Split-thickness skin graft donor-site morbidity: A systematic literature review

The purpose of this systematic literature review is to critically evaluate split-thickness skin graft (STSG) donor-site morbidities. The search of peer-reviewed articles in three databases from January 2009 to July 2019 identified 4271 English-language publications reporting STSG donor-site clinical outcomes, complications, or quality of life. Of these studies, 77 met inclusion criteria for analysis. Mean time to donor-site epithelialization ranged from 4.7 to 35.0 days. Mean pain scores (0–10 scale) ranged from 1.24 to 6.38 on postoperative Day 3. Mean scar scores (0–13 scale) ranged from 0 to 10.9 at Year 1. One study reported 28% of patients had donor-site scar hypertrophy at 8 years. Infection rates were generally low but ranged from 0 to 56%. Less frequently reported outcomes included pruritus, wound exudation, and esthetic dissatisfaction. Donor-site wounds underwent days of wound care and were frequently associated with pain and scarring. Widespread variations were noted in STSG donor-site outcomes likely due to inconsistencies in the definition of outcomes and utilization of various assessment tools. Understanding the true burden of donor sites may drive innovative treatments that would reduce the use of STSGs and address the associated morbidities.     

Current updates in management of extremity injuries in polytrauma

Injury-related morbidity and mortality have been one of the most common causes of loss in productivity across all geographic distributions. It remains to be a global concern despite a continual improvement in regional and national safety policies. The establishment of trauma care systems and advancements in diagnostics and management have improved the overall survival of severely injured. A better understanding of the physiopathological and immunological responses to injury led to a significant shift in trauma care from “Early Total Care” to “Damage Control Orthopedics.” While most of these algorithms were tailored to the philosophy of “life before limb,” the impact of improper fracture management on disability and societal loss is increasingly being recognized. Recently, “Early Appropriate Care” of extremities has gained importance; however, its implementation is influenced by regional health care policies, available resources, and expertise and varies between low and high-income countries. A review of the literature was performed using PubMed, Embase, Web of Science, and Scopus databases on articles published from 1990 to 2020 using the Mesh terms “Polytrauma,” “Multiple Trauma,” and “Fractures.” This review aims to consolidate on guidelines and available evidence in the management of extremity injuries in a polytraumatized patient to achieve better clinical outcomes of these severely injured.     

创伤性脑损伤患者脑脊液中嗜中性白细胞碱性磷酸酶-1的表达及意义

目的探讨炎性体蛋白嗜中性白细胞碱性磷酸酶-1(NALP-1)在创伤性脑损伤患者脑脊液中表达水平及其与预后相关性。方法选取2017年2月至2018年9月来自首都医科大学附属北京同仁医院的120例创伤性脑损伤患者,选取同期健康体检者30例作为对照组,采用免疫印迹化学发光法检测研究对象脑脊液中炎性体蛋白NALP-1表达水平,根据格拉斯哥预后评分(GOS)将创伤性脑损伤患者分为预后良好组(GOS>3分)和预后不良组(GOS≤3分)。χ²检验和t检验分析预后良好组和预后不良组NALP-1和临床资料差异,采用多因素Logistic回归模型分析创伤性脑损伤后患者预后影响因素。结果创伤性脑损伤患者脑脊液中NALP-1表达(1.64±0.52)高于对照组(0.94±0.28,t=7.108,P<0.05),差异有统计学意义。NALP-1高表达组急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)得分(26.4±5.4)分、脑挫伤比例(76.62%)、蛛网膜下腔出血比例(77.27%)高于低表达组[(22.3±4.5)分、23.38%、22.73%],差异有统计学意义(χ²/t=4.135、9.586、7.424,P<0.05)。年龄[比值比(OR):2.175,95%可信区间(CI):1.167~8.767,P<0.05]、蛛网膜下腔出血(OR:1.241,95%CI:1.101~3.794,P<0.05)、NALP-1(OR:2.841,95%CI:1.675~10.717,P<0.05)、纤维蛋白原水平(OR:1.215,95%CI:1.056~3.627,P<0.05)、APACHEⅡ得分(OR:1.615,95%CI:1.314~5.485,P<0.05)是预后不良独立影响因素,差异均有统计学意义。结论创伤性脑损伤脑脊液中NALP-1表达增加,且表达量升高与预后不良相关。     

NOD样受体蛋白1炎性小体在创伤性中枢神经损伤中的作用

NOD样受体蛋白1（NOD-like receptor protein 1,NLRP1）炎性小体在人体固有免疫反应中发挥着重要作用,可促进半胱氨酸蛋白水解酶（cysteinyl aspartate specific proteinases,Caspases）的活化,进一步激活白介素-18和白介素-1β,同时介导细胞焦亡,NLRP1炎性小体在创伤性中枢神经损伤中发挥着作用,本文就NLRP1炎性小体的结构、NLRP1炎性小体在创伤性中枢神经损伤中的激活以及以NLRP1炎性小体为靶点的治疗等方面进行了综述。     

Novel approach to an early assessment of a patient’s potential for neurological remission after acute spinal cord injury: Analysis of hemoglobin concentration dynamics

