Toexploretheclinicaleffectofgracilismuscleislandcomposite tissue flap combined with local scar fascia flap in repairing stage Ⅳ sinus cavity pressure injury in ischial tuberosity.
Methods
A retrospective analysis was conducted on the clinical data of 45 patients with stage Ⅳ sinus cavity pressure injury in ischial tuberosity who met the inclusion and exclusion criteria and were admitted to the Department of Burns and Cutaneous Surgery in the First Affiliated Hospital of Air Force Medical University from April 2015 to April 2023. There were 38 males and 7 females. The age ranged from 23 to 64 years， with an average of 41 years. After optimizing the overall condition of the patients， the pressure injury lesion tissues were completely removed through en bloc resection and debridement. After being treated with negative pressure suction combined with enclosed lavage， the gracilis muscle island composite tissue flap combined with local scar fascia flap was used to fill the sinus cavity for repair.
Results
All composite tissue flaps survived postoperatively， with a good appearance and soft texture. Five cases of pressure injury wounds had poor healing， of which two cases healed after three weeks of bedside debridement and dressing changes，and three cases healed after undergoing surgical debridement and suturing again. Three cases of poor healing in the donor area were healed after three weeks of debridement and dressing changes. The total incidence of complications was 17.8%（8/45）. Follow-up for 6-18 months showed no recurrence of pressure injuries in the patients.
Conclusion
The combination of gracilis muscle island composite tissue flap and the local scar fascia flap for the repair of stage Ⅳ sinus cavity pressure injury in ischial tuberosity is reliable， with few complications and a low recurrence rate.
Exploring the clinical application value of the combination of 3D digital subtraction angiography （3D-DSA） and color Doppler flow imaging （CDFI） for positioning precisely on the perforator vessels in the preoperative evaluation of the anterolateral thigh perforator flap （ALTFP） for repairing lower limb defects after leg salvage surgery.
Methods
From June 2022 to June 2023， 25 cases of wounds after lower leg limb-sparing surgery were covered with ALTFP in Department of Traumatic Orthopedics of Suzhou Ruihua Orthopedic Hospital. Prior to surgery， 3D-DSA combined with CDFI was used to locate the perforator vessels of ALTFP and the vessels in the affected area of the leg wound. The preoperative location of the perforator vessels in the skin flap， the number， diameter， and type of perforator were recorded， as well as the type and diameter of the vessels in the affected area of the leg wound were recorded. The number， diameter， type of perforations of the skin flap during surgery， as well as the compatibility rate between the vascular pedicle of the skin flap and the diameter of the blood vessels in the affected area of the leg wound were recorded， to verify the accuracy of preoperative combined positioning and the efficiency of skin flap harvesting. Postoperative flap survival rate and complications in the flap donor site were collected.
Results
In this series of 25 cases， the combination of 3D-DSA and CDFI was used to identify 70 perforators， of which 40 were actually utilized during surgery. The remaining unused perforators were not traced back to their origins. All the perforators used in the surgery were the preoperatively localized ones， with a positive predictive value of 100%. The average length of the vascular pedicles measured intraoperatively was 12.96 （8-18）cm， and the average predicted length of the vascular pedicles before surgery was 13.76 （7-19）cm， with the difference within 1-3 cm. The average proximal caliber of the main vessel was 1.77（1.55-1.90）mm， which could be matched and anastomosed with the recipient area vessels.According to the preoperative design， the flaps met the requirements for intraoperative wound repair. The preoperative angiography exposure time was 45（30-70）seconds. The time spent on harvesting the flap was 25（10-60）minutes. All 25 flaps survived successfully， with primary healing of both the donor and recipient sites， and no vascular complications occurred in the flaps postoperatively. Length of hospitalization was 14-60 days after flap coverage， with an average of 25 days. Postoperative follow-up was conducted 6-18 months， with no wound infections observed. The flaps exhibited healthy reddish color， no significant hyperpigmentation， soft texture， and good appearance. All postoperative fractures achieved union.
Conclusion
3DDSA combined with CDFI can accurately locate the blood vessels of ALTPF and recipient vessels in the lower leg wound area. This approach provides excellent preoperative plan for transplantation of free ALTPF to repair the wound after limb salvage in the lower leg， which is worth reference in clinical applications.
To investigate the clinical efficacy and influencing factors of double reverse traction external fixation frame combined with intramedullary nailing in the treatment of multiple tibial fractures.
