The Effects of Recombinant Human Granulocyte-Macrophage Colony-Stimulating Factor Gel on Third-Degree Frostbite Wounds in Northeastern China: A Randomized Controlled Trial.

The aim of the study was to investigate the effects of the rhGM-CSF gel on third-degree frostbite wounds. Sixty-two patients who had suffered third-degree frostbite on their hand or foot (91 wounds in total) were selected using a convenience sampling method and randomly allocated to two groups: the rhGM-CSF group(31patients,45 frostbite wounds) received the rhGM-CSF gel when wound dressing change daily; however, the control group (31patients, 46 frostbite wounds) received aloe glue. The wound healing time, the score of inflammation about the wound and the positive bacterial culture of wound secretions were used to measure outcomes, respectively. Data were analyzed using SPSS (25.0), Student's t test or Mann-Whitney U test and chi-square test or Fisher exact test were selected, as appropriate. The healing time of the rhGM-CSF group was (12.2 ± 5.0) days, which was significantly shorter than that of the control group (15.5 ± 4.7) days (P < .0001). The rhGM-CSF group's wound inflammation scores on the 7th and 14th day of treatment were (0.96 ± 0.21) and (1.88 ± 0.29), respectively, which were better than those of the control group (1.12 ± 0.24) and (1.38 ± 0.15) (both P < .0001). The positive bacterial culture of wound secretions in the rhGM-CSF group was also better than that in the control group on the 3rd, 7th, and 14th day after treatment (P = .027, .004, .030, respectively). According to the results, using rhGM-CSF gel considerably increases the speed of frostbite wounds healing, and have an effect on protecting third-degree frostbite wounds regarding the positive effects. Trial Registration: This trial was registered in the Chinese Clinical Trial Register, ChiCTR1900021299.

Efficacy and Safety of PL-5 (Peceleganan) Spray for Wound Infections: A Phase IIb Randomized Clinical Trial.

OBJECTIVE: To assess the safety and efficacy of antimicrobial peptide PL-5 (Peceleganan) spray in the treatment of wound infections. BACKGROUND: Antimicrobial peptide PL-5 spray is a novel topical antimicrobial agent. METHODS: We conducted a multicenter, open-label, randomized, controlled phase IIb clinical trial to evaluate the efficacy and safety of PL-5 spray, as compared with silver sulfadiazine, in patients with skin wound infections. The primary efficacy outcome was the clinical efficacy rate on the first day after ending the treatment (D8). The secondary efficacy outcome was the clinical efficacy rate on the fifth day posttreatment (D5), the bacteria clearance rate, and the overall efficacy rate at the mentioned 2 time points. The safety outcomes included adverse reactions and pharmacokinetic analysis posttreatment. RESULTS: A total of 220 patients from 27 hospitals in China were randomly assigned to 4 groups. On D8, the efficacy rate was 100.0%, 96.7%, 96.7% for the 1‰ PL-5, 2‰ PL-5, 4‰ PL-5 groups, respectively, as compared with 87.5% for the control group. The efficacy rate among the 4 groups was significantly different ( P <0.05). On D5, the efficacy rate was 100.0%, 93.4%, 98.3% for the 1‰ PL-5, 2‰ PL-5, 4‰ PL-5 groups, respectively, as compared with 82.5% for the control group. The efficacy rate among the 4 groups was significantly different ( P <0.05). The blood concentration of PL-5 was not detectable in pharmacokinetic analysis. No severe adverse event related to the application of PL-5 was reported. CONCLUSIONS: Antimicrobial peptide PL-5 spray is safe and effective for the treatment of skin wound infections. TRIAL REGISTRATION: ChiCTR2000033334.

A modelling approach to explore the optimum bubble size for micro-nanobubble aeration.

