中华烧伤与创面修复杂志

Holistic integrative medicine: the road to the future of the development of burn medicine

Fan Daiming

2017, 33(1): 1-3. doi: 10.3760/cma.j.issn.1009-2587.2017.01.001

PDF

Abstract:
Holistic integrative medicine is the road to the future of the development of burn medicine. Not only burn medicine, but also human medicine gradually enters the era of holistic integrative medicine. Holistic integrative medicine is different from translational medicine, evidence-based medicine or precision medicine, which integrates the most advanced knowledge and theories in medicine fields with the most effective practices and experiences in clinical specialties to form a new medical system.

Four awareness of clinical lean management

Xiong Lize, Zhang Chongfei

2017, 33(1): 4-8. doi: 10.3760/cma.j.issn.1009-2587.2017.01.002

Abstract

PDF

Abstract:
Along with changes of medical model, hospitals need to provide best outcome with lowest cost and best patient′s experience rather than merely medical treatments. It is the cultivation of lean awareness to the doctors that could acquire such outcome. The healthcare lean awareness can be summarized as responsibility awareness, digitalized awareness, detail awareness, and outstanding awareness. Through the cultivation of lean awareness, humanism can immerse into the doctors′practice, which is conducive to train for the great masters of the medicine.

To enhance study on translation and application of mesenchymal stem cells in wound repair

Hu Dahai, Zhang Wei

2017, 33(1): 9-11. doi: 10.3760/cma.j.issn.1009-2587.2017.01.003

Abstract

PDF

Abstract:
Wound repair is a complicated process of interactions among numerous types of cells, involving the activation of multiple cells and various cytokines. The extensive burn and chronic wound are already big challenges for clinic due to the limitations of existing treatment means. Stem cell technology, as a new therapy, may be the optimum choice for wound repair. Mesenchymal stem cells are multipotent cells with self-renewal and differentiation capacity and have a broad tissue distribution, which are promising in treating wound, and it is worthy to discuss and analyze their role, clinical translation and application in wound repair, the facing problems at present and solving strategies as well.

Experimental research on the effects of different activators on the formation of platelet-rich gel and the release of bioactive substances in human platelet-rich plasma

Yang Yu, Zhang Wei, Cheng Biao

2017, 33(1): 12-17. doi: 10.3760/cma.j.issn.1009-2587.2017.01.004

Abstract

PDF

Abstract:
Objective To explore the effects of calcium gluconate and thrombin on the formation of platelet-rich gel (PRG) and the release of bioactive substances in human platelet-rich plasma (PRP) and the clinical significance. Methods Six healthy blood donors who met the inclusion criteria were recruited in our unit from May to August in 2016. Platelet samples of each donor were collected for preparation of PRP. (1) PRP in the volume of 10 mL was collected from each donor and divided into thrombin activation group (TA, added with 0.5 mL thrombin solution in dose of 100 U/mL) and calcium gluconate activation group (CGA, added with 0.5 mL calcium gluconate solution in dose of 100 g/L) according to the random number table, with 5 mL PRP in each group. Then the PRP of the two groups was activated in water bath at 37 ℃ for 1 h. The formation time of PRG was recorded, and the formation situation of PRG was observed within 1 hour of activation. After being activated for 1 h, one part of PRG was collected to observe the distribution of fibrous protein with HE staining, and another part of PRG was collected to observe platelet ultrastructure under transmission electron microscope (TEM). After being activated for 1 h, the supernatant was collected to determine the content of transforming growth factor β₁, platelet-derived growth factor BB (PDGF-BB), vascular endothelial growth factor, basic fibroblast growth factor (bFGF), epidermal growth factor, and insulin-like growth factorⅠby enzyme-linked immunosorbent assay. (2) Another 10 mL PRP from each donor was collected and grouped as above, and the platelet suspension was obtained after two times of centrifugation and resuspension with phosphate buffered saline, respectively. And then they were treated with corresponding activator for 1 h as that in experiment (1). Nanoparticle tracking analyzer was used to detect the concentrations of microvesicles with different diameters and total microvesicles derived from platelet. Data were processed with t test. Results (1) The formation time of PRG in group TA was (228±40) s, and the PRG volume reached the maximum at this moment. The PRG volume shrunk to the minimum after 30 minutes of activation. The formation time of PRG in group CGA was (690±71) s, and the PRG volume reached the maximum at this moment. After 55 minutes of activation, the PRG volume shrunk to the minimum. The formation time of PRG in group TA was obviously shorter than that in group CGA (t=15.17, P<0.01). (2) HE staining showed that after 1 hour of activation, the red-stained area of fibrous protein in PRG of group TA was large and densely distributed, while that of group CGA was small and loosely distributed. TEM revealed that after 1 hour of activation, the platelets in PRG of group TA were fragmented, while lysing platelet structure, lysing α granule structure, intact α granule structure, and intact dense body structure were observed in PRG of group CGA. (3) The content of PDGF-BB released by PRP in group TA was (7.4±0.8) ng/mL, which was obviously higher than that in group CGA [(4.9±0.5) ng/mL, t=5.41, P<0.01]. The content of bFGF released by PRP in group CGA was (960±151) pg/mL, which was significantly higher than that in group TA [(384±56) pg/mL, t=8.75, P<0.01]. The content of the other 4 growth factors released by PRP in the two groups was close (with t values from 0.11 to 1.97, P values above 0.05). (4) The concentrations of total microvesicles, microvesicles with diameter more than 100 nm, and exosomes with diameter less than or equal to 100 nm derived from platelet in group CGA were (165.8±15.1)×10⁸/mL, (142.4±12.3)×10⁸/mL, and (23.4±2.9)×10⁸/mL respectively, which were significantly higher than those in group TA [(24.7±4.6)×10⁸/mL, (22.6±4.0)×10⁸/mL, and (2.1±0.7)×10⁸/mL, with t values from 17.36 to 22.66, P values below 0.01]. Conclusions Calcium gluconate can slowly activate PRP, resulting in slowly shrunk PRG with high content of bFGF and high concentration of microvesicles, which is suitable for repairing articular cavity and sinus tract wound. Thrombin can rapidly activate PRP, resulting in quickly shrunk PRG with high content of PDGF-BB and a certain concentration of microvesicles, which is suitable for repairing acute trauma.

