中华烧伤与创面修复杂志

Evolution of DFU treatment strategies: from simple coverage with traditional dressings to active modulation with smart materials

Chen Xulin

2026, 42(7): 603-610. doi: 10.3760/cma.j.cn501225-20260409-00146

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Diabetic foot ulcers (DFUs) fall into a vicious cycle of difficulty healing due to hyperglycemia-induced persistent inflammation, accumulation of reactive oxygen species (ROS), tissue hypoxia, and susceptibility to infection. This paper reviews the pathological microenvironmental characteristics of DFUs, the design strategies of smart materials, and their integration with artificial intelligence (AI). Given the complex pathological microenvironment of DFUs, traditional dressings that provide simple coverage are no longer adequate, whereas responsive smart materials that are capable of dynamically sensing and actively modulating the wound microenvironment have demonstrated great potential. Furthermore, the paper highlights four key design strategies for responsive smart materials: using glucose-responsive smart materials to improve local hyperglycemia at the wound site; using ROS-scavenging smart materials to eliminate ROS and restore redox homeostasis; applying oxygen-generating materials to relieve hypoxia and to promote angiogenesis; and utilizing smart antibacterial materials to combat microbial biofilms and achieve potent bactericidal effects. Currently, the development trend of smart materials has shifted from single functionality towards integrated multifunctional synergistic systems. The paper further discusses the potential of integrating AI into material design, preparation optimization, and wound monitoring and treatment decision-making. Although most smart materials are still at the experimental stage and face challenges related to cost and manufacturing processes, next-generation smart materials are expected to achieve dynamic monitoring and autonomous treatment through interdisciplinary innovation, thereby fundamentally improving DFU healing rates and reducing the risk of amputation in patients.

Effects and mechanisms of cerium-myricetin nanosystem on wound healing in rats with full-thickness burns

Wang Tao, Teng Junfei, Hu Chao, Wan Luyao, Zhang Wei, Bai Xiangyang, Deng Jun, Luo Gaoxing

2026, 42(7): 611-620. doi: 10.3760/cma.j.cn501225-20260312-00101

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Objective To investigate the effects and mechanisms of cerium-myricetin nanosystem (Ce-MYR) on wound healing in rats with full-thickness burns. Methods This study was an experimental study with a grouped design and repeated measurement design. Ce-MYR was prepared by coordination self-assembly and characterized. Mouse RAW264.7 cells were divided into control group cultured normally, hydrogen peroxide group treated with hydrogen peroxide, and low Ce-MYR group, medium Ce-MYR group, and high Ce-MYR group which were first exposed to hydrogen peroxide and subsequently treated with Ce-MYR at final mass concentrations of 5, 10, and 20 μg/mL, respectively. After 24 h of culture, intracellular reactive oxygen species (ROS) levels were detected using the fluorescent probe method. Mouse bone marrow-derived macrophages (BMDMs) were divided into control group cultured normally, lipopolysaccharide (LPS) group treated with LPS, and Ce-MYR group treated with LPS combined with Ce-MYR. After 24 h of culture, the percentages of CD86- and CD206-positive areas in cells were calculated after immunofluorescence staining. Additional mouse BMDMs were divided into the LPS group and the Ce-MYR group, as described above. After 24 h of culture, the protein expressions of heme oxygenase-1 (HO-1), arginase-1 (Arg-1), inducible nitric oxide synthase (iNOS), and NOD-like receptor family pyrin domain-containing protein 3 (NLRP3) in cells were detected by Western blotting. The sample size in all the above experiments was 4. Ten 6-week-old male Sprague-Dawley rats were used to establish four full-thickness burn wounds on the back of each rat, which were divided into phosphate-buffered saline (PBS) group and Ce-MYR group according to the random number table method, with 5 rats in each group. PBS or Ce-MYR was subcutaneously injected at the wound margin at post-injury days 0 (immediately), 3, and 6, respectively. The percentages of residual wound area were calculated at post-injury days 3, 7, 14, and 21. At post-injury day 21, the wound tissue of rats was collected and the number of CD31-positive blood vessels was counted after immunohistochemical staining, the percentages of CD86- and CD206-positive areas were calculated after immunofluorescence staining, and the levels of interleukin-6 (IL-6), IL-1β, and tumor necrosis factor-α (TNF-α) were measured by enzyme-linked immunosorbent assay. Results After 24 h of culture, the ROS level in RAW264.7 cells in hydrogen peroxide group was significantly higher than that in control group (P<0.05); the ROS level in RAW264.7 cells in medium Ce-MYR group was significantly lower than that in low Ce-MYR group (P<0.05) and significantly higher than that in high Ce-MYR group (P<0.05). After 24 h of culture, the percentage of CD86-positive area in BMDMs in Ce-MYR group was significantly lower than that in LPS group (P<0.05) and significantly higher than that in control group (P<0.05); the percentage of CD206-positive area in BMDMs in Ce-MYR group was significantly higher than that in control group and LPS group (with P values both <0.05). After 24 h of culture, compared with those in LPS group, the protein expressions of HO-1 and Arg-1 in BMDMs in Ce-MYR group were significantly increased (P<0.05), whereas the protein expressions of iNOS and NLRP3 were significantly decreased (P<0.05). At post-injury days 3, 7, 14, and 21, the percentages of residual wound area in rats in Ce-MYR group were (87.1±2.4)%, (65.1±2.2)%, (16.6±1.9)%, and (0.5±0.4)%, respectively, which were significantly lower than (101.5±3.5)%, (79.9±3.2)%, (36.2±3.9)%, and (14.5±1.9)% in PBS group (with t values of 7.604, 8.478, 10.193, and 16.166, respectively, P<0.05). At post-injury day 21, compared with those in PBS group, the number of CD31-positive blood vessels in wound tissue of rats in Ce-MYR group was significantly increased (t=3.395, P<0.05), the percentage of CD86-positive area was significantly decreased (t=4.474, P<0.05), the percentage of CD206-positive area was significantly increased (t=4.713, P<0.05), and the levels of IL-1β, IL-6, and TNF-α were significantly decreased (with t values of 3.999, 5.040, and 6.023, respectively, P<0.05). Conclusions Ce-MYR may promote wound healing by reducing ROS levels, enhancing HO-1-related antioxidant responses in macrophages, thereby facilitating macrophage polarization from the M1 phenotype toward the M2 phenotype and improving oxidative stress and inflammatory imbalance in rats with full-thickness burn wounds.

