Severe mosquito bite allergy complicated by bacterial infection in a 7-year-old child: a case report and brief review of the literature.

INTRODUCTION: SMBA is a cutaneous form of CAEBV that predominantly affects adolescents and children from East Asian countries. It is characterized by local skin erythema, bullae, ulcers, necrosis, and scarring following a mosquito bite. Affected patients may experience IM-like systemic inflammatory reactions. SMBA mainly involves NK cells and has the potential to progress to NK/T-cell lymphoma or invasive NK-cell leukemia. CASE REPORT: A 7-year-old female was admitted to the hospital owing to recurring fever, skin allergies, and multifocal severe ulcerative necrotic skin lesions affecting both lower limbs. The authors primarily suspected bacterial infection, and debridement was insufficient to manage it. Pathological examination of residual skin tissues around the necrotic lesion revealed EBER-positive T cells. Eventually, the patient was diagnosed with SMBA complicated by bacterial infection based on diagnostic criteria and pathology findings. The patient responded well to timely antiviral and antibacterial treatment, with no deterioration during regular follow-up visits. CONCLUSIONS: SMBA is a subtype of CAEBV that is characterized by severe skin ulceration and is easily missed or misdiagnosed. Based on its mosquito bite history, pathological characteristics, and laboratory indicators, SMBA could expand new diagnostic and therapeutic approaches to the ulcerative skin diseases.

Lateral Osteotomy for the Surgical Treatment of the Asian Wide Nose.

OBJECTIVE: Narrowing of the nasal dorsum allows for a more pleasing moderate width. We here introduce a lateral osteotomy technique that is less traumatic and easier to perform than commonly used procedures in Asian and share our experiences in the application. METHODS: After a blunt dissection of the periosteum at the mucosal side of the nasal bone, all patients who underwent treatment using nasal osteotomy at the level of the maxillary nasal process were retrospectively analyzed. The bony nasal width, height, and the nasal lateral wall slope of bone before and after surgery were measured. The postoperative outcomes, complications, and patient satisfaction were analyzed and evaluated. RESULTS: From January 2008 to January 2018, nasal dorsum narrowing was implemented in 106 patients. On average, nasal width was significantly decreased and no change in nose height after the nasal osteotomy. The nasal width was significantly reduced by 8.51 ± 2.16 mm compared with before surgery. The slope of the nasal lateral wall was reduced from the mean of 155.0 ± 7.63-degree preoperation to the mean of 135.25 ± 7.50-degree postoperation. The follow-up period ranged from 6 months to 4 years, with an average of 10.3 months. CONCLUSIONS: This type of nasal bone base osteotomy is a simple and feasible method for the treatment of wide Asian noses with a high patient acceptance and stable postoperative results. LEVEL OF EVIDENCE: Level IV.

Application of 3 different types of pedicled adipofascial flaps in the repair of deep dead space wounds.

INTRODUCTION: Dead space is an important risk factor for poor wound healing; therefore, it is important to effectively fill deep dead space through individualized tissue flap design during the repair of complex wounds. Adipofascial flaps have yielded good results in the repair of deep dead space wounds. OBJECTIVE: The authors evaluated the efficacy of 3 kinds of adipofascial flaps to repair deep dead space wounds. METHODS: From January 2019 to January 2022, 15 patients with complicated wounds accompanied by deep dead space underwent repair via 1 of 3 kinds of adipofascial flaps, and the clinical efficacy was observed. RESULTS: All 15 transplanted adipofascial flaps exhibited complete survival, and within a mean follow-up of 14.7 months, both the donor and recipient sites had successfully healed. CONCLUSION: The traditional pedicled adipofascial flap was used to repair single deep dead space wounds, and pedicled perforator adipofascial extension flaps or layered fasciocutaneous flaps were used on compound tissue defect wounds, thus providing a relatively simple, safe, and effective method to repair a small area of tissue defect with deep dead space wounds.

Design and synthesis of Ag NPs/chitosan-starch nano-biocomposite as a modern anti-human malignant melanoma drug.

