2015 Vol. 31, No. 2

Expert Forum
Lay emphasis on the application of negative pressure wound therapy technique in burn surgery
Chai Jiake, Shen Chuanan
2015, 31(2): 81-83. doi: 10.3760/cma.j.issn.1009-2587.2015.02.001
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In recent years, negative pressure wound therapy (NPWT) technique has been widely used in burn surgery, including wound repair, skin grafting, and cosmetic procedures, showing promising clinical results. Based on the literature and clinical experience, the mechanism of NPWT and its clinical application in burn surgery are briefly iterated herewith.
Expert Comment
Reaffirmation on rational application of negative pressure wound therapy technique
Lyu Guozhong
2015, 31(2): 84-85. doi: 10.3760/cma.j.issn.1009-2587.2015.02.002
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Along with improvements in the embedding materials, continual innovation of the applied technique, and further understanding of therapeutic mechanism, the application scope of negative pressure wound therapy (NPWT) becomes broader, clinical experience in its use becomes more abundant. This issue of the journal highlights 5 papers to introduce the experience and knowledge regarding NPWT technique of the authors.
Effects of vacuum sealing drainage combined with irrigation of oxygen loaded fluid on wounds of patients with chronic venous leg ulcers
Wen Huangding, Li Zhiqing, Zhang Meiguang, Wang Jiahan, Wang Guifang, Wu Qi, Tong Sen
2015, 31(2): 86-92. doi: 10.3760/cma.j.issn.1009-2587.2015.02.003
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Objective To evaluate the therapeutic effects of VSD combined with irrigation of oxygen loaded fluid on the growth of granulation tissue and macrophage polarization in chronic venous leg ulcers. Methods Thiry-four patients with chronic venous leg ulcers hospitalized in our department from December 2010 to July 2014 were divided into VSD group (A, n=11), VSD+ irrigation group (B, n=11), and VSD+ oxygen loaded fluid irrigation group (C, n=12) according to the random number table. After admission, debridement was performed, and granulation tissue in the center of the wound was harvested during the operation. After debridement, the patients in group A were treated with VSD only (negative pressure from -30 to -25 kPa, the same below); the patients in group B were treated with VSD combining irrigation of normal saline; the patients in group C were treated with VSD combining normal saline loaded with oxygen irrigation (flow of 1 L/min). On post treatment day (PTD) 7, the VSD devices were removed. Gross observation was conducted before debridement and on PTD 7. On PTD 7, the granulation tissue in the center of the wound was harvested for histopathological observation with HE staining and Masson staining, following calculation of granulation tissue coverage rate. After debridement but before the negative pressure therapy (hereinafter referred to as before treatment) and on PTD 7, partial pressure of oxygen of the skin around the wound was measured by transcutaneous tissue oxygen tension survey meter. On PTD 7, expression of vascular endothelial growth factor (VEGF) was determined with immunohistochemistry. Before treatment and on PTD 7, cells with double positive expressions of induced nitric oxide synthase plus CD68 (type Ⅰ macrophage) and arginase 1 plus CD68 (type Ⅱ macrophage) were observed with immunofluorescence staining and quantified. Data were processed with Fisher's exact test, one-way analysis of variance, covariance analysis, paired t test, and LSD test. Results (1) The gross observation showed that before debridement there was a certain amount of necrotic tissue and little granulation tissue in the wounds of patients in all the 3 groups. On PTD 7, new granulation tissue was found in the wounds of patients in all the 3 groups, and in group C its amount was the largest. (2) On PTD 7, the granulation tissue coverage rate of wounds in patients of group C was higher than that of group A or B (P<0.05 or P<0.01). (3) On PTD 7, HE staining showed that there appeared more abundant new born microvessels and fibroblasts in the wounds of patients in group C than those in groups A and B; Masson staining