Functional late outgrowth endothelial progenitors isolated from peripheral blood of burned patients

Background

Bioengineered skin substitutes are increasingly considered as a useful option for the treatment of full thickness burn injury. Their viability following grafting can be enhanced by seeding the skin substitute with late outgrowth endothelial progenitor cells (EPCs). However, it is not known whether autologous EPCs can be obtained from burned patients shortly after injury.

Methods

Late outgrowth EPCs were isolated from peripheral blood sampled obtained from 10 burned patients (extent 19.6 ± 10.3% TBSA) within the first 24 h of hospital admission, and from 7 healthy subjects. Late outgrowth EPCs were phenotyped in vitro.

Results

In comparison with similar cells obtained from healthy subjects, growing colonies from burned patients yielded a higher percentage of EPC clones (46 versus 17%, p = 0.013). Furthermore, EPCs from burned patients secreted more vascular endothelial growth factor (VEGF) into the culture medium than did their counterparts from healthy subjects (85.8 ± 56.2 versus 17.6 ± 14 pg/mg protein, p = 0.018). When injected to athymic nude mice 6 h after unilateral ligation of the femoral artery, EPCs from both groups of subjects greatly accelerated the reperfusion of the ischaemic hindlimb and increased the number of vascular smooth muscle cells.

Conclusions

The present study supports that, in patients with burns of moderate extension, it is feasible to obtain functional autologous late outgrowth EPCs from peripheral blood. These results constitute a strong incentive to pursue approaches based on using autotransplantation of these cells to improve the therapy of full thickness burns.     

Effects of a hospital based Wellness and Exercise program on quality of life of children with severe burns

Objective

To examine the effect of a 12-week Wellness and Exercise (W&E) program on the quality of life of pediatric burn survivors with burns of ≥40% total body surface area. We hypothesized this comprehensive regimen would improve physical and psychosocial outcomes.

Methods

Children were recruited for participation upon their discharge from the ICU. They were not taking anabolic/cardiovascular agents. Seventeen children participated in the W&E group and 14 children in the Standard of Care (SOC) group. Quality of life was assessed with the Child Health Questionnaire (CHQ) at discharge and 3 months. Children completed the CHQ-CF 87 and caregivers completed the CHQ-PF 28.

Results

The mean age of children in the W&E group was 14.07 ± 3.5 years and mean TBSA was 58 ± 11.8%. The mean age of children in the SOC group was 13.9 ± 3.1 years and mean TBSA was 49 ± 7.8%. ANOVA did not reveal statistically significant differences between the groups. Matched paired t-tests revealed that parents with children in the W&E group reported significant improvements with their children's physical functioning, role/social physical functioning, mental health, overall physical and psychosocial functioning after exercise.

Conclusions

These results are clinically relevant in that a comprehensive W&E program may be beneficial in promoting physical and psychosocial outcomes.     

Simulation-assisted burn disaster planning

The aim of the study was to evaluate the Swedish medical systems response to a mass casualty burn incident in a rural area with a focus on national coordination of burn care. Data were collected from two simulations of a mass casualty incident with burns in a rural area in the mid portion of Sweden close to the Norwegian border, based on a large inventory of emergency resources available in this area as well as regional hospitals, university hospitals and burn centres in Sweden and abroad. The simulation system Emergo Train System^® (ETS) was used and risk for preventable death and complications were used as outcome measures: simulation I, 18.5% (n = 13) preventable deaths and 15.5% (n = 11) preventable complications; simulation II, 11.4% (n = 8) preventable deaths and 11.4% (n = 8) preventable complications. The last T1 patient was evacuated after 7 h in simulation I, compared with 5 h in simulation II. Better national coordination of burn care and more timely distribution based on the experience from the first simulation, and possibly a learning effect, led to a better patient outcome in simulation II. The experience using a system that combines both process and outcome indicators can create important results that may support disaster planning.     

