中华烧伤与创面修复杂志

Lay emphasis on early rehabilitation after extensive burn to prevent severe complications in late stage

Lyu Guozhong, Xu Liwen

2017, 33(5): 257-259. doi: 10.3760/cma.j.issn.1009-2587.2017.05.001

PDF

Abstract:
The mental disorders, scar, and dysfunction will affect the work and study of patients with extensive burn, which can further affect the quality of life and the rate of return to society. Under the premise of saving life, the function of patients with extensive burn should be reserved as much as possible for a better living quality. In addition to the specialized treatment, body positioning, therapeutic exercise, orthosis application, and psychotherapy can be used in the early stage of burn rehabilitation. Early rehabilitation training is beneficial to the circulatory system, immune system, functional and psychological recovery of patients. It can also improve the quality of extensive burn treatment, and decrease deformities and the incidence of complications in the late stage.

Investigation of burn rehabilitation development of China in 2014

Ao Ming, Wu Jun, Chen Jian

2017, 33(5): 260-266. doi: 10.3760/cma.j.issn.1009-2587.2017.05.002

Abstract

PDF

Abstract:
Objective To further study the development of burn rehabilitation in China, so as to promote the development of burn rehabilitation in China. Methods The questionnaire about the development of burn rehabilitation treatment was started by Specialized Committee of Burn Treatment and Rehabilitation Science of Chinese Association of Rehabilitation Medicine (hereinafter referred to as Specialized Committee) in the end of 2014, and 65 affiliations of Specialized Committee members participated in. There was a total of 26 questions, mainly focusing on problems as below: (1) General information of the burn department of the units, including the number of authorized beds, annual admitted burn patients, annual admitted patients with extremely severe burn, doctors, nurses, rehabilitation therapists, and the condition of rehabilitation area and rehabilitation beds, etc. (2) Development of burn rehabilitation treatment, including the development of rehabilitation treatment, the intervention time of rehabilitation treatment, the rehabilitation treatment carried out in intensive care unit (ICU), the composition of rehabilitation treating personnel, and the professional title and background, educational background, and division of responsibilities of rehabilitation therapists, etc. (3) Major problems affecting the development of burn rehabilitation treatment of the units. The burn treatment units were grouped according to the number of annual admitted patients. The units′ situation of authorized beds, admitted patients, allocation of medical personnel and rehabilitation, and the ratio of beds to doctors, beds to nurses, beds to full-time burn rehabilitation treating personnel were recorded. Data were processed with t test, one-way analysis of variance, and chi-square test. Results (1) A total of 65 questionnaires were sent, and 45 questionnaires (69.2%) were retrieved. Among the 45 units that replied the questionnaires, 35 units were burn treatment units. (2) The 35 burn treatment units were divided into less than 500 cases group (n=8), 501-1 000 cases group (n=11), 1 001-1 500 cases group (n=10), and more than 1 500 cases group (n=6) according to the number of annual admitted patients. The number of authorized beds of units in 1 001-1 500 cases group was significantly more than that in less than 500 cases group (t=4.563, P<0.05). The number of authorized beds of units in more than 1 500 cases group was significantly more than that in the other 3 groups, respectively (with t values from 1.859 to 3.743, P values below 0.05). The number of annual admitted patients of units in 501-1 000 cases group, 1 001-1 500 cases group, and more than 1 500 cases group was dramatically more than that in less than 500 cases group (with t values from 6.027 to 12.684, P values below 0.05). The number of annual admitted patients of units in 1 001-1 500 cases group and more than 1 500 cases group was significantly more than that in 501-1 000 cases group (with t values respectively 7.408 and 6.980, P values below 0.05). The number of annual admitted patients of units in more than 1 500 cases group was significantly more than that in 1 001-1 500 cases group (t=4.239, P<0.05). The number of annual admitted patients with extremely severe burn and the condition of rehabilitation area and rehabilitation beds of units in the 4 groups was similar (F=0.820, with χ² values respectively 5.266 and 2.848, P values above 0.05). The number of doctors of units in more than 1 500 cases group was significantly more than that in less than 500 cases group (t=2.836, P<0.05). The number of nurses of units in 1 001-1 500 cases group was significantly more than that in less than 500 cases group (t=2.837, P<0.05). The number of nurses and that of rehabilitation therapists of units in more than 1 500 cases group were significantly more than those in the other 3 groups (with t values from 1.762 to 4.789, P values below 0.05). (3) The 35 burn treatment units were able to provide at least one rehabilitation treatment for patients, among which body positioning, motion of joint exercise, infrared ray irradiation, hydrotherapy, function training, activities of daily life training, scar massage, and drug injection in scar were carried out well, while psychological therapy, music therapy, occupational rehabilitation, and social rehabilitation were mostly not carried out. (4) Only 9 (25.7%) burn treatment units started rehabilitation treatment for patients within 3 days after injury. (5) Twenty-seven (77.1%) burn treatment units could carry out body positioning in ICU. (6) Twenty-three burn treatment units had full-time rehabilitation treating personnel, and the units were divided into less than 500 cases group (n=1), 501-1 000 cases group (n=8), 1 001-1 500 cases group (n=9), and more than 1 500 cases group (n=5) according to the number of annual admitted patients. The ratio of beds to doctors of units in more than 1 500 cases group was significantly higher than that in 501-1 000 cases group (t=2.810, P<0.05) and the ratios of beds to doctors of units in 501-1 000 cases group and 1 001-1 500 cases group were similar (t=1.506, P>0.05). The ratios of beds to nurses and beds to full-time burn rehabilitation treating personnel in 4 groups were similar (with F values respectively 0.783 and 0.434, P values above 0.05). (7) Twenty burn treatment units had rehabilitation therapists with rehabilitation treatment related professional background (a total of 73 person, account for 76.0%), 80.8% (59/73) rehabilitation therapists with rehabilitation and therapeutic professions, 60.3% (44/73) with bachelor degree or above, and 87.7% (64/73) with primary and intermediate titles. Besides, 39.7% (29/73) rehabilitation therapists did physical therapy; 12.3% (9/73) rehabilitation therapists did occupational therapy; 38.4% (28/73) rehabilitation therapists did not have specific duties. (8) During the development of burn rehabilitation treatment of 35 burn treatment units, the common problems were reflected in the authorized strength and professional technology level of rehabilitation treatment relating personnel, and the area and equipment for rehabilitation. There were also many problems in cooperation between burn surgeons and rehabilitation therapists and fund. The supports from hospital and department leaders were good. Conclusions Through the development of several years, the general condition and the development of rehabilitation treatment of burn treatment units in China are improved; the beginning time of burn rehabilitation treatment is advanced; the number of rehabilitation treatment personnel is increased with their speciality improved; the burn rehabilitation work get great support from hospitals and departments.

