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2026 Vol. 42, No. 6

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Guideline and Consensus
Expert consensus on adjunctive Chinese medicine therapy for burn shock (2026 edition)
2026, 42(6): 503-513. doi: 10.3760/cma.j.cn501225-20250717-00311
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Burn shock is a complex systemic pathophysiological process and clinical syndrome that appears in the early stages of severe burns and influences the entire disease progression and treatment outcomes. Fundamental research and clinical outcomes in shock prevention and treatment represent the cornerstone and pivotal driver for the advancements in the field of burn surgery and critical care medicine of China. Exploring the practical experience and distinctive theories of Chinese medicine (CM) in treating severe burn shock not only compensates for the limitations of modern medicine and improves clinical outcomes, but also fosters the development of CM, holding profound significance. Based on this, the Burns and Trauma Branch of Chinese Geriatrics Society organized a multidisciplinary expert panel to develop this consensus through a combination of systematic literature review, Delphi expert questionnaire survey, and expert consensus meeting. On the basis of standard modern medical treatment, the panel explored the timing, principles, specific regimens, and precautions for using CM as an adjunctive therapy for adult patients with burn shock. The aim is to provide a reference framework grounded in the best available evidence and expert experience to guide clinical practice, and ultimately enhancing the clinical treatment of burn shock through the integration of Chinese and Western medicine.
Expert Forum
Organoid-based strategies and challenges in tissue regeneration
Wang Guangchao, Su Jiacan
2026, 42(6): 514-521. doi: 10.3760/cma.j.cn501225-20260119-00033
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Tissue regenerative medicine aims to repair or replace tissue and organs that have lost function due to disease, trauma, or aging, and the emergence of organoid technology has provided a new avenue for this field. Organoids are self-organized structures formed under three-dimensional culture conditions. They can recapitulate the structure and function of native organs, demonstrating unique advantages in disease modeling, drug screening, personalized medicine, and regenerative application. This article systematically summarizes the core strategies of organoids in tissue regeneration, including in vitro modeling and drug screening, in situ transplantation and functional repair, biohybrid organ construction, and organoid chip platform. It further analyzes the major challenges such as insufficient technological maturity, limited functional fidelity, restricted large-scale production, and ethical regulations for clinical application. In addition, potential solutions are proposed to overcome current bottlenecks and challenges through technological integration, standardization and automation, and the promotion of clinical translation. Overall, organoids, as a key strategy in regenerative medicine, are reshaping the landscape of tissue regeneration research and offering new hope for future clinical therapies.
Skin organoids: an emerging platform from three-dimensional construction to regenerative application
Leng Ling, Xiao Shichu
2026, 42(6): 522-531. doi: 10.3760/cma.j.cn501225-20260121-00039
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Skin organoids are three-dimensional, self-organized in vitro models that recapitulate the architecture and function of skin tissue. This article comprehensively outlines the current progress and application prospects of skin organoids. Based on complexity, skin organoids can be classified into epidermal, appendage-specific, and full-thickness skin organoids. The construction of skin organoids highly depends on extracellular matrix capable of replicating tissue-specific microenvironment to provide essential physical scaffolding and biochemical cues. Construction strategies encompass natural/synthetic hydrogels scaffold and engineered approaches such as three-dimensional bioprinting, which provide tunable physicochemical and biological support. In terms of applications, skin organoids have been widely used to model physiological and pathological processes, including skin development, tumors, and infectious and inflammatory skin diseases, serving as valuable platforms for studying disease mechanisms and screening drug targets. In the field of wound repair, organoids not only serve as research models to uncover healing mechanisms, but also act as transplantable units that promote re-epithelialization, vascularization, and the regeneration of hair follicles and sweat glands, thereby achieving functional skin restoration. Although skin organoids are currently still facing challenges in terms of structural maturity, vascularization, recapitulation of the immune microenvironment, and heterogeneity, their potential in regenerative medicine, personalized therapy, and translational applications will continue to expand with the advances of technologies such as matrix biology, organ-on-a-chip systems, and automated culture.
