Marjolin's ulcer is a rare malignancy arising from various forms of scars, mainly an old scar resulted from burn. The second most common origin is malignant degeneration arising from tissue within osteomyelitis fistulae. Not uncommonly, the lesions may arise secondary to ulcers due to venous insufficiency or pressure sores. The pathology of the majority of Marjolin's ulcer is a well-differentiated squamous cell carcinoma. The exact reason for an ulcer which undergoes a malignant transformation is unknown. The pathologic diagnosis is the gold standard. Surgery remains the preferred treatment after diagnosis is reached. Wide surgical excision with margins up to 2-3 cm has been suggested. The necessity of whether lymphatic dissection should be executed, or radiotherapy and chemotherapy following surgery is still in dispute. This article deals with the etiology of Marjolin's ulcer and its pathological grading, diagnosis, treatment, prognosis, and prevention, with a hope to provide some useful clinical information.
Burns ; complications ; Carcinoma, Squamous Cell ; etiology ; pathology ; surgery ; Cicatrix ; Humans ; Lymphatic Vessels ; Pressure Ulcer ; pathology ; surgery ; Prognosis ; Skin Neoplasms ; etiology ; pathology ; surgery ; Skin Ulcer

OBJECTIVETo survey the curative effects of kinesitherapy in combination with self-made simple orthosis (SO) in treatment of scar contracture of burned hand in children.

METHODSFifty-eight children with burns of unilateral hand and received treatment in our rehabilitation center from January 2012 to January 2014 were divided into common rehabilitation (CR) and SO groups according to the random number table, with 29 cases in each group. After the wounds were healed, patients in group CR were treated with kinesitherapy combined with hand game exercises and pressure gloves, while patients in group SO were treated with kinesitherapy combined with hand game exercises and self-made SO, which was composed of finger web dividing belt, self-adhesive bandage, and infusion set fixing plate. Before treatment and 16 weeks after treatment, scar condition was assessed with the Vancouver Scar Scale (VSS); hand function was evaluated by the Jebsen Test of Hand Function, and the completion time was recorded; and the activities of daily life (ADL) was measured by the modified Barthel Index. Sixteen weeks after treatment, the range of motion was measured with the Total Active Movement (TAM) method. Data were processed with t test and chi-square test.

RESULTSThe score of VSS in group SO was (12.2 ± 1.3) points before treatment and (6.7 ± 2.2) points 16 weeks after treatment, and the improvement score was (5.6 ± 1.8) points. The score of VSS in group CR was (12.0 ± 1.4) points before treatment and (7.0 ± 1.8) points 16 weeks after treatment, and the improvement score was (5.0 ± 1.0) points. There was no obvious difference in improvement score of VSS between the two groups (t = 1.452, P = 0.152). The ratio of excellent and good results according to TAM method in group SO was 75.9% (22/29) , while it was 37.9% (11/29) in group CR (t = 8.507, P = 0.004). The completion time for the Jebsen Test of group OS was (8.2 ± 1.6) min before treatment and (7.1 ± 1.4) min after treatment, and the improvement time was (1.2 ± 1.5) min. The completion time for the Jebsen Test of group CR was (9.0 ± 1.9) min before treatment and (6.3 ± 1.4) min 16 weeks after treatment, and the improvement time was (2.7 ± 2.7) min. There was a significant difference in improvement time for the Jebsen Test between the two groups (t = 2.618, P = 0.012). The score of ADL in group CR was (7.7 ± 1.4) points before treatment and (10.4 ± 1.4) points 16 weeks after treatment, and the improvement score was (2.7 ± 1.7) points. The score of ADL in group CR was (7.8 ± 1.4) points before treatment and (9.5 ± 1.4) points 16 weeks after treatment, and the improvement score was (1.7 ± 1.6) points. There was a significant difference in improvement score of ADL between the two groups (t = 2.246, P = 0.029).

CONCLUSIONSKinesitherapy in combination with self-made SO can improve the functional recovery of burned hand in children and prevent contractures in hand, and it is worth applying generally.

