BACKGROUND:Mesenchymal stem cells, found in various tissues, possess significant healing and immunomodulatory properties, influencing macrophage polarization, which is essential for wound repair. However, chronic wounds present significant therapeutic challenges, requiring novel strategies to improve healing outcomes. AIM:To investigate the potential of fetal dermal mesenchymal stem cells (FDMSCs) in enhancing wound healing through modulation of macrophage polarization, specifically by promoting the M2 phenotype to address inflammatory responses in chronic wounds. METHODS:FDMSCs were isolated from BalB/C mice and co-cultured with RAW264.7 macrophages to assess their effects on macrophage polarization. Flow cytometry, quantitative reverse transcriptase polymerase chain reaction, and histological analyses were employed to evaluate shifts in macrophage phenotype and wound healing in a mouse model. Statistical analysis was performed using GraphPad Prism. RESULTS:FDMSCs induced macrophage polarization from the M1 to M2 phenotype, as demonstrated by a reduction in pro-inflammatory markers (inducible nitric oxide synthase, interleukin-6) and an increase in anti-inflammatory markers [mannose receptor (CD206), arginase-1] in co-cultured RAW264.7 macrophages. These shifts were confirmed by flow cytometry. In an acute skin wound model, FDMSC-treated mice exhibited faster wound healing, enhanced collagen deposition, and improved vascular regeneration compared to controls. Significantly higher expression of arginase-1 further indicated an enriched M2 macrophage environment. CONCLUSION:FDMSCs effectively modulate macrophage polarization from M1 to M2, reduce inflammation, and enhance tissue repair, demonstrating their potential as an immunomodulatory strategy in wound healing. These findings highlight the promising therapeutic application of FDMSCs in managing chronic wounds.

血小板衍生生长因子(platelet-derived growth factor,PDGF)是间充质来源细胞的有效激活剂,参与创伤后细胞增殖、趋化和迁移,促进炎症反应、再上皮化和血管生成以及愈合过程中的组织重塑,在创面愈合的各阶段发挥重要作用,被称为"创伤因子".本文就PDGF在促进创面愈合中的基础及临床应用进展、适应证、禁忌证和安全性等内容进行综述.

Brain edema could be secondary to cerebral lesion caused by a variety of reasons, severe cases may result in brain herniation or even death. Accurate real-time monitoring of cerebral edema, rational application of dehydrating drugs, and timely treatment of cerebral edema were very important for patients. However, there were defects in the monitoring methods commonly used in clinical practice. Noninvasive brain-edema monitoring was a new method, which can quantify the degree of brain edema by electromagnetic disturbance and directly reflect the state of brain edema. This article reviews the application of noninvasive brain-edema monitoring in the treatment of in critically ill patients with traumatic brain injury.

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.

目的:检索并整合重症监护室(ICU)严重创伤病人静脉血栓栓塞症预防及管理的相关证据,为临床实践降低严重创伤病人静脉血栓栓塞症的发生率提供循证依据.方法:针对ICU严重创伤病人静脉血栓预防及管理提出问题,系统检索相关主题文献,应用澳大利亚循证卫生保健中心(Joanna Briggs Institute,JBI)的文献评价标准和证据分级系统进行文献质量评价及证据级别评定.结果:最终纳入14篇文献,其中临床决策1篇,最佳实践1篇,证据总结1篇,指南7篇,系统评价1篇,专家共识3篇,共提取证据20条,主要内容包括静脉血栓栓塞症风险评估、预防策略及方法、护理要点、健康教育及组织保障5个方面.结论:总结了目前ICU严重创伤病人静脉血栓栓塞症预防及管理的最佳证据,临床护理工作者及管理者可通过应用最佳证据,以科学的方法预防和管理静脉血栓,不断提升护理质量.

