中华烧伤与创面修复杂志

Review of development of Department of Burn Surgery in the First Hospital of Naval Medical University over the past 60 years

Xia Zhaofan, Xiao Shichu, Ge Shengde

2018, 34(11): 741-743. doi: 10.3760/cma.j.issn.1009-2587.2018.11.001

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This paper briefly described the establishment and development of Department of Burn Surgery in the First Affiliated Hospital of Naval Military Medical University (the former Changhai Hospital of the Second Military Medical University) over the past 60 years. After several generations of hard work and innovative development, our department has accumulated a wealth of experience and outstanding treatment effects in the treatment of severe burn and trauma patients. We have made great achievements in clinical practice, scientific development, and talent cultivation, as well as making important contribution to the development of burn and trauma medicine in Shanghai and even in China.

Inheriting, innovating, and developing: a celebration of the 60th anniversary of Chinese modern burn discipline

Sun Yonghua

2018, 34(11): 744-746. doi: 10.3760/cma.j.issn.1009-2587.2018.11.002

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In 1958, with the national steelmaking, the number of burn victims greatly increased. With general surgery, trauma, and plastic surgeons as the core, a burn rescue group formed through multi-disciplinary cooperation, which gradually developed into an independent discipline. With great love and responsibility, the vast number of medical and nursing staff of burn discipline learned and discussed in practice, who were constantly improving and daring to break through and innovate. At that time, Qiu Caikang, the steel-making worker, with 89% total body surface area (TBSA) of total burn area and 23% TBSA of full-thickness burn, was rescued in Shanghai Guangci Hospital (now known as Ruijin Hospital, Shanghai Jiao Tong University School of Medicine), which was the first to succeed, rewriting the world record, followed by successful reports from hospitals in Chongqing, Xi′an, Beijing, and other places. The modern Chinese burn discipline has gone through 60 years since its inception in 1958. Several generations have carried out experimental research in combination with clinical practice, established the Society of Burn Surgery of the Chinese Medical Association and academic journals, created a treatment program for severe burns in China with treatment level in the world′s leading position, enriching the world′s treasure trove of burn medicine!

Sixty years of classics and sixty years of fulfilling mission

Shen Yuming

2018, 34(11): 747-749. doi: 10.3760/cma.j.issn.1009-2587.2018.11.003

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The Department of Burns of Beijing Jishuitan Hospital has gone through 60 years of glorious course as well as Chinese burn surgery. Over the past 60 years, our department developed from scratch, from weak to strong, with continuous innovation. Under the efforts of several generations, remarkable achievements have been made one after another. This article mainly introduces the contribution of our department to burn medicine from five aspects as follows: critical burn treatment, wound repair, electric burn treatment, flap transplantation, and emergency rescue.

Keep initiative mind to save burn crisis and strive hard to reach the summit of the burn discipline

Li Xiaojian

2018, 34(11): 750-752. doi: 10.3760/cma.j.issn.1009-2587.2018.11.004

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The Department of Burns and Plastic Surgery in Guangzhou Red Cross Hospital of Medical College of Ji′nan University grew up along with the development of burn discipline in China. In the past 60 years, it has developed into a burn specialty with three wards, 100 beds, and nearly 100 medical staff from several beds and surgeons. It is characterized by the treatment of severe burns and is a medical burn center integrating medical treatment, teaching and scientific research. In recent ten years or more, the subject development has closely followed the changes of burn discipline and society and has carried out the construction of sub-specialties. It has formed obvious speciality features in the network construction for severe burn rescue, the construction and management of burn intensive care unit and the comprehensive prevention and treatment of multiple organ dysfunction syndrome for severe burn patients and has enjoyed a good reputation in our speciality. We will continue to maintain the professional spirit of burn medicine workers for emergency and disaster relief for burned patients, keep initiative mind, strive hard to continuously improve the professional and technical level, and strive to establish a regional burn treatment center to make more contributions to the development of burn discipline.

