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2015 Vol. 31, No. 6

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Expert Forum
Lay emphasis on the treatment and exploration of extraordinary injuries
Zhang Guoan
2015, 31(6): 401-403. doi: 10.3760/cma.j.issn.1009-2587.2015.06.001
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Treatment of"extraordinary injuries"is a major challenge for surgeons major in burn care and plastic surgery, though they are experts in wound treatment and repair. The"extraordinary injuries"is very complicated, and its treatment needs multidisciplinary cooperation. Surgeons not only have to master the relevant knowledge, but also should have the expertise to choose the appropriate treatment targeting the special pathological characteristics of the extraordinary wounds. Therefore, surgeons should learn and aggregate more knowledge regarding extraordinary injuries, strengthen muture communication, and encourage research work.
Expert Comment
Enlightenment and deliberation after treatment for extraordinary injuries
Li Zongyu, Liu Rui, Mao Ye
2015, 31(6): 404-405. doi: 10.3760/cma.j.issn.1009-2587.2015.06.002
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With the development of modern society, the range of disease spectrum is changing, and risk factors leading to human trauma and damage are also in the shift. In addition to the extraordinary burns in the traditional sense, we also call extraordinary injury as damage induced by some of extraordinary insults in the past. In recent years, damage to skin and soft tissue caused by an extraordinary injury showed a gradually increasing trend. Manifestations of the wound of an extraordinary injury are various and its clinical treatment is very difficult, often requiring exceptional systemic comprehensive treatments. Currently, it is the duty of colleagues in the burn unit to actively deliberate about their realities regarding the following aspects: to accurately define the concept and scope of extraordinary injury, to include it into the range of clinical research and treatment of burns, to fully use professional skills of burn surgeons in dealing with wounds, and to effectively treat the patients through learning and mastering treatment skills of other clinical disciplines for treatment of extraordinary injury.
Extraordinary Injurie
Clinical application of modified skin soft tissue expansion in early repair of devastating wound on the head due to electrical burn
Lei Jin, Hou Chunsheng, Duan Peng, Hao Zhengming, Zhai Yanbin, Meng Yanbin
2015, 31(6): 406-409. doi: 10.3760/cma.j.issn.1009-2587.2015.06.003
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Objective To observe the clinical effect of modified skin soft tissue expansion in repair of devastating wound on the head due to electrical burn in the early stage. Methods Twenty-one patients with partial scalp soft tissue defect accompanying skull exposure and necrosis in different degree due to high-voltage electrical burn were hospitalized from April 2009 to October 2014, with wound area ranging from 7 cm×5 cm to 15 cm×13 cm. The wounds were debrided as early as possible, and necrotic skulls were kept in situ and covered with porcine ADM and silver-containing dressing. Bacterial culture of exudate from the residual soft tissue was carried out 3 days after hospitalization. Pertinent antibiotics were applied topically to control infection, and autologous split-thickness skin grafts were transplanted. Two to three weeks after injury when the skin grafts survived, modified skin soft tissue expansion was carried out. The crossbow-form incision was made on the normal scalp 2 cm away from the edge of transplanted skin; a capsule cavity was formed by ladder-like dissection. An expander was inserted with the injection port laying outside. The expander was stretched by inflation and deflation. The incisions were sutured layer by layer. The time of continuing negative pressure drainage in the interval of expansion was extended. Volume of water reaching 2 to 3 times of the capacity of expander was injected for excessive expanding. The expanded skin flap was rotated to repair the wound after expansion was ended. Results Within 1 week after debridement, 4 kinds of bacteria were detected in the bacterial culture of wound exudate, including 4 cases of Staphylococcus aureus, 5 cases of Staphylococcus epidermidis, 5 cases of Pseudomonas aeruginosa, and 3 cases of Acinetobacter baumannii. A total of 26 expanders were imbedded. No infection or incision dehiscence in the expanding area or cracking and leakage of expander was observed during expanding period. Two to three months after injury, expanded skin flap transplantation was completed, and the wound was repaired. Raw wounds were seen in 4 expanded skin flaps after transfer, and they healed after dressing change. Punctiform ulceration at the seams of 2 flaps was observed one month after the operation, which healed after removing few pieces of sequestra by themselves. The other expanded skin flaps survived well. During the postoperative follow-up for 3 to 12 months, satisfactory appearance and hair growth was observed in the operation area. Conclusions Repair of the devastating wound on the head due to electrical burn with modified skin soft tissue expansion could achieve the result of early wound covering and cosmetic repair without alopecia in one time.