showed that there was more abundant fresh collagen distributed orderly in the wounds of patients in group C compared with group A or B. (4) On PTD 7, it was found that partial pressure of oxygen of the skin around the wounds in patients of group C [(40.7±4.1) mmHg, 1 mmHg=0.133 kPa] was higher than that of group A [(35.0±3.1)mmHg] or B [(35.4±2.7) mmHg, with P values below 0.01]; the partial pressure of oxygen of the skin around the wounds of patients in all the 3 groups was increased significantly compared with that before treatment (with t values from 10.38 to 22.52, P values below 0.01). (5) On PTD 7, the expression of VEGF in the wounds of patients in group C was higher than that in group A or B (P<0.05 or P<0.01). (6) On PTD 7, the number of type Ⅰ macrophages in granulation tissue of patients was respectively 14.3±2.3, 11.5±3.0, and 10.7±2.3 per 400 times vision field in groups A, B, and C (F=25.14, P<0.01), while the number in group C was less than that in group A or B (P<0.05 or P<0.01). Compared with that before treatment, the number of type Ⅰ macrophages was significantly decreased on PTD 7 in all the 3 groups (with t values from 14.76 to 23.73, P values below 0.01). On PTD 7, the number of type Ⅱ macrophages in granulation tissue of patients was respectively 32.7±3.2, 35.1±3.3, and 41.3±3.2 per 400 times vision field in groups A, B, and C (F=81.10, P<0.01), and the number in group C was lager than that in group A or B (with P values below 0.01). Compared with that before treatment, the number of type Ⅱ macrophages in all the 3 groups was significantly increased (with t values from -69.34 to -47.95, P values below 0.01). Conclusions VSD combined with irrigation of oxygen loaded fluid can raise the partial pressure of oxygen of the skin around the wounds effectively, promoting the transition of macrophages from type Ⅰ to type Ⅱ, thus it may promote the growth of granulation tissue, resulting in a better recipient for skin grafting or epithelization.
Clinical study on repair of open joint wounds and/or wounds with exposed bone fracture using negative pressure wound therapy combined with artificial dermis grafting and autologous skin grafting
Chen Xin, Wang Hao, Dai Yundong, Zhang Cong, Wang Cheng
2015, 31(2): 93-97. doi: 10.3760/cma.j.issn.1009-2587.2015.02.004
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Objective To explore the clinical effects of negative pressure wound therapy (NPWT) combined with artificial dermis grafting and autologous skin grafting on repair of open joint wounds and/or wounds with exposed bone fracture. Methods Eleven patients with open joint wounds and/or wounds with exposed bone fracture, hospitalized from November 2008 to November 2014, were enrolled in the study. According to the differences of the first stage treatment, all patients were divided into experimental group (n=6, including 4 patients of open joint wounds, 1 patient of wound with exposed bone fracture, and 1 patient of open joint wound with exposed bone fracture), and control group (n=5, including 2 patients of open joint wounds, 2 patients of wounds with exposed bone fracture, and 1 patient of open joint wound with exposed bone fracture). After debridement, the wounds in both groups were grafted with punctured artificial dermis, while NPWT was only used over the artificial dermis of experiment group for 1 week. In the operation at second stage, autologous split-thickness skin was grafted on the vascularized artificial dermis in both groups. Results In 5 patients of open joint wounds in experimental group, the artificial dermis was vascularized well, autologous skin grafts survived, and wounds were healed. In 3 patients of open joint wounds in control group, the artificial dermis grafting all failed due to local infection, and then these wounds were repaired with local tissue flap grafting. Artificial dermis in 3 patients of wounds with exposed bone fracture in both groups was vascularized well after grafting, and the wounds were healed after autologous skin grafting, whether or not NPWT was used. Conclusions NPWT combined with artificial dermis grafting and autologous skin grafting can be used for repairing open joint wounds and/or wounds with exposed bone fracture.
