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BACKGROUND:Skin damage caused by radiation therapy and nuclear accidents is still a serious medical problem.It is difficult to achieve effective treatment results with single prevention and treatment methods.It is an important research direction to find new comprehensive treatment methods. OBJECTIVE:To observe the protective effect and the underlying mechanism of 1,2-propanediol combined with hepatocyte growth factor-modified exosomes derived from dental pulp stem cells on human epidermal radiation damage cell models. METHODS:(1)After infection of human dental pulp stem cells using recombinant adenovirus of human hepatocyte growth factor gene,exosomes,i.e.,Ad.HGF DPSC-Exo,were isolated with ultracentrifugation.(2)HaCat cells were irradiated with X-ray.The cells were treated with 1,2-propanediol before irradiation and Ad.HGF DPSC-Exo after irradiation.Cell proliferative activity was determined by CCK-8 assay.Cell apoptosis was detected by flow cytometry.Cell migration was detected by cell scratch assay.The expression levels of P21 and P53 were detected by PCR. RESULTS AND CONCLUSION:1,2-Propanediol,Ad.HGF.DPSC-Exo,Ad.HGF.DPSC-Exo + 1,2-propanediol could significantly improve the growth inhibition of HaCaT cells,reduce cell apoptosis,elevate cell proliferation and migration,and exhibit a good radiation protection effect.Moreover,the combined effect of Ad.HGF.DPSC-Exo + 1,2-propanediol was better.Furthermore,Ad.HGF.DPSC-Exo + 1,2-propanediol alleviated the cellular G2/M phase block and decreased the expression of cell cycle genes P53 and P21.In conclusion,1,2-propanediol pretreatment combined with Ad.HGF.DPSC-Exo had significant protective effects on radiation-induced HaCaT cell injury and it provided novel ideas and potential methods for the prevention and treatment of radiation-induced skin damage.
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BACKGROUND:The clinical manifestation of acute radiation skin injury is recurrent necrotic ulcers,and its pathogenesis is still not fully understood.The establishment of a suitable animal model will have important clinical implications for the study of its pathogenesis,prevention and treatment. OBJECTIVE:To establish a model of acute β-ray radiation skin injury and to investigate the mechanism of injury. METHODS:Sixty-nine Sprague-Dawley rats were randomly divided into 30,45,60 Gy 32P-β-ray groups(n=21 per group)and control group(n=6).A single local irradiation of the back of the rats was performed using 32P radionuclide.The control group was operated in the same way as the irradiated groups except that it was not irradiated.The body mass and skin appearance of the rats were measured at 7,15,30,45,and 60 days after irradiation.Three rats from each group were selected at each observation time point.The skin injury was observed by hematoxylin-eosin staining,Masson staining,transmission electron microscopy,and TUNEL assay.P53,Bcl-2 and Bax protein levels in the skin were measured by immunohistochemistry and western blot assay. RESULTS AND CONCLUSION:There was no accidental death after irradiation,and the body mass of rats showed a gradual increase.The rats showed different degrees of epidermal necrosis,inflammatory cell infiltration,reduction of hair follicles and appendages,and collagen fibrillation,which were evident at 60 and 45 Gy.The levels of serum inflammatory factors,interleukin-6 and tumor necrosis factor-α,were significantly increased in a dose-dependent manner.Under the electron microscope,there are varying degrees of mitochondrial reduction,vacuolization and nuclear pyknosis in the cells.The degree of cell apoptosis showed a certain dose-dependence.Immunohistochemistry and western blot results showed an increase in the expression of P53 and Bax proteins and a decrease in the expression of Bcl-2 protein in the skin after irradiation.There were significant differences between the 60 Gy group and the 45 Gy and 30 Gy groups(P＜0.05).To conclude,irradiation with 60 Gy and 45 Gy 32P radionuclide on the back of rats could successfully establish a practically pre-clinical animal model,and the mechanism is related to the up-regulation of P53 and Bax and the down-regulation of Bcl-2.This model can provide a reference for the establishment of animal models for the study of the mechanism of radiation skin injury and its prevention and treatment.
