中华烧伤与创面修复杂志

To see the future development of burn medicine from the view of holistic integrative medicine

Hu Dahai, Tao Ke

2017, 33(4): 193-195. doi: 10.3760/cma.j.issn.1009-2587.2017.04.001

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The therapeutic methods and effects have been improved greatly in the past few decades for burn care and management with several important advancements which have resulted in more effective patient stabilization and significantly decreased mortality in China. However, the challenges still exist, such as how to further improve the recovery of the patients′ appearance and function, and how to advance the treatment of severe deep extensive burn injury, etc. The theory of holistic integrative medicine (HIM) provides a new opportunity for the development of clinical medicine. This article emphasizes the important roles of HIM in exploration of burn medicine, considering the advanced development of modern life sciences and relevant techniques.

Recognizing prevention and treatment of burn sepsis with the concept of holistic integrative medicine

Huan Jingning

2017, 33(4): 196-199. doi: 10.3760/cma.j.issn.1009-2587.2017.04.002

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Sepsis remains a major cause of death in severe burns. The effect of sepsis management is influenced by its complicated pathophysiologic changes. In order to improve the outcome of burn sepsis, the predisposing factor of sepsis after burn analyzed by advanced technology, the early prevention, antibiotics therapy, and combined treatment in severe burns with sepsis are discussed using the concept of holistic integrative medicine.

Influences of abaR gene on biofilm formation of Acinetobacter baumannii

Guo Haina, Xiang Jun

2017, 33(4): 200-205. doi: 10.3760/cma.j.issn.1009-2587.2017.04.003

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Objective To detect drug-resistant phenotype and abaR gene of Acinetobacter baumannii (AB) and investigate influences of abaR gene on biofilm formation of AB. Methods From February to July 2014, 159 strains AB were collected from Department of Clinical Microbiology of Ruijin Hospital of School of Medicine of Shanghai JiaoTong University and numbered starting from 1 according time when they were collected. (1) The above-mentioned 159 strains of AB were identified by detecting gene sequence of 16S ribosomal DNA. According to results of drug sensitivity test, extensively drug-resistant strains and sensitive strains of AB were selected and counted, and their sources were recorded. (2) Extensively drug-resistant strains and sensitive strains of AB were collected to measure biofilm formation (denoted as absorbance value) by methyl thiazolyl tetrazolium method when strains at culture hour 12, 24, 48 and 72. (3) The abaR gene sequence of ATCC 17978 of AB was analyzed through Gene banks of National Center for Biotechnology Information and compared with AqsR gene sequence of LuxR type receptor of Acinetobacter oleivorans DR1. No. 87 and No. 96 AB strains were amplified and sequenced by polymerase chain reaction according to target gene sequence of abaR of ATCC 17978 of AB. The sequencing result was compared with abaR gene sequence of ATCC 17978. (4) No. 87 and No. 96 AB strains were collected and divided into 0.1% dimethyl sulfoxide (DMSO) group, 10 μmol/L N-heptanoyl-L-Homoserine lactone (C7-HSL) group, 