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2026 Vol. 42, No. 5

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Guideline and Consensus
Expert consensus on airway lavage therapy for adult burn patients (2026 edition)
2026, 42(5): 403-414. doi: 10.3760/cma.j.cn501225-20260212-00080
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Airway lavage therapy is an important method for clearing airway secretions and sloughed tissue in burn patients. It primarily includes fiberoptic bronchoscopy-guided lavage and direct airway lavage. To further improve the standardization, safety, and effectiveness of airway lavage therapy in burn patients, the consensus writing group, based on evidence from evidence-based medicine and guided by the Delphi method, conducted literature searches, quality evaluations, evidence synthesis, and expert consultations. They formulated the Expert consensus on airway lavage therapy for adult burn patients (2026 edition), which provides a reference for clinical practice, covering topics such as indications, contraindications, pre-operational preparation, timing and protocols of operation, monitoring, and complication management of airway lavage therapy for adult burn patients.
Expert Forum
Clinical categorization and microsurgical reconstruction strategies for complex foot-ankle tissue defects
Tang Juyu
2026, 42(5): 415-420. doi: 10.3760/cma.j.cn501225-20260407-00143
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The foot and ankle have a special anatomical structure and bear crucial functions of body such as weight bearing, walking, running, and jumping. High-energy injuries to these areas are complex, posing challenges to clinical tissue reconstruction. Complex foot-ankle tissue defects mostly present as multicompartmental defects involving skin and soft tissue, tendons, bones, and joints, as well as large-area skin and soft tissue defects. We divided the foot and ankle into nine regions based on the anatomical characteristics and physiological functions of different sites. Ten clinical types were then classified according to the involved regions of tissue defects and the presence of combined deep tissue defects. For each clinical type, appropriate flap donor sites and suitable special form of perforator flap procedures can be selected based on the requirements of microsurgical reconstruction to achieve personalized and precise reconstruction, so as to achieve the optimal restoration of the appearance and function of the foot and ankle with minimal donor-site damage.
A brief discussion on microsurgery techniques and free perforator flaps for wound repair
Deng Chengliang, Jian Xichao
2026, 42(5): 421-427. doi: 10.3760/cma.j.cn501225-20260224-00085
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Microsurgical techniques have evolved from conventional microsurgical anastomosis to supermicrosurgery, and then to robot-assisted surgery, continuously advancing towards greater precision, finer detail, and greater intelligence. Free flap transplantation has undergone a conceptual shift from focusing solely on recipient site repair to also emphasizing donor-site protection, driving the development of free perforator flaps towards ultra-thin, chimeric, and functional designs, and also gradually opening the exploration into cutting-edge fields such as allogeneic or xenogeneic transplantation. Furthermore, artificial intelligence technology is increasingly integrated into the entire process of wound repair preoperative planning, intraoperative navigation, and postoperative evaluation, prompting clinical decision-making to shift from experience-dependent reliance to evidence-based support. This paper briefly discusses the microsurgical techniques and free perforator flaps for wound repair, aiming to offer theoretical support for their clinical application and optimization.
Original Article·Flap Transplantation for Wound Repair
Clinical application effects of vertical mattress suture combined with teardrop-shaped end-to-side arterial anastomosis technique in free flap transplantation for repairing limb wounds
Chen Tao, Deng Chengliang, Gao Shaoying, Zhou Jian, Zhang Tianhua
2026, 42(5): 428-435. doi: 10.3760/cma.j.cn501225-20260131-00061
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  Objective  To explore the clinical application effects of vertical mattress suture combined with teardrop-shaped end-to-side arterial anastomosis technique in free flap transplantation for repairing limb wounds.  