Nanosilver alleviates foreign body reaction and facilitates wound repair by regulating macrophage polarization. / 纳米银通过调控巨噬细胞极化以减轻异物反应并促进创面修复.

Foreign body reactions induced by macrophages often cause delay or failure of wound healing in the application of tissue engineering scaffolds. This study explores the application of nanosilver (NAg) to reduce foreign body reactions during scaffold transplantation. An NAg hybrid collagen-chitosan scaffold (NAg-CCS) was prepared using the freeze-drying method. The NAg-CCS was implanted on the back of rats to evaluate the effects on foreign body reactions. Skin tissue samples were collected for histological and immunological evaluation at variable intervals. Miniature pigs were used to assess the effects of NAg on skin wound healing. The wounds were photographed, and tissue samples were collected for molecular biological analysis at different time points post-transplantation. NAg-CCS has a porous structure and the results showed that it could release NAg constantly for two weeks. The NAg-CCS group rarely developed a foreign body reaction, while the blank-CCS group showed granulomas or necrosis in the subcutaneous grafting experiment. Both matrix metalloproteinase-1 (MMP-1) and tissue inhibitor of metalloproteinase-1 (TIMP-1) were reduced significantly in the NAg-CCS group. The NAg-CCS group had higher interleukin (IL)-10 and lower IL-6 than the blank CCS group. In the wound healing study, M1 macrophage activation and inflammatory-related proteins (inducible nitric oxide synthase (iNOS), IL-6, and interferon-|γ (IFN-|γ)) were inhibited by NAg. In contrast, M2 macrophage activation and proinflammatory proteins (arginase-1, major histocompatibility complex-II (MHC-II), and found in inflammatory zone-1 (FIZZ-1)) were promoted, and this was responsible for suppressing the foreign body responses and accelerating wound healing. In conclusion, dermal scaffolds containing NAg suppressed the foreign body reaction by regulating macrophages and the expression of inflammatory cytokines, thereby promoting wound healing.

The correlation between serum creatinine and burn severity and its predictive value.

This study aimed to explore the correlation between serum creatinine and burn severity and the value of predicting the outcome of patients. For this purpose, a total of 268 burn patients (BUP) were collected. According to the burn area, they were divided into mild group (MIG) (n = 125, burn area 30% - 49%), moderate group (MOG) (n = 80, burn area 50% - 79%) and severe group (SEG) (n = 63, burn area ≥ 80%). According to the prognosis, they were divided into survival group (SUG) (n = 170) and death group (DEG) (n = 98). At the same time, the control group (COG) was selected from the physical examination center of our hospital. 5 mL of fasting venous blood was collected from all BUP on the first, seventh, 14th and 21st days after admission. 5 mL of fasting venous blood was collected from the COG. Creatinine (CRE) level was measured by enzyme method. Cholinesterase (CHE) level in serum was measured by improved Ellman method. The changes of CRE and CHE in serum were compared among all groups to explore the correlation between serum creatinine and burn severity and its prediction Measure the value of patients' outcomes. Results showed that except for the first day after burn, the level of serum CRE in BUP was raised than that in the COG, and the level of serum CHE in BUP was reduced than that in the COG (P<0.05). The serum CHE level of BUP in all groups increased at first and then decreased, and the highest level was on the first day after injury. At the same time, the level of CRE in SEG was raised than that in MIG and MOG, and the level of CRE in MOG was raised than that in MIG (P<0.05). The serum CHE level of BUP in all groups decreased at first and then increased, and the lowest level was on the first day after injury. At the same time, the level of CRE in SEG was reduced to that in MIG and MOG, and the level of CRE in MOG was reduced to that in MIG (P<0.05). The level of CRE in serum of BUP in both groups increased at first and then decreased, and the level was the highest on the first day after injury. At the same time, the level of CRE in the DEG was raised than that in the SUG (P<0.05). The level of CHE in serum of BUP in both groups decreased at first and then increased, and the level was the lowest on the first day after injury. At the same time, the level of CRE in the death group was reduced than that in the SUG (P<0.05). Logistic regression analysis showed that there was statistical significance in the regression coefficients on the 1st, 7th, 14th and 21st day after burn, and on the 1st and 21st day after-burn. ROC curve analysis shows that CRE and CHE have certain value in diagnosing the prognosis of BUP, and the diagnostic value of CRE is higher. Cre level increases with the aggravation of burn patients, and ChE level decreases with the aggravation of BUP. In conclusion, Cre and ChE have certain value in diagnosing the prognosis of BUP and can be widely used in clinical practice.