In recent years, the unprecedented increase in various cancers such as melanoma has caused researchers to focus more on the formulation of newer drugs with less side effects. In this study, we herein indicate the biogenic nanoarchitechtonics of Ag NPs template over chitosan/starch mixed hydrogel having notable reducing potential and anti-malignant melanoma effects. The two biopolymers also could stabilize as-synthesized Ag NPs. Physicochemical features of the material were further characterized over a range of advanced methods like X-ray diffraction (XRD), elemental mapping, dynamic light scattering (DLS), energy-dispersive X-ray spectroscopy (EDS), transmission electron microscopy (TEM), field emission scanning electron microscopy (FESEM), and Fourier transformed infrared spectroscopy (FT-IR). TEM analysis showed the spherical-shaped nanocomposite with the mean diameter in the range of 5-15 nm. Thereafter, the nanocomposite was exploited in the anti-malignant melanoma and cytotoxicity effects studies against various human malignant melanoma cell lines (HT144, RPMI7951, SKMEL2, UACC3074, WM266-4 and MUM2C) in situ. The bio-composite corresponding IC50 values were 193, 102, 227, 250, 301, and 203 µg/mL against MUM2C, WM266-4, UACC3074, SKMEL2, RPMI7951, and HT144 cell lines, respectively. A significantly high IC50 value offered an excellent antioxidant capacity of bio-composite. According to the above results, Ag NPs/CS-Starch nanomaterial can be utilized as an efficient drug to treat malignant melanoma in humans after doing clinical trial studies.

Effect of the layered fasciocutaneous flap in the repair of complex wounds of the lower extremity.

INTRODUCTION: Repair of complex wounds of the lower extremity remains challenging for clinicians. When repairing complex wounds, it is necessary to customize the skin flap to simultaneously repair both the superficial soft tissue defect and the deep dead space wound. OBJECTIVE: This case series describes the use of a layered fasciocutaneous flap with pedicled perforator to repair complex wounds of the lower extremity. MATERIALS AND METHODS: Three cases with complex wounds of the lower extremity underwent repair using layered fasciocutaneous flap, and clinical efficacy was observed. RESULTS: In cases 1 and 3, complete survival of the layered flaps was achieved. In case 2, congestion measuring 1 cm × 1 cm occurred at the distal end of the skin paddle, followed by superficial skin ulceration, which healed 2 weeks after a dressing change. CONCLUSION: These findings indicate that a layered fasciocutaneous flap with pedicled perforator can be used to repair complex wounds of the lower extremity.

Lower trapezius myocutaneous flap repairs adjacent deep electrical burn wounds.

BACKGROUND: Local tissue damage caused by electrical burns is often deep and severe. High-voltage electrical burns are common in the head, neck and torso areas. These are mostly caused by direct contact with the power supply and are often accompanied by deep injuries of the nerve, blood vessel, muscle, tendon, and bone. We must pay great attention to the clinical treatment of these parts injured by electrical burn. CASE PRESENTATION: The first case involved a migrant worker who touched a 6-kV high-tension wire when welding steel; this electric shock caused burns in many places. Deep electrical burn wounds were mainly located on the left shoulder and back, characterized by widespread skin and soft tissue defect and bone necrosis. We utilized a lower trapezius myocutaneous flap to repair these wounds in the neck and back caused by deep electrical burns. The flap survived completely and the wound was effectively repaired. The function and shape of the shoulder and back after the restoration were satisfactory. The second case involved a 29-year-old who accidentally touched a high-voltage wire while working and was burned by a 30,000-V electric shock. His wounds were mainly located on the left head, neck, back and left upper limbs. We designed a 30 cm × 12 cm right trapezius myocutaneous flap which completely covered the wound surface; the electrical burn wounds on the neck and back were effectively repaired. After the electrical burn wound was repaired, the neck function returned to normal with a satisfactory shape. CONCLUSION: The authors report two cases of patients who were burned by high voltage. We used lower trapezius myocutaneous flaps to repair their wounds, which achieved satisfactory clinical results. This study has provided a reliable surgical method for the clinical treatment of deep electrical burn wounds in the neck, shoulders and back.

Efficacy of Treating Chronic Tibial Osteomyelitis With Bone Defect Using a Pedicled Perforator-Layered Flap and Fasciocutaneous Flap of the Posterior Tibial Artery: A Case Report.

