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Objective@#To observe the clinical effects of stage-Ⅱ Meek skin grafting on adipose tissue after tangential excision in patients with extensive deep burns, and to explore the functional mechanism.@*Methods@#The medical records of 26 extensively burned patients who met the inclusion criteria and were admitted to the Department of Burns and Plastic Surgery of the Fourth Medical Center of PLA General Hospital from May 2015 to December 2017 were retrospectively analyzed. According to the treatment methods, 14 patients were enrolled in stage-Ⅰ skin grafting group (10 males and 4 females, aged 27 to 75 years), and 12 patients were enrolled in stage-Ⅱ skin grafting group (10 males and 2 females, aged 31 to 76 years). Patients in the 2 groups all underwent debridement of tangential excision, and their healthy adipose tissue was preserved. Meek skin grafting was performed just after tangential excision in patients in stage-Ⅰ skin grafting group. In patients in stage-Ⅱ skin grafting group, porcine acellular dermal matrix (ADM) was applied to cover the wound after tangential excision, and 3 days later, it was removed and Meek skin grafting was performed. The times of complement skin grafting and the wound basic healing time of patients in the 2 groups were observed and recorded. In the stage-Ⅱ skin grafting group, the adipose tissue of patients were taken from the wound center immediately after tangential excision and immediately after the removal of porcine ADM, for the observation of structure of the fault surface of adipose tissue through hematoxylin and eosin staining and microvessel density (MVD) through immunohistochemical staining. Data were processed with independent sample t test and Fisher′s exact probability test.@*Results@#(1) The times of complement skin grafting of patients in stage-Ⅱ skin grafting group was (1.83±0.17) times, which was obviously less than (3.36±0.63) times in stage-Ⅰ skin grafting group (t=2.19, P<0.05). The wound basic healing time of patients in stage-Ⅱ skin grafting group was (35.1±2.3) d, which was obviously shorter than (48.8±4.9) d in stage-Ⅰ skin grafting group (t=2.27, P<0.05). (2) Immediately after tangential excision, the intercellular substance was few between the adipose cells in adipose tissue of patients in stage-Ⅱ skin grafting group. Immediately after the removal of porcine ADM, there was regenerated granulation tissue in the intercellular space of adipose cells of adipose tissue of patients in stage-Ⅱ skin grafting group. Immediately after tangential excision, the MVD of adipose tissue of patients in stage-Ⅱ skin grafting group was 20.2±1.3 under per 400-time field, which was obviously less than 32.2±1.9 under per 400-time field immediately after the removal of porcine ADM (t=-5.38, P<0.01).@*Conclusions@#Meek skin grafting on the adipose tissue in stage-Ⅱ surgery after tangential excision could reduce the times of complement skin grafting and shorten wound healing time of patients with extensive deep burns. The mechanism may be related to the improvement of the recipient condition of adipose tissue.
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Objective@#To explore the surgical methods for children with contracture deformity on hands after burn.@*Methods@#From January 2014 to January 2018, 33 pediatric patients, a total of 42 hands with scar contracture deformities were reviewed. There were 24 males and 9 females, aged from 11 months to 6 years and 7 months. Among them, 20 hands were volar metacarpophalangeal joint contractures, 9 were volar interphalangeal joint contractures, 7 were dorsal metacarpophalangeal joint contractures (3 claw-shaped hands), 3 were hand back contractures, and 3 were palm contractures. Of the 42 hands, 36 hands were repaired with full-thickness skin grafts or split-thickness skin grafts, after the removal of contracted scar, and 6 hands were repaired with abdominal skin flaps, due to the tendon or bone exposure after the scar removal.@*Results@#Skin grafts on 31 hands were all survived after 2 weeks. However, the survival area of 3 skin grafts was about 90%, and 2 skin grafts survived about 80%. All of them healed well after dressing changing. The 6 hands repaired with abdominal skin flap healed well too. After 1-2.5 years of follow-up, finger scar contracture occurred in 4 hands with skin grafting, and they were performed scar excision and sheet skin grafting. Three hands were treated with Z-plasty, due to web space contracture. The function of other hands were normal, without contracture or deformity. The skin color and texture were similar to the surrounding skin, with limited pigmented. Scars on the edge of skin grafts was not obvious. Patients and their families were satisfied.@*Conclusions@#The sheet skin graft is the main method for postburn scar contracture in children′s hands. The abdominal skin flap should be considered, if tendon or bone is exposed, especially for large wound or multiple sites.