Original Article · Skin Organoids and Tissue Regeneration
Influence of human skin organoid-derived extracellular vesicles composite hydrogels on wound healing of full-thickness skin defects in mice
Li Ruiyang, Zhou Qirong, He Chongru, Wang Guangchao, Chen Xiao, Su Jiacan
2026, 42(6): 532-541. doi: 10.3760/cma.j.cn501225-20260107-00013
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  Objective  To investigate the influence of human skin organoid-derived extracellular vesicles (SOEVs) composite hydrogels on wound healing of full-thickness skin defects in mice.  Methods  This study was an experimental study using a group design and a repeated-measures design. HaCaT cells, human skin fibroblasts, and human umbilical vein endothelial cells (HUVECs) were mixed in a ratio of 2∶1∶1 and cultured three-dimensionally in 6-well ultra-low attachment plates to generate skin organoids. The formation of skin organoids was observed on days 1, 3, 7, and 14 of culture. On day 7 of culture, the expressions of epidermal marker cytokeratin 14 (CK14), vascular marker CD31, and dermal marker vimentin in skin organoids were detected by immunofluorescence method. On day 7 of culture, SOEVs were isolated from the culture supernatant of skin organoids by sequential differential ultracentrifugation. The ultrastructure of SOEVs was observed using transmission electron microscopy, and the particle size of SOEVs was measured using a nanoparticle tracking analyzer. HaCaT cells and HUVECs were collected, and both cell types were divided into a SOEV group cultured with 30 μg/mL SOEV and a control group cultured under conventional condition. A scratch test was performed, and cell migration rate was calculated at 24 h after scratching (n=6). Gelatin methacrylate anhydride (GelMA) hydrogel and GelMA hydrogel containing 30 μg/mL SOEV (i.e. SOEV composite hydrogel) were prepared. Eighteen 6-week-old male C57BL/6J mice were divided into a control group, a GelMA group, and a SOEV@GelMA group using a random number table method, with 6 mice in each group. A full-thickness skin defect wound was created on the back of each mouse. Immediately after injury (day 0), phosphate-buffered saline, GelMA hydrogel, and SOEV composite hydrogel were applied to the wounds of mice in control group, GelMA group, and SOEV@GelMA group, respectively. Wound healing was observed at post-injury day (PID) 0, 3, 7, 10, and 14, and the wound healing rate was calculated at PID 3, 7, 10, and 14. At PID 14, wound tissue was collected. Hematoxylin-eosin staining was performed to observe the degree of wound epithelial regeneration; Masson staining was performed to observe collagen fiber deposition, and the proportion of collagen fiber-positive area was calculated.  Results  After 1 to 14 days of culture, the skin organoids gradually matured, with the structures becoming increasingly compact and dense, and the spheroids exhibiting clear boundaries. On day 7 of culture, the skin organoids expressed CK14, CD31, and vimentin. SOEVs extracted from the culture supernatant of skin organoids on day 7 of culture exhibited a typical disc-shaped vesicular structure, with an average particle size of 70.1 nm. At 24 h post-scratching, the migration rates of HaCaT cells and HUVECs in SOEV group were significantly higher than those in corresponding control group (with t values of 16.73 and 7.71, respectively, P<0.05). From PID 0 to 14, the wound area in all three groups of mice gradually decreased. At PID 3, 7, 10, and 14, the wound healing rates of mice in SOEV@GelMA group were (56.47±9.26)%, (73.87±6.02)%, (92.69±3.74)%, and (98.92±0.26)%, respectively, which were significantly higher than (28.18±15.63)%, (49.21±11.96)%, (72.53±7.93)%, and (87.39±0.83)% in control group (P<0.05) and (34.51±14.43)%, (58.30±8.00)%, (79.16±4.15)%, and (90.16±0.80)% in GelMA group (P<0.05). At PID 14, the area of neo-epithelial coverage in the wounds of mice in GelMA group and SOEV@GelMA group was greater than that in control group; some wounds of mice in GelMA group and control group still showed separation of the epidermis and dermis, while the wounds of mice in SOEV@GelMA group achieved almost complete re-epithelialization. At PID 14, collagen fiber deposition was observed in the wound tissue in all three groups of mice, with the collagen fibers in the dermal layer of the wound tissue of mice in SOEV@GelMA group arranged in a more orderly manner. The proportion of collagen fiber-positive area in the wound tissue of mice in GelMA group and SOEV@GelMA group was significantly higher than that in control group (P<0.05), and the proportion of collagen fiber-positive area in the wound tissue of mice in SOEV@GelMA group was significantly higher than that in GelMA group (P<0.05).  Conclusions  The human SOEV composite hydrogel can promote collagen fiber deposition in full-thickness skin defect wounds of mice and accelerate the wound repair process, significantly improving the efficacy and quality of wound healing.