Clinical Effect of Emergency Dermabrasion Combined with Biological Dressing A on Wound Microcirculation and Preventing Sepsis in Deep Degree-II Burns.

Objective: The aim of this study is to explore the clinical effect of emergency dermabrasion combined with biological dressing A on wound microcirculation and preventing sepsis in deep degree-II burns. Methods: A total of 90 patients with deep degree-II burns admitted to the hospital were retrospectively enrolled between January 2020 and January 2022. According to different treatment methods, they were divided into the control group (42 cases, biological dressing A) and the observation group (48 cases, emergency dermabrasion combined with biological dressing A). The clinical curative effect in both groups was observed. The wound repair rate and wound healing quality, and changes in levels of wound microcirculation-related indexes (serum epidermal growth factor (EGF), wound blood flow, and partial pressure of transcutaneous oxygen) and inflammatory cytokines (C-reactive protein (CPR), interleukin-6 (IL-6), erythrocyte sedimentation rate (ESR), and procalcitonin (PCT)) before treatment, at 3d and 7d after treatment were compared between the two groups. The incidence of wound infection and sepsis in both groups was recorded. Results: The wound healing time in the observation group was significantly shorter than that in the control group, and wound healing quality in the observation group was better than that in the control group (P < 0.05). At 3 d and 7d after treatment, the levels of serum EGF, wound blood flow and partial pressure of transcutaneous oxygen in both groups were all increased (P < 0.05), which were higher in the observation group than those in the control group (P < 0.05). The levels of CRP, IL-6, ESR, and PCT in both groups were all decreased (P < 0.05), which were lower in the observation group than those in the control group (P < 0.05). There was no significant difference in incidence of sepsis between observation group and control group (4.17% (2/48) vs. 7.14% (3/42)) (Fisher = 0.539). Conclusion: Emergency dermabrasion combined with biological dressing A can effectively improve wound microcirculation in patients with deep degree-II burns, promote wound healing, shorten wound healing time, improve wound healing quality, effectively control inflammatory response, and prevent sepsis.

Idiopathic necrotizing fasciitis following fracture fixation: A case report.

INTRODUCTION: Idiopathic necrotizing fasciitis (NF) is an infrequent, highly lethal skin infection that spreads rapidly, marked by fascia and subcutaneous tissue necrosis. It occurs in the absence of a known causative factor. Its emergence after sterile orthopedic fixation with unexpected spread to the abdomen may turn to be challenging both as a medical and surgical emergency. PATIENT CONCERNS: A 56-year-old diabetic female presented with multiple fractures. After open reduction and internal fixation (ORIF) with iliac crest grafting of hip fracture, she developed incisional NF which later spread to the abdomen. DIAGNOSIS: Post-ORIF of hip fracture complicated with idiopathic NF and abdominal spread. INTERVENTIONS: She underwent emergency débridements with negative pressure wound therapy and broad-spectrum intravenous antibiotic therapy. After granulation, the wounds were closed with skin flaps and grafts with antibiotic beads. When the NF spread to the abdomen, additional débridements during abdominal explorations were performed. OUTCOMES: The patient was initially stable with promising healings of the wounds. Later, the patient suddenly developed a high fever and severe abdominal pain. Ultrasound revealed that NF emerged unexpectedly in the right lower abdomen. The causative agent of the NF remained undetected. Despite all the extensive treatments, the patient's condition deteriorated rapidly. She died of septic shock and multiple organ failure. CONCLUSION: The idiopathic NF may still potentially occur after a clean ORIF of the hip region. The implementation of intensive guideline-based treatments may show improvements, but the risk of unexpected NF spread to the abdomen should be anticipated, which may increase the mortality rates in diabetic or immunocompromised patients.

