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In this study, we aimed to investigate the phenotypic characteristics of human immortal skin keratinocytes (HaCaT) cells and the role of acellular dermal matrix (ADM) in coculture system of HaCaT cells and ADM. Flow cytometry was used to examine the cluster of differentiation (CD) makers of HaCaT cells. Apoptosis analysis was applied to detect the apoptosis rate of HaCaT cells. Morphological observation of ADM isolated from the reticular layer of Sprague-Dawley rat dermis was utilized to evaluate the morphological structure of ADM. Methylthiazolyl tetrazolium (MTT) assay and morphological experiments were further used to confirm the scaffold role of ADM in HaCaT cells. A wound-healing mice model accompanied by HaCaT-ADM scaffold transplantation was performed to further verify the function of HaCaT-ADM scaffold. Our results showed that CD71, CD49f, K19, and CD29 were highly expressed in HaCaT cells, and the percentage of apoptosis cells was significantly increased, which represented that HaCaT cells had much stronger capacities of adhesion and proliferation than normal human keratinocytes. Additionally, the morphological structure of ADM presented many natural microbores, which made cells rapidly grow on ADM. The results exhibited that the HaCaT cells indeed promptly proliferate on ADM and easily grow into the microbores of ADM. Finally, an in vivo experiment further confirmed that the transplantation of the HaCaT-ADM scaffold into the dorsal skin of a wound-healing mice model could gradually repair the injured wound. Thus, these findings indicated that HaCaT cells might be as seed cells to develop skin tissue engineering and the HaCaT-ADM scaffold might be a better candidate to promote skin repair and regeneration.

Sepsis is one of the most common causes of death in severely injured patients worldwide. The early detection of sepsis still has to be solved in clinical practice. The delayed diagnosis often contributes to inappropriate antimicrobial treatment and subsequent high mortality. Sepsis biomarkers are produced during the host response to infection. Traditional biomarkers are polypeptides and/or proteins derived from this response. Omics-based biomarkers are screening out from all kinds of molecules of host response while high-throughout omics technologies are emerging. This review describes traditional and potential omics-based sepsis biomarkers from currently available literatures. The combination of these biomarkers would refine the identification of sepsis for further clinical and experimental sepsis studies.

To observe the effects of artificial dermis combined with basic fibroblast growth factor (bFGF) on the treatment of cicatrix and deep skin wounds.The clinical data of 72 patients with wounds repaired with artificial dermis, hospitalized in our unit from October 2010 to April 2015, conforming to the study criteria, were retrospectively analyzed. The types of wounds were wounds after resection of cicatrices, deep burn wounds without exposure of tendon or bone, and wounds with exposure of small area of tendon or bone, in a total number of 102. Wounds were divided into artificial dermis group (A, n=60) and artificial dermis+ bFGF group (B, n=42) according to whether or not artificial dermis combined with bFGF. In group A, after release and resection of cicatrices or thorough debridement of deep skin wounds, artificial dermis was directly grafted to wounds in the first stage operation. After complete vascularization of artificial dermis, wounds were repaired with autologous split-thickness skin grafts in the second stage operation. In group B, all the procedures were exactly the same as those in group A except that artificial dermis had been soaked in bFGF for 30 min before grafting. Operation area, complete vascularization time of artificial dermis, survival of skin grafts, and the follow-up condition of wounds in the two groups were recorded. Data were processed with t test and Fisher's exact test.(1) Operation areas of wounds after resection of cicatrices, deep burn wounds without exposure of tendon or bone, and wounds with exposure of small area of tendon or bone in the two groups were about the same (with t values from -1.853 to -0.200, P values above 0.05). Complete vascularization time of artificial dermis in wounds after resection of cicatrices, deep burn wounds without exposure of tendon or bone, and wounds with exposure of small area of tendon or bone in group B were respectively (15.6 ± 2.9), (14.7 ± 2.7), and (20.3 ± 4.4) d, and they were shorter by an average time of 2.7, 4.0, 7.4 d, respectively, as compared with those in corresponding types of wounds in group A [respectively (18.3 ± 4.7), (18.7 ± 4.2), and (27.7 ± 8.8) d, with t values from -2.779 to -2.383, P values below 0.05]. (2) The ratio of skin grafts with excellent survival in the three types of wounds in group B were higher than those in corresponding types of wounds in group A, but there were no statistically significant differences (with P values above 0.05). (3) Patients were followed up for 1 to 48 months, and there were no obvious cicatrices in skin graft sites and the donor sites during the following time.Artificial dermis combined with bFGF can effectively shorten the vascularization time of artificial dermis in wounds after resection of cicatrices and deep skin wounds.

Quality of life and functional recovery after burn injury is the final goal of burn care, especially as most of burn patients survive the injury due to advanced medical science. However, dysfunction, disfigurement, contractures, psychological problems and other discomforts due to burns and the consequent scars are common, and physical therapy and occupational therapy provide alternative treatments for these problems of burn patients. This guideline, organized by the Chinese Burn Association and Chinese Association of Burn Surgeons aims to emphasize the importance of team work in burn care and provide a brief introduction of the outlines of physical and occupational therapies during burn treatment, which is suitable for the current medical circumstances of China. It can be used as the start of the tools for burn rehabilitation.