Methods  This study was a retrospective case series study. From March 2023 to December 2024, 41 patients with skin and soft tissue defect wounds in limbs who met the inclusion criteria were admitted to the Department of Burns and Plastic Surgery of the Affiliated Hospital of Zunyi Medical University. Among them, there were 29 males and 12 females, aged from 39 to 74 years. After debridement, the wound areas ranged from 5.8 cm×3.5 cm to 17.5 cm×6.6 cm. The wounds were repaired with free anterolateral femoral perforator flaps, thoracodorsal artery perforator flaps, latissimus dorsi myocutaneous flaps, and medial sural artery perforator flaps, with flap areas of 8.0 cm×4.0 cm to 19.5 cm×7.0 cm. Due to atherosclerosis or intimal delamination of recipient arteries, or significant mismatch in arterial diameters between the donor and recipient sites, the vertical mattress suture combined with teardrop-shaped end-to-side arterial anastomosis technique was used for arterial anastomosis in the donor and recipient sites. The wounds in the donor site were directly closed after reducing tension. During the surgery, the situation of atherosclerosis or intimal delamination of recipient arteries, or significant mismatch in arterial diameters between the donor and recipient sites was observed. After surgery, the complete survival of the flaps was observed, and the complete flap survival rate was calculated. The occurrence of postoperative complications was recorded. During the follow-up after surgery, the color, texture, and hypertrophy of the surviving flaps, as well as scar hyperplasia in the donor site were observed. Before surgery and at the final follow-up, the function of the affected limbs was assessed in patients with wounds in upper and lower limbs using the upper limb function index (UEFI) and foot function index (FFI), respectively. At the final follow-up, the satisfaction of patients with the appearance of the donor and recipient sites and the function of the affected limbs were recorded.  Results  During the surgery, it was observed that 23 patients had atherosclerosis or intimal delamination in the recipient artery anastomosis site; in 18 patients, there was a significant difference in the diameter of the flap artery and the recipient artery, with the ratio ranging from 1.0∶1.5 to 1.0∶3.3, with an average of 1.0∶2.4. After surgery, 40 patients had complete flap survival, with a complete flap survival rate of 97.6% (40/41). After surgery, 5 patients with infectious wounds had delayed suture healing, which healed after dressing changes. No arterial crisis occurred in any patient during hospitalization after surgery. During follow-up of 6 to 18 months after surgery, the surviving flaps had similar color and texture to the recipient skin, with a full but non-bulky appearance. Only linear scars occurred in the donor site, with no obvious hypertrophic scar. Before surgery, the UEFI of upper limbs ranged from 29 to 54, with an average of 41; at the final follow-up, the UEFI of upper limbs ranged from 59 to 72, with an average of 65. Before surgery, the FFI of lower limbs ranged from 43 to 87, with an average of 73; at the final follow-up, the FFI of lower limbs ranged from 15 to 42, with an average of 29. At the final follow-up, 24 out of 28 patients with wounds in lower limbs were able to walk without the assistance of auxiliary tools; all the patients were satisfied with the appearance of the donor and recipient sites, as well as the function of the affected limbs.  Conclusions  The vertical mattress suture combined with teardrop-shaped end-to-side arterial anastomosis technique effectively achieves the eversion and apposition of the arterial intima. This technique applied in free flap transplantation to repair limb wounds can prevent arterial crisis, with high flap survival rate and satisfaction of patients after surgery, thus having application value in clinical practice.
Clinical efficacy of applying orthoplastic principle in treating Gustilo type ⅢB open ankle joint fractures
Lin Fang, Kang Yongqiang, Rui Yongjun, Liu Jun, Wang Yapeng, Wu Yongwei, Ma Yunhong, Wang Peng, Shan Xiaotian
2026, 42(5): 436-443. doi: 10.3760/cma.j.cn501225-20260108-00016
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  Objective  To investigate the clinical efficacy of applying orthoplastic principle in treating Gustilo type ⅢB open ankle joint fractures.  Methods  This study was a retrospective case series study. From January 2018 to August 2024, 33 patients with Gustilo type ⅢB open ankle joint fractures who met the inclusion criteria were admitted to Wuxi Ninth People's Hospital, including 25 males and 8 females, aged 25-65 (44±12) years. The area of skin and soft tissue defects ranged from 6 cm×3 cm to 27 cm×14 cm. The length of bone defect ranged from 3.0 to 9.2 cm (with mean of 3.7 cm). All patients were treated based on the orthoplastic principle. Phase Ⅰ-Stage 1: after thorough debridement was performed in emergency department, antibiotic bone cement was inserted in the tibial defect, an external fixator or an antibiotic bone cement-coated steel plate was applied for temporary stabilization. Nerves and tendons were repaired, and the remaining wound was covered with vacuum sealing drainage dressing. Phase Ⅰ-Stage 2: on days 3 to 7 after injury, the wound was debrided again, and the antibiotic bone cement was replaced. The internal fixation was adjusted or retained according to the fracture status, and an anterolateral thigh flap (with size ranging from 7 cm×3 cm to 30 cm×15 cm) was designed and harvested to repair the wound. A stepwise strategy