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Brain edema could be secondary to cerebral lesion caused by a variety of reasons, severe cases may result in brain herniation or even death. Accurate real-time monitoring of cerebral edema, rational application of dehydrating drugs, and timely treatment of cerebral edema were very important for patients. However, there were defects in the monitoring methods commonly used in clinical practice. Noninvasive brain-edema monitoring was a new method, which can quantify the degree of brain edema by electromagnetic disturbance and directly reflect the state of brain edema. This article reviews the application of noninvasive brain-edema monitoring in the treatment of in critically ill patients with traumatic brain injury.
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The fatality rate of traumatic cardiac arrest (TCA) is extremely high, and it is very different from that of non-traumatic cardiac arrest (NTCA) in resuscitation strategy. Only when the standard resuscitation process is combined with rapid treatment of various reversible causes can the mortality rate of patients be decreased. In this paper, the key factors leading to TCA are reviewed, such as hypovolemic shock, asphyxia, tension pneumothorax, pericardial tamponade, crush syndrome, craniocerebral injury, cerebral hernia, and the control measures are elaborated respectively, so as to provide references for clinical treatment of patients with severe trauma, and reduce TCA incidence and mortality.
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Objective@#To investigate the promoting effect of local compression and fixation on the healing of anterior tibial flask-like wound after debridement and suture.@*Methods@#A retrospective case control study was conducted to analyze the clinical data of 57 patients with simple anterior tibial flask-like wound admitted to the Second Hospital of Shandong University from May 2017 to June 2018. There were 32 males and 25 females, aged 20-60 years [(41.4±8.1)years]. The length of wound ranged from 1 to 10 cm. All patients had only acute skin and soft tissue injury, without any fracture, large area skin defect, large area avulsion injury, or chronic diseases such as diabetes mellitus and lower limb vascular disease. The study group contained 37 patients who were treated with local pressure dressing and limb fixation after debridement and suture while the control group included 20 patients who were treated with simple dressing after debridement and suture. At 3, 5, 7, 14, and 21 days after operation, the size of the wound, the type and quantity of exudate, the color of skin around the wound and the type of wound tissue were compared, and the healing time was recorded.@*Results@#All patients were followed up for 30-90 days [(52.2±3.5) days]. Three days after operation, there was no significant difference between the two groups (P>0.05). On the 5th day after operation, the scores of exudate amount, skin color surrounding wound and tissue types of the wound bed in the control group and the study group were (4.2±0.7)points ∶(3.3±0.6)points, (3.5±0.7)points ∶ (2.5±0.6)points, (3.4±0.6)points ∶ (2.5±0.5)points (P<0.05), but there was no significant difference between the two groups in the scores of the size of wound and the type of exudate (P>0.05). On the 7th day after operation, the scores of the size of wound, type of exudate, amount of exudate, skin color around the wound and the type of wound tissue in the control group and study group were (3.5±0.5)points ∶ (2.5±0.7)points, (3.4±0.7)points ∶ (2.4±0.5)points, (4.0±0.8)points ∶ (2.8±0.5)points, (3.4±0.5)points ∶ (1.3±0.5)points, (3.3±0.5)points ∶ (2.1±0.4)points (P<0.05). On the 14th day after operation, the scores of the scores of the size of wound, type of exudate, amount of exudate, skin color around the wound and the type of wound tissue in the control group and study group were (2.9±0.6)points ∶ (1.2±0.7)points, (2.8±0.7)points ∶ 0 point, (3.3±0.7)points ∶ (1.0±0.0)points, (3.1±0.6)points ∶ (1.1±0.4)points, (3.0±0.6)points ∶ (1.2±0.5)points (P<0.05). Twenty-one days after operation, the scores of the scores of the size of wound, type of exudate, amount of exudate, skin color around the wound and the type of wound tissue in the control group and study group were (2.5±0.7)points ∶ 0 point, (2.5±0.5)points ∶ 0 point, (3.0±0.7)points ∶ (1.0±0.0)points, (2.6±0.7)points ∶ (1.1±0.3)points, (2.6±1.1)points ∶ 0 point (P<0.05). The wound healing rate was 100% in both groups. The wound healing time of the control group and the study group was (28.3±6.7)days and (15.2±0.9)days respectively (P<0.05).@*Conclusion@#For anterior tibial flask-like wound, local pressure bandaging and fixation after debridement and suture can significantly promote wound healing compared with conventional simple bandaging, with the advantages of better healing quality and shorter healing time.
