Objective To explore the effects of B-cell lymphoma-2/adenovirus E1B 19 000 interacting protein 3 (BNIP3) on the migration and motility of human dermal microvascular endothelial cells (HDMECs) under hypoxia and the mechanism. Methods The experimental research method was applied. (1) HDMECs were divided into normoxia group received routine culture and hypoxia 6, 12, 24 h groups treated under hypoxia with oxygen volume fraction of 2% for corresponding time according to the random number table (the same grouping method below). Western blotting was used to detect the protein expressions of BNIP3 and microtubule-associated protein 1 light chain 3Ⅱ (LC3Ⅱ) in HDMECs. (2) HDMECs were divided into normoxia+ unloaded group, normoxia+ BNIP3 knockdown group, hypoxia+ unloaded group, and hypoxia+ BNIP3 knockdown group which were transfected with unloaded virus or BNIP3 knockdown virus and were subjected to normoxic or hypoxic treatment. The BNIP3 protein expression was detected by Western blotting and immunofluorescence staining. The scratch area at 24 h post scratching was detected by scratch test, and the healing rate of scratch was calculated. The curve distance of cell movement was measured with the living cell workstation, and the speed of movement was calculated within 3 hours. (3) HDMECs were grouped and treated as experiment (2). Western blotting and immunofluorescence staining were performed to detect the protein expression of LC3Ⅱ. The number of sample was 3 in the above-mentioned experiments. Data were statistically analyzed with one-way analysis of variance and least significant difference test. Results (1) Compared with those of normoxia group, the protein expressions of BNIP3 and LC3Ⅱ of cells in hypoxia 6, 12, 24 h groups were significantly increased (

<0.01). (2) After 6 hours of culture, compared with that of hypoxia+ unloaded group, the BNIP3 protein expressions of cells in normoxia+ unloaded group and hypoxia+ BNIP3 knockdown group were significantly decreased (

<0.05 or

<0.01). The red fluorescence denoting BNIP3 protein expression of cells in normoxia+ unloaded group and normoxia+ BNIP3 knockdown group was weak, the red fluorescence of cells in hypoxia+ unloaded group was strong, and the red fluorescence of cells in hypoxia+ BNIP3 knockdown group was significantly decreased compared with that in hypoxia+ unloaded group. After scratching for 24 hours, the scratch of cells in hypoxia+ unloaded group basically healed, while the remaining scratch area in the other three groups were large. The healing rates of scratch of cells in normoxia+ unloaded group, normoxia+ BNIP3 knockdown group, hypoxia+ unloaded group, and hypoxia+ BNIP3 knockdown group were (61±4)%, (58±4)%, (88±4)%, and (57±4)%, respectively. The healing rate of scratch of cells in hypoxia+ unloaded group was significantly higher than that in normoxia+ unloaded group (

<0.01) and hypoxia+ BNIP3 knockdown group (

<0.05). Within 3 hours of observation, the range of cell movement in hypoxia+ unloaded group was significantly larger than that in normoxia+ unloaded group, the range of cell movement in hypoxia+ BNIP3 knockdown group was significantly smaller than that in hypoxia+ unloaded group, and the curve movement velocity of cells in hypoxia+ unloaded group was significantly higher than that in normoxia+ unloaded group and hypoxia+ BNIP3 knockdown group (

<0.01). (3) After 6 hours of culture, compared with hypoxia+ unloaded group, the LC3Ⅱ protein expressions of cells in hypoxia+ unloaded group and hypoxia+ BNIP3 knockdown group were decreased significantly (

<0.05 or

<0.01). After 6 hours of culture, the red fluorescence denoting LC3 protein expressions of cells was weak in normoxia+ unloaded group and normoxia+ BNIP3 knockdown group, the red fluorescence of cells was significantly enhanced in hypoxia+ unloaded group, and the red fluorescence of cells was significantly inhibited in hypoxia+ BNIP3 knockdown group. Conclusions BNIP3 can promote the migration and motility of HDMECs under hypoxia, and autophagy may be involved in the regulation migration of HDMECs by BNIP3.