Review of development of Department of Burns and Plastic Surgery in the Affiliated Hospital of Zunyi Medical College

Wei Zairong, Huang Guangtao, Wang Dali

2018, 34(11): 753-755. doi: 10.3760/cma.j.issn.1009-2587.2018.11.005

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In the 60th anniversary of Chinese burn medicine, I am honored to review the development of Department of Burns and Plastic Surgery in the Affiliated Hospital of Zunyi Medical College. The Affiliated Hospital of Dalian Medical college was relocated to Zunyi in 1969 to support the development of southwestern China and renamed Affiliated Hospital of Zunyi Medical College. Only a few medical workers stayed in Zunyi when the State Council decided to reestablish Dalian Medical University in 1978. In the last 30 years, our department made great progress in the field of burns treatment with Chinese and Western medicine and complex wounds repair with flap, especially with perforator flap. We also took the lead to achieve the integrated treatment model, including peripheral vascular intervention, autogenous adipose cells/adipose-derived stem cells transplantation, platelet-rich plasma/platelet-rich fibrin, flap grafting, vacuum sealing drainage, Ilizarov technology, and functional active dressing for the treatment of chronic and ischemic wounds. Our department has become one of the national key clinical subject with certain influence from low ebb.

Retrospect on 60 years′ history and prospect of Department of Burns and Plastic Surgery of Provincial Hospital Affiliated to Shandong University

Zhao Ran, Wang Dechang, Xue Wenjun, Huo Ran, Wang Yibing

2018, 34(11): 756-758. doi: 10.3760/cma.j.issn.1009-2587.2018.11.006

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The Department of Burns and Plastic Surgery of Provincial Hospital Affiliated to Shandong University is the leading team in Shandong province. It is integrated with clinical treatment, scientific research, teaching, personnel training, and medical service for social crisis, which undertakes the tasks of giving lessons and offering chances for noviciate and internship of burns and plastic surgery in College of Medicine of Shandong University. It is not only the training unit affiliated to College of Medicine of Shandong University for master students and doctoral students major in burns and plastic surgery, but also the national training base for specialists of burns and plastic surgery. It is the national key clinical subject of burn surgery. Over the past 60 years, with the concerted efforts of several generations, it has made significant contributions to the development and innovation of burns and plastic surgery in Shandong province and the whole China.

2018, 34(11): 743-743. doi: 10.3760/cma.j.issn.1009-2587.2018.11.101

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2018, 34(11): 760-760. doi: 10.3760/cma.j.issn.1009-2587.2018.11.102

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2018, 34(11): 789-789. doi: 10.3760/cma.j.issn.1009-2587.2018.11.104

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2018, 34(11): 789-789. doi: 10.3760/cma.j.issn.1009-2587.2018.11.103

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Chinese burn referral criteria (2018 version)

Chinese Burn Association, Society of Burn Surgery of Chinese Medical Doctor Association, Editorial Committee of Chinese Journal of Burns, Burn Medicine Branch of China International Exchange and Promotion Association for Medical and Healthcare, the Burn and Trauma Branch of Chinese Geriatrics Society, Luo Gaoxing, Yuan Zhiqiang, Peng Yizhi, Huang Yuesheng, Wu jun

2018, 34(11): 759-760. doi: 10.3760/cma.j.issn.1009-2587.2018.11.007

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There is no national referral criteria for burns in China till now, which brings inconvenience and confusion. Based on the oversea experiences and the actual situation in China, many famous experts in burns discussed and developed this Chinese burn referral criteria (2018 version). We hope these referral criteria will be helpful in clinical practice of burns and can be improved continuously through application.

National experts consensus on application of silver-containing dressings in wound therapy (2018 version)

The Burn and Trauma Branch of Chinese Geriatrics Society, Zhang Jiaping

2018, 34(11): 761-765. doi: 10.3760/cma.j.issn.1009-2587.2018.11.008

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New silver-containing dressings developed in recent years have brought new and powerful means for the prevention and treatment of wound infection, which promote development and progress of wound therapy. There are many kinds of silver-containing dressings, however, misunderstanding and even misapplication exist in how to choose and use these dressings. Based on literature evidence, we propose this national expert consensus on clinical application of silver-containing dressings, particularly in terms of kinds and mechanisms, indications, contraindications, rational selections in different wounds, and cautions in the clinical application of silver-containing dressings. This consensus would be helpful for medical and nursing personnel to use silver-containing dressings in wound repair field in clinic correctly and professionally.

National experts consensus on clinical application of collagen-based wound biomaterials (2018 version)

The Burn and Trauma Branch of Chinese Geriatrics Society, Lyu Guozhong

2018, 34(11): 766-769. doi: 10.3760/cma.j.issn.1009-2587.2018.11.009

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Collagen, as the main structural protein in human body, plays an important role in the wound healing process. Due to their inherent hemostatic characteristics, good biocompatibility, low immunogenicity, as well as controllable biodegradability, collagen-based materials have attracted much attention. In this article, we mainly introduce the characteristics of collagen-based wound biomaterials and the application mechanism as scaffold and wound dressing. And the standard and unified experts′ consensus formed on the clinical indications, recommended applications, contraindications, and matters needing attention. The consensus wound help clinicians and patients to recognize collagen-based wound biomaterials correctly and use them rationally.