10 μmol/L N-(3-Hydroxydodecanoyl)-DL-homoserine lactone (OH-dDHL) group, 1% DMSO group, 100 μmol/L C7-HSL group, and 100 μmol/L OH-dDHL, with 3 wells of each group. AB strains in the above groups were respectively dealt with DMSO of corresponding final volume fraction, C7-HSL and OH-dDHL of corresponding final amount-of-substance concentration. Biofilm formation (denoted as absorbance value) of AB was measured by methyl thiazolyl tetrazolium method at culture hour 12, 24, 48 and 72. Data were processed with analysis of variance of factorial design, one-way analysis of variance, LSD test and Bonferroni correction. Results (1) There were 18 extensively drug-resistant strains and 5 sensitive strains of AB. Samples of extensively drug-resistant strains were mainly collected from Emergency ICU and Department of Burns and Plastic Surgery of our hospital and were mainly from sputum, blood, and wound exudate. Samples of sensitive strains were collected dispersedly and were mainly from sputum. (2) Absorbance values of extensively drug-resistant strains and sensitive strains of AB at all culture time points were similar (with P values above 0.05). Absorbance value of extensively drug-resistant strains of AB at culture hour 24 was obviously higher than that of these strains at culture hour 12, 48, or 72 (with P values below 0.01). Absorbance value of sensitive strains of AB at culture hour 24 was obviously higher than that of these strains at culture hour 12 (P<0.01). (3) AbaR gene sequence of LuxR type receptor existed in AB. Similarity ratio between abaR gene sequence and LuxR type receptor AqsR gene sequence in Acinetobacter oleivorans DR1 was 87%. Similarity ratios between abaR gene sequence of No. 87 and No. 96 strains and ATCC 17978 of AB were 98% and 99%, respectively. (4) Absorbance values of 0.1% DMSO group of No. 87 strain at all culture time points were similar to those of 1% DMSO group (with P values above 0.05). Absorbance value of 0.1% DMSO group of No. 96 strain at culture hour 12 was obviously lower than that of 1% DMSO group (P<0.01), while that at culture hour 24 was obviously lower than that of 1% DMSO group (P<0.01). Absorbance values of 10 μmol/L C7-HSL group of No. 87 and No. 96 strains at culture hour 24 were obviously lower than those of 0.1% DMSO group (with P values below 0.01). Absorbance values of 100 μmol/L C7-HSL group of No. 87 strain at all culture time points were similar to those of 1% DMSO group, respectively (with P values above 0.05). Absorbance value of 100 μmol/L C7-HSL group of No. 96 strain at culture hour 12 was lower than that of 1% DMSO group (P<0.01). Absorbance values of 10 μmol/L OH-dDHL group of No. 87 and No. 96 strains were similar to those of 0.1% DMSO group (with P values above 0.05). Absorbance values of 100 μmol/L OH-dDHL group of No. 87 strain at all culture time points were similar to those of 1% DMSO group (with P values above 0.05). Absorbance value of 100 μmol/L OH-dDHL group of No. 96 strain at culture hour 12 was obviously higher than that of 1% DMSO group (P<0.01). Absorbance values of 0.1% DMSO group and 1% DMSO group of No. 87 and No. 96 strains at culture hour 24 were obviously higher than those at culture hour 12 and 48 (with P values below 0.01). Conclusions Extensively drug-resistant strains of AB exist commonly. AbaR gene exists in AB has relation with biofilm formation of AB.