Clinical effects of Joint Active System on the treatment of joint dysfunction after deep burn

Ru Tianfeng, Li Feihong, Chen Pei, Luo Hao, Yuan Lin, Lei Fang, Tang Youling, Xie Weiguo

2017, 33(5): 267-271. doi: 10.3760/cma.j.issn.1009-2587.2017.05.003

Abstract

PDF

Abstract:
Objective To observe the clinical effects of the Joint Active System on the treatment of joint dysfunction after deep burn. Methods Twenty-two patients with joint dysfunction after deep burn were hospitalized in Institute of Burns of Tongren Hospital of Wuhan University & Wuhan Third Hospital from January 2015 to October 2016, involving 18 elbow joints with flexion disorder, 10 wrist joints with dorsal extension disorder, and 12 ankle joints with dorsal extension disorder. They were treated with the elbow joint activity training device, the wrist joint activity training device, and the ankle joint activity training device of the Joint Active System, respectively. The treatment was carried out 3 times each day with interval of 6 h, 30 minutes each time, and it lasted for four to seven months, with one month as a course of treatment. Before treatment and 1, 2, 3, 4 month (s) after, active motion range of each joint was measured by joint goniometer. Function improvement of each joint was evaluated, and the total effective ratio was calculated 4 months after treatment. Satisfaction degree of patients was assessed by the modified Likert Scale 1, 2, 3, 4 month (s) after treatment. Data were processed with one-way analysis of variance for repeated measurement and LSD test. Results Before treatment and 1, 2, 3, 4 month (s) after, flexion active motion range of elbow joints were (61±23), (78±22), (89±20), (96±20), and (103±19)°; dorsal extension active motion range of wrist joints were (23±7), (31±6), (38±9), (44±5), and (49±8)°; dorsal extension active motion range of ankle joints were (-31±12), (-23±10), (-16±7), (-12±6), and (-8±4)°, respectively. The active motion range of each joint was obviously higher 1, 2, 3, 4 month (s) after treatment than the previous time point of the same joint (with P values below 0.01). Four months after treatment, the total effective ratios of function improvement of elbow joints, wrist joints, and ankle joints were 5/6, 9/10, and 2/3, respectively. Scores of satisfaction degree of the patients 1, 2, 3, 4 month (s) after treatment were (1.3±0.7), (2.2±1.0), (2.8±0.8), and (3.3±0.6) points, respectively. Scores of satisfaction degree of the patients were obviously higher 2, 3, 4 months after treatment than the previous time point (with P values below 0.05). Conclusions Joint Active System can improve the active range of motion of each joint obviously in treating joint dysfunction after deep burn, with total effective ratio of function improvement of each joint surpassing 0.66, and the majority of patients are quite satisfied with the curative effects.

