Objective To investigate the expression of c-kit in human intermediate-spl it-thickness skin grafts and normal skin, and to recognize the role of c-kit in hyperpigmented process of the skin grafts. Methods The hyperpigmented intermediate-spl it-thickness skin grafts of 16 patients’ face and cervicum 1 year after operation was harvested and the normal skins around the recipient site and the donor site were used as controls. Envision immunohistochemical technique was usedto detect the expression and distribution of c-kit in the skin grafts and in the normal control skins, respectively. Medical image quantitative analysis system was used to quantitate the positive expression index (PI). Results The expression of c-kit was located in endochylema and cytolemma of melanocytes and keratinocytes in the basilar part of epidermis. The positive expression of c-kit was obvious in the intermediate-spl it-thickness skin grafts and blown zone was observed in the basilar part of epidermis; and was not obvious and local in normal control skins. The PI of c-kit in the intermediate-spl it-thickness skin grafts (131 216 ± 19 130) was significantly higher than that in the normal skin around the recipient site (92 958 ± 16 208) and in the normal skin around the donor site (91 306 ± 8 135); showing statistically significant difference (P lt; 0.05). Conclusion The expression of c-kit in intermediate-spl it-thickness skin grafts increases remarkably compared with that in normal control skin. c-kit may play an important adjusting role in the process of hyperpigmentation of skin grafts．
Objective To introduce experiences in the application of island myocutaneous flap for refractory wound in cervicothoracic region. Methods From August 1994 to December 2004, 98 cases of refractory wound in cervicothoracic region were treated; there 42 males and 56 females, aging 2168 years.The course of disease was 3 hours to 13 months. The locations were anterior pectorial region(29 cases), cervical part (28 cases), nuchal region (18 cases), subaxillary and axillary region (15 cases), and thoracic wall (8 cases). The defect area ranged from 6 cm×4 cm to 20 cm×15 cm. According to location, peculiarity and etiological factor of wound, various island myocutaneous flaps were selected: 28 pectoralis major island myocutaneous flaps,34 latissimus dorsi island myocutaneous flaps, 19 trapizius island myocutaneousflaps and 17 rectus abdominis island myocutaneous flap. The sizes of the dissected flap ranged from 8 cm×6 cm to 35 cm×15 cm. Results Of 98 patients, the woundhealed by first intention and the flap survived completely in 92 and the flap necrosed partially in 6. The good function and cosmetic results were obtained without severe complication. Eightythree cases were followed up from 2 weeks to 5 years. The flap obtained satisfactory appearance, good function and cosmetic results. Conclusion Repairing refractory wound in cerviconuchal region may selectpectoralis major island myocutaneous flap, latissimus dorsi island myocutaneousflap, and trapizius island myocutaneous flap; repairing refractory wound on thoracic region may select latissimus dorsi island myocutaneous flap and rectus abdominis island myocutaneous flap. According to specific condition of wound, using suitable island myocutaneous flap for refractory wound in cervicothoracic region may obtain satisfactory functional and cosmetic results.
OBJECTIVE: To investigate the clinical application of subdermal vascular network skin flap pre-fabricated by ultrasonic liposuction in reconstruction of digital avulsion. METHODS: Forty-seven injured fingers of 23 cases were treated from June 1997 to February 2000. Conventional abdominal skin flap was elevated, according to the size of digital avulsion, and subcutaneous fat was removed with scissors. Ultrasonic liposuction technology was adopted, in order to minimize the injury of subdermal vascular vessels, to remove the fat particles close to the vascular network. Finally, the pre-fabricated skin flap was used to repair the digital avulsion. The vascular pedicle was severed in 5 to 7 days after operation. The range of skin flap was 4 cm x 3 cm to 8 cm x 7 cm, and the ratio of length and width was (2 to 3) to 1. RESULTS: All the skin flaps were survived. Twenty-one patients were available for postoperative follow-up for 6 to 24 months. The motion of interphalangeal joint achieved functional recovery, and the sensation of pain, temperature and taction recovered well. CONCLUSION: Ultrasonic liposuction does not obviously injure the subdermal vascular network skin flap, it is a simple and safe method for treatment of digital avulsion.