Objective To investigate the receptor pathways of glycated basic fibroblast growth factor (bFGF) on proliferation and vascularization of human dermal microvascular endothelial cells (HDMECs). Methods The experimental research method was used. Glycated bFGF stimulating solution was prepared with glucose and bFGF. HDMECs of the third to sixth passages were used in the experiment. Cells were divided into small interfering RNA (siRNA)-positive control group, siRNA-negative control group, siRNA-receptor for advanced glycation end product (RAGE) group, and siRNA-receptor for fibroblast growth factor (FGFR) group and transfected with siRNA-positive control glyceraldehyde-3-phosphate dehydrogenase, siRNA-negative control, siRNA-RAGE, and siRNA-FGFR for 4 to 6 hours, and then were added into HDMEC culture medium for routine culture. The transfection effect of siRNA was identified by reverse transcription polymerase chain reaction. The cells were divided into normal control group, glycated bFGF alone group, siRNA-RAGE alone group, and siRNA-RAGE+ glycated bFGF group, and seeded into 96-well plate and 6-well plate. Cells in siRNA-RAGE alone group and siRNA-RAGE+ glycated bFGF group were transfected with siRNA-RAGE and then were added into HDMEC culture medium for routine culture. After two days, the original HDMEC culture medium was discarded, and cells in siRNA-RAGE alone group were routinely cultured in HDMEC culture medium, cells in siRNA-RAGE+ glycated bFGF group were routinely cultured in glycated bFGF stimulating solution. Cells in normal control group were routinely cultured in HDMEC culture medium, and cells in glycated bFGF alone group were routinely cultured in glycated bFGF stimulating solution. After transfection with siRNA-RAGE, cells were seeded into 48-well plate and divided into siRNA-RAGE alone group and siRNA-RAGE+ glycated bFGF group. Another cells were directly seeded into 48-well plate without transfection and divided into normal control group and glycated bFGF alone group. Cells in the 4 groups were conducted with the corresponding treatment as above. Cells were divided into normal control group, glycated bFGF alone group, siRNA-FGFR alone group, and siRNA-FGFR+ glycated bFGF group and seeded into 96-, 6-, and 48-well plates, respectively, with the corresponding treatment the same as above. Only siRNA-RAGE was replaced by siRNA-FGFR. Cell counting kit 8 method was used to determine the proliferation of cells after 2 days of culture (sample number was 6), flow cytometry was used to detect the apoptosis of cells after 2 days of culture (sample number was 3), tube forming test was used to detect the angiogenesis of cells after 6 hours of culture (sample number was 4). Data were statistically analyzed with one-way analysis of variance and least significant difference

test. Results At the 200 bp band, there were no target genes in siRNA-positive control group, siRNA-RAGE group, or siRNA-FGFR group, but target genes were detected in siRNA-negative control group, indicating the success of siRNA transfection. After 2 days of culture, the absorbance value of cells in glycated bFGF alone group was significantly lower than that of normal control group (

=2.359,

<0.05); absorbance value of cells in siRNA-RAGE+ glycated bFGF group was significantly higher than that of glycated bFGF alone group (

=3.858,

<0.01), which was similar to that of siRNA-RAGE alone group (

=2.148,

>0.05). The absorbance value of cells in siRNA-FGFR+ glycated bFGF group was similar to that of glycated bFGF alone group (

=0.805,

>0.05), but significantly lower than that of siRNA-FGFR alone group (

=4.201,

<0.01). After 2 days of culture, the apoptotic rate of cells in glycated bFGF alone group was significantly higher than that of normal control group (

=2.416,

<0.05). The apoptotic rate of cells in siRNA-RAGE+ glycated bFGF group was significantly lower than the rates in glycated bFGF alone group and siRNA-RAGE alone group (

=3.861, 2.724,

<0.05 or

<0.01). There were no statistically significant differences in apoptosis rate of cells among normal control group, glycated bFGF alone group, siRNA-FGFR alone group, and siRNA-FGFR+ glycated bFGF group (

