BACKGROUND:Ideal dural substitute materials requires its good biomechanics properties,tenacity and elasticity.OBJECTIVE:To determine freeze-dried and irradiated porker dura's resistant ability,including type Ⅰ collagenase digestion,the biggest load and tensile strength,to assess the porker's dura irradiated and freeze-dried whether or not can satisfy the biomechanics requirment in dura draft.DESIGN,TIME AND SETTING:This controlled analysis experiment was performed at the Burn Institute,Nanchang University,Association Mechanics Laboratory,Nanchang University-New Sans Company,Chinese Crude Drug Solid Preparation Nation Project Research Center of Jiangxi Traditional Chinese Medical College and Jiangxi Tianzhao Technology Development Company from July 2007 to June 2008.MATERIALS:Six healthy living pigs was used to sterilely obtain fresh dura mater.METHODS:After washing,pre-frozen,freeze-dried and radiation by Co ?-ray,we prepared fresh,freeze-dried,irradiated and 60 freeze-dried plus irradiated pig dura.MAIN OUTCOME MEASURES:5-mm wafer of four group dura were dealt with typeⅠcollagenase meanwhile,digested time was recorded.EMT color screen electronic testing machine was used to measure the biggest load and tensile strength of the porker dura in each group.RESULTS:Time of the dura resistance to collagenase digestion were respectively(8.3 ? 2.5),(7.6 ? 1.8),(23.6 ? 5.7)and(21.1 ? 5.3)minutes,and the largest load and tensile strength were(79.93 ? 4.36),(70.50 ? 5.97),(96.97 ? 4.84)N and(93.59 ? 4.61),(7.98?0.44),(7.05?0.60),(9.70?0.48)and(9.40?0.46)N/mm in the fresh,freeze-dried,irradiated,and freeze-dried plus irradiated pig dura groups.Compared with the fresh and freeze-dried pig dura groups,the time was longer in the irradiated and freeze-dried plus irradiated pig dura groups(P 0.05).CONCLUSION:Dural substitute materials irradiated by Co ?-ray enhanced the ability against enzymatic hydrolysis and 60 biomechanics.Irradiated and freeze-dried plus irradiated dural substitution can meet the requirements of the biomechanics in dura mater transplantation.

BACKGROUND: Wuhuang oil has a bacteriostatic action to treat burn wound and promote traumatic healing, but the action on inhibition of scars formation remains poorly understood.OBJECTIVE: To investigate the effects of modified Wuhuang oil at different concentrations and administration times on the growth and proliferation of human fibroblasts in vitro.DESIGN, TIME AND SETTING: Comparison observation regarding cytology in vitro was performed at the Burns Institute in the First Affiliated Hospital of Nanchang University between April 2006 and January 2007.MATERIALS: Prepuce specimens were harvested from patients who underwent circumcision in Department of urinary surgery, at First Affiliated Hospital of Nanchang University and Jiangxi Provincial Children Hospital. All patients aged 2-12 years old, and informed consents were obtained from their relatives. Wuhuang oil and modified Wuhuang oil (water-solubility) were offered by Department of Pharmaceutical Preparation in the First Affiliated Hospital of Nanchang University, China. METHODS: Human fibroblasts cultured in vitro were divided into 2 groups at random, experiment and control. Experiment group was treated with 300 g/L Wuhuang oil, while control group with 300 g/L modified Wuhuang oil. Serum-free culture fluid was used to prepare 6 concentrations of oil solution: 0 (blank control), 100, 150, 200, 250, 300 g/L.MAIN OUTCOME MEASURES: MTT assay was used to determine the growth and proliferation of human fibroblasts at 2, 3, 4, 5,6 days; inhibition rate of cell growth was observed at 2, 4, 6, 8, 10 days.RESULTS: Modified Wuhuang oil (0-300 g/L) concentration positively correlated with inhibition of human fibroblast proliferation;the inhibition was not related to culture time. Modified Wuhuang oil (300 g/L) had the greatest inhibition rate of human fibroblasts at 8-10 days, there were significant differences between experiment group and control group (P < 0.01).CONCLUSION: Modified Wuhuang oil has an effective inhibition on the proliferation of human fibroblasts in vitro, and shows a dose-dependent tendency. Compared with Wuhuang oil, 300 g/L modified Wuhuang oil is superior to suppress the growth of human fibroblasts.

