BackgroundKawasaki disease (KD) is a systemic medium-vessel vasculitis of early childhood that, rarely, has been reported during the course of a pediatric burn. Because persistent fever, rash, and mucocutaneous changes overlap with the systemic inflammatory response to a burn wound, KD can go unrecognized, delaying the administration of intravenous immunoglobulin (IVIG), which reduces the risk of coronary sequelae.Case descriptionA previously healthy 1-year-old boy sustained a 6% total body surface area deep partial-thickness scald to the left lower limb. The wound healed with conservative dressing care and was almost completely re-epithelialized (>99%) by postburn day 10. On that same day, he developed an abrupt, persistent fever that peaked at 39.5°C–40°C and did not respond to empirical antibiotics. Over the next 48 h, he developed bilateral non-purulent bulbar conjunctival injection, erythematous cracked lips with a strawberry tongue, a polymorphous trunk rash, palmoplantar erythema with hand induration, and non-suppurative cervical lymphadenopathy (largest node 20 × 15 mm). Investigations showed neutrophilic leukocytosis (WBC 16.22 × 10⁹/L), a C-Reactive Protein (CRP) level of 42.65 mg/L, mild hyperbilirubinemia and transaminitis, and elevated levels of IL-6, soluble IL-2 receptor, and TNF-α. The platelet count was 456 × 10⁹/L at admission, 384 × 10⁹/L during the acute phase, and increased to 657 × 10⁹/L during convalescence. Infectious and rheumatological differentials were excluded. The patient met all six principal criteria of the JCS/JSCS 2020 guideline, leading to a diagnosis of complete KD. He received IVIG (2 g/kg) and oral aspirin (30 mg/kg/day, tapered after defervescence). Fever resolved within 24 h, followed by periungual desquamation. Transthoracic echocardiography showed a patent foramen ovale without coronary artery abnormalities, and repeat imaging at approximately 1 week and 1 month after onset confirmed normal coronary arteries with no evidence of aneurysms.ConclusionThis case illustrates that KD can emerge as a burn wound re-epithelializes, at which point the reappearance of fever is easily misattributed to an intercurrent infection. Across the present case and 13 previously reported, primary-source-verified cases, burn-associated KD occurred in children aged 5 years or younger, usually presented within about 2 weeks of the burn, mostly followed modest burns, and responded promptly to IVIG, with acute coronary artery changes observed in a minority (three of 14) that regressed after treatment. Whether burn injury triggers KD or the two co-occur by chance cannot be determined from a single case; the practical message is that clinicians should re-examine all mucocutaneous surfaces and consider KD in any pediatric burn patient with unexplained persistent fever, so that IVIG is not delayed.

OBJECTIVE:To investigate the association between craniofacial scar severity and psychological status in patients with craniofacial scars. METHODS:This cross-sectional study enrolled adult patients with craniofacial scars. Scar severity was objectively assessed using the Vancouver Scar Scale (VSS), while depressive and anxiety symptoms were evaluated using the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7), respectively. Multivariable linear regression analyses were performed to examine the associations between scar severity and psychological outcomes, adjusting for age, sex, scar etiology, scar location, time since injury, appearance-exposed occupation, prior psychological history, and previous scar treatment. RESULTS:After multivariable adjustment, higher VSS scores were significantly associated with higher PHQ-9 and GAD-7 scores. Time since injury showed a negative association with both depressive and anxiety symptom scores. Other demographic and clinical variables were not significantly associated with psychological outcomes after adjustment. CONCLUSION:Greater objective severity of craniofacial scars may be associated with increased depressive and anxiety symptoms. These findings highlight the importance of psychological assessment and appropriate support in the comprehensive management of patients with craniofacial scars.