Effects of human amniotic epithelial stem cells-derived exosomes on healing of wound with full-thickness skin defect in rats

Zhao Bin, Wu Gaofeng, Zhang Yijie, Zhang Wei, Yang Fangfang, Xiao Dan, Zeng Kaixuan, Shi Jihong, Su Linlin, Hu Dahai

2017, 33(1): 18-23. doi: 10.3760/cma.j.issn.1009-2587.2017.01.005

Abstract

PDF

Abstract:
Objective To investigate the effects of human amniotic epithelial stem cells-derived exosomes on healing of wound with full-thickness skin defect in rats. Methods (1) Human amniotic epithelial stem cells were isolated from the amnion tissue of 5 full-term pregnant women in Department of Obstetrics of our hospital by the method of trypsin digestion, and their morphology was observed. The third passage of cells were stained with rhodamine-phalloidin for cytoskeleton observation. The third passage of cells were identified with flow cytometry through the detection of expressions of cell surface markers CD29, CD31, CD34, CD90, CD105, SSEA3, SSEA4 and immunity-related marker human leukocyte antigen-D related site (HLA-DR). The third passage of cells were also assessed the ability of adipogenic and osteogenic differentiation. (2) The third passage of human amniotic epithelial stem cells were cultured in DMEM medium supplemented with 10% exosome-free fetal bovine serum. Exosomes were isolated from culture supernatant by the method of ultracentrifugation and represented with scanning electron microscope for morphologic observation. (3) Six adult SD rats were anesthetized, and four 1 cm×1 cm sized wounds with full-thickness skin defect were made on the back of each rat. The wounds on the back of each rat were divided into control group, 25 μg/mL exosomes group, 50 μg/mL exosomes group, and 100 μg/mL exosomes group according to the random number table (with 6 wounds in each group), and a total volume of 100 μL phosphate buffered saline, 25 μg/mL exosomes, 50 μg/mL exosomes, and 100 μg/mL exosomes were evenly injected around the wound through multiple subcutaneous sites, respectively. The wound healing rate was calculated based on measurement on post injury day (PID) 7, 14, and 21. On PID 21, the healed wound tissue of each group was collected and stained with HE to observe and count skin accessories, and the arrangement of collagen fibers was observed with Masson staining. Data were processed with analysis of variance for repeated measurement, analysis of variance of randomized block design, one-way analysis of variance, and Bonferroni test. Results (1) The cells, which were isolated and cultured, displayed typical cobblestone morphology with many microvilli on cell surface. Among the cells, the positive expression rates of CD29, CD90, SSEA3, and SSEA4 were above 50.0%, and the rate of CD105 was 8.0%, while the rates of CD31, CD34, and HLA-DR were almost 0. The cells could differentiate into adipocytes and osteoblasts. The above results revealed that the cells cultured were human amniotic epithelial stem cells. (2) Human amniotic epithelial stem cells-derived exosomes were round or oval vesicles with diameter from 50 to 150 nm. (3) On PID 7 and 21, wound healing rates of the four groups were close (with P values above 0.05). On PID 14, wound healing rates of 50 and 100 μg/mL exosomes groups were (89.8±4.3)% and (92.0±4.6)% respectively, significantly higher than the wound healing rate of control group [(80.3±6.4)%, P<0.05 or P<0.01]. Moreover, the wound healing rate of 100 μg/mL exosomes group was significantly higher than that of 25 μg/mL exosomes group [(83.3±5.1)%, P<0.05]. On PID 21, the numbers of skin accessories in 50 and 100 μg/mL exosomes groups were 4.3±1.4 and 5.1±1.6 respectively, obviously more than those of control group and 25 μg/mL exosomes group (respectively 1.4±0.5 and 1.8±0.6, with P values below 0.01). Well reorganized collagen fibers were observed just in the healed wound tissue of 50 and 100 μg/mL exosomes groups. Conclusions Human amniotic epithelial stem cells-derived exosomes can promote healing of wound with full-thickness skin defect in rats.