Effects of application of vancomycin in the early stage of patients with extremely severe burn

Zhu Zhu, Cao Guowen, Bao Junjie, Hu Zhanhong, Shen Zhu, Tao Hong, Cao Bin, Xu Feng

2017, 33(4): 206-210. doi: 10.3760/cma.j.issn.1009-2587.2017.04.004

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Objective To evaluate the effects of application of vancomycin in the early stage of patients with extremely severe burn, in order to provide reference to drug for anti-infection treatment in the early stage of patients with extremely severe burn. Methods Data of 15 patients of Kunshan explosion on August 2nd, 2014, admitted to the Department of Intensive Care in our hospital were retrospectively analyzed. The clinical efficacy of continuously intravenous dripping of vancomycin (combined with imipenem) in the early stage of burns (before and on post burn day 14) was analyzed. (1) The steady state plasma concentration of vancomycin was monitored respectively 30 min before the third, sixth, and tenth medication with direct chemiluminescent imaging method. (2) The distribution of Gram-positive bacteria of patients during hospitalization and their drug resistance to 14 antibiotics commonly used in clinic were analyzed. (3) Serum level of procalcitonin (PCT), white blood cell count, percentage of neutrophils before and after treatment, and efficacy grade of anti-infection treatment in the early stage of burns were analyzed. (4) Serum levels of aspartate transaminase (AST), alanine aminotransferase (ALT), creatinine before and after treatment, and the adverse effects during medication were analyzed. The WHONET 5.5 statistical software was used to analyze the distribution of Gram-positive bacteria in all the pathogens, and the status of drug resistance of Gram-positive bacteria to 14 antibiotics. Data were processed with Wilcoxon rank sum test. Results (1) Twenty-nine times of steady state plasma concentration monitoring were performed in the patients in total, with the steady state plasma concentration of vancomycin from 4.3 to 42.1 μg/mL. In the monitoring before third, sixth, and tenth medication, the percentages of result reaching the standard were respectively 1, 3/14, and 2/7. (2) A total of 79 Gram-positive bacteria were isolated, including 49 (62.03%) strains of Staphylococcus aureus, 9 (11.39%) strains of Staphylococcus haemolyticus, 7 (8.86%) strains of Staphylococcus epidermidis, 12 (15.19%) strains of Enterococcus faecium, and 2 (2.53%) strains of Enterococcus faecalis. The above-mentioned Staphylococcus strains were with high drug resistance to antibiotics including penicillins, erythromycin, ciprofloxacin, and low drug resistance to linezolid, teicoplanin, and nitrofurantoin. The above-mentioned Enterococcus strains were with high drug resistance to antibiotics including erythromycin, ciprofloxacin, gentamicin, and low drug resistance to linezolid and teicoplanin. The above-mentioned Staphylococcus strains were all sensitive to vancomycin. Two strains of vancomycin-resistant Enterococcus were detected in the above-mentioned Enterococcus strains. (3) Serum level of PCT, white blood cell count, percentage of neutrophils of patients were (8.1±7.5) ng/mL, (24±10)×10⁹/L, and 0.898±0.029 before treatment, which were significantly higher than (3.0±2.8) ng/mL, (12±5)×10⁹/L, and 0.867±0.016 after treatment (with Z values respectively -2.103, -3.237, and -3.068, P<0.05 or P<0.01). After the early treatment, excellence, progess, and invalid results were achieved in 7, 5, and 3 patients, with the effective percentage of 4/5 in clinic. (4) There were no statistically significant differences in serum levels of AST, ALT, and creatinine of patients between before and after treatment (with Z values respectively-0.057, -1.508, and -1.363, P values above 0.05). Only one patient had liver and renal dysfunction during treatment. Conclusions The positive and reasonable use of vancomycin can remove most of the Gram-positive bacteria, and control the development of sepsis combined with imipenem in the early stage of patients with extremely severe burn. However, the dose of vancomycin should be individualized and the steady state plasma concentration should be monitored to maintain the blood concentration within the safe and effective range, so as to improve the rational use of vancomycin.