Skin perfusion pressure for the prediction of wound healing in critical limb ischemia: a meta-analysis.

INTRODUCTION: The purpose of this meta-analysis was to determine the value and efficacy of skin perfusion pressure (SPP) for the prediction of wound healing in patients with critical limb ischemia. MATERIAL AND METHODS: Medline, Cochrane, EMBASE, and Google Scholar databases were searched from inception until December 31, 2014 using combinations of the following keywords: skin perfusion pressure, limb ischemia, wound healing, prediction. Randomized controlled trials, 2-arm prospective studies, and retrospective studies that measured SPP in patients with limb ischemia were included. The outcome was the sensitivity and specificity of SPP for the prediction of wound healing. RESULTS: Five studies were included in the meta-analysis. The mean patient age ranged from 62.2 to 71.5 years, and the majority were male. The pooled sensitivity of SPP for the prediction of wound healing was 79.9% using 30 mm Hg as the cut-off, 67.1% using 40 mm Hg, and 76.1% for all included studies (95% CI: 73.9-84.9%, 55.8-76.8%, and 70.7-80.8%, respectively). The pooled specificity was 78.2% using 30 mm Hg, 84.2% using 40 mm Hg, and 82.1% for all included studies (95% CI: 61.5-89.0%, 74.0-90.9%, 73.7-88.3%, respectively). CONCLUSIONS: Skin perfusion pressure can accurately predict wound healing in patients with critical limb ischemia.

Rare Skin Fistulas Relating to Ascending Colonic Carcinoma: An Unusual Mode of Revelation.

Chronic or nonhealing wounds is a complex disease influenced by a multitude of factors, such as infection, ischemia, malnutrition, and diabetes and infrequently relates to retroperitoneal carcinoma. We present a case of an adenocarcinoma of ascending colon in a 68-year-old male who had lumbago and waist fistulas with retroperitoneal abscesses preceding other signs or symptoms of colonic malignancy. Supplemental information regarding the diagnosis and treatment of nonhealing wounds and colon carcinoma has also been included in the report. Adenocarcinoma of ascending colon is rarely associated with nonhealing wounds; nevertheless, it should be considered in cases with long-term healing complications. Precise diagnostic deliberation is crucial in the management and treatment of all chronic and long-term nonhealing lesions, and appropriately performed biopsies are essential to determine whether malignancy is the primary cause.

Silver nanoparticle loaded collagen/chitosan scaffolds promote wound healing via regulating fibroblast migration and macrophage activation.

Treatment of full-thickness skin defects poses significant clinical challenges including risk of infection and severe scaring. Silver nanoparticle (NAg), an effective antimicrobial agent, has provided a promising therapeutic method for burn wounds. However, the detailed mechanism remains unknown. Hence, we constructed a metallic nanosilver particles-collagen/chitosan hybrid scaffold (NAg-CCS) and investigated its potential effects on wound healing. In vitro scratch assay, immunofluorescence staining and antibacterial activity of the scaffold were all studied. In vivo NAg-CCS was applied in full-thickness skin defects in Sprague-Dawley (SD) rats and the therapeutic effects of treatment were evaluated. The results showed that NAg at a concentration of 10 ppm accelerated the migration of fibroblasts with an increase in expression of α-smooth muscle actin (α-SMA). Furthermore, in vivo studies showed increased levels of pro-inflammatory and scar-related factors as well as α-SMA, while markers for macrophage activation were up-regulated. On day 60 post transplantation of ultra-thin skin graft, the regenerated skin by NAg-CCS had a similar structure to normal skin. In summary, we demonstrated that NAg-CCS was bactericidal, anti-inflammatory and promoted wound healing potentially by regulating fibroblast migration and macrophage activation, making it an ideal dermal substitute for wound regeneration.

Targeted killing of myofibroblasts by biosurfactant di-rhamnolipid suggests a therapy against scar formation.