Performance of PHMB-surface mesoporous silica composite material and its effect on infected full-thickness skin defect wounds in rats

Zhu Yimeng, Jin Jian, Wang Weiwei

2026, 42(7): 621-630. doi: 10.3760/cma.j.cn501225-20250830-00373

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Objective To investigate the performance of polyhexamethylene biguanide hydrochloride (PHMB)-surface mesoporous silica composite material (hereinafter referred to as the composite material) and its effect on infected full-thickness skin defect wounds in rats. Methods This study was an experimental study including group design, factorial design, and repeated measures design. The composite material with a 1:1 mass ratio of PHMB to surface mesoporous silica and good biocompatibility was prepared by rotary evaporation method. The in vitro release of PHMB from the composite material was detected by continuous quantitative measurement. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of PHMB and the composite material against Staphylococcus aureus ATCC 6538 and Escherichia coli ATCC 35150 were detected by broth microdilution method. The continuous bactericidal duration of PHMB and the composite material against the above-mentioned two types of bacteria was detected by continuous bacterial addition assay. The resistance of the above-mentioned two types of bacteria to PHMB and the composite material was detected by sub-lethal concentration induction assay. The sample size for the above experiments was 3. Forty-five female Sprague-Dawley rats aged 10-12 weeks were divided into routine dressing change group, PHMB group, and composite material group by random number table method, with 15 rats in each group. After preparing infected full-thickness skin defect wounds on the back of all rats, the wounds of rats in routine dressing change group, PHMB group, and composite material group were rinsed and dressed with normal saline, PHMB solution and composite material dispersion with a final PHMB mass fraction of 0.100%, respectively. The wound healing rates were calculated, the wound infection status was observed, and the wound tissue bacterial load was detected by the plate counting method at post injury day (PID) 6, 12, and 18, respectively. Results The composite material could continuously release PHMB for >144 h. For both Staphylococcus aureus and Escherichia coli, the MICs of the composite material were lower than those of PHMB, but the MBCs of both materials against two bacteria were identical. The continuous bactericidal duration of PHMB against Staphylococcus aureus and Escherichia coli was both 3 d, and the continuous bactericidal duration of the composite material against Staphylococcus aureus and Escherichia coli was both 6 d. Staphylococcus aureus and Escherichia coli exhibitedresistance to composite materials significantly later than to PHMB. The wound healing rates of rats in composite material group at PID 6, 12, and 18 were significantly higher than those in routine dressing change group and PHMB group (P<0.05). At PID 6, 12, and 18, no infection occurred in the wounds of rats in composite material group, whereas all wounds of rats in routine dressing change group continuously showed infection, and some wounds of rats in PHMB group still continuously showed infection. The wound tissue bacterial loads of rats in composite material group at PID 6, 12, and 18 were (4.6±3.1), (3.4±3.4), and (1.6±1.5) colony-forming unit (CFU)/g, respectively, which were all significantly lower than those in routine dressing change group ((1 876.0±241.5), (1 076.0±151.1), and (1 184.0±156.6) CFU/g) and PHMB group ((824.0±277.6), (800.0±231.0), and (832.0±350.9) CFU/g, P<0.05). The wound tissue bacterial loads of rats in PHMB group at PID 6 and 12 were both significantly lower than those in routine dressing change group (P<0.05). Conclusions The composite material can enhance and sustain the release of PHMB, thereby delaying the development of bacterial resistance, reducing the bacterial load in wound tissue, and facilitating the healing of infected full-thickness skin defect wounds in rats.

