Objective To analyze the bacterial distribution and antibiotic resistance of pathogenic bacteria in elderly patients with hospital-acquired pneumonia (HAP) so as to provide evidence for rational use of antibiotics. Methods The clinical data of 160 elderly patients with HAP in our hospital from June 2006 to September 2009 were analyzed retrospectively. And the pathogenic characteristics and antibiotic resistance were analyzed. Results A total of 180 pathogenic bacteria were separated: 108 Gram-negative bacteria (60.0%), 48 Gram-positive bacteria (26.7%) and 24 fungi (13.3%). In Gram-negative bacteria, Pseudomonas aeruginosa was the major pathogen (20.5%), and Staphylococcus aureus was the most prominent in Gram-positive bacteria (11.1%).The detection rate of fungi was increased in patients with long-term use of antibiotics and broadspectrum antibiotics. The Gram-negative bacilli was resistant to third-generation cephalosporin, and extended-spectrum β-lactamases (ESBLs) producing Escherichia coli and Klebsiella pneumonia were resistant to penicillin, penicillin + enzyme inhibitor, cephalosporin and monobactam antibiotics. The drug resistance of Pseudomonas aeruginosa was severe, but it was still sensitive to Ceftazidime. Gramnegative bacteria showed high sensitivities to Amikacin, Piperacillin + Tazobactam, Cefoperazone +Sulbactam, Imipenem and Meropenem. Methicillin-resistant Staphylococcus aureus (MRSA) occupied 92.6% of Staphylococcal aureus. The resistance rates of Gram-positive bacteria to Azithromycin,Ciprofloxacin, Oxacillin, Ampicillin + Sulbactam were all higher than 76%, but Gram-positive bacteria showed high sensitivities to Vancomycin, Linezolid and Teicoplanin. The staphylococcal strains that were resistant to Vancomycin, Linezolid and Teicoplanin were not found. Conclusions The major pathogen of HAP in elderly patients is Gram-negative bacilli. The detection rate of ESBLs producing Escherichia coil and Klebsiella pneumonia increases annually, and the drug resistances to the above bacteria is becoming more and more serious. But they are still highly sensitive to Amikacin,Piperacillin+ Tazobactam, Cefoperazone+ Sulbactam, Imipenem and Meropenem. The appropriate antibiotics for Gram-positive bacterial infections are Vancomycin, Linezolid and Teicoplanin.

BACKGROUND: Thoracodorsal artery perforator flap can relieve damage to donor site and avoid bulk in the recipient site,but dissociation of perforating branch took time.Some one believed that it should be done by very experienced physicians and some muscle tissues should be reserved.OBJECTIVE: To investigate the method,effectiveness and clinical application of improved latissimus dorsi flap based on perforator flap conception for reconstruction of soft tissue defects of lower extremity.METHODS: A total of 17 patients needing skin flap transplantation were selected.12 latissimus dorsi musculocutaneous/muscle flaps,3 latissimus dorsi flaps with a few muscle and 2 double-leaf segmental latissimus dorsi compound flaps were designed based on perforator flap conception.According to the territory of latissimus dorsi musculocutaneous flap,a skin paddle in which anterior underlying muscle and main perforator was designed,extend about to the anterior edge of the latissimus dorsi muscle.An additional latissimus dorsi muscle flap was selected for soft tissue enlargement if necessary.Sometimes,double-leaf segmental latissimus dorsi musculocutaneous/muscle flap,including one muscle-sparing latissimus dorsi musculocutaneous flap and the other segmental latissimus dorsi muscle flap nourished by the lateral branches of the thoracodorsal vessels was selected to repair two adjacent defects.The harvested tissue area ranged from 12 cm×8 cm to 28 cm×17 cm.Survival state of skin flap,together with shape and function of donor site and recipient site of skin flap were observed.RESULTS AND CONCLUSION: Following skin flap transplantation,one case developed vascular crisis that was relieved following re-exploration for vessel anastomosis.All skin flap survived.Second-stage skin grafting was done on one muscle flap wound.All donor sites were sutured directly.After a follow-up of 3 to 18 months in 15 cases,only two cases received two-stage plastic operation because bulky flaps brought some trouble in wearing shoes.Improved latissimus dorsi flap based on perforator flap conception can reduce damage to the donor site and the receipt area bulk.Double-leaf segmental latissimus dorsi compound flaps can repair both heel and toe wound.The versatile latissimus dorsi flap designed using thoracodorsal artery perforator flap conception is an ideal flap for repairing widespread soft tissue defects in the lower extremity.

