中华烧伤与创面修复杂志

Treatment of patients with refractory wounds

Lu Shuliang

2016, 32(10): 577-579. doi: 10.3760/cma.j.issn.1009-2587.2016.10.001

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Experienced over twenty years of theoretical accumulation and ten years of clinical exploration, wound repair speciality in our country is in the phase of enhancing comprehensive ability. Our wound healing experts team has successfully carried out treatment of suspected bacterial weapon related chronic wounds, which lasted up to more than 70 years, through multilateral cooperation. We summarized the surgical program of wound fibrous tissue removal and scalp as donor sites for long-term non-healing wounds in the elderly. At the same time, we explored the operating mode of internet-based technology to extend diagnosis and treatment of chronic wounds in remote areas, which was with efficiency and convenience.

2016, 32(10): 579-579. doi: 10.3760/cma.j.issn.1009-2587.2016.10.101

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2016, 32(10): 581-581. doi: 10.3760/cma.j.issn.1009-2587.2016.10.102

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2016, 32(10): 605-605. doi: 10.3760/cma.j.issn.1009-2587.2016.10.103

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2016, 32(10): 612-612. doi: 10.3760/cma.j.issn.1009-2587.2016.10.104

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2016, 32(10): 618-619. doi: 10.3760/cma.j.issn.1009-2587.2016.10.009

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2016, 32(10): 620-622. doi: 10.3760/cma.j.issn.1009-2587.2016.10.010

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2016, 32(10): 623-625. doi: 10.3760/cma.j.issn.1009-2587.2016.10.011

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2016, 32(10): 626-627. doi: 10.3760/cma.j.issn.1009-2587.2016.10.012

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Wound healing is still a game of " blind men and an elephant"

Han Chunmao

2016, 32(10): 580-581. doi: 10.3760/cma.j.issn.1009-2587.2016.10.002

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The wound healing includes non-healing and overhealing of the wounds. The results of wound healing are well known by people such as non-healing of the diabetic ulcer or hypertrophic scar after deep burn. In this issue, three papers involve in wound healing, one about autologous adipose-derived mesenchymal stem cells injected into wound or scar of rabbit ear, one about severe hypoxia and hypoalbuminemia inducing human hypertrophic scar derived fibroblast apoptosis in vitro, and another about the dysfunction of protein kinase B/mammalian target of rapamycin signaling pathway contributing to the pathophysiological characteristics of diabetic skin and non-healing wound. The basic problem of hypertrophic scar study is lacking an ideal animal model. Although rabbit ear model or red Duroc pig model has been used widely for study on hypertrophic scar, they can not fully represent human dermal fibrosis after deep trauma on the skin. I recommend A novel nude mouse model of hypertrophic scarring using scratched full thickness human skin grafts recently published in Advances in Wound Care to the readers. The author emphasizes that the wound healing study is still in the situation like the game of " blind men and an elephant" .

Effects of local transplantation of autologous adipose-derived mesenchymal stem cells on the formation of hyperplastic scar on rabbit ears