=2.218,

>0.05). After 6 hours of culture, the number of tubules of cells in normal control group (636±5) was significantly more than that of glycated bFGF alone group (580±8,

=10.825,

<0.01), and the number of tubules of cells in siRNA-RAGE+ glycated bFGF group (647±10) was significantly more than those of glycated bFGF alone group and siRNA-RAGE alone group (628±4,

=13.040, 3.641,

<0.01). After 6 hours of culture, the number of tubules of cells in siRNA-FGFR+ glycated bFGF group (619±5) was more than that of glycated bFGF alone group (

=9.000,

<0.01), but less than that of siRNA-FGFR alone group (632±3,

=2.814,

<0.05). Conclusions Glycated bFGF affects the proliferation and angiogenesis of HDMEC through RAGE pathway, which may be one of the reasons for impaired wound healing of diabetic skin.

Objective To analyze the mechanism of acidified silk protein sponge matrices and methanolized silk protein sponge matrices in promoting wound healing. Methods The experimental method was conducted. Acidified silk protein sponge matrices with vascularization ability and methanolized silk protein sponge matrices without vascularization ability were prepared by improved freeze-drying method. General observation was performed. Internal morphology was observed with scanning electron microscope. The secondary structure was observed with X-ray diffractometer (XRD) and infrared spectrometer. Compressive modulus was tested by tensile machine. Two 3-week-old male Sprague-Dawley (SD) rats were used to isolate bone marrow mesenchymal stem cells (BMSCs) cultured in above-mentioned two silk protein sponge matrices, the number of cells was counted under laser scanning confocal microscope after 1, 6 days of culture. Four full-thickness skin defect wounds were made on each one of twelve 8-week-old male SD rats, which were divided into methanolized silk group (24 wounds) and acidified silk group (24 wounds) covered with the corresponding silk protein sponge matrices. On post operation day (POD) 3, 7, 10, and 14, general observation was performed and the remaining wound area was recorded. On POD 3, 7, and 14, the wounds and marginal tissue were collected for hematoxylin-eosin staining (HE) staining and Masson staining to observe growth of new tissue and collagen deposition and CD34 immunohistochemical staining to observe vascularization. Sample number of each index of each group at every time point in animal experiment was 6. Data were statistically analyzed with analysis of variance of factorial design, analysis of variance for repeated measurement, independent-samples

test, and Bonferroni correction. Results Methanolized silk protein sponge matrices and acidified silk protein sponge matrices had the same composition and similar porous structure, with pore size of 300-500 μm. XRD showed that methanolized silk protein sponge matrices showed a significant crystallization peak, while acidified silk protein sponge matrices was mainly composed of amorphous structure. Infrared spectrometer showed that acidified silk protein sponge matrices appeared a strong absorption peak at 1 650 cm^-1, and the methanolized silk protein sponge matrices appeared a strong absorption peak at 1 630 cm^-1. Compressive modulus of methanolized silk protein sponge matrices was (23.8±1.3) kPa, which was significantly higher than (6.1±0.9) kPa of acidified silk protein sponge matrices (

=19.550,

<0.01). After one day of culture, BMSCs successfully adhered to the two kinds of silk protein sponge matrices, and the cells were not spread. After six days of culture, BMSCs were spread on the two kinds of silk protein sponge matrices, and the number of cells on the acidified silk protein sponge matrices increased significantly. On POD 3, the wounds of the 2 groups did not shrink significantly. On POD 7, the wound area in acidified silk group was significantly smaller than that in methanolized silk group, and new epithelium growth occurred at the wound edge. On POD 14, the wounds of acidified silk group basically healed, and the wounds of methanolized silk group were dry and shrinked significantly. Remaining wound area of acidified silk group on POD 3, 7, 10, and 14 were significantly smaller compared with that in methanolized silk group (

