BackgroundEndoscopic Submucosal Dissection (ESD) is a well-established technique for the removal of early gastrointestinal cancers. However, it is often perceived as time-consuming and carries a higher risk, particularly when dealing with larger lesions, especially those exceeding 3 cm in diameter. In this case report, we introduce the application of Endoscopic Submucosal Tunneling Dissection (ESTD) for the management of a substantial gastric superficial neoplasia, which encompassed a considerable area of early gastric cancer. Although there are several case reports detailing the use of ESTD for the resection of gastrointestinal cancers, there have been no documented instances of utilizing a “Golden Knife” specifically for the treatment of large gastric cancer lesions.Case presentationThis case report details the treatment of a 64-year-old male diagnosed with a large early-stage gastric cancer, measuring approximately 140 mm by 88 mm. The medical team opted for endoscopic submucosal tunneling dissection (ESTD) using a golden knife, a technique chosen for its effectiveness in managing such tumors. Following the procedure, pathological examination indicated a pT1a tumor of the tub2 type, with dimensions of 120 mm by 42 mm. Importantly, all assessments, including ulcer (UL), lymphatic (LY, vascular (V), histological margin (HM), and vascular margin (VM), returned negative results, suggesting no further spread of the cancer. However, post-surgery, the patient experienced gastric stenosis, necessitating additional interventions, which included the placement of a nutritional tube and dilation of the stenosis to alleviate symptoms. The intraoperative strategies employed during the ESTD procedure, along with coordinated care and psychological support throughout the recovery process, played a crucial role in helping the patient regain confidence. This comprehensive approach ultimately contributed to satisfactory outcomes in his recovery journey.ConclusionIn conclusion, ESTD offers a safer and more effective alternative to traditional methods in specific cases, especially for patients with large or challenging gastric lesions who favor a minimally invasive approach.

Patients with extensive and deep skin defects treated with dermal scaffolds usually emphasize the importance of rapid angiogenesis, while overlook the crucial role of skin nerves in regenerative repair. Insufficient early nerve regeneration not only impedes skin reinnervation and angiogenesis, but also damages the synergistic effects among them, eventually hinders healing quality. Nerve growth factor (NGF) has shown potent potential in peripheral nerve regeneration and promotion of angiogenesis. Angiogenin (ANG) is an independent angiogenic factor, supplying microenvironment needed for neurogenesis. This study presents a dermal scaffold with dual gene activity, fabricated by incorporating nanoparticles (NPs) composed of polyethylenimine (PEI)-chimeric plasmids encoding both NGF and ANG (PEI-plasmid NGF/ANG dermal scaffold (NADS)). Specifically, NADS achieves sustained and in situ release of these two factors, and encourages the repair cells to fulfill their regenerative roles. In vivo experiments confirm the efficacy of NADS in promoting fully functional innervated skin regeneration, inducing the fastest healing rates and rapidly facilitating the formation of a mature vascular network, thus resulting in high-quality wound healing. This approach offers an effective and comprehensive strategy for clinical application.

Abstract Purpose The totally implanted venous access port (TIVAP) is widely applied to chemotherapy. The traditional approach is to implant the port by directly cutting skin at the chest wall, but surgical scarring on the chest wall may bring permanent psychological trauma to patients and affect the port once the incision is infected. In this study, the effect and safety of an improved port implantation (noninvasive chest wall implantation) via the axillary approach on breast cancer patients were evaluated. Methods This study discusses the surgical steps of the improved port implantation. The incidences of complication, comfort, convenience, aesthetics, and privacy from the improved operation were analyzed and compared with the traditional operation. Results All patients successfully presented improved infusion port implantation through the axillary access (noninvasive chest wall implantation). Two cases had a hemorrhage during the operation. One case had a postoperative subcutaneous hemorrhage, and one case had a folded catheter. Nevertheless, the patients did not need a secondary operation for adjustment. The average operation time of the improved infusion port implantation was 51.85 min (range: 37–69 min). The improved operation was significantly better than the traditional operation in terms of aesthetics and privacy. In terms of comfort and convenience, the difference between the two operations was not significant. Conclusions This study described the specific steps and particular aspects of the improved operation. The effectiveness and safety of the improved operation were reported for the first time. The improved operation has been proven safe and reliable, and it entails only a few intraoperative and postoperative complications.