Chen Lu, Wang Dali, Wei Zairong, Wang Bo, Qi Jianping, Sun Guangfeng

2016, 32(10): 582-587. doi: 10.3760/cma.j.issn.1009-2587.2016.10.003

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Objective To investigate the effects of local transplantation of autologous adipose-derived mesenchymal stem cells (ADSCs) on the formation of hyperplastic scar on rabbit ears. Methods ADSCs were isolated from inguinal fat of six New Zealand rabbits and then sub-cultured. ADSCs of the third passage of each rabbit were used in the following experiments. Six full-thickness skin defect wounds with diameter of 6 mm on the ventral surface of every rabbit ear were made. Wound healing and local-tissue proliferation were observed, and complete epithelization time of wounds and formation time of hyperplastic scar were recorded. The wounds on left ears were selected as group ADSCs, and the wounds on right ears were selected as control group, with 36 wounds in each group. After the complete epithelization of wounds (post injury day 25), 0.2 mL bromodeoxyuridine (BrdU) labeled autologous ADSCs with the concentration of 5×10⁶ per milliliter were injected into each wound of the rabbit of group ADSCs, while the same amount of phosphate buffer solution was injected into each wound of the rabbit of control group. The frequency of injection was once every 5 days, totally for 3 times, and the latter 2 times were injected into scars generated from healed wound. Hyperplastic scars of rabbits of two groups were harvested on the fifth day after the third injection, then the morphology was observed by HE staining, and the arrangement of collagen in hyperplastic scar was observed by VG staining. The distribution of BrdU-labeled ADSCs in the hyperplastic scar was observed with fluorescence microscope. The protein content of type Ⅰ collagen, type Ⅲ collagen, transforming growth factor β₁ (TGF-β₁), and decorin in hyperplastic scar were detected by enzyme-linked immunosorbent assay, and the mRNA expression of decorin and TGF-β₁ in hyperplastic scar were tested by real-time fluorescent quantitative reverse transcription-polymerase chain reaction. Data were processed with paired t test. Results (1) The complete epithelization time of wounds of rabbits' ears was (20.0±2.0) d post injury, and hyperplastic scars were formed on post injury day 35.0±2.2. On post injury day 40, hyperplastic scars of rabbits of control group were still obvious, while those of group ADSCs became smaller, flat, soft, and light colored. (2) Compared with those in control group, epithelial cell layers and the number of nucleated cells in corium layer of hyperplastic scars of rabbits of group ADSCs were increased, and epithelium foot like and dermal papilla like structures were observed. The collagen density of hyperplastic scars of rabbits of control group was tight and arranged disorderly, while that of group ADSCs were decreased significantly and arranged regularly as compared with that of control group. (3) On post injury day 40, BrdU-labeled ADSCs were still observed in the hyperplastic scars of rabbits of group ADSCs. (4) The protein content of type Ⅰ collagen, type Ⅲ collagen, TGF-β₁, and decorin in hyperplastic scars of rabbits of group ADSCs were respectively (1.40±0.04) and (8.18±0.23) μg/L, (25.1±0.7) ng/L, and (4.872±0.101) ng/mL, and those in hyperplastic scars of rabbits of control group were respectively (2.29±0.05) and (12.20±0.38) μg/L, (37.2±1.1) ng/L, and (4.143±0.024) ng/mL. Compared with those in control group, the protein content of type Ⅰ collagen, type Ⅲ collagen, and TGF-β₁ in hyperplastic scars of rabbit of group ADSCs were significantly decreased (with t values from -33.66 to -22.84, P values below 0.001), while the protein content of decorin were significantly increased (t=10.41, P<0.001). (5) Compared with those in control group, the mRNA expression of TGF-β₁ in hyperplastic scars of rabbits of group ADSCs was significantly decreased (t=4.45, P<0.01), while the mRNA expression of decorin was significantly increased (t=5.61, P<0.01). Conclusions Autologous transplantation of ADSCs into scar of rabbit at the early stage can inhibit the formation of hyperplastic scar, promote the quality of wound healing, and the mechanism may relate to the down-regulation of TGF-β₁, type Ⅰ collagen, and type Ⅲ collagen and the up-regulation of decorin induced by ADSCs.

Expressions of the key proteins of the protein kinase B/mammalian target of rapamycin signaling pathway in skin tissue and wound tissue of diabetic rats

Huang Hong, Qiu Wei, Zhu Ming, Zhang Ya, Cui Wenhui, Xing Wei, Li Xiangyun, An Tianchen, Chen Minjia, Guo Wei, Xu Xiang