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Objective@#To observe the effects of minimally invasive tangential excision in treating deep partial-thickness burn wounds on trunk and limbs in pediatric patients in the early stage post burn.@*Methods@#Clinical data of 40 children with deep partial-thickness burn wounds on trunk and limbs, admitted to our burn ward from January 2016 to June 2017, conforming to the study criteria, were retrospectively analyzed. They were divided into conventional treatment group (CT, n=19) and minimally invasive tangential excision group (MITE, n=21) according to the different treatments. The patients in group CT were treated with eschar-reserving therapy firstly. When tangential excision was performed, the roller knife was used, and no necrotic tissue left on the wound bed was considered the proper depth of excision. Razor-thickness skin grafting was performed to cover the wound when adipose tissue exposed markedly after tangential excision. Dressing change was performed within 48 h after the operation and repeated every 2 days. Unhealed wounds were covered by razor-thickness skin grafting. The patients in group MITE were treated with tangential excision in the early stage post burn. The tangential excision was operated with electric dermatome, and the thickness was set at 0.1 mm to excise the surface of eschar until the sporadic punctate hemorrhage on wound surface was observed and some necrotic tissue was left on the wound bed. Porcine acellular dermal matrix was applied after tangential excision. The first dressing change was often performed about 1 week after the operation. Razor-thickness skin grafting was performed to cover the unhealed wounds. The length of wound healing, high fever, antibiotic usage, and hospital stay, times of later operation, and hospitalization expenses of patients in the 2 groups were recorded. The excisional eschar and wound bed tissue of patients in group MITE were harvested for pathological observation. Data were processed with t test and Fisher′s exact probability test.@*Results@#(1) There were no statistically significant differences in length of high fever and length of hospital stay and hospitalization expenses between patients in the 2 groups (t=-1.67, -1.93, 0.31, P>0.05). The lengths of wound healing [(24.8±2.5) d] and antibiotic usage [(4.4±0.7) d] of patients in group MITE were significantly shorter than those in group CT [(33.3±2.5) and (7.0±0.7) d, t=-2.44, -2.44, P<0.05], and times of later operation of patients in group MITE [(0.29±0.14) times] were significantly less than those in group CT [(0.79±0.21) times, t=-2.03, P<0.05]. (2) The thickness of the excisional eschar of patients in group MITE was about 150 μm. The eschar has epidermis and upper dermis. Some necrotic tissue was left on the wound bed.@*Conclusions@#The treatment for pediatric deep partial-thickness burn wounds on trunk and limbs with minimally invasive tangential excision using electric dermatome in the early stage post burn can accelerate wound healing, shorten length of antibiotic usage, and reduce times of later operations.
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The therapeutic effects of intensive insulin therapy in treatment of traumatic shock combined with multiple organ dysfunction syndrome (MODS) were investigated. A total of 114 patients with traumatic shock combined with MODS were randomly divided into two groups: control group (n=56) treated with conventional therapy, and intensive insulin therapy group (n=58) treated with conventional therapy plus continuous insulin pumping to control the blood glucose level at range of 4.4-6.1 mmol/L. White blood cells (WBC) counts, prothrombin time (PT), serum creatinine (SCr), alanine aminotransferase (ALT), serum albumin and PaO(2) were measured before and at the day 1, 3, 5, 7 and 14 after treatment. The incidence of gastrointestinal dysfunction, the incidence of MODS, hospital stay and the mortality were also observed and compared. After intensive insulin therapy, the WBC counts, SCr, ALT and PT were significantly reduced (P<0.05), but the level of serum albumin was significantly increased (P<0.05) at the day 3, 5, 7 and 14. In the meantime, the PaO2 was significantly elevated at the day 3, 5 and 7 (P<0.01) after intensive insulin therapy. The incidence of gastrointestinal dysfunction, the incidence of MODS, the length of hospital stay and the mortality were markedly decreased (P<0.01). The results suggest early treatment with intensive insulin therapy is effective for traumatic shock combined with MODS and can decrease the length of hospital stay and the mortality.
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Objective To investigate the influence of gender differences on NF-kB activation in livers in septic rats. Methods Total 20 female and 20 male Wistar rats were randomly divided into four groups.Tissue samples of the livers were collected to measure NF-kB activation by EMSA.The level of plasma ALT,TNF-?and estrogen were measured also. Results NF-kB activation in normal male and female rats has no significant difference (P＞0.05).After stimulated by LPS,the level of NF-kB activation and ALT,TNF-?in plasma were markedly upregulated,and the index of female group lower than that in male group (P＜0.01).The level of NF-kB activation in livers and ALT,TNF-?in plasma both in male and female have significantly negative correlation with the level of estrogen in plasma (P＜0.05 ).Conclusion There are significantly gender differences on NF-kB activation in livers in septic rats.Estrogen may decrease the injury of livers in septic rats.