Effects and mechanisms of PIT on wound healing of full-thickness skin defects in diabetic mice

Zong Yuange, Huang Wanqi, Zhang Ze, Peng Yuan

2026, 42(7): 631-640. doi: 10.3760/cma.j.cn501225-20260127-00049

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Objective To investigate the effects and mechanisms of polyvinyl alcohol/ionic liquid-tannic acid composite hydrogel (PIT) on wound healing of full-thickness skin defects in diabetic mice. Methods This study was an experimental research involving grouped design and repeated measurements. An ionic hydrogel matrix crosslinked by polyvinyl alcohol-4-(1H)-vinylimidazole-1-methylene benzoic acid and oxidized hyaluronic acid was prepared, and tannic acid was loaded via Cu²⁺ chelation to construct PIT. A 1,1-diphenyl-2-picrylhydrazyl (DPPH) solution was prepared and reacted respectively with tannic acid and PIT for 24 hours. An ultraviolet spectrophotometer was used to detect the DPPH radical scavenging rate. According to the random number table method (the same grouping method below), mouse macrophage RAW264.7 cells were divided into a phosphate buffered saline (PBS) group cultured with PBS, as well as a hydrogen peroxide group and a PIT group, in which cells were first treated with hydrogen peroxide for 12 hours and then respectively cultured under routine condition and with PIT. After 24 hours of culture, the fluorescent probe method was adopted to detect the intracellular reactive oxygen species (ROS) level. Escherichia coli ATCC 25922, Staphylococcus aureus ATCC 25923, methicillin-resistant Staphylococcus aureus (MRSA) BNCC 337371, and human umbilical vein endothelial cells (HUVECs) were collected and all divided into PBS group, tannic acid (TA) group, and PIT group, which were cultured with PBS, TA solution, and PIT, respectively. After 12 hours of bacterial culture, the plate counting method was used to count bacterial colonies; after 24 hours of cell culture, the tube formation assay was performed to measure the total tube length, the number of branching nodes, and the number of branches. The sample size of all the above experiments was 3. Eighteen 8-week-old male Kunming mice were selected and divided into PBS group, TA group, and PIT group (with 6 mice in each group) to establish a full-thickness skin defect wound model of diabetes (with one wound in each mouse). At post injury day (PID) 0 (immediately), the wounds of mice in PBS group, TA group, and PIT group were treated respectively with PBS, TA solution, and PIT by topical application, and then the dressings were changed daily. The wound healing status was observed at PID 0, 4, 8, and 12, and the wound healing rates at PID 4, 8, and 12 were calculated. At PID 12, wound tissue was harvested. Hematoxylin-eosin staining was performed to observe the status of wound re-epithelialization and to measure the thickness of newly formed epithelium. Masson staining was performed to observe the deposition of collagen fibers in wounds and to calculate the proportion of collagen fiber-positive area. Results After 24 hours of reaction, the DPPH radical scavenging rate of PIT was significantly higher than that of TA (t=16.35, P<0.05). After 24 hours of culture, the ROS level of RAW264.7 cells in hydrogen peroxide group was significantly higher than that in PBS group (P<0.05), and the ROS level of RAW264.7 cells in PIT group was significantly lower than that in hydrogen peroxide group (P<0.05). After 12 hours of culture, the bacterial colony counts of Escherichia coli, Staphylococcus aureus, and MRSA in PIT group were significantly less than those in PBS group and TA group (P<0.05). After 24 hours of culture, compared with those in PBS group and TA group, the total tube length of HUVECs in PIT group was significantly increased (with P values both <0.05), and the number of branching nodes and the number of branches increased significantly (with P values all <0.05). From PID 0 to 12, the wounds of mice in all three groups healed gradually. At PID 4, 8, and 12, the wound healing rates of mice in PIT group were (31.6±2.0)%, (51.8±2.5)%, and (97.9±1.5)%, respectively, which were significantly higher than (18.6±0.6)%, (39.5±2.0)%, and (74.6±2.0)% in PBS group and (21.5±1.1)%, (40.7±0.8)%, and (85.3±2.1)% in TA group (P<0.05). At PID 12, the wound re-epithelialization of mice in PBS group was incomplete, and collagen fibers were sparsely distributed with disordered arrangement; the degree of wound re-epithelialization of mice in TA group was higher than that in PBS group, and collagen fibers were distributed in bundles with loose arrangement; the degree of wound re-epithelialization of mice in PIT group was higher than that in TA group, and collagen fibers were densely and orderly arranged in layers. At PID 12, compared with those in PBS group and TA group, the thickness of newly formed epithelium in wounds of mice in PIT group was significantly increased (with P values both <0.05), and the proportion of collagen fiber-positive area was significantly increased (with P values both <0.05). Conclusions PIT significantly accelerates the wound healing of full-thickness skin defects in diabetic mice through multiple mechanisms driven by metal ion chelation including antibacterial, antioxidant, and pro-angiogenesis activities, thereby improving the quality of tissue repair.