Methods
The clinical data of 110 patients with multiple tibia fractures who were admitted to the Department of Orthopedics and Traumatology in Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University from February 2021 to December 2022 were selected， and they were divided into 55 cases of the double-reverse retractor combined with intramedullary nailing group and 55 cases of the traditional compression plate combined with intramedullary nailing group according to the different treatment modalities， and the differences in the surgery-related indexes， ankle function （Kofoed score）， joint mobility and fracture healing rate at 3 months after surgery and the factors influencing the prognosis of the fracture were analyzed.
Results
The operation time［（64.29±17.46） min］， intraoperative bleeding［ （41.99±6.21） ml］， fracture end dissection rate （16.36%）， fracture healing time［（21.82±5.76） weeks］， and time to get out of bed ［ （4.24±1.29） weeks］were lower in the double retractor combined with intramedullary nailing group than in the traditional compression plate combined with intramedullary nailing group ［（89.71±23.58） min， （56.69±12.00） ml， 45.45%， （30.87±7.77） weeks， （6.36±1.75）weeks］（t/χ2=5.247， 6.966， 10.890， 6.942， 7.236， P＜0.05）， and the fracture healing rate was higher than that of the traditional compression plate combined with intramedullary nailing group at 3 months postoperatively （85.45% vs 67.27%）（χ2=5.037， P＜0.05）. Repeated-measures ANOVA showed that the Kofoed scores of both groups at the time of external fixation and at the last follow-up were higher than those of the preoperative period （P＜0.05）， and the Kofoed scores at the time of external fixation and at the last follow-up were higher in the double-reverse retractor combined with intramedullary nailing group ［（83.59±5.14）points and （94.67±5.53）points］than those in the conventional compression plate combined with intramedullary nailing group ［（79.54 ±5.21） points， （88.39±5.42） points］（t=3.191， 4.651， P＜0.05）. The ankle joint range of motion and knee joint range of motion at the last follow-up were higher than those at external fixation in both groups （P＜0.05）， and the ankle joint range of motion and knee joint range of motion at external fixation and at the last follow-up in the patients in the double-reverse retractor combined with intramedullary nailing group ［（50.30±4.51）°， （100.81±11.96）°］were higher than those in the traditional compression plate combined with intramedullary nail group ［（37.21 ±4.66）°， （82.72±8.96）°］（t=11.678，6.660， P＜0.05）. Patients were categorized into healed and non-healed groups according to their postoperative fracture healing status. Logistic regression analysis showed that age （≥60 years）， cause of fracture （high energy）， time from injury to treatment （≥6 h）， and timing of soft tissue repair （second stage repair） were risk factors for fracture healing， and albumin level was a protective factor for fracture healing （OR=9.369， 4.961， 6.825， 10.000， 0.830， P＜0.05）.
Conclusion
The combination of dual reverse traction device and temporary external fixator for the treatment of multiple tibial fractures has a good clinical effect， which can effectively improve ankle joint function and joint mobility， promote postoperative fracture healing. ≥60 years old， high energy fracture， time from injury to treatment ≥6 hours， secondary soft tissue repair， and albumin level are factors related to fracture healing. Clinical attention should be paid to these factors.
To analyze recent 10 years literature on inhalation injury， and to explore the current situation and frontiers in this field.
Methods
Using bibliometric methods searched for Chinese and English literature related to inhalation injury published from January 1， 2015， to July 5， 2024， in China National Knowledge Infrastructure （CNKI）， Wanfang Database， VIP Database， and Web of Science Core Collection，and utilized CiteSpace 6.1.R6 software for analysis.The publication volume， authors， countries and institutions of both Chinese and English literature were statistically analyzed. Co-occurrence analysis of keywords was performed， followed by cluster analysis and burst detection. Keywords were sorted by time to obtain a cluster timeline， exploring the current research status and the evolution of hotspots in the field of inhalation injury.