Objective To analyze and evaluate changes of the brain gray matter in patients with Parkinson's disease (PD).Methods 46 patients with PD and 19 normal control(NC) subjects(matched to the patients in age and gender) were selected in this study.46 cases of PD were divided into early PD group(ePD,25 cases) and middle-advanced PD group(maPD,21 cases) by improved Hoehn-Yahr(H-Y) stages.All the subjects underwent 3.0T MR scanning,and data of high resolution T1-weighted imageing (T1WI) were acquired.Gray matter volume differences between PD group and NC group,or ePD group and maPD group were assessed by voxel-based morphometry (VBM) combined diffeomorphic anatomical registration through exponentiated lie (DARTEL) method.Results The gray matter volume of the bilateral frontal lobes, temporal lobes, insular lobes, cingulum gyrus, hippocampus, fusiform gyrus, cerebellum and right cuneus lobe and precuneus lobe in the PD group was smaller than that in the NC group.The gray matter volume of the bilateral frontal lobes, temporal lobes,insular lobes,cingulum gyrus,rectus gyrus,lingualis gyrus,fusiform gyrus,hippocampus,amygdaloid and cerebellum in the maPD group was smaller than that in the ePD group.Conclusion VBM reveals a widespread volume reduction of the gray matter in PD patients,and detectes a correlation with disease duration and severity.These changes located in special distribution may be in line with the pathology of PD.

Objective To develop MSNs loaded with ICG and investigate its diagnostic value and photodynamic therapeutic value in the experimental pancreatic cancer. Methods ICG was loaded into MSNs to prepare the ICG/MSNs probe. The probe toxicity was evaluated by MTT assays. Near?infrared stereo fluores?cence microscope ( NISFM) was applied to investigate whether the ICG/MSNs would be uptaken by the human pancreatic cancer cells. After incubated with PBS, ICG (10μg/ml), MSNs or ICG/MSNs (10μg/ml ICG) for 24 h and treated with photodynamic therapy (PDT, (780±25) nm laser, 500 mW/cm2), the human pancreatic cancer cells survival rate was determined by MTT method. The human pancreatic cancer cells were implanted into nude mice to prepare subcutaneous tumor models. The distribution of ICG/MSNs in sub?cutaneous tumor models was studied with in vivo imaging system ( IVIS ) . With reference to the injection dose of ICG(0.5 mg/kg), the mice in PBS group, ICG group, ICG/MSNs group (4 mice per group) were injected via tail vein with 150μl PBS, ICG solution and ICG/MSNs solution, respectively. After treated by PDT for 48 h, the mice were observed by IVIS for 2 weeks using BLI to evaluate the therapeutic effect of PDT. NISFM was used to observe the fluorescence in tumor region. One?way analysis of variance was used to analyze the data. Results The diameter of ICG/MSNs was about 100 nm and it could be uptaken by human pancreatic cancer cells. After treated by PDT, the survival rates of human pancreatic cancer cells were (24?5±5.0)%, (81.2±1.6)%, (90.7±2.0)% and (93.4±1.7)% in ICG/MSNs group, ICG group, MSNs group and PBS group, respectively(F=212.289, P<0.05). ICG/MSNs group showed better therapeutic effect than ICG group( P<0.05) . After 12 d treated by PDT, the tumor did not recur or grow in ICG/MSNs group, but grew obviously in ICG group and PBS group. The BLI of tumor area in PBS group, ICG group and ICG/MSNs group were (61.2±7.7)×108, (56.7±9.0)×108 and (2.4±1.5)×108, respectively(F=67?098, P<0.05) . And the difference between ICG/MSNs and ICG group was statistically significant ( P<0.05) . Meanwhile, the NISFM showed clearly the tumor location with ICG/MSNs. Conclusions ICG/MSNs have good biocompatibility, good PDT effect on pancreatic cancer cells and pancreatic cancer xeno?grafts. Near?infrared fluorescence imaging with ICG/MSNs could delineate the tumor location.