Clinical efficacy of pedicled double-perforator flap of the inferior epigastric artery in reconstructing the soft tissue defects following resection of cutaneous malignant tumors

Zhou Shuping, Zhang Dong, Wei Haili, Li Shimin, Chen Junjie, Li Sen, Shi Pancheng, Xing Xinfeng, Chang Chaonan, Shi Yingguang, Zheng Liwu, Wang Huanpeng, Gai Yuning

2026, 42(7): 641-648. doi: 10.3760/cma.j.cn501225-20250227-00096

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Objective To investigate the clinical efficacy of pedicled double-perforator flap of the inferior epigastric artery in reconstructing the soft tissue defects following resection of cutaneous malignant tumors adjacent to major vessels and/or nerves in the groin or thigh. Methods This study was a retrospective case series study. From June 2016 to June 2023, 12 patients (8 males and 4 females, aged 58 to 76 years) with cutaneous malignant tumors in the groin or thigh who met the inclusion criteria were admitted to the Department of Burn Plastic Surgery and Wound Healing of the 988^th Hospital of the Joint Logistics Support Force of PLA. In all patients, the depth of tumor invasion extended close to the major vessels and/or nerves. Radical extended resection of the tumors was performed, resulting in postoperative soft tissue defects ranging from 16 cm×13 cm to 37 cm×17 cm in size. A pedicled double-perforator flap of the inferior epigastric artery based on the paraumbilical and thoracic paraumbilical perforators was designed and harvested, with flap dimensions ranging from 15 cm×14 cm to 38 cm×18 cm. The flaps were transferred to the recipient site wound through a subcutaneous tunnel and sutured in place. Primary closure of the donor site wound was achieved in 8 patients; in the remaining 4 patients, the donor site wound was first approximated with sutures to reduce its size, then covered with negative-pressure sealing drainage dressing, with secondary closure performed at a later stage. Postoperative observations included flap blood supply, flap survival, occurrence of vascular crisis, and wound healing of donor and recipient sites. Operative duration and length of hospital stay of patients were recorded. During follow-up after surgery, tumor recurrence, flap contour, and donor site scar were observed, and whether abdominal wall function was affected by the scar was assessed. Results All 12 patients achieved good flap blood supply and uneventful survival, with no vascular crisis. Wounds in both donor and recipient sites healed successfully. Operative duration of patients ranged from 2.0 to 3.0 hours, and length of hospital stay ranged from 15 to 24 days, with a mean of 18.6 days. During a follow-up period of 1 to 6 years after surgery, no local tumor recurrence was observed. Some flaps appeared slightly bulky, but their elasticity and texture showed no significant differences compared with the surrounding tissue. The donor site only exhibited a linear scar, with no significant impact on abdominal wall function. Conclusions For soft tissue defects following resection of cutaneous malignant tumors adjacent to major vessels and/or nerves in the groin or thigh, the pedicled double-perforator flap of the inferior epigastric artery is a viable reconstructive option. This flap provides a large surface area for effective reconstruction while minimizing the impact on aesthetics and function of the donor site.