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Objective To investigate the promoting effect of local compression and fixation on the healing of anterior tibial flask-like wound after debridement and suture.Methods A retrospective case control study was conducted to analyze the clinical data of 57 patients with simple anterior tibial flask-like wound admitted to the Second Hospital of Shandong University from May 2017 to June 2018.There were 32 males and 25 females,aged 20-60 years [(41.4 ± 8.1) years].The length of wound ranged from 1 to 10 cm.All patients had only acute skin and soft tissue injury,without any fracture,large area skin defect,large area avulsion injury,or chronic diseases such as diabetes mellitus and lower limb vascular disease.The study group contained 37 patients who were treated with local pressure dressing and limb fixation after debridement and suture while the control group included 20 patients who were treated with simple dressing after debridement and suture.At 3,5,7,14,and 21 days after operation,the size of the wound,the type and quantity of exudate,the color of skin around the wound and the type of wound tissue were compared,and the healing time was recorded.Results All patients were followed up for 30-90 days [(52.2 ± 3.5) days].Three days after operation,there was no significant difference between the two groups (P ＞0.05).On the 5th day after operation,the scores of exudate amount,skin color surrounding wound and tissue types of the wound bed in the control group and the study group were (4.2 ± 0.7) points ∶ (3.3 ± 0.6) points,(3.5 ± 0.7) points ∶ (2.5 ± 0.6) points,(3.4 ± 0.6) points ∶(2.5 ± 0.5) points (P ＜ 0.05),but there was no significant difference between the two groups in the scores of the size of wound and the type of exudate (P ＞ 0.05).On the 7th day after operation,the scores of the size of wound,type of exudate,amount of exudate,skin color around the wound and the type of wound tissue in the control group and study group were (3.5 ± 0.5) points ∶ (2.5 ± 0.7) points,(3.4 ±0.7)points ∶ (2.4 ±0.5)points,(4.0±0.8)points ∶ (2.8 ±0.5)points,(3.4 ±0.5)points ∶ (1.3 ±0.5) points,(3.3 ± 0.5) points ∶ (2.1 ± 0.4) points (P ＜ 0.05).On the 14th day after operation,the scores of the scores of the size of wound,type of exudate,amount of exudate,skin color around the wound and the type of wound tissue in the control group and study group were (2.9 ± 0.6)points ∶ (1.2 ±0.7)points,(2.8 ±0.7)points ∶ 0 point,(3.3 ±0.7)points ∶ (1.0 ±0.0)points,(3.1 ±0.6)points ∶(1.1 ± 0.4) points,(3.0 ± 0.6) points ∶ (1.2 ± 0.5) points (P ＜ 0.05).Twenty-one days after operation,the scores of the scores of the size of wound,type of exudate,amount of exudate,skin color around the wound and the type of wound tissue in the control group and study group were (2.5 ±0.7)points ∶0 point,(2.5 ±0.5)points ∶ 0 point,(3.0 ±0.7)points ∶ (1.0 ±0.0)points,(2.6±0.7)points ∶ (1.1 ±0.3) points,(2.6 ± 1.1) points ∶ 0 point (P ＜ 0.05).The wound healing rate was 100％ in both groups.The wound healing time of the control group and the study group was (28.3 ± 6.7) days and (15.2 ± 0.9) days respectively (P ＜ 0.05).Conclusion For anterior tibial flask-like wound,local pressure bandaging and fixation after debridement and suture can significantly promote wound healing compared with conventional simple bandaging,with the advantages of better healing quality and shorter healing time.
