Therapeutic approach to emotional reactions accompanied with thermal skin injury–from basic to epidemiological research

In this editorial,we discuss the status of a therapeutic approach to emotional reactions accompanying thermal skin injuries.Burns are considered a major health problem,as well as an economic and social problem,with potentially devastating and life-changing consequences.They affect a wide range of patients with different damage mechanisms,varied depths,and localizations of the burns.The most common are thermal burns,with more than 11 million occurrences annually according to the World Health Organization data.Thermal skin injuries are among the most tragic and catastrophic injuries,almost unsurpassed in terms of severity,morbidity,and mortality,as well as functional,aesthetic,social,economic,and psychological consequences.Burn survivors face stress,anxiety,depression,low self-esteem,body deformity,social isolation,unemployment,financial burden,and family problems.The advances in acute burn care have allowed researchers and physicians to pay more attention to other effects of burns,focusing on psychological consequences in particular.Apart from the significant improvements in routine protocols,it seems useful to take care of psychological disturbances that occur simultaneously but may emerge as the most lasting outcome of those injuries.In that sense,various standards and additional approaches may be involved to achieve overall recovery.

Olfactory ensheathing cell transplantation improves sympathetic skin responses in chronic spinal cord injury

Forty-three patients with chronic spinal cord injury for over 6 months were transplanted with bryonic olfactory ensheathing cells, 2-4 × 106, into multiple sites in the injured area under the sur-gical microscope. The sympathetic skin response in patients was measured with an electromyo-graphy/evoked potential instrument 1 day before transplantation and 3-8 weeks after trans-tion. Spinal nerve function of patients was assessed using the American Spinal Injury Association impairment scale. The sympathetic skin response was elicited in 32 cases before olfactory en-sheathing celltransplantation, while it was observed in 34 cases after transplantation. tantly, sympathetic skin response latency decreased significantly and amplitude increased cantly after transplantation. Transplantation of olfactory ensheathing cells also improved American Spinal Injury Association scores for movement, pain and light touch. Our findings indicate that factory ensheathing celltransplantation improves motor, sensory and autonomic nerve functions in patients with chronic spinal cord injury.

Risk Factors of Neonatal Medical Adhesive-Related Skin Injury and Management of High-Risk Nodes

Objective:To analyze the risk factors of neonatal medical adhesive-related skin injury and put forward targeted preventive measures,so as to provide reference for the care and prevention of neonatal medical adhesive-related skin injuries.Methods:Using the convenience sampling method,262 neonates admitted to the neonatal intensive care unit(NICU)of a tertiary general hospital in Wenzhou from April 2021 to May 2022 were selected as the study subjects.The incidence of medical adhesive-related skin injuries in these neonates was retrospectively analyzed.Results:Among the 262 children,43 cases had skin injuries,with an incidence rate of 16.4%.Single factor analysis showed that the occurrence of medical adhesive-related skin injury was related to gestational age,weight,electrocardiogram(ECG)monitoring,venous access,ambient temperature,and mechanical ventilation(P<0.05).Multivariate logistic regression showed that gestational age,ECG monitoring,and ambient temperature were independent risk factors of medical adhesive-related skin injury(OR values were 0.700,0.431,and 6.365,respectively).Conclusion:The high incidence of neonatal medical adhesive-related skin injury may be caused by one or more factors.Clinical measures should be taken,such as selecting the appropriate type of adhesive according to gestational age and using skin-protecting membrane,minimizing ECG monitoring,etc.,to prevent the occurrence of neonatal medical adhesive-related skin injury.

Regulatory T cells in skin regeneration and wound healing

As the body’s integumentary system,the skin is vulnerable to injuries.The subsequent wound healing processes aim to restore dermal and epidermal integrity and functionality.To this end,multiple tissue-resident cells and recruited immune cells cooperate to efficiently repair the injured tissue.Such temporally-and spatially-coordinated interplay necessitates tight regulation to prevent collateral damage such as overshooting immune responses and excessive inflammation.In this context,regulatory T cells(Tregs)hold a key role in balancing immune homeostasis and mediating cutaneous wound healing.A comprehensive understanding of Tregs’multifaceted field of activity may help decipher wound pathologies and,ultimately,establish new treatment modalities.Herein,we review the role of Tregs in orchestrating the regeneration of skin adnexa and catalyzing healthy wound repair.Further,we discuss how Tregs operate during fibrosis,keloidosis,and scarring.

