Clinical analysis of 56 cases with surgical operation of congenital tumor in conus medullaris position / 中国医师杂志

Objective@#To analyze the curative effect of 56 cases with surgical operation of congenital tumor in conus medullaris position, to provide valuable reference information for the surgical operation of congenital tumor in conus medullaris position.@*Methods@#The cases were from 56 patients with congenital tumors in conus medullaris position in Xinjiang Uygur municipal people's hospital from January 2015 to February 2018. According to the classifications of congenital tumors in the conus medullaris position, surgical operation was performed on patients. The curative effect of patients with all kinds of congenital tumors in the conus medullaris position was analyzed and summarized.@*Results@#After 9 months of the follow-up: ⑴ There were totally 18 cases of epidermoid cysts, 16 cases with obvious improvement in lower limb numbness and lower limb motor function, 13 cases with the pain degree effectively relieved and 3 cases without significant improvement in early defecation function. ⑵ There were 15 cases of teratomas, 13 cases without significant improvement in lower extremity numbness, 2 cases with reduced lower extremity numbness, 3 cases with reduced urination and defecation function disturbance and 1 case not recovered. There was no recurrence of tumor. ⑶ There were 8 lipoma patients who were cured and discharged without urination and defecation function disturbance. Life was basically self-sustaining. ⑷ There were 9 cases of hemangioblastoma with significant improvement in spinal cord function, 5 cases without postoperative pain symptoms and 1 case with significant improvement in pain degree. ⑸ There were 6 cases of ependymoma, 2 cases with significant reduction on limb numbness symptoms, 1 case with urinary retention after surgery. There was no significant change in muscle strength of the 2 cases before and after surgery.@*Conclusions@#The clinical effect of surgical operation of congenital tumor in conus medullaris position is clear. Combined with imaging examination and attention to surgical precautions, the surgical treatment effect of congenital tumors in the conus region of the spinal cord can be effectively improved.

Expert consensus on early treatment of deep electric burn wound / 中华创伤杂志

Electric burn is a kind of severe burn with a high disability rate. Although some experience in the diagnosis and treatment of electric burn has been accumulated over the years, there still lacks consensus on a standard treatment of the electric burn wound. To improve the treatment level and the life quality of electric burn patients, the Burns and Trauma branch of Chinese Geriatrics Society and the Expert Committee of Standardization Construction of Wound Repair Department under Chinese Medical Doctor Association have made the consensus on electric burn wound management and repair according to relevant research reports at home and abroad. In this consensus, the standardized wound repair measures of electric burns are systematically introduced from the aspects of injury mechanism, pathophysiological changes, clinical manifestations and diagnosis of wounds, debridement and repair, and matters needing attention, so as to provide a reference for clinical diagnosis and treatment.

Clinical analysis of 56 cases with surgical operation of congenital tumor in conus medullaris position / 中国医师杂志

Objective To analyze the curative effect of 56 cases with surgical operation of congenital tumor in conus medullaris position,to provide valuable reference information for the surgical operation of congenital tumor in conus medullaris position.Methods The cases were from 56 patients with congenital tumors in conus medullaris position in Xinjiang Uygur municipal people's hospital from January 2015 to February 2018.According to the classifications of congenital tumors in the conus medullaris position,surgical operation was performed on patients.The curative effect of patients with all kinds of congenital tumors in the conus medullaris position was analyzed and summarized.Results After 9 months of the follow-up:(1) There were totally 18 cases of epidermoid cysts,16 cases with obvious improvement in lower limb numbness and lower limb motor function,13 cases with the pain degree effectively relieved and 3 cases without significant improvement in early defecation function.(2) There were 15 cases of teratomas,13 cases without significant improvement in lower extremity numbness,2 cases with reduced lower extremity numbness,3 cases with reduced urination and defecation function disturbance and 1 case not recovered.There was no recurrence of tumor.(3) There were 8 lipoma patients who were cured and discharged without urination and defecation function disturbance.Life was basically self-sustaining.(4) There were 9 cases of hemangioblastoma with significant improvement in spinal cord function,5 cases without postoperative pain symptoms and 1 case with significant improvement in pain degree.(5) There were 6 cases of ependymoma,2 cases with significant reduction on limb numbness symptoms,1 case with urinary retention after surgery.There was no significant change in muscle strength of the 2 cases before and after surgery.Conclusions The clinical effect of surgical operation of congenital tumor in conus medullaris position is clear.Combined with imaging examination and attention to surgical precautions,the surgical treatment effect of congenital tumors in the conus region of the spinal cord can be effectively improved.

