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The incidence of liquefied petroleum gas (LPG)-related accidents in China has increased over the recent years. In addition, infection remains a big challenge in cases of severe burns. Therefore, the present study aimed to provide valuable information for a better control of infections in the event of such disasters. In this study, a total of 16 patients who suffered extremely severe burns after an LPG tanker explosion were included. Thereafter, bacteriological culture results were collected within a week. Of 16 patients, 13 (81.25%) were male and the average age of all patients was 60.63 years. In addition, the mean burned area was 83.03% TBSA. Additionally, a total of 553 organism cultures were conducted out of which 287 isolates (51.90%) showed positive results. Notably, 38.52% were Gram-negative bacteria, 7.59% were Gram-positive bacteria and 5.79% were fungi. Moreover, the most prevalent Gram-negative bacteria were Stenotrophomonas maltophilia (28.97%) followed by Acinetobacter baumannii (28.53%), and Klebsiella pneumoniae (14.02%). On the other hand, the three most predominant Gram-positive bacteria were Enterococcus faecalis (33.33%), Staphylococcus aureus (28.89%) and Staphylococcus sciuri (17.78%). Furthermore, the most common fungi included Candida (38.24%), Fusarium (20.59%) and Aspergillus fumigatus (14.71%). With regard to the bacterial resistance patterns, carbapenem-resistant organisms included Acinetobacter baumannii (97.80%), Pseudomonas aeruginosa (67.57%), and Klebsiella pneumoniae (75.56%). In addition, Staphylococcus sciuri, Staphylococcus epidermidis, and Staphylococcus haemolyticus were identified to be methicillin-resistant. This study revealed that there was a high incidence of infection in victims of severe burns as a result of mass burn accidents, accompanied by early fungal infection.

On June 13, 2020, a liquefied petroleum gas tanker exploded in Wenling. Here, we describe the mass casualty emergency response to the explosion. We collected the medical records of 176 inpatients at 8 hospitals from Taizhou and Hangzhou. The 176 inpatients with blast injuries comprised 70 females and 106 males, with an average age of 45.48 ± 19.96 years, and more than half of the patients were farmers. They were transported to 6 hospitals distributed around the explosion site in Taizhou in the initial rescue period and were grouped according to their new injury severity score as having mild, moderate, severe, or extremely severe injuries. Most patients with severe and extremely severe injuries were admitted to a superior hospital post-secondary triage. 44 patients experienced primary blast injuries, 137 experienced secondary blast injuries, 37 experienced tertiary blast injuries, and 40 patients experienced quaternary blast injuries. Multiple blast injuries were suffered by 62 patients. Most patients (95.45%) suffered external injuries, with the chest, extremities, and face as the main affected areas. Burns were diagnosed in 26 adults, of which 15.38%, 19.23%, 7.70%, and 57.69% suffered mild, moderate, severe, and extremely severe cases. 16 burn patients suffered from burn-blast injuries. Upper limbs and the head/face/neck area, as exposed areas, were more likely to experience a burn injury. Inhalation was the main accompanying injury. Of the 8 patients who died in the prehospital session, 7 had burn injuries. This report on the accident and injury characteristics of an open-air LPG-related explosion will facilitate responses to subsequent catastrophes.

Objective. Bacterial cellulose (BC) dressing, which can maintain a moist environment and prevent the invasion of pathogens, has become a competitive dressing material for burn wound treatment. This study was conducted to evaluate the treatment efficacy of a novel China-made BC dressing for the treatment of second-degree burn wounds and skin graft donor sites. Methods. 212 patients with second-degree burn wounds or skin graft donor sites were enrolled from two research centers. They were randomly assigned to the BC dressing group (study group) or the Vaseline gauze (VG) dressing group (control group). Wound conditions were assessed before and after treatment. Dressings were changed according to the condition of the wound bed. Healing rate and healing time were recorded as primary endpoints to evaluate the efficacy of BC dressing against VG dressing. Erythema, swelling, exudation, bleeding, subeschar purulence, and pain were assessed as secondary endpoints. Results. 207 participants completed the trial and their wounds all healed within 28 days. The average healing times for superficial and deep secondary burn wounds and skin graft donor sites in the BC group were 8.12, 15.77, and 10.55 days, respectively. In the VG group, the average healing times for superficial and deep secondary burn wounds and skin graft donor sites were 9.30, 15.27, and 11.19 days, respectively. The healing time of superficial burn wounds in the BC group was statistically shorter than that in the VG group. There was no difference in the frequency of dressing changing between two groups. The BC dressing showed equal efficacy with the VG dressing at all secondary endpoints. Conclusion. The novel BC dressing could be used for the management of second-degree burn wounds and skin graft donor sites. With a shorter healing time in superficial secondary burn wound than that of the VG dressing, the BC dressing showed noninferiority in the treatment of superficial and deep secondary burn wounds and skin graft donor sites versus the VG dressing. This study is registered with the Chinese Clinical Trial Registry (registry number: ChiCTR1800014377 (http://www.chictr.org.cn)).