PNU282987对烧伤休克犬复苏时脂质过氧化损伤和组织含水率的影响

目的：研究α7烟碱型乙酰胆碱受体（α7nAChR）激动剂PNU282987对致死性烧伤休克犬脂质过氧化损伤和组织含水率的影响.方法：成年雄性Beagle犬12只,按完全随机数字表法分为烧伤补液组和烧伤PNU282987组,每组6只.采用凝固汽油燃烧法造成50%总体表面积Ⅲ度烧伤.于伤后0.5 h分别通过颈静脉补液,烧伤补液组给予林格液,烧伤PNU282987组给予等量含有PNU282987 （0.38 mg/kg）的林格液.补液量和速率均根据Parkland公式确定.于伤前和伤后2、4、8、12和24 h颈静脉取血,测定丙二醛（MDA）含量和超氧化物歧化酶（SOD）活性,并于伤后24 h处死动物,留取心、肝、脾、肺、肾和回肠组织,测定组织含水率.结果：两组犬伤后SOD水平显著降低;伤后4 h起烧伤PNU282987组SOD水平显著高于烧伤补液组（P＜0.05）,而单纯烧伤组SOD水平持续降低.两组犬伤后MDA水平均上升,伤后4h起烧伤PNU282987组血浆MDA水平均显著低于烧伤补液组（P＜0.05）.烧伤PNU282987组脏器含水率显著低于烧伤补液组[心：（68.6±1.1）% vs.（78.3±1.8）%;肝：（70.0±1.4）% vs.（ 79.8±0.7）%;脾：（67.2±1.2）% vs.（78.8±0.8）%;肺：（74.3±0.5）% vs.（ 80.2±1.6）%;肾：（71.2±0.8）% vs.（ 80.1±0.9）%;回肠：（68.9±1.1）% vs.（ 78.7±0.8）%],差异均有统计学意义（P＜0.05）.结论：PNU282987能抑制烧伤休克犬复苏时引起的脏器氧自由基生成,减轻组织水肿,具有潜在临床应用价值.     

点状自体皮与辐照异种皮改良复合移植的临床应用研究

目的 探讨点状自体皮与辐照异种皮改良复合移植的临床效果.方法 对入选的80例大面积烧伤患者,采用分层随机分组的方法分为治疗组及对照组,每组40例,治疗组在常规治疗的基础上,入院后第3～5天行切削痂,点状自体皮移植后辐照异种皮覆盖;对照组40例,其中20例行点状自体皮移植网眼油纱覆盖后加压包扎,20例行点状自体皮移植新鲜猪皮覆盖.观察比较两组患者点状自体皮成活情况、辐照异种皮排斥、创面愈合时间及愈合率、换药工作量、患者疼痛度及1年后患者瘢痕及功能恢复情况.结果 治疗组术后1周换药见辐照异种皮贴服完整,2周辐照异种皮呈干痂状.4～5周干痂逐渐分离,创面愈合.创面愈合时间治疗组(29.5±5)d较对照组(39.6±4)d明显缩短(P＜0.01).创面愈合率治疗组(86.8±3.8)％较对照组(34.2±2.1)％明显提高(P＜0.01).创面感染率降低30％,换药的劳动强度降低70％,减轻患者疼痛.1年后患者瘢痕平整其弹性及功能良好.结论 点状自体皮与辐照异种皮改良复合移植提高了皮肤移植的成活率,有利于创面愈合,对治疗大面积烧伤创面修复可行有效.     

ERADICATION OF METASTATIC ANGIOSARCOMA OF THE LOWER EXTREMITY: Case report

A 47-year-old man with an angiosarcoma of the right lower extremity was cured with mainly surgery and radiotherapy despite an inguinal metastasis. Histologically, the amputation stump of the metastatic tumour showed invasion by tumour. Radiotherapy, chemotherapy, and treatment with interleukin-2 was added. Ten years later he has had no recurrence.     

MEBT/MEBO对小鼠烧伤创面组织中K19表达的影响及作用机制

目的探究烧伤创疡再生医疗技术(moist exposed burn therapy/moist exposed burn ointment, MEBT/MEBO)对烧伤创面组织中角蛋白19 (keratin 19, K19)表达的影响及可能的作用机制。方法选取15只健康雄性昆明小鼠,按照随机数表法随机选取5只作为对照组,10只建立深Ⅱ度烫伤模型后随机分为模型组与治疗组,其中治疗组小鼠创面采用湿润烧伤膏进行处理、模型组小鼠创面采用生理盐水进行处理、对照组小鼠背部脱毛后不做任何处理,1周后取皮肤或创面组织并通过免疫组织化学染色、蛋白质印迹(Western blot)及定量聚合酶链反应(quantitative polymerase chain reaction, Q-PCR)等技术检测自噬相关蛋白Beclin-1、LC3及K19的表达水平。结果治疗第1-7天,治疗组小鼠创面清洁,并始终保持湿润状态,且随着治疗时间的延长逐渐呈现上皮化状态;模型组小鼠创面逐渐加深,并出现感染征象。治疗1周后,免疫组织化学染色法及Western blot法检测结果显示,3组小鼠皮肤或创面组织中Beclin-1、LC3及K19表达水平对比,治疗组模型组对照组,P均0.01,差异具有统计学意义;除Western blot法检测结果显示治疗组与模型组小鼠创面组织中LC3表达水平对比,P0.05外,其余各检测结果均显示小鼠皮肤或创面组织中Beclin-1、LC3及K19表达水平两两对比,P0.01,差异具有统计学意义。Q-PCR技术检测结果显示,3组小鼠皮肤或创面组织中K19 mRNA表达水平对比,治疗组模型组对照组,P 0.01,差异具有统计学意义;3组小鼠皮肤或创面组织中K19mRNA表达水平两两对比,P均0. 01,差异具有统计学意义。结论 MEBT/MEBO促进烧伤创面愈合可能与增加创面组织中K19的表达有关,而诱导自噬相关蛋白的高表达可能是其具体机制之一。     