Bubble aeration has been widely applied in water/wastewater treatment, however its low gas utilization rate results in high energy consumption. Application of micro-nanobubbles (MNB) has emerged as a process with the potential to significantly increase gas utilisation due to their high relative surface area and high gas-liquid mass transfer efficiency. In this study, we demonstrate through calibrated models that MNB of an optimum bubble size can shrink and burst at or below the water surface enabling (1) all encapsulated gas to thoroughly dissolve in water, and (2) the bursting of nanobubbles to potentially generate free radicals. Through the understanding of MNB dimensional characteristics and bubble behaviour in water, a dynamic model that integrated force balance (i.e. buoyancy force, gravity, drag force, Basset force and virtual mass force), and mass transfer was developed to describe the rising velocity and radius variation of MNB along its upward trajectory. Unlike for conventional millimetre-sized bubbles, intensive gas dissolution of MNBs led to radius reduction for small bubbles, while a large initial radius triggers bubble swelling. The initial water depth was also crucial, where greater depth could drive the potential for bubble shrinkage so that they were more liable to contract. For example, the optimum bubble size of air (42-194 µm) and oxygen (127-470 µm) MNB that could achieve complete gas transfer (100% gas utilisation) for a range of specific water depths (0.5-10 m) were calculated. The modelling results for microbubbles (10-530 µm) were well validated by the experimental data (R2>0.85). However, the validation of the modelling results for nanobubble (<1 µm) aeration requires further study due to a lack of available empirical data. In this study, the proposed model and analysis provided new insights into understanding bubble dynamics in water and offered fundamental guidance for practitioners looking to upgrade bubble aeration system.

A Method for Determining Ultimate Grouting Pressure for Reinforcement of Masonry Arch Dam with Mortar Deterioration: A Case Study.

The deterioration of mortar has an adverse impact on the deformation and stress state of the masonry arch dam, after freeze-thaw cycles, in long-term operation. The purpose of this paper is to investigate the effect of reinforcement grouting on the stress of a thin masonry arch dam and propose a reasonable grouting method in the case of mortar deterioration. The determination of the ultimate grouting pressure is another main focus. The masonry material was generalized by combining a linear elastic model and the proportional weighted average under the condition of deterioration caused by freeze-thaw cycles. A series of analytical methods were proposed for the research of grouting effect on dam stress, based on which the ultimate grouting pressure is calculated in various cases. Results demonstrate that the dam tensile stress may exceed the allowable value in the following operation. Then, some recommended methods for the grouting layout and the estimation of grouting pressure were put forward by integrating the grouting field test with numerical analysis for reinforcement. The research conclusions might have a guiding significance for the reinforcement of similar projects.

A specially designed medical screen for children suffering from burns: A randomized trial of a distraction-type therapy.

OBJECTIVE: To evaluate the impact of the specially designed medical dressing screen during wound dressing changes of children who suffered burns to their hand or foot. DESIGN: Randomized controlled trial. SETTING: Burns and Plastic Reconstruction Unit. PARTICIPANTS: Children (N=120) with burns on up to 1-5% of the total body surface area. INTERVENTIONS: The patients were selected and randomly allocated to 3 equal-sized groups as follows: control group (N=40): the children received only regular dressing changes; computer group (N=40): a touch-screen computer was used for children during dressing changes; medical screen group (N=40): a medical screen combined with the touch-screen computer were used for children during dressing changes. All patients underwent a dressing change once per day for four days. Data were distributed four times: immediately after the initial dressing change (T1); and immediately after each times at next three consecutive days (T2-T4). MAIN OUTCOME MEASURES: The Pain level of the children evaluated by medical staffs was the primary outcome, the Pain level of the children evaluated by children's parents and the satisfaction of wound therapist were used as second outcomes. RESULTS: The mean scores related to pain level at the medical screen group displayed significantly better results than those of control group and those of the computer group. Additionally, the results of the pain evaluated by parents and satisfaction score of the wound therapist at the medical screen group was also better than other groups. CONCLUSIONS: This study demonstrated "that the" application of the medical screen for burns can relieve the pain of 1-3 years old children suffering from a burns during dressing changes. Additionally, the application of the medical screen also increased the satisfaction of the parents and the wound therapist performing the dressing changes.

