In the early developing stage of burn surgery, severe burn patients with large and deep burn wound often died of complications because of shortage of auto-skin. The method of intermingled transplantation composed of a large sheet of partial thickness allo-skin with punched holes for in laying small pieces of partial thickness auto-skin was first advocated by Chinese doctors (Ruijin Hospital) in 1960's. This intermingled transplantation method has saved many severe burn patients with extensive full-thickness burn wound. The mortality rate of severe burn patients has decreased and the survival rate has increased remarkably since the intermingled transplantation treatment method used in the burn units. In this paper we review the process of formation of intermingled transplantation and the mechanisms of success of this Chinese method in repairing the large wound surface area after eschar excision. We will focus our discussion on the low systemic immunological reaction, the effect of auto-skin islet, local immunological tolerance induced by in layed auto skin, the balance of Th1 and Th2 cells and the effects of some cytokines such as IL-10 in local immunological tolerance and etc. after intermingled transplantation.
Burns ; immunology ; pathology ; surgery ; Humans ; Skin Transplantation ; immunology ; methods ; Wound Healing

BACKGROUNDTransitional cell carcinoma of the upper urinary tract (UUT-TCC) accounts for 5% to 10% of all renal tumours and 5% to 6% of all urothelial tumours all over the world. In China, the proportion of UUT-TCC to all urothelial tumours may be 26%, which is higher than that in the western world. The early diagnosis of UUT-TCC is difficult and the present study elucidates the diagnostic value of poor or nonvisualization (PNV) in intravenous urography in patients with UUT-TCC and its correlations with pathological findings and clinical characteristics.

METHODSThe data of 172 consecutive patients between January 1997 and January 2005 with UUT-TCC who underwent nephroureterectomy in our departments were selected and analyzed retrospectively.

RESULTSOf our sample, 144 cases presented with gross haematuria (83.7%) and 12 with microscopic haematuria (7.0%). Forty-six cases (26.7%) were detectable by cytology. Filling defect identified 36 positive cases of 172 patients (20.9%), PNV was present in the images of 105 of 172 patients (61.0%). The detection rate by PNV (61.0%) was significantly different from that by cytology (26.7%) or by filling defect (20.9%) (P = 0.031, P = 0.001, respectively). Univariate logistic regression analysis for PNV showed that tumour stage, grade and size were significant predictors (P = 0.028; P = 0.031; P = 0.006, respectively). Tumour stage and size were identified as independent risk factors in the multivariate logistic regression model (P = 0.042; P = 0.014).

CONCLUSIONSExcept for suspected urolithiasis, urinary tuberculosis or congenital abnormalities, UUT-TCC should be considered if PNV exists in intravenous urography especially of old patients. The value of PNV is much more significant than filling defect in intravenous urography in the diagnosis of UUT-TCC. It is supposed that PNV carries more risk of higher stage and larger tumour size in UTT-TCC.

Adult ; Aged ; Aged, 80 and over ; Carcinoma, Transitional Cell ; diagnostic imaging ; Female ; Humans ; Kidney ; diagnostic imaging ; Logistic Models ; Male ; Middle Aged ; Radiography ; Sensitivity and Specificity ; Urologic Neoplasms ; diagnostic imaging

Since the definition of sepsis was proposed in Chest by American College of Chest Physicians and Society of Critical Care Medicine in 1992, researches on burn sepsis have focused on the regulation of immune-inflammation response resulting in minimizing tissue injury resulted from excessive inflammatory response. Treatment of sepsis should focus on effect of early circulation oxygenation support in preventing and treating multiple organ dysfunction. The hypothesis of producing a hibernation-like state which might prevent multiple organ dysfunction in patients with sepsis provides us a new therapeutic strategy in protecting organs in the early stage of sepsis in future.
Burns ; complications ; therapy ; Humans ; Sepsis ; diagnosis ; etiology ; therapy

OBJECTIVETo evaluate the efficacy of piperacillin/tazobactam in the management of burn infection.

