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2025, Volume 41,  Issue 11

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Guideline and Consensus
Clinical practice guideline for pediatric scar prevention and treatment (2025 edition)
2025, 41(11): 1011-1028. doi: 10.3760/cma.j.cn501225-20250630-00285
Abstract [FullText HTML]
Abstract:
Children constitute a key population for scar prevention and treatment, attributed to the unique features of their skin's physiological structure and psychosomatic growth. Current approaches for preventing and treating pediatric scars are formulated with reference to relevant consensuses and guidelines for adult, failing to fully consider the specific characteristics of pediatric scars and their special needs of growth and development. As a result, some strategies for prevention and treatment remain controversial. To address this limitation, the Chinese Burn Association brought together domestic and international experts in the field of scar prevention and treatment from relevant disciplines. Guided by evidence-based medicine, referring domestic and international literature, and combining the clinical experience of specialist physicians, the Clinical practice guideline for pediatric scar prevention and treatment (2025 edition) was finally developed after consultations on clinical issues and then multiple rounds of expert meetings for discussions. This guideline outlines 20 recom-mendations addressing 10 key issues in pediatric scar prevention and treatment, and discusses the controversial issues in this field, aiming to provide scientific guidance for the entire process of prevention, treatment, and rehabilitation of scars in children aged 1-14 years.
Practical guideline on the prevention and management of diabetic foot in China (Ⅰ)
2025, 41(11): 1029-1049. doi: 10.3760/cma.j.cn501225-20250801-00345
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Diabetic foot is one of the common and serious complications among the patients with diabetes mellitus. The major causes of amputation and/or death in the patients are foot deformities, ulcers, ischemia, and possible concurrent infections. To further standardize diabetic foot prevention and treatment in China, improve its diagnostic and therapeutic consistency, and promote the development of a specialized tiered care system, Chinese Burn Association, Yangtze River Delta Integrated Diabetic Foot Alliance, and Editorial Committee of Chinese Journal of Burns and Wounds organized a multidisciplinary expert team. The team determined clinical issues related to the diagnosis, treatment, and prevention of diabetic foot and evaluated the quality grades of relevant evidence using the grading of recommendations assessment, development, and evaluation system, and eventually developed the Practical guideline on the prevention and management of diabetic foot in China. There were 46 recommendations formed in the guideline, covering comprehensive medical assessment, internal medical treatments such as control of blood glucose, blood pressure, and blood lipid, antithrombotic and anti-infection therapy, perioperative risk assessment and management, surgical treatments such as debridement, vascular reconstruction, and tissue repair surgeries, as well as foot disease prevention, multidisciplinary team cooperation, and the construction of a tiered care system, aiming to provide guidance for the clinical practice of diabetic foot in China.
Expert Forum
Multidisciplinary integration in the diagnosis and treatment in burns and wound repair surgery: current status, challenges, and future
Guan Hao, Zhang Dongliang
2025, 41(11): 1050-1056. doi: 10.3760/cma.j.cn501225-20250901-00379
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Burn medicine, as the only clinical discipline named based on etiology, is an interdisciplinary subject that integrates burn trauma emergency, wound repair, functional reconstruction, and comprehensive rehabilitation. The history of burn medicine development is an evolutionary history of the continuous integration and permeation of multi-disciplinary technologies and the continuous improvement of theoretical systems. In recent years, with the improvement of public protection awareness and changes in the disease spectrum, the burn discipline is undergoing a profound transformation from single-specialty treatment to the multidisciplinary team (MDT) collaborative diagnosis and treatment model. Its scope has gradually expanded to a more integrated burns and wound repair surgery. This article starts from the changes in the disease spectrum of the discipline, systematically analyzes the necessity, current status, and main practice models of multidisciplinary integration in the diagnosis and treatment of burns and wound repair surgery. It explores the opportunities and challenges that cutting-edge technologies such as artificial intelligence and regenerative medicine pose to the innovative development of the discipline in promoting the MDT collaboration, and puts forward the future direction for the development of MDT collaborative diagnosis and treatment in burns and wound repair surgery, hoping to provide a reference for the discipline construction.
