中华烧伤与创面修复杂志

Long term efficacy of absorbable sutures coated with silver nanoparticles on the suture tract of skin wounds in mice

He Feng, Du Juan, Song Yanbiao, Ye Mao, Wei Yandong, Liu Xuelai

, Available online , doi: 10.3760/cma.j.cn501225-20231007-00104

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Objective To explore the long term efficacy of absorbable sutures coated with silver nanoparticles on the suture tract of skin wounds in mice. Methods This study was an experimental research. Eighteen half male and half female BALB/c mice aged 10-12 weeks were divided into normal Vicryl suture group, antibiotic Vicryl suture group, and silver nanoparticle Vicryl suture group, according to the random number table, with 6 mice in each group, half male and half female. After the skin wounds were created on the back of all mice, the skin incisions of mice in normal Vicryl suture group, antibiotic Vicryl suture group, and silver nanoparticle Vicryl suture group were performed with continuous intradermal suture by absorbable Vicryl sutures, absorbable Vicryl sutures coated with triclosan antimicrobial, and absorbable Vicryl sutures coated with silver nanoparticles, respectively. On the 25^th day after surgery, the skin tissue in the suture tract was collected, immunohistochemical staining was used to detect the positive area percentages of F4/80, interleukin-6 (IL-6), and tumor necrosis factor α (TNF-α) in the wound suture tract of mice, the TdT-mediated dUTP nick-end labeling (TUNEL) staining was used to detect positive area percentage of TUNEL in the wound suture tract of mice, Masson staining was used to observe the collagen fiber formation in the wound suture tract of mice, and immunohistochemical staining was used to detect the positive area percentage of tissue cathepsin K in the wound suture tract of mice. The number of the above experimental samples was 6. Results On the 25^th day after surgery, the positive area percentages of F4/80, IL-6, and TNF-α in the wound suture tract of mice in silver nanoparticle Vicryl suture group ((19.2±1.6)%, (20.2±1.7)%, and (16.0±1.6)%) were significantly lower than those in normal Vicryl suture group ((100±6.4)%, (100±7.6)%, and (100±9.6)%) and antibiotic Vicryl suture group ((47.2±3.2)%, (53.8±5.0)%, and (43.2±0)%, P<0.05). The positive area percentages of F4/80, IL-6, and TNF-α in the wound suture tract of mice in antibiotic Vicryl suture group were significantly lower than those in normal Vicryl suture group (P<0.05). On the 25^th day after surgery, the positive area percentage of TUNEL in the wound suture tract of mice in silver nanoparticle Vicryl suture group was significantly lower than those in normal Vicryl suture group and antibiotic Vicryl suture group (with P values all <0.05), the positive area percentage of TUNEL in the wound suture tract of mice in antibiotic Vicryl suture group was significantly higher than that in normal Vicryl suture group (P<0.05). On the 25^th day after surgery, the collagen fiber deposition was not obvious in the wound suture tract of mice in normal Vicryl suture group, no obvious collagen fiber formation was observed in the wound suture tract of mice in antibiotic Vicryl suture group, while the collagen fibers were mostly densely arranged and well-ordered in the wound suture tract of mice in silver nanoparticle Vicryl suture group. On the 25^th day after surgery, the positive area percentage of tissue cathepsin K in the wound suture tract of mice in silver nanoparticle Vicryl suture group was significantly lower than those in normal Vicryl suture group and antibiotic Vicryl suture group (with P values all <0.05), the positive area percentage of tissue cathepsin K in the wound suture tract of mice in antibiotic Vicryl suture group was significantly lower than that in normal Vicryl suture group (P<0.05). Conclusions In the wound suture tract of mice, silver nanoparticle Vicryl sutures exhibit superior long-term anti-inflammatory effects compared with absorbable Vicryl sutures coated with triclosan antimicrobial, and absorbable Vicryl sutures. Additionally, cell apoptosis is reduced, collagen fiber deposition is obvious, and delayed-type hypersensitivity reactions is the weakest in the wound suture tract of mice sutured by silver nanoparticle Vicryl sutures. The silver nanoparticle Vicryl sutures have potential value for clinical application.