Pathological myofibroblasts are often involved in skin scarring via generating contractile force and over-expressing collagen fibers, but no compound has been found to inhibit the myofibroblasts without showing severe toxicity to surrounding physiological cells. Here we report that di-rhamnolipid, a biosurfactant secreted by Pseudomonas aeruginosa, showed potent effects on scar therapy via a unique mechanism of targeted killing the myofibroblasts. In cell culture, the fibroblasts-derived myofibroblasts were more sensitive to di-rhamnolipid toxicity than fibroblasts at a concentration-dependent manner, and could be completely inhibited of their specific functions including α-SMA expression and collagen secretion/contraction. The anti-fibrotic function of di-rhamnolipid was further verified in rabbit ear hypertrophic scar models by presenting the significant reduction of scar elevation index, type I collagen fibers and α-SMA expression. In this regard, di-rhamnolipid treatment could be suggested as a therapy against skin scarring.

A randomized controlled trial to compare the effects of liquid versus powdered recombinant human growth hormone in treating patients with severe burns.

Recombinant human growth hormone (rhGH) promotes protein utilization and synthesis, and is widely used as a therapy to treat severe burns. The present randomized controlled trial evaluated the effects of different forms of rhGH on patients with severe burns. A total of 29 adult severe burns patients were enrolled between February 2009 and November 2011, and randomly assigned to either treatment group (T, liquid rhGH) or control group (C, powder rhGH). From days 5 to 7 following the infliction of burns, both patient groups received rhGH at 0.067 mg/kg/d, once for 10 days. Median serum pre-albumin levels increased in both groups following treatment, the elevation from baseline was significantly higher in the T group on day 10 compared to the C group (88 mg/l vs. 65 mg/l, P=0.046). C-reactive protein, fasting plasma glucose and body weight decreased in both groups. Body weight was significantly lower in the T compared to the C group at baseline, Day 5 and Day 10 (P=0.046, P=0.018 and P=0.006, respectively), however the decrease from baseline levels were not significantly different. Wound healing time was similar between groups (P=0.270). In conclusion the early use of liquid rather than powder rhGH may be more beneficial for treating adult patients with severe burns.

The characteristics and correlation between the ischemia-reperfusion and changes of redox status in the early stage of severe burns.

OBJECTIVE: Both the ischemia-reperfusion injury and the abnormal changes of redox status are the important pathologic changes in the burn shock stage for severe burns. The study of clinical dynamic, quantitative relevance about them was performed. METHODS: In this study, blood redox potential (ORP) values (ΔORP value was adopted, as the quantitative index to reflect the overall redox status), plasma uric acid levels (important antioxidant, as antioxidant index), and the burn shock state-related indicators (lactic acid and hematocrit) of 48 burn patients were dynamically, quantitatively monitored during the early stage after injury. RESULTS: The results revealed that the duration of abnormal fluctuation of redox status in the early stage of severe burns was longer than that of the traditional clinical shock stage (2-3 days). The changes of overreduction soon after injury were closely related to the hypovolemia-related hypoxia, and the following overoxidation status was consistent with the pathophysiological changes related to the reperfusion, and the degrees of variation were closely related to the severity of burn injury and prognosis. Moreover, early surgery (3 days after injury) had no significant influence on the changing trend of abnormal redox status in the early stage of severe burns. CONCLUSION: The ischemia-reperfusion injury caused by burn shock appears the main factor contributing to the abnormal biphasic changes of redox status in the early stage of severe burns. Our findings provide useful information for the redox regulation treatment for burn shock.

Follicular unit transplantation for the treatment of secondary cicatricial alopecia.

