Objective:To explore the risk factors for atrial fibrillation in adult patients with critically severe burns after the first surgery.Methods:This study was a retrospective case series study. From January 1, 2018 to March 31, 2023, 211 adult patients with critically severe burns were admitted to the Department of Burns of Tongren Hospital of Wuhan University & Wuhan Third Hospital and met the inclusion criteria, including 158 males and 53 females, aged 24-81 years. According to whether atrial fibrillation occurred after the first surgery, the patients were divided into postoperative atrial fibrillation (POAF) group (23 cases) and non-POAF group (188 cases). The following indexes of patients in POAF group were collected, including the onset time, duration, treatment method, and number of patients with more than once of atrial fibrillation after the first surgery. The following data of the two groups of patients were collected, including general data, such as gender, age, burn type, total burn area, full-thickness burn area, inhalation injury, underlying diseases, mechanical ventilation, and sepsis; electrolyte imbalance and blood index level before the first surgery; the first surgery-related information such as surgical length and surgical method; volume changes and vital signs during the first surgery, such as total volume of fluid infusion, total volume of blood transfusion, volume of blood loss, hypotension, and hypothermia; postoperative hypothermia; inflammatory index levels before the first surgery and on the first day after the first surgery, such as procalcitonin levels, white blood cell count, neutrophil count, lymphocyte count, platelet count, neutrophil to lymphocyte ratio (NLR), platelet count to lymphocyte ratio (PLR); mortality within 30 days of admission. The independent risk factors for occurrence of atrial fibrillation in adult patients with critically severe burns after the first surgery were screened.Results:The onset time of atrial fibrillation of patients in POAF group was 2 (2, 4) hours after the first surgery, and the duration of atrial fibrillation was 16 (6, 26) hours. Twenty-one patients were treated with intravenous injection of amiodarone, two patients were treated with cardiac electrical cardioversion, and atrial fibrillation of all patients converted to sinus rhythm after treatment. Three patients experienced atrial fibrillation more than once. The age was 59 (42, 70) years and the total burn area was 90% (70%, 94%) total body surface area (TBSA) in patients in POAF group, which were significantly higher than 48 (38, 56) years and 70% (60%, 83%) TBSA in non-POAF group (with Z values of -2.64 and -3.56, respectively, P<0.05). Compared with those in non-POAF group, the incidence rate of inhalation injury of patients in POAF group was significantly higher ( χ2=4.45, P<0.05), the total volumes of fluid infusion and blood transfusion during the first surgery were significantly increased (with Z values of -3.98 and -3.75, respectively, P<0.05), the incidence rates of hypothermia during the first surgery and hypothermia after the first surgery were significantly increased (with χ2 values of 8.24 and 18.72, respectively, P<0.05), the levels of procalcitonin before the first surgery and on the first day after the first surgery, as well as the NLR on the first day after the first surgery were significantly increased (with Z values of -3.03, -2.19, and -2.18, respectively, P<0.05), the lymphocyte count (with Z values of -2.07 and -2.60, respectively, P<0.05) and platelet count (with Z values of -3.35 and -3.58, respectively, P<0.05) were significantly reduced before the first surgery and on the first day after the first surgery, and the mortality rate within 30 days of admission was significantly higher ( χ2=4.03, P<0.05). There were no statistically significant differences in other indexes between the two groups of patients ( P>0.05). Multivariate logistic regression analysis showed that age, total burn area, and intraoperative hypothermia were independent risk factors for the occurrence of atrial fibrillation in adult patients with critically severe burns after the first surgery (with odds ratios of 1.08, 1.07, and 4.18, 95% confidence intervals of 1.03-1.12, 1.03-1.11, and 1.48-11.80, respectively, P<0.05). Conclusions:Age, total burn area, and intraoperative hypothermia are independent risk factors for the occurrence of atrial fibrillation in adult patients with critically severe burns after the first surgery. Patients with atrial fibrillation have an increased risk of death.