Cloning and analyzing of MDCK cells for H5N1 influenza vaccine production / 中华微生物学和免疫学杂志

Objective To screen a Madin-Darby canine kidney (MDCK) cell line for H5N1 influ-enza virus isolation and to evaluate its safety in vaccine production. Methods MDCK cells were cloned by the method of limiting dilution. Hemagglutination test was used to screen MDCK cells that were suitable for H5N1 influenza virus production. Tests for analyzing the characteristics, extraneous agents, endogenous agents and tumorigenicity of MDCK cells were performed according to Chinese Pharmacopeia Volume Ⅲ. Results A total of 108 MDCK cell lines were obtained and three of them were selected after hemagglutina-tion test. G1 cells were chosen following further screening with tumorigenicity test and receptor abundance analysis. The average number of chromosomes of the MDCK-G1 cells was 78±4. No bacteria, fungi or myco-plasma contamination was detected. In experimental group, each nude mouse was injected with 1×107/ml viable cells to observe their tumorigenicity. Twelve weeks after cell injection, no node was found at injection sites or in gross anatomy. There was no significant difference between the experimental and negative control groups. The result of the tumorigenicity test was negative. No node formation was found after injecting nude mice with cell lysate or cellular DNA collected from equivalent amount of cells. It was indicated that the MDCK-G1 cells were of low-oncogenic potential. Conclusions The MDCK-G1 cell line could be used as a substrate to produce H5N1 influenza virus vaccine.

Clinical characteristics and repair effect of 136 patients with electric burns of upper limb / 中华烧伤杂志

Objective@#To analyze clinical characteristics and wound repair methods and effects of patients with upper limb electric burns.@*Methods@#Medical records of 136 patients with upper limb electric burn who met the inclusion criteria and hospitalized in our unit from January 2015 to March 2019 were retrospectively analyzed. Proportion in patients with electric burns in the same period, gender, age, admission time, categories, injury causes, injury voltage, burn area and depth of upper limb, simultaneous injury of both upper limbs, and early wound treatment measure of patients with upper limb electric burn were recorded. The main repair methods of each affected limb were classified and recorded. The overall efficacy of the patients was recorded, including postoperative wound complications and healing condition. The patients repaired with distal pedicled flaps and those with free flaps were followed up for 3 to 6 months. The survival rate of flaps were recorded, the function of affected limbs after operation was evaluated, and the satisfaction degree of patients was investigated by Curative Effect Score Table. The amputation rate, age, and burn area of upper limbs of patients caused by high-voltage and low-voltage electricity were compared. Data were processed with Wilcoxon rank sum test, chi-square test, or Fisher′s exact probability test.@*Results@#(1) The number of upper limb electric burn patients accounted for 88.3% of 154 patients with electric burns hospitalized in the same period, including 117 males and 19 females, aged 1 year and 2 months to 72 years [(34±18) years], admitted 1 h to 48 d after injury, including 51 electricians, 32 rural migrant workers, 31 students and preschool children, and 22 patients belonging to other categories. Patients of the first two categories were mainly injured by work accidents, and those of the latter two categories mainly suffered from touching power source or power leakage. Among all the patients, 75 cases were injured by high-voltage electric burn, and 61 cases were injured by low-voltage electric burn, with burn area of upper limb from 0.2% to 16.0% [2% (1%, 5%)] total body surface area (TBSA) and area of wounds deep to bone from 0.2% to 15.0% [2% (1%, 5%)] TBSA. Two upper limbs in 54 cases were simultaneously injured, accounting for 39.7%. Early fasciotomy was performed for 73 limbs. (2) Thirteen affected limbs were treated with dressing change, 2 affected limbs were sutured directly after debridement, 56 affected limbs were repaired by skin grafting, 12 affected limbs were repaired by local flap, 45 affected limbs were repaired by distal pedicled flap, 22 affected limbs were repaired by free flap, and 40 affected limbs were amputated (accounting for 21.1%). (3) One case died of pulmonary infection, sepsis, and multiple organ failure after operation, and the rest patients were all cured. One case with avulsion of abdominal flap was repaired by skin grafting after dressing change. The anterolateral thigh flap in one case necrotized after transplantation, which was replaced by pedicled abdominal flap. Seven cases had small erosion on the pedicle or margin after transplantation of abdominal flap and were healed by dressing change. Six cases had local bruising at the distal end after transplantation of abdominal flap and were healed after conservative treatment such as hyperbaric oxygen. The other flaps survived well. (4) The survival rate of distal pedicled flap grafting was 97.8% (44/45), which was close to that of free flap grafting (95.5%, 21/22, P>0.05). The function recovery of affected limb after free flap grafting was better than that of distal pedicled flap grafting (Z=-3.054, P<0.01), but their satisfaction degree of patients was similar (Z=-0.474, P>0.05). (5) Patients with high-voltage electric burn had higher amputation rate, older age, and larger upper limb burn area than those with low-voltage electric burn (χ2=4.743, Z=-2.801, -6.469, P<0.05 or P<0.01).@*Conclusions@#Upper extremity electric burn often occurs in children, electricians, and rural migrant workers with high rate of amputation. Teachers and parents should strengthen safety education for children and manage power source of life well. Workers should improve safety awareness and operate standardly. Fasciotomy for relaxation should be performed for electric burn wound as soon as possible, and flap grafting can effectively repair wound after early debridement. The function recovery of affected upper limb repaired with free flap grafting is better.