Culture and identification of human induced pluripotent stem cell-derived skin organoids
Xia Juzi, Wang Zhenxing, Sun Di, Zhang Zhaodong, Ding Yanan, Chen Bo, Xia Mingxue, Liu Zhirong
2026, 42(6): 542-551. doi: 10.3760/cma.j.cn501225-20260205-00074
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  Objective  To establish and identify a culture system for skin organoids based on human induced pluripotent stem cells (hiPSCs).  Methods  This study was a basic research with a self-controlled pre-post design. Human primary skin fibroblasts (Fbs) were obtained from discarded hair follicle tissue of a 45-year-old male patient undergoing hair transplant surgery at Tongji Medical College of Huazhong University of Science and Technology. Primary skin Fbs were induced into hiPSCs, which were then cultured to form three-dimensional aggregates. Then the induced differentiation was performed as followings. On differentiation day 0 (the day of differentiation initiation), the three-dimensional aggregates were transferred to ultra-low attachment culture plate and cultured in E6 medium supplemented with Matrigel, transforming growth factor-β type Ⅰ receptor inhibitor of SB431542, basic fibroblast growth factor (bFGF), and bone morphogenetic protein-4 to induce non-neural ectoderm formation. On differentiation day 3, one-quarter volume of E6 medium supplemented with bone morphogenetic protein signaling pathway inhibitor of LDN193189 and bFGF was added to the original medium to continue culturing and to induce the formation of cranial neural crest cells. On differentiation day 6, culture continued with approximately 3/5 volume of plain E6 medium added to the original medium. Half-medium changes were performed on differentiation days 8 and 10 (once each), followed by continued culture. On differentiation day 12, cell clumps were seeded into new ultra-low attachment culture plate to continue culturing, and epidermal self-assembly was induced using organoid maturation medium supplemented with Matrigel. On differentiation day 15, a half-medium change was performed, and culture was continued. On differentiation day 18, the original medium was replaced with organoid maturation medium supplemented with α-melanocyte-stimulating hormone to continue culturing. Starting from differentiation day 21, half-medium changes were performed every 3 days, and culture continued. After differentiation initiation, the stage-specific morphological characteristics of hiPSC differentiation into skin organoids were observed daily. Immunofluorescence staining was performed to assess skin organoids on different days of differentiation: on day 12 for the presence of mesenchymal cells, on day 20 for epidermal terminal differentiation, on day 35 for mesenchymal and epithelial structure formation as well as hair follicle stem cell and basal layer keratinocyte related characteristics, on day 55 for dermal papilla formation, on day 75 for hair germ-like structure formation, and on day 90 for organoid proliferative activity. Fluorescence probe staining was performed on differentiation day 110 to detect hair follicle formation, as well as lipid deposition and sebaceous gland-like structure formation.  Results  On differentiation day 0, hiPSCs formed three-dimensional aggregates with clear boundaries and relatively uniform size. On differentiation day 3, ectoderm-like structures appeared on the surface of the aggregates, accompanied by non-epithelial-like cells beginning to migrate outward. During differentiation days 6 to 8, mesenchymal cells and neuroglial-like cells gradually increased. During differentiation days 12 to 18, organoids with spatial heterogeneity gradually formed within the aggregates, exhibiting preliminary epidermal-dermal-like bilayer structures. On differentiation day 60, hair germ-like structures were observed. During differentiation days 80 to 130, more mature hair germ-like structures and hair follicle-like structures gradually emerged. Immunofluorescence detection showed that on differentiation day 12, early mesenchymal cells were observed around the skin organoids. On differentiation day 20, keratinocytes emerged in the outer layer of the skin organoids. On differentiation day 35, dermal-like cells emerged in the skin organoids, forming distinct spatial compartments with epithelial-like structures, accompanied by the presence of basal layer-like cell populations. On differentiation day 55, dermal papilla-like cell populations were detected and were spatially adjacent to epidermal regions. On differentiation day 75, thickened epithelial-like structures growing inward were observed in localized areas of the skin organoids, along with cell aggregation forming hair germ-like structures; dermal papilla-like cell populations were detected in regions adjacent to the hair germ and were spatially adjacent to epithelial structures. On differentiation day 90, proliferating cell enrichment was observed in the hair germ region. Fluorescence probe staining showed that by differentiation day 110, more mature hair follicle-like structures, hair shaft-like protrusions, lipid deposition, and sebaceous gland-like structures were observed in the skin organoids.  Conclusions  By stage-wise modulation of key signaling pathways, we successfully established a hiPSC-based a culture system for skin organoids. The induced differentiation process of this system highly mimics the in vivo developmental program of skin and hair follicles, resulting in the reconstitution of a complex in vitro skin model with hair follicle-like structures.
