Objective　To investigate the effects of escharectomy at different time points on myocardial damages in scalded rats during shock stage. Methods　A total of 42 rats were inflicted with 30% TBSA Ⅲ scalding on their backs and then randomly and equally divided into 7 groups: burned control group (C) and escharectomy groups at hour 1, 3, 6, 12, 24 and 36 postburn. Another 6 rats were employed as normal control (N). The serum levels of creatine kinase isoenzymes MB (CKMB), aspartate aminotransferase (AST) were determined and morphological changes in myocardial tissues were observed 72 hours after the burn. Results　The serum levels of CKMB and AST were higher in the C group than in other groups, and the levels in escharectomy groups were increased along with the prolongation of scar cutting. Pathologically, the myocardial tissues were severely damaged in C group, and the later the scars were cut, the severe the damages were in the escharectomy groups except the 2 groups with scars cut at hour 1 and 3. Conclusion　Escharectomy in shock stage can effectively prevent the damage of the myocardial tissues from postburn injury and the earlier it is performed, the better the result is.

Objective:To explore the mode,methods,and attentive problems of bilingual teaching of Burn Surgery for Seven-year medical program students.Methods:The bilingual teaching project of Burn Surgery was considered comprehensively from various angles,such as the teaching mode,methodology,teacher training,teaching material selection and teaching management in specialized course.Conclusion:It is very necessary to develop bilingual education for Seven-year program students.The course of bilingual teaching should be student-oriented to improve their integrated ability of English and to assure mastery of professional theory and knowledge.

The construction of excellent courses is one important measure of carrying out the teaching quality project in university.To improve the quality of the construction of excellent courses,we must emphasize some basic operation strategies such as practical results,innovation,digital processing and integration.We should adopt workable measures to carry out the teaching quality project in university and strengthen the key position of teaching.

To explore the hemodynamic characteristics during burn shock stage in dogs immigrated onto high altitude, dogs scalded with 40% TBSA of Ⅲ degree burn (n=8) were randomly divided into a high altitude treatment group (H group) and a flatlands treatment group (F group) . All subjects were infused with lactated Ringefs solution at 1 postburn hour according to the Parkland formula. The changes in hemodynamic parameters, organ water content, pulmonary microvascular permeability, serum activity of PLA2 and CK-MB were determined. The results showed that under simulated high altitude condition sustained hypoxemia and acidosis as well as hypoxic damage of myocardial function were present before scalding, and sustained increase of PAP, PCWP and RVWI, even pulmonary hypertension and lung edema were found at 24 postburn hour in H group. At 48 postburn hour, the organ water content of heart, lung, etc increased more remarkably but urine output decreased more obviously in H group than those in F group. Serum activity of PLA2 and CK-MB increased gradually after burn. It is suggested that tissue edema may easily supervene with infusion according to Parkland formula under plateau condition. Hypoxic damage of organs should be corrected by increase of colloid volume resuscitation and dehydration treatment. Administration of hypertonic solution is able to correct burn shock.

It has not been well agreed on transportation of severely burned patients for a long distance during shock stage due to having high risks. After meticulouss preparation and much effort, a group of severely burned patients during shock period were safely transferred by air far away from our hospital in Aug. 2000, and fluid resuscitation and hemodynamical stabilization were maintained on the plane. The process passed smoothly. All the patients survived finally after active and effective treatment in our burn center. The experience shows that transportation by air of burned patients for a long distance during shock stage is possible on condition that all relative measures are properly carried out during the journey.

Objective:To explore the mode,methods,and attentive problems of the network teaching carried out during the standardized training in residents.Methods:The project of carrying out network teaching during the standardized training in residents was considered comprehensively from various angles,such as teaching mode,teacher training,construction of the network teaching system and resources base,teaching management in specialized course.Conclusion:It is very necessary and helpful to develop network teaching during the standardized training in residents.The course of network teaching should be student-oriented,carried out to improve their self-educated ability and to assure mastery of professional theory and knowledge.