This prospective interventional study investigated the impact of individualized nutritional interventions on immune function and infection rates in burn patients. This study enrolled 120 burn patients between December 2022 and January 2024. The nutritional interventions focused on protein supplementation, micronutrient replenishment, and inclusion of anti-inflammatory nutrients, specifically omega-3 fatty acids and vitamin C. The nutrients were administered through oral, enteral, and parenteral routes based on dietary preferences and the medical condition of individuals. Protein was prioritized because of its role in leukocyte production; zinc and vitamin C were supplemented to optimize immune function; and omega-3 fatty acids were included to mitigate inflammation and enhance wound healing. The study assessed outcomes through changes in leukocyte and lymphocyte counts, cytokine levels, infection rates, wound healing rates, and the length of hospital stays. Results indicated significant improvements in immune markers and reduced infection rates post-intervention (P < 0.05). Leukocyte count increased significantly, cytokine levels decreased, and the infection rate reduced from 30% to 14.2% (P < 0.05). These outcomes highlighted the efficacy of targeted nutritional interventions in supporting immune health and reducing infections in burn patients. The findings advocated for integrating comprehensive nutritional strategies in managing burn injuries to improve clinical outcomes.

摘要: 患者男,50岁,因右肩部反复发生肿物30年、再次发现肿物3个月于2021年4月就诊。1991年患者20岁时初次发现右肩部1个黄豆大小、凸出的肿物,同年7月10日在泰州人民医院紧贴肿物边缘切除,术后病理诊断"纤维瘤"……

Background: Circular RNA (circRNA) has been proved to mediate the biological functions of fibroblasts to participate in the regulation of keloid formation. However, the role of circCOL5A1 in keloid formation remains to be further confirmed.Methods: Primary keloid fibroblasts were isolated form keloid tissues. The expression of circCOL5A1, microRNA (miR)- 877-5p, and early growth response 1 (EGR1) were determined by quantitative real-time PCR. Transfection experiments were carried out to explore the effects of circCOL5A1, miR-877-5p, and EGR1 on cell functions. Cell proliferation, migration, invasion and apoptosis were detected using cell counting kit 8 assay, colony formation assay, transwell assay and flow cytometry. The protein levels of apoptosis markers, extracellular matrix (ECM) markers and EGR1 were measured by western blot analysis. The mechanism of circCOL5A1 was confirmed by RNA pull-down assay, dual-luciferase reporter assay and RIP assay.Results: Our data showed that circCOL5A1 was upregulated in keloid tissues and fibroblasts. Silencing of circCOL5A1 had an inhibition effect on proliferation, migration, invasion and ECM production, while had a promotion effect on apoptosis in keloid fibroblasts. MiR877-5p could be sponged by circCOL5A1, and its overexpression could repress the biological functions of keloid fibroblasts. The rescue experiments showed that miR-877-5p inhibitor could reverse the suppressive effect of circCOL5A1 knockdown on the biological functions of keloid fibroblasts. In addition, EGR1 was a target of miR-877-5p, and its expression was positively regulated by circCOL5A1. The inhibition effect of miR-877-5p on the biological functions of keloid fibroblasts could be abolished by EGR1 overexpression.

Introduction: Negative pressure wound therapy (NPWT) has been used in reducing the incidence of surgical site infections (SSIs) and wound complications across various surgical categories. SSIs are a common post-surgical com-plication following caesarean section (CS) births, making it necessary to use prophylactic interventions to reduce SSI and wound complication incidences.Aim: To conduct an updated meta-analysis on randomized controlled trials (RCTs) comparing SSI incidence and wound complications in women undergoing C-sections receiving NPWT or standard dressings after wound closure.Material and methods: A systematic literature review was conducted using MEDLINE and CENTRAL databases, and clinical trial registries for RCTs that involved NPWT versus standard dressings in participants undergoing C-section procedures. The primary outcome was surgical site infection (SSI) and other wound complications (haematoma, dehiscence, seroma.Results: A total of 11 RCTs were included in the meta-analysis with information from 5,693 patients. A reduction in overall SSI incidence (RR = 0.79, 95% CI: 0.66-0.95, p = 0.01, I2 = 0%) and wound complication rate (RR = 0.86, 0.75 to 0.98, p = 0.02, I2 = 5%) was found with all studies pooled together. Subgroup analyses showed that NPWT did not significantly reduce SSI incidence when stratified by the type of C-section (emergency/elective) whereas the type of NPWT device had a differential effect on SSI reduction, with PICO NPWT systems showing a beneficial effect (RR = 0.72, 0.58 to 0.91, p = 0.006, I2 = 0%) in comparison to the PREVENA closed-incision device (RR = 0.94, 0.68 to 1.29, p = 0.73, I2 = 0%).Conclusions: Prophylactic NPWT is useful in reducing the incidence of SSIs in women undergoing C-sections based on synthesis of results from RCTs in obese women (BMI > 30 kg/m2).

