ObjectiveMechanical ventilation (MV) has long been used as a life-sustaining approach for several decades. However, researchers realized that MV not only brings benefits to patients but also cause lung injury if used improperly, which is termed as ventilator-induced lung injury (VILI). This review aimed to discuss the pathogenesis of VILI and the underlying molecular mechanisms.

Data SourcesThis review was based on articles in the PubMed database up to December 2017 using the following keywords: "ventilator-induced lung injury", "pathogenesis", "mechanism", and "biotrauma".

Study SelectionOriginal articles and reviews pertaining to mechanisms of VILI were included and reviewed.

ResultsThe pathogenesis of VILI was defined gradually, from traditional pathological mechanisms (barotrauma, volutrauma, and atelectrauma) to biotrauma. High airway pressure and transpulmonary pressure or cyclic opening and collapse of alveoli were thought to be the mechanisms of barotraumas, volutrauma, and atelectrauma. In the past two decades, accumulating evidence have addressed the importance of biotrauma during VILI, the molecular mechanism underlying biotrauma included but not limited to proinflammatory cytokines release, reactive oxygen species production, complement activation as well as mechanotransduction.

ConclusionsBarotrauma, volutrauma, atelectrauma, and biotrauma contribute to VILI, and the molecular mechanisms are being clarified gradually. More studies are warranted to figure out how to minimize lung injury induced by MV.

Animals ; Barotrauma ; metabolism ; Humans ; Reactive Oxygen Species ; metabolism ; Ventilator-Induced Lung Injury ; metabolism ; Wounds and Injuries ; metabolism

BACKGROUND: Keloids are abnormal wound responses that are caused by hyperproliferative growth of connective tissue during the healing process. Recent research findings introduced the roles of reactive oxygen species (ROS) in the process of keloid formation. ROS induces oxidative stress and promotes the activities of oxidative damage-inducible genes. Aldo-keto reductase 1C3 (AKR1C3) prevents destructive ROS toxicity by detoxification of reactive carbonyl species. Thus, this study aimed to compare the expression of AKR1C3 in both normal and keloid skin in vivo. METHODS: Six specimens of normal skin and six specimens of keloid tissues from human subjects were used to evaluate the expression of AKR1C3 by immunofluorescent staining of tissues and western blotting. RESULTS: By western blotting, it was confirmed that the amount of AKR1C3 protein is significantly reduced in keloid tissues compared to normal tissues. Weak expression of AKR1C3 was also found in keloid tissues by immunofluorescent staining. CONCLUSIONS: This study confirmed that the expression of AKR1C3 protein participates in ROS metabolism and plays a part in the downregulation of human keloid formation. To the best of our knowledge, this is the first work that reveals that AKR1C3 can affect the formation of keloids.
Blotting, Western ; Connective Tissue ; Down-Regulation ; Humans* ; Keloid* ; Metabolism ; Oxidative Stress ; Oxidoreductases ; Reactive Oxygen Species ; Skin* ; Wounds and Injuries

This study was conducted to identify the effectiveness of platelet-rich plasma (PRP) and efficacy of intralesional injection as a method of application to acute cutaneous wounds in dogs. Healthy adult beagles (n = 3) were used in this study. Autologous PRP was separated from anticoagulant treated whole blood in three dogs. Cutaneous wounds were created and then treated by intralesional injection of PRP in the experimental group, while they were treated with saline in the control group on days 0, 2 and 4. The healing process was evaluated by gross examination throughout the experimental period and histologic examination on day 7, 14 and 21. In PRP treated wounds, the mean diameter was smaller and the wound closure rate was higher than in the control. Histological study revealed that PRP treated wounds showed more granulation formation and angiogenesis on day 7, and faster epithelialization, more granulation formation and collagen deposition were observed on day 14 than in control wounds. On day 21, collagen deposition and epithelialization were enhanced in PRP treated groups. Overall, PRP application showed beneficial effects in wound healing, and intralesional injection was useful for application of PRP and could be a good therapeutic option for wound management in dogs.
Animals ; Collagen/metabolism ; Dermis/cytology/injuries/physiology ; Dogs ; Epidermis/cytology/injuries/*physiology ; Female ; Granulation Tissue/cytology ; Injections, Intralesional/veterinary ; Male ; Neovascularization, Physiologic ; *Platelet-Rich Plasma ; Regeneration ; Treatment Outcome ; *Wound Healing ; Wounds and Injuries/therapy/*veterinary