Objective To know the understanding of acupuncture and moxibustion and learning interest of students in western medical colleges and universities;To analyze the feasibility and possibility of establishing acupuncture and moxibustion course in western medical colleges and universities. Methods A survey was made among 535 medical students in five majors from grade one to grade three in Medical School in Nanchang University:clinical specialty, anesthesiology, medical imaging, prophylactic medicine and nursing. Data were statistically analyzed by analysis of variance and Kruskal-Wallis test. Results Among all the students, 46.2%of them did not know anything about acupuncture and moxibustion, but 97% of them were interested in learning it. 76.8% students wished to learn the acupuncture theories based on modern science and clinical research. In addition, 79.3%students chose elective course as teaching form. Compared with the freshmen and junior students, sophomores were more interested in accepting acupuncture and moxibution course, with statistical significance (P<0.05). There was no statistical significance in different medical majors (P >0.05). Conclusion Students of western medical colleges and universities are interested in learning acupuncture and moxibustion. The feasibility and possibility of establishing acupuncture and moxibustion course in western medical colleges and universities are affirmed.

Objective To study the effect of thymosin beta4 on the expression of matrix metalloproteinase‐2(MMP‐2) and MMP‐9 of human hypertrophic scar fibroblasts and explore mechanism of thymosin beta4 on hypertrophic scar .Methods Fibro‐blasts were cultured in vitro from the orthopaedic patients(within 6 months after burns) admitted in the first affiliated hospital of Nanchang university from June to September 2013 .The Fibroblasts were divided into experiment group :0 .05 ,0 .1 ,1 .0 μg/mL and 5 .0 μg/mL ,and control group :no thymosin beta4 .The expression levels of MMP‐2 ,MMP‐9 were observed by RT‐PCR and West‐ern blot .Results The expression levels of MMP‐2 and MMP‐9 were increased after the thymosin beta4 took effect ,and it was espe‐cially significant in 1 .0 μg/mL and 5 .0 μg/mL group ,there was statistical difference between experiment group and control group (P<0 .05) .Conclusion Thymosin beta4 can dose‐dependently promote the expression of MMP‐2 and MMP‐9 and inhibit the pro‐liferation of hypertrophic scar .

Objective To evaluate the capability of Turbo inversion recovery magnitude (TIRM) magnetic resonance neurography (MRN) in the diagnosie of sacral plexus injury by comparing MRN findings with surgical results.Methods Ten patients with sacral plexus injury confirmed surgically underwent conventional T1WI,T2WI,TIRM and coronal TIRM MRN before operations from June,2011 to December,2012.The MRI data and surgical data were analyzed retrospectively to observe nerve injury.Results The coronal TIRM MRN images displayed 93 trunks of sacral plexus,of which 37 were confirmed injury by operation.The MRI findings were as follows:6 trunks involved continuous nerves,but with thickening and blurred margin,as well as abnormal high signal intensity;22 trunks were continuous,but with distortion,stiffness and adhesion accompanied by heterogeneous signal intensity and structural disorder;3 trunks showed complete loss of continuity,absence of normal signal,accompanied by retraction;and 3 trunks involved formation of traumatic neurofibroma.The coincidence of injured nerve trunks diagnosed by MRN with surgical findings amounts to 81.08％ (30/37).Conclusion MR with coronal TIRM imaging is effective in the diagnosis and depiction of sacral plexus injury,therefore it can be used as conventional sequence in sacral plexus examination to detect sacral plexus avulsion.

Objective To observe the effects of sodium‐selenite on human hypertrophic scar fibroblasts proliferation in vitro . Methods Human hypertrophic scar fibroblast culture was conducted in vitro ,the status of fibroblast proliferation of the 4th gener‐ation cells was tested by CCK‐8 ,which was divided into experimental group and control group ,the experimental group was divided into six groups (A ,B ,C ,D ,E ,F) ,and were added an equal volume‐containing 2 .5 ,5 .0 ,10 .0 ,20 .0 ,40 .0 ,80 .0 μmol/L concentra‐tions of sodium selenite in 10% FBS culture medium ;the control group added an equal volume of 10% FBS culture medium ,testing cell proliferation by CCK‐8 at 24 ,48 ,72 ,96 h respectively ;testing different concentrations of sodium‐selenite cell survival situation after 24 h by Live/dead reagent ;immunohistochemical was used to test intracellularⅠ ,Ⅲ type collagen expression after 24 h .Re‐sults (1)With the increased of concentration ,the inhibition rate of fibroblasts gradually increased as the concentration of sodium‐selenite ranged in 2 .5-80 .0 μmol/L(P<0 .05);(2) the inhibition rate of sodium‐selenite on fibroblasts gradually increased at the same concentration with time(P<0 .05);(3)Live/dead reagent test results showed that apoptosis cell number increased with the concentration increasing ;(4 ) With concentrations of sodium‐selenite increasing ,typeⅠ ,Ⅲ collagen expression of fibroblast de‐creased gradually .Conclusion Sodium‐selenite can inhibit human hypertrophic scar fibroblast proliferate in vitro and reduce Ⅰ ,Ⅲcollagen expression of fibroblast type.