Objectives Early acute kidney injury (AKI) after burn contributes to disastrous prognoses for severely burned patients. Burn-induced renal oxidative stress and secondary proinflammatory mediator release contribute to early AKI development, and Toll-like receptor (TLR) 4 regulates inflammation. Heme oxygenase-1 (HO-1) is a stress-responsive enzyme that plays a vital role in protecting against ischemia-induced organ injury via its antioxidant properties and regulation of inflammation. We investigated the potential effect of HO-1 induction in preventing burn-induced early AKI and its related mechanism. Methods A classic major-burn rat model was established using a 100 °C water bath, and hemin was injected intraperitoneally immediately after the injury to induce HO-1. Histological staining and blood tests were used to assess AKI progression based on structural changes and function. Renal levels of HO-1, oxidative stress, proinflammatory mediators and TLR4-related signals were detected using ELISA, immunostaining, qRT-PCR, and western blotting. The selective TLR4 inhibitor TAK242 and TLR4 inducer LPS were introduced to determine the roles of HO-1 in burn-related renal inflammation and the TLR4 pathway. Results Hemin improved burn-induced renal histological damage and dysfunction, and this beneficial effect was related to reduced renal oxidative stress and the release of proinflammatory mediators, such as tumor necrosis factor-alpha (TNF-α), interleukin (IL)-1β, IL-6 and intracellular adhesion molecule-1 (ICAM-1). Hemin downregulated the expression of TLR4 and the subsequent phosphorylation of IKKα/β, IκBα, and NF-κB p65;. TAK242 exerted an effect similar to but weaker than hemin; and LPS reversed the antiinflammatory effect of hemin and the regulation of TLR4 signals. These results suggested that the TLR4 signaling pathway mediated the HO-1-facilitated regulation of renal inflammation after burn. Conclusion The present study demonstrated that HO-1 induction prevented burn-induced early AKI by targeting renal inflammation, which was mediated via regulation of the TLR4/NF-κB signaling pathway.

Treatment of full-thickness skin defects still presents a significant challenge in clinical practice. Three-dimensional (3D) bioprinting technique offers a promising approach for fabricating skin substitutes. However, it is necessary to identify bioinks that have both sufficient mechanical properties and desirable biocompatibilities. In this study, we successfully fabricated acellular dermal matrix (ADM) and gelatin methacrylamide (GelMA) bioinks. The results demonstrated that ADM preserved the main extracellular matrix (ECM) components of the skin and GelMA had tunable mechanical properties. Both bioinks with shear-thinning properties were suitable for 3D bioprinting and GelMA bioink exhibited high printability. Additionally, the results revealed that 20% GelMA with sufficient mechanical properties was suitable to engineer epidermis, 1.5% ADM and 10% GelMA displayed relatively good cytocompatibilities. Here, we proposed a new 3D structure to simulate natural full-thickness skin, which included 20% GelMA with HaCaTs as an epidermal layer, 1.5% ADM with fibroblasts as the dermis, and 10% GelMA mesh with human umbilical vein endothelial cells (HUVECs) as the vascular network and framework. We demonstrated that this 3D bioprinting functional skin model (FSM) could not only promote cell viability and proliferation, but also support epidermis reconstruction in vitro. When transplanted in vivo, the FSM could maintain cell viability for at least 1 week. Furthermore, the FSM promoted wound healing and re-epithelization, stimulated dermal ECM secretion and angiogenesis, and improved wound healing quality. The FSM may provide viable functional skin substitutes for future clinical applications. Statement of significance We propose a new 3D structure to simulate natural full-thickness skin, which included 20% GelMA with HaCaTs as an epidermal layer, 1.5% ADM with fibroblasts as the dermis, and 10% GelMA mesh with HUVECs as the vascular network. It could not only maintain a moist microenvironment and barrier function, but also recreate the natural skin microenvironment to promote cell viability and proliferation. This may provide viable functional skin substitutes for future clinical applications.