Burns ; complications ; Child ; Cicatrix ; therapy ; Compression Bandages ; Contracture ; Hand Injuries ; therapy ; Humans ; Orthotic Devices ; Physical Therapy Modalities ; Time ; Wrist Injuries

OBJECTIVETo observe the change in phosphoinositide 3-kinase/protein kinase B (PI3K/Akt) signal pathway in monocytes as induced by serum of rats with electrical burn, and to explore the effects of PI3K/Akt pathway on monocyte-endothelial cell adhesion.

METHODSSixty-four SD rats of clean grade were inflicted with electrical burn for the collection of serum of rats with electrical burn; another group of twenty-four SD rats were used to obtain normal serum without treatment. (1) Human monocyte line THP-1 was routinely cultured. The THP-1 cells in logarithmic phase were divided into normal serum group (resuspended in RPMI 1640 medium with 20% normal rat serum) and burn serum group (resuspended with RPMI 1640 medium with 20% serum of rats with electrical burn) according to the random number table, with 6 wells in each group. Morphology of THP-1 cells in normal serum group was observed at post culture hour (PCH) 24, and that in burn serum group at PCH 3, 6, 24. The contents of TNF-α in culture supernatant were determined by double-antibody sandwich ELISA at the corresponding time point in each group. The state of Akt activation was determined by Western blotting at PCH 3, 6, 24. (2) Another portion of THP-1 cells were divided into 4 groups according to the random number table, with 6 wells in each group. Cells in normal serum group and burn serum group were given with the same culture condition as above; cells in normal serum+inhibitor group and burn serum+inhibitor group were cultured with the same culture conditions as in the former two groups correspondingly with addition of 100 nmol/L wortmannin in the nutrient solution. At PCH 3 and 6, THP-1 cells were added into the well with a monolayer of endothelial cell line EA.hy926 to observe the monocyte-endothelial cell adhesion. Data were processed with one-way analysis of variance and LSD- t test.

RESULTS(1) In normal serum group, THP-1 cells showed growth in suspension, with uniform shape at PCH 24. In burn serum group, the cell shape became irregular though the membrane was complete at PCH 3; cellular size became irregular and cell membrane and cytoplasm were swollen at PCH 6; cell membrane was disrupted with death of cells at PCH 24. The contents of TNF-α in culture supernatant in normal serum group at PCH 24 and in burn serum group at PCH 3, 6, 24 were respectively (38.5 ± 1.4), (75.1 ± 1.5), (91.5 ± 1.8), (117.0 ± 1.4) pg/mL (F = 1 415.306, P < 0.01). The contents of TNF-α in culture supernatant in burn serum group at PCH 3, 6, 24 were all significantly higher than the content of TNF-α in normal serum group at PCH 24 (with t values respectively 29.614, 42.852, 63.485, P values below 0.01). The ratio values of phosphorylated Akt to Akt in burn serum group at PCH 3, 6, 24 were respectively 2.66, 3.69, 1.17 times of those in normal serum group at the corresponding time point. (2) In normal serum group, normal serum+inhibitor group, burn serum group, and burn serum+inhibitor group at PCH 3 and 6, the numbers of THP-1 cells adherent to endothelial cells were respectively (231 ± 45), (280 ± 47), (703 ± 169), (335 ± 85) per 100-time field; (219 ± 49), (235 ± 21), (562 ± 123), (226 ± 29) per 100-time field (with F values respectively 25.630 and 18.975, P values below 0.01). The number of THP-1 cells adhered to EA.hy926 cells was significantly more in burn serum group than in normal serum group at PCH 3 and 6 (with t values respectively 6.189 and 6.601, P values below 0.01). The number of THP-1 cells adherent to EA.hy926 cells was significantly fewer in burn serum+inhibitor group than in burn serum group at PCH 3 and 6 (with t values respectively 6.821 and 6.465, P values below 0.01).

CONCLUSIONSThe serum of rats suffering from electrical burn can induce the monocytes to secrete TNF-α, thus enhancing monocyte-endothelial cell adhesion, but it can be inhibited by blocking PI3K/Akt signal pathway.