=7.782, 10.620, 3.707, 6.830,

<0.05 or

<0.01). HE staining, Masson staining, and CD34 immunohistochemical staining showed on POD 3, new tissue growing into silk protein sponge matrices of wounds of acidified silk group was more than that in methanolized silk group, the former group secreted a small amount of collagen, collagen formation was not observed in the latter group, the number of vascular endothelial cells migrated into the matrices were more in the former group than the latter group; on POD 7, the area of new tissue covering matrices hole of wounds of acidified silk group was larger than that in methanolized silk group, collagen in the former group was more than that in the latter group and was evenly distributed, the number of blood vessels in the former group was more than that on POD 3, and the new blood vessels in the latter group were scattered; on POD 14, the new tissue in acidified silk group was similar in structure to normal skin tissue and formed a certain thickness, the new tissue in methanolized silk group basically grew into the matrices, the former group had rich collagen deposition, the latter group had scattered collagen, and blood vessels in the former group distributed uniformly and density of blood vessels was significantly higher than that in the latter group ((55.7±6.0) and (34.1±1.0) pieces/mm², respectively,

=9.042,

<0.01). Conclusions Angiogenesis-promoting acidified silk protein sponge matrices have good cytocompatibility, which can facilitate the rapid formation of vascular network in wound area, providing sufficient blood supply to accelerate the tissue regeneration and collagen deposition, thereby promoting wound healing and improving healing quality, these effects are better than methanolized silk protein sponge matrices.

Objective To investigate the regulatory effect of bio-strength electric field (EF) on the motility and CD9 expression of human epidermal cell line HaCaT and mouse epidermal cells. Methods The experimental research method was used. Human immortal epidermal cell line HaCaT cells in logarithmic growth phase and primary epidermal cells isolated from 16 BALB/c mice (no matter male or female) aged 1-3 days were used for experiments. HaCaT cells were divided into EF group treated for 3 h at the EF intensity of 200 mV/mm and sham EF group with simulated treatment. The cell migration (direction, displacement velocity, and trajectory velocity, with 46 samples in EF group and 34 samples in sham EF group) and arrangement were observed in the living cell workstation, and the distribution and expression of CD9 protein were detected by immunofluorescence method. Both HaCaT cells and mouse epidermal cells were divided into sham EF group (simulated treatment) and EF groups treated respectively for 3 h at the corresponding EF intensity of 50, 100, 200, and 400 mV/mm. Both HaCaT cells and mouse epidermal cells were divided into blank control group without any treatment, and 1 h group, 3 h group, and 6 h group treated with EF at the intensity of 200 mV/mm for corresponding time respectively. The expression of CD9 protein was detected by Western blotting (

=3). Data were statistically analyzed with Mann-Whitney

test, one-way analysis of variance, independent sample

test and least significant difference test. Results Within 3 hours of treatment, HaCaT cells in EF group tended to move towards the negative electrode obviously, while HaCaT cells in sham EF group moved randomly around the origin; compared with those of sham EF group, the directivity of HaCaT cells in EF group was significantly enhanced, and the displacement velocity and trajectory velocity were significantly increased (

=-3.975, -6.052, -6.299,

<0.01). After 3 hours of treatment, the long axis of HaCaT cells in EF group was perpendicular to the direction of EF, while HaCaT cells in sham EF group arranged randomly. After 3 hours of treatment, the expression of CD9 protein in HaCaT cells in EF group was significantly down-regulated compared with that of sham EF group (

=4.527,

<0.01), although both expressed on cytomembrane. After 3 hours of treatment, the expression of CD9 protein in HaCaT cells and mouse epidermal cells in sham EF group, 50 mV/mm group, 100 mV/mm group, 200 mV/mm group, and 400 mV/mm group were 0.332±0.021, 0.283±0.032, 0.254±0.020, 0.231±0.041, 0.212±0.031 and 0.565±0.021, 0.453±0.022, 0.389±0.020, 0.338±0.021, 0.233±0.011, respectively. For both types of cells, compared with that of sham EF group, the expression of CD9 protein in cells was significantly decreased in the four groups of EF treatment (

