Research progress in the mechanisms of Mycobacterium tuberculosis-mediated formation of foamy macrophages / 中华微生物学和免疫学杂志

Foamy macrophages (FM), also known as foam-like macrophages, refer to lipid-laden monocytes or macrophages. FM are a kind of inflammatory cells that are rich in lipid droplets in cytoplasm. In the diseases caused by Mycobacterium tuberculosis (Mtb), such as granuloma and tuberculous wounds, FM can not only inhibit the immune response, but also affect the prognosis and outcomes. The formation mechanisms of FM caused by Mtb infection have some specificity, which may be an important factor for its long-term survival in cells and influences on disease prognosis and outcomes. Therefore, studying the mechanisms of Mtb-mediated formation of FM is conductive to further reveal the pathological evolution of diseases and provide new ideas for further precise treatment. This article reviewed the mechanisms of Mtb-mediated formation of FM in recent years.

Effects of basic fibroblast growth factor on healing of Mycobacterium tuberculosis infective wound in New Zealand rabbit after debridement / 中华烧伤杂志

Objective@#To investigate the effects of basic fibroblast growth factor (bFGF) on healing of Mycobacterium tuberculosis infective wound in New Zealand rabbit after debridement.@*Methods@#Thirty-two New Zealand rabbits (3 to 4 months old, no matter male or female) were intradermally injected with 0.1 mL of complete Freund′s adjuvant on the buttocks. Six weeks later, each rabbit was injected with 0.5 mL 5×107 colony forming unit/mL Bacillus Calmette-Guerin on both sides of the back to reproduce the model of Mycobacterium tuberculosis infective wound in New Zealand rabbit. After successful modeling, the 32 rabbits were divided into growth factor (GF) group, antituberculosis drug (AD) group, combined treatment (CT) group, and blank control (BC) group according to the random number table, with 8 rabbits in each group. After a complete debridement, the wounds of rabbits in group GF were treated with recombinant bovine bFGF gel (300 IU/cm2, about 0.45 g for each wound), the wounds of rabbits in group AD were covered with gauze which was impregnated with 6 mL isoniazid injection and 0.15 g rifampicin powder-injection, the wounds of rabbits in group CT were covered with gauze which was impregnated with isoniazid injection and rifampicin powder-injection after being treated with recombinant bovine bFGF gel as before, the wounds of rabbits in group BC were covered with sterile gauze, with dressing change of once every two days until the wounds were completely healed. Immediately after surgery and on post surgery day (PSD) 7, 14, 21, and 28, the wounds of rabbits in each group were observed with naked eyes and photos. On PSD 7, 14, 21, and 28, the wound healing rate was calculated and the complete healing time of wound was recorded. On PSD 7, 14, 21, and 28, the tissue samples of wound edge were collected for histomorphological observation with hematoxylin and eosin staining and Masson staining. On PSD 21, the number of microvessels was counted with immunohistochemical method. On PSD 7, 14, 21, and 28, the content of hydroxyproline in wound edge was determined by enzyme-linked immunosorbent assay. The numbers of samples of above-mentioned experiments were all 8. Data were processed with analysis of variance for repeated measurement, analysis of variance of factorial design, one-way analysis of variance, least significant difference test and Bonferroni correction.@*Results@#(1) The rabbits in four groups all survived to the end of experiment. Immediately after surgery, edema was observed in basal wounds of rabbits in the four groups. On PSD 7, the wounds of rabbits in the 4 groups were contracted with scabs and less edema. The wounds of rabbits in groups GF and CT became redder. On PSD 14, the wounds of rabbits in the 4 groups contracted obviously. There were no obvious exudates in wounds of rabbits in groups AD and CT, while 1 wound of rabbit in group GF and 2 wounds of rabbits in group BC became red and swelling with purulent exudates. On PSD 21, wounds of rabbits in groups GF and CT were basically healed, while 2 wounds of rabbits in group BC healed slowly with purulent secretion. On PSD 28, wounds of rabbits in the 4 groups were basically healed, while 2 wounds of rabbits in group BC hardly healed with redness and swelling. (2) From PSD 7 to 28, the wound healing rates of rabbits in groups GF, AD, and CT were significantly higher than those in group BC (P<0.05). On PSD 14 and 21, the wound healing rates of rabbits in groups GF and CT were significantly higher than those in group AD (P<0.05). From PSD 7 to 28, the wound healing rates of rabbits in group GF were close to those in group CT (P>0.05). (3) The complete healing time of wounds of rabbits in groups GF, AD, and CT was significantly shorter than that in group BC (P<0.05). The complete healing time of wounds of rabbits in groups GF and CT was significantly shorter than that in group AD (P<0.05). The complete healing time of wounds of rabbits in group GF was close to that in group CT (P>0.05). (4) On PSD 7, a large number of inflammatory cells infiltration were observed in wound tissue of rabbits in the 4 groups and a few epithelial cells were observed in wound tissue of rabbits in groups GF, AD, and CT. On PSD 14, more epithelial cells were observed in wound tissue of rabbits in groups GF and CT, and an obvious reduction of inflammatory cells infiltration was observed in wound tissue of rabbits in groups AD and CT. On PSD 21, there was a complete wound tissue structure and distinctive nuance of dyeing in wound tissue of rabbits in groups GF and CT while thinner new epithelium in wound tissue of rabbits in groups AD and BC, and inflammatory cell infiltration was observed in wound tissue of rabbits in group BC. On PSD 28, there was a complete wound tissue structure in wound tissue of rabbits in the 4 groups, the new epithelium in wound tissue of rabbits in groups GF, AD, and CT was thicker than that in group BC. (5) On PSD 7 and 14, the quantity of collagen fibers in wound tissue of rabbits in groups GF and CT was larger than that in the other two groups. On PSD 21, a large quantity of fibroblasts and well reorganized collagen fibers were observed in wound tissue of rabbits in groups GF and CT, a moderate quantity of fibroblasts and collagen fibers in a random arrangement were observed in wound tissue of rabbits in group AD, and a little quantity of fibroblasts and collagen fibers were observed in wound tissue of rabbits in group BC. On PSD 28, the quantity of collagen fibers in wound tissue of rabbits in the 4 groups was close to that of normal skin tissue, and the collagen fibers performed more well reorganized in wound tissue of rabbits in groups GF and CT. (6) On PSD 21, the numbers of microvessels per 200-time visual field in wound edge of rabbits in groups GF (31.6±1.2), AD (27.5±1.3), and CT (32.8±1.6) were significantly higher than the number in group BC (22.3±1.7, P<0.05). The numbers of microvessels in wound edge of rabbits in groups GF and CT were significantly higher than the number in group AD (P<0.05). The number of microvessels in wound edge of rabbits in group GF was close to that in group CT (P>0.05). (7) On PSD 7 and 28, there were no statistically significant differences in content of hydroxyproline in wound edge of rabbits in the 4 groups (F=0.916, 1.752, P>0.05). On PSD 14 and 21, the content of hydroxyproline in wound edge of rabbits in groups GF, AD, and CT was significantly higher than that in group BC (P<0.05). The content of hydroxyproline in the wound edge of rabbits in groups GF and CT was significantly higher than that in group AD (P<0.05). The content of hydroxyproline in the wound edge of rabbits in group GF was close to that in group CT (P>0.05).@*Conclusions@#bFGF can be used solely or combined with AD to promote Mycobacterium tuberculosis infective wound healing in New Zealand rabbit after complete debridement of wound, which is better than single use of AD.

