Negative pressure wound therapy promotes wound healing of diabetic foot ulcers by up-regulating PRDX2 in wound margin tissue.

To understand the changes in the peroxiredoxin-2 (PRDX2) expression level in the wound margin tissue (T-PRDX2) of patients with diabetic foot ulcer (DFU) before and after negative pressure wound therapy (NPWT). Additionally, the study aimed to explore the association between PRDX2 expression and the treatment outcome of DFUs to provide a new theoretical basis for revealing the mechanism of NPWT promoting the healing of DFUs. Fifty-six type 2 diabetes patients with foot ulcers undergoing NPWT (the DFU group) and 28 patients with chronic lower limb skin ulcers with normal glucose tolerance undergoing NPWT (the skin ulcer control [SUC] group) were included in the study. T-PRDX2 was detected using Western blotting, and the superoxide dismutase (SOD) activity and the malondialdehyde (MDA) and glutathione (GSH) levels were detected using a biochemical method. In addition, in vitro experiments were conducted to determine the effect of PRDX2 expression on normal human dermal fibroblast (NHDF) proliferation, migration, and apoptosis. Before NPWT, the DFU group exhibited a significantly lower T-PRDX2 expression level compared with the SUC group. After one week of NPWT, the T-PRDX2 expression level, SOD activity, and GSH content in the wound margin tissues of the DFU and SUC groups significantly increased compared with the before NPWT levels. Conversely, the inflammatory indicators (white blood cell, neutrophil percentage, C-reactive protein, and procalcitonin) and MDA content were significantly lower than the before NPWT levels. The expression changes of T-PRDX2 before and after NPWT in the DFU and SUC groups were positively correlated with the 4-week wound healing rate. In vitro experiments demonstrated that PRDX2 could alleviate the oxidative stress in NHDFs, thereby promoting their proliferation and migration, while reducing cell apoptosis. NPWT promotes DFU healing by increasing T-PRDX2, and changes in the T-PRDX2 might be associated with the therapeutic effect of NPWT.

Proteomics changes after negative pressure wound therapy in diabetic foot ulcers.

Label­free quantitative mass spectrometry was used to analyze the differences in the granulation tissue protein expression profiles of patients with diabetic foot ulcers (DFUs) before and after negative­pressure wound therapy (NPWT) to understand how NPWT promotes the healing of diabetic foot wounds. A total of three patients with DFUs hospitalized for Wagner grade 3 were enrolled. The patients received NPWT for one week. The granulation tissue samples of the patients prior to and following NPWT for one week were collected. The protein expression profiles were analyzed with label­free quantitative mass spectrometry and the differentially expressed proteins (DEPs) in the DFU patients prior to and following NPWT for one week were identified. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses were conducted to annotate the DEPs and DEP­associated signaling pathways. Western blotting and ELISA were performed to validate the results. By comparing the differences in the protein profiles of granulation tissue samples prior to and following NPWT for one week, 36 proteins with significant differences were identified (P<0.05); 33 of these proteins were upregulated and three proteins were downregulated. NPWT altered proteins mainly associated with antioxidation and detoxification, the cytoskeleton, regulation of the inflammatory response, complement and coagulation cascades and lipid metabolism. The functional validation of the DEPs demonstrated that the levels of cathepsin S in peripheral blood and granulation tissue were significantly lower than those prior to NPWT (P<0.05), while the levels of protein S isoform 1, inter α­trypsin inhibitor heavy chain H4 and peroxiredoxin­2 in peripheral blood and granulation tissue were significantly higher than those prior to NPWT (P<0.05). The present study identified multiple novel proteins altered by NPWT and laid a foundation for further studies investigating the mechanism of action of NPWT.

Efficacy of Treating Chronic Tibial Osteomyelitis With Bone Defect Using a Pedicled Perforator-Layered Flap and Fasciocutaneous Flap of the Posterior Tibial Artery: A Case Report.

INTRODUCTION: Tibial osteomyelitis is a common complication of bone tissue trauma. Obtaining good soft tissue coverage and effective infection management is key to the treatment of chronic osteomyelitis of the tibia accompanied with bone defect and bone exposure. The pedicled posterior tibial artery perforator layered fasciocutaneous flap can be used to repair soft tissue defects and can be used as a long-term, localized anti-infective. CASE REPORT: A 54-year-old male presented with an ulcer, purulent discharge at the left anterior tibia, and a fever 28 years after complete healing of the scar site. The patient received debridement and negative pressure wound therapy (NPWT) in a hospital setting. After presenting to the authors' department, there was difficulty in closing the exposed bone marrow cavity. On the basis of systemic use of intravenous antibiotics, multiple debridements and NPWT were used to effectively remove necrotic tissue and control infection. Afterward, the pedicled posterior tibial artery perforator layered fasciocutaneous flap was designed to fill the bone marrow cavity as well as cover and seal the wound of bone exposure and soft tissue defect simultaneously. The layered fasciocutaneous flap was well established after operation, and no recurrence of osteomyelitis was found. CONCLUSION: Debridement with negative pressure wound therapy can be an effective treatment for the wound bed preparation in advance of surgery, and the pedicled posterior tibial artery perforator layered fasciocutaneous flap can be used for the treatment of several soft tissue defects.

