Study of the use of recombinant human granulocyte-macrophage colony-stimulating factor hydrogel externally to treat residual wounds of extensive deep partial-thickness burn.

OBJECTIVE: The objective of this study was to observe the clinical effects of recombinant human granulocyte-macrophage colony stimulating factor (rhGM-CSF) hydrogel in the treatment of residual wounds of extensive deep partial-thickness burn. METHODS: In this study, 21 subjects who sustained deep partial-thickness burns, which did not heal over 8 weeks, were observed. These were randomly assigned to two paired groups: the experimental group (using rhGM-CSF, n = 21) and the control group (using mupirocin ointment, n = 21). The wound dressings were changed once daily. Wound secretion, inflammation, granulation tissues, local and general side effects of the drug, wound healing time, and healing rate at different times were observed and compared between the two groups. The differences in the pathology of new vessels and fibroblasts between the two groups were observed, and their number in immunohistochemistry was detected. RESULTS: The wound healing time was 17.28 ± 6.70 days in the experimental group. It was significantly shorter than that of the control group (22.14 ± 7.38 days). The healing rates at 10 and 14 days in the experimental group were 54 ± 27% and 60 ± 36%, respectively. These healing rates were remarkably higher than those of the control group (43 ± 27% and 48 ± 30%). On the 3rd, 7th, 10th, and 14th day, the experimental group was obviously superior to the control group in wound inflammation, secretion, and granulation tissues. Furthermore, on the 7th, 10th, 14th, 21st, and 28th day, the bacterial clearance rates of the experimental group (42.85%, 52.38%, 90.47%, 95.24%, and 95.24%) were higher than those of the control group (4.76%, 4.76%, 38.10%, 76.19%, and 80.95%). On the 14th day, the average optical density of the vascular endothelial factor (VEGF) of the experimental group (0.21 ± 0.01) is bigger than that of the control group (0.18 ± 0.02) (P < 0.05), and the average optical density of the fibroblast growth factor (FGF) of the experimental group (0.25 ± 0.01) is also larger than that of the control group (0.18 ± 0.02) (P < 0.05). CONCLUSION: rhGM-CSF hydrogel effectively promotes the healing process of residual wounds of extensive deep partial-thickness burns. The hydrogel removed most of the bacteria or inhibited growth, and the local and general side reactions of the drug were mild during the study.

Clinical efficacy of laparoscopic common bile duct exploration combined with endoscopic nasobiliary drainage versus T-tube drainage in the treatment of choledocholithiasis: a Meta analysis / 中华消化外科杂志