Application of free vein skin flap on the anterior aspect of wrist in the case of finger injury with vessel and skin defect

Objective To introduce an effective reconstruction method for the finger injured with vessel and skin defect. Methods Free skin flap with skin vein was transplanted on the site of tissue defect, connecting by anastomosis the vein with artery or vein of the finger. Results Seven cases were treated with this method,among which 5 cases have sikin defect on the palm aspect of fingers, the rest have skin defect on the dorsal aspect skin of finger. All fingers survived with good shape and function. Conclusion This is a simple and effective method of finger reconstruction for the patients with defect of vessels and skin. 6 refs.

不同胚层来源成体干细胞修复周围神经损伤

背景:成体干细胞疗法是周围神经损伤修复与再生领域的研究热点之一。中胚层被视为成体干细胞的理想来源,间充质干细胞具有获得率高、来源广、增殖快等优异性能。而外胚层来源成体干细胞,尤其是神经嵴干细胞,具有神经源性,越来越受到研究人员的关注。目的:对来自外胚层和中胚层的多功能成体干细胞在周围神经损伤修复与再生中的作用及机制进行简要综述,探究不同来源成体干细胞的研究进展与应用前景,并结合临床研究,探讨成体干细胞疗法潜在的应用价值以及亟待解决的问题。方法:第一作者于2024年2月应用计算机在PubMed和SinoMed数据库检索2001年12月至2024年2月相关文献,以“ectodermal stem cells,mesenchymal stem cells,peripheral nerve injury,repair,regeneration”为英文检索词,以“外胚层干细胞、间充质干细胞、周围神经损伤、修复、再生”为中文检索词,最终纳入69篇文献进行分析论述。结果与结论:①外胚层来源成体干细胞具有优异的分化和再生潜能,尤其是毛囊神经嵴干细胞、嗅干细胞、牙外胚层干细胞等,具有神经源性,可在体外表达神经特异性标志物,但目前缺少临床试验研究。②中胚层来源成体干细胞种类多、易获得及纯化,其中骨髓间充质干细胞和脐带间充质干细胞在周围神经损伤修复的应用疗效及安全性方面有相关临床试验支持,能改善感觉及运动神经传导,且在随访中未出现并发症和明显不良反应。骨髓间充质干细胞的获取需行侵入性外科手术且要求患者与捐赠者骨髓配型吻合,应用受到一定限制;而脐带间充质干细胞虽无需侵入性获取,但分离较困难且表型不稳定。③内胚层来源成体干细胞常难以在体外生长,应用受限,目前应用于临床的可能性低。④综合来看,骨髓间充质干细胞仍为周围神经损伤干细胞治疗的首选细胞,适用于无外科手术禁忌且符合配型要求的情况,其次为脐带间充质干细胞,辅以分离方法的改进和表型稳定性的提高策略。⑤牙外胚层干细胞以及脂肪间充质干细胞具有较高应用潜能,有待进一步临床试验,其他外胚层、中胚层来源成体干细胞各以其优异特性在动物及细胞实验研究中具有显著优势。

