Inflammation is generally considered as a pathological process, and the occurrence of multi-organ inflammatory diseases is usually accompanied by an inflammatory response. Persistent inflammation can eventually lead to organ dysfunction. In recent years, the study of mesenchymal stem cell-derived exosomes has found its unique anti-inflammatory effect, which provides a new idea for the treatment of multi-organ inflammatory diseases. This article reviews the effect of mesenchymal stem cell exosomes on multi-organ inflammatory diseases.
皮肤移植是烧创伤、慢性创面修复的主要方法,特别在大面积烧伤创面治疗中,植皮扩展比例、供区愈合时间、供受区瘢痕形成及手术疼痛等瓶颈问题亟待解决.本文综述微针技术的应用现状及皮肤移植技术的新进展,并介绍一种硅基微针负压提取法进行自体表皮移植的研究现状.
Objective:To detect the oncological and functional result of segmental reconstruction for the diaphyseal defect after the femur tumor resection under navigation.Methods:Between September 2008 and May 2017, 28 patients with bone sarcomas underwent surgical resection and diaphyseal segmental reconstruction under computer-assisted navigation in Department of Orthopaedic Oncology Surgery, Beijing Jishuitan Hospital, Capital Medical University. The cohort comprised 18 males and ten females with a median age of 20 years (range: 8-60 years). The tumors were osteosarcoma (n=20), chondrosarcoma (n=4), Ewing sarcoma (n=2), undifferentiated pleomorphic sarcoma (n=1), spindle cell sarcoma (n=1). This study made a pre-operative plan for each patient using navigation system software and performed navigation-aided resection. The reconstruction included custom-made prosthesis (n=22) and allograft (n=6). The average reconstruction length was 181 mm (85-275 mm). The average follow-up was 86.5 months (6-166 months). The oncological and functional results were detected.Results:Of the 28 patients, 22 remain disease free, one is alive with disease, and five died of the disease. The 5-years survival rate was 80.8%. Six patients developed lung metastasis. Three patients developed local recurrence and the LR rate was 10.7%(3/28). The custom-made prosthesis fracture occurred in 1 patient and the revision for distal femur tumor prosthesis performed. In another patient the prosthesis failed mechanically and revision needed. Two allograft fractures and one deep infection occurred in the allograft reconstruction group. The distal femur tumor prosthesis reconstruction in one fracture patient, plate removal and intramedullary fixation in another patient and debridement performed for deep infection patient. The mean Musculoskeletal Tumor Society score at the final follow-up was 91%(80%-100%). The 5-year survival rates for prosthesis and allograft were 92.3% and 75%, respectively.Conclusion:The oncological results are good for the resection of femur sarcoma under computer-assisted navigation. The MSTS function are good for both custom-made prosthesis and allograft reconstruction although the complication occurred. The salvage for the failure of reconstruction is conventional tumor implant reconstruction.
The skin stretching device designed based on skin stretching technique has been widely used in clinical practice due to its simple operation and better wound healing effect compared with the traditional treatment method. This paper reviews the theoretical basis, the advantages and disadvantages of common clinical stretching device, the precautions and contraindications of clinical application, and discusses the future development direction of skin stretching device.
Blunt aortic injury is a potentially fatal vascular trauma. However, due to its non-specific clinical manifestations and common combination with other traumas, it is difficult to be diagnosed and treated in time in many cases. Computed tomography angiography (CTA) has become the first choice for the diagnosis of blunt aortic injury. The grade of arterial injury based on CTA is an important determinant for perioperative mortality, as well as the indication of treatment. According to the severity of arterial injury, patients may receive conservative or surgical treatment. As long as the anatomical and clinical conditions permit, the mainstream operation is endovascular repair. Endovascular repair has a significant advantage over open surgery in reducing perioperative complications and death. This article reviewed the research progress of diagnosis, classification and treatment of blunt aortic injury, aiming to provide reference for clinical diagnosis and treatment of blunt aortic injury.