2015, 31(2): 97-97. doi: 10.3760/cma.j.issn.1009-2587.2015.02.102
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2015, 31(2): 97-97. doi: 10.3760/cma.j.issn.1009-2587.2015.02.101
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Application of vacuum sealing drainage in the treatment of severe necrotizing fasciitis in extremities of patients
Li Longzhu, Li Dawei, Shen Chuanan, Li Dongjie, Cai Jianhua, Tuo Xiaoye, Zhang Lin
2015, 31(2): 98-101. doi: 10.3760/cma.j.issn.1009-2587.2015.02.005
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Objective To study the application of VSD in the treatment of severe necrotizing fasciitis in extremities of patients. Methods Eight patients, suffering from severe necrotizing fasciitis, who had been traditionally treated with iodophor-soaked gauze for 21 to 365 days in other hospitals, were transferred to our institute because of the nonhealing wounds and systemic toxic symptoms induced by infection, from January 2011 to August 2013. After admission, surgical debridement was performed timely, and the necrotic tissue was collected during the operation for pathological observation after HE staining. After the operation, VSD was started with negative pressure ranging from -100 to -80 kPa, and the furacilin solution (0.2 g/L) and oxygen (2 L/min) were continuously infused into the wound during the treatment. Surgical debridement was performed repeatedly according to the wound condition followed by change of VSD dressings to continue VSD treatment. The wounds were closed by suturing or with autologous skin grafts after being covered by fresh granulation tissue. The times of surgical debridement, times of change of VSD materials, wound healing status, and length of stay in our institute were recorded. All patients were followed up for a long time. Results HE staining showed that there were diffuse necrotic adipose and fibrous connective tissues in the necrotic tissue, and the normal tissue structure disappeared accompanied by significant infiltration of inflammatory cells. The number of surgical debridement was 2 to 10 (3.9±2.8) times. The number of VSD materials change was 2 to 10 (4.0±2.9) times. Wounds were closed by suturing and healed in two patients; wounds in the other six patients were partially sutured, their residual wounds were healed by autologous skin grafting. The length of stay in our institute was 20 to 49 (33±10) days. All patients were discharged after recovery. Patients were followed up for 2 to 24 months, and their wounds were found to be in good condition without ulceration or recurrence. Conclusions VSD can effectively remove the necrotic tissues and exudates from the fascial spaces and promote proliferation of granulation tissue. Therefore it serves as an effective approach to the treatment of severe necrotizing fasciitis in extremities.
2015, 31(2): 101-101. doi: 10.3760/cma.j.issn.1009-2587.2015.02.103
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2015, 31(2): 102-104. doi: 10.3760/cma.j.issn.1009-2587.2015.02.006
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2015, 31(2): 105-106. doi: 10.3760/cma.j.issn.1009-2587.2015.02.007
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2015, 31(2): 111-111. doi: 10.3760/cma.j.issn.1009-2587.2015.02.104
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Integration of burn treatment and rehabilitation for a child with extremely severe burn
Li Hongming, Zhang Jiaping, Chen Jian, Song Huapei, Liu Qiushi, Fan Xin, Peng Yizhi, Wu Jun
2015, 31(2): 130-134. doi: 10.3760/cma.j.issn.1009-2587.2015.02.013
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This article reports the successful experience of integration of burn treatment and rehabilitation for a child suffering from 91% TBSA flame burn injury (with 60% TBSA full-thickness injury, 30% TBSA deep partial-thickness injury, and 1% TBSA superficial partial-thickness injury), severe inhalation injury, severe burn shock, stress ulcer, gastrointestinal bleeding and atelectasis of the right upper lung. The patient was given effective fluid infusion against shock, treatment for gastrointestinal bleeding, and other effective supportive treatment for functions of various organs after being admitted to our burn ward. When vital signs became stable at 30 hours post injury, bedside rehabilitation was begun. On post injury day (PID) 4, escharectomy was performed for both lower limbs, followed by microskin grafting and allogeneic skin covering. On PID 10, invasive infection of multi-drug resistant bacteria was found with accompanied high fever, and at the same time allograft began to disintegrate, with dissolution of large area of eschar, leading to a raw surface reaching 86% TBSA. Following debridement, dressing, application of compound polymyxin B ointment, temporary covering of wounds with porcine acellular dermal matrix, adjustment of antibiotics, patient's condition was finally stabilized. From PID 28 on, split-thickness skin grafting was conducted 7 times, and the raw surface of 75% TBSA involving the upper and lower limbs and trunk was successfully covered. At the same time, our rehabilitation team launched comprehensive rehabilitation measures comprising active exercise, occupational therapy, prevention of scar formation, organ function training and psychological intervention. Finally, the patient was able to walk unaided and fed herself when the wounds were almost entirely healed in 3 months after injury. Oriented forwards functional rehabilitation, strong cooperation between team members, and synchronous effective implementation of burn treatment and rehabilitation in the whole process are the keys to achieve successful integration of burn treatment and rehabilitation of this child.