Application of latissimus dorsi flap and thoracodorsal artery perforator flap in different wounds / 中华整形外科杂志

Objective@#To explore the application and choice of latissimus dorsi musculocutaneous flap and thoracodorsal artery perforator flap in different wound repair.@*Methods@#From March 2012 to February 2018, 8 cases of different wounds were repaired with island latissimus dorsi myocutaneous flap pedicled with dorsal thoracic artery, free latissimus dorsi myocutaneous flap, or thoracodorsal artery perforator flap combined with scapular flap. The patients includes 4 cases of trauma, 2 cases of tumor and 2 cases of osteomyelitis. Among them, 5 cases received pedicled grafting, 2 cases had anastomotic vascular free grafting combined with antibiotic bone cement chain bead, 1 case had thoracodorsal artery perforator flap combined with scapular flap.@*Results@#All 9 flaps of 8 patients survived. The size of the flaps ranged from 22.0 cm×7.5 cm to 28.0 cm×21.0 cm. All the donor and recipient areas healed well. After 2 months to 2 years follow up, all flaps have good blood supply, and the limbs′ function was normal. The appearance of flaps were satisfactory, with fully treated osteomyelitis, and no recurrence of the tumor was observed.@*Conclusions@#According to wound characteristics, selective application of thoracodorsal artery perforator flap, pedicled or free latissimus dorsi myocutaneous flap is effective for the repair of muscle, skin and soft tissue defects, as well as osteomyelitis, after tumor resection.

Dedifferentiated liposarcoma of extremities: a clinicopathologic analysis / 中华病理学杂志

Objective@#To study the clinicopathologic features of dedifferentiated liposarcoma of extremities.@*Methods@#Nine cases of dedifferentiated liposarcoma of extremities diagnosed at Beijing Jishuitan Hospital from 2009 to 2017 were selected. The histological features of cases of dedifferentiated liposarcoma of extremities were evaluated by HE and immunohistochemistry, together with the clinical and radiological features. Flourescence in situ hybridization(FISH) was used to detect MDM2 amplification.@*Results@#They were located in the thigh (6 cases), calf (2 cases) and buttock (1 case). There were six females and three males. Patients′ age ranged from 61 to 79 years (mean 68 years). Histologically, there were two components, well-differentiated liposarcoma and dedifferentiated sarcoma with or without transitional lesions between them. The histology of dedifferentiated liposarcoma included undifferentiated sarcoma and fibrosarcoma. Heterologous elements such as bone and cartilage were present in two cases. Immunohistochemical study showed the tumor cells expressed vimentin, CDK4 and p16. MDM2 were positive in 6 cases (6/9) and p53 was positive in one case(1/9). CKpan was positive in the epithelioid differentiation area. S-100 protein was positive in the well-differentiated liposarcoma component. FISH showed the amplification of MDM2(6/9).@*Conclusions@#Dedifferentiated liposarcoma of extremities is very rare. The diagnosis should be combined with the histological characteristics and immunohistochemical results and differentiated from the other tumors and tumor-like lesions.

Clinical application of negative pressure dressing in the full-thickness skin grafting / 中华烧伤杂志

Objective@#To investigate the effect of different negative pressure of wound negative pressure dressing (NPD) on the survival of full-thickness skin grafts of patients.@*Methods@#One hundred and eleven patients who need skin grafting, conforming to the inclusion criteria were hospitalized in our unit from August 2012 to March 2017, and their clinical data were retrospectively analyzed. Forty-seven patients hospitalized from August 2012 to October 2015 were assigned into traditional treatment group. Sixty-four patients hospitalized from November 2015 to March 2017 were divided into -9.975 kPa negative pressure treatment group (n=34) and -13.300 kPa negative pressure treatment group (n=30). Patients in traditional treatment group received conventional dressing after full-thickness skin grafting. Patients in -9.975 kPa and -13.300 kPa negative pressure treatment groups received -9.975 kPa and -13.300 kPa NPD based on traditional treatment after vacuum sealing, respectively. Dot necrosis area of skin grafts and erosion and escharosis of graft edges of patients in the three groups on post operation day 10 were observed. The percentage of dot necrosis area of skin grafts and occurrence rate of erosion and escharosis of skin graft edges were calculated, respectively. Data were processed with chi-square test, Fisher′s exact test, and Kruskal-Wallis H test.@*Results@#Percentages of dot necrosis area of skin grafts of patients in traditional treatment group and -9.975 kPa and -13.300 kPa negative pressure treatment groups were 17.81%, 3.20%, and 3.00%, respectively. Percentage of dot necrosis area of skin grafts of patients in traditional treatment group was significantly higher than that in -9.975 kPa and -13.300 kPa negative pressure treatment groups (Z=-5.770, -4.690, P<0.001). Percentages of dot necrosis area of skin grafts of patients in -9.975 kPa and-13.300 kPa groups were close (Z=-0.619, P>0.05). The occurrence rates of erosion and escharosis of skin graft edges of patients in traditional treatment group and -9.975 kPa and -13.300 kPa negative pressure treatment groups were 78.7% (37/47), 32.4 (11/34), and 36.7% (11/30), respectively. Erosion and escharosis of skin graft edges of patients in -9.975 kPa and -13.300 kPa negative pressure treatment groups were better than those in traditional treatment group (P<0.001). Erosion and escharosis of skin graft edges of patients in -9.975 kPa and -13.300 kPa negative pressure treatment groups were close (P>0.05).@*Conclusions@#The use of -9.975 kPa and -13.300 kPa NPD in skin grafts after full-thickness skin grafting significantly diminishes the occurrence rates of dot necrosis area of skin grafts and erosion and escharosis of graft edges.