Review of the initial treatment and avoidance of scald injuries

Scald injuries,which describe burns to living tissue from hot liquids,are a very common injury that occur across geographical,social,economic,and national boundaries.Despite their ubiquitous nature,a complete understanding of the conditions which are required to cause scald burns is not yet available.In addition,clear guidance to medical practitioners is available through various guidelines however in actual situations,the extent of the burn is not fully known and this lack of knowledge complicates care.Here,a comprehensive review is made of the available knowledge of temperatures and scald durations which lead to skin-burn injuries.The range of volumes and liquid temperatures are typical of those found in heated consumer beverages.This review can help medical practitioners design initial treatment protocols and can be used by manufacturers of hot-liquid products to avoid the most severe burns.Next,within the context of this ability to quantify burn depths,a review of current burn treatment guidelines is given.Included in this review is a visual recognition of the extent of burns into the dermal layer as well as decision guidelines for selection of patients which would benefit from referral to a dedicated burn center.It is hoped that by bringing together both the quantified burn-depth information and current treatment guidelines,this review can be used as a resource for persons in the medical,manufacturing,beverage service,and other industries to reduce the human impact of scald injuries.

Clinical Use of Growth Factors in the Improvement of Skin Wound Healing

To discuss the normal mechanism of wound healing (WH), the role of growth factors (GF) in prec-linical and clinical studies and its importance in the healing of abnormal wound therapy. For search, we used the PUBMED and LILACS database, and the following descriptors: skin, wound healing, growth factor and clinical trials. We also prioritized the analysis of the Clinical Trials in the previous 10 years. Although there are many studies being conducted in the pre-clinical phase, we see that there are few studies in the clinical phase. 274 studies were identified, and 58 were selected. After tissue injury, repair occurs through coordinated biological actions that are healing. The importance of the study of healing in the skin is not only because of its anatomical location, easy access and exposure, but also because of its vital function. There is accumulating evidence that the process of healing after injury may be mediated by several GF. However, may this class of molecules even act effectively on the clinical response of this pathological condition? Many preclinical studies (in vitro and in vivo) reinforce the importance and efficacy of GF in the regeneration of damaged skin. Furthermore, recent studies have reported the use in adjuvant or not, of GF in clinical treatment to improve WH in humans. Therefore, we conclude that it seems to be effective by the use of GF in adjuvant or not in WH. However, it still seems to be necessary to carry out more clinical trials in phase I and II.

Physicians Attitude towards Pressure Injury Prevention and Management

Background: Cancer and its management can cause cachexia, which, along with prolonged immobility could lead to the development of chronic pressure ulcers (PU). These complications result into infection and/or pressure injury. Though pressure injury related tasks, are deemed to be given to staff nurses alone. Little of literature is available on the physician’s attitude towards PU prevention and management. Medical interns in 2015 concluded that 70% of them need more education in pressure injury. Present study is about physicians involved in pressure injury identification and management in a Cancer Center. Material and methods: A cross-sectional study was conducted in King Fahad Medical City among oncology physicians using self-administered 11 statement survey questionnaire. Physician residents, fellows, assistant consultants’ and consultants’ attitudes were compared. Statistical analyses were performed using SPSS. Results: In total 50 physicians completed the survey. The physicians demonstrated a positive attitude with an average mean score of 42.35 ± 4.65 (32, 51). The difference in the attitude scores among sub-groups was not statistically significant. Conclusions: Our study demonstrated a positive attitude towards pressure ulcer prevention and management among physicians working in Cancer Center. We have also highlighted the challenges in maintaining this positive attitude and possible strategies for improvement in the future.

Melatonin modulates the expression of Bcl-2 family proteins in liver after thermal injury in rats

Melatonin, the principal secretory product of the pineal gland, functions as a potent antioxidant and free radical scavenger. Additionally, the antiapoptotic effect of melatonin has been observed both in vivo and in vitro. The aim of this study was to investigate the protective effects of melatonin against burn-induced injury in rat liver and whether these changes were associated with oxidative stress and changes in the expression of apoptosis related genes Bcl-2 and Bax. Melatonin (10 mg/kg, i.p.) was applied immediately after 30% of total body surface area (TBSA) burns of male Wistar rats. Malondialdehyde (MDA) as marker of oxidative stress and tumor necrosis factor (TNF-α) as inflammatory marker were assayed by biochemical methods. The hepatic apoptosis related genes Bcl-2 and Bax using light immunоchistochemistry were investigated, too. Hepatic TNF-α and MDA levels were increased significantly following severe burn. Thermal trauma increased the Bax expression without any changes of anti-apoptotic Bcl-2 protein in sinusoidal endothelial cells (SECs) of burn-treated animals compared with the control group animals as well as elevated ratio Bax/Bcl-2 suggesting the susceptibility of these cells to apoptosis. Melatonin significantly decreased the MDA and TNF-α levels in the liver tissue. It decreased also expression of Bax, increased expression of Bcl-2 and reduced Bax/Bcl-2 ratio. In conclusion, experimental data show that melatonin modulates the expression of Bcl-2 family proteins by increasing anti-apoptotic Bcl-2, inhibits apoptosis and restricts the burn-induced damage.