OBJECTIVE: To explore the mechanism of microvascular spasm after limb ischemia-reperfusion. METHODS: The rabbit hindlimb normothermic tourniquet ischemia model was employed. The tendon on the dorsum of the foot was exposed for observation of microvessels. The responses of arterioles on tendon surface to topical application of 10(-6) mol/L noradrenaline (NE) (a vasoconstrictor), 10(-6) mol/l acetylcholine(Ach) (an endothelium-dependent vasodilator) and 10(-4) mol/L nitroglycerin(NTG) (an endothelium-independent vasodilator) were observed at the period of ischemia and following 30 minutes of reperfusion after 2 hours and 5 hours of ischemia by use of intravital microscopy. RESULTS: No significant changes in the responses of arterioles to NE, Ach and NTG were noted following 30 minutes of reperfusion after 2 hours of ischemia compared with pre-ischemia. The constrictor responses of arterioles to NE were still not significantly altered following 30 minutes of reperfusion after 5 hours of ischemia, however, the dilation responses to Ach and NTG were significantly decreased (to Ach P lt; 0.01; to NTG, P lt; 0.05). CONCLUSION: Reperfusion after 5 hours of ischemia significantly impairs both the endothelium-dependent and endothelium-independent vasodilation, meanwhile preserves constrictor responses to NE, these may contribute to the genesis of the vasospasm in ischemia reperfusion.
OBJECTIVE The human epidermal cells were bred on a kind of bio-membrane, the bio-brane, in engineering a kind of new epidermal substitute, the bio-membrane bred cell graft. METHODS Fresh and frozen grafts of biomembrane bred epidermal cells were transplanted into the full-thickness wounds of nude mice and those received simple Bio-brane were served as control. The wounds of the two groups were observed daily and biopsy was taken on the 3, 5, 7, 10, 21 and 35 days respectively. RESULTS Epidermal cells could be cultured in vitro on the bio-membrane reaching the sub-saturated state of 60 to 70 percents. The bio-membrane after being grafted the epidermal cells continued to proliferate and differentiate to form a layer of new epidermis. There was no difference between the fresh and the frozen bio-membranes. CONCLUSION Bio-membrane bred with epidermal cells could be a kind of ideal epidermal substitute.
Objective To observe and explore the effects of adipose-derived stem cells (ADSCs)-hyaluronic acid (HA) composite on heal ing of wound combined with radiation injury. Methods The ADSCs were harvested from the fat tissue in groin of 10 inbred Sprague Dawley (SD) rats and were isolated and cultured by enzyme digestion. The ADSCs-HA composite wasprepared with ADSCs (5 × 106 cells/mL) at passage 6 and HA (10 mg/mL). Thirty inbred SD rats, 15 males and 15 females, were randomly divided into groups A (n=10), B (n=10), and C (n=10). A 2 cm × 2 cm full-thickness skin defect was made on the rat back before 20 Gy 60Co radiation exposure. One week after debridement, wounds were treated by petrolatum gauze in group A as the control group, by HA (0.4 mL) and petrolatum gauze in group B, and by ADSCs-HA composite (0.4 mL) and petrolatum gauze in group C. The microvessel density (MVD) and the distribution of CD90 positive cells were observed at 1st, 2nd, 3rd, and 4th weeks. Results The wound heal ing was slower, and wound did not heal at 4th week and still filled with granulation tissue in group A; the wound heal ing of group B was faster than that of group A, and the wound did not heal completely with depression in the center at 4th week; the wound healed completely with epidermil izated surface and no obvious depression at 4th week in group C. The histological observation showed that MVD was significantly higher in group C than in groups A and B at the 1st, 2nd, and 3rd weeks (P lt; 0.05), and in group B than in group A at the 3rd week (P lt; 0.05); MVD was significantly higher in groups B and C than in group A (P lt; 0.05), but no significant difference was found between groups B and C (P gt; 0.05) at 4th week. No CD90 positive cell was found in groups A and B; CD 90 positive cells were observed in group C and gradually decreased with time. Conclusion ADSCs-HA composite can accelerate heal ing of wound combined with radiation injury by promoting and controll ing wound angiogenesis.