Shock is a major complication in the early stage of burn injuries and one of the main causes of poor prognosis. The response to burn injuries in children differs significantly from adults, and they are more prone to develop shock. Timely and effective correction of shock is crucial for burn treatment. After reviewing relevant literature, selecting and analyzing studies with high-level evidence, and conducting in-depth discussions, the expert group has reached a consensus on fluid resuscitation of early pediatric burn shock, covering clinical manifestations, diagnosis, treatment, and monitoring. The consensus aims to provide reference standards for clinical treatment.
Objective:To investigate the effects of kunzea ericoides leaf extract on human dermal fibroblasts (HDFs) concerning the migration, proliferation, and collagen synthesis ability and to observe the impact of kunzea ericoides leaf extract on wound healing in rats.Methods:After stimulation of kunzea ericoides leaf extract in different concentrations, assays of CCK-8 and Calcein/PI staining were applied to screen the optimal concentration of kunzea ericoides leaf extract on HDFs. The expression of Ki67 was detected to observe the proliferation ability of HDFs. Wound-healing assay was applied to detect the migration ability of HDFs after incubation with kunzea ericoides leaf extract. The expressions of typeⅠcollagen, type Ⅲ collagen, and α-smooth muscle actin were detected using the immunofluorescence and western blot assay, representing the collagen synthesis ability change of HDFs. The models of rat skin defect were established and treated with or without kunzea ericoides leaf extract, and the healing time was compared. Furthermore, the wound area tissue's morphology and collagen composition were observed using HE and Masson staining assays after complete healing.Results:The optimal concentration of kunzea ericoides leaf extract for HDFs was determined as 1% based on CCK-8 assay and Calcein/PI staining. In addition, the Ki67 expression was increased significantly [(0.71±0.16) vs (0.18±0.06), t=7.156, P<0.001], kunzea ericoides leaf extract enhanced the cell proliferation. The wound-healing assay confirmed that kunzea ericoides leaf extract improved the migration ability of HDFs. The results of the immunofluorescence and western blot assay showed that kunzea ericoides leaf extract increased the expressions of typeⅠcollagen, type Ⅲ collagen, and α-smooth muscle actin in HDFs [(43.22±7.58) vs (16.71±1.68), t=7.635, P<0.001; (46.62±5.90) vs (27.44±1.60), t=7.016, P<0.01; (1.32±0.14) vs (0.46±0.06), t=9.947, P<0.01], which meant kunzea ericoides leaf extract improved the collagen synthesis ability of HDFs. The healing time in the kunzea ericoides leaf extract group was (13.6±1.5)d, significantly shorter than (16.7±1.6)d of the control group (t=6.270, P<0.001). The results of HE and Masson staining suggested that after applying kunzea ericoides leaf extract, the skin tissue from the wound area resembled normal skin morphology and demonstrated more collagen deposition [(84.36±7.82) vs (67.72±5.24), t=5.595, P<0.001].Conclusion:Kunzea ericoides leaf extract can promote the proliferation, migration, and collagen synthesis ability of HDFs, and might promote wound healing in rats by enhancing the function of dermal fibroblasts.
Objective:To assess the clinical efficacy of antibiotic bone cement combined with vacuum sealing drainage in the treatment of diabetic foot ulcers, and to provide basis of evidence-based medicine.Methods:A computerized literature search in CNKI, Wanfang, Vipshop, China Biomedical Literature, Pubmed, The Cochrane Library, and Web of Science, Embase, Clinical Trials databases was performed, screened clinical randomized controlled trials of antibiotic bone cement combined with vacuum sealing drainage for the treatment of diabetic foot. The retrieval time was from the time of database establishment to March 2023. Meta-analysis of the included studies was performed using RevMan 5.4 software.Results:A total of 12 studies with 789 patients were included, including 399 cases in the trial group and 390 cases in the control group. Due to the specificity of the treatment modality, it was difficult to implement the blinded method, so there was some bias. Meta-analysis results showed that compared to patients using vacuum sealing drainage alone for treatment, the time of wound healing was shorter (MD= -8.97, 95%CI: -11.64--6.29, P<0.001), the efficiency was better (RR=1.25, 95%CI: 1.14-1.37, P<0.001), the length of hospital stay was less (MD=-7.94, 95%CI: -11.21--4.66, P<0.001), the number of surgical procedures decreased (MD=-1.90, 95%CI: -2.97--0.82, P<0.001), the time of bacterial negative conversion was shorter (MD=-5.00, 95%CI: -5.26--4.73, P<0.001) in patients using antibiotic bone cement combined with vacuum sealing drainage.Conclusion:The combination of antibiotic bone cement and vacuum sealing drainage for the treatment of diabetic foot has significant advantages over the use of vacuum sealing drainage alone, but due to the low quality of some of the included literature, the results may vary, and therefore a large amount of high-quality literature is needed to verify the above conclusions.