Establishment and validation of a risk prediction model for pulmonary embolism in severe burn patients

Jiang Shengpan, Gao Xiaoqing, Tan Yiqing

, Available online , doi: 10.3760/cma.j.cn501225-20240122-00028

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Objective To screen the risk factors risk factors for pulmonary embolism in severe burn patients, based on which, a risk prediction model was established and validated. Methods This study was a retrospective case series study. The clinical data of 267 severe burn patients who met the inclusion criteria and were admitted to the Department of Burns of Wuhan Third Hospital from March 2021 to March 2023 were collected, including 159 males and 108 females, aged 18-82 years. The patients were divided into pulmonary embolism group (26 cases) and non-pulmonary embolism group (241 cases) according to whether they were complicated with pulmonary embolism. The following data of patients in the 2 groups were collected and compared, including gender, age, body mass index, bedtime during treatment, cause of burn, albumin level on admission, combination of chronic obstructive pulmonary disease (COPD), combination of diabetes mellitus, combination of hypertension, combination of inhalation injury, and the abbreviated burn severity index (ABSI) on admission. The indicators with statistically significant differences between the two groups were conducted with univariate and multivariate logistic regression analyses to identify the independent risk factors for pulmonary embolism in 267 severe burn patients. Based on these findings, a nomogram prediction model was constructed. The performance of the prediction model was evaluated by the receiver operating characteristic (ROC) curve, while its validation was conducted through calibration curve and clinical decision curve analysis. Results The proportions of beyond 60 years old, bedtime during treatment beyond 7 days, combination of COPD, and combination of diabetes (with χ² values of 7.75, 29.15, 29.86, and 5.94, respectively), and ABSI score on admission (t=6.01) of patients in pulmonary embolism group were higher than those of non-pulmonary embolism group (P<0.05). There were no statistically significant differences in the other indicators between the two groups of patients (P>0.05). The univariate logistic regression analysis showed that, age, bedtime during treatment, combination of COPD, combination of diabetes, and ABSI score on admission were the risk factors for pulmonary embolism in severe burn patients (with odds ratios of 3.40, 14.87, 17.78, 2.80, and 1.88, respectively, 95% confidence intervals of 1.38-8.39, 4.34-50.98, 4.63-68.22, 1.19-6.58, and 1.47-2.41, respectively, P<0.05). The multivariate logistic regression analysis showed that, bedtime during treatment beyond 7 days, combination of COPD, and high ABSI score on admission were the independent risk factors for pulmonary embolism in severe burn patients (with odds ratios of 11.02, 30.82, and 1.86, respectively, 95% confidence intervals of 2.76-43.98, 3.55-267.33, and 1.38-2.50, respectively, P<0.05). Based on the three aforementioned independent risk factors, a nomogram prediction model for the risk of pulmonary embolism in severe burn patients was constructed. The ROC curve of prediction model showed that, the area under the ROC curve was 0.91 (with 95% confidence interval of 0.82-0.99). When the optimal cut-off value of 25% was taken, the sensitivity and specificity of prediction model was 84.6% and 93.4%, respectively. The calibration curve showed that, the calibration curve of prediction model was around the ideal curve, with a consistency index of 0.80 in Cox regression (with 95% confidence interval of 0.74-0.87). The clinical decision curve showed that the threshold probability value of the prediction model was in the range of 1% to 98%, with net return rate over 0. Conclusions The independent risk factors for pulmonary embolism in severe burn patients include bedtime during treatment beyond 7 days, combination of COPD, and high ABSI score on admission. The nomogram prediction model constructed based on this has a good ability to predict pulmonary embolism in severe burn patients.

Curative effects of two kinds of pedicled flaps in repairing the full-thickness electric burn wounds deep to tendon or bone in the knee

Xue Jidong, Liang Yan, Di Haiping, Xing Peipeng, Dong Guoyun, Liang Zhanling, Xia Chengde