Skin damage due to personal protective equipment among nursing staff in a dedicated coronavirus disease-2019 hospital of tribal India

Background:Nursing staff are at much greater risk of infection(Ebola virus diseases and severe acute respiratory syndrome)due to their exposure to highly infectious bodily fluids and droplet nuclei and the need for personal protective equipment(PPE)to reduce the transmission risk.Aim:The present study was conducted to estimate the prevalence of skin injuries and their types due to PPE usage among nursing staff in tribal India.Materials and Methods:This descriptive cross-sectional study was conducted in the dedicated coronavirus disease-2019(COVID-19)hospital for a period of 4 months among 144 nursing staff wearing Grade 2 and 3 PPE kits.Study subjects were approached through social networking websites and survey questionnaires(Google forms)according to relevant guides,and research literature was used to collect the details regarding baseline,duty,and skin injury characterization.Chi-square test was used to find the association between skin injury and baseline or duty characteristics,and the association was significant at a P<0.05.Results:It was observed that 54.7%of nursing staff were working for 6 or more hours and 16.5%of subjects were wearing the PPE kit for 5 or more hours per day.Skin injury was reported by 86.3%of the subjects after using PPE.Skin injuries among nurses were statistically significant with their current place of stay and daily duty hours(P<0.05).Conclusion:In this study,it was found that 86.3%of subjects had suffered from skin injuries by using PPE while caring for COVID-19 patients during duty hours,so an effective preventive measure should be adopted.

婴幼儿头皮医用粘胶相关性皮肤损伤防护方案的构建与应用

目的降低视频脑电图监测婴幼儿头皮医用粘胶相关性皮肤损伤。方法采用历史对照设计,将2018年1月至2019年12月入住癫痫监测单元行头皮视频脑电图监测的患儿856例纳入对照组,实施常规皮肤护理;将2021年1月至2022年12月入住癫痫监测单元行头皮视频脑电图监测的患儿851例纳入观察组,构建和实施医用粘胶相关性皮肤损伤防护方案。比较两组头皮医用粘胶相关性皮肤损伤发生率。结果观察组头皮医用粘胶相关性皮肤损伤发生率显著低于对照组(P<0.05)。结论婴幼儿头皮医用粘胶相关性皮肤损伤防护方案的应用,可有效降低婴幼儿头皮医用粘胶相关性皮肤损伤发生率。

Schwann cells originating from skin-derived precursors promote peripheral nerve regeneration in rats

Artificial guidance channels containing Schwann cells can promote the regeneration of injured peripheral nerve over long distances. However, primary Schwann cells are not suitable for autotransplantation. Under specific conditions, skin-derived progenitors can be induced to dif- ferentiate into Schwann cells. Therefore, adult rat dorsal skin （dermis）-derived progenitors were isolated and induced to differentiate with DMEM/F12 containing B27, neuregulin 1, and for- skolin. Immunofluorescence staining and reverse transcription polymerase chain reaction （RT- PCR） confirmed that the resultant cells were indeed Schwann cells. Artificial guidance channels containing skin-derived progenitors, Schwann cells originating from skin-derived progenitors, or primary Schwann cells were used to bridge 5 mm sciatic nerve defects. Schwann cells originating from skin-derived progenitors significantly promoted sciatic nerve axonal regeneration. The sig- nificant recovery of injured rat sciatic nerve function after the transplantation of Schwann cells originating from skin-derived progenitors was confirmed by electromyogram. The therapeutic effect of Schwann cells originating from skin-derived progenitors was better than that of skin-de- rived progenitors. These findings indicate that Schwann cells originating from skin-derived precursors can promote peripheral nerve regeneration in rats.