Characteristics of patients with tuberculous wounds and non-tuberculous chronic refractory wounds in single center / 中华烧伤杂志

Objective@#To explore the characteristics of patients with tuberculous wounds and non-tuberculous chronic refractory wounds in single center.@*Methods@#From January 2010 to June 2017, 43 patients with tuberculous wounds and 44 patients with non-tuberculous chronic refractory wounds admitted to the Department of Burns and Plastic Surgery of the Eighth Medical Center of the General Hospital of the Chinese People′s Liberation Army were conforming to the inclusion criteria. The patients were assigned to tuberculous wound group and non-tuberculous wound group, respectively, and their clinical records were retrospectively analyzed. The gender, place of residence, history of trauma, time of wound formation, time of wound diagnosis, number and length of hospital stay, age, wound site, wound area, sinus occurrence, number of dressing change, number of operation, vacuum sealing drainage (VSD) treatment, recovery, source of medical expense, expense paid by social basic medical insurance and the self-payment of patients in the 2 groups were investigated. Data were processed with independent sample t test and chi-square test.@*Results@#(1) Except for gender (χ2=0.019, P>0.05), there were significantly statistical differences in place of residence, history of trauma, time of wound formation, time of wound diagnosis, number and length of hospital stay between patients in tuberculous wound group and non-tuberculous wound group (χ2=4.535, 27.651, t=7.252, 16.131, 4.663, 7.416, P<0.05 or P<0.01). (2) There was no statistically significant difference in the composition ratio of age between patients in tuberculous wound group and non-tuberculous wound group (χ2=11.522, P>0.05). (3) The wounds of patients in tuberculous wound group were more common in the chest, and the wounds of patients in non-tuberculous wound group were more common in the lower limbs. There was statistically significant difference in the composition ratio of the wound sites between patients in the two groups (χ2=28.450, P<0.01). (4) There were statistically significant differences in wound area, sinus occurrence, number of dressing change, number of operation between patients in tuberculous wound group and non-tuberculous wound group (t=-8.524, 9.846, -15.426, 4.663, P<0.01). There were no statistically significant differences in VSD treatment and recovery between patients in the two groups (χ2=0.032, 0.111, P>0.05). (5) The medical expenses of patients in tuberculous wound group from social basic medical insurance, free medical service, the self-paid, and military medical services accounted for 48.8% (21/43), 7.0% (3/43), 39.5% (17/43), and 4.7% (2/43), respectively. The medical expenses of patients in non-tuberculous wound group from social basic medical insurance, free medical service, the self-paid, and military medical services accounted for 59.1% (26/44), 4.5% (2/44), 29.5% (13/44), and 6.8% (3/44), respectively. There was no statistically significant difference in the composition ratio of sources of medical expense between patients in the two groups (χ2=1.154, P>0.05). (6) There were statistically significant differences in expenses for diagnosis, medicine, surgery, examination, laboratory test, and bed, and total expenses paid by social basic medical insurance and the self-payment between patients in tuberculous wound group and non-tuberculous wound group (t=45.051, 39.995, 64.212, 32.584, 8.754, 43.991, 15.671, 17.640, 65.155, 35.546, 35.903, -4.329, 3.344, 12.984, P<0.01).@*Conclusions@#Compared with those of patients with non-tuberculous chronic refractory wounds, the tuberculous wounds of patients have longer formation time, the diagnosis and treatment of the wounds are difficult, their wounds are mostly distributed in the chest and often accompanied by sinus formation, and patients with the wounds have long hospital stay and high medical expenses. Besides, the medical expenses for treating wounds of patients in the two groups are mainly paid by social basic medical insurance and the patients themselves.

