Guideline for the diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients (version 2023) / 中华创伤杂志

Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.

Rethinking on the promotion of the traumatology discipline system construction with Chinese characteristics / 中华创伤杂志

China has experienced three-year anti-epidemic struggle against coronavirus disease 2019 (COVID-19) epidemic and obtained fruitful achievements in the construction of rescue system for major infectious disease. Treatment of severe mass trauma is a major national need. How to learn from the successful experiences of the construction of this rescue system for major infectious disease is a question worth considering. The author rethink s on how to further promote the construction of the traumatology discipline system with Chinese characteristics from six aspects, ie, the construction of the traumatology discipline system as a national strategy, the connotation of the trauma treatment system with Chinese characteristics, the role of the self-characteristics of traumatology in the trauma treatment chain, the new breakthrough in the basic theory and key technology of trauma treatment, the construction of innovative talents in traumatology to a new level as well as public training and education and the legislation strengthening.

Modeling human hypertrophic scars with 3D preformed cellular aggregates bioprinting.

The therapeutic interventions of human hypertrophic scars (HHS) remain puzzle largely due to the lack of accepted models. Current HHS models are limited by their inability to mimic native scar architecture and associated pathological microenvironments. Here, we create a 3D functional HHS model by preformed cellular aggregates (PCA) bioprinting, firstly developing bioink from scar decellularized extracellular matrix (ECM) and alginate-gelatin (Alg-Gel) hydrogel with suitable physical properties to mimic the microenvironmental factors, then pre-culturing patient-derived fibroblasts in this bioink to preform the topographic cellular aggregates for sequent printing. We confirm the cell aggregates preformed in bioink displayed well defined aligned structure and formed functional scar tissue self-organization after bioprinting, hence showing the potential of creating HHS models. Notably, these HHS models exhibit characteristics of early-stage HHS in gene and protein expression, which significantly activated signaling pathway related to inflammation and cell proliferation, and recapitulate in vivo tissue dynamics of scar forming. We also use the in vitro and in vivo models to define the clinically observed effects to treatment with concurrent anti-scarring drugs, and the data show that it can be used to evaluate the potential therapeutic target for drug testing. The ideal humanized scar models we present should prove useful for studying critical mechanisms underlying HHS and to rapidly test new drug targets and develop patient-specific optimal therapeutic strategies in the future.

Autophagy, not apoptosis, plays a role in lumen formation of eccrine gland organoids / 中华医学杂志(英文版)

BACKGROUND@#Sweat secreted by eccrine sweat glands is transported to the skin surface through the lumen. The eccrine sweat gland develops from the initial solid bud to the final gland structure with a lumen, but how the lumen is formed and the mechanism of lumen formation have not yet been fully elucidated. This study aimed to investigate the mechanism of lumen formation of eccrine gland organoids (EGOs).@*METHODS@#Human eccrine sweat glands were isolated from the skin for tissue culture, and the primary cultured cells were collected and cultured in Matrigel for 14 days in vitro. EGOs at different development days were collected for hematoxylin and eosin (H&E) staining to observe morphological changes and for immunofluorescence staining of proliferation marker Ki67, cellular motility marker filamentous actin (F-actin), and autophagy marker LC3B. Western blotting was used to detect the expression of Ki67, F-actin, and LC3B. Moreover, apoptosis was detected using a terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) apoptosis assay kit, and the expression of poly (ADP-ribose) polymerase and Caspase-3 was detected by Western blot. In addition, 3-methyladenine (3MA) was used as an autophagy inhibitor to detect whether the formation of sweat glands can be effectively inhibited.@*RESULTS@#The results showed that a single gland cell proliferated rapidly and formed EGOs on day 4. The earliest lumen formation was observed on day 6. From day 8 to day 14, the rate of lumen formation in EGOs increased significantly. The immunofluorescence and Western blot analyses showed that the expression of Ki67 gradually decreased with the increase in days, while the F-actin expression level did not change. Notably, the expression of autophagy marker LC3B was detected in the interior cells of EGOs as the apoptosis signal of EGOs was negative. Compared with the control group, the autophagy inhibitor 3MA can effectively limit the formation rate of the lumen and reduce the inner diameter of EGOs.@*CONCLUSION@#Using our model of eccrine gland 3D-reconstruction in Matrigel, we determined that autophagy rather than apoptosis plays a role in the lumen formation of EGOs.

