Management of the wound care clinic during the novel coronavirus pneumonia pandemic period: Sharing of management experience in a general hospital of China

With the surge in the confirmed cases of the novel coronavirus pneumonia, medical resources in many countries have been put on red alert levels. The operation management systems of hospitals, including wound care clinics, must be innovated to ensure the normal operation of the hospital and meet the medical care needs of the people. At the same time, scientific control measures are also required to prevent the spread of the novel coronavirus pneumonia in the hospital. Actually, during the novel coronavirus pneumonia pandemic, emergency management methods for wound care clinics such as online appointments and remote online diagnosis and treatment, the rational arrangement of human resources, the scientific implementation of epidemic prevention and control measures, and the strict implementation of the management of the clinic environment and item disinfection measures to strengthen the management of protective materials, wound care materials, and dressing equipment by partition have been introduced and innovated, thus helping reduce the gathering of people in wound care clinics, create a safe medical environment, and avoid the spread of the novel coronavirus pneumonia caused by diagnosis and treatment.     

Safety of mTOR inhibitor continuation in pediatric heart transplant recipients undergoing surgical procedures

mTOR inhibitors have been associated with SWC when used in the perioperative period. Limited literature is available to guide providers in managing chronic mTOR inhibitor use in the perioperative period, especially in the pediatric setting. The primary aim of this study was to describe the prevalence of SWC with mTOR inhibitor continuation during the perioperative period for major surgeries. Heart transplant recipients ≤25 years old at the time of primary heart transplant receiving sirolimus maintenance therapy during a surgical procedure and within the study period were included. Surgeries identified within the study period included otolaryngology procedures (46.2%), such as tonsillectomies with or without adenoidectomies, cardiac surgeries (30.8%) including a sternal revision, pulmonary vein repair, and pacemaker placement in two patients, orthopedic surgeries (15.4%) including a posterior spinal fusion and an Achilles tendon lengthening with ankle and subtalar joint release, and a neurosurgery (7.7%), which was a ventriculoperitoneal shunt revision. Thirteen surgical encounters were examined. One SWC was observed, an infected pacemaker requiring systemic antibiotics and removal of the device. The results of this study suggest that sirolimus may be continued in the perioperative period based on the low rate of SWC observed.     

新型医用黏合剂治疗角膜穿通伤对眼前节的影响

目的探讨医用组织黏合剂治疗角膜穿通伤对眼前节的刺激反应,及对角膜内皮细胞和血-房水屏障功能的影响。方法 20只日本大耳白兔建立角膜穿通伤模型,右眼采用医用胶黏合、左眼采用缝线缝合术,术后大体观察兔眼前节情况;角膜共聚焦显微镜观察角膜内皮细胞形态和密度变化,抽兔眼房水行房水蛋白含量测定,透射电镜观察内皮细胞超微组织结构变化。结果术中和术后各时间点医用胶组和缝线组角膜伤口均密闭。两组术后不同时间点角膜共聚焦显微镜观察角膜穿通伤口周边内皮细胞形态和密度无明显差异。房水蛋白含量在术后7d均为最高,医用胶组和缝线组分别为(0.561±0.284)g·L-1、(0.523±0.303)g·L-1,随伤口愈合术后90d恢复正常,各观察时间点两组间差异均无统计学意义(均为P>0.05)。透射电镜观察角膜内皮细胞示:术后14d细胞超微结构基本正常,两组均可见细胞内少量粗面内质网扩张,空泡稍增多,线粒体肿胀;术后30d均恢复正常。结论医用组织黏合剂治疗角膜穿通伤口组织相容性好,对眼前节无明显刺激反应和异物反应。     