New opportunity of management strategy of diagnosis and treatment of chronic wound: emerging technology / 中华烧伤杂志

Along with the development of society and the change of disease spectrum, chronic wound is gradually becoming the core of burn and plastic surgery field. Although there have been some progresses in the diagnosis and treatment technology, the management strategy of chronic wound is still in the traditional mode stage. The development of internet of things, cloud computing, big data, artificial intelligence, and other emerging technologies is changing with each passing day, and they have rapidly penetrated into the health care field. To explore the application prospect of emerging technology in the diagnosis and treatment management of chronic wound and to plan its strategy and mode in the diagnosis and treatment of chronic wound can further promote development of discipline of burns.

Innovation drive is the original motive force of discipline construction: the developing road of Department of Burns and Plastic Surgery in the 309th Hospital of PLA / 中华烧伤杂志

Discipline construction is a systematic project, covering clinic, teaching, scientific research, management, and humanity. Based on the perspective of innovation drive, from the aspects of discipline structure setting, specialized laboratory construction, sub-specialty formation, clinical characteristic and advantage formation, and management concept update, this article summarizes the growth process of Department of Burns and Plastic Surgery in the 309th Hospital of PLA.

Discipline construction is the theme of the development of burn surgery / 中华烧伤杂志

Discipline construction is the core element of department development, including discipline structure setting, scale, equipment, medical workers structure, clinical feature and advantage, talent training, teaching level, scientific research level, management system, and cultural construction of department. As leader and engine of discipline construction, directors′ ability is an important factor for discipline construction. Clinical characteristic is the basis of discipline construction; innovation actuation is the essence of discipline construction; talents training is the guarantee of discipline construction; scientific research is the wing of discipline construction; cultural construction is the hot spring of discipline construction. Discipline construction is the theme of the development of burn surgery.

To further strengthen the construction of emergency medical treatment system of massive burn / 中华烧伤杂志

Although clinical medicine of our country has made great progress in recent years, the rescue of massive burn casualties is still facing enormous challenges. No matter it is the top level design, system configuration, plan preparation, training, education, or the operation process, the medical resource allocation, and the treatment efficiency, are far behind the demand of social development. Therefore, further strengthen the construction of emergency medical treatment system of massive burn is the unshirkable responsibility of burn medical workers in our country.

Construction of nuclear factor of activated T-cells 5 mRNA 3'-untranslated region reporter vector and targeting verification between NFAT5 and miR-155 / 重庆医学

Objective To construct a Luciferace reporter vector containing the 3'untranslated region (3'UTR) of NFAT5 and measure the correlation between NFAT5 and miR-155.Methods The miR-155 targeting NFAT5 3'UTR was predicted by Target Scan,Mir Base and Pic Tar.NFAT5 and mutant NFAT5 sequence(NFAT5-mu) were then designed and synthesized,and they were cloned into pMIR-REPORTTM Luciferace reporter vector.Human embryonic kidney-293AD (HEK-293AD) cells of the 4th passage were divided into 4 groups according to the random number table.cells in plasimd +miR-155 mimics groups were transfected with pMIR-NFAT5 recombinant plasimid,pRL-Tk plasmid and miR-155 mimics;cells in plasimd + miR-155 mutated groups were transfected with pMIR-NFAT5-mu recombinant plasimid,pRL-Tk plasmid and miR-155 mimics;cells in plasimd + miR-155 control groups were transfected with pMIR-NFAT5 recombinant plasimid,pRL-Tk plasmid and miR-155 Negative control;cells in plasimd +miR-155 inhibitor were transfected with pMIR-NFAT5 recombinant plasimid,pRL-Tk plasmid and miR-155 inhibitor;and were respectively transfected into together by liposome.After culture for 24 h,the luciferase activity was detected by dual luciferase reporter assay system.Results TargetScan,Miranda and PicTar shared the results that NFAT5 has the complementary binding sites with 3'UTR of miR-155.And luciferase reporter vectorwas constructed.Therefore the result of sequencing and double digesting of recombined plasmid were completely correct.Dual-luciferase reporter assay showed that miR-155 possesses a target effect on 3'UTR of NFAT5.Compared to the pMIR-NFAT5 + miR-control group,the luciferase activity of the pMIR-NFAT5 + miR-1 5 5 mimics group was decreased,with statistically significant difference(P＜0.01),while there was no significant difference at other time points(P＞0.05).Conclusion The pMIR-NFAT5 recombinant plasmid and pMIR-NFAT5 recombinant mutated plasmid were confirmed with successful construction.and it was found that miR-155 can target NFAT5 mRNA 3'-UTR.The results provide the experiment data for further disclosing the mechanism of inhalation injury on the level of gene expression.