Objective:To explore the clinical effect of non-expansion whole framework ear reconstruction for microtia (referred to as the NEWF ear reconstruction).Methods:The clinical data of congenital microtia patients underwent NEWF ear reconstruction at Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences were retrospectively analyzed. This advanced method used a tissue non-expansion approach, employing a double flap consisting of preauricular skin flap and fascia flaps, to fabricate and elevate the ear framework in the first stage concurrently. In the subsequent stage, residual ear tissues were utilized to reconstruct key elements such as the tragus, crus of the helix, cavum concha, and so on. At 6 months follow-up, the effectiveness of the reconstructed ear was assessed based on its aesthetic outcomes and complications. Aesthetic outcomes evaluation included 4 items: skin color (front of ear, back of ear and skin graft area were evaluated respectively), appearance of reconstructed ear substructure, scar of incision and hair condition. The individual score was 0-2 points, total scores from 0 to 10, with scores of 9-10 signifying excellent, 6-8 good, 3-5 moderate, and 0-2 poor. The data were analyzed by descriptive statistics.Results:Ear reconstruction was performed on 49 unilateral microtia cases, aged 6-33 years, including 37 males and 12 females, 34 right ears and 15 left ears. According to the Nagata classification: 30 cases were lobule-type, 5 cases were conchal-type, and 14 cases were small conchal-type. The follow-up period averaged 10.63 months, ranging from 6 to 13 months. One patient experienced exposure of the framework 1 month after the first stage surgery, then recovered well after surgery. The skin color of the front side of the reconstructed ear was close to normal, the substructure was clear, the skin graft area behind the ear recovered well, and the reconstructed ear was basically symmetrical with the healthy side. 9 cases (18.4%) had scar hyperplasia in the mastoid area behind the ear. 9 cases (18.4%) had hair growth on the front of the reconstructed ears. Aesthetic outcomes showed that excellent in 8 cases (16.3%), good in 36 cases (73.5%), moderate in 4 cases (8.2%), poor in 1 case (2.0%).Conclusion:The NEWF ear reconstruction enhances the stability of the ear framework, reduces the overall duration of treatment, making it a viable option for ear reconstruction for microtia.

Objective:To explore the clinical effect of non-expansion whole framework ear reconstruction for microtia (referred to as the NEWF ear reconstruction).Methods:The clinical data of congenital microtia patients underwent NEWF ear reconstruction at Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences were retrospectively analyzed. This advanced method used a tissue non-expansion approach, employing a double flap consisting of preauricular skin flap and fascia flaps, to fabricate and elevate the ear framework in the first stage concurrently. In the subsequent stage, residual ear tissues were utilized to reconstruct key elements such as the tragus, crus of the helix, cavum concha, and so on. At 6 months follow-up, the effectiveness of the reconstructed ear was assessed based on its aesthetic outcomes and complications. Aesthetic outcomes evaluation included 4 items: skin color (front of ear, back of ear and skin graft area were evaluated respectively), appearance of reconstructed ear substructure, scar of incision and hair condition. The individual score was 0-2 points, total scores from 0 to 10, with scores of 9-10 signifying excellent, 6-8 good, 3-5 moderate, and 0-2 poor. The data were analyzed by descriptive statistics.Results:Ear reconstruction was performed on 49 unilateral microtia cases, aged 6-33 years, including 37 males and 12 females, 34 right ears and 15 left ears. According to the Nagata classification: 30 cases were lobule-type, 5 cases were conchal-type, and 14 cases were small conchal-type. The follow-up period averaged 10.63 months, ranging from 6 to 13 months. One patient experienced exposure of the framework 1 month after the first stage surgery, then recovered well after surgery. The skin color of the front side of the reconstructed ear was close to normal, the substructure was clear, the skin graft area behind the ear recovered well, and the reconstructed ear was basically symmetrical with the healthy side. 9 cases (18.4%) had scar hyperplasia in the mastoid area behind the ear. 9 cases (18.4%) had hair growth on the front of the reconstructed ears. Aesthetic outcomes showed that excellent in 8 cases (16.3%), good in 36 cases (73.5%), moderate in 4 cases (8.2%), poor in 1 case (2.0%).Conclusion:The NEWF ear reconstruction enhances the stability of the ear framework, reduces the overall duration of treatment, making it a viable option for ear reconstruction for microtia.

