Objective: To investigate the effects and mechanism of diammonium glycyrrhizinate (DG) on liver injury in severely scalded rats. Methods: The experimental research method was used. Fifty-four female Sprague-Dawley rats aged 7-9 weeks were divided into sham injury group with simulated injury on the back, and simple scald group and scald+DG group with scald of 30% total body surface area on the back, with 18 rats in each group. Rats in sham injury group were not specially treated after injury, and rats in simple scald group and scald+DG group were rehydrated for antishock. Besides, rats in scald+DG group were injected intraperitoneally with 50 mg/kg DG at post injury hour (PIH) 1, 25, and 49. Rats in the three groups were collected, the serum content of liver function injury related indexes including aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), total protein, and albumin was measured by automatic biochemical assay analyzer, and serum content of ornithine carbamoyl transferase (OCT) was measured by enzyme-linked immunosorbent assay method at PIH 24, 48, and 72; hepatic histopathological changes at PIH 72 were observed by hematoxylin-eosin staining; the mRNA expressions of B-cell lymphoma 2 (Bcl-2), Bcl-2-associated X protein (Bax), glucose regulated protein 78 (GRP78), activating transcription factor 4 (ATF4), and protein kinase R-like endoplasmic reticulum kinase (PERK) in liver tissue were detected by real-time fluorescent quantitative reverse transcription polymerase chain reaction at PIH 24, 48, and 72. The protein expressions of Bcl-2, Bax, GRP78, PERK, and ATF4 in liver tissue were detected by Western blotting at PIH 72 in sham injury group and PIH 24, 48, and 72 in simple scald group and scald+DG group. The number of samples was 6 in each group at each time point. Data were statistically analyzed with analysis of variance for factorial design, one-way analysis of variance, and Bonferroni test. Results: Compared with that in sham injury group, the serum content of AST, ALT, and LDH was significantly increased (P<0.01), and the serum content of total protein and albumin was significantly decreased (P<0.05 or P<0.01) of rats in simple scald group at all post-injury time points. Compared with those in simple scald group, the serum AST content of rats in scald+DG group at PIH 24 was decreased significantly (P<0.05); the serum AST, ALT, and LDH content of rats in scald+DG group at PIH 48 was decreased significantly (P<0.01), and the serum total protein content was increased significantly (P<0.01); the serum AST, ALT, and LDH content of rats in scald+DG group at PIH 72 was decreased significantly (P<0.01), and the serum total protein and albumin content was increased significantly (P<0.01). At PIH 24, 48, and 72, the serum OCT content of rats in simple scald group was (48.5±3.9), (40.8±2.4), and (38.7±2.0) U/L, which was significantly higher than (15.1±2.5), (15.7±2.6), and (16.4±3.7) U/L in sham injury group (P<0.01), and (39.0±4.5), (31.8±2.0), and (22.1±2.6) U/L in scald+DG group (P<0.05 or P<0.01). At PIH 72, the cells in liver tissue of rats in sham injury group had normal morphology and regular arrangement, with no obvious inflammatory cell infiltration; the cells in liver tissue of rats in simple scald group had disordered arrangement, diffuse steatosis, and moderate inflammatory cell infiltration; the cells in liver tissue of rats in scald+DG group arranged regularly, with scattered steatosis and a small amount of inflammatory cell infiltration. Compared with those in sham injury group, the Bcl-2 mRNA (P<0.05 or P<0.01) and protein expressions of liver tissue were significantly decreased, and the mRNA (P<0.01) and protein expressions of Bax were significantly increased in rats in simple scald group at PIH 24, 48, and 72. Compared with those in simple scald group, the mRNA (P<0.05) and protein expressions of Bax in liver tissue of rats in scald+DG group were decreased significantly at PIH 48; the mRNA (P<0.01) and protein expressions of Bax in liver tissue of rats in scald+DG group were significantly decreased, and the mRNA (P<0.01) and protein expressions of Bcl-2 were significantly increased at PIH 72. Compared with those in sham injury group, the mRNA (P<0.05 or P<0.01) and protein expressions of ATF4, GRP78, and PERK in liver tissue were significantly increased in rats in simple scald group at all post-injury time points. Compared with those in simple scald group, the mRNA (P<0.01) and protein expressions of ATF4 in liver tissue of rats in scald+DG group at PIH 48 were significantly decreased, and the mRNA (P<0.05 or P<0.01) and protein expressions of ATF4, GRP78, and PERK were significantly decreased in liver tissue of rats in scald+DG group at PIH 72. Conclusions: DG can effectively reduce the degree of liver injury in rats after severe scald, and the mechanism may involve alleviating endoplasmic reticulum stress and mitigating mitochondrial damage.
Albumins/pharmacology* ; Animals ; Burns/pathology* ; Female ; Glycyrrhizic Acid/pharmacology* ; Liver ; RNA, Messenger/genetics* ; Rats ; Rats, Sprague-Dawley ; bcl-2-Associated X Protein/pharmacology*