, Available online , doi: 10.3760/cma.j.cn501225-20240419-00143

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Objective To compare the curative effects of saphenous artery flap and retrograde anterolateral femoral perforator flap in repairing the full-thickness electric burn wounds deep to tendon or bone in the knee. Methods This study was a retrospective observational study. From July 2018 to February 2022, 34 patients with full-thickness electric burn wounds deep to tendon or bone in the knee and conformed to the inclusion criteria were admitted to Zhengzhou First People's Hospital, including 26 males and 8 females, aged 18 to 54 years. According to the repair method of the electric burn wounds in the knee, the patients were divided into saphenous artery flap group (18 cases) repaired with saphenous artery flap and anterolateral femoral flap group (16 cases) repaired with retrograde anterolateral femoral perforator flap. The exposed area of bone or tendon after debridement was 5 cm×4 cm to 12 cm×7 cm, 5 patients were combined with open joint, and the resected area of the flap was 9 cm×6 cm to 25 cm×12 cm in saphenous artery flap group; the exposed area of bone or tendon after debridement was 7 cm×5 cm to 15 cm×7 cm, 6 patients were combined with open joint, and the resected area of the flap was 15 cm×10 cm to 39 cm×25 cm in anterolateral femoral flap group. According to the resected width of the flap, the wounds in the flap donor areas were repaired by direct suture or medium thickness skin graft. The survival of the flap was observed after surgery. At the last follow-up, the color and texture of the flap were recorded, and the two-point discrimination distance of the flap was detected. The sensory recovery of the flap was evaluated using the trial standards for evaluation of partial function of upper extremity by the Hand Surgery Society of Chinese Medical Association, and the excellent ratio of sensory recovery was calculated. The function of knee joint was assessed using the Knee Subjective Score Scale of International Knee Documentation Committee. The repairing effect of the flap was evaluated using comprehensive evaluation scale of flap, and the excellent ratio was calculated. Results Most of the flaps in patients in the 2 groups survived well after surgery, only 2 patients in the anterolateral femoral flap group had distal flap necrosis of 3 to 5 cm², which healed after skin grafting or local suture. At the last follow-up of 12 to 18 months after surgery, the color and texture of the flap in patients in the two groups were similar to that of the skin tissue in the knee. The excellent ratio of sensory recovery of the flap was 18/18 in patients in saphenous artery flap group, which was significantly higher than 5/16 in anterolateral femoral flap group (χ²=5.71, P<0.05). The two-point discrimination distance of the flap was (11.7±1.5) mm in patients in saphenous artery flap group, which was significantly shorter than (21.5±1.7) mm in anterolateral femoral flap group (t=-1.84, P<0.05). The score of the knee joint function and the excellent ratio of the repairing effect of the flap had no statistically significant differences in patients in the two groups (P>0.05). Conclusions The full-thickness electric burn wounds deep to tendon or bone in the knee can be repaired by the saphenous artery flap and retrograde anterolateral femoral perforator flap. After repaired by the two flaps, the appearance and the function of the knee joint recover well, while the sensory recovery is better after repaired by the saphenous artery flap.

Prospective self-controlled clinical trial on the effects of without outer suture on skin incision healing

Chen Zongan, Yang Yating, Wang Wenbo, Xia Lingling, Liu Wei, Gao Zhen, Wu Xiaoli

, Available online , doi: 10.3760/cma.j.cn501225-20240206-00051

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Objective To compare the impact of whether to apply the outer suture after inner suture on skin incision healing. Methods This study was a prospective self-controlled clinical trial. From November 2020 to September 2021, 49 patients who underwent skin resection surgery and met the inclusion criteria were admitted to Shanghai Ninth People's Hospital of Shanghai Jiao Tong University School of Medicine, including 39 females and 10 males, aged 18 to 55 years. The surgical sites included the upper limbs (17 cases), lower limbs (2 cases), shoulders (3 cases), neck (8 cases), abdomen (8 cases), chest (10 cases), and back (1 case). Each patient's surgical incision was divided equally into the outer suture segment (with inner suture and outer suture) and the outer sutureless segment (only with inner suture) using the random sequence method. On the day of suture removal and at the 1^st month of follow-up after surgery, the incision dehiscence was observed. At the 12^th month of follow-up after surgery, the scar hyperplasia was observed and the scar hyperplasia rate was calculated. At the 6^th and 12^th months of follow-up after surgery, the scar width of incision was measured. At the 1^st, 6^th, and 12^th months of follow-up after surgery, the Vancouver Scar Scale (VSS) was used to assess scar condition of the incision in terms of color, thickness, vascularization, and pliability, and the total score was calculated. The number of patients corresponding to the VSS score in the 1^stand 12^th months of follow-up after surgery was 41 and 46, respectively, while the number of patients corresponding to other indicators was 49. Results On the day of suture removal and at the 1^st month of follow-up after surgery, no dehiscence was observed in either the outer suture segment or outer sutureless segment of any patient's surgical incision. At the 12^th month of follow-up after surgery, the scar hyperplasia rate in the outer suture segment was 2.04% (1/49), which was not significantly different from 4.08% (2/49) in the outer sutureless segment (P>0.05). At the 6^th and 12^th months of follow-up after surgery, the scar widths in the outer sutureless segment of incision were 1.48 (1.01, 1.91) and 1.41 (1.13, 1.93) mm, respectively, which were not significantly different from 1.38 (1.00, 1.94) mm and 1.45 (1.17, 1.84) mm in the outer sutureless segment (P>0.05). At the 1^st, 6^th, and 12^th months of follow-up after surgery, there were no statistically significant differences either in scores of scar color, thickness, vascularization, pliability, or in the total score of scar of the incision between the outer suture segment and the outer sutureless segment (P>0.05). Conclusions After tension reduction and fine inner suture of skin incisions, outer suture has no significant effect on incision healing or postoperative scar appearance.