To assess the safety and efficacy of antimicrobial peptide PL-5 (Peceleganan) spray in the treatment of wound infections.Antimicrobial peptide PL-5 spray is a novel topical antimicrobial agent.We conducted a multicenter, open-label, randomized, controlled phase IIb clinical trial to evaluate the efficacy and safety of PL-5 spray, as compared with silver sulfadiazine, in patients with skin wound infections. The primary efficacy outcome was the clinical efficacy rate on the first day after ending the treatment (D8). The secondary efficacy outcome was the clinical efficacy rate on the fifth day posttreatment (D5), the bacteria clearance rate, and the overall efficacy rate at the mentioned 2 time points. The safety outcomes included adverse reactions and pharmacokinetic analysis posttreatment.A total of 220 patients from 27 hospitals in China were randomly assigned to 4 groups. On D8, the efficacy rate was 100.0%, 96.7%, 96.7% for the 1‰ PL-5, 2‰ PL-5, 4‰ PL-5 groups, respectively, as compared with 87.5% for the control group. The efficacy rate among the 4 groups was significantly different (P0.05). On D5, the efficacy rate was 100.0%, 93.4%, 98.3% for the 1‰ PL-5, 2‰ PL-5, 4‰ PL-5 groups, respectively, as compared with 82.5% for the control group. The efficacy rate among the 4 groups was significantly different (P0.05). The blood concentration of PL-5 was not detectable in pharmacokinetic analysis. No severe adverse event related to the application of PL-5 was reported.Antimicrobial peptide PL-5 spray is safe and effective for the treatment of skin wound infections.ChiCTR2000033334.

Collagen-based scaffolds reveals promising to repair severe skin defects. The mechanical strength of collagen-based scaffold (CCS) limited its clinical application. Embedding poly(lactic-co-glycolic) acid (PLGA) knitted mesh into CCS improves the mechanical strength of the scaffold. This study was conducted to optimize the configuration of PLGA knitted mesh-collagen-chitosan scaffold (PCCS), and explore possible mechanisms. PLGA knitted mesh was embedded in CCS through freeze-drying method. With the PLGA knitted mesh located at the bottom, middle, or both bottom and top layers of the CCS, three kinds of PCCS were developed. A full-thickness skin wound model was established in Sprague Dawley rats to evaluate the therapeutic effects of different PCCS against CCS. The properties and healing effect of the scaffolds were investigated. Several growth factors and chemotactic factors, that is, VEGF, PDGF, CD31, α-SMA, TGF-β1, and TGF-β3 were analyzed and evaluated. Re-epithelialization and angiogenesis were observed in all animal groups with the treatment of three kinds of PCCS scaffolds and the CCS scaffold (control). The protein and gene expression of VEGF, PDGF, CD31, α-SMA, TGF-β1, and TGF-β3 showed different dynamics at different time points. Based on the healing effects and the expression of growth factors and chemotactic factors, scaffold with the PLGA knitted mesh located at the bottom layer of the CCS demonstrated the best healing effect and accelerated re-epithelialization and angiogenesis among all the scaffolds evaluated. PCCS with the PLGA mesh located in the bottom layer of the scaffold accelerated wound healing by creating a more supportive environment for re-epithelialization and angiogenesis.