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Objective@#To investigate the preparation of bioactive denatured acellular dermal matrix (DADM) from burn mice riched in mice bone marrow mesenchymal stem cells.@*Methods@#Twelve BALB/c mice were collected and 20% total body surface area scalds (hereinafter referred to as burns) with deep partial thickness were inflicted on the back skin of each mouse. After removing epidermis, the burned skin were collected and divided into Triton X-100 group and elhylene diamine tetraacetic acid (EDTA) group according to the random number table, with 15 samples in each group. Samples in Triton X-100 group and EDTA group were respectively placed in mixture of 2.5 g/L Triton X-100 and 2.5 g/L trypsin solution and mixture of 0.2 g/L EDTA and 2.5 g/L trypsin solution for sustained vibration and elution for 24 hours to make mice DADM. The general appearance of DADM was observed. The structure and arrangement of collagen fibers of DADM were observed by scanning electron microscope and tissue structure of DADM were observed by fluorescence microscope. Bone marrow mesenchymal stem cells (BMSCs) from mice were transplanted in mice DADM in the two groups with concentration of 2×105 cells per well to prepare bioactive mice DADM. After cultured for 3 days, tissue structure of bioactive mice DADM was observed by hematoxylin and eosin staining, distribution and number of BMSCs of bioactive mice DADM were observed by immunofluorescence staining. Proliferation of BMSCs of bioactive mice DADM after cultured for 2 h, 1 d, 3 d, and 5 d was detected by cell count kit-8. Data were processed with analysis of variance for repeated measurement and t test.@*Results@#(1) Mice DADM in the two groups were white in appearance with certain tenacity and elasticity. Mice DADM in the two groups maintained good three-dimensional porous network structure. Collagen fibers of mice DADM in EDTA group were with good continuity, and collagen fibers of mice DADM in Triton X-100 group were fractured in varying degrees. Mice DADM in the two groups were decellularized completely, and the collagen fibers were loose and arranged disorderly. The continuity of tissue structure of mice DADM in EDTA group was better than that of mice DADM in Triton X-100 group. (2) After cultured for 3 days, the BMSCs in bioactive mice DADM in the two groups were evenly distributed. The number of bioactive BMSCs in mice DADM in EDTA group was 37±7, which was significantly more than that of mice DADM in Triton X-100 group (25±8, t=0.128, P<0.05). The proliferation of bioactive BMSCs in mice DADM in Triton X-100 group and EDTA group was similar at 2 hours and on day 1 after cultured (t=1.292, 0.656, P>0.05). On 3, 5 days after cultured, the proliferation of bioactive BMSCs in mice DADM in EDTA group was significantly higher than that of mice DADM in Triton X-100 group (t=2.309, 14.128, P<0.05 or P<0.01).@*Conclusions@#Mice DADM prepared by decellularization of EDTA has better three-dimensional porous network structure and good continuity of collagen fiber. The BMSCs in bioactive DADM from burn mice prepared by transplanting BMSCs are evenly distributed with large quantity and strong proliferative capacity, which has the potential to be good autologous dermal substitute.
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The correct thoughts and principles of diagnosis and treatment of chronic refractory wounds need to be formulated. Through the relevant domestic and international consensus and based on clinical experience, the Thoughts and principles of diagnosis and treatment of chronic refractory wounds in China is proposed. It is considered that in the diagnosis and treatment of chronic refractory wounds, in the case of fully understanding the patient′s medical history, the following thoughts and principles should be complied in order. (1) Pay attention to the cleanliness of the wound after being cleaned. (2) Reasonably perform debridement to avoid being " excessive" or " not thorough". (3) Reasonably perform examination, diagnosis, and differential diagnosis of pathogenic factors. (4) Treat according to etiology. (5) Find comorbidities and prevent adverse outcomes. (6) Select the correct wound treatment method reasonably and timely. When the conservative wound care treatment is considered, pay attention to embodying the concept of etiological treatment, treat the wound according to the principles of safety, phase, selectivity, and effectiveness, and make a reasonable choice of continuing conservative treatment or surgical treatment in time after completing the preparation of the wound bed. When surgical treatment is considered, pay attention to the selection of reasonable surgical method and donor site, pay attention to the healing rate of surgical wound site and the outcome of donor site, and give reasonable protection to the wound site after surgery. (7) Carry out rehabilitation treatment after wound healing and related health education.
