Objective:To explore the effect of chitosan hydrogel on the serum levels of tumor necrosis factor (TNF-α),interleukin (IL-10) and intercellular adhesion molecule (ICAM-1) of patients with burns.Methods:96 cases with second degree burns who were treated in our hospital from June 2015 to November 2016 were selected and randomly divided into two groups,with 48 cases in each group.The patients in the observation group were treated with chitosan hydrogel,while the patients in the control group were treated with conventional vaseline gauze wound.Then the wound healing,the serum levels of tumor necrosis factor (TNF-α),interleukin (IL-10) and intercellular adhesion molecule (ICAM-1) and the incidence of adverse reactions were observed and compared between the two groups before and after the treatment.Results:The healing rate of superficial burns at the 7th day in the observation group was significantly higher than that of the control group (P＜0.01).The healing rate of deep burns at the 15th day and 25th day were significantly higher than those of the control group (P＜0.05).The healing time of the superficial burns and deep bums in the observation group were significantly shorter than those of the control group,and the SI score was significantly lower (P＜0.01).After treatment,the serum levels of TNF-α,IL-10 and ICAM-1 of patients with superficial burns significantly decreased in the two groups,and the observation group was lower than that of the control group (P＜0.05).The serum levels of TNF-α,IL-10 and ICAM-1 of patients with deep burns were significantly lower than before,and the observation group was lower than that of the control group (P＜0.01).The incidence of wound infection in the observation group was lower than that of the control group (P＜0.05).Conclusion:Chitosan wound repair membrane gel could accelerate the wound healing,prevent the wound infection,and reduce the inflammation with high safety.

Objective Toinvestigatethecorrelationbetweentheredbloodcelldistributionwidth (RDW)and in-hospital prognosis in elderly patients with cerebral infarction and severe hemiplegia. Methods Atotalof209consecutiveelderlypatientswithcerebralinfarctionandhemiplegiadiagnosedat the Emergency Department,Central Hospital of Jiading District in Shanghai from January 2012 to December 2013 were enrolled retrospectively. All patients were divided into an L-RDW group (n=73 ),an M-RDW group (n=56),and an H-RDW group (n=80)according to the RDW trisection level. A single factor analysis of variance was used to compare the differences of clinical data,laboratory indexes,and mortality during hospitalization among the three groups. The patients were redivided into either a survival group (n=170)or a death group (n=39)according to their clinical outcomes. Its differences of RDW levels in the acute phase were compared. Logistic regression analysis was used to analyze the independence risk factors for the death of patients,and the risk ratio (OR)was calculated. Spearman correlation analysis was used to analyzeRDWandtheNationalInstitutesofHealthStrokeScale(NIHSS)scores.Results Themortality of the M-RDW group was significantly lower than that of the L-RDW and the H-RDW groups (1. 8%[n=1] vs. 12. 3%[n=9]and 36. 2%[n=29],all P<0. 01). the RDW level of the death group was significantly higher than that of the survival group (14.2 [13.3,15.1]vs.12.5 [11. 9,13. 5];P =0. 002). The H-RDW level (OR,12. 164,95%CI 2.544-58.181,P=0.002)and the NIHSS score (OR,1. 136, 95%CI 1. 056-1. 221,P=0. 001)were the independence risk factors for the death of the elderly patients with severe hemiplegia cerebral infarction;the RDW level was positively correlated with the NIHSSscore(r=0.167,P=0.016).Conclusion ThemortalityofdifferentRDWlevelsinelderly patients with cerebral infarction and severe hemiplegia showed aU shape. The mortality of the H-RDW is the highest. The RDW level has an important reference value for identifying the prognosis in elderly patients with cerebral infarction and severe hemiplegia.

OBJECTIVETo observe the curative effects of platelet-rich plasma (PRP) combined with negative-pressure wound therapy (NPWT) on patients with sternal osteomyelitis and sinus tract after thoracotomy.