Risk factors of wound infection after lung transplantation: a narrative review

Background and ObjectiveThe incidence of incision infection after lung transplantation is prominently high which affect the prognosis. Summarizing the risk factors related to incision infection after lung transplantation contribute to the control of incision infection by pre-controlling the risk factors. The objective is to summarize risk factors related to wound infection after lung transplantation.MethodsPubMed was used to research the literature relating to the risk factors to incision infection after lung transplantation through 1990 to 2022. The retrieval strategy were Medical Subject Heading (MeSH) terms combined entry terms. Two researchers conducted the literature retrieval independently. Two researchers independently evaluate the quality of the literature and summarize the indicators.Key Content and FindingsA total of 98 researches were collected from PubMed and 8 articles described the related risk factors of incision infection after lung transplantation. All of the 8 articles were retrospective studies, of which 4 articles were grouped by the delayed chest closure (DCC) execution and the other 4 articles were grouped by the surgical site infection (SSI) occurred. Two articles performed multivariate regression analysis to determine the independent risk factors of SSI after lung transplantation and the other 6 articles compared the SSI rate in different patients population. The integrated results showed that bronchoalveolar lavages (BALs), smoking status, body mass index (BMI), diabetes, operation duration, thoracic drainage tube placement time and DCC were related to the SSI after lung transplantation.ConclusionsBALs, smoking status, BMI, diabetes, operation duration, thoracic drainage tube placement time and DCC were related to the SSI after lung transplantation.     

感觉神经肽P物质在糖尿病大鼠皮肤损伤修复中的应用

目的 观察外源性感觉神经肽P物质(SP)在糖尿病大鼠皮肤伤口愈合中的作用.方法 链脲佐菌素(STZ)致糖尿病大鼠48只,行鼠背部脊柱两侧皮肤切割伤口后,随机分为实验组与对照组,每组24只.实验组伤后在伤口四周注射10-7mol/L的SP,每日2次,每个伤口 200μl/次,连续注射4天;对照组注射等量SP溶剂生理盐水.伤后4、7、10、14、17、21天用透明膜描记法记录伤口愈合面积,伤后4、7、10天取材检测肉芽组织羟脯氨酸总量和Ⅰ型、Ⅲ型胶原含量.结果 实验组在伤后4、7、10、14天伤口愈合面积明显高于对照组(P<0.01),愈合时间比对照组缩短1周;伤后4、7、10天肉芽组织中羟脯氨酸含量、Ⅰ型、Ⅲ型胶原含量明显高于对照组(P<0.01).结论 应用外源性SP明显促进糖尿病大鼠皮肤创伤愈合.     

Transperineal pelvic drainage combined with lateral position to promote perineal wound healing after abdominoperineal resection: A prospective cohort trial

Background:For the rectal cancer <5 cm from anal margin, extralevator abdominoperineal resection (eAPR) has been accepted widely by surgeons. However, the rate of perineal infection following up eAPR is approximately 70%. We did the study with the aim of evaluating the effect and safety of transperineal pelvic drainage combined with lateral position (TPDLP) on perineal wound in patients undergoing eAPR.Methods:Patients were randomly assigned to N-TPDLP group (standard arm) or TPDLP group (intervention arm). In the standard arm, surgery was completed after abdominal drainage tube was placed in pelvic. Comparatively, an additional transperineal wound drainage tube was applied in the experimental arm. Postoperatively, patients of both 2 groups were informed not to sit to reduce perineal compression until the perineal wound healed. But lateral position was demanded in the intervention arm. The primary endpoint was the rate of uncomplicated perineal wound healing defined as a Southampton wound score of <2 at 30 days postoperatively. Patients were followed for 6 months.Results:In total, 60 patients were randomly assigned to standard arm (n = 31) and intervention arm (n = 29). The mean perineal wound healing time was 34.2 (standard deviation [SD] 10.9) days in TPDLP arm, which significantly differ from 56.4 (SD 34.1) in N-TPDLP arm (P = .001). At 30 days postoperatively, 3 (10%) of 29 patients undergoing TPDLP were classified into grade 4 according to Southampton wound score, however, 16 (52%) of 31 patients were classified into grade 4 in control arm, and significantly difference was observed between randomization groups (P = .001). What''s more, perineal wound pain was assessed at 30 days postoperatively, and it is discovered that the pain degree of patients in control arm was significantly more severe than the interventive arm (P = .015).Conclusion:In the present study, we found that TPDLP generated a favorable prognosis for perineal wounds with acceptable side-effects.     