National experts consensus on clinical diagnosis and treatment of inhalation injury (2018 version)

The Burn and Trauma Branch of Chinese Geriatrics Society, Guo Guanghua, Zhu Feng, Huang Yuesheng, Wu Jun, Sun Yonghua, Xia Zhaofan, Fu Xiaobing

2018, 34(11): 770-775. doi: 10.3760/cma.j.issn.1009-2587.2018.11.010

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Inhalation injury is caused by inhalation of heat, toxic or irritating gases which lead to respiratory and pulmonary parenchyma damage. At present, the clinical understanding about it is still limited and lack of effective diagnosis and treatment standard. Based on the experience of diagnosis and treatment of domestic inhalation injury, combined with reports of international researches, criteria (expert consensus) for inhalation injury were systematically discussed from pathological and pathophysiological changes, clinical diagnosis and evaluation, and clinical treatment, which provides reference for clinical diagnosis and treatment of patients inflicted with inhalation injury.

National experts consensus on application of pulse contour cardiac output monitoring technique in severe burn treatment (2018 version)

The Burn and Trauma Branch of Chinese Geriatrics Society, Zhang Jiaping, Wang Weiyi

2018, 34(11): 776-781. doi: 10.3760/cma.j.issn.1009-2587.2018.11.011

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As a newly developed technique for hemodynamic monitoring, pulse contour cardiac output (PiCCO) monitoring takes great advantages in guiding shock resuscitation and fluid administration. PiCCO has been used more and more in burn patients in recent years, however there is no clinic consensus on how to apply PiCCO monitoring, understand the significance of PiCCO monitored parameters, and guide the treatment using PiCCO monitored parameters in patients with severe burns. Based on the current literature and the experts′ clinical experience, national experts consensus on application of pulse contour cardiac output monitoring technique in severe burn treatment (2018 version) is now issued by the Burn and Trauma Branch of Chinese Geriatrics Society, aiming to provide practical guidance for its usage in clinic.

National experts consensus on tracheotomy and intubation for burn patients (2018 version)

The Burn and Trauma Branch of Chinese Geriatrics Society, Ming Zhiguo, Lei Jin, Duan Peng, Tan Jianglin, Lou Jihe, Di Haiping, Wang Deyun

2018, 34(11): 782-785. doi: 10.3760/cma.j.issn.1009-2587.2018.11.012

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Airway edema, stenosis, obstruction and even asphyxia are easy to occur in patients with extensive burn, deep burn of head, face, and neck area, inhalation injuries, etc., which threaten life. Timely tracheotomy and intubation is an important treatment measure, but lack of knowledge and improper handling in some hospitals resulted in airway obstruction. The technique of percutaneous tracheotomy and intubation provides convenience for emergency treatment of critical burns and mass burn. The Burn and Trauma Branch of Chinese Geriatrics Society organized some experts in China to discuss the indications, timing, methods, extubation, and precautions of tracheotomy and intubation for burn patients. The national experts consensus on tracheotomy and intubation for burn patients (2018 version) was written to provide a reference standard for clinical treatment.

Precision evaluation of immune status and its significance in sepsis after burns or trauma

Yao Yongming, Luan Yingyi

2018, 34(11): 786-789. doi: 10.3760/cma.j.issn.1009-2587.2018.11.013

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Sepsis induced by major burns, trauma, and hemorrhage, remains a major cause of death of patients in intensive care units, and it may result in both the widespread activation and dysfunction of the innate as well as adaptive responses in host immune system. A large amount of information concerning subsets of innate and adaptive immune cells in sepsis has implicated that these cells, including neutrophils, macrophages, dendritic cells, T lymphocytes, regulatory T lymphocytes, and natural killer cells, have profound effects on immunoreactivity during acute insults or sepsis through modulating multiple receptor expressions or cytokine secretion, in turn contributing to the development and outcome of sepsis. It is of great significance that precision monitoring of immune function and the related indicators might help to assess the risk of secondary infection, the prognosis of septic patients, and guide the treatment of septic complications.