[Study on the mechanism of hypertonic salt solution alleviates lung injury of rats at the early stage of severe scald].

OBJECTIVE: To explore the mechanism of hypertonic salt solution (HS) alleviates lung injury of rats at the early stage of severe scald. METHODS: Thirty-two female Sprague-Dawley (SD) rats were randomly assigned to sham group, lactated Ringer solution (LR) group, HS200 group (200 mmol/L HS group, 1 L 200 mmol/L HS contained 955 mL LR and 45 mL 10% NaCl) and HS400 group (400 mmol/L HS group, 1 L 400 mmol/L HS contained 846 mL LR and 154 mL 10% NaCl), with 8 rats in each group. A 30% total body surface area (TBSA) III degree scalded model was reproduced by scalded on the back with 98 centigrade boiling water for 12 seconds, whereas those in the sham group were exposed to 37 centigrade water without liquid resuscitation. Rats in the three drug intervention groups were resuscitated with LR, 200 mmol/L HS and 400 mmol/L HS by caudal vein according to the Parkland formula, respectively. All rats were sacrificed at 8 hours after scald injury to harvest abdominal aorta blood and lung tissues. Interleukins (IL-6, IL-10 and IL-17) in serum were determined by enzyme-linked immunosorbent assay (ELISA). Samples from the lung tissue were used to measure malondialdehyde (MDA) and superoxide dismutase (SOD) levels by ultraviolet spectrophotometer. Expressions of p38 mitogen-activated protein kinase (p38MAPK) and extracellular regulated protein kinase 1/2 (ERK1/2) in the lung were determined by Western Blot. The lung tissue was stained with hematoxylin and eosin (HE), and the pathological changes were observed with a light microscope. RESULTS: Compared with the sham group, the lung tissues in the LR group were damage obviously, which accompanied with more inflammatory cell infiltration, cell edema and pulmonary septum thickening, and the levels of IL-6, IL-10, IL-17 in serum and MDA content, the phosphorylation of p38MAPK and ERK1/2 in lung tissues were increased whereas the activity of SOD was decreased. Compared with the LR group, the lung injury was significantly alleviated, the levels of IL-6, IL-17 in serum and MDA content and the phosphorylation of p38MAPK and ERK1/2 were decreased, and the levels of IL-10 and SOD were increased in both HS groups with a dose-dependent manner. There were significant difference in above parameters between HS400 group and LR group [serum IL-6 (ng/L): 3.76±0.12 vs. 6.72±0.90, serum IL-10 (ng/L): 33.76±3.71 vs. 16.77±3.19, serum IL-17 (ng/L): 103.52±2.78 vs. 124.96±4.96, lung MDA (nmol/mg): 5.59±0.24 vs. 7.09±0.39, lung SOD (U/mg): 226.7±3.9 vs. 172.7±3.4, lung phosphorylation of p38MAPK (p-p38MAPK)/p38MAPK: 0.15±0.09 vs. 0.35±0.19, lung phosphorylation of ERK1/2 (p-ERK1/2)/ERK1/2: 0.27±0.01 vs. 0.70±0.01, all P < 0.01]. CONCLUSIONS: HS protected against lung injury induced by severe burns in rats with a dose-dependent manner, and it was better than LR, and its possible mechanism was related with reducing the expression of p38MAPK and ERK1/2 pathway in lung tissue, increasing the level of anti-inflammatory cytokines and decreasing the release of pro-inflammatory cytokines, thus inhibiting excessive inflammation and oxidative stress injury in lung.

Successful Treatment of Life-threatening Posttraumatic Wounds With Negative Pressure Wound Therapy: A Case Report.

INTRODUCTION: Debridement and control of wound drainage are critical for managing patients with extensive traumatic wounds because wound infection can result in sepsis and further complications. CASE REPORT: The authors report the case of a 19-year-old woman with an extensive crush/degloving injury to her right lower limb that was treated with negative pressure wound therapy (NPWT) with a reticulated open-cell foam dressing. The patient received 2 treatments of sharp debridement and vacuum drainage using wall suction and polyvinyl alcohol dressings. Her respiratory failure, sepsis, and septic shock continued to worsen, and she could not tolerate anesthesia. On post admission day 9, after simple debridement where only superficial necrosis tissue was debrided without anesthesia, NPWT was applied for 5 days and removed about 8500 mL of exudate the first day and 6000 mL on the second. After 5 days, her wound began to improve, granulation tissue formed, no necrotic tissues were visible, and vital signs were stable. On day 14, she underwent anesthesia, surgical debridement, and application of NPWT for an additional 5 days. Following autologous skin grafting on day 19, she was removed from the ventilator (which was started on day 3). The extensive wound was effectively closed; she recovered satisfactorily. There was no patient follow-up. CONCLUSIONS: In this case, NPWT, in continuous mode at -125 mm Hg, effectively removed exudate after simple debridement in a patient who could not tolerate anesthesia.