METHODSSixty-three burn patients were enrolled in the study with burn sepsis or burn area more than 50%TBSA or full skin loss more than 30% TBSA. The administration regime of the antibiotics was 4.5 g intravenously administered every 8 hours in the treatment of burn sepsis or in the prophylactic management. The effectiveness was identified when the septic symptoms disappeared or focal infection did not develop into sepsis.

RESULTSThe overall clinical efficacy was 90.4%, and success in sepsis (control) was 75%. Furthermore, 95.7% of the focal infection was prevented from developing into systemic infection. The bacterial clearance rates were 71.4% and 51.4% in treatment and prophylaxis groups, respectively.

CONCLUSIONPiperacillin/taxobactam was effective in the treatment and/or prophylaxis of burn sepsis caused by bacteria susceptible to it, so it could be applied empirically.

Adult ; Burns ; complications ; drug therapy ; Female ; Humans ; Infusions, Intravenous ; Male ; Middle Aged ; Penicillanic Acid ; analogs & derivatives ; therapeutic use ; Piperacillin ; therapeutic use ; Sepsis ; etiology ; prevention & control ; Treatment Outcome

OBJECTIVETo investigate the effect of Tauroursodeoxycholic acid (TUDCA) on Taurodeoxycholic acid (TDCA)-induced HepG2 cell apoptosis and to clarify the molecular mechanism of its anti-apoptosis effect of TUDCA.

METHODSMorphologic evaluation of apoptotic cells was performed by Hoechst 33258 staining and electron microscope. DNA fragment was detected by electrophoresis on 1.5% agarose gels. Apoptosis rate was measured by flow cytometry using PI dye. Following incubation of HepG2 cells either with TDCA alone, or coincubation with TUDCA and TDCA, the releasing level of cytochrome c from mitochondria into cytosol was determined by western blot, also the activity of caspase-3, 8, 9.

RESULTSIncubating the cells with 400 micromol/L TDCA for 12 h induced the cells apoptosis significantly. The apoptotic rate decreased from 50.35% +/- 2.20% to 13.78% +/- 0.84% after coincubation with TUDCA, and this anti-apoptotic effect of TUDCA was confirmed by morphological and DNA ladder detection. TUDCA significantly inhibited the release of cytochrome C from mitochondria into cytosol, and the activity of caspase-9, 3 (t > or = 13.00, P < 0.01), especially at 12 h, caspase-3 activity decreased by 54.9% (t = 16.88, P < 0.01) and 52.5%, however it had no obvious effect on the activity of caspase-8 (t = 1.94, P > 0.05).

CONCLUSIONSTUDCA prevents HepG2 cells apoptosis induced by TDCA through modulating mitochondrial membrane stability, inhibiting the release of cytochrome c and the activation of procaspase-9 and 3. Anti-apoptotic mechanism of TUDCA may be considered to be one of the most important reasons that TUDCA exerts significant efficacy in the treatment of cholestatic liver diseases.

Apoptosis ; drug effects ; Carcinoma, Hepatocellular ; pathology ; Caspase 3 ; Caspase 9 ; Caspases ; metabolism ; Cytochromes c ; pharmacology ; Humans ; Liver Neoplasms ; pathology ; Taurochenodeoxycholic Acid ; pharmacology ; Taurodeoxycholic Acid ; analogs & derivatives ; pharmacology ; Tumor Cells, Cultured

Experimental research of injury on tumor tissue in vitro is conducted with homemade energy-controllable steep pulse device. With the comparison of histological assay results between treatment group and non-treatment group, basic phenomenon of electrochemical reaction and pathology reaction of tumor tissue during the experiment is observed. The results showed the irreversible breakdown penetrating effect of energy-controllable steep pulse on tumor cells and the feasibility of this therapy are also demonstrated. These results provide a consolidate theoretic and applicable basis for further study on mechanism and animal experiment in vivo.
Electric Stimulation Therapy ; instrumentation ; methods ; Electromagnetic Fields ; Female ; Humans ; In Vitro Techniques ; Male ; Middle Aged ; Neoplasms ; pathology ; therapy

OBJECTIVETo evaluate the effects of postburn dietary supplementation of arginine (Arg), omega-3 polyunsaturated fatty acid (omega-3PUFA) and glutamine (Glu) on the metabolism, immunology and wound healing in scalded rats.