Deepening of wounds not only prolongs the wound repair time, increases the chance of scar formation after healing, but also is one of the important causes of death in severe burn patients. How to prevent wound deepening is a clinical problem in the treatment of burns. The mechanism of deepening burn wounds has not been fully elucidated, and the prevention and treatment measures in clinic need to be further explored. Based on the research results of the early deepening mechanism and prevention measures of burn wounds at home and abroad, this paper intends to summarize the three aspects including deepening mechanism, prevention measures, and research prospects of burn wounds.

Objective:To investigate the clinical repair strategy for ischial tuberosity pressure ulcers based on the sinus tract condition and range of skin and soft tissue defects.Methods:The study was a retrospective observational study. From July 2017 to March 2023, 21 patients with stage Ⅲ or Ⅳ ischial tuberosity pressure ulcers who met the inclusion criteria were admitted to the First Affiliated Hospital of Nanchang University, including 13 males and 8 females, aged 14-84 years. There were 31 ischial tuberosity pressure ulcers, with an area of 1.5 cm×1.0 cm-8.0 cm×6.0 cm. After en bloc resection and debridement, the range of skin and soft tissue defect was 6.0 cm×3.0 cm-15.0 cm×8.0 cm. According to the depth and size of sinus tract and range of skin and soft tissue defects on the wound after debridement, the wounds were repaired according to the following three conditions. (1) When there was no sinus tract or the sinus tract was superficial, with a skin and soft tissue defect range of 6.0 cm×3.0 cm-8.5 cm×6.5 cm, the wound was repaired by direct suture, Z-plasty, transfer of buttock local flap, or V-Y advancement of the posterior femoral cutaneous nerve nutrient vessel flap. (2) When the sinus tract was deep and small, with a skin and soft tissue defect range of 8.5 cm×4.5 cm-11.0 cm×6.5 cm, the wound was repaired by the transfer and filling of gracilis muscle flap followed by direct suture, or Z-plasty, or combined with transfer of inferior gluteal artery perforator flap. (3) When the sinus tract was deep and large, with a skin and soft tissue defect range of 7.5 cm×5.5 cm-15.0 cm×8.0 cm, the wound was repaired by the transfer and filling of gracilis muscle flap and gluteus maximus muscle flap transfer, followed by direct suture, Z-plasty, or combined with transfer of buttock local flap; and transfer and filling of biceps femoris long head muscle flap combined with rotary transfer of the posterior femoral cutaneous nerve nutrient vessel flap; and filling of the inferior gluteal artery perforator adipofascial flap transfer combined with V-Y advancement of the posterior femoral cutaneous nerve nutrient vessel flap. A total of 7 buttock local flaps with incision area of 8.0 cm×6.0 cm-19.0 cm×16.0 cm, 21 gracilis muscle flaps with incision area of 18.0 cm×3.0 cm-24.0 cm×5.0 cm, 9 inferior gluteal artery perforator flaps or inferior gluteal artery perforator adipofascial flaps with incision area of 8.5 cm×6.0 cm-13.0 cm×7.5 cm, 10 gluteal maximus muscle flaps with incision area of 8.0 cm×5.0 cm-13.0 cm×7.0 cm, 2 biceps femoris long head muscle flaps with incision area of 17.0 cm×3.0 cm and 20.0 cm×5.0 cm, and 5 posterior femoral cutaneous nerve nutrient vessel flaps with incision area of 12.0 cm×6.5 cm-21.0 cm×10.0 cm were used. The donor area wounds were directly sutured. The survival of muscle flap, adipofascial flap, and flap, and wound healing in the donor area were observed after operation. The recovery of pressure ulcer and recurrence of patients were followed up.Results:After surgery, all the buttock local flaps, gracilis muscle flaps, gluteus maximus muscle flaps, inferior gluteal artery perforator adipofascial flaps, and biceps femoris long head muscle flaps survived well. In one case, the distal part of one posterior femoral cutaneous nerve nutrient vessel flap was partially necrotic, and the wound was healed after dressing changes. In another patient, bruises developed in the distal end of inferior gluteal artery perforator flap. It was somewhat relieved after removal of some sutures, but a small part of the necrosis was still present, and the wound was healed after bedside debridement and suture. The other posterior femoral cutaneous nerve nutrient vessel flaps and inferior gluteal artery perforator flaps survived well. In one patient, the wound at the donor site caused incision dehiscence due to postoperative bleeding in the donor area. The wound was healed after debridement+Z-plasty+dressing change. The wounds in the rest donor areas of patients were healed well. After 3 to 15 months of follow-up, all the pressure ulcers of patients were repaired well without recurrence.Conclusions:After debridement of ischial tuberosity pressure ulcer, if there is no sinus tract formation or sinus surface is superficial, direct suture, Z-plasty, buttock local flap, or V-Y advancement repair of posterior femoral cutaneous nerve nutrient vessel flap can be selected according to the range of skin and soft tissue defects. If the sinus tract of the wound is deep, the proper tissue flap can be selected to fill the sinus tract according to the size of sinus tract and range of the skin and soft tissue defects, and then the wound can be closed with individualized flap to obtain good repair effect.