2015, 31(2): 135-137. doi: 10.3760/cma.j.issn.1009-2587.2015.02.014
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2015, 31(2): 137-139. doi: 10.3760/cma.j.issn.1009-2587.2015.02.015
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2015, 31(2): 140-142. doi: 10.3760/cma.j.issn.1009-2587.2015.02.016
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2015, 31(2): 143-144. doi: 10.3760/cma.j.issn.1009-2587.2015.02.017
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2015, 31(2): 145-146. doi: 10.3760/cma.j.issn.1009-2587.2015.02.018
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2015, 31(2): 147-148. doi: 10.3760/cma.j.issn.1009-2587.2015.02.019
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2015, 31(2): 148-149. doi: 10.3760/cma.j.issn.1009-2587.2015.02.020
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2015, 31(2): 149-150. doi: 10.3760/cma.j.issn.1009-2587.2015.02.021
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2015, 31(2): 151-152. doi: 10.3760/cma.j.issn.1009-2587.2015.02.022
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2015, 31(2): 160-160. doi: 10.3760/cma.j.issn.1009-2587.2015.02.025
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Original Article
Repair of skin and soft tissue defects at distal end of finger and donor site with relaying reversed perforator flaps
Deng Chengliang, Wei Zairong, Sun Guangfeng, Tang Xiujun, Jin Wenhu, Li Hai, Wu Bihua, Wang Dali
2015, 31(2): 107-111. doi: 10.3760/cma.j.issn.1009-2587.2015.02.008
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Objective To explore the clinical effects of relaying reversed perforator flaps in repairing skin and soft tissue defects at distal end of finger and donor site. Methods Seventeen patients (17 fingers) with skin and soft tissue defects at distal end of finger were hospitalized from June 2011 to June 2013. The reversed digital artery perforator flap with branch of digital nerve was used to repair the defect. The first donor site was repaired by dorsal metacarpal artery perforator flap; the second donor site was closed by suturing. The area of skin defect at distal end of finger ranged from 2.0 cm×1.5 cm to 3.0 cm×2.0 cm, and the area of digital artery perforator flap and dorsal metacarpal artery perforator flap ranged from 2.2 cm×1.5 cm to 3.6 cm×2.5 cm and 2.5 cm×2.0 cm to 4.2 cm×3.0 cm, respectively. Results All the 34 flaps survived completely. Cyanosis and partial necrosis of the epidermis appeared in 1 flap, which was healed after dressing change. All the patients were followed up for 1 to 18 months, with mean time of 8 months. The color, texture and appearance of flaps were satisfactory. There was no depression or breakdown in the first donor sites. Some linear scars appeared in the second donor sites, but they did not affect the general appearance. The donor sites at joint or tendon did not affect the joint activity after healing. The results of function evaluation of range of active movement of the fingers were excellent in 15 cases and good in 2 cases. The results of sensation of the flaps were S3 in 1 finger, S4 in 2 fingers, and S5 in 14 fingers. The distance of two-point discrimination of flaps ranged from 5 to 7 mm, with mean distance of 6 mm. Conclusions Relaying reversed perforator flap, with reliable blood supply and both donor sites in the hand, can improve the appearance and function of the first donor site as well as repair skin and soft tissue defects at distal end of finger.