Clinical efficacy of plastic surgery and wound healing to repair the wounds of chest wall tuberculosis / 中华医学美学美容杂志

Objective To treat complex wounds of the chest wall tuberculosis by the use of wound healing techniques (focal debridement + the VSD) and joint plastic surgery (transfer of skin flap, skin graft, flap stuffing, etc) and to explore the clinical features of the tuberculous chest wound, the feasibility and effectiveness of treatments.Methods Clinical data of 11 hospitalized patients with chest wall tuberculosis were collected during 2012-2014.The therapeutic effect, intraoperative and postoperative complications, and postoperative follow-up were retrospectively analyzed.Results Among 7 cases using lesion debridement, VSD suction drainage and local flap repair (skin grafting), 6 cases were cured.The response rate was 90.9%.All 4 cases using debridement and local flap repair (skin grafting) were cured.Only one case of recurrence was observed during the follow-up period of 3-34 months.Conclusions Using of wound healing techniques with plastic surgery is an effective treatment, which has good therapeutic effect on the wound deeply infiltrated.

Effects of microRNA-146a on Fas-associated factor 2 and inflammatory factors in human lung adenocarcinoma A549 cells under the stimulation of cigarette smoke extract / 中华烧伤杂志

<p><b>OBJECTIVE</b>Under the premise of smoke inhalation injury, to explore the effects of microRNA-146a on Fas-associated factor 2 (FAF-2) and inflammatory factors in human lung adenocarcinoma A549 cells under the stimulation of cigarette smoke extract (CSE).</p><p><b>METHODS</b>(1) The pMIR-FAF-2 recombinant plasmid and the pMIR-FAF-2 recombinant mutated plasmid were constructed. Human embryonic kidney 293 (HEK-293) cells of the third passage were divided into 3 groups according to the random number table, with 5 wells in each group. Cells in plasmid+ microRNA control group were transfected with pMIR-FAF-2 recombinant plasmid, pRL-TK plasmid, and microRNA control; cells in plasmid+ microRNA-146a group were transfected with pMIR-FAF-2 recombinant plasmid, pRL-TK plasmid, and microRNA-146a mimics; cells in mutated plasmid+ microRNA-146a group were transfected with pMIR-FAF-2 recombinant mutated plasmid, pRL-TK plasmid, and microRNA-146a inhibitor. After culture for 24 h, the relative luciferase activity in cells was assessed by dual-luciferase reporter gene assay. (2) Human lung adenocarcinoma A549 cells of the third passage were divided into 3 groups according to the random number table, with 4 wells in each group. Cells in microRNA control group were transfected with microRNA control; cells in microRNA-146a enhancement group were transfected with microRNA-146a mimics; cells in microRNA-146a inhibition group were transfected with microRNA-146a inhibitor. After culture for 24 h, the mRNA expression levels of microRNA-146a and FAF-2 in cells were determined with real-time fluorescent quantitative reverse transcription-PCR. (3) A549 cells of the third passage were stimulated by 0.8% CSE for 24 h after being divided and treated with the same method used in experiment (2). The mRNA expression levels of FAF-2, IL-8, monocyte chemotactic protein-1 (MCP-1), and growth-regulated oncogene-α (GRO-α) in cells were determined with real-time fluorescent quantitative reverse transcription-PCR. The protein expression levels of IL-8, MCP-1, and GRO-α in A549 cell culture supernatant were determined by enzyme-linked immunosorbent assay. The protein expression level of cyclooxygenase 2 (COX-2) of cells was assessed by Western blotting. Data were processed with one-way analysis of variance and LSD test.</p><p><b>RESULTS</b>(1) The pMIR-FAF-2 recombinant plasmid and pMIR-FAF-2 recombinant mutated plasmid were confirmed with successful construction. The relative luciferase activity in HEK-23 cells of plasmid+ microRNA control group was close to that of mutated plasmid+ microRNA-146a group (P>0.05). The relative luciferase activity in HEK-23 cells of plasmid+ microRNA-146a group was significantly lower than that of plasmid+ microRNA control group and mutated plasmid+ microRNA-146a group (with P values below 0.01). (2) The expression level of microRNA-146a in A549 cells of microRNA control group was close to that of microRNA-146a inhibition group (P>0.05), and they were both significantly lower than the expression level of microRNA-146a in A549 cells of microRNA-146a enhancement group (with P values below 0.01). The mRNA expression level of FAF-2 in A549 cells of microRNA control group was close to that of microRNA-146a inhibition group (P>0.05), and they were both significantly higher than the mRNA expression level of FAF-2 in A549 cells of microRNA-146a enhancement group (with P values below 0.05). (3) After stimulation of CSE, the mRNA expression level of FAF-2 in A549 cells of microRNA control group (1.46±0.21) was close to that of microRNA-146a inhibition group (1.43±0.34, P>0.05), which were both significantly higher than the mRNA expression level of FAF-2 in A549 cells of microRNA-146a enhancement group (0.57±0.11, with P values below 0.05). The mRNA expression levels of IL-8, MCP-1, and GRO-α in A549 cells of microRNA-146a enhancement group were significantly lower than those of microRNA control group and microRNA-146a inhibition group (with P values below 0.01). The mRNA expression levels of IL-8, MCP-1, and GRO-α in A549 cells of microRNA-146a inhibition group were significantly higher than those of microRNA control group (with P values below 0.05). The protein expression levels of IL-8, MCP-1, and GRO-α in A549 cell culture supernatant of microRNA-146a enhancement group were significantly lower than those of microRNA control group and microRNA-146a inhibition group (with P values below 0.05). The protein expression level of IL-8 in A549 cell culture supernatant of microRNA-146a inhibition group was close to that of microRNA control group (P>0.05), while the protein expression levels of MCP-1 and GRO-α in A549 cell culture supernatant of microRNA-146a inhibition group were significantly lower than those of microRNA control group (with P values below 0.05). The protein expression level of COX-2 in A549 cells of microRNA-146a enhancement group was significantly lower than the levels of microRNA control group and microRNA-146a inhibition group (with P values below 0.05). The protein expression level of COX-2 in A549 cells of microRNA control group was close to that of microRNA-146a inhibition group (P>0.05).</p><p><b>CONCLUSIONS</b>In A549 cells, after being transfected with microRNA-146a and stimulated by CSE, microRNA-146a can decrease the expression of FAF-2 through integrating with the 3'-untranslated region of target gene FAF-2, thereby decrease the expression of inflammatory factors.</p>