AbstractCollagen‐based scaffolds reveals promising to repair severe skin defects. The mechanical strength of collagen‐based scaffold (CCS) limited its clinical application. Embedding poly(lactic‐co‐glycolic) acid (PLGA) knitted mesh into CCS improves the mechanical strength of the scaffold. This study was conducted to optimize the configuration of PLGA knitted mesh‐collagen‐chitosan scaffold (PCCS), and explore possible mechanisms. PLGA knitted mesh was embedded in CCS through freeze‐drying method. With the PLGA knitted mesh located at the bottom, middle, or both bottom and top layers of the CCS, three kinds of PCCS were developed. A full‐thickness skin wound model was established in Sprague Dawley rats to evaluate the therapeutic effects of different PCCS against CCS. The properties and healing effect of the scaffolds were investigated. Several growth factors and chemotactic factors, that is, VEGF, PDGF, CD31, α‐SMA, TGF‐β1, and TGF‐β3 were analyzed and evaluated. Re‐epithelialization and angiogenesis were observed in all animal groups with the treatment of three kinds of PCCS scaffolds and the CCS scaffold (control). The protein and gene expression of VEGF, PDGF, CD31, α‐SMA, TGF‐β1, and TGF‐β3 showed different dynamics at different time points. Based on the healing effects and the expression of growth factors and chemotactic factors, scaffold with the PLGA knitted mesh located at the bottom layer of the CCS demonstrated the best healing effect and accelerated re‐epithelialization and angiogenesis among all the scaffolds evaluated. PCCS with the PLGA mesh located in the bottom layer of the scaffold accelerated wound healing by creating a more supportive environment for re‐epithelialization and angiogenesis.

The vascularization of dermal substitutes is a key challenge in efforts to heal deep skin defects. In this study, dual gene-activated dermal scaffolds (DGADSs-1) were fabricated by loading nanocomposite particles of polyethylenimine (PEI)/multiple plasmid DNAs (pDNAs) encoding vascular endothelial growth factor and angiopoietin-1 at a ratio of 1:1. In a similar manner, DGADSs-2 were loaded with a chimeric plasmid encoding both VEGF and Ang-1. In vitro studies showed that both types of DGADSs released PEI/pDNA nanoparticles in a sustained manner; they demonstrated effective transfection ability, leading to upregulated expression of VEGF and Ang-1. Furthermore, both types of DGADSs promoted fibroblast proliferation and blood vessel formation, although DGADSs-1 showed a more obvious promotion effect. A rat full-thickness skin defect model showed that split-thickness skin transplanted using a one-step method could achieve full survival at the 12th day after surgery in both DGADSs-1 and DGADSs-2 groups, and the vascularization time of dermal substitutes was significantly shortened. Compared with the other three groups of scaffolds, the DGADSs-1 group had significantly greater cell infiltration, collagen deposition, neovascularization, and vascular maturation, all of which promoted wound healing. Thus, compared with single-gene-activated dermal scaffolds, DGADSs show greater potential for enhancing angiogenesis. DGADSs with different loading modes also exhibited differences in terms of angiogenesis; the effect of loading two genes (DGADSs-1) was better than the effect of loading a chimeric gene (DGADSs-2). In summary, DGADSs, which continuously upregulate VEGF and Ang-1 expression, offer a new functional tissue-engineered dermal substitute with the ability to activate vascularization.