Objective To investigate the time course of infiltrated leukocytes and the subpopulations of infiltrated lymphocytes in deep wounds, and their relationship with injury severity in seriously burned patients. Methods Six patients with major burns were enrolled in the study. Specimens were taken from deep partial-thickness burn wounds of all patients at 3 days, 1 week, 2 weeks and 3 weeks after burn. The appearance time and cellular components of infiltrated leukocyte zone in the burn wound were evaluated by histological and immunohistochemistry examination with lymphocyte monoclonal antibodies. Results The infiltrated leukocyte zone of burn wound formed 1–2 weeks after burn. The more severe the degree of injury (including burn area, depth and combined injuries) was, the later the infiltrated leukocyte zone appeared. The infiltrated cells mainly consisted of polymorphonuclear leukocytes (PMN) during the early period after burn while macrophages and lymphocytes appeared later. There were some changes of the T lymphocyte subsets and their activation degree in the burn wound. Conclusion The changes of infiltrated leukocyte zone of wound following burns were closely related to the injury severity, and represented alteration of the anti-infection ability and immune rejection of local wound. These results provide important evidence for appropriate wound treatment and prolonging the survival of skin allograft.

Since the early 1960s, modern immunology has gradually been involved in every department of clinical medicine. There is no exception for burn medicine. Several burn units in Chongqing, Shanghai, and Beijing of China began to research the immunological consequences of burn clinically and experimentally in the late 1970s [1–4]; their studies have been continued over 30 years [5–8]. Relevant research in this field has been carried out by institutions in other regions in recent years. Overall, the study of burn immunology in China has its own characteristics and advantages with the unremitting efforts of many scholars in the last decades. Our studies in several aspects, including the initiating factors in the pathogenesis of immune dysfunction and molecular mechanism of the immune cell dysfunction after burns, have come up to the international advanced level. Therefore, the phenomena of immune function alterations, etiological analysis, pathogenesis, clinical consequences, and modulating measures of postburn immune dysfunction are summarized as follows, and the future directions in the study of burn immunology and related research are also analyzed.

Aim: To explore the role of nitric oxide (NO) in macrophage dysfunction at early stage after burn injury. Method: Peritoneal macrophages were isolated and cultured from early stage burnt mice. NO production and inducible NO synthase (iNOS) expression in the macrophages were checked by the Greiss method and real-time PCR (TaqMan), respectively. l -Arginine, the substrate of NO producing, or N-monomethyl- l -arginine ( l -NMMA), a competing blocker of NOS was administered to the culture, the changes of NO, TNF-α and PGE2 productions were measured, additionally the changes of the iNOS, TNF-α and COX-2 expression were assayed by real-time PCR. After that, the effects of l -arginine and l -NMMA were determined on burnt macrophage influencing the proliferation of normal splenic lymphocytes. Result: A large amount of NO was produced by macrophages from post burn hour 6 (6PBH) with a high level of iNOS expression. l -Arginine could increase NO production in a dosage-dependent manner, while l -NMMA attenuated NO production, but neither could affect iNOS expression. Moreover, l -arginine enhanced productions of both the latter produced TNF-α and PGE2 from burnt macrophages, and the expressions of TNF-α and COX-2 were improved significantly, while l -NMMA did reverse ways. It was found that macrophages from post burn hour 24 mice could inhibit Con A-stimulated normal splenic lymphocytes dramatically, l -NMMA could decrease this function significantly, but l -arginine could not influence the suppression. Conclusion: Our experiment indicated NO derived from burnt macrophage played a vital role in macrophage producing excessive TNF-α and PGE2, and suppressing lymphocyte function at early stage after burn injury.

Mortality remains one of the most important end-point quality control parameters to evaluate a burn care system. We retrospectively reviewed the characteristics and multiple organ dysfunction syndrome (MODS) patterns of burn deaths in our center from January 2003 to December 2009. The mortality rate during this time period was 2.3%. Fifty-six patients died, including 49 males and 7 females. The mean survival time was 28.45 ± 24.60 days. The burn percentage was (76.70 ± 26.86) % total burn surface area (TBSA), with (27.74 ± 24.95) % deep-partial thickness burns and (46.88 ± 33.84) % full-thickness burns. Inhalation injury was diagnosed in 36 (64.29%) patients. Patients who had undergone an operation, particularly in the first week post-burn, had a significantly longer survival time. An average of 5.50 ± 1.35 malfunctioning organs per patient and a mean sequential organ failure assessment (SOFA) score of 13.91 ± 3.65 were observed. The most frequently malfunctioning organs were involved in the respiratory, hematologic, circulatory, and central nervous systems. Most of the organ damage occurred during the first week post-burn, followed by 4 weeks later, with relatively less organ damage observed in the third week. Among patients with a TBSA over 50%, non-survivors had larger burn sizes (particularly larger full-thickness burns) and a higher incidence of inhalation injury compared with survivors; non-survivors were also more likely to have microorganism-positive blood and sputum cultures. In conclusion, burn deaths are related to a higher burn percentage, inhalation injury, MODS, and infection. Early operation may help improve survival duration.