was employed for treating the donor site wounds based on the defect size and local tension. For wounds with low tension, primary closure was performed. For wounds with high tension, the wound edges were appropriately pulled together during operation, and either direct closure or split-thickness skin grafting from the opposite thigh was carried out after the postoperative edema subsided. Phase Ⅱ-Stage 3 (the only stage): 7 to 30 weeks after injury (with mean of 15.8 weeks), the antibiotic bone cement was removed, the volume of bone defect was measured, and the iliac crest bone was harvested precisely, mixed with vancomycin, and used to fill the bone defect; the induced membrane and skin soft tissue were then sutured. Postoperative flap survival and infection-related complications at different stages were recorded. During follow-up, flap appearance and texture, scar condition at the donor and recipient sites, and bone healing were documented. At the last follow-up, the affected foot function was assessed using the foot and ankle ability measure (FAAM) scale, and the percentage of recovery in daily living ability was calculated. Patient health outcomes were assessed using the 36-item short form health survey (SF-36), and the scores of the physical component summary (PCS) and mental component summary (MCS) were calculated.  Results  Complete flap survival was achieved in 30 patients after operation. Partial flap necrosis occurred in 3 patients, among whom 1 case healed by direct suture after debridement, and 2 cases healed by skin grafting after debridement. Infection-related complications occurred in 4 patients, including superficial infection in 3 cases (1 case after Stage 2 in Phase Ⅰ, 2 cases after Stage 3 in Phase Ⅱ), all of which were controlled after debridement with wound healing. Bone infection occurred in 1 case (after Stage 2 in Phase Ⅰ), which was controlled after repeated thorough debridement and antibiotic bone cement packing, and bone grafting healed. The follow-up period ranged from 12 to 57 months (with mean of 26.7 months). All flaps showed good color and texture. Scar hyperplasia at the flap donor site occurred in 3 cases, while only linear scars remained at the recipient site. At final follow-up, the FAAM scale score of the affected foot was 71±4, and the recovery of daily living ability reached (85±5)%. The PCS score on the SF-36 was 78±4, and the MCS score was 70±11.  Conclusions  Applying the orthoplastic principle for treating Gustilo type ⅢB open ankle joint fractures results in low infection and other complication rates, along with satisfactory functional recovery of the ankle joint.
Clinical efficacy of ALTF combined with "Y"-shaped great saphenous vein graft in repairing large soft tissue defects in the proximal-middle segment of the lower leg
Zhong Shuo, Wang Yunpeng, Xu Chanjun, Liu Linfeng
2026, 42(5): 444-451. doi: 10.3760/cma.j.cn501225-20260130-00055
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  Objective  To explore the clinical efficacy of using the anterolateral thigh flap (ALTF) combined with "Y"-shaped great saphenous vein graft in repairing large soft tissue defects in the proximal-middle segment of the lower leg.  Methods  This study was a retrospective case series study. From January 2019 to December 2023, 8 patients with large soft tissue defects in the proximal-middle segment of the lower leg meeting the inclusion criteria were admitted to the Department of Hand & Foot and Reconstructive Microsurgery of Shandong Provincial Hospital Affiliated to Shandong First Medical University, including 7 males and 1 female, aged 15 to 63 years. After the wounds were cleaned and the infection was controlled, the areas of soft tissue defects in the lower leg ranged from 18 cm×7 cm to 30 cm×14 cm. The ALTF combined with "Y"-shaped great saphenous vein graft was conducted to repair the soft tissue defects in the lower leg. The flap harvest areas were 19 cm×8 cm to 31 cm×15 cm. Intraoperatively, the bifurcated ends of the "Y"-shaped great saphenous vein were end-to-end anastomosed with the descending genicular artery and the medial femoral muscle branch (MFMB), respectively, and the main trunk end was end-to-end anastomosed with the descending branch of lateral femoral circumflex artery (LFCA-DB), constructing a "dual-in, single-out" venous bridging mode. The dominant concomitant vein of LFCA-DB was end-to-end anastomosed with the recipient great saphenous vein. If there was no suitable vein in the recipient area of the lower leg for anastomosis with the dominant concomitant vein of LFCA-DB, a segment of the great saphenous vein from the contralateral lower leg was harvested and bridged to the dominant concomitant vein of LFCA-DB, and then end-to-end anastomosed with the above-knee great saphenous vein. The flap donor site wounds were directly sutured in 3 cases, and repaired with full-thickness skin grafts from the ipsilateral inguinal region in 5 cases. The length of the flap pedicle vessels and the length of the defect between the flap pedicle vessels and the planned anastomotic descending genicular artery and MFMB were recorded. Postoperatively, the flap survival and the wound healing in the donor sites were observed. During follow-up, the appearance, texture, and sensory recovery of the flaps, the recovery of flap donor sites, and the limb swelling in the vein donor sites were observed. At the last follow-up, the 5-point Likert scale was used to investigate the satisfaction of patients with the treatment effects in the flap recipient and donor sites.  