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Objective@#To establish a method for repairing extremities with extensively deep burn using large piece of fresh allogeneic scalp spliced by Meek glue combined with autologous microskin and observe its effect.@*Methods@#Medical records of two male patients with extremely extensive deep burn admitted to our hospital from May to November in 2018 were retrospectively analyzed. Two patients aged 44 and 25 years respectively, with total burn area of 90% and 97% total body surface area (TBSA) and full-thickness burn area of 85% and 70% TBSA, respectively. Preoperatively, the surgical area on the extremities was calculated to estimate the necessary amount of allogeneic scalp and Meek miniature skin. The large piece of fresh allogeneic scalp spliced by Meek glue combined with autologous microskin was prepared according to the methods described as follows. Thin medium-thickness fresh scalps with 3% TBSA and 0.30-0.35 mm in depth were harvested from each donor and spliced into a large piece with epidermis upward by spraying Meek glue. Then the spliced scalp was punched after covered with a single-layer gauze. Autologous microskin was transported onto the dermis of fresh large piece of allogeneic scalp by traditional floating method. Bilateral extremities with full-thickness burn of two patients were selected for self-control. The left upper extremity was denoted as treatment group while the right upper extremity was denoted as control group in Patient 1. The right lower extremity was denoted as treatment group while the left lower extremity was denoted as control group in Patient 2. Wounds in the treatment group were treated with fresh large piece of allogeneic scalp spliced by Meek glue and autologous microskin with expansion ratio of 1∶15 after escharectomy, while wounds in control group received grafting of Meek miniature skin with expansion ratio of 1∶6 and or 1∶9 after escharectomy. The donors of allogeneic scalp were 32 males who were the relatives or friends of the patients, aged 21-50 years, with scalp area of (548±48) cm2. The healing conditions of donor sites of scalp were observed on post operation day 10, and were followed up within 3 months after operation to observe whether forming alopecia and hypertrophic scar or not. Wound healing condition was evaluated during follow-up in post operation week (POW) 2-5 and 4 months after operation. Wound coverage rates were calculated in both treatment and control groups in POW 2, 3, 4, and 5.@*Results@#The donor sites of all allogeneic scalp of donors healed completely on post operation day 10. There was no alopecia or hypertrophic scar within 3 months after operation for follow-up. In POW 2, allogeneic scalp grafts basically survived in treatment group without obvious exudation, and most of the Meek miniature skin survived in control group with obvious exudation. Part of allogeneic scalp grafts dissolved and detached in treatment group in POW 3, and the surviving grafts scabbed. The eschar detached and new epithelium was observed in treatment group in POW 4 and 5. In POW 3-5, surviving Meek miniature skin in control group creeped and was incorporated, and the wounds shrank. Hypertrophic scar was observed in both treatment and control groups 4 months after operation, without obvious difference in scar as a whole. The wound coverage rates were respectively 84%-98% and 76%-92% in treatment group of two patients in POW 2-5, close to or higher than those of control group (35%-97% and 28%-81%, respectively).@*Conclusions@#The study establishes a novel method for splicing fresh allogeneic scalps into a large piece as the covering of microskin, which has good effect for repairing extensively deep burn wounds. Considering that allogeneic skin is scarce, this method may be a new option in clinical treatment for extensively deep burn patients.
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Objective To evaluate the safety and effectiveness of drug-eluting stents (DES)implanted in the main branch(MB)of the coronary artery combined with drug-coated balloon(DCB)inflation in the side branch(SB)in patients with coronary bifurcation lesions.Methods A total of 68 patients with true coronary bifurcation lesions(Medina 1,1,1;1,0,1;0,1,1) admitted into our hospital from June 2017 to June 2018 were enrolled in this single center observation study.Patients were treated with DES MB implantation and DCB SB inflation,and were followed up and assessed with quantitative coronary angiography(CAG)at 6 months after PCI.The primary endpoints were late lumen loss(LLL)of MB and SB at 6 months after PCI.Results DES was implanted in MB in 68 patients.DCB was used in SB in 67 patients,and DES was implanted in SB in 1 patient due to TIMI 1 flow in SB after predilation.The rate of residual stenosis was (8.9 ± 5.6) ％ in MB and (19.7 ± 6.2)％ in SB immediately after PCI.Of 68 patients,type A dissection occurred in 7 cases and type B dissection in 5 cases in MB immediately after PCI.Overall 64 patients were followed up and assessed with quantitative CAG at 6 months after PCI.The LLL of MB was (0.25±0.31)mm and the LLL of SB was-(0.12±0.38)mm.All patients' SB dissection disappeared,and 1 patient died due to cerebral hemorrhage at 2 months after PCI.The 30-day main adverse cardiac events(MACE)was 0,and 6-month MACE was 5.97％,in which 2 cases had angina pectoris at about 3 months after PCI,with CAG showing in-stent restenosis(ISR)in the left anterior descending coronary artery(LAD)and good SB.DCB was used to treat ISR.LAD was good when assessed with CAG at 6 months during follow-up.Myocardial infarction occurred in 2 cases at about 4 months after PCI,but not in the target-vessel.Conclusions DES MB implantation combined with DCB SB inflation is safe and effective in treating coronary bifurcations lesions.