Study on sweat gland regeneration induced by microenvironment of three-dimensional bioprinting

Yao Bin, Xie Jiangfan, Huang Sha, Fu Xiaobing

2017, 33(1): 24-26. doi: 10.3760/cma.j.issn.1009-2587.2017.01.006

Abstract

PDF

Abstract:
Sweat glands are abundant in the body surface and essential for thermoregulation. Sweat glands fail to conduct self-repair in patients with large area of burn and trauma, and the body temperature of patients increases in hot climate, which may cause shock or even death. Now, co-culture system, reprogramming, and tissue engineering have made progresses in inducing sweat gland regeneration, but the inductive efficiency and duration need to be improved. Cellular microenvironment can regulate cell biological behavior, including cell migration and cell differentiation. This article reviews the studies of establishment of microenvironment in vitro by three-dimensional bioprinting technology to induce sweat gland regeneration.

Advances in the research of three-dimensional skin printing

Sheng Jiajun, Liu Gongcheng, Li Haihang, Zhu Shihui

2017, 33(1): 27-30. doi: 10.3760/cma.j.issn.1009-2587.2017.01.007

Abstract

PDF

Abstract:
As a new technology, three-dimensional printing possesses the characteristics of high precision and strong controllability, which has become a new technology and can be used in tissue engineering. Currently, using three-dimensional printing to build artificial skin has made certain achievement, and experiments in vitro have confirmed that the three-dimensional printing has the possibilities to build artificial skin whose structure and function are close to those of nature skin. However, the technology is not yet very mature and there are still some problems need to be solved, such as the recreation of the cutaneous appendages and the degradation and absorption of the extracellular matrix.

Effects of hypertonic sodium saline resuscitation on the liver damage of rats at early stage of severe scald

