中华烧伤与创面修复杂志

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Objective To investigate the effects and mechanism of mitochondrial transcription factor A (TFAM) and cytochrome c oxidase (COX) pathway in the energy production of hypoxic cardiomyocytes of rats regulated by tumor necrosis factor receptor associated protein 1 (TRAP1). Methods The cardiomyocytes were isolated from 135 neonatal Sprague-Dawley rats (aged 1-3 d) and cultured for the following experiments. (1) Cells were collected and divided into normoxia blank control (NBC) group, hypoxia blank control (HBC) group, hypoxia+ TRAP1 over-expression control (HTOC) group, and hypoxia+ TRAP1 over-expression (HTO) group according to the random number table (the same grouping method below), with 1 bottle in each group. Cells in NBC group were cultured routinely, cells in HBC group were cultured in hypoxic condition for 6 hours after routine culture, cells in HTOC and HTO groups were respectively added with TRAP1 over-expression empty virus vector and TRAP1 over-expression adenovirus vector virus suspension for transfection for 48 hours after routine culture and then cultured in hypoxic condition for 6 hours. The protein expression of TFAM of cells in each group was detected by Western blotting. (2) Cells were collected and divided into NBC, HBC, HTOC, HTO, HTO+ TFAM interference control (HTOTIC), and HTO+ TFAM interference (HTOTI) groups, with 1 well in each group. Cells in the former 4 groups were dealt with the same methods as the corresponding groups in experiment (1). Cells in HTOTIC and HTOTI groups were respectively added with TFAM interference empty virus vector and TFAM interference adenovirus vector virus suspension for transfection for 48 hours, and the other processing methods were the same as those in HTO group. The content of ATP of cells in each group was determined by ATP determination kit and microplate reader, and the COX activity of cells in each group was determined by COX activity assay kit and microplate reader. (3) Cells were collected and divided into NBC group, normoxia+ sodium azide (NSA) group, HBC group, and hypoxia+ sodium azide (HSA) group, with 1 well in each group. Cells in NBC and HBC groups were respectively dealt with the same methods as the corresponding groups in experiment (1). Cells in NSA and HSA groups were respectively added with 32 nmol sodium azide at 30 min before experiment or hypoxia, and then cells in HSA group were cultured in hypoxic condition for 6 hours. The content of ATP was determined by the same method as above. The above three experiments were repeated for three times. Data were statistically analyzed with one-way analysis of variance and least significant difference test. Results (1) Compared with that in NBC group, the protein expression of TFAM of cells in HBC group was significantly decreased (P<0.01). Compared with that in HBC group or HTOC group, the protein expression of TFAM of cells in HTO group was significantly increased (P<0.01). (2) Compared with 0.552±0.041 and 1.99±0.15 in NBC group, the COX activity (0.270±0.044) and ATP content (1.09±0.11) of cells in HBC group were significantly decreased (P<0.01). Compared with 0.269±0.042 and 1.17±0.12 in HBC group and those in HTOC group, the COX activity (0.412±0.032 and 0.404±0.016) and ATP content (1.75±0.06 and 1.69±0.07) of cells in HTO and HTOTIC groups were significantly increased (P<0.01). Compared with those in HTO and HTOTIC groups, the COX activity (0.261±0.036) and ATP content (1.23±0.07) of cells in HTOTI group were significantly decreased (P<0.01). (3) Compared with that in NBC group, the ATP content of cells in NSA and NBC groups was significantly decreased (P<0.01). Compared with that in HBC group, the ATP content of cells in HSA group was significantly decreased (P<0.01). Conclusions TRAP1 can increase the COX activity of cardiomyocytes by raising the expression of TFAM, and finally alleviate the impairment in energy production of cardiomyocytes caused by hypoxia.

Influence of Xuebijing injection and its component paeoniflorin on immune function and survival rate of septic rats