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Objective: To compare the detectability of hepatocellular carcinoma (HCC) based on DWI during gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) enhanced MR scanning between short tau inversion recover (STIR) and chemical shift selective (CHESS) sequences. Methods: Thirty-seven patients with pathologically confirmed HCC were selected for retrospective analysis. All patients underwent Gd-EOB-DTPA enhanced MR scanning of the upper abdomen. Images of DWIs with STIR and CHESS sequences were acquired at 13-15 minutes after Gd-EOB-DTPA injection. The signal intensity (SI), standard deviation (SD), ADC of liver parenchyma and SI,ADC of HCC on DWI with STIR and CHESS sequences were measured. And the SNR of liver parenchyma and CNR of HCC were calculated. The visual grade of conspicuity of HCC and the clarity of hepatic anatomical structure were scored on both two sequences. Statistical analysis was performed. SNR of liver parenchyma, CNR of HCC, ADC of liver parenchyma and HCC, as well as visual score of HCC conspicuity, clarity of hepatic anatomical structure were compared between DWI with STIR and CHESS sequences. The consistency of observation scores between two physicians were also analyzed. Results: CNR of HCC of STIR sequence was significantly higher than that of CHESS sequence (P=0.034). SNR of liver parenchyma, as well as ADC of liver parenchyma and HCC of STIR sequence were significantly lower than those of CHESS sequence (all P<0.05). The consistency of visual scores of HCC conspicuity and clarity of hepatic anatomical structure between the two physicians were good (both Kappa≥0.75). Visual scores of physician-1 and physician-2 of HCC conspicuity and the clarity of hepatic anatomical structure were significantly different between STIR and CHESS sequences (all P<0.001). Most of the visual scores of HCC conspicuity of STIR sequence were scored as 4, and most of the clarity of hepatic anatomical structure scores were as 1. The visual scores of HCC conspicuity and clarity of hepatic anatomical structure of CHESS sequence were mainly scored as 3. Conclusion: DWI using STIR sequence is helpful to detecting HCC after Gd-EOB-DTPA administration compared with CHESS sequence.
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Objective@#To explore the effects of scar excision combined with negative-pressure on repair of hypertrophic scar in burn children.@*Methods@#From October 2010 to August 2016, 25 children with hypertrophic scar after deep burn were hospitalized, with scar course ranging from 3 months to 11 years and scar area ranging from 35 to 427 [83(51, 98)]cm2. A total of 35 scars of 25 children were located in trunk (11 scars), upper limb (11 scars), and lower limb (13 scars). All children received scar excision operation and negative-pressure treatment (negative-pressure value ranged from -40 to -20 kPa), among which 6 cases received scar excision operation and negative-pressure treatment for two times for further removal of scars. After scar excision, electronic spring scale was used to measure the tension of the incision. The tension value of children ranged from 3.43 to 23.84 [7.16 (5.59, 9.12)] N, and then the incision was closed with appropriate suture according to the value of the tension. The incision with smaller tension was firstly opened on post operation day (POD) 8. After removing the suture, negative-pressure was conducted to POD 14. The incision with larger tension was firstly opened on POD 12. After removing the suture, biological semi-membrane was used to reduce tension to POD 16. All healed incisions were performed with anti-scar treatment for 1 year and relaxation and fixation for 3 months. General condition of the incision was observed after operation. The reduction percentage of scar area was calculated half-year after operation. The Patient and Observer Scar Assessment Scale was used to record the overall score of scar and scar score of trunk, upper limb, and lower limb before operation and half-year after operation. Data were processed with paired t test and Wilcoxon rank sum test.@*Results@#After removing the suture, all incisions of children healed well without redness, effusion, and rupture. Half-year after operation, the appearance and deformity of incision were obviously improved, and the symptoms including pruritus and pain were basically relieved. Half-year after operation, the scar area of children ranged from 0 to 174 [21(9, 47)]cm2, which was significantly decreased as compared with that before operation (Z=-5.16, P<0.05). The reduction percentage of scar area ranged from 36% to 100% [(73±19)%]. Half-year after operation, the overall score of scar and scar score of trunk, upper limb, and lower limb of children were obviously decreased as compared with those before operation (with t values from 6.42 to 17.37, P values below 0.05).@*Conclusions@#Scar excision combined with negative-pressure treatment has a good clinical effect on repair of hypertrophic scar in burn children, which is suitable for clinical application.
