Objective: To investigate the clinical effects of negative pressure wound therapy (NPWT) in treating the poor healing of incisions after different abdominal operations. Methods: The retrospective observational study was conducted. From June 2019 to December 2020, 42 patients with poor healing of incisions after abdominal surgery were admitted to Center of Burns and Trauma of the First Affiliated Hospital of Naval Medical University, including 29 males and 13 females, aged 23-81 years. The disease course of poor healing of abdominal incision was 3-60 d. The preoperative examination of patients was completed after admission, and NPWT was used after debridement. According to the dehiscence level of incision, the negative pressure value of -10.64 to -6.65 kPa was set. The incisions were sutured in the second stage when the incisions had good blood circulation. The cause of abdominal surgery, the dehiscence level and the cause of poor healing of abdominal incision were investigated, and the final healing of abdominal incision and the occurrence of complication were observed. Results: The causes of abdominal operations in this group of patients who ocurred poor healing of abdominal incisions were ranked according to the composition ratio, with the top 4 causes being colon cancer (9 cases, accounting for 21.4%), bile duct disease (8 cases, accounting for 19.0%), liver cancer (5 cases, accounting for 11.9%), and appendicitis (4 cases, accounting for 9.5%). There were 25 cases (59.5%) with dehiscence of abdominal incision in the deep fascia layer, and the other 17 cases (40.5%) with dehiscence of abdominal incision in the superficial fascia layer. The causes of poor healing of abdominal incision were ranked according to the composition ratio, with the top 3 causes being infection (24 cases, accounting for 57.1%), fat liquefaction (11 cases, accounting for 26.2%), and suture reaction (5 cases, accounting for 11.9%). The blood circulation in 40 patients was improved after being treated with NPWT, and the incisions were sutured in the second stage. The incisions healed well when the suture lines were removed in the second to third week. Intestinal fistula and bile leakage developed during the NPWT treatment, respectively in the other 2 patients, in which negative pressure equipment was removed subsequently, and the incisions healed after adequate drainage and conventional dressing changes. Conclusions: NPWT is effective in treating poor healing of abdominal incision after different abdominal surgeries. The clinicians need to comprehensively assess the patient's condition to determine when and how to use NPWT to avoid the occurrence of intestinal fistula, bile leakage, and other complications.

The case of long-term complicated infectious mass on the inner thigh root after transobturator urethral sling is rare. This paper reported a case, who underwent a surgery of the "trans-obturator mid-urethral slings" for stress urinary incontinence 9 years ago. A mass on the root of the right thigh was found 3 months ago, accompanied with low fever. About 1cm tape was exposed on the front wall of the right side of the vagina. The patient underwent resection of the mass on the root of the right thigh and partial removal of the tape under spinal anesthesia. After one year’ follow-up, there was no significant change in urinary control ability compared with that before the operation.

目的 探讨双蒂皮瓣在复杂软组织缺损创面修复中的应用价值.方法 2014年1月至2018年12月,海军军医大学(第二军医大学)长海医院烧创伤外科对92例因肿瘤、创伤等因素导致软组织缺损的患者行双蒂皮瓣移植术,观察并记录病因、缺损部位、双蒂皮瓣的长宽比和覆盖创面的面积、供瓣区的处置方式、血管穿支的保留情况、双蒂皮瓣的成活情况、供瓣区是否需要二次手术等.结果 92例患者中,引起缺损的原因包括肿瘤切除术后49例、外伤36例(骨外露17例、内固定外露12例、肌腱外露7例)、其他原因7例(压疮5例、电烧伤2例).软组织缺损部位依次为小腿(28例)、踝(16例)、大腿(14例)、躯干(12例)、上肢(11例)、臀部(6例)、足(5例).双蒂皮瓣的长宽比为1.2～2.8,平均覆盖创面面积为(16.55±4.83)cm×(9.88±4.20)cm.供瓣区的处置方式包括直接缝合43例、延迟缝合26例、植皮23例.9例因皮瓣转移跨度、面积或长宽比较大,在分离时保留部分肌皮血管穿支.术后21 d时,89例皮瓣完全成活,3例皮瓣边缘少许坏死,祛除坏死部分后拉拢缝合.9例供瓣区存在残余创面,行二次植皮手术.结论 双蒂皮瓣具有操作简便、存活可靠、创伤较少、部分供瓣区能直接或延迟缝合的优势,在肿瘤、创伤等复杂软组织缺损创面的修复中具有良好的应用价值.