Value of shear wave elastography in the early diagnosis of DPN in patients with type 2 diabetes mellitus

Zhang Yanji, Tang Mingyuan, Jian Yang, Wu Xiuping, Ma Lihong, Cai Silang, Deng Chengliang, Wei Zairong

2026, 42(7): 649-658. doi: 10.3760/cma.j.cn501225-20241230-00513

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Objective To investigate the value of shear wave elastography (SWE) in the early diagnosis of diabetic peripheral neuropathy (DPN) in patients with type 2 diabetes mellitus. Methods This study was a diagnostic case-control study. From May 2021 to October 2022, 68 patients with type 2 diabetes mellitus who met the inclusion criteria were admitted to the Department of Burns and Plastic Surgery of Affiliated Hospital of Zunyi Medical University, including 45 males and 23 females, aged (57±10) years. According to whether the DPN was present, the patients were divided into DPN group (38 patients) and non-DPN group (30 patients). During the same period, 30 healthy volunteers who underwent physical examinations at the health examination center of the hospital were recruited as healthy control group, including 19 males and 11 females, aged (56±10) years. Cross-sectional areas of the bilateral common peroneal nerves and tibial nerves measured by a color Doppler ultrasonography system in two-dimensional ultrasonography mode, and the stiffness of the bilateral common peroneal nerves and tibial nerves measured in SWE mode were compared between volunteers in healthy control group and two groups of patients at admission. Independent risk factors for the development of DPN were screened in the three groups of participants. Receiver operating characteristic curves were used to evaluate the diagnostic value of common peroneal nerve stiffness, common peroneal nerve cross-sectional area, tibial nerve stiffness, and tibial nerve cross-sectional area for DPN in two groups of patients. The correlations of common peroneal nerve stiffness and common peroneal nerve cross-sectional area with the Toronto clinical scoring system (TCSS) score were analyzed in patients of DPN group. Results At admission, the cross-sectional areas of the bilateral common peroneal nerves of patients in DPN group were significantly larger than those of patients in non-DPN group and volunteers in healthy control group (P<0.05); there was no statistically significant difference in the cross-sectional area of the bilateral tibial nerves between volunteers in healthy control group and two groups of patients (P>0.05). At admission, the stiffness of the bilateral tibial nerves and common peroneal nerves of patients in both non-DPN group and DPN group was significantly greater than that of volunteers in healthy control group (P<0.05); the stiffness of the left tibial nerve and the bilateral common peroneal nerves of patients was significantly greater in DPN group than in non-DPN group (P<0.05). The results of multivariable ordinal logistic regression analysis showed that common peroneal nerve stiffness, tibial nerve stiffness, and common peroneal nerve cross-sectional area were all independent risk factors for the development of DPN among the participants in the three groups (with ORs of 0.91, 0.93, and 0.75, respectively, 95% CIs of 0.89 to 0.95, 0.89 to 0.97, and 0.58 to 0.96, respectively, P<0.05). In the two groups of patients, common peroneal nerve stiffness yielded the largest area under the curve for diagnosing DPN, which was 0.85 (with a 95% CI of 0.74 to 0.92). The optimal cutoff value was 75.29 kPa, with a sensitivity of 76.32% and a specificity of 90.00% at the optimal cutoff value. In DPN group, common peroneal nerve stiffness and common peroneal nerve cross-sectional area of patients were significantly positively correlated with the TCSS score (with r_s values of 0.83 and 0.89, respectively, P<0.05). Conclusions SWE demonstrates excellent performance in assessing peripheral nerve stiffness in patients with type 2 diabetes mellitus. In particular, common peroneal nerve stiffness measured by SWE has high diagnostic value for patients complicated with DPN and is correlated with clinical severity. It may serve as an auxiliary imaging marker for the early screening and severity assessment of DPN.

Influence and mechanism of PBNP combined with mouse ADSCs on full-thickness skin defect wounds in diabetic mice

