2016 Vol. 32, No. 11

Expert Forum
Integrated diagnosis and treatment of scar
Cen Ying, Chen Junjie
2016, 32(11): 641-643. doi: 10.3760/cma.j.issn.1009-2587.2016.11.001
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Scar is the common disease in the field of burn and plastic surgery, and its diagnosis and treatment should be involved in overwhelming majority hospitals. There are many substandard methods and medical hidden dangers in diagnosis and treatment of scar, due to the unevenness of doctors′ clinical experience. According to the classification of integral scar and diabrotic scar, the problems related to diagnosis and treatment of scar are systemically summarized and normalized in this article for decrease in the incidence of adverse events and medical hidden dangers.
2016, 32(11): 643-643. doi: 10.3760/cma.j.issn.1009-2587.2016.11.102
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2016, 32(11): 643-643. doi: 10.3760/cma.j.issn.1009-2587.2016.11.101
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2016, 32(11): 648-648. doi: 10.3760/cma.j.issn.1009-2587.2016.11.103
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2016, 32(11): 648-648. doi: 10.3760/cma.j.issn.1009-2587.2016.11.104
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2016, 32(11): 666-666. doi: 10.3760/cma.j.issn.1009-2587.2016.11.006
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2016, 32(11): 667-669. doi: 10.3760/cma.j.issn.1009-2587.2016.11.007
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2016, 32(11): 688-691. doi: 10.3760/cma.j.issn.1009-2587.2016.11.011
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2016, 32(11): 692-694. doi: 10.3760/cma.j.issn.1009-2587.2016.11.012
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2016, 32(11): 695-697. doi: 10.3760/cma.j.issn.1009-2587.2016.11.013
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Prevention and Treatment of Pathological Scar
Reconstruction of anal stenosis induced by scar contracture after repair of defect in perineal region with paraumbilical flap using random pattern flap
Liu Quan, You Xiaobo, Cai Zhen, Tang Kuangyun, Zhang Han
2016, 32(11): 644-648. doi: 10.3760/cma.j.issn.1009-2587.2016.11.002
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Objective To investigate the method and timing of reconstruction of anal stenosis induced by scar contracture after repair of defect in perineal region with paraumbilical flap using random pattern flap. Methods Ten patients who suffered anal stenosis induced by scar contracture after the first phase repair of defect of perineal region with paraumbilical flap were hospitalized from July 2009 to September 2015. Eight patients were with central type scar contracture of perineal region after healing of burn wound, and two patients were with lesion of perineal region which had been excised. In 6 to 8 weeks after the first phase surgery, two or three random pattern flaps were designed around the narrow anus in the survived paraumbilical flap. After thorough release of the narrow anus, the random pattern flaps were transferred to enlarge the anus. The tip of the lifted triangular flap was transferred to insert into the anal canal. The skin of anal canal or rectal mucosa was pulled out to be crossly-stitched with the flap. Results All the patients′ narrow anuses were released and enlarged with one operation, and the diameters of the narrow anuses were enlarged to 2.0 to 3.0 cm. During follow-up of 6 to 36 months, the anal stenosis was totally released, and the symptom of difficult defecation was significantly improved; 7 patients were excellent and 3 patients were good with evaluation of clinical criteria of anus function; no symptom of anal stenosis or rectal mucosal prolapse was observed any more. Conclusions In 6 to 8 weeks post repair of defect in perineal region with paraumbilical flap, designing of random pattern flap in the survived paraumbilical flap to enlarge and reconstruct the narrow anus has good therapeutic effects on anatomical narrow and difficult defecation.