Clinical, radiologic and pathologic features of giant cell tumor of bone treated with denosumab / 中华病理学杂志

Objective@#To investigate the radiological and histopathological features of giant cell tumor of bone treated with RANKL inhibitor denosumab.@*Methods@#Eleven cases were retrieved from the surgical pathology records between March 2015 and June 2017 in Beijing Jishuitan Hospital. Formalin fixed, paraffin embedded specimens were collected and the histological features were evaluated. The imaging features including X ray, magnetic resonance imaging, and computed tomography were also reviewed.@*Results@#These 11 cases of giant cell tumor of bone were derived from five female and six male patients, with age ranged from 20 to 62 years (mean age, 35 years). The tumors were located in the sacrum (6 cases), femur (2 cases), radius (1 case), tibia (1 case) and patella (1 case), respectively. Histologically, all cases showed depletion of giant cells, proliferation of mononuclear cells and different degrees of ossification 3 to 6 months after denosumab therapy. Radiography showed marked osteosclerosis and sclerotic rim formation. Three cases of the sacrum recurred after 5, 6 and 11 months of surgery, and the remaining cases showed no recurrence within follow-up of 1 to 14 months.@*Conclusions@#Denosumab treated giant cell tumors morphologically differ from untreated tumors. Careful attention to a history of denosumab administration is crucial to avoid misdiagnosis and to allow proper differentiation from other tumors and tumor-like lesions.

Dedifferentiated chordoma of sacrococcygeal region: a clinicopathologic analysis and review of literature / 中华病理学杂志

Objective@#To study the clinicopathologic features of dedifferentiated chordoma.@*Methods@#Four cases of dedifferentiated chordoma of sacrococcygeal region were collected at Beijing Jishuitan Hospital, from 2009 to 2014. HE and immunohistochemistry (EnVision method) were used to observe the clinical, radiological and histological features of dedifferentiated chordoma and to make the diagnosis and differential diagnosis. The literature was reviewed.@*Results@#Four cases of dedifferentiated chordoma were all located in the sacrococcygeal region. The mean age at diagnosis was 57 years (range 49-64 years). There were 1 female and 3 males. Histologically, there were two components of conventional chordoma and dedifferentiated sarcoma with or without transitional area between them. The histology of dedifferentiated components includes undifferentiated sarcoma and fibrosarcoma. Immunohistochemical study showed that cytokeratin, epithelial membrane antigen, S-100, Brachyury were positive in the portion of chordoma while p53 were positive in the portion of undifferentiated sarcoma. INI1 and vimentin were both positive.@*Conclusions@#The dedifferentiated chordoma is very rare. The diagnosis should combine the histological characters and immunohistochemical results and should be differentiated from the sarcomatoid chordoma, poorly differentiated chordoma and other high grade sarcoma. p53 may play a role in the malignant transformation mechanism of chordoma.

Sheep acellular dermal matrix microparticle transplant for wound in rats / 中南大学学报(医学版)

To explore the healing effect on wound after transplanting sheep acellular dermal matrix (ADM) microparticle together with autoallergic skin microparticle.
 Methods: The rats were divided into three groups. Full-thickness skin wound at size about 4.0 cm×4.0 cm was generated on the back of every rat. Group A, the sheep ADM microparticle and autoallergic skin microparticle were mixed according to the ratio of 5:1, coating on wound of rat back. Group B, the sheep ADM microparticle and autoallergic skin microparticle were mixed according to the ratio of 2:1. Group C, autoallergic skin microparticle was only put on wound and be covered with heterograft. We observed the development of wound healing and compared the wound contraction rate among the three groups.
 Results: Three groups displayed same speed on extending of autoallergic skin microparticle and wound healing. The skin microparticles in Group A were wrapped up by around tissues and fused each other. A few renewal blood vessels were found in tissues, and ADM was replaced by around tissues and mixed with autoallergic skin microparticle. At the muscle surface, a few derma tissues distributed into point or patch, and the wound contraction rate was the lowest one among the 3 groups. The skin microparticles in Group B were mixed with more sheep ADMs than those in Group A. Some ADMs were wrapped by around tissues but could not been absorbed. Sheep ADM microparticles were free from around tissues, and the wound healing was delayed. The wound contraction rate in Group B was higher than that in Group A. The wound healing in Group C was faster than that in Group B, but there were few derma tissues under the skin. The wound contraction rate was the highest one.
 Conclusion: Mixing sheep ADM microparticle with autoallergic skin microparticle according to the ratio of 5:1 is good for regenerating derma tissues, and it can improve healing effect of wound.

