To explore the relationship between nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) inflammasome, inflammatory factors, cysteine aspartic acid protease-1 (Caspase-1) and the prognosis of burn combined with inhalation injury.

The clinical data of 47 burn patients with inhalation injury from March 2015 to December 2019 in Department of Burn Surgery, Beihai People′s Hospital were analyzed retrospectively. The patients were divided into good prognosis group (n=19) and poor prognosis group (n=28) according to the recovery of disease during hospitalization. The clinical data of all patients were collected, including sex, age, hospitalization time after burns, burns area, burns depth. The levels of interleukin (IL)-1β, IL-6, IL-8, IL-18 and tumor necrosis factor-α (TNF-α) in serum were collected. NLRP3 inflammasome mRNA and Caspase-1 mRNA in peripheral blood mononuclear cells were detected by enzyme-linked immunosorbent assay(ELISA) and real-time quantitative polymerase chain reaction (qRT-PCR) respectively. Data were analyzed with t test, chi-square test or Fisher exact probability method, multivariate logistic regression and pearson correlation.

There were no statistically significant differences in gender, age, hospitalization time, burns area, burns depth and IL-6 between the two groups (with P values above 0.05). The expression levels of IL-1β, IL-18, NLRP3 inflammasome mRNA and Caspase-1 mRNA in good prognosis group were (37.28±6.54) pg/mL, (38.26±8.79) pg/mL, 1.75±0.35 and 1.15±0.27, while those in poor prognosis group were (49.46±8.87) pg/mL, (76.83±10.58) pg/mL, 2.23±0.41 and 1.94±0.36. The differences between the two groups were statistically significant (t=5.11, 13.10, 4.17, 8.13; with P values below 0.05). Multivariate logistic regression analysis showed that the levels of IL-1β, IL-18, NLRP3 inflammasome mRNA and Caspase-1 mRNA were independent risk factors for poor prognosis of burn inhalation injury (β= 1.56, 0.87 1.05, 1.11; with P values below 0.05). Pearson correlation analysis showed that the levels of IL-1β, IL-18, NLRP3 inflammasome mRNA and Caspase-1 mRNA were positively correlated with the poor prognosis of burn inhalation injury (r= 0.42, 0.39, 0.52, 0.56; with P values below 0.05).

Abnormal elevated levels of IL-1β, IL-18, NLRP3 inflamesome, and Caspase-1 can be used as indicators of poor prognosis in patients with burn inhalation injury, and can guide clinical early treatment according to these indicators, which can help reduce the mortality of patients with burn combined with inhalation injury.

To explore the clinical effect of carbon dioxide fractional laser combined with conventional rehabilitation methods on hypertrophic scar after burned.

From January to December 2018, 59 patients with hyperplastic scars after burns admitted to Kunshan Rehabilitation Hospital were divided into rehabilitation group (n=30) and laser group (n=29) by the random number table method. Conventional scar treatments in the rehabilitation group and laser group include: topical silicone preparations, pressure therapy, scar massage, ultrasound therapy, etc.; both the rehabilitation group and laser group were received burn rehabilitation treatment [exercise therapy (joint mobility training, joint loosening therapy, muscle strength training, aerobic training, etc.), occupational therapy (daily self-care ability training, hand function training, recreational activities, etc.), physical factor therapy (air pressure therapy, red and blue light therapy on wounds, etc.), psychological rehabilitation, orthopedic therapy, hydrotherapy, etc.]. Patients in the laser group were treated with carbon dioxide fractional laser treatment on the basis of conventional scar treatment and burn rehabilitation treatment, once every 2 months. Both groups of patients were treated continuously for 12 months. Before and after treatment (at the 12th month after enrollment), the Vancouver scar scale (VSS) was used to assess the scar; before treatment, immediately after the first laser treatment, 1 d after the first laser treatment, 14 d after the first laser treatment, and after treatment (at the 12th month after enrollment), the degree of scar tightening of patients were scored by the visual analogue scale (VAS); after treatment (at the 12th month after enrollment), the VAS was used to evaluate the patient′s satisfaction with the scar curative effect and the satisfaction rate was calculated; the occurrence of adverse reactions in patients within 12 months were recorded. The data were analyzed by t test, Mann-Whitney U test, Wilcoxon test and chi-square test.