Effect of expanded lateral thoracic abdominal flap transferred with pedicle on repairing large area of hypertrophic scar after burn of the upper extremity
Xia Chengde, Xue Jidong, Di Haiping, Niu Jinglin, Li Xiaoliang, Cao Dayong, Li Qiang, Niu Xihua
2016, 32(11): 649-652. doi: 10.3760/cma.j.issn.1009-2587.2016.11.003
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Objective To observe the effect of expanded lateral thoracic abdominal flap transferred with pedicle on repairing large area of hypertrophic scar after burn of the upper extremity. Methods Twelve patients with large area of secondary hypertrophic scar 8 month to 3 years after healing of burn wound on the upper extremity were hospitalized in Zhengzhou First People′s Hospital from October 2008 to October 2015, with scar area ranging from 11 cm×7 cm to 20 cm×10 cm. Five patients were with limited straightening and bending of elbow. The scars were reconstructed with ipsilateral expanded lateral thoracic abdominal flap or that combined with expanded upper extremity flap according to the area of scar. Lateral thoracic abdominal incision was located near the anterior axillary line, and upper extremity incision was located near scar edge. A capsule cavity was formed by blunt dissection in the superficial fascia layer. Expander with suitable capacity was implanted with the injection pot being built-in. Volume of water reaching 1 time to 3 times of the capacity of expander was injected for excessive expanding. The expanded lateral thoracic abdominal flap supplied by lateral thoracic cutaneous artery and expanded upper extremity flap were dissected after the completion of expanding. The expanded upper extremity flap was advanced locally to cover the surrounding secondary wound after resection of hypertrophic scar. The expanded lateral thoracic abdominal flap was transferred with pedicle to reconstruct scar, with pedicle being sutured in skin tube-like shape, and the flap donor site was sutured directly. Flap pedicle separation was carried out 3 weeks after surgery. Anti-scar treatment was carried out after healing of sutured area. Results Totally 18 expanders were implanted, without complications such as infection, exposure of expander, and so on. The areas of expanded lateral thoracic abdominal flaps were from 11 cm×7 cm to 16 cm×11 cm. The combined application of expanded upper extremity flaps with area ranging from 8 cm×4 cm to 9 cm×6 cm was used in 6 patients. All the flaps survived with incision healed. The color, texture, and thickness of skin area repaired by flap were close to those of the normal skin of upper extremity after 6 months to 2 years′ follow-up afer discharge. The limited straightening and bending of elbow in 5 patients were rectified. Obvious linear scar was observed in the sutured area of surgery in 3 patients, while light linear scar was observed in the sutured area of surgery in 9 patients. Conclusions Expanded lateral thoracic abdominal flap has constant blood vessel and is easy to be dissected. It can achieve well reconstruction of appearance and function in repairing large area of hypertrophic scar after burn of the upper extremity.
Study of the correlation between the expression of angiotensin Ⅱ and its receptors and collagen deposition in human keloid
Chen Junjie, Wu Xiaojing, Zhang Zhenyu, Chen Zhixing, Cen Ying
2016, 32(11): 653-657. doi: 10.3760/cma.j.issn.1009-2587.2016.11.004
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Objective To study the correlation between the expression of angiotensin Ⅱ, angiotensin Ⅱ type 1 receptor (AT1R), angiotensin Ⅱ type 2 receptor (AT2R) and collagen deposition in human keloid. Methods The keloid from 19 keloid patients and normal skin from 13 patients performed with free skin transplantation hospitalized in our unit from May 2014 to January 2015 were obtained. The expressions of angiotensin Ⅱ, AT1R, and AT2R were detected by immunohistochemical staining, and the results were semi-quantitatively analyzed by immunohistochemical scoring. The expression of collagen in keloid was detected by picrosirius-red staining, and the percentage of total collagen was calculated. Data were processed with t test. The expressions of angiotensin Ⅱ, AT1R, AT2R and the total content of collagen of 13 keloid patients were analyzed by Pearson correlation analysis. Results (1) There was negative or probably positive expression of angiotensin Ⅱ in normal skin tissue, mainly distributed in the epidermal basal layer. The expression of angiotensin Ⅱ was strong in keloid, most distributed in spinous layer and basal layer of epidermis and most region of dermis, and was strongly positive in most cells, and most cells were fibroblasts. The expressions of AT1R and AT2R were similar to angiotensin Ⅱ in two types of tissue. The expressions of angiotensin Ⅱ, AT1R, and AT2R in keloid scored (305±34), (281±32), and (285±25) points, respectively, which were significantly higher than those in normal tissue [respectively (54±17), (89±47), and (97±32) points, with t values from 12.03 to 23.21, P values below 0.01]. (2) The total content of collagen in keloid was (88±4)%. There was a lot of thick and dense type Ⅰcollagen in keloid, with massive structure and distributed like bamboo segment and arranged in disorder. The expression of type Ⅲ collagen was increased, which was distributed scatteredly around type Ⅰcollagen. (3) There were positive correlations between the expressions of angiotensin Ⅱ, AT1R, AT2R and the total content of collagen in keloid (with r values from 0.452 to 0.720, P values below 0.05). Conclusions The expressions of angiotensin Ⅱ, AT1R, and AT2R were abnormally increased in human keloid, which may play an important role in the collagen deposition of keloid.