<0.01); compared with that of 50 mV/mm group, the expression of CD9 protein in cells was significantly decreased in the other three groups of EF treatment (

<0.01); compared with that of 100 mV/mm group, the expression of CD9 protein in cells was significantly decreased in 200 mV/mm group and 400 mV/mm group (

<0.01); compared with that of 200 mV/mm group, the expression of CD9 protein in cells was significantly decreased in 400 mV/mm group (

<0.01). The expression levels of CD9 protein in HaCaT cells and mouse epidermal cells in blank control group, 1 h group, 3 h group, and 6 h group were 0.962±0.031, 0.784±0.020, 0.531±0.021, 0.409±0.011 and 0.963±0.031, 0.872±0.031, 0.778±0.040, 0.591±0.041, respectively. For both types of cells, compared with that of blank control group, the expression of CD9 protein in cells was significantly decreased in 1 h group, 3 h group, and 6 h group (

<0.01); compared with that of 1 h group, the expression of CD9 protein in cells was significantly decreased in 3 h group and 6 h group (

<0.05 or

<0.01); compared with that of 3 h group, the expression of CD9 protein in cells was significantly decreased in 6 h group (

<0.01). Conclusions The bio-strength intensity EF can induce the directional migration and arrangement of HaCaT cells and down-regulate the expression of CD9 in HaCaT cells and mouse epidermal cells in a time-dependent and intensity-dependent manner.

Objective To investigate the clinical effects of autologous platelet rich plasma (PRP) gel in combination with vacuum sealing drainage (VSD) technology in repairing refractory wounds. Methods From March 2011 to January 2015, 44 patients with refractory wounds meeting the inclusion criteria were recruited into VSD alone group, who were admitted to the Department of Burns and Plastic Surgery of the Yidu Central Hospital of Weifang and received intermittent VSD treatment. From February 2015 to September 2019, 43 patients with refractory wounds meeting the inclusion criteria were recruited into PRP+ VSD group, who were admitted to the same unit as above-mentioned and received PRP combined with intermittent VSD treatment. The retrospective cohort study was conducted. There were 24 males and 20 females with age of (37.5±2.2) years in VSD alone group, and there were 25 males and 18 females with age of (37.0±2.5) years in PRP+ VSD group. The wound exudate of patients in the two groups before and 7 and 14 d after the first treatment were collected for bacterial culture, and the positive rate of bacterial culture was calculated. The wound healing of patients in the two groups was observed on 7, 14, and 21 d after the first treatment, and the wound healing rate was calculated. The complete wound healing time of patients in the two groups was recorded. The degree of wound pain of patients in the two groups was evaluated by the Visual Analog Scale (VAS) before and 14 d after the first treatment. The scar hyperplasia of patients in the two groups was evaluated by the Vancouver Scar Scale (VSS) in 1 and 2 months after the wound healed completely. The occurrence of adverse reactions of patients in the two groups during the whole period of treatment was observed and the incidence of adverse reactions was calculated. Data were statistically analyzed with analysis of variance for repeated measurement, chi-square test, paired

test, and Bonferroni correction. Results The positive rates of bacterial culture in wound exudate of patients in PRP+ VSD on 7 and 14 d after the first treatment were 37.2% (16/43) and 11.6% (5/43), which were significantly lower than 56.8% (25/44) and 29.5% (13/44) in VSD alone group,

²=4.212, 4.255,

<0.05. The wound healing rates of patients in PRP+ VSD group on 7 and 14, and 21 d after the first treatment were respectively (58±14)%, (70±13)%, (89±12)%, which were significantly higher than (41±11)%, (60±11)%, (74±12)% in VSD alone group,

=6.323, 3.820, 5.751,

<0.01. The complete wound healing time of patients in PRP+ VSD group was (30±6) d, which was significantly shorter than (61±8) d in VSD alone group,

=20.890,

<0.05. The VAS score of patients in PRP+ VSD group was significantly lower than that in VSD alone group on 14 d after the first treatment (