Animals ; Burns, Electric ; blood ; Cell Line ; Humans ; Monocytes ; Phosphatidylinositol 3-Kinases ; metabolism ; Proto-Oncogene Proteins c-akt ; metabolism ; Rats ; Serum ; Signal Transduction ; Tissue Adhesions ; metabolism ; pathology ; Tumor Necrosis Factor-alpha ; metabolism

OBJECTIVETo explore the effects of microRNA-21 on apoptosis of myocardial cell of rats as induced by ischemia and hypoxia, and to analyze the underlying mechanisms.

METHODS(1) Rat myocardial cell line H9C2 was cultured in a serum-free and low glucose DMEM medium using a hypoxic incubator which was filled with 1% oxygen, 5% carbon dioxide, and 94% nitrogen to simulate ischemic environment. The expression of microRNA-21 in normal myocardial cells and cells treated with low oxygen exposure for 6 and 24 h were assessed by real-time fluorescent quantitative RT-PCR. (2) Another portion of myocardial cells were divided into 4 groups according to the random number table: normal control group (NC, ordinary culture without any treatment), ischemia/hypoxia group (IH, treated with ischemia and hypoxia for 24 h), negative transfection control+ischemia/hypoxia group (NC+IH, treated with ischemia and hypoxia for 24 h after the transfection of microRNA mimics control for 24 h), microRNA-21+ischemia/hypoxia group (M+IH, treated with ischemia and hypoxia for 24 h after the transfection of microRNA-21 mimics for 24 h). The cells in the latter three groups were examined immediately after treatment, and cells in group NC were collected and examined at the same time point. Apoptosis rate of myocardial cells was determined by flow cytometer. The mRNA and protein expression levels of programmed cell death 4 (PDCD4) in myocardial cells were determined by real-time fluorescent quantitative RT-PCR and Western blotting respectively. The sample numbers in this experiment were 6 or 3. Data were processed with one-way analysis of variance and LSD- t test.

RESULTS(1) The expression level of microRNA-21 in normal myocardial cells and cells treated with ischemia and hypoxia for 6 and 24 h were respectively 1.09 ± 0.17, 0.75 ± 0.08, and 0.67 ± 0.08 (F = 11.280, P = 0.009). Compared with expression level of microRNA-21 in normal myocardial cells, those of cells treated for 24 h (t = 4.461, P = 0.004) and 6 h (t = 3.642, P = 0.011) were both lower, and the former was more obvious. Therefore all the ischemia and hypoxia treatment time of cells in the following experiment was 24 h. (2) The apoptosis rate of myocardial cells in group NC was (3.5 ± 0.7)%. After being treated with ischemia and hypoxia for 24 h, the apoptosis rates of myocardial cells in groups IH, NC+IH, and M+IH were respectively (17.3 ± 3.2)%, (16.4 ± 3.0)%, and (7.6 ± 2.0)% (F = 15.176, P = 0.001). Compared with that of group NC, the apoptosis rate of myocardial cells of group IH was significantly increased (t = 5.641, P < 0.001), while it was significantly decreased in group M+IH as compared with group NC+IH (t = 3.588, P = 0.007). The mRNA expression level of PDCD4 in group NC was 1.06 ± 0.21. After being treated with ischemia and hypoxia for 24 h, the mRNA expression levels of PDCD4 in groups IH, NC+IH, and M+IH were respectively 3.01 ± 0.34, 3.05 ± 0.25, and 1.48 ± 0.24 (F = 44.952, P < 0.001). Compared with that of group NC, the mRNA expression level of PDCD4 in group IH was higher (t = 8.945, P < 0.001), while it was significantly lower in group M+IH as compared with group NC+IH (t = 7.253, P < 0.001). The protein expression level of PDCD4 in group NC was 0.44 ± 0.08. After being treated with ischemia and hypoxia for 24 h, the protein expression levels of PDCD4 in groups IH, NC+IH, and M+IH were respectively 0.96 ± 0.13, 1.05 ± 0.12, and 0.58 ± 0.12 (F = 18.804, P = 0.008). Compared with that of group NC, the protein expression level of PDCD4 in group IH was higher (t = 5.429, P = 0.006), while it was significantly reduced in group M+IH as compared with group NC+IH (t = 4.903, P = 0.008).