Results  The lengths of the flap pedicle vessels of patients were 12 to 17 cm, with an average of 14.1 cm. The lengths of the defects between the flap pedicle vessels and the planned anastomotic descending genicular artery and MFMB were 9 to 16 cm, with an average of 12.3 cm. Postoperatively, all flaps survived completely, without vascular crisis; all flap donor site wounds healed well. During follow-up of 12 to 40 months, the flaps of 6 patients showed no bulkiness; two flaps developed local bulkiness due to compression during the subsequent tibial bone transport treatment, of which one case improved after surgical debulking, and one case received no modification treatment. The flaps were soft in texture, with moderate tension and no ulcer, and all regained protective sensation. The flap donor sites all recovered well. The direct suture areas left slight linear scars, the skin grafted areas left slight scars, and the limbs in the vein donor sites showed no swelling. At the last follow-up, the satisfaction scores of patients with the treatment effects in the recipient and donor sites were all 4 and 5.  Conclusions  The application of ALTF combined with "Y"-shaped great saphenous vein graft anastomosed to the descending genicular artery and MFMB to repair large soft tissue defects in the proximal-middle segment of the lower leg can effectively achieve the caliber physiological matching of the donor and recipient vessels, ensure the blood supply of the large-area flaps through dual blood supply, and avoid the periwound inflammation to reduce the risk of vascular crisis. The patients are satisfied with the treatment effect of the donor and recipient sites.
Original Article
Clinical effects of harvesting superficial circumflex iliac artery PSP flaps via the subdermal approach to repair skin and soft tissue defects in hands and feet
Zhu Xuwei, Zhou Feiya, Ding Jian, Li Zhijie, Zhang Wenzhen, Li Shi
2026, 42(5): 452-458. doi: 10.3760/cma.j.cn501225-20241215-00487
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  Objective  To investigate the effects and safety of harvesting superficial circumflex iliac artery pure skin perforator (PSP) flaps via the subdermal approach to repair skin and soft tissue defects in hands and feet.  Methods  This study was a retrospective case series study. From March 2022 to February 2024, 14 patients with 15 skin and soft tissue defect wounds in hands and feet who met the inclusion criteria were admitted to the Department of Wound Repair of the Second Affiliated Hospital of Wenzhou Medical University. There were 9 males and 5 females, aged 6 to 64 years. After debridement, the wound areas ranged from 5.6 cm×1.9 cm to 14.0 cm×7.0 cm. Before surgery, the perforators were located using high-frequency ultrasound. During surgery, 15 superficial circumflex iliac artery PSP flaps were harvested via the subdermal approach to repair the wounds. The flap harvesting time ranged from 37 to 140 minutes, and the flap areas ranged from 5.6 cm×1.9 cm to 14.0 cm×7.0 cm. Vascular anastomosis was performed between the donor and recipient sites. The donor site wounds were closed by direct suturing. After surgery, the survival of flaps was observed, and the occurrence of complications was recorded. At the final follow-up, the 5-point Likert scale was used to evaluate the flaps from 4 aspects: overall aesthetic appearance, contour similarity to surrounding tissue, color similarity to surrounding tissue, and texture similarity to surrounding tissue.  Results  All 15 flaps survived successfully after surgery. One flap developed purple plaque, which stabilized after dressing changes. One flap developed venous crisis, which was alleviated after surgery. One patient experienced wound dehiscence in the donor site, which successfully healed after debridement and dressing changes for one week. At the final follow-up, the overall aesthetic appearance score of the flaps ranged from 3.3 to 5.0, with an average of 4.5; the contour similarity to surrounding tissue ranged from 3.7 to 5.0, with an average of 4.7; the color similarity to surrounding tissue ranged from 3.3 to 5.0, with an average of 4.5; the texture similarity to surrounding tissue ranged from 3.7 to 5.0, with an average of 4.8.  Conclusions  Harvesting superficial circumflex iliac artery PSP flaps via the subdermal approach to repair skin and soft tissue defects in hands and feet is a safe and feasible surgery as all the flaps survived after surgery, with favorable aesthetic appearance, contour, color, and texture.