(1) Before treatment, there was no significant difference in VSS score between the two groups (Z=-0.777, P>0.05); after treatment (at the 12th month after enrollment), the VSS scores of patients in the laser group and rehabilitation group were [10.00 (9.00, 10.00) points and 12.00 (10.75, 13.00) points], which were significantly lower than those before treatment, the differences were statistically significant (Z=-4.795, -4.852; with P values below 0.05), and the VSS score of the laser group was significantly lower than that of the rehabilitation group, the difference was no statistically significant (Z=-4.514, P<0.05). (2) Before treatment, there was no significant difference in the VAS score of the degree of scar tightening between the two groups (Z=-1.420, P>0.05); immediately after the first laser treatment, 1 d after the first laser treatment, 14 d after the first laser treatment, and after treatment (at the 12th month after enrollment), the VAS score of the degree of scar tightening in the laser group [2(1, 3), 3( 3, 4), 6 (6, 7), 7 (6, 7) points] were significantly lower than before treatment [10(10, 10) points], and the differences were statistically significant (Z=-4.736, -4.788, -4.760, -4.767; with P values below 0.05); patients in the rehabilitation group immediately after the first laser treatment, 1 d after the first laser treatment, 14 d after the first laser treatment, and after treatment (at the 12th month after enrollment), the VAS score of the degree of scar tightness [8 (8, 10), 9 (9, 10), 8 (8, 9), 8 (8, 9) points] were significantly lower than the before treatment [10 (9, 10) points], the differences were statistically significant (Z=-5.035, -2.828, -2.449, -5.002; with P values below 0.05); and immediately after the first laser treatment, 1 d after the first laser treatment, 14 d after the first laser treatment, and after treatment (at the 12th month after enrollment), the VAS scores of the patients in the laser group were significantly lower than those in the rehabilitation group, the differences were statisctically significant (Z=-6.651, -6.732, -4.953, - 6.029, with P values below 0.05). (3) After treatment (at the 12th month after enrollment), the frequency distribution of satisfaction grading in the laser group was statistically different than that in the rehabilitation group (Z=-2.214, P=0.027); the satisfaction rate of patients in the laser group (58.62%) was high than that in the control group (36.67%); the difference in the number of satisfied cases/dissatisfied cases in the laser group (17/12) and the rehabilitation group (11/19) was statistically significant (χ²=9.696, P=0.002). (4) The incidence of adverse reactions in the laser group was 10.34% (3/29), and the incidence of adverse reactions in the rehabilitation group was 6.67% (2/30), there was no statistically significant difference in the incidence of adverse reactions between the two groups (χ² =0.579, P=0.447).

Carbon dioxide fractional laser combined with rehabilitation measures are more effective in treating hypertrophic scar than using rehabilitation measures alone, and the patient′s scar tightening feeling is improved more significantly, and the curative effect satisfaction is higher.

To explore the influence of new high frequency square wave electric pulse in the ablation treatment of liver cancer in rats.