Original Article · Severe Burns
Construction and validation of a predictive model for the risk of ARDS in severely burned patients
Yao Yi, Liu Wei, Wang Shengshu, Hua Tianzhen, Zhang Guangliang, Jia Haoran, Ma Shujie, Shen Chuan'an
2026, 42(6): 552-561. doi: 10.3760/cma.j.cn501225-20260204-00070
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  Objective  To construct and validate a nomogram model for predicting the risk of acute respiratory distress syndrome (ARDS) in severely burned patients.  Methods  This study was a retrospective cohort study. From January 2015 to August 2025, 372 severely burned patients who met the inclusion criteria were admitted to the Fourth Medical Center of Chinese PLA General Hospital, including 279 males and 93 females, aged 18 to 78 years. According to whether ARDS occurred within 7 days post-injury, patients were divided into ARDS group and non-ARDS group. Stratified random sampling was used to allocate patients into training set and validation set in a ratio of 7∶3. In training set, there were 35 patients in ARDS group and 227 patients in non-ARDS group; in validation set, there were 14 patients in ARDS group and 96 patients in non-ARDS group. General clinical data of the patients were collected, including total burn area, modified Baux score, burn index, partial-thickness burn area, full-thickness burn area, severity of inhalation injury, whether mechanical ventilation or high-flow oxygen therapy performed upon admission, number of days after tracheostomy, length of hospital stay, duration in critical illness, and mortality rate, as well as data related to post-burn ARDS development within 24 hours of admission, including white blood cell count, neutrophil count, thrombin time, and levels of hemoglobin, creatinine, chloride, procalcitonin, albumin, and fibrinogen (FIB). Variables with statistically significant differences between two groups in training set were screened, and characteristic variables were further selected using least absolute shrinkage and selection operator (LASSO) regression combined with a weight adjustment strategy. Multivariate logistic regression analysis was performed to identify independent predictors, based on which a nomogram model was constructed. The performance of the model was validated in both training set and validation set.  Results  In the general clinical data of training set, patients in ARDS group had significantly larger total burn area and full-thickness burn area (P<0.05), significantly higher modified Baux score, burn index, proportion of patients receiving mechanical ventilation or high-flow oxygen therapy upon admission, and mortality rate (P<0.05), significantly more severe degree of inhalation injury (P<0.05), significantly greater number of days after tracheostomy, length of hospital stay, and duration in critical illness (P<0.05), and significantly smaller partial-thickness burn area (P<0.05) than those in non-ARDS group. With the data related to post-burn ARDS development, patients in ARDS group had significantly higher white blood cell count, neutrophil count, and levels of hemoglobin, creatinine, chloride, and procalcitonin (P<0.05), significantly longer thrombin time (P<0.05), and significantly lower levels of albumin and FIB (P<0.05) than those in non-ARDS group within 24 hours of admission. LASSO regression analysis showed that modified Baux score, neutrophil count, albumin level, and FIB level were the characteristic variables for the development of ARDS in 262 severely burned patients in training set. Multivariate logistic regression analysis revealed that modified Baux score, neutrophil count, albumin level, and FIB level were independent predictors of ARDS in 262 severely burned patients in training set (with ORs of 1.058, 1.147, 0.752, and 0.615, respectively, 95%CIs of 1.045-1.072, 1.092-1.206, 0.694-0.814, and 0.500-0.757, respectively, P values all <0.05). A nomogram model for predicting the risk of ARDS in 262 severely burned patients in training set was constructed based on the above four independent predictors. Receiver operating characteristic curve analysis showed that the model had an area under the curve (AUC) of 0.960 (with 95%CI of 0.934-0.986) in training set and an AUC of 0.914 (with 95%CI of 0.837-0.991) in validation set. The calibration curve showed that the risk of ARDS predicted by the model was in high agreement with the actual observed values. Clinical decision curve analysis showed that within the threshold probability range of 17% to 78%, the clinical net benefit obtained by applying this model for clinical decision-making was significantly higher than that of the strategies of intervening in all patients or intervening in none.  Conclusions  The constructed nomogram model incorporating the modified Baux score, neutrophil count, albumin level, and FIB level demonstrates good predictive performance for the risk of ARDS in severely burned patients and holds potential value for clinical decision-making.