Influences of different rehabilitative methods on function of hands and psychological anxiety of patients with deeply burned hands retaining denatured dermis and grafting large autologous skin

Peng Huan, Liang Pengfei, Wang Ang, Yue Liqing

2017, 33(5): 272-276. doi: 10.3760/cma.j.issn.1009-2587.2017.05.004

Abstract

PDF

Abstract:
Objective To investigate influences of different rehabilitative methods on function of hands and psychological anxiety of patients with deeply burned hands retaining denatured dermis and grafting large autologous skin. Methods Forty-four patients with deeply burned hands, conforming to the study criteria were admitted to Department of Burns and Reconstructive Surgery of Xiangya Hospital of Central South University from January 2014 to June 2015. Patients were divided into propaganda education rehabilitation group (PER, n=23) and specially-assigned person rehabilitation group (SAPR, n=21) according to the random number table and patients′ willingness. On post injury day 3 to 7, 36 burned hands in group PER and 33 burned hands in group SAPR underwent operation of retaining denatured dermis and grafting large autologous skin. Patients in 2 groups received anti-scar treatment of hands with silicone gel from postoperative day 10. Besides, patients in group PER underwent active functional exercise under guidance of duty nurse and received psychological guidance from duty nurse with grade two psychological consultant certificate. Patients in group SAPR underwent active and passive functional exercise under guidance of rehabilitation therapist and received psychological guidance from psychotherapist with intermediate title. In postoperative month (POM) 1, 3 and 6, ranges of active motion of burned finger joints of patients in 2 groups were measured with joint goniometer to calculate excellent and good ratio of total active motion (TAM) range. Values of grip strength of burned hands of patients were measured with electronic hand dynamometer, and psychological anxiety was scored with Self-rating Anxiety Scale (SAS). Data were processed with chi-square test, independent sample t test, McNemar test, analysis of variance of repeated measurement, SNK test and Bonferroni correction. Results (1) Ratio of excellent and good of TAM range of burned finger joints of patients in group SAPR in POM 6 was obviously higher than that in group PER (χ²=10.745, P<0.0167 ). Ratio of excellent and good of TAM range of burned finger joints of patients in 2 groups in POM 3 were obviously higher than that in POM 1 of the same group, respectively (with P values below 0.0167). (2) Values of grip strength of burned hands of patients in group SAPR in POM 1, 3, and 6 were respectively (8.2±2.6), (21.6±2.6) and (30.1±2.3) kg, obviously higher than those in group PER [ (5.3±1.3), (12.8±2.7), (20.0±1.8) kg, respectively, with t values from 5.934 to 20.403, P values below 0.01]. Values of grip strength of burned hands of patients in 2 groups in POM 3 and 6 were obviously higher than those at the previous time point of the same group (with P values below 0.05). (3) SAS scores of patients in group SAPR in POM 1, 3 and 6 were significantly lower than those in group PER (with t values from 2.944 to 4.758, P values below 0.01). SAS scores of patients in 2 groups in POM 3 and 6 were significantly lower than those at the previous time point of the same group (with P values below 0.05). Conclusions Compared with rehabilitation of propaganda and education, rehabilitation under specially-assigned person can improve TAM range of burned finger joints, value of grip strength, and psychological anxiety of patients with deeply burned hands retaining the denatured dermis and grafting large autologous skin.