LncRNA-FKBP1C regulates muscle fiber type switching by affecting the stability of MYH1B.

Long non-coding RNAs (lncRNAs) are well-known to participate in a variety of important regulatory processes in myogenesis. In our previous RNA-seq study (accession number GSE58755), we found that lncRNA-FKBP1C was differentially expressed between White Recessive Rock (WRR) and Xinghua (XH) chicken. Here, we have further demonstrated that lncRNA-FKBP1C interacted directly with MYH1B by biotinylated RNA pull-down assay and RNA immunoprecipitation (RIP). Protein stability and degradation experiments identified that lncRNA-FKBP1C enhanced the protein stability of MYH1B. Overexpression of lncRNA-FKBP1C inhibited myoblasts proliferation, promoted myoblasts differentiation, and participated in the formation of skeletal muscle fibers. LncRNA-FKBP1C could downregulate the fast muscle genes and upregulate slow muscle genes. Conversely, its interference promoted cell proliferation, repressed cell differentiation, and drove the transformation of slow-twitch muscle fibers to fast-twitch muscle fibers. Similar results were observed after knockdown of the MYH1B gene, but the difference was that the MYH1B gene had no effects on fast muscle fibers. In short, these data demonstrate that lncRNA-FKBP1C could bound with MYH1B and enhance its protein stability, thus affecting proliferation, differentiation of myoblasts and conversion of skeletal muscle fiber types.

Negative pressure wound therapy with instillation and dwell time in the wound management of necrotizing fasciitis.

OBJECTIVE: Recent literature has shown that negative pressure wound therapy with instillation and dwell time (NPWTi-d) is a valid method of managing complex wounds and gained increasingly wider interest due in part to the increasing complexity of wounds. The purpose of this case study was to obtain information on the profile of NPWTi-d in necrotizing fasciitis patients, investigate the role it play in wound bed preparation, length of hospital stay and number of debridement operations. METHODS: NPWTi-d has been used in patients with necrotizing fasciitis with either normal saline or Prontosan® solution and complete the treatment were involved in the present study. Following aggressive surgical debridement, NPWTi-d was initiated by instilling solution with a set dwell time of 5-10 min, followed by continuous NPWT of -125 mm Hg for 3-5 h. The system was changed on a 3-5 days schedule until sufficient granulation tissue was evident. Patients received systemic antibiotics and underwent wound debridement as indicated. Data of wound bed preparation, length of hospital stay, duration of NPWTi-d therapy, number of surgical interventions were collected retrospectively from patient medical records. RESULTS: A total of 32 patients with diagnosis of necrotizing fasciitis received NPWTi-d were included. Granulation tissue was found to be sufficient in 9-16 days. The mean duration of NPWTi-d therapy was 12.5 days prior to wound closure by split-thickness autograft (n = 21), suture (n = 9), or flap transplantation (n = 2).Patients received NPWTi-d treatment over a period of 8-16 days. The mean length of hospitalization was 22.8 days. All wounds were successfully closed and no recurrence of infection or adverse event was observed during NPWTi-d treatment. CONCLUSION: In these patients, NPWTi-d facilitates wound cleansing and wound bed preparation and offers the clinician an additional tool for the management of necrotizing fasciitis. Further well designed prospective investigations with low risk of bias are needed to confirm these findings in the future work.

The physiological and psychological mechanisms of infra-slow oscillation / 生理学报

Infra-slow oscillation (ISO) is a kind of brain rhythm between 0.01 and 0.5 Hz. ISO is widely distributed in multiple brain regions. As an important psychophysiological activity, the ISO interacts with high-frequency neural rhythm via cross-frequency coupling, but has different activity patterns from high-frequency neural activity. Physiologically, the ISO may be generated by the dynamic activity of thalamus, glia, and ions. Psychologically, the frequency, amplitude, and phase of ISO could all regulate cognitive activities, but in different ways. Investigations on the ISO expands the neural rhythm research to lower frequency range, further promoting the construction of rhythmic theory of brain function.

