Epididymis cell atlas in a patient with a sex development disorder and a novel NR5A1 gene mutation / 亚洲男科学杂志(英文版)

This study aims to characterize the cell atlas of the epididymis derived from a 46,XY disorders of sex development (DSD) patient with a novel heterozygous mutation of the nuclear receptor subfamily 5 group A member 1 (NR5A1) gene. Next-generation sequencing found a heterozygous c.124C>G mutation in NR5A1 that resulted in a p.Q42E missense mutation in the conserved DNA-binding domain of NR5A1. The patient demonstrated feminization of external genitalia and Tanner stage 1 breast development. The surgical procedure revealed a morphologically normal epididymis and vas deferens but a dysplastic testis. Microfluidic-based single-cell RNA sequencing (scRNA-seq) analysis found that the fibroblast cells were significantly increased (approximately 46.5%), whereas the number of main epididymal epithelial cells (approximately 9.2%), such as principal cells and basal cells, was dramatically decreased. Bioinformatics analysis of cell-cell communications and gene regulatory networks at the single-cell level inferred that epididymal epithelial cell loss and fibroblast occupation are associated with the epithelial-to-mesenchymal transition (EMT) process. The present study provides a cell atlas of the epididymis of a patient with 46,XY DSD and serves as an important resource for understanding the pathophysiology of DSD.

Effect of artificial colloids on blood coagulation during shock stage of severe burn injury / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>There are controversies about the use of artificial colloids. This research was aimed to determine the effect of various artificial colloids on blood coagulation in the shock stage of severe burn injury.</p><p><b>METHODS</b>Totally, 18 female Ba-Ma mini-pigs were subjected to a 40% total body surface third-degree flame burn under anesthesia. Resuscitation therapy was applied 2 hours after the injury, using the burn shock fluid resuscitation formula commonly accepted in the surgical treatment of burns. The Ba-Ma mini-pigs were randomly assigned to three groups (six pigs in each group): succinylated gelatin group (the artificial colloid used was succinylated gelatin Injection), hydroxyethyl starch group (the artificial colloid used was hydroxyethyl starch (130/0.4)), and allogeneic plasma group (the colloid used was allogeneic plasma). Blood samples were collected from the animals prior to the burn injury and again at intervals of 4, 8, 24 and 48 hours post-injury. The platelet count (PLT), prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), and fibrinogen (Fib) were measured, followed by a statistical analysis of all results.</p><p><b>RESULTS</b>The PLT of succinylated gelatin group and hydroxyethyl starch group at intervals of 24 and 48 hours were (124.3 ± 52.7), (78.8 ± 16.4) × 10(9)/L and (159.0 ± 62.8), (87.3 ± 32.0)× 10(9)/L respectively. But in the allogeneic plasma group at intervals of 8, 24, and 48 hours were (234.3 ± 52.6), (136.0 ± 47.4), (75.8 ± 31.0) × 10(9)/L. The decrease were all statistically significant (P < 0.05, P < 0.01) when compared to pre-burn ((383.3 ± 77.9), (382.7 ± 65.7), (381.0 ± 49.4)× 10(9)/L). The PLT among the three groups, at all the time points, had no statistical difference (P > 0.05). Compared to pre-burn ((10.8 ± 0.9), (11.4 ± 0.8), (10.6 ± 0.7) seconds), the PT of succinylated gelatin group and hydroxyethyl starch group at 24 hours were (14.5 ± 1.5) and (16.2 ± 1.3) seconds, whereas in the allogeneic plasma group at 8 and 24 hours the PT were (13.0 ± 0.9) and (14.5 ± 1.5) seconds, i.e., an increase in the statistical significance (P > 0.01). Statistical significance was observed at 8 and 48 hours between the succinylated gelatin group and hydroxyethyl starch group, and at 48 hours between the hydroxyethyl starch and allogeneic plasma group (P < 0.05). The INR at 24 hours were (1.26 ± 0.13) in the succinylated gelatin group, (1.40 ± 0.11) in the hydroxyethyl starch group, and (1.13 ± 0.07) and (1.26 ± 0.13) at 8 and 24 hours in the allogeneic plasma group. When compared with pre-burn ((0.94 ± 0.08), (0.99 ± 0.07), and (0.92 ± 0.06) seconds), the other groups have increased significantly (P > 0.01). The comparison at 8 and 48 hours between the succinylated gelatin group and the hydroxyethyl starch group, at 48 hours between hydroxyethyl starch group and allogeneic plasma group showed statistical difference (P < 0.01). The APTT of succinylated gelatin group and hydroxyethyl starch group at 24 hours were (13.1 ± 1.1) and (14.6 ± 2.9) seconds. The APTT of the allogeneic plasma group at 4, 8 and 24 hours were (10.9 ± 1.4), (11.8 ± 1.1), and (13.7 ± 1.5) seconds. Compared to pre-burn ((11.5 ± 4.2), (11.2 ± 3.3), (10.1 ± 1.4) seconds), they were statistically significant (P < 0.05). There was no statistical difference in the APTT between the three groups, at all the time points. The Fib of the succinylated gelatin group at 24 and 48 hours were (4.3 ± 0.3) and (4.7 ± 0.2) g/L, (4.1 ± 0.3), and (5.0 ± 0.1) g/L in allogeneic plasma group, and at 8, 24, and 48 hours the Fib for the hydroxyethyl starch group was (2.9 ± 0.4), (4.0 ± 0.5), and (4.6 ± 0.6) g/L. Compared to pre-burn ((2.4 ± 0.2), (2.5 ± 0.3), (2.6 ± 0.5) g/L), they were all statistically significant (P < 0.01). There was no statistical difference in APTT between the three groups, at all time points.</p><p><b>CONCLUSION</b>The changes of the indices in blood coagulation during the shock phase of a severe burn injury correlate with the stress response to the burn, rather than to the application of HES (130/0.4) and succinylated gelatin.</p>