Treatment of 568 patients with frostbite in northeastern China with an analysis of rate of amputation
Su Haitao, Li Zongyu, Li Yishu, Zhu Yinglai, Zhao Hongwei, Kan Kan, Lyu Zhuo
2015, 31(6): 410-415. doi: 10.3760/cma.j.issn.1009-2587.2015.06.004
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Objective To study the key points of treatment and amputation in patients with frostbite, so as to increase the successful rate of the treatment. Methods Five hundred and sixty-eight patients with frostbite admitted to our department from January 2005 to December 2014. (1) For the patients admitted to our department within one week after injury, the frostbite wounds were soaked in 42 ℃ herbal fluid (twice per day, 30 min for each time) and irradiated with infrared or red light (three times per day, 40 min for each time) from the day of admission to the 7th day after injury. Meanwhile, treatment for improvement of microcirculation, vasodilation, and anti-infection were also given. Then they received infrared or red light irradiation to the wound sites. For the patients admitted to our department longer than one week after frostbite, the frostbite wounds were irradiated with infrared or red light, and treated with antibiotics if inflammation was found around the wound. Among all the patients, 5 cases suffered from frozen stiff, and they were given fluid resuscitation as well as above-mentioned treatments after admission. (2) All patients were given wound treatment immediately after admission. The superficial partial-thickness wounds and deep partial-thickness wounds of 264 patients were given routine dressing change. The full-thickness wounds in 79 patients were treated with exposure therapy after routine dressing change first, and then granulation tissue of these wounds were grafted with autologous thigh split-thickness skin grafts. After debridement and exposure therapy, amputation was done in 225 patients 3 to 4 weeks after injury when the underlying bone was exposed. In 4 patients with exposure of calcaneus, the wounds were covered with reverse sural nerve nutrient vessels island flap. Mean healing time of superficial partial-thickness wound and deep partial-thickness wound, survival rate of skin graft in full-thickness wound, and survival rate of flap covering wound deep to bone at the heel were all recorded. The amputation rate of patients injured in December, January, February, and other months, that of patients admitted shorter than 1 day after frostbite, 1 to 3 days after frostbite, longer than 3 days and shorter than or equal to 5 days after frostbite, and longer than 5 days after frostbite, that of patients caused by drunkenness, mental disorders, improper protection, going astray, and trauma including traffic accident etc., and that of patients treated with rewarming under room temperature, rubbing with snow, wrapping with quilt, and soaking in warm water before admission were all recorded and analyzed. Parts of the data were processed with χ2 test. Results All patients were survived after treatment. Average wound healing time of superficial partial -thickness wound and deep partial-thickness wound was respectively 10 and 23 days. The survival rate of skin graft on full-thickness wound was about 95%. Survival rate of flap on wound deep to bone at the heel was 100%. Amputation rates of patients injured in December and January were respectively 47.46% (84/177), 42.56% (103/242), and both were significantly higher than those of patients injured in February and the other months [respectively 29.55% (26/88), 13.11% (8/61), with χ2 values from 42.595 to 220.900, P values below 0.01]. Amputation rate of patients with admission time shorter than 1 day after frostbite was 32.06% (84/262), which was obviously lower than that of patients with admission time from 1 to 3 days after frostbite, longer than 3 days and less than or equal to 5 days after frostbite, or longer than 5 days after frostbite [respectively 40.48% (68/168), 49.02% (50/102), 52.78% (19/36), with χ2 values from 107.284 to 165.350, P values below 0.01]. Amputation rates of patients with frostbite occurring after getting drunkenness, mental disorders, and trauma including traffic accident etc. were respectively 42.06% (106/252), 43.48% (60/138), and 53.12% (17/32), and they were all significantly higher than those of patients with frostbite caused by improper protection and going astray [respectively 27.45% (28/102), 22.73% (10/44), with χ2 values from 187.260 to 209.738, P values below 0.01]. Amputation rates of patients undergoing treatment of rewarming under room temperature, rubbing with snow, wrapping with quilt before admission were respectively 44.29% (62/140), 48.28% (84/174), and 35.38% (46/130), and they were significantly higher than the amputation rate of patients who received the treatment of soaking in warm water [23.39% (29/124), with χ2 values from 97.364 to 136.189, P values below 0.01]. Conclusions Early diagnosis and treatment, properly rewarming at early stage, and correct wound treatment are the key points for reducing amputation rate of patients after frostbite. Attention should be paid to the occurrence of frostbite in December and January, and also to protection of high-risk groups (patients with mental disorders and drunker).