Burns often cause loss of skin barrier protection, fluid exudation, and local tissue edema, which hinder functional recovery. Effectively improving the quality of deep burn wound healing, shortening the wound healing time, and reducing tissue fluid leakage are urgent problems in the medical field. Human mesenchymal stem cells (MSCs) can effectively stabilize vascular endothelial injury. Fetal dermal MSCs (FDMSCs) are a newly discovered source of MSCs derived from the skin of accidentally aborted fetuses. However, the effect of FDMSCs on vascular permeability remains poorly understood. In this study, conditioned media from FDMSCs (F-CM) extracted from fetal skin tissue was prepared. The effect of F-CM on vascular permeability was evaluated using the internal circulation method FITC-dextran in vivo, and several in vitro assays, including cell viability assay, transwell permeability test, immunofluorescence, and western blotting. Altogether, our results demonstrate that F-CM could inhibit burn-induced microvascular hyperpermeability by increasing the protein expression levels of occludin and VE-cadherin, while restoring the expression of endothelial F-actin, and providing the foundation of a novel therapy for the treatment of burns with F-CM.

Background: Foreign body(FB) ingestion in the upper digestive tract is a common emergency that lacks sufficient attention in adult population. Improper management may bring additional injuries and financial burdens to patients. This review was performed to determine the clinical characteristics of upper gastrointestinal FBs, including the demographic of adult patients, the type and location of FBs, underlying diseases of patients and other risk factors, and outcomes. Methods: We searched PubMed, MEDLINE, EMBASE and Cochrane databases with the terms "foreign body AND upper gastrointestinal NOT child". Finally, we got 7 articles between 2001 and 2020 and extracted the information. Results: A total of 1391 patients were included. 736 (52.9%) patients were males and 655 (47.1%) were females. Fish bone was the most common type of FBs. Esophagus accounts for the most location in the upper digestive tract. 18.2% (235/1291) patients had the underlying diseases, and 11.7% (58/494) had other risk factors. The overall complication rate was 4.5% (63/1391). (C) 2021 Elsevier Inc. All rights reserved.

The treatment of burn wound is an important link throughout the whole treatment process, which affects the life, limb function and appearance of patients. Under the current medical conditions, there are few patients died of shock after burn, but the lack of autologous skin, infection, scar hyperplasia and contracture after wound healing are always challenges for burn wound treatment. The faster and more beautiful healing of burn wound is related to the quality of life of patients in the future, which is also a problem that has been explored in burn treatment. In this paper, the progress and difficulties of burn wound treatment, as well as some understanding of the possible direction in the future are briefly described.

The fatality rate of traumatic cardiac arrest (TCA) is extremely high, and it is very different from that of non-traumatic cardiac arrest (NTCA) in resuscitation strategy. Only when the standard resuscitation process is combined with rapid treatment of various reversible causes can the mortality rate of patients be decreased. In this paper, the key factors leading to TCA are reviewed, such as hypovolemic shock, asphyxia, tension pneumothorax, pericardial tamponade, crush syndrome, craniocerebral injury, cerebral hernia, and the control measures are elaborated respectively, so as to provide references for clinical treatment of patients with severe trauma, and reduce TCA incidence and mortality.

Objective: To explore the efficacy of air impact-assisted intermittent subglottic secretion drainage (ISSD) on the blood gas indicators, postoperative complications, and prognosis of chronic obstructive pulmonary disease (COPD) patients with respiratory failure. Methods: 128 COPD patients with respiratory failure and underwent invasive mechanical ventilation with tracheotomy were selected. The patients were randomly divided into the trial group (N=64) and the control group (N=64). The patients in the trial group were treated with air impact combined with intermittent subglottic secretion drainage (ISSD). The patients in the control group were treated with ISSD. Both air impact method and ISSD are commonly used in clinical practice to clear sputum. During treatment, we recorded the amount of airway secretion aspiration, positive rate of bacteria in the sputum smear, blood-gas indicators before and after sputum aspiration (including partial pressure of carbon dioxide [PaCO2]) and partial pressure of blood oxygen [PaO2]), vital signs per hour and the differences in vital signs before and after treatment (including heart rate, respiration, systolic blood pressure, and diastolic blood pressure), number of coughs, mechanical ventilation time, ventilator-associated pneumonia (VAP) incidence, and mortality rate of patients between the two groups. Results: In the trial group, the positive rate of the bacteria smear was significantly lower than that in the control group (P<0.05). After sputum aspiration, the PaCO2 and PaO2 in the trial group improved significantly than those observed in the control group (P<0.05). Before and after sputum aspiration, the vital signs of the patients in the trial group were significantly lower than those of the patients in the control group (P<0.05). Additionally, the number of coughs, mechanical ventilation time, VAP incidence, and mortality rate in the trial group were significantly decreased compared to those in control group (P<0.05). Conclusion: Following tracheotomy in COPD patients, air impact combined with ISSD can decrease the blood-gas indicators, incidence rates of cough and VAP, and mortality rate, and improve the prognosis of patients.