Development of extramural health care for chronic wounds is still in its infancy in China, and thus it is urgent and vital to establish a correct concept and practicable principles. The authors reviewed recent domestic and international literature and summarized the following treatment procedures and principles for extramural health care of chronic wounds. (1) The patient needs to do self-assessment of the wound by using available simple methods; (2) The patient consults with professional physicians or nurses on wound care to define the severity and etiology of the non-healing wound; (3) Professionals evaluate the existing treatment strategies; (4) Etiological treatments are given by professionals; (5) Patients buy needed dressings via the more convenient ways from pharmacies, e-commerce platform or others; (6) Professionals provide a standardized and reasonable therapeutic plan based on the patient's wound conditions; (7) Both professionals and the patient pay attention to complications to prevent adverse outcomes; (8) Professionals strengthen the public education on wound care and integrated rehabilitation. This review expected to provide new perspectives on the therapeutic strategies for chronic wounds in an extramural setting.

Tissue engineering techniques have enabled to replicate the geometrical architecture of native tissues but usually fail to reproduce their exact cellular arrangements during the fabricating process, while it is critical for manufacturing physiologically relevant tissues. To address this problem, a "sewing-like" method of controlling cellular alignment during the fabricating process is reported here. By integrating the stretching step into the fabricating process, a static mechanical environment is created which, in turn, regulates the subsequent cellular alignment, elongation, and differentiation in the generated tissues. With this method, patterned cellular constructs can be fabricated with controlled cellular alignment. Moreover, this method shows a potent capability to fabricate physiologically relevant skeletal muscle constructs in vitro by mechanically inducing myoblast fusion and maturation. As a potential clinical application, aligned myofibers are directly fabricated onto injured muscles in vivo, which repair the damaged tissues effectively. This study shows that the "sewing-like" method can produce engineered tissues with precise control of cellular arrangements and more clinically viable functionalities.

Dermal substitutes provide a template for dermal regeneration and reconstruction. They constitutes an ideal clinical treatment for deep skin defects. However, rapid vascularization remains as a major hurdle to the development and application of dermal substitutes. Several bioactive factors play an important regulatory role in the process of angiogenesis and an understanding of the mechanism of achieving their effective delivery and sustained function is vital. Nanomaterials have great potential for tissue engineering. Effective delivery of bioactive factors (including growth factors, peptides and nucleic acids) by nanomaterials is of increasing research interest. This paper discusses the process of dermal substitute angiogenesis and the roles of related bioactive factors in this process. The application of nanomaterials for the delivery of bioactive factors to enhance angiogenesis and accelerate wound healing is also reviewed. We focus on new systems and approaches for delivering bioactive factors for enhancing angiogenesis in dermal substitutes.

Diseases, trauma, and injuries are highly prevalent conditions that lead to many critical tissue defects. Tissue engineering has great potentials to develop functional scaffolds that mimic natural tissue structures to improve or replace biological functions. In many kinds of technologies, electrospinning has received widespread attention for its outstanding functions, which is capable of producing nanofibre structures similar to the natural extracellular matrix. Amongst the available biopolymers for electrospinning, poly (caprolactone) (PCL) has shown favorable outcomes for tissue regeneration applications. According to the characteristics of different tissues, PCL can be modified by altering the functional groups or combining with other materials, such as synthetic polymers, natural polymers, and metal materials, to improve its physicochemical, mechanical, and biological properties, making the electrospun scaffolds meet the requirements of different tissue engineering and regenerative medicine. Moreover, efforts have been made to modify nanofibres with several bioactive substances to provide cells with the necessary chemical cues and a more in vivo like environment. In this review, some recent developments in both the design and utility of electrospun PCL-based scaffolds in the fields of bone, cartilage, skin, tendon, ligament, and nerve are highlighted, along with their potential impact on future research and clinical applications.

Skin and skin appendages are vulnerable to injury, requiring rapidly reliable regeneration methods. In recent years, 3D bioprinting has shown potential for wound repair and regeneration. 3D bioprinting can be customized for skin shape with cells and other materials distributed precisely, achieving rapid and reliable production of bionic skin substitutes, therefore, meeting clinical and industrial requirements. Additionally, it has excellent performance with high resolution, flexibility, reproducibility, and high throughput, showing great potential for the fabrication of tissue-engineered skin. This review introduces the common techniques of 3D bioprinting and their application in skin tissue engineering, focusing on the latest research progress in skin appendages (hair follicles and sweat glands) and vascularization, and summarizes current challenges and future development of 3D skin printing.

