Machine learning links different gene patterns of viral infection to immunosuppression and immune-related biomarkers in severe burns.

Introduction: Viral infection, typically disregarded, has a significant role in burns. However, there is still a lack of biomarkers and immunotherapy targets related to viral infections in burns. Methods: Virus-related genes (VRGs) that were extracted from Gene Oncology (GO) database were included as hallmarks. Through unsupervised consensus clustering, we divided patients into two VRGs molecular patterns (VRGMPs). Weighted gene co-expression network analysis (WGCNA) was performed to study the relationship between burns and VRGs. Random forest (RF), least absolute shrinkage and selection operator (LASSO) regression, and logistic regression were used to select key genes, which were utilized to construct prognostic signatures by multivariate logistic regression. The risk score of the nomogram defined high- and low-risk groups. We compared immune cells, immune checkpoint-related genes, and prognosis between the two groups. Finally, we used network analysis and molecular docking to predict drugs targeting CD69 and SATB1. Expression of CD69 and SATB1 was validated by qPCR and microarray with the blood sample from the burn patient. Results: We established two VRGMPs, which differed in monocytes, neutrophils, dendritic cells, and T cells. In WGCNA, genes were divided into 14 modules, and the black module was correlated with VRGMPs. A total of 65 genes were selected by WGCNA, STRING, and differential expression analysis. The results of GO enrichment analysis were enriched in Th1 and Th2 cell differentiation, B cell receptor signaling pathway, alpha-beta T cell activation, and alpha-beta T cell differentiation. Then the 2-gene signature was constructed by RF, LASSO, and LOGISTIC regression. The signature was an independent prognostic factor and performed well in ROC, calibration, and decision curves. Further, the expression of immune cells and checkpoint genes differed between high- and low-risk groups. CD69 and SATB1 were differentially expressed in burns. Discussion: This is the first VRG-based signature (including 2 key genes validated by qPCR) for predicting survival, and it could provide vital guidance to achieve optimized immunotherapy for immunosuppression in burns.

Satisfactory Wound Reconstruction with a Local Rotation Flap After Removal of Large Penile Divided Nevi: Original Technique, Early and Mid-Term Results.

Objective: To investigate the application of local rotation flaps for reconstruction of divided nevi of the penises in young male patients. Methods: A group of 8 patients of divided nevi of the penises who underwent wound reconstruction with local rotation flaps after surgical lesion removal was enrolled in a retrospective clinical study. Postoperative complication, sexual function and psychological traits were evaluated during the follow-up. Results: All patients, with ages ranged from 16 to 32 years (mean 23.25 years), were followed up for 6 to 48 months (mean 19.86 months). The patient's average length of hospital stay was 7.85 day (7 to 15 days). The average dimension of the lesions was (2.31±0.44) × (1.46±0.48) cm2 on the glans and (1.38±0.40) × (1.01±0.46) cm2 on the inner prepuce plate. All patients had no postoperative infection and were satisfied with the postoperative outcome upon discharge. Five cases of benign intradermal nevi and 3 cases of compound nevi without malignant transformation were confirmed by pathological evaluation on the removed samples. The sexual function of all patients was unaffected postoperatively by male sexual function scale (BMSFI and IIEF-5) evaluation. The psychological status of depression, anxiety and stress was all improved after the surgical reconstruction confirmed by the psychological traits scale (DASS) evaluation. Conclusion: Reconstruction with the local rotation flap is a simple, safe and appropriate surgical procedure, achieves satisfactory cosmetic outcome, and maintains intact male sexual function when used for the repair of defect after removal of divided nevi of the penises.

[Clinical application of human tissue engineered skin with full thickness on donor site of split thickness skin graft in burn wounds].

OBJECTIVE: To observe the clinical effect of the human tissue engineered active skin (ActivSkin) with full thickness on the donor site of the split thickness skin graft. METHODS: Nine patients with 18 wounds of the donor sites, and every patient had 2 wounds. The wounds of each patient were randomly assigned to the therapy group and the control group. Auto-control observation was performed. Nine donor sites of the split thickness skin graft were repaired with ActivSkin in the therapy group. Nine donor sites of the split thickness skin graft were repaired with the vash oil gauze in the control group. The wound pain, the time to complete closure, and the ratio of the complete healing in the ActivSkin therapy group was measured and compared with those in the control group. The donor sites of the split thickness skin graft were assessed at 180 days of the follow-up visit. RESULTS: The wound pain was obviously reduced after the harvesting of the skin grafts in the therapy group. The time to complete closure on the donor sites of the split thickness skin graft was significantly shorter in the ActivSkin therapy group than in the control group (9.67 +/- 2.92 d vs. 16. 56 +/- 2.96 d, P < 0.05). Both the ratios of the complete healing in the ActivSkin therapy group and the control group were 100% (P > 0.05). The subsequent results showed that neither the blister nor the residual wound occurred with an alleviated scar after the ActivSkin treatment. CONCLUSION: ActivSkin can promote wound closure, prevent blister and residual wound, and alleviate scarring on the donor sites of the split thickness skin graft after the ActivSkin treatment.