Analyzing the multidisciplinary strategies for diagnosis and treatment of patients with burns and trauma from a management perspective
Chen Hui
2025, 41(11): 1057-1063. doi: 10.3760/cma.j.cn501225-20250731-00341
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Patients with burns and trauma often have complex conditions that require multidisciplinary diagnosis and treatment as a single discipline is insufficient to meet the needs of modern medical goals. Multidisciplinary team (MDT) collaborative diagnosis and treatment, as an important model for solving this problem, faces challenges such as the lack of initiation mechanisms, loose process management, and absence of value-based incentives in practical clinical applications. From a management perspective, this article analyzes the essential differences between MDT collaborative diagnosis and treatment for burn and trauma patients and traditional consultations, and explores the core issues from the technical level to management innovation, including leveraging on the advance technologies of burn discipline, relying on the strong disciplines of medical institutions, integrating disciplines centered on patients, optimizing processes with management as a link, and driving long-term operation with performance-based incentives. The aim is to provide strategic references for the effective implementation of MDT collaborative diagnosis and treatment for burn and trauma patients.
Original Article·Multidisciplinary Integration in Burn Treatment and Diagnosis and Research
Clinical efficacy of multidisciplinary team collaboration in the treatment of deep sternal wound infection
Tong Lin, Lei Chenjia, Zhang Wanfu, Han Fei, Chen Yang, Zhang Hao, Guan Hao
2025, 41(11): 1064-1073. doi: 10.3760/cma.j.cn501225-20250402-00159
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  Objective  To evaluate the clinical efficacy of multidisciplinary team (MDT) collaboration in the treatment of deep sternal wound infection (DSWI).  Methods  This study was a historical controlled trial. According to the diagnosis and treatment model adopted by the patients, 23 DSWI patients who met the selection criteria and were treated in the Department of Burns and Cutaneous Surgery of the First Affiliated Hospital of Air Force Medical University from June 2022 to March 2023 using the traditional single discipline led diagnosis and treatment model were included in non-MDT group, including 13 males and 10 females, aged (56±11) years; 25 DSWI patients who met the inclusion criteria and were treated using MDT diagnosis and treatment model in the unit from April 2023 to May 2024 were included in MDT group, including 12 males and 13 females, aged (54±10) years. For patients in MDT group, after admission, the MDT, composed of chief physicians from 13 departments including burns and cutaneous surgery, cardiothoracic surgery, intensive care medicine, anesthesiology, pharmacy, nutrition, endocrinology, vascular surgery, laboratory medicine, radiology, ultrasound, transfusion, and rehabilitation, jointly evaluated the condition and developed personalized plans for systematic diagnosis and treatment. For patients in non-MDT group, the diagnosis and treatment were led by surgeons from department of burns and cutaneous surgery after admission. When specialist care was limited, consultation with physicians from relevant departments were requested as needed, and a comprehensive plan for diagnosis and treatment was formulated after summarizing the consultation opinions. Once the conditions of patients in both groups stabilized, a thorough debridement of the chest wound was performed, followed by repair surgery with unilateral or bilateral pectoralis major muscle flap or combined rectus abdominis muscle flap. The time from the first surgery for the infected wound to healing, the number of surgeries performed from admission to wound healing, intraoperative blood loss, and operation duration, perioperative complications, wound infection recurrence within 15 d after muscle flap repair surgery, and corresponding incidences of complications and recurrence of wound infection were recorded, and the patient's satisfaction score evaluated using the Patient Satisfaction Scale at discharge.  Results  The time from the first surgery for the infected wound to healing of patients in MDT group was (12.5±2.8) d, which was significantly shorter than (16.3±2.7) d in non-MDT group (with mean difference of -3.8 d, 95% confidence interval of -5.4 to -2.2 d, t=-4.78, P<0.05). Compared with those in non-MDT group, the number of surgeries performed from admission to wound healing and intraoperative blood loss of patients in MDT group were significantly reduced (Z=-2.54, t=-2.20, P<0.05), and the operation duration was significantly shortened (t=-3.41, P<0.05). During the perioperative period, in MDT group, one patient experienced delayed wound healing, and one patient developed a pulmonary infection; in non-MDT group, two patients experienced delayed wound healing, one patient developed pulmonary infection, and two patients developed deep vein thrombosis in the lower limbs. Wound infection recurrence within 15 d after muscle flap repair surgery occurred in one patient in MDT group and 4 patients in non-MDT group, all of whom healed after dressing change. There were no statistically significant differences in the incidence of perioperative complication or wound infection recurrence within 15 d after muscle flap repair surgery between the two groups of patients (P>0.05). The patient's satisfaction score at discharge in MDT group was 97.7±2.4, which was significantly higher than 95.1±3.5 in non-MDT group (t=3.04, P<0.05).  