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<p><b>OBJECTIVE</b>To study the application of VSD in the treatment of severe necrotizing fasciitis in extremities of patients.</p><p><b>METHODS</b>Eight patients, suffering from severe necrotizing fasciitis, who had been traditionally treated with iodophor-soaked gauze for 21 to 365 days in other hospitals, were transferred to our institute because of the nonhealing wounds and systemic toxic symptoms induced by infection, from January 2011 to August 2013. After admission, surgical debridement was performed timely, and the necrotic tissue was collected during the operation for pathological observation after HE staining. After the operation, VSD was started with negative pressure ranging from -100 to -80 kPa, and the furacilin solution (0.2 g/L) and oxygen (2 L/min) were continuously infused into the wound during the treatment. Surgical debridement was performed repeatedly according to the wound condition followed by change of VSD dressings to continue VSD treatment. The wounds were closed by suturing or with autologous skin grafts after being covered by fresh granulation tissue. The times of surgical debridement, times of change of VSD materials, wound healing status, and length of stay in our institute were recorded. All patients were followed up for a long time. Results HE staining showed that there were diffuse necrotic adipose and fibrous connective tissues in the necrotic tissue, and the normal tissue structure disappeared accompanied by significant infiltration of inflammatory cells. The number of surgical debridement was 2 to 10 (3.9 +/- 2.8) times. The number of VSD materials change was 2 to 10 (4.0 +/- 2.9) times. Wounds were closed by suturing and healed in two patients; wounds in the other six patients were partially sutured, their residual wounds were healed by autologous skin grafting. The length of stay in our institute was 20 to 49 (33 +/- 10) days. All patients were discharged after recovery. Patients were followed up for 2 to 24 months, and their wounds were found to be in good condition without ulceration or recurrence.</p><p><b>CONCLUSIONS</b>VSD can effectively remove the necrotic tissues and exudates from the fascial spaces and promote proliferation of granulation tissue. Therefore it serves as an effective approach to the treatment of severe necrotizing fasciitis in extremities.</p>
Subject(s)
Humans , Debridement , Drainage , Extremities , General Surgery , Fasciitis, Necrotizing , General Surgery , Granulation Tissue , Negative-Pressure Wound Therapy , Oxygen , Pressure , Skin , Skin Transplantation , Ulcer , VacuumABSTRACT
@#Objective To investigate the impact of chronic disease self-management on motor function, activities of daily living, quality of life, and depression of patients in poststroke rehabilitation in community. Methods 120 stroke patients living in Gangdu community, Wuhan city were selected and randomly divided into self-management group (n=60) and control group (n=60). The control group experienced home rehabilitation and functional training by themselves, meanwhile they were asked to have regular outpatient referral and do the followup clinic when feeling indisposed. Self-management mode was used in the self-management group instructed by the professor and under the rehabilitation assessment by community doctors, therapist and family members. Also group separated instruction, individualized rehabilitation plan, home visit processes and patients' group activity had been organized. They were evaluated with Fugl-Meyer Assessment (FMA), modified Barthel Index (MBI), Hamilton Depression Rating Scale (HAMD) and the World Health Organization Quality of Life (WHOQOL-100) before and 6 months after intervention. Results There were no difference in FMA upper and lower limbs scores as well as the MBI score, HAMD score and WHOQOL-100 score before intervention (P>0.05). The FMA upper and lower limbs score, MBI score and WHOQOL- 100 score significantly improved in the self-management group and were better than in the control group 6 months after intervention (P<0.05). The control group also improved in the above items, however, the differences were not statistically significant (P>0.05). HAMD score significantly reduced in the self-management group and less than in the control group 6 months after intervention (P<0.05). The control group also reduced in the above scores, however, the differences were not statistically significant (P>0.05). Conclusion Chronic disease self-management for stroke patients in community can significantly improve their motor function, activities of daily living and quality of life, and reduce depression caused by stroke.