Advances in the research of pathogenesis and treatment of severe smoke inhalation injury / 中华烧伤杂志

Among the fire victims, respiratory tract injury resulted from smoke inhalation is the major cause of death. Particulate substances in smoke, toxic and harmful gas, and chemical substances act together would rapidly induce the occurrence of dramatic pathophysiologic reaction in the respiratory tract, resulting in acute injury to the respiratory tract, thus inducing serious injury to it and acute respiratory distress syndrome, leading to death of the victims. In recent years, the pathophysiologic mechanism of severe smoke inhalation injury has been gradually clarified, thus appreciable advances in its treatment have been achieved. This paper is a brief review of above-mentioned aspects.

Pay more attention to the precise assessment of extraordinary agent wounds / 中华烧伤杂志

Although the extraordinary agent wound is not common, the difficulties of its diagnosis, treatment, and the high medical risk as well as the indeterminacy of its prognosis bring great challenges to the clinicians. It is mainly attributed to the complexities of extraordinary agent wounds and the deficiency in the assessment technic of wound. Therefore, it is necessary and important to establish a precise assessment method to benefit the surgical planning, pre-estimation of peri-operative risk, and the doctor-patient communication. Based on the relative scientific research and our recent clinical research data, we bring forth our opinions on the current status and the development trend of the assessment of extraordinary agent wounds in this article.

Clinical application of surgical intervention model for repairing tuberculosis wound with sinus tract / 中华烧伤杂志

<p><b>OBJECTIVE</b>To retrospectively explore the effectiveness of surgical intervention model for repairing the tuberculosis wound with sinus tract.</p><p><b>METHODS</b>Forty-three patients with tuberculosis wound with sinus tract who met the inclusion criteria were admitted to the 309th Hospital of PLA from January 2010 to October 2015. These patients were divided into test group (n=38) and control group (n=5) according to the different treatment and patient's consent. Patients in test group were treated as follows. Firstly, antituberculosis drugs were taken orally for at least 3 weeks, and the wounds were accurately assessed using magnetic resonance imaging combined with 3-dimensional reconstruction software. Then sinus tract and its surrounding devitalized tissue were completely excised, and vacuum sealing drainage (VSD) treatment with negative pressure value of -26.6 kPa was performed for 1 to 2 weeks (dressing change was performed per 7 days). Lastly, the wounds were covered through direct suture or grafting skin or flap. Patients in control group were firstly given antituberculosis drugs orally for at least 3 weeks, and then they were treated with routine dressing change in outpatient service every 3 days. After the former therapy, patients in both groups were given antituberculosis drugs by oral administration for at least 6 months and were followed up for 6 to 36 months. Detection of Bacillus tuberculosis, Acid-fast bacilli, and tuberculosis granuloma, wound healing time, and relapse of tuberculosis wound in patients of both groups were recorded. The rates of single sinus tract, two sinus tracts, and more than or equal to 3 sinus tracts of patients in test group were recorded. Data were processed with Fisher's exact test and Wilcoxon rank-sum test.</p><p><b>RESULTS</b>Bacillus tuberculosis was respectively detected in wounds of 5 patients in test group and 2 patients in control group. Acid-fast bacilli were positively expressed in wounds of 8 patients in test group and 3 patients in control group. A typical tuberculosis granuloma phenomenon was observed in the wounds of 27 patients in test group and 4 patients in control group. These differences in above-mentioned 3 indexes between two groups were not statistically significant (with P values respectively 0.238 4, 0.154 4, 1.000 0). The median of wound healing time of patients in test group was 19.6 d, which was significantly shorter than that in control group (94.4 d, χ(2)=12.986 0, P=0.000 3). There were 2 and 1 patients with recurrent tuberculosis wound in test group and control group respectively, without statistically significant difference (P=0.363 0). Among patients in test group, the rate of single sinus tract was 23.7%(9/38), the rate of two sinus tracts was 28.9%(11/38), and the rate of more than or equal to 3 sinus tracts was 47.4% (18/38).</p><p><b>CONCLUSIONS</b>Repairing the tuberculosis wound with sinus tract in surgical intervention model of antituberculosis therapy+ accurate wound assessment+ debridement+ VSD treatment+ surgical repair is beneficial to making the optimal operation plan under the premise of knowing location of sinus tract, which can reduce surgical risk.</p>