Yao Renqi, Ren Chao, Wang Lixue, Dong Ning, Wu Yao, Yao Yongming

2020, 36(8): 658-664. doi: 10.3760/cma.j.cn501120-20200430-00246

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Objective To explore the influence of Xuebijing injection (hereinafter referred to as Xuebijing) and its component paeoniflorin on immune function of regulatory T cells (Tregs) of spleen and survival rate of septic rats. Methods (1) CD4⁺ CD25⁺ Tregs and CD4⁺ T cells were isolated and purified from spleens of three 9 to 12 weeks old Sprague-Dawley male rats (the same age, breed, and gender below) by immunomagnetic beads. According to the random number table (the same grouping method below), CD4⁺ CD25⁺ Tregs were divided into blank control group, simple CD3/CD28 group, simple endotoxin/lipopolysaccharide (LPS) group, LPS+ Xuebijing group, and LPS+ paeoniflorin group, with 6 wells in each group. The cells in simple CD3/CD28 group, simple LPS group, LPS+ Xuebijing group, and LPS+ paeoniflorin group were cultured in RPMI 1640 medium containing fetal bovine serum in volume fraction of 10%, 1.25 μg CD3, and 2.5 μg CD28 for 24 hours. Then 1 μg/mL LPS in the volume of 1 μL was added to the cells in simple LPS group, LPS+ Xuebijing group, and LPS+ paeoniflorin group. Moreover, 5 mg/mL Xuebijing in the volume of 1 μL and 80 μmol/L paeoniflorin in the volume of 1 μL were added to the cells in LPS+ Xuebijing group and LPS+ paeoniflorin group, respectively, which were cultured for another 72 hours. Cells in blank control group were routinely cultured in RPMI 1640 medium containing fetal bovine serum in volume fraction of 10% for 96 hours. The expressions of cytotoxic T lymphocyte antigen 4 (CTLA-4) and forkhead wing-link transcription factor 3 (Foxp3) and apoptosis of CD4⁺ CD25⁺ Tregs were measured by flow cytometry. The interleukin-10 (IL-10) level from culture supernatant of CD4⁺ CD25⁺ Tregs was determined by enzyme-linked immunosorbent assay (ELISA). CD4⁺ T cells were divided into blank control′ group, simple CD3/CD28′ group, simple LPS′ group, LPS+ Xuebijing′ group, and LPS+ paeoniflorin′ group, with 6 wells in each group. After being cocultured with the corresponding CD4⁺ CD25⁺ Tregs treated as before for 72 hours, the proliferative activity of CD4⁺ T cells was measured by flow cytometry, and IL-4 level from culture supernatant of CD4⁺ T cells was determined by ELISA. (2) One hundred and twenty rats were divided into sham surgery group, simple sepsis group, sepsis+ Xuebijing group, and sepsis+ paeoniflorin group, with 30 rats in each group. The septic rat model was reproduced by cecal ligation and puncture surgery in simple sepsis group, sepsis+ Xuebijing group, and sepsis+ paeoniflorin group. In sham surgery group, the rats were only performed with laparotomy to simulate surgery. In sepsis+ Xuebijing group, the rats were given post-surgical injection of 4 mL/kg Xuebijing through tail vein, twice a day. In sepsis+ paeoniflorin group, the rats received 978 μg paeoniflorin via tail vein, twice a day. The survival rates of rats in the four groups on post surgery day 1, 2, 3, 4, 5, 6, and 7 were observed and recorded. The surviving cure of Kaplan-Meier was drawn. Data were statistically analyzed with one-way analysis of variance, least significant difference t test. The surviving curve was analyzed by Log-rank (Mantel-Cox) test. Results (1) Compared with those in blank control group, the expressions of CTLA-4 and Foxp3 of CD4⁺ CD25⁺ Tregs (t=27.19, 17.00, P<0.01) and IL-10 level from culture supernatant (t=40.76, P<0.01) were significantly increased in rats in simple LPS group. Compared with those in simple LPS group, the expressions of CTLA-4 and Foxp3 of CD4⁺ CD25⁺ Tregs (t_{LPS+ Xuebijing group}=31.03, 11.27, t_{LPS+ paeoniflorin group}=5.79, 5.64, P<0.01) and IL-10 level from culture supernatant (t=15.49, 4.20, P<0.01) was significantly decreased in LPS+ Xuebijing group and LPS+ paeoniflorin group. Compared with that in blank control group, the apoptosis rate of CD4⁺ CD25⁺ Tregs in simple LPS group was significantly declined (t=6.02, P<0.01). Compared with the rate in simple LPS group, the apoptosis rates of CD4⁺ CD25⁺ Tregs in LPS+ Xuebijing group and LPS+ paeoniflorin group were significantly increased (t=20.32, 8.60, P<0.01). (2) Compared with those in simple CD3/CD28′ group, the proliferative rate of CD4⁺ T cells was significantly decreased in simple LPS′ group (t=22.47, P<0.01), while IL-4 level from culture supernatant was significantly elevated (t=3.51, P<0.01). Compared with those in simple LPS′ group, the proliferative rates of CD4⁺ T cells in LPS+ Xuebijing′ group and LPS+ paeoniflorin′ group were significantly increased (t=16.31, 11.48, P<0.01), while IL-4 level from culture supernatant showed no obvious change. (3) The post-operative 7-day survival rates of rats in sham surgery group, simple sepsis group, sepsis+ Xuebijing group, sepsis+ paeoniflorin group were 100% (30/30), 30% (9/30), 57% (17/30), and 47% (14/30), respectively. Compared with that in simple sepsis group, the survival rate within post-operative 7-day of rats in sepsis+ Xuebijing group was significantly higher (χ²=4.34, P<0.05), while the survival rate within post-operative 7-day of rats in sepsis+ paeoniflorin group showed no obvious change. Conclusions Both Xuebijing and its component paeoniflorin are capable of reversing sepsis-induced inhibitory immune function and apoptotic resistant of Tregs in rats, and further improving the proliferative activity of T cells. In addition, the effect of paeoniflorin on improvement of survival rate of rats with sepsis is weaker than Xuebijing.

Establishment and application of a clustered management plan for pulmonary care of massive burn casualties

Wang Shujun, Ma Chunting, Lu Hongyan, Song Xihe, Niu Yuezeng, Chen Guojie, Zhou Ti, Shen Chuan′an

2020, 36(8): 665-670. doi: 10.3760/cma.j.cn501120-20200220-00073

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Objective To establish a clustered management plan for pulmonary care of massive burn casualties (hereinafter referred to as the clustered management plan for pulmonary care), and to explore its application effects. Methods (1) A clustered care intervention group was established, including the medical and nursing staff from the Department of Burns and Plastic Surgery, Department of Respiratory Medicine, and Department of Infection Control at the Fourth Medical Center of PLA General Hospital (hereinafter referred to as our hospital). Four major links, including pulmonary care assessment, chest and lung physical therapy, artificial airway management, and specialized infection control were sorted out according to the key points and difficulties in pulmonary care for massive burn casualties. Evidence-based nursing methods were employed to retrieve articles related to the above-mentioned four links from PubMed, Chinese Journal Full-Text Database, VIP Database and Wanfang Data using terms of " mass burn, respiratory management and airway management" and terms of "成批烧伤,肺部护理,集束化管理" , and the clustered management plan for pulmonary care was established based on reading and discussion in combination with clinical practice and experience. (2) In this non-randomized controlled study, the clustered management plan for pulmonary care was applied to 73 massive burn patients (48 males and 25 females, aged 32 (25, 38) years) who were admitted to our hospital from January 2016 to December 2019 and met the inclusion criteria, and they were included into the clustered care group; 43 massive burn patients (25 males and 18 females, aged 35 (17, 45) years) who were admitted to our hospital from January 2013 to December 2015, received routine care and met the inclusion criteria were retrospectively included into routine care group. The pulmonary infection rate and mortality of patients in the two groups were recorded during the hospital stay. Data were statistically analyzed with chi-square test, Mann-Whitney U test, and independent sample t test. Results (1) The clustered management plan for pulmonary care included a total of 12 specific measures covering four aspects of pulmonary care. The contents in pulmonary care assessment clearly stated to include the previous medical history, history of injury, respiratory status, hoarseness, pulmonary auscultation, etc. Chest and lung physical therapy included how to guide patients to effectively cough and do pursed lip breathing and abdominal breathing exercise, etc. Artificial airway management specified the preparation for the establishment of artificial airway at clinical reception, the observation index and frequency after tracheotomy, the method of humidification, the method and frequency of sputum suction, and the management of mechanical ventilation, etc. Specialized infection control required to strengthen hand hygiene and ventilator management. (2) The pulmonary infection rate and mortality of patients in the clustered care group were 2.74% (2/73) and 4.11% (3/73), respectively, significantly lower than 25.58% (11/43) and 18.60% (8/43) in routine care group (χ²=11.986, 5.043, P<0.05 or P<0.01). Conclusions The clustered management plan for pulmonary care developed for massive burn casualties focuses on the major links and key points. The measures are systemic and comprehensive, simple but precise, and highly operable, covering the entire process of massive burn care, hereby reducing the pulmonary infection rate significantly and improving the success rate of treatment.