Original Article
Effects and mechanisms of broccoli-derived extracellular vesicles on wound healing of full-thickness skin defects in diabetic mice
Shen Qi, Jian Ning, Zhang Cuiping, Fu Xiaobing
2026, 42(6): 562-571. doi: 10.3760/cma.j.cn501225-20260105-00005
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  Objective  To explore the effects and mechanisms of broccoli-derived extracellular vesicles (BEVs) on wound healing of full-thickness skin defects in diabetic mice.  Methods  This study was an experimental study using a group design and a repeated-measures design. BEVs were isolated and purified using ultrafiltration concentration combined with size-exclusion chromatography, and were successfully identified. According to the random number table method, mouse RAW264.7 cells were divided into a control group cultured under routine condition, as well as a lipopolysaccharide (LPS) group and a BEV group, in which cells were first stimulated with LPS for 12 hours and then respectively cultured under routine condition and with BEV. After 24 hours of culture, Western blotting was used to detect the protein expression levels of inducible nitric oxide synthase (iNOS) and arginase-1 (Arg-1) in cells. Immunofluorescence method was used to detect the protein expression levels of CD86 and CD206 in cells. The level of reactive oxygen species in cells was measured using the 2',7'-dichlorodihydrofluorescein diacetate fluorescence probe assay. The mRNA expression levels of nuclear factor-erythroid 2-related factor 2 (Nrf2) and heme oxygenase-1 (HO-1) in cells were detected using the real-time fluorescence quantitative reverse transcription polymerase chain reaction method. The sample sizes for all of the above experiments were 3. Twenty-four 7-week-old male db/db mice were used, and a full-thickness skin defect wound was created in the dorsal region. The mice were then assigned to control group and BEV group according to the random number table method, with 12 mice in each group. At post injury day (PID) 0 (immediately), 3, 6, and 9, normal saline and 1×1010 particles/mL BEVs solution were injected into the wound sites of mice in control group and BEV group, respectively. Wound healing was assessed at PID 0, 3, 6, 9, and 12, and wound healing rates were calculated at PID 3, 6, 9, and 12. At PID 6, the proportion of CD86- and CD206-positive areas in the wound tissue was assessed using the immunofluorescence method, and the level of reactive oxygen species in the wound tissue was measured using the dihydroethidium fluorescence probe assay.  Results  After 24 hours of culture, compared with those in control group, the protein expression levels of iNOS and CD86 of cells in LPS group were significantly elevated (P<0.05), and the level of reactive oxygen species was significantly increased (P<0.05). Compared with those in LPS group, the cells in BEV group showed significantly reduced protein expression levels of iNOS and CD86 (P<0.05), significantly increased protein expression levels of Arg-1 and CD206 (P<0.05), significantly decreased level of reactive oxygen species (P<0.05), and significantly increased mRNA expression levels of Nrf2 and HO-1 (P<0.05). From PID 0 to 12, wounds of mice in both control group and BEV group gradually healed. Specifically, at PID 3, 6, 9, and 12, the wound healing rates of mice in BEV group were significantly higher than those in control group (with t values of 5.98, 5.79, 7.40, and 8.67, respectively, P<0.05). At PID 6, the proportion of CD86-positive area in the wound tissue of mice in BEV group was (0.60±0.29)%, which was significantly lower than (1.61±0.19)% in control group (t=7.20, P<0.05); the proportion of CD206-positive area in the wound tissue of mice in BEV group was (3.42±0.77)%, which was significantly higher than (0.66±0.20)% in control group (t=8.48, P<0.05); the level of reactive oxygen species in the wound tissue of mice in BEV group was significantly lower than that in control group (t=8.38, P<0.05).  Conclusions  BEVs can restore the "immuno-oxidative" homeostasis of full-thickness skin defect wounds in diabetic mice by activating the Nrf2/HO-1 axis, inducing the polarization of macrophages from the M1 phenotype to the M2 phenotype, and decreasing the level of reactive oxygen species, thereby significantly accelerating the wound healing process.