Effects of analgesic and sedation model in critical care medicine on patients with severe burns combined with inhalation injury

Pan Yanyan, Fan Youfen

, Available online , doi: 10.3760/cma.j.cn501225-20240625-00248

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Objective To analyze the effects of analgesic and sedation model in critical care medicine on patients with severe burns combined with inhalation injury. Methods The study was a historical controlled study. A total of 157 patients with severe burns combined with inhalation injury who met the inclusion criteria were admitted to the Department of Burns of Ningbo No. 2 Hospital from January 2017 to December 2022, including 126 males and 31 females, aged 14-87 years. Medical records of patients were collected before adopting the analgesic and sedation model in critical care medicine from January 2017 to December 2019 (pre-intervention, 77 patients) and after adopting the analgesic and sedation model in critical care medicine from January 2020 to December 2022 (post-intervention, 80 patients), including the total burn area, degree of inhalation injury, abbreviated burn severity index score, and other general information; the number of patients, dosage, and day of using analgesic drugs (tramadol, fentanyl, and remifentanil), and the total cases and day of analgesia; the number of patients, dosage, day of using sedative drugs (midazolam, dexmedetomidine, lytic cocktail), and the total cases and day of sedation; the days of tracheal tube placement, hospitalization costs, cases and day of mechanical ventilation, and incidence of complications (secondary pneumonia and hypotension). The effects of analgesic and sedation model in critical care medicine on the day of tracheal tube placement was analyzed using the interrupted time series (ITS) analysis and univariate Fine-Gray competing risk model, and the independent factors influencing the day of tracheal tube placement were screened using univariate and multivariate Fine-Gray competing risk model. Results There were no statistically significant differences in the total burn area and degree of inhalation injury in patients in pre-intervention and post-intervention (P>0.05). The total sedation day and total analgesia day in patients in post-intervention were 7.0 (2.0, 14.0) and 7.0 (4.0, 14.0) d, respectively, which were significantly more than 3.0 (1.0, 5.0) and 4.0 (3.0, 7.0) d in patients in pre-intervention (with Z values of -2.84 and -2.91, respectively, P<0.05). Compared with those in patients in pre-intervention, the proportion of patients and days of using midazolam and fentanyl were significantly higher (with χ² values of 5.68 and 6.19, Z values of -3.67 and -2.16, respectively, P<0.05), and the proportion of patients using tramadol was significantly higher (χ²=6.57, P<0.05), while the dosage of dexmedetomidine and the proportion of patients using lytic cocktail were significantly lower (Z=-2.17, χ²=14.54, P<0.05) in post-intervention. The day of tracheal tube placement in patients in post-intervention was 15.0 (9.0, 31.0) d, which was significantly more than 12.0 (9.0, 16.5) d in pre-intervention (Z=-2.57, P<0.05). Compared with those in patients in pre-intervention, the hospitalization costs, the proportion of patients and days of undergoing mechanical ventilation, and the proportion of patients with secondary pneumonia were significantly increased (Z=-2.62, χ²=8.79, Z=-3.80, χ²=8.67, P<0.05) in patients in post-intervention. ITS analysis showed that the day of tracheal tube placement in patients with severe burns combined with inhalation injury decreased by 0.57 d per half year in pre-intervention (P<0.05), and the day of tracheal tube placement increased by 0.62 d per half year in post-intervention (P<0.05). The analysis of univariate Fine-Gray competing risk model showed that after controlling the competing risk event, the day of tracheal tube placement in patients in pre-intervention was significantly shorter than that in post-intervention (Z=44.81, P<0.05). Multivariate Fine-Gray competing risk model analysis showed that the ABSI score, underlying disease, and day of using midazolam were the independent factors influencing the day of tracheal tube placement (with risk ratios of 0.67, 0.34, and 1.93, 95% confidence intervals of 0.66-0.73, 0.16-0.73, and 1.04-3.60, respectively, P<0.05). Conclusions After adopting the analgesic and sedation model in critical care medicine in patients with severe burns and inhalation injury, the total day of analgesia and sedation were significantly prolonged, and the day of tracheal tube placement, day of mechanical ventilation, and hospitalization costs are increased. The proportion of mechanical ventilation and the incidence of secondary pneumonia are also increased. The ABSI score, underlying disease, and day of using midazolam are the independent factors influencing the day of tracheal tube placement.