Development and characteristic evaluation of wireless sensor module for wound temperature and pressure

Zhang Yuheng, Han Bo, Pan Zeping, Zhang Cheng, Xu Xiaoli, Li Xueyong

2020, 36(8): 671-678. doi: 10.3760/cma.j.cn501120-20190508-00225

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Objective To develop a wireless sensor module for wound temperature and pressure (hereinafter referred to as wireless sensor module), and to carry out related characteristic test and biosafety evaluation. Methods (1) The structure and working mode of the wireless sensor module were designed. The temperature and humidity sensor welded at one end of the flexible cable and the pressure sensor were simultaneously connected with the printed circuit board, which was welded with the Bluetooth transmitter, microprocessor, and power interface to establish a wireless sensor module. A mobile data receiving application was developed and the monitoring values of the wireless sensor module exposed to the air were read through the Bluetooth function on the smart phone. (2) The temperature of a 35-42 ℃ hot water bag was measured by the wireless sensor module and an infrared thermometer at the same time, and 30 pairs of data were compared with correlation analysis performed. (3) The vacuum sealing drainage material was pasted on the arm of the second author, and the wireless sensor module was placed in the condition of negative pressure. The negative pressure values measured by the wireless sensor module and the negative pressure meter values were recorded at the same time, and 14 pairs of data were compared with correlation analysis performed. (4) The corresponding material extract was prepared by adding 1 mL normal saline per 3 square centimeters surface area of the pressure sensor or flexible cable with temperature and humidity sensor welded respectively. Twenty 6-8 week-old female C57BL/6 mice were weighed before experiment and divided into pressure sensor extract group, flexible cable extract group, mixed extract group, and normal saline group according to the random number table (n=5). The abnormal toxic reactions of mice were observed after intraperitoneal injection of pressure sensor extract, flexible cable with temperature and humidity sensor welded extract, 1∶1 mixed extract of pressure sensor extract and flexible cable with temperature and humidity sensor welded extract, and normal saline for 50 mL/kg in corresponding groups. The body mass of mice was weighed at 24, 48, and 72 hours after injection, and the toxicity of the materials was evaluated comprehensively. (5) Four Japanese big ear white rabbits aged 3-6 months were selected, and there was no limit between male and female. Two regions on the left side of the spine were applied with aseptic gauze as aseptic gauze group, and two areas on the right side of the spine were applied with wireless sensor module as wireless sensor module group. The skin status of each region was evaluated at 1, 12, 24, 48 hours after application, and the score according to the skin irritation score standard was recorded. (6) The corresponding material extract was prepared by adding 1 mL serum-free Dulbecco′s modification of Eagle′s medium (DMEM) per 1 square centimeter surface area of the pressure sensor or flexible cable with temperature and humidity sensor welded respectively. L-929 fibroblasts were divided into pressure sensor extract group, flexible cable extract group, phenol control group, and medium control group. The corresponding extract was added in the first two groups, the phenol control group was added with 64 g/L phenol, and the medium control group was cultured with serum-free DMEM. The total volumes of the above four groups were all 100 μL. The absorbance values on the 2nd, 4th, 7th day of culture were detected by methyl thiazolyl tetrazolium method to calculate the cell proliferation rate (n=6 at each time point) and to grade the cytotoxicity. Data were statistically analyzed with paired samples t test, Wilcoxon signed rank test, Pearson correlation analysis, Spearman correlation analysis, Mann-Whitney U test, analysis of variance for repeated measurement, analysis of variance for factorial design, one-way analysis of variance, and Bonferroni correction. Results (1) The smart phone successfully received the air temperature, humidity, and pressure information detected by the wireless sensor module through the Bluetooth function. (2) The temperature of the hot water bag measured by the wireless sensor module was (37.7±1.7) ℃, which was close to (37.7±1.7) ℃ of the infrared thermometer (t=-0.112, P>0.05), and there was a significant positive correlation between them (r=0.996, P<0.01). (3) The negative pressure of arm under negative pressure material measured by the wireless sensor module was -36.7 (-38.8, -27.4) kPa, which was significantly lower than -22.7 (-32.7, -12.5) kPa of negative pressure meter (Z=-3.235, P<0.01), but there was a significant positive correlation between their absolute values (ρ=1.000, P<0.01). (4) There was no abnormal toxic reaction in all groups of rats, and there was no statistically significant difference in body mass among the four groups of mice (F=3.132, P>0.05). (5) The scores of skin irritation in application region of rats in the two groups were similar at 1, 12, 24, 48 hours after application (Z=-1.000, <0.001, -0.620, <0.001, P>0.05). (6) At each time point of culture, compared with that of medium control group, the cell proliferation rate increased significantly in pressure sensor extract group and flexible cable extract group (P<0.01) but decreased significantly in phenol control group (P<0.01). On the 2nd, 4th, 7th day of culture, the cytotoxicity grade of phenol control group was 1, 1, and 2 respectively, and the cytotoxicity grade of each extract group was 0. Conclusions The wireless sensor module integrates temperature, humidity, and pressure sensors, which can monitor local temperature and pressure and realize the visualization of parameters on the mobile application program. The measurement of temperature is accurate and the pressure measurement results are consistent with the values of the negative pressure meter with good biosafety. It possesses a big value in clinical application and prospects for development.