目的 探讨B和T淋巴细胞弱化因子(BTLA)基因rs1982809多态性对重度烧伤患者脓毒症风险和患者预后的影响.方法 选择江苏省泰州市人民医院烧伤科2018年8月-2021年8月因严重烧伤入院接受治疗患者为研究对象,根据患者烧伤后是否发生脓毒症,将其分为脓毒症组和对照组.所有患者均在入院当天采血,以实时荧光定量聚合酶链式反应(RT-PCR)检测BTLA基因rs1982809位点多态性分布.通过电子病历系统调取并收集患者年龄、性别、总体表面积(TBSA)、Ⅲ度烧伤面积、合并吸入性损伤和机械通气情况;根据实验室检查结果统计发生脓毒症患者脓毒症确诊当天C-反应蛋白(CRP)、血乳酸和急性生理与慢性健康评分Ⅱ(APACHEⅡ)情况;统计脓毒症患者入院7 d预后.结果 脓毒症组和对照组患者BTLA基因rs1982809位点TT、TC和CC基因型分布实际频数和理论频数比较差异均无统计学意义;脓毒症组携带BTLA基因rs1982809位点CC基因型和C等位基因频率高于对照组,TT基因型和T等位基因频率低于对照组(P＜0.05);携带CC基因型脓毒症患者血清血乳酸和APACHEⅡ评分高于TT+TC组,且其7d死亡人数高于TT+TC组(P＜0.05).结论 BT-LA基因rs1982809位点CC基因型增加严重烧伤患者发生脓毒症风险,且与病情严重程度及患者预后相关.

南京医科大学附属泰州人民医院整形外科专业基地住院医师规范化培训过程中,在坚持现行培训内容与标准、有利于质量提升的总体原则下,积极开展以"分层递进、螺旋上升"为方向的培训模式,探索建立以进阶式培训为导向、符合整形外科专业特点的培训带教模式,取得了良好的效果,建立了一套适合中国国情的整形外科专科医师培训制度,为中国整形外科专业人才的培养打好基础.

Melanoma is a kind of aggressive skin neoplasms with high mortality. The purpose of this present research was to investigate the effects and potential mechanisms of long-noncoding RNA (lncRNA) MSC antisense RNA 1 (MSC-AS1) in melanoma. MSC-AS1, miR-330-3p and YAP1 expression levels in melanoma tissues and cells were assessed by quantitative real-time polymerase chain reaction. Melanoma cells were evaluated using cell count kit-8, clone formation and ELISA in vitro . The relationship among MSC-AS1, YAP1 and miR-330-3p was validated by pull-down and luciferase reporter assays. Finally, the role of MSC-AS1 in vivo was determined by the xenograft model. Results showed that lncRNA MSC-AS1 was upregulated in melanoma tissues and cells. High expression of MAS-AS1 was positively correlated with a poor prognosis. Pull-down and luciferase reporter demonstrated that miR-330-3p specifically binds directly to YAP1 and MSC-AS1, respectively. MSC-AS1 promoted the expression of YAP1 by downregulating miR-330-3p. Functional experiments suggested that knockdown of MSC-AS1 suppressed the proliferation of melanoma cells and decreased the levels of glutamine, glutamate and α-ketoglutarate, glutaminase and glutamine transporter alanine-serine-cysteine transporter 2. Upregulation of miR-330-3p alleviated the promotion effect of MSC-AS1 overexpression on the proliferation and glutaminolysis of melanoma cells. The above changes could be reversed by YAP1 overexpression. In addition, knockdown of MSC-AS1 dramatically restrained the growth of melanoma cells in xenograft model. In conclusion, our results revealed that MSC-AS1 facilitated the proliferation and glutaminolysis of melanoma cells by regulating miR-330-3p/ YAP1 pathway, suggesting that MSC-AS1 could provide a new idea for the treatment of melanoma.