The effect of platelet-rich plasma gels on adipose mesenchymal stem cells overexpressing glia-derived neurotrophic factor

Cai Weixia, Zheng Zhao, Liu Jiaqi, Liu Yang, Zhang Ting, Ji Peng, Tian Chenyang

, Available online , doi: 10.3760/cma.j.cn501225-20240408-00126

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Objective To investigate the effect of platelet-rich plasma (PRP) gel on adipose mesenchymal stem cells (ADSCs) overexpressing glial cell-derived neurotrophic factor (GDNF), namely GDNF-ADSCs. Methods This study was an experimental study. Five adult male Sprague-Dawley rats (the same below) were used, and the primary ADSCs were obtained by collagenase digestion, and then the cells were indentified. The 3^rd generation ADSCs were obtained and divided into negative control group infected with empty adenovirus and overexpressing GDNF group infected with overexpressing GDNF adenovirus, according to random number table method. After 48 hours of culture, the infection of cells was observed. Five adult male Sprague-Dawley rats (the same below) were used, and the PRP was obtained after collecting blood by differential centrifugation. The microstructure of PRP was observed by scanning electron microscope. The 3^rd generation ADSCs were added into the mixture before PRP being gel and cultured for 48 h ours. The cell growth was observed by hematoxylin-eosin staining, and the cell viability/death was detected by calcein/propyl iodide staining. PRP gels loaded with overexpression of GDNF-ADSCs and PRP gels loaded with ADSCs infected with empty adenovirus were prepared. A 24-well plate/confocal dish was divided into negative control gel group and GDNF overexpressed gel group. After 48 hours of culture, the cell viability/death was detected by calcein/propyl iodide staining. After culture for 24, 48, 72 hours and 1, 2, 3, 4 weeks, the supernatant of cell culture medium was collected, the absorbance value was determined by enzyme-labeled analyzer and the GDNF content was calculated, with the sample number of 3. After 48 hours of culture, the expression of S100 protein (a specific marker of Schwann cells) was detected by immunofluorescence assay. Results After 48 hours of culture, the proportions of cells infected with adenovirus in negative control group and overexpressed GDNF group were close to 90%, and the cell growth was good. The cells in negative control group grew normally. The morphology of the cells in overexpressed GDNF group was significantly changed, about 80%-90% of the cells had two or more protruding processes, and the protruding processes were interwoven to form a network where the cells gathered. PRP gel formed a three-dimensional network structure with different pore sizes. After 48 hours of culture, ADSCs could be well attached to PRP gel, and 98% of the cells were alive. After 48 hours of culture, the cells in negative control gel group grew well and showed typical ADSC-like spindle-shaped growth. The cells in overexpressed GDNF gel group grew well, and most of the cells had two or more protrusions, and the protrusions were interwoven into a network. After culture for 24, 48, 72 hours and 1, 2, 3, 4 weeks, the content of GDNF in the supernatant of cell culture medium in overexpressed GDNF gel group was (90±10), (133±15), (150±10), (137±15), (132±18), (120±10), and (127±16) pg/mL, which was significantly higher than (41.67±7.29), (44.00±6.95), (43.00±6.09), (47.00±5.51), (49.00±5.05), (48.67±5.93), and (51.33±4.16) pg/mL in negative control gel group (with t values of 6.20, 8.08, 15.18, 9.12, 7.99, 9.61, and 7.86, respectively, P<0.05). After 48 hours of culture, the fluorescence intensity of S100 protein expression of cells in GDNF overexpressed gel group was significantly stronger than that in negative control gel group. Conclusions The prepared three-dimensional PRP gel has good biocompatibility and can lood GDNF-ADSCs and release GDNF slowly, inducing ADSCs to differentiate into Schwann cells with high S100 protein expression.

Effects and underlying mechanism of exosomes of adipose-derived mesenchymal stem cells on acute lung injury of septic mice