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Scarless healing is considered as the most ideal mode of wound repair. This ability generally exists in the early period of mammalian embryos, however it gradually turns to scar healing with the development of the embryos. This phenomenon is the result of the interaction of multiple biological functions, and the mechanism is still uncertain. This article deals with a systematical review of literature concerning the mechanism of scarless healing based on the recent experimental studies, hoping to provide evidence for the treatment of wounds to realize scarless healing in adult.
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Adult , Animals , Humans , Cicatrix , Fetus , Physiology , Wound Healing , PhysiologyABSTRACT
<p><b>OBJECTIVE</b>To lower down the antigenicity of heterogenous swine acellular dermal tissue, and to explore the feasibility of clinical using it as a composite graft for human patients.</p><p><b>METHODS</b>Split-thickness skin was harvested from healthy swines and then processed by two methods. The swine acellular dermal matrix (sADM) was prepared by removing cells from the skin with trypsin and Triton X-100. Then the cross-linked sADM (sADM(1)) and non-cross-linked sADM (sADM(0)) were embedded subcutaneously in rabbits and also transplanted onto the burn wounds of patients. The histological changes and also transplantation results were observed.</p><p><b>RESULTS</b>(1) In animals with sADM(0) embedded subcutaneously, the grafted tissue was invaded immediately by host cells with obvious inflammatory reaction and tissue degradation. But there was less inflammatory reaction, and with no obvious skin degradation and contraction with sADM(1). (2) In ten burn patients with III degree burn wounds and one patient with wound in chest after scar removal, sADM and ultra-thin skin (UTS) composite graft were grafted on the wounds with autologous thin skin (ATS) and autologous razor-thin or UTS as the control. Nineteen pieces of composite skin of sADM with UTS were grafted on the wounds with survival rate of 78.9%, exhibiting no evident difference with that of ATS. When sADM(0) and UTS were grafed, there exhibited remarkable early inflammatory reaction and wound contraction with similar external appearance with that of UTS. Whereas when sADM(1) and UTS were grafted, there appeared less early inflammatory reaction and wound contraction, resulting in an even appearance and soft to touch similar to that with ATS. But ulceration occurred, with exposure of sADM(1), exposure and severe macrophage reaction to foreign body in 6 wounds of 3 cases 12.8 +/- 6.9 weeks after sADM(1) and UTS grafting.</p><p><b>CONCLUSION</b>Grafting of sADM as a dermal substitute of composite skin could alleviate early post-grafting immune reaction and improve UTS grafting results. But the delayed graft rejection couldn't be avoided.</p>
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Animals , Humans , Rabbits , Burns , General Surgery , Dermatologic Surgical Procedures , Dermis , Allergy and Immunology , Transplantation , Skin , Allergy and Immunology , Wounds and Injuries , Skin Transplantation , Methods , Skin, Artificial , Swine , Time Factors , Transplantation, Heterologous , Wound HealingABSTRACT
Objective To explore the correlation of the formation of pseudoepitheliomatous hyperplasia (PEH) after healing of inappropriately treated wound of skin with epithelial mesenchymal cells transdifferentiation (EMT). Methods Morphological change in epithelial tissue was observed with histopathologic methods in epithelial cells from PEH lesions ( n =11) and normal skin specimens obtained adjacent to PEH (PEH N, n =6) from 11 patients with PEH. At the same time, the characteristic of expressions and distribution of type Ⅰ and Ⅲ collagen, alpha smooth muscule actin (? SMA), vimentin (Vim), desmin (Des), transforming growth factor ?1 (TGF ?1)and its receptor (TGFRI), pan cytokeratin (CKp), and type Ⅳ collagen in PEH were examined with indirect immunofluorescent double labelling method. Results