METHODSThirty Sprague-Dawley (SD) rats inflicted with 30% total body surface area deep partial thickness scald on the back after the gastrostomy catheter was placed were employed as the model. The rats were randomly divided into A and B groups, and all of them received continuous isonitrogenous (25% protein, 12% fat, 63% carbohydrate), isocaloric (175 kcal/kg/day), and isovolemic intragastric tube feedings. The contents of Arg, omega-3PUFA, Glu in the dietary of B group were enriched. The parameters were measured on the 10th day after injury, including the response of spleen cells to ConA, the plasma levels of PGE(2), IL-2, albumin, transferrin, glucagons, cortisol in blood, the urinary content of vanillylmandelic acid (VAM) in 24-hour urine, the content of hydroxyproline, the ratio of type I to type III collagen in burn wounds, and the nitrogen content in the liver and in the jejunal mucosa, as well as the weight changes, skin delayed hypersensitivity test, and wound healing time.

RESULTSIt was revealed that the serum level of albumin, the nitrogen content in the liver and in the jejunal mucosa were obviously higher in B than those in A group. At the same time, there was no statistical difference in the plasma levels of cortisol and glucagons and urinary content of VAM between the two groups, nor in body weight changes. Meanwhile, the response of spleen cells to ConA and the skin delayed hypersensitivity induced by DNFB 14 days after injury in group B were also enhanced compared with those in group A. Although the expression of PGE2 from peritoneal macrophages was lower, the content of hydroxyproline from burn wounds in group B was significantly higher than that in group A, and the ratio of type l to type III collagen in group B was significantly lower than that in group A. Compared with group A, the wound healing time in group B was significantly shortened (P < 0.05).

CONCLUSIONThe low-fat and high-protein feeding diet with enriched arginine, omega-3 PUFA, glutamine could benefit the nutritional status after burn injury, thus improve the immunological function and promote wound healing.

Animals ; Arginine ; therapeutic use ; Burns ; drug therapy ; immunology ; metabolism ; Dietary Supplements ; Enteral Nutrition ; Female ; Glutamine ; therapeutic use ; Linolenic Acids ; therapeutic use ; Male ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Wound Healing

OBJECTIVETo investigate the influence of dermal template on the expressions of signal transduction protein Smad 3 and transforming growth factor beta1 and its receptor during wound healing process in patients with deep burns.

METHODSTwenty burn patients with excision of full thickness burn in the extremities were enrolled in the study and divided into two groups, i.e. template interfering group (E, n = 20, grafting of dermal template [allogeneic acellular dermal matrix] with razor thin autoskin) and control group (C, n = 20, grafting of razor thin autoskin only). The contralateral side served as the self-control. Tissue samples from the burn wounds were harvested at 1, 2, 3 and 4 post-operative weeks (POW) for immunohistochemistry staining. The positive expression rates of TGF-beta1, TbetaRI, TbetaRII and Smad3 proteins were determined by image analysis system.

RESULTSThe positive expressions of TGFbeta1, TbetaRI, TbetaRII and signal transduction protein Smad 3 in the tissue samples in both groups could be identified during 1 approximately 4 POW, and they diminished thereafter with the process of wound healing. The expression rate of TGF-beta1 in E group was (13.08 +/- 4.65)% at 1 POW and (9.03 +/- 1.89)% at 4 POW. The positive expression rate of above indices in E group was obviously lower than that in C group in corresponding time points (P < 0.05).