Objective To investigate the surgical techniques and effectiveness for reconstruction of severe full-thickness chest wall defects. Methods Between January 2006 and December 2010, 14 patients with full-thickness chest wall defects were treated, including 12 cases caused by giant chest wall mal ignant tumor excision, 1 case by thermocompression injury, and 1 case by radiation necrosis. There were 8 males and 6 females with an average age of 42 years (range，23-65 years). The size of chest wall defects ranged from 8 cm × 5 cm to 26 cm × 14 cm. All patients compl icated by rib defect (1-5 ribs), and 3 cases by sternum defect. Thoracic skeleton reconstruction was performed with Vicryl mesh or polytetrafluroethylene mesh in 10 patients. Other 4 patients did not undergo thoracic skeleton reconstruction. The bilobed skin flaps, pectoral is major myocutaneous flap, latissimus dorsi myocutaneous flap, and rectus abdominis myocutaneous flap were util ized for repairing soft tissue defects. The size of the dissected flaps ranged from 10 cm × 7 cm to 25 cm × 13 cm. The donor sites were sutured directly or were repaired by free skin graft. Results Poor heal ing of incision occurred in 2 cases, which was cured after debridement, myocutaneous flap transfer, and skin graft. The other wounds healed by first intention. All patients were followed up 6-36 months (mean, 8 months). No tumor recurrence during follow-up, except 1 patient with osteosarcoma who died of l iver matastasis at 6 months after operation. Transient sl ight paradoxical respiration occurred in 1 patient who did not undergo thoracic skeleton reconstruction at 5 days after operation. Integrity of chest wall in other patients was restored without paradoxical respiration and dyspnea. Conclusion Depending on the cause, the size, and the location of defect, single or combination flaps could be used to repair soft tissue defect, and thoracic skeleton reconstruction should be performed when defect is severe by means of syntheticmaterials.
ObjectiveTo biliometric analysis of the status quo of tracking rural health service quality, evaluation and supervision mechanism, in order to improve the quality of rural health service, optimize the allocation of resources and increase the quality and level of health service of rural medical staff. MethodsWe searched PubMed, The Cochrane Library (Issue 3, 2016), The Campbell Library, Web of Science, CBM, CNKI, and WanFang Data, as well as relevant websites up to March 2016. EndNote X7 software and Excel 2007 software were used for screening literature and analysis data. ResultsA total of 39 studies were included in the biliometric analysis. Eighteen studies were cross-sectional studies (46.2%), 18 were reviews (46.2%), 2 were cluster randomized trials (5.1%) and 1 was randomized controlled trial (2.6%). Thirteen studies were published in journals indexed by Science Citation Index, 3 were published in journals indexed by Chinese Science Citation Database, 18 were published on other peer-review journals, and 5 were thesis's. The involved theoretical models were as follows: 10 mechanisms (30.8%), 4 frameworks (18%), 11 systems (30.8%) and 12 methods (30.8%). The serviceable range included village clinics (n=3, 7.7%), town-level hospitals (n=3, 7.7%), and community (n=2, 5.1%). The research topics included public health (n=19, 48.7%), clinical care (n=16, 41%), medical insurance (n=4, 10.3%). ConclusionThe studies for rural health service quality tracking, research evaluation and supervision mechanism are still lack of systematic, pertinence and practicability, and the level of evidence is still low. We suggest pay attention and strengthen the rural health service quality tracking, research evaluation and supervision mechanism, and to provide effective evidence for effective evaluation and supervision to promote rural health service quality, and to promote the reasonable optimization the allocation of health resources in rural areas, and to greatly improve the quality and level of rural health service.
Evidence-based medicine (EBM) is a compulsory course for clinical medicine. How to use massive open online courses (MOOC) to improve teaching of EBM and teaching effect is what we should think and explore. Based on the practical applications and features of MOOC, this paper introduces conciseness of knowledge points for MOOC of EBM, design of the videos for MOOC of EBM, the preliminary exploration of MOOC in teaching practice. It is hopefully that using application of MOOC to promote the teaching effect for EBM, and promote the educational reform.
ObjectiveTo explore the current situation, progress and hot spots of hospital-based health technology assessment (HB-HTA) at home and abroad. MethodsThe China National Knowledge Infrastructure (CNKI) and Web of Science databases were electronically searched to collect publications on HB-HTA. The bibliographic item co-occurrence mining system and VOSviewer software were used to extract and visually analyze HB-HTA literature. ResultsA total of 6 016 publications were included. Research on HB-HTA started late in China, however, it gradually increased in recent years. The Chinese research topics mainly focused on the application of hospital health technology evaluation in the management of medical equipment and consumables, and the English research topics mainly focused on the evaluation of the effectiveness, safety and cost of hospital health technology, especially information technology. ConclusionIn recent years, increasing attention has been given to HB-HTA. Related research topics have mainly focused on hospital technology access, management, and hospital health decision management.