Effects of resuscitation with different kinds of colloids on pulmonary edema in swine in shock stage of severe burn injury / 中华烧伤杂志

<p><b>OBJECTIVE</b>To observe and compare the effects of natural colloid and artificial colloid on pulmonary edema of swine during shock stage of severe burn injury.</p><p><b>METHODS</b>Twelve Guangxi Bama miniature swine were inflicted with 40% TBSA full-thickness burn on the back, and then they were divided into natural colloid group (N) and artificial colloid group (A) according to the random number table, with six swine in each group. At post injury hour (PIH) 2, fluid resuscitation was begun. The main part of electrolyte was lactic acid Ringer's solution. The colloids included swine plasma and hydroxyethyl starch 130/0.4. Before injury and at every hour within PIH 48, heart rate, blood pressure, urine volume, central venous pressure (CVP), and pulmonary arterial wedge pressure (PAWP) were recorded. The mean heart rate, blood pressure, urine volume per hour per kg of body weight, CVP, PAWP, resuscitation liquid volume, and the ratio of fluid intake to output during the first and second PIH 24 were calculated. At PIH 48, lung tissue was harvested for histopathological observation and calculation of lung water ratio. Data were processed with one-way analysis of variance, analysis of variance of repeated measurement, LSD test and independent sample t test.</p><p><b>RESULTS</b>(1) There were no statistically significant differences between two groups in heart rate, blood pressure, and urine volume before injury and during the first and second PIH 24 (P values all above 0.05); during the first PIH 24, the CVP and PAWP of group A were significantly higher than those of group N (P values all below 0.05). Compared with those before injury, the heart rate, CVP and PAWP of two groups during the first and second PIH 24 were significantly higher (P < 0.05 or P < 0.01); the urine volume of group N was decreased during the first PIH 24 (P < 0.05), while there was no significant change in group A (P > 0.05); the urine volumes of two groups during the second PIH 24 were increased, while no statistically significant differences were observed (P values all above 0.05). There were no statistically significant differences in blood pressure of two groups between the first, second PIH 24 and before injury (P values all above 0.05). (2) There were no statistically significant differences in the resuscitation liquid volume and fluid intake to output ratio between two groups during the first and second PIH 24 (P values all above 0.05). (3) The alveolar septum was found widened in varying degrees, and there were edema fluid accumulating and inflammatory cell infiltrating within the pulmonary interstitial of lung tissue sections in both two groups. (4) The lung water ratio of group N [(71 ± 10)%] was not statistically significant different from that of group A [(79 ± 4)%, t = -1.753, P > 0.05].</p><p><b>CONCLUSIONS</b>The natural colloid or artificial colloid (hydroxyethyl starch 130/0.4) applied during shock stage had similar effects on pulmonary edema in swine with severe burn.</p>