INTRODUCTION: Tibial osteomyelitis is a common complication of bone tissue trauma. Obtaining good soft tissue coverage and effective infection management is key to the treatment of chronic osteomyelitis of the tibia accompanied with bone defect and bone exposure. The pedicled posterior tibial artery perforator layered fasciocutaneous flap can be used to repair soft tissue defects and can be used as a long-term, localized anti-infective. CASE REPORT: A 54-year-old male presented with an ulcer, purulent discharge at the left anterior tibia, and a fever 28 years after complete healing of the scar site. The patient received debridement and negative pressure wound therapy (NPWT) in a hospital setting. After presenting to the authors' department, there was difficulty in closing the exposed bone marrow cavity. On the basis of systemic use of intravenous antibiotics, multiple debridements and NPWT were used to effectively remove necrotic tissue and control infection. Afterward, the pedicled posterior tibial artery perforator layered fasciocutaneous flap was designed to fill the bone marrow cavity as well as cover and seal the wound of bone exposure and soft tissue defect simultaneously. The layered fasciocutaneous flap was well established after operation, and no recurrence of osteomyelitis was found. CONCLUSION: Debridement with negative pressure wound therapy can be an effective treatment for the wound bed preparation in advance of surgery, and the pedicled posterior tibial artery perforator layered fasciocutaneous flap can be used for the treatment of several soft tissue defects.

Ilioinguinal Flap Combined With Tensor Fascia Lata Muscle Flap to Repair Deep Electrical Burns in the Lower Abdomen: A Report of Two Cases.

INTRODUCTION: Electrical burns are caused by the conversion of electrical energy flowing through the body into heat energy, which can cause coagulative necrosis of the skin and deep tissues. Deep tissue damage is often more serious than skin damage. Electrical burns have the characteristics of destructive and progressive damage and present the common symptoms of severe local tissue damage accompanied by a wide range of deep tissue necrosis, resulting in injury of nerves, blood vessels, bones, and internal organs. Autologous skin grafting alone cannot effectively cover deep tissues or repair electrical burn wounds. CASE REPORT: This article describes 2 patients with deep electrical burns in the lower abdomen that showed extensive skin and soft tissue damage, partial necrosis of abdominal muscle tissue, and weak abdominal wall. As a single tissue flap was too small to effectively cover the defect wound, ilioinguinal flap and tensor fascia lata muscle flap were utilized in both cases with good outcomes. These flaps survived completely, and the wounds were effectively repaired. After repair, the shape was satisfactory, and the function of the lower abdomen was normal. CONCLUSIONS: Transfer of flaps from a site near the wound for repairing electrical burns is convenient for transfer with minimal surgical trauma and a simpler operating procedure than the free flap.

Use of immunoproteomics to identify immunogenic proteins in a rat model of acute respiratory distress syndrome.

Acute respiratory distress syndrome (ARDS) is a common and life­threatening clinical syndrome, and seeking biomarkers of ARDS has been an area of continuing research. The present study hypothesized that alterations to certain immunogenic substances occur in injured lungs and are able to specifically bind with corresponding proteins in the blood, and that these proteins may be readily detected. To investigate this hypothesis, a rat model of ARDS was established by cecal ligation and puncture surgery, and an immunoproteomics approach, using serum as the primary antibody in a western blot analysis, was used with the aim of identifying immunogenic proteins in the injured lungs. Ingenuity Pathway Analysis (IPA) was used for bioinformatics analysis, and mass spectrometric analysis was used to identify a total of 38 differentially expressed immunogenic proteins. Bioinformatics analysis revealed that the top canonical pathways in which the identified proteins may be involved were gluconeogenesis I, glycolysis I, choline degradation I, NADH repair and heme degradation. IPA Biomarker Filter analysis with the terms 'acute respiratory distress syndrome/acute lung injury' was used to screen 13 proteins as candidate biomarkers. These proteins were described as antigens, and suggested that paired antibodies may be detected in the plasma of patients at high risk of ARDS. Analysis of these identified proteins may provide novel insights into the potential pathological mechanisms of ARDS.

[Adventitious Buds Induction of Mentha haplocalyx Under Variation Inducted by NaN3].

Objective: To establish the chemical mutagenesis in vitro system of Mentha haplocalyx,the effects of different plant hormone combination and Vc on the induction of mint stem adventitious buds and the mutation effects of different concentrations of NaN3 on their calli were studied. Methods: The internodes of mint used as the material,and based on the preliminary experiment, the effects of different concentrations of TDZ,6-BA,NAA and Vc on adventitious buds induction rate were researched. On the basis of screening the best induction formula, the Mentha haplocalyx calli were treated with different concentrations of NaN3（ 0,2,4,6,8,10,12,14,16 mg/L）. Results: The optimum medium for calli induction and adventitious buds formation was MS + 0. 1 mg / L TDZ + 0. 2 mg / L NAA + 1mg / L Vc + 30 g / L sucrose + 5. 5 g / L agar, the treatment concentration of NaN3 for LD50of calli induction was 14 mg / L for 10 d,or 12 mg / L for 20 d,or 10 mg / L for 30 d. Plantlet could differentiate from the calli treated with NaN3. By comparing to the regenerated plants,81 mutants had been selected. Conclusion: A chemical mutagenesis in vitro system for Mentha haplocalyx with NaN3 was preliminarily established.

microRNA-98 mediated microvascular hyperpermeability during burn shock phase via inhibiting FIH-1.