In clinical practice, skin defects occur frequently due to various kinds of acute and chronic diseases. The standard treatment for these wounds is autografting, which usually results in complications such as scar formation and new wounds at donor sites. The advent of dermal substitutes has provided a novel method for wound repair, and rapid angiogenesis of the dermal substitutes is crucial for the graft to take. At present, many strategies have been developed to improve the process of vascularisation, some of which have shown promising potentials, but they could be very far from clinical applications. Most recently, negative-pressure wound therapy (NPWT) has been used extensively in clinical practice for wound care and management. It has been reported that NPWT reduces the time required for vascular ingrowth into the dermal substitute and improves graft take, indicating great potentials for wound repair. This article presents a comprehensive overview of the combined use of NPWT and dermal substitutes for tissue repair and regeneration. Relative concerns and prospects are also discussed.

Bioprinting is a common method to replicate geometrical architecture of native tissues. However, it usually fails to modulate cellular arrangements, which is critical for the tissue’s functionality. To our knowledge, no method has successfully addressed this challenge. Here, we report a method of controlling cellular orientation during the bioprinting process by integrating a stretch process into a modified bioprinting frame. We demonstrate that the cellular orientation is a result of cells’ sensing and responding to the tensile stress, instead of shear stress or topographical patterns. Moreover, our method shows a potent capability to induce myoblast differentiation, fusion and maturation without the presence of differentiation medium. As a potential clinical application, we demonstrate that aligned myofibers directly printed onto injured muscle in vivo, can not only repair the structure of damaged tissue, but also recover the muscle functionalities effectively. This study shows that the new method can produce tissues with precise control of cellular arrangements and more clinically viable functionalities. Significance Statement Due to no method could reproduce the exact cellular arrangements of native tissues in engineered tissues, tissue engineering facing difficult in fabricating 3D tissues that possess desirable biological and mechanical functionalities for biomedical applications. For the first time, we report a method of controlling cellular orientation during 3D bio-printing process. This method can be used to produce engineered tissues with controlled cellular arrangement with several different cell types. Moreover, this method shows a potent capability of fabricating fully mature and aligned myofibers in vitro in the absence of differentiation medium. As potential clinical applications, with this method, engineered tissues could be directly printed in vivo with high efficacy of tissue repair and function recovery.

Tissue-engineered skin (TES), as an analogue of native skin, is promising for wound repair and regeneration. However, a major drawback of TES products is a lack of skin appendages and nerves to enhance skin healing, structural integrity and skin vitality. Skin appendages and nerves are important constituents for fully functional skin. To date, many studies have yielded remarkable results in the field of skin appendages reconstruction and nerve regeneration. However, patients often complain about a loss of skin sensation and even cutaneous chronic pain. Restoration of pain, temperature, and touch perceptions should now be a major challenge to solve in order to improve patients' quality of life. Current strategies to create skin appendages and sensory nerve regeneration are mainly based on different types of seeding cells, scaffold materials, bioactive factors and involved signaling pathways. This article provides a comprehensive overview of different strategies for, and advances in, skin appendages and sensory nerve regeneration, which is an important issue in the field of tissue engineering and regenerative medicine.

An increased number of patients with skin wounds have been witnessed in the past decades. Among the various kinds of treatments for skin wounds, topical exogenous growth factors are indispensable and have been used in many countries. However, whether they have reliable effects remains controversial, and their application for skin wound treatment needs to be further standardized and optimized in terms of socio-economic considerations. Thus, the Chinese Burn Association developed this guideline indicating efficacy, application details, adverse reactions and precautions of five clinically common topical growth factors using the Grading of Recommendations Assessment Development and Evaluation method to promote the rational application of topical exogenous growth factors in skin wounds and to benefit more patients.