Objective:To explore the effect of neurolysis and tendon transplantation in functional reconstruction of the upper limb with severe thermal crush injury.Methods:A retrospective case series study was conducted to analyze the clinical data of 12 patients with thermal crush injuries of the upper limb admitted to Changhai Hospital of Naval Medical University from January 2014 to December 2018. There were 9 males and 3 females, aged 22-54 years (mean, 38 years). The percentage of total body surface area (TBSA) burn ranged from 3% to 8% [(4.9±1.4)%], and wound depth was III degree. According to the damage condition of nerve/tendon and whether there was any dysfunction of the affected limb after wound healing, 12 patients received 2 to 4 times of neurolysis and tendon transplant-related surgeries, with an average surgery of 2.7 times. Among them, a total of 18 times of neurolysis were performed, including 7 times of radial neurolysis, 6 times of median nerve neurolysis and 5 times of ulnar neurolysis, and 14 times of tendon transplantation were done, including 6 times of anastomosis of superficial flexor tendon and long thumb extensor tendon, 5 times of tendon repair transplantation and 3 times of anastomosis of lateral wrist extensor tendon and long thumb extensor tendon. The time interval of each operation was 3-6 months [(4.5±1.0) months]. The Changhai pain ruler, disability of arm-shoulder-hand table (DASH) and joint activity assessment table were assessed before the first operation, 3 months and 6 months after the last operation.Results:All the patients were followed up for 6-12 months (mean, 9.2 months). The score of Changhai pain ruler in the affected limb improved from 3 (2, 3)points before surgery to 1 (0.5, 1)points 3 months after surgery and 1 (0, 1)points 6 months after surgery ( P<0.01). The score of DASH improved from (69.9±2.7) points before surgery to (35.1±1.7) points 3 months after surgery and (33.8±2.0) points 6 months after surgery ( P<0.01). The range of motion score was improved from (1.3±0.5) points before surgery to (2.4±0.5) points 3 months after surgery and (2.8±0.4) points 6 months after surgery ( P<0.01). Conclusion:Neurolysis and tendon transplantation in the treatment of severe thermal crush injuries of the upper limb can alleviate pain in the affected limbs, improve upper limb dysfunction, increase mobility of the palm and upper limb joints, and enhance the quality of life of the patients.

The soluble form of the migration inhibitory factor receptor cluster of differentiation 74 (sCD74) has previously been shown to be elevated during the development of acute lung injury (ALI) in mice. However, the biological role of increased sCD74 in ALI remans poorly understood. Synthesized recombinant sCD74 protein was administered to mice intratracheally. Pro-inflammatory genes in lung tissue and the inflammatory factors in bronchoalveolar lavage fluid (BALF) were analyzed using RT-PCR and ELISA, respectively. Additionally, RAW264.7, A549, and human umbilical vein endothelial cells (HUVEC) were treated with sCD74, and the resulting pro-inflammatory factor protein and gene expression levels were analyzed in the supernatants and cell lysates. Meanwhile, the level of nuclear factor (NF)-κB components in cell lysates after stimulating macrophages with sCD74 was also assessed. After administration of 0.5 mg/kg body weight sCD74 to mice, the expression of Tnfa, Mip2, and Il6 increased in lung tissues after 2 h by 2.1-, 3.4-, and 2.8-fold, respectively. Moreover, the BALF concentrations of TNF-α and MIP-2 reached maximal levels of 560 and 107 pg/mL at 8 h compared to those in the saline group, respectively. Similarly, TNFA, MIP2, and IL6 expression increased by 4.0-, 11.8-, and 2.6-fold, respectively, 2 h after stimulating macrophages with 1000 ng/mL sCD74. The levels of phospho-IκB and phospho-p65 were also significantly increased in the cytoplasm and nucleus of macrophages following sCD74 stimulation. Taken together, these results suggest that sCD74 is a critical cellular factor involved in the lung acute inflammatory response through nuclear factor-κB signaling.