ICU护士医用粘胶相关性皮肤损伤知信行现状及培训需求

目的调查ICU护士医用粘胶相关性皮肤损伤(medical adhesive-related skin injury,MARSI)的知信行现状及培训需求,为推进相关培训及提升MARSI管理提供参考。方法采用MARSI知信行量表及自行设计MARSI培训需求调查表,选取济宁地区710名ICU护士进行线上调查。结果ICU护士MARSI知识、态度、行为维度得分率分别为58.53%、90.65%、78.87%,知信行总得分率为77.56%;不同学历、ICU工作年限、职称、职务在知识维度中、态度维度中和行为维度中差异均有统计学意义(P<0.05);63.81%ICU护士认为目前MARSI专业培训不能满足现任工作需求,96.9%ICU护士有意愿参加MARSI专业培训。结论ICU护士MARSI知信行总体呈中等水平,亟待加强;护理管理者应建立ICU护士MARSI培训方案,完善MARSI干预策略,提高ICU护士预防MARSI的能力和水平。

危重症新生儿医源性皮肤损伤风险评估量表的编制及信效度检验

目的编制危重症新生儿医源性皮肤损伤风险评估量表,并检验其信效度。方法基于文献分析、半结构式访谈和专家小组讨论,结合现有的新生儿皮肤损伤风险评估量表构建条目池,经德尔菲法和预调查构建量表。采用便利取样法选取2023年1月—5月于天津市3所三级甲等医院内科NICU住院的219例新生儿为研究对象开展问卷调查,检验量表的信效度。结果最终版量表包括生理状况、医用粘胶相关性皮肤损伤风险要素、药物外渗性损伤风险要素和医疗器械相关性皮肤损伤风险要素4个维度,共13个条目。量表水平的内容效度指数为0.92,条目水平的内容效度指数为0.83~1.00;探索性因子分析结果显示,共提取4个公因子,累计方差贡献率为75.36%;量表Cronbach's α系数为0.877,评分者间信度为0.997;量表预测危重症新生儿医源性皮肤损伤发生风险的受试者操作特征曲线下面积为0.92(P<0.001,95%CI为0.884~0.956),截断值为34.5分。结论本研究编制的危重症新生儿医源性皮肤损伤风险评估量表信效度良好,可为评估内科危重症新生儿发生医源性皮肤损伤的风险提供可靠的测评工具。

ICU护士对急性皮肤衰竭认知体验的质性研究

目的探索ICU护士对急性皮肤衰竭的认知体验。方法采用目的抽样法,于2022年8月-12月在杭州市某三级甲等综合性医院ICU,对符合纳入标准的12名护士进行半结构式访谈,采用Colaizzi现象学研究方法,对访谈资料进行分析。结果共提炼出4个主题:感知到认识急性皮肤衰竭的益处、期望建立急性皮肤衰竭的护理管理规范、渴望拥有不同学科间的知识共享和意识到ICU家属关于急性皮肤衰竭的信息支持不足。结论护理管理者可通过重视临床护士对急性皮肤衰竭的认知管理、制订急性皮肤衰竭护理管理规范、构建围危重期家属关于急性皮肤衰竭的信息支持方案等策略,以促进危重症患者皮肤护理临床实践。同时,亦需积极探索皮肤器官视角下的多学科知识共享模式,促进皮肤护理的创新科学研究,实现危重症领域皮肤护理的高质量发展。

光电损伤后的皮肤特点及其护理

光电治疗通过启动皮肤的创伤修复过程,起到治疗疾病和皮肤美容的作用。本文总结了不同类型光电治疗后皮肤急性损伤期的变化,梳理术后皮肤损伤修复的过程和特点,以及术后皮肤护理方案的原则,拟减少术后不良反应的发生以及促进术后皮肤修复,减少停工期,提升患者满意度。