Bai Xiaozhi, Tao Ke, Liu Yang, Hao Tong, Zhang hao, Guan Hao

, Available online , doi: 10.3760/cma.j.cn501225-20240927-00355

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Objective To explore effects and underlying mechanism of exosomes of adipose-derived mesenchymal stem cells (ADSC) on acute lung injury of septic mice. Methods The study was an experimental study. ADSC of passages 4-5 were selected, and exosomes in their supernatant were isolated and extracted by differential ultracentrifugation. Exosomes were then used after identification. Twenty-four adult male BALB/c mice were selected and divided into control group, simple cecal ligation and puncture (CLP) group, and CLP+ADSC-exosome group according to the random number table method (the grouping method was the same as below), with 8 mice in each group, which were treated accordingly. At 24 hours after injury, hematoxylin-eosin staining was used to observe the morphology of lung tissues, the in-situ end-labeling method was used to detect the apoptosis of lung tissue cells, the enzyme-linked immunosorbent assay was used to detect the levels of tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) in the serum of mice, relevant kits were used to detect the contents of malondialdehyde and superoxide dismutase (SOD) in lung tissues, and immunofluorescence method was used to detect the expressions of CD86 and CD206 in lung tissue cells of mice. Mouse macrophage RAW246.7 was taken and divided into control group, simple LPS group, and LPS+ADSC-exosome group, which were treated accordingly. Twelve hours later, the ATP content, the percentage of mitochondrial ROS positive cells, as well as mitochondrial membrane potential in cells were detected by related detection kits. The real-time fluorescence quantitative reverse-ranscription PCR method was used to detect the mRNA expression levels of M1 polarization marker factor inducible nitric oxide synthase (iNOS), M2 polarization marker factor arginase-1 (Arg1), and inflammatory factors TNF-α and IL-1β in cells. Three samples were used for mRNA expression detection, and four samples were used for the detection of other indicators. Results At 24 hours after injury, the lung tissue structure of mice in control group was clear and intact without inflammatory cell infiltration. Compared with that in control group, the lung tissue edema as well as the inflammatory cell infiltration of mice was much more obvious in simple CLP group. However, compared with that in simple CLP group, the lung tissue edema in CLP+ADSC-exosome group mice was significantly alleviated, the inflammatory cell infiltration was significantly reduced, and the cell apoptosis and necrosis were significantly improved. Twenty-four hours after injury, compared with that in control group, the contents of TNF-α and IL-1β in the serum of mice in simple CLP group were significantly increased (with t values of 50.82 and 30.81, respectively, P<0.05); compared with that in simple CLP group, the contents of TNF-α and IL-1β in the serum of mice in CLP+ADSC-exosome group were significantly decreased (with t values of 16.36 and 19.25, respectively, P<0.05). Compared with that in control group, the content of malondialdehyde in the lung tissue of mice in simple CLP group was significantly increased (t=9.89, P<0.05), and the content of SOD was significantly decreased (t=5.01, P<0.05); compared with that in simple CLP group, the content of malondialdehyde in the lung tissue of mice in CLP+ADSC-exosome group was significantly decreased (t=4.38, P<0.05), and the content of SOD was significantly increased (t=2.97, P<0.05). Twenty-four hours after injury, compared with that in control group, the number of CD86 positive cells in the lung tissue of mice in simple CLP group was significantly increased, and the number of CD206 positive cells was significantly decreased; compared with that in simple CLP group, the number of CD86 positive cells in the lung tissue of mice in CLP+ADSC-exosome group was significantly decreased, and the number of CD206 positive cells was significantly increased. After 12 hours of culture, compared with that in control group, the ATP content of RAW246.7 cells in simple LPS group was significantly decreased (t=6.28, P<0.05); compared with that in simple LPS group, the ATP content of RAW246.7 cells in LPS+ADSC-exosome group was significantly increased (t=4.01, P<0.05). After 12 hours of culture, compared with 22%±4% in blank control group, 40%±6% of positive cells of mitochondrial reactive oxygen species in RAW246.7 cells in simple LPS group was significantly increased (t=5.04, P<0.05); Compared with that in LPS group, 30%±5% of positive cells of mitochondrial reactive oxygen species in RAW246.7 cells in LPS+ADSC-exosome group was significantly decreased (t=2.65, P<0.05). After 12 hours of culture, compared with that in control group, the mRNA expressions of TNF-α, IL-1β, and iNOS in RAW246.7 cells in simple LPS group were significantly increased (with t values of16.51, 31.04, and 7.70, respectively, P<0.05), and the decrease in the mRNA expression of Arg1 was not statistically significant (P>0.05); compared with that in simple LPS group, the mRNA expressions of TNF-α, IL-1β, and iNOS in RAW246.7 cells in LPS+ADSC-exosome group were significantly decreased (with t values of 11.38, 22.58, and 5.28, respectively, P<0.05), and the mRNA expression of Arg1 was significantly increased (t=7.66, P<0.05). Conclusions Human ADSC-exosomes may play a role in improving lung injury in septic mice by improving LPS-induced mitochondrial dysfunction in RAW246.7 cells, inhibiting macrophage polarization to M1, and reducing the inflammatory response.

