大鼠二次脑损伤后脑组织SOD及MDA的变化研究

目的:观察大鼠二次脑损伤后脑组织SOD及MDA的变化,进一步探讨过氧化反应在二次脑损伤机制中的作用。方法:90只雄性SD大鼠随机分为正常对照组(A组)、弥漫性脑损伤组(B组)和二次脑损伤组(C组),建模成功后,分别于伤后1 h、3 h、6h、12 h、24 h、48 h处死动物,取额叶组织匀浆,分别测定大鼠脑内SOD及MDA的含量。结果:伤后1h开始,B、C组中SOD含量呈现先上升后下降的趋势,并随时间呈持续下降趋势直至伤后24 h,C组较B组下降程度更加明显(P0.05);伤后3 h,B、C组中SOD含量均增高,B组增高程度和速率均高于C组(P0.05)。伤后1 h开始,B、C组MDA含量呈升高趋势,并于24小时达峰值,C组升高趋势较B组更显著,伤后6 h、24 h、48 h,C组与B组之间相比统计学差异显著(P0.05)。结论:创伤性脑损伤及二次脑损伤后,脑组织内过氧化反应明显加重,SOD及MDA均出现明显变化,二次脑损伤的过氧化反应较脑损伤组更加严重且持续时间更长,且MDA较SOD的变化具有滞后性。     

硫酸镁对脑源性肺损伤综合征的影响

目的探讨不同剂量的硫酸镁(MgSO4)对大鼠脑源性肺损伤后神经源性肺水肿、血浆炎性因子TNF-α及肺组织病理形态学变化的影响。方法将30只SD雄性大鼠按随机数字法分为假手术组(A组)、模型组(B组)及硫酸镁50mg/kg干预组(C组)、硫酸镁100mg/kg干预组(D组)、硫酸镁200mg/kg干预组(E组),每组6只。建立大鼠颅脑损伤模型后,硫酸镁干预组即刻按50mg/kg 25%MgSO4腹腔注射,C组注射1次、D组注射2次、E组注射4次,每8h注射1次。A组及B组的大鼠注射相同剂量生理盐水作对照,C组大鼠注射1次及D组大鼠注射2次MgSO4后给予注射相同剂量的生理盐水作对照,注射方法及间隔时间同E组。伤后48h测定大鼠肺组织含水量、血浆TNF-α浓度,肺组织常规HE染色,光镜观察肺组织病理形态学变化。结果大鼠颅脑创伤后肺组织含水量均高于假手术组,以C组最明显(P0.05),差异有统计学意义。B、C、D、E组大鼠之间肺组织含水量比较差异无统计学意义。B、C、D、E组大鼠TNF-α浓度均明显高于假手术组(P0.05),D组血浆TNF-α浓度明显低于B组(P0.05),E组血浆TNF-α浓度明显低于B组(P0.01),其他各组间差异无统计学意义。假手术组肺组织形态正常,肺血管无扩张,无炎症细胞浸润;B、C、D、E组与假手术组比较均可见终末支气管腔内充满炎症细胞,周围肺组织的肺泡腔内可见炎细胞浸润,肺血管扩张、充血。B、C、D、E组在炎症细胞浸润及肺毛细血管扩张方面无明显差异。结论脑外伤可导致脑源性肺损伤综合征,可导致神经源性肺水肿;硫酸镁可降低大鼠脑损伤后血浆TNF-α浓度,对肺水肿无明显影响。     

颈交感神经阻滞对严重烧伤大鼠肾脏的保护作用及其机制研究

目的:观察颈交感神经阻滞(CSB)对严重烧伤大鼠肾脏的保护作用,并对其可能机制进行初步探讨。方法:制作放烧严重烧伤伤大鼠大鼠模型,在伤后即刻及连续4天内进行双侧颈交感神经阻滞,观察生命体征、肾功能指标、肾脏组织学改变、血流灌注、抗氧化能力、肾组织Bcl-2表达改变。结果:经过颈交感神经阻滞处理后,伤后各时相点动物肾功能均较对照组为好,组织学病变减轻,器官血流量下降幅度减小,总抗氧化能力好于对照组,免疫组化显示CSB组肾组织中Bcl-2的表达较严重烧伤组明显增高。结论:颈交感神经阻滞可改善严重烧伤大鼠肾脏血液灌注,增强抗氧化能力,预防伤后肾脏功能损害。     