Repair of perforating skin and soft tissue defects of the palms with dorsalis pedis parallel flaps
Feng Shiming, Wang Aiguo, Gao Shunhong
2015, 31(2): 112-115. doi: 10.3760/cma.j.issn.1009-2587.2015.02.009
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Objective To explore the effect of dorsalis pedis parallel flaps in repairing perforating skin and soft tissue defects of the palms. Methods Eighteen patients with perforating skin and soft tissue defects of the palms were hospitalized from July 2008 to November 2010. The area of skin defect ranged from 2.0 cm×1.5 cm to 5.0 cm×2.5 cm. The dorsalis pedis parallel flaps were used to repair these defects, with the area ranging from 2.0 cm×2.0 cm to 5.5 cm×3.0 cm. The donor sites were covered with autologous full-thickness skin from inner thigh. Results All the 18 flaps and skin grafts of donor sites survived completely. Seventeen patients were followed up for 6 to 23 months, with mean time of 10 months, and one patient was lost to follow-up. The texture, elasticity, and appearance of all the 17 flaps were satisfactory, with no obvious pigmentation or cicatricial contracture. At the last follow-up, the distance of two-point discrimination of flaps ranged from 6 to 9 mm, with mean distance of 7.4 mm, and the sensation of flaps reached S3 in 13 patients who had nerve anastomosis. Conclusions The dorsalis pedis parallel flap, with reliable blood supply and flexible design, is a good choice for repairing perforating skin and soft tissue defects of the palms.
Activation of cofilin and its relation with distribution of tight junction protein zonula occludens 1 in hypoxic human intestinal epithelial cells
He Wen, Wang Pei, Zhang Jian, Wang Fengjun
2015, 31(2): 116-121. doi: 10.3760/cma.j.issn.1009-2587.2015.02.010
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Objective To study the effect of hypoxia on cofilin activation in intestinal epithelial cells and its relation with distribution of tight junction protein zonula occludens 1 (ZO-1). Methods The human intestinal epithelial cell line Caco-2 was used to reproduce monolayer cells. The monolayer-cell specimens were divided into control group (no treatment), hypoxic group (exposed to hypoxia), and normoxic group (exposed to normoxia) according to the random number table. Western blotting was used to detect the protein expressions of cofilin and phosphorylated cofilin (p-cofilin) of cells in normoxic group and hypoxic group exposed to normoxia or hypoxia for 1, 2, 6, 12, and 24 h and control group, with 9 samples in control group and 9 samples at each time point in the other two groups. The other monolayer-cell specimens were divided into hypoxic group (exposed to hypoxia) and control group (no treatment) according to the random number table. Cells in hypoxic group exposed to hypoxia for 1, 2, 6, 12, and 24 h and control group were obtained. Morphology and distribution of F-actin was observed with laser scanning confocal microscopy, the ratio of F-actin to G-actin was determined by fluorescence method, and distribution of ZO-1 and cellular morphology were observed with laser scanning confocal microscopy. The sample number of last 3 experiments was respectively 3, 6, and 3 in both hypoxic group (at each time point) and control group. Data were processed with paired t test, analysis of variance of repeated measurement, and LSD-t test. Results The protein expressions of cofilin and p-cofilin of cells between normoxic group exposed to normoxia for 1 to 24 h and control group showed no significant changes (with tcofilin values from -0.385 to 1.701, tp-cofilin values from 0.040 to 1.538, P values above 0.05). There were no obvious differences in protein expressions of cofilin of cells between hypoxic group exposed to hypoxia for 1 to 24 h and control group (with t values from 1.032 to 2.390, P values above 0.05). Compared with that in control group, the protein expressions of p-cofilin of cells were greatly reduced in hypoxic group exposed to hypoxia for 1 to 24 h (with t values from 4.563 to 22.678, P values below 0.01), especially exposed to hypoxia for 24 h. The protein expressions of cofilin of cells between normoxic group and hypoxic group at each time point were close (with t values from -0.904 to 1.433, P values above 0.05). In hypoxic group, the protein expressions of p-cofilin of cells exposed to hypoxia for 1, 2, 6, 12, and 24 h were 0.87±0.08, 0.78±0.05, 0.89±0.07, 0.68±0.07, and 0.57±0.06, respectively, significantly lower than those in normoxic group (0.90±0.07, 0.97±0.06, 1.00±0.06, 1.00±0.05, and 0.99±0.05, with t values from 3.193 to 16.434, P values below 0.01). In control group, F-actin in the cytoplasm was abundant, most of it was in bunches. The trend of F-actin was disorderly in hypoxic group from being exposed to hypoxia for 1 h, shortened in length or even dissipated. The ratios of F-actin to G-actin of cells in hypoxic group exposed to hypoxia for 12 and 24 h (0.89±0.12 and 0.84±0.19) were obviously decreased as compared with that in control group (1.00, with t values respectively 3.622 and 3.577, P values below 0.01). There were no obvious differences in the ratios of F-actin to G-actin of cells between hypoxic group exposed to hypoxia for 1, 2, and 6 h and control group (with t values from 0.447 to 1.526, P values above 0.05). In control group, cells were compact in arrangement, and ZO-1 was distributed continuously along the cytomembrane. From being exposed to hypoxia for 2 h, cells became irregular in shape in hypoxic group. ZO-1 was distributed in discontinuous fashion along the cytomembrane with breakage in hypoxic group exposed to hypoxia for 24 h. Conclusions Hypoxia may cause the disorder of dynamic balance between F-actin and G-actin by inducing cofilin activation, which in turn leads to the changes in distribution of tight junction protein ZO-1 in intestinal epithelial cells.