Chronic wounds are a challenge for clinicians. Treating chronic wounds in elderly patients is difficult due to comorbidities and poor immunity, tissue renewal, and regeneration. This study shared the therapeutic experiences of 40 patients with super long-term difficult-to-heal wounds and to describe the effects of negative pressure wound therapy (NPWT)-assisted debridement and autologous scalp grafting. Elderly patients with chronic wounds for more than 60 years who underwent NPWT-assisted debridement and autologous scalp grafting between 2015 and 2017 were retrospectively analyzed. Forty patients were identified and analyzed. Among all patients, the average wound area was 56 (interquartile range 30-90) cm2. The wound infection rate was 82.1%, and that before the first autologous scalp grafting was 51.3%. The average total number of surgeries was 3, and the number of times the NPWT device was replaced was once. A total of 97.4% of patients had one autologous scalp grafting performed. The transplanted scalp survived completely in 97.4% of patients. One hundred percent of patients had no postoperative complications and healed. The average wound healing time was 34.5 ± 10.1 days. This study showed that NPWT-assisted debridement and autologous scalp grafting have the advantages of high survival rate of the skin and decreased wound recurrence and may be a suitable treatment for super long-term difficult-to-heal wounds in elderly patients.

The increased incidence of chronic cutaneous wounds is likely to lead to increased mortality, and therefore, deserves greater attention. More insight is needed into the magnitude of the problem of chronic cutaneous wounds and methods for their prevention and treatment in China. A retrospective analysis of data retrieved from an electronic health-records database on 3300 patients with chronic skin wounds was conducted from 1 January 2018 to 31 December 2018. The patients had been admitted to the medical and surgical wards of 17 third-grade class-A hospitals in China. The study's aim was to compare the characteristics (eg, demographic and clinical) associated with different causes and distributions of patients' chronic wounds. Among the 3300 patients, 66.03% were males and 33.97% were females. The mean age was 57 years and the increasing prevalence of chronic skin wounds with aging was quite high. The primary causes of chronic wounds were diabetes or infection, followed by pressure ulcers, trauma, and iatrogenic wounds. The distribution of skin wounds was mainly in the lower extremities (56.1%), followed by the trunk (18.6%). The mean duration of hospital stay was 29 days and the mean recurrence was 3 months. Chronic skin wounds were related to occupation, educational level, lifestyle habits, and income. The main cause of chronic skin wounds has shifted from trauma to chronic disease. Normalization checks, bacterial cultures, and antibiotic use in China need to be standardized and the training of wound specialists should be further strengthened. The association of aging and wound infection was significant. Preventive management and efficient treatment should correspond to the needs of the different regions of China. These results may serve as a reference for other developing countries in their transitional development.

Liquefied petroleum gas (LPG) is a widely used environment-friendly fuel. Previous studies have shown an increasing number of LPG-related burns. Our study was designed to evaluate the epidemiologic pattern of these injuries and provide recommendations for burn prevention. This retrospective study included all patients with LPG-related burns from eight burn centers in Zhejiang Province, China between 2011 and 2015. Database variables included patient demographics, accident characteristics, and injury characteristics. The association between different categorical variables was identified using the chi-square test. And the association between two or more means of quantitative variables was analyzed by the one-way analysis of variance or t-test. A total of 1898 patients were included, 47.31% were males and 52.69% were females. The predominant age group was 31 to 70 years (74.50%), and the majority were poorly educated and the incidence peaked from June to September. The most common place of occurrence was home (74.08%) and gas leak (96.52%) was the most common cause. The four limbs (43.33%) were the most frequently affected areas; the mean burn area was 25.19 ± 20.97% of the total body surface area and most patients (46.89%) suffered from moderate burns. The mean length of hospital stay was 17.66 ± 16.55 days and the majority of patients (89.36%) recovered with a 0.84% mortality rate. Our findings reflected that the increase in incidence rate was alarming, and the causes resulting in LPG-related burns have not gained much attention yet. Therefore, this calls for simple but strict measures aiming at each hazardous step during the use of LPG to prevent these burn injuries.