Further understanding of infection of carbapenems-resistant Klebsiella pneumoniae among burn patients and the related strategies for antimicrobial treatment

Xiang Jun, Huan Jingning

2018, 34(11): 790-795. doi: 10.3760/cma.j.issn.1009-2587.2018.11.014

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The prevalence of carbapenems-resistant Klebsiella pneumoniae (CRKP ) in burn wards has become one of the most troublesome issues in current management of bacterial infections. It is necessary for us to reconsider the epidemiology, risk factors and clinical characteristics of CRKP infection as well as therapeutic options. Formulating the principles of antimicrobial therapy of CRKP infection and combined antibiotics therapy and implementing appropriate dosage regimens designed by pharmacokinetic and pharmacodynamic profiles will be of importance. Common antimicrobial agents for the treatment of CRKP infection include polymyxins, tigecycline, fosfomycin, and carbapenems. Infection control measures such as contact isolation, active screening, and environmental surface disinfection must be integrated with antimicrobial stewardship to effectively curb and prevent the spread of CRKP.

Preliminary study on resistance mechanism and virulence features in carbapenems-resistant Klebsiella pneumoniae from burn patients

Chen Zheng, Xiang Jun

2018, 34(11): 796-801. doi: 10.3760/cma.j.issn.1009-2587.2018.11.015

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Objective To investigate resistance mechanism and virulence features of carbapenems-resistant Klebsiella pneumoniae (CRKP) and to provide theoretical foundation for the prevention and control of nosocomial infections in burn wards as well as clinical therapy of CRKP. Methods Strains of Klebsiella pneumoniae isolated from clinical samples of burn patients hospitalized in our unit from February to December 2016 were collected. The diameters of inhibition zone of imipemen or meropenem susceptibility disk of the above strains were≤22 mm. Kirby-Bauer disk diffusion method and automated instrument were applied to test drug resistance of the strains to 17 antibiotics of cephalosporins, aminoglycosides, sulfonamides, quinolones, and carbapenems. Pulsed-field gel electrophoresis (PFGE) was used to analyze homology of the strains. Crystal violet staining was applied to assess ability of biofilm formation of the strains. The hypermucoviscosity (HM) phenotype of the strains was determined by string test. Polymerase chain reaction was used to detect common carbapenemase genes of bla_KPC, bla_IMP, bla_OXA-48, and bla_NDM, capsular serotype genes of K1, K2, and K57, and virulence-associated gene of rmpA. Results (1) A total of 29 CRKP strains were isolated. The 29 CRKP strains were with high drug resistance rate to carbapenems antibiotics of imipenen, meropenem, and ertapenem, and cephalosporins, aminoglycosides, and quinolones antibiotics, while the strains were with low drug resistance rate to sulfonamides antibiotics and tegafycline. (2) The 29 CRKP strains had 4 types of A, B, C, and D according to PFGE, with 11 strains of type A, 10 strains of type B, 6 strains of type C, and 2 strains of type D. (3) Among the 29 CRKP strains, 25 strains were positive in biofilm formation, with positive rate of 86.2%. (4) None of the 29 CRKP strains was positive in the string test with HM phenotype. (5) All the 29 CRKP strains carried carbapenemase genes. Among the 29 CRKP strains, 11 strains carried both bla_NDM-1 and bla_OXA-48 genes, 1 strain carried both bla_NDM-1 and bla_KPC-2 genes, 12 strains only carried bla_KPC-2 gene, and 5 strains only carried bla_NDM-1 gene. The 79.3% (23/29) strains were completely resistant to 3 kinds of carbapenems antibiotics. (6) Among the 29 CRKP strains, 3 strains carried K2 gene, 2 of which were completely resistant to 3 kinds of carbapenems antibiotics, 1 strain carried rmpA gene, and no strain carried K1 or K57 gene. Conclusions The detection rate of CRKP isolated from burn patients hospitalized in our unit is high. The strains are mostly extensively drug-resistant bacteria, and the mechanism of drug resistance of which is complicated. There may have clonal spread of CRKP. And appropriate measures should be taken timely and effectively to prevent nosocomial spread of CRKP.