Zhou Jiping, Gao Zhi, Sun Yexiang, Chen Xulin, Wu Xuesheng, Wang Fei

2017, 33(1): 31-36. doi: 10.3760/cma.j.issn.1009-2587.2017.01.008

Abstract

PDF

Abstract:
Objective To explore the effects of hypertonic sodium saline (HSS) resuscitation on the liver damage of rats at early stage of severe scald. Methods Fifty-six SD rats were divided into sham injury group (SI, n=8), lactated Ringer′s solution group (LRS, n=24), and group HSS (n=24) according to the random number table. Rats in group SI were sham injured without resuscitation, while rats in the other two groups were reproduced deep partial-thickness to full-thickness scald model with 30% total body surface area on the back. Rats in group LRS were resuscitated with LRS, while rats in group HSS were resuscitated with 300 mmol/L sodium ion solution according to the Parkland formula. Blood of abdominal aorta and liver of 8 rats in group SI immediately post injury and in the other two groups at post injury hour (PIH) 2, 8, and 24 respectively were collected. Then liver water content was determined by dry-wet weight method. Serum content of alanine aminotransferase (ALT) and aspartate transaminase (AST) was detected by automatic biochemical analyzer. Serum content of tumor necrosis factor α (TNF-α), interleukin-1 (IL-1), and high mobility group box 1 (HMGB1) was determined by enzyme-linked immunosorbent assay. Liver content of malondialdehyde (MDA) and superoxide dismutase (SOD) was detected by ultraviolet spectrophotometer. Pathologic changes of liver were observed by HE staining. Data were processed with one-way analysis of variance and SNK test. Results (1) At PIH 2, 8, and 24, liver water content of rats in group LRS was higher than that in group SI and group HSS (P<0.05 or P<0.01). (2) At PIH 2, serum ALT content of rats in the three groups was similar (with P values above 0.05). At PIH 8 and 24, serum ALT content of rats in group HSS and group LRS was higher than that in group SI (P<0.05 or P<0.01), and serum ALT content of rats in group HSS was lower than that in group LRS (with P values below 0.01). At PIH 2, 8, and 24, serum AST content of rats in group HSS and group LRS was higher than that in group SI (with P values below 0.01). At PIH 2 and 8, serum AST content of rats in group HSS was lower than that in group LRS (P<0.05 or P<0.01). (3) At PIH 2 and 8, serum TNF-α content of rats in group LRS was (123±39) and (153±38) pg/mL respectively, higher than that in group SI [(60±18) pg/mL] and group HSS [(85±10) and (94±16) pg/mL respectively, with P values below 0.01]. At PIH 8, serum TNF-α content of rats in group HSS was higher than that in group SI (P<0.05). At PIH 24, serum TNF-α content of rats in the three groups was similar (with P values above 0.05). At PIH 2, 8, and 24, serum IL-1 content of rats in group LRS was (122±35), (141±30), and (122±31) pg/mL respectively, and that in group HSS was (80±12), (93±15), and (80±11) pg/mL respectively, all higher than that in group SI [(40±17) pg/mL, with P values below 0.01]; serum IL-1 content of rats in group HSS was lower than that in group LRS (with P values below 0.01). At PIH 2, serum HMGB1 content of rats in the three groups was similar (with P values above 0.05). At PIH 8 and 24, serum HMGB1 content of rats in group LRS was (0.386±0.146) and (0.590±0.188) ng/mL respectively, higher than that in group SI [(0.050±0.027) ng/mL] and group HSS [(0.143±0.038) and (0.309±0.095) ng/mL respectively, with P values below 0.01]. At PIH 24, serum HMGB1 content of rats in group HSS was higher than that in group SI (P<0.01). (4) At PIH 2, 8, and 24, liver MDA content of rats in group HSS and group LRS was higher than that in group SI and their liver SOD content was lower than that in group SI (with P values below 0.01); liver MDA content of rats in group HSS was lower than that in group LRS and their liver SOD content was higher than that in group LRS (with P values below 0.01). (5) Compared with those of rats in group SI, liver cells of rats in group LRS showed massive steatosis at each time point, and liver cell-edema appeared at PIH 8 and 24; while liver cells of rats in group HSS showed little steatosis only at PIH 8 and 24, and the liver cell-edema never appeared. Conclusions Compared with LRS, HSS resuscitation can alleviate liver injury of rats at the early stage of severe scald through relieving inflammatory mediators and reducing degree of oxidative stress, etc.

Analysis of microRNA expression profile in serum of patients with electrical burn or thermal burn