Zhang Xiaowei, Xu Shuangyi, Han Yujia, Li Xiaomei, Xu Gang

2026, 42(7): 659-668. doi: 10.3760/cma.j.cn501225-20250106-00009

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Objective To investigate the influence and mechanism of Prussian blue nanoparticles (PBNPs) combined with mouse adipose-derived mesenchymal stem cells (ADSCs) on full-thickness skin defect wounds in diabetic mice. Methods This study was an experimental study using group design and repeated-measures design. PBNPs were prepared by hydrothermal synthesis, and their morphology was characterized by transmission electron microscopy. ADSCs were isolated from five male 6-8-week-old Institute of Cancer Research (ICR) mice, USA via collagenase digestion. The cells were divided into control group cultured under routine conditions, high-glucose group cultured with glucose in a final molarity of 30.0 mmol/L, and low-PBNP group and high-PBNP group pretreated with 10 or 20 μg/mL PBNP for 12 h, respectively, followed by the same treatment as in high-glucose group. After 24 h of culture, cell viability was assessed using the cell counting kit-8, the proportion of senescent cells in the cells was detected by β-galactosidase staining, and the protein expression levels of senescence-associated proteins p16 and p21 were determined by Western blotting. Twenty-four male 6-8-week-old ICR mice were used to establish the diabetic model. A full-thickness skin defect wound was then created on the back of each mouse. The injured mice were divided into four groups (with 6 mice in each group) according to the random number table method, including control group with wounds treated with normal saline, ADSC group with wounds treated with normal saline containing 5×10⁶ ADSC (the same number of cells used below), low-PBNP group and high-PBNP group with wounds treated with normal saline containing ADSC pretreated with 10 and 20 μg/mL PBNP for 12 h, respectively. Wound healing was observed at post-injury day (PID) 0 (immediately), 3, 7, 10, and 14. The percentage of remaining wound area was calculated at PID 3, 7, 10, and 14. At PID 7, the protein expression levels of the cell proliferation markers Ki67 and vascular endothelial growth factor (VEGF) in wound tissue were detected by immunofluorescence method. At PID 14, the expression levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), IL-6, and IL-10 in wound tissue were determined by enzyme-linked immunosorbent assay. Results PBNPs exhibited a dispersed regular cubic structure. After 24 h of culture, compared with those in control group, cells in high-glucose group showed a significantly lower cell viability (P<0.05), a significantly higher proportion of senescent cells (P<0.05), and significantly higher protein expression levels of p16 and p21 (P<0.05). Compared with those in high-glucose group, cells in low-PBNP and high-PBNP groups showed significantly higher cell viability (P<0.05), significantly lower proportions of senescent cells (P<0.05), and significantly lower protein expression levels of p16 and p21 (P<0.05). From PID 0 to 14, the wounds of mice in all four groups healed gradually. At PID 3, 7, 10, and 14, the percentages of remaining wound area of mice in high-PBNP group were (75.3±3.1)%, (46.7±2.5)%, (24.0±5.2)%, and (8.0±1.0)%, respectively, all significantly lower than (85.0±2.0)%, (62.7±3.1)%, (46.7±3.8)%, and (19.3±2.1)% in ADSC group (P<0.05). At PID 7, the percentage of remaining wound area of mice in ADSC group was significantly lower than that in control group ((77.3±3.2)%, P<0.05). At PID 7, the protein expression levels of Ki67 and VEGF of cells in ADSC group were significantly higher than those in control group (P<0.05), the protein expression levels of Ki67 of cells in low-PBNP and high-PBNP groups and the protein expression level of VEGF of cells in high-PBNP group were significantly higher than those in ADSC group (P<0.05). At PID 14, compared with those in control group, wound tissue in ADSC group showed a significantly higher expression level of IL-10 (P<0.05) and significantly lower expression levels of TNF-α, IL-1β, and IL-6 (P<0.05); compared with those in ADSC group, wound tissue in low-PBNP and high-PBNP groups showed significantly higher expression levels of IL-10 (P<0.05) and significantly lower expression levels of TNF-α, IL-1β, and IL-6 (P<0.05). Conclusions PBNP can inhibit high glucose-induced senescence of mouse ADSCs. PBNP combined with mouse ADSCs is more effective than mouse ADSCs alone in promoting cell proliferation and angiogenesis in full-thickness skin defect wounds of diabetic mice, inhibiting the release of inflammatory cytokines, and accelerating wound healing.

Bidirectional two-sample MR analysis of causal relationships between human inflammatory proteins and HS and keloids