烧伤患者疼痛管理的应用分析

目的探讨疼痛管理对烧伤患者焦虑情绪、疼痛、依从性及生活质量的影响。方法选择2017年5月至2018年5月河南理工大学第一附属医院烧伤整形科收治的90例烧伤患者作为研究对象,并按照随机数表法随机分为观察组(45例)与对照组(45例),其中观察组患者采用疼痛管理护理措施予以护理,对照组患者采用常规护理措施予以护理,对比观察两组患者的焦虑评分、疼痛评分、依从性评分及生活质量评分。结果护理4周后,两组患者焦虑评分及疼痛评分均显著降低,且尤以观察组患者降低程度最明显,两组对比,P均0.01,差异具有统计学意义;依从性评分及生活质量评分均显著升高,且尤以观察组患者升高程度最明显,两组对比,P均0.01,差异具有统计学意义。结论疼痛管理可显著改善烧伤患者的疼痛程度及焦虑情绪,提高患者依从性及生活质量,值得临床推广应用。     

全身综合治疗联合湿润烧伤膏外敷治疗老年重度烧伤疗效分析

目的总结分析全身综合治疗联合湿润烧伤膏外敷治疗老年重度烧伤的临床疗效。方法回顾性分析2015年10月至2018年9月郫都区人民医院外科收治的符合纳入标准的48例老年重度烧伤患者的病历资料,所有患者均在补液抗休克、抗感染、脱水、改善血液供应、预防应激性溃疡等全身综合治疗的同时,采用湿润烧伤膏治疗局部创面,分析治疗效果,总结创面愈合时间、并发症发生情况及瘢痕增生情况。结果所有患者治疗期间均未出现休克、心衰等并发症,最终创面均完全愈合后出院,创面愈合时间为14～28 d;出院后随访1个月～3年,部分愈后皮肤留有表浅性瘢痕及少许色素脱失或色素沉着。结论全身综合治疗联合湿润烧伤膏局部外敷可有效减少老年重度烧伤患者休克、心衰等并发症的发生,促进创面愈合,减少瘢痕增生,疗效显著。     

红细胞分布宽度与血小板计数的比值对严重烧伤患者预后的判断价值

目的:探讨伤后第3天外周血红细胞分布宽度(RDW)与血小板计数的比值(RPR)在严重烧伤患者预后中的判断作用.方法:回顾性分析我院2008年1月 201 4年12月收治的符合重度以上烧伤标准的成年患者325例,检测患者伤后第3天RDW和血小板计数.根据患者伤后第3天RPR中位数值将其分为高RPR (RPR≥0.124)组和低RPR (RPR＜0.124)组,收集两组患者性别、年龄、烧伤严重程度、是否有吸入性损伤等指标的数据,采用Kaplan-Meier法分析严重烧伤住院期间生存率并将结果带入Cox回归分析,同时绘制61例死亡患者ROC受试者工作曲线,探讨伤后第3天RPR对严重烧伤患者预后的判断作用.结果:伤后第3天高RPR组和低RPR组在严重烧伤住院期间生存率分别为70.2％(118例)和93.0％(146例),差异有统计学意义(P＜0.05).Cox回归分析提示伤后第3天RPR为预测烧伤死亡的独立危险因素(风险比:0.398,95％置信区间:0.200～0.794,P＜0.01).对61例死亡患者ROC曲线分析提示,伤后第3天RPR值ROC曲线下总面积为0.776(95％置信区间为0.706～0.846,P＜0.01).其中伤后第3天RPR的最佳阈值为0.192时敏感性62.3％,特异性86.3％.结论:伤后第3天RPR对严重烧伤患者预后的预测有临床意义.