Epidemiological investigation of 235 patients with extra-pulmonary tuberculosis wounds
Chang Na, Jia Chiyu, Liu Zhen, Zhang Yajie, Li Wenting, Tian Tian
2015, 31(2): 122-124. doi: 10.3760/cma.j.issn.1009-2587.2015.02.011
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Objective To investigate the epidemiological characteristics and patterns of extra-pulmonary tuberculosis wounds in order to provide reliable data for further clinical research. Methods Records of patients with extra-pulmonary tuberculosis wounds hospitalized from January 2010 to December 2012 were retrospectively analyzed, including gender, age, nationality, family background, Bacille Calmette-Guerin (BCG) vaccination, primary lesion, and history of injury. Results Tuberculosis wounds were found in 235 patients among 5 863 patients with extra-pulmonary tuberculosis, accounting for 4.0%. Among the patients with tuberculosis wounds, there were 139 male and 96 female, and the ratio of male to female was 1.4∶1.0. The age of patients ranged from 1 to 87 (37±18) years old, and the highest incidence occurred in patients older than 15 and younger than or equal to 30 years old (100 cases, accounting for 42.6%). Most patients with tuberculosis wounds were Han, and only 11 patients were minorities, accounting for 4.7%. Tuberculosis wounds were more prevalent in rural areas (163 cases, accounting for 69.4%), with a smaller number in urban areas (72 cases, accounting for 30.6%). The BCG vaccination rate was 13.6%. The main primary lesions were lymph node infection (112 cases, accounting for 47.7%), among which involvement of cervical lymph nodes accounted for the highest ratio (99 cases, accounting for 88.4%). Twenty-one patients had the traffic accident etc. injury history recently, among which 19 were male and 2 were female. Conclusions Tuberculosis wound, with certain incidence, was more frequently found among young adults from rural areas. The BCG vaccination rate was low among the patients and the main primary lesion was tuberculosis of cervical lymph nodes.