Analysis of distribution and drug resistance of pathogens from the wounds of 1 310 thermal burn patients

Zhang Cheng, Gong Yali, Luo Xiaoqiang, Liu Meixi, Peng Yizhi

2018, 34(11): 802-808. doi: 10.3760/cma.j.issn.1009-2587.2018.11.016

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Objective To analyze the distribution and drug resistance of pathogens from the wounds of thermal burn patients, so as to provide reliable basis for the rational use of antibiotics and the effective control over nosocomial infection. Methods Wound samples of 1 310 thermal burn patients admitted into our burn wards from January 2012 to December 2017 were collected and retrospectively analyzed. API bacteria identification panels and automatical bacteria identification equipment were used to identify pathogens. E test was conducted to detect drug resistance of pathogens to vancomycin, tigecycline, and oxacillin. Kirby-Bauer paper disk diffusion method was used to detect drug resistance of pathogens to 31 antibiotics including penicillin G, gentamicin and rifampicin, etc., and drug resistance of fungi to 5 antifungal agents (voriconazole, amphotericin B, fluconazole, itraconazole, and ketoconazole). The WHONET 5.6 software was used to analyze the constituent ratios of Gram-negative bacteria, Gram-positive bacteria, and fungi in each year; the distribution of fungi; the distribution of top 10 bacteria with the highest constituent ratios in each year; the constituent ratios of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA); the drug resistance of top 3 bacteria with the highest constituent ratios to commonly used antibiotics in each year; and the drug resistance of Candida to commonly used antifungal agents. Results (1) Totally 2 183 strains of pathogens were isolated for the first time, including Gram-negative bacteria 1 194 (54.70%) strains, Gram-positive bacteria 879 (40.27%) strains, and fungi 110 (5.04%) strains. From 2012 to 2016, the constituent ratio of Gram-negative bacteria showed a decreasing trend, while that of Gram-positive bacteria showed an increasing trend year by year; and the constituent ratio of fungi was with a significantly increasing trend from 2016 to 2017. (2) Among all the fungi, the constituent ratio of Candida parapsilosis ranked the first, Aflatoxin ranked the second, Candida albicans and Candida tropicalis both ranked the third. (3) From 2012 to 2017, top 10 bacteria with the highest constituent ratios, from high to low, were Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumannii, Enterobacter cloacae, Escherichia coli, Staphylococcus haemolyticus, Klebsiella pneumoniae, Enterococcus faecalis, Aeromonas hydrophila, and Stenotrophomonas maltophilia respectively. The constituent ratio of Staphylococcus aureus ranked the first in each year. The constituent ratio of Pseudomonas aeruginosa was fluctuating but showed a rising trend comprehensively. The constituent ratio of Acinetobacter baumannii went up after decreasing. (4) Among all the Staphylococcus aureus, constituent ratio of MRSA was above 65.00%, while that of MSSA was below 31.00% in each year. (5) From 2012 to 2017, Staphylococcus aureus resistant to vancomycin, linezolid, or teicoplanin was not detected; the drug-resistant rates of MRSA to penicillin G, oxacillin, gentamicin, rifampicin, tetracycline, ciprofloxacin, ofloxacin, and levofloxacin were above or equal to 80.0% in each year; the drug-resistant rates of Staphylococcus aureus to clindamycin and erythrocin showed an obviously increasing trend, the drug-resistant rates of Staphylococcus aureus to moxifloxacin and queenoputin/daputin in 2017 were higher than those in 2016, while the drug-resistant rates of Staphylococcus aureus to the other 14 antibiotics showed no significant change in trend. From 2012 to 2017, Acinetobacter baumannii was sensitive to polymyxin B and tigecycline; the drug-resistant rate of Acinetobacter baumannii to ceftriaxone was relatively high; the drug-resistant rates of Acinetobacter baumannii to levofloxacin, minocycline, and tetracycline were decreasing while those to the other 14 antibiotics went up after decreasing. From 2012 to 2017, Pseudomonas aeruginosa wasn′t resistant to polymyxin B, and its drug-resistant rates to the other 14 antibiotics showed decreasing trends. (6) The drug-resistant rates of Candida albicans to voriconazole, amphotericin B, fluconazole, itraconazole, and ketoconazole were all zero. The drug-resistant rates of non-Candida albicans to voriconazole, fluconazole, itraconazole, and ketoconazole were higher than those of Candida albicans. Conclusions Among the pathogens from the wounds of thermal burn patients, Staphylococcus aureus, Pseudomonas aeruginosa, and Acinetobacter baumannii had the top 3 constituent ratios; the constituent ratio of non-Candida albicans was obviously higher than that of Candida albicans. The high drug resistance rates of Staphylococcus aureus and Acinetobacter baumanni require more attention from clinicians and the local hospital′s infection control department.

