Randomized, multicenter, double-blind, and placebo-controlled trial using topical recombinant human acidic fibroblast growth factor for deep partial-thickness burns and skin graft donor site

Wound healing is a dynamic and complex biologic process that could be accelerated by growth factors. To investigate the efficacy of topical recombinant human acidic fibroblast growth factor (rh-aFGF) treatment in deep partial-thickness burn or skin graft donor sites, we designed a randomized, multicenter, double-blind, and placebo-controlled clinical trial. The healing rate, fully healed rate, and healing time were evaluated to assess the efficacy of rh-aFGF application. Laboratory examinations and abnormal signs were used to assess the side and toxic effects. The results showed that the healing rate of burn wounds and skin graft donor sites treated by rh-aFGF was significantly higher than that by placebo, and the mean healed time of burn wounds and skin graft donor sites in the rh-aFGF group was significantly the shorter than that in the placebo group. In conclusion, topical administration of rh-aFGF can accelerate the wound healing process and shorten the healed time. It is a potential therapeutic application for promoting healing of deep partial-thickness burns or skin graft donor sites.     

Burn injuries caused by ship fire: A 12-year study in Shanghai

The 105 patients admitted to our Burn Institute from 1st January 1996 to 31st December 2007, with ship fire-related burns were studied retrospectively. The mean age was 30.2 ± 12.6 years with a range of 1–58. One hundred and three patients (98.1%) were men and 2 (1.9%) women. The mean total burn surface area (TBSA) was 46.5%, mostly deep burns. The most common areas of burn were the head, neck and upper limb. Summer months July, August, June and September were times of highest incidence. Fifty-seven (54.3%) patients had inhalation injury, 42 received tracheotomy, and 38 received mechanical ventilation. The treatment was complex, difficult, long, and costly. The interval between burn and start of resuscitation ranged from 2.1 to 67 h with a mean of (5.9 ± 4.4) h. Forty-two patients (40%) started intravenous fluid resuscitation 6 h after burn. Twenty-four patients (23%) received insufficient fluid resuscitation developed hypotension and severe shock at admission. Ninety-two (87.6%) patients required operations including tracheotomy, debridement and grafting, per patient was 5.2. The mean length of hospital stay was 44.2 days. Pulmonary edema was the most common complication during the early post-burn period (within 7 days), and sepsis during the later period (>7 days). Nine patients died of MODS or sepsis, giving a mortality rate of 8.57%. Conclusion: Caution and preventive measures are needed for persons in ships for fire-related burns.     

案例教学法在临床医学硕士研究生培养中的应用

医学统计学是现代临床医学教育课程体系中的重要组成部分.教学实践中利用2009年全国博士生学术论坛<灾难医学的现状与未来>这一实验载体,作为教学案例进行教学.经过此课程,临床型硕士研究生对基本统计学方法的掌握程度有明显提高.案例教学法是临床型医学研究生统计思维培养的有效途径.     

天然产物中的抗补体活性成分

补体系统的非正常激活会引发类风湿性关节炎、老年性痴呆、急性呼吸窘迫综合征以及系统性红斑狼疮等多种疾病。目前临床上尚无高效、低毒、专一的补体抑制剂。国内外已完成部分天然产物的筛选,发现自然界中广泛存在的某些多糖、黄酮、甾类和萜类化合物具有显著的抗补体活性。本文对天然产物类抗补体活性成分的研究方法、已发现活性化合物的化学结构以及体内外药理研究概况进行综述,并分析了天然产物类补体抑制剂的应用前景。     

食管间质瘤与平滑肌肿瘤的临床鉴别及治疗

背景与目的：食管间质瘤与平滑肌肿瘤虽然具有不同的病理学特征,但是临床上不易鉴别。本研究比较食管间质瘤和平滑肌肿瘤的临床特征,并探讨其治疗原则。方法：用免疫组织化学法检测原诊断为食管平滑肌（肉）瘤20例和间质瘤1例肿瘤组织中CD117和CD34等一组抗体表达。结合病理学形态表现和临床表现进行分析,并总结各自的治疗原则及疗效。结果：16例原诊断为食管平滑肌瘤有5例CD117（＋）,按照间质瘤评定标准,均为非高度侵袭危险性食管间质瘤,余11例CD117（-）;1例原间质瘤CD117（＋）和CD34（＋）,为高度侵袭危险性食管间质瘤;4例食管平滑肌肉瘤CD117（-）和CD34（-）。食管非高度侵袭危险性间质瘤和平滑肌瘤的病理学形态表现、临床表现、治疗方法和预后没有明显差异;食管高度侵袭危险性间质瘤和平滑肌肉瘤的病理学形态表现、临床表现、治疗方法和预后也没有明显差异。结论：病理学形态表现和临床表现无法区分食管间质瘤和平滑肌肿瘤,CD117等抗体的免疫组织化学法检测是区分食管间质瘤和平滑肌肿瘤必不可少的手段。食管非高度侵袭危险性间质瘤和平滑肌瘤局部切除术或部分食管切除术可以达到根治,预后良好;高度侵袭危险性食管间质瘤和平滑肌肉瘤需行食管部分切除术。     

Uric acid enhances T cell immune responses to hepatitis B surface antigen-pulsed-dendritic cells in mice