Research on the pharmacokinetics of linezolid in burn patients
Fang Yan, Ding Peijie, Fang Jie, He Xiaoshuang, Bian Xiaolan, Liu Yan, Wei Lailai, Shi Yan
2026, 42(5): 459-466. doi: 10.3760/cma.j.cn501225-20251028-00447
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  Objective  To explore the pharmacokinetic characteristic of linezolid in burn patients and its influencing factors.  Methods  This study was a retrospective cohort study. From August 1st, 2024 to August 1st, 2025, 74 burn patients who were admitted to the Department of Burn of Ruijin Hospital of Shanghai Jiao Tong University School of Medicine, received linezolid treatment under the standard dosing regimen of 600 mg every 12 hours, and completed monitoring of plasma trough concentration of linezolid (hereinafter referred to as plasma trough concentration), were included as burn group, including 22 males and 52 females, aged 16-87 years, with a total of 81 plasma trough concentration measurements. During the same period, 74 patients with pulmonary infection who were admitted to the Department of Critical Care Medicine of the same hospital, received the same linezolid treatment, and completed monitoring of plasma trough concentration, were included as pulmonary infection group, including 51 males and 23 females, aged 23-90 years, with a total of 75 plasma trough concentration measurements. The plasma trough concentrations of patients in two groups were detected at 30 min before the fifth administration using liquid chromatography-tandem mass spectrometry. In burn group of patients, the correlations between the plasma trough concentration and age, body weight, total burn area, full-thickness burn area, admission time after burn, serum albumin level, serum creatinine level, and creatinine clearance rate were analyzed. In pulmonary infection group of patients, the correlations between the plasma trough concentration and age, body weight, serum albumin level, serum creatinine level, and creatinine clearance rate were analyzed. The interaction of plasma trough concentration with age, body weight, serum albumin level, and serum creatinine level in two groups of patients were analyzed.  Results  The plasma trough concentration in burn group of patients was 2.30 (0.65, 5.70) mg/L, which was significantly lower than 4.07 (2.01, 7.82) mg/L in pulmonary infection group (Z=-3.131, P<0.05). The proportion with plasma trough concentration <2 mg/L in burn group of patients was 46.91% (38/81), which was significantly higher than 22.67% (17/75) in pulmonary infection group (χ²=10.030, P<0.05). In burn group of patients, the plasma trough concentration was significantly positively correlated with age (rs=0.483, P<0.05), and significantly negatively correlated with body weight and full-thickness burn area (with rs values of -0.247 and -0.231, respectively, P<0.05). In pulmonary infection group of patients, the plasma trough concentration was significantly negatively correlated with creatinine clearance rate (rs=-0.344, P<0.05), and significantly positively correlated with serum creatinine level (rs=0.255, P<0.05). In both pulmonary infection group and burn group of patients, the plasma trough concentration showed a significant interaction with the serum albumin level (with β values of 0.201 and -0.145, respectively, 95%CI of -0.085 to 0.488 and -0.344 to 0.055, respectively, P<0.05).  Conclusions  Under the standard dosing regimen of linezolid, the plasma trough concentration in patients with burns was significantly lower than that in patients with pulmonary infection, and the proportion of low drug exposure was higher. In patients with burns, the plasma trough concentration was correlated with age, body weight, and full-thickness burn area. The plasma trough concentration in both patients with burns and patients with pulmonary infection showed a significant interaction with the serum albumin level.