Advances in the research of pressure therapy for pediatric burn patients with facial scar

Wei Yating, Fu Jinfeng, Li-Tsang Cecilia W. P.

2017, 33(5): 277-280. doi: 10.3760/cma.j.issn.1009-2587.2017.05.005

Abstract

PDF

Abstract:
Facial scar and deformation caused by burn injury severely affect physical and psychological well-being of pediatric burn patients, which needs medical workers and pediatric burn patients′ family members to pay much attention to and to perform early rehabilitation treatment. Pressure therapy is an important rehabilitative strategy for pediatric burn patients with facial scar, mainly including wearing headgears and transparent pressure facemasks, which have their own features. To achieve better treatment results, pressure therapy should be chosen according to specific condition of pediatric burn patients and combined with other assistant therapies. Successful rehabilitation for pediatric burn patients relies on cooperation of both family members of pediatric burn patients and society. Rehabilitation knowledge should be provided to parents of pediatric burn patients to acquire their full support and cooperation in order to achieve best therapeutic effects and ultimately to rebuild physical and psychological well-being of pediatric burn patients.

2017, 33(5): 276-276. doi: 10.3760/cma.j.issn.1009-2587.2017.05.101

Abstract

Abstract:

2017, 33(5): 286-286. doi: 10.3760/cma.j.issn.1009-2587.2017.05.102

Abstract

Abstract:

2017, 33(5): 309-311. doi: 10.3760/cma.j.issn.1009-2587.2017.05.010

Abstract

PDF

Abstract:

2017, 33(5): 312-314. doi: 10.3760/cma.j.issn.1009-2587.2017.05.011

Abstract

PDF

Abstract:

2017, 33(5): 315-316. doi: 10.3760/cma.j.issn.1009-2587.2017.05.012

Abstract

PDF

Abstract:

Significance of evaluating the severity of patients with extremely severe burn by platelet count recovery in the early stage post burn