Epidemiological investigation of 235 patients with extra-pulmonary tuberculosis wounds / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the epidemiological characteristics and patterns of extra-pulmonary tuberculosis wounds in order to provide reliable data for further clinical research.</p><p><b>METHODS</b>Records of patients with extra-pulmonary tuberculosis wounds hospitalized from January 2010 to December 2012 were retrospectively analyzed, including gender, age, nationality, family background, Bacille Calmette-Guerin (BCG) vaccination, primary lesion, and history of injury.</p><p><b>RESULTS</b>Tuberculosis wounds were found in 235 patients among 5 863 patients with extra-pulmonary tuberculosis, accounting for 4.0%. Among the patients with tuberculosis wounds, there were 139 male and 96 female, and the ratio of male to female was 1.4: 1.0. The age of patients ranged from 1 to 87 (37 +/- 18) years old, and the highest incidence occurred in patients older than 15 and younger than or equal to 30 years old (100 cases, accounting for 42.6%). Most patients with tuberculosis wounds were Han, and only 11 patients were minorities, accounting for 4.7%. Tuberculosis wounds were more prevalent in rural areas (163 cases, accounting for 69.4%), with a smaller number in urban areas (72 cases, accounting for 30.6%). The BCG vaccination rate was 13.6%. The main primary lesions were lymph node infection (112 cases, accounting for 47.7%), among which involvement of cervical lymph nodes accounted for the highest ratio ( 99 cases, accounting for 88.4%). Twenty-one patients had the traffic accident etc. injury history recently, among which 19 were male and 2 were female.</p><p><b>CONCLUSIONS</b>Tuberculosis wound, with certain incidence, was more frequently found among young adults from rural areas. The BCG vaccination rate was low among the patients and the main primary lesion was tuberculosis of cervical lymph nodes.</p>

Advances in the research of an animal model of wound due to Mycobacterium tuberculosis infection / 中华烧伤杂志

Tuberculosis ranks as the second deadly infectious disease worldwide. The incidence of tuberculosis is high in China. Refractory wound caused by Mycobacterium tuberculosis infection ranks high in misdiagnosis, and it is accompanied by a protracted course, and its pathogenic mechanism is still not so clear. In order to study its pathogenic mechanism, it is necessary to reproduce an appropriate animal model. Up to now the study of the refractory wound caused by Mycobacterium tuberculosis infection is just beginning, and there is still no unimpeachable model for study. This review describes two models which may reproduce a wound similar to the wound caused by Mycobacterium tuberculosis infection, so that they could be used to study the pathogenesis and characteristics of a tuberculosis wound in an animal.

Expression of coxsackie-adenovirus receptor in keratinocytes of mouse skin after heat stimulation and the effect of coxsackie-adenovirus receptor on dendritic epidermal T lymphocytes / 中华烧伤杂志

<p><b>OBJECTIVE</b>To study the influence of heat stimulation on expression of coxsackie-adenovirus receptor (CAR) in keratinocytes (KCs) of mouse skin and the effect of CAR on production of cell growth factors by dendritic epidermal T lymphocytes (DETCs).</p><p><b>METHODS</b>(1) Twenty BALB/c mice were divided into heat stimulation group (HS) and control group (C) according to the random number table, with 10 mice in each group. Mice in group HS were inflicted with scald milder than superficial-thickness by dressing wet hot gauze, which had been soaked in 100°C hot water for 3 min, in the hair removed area on the back for 1 to 3 s, while mice in group C were sham injured by dressing a wet gauze which had been soaked in water of room temperature for 3 min in the hair removed area on the back for 1 to 3 s. Square full-thickness skin specimens measuring 2.0 cm × 2.0 cm in size were obtained from the center of the bare skin. The expression of CAR in skin tissue sections were detected by immunohistochemistry staining. The mRNA and protein expression levels of CAR in skin tissue sections were respectively determined by real-time fluorescent quantitation RT-PCR and Western blotting. (2) KCs were isolated and cultured from full-thickness skin obtained from the trunk of 2 fetal BALB/c mice, and they were divided into 2 groups according to the random number table, with 5 wells in each group. The cells in group HS and group C were respectively cultured in 42°C and 37°C, 5% CO2 incubator for 1 h, and then all the cells were cultured in 37 °, 5% CO2 incubator for 6 h. The apoptosis of the cells and their expression of CAR were detected by flow cytometer. (3) Five BALB/c mice were sacrificed, and full-thickness skin was obtained from the trunk. The DETCs were divided into 7 groups according to the random number table after being isolated and purified from the skin specimens. Cells in group C were cultured without any stimulation, and cells in the 0.5, 1.0, 2.0, 4.0, 8.0, and 16.0 mg/L CAR groups were respectively cultured with corresponding concentration of recombinant mice CAR nutrient solutions, with 5 wells in each group. The contents of insulin-like growth factor I (IGF-I) and keratinocyte growth factor (KGF) were determined with ELISA. Data were processed with independent samples t test and one-way analysis of variance.</p><p><b>RESULTS</b>(1) The immunohistochemistry staining showed that there was mild positive staining in the skin tissue sections of mice in group C, while the positive staining was more obvious in group HS. The positive staining was mainly located in KCs, hair follicles, and sweat gland epithelial cells, while no positive staining was observed in fibroblasts. The mRNA expression levels of CAR in skin tissue sections in group C and group HS were respectively 0.157 ± 0.027 and 0.773 ± 0.029. There was statistically significant difference between them (t = 3.052, P < 0.01). The protein expression levels of CAR in skin tissue sections in group C and group HS were respectively 0.23 ± 0.09 and 0.89 ± 0.14. There was statistically significant difference between them (t = 2.556, P < 0.05). (2) The apoptosis rates of KCs in group C and group HS were respectively (5.7 ± 1.3)% and (7.4 ± 1.7)% (t = 0.464, P > 0.05). The expression rates of CAR in KCs in group C and group HS were respectively (48 ± 6)% and (80 ± 8)%. There was statistically significant difference between them (t = 2.585, P < 0.05). (3) The contents of IGF-Iin culture supernatants in group C and 0.5, 1.0, 2.0, 4.0, 8.0, 16.0 mg/L CAR groups were respectively (23.1 ± 1.8), (22.5 ± 2.1), (31.2 ± 2.5), (39.7 ± 2.3), (61.8 ± 3.5), (45.1 ± 2.8), and (29.0 ± 2.0) µg/L. There was statistically significant difference among 7 groups (F = 3.414, P < 0.05). The contents of KGF in culture supernatants in group C and 0.5, 1.0, 2.0, 4.0, 8.0, 16.0 mg/L CAR groups were respectively (131 ± 9), (217 ± 12), (355 ± 21), (563 ± 21), (535 ± 34), (292 ± 20), and (245 ± 10) ng/L. There was statistically significant difference among 7 groups (F = 5.063, P < 0.01).</p><p><b>CONCLUSIONS</b>The expression of CAR in KCs would rise after HS. The optimum CAR concentration to increase IGF-I and KGF production in DETCs is low.</p>