2016, 32(10): 588-593. doi: 10.3760/cma.j.issn.1009-2587.2016.10.004

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Objective To explore the changes in the expressions of key proteins of the protein kinase B/mammalian target of rapamycin (Akt/mTOR) signaling pathway in skin tissue and wound tissue of diabetic rats, and to elucidate the associated mechanisms. Methods Seventy-eight SD rats aged from 7 to 8 weeks were divided into diabetes group and non-diabetes group according to the random number table, with 39 rats in each group. Rats in diabetes group were intraperitoneally injected with 20 mg/mL streptozotocin fluid in the dose of 65 mg/kg (dissolved in citrate buffer solution) for once to establish the model of diabetes mellitus. Rats in non-diabetes group were injected with the equivalent volume of citrate buffer solution in the same way. Three rats of each group were respectively selected in each week from post injection week (PIW) 1 to 8 for collection of full-thickness skin samples on the back with area approximately of 1.0 cm×1.0 cm to determine epidermal thickness with HE staining. Fifteen rats of each group were inflicted with full-thickness skin defect by resection of skin as above in PIW 1. Three rats of each group were respectively sacrificed immediately after injury and on post injury day (PID) 1, 3, 5 and 7. One piece of skin tissue around the wound edge in each rat was cut off immediately after injury, and wound tissue in each rat was cut off from PID 1 to 7. One part of the tissue was used for determination of protein expression levels of Akt, phosphorylated Akt, mTOR, and phosphorylated mTOR in skin tissue and wound tissue with Western blotting. Surplus tissue was used for observation of expressions of phosphorylated Akt and vimentin in skin tissue and wound tissue with immunofluorescent staining. Data were processed with analysis of variance of factorial design and multiple t test. Results (1) The epidermal thicknesses in rats between the two groups were similar in PIW 1 and 2 (with t values respectively 0.25 and 1.33, P values above 0.05). From PIW 3 on, the epidermal thicknesses were significantly thinned in rats of diabetes group as compared with those of non-diabetes group (with t values from 4.44 to 9.71, P<0.05 or P<0.01). (2) Compared with those in skin tissue immediately after injury, the protein expression levels of Akt, phosphorylated Akt, mTOR, and phosphorylated mTOR in wound tissue of rats in non-diabetes group were increased remarkably from PID 1 to 7 (except for mTOR on PID 3, with t values from 3.75 to 21.44, P<0.05 or P<0.01). Compared with those in skin tissue immediately after injury, the protein expression levels of Akt and mTOR in wound tissue of rats in diabetes group were not significantly changed from PID 1 to 7 (except for mTOR on PID 1, with t values from 0.03 to 2.32, P values above 0.05), but the protein expression levels of phosphorylated Akt and phosphorylated mTOR in wound tissue were increased remarkably from PID 1 to 7 (except for phosphorylated Akt on PID 1, with t values from 3.79 to 8.11, P<0.05 or P<0.01). The protein expression levels of Akt in skin tissue of rats between the two groups were similar immediately after injury (t=0.66, P>0.05). However, the protein expression level of phosphorylated Akt in skin tissue of rats in diabetes group immediately after injury (0.310±0.035) was significantly decreased as compared with that in non-diabetes group (0.790±0.032, t=6.20, P< 0.05). Compared with those in non-diabetes group, the protein expression levels of mTOR and phosphorylated mTOR in skin tissue of rats in diabetes group immediately after injury and the protein expression levels of Akt, phosphorylated Akt, mTOR, and phosphorylated mTOR in wound tissue from PID 1 to 7 were all significantly decreased (with t values from 3.52 to 13.44, P<0.05 or P<0.01). (3) Compared with those in skin tissue immediately after injury, the expressions of phosphorylated Akt and vimentin in wound tissue of rats in the two groups from PID 1 to 7 presented a gradually increased tendency, however, the expressions of these indexes in skin tissue and wound tissue of rats in diabetes group were significantly weaker than those in non-diabetes group. Conclusions Trauma can stimulate activation of Akt/mTOR signaling pathway, and upregulate the expression of key proteins. The attenuation of this signaling pathway in skin tissue and wound tissue of diabetes mellitus may be the key mechanism for causing impaired healing of wound.

