Humans ; Reconstructive Surgical Procedures ; adverse effects ; Surgery, Plastic

The scar formation and chronic ulcer development are the iain sequelae faced by surgeons in the treatmemt of wounds. Therefore,the prevention and treatment of these sequelae are the main tasks for clinicians.In this paper,the current research concerning both sequelae is reviewed.The authors emphasize that the use of some high technologiesl, such as stem cell technology, clone technology and tissue engineering may bring the hope in improving the treatment and prevention of these sequelae.

Background The loss of perspiration after a massive deep burn hampers the survivor to lead a life of high quality, as they are deprived the function of regulating body temperature through perspiration during sultry months. With maturation of science of burn care, the number of survivors is increased, therefore, it is imperative that this problem should be tackled in order to improve their quality of life. Objective To explore the possibility of transdifferentiating bone marrow mesenchymal stem cells (MSCs) into sweat gland cells (SGCs), and implanting the latter into fresh skin wound to generate functional sweat glands. Methods Human bone marrow MSCs and SGCs were isolated from the same patients. They were identified with specific markers, and then co-cultured. The stem cells which subsequently exhibited the phenotype of sweat gland cells were implanted into scald injured paws of nude mice, and regeneration of functioning sweat glands was confirmed by perspiration test (iodine and starch) and histological examination. A male patient bearing almost iden- tical burn scars on the posterior aspect of both arms was enrolled for clinical trial. The scars were first proved to be anhydrotic with iodine and starch test. With patient's written consent, the clinical trial was carried out. Bone marrow MSCs and sweat gland cells were obtained from the patient. After being heat shocked, the SGCs were co-cultured with MSCs. Three days later, the scars of both arms were excised. MSCs having acquired the phenotype of sweat gland cells after co-culture were evenly spread onto the excision wound on the right arm. They were covered with a piece of acellular allogeneic dermis, which was perforated with numerous micropores. On top of the latter, micrografts of autologous origin were transplanted, and the wound was finally covered with a piece of allogeneic skin graft. The wound on the left side was similarly covered, but without transdifferentiated MSCs. After complete healing of the wounds, perspiration test with iodine and starch was performed, and biopsy was taken from the MSCs transplanted area. The components of the sweat collected from the implantation area were analyzed and compared with that from normal skin elsewhere on the body. The same procedure was performed in a girl patient with a chin-neck contracture. The scar was totally excised, and into one third of the excision wound in vitro transdifferentiated MSCs were implanted similar to the above patient. The examinations were repeated after wound healed. Results In the animal experiment, it was shown that there was regeneration of functional sweat glands in the burned paws of the nude mice. In human patients, all wounds healed nicely. The areas where transdifferented MSCs were implanted showed positive iodine-starch perspiration test. Histological and immunohistochemical examination confirmed that the transformed MSCs bore the specific marker carcinoembryonic antigen (CEA) of sweat gland cells. Biochemical analysis of the excreted sweat contained similar components as that of sweat collected from normal skin. Conclusions MSCs can be transdifferentiated into SGCs in vitro, and they can be implanted into a fresh wound to form functional sweat glands. However, enormous amount of work should be done before the same result would be realized in patients with massive deep burn within a short duration after the injury, so that the patients could regain the function of perspiration after surviving the massive loss of normal skin.

OBJECTIVE To explore the changes in foot fungus mobility and its drug resistance for further etiology investigation and clinical treatment. METHODS Sabourand′s agar culture medium was used to culture fungi, ID identification strip was employed to identify the fungi and drug sensitive test was performed by disk diffusion test. RESULTS The incidence of Trichophyton rubrum infection was the highest (79.1%). The isolated fungi were relatively sensitive to amphotericin B (AMB, 98.9%) and itraconazole (ITC, 98.0%), and resistant to 5-fluorocytosine (5-FC, 22.1%). CONCLUSIONS Detection technique of fungal infection should be improved and anti-fungal medicine should be used reasonably according to the results of drug sensitive test so that the fungal infection, especially fungi-resistant infection could be reduced.

OBJECTIVE To monitor the characteristics of distribution and drug resistance of Acinetobacter baumannii in our hospital. METHODS A. baumannii isolates were collected in our hospital from Jan 2004 to Dec 2005. Antimicrobial susceptibility testing was performed by disk-diffusion method,according to the standards of NCCLS 2004. RESULTS Totally 177 strains of A. baumannii were distributed clinically in the respiratory unit as the most ones (47 strains, 26.6%), and in ICU as the next (38 strains, 21.5%); the older the age, the higher the appearing rate; the highest appearing rate was from the sputum, up to 78.1%; more than 60% of isolates were resistant to all antimicrobial agents tested except imipenem, meropenem and cefoperazone/sulbactam. However,10 pan-resistant strains were found. CONCLUSIONS With the increasing isolation rate of A. baumannii, its drug resistance increases simultaneously.