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【Objective】 To investigate the feasibility of allogeneic platelet-rich plasma (PRP) for the treatment of skin injury around enterostomy. 【Methods】 The treatment process by PRP of 2 patients with skin injury around enterostomy was analyzed, and the PRP for each patient was tested with platelet count, bacteria and 5 growth factors. The clinical efficacy of enteral nutrition support therapy combined with allogeneic PRP was explored through analyzing treatment key points and literature review. 【Results】 After cleaning the skin around enterostomy, the patients were treated with PRP once daily for 5 days, adjusted to once every other day, and cure was achieved at 15 and 18 days, respectively. 【Conclusion】 Allogeneic PRP is a safe and effective treatment to promote skin injury around enterostomy regeneration in a short time, which can provide a new perspective for clinical.
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Objective:To investigate the conversion of stromal vascular fraction (SVF) in the microenvironment of radiation-induced skin injuries to provide guidance for clinical applications.Methods:Based on a random number table, C57BL/6N mice were categorized into four groups: the blank control, negative control, acute injury, and chronic injury groups, with each group containing 25 mice. The backs of mice in the blank control, acute injury, and chronic injury groups were exposed to 15 Gy X-ray irradiation. Then, the mice in the negative control, acute injury, and chronic injury groups were injected subcutaneously with the SVF derived from B6/G-R mice. The survival of these mice was observed 1, 3, 7, 14, and 21 d after the injection through fluorescence tracing and in vivo imaging. Accordingly, the clinical SVF injection regimens were optimized based on the experimental result of mice. Finally, local SVF injection was performed on different frequencies for patients in different wound conditions, with the efficacy being observed. Results:The fluorescence of SVF was observed from the tissue slices of the acute injury, chronic injury, and negative control groups 14 d post-injection. The result showed that the fluorescence intensity of SVF 1, 3, and 7 d post-injection was in the order of the negative control group > the acute injury group > the chronic injury group. The acute injury group ranked at the top and the chronic injury group remained at the bottom 14 d after the injection. The fluorescence of SVF in each group was barely detected 21 d after the injection. Compared to the negative control group, the acute injury group exhibited statistical differences only 14 d post-injection ( t = 4.11, P < 0.05), while the chronic injury group displayed statistical differences 1, 3, 7, and 14 d after the injection ( t = 3.88-5.74, P < 0.05). Furthermore, the acute injury group exhibited significantly higher fluorescence intensity of SVF than the chronic injury group ( t = 4.73-8.38, P < 0.05). The half-life of SVF for the negative control, acute injury, and chronic injury groups was 6.336, 6.014, and 2.163 d, respectively. As indicated by the application of SVF transplantation based on traditional surgical protocols in the clinical trial, SVF can significantly promote wound repair, with earlier SVF transplantation being more beneficial for wound healing. Conclusions:The conversion of SVF differs in the microenvironments of acute and chronic radiation-induced skin injuries. This can serve as an essential guide for the administration timing and injection frequency of SVF in clinical applications.
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When skin injuries are healing, complex wound environments can be easily created, which can result in wound infection, excessive inflammation caused by neutrophil accumulation and inflammatory factors, and excessive reactive oxygen species, resulting in high levels of oxidative stress. As a result of these factors, cell membranes, proteins, DNA, etc. may become damaged, which adversely affects the repair function of normal cells around the wound, resulting in the formation of chronic wounds. The effectiveness of wound dressings as a treatment is well known. They can offer temporary skin damage protection, prevent or control wound infection, create an environment that is conducive to mending skin damage, and speed wound healing. Traditional dressings like gauze, cotton balls, and bandages, however, have the drawbacks of having no antimicrobial properties, having weak adhesive properties, having poor mechanical properties, being susceptible to inflammation, obstructing angiogenesis, needing frequent replacement, and being unable to create an environment that is conducive to wound healing. As an innovative bandage, self-assembled hydrogel has great water absorption, high water retention, superior biocompatibility, biodegradability and three-dimensional (3D) structure. With properties including hemostasis, antibacterial, anti-inflammatory, and antioxidant, the synthesized raw material itself and the loaded active compounds have a wide range of potential applications in the treatment of skin injuries and wound healing. This research begins by examining and discussing the mechanism of cross-linking in self-assembled hydrogels. The cross-linking modes include non-covalent consisting of physical interaction forces such as electrostatic interactions, π-stacking, van der Waals forces, hydrophobic interactions, and metal-ligand bonds, covalent cross-linking formed by dynamic covalent bonding such as disulfide bonding