Effects of endotoxin/lipopolysaccharide on early apoptosis of human neutrophil through PIM3

Song Mingming, Li Ping, Jin Xinyuan, Su Jiandong, Sun Bingwei

2018, 34(11): 809-814. doi: 10.3760/cma.j.issn.1009-2587.2018.11.017

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Objective To explore the effects of endotoxin/lipopolysaccharide (LPS) on early apoptosis of human neutrophil through PIM3. Methods Venous blood samples were collected from a healthy adult volunteer to isolate neutrophils. The neutrophils were divided into control group, LPS group, and LPS+ PIM447 group according to the random number table. No treatment was given to the cells in control group. The cells in LPS group underwent LPS stimulation (1 μL, 1 μg/mL). The cells in LPS+ PIM447 group underwent PIM447 (1 μL, final amount-of-substance concentration of 5 μmol/L) intervention 30 min before having the same LPS stimulation as that in LPS group. After conventional culture for 1 h, the early cell apoptosis rate was determined with flow cytometer; the generation level of reactive oxygen species (ROS) was assessed with dihydrogenrhodamine 123 fluorescent probe staining method; and the level of PIM3 was detected by Western blotting. After conventional culture for 2 h, the cell chemotaxis distance was measured by agarose chemotaxis cell model. The sample numbers of each group in the 4 experiments were all 5. Data were processed with one-way analysis of variance and Student-Newman-Keuls test. Results (1) The early apoptosis rate of cells in LPS group [(0.891±0.012)%] was close to that in control group [(1.351±0.183)%, P>0.05)]. The early apoptosis rate of cells in LPS+ PIM447 group [(82.057±0.121)%] was higher than that in LPS group (P<0.01). (2) The cell chemotaxis distance of cells in LPS group [(984±5) μm] was significantly shorter than that in control group [(2 241±7) μm, P<0.01]. The cell chemotaxis distance of cells in LPS+ PIM447 group [(1 785±11) μm]was significantly longer than that in LPS group (P<0.05). (3) The generation level of ROS in cells of LPS group was significantly higher than that in control group (P<0.05). The generation level of ROS in cells of LPS+ PIM447 group was significantly lower than that in LPS group (P<0.05). (4) The expression level of PIM3 in cells of LPS group (1.297±0.015) was significantly higher than that in control group (0.789±0.021, P<0.05). The expression level of PIM3 in cells of LPS+ PIM447 group (0.731±0.011) was significantly lower than that in LPS group (P<0.05). Conclusions LPS stimulation can reduce the early apoptosis of human neutrophils. Pre-intervention with PIM447 can significantly increase the early apoptosis of neutrophils after LPS stimulation, recover the chemotaxis, and inhibit the production of ROS. The mechanism may be related to LPS promoting the expression of PIM3.

Influence of vagus nerve on multiple organ function and immune reaction of T lymphocytes in septic rats