Objective: To explore the effects of pulsed dye laser (PDL) and ultra-pulsed fractional carbon dioxide laser (UFCL) combined with multipoint microinjection of triamcinolone acetonide in the treatment of red hypertrophic scar at early stage in burn children. Methods: A retrospective cohort before-after control study in the same patients was conducted. From February 2019 to December 2020, a total of 67 burn children who met the inclusion criteria (32 males and 35 females, aged 1 to 12 years) with red hyperplastic scar at early stage, were treated in Hunan Provincial People's Hospital (1^st Affiliated Hospital of Hunan Normal University). All the children were treated with composite laser technique (PDL and UFCL) combined with triamcinolone acetonide (hereinafter referred to as combined treatment). After 2 months, they received the second combined treatment. Before the first combined treatment and 6 months after the last combined treatment, the scar of children was evaluated with the patient and observer scar assessment scale (POSAS) by physicians and family members. Six months after the last combined treatment, the satisfaction of the patients' family members with the efficacy was recorded and the overall satisfaction rate was calculated. Adverse reactions were recorded throughout the treatment process. Data were statistically analyzed with paired sample t test. Results: Six months after the last combined treatment, the POSAS scores of children on the thickness, blood vessels distribution, color, surface roughness, texture, scope, and overall evaluation of scar evaluated by the physicians, and the POSAS scores of children on the color, degree of pain, degree of itching, hardness, thickness, shape and size, and overall evaluation of scar evaluated by the family members were significantly lower than those before the first combined treatment (with t values of 17.32, 16.73, 15.00, 14.91, 19.62, 28.74, 29.83, 17.43, 20.52, 29.01, 28.82, 24.91, 20.30, and 42.13, respectively, P<0.01). Six months after the last combined treatment, 62 (93%), 3 (4%), and 2 (3%) children's family members were very satisfied, satisfied, and relatively satisfied with the treatment effect, respectively, and the overall satisfaction rate was 97% (65/67). Six months after the last combined treatment, no scar thickening or infection occurred in all the wounds of children. Conclusions: Composite laser technique combined with multipoint microinjection of triamcinolone acetonide in the treatment of red hypertrophic scar at early stage in burn children can improve the appearance and texture of scar, reduce scar pain and pruritus, with high satisfaction of children's family members to the treatment effect and less adverse reactions.
Burns/therapy* ; Child ; Cicatrix, Hypertrophic/pathology* ; Female ; Humans ; Lasers, Gas ; Male ; Microinjections ; Pain ; Pruritus ; Retrospective Studies ; Treatment Outcome ; Triamcinolone Acetonide/therapeutic use*

