Objective To repair and reconstruct severe burn wounds on face,hands and joints with the principles and techniques of plastic and aesthetic surgery.Methods Twenty three burn victims in a single batch were transferred from a remote area to our Burns Institute on post burn day 2,June 28,2006.All the patients were males aged from 17 to 46 years,with a mean of 24.4?6.3 years,the mean total burn area was 15.7%?13.9% TBSA(ranged from 6% to 75%),with moderate to severe inhalation injury,and fourteen of them had received tracheostomy.The burn areas on face ranged from 0.5% to 3% TBSA,and all of them were deep second or third degree burn.The burn areas on hands ranged from 1% to 4% TBSA of deep second or third degree.On post burn day 3,the patients received escharectomy or tangential excision of eschar on hands followed by split thickness skin grafting with the principles and techniques of plastic and aesthetic surgery.During post burn week 2 to 3,the eschar on the faces were peeled off,followed by split-thickness skin grafting according to the principles and techniques of plastic and aesthetic surgery.Results All the wounds on the face and joints were repaired successfully,the configuration and functions were satisfactory.Conclusion It is feasible to repair the burn wounds on face and joints with the principles and techniques of plastic and aesthetic surgery for the burn patients of mass fire catastrophe.

No abstract available.
Evoked Potentials, Auditory, Brain Stem*

Objective To explore a method of large cranial bone defect reconstructed by titanium implant with computer aided design(CAD)/computer aided manufacture(CAM)technique.Methods From April 2006 to June 2008,7 cases of cranial bone defect due to tumor and trauma were admitted.The data of skull bone defects were obtained by CT.The resin model was designed and manufactured with rapid prototyping technique.Results The CT data could be used by image software directly.The resin model was manufactured accurately by RP technique.The titanium implant design could be completed by CAD/CAM.7 patients achieved one stage healing.After a follow-up of 6 months to 1 year,cranial bone defect was reconstructed satisfactorily.Conclusion Individual design and repair of large cranial bone defect with CAD/CAM technique is worth extending application clinically.It is a quite ideal and very simple method for the surgical treatment of the cranial bone defect.

This study determined the whole genome sequence and phylogenetic characteristics of a rat coronavirus.Nucleic acids were extracted from rat intestinal tissues collected in Inner Mongolia,and high-throughput sequencing was performed.A novel alphacoronavirus was present in the samples.The complete genome was amplified with PCR and RACE.Multiple se-quence alignment and a phylogenetic tree were constructed in MEGA.The whole genome of the rat coronavirus,denoted NMR-13,was 27 674 bp and included two non-coding regions and eight open reading frames,successively 5'UTR-ORF1ab-S-ORF3-E-M-ORF6-N-ORF8-3'UTR.Sequence identity analysis indicated that NMR-13 was most closely related to alphacoronavirus,which shared 91.3％nt identity with strain FiCoV/UMN2020.NMR-13h shared the next highest-sequence identitywiththe strains Lucheng/Lijiang-170,Lucheng/Ruian-83 and Lucheng/Lijiang-71 found in Zhejiang Province,China(79.49％,80.6％and 81.0％,respectively).Phylogeneticanalysis indicated that NMR-13 clustered with FiCoV/UMN2020.Recombination analy-sis indicated no recombination phenomenon.A rat coronavirus was isolated in this study,thus enriching the diversity of known alphacoronaviruses,and providing a reference for understanding the molecular genetic characteristics and molecular evolution of mouse coronaviruses in China.

OBJECTIVETo explore the ultrastructure of the palate-maxillary sutures under tensile forces by transmission electron microscope (TEM).

METHODSThe Suture expanders were made in NiTi-Shape memory alloy (NiTi-SMA). The maximum force was 3.5 N. Fourteen 8-month old mongrel dogs were used in the study. They were divided into three groups, (1) experimental group, (2) control group, (3) sham group. In the experiment and control groups, an 8 mm wide cleft was made by surgery. The suture expanders were fixed onto the palatine bones of the experimental group. The dogs of the experimental group were executed after 3, 7, 14, 28, 56 days of suture expansion. The change of suture tissue was examined by TEM.

RESULTSThe cleft of the experiment group were closed at the ninth day of expansion. At the beginning, tissue rupture, exudation, death of fibroblasts, disruption of collagen and tear vessels were seen at the early stage of suture expansion. Then highly active functional manifestations were seen in both osteocytic and fibrocytic populations. At last, normal structure restored.

CONCLUSIONSCell types and functional condition could be distinguished clearly by TEM. It suggests that the suture expansion should be the process of tissue repair and regeneration. The suture cells response, especially, the osteogenic response were the major factor of increasing suture width.

Alloys ; Animals ; Bone Regeneration ; Cranial Sutures ; surgery ; Dogs ; Maxilla ; surgery ; ultrastructure ; Microscopy, Electron, Transmission ; Nickel ; Osteogenesis ; Osteogenesis, Distraction ; Palate, Hard ; surgery ; ultrastructure ; Tensile Strength ; Titanium

BACKGROUNDMass burn casualties are always a great challenge to a medical team because a large number of seriously injured patients were sent in within a short time. Usually a high mortality is impending. Experiences gained from successful treatment of the victims may be useful in guiding the care of mass casualties in an armed conflict.

METHODSThirty-five burn victims in a single batch, being transferred nonstop by air and highway from a distant province, were admitted 48 hours post-injury. All patients were male with a mean age of (22.4 +/- 8.7) years. The burn extent ranged from 4% to 75% ((13.6 +/- 12.9)%) total body surface area. Among them, thirty-two patients were complicated by moderate and severe inhalation injury, and tracheostomy had been performed in 15 patients. Decompression incisions of burn eschar on extremities were done in 17 cases before transportation. All the thirty-five patients arrived at the destination smoothly via 4-hour airlift and road transportation. Among them, twenty-five patients were in critical condition.

RESULTSThese thirty-five patients were evacuated 6 hours from the scene of the injury, and they were transferred to a local hospital for primary emergency care. The patients were in very poor condition when admitted to our hospital because of the severe injury with delayed and inadequate treatment. Examination of these patients at admission showed that one patient was suffering from sepsis and multiple organ dysfunction syndrome. Dysfunction of the heart, lung, liver, kidney, and coagulation were all found in the patients. Forty-eight operations were performed in the 23 patients during one month together with comprehensive treatment, and the function of various organs was ameliorated after appropriate treatment. All the 35 patients survived.

CONCLUSIONSA well-organized team consisting of several cooperative groups with specified duties is very important. As a whole, the treatment protocol should be individualized, basing on the extent of the injury and the care that the patient had received at the spot. During airlift, the stretchers should be arranged perpendicular to the longitudinal axis of the cabin. The treatment protocol in our hospital consisted mainly of prompt effective relief of all life-threatening complications, followed by early closure of burn wounds, appropriate use of anti-infection therapy, emphasis on nutritional support, correction of metabolic disorders, alleviation of immunosuppression, correction of coagulopathy, and effective support and protection of organ function.

Adolescent ; Adult ; Burns ; drug therapy ; pathology ; surgery ; therapy ; Emergency Medical Services ; Emergency Service, Hospital ; Female ; Hospitals ; Humans ; Male ; Middle Aged ; Time Factors ; Transportation of Patients ; Treatment Outcome ; Young Adult