In recent years, the high incidence of vascular disease has promoted the research of interventional treatment in this field. Compared with traditional surgical treatment methods, it is more minimally invasive and effective. With the clinical application of interventional therapy, the incidence of iatrogenic femoral artery pseudoaneurysms caused by puncture has also increased. At present, the treatment methods for pseudoaneurysms tend to develop towards minimally invasive approaches, mainly including ultrasound-guided puncture compression, thrombin injection into the tumor cavity, and intravascular intervention. Especially for deeper puncture positions, intervention methods should firstly be considered. The treatment plans also show diversification and individualization according to the actual situation.
Objective:To modify the existing liquid dressing with pH dependence, verify its effectiveness through animal experiments.Methods:Measured the pH of normal skin, clean wounds, and infected wounds as the theoretical basis for pH dependent film formation. On the basis of existing commercialized liquid dressings, a new type of pH dependent film-forming liquid dressing was prepared by adding different concentrations of carbopol. The moldability was tested in vitro under different pH conditions. Based on the pH of the wound, a carbopol concentration that could form a film on the wound but couldn′t form a film on normal skin was selected to prepare a pH dependent film-forming liquid dressing. Detectd the biocompatibility (cytotoxicity, sensitization, intradermal stimulation) and physical barrier effect (moisturizing properties, antibacterial properties) of the liquid dressing. The effectiveness of the liquid dressing in vivo was detected though the full thickness skin defect wound model in SD rats.Results:The pH of normal skin was 5.90±0.25, which was significantly lower than 6.54±0.36 of clean wounds and 7.54±0.35 of infected wounds (t=-3.32, P=0.011; t=8.61, P<0.001). The pH of clean wounds was also significantly lower than that of infected wounds (t=-4.44, P=0.002). Configured agar plates with pH values of 6, 7, and 8, applied liquid dressings. Complete film formation could be achieved at pH values of 7 and 8, but sheet-like film couldn′t be formed at pH values of 6. The cytotoxicity of the liquid dressings was level 1, with no potential cytotoxicity. No sensitization and irritation during intradermal implantation was found in the liquid dressings. Adjusted the pH of the liquid dressing to 6, 7, and 8. When the pH was 6, it didn′t have moisturizing and antibacterial properties. When the pH was 7 and 8, the moisture retaining rate was (4.76±2.04)% and (7.58±1.62)%, respectively, and the antibacterial rate was (33.17±5.59)% and (45.36±7.57)%, respectively. Animal experiments showed that compared to liquid dressings without film forming properties, the wound healing rate on the 10th day after modeling significantly increased[(69.02±3.39)% vs (75.34±3.64)%, t=2.84, P=0.022], and the wound healing time significantly reducted [(23.60±0.89)d vs (20.40±2.61)d, t=2.60, P=0.032] .Conclusion:By adjusting the concentration of carbopol, pH dependent film-forming liquid dressings can be made, which form a film on the wound surface without affecting normal skin, promote wound healing, and improve comfort level.
Carotid blowout syndrome refers to the fatal complications of vascular wall necrosis, rupture and massive hemorrhage caused by tumor direct invasion and infection after head and neck tumor surgery, recurrence or re-release. The mortality rate is 40% and the neurological complications rate can be as high as 60%. In this article, the pathogenesis and treatment progress of carotid blowout syndrome were reviewed based on relevant literature, the current treatment modalities and prognosis evaluation of CBS were summarized, and the individual treatment of CBS was further discussed.