Objective:To preliminarily investigate the effect of blue light on the biological activity of human skin keratinocytes, fibroblasts and melanocytes.Methods:Discarded foreskin tissues were collected from 10 healthy children aged from 3 to 12 years after circumcision surgery in the First Affiliated Hospital of Kunming Medical University from June 2021 to December 2021. After epidermis-dermis separation, selective culture was performed to isolate keratinocytes, fibroblasts, and melanocytes. According to the pre-experiment results, the above three types of cells were irradiated with 440 - 450 nm blue light at doses of 0, 5, 10, 20, 30, and 40 J/cm 2, and then continued to be cultured for 0, 6, 24, and 48 hours. Cell counting kit 8 (CCK8) assay was performed to evaluate cellular proliferative activity at each time point, enzyme-linked immunosorbent assay (ELISA) to detect levels of interleukin (IL) -18, IL-33, nerve growth factor (NGF), and granulocyte-macrophage colony-stimulating factor (GM-CSF) secreted by keratinocytes, as well as levels of IL-33 and keratinocyte growth factor (KGF) secreted by fibroblasts, NaOH lysis method to determine melanin synthesis rates in melanocytes, and Western blot analysis to determine the relative expression of tyrosinase (TYR), tyrosine-related protease 1 (TRP-1) and dopachrome isomerase (DCT) in melanocytes. Two-way analysis of variance was used to analyze group effects, time effects and interaction effects. Results:After irradiation with blue light, the cellular proliferative activity significantly differed among different doses of blue light irradiation groups and different time points in keratinocytes ( Ftime = 516.20, Fdose = 421.20, Finteraction = 25.05, all P < 0.003), fibroblasts ( Ftime = 129.30, Fdose = 477.80, Finteraction = 10.91, all P < 0.003), and melanocytes ( Ftime = 77.61, Fdose = 138.70, Finteraction = 3.50, all P < 0.003) ; immediately after irradiation, the proliferative activity of keratinocytes and fibroblasts was significantly lower in the 20 - 40 J/cm 2 blue light group than in the 0 J/cm 2 blue light group (all P < 0.003), and the proliferative activity of melanocytes was significantly higher in the 5 J/cm 2 blue light group than in the 0 J/cm 2 blue light group ( P < 0.003) ; the proliferative activity of the 3 types of cells showed decreasing trends with the increase of blue light irradiation doses and culture time. ELISA showed that the concentrations of IL-18, IL-33, NGF, and GM-CSF secreted by keratinocytes, as well as the concentrations of IL-33 and KGF secreted by fibroblasts, tended to increase with the increase of blue light irradiation doses and culture time. The melanin synthesis rates in melanocytes significantly differed among different doses of blue light irradiation groups and different time points ( Ftime = 833.50, Fdose = 249.40, Finteraction = 81.38, all P < 0.003) ; during 0 - 24 hours after blue light irradiation, the melanin synthesis rates tended to increase with the increase of blue light irradiation doses and time; during 24 - 48 hours, the melanin synthesis rates showed decreasing trends with the increase of blue light irradiation doses and culture time compared with that at 24 hours after irradiation; 24 hours after irradiation, the melanin synthesis rates were significantly higher in the 5, 10, 20, 30 and 40 J/cm 2 blue light groups (159.50% ± 10.88%, 218.76% ± 8.49%, 333.72% ± 7.72%, 393.29% ± 6.00%, 427.21% ± 8.39%, respectively) than in the 0 J/cm 2 blue light group (102.29% ± 6.57%, all P < 0.003). The relative expression of TYR ( Ftime = 67.94, Fdose = 28.99, Finteraction = 3.71, all P < 0.003), TRP-1 ( Ftime = 21.73, Fdose = 8.38, both P < 0.003) and DCT ( Ftime = 34.51, Fdose = 11.79, both P < 0.003) in melanocytes significantly differed among different doses of blue light irradiation groups and different time points, and tended to increase with the increase of blue light irradiation doses and culture time. Conclusion:Blue light irradiation at doses of 5 - 40 J/cm 2 could inhibit the proliferative activity of human skin keratinocytes, fibroblasts, and melanocytes, and the inhibitory effect tended to increase with the increase of blue light irradiation doses, except an enhancing effect on the proliferative activity of melanocytes observed immediately after irradiation with blue light at 5 J/cm 2; additionally, blue light irradiation at 5 - 40 J/cm 2 could enhance the expression of melanin synthesis-related enzymes in melanocytes, and increase the melanin synthesis rate in melanocytes over a short period of time.