Meek skin grafting combined with platelet-rich plasma in repairing of extensive deep burn wounds: a clinical study

Zhang Ting, Liu Jiaqi, Yang Yunshu, Han Juntao, Hu Dahai, Zheng Zhao

, Available online , doi: 10.3760/cma.j.cn501225-20231124-00206

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Objective To investigate the clinical effects of Meek skin grafting combined with platelet-rich plasma (PRP) in repairing of extensive deep burn wounds. Methods This study was a retrospective observational study. From August 2018 to August 2023, 44 patients who met the inclusion criteria were admitted to the First Affiliated Hospital of Air Force Medical University, including 23 males and 21 females. Their age ranged from 22 to 62 years old and the total burn area was 30%TBSA-80%TBSA, the burns on limbs or torso were deep partial-thickness to full-thickness. According to the treatment process, the patients were divided into observation group (21 cases) and control group (23 cases). For deep burns on the limbs or torso, patients in observation group were treated with Meek skin grafting combined with PRP at the same time, while patients in control group were treated with Meek skin grafting alone. The survival rate of Meek skin grafts was observed on the 10^th day after operation. The wound healing rate of patients was observed on the 14^th day after operation. The postoperative wound healing time and positive rate of bacterial culture of wound specimens were recorded. Results On the 10^th day after operation, the skin grafting area in observation group were dry, and the skin grafts adhered closely to the wound base with ruddy color, with a survival rate of 89%±4%. Whereas in control group, some skin grafts fell off, and the residual wounds were scattered in irregular map shape, accompanied by purulent secretion. The survival rate of skin grafts was about 79%±6%, which was significantly lower than that in observation group (t=6.72, P<0.05). On the 14^th day after operation, 19 patients in observation group had complete wound healing in the operation area, and the other 2 patients had small residual wounds, which healed after 1 week of dressing change; in control group, 12 patients had complete wound healing, 6 patients had wound healing after supplementary stamp skin grafting, and 5 patients had delayed wound healing after dressing change. The wound healing rate was significantly lower than that in observation group (P<0.05). The wound healing time of the operation area in observation group was (13.29±1.65) days, which was significantly shorter than (16.39±3.49) days in control group (t=3.72, P<0.05). There was no statistically significant difference in the positive rate of bacterial culture of wound specimens between the two groups after operation. Conclusions Compared with Meek skin grafting alone, Meek skin grafting combined with autologous PRP can improve the therapeutic effect in the repairing of extensive deep burn wounds, by promoting the survival of skin grafts, accelerating the expansion and fusion of skin grafts, and shortening the wound healing time.

Biofilm and quorum sensing genes analysis of carbapenem resistant Acinetobacter baumannii in diabetic foot wound

Xu Jun, Han Xiaocui, He Lu, Feng Shuhong, Sun Dongjian, Cao Chen, Liu Xijiao, Zhang Yanyan, Ding Baixing, Chang Bai