温肾健脾方对大鼠慢性创面愈合的影响

目的:探讨温肾健脾中药对慢性创面愈合的影响及可能作用机制.方法:采用大鼠背部开放性创面模型,用肌注氢化可的松的方法造成慢性难愈性创面,以辛葡康为阳性对照药,应用免疫组化、流式细胞术等方法,观察创面愈合时间、新生上皮宽度、肉芽组织形态学变化、肉芽组织细胞周期、表皮生长因子(epidermal growth factor, EGF)、转化生长因子β1 (transforming growth factor-β1, TGF-β1)及纤维连接蛋白(fibronectin, FN)等指标.结果:温肾健脾方治疗组与辛葡康对照组平均创面愈合时间分别为(17.0±1.9)和(18.8±1.9) d,较模型组及空白组明显缩短(P<0.05);治疗14 d后,治疗组及对照组新生上皮宽度分别为(3.73±0.19)和(3.21±0.15)mm,较模型组及空白组明显增宽(P<0.05);治疗组新生毛细血管丰富,成纤维细胞数量多,而对照组、模型组及空白组新生毛细血管及成纤维细胞数量均较治疗组明显减少(P <0.05);治疗组S期细胞比例较对照组、模型组及空白组明显提高(P<0.05);治疗组及对照组与模型组及空白组比较,EGF、TGF-β1、FN蛋白表达均增强(P<0.05).结论:温肾健脾方有促进大鼠慢性难愈创面修复的作用,其机制与调节细胞周期,上调EGF、TGF-β1细胞因子蛋白表达水平,促进间质FN的表达有关.     

Enhanced healing efficacy of an optimized gabapentin-melittin nanoconjugate gel-loaded formulation in excised wounds of diabetic rats

The present study aimed to design and optimize, a nanoconjugate of gabapentin (GPN)-melittin (MLT) and to evaluate its healing activity in rat diabetic wounds. To explore the wound healing potency of GPN-MLT nanoconjugate, an in vivo study was carried out. Diabetic rats were subjected to excision wounds and received daily topical treatment with conventional formulations of GPN, MLT, GPN-MLT nanoconjugate and a marketed formula. The outcome of the in vivo study showed an expedited wound contraction in GPN-MLT-treated animals. This was confirmed histologically. The nanoconjugate formula exhibited antioxidant activities as evidenced by preventing malondialdehyde (MDA) accumulation and superoxide dismutase (SOD) and glutathione peroxidase (GPx) enzymatic exhaustion. Further, the nanoconjugate showed superior anti-inflammatory activity as it inhibited the expression of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α). This is in addition to enhancement of proliferation as indicated by increased expression of transforming growth factor-β (TGF- β), vascular endothelial growth factor-A (VEGF-A) and platelet-derived growth factor receptor-β (PDGFRB). Also, nanoconjugate enhanced hydroxyproline concentration and mRNA expression of collagen type 1 alpha 1 (Col 1A1). In conclusion, a GPN-MLT nanoconjugate was optimized with respect to particle size. Analysis of pharmacokinetic attributes showed the mean particle size of optimized nanoconjugate as 156.9 nm. The nanoconjugate exhibited potent wound healing activities in diabetic rats. This, at least partly, involve enhanced antioxidant, anti-inflammatory, proliferative and pro-collagen activities. This may help to develop novel formulae that could accelerate wound healing in diabetes.     

Feasibility of open chest management with modified negative pressure wound therapy immediately after cardiac surgery

OBJECTIVESTo evaluate the feasibility of open chest management with our modified negative pressure wound therapy immediately after cardiac surgery as a therapy for atypical tamponade.METHODSOpen chest with modified negative pressure wound therapy was performed immediately after cardiac surgery. The surface of the heart and the vessels were covered with non-adherent siliconized gauze. The sternal halves were stented using edge-cut disposable syringes to maintain a larger mediastinal cavity. Approximately 45 mm of distance was kept between the sternal edges. A trimmed sterile polyvinyl foam sponge was inserted into the mediastinum, the entire wound was sealed and negative pressure (−50 to −75 mmHg) was applied using a suction generator. Delayed chest closure was performed in a standard manner once the haemodynamic status was stabilizsed.RESULTSThe mortality rate was 3/15 (20%) patients. Deep sternal wound infection occurred in 1/15 (6.7%) patients. Five patients were extubated during the open chest management. Sternal closure was delayed for median of 3 days after the initial surgery. There was no incidence of bleeding complications or need for additional haemostatic procedures.CONCLUSIONSNegative pressure wound therapy performed immediately after cardiac surgery was feasible in our small number of patients.Clinical registration numberStudy ID: 2020-149.