Results
A total of 609 English articles were retrieved from the Web of Science Core Collection， and 521 Chinese articles were obtained after deduplication from CNKI， Wanfang Database， and VIP Database. From 2015 to 2024， the number of English publications in the field of inhalation injury showed a steady upward trend， while the number of Chinese publications showed a declining and then stabilizing trend. In the Chinese literature， 289 authors published articles on inhalation injury as the first author， with 32 core authors publishing three or more articles. In the English literature， 353 authors published articles as the first author. A total of 56 countries conducted research on inhalation injury， with the United States being the country with the most collaborations and publications. A total of 497 institutions published articles on inhalation injury， with the First Affiliated Hospital of Nanchang University （25 articles） and the University of Texas Medical Branch （37 articles） being the institutions with the most publications in Chinese and English， respectively. A co-occurrence analysis of 308 Chinese keywords and 330 English keywords was conducted. After excluding keywords related to search terms， the Chinese literature frequently featured keywords such as nursing， tracheotomy， and risk factors， while the English literature frequently featured keywords such as mortality， management， and epidemiology. The Chinese keyword analysis identified 38 clusters， with the largest clusters being risk factors， followed by nursing and severe burns. Recent burst nodes included indicator system and drug resistance. The English keyword analysis identified 18 clusters， with the largest clusters being baux score， followed by extracorporeal membrane oxygenation and acute kidney injury. Recent burst nodes included intubation and difficult airway.In the Chinese literature， the keyword with the longest burst duration （2021-2024） and highest burst strength was risk factors. In the English literature， the keyword with the longest burst duration （2016-2019）and highest burst strength was acute respiratory distress syndrome.
Conclusion
Epidemiological studies on inhalation injury in China are scarce. In the future， the development of diagnostic and assessment criteria for evaluating the condition of patients with inhalation injury is expected to become a significant trend， which can aid clinicians in determining the optimal timing for tracheostomy and improve patient outcomes.
To establish a comprehensive nursing training program focused on trauma care to serve as a reference and foundation for enhancing the standards and quality of trauma management within the hospital.
Methods
Drawing on the disease data survey from the War （Burn） Trauma Center at the First Affiliated Hospital of Naval Medical University， a training program integrating generic and specialty indicators was developed based on an evidence-based approach. Following this， a preliminary questionnaire was formulated by the research team， and two rounds of expert consultations were conducted using the Delphi method to ascertain the weights of each indicator. The consistency of the program was subsequently validated through Analytic Hierarchy Process.
Results
The response rates for both rounds of questionnaires achieved 100%， with expert authority coefficients ranging from 0.877 to 0.933. The Kendall′s coefficient of concordance was recorded at 0.123 and 0.208 （P＜0.001）， indicating successful consistency testing. A comprehensive nursing emergency care skills training program for the in-hospital trauma center had been established， encompassing classification indicators for six types of injuries； common indicators comprising six primary indicators， 23 secondary indicators， and 88 tertiary indicators； specialty indicators including 12 secondary and 31 tertiary indicators for burn injuries； five secondary and 14 tertiary indicators for craniocerebral injuries； six secondary and 15 tertiary indicators for multiple fractures； two secondary and nine tertiary indicators for abdominal injuries； five secondary and ten tertiary indicators for chest injuries； as well as seven secondary and 15 tertiary indicators pertaining to spinal cord injuries.
Conclusion
The nursing training program for trauma care within the hospital′s intensive care unit is meticulously designed， incorporating comprehensive indicators and content that emphasize both specialty and practicality. Given the advantageous conditions of an ongoing enhancement of a seamless treatment linkage platform， this program serves as a valuable reference for effectively elevating nursing rescue capabilities and quality.
To explore the relationship between disease uncertainty， caregiver burden and quality of life in family members of severely burned patients.
Methods
A simple sampling method was used to select 80 family members of severely burned patients admitted to the Department of Burns， Tongren Hospital of Wuhan University &Wuhan Third Hospital from October 2020 to October 2022. The patients′family members were provided with mishel uncertainly in illness scale for family member（MUIS-FM），caregiver burden inventory （CBI） and 36-item short-form health （SF-36）. Correlation analysis was conducted based on the questionnaire results， and a structural equation model was built.
Results
A total of 80 questionnaires for MUIS-FM， CBI and SF-36 were distributed respectively and effectively recovered. The disease uncertainty of 80 family members of severely burned patients was at the intermediate level， of which 22.5%（18/80）， 61.3%（49/80） and 16.3%（13/80） were at the low， middle and high level of MUIS-FM scores， respectively. The caregiver burden of patients′ family members was at the severe level， of which 21.3%（17/80）， 23.8%（19/80） and 55.0%（44/80） were at the mild， moderate and severe level of CBI scores， respectively. All dimensions of quality of life and total SF-36 scores of patients′ family members were at a low level. The disease uncertainty score of family members of severely burned patients was positively correlated with the caregiver burden score （r=0.420，P＜0.001）， and negatively correlated with the quality of life score （r=-0.326，P=0.009）. The caregiver burden score was negatively correlated with the quality of life score （r=-0.420，P=0.003）. The disease uncertainty played a mediating role between the caregiver burden and the quality of life of the family members of severely burned patients. The direct effect of caregiver burden on quality of life was -0.53， the total effect was -0.97. The indirect effect of disease uncertainty was-0.44， which comprised 45.36% of the total effect.
