 was 0.307±0.064, significantly lower than that at PIH 0, 24, 48, and 72 in the same group (0.944±0.023, 0.625±0.091, 0.744±0.104, and 0.821±0.072, respectively, with P values below 0.05). Conclusions Severe burn injury could induce decrease of proliferation activity of T-lymphocyte and content and mRNA expressions of gelsolin in spleen of mice, and all of them decreased into the lowest at PIH 8. Optimum intervention time of gelsolin for severe burn would be before PIH 8.
Original Article
Analysis on the risk factors of diabetic foot ulcer in diabetic patients of Uyghur nationality and Han nationality in the Xinjiang Uygur Autonomous Region
Liu Xiaolong, Su Fuzeng, Zha Tianjian, Liu Lihua, Wang Zhizhong, Nuerlan null
2017, 33(8): 486-490. doi: 10.3760/cma.j.issn.1009-2587.2017.08.006
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Objective To explore the risk factors of diabetic foot ulcer (DFU) in diabetic patients of Uyghur nationality and Han nationality in the Xinjiang Uygur Autonomous Region. Methods Clinical data of 640 diabetic patients admitted to our ward from January 2015 to November 2016, conforming to the study criteria, were retrospectively analyzed. Patients were divided into DFU group (n=403) and non-DFU group (n=237) according to whether DFU occurred or not. The data of gender, age, nationality, body mass index (BMI), smoking, drinking, binge eating, triglyceride (TG), total cholesterol (TC), and high-density lipoprotein (HDL) of patients between two groups were compared with chi-square test and t test. Indexes with statistically significant differences between two groups were selected, and they were processed with non-conditional multivariate logistic regression analysis to screen the independent risk factors of DFU. The possible risk factors of DFU of patients of Uyghur nationality and Han nationality were further processed with non-conditional multivariate logistic regression analysis respectively to screen the independent risk factors of DFU of patients of Uyghur nationality and Han nationality. Results (1) There were no statistically significant differences in gender, age, TC, and HDL of patients between two groups (with χ2=0.149, t values respectively 1.163, 1.033, and 1.026, P values above 0.05). There were statistically significant differences in nationality, BMI, smoking, drinking, binge eating, and TG of patients between two groups (with χ2 values from 4.778 to 13.694, t values respectively 4.703 and 4.237, P<0.05 or P<0.01). (2) Nationality, BMI, smoking, drinking, binge eating, and TG were the independent risk factors of DFU(with odds ratios respectively 1.488, 1.527, 1.736, 1.738, 1.382, and 1.648, 95% confidence intervals respectively 1.315-3.175, 1.488-4.393, 1.834-4.675, 1.474-2.695, 1.342-4.678, and 1.105-6.747, P values below 0.05). (3) Smoking, drinking, binge eating, and TG were the independent risk factors of DFU in diabetic patients of Uyghur nationality (with odds ratios respectively 1.673, 1.387, 1.328, and 1.486, 95% confidence intervals respectively 1.384-1.765, 1.414-1.659, 1.423-1.687, and 1.150-1.670, P values below 0.05). BMI, smoking, and drinking were the independent risk factors of DFU in diabetic patients of Han nationality (with odds ratios respectively 2.442, 1.604, and 1.251, 95% confidence intervals respectively 2.223-2.699, 1.268-2.028, and 1.164-1.344, P<0.05 or P<0.01). Conclusions Smoking, drinking, binge eating, and TG were the independent risk factors of DFU in diabetic patients of Uyghur nationality. BMI, smoking, and drinking were the independent risk factors of DFU in diabetic patients of Han nationality.