OBJECTIVE:Skin cutaneous melanoma (SKCM) is a common cutaneous malignant tumour. This study explored the expression and the downstream regulation mechanism of guanylate binding protein 2 (GBP2), an interferon (IFN)-induced protein, in SKCM.METHODS:Western blot was employed to verify the expression of SBP2 and its downstream Wnt/β-catenin pathway-related proteins. We studied the relationship between GBP2 and the SKCM prognosis through database analysis. In vitro, gain-and-loss-of function experiments were conducted in SKCM cells. Cell viability was monitored by the cell counting kit-8 (CCK8) assay, the colony formation assay detected cell proliferation, and apoptosis was verified by flow cytometry. Transwell assay was conducted to test cell invasion and migration, while Western blot was employed to monitor the epithelial-mesenchymal transition (EMT) of SKCM cells.RESULTS:The GBP2 expression in SKCM cells and tissues was lower than normal cells and tissues. GBP2 overexpression inhibited SKCM cell proliferation, migration, invasion, and EMT and promoted cell apoptosis. In contrast, the GBP2 knockdown had the reverse effect. Mechanically, Wnt/β-catenin was inactivated by GBP2 overexpression and was enhanced by GBP2 knockdown. Drug activation of Wnt/β-catenin significantly attenuated the malignant phenotypic inhibition induced by GBP2 up-regulation in SKCM cells.CONCLUSION:GBP2 exerts anti-tumour effects by inhibiting the Wnt/β-catenin pathway in SKCM and is related to a favourable prognosis.

Objective:To study the accuracy and stability of mandible osteotomy assisted by navigation robot system.Methods:One 27-year-old female patient with hypertrophic mandible angle was selected from Taizhou People’s Hospital, and five same mandible manikins were made by 3D printing technology, according to the CT scan data of her head. The mandible navigation robot system was built, and the 3D data of the skull was imported into FaceGraph software to form the virtual 3D image, then the osteotomy line was preset according to the "ideal osteotomy line" . The surface features of the manikin was scanned by a 3D laser scanner, and registered with the virtual 3D images. The robot arms transmitted the inter-arm joints angle value to the host computer through signal transmission connections, and the real-time position of the end of the robot arm was calculated, based on the spatial modeling of the robot arms. After the steps above, the coordinates of virtual space, real space and the relative position of the robot arm were unified. With the assistance of navigation system, the operator held the end of the arms and completed 5 cases of osteotomy on mandible manikins. SPSS 20.0 software was used to make descriptive statistics on the total 40 deviation values of the 5 manikins, which were between the actual osteotomy line on the manikins and the preset osteotomy line in the software. One-way ANOVA was performed on the respective deviation values of the five manikins to find out whether there was a difference among deviations of the five manikins.Results:The milling cutter in the end of the robot operated steadily, and could run along the osteotomy line on the mandible manikins preseted before the experiment. The deviation value between the actual osteotomy line and the preset one in the pre-set locations was (0.92±0.43) mm (95%CI: 0.78-1.05 mm); there was no statistic difference of the deviation values comparing the five manikins with one-way ANOVA ( F=0.320, P>0.05). Conclusions:Under the operator’s control, the navigation robot system can perform an osteotomy to the mandible model accurately and stably according to the preset osteotomy line.

目的 探讨臀大肌肌瓣结合皮瓣治疗褥疮合并坐骨结节囊肿的疗效.方法 2011年1月至2019年9月,共收治褥疮合并坐骨结节囊肿患者14例,行褥疮和坐骨结节囊肿切除手术,所有患者均一期用臀大肌肌瓣结合任意皮瓣修复创面.结果 2例患者术后皮瓣切口部分裂开,分别在二期缝合和小面积植皮后愈合;其余患者术后愈合良好.结论 臀大肌肌瓣结合皮瓣修复创面是治疗褥疮合并坐骨结节囊肿的有效方法.