Role of bone marrow tyrosine kinase on chromosome X in the production of pro-inflammatory cytokines from mouse mononuclear-macrophages RAW264.7 induced by endotoxin/lipopolysaccharide and its mechanism

Fang Xu, Hu Ying, Wang Yi, Liu Sheng, Wang Fei, Chen Xulin

2017, 33(4): 211-216. doi: 10.3760/cma.j.issn.1009-2587.2017.04.005

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Objective To investigate the role of bone marrow tyrosine kinase on chromosome X (BMX) in the production of tumor necrosis factor α (TNF-α) and interleukin-1β (IL-1β) from mouse mononuclear-macrophages induced by endotoxin/lipopolysaccharide (LPS) and its related mechanism. Methods Mouse mononuclear-macrophages RAW264.7 were inoculated in 6-well plates and routinely cultured for the following experiments. (1) Cells were collected and divided into blank control group, LPS control group, and 75, 750, 7 500, 75 000 nmol/L BMX-IN-1 pretreatment groups according to the random number table, with 8 wells in each group. Cells in blank control group were routinely cultured for 25 h. Cells in LPS control group were routinely cultured for 24 h and stimulated by LPS in the final mass concentration (the same below) of 0.1 μg/mL for 1 h. Cells in the latter 4 groups were pretreated with BMX-IN-1 in the final molarity (the same below) of 75, 750, 7 500, 75 000 nmol/L for 24 h and stimulated by 0.1 μg/mL LPS for 1 h. The mRNA expression of TNF-α of cells in each group was determined by real-time fluorescent quantitative reverse transcription polymerase chain reaction (RT-PCR) to screen the optimum concentration of BMX-IN-1. (2) Cells were collected and divided into LPS control group and 2, 4, 8, 12, 18 h BMX-IN-1 pretreatment groups according to the random number table, with 8 wells in each group. Cells in LPS control group were stimulated by 0.1 μg/mL LPS for 1 h. Cells in the latter 5 groups were pretreated with optimum concentration of BMX-IN-1 for 2, 4, 8, 12, 18 h respectively and stimulated by 0.1 μg/mL LPS for 1 h. The mRNA expression of TNF-α of cells in each group was determined by real-time fluorescent quantitative RT-PCR to screen the optimum time for BMX-IN-1 pre-treatment. (3) Cells were collected and divided into blank control group, BMX-IN-1 control group, LPS control group, and BMX-IN-1+ LPS group according to the random number table, with 16 wells in each group. Cells in blank control group were routinely cultured for the optimum time plus 1 h. Cells in BMX-IN-1 control group were pretreated with BMX-IN-1 in the optimum concentration for the optimum time and then routinely cultured for 1 h. Cells in LPS control group were routinely cultured for the optimum time and then stimulated by 0.1 μg/mL LPS for 1 h. Cells in BMX-IN-1+ LPS group were pretreated with BMX-IN-1 in the optimum concentration for the optimum time and then stimulated by 0.1 μg/mL LPS for 1 h. The mRNA expressions of TNF-α and IL-1β were determined by real-time fluorescent quantitative RT-PCR, and the activity of BMX and p38 mitogen-activated protein kinase (MAPK) were determined by Western blotting, with 8 samples in each determination. Data were processed with one-way analysis of variance and LSD test. Results (1) Compared with that in blank control group, the mRNA expression of TNF-α of cells was significantly increased in the other 5 groups (with P values below 0.01). Compared with that in LPS control group, the mRNA expression of TNF-α of cells was decreased in each BMX-IN-1 pretreatment group, but only the mRNA expression of TNF-α of cells in 75 000 nmol/L BMX-IN-1 pretreatment group was significantly decreased (P<0.05). The optimum concentration of BMX-IN-1 was 75 000 nmol/L. (2) Compared with that in LPS control group, the mRNA expression of TNF-α of cells was not significantly changed in 2 and 4 h BMX-IN-1 pretreatment groups (with P values above 0.05) but significantly decreased in 8, 12, and 18 h BMX-IN-1 pretreatment groups (P<0.05 or P<0.01). The mRNA expression of TNF-α of cells in 12 h BMX-IN-1 pretreatment group was the lowest. The optimum time for BMX-IN-1 pre-treatment was 12 h. (3) The mRNA expressions of TNF-α and IL-1β of cells in BMX-IN-1 control group were 0.97±0.13 and 0.98±0.06, respectively, which were similar to 1.00 of blank control group (with P values above 0.05). The mRNA expressions of TNF-α and IL-1β of cells in LPS control group were 2.97±0.17 and 3.07±0.60, respectively, while those in BMX-IN-1+ LPS group were 2.31±0.94 and 2.55±0.73, respectively, with the 4 values significantly higher than those in blank control group (with P values below 0.01). The mRNA expressions of TNF-α and IL-1β of cells in BMX-IN-1+ LPS group were significantly lower than those in LPS control group (with P values below 0.05). The activity values of BMX and p38MAPK of cells in BMX-IN-1 control group were 0.95±0.19 and 0.98±0.18, respectively, which were close to 1.00±0.14 and 1.00±0.22 of blank control group (with P values above 0.05). The activity values of BMX and p38MAPK of cells in LPS control group were 1.98±0.33 and 2.05±0.34, respectively, which were significantly higher than those of blank control group (with P values below 0.01). The activity values of BMX and p38MAPK of cells in BMX-IN-1+ LPS group were 1.00±0.17 and 1.67±0.27, respectively, which were obviously lower than those of LPS control group (P<0.05 or P<0.01). Conclusions BMX can increase the production of pro-inflammatory cytokines TNF-α and IL-1β from mouse mononuclear-macrophages induced by LPS, which may be associated with the activation of the p38MAPK pathway by BMX.

Effects of allogeneic bone marrow mesenchymal stem cells on polarization of peritoneal macrophages in rats with sepsis

Zheng Yuanhua, Xiong Bing, Deng Yiyu, Lai Wen, Zheng Shaoyi, Bian Huining, Liu Zu′an, Huang Zhifeng, Sun Chuanwei, Li Hanhua, Luo Hongmin, Ma Lianghua, Chen Hanxi