Changes of the brain gray matter in Parkinson's disease:a voxel-based morphometry study / 实用放射学杂志

Objective To analyze and evaluate changes of the brain gray matter in patients with Parkinson's disease (PD).Methods 46 patients with PD and 19 normal control(NC) subjects(matched to the patients in age and gender) were selected in this study.46 cases of PD were divided into early PD group(ePD,25 cases) and middle-advanced PD group(maPD,21 cases) by improved Hoehn-Yahr(H-Y) stages.All the subjects underwent 3.0T MR scanning,and data of high resolution T1-weighted imageing (T1WI) were acquired.Gray matter volume differences between PD group and NC group,or ePD group and maPD group were assessed by voxel-based morphometry (VBM) combined diffeomorphic anatomical registration through exponentiated lie (DARTEL) method.Results The gray matter volume of the bilateral frontal lobes, temporal lobes, insular lobes, cingulum gyrus, hippocampus, fusiform gyrus, cerebellum and right cuneus lobe and precuneus lobe in the PD group was smaller than that in the NC group.The gray matter volume of the bilateral frontal lobes, temporal lobes,insular lobes,cingulum gyrus,rectus gyrus,lingualis gyrus,fusiform gyrus,hippocampus,amygdaloid and cerebellum in the maPD group was smaller than that in the ePD group.Conclusion VBM reveals a widespread volume reduction of the gray matter in PD patients,and detectes a correlation with disease duration and severity.These changes located in special distribution may be in line with the pathology of PD.

Inflammatory myofibroblastic tumor of long bone:a clinicopathologic analysis and review of literatures / 临床与实验病理学杂志

Purpose To study the clinicopathologic features of inflammatory myofibroblastic tumor (IMT) of long bone.Methods HE and immunohistochemistry of EnVision two-step were used to observe the clinical,radiological,histological and immunophenotype features of IMT of bone.The literatures were reviewed.Results 4 cases of IMT of bone were respectively located in the tibia (2 cases) and femur (2 cases).Histologically,the lesions were characterized by collagen-rich and spindled to plump myofibroblast-like cells and a variable admixture of inflammatory cells.Immunohistochemical study showed that the vimentin,SMA,actin,H-caldesmon and CD34 were positive.Conclusion The IMT is a rare and locally aggressive tumor.The diagnosis should combine the histological characters with immunohistochemical results and should be differentiated from the other tumors and tumor-like lesions.

Toxicity studies in vivo and in vitro for sheep skin acellular dermal matrix / 中南大学学报(医学版)

To detect the toxic reaction degree for sheep acellular dermal matrix (ADM) in vivo or vitro by using hemolytic, pyrogen and cell-cytotoxic reaction experiments, respectively.
 Methods: Leach liquor of cross-linked and non-cross-linked sheep ADMs were set for cross-linked group and non-cross-linked group, respectively, with a positive control group (10 mL sterile water for injection in test tube) and a negative control group (10 mL 0.9% sodium chloride solution in test tube). The supernatants were obtained from each group and were measured for the absorbance. The hemolysis degree was calculated; 16 New-Zealand rabbits were selected and then divided into 4 groups, A, B, C and D group. The leach liquor of cross-linked and non-cross-linked sheep ADMs were injected into bodies of the 6 New-Zealand rabbits in the A and B groups, and then the body temperatures were measured in every half hour after injection, 6 times in total. The value of highest temperature among 6 measurements minus the normal temperature was the fever degree for the body temperature. Based on these fever degree, the criterion of biological pyrogen reaction for sheep ADM pyrogen experiment was evaluated; the mice fibroblasts were collected during logarithmic phase and were cultured in the nutrient medium containing sheep ADM leach liquor with different density. The absorbance was measured to evaluate relative growth rate for fibroblast.
 Results: The hemolysis degree for the group A and B are less than 5%. The summary of fever degree for New-Zealand rabbits were lower than 1.8 ℃. MTT experiment showed that the toxicity of 10%-90% or 100% leach liquor nutrient medium with sheep ADM for the mice fibroblast is at level 1 or level 2. There was no significant difference between leach liquor of cross-linked and non-cross-linked sheep ADMs (P>0.05). The effects on relative growth rate for mice fibroblasts were minor. 
 Conclusion: The hemolytic and pyrogen reactions for the sheep ADMs embedded in New-Zealand rabbit were within the evaluation criterion, and the effects on vitality and growth rate for the fibroblast were not significant.