Effect of hydrocinnamoyl-L-valyl pyrrolidine on healing quality of deep partial-thickness scald wound in mice
Yang Minlie, Li Yuehua, Tan Qian, Li Jiantao, Que Lingli
2016, 32(11): 658-666. doi: 10.3760/cma.j.issn.1009-2587.2016.11.005
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Objective To observe the effect of Toll interleukin-1 recptor homology/BB-loop mimetic hydrocinnamoyl-L-valyl pyrrolidine (AS-1) on the healing quality of deep partial-thickness scald wound in mice. Methods Forty-two adult C57BL/6 mice were divided into sham injury group (SI), scald group (S), early AS-1 treatment group (EAT), early dimethyl sulfoxide (DMSO) control group (EDC), late AS-1 treatment group (LAT), late DMSO control group (LDC) according to the random number table, with 7 mice in each group. Mice in group SI were sham injured without other treatment. Deep partial-thickness scald model with 10% total body surface area was reproduced on the back of the other mice, and the wound was treated by daily wound cleaning with saline and dressing changing with vaseline gauze after injury. Mice in group EAT and those in group LAT were intraperitoneally injected with 20 mg/mL AS-1 50 mg/kg each day respectively from post scald hour (PSH) 8 and post scald day (PSD) 15 on. Mice in group EDC and those in group LDC were intraperitoneally injected with 20 mg/mL DMSO 50 mg/kg each day respectively from PSH 8 and PSD 15 on. On PSD 21, the gross condition of wound healing of mice with scald was observed, and the wound healing rate was calculated. Tissue samples of healed wound were collected and stained with HE and Masson respectively to observe the histomorphological change and fibrosis of collagen, and the percentage of fibrosis of collagen was calculated. The mRNA expressions of interleukin-1β (IL-1β), tumor necrosis factor α (TNF-α), transforming growth factor β1 (TGF-β1), matrix metalloproteinase-1 (MMP-1), tissue inhibitors of metalloproteinase 1 (TIMP-1), connective tissue growth factor (CTGF), type Ⅰ collagen and type Ⅲ collagen in healed wound tissue were detected by real time fluorescent quantitive reverse transcription polymerase chain reaction. The protein expressions of type Ⅰ collagen and type Ⅲ collagen in healed wound tissue were detected by Western blotting. Skin tissue of mice in group SI at the same area as that observed and collected in mice with scald was performed with the same observation and detection as mentioned above at the same time. Data were processed with one-way analysis of variance and Tukey test. Results On PSD 21, no abnormal appearance was found in skin tissue of mice in group SI. Wounds of mice in group EAT were healed completely without scar formation, while those in the other four groups were not completely healed with scars formed in different degree. The wound healing rate of mice in group EAT was (97±4)%, close to that of group SI (100%, q=1.753, P>0.05), and both of them were obviously higher than those of groups S, EDC, LAT, and LDC [respectively (83±8)%, (87±6)%, (85±9)%, and (85±7)%, with q values from 4.819 to 6.803, P<0.05 or P<0.01]. On PSD 21, no abnormal appearance was found in morphology of skin tissue of mice in group SI. The morphology of healed wound tissue of mice in group EAT was close to that in group SI, with little epidermis hyalinosis and few newly formed collagen fibers arranged orderly. Epidermis hyalinosis in band- or flake-shape and obvious proliferation of collagen fibers arranged disorderly were observed in healed wound tissue of mice in the other four groups. Much infiltration of inflammatory cells was found in group S. The percentage of fibrosis of collagen in healed wound tissue of mice in group EAT was (30±3)%, close to that of group SI [(30±4)%, q=0.159, P>0.05], and both of them were obviously lower than those of groups S, EDC, LAT, and LDC [respectively (86±9)%, (74±5)%, (82±4)%, and (82±7)%, with q values from 12.080 to 15.530, P values below 0.01]. On PSD 21, compared with those of group SI, the mRNA expressions of IL-1β, TNF-α, TGF-β1, MMP-1, and CTGF in healed wound tissue of mice in group S, the mRNA expressions of TGF-β1 in healed wound tissue of mice in groups EDC and LDC, and the mRNA expression of MMP-1 in healed wound tissue of mice in group LAT were significantly increased (with q values from 4.039 to 5.232, P values below 0.05), while the mRNA expression of TIMP-1 in healed wound tissue of mice in group S was significantly decreased (q=4.921, P<0.05). Compared with those of group S, the mRNA expressions of IL-1β, TNF-α, TGF-β1, MMP-1, and CTGF in healed wound tissue of mice in group EAT and the mRNA expressions of IL-1β and CTGF in healed wound tissue of mice in group LAT were significantly decreased (with q values from 4.418 to 6.402, P<0.05 or P<0.01), while the mRNA expressions of TIMP-1 in healed wound tissue of mice in groups EAT and