Complicated Posterior Cervical Skin and Soft Tissue Infections at a Single Referral Center.

BACKGROUND: Although the incidence and mortality of complicated skin and soft tissue infections have decreased, this infection is still relatively frequent and can be associated with lethal complications. In this study, the authors present our clinical experience of patients with complicated posterior cervical skin and soft tissue infections (CPCSSTIs) diagnosed and treated in a reconstructive unit in northeastern China. METHODS: A retrospective chart review of patients diagnosed with CPCSSTIs from January 2009 to December 2018 was performed. To make the results objective and convincing, a data analysis was performed relating to demographic characteristics, clinical presentation, predisposing factor, bacterial culture, laboratory and radiographic evaluations, diagnostic clues, management, and complications as well as the clinical course and outcome. RESULTS: During the ten-year period, there were 174 consecutive patients admitted to our reconstructive center with final diagnosis of CPCSSTIs included. All the patients were adults, and the majority were male (67.2%). The patient's mean age was 51.3 years (range, 15-88 years). There were 114 patients (65.5%) that had associated systemic diseases, with diabetes mellitus (40.2%) as the most common predisposing factor. Common presented clinical symptoms were pain (90.8%), swelling (85.1%), and erythema (77%) of the neck. Surgical treatment was performed in all the patients, and most of them (83.9%) received the first surgery within 24 h. The most commonly isolated pathogen was Staphylococcus aureus (30%). Vancomycin (21.3%) was the most commonly used antibiotics, followed by cefepime (18.4%). All the patients survived and were discharged with a mean duration of hospitalization of 28.7 days. Those patients with predisposing factors (31.4 ± 12.35 days) or complications (41.0 ± 12.5 days) tended to have a longer hospital stay. The mean total costs of admission per patient were 47 644 RMB. CONCLUSION: This study highlights the high cost burden of CPCSSTI patients. Those patients with predisposing factors or complications tended to have a longer hospital stay.

Deep frostbite: Clinical characteristics and outcomes in northeastern China.

OBJECTIVE: To investigate the clinical characteristics and treatment outcomes in patients with severe frostbite in a single institution in northeastern China. METHODS: The clinical records of patients with severe frostbite of the extremities who were hospitalized at the authors' institution between January 2009 and April 2019 were retrospectively reviewed. Demographic data, predisposing factors, clinical presentation, duration of signs and symptoms, number of surgical interventions, and length of hospital stay were extracted and analyzed. RESULTS: A total of 156 consecutive inpatients were treated for severe frostbite with the mean age was 43.7 ± 14.15 years. Hands were the most common site involved (38.5%). The most prevalent predisposing factor for frostbite included alcohol abuse (41.67%), smoking habits (37.18%) and psychiatric illness (14.11%). Mean duration of signs and symptoms was 3.6 days. Most of patients (37.8%) sustained frostbite injury in January. All patients survived, and the mean length of hospital stay was 45.6 days (range, 29-62). Amputations of limbs were performed in 40.4% of patients. CONCLUSION: The incidence of deep frostbite in Jilin province correlates with the environmental temperature and is often associated with alcohol abuse, smoking and other psychosocial factors. Delayed presentation would increase the risk of amputation. These findings should guide clinical decisions about the treatment of individual patients with deep frostbite.

Moxibustion-Induced Burns in a Burn Unit in Northeast China: An 8-Year Retrospective Analysis.