Analysis of factors influencing tension blister formation on the skin at the dressing edges in patients undergoing negative pressure wound therapy
Guo Huihui, Ning Tao, Ma Mingming, Mei Siwei, Ruan Xiaojun
2026, 42(6): 572-578. doi: 10.3760/cma.j.cn501225-20240911-00334
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  Objective  To investigate the factors that influence the formation of tension blisters on the skin at the dressing edges in patients undergoing negative pressure wound therapy (NPWT).  Methods  This study was a retrospective case-control study. From September 2020 to August 2023, 187 patients undergoing NPWT who met the inclusion criteria were admitted to the Department of Orthopedics of Fuyang People's Hospital Affiliated to Anhui Medical University, including 112 males and 75 females, aged (52±17) years. Based on the presence or absence of tension blisters on the skin at the edge of NPWT filling dressings (hereinafter referred to as dressings) after 3 days of NPWT, the patients were divided into no blister group (97 cases) and blister group (90 cases). The clinical characteristics (gender, age, systolic blood pressure on admission, diastolic blood pressure on admission, body mass index, wound area, duration of wound debridement, wound infection status, concomitant fractures, wound irrigation, dressing application site, and dressing management method) as well as biochemical indicators on day 1 after admission were compared between the two groups. The independent influencing factors for tension blister formation at the dressing edges in 187 patients after 3 days of NPWT were screened.  Results  There were statistically significant differences between the two groups of patients in terms of age, dressing application site, and dressing management method (t=2.057, with χ2 values of 5.589 and 27.686, respectively, P<0.05); there were no statistically significant differences in the other clinical characteristics or biochemical indicators on day 1 after admission (P>0.05). Univariate logistic regression analysis results showed that age, dressings treated with petrolatum jelly gauze and dressing trimming were protective factors against the formation of tension blisters on the skin at the dressing edges in patients after 3 days of NPWT (with ORs of 0.983, 0.130, and 0.381, respectively, 95% CIs of 0.966-0.999, 0.058-0.287, and 0.178-0.816, respectively, P<0.05); trunk was the risk factor facilitating the formation of tension blisters on the skin at the dressing edges in patients after 3 days of NPWT (OR=2.028, with 95% CI of 1.125-3.655, P<0.05). Multivariate logistic regression analysis results showed that trunk was the independent risk factor facilitating the formation of tension blisters on the skin at the dressing edges in patients after 3 days of NPWT (OR=2.566, with 95% CI of 1.306-5.043, P<0.05); dressings treated with petrolatum jelly gauze and dressing trimming were independent protective factors against the formation of tension blisters on the skin at the dressing edges in patients after 3 days of NPWT (with ORs of 0.111 and 0.363, respectively, 95% CIs of 0.048-0.257 and 0.165-0.797, respectively, P<0.05).  Conclusions  For patients who developed tension blisters on the skin at the dressing edges after 3 days of NPWT, the trunk is identified as the independent risk factor, whereas dressings treated with petrolatum jelly gauze, and dressing trimming are the independent protective factors.