Wu Yi, Zhang Qin, Liu Jian, Tang Jiajun, Zheng Jiexin, Liu Meng

2017, 33(5): 281-286. doi: 10.3760/cma.j.issn.1009-2587.2017.05.006

Abstract

PDF

Abstract:
Objective To retrospectively analyze the prognostic value of platelet count recovery in the early stage post burn for patients with extremely severe burn, so as to evaluate their severity. Methods A study involving 244 adult patients with extremely severe burn admitted to our hospital from January 2006 to December 2015, conforming to the inclusion criteria, was conducted. Data of their demography, injury, transmission, disease change in hospital, and platelet count from post injury day (PID) 1 to 10 were collected. (1) Patients were divided into survival group (n=212) and non-survival group (n=32) according to whether death or not. The dynamic change characteristic of platelet count in patients of two groups from PID 1 to 10 was analyzed and compared. (2) Patients were divided into return to normal group (RN, n=163) and non-return to normal group (NRN, n=81) according to whether platelet count returned to normal within one week post burn. The proportion of patients who received mechanical ventilation and mortality in groups RN and NRN, and length of stay in ICU between patients with platelet count that returned to normal and that did not return to normal in the early stage post burn in survival group were compared. Data were processed with independent samples t test , analysis of variance of repeated measurement, chi-square test, and binomial distribution test. Correlation was analyzed between data of sex, age, weight, total burn area, full-thickness burn area, inhalation injury, length of hospital stay, receiving mechanical ventilation, platelet count recovery condition within one week post burn and death of patients using the univariate and multivariate Cox regression analysis. Receiver operating characteristic (ROC) curve of platelet count on PID 8 was drawn to evaluate predicting value for death of 244 patients. Results (1) The platelet count kept declining from PID 1 to 4, declined to below the normal low limit on PID 2, and reached its lowest level on PID 4 both in survival group and non-survival group. The platelet count both in survival group and non-survival group rose gradually from PID 4 to 10, and returned to normal on PID 8 and 10, respectively. There was no significant difference in platelet count of patients in two groups on PID 1 (t=1.01, P>0.05), while platelet count of patients in non-survival group was obviously lower than that in survival group from PID 2 to 10 (with t values from 2.64 to 7.17, P values below 0.01). The daily increment of platelet count in survival group from PID 4 to 10 was (26±13)×10⁹/L, obviously higher than that in non-survival group [(19±11)×10⁹/L, t=2.76, P<0.01]. (2) The proportion of patients who received mechanical ventilation was obviously lower than that of patients who did not receive mechanical ventilation in group RN (P<0.01), while the proportion of patients who received mechanical ventilation was obviously higher than that of patients who did not receive mechanical ventilation in group NRN (P<0.05). The proportion of patients who received mechanical ventilation in group NRN was obviously higher than that in group RN (χ²=32.93, P<0.01). The mortality of patients in group NRN was obviously higher than that in group RN (χ²=20.99, P<0.01). The length of stay in ICU of patients whose platelet count did not return to normal in the early stage was significantly longer than that of patients whose platelet count returned to normal in the early stage in survival group (t=4.20, P<0.01). (3) Total burn area, receiving mechanical ventilation, and platelet count did not return to normal within one week post burn were independent risk factors for death of patients with extremely severe burn (with hazard ratio respectively 1.073, 16.552, and 2.249, 95% confidence interval respectively 1.033-1.115, 2.147-127.580, and 0.993-5.096, P<0.05 or P<0.01). (4) The area under the ROC curve of platelet count on PID 8 to predict death of 244 patients with extremely severe burn was 0.745 (with 95% confidence interval 0.645-0.845, P<0.01), and 150×10⁹/L was chosen as the optimal threshold value, with sensitivity of 71.4% and specificity of 71.0%. Conclusions Platelet count recovery in the early stage post burn of patients with extremely severe burn was significantly associated with their prognosis and could be used as an important indicator to evaluate the severity of illness.

Effects of hypoxia inducible factor-1α on P311 and its influence on the migration of murine epidermal stem cells