Objective: To assess the current situation of early treatment of partial-thickness burn wounds by professional burn medical staff in China, and to further promote the standardized early clinical treatment of partial-thickness burn wounds. Methods: A cross-sectional investigation was conducted. From November 2020 to February 2021, the self-designed questionnaire for the early treatment of partial-thickness burn wounds was published through the "questionnaire star" website and shared through WeChat to conduct a convenient sampling survey of domestic medical staff engaged in burn specialty who met the inclusion criteria. The number, region, and grade of the affiliated hospital, the age, gender, occupation, and seniority of the respondents were recorded. The respondents were divided into physician group and nurse group, senior group and junior group, eastern region group and non-eastern region group, primary and secondary hospital group and tertiary hospital group. Then the seniority, grade of the affiliated hospital, region of the affiliated hospital of the respondents in physician group and nurse group, conventional treatment of partial-thickness burn blisters, reasons for retaining vesicular skin, reasons for removing vesicular skin, and the conventional selection and optimal solution recommendation of topical drugs or dressings for partial-thickness burn wounds in the early stage of respondents in each of all the groups were recorded. Data were statistically analyzed with chi-square test. Results: The survey covered 31 provinces, municipalities, and autonomous regions in China (except for Hong Kong, Macau, and Taiwan regions). A total of 979 questionnaires were recovered, which were all valid. The 979 respondents came from 449 hospitals across the country, including 203 hospitals in the eastern region, 116 hospitals in the western region, 99 hospitals in the central region, and 31 hospitals in the northeast region, 348 tertiary hospitals, 79 secondary hospitals, and 22 primary hospitals. The age of the respondents was (39±10) years. There were 543 males and 436 females, 656 physicians and 323 nurses, 473 juniors and 506 seniors, 460 in the eastern regions and 519 in the non-eastern regions, 818 in tertiary hospitals and 161 in primary and secondary hospitals. There were statistically significant differences in the composition of different seniority in the respondents between physician group and nurse group (χ²=44.32, P<0.01), while there were no statistically significant differences in grade or region of the affiliated hospital of the respondents between physician group and nurse group (P>0.05). There were no statistically significant differences in the conventional treatment of partial-thickness burn blisters among respondents between different occupational groups, seniority groups, and region of the affiliated hospital groups (P>0.05).The respondents in different grade of the affiliated hospital groups differed significantly in the conventional treatment of partial-thickness burn blisters (χ²=6.24, P<0.05). Compared with respondents in nurse group, larger percentage of respondents in physician group chose to retain vesicular skin for protecting the wounds and providing a moist environment, and alleviating the pain of dressing change (with χ² values of 21.22 and 19.96, respectively, P values below 0.01), and smaller percentage of respondents in physician group chose to retain vesicular skin for prevention of wound infection (χ²=23.55, P<0.01). The reasons for retaining vesicular skin of respondents between physician group and nurse group were similar in accelerating wound healing, alleviating pigmentation and scar hyperplasia post wound healing (P>0.05). Compared with respondents in junior group, larger percentage of respondents in senior group chose to retain vesicular skin for protecting the wounds and providing a moist environment and alleviating the pain of dressing change (with χ² values of 10.36 and 4.60, respectively, P<0.05 or P<0.01), and smaller percentage of respondents in senior group chose to retain vesicular skin for prevention of wound infection (χ²=8.20, P<0.01). The reasons for retaining vesicular skin of respondents in senior group and junior group were similar in accelerating wound healing, alleviating pigmentation and scar hyperplasia post wound healing (P>0.05). The 5 reasons for the respondents between eastern region group and non-eastern region group, primary and secondary hospital group and tertiary hospital group chose to retain vesicular skin were all similar (P>0.05). Compared with those in physician group, significantly higher percentage of respondents in nurse group were in favor of the following 6 reasons for removing the vesicular skin, including convenience for using more ideal dressings to protect the wounds, prevention of wound infection, facilitating the effect of topical drugs on the wounds, the likely rupture of blisters and wound contamination, accelerating wound healing, and alleviating pigmentation and scar hyperplasia post wound healing (with χ² values of 4.35, 25.59, 11.83, 16.76, 46.31, and 17.54, respectively, P<0.05 or P<0.01). Compared with respondents in senior group, larger percentage of respondents in junior group chose to remove vesicular skin for the reasons such as the likely blister rupture and wound contamination, preventing wound infection, accelerating wound healing, and alleviating pigmentation and scar hyperplasia post wound healing (with χ² values of 17.25, 18.63, 14.83, and 10.23, respectively, P values below 0.01). Compared with respondents in non-eastern region group, larger percentage of respondents in eastern region group chose to remove vesicular skin for preventing wound infection and the likely rupture of blisters and wound contamination (with χ² values of 9.30 and 8.65, respectively, P values below 0.01). The 6 reasons for the respondents between tertiary hospital group and primary and secondary hospital group choose to remove vesicular skin were similar (P>0.05). Compared with respondents in physician group, larger percentage of respondents in nurse group chose to use moisturizing materials for partial-thickness burn wounds in the early stage (χ²=6.18, P<0.05), and smaller percentage of respondents in nurse group chose other topical drugs or dressings (χ²=5.20, P<0.05). Compared with respondents in junior group, larger percentage of respondents in senior group chose to use moisturizing materials and other topical drugs or dressings for partial-thickness burn wounds in the early stage (with χ² values of 4.97 and 21.80, respectively, P<0.05 or P<0.01). Compared with respondents in non-eastern region group, larger percentage of respondents in eastern region group chose to use topical antimicrobial drugs for partial-thickness burn wounds in the early stage (χ²=4.09, P<0.05), and smaller percentage of respondents in eastern region group chose to use other topical drugs or dressings for the partial-thickness burn wounds in the early stage (χ²=5.63, P<0.05). Compared with respondents in primary and secondary hospital group, larger percentage of respondents in tertiary hospital group chose to use biological dressings for partial-thickness burn wounds in the early stage (χ²=9.38, P<0.01). The optimal solution recommendation of topical drugs or dressings for partial-thickness burn wounds in the early stage varied significantly among the respondents between different occupational groups and seniority groups (with χ² values of 39.58 and 19.93, respectively, P values below 0.01). There were no statistically significant differences between eastern and non-eastern region groups, tertiary hospital group and primary and secondary hospital groups in optimal solution recommendation of topical drugs or dressings for partial-thickness burn wounds in the early stage (P>0.05). Conclusions: The conventional treatment measures of partial-thickness burn blisters and reasons for preserving blister skin by professional burn medical staff in China are relatively consistent, but there are great differences in the selection of reasons for removing blister skin, the conventional selection and optimal solution recommendation of topical drugs or dressings for partial-thickness burn wounds in the early stage. Therefore, it is urgent to establish a clinical treatment standard for partial-thickness burn wounds.
Adult ; Blister ; Burns/drug therapy* ; Cicatrix/pathology* ; Cross-Sectional Studies ; Female ; Humans ; Hyperplasia ; Male ; Medical Staff ; Middle Aged ; Occupations ; Pain ; Soft Tissue Injuries ; Wound Infection