, Available online , doi: 10.3760/cma.j.cn501225-20240715-00269

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Objective To investigate the biofilm genes and quorum sensing genes of carbapenem resistant Acinetobacter baumannii (CRAB) in the wounds of diabetic foot and their effects on antibiotic resistance. Methods This study was an experimental study. The 233 strains of Acinetobacter baumannii cultured from 177 inpatients (128 males and 49 females, aged (56±10) years) with diabetic foot admitted to the Department of Diabetic Foot of Chu HsienI Memorial Hospital & Tianjin Institute of Endocrinology of Tianjin Medical University from October 2020 to September 2023. All Acinetobacter baumannii were subjected to antibiotic sensitivity testing using broth microdilution method, followed by identification and analysis of their resistance rate using a fully automated antibiotic sensitivity analyzer. Randomly select 10 strains of CRAB (from 10 patients, 9 males and 1 femles, aged (63±13) years) and 10 strains of carbapenem sensitive Acinetobacter baumannii (CSAB; from 10 patients, 8 males and 2 femles, aged (63±9) years) for whole genome sequencing. The antibiotic resistance genes were annotated using a comprehensive antibiotic resistance gene database, and a phylogenetic tree was draw to analyze the homologous relationship between CRAB and CSAB. The 7 housekeeping genes of Acinetobacter baumannii was entered into the website https://pubmlst.org to analyze the multilocus sequence typing between CRAB and CSAB. All the measured genes were putted into the PubMLST website to search for the biofilm genes bap, csuA, csuB, csuA/B, csuC, csuD, csuE, pagA, pagB, pagC, pagD, bfmR, bfmS, ompA carried by each Acinetobacter baumannii, as well as the quorum sensing genes abaI, abaR, and flagellar gene pilA. The differences in carrying these genes between CRAB and CSAB were compared. The correlation between biofilm genes, quorum sensing genes and Oxacillinase (OXA) resistance gene blaOXA from CRAB and CSAB was analyzed. Whether there was gel-like membrane-like substance in the wound of diabetic foot infected with CRAB and CSAB was observed by gross observation, and if there was, the microstructure was observed by scanning electron microscope. Results Among the detected Acinetobacter baumannii, the positive detection rates of CSAB, CRAB, multi-drug resistant Acinetobacter baumannii, and extensively-drug resistant Acinetobacter baumannii were 16.7% (39/233), 83.3% (194/233), 95.3% (222/233), and 34.3% (80/233), respectively, and no pan-drug resistant Acinetobacter baumannii was detected. Among 233 strains of Acinetobacter baumannii, the resistance rate of carbapenem antibiotics exceeded 80%; the resistance rates of cefoperazone/sulbactam was relatively low, at 37%; the resistance rates to other cephalosporin antibiotics (cefotaxime, ceftazimide, cefotetan, and cefuroxime) were more than 80%; the resistance rates to all penicillin antibiotics were greater than 80%; the resistance rates to quinolone antibiotics were all over 60%; the resistance rate to minocycline was only 12.0%; the resistance rates to tigecycline and colistin did not exceed 1%. The phylogenetic tree showed that 10 strains of CRAB were highly homologous, while 10 strains of CSAB had low homology. The analysis of multilocus sequence typing showed that 10 strains of CRAB strains were all the same type; except 1 strain without typing, the remaining 9 strains in 10 strains of CSAB had 7 types. Eight strains in 10 strains of CRAB contained complete biofilm genes and quorum sensing genes. The biofilm genes and quorum sensing genes from the strains of CSAB were incomplete and none carried the bap gene. Neither CRAB nor CSAB carried the flagellar gene pilA. Compared with that carried by CRAB, biofilm genes bap, csuA, csuC, and csuD and quorum sensing genes abaI and abaR carried by CSAB were significantly decreased (all P values <0.05). The main blaOXA categories carried by CRAB were BlaOXA-23-like (specifically BlaOXA-167) and BlaOXA-51-like (specifically BlaOXA-66), both of which had carbapenase activity. Eight of ten CRAB strains carried both blaOXA-66 and bla-OXA167, and all of them had relatively complete quorum sensing genes and biofilm genes. The main blaOXA categories carried by CSAB were BlaOXA-51-like and BlaOXA-213-like. Although they had carbapenemase activity, they were all sensitive to carbapenems in clinical drug sensitivity test. The biofilm genes carried by 10 strains of CSAB were incomplete, and only 3 strains of CSAB had complete quorum sensing genes. Gel-like and membrane-like substance could be seen in wounds infected with CRAB, which were biofilm; No gel-like and membrane-like substance was found in the wound infected with CSAB. Conclusions CRAB and CSAB in diabetic foot wounds are significantly different in multilocus sequence typing, carrying biofilm genes and quorum sensing genes, and the correlation with blaOXA gene, leading to differences in antibiotic resistance between the two.

Clinical practice and mode exploration of comprehensive intensive care unit led by burn department in the treatment of critical burns

Zhang Pihong, Zhang Yikun, Liang Pengfei

, Available online , doi: 10.3760/cma.j.cn501225-20240906-00329

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Abstract:
At present, although many burn centers and treatment units in China have established burn intensive care units (ICU), due to their limited capacity, the suddenness of burn accidents, and the gradual specialty-change of professional burn rescue teams, more and more critically burned patients are mainly treated in comprehensive ICU. The comprehensive ICU is gradually adopting a semi-open management mode, with multidisciplinary collaboration led by ICU or burn specialists for critical burn treatment. Based on clinical practice, this paper shares the experience of treating critical burns with semi-open management led by the burn department in comprehensive ICU, briefly introduces the capacity management strategies and infection prevention and control experiences in the course of critical burns, and explores the mode of comprehensive ICU led by the burn department in treating critical burns, so that the burn surgeon can better treat critically burned patients by combining burn treatment experience and modern critical monitoring and diagnosis and treatment technology.

Practice and thinking of integrated treatment mode for critical burns

Li Xiaojian, Tang Wenbin, Li Shanghua

, Available online , doi: 10.3760/cma.j.cn501225-20240827-00317

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On the basis of further improving the survival rate, the treatment of critical burns should prevent and treat all kinds of serious complications during the rescue process, shorten the time of wound healing, improve the quality of wound healing, and reduce scar hyperplasia and contracture after wound healing, so that patients with critical burns can return to work and society after being cured. Based on the clinical practice of the Department of Burn and Plastic Surgery of Guangzhou Red Cross Hospital Affiliated to Jinan University in the aspects of integrated treatment mode including pre-hospital first aid and early treatment, early specialist treatment and rehabilitation, multidisciplinary cooperation and doctor-nurse cooperation in the treatment process, and regional treatment system, this paper discusses the composition and application of the integrated treatment mode for critical burns under the condition that a perfect treatment system for critical burns has not yet been formed, for the reference of fellow practitioners.

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