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Objective:To explore rational surgical treatment for childhood nail matrix nevi.Methods:A retrospective analysis was conducted on clinical data from 35 children with pathologically confirmed nail matrix nevi, who received surgical treatment in Children′s Hospital of Chongqing Medical University from September 2015 to March 2019. Different surgical approaches were adopted according to the site and width of lesions. For lesions with a width of ≤ 3 mm, the nail bed and nail matrix lesions were directly excised with 1-to-2-mm margins and sutured in 11 cases. For lesions with a width of > 3 mm, one of the following 3 surgical procedures was selected by the children′s parents: (1) shaving of nail bed and nail matrix lesions under a microscope at ×8 magnification (8 cases) ; (2) excision of lesions followed by full-thickness skin grafting on the periosteum of the phalanx (8 cases) ; (3) excision of lesions of the second to fifth fingers followed by transfer of skin flaps from the thenar muscle area and full-thickness skin grafting (5 cases) , or excision of lesions of the thumb followed by abdominal-wall flap transfer (3 cases) . The patients were followed up for 12 months, and clinical efficacy was evaluated.Results:During the follow-up, no recurrence occurred in the 11 cases receiving direct excision and suture, with good appearances and longitudinal linear scars on the nail. Among the 8 cases receiving shaving therapy under a microscope, 4 experienced relapse during the follow-up of 6 - 12 months, and the nail/toenail plates were rough and poor in lustrousness in the other 4 without recurrence. No recurrence was observed in the 8 cases receiving excision of the lesions and full-thickness skin grafting, of whom 1 experienced skin graft necrosis, and skin grafts survived with obvious pigmentation in the other 7 cases. Among cases receiving excision of the lesions combined with transfer of skin flaps from the thenar muscle area or abdominal-wall flap transfer, no recurrence was observed, and all transferred flaps survived; good appearances, nearly normal color and gloss of nails were obtained in the cases after transfer of skin flaps from the thenar muscle area, while the color and gloss of postoperative nails were markedly different from those of normal nails in the cases receiving abdominal-wall flap transfer.Conclusion:For nail matrix nevi with a width of ≤ 3 mm, direct excision and suture with 1-to-2-mm margins are recommended; for those with a width of > 3 mm, excision of lesions combined with full-thickness skin grafting, transfer of skin flaps from the thenar muscle area or abdominal-wall flap transfer is recommended; the shaving procedure under a microscope should be used with caution.
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Objective@#To preliminarily investigate the influence of recombinant human growth hormone (rhGH) on the immune function of younger children with severe burn injuries.@*Methods@#A total of 30 younger children with severe burn injuries, conforming to the study criteria, were admitted to our hospital from July 2016 to July 2018. They were enrolled in the prospective, randomized, double-blinded, controlled trial and divided into group rhGH [n=15, 10 boys and 5 girls, aged (22±10) months] and control group [n=15, 8 boys and 7 girls, aged (21±7) months] according to the random number table. The patients in control group received anti-shock, anti-infection, and wound caring therapies, etc. On the basis of above-mentioned treatment, the patients in group rhGH were subcutaneously injected with rhGH once every night before bedding, with a dosage of 0.2 IU·kg-1·d-1, from the 3rd day post injury for 7 consecutive days. Before and on the 3rd and 7th day of rhGH treatments, the fasting peripheral venous blood was collected from patients in both groups. Blood glucose level was detected by glucometer. Percentages of CD4+ T lymphocytes, CD8+ T lymphocytes, CD3+ T lymphocytes, CD19+ B lymphocytes, and ratio of CD4+ T lymphocytes to CD8+ T lymphocytes were determined by flow cytometer. Mass concentration of serum immune globulin (Ig) A, IgG, and complement C3 were detected by enzyme-linked immunosorbent assay. Data were processed with Fisher′s exact probability test, independent sample t test, analysis of variance for repeated measurement and Bonferroni correction, and Mann-Whitney U test.@*Results@#(1) The blood glucose levels of children in the two groups were similar before and on the 3rd and 7th day of rhGH treatment (t=0.474, 1.652, 1.997, P>0.05). The glucose levels of children in group rhGH on the 3rd and 7th day of rhGH treatment [(6.9±1.0) and (7.7±1.1) mmol/L] were significantly higher than (5.9±0.9) mmol/L before rhGH treatment (P<0.05). The glucose level of children in control group on the 7th day of rhGH treatment was significantly higher than that before rhGH treatment (P<0.05). (2) The percentages of CD4+ T lymphocytes of children in group rhGH before rhGH treatment and on the 7th day of rhGH treatment were (35.1±2.0)% and (38.5±2.2)%, which were close to (36.2±2.0)% and (33.6±2.2)% in control group, respectively (t=0.371, 1.553, P>0.05). The percentages of CD4+ T lymphocytes of children in group rhGH on the 7th day of rhGH treatment[(44.7±2.2)%] was significantly higher than (36.5±2.2)% in control group (t=2.624, P<0.05). The percentage of CD4+ T lymphocytes of children in group rhGH on the 7th day of rhGH treatment was significantly higher than that before rhGH treatment (P<0.05). The