Conclusion
The caregiver burden of the family members of severely burned patients can directly affect their quality of life. The disease uncertainty plays a part of intermediary role between the caregiver burden and the quality of life. The caregiver burden can indirectly affect the quality of life by influencing the disease uncertainty. Therefore， attention should be paid to improving the caregiver burden of the family members of severely burned patients to improve their quality of life.
To understand the metabolic changes of severe burn rats under plateau and cold conditions by metabolomics technology， map the metabolic fingerprint of rats or burn rats in plateau environment， screen potential metabolic markers， and provide evidence for the development of nutritional treatment of burn at high altitude.
Methods
A total of 60 healthy male SD rats were randomly divided into non-plateau control group， plateau group and plateau burn group. The 1st， 3rd， 7th， and 14th day after establishing model were set as the observation phase points， with 5 experimental rats at each time. Rats in plateau group and plateau burn group were fed in a simulated plateau condition of 5 000 meters above sea level in a special environment simulation chamber in northwest China. Rat models with a 30% total body surface area （TBSA） full-thickness burn were established in plateau burn group. Blood samples from each group were collected and detected by high performance liquid chromatography-tandem mass spectrometry（HPLC-MS/MS） at 1，3，7，14 d after the model was established. Principal component analysis （PCA） and orthogonal partial least squares discriminant analysis （OPLS-DA） were used to draw metabolic fingerprints of plateau rats and plateau burn rats. Metabolic markers related to altitude and altitude burn were screened by Z-score， volcano plot and box-plot analysis.
Results
Compared with the non-plateau control group， the metabolites in the plateau rats and the plateau burn rats showed obvious clustering at each time point， and the metabolic fingerprints of the plateau rats and the plateau burn rats were successfully mapped. A total of 118 metabolites with high expression （mainly included D-maltose，glycine， nicotinamide ribose） and 101 metabolites with low expression （mainly included perilline，mannitol， sorbitol） were selected in the plateau rats. Glycine， 2-ethyl-2-hydroxybutyric acid， D-2， 3-dihydroxypropionic acid， leucine， 2-hydroxycaproic acid， 3-hydroxybutyric acid， uracil， L-histidine and cysteine sulfate were selected as potential metabolic markers in plateau burn rats.
Conclusion
The metabolic fingerprint of severely burned rats in plateau environment was successfully mapped by applying metabolomics methods. The selected metabolites may be potential markers related to the special environment of plateau and plateau burn.
To explore the impact of cellular senescence on acute lung injury in septic mice.
Methods
Forty-five 8-week-old male C57BL/6 mice were selected and randomly divided into sham surgery group， model group， and ABT-263-treated group for senescent cells（ABT-263 group）， with 15 mice in each group. The acute lung injury in sepis model was set up by cecal ligation and puncture. The sham surgery group only exposed the cecum without performing ligation or puncture procedures. The ABT-263 group was given intragastric administration of ABT-263 at a dose of 100 mg/kg once a day. The expression of cellular senescence markers（p16INK4A and p21CIP1）， senescence-associated secretory phenotype（SASP） related inflammatory cytokines， chemokines， matrix metalloproteinases， cell proliferation marker Ki67 and cell cycle-related molecules in the lung tissues of the mice were detected. Additionally，pathological changes in lung tissue and the senescence of alveolar macrophages were observed using HE staining and β-galactosidase staining.
Results
Compared to the sham surgery group，the expression of p16INK4A in the lung tissues， and the expression of SASP-related genes of the model group were significantly higher， while the expression of Ki67 was significantly lower. The proportion of alveolar macrophage β-galactosidase-positive cells in the model group was significantly higher than that in the sham surgery group. Compared to the model group， the expression of p16INK4A and p21CIP1 in the lung tissues， and the expression of SASP-related genes in the ABT-263 group were significantly lower， while the expression of Ki67 was significantly increased. The proportion of alveolar macrophage β-galactosidase-positive cells in the ABT-263 group was significantly lower than that in the model group. The injury score of lung tissues in the ABT-263 group was significantly lower than that in the model group.