Effects of severe hypoxia and low concentration of serum protein on the function of human hypertrophic scar fibroblasts

Dong Jiaoyun, Song Fei, Liu Yingkai, Wang Xiqiao

2016, 32(10): 594-598. doi: 10.3760/cma.j.issn.1009-2587.2016.10.005

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Objective To simulate the environmental factors during the process of formation and evolution of hypertrophic scar, so as to explore the effects of moderate and severe hypoxia and low concentration of serum protein on the function of human hypertrophic scar fibroblasts (HSFs). Methods Human HSFs were routinely cultured. Cells of the 3rd to the 6th passage were divided into 10.0% oxygen+ 10.0% fetal calf serum (FCS), 5.0% oxygen+ 5.0% FCS, and 0.5% oxygen+ 0.5% FCS groups according to the random number table. After being cultured with DMEM nutrient solution with no FCS for 24 h, the cells were cultured with the corresponding volume fraction of oxygen and FCS. Cell proliferation activity was determined with methyl-thiazole-tetrazolium assay (denoted as actual cell number). Content of total collagen was detected with Sirius red staining method (denoted as absorbance value). Protein expression levels of hypoxia-inducible factor 1α (HIF-1α), vascular endothelial growth factor (VEGF), transforming growth factor β₁ (TGF-β₁), B-cell lymphoma 2 (Bcl-2), and P53 were determined with Western blotting (denoted as ratio of gray value). Cell apoptosis rate was detected by in situ end labeling method. The sample numbers of each group in the above experiments were all 3. Data were processed with Kruskal-Wallis test and Dunnett test. Results (1) Compared with 11 000±1 306 in 10.0% oxygen+ 10.0% FCS group, the cell proliferation activity was higher in 5.0% oxygen+ 5.0% FCS group (13 290±1 500, P<0.05), but lower in 0.5% oxygen+ 0.5% FCS group (6 999±765, P<0.05). (2) Compared with 0.039 6±0.004 2 in 10.0% oxygen+ 10.0% FCS group, the content of total collagen of cells was higher in 5.0% oxygen+ 5.0% FCS group (0.051 6±0.005 1, P<0.05), but lower in 0.5% oxygen+ 0.5% FCS group (0.015 6±0.002 4, P<0.05). (3) Compared with those in 10.0% oxygen+ 10.0% FCS group, the protein expression levels of HIF-1α, VEGF, TGF-β₁, and Bcl-2 were increased (with P values below 0.05), with no obvious difference in protein expression level of P53 in 5.0% oxygen+ 5.0% FCS group (P>0.05), whereas the protein expression levels of HIF-1α, VEGF, TGF-β₁, and Bcl-2 were decreased (with P values below 0.05), while the protein expression level of P53 was increased in 0.5% oxygen+ 0.5% FCS group (P<0.05). (4) Compared with (1.2±0.9)% in 10.0% oxygen+ 10.0% FCS group, the cell apoptosis rate in 5.0% oxygen+ 5.0% FCS group showed no significant difference [(2.6±0.9)%, P>0.05], while it was significantly increased in 0.5% oxygen+ 0.5% FCS group [(13.3±4.1)%, P<0.05]. Conclusions Severe hypoxia and low concentration of serum protein can inhibit proliferation activity and production of total collagen of human HSFs and induce their apoptosis.

Multicenter epidemiological investigation of hospitalized children with severe burn

Tang Yong, Wang Liangxi, Chen Junjie, Liu Jiaqi, Ren licheng, Liu Xusheng, Yin Meifang, Zhang Dongxia, Huang Yuesheng, Zhang Jiaping