Conclusions  For DSWI patients, the MDT diagnosis and treatment model can optimize the treatment plan through joint assessment by physicians from multiple disciplines. It significantly shortens the wound healing time, reduces the number of surgeries and intraoperative blood loss, and improves patient satisfaction without increasing the risk of complications or wound infection recurrence, which is worthy of clinical promotion and application.
Indicative effect of indocyanine green-near-infrared fluorescence imaging in the thickness of necrotic dermal tissue in porcine burn wounds
Zhang Yushen, Pan Xiang, Ge Yunlong, Yue Junchen, Song Yixuan, Song Weiye, Zhao Ran
2025, 41(11): 1074-1082. doi: 10.3760/cma.j.cn501225-20250731-00337
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  Objective  To explore the indicative effects of indocyanine green-near-infrared fluorescence imaging (ICG-NIFI) in the thickness of necrotic dermal tissue in porcine burn wounds.  Methods  This study was a medical-engineering interdisciplinary basic research. One 3-month-old male Bama miniature pig was selected, and circular burn wounds with a diameter of 2 cm were created by applying a scalding instrument with inflicting temperature of 75 ℃ to the skin on the dorsal side of the pig for 3, 7, and 11 seconds, respectively, with two wounds for each duration of injury. The fluorescence intensity of the regions of interest in the wounds and the surrounding normal skin was detected by ICG-NIFI technology within 700 seconds after injecting indocyanine green (hereinafter referred to as after administration). The trend of the normalized fluorescence intensity was observed, and the time when the fluorescence intensity of the regions of interest in the wounds and the surrounding normal skin reached the peak (hereinafter referred to as the peak time) was determined. Additional two 3-month-old male Bama miniature pigs were selected, and circular burn wounds with a diameter of 2 cm were created on the skin of bilateral thoracic walls by applying a scalding instrument with inflicting temperature of 75 ℃ for 5, 7, 9, 11, 13, 15, 17, and 19 seconds, respectively, with 4 wounds for each duration of injury. The blood flow intensity of the regions of interest in the wounds was detected by laser speckle contrast imaging technology; the relative fluorescence intensity of the regions of interest in the wounds was detected by ICG-NIFI technology at the peak time of the wounds and the surrounding normal skin. The full-thickness skin tissue of the wounds was taken for hematoxylin-eosin staining, and the thickness of necrotic dermal tissue was measured. The correlation between the blood flow intensity of the regions of interest in the wounds and the relative fluorescence intensity at the peak time of the regions of interest in the wounds and the surrounding normal skin and the thickness of necrotic dermal tissue in the wounds was analyzed.  Results  The fluorescence intensity of the regions of interest in the surrounding normal skin showed a rapid increase followed by a slow decrease, with the peak time of approximately 60 seconds after administration. The fluorescence intensity of the regions of interest in the wounds showed a slow increase followed by a sustained stable trend, with the peak time of approximately 600 seconds after administration. The thickness of necrotic dermal tissue in the wounds caused by durations of injury of 5, 7, 9, 11, 13, 15, 17, and 19 seconds was (101±8), (130±6), (201±19), (197±30), (204±21), (280±39), (302±35), and (366±27) μm, respectively. The correlation between the blood flow intensity of the regions of interest in the wounds and the thickness of necrotic dermal tissue in the wounds was not significant (P>0.05). The relative fluorescence intensity of the regions of interest in the wounds at 60 seconds after administration was significantly negatively correlated with the thickness of necrotic dermal tissue in the wounds (R²=0.97, P<0.05), and the relative fluorescence intensity of the regions of interest in the wounds at 600 seconds after administration was significantly positively correlated with the thickness of necrotic dermal tissue in the wounds (R²=0.96, P<0.05).  Conclusions  The relative fluorescence intensity of the regions of interest in porcine burn wounds detected by ICG-NIFI at 60 and 600 seconds after administration was significantly correlated with the thickness of necrotic dermal tissue in the wounds, indicating that ICG-NIFI has a significantly sensitive indicative effects for the thickness of necrotic dermal tissue in porcine burn wounds.