BACKGROUND: microRNA is a small non-coding RNA molecule and functions in RNA silencing and post-transcriptional regulation of gene expression. This study was designed to evaluate the role of miR-98 in the development of microvascular permeability and its molecular pathogenesis. METHODS: Forty-eight healthy adult Wistar rats were divided into the control group (n = 8) and burn group (n = 40) that inflicted with 30% total body surface area third-degree burn. Groups were processed at 2, 4, 8, 12, and 24 h post-burn. Plasma for vascular endothelial cell culture was collected from control and 12 h post-burn rats. Organic microvascular permeability and serum miR-98 level were measured. In vitro, rat aorta endothelial cells were stimulated with burn serum. Level of miR-98 and protein of hypoxia-inducible factor-1 (HIF-1), factor inhibiting HIF-1α (FIH-1), and tight junction-associated proteins were determined. RESULTS: Organic microvascular permeability began to rise at 2 h post-burn and maintained the same character throughout the experiment except in lung tissue that was still rising at 12 h; the serum level of miR-98 was elevated (P < 0.05). In vitro, burn serum stimulation increased rat aorta endothelial monolayer cell permeability as well as upregulated miR-98 expression (P < 0.05). As shown in the result of transfection experiment, miR-98 negatively regulated FIH-1 and tight junction-associated protein expression (P < 0.05). CONCLUSIONS: The findings of the present study suggest severe microvascular permeability due to burns; and the underlying mechanism bases on the promotion of miR-98 level to the extent that it activated HIF-1 gene expression, resulting in junction-associated protein deficiency.

[To further enhance the comprehensive prevention and treatment of burn infection].

Comprehensive prevention and treatment of burn infection should be further enhanced, as monotonous treatment is prone to fail to get satisfying curative effects. In the articles to be published in this issue, causative factors for burn infection are analyzed in depth and discussed from different angles, and they will lay the foundation for the comprehensive prevention and treatment of burn infection.

[The influence of changes in the levels of calcitonin gene-related peptide and neuropeptide Y on cardiac function of severe burn patients during shock stage].

OBJECTIVE: To investigate the influence of the changes in the levels of calcitonin gene-related peptide (CGRP) and neuropeptide Y (NPY) on cardiac function of severe burn patients during shock stage. METHODS: Sixty severe burn patients with total burn surface area larger than 30% were enrolled as experiment group (E group) , and they received fluid resuscitation and debridement during shock stage. Sixty healthy volunteers were enrolled as control group (C group). The changes in the plasma level of CGRP, NPY and cTnT in E and C groups were observed at 1, 3, 6, 12, 24, 48 post-burn hours (PBH). The correlation among the CGRP, NPY and cTnT in the C group were analyzed. RESULTS: At 3 PBH, the plasma level of CGRP in E group (28 +/- 6) ng/L was lower than that in C group (55 +/- 7) ng/L , and it reached the lowest level at 12 PBH (15 +/- 4)ng/L . It was still lower than that in C group at 48 PBH (P < 0.05). The levels of NPY and cTnT in E group were significantly increased at 1PBH [(136 +/- 20) ng/L, (0.41 +/- 0.08) microg/L] compared with that in C group[ (86 +/- 13) ng/L, (0.16 +/- 0.06) microg/L], peaking at 12PBH [(189 +/- 31) ng/L, (1.78 +/- 0. 47) microg/L], and remaining higher than those in C group at 48PBH. There exhibited obvious negative correlation between the changes in the level of CGRP and cTnT ( r = -0.76, P < 0.01), while obvious positive correlation was found between the changes in level of NPY and cTnT ( r = 0.79, P < 0.01). CONCLUSION: The decrease in CGRP level and the increase in NPY level might play important roles in myocardial injury during shock stage of severe burn patients.