Clinical application effect of modified nasopharyngeal swab sampling for 2019 novel coronavirus nucleic acid detection

Ma Siyuan, Luo Yimei, Hu Tianyu, You Zaichun, Sun Jianguo, Yu Shiyong, Yuan Zhiqiang, Peng Yizhi, Luo Gaoxing, Xu Zhi

2020, 36(8): 679-685. doi: 10.3760/cma.j.cn501120-20200312-00153

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Objective To study the clinical application effect of modified nasopharyngeal swab sampling for 2019 novel coronavirus nucleic acid detection. Methods This study covered the period from January 14 to March 1, 2020.The supine position method and the protective face screen were used to collect nasopharyngeal swabs from February 24 onwards, before which, the nasopharyngeal swabs were collected by sitting position method. All the patients who were diagnosed with suspected/confirmed 2019 novel coronavirus infection were admitted from February 19 with the nasopharyngeal swabs collected outside the hospital before admission. (1) Thirty-four swabbing operators meeting the inclusion criteria of the study were recruited in this retrospective cohort study. They were grouped according to the collection method of nasopharyngeal swabs. Sixteen operators of Wuhan Taikang Tongji Hospital who applied the supine position method and the protective face screen were included in supine position method+ protective face screen group (15 males and 1 female, aged 34-49 years); 18 operators (12 from the First Affiliated Hospital of Army Medical University (the Third Military Medical University), 1 from Wuhan Jiangxia Mobile Cabin Hospital, 5 from the East District of People′s Hospital of Wuhan University) who applied the traditional sitting position method were included in sitting position method group (2 males and 16 females, aged 25-49 years). In supine position method+ protective face screen group, when collecting sample, the patient lay flat and wore a special protective face screen for nasopharyngeal swab sampling, with neck slightly extending and face turning to the opposite side of the operator about 10°. The self-designed questionnaire was used to investigate the cooperation, the incidence of nausea, coughing, sneezing, and struggling of patients evaluated by the operators, the operation time for a single swab sample, the fear of operation and the perceived exposure risk of operators in the two groups. (2) Sixty-five patients (22 males and 43 females, aged 25-91 years) admitted to Wuhan Taikang Tongji Hospital who successively received the sitting position method and supine position method+ protective face screen for nasopharyngeal swabs sampling and with complete nucleic acid detection results were included. The positive rates of nucleic acid detection by the two sampling methods of nasopharyngeal swabs of the patients were statistically analyzed. (3) Forty-one patients who could express their feelings accurately were selected out of those 65 patients (12 males and 29 females, aged 27-83 years). The comfort of patients in the process of sampling by the two methods was investigated. (4) Thirty-four patients (10 males and 24 females, aged 25-83 years) with two or more consecutive negative results of nucleic acid detection of nasopharyngeal swabs by sitting position method were selected from the above 65 patients. The positive rate of nucleic acid detection of nasopharyngeal swab of patients by supine position method+ protective face screen, i. e. negative to positive rate was statistically analyzed. Data were statistically analyzed with t test, Wilcoxon signed rank test, and chi-square test. Results (1) Compared with those of sitting position method group, the cooperation score of patients evaluated by the operators in supine position method+ protective face screen group was significantly higher (Z=-4.928, P<0.01), the incidence of nausea, choking cough, sneezing, and struggling of patients evaluated by the operators, and the fear of operation score and the perceived exposure risk score of operators in supine position method+ protective face screen group were significantly lower (Z=-5.071, -5.046, -4.095, -4.397, -4.174, -5.049, P<0.01), and the operation time for a single swab sample in supine position method+ protective face screen group was significantly longer (t=223.17, P<0.01). (2) The positive rate of nucleic acid detection of nasopharyngeal swabs by supine position method+ protective face screen was 60.00% (39/65), which was obviously higher than 41.54% (27/65) by sitting position method (χ²=4.432, P<0.05). (3) The comfort score of the 41 patients during nasopharyngeal swabs sampling by supine position method+ protective face screen was significantly higher than that by sitting position method (Z=-5.319, P<0.01). (4) Of the 34 patients with two or more consecutive negative results of nucleic acid detection of nasopharyngeal swabs by sitting position method, the rate of negative to positive of nucleic acid detection was 26.47% (9/34) after sampling by supine position method+ protective face screen. Conclusions Compared with the traditional sitting position method, detection of 2019 novel coronavirus nucleic acids of nasopharyngeal swabs collected by supine method combined with protective face screen is worth promoting, because of its better comfort of patients, low exposure risk for operators, in addition to reducing in the false negative result to some extent, which may help reduce false recurrence of discharged patients.

Nursing strategies for the facial skin injuries caused by wearing medical-grade protective equipment

Zhou Qin, Xue Jiao, Wang Lina, Ma Ningxia, Tong Cuifang, Wang Qing, Shi Xueqin, Lu Ying, Jiao Xiaochun, Hu Dahai

2020, 36(8): 686-690. doi: 10.3760/cma.j.cn501120-20200212-00054

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Research advances in the mechanism of pulmonary fibrosis induced by coronavirus disease 2019 and the corresponding therapeutic measures

Wang Jue, Wang Binjie, Yang Jiacai, Wang Mingying, Chen Cheng, Luo Gaoxing, He Weifeng

2020, 36(8): 691-697. doi: 10.3760/cma.j.cn501120-20200307-00132

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Influence of silver ion dressing on central venous catheter-related infection in severe burn patients