Objective To investigate the effects of NF-κB activation on paihogenesis of PMN aggregation in myocardium and early myocardial dysfunction induced by polymorphonuclear leukocyte (PMN) in burned rats. Method One hundred and seventy wistar rats were randomly divided into three groups, control group ( n = 20, with isotonic saline solution), bum group ( n = 90, with isotonic saline solution after bum), bum and pyrrolidine dithioncarbamate group ( PDTC group, n = 60, with isotonic saline solution and 250 mg/kg PDTC after bum). The rats in bum group and PDTC group underwent 35% TBSA full-thickness bums on the back. The acb'vaty of myocardial NF-κB was tested by electrophoretic mobility shift assay (EMSA) at 1, 3, 6, 12,24 postbum hours (PBH). Expressions of myocardial IL-8 and ICAM-1 mRNA were assessed by reverse transcription polymerase chain reaction (RT-PCR) at 3,6,12,24 PBH. Meanwhile, the avtivity of myocardial myeloperoxidse(MPO), the left ventricular systolic pressure(LVSP) and the left ventricular end diastolic pressure (LVEDP) as well as maximum positive and negative left ventricular pressure change (± dp/dtmax) were observed at 3,6,12,24 PBH. Results The activity of myocardial NF-κB in bum groups was markedly increased at 1 PBH [(20.27± 3.43) × 104 A] .which was obviously higher than that in control group [(2.18±0.38) × 104 A, P ＜ 0.01], and was still higher than that in control group at 24 PBH ( P ＜ 0.01). The expressions of myocardial IL-8 and ICAM-1 mRNA and avtivity of myocardial myeloperoxidse were obviously higher than that in control group at 3,6,12,24 PBH respectively (P ＜ 0.01), LVSP and ± dp/dtmax significantly were lower, but LVEDP was higher than that in control group during 3-24 PBH (P ＜ 0.01). Compared with that in bum group, these indices were ameliorated in PDTC group. Conclusions Severe bum might activate myocardial NF-κB, which ultimately lead to the production of cytokines, PMN aggregation in myocardium and deterioration of cardiac contractility and relaxation consequently.

AIM: To investigate the effects of burn sera on I?B? degradation, NF-?B activation in peripheral blood monocytes (PBMCs) in order to explore the role of burn sera on activation of monocytes. METHODS: PBMCs isolated from healthy volunteers were stimulated by sera from healthy volunteers and burn patients and by burn sera together with PDTC (pyrrolidine dithioncarbamate). Activation of monocytic NF-?B was tested by electrophoretic mobility shift assay (EMSA) and the degradation of monocytic I?B? was determined by Western blotting. RESULTS: When compared to that in control group, cytosolic I?B? degradation occurred within 30 min after PBMCs stimulated by burn sera, and peaked at 60 min. But I?B? gradually recovered in the cytoplasm after 2 h of stimulation. Meanwhile, activity of monocytic NF-?B was markedly increased, reached the peak at 30 min to 60 min after stimulation, and gradually decreased after 2 h of stimulation. PDTC (an antioxidants) effectively inhibited the monocytic I?B? degradation and activation of NF-?B induced by burn sera. CONCLUSION: Burn sera might induce the degradation of I?B?, then activate NF-?B, which ultimately lead to the secretion of cytokines from the monocytes. [

Objective To evaluate the effects of surgical and physical therapy on functional reconstruction post severe burn. Methods 21 patients with severe burn accepted comprehensive rehabilitation, while the other 18 cases accepted surgical therapy only. Modified Barthel Index and Vancouver Scar Scale were applied to assess their activities of daily living (ADL) and scar recovery 3 months, 1 year or 2 years post injury. Results Compared with the control group, the observation significantly improved in ADL and scar recovery with fewer operations (P<0.01). Conclusion The surgical and physical therapy facilitates to improve the functional recovery post severe burn.

OBJECTIVETo evaluate the therapeutic effects of VSD combined with irrigation of oxygen loaded fluid on the growth of granulation tissue and macrophage polarization in chronic venous leg ulcers.