OBJECTIVE To investigate the methylation status and mRNA expression of the estrogen receptors(ERs) gene promoter in acute leukemic patients and detect the protein expression in leukemia cell lines with or without treatment of 5'-aza-Dc.And to find out the possibility of promoters methylation profile of estrogen receptor gene as an early diagnosis biomarker in leukemia.METHODS With RT-PCR and MSP,evaluating ERs mRNA expression and status of methylation in 40 acute leukemia patients without treatment.With Western-blot,detecting protein expression in leukemic cell lines with or without treatment of 5-azaDc.RESULTS The protein expression was significantly enhanced in all of leukemic cell lines with 5'-Aza-Dc.ER?-A was inactivated and specifically methylated(97.5%;39/40) in most of the acute leukemic patients.CONCLUSIONS The promoter ER?-A is inactivated and specifically methylated(97.5%;39/40) in most of the acute leukemic patients.This study may provide a new direction method to study the pathogenic mechanism of leukemia,and indicates that ER?-A methylation could be a potential reference marker for leukemia diagnosis.

OBJECTIVE To investigate the epidemiology of fungemia and provide evidence for clinical therapy.METHODS A retrospective survey was done with the 69 cases of fungemia in our hospital from Jan 2004 to Dec 2008.RESULTS More than 65% of the patients suffered from two and more underlying diseases.Over a half of infections were developed following placement of catheters.And all of the patients had a history of antimicrobial agents use before blood culture.53(76.8%) cases were associated with Candida spp.Only 18 strains were C.albicans.The mortality rate of fungemia was 44.9%.Different Candida species had different resistance rates to antifungal agents.CONCLUSIONS Fungemia patients often have serious underlying diseases.Most fungemia cases are candidemia caused by non-C.albicans.Some fungal pathogens are resistant to fluconazole and itraconazole.

OBJECTIVE To analyze pathogenic bacterium distribution and antibiotic resistance of our hospital,and provide scientific basis for clinical rational using of antibiotics.METHODS The patients′ clean catch(midstream)(urine) was collected from Jan 2004 to Dec 2005 and cultivated.Antibiotic sensitivity test and adopted by Kirby-Bauer method.RESULTS The pathogenic bacteria mainly consisted of Gram-negatives,among which Escherichia coli was the most frequent,the others in turn were Pseudomonas aeruginosa,Enterobacter cloacae and(Proteus) mirabilis;Enterococcus were the most common among Gram-positives;fungal infection obviously(increased).The bacteria showed different antibiotic resistance rate and multi-drug resistance.CONCLUSIONS It′s very important for making the clinical use of antibiotic more reasonable and controlling drug resistant strains(transmission).

OBJECTIVE To study the constituent ratio of the pathogenic fungi of blood culture in recent 24 months and their resistance in our hospital.METHODS Blood culture of patients in our hospital was performed by BacT/AlerT120 and the isolated pathogenic fungi were identified by API identified tests(API Inc,France).In(addition) antibiotics sensitivity test was by K-B.RESULTS Of the specimens in 4135 cases,there were 110 strains((2.7%)) with Candida albicans(29%).C.tropicalis(21%) and C.portugal(9%).The(specimens) come from(hepatobilliary)(25%),neurosurgery(24%) and emergency(10%) departments.CONCLUSIONS It is important and necessary to monitor the circumstance of fungal(infection) and resistance of the pathogenic fungi due to its(morbidity) increased.

OBJECTIVE To investigate the distribution and resistance of non-fermenting bacteria isolated from(patients) in 2005 and offer a basis for the treatment of bacterial infection.METHODS The isolated bacteria were(identified) with API identified test(API Inc,France) and Kirby-Bauer(K-B) test used for the antibiotics(susceptivity) test.The data were analyzed by using WHONET-5 software.RESULTS Totally 604 strains of non-fermenting bacteria were isolated from the 2908 pathogenic strains.The most common bacteria were Pseudomonas aeruginosa(52.32%),followed by Stenotrophomonas maltophilia(14.07%) and Acinetobacter baumannii((13.74%)).76.32% of non-fermenting bacteria were isolated from the sputum.These bacteria had various(resistances) to all detected antibiotics.CONCLUSIONS Non-fermenting bacteria have high isolation rate and(multi-drug) resistance,so antibiotics should be used correctly under the guidance of antibiotic susceptibility testing.