Clinical observation on the treatment of phenol burn patients complicated by acute kidney injury with early blood purification
Feng Shihai, Liu Qun, Ma Wei, Jia Xiangcheng, Xie Yugang
2015, 31(6): 416-420. doi: 10.3760/cma.j.issn.1009-2587.2015.06.005
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Objective To observe the clinical effects of early blood purification in the treatment of phenol burn patients complicated by acute kidney injury (AKI). Methods Five phenol burn patients complicated by AKI, matched with the inclusion criteria, were hospitalized from January 2010 to July 2014. Within post injury hour 24, patients received rapid liquid support, positive wound management, and hemoperfusion (HP) combined with continuous veno-venous hemofiltration (CVVH) for 2 to 3 hours, then HP was stopped and CVVH was continued for 16 to 21 hours. HP combined with CVVH was performed for 2 to 3 times, then HP was stopped and CVVH was continued for 12 to 22 days. On post injury day (PID) 1, 3, 5, 7, 14, and 21, urea nitrogen, creatinine, ALT, AST, total bilirubin (TBIL), direct bilirubin (DBIL) in serum were determined, and the volume of liquid intake, urine, ultrafiltration, and liquid output were recorded, and the concentrations of IL-6, IL-10 and TNF-α in serum were determined by ELISA. General conditions of patients were recorded. Data were processed with one-way analysis of variance and LSD- t test. Results (1) On PID 1, the levels of urea nitrogen and creatinine were (9.0±3.2) mmol/L and (115±24) μmol/L respectively, which were obviously higher than normal values (with the values of 2.9-8.2 mmol/L and 45-104 μmol/L respectively). On PID 3, 5, 7 and 21, the levels of urea nitrogen were (12.5±4.1), (11.2±5.6), (8.7±2.3) and (6.4±3.9) mmol/L respectively, which were similar with the value of DID 1 (with t values 1.53, 0.76, 0.17 and 1.17 respectively, P values above 0.05). On PID 14, the level of urea nitrogen was (15.8±3.3) mmol/L, which was obviously higher than the value of PID 1 (t=3.29, P=0.023). On PID 3, 5, 7 and 14, the levels of creatinine were (248±67), (224±87), (276±59) and (307±77) μmol/L respectively, which were obviously higher than the value of PID 1 (with t values 4.17, 2.70, 5.65 and 5.32 respectively, P values below 0.01). On PID 21, the level of creatinine was (78±28) μmol/L, which was obviously lower than the value of PID 1 (t=2.23, P=0.041). The levels of ALT, AST, TBIL, and DBIL were higher than normal values from PID 1, and the levels were higher than normal values on PID 3, 5, 7, and 14, and they were similar with the normal values on PID 21. (2) On PID 1, 3, 5, 7, 14, and 21, the volume ratio of liquid intake to liquid output maintained from1∶1 to 2∶1. On PID 1, 3, 5, 7, and 14, although the volume of urine fluctuated, they were still less than 400 mL/d, and the volume for ultrafiltration showed a tendency from declining at first to a rise later. On PID 21, the volume of urine increased, and the volume for ultrafiltration decreased. (3) On PID 1, the serum concentrations of TNF-α and IL-6 increased, and the serum concentration of IL-10 decreased. On PID 3, 5, and 7, the serum concentrations of TNF-α and IL-6 decreased, and the serum concentration of IL-10 increased. On PID 14, the serum concentrations of TNF-α and IL-6 were elevated again but without a high peak value, and the serum concentration of IL-10 decreased but still higher than the value of PID 1. On PID 21, the serum concentrations of TNF-α and IL-6 obviously decreased, and the serum concentration of IL-10 obviously elevated. (4) Primary healing of the wound was achieved on PID 21 to 28. Patients were all cured and left hospital on PID 28 to 45. All the patients were followed up for 6 months to 3 years. At the last follow up, patients had no symptoms of chronic poisoning and the functions of liver and kidney were normal. Conclusions Early blood purification treatment is effective for phenol patients phenol burn patients complicated by AKI, and wound healing and kidney function recovery were assured.