Objective: To understand the health education demands of primary and middle school students in Guiyang. Methods: A multi-stage stratified cluster random sampling was used to conduct a questionnaire survey for 5 540 students in grades 3-9 in Guiyang. Results: The report rate of dental caries decreases with the increase of school age(P<0.05), and the reporting rate of myopia and the appearance of sexual development characteristics increases with the increase of school age(P<0.05). Proportion of middle and primary school students who could get enough sleep every day(17.6% and 22.0%) and one hour of outdoor activities every day(13.9% and 20.9%) was relatively low.The proportion of graduating students with running away from home and suicide/self-injury ideas/plans and behaviors was higher than other grades in the same school period(P<0.05).The proportion of middle school female students who have thoughts/plans of running away from home, suicidal/self-injury plans and behaviors was higher than that of male students.Students with greater academic pressure,fewer friends,and lack of communication with their parents were more likely to have thoughts/plans or behaviors of running away from home and suicide/self-harm(P<0.05). There were 4 600 students(83.3%) who expressed the demands for health education.School was the primary source of health knowledge for students,with the class meetings accounted for the most practices.Health education on healthy behaviors and lifestyles were highly expected. Conclusion The health education demands of primary and middle school students in Guiyang show age and sex specific characteristics.Health education should follow the physical and psychological development characteristics of students and adapt to the needs of students.

Objective To investigate the mediating role of medical coping strategies in the relationship between perceived social support and resilience among patients with occupational pneumoconiosis (hereinafter referred to as pneumoconiosis). Methods A total of 240 pneumoconiosis patients were selected as the study subjects using the convenience sampling method. The Perceived Social Support Scale, the 10-item Connor-Davidson Resilience Scale and Medical Coping Strategies Questionnaire were used to evaluate their perceived social support, resilience and medical coping strategies. AMOS 26.0 software was used to construct the structural equation model. Results The average scores of perceived social support and resilience were (56.6±0.9) and (20.9±7.5), respectively. The scores for the dimensions of confrontation, avoidance and resignation of medical coping strategies were (20.2±3.6), (11.2±3.1) and (18.1±2.9), respectively. The score of resilience was positively correlated with the score of perceived social support, avoidance dimension and confrontation dimension of medical coping strategies (r=0.260, 0.176, 0.174, all P<0.01). It was negatively correlated with resignation coping (r=-0.292, P<0.01). The results of mediating effect test showed that the total effect of perceived social support on resilience was 0.252 [95% confidence interval (CI) was 0.056-0.448], which mainly affected the resilience by affecting the resignation coping (95%CI: -0.458 to -0.104), with the indirect effect value of 0.120, accounting for 47.6% of the total effect. Conclusion The resilience of pneumoconiosis patients is moderately low. Resignation coping in medical coping strategies plays a mediating role between perceived social support and resilience in pneumoconiosis patients.

OBJECTIVETo study the expression levels of annexin A1 (ANXA1), GATA-3, and T-bet in T lymphocytes of peripheral blood in burned mice with sepsis at early stage, and to analyze their immune regulatory mechanisms.

