Nanosilver alleviates foreign body reaction and facilitates wound repair by regulating macrophage polarization / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Foreign body reactions induced by macrophages often cause delay or failure of wound healing in the application of tissue engineering scaffolds. This study explores the application of nanosilver (NAg) to reduce foreign body reactions during scaffold transplantation. An NAg hybrid collagen-chitosan scaffold (NAg-CCS) was prepared using the freeze-drying method. The NAg-CCS was implanted on the back of rats to evaluate the effects on foreign body reactions. Skin tissue samples were collected for histological and immunological evaluation at variable intervals. Miniature pigs were used to assess the effects of NAg on skin wound healing. The wounds were photographed, and tissue samples were collected for molecular biological analysis at different time points post-transplantation. NAg-CCS has a porous structure and the results showed that it could release NAg constantly for two weeks. The NAg-CCS group rarely developed a foreign body reaction, while the blank-CCS group showed granulomas or necrosis in the subcutaneous grafting experiment. Both matrix metalloproteinase-1 (MMP-1) and tissue inhibitor of metalloproteinase-1 (TIMP-1) were reduced significantly in the NAg-CCS group. The NAg-CCS group had higher interleukin (IL)-10 and lower IL-6 than the blank CCS group. In the wound healing study, M1 macrophage activation and inflammatory-related proteins (inducible nitric oxide synthase (iNOS), IL-6, and interferon-‍γ (IFN-‍γ)) were inhibited by NAg. In contrast, M2 macrophage activation and proinflammatory proteins (arginase-1, major histocompatibility complex-II (MHC-II), and found in inflammatory zone-1 (FIZZ-1)) were promoted, and this was responsible for suppressing the foreign body responses and accelerating wound healing. In conclusion, dermal scaffolds containing NAg suppressed the foreign body reaction by regulating macrophages and the expression of inflammatory cytokines, thereby promoting wound healing.

Research on the application of Miller's pyramid theory combined with Bahrain's team activities in standardized residency training of burn surgeons / 中华医学教育探索杂志

Objective:To explore the application of Miller's pyramid theory combined with Bahrain's team activities in the standardized residency training (SRT) of burn surgeons.Methods:Seventy-four residents who were on the SRT program in the Department of Burns & Wound Care in The Second Affiliated Hospital of Zhejiang University were enrolled in the study. The students were divided into control group and observation group according to the teaching methods. Thirty-seven students in the control group were provided with conventional teaching, and 37 students in the observation group were provided with training based on Miller' pyramid theory combined with Bahrain's team activities. The two groups were evaluated for teaching effectiveness and doctor-patient communication skills. SPSS22.0 was used for the chi-square test and t test. Results:The evaluation outcome of teaching effectiveness in the observation group was better than that in the control group ( t=3.01, 3.47, 3.49, 3.32, and 2.54; P=0.004, 0.001, 0.001, 0.001, and 0.013). After the training, the scores of Set Elicit Give Understand End scale in the two groups increased, with significantly higher scores achieved in the observation group than in the control group ( t=3.23, 2.99, 2.07, 3.62, 3.00, and 7.89; P=0.002, 0.004, 0.042, 0.001, 0.004, and <0.001). Conclusion:The application of Miller's pyramid theory and Bahrain's team activities in the SRT of burn surgeons can improve students' evaluation of teaching effectiveness and improve their doctor-patient communication skills.

Basic investigation into the present burn care system in China: burn units, doctors, nurses, beds and special treatment equipment.