Xu Zhengdong, Li Haisheng, Wang Song, He Weifeng, Wu Jun, Luo Gaoxing

2017, 33(5): 287-294. doi: 10.3760/cma.j.issn.1009-2587.2017.05.007

Abstract

PDF

Abstract:
Objective To explore the effects of hypoxia inducible factor-1α (HIF-1α) on P311 and its influence on the migration of murine epidermal stem cells (ESCs) under hypoxia in vitro. Methods Two kinds of murine ESCs were isolated and obtained from 15 neonatal wild-type C57BL/6J mice and 5 congeneric source P311 gene knock-out mice, respectively. The first passage of cells were used in the following experiments after morphologic observation and detection of expression of cell surface markers CD71 and CD49f with flow cytometer. (1) After cell scratch assay, according to the random number table (the same dividing method below), ESCs of P311 gene knock-out mice were divided into normoxia group (cells were cultured with complete medium in normoxic carbon dioxide incubator, and the subsequent normoxic treatments were the same) and hypoxia group (cells were cultured in hypoxic carbon dioxide incubator containing 1% oxygen, and the subsequent hypoxic treatments were the same), with 12 inserts in each group. ESCs of wild-type mice were divided into normoxia group, pure hypoxia group, dimethyl sulfoxide (DMSO) control group (2 μL DMSO solvent was added for 1 h of normoxia treatment before hypoxia treatment), HIF-1α inhibitor group (cells were treated with 11 μmol/L HIF-1 inhibitor of 2 μL under normoxia condition for 1 h before hypoxia treatment), HIF-1α stabilizer group (the cells were treated with 2 μmol/L FG-4592 of 2 μL under normoxia condition for 1 h before hypoxia treatment), with 12 inserts in each group. Three inserts of each time point in each group were adopted respectively to measure the residual width of scratch under inverted phase contrast microscope at post scratch hour (PSH) 0 (immediately), 12, 24, and 48. (2) After hypoxia treatment, the protein level of HIF-1α in ESCs of wild-type mice was detected by Western blotting at post hypoxia hour (PHH) 0, 12, 24, and 48. (3) ESCs of wild-type mice were divided into pure hypoxia group, DMSO control group, HIF-1α inhibitor group, and HIF-1α stabilizer group as that of experiment (1) with the same treatment. The mRNA expression of P311 and expression of P311 in ESCs were determined by real-time fluorescent quantitative reverse transcription polymerase chain reaction and immunocytochemical staining, respectively, at PHH 0 (immediately), 12, 24, and 48 (with sample numbers of 12). (4) The second passage of human embryonic kidney 293 (HEK-293) cells were divided into empty vector hypoxia group (cells were cultured under hypoxia condition after being transfected with empty vector plasmid), P311 normoxia group (cells were cultured under normoxia condition after being transfected with P311 reporter gene plasmid), P311 hypoxia group (cells were cultured under hypoxia condition after being transfected with P311 reporter gene plasmid), P311 hypoxia+ HIF-1α inhibitor group (cells which were incubated with HIF-1α inhibitor were cultured under hypoxia condition after being transfected with P311 reporter gene plasmid). The luciferase activity was detected at post culture hour (PCH) 0 and 12, respectively, and then the P311 transcriptional regulatory binding site of HIF-1α and the promoter sequence of P311 were predicted and searched by bioinformatics methods. Data were processed with factorial design variance analysis, one-way analysis of variance, LSD test and Bonferroni correction. Results (1) The results of ESCs. The cells showed cobblestone-like pattern and different clonal morphology due to the different cell proliferation potential. The proportion of CD71^-CD49f⁺ cells accounted for about 85%. The identification results indicated that the cells showed strong stem cell properties and high purity. Compared with those in cells of normoxia group of P311 gene knock-out mice, the residual widths of scratch of cells in pure hypoxia group were smaller at PSH 12 and 24 (with P values below 0.05), and those in hypoxia group, normoxia group of wild-type mice, DMSO control group, HIF-1α inhibitor group, and HIF-1α stabilizer group were smaller at PSH 12 (with P values below 0.05). Compared with those in cells of normoxia group of wild-type mice, the residual widths of scratch of cells in hypoxia group, pure hypoxia group, and DMSO control group were smaller at PSH 12 and 24 (with P values below 0.05), and the residual width of scratch of cells in HIF-1α stabilizer group was smaller at PSH 12 (P<0.05). Compared with those of cells in pure hypoxia group, the residual widths of scratch of cells in hypoxia group were wider at PSH 12 and 24 (with P values below 0.05), and the residual width of scratch of cells in HIF-1α inhibitor group was wider at PSH 12 (P<0.05), and those of cells in HIF-1α stabilizer group were smaller at PSH 12 and 24 (with P values below 0.05). There was no obvious difference in the width of scratch in cells among the 7 groups (F=19.02, P>0.05). The protein levels of HIF-1α in ESCs of wild-type mice at PHH 0, 12, 24, and 48 were respectively 1.02±0.05, 2.56±0.09, 1.60±0.17, and 1.17±0.03. Compared with that at PHH 0, the protein level of HIF-1α at PHH 12 was significantly enhanced (P<0.01). It began to decline at PHH 24 but was still higher than that at PHH 0 (P<0.05), and the protein level of HIF-1α at PHH 48 was close to the normoxia level (P>0.05). Compared with those of cells in pure hypoxia group, the mRNA expressions of P311 of cells in HIF-1α inhibitor group were significantly decreased at each time point (with P values below 0.05), and those in HIF-1α stabilizer group were significantly increased at PHH 12 and 24 (with P values below 0.05). Compared with those of cells in HIF-1α inhibitor group, the mRNA expressions of P311 of cells in DMSO control group and HIF-1α stabilizer group were significantly increased at PHH 0, 12, and 24 (with P values below 0.05). Compared with those of cells in pure hypoxia group, the expressions of P311 of cells in HIF-1α inhibitor group were significantly decreased at each time point (with P values below 0.05), while those in HIF-1α stabilizer group were significantly increased at PHH 12 and 24 (with P values below 0.05). Compared with those of cells in HIF-1α inhibitor group, the expressions of P311 of cells in DMSO control group and HIF-1α stabilizer group were significantly increased at PHH 12 and 24 (with P values below 0.05). (2) The results of HEK-293 cells. At PCH 0, there was no significant difference in the luciferase activity among cells of empty vector hypoxia group, P311 normoxia group, P311 hypoxia group, and P311 hypoxia+ HIF-1α inhibitor group (F=13.33, P>0.05). At PCH 12, the luciferase activity of cells in P311 hypoxia group was higher than that in empty vector hypoxia group (P<0.01). The luciferase activity of cells in hypoxia group was higher than that in P311 normoxia group (P<0.05), while that of cells in P311 hypoxia+ HIF-1α inhibitor group was lower than that in P311 hypoxia group (P<0.01). Conclusions HIF-1α may increase the migration of murine ESCs through inducing the expression of P311 at the early stage of hypoxia.