2017, 33(4): 217-223. doi: 10.3760/cma.j.issn.1009-2587.2017.04.006

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Objective To explore the effects of allogeneic bone marrow mesenchymal stem cells (BMSCs) on polarization of peritoneal macrophages isolated from rats with sepsis induced by endotoxin/lipopolysaccharide (LPS). Methods (1) BMSCs were isolated, cultured and purified from 5 SD rats with whole bone marrow adherent method. The third passage of cells were collected for morphologic observation, detection of expressions of stem cell surface markers CD29, CD44, CD45, and CD90 with flow cytometer, and identification of osteogenic and adipogenic differentiation. (2) Another 45 SD rats were divided into sham injury group (SI, n=5), LPS control group (LC, n=20), and BMSCs-treated group (BT, n=20) according to the random number table. Rats in groups LC and BT were injected with LPS (5 mg/kg) via tail vein to induce sepsis; rats in group SI were injected with the same amount of normal saline to simulate the damage. At post injury hour (PIH) 1, rats in group BT were given 1 mL BMSCs (2×10⁶/mL) via tail vein injection; rats in another two groups were injected with equal volume of phosphate buffer saline. Five rats in group SI at PIH 24 and in groups LC and BT at PIH 6, 12, 24, and 48 were sacrificed to harvest lung tissue for pathological observation with HE staining. In addition, rats in group SI at PIH 24 and in groups LC and BT at PIH 24 and 48 were simultaneously performed with intraperitoneal injection of low-glucose DMEM. Then peritoneal fluid was harvested to culture peritoneal macrophages. Flow cytometer was used to assess the positive expression of cell makers of macrophages including CD68 (making gate), CD11c, and CD206 in group SI at PIH 24 and in groups LC and BT at PIH 24 and 48. Data were processed with one-way analysis of variance and LSD test. Results (1) The third passage of cells showed uniform fiber-like shape similar to fibroblasts. These cells showed positive expressions of CD29, CD44, CD90 and weak positive expression of CD45. They were able to differentiate into osteoblasts and adipocytes. These cells were identified as BMSCs. (2) At PIH 24, the structure of pulmonary alveoli of rats in group SI was clear and complete with no congestion or inflammatory cell infiltration. At PIH 6, the structure of pulmonary alveoli of rats in groups LC and BT was clear with a small amount of inflammatory cell infiltration, slight congestion and pulmonary interstitial thickening. At PIH 12, the inflammatory responses in lung tissue of rats in group LC were more severe than those in group BT with a large amount of inflammatory cell infiltration, serious congestion, and obvious pulmonary interstitial thickening. The pathological results of rats in group BT at PIH 12 was consistent with the results at PIH 6. At PIH 24, the pathological results of rats in groups LC and BT were similar to the results at PIH 12. At PIH 48, the structure of pulmonary alveoli tissue of rats in group LC was still severely disrupted, with a large number of inflammatory cell infiltration and congestion in lung tissue, but pulmonary interstitial thickening was slightly alleviated than before. The condition of rats in group BT nearly recovered to that in group SI. (3) At PIH 24, the positive expression rate of CD11c in peritoneal macrophages of rats in group LC [(83±10)%] was close to that in group BT [(87±7)%, P>0.05], and they were both significantly higher than the rate in group SI [(55±12)%, with P values below 0.01]. The positive expression rate of CD11c in peritoneal macrophages of rats in group LC [(59±11)%] at PIH 48 was close to that in group SI at PIH 24 (P>0.05), and they were both significantly higher than the rate in group BT [(20±11)%] at PIH 48 (with P values below 0.01). At PIH 24, the positive expression percentages of CD206 in peritoneal macrophages of rats were similar among the three groups (with P values above 0.05). The positive expression percentage of CD206 in peritoneal macrophages of rats in group SI at PIH 24 was close to that in group BT at PIH 48 (P>0.05), and they were both significantly lower than the percentage in group LC at PIH 48 (with P values below 0.01). Conclusions BMSCs can reduce the pathological inflammatory responses in the lung of rats with sepsis and inhibit peritoneal macrophages from polarizing into M1 phenotype, whereas they can not promote macrophages to polarize into M2 phenotype.

2017, 33(4): 210-210. doi: 10.3760/cma.j.issn.1009-2587.2017.04.101

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2017, 33(4): 224-227. doi: 10.3760/cma.j.issn.1009-2587.2017.04.007

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2017, 33(4): 232-232. doi: 10.3760/cma.j.issn.1009-2587.2017.04.102

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2017, 33(4): 238-240. doi: 10.3760/cma.j.issn.1009-2587.2017.04.010

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2017, 33(4): 240-240. doi: 10.3760/cma.j.issn.1009-2587.2017.04.103

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2017, 33(4): 241-243. doi: 10.3760/cma.j.issn.1009-2587.2017.04.011

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2017, 33(4): 243-244. doi: 10.3760/cma.j.issn.1009-2587.2017.04.012

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2017, 33(4): 244-246. doi: 10.3760/cma.j.issn.1009-2587.2017.04.013