Wang Sisi, Xiao Kui, Xiao Hongtao, Han Dawei, Zhang Jian, Wang Lei, Li Yancang

2026, 42(7): 669-678. doi: 10.3760/cma.j.cn501225-20250117-00025

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Objective To explore the causal relationships between human inflammatory proteins and hypertrophic scars (HS) and keloids. Methods This study was conducted based on bidirectional two-sample Mendelian randomization (MR) analysis. Data of human inflammatory proteins, HS, and keloids were acquired from genome-wide association study database. The inverse variance weighted (IVW) method was adopted to evaluate the causal relationships between 91 kinds of human inflammatory proteins and HS and keloids, i.e., a forward MR analysis. For the above associations, Cochran's Q test was used to assess heterogeneity, MR-Egger regression and MR-PRESSO outlier tests were performed to evaluate horizontal pleiotropy, and the leave-one-out method was applied to analyze the robustness of the results. The IVW method was also used to evaluate whether there was a reverse causal relationship between HS, keloids and inflammatory proteins screened out by aforementioned forward MR analysis. Results CD6, leukemia inhibitory factor (LIF), tumor necrosis factor ligand superfamily member 12 (TNFSF12), programmed death-ligand 1 (PD-L1), interleukin-17C (IL-17C), LIF receptor (LIFR), osteoprotegerin (OPG), and fibroblast growth factor 23 (FGF23) had significant causal relationships with HS (with ORs of 1.365, 0.506, 1.567, 1.683, 0.621, 1.375, 0.623, and 0.553, respectively, 95% CIs of 1.100-1.693, 0.289-0.887, 1.081-2.273, 1.090-2.599, 0.408-0.947, 1.025-1.845, 0.402-0.966, and 0.315-0.971, respectively, P<0.05). Among them, CD6, TNFSF12, PD-L1, and LIFR were risk factors for HS, while LIF, IL-17C, OPG, and FGF23 were protective factors for HS. CD5, IL-10 receptor subunit alpha (IL-10RA), IL-5, LIF, and OPG had significant causal relationships with keloids (with ORs of 0.744, 1.303, 0.686, 0.603, and 0.715, respectively, 95% CIs of 0.573-0.965, 1.024-1.660, 0.472-0.996, 0.431-0.842, and 0.553-0.924, respectively, P<0.05). Among them, IL-10RA was a risk factor for keloids, whereas CD5, IL-5, LIF, and OPG were protective factors for keloids. No significant heterogeneity or horizontal pleiotropy was observed in the above associations (P>0.05), and the robustness of the results was not driven by any single nucleotide polymorphism. Significant reverse causal relationships existed between HS and TNFSF12 and LIFR of the 8 inflammatory proteins which had significant causal relationships with HS screened out by aforementioned forward MR analysis (with ORs of 0.972 and 0.968, respectively, 95% CIs of 0.949-0.997 and 0.942-0.994, respectively, P<0.05). No reverse causal relationship was found between keloids and the 5 inflammatory proteins which had significant causal relationships with keloids screened out by aforementioned forward MR analysis (P>0.05). Conclusions CD6, TNFSF12, PD-L1, and LIFR may increase the risk of HS, while LIF, IL-17C, OPG, and FGF23 may decrease the risk of HS. IL-10RA may increase the risk of keloids, while CD5, IL-5, LIF, and OPG may decrease the risk of keloids.

Meta-analysis of the effects of PDL combined with fractional carbon dioxide laser in the treatment of hypertrophic scars in children

Wu Jie, Zhang Huimin, Liu Rui, Zhang Nanxin, Cui Rongtao

2026, 42(7): 679-686. doi: 10.3760/cma.j.cn501225-20241224-00502

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Objective To evaluate the effects of pulsed dye laser (PDL) combined with fractional carbon dioxide laser in the treatment of hypertrophic scars (HSs) in children. Methods This study was a meta-analysis. Databases including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, and VIP Chinese Journal Service Platform were retrieved to obtain the publicly published retrospective and prospective studies on the effects of PDL combined with fractional carbon dioxide laser for pediatric HS from the establishment of each database to October 31, 2024. The outcome indexes included the total score of the patient and observer scar assessment scale (POSAS) and laser treatment-related adverse reactions. Stata version 16.0 software was used to conduct a meta-analysis. Results A total of 7 studies were included, involving 348 children with HSs. Meta-analysis results showed that the total POSAS scores in HS children who received PDL combined with fractional carbon dioxide laser treatment were significantly lower than those before treatment (with a standardized mean difference of -7.76, a 95% CI of -10.91 to-4.61, P<0.05). Subgroup analysis results suggested that geographic distribution, scar duration (divided into ≤3 months group and >3 months group), intervention measures, and fractional carbon dioxide laser energy parameters might be sources of heterogeneity for the total POSAS score. The incidence of adverse reactions of PDL combined with fractional carbon dioxide laser for pediatric HS was 3.50% (with a 95% CI of 1.60% to 6.00%, P<0.05). There was no publication bias in the total POSAS score, its subgroup analyses (including geographic distribution, scar duration, intervention measures, fractional carbon dioxide laser energy parameters, and assessor), or adverse reactions related to laser treatment (P>0.05). Conclusions PDL combined with fractional carbon dioxide laser is beneficial for the recovery of pediatric HS, with a low rate of adverse reactions and a favorable safety profile. For pediatric HS, the early intervention window within 3 months after scar formation should be prioritized, and a regimen combining low-energy fractional carbon dioxide laser flexibly with PDL should be adopted to achieve better therapeutic outcomes.