OBJECTIVE: The aim of the study was to survey the current burn units in China to understand the burn care system in the country and supply basic data for the National Burn Repository of China (NBRC) and further research. METHOD: A questionnaire was developed and sent to burn unit directors in China via e-mail, which was followed up with reminder text messages to obtain information for the study. RESULTS: Of the 405 hospitals from the 31 provinces in mainland China that responded to the questionnaire, 63.7% of the responses came from Grade 3A hospitals, and the most popular model of organisation was the Burns and Plastic Surgery arrangement (63.0%). An average of 9.43±0.351 doctors work in each burn unit with 70.4% of all units having 4-11 doctors. The ratio of chief surgeon to associate chief surgeon to attending surgeon to resident surgeon and surgeon assistant was 1:1.8:2.2:2.3. An average of 30% of all doctors in each burn unit held postgraduate degrees, and more than 90% of all surgeons held a bachelor's degree or higher. There were 16.48±0.637 nurses per burn unit, 56.5% of burn units had 8-15 nurses, and the ratio of chief nurse to associate chief nurse to supervisor nurse to nurse practitioner to junior nurse was 1:11.8:57.0:82.1:86.1. More than 80% of all nurses had received a college education or above. However, only 30% of nurses held bachelor's degrees or higher, while only 0.66% of nurses had received postgraduate degrees. A total of 39.91±1.50 beds were available in each burn unit and 45% of burn units had 20-39 beds. Up to 70% of the total beds were prepared for patients with burn, and more than 10% of the beds were specifically for patients with severe burn. The ratios of doctors to nurses, beds to doctors, beds to nurses, and beds to doctors and nurses were 0.64±0.01, 4.48±0.12, 2.67±0.09, and 1.66±0.06, respectively. The workload of each doctor and nurse was most heavy in units with 40-59 beds. In addition, we estimated that there were 0.05, 0.5, 0.8, and 1.9 burn units, burn doctors, nurses, and beds, respectively, per 100,000 members of the population in mainland China. Chinese burn units lack special burn treatments, nursing equipment, and operation apparatuses. CONCLUSION: To the best of our knowledge, this is the first survey of the present burn care system in China. These results confirm that the burn care system is not equivalent to the national power of this country and the system lacks a great number of trained burn professionals. Burn doctors and nurses bear a heavy burden of work. This report supplies basic data to spur further research. We propose creating a burn unit registration system and a special database in China.

Application of Nutrition Risk Screening 2002 in China / 中华临床营养杂志

Nutrition Risk Screening 2002 (NRS 2002) was developed on the basis of 128 randomized controlled clinical studies by a group of experts led by Kondrup from the European Society for Parenteral and Enteral Nutrition (ESPEN).As the first evidence-based nutritional screening tool worldwide,NRS 2002 has been recommended for nutritional risk assessment of hospitalized patients in Europe for the addition of disease metabolism and its simplicity.In this article,we reviewed the increasing applications of NRS 2002 in China,pointed out the existing problems and made several suggestions on improvement for popularization and standardization of its clinical use.

The effect of collagen-chitosan porous scaffold thickness on dermal regeneration in a one-stage grafting procedure.

Dermal substitutes are used as dermal regeneration templates to reduce scar formation and improve wound healing. Unlike autografts, dermal substitutes lack normal vascular networks. The increased distance required for diffusion of oxygen and nutrients to the autograft following interpositioning of the substitute dramatically affects graft survival. To evaluate the effect of collagen-chitosan scaffold thickness on dermal regeneration, single-layer collagen-chitosan porous scaffolds of 0.5-, 1- and 2-mm thicknesses were fabricated and used to treat full-thickness wounds in a one-stage grafting procedure in a rat model. Skin-graft viability, wound contraction, histological changes, and wound tensile strength were evaluated. The results indicated that the distance for the diffusion of oxygen and nutrients to the autograft in the 2-mm-thick scaffold provided less support for graft take, which resulted in graft necrosis, extensive inflammatory reaction, marked foreign-body reaction (FBR), rapid scaffold degradation, and abnormal collagen deposition and remodeling. In contrast, the thinner scaffolds, especially of that 0.5-mm thickness, promoted earlier angiogenesis, ensuring skin-graft viability with a mild FBR, and ordered fibroblast infiltration and better collagen remodeling. It can be concluded that collagen-chitosan porous scaffolds with a thickness of <1mm are more suitable for dermal regeneration and can be used as dermal templates for treatment of dermal defects using a one-stage grafting procedure.