Objective:To investigate the effect of oxygen concentration on proliferation, apoptosis and migration of rabbit auricular chondrocytes at different time points of culture.Methods:Bilateral auricular cartilage from 6 Japanese white rabbits were harvested and cultured, auricular chondrocytes at passage 2 (P2) were used in this study. Five groups were set: Group A (control group): chondrocytes were cultured in atmospheric (21%) oxygen condition, group B: chondrocytes were cultured in 5% oxygen condition for 12 hours (h), group C: chondrocytes were cultured in 5% oxygen condition for 36 h, group D: chondrocytes were cultured in 1% oxygen condition for 12 h, and group E: chondrocytes were cultured in 1% oxygen condition for 36 h. Cell counting kit-8 (CCK-8) assay was adopted to evaluate the proliferation of chondrocytes. Proliferation curves were drawn according to the absorbance value detected. Cell apoptosis was investigated by annexin V-FITC and flow cytometry. Cell scratch test was used to observe the migration ability. One-way ANOVA and LSD- t were used to verify differences between the groups. P<0.05 was considered as statistically significant. Results:In terms of cell proliferation, on the sixth day of culture, the absorbance values of group A, B, C, D and E were 1.38 ± 0.29, 1.59 ± 0.27, 1.37 ± 0.22, 2.06 ± 0.64, 2.23 ± 0.56 respectively. Significant difference was found between the five groups ( F=4.207, P=0.012), and there were significant differences between group D and A ( t=-2.487, P=0.022), group E and A ( t=-3.095, P=0.006). On the seventh day of culture, the absorbance values of the five groups were 1.72 ± 0.30, 2.26 ± 0.44, 2.30 ± 0.29, 2.49 ± 0.73, 2.74 ± 0.54. Significant difference was found between five groups ( F=2.948, P=0.046), and there were significant differences between group D and A ( t=-2.480, P=0.022), group E and A ( t=-3.287, P=0.004). The apoptosis rate of group A, B, C, D and E were (2.97±1.14)%, (3.92±1.14)%, (3.38±0.83)%, (1.54±0.50)%, (0.99±0.59)%. The difference between groups for cell apoptosis were also significant ( F=7.957, P=0.001), among which there were significant differences between group D and A ( t=-2.300, P=0.036), group E and A ( t=-3.180, P=0.006), group B and D ( t=3.812, P=0.002), group C and E ( t=3.832, P=0.002). As for cell migration, at the 12th hour, the cell migration rates of groups A, B, C, D and E were(13.10±3.32)%, (9.23±3.56)%, (10.60±2.03)%, (13.33±1.72)%, (15.32±4.72)%. Significant difference was found between the five groups ( F=3.278, P=0.027). And there were significant differences between group D and B ( t=2.183, P=0.039), group C and E ( t=-2.513, P=0.019). At 24 h, the cell migration rates of the five groups were(19.7±2.97)%, (16.62±3.30)%, (18.99±2.61)%, (20.92±5.18)%, (25.29±5.83)%. Significant difference was found between five groups ( F=3.513, P=0.021). And there were significant differences between group E and A ( t=2.315, P=0.029), group E and C ( t=2.609, P=0.015). Conclusions:When cell culture time exceeded 12 h, 1% oxygen condition induced higher proliferation, lower apoptosis, and higher migration ability than 5% or 21% oxygen conditions in cultured chondrocytes. Moreover, oxygen concentration had stronger influence on the biological characteristics of rabbit auricular chondrocytes compared to intervention time.

Objective:To investigate the effect of oxygen concentration on proliferation, apoptosis and migration of rabbit auricular chondrocytes at different time points of culture.Methods:Bilateral auricular cartilage from 6 Japanese white rabbits were harvested and cultured, auricular chondrocytes at passage 2 (P2) were used in this study. Five groups were set: Group A (control group): chondrocytes were cultured in atmospheric (21%) oxygen condition, group B: chondrocytes were cultured in 5% oxygen condition for 12 hours (h), group C: chondrocytes were cultured in 5% oxygen condition for 36 h, group D: chondrocytes were cultured in 1% oxygen condition for 12 h, and group E: chondrocytes were cultured in 1% oxygen condition for 36 h. Cell counting kit-8 (CCK-8) assay was adopted to evaluate the proliferation of chondrocytes. Proliferation curves were drawn according to the absorbance value detected. Cell apoptosis was investigated by annexin V-FITC and flow cytometry. Cell scratch test was used to observe the migration ability. One-way ANOVA and LSD- t were used to verify differences between the groups. P<0.05 was considered as statistically significant. Results:In terms of cell proliferation, on the sixth day of culture, the absorbance values of group A, B, C, D and E were 1.38 ± 0.29, 1.59 ± 0.27, 1.37 ± 0.22, 2.06 ± 0.64, 2.23 ± 0.56 respectively. Significant difference was found between the five groups ( F=4.207, P=0.012), and there were significant differences between group