Creating realistic 3D hairs that closely match the real-world inputs remains challenging. With the increasing popularity of lightweight depth cameras featured in devices such as iPhone X, Intel RealSense and DJI drones, depth cues can be very helpful in consumer applications, for example, the Animated Emoji. In this paper, we introduce a fully automatic, data-driven approach to model the hair geometry and compute a complete strand-level 3D hair model that closely resembles the input from a single RGB-D camera. Our method heavily exploits the geometric cues contained in the depth channel and leverages exemplars in a 3D hair database for high-fidelity hair synthesis. The core of our method is a local-similarity based search and synthesis algorithm that simultaneously reasons about the hair geometry, strands connectivity, strand orientation, and hair structural plausibility. We demonstrate the efficacy of our method using a variety of complex hairstyles and compare our method with prior arts.

Critical tissue defects frequently result from trauma, burns, chronic wounds and/or surgery. The ideal treatment for such tissue loss is autografting, but donor sites are often limited. Tissue engineering (TE) is an inspiring alternative for tissue repair and regeneration (TRR). One of the current state-of-the-art methods for TRR is gene therapy. Non-viral gene delivery systems (nVGDS) have great potential for TE and have several advantages over viral delivery including lower immunogenicity and toxicity, better cell specificity, better modifiability, and higher productivity. However, there is no ideal nVGDS for TRR, hence, there is widespread research to improve their properties. This review introduces the basic principles and key aspects of commonly-used nVGDSs. We focus on recent advances in their applications, current challenges, and future directions.

OBJECTIVE:This study analyses the epidemiological characteristics of bus fires in mainland China over the past 10 years to develop prevention strategies and emergency procedures for such incidence and the resulting casualties. METHODS:We collected reports on bus fires from the media and news websites and looked up on Medline, PubMed, and Chinese National Knowledge Infrastructure databases for relevant publications in English or Chinese from January 1, 2006 to December 31, 2015. RESULTS:In the past 10 years, there were 382 bus fires in mainland China. The frequency of fires was markedly higher in 2013 and 2014. The vast majority (89.1%) of the fires were caused by spontaneous combustion, followed by arson (5.0%). There were reports of casualties in 41 (10.7%) of the bus fires, including 144 deaths and 567 injuries. The fires leading to casualties resulted from spontaneous combustion in 22 (53.7%) incidents, arson in 12 (29.3%) incidents, and traffic accidents in 7 (17.1%) incidents. Arson caused the most casualties, including 91 deaths and 323 injuries. CONCLUSIONS:This epidemiological study presents characteristic findings related to bus fires in China mainland. The general trend of bus fires showed a gradual increase but with a fluctuation in several years. The regional distribution of bus fires revealed some specific characteristics, and most of bus fires happened in those regions locating in the eastern area of China mainland. The largest number of bus fires were caused by spontaneous combustion. Bus fires caused by arson accounting for only 5% of the total bus fires resulted in the most severe casualties. Most of bus arson occurred in the morning and evening rush hours.

Skin perfusion pressure (SPP) is the blood pressure that is the requisite for the restoration of microcirculatory or capillary flow following controlled occlusion and subsequent flow return. The purpose of the current review was to evaluate the value of SPP for the prediction of wound healing in patients with limb ischemia. Articles published up to January 31, 2017 were searched in the PubMed database and Chinese database CNKI, using the keywords of 'skin perfusion pressure', 'limb ischemia' and 'wound healing'. Articles were obtained and reviewed to analyze the predictive value of SPP with regard to the healing potential of ischemia wounds on limbs. Three different types of techniques are currently used for the measurement of SPP, namely radioisotope clearance, photoplethysmography and laser Doppler, with laser Doppler as the most widely applied technique, due to its noninvasiveness and ease of operability. SPP may effectively assess wound healing potential in ischemic limbs with high sensitivity and specificity; however, its optimum cut-off point remains uncertain. Compared with other noninvasive microcirculatory assessment tools including ankle-brachial index, toe blood pressure and transcutaneous oxygen pressure, SPP has its advantages including that it is not affected by vascular calcification, anatomical structure or patient condition. In conclusion, SPP may be used as an index to accurately predict wound healing in patients with limb ischemia. However, it is difficult to determine the optimum cut-off of SPP due to the limitations of current data. Further study is necessary to confirm the optimum cut-off value of SPP in predicting wound healing potential.