BACKGROUND: Cicatricial alopecia encompasses a diverse group of disorders characterized by the permanent destruction of hair follicles and irreversible hair loss. Follicular unit transplantation was developed in 1994. However, large-scale clinical trials are necessary to study follicular unit transplantation for treating Chinese cicatricial alopecia patients. OBJECTIVE: To investigate the efficacy of follicular unit transplantation in the treatment of cicatricial alopecia in Chinese patients. METHODS: Patients with cicatricial alopecia were enrolled. The designated recipient area, follicular unit density of the donor site, transplanted density and operative time were recorded. Postoperative follow-up was conducted within six to 24 months; the density of hair in the recipient area was calculated using a Folliscope (Hansderma Co, USA). Patients' self-reported satisfaction and long-term complications were recorded. RESULTS: Thirty-seven patients were enrolled. Cicatricial alopecia was caused by burns (n=8), trauma (n=21) and plastic surgery (cleft lip and palate repair [n=8]). Burn patients had a significantly larger bald area than the other patients (P<0.01). The operative time was significantly correlated with recipient area. The longest operation was 14.5 h; the largest transplanted area was 96 cm(2). At follow-up, the surviving follicular unit density/transplanted follicular unit density rate was 64.29% to 95.00% (mean 78.96%); the surviving/transplanted (S/T) area was 100% for 30 patients, 90% to 100% for five patients and <90% for two patients. The lowest S/T area was 82.81%. The S/T index was significantly and inversely correlated with operative time. Regarding long-term complications, two patients had postoperative epidermoid cysts that healed with local treatment. CONCLUSION: Follicular unit transplantation is an effective method for treating cicatricial alopecia. It is relatively safe and yields satisfactory postoperative results. Extending the results of the present study to Chinese clinical practice is warranted.

HISTORIQUE: L'alopécie cicatricielle englobe un groupe diversifié de troubles caractérisés par la destruction permanente de follicules pileux et une perte de cheveux irréversible. La greffe folliculaire a été mise au point en 1994. Cependant, des essais cliniques à grande échelle s'imposent pour l'étudier dans le traitement de l'alopécie cicatricielle chez des patients chinois. OBJECTIF: Étudier l'efficacité de la greffe folliculaire pour traiter l'alopécie cicatricielle chez des patients chinois. MÉTHODOLOGIE: Les chercheurs ont recruté des patients présentant une alopécie cicatricielle. Ils ont consigné la zone désignée, la densité des unités folliculaires au foyer du donneur, la densité greffée et le temps d'opération. Ils ont effectué un suivi postopératoire dans les six à 24 mois et calculé la densité pileuse du receveur à l'aide d'un folliscope (Hansderma Co, États-Unis). Ils ont consigné la satisfaction des patients et les complications à long terme. RÉSULTATS: Trente-sept patients ont participé. L'alopécie cicatricielle était causée par des brûlures (n=8), des traumatismes (n=21) et la chirurgie plastique (réparation d'une fissure palatine et labiale [n=8]). Les patients brûlés présentaient des zones d'alopécie beaucoup plus importantes que les autres patients (P<0,01). Le temps de l'opération était corrélé avec la zone du receveur. L'opération la plus longue a pris 14,5 heures et la greffe la plus vaste était de 96 cm2. Au suivi, le ratio entre la densité des unités folliculaires survivantes et la densité des unités folliculaires greffées variait entre 64,29 % et 95,00 % (moyenne de 78,96 %). Le ratio entre la zone survivante et la zone greffée (S/T) était de 100 % pour 30 patients, de 90 % à 100 % pour cinq patients et de moins de 90 % pour deux patients. La zone S/T la plus faible était de 82,81 %. L'indice S/T, significatif, était inversement proportionnel avec la durée de l'opération. Pour ce qui est des complications à long terme, deux patients ont présenté des kystes épidermoïdes postopératoires qui ont guéri grâce à un traitement localisé. CONCLUSION: La greffe folliculaire traite l'alopécie cicatricielle avec efficacité. Relativement sécuritaire, elle donne des résultats postopératoires satisfaisants. Il faudra étendre les résultats de la présente étude à la pratique clinique en Chine.

Effect of heparin on prevention of flap loss in microsurgical free flap transfer: a meta-analysis.