The purpose of this paper was to analyze the characteristics of burns caused by moxibustion. A retrospective survey of the medical records of patients was performed on patients who visited our center from January 2009 to January 2017, treating for burns caused by moxibustion. Data were extracted and evaluated, including demographics, site and extent of burns, type and treatment duration of moxibustion, practitioners, and cost. A total of 82 consecutive patients treated for moxibustion-induced burns were included. The average patient age was 42.4 years, with the male to female ratio of 1.2:1. Burns caused by direct and indirect moxibustion were 7 and 75 cases, respectively. Averagely, moxibustion was performed 3.6 times a week for 3.7 weeks and lasts for 16.2 minutes each treatment. The average distance for indirect moxibustion was 3.4 cm (ranged from 2 to 5 cm) away from the acupoints. First-degree and superficial partial thickness burns, deep partial thickness burns, and full thickness burns were present in 16, 59, and 7 cases, respectively. Most of the burns were minor burns, with diameter less than 2 cm (69 cases). The most common sites were the lower extremities (46 cases), followed by abdomen (29 cases) and upper extremities (5 cases). The average cost for inpatients and outpatients was 5 164 and 2 192 RMB, respectively. Majority of moxibustion-induced burns are minor burns, and there is a high probability of the burn being deep if it occurs in the lower extremities.

A randomized trial of a distraction-type intervention to assist in managing dressing changes for children experienced burns.

AIM: To evaluate the impact of the specially designed medical dressing screen during wound dressing changes for children aged 1-3 who experienced a burn on their hand or foot. DESIGN: Randomized controlled trial. METHODS: The study was performed, between January 2019 - April 2019, at a Burn Outpatient Ward. A total of 52 outpatient children who had suffered burns were included in the clinical trial. The burn area of these participants accounted for 1-5% of the total body surface area. The children were randomly divided into two equal-sized groups, each receiving a different treatment. In the medical screen group (N = 26), a medical screen was used for children during the dressing changes. In the control group (N = 26), the children received only regular dressing changes. Pain level of the children during dressing change was the primary outcome, the satisfaction of children's parents and wound therapist were used as second outcomes. The Bonferroni method was used to perform pairwise comparisons of repeatedly measured data at different measurement times in two groups. RESULTS: The results showed that the medical screen group had better outcomes with respect to pain management during dressing changes; in addition, the satisfaction score of the wound therapist and children's parents presented also better outcomes compared with the control group. CONCLUSION: This study demonstrated application of the medical screen for burns can relieve the pain of 1 - 3-year old children experienced a burn during dressing changes. In addition, the application of the medical screen also increased the satisfaction of the child's parents and wound therapist. Registration NO: 1,900,020,953. IMPACT: Compared with conventional dressing methods, the medical screen can be used as a novel way to decrease the negative experience of burn patients ages 1-3 who require dressing changes.

Impact of orally administered tramadol combined with self-selected music on adult outpatients with burns undergoing dressing change: A randomized controlled trial.

OBJECTIVE: To investigate the effects of music and/or tramadol on pain and anxiety in burn outpatients undergoing dressing changes. DESIGN: Randomized controlled trial. SETTING: Burns and Plastic Reconstruction Unit. PARTICIPANTS: Patients (N=180) with burns on up to 10%-30% of the total body surface area (TBSA). INTERVENTIONS: The patients were randomly allocated to 4 equal-sized groups as follows: (1) tramadol group (TG), patients received 100mg of tramadol orally 20min before the dressing change; (2) music group (MG), patients listened to self-selected music during the dressing change; (3) music-plus-tramadol group (MTG), patients received tramadol and listened to self-selected music; and (4) control group (CG), patients received a routine dressing change only. All patients underwent the interventions once per day for 2days. MAIN OUTCOME MEASURES: McGill Pain Questionnaire Short Form (MPQ-SF) (primary outcome), McGill Pain Persian version of Burn Specific Pain Anxiety Scale (BSPAS) (primary outcome), and heart rate (HR) and overall patient satisfaction (secondary outcomes). RESULTS: The results showed that music-plus-tramadol group (MTG) had better outcomes with respect to pain and anxiety management during dressing changes. CONCLUSIONS: In comparison with music or tramadol alone, the integration of music and tramadol offers a secure and favorable treatment choice to relieve pain and anxiety, ultimately improving the satisfaction levels of burn outpatients during dressing changes.

Characterisation of the complete chloroplast genome of an endemic herb plant species, Rheum palmatum (Polygonaceae) in China.