and Schiff bases. And hybrid cross-linking with mixed physical forces and dynamic covalent bonding. The next part describes the special structure and excellent functions of self-assembled hydrogels, which include an extracellular matrix-like structure, the removal of exogenous microorganisms, and the mitigation of inflammation and oxidative stress. It goes on to explain the benefits of using self-assembled hydrogels as dressings for skin injuries. These dressings are capable of controlling cell proliferation, loading active ingredients, achieving hemostasis and coagulation, hastening wound healing, and controlling the regeneration of the injured area. The development of self-assembly hydrogels as dressings is summarized in the last section. The transition from purely non-covalent or covalent cross-linking to hybrid cross-linking with multiple networks, from one-strategy action to multi-strategy synergy in exerting antimicrobial, anti-inflammatory, and antioxidant effects and from single-function to multi-functioning in a single product. Additionally, it is predicted that future developments in self-assembled hydrogels will focus on creating biomimetic gels with multi-strategy associations linkage from naturally self-assembling biomolecules peptides, lipids, proteins and polysaccharides; improving the properties and cross-linking of raw materials to enhance the storage capabilities of hydrogels and cross-linking techniques, realizing the recycling of hydrogels; conducting additional research and exploration into the cross-linking process of hydrogels; and realizing the gel’s controllable rate of degradation. Furthermore, combining 3D printing and 3D microscopic imaging technology to design and build one-to-one specialized gel dressings; using computer simulation and virtual reality to eliminate the time factor, resulting in self-assembled hydrogels that perfectly fit the ideal dressing.
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Radiation skin injury can be induced by medical exposure, occupational exposure, and emergency exposure. Many relevant studies focused on the prevention and treatment of radiation-induced skin injury, but the underlying molecular mechanisms have not been fully clarified. It has been demonstrated that radiation-induced premature cellular senescence is involved in radiation skin injury. To discuss the relationship between radiation-induced premature cellular senescence and radiation-induced skin injury, this paper reviewed the mechanism of radiation-induced skin injury, the promotion of premature cellular senescence and related signal pathways, and the role of premature cellular senescence in wound healing.
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Objective:To observe the rate of skin injury after spinal cord injury (SCI) in the rehabilitation department and analyze its risk factors.Methods:A total of 120 SCI patients were divided into an injury group of 33 and a control group of 87 without injury. The occurrence, type and location of any skin injuries incurred during hospitalization were recorded along with the subjects′ general condition, injury and functional status, complications, and the rehabilitation and nursing measures applied. Multivariate logistic regressions were evaluated to identify the risk factors for skin injury.Results:Among the 33 injuries, 27 were bruises (58.7%), 10 were stress injuries (21.7%), 5 were lacerations (10.9%) and 4 were burns (8.7%). Most injuries (65.2%) were to the limbs, followed by the buttocks and the sacrococcygeal tail (34.8%). All of the skin injuries required nursing intervention, with 47.8% lasting more than 7 days. There were significant differences between the two groups in terms of their average hospital stay, dysfunction, mode of admission, risk of pressure injury, nutrition and assisted urination. The regressions identified significant relationships between the occurrence of skin injury and length of hospital stay, risk of pressure injury and nutrition.Conclusions:The incidence of skin injury is high among hospitalized SCI patients. A long hospital stay, pressure injury and poor nutrition are independent risk factors for such patients. Such patients should receive skin management education.
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Skin is the first organ of contact with ionizing radiation. Radiation-induced skin injury is common because the basal cell layer and capillaries of the skin are very sensitive to radiation. Acute radiation-induced skin injury primarily involves cellular alterations and inflammation in the epidermis and dermis, and late skin injury is mainly related to the effect of radiation on blood vessels. Clinical manifestations of radiation-induced skin injury include erythema, dry desquamation, moist desquamation, and ulceration in the skin mucosa, and the severity is related to the type and dose of radiation. Currently, the underlying mechanisms of radiation-induced skin injury are largely unknown, and the gold standard for the treatment of radiation injury has not been established. The known mechanisms of radiation-induced skin injury can be roughly divided into three pathways: oxidative stress injury caused by excessive production of reactive oxygen species, inflammation triggered by transcriptional activation of cytokines, and immune response evoked by bone marrow-derived cells. This paper reviews the three major pathways of mechanisms of radiation-induced skin injury, giving a reference for further mechanism study and preventive treatment of radiation-induced skin injury.