Reconsideration on construction of emergency medical disciplinary system characterized by trauma prevention in China / 中华创伤杂志

The public trauma is characterized by suddenness, mass occurrence, destructiveness and huge loss. Measures for trauma prevention are completely different from infectious diseases. Therefore, it is urgently necessary to establish the national emergency medical disciplinary system. Based on the vast demand in trauma prevention in China and the primary opinions proposed previously, the author discusses the necessity and importance of constructing emergency medical disciplinary system characterized by trauma prevention in China, main content of the system, preliminary experiences and some new considerations, hoping to provide some suggestions to further improve the establishment and practice of emergency medical disciplinary system characterized by trauma prevention in China and better serve the construction of a healthy China and efficient development of social economy.

Thinking and practice on healthy development of tissue repair and regenerative medicine in China / 中华创伤杂志

Tissue repair and regeneration is one of the oldest medical problems. Regenerative medicine as a discipline is gradually developed with the progress of science and technology. In recent decades，the development of tissue repair and regenerative medicine in China has experienced the processes of awareness raising，team organization，scientific research，product development and clinical application，and the achievements are the result of joint efforts of several generations. In this study，the author’s contribution to the development of modern tissue repair and regenerative medicine in China is systematically reviewed，including strategic planning，scientific research，clinical translational application and academic exchanges，etc. It is expected that the data will be helpful for the follow-up research in this field.

Achievements and prospects of wound repair discipline system with Chinese characteristics during "13th five-year plan" period / 中华创伤杂志

The 13th five-year plan is a critical period for China's social and economic development and it is also the key time for the development of the discipline system of wound repair with Chinese characteristics. Wound repair is not only a clinical treatment issue, but also relates to the construction of the discipline system, and it is an important part of the construction of a healthy China. During the "13th five-year plan" period, under the joint promotion or efforts of the country, societies and experts, the construction of the discipline system of wound repair with Chinese characteristics achieves rapid development in aspects of construction of discipline and discipline base, featured wound repair model, and training of professionals and talents. Therefore, the author summarizes the achievements of discipline system of wound repair with Chinese characteristics in the 13th five-year plan. Meanwhile, its future development is prospected.

Biological approaches for hypertrophic scars.

Scar formation is usually the pathological consequence of skin trauma. And hypertrophic scars (HSs) frequently occur in people after being injured deeply. HSs are unusually considered as the result of tissue contraction and excessive extracellular matrix component deposition. Myofibroblasts, as the effector cells, mainly differentiated from fibroblasts, play the crucial role in the pathophysiology of HSs. A number of growth factors, inflammatory cytokines involved in the process of HS occurrence. Currently, with in-depth exploration and clinical research of HSs, various creative and effective treatments budded. In here, we summarize the progress in the molecular mechanism of HSs, and review the available biotherapeutic methods for their pathophysiological characteristics. Additionally, we further prospected that the comprehensive therapy may be more suitable for HS treatment.

Analysis of the Common Problems of Combination Products Application / 中国医疗器械杂志

The number of combination products is increasing, and the cutting-edge and innovative technologies are constantly being used. How to evaluate combination products become difficult points. This study team summarizes the supervision conditions of the combination products and analyzes the common problems of these products application from the perspective of technical review, in order to provide reference for Chinese manufacturers and investigators in these products registration.