Influence and mechanism of exosomes derived from rat bone marrow mesenchymal stem cells on rat Fbs under high glucose conditions
Wu Yue, Yin Wenhui, Yu Miao, Wang Da, Wu Jian
2026, 42(5): 467-476. doi: 10.3760/cma.j.cn501225-20250402-00158
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  Objective  To investigate the influence and mechanism of exosomes derived from rat bone marrow mesenchymal stem cells (BMSCs) on rat fibroblasts (Fbs) under high glucose conditions, with the aim of exploring a potential novel strategy for the treatment of diabetic wounds.  Methods  This study was designed as grouped experimental study. The exosomes derived from BMSCs (BMSC-Exos) were extracted from the rat primary BMSCs and were identified successfully. The BMSC-Exos were divided into control group and high-glucose group. The BMSC-Exos in control group were cultured routinely, while the BMSC-Exos in high-glucose group were cultured in DMEM medium containing glucose at a final molarity of 30 mmol/L (hereinafter referred to as high-glucose medium). The eukaryotic mRNA sequencing was performed on BMSC-Exos in both groups, combined with multi-database prediction and enrichment analysis, differentially expressed genes that strongly interacted with the classical pyroptosis signaling pathway were screened and identified. The rat BMSCs of passages 1 to 3 were divided into microRNA-140-3p (miR-140-3p) mimic control group, miR-140-3p mimic group, miR-140-3p inhibitor control group, and miR-140-3p inhibitor group according to the random number table method, then the corresponding miR-140-3p mimic control, miR-140-3p mimic, miR-140-3p inhibitor control, and miR-140-3p inhibitor were transfected into cells, respectively, after 24 hours of culture. The BMSC-Exos were extracted at 24 hours post-transfection, and the expression of miR-140-3p in BMSC-Exos was detected by real-time fluorescence quantitative polymerase chain reaction. The rat Fbs in the logarithmic growth phase were divided into miR-140-3p mimic control group, miR-140-3p mimic group, miR-140-3p inhibitor control group, and miR-140-3p inhibitor group. After 24 hours of culture in high-glucose medium, the Fbs were added with the exosomes secreted by BMSCs after being transfected with miR-140-3p mimic control, miR-140-3p mimic, miR-140-3p inhibitor control, and miR-140-3p inhibitor, respectively (the same grouping and treatment below). At 24 hours post-transfection, the cell absorbance value was detected using cell counting kit-8, representing cell proliferation activity. The rat Fbs in the logarithmic growth phase were grouped and treated, then the cell migration rate at 24 hours after scratching was detected by scratch test. At 24 hours post-transfection, the protein expression levels of pyroptosis-related protein, including interleukin-1β (IL-1β), IL-18, NOD-like receptor pyrin domain-containing protein 3 (NLRP3), cysteine aspartic acid specific protease-1 (caspase-1), and gasdermin D in cells were detected by Western blotting. The sample size was 3.  Results  Compared with that in control group, the expressions of miR-140-3p and miR-542-5p were significantly upregulated in BMSC-Exos of high-glucose group. MiR-140-3p was identified as the differentially expressed gene that strongly interacted with the classical pyroptosis signaling pathway. At 24 hours post-transfection, the expression of miR-140-3p in BMSC-Exos of miR-140-3p mimic group was significantly higher than that in miR-140-3p mimic control group (P<0.05), and the expression of miR-140-3p in BMSC-Exos of miR-140-3p inhibitor group was significantly lower than that in miR-140-3p inhibitor control group (P<0.05). At 24 hours post-transfection, the absorbance value of Fbs in miR-140-3p mimic group was 0.940±0.031, which was significantly higher than 0.781±0.020 in miR-140-3p mimic control group (P<0.05); the absorbance value of Fbs in miR-140-3p inhibitor group was 0.510±0.041, which was significantly lower than 0.822±0.061 in miR-140-3p inhibitor control group (P<0.05). The Fb migration rate at 24 hours after scratching in miR-140-3p mimic group was significantly higher than that in miR-140-3p mimic control group (P<0.05), and the Fb migration rate at 24 hours after scratching in miR-140-3p inhibitor group was significantly lower than that in miR-140-3p inhibitor control group (P<0.05). At 24 hours post-transfection, the protein expressions of NLRP3, IL-18, IL-1β, caspase-1, and gasdermin D in Fbs of miR-140-3p mimic group were significantly lower than those in miR-140-3p mimic control group (P<0.05); the protein expressions of NLRP3, IL-18, IL-1β, caspase-1, and gasdermin D in Fbs of miR-140-3p inhibitor group were significantly higher than those in miR-140-3p inhibitor control group (P<0.05).  Conclusions  The rat BMSC-Exos can deliver miR-140-3p to promote the proliferation and migration of rat Fbs under high-glucose conditions, inhibit the expression of pyroptosis-related protein, and alleviate cell pyroptosis. This study provides a promising therapeutic target for diabetic wound repair.