Effects of change in the activity of vacuolar adenosine triphosphatase of myocardial lysosome on myocardial damage in rats after severe burn and its mechanism

Yan Xueping, Zhang Dongxia, Yan Tiantian, Zhang Qiong, Jia Jiezhi, Huang Yuesheng

2017, 33(5): 295-300. doi: 10.3760/cma.j.issn.1009-2587.2017.05.008

Abstract

PDF

Abstract:
Objective To explore the effects of change of activity of vacuolar adenosine triphosphatase (V-ATPase) of myocardial lysosome on myocardial damage in rats after severe burn and its mechanism. Methods The myocardial lysosomes were extracted from the hearts of 12 SD rats with ultra-high speed gradient density centrifugation, then Western blotting and transmission electron microscope observation were conducted for identification. One hundred and twenty rats were divided into pure burn group, ATP group, normal control group, and bafilomycin group according to the random number table, with 30 rats in each group. Rats in pure burn group and ATP group were inflicted with 40% TBSA full-thickness scald on the back. Immediately after injury, rats in pure burn group were intraperitoneally injected with lactated Ringer′s solution in 4 mL·%TBSA^-1·kg^-1, and rats in ATP group were intraperitoneally injected with ATP in 0.4 mg/kg at 12 h before burn, immediately after burn, and 12 h after burn. Rats in normal control group did not receive any treatment, and rats in bafilomycin group were intraperitoneally injected with bafilomycin A1 in 0.3 mg/kg at the same time points as those of ATP group. At 24 h after burn, 30 rats from each group were collected for determining activity of V-ATPase of myocardial lysosome with coupled-enzyme assay and the expression of myocardium autophagy-related proteins microtubule-associated protein 1 light chain 3 (LC3) and P62 by Western blotting. Left ventricular arterial blood was collected to detect the content of 5 items of myocardial enzyme spectrum and cardiac troponin T (cTnT). Data were processed with one-way analysis of variance and t test. Results (1) After identification, both the expression level of lysosome-related membrane protein 1 and purity of lysosome in the sample were high, and the structure of lysosome was intact. (2) At 24 h after burn, the activity values of V-ATPase of myocardial lysosome in rats of pure burn group, ATP group, normal control group, and bafilomycin group were (2.03±0.67), (3.01±0.58), (4.29±0.26), and (1.83±0.52) μmol·mg^-1·h^-1, respectively. The activity value of V-ATPase of myocardial lysosome in rats of pure burn group was significantly lower than the values in ATP group and normal control group (with t values respectively 3.14 and 8.87, P values below 0.01). The activity values of V-ATPase of rats in normal control group were significantly higher than those in bafilomycin group (t=11.87, P<0.01). At 24 h after burn, the expressions of myocardial LC3 and P62 in pure burn group were significantly higher than those in ATP group and normal control group (with t values from 3.73 to 5.88, P values below 0.01). The expressions of myocardial LC3 and P62 in normal control group were significantly lower than those in bafilomycin group (with t values respectively 2.64 and 3.07, P<0.05 or P<0.01). At 24 h after burn, the content of 5 items of myocardial enzyme spectrum and cTnT in pure burn group was significantly higher than that in ATP group and normal control group (with t values from 3.24 to 16.72, P values below 0.01). The content of 5 items of myocardial enzyme spectrum and cTnT in normal control group was significantly lower than that in bafilomycin group (with t values from 2.39 to 10. 70, P values below 0.01). Conclusions The activity of V-ATPase of myocardial lysosome decreased in rats after severe burn, which can result in myocardial damage by inhibiting myocardial autophagy flux.