Value of the CD177/CD10 ratio in neutrophils in predicting infection risk in burn patients and the establishment of its normal reference range
Li Heyue, Huang Jiamin, Mei Yiwen, Wen Xiao, Shao Lifei, Sun Bingwei
2026, 42(6): 579-588. doi: 10.3760/cma.j.cn501225-20251118-00473
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  Objective  To explore the value of the ratio of CD177 level to CD10 level (hereinafter referred to as CD177/CD10 ratio) in neutrophils in predicting infection risk in burn patients, and to establish its normal reference range.  Methods  This study was a cross-sectional study. From February 2023 to November 2025, 61 burn patients who met the inclusion criteria were admitted to Affiliated Suzhou Hospital of Nanjing Medical University, including 52 males and 9 females, aged 41.0 (32.0, 55.0) years. Among them, 59 patients underwent inflammatory marker monitoring during the acute stress period on post injury day 1, and 48 patients underwent inflammatory marker monitoring during the high-risk period for infection (hereinafter referred to as high-risk period monitoring) from post injury day 3 to 14. During the same period, 204 healthy volunteers who underwent physical examinations in the physical examination center of the same unit with normal examination results were recruited, including 110 males and 94 females, aged 47.5 (31.0, 67.0) years. Flow cytometry was used to monitor the levels of CD177 and CD10 in the neutrophils from patients on post injury day 1, 3, 5, 7, 10, and 14, as well as from healthy volunteers. According to whether infection occurred, the patients who underwent high-risk period monitoring were divided into infection group (n=31) and non-infection group (n=17). General information such as total burn area at admission, as well as inflammatory markers such as the white blood cell count, neutrophil count, neutrophil, C-reactive protein level, procalcitonin level, CD177 level, CD10 level, and CD177/CD10 ratio, and sequential organ failure assessment (SOFA) scores were compared between the two groups of patients to screen for risk factors affecting the occurrence of infection in patients undergoing high-risk period monitoring. For patients in infection group, the most recent detection data before the confirmed infection was taken for analysis, and for patients in non-infection group, the highest values detected from post injury day 3 to 14 were taken for analysis (the same data selection below). The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of the aforementioned inflammatory markers and SOFA score for the infection risk in patients undergoing high-risk period monitoring. The correlation between CD177 level and CD10 level in patients undergoing high-risk period monitoring was analyzed. The CD177 level, CD10 level, and CD177/CD10 ratio were compared among healthy volunteers, patients during the acute stress period and high-risk period for infection. Based on the data of healthy volunteers, the normal reference range for the CD177/CD10 ratio was established using the non-parametric percentile method.  Results  There were statistically significant differences between patients in infection group and non-infection group in terms of total burn area, C-reactive protein level, SOFA score, CD177 level, CD10 level, and CD177/CD10 ratio (with Z values of -2.08, -2.58, 0.04, -2.72, -2.86, and -3.20, respectively, P<0.05). The results of univariate logistic regression analysis showed that both total burn area and the lg (CD177/CD10 ratio) were risk factors for infection in patients undergoing high-risk period monitoring (with ORs of 1.03 and 6.91, respectively, 95%CIs of 1.00 to 1.06 and 1.84 to 25.91, respectively, P<0.05). The results of multivariate logistic regression analysis showed that the lg (CD177/CD10 ratio) was an independent risk factor for infection in patients undergoing high-risk period monitoring (OR=5.73, with a 95%CI of 1.11 to 29.60, P<0.05). ROC curve analysis showed that the CD177/CD10 ratio had the largest area under the curve for predicting the infection risk in patients undergoing high-risk period monitoring, which was 0.78 (with a 95%CI of 0.65 to 0.91). Its optimal cut-off value was 3.84, with the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value at the optimal cut-off value being 58.06%, 94.12%, 76.09%, 94.74%, and 55.17%, respectively. In patients undergoing high-risk period monitoring, the CD177 level was significantly negatively correlated with the CD10 level (r=-0.60, P<0.05). Compared with those of healthy volunteers and patients in the acute stress period, the CD10 level of patients in the high-risk period for infection was significantly decreased (with P values both <0.05), while the CD177 level and the CD177/CD10 ratio were significantly increased (P<0.05). The established normal reference range for the CD177/CD10 ratio was 0-0.64.  Conclusions  The CD177/CD10 ratio in neutrophils has a certain predictive value for the infection risk in burn patients, and its predictive value is higher than that of white blood cell count, neutrophil count, neutrophil, C-reactive protein level, procalcitonin level, and SOFA score. The established normal reference range for the CD177/CD10 ratio is 0-0.64.