OBJECTIVE: Decompressive craniectomy is an effective therapy to relieve high intracranial pressure after acute brain damage. However, the optimal timing for cranioplasty after decompression is still controversial. Many authors reported that early cranioplasty may contribute to improve the cerebral blood flow and brain metabolism. However, despite all the advantages, there always remains a concern that early cranioplasty may increase the chance of infection. The purpose of this retrospective study is to investigate whether the early cranioplasty increase the infection rate. We also evaluated the risk factors of infection following cranioplasty. METHODS: We retrospectively examined the results of 131 patients who underwent cranioplasty in our institution between January 2008 and June 2015. We divided them into early (≤90 days) and late (>90 days after craniectomy) groups. We examined the risk factors of infection after cranioplasty. We analyzed the infection rate between two groups. RESULTS: There were more male patients (62%) than female (38%). The mean age was 49 years. Infection occurred in 17 patients (13%) after cranioplasty. The infection rate of early cranioplasty was lower than that of late cranioplasty (7% vs. 20%; p=0.02). Early cranioplasty, non-metal allograft materials, re-operation before cranioplasty and younger age were the significant factors in the infection rate after cranioplasty (p<0.05). Especially allograft was a significant risk factor of infection (odds ratio, 12.4; 95% confidence interval, 3.24–47.33; p<0.01). Younger age was also a significant risk factor of infection after cranioplasty by multivariable analysis (odds ratio, 0.96; 95% confidence interval, 0.96–0.99; p=0.02). CONCLUSION: Early cranioplasty did not increase the infection rate in this study. The use of non-metal allograft materials influenced a more important role in infection in cranioplasty. Actually, timing itself was not a significant risk factor in multivariate analysis. So the early cranioplasty may bring better outcomes in cognitive functions or wound without raising the infection rate.
Allografts ; Brain ; Cerebrovascular Circulation ; Cognition ; Decompression ; Decompressive Craniectomy ; Female ; Humans ; Intracranial Pressure ; Male ; Metabolism ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Wounds and Injuries

OBJECTIVETo explore the effect and action mechanism of moxibustion on healing of cutaneous wound in rats.

METHODSTwenty-four SD rats were selected and made into linear full-thickness skin injury model. With randomized digital table, rats were randomly divided into a treatment group and a model group, 12 cases in each one. Then according to treatment time, each group was again divided into a 1d group, a 3d group and a 7d group, 4 cases in each one. The moxibustion at injured skin was applied in the treatment group, 30 min per time, once a day. Hematoxylineosin (HE) staining method was adapted to measure growth status of capillary and number of vascular endothelial cell; immunohistochemical method was used to measure the expression of vascular endothelial growth factor (VEGF).

RESULTSThe wound healing indices in the treatment 7d group were higher than those in the model 7d group on both the 4th day and 8th day after treatment (both P < 0.05). The number of capillary in the treatment 1d group and 3d group was higher than that in the model 1 d and 3 d groups (both 1 < 0.05). The number of capillary in the treatment 7d group was lower than that in the model 7d group (P < 0.05). The number of vascular endothelial cell in the treatment 3d group was higher than that in the model 3d group (P < 0.05). The number of vascular endothelial cell in the treatment 7d group was lower than that in the model 7d group (P < 0.05). The difference of number of vascular endothelial cell between the treatment 1d group and model 1d group was not significant (P > 0.05). Positive cells accumulated score of V EGF expression in the treatment 3d group was higher than that in the model 3d group (P < 0.05). Positive cells accumulated score of VEGF expression in the treatment 7d group was lower than that in the model 7d group (P < 0.05). The difference of positive cells accumulated score of VEGF expression between the treatment 1d group and model 1d group was not significant (P > 0.05).

CONCLUSIONMoxibustion could improve the healing of skin wound in rats, which could be related with regulating vascular endothelial cell and VEGF in wound tissue at different time.

Animals ; Endothelial Cells ; metabolism ; Female ; Humans ; Male ; Moxibustion ; Rats ; Rats, Sprague-Dawley ; Skin ; injuries ; metabolism ; Vascular Endothelial Growth Factor A ; genetics ; metabolism ; Wounds and Injuries ; genetics ; metabolism ; therapy

OBJECTIVETo observe the efficacy of the treatment of refractory wound by VSD combined with platelet-rich plasma.