Correlation between acoustic radiation force impulse imaging and reserve function of liver / 中华超声影像学杂志

Objective:To investigate the correlation between acoustic radiation force impulse imaging(ARFI) and reserve function of liver and the feasibility of liver reserve function assessment by ARFI.Methods:According to the inclusion criteria, 74 patients were screened and 71 patients were finally enrolled from Henan Province People′s Hospital during June 2017 and June 2019. The portal vein diameter (D PV), spleen length (L SP) were measured by two-dimensional ultrasound. The liver shear wave velocity (LSWV) and spleen shear wave velocity (SSWV) were measured by ARFI. Serological markers were checked, and the indocyanine green (ICG)15-minute retention rate (ICG R15) was measured by excretion test. The patients were divided into ICG R15<10% group and ICG R15≥10% group, the difference of the measurements between two groups were calculated, the correlations of the measurements and ICG R15 were analyzed. LSWV diagnostic performance for liver reserve function was evaluated by the ROC curve. Results:There were significant differences in LSWV, D PV, SSWV, L SP, aspartate transaminase(AST), alkaline phosphatase(ALP), y-glutamyl transpeptidase(γ-GGT) and albumin (ALB) between ICG R15<10% group and ICG≥10% group( P<0.05), but no significant differences in other measurements( P>0.05). The correlations between ICG R15 and LSWV( r=0.673, P<0.001), D PV( r=0.355, P<0.05), SSWV( r=0.384, P<0.05), L SP( r=0.403, P<0.001), ALP( r s=0.245, P<0.05) and ALB( r s=-0.390, P<0.05) were statistically significant. The ROC curve showed high diagnostic performance for liver reserve function assessment by LSWV. The area under the ROC curve was 0.903 (95% CI=0.810-0.961, P<0.01), and the cut-off value was 2.15 m/s (sensitivity 84.6%, specificity 86.7%). Conclusions:The LSWV can evaluate the reserve function and it is a useful supplement to the ICG excretion experiment.

Protective role of umbilical cord mesenchymal stem cells on encephaledema after severe cut injury / 中华创伤杂志

Objective:To observe the extent of brain edema caused by severe cut injury and the protective role of umbilical cord mesenchymal stem cells (UC-MSCs).Methods:A total of 90 female C57L mice were selected and the models of severe cut injury were prepared with surgical blade. According to the random number table, the animals were divided into control group (20 mice), cut group (20 mice), interleukin-6 antibody (IL-6-AB) before cut group (administered IL-6-AB at 18 hours before cut, 15 mice), IL-6-AB after cut group (administered IL-6-AB at 1 hour after cut, 15 mice) and UC-MSCs group (20 mice). The extent of brain edema was detected, the level of IL-6 in brain tissue by ELISA method and the expression of aquaporin-4 (AQP-4) by Western blot assay.Results:Brain water content test showed brain edema in cut group was (81.5±1.8)%, significantly higher than (77.1±2.4)% in control group ( P<0.05). Compared with cut group, brain edema in UC-MSCs group [(76.8±2.4)%] and IL-6-AB before cut group [(76.2±2.9)%] were significantly decreased ( P<0.05), while that in IL-6-AB after cut group [(82.4±1.7)%] was little decreased ( P>0.05). ELISA showed the level of IL-6 in cut group was significantly increased in mouse brain [(16.6±1.3)pg/ml], when compared with control group [(10.3±0.3)pg/ml] ( P<0.01). Compared with cut group, the levels of IL-6 in UC-MSCs group [(10.7±0.6)pg/ml] and IL-6-AB before cut group [(10.1±0.4)pg/ml] were significantly decreased ( P<0.01), while that in IL-6-AB after cut group [(14.9±1.2)pg/ml] was little decreased in mouse brain ( P>0.05). Western blot assay showed that compared with control group (1.0±0.1), the expression of AQP-4 in cut group (2.4±0.5) was significantly increased in mouse brain ( P<0.01). Compared with cut group, the expression of AQP-4 in UC-MSCs group (1.2±0.3) and IL-6-AB before cut group (1.0±0.1) were significantly decreased ( P<0.01), while that in IL-6-AB after cut group (2.3±0.3) was little decreased in mouse brain ( P>0.05). Conclusions:Severe cut injury can increase brain water content and eventually lead to brain edema through upregulating the levels of IL-6 and AQP-4 protein in the brain. Moreover, UC-MSCs effectively prevent the formation of brain edema by inhibiting the above effects.