METHODSSeven-hundred and eighty male mice of clean grade were divided into sham injury group (n=60, sham injured on the back by immersing in 37 ℃ warm water for 10 s), burn group (n=240, inflicted with 20% TBSA deep partial- thickness burn on the back by immersing in 100 ℃ hot water for 10 s), sepsis group (n=240, intraperitoneally injected with 6 mg/kg lipopolysaccharide), and burn+ sepsis group (n=240) according to the random number table. Mice of burn+ sepsis group were treated as that in burn group at first, and then they were treated as that in sepsis group. (1) Immediately after injury, six mice in sham injury group were selected to collect lymphocyte suspension of peripheral blood (1 tube each mouse) according to the random number table. According to the random number table, 6 mice of each of the other three groups were respectively selected at post injury hour (PIH) 12, 24, 48, and 72 for the collection of lymphocyte suspension from peripheral blood (1 tube each mouse). Each tube of cell suspension was equally divided into two parts. Fluorescein isothiocyanate (FITC)-labeled human anti-mouse CD4 monoclonal antibody and phycoerythrin (PE)-labeled human anti-mouse interferon-γ monoclonal antibody were added to one part of cell suspension to mark helper T lymphocyte 1 (Th1). FITC-labeled human anti-mouse CD4 monoclonal antibody and PE-labeled human anti-mouse interleukin-4 (IL-4) monoclonal antibody were added to the other part of cell suspension to mark Th2. The percentages of Th1 and Th2 were determined with flow cytometer, and the ratio of Th1 to Th2 was calculated. (2) According to the random number table, 18 mice in sham injury group were selected immediately after injury for the collection of lymphocyte suspension of peripheral blood (1 tube each mouse), and 18 mice of each of the other 3 groups were respectively selected at PIH 12, 24, 48, and 72 to collect the lymphocyte suspension of peripheral blood (1 tube each mouse). The mRNA expression levels of ANXA1, GATA-3, and T-bet were determined by real-time fluorescent quantitative reverse transcription-PCR. (3) Immediately after injury, 36 mice in sham injury group were selected to collect lymphocyte suspension of peripheral blood (1 tube each mouse) according to the random number table, and then 36 tubes of cell suspension were divided into 6 batches (6 tubes each batch). Each one of 6 kinds of antibody combinations: antibodies for labeling Th1 and Th2 in combination with PE-anthocyanin 7 labeled human anti-mouse ANXA1 monoclonal antibody, PE-anthocyanin 7 labeled human anti-mouse GATA-3 monoclonal antibody, and PE-anthocyanin 7 labeled human anti-mouse T-bet monoclonal antibody was added to 1 tube of cell suspension at each batch. According to the random number table, 36 mice of each of the other 3 groups were respectively selected at PIH 12, 24, 48, and 72 for the collection of lymphocyte suspension of peripheral blood (1 tube each mouse), and then 36 tubes of cell suspension at each time point were divided into 6 batches for marking with 3 kinds of surface markers of Th1 and Th2 (6 tubes each batch). Each one of above-mentioned 6 kinds of antibodies was added to 1 tube of cell suspension at each time point for each batch. The percentages of ANXA1, GATA-3, and T-bet positive cells in Th1 and Th2 were determined with flow cytometer. Data were processed with one-way analysis of variance, analysis of variance of factorial design, and SNK test. The relationship between the percentages of ANXA1 positive cell and the percentages of GATA-3 positive cell in Th1 and Th2, and mRNA expression level of ANXA1 and mRNA expression level of GATA-3 in lymphocytes were assessed by linear correlation analysis.

RESULTS(1) Compared with those in sham injury group immediately after injury, the percentages of Th1 and Th2 and the ratio of Th1 to Th2 of mice in burn group were significantly decreased from PIH 24 on, with P values below 0.05; the percentages of Th1 and Th2 and the ratios of Th1 to Th2 of mice in sepsis group and burn+ sepsis group were significantly decreased from PIH 12 on, with P values below 0.05. (2) Compared with those in sham injury group immediately after injury, the mRNA expression levels of ANXA1 and GATA-3 in lymphocyte of mice in burn group were significantly decreased from PIH 24 on, with P values below 0.05; the mRNA expression level of T-bet was significantly decreased at PIH 24 but significantly increased at PIH 48 and 72, with P values below 0.05. Compared with those in sham injury group immediately after injury, the mRNA expression levels of ANXA1 and GATA-3 in lymphocytes of mice in sepsis group were significantly decreased from PIH 12 on, and the mRNA expression level of T-bet was increased significantly from PIH 12 on, with P values below 0.05; the mRNA expression levels of ANXA1, GATA-3, and T-bet in lymphocytes of mice in burn+ sepsis group were significantly decreased from PIH 12 on, with P values below 0.05, reaching the nadir at PIH 72 (0.50±0.04, 0.45±0.03, 0.21±0.05, respectively). (3) A significant positive correlation was observed between ANXA1 mRNA expression level and GATA-3 mRNA expression level in lymphocytes of peripheral blood (r=0.862, P<0.05). (4) Compared with those in sham injury group immediately after injury, the percentages of ANXA1 and GATA-3 positive cellsin Th1 and Th2 of mice in burn group were significantly lowered from PIH 24 on, and the percentage of T-bet positive cells was significantly decreased at PIH 24, but it was increased from PIH 48 on, with P values below 0.05. The percentages of ANXA1 and GATA-3 positive cells in Th1 and Th2 of mice in sepsis group were continuously decreased from PIH 12 on, which were lower at most time points than those in sham injury group immediately after injury, with P values below 0.05. The percentages of T-bet positive cells in Th1 and Th2 of mice in sepsis group were significantly increased since PIH 12 as compared with those in sham injury group immediately after injury, with P values below 0.05. The percentages of ANXA1, GATA-3, and T-bet positive cells in Th1 and Th2 of mice in burn+ sepsis group were continuously lowered from PIH 12, with significantly statistical differences at most time points as compared with those in sham injury group immediately after injury, with P values below 0.05. (5) The percentages of GATA-3 positive cells in Th1 and Th2 were significantly positively correlated with those of ANXA1 (with r values respectively 0.747 and 0.787, P values below 0.05).