Early effects of ulinastatin by aerosol inhalation on rabbits with lipopolysaccharide-induced acute lung injury / 中华烧伤杂志

<p><b>OBJECTIVE</b>To study the early effects of ulinastatin (UTI) by aerosol inhalation on rabbits with acute lung injury induced by LPS, and to observe the early diagnostic value of 320-slice CT.</p><p><b>METHODS</b>According to the random number table, 18 specific pathogen free New Zealand white rabbits were divided into normal control group, group LPS, and group UTI, with 6 rabbits in each group. Rabbits in group LPS and group UTI were given 15 mL lipopolysaccharide (0.16 mg/mL, in the dose of 0.8 mg/kg) to reproduce acute lung injury model. Rabbits in normal control group were given equal volume of normal saline. Rabbits in UTI group were treated with UTI by aerosol inhalation for 10 min from 30 min after injury, while those in the other two groups received normal saline by aerosol inhalation. Rabbits in group LPS and group UTI were scanned by 320-slice CT at post injury hour (PIH) 6 and 24. After anesthesia, heart blood of rabbits in group LPS and group UTI was collected for determination of serum levels of TNF-α, IL-1β, and IL-6 by ELISA at PBH 24. At PBH 24, lung tissue samples were harvested for gross observation and histomorphological observation, measurement of wet to dry weight ratio, and detection of mRNA expressions of TNF-α, IL-1β, and IL-6 with RT-PCR. Above-mentioned indexes were detected in rabbits of normal control group at the same time point. Data were processed with one-way analysis of variance and LSD test.</p><p><b>RESULTS</b>(1) CT perfusion (CTP) image. The difference in CTP image of rabbits in group LPS between PBH 6 and PBH 24 was obvious, while that of rabbits in group UTI and normal control group was slight and not obvious respectively. (2) There were statistically significant differences in the serum levels of TNF-α, IL-1β, and IL-6 of rabbits among the three groups (with F values from 843.896 to 2 564.336, P values below 0.001). The serum levels of TNF-α, IL-1β, and IL-6 in group UTI were respectively (225 ± 9), (190 ± 8), (227 ± 6) pg/mL, and they were significantly lower than those in group LPS [(710 ± 25), (306 ± 16), (422 ± 16) pg/mL, with P values below 0.001]. (3) Gross observation. In group UTI, the degrees of pulmonary edema and pneumorrhagia of rabbits were lower than those in group LSP. (4) Histological observation. The damage to alveolar wall in group UTI was milder, and alveolar space hemorrhage and inflammatory cell infiltration were significantly less intense as compared with those in group LPS. (5) Compared with that in normal control group, the wet to dry weight ratio of lung tissue was increased in group LPS (P < 0.001). The wet to dry weight ratio of lung tissue in group UTI was significantly higher than that in normal control group but lower than that in group LPS (P values below 0.001). (6) There were statistically significant differences in mRNA levels of TNF-α, IL-1β, and IL-6 in lung tissue of rabbits among three groups (with F values from 24.700 to 69.538, P values below 0.001). The mRNA levels of TNF-α, IL-1β, and IL-6 in lung tissue of rabbits in group UTI were respectively (31.4 ± 2.7), (21.2 ± 3.3), (13.9 ± 2.4) pg/mL, which were significantly lower than those in group LPS [ (58.5 ± 10.0) , (35.1 ± 5.1), (20.7 ± 3.2) pg/mL, P values below 0.001].</p><p><b>CONCLUSIONS</b>UTI by aerosol inhalation can mitigate pulmonary edema and hemorrhage and inhibit inflammatory response. 320-slice CT may be used for detection of early lung injury.</p>