Li Juan, Li Na, Fu Wei, Feng Jianke, Zhang Qingfu

2020, 36(8): 698-703. doi: 10.3760/cma.j.cn501120-20190519-00246

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Objective To investigate the influence of silver ion dressing on related infections induced by inserted central venous catheter through wounds in patients with severe burn. Methods From June 2017 to December 2018, 90 severe burn patients who were admitted to the First Hospital of Hebei Medical University and met the inclusion criteria were included in this prospectively randomized control study. According to the random number table, they were divided into silver ion dressing group (30 patients, 20 males and 10 females, aged (37.2±3.4) years), sterile dressing group (30 patients, 18 males and 12 females, aged (35.2±4.1) years), and Anerdian dressing group (30 patients, 17 males and 13 females, aged (36.3±2.6) years). After admission, the patients in three groups were treated with a 16 G single-lumen central venous catheter inserted into the subclavian vein of burn wounds, with the depth of 19 cm. The puncture points of the patients in silver ion dressing group, sterile dressing group, and Anerdian dressing group were covered with silver ion medical antibacterial dressing, sterile dressing, and sterile gauze dressing infiltrated with Anerdian skin and mucous membrane washing and disinfecting solution, respectively. The patients in three groups underwent catheter maintenance and dressing change every 12 hours. The thousand-day infection rates of catheter outlet infection and catheter-related bloodstream infection (CRBSI), catheter indwelling days, and pathogen detection of the patients in three groups were counted. Data were statistically analyzed with chi-square test, one-way analysis of variance, least significant difference test, Fisher′s exact probability test, and Bonferroni correction. Results (1) The thousand-day infection rates of catheter outlet infection of patients in sterile dressing group and Anerdian dressing group were 22.29‰ (7/314) and 20.83‰ (7/336), respectively, which were similar (P>0.05), and both were significantly higher than 1.54‰ (1/651) in silver ion dressing group (P<0.01). The thousand-day infection rates of CRBSI of patients in sterile dressing group and Anerdian dressing group were 25.48‰ (8/314) and 20.83‰ (7/336), respectively, which were similar (P>0.05), and both were significantly higher than 1.54‰ (1/651) in silver ion dressing group (P<0.01). The catheter indwelling days of patients in sterile dressing group and Anerdian dressing group were similar (P>0.05), and both were significantly shorter than the days in silver ion dressing group (P<0.01). (2) A total of 16 cases of CRBSI occurred in all the patients in 3 groups. A total of 16 pathogenic bacteria were isolated from catheter tip attachment microbial culture and blood microbial culture. The detections rates of pathogenic bacteria of patients in sterile dressing group and Anerdian dressing group were significantly higher than the rate in silver ion dressing group (P<0.05). Conclusions For severe burn patients, the use of silver ion dressings in the maintenance of central venous catheters inserted through wounds can effectively reduce the rate of central venous catheter-related infections and extend the catheter indwelling days.

Changes in serum osteoprotegerin/receptor activator of nuclear factor-κB ligand and related indexes of calcium and phosphorus in the early stage of severe burn patients

Gong Xiang, Ye Ziqing, Zhang Wei, Yu Gang, Ruan Qiongfang, Xie Weiguo

2020, 36(8): 704-709. doi: 10.3760/cma.j.cn501120-20190616-00272

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Objective To investigate the early changes in serum osteoprotegerin/receptor activator of nuclear factor-κB ligand (RANKL) and related indexes of calcium and phosphorus in severe burn patients. Methods Thirty severe burn patients who met the inclusion criteria and were admitted to Tongren Hospital of Wuhan University & Wuhan Third Hospital within 8 hours post injury from June 2017 to December 2018 were recruited into severe burn group (24 males and 6 females, aged (38±13) years). Ten healthy volunteers with normal physical examination results in the Physical Examination Center of the same hospital in the same period of time were recruited into healthy control group (7 males and 3 females, aged (37±8) years). A prospective controlled study was conducted. The fasting venous blood of 5 mL was taken from each patient in severe burn group on post injury day (PID) 1, 7, 14, 21, and 28, respectively, and the fasting venous blood of 5 mL was taken from each volunteer in healthy control group. The serum osteoprotegerin, RANKL, 25 hydroxyvitamin D, and parathyroid hormone (PTH) levels were determined by enzyme-linked immunosorbent assay, and the RANKL/osteoprotegerin ratio was calculated. Serum albumin, serum calcium, and serum phosphorus levels were determined by bromocresol green method, methylthymol blue method, and phosphomolybdic acid method, respectively. Data were statistically analyzed with Fisher′s exact probability test, analysis of variance for repeated measurement, Mann-Whitney U test, independent sample t test, and Bonferroni correction. Results (1) The serum osteoprotegerin levels of patients in severe burn group on PID 1, 7, 14, 21, and 28 were 155.11 (102.91, 187.02), 170.07 (84.60, 196.86), 174.95 (59.09, 208.35), 190.01 (47.08, 214.52), and 188.85 (58.73, 223.13) pg/mL, respectively, which were significantly higher than 33.34 (28.59, 45.68) pg/mL of volunteers in healthy control group, Z=-3.436, -4.311, -3.248, -2.811, -4.217, P<0.01. The serum levels of RANKL of patients in severe burn group on PID 1, 7, 14, 21, and 28 were (1 869±791), (1 746±857), (1 781±713), (2 015±825), and (2 272±583) pg/mL, respectively, significantly higher than (49±16) pg/mL of volunteers in healthy control group, t=12.600, 10.844, 13.294, 13.041, 20.880, P<0.01. The ratios of RANKL/osteoprotegerin of patients in severe burn group on PID 1, 7, 14, 21, and 28 were 12.23 (8.10, 24.73), 11.40 (8.25, 16.96), 11.15 (6.91, 38.32), 12.98 (9.22, 49.68), and 13.91 (10.29, 40.68), respectively, which were significantly higher than 1.17 (0.91, 1.74) of volunteers in healthy control group, Z=-4.560, -4.529, -4.529, -4.560, -4.623, P<0.01. (2) The serum level of 25 hydroxyvitamin D of patients in severe burn group on PID 1 was significantly lower than that of volunteers in healthy control group (Z=-2.749, P<0.01). Compared with those of volunteers in healthy control group, the serum levels of albumin of patients in severe burn group on PID 1, 7, 14, 21, and 28 were significantly lower (t=-4.374, -7.689, -8.257, -7.651, -6.259, P<0.01), the serum levels of PTH were significantly elevated (Z=-4.685, -4.685, -4.685, -4.654, -4.685, P<0.01), and the serum levels of phosphorus were not changed significantly. The serum levels of calcium of patients in severe burn group on PID 1, 7, 14, and 21 were significantly lower than the level of volunteers in healthy control group (Z=-2.375, -3.455, -2.442, -2.016, P<0.05 or P<0.01). Conclusions The serum osteoprotegerin, RANKL, RANKL/osteoprotegerin ratio, and PTH are increased, and the serum 25 hydroxyvitamin D, albumin, and calcium are decreased in the early stage of severe burn patients, which may be the mechanism leading to bone loss in patients.