OBJECTIVE: To investigate the protective effects of shen-mai injection on intestinal barrier function in the early stage of 30% 3° scald, and to provide experimental basis for the prevention and control of enterogenic infection. METHODS: A total of 60 Wistar rats were randomly divided into 6 groups: normal control group (without treatment), model control group (with 30% total body surface area (TBSA) fully thickness burn on the back), hexadecadrol (5 mg/kg) group, Shenmai injection (5, 10, 15 mg/kg) groups, with 10 rats in each group. After burned by scald apparatus, rats in each group were treated with drugs immediately by intraperitoneal injection once a day. At 72 hours after burned, the levels of plasma endotoxin, diamine oxidase (DAO), tumor necrosis factor-alpha (TNF-α), interleukins-6(IL-6) in all rats were detected and the mesenteric lymph nodes, liver and spleen were homogenized to culture for bacteria. The change of secretory immunoglobulin A (sIgA) in intestinal mucosa was measured. RESULTS: Compared with normal control group, bacterial translocation quantity in mesenteric lymph nodes(MLN), liver, and spleen, and the plasma levels of DAO, endotoxin, TNF-α, IL-6 and the level of sIgA in intestinal mucosa in model control group were increased significantly (P＜0.01); compared with model control group, bacterial translocation quantity in MLN, liver, and spleen, and the plasma levels of DAO, endotoxin, TNF-α, IL-6 and the level of sIgA in intestinal mucosa in hexadecadrol (5 mg/kg) group and shen-mai injection (5, 10, 15 mg/kg) groups were decreased significantly (P＜0.05 or P＜0.01). CONCLUSION Shen-mai injection can alleviate intestinal mucosa injury caused by severe scald, and the effects are similar with those of dexamethasone, and the effect is better in the high-dose group.
Animals ; Bacterial Translocation ; drug effects ; Burns ; complications ; Drug Combinations ; Drugs, Chinese Herbal ; pharmacology ; Intestinal Mucosa ; drug effects ; pathology ; Random Allocation ; Rats ; Rats, Wistar