Rheum palmatum has a long history in medicine, which is one of the main export medicinal herb in China. The complete chloroplast genome of R. palmatum was assembled and reported in this study. The R. palmatum chloroplast genome was 161,541 bp in length as the circular and consisted a large single-copy (LSC) region of 86,519 bp, a small single-copy (SSC) region of 13,112 bp and a pair of inverted-repeat (IR) regions of 30,955 bp. The nucleotide composition was asymmetric 31.2% A (Adenine), 31.5% T (Thymine), 19.0% C (Cytosine), and 18.3% G (Guanine) with an overall G + C content of 37.3%. It encoded 131 genes, including 86 protein-coding genes (76 PCG species), 37 transfer RNA genes (26 tRNAs species), and eight ribosomal RNA genes (four rRNAs species). The Phylogenetic relationships used neighbour-joining (NJ) method and the result showed that R. palmatum and Rheum officinale are phylogenetically related to each other in the family Polygonaceae. This study will be very important for Chinese medicinal herb research value and clinical drug development for future in China.

A Novel Dnmt3a1 Transcript Inhibits Adipogenesis.

DNA (cytosine-5)-methyltransferase 3a (Dnmt3a) is an enzyme that catalyzes the transfer of methyl groups to specific CpG forms in DNA. In mammals, two variant transcripts of Dnmt3a have been successfully identified. To the best of our knowledge, no Dnmt3a transcripts in an avian have been successfully identified. This study was performed to detect different transcripts of Dnmt3a in chickens and to examine whether a novel Dnmt3a transcript named Dnmt3a1 may regulate adipogenesis. In addition to cloning, sequencing, transcript detection, and expression studies, a novel Dnmt3a1 transcript overexpression and knockdown were conducted to explore the potential role of Dnmt3a1 in preadipocyte proliferation and the early stage of adipocyte differentiation. In chicken abdominal fat tissue, we detected a novel Dnmt3a1 transcript that differs from Dnmt3a by lacking 23 amino acids at the exon-1/exon-2 border. Dnmt3a1 mRNA was ubiquitously expressed in a variety of tissues or cells and highly expressed in chicken adipose tissue/cells. The expression of Dnmt3a1 was regulated under different physiological conditions including aging, fasting, and high-fat diet. In addition, overexpression of Dnmt3a1 significantly decreased preadipocyte proliferation and induced cell-cycle arrest while its inhibition increased cell proliferation and S-phase cells. Furthermore, the overexpression of Dnmt3a1 significantly upregulated the mRNA level of cell-cycle-related genes, such as CDKN1A, CDKN1B, CCNB3, CCND2, CCNG2, CDKN2B, and CDK9, or the protein level of CDKN1A, CDKN1B, and CCNG2. Conversely, the knockdown of Dnmt3a1 by siRNA had the opposite effects. Moreover, during early adipocyte differentiation, the overexpression of Dnmt3a1 significantly decreased the mRNA and the protein levels of PPAR-γ, C/EBP-α, ADIPOR1, and STAT3, and the mRNA levels of FAS, LEPR, LPL, PRKAB2, and ATGL. In contrast, their expression was significantly increased after the knockdown of Dnmt3a1. Taken together, we identified a novel transcript of Dnmt3a, and it played a potential role in adipogenesis.

Lower energy radial shock wave therapy improves characteristics of hypertrophic scar in a rabbit ear model.