CONCLUSIONSThe expression levels of ANXA1, GATA-3, and T-bet were continuously lowered in burned mice with sepsis, and it may play an important role in Th1/Th2 balance switching to Th2 bias and immunosuppressive process.

Animals ; Biomarkers ; Burns ; immunology ; metabolism ; GATA3 Transcription Factor ; biosynthesis ; genetics ; Humans ; Interferon-gamma ; biosynthesis ; genetics ; Interleukin-4 ; metabolism ; Male ; Mice ; RNA, Messenger ; Real-Time Polymerase Chain Reaction ; Sepsis ; blood ; T-Lymphocytes ; metabolism ; Transcription Factors ; biosynthesis ; genetics

OBJECTIVETo analyze the clinical efficacy and toxicity of vitamin support in lung adenocarcinoma patients treated with pemetrexed second-line chemotherapy.

METHODSTwo hundred and eighty-three patients with stage 3/4 lung adenocarcinoma treated at our hospital from August 2010 to August 2013 were included in this study. The lung adenocarcinomas in all the 283 patients were confirmed by pathology or cytology, all were EGFR-negative, and all patients received pemetrexed second line chemotherapy. The 283 patients were randomly divided into two groups: the improved treatment group (142 cases) and the conventional treatment group (141 cases). The patients of conventional treatment group received 400 µg folic acid per os daily for 7 days before the first dose of pemetrexed, and continued until 21 days after the last dose of pemetrexed. Besides, they received 1000 µg vitamin B12 injection at 7 days before the first dose of pemetrexed, and once per cycle of pemetrexed for 3 cycles after the last dose of pemetrexed. The patients of the improved treatment group took 400 µg folic acid daily per os from the day before the first dose to 21 days after the last dose of pemetrexed. They also received 500 µg vitamin B12 by injection one day before the first dose, and one day before each therapy cycle of pemetrexed therapy.

RESULTSThe mean number of cycles of pemetrexed chemotherapy was 4 in both groups. In the 142 patients of improved treatment group, complete response (CR) was observed in two cases, partial remission (PR) in 28, stable disease (SD) in 21, and progressive disease (PD) in 91 cases, with a total effective rate of 21.1%. While in the conventional treatment group, CR was observed in one case, PR in 27 cases, SD in 23 cases, and PD in 90 cases, with a total effective rate of 19.9%. The median progression-free survival (PFS) was 3.8 months in the improved treatment group and 4.2 months in the conventional treatment group (P=0.143). The toxicity of chemotherapy was mild in both groups, with no significant difference between the two groups (P>0.05). The most common side effects of hematological system were leukopenia and neutropenia, and the most common side effects of non-blood system were nausea and vomiting. The most common grade 3-4 toxic reaction in both groups was leukopenia and neutropenia, with no significant difference between the two groups (P>0.05). Multivariate analysis showed that the age of patients was an independent factor of grade 3-4 chemotherapy toxic reaction (P<0.05), while gender, the baseline level of PS score or blood system had no significant effect on the grade 3-4 chemotherapy toxic reaction (P>0.05).