Meta-analysis of the effects of supplemental parenteral nutrition on prognosis of critically ill patients

Chu Xin, Chang Zhigang, Li Peng, Zhu Mingwei, Wei Junmin

2020, 36(8): 710-717. doi: 10.3760/cma.j.cn501120-20190404-00165

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Objective To compare the effects of supplemental parenteral nutrition (SPN) and enteral nutrition (EN) on prognosis of critically ill patients in intensive care unit (ICU) using meta-analysis. Methods Foreign language databases including PubMed, Embase, Cochrane Library, and Cochrane Central Register of Controlled Trials were retrieved with the search terms of " supplemental parenteral nutrition, parenteral nutrition, enteral nutrition, critically ill" , and Chinese database SinoMed database was retrieved with the search terms of "补充性肠外营养,肠外营养,肠内营养,重症" to obtain the publicly published randomized controlled trials about the effects of SPN and EN supportive treatment on prognosis of critically ill patients in ICU from the establishment of each database to December 2018. The Google Scholar was retrieved for supplement. The outcome indexes included the infection rate, anti-infection time, antibiotic-free time, ICU overall mortality, overall mortality during hospitalization, mechanical ventilation time, length of ICU stay, and length of hospital stay. RevMan 5.3 and Stata 14.0 statistical software were used to conduct a meta-analysis of eligible studies. Results A total of 794 patients were included in 8 studies, including 387 patients in SPN group who received SPN and EN and 407 patients in EN group who only received EN. The bias risks of the eight studies included were uncertain. Compared with that of EN group, the infection rate of patients in SPN group was significantly decreased (relative risk=0.79, 95% confidence interval=0.66-0.94, P<0.01). However, there were no statistically significant differences in ICU overall mortality, overall mortality during hospitalization, mechanical ventilation time, length of ICU stay, and length of hospital stay of patients between SPN group and EN group. The subgroup analysis showed that the risks of bias of studies and follow-up time might be sources of the heterogeneity of mechanical ventilation time. There was publication bias in ICU overall mortality (P<0.05), while no publication bias in the other outcome indexes (P>0.05). Conclusions SPN supportive treatment can decrease the infection rate of critically ill patients in ICU, but it has no obvious influences on overall mortality, mechanical ventilation time, and length of hospital stay.

Application effects of self-made simple vacuum sealing drainage device in postoperative treatment of sural neurocutaneous flap transplantation in the foot and ankle

Jiao Jinglong, Nu Erlan, Zha Tianjian, Liu Lihua, Wang Zhizhong, Liu Xiaolong

2020, 36(8): 718-721. doi: 10.3760/cma.j.cn501120-20190528-00259

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Objective To investigate the application effects of self-made simple vacuum sealing drainage (VSD) device in the postoperative treatment of sural neurocutaneous flap transplantation in the foot and ankle. Methods From January 2017 to January 2019, 36 patients with foot and ankle skin defects and bone exposure admitted to People′s Hospital of Xinjiang Uygur Autonomous Region met the inclusion criteria, and a retrospective cohort study was conducted. According to the bandaging method of the operative area, simple negative pressure group and antibacterial dressing group were both allocated with 18 patients, with 12 males and 6 females in the former group, 14 males and 4 females in the latter group, aged (41.6±2.8) and (42.3±2.6) years, respectively. Patients in the two groups all received sural neurocutaneous flap transplantation. Patients in antibacterial dressing group received nano silver antibacterial dressing change in the operative area, and the dressing was changed once every 3 days. In simple negative pressure group, the operative area was sealed with a simple VSD device made of gauze, silicone sputum suction tube with holes cut out, and biological permeable membrane, etc., which was connected with the wall central negative pressure suction system for continuous VSD treatment of -40.0 to -16.6 kPa. The negative pressure material was changed once every 5 days. The number of dressing change, the pain score evaluated by Numeric Rating Scale during each dressing change, the cost of dressing change, and the degree of flap swelling evaluated on the 3rd and 5th day after surgery were recorded, and the flap survival was observed. Data were statistically analyzed with independent sample t test, Wilcoxon rank sum test, and chi-square test. Results The number of dressing change of patients in simple negative pressure group was (3.4±0.5) times, which was significantly less than (7.0±0.8) times in antibacterial dressing group (t=15.338, P<0.01). The pain score during dressing change of patients in simple negative pressure group was (4.3±0.8) points, which was significantly lower than (6.8±0.7) points in antibacterial dressing group (t=10.168, P<0.01). The cost of dressing change of patients was similar between the two groups. On the 3rd and 5th day after surgery, the degrees of flap swelling of patients in simple negative pressure group were significantly superior to those in antibacterial dressing group (Z=4.448, 2.395, P<0.05 or P<0.01). The flap survival of patients in simple negative pressure group was significantly superior to that in antibacterial dressing group (χ²=4.500, P<0.05). Conclusions Compared with the traditional dressing bandage, the self-made simple VSD device used after sural neurocutaneous flap transplantation can reduce the frequency of dressing change, relieve the pain of dressing change and the swelling of flap, and promote the flap survival, which is worth popularizing and applying in clinic.