BACKGROUND:Acute lung injury (ALI) is a common disease that usually progresses to acute respiratory distress syndrome (ARDS) with high morbidity and mortality. We aim to analyze the trends in ALI/ARDS, and to compare the differences in aspects of years, countries, institutions, journals, etc. Methods: We screened all relevant literature on ALI/ARDS from Web of Science during 2009-2019, and analyzed the research trends in this field by VOSviewer.RESULTS:We had screened 7,890 publications with a total cited frequency of 164,713. The United States contributed the largest number of publications (2,612, 33.11%), cited frequency (81,376, 48.61%), and the highest H-index (107). Journal of Critical Care Medicine published the largest number of literatures on ALI/ARDS, MATTHAY MA published the majority of articles in this field (147), while SLUTSKY AS received the most cited frequency (10015). University of California San Francisco had the largest number of publications (243, 3.08%) among all full-time institutions. In the aspect of clinical research in ALI/ARDS, the keyword "Berlin definition" emerged in recent years, with an average year of 2016.3; in the basic research, the key word "protects" appeared latest, and the average years were 2016.5. The current research trend indicates that basic research is gradually transforming into clinical research.CONCLUSIONS:The United States have made the most significant contribution to the ALI/ARDS field in the last decade. The current research 'hotspot' mainly appeared in clinical research, such as "Berlin definition". In regards to basic research, studies tend to explore the protective mechanisms against ALI/ARDS.

肺部疾病是临床常见病,其发病率逐年升高且治疗难度日益增大,严重威胁人类的生命健康.高通量测序和基因芯片技术的长足发展使得被学术界忽略已久的环状RNA(circRNA)再度成为研究热点.CircRNA在生物体内均有广泛表达,对生物功能发挥着重要的调控作用,并具有高度的特异性、稳定性和保守性,在疾病的诊疗方面潜力巨大.本文总结了circRNA在肺部疾病中的研究进展,为肺部疾病的诊治提供一定的理论依据.

Objective: To explore the effect of debridement combined with vacuum sealing drainage (VSD) on the treatment of severe infection in abdominal wall due to allogeneic umbilical cord embedded in abdominal wall for immunotherapy. Methods: From January 2015 to December 2016, 12 patients with severe infection in abdominal wall due to allogeneic umbilical cord embedded in abdominal wall for immunotherapy were admitted to our department. They were conducted with systemic anti-infective treatment, local debridement, and VSD. The wounds were continuously washed for 3 to 5 days after the VSD device installed, with negative pressure value from -16.0 to -12.0 kPa. The VSD device was removed 5 to 7 days later. Continue wound dressing by aseptic ribbon gauze was stuffed in the cavity, and the incision was sutured after the granulation tissue grew well in the cavity. Results: In all patients, allogeneic umbilical cords were completely removed and abdominal infection was cured. The wounds healed well, the sensory function of abdominal was normal, and the activity was not restricted. All the patients were followed up for 3 to 6 months with no reinfection or incisional hernia. Conclusions: Embeding the whole allogeneic umbilical cord in abdominal wall for immunotherapy can lead to severe infection in abdominal wall. Abdominal infection can be cured by debridement combined with VSD with good clinical results.

烧伤是战时陆地和海上的常见伤类,且随着武器性能的提高呈上升趋势.海军一线医务人员熟练掌握舰船烧伤的基本特点与处理原则,是增强战时卫勤保障能力,提高伤员存活率和改善功能恢复的必然要求.战时舰船烧伤伤员往往为批量出现、救治困难,平时船舶火灾相关的烧伤也是伤情复杂、治疗难度大.本文探讨了舰船烧伤流行病学特点、伤情判断的常用方法、现场急救与早期治疗的相关措施,以及烧烫伤的预防策略与舰船火灾逃生对策.