PURPOSE: This study investigated the morphological characteristics of hypertrophic scars of various ages. METHODS: This was a retrospective study. Tissue samples from 170 normal skin (control) and 126 scar tissue after undergoing conservative treatment (CT) (n=62) or split thickness skin graft (STSG) (n=64) were obtained. Time from injury (CT) or surgery (STSG) was grouped into periods as follows: first 6 months (period 1), 7~12 months (period 2), 13~24 months (period 3), 25~120 months (period 4), >120 months (period 5). Epidermal thickness (ET), dermal thickness (DT), and dermal collagen fiber thickness and length (CFT, CFL) were measured using an image analyzer. RESULTS: Scar tissue ET was significantly thicker compared to normal skin (P<0.05) and was greatest at period 1. Scar tissue DT was significantly thicker compared to normal skin (P<0.05), which increased until period 3 but then decreased afterwards. Scar tissue CFT was significantly thinner compared to normal skin (P<0.05) except for period 5. Scar tissue CFL was significantly longer compared to normal skin (P<0.05). Significant differences were observed especially in younger scar ET, DT, CFT, and CFL. CONCLUSION: These findings may assist to increase the understanding of the pathohistological changes in burn scar tissues over time and provide guidance in receiving burn treatment.
Burns ; Cicatrix* ; Cicatrix, Hypertrophic* ; Collagen ; Pathology ; Retrospective Studies ; Skin ; Transplants

Functional dyspepsia is one of the most common bowel disorders as prevalent of 7.7% Korean population. The cardinal manifestations include bothersome postprandial fullness, early satiation, epigastric burning or pain. These features are chronic and should be presented recurrently with no other compatible organic disease to explain the symptoms. Even though it is not life-shortening, functional dyspepsia usually make the health-related quality of life worse especially if other functional bowel disorder coexist. The coexistence of functional bowel disorders is called as 'overlap syndrome'. Anxiety, somatization and insomnia is more prevalent in overlap syndrome compared with sole functional bowel disorder. Therefore, it is worthwhile that physician interviews and elucidates whether the dyspeptic patient had other kinds of functional bowel disorders, and manages the underlying psychotic pathology. Placebo effect is large in functional dyspepsia, and there is only four kinds of prokinetics that is proven to be superior to placebo. Adverse events relating prolonged administration of prokinetics sometimes fatal or irreversible, physician willing to describe prokinetics should be familiar to the possible adverse effects and the relating risk factors. Pathologic acid reflux is not uncommon in functional dyspepsia, and acid-suppressant is equivalent to the prokientics in most of dyspeptic patients.
Anxiety ; Burns ; Drug-Related Side Effects and Adverse Reactions ; Dyspepsia* ; Humans ; Pathology ; Placebo Effect ; Quality of Life ; Risk Factors ; Satiation ; Sleep Initiation and Maintenance Disorders