Conclusion
Cellular senescence is correlated with acute lung injury in sepsis， and the elimination of senescent cells can significantly alleviate acute lung injury in sepsis.
To investigate the effects of hsa_circ_0001618 on the proliferation， migration，and apoptosis of post-burn skin fibroblasts through the miR-184/LARP1 pathway.
Methods
Skin tissue samples were obtained from 17 patients with second or third-degree burn admitted to the Burns Department of Ningbo No.2 Hospital in May 2020. Quantitative real-time polymerase chain reaction （qRT-PCR） was used to detect the expression of hsa_circ_0001618， miR-184， and LARP1 in fibroblasts and tissue samples.Proliferation， migration， and apoptosis of fibroblasts were analyzed using CCK-8 assay，Transwell experiments，and flow cytometry， respectively. Gene expression regulation was observed through dual-luciferase reporter gene assays and Western blot. Bioinformatics methods were used to analyze the role of hsa_circ_0001618/miR-184/LARP1 axis in the proliferation， migration， and apoptosis of post-burn skin fibroblasts.
Results
Compared to normal tissues， the expression of miR-184 was downregulated in burn tissues （0.413±0.348 vs 0.122±0.097，P=0.001）. The expression level of miR-184 in skin fibroblasts decreased after heat treatment compared to untreated control fibroblasts， with the most significant decrease at 48 h （0.994±0.028 vs 0.173±0.019，t=3.120，P＜0.001）. Overexpression of miR-184 inhibited the proliferation and migration，and promoted the apoptosis of fibroblasts （P＜0.05）. miR-184 was negatively correlated with LARP1 in fibroblasts （r=-0.468， P=0.032）. Bioinformatics analysis showed that hsa_circ_0001618 regulated the proliferation， migration， and apoptosis in skin fibroblasts after thermal injury through miR-184.
Conclusion
hsa_circ_0001618 inhibits the proliferation and migration， and promotes the apoptosis of post-burn skin fibroblasts via the miR-184/LARP1 pathway， potentially serving as a therapeutic target to promote burn wound healing.
After severe burns， the skin′s natural barrier function is destroyed， causing pathogens to invade the body and cause sepsis， endangering the life of the patient seriously.Although the survival rate of sepsis patients has been improving in recent years， the mortality rate is still as high as 30%-60%.If can identify the relevant biomarkers after severe burn and realize early diagnosis of sepsis after burn， the survival rate of patients can be greatly improved.In this paper， the traditional and new biomarkers of post-burn sepsis are reviewed， aiming to provide theoretical basis for the early diagnosis of post-burn sepsis.
Nonfermenting gram-negative bacilli are the most common pathogenic bacteria in burn infection and play an important role in burn infection. The treatment of burn infection is an important part of burn management， heteroresistance is an important topic of microbial infection， which may cause clinical treatment failure， while heteroresistance of nonfermenting gram-negative bacilli may play an important role in burn infection. This article focuses on the current situation of nonfermenting gram-negative bacilli（pseudomonas aeruginosa and acinetobacter baumannii） infection in burns， the concept and mechanism of heteroresistance， heteroresistance of nonfermenting gram-negative bacilli and heteroresistance of nonfermenting gram-negative bacilli in the treatment of burn infection， looking forward to providing new perspectives and ideas for the treatment of burn infection.
Acute lung injury （ALI）/acute respiratory distress syndrome （ARDS） is a clinically critical syndrome with a high mortality rate. At present， there is no effective treatment strategy， and the prognosis of most patients is poor. At present， research has found that mesenchymal stem cell-derived exosomes （MSC-Exos） have functions ，such as inhibiting excessive lung inflammation， suppressing alveolar cell apoptosis， promoting epithelial cell regeneration and alleviating mitochondrial damage. This article reviews the possible mechanisms about how MSC-Exos improves ALI/ARDS， providing new therapeutic approaches for ALI/ARDS.
Vascular dysfunction is one of the main reasons for delayed healing in chronic nonhealing wounds，and promoting adaptive angiogenesis is key to treating chronic non-healing wounds.Mesenchymal stem cells （MSCs） and exosomes derived from MSCs possess the ability to induce angiogenesis and promote wound repair. Compared to the stem cells themselves，exosomes offer advantages such as lower immunogenicity，higher stability，greater bioactivity，and a reduced risk of tumorigenesis. This article focuses on recent advancements in understanding the mechanisms by which MSC-derived exosomes promote angiogenesis in wound healing，aiming to provide new insights for wound therapy.