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Objective To explore the effects of continuous renal replacement thempy ( CRRT) on efficacy in severe acute pancreatitis ( SAP) patients based on different time .Methods A total of 38 SAP patients were divided into two groups randomly:early group(CRRT within 48h) for 21 patients and late group(CRRT after 48h)for 17 pa-tients.the APACHE II score,the length of stay ICU and the mortality of 28d were compared between the two groups . Results The APACHE Ⅱscore was significantly higher in late group than that in early group in day 1 and 2 ( t=2.231,2.304,both P0.05);the hospitalizing days and mortality were significantly higher in late group than that in early group(t=2.156,χ2 =4.293,both P0.05).Conclusion Early CRRT can decrease both the hospi-talizing days and mortality in SAP patients .CRRT may provide more clinical benefits in the early phase (within 48h) of SAP.
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Objective To investigate the impact of chronic disease self-management on motor function, activities of daily living, quality of life, and depression of patients in poststroke rehabilitation in community. Methods 120 stroke patients living in Gangdu community, Wu-han city were selected and randomly divided into self-management group (n=60) and control group (n=60). The control group experienced home rehabilitation and functional training by themselves, meanwhile they were asked to have regular outpatient referral and do the follow-up clinic when feeling indisposed. Self-management mode was used in the self-management group instructed by the professor and under the rehabilitation assessment by community doctors, therapist and family members. Also group separated instruction, individualized rehabilita-tion plan, home visit processes and patients' group activity had been organized. They were evaluated with Fugl-Meyer Assessment (FMA), modified Barthel Index (MBI), Hamilton Depression Rating Scale (HAMD) and the World Health Organization Quality of Life (WHOQOL-100) before and 6 months after intervention. Results There were no difference in FMA upper and lower limbs scores as well as the MBI score, HAMD score and WHOQOL-100 score before intervention (P>0.05). The FMA upper and lower limbs score, MBI score and WHO-QOL-100 score significantly improved in the self-management group and were better than in the control group 6 months after intervention (P0.05). HAMD score significantly reduced in the self-management group and less than in the control group 6 months after intervention (P0.05). Conclusion Chronic disease self-management for stroke patients in community can significantly improve their motor function, activities of daily living and quality of life, and reduce depression caused by stroke.
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ObjectiveTo explore the correlation between cortactin differential expression and metastasis of colorectal cancer by testing the expression of cortactin in cell sublines with different metastatic ability.MethodHuman colon cancer cell line SW1116, and sublines of fifth subcutaneous ( SW1116_5), first, fifth generation (CRCLM1 、CRCLM3 ) characteristic of different liver metastasis were implanted subcutaneously in BALB/c mouse.Tumors were transplanted into the colon, and liver metastasis was observed, Western blotting and real time-PCR was used to detect the varience of cortactin. Transwell assay was applied to evaluate four cell lines migration and invasion ability. Immunohistochemistry was used to analyze the relationship of cortactin and clinicopathological characterizing in 86 cases of colorectal cancer.ResultCRCLM3( 100％ )has higher ability of metastasis than that of CRCLM1 ( 89％ ), SW1116(40％ )and SW1116_5 (44％) respectively. Expression of cortactin in the SW1116, SW1116_5, CRCLM1,CRCLM3 was gradually increased. There were significant differences between four cell lines by comparison between each others ( P ＜ 0.05 ). Immunohistochemical expression of cortactin in 86 cases was positive in 57 cases(66％ ), and negative in 29 cases (34％).ConclusionsDifferent expression of cortactin with colorectal cancer metastasis and clinical stage was positively correlated. Cortactin is a potential indicator for clinical staging and tumor metastasis of colorectal cancer.