Context/objective: Examining hemoglobin (Hb) dynamics with regard to the potential of neurological remission in patients with traumatic spinal cord injury (TSCI).Design: Prospective Clinical Observational Study.Setting: BG Trauma Centre Ludwigshafen, Department of Paraplegiology, Rhineland-Palatinate, Germany.Methods: From 2011 to 2017 a total of 80 patients with acute spinal injury were enrolled and divided into three groups: initial neurological impairment either with (G1; n = 33) or without subsequent neurological remission (G0; n = 35) and vertebral fractures without initial neurological impairment as control group (C; n = 12). Blood samples were taken for 3 months at 11 time-points after injury. Analyses were performed using routine diagnostics.Outcome measures: Multiple logistic regression was used to determine the prognostic value of Hb regarding neurological remission respecting clinical covariates.Results: Data showed elevated mean Hb concentrations in G1 from the third day to 1 month compared to G0, Hb levels were significantly higher in G1 after 3 days (P = 0.03, G1 > G0). The final multiple logistic regression model based on this data predicting the presence of neurological remission resulted in an AUC (area under the curve) of 80.5% (CI: 67.8%–93.2%) in the ROC (receiver operating characteristic) analysis.Conclusion: Elevated Hb concentrations are associated with a higher likelihood of neurological remission. Elevated concentrations of Hb in G1 compared to G0 over time might be linked to both a better initial oxygen supply response and a decreased ECM (extracellular matrix) degradation highlighting the role of Hb as a valuable biomarker for neural regeneration after TSCI.     

丹皮酚对增生性瘢痕成纤维细胞的抑制作用

目的探讨丹皮酚对增生性瘢痕成纤维细胞的抑制作用。方法自2018年9月至2020年6月北部战区总医院烧伤整形科提取原代增生性瘢痕成纤维细胞后,将细胞平分为4组,分别采用0μmol/L(对照组)、50μmol/L、100μmol/L的丹皮酚及10μmol/L的5-氟尿嘧啶(5-Fu)处理;CCK-8实验检测细胞处理后第0、3、5、7天的增殖情况。处理3 d后通过ELISA实验检测增生性成纤维细胞中活性氧基团或分子、丙二醛和超氧化物歧化酶的含量;Western blot实验检测丹皮酚对于细胞中TGF-β1、Ⅰ和Ⅲ型胶原的表达情况。结果50、100μmol/L的丹皮酚和10μmol/L的5-FU分别作用于细胞3 d后与对照组相比,对于细胞增殖的抑制率分别为(32.63±3.06)%、(46.41±4.41)%和(45.32±9.26)%,组间比较差异显著,具有统计学意义(P<0.05)。丹皮酚能够显著下调增生性成纤维细胞中ROS和MDA的表达情况,上调SOD的含量,降低TGF-β1、Ⅰ和Ⅲ型胶原的表达。结论丹皮酚能够抑制增生性瘢痕成纤维细胞的生长、减轻氧化应激损伤,下调TGF-β1和胶原的表达。     

车祸致颅脑损伤患者家属心理健康状况与社会支持相关性研究

目的 了解车祸致颅脑损伤患者家属的心理健康状况和社会支持状况,探讨其相关性。方法 采用自编一般资料调查表、症状自评量表（SCL - 90）和社会支持量表（SSRS）,对225名到精神专科医院就诊的车祸致颅脑损伤患者家属进行问卷调查。结果 车祸致颅脑损伤患家属的SCL - 90总分为（178.45±82.56）分, SCL - 90总分、阳性项目数和9个因子分均显著高于肿瘤患者家属和全国常模(P＜0.05)。社会支持总分为（38.52±8.23）分,社会支持水平与家属的心理健康状况呈显著的负相关（r = - 0.416, P＜0.05）。多元线性回归分析显示,社会支持总分可以负向预测家属的心理健康状况（β = - 0.399,P＜0.05）。结论 车祸致颅脑损伤患者家属的心理问题发生率较高,应从个人、家庭和社会层面为家属提供社会支持资源。     

粉防己碱对兔瘢痕组织作用的实验研究

目的 :研究粉防己碱对兔病理性瘢痕的组织学作用 ,为瘢痕治疗提供一种新方法。方法 :采用兔耳腹侧瘢痕模型 ,用粉防己碱 5 0mg /ml、粉防己碱 10mg /ml、去炎松 40mg /ml及生理盐水分别注入瘢痕组织 ,图像分析瘢痕组织中成纤维细胞数量和胶原含量的变化。结果 :粉防己碱治疗组瘢痕组织中成纤维细胞数量与胶原含量均明显减少 ,呈剂量效应关系 ;与生理盐水对照组比较 ,有极显著差异 (P <0 .0 1) ;与去炎松对照组比较无显著差别 (P >0 .0 5 )。结论 :粉防己碱抑制瘢痕组织中成纤维细胞增殖 ,并使胶原合成减少 ,从而抑制瘢痕组织生长 ,有望成为防治病理性瘢痕的新药物     

He-Ne激光重复照射抑制培养增生性瘢痕成纤维细胞胶原合成的实验研究

目的 探讨Ｈｅ－Ｎｅ激光重复照射对培养增生性瘢痕成纤维细胞胶原合成的抑制作用。方法 以不同功率密度（１０、５０、１００和１５０ｍＷ／ｃｍ＾２）Ｈｅ－Ｎｅ激光照射培养增生性瘢痕成纤维细胞３０ｍｉｎ,１／ｄ,连续照射３ｄ,在３ｄ重复照射后２４ｈ用＾３Ｈ－脯氨酸掺入法和斑点杂交法分别检测成纤维细胞胶原合成和Ⅰ型前胶原基因表达。结果 培养增生性瘢痕成纤维细胞的胶原合成、Ⅰ型前胶原基因表达水平在１０、５０ｍ