Repair of cervical postradiation ulcer following radical mastectomy with lower trapezius myocutaneous flap
Ning Fanggang, Qin Fengjun, Chen Xin, Zhang Guoan
2015, 31(6): 421-423. doi: 10.3760/cma.j.issn.1009-2587.2015.06.006
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Objective To explore the clinical effects of ipsilateral lower trapezius myocutaneous flap for repairing cervical ulcer as a result of radiotherapy after radical mastectomy. Methods Six patients with cervical ulcers as a result of radiotherapy after radical mastectomy were hospitalized from March 2010 to February 2015, suffering from persistent pain in different degrees. The wound area ranged from 6 cm×4 cm to 10 cm×6 cm before debridement, 8 cm×5 cm to 16 cm×10 cm after debridement. Ipsilateral lower trapezius myocutaneous flap was used to repair the wound after thorough debridement, with the area ranging from 10 cm×7 cm to 20 cm×13 cm. The donor sites were sutured directly or covered with medium-thickness skin graft obtained from the back. Results Pain was obviously relieved in all the patients 2 days after surgery. The wounds in five patients were healed, while necrosis of superficial skin approximately 1 cm in diameter appeared at the distal end of one myocutaneous flap, and it healed after dressing change. During the follow-up period of 3 to 18 months, no recurrence of ulcer was found, the texture of the myocutaneous flaps was soft with good appearance, and the donor sites healed well. Conclusions On the basis of thorough debridement, it is feasible to repair the cervical ulcer as a result of radiotherapy after radical mastectomy with the ipsilateral lower trapezius myocutaneous flap.
Advances in the research of an animal model of wound due to Mycobacterium tuberculosis infection
Chen Ling, Jia Chiyu
2015, 31(6): 436-438. doi: 10.3760/cma.j.issn.1009-2587.2015.06.012
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Tuberculosis ranks as the second deadly infectious disease worldwide. The incidence of tuberculosis is high in China. Refractory wound caused by Mycobacterium tuberculosis infection ranks high in misdiagnosis, and it is accompanied by a protracted course, and its pathogenic mechanism is still not so clear. In order to study its pathogenic mechanism, it is necessary to reproduce an appropriate animal model. Up to now the study of the refractory wound caused by Mycobacterium tuberculosis infection is just beginning, and there is still no unimpeachable model for study. This review describes two models which may reproduce a wound similar to the wound caused by Mycobacterium tuberculosis infection, so that they could be used to study the pathogenesis and characteristics of a tuberculosis wound in an animal.
2015, 31(6): 415-415. doi: 10.3760/cma.j.issn.1009-2587.2015.06.101
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2015, 31(6): 415-415. doi: 10.3760/cma.j.issn.1009-2587.2015.06.103
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2015, 31(6): 415-415. doi: 10.3760/cma.j.issn.1009-2587.2015.06.102
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2015, 31(6): 424-426. doi: 10.3760/cma.j.issn.1009-2587.2015.06.007
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2015, 31(6): 427-429. doi: 10.3760/cma.j.issn.1009-2587.2015.06.008
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2015, 31(6): 430-431. doi: 10.3760/cma.j.issn.1009-2587.2015.06.009
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2015, 31(6): 432-433. doi: 10.3760/cma.j.issn.1009-2587.2015.06.010
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2015, 31(6): 434-435. doi: 10.3760/cma.j.issn.1009-2587.2015.06.011
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2015, 31(6): 451-453. doi: 10.3760/cma.j.issn.1009-2587.2015.06.015
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2015, 31(6): 454-456. doi: 10.3760/cma.j.issn.1009-2587.2015.06.016
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2015, 31(6): 456-457. doi: 10.3760/cma.j.issn.1009-2587.2015.06.017
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2015, 31(6): 458-459. doi: 10.3760/cma.j.issn.1009-2587.2015.06.018
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2015, 31(6): 460-461. doi: 10.3760/cma.j.issn.1009-2587.2015.06.019
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2015, 31(6): 462-463. doi: 10.3760/cma.j.issn.1009-2587.2015.06.020
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2015, 31(6): 464-465. doi: 10.3760/cma.j.issn.1009-2587.2015.06.021
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2015, 31(6): 466-467. doi: 10.3760/cma.j.issn.1009-2587.2015.06.022
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2015, 31(6): 479-480. doi: 10.3760/cma.j.issn.1009-2587.2015.06.027
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Original Article
Effects of exogenous recombinant human basic fibroblast growth factor on the healing of muscles in rats after deep tissue injury of pressure ulcers
Xie Haohuang, Zhang Hongyu, Mao Tingting, Wang Xiaohui, Pan Yingying, Xiao Jian, Jiang Liping
2015, 31(6): 439-445. doi: 10.3760/cma.j.issn.1009-2587.2015.06.013