Effects of rat allogeneic adipose-derived stem cells on the early neovascularization of autologous fat transplantation / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the effects of allogeneic adipose-derived stem cells (ADSCs) of rat on the early neovascularization of autologous fat transplantation.</p><p><b>METHODS</b>(1) Experiment 1. Adipose tissue was collected from both inguinal regions of two SD rats to isolate, culture, and purify ADSCs through collagen enzyme digestion, density gradient centrifugation, and adherence method. The fourth passage of cells were collected for morphologic observation, detection of expressions of surface markers CD34, CD49d, CD106, and CD45 of ADSCs with flow cytometer, identification of adipogenic and osteogenic differentiation, and determination of the cell proliferation ability with thiazolyl blue method. (2) Experiment 2. Another 30 SD rats were divided into allogeneic adipose granule (AG) group (A, n = 6), autologous AG group (B, n = 8), autologous ADSCs+autologous AG group (C, n = 8), and allogeneic ADSCs+autologous AG group (D, n = 8) according to the random number table. The fourth passage of ADSCs were obtained from adipose tissue from one side of inguinal region of SD rats in group C. Adipose tissue obtained from one side of inguinal region of SD rats of the other 3 groups was abandoned. The AG was prepared from another side of inguinal region of SD rats in the 4 groups. The mixture of 0.6 g AG from one rat and 1 mL DMEM/F12 nutrient solution was injected subcutaneously into the back of another rat in group A, and so on. Autologous AG was injected into its own body of the rats in group B. The mixture of 1 mL autologous ADSCs mixture which contains 3.0 × 10⁶ cells per mililitre autologous ADSCs combined with autologous AG was injected into the rats in group C. The mixture of 1 mL allogeneic ADSCs mixture which contains 3.0 × 10⁶ cells per mililitre ADSCs extractived from the former 2 rats in experiment 1 combined with autologous AG was injected into the rats in group D. At 7 days post transplantation, fat transplants were harvested for gross observation, measurement of wet weight, pathological observation, and assessment of cells with positive expression of CD31 with immunohistochemical method. Data were processed with one-way analysis of variance and SNK test.</p><p><b>RESULTS</b>(1) The fourth passage of cells proliferated well showing fusiform shape similar to fibroblasts. These cells showed positive expression of CD34 and CD49d and weak positive expression of CD106 and CD45. They were able to differentiate into adipocytes and osteoblasts. These cells were identified as ADSCs. The fourth passage of cells grew faster than that of the tenth passage. (2) At 7 days post transplantation, no liquifying necrosis or infection was observed in the fat transplants of the rats in the 4 groups. Wet weight of the fat transplants in groups A and B was respectively (0.25 ± 0.04) and (0.26 ± 0.03) g, which were less than those of groups C and D [(0.36 ± 0.03) and (0.35 ± 0.04) g, with P values below 0.05]. HE staining showed that there were less fat cells and more fibroblasts in the transplants of group A, visible fibrous tissue around uneven shape of fat cells in the transplants of group B, and almost identical size and shape of fat cells and unobvious fibrous tissues were found in the transplants of groups C and D. The cells with positive expression of CD31 were distributed in fibrous tissues in larger number but less around fat cells in the transplants of group A, while more of these cells were observed surrounding fat cells in the transplants of group B. There were more cells with positive expression of CD31 distributed surrounding fat cells in the transplants of groups C and D than that in group B. The cells with positive expression of CD31 observed under 400 times field were more in number in groups C (20.5 ± 1.1) and D (22.1 ± 1.0) than in groups A (8.0 ± 3.6) and B (10.9 ± 1.7), with P values below 0.05.</p><p><b>CONCLUSIONS</b>Allogeneic ADSCs combined with autologous AG can significantly improve the early vascularization of fat transplantation as well as autologous ADSCs combined with autologous AG.</p>

Treatment of severe gynecomastia by double-ring supra-medialis pedicle for breast reduction / 中华医学美学美容杂志

Objective To introduce a surgical method for treatment of severe gynecomastia.Methods After designing double rings and ectomizing epidermis between two rings,a supra-medialis derma mammary pedicle of the nipple and areola was formed,most of the gland and fatty tissue was ectomized,the pedicle was fixed with the sarcolemma,and the two rings were sutured together.Resuits There were no severe postoperative complications.Following-up of 9 cases (18 sites) for 6 to 24 months showed symmetrical and satisfactory contour.Conclusions The breast reduction with doublering supra-medialis pedicle can be an effective procedure of severe gynecomastia,in which the supramedialis pedicle can ensure the blood supply of nipple and areola and avoid late mastoptosis.

Cellular phenotype conversion and relative mechanism of human mesenchymal stem cells cocultured indirectly with human sweat gland cells: a preliminary study / 中华创伤杂志

Objective To observe the cellular phenotype conversion of human mesenchymal stem cells (MSCs) cocultured indirectly with heat-shocked human sweat gland cells (SGCs) in vitro and explore the relative mechanism. Methods MSCs and SGCs were isolated and amplified in vitro. First,primary confluent cultures of SGCs were heat-shocked at 47℃. Then, the supernatants were collected immediately and 24 hours before applied to the third generation of MSCs. After seven days, the MSCs expressing CK7, CK18 and CEA were examined by two-step immunocytochemistry and flow cytometry and compared with the control group. Results MSCs treated with the supernatants of SGCs proliferated slowly, with no obvious morphological changes during seven days. Two-step immunocytochemistry demonstrated positive staining of CK7 and CEA in some cells. Additionally, the positive rate of CK7 and CEA was 5.76% and 2.01% by flow cytometry, much higher than that of the control sample, which was only 1.12% and 0.51% respectively (P ＜ 0.01 ). Conclusions There are some signal moleculars in the supernatants of heat-shocked SGCs, which benefits the transdifferentiation of MSCs.