Effects of axial vascular network flap of scalp or anterolateral thigh perforator flap with fascia lata on repairing defects after radical resection of scalp carcinoma in patients
Zhang Wanfeng, Zhang Xiaofeng, Gao Qiufang, Niu Xuetao, Ma Yajun, Wu Baoen, Ma Bin, Liang Feng, Wang Aiwu
2017, 33(8): 491-496. doi: 10.3760/cma.j.issn.1009-2587.2017.08.007
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Objective To observe the effects of axial vascular network flap of scalp or anterolateral thigh perforator flap with fascia lata on repairing defects after radical resection of scalp carcinoma in patients. Methods From February 2006 to December 2015, twenty-one patients with scalp carcinoma were admitted to our hospital, and the carcinoma invaded external lamina or full-thickness of skull and dura mater. After perfect preoperative examination, carcinoma and scalp tissue in 3 to 5 cm from the edge of carcinoma, external lamina or full-thickness of skull and invaded dura mater were resected and sentinel lymph nodes around carcinoma were cleaned in 3 to 4 days after admission. The postoperative defects with size reached from 11 cm×8 cm to 22 cm×18 cm. The flap transplantation was performed at the same time when quick frozen pathological examination results of resected scalp carcinoma margin tissue, skull, dura mater margin and basal tissue, and sentinel lymph nodes showed completely negative. Defects in 3 elderly patients were repaired by single or multiple axial scalp vascular network flaps, with the resected flaps size ranged from 12 cm×7 cm to 19 cm×14 cm. Defects in the other 18 patients were repaired by anterolateral thigh perforator flaps with fascia lata, with the resected flaps size ranged from 13 cm×10 cm to 23 cm×19 cm and the resected fascia lata size ranged from 8 cm×7 cm to 10 cm×10 cm. The head donor site of flap was repaired by medium thickness skin of head and back; the thigh donor site of flap was repaired by medium thickness skin of thigh on the same side. All patients gave up postoperative radiotherapy, chemotherapy, and other follow-up treatments. Results After operation, the flap and skin in all patients survived completely, with no vascular crisis or other condition. During the follow-up for 6 months to 9 years, all patients showed good appearance except for baldness in operation area of head, with no obvious malformation in head donor site of flap and skin, no swollen external hernia in the brain tissue, and no local recurrence or distant metastasis of carcinoma. The appearance of thigh donor site of flap and skin was good, with normal muscle strength and movement of lower limbs. Conclusions Patients with scalp carcinoma were performed with radical resection of carcinoma, and axial vascular network flap of scalp or anterolateral thigh perforator flap with fascia lata were applied to repair the postoperative defects, with good appearance of head operation area and no local recurrence or distant metastasis of carcinoma.
Review
Advances in preparation and clinical application of amniotic membrane graft
Zheng Shiqing, Chen Tiansheng, Ji Shi-zhao, Luo pengfei, Xiao Shichu
2017, 33(8): 514-516. doi: 10.3760/cma.j.issn.1009-2587.2017.08.016
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Amniotic membrane has been used as wound dressing for more than 100 years. With the development of the preservation and preparation techniques, amniotic membrane is widely used in ophthalmology, burns, plastic surgery, dentistry, and neurosurgery. In recent years, as more and more amniotic membrane is used in chronic wounds, it will be a new treatment method for wounds. This paper is a brief review about advances in preparation and clinical application of amniotic membrane graft.
Advances in the research of effects of heat-shock factor 1 and heat-shock proteins on wound healing and the mechanism
Zhang Zhenyu, Wang Ru, Chen Junjie, Cen Ying
2017, 33(8): 517-519. doi: 10.3760/cma.j.issn.1009-2587.2017.08.017
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Heat-shock proteins (HSPs) are the protective proteins expressed by cells under stress. Heat-shock factors (HSFs) are the key factors to regulate HSPs. Researches about the effects of HSF1 and HSPs in cells after stress and the mechanism have become the important entry point to explore the cell response in wound healing after trauma. This article reviews the effects of HSPs and HSF1 which regulate the proteins on wound healing and the mechanism, so as to deliver message for studying effects of intervening HSF1 on expression of HSPs and wound healing and the mechanism.
Advances in the research of effects of circulating fibroblasts on wound repair
Xie Ying, Wang Hong, Zhang Wei, Zhao Yang
2017, 33(8): 520-522. doi: 10.3760/cma.j.issn.1009-2587.2017.08.018
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Wound repair is a complex process involving multiple disciplines, cell factors, cell types, and signaling pathways. In recent years, many researches showed that circulating fibroblasts (cFbs) deriving from bone marrow and residing in peripheral blood, played a role in wound repair by migrating to wound sites, differentiating into fibroblasts and myofibroblasts, and secreting cytokines, extracellular matrix, chemokines, growth factors, and antigen-presenting molecules, etc. cFbs also involve in three phases of inflammation, proliferation, and remodeling in wound repair of diabetes, ulcers, burns and other wounds, which indicate that they could be a potential treatment for wound repair. This article aims to review the latest development in circulating fibroblasts and wound repair.
Advances in the research of negative-pressure wound therapy inducing the vascularization of dermal substitute
Shao Huawei, Wang Xin′gang, You Chuan′gang, Han Chunmao
2017, 33(8): 523-525. doi: 10.3760/cma.j.issn.1009-2587.2017.08.019
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In clinical practice, skin defects resulted from various acute and chronic diseases occur frequently. Dermal substitute (DS), known as dermal regenerative template, is used more and more widely, but the slow process of vascularization limits its clinical application. At present, there are many strategies developed to enhance the process of vascularization, such as modifying the structure of dermal scaffolds, prevascularization by seeding stem cells and/or endothelial cells. Recently, negative-pressure wound therapy (NPWT) emerged and rapidly became popular in promoting wound healing due to its intrinsic advantages. Furthermore, some researchers introduced this technique to accelerate the vascularization process of DS. This paper represents a comprehensive overview on the efficiency of NPWT in different combination models, and the related mechanism.

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