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Objetivo Analizar información bibliográfica relacionada con las principales lesiones ocasionadas por los adhesivos tisulares, y el manejo de los dispositivos médicos. Metodología Revisión documental durante los meses de mayo, junio y julio de 2018 búsqueda exhaustiva de 68 artículos en diferentes bases de datos como PubMed, Scielo, Elsevier, Scient Direct, FECYT, Embase, Ovid Nursing y Medline. Con criterios de búsqueda como lesiones cutáneas y lesiones por dispositivos médicos de los cuales se tomaron 50 artículos teniendo en cuenta como método de inclusión el año (no mayor a 6 años de publicado) y la pertinencia en el tema de lesiones en piel por adhesivos y dispositivos clínicos. Resultados Las lesiones cutáneas más comunes son: reacciones alérgicas y las lesiones derivadas de los actos inseguros que alteran seguridad y bienestar del paciente, derivados de las prácticas por parte del personal médico y de enfermería. Conclusiones El uso de adhesivos tisulares y dispositivos de uso clínico prevé una problemática, que debe ser tratada con educación y estrategias de prevención.
Objective To analyze bibliographic information related to the main injuries caused by tissue adhesives, and the management of medical devices. Methodology Documentary review during the months of May, June and July of 2018 exhaustive search of 68 articles in different databases such as PubMed, Scielo, elsevier, Direct, FECYT, Embase, Ovid Nursing and Medline, with search criteria such as skin lesions and injuries by medical devices of which 50 were taken into account as inclusion method the year (no more than 6 years of publication) and the pertinence in the topic of skin lesions by adhesives and clinical devices. Results The most common skin lesions are: allergic reactions and injuries derived from unsafe acts that alter the safety and well-being of the patient, derived from the practices by medical and nursing staff. Conclusions the use of tissue adhesives and devices for clinical use, foresees a problem that must be treated with education and prevention strategies.
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Humanos , Pancreas DivisumRESUMEN
BACKGROUND: Nowadays, the ray types, animal species, irradiation modes and sites used in the establishment of animal models of radioactive skin injury in China are not consistent. Meanwhile, there is no uniform standard for the prevention and treatment of radioactive skin injury in clinical practice. OBJECTIVE: To establish an ideal rat model of acute radioactive skin injury. METHODS: Sixty Wistar rats were randomly divided into 32, 38, 45 Gy X-ray groups (n=18) and non-irradiated group (n=6). Three X-ray irradiated groups (32, 38, 45 Gy) received single irradiation of the right posterior buttock, 300 cGy/min, 100 cm between the skin and irradiated source, for 10.67, 12.67, and 15 minutes respectively. No irradiation was given in the non-irradiated group. The study protocol was approved by the Animal Ethic Committee of Shanxi Cancer Hospital (approval No. GDY2018001). RESULTS AND CONCLUSION: There was no accidental death after irradiation. The body mass of the rats decreased within 3 days after irradiation, and then increased. Irradiated wound was severest at about 15 days after irradiation, and the body mass dropped again, and returned to normal 2 days later. Two weeks after radiation, with the increase of X-ray dose, the structures of rat’s skin appendages were destroyed and a large number of inflammatory cells were infiltrated, indicating that the acute radiation skin injury was dose-dependent within a certain range. On the other hand, with the increase of irradiation time, the skin wound in the 38 and 45 Gy groups gradually deepened. At the same dose, the severity of acute radiation skin injury was also positively correlated with the irradiation time. After 6 hours to 15 days of 38 Gy irradiation on the rat skin, macrophages were activated, and the expression of Nod-like receptor pyrin domain-containing protein 3 was enhanced, indicating obvious inflammatory response, and thereby verifying the reliability of the model. To conclude, it is an ideal animal model of acute X-ray skin injury model made by the X-ray linear accelerator, which is easily observed and obtained, with obvious skin inflammation expression. This model is also of high safety and strong tolerance.