METHODSThiry-four patients with chronic venous leg ulcers hospitalized in our department from December 2010 to July 2014 were divided into VSD group ( A, n = 11) , VSD + irrigation group ( B, n = 11) , and VSD + oxygen loaded fluid irrigation group ( C, n = 12) according to the random number table. After admissian, debridement was performed, and granulation tissue in the center of the wound was harvested during the operation. After dehridement, the patients in group A were treated with VSD only (negative pressure from -30 to -25 kPa, the same below) ; the patients in group B were treated with VSD combining irrigation of normal saline; the patients in group C were treated with VSD combining normal saline loaded with oxygen irrigation (flow of 1 L/min) . On post treatment day (PTD) 7, the VSD devices were removed. Cross observation was conducted before debridement and on PTD 7. On PTD 7, the granulation tissue in the center of the wound was harvested for histopathological observation with HE staining and Masson staining, following calculation of granulation tissue coverage rate. After debridement but before the negative pressure therapy (hereinafter referred to as before treatment) and on PTD 7, partial pressure of oxygen of the skin around the wound was measured by transcutaneous tissue oxygen tension survey meter. On PTD 7, expression of vascular endothelial growth factor (VECF) was determined with immunohistochemistry. Before treatment and on PTD 7, cells with double positive expressions of induced nitric oxide synthase plus CD68 ( type I macro- phage) and arginase 1 plus CD68 ( type II macrophage) were observed with immunofluorescence staining and quantified. Data were processed with Fisher's exact test, one-way analysis of variance, covariance analysis, paired test, and LSD test.

RESULTS(1) The gross observation showed that before debridement there was a certain amount of necrotic tissue and little granulation tissue in the wounds of patients in all the 3 groups. On PTD 7, new granulation tissue was found in the wounds of patients in all the 3 groups, and in group C its amount was the largest. (2) On PTD 7, the granulation tissue coverage rate of wounds in pa- tients of group C was higher than that of group A or B ( P <0.05 or P <0.01). (3) On PTD 7, HE staining showed that there appeared more abundant new born microvessels and fibroblasts in the wounds of patients in group C than those in groups A and B; Masson staining showed that there was more abundant fresh collagen distributed orderly in the wounds of patients in group C compared with group A or B. (4) On PTD 7, it was found that partial pressure of oxygen of the skin around the wounds in patients of group C [(40.7 +/- 4.1) mmHg, 1 mmHg = 0.133 kPa] was higher than that of group A [ (35.0 +/- 3.1) mmHg] or B [(35.4 +/- 2.7) mmHg, with P values below 0.01]; the partial pressure of oxygen of the skin around the wounds of patients in all the 3 groups was increased significantly compared with that before treatment (with values from 10.38 to 22.52, P values below 0.01). (5) On PTD 7, the expression of VECF in the wounds of patients in group C was higher than that in group A or B ( P <0.05 or P < 0.01). (6) On PTD 7, the number of type I macrophages in granulation tissue of patients was respectively 14.3 +/- 2.3, 11.5 +/- 3.0, and 10.7 +/- 2.3 per 400 times vision field in groups A , B, and C ( F = 25.14, P < 0.01), while the number in group C was less than that in group A or B ( P < 0.05 or P < 0.01). Compared with that before treatment, the number of type I macrophages was significantly decreased on PTD 7 in all the 3 groups (with values from 14.76 to 23. 73, P values below 0. 01). On PTD 7, the number of type II macrophages in granulation tissue of patients was respectively 32.7 +/- 3.2, 35.1 +/- 3.3 , and 41.3 +/- 3.2 per 400 times vision field in groups A, B, and C ( F = 81.10, P < 0.01), and the number in group C was lager than that in group A or B ( with P values below 0. 01). Compared with that before treatment, the number of type II macrophages in all the 3 groups was significantly increased (with t values from -69.34 to -47.95, P values below 0.01).

CONCLUSIONSVSD combined with irrigation of oxygen loaded fluid can raise the partial pressure of oxygen of the skin around the wounds effectively, promoting the transition of macrophages from type I to type II, thus it may promote the growth of granulation tissue, resulting in a better recipient for skin grafting or epithelization.

Debridement ; Drainage ; Granulation Tissue ; Humans ; Leg Ulcer ; etiology ; surgery ; Macrophages ; Microvessels ; Negative-Pressure Wound Therapy ; methods ; Nitric Oxide Synthase Type II ; Oxygen ; Skin ; Skin Transplantation ; Skin Ulcer ; Surgical Flaps ; Treatment Outcome ; Vacuum ; Vascular Endothelial Growth Factor A ; Veins ; Wound Healing