AIMTo study the induction of T cellular immune responses in BALB/c mice immunized with uric acid and dendritic cells(DCs)pulsed with hepatitis B virus surface antigen(HBsAg).METHODSDCs were generated from bone-marrow cells of BABL/c mice,and then pulsed or unpulsed with HBsAg protein(HBsAg-pulsed-DCs or unpulsed-DCs)in vitro.BABL/c mice were immunized with HBsAg-pulsed-DCs(1×106)and uric acid,injected through the tail vein of each mouse.The mice in control groups were immunized with HBsAg-pulsed-DCs alone,unpulsed-DCs alone or 200 μg uric acid alone or PBS alone.The immunization was repeated 7 d later.Cytotoxic T lymphocytes(CTLs)/n vivo were determined by the CFSE labeled spleen lysis assay.Spleen cells or spleen T cells were isolated,and re-stimulated in vitro with HBsAg for 120 h or 72 h.Production of IFN-γ and IL-4 secreted by spleen cells were determined by ELISA method;proliferation of spleen T cells were detected by flow cytometry.RESULTSThe cytotoxicities of HBsAg-specific-CTLs,generated after immunization of HBsAg-pulsed-DCs and uric acid,were 68.63% ± 11.32% and significantly stronger than that in the control groups(P ＜ 0.01).Compared with control groups,in mice treated with uric acid and HBsAg-pulsed-DCs,the spleen T cell proliferation to HBsAg re-stimulation was stronger(1.34 ± 0.093 vs 1.081 ± 0.028,P ＜ 0.01),the level of IFN-γsecreted by splenocytes was higher(266.575 ± 51.323 vs 135.223 ± 32.563,P ＜ 0.01),and IL-4 level was lower(22.385 ± 2.252 vs 40.598 ± 4.218,P ＜ 0.01).CONCLUSIONUric acid can strongly enhance T cell immune responses induced by HBsAg-pulsed-DCs vaccine.Uric acid may serve as an effective adjuvant of DC vaccine against HBV infection.     

The direct hospitalisation costs of paediatric scalds: 2-Year results of a prospective case series

Objective

To reveal the characteristic and distribution of length of hospital stay (LOS) and direct hospitalisation costs of paediatric scald.

Methods

A prospective case series observation was performed from January 2005 to December 2006 at the Burn Center, Changhai Hospital, Shanghai, China. The information, such as demographics, clinical diagnosis and treatments since admission, of the paediatric scald patients included in the series was recorded. The direct cost of a treatment event was recorded into the price system when it was incurred. All cost data were summarised on completion of the study. The distribution of LOS and the hospitalisation costs were recorded by gender, age, total burn area, depth of burn, blood transfusion and patterns of treatment. Mann–Whitney signed-rank test was used to assess the differences between continuous, non-normally distributed variables, and multiple linear regression was used to model LOS and direct hospitalisation costs. Statistical analyses were undertaken with SPSS 15.0 statistical software.

Results

Patients aged 3 years or less accounted for more than half of the total LOS and hospitalisation costs, patients with burn area less than 10%TBSA (total burn surface area) accounted for more than 70% of the total LOS and more than half of the hospitalisation costs and patients with second-degree burn accounted for more than 78% of the total LOS and hospitalisation costs. Depth of burn, area of burn, patterns of treatment and blood transfusion were independent predictors of LOS; whereas LOS, area of burn and blood transfusion were independent predictors of hospitalisation costs.

Conclusion

Paediatric scalds have particular characteristics in terms of distribution of LOS and direct hospitalisation costs and the factors influencing them. The data presented in this study should assist burn care practitioners and hospital epidemiologists estimate and compare the economic burden of paediatric burns at other institutions; it may also be useful in resource allocation and cost-effectiveness analysis of treatment versus prevention strategies.     

Effect of Matteuccia struthiopteris polysaccharides on systemic lupus erythematosus-like syndrome induced by Campylobacter jejuni in BALB/c mice

Matteuccia struthiopteris is a nature plant, which contains a lot of potential active components. In the present study, we investigated the effect of polysaccharides extracted from Matteuccia struthiopteris on lupus-like syndrome induced by Campylobacter jejuni CJ-S131 in BALB/c mice. Mice were randomly divided into normal, model control, SLE model (vehicle treated), Matteuccia struthiopteris polysaccharides treated (30 and 15 mg x kg(-1)) groups and prednisone 5 mg x kg(-1) treated groups. The effect of Matteuccia struthiopteris polysaccharides (Ms) on weight and organ index of BALB/c mice was detected. Autoantibodies and total IgG production were measured by enzyme linked immunosorbent assay. Proteinuria was measured and kidneys were examined by light microscopy. Compared with SLE model group, treatment with Matteuccia struthiopteris polysaccharides 30 and 15 mg x kg(-1) reduced weight loss and Matteuccia struthiopteris polysaccharides 15 mg x kg(-1) reduced spleen swelling (P < 0.05). The increased production of autoantibodies and total immunoglobulin G (IgG) were also significantly inhibited. Matteuccia struthiopteris polysaccharides protected kidney against glomerular injury in BALB/c mice with reduced immunoglobulin deposition and lowered proteinuria (P < 0.01). Matteuccia struthiopteris polysaccharides had a protective effect on lupus-like syndrome induced by CJ-S131 in BALB/c mice.     

Eremophilane sesquiterpenes from Ligularia macrophylla

New eremophilane sesquiterpenes, 6beta-sarracinoyloxy-1beta,10beta-epoxy-furanoeremophilane (1), 6alpha-angeloyloxy-10betaH-furanoeremophil-1-one (2), 1alpha-hydroxy-9-deoxycacalol (3), and 1beta-hydroxy-11(R,S)-8-oxoeremophil-6,9-dien-12-al (4a+4b), together with five known sesquiterpenes (5-9) were isolated from the roots and rhizomes of Ligularia macrophylla. The structures were elucidated by spectroscopic methods including 2D NMR techniques, and the structure of 1 was confirmed by a single-crystal X-ray diffraction experiment. The compounds were also evaluated for cytotoxic activity against human lung carcinoma (A-549) and human breast adenocarcinoma (MCF-7) and were found to show only very weak cytotoxicity.