Tissue-engineered skin (TES), as an analogue of native skin, is promising for wound repair and regeneration. However, a major drawback of TES products is a lack of skin appendages and nerves to enhance skin healing, structural integrity and skin vitality. Skin appendages and nerves are important constituents for fully functional skin. To date, many studies have yielded remarkable results in the field of skin appendages reconstruction and nerve regeneration. However, patients often complain about a loss of skin sensation and even cutaneous chronic pain. Restoration of pain, temperature, and touch perceptions should now be a major challenge to solve in order to improve patients’ quality of life. Current strategies to create skin appendages and sensory nerve regeneration are mainly based on different types of seeding cells, scaffold materials, bioactive factors and involved signaling pathways. This article provides a comprehensive overview of different strategies for, and advances in, skin appendages and sensory nerve regeneration, which is an important issue in the field of tissue engineering and regenerative medicine.

Open wounds (e.g., burns and trauma) are always challenged by various opportunistic bacteria. There is an urgent need for developing novel wound dressing that is able to prevent bacterial infection and promote the healing simultaneously. Herein, we developed a new type of antimicrobial hydrogels for the open wound healing through imitating a facile mussel-inspired catechol/polyamine chemistry. This hydrogel was prepared using catechol (CT) and ε-poly-l-lysine (EPL) by oxidative cross-linking directly in the open air at room temperature. This nonleaching CT/EPL hydrogel not only exhibited excellent contact-active antimicrobial activities against Gram-negative bacteria

Tissue engineering techniques have enabled to replicate the geometrical architecture of native tissues but usually fail to reproduce their exact cellular arrangements during the fabricating process, while it is critical for manufacturing physiologically relevant tissues. To address this problem, a "sewing-like" method of controlling cellular alignment during the fabricating process is reported here. By integrating the stretching step into the fabricating process, a static mechanical environment is created which, in turn, regulates the subsequent cellular alignment, elongation, and differentiation in the generated tissues. With this method, patterned cellular constructs can be fabricated with controlled cellular alignment. Moreover, this method shows a potent capability to fabricate physiologically relevant skeletal muscle constructs in vitro by mechanically inducing myoblast fusion and maturation. As a potential clinical application, aligned myofibers are directly fabricated onto injured muscles in vivo, which repair the damaged tissues effectively. This study shows that the "sewing-like" method can produce engineered tissues with precise control of cellular arrangements and more clinically viable functionalities. This study was supported by the Major International Cooperation Project of National Natural Science Foundation of China (No. 62120106004) and the Key R&D project of Ministry of Science and Technology of China (No. 2021YFB3200801).

Purpose: To investigat the positive influence of AgNP on preventing early burn-wound progression.Patients and methods: After a deep burn, progression of burns may occur in the initial or surrounding area，even after thermal factors have been removed. Due to the influence of many factors such as residual heat, the risk of burn stagnant area deterioration is very high which is considered to be salvable. Silver nanoparticles (AgNP), which has been wide used in burns, is a strong antibacterial agent that has been reported to regulate inflammation. Hence, to investigat the positive influence of AgNP on avoid early burn wound progressive deterioration, a isomorphic “comb” burn animal model was made in this study which were treated with silver nanoparticles. The wound tissues were taken for molecular biological and histological evaluation, which revealed that AgNP alleviated histological deterioration in burn stagnant area. Results: Furthermore, AgNP can alleviate the early progressive necrosis and inflammatory response of burn wound, which was accociated with excitation in M2 macrophage and a suppression of M1 macrophage.Conclusion: In conclusion, we demonstrate that AgNP has a protective effect on acute burn wound deterioration in a rat model. It might be regulated by the macrophage activation-induced inflammation and apoptosis.