CONCLUSIONSIschemia and hypoxia reduce the expression of microRNA-21 in myocardial cells, while increasing the expression of microRNA-21 can alleviate the ischemia/hypoxia-induced apoptosis by lowering the expression of PDCD4.

Animals ; Apoptosis ; genetics ; physiology ; Apoptosis Regulatory Proteins ; genetics ; metabolism ; Blotting, Western ; Cell Line ; Flow Cytometry ; Hypoxia ; Ischemia ; MicroRNAs ; genetics ; Myocardium ; Myocytes, Cardiac ; RNA, Messenger ; genetics ; Rats ; Reverse Transcriptase Polymerase Chain Reaction ; Transfection

OBJECTIVETo observe the effects of low molecular weight heparin (LMWH) on the inflammatory response and vascular injury in rat after electric burn.

METHODSA homemade regulator and transformer apparatus was used to reproduce the model of electric burn (0.5 cm×0.5 cm in size) with depth from full-thickness to full-thickness skin plus muscle and bone on the middle of the inside of right hind limb in 60 Wistar rats. The open wounds were covered with 20 g/L sulfadiazine silver paste immediately after injury. The wound condition was observed every day. The injured rats were divided into group LMWH and control group (C) according to the random number table, with 30 rats in each group. Rats in group LMWH were given subcutaneous injection of LMWH (1 U/g) in abdominal wall, 2 times a day. No other treatment was given in rats in group C. On post burn day (PBD) 3, 5, and 10, 10 rats respectively of two groups were sacrificed. The damaged tissue of wound and that around the wound (1.0 cm×0.5 cm in size) were excised, and heart blood was obtained. The pathological changes and thrombosis in damaged tissue were observed with HE, Masson, and aldehyde fuchsin staining, and the thrombosis rate was calculated. Serum contents of TNF-α and endothelin-1 were determined with ELISA. The mRNA expression of TNF-α in damaged tissue was detected with RT-PCR. Data were processed with Levene homogeneity test, analysis of variance of factorial design, LSD- t test, SNK- q test, and Friedman M nonparametric test.

RESULTS(1) The injured limb of rats was obviously swollen after electric burn, which reached deeply to the muscle and bone. Compared with those of group C, the swelling of rats subsided slightly faster and the inflammatory response was lighter in group LMWH at each time point. (2) The necrosis of damaged tissue and profuse infiltration of inflammatory cells were observed. Dilatation of blood vessels, congestion and thrombosis, and swelling, necrosis, and desquamation of vascular endothelial cells were observed in the damaged tissue. Damaged blood vessel wall, ruptured elastic fiber, loss of internal elastic membrane, and other pathological changes were observed in the damaged tissue of rats in the two groups. Above lesions were improved gradually along with the passage of time, and the improvement was more obvious in rats of group LMWH compared with that of group C on PBD 5 and 10. (3) The thrombosis rates of rats in group LMWH were obviously lower than those of rats in group C (F = 4.921, P < 0.05). The thrombosis rates of rats in group LMWH on PBD 3 and 10 were respectively (0.07 ± 0.11)% and (0.03 ± 0.05)%, which were significantly lower than those of rats in group C [(0.16 ± 0.15)% and (0.13 ± 0.18)%, with t values respectively 2.17 and 2.07, P values below 0.05]. In group LMWH, the thrombosis rate of rats on PBD 10 was obviously lower than that on PBD 3 (t = 3.61, P < 0.05). (4) The serum contents of TNF-α and endothelin-1 of rats in group LMWH were significantly lower than those of rats in group C (F = 47.161, χ(2) = 81.46, P values below 0.01). In group LMWH, TNF-α contents were respectively (71 ± 24), (74 ± 14), (72 ± 20) pg/mL, and endothelin-1 contents were respectively (20.9 ± 3.2), (19.8 ± 5.2), (18.6 ± 1.1) ng/mL on PBD 3, 5, and 10, and they were significantly lower than those of rats in group C [(195 ± 148), (96 ± 20), (159 ± 46) pg/mL and (38.8 ± 15.4), (27.9 ± 3.6), (25.6 ± 7.6) ng/mL, with t values from 3.81 to 8.05, q values from 4.41 to 7.85, P < 0.05 or P < 0.01]. (5) The mRNA expression levels of TNF-α in damaged tissue of rats in group LMWH were significantly lower than those of rats in group C (F = 199.113, P < 0.01). The mRNA expression levels of TNF-α of rats in group LMWH were respectively 0.93 ± 0.10, 1.15 ± 0.12, 1.21 ± 0.11 on PBD 3, 5, and 10, and they were significantly lower than those of group C (1.68 ± 0.15, 1.43 ± 0.12, 1.50 ± 0.13, with t values from 3.75 to 6.12, P < 0.05 or P < 0.01). In group LMWH, the mRNA expression level of TNF-α of rats on PBD 10 was obviously higher than that on PBD 3 (t = 3.61, P < 0.05).