Fetal dermal mesenchymal stem cells (FDMSCs), isolated from fetal skin, are serving as a novel MSC candidate with great potential in regenerative medicine. More recently, the paracrine actions, especially MSC-derived exosomes, are being focused on the vital role in MSC-based cellular therapy. This study was to evaluate the therapeutic potential of exosomes secreted by FDMSCs in normal wound healing. First, the in vivo study indicated that FDMSC exosomes could accelerate wound closure in a mouse full-thickness skin wound model. Then, we investigated the role of FDMSC-derived exosomes on adult dermal fibroblast (ADFs). The results demonstrated that FDMSC exosomes could induce the proliferation, migration, and secretion of ADFs. We discovered that after treatment of exosomes, the Notch signaling pathway was activated. Then, we found that in FDMSC exosomes, the ligands of the Notch pathway were undetectable expect for Jagged 1, and the results of Jagged 1 mimic by peptide and knockdown by siRNA suggested that Jagged 1 may lead the activation of the Notch signal in ADFs. Collectively, our findings indicated that the FDMSC exosomes may promote wound healing by activating the ADF cell motility and secretion ability via the Notch signaling pathway, providing new aspects for the therapeutic strategy of FDMSC-derived exosomes for the treatment of skin wounds.

Objective To investigate the promoting effect of local compression and fixation on the healing of anterior tibial flask-like wound after debridement and suture.Methods A retrospective case control study was conducted to analyze the clinical data of 57 patients with simple anterior tibial flask-like wound admitted to the Second Hospital of Shandong University from May 2017 to June 2018.There were 32 males and 25 females,aged 20-60 years [(41.4 ± 8.1) years].The length of wound ranged from 1 to 10 cm.All patients had only acute skin and soft tissue injury,without any fracture,large area skin defect,large area avulsion injury,or chronic diseases such as diabetes mellitus and lower limb vascular disease.The study group contained 37 patients who were treated with local pressure dressing and limb fixation after debridement and suture while the control group included 20 patients who were treated with simple dressing after debridement and suture.At 3,5,7,14,and 21 days after operation,the size of the wound,the type and quantity of exudate,the color of skin around the wound and the type of wound tissue were compared,and the healing time was recorded.Results All patients were followed up for 30-90 days [(52.2 ± 3.5) days].Three days after operation,there was no significant difference between the two groups (P ＞0.05).On the 5th day after operation,the scores of exudate amount,skin color surrounding wound and tissue types of the wound bed in the control group and the study group were (4.2 ± 0.7) points ∶ (3.3 ± 0.6) points,(3.5 ± 0.7) points ∶ (2.5 ± 0.6) points,(3.4 ± 0.6) points ∶(2.5 ± 0.5) points (P ＜ 0.05),but there was no significant difference between the two groups in the scores of the size of wound and the type of exudate (P ＞ 0.05).On the 7th day after operation,the scores of the size of wound,type of exudate,amount of exudate,skin color around the wound and the type of wound tissue in the control group and study group were (3.5 ± 0.5) points ∶ (2.5 ± 0.7) points,(3.4 ±0.7)points ∶ (2.4 ±0.5)points,(4.0±0.8)points ∶ (2.8 ±0.5)points,(3.4 ±0.5)points ∶ (1.3 ±0.5) points,(3.3 ± 0.5) points ∶ (2.1 ± 0.4) points (P ＜ 0.05).On the 14th day after operation,the scores of the scores of the size of wound,type of exudate,amount of exudate,skin color around the wound and the type of wound tissue in the control group and study group were (2.9 ± 0.6)points ∶ (1.2 ±0.7)points,(2.8 ±0.7)points ∶ 0 point,(3.3 ±0.7)points ∶ (1.0 ±0.0)points,(3.1 ±0.6)points ∶(1.1 ± 0.4) points,(3.0 ± 0.6) points ∶ (1.2 ± 0.5) points (P ＜ 0.05).Twenty-one days after operation,the scores of the scores of the size of wound,type of exudate,amount of exudate,skin color around the wound and the type of wound tissue in the control group and study group were (2.5 ±0.7)points ∶0 point,(2.5 ±0.5)points ∶ 0 point,(3.0 ±0.7)points ∶ (1.0 ±0.0)points,(2.6±0.7)points ∶ (1.1 ±0.3) points,(2.6 ± 1.1) points ∶ 0 point (P ＜ 0.05).The wound healing rate was 100％ in both groups.The wound healing time of the control group and the study group was (28.3 ± 6.7) days and (15.2 ± 0.9) days respectively (P ＜ 0.05).Conclusion For anterior tibial flask-like wound,local pressure bandaging and fixation after debridement and suture can significantly promote wound healing compared with conventional simple bandaging,with the advantages of better healing quality and shorter healing time.