目的 对比研究包扎疗法及清创磨痂丝蛋白敷料覆盖疗法两种干预方式治疗面部深Ⅱ度烧伤的疗效.方法 对2015年1月至2018年12月于我科住院治愈的面部深Ⅱ度烧伤的131例患者进行研究,依患者烧伤的治疗方式分为包扎治疗组及清创磨痂丝蛋白敷料覆盖组,在创面愈合时间、换药次数、色素改变、瘢痕形成等四个方面进行对比研究.结果 对于面部深Ⅱ度烧伤,清创磨痂丝蛋白敷料覆盖治疗相比包扎治疗不仅能减少换药次数,还能促进创面愈合.结论 清创磨痂丝蛋白敷料覆盖法是治疗面部深Ⅱ度烧伤的一个更好的选择.

目的 研究不同剂量氨溴索联合乌司他丁对重度烧伤患者血气指标及脂质过氧化物(LPO)、丙二醛(MDA)、总抗氧化能力(TAO)、髓过氧化物酶(MPO)的影响.方法 选取泰州市人民医院2017年5月至2019年10月收治的58例重度烧伤患者,按随机数字表法分为观察组和对照组,各29例.对照组患者采用常规剂量氨溴索联合乌司他丁治疗,观察组患者给予大剂量氨溴索联合乌司他丁治疗,两组患者均连续治疗10 d.比较两组患者治愈率,治疗前后血气指标,血清LPO、MDA、TAO、MPO水平以及并发症发生情况、呼吸机使用时间.结果 观察组患者的治愈率为96.56％,高于对照组的68.97％;与治疗前相比,治疗后两组患者第1秒最大用力呼气容积(FEV1)、最大呼气峰流速(PEF)、用力呼气25％时瞬时流量(PEF25％)、用力肺活量(FVC)及观察组患者动脉血氧分压(PaO2)/吸入氧浓度百分比(FiO2)、血清TAO水平均显著升高,且观察组显著高于对照组;两组患者动脉血二氧化碳分压(PaCO2)、血清LPO、MDA水平均显著降低,且观察组显著低于对照组(均P<0.05);两组患者血清MPO水平治疗前后比较,差异无统计学意义(P>0.05);与对照组相比,观察组患者ALI、ARDS的发生率均降低,呼吸机使用时间明显缩短(均P<0.05).结论 大剂量氨溴索联合乌司他丁治疗重度烧伤可有效改善肺功及血气指标,减轻氧化应激反应,降低并发症的发生率,临床疗效显著提高.

目的:了解微动力负压引流技术在烧伤难愈创面的临床预后.方法:2016年1月-2018年12月收治烧伤难愈创面患者50例,随机分为两组,各25例.常规组采取常规处理治疗;微动力组采取常规处理+微动力负压引流技术治疗.比较两组治疗效果.结果:微动力组烧伤难愈创面愈合效率、烧伤难愈创面愈合平均时间、平均换药次数、疼痛视觉模拟评分、烧伤难愈创面分泌物炎症监测指标水平均优于常规组,微动力组医疗费用少于常规组,差异均有统计学意义(P<0.05).结论:常规处理+微动力负压引流技术治疗烧伤难愈创面效果好,可有效加速创面愈合,减轻患者痛苦,控制炎症,减少费用.