Effects of ilioinguinal composite tissue flaps in repairing skin and soft tissue defects on hand or foot

Wu Xueren, Wei Panjie, Zhao Yaohua, Li Weizhong, Wang Shuli, Duan Zhaopin, Liu Chang

2020, 36(8): 722-725. doi: 10.3760/cma.j.cn501120-20190408-00171

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Objective To explore the effects of ilioinguinal composite tissue flaps in repairing skin and soft tissue defects on hand or foot and reconstructing the flexion and extension functions of wrist, finger, ankle, and toe. Methods From February 2012 to March 2018, 4, 5, and 3 patients (11 males and 1 female, 23-62 years old) with skin and soft tissue defects on hand or foot were admitted to Traditional Chinese Medicine Hospital of Zhongmu County of Henan Province, Henan Armed Police Corps Hospital, and the Affiliated Jiangyin Hospital of Medical College of Southeast University, respectively. Five patients had hand defects, and 7 patients had foot defects. The areas of skin and soft tissue defects after debridement were 10 cm×8 cm-15 cm×10 cm. The ilioinguinal composite tissue flaps were designed and resected according to the wound area and the length of tendon defects, and the areas of flaps were 10 cm×8 cm-15 cm×12 cm. According to the specific condition of the recipient area, the superficial iliac circumflex artery in the tissue flap was reconstructed by end-to-side anastomosis in 2 patients and end-to-end anastomosis in 1 patient with ulnar artery, end-to-side anastomosis in 4 patients with the dorsal foot artery, end-to-side anastomosis in 2 patients with the posterior tibial artery, and end-to-end anastomosis in 1 patient with the external tarsal foot artery in the recipient area, and the superficial epigastric artery in the tissue flap was reconstructed by end-to-side anastomosis in 1 patient with the radial artery and end-to-end anastomosis in 1 patient with the ulnar artery in the recipient area. The donor sites were sutured directly or repaired with medium split-thickness skin grafts. The survival of tissue flap after the operation and the appearance, texture, and the two-point discrimination distance of the tissue flaps during follow-up were observed. The hand function and foot function were evaluated by the total active movement standard of hand and the Maryland foot score standard, respectively. Results All the tissue flaps in 12 patients survived. During follow-up of 6-36 months after operation, the tissue flaps were slightly bloated, with linear scars at the junction site in the recipient area, and the two-point discrimination distances of the tissue flaps were 15-22 mm. The hand function was excellent in 3 cases, good in 1 case, and fair in 1 case, and the foot function was excellent in 4 cases, good in 2 cases, and fair in 1 case, and all the patients were satisfied with the function and appearance of hand or foot. Conclusions The ilioinguinal composite tissue flaps can repair the hand and foot wounds and reconstruct the flexion and extension functions of wrist, finger, ankle, and toe at the same time, which is an effective method to repair this kind of defects.

Clinical effects of superior gluteal artery perforator " buddy flap" in repairing pressure ulcer in sacrococcygeal region

Sun Jialin, Guo Pengfei, Cui Zhengjun, Meng Qingnan, Wei Aizhou, Zhou Jian

2020, 36(8): 726-729. doi: 10.3760/cma.j.cn501120-20190607-00265

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Objective To investigate the clinical effects of superior gluteal artery perforator " buddy flap" in repairing pressure ulcer in sacrococcygeal region. Methods From January 2017 to December 2018, 13 patients (8 males and 5 females) aged 24-79 years with stage 4 pressure ulcers in sacrococcygeal region were admitted to the First Affiliated Hospital of Zhengzhou University, with wound area from 5 cm×4 cm to 12 cm×10 cm. After thorough debridement and vacuum sealing drainage, the superior gluteal artery perforator " buddy flap" was designed to repair the pressure ulcer in sacrococcygeal region. The pressure ulcer was repaired by the main flap with area from 7.0 cm×5.0 cm to 18.0 cm×12.0 cm; the main flap′s donor area was covered by the auxiliary flap with area from 5.0 cm×3.0 cm to 11.0 cm×7.0 cm; the auxiliary flap′s donor area was covered by the connecting flap between the main flap and the auxiliary flap. The remaining wound without covering was directly closed by suturing. The postoperative flap survival and complications were observed. The appearance and function of flaps and the recurrence of pressure ulcer were followed up. Results The flaps of 12 patients survived after operation without complications of infection, fat liquefaction, or poor flap survival. A small area of superficial necrotic skin at the distal end of flap was observed in one case, which was healed after dressing change. All the patients were followed up for 6 months without recurrence of pressure ulcer, and the operation area was naturally full in appearance, which was pressure and wear resistant. Conclusions Superior gluteal artery perforator " buddy flap" is an effective method for the treatment of pressure ulcer in sacrococcygeal region. The effect of tension-free repair of the pressure ulcer and main flap donor area can be achieved in one operation. The operation is simple, the curative effect is accurate, and it has certain clinical value.

Clinical effects of individualized free anterolateral thigh flap in repairing complex refractory wound

Yang Li, Cai Bin, Xue Junrong, Jiang Peng, Guo Xianzhao

2020, 36(8): 730-734. doi: 10.3760/cma.j.cn501120-20190621-00281

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Objective To explore the clinical effects of individualized free anterolateral thigh flap in repairing complex refractory wound. Methods From July 2015 to May 2019, 19 patients with complex refractory wounds were hospitalized in Yulin NO.1 People′s Hospital of Guangxi Zhuang Autonomous Region, including 12 males and 7 female, aged 13-67 years. There were 5 patients with multiple tissue defects, 7 patients with large area of wounds, and 7 patients with wounds in special areas. The sizes of wounds after complete debridement were 8 cm×5 cm-23 cm×7 cm. According to the repair demand, the wounds in 5 patients were repaired with anterolateral thigh flaps and flow-through, the wounds in 7 patients were repaired with anterolateral thigh flaps chimed with lateral thigh muscle flaps, with vascular anastomosis in 2 patients, the wounds in 6 patients were repaired with unilateral anterolateral thigh lobulated flaps, and the wound in 1 patient was repaired with bilateral anterolateral thigh flap in series connection. The sizes of flaps were 10 cm×7 cm-25 cm×9 cm. The donor sites were sutured directly or repaired with thin split-thickness skin graft of head. The survival of the flaps, the appearance of the donor sites, and wounds repair after the operation and during follow-up were observed. Results The lobulated flap in 1 patient had local necrosis after the operation and finally healed by debridement, dressing change, and transplanting medium split-thickness skin graft in groin. The flaps in 18 patients survived with good blood supply, and the lobulated flap tissue was swollen in 1 of 18 patients. The donor sites which were directly sutured in 18 patients only had linear scar, and the donor site which was repaired with thin split-thickness skin graft of head in 1 patient had flaky scar. Follow-up of 1-12 months showed that all the wounds healed well, the flap thinning operations were performed in 5 patients in 3 months post operation because the flaps were slightly bloated. The CT angiography after the operation showed that the anastomosed blood vessels were unobstructed in 7 patients with reconstructed local blood supply. Conclusions The special forms of anterolateral thigh flap, such as lobulation, series connection, and chimerism can be designed according to the anatomical characteristics of the descending branch of the lateral femoral artery to meet individualized repair demand for complex refractory wounds, and achieve the double purposes of making full use of the donor site tissue and good repair of the recipient site.