=13.904,

<0.01). The VSS score of patients in PRP+ VSD group was significantly lower than that in VSD alone group in 1 and 2 months after the wound healed completely (

=3.307, 3.637,

<0.01). The incidence of adverse reactions of patients in PRP+ VSD group during the whole period of treatment was 7.0% (3/43), which was significantly lower than 22.7% (10/44) in VSD alone group,

²=4.245,

<0.05. Conclusions Autologous PRP gel combined with VSD technology in repairing refractory wounds not only has good bacteriostatic effect, but also can increase wound healing rate, shorten wound healing time, alleviate wound pain, reduce scar hyperplasia, with less adverse reaction, which is worthy of promotion.

Objective To explore the clinical effects of fractional carbon dioxide laser combined with autologous fat injection in the treatment of hypertrophic scar after burn. Methods From April 2018 to April 2019, 12 patients with hypertrophic scar after burn who met the inclusion criteria were admitted to the Department of Plastic Surgery and Burns of Xuzhou Renci Hospital, and were included in this prospective randomized controlled clinical study. There were 7 males and 5 females with age of (32±11) years and scar area of (612±195) cm². One scar was selected from each patient and divided into two equal area scars, and they were divided into combined treatment group and laser alone group with 12 scars in each group according to the random number table. The scar in laser alone group was only treated with fractional carbon dioxide laser, while the scar in combined treatment group was injected with autologous granular fat and then treated with fractional carbon dioxide laser. Scars in the two groups were treated once every 2 months, totally 3 times. Before the first treatment and 6 months after the last treatment, the scars in the two groups were evaluated by modified Vancouver Scar Scale (mVSS), hematoxylin-eosin staining and color Doppler ultrasound. Six months after the last treatment, the curative effect of scars in the two groups was evaluated, and the effective number of scar treatment was calculated. The adverse reactions during the whole treatment were recorded. Data were statistically analyzed with independent sample

test, paired sample

test, and McNemar exact probability method test. Results Six months after the last treatment, the mVSS score of scars in combined treatment group was (4.5±0.4) points, which was significantly lower than (7.8±0.6) points in laser alone group (

=10.000,

<0.01). Six months after the last treatment, the mVSS scores of scars in combined treatment group and laser alone group were significantly lower than those before the first treatment ((13.5±0.7) and (13.8±0.6) points,

=8.805, 9.010,

<0.01). The effective number of scar treatment in combined treatment group was significantly more than that in laser alone group (

<0.05). There was no scar aggravation, infection, or other adverse reactions during the treatment of scars in both groups. Before the first treatment, the scars in both groups had large collagen, disordered arrangement, proliferation of capillaries, infiltration of some inflammatory cells, and disappearance of skin appendages. Six months after the last treatment, the scar collagen in both groups was sparse and orderly arranged, and the vascular density was reduced. The improvement of scars in combined treatment group was more obvious than that of laser alone group. Six months after the last treatment, the scar thickness in combined treatment group was significantly smaller than that in laser alone group (

=2.657,

<0.05). Before the first treatment, the blood flow of scars in both groups was abundant; 6 months after the last treatment, the blood flow of scars in combined treatment group was significantly less than that in laser alone group. Conclusions Fractional carbon dioxide laser combined with autologous fat injection in the treatment of hypertrophic scar after burn can significantly reduce the pain and itching symptoms of scar, and improve the thickness, texture, and congestion of scar. The combined treatment has synergistic effect and less adverse reactions, providing a more effective treatment for patients with hypertrophic scar.