CONCLUSIONSLMWH intervention can ameliorate vascular injury and inflammatory response of electrically burned wounds in rats, and it decreases thrombosis rate in the vessels of injured limb.

Animals ; Anticoagulants ; administration & dosage ; Burns, Electric ; blood ; complications ; therapy ; Endothelin-1 ; Heparin, Low-Molecular-Weight ; administration & dosage ; Male ; Rats ; Rats, Wistar ; Serum ; metabolism ; Treatment Outcome ; Tumor Necrosis Factor-alpha ; blood ; Vascular System Injuries ; therapy

OBJECTIVETo observe the changes in the expressions of microRNA-126 in myocardial tissue and cardiac troponin I (cTnI) in serum of rats in the early stage of severe burn injury with analysis of their relationship, and to validate the relationship between microRNA-126 and myocardial damage in cellular level.

METHODS(1) Forty-eight SD rats were divided into sham injury group (n=8, without fluid therapy after sham injury) and burn injury group (n=40, inflicted with 30% TBSA full-thickness scald on the back, hereinafter referred to as burn, and received intraperitoneally injection of lactic acid Ringer's solution) according to the random number table. Blood was collected from abdominal aorta of rats in sham injury group at post injury hour (PIH) 1, and then these 8 rats were sacrificed for obtaining left ventricular tissue. Blood was respectively collected from abdominal aorta of 8 rats in burn injury group at PIH 3, 6, 12, 24, and 48, and then they were sacrificed and the left ventricular tissue was obtained at each time point. The expression of microRNA-126 in myocardial tissue was assessed by real-time fluorescent quantitative RT-PCR. Serum level of cTnI was assessed by ELISA. (2) Rat myocardial cell line H9C2 was divided into normal control group (NC, routinely cultured), stimulation group (S), negative transfection+stimulation group (NT+S), and transfection+stimulation group (T+S) according to the random number table. Cells in S group were treated with hypoxia for 24 h after being cultured with DMEM containing 10% burn serum obtained from rats in burn injury group at PIH 6 in experiment (1). Cells in NT+S group and T+S group were respectively transfected with the negative control of microRNA mimics and microRNA-126 mimics for 24 h, and then were given the same treatment as that of S group. The expression of microRNA-126 in myocardial cells was determined by real-time fluorescent quantitative RT-PCR (with the sample number of 3). Cell counting kit 8 was used to examine the vitality of myocardial cell (with the sample number of 4, denoted as absorbance value). Apoptotic rate of myocardial cells was determined by flow cytometer (with the sample number of 3). Data were processed with one-way analysis of variance and LSD-t test. The relationship between microRNA-126 expression in myocardial tissue and serum level of cTnI of rats was assessed by linear correlation analysis.