Comparison among several foam dressings in the properties of water-absorption, water-locking and air permeability / 中华烧伤杂志

<p><b>OBJECTIVE</b>To compare the properties of water-absorption, water-locking, and air permeability among several foam dressings, and to provide references for clinician in choosing dressings for different types of wounds.</p><p><b>METHODS</b>The comparison was made among Allevyn foam dressing, Mepilex foam dressing, and Biatain foam dressing that were commonly used in clinic. NaCl and CaCl2·H2O respectively in the weight of 8.3 g and 0.367 g were diluted with distilled water to the volume of 1 L to simulate wound exudation. The simulated wound exudation was used to test the water-absorbing rate of dressings at post immersion hour (PIH) 24, water-absorbing speed of dressings at post immersion minute (PIM) 1, 5, 10, and 20, the diffusion diameter of exudation dripped on the surface of dressings for 5 min to reflect the water-locking capacity of dressings, and the water evaporation capacity of exudation after being sealed up by dressings for 24 h to reflect the air permeability of dressings. Five samples of each dressing were used for each index. Data were processed with one-way analysis of variance and analysis of variance of repeated measurement, and LSD method was applied in paired comparison.</p><p><b>RESULTS</b>(1) The water-absorbing rate at PIH 24 of Allevyn foam dressing, Mepilex foam dressing, and Biatain foam dressing were respectively (646 ± 18)%, (616 ± 19)%, and (499 ± 11)% (F = 423.854, P < 0.01). The differences between each two dressings in water-absorbing rate were statistically significant (with P values all below 0.01). (2) The water-absorbing speed of Allevyn foam dressing at PIM 1, 5, 10, and 20 were (35.20 ± 2.31), (12.48 ± 0.37), (6.63 ± 0.23), and (3.39 ± 0.08) g×s(-1)×m(-2), which were obviously lower than those of Mepilex foam dressing [(119.68 ± 2.59), (24.39 ± 0.62), (12.33 ± 0.29), and (6.18 ± 0.13) g×s(-1)×m(-2)] and Biatain foam dressing [(121.09 ± 3.41), (24.73 ± 0.52), (12.37 ± 0.25), (6.18 ± 0.13) g×s(-1)×m(-2)], with P values all below 0.01. The water-absorbing speed of each dressing showed the trend of declination among three dressings with prolongation of time. The differences between two adjacent time points within each dressing in water-absorbing speed were statistically significant (with P values below 0.01). (3) Diffusion diameters of exudation dripped on the surface of Allevyn foam dressing, Mepilex foam dressing, and Biatain foam dressing were respectively (5.66 ± 0.15), (4.84 ± 0.15), (3.94 ± 0.21) cm (F = 124.742, P < 0.01). The differences between each two of the three dressings in diffusion diameter were statistically significant (with P values all below 0.01). (4) The water evaporation capacity of exudation after being sealed up by each dressing for 24 h decreased in succession for Allevyn foam dressing, Mepilex foam dressing, and Biatain foam dressing, which were respectively (31.2 ± 3.1), (29.7 ± 8.7), (5.6 ± 2.8) g×h(-1)×m(-2) (F = 24.324, P < 0.01). The water evaporation capacity of exudation sealed with Biatain foam dressing was significantly lower than that of exudation sealed with Allevyn foam dressing and Mepilex foam dressing (with P values below 0.01).</p><p><b>CONCLUSIONS</b>Among the three kinds of foam dressings, Allevyn performs best in water-absorbing rate, water-locking capacity, and air permeability, while Mepilex and Biatain perform best in water-absorbing speed. For selecting foam dressing in clinic, the properties of foam dressings and wound characteristics should be considered at the same time.</p>