CONCLUSIONSCompared with the conventional treatment scheme, the improved treatment scheme has similar therapeutic effects and could be used more conveniently, while the toxic effects of chemotherapy are not increased at the same time. Our results indicate that pemetrexed-based chemotherapy does not need to delay the chemotherapy because of vitamin support treatment.

Adenocarcinoma ; drug therapy ; Antineoplastic Agents ; therapeutic use ; Disease-Free Survival ; Folic Acid ; therapeutic use ; Humans ; Lung Neoplasms ; drug therapy ; Pemetrexed ; therapeutic use ; Treatment Outcome ; Vitamin B 12 ; therapeutic use ; Vitamin B Complex ; therapeutic use

Objective: To analyze clinical characteristics and wound repair methods and effects of patients with upper limb electric burns. Methods: Medical records of 136 patients with upper limb electric burn who met the inclusion criteria and hospitalized in our unit from January 2015 to March 2019 were retrospectively analyzed. Proportion in patients with electric burns in the same period, gender, age, admission time, categories, injury causes, injury voltage, burn area and depth of upper limb, simultaneous injury of both upper limbs, and early wound treatment measure of patients with upper limb electric burn were recorded. The main repair methods of each affected limb were classified and recorded. The overall efficacy of the patients was recorded, including postoperative wound complications and healing condition. The patients repaired with distal pedicled flaps and those with free flaps were followed up for 3 to 6 months. The survival rate of flaps were recorded, the function of affected limbs after operation was evaluated, and the satisfaction degree of patients was investigated by Curative Effect Score Table. The amputation rate, age, and burn area of upper limbs of patients caused by high-voltage and low-voltage electricity were compared. Data were processed with Wilcoxon rank sum test, chi-square test, or Fisher′s exact probability test. Results: (1) The number of upper limb electric burn patients accounted for 88.3% of 154 patients with electric burns hospitalized in the same period, including 117 males and 19 females, aged 1 year and 2 months to 72 years [(34±18) years], admitted 1 h to 48 d after injury, including 51 electricians, 32 rural migrant workers, 31 students and preschool children, and 22 patients belonging to other categories. Patients of the first two categories were mainly injured by work accidents, and those of the latter two categories mainly suffered from touching power source or power leakage. Among all the patients, 75 cases were injured by high-voltage electric burn, and 61 cases were injured by low-voltage electric burn, with burn area of upper limb from 0.2% to 16.0% [2% (1%, 5%)] total body surface area (TBSA) and area of wounds deep to bone from 0.2% to 15.0% [2% (1%, 5%)] TBSA. Two upper limbs in 54 cases were simultaneously injured, accounting for 39.7%. Early fasciotomy was performed for 73 limbs. (2) Thirteen affected limbs were treated with dressing change, 2 affected limbs were sutured directly after debridement, 56 affected limbs were repaired by skin grafting, 12 affected limbs were repaired by local flap, 45 affected limbs were repaired by distal pedicled flap, 22 affected limbs were repaired by free flap, and 40 affected limbs were amputated (accounting for 21.1%). (3) One case died of pulmonary infection, sepsis, and multiple organ failure after operation, and the rest patients were all cured. One case with avulsion of abdominal flap was repaired by skin grafting after dressing change. The anterolateral thigh flap in one case necrotized after transplantation, which was replaced by pedicled abdominal flap. Seven cases had small erosion on the pedicle or margin after transplantation of abdominal flap and were healed by dressing change. Six cases had local bruising at the distal end after transplantation of abdominal flap and were healed after conservative treatment such as hyperbaric oxygen. The other flaps survived well. (4) The survival rate of distal pedicled flap grafting was 97.8% (44/45), which was close to that of free flap grafting (95.5%, 21/22, P>0.05). The function recovery of affected limb after free flap grafting was better than that of distal pedicled flap grafting (Z=-3.054, P<0.01), but their satisfaction degree of patients was similar (Z=-0.474, P>0.05). (5) Patients with high-voltage electric burn had higher amputation rate, older age, and larger upper limb burn area than those with low-voltage electric burn (χ²=4.743, Z=-2.801, -6.469, P<0.05 or P<0.01). Conclusions Upper extremity electric burn often occurs in children, electricians, and rural migrant workers with high rate of amputation. Teachers and parents should strengthen safety education for children and manage power source of life well. Workers should improve safety awareness and operate standardly. Fasciotomy for relaxation should be performed for electric burn wound as soon as possible, and flap grafting can effectively repair wound after early debridement. The function recovery of affected upper limb repaired with free flap grafting is better.