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Mesenchymal stem cells (MSCs) are pluripotent stem cells with high self-proliferation and multidirectional differentiation potential. They also have other functions including immune regulation, paracrine and so on, playing an important role in repairing injured tissues. In recent years, a lot of research has been done on how MSCs promote skin injury repair, and a lot of progress has been made. Compared with direct injection of MSCs in the wound area, some special treatments or transplantation methods could enhance the ability of MSCs to repair skin injury. This paper mainly discusses the role of MSCs in skin injury repair and technical ways to improve its repairing capacity, and discusses the existing problems in this field and prospects for future research directions.
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Diferenciación Celular , Trasplante de Células Madre Mesenquimatosas , Células Madre Mesenquimatosas , PielRESUMEN
Objective:To carry out investigation and analysis of an extensive skin radiation injury to the back accidentally caused by interventional procedure and to explore the problems faced in the event with emphasis on avoiding the reoccurance of similar events in the future.Methods:The data were collected by consulting the patient′s detailed medical history, collecting and analyzing clinical diagnosis and treatment data, tracking and observing their clinical manifestations and signs. The patient′s peripheral blood samples were also collected, together with the biological dose estimated and the equipment data collected on the site of the interventional treatment hospital.Results:The whole body dose to the patient was estimated to be 0.95 Gy. The typical values of kerma rate of radiation incident on the body surface due to fluoroscopic procedures were 373.5 mGy/min in subtraction modality and 47.8 mGy/min in fluoroscopy modality, respectively. The annual effective dose to the interventional radiologist was 20.51 mSv due to his operation in long-time radiation exposure conditions, higher than 3.09 mSv for other interventional radiologists with similar workload in the same department. The whole body and local clinical manifestations of the patients were in line with radiation injury. No clear diagnosis has been obtained in several hospitals, nor can obvious treatment outcomes be obsevered.Conclusion:Combined with the biological dose estimation result and clinical manifestations, the case was diagnosed as degree Ⅳ skin radiation injury. Radiation injury is closely related to whether the operation is conducted according to the standard and the output dose of X-ray machine. Non-specialized hospitals should strengthen clinical diagnosis and treatment of radiation injury.
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Objective:To evaluate biological dose and retrospective biodosimetry of a case of large area back skin injury caused by suspected interventional procedure.Methods:Peripheral blood from the patient was collected at about 7 months after interventional procedure, and the chromosomal aberrations in peripheral blood cells were analyzed to evaluate the retrospective biodosimetry using the correction factor of dose estimation, Dolphin′s model and Qdr method, respectively. Results:Based on the amounts of semi-automated dic and manually detected dic plus ring, the whole-body average absorbed dose of the victim was estimated to be 0.68-0.95 Gy by four different dose response curves. Over dispersion of dic or dic plus ring was also detected, and the efficiency of dose assessment was obviously increased using dic semi-automatic detection. Based on three different retrospective biodosimetry models, the estimated average absorbed dose was further corrected to be between 1.80-2.86 Gy, which was consistent with clinical diagnosis of degree Ⅳ radiation skin injury.Conclusions:A case of suspected radiation skin injury was confirmed by chromosomal aberration analysis and it’s biodosimetry was reconstructed, suggesting that the unstable chromosomal aberration analysis may be applicable to assess the retrospective biodosimetry of non-uniform local radiation exposure.