Ren Chao, Li Xiuhua, Wu Yao, Dong Ning, Yao Yongming

2018, 34(11): 815-820. doi: 10.3760/cma.j.issn.1009-2587.2018.11.018

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Objective To explore influence of vagus nerve on multiple organ function and immune reaction of T lymphocytes in septic rats. Methods Forty Sprague-Dawley rats were divided into sham injury group, sepsis group, vagus nerve stimulation (VNS) group, and vagotomy (VGX) group, according to the random number table, with 10 rats in each group. Rats in sepsis group, VNS group, and VGX group were inflicted with sepsis by cecal ligation and puncture (CLP). Rats in VNS group were given electrical stimulation on left cervical vagus nerve for 15 min right after CLP. Rats in VGX group underwent vagotomy of left cervical vagus nerve at 30 min before CLP. At 24 h after CLP, serum of rats was collected to detect levels of alanine transaminase (ALT), aspartate aminotransferase (AST), glycocholic acid (CG), creatine kinase (CK), myocardial creatine kinase (CK-MB), blood urea nitrogen (BUN), and serum creatinine by fully automatic biochemistry analyzer. The left lung of rats was collected to determine wet or dry mass, and wet to dry (W/D) ratio was calculated. The right lung of rats was collected to measure the activity of pulmonary myeloperoxidase (MPO) by enzyme linked immunosorbent assay (ELISA). Spleen of rats was collected to determine the proliferative activity of CD4⁺ T lymphocytes by cell counting kit 8, and real-time fluorescence quantitative polymerase chain reaction and ELISA were used to quantify mRNA expressions and levels of interleukin 2 (IL-2), interferon-γ, and IL-4, respectively. Data were processed with one-way analysis of variance and Tukey′s honest significant difference test. Results (1) The levels of serum ALT, AST, CG, CK, CK-MB, BUN, and creatinine, pulmonary W/D ratio, as well as MPO activity of rats in sepsis group were significantly higher than those in sham injury group and VNS group (P<0.01) and were significantly lower than those in VGX group (P<0.01). (2) The proliferative activity of CD4⁺ T lymphocytes of rats in sepsis group was 0.93±0.03, which was significantly lower than 1.54±0.07 of rats in sham injury group (P<0.01). The proliferative activity of CD4⁺ T lymphocytes of rats in VNS group was 1.15±0.15, which was significantly higher than that of rats in sepsis group (P<0.01). The proliferative activity of CD4⁺ T lymphocytes of rats in VGX group was 0.75±0.06, which was obviously lower than that of rats in sepsis group (P<0.01). (3) In comparison with those of rats in sham injury group, the levels of IL-2 and interferon-γ in CD4⁺ T lymphocytes of rats in sepsis group were markedly decreased (P<0.01), while the level of IL-4 was significantly increased (P<0.01). In comparison with those of rats in sepsis group, the levels of IL-2 and interferon-γ in CD4⁺ T lymphocytes of rats in VNS group were obviously increased (P<0.01), while the level of IL-4 was markedly decreased (P<0.01). As compared with those of rats in sepsis group, the levels of IL-2 and interferon-γ in CD4⁺ T lymphocytes of rats in VGX group were markedly decreased (P<0.01), while the level of IL-4 was significantly increased (P<0.01). (4) As compared with those of rats in sham injury group, expressions of IL-2 and interferon-γ mRNA in CD4⁺ T lymphocytes of rats in sepsis group were markedly decreased (P<0.01), while expression of IL-4 mRNA was significantly increased (P<0.01). Expressions of IL-2 and interferon-γ mRNA in CD4⁺ T lymphocytes of rats in VNS group were obviously increased when compared with those of rats in sepsis group (P<0.01), while expression of IL-4 mRNA was markedly decreased (P<0.01). In comparison with those of rats in sepsis group, expressions of IL-2 and interferon-γ mRNA in CD4⁺ T lymphocytes of rats in VGX group were markedly decreased (P<0.01), while expression of IL-4 mRNA was significantly increased (P<0.01). Conclusions Electrical stimulation of vagus nerve can significantly improve multiple organ dysfunction and reverse immunosuppression of T lymphocytes in septic rats, while vagotomy of vagus nerve may enhance the susceptibility of rats to sepsis.

Influence of nicotinic acid adenine dinucleotide phosphate on autophagy in hypoxic cardiomyocytes of rats and its mechanism

Ye Jingying, Zhang Junhui, Cui Lin, Yang Lei, Zhang Qiong, Zhang Dongxia, Huang Yuesheng