METHODSSixty-two patients with sternal osteomyelitis and sinus tract after thoracotomy, hospitalized from March 2011 to June 2015, were retrospectively analyzed. Based on whether receiving PRP or not, patients were divided into two groups, group NPWT ( 22 patients hospitalized from March 2011 to December 2012) and combination treatment group (CT, 40 patients hospitalized from January 2013 to June 2015). After debridement, patients in group NPWT were treated with continuous NPWT (negative pressure values from -15.96 to -13.30 kPa), while those in group CT were treated with PRP gel (blood platelet counts in PRP ranged from 1 450×10(9)/L to 1 800×10(9)/L, with 10-15 mL in each dosage) made on the surgery day to fill the sinus tract and wound, followed by NPWT. Negative pressure materials were changed every 5 days until 20 days after surgery in patients of both groups. PRP gel was replenished before changing of negative pressure materials in patients of group CT. The sinus tract sealing time, wound healing time, number of patients who had secondary repair surgery, number of patients who had recurrence of sinus tract within three months after wound healing, and length of hospital stay were recorded. Data were processed with t test, Fisher's exact test, and chi-square test.

RESULTSThe sinus tract sealing time, wound healing time, and length of hospital stay in patients of group CT were (16±8), (27±13), and (43±13) d respectively, which were all significantly shorter than those in group NPWT [(29±14), (41±17), and (60±20) d, with t values from 3.88 to 4.67, P values below 0.01]. The number of patients who had secondary repair surgery in group CT was less than that in group NPWT (P<0.01). There was no statistically significant difference in the number of patients who had recurrence of sinus tract between two groups (P>0.05).

CONCLUSIONSCompared with NPWT only, PRP combined with NPWT has great curative effects on patients with sternal osteomyelitis and sinus tract after thoracotomy, for it shortens sinus tract sealing time, wound healing time, and length of hospital stay, and avoids the secondary repair surgery. This method is simple and safe with little injury.

Debridement ; Humans ; Length of Stay ; Negative-Pressure Wound Therapy ; Osteomyelitis ; surgery ; therapy ; Paranasal Sinuses ; pathology ; Platelet-Rich Plasma ; Retrospective Studies ; Sternum ; surgery ; Thoracotomy ; Wound Healing

Objective To investigate the predictive value of intracerebral hemorrhage (ICH) score for stroke-associated pneumonia (SAP) in patients with primary intracerebral hemorrhage. Methods From January 2014 to July 2015,209 consecutive patients with ICH at the Emergency Department,Shanghai Jiading District Central Hospital were enrolled retrospectively.The general information of the patients were analyzed. They were divided into either a SAP group (n=73) or a non-SAP group (n=136) according to whether they had SAP or not.Based on the ICH score,the incidence and mortality of SAP were analyzed;the occurrence of SAP was prejudged by ICH score.The ROC curve was plotted,and the sensitivity,specificity and the best cut-off value were calculated. Results (1) The incidence of SAP was 34.9% (73/209) and the mortality was 21.1% (44/209) in patients with ICH.(2) There were significant differences in age (73 ± 12 and 63 ± 14),hematoma volume (23.4 [9.6,51.1] and 6.2 [3.1,16.0],and ICH score (2[1,3] and 1 [0,2]) between the SAP group and the non-SAP group (all P<0.01).Compared with non-SAP group,Glasgow coma scale(GCS) score of the SAP group was significantly decreased(8 [4,11] and 15 [13,15],P<0.01).The area under the ROC curve of the ICH score predicting the occurrence of SAP was 0.775 (95% CI 0.709-0.842,P<0.01).When the maximum Youden index was 0.453,the best cut-off value of the corresponding ICH score was 2,its sensitivity was 74%,specificity was 71%,the positive predictive value was 0.58,and the negative predictive value was 0.84. Conclusions The incidence of SAP in patients with ICH is higher.The ICH score may predict the clinical value of the occurrence of SAP. Clinical attention should be paid to the risk of occurring SAP in patients with ICH whose ICH score≥2.