张树堂教授是国内知名烧伤专家，历任郑州市第一人民医院烧伤科主任、院党委委员，郑州市整形烧伤研究所所长，河南省医学会烧伤外科学分会副主任委员，郑州市医学会烧伤外科学分会主任委员，河南省和郑州市医疗事故技术鉴定专家库资深成员，省学科带头人。多年临床工作中，在救治大面积深度烧伤、电击伤等方面积累了丰富的临床经验。
Objective:To explore the clinical characteristics of 19 cases of Vibrio vulnificus infection in Humen area.Methods:The clinical data of 19 patients with Vibrio vulnificus infection admitted to Burn Plastic & Hand and Foot Surgery, Dongguan Binhai Bay Central Hospital from January 2018 to January 2023 were retrospectively analysed, observed the clinical characteristics and summarized the experience and lessons of treatment.Results:Vibrio vulnificus infection mostly occured in summer and autumn (13/19, 68.42%). The patients with metabolic disease or abnormal liver function were susceptible (11/19, 57.89%), and the prognosis of gout patients was relatively worse, the three deaths were all gout patients. There were 18 positive cases in bacterial culture of Vibrio vulnificus before the application of antibiotics on the day of admission, one positive case was found one day later. Afterwards, no Vibrio vulnificus was found in bacterial culture. The number of white blood cells were closely related to the percentage of neutrophils and the level of procalcitonin (r=0.972, P=0.000; r=0.861, P=0.006). The white blood cell levels gradually decreased along with the condition improved.Conclusion:The infection of Vibrio vulnificus in Humen area mostly occurs in summer and autumn. Patients with metabolic diseases are more susceptible, and gout patients have a poor prognosis. Vibrio vulnificus is sensitive to most antibiotics. The white blood cell and procalcitonin are good indicators for the severity and prognosis.
Drug-induced pyoderma gangrenosum is an extremely rare neutrophilic dermatoses with unclear pathophysiology, difficult diagnosis and non-uniform treatment protocol. However, drug-induced pyoderma gangrenosum is a rare adverse drug reaction that often causes great suffering to patients. In this article, the pathogenesis, pathological examination, clinical manifestations, diagnosis and differential diagnosis, and treatment options of drug-induced pyoderma gangrenosum were reviewed, with the aim of providing a reference for the diagnosis and treatment of drug-induced pyoderma gangrenosum in clinical practice.
Objective:To explore the application effect of QC circle intervention activities in reducing the incidence of catheter-related infection (CRI) during femoral vein catheterization through burn wounds, and explore the establishment of maintenance standards for deep vein catheterization through burn wounds.Methods:Patients who underwent femoral vein catheterization through burn wounds from January 2017 to December 2021 in Department of Burns and Plastic Surgery, the Second People′s Hospital of Shantou were selected and retrospectively investigated. Among them, 65 patients (95 times) who underwent routine treatment were set as non-intervention group, and 115 patients (185 times) who used QC group intervention activities to intervene in the QC nursing during catheterization were set as intervention group. The two groups of patients were divided into the duration of catheterization (0-22 d, 23-30 d, 31-45d). The occurrence of CRI after catheterization was counted. The measurement data were first tested for normality, expressed as ±s deviation, and t test was used for comparison between groups. Otherwise, the median (interquartile range) was expressed as Mann-Whitney U test; the enumeration data were expressed as the number of cases. Chi-square test or Fisher exact probability method was used according to the data. Bonferroni was used for multiple comparisons between the two groups.Results:In the intervention group, there were 99 cases of catheter indwelling for 0-22 days, 51 cases for 23-30 days and 35 cases for 31-45 days. In the non-intervention group, there were 30 cases of catheter indwelling for 0-22 days, 27 cases for 23-30 days and 38 cases for 31-45 days. The incidence of CRI in the non-intervention group was 30.00%, 40.47% and 47.37% at 0-22 d, 23-30 d and 31-45 d after catheter indwelling, which was higher than 14.14%, 17.65% and 22.86% in the intervention group, respectively. The incidence of CRI was statistically significant (χ2= 3.952, 4.938, 4.773, P<0.05). The incidence of CRI in the intervention group (16.76%) was significantly lower than that in the non-intervention group (40.00%)(χ2= 18.261, P<0.001). In addition, by Logistic multivariate analysis, burn depthⅡ° and Ⅲ° (OR=9.924, 95%CI: 5.376-16.921), total burn area (OR=1.048, 95%CI: 1.019-1.078), catheterization time (OR=1.074, 95%CI: 1.032-1.117) and QC intervention nursing method (OR=0.181, 95%CI: 0.103-0.256) were the key factors affecting CRI.Conclusion:The intervention of QC circle can improve the quality and safety of patient care during femoral vein catheterization through the burn wound. While the catheter was removed as planned, the incidence of complications during catheterization through the burn wound is effectively reduced, as well as the medical and nursing costs, benefiting the patients.