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2017, 33(4): 247-248. doi: 10.3760/cma.j.issn.1009-2587.2017.04.014

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2017, 33(4): 249-250. doi: 10.3760/cma.j.issn.1009-2587.2017.04.015

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2017, 33(4): 250-250. doi: 10.3760/cma.j.issn.1009-2587.2017.04.104

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Cai Leyi, Wang Te, Lin Dingsheng, Lu Di

2017, 33(4): 228-232. doi: 10.3760/cma.j.issn.1009-2587.2017.04.008

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Objective To investigate the effects and related mechanism of bivalirudin on the survival of random skin flap on the back of rat. Methods Thirty SD rats were divided into bivalirudin group and normal saline group according to the random number table, with 15 rats in each group. The random flap model with size of 9 cm×3 cm was reproduced on the back of rats in two groups. Immediately post injury, rats in bivalirudin group were intraperitoneally injected with 5 mg/mL bivalirudin (0.8 mL/kg), while rats in normal saline group were intraperitoneally injected with normal saline (0.8 mL/kg) once a day. The continuous injection lasted for 7 days. The flap was divided into distal area, middle area and proximal area averagely based on the flap blood supply. On post injury day (PID) 1, 3, and 7, the overall survival of each area of flap was observed with naked eyes. On PID 7, the survival rate of flap was calculated, and then the morphology of skin tissue at the center of the three areas of flap was observed by HE staining, the microvessel density (MVD) of the middle area of flap was calculated, and the expression of vascular endothelial growth factor (VEGF) of the middle area of flap was detected with immunohistochemical staining. Data were processed with t test. Results (1) On PID 1, flaps of rats in two groups had different degrees of swelling, mainly concentrated in distal area, but there was no obvious necrosis. The middle area and proximal area of flaps in two groups were survived. On PID 3, the necrosis of flaps of rats in two groups was concentrated in the middle area, while the proximal area of flap was still in survival state, and most distal area of flap was necrosis with a little scab. On PID 7, the necrosis of middle area of flaps of rats in two groups was gradually fused, and the survival area of flap of rats in bivalirudin group was larger than that in normal saline group. The distal area of flap was almost necrotic, and the proximal area of flap was almost survived. (2) On PID 7, the survival rate of flap of rats in bivalirudin group was (64±4)%, significantly higher than that in normal saline group [(45±3)%, t=13.49, P<0.01]. (3) On PID 7, the histological morphology of distal area of flap of rats in two groups was similar, the inflammatory cells were infiltrated abundantly, and tissue edema was obvious. A large number of new blood vessels appeared in the middle area of flap of rats in bivalirudin group, with the formation of collateral vessels, and basic dilation of new blood vessels was seen. There were fewer new blood vessels appeared in the middle area of flap of rats in normal saline group, and dilation of new blood vessels was not obvious. There was little inflammatory cells infiltration in the proximal area of flap of rats in two groups. Compared with that in normal saline group, tissue edema extent of proximal area of flap of rats in bivalirudin group was less, and expansion was observed in more blood vessels. (4) The MVD of middle area of flap of rats in bivalirudin group was (26±5)/mm^2, significantly higher than that in normal saline group [(18±3)/mm^2,t=5.43, P<0.05]. (5) The expression of VEGF of middle area of flap of rats in bivalirudin group was 6 534±384, significantly higher than that in normal saline group (4 659±448, t=12.31, P<0.05). Conclusions Bivalirudin can promote the survival of random skin flap in rats, and the mechanisms may include reducing the formation of thrombosis, improving the blood supply of flap, and increasing the expression of VEGF, promoting the formation of new blood vessels.

Bibliometric analysis of scientific articles on epidemiological study of burns in China