Diabetic foot ulcer is one of the serious complications of diabetes. Diabetic wounds are of great difficulty to repair, causing a high amputation rate and a great burden to patients and their family members and society. Researches showed that the delayed sural neurotrophic vascular flap has a great effect in repairing diabetic foot ulcers. This article mainly reviewed the clinical status and research advances of the delayed sural neurotrophic vascular flap in repairing diabetic foot ulcers, intending to provide a reference for its application and research.

Objective:To explore the clinical effect of a pedicled gracilis musculocutaneous flap on reconstruction of chronic sinus wounds in inguinal region.Methods:From September 2015 to June 2023, 10 patients with chronic inguinal sinus wounds were treated in Medical Centre of Burn Plastic and Wound Repair, the First Affiliated Hospital of Nanchang University. The patients were 6 males and 4 females, aged 15-72 years old with an average age of 45 years old. Causes of injury: 4 patients were of non-healed wound after inguinal lymph node dissection for external genital or penile cancer, 2 of chronic radiation ulcers formed in the inguinal area after radiotherapy, 2 of femoral artery angiography site non-healing after lower limb artery balloon angioplasty, 1 of wound non-healing after resection of inguinal protuberant skin fibrosarcoma, and 1 of non-healing ulceration after repeated scratching due to inguinal pruritus. The wounds were all chronic in the groin region, all with a course over 30 days and sinus formation. Soft tissue defects on the surface of wounds ranged from 2.0 cm × 3.0 cm to 5.0 cm × 7.0 cm, and the depth of the sinus was from 2.0 cm to 5.0 cm. After debridement, ipsilateral gracilis musculocutaneous flaps were taken for defect reconstruction. Size of the flaps was 3.5 cm × 4.0 cm - 8.0 cm × 9.0 cm, the length of the gracilis musculocutaneous composite flaps was 16.0 - 24.0 cm, and the volume of the flap was 96.0 - 180.0 cm 3. The gracilis tissue of the flap was filled into the sinus tract and the wound was covered by the cutaneous tissue of the flap. Donor sites of the flap were pulled together and directly sutured. After surgery, hip movements were avoided and appropriately raised the affected limb, observed the survival of gracilis musculocutaneous flap as well as the healing of donor site. Scheduled postoperative follow-ups were conducted through the visits of outpatient clinic and interviews via WeChat or Internet hospital. Results:All the flaps survived. One flap had bleeding at the edge of flap within 24 hours after surgery and resulted in suture dehiscence. After bedside haemostasis, debridement and re-suture, it was healed. All donor sites achieved primary healing. All of the 10 patients were included in the postoperative follow-up for 6-21 months, with an average of 13 months. The flaps were in good colour and appearance, and the patients were satisfactory with the appearance. Scars were seen in the donor sites, but there was no obvious functional impairment. During the follow-up, no flap rupture occurred.Conclusion:The pedicled gracilis musculocutaneous flap is used to reconstruction of chronic inguinal sinus wounds, which can fully fill the sinus tract and simultaneously reconstruct the soft tissue defect of wound. This surgery is simple, practical and with good clinical efficacy.