Effects of glutathione on acute cutaneous photodamage in mice and its mechanism
Wang Qi, Zhou Ling, Deng Yin, Qiu Zijin, Wu Xia, Zhao Chuan
2026, 42(5): 477-485. doi: 10.3760/cma.j.cn501225-20250628-00284
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  Objective  To investigate the effects of glutathione on acute cutaneous photodamage in mice and its mechanism.  Methods  This study was a group-designed experimental study. Fifteen 8-week-old male C57BL/6 mice were shaved on the dorsal skin and divided into blank control group, model group, low-dose intervention group, medium-dose intervention group, and high-dose intervention group using a random number table, with 3 mice in each group. Mice in model group received daily combined irradiation of ultraviolet B and ultraviolet A on the dorsal skin to cause acute photodamage, followed by intraperitoneal injection of phosphate-buffered saline (PBS). Mice in blank control group were subjected to sham injury without ultraviolet irradiation and received daily intraperitoneal injection of PBS only. Mice in low-dose intervention group, medium-dose intervention group, and high-dose intervention group received daily ultraviolet irradiation as the model group, followed by intraperitoneal injection of 50, 100, and 200 mg/kg of glutathione, respectively. Two hours after the last injection on day 7 post injury (hereinafter referred to as day 7 post injury), the color and morphology of the dorsal skin of mice in each group were observed grossly. Then, dorsal skin tissue was excised for the following assays. Hematoxylin-eosin staining was used to examine the structure of the stratum corneum, epidermis, and dermis, the morphology of appendages (hair follicles, sweat glands, and sebaceous glands), the presence of hemorrhage, inflammatory cell infiltration, and the thickness of epidermis were also measured. Masson staining was used to detect collagen fiber deposition in the skin tissue. Western blotting was used to detect the protein expressions of inflammation-related proteins (interleukin-1β (IL-1β), IL-6, tumor necrosis factor-α (TNF-α), and matrix metalloproteinase 1 (MMP-1)) in the skin tissue.  Results  On day 7 post injury, compared with that in blank control group, the skin of mice in model group showed extensive scaling, redness, swelling, and crusting. Compared with that in model group, the severity of photodamage of the skin of mice in low-dose intervention group, medium-dose intervention group, and high-dose intervention group was alleviated successively. On day 7 post injury, compared with that in blank control group, the skin tissue structure of mice in model group was disorganized, characterized by thickened and detached stratum corneum, increased number and disordered arrangement of epidermal cell layers, dermal edema, abnormal morphology of appendages (hair follicles, sweat glands, sebaceous glands), scattered hemorrhagic foci, and extensive inflammatory cell infiltration. Compared with that in model group, the degree of tissue disorganization in the skin of mice in low-dose intervention group, medium-dose intervention group, and high-dose intervention group was alleviated successively. On day 7 post injury, the epidermal thickness of the skin of mice in model group was (116.4±6.4) μm, which was significantly greater than (20.9±1.6) μm in blank control group (P<0.05). Compared with that in model group, the epidermal thickness of the skin of mice in medium-dose intervention group and high-dose intervention group ((77.7±5.6) μm and (56.9±0.8) μm, respectively) was significantly decreased (with P valuesboth <0.05). On day 7 post injury, compared with that in blank control group, the skin tissue of mice in model group showed a significant increase in collagen fiber content and disorganized fiber arrangement, indicating a certain degree of collagen fiber proliferation. Compared with that in model group, the arrangement of collagen fibers in the skin tissue of mice in low-dose intervention group, medium-dose intervention group, and high-dose intervention group became progressively more regular, and the overall tissue structure gradually recovered to normal. On day 7 post injury, compared with those in blank control group, the protein expression levels of IL-1β, IL-6, TNF-α, and MMP-1 in the skin tissue of mice in model group were significantly increased (with P values all <0.05). Compared with those in model group, the protein expression levels of IL-1β and IL-6 in the skin tissue of mice in low-dose intervention group were significantly decreased (with P values both <0.05), while the protein expression levels of IL-1β, IL-6, TNF-α, and MMP-1 in the skin tissue of mice in medium-dose intervention group and high-dose intervention group were significantly decreased (with P values all <0.05).  Conclusions  Glutathione can significantly alleviate acute cutaneous photodamage induced by combined irradiation of ultraviolet B and ultraviolet A in mice, with a clear dose-dependent protective effect, and its mechanism may be related to inhibiting the expression of inflammatory factors, reducing MMP-1-mediated collagen degradation, and improving dermal collagen structure.