CONCLUSIONThe expression levels of TGFbeta1, TbetaRI, TbetaRII and Smad 3 protein in deep burn wounds could be lowered by mixed grafting of dermal template with razor thin autoskin, which might be beneficial in ameliorating of scar hyperplasia in the burn wound.

Adolescent ; Adult ; Burns ; metabolism ; surgery ; Dermis ; transplantation ; Humans ; Middle Aged ; Receptors, Transforming Growth Factor beta ; biosynthesis ; Signal Transduction ; Skin Transplantation ; Smad3 Protein ; biosynthesis ; Transforming Growth Factor beta1 ; biosynthesis ; Transplantation, Heterologous ; Wound Healing

OBJECTIVETo study difference in curative effect between intermingled skin transplantation (IT) and microskin grafting (MG) in repairing massive deep burn.

METHODSClinical materials of 101 patients with massive deep burn hospitalized from 1992 to 2008 were retrospectively summarized. Patients were divided into IT group (n = 52) and MG group (n = 49). The size of initial donor site for autologous skin, the wound size initially covered with autologous skin, the survival rate of initial autologous skin grafting, the theoretical expansion multiple of the autologous skin, the actual expansion multiple of the autologous skin, the total size of donated autologous skin, the remained wound condition, and the function of large joint of patients in two groups were compared.

RESULTSIn IT group and MG group, the size of initial donor site for autologous skin was respectively (3.25 +/- 0.48)%TBSA and (3.01 +/- 0.21)%TBSA, the wound size initially covered by autologous skin was respectively (30.4 +/- 3.6)%TBSA and (41.4 +/- 1.3)%TBSA, the survival rate of autologous skin grafting was respectively (99.9 +/- 1.9)% and (87.5 +/- 6.8)%, the theoretical expansion multiple of the autologous skin was respectively 9.5 +/- 1.3 and 13.9 +/- 1.4, the actual expansion multiple of the autologous skin was respectively 9.5 +/- 1.3 and 12.0 +/- 1.5, the difference between two figures of each index was statistically significant (P < 0.05). There was no statistical significant difference between IT and MG group in respect of the total size of donated autologous skin [respectively (14.2 +/- 1.9) and (14.0 +/- 2.1)%TBSA, P > 0.05]. There were 23 patients (44.2%) with residual wounds over 0.5%TBSA in IT group, and 37 cases (75.5%) in MG group. There were 34 patients (65.4%) with good function of large joints in IT group, and 18 cases (36.7%) in MG group.

CONCLUSIONSExpansion multiple of autologous skin after MG is obviously larger than that after IT, thus limited skin source can be fully used. The wound healing quality and the restoration of large joint function of patients treated with IT are better than those of patients treated with MG.

Adult ; Burns ; surgery ; Humans ; Retrospective Studies ; Skin ; injuries ; Skin Transplantation ; methods ; Surgical Flaps ; Transplantation, Autologous ; Wound Healing

To investigate the lethal effect of steep pulsed electric fields (SPEFs) on cancer cells and the life-prolonging effect of SPEFs on the survival of tumour-bearing mice, this study was carried out with the use of SPEFs to treat 40 BALB/C mice inoculated by cervical cancer. The lethal effect on cancer cells and the life-prolonging effect on tumour-bearing mice were examined and compared between the experiment group and control group. The survival periods of the experiment group and control group were 52.05 days and 33.03 days, respectively. There was a significant difference in survival curve between the two groups. The results confirmed the inhibitiory effect and lethal effect of SPEFs on cancer cells. SPEFs can prolong the survival period of tumour-bearing mice.
Animals ; Electrodes ; Electromagnetic Fields ; Electroporation ; Female ; Mice ; Mice, Inbred BALB C ; Neoplasm Transplantation ; Pulse ; Survival Rate ; Uterine Cervical Neoplasms ; pathology ; therapy