OBJECTIVETo analyze the etiology and clinical characteristics of Marjolin's ulcer, and to explore its prevention and treatment.

METHODSMedical records of 187 patients with Marjolin's ulcers admitted to the Department of Burns and Reconstructive Surgery of Xiangya Hospital of Central South University from January 1998 to May 2015 were retrospectively analyzed, including gender, age of onset of initial injury or primary disease, age of onset of Marjolin's ulcer, initial injury or primary disease, length of latency, lengths of pre- and post-ulceration periods, lesion site, lesion type, lesion area, local scar tension, histopathological type, degree of carcinoma cell differentiation, bone invasion and lymphadenopathy, treatment, and prognosis. The relationships between the age of onset of initial injury or primary disease and the length of latency, and the length of pre-ulceration period and the length of post-ulceration period were assessed by Spearman correlation analysis. The recurrence rates were processed with Fisher's exact test.

RESULTS(1) Among the patients, the ratio of male to female was nearly 1.6:1.0. The age of onset of initial injury or primary disease was 0.17-78.00 (17±18) years, and the age of onset of Marjolin's ulcers was 18-84 (49±14) years. (2) The most common initial injury among the patients was flame burn. The length of latency was 0.25-74.00 (32±16) years, and the lengths of pre- and post-ulceration periods were 0-73.00 (26±19) years and 0.08-59.00 (6±11) years respectively. The common lesion sites were the lower limbs and head and face. The rodent ulcer was the most common lesion type, and the lesion area was 1-625 (69±110) cm(2). There were obviously negative correlations between the age of onset of initial injury or primary disease and the length of latency, as well as the length of pre-ulceration period and the length of post-ulceration period (with r values respectively -0.71 and -0.50, P values below 0.01). The pathological scars of strong tension around lesions were seen in 176 cases. (3) The major histopathological type was squamous cell carcinoma, with high cell differentiation in most cases. (4) Bone invasion of carcinoma cells was observed in 59 cases. Lymph node enlargement was observed in 100 cases, and lymph node metastasis was observed in 18 cases. (5) Twenty patients did not receive any surgery, while 167 patients were treated by surgery with lesion extended resection as the main method. According to the condition of wound after the lesion extended resection, the wounds were mainly repaired by skin grafting and transplantation of local skin flap. The majority of wounds in 139 patients who underwent lesion extended resection were repaired in one surgery. Twenty-eight patients out of 104 followed-up cases had recurrence after surgery, mainly seen on head and face, upper limb, lower limb, and buttock, and there was no significant difference among them (P>0.05). The recurrence time of most patients was longer than 6 months after cure.

CONCLUSIONSPatients with Marjolin's ulcers in younger age of onset of initial injury or primary disease tend to have longer latency, during which the shorter the pre-ulceration period is, the longer the post-ulceration period will be. Marjolin's ulcers are prone to occur in scar sites with large tension. Early treatment of high tension scar and scar ulcer is important in prevention, and surgery is the optimal treatment for Marjolin's ulcers. Regular follow-up should be carried out owning to recurrence rate in certain degree after surgery.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Burns ; pathology ; Carcinoma, Squamous Cell ; pathology ; surgery ; Child ; Child, Preschool ; Cicatrix ; pathology ; Face ; pathology ; Female ; Humans ; Infant ; Lower Extremity ; pathology ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Skin Neoplasms ; pathology ; surgery ; Skin Transplantation ; Skin Ulcer ; pathology ; surgery ; Surgical Flaps ; Young Adult