OBJECTIVE: Sensory symptoms are common in patients with Parkinson disease (PD), although its exact prevalence and causes are not well known. We aimed to investigate whether peripheral pathology contribute to chronic sensory symptoms in patients with PD by nerve conduction test. METHODS: We recruited consecutively 34 patients with clinically probable PD (Hoehn-Yahr stage, 1–3) who developed persistent sensory symptoms in their lower extremities during optimal dopamine replacement therapy. Twenty-five patients who are above age of 70 or have other possible causes of neuropathy as determined by laboratory testing or medical record were excluded. Age- and gender-matched PD patients with same disease severity who have never developed sensory symptom during the same period were allocated to paired controls. Total 18 subjects participated in this study. Nerve conduction tests on peroneal motor nerve and sural sensory nerve were performed in all subjects. Amplitude and conduction velocity were compared between the paired subjects using Wilcoxon signed rank test. RESULTS: Subjective sensory symptoms of the 9 patients were variable: pain (4/9), chilling (3/9), burning (1/9), and tingling sense (1/9). There were no significant difference of mean values of compound muscle action potential/sensory nerve action potential amplitude and conduction velocity between patients and their paired controls. CONCLUSION: This study supports the hypothesis that the origin of chronic sensory symptoms in PD patients is more central than peripheral.
Action Potentials ; Burns ; Dopamine ; Humans ; Levodopa* ; Lower Extremity ; Medical Records ; Neural Conduction* ; Parkinson Disease* ; Pathology ; Prevalence

OBJECTIVETo observe the clinical efficacy of negative pressure wound therapy (NPWT) in combination with porcine acellular dermal matrix (ADM) dressing for repairing deep burn wounds in limbs of patients with non-surgical treatment.

METHODSThirty-two patients with deep partial-thickness burn to full-thickness burn on the limbs admitted to our ward from June 2012 to December 2015, conforming to the inclusion criteria, were divided into group NPWT (n=10, treated with interval negative pressure drainage at -16.6 kPa), group ADM (n=7, treated with porcine ADM dressing), and group NPWT+ ADM (n=15, treated with interval negative pressure drainage and porcine ADM dressing as above) according to the random number table and patient's consent. After being treated for 21 d, residual wounds were cured by routine dressing change using sulfadiazine silver. On post treatment day (PTD) 7, 14, and 21, wound gross observation was conducted, wound drainage fluid volume was recorded, and wound healing rate was calculated. Wound secretion was collected for bacterial culture before treatment and on PTD 21, and bacterial clearance effect was recorded. The wound healing time was also recorded. Measurement data were processed with analysis of variance for repeated measurement, one-way analysis of variance, and LSD test. Eenumeration data were processed with chi-square test or Fisher's exact test.