Thoughts and suggestions on construction of high-level wound repair department in China / 中华创伤杂志

After the notice strengthening the management of diagnosis and treatment of chronic wounds on the body surface is issued by the General Office of the National Health and Health Commission [(2019) No.865], how to speed up the construction of wound repair discipline in China, especially how to build a group of high-level wound repair department, become an important and urgent task for the medical workers who are interested in the construction of wound repair discipline. The authors put forward suggestions on the construction of high-level wound repair department from five elements, including attention from departments and hospitals, talent construction, supporting conditions construction, academic and technological development, and department culture construction. The authors hope that it will be a reference to colleagues who are preparing for the wound repair department in China.

Experiences in construction of wound repair discipline in Zibo, Shandong Province / 中华创伤杂志

The construction of wound repair discipline in China is still at the initial stage of exploration, and there is no systematic and mature experiences to learn from. The Luzhong Hospital of Beijing University established a professional committee for wound repair, opened a mobile workstation for wound repair, established a wound repair alliance and quality control center, advocated a medical-care integrated treatment model, and carried out academic exchanges and scientific research, the discipline of wound repair in Shandong Province got a rapid development and the pattern of "Zibo mode" of wound repair emerged. The authors introduce the experiences in construction of the discipline of wound repair in Zibo city, in order to provide some references for the grass-roots counterparts.

Application of constructing standardized and well-developed wound repair department in China / 中华创伤杂志

Based on the spirit of the regulations about diagnosis and treatment of chronic skin wounds and its standardization for doctors and nurses just issued by National Health and Health Commission,the author offers his own understanding and comments about how to establish a welldeveloped wound repair department with Chinese characteristic in China in combining with their previous practice of exploring the establishment of a wound repair discipline system,and puts forward relevant suggestions for readers.

To build a well-developed wound repair department in China with the original mind and mission / 中华烧伤杂志

Based on the spirit of the regulations about diagnosis and treatment of chronic skin wounds just issued by National Health Commission, we systematically review the history of the construction of wound repair department in China and discuss the opportunities and challenges faced by the construction of wound repair department in China. We emphasize on seizing historical opportunities and grasping the development direction of the discipline with the original mind and mission to build a well-developed wound repair department in China, so as to benefit the majority of patients.

Application of constructing standardized and well-developed wound repair department in China / 中华创伤杂志

Based on the spirit of the regulations about diagnosis and treatment of chronic skin wounds and its standardization for doctors and nurses just issued by National Health and Health Commission, the author offers his own understanding and comments about how to establish a well-developed wound repair department with Chinese characteristic in China in combining with their previous practice of exploring the establishment of a wound repair discipline system, and puts forward relevant suggestions for readers.

Innovation and development of modern trauma repair discipline in China / 中华创伤杂志

The author systematically reviews some significant events and major academic achievements in the construction of modern trauma repair discipline system in China in the past 30 years. The construction of modern trauma repair discipline in China contains academic, technological, management innovation and transformation application. There has formed trauma repair discipline system with distinct characteristics and meeting the country's major needs, which may serve the needs of patients and is highly recognized by domestic and foreign counterparts.

Innovation and development of modern trauma repair discipline in China / 中华创伤杂志

The author systematically reviews some significant events and major academic achievements in the construction of modern trauma repair discipline system in China in the past 30 years. The construction of modern trauma repair discipline in China contains academic, technological, management innovation and transformation application. There has formed trauma repair discipline system with distinct characteristics and meeting the country's major needs, which may serve the needs of patients and is highly recognized by domestic and foreign counterparts.

Consideration for the Common Problems of Combination Products Attribution Defnition / 中国医疗器械杂志

This article summarizes the attribute conditions to the combination products designation from 2009 to 2018 in China,analyzes the common problems of combination products attribution definition.It is hoped to be helpful for researchers and manufacturers of combination products.

Establishment of a wound care discipline system in China: the review of the construction of wound care center with Chinese characteristics in 20 years and prospect / 中华烧伤杂志

The construction of wound treatment specialty (center) with Chinese characteristics began in the early 21st century. Based on my personal experience, this paper systematically reviews the key points and characteristics of the specialty (center) construction of wound treatment with Chinese characteristics and its phased progress. Its future development is also prospected.