Objective:To systematically evaluate the clinical efficacy of laparoscopic common bile duct exploration (LCBDE) combined with endoscopic nasobiliary drainage (ENBD) versus T-tube drainage in the treatment of choledocholithiasis.Methods:Databases including PubMed(Medline), Embase, the Cochrane Library, Web of Science, Wanfang, CNKI and CBM were searched for literatures from January 1960 to May 2019 with the key words including "胆总管结石病,胆总管结石; T管引流, T管;鼻胆管引流,经内镜鼻胆管引流术, ENBD管, ENBD引流; cholelithiasis, common bile duct stone, jaundice, obstructive, Jaundice, gallstone; T-tube drainage, T-tube, t-tube, biliary tract drainge, drainge tube; endoscopic nasobiliary drainage, nasobiliary drainage, nasobiliary tube, endoscopic drainage tubes, endoscopic drainage tube, endoscopic retrograde biliary drainage" . The randomized controlled trials (RCTs) and high quality non-randomized controlled trials (NRCTs) on comparing ENBD and T-tube drainage during laparoscopic choledocholithotomy were included.Patients who received LCBDE combined with preoperative or intraoperative ENBD were allocated into ENBD group, and patients who received LCBDE combined with postoperative T-tube drainage were allocated into T-tube drainage group. Reported outcomes: operation time, volume of intraoperative blood loss, duration of postoperative hospital stay, time to drainage tube removal, time to postoperative gastrointestinal function recovery, treatment expenses, rate of surgical failure, incidence of postoperative biliary fistula, incidence of postoperative incisional infection, incidence of postoperative residual stones, incidence of postoperative pancreatitis, incidence of postoperative hyperamylasemia, incidence of postoperative bile peritonitis. Count data were represented as odds ratio ( OR) and 95% confidence interval (95% CI). Measurement data were represented as mean difference ( MD) and 95% CI. The I2 and Q tests were used to analyze literature heterogeneity. I2≤50% or P>0.10 indicated no significant heterogeneity, so fixed effects model was used for Meta analysis. I2>50% and P≤0.10 indicated a significant heterogeneity, so random effects model was used for Meta analysis. When analyzing the measurement data, subgroup analysis of individual indicators was performed if there were more than 4 RCTs included, and NRCTs were analyzed for supplement if there were no more than 4 RCTs included. When analyzing the count data, RCTs and NRCTs were combined for analysis. Funnel plots were used to test potential publication bias if there were more than or equal to 10 studies included, while no test was needed if there were less than 10 studies included. Results:(1) Document retrival: 26 literatures meeting the standards were included, including 9 RCTs and 17 NRCTs (4 semi-randomized studies and 13 case-control studies). There were 2 098 patients, including 1 114 patients in the ENBD group and 984 patients in the T-tube drainage group. (2) Results of Meta analysis. ① Duration of postoperative hospital stay: there was a significant difference in the duration of postoperative hospital stay between the ENBD group and T-tube drainage group ( MD=-6.53, 95% CI: -8.64 to -4.43, P<0.05). Further analysis of 9 RCTs showed significant differences in the duration of postoperative hospital stay between patients without acute complications of choledocholithiasis in the ENBD group and those in the T-tube drainage group, between patients with acute complications of choledocholithiasis in the ENBD group and T-tube drainage group, respectively ( MD=-5.88, -8.77, 95% CI: -8.32 to -3.45, -12.39 to -5.15, P<0.05). ② Time to drainage tube removal: for the RCTs, there was a significant difference in the time to drainage tube removal between the ENBD group and T-tube drainage group ( MD=-46.01, 95% CI: -83.64 to -8.37, P<0.05). For the NRCTs, there was a significant difference in the time to drainage tube removal between the ENBD group and T-tube drainage group ( MD=-24.05, 95% CI: -32.93 to -15.18, P<0.05). ③ Time to postoperative gastrointestinal function recovery: for the RCTs, there was a significant difference in the time to postoperative gastrointestinal function recovery between the ENBD group and T-tube drainage group ( MD=17.80, 95% CI: -31.11 to -4.48, P<0.05). For the NRCTs, there was a significant difference in the time to drainage tube removal between the ENBD group and T-tube drainage group ( MD=-5.64, 95% CI: -10.16 to -1.12, P<0.05). ④ Incidence of postoperative biliary fistula: there was a significant difference in the incidence of postoperative biliary fistula between the ENBD group and T-tube drainage group ( OR=0.50, 95% CI: 0.28-0.89, P<0.05). ⑤ Incidence of postoperative incisional infection: there was a significant difference in the incidence of postoperative incisional infection between the ENBD group and T-tube drainage group ( OR=0.35, 95% CI: 0.17-0.73, P<0.05). (3) Analysis of publication bias. The incidence of postoperative biliary fistula in the two groups was analyzed by funnel plot based on the 15 studies. The bilateral symmetry was presented in the funnel plot for incidence of postoperative biliary fistula, suggesting that publication bias had little influence on results of Meta analysis. Conclusion:For patients with choledocholithiasis that endoscopic lithotomy is not feasible, LCBDE combined with ENBD can significantly shorten duration of postoperative hospital stay, time to drainage tube removal, postoperative gastrointestinal function recovery time, reduce the incidence of postoperative biliary fistula and incisional infection compared with LCBDE combined with T-tube drainage.