Macrophage polarization plays an important role during the stages of wound healing, in terms of the inflammation, the proliferation as well as tissue remodeling. As macrophages have strong plasticity and the factors affecting the macrophages polarization are relatively complex, meanwhile, factors that positively regulate polarization to promote wound healing and factors that negatively regulate polarization or abnormal polarization to inhibit wound healing exist in the body simultaneously. Therefore, for studying the pathological mechanism of wound healing, it is important to understand and summarize the effect of different factors regulating macrophage polarization in chronic refractory wounds. Recent studies have shown that factors affecting the healing process of chronic refractory wounds include different colonization sites of macrophages, differences in inflammatory microenvironment, synergistic effect of stem cells, infection of pathogenic microorganisms, application of cellular biomaterials, macrophage autophagy and lipid metabolism disorders of macrophages, which are involved in regulating the polarization and metastasis of macrophages. Therefore, this article summarizes the mechanism of different factors regulating macrophage polarization in the process of chronic refractory wound healing, in order to provide ideas for the follow-up study of chronic refractory wounds.
Objective:To evaluate the clinical effect of traditional Chinese medicine in treating burns.Methods:Randomized controlled trials (RCTs) studies on treatment of burns with traditional Chinese medicine were searched from Cochrane, PubMed, Embase, Ovid, CNKI and Wanfang databases for systematic review. The retrieval time limit was from the establishment of the databases to April 18, 2023.Results:A total of 31 RCTs were included in the meta-analysis. Traditional Chinese medicine treatment could improve the clinical effective rate (RR=1.20, 95%CI: 1.15-1.26, P<0.001) bacterial clearance rate (RR=1.68, 95% CI: 1.44-1.97, P<0.001) and wound healing rate (SMD=1.37, 95%CI: 0.81-1.93, P<0.001), reduce the incidence of scar (RR=0.29, 95%CI: 0.23-0.38, P<0.001) and pain scores (SMD=-1.76, 95%CI: -2.40--1.11, P<0.001), and shorten the wound healing time (SMD=-1.69, 95%CI: -2.06--1.32, P<0.001), and no obvious adverse reactions occurred.Conclusion:Traditional Chinese medicine treatment of burns can significantly improve the clinical effective rate, bacterial clearance rate and wound healing rate, shorten wound healing time, reduce the incidence of scar and pain score. Traditional Chinese medicine preparations have good application prospects, but the long-term efficacy and safety need to be verified by more RCTs with high quality, large samples and long-term follow-up.