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Objective To investigate the effect of exogenous recombinant human basic fibroblast growth factor (rhbFGF) on the healing of muscles in rats after deep tissue injury of pressure ulcers. Methods Forty-eight SD rats were randomly divided into normal control group, injury control group, post injury day (PID) 4 group, PID 7 group, PID 14 group, PID 21 group according to the random number table, with 8 rats in each group. The rats in normal control group did not receive any treatment, whereas the rats in the latter 5 groups were established the deep tissue injury of pressure ulcer model on both sides of the gracilis muscle on the hind limb. The rats in injury control group did not receive any treatment after injury, while the rats in the latter 4 groups were given subcutaneous injection of 0.1 mL rhbFGF to the left gracilis in a dosage of 100 μg/mL immediately after injury, and an equal volume of normal saline (NS) was injected to right gracilis, once every other day. The rats in injury control group were sacrificed immediately after injury, and the rats in normal control group were sacrificed at the same time point. The rats in the other 4 groups were sacrificed on PID 4, 7, 14, 21, and the gracilis muscles on both sides were harvested respectively. The morphology of the gracilis muscle was examined after HE staining. The expression of myogenin in the tissues was detected by immunofluorescence method. The levels of muscle structural proteins myosin heavy chain (MyHC), phosphorylated protein kinase B (Akt), and phosphorylated mammalian target of rapamycin (mTOR) were determined by Western blotting. Data were processed with one-way analysis of variance and LSD test. Results (1) In normal control group, the nuclei of graciles cells were in uniform size, and they were closely arranged with clear structure, and there were no significant infiltration of inflammatory cells. In injury control group, the nuclei of graciles cells showed signs of pyknosis, dissolution, fracture and structural disorder. Swelling of muscle cells, inflammation infiltration, structural disorder and other pathological signs of injury phenomena in graciles of PID 4 group, PID 7 group, PID 14 group, PID 21 group after rhbFGF treatment were milder compared with those after NS treatment. In addition, the numbers of regenerated myocytes in graciles of PID 4 group, PID 7 group, PID 14 group, PID 21 group after rhbFGF treatment were higher than those after NS treatment. (2) The numbers of graciles myogenin positive cells in normal control group and injury control group were respectively 28±17 and 42±28. The numbers of graciles myogenin positive cells in PID 4 group, PID 7 group, PID 14 group after NS treatment were 100±50, 196±87, 460±110 respectively, while the numbers of graciles myogenin positive cells in PID 4 group, PID 7 group, PID 14 group after rhbFGF treatment were 174±34, 717±182, 613±122 respectively, and the numbers of graciles myogenin positive cells after rhbFGF treatment were significantly higher than those after NS treatment in each group(P<0.05 or P<0.01). The number of graciles myogenin positive cells in PID 21 group after rhbFGF treatment was 109±34, which was significantly lower than that after NS treatment (218±71, P<0.05). (3) The expression of MyHC in graciles in normal control group was high, which was decreased in injury control group. Both the expressions of MyHC in graciles in PID 4 group, PID 7 group, PID 14 group, PID 21 group after treatment of NS and rhbFGF showed a trend of gradual elevation, while the expressions of MyHC in graciles after rhbFGF treatment were significantly higher than those after NS treatment (P<0.05 or P<0.01). The expression of MyHC in graciles in PID 21 group showed a high level, and it was similar to that of the normal control group (P>0.05). The expressions of phosphorylated Akt and phosphorylated mTOR in graciles of normal control group were low, and the expression of phosphorylated Akt in graciles increased in injury control group, while the expression of phosphorylated mTOR in graciles decreased in injury control group. The expressions of phosphorylated Akt and phosphorylated mTOR in graciles of PID 4 group, PID 7 group, PID 14 group, PID 21 group after treatment with rhbFGF showed a trend of elevation in the beginning but declined afterwards. The expressions of phosphorylated Akt and phosphorylated mTOR in graciles of PID 4 group after rhbFGF treatment were significantly lower than those after NS treatment (P<0.05 or P<0.01). The expressions of phosphorylated Akt and phosphorylated mTOR in graciles of PID 7 group, PID 14 group, PID 21 group after rhbFGF treatment were significantly higher than those after NS treatment (P<0.05 or P<0.01). Conclusions Exogenous rhbFGF may effectively facilitate the healing of muscle structure and accelerate the regeneration of muscles in rats after deep tissue injury of pressure ulcers, and its mechanism may be related to the improvement of the expression of myogenin and enhancement of the expression of protein of muscle growth-related signaling pathways.