LAT were significantly increased (with q values respectively 3.929 and 8.299, P<0.05 or P<0.01). Compared with those of group SI, the mRNA and protein expressions of type Ⅲ collagen in healed wound tissue of mice in the other groups and the mRNA and protein expressions of type Ⅰ collagen in healed wound tissue of mice in groups S, EDC, LAT, and LDC were significantly increased (with q values from 7.054 to 11.650, P values below 0.01). Compared with those of group EAT, the mRNA and protein expressions of type Ⅰ collagen in healed wound tissue of mice in groups S, EDC, LAT, and LDC were significantly increased (with q values from 5.156 to 7.451, P<0.05 or P<0.01). Conclusions AS-1 can effectively promote wound healing and reduce fibrosis degree in the early stage of inflammation response after deep partial-thickness scald in mice, which may be related to its effect in decreasing the expression of inflammation related factors IL-1β and TNF-α and fibrosis related factors TGF-β1, MMP-1, CTGF, and type Ⅰ collagen.
Original Article
Analysis of distribution and drug resistance of pathogens isolated from 541 hospitalized children with burn infection
Dai Jiaxi, Li Lin, Xu Le, Chen Zhaohong, Li Xiaoyi, Liu Min, Wen Yuqing, Chen Xiaodong
2016, 32(11): 670-675. doi: 10.3760/cma.j.issn.1009-2587.2016.11.008
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Objective To investigate the distribution and drug resistance of pathogens isolated from hospitalized children with burn infection. Methods Totally 541 patients were hospitalized in Fujian Medical University Union Hospital, the 180th Hospital of Chinese People′s Liberation Army(PLA), the 92th Hospital of PLA, and Longyan First Hospital from January 2013 to December 2015. Totally 848 clinical specimens (blood, catheter tip attachments, wound exudate, etc.) were collected for pathogen detection. After being identified by an automatic microbiological identification system, drug resistance of pathogens to 41 commonly-used antibiotics in clinic including gentamicin, aztreonam, erythromycin, clindamycin, etc. was tested by K-B paper disk diffusion method or minimal inhibitory concentration detection method. The SPSS 20.0 statistical software was used to analyze the following subjects: the detection rates of pathogens in different years, from different hospitals, and with different sources, the distribution of gram-negative bacteria, gram-positive bacteria, and fungi, the distribution of major pathogens, the detection rate of methicillin-resistant Staphylococcus, the resistant rates of common gram-positive bacteria and gram-negative bacteria to antibiotics. Results The total detection rate of pathogens was 35.14% (298/848). The detection rates of pathogens were 52.29% (114/218), 33.20% (83/250), and 26.58% (101/380) in 2013, 2014, and 2015 respectively, 38.45% (198/515), 51.43% (18/35), 71.70% (38/53), and 17.96% (44/245) from Fujian Medical University Union Hospital, the 180th Hospital of PLA, the 92th Hospital of PLA, and Longyan First Hospital respectively, and 136/261, 8/137, 3/4, and 7/48 from wound exudate, blood, drainage fluid or tissue fluid, and the other specimens (including catheter tip attachments, sputum, feces) respectively. Among the 298 pathogens, 159 (53.36%) strains were gram-positive bacteria, 129 (43.29%) strains were gram-negative bacteria, and 10 (3.36%) strains were fungi. The detection rate of Staphylococcus aureus was the highest, totally 68 strains, accounting for 22.82%, followed by Pseudomonas aeruginosa, Acinetobacter baumannii, and Staphylococcus epidermidis, with 37, 31, and 22 strains, accounting for 12.42%, 10.40%, and 7.38% respectively. Among Staphylococcus aureus, methicillin-resistant Staphylococcus aureus (MRSA) accounted for 70.59% (48/68). Among Staphylococcus epidermidis, methicillin-resistant Staphylococcus epidermidis (MRSE) accounted for 68.18% (15/22). The resistant rates of MRSA and MRSE to penicillin and ampicillin were all 100.0%, and the resistant rates of MRSA to erythromycin, tetracycline, clindamycin and those of MRSE to erythromycin, cotrimoxazole were high. The high resistant rate of Pseudomonas aeruginosa towards antibiotics was detected with cotrimoxazole (83.3%) only. The resistant rates of Acinetobacter baumannii towards piperacillin, ceftazidime, and cotrimoxazole were high (from 58.8% to 71.4%). Conclusions During the three years, there is large difference in the detection rate of pathogens from these four hospitals in Fujian province. The majority of pathogens were Gram-positive bacteria. The four dominant pathogens were Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumannii, and Staphylococcus epidermidis. Most of the pathogens were resistant to antibiotics commonly used in clinic in different degree, especially MRSA, MRSE and Acinetobacter baumannii, which showed high resistance towards antibiotics.