BACKGROUND:Skin flap-like wounds are common. These wound flaps are prone to avascular necrosis with simple debrided and sutured, and postoperative hyperplastic scarring and contracture of wound surfaces can adversely affect the patient's appearance. Here, we evaluate the data of cases with flap-like wounds to identify the causes of flap necrosis. METHODS:Six hundred patients with skin flap-like wounds between January 1, 2013 and December 31, 2016 were retrospectively reviewed. Their age, sex, injury reason, size of flap, length-width ratio of wound, thickness of pedicle, operation time, injury site, direction of blood perfusion in the flap and operating methods were recorded. The risks for flap necrosis were analyzed with one-factor analysis. RESULTS:A total success rate of 92.5% (555/600) for flap-like wound reconstruction was obtained. Among 67 flaps with vascular crisis, 22 were salvaged by subcutaneous injection of anisodamine, selective suture removal, and pressure dressing with elastic bandages. For the 45 patients with flap necrosis, there was no significant difference from patients without necrosis in terms of sex, age, and size of flap (P > 0.05). The incidence of flap necrosis was significantly different in terms of injury reason, length-width ratio of wound, thickness of pedicle, operation time, injury site, direction of blood perfusion in the flap and operating methods (P < 0.05). CONCLUSION:Injury reason, length-width ratio of wound, thickness of pedicle, operation time, injury site, direction of blood perfusion in the flap and operating methods, rather than age, sex and size of flap, were significant risk factors for necrosis of flap-like wounds.

The regenerative repair of deep-degree (second degree) burned skin remains a notable challenge in the treatment of burn injury, despite improvements being made with regards to treatment modality and the emergence of novel therapies. Fetal skin constitutes an attractive target for investigating scarless healing of burned skin. To investigate the inflammatory response during scarless healing of burned fetal skin, the present study developed a nude mouse model, which was implanted with normal human fetal skin and burned fetal skin. Subsequently, human peripheral blood mononuclear cells (PBMCs) were used to treat the nude mouse model carrying the burned fetal skin. The expression levels of matrix metalloproteinase (MMP)-9 and tissue inhibitor of metalloproteinases (TIMP)-1 were investigated during this process. In the present study, fetal skin was subcutaneously implanted into the nude mice to establish the murine model. Hematoxylin and eosin staining was used to detect alterations in the skin during the development of fetal skin and during the healing process of deep-degree burned fetal skin. The expression levels of MMP-9 and TIMP-1 were determined using immunochemical staining, and their staining intensity was evaluated by mean optical density. The results demonstrated that fetal skin subcutaneously implanted into the dorsal skin flap of nude mice developed similarly to the normal growth process in the womb. In addition, the scarless healing process was clearly observed in the mice carrying the burned fetal skin. A total of 2 weeks was required to complete scarless healing. Following treatment with PBMCs, the burned fetal skin generated inflammatory factors and enhanced the inflammatory response, which consequently resulted in a reduction in the speed of healing and in the formation of scars. Therefore, exogenous PBMCs may alter the lowered immune response environment, which is required for scarless healing, resulting in scar formation. In conclusion, the present study indicated that the involvement of inflammatory cells is important during the healing process of deep-degree burned skin, and MMP-9 and TIMP-1 may serve important roles in the process of scar formation.