Objective To observe the influence of different treatment intervals of pulsed dye laser (PDL) in treating hypertrophic scar after burn, and to explore the optimal treatment interval. Methods From May 2018 to March 2019, 20 burn patients who met the inclusion criteria and were admitted to the First Affiliated Hospital of Air Force Medical University were included in this prospective randomized controlled study. Patients were divided into 1 week group (4 patients, 2 males and 2 females, aged 27 (4, 67) years, 19 scars), 2 weeks group (5 patients, 2 males and 3 females, aged 9 (3, 55) years, 15 scars), 3 weeks group (5 patients, 4 males and 1 female, aged 26 (19, 45) years, 15 scars), and 4 weeks group (6 patients, 4 males and 2 females, aged 31 (14, 48) years, 13 scars), according to the random number table, and treated with PDL with the treatment intervals of 1 week, 2 weeks, 3 weeks, and 4 weeks, respectively, with total treatment cycle of 3 months. Before the first treatment and three months after the first treatment, the Vancouver Scar Scale (VSS) was conducted and the decreased value of VSS score was calculated; the laser Doppler blood flow meter was used to measure scar blood perfusion and the proportion of change in blood perfusion volume was calculated. Data were statistically analyzed with Kruskal-Wallis test, Wilcoxon rank sum test, Wilcoxon symbolic rank sum test, Bonferroni correction, and Fisher′s exact probability test. Results The VSS scores of patients in 1 week group, 2 weeks group, 3 weeks group, and 4 weeks group in three months after the first treatment were significantly lower than those before the first treatment (

=-3.74, -3.47, -2.69, -3.25,

<0.01). There were no statistically significant differences in the decreased values of VSS scores in three months after the first treatment among the patients in 4 groups (

=2.35,

>0.05). Three months after the first treatment, the blood perfusion volumes of patients in 2 weeks group and 3 weeks group were significantly lower than those before the first treatment (

=-2.95, -2.50,

<0.05 or

<0.01). The proportions of changes in blood perfusion volume of patients in 1 week group, 2 weeks group, 3 weeks group, and 4 weeks group were respectively -0.02 (-1.05, 0.69), -0.29 (-0.75, 0.18), -0.11 (-0.55, 0.23), 0.05 (-0.61, 0.75). There were statistically significant differences among the 4 groups (

=9.39,

<0.05). The proportions of changes in blood perfusion volume of patients in 2 weeks group was statistically higher than that of 1 week group (

=2.76,

<0.01). Conclusions PDL treatment can reduce the VSS score and blood perfusion volume of scar. One treatment every two weeks or three weeks improve the scar blood perfusion volume more significantly, and can be recommended as the appropriate treatment interval of PDL for hypertrophic scar after burn.

Objective To investigate the effects of the dorsal branch of digital artery pedicled flap combined with V-Y advancement flap for repair of degloving injury of fingertip and reverse dorsal metacarpal recurrent artery pedicled island flap for relaying repair of the soft tissue defects in the donor sites of the proximal dorsum. Methods A total of 21 patients with degloving injuries of fingertips at the 2nd to 5th fingers were hospitalized in the Department of Hand Surgery of the Second Hospital of Tangshan from June 2016 to January 2019, including 14 males and 7 females aged 24-60 years. The retrospective clinical follow-up study was conducted. The areas of wounds after debridement ranged from 2.0 cm×1.5 cm to 3.5 cm×2.2 cm. The dorsal branch of digital artery pedicled flaps with dorsal branch of the proper digital nerve and dorsal digital nerve were designed in the proximal dorsum of the affected fingers to repair dorsal wounds in the distal dorsum of the affected fingers, and the sizes of the flaps ranged from 1.6 cm×1.5 cm to 2.6 cm×2.4 cm. The V-Y advancement flaps in the palmar side of the affected fingers were designed to repair palmar wounds in the distal segment of the affected fingers, and the sizes of the flaps ranged from 0.8 cm×0.6 cm to 2.0 cm×1.5 cm. The reverse dorsal metacarpal recurrent artery pedicled island flaps were used to repair the soft tissue defects in the donor sites of proximal dorsum, the sizes of the flaps ranged from 1.8 cm×1.7 cm to 2.8 cm×2.6 cm, and the donor sites of the flaps in back of hand were sutured directly. The survivals after the operation and the blood supply and appearance during follow-up of the three flaps were observed. At the final follow-up, the static two-point discrimination distance of the three flaps was measured, the satisfaction degree of patients for the appearance of hand was evaluated based on Michigan Hand Function Questionnaire, and the total active range of motion of the injured finger joints was assessed by the trial standard for the evaluation of the functions of the upper limbs of the Hand Surgery Society of the Chinese Medical Association. Results All the flaps survived after operation. Tension blisters appeared on the surface of one dorsal branch of digital artery pedicled flap, and the wound healed after removing the stitch at the pedicle and changing dressings. During follow-up of 6-20 months, with an average of 12 months, the three kinds of flaps had good appearance, soft texture, and similar color with surrounding tissue, and with only linear scars in donor sites of the dorsal hand. At the final follow-up, the static two-point discrimination distances of V-Y advancement flaps, dorsal branch of digital artery pedicled flaps, and reverse dorsal metacarpal recurrent artery pedicled island flaps were 4-7 mm, 5-10 mm, and 8-15 mm, respectively. Sixteen patients were strongly satisfied with the appearance of hand, and the remaining five patients were satisfied with the appearance of hand. The total active range of motion of the injured finger joints was evaluated as excellent in 17 cases, good in 4 cases. Conclusions The operation is simple and reliable for dorsal branch of digital artery pedicled flap combined with V-Y advancement flap to repair the degloving injury of fingertip, and reverse dorsal metacarpal recurrent artery pedicled island flaps to repair the soft tissue defects in the donor sites of the proximal dorsum, and the appearance and function of the affected fingers recover well, with minimal injury.