2016, 32(10): 599-605. doi: 10.3760/cma.j.issn.1009-2587.2016.10.006

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Objective To analyze the epidemiological characteristics of hospitalized children with severe burn from several regions in China during 3 years, so as to provide evidence for prevention of burns in children. Methods Relying on the entry system of epidemiology data and biological sample of severe burn from multicenter in clinic, medical records of children with severe burn, aged 18 and under, hospitalized in 6 burn wards from February 2012 to February 2015 were collected. The children were divided into 5 age brackets: less than or equal to 1 year old, more than 1 year old and less than or equal to 3 years old, more than 3 years old and less than or equal to 6 years old, more than 6 years old and less than or equal to 12 years old, more than 12 years old and less than or equal to 18 years old. Meanwhile the children were divided into rural and urban children according to their residences. Data of gender and residence of children in the 5 age brackets, cause of injury, location of injury, total burn area, wound site, inhalation injury and combined injury, and source of hospitalization expenses of children in the 5 age brackets and two types of residence, and outcome and length of hospital stay of the children were analyzed. The cause of injury of children in different location of injury was analyzed. In addition, they were divided into 2 age brackets: less than or equal to 6 years old and more than 6 years old and less than or equal to 18 years old, and then incidences of hand and foot burn injury were compared. Data were processed with chi-square test, and the correlation between age and total burn area was processed with Spearman correlation analysis. Results Four hundred and forty out of 1 106 inpatients with severe burn were children, accounting for 39.8% who were included in the system. (1) The majority of children were male (270, 61.4%). The number of children more than 1 year old and less than or equal to 3 years old ranked the first (222, 50.5%) in the 5 age brackets. The ratio of children from rural areas to that from urban areas was 2.9∶1.0. There were no statistically significant differences in both gender and residence of children among the 5 age brackets (with χ² values respectively 7.649 and 9.399, P values above 0.05). (2) Scald was the most common cause of burn. There was statistically significant difference in injury cause of children among the 5 age brackets (χ²=136.307, P<0.001). There was no statistically significant difference in injury cause of children among the two types of residence (χ²=5.164, P>0.05). (3) Private house was the most common location of injury. There was statistically significant difference in location of injury of children among the 5 age brackets (χ²=124.930, P<0.001). There was no statistically significant difference in location of injury of children among the two types of residence (χ²=3.364, P>0.05). There was statistically significant difference in injury cause of children in different location of injury (χ²=118.284, P<0.001). (4) Most of children were with total burn areas from 10% to 39% total body surface area. There was statistically significant difference in total burn area of children among the 5 age brackets (χ²=103.568, P<0.001). There was positive correlation between age and total burn area (r=0.177, P<0.001). There was no statistically significant difference in total burn area of children among the two types of residence (χ²=16.213, P>0.05). (5) Trunk, lower extremity, and upper extremity were the most common wound sites, respectively. There was statistically significant difference in wound site of children among the 5 age brackets (χ²=45.674, P=0.019). There was statistically significant difference in incidence of hand and foot burn between children less than or equal to 6 years old and children more than 6 years old and less than or equal to 18 years old (with χ² values respectively 29.188 and 14.612, P values below 0.01). There was no statistically significant difference in wound site of children among the two types of residence (χ²=8.515, P>0.05). (6) Twenty-seven children suffered inhalation injury. The main age bracket was more than 12 years old and less than or equal to 18 years old (8 children). The main residence was rural area (18 children). The main cause of inhalation injury was flame burn (23 children). Nine children suffered combined injury, among which the children more than 12 years old and less than or equal to 18 years old accounted for the highest ratio (5 children), and the urban children accounted for higher ratio (5 children). (7) Among the 437 children, most of their hospitalization expenses were at their own expense. There was statistically significant difference in the source of hospitalization expenses of children among the 5 age brackets (χ²=17.917, P=0.001). There was no statistically significant difference in the source of hospitalization expenses of children among the two types of residence (χ²=0.749, P>0.05). (8) Among the 437 children, 34 children abandoned treatment and were discharged from hospital, attributed to lack of funding. Seventy-eight children were discharged with a better health condition and 347 were cured. The condition of 6 children worsened and 6 children died. Mean length of hospital stay was 28.6 days for all the children, and 8.8 days for the deteriorated and dead children. Conclusions Children were the major group of patients with severe burn in China. Male children less than or equal to 6 years old were common with scald as the major cause of injury, private house as the major location of injury, and trunk, lower and upper extremity as the most common wound sites, their own expenses as the major source of hospitalization expenses. There were statistically significant differences in cause of injury, location of injury, total burn area, wound site, and hospitalization expenses source of children among the 5 age brackets.