Qualitative study on the current status of hospitalized burn children′s quality of life
Lin Renqin, Li Lin, Xu Le, Pan Qiong, Dai Jiaxi
2016, 32(11): 676-680. doi: 10.3760/cma.j.issn.1009-2587.2016.11.009
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Objective To explore the current status of hospitalized burn children′s quality of life, so as to lay foundation for carrying out the related intervention in future. Methods Using qualitative research method, semi-structured interviews were conducted on 11 parents of burn children hospitalized in Department of Burns of Fujian Medical University Union Hospital from March to May 2016. Then the data were analyzed and concluded with phenomenological analysis method to refine the themes. Results Parents′ description about the current status of hospitalized burn children′s quality of life could be summed up into four areas: physiology, psychology, social development, and family; and in six themes: obvious itching symptom, limited movement development, night terror and constant cry because of fear, reduced social game, negative attachment type, and parents under multiple pressures. Conclusions Burn brings serious harm to children′s physical and mental development, as well as negative effects on the parents, thus lowering the children′s quality of life. Medical workers should increase knowledge and attention of it, and carry out targeted health management project.
Effects of different fluid resuscitation program on renal function in swine during shock stage of severe burn
Su Guoliang, Huang Wenxiang, Chen Jiong, Xue Dijian, Zhou Jianjun
2016, 32(11): 681-687. doi: 10.3760/cma.j.issn.1009-2587.2016.11.010
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Objective To explore the effects of different fluid resuscitation program on renal function in swine during shock stage of severe burn. Methods Twenty-four Guangxi Bama miniature swine were inflicted with 40% total body surface area on the back, and then they were divided into four groups according to the random number table, with 6 swine in each group. At post injury hour (PIH) 2, swine in succinylated gelatin group (S), hydroxyethyl starch group (H), and allogeneic plasma group (A) were respectively resuscitated with succinylated gelatin, hydroxyethyl starch 130/0.4, and plasma according to burn shock " domestic general" resuscitation formula, and swine in Parkland group (P) were resuscitated with lactated Ringer′s solution according to Parkland formula. Hemodynamic indexes including heart rate, blood pressure, urine volume, pulmonary capillary wedge pressure, and central venous pressure before injury, at the first and second PIH 24 were recorded. The volume of resuscitation fluid was calculated at the first and second PIH 24. Blood and urine samples were collected before injury and at PIH 4, 8, 24, and 48, and then serum creatinine and urea nitrogen were detected by automatic biochemical analyzer, urine microalbumin and urine creatinine were detected by automated urine analyzer and the ratio of which was calculated. The renal tissue of swine in each group was obtained at PIH 48, and the pathologic changes were observed by optical microscopy and electron microscope. Data were processed with analysis of variance of repeated measurement, one-way analysis of variance, and LSD test. Results (1) The hemodynamic indexes of swine in each group were similar before injury and at the first and second PIH 24 (with P values above 0.05). Compared with those before injury, except that the heart rate of swine in group A had no significant change at the first PIH 24 (P>0.05), the heart rate of swine in each group was significantly increased at the first and second PIH 24 (with P values below 0.01); except that the systolic blood pressure of swine in group P was significantly increased at the first and second PIH 24 (P<0.05 or P<0.01), there were no significant changes of systolic blood pressure and diastolic blood pressure of swine in each group at the first and second PIH 24 (with P values above 0.05); except that urine volume of swine in groups S and A was significantly decreased at the first PIH 24 (P<0.05 or P<0.01), there were no significant change of urine volume of swine in each group at the first and second PIH 24 (with P values above 0.05); pulmonary capillary wedge pressure and central venous pressure of swine in each group were significantly increased at the first and second