RESULTS(1) On PTD 7, the wounds of patients in group NPWT and group NPWT+ ADM were significantly shrinked as compared with those before treatment. Skin paddle scattered on the wounds of patients in group NPWT+ ADM on PTD 7. The wounds of patients in group ADM were slightly shrinked on PTD 7 as compared with those before treatment. On PTD 14, the wounds of patients in group NPWT were slightly shrinked as compared with those on PTD 7, while those in group NPWT+ ADM were significantly shrinked as compared with those on PTD 7. Skin paddle on the wounds of patients in group NPWT+ ADM on PTD 14 were increased and fused. The wounds of patients in group ADM were significantly shrinked on PTD 14 as compared with those on PTD 7. On PTD 21, partial wounds of patients in group NPWT were healed, while the wounds of patients in group ADM were slightly shrinked in comparison with those on PTD 14 and most of wounds were not healed. Most of wounds of patients in group NPWT+ ADM were healed. (2) On PTD 7, the wound drainage fluid volumes of patients in group NPWT and group NPWT+ ADM were obviously more than the wound drainage fluid volume of patients in group ADM (with P values below 0.01). On PTD 14, the wound drainage fluid volume of patients in group NPWT was significantly more than that in group ADM (P<0.01); while that between group ADM and group NPWT+ ADM was close (P>0.05). On PTD 21, the wound drainage fluid volume of patients in group NPWT and group NPWT+ ADM was significantly less than that in group ADM (with P values below 0.01). From PTD 7 to 21, the wound drainage fluid volumes of patients in group NPWT+ ADM were significantly reduced as compared with those in group NPWT (with P values below 0.01). (3) On PTD 7, the wound healing rates of patients in group ADM and group NPWT+ ADM were significantly lower than the wound healing rate of patients in group NPWT (P<0.05 or P<0.01), and the wound healing rate of patients in group NPWT+ ADM was significantly higher than that in group ADM (P<0.01). On PTD 14 and 21, the wound healing rates of patients in group NPWT+ ADM were significantly higher than those in group NPWT and group ADM (with P values below 0.01), and the wound healing rates of patients in group NPWT were significantly higher than those in group ADM (with P values below 0.01). (4) Before treatment, the bacteria were respectively detected in 18, 11, and 23 wounds of patients in group NPWT, group ADM, and group NPWT+ ADM. On PTD 21, the bacteria were respectively detected in 2, 8, and 2 wounds of patients in group NPWT, group ADM, and group NPWT+ ADM. The bacterial clearance of wounds of patients in group NPWT and group NPWT+ ADM was significantly better than that of patients in group ADM (with P values below 0.01). The bacterial clearance of wounds of patients in group NPWT+ ADM was close to that in group NPWT (P=1.00). (5) The wound healing time of patients in group NPWT+ ADM was (18.7±1.2) d, which was significantly shorter than that in group NPWT [(23.9±1.5) d] and group ADM [(28.4±1.8) d], with P values below 0.01. The wound healing time of patients in group NPWT was significantly shorter than that in group ADM (P<0.01).

CONCLUSIONSNPWT combined with porcine ADM dressing can effectively remove wound bacteria, reduce wound exudation, and promote wound healing in repairing deep partial-thickness burn wounds and full-thickness burn wounds. Its clinical effect is better than NPWT or porcine ADM dressing alone, and this method may be suitable for patients with non-surgical treatment.

Acellular Dermis ; Animals ; Bandages ; Burns ; therapy ; Extremities ; pathology ; Humans ; Negative-Pressure Wound Therapy ; Swine ; Treatment Outcome ; Wound Healing

One in 10 people suffer from functional dyspepsia (FD), a clinical syndrome comprising chronic bothersome early satiety, or postprandial fullness, or epigastric pain or burning. Postprandial distress syndrome (PDS, comprising early satiety and/or postprandial fullness) and epigastric pain syndrome (EPS) are increasingly accepted as valid clinical entities, based on new insights into the pathophysiology and the results of clinical trials. Diagnosis is based on the clinical history, and exclusion of peptic ulcer and cancer by endoscopy. Evidence is accumulating FD and gastroesophageal ref lux disease are part of the same disease spectrum in a major subset. The causes of FD remain to be established, but accumulating data suggest infections and possibly food may play an important role in subsets. FD does not equate with no pathology; duodenal eosinophilia is now an accepted association, and Helicobacter pylori infection is considered to be causally linked to dyspepsia although only a minority will respond to eradication. In those with EPS, acid suppression therapy is a first line therapy; consider a H2 blocker even if proton pump inhibitor fails. In PDS, a prokinetic is preferred. Second line therapy includes administration of a tricyclic antidepressant in low doses, or mirtazapine, but not a selective serotonin reuptake inhibitor.
Burns ; Diagnosis ; Duodenum ; Dyspepsia* ; Endoscopy ; Eosinophilia ; Eosinophils ; Helicobacter pylori ; Pathology ; Peptic Ulcer ; Proton Pumps ; Serotonin

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