The aim of the present study was to investigate the effects of radial extracorporeal shock wave therapy (rESWT) on scar characteristics and transforming growth factor (TGF)-ß1/Smad signaling in order to explore a potential modality for the treatment of hypertrophic scars (HS). The HS model was generated in rabbit ears, then rabbits were randomly divided into 3 groups: Lower (L)-ESWT [treated with rESWT with lower energy flux density (EFD) of 0.1 mJ/mm2], higher (H)-ESWT (treated with a higher EFD of 0.18 mJ/mm2) and the sham ESWT group (S-ESWT; no ESWT treatment). Scar characteristics (wrinkles, texture, diameter, area, volume of elevation, hemoglobin and melanin) were assessed using the Antera 3D® system. The protein and mRNA expression of TGF-ß1, Smad2, Smad3 and Smad7 was assessed by enzyme-linked immunosorbent assay and reverse transcription-quantitative polymerase chain reaction, respectively. The Antera 3D® results indicated that wrinkles and hemoglobin of the HS were significantly improved in both of the rESWT groups when compared with the S-ESWT group. However, these changes appeared much earlier in the L-ESWT group than the H-ESWT. Scar texture was also improved in the L-ESWT group. However, rESWT did not influence HS diameter, area, volume of elevation or melanin levels. rESWT had no effect on TGF-ß1 or Smad7 expression in either of rESWT groups. Although no difference was observed in Smad2 mRNA expression in the L-ESWT group, the Smad3 mRNA and protein expression significantly decreased when compared with the H-ESWT and S-ESWT groups. By contrast, Smad2 and Smad3 mRNA expression were upregulated in the H-ESWT group. These results demonstrated that rESWT with 0.1 mJ/mm2 EFD improved some characteristics of the HS tissue. Downregulation of Smad3 expression may underlie this inhibitory effect. Inhibition of the TGF-ß1/Smad signal transduction pathway may be a potential therapeutic target for the management of HS.

Extracorporeal shock wave therapy with low-energy flux density inhibits hypertrophic scar formation in an animal model.

Hypertrophic scar is characterized by excessive deposits of collagen during skin wound healing, which could become a challenge to clinicians. This study assessed the effects of the extracorporeal shock wave therapy (ESWT) on hypertrophic scar formation and the underlying gene regu-lation. A rabbit ear hypertrophic scar model was generated and randomly divided into three groups: L-ESWT group to receive L-ESWT (energy flux density of 0.1 mJ/mm2), H-ESWT (energy flux density of 0.2 mJ/mm2) and sham ESWT group (S-ESWT). Hypertrophic scar tissues were then collected and stained with hematoxylin and eosin (H&E) and Masson's trichrome staining, respectively, to assess scar elevation index (SEI), fibroblast density and collagen fiber arrangement. Expression of cell proliferation marker proliferating cell nuclear antigen (PCNA) and α-smooth muscle actin (α-SMA) were assessed using RT-PCR and immunohistochemistry in hypertrophic scar tissues. H&E staining sections showed significant reduction of SEI and fibroblast density in both ESWT treatment groups compared to S-ESWT, but there was no dramatic difference between L-ESWT and H-ESWT groups. Masson's trichrome staining showed that collagen fibers were more slender and broader and oriented in parallel to skin surface after administration of ESWT compared to control tissues. At the gene level, PCNA­positive fibroblasts and α-SMA-positive myofibroblasts were significantly decreased after L-ESWT or H-ESWT compared to the controls. Furthermore, there was no significant difference in expression of PCNA mRNA between L-ESWT or H-ESWT and S-ESWT, whereas expression of α-SMA mRNA significantly decreased in L-ESWT compared to that of H-ESWT and S-ESWT (P=0.002 and P=0.030, respectively). In conclusion, L-ESWT could be effective on suppression of hypertrophic scar formation by inhibition of scar elevation index and fibroblast density as well as α-SMA expression in hypertrophic scar tissues of the rabbit model.

Retrospective Review of Free Anterolateral Thigh Flaps for Limb Salvage in Severely Injured High-Voltage Electrical Burn Patients.