Acute toxicity and bio-distribution of silver nitrate and nano-silver with different particle diameters in rats

Li Tingzhu, Gong Fan, Zhang Bangyong, Sun Jindu, Zhang Ting, Kong Lu, Xue Yuying, Tang Meng

2016, 32(10): 606-612. doi: 10.3760/cma.j.issn.1009-2587.2016.10.007

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Objective To explore the acute toxic effect and the cumulative target organ of silver nitrate and nano-silver with two different particle diameters in rats. Methods Thirty-six adult SD rats were divided into small particle size nano-silver group (SNS), large particle size nano-silver group (LNS), silver nitrate group (SN), and control group (C) according to the random number table, with 9 rats in each group. The rats of the four groups were respectively injected with 10 mg/mL nano-silver solution (particle diameter of 20 nm, prepared by saline) in silver dose of 30 mg/kg by tail vein for once, 10 mg/mL nano-silver solution (particle diameter of 100 nm, prepared by saline) in silver dose of 30 mg/kg, 1.67 mg/mL silver nitrate solution (prepared by glucose solution) in silver dose of 3 mg/kg, and 30 mg/mL polyvinylpyrrolidone solution (prepared by saline) in dose of 90 mg/kg. (1) Toxicity test. The general observation was performed within 14 days after injection, and the deviation between value of body mass before injection and each of that on post injection day (PID) 1, 7, and 14 were respectively recorded. On PID 1, 7, and 14, 3 rats of each group were harvested for determination of serum content of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total protein, and albumin by fully automatic biochemical analyzer. Then the rats were sacrificed immediately, and heart tissue, liver tissue, spleen tissue, lung tissue, kidney tissue, and brain tissue were collected to calculate the organ coefficient. Organ samples with obvious changes in organ coefficient were collected for histopathological observation by HE staining, with 3 samples in each group at each time point. (2) Bio-distribution. The specimens of heart, liver, spleen, lung, and kidney of rats from groups SNS, LNS, and SN were collected for detection of silver content by inductively coupled plasma mass spectrometry, with 3 samples in each group at each time point. Data were processed with analysis of variance of factorial design, LSD test, and Dunnett's T3 test. Results (1) The general condition of rats in groups C and SN after injection were normal. The state of rats of groups SNS and LNS was poor with black secretion in the eye and other phenomena on PID 1, which recovered from PID 3 on. (2) The deviations between values of body mass before injection and that on PID 14 in rats of groups LNS and SN were significantly decreased as compared with deviation of group C (with P values below 0.01), but deviation of group SNS was not significantly changed (P>0.05). The deviations between values of body mass before injection and each of that on PID 1 and 7 in rats in the other three groups were similar to those in group C (with P values above 0.05). (3) Compared with those in group C, the serum content of total protein of rats in group SN on PID 1 was significantly decreased, and liver coefficient was significantly increased (with P values below 0.05). On PID 1, the serum content of ALT of rats in group LNS was (61.0±8.7) U/L, which was significantly higher than that in group C [(40.0±4.6) U/L, P<0.01]. Compared with those in group C [(126.0±3.5) U/L and 4.05±0.23], the serum content of AST of rats in groups SNS and LNS on PID 1[(249.7±107.2) and (237.0±38.3) U/L] was significantly increased, and liver coefficients (3.50±0.38 and 3.31±0.07) were significantly decreased, with P values below 0.05. Compared with those in group C [(69.2±4.8) U/L and 4.32±0.39], the serum content of AST of rats in groups SNS and LNS on PID 7 [(181.0±51.5) and (167.7±16.5) U/L] was also significantly increased, and liver coefficients (3.55±0.18 and 3.62±0.21) were also significantly decreased, P<0.05 or P<0.01. On PID 14, the four liver biochemical indexes in serum and all organ coefficients of rats in the other three groups were similar to those in group C (with P values above 0.05). (4) The liver of rats in group SN had slight degeneration on PID 1, the liver cells around the central vein of liver of rats in group SNS had slight degeneration on PID 7, and the liver cells got severely eosinophilic degeneration in liver of rats in group LNS on PID 7. There was no significant pathological change in the liver of rats in each group at the rest time points. (5) The silver content of lung and kidney in rats of group SNS on PID 1, that of spleen and kidney in rats of group LNS on PID 1, and that of heart and kidney in rats of groups LNS and SNS on PID 7 was significantly less than that of group SN (with P values below 0.05). The silver content of liver and spleen in rats of group SNS on PID 14 was significantly more than that of group SN (with P values below 0.05). Compared with that of group SN, the silver content of lung on PID 1 and liver on PID 7 in rats of group LNS was significantly increased (with P values below 0.05). On PID 14, there was no significant change in the silver content of all organs of rats between group SN and group LNS (with P values above 0.05). The silver content of heart, lung, and kidney on PID 1 and heart on PID 7 in rats of group LNS was significantly more than that of group SNS (with P values below 0.05). On PID 14, the silver content of each organ of rats in group SNS was close to that in group LNS (with P values above 0.05). Conclusions Silver nitrate and nano-silver with two different particle diameters have a short acute toxic effect on the liver of rats, and the liver has certain ability of self-healing. Nano-silver is mainly accumulated in the liver. The distribution of nano-silver with large particle diameter in organs is more widely than that of nano-silver with small particle diameter.