双层人工真皮联合诱导膜技术修复足踝部皮肤缺损伴感染的疗效

目的 探讨双层人工真皮联合诱导膜技术修复足踝部皮肤缺损伴感染的疗效。方法 按创面缺损修复方式不同将64例足踝部皮肤缺损伴感染患者分为对照组(采用双层人工真皮修复后全厚皮片移植治疗,32例)和观察组(采用双层人工真皮联合诱导膜技术修复后全厚皮片移植治疗,32例)。记录两组人工真皮血管化时间、创面感染情况、移植皮片成活情况。采用温哥华瘢痕量表(VSS)评分评价植皮区瘢痕情况,采用AOFAS踝-后足评分评估踝关节功能恢复情况。结果 患者均获得12个月随访。人工真皮血管化时间观察组短于对照组(P<0.05)。移植皮片成活率观察组高于对照组(P<0.05)。创面感染率观察组低于对照组(P<0.05)。术后12个月VSS评分、AOFAS踝-后足评分两组比较差异均无统计学意义(P>0.05)。结论 双层人工真皮联合诱导膜技术修复足踝部皮肤缺损伴感染,手术操作相对简单易行,对供区损伤小,且可以明显缩短双层人工真皮血管化时间,提高创面修复成功率,降低创面感染率。

CT增强检查中碘对比剂外渗病人皮肤损伤风险预测模型的构建

目的:探讨CT增强检查中碘对比剂外渗病人皮肤损伤发生风险的影响因素,构建并验证风险预测模型。方法:采用便利抽样法抽取2023年1月—7月在广西医科大学第一附属医院放射科接受CT增强检查的碘对比剂外渗病人286例作为研究对象,自制CT增强检查碘对比剂外渗病人皮肤损伤风险调查问卷对病人进行调查,采用单因素分析、Logistic回归分析筛选CT增强检查中碘对比剂外渗病人皮肤损伤发生风险的影响因素,构建风险预测模型,绘制列线图,运用受试者工作特征(ROC)曲线、校准曲线评价模型。结果:CT增强检查中碘对比剂外渗病人皮肤损伤发生率为18.5%。Logistic回归分析结果显示,过敏史、碘对比剂黏稠度、碘对比剂注射速度是CT增强检查中碘对比剂外渗病人皮肤损伤的影响因素(P<0.05),基于上述结果构建的预测模型建模组ROC曲线下面积为0.842[95%CI(0.770,0.915)],约登指数为0.667,最优截断值灵敏度为0.893,特异度为0.774;验证组ROC曲线下面积为0.924[95%CI(0.872,0.975)],约登指数为0.793,最优截断值灵敏度为0.891,特异度为0.902。Hosmer-Lemeshow检验结果显示,χ2=9.566,P=0.221 5,校准曲线与参考线相接近。结论:CT增强检查中碘对比剂外渗病人皮肤损伤风险预测模型预测效能良好,可为医务人员制订个性化的预防措施提供参考。

手术室口诀式项目管理预防原位肝移植患者术中获得性压力性损伤的效果

目的探讨手术室口诀式项目管理预防原位肝移植患者术中获得性压力性损伤(intraoperative acquired pressure injury,IAPI)的效果。方法选取2022年1月-2023年10月于笔者所在医院行肝移植手术的64例患者为研究对象。按照入院先后顺序,将2022年1月-12月的32例患者设为对照组,将2023年1月-10月的32例患者设为观察组。对照组实施术中IAPI风险常规管理,观察组采用“一看、二定、三查、四准、五巡”的口诀式项目管理,比较2组IAPI预防措施落实情况及IAPI发生率。结果观察组IAPI预防措施落实得分高于对照组(t=6.920,P<0.001),IAPI发生率低于对照组(χ2=6.093,P=0.014)。结论手术室口诀式项目管理可以促进肝移植患者IAPI预防措施的落实,降低术中获得性压力性损伤发生率,值得临床推广应用。