Application of multidisciplinary team diagnosis and treatment model in the management of patients with combined burns and heat stroke
Jiang Shasha, Wang Nannan, Wang Huanhuan, Xiao Rong, Zhang Senlin, Wang Chao, Yan Jin, Hu Dongsheng, Duan Senling, Lin Zhichen, Hu Mingyuan, Li Song, Wang Ming, Lyu Na, Ji Yunliang, Feng Qi, Li Qinghua, Lin Guo'an, Yan Tiantian
2025, 41(11): 1083-1090. doi: 10.3760/cma.j.cn501225-20250729-00330
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  Objective  To explore the application of multidisciplinary team (MDT) diagnosis and treatment model in the management of patients with combined burns and heat stroke.  Methods  This study was a retrospective observational study. From January 2022 to December 2024, the Military Burn Center admitted 5 patients and the Department of Critical Care Medicine of the 990th Hospital of PLA Joint Logistic Support Force admitted 4 patients with combined burns and heat stroke that met the inclusion criteria. All patients were male, aged 64-78 (70±5) years. The onset of the disease in patients occurred mainly during June to September, with the time frame predominantly between 10:00 and 14:30, in environment with temperature>30 ℃ and humidity≥60%. Under the MDT diagnosis and treatment model, a fixed MDT was established with the director of the Military Burn Center as the leader, which included specialists from critical care medicine, nephrology, respiratory medicine, cardiology, neurology, anesthesiology, endocrinology, pharmacy, rehabilitation, nutrition, and transfusion medicine. Through clear division of responsibilities, standardized information communication, and daily interdisciplinary handovers, integrated coordination and decision-making in the diagnosis and treatment process were achieved. The burn-related characteristics including total burn area, burn index, and combination of inhalation injury, treatment including infusion rate in the first 24 h post admission, infusion rate in the second 24 h post admission, and total infusion rate within 48 h post admission, use of blood products, status of continuous blood purification (CBP) treatment, administration of invasive mechanical ventilation, and timing of the first surgery, outcomes including length of intensive care unit (ICU) stay, total hospital stay, and mortality within 7 days after admission of patients were recorded.  Results  The total burn area of patients was 22.6% (10.5%, 23.0%) total body surface area, the burn index was 12.5 (8.0, 13.5), and 5 patients were combined with inhalation injury. The infusion rate in the first 24 h post admission, infusion rate in the second 24 h post admission, and total infusion rate within 48 h post admission of 7 patients were significantly higher than the planned fluid infusion rates (with t values of 4.39, 8.58, and 3.69, respectively, P<0.05). Blood products were used in 6 patients. CBP was performed in 3 patients with an average duration of 64.7 h, and invasive mechanical ventilation was applied in 4 patients with an average duration of 60.0 h. Five patients underwent surgery, with the first surgery performed at 13-19 (16.0 (13.7, 19.0)) days post admission. The patients' length of ICU stay was 0-504 (216 (18, 252)) h, and the total hospital stay was 0.5-71.0 (11.0 (1.4, 46.5)) d. Four patients died within 7 days after admission.  Conclusions  Patients with combined burns and heat stroke are characterized by relatively limited burn area, frequent inhalation injury, and large volume of fluid resuscitation, thus facing clinical challenges such as the need for multiple ways of organ support and delayed surgical timing. In this context, the MDT diagnosis and treatment model centered on the department of burns and department of critical care medicine provides a rational pathway for coordinating complex resuscitation management, organ function support, and decisions on the timing of surgery.