Laparoscopic treatment of endometrial cancer: systematic review.

The objective of this review was to assess the efficacy and safety of laparoscopy compared with laparotomy for treatment of endometrial cancer. Trials were identified by searching the Cochrane Gynecological Cancer Collaborative Review Group Trial Register, MEDLINE, EMBASE, PubMed, BIOSIS Previews, the China Biological Medicine Database, China National Knowledge Infrastructure Whole Article Database, Wan Fang Data, and VIP Information, from January 1991 to May 2012, as well as the Cochrane Central Register of Controlled Trials (Cochrane Library, issue 5, 2012). We also hand searched unpublished and gray literature, reference lists of identified studies, gynecologic cancer handbooks, and conference abstracts. All randomized controlled trials (RCTs) comparing laparoscopic surgery with laparotomy for treatment of all stages of endometrial cancer were selected. Data extraction was performed independently by 2 review authors who assessed study quality and extracted data. The whole articles were assessed for method quality by using the Cochrane Collaboration Back Review Group method quality criteria. Heterogeneity between studies was assessed using the I2 statistic, which estimates the percentage of heterogeneity between trials. The outcomes were pooled statistically when no clinical heterogeneity was apparent. For time to event data, hazard ratios were pooled using the generic inverse variance facility of RevMan 5. Random effects models were used for all meta-analyses. The search yielded 9 eligible RCTs (1361 laparotomy and 2255 laparoscopy). There was no significant difference between laparoscopic and laparotomic approaches to endometrial cancer in 3-year overall survival (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.49 to 1.71; p = .77), 3-year disease-free survival (OR, 0.95; 95% CI, 0.29 to 1.80; p = .89), recurrence at 3-year follow-up (OR, 1.11; 95% CI, 0.60 to 2.06; p = .74), and pelvic node yield (mean difference [MD, 0.45; 95% CI, -0.41 to 1.32; p = .30). The benefits of laparoscopic surgery vs laparotomy were shorter length of hospital stay (MD, -3.42; 95% CI, -3.81 to -3.03; p < .01), and lower rates of postoperative complications (OR, 0.62; 95% CI, 0.52 to 0.73; p < .01). Disadvantages were higher rates of intraoperative complications (OR, 1.35; 95% CI, 1.05 to1.74; p = .02) and longer duration of surgical procedures (MD, 32.73; 95% CI, 16.34 to 49.13; p < .01). We conclude that, compared with laparotomy, laparoscopic surgery seems to be beneficial in women with endometrial cancer, in particular insofar as postoperative complications and length of hospital stay. However, more well-designed RCTs are needed to assess the long-term clinical outcomes, in particular the quality of life.

[Influence of omega-3 polyunsaturated fatty acids on inflammation-related parameters in lung tissue of rats with severe scald].

OBJECTIVE: To study the effect of omega-3 polyunsaturated fatty acids (omega-3 PUFA) on inflammation in lung tissue of rats with severe scald and its mechanism. METHODS: Seventy-two adult SD rats were divided into sham scald group (SS, n = 8), treatment group 1 (T1, n = 32), treatment group 2 (T2, n = 32) according to the random number table. Rats in T1 group and T2 group were inflicted with 30% TBSA full-thickness scald, and then they were respectively injected with 100 g/L omega-3 PUFA (1 mL/kg) and 200 g/L long-chain fatty acid (2 mL/kg) via tail vein within 5 minutes after burn. The above two fatty acids with equivalent calories were continuously injected for 10 days (once a day). On post burn day (PBD) 1, 4, 7, and 10, serum level of TNF-alpha and level of macrophage inflammatory protein 1alpha (MIP-lalpha) in lung homogenate of T1 and T2 groups were detected, the levels of NF-kappaBp65 and macrophage migration inhibitory factor (MIF) in lung tissue of T1 and T2 groups were observed with immunohistochemical staining (recorded as score). Above-mentioned parameters were also determined in SS group. Data were processed with t test. RESULTS: The levels of 4 parameters in T1 and T2 groups on PBD 1, 4, 7, 10 were higher than those in SS group (with t values from 3.411 to 8.782, P values all below 0.01), and those in T1 group on PBD 4, 7, 10 were lower than those in T2 group (with t values from 2. 321 to 2.785, P values all below 0.05). The serum level of TNF-alpha and levels of MIP-1alpha, NF-kappaBp65, and MIF in lung tissue in SS group was respectively (0.96 +/- 0.32) ng/mL, (76 +/- 16) pg/mL, 0.24 +/- 0.03, 1.31 +/- 0.03, and those in T1 and T2 groups all peaked on PBD 7 [(2.43 +/- 0.32) ng/mL, (210 +/- 56) pg/mL, 4.23 +/- 2.15, 4.69 +/- 1.83; (3.15 +/- 0.54) ng/mL, (274 +/- 64) pg/mL, 5.15 +/- 2.31, 5.37 +/- 2.16]. CONCLUSIONS: Omega-3 PUFA can effectively reduce serum level of TNF-alpha and levels of MIP-1alpha, NF-kappaBp65, and MIF in lung tissue of rats with severe scald, showing that it has a protective effect against injury of lung tissue.