RESULTS(1) Compared with that of sham injury group at PIH 1, the expression levels of microRNA-126 in myocardial tissue of rats in burn injury group at PIH 3, 6, 12, 24, and 48 were significantly decreased (with t values from 5.68 to 9.79, P values below 0.01), reaching its nadir at PIH 24 (0.40 ± 0.08). Compared with that of sham injury group at PIH 1, the serum levels of cTnI of rats in burn injury group at PIH 3, 6, 12, 24, and 48 were significantly increased (with t values from 6.68 to 12.79, P values below 0.01), peaking at PIH 12 [(1 035 ± 177) pg/mL]. A significant negative correlation between the expression level of microRNA-126 in myocardial tissue and serum level of cTnI was observed in rats of burn injury group at each time point (r=-0.797, P<0.001). (2) Compared with those of NC group, the microRNA-126 expression levels in myocardial cells of S group and T+S group were respectively decreased and increased (with t values respectively 4.57 and 5.73, P<0.05 or P<0.01), the cell vitality levels were obviously decreased (with t values respectively 14.88 and 6.48, P values below 0.01), and the apoptotic rates were significantly increased (with t values respectively 13.82 and 6.96, P values below 0.01). Compared with that in NT+S group, the microRNA-126 expression level in myocardial cells of T+S group was significantly increased (t=6.77, P<0.01), the cell vitality level was obviously increased (t=8.23, P<0.001), and the apoptotic rate was significantly decreased (t=6.14, P<0.001).

CONCLUSIONSExpression level of microRNA-126 in myocardial tissue of rat was decreased in the early stage of severe burn injury. It may participate in regulating myocardial damage and play a protective role.

Animals ; Burns ; metabolism ; pathology ; Cell Line ; Enzyme-Linked Immunosorbent Assay ; Hypoxia ; MicroRNAs ; genetics ; metabolism ; Myocardium ; metabolism ; pathology ; Myocytes, Cardiac ; metabolism ; pathology ; Rats ; Rats, Sprague-Dawley ; Real-Time Polymerase Chain Reaction ; Reverse Transcriptase Polymerase Chain Reaction ; Serum ; Soft Tissue Injuries ; Transfection ; Troponin I ; metabolism

A 55-year-old male patient suffered from severe high-voltage electric burn with an area of 20%TBSA full-thickness injury. The injury involved the distal end of left upper limb, right trunk, and whole abdominal wall. Fracture of the 7th-10th ribs was found in the right side of chest, with perforation of abdominal cavity, and bilateral pleural effusion was found. Part of the small intestine was necrotic and exposed. At the early stage, xeno-acellular dermal matrix was grafted after debridement of abdominal wound; peritoneal lavage was performed; negative pressure drainage was performed in orificium fistula of intestine for promoting the adhesion between perforated intestine and abdominal scar. Two orificium fistulas formed after closure of abdominal granulation wound by autologous skin grafting. Eschar of chest wall and denatured ribs were retained. The risk of infection of thoracic cavity was decreased by promoting the adhesion between lung tissue and chest wall. During the treatment, the patient was diagnosed with Henoch-Schonlein purpura nephritis by renal biopsy, with the symptoms of purpura in the lower limbs, heavy proteinuria, severe hypoalbuminemia, edema, etc. After control of kidney damage by immunosuppressive treatment instead of glucocorticoid, alleviation of the levels of proteinuria and blood albumin, free latissimus dorsi myocutaneous flap was excised to repair chest wall, and free skin graft was excised to repair intestinal fistula. After all the wounds were successfully covered, the patient was treated with glucocorticoid combined with immunosuppressants for more than 1 year. The patient was followed up for 3 years, and his renal function was completely recovered with satisfactory clinical outcome.
Abdominal Cavity ; Abdominal Injuries ; complications ; surgery ; Burns, Electric ; complications ; surgery ; Humans ; Male ; Middle Aged ; Nephritis ; complications ; surgery ; Purpura, Schoenlein-Henoch ; complications ; surgery ; Thoracic Cavity ; Thoracic Injuries ; complications ; surgery