PIH 24 (P<0.05 or P<0.01). (2) Compared with that in group A, the volume of resuscitation fluid of swine in groups S and H had no significant change in the first and second PIH 24 (with P values above 0.05), while it was significantly increased in group P in the first PIH 24 and significantly decreased in the second PIH 24 (with P values below 0.05). (3) Compared with those in group A, except that serum creatinine of swine in group H was significantly increased at PIH 24 and significantly increased in group P at PIH 4, 8, 24, and 48, urea nitrogen of swine in group P was significantly decreased at PIH 4 and 8 and significantly increased at PIH 48, the ratio of urine microalbumin to urine creatinine of swine in group P was significantly increased at PIH 8, 24, and 48 (P<0.05 or P<0.01), serum creatinine, urea nitrogen, and the ratio of urine microalbumin to urine creatinine of swine in each group had no significant change at each time point (with P values above 0.05). Serum creatinine of swine in group P was (125±16) μmol/L at PIH 24, which was significantly higher than that before injury [(75±13) μmol/L, P<0.05]. Urea nitrogen of swine in group S was (2.90±1.17) μmol/L at PIH 48, which was significantly lower than that before injury [(4.60±0.47) μmol/L, P<0.05]; urea nitrogen of swine in group H was (4.82±0.82) μmol/L at PIH 4, which was significantly higher than that before injury [(3.80±0.73) μmol/L, P<0.05]; urea nitrogen values of swine in group A were respectively (4.80±0.33), (4.92±0.35), and (2.60±0.27) μmol/L at PIH 4, 8, and 48, while those at PIH 4, 8 were significantly higher and at PIH 48 was significantly lower than the value before injury [(3.93±0.32) μmol/L, with P values below 0.01]. The ratios of urine microalbumin to urine creatinine of swine in group P were respectively (106.7±16.4) and (171.6±36.9) mg/mmol at PIH 24 and 48, which were significantly higher than the ratio before injury [(59.0±3.0) mg/mmol, with P values below 0.01]. The serum creatinine, urea nitrogen, and the ratio of urine microalbumin to urine creatinine of swine in each group at the other time points were similar to those before injury (with P values above 0.05). (4) The renal tissue of swine in the four groups had no obvious pathological change. Conclusions According to the renal function results, fluid resuscitation with electrolyte and colloids are better than with lactated Ringer′s solution in swine during shock stage of burn injury, while natural colloids and succinylated gelatin have similar effects, and both are superior to hydroxyethyl starch 130/0.4.
Review
Advances in the research of diagnosis techniques of burn depth
Nian Yongjian, Chen Zhiqiang, Xue Dongdong, Yin Meifang
2016, 32(11): 698-701. doi: 10.3760/cma.j.issn.1009-2587.2016.11.014
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The accurate diagnosis of burn depth is one of the important problems in the field of burn surgery. The diagnosis accuracy rate is directly related to the treatment plan and effect. The existed clinical diagnosis methods mainly depend on the experience of burn surgeon, making the accuracy rate from 50% to 65%. In order to improve the accuracy rate of clinical burn depth diagnosis, a large number of diagnosis methods based on imaging are proposed, however, all of the methods are still in the stage of experimental research. In this paper, the research advances on the diagnosis techniques of burn depth are summarized, both the advantages and the shortcomings are pointed, and the development trend of diagnosis techniques of burn depth is expected.
Advances in the research on effect of detecting skin perfusion pressure in clinic
Pan Xuanliang, Han Chunmao
2016, 32(11): 702-704. doi: 10.3760/cma.j.issn.1009-2587.2016.11.015
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Skin perfusion pressure (SPP) is the perfusion pressure at the skin level, and it can serve as an index of microcirculation in skin and subcutaneous tissue. SPP can be measured simply, with less injury and high reproducibility in a short time, without interfering vascular calcification. It has been widely used in various fields, including evaluation of critical limb ischaemia and effect of vascular surgery, selection of proper level of amputation, and prediction of wound healing. So far, there is no relevant reports about the application of SPP in China. This article reviews the clinical application of SPP abroad.