清得佳凝胶治疗烧伤创面的生物学作用

目的探讨清得佳凝胶治疗烧伤创面的效果及其意义。方法采用家兔皮肤创伤模型,将每只家兔的背部烧伤区域用2种不同颜色的记号笔分成二组:A组(n=9):为实验组(6个部位):常规方法清洁、消毒创口,使用清得佳凝胶涂抹;B组(n=9):为对照组(6个部位):使用常规的无菌敷料覆盖包扎创口。实验于第3、5、7、9天分别取各组皮肤组织进行切片,作组织病理学及免疫组织化学观察。结果1.HE观察结果:烧伤后第3天,A组与B组皮肤烧伤创面结构变化不明显;烧伤后第5天,A组表皮细胞变性坏死程度减轻,成纤维细胞增生,水肿减轻,而B组表皮细胞变性坏死减轻程度不明显,结缔组织胶原纤维变性坏死程度没有得到明显的改善;烧伤后第7天,A组表皮细胞生长良好,真皮组织水肿基本消失;而B组表皮细胞变性坏死程度开始出现减轻,可见部分上皮增生;烧伤后第9天,A组上皮及结缔组织结构基本接近正常,创面愈合情况较好。而B组以上结构出现改变,但愈合状况不是很理想,真皮组织轻、中度水肿,有少量的炎性细胞浸润。2.转化生长因子β1(transforming growth factor β1,TGF-β1)的表达:烧伤后第3天和第5天,A组成纤维细胞胞浆中可见一些棕黄色颗粒,TGF-β1表达较强;B组成纤维细胞胞浆中未见或少见棕黄色颗粒,TGF-β1无表达或表达很弱。烧伤后第7天和第9天,A组成纤维细胞胞浆中可见密集分布的棕黄色颗粒,TGF-β1表达强;B组成纤维细胞胞浆中可见少量的棕黄色颗粒,TGF-β1表达弱。结论清得佳凝胶是一种烧伤创面良好的外用药,能清除创面坏死组织,有利于烧伤创面愈合。     

大鼠门静脉分支残端置管模型构建及细胞移植途径的评价*

摘要目的：大鼠肝部分切除模型被广泛的应用于肝脏疾病的研究,随着干细胞治疗肝损伤及护肝药物研究的发展,对大鼠肝损伤 模型也提出了很多新的要求。本实验拟在大鼠肝部分切除术的基础上改进以建立大鼠肝断面门静脉分支残端的静脉置管模型,并 进行细胞移植实验,对比分析新模型的优劣。方法：60 只F344 大鼠分为三组。A、B 组行行85 %肝切除术;C组行85 %肝切除术+ 肝断面门静脉分支残端置管术。术中B 组经门静脉注入4× 105个表达GFP（green fluorescence protein, GFP）的胎肝干细胞（fetal liver stem/progenitor cells, FLSPCs）。C组经留置导管注射入同等量的FLSPCs,A组注射同等剂量的培养液。72小时取血清,测定 肝功能ALT、AST,统计死亡率;取肝脏组织切片观察其修复情况。统计学采用方差分析和LSD-t 检验。结果：B、C组F344 大鼠 72 小时肝功指标（ALT、AST）均明显优于A 组;B 组、C 组肝脏组织学的病理损伤的恢复分别较A 组快。B、C组间肝功指标无统 计学意义。结论：经门静脉分支残端置管途径移植FLSPCs 效果等同于经门静脉穿刺途径,且该模型具有可反复、可选时、减少创 伤等优点。     

颈交感神经阻滞对严重烧伤大鼠的救治作用及其机制研究

目的:观察颈交感神经阻滞(CSB)对严重烧伤大鼠的救治作用,并对其可能机制进行初步探讨。方法:将大鼠随机分为正常对照组、烧伤组和CSB组,烧伤组与CSB组均制作20%体表面积Ⅲ0烧伤模型,CSB组于致伤后进行颈交感神经阻滞,观察动脉血压和心率变化;测定大鼠血中皮质酮、肾上腺素浓度;观察伤后21天动物伤死情况。结果:1.颈交感神经对严重烧伤大鼠救治效果显著,烧伤组和CSB组动物21天死亡率分别为73.33%和53.33%;2.创伤后大鼠血浆内肾上腺素浓度在伤后24小时有明显上升,然后迅速下降,但是CSB组肾上腺素浓度上升幅度远远低于烧伤组;3.与正常组相比,烧伤后血清GC的水平升高非常显著,CSB治疗组虽较正常组也升高,但显著低于烧伤组。结论:颈交感神经阻滞对严重创伤动物具有明显保护效应,其保护作用机制可能与调节创伤后神经-内分泌-免疫系统功能紊乱有关。     