Research progress on the role of calcitonin gene-related peptide in the repair of diabetic wounds

Wang Xiyu, Tan Qian

2026, 42(7): 687-693. doi: 10.3760/cma.j.cn501225-20250215-00063

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Abstract:
Diabetic wounds are a severe complication of diabetes, which can lead to amputation or even mortality in severe cases. While normal wound healing consists of four phases: hemostasis, inflammation, proliferation, and remodeling, diabetic wounds tend to become chronic and refractory primarily due to a prolonged inflammatory phase. In diabetic wounds, insufficient synthesis and release of endogenous calcitonin gene-related peptide (CGRP) is a critical upstream mechanism underlying the disrupted neuro-immune communication, the persistent inflammation, and the arrested wound healing process. In contrast to pure skin defect wounds, where CGRP is rapidly upregulated after injury, CGRP remains persistently low in diabetic wound tissue, consequently failing to drive macrophage polarization towards the M2 phenotype or promote vascular maturation and collagen fiber deposition in the later phase of inflammation. In the early inflammatory phase, CGRP exerts pro-inflammatory effects by enhancing angiogenesis and modulating macrophage polarization. In the late inflammatory phase, CGRP upregulates thrombospondin-1, promotes neutrophil apoptosis and phagocytic clearance, thereby inhibiting excessive inflammatory response and shifting the wound microenvironment from a pro-inflammatory state to a pro-reparative state. Restoring CGRP signaling reconstructs the neuroimmunomodulation axis and improves wound repair while relieving diabetic neuropathic pain. Engineered CGRP combined with intelligent delivery systems offers promising prospects for diabetic wound therapy. However, large-scale clinical trials are still required to validate its clinical efficacy and safety. This paper systematically analyzes the mechanisms and application strategies of CGRP in facilitating diabetic wound repair, which can provide a theoretical basis and innovative strategies for clinical management.

Interpretation of the 2025 American Burn Association Clinical Practice Guideline on blood product transfusion in burn care

Sun Linli, Ding Li, Zhang Lingchun, Duan Shengdong, Jin Yongfei, Liu Wenjun

2026, 42(7): 694-699. doi: 10.3760/cma.j.cn501225-20251210-00516

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Abstract:
The American Burn Association Clinical Practice Guideline on blood product transfusion in burn care was released in July 2025. Based on the PICO (Population, Intervention, Comparison, Outcome) framework and available evidence, the guideline provided evidence-based recommendations for blood product transfusion issues during hospitalization of adult burn patients, covering the management of transfusion indications, viscoelastic testing, the use of erythropoietin and tranexamic acid, and blood product transfusion strategies, etc. This article interpreted the key points of the guideline to facilitate their understanding and application by clinical medical professionals.

Summary of the 21^st Chinese Conference on Burns and Wound Repair

Bu Yanhong, Liang Guangping, Yang Xuekang, Zheng Zhao, Luo Gaoxing

2026, 42(7): 700-702. doi: 10.3760/cma.j.cn501225-20260612-00236

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Abstract:
The 21^st Chinese Conference on Burns and Wound Repair was successfully held in the historic city of Xi'an from May 28^th to 30^th, 2026, bringing together over 800 participants from across the country for this academic event. The conference featured one main venue and six parallel thematic sub-forums and invited over 300 renowned experts and scholars from China and abroad to engage in in-depth academic exchanges and intellectual dialogues over three days around key topics such as severe burn care, acute and chronic wound management, scar prevention and treatment, rehabilitation and nursing, and youth innovation. The conference showcased the latest breakthroughs and cutting-edge achievements in burn medicine and wound repair fields in China, enhanced the capabilities and standards in critical injury management, complex wound repair, and comprehensive scar prevention and treatment. The conference thereby effectively promoted the high-quality development of burn care and wound repair in China.

Current Issue
2026 Vol. 42, No. 7

Guidelines and Consensus>>

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Current Issue 2026 Vol. 42, No. 7

Guidelines and Consensus>>

Notice>>

Current Issue
2026 Vol. 42, No. 7