2018, 34(11): 821-826. doi: 10.3760/cma.j.issn.1009-2587.2018.11.019

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Objective To investigate influence of nicotinic acid adenine dinucleotide phosphate (NAADP) on autophagy in hypoxic cardiomyocytes of rats and its mechanism. Methods Five neonatal Sprague-Dawley rats were collected and sacrificed to harvest the hearts, and primary cardiomyocytes were separated for the following experiments. (1) Primary cardiomyocytes were collected and divided into normoxia group, hypoxia 9 h group, and hypoxia 9 h+ NAADP group according to random number table, with 5 wells in each group. Cells in normoxia group were cultured routinely in the constant temperature incubator at 37 ℃ for 9 hours. Cells in hypoxia 9 h group and hypoxia 9 h+ NAADP group were cultured in hypoxic incubator with volume fraction 94% nitrogen, 5% carbon dioxide, and 1% oxygen for 9 hours. Before hypoxia, cells in hypoxia 9 h+ NAADP group were dealt with final amount-of-substance concentration 10 μmol/L NAADP. Cell counting kit 8 was used to measure cell viability. (2) Primary cardiomyocytes were collected and divided into normoxia group, hypoxia 9 h group, hypoxia 9 h+ NAADP group, hypoxia 9 h+ tran-Ned-19 group, and hypoxia 9 h+ trans-Ned-19+ NAADP group according to the random number table, with 2 wells in each group. Cells in normoxia group were cultured routinely in the constant temperature incubator at 37 ℃ for 9 hours. And cells in the other 4 groups were cultured in hypoxic incubator as that in experiment (1) Before hypoxia, cells in hypoxia 9 h+ NAADP group were dealt with amount-of-substance concentration 10 μmol/L NAADP, cells in hypoxia 9 h+ tran-Ned-19 group were dealt with amount-of-substance concentration 1 μmol/L trans-Ned-19, and cells in hypoxia 9 h+ trans-Ned-19 + NAADP group were dealt with amount-of-substance concentration 10 μmol/L NAADP and 1 μmol/L trans-Ned-19. Protein expressions of microtubule associated protein 1 light chain 3-Ⅱ and P62 were detected by Western blotting. (3) Primary cardiomyocytes were collected and grouped as those in experiment (1). The lysosomal acidity was determined by immunofluorescence method. Data were processed with one-way analysis of variance and least-significant difference test. Results (1) The cell viability in normoxia group was 1.114±0.024, which was significantly higher than 0.685±0.079 of cells in hypoxia 9 h group (P<0.01). The cell viability of hypoxia 9 h+ NAADP group was 0.886±0.061, which was obviously higher than that of cells in hypoxia 9 h group (P<0.05). (2) Expressions of microtubule-associated protein 1 light chain 3-Ⅱ and P62 of cells in hypoxia 9 h group were significantly higher than those of cells in normoxia group (P<0.01). Compared with those in hypoxia 9 h group, expression of P62 in hypoxia 9 h+ NAADP group was significantly decreased (P<0.01), while expression of microtubule-associated protein 1 light chain 3-Ⅱ did not change significantly (P>0.05). There were no significantly statistical difference in expressions of microtubule-associated protein 1 light chain 3-Ⅱ and P62 between hypoxia 9 h group and hypoxia 9 h+ trans-Ned-19 group (P>0.05). Compared with those of cells in hypoxia 9 h+ NAADP group, expression of P62 of cells in hypoxia 9 h+ trans-Ned-19+ NAADP group was obviously increased (P<0.01), while expression of microtubule-associated protein 1 light chain 3-Ⅱ did not change significantly (P>0.05). (3) The intensity of green fluorescence of cells in normoxia group was strong and co-localized well with red fluorescence, and internal environment of lysosome was with stronger acidity. The intensity of green fluorescence in cells of hypoxia 9 h group was significantly lower than that of cells in normoxia group, and acidity of internal environment of lysosome was weakened. The intensity of green fluorescence and acidity of internal environment of lysosome in hypoxia 9 h+ NAADP were significantly stronger than those of cells in hypoxia 9 h group, but significantly lower than those of cells in normoxia group. Conclusions NAADP can improve myocardial cell viability through acidifying internal environment of lysosome of cardiomyocyte after hypoxia, promoting degradation of autophagosomes, reducing autophagic lysosomal accumulation, and repairing damaged autophagic flow.

Application of self-made stretch pants in patients with burn in special sites

Chen Pei, Yang Shuijuan, Yuan Xiaoxiao, Xu Juan, Tang Youling, Xie Weiguo

2018, 34(11): 827-828. doi: 10.3760/cma.j.issn.1009-2587.2018.11.020

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Abstract:
The change and fixation of dressing are difficult in patients with burn in special sites of perineum, buttocks, and bilateral thighs. Therefore, we designed and made stretch pants by ourselves for dressing fixation after dressing change in patients with burns in abdomen, buttocks, and bilateral thighs. The stretch pants are made by cutting and splicing elastic fabric according to perimeters of abdomen and legs. The stretch pants are used after wound dressing change, which can fix the dressing stably, accelerate wound healing, and reduce the medical workers′ labor intensity of dressing change and economic burden of patients. And patients can walk out of bed early. It′s especially suitable for dressing fixation of infants and other patients who are unwilling to cooperate. Besides, it′s easy to make with low cost and suitable for clinical promotion.

Advances in the research of the relationship between wound temperature and wound healing

Zhu Lingya, Guo Songxue, Wu Pan, Li Qiong, Ho Jonkee, Yu Meirong, Weng Tingting, Han Chunmao

2018, 34(11): 829-832. doi: 10.3760/cma.j.issn.1009-2587.2018.11.021

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Abstract:
There are many factors that may affect the microenvironment of acute and chronic wounds. This article reviews the relationship between temperature factor in the external microenvironment of wound surface and wound healing. The temperature changes in different types and stages of wounds are closely related to the wound healing status. Therefore, wound temperature monitoring provides timely, reliable, and non-invasive method in the evaluation of wound status. As low temperature affects the physiological state of wound, relieving the low temperature state and maintaining normal temperature of the microenvironment of wound can promote wound healing. Further research is needed on the wound repair related effector cell proliferation and the mechanism of regulatory function to determine the optimal constant temperature and heat treatment duration needed for wound healing.

2018 Vol. 34, No. 11

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