Ruan Qiongfang, Jiang Meijun, Ye Ziqing, Zhao Chaoli, Xie Weiguo

2017, 33(1): 37-42. doi: 10.3760/cma.j.issn.1009-2587.2017.01.009

Abstract

PDF

Abstract:
Objective To explore the differential expression of microRNAs in the serum among patients with electrical burn or thermal burn and healthy persons and to explore the significance. Methods In this study we included three patients with electrical burn and three patients with thermal burn, conforming to the inclusion criteria and hospitalized in our burn ward from June to August 2015, and three healthy adult volunteers. Their serum samples were separated from whole blood and divided into electrical burn group, thermal burn group, and normal control group. Total RNA was extracted from their serum samples using Trizol method. The differentially expressed microRNAs (with differential ratio larger than or equal to 2.000, less than or equal to 0.500) among the three groups were screened by microRNA chip technique. Then cluster and Venn diagram analysis of the differentially expressed microRNAs were performed. Enrichment analysis of Kyoto encyclopedia of genes and genomes (KEGG) signaling pathway was performed on the distinctly changed microRNAs (with differential ratio larger than or equal to 5.000, less than or equal to 0.500). Results There were 220 differentially expressed microRNAs among serum of the three groups. MicroRNA expression profiles in serum of electrical burn and thermal burn groups were different from that in serum of normal control group. Compared with those in serum of normal control group, the expressions of 59 microRNAs changed more than 2.000 times in serum of electrical burn group, with 50 up-regulated microRNAs and 9 down-regulated microRNAs; the expressions of 40 microRNAs changed more than 2.000 times in serum of thermal burn group, with 21 up-regulated microRNAs and 19 down-regulated microRNAs. Compared with those in serum of thermal burn group, the expressions of 167 microRNAs changed more than 2.000 times in serum of electrical burn group. There were 17 exclusively expressed microRNAs in serum of thermal burn group and 26 exclusively expressed microRNAs in serum of electrical burn group, compared with those in serum of normal control group. Enrichment analysis of KEGG signaling pathway showed that compared with those in serum of normal control group, microRNAs which changed distinctly in serum of electrical burn group took part in the insulin secretion signaling pathway, arrhythmogenic right ventricular cardiomyopathy signaling pathway, hypertrophic cardiomyopathy signaling pathway, glutamatergic synapse signaling pathway, calcium signaling pathway, cyclic adenosine monophosphate signaling pathway, glycerophospholipid metabolism, pyrimidine metabolism, serotonergic synapse signaling pathway, etc, while microRNAs which changed distinctly in serum of thermal burn group took part in the tumor transcription misregulation signaling pathway, proteoglycans in tumor signaling pathway, microRNAs in tumor signaling pathway, long-term potentiation signaling pathway, citrate cycle signaling pathway, tumor necrosis factor signaling pathway, focal adhesion signaling pathway, endocytosis signaling pathway, insulin secretion signaling pathway, p53 signaling pathway, and estrogen signaling pathway, etc. Conclusions MicroRNA expression profiles in serum of electrical and thermal burn are different from that in serum of healthy adult. The signaling pathways enriched with target genes which are regulated by the differentially expressed microRNAs are related to the pathological changes and clinical manifestations after electrical or thermal burn.

2017, 33(1): 43-45. doi: 10.3760/cma.j.issn.1009-2587.2017.01.010

Abstract

PDF

Abstract:

2017, 33(1): 46-48. doi: 10.3760/cma.j.issn.1009-2587.2017.01.011

Abstract

PDF

Abstract:

2017, 33(1): 49-50. doi: 10.3760/cma.j.issn.1009-2587.2017.01.012

Abstract

PDF

Abstract:

2017, 33(1): 51-52. doi: 10.3760/cma.j.issn.1009-2587.2017.01.013

Abstract

PDF

Abstract:

2017, 33(1): 53-55. doi: 10.3760/cma.j.issn.1009-2587.2017.01.014

Abstract

PDF

Abstract:

2017, 33(1): 56-57. doi: 10.3760/cma.j.issn.1009-2587.2017.01.015

Abstract

PDF

Abstract:

Advances in the research of prevention and treatment of postburn contractures of hand

Wang Kang′an, Wu Guosheng, Sun Yu, Xia Zhaofan

2017, 33(1): 58-61. doi: 10.3760/cma.j.issn.1009-2587.2017.01.016

Abstract

PDF

Abstract:
Scar contracture deformity, which can lead to dysfunction of hand and low quality of life, is one of the common complication after hand burns. The prevention measures of scar contracture after hand burns include large skin grafting, prevention of infection, insistence on wearing pressure gloves, use of silicone sheets, wearing orthosis, accepting proper physical therapy, and early functional exercise. The primary treatments of postburn contractures of the hand are surgery, drugs, laser treatment, and rehabilitation therapy. Excision of scars, release of muscle, joints or bones, and soft tissue transplantation are the core of surgery. Laser treatment has a bright future but still needs to be further studied. Additionally, some novel treatments such as molecular targeted therapy, cell therapy, fat injection, and botulinum toxin injection will play important roles in prevention and treatment of postburn contractures in the future. The purpose of this article is to review the literature concerning postburn contractures of the hand, and summarize the present situation of prevention and treatment of such disease comprehensively.

Advances in the research of burn pain

Yang Chenglan, Wei Zairong

2017, 33(1): 61-64. doi: 10.3760/cma.j.issn.1009-2587.2017.01.017

Abstract

Abstract:
Burn pain starts immediately after burn and may last through the whole course of treatment, and it even may accompany patients with deep burn in the phase of scar formation. Burn pain makes patients anxious for a long period of time, thus seriously lowers life quality of them. In recent years, researchers at home and abroad have had new understanding for ideas of treating burn pain, and reports about the treatment of burn pain have been growing. At present, attention to and knowledge about burn pain are far from enough in clinic. There is a long way to go for further improving the treatment level of burn pain and changing ideas about treating it. This article reviews the clarification, the mechanism, the method of assessment, and therapy of burn pain.

2017 Vol. 33, No. 1

Guidelines and Consensus>>

Notice>>