Background Gelatin methacryloyl (GelMA) hydrogels loaded with stem cells have proved to be an effective clinical treatment for wound healing. Advanced glycation end product (AGE), interacting with its particular receptor (AGER), gives rise to reactive oxygen species (ROS) and apoptosis. Curcumin (Cur) has excellent antioxidant activity and regulates intracellular ROS production and apoptosis. In this study, we developed a Cur-incorporated 3D-printed GelMA to insert into adipose-derived stem cells (ADSCs) and applied it to diabetic wounds. Methods GelMA hydrogels with Cur were fabricated and their in vitro effects on ADSCs were investigated. We used structural characterization, western blot, ROS and apoptosis assay to evaluate the antioxidant and anti-apoptotic activity, and assessed the wound healing effects to investigate the mechanism underlying regulation of apoptosis by Cur via the AGE/AGER/nuclear factor-κB (NF-κB) p65 pathway. Results A 10% GelMA scaffold exhibited appropriate mechanical properties and biocompatibility for ADSCs. The circular mesh structure demonstrated printability of 10% GelMA and Cur-GelMA bioinks. The incorporation of Cur into the 10% GelMA hydrogel showed an inhibitory effect on AGEs/AGER/NF-κB p65-induced ROS generation and ADSC apoptosis. Furthermore, Cur-GelMA scaffold promoted cell survival and expedited in vivo diabetic wound healing. Conclusions The incorporation of Cur improved the antioxidant activity of 3D-printed GelMA hydrogel and mitigated AGE/AGER/p65 axis-induced ROS and apoptosis in ADSCs. The effects of scaffolds on wound healing suggested that Cur/GelMA-ADSC hydrogel could be an effective biological material for accelerating wound healing.

Open wounds (e.g., burns and trauma) are always challenged by various opportunistic bacteria. There is an urgent need for developing novel wound dressing that is able to prevent bacterial infection...

Early acute kidney injury (AKI) contributes to severe morbidity and mortality in critically burned patients. Renal inflammation plays a vital role in the progression of early AKI, acting as a therapeutic target. Astaxanthin (ATX) is a strong antioxidant widely distributed in marine organisms that exerts many biological effects in trauma and disease. ATX is also suggested to have anti-inflammatory activity. Hence, we attempted to explore the role of ATX in protecting against early postburn AKI via its anti-inflammatory effects and the related mechanisms. A severely burned model was established for histological and biochemical assessments based on adult male rats. We found that oxidative stress-induced tissue inflammation participated in the development of early AKI after burn injury and that the MyD88-dependent TLR4/NF-κB pathway was activated to regulate renal inflammation. The TLR4 and NF-κB inhibitors TAK242 and PDTC showed similar effects in attenuating burn-induced renal inflammation and early AKI. Upon ATX treatment, the release of inflammatory mediators in the kidneys was downregulated, while the TLR4/MyD88/NF-κB axis was inhibited in a dose-related manner. TAK242 and PDTC could enhance the anti-inflammatory effect of high-dose ATX, whereas lipopolysaccharide (LPS) reversed its action. Furthermore, the expression of heme oxygenase (HO)-1 was upregulated by ATX in a dose-related manner. Collectively, the above data suggest that ATX protects against renal inflammation in a dose-related manner by regulating the TLR4/MyD88/NF-κB axis and HO-1 and ultimately prevents early AKI following severe burns.

BackgroundWound healing is a complex process and the treatment of chronic non-healing wounds still remains a tough challenge. Mesenchymal stem cell (MSC) based therapy has emerged as a promising therapeutic strategy for wound healing. Stem cell factor/stem cell factor receptor (SCF/c-kit) interaction activates downstream signal pathways in stem cells. microRNAs (miRNAs) regulate the effect of adipose tissue-derived stem cells (ADSCs) in cutaneous wound, but the associated cellular mechanisms are not fully understood. In the research, we investigate the inhibitory effect of miR-466 in ADSC migration induced by SCF/c-kit/ERK axis.MethodsHuman ADSCs were tested by scratch assay and Transwell assay to evaluate the migration ability. MicroRNA sequencing was used to find the discrepancy miRNA in ADSCs with or without SCF pretreatment. The ERK signaling pathway was investigated by pharmacological disruption of PD98059. In addition, siRNA, RT-qPCR, western blotting, and luciferase reporter assay were used to investigate the mechanism of miR-466 regulating migration via the SCF/c-kit/ERK pathway. In the in vivo study, the wound healing ability of miR-466 and SCF was evaluated in a nude mouse full-thickness skin wound model.ResultsADSCs incubated with SCF induces the expression of c-kit and promotes ADSC migration, whereas siRNA c-kit inhibited the effects. microRNAs microarray showed that miR-466 was upregulated in SCF pretreatment ADSCs compared to ADSCs. The luciferase reporter assay indicated that miR-466 may target c-kit and suppress SCF/c-kit-mediated migration of ADSCs. The ERK signaling pathway was confirmed to be involved in SCF/c-kit induced migration. In addition, pre-treatment with PD98059 reversed the effects of SCF/c-kit on the ERK signaling and migration-related proteins. Furthermore, miR-466 inhibits ADSC migration to wound site and defects cutaneous wound healing in vivo.Conclusions Taken together, our data suggested that SCF/c-kit signal axis can enhance the activation of ERK signal pathway, which will promote ADSC migration. miR-466 regulates ADSC migration by targeting SCF/c-kit/ERK signaling and defects wound healing.