Evaluation of the clinical curative effect of applying vacuum sealing drainage therapy in treating deep partial-thickness burn wound at the initial stage / 中华烧伤杂志

<p><b>OBJECTIVE</b>To evaluate the clinical curative effect of applying vacuum sealing drainage (VSD) therapy in treating deep partial-thickness burn wound at the initial stage prospectively, and to provide the basis for its clinical application.</p><p><b>METHODS</b>Twenty-two patients with about 10% TBSA burn of the lower limbs, and in which partial-thickness wound exceeded 1% TBSA in each limb, were admitted to our hospital within 3 hours after burn from May 2009 to March 2010. Wounds in each patient were divided into VSD treatment group (treated with VSD therapy) and control group (treated with 10 g/L silver sulfadiazine cream) based on the principles of symmetry of location, identical deepness, and similarity in size etc. The amount of water evaporation, the swelling intensity, the status of bacterial colonization, the degree of pain, the healing time, and the quality of healing of wounds in 2 groups were observed and compared. Data were processed with t test and rank-sum test.</p><p><b>RESULTS</b>The observation was completed in 21 patients. All of the wounds were treated within 4 hours post burn (PBH). The amount of water evaporation of the normal skin and burn wounds before dressing coverage in VSD treatment group was respectively close to that in control group (with t value respectively 1.310, -0.911, P values all above 0.05); the amount of water evaporation on the surface of dressing in VSD treatment group [(44.3+/-3.9) mLxh(-1)xm(-2)] was less than that in control group [(66.1+/-6.4) mLxh(-1)xm(-2), t=-11.39, P<0.01]. In VSD treatment group, the circumference of proximal thigh increased (3.48+/-0.35) and (2.51+/-0.21) cm on post burn day (PBD) 3, 7 as compared with that on PBH 5, which was respectively smaller than that [(8.02+/-0.41), (3.99+/-0.32) cm] in control group (with t value respectively 4.110, 3.569, P values all below 0.01). Positive bacteria' culture rate on PBD 10 of each group was respectively lower than that at admission (with Z value respectively -3.220, -3.870, P values all below 0.01), and there was no significant statistical difference between 2 groups at admission or on PBD 10 (with Z value respectively -0.894, 0.000, P values all above 0.05). The wound surface in VSD treatment group was weak acidic (pH value 7.12+/-0.06) on PBD 10, and it was neutral (pH value 7.41+/-0.13) in control group. The wound pain degree in control group on PBD 1, 3, 7 was respectively higher than that in VSD treatment group (with t value respectively -16.132, -21.230, -16.453, P values all below 0.01). There was no significant statistical difference between 2 groups in healing time of wounds (t=1.186, P>0.05). The healing quality of wounds in VSD treatment group (100.00%, 100.00%) 2 or 3 months after burn was better than that in control group (19.05%, 85.71%) (with Z value respectively -11.638, -3.870, P values all below 0.01).</p><p><b>CONCLUSIONS</b>Early application of VSD therapy cannot expedite the healing process of deep partial-thickness burn wounds, but it can improve the healing quality. It is one of the effective methods to deal with deep partial-thickness burn wounds, which is worthy of clinical attention and further research.</p>

The relationship between rhGH and blood sugar on different ages of severe degree burned patients / 中华外科杂志