percentages of CD4+ T lymphocytes of children in control group on the 3rd and 7th day of rhGH treatment were both close to the percentage before rhGH treatment (P>0.05). (3) The percentage of CD8+ T lymphocytes of children in group rhGH on the 3rd day of rhGH treatment was significantly lower than that in control group (t=2.107, P<0.05). (4) The ratio of CD4+ T lymphocytes to CD8+ T lymphocytes of children in group rhGH on the 7th day of rhGH treatment (2.36±0.20) was significantly higher than 1.72±0.20 in control group (t=2.285, P<0.05). The ratio of CD4+ T lymphocytes to CD8+ T lymphocytes of children in group rhGH on the 7th day of rhGH treatment was significantly higher than 2.04±0.19 before rhGH treatment (P<0.05). (5) The percentages of CD3+ T lymphocytes and CD19+ B lymphocytes of children in the two groups were similar before and on the 3rd and 7th day of rhGH treatment (t=1.913, 0.552, 1.327, 1.465, 1.587, 0.407, P>0.05). The percentages of CD3+ T lymphocytes of children in group rhGH on the 3rd and 7th day of rhGH treatment were significantly higher than the percentage before rhGH treatment (P<0.05). (6) The mass concentration of serum IgA, complement C3, and IgG of children in the two groups was similar before and on the 3rd and 7th day of rhGH treatment (t=-1.596, -0.100, 1.263, -0.220, 1.378, 1.631, Z=0.228, 0.519, 1.182, P>0.05). The mass concentration of serum IgA and complement C3 of children in group rhGH on the 3rd and 7th day of rhGH treatment was significantly higher than that before rhGH treatment(P<0.05).@*Conclusions@#rhGH has little effect on humoral immunity of younger children with severe burn injuries with limited influence on CD19+ B lymphocyte, mass concentration of serum IgA, IgG, and complement C3. It may improve the cellular immunity function mainly through promoting the release of CD4+ T lymphocyte, reducing the release of CD8+ T lymphocyte. It can be used in clinical treatment of younger children with severe burn injuries.
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Objective@#To evaluate the value of laser Doppler imaging (LDI) in diagnosing deep or superficial partial-thickness burn wound with meta-analysis.@*Methods@#Databases including PubMed, Cochrane Library were searched using key words " burn, burns, burn depth, laser Doppler imaging, laser Doppler perfusion imaging, LDI, LDPI" , and Chinese Journals Full-text Database, Wanfang Database, VIP Database were searched using Chinese key words "烧伤,烧伤深度,激光多普勒,激光多普勒血流灌注成像,激光多普勒成像仪" to obtain the published trials of LDI in diagnosing deep or superficial partial-thickness burn wound from the establishment of each database to October 2015. The risk of bias and applicability concerns of the included studies were evaluated by Quality Assessment of Diagnostic Accuracy Studies-2. Data were processed with Meta-DiSc 1.4 statistical software. The heterogeneity among the included studies was evaluated. The pooled estimates of LDI in diagnosing deep or superficial partial-thickness burn wound in the included studies, including sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, as well as the area under the curve of summary receiver operating characteristic and index of Q* were calculated. The stability of results of the overall pooled estimates of the included studies was validated by sensitivity analysis. The sources of heterogeneity among the included studies were sought through subgroup analysis. The publication bias caused by the results of the included studies was evaluated by drawing the Deek′s funnel plot.@*Results@#A total of 5 articles conforming to the inclusion criteria, involving 138 patients and 179 burn wounds, were included. One of the included studies had low risk of bias, while the other 4 studies had high/unclear risk of bias. In applicability concern aspect, one of the included studies had high/unclear concerns regarding applicability, while the other 4 studies had low concerns regarding applicability. There was no heterogeneity caused by threshold effects among the included studies (no " shoulder arm" plot of the scattered-point distribution was observed in the space of the receiver operating characteristic, βs=0.01, P>0.05). There was a high heterogeneity caused by non-threshold effects among the included studies (sensitivity I2=54%). The overall pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of the included studies on LDI in diagnosing deep or superficial partial-thickness burn wound were 95% (with 95% confidence interval 88%-99%), 96% (with 95% confidence interval 90%-99%), 9.75 (with 95% confidence interval 4.35-21.81), 0.11 (with 95% confidence interval 0.05-0.22), and 257.93 (with 95% confidence interval 58.96-1 128.41), respectively. The area under the curve of summary receiver operating characteristic was 0.98, with index of Q* 94%. The results of the overall pooled estimates of the included studies was stable. The risk of bias of the selection of the patients, equipment type of LDI, and the selection of diagnostic method in control might be sources of the heterogeneity of the included studies. The Deek′s funnel plot indicated that there was no publication bias caused by the results of the included studies (P>0.05).@*Conclusions@#LDI has high sensitivity, specificity, positive likelihood ratio, diagnostic odds ratio and index of Q*, large area under the curve of summary receiver operating characteristics, and low negative likelihood ratio in diagnosing deep or superficial partial-thickness burn wound, which has relatively high diagnostic value.