Objective To investigate the effect of virtual reality (VR) video-based pre-discharge psychological intervention on the post-discharge emotions of patients with deep facial burn. Methods From October 2017 to September 2019, 84 patients with deep facial burn who were hospitalized in the First Hospital of Jilin University and met the inclusion criteria were enrolled in the prospective randomized controlled study were. According to the random number table, the patients were divided into two groups, with 40 cases (21 males and 19 females) left in VR video group, aged 18-53 years and 41 cases (22 males and 19 females) in general video group, aged 19-55 years after several patients dropped out in follow-up. Seven patients who had been treated in the First Hospital of Jilin University from January 2014 to December 2016 and returned to work and life after recovering from the deep facial burn were selected, and then the pictures and corresponding commentaries before and after burn injuries, the problems and solutions after discharge, and the image data of living status of each patient were edited and recorded into a video. From seven days before discharge, the patients in VR video group began to watch videos by wearing VR glasses, while the patients in general video group began to watch videos on a tablet computer, for 7 days . On the 7th day before discharge (before watching the videos) and one month after discharge, the Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), and Social Avoidance and Distress (SAD) Scale were used to evaluate the level of anxiety, depression, and social avoidance and distress of patients in both groups. Data were statistically analyzed with paired or independent sample

test, chi-square test, or Fisher′s exact probability test. Results On the 7th day before discharge, the scores of anxiety, depression, and social avoidance and distress of patients in general video group were (34±7), (34±6), and (11.5±3.9) points, respectively, close to (35±7), (35±5), and (10.5±3.9) points in VR video group (

=-0.803, -1.050, 1.122,

>0.05), and the scores of both groups were higher than the national norms. One month after discharge, the scores of anxiety, depression, and social avoidance and distress of patients in VR video group were (31±5), (31±5), and (7.2±2.5) points, respectively, significantly lower than the scores on the 7th day before discharge (

=6.609, 7.492, 7.622,

<0.01); the scores of anxiety, depression, and social avoidance and distress of patients in general video group were (37±7), (38±8), and (13.9±7.4) points, respectively, significantly higher than the scores on the 7th day before discharge (

=2.802, 3.599, 2.739,

<0.01). One month after discharge, the scores of anxiety, depression, and social avoidance and distress of patients in VR video group were significantly lower than those in general video group (

=4.722, 5.043, 5.490,

<0.01). Conclusions Pre-discharge psychological intervention of patients with deep facial burn using VR videos can alleviate their bad emotions after discharge, such as anxiety, depression, and social avoidance and distress.