Levels of IL-4 and IFN-γ in serum of mice after the sheep skin acellular dermal matrix transplant / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the immunogenicity of self-made sheep skin acellular dermal matrix (ADM).
@*METHODS@#Both cross-linked and non-crosslinked ADMs were made after the sheep skin ADM was ready. A total of 160 healthy mice were then randomly divided into 4 groups. Group A, cross-linked ADM was implanted under skin; Group B, non-crosslinked ADM was implanted under skin; Group C, allosome skin was embedded under skin; Control group, without any implantation. Any visible changes in implantation region and any apparent rejection was recorded. Any symptoms of inflammatory reaction in implantation region were also observed by microscope. The levels of IL-4 and IFN-γ in serum were measured on the 3rd day, 1 week, 2 weeks and 3 weeks after the operation, respectively.
@*RESULTS@#Visual study: wound healing in implantation regions were obvious, the immunologic rejection was not significant, and the sheep ADM was absorbed gradually by ambient tissues. Microscope results: the connection between the sheep ADM and surrounding tissues was very tight with infiltration of a few inflammatory cells into the depth of sheep ADM. The structure of sheep ADM was gradually destroyed by inflammatory cells. The levels of IL-4 and IFN-γ were not significant difference between the group of A, B or C and the control group on the 3rd day after the operation. The inflammatory reaction in implantation region of the control group degraded after 3 days, concomitant with a decrease in the levels of IL-4 and IFN-γ. But the levels of IL-4 and IFN-γ in the Group A, B or C remained at high level, suggesting the elevation of IL-4 and IFN-γ levels were related to the immunologic reaction by sheep ADM. The values of IL-4/IFN-γ were significant difference between the group A, B or C and the control group at the end of the 1st week, 2nd week, and 3rd week. However, there were not significantly different among the Group A, B and C.
@*CONCLUSION@#Sheep skin ADMs do not cause apparent rejection from mice after the transplantation because of the low immunogenicity. The cross-linked and non-crosslinked ADMs do not obviously affect the levels of IL-4 and IFN-γ.

Changes in the expression of three markers in T lymphocytes of peripheral blood and immunoregulatory mechanisms of burned mice with sepsis at early stage / 中华烧伤杂志