Meta-analysis on the diagnostic value of laser Doppler imaging for burn depth

Huang Ying, Qiu Lin, Mei Ailian, Li Jiaoxun

2017, 33(5): 301-308. doi: 10.3760/cma.j.issn.1009-2587.2017.05.009

Abstract

PDF

Abstract:
Objective To evaluate the value of laser Doppler imaging (LDI) in diagnosing deep or superficial partial-thickness burn wound with meta-analysis. Methods Databases including PubMed, Cochrane Library were searched using key words " burn, burns, burn depth, laser Doppler imaging, laser Doppler perfusion imaging, LDI, LDPI" , and Chinese Journals Full-text Database, Wanfang Database, VIP Database were searched using Chinese key words "烧伤,烧伤深度,激光多普勒,激光多普勒血流灌注成像,激光多普勒成像仪" to obtain the published trials of LDI in diagnosing deep or superficial partial-thickness burn wound from the establishment of each database to October 2015. The risk of bias and applicability concerns of the included studies were evaluated by Quality Assessment of Diagnostic Accuracy Studies-2. Data were processed with Meta-DiSc 1.4 statistical software. The heterogeneity among the included studies was evaluated. The pooled estimates of LDI in diagnosing deep or superficial partial-thickness burn wound in the included studies, including sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, as well as the area under the curve of summary receiver operating characteristic and index of Q^* were calculated. The stability of results of the overall pooled estimates of the included studies was validated by sensitivity analysis. The sources of heterogeneity among the included studies were sought through subgroup analysis. The publication bias caused by the results of the included studies was evaluated by drawing the Deek′s funnel plot. Results A total of 5 articles conforming to the inclusion criteria, involving 138 patients and 179 burn wounds, were included. One of the included studies had low risk of bias, while the other 4 studies had high/unclear risk of bias. In applicability concern aspect, one of the included studies had high/unclear concerns regarding applicability, while the other 4 studies had low concerns regarding applicability. There was no heterogeneity caused by threshold effects among the included studies (no " shoulder arm" plot of the scattered-point distribution was observed in the space of the receiver operating characteristic, β^s=0.01, P>0.05). There was a high heterogeneity caused by non-threshold effects among the included studies (sensitivity I²=54%). The overall pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of the included studies on LDI in diagnosing deep or superficial partial-thickness burn wound were 95% (with 95% confidence interval 88%-99%), 96% (with 95% confidence interval 90%-99%), 9.75 (with 95% confidence interval 4.35-21.81), 0.11 (with 95% confidence interval 0.05-0.22), and 257.93 (with 95% confidence interval 58.96-1 128.41), respectively. The area under the curve of summary receiver operating characteristic was 0.98, with index of Q^* 94%. The results of the overall pooled estimates of the included studies was stable. The risk of bias of the selection of the patients, equipment type of LDI, and the selection of diagnostic method in control might be sources of the heterogeneity of the included studies. The Deek′s funnel plot indicated that there was no publication bias caused by the results of the included studies (P>0.05). Conclusions LDI has high sensitivity, specificity, positive likelihood ratio, diagnostic odds ratio and index of Q^*, large area under the curve of summary receiver operating characteristics, and low negative likelihood ratio in diagnosing deep or superficial partial-thickness burn wound, which has relatively high diagnostic value.

Advances in the research of role of integrin-linked kinase in angiogenesis

Zhou Wangbiao, Li Yeyang

2017, 33(5): 317-320. doi: 10.3760/cma.j.issn.1009-2587.2017.05.013

Abstract

PDF

Abstract:
Integrin-linked kinase (ILK) has been found for twenty years, and its biological characteristics have been extensively studied by multi-discipline. At present, studies of ILK are mainly focused on its roles in angiogenesis, tumor formation, and tissue fibrosis, etc. In recent years, the regulation effect of ILK in angiogenesis attracts attention of researchers. The studies showed that ILK can stimulate the secretion of angiogenic factor, promote the proliferation and migration of endothelial cells and inhibit their apoptosis, and therefore play an important role in the regulation of angiogenesis. Further research on molecular mechanism about the role of ILK playing in angiogenesis may provide an effective method for the treatment of some diseases.

2017 Vol. 33, No. 5

Guidelines and Consensus>>

Notice>>