Tumor cells suspension was prepared by in vitro culture of liver cancer McA-RH7777 cells, and 50 clean SD rats were injected intrahepatically to establish a liver cancer model. One week after modeling, 40 liver cancer model rats were randomly selected and divided into an experimental group (n=26) and a control group (n=14) according to the simple sampling method. The liver tumors of the experimental group rats were treated with electrical pulses at a field intensity of 2 000 V/cm, while the tumors of the control group rats were treated with pulses at a field intensity of 0, frequency of 1 Hz and pulse width of 100 μs. Blood samples were collected from tail vein on 3 and 1 d before operation and 1, 7, 14, 21 and 30 d after operation, and serum biochemical indexes [alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine, urea nitrogen, creatine kinase (CK), lactate dehydrogenase (LDH)] and the tumor marker alpha-fetoprotein (AFP) were monitored. The changes of tumor length was recorded at 1 d before operation and 7, 14, and 21 d after operation in the two groups of rats, and the survival time was recorded at 60 d after operation, in the two groups of rats, respectively, and the related complications were recorded during the treatment process. Two rats in the experimental group and the control group were randomly sacrificed 30 d after operation. The expression levels of cysteine aspartic acid protease-3 (Caspase-3), B-cell lymphoma-2 proto oncogene (Bcl-2), Bcl-2 related X protein (Bax) in the tumor tissues of the target area of the ablation of the rats in the two groups were detected. Lignin-eosin staining, vascular endothelial growth factor (VEGF) immunohistochemical observation of histomorphological changes, KI67 staining, TUNEL staining, cell proliferation rate and cell apoptosis rate were calculated. Data were analyzed by t test, repeated measures, Kaplan-Meier curves and chi-square test.

ALT, AST, CK, LDH level were compared at different time points in the experimental group at 3, 1 d before operation and 1, 7, 14, 21, 30 d after operation, the differences were statistically significant (F=41.458, 39.842, 33.343, 52.335; with P values above 0.05), there were no differences in creatinine and blood urea nitrogen at different time points in rats (F=0.702, 2.429; with P values above 0.05). ALT and AST were compared at 3, 1 d before operation and 1, 7, 14, 21, 30 d after operation in the control group, the differences were statistically significant (F=12.267, 3.646; with P values below 0.05), and there were no statistically significant differences in creatinine, blood urea nitrogen, CK and LDH at different time points(F=0.885, 1.100, 1.773, 1.338; with P values above 0.05). There were no statistically significant differences in the levels of ALT, AST, creatinine, blood urea nitrogen, CK, and LDH between the experimental group and the control group at 1 and 3 d before operation (with P values above 0.05). There were obvious differences in ALT and AST at 1, 21, and 30 d after operation between the experimental group and the control group and the differences were statistically significant (t=5.414, -9.993, -9.362; 4.345, -4.802, -7.159; with P values below 0.05). There were no statistically significant differences in creatinine and blood urea nitrogen at 1, 7, 14, 21, and 30 d after operation between the two groups (t=0.651, 0.322, 0.045, -0.760, -0.741; 4.345, 0.784, -1.835, -4.802, -6.415; with P values above 0.05). CK and LDH were compared between the experimental group and the control group at 1 and 7 d after operatio, the differences were statistically significant (t=5.613, 4.437, 7.817, 5.183; with P values below 0.05). The tumor marker AFP levels were (4.63±0.53), (4.84±1.63), (5.54±1.96), (3.87±2.19), (2.34±0.28), (1.61±0.51), (1.18±0.36) ng/L at 3, 1 d before operation and 1, 7, 14, 21, 30 d after operation in the experimental group, the difference was statistically significant (F=44.339, P<0.05). The tumor marker AFP levels of the control group at each time point were (4.44±0.91), (4.61±0.91), (4.86±0.95), (5.55±1.08), (6.10±1.42), (6.93±1.80), (6.70±2.686) ng/L, the difference was statistically significant (F=6.184, P<0.05). At 3 and 1 d before operation, there were no significant differences in AFP levels between the experimental group and the control group (t=0.862, 0.501; P=0.414, 0.619); at 7, 14, 21, and 30 d after operation, the difference between the experimental group and the control group were statistically significant (t=-2.682, -9.004, -10.809, -7.762; with P values below 0.05). The tumor length diameter of the experimental group were (11.2±3.1), (8.1±2.3), (5.3±1.6), (3.5±1.1) mm at 1 d before operation and 7, 14, 21 d after operation, respectively, while the tumor length diameter of the control group were (9.8±2.1), (14.1±2.7), (17.8±3.7), (14.4±2.7) mm at each time point. There was no statistically significant difference in tumor length diameter between the two groups at 1 d before operation(t=1.526, P=0.135). At 7, 14, and 21 d after operation, the differences in the length diameter between the experimental group and the control group were statistically significant (t=-7.330, -14.800, -18.244; with P values below 0.05). Compared with the control group 30 d after operation, the results of protein blotting showed that the expression levels of Caspase-3 and Bax increased and Bcl-2 decreased in the experimental group. Thirty days after surgery, hematoxylin-eosin staining was performed on tumor tissue. In the experimental group, a large number of tissue necrosis and obvious apoptotic areas were observed, while the cell duct results remained intact. No obvious destruction of tumor cells was observed in the control group. Thirty days after surgery, immunohistochemical staining of VEGF was performed on tumor tissues. In the experimental group, the cell structure arrangement was still clear, no obvious cell destruction was observed, and only a small amount of brown-yellow positive staining (1+ , moderate staining) was observed. In the control group, the arrangement of cells was disordered, with a large amount of brown-yellow positive staining (4+ , strong staining). Thirty days after surgery, the tumor tissues were stained with KI67 immunohistochemistry. In the experimental group, the cell structure arrangement was intact, no obvious damage was observed, and only a small amount of brown-yellow positive staining (1+ , weak staining) was observed. In the control group, the tissue structure was disordered, and the cells showed a large number of brown-yellow positive staining (4+ , strong staining). TUNEL staining was performed on tumor tissue 30 days after surgery. In the experimental group, the cell arrangement was slightly disordered and the structure of the pipeline was unclear. In the control group, the tissues were neatly arranged with only a small amount of brown-yellow positive staining. The tumor cell proliferation rates of the experimental group and the control group were (2.8±0.8)% and (43.1±3.8)%, respectively, and the difference was statistically significant (t=3.765, P<0.05). TUNEL staining showed strong staining in the experimental group and weak staining or no staining in the control group, the apoptosis rate of tumor cells in the experimental group and the control group were (76.85±10.27)% and (2.56±1.67)%, respectively, and the difference was statistically significant (t=4.456, P<0.05).