Original Article
Clinical application effects of indocyanine green angiography combined with color Doppler ultrasound in perforator localization of anterolateral thigh perforator flaps
Dong Shuai, Wang Shi, Teng Zhicheng, Liu Yucheng, Zhang Yan, Cao Yang, Wang Kai, Zhou Rong, Jin Guangzhe, Ju Jihui
2025, 41(11): 1091-1100. doi: 10.3760/cma.j.cn501225-20240629-00254
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  Objective  To investigate the clinical application effects of indocyanine green angiography (ICGA) combined with color Doppler ultrasound (CDU) in perforator localization of anterolateral thigh perforator flaps.  Methods  This study was a retrospective observational study. From January to August 2024, the Department of Hand Surgery admitted 21 patients and the Department of Wound Repair Surgery of Suzhou Ruihua Orthopedic Hospital admitted 35 patients that met the inclusion criteria. These patients underwent surgical repair of the extremity skin and soft tissue defects using anterolateral thigh perforator flaps designed under the assistance of CDU and ICGA. Among them, there were 44 males and 12 females, aged 16 to 71 years. After debridement, the wound area ranged from 7.0 cm×5.5 cm to 40.0 cm×10.0 cm. Before surgery, CDU and ICGA were used to locate the perforators of anterolateral thigh perforator flap. The area of harvested flap ranged from 8.0 cm×6.0 cm to 40.5 cm×11.0 cm. The wounds in flap donor sites were closed directly or covered with the full-thickness skin graft from the contralateral thigh. The number of perforators located by preoperative CDU or ICGA, and the number, origin, type, and caliber of perforators in intraoperative exploration, and flap thickness were recorded. The consistency between preoperative CDU or ICGA localization results and intraoperative exploration findings was assessed. The error distances between preoperative CDU or ICGA localization and intraoperative exploration of perforator, respectively, were measured. Using intraoperative exploration of perforator as the gold standard, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of preoperative CDU and ICGA for perforator localization were calculated. The independent influencing factor for the consistency between CDU or ICGA localization results and intraoperative exploration findings of 56 patients who had anterolateral thigh perforator flap designed under the assistance of CDU and ICGA were screened.  Results  A total of 131 perforators were located by CDU and 130 perforators were located by ICGA preoperatively. Intraoperatively, 132 perforators were explored, including 64 perforators from the oblique branch, 49 perforators from the descending branch, 9 perforators from the transverse branch, and 10 perforators from the anterior branch. Among them, 46 perforators were septocutaneous perforators and 86 perforators were musculocutaneous perforators, with a mean caliber of (0.72±0.21) mm. The flap thickness was (1.5±0.6) cm. There was no statistically significant difference in the consistency between preoperative CDU localization results and intraoperative exploration findings and ICGA localization results and intraoperative exploration findings (P>0.05). There was no statistically significant difference in the error distance between preoperative CDU localization and intraoperative exploration of perforator and preoperative ICGA localization and intraoperative exploration of perforator (P>0.05). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of ICGA and CDU in locating perforators were 92.42%, 92.00%, 93.85%, 90.20%, and 92.24%, 84.09%, 80.00%, 84.73%, 79.21%, and 82.33%, respectively. Flap thickness was an influencing factor for the consistency between preoperative ICGA localization results and intraoperative exploration findings of 56 patients who had anterolateral thigh perforator flap designed under the assistance of CDU and ICGA (with odds ratio of 0.20, 95% confidence interval of 0.06-0.66, P<0.05). Perforator type was an influencing factor for the consistency between preoperative CDU localization results and intraoperative exploration findings of 56 patients who had anterolateral thigh perforator flap designed under the assistance of CDU and ICGA (with odds ratio of 3.07, 95% confidence interval of 1.11-8.46, P<0.05). After adjusting for sex, age, body mass index, perforator type, and perforator caliber, flap thickness was an independent influencing factor for the consistency between preoperative ICGA localization results and intraoperative exploration findings of 56 patients who had anterolateral thigh perforator flap designed under the assistance of CDU and ICGA (with odds ratio of 0.15, 95% confidence interval of 0.03-0.73, P<0.05). After adjusting for sex, age, body mass index, flap thickness, and perforator caliber, perforator type was an independent influencing factor for the consistency between preoperative CDU localization results and intraoperative exploration findings of 56 patients who had anterolateral thigh perforator flap designed under the assistance of CDU and ICGA (with odds ratio of 4.25, 95% confidence interval of 1.39-12.98, P<0.05).  Conclusions  The combined application of ICGA and CDU for perforator localization in anterolateral thigh perforator flaps in clinic can complete each other to improve the accuracy of localization. Flap thickness significantly affects the accuracy of ICGA localization, while perforator type significantly affects the accuracy of CDU localization.
Effect and mechanism of astaxanthin on the aging of high glucose-treated human skin fibroblasts
Tang Lijun, Fan Lianghua, Wang Jingrong, Luo Meng, Yang Xiaoxin, Zhong Ruiqing, Gao Hongyan
2025, 41(11): 1101-1110. doi: 10.3760/cma.j.cn501225-20250109-00018
Abstract [FullText HTML] PDF
Abstract:
  Objective  To investigate the effect and mechanism of astaxanthin on the aging of high glucose-treated human skin fibroblasts (Fbs).  Methods  The study was an experimental study. Human skin Fbs were collected and divided into control group with conventional culture, high glucose group treated with glucose at a final molarity of 30 mmol/L, and low astaxanthin group and high astaxanthin group pretreated with astaxanthin at final molarities of 25 and 50 μmol/L respectively and then treated as that in high glucose group. After 48 h of culture, the cell survival rate was detected by the cell counting kit-8, the reactive oxygen species level in cells was detected by the fluorescent probe method, the levels of malondialdehyde, glutathione, superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GSH-Px) in cells were detected by colorimetry, and the protein expression levels of p53, phosphorylated p53, p21, p16, Rb, phosphorylated Rb, matrix metalloproteinase 1 (MMP1), MMP3, and MMP13 in cells and nuclear factor-erythroid 2-related factor 2 (Nrf2) in cytoplasm and nucleus were detected by Western blotting. Another batch of human skin Fbs were collected and divided into control group, high glucose group, and high astaxanthin group which were treated as before, and high astaxanthin+ML385 group, which were pretreated with astaxanthin at a final molarity of 50 μmol/L and ML385 at a final molarity of 10 μmol/L respectively and then treated as that in high glucose group. After 48 h of culture, the cell survival rate, the protein expression levels of p53, phosphorylated p53, p21, p16, Rb, phosphorylated Rb, MMP1, MMP3, and MMP13 in cells and Nrf2 in cytoplasm and nucleus were detected as before. The sample number in all experiments above was 3.  Results  After 48 h of culture, compared with that in control group, the cell survival rate in high glucose group was significantly decreased (P<0.05); compared with that in high glucose group, the cell survival rates in low astaxanthin group and high astaxanthin group were significantly increased (P<0.05); compared with that in low astaxanthin group, the cell survival rate in high astaxanthin group was significantly increased (P<0.05). Compared with those in control group, the levels of reactive oxygen species and malondialdehyde in cells were significantly increased (P<0.05), while the levels of glutathione, SOD, CAT, and GSH-Px in cells were significantly decreased in high glucose group (P<0.05). Compared with those in high glucose group, the levels of reactive oxygen species and malondialdehyde in cells were significantly decreased (P<0.05), while the levels of CAT and GSH-Px in cells