目的 探讨三种不同术式治疗大面积烧伤的临床效果.方法 回顾性分析2016年8月1日～2018年11月我院收治的33例大面积烧伤患者临床资料,依据植皮方式不同分为微粒皮组(6例)、自异种皮混合移植组(7例)、邮票植皮组(20例),三组分别予以微粒皮联合异体大张皮移植手术、自体异种皮混合移植手术以及邮票植皮手术.对比三组治疗和预后情况.结果 三组在创面愈合时间方面、植皮成活率方面和住院费用方面,差异有统计学意义(P<0.05).在创面愈合率方面,邮票皮组高于微粒皮组、自异种皮混合移植组,差异有统计学意义(P<0.05).在手术费用方面,邮票皮组低于自异种皮混合移植组、微粒皮组,差异有统计学意义(P<0.05).在植皮成活率方面,自异种皮混合移植组、邮票皮组高于微粒皮组;而创面愈合时间则短于微粒皮组,差异有统计学意义(P<0.05).自异种皮混合移植组痊愈率高于微粒皮组、邮票皮组,但差异无统计学意义(P>0.05).三组在病死率方面,差异无统计学意义(P>0.05).结论 三种植皮方式用于修复大面积烧伤创面临床疗效均较确切,其中邮票皮术创面植皮成活率高、愈合效果较好且手术费用较低,但其仅仅适用于有较多的供皮区的患者.自异种皮混合移植术其适用于工皮区较少,需植皮面积较大的患者,但创面愈合效果较好.微粒植皮手术适用于供皮区极度不足的患者,移植成功后扩展率较高,但植皮成活率低且愈合效果较差,使用需谨慎.临床治疗时应依据患者实际情况灵活选择术式.

From April 2017 to April 2018, three male patients aged 46-71 years with large area burns were treated in our hospital. Acute acalculous cholecystitis (AAC) symptoms of the patients began to appear 15-81 days after injury. AAC was diagnosed 24-81 days after injury. Ultrasound-guided percutaneous transhepatic cholecystostomy was performed 26-82 days after injury. The symptoms subsided in 2 patients, and cholecystectomy was performed in 1 patient with gallbladder perforation 94 days after injury. The patients were cured and discharged 41-118 days after injury. No recurrence of cholecystitis occurred during 8-9 months of follow-up after discharge.

目的 探究在医学整形的鼻整形中透明质酸钠注射的临床效果和影响,从而为医疗事业的健康发展提供建设性意见.方法 对我院2015年5月-2017年5月前来接受治疗的250名患者进行研究,所有患者均为自愿参与研究.在研究开展前将患者随机分为两个不同组别,分别为整形1组和整形2组,每组患者均为125人.整形1组患者采用传统鼻整形法进行整形,整形2组患者采用扇形注射等方法来进行透明质酸填充.在整形结束后对比两组患者的整形效果以及不良反应发生情况.同时在手术过后的一年之内对患者进行跟踪随访,了解患者治疗后的持续作用.结果 在整形1组的患者中,有14例出现了毛细血管方面的问题;有29例患者出现淤青等情况.在整形2组的患者中有3例出现了毛细血管方面的问题;有4例患者出现淤青且该情况能够自行缓解,无其他明显并发症.结论 通过注射透明质酸进行隆鼻风险较小,能达到理想效果且患者不良反应发生率较少.因此此种整形手段具有显著的临床价值,值得大力推广并使用.

目的:介绍"三明治"腹壁带蒂皮瓣移植术在修复手双侧创面中的应用.方法:针对12例手掌、背侧同时受损创面,应用两个方向相对的腹壁带蒂皮瓣分别覆盖手双侧创面,呈"三明治"状包裹患手,术后3周断蒂,后期再行皮瓣修薄术,改善皮瓣形态.结果:12例患者手掌、背侧皮瓣均成活良好,形态可,手部活动自如,效果满意.结论:"三明治"腹壁带蒂皮瓣移植术能简单、有效地同时修复手双侧创面,具有推广应用的价值.

目的 研究分析深Ⅱ度烧伤创面修复中富含血小板血浆外敷的应用效果.方法 将2016年2月～2018年2月在本院烧伤整形科接受治疗的深Ⅱ度烧伤患者共52例作为研究对象,在每位患者的创面中选择一块深Ⅱ度烧伤创面,将烧伤创面均分为面积相近、创面深度一致的两块,分别作为观察组和对照组,则每组有52块烧伤创面.对照组使用磺胺嘧啶银霜进行治疗,观察组使用富含血小板血浆凝胶覆盖创面,对比治疗效果.结果 观察组的创面愈合率都要高于对照组,且创面完全愈合的时间短于对照组,差异明显,有统计学意义(P<0.05).结论 在应对深Ⅱ度烧伤创面时,使用富含血小板血浆进行创面的外敷,能够促进创面快速愈合,减少中途换药的次数,提高患者的恢复效果,值得在临床上进行推广使用.