The new high-frequency square-wave electrical pulses can effectively control the local progression of liver cancer in rats.

To study the effect of granulation tissue injection of micropar skin pulp on the healing of traumatic chronic wound in rats.

Sixty SD male rats were selected to make wounds of 3.0 cm×3.0 cm in the back and sewed on the inner edge of the wound with wire coils. The rats were divided into 3 groups according to the random number table method, which were general wound group, chronic wound group and micropar skin pulp group. There were 20 rats in each group. The general wound group was treated with anti-infective therapy and the routine dressing change after the wound was caused by the back. The chronic wound group was treated with anti-infection treatment and routine dressing change after the formation of the back wound. Chronic wound formation was completed by intramuscular injection of hydrocortisone for 7 days. After the formation of the wound on the back of the micropar skin pulp group, anti-infection treatment and the routine dressing change were given, intramuscular injection of hydrocortisone was performed for 7 days in a row to interfere with the formation of the chronic wound, and the microne was prepared from the skin on the lateral side of the right thigh of the rats and injected under granulation tissue. The observation of wound surface was started next day after the completion of modeling, which was set as the observation day. The wound healing of each group was observed on the 7th, 14th, 21st, 28th day of observation and the wound healing rate was calculated. Granulation tissues on 14th day of observation were retained and observed for hematoxylin-eosin staining and CD31 immunohistochemical staining. The distribution of new capillaries was observed under hematoxylin -eosin staining and the expression of CD31, microvessel density of the wound were observed by CD31 immunohistochemical staining. Data were analyzed with one-way analysis of variance and LSD-t test.