The effectiveness of heparin for thromboprophylaxis during microvascular free flap transfer is uncertain. The purpose of this meta-analysis was to determine the effect of heparin on the prevention of flap loss in microsurgical free flap transfer.A search of PubMed, Cochrane databases, and Google Scholar using combinations of the search terms heparin, free flap, flap loss, free tissue transfer was conducted on March 15, 2013. Inclusion criteria were: 1) Prospective randomized trials. 2) Retrospective, non-randomized studies. 3) Patients received free tissue transfer. Flap loss rate was used to evaluate treatment efficacy. Odds ratios (ORs) with 95% confidence intervals (CI) were calculated and compared between therapies. Four studies meet the criteria for analysis and were included. Two studiescompared aspirin and heparin, and the ORs of the 2 studies were 1.688 and 2.087. The combined OR of 2.003 (95% CI 0.976-4.109, p = 0.058) did not indicate any significant difference between heparin and aspirin therapies. Two studiescompared high and low doses of dalteparin/heparin therapies, and the ORs of the 2 studies were 4.691 and 11.00. The combined OR of 7.810 (95% CI 1.859-32.808, p = 0.005) revealed a significant difference indicating that high dose dalteparin or heparin therapy is associated with a greater flap loss rate than low dose therapy. Heparin and aspirin prophylaxis are associated with similar flap loss rates after free flap transfer, and high dose dalteparin or heparin therapy is associated with a greater flap loss rate than low dose therapy.

The reliability of clinical dynamic monitoring of redox status using a new redox potential (ORP) determination method.

PURPOSE: Quantitative monitoring of the redox status is the foundation for redox-related treatment. The purpose of this study was to evaluate the reliability of a new depolarization curve method for plasma redox potential (ORP) monitoring. METHODS: Using the new method, we performed redox determinations for the first time under different sample-handling conditions, including redox titration experiments using KMnO4 and vitamin C and dynamic redox monitoring in burn patients. The relative ORP value (ΔORP) method (improved traditional method) was used as the reference. RESULTS: The new method's better reliability, electrochemical specificity and practicability, and known group validity, which are closely associated with the redox-related pathological processes of severe burns, were confirmed. Furthermore, bidirectional change in the redox status in severe burn patients was also observed for the first time. CONCLUSIONS: This simple, stable new method could be a better practical tool for making the dynamic monitoring of the redox status feasible and for providing useful quantitative information for the judgment of redox-related pathological process, thus improving corresponding individualized treatments that rely on quantitative adjustments to the redox status.

[Influence of recombinant human growth hormone on body fluid compartments and water-sodium retention in severe burn patients].

OBJECTIVE: To investigate the influence of recombinant human growth hormone (rhGH) on body fluid compartments and water-sodium retention in severe burn patients. METHODS: Thirty adult patients with severe burn were divided into treatment (T) and control (C) groups by block randomized design. Patients in both groups were subcutaneously injected with same amount of rhGH (12 IU/d) or isotonic saline during 7 - 21 post burn day (PBD). The total body water (TBW), intracellular water (ICW), extracellular water (ECW) were measured by bioelectrical impedance analysis (BIA) on 7, 14, 21 PBD. The 24 h urinary output of Na+ was determined by ion selective electrode method (ISE). RESULTS: There were no significant difference in levels of TBW, ICW, ECW and 24 h urinary output of Na+ between two groups on 7, 14, 21 PBD (P > 0.05). No difference in results was found between groups at different time points (P > 0.05). After the data were analyzed, the level of TBW (36 +/- 6 L), ICW (21 +/- 4 L) on 21 PBD were evidently lower than those on 7 PBD (38 +/- 6 L, 23 +/- 7 L, P < 0.01). CONCLUSION: The level of ICW and TBW in severe burn patients decreased along with the time. Proper dosage of rhGH has no significant effect on body fluid compartments and water-sodium retention.

[Postoperative electron beam irradiation therapy for keloid:a follow-up study of 48 patients].

OBJECTIVE: To explore the effectiveness of postoperative electron beam irradiation therapy for keloid. METHODS: Forty-eight patients with 65 keloid sites were treated by surgical removal and postoperative 25 Gy electron beam irradiation from 1994 to 2002 and followed for over eighteen months. Statistical analysis was performed and therapeutic outcome was evaluated. RESULTS: The overall recurrence rate was 26%. Higher post-treatment recurrence rates were noted with keloid forming at infected sites and in patients with family history (47.8% and 53.3%) (P < 0.05). Meanwhile, patient age, sex, keloid size and location had no increased likehood of recurrence rate. CONCLUSION: The study shows that postoperative electron beam irradiation therapy is a kind of safe and effective method in inhibiting recurrence of keloid formation and eradicating it.