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0.05). Yet, the activity of NF-?B (female: 12.10?2.89; male: 19.53? 2.12) and the level of TNF-? female: (4.10?0.72) ng/ml; male: (6.37?1.29) ng/ml were significantly increased after injection of lipopolysaccharide (P
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Objevtive To study the effect of ubiquitin proteasome pathway inhibition on NF ?B activity and I?B?expression as well as TNF ? secretion in the liver in burned rats with sepsis. Methods Rats were subjected to 30% full thickness scald injury, followed by intraperitoneal injection of lipopolysaccharide (LPS), was used for this experiment to mimic early sepsis after burn. Sixty Wistar rats were randomly divided into normal control group, burn sepsis group, burn sepsis with proteasome inhibitor N Acetyl leucinyl leucinyl norleucinal (ALLN) treatment group, and burn sepsis with NF ?B inhibitor Pyrrolidine Dithiocarbamate (PDTC) treatment group with 6 rats in each group. The following parameters were measured with the method indicated in parentheses: NF ?B activity (electrophoretic mobility shift assay, EMSA), I?B ? expression (Western blotting), and TNF ? (Enzyme linked immunoadsordent assay, ELISA). Results These showed that NF ?B activity was markedly activated and reached its peak 1h after challenge ( P
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Free clodronate has a very poor ability to permeate cell membrane and an extremely short half-life in circulation. However, it can be encapsulated with liposomes, and then can be phagocytosed by monocytes/macrophages. Clodronate is released in the cells and be metabolized to a toxic ATP analog. By this way, monocytes/macrophages can be effectively depleted. The study showed that the prepared liposomes had a negative charge (-40mV) on the surface and a high encapsulation efficiency of clodronate (17.6%～19.0%) with an average size of 200nm. The spherical shape of liposome was confirmed both by transmission electron microscope and laser scanning confocal microscope. Neither free clodronate nor liposome clodronate inhibited vascular endothelial cell and smooth muscle cell proliferation. Clodronate, once encapsulated in liposomes, significantly reduced macrophage proliferation in a dose dependent manner, while free clodronate or empty liposomes had no effect on macrophages. With laser scanning confocal microscope observation, rhodamine labeled liposomes were found to penetrate and accumulate inside monocytes and macrophages, but not into the smooth muscle cells. Furthermore, rhodamine labeled liposomes without encapsulating clodronate was found to accumulate inside macrophages, but causing no damage to cells. The macrophages which engulfed rhodamine labeled clodronate liposomes would manifest a morphological structure resembling apoptotic state. The results suggest that monocytes/macrophages can be depleted via phagocytosis of liposome encapsulated clodronate without affecting non-phagocytotic cells.
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Objective To study the therapeatic effect of testosterone on skeletal muscle atrophy induced by dexamethasone in rat, and to explore the relationship between androgen and insulin like growth factor 1 (IGF-1) expression in skeletal muscle and serum. Methods Forty female Sprague-Dawley rats were randomly divided into four groups: control group (CON) in which the rats were injected with saline and sesame oil for 10 days; dexamethasone group (DEX) in which the rats were injected with dexamethasone and sesame oil for 10 days; testosterone group (TES) in which the rats were injected with saline and testosterone for 13 days; and the testosterone+dexamethasone group (TES+DEX) in which the rats were injected with dexamethasone and testosterone. The animals were weighed daily. 24 hours following the final injection, animals were weighed and sacrificed. Blood samples were withdrawn from the abdominal aorta and centrifuged at 3 000r/min for 10min. The supernatant was collected and stored at -20?C. Gastrocnemius muscle was removed, weighed and stored at -80?C. IGF-1 mRNA expression in skeletal muscle was determined by real-time PCR. IGF-1 protein expression in serum was determined by enzyme-linked immunosorbent assay (ELISA). Results Testosterone attenuated the body weight loss and gastrocnemius muscle weight loss in rats as a result of dexamethasone adminishation (P
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Objective To investigate the potential role of nuclear factor kappa B (NF-?B) in the development of acute liver injury induced by postburn sepsis in rats. Methods Sixty-three Wistar rats were randomly divided into normal control group, burn sepsis group, burn sepsis with pyrrolidine dithiocarbamate (PDTC) treatment group, and simple PDTC treatment group. Rats in experimental groups were subjected to 30% full-thickness scald injury combined with intraperitoneal injection of lipopolysaccharide (LPS) to mimic early sepsis after burns. The following parameters were measured with the method indicated in parentheses: NF-?B activity (electrophoretic mobility shift assay, EMSA), I?B-? expression (Western blotting), TNF-? (enzyme-linked immunoadsordent assay, ELISA). Results NF-?B activity was markedly enhanced and reached its peak at 1 hour after LPS challenge (P
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Objective To study the effect of testosterone on skeletal muscle atrophy of rats induced by dexamethasone,and to explore the relationship between androgen and ubiquitin ligase expression in skeletal muscle.Methods Forty female SD rats were randomly divided into four group:control group(CON),dexamethasone group(DEX),testosterone group(TES)and testosterone plus dexamethasone group(TES+DEX).Blood samples were collected from the abdominal aorta and then centrifuged.The supernatant was collected and stored at-20℃.Gastrocnemius was removed and stored at-80℃.The cross-sectional area(CSA)of muscle fiber was determined by microscopic images of digitized muscle sections,using a computer-based imaging processing system.The expression of muscle atrophy F-box(MAFbx)and muscle RING finger-1(MuRF1)mRNA in skeletal muscle was determined by real-time PCR.The expression of testosterone protein in serum was determined by immunoradiometry.Results Dexamethasone increased the expression of MAFbx and MuRF1 mRNA in skeletal muscle(P