Effects of microporous polysaccharide on foreign body reaction induced by subcutaneously imbedding expanded polytetrafluoroethylene in mice

Liu Yuanhang, Chen Lei, Wu Yiping, Cao Wei

2016, 32(10): 613-617. doi: 10.3760/cma.j.issn.1009-2587.2016.10.008

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Objective To observe the effects of early applying of microporous polysaccharide on foreign body reaction induced by subcutaneously imbedding expanded polytetrafluoroethylene (e-PTFE) in mice. Methods Ten wide type adult C57BL/6J mice were collected and made a full-thickness skin incision on both sides of their back. The two incisions on the back of each mouse were divided into two groups according the random number table, with 10 incisions in each group. A tube-shaped e-PTFE was imbedded into each incision in microporous polysaccharide group, and then 0.03 g microporous polysaccharide was evenly sprayed in the cavity. Whereas, a tube-shaped e-PTFE was imbedded into each incision in control group without other treatment. The incisions in two groups were performed with conventional full-thickness suture. On post operation day (POD) 14, the e-PTFE surrounded with fibrous capsule in each incision of two groups was taken out, and then fibrous capsule tissue was harvested. The thickness of fibrous capsule was observed and measured with HE staining. Collagen fiber distribution in fibrous capsule tissue was observed with Masson staining to calculate the collagen fiber index. Neovascularization and macrophage infiltration in fibrous capsule tissue were observed respectively with immunohistochemical staining, and the numbers of new vessels and macrophages were counted. Data were processed with t test. Results On POD 14, the thickness of fibrous capsule surrounding e-PTFE imbedded into the incision of microporous polysaccharide group was (127±19) μm, which was significantly thinner than that of control group [(250±35) μm, t=4.13, P<0.05]. On POD 14, the collagen fiber index of fibrous capsule tissue surrounding e-PTFE imbedded into the incision of microporous polysaccharide group was 0.500±0.003, which was significantly higher than that of control group (0.488±0.004, t=5.00, P<0.05). On POD 14, the number of new vessels in fibrous capsule tissue surrounding e-PTFE imbedded into the incision of microporous polysaccharide group was 19±3 per 400 fold visual field, which was significantly more than that of control group (11±3 per 400 fold visual field, t=2.05, P<0.05). On POD 14, the number of macrophages in fibrous capsule tissue surrounding e-PTFE imbedded into the incision of microporous polysaccharide group was 64±5 per 400 fold visual field, which was close to that of control group (66±7 per 400 fold visual field, t=0.78, P>0.05). Conclusions Topically applying microporous polysaccharide can reduce the formation of fibrous capsule after subcutaneous imbedding of e-PTFE in mice, and it can improve the collagen deposition and angiogenesis but not impact on macrophage infiltration.