目前，随着创面修复科的兴起，慢性创面的规范诊疗工作正在逐渐深入进行，但是仍然存在许多需要长期换药的慢性创面患者。这些患者往往年龄大、行动不便且经济相对困难。我们建立了叮咚依生平台开展规范的居家创面护理，经过4年多的实践取得了很好的成绩。伤口居家护理服务次数500余次，护士上门平均单程8.1 km，最大单程29 km。创面愈合率25%，绝大多数创面明显好转。该平台在管理上有一键报警、定位跟踪和数据实时上传。对于患者而言，平台上门医护人员给予其全身和局部评估、创面换药处理及诊疗记录和回访。对于医护人员有培训和资质评估、患者满意度评价和医疗争议处理，对于疑难创面患者有远程会诊和专家指导等。平台还开设了健康宣教、健康商城和慈善救助项目。尤其是慈善救助项目救助慢性创面患者400多人，健康宣教1500多人，医护培训800多人，总救助金额500万元。慈善救助项目除了浙江省以外，还远及四川大凉山、新疆阿克苏和青海海西州。希望通过这些行动真正解决慢性创面患者医疗服务的最后一公里。
Objective:To study the repairing effect of drug-coated balloon (DCB) to the injured side-branch after drug-eluting stent (DES) implement at the main-branch in the treatment ofelderly patients with coronary bifurcation lesion.Methods:260 cases of elderly patients with coronary bifurcation lesions was studied in Cardio Department, Beijing Anzhen Hospital, Capital Medical University hospital from January 2019 to June 2021 had implantation of drug-eluting stents in the main branch according to the principle of necessity stenting. Branch application of drug-coated balloons were randomly divided into drug-eluting stents in combination with ordinary coating and drug-eluting stents in combination with drug-coated group, 130 cases in each group. Coronary angiography was performed at 12 months, and the incidence of MACE at different periods was recorded.Results:The surgical success rates of ordinary balloon group and drug balloon group were 85.8% and 91.2%(P>0.05), respectively, the MLD of lateral branch vessels in the ordinary balloon group increased from (1.22±0.14)mm to (1.53±0.13)mm, and the MLD of branch vessels in the drug balloon group increased from (1.25±0.12)mm to (1.69±0.22)mm. There was no significant difference in preoperative MLD between the two groups, and there was a significant difference in MLD in postoperative branch vessels (P<0.05). During hospitalization, there was no target vascular-related myocardial infarction in 0-3 months, 3-6 months, and 6-12 months after discharge. During hospitalization, 5 cases (3.8%) and 3(2.3%) of angina pectoris occurred in the general balloon group and the drug balloon group, respectively, all of which were in CCS grade I (P>0.05). In the follow-up of 0-3 months, the incidence of angina pectoris after CCS grading was compared between the two groups (P<0.05). There was no significant difference in the incidence of different CCS-graded angina between the two groups at 3-6 months and 6-12 months (P>0.05). In the 3-6 months follow-up, 3 cases of non-target vascular myocardial infarction occurred in the ordinary balloon group (P<0.05); During the 6-12 months follow-up period, 6 cases of target vascular revascularization (P<0.05) appeared in the ordinary balloon group. There was no clear difference in the incidence of MACE between the two groups at 12 months follow-up.Conclusion:After the implantation of the main branch stent in the treatment of elderly bifurcation lesions, the use of DCB for repair of damaged limb vessels is more obvious than that of ordinary balloon MLD.
The wound without or with difficulties in vascular anastomosis is a kind of complex wounds caused by trauma, tumor, operation, radiation therapy, and other causes. The lack of blood vessels in the recipient area makes it challenging to repair wound using conventional methods. Therefore, establishing new blood vessels that can support free tissue flap transfer is crucial. Surgeons employ various solutions to construct anastomotic vessels in the recipient area, including vascular bundle transplantation, which may involve autogenous vein or artificial blood vessels, cross-crossing leg-free skin flaps, flow-through flaps, and end-to-patch anastomosis. Once established, these anastomotic vessels serve as a foundation for therapeutic approaches such as free skin flap, muscle flap, fascia flap, greater omentum flap, and other methods used to repair wounds and cure diseases. This article reviews the characteristics and existing solutions of vascular anastomosis without or with difficulties, aiming to provide with such challenges. It clinical decision-making and treatment strategies for surgeons faced underscores the importance of establishing new blood vessels in the recipient area to support free tissue flap transfer and highlights the clinical techniques utilized to achieve successful outcomes.