Wound healing is an inherent response resulting in the restoration of tissue integrity. It is a complex process involving cell migration, proliferation, differentiation, apoptosis, and the synthesis and remodeling of the extracellular matrix (ECM). The dermal tissue is an important component of skin that acts as a connecting link between the epidermis and hypodermis. The appearance of scars and contractures after autologous split-thickness skin transplantation or single epidermis diaphragm transplantation for full skin defects indicates that the dermal tissue plays an important role in skin regeneration. Theoretically, dermis cannot regenerate like the liver, bone and epidermis after being destroyed by burns or avulsion. Scarring is hard to avoid during the process of natural healing. However, if the dermis could be reconstructed perfectly, this would be a breakthrough in the methods used for wound healing. In this review, we summarize recent research about dermal regeneration and discuss the probability of advances in the field. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 1208-1218, 2017.

Background: The incidence of liquefied petroleum gas (LPG)-related burns has increased over recent years, and it has become a serious public health issue in developing countries such as India and Turkey. This paper aims to investigate the epidemiological characteristics of LPG-related burns to provide assistance and suggestions for planning prevention strategies. Methods: A 5-year retrospective study was conducted in patients with LPG-related burns admitted to the Department of Burns & Wound Care Center, Second Affiliated Hospital of Zhejiang University, College of Medicine, between 1st January 2011 and 31st December 2015. Information obtained for each patient included age, gender, education status, occupation, medical insurance, average hospital cost, length of hospital stay, monthly distribution of incidence, place of burns, mechanism of burns, extent of burns, site of burns, accompanying injuries, and treatment outcomes. Results: For the first 4 years (2011-2014), the yearly incidence of LPG-related burns was at approximately 10% of all burns; however, in the fifth year (2015) alone, there was a surge to 26.94%. A total of 1337 burn patients were admitted during this period. Of these, 195 patients were admitted because of 169 LPG-related accidents; there were 11 accidents involving more than one victim. LPG-related burns occurred most frequently in patients aged 21-60 years (73.85%). The majority of injuries occurred from May to August (56.41%), and the most common place was home (83.08%, 162 patients). Gas leak (81.03%) was the main cause of LPG-related burns, followed by inappropriate operation (7.69%) and cooking negligence (2.05%). The mean burn area was 31.32 +/- 25.40% of TBSA. The most common sites of burns were the upper extremities (37.47%), followed by the head/face and neck (24.80%) and lower extremities (19.95%). The most common accompanying injuries included inhalation injury (23.59%), shock (8.71%), and external injury (7.18%). The average hospital stay was 22.90 +/- 19.47days (range 2-84 days). Only 48 patients (24.62%) had medical insurance, while 124 patients (63.59%) had no medical insurance. The average hospital cost of the no medical insurance group was significantly higher (p<0.0001) than that of the medical insurance group. In addition, 72.73% of patients who left against medical advice (LAMA) were uninsured. The number of patients who recovered at our hospital was 165 (84.62%), while 22 patients (11.28%) LAMA. The overall mortality rate was 4.10% (8 patients). Conclusion: Our study shows that the exponential increase in LPG-related burns is alarming. This calls for rigorous precautions. Because gas leak was the main cause of LPG-related burns, any part of LPG stove system that shows signs of weathering should be replaced regularly. In addition, we also found that most of the LAMA patients were uninsured. Thus, comprehensive medical insurance should be involved early in the recovery process to assure a safe and adequate discharge. (c) 2017 Elsevier Ltd and ISBI. All rights reserved.