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Objective:To evaluate the skin development and repair process of X-ray radiation damage in rat with non-invasive two-photon excitation fluorescence (TPEF) imaging technology in vivo. Methods:Totally 24 SD rats were randomly divided into four groups including X-ray irradiated group (25, 35 and 45 Gy) and non-irradiation control group. At different times after irradiation, the degree of skin injury was evaluated, and the pathological changes of nicotinamide adenine dinucleotide (phosphate) [NAD(P)H] and collagen fiber fluorescence signals in epidermal cells were detected in vivo by TPEF imaging technology. Results:At 10 d post-irradiation, the skin of irradiation groups showed erythema and desquamation. At 15-20 d post-irradiation, the skin of radiation groups developed progressive exudation, edema and ulcers with increasing radiation dose. On day 25, the skin began to repair in the 25 Gy group, however, the skin of other groups still had exudation and ulcers. On day 10, NAD(P)H fluorescence signal in epidermal cells of irradiation groups decreased and the fluorescence signal of collagen fibers in papillary layer and reticular layer of irradiation groups reduced, which were significantly lower than that of normal control group ( t=24.145, 28.303, 26.989, 6.654, 7.510, 7.997, P<0.05). On day 30, fluorescence signal of NAD(P)H and collagen fibers in epidermal cells and dermis began to repair, the cell from stratum granulosum, stratum spinosum, and stratum basale in the 25 Gy group showed fluorescence signal, the other groups did not show. The fluorescence signal of collagen fibers in the 25 Gy group were gradually increased in papillary layer and reticular layer, however, they were significantly lower than normal control group ( t=115.133, 17.431, P<0.05), the skin of 45 Gy group did not show fluorescence signal of collagen fibers. Conclusions:The damage and repair process of epidermal cells and dermal collagen fiber can be detected noninvasively by TPEF imaging technology after X-ray irradiation in vivo.
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Radiation skin injury is a common and severe adverse event of radiotherapy in patients with head and neck cancer or nasopharyngeal carcinoma, which not only limits the radiation dose of the tumor, but also seriously affects the follow-up treatment and quality of life of the patients. It has become a bottleneck to improve the curative effect of tumor. The occurrence of radiation skin injury is a complex process of the interaction of many factors, which is closely related to the patient's own factors, radiotherapy technology, radiotherapy dose segmentation scheme and the combined regimens of radiotherapy and chemotherapy. Different regimens of radiotherapy and chemotherapy with drugs have effects on the occurrence and development of acute skin injury. There is still a lack of effective prevention and treatment of radiation-induced skin injury. Therefore, it is of great significance to explore its mechanism and radiation skin damage caused by different radiotherapy and chemotherapy regimens. This paper mainly reviews the combined application of concurrent chemoradiotherapy, induction and adjuvant chemotherapy to aggravate skin injury and its related mechanisms.
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Infection plays an important role in the pediatric intensive care unit. Severe skin damage caused by bacterial infection often causes acute onset and high mortality,which should be paid attention to by clinicians. In this paper,the diagnosis,differential diagnosis and treatment of Staphylococcus aureus scalding syndrome and ecthyma gangrenosum caused by Pseudomonas aeruginosa infection were reviewed.
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Objective@#To evaluate the parabiotic tissue protection concept in the repairment of acute radiation-induced skin injury.@*Methods@#Seven patients(3 males and 4 females) with acute radiation injury treated in the Department of Plastic Surgery of the Second Affiliated Hospital of Soochow University from February 2014 to January 2018. The ages of patients ranged from 45 to 76 years. The wound areas include perineum and buttock (n=3), chest(n=2), and thigh(n=2). In the early stage, subregional " sandwich" surgical dressing was used to protect the probiotic tissue. Two months later, the necrotic tissue was clearly demarcated, the debridement was underwent, and the parabiotic tissue was preserved as far as possible. Vacuum sealing drainage(VSD)was applied to cover and soak wound with normal saline to moisturize the wound and promote the benign transformation of ecological tissue. Ten days later, the granulation grown well, and the skin flaps and myocutaneous flaps with good blood supply were designed to repair the wounds. The VSD device was continued to be used, to drain effusion under flap and promote the growth of cystic cavity granulation, with the purpose to promote blood supply of the skin flap, perform the final biological cleaning effect on the parabiotic tissue of the wound surface, promote the benign transformation of parabiotic tissue, and reduce the further necrosis.@*Results@#Seven patients with Ⅳ degree acute radiation-induced injury wounds were treated 6-10 weeks for surgery preparation, and 2-4 weeks for VSD-application after debridement. Except for part of flap was necrotized on 10th day after the first operation in one patient, all the other patients achieved satisfied outcome in a surgery. There was no further radiation-induced ulcer occurred during the 0.5-3 years of follow-up.@*Conclusions@#The concept of parabiotic tissue protection during preoperative, intraoperative and postoperative recovery phase can promote parabiotic tissue transformed to a good result after acute radiation injury, and reduce the size and depth of soft tissue necrosis, which can provide a good foundation for the secondary repair with flap and reduce complications.