<p><b>OBJECTIVE</b>Probe the effects of rhGH on severe degree burned patients' blood sugar in different age of years.</p><p><b>METHODS</b>Elected 210 patients hospitalized in the Third Affiliated Hospital of Wenzhou Medical College from January 2005 to December 2008, who were burned in 48 h, older than 18 years, ever had no diabetes and tumor history and placidly pull through shock stage. Among the patients there were 132 males and 78 females. The age was from 18 to 65 years old, average (40.7 +/- 7.2) years old. The extent of burn were form TBSA 25% to TBSA 86%, average TBSA (40.4 +/- 12.5)%. The depths of burn were from superficial second degree to third degree. All of the total divided into A (18 - 44 years old) and B (> 45 years old)groups. Each group had 105 patients. Two groups were randomly divided into A(1), A(2), A(0) and B(1), B(2), B(0) groups. Each group had 35 patients. The A(1) and B(1) groups were used 0.15 U/(kg.d) growth hormone (Somatropin, S19990021), A(2) and B(2) groups were used 0.2 U/(kg.d) growth hormone, A(0) and B(0) groups were used NS as control. Observed and analyzed the change of blood sugar and insulin amount used in 210 patients.</p><p><b>RESULTS</b>Of all the patients in 6 groups, there were 190 patients finished the experimentation in four weeks. The insulin amount of A(1), A(2), A(0) groups used were (2123.3 +/- 152.3), (2885.6 +/- 148.5), (724.1 +/- 31.1) U, B(1), B(2), B(0) group were (2715.1 +/- 95.3), (3652.2 +/- 198.1), (801.8 +/- 22.2) U. The consequence showed that the number need insulin to control blood sugar in B group was more than A group, as well as using 0.2 U/(kg.d) does to 0.15 U/(kg.d) does, and using growth hormone to no using(P < 0.01). The time that blood sugar of A(1), A(2), B(1), B(2) group recovered to normal range without using insulin were (5.11 +/- 0.82), (4.93 +/- 0.89), (5.2 +/- 0.65), (5.13 +/- 1.02) d (P > 0.05).</p><p><b>CONCLUSIONS</b>The blood sugar's alteration has positive correlation with the age of years and the does of rhGH. As long as normative using rhGH it doesn't induce diabetes.</p>

Effect of different dressing materials in various combinations on wound microenvironment of donor site in burn patients / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the effect of dressing materials in various combinations on burn wound microenvironment and healing condition.</p><p><b>METHODS</b>Two hundred donor sites with wounds of 0.3 mm in depth in 186 burn patients, who needed skin grafting and admitted to our ward were enrolled in study, and they were divided into A (with dressing composed of alginate + cotton pad for donor area), B (with dressing composed of vaseline gauze + cotton pad for donor area), C (with dressing composed of alginate + foam dressing for donor area), D (with dressing composed of vaseline gauze + foam dressing for donor area) groups according to random table method. Effect of dressings on wound evaporation and pH value were observed. Bacterial colonization, degree of pain complained by patients after dressing change, and wound healing time in each group were compared.</p><p><b>RESULTS</b>One hundred and eighty-four patients complied with the study, while 2 patients were excluded due to untimely falling-off of the dressing. Wound evaporation in A, B, C, D groups was (35.5 +/- 3.2), (31.3 +/- 2.8), (23.1 +/- 2.9), (18.1 +/- 2.3) mL x h(-1) x m(-2) respectively, among them B group showed optimal effect of keeping humidity (P < 0.01). Wound pH value in A, B, C, D groups was 7.22 +/- 0.06, 7.41 +/- 0.03, 7.05 +/- 0.03, 7.34 +/- 0.06, respectively, among them it was highest in B group. The positive rate of bacteria in D group was highest (22.4%), and lowest in C group (4.0%). Pain was lightest in C group (score was 0.98 +/- 0.12), and most serious in B group (score was 8.14 +/- 0.82). The shortest wound healing time was seen in C group (6.7 +/- 0.8 d), and longest in D group (15.6 +/- 3.5 d).</p><p><b>CONCLUSIONS</b>Application of various dressings on similar wounds can produce different wound microenvironment, which is closely related to wound healing time. Compared with pH value, humidity is the more important factor for wound healing.</p>