<p><b>OBJECTIVE</b>To study the expression levels of annexin A1 (ANXA1), GATA-3, and T-bet in T lymphocytes of peripheral blood in burned mice with sepsis at early stage, and to analyze their immune regulatory mechanisms.</p><p><b>METHODS</b>Seven-hundred and eighty male mice of clean grade were divided into sham injury group (n=60, sham injured on the back by immersing in 37 ℃ warm water for 10 s), burn group (n=240, inflicted with 20% TBSA deep partial- thickness burn on the back by immersing in 100 ℃ hot water for 10 s), sepsis group (n=240, intraperitoneally injected with 6 mg/kg lipopolysaccharide), and burn+ sepsis group (n=240) according to the random number table. Mice of burn+ sepsis group were treated as that in burn group at first, and then they were treated as that in sepsis group. (1) Immediately after injury, six mice in sham injury group were selected to collect lymphocyte suspension of peripheral blood (1 tube each mouse) according to the random number table. According to the random number table, 6 mice of each of the other three groups were respectively selected at post injury hour (PIH) 12, 24, 48, and 72 for the collection of lymphocyte suspension from peripheral blood (1 tube each mouse). Each tube of cell suspension was equally divided into two parts. Fluorescein isothiocyanate (FITC)-labeled human anti-mouse CD4 monoclonal antibody and phycoerythrin (PE)-labeled human anti-mouse interferon-γ monoclonal antibody were added to one part of cell suspension to mark helper T lymphocyte 1 (Th1). FITC-labeled human anti-mouse CD4 monoclonal antibody and PE-labeled human anti-mouse interleukin-4 (IL-4) monoclonal antibody were added to the other part of cell suspension to mark Th2. The percentages of Th1 and Th2 were determined with flow cytometer, and the ratio of Th1 to Th2 was calculated. (2) According to the random number table, 18 mice in sham injury group were selected immediately after injury for the collection of lymphocyte suspension of peripheral blood (1 tube each mouse), and 18 mice of each of the other 3 groups were respectively selected at PIH 12, 24, 48, and 72 to collect the lymphocyte suspension of peripheral blood (1 tube each mouse). The mRNA expression levels of ANXA1, GATA-3, and T-bet were determined by real-time fluorescent quantitative reverse transcription-PCR. (3) Immediately after injury, 36 mice in sham injury group were selected to collect lymphocyte suspension of peripheral blood (1 tube each mouse) according to the random number table, and then 36 tubes of cell suspension were divided into 6 batches (6 tubes each batch). Each one of 6 kinds of antibody combinations: antibodies for labeling Th1 and Th2 in combination with PE-anthocyanin 7 labeled human anti-mouse ANXA1 monoclonal antibody, PE-anthocyanin 7 labeled human anti-mouse GATA-3 monoclonal antibody, and PE-anthocyanin 7 labeled human anti-mouse T-bet monoclonal antibody was added to 1 tube of cell suspension at each batch. According to the random number table, 36 mice of each of the other 3 groups were respectively selected at PIH 12, 24, 48, and 72 for the collection of lymphocyte suspension of peripheral blood (1 tube each mouse), and then 36 tubes of cell suspension at each time point were divided into 6 batches for marking with 3 kinds of surface markers of Th1 and Th2 (6 tubes each batch). Each one of above-mentioned 6 kinds of antibodies was added to 1 tube of cell suspension at each time point for each batch. The percentages of ANXA1, GATA-3, and T-bet positive cells in Th1 and Th2 were determined with flow cytometer. Data were processed with one-way analysis of variance, analysis of variance of factorial design, and SNK test. The relationship between the percentages of ANXA1 positive cell and the percentages of GATA-3 positive cell in Th1 and Th2, and mRNA expression level of ANXA1 and mRNA expression level of GATA-3 in lymphocytes were assessed by linear correlation analysis.</p><p><b>RESULTS</b>(1) Compared with those in sham injury group immediately after injury, the percentages of Th1 and Th2 and the ratio of Th1 to Th2 of mice in burn group were significantly decreased from PIH 24 on, with P values below 0.05; the percentages of Th1 and Th2 and the ratios of Th1 to Th2 of mice in sepsis group and burn+ sepsis group were significantly decreased from PIH 12 on, with P values below 0.05. (2) Compared with those in sham injury group immediately after injury, the mRNA expression levels of ANXA1 and GATA-3 in lymphocyte of mice in burn group were significantly decreased from PIH 24 on, with P values below 0.05; the mRNA expression level of T-bet was significantly decreased at PIH 24 but significantly increased at PIH 48 and 72, with P values below 0.05. Compared with those in sham injury group immediately after injury, the mRNA expression levels of ANXA1 and GATA-3 in lymphocytes of mice in sepsis group were significantly decreased from PIH 12 on, and the mRNA expression level of T-bet was increased significantly from PIH 12 on, with P values below 0.05; the mRNA expression levels of ANXA1, GATA-3, and T-bet in lymphocytes of mice in burn+ sepsis group were significantly decreased from PIH 12 on, with P values below 0.05, reaching the nadir at PIH 72 (0.50±0.04, 0.45±0.03, 0.21±0.05, respectively). (3) A significant positive correlation was observed between ANXA1 mRNA expression level and GATA-3 mRNA expression level in lymphocytes of peripheral blood (r=0.862, P<0.05). (4) Compared with those in sham injury group immediately after injury, the percentages of ANXA1 and GATA-3 positive cellsin Th1 and Th2 of mice in burn group were significantly lowered from PIH 24 on, and the percentage of T-bet positive cells was significantly decreased at PIH 24, but it was increased from PIH 48 on, with P values below 0.05. The percentages of ANXA1 and GATA-3 positive cells in Th1 and Th2 of mice in sepsis group were continuously decreased from PIH 12 on, which were lower at most time points than those in sham injury group immediately after injury, with P values below 0.05. The percentages of T-bet positive cells in Th1 and Th2 of mice in sepsis group were significantly increased since PIH 12 as compared with those in sham injury group immediately after injury, with P values below 0.05. The percentages of ANXA1, GATA-3, and T-bet positive cells in Th1 and Th2 of mice in burn+ sepsis group were continuously lowered from PIH 12, with significantly statistical differences at most time points as compared with those in sham injury group immediately after injury, with P values below 0.05. (5) The percentages of GATA-3 positive cells in Th1 and Th2 were significantly positively correlated with those of ANXA1 (with r values respectively 0.747 and 0.787, P values below 0.05).</p><p><b>CONCLUSIONS</b>The expression levels of ANXA1, GATA-3, and T-bet were continuously lowered in burned mice with sepsis, and it may play an important role in Th1/Th2 balance switching to Th2 bias and immunosuppressive process.</p>

Analysis of clinical characteristics of 187 patients with Marjolin's ulcers / 中华烧伤杂志