Analysis of the characteristics and changing trends of burn disease burden in the Chinese population based on the GBD 2021 database
Liang Jinyu, Xi Maomao, Tang Ning, Tian Wei, Zhang Jing, Peng Junyi, Xin Yuze, Ivers Rebecca, Ye Pengpeng, Tian Maoyi
2026, 42(6): 589-596. doi: 10.3760/cma.j.cn501225-20251208-00512
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Abstract:
  Objective  To analyze the characteristics and changing trends of burn disease burden in the Chinese population based on the Global Burden of Disease (GBD) 2021 database.  Methods  This study was a secondary study based on public databases. Data related to burns caused by "fire, heat, and hot substances" in 22 provinces, 5 autonomous regions, 4 municipalities, Hong Kong Special Administrative Region, and Macao Special Administrative Region of China except for the Taiwan region of China from 1990 to 2021 were extracted from the GBD 2021 database. Stratified analyses were conducted by gender, age bracket, and provincial-level administrative region. Disability-adjusted life year (DALY) rate, years of life lost (YLL) rate, years lived with disability (YLD) rate, and their age-standardized rates were used to evaluate the burn disease burden. The changing trends of burn disease burden among populations across different genders, age brackets and provincial-level administrative regions in China from 1990 to 2021 were compared. The burn disease burden among populations across different genders, age brackets and provincial-level administrative regions in China in 2021 was evaluated.  Results  From 1990 to 2021, the burn disease burden in the Chinese population decreased overall. The overall age-standardized DALY rate (95% UI) of burns in the Chinese population decreased from 135.6 (109.8-158.4)×10-5 in 1990 to 33.6 (27.0-41.8)×10-5 in 2021, with a decline of 75.2%. The age-standardized YLL rate and age-standardized YLD rate of burns also decreased, with declines of 81.4% and 54.5%, respectively. Compared with that in 1990, the age-standardized DALY rates of burns in all provincial-level administrative regions decreased in 2021, but the magnitudes of decline varied. In 25 provincial-level administrative regions, the decline in age-standardized DALY rate of burns was more pronounced in women than in men, whereas the opposite pattern was observed in 8 provincial-level administrative regions. The burn DALY rate decreased relatively rapidly in young children aged 1 to <2 years, while it decreased relatively slowly in the oldest-old population aged ≥80 years. In 2021, differences in burn disease burden were observed among populations across different genders, age brackets and provincial-level administrative regions in China. In all age brackets, burn DALY rates in men were higher than those in women. Among age brackets, the burn DALY rate (95% UI) was the highest in the ≥80 years age bracket, at 147.3 (114.5-176.3)×10-5. In 2021, the top 3 provincial-level administrative regions with relatively high age-standardized DALY rates of burns, in descending order, were Yunnan Province, Guizhou Province, and Shanghai, with values of 45.4 (37.2-58.7)×10-5, 43.8 (34.3-55.4)×10-5, and 43.3 (29.6-62.2)×10-5, respectively.  Conclusions  From 1990 to 2021, the burn disease burden in China showed an overall downward trend. However, men, young children, the oldest-old population, and population in provincial-level administrative regions with high burn disease burden, such as Yunnan Province and Guizhou Province, should still be regarded as key targets for burn prevention and control.
Review · Skin Organoids and Tissue Regeneration
Research advances on the application of skin appendage organoids in wound repair
Wang Miaomiao, He Yutong, Xie Qiaoli, Zhou Wei, Xiang Xiao, Lei Mingxing
2026, 42(6): 597-602. doi: 10.3760/cma.j.cn501225-20260228-00092
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Abstract:
Skin wounds are often accompanied by structural damage and functional loss of appendages such as hair follicles and sweat glands, which cannot be fully restored by conventional repair methods. The development of skin organoid technology provides a new avenue to overcome this bottleneck. This article reviews the developmental history of skin organoids and systematically elaborates on the strategies and applications of skin appendage organoids in promoting functional skin regeneration. Furthermore, it analyzes the critical role of vascular and neural integration in improving the quality of wound repair. Finally, the article summarizes the current challenges associated with technologies such as stem cell induction, three-dimensional bioprinting, microfluidics, organ-on-a-chip, and air-liquid interface culture, and provides perspectives on the clinical translation of skin appendage organoids.

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