METHODSFrom April 2010 to June 2012,15 patients with refractory wound were treated including 11 males and 4 females with an average age of 35.2 years old ranging from 18 to 45 years old. The formation time of wound was from 6 to 24 months, which was unhealed after long-term medication or repeated treatment. The VSD combined with autologous platelet-rich plasma was applied to treat the wound. The wound healing was an indicator and treatment and clinical features were summarized.

RESULTSAll the patients were followed up for 3 to 8 months (means 5 months). The wound of all patients were healed without recurrence.

CONCLUSIONThe curative effect of VSD combined with platelet rich plasma for treatment of refractory wounds is obvious. It could reduce the treatment course and the treatment cost.

Adolescent ; Adult ; Drainage ; methods ; Female ; Humans ; Male ; Middle Aged ; Negative-Pressure Wound Therapy ; methods ; Platelet-Rich Plasma ; metabolism ; Wound Healing ; Wounds and Injuries ; metabolism ; physiopathology ; therapy ; Young Adult

Stress conditions such as sepsis, trauma, burn, fracture, and major surgery are associated with hypermetabolism and hypercatabolism. Protein is mobilized for energy and uptake of amino acids by muscle tissue is decreased in stress conditions. The metabolic response to stress causes movement of amino acids (predominantly alanine and glutamine) from peripheral reserves to metabolically active tissues. Glutamine is a conditionally essential amino acid during stress. Glutamine plays a role in maintenance of intestinal immune function and reinforcement of wound repair. Supplementation of parenteral glutamine (0.3~0.5 g/kg/day) as a component of nutrition support may improve clinical outcomes in appropriate patients. In patients with multiorgan failure, supplementation with a high dose of glutamine (>0.5 g/kg/day) in the acute phase of critical illness is not recommended. In stress conditions, provision of adequate protein is essential and glutamine supplementation should be considered in patients without specific contraindications.
Alanine ; Amino Acids ; Burns ; Critical Illness ; Glutamine* ; Humans ; Metabolism* ; Sepsis ; Wounds and Injuries

Traumatic stressor could lead to a series of neuroendocrine responses, such as increased sympathetic activity and secretion of stress hormones, because of the local-pathological-changed tissues and stress response. These changes will have a huge impact on nutrient metabolism. In this article, we reviewed the researches on the change in lipid metabolism after trauma, associated factors, possible mechanisms and possible interventions.
Lipid Metabolism ; Risk Factors ; Wounds and Injuries ; metabolism

OBJECTIVE: To explore the effect of nitric oxide (NO) on the gene expression of hepatic TNF-α and IL-1β by crush injury of rat's soft tissues. METHODS: Rats were randomly divided into sham group, crush group, crush+aminoguanidine (AG) group, and crush+L-arginine (L-Arg) group. Activities of ALT and AST as well as NO level in serum were measured. Gene expressions of TNF-α and IL-1β were detected with RT-PCR. RESULTS: Obvious increase in TNF-α and IL-1β mRNA expression was detected in the crush group compared with the sham group (P<0.05). After pretreated L-Arg, expressions of TNF-α and IL-1β mRNA were markedly increased (P<0.05). After pretreated AG, those indices obviously decreased (P<0.05). Activities of ALT and AST enhanced and NO level increased in the crush group compared with the sham group (P<0.05). Pretreatment with L-Arg or AG led to substantial increased or reduced activities of ALT and AST as well as NO levels, respectively. CONCLUSION Endogenous NO mediated TNF-α, IL-1β mRNA up expression in liver induced by increased production of NO after crush injury of rat's soft tissues.
Animals ; Gene Expression ; Interleukin-1beta/metabolism* ; Liver ; Nitric Oxide/physiology* ; RNA, Messenger ; Rats ; Tumor Necrosis Factor-alpha/metabolism* ; Wounds and Injuries

Trauma can induce a series of dynamic metabolic responses with different characteristics in three stages, including ebb phase, flow phase, and recovery phase. Nutrition support after trauma should be dynamically adjusted according to metabolic response and its individual phase, focusing on energy balance as well as metabolic modulation, adjusting immunological response to trauma by reduction of the exaggerated cytokines production, maintaining body protein balance, and enhancing wound healing.
Energy Metabolism ; Humans ; Nutritional Support ; Wound Healing ; Wounds and Injuries ; metabolism ; therapy