Role of dentritic epidermal T lymphocytes in immune rejection of skin allograft in mice and its mechanism
Huang Hua, Yan Rongshuai, Liu Meixi, Zhou Junyi, Tan Jianglin, Zhang Xiaorong, Hu Xiaohong, Huang Yong, He Weifeng, Wu Jun, Luo Gaoxing
2015, 31(2): 125-129. doi: 10.3760/cma.j.issn.1009-2587.2015.02.012
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Objective To explore the role of dentritic epidermal T lymphocytes (DETCs) in immune rejection of skin allograft in mice and its related mechanism. Methods (1) Full-thickness skin was harvested from back of one male wild type (WT) C57BL/6 mouse. Epithelial cells were isolated for detection of the expression of DETCs and their phenotype with flow cytometer. Another male WT C57BL/6 mouse was used to harvest full-thickness skin from the back. Epidermis was isolated for observation of the morphological characteristics of DETCs with immunofluorescence technology. (2) Four male green fluorescence protein (GFP)-marked C57BL/6 mice, 7 female WT C57BL/6 mice (group WT), and 7 female γδT lymphocytes δ gene knock-out (GK) C57BL/6 mice (group GK) were used. Full-thickness skin in the size of 1.4 cm×1.4 cm on the back of mice in groups WT and GK were excised, and the wounds were transplanted with full-thickness skin in the size of 1.2 cm×1.2 cm obtained from male GFP-marked C57BL/6 mice. The survival time of skin grafts was affirmed with small animal in vivo imager and naked eyes and recorded. (3) Two male WT C57BL/6 mice were used to isolate epithelial cells. Cells were inoculated into 48-well plate and divided into activation group (A) and control group (C) according to the random number table, with 4 wells in each group. Cells in group A were treated with 10 μL concanavalin A in the concentration of 2 μg/mL for 24 hours, while those in group C with PBS in the same volume as that in group A. The expression of interferon γ in DETCs was detected with flow cytometer. (4) Four male GFP-marked C57BL/6 mice were used as donors. Fourteen female WT C57BL/6 mice were used as receptors and divided into interferon γ neutralizing group (IN) and control group (C) according to the random number table, with 7 mice in each group. The skin transplantation model of C57BL/6 male to C57BL/6 female was established as in part (2). Before surgery and 72 hours after, mice in group IN were intraperitoneally injected with 200 μL interferon γ neutralizing antibody in the concentration of 1 mg/mL, and those in group C with normal saline in the same volume as that in group IN. The survival time of skin grafts was observed and recorded using the methods in part (2), and the result of group IN was compared with that of group GK in part (2). The survival curve of skin grafts was processed with Log-rank (Mantel-Cox) test. Results (1) The positive expression rate of DETCs in epithelial cells of skin in mouse was 7.27%, and they were all CD3+ cells. DETCs were found to be scattered in the epidermis of skin in mouse with dendritic morphology. (2) The survival time of skin grafts of mice in group GK was 22-35 d, obviously longer than that in group WT (12-16 d, χ2=14.10, P<0.001). (3) Expression of interferon γ was detected in 22.70% DETCs in group A, which was obviously higher than that in group C (0.51%). (4) The survival time of skin grafts of mice in group IN was 19-24 d, which was obviously longer than that in group C (12-16 d, χ2=13.60, P<0.001) but close to that in group GK as in part (2) (χ2=0.06, P=0.810). Conclusions DETCs are involved in promotion of immune rejection of skin allograft probably by secreting interferon γ.
Review
Advances in the research of extravascular lung water after severe burn
Yu Xiaofeng, Ren Hui, Zhang Jiaping
2015, 31(2): 153-156. doi: 10.3760/cma.j.issn.1009-2587.2015.02.023
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Pulmonary edema frequently occurs after severe burn. It not only impairs pulmonary function directly, but also can induce or exacerbate other pulmonary complications such as lung infection, acute lung injury (ALI), and ARDS. Extravascular lung water (EVLW) is closely related to the pulmonary edema. Dynamical monitor of EVLW has been used to predict and quantify the degree of pulmonary edema clinically. This review focuses on the recent progresses at home and abroad on the formation mechanism, monitoring approach, and prevention and treatment of EVLW after severe burn injury.
Advances in the research of modulation of dermal collagen fibrin assembly by decorin
Qi Deqing, Zhou Yue, Zhang Xuanfen
2015, 31(2): 157-159. doi: 10.3760/cma.j.issn.1009-2587.2015.02.024
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Formation of dermal collagen fiber is a complicated and sequential process with the progressive assembly of collagen. Collagen monomers form stepped and orderly protofibrils through longitudinal displacement. Subsequently, protofibrils or protofibrils and collagen are bonded by covalent bonds to form orderly lamellar structure of collagen fibers. Then collagen fibers are tightly wound into coarse collagen fiber bundles by covalent crosslinking. Decorin is a multifunctional small leucine-rich proteoglycan. It can prevent the aggregation of protofibrils by binding to the specific site of collagen with its core protein, and adjusting the spacing between the protofibrils with its glycosaminoglycan chain. Thus, by effecting the formation of collagen fibers with regulation of collagen assembly, decorin may help prevent scar formation and even promote regeneration.