[Meek technique skin graft for treating exceptionally large area burns].

OBJECTIVE: To investigate the clinical effect of Meek technique skin graft in treating exceptionally large area burns. METHODS: The clinical data were retrospectively analysed from 10 cases of exceptionally large area burns treated with Meek technique skin graft from April 2009 to February 2010 (Meek group), and were compared with those from 10 cases of exceptionally large area burns treated with the particle skin with large sheet of skin allograft transplantation from January 2002 to December 2006 (particle skin group). In Meek group, there were 8 males and 2 females with an average age of 34.5 years (range, 5-55 years), including 6 cases of flame burns, 2 cases of hot liquid burns, 1 case of electrical burn, and 1 case of high-temperature dust burn. The burn area was 82.6% +/- 3.1% of total body surface area (TBSA). The most were deep II degree to III degree burns. The time from burn to hospitalization was (3.5 +/- 1.3) hours. In particle skin group, there were 8 males and 2 females with an average age of 36.8 years (range, 18-62 years), including 5 cases of flame burns, 2 cases of hot liquid burns, and 3 cases of gunpowder explosion injury. The burn area was 84.1% +/- 7.4% of TBSA. The most were deep II degree to III degree burns. The time from burn to hospitalization was (4.9 +/- 2.2) hours. There was no significant difference in general data between 2 groups (P > 0.05). RESULTS: The skin graft survival rate, the time of skin fusion, the systemic wound healing time, and the treatment cost of 1% of burn area were 91.23% +/- 5.61%, (11.14 +/- 2.12) days, (38.89 +/- 10.36) days, and (5113.28 +/- 552.44) yuan in Meek group, respectively; and were 78.65% +/- 12.29%, (18.37 +/- 4.63) days, (48.73 +/- 16.92) days, and (7386.36 +/- 867.64) yuan in particle skin group; showing significant differences between 2 groups (P < 0.05). CONCLUSION: Meek technique skin graft has good effect in treating exceptionally large area burns with the advantages of high survival rate of skin graft, short time of skin fusion, and low treatment cost of 1% of burn area.

[Protective effects of enteral immuno-nutrition on intestinal mucosa injury in burned rats].

OBJECTIVE: To investigate the protective effects of enteral immuno-nutrition on intestinal mucosa injury following severe burn. METHODS: Sixty-four Wistar rats with 30% total body surface area (TBSA) full-thickness burn were randomly divided into enteral nutrition (EN, n=32) group and enteral immuno-nutrition (EIN, n=32) group. Another 8 Wistar rats were used as normal control group. The concentration of secretory immunoglobulin A (sIgA) in intestinal mucosa, the blood levels of diamine oxidase (DAO) activity and tumor necrosis factor-alpha (TNF-alpha) were determined, and the expression of TNF-alpha mRNA in intestinal mucosa was determined by reverse transcription polymerase chain reaction (PT-PCR) in control group and on 1st, 4th, 7th, and 10th day postburn in EN and EIN group. RESULTS: Compared with that of before injury, the blood levels of DAO activity, TNF-alpha content, the concentration of sIgA and the expression of TNF-alpha mRNA in intestinal mucosa were significantly increased in both EN and EIN groups (P<0.05 or P<0.01). However, the blood levels DAO activity, TNF-alpha content, the concentration of sIgA on 4th, 7th and 10th postinjury days and the expression of TNF-alpha mRNA in intestinal mucosa on 1st, 4th, 7th and 10th days postinjury in EIN group were significantly lower than those in EN group (P<0.05 or P<0.01). CONCLUSION: EIN can ameliorate the damage of the intestinal mucosa in burned rats compared with EN group. This might be related to an increase in the sIgA level and reduction of the expression of TNF-alpha mRNA in intestinal mucosa.