Current status of post-traumatic growth among university students and its mediation pathway with post-traumatic stress symptoms
Wang Ya, Xiang Xiaorun, Zhao Yaping, Gu Haiyan, Deng Xiaofeng, Sun Wei
2026, 42(5): 486-495. doi: 10.3760/cma.j.cn501225-20260309-00099
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Abstract:
  Objective  To investigate the current status of post-traumatic growth (PTG) among university students, and to explore its mediation pathway with post-traumatic stress symptoms (PTSS).  Methods  This study was a multicenter cross-sectional survey. From December 2024 to January 2025, using convenience sampling, 718 university students aged >18 years who met the inclusion criteria and had experienced stressful life events in the past year were selected from two comprehensive universities and one medical university in Chongqing as the study participants. A self-designed demographic questionnaire was used to collect demographic information of the university students, including gender, age, grade level, and family structure, etc. The adolescent self-rating life events checklist was used to assess university students' experiences of stressful life events and whether they were affected by these events. The post-traumatic stress disorder checklist-civilian version, the Chinese-Posttraumatic Growth Inventory, the 10-item Connor-Davidson resilience scale, and the Chinese PERMA-Profiler were used to assess university students' levels of PTSS, PTG, psychological resilience, and well-being, respectively. University students were classified according to demographic information and whether they were affected by stressful life events, and their total PTG scores were compared. Analysis of the correlation among PTG, PTSS, psychological resilience, and well-being in university students was carried out. Independent influencing factors for PTG among university students were identified. A structural equation model was constructed to analyze the mediating effects of well-being and psychological resilience on the transformation between PTSS and PTG.  Results  Totally 718 questionnaires were distributed, and 647 valid questionnaires were returned, with a valid response rate of 90.1%. Among the university students, there were 584 males and 63 females, aged 18 to 27 years. There were 84 first-year students, 178 second-year students, 196 third-year students, and 189 fourth-year students. Among them, 582 students were from two-parent families, and 65 students were from single-parent families. Totally 102 students were affected by stressful life events, while 545 students were not affected by stressful life events. The stressful life events experienced by university students included 27 items, such as physical trauma, acute or serious illness, interpersonal tension, and academic pressure. The total scores of PTSS, PTG, psychological resilience, and well-being among university students were 18.00 (17.00, 27.00), 64.00 (41.00, 80.00), 30.00 (21.00, 39.00), and 118.00 (90.00, 135.00), respectively. Comparisons of total PTG scores among university students showed statistically significant differences by different age, family structure, and exposure to stressful life events (with Z values of -3.426, -2.285, and -3.693, respectively, P<0.05). The total PTG score and its subdimension scores of university students were significantly positively correlated with the total psychological resilience score, the total well-being score and its subdimension scores (with r values of 0.377 to 0.653, P<0.05). Age, family structure, whether being affected by stressful life events, well-being, and psychological resilience were independent influencing factors for PTG among university students (with β values of -0.144, 0.109, -0.151, 0.181, and 0.603, respectively, P<0.05). The constructed model was a multiple mediation model. Between PTSS and PTG transformation, both the independent mediating effect of well-being and the chain-mediating effects of well-being and psychological resilience were statistically significant (with β values of -0.140 and -0.287, respectively, 95% CI of -0.224 to -0.075 and -0.381 to -0.214, respectively, P<0.05), and the chain-mediating effect of well-being and psychological resilience was significantly higher than the independent mediating effect of well-being (β=0.146, with a 95% CI of 0.027 to 0.275, P<0.05).  Conclusions  PTG among university students is at a moderate level. Well-being and psychological resilience play a chain-mediating role in the transformation between PTSS and PTG among university students.
Review
Research progress on the mechanism of mitochondrial dynamics in diabetic foot ulcers and its related intervention strategies
Shan Bin, Guo Ze'ao, Ma Xuepeng, Jing Shuaishuai, Wu Yu, Pan Haibang, Zeng Zhaoyang
2026, 42(5): 496-502. doi: 10.3760/cma.j.cn501225-20250304-00114
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Abstract:
Diabetic foot ulcer (DFU) is a common and serious chronic complication in patients with diabetes, characterized by high recurrence rates, risks of disability and mortality, which imposes a heavy burden on individual health and the social healthcare system. Mitochondrial dynamics refer to the dynamic balance between mitochondrial fission and fusion that maintains cellular energy metabolism and homeostasis. However, in the pathological environment of diabetes, hyperglycemia and oxidative stress disrupt this balance, leading to mitochondrial dysfunction and further exacerbating the inflammatory response and tissue damage in DFU. In recent years, intervention strategies targeting mitochondrial dynamics have been considered a potential therapeutic approach to alleviate DFU symptoms and promote wound healing. Based on the latest domestic and international research, this article reviews the progress of research on mitochondrial dynamics in DFU, with a focus on exploring its core mechanisms and regulatory factors in the pathological process of DFU, and summarizes the current main intervention strategies. Through systematic analysis, this article aims to deepen the understanding of the mechanisms underlying mitochondrial dynamics in DFU and to provide new ideas for targeted therapy in clinical practice.

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