were significantly increased in low astaxanthin group (P<0.05); the levels of reactive oxygen species and malondialdehyde in cells were significantly decreased (P<0.05), while the levels of glutathione, SOD, CAT, and GSH-Px in cells were significantly increased in high astaxanthin group (P<0.05). Compared with those in low astaxanthin group, the levels of reactive oxygen species and malondialdehyde in cells were significantly decreased (P<0.05), while the levels of glutathione, CAT, and GSH-Px in cells were significantly increased in high astaxanthin group (P<0.05). Compared with those in control group, the protein expression levels of p53, p21, phosphorylated p53, p16, Rb, MMP1, MMP3, and MMP13 in cells were significantly increased (P<0.05), while the protein expression level of phosphorylated Rb in cells was significantly decreased in high glucose group (P<0.05). Compared with those in high glucose group, the protein expression levels of p53, p21, phosphorylated p53, and MMP13 in cells were significantly decreased (P<0.05), while the protein expression level of phosphorylated Rb in cells was significantly increased in low astaxanthin group (P<0.05); the protein expression levels of p53, p21, phosphorylated p53, p16, Rb, MMP1, MMP3, and MMP13 in cells were significantly decreased (P<0.05), while the protein expression level of phosphorylated Rb in cells was significantly increased in high astaxanthin group (P<0.05). Compared with those in low astaxanthin group, the protein expression levels of p21, phosphorylated p53, p16, Rb, and MMP1 in cells in high astaxanthin group were significantly decreased (P<0.05). Compared with those in control group and high astaxanthin group, the protein expression level of cytoplasmic Nrf2 was significantly increased (with P values both <0.05), while the protein expression level of nuclear Nrf2 was significantly decreased in high glucose group (with P values both <0.05). Compared with those in low astaxanthin group, the protein expression level of cytoplasmic Nrf2 was significantly increased in high glucose group (P<0.05); the protein expression level of cytoplasmic Nrf2 was significantly decreased (P<0.05), while the protein expression level of nuclear Nrf2 was significantly increased in high astaxanthin group (P<0.05). After 48 h of culture, compared with (100.0±6.0)% in control group, the cell survival rate was significantly decreased in high glucose group ((73.9±2.2)%, P<0.05); compared with that in high glucose group, the cell survival rate was significantly increased in high astaxanthin group ((93.8±1.5)%, P<0.05); compared with that in high astaxanthin group, the cell survival rate was significantly decreased in high astaxanthin+ML385 group ((71.7±2.7)%, P<0.05). Compared with those in control group and high astaxanthin group, the protein expression levels of p53, phosphorylated p53, p21, p16, Rb, MMP1, MMP3, and MMP13 in cells were significantly increased (P<0.05), while the protein expression level of phosphorylated Rb in cells was significantly decreased in high glucose group (with P values both <0.05); compared with those in high astaxanthin group, the protein expression levels of p53, phosphorylated p53, p21, p16, Rb, MMP1, and MMP13 in cells were significantly increased (P<0.05), while the protein expression level of phosphorylated Rb in cells was significantly decreased in high astaxanthin+ML385 group (P<0.05). Compared with that in control group, the protein expression level of cytoplasmic Nrf2 was significantly increased in high glucose group (P<0.05); compared with those in high glucose group, the protein expression level of cytoplasmic Nrf2 was significantly decreased (P<0.05), while the protein expression level of nuclear Nrf2 was significantly increased in high astaxanthin group (P<0.05); compared with that in high astaxanthin group, the protein expression level of nuclear Nrf2 was significantly decreased in high astaxanthin+ML385 group (P<0.05).  Conclusions  Astaxanthin can alleviate aging of high glucose-treated human skin Fbs by regulating Nrf2 nuclear translocation to inhibit oxidative stress and downregulate the expression of aging-related proteins.

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