Clinical effects of modified fascia flap from cutaneous branch of dorsal metacarpal artery in repairing the wound at the proximal and middle finger segments

Zhou Jian, Wei Zairong, Huang Guangtao, Jin Wenhu, Li Hai, Liu Zhiyuan, Deng Chengliang, Xiao Shun′e

2020, 36(8): 734-737. doi: 10.3760/cma.j.cn501120-20200212-00055

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Objective To investigate the clinical effects of modified fascia flap from cutaneous branch of dorsal metacarpal artery in repairing the wound at the proximal and middle finger segments. Methods From January 2017 to September 2018, 12 patients with wounds at the proximal and middle finger segments were admitted to the Affiliated Hospital of Zunyi Medical University, including 8 males and 4 females, aged 35-70 years. The areas of wounds ranged from 3.4 cm×2.4 cm to 6.5 cm×4.0 cm. The modified fascia flaps from cutaneous branch of dorsal metacarpal artery were resected to repair the wounds, with the size ranging from 3.5 cm×2.5 cm to 6.7 cm×4.1 cm. The flap donor sites of 5 patients were repaired with direct intermittent suture, the flap donor sites of 4 patients were repaired with full-thickness skin grafts from ipsilateral medial forearm, and the flap donor sites of 3 patients were repaired with wrist pedicled flaps. The survival of the flaps was recorded. Healing of donor site and recipient site was followed. The hand functions were evaluated with trial standard for the evaluation of the functions of the upper limbs of the Hand Surgery Society of the Chinese Medical Association. Results All the flaps survived in 12 cases. During 3 to 12 months of follow-up, the flaps recovered satisfactorily in texture and shape. The donor sites of 11 patients were healed, and the skin graft edge area was partially necrotic in the other patient but healed later after dressing change. The distances of two-point discrimination of the patients ranged from 5.6 to 9.0 mm. Hand functions were evaluated as excellent in 5 cases, good in 4 cases, and fair in 3 cases. Conclusions Modified fascia flap from cutaneous branch of dorsal metacarpal artery for repairing the wounds at the proximal and middle finger segments has reliable blood supply. The operation is simple and safe with short course of treatment, which is worthy of clinical promotion.

Effects of pedicled anterolateral thigh flaps in repairing skin and soft tissue defects in perineal region caused by necrotizing fasciitis

Gao Qiufang, Niu Xuetao, Ma Bin, Li Zibiao, Zhang Wanfeng, Guan Hao

2020, 36(8): 738-742. doi: 10.3760/cma.j.cn501120-20190528-00257

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Objective To explore the effects of pedicled anterolateral thigh flaps in repairing skin and soft tissue defects in perineal region caused by necrotizing fasciitis. Methods From March 2014 to December 2018, 6 patients with skin and soft tissue defects in perineal region caused by necrotizing fasciitis were admitted to Department of Burns of Hanzhong Central Hospital (hereinafter referred to as our hospital). Two female patients had labia major defects and 4 male patients had scrotum defects, with age of 43-68 years. The areas of skin and soft tissue defects after debridement were 4%-8% total body surface area. The wounds in non-joint and non-functional area were repaired with free split-thickness skin grafts from medial femoral region, and the residual wounds areas in perineal region after repair were 10 cm×4 cm-22 cm×10 cm, which were repaired with pedicled anterolateral thigh flaps, with area of 12 cm×5 cm-24 cm×12 cm. The secondary wounds in the donor sites were sutured directly or repaired with free split-thickness skin grafts from medial thigh on the same or opposite side of the wounds. The bacterial culture result of wound exudate, drug sensitivity test result, and blood bacterial culture result on admission were recorded. The postoperative flap survival was observed. The length of hospital stay, debridement times, and antibiotics use time were recorded. The flap swelling condition was observed to evaluate whether flap thinning operation was necessary, the sensory recovery of the flap and hip joint activity were evaluated, and the scrotum function of male patients was evaluated by urologist in our hospital during follow-up. Results The bacterial culture results of wound exudate in 5 patients on admission showed Escherichia coli with 4 of them having the same bacteria and the other one having methicillin-resistant Staphylococcus aureus detected in their blood samples. All the flaps survived in 6 patients after the operation, with total length of hospital stay of (22±5) d, debridement of 3-5 times, and antibiotics use time of (13±3) d. During follow-up of 3 to 6 months after the operation, the flaps were slightly bloated in 2 patients, and the flap thinning operation was performed 6 months after wound repair. The sensory function recovered to normal in 2 flaps of patients with anterolateral femoral cutaneous nerve, and the superficial sensory function in the other flaps of patients recovered in different degrees.The hip joint activity was close to normal in all the patients, and the scrotum function was normal in 4 male patients. Conclusions The pedicled anterolateral thigh flap showed good effects in repairing skin and soft tissue defects on perineal region caused by necrotizing fasciitis, with good appearance and function after operation, and the method is simple, safe, and easy to apply.

Successful rescue of one severe burn patient accompanied by asphyxia, sudden cardiac arrest, and acute respiratory distress syndrome