On the 14th day of observation, the wound of the general wound group was significantly reduced, the skin climbing of the chronic wound group was not obvious, and most of the wound was healed in the micropar skin pulp group. On the 28th day of observation, there was remaining wound in the general wound group, the wound healing in the chronic wound group were not obvious, most of wounds in the micropar skin pulp group healed. On the 14th, 21st, 28th day of observation, the healing rates of the general wound group were (51.09±0.94)%, (75.43±0.92)%, (86.51±0.57)%, and healing rates of the chronic wound group were (20.30±0.95)%, (35.59±1.18)%, (45.82±1.35)%, and the healing rates of the micropar skin pulp group were (39.00±0.86)%, (64.62±0.15)%, (91.25±0.87)%, the comparative differences were statistically significant (F=1 993.60, 6 475.02, 9 984.47, with P values below 0.05). Comparing the chronic wound group with the general wound group and the micropar skin pulp group respectively on the 14th day of observation, the differences were statistically significant (t=89.90, 50.93, with P values below 0.05). Comparing the chronic wound group with the general wound group and the micropar skin pulp group respectively on the 21st day of observation, the differences were statistically significant (t=117.90, 116.10, with P values below 0.05). Comparing the chronic wound group with the general wound group and the micropar skin pulp group respectively on the 28th day of observation, the differences were statistically significant (t=86.43, 94.29, with P values below 0.05). On the 14th day of observation, hematoxylin-eosin staining was observed on the wound surface, a little new capillaries were observed in the general wound group, no obvious new capillaries were observed in chronic wound group, a large number of new capillaries were observed in the micropar skin pulp group.On the 14th day of observation, the immunohistochemical comparison of CD31 (The positive expression of CD31 was brown-yellow) showed that brown-yellow particles were scattered in the general wound group, while brown-yellow particles were sparsely distributed in the chronic wound group, and a large number of brown-yellow particles could be seen in the micropar skin pulp group.On the 14th day of observation, the comparison of microvascular density was observed, the comparison of microvascular density in the general wound group, the chronic wound group, the micropar skin pulp group were (49.20±17.96), (37.32±9.57), (64.93±20.29) (individual/field of view), the comparative differences were statistically significant (F=34.09, P<0.05), and the chronic wound group was compared with the general wound group, micropar skin pulp group, the differences were statistically significant (t=3.23, 11.50, with P values below 0.05).

Granulation tissue injection of micropan skin pulp can promote vascular proliferation in traumatic chronic wounds in rats, and the wound healing rate is significantly higher, and the wound healing time is shorter.

探讨脱细胞异体网状真皮支架联合自体刃厚断层皮片复合移植修复小儿功能部位瘢痕挛缩创面愈合后的临床效果。

2016年1月至2018年12月，安徽省六安市人民医院收治32例小儿烧伤后功能部位瘢痕挛缩患者，挛缩瘢痕彻底松解后创面缺损面积大小为5.5 cm×4.5 cm～20.0 cm×10.0 cm。运用脱细胞异体网状真皮支架联合自体刃厚断层皮片复合移植封闭创面。术后1个月内每周随访1次，以后每1月随访1次；随访方式均采用门诊复查。术后观察受区真皮支架及刃厚断层皮片成活情况、皮肤弹性及延展情况、外观情况、关节活动功能恢复情况；观察供区愈合情况、瘢痕存留情况。

30例创面经复合移植后，皮片生长、愈合均良好，2例创面移植皮片可见点状表皮坏死，经换药愈合。随访3～12个月，受区皮肤弹性良好，无明显瘢痕挛缩，外观及关节功能满意。供区创面均愈合，无瘢痕存留，部分有色差存留。

脱细胞异体网状真皮支架联合自体刃厚断层皮片复合移植修复小儿功能部位瘢痕挛缩创面效果良好，具有较好的临床应用与推广价值。