Biologic effects of different concentrations of putrescine on human umbilical vein endothelial cells
Chen Jianxia, Rong Xinzhou, Fan Guicheng, Li Songze, Zhang Tao, Li Qinghui
2015, 31(6): 446-450. doi: 10.3760/cma.j.issn.1009-2587.2015.06.014
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Objective To explore the effects of different concentrations of putrescine on proliferation, migration, and apoptosis of human umbilical vein endothelial cells (HUVECs). Methods HUVECs were routinely cultured in vitro. The 3rd to the 5th passage of HUVECs were used in the following experiments. (1) Cells were divided into 500, 1 000, and 5 000 μg/mL putrescine groups according to the random number table (the same grouping method was used for following grouping), with 3 wells in each group, which were respectively cultured with complete culture solution containing putrescine in the corresponding concentration for 24 h. Morphology of cells was observed by inverted optical microscope. (2) Cells were divided into 0.5, 1.0, 5.0, 10.0, 50.0, 100.0, 500.0, 1 000.0 μg/mL putrescine groups, and control group, with 4 wells in each group. Cells in the putrescine groups were respectively cultured with complete culture solution containing putrescine in the corresponding concentration for 24 h, and cells in control group were cultured with complete culture solution with no additional putrescine for 24 h. Cell proliferation activity (denoted as absorption value) was measured by colorimetry. (3) Cells were divided (with one well in each group) and cultured as in experiment (2), and the migration ability was detected by transwell migration assay. (4) Cells were divided (with one flask in each group) and cultured as in experiment (2), and the cell apoptosis rate was determined by flow cytometer. Data were processed with one-way analysis of variance, Kruskal-Wallis test, and Dunnett test. Results (1) After 24-h culture, cell attachment was good in 500 μg/mL putrescine group, and no obvious change in the shape was observed; cell attachment was less in 1 000 μg/mL putrescine group and the cells were small and rounded; cells in 5 000 μg/mL putrescine group were in fragmentation without attachment. (2) The absorption values of cells in 0.5, 1.0, 5.0, 10.0, 50.0, 100.0, 500.0, 1 000.0 μg/mL putrescine groups, and control group were respectively 0.588±0.055, 0.857±0.031, 0.707±0.031, 0.662±0.023, 0.450±0.019, 0.415±0.014, 0.359±0.020, 0.204±0.030, and 0.447±0.021, with statistically significant differences among them (χ2=6.86, P=0.009). The cell proliferation activity in 0.5, 1.0, 5.0, and 10.0 μg/mL putrescine groups was higher than that in control group (P<0.05 or P<0.01). The cell proliferation activity in 500.0 and 1 000.0 μg/mL putrescine groups was lower than that in control group (with P values below 0.01). The cell proliferation activity in 50.0 and 100.0 μg/mL putrescine groups was close to that in control group (with P values above 0.05). (3) There were statistically significant differences in the numbers of migrated cells between the putrescine groups and control group (F=138.662, P<0.001). The number of migrated cells was more in 1.0, 5.0, and 10.0 μg/mL putrescine groups than in control group (with P value below 0.01). The number of migrated cells was less in 500.0 and 1 000.0 μg/mL putrescine groups than in control group (with P value below 0.01). The number of migrated cells in 0.5, 50.0, and 100.0 μg/mL putrescine groups was close to that in control group (with P values above 0.05). (4) There were statistically significant differences in the apoptosis rate between the putrescine groups and control group (χ2=3.971, P=0.046). The cell apoptosis rate was lower in 0.5, 1.0, 5.0, and 10.0 μg/mL putrescine groups than in control group (with P values below 0.05). The cell apoptosis rate was higher in 500.0 and 1 000.0 μg/mL putrescine groups than in control group (with P values below 0.01). The cell apoptosis rates in 50.0 and 100.0 μg/mL putrescine groups were close to the cell apoptosis rate in control group (with P values above 0.05). Conclusions Low concentration of putrescine can remarkably enhance the ability of proliferation and migration of HUVECs, while a high concentration of putrescine can obviously inhibit HUVECs proliferation and migration, and it induces apoptosis.