Cheng Wenfeng, Shen Chuan′an, Zhao Dongxu, Li Dawei, Shang Yuru

2017, 33(4): 233-237. doi: 10.3760/cma.j.issn.1009-2587.2017.04.009

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Objective To analyze the current status of epidemiological study of burns in China, and to explore the related strategies. Methods Retrospective or cross-sectional scientific articles in Chinese or English on epidemiological study of burns in China published from January 2005 to December 2015 were systemically retrieved from 4 databases. The databases include PubMed, Embase, China Biology Medicine disc, and Chinese Journals Full-text Database. From the results retrieved, data with regard to publication year, journal distribution, number of institutions participated in the study, affiliation of the first author and its location, and admission time span and age of patients in all the scientific articles were collected. Furthermore, the definition of age range and the grouping method of age of pediatric patients in English articles on epidemiological study of pediatric burns of China were recorded. Data were processed with descriptive statistical analysis. Results A total of 256 scientific articles conforming to the study criteria were retrieved, among which 214 (83.59%) articles were in Chinese, and 42 (16.41%) articles were in English; 242 (94.53%) articles were retrospective studies, and 14 (5.47%) articles were cross-sectional studies. During the 11 years, the number of the relevant articles was fluctuant on the whole. The scientific articles were published in 130 journals, with 42 English articles in source journals for SCIENCE CITATION INDEX EXPANDED-JOURNAL LIST, accounting for 16.41%, and 116 Chinese articles in Source Journal for Chinese Scientific and Technical Papers, accounting for 45.31%. Totally 215 (83.98%) articles were single-center studies, and 29 (11.33%) articles were multicenter studies which were conducted by three or more centers. The number of affiliations of the first author of articles was 161 in total. The top 10 institutions regarding the article publishing number published 58 articles, accounting for 22.66%. Scientific articles on epidemiological study of burns were retrieved with location of affiliation of the first author in 31 provinces, autonomous regions, and municipalities directly under the Central Government in Mainland China, and also in Taiwan Province and Hong Kong Special Administrative Region, among which Shanghai ranked first with 24 (9.38%) articles published. The admission time span of patients in the articles ranged from 3 months to 47 years, with 120 (46.87%) articles from 3 months to 5 years, 79 (30.86%) articles from 6 to 10 years, and 57 (22.27%) articles more than 10 years, respectively. Regarding the age of patients in the study, 123 articles were on epidemiological study of pediatric burns, and 16 articles on epidemiological study of elderly burns, accounting for 48.05% and 6.25%, respectively. Further analysis of articles on epidemiological study of pediatric burns in English showed that there was no standard definition of age range or unified grouping method of age for pediatric burn patients. Conclusions The epidemiological study of burns in China has been carried out nationwide, but the number of institutions conducted relevant study is not that much, and multicenter epidemiological studies remain scanty. The quality of the articles needs to be further improved. The epidemiological study of elderly burns is relatively deficient and calls for more attention. The epidemiological study of burns in China lacks regularity or continuity in time scope. There is an urgent need for the guideline on classification method for items of epidemiological study of burns in China so as to standardize the related research.

Advances in the research of treatment of burns in the elderly

Jiang Zhengying, Min Dinghong, Guo Guanghua

2017, 33(4): 251-254. doi: 10.3760/cma.j.issn.1009-2587.2017.04.016

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With our country going into the aging society, burns in the elderly often occur. Studies have shown that the number of elderly burn patients has reached 13% to 20% of the total number of burn patients. As the sensory and cognitive functions are low, skin is thinning, the functions of heart, lung, and kidney are reduced, the immunity is impaired, and other physiological characteristics exist in the elderly, the wounds of elderly burn patients often heal slowly, and the mortality is high. At present, there is still a lack of enough attention to the elderly burn patients. In this review, according to the physiological characteristics of the elderly, for reference to our peers, we make a summary of the treatment of elderly burn patients, such as fluid resuscitation, wound treatment, acute kidney injury management, infection management, and nutritional support.

Advances in the research of mechanism in prevention and treatment of scar with botulinum toxin type A and its clinical application

Li Yuehua, Liu Jiaqi, Xiao Dan, Zhang Wei, Hu Dahai

2017, 33(4): 254-256. doi: 10.3760/cma.j.issn.1009-2587.2017.04.017

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Scar is a common complication in wound healing process, and how to effectively prevent and treat it is a hot and difficult problem in burns and plastic surgery field. Botulinum toxin type A is a neurotoxin that has been widely and effectively used in the cosmetic surgery field such as anti-wrinkle and thin face. In recent years, botulinum toxin type A has been applied in prevention and treatment of scar, which causes a great concern. Nowadays, the relevant reports have gradually increased, and the mechanisms have been explored more deeply. This article aims to summarize the possible mechanisms and clinical reports on the prevention and treatment of scar by botulinum toxin type A to provide a new way for the prevention and treatment of scar after surgery.

2017 Vol. 33, No. 4

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