Background Eyelashes play an important role in perception of beauty and protection of eyeballs. The outcome of eyelash restoration varies and mainly depends on the surgeon's technique and no standard procedure exists. Aims To evaluate the effect of modified single-hair follicular unit grafting to aesthetically restore eyelashes and provide a potential alternative of standard procedure. Patients and methods A total of 34 patients with sparse or partially absent eyelashes who underwent modified procedure were included. Single-hair grafts were harvested from the donor site (post-auricular, nape, frontal hairline area). Grafts were transplanted with 23 gauge needle and fine forceps in the modified procedure. The patients were followed for a mean of 12 months after surgery. Results All patients were satisfied with the result 12 months after the surgery. An average of 46.5 grafts (34-68) were transplanted in each upper eyelid. The mean graft survival rate after 1 year was 87.2% (84%-92%). Of the 34 patients, 3 patients received a second session to achieve a denser appearance. No significant complication as trichiasis, infection, scarring or eyeball injury occurred. Conclusion This modified single-hair follicular unit grafting is a good alternative for aesthetic eyelash restoration with good cosmetic results, relative easy maintenance, lack of complications, and long-term patient satisfaction.

Because China is becoming an aging society, the incidence of diabetes and diabetic foot have been increasing. Diabetic foot has become one of the main health-related killers due to its high disability and mortality rates. Negative pressure wound therapy (NPWT) is one of the most effective techniques for the treatment of diabetic foot wounds and great progress, both in terms of research and its clinical application, has been made in the last 20 years of its development. However, due to the complex pathogenesis and management of diabetic foot, irregular application of NPWT often leads to complications, such as infection, bleeding and necrosis, that seriously affect its treatment outcomes. In 2020, under the leadership of Burns, Trauma and Tissue Repair Committee of the Cross-Straits Medicine Exchange Association, the writing group for ‘Consensus on the application of negative pressure wound therapy of diabetic foot wounds’ was established with the participation of scholars from the specialized areas of burns, endocrinology, vascular surgery, orthopedics and wound repair. Drawing on evidence-based practice suggested by the latest clinical research, this consensus proposes the best clinical practice guidelines for the application and prognostic evaluation of NPWT for diabetic foot. The consensus aims to support the formation of standardized treatment schemes that clinicians can refer to when treating cases of diabetic foot.

With the development of social economy and the aging of the population, the human disease spectrum has undergone significant changes. The epidemiological data of Fu Xiaobing’s team showed that as prevailing in 1998 [1], the 2008 survey showed that burn wounds accounted for only 18% of wound diseases, and the remaining 82% were chronic wounds. The survey data also estimated that nearly 100 million people in China need wound treatment every year [2]. The survey also found that wound disease brings a lot of burden to social medical resources. The first is the burden of manpower; the second is the average length of stay (ALOS). The third is the cost of hospitalization. These data show that we are not only faced with the major medical needs of wound disease treatment, but also the wound disease has brought us a major social medical burden. It can be seen that all kinds of chronic wounds have become one of the important diseases affecting people’s life and health, and one of the important issues that modern clinicians and researchers must face.