Review
Advances in the application of extracorporeal membrane oxygenation in the treatment of severe burn
Lyu Lin, Gao Guodong, Long Cun
2015, 31(6): 468-470. doi: 10.3760/cma.j.issn.1009-2587.2015.06.023
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Extracorporeal membrane oxygenation (ECMO) is a kind of technique that uses extracorporeal circulation system to draw patients' blood into the circuit, and then oxygenate the blood when it passes along the membrane, followed by returning the blood into patients. At present, ECMO is mainly used in treating patients with respiratory failure and circulatory failure, for whom the conventional treatment such as mechanical ventilation and vasoactive drugs are invalid. ECMO can provide cardiopulmonary support for burn patients with respiratory failure or circulatory failure, and put the heart and lung at rest. The purpose of this paper is to review the application of ECMO in the treatment of severe burn.
Debridement of burn wounds using a hydrosurgery system
Gong Chen, Lyu Kaiyang, Wang Guangyi, Wang Guangqing, Zhu Shihui, Xia Zhaofan
2015, 31(6): 470-472. doi: 10.3760/cma.j.issn.1009-2587.2015.06.024
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The healing process of burn wounds is strongly associated with the depth of wounds, and the depth of wounds is dependent to initial temperature and duration of contact with source of heat, infection, and secondary damage in the debridement process. On this basis, some experts present a concept of accurate debridement, which denotes removal of all necrotic tissue and at the same time protecting viable tissue for repair of raw wounds in order to maximally maintain patients' appearance and functions. A new technology of burn wound debridement--hydrosurgery system has been applied clinically. This paper summarizes the characteristics of hydrosurgery in the aspects of its technology, suitable wounds, bacterial load, amount of blood loss, and degree of pain produced during operation, and also the author's opinions regarding its efficacy to realize an accurate debridement for burn injury.
Advances in the research of mechanisms of promotion of vascularization by angiogenin and its application
Wang Xingang, Wu Pan, Han Chunmao
2015, 31(6): 473-475. doi: 10.3760/cma.j.issn.1009-2587.2015.06.025
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Angiogenin, as a member of the ribonuclease superfamily, is an angiogenic protein. The angiogenic ability of angiogenin plays an important role in many physical and pathological processes. Angiogenin can induce endothelial cell migration, proliferation, tubulation, as well as inhibition of cellular apoptosis. Angiogenin can be used to modulate the angiogenetic process of tissue engineered constructions via local delivery. Furthermore, angiogenin can also be regarded as a biomarker for diagnostic evaluation of malignancy, or as a target for cancer therapy. This paper presents a comprehensive overview of the angiogenic mechanisms of angiogenin, as well as its potential application in the process of wound healing and treatment of ischemic diseases and malignancy.
Advances in the mechanism of mesenchymal stem cells in promoting wound healing
Zhu Wenjing, Sun Haobo, Lyu Guozhong
2015, 31(6): 476-478. doi: 10.3760/cma.j.issn.1009-2587.2015.06.026
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Mesenchymal stem cells possess the ability of self-renewal and multiple differentiation potential, thus exert immunomodulatory effect during tissue repair. Mesenchymal stem cells can stimulate angiogenesis and promote tissue repair through transdifferentiation and secreting a variety of growth factors and cytokines. This review outlines the advances in the mechanism of mesenchymal stem cells in promoting wound healing, including alleviation of inflammatory response, induction of angiogenesis, and promotion of migration of mesenchymal stem cells to the site of tissue injury.

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