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An 87-year-old woman was referred for the extraction of residual teeth and removal of tori prior to prosthetic treatment. After surgery under general anesthesia, the surgical tape was removed to detach the bispectral index sensor and the hair cover. After the surgical tape was removed, skin injury occurred on the left side of her face. After epidermis repositioning and ointment application, a dressing was placed over the injury. Her wound was found to have healed completely on follow-up examination. Medical adhesive related skin injury (MARSI) is a complication that can occur after surgery and subjects at the extremes of age with fragile skin are at a higher risk for such injuries. Careful assessment of the risk factors associated with MARSI is an absolute necessity.
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Anciano de 80 o más Años , Femenino , Humanos , Adhesivos , Anestesia General , Vendajes , Epidermis , Estudios de Seguimiento , Cabello , Factores de Riesgo , Piel , Cinta Quirúrgica , Diente , Heridas y LesionesRESUMEN
Objective To investigate and analyze the prevalence of pressure ulcer and other skin injuries, and the implementation of pressure ulcer prevention measures among inpatients in Class ⅢGrade A hospitals in Hainan province. To provide basis for fomulating bundle of care model to prevent and intervent pressure ulcer, and establishing early warning management model on nosocomial pressure ulcer in ClassⅢGrade A hospitals in Hainan province. Methods A cross-sectional survey was conducted on inpatients from 7 ClassⅢGrade A hospitals in Hainan province. A investigation was performed by a self-designed inpatients'questionnaire and qualified tools on pressure ulcer and other skin injuries. Statistical analysis of data using by SPSS19.0 software. Results The content validity index of the self-designed inpatients'questionnaire and qualified tools on pressure ulcer and other skin injuries was 0.91, Cronbach α coefficient was 0.93. The prevalence of pressure sores was 2.28% (165/7 248), of which 66.06% (109/ 165) was family involvement, 30.30% (50/165) was hospital acquired, 3.03% (5/165) was community involvement,and 0.61% (1/165) was both from family and hospital acquired. Medical instrument related pressure ulcer accounted for 18.18%(30/165) of the total number of pressure ulcer. The most common site of pressure ulcer was the sacrococcygeal region, accounting for 47.94% (93/194). The proportion of pressure ulcer in stageⅡwas the highest (35.57% , 69/194). 52.01% (647/1 244) of patients at risk of pressure ulcer did not use the anti-pressure devices,and 81.40% (1 013/1 244) of patients' main compression sites were not covered by dressings.35.50%(442/1 244) of patients did not according to plans or regularly turn over, only 56.19% (699/1 244) patients turned over every 2 hours. 61.57% (442/1 244) patients who have pressure ulcer did not have anti-pressure ulcer signs. Among other skin injuries: the prevalence of incontinence related dermatitis was 0.88%(64/7 248), and the prevalence of avulsion skin injury was 0.37%(27/7 248). Conclusions The incidence of acquired pressure ulcer in ClassⅢGrade A hospitals in our province is slightly higher than other domestic investigation results. The reasons may be that anti-pressure devices in hospital configuration are not enough, lack of the tailored bundle of prevention measures of pressure ulcer, and failure to establish an effective early warning management model on pressure ulcer etc. So prevention and treatment of pressure ulcer should have a further standard management. Instrument related pressure ulcer and incontinence related dermatitis should also attract the attention of clinical nurses and managers.
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Objective To analyze prevalence and determinants of medical adhesive-related skin injury (MARSI) in peripherally inserted central catheter implanted patients with lung cancer,to create evidence for improved clinical care.Methods A cross-sectional observational study design was adopted.Skin pictures and electronic medical records of 200 lung cancer patients who visited Shanghai Chest Hospital for PICC between June 2017 and September 2017 were analyzed to calculate prevalence of MARSI and identify related factors.Results The prevalence of MARSI was 31.5％ (63/200),and mechanical trauma accounted for 50.8％ of all cases (32/63).Age,diabetes and anaphylaxis were significantly related to MARSI.Conclusion Analysis of MARSI in PICC implanted patients with lung cancer provided evidence for improved clinical care of such patients.