D and A ( t=-2.487, P=0.022), group E and A ( t=-3.095, P=0.006). On the seventh day of culture, the absorbance values of the five groups were 1.72 ± 0.30, 2.26 ± 0.44, 2.30 ± 0.29, 2.49 ± 0.73, 2.74 ± 0.54. Significant difference was found between five groups ( F=2.948, P=0.046), and there were significant differences between group D and A ( t=-2.480, P=0.022), group E and A ( t=-3.287, P=0.004). The apoptosis rate of group A, B, C, D and E were (2.97±1.14)%, (3.92±1.14)%, (3.38±0.83)%, (1.54±0.50)%, (0.99±0.59)%. The difference between groups for cell apoptosis were also significant ( F=7.957, P=0.001), among which there were significant differences between group D and A ( t=-2.300, P=0.036), group E and A ( t=-3.180, P=0.006), group B and D ( t=3.812, P=0.002), group C and E ( t=3.832, P=0.002). As for cell migration, at the 12th hour, the cell migration rates of groups A, B, C, D and E were(13.10±3.32)%, (9.23±3.56)%, (10.60±2.03)%, (13.33±1.72)%, (15.32±4.72)%. Significant difference was found between the five groups ( F=3.278, P=0.027). And there were significant differences between group D and B ( t=2.183, P=0.039), group C and E ( t=-2.513, P=0.019). At 24 h, the cell migration rates of the five groups were(19.7±2.97)%, (16.62±3.30)%, (18.99±2.61)%, (20.92±5.18)%, (25.29±5.83)%. Significant difference was found between five groups ( F=3.513, P=0.021). And there were significant differences between group E and A ( t=2.315, P=0.029), group E and C ( t=2.609, P=0.015). Conclusions:When cell culture time exceeded 12 h, 1% oxygen condition induced higher proliferation, lower apoptosis, and higher migration ability than 5% or 21% oxygen conditions in cultured chondrocytes. Moreover, oxygen concentration had stronger influence on the biological characteristics of rabbit auricular chondrocytes compared to intervention time.

As one of the important means for saving severely burned patients, mechanical ventilation can not only improve the function of important organs such as heart, lung, and kidney, but also stabilize the homeostasis of the body, thus promoting the recovery of patients. Improper use of mechanical ventilation, however, can lead to many complications, among which the ventilator-induced lung injury (VILI) is one of the most common and serious complications, accompanying with a high mortality rate. The target of preventing VILI is to minimize the risk of lung injury caused by mechanical ventilation. This article reviews the pathogenesis, diagnosis, and early prevention and treatment of VILI caused by mechanical ventilation in burned patients.

Background: High concentrations of particulate matter less than 2.5 μm in diameter (PM2.5) in poultry houses is an important cause of respiratory disease in animals and humans. Pseudomonas aeruginosa is an opportunistic pathogen that can induce severe respiratory disease in animals under stress or with abnormal immune functions. When excessively high concentrations of PM2.5 in poultry houses damage the respiratory system and impair host immunity, secondary infections with P. aeruginosa can occur and produce a more intense inflammatory response, resulting in more severe lung injury. Objectives: In this study, we focused on the synergistic induction of inflammatory injury in the respiratory system and the related molecular mechanisms induced by PM2.5 and P. aeruginosa in poultry houses. Methods: High-throughput 16S rDNA sequence analysis was used for characterizing the bacterial diversity and relative abundance of the PM2.5 samples, and the effects of PM2.5 and P. aeruginosa stimulation on inflammation were detected by in vitro and in vivo. Results: Sequencing results indicated that the PM2.5 in poultry houses contained a high abundance of potentially pathogenic genera, such as Pseudomonas (2.94%). The lung tissues of mice had more significant pathological damage when co-stimulated by PM2.5 and P. aeruginosa, and it can increase the expression levels of interleukin (IL)-6, IL-8, and tumor necrosis factor-α through nuclear factor (NF)-κB pathway in vivo and in vitro. Conclusions The results confirmed that poultry house PM2.5 in combination with P. aeruginosa could aggravate the inflammatory response and cause more severe respiratory system injuries through a process closely related to the activation of the NF-κB pathway.

[Abstract]? Stroke patients' return to work(RTW) is of great economic, social and research significance. The young and middle-aged stroke patients have become the focus of attention because of their high need to RTW and the possibility of returning to work. This paper summarizes the influencing factors affecting the return of young and middle-aged stroke patients to work as well as the method to increase their RTW through literature review, so as to lay the foundation for the follow-up study.