The risk factors of pressure ulcers in critically ill patients: a systematic review / 中国实用护理杂志

Objective To make a systematic review of pressure ulcers risk factors in critically ill patients. Methods We systematically reviewed all articles related to the pressure ulcers risk factors in critically ill patients. The Cochrane Library, PubMed, EMBASE, Web of Science Core Collection, CNKI, WANFANG and SinoMed were searched to August 2016. Results In total, 13 eligible articles were included. These studies included 18, 184 critically ill patients, six studies were classified as high quality, and seven were classified as moderate quality. Risk factors for the development of pressure ulcers include age, ICU stay, diabetes, mean arterial pressure<60-70 mmHg (1 mmHg=0.133 kPa), mechanical ventilation and mechanical ventilation, drugs, sedation and postural changes. Conclusions There is no single factor that can explain the occurrence of pressure ulcers. So it is in a variety of factors interaction, the occurrence of a significant increase in risk.

Experimental study on the inflammatory and immune responses of xenogenic acellular dermal matrix transplantation combined with thin split-thickness skin autograft / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the dynamic process of the inflammatory response and the profile of Th1/Th2 cytokines after xenogenic acellular dermal matrix (ADM) transplantation with thin split-thickness skin autograft overlay.</p><p><b>METHODS</b>SD rats were used in the study. In the control group, thin split-thickness skin autograft (STSG) was transplanted in the full-thickness skin defect of the SD rats; in the experimental group, the xenogenic acellular dermal matrix combined with thin split-thickness skin autograft was transplanted. The inflammatory response was examined histologically and Th1/Th2 cytokine mRNA expression in skin grafts was determined by reverse transcription-polymerase chain reaction.</p><p><b>RESULTS</b>Inflammatory reaction was induced by ADM at the early stage of transplantation and decreased gradually. Th2 cytokine mRNA expression was higher in the ADM group than that of the control group whereas the Th1 cytokine mRNA expression was undetected in both groups.</p><p><b>CONCLUSION</b>Xenogenic acellular dermal matrix is immunogenic. The increased expression of Th2 cytokines may be related to the humoral immune responses and the absence of ADM graft rejection.</p>

An experimental study on the influence of inhibition of postburn stress on inflammatory reaction in severely scalded rats / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the influence of hibernation drugs on postburn stress and inflammatory reaction in severely scalded rats.</p><p><b>METHODS</b>Sprague-Dawley rats inflicted with 30% TBSA deep partial thickness scalding were employed as the model. The rats were divided into A (scalding with immediate resuscitation), B (scalding with immediate resuscitation and lytic cocktail), C (scalding with delayed resuscitation), D (scalding with delayed resuscitation and lytic cocktail) and E (sham injury) groups. The rat plasma levels of NE (norepinephrine), E (epinephrine) and DA (dopamine) were determined by HPLC (high performance liquid chromatography) at 3, 6, 12, 24 and 48 postburn hours (PBHs), and the plasma IL-1alpha and PGE(2) levels were detected by ELISA (enzyme-linked immunosorbent assay) and RIA (radioimmunoassay) methods. The NF-kappaB activity in PBMCs (peripheral blood mononuclear cells) was determined by laser scanning confocal microscope.</p><p><b>RESULTS</b>The plasma NE and E levels reached summit at 6 PBH, while those in B group were lowest. But the plasma DA level was similar among all groups at all time points. The plasma IL-1alpha and PGE(2) levels increased continuously, however, the levels were were lower in B than A groups at the same time points, and also that of D were lower than C groups. At the same time points, the levels in B group were lower than those in D group. The NF-kappaB was located in the cytoplasma of PBMCs in E group and in the nucleus in A group at 6 PBH. Furthermore, the NF-kappaB was concentrated more in the cytoplasm than that in the nucleus in B group, while it was more concentrated in the nucleus in C and D groups.</p><p><b>CONCLUSION</b>The secretion of stress hormones could be attenuated by hibernation drugs. The plasma cytokine levels and the nuclear translocation of NF-kappaB in PBMCs could also be modulated by the drugs.</p>

A multicenter clinical trial of piperacillin/tazobactam in burn infection / 中华烧伤杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of piperacillin/tazobactam in the management of burn infection.</p><p><b>METHODS</b>Sixty-three burn patients were enrolled in the study with burn sepsis or burn area more than 50%TBSA or full skin loss more than 30% TBSA. The administration regime of the antibiotics was 4.5 g intravenously administered every 8 hours in the treatment of burn sepsis or in the prophylactic management. The effectiveness was identified when the septic symptoms disappeared or focal infection did not develop into sepsis.</p><p><b>RESULTS</b>The overall clinical efficacy was 90.4%, and success in sepsis (control) was 75%. Furthermore, 95.7% of the focal infection was prevented from developing into systemic infection. The bacterial clearance rates were 71.4% and 51.4% in treatment and prophylaxis groups, respectively.</p><p><b>CONCLUSION</b>Piperacillin/taxobactam was effective in the treatment and/or prophylaxis of burn sepsis caused by bacteria susceptible to it, so it could be applied empirically.</p>

An observation of the basement membrane remodeling after the combined grafting of xenogenic acellular dermal matrix with autoskin in rats / 中华烧伤杂志

<p><b>OBJECTIVE</b>To observe the dynamic process of basement membrane remodeling after the combined grafting of xenogenic acellular dermal matrix with autoskin.</p><p><b>METHODS</b>The rat skin wounds were covered with xenogenic porcine acellular dermal matrix overlaid with razor thin autoskin. The skin samples were collected at 1, 2, 3, 4, 8, 12 and 16 post-grafting weeks. The changes in laminin expression in the basement membrane and the ultrastructure of the basement membrane at 12 post-grafting weeks were observed by immunohistochemistry and transmission electron microscopy. The results were compared with those in simple thin autoskin grafting as the control.</p><p><b>RESULTS</b>The laminin expression in the combined grafting was higher than that in control. At 12 post-grafting weeks, the basement membrane in combined grafting rats was clear and continuous and the hemidesmosome was relatively more in amount and distributed evenly. While in the autoskin group, the lamina densa in the basement membrane was blurred and discontinuous with a decrease in and uneven distribution of hemidesmosome.</p><p><b>CONCLUSION</b>The increased expression of laminin in the basement membrane in the combined grafting rats might be beneficial to the remodeling of the basement membrane and to strengthening the connection of epithelium to the dermis, thus wound healing quality would be improved.</p>