BACKGROUND: High-voltage electrical injuries usually cause extensive and devastating damages to the extremities. Timely and effective coverage of the wounds to maximally preserve the viable tissue is important for salvage and the ultimate functional outcome of the involved extremities. In this study, free anterolateral thigh flaps with a single-perforator pedicle were conducted to maximize tissue salvage and decrease late skeletal and neuromuscular complications of the involved extremities injured by high-voltage electricity. METHODS: From June 2012 to December 2015, 12 patients with high-voltage electrical injuries on the extremities were recruited. After primary or secondary debridement, free anterolateral thigh flaps with a single-perforator pedicle were used for limb salvage. Patients' clinical records, including etiology, sex, age, perforator type, defect location, duration before admission, defect and flap size, timing of reconstruction, and complications, were extracted and analyzed. RESULTS: All patients were followed up ranging from 10 to 25 months, with an average follow-up of 15.9 months. Free anterolateral thigh flap with a single-perforator pedicle was performed for 12 consecutive patients with high-voltage electrical injuries. The mean time taken before the transplantation of the flap was 5.25 days, with a range from 2 to 8 days. The average size of the resultant defects after debridement was 187.0 cm (84-350 cm), the average size of the flaps was 265.3 cm (119-448 cm), and the average time of the surgical operation was 314.6 minutes (260-355 minutes). All flaps healed uneventfully without associated complications. No weakness of the donor thigh was observed in all cases. CONCLUSIONS: Free anterolateral thigh flaps with a single-perforator pedicle were an effective and reliable therapeutic intervention for the management of severe high-voltage electrical injuries on the extremities.

Couple-kissing flaps for successful repair of severe sacral pressure ulcers in frail elderly patients.

BACKGROUND: Surgical repair of severe pressure ulcers (PUs) in elderly patients remains a challenge for clinicians due to the complicated comorbidities and the special physical characteristics of elderly patients. The objective of this study was to evaluate the application of couple-kissing flaps (CKF) in the reconstruction of sacral PUs in these patients. METHODS: Elderly patients (over 70 years) with stage 3 or stage 4 PUs who underwent CKF immediately after radical debridement between July 2012 and December 2015 were enrolled in this retrospective study. Patients' demographics were extracted from the medical records. RESULTS: A total of 12 patients were involved in this study. The average age of the patients was 76.83 years (ranged from 71 to 92 years). The donor site was closed primarily in all cases. All the flaps healed uneventfully without complications. Follow-up observations were conducted for an average of 13.6 months (ranged from 9 months to 2 years). Cosmetic results were satisfactory, with no surgical site breakdown or recurrence of PU in any of the cases. Three representative cases are presented. CONCLUSIONS: The CKF is a reliable and satisfactory option for the reconstruction of severe sacral PUs defects in elderly patients. CKF is associated with an relatively low rate of complications and recurrence.

Necrotizing soft tissue infection: clinical characteristics and outcomes at a reconstructive center in Jilin Province.

BACKGROUND: To investigate the clinical characteristics and treatment outcomes in necrotizing fasciitis (NF) patients in a reconstructive unit in northeastern China. METHODS: Medical records of patients diagnosed with and treated for NF in the extremities from November 2013 to December 2016 were retrospectively reviewed. Demographic data, clinical presentation, duration of signs and symptoms, location of infection, predisposing factors, causative microbiological organisms, laboratory risk indicator for necrotizing fasciitis (LRINEC) score, number of surgical debridements, length of hospital stay, treatments, and outcomes were recorded. RESULTS: A total of 39 consecutive patients were treated for severe NF (32 male and 7 female). Diabetes mellitus and blunt trauma were the most common risk factors (13 and 9 cases, respectively). The positive predictive value of the LRINEC score in NF diagnosis was 46.2%. Mean duration of signs and symptoms was 4.6 days. Staphylococcus aureus was the most commonly isolated bacteria (20 cases). All patients underwent their first debridement within 12 h of presentation (mean, 4.6 h). Mean number of surgical treatments was 2.8 (range, 2-5) per patient, including debridements. All patients survived, and mean length of hospital stay was 30.81 (range, 21-43) days. Three patients underwent limb amputation. CONCLUSIONS: In our clinical experience, early detection and aggressive debridement are the cornerstones of NF treatment. Antibiotic therapy and intensive care support is essential in severe cases of NF. Anaerobic tissue culture and frozen section biopsy could be adopted as routine tests for diagnosis and decision-making in NF. These findings should inform clinical decisions about the treatment of individual patients with NF.