OBJECTIVETo evaluate the effectiveness of liquid wound dressing in the treatment of chronic ulcer wounds.METHODSBetween January 2014 and October 2015, 84 patients with chronic ulcer wounds were included and divided into 2 groups randomly. The chronic ulcer wounds were covered with liquid wound dressing in the treatment group (n=44) and were managed with iodophor in the control group (n=40). There was no significant difference in age, gender, causes, location, wound area, and disease duration between 2 groups (P>0.05). The frequency of dress changing, effective rate of treatment, wound healing time, wound healing rate at 5, 10, and 20 days, positive rate of bacteria culture at 1, 5, and 10 days, and the rate of side effect were recorded and compared between 2 groups. Vancouver scar scale was used to evaluate scar formation.RESULTSThe effective rate of the treatment group (100%) was significantly higher than that of the control group (85%) (P=0.009). The frequency of dress changing in the treatment group[(11.36±3.40) times] was significantly lower than that in the control group[(16.94±4.51) times] (t=-6.231, P=0.000). The wound healing rates at 5, 10, and 20 days were significantly increased (P<0.05) and the wound healing time was significantly decreased (t=-6.627, P=0.000) in the treatment group when compared with the control group. The positive rates of bacteria culture at 5 and 10 days in the treatment group were significantly lower than those in the control group (χ2=12.313, P=0.000; P=0.005), but no significant difference was found at 1 day (χ2=0.066, P=0.797). Side effect was observed in 4 cases of the control group. Vancouver scar scale score was 8.59±1.32 in the treatment group and was 9.85±1.65 in the control group, showing significant difference (t=-3.752, P=0.000).CONCLUSIONSThe application of the liquid wound dressing in the treatment of chronic ulcer wound can improve the wound healing rate, shorten the healing time and decrease the frequency of dress change, which could promote the wound healing process.

目的 与传统的切削痂自体中厚皮移植术相比,探讨切削痂人工真皮支架植入术+自体刃厚皮移植术修复特重烧伤患者手足深度创面的疗效.方法 选择2012年3月至2015年3月第二军医大学长海医院烧伤外科收治的有手足深度创面的特重烧伤患者作为研究对象.符合纳入标准的28例患者按手术方法不同分为两组,观察组(14例)在伤后第4～7天行四肢深度创面切削痂、生物敷料覆盖+手足创面切削痂、人工真皮支架植入术,伤后第21～28天行手足创面自体刃厚皮移植术;对照组(14例)在伤后第4～7天行四肢深度创面切削痂、生物敷料覆盖术,手足深度创面以保痂换药为主,第28～35天行手足深度创面切削痂自体中厚皮移植术.记录每次手术持续时间、植皮成活情况、皮片坏死的原因、供皮区愈合时间、能否再次供皮、随访手足瘢痕增生情况.结果 观察组第1次手术持续时间(h)与对照组比较差异无统计学意义[(4.50±0.76) vs(4.14±0.86),P＞0.05];第2次手术持续时间(h)少于对照组[(2.11±0.35) vs (3.39±0.49),P＜0.001].植皮术后第8天打开换药时,观察组皮片全部成活者占97.37％(37/38),创面出现感染者占2.63％(1/38);对照组皮片全部成活者占73.68％(28/38),部分成活者占23.68％(9/38),创面感染者占2.63％(1/38).观察组供皮区愈合时间(d)少于对照组[(6.07±0.83) vs(14.64±0.93),P＜0.001].经评估观察组可再次供皮者占78.57％(11/14),对照组可再次供皮者占14.29％(2/14,P＜0.05).随访1年,根据温哥华瘢痕量表评分(分)观察组手足瘢痕增生情况好于对照组[(5.07±1.21) vs (8.07±1.14),P＜0.001].结论应用人工真皮支架能早期修复特重烧伤手足深度创面,不需额外增添手术操作时间,植皮成活情况及远期活动功能可,对供皮区损伤小.