Advances in the research of nutrition therapy in patients with severe burn

Chen Qiaohua, Yang Xuekang, Hu Dahai

2016, 32(10): 628-631. doi: 10.3760/cma.j.issn.1009-2587.2016.10.013

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Patients with severe burn are characterized by strong oxidative stress and intense inflammatory response, which will cause metabolic disorder. Therefore, nutrition therapy is very important for severe burn. Nutrition therapy includes enteral nutrition (EN) and parenteral nutrition, and EN has the unique advantages. In recent years, more and more researchers focused on the EN for severe burn injuries, but there were still some confusing problems needing to solve. This article reviews the recent research about nutrition therapy for severe burn, including the route of feeding, energy requirements, and supplements of protein, carbohydrates, and microelements, and so on, so as to clarify some confusing questions about nutrition therapy for severe burn in clinical practice.

Antimicrobial applications and toxicity of nano-silver in the medical field

Wang Junjun, Xue Yuying, Tang Meng

2016, 32(10): 631-634. doi: 10.3760/cma.j.issn.1009-2587.2016.10.014

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With the rapid development of modern science and technology, the application of nanomaterial is ubiquitous in our daily life and medical field, in which the application related to nano-silver is more extensive. On one hand, it can make positive effects, such as anti-bacteria, anti-virus, anti-fungi, anti-parasitic infection and anti-tumor. In particular, its anti-bacterial activity in some acute or chronic treatment of infected wounds is more prominent. The application in diseases of gynecology, orthopedics, cardiovascular system, oral cavity, and ophthalmology is increasing. On the other hand, it can induce negative impacts and potential toxicity. It can be harmful to skin, gastrointestinal tract, respiratory tract, cardiovascular system, and so on. This article summarizes the antimicrobial application of nano-silver on treatment of diseases, its potential toxic effects on some organs or systems, and the possible toxic mechanism, as well as makes prospects of the research trends of nano-silver in future.

Advances in the research of promotion effect of Aloe vera on wound healing and its clinical use

Song Xinfu, Chen Xiaodong

2016, 32(10): 634-637. doi: 10.3760/cma.j.issn.1009-2587.2016.10.015

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Abstract:
Aloe vera has been widely investigated and used as folk medicine since ancient time. Biologically active substances in its gel include polysaccharides, glycoprotein, enzymes, anthraquinones or phenolic compounds, vitamins, minerals, and so on, which play important roles in anti-inflammatory response, antimicrobial, antiviral, antioxidant activity, immunoregulation effects, and especially in wound healing. In this paper, we review the advances in the mechanism and clinical application of Aloe vera and its extract on wound healing, so as to provide new ideas for the treatment of various kinds of wounds.

Advances in the research of application of collagen in three-dimensional bioprinting

Li Haihang, Luo Pengfei, Sheng Jiajun, Liu Gongcheng, Zhu Shihui

2016, 32(10): 638-640. doi: 10.3760/cma.j.issn.1009-2587.2016.10.016

Abstract

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Abstract:
As a new industrial technology with characteristics of high precision and accuracy, the application of three-dimensional bioprinting technology is increasingly wide in the field of medical research. Collagen is one of the most common ingredients in tissue, and it has good biological material properties. There are many reports of using collagen as main composition of " ink" of three-dimensional bioprinting technology. However, the applied collagen is mainly from heterogeneous sources, which may cause some problems in application. Recombinant human source collagen can be obtained from microorganism fermentation by transgenic technology, but more research should be done to confirm its property. This article reviews the advances in the research of collagen and its biological application in three-dimensional bioprinting.

2016 Vol. 32, No. 10

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