目的 了解某院2013年急诊患者流行病学特征,为急诊科的医疗、服务与管理提供参考依据.方法 对2013年1月1日至2013年12月31日,来该院就诊的62 576例急诊患者预检分诊登记记录建立数据库,对就诊患者的性别、年龄、就诊时间、就诊月份、就诊专业、留观病例、入抢救室病例、院前急救、患者转归等资料,进行流行病学特征分析.结果在62576例急诊患者中,男女之比为1.19∶1;以19～30岁年龄组为主(31.57％);7、8月份就诊患者最多,达12 541例,占全年总人数的20.04％;每日高峰就诊时间为17:00～24:00;以外科专业为主要急诊人群(47.41％);神经内科与心血管内科两专业患者中,以60岁以上患者就诊为主要群体(38.72％),60岁以上患者也是入抢救室患者最多的群体(52.63％);8岁以下患者以交通车祸伤多见(51.40％),死亡构成比为68.60％;50％的急诊患者病情较重,平均每日留院观察达81.50例.结论 急诊医学专业应根据主要急诊人群、高发年龄段和不同季节、不同时间就诊病人的特点.

盐霉素又名沙利霉素(Salinomycin),商品名为优素精,是由白色链霉菌(streptomyces albus)经发酵提取而得到的动物专用抗生素.盐霉素致人类中毒十分罕见,现将我院近期收治的1例因误食盐霉素中毒致死亡的病例报道如下.

Objective To observe the effects of Shengmai Injection on NF-κB activation of the neutrophile granulocyte,serum TNF-a level and the prognosis of resuscitation on patients who had recovered from cardiac arrest.Methods The enzyme labeled immunohistochemical method was used to determine the NF-κB activation degree.Radio-immunity(RI) was used to determine the blood serum level of TNF-a.Changes of vital signs and laboratory examination indexes were also observed.Results ①The time,degree of vital signs recovery of the test group were superior to those of the control group,and the differences were statistically significant(P0.05).② The degree that NF-κB moved into the nucleolus and the TNFa level of the control group were higher than those of the test group,and the differences were statistically significant(P0.01).③Shengmai Injection suppressed the activation of NF-κB and the blood serum level of TNF-a on dosage(P0.01).④ The NF-κB activation degree and the TNF-a level were negatively correlated with the recovery of vital signs.The better the vital signs recovered,the lower were the NF-KB activation and the TNF-a level.Conclusion Shengmai Injection plus routine therapeutics have obvious therapeutic efficiency in protecting heart function,supporting good circulation state,and increasing the success rate of CPR possibly by suppressing the NF-κB signaling pathway and reducing NF-κB controled inflammation factors in a dose-dependent manner.

2005年8月～2006年8月,我们对18例有机磷农药中毒患者实行长托宁替代阿托品治疗,经精心护理,效果满意.现报告如下.

有机磷农药中毒是临床上常见的中毒类型,近年来发生率居高不下,中毒年龄趋向年轻化,以女性患者为主.各地医院的治疗方案不尽相同.本研究主要讨论早期大剂量静注肟类胆碱酯酶复能剂-氯磷定[1]和常规静注经验剂量氯磷定两种方法治疗急性有机磷中毒(AOPP).从胆碱酯酶(CHE)的恢复情况,病人临床症状的改善以及有无中间综合征(IMS),迟发性神经症状等方面比较两种方法的优劣.