目的 研究人工真皮支架在大面积撕脱伤救治中的应用.方法 回顾性分析第二军医大学长海医院烧创伤外科2011年1月至2014年12月收治的大面积撕脱伤患者20例,年龄6～68岁,撕脱面积占总体表面积(total body surfacearea,TBSA) 10％～40％.按照治疗方法不同将患者分为两组,每组各10例,对照组患者一期行清创+负压引流术,二期行取植皮术;治疗组患者一期行清创+真皮支架+负压引流术,5～7 d后更换负压装置,观察基底血管化程度,伤后12～14 d行取植皮术.分别统计两组患者从清创到植皮的间隔时间,供皮区愈合时间和愈合质量以及植皮区皮片成活率、愈合时间及愈合质量.结果 与对照组相比,治疗组患者从清创到植皮的间隔时间延长[(13.30±2.06)d vs (7.90±1.10)d,P＜0.01];供皮区愈合时间缩短[(8.10±0.99)d vs(13.10±1.10)d,P＜0.01],供皮区愈合质量提升(4.40±1.58 vs7.80±1.14,P＜0.01);植皮区皮片成活率[(87.30±5.27)％vs (85.10±5.53)％]、愈合时间[(17.80±1.14)d vs (18.70±2.06) d]、愈合质量(8.40±1.07 vs 9.00±1.05)差异均无统计学意义(P＞0.05).结论 在大面积撕脱伤的治疗过程中早期应用真皮支架联合负压引流技术,可避免在伤后1周左右大范围取皮,手术损伤少,对全身干扰小,可保证患者平稳度过病程早期阶段;同时通过支架自身的血管化可促进创面恢复,减少植皮所需皮片厚度,从而缩短供皮区愈合时间、提高供皮区愈合质量.

目的:评价内外科综合治疗重型毛囊闭锁三联征的疗效.方法:对3例严重毛囊闭锁三联征患者进行异维A酸及敏感抗生素治疗后,采用外科清创及植皮术治疗,收集其临床资料并对相关文献进行复习.结果:例1.患者男,26岁.头皮、颈项、背部及臀部多发疖肿、窦道12年;例2.患者男,35岁.颈部、腋窝及腹股沟多发化脓性感染灶10年;例3.患者男,44岁.颈部及背部多发脓性皮疹6年,臀部类似损害2年.所有患者临床表现及皮损组织病理学检查均符合毛囊闭锁三联征.予维A酸类及抗生素等治疗稳定病情后,再行局部病灶切除及植皮术,取得了良好疗效.结论:对于重型毛囊闭锁三联征患者,可内科治疗控制病情,外科完整切除病灶可以达到根治目的.

反常性痤疮又称为毛囊闭锁三联征、Verneuil病、化脓性汗腺炎,是一类较少见的以反复发生的皮肤脓肿、结节伴窦道和瘢痕形成为特征的慢性化脓性皮肤附属器疾病[1].第二军医大学附属长海医院皮肤科采用中厚皮片移植术治愈1例HurleyⅢ级反常性痤疮患者,现报道如下.

The technique of negative pressure wound therapy (NPWT),initially used for better wound healing,has been widely applied to all kinds of refactory wound.This article reviewed the two important techniques including VSD and VAC of NPWT and indicated that the two are different techniques sharing the same principle,but with different materials,methods and indications.Furthermore,this review updated and made a induction of the enhancing mechanism that NPWT can promote wound blood circulation, reduce swelling,inhibit bacterial growth,stimulate growth of granulation tissue to mechanical stress,inhibit cell apoptosis thereby helping wound healing.Meanwhile,the author also summarized recent progress in clinical applications of NPWT used in a variety of acute and chronic wound treatment.In the end,the author provided a prospect for the further development of NPWT in this review.

报道1例患重度反常性痤疮经非手术治疗效果不佳的临床病例,经自体皮移植术治疗获得较好效果,希望能为临床该类疾病的治疗提供一定的借鉴.