Background: Antimicrobial Peptide PL-5 (Peceleganan) Spray is a novel topical antimicrobial agent targeted on the treatment of skin wound infections. Methods: We conducted a multicenter, open-label, randomized, controlled phase IIb clinical trial to evaluate the efficacy and safety of PL-5 Spray, as compared with silver sulfadiazine, in patients with skin wound infections. The primary efficacy outcome was the clinical efficacy rate on the first day after ending the treatment (D8). The secondary efficacy outcome was the clinical efficacy rate on the fifth day post-treatment (D5), the bacteria clearance rate and the overall efficacy rate at the mentioned two timepoints. The safety outcomes included adverse reactions and pharmacokinetic analysis post-treatment. Findings: Between Jul 29, 2020, and May 10, 2021, a total of 220 patients from 27 hospitals in China were randomly assigned to 4 groups. On D8, the efficacy rate was 91·6%, 83·6%, 85·0% for the 1 ‰ PL-5, 2 ‰ PL-5, 4 ‰ PL-5 groups respectively, as compared with 60% for the control group. The efficacy rate between each PL-5 group and the control group was significantly different (P

Aims Deep burn-wounds undergo a dynamic progression in the initial or periburn area after insults, and the zone of stasis is the crucial region suffering the deterioration, considered as salvageable. Few studies explored the role of mitochondria in this process. This study is to clarify a possible “built-in” protection of mitophagy. Main methods A classic “comb” scald rat model was established. Histological and blood-flow observation were processed based on hematoxylin-eosin staining and laser analysis. Oxidative and apoptotic status were analyzed by commercial kits. Transmission-electron microscope, immunofluorescence staining, and western blot were applied to detect the mitophagy in the zone of stasis and potential regulators. Adenovirus-based gene-silence contributed to determine the role of HIF-1α as a regulatory mediator. Key findings We found that burn-caused typical ischemia and histological deterioration in the zone of stasis, in parallel with increases in oxidative stress and apoptosis. Mitochondrial damage was involved in the aforementioned changes. Furthermore, we detected mitophagy in burn-wounds, which was contradictory to the burn-wound conversion. HIF-1α expression was closely related to the level of mitophagy, while BNIP3 and PARKIN are involved downstream. Significance We demonstrate that burn-induced mitochondrial impairment contributes to the mobilization of injurious mechanisms in the zone of stasis and that mitophagy provides a beneficial way to protect against burn-wound progression via the elimination of damaged mitochondria. Our findings offer insights into mitochondrial quality control in burn-wound progression and suggest the novel concept that HIF-1α may be a therapeutic target due to its possible regulation on BNIP3- or PARKIN-mediated mitophagy.

Background: Early acute kidney injury (AKI) contributes to severe morbidity and mortality in critically-burned patients. Renal inflammation plays a vital role in the progression of early AKI. Astaxanthin (ATX) is a strong antioxidant widely-distributed in marine organisms, exhibiting diverse biological effects in trauma and diseases. The anti-inflammatory property of ATX is also suggested. Hence, we attempted to explore the anti-inflammation-based protection of ATX against early AKI post-burn and related mechanisms. Methods: A severely-burned rat model was established in this study. The changes of renal structure and function were determined by hematoxylin-eosin staining and blood test. The oxidative status in kidneys was detected by commercial kits and quantitative real time PCR. Furthermore, immunofluorescence staining, quantitative real‐time, and western blot were performed on renal tissues of burned rats to explore the underlying effects and mechanisms of ATX on burn-induced AKI with the help of inflammation inducer and several signal inhibitors.Results: We found oxidative stress-induced tissue inflammation participated in the development of early AKI after burn paralleling with the deterioration of histological damage and function in kidneys, and MyD88-dependent TLR4/NF-kB pathway was activated to regulate renal inflammation. TLR4 and NF-kB inhibitor-TAK242 and PDTC showed similar effects to attenuate burn-induced renal inflammation and early AKI. Upon ATX treatment, the release of inflammatory mediators in kidneys was downregulated, while TLR4/MyD88/NF-kB axis was inhibited dose-relatedly. Lipopolysaccharide (LPS) could reverse the anti-inflammatory effect of high-dose ATX, whereas TAK242 and PDTC antagonized its action. Furthermore, the expression of heme oxygenase(HO)-1 was also dose-relatedly upregulated by ATX. Conclusions: Collectively, the data above suggests ATX dose-relatedly protects against renal inflammation through regulating TLR4/MyD88/NF-kB axis and HO-1, and finally prevent early AKI following severe burns.