<p><b>OBJECTIVE</b>To analyze the etiology and clinical characteristics of Marjolin's ulcer, and to explore its prevention and treatment.</p><p><b>METHODS</b>Medical records of 187 patients with Marjolin's ulcers admitted to the Department of Burns and Reconstructive Surgery of Xiangya Hospital of Central South University from January 1998 to May 2015 were retrospectively analyzed, including gender, age of onset of initial injury or primary disease, age of onset of Marjolin's ulcer, initial injury or primary disease, length of latency, lengths of pre- and post-ulceration periods, lesion site, lesion type, lesion area, local scar tension, histopathological type, degree of carcinoma cell differentiation, bone invasion and lymphadenopathy, treatment, and prognosis. The relationships between the age of onset of initial injury or primary disease and the length of latency, and the length of pre-ulceration period and the length of post-ulceration period were assessed by Spearman correlation analysis. The recurrence rates were processed with Fisher's exact test.</p><p><b>RESULTS</b>(1) Among the patients, the ratio of male to female was nearly 1.6:1.0. The age of onset of initial injury or primary disease was 0.17-78.00 (17±18) years, and the age of onset of Marjolin's ulcers was 18-84 (49±14) years. (2) The most common initial injury among the patients was flame burn. The length of latency was 0.25-74.00 (32±16) years, and the lengths of pre- and post-ulceration periods were 0-73.00 (26±19) years and 0.08-59.00 (6±11) years respectively. The common lesion sites were the lower limbs and head and face. The rodent ulcer was the most common lesion type, and the lesion area was 1-625 (69±110) cm(2). There were obviously negative correlations between the age of onset of initial injury or primary disease and the length of latency, as well as the length of pre-ulceration period and the length of post-ulceration period (with r values respectively -0.71 and -0.50, P values below 0.01). The pathological scars of strong tension around lesions were seen in 176 cases. (3) The major histopathological type was squamous cell carcinoma, with high cell differentiation in most cases. (4) Bone invasion of carcinoma cells was observed in 59 cases. Lymph node enlargement was observed in 100 cases, and lymph node metastasis was observed in 18 cases. (5) Twenty patients did not receive any surgery, while 167 patients were treated by surgery with lesion extended resection as the main method. According to the condition of wound after the lesion extended resection, the wounds were mainly repaired by skin grafting and transplantation of local skin flap. The majority of wounds in 139 patients who underwent lesion extended resection were repaired in one surgery. Twenty-eight patients out of 104 followed-up cases had recurrence after surgery, mainly seen on head and face, upper limb, lower limb, and buttock, and there was no significant difference among them (P>0.05). The recurrence time of most patients was longer than 6 months after cure.</p><p><b>CONCLUSIONS</b>Patients with Marjolin's ulcers in younger age of onset of initial injury or primary disease tend to have longer latency, during which the shorter the pre-ulceration period is, the longer the post-ulceration period will be. Marjolin's ulcers are prone to occur in scar sites with large tension. Early treatment of high tension scar and scar ulcer is important in prevention, and surgery is the optimal treatment for Marjolin's ulcers. Regular follow-up should be carried out owning to recurrence rate in certain degree after surgery.</p>

To further improve the techniques for repair and reconstruction of skin and soft tissue defects around the knee joints / 中华烧伤杂志

This article briefly summarizes the techniques for repair of skin and soft tissue defects around the knee joints as reported in 5 papers in this issue, including how to choose the skin flap, muscle flap, myocutaneous flap, and vascular anastomosis in recipient site. It is found that the anterolateral femoral flap, latissimus dorsi myocutaneous flap, and gastrocnemius flap are widely used in clinic with high survival rates, and they can be used for the repair of large soft tissue defects as well as the reconstruction of the knee joint function.

Repair of large and deep skin and soft tissue defects around the knee joints with free latissimus dorsi musculocutaneous flaps / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the clinical efficacy of free latissimus dorsi musculocutaneous flaps in repairing large and deep skin and soft tissue defects around the knee joints.</p><p><b>METHODS</b>Twenty-five patients with large and deep skin and soft tissue defects around the knee joints were hospitalized from March 2005 to March 2014. The area of defects around the knee joints ranged from 10 cm × 8 cm to 43 cm × 23 cm. The free latissimus dorsi musculocutaneous flaps were used to repair the defects, with the area ranging from 12 cm × 10 cm to 45 cm × 25 cm. The thoracodorsal artery and its concomitant vein of the musculocutaneous flap were anastomosed to the descending branch of the lateral circumflex femoral artery and its concomitant vein respectively to reconstruct blood supply. Split-thickness skin grafts around the flap donor sites were harvested to cover the muscle surface of the musculocutaneous flaps. The flap donor sites were closed directly with suture, and the skin donor sites were healed by dressing change.</p><p><b>RESULTS</b>All the 25 flaps survived without vascular crisis. The flaps were in satisfactory appearance. The flap donor sites were healed with linear scar. All the patients were followed up for 3 to 6 months. At last, they were able to stand up and walk.</p><p><b>CONCLUSIONS</b>The free latissimus dorsi musculocutaneous flap transplantation is an effective treatment for the repair of large and deep soft tissue defects around the knee joints, and the descending branch of lateral circumflex femoral artery and its concomitant vein are the appropriate recipient vessels.</p>

Detection and homology analysis of virulence genes in pandrug-resistant Pseudo-monas aeruginosa / 中国感染与化疗杂志

Objective To study the prevalence and sequence homology of virulence genes exoU and exoS in 53 strains of pan-drug-resistant Pseudomonas aeruginosa .Methods The virulence genes exoU and exoS were detected by PCR.Sequence homo-logy was analyzed by BOX-PCR.Results Of the 53 clinical isolates of pandrug-resistant Pseudomonas aeruginosa ,the exoS+/exoU- genotype was identified in 40 strains,exoU+/exoS - genotype in 10 strains,exoS +/exoU+ genotype in 1 strain, and exoS-/exoU- genotype in 2 strains.BOX-PCR results showed that 41 exoS+ isolates belonged to 24 genotypes,and 11 exoU+ strains could be grouped into 7 genotypes.Conclusions The prevalence of virulence genes is high in clinical isolates of pandrug-resistant Pseudomonas aeruginosa .BOX-PCR fingerprint analysis combined with sequence homology analysis is help-ful for effective monitoring and control of hospital pandrug-resistant pseudomonas aeruginosa infection.