目的：与内置吸管式负压创面治疗技术（negative pressure wound therapy，NPWT）比较，总结一种新型吸盘式NPWT联合植皮应用于车祸所致较大面积撕脱伤的体会。方法2012年1月至2013年12月，第二军医大学附属长海医院烧创伤外科共收治43例较大面积四肢躯干等皮肤软组织撕脱伤患者，其中22例采用新型吸盘式 NPWT联合植皮治疗（试验组），21例采用内置吸管式NPWT联合植皮治疗（对照组）。试验组：创面清创处理后，将多个NPWT敷料按创面大小先行拼接排列修剪，贴附于创面并缝合，使用生物半透性薄膜封闭整个创面和敷料，通过N个三通管最后将敷料的硅胶管连接，最后与中心负压吸引装置连接，调节最佳负压吸引状态保持负压恒定[-80～-200 mmHg（1 mmHg＝0．133 kPa）]；对照组：创面清创处理后，敷料直接顺排后用生物半透膜封闭，然后将半透膜开孔接1～2个外置吸盘，采用间隙负压[-80～-160 mmHg（1 mmHg＝0．133 kPa）]，连接自带电源的负压集液罐。两组患者一般资料比较，差异均无统计学意义（P＞0．05），具有可比性。结果试验组：管道堵塞需要更换吸盘比例为1例2处，患者因创面原因出现发热1例，血象改变2例，术后植皮成活率100％；植皮愈合时间（8．9±4．5）d 。对照组：管道堵塞需要更换三通比例为16例98处，术后2例出现皮片局部感染，患者因创面原因出现发热5例，血象改变6例。植皮成活率90．5％；植皮愈合时间（9．4±5．2）d。两组植皮成活率和植皮愈合时间比较，差异未见有统计学意义（P＞0．05）。结论新型吸盘式NPWT适用于车祸所致较大面积撕脱伤创面，具有手术简单、不易堵塞、术后维护方便、创面感染机会少等优点。

Sepsis is a common and critical complication in surgical patients that often leads to multiple organ failure syndrome (MOFS), including acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Despite intensive supportive care and treatment modalities, the mortality of these patients remains high. In this study, we investigated the role of Burton’s tyrosine kinase (BTK), a member of the Btk/Tec family of cytoplasmic tyrosine kinases, in the pathogenesis of sepsis, and evaluated the protective effect of in vivo Btk RNA interference in a mouse model of cecal ligation and puncture (CLP)-induced sepsis. After intratracheal injection of Btk siRNA, the mice were then subjected to CLP to induce sepsis. The results demonstrated that this approach conferred potent protection against sepsis-induced ALI, as evidenced by a significant reduction in pathological scores, epithelial cell apoptosis, pulmonary edema, vascular permeability, and the expression of inflammatory cytokines and neutrophil infiltration in the lung tissues of septic mice. In addition, RNA interference of Btk significantly suppressed p-38 and iNOS signaling pathways in transduced alveolar macrophages in vitro. These results identify a novel role for BTK in lethal sepsis and provide a potential new therapeutic approach to sepsis and ALI.

患者男,28岁,2012年11月15日因接触1万V高压电,自4.5m高处坠落.伤后立即送至当地医院,患者昏迷,双侧瞳孔散大,创面呈黑色焦痂样.急诊CT示:脑疝和硬脑膜外血肿.诊断为:(1)电烧伤四肢、头颅、骶尾部,总面积15％ TBSA,深度Ⅲ～Ⅳ度.(2)脑疝.(3)硬脑膜外血肿.急诊行去除右侧额颞部骨瓣减压和硬脑膜外血肿清除术.术后患者意识逐渐恢复,病情稳定.伤后10～18 d,四肢Ⅲ度创面经多次扩创、植皮手术后大部分愈合,头颅部残余大小约6 cm×5 cm全层皮肤坏死,清创后颅骨外露,骨质无明显缺损.伤后21 d行头部扩张器置入术,放置部位距颅骨外露创面约2 cm.