In comparison with PEH N, squamous epithelium in PEH presented a picture of atypical hyperplasia, there was a derangement of basal apical polarity, disrupture in structure, and a displacement of cells foward mesenchyme. Examination under electron microscope revealed deformation of epithelial basal cells, with loose intercellular junction, and newly formed tumor like cells distingaishable from original epithelial cells. Expressions of type Ⅰ and Ⅲ collagen,? SMA,Vim and Des could be detected in the epithelial cells of PEH. However,the protein expressions of CKp, Ⅳ type collagen were significantly decreased in basal epithelial cells. Furthermore, free epithelial cells expressing CKp were found in the deep layer of mesenchyme. Conclusion It was confirmed for the first time that there was a phenomenon of EMT during the course of PEH formation. Epithelial cells in PEH lesion with granuloma and non hypertrophic scar are characteristized by de differentiation, redifferentiation and a decrement of TGF ?1 induction, which are involved in reactive hyperplasia of the epithelium.
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To investigate the expression characteristics of fibroblast growth factor 10 (FGF10) and its receptor (Bek) underlying their effect on the formation of fetal skin appendages (SA). Expressions of FGF10, Bek, cytokeratin (CK19), Bcl-2 and proliferating cell nuclear antigen (PCNA) were detected with pathological and immunohistochemistry techniques in 130 skin specimens, which were obtained from 5 different sites (head, lower jaw, ear lobe, shoulder and presternal region) of 26 fetuses at different embryonic ages (E 8～31weeks). Results showed that FGF10, PCNA and Bcl-2 were over-expressed in interstitial cells distributed in clumps under the epidermis, and all proteins were strongly expressed in epidermal cells and pericytes at E 11weeks. In E 13weeks fetal skin, epidermal cells formed SA anlage through focal proliferation; then they developed, differentiated and migrated towards the dermis. In the skin of E 11～13weeks fetus, the expression of FGF-10, PCNA and Bcl-2 in interstitial cells in the dermis, and the expression of FGF10, Bek, PCNA, CK19, and Bcl-2 proteins in the epithelial cells in SA showed the expression characteristics of these proteins which were in accordance with growth and development of fetal SA. The results suggested that the specific binding of FGF10 from interstitial cells with Bek on the membrane of epithelial cells was the important signal to induce the proliferation and morphogenesis of embryonic SA epithelial \{cells.\ \ \ \}
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The cytokine-receptor- heparin sulfate functional complex combined by cytokines, cytokine receptors, and heparin sulfate chains formed by concatenation of heparin sulfate proteoglycans (HSPG), an important component of extracellular matrix and modified by some relative enzymes, can regulate the density of cytokine receptors and their intracellular signal transduction. This article focused on the regulatory function of this complex. Many morphological abnormalities and diseases occur when the complex is dysfunctional.
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AIM: To investigate gene expression of bax, bcl-2 and p53 in fetal skin at different gestational ages and children skin in order to explore their potentially biological significance. METHODS: Apoptosis in skin specimens was determined by terminal deoxynucleotidy transferase mediated dUTP-biotin nick-end labeling technique (TUNEL). Gene expressions of bax, bcl-2 and p53 in skin at different developmental stages was examined with reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: Along with fetal growth and development, the incidence rate of apoptosis was increased progressively in skin. In skin from early gestational fetus, bcl-2 was strongly expressed. This gene expression was progressively decreased with increment in gestational age. In children skin, the mRNA content of this gene was significantly reduced compared with fetal skin (P