皮肤损伤后SDF-1分泌量的变化及其受体CXCR4在表皮组织中分布表达的实验研究

目的:研究皮肤受损后不同时间点伤口液和皮肤组织中基质细胞衍生因子-1(SDF-1)的含量变化,同时验证SDF-1受体CXCR4在表皮组织内的分布.方法:分别在伤后即刻、12小时、24小时、36小时、48小时、60小时、72小时、96小时留取Ⅱ°烧伤患者的大疱液,用ELISA法检测伤口液中SDF-1的含量;用免疫组织化学染色的方法检测伤后1天、3天、7天创缘表皮内SDF-1的表达水平和其受体CXCR4在表皮组织上的分布.结果:用ELLSA法检测发现在受伤后几小时内大疱液中SDF-1的含量开始升高,1天后达到最高水平,伤后的3天SDF-1分泌量逐渐下降,而免疫组织化学染色结果显示创缘表皮层和真皮层上有散在的SDF-1分泌,且分泌量随创面愈合时间的推移逐渐增多;表皮细胞表达有CXCR4,且越靠近表皮基底层细胞膜的阳性越强.结论:SDF-1在皮肤损伤后表达量的增多可能对皮肤组织创伤修复起一定的调节作用.     

EPO对肾脏缺血再灌注损伤大鼠肺内氧化应激状态的影响

目的:探讨促红细胞生成素(erythropoietin,EPO)对大鼠肾脏再灌注损伤模型肺内氧化应激状态的影响。方法:清洁级Sprague-Dawly(SD)大鼠36只适应性喂养1周后,随机分为3组,即假手术组(A组)、肾脏再灌注损伤组(B组)和EPO预处理组(C组),每组12只。A组大鼠只打开腹腔,游离双侧肾蒂但不夹闭;B组与C组都建立了大鼠肾脏再灌注损伤模型,且C组在夹闭肾蒂前2 h腹腔注射人重组EPO(5000 U/kg)。术后24 h,处死大鼠,检测肺内氧化应激水平。结果:A组大鼠精神状态良好,肾小管结构正常,未见明显上皮细胞肿胀、脱落,肺泡结构基本完整,肺泡间隔未增厚,有少量炎性细胞浸润;B组鼠毛耸立,无光泽,饮水量减少,肾小管结构破坏消失,肾小管扩张,可见大量蛋白管型,肺泡结构破坏,肺泡腔缩窄,肺泡间隔增厚,组织水肿,大量炎性细胞浸润;C组大鼠精神状态有所恢复,一般状况尚可,肾小管损伤较B组轻似,肾小管坏死区域有所减少,坏死偶见,肺泡壁轻度破坏,结构较为清晰,可见少量炎性细胞浸润。B组与C组大鼠的血尿素氮(blood urea nitrogen, BUN)与血肌酐(serum creatinine,Scr)水平、肺组织血红素氧合酶(heme oxygenase, HO)-1与丙二醛(malondialdehyde, MDA)水平都显著高于A组,C组以上指标均显著低于B组(P0.05)。B组超氧化物歧化酶(superoxide dismutase, SOD)和谷胱甘肽过氧化物酶(glutathione peroxidase,GSH-Px)的水平均显著高于A组(均P0.05),而C组SOD和GSH-Px的水平均显著高于B组(均P0.05),A组与C组间对比无显著差异。结论:EPO用于大鼠肾脏再灌注损伤模型能缓解肺内氧化应激状态,促进肾功能及肺组织恢复,发挥肾脏保护作用。     

重型颅脑外伤患者肠内营养应用时机的比较分析

目的观察重型颅脑外伤患者应用肠内营养的最佳时机。方法选择重型颅脑外伤患者108例,随机分为A、B、C 3组,各36例。3组病人均经胃管或空肠管进行肠内营养支持,A组治疗开始时间为伤后24~48h,B组为伤后48~72h,C组为伤后72~96h。2周后对3组病人的血红蛋白、总蛋白、血清白蛋白等营养指标以及临床耐受情况、腹泻发生率进行比较。结果治疗后3组患者血红蛋白、总蛋白、血清白蛋白等均较治疗前有不同程度增高,组间比较,A、C组差异无统计学意义(P0.05),但A组较C组明显增高(均P0.05);腹泻发生率比较,A组较B、C组明显增加(P0.05),而B组与C组比较无明显差异(P0.05)。结论重型颅脑外伤患者伤后48~72h较适合采用肠内营养。     

微量失血对左肝外叶切除+ 定容失血性休克大鼠生存率的影响

目的:观察在大鼠左肝外叶切除+定容失血性休克模型制作过程中微量失血对最终大鼠生存率的影响。方法:45只SD大鼠按不同的放血比例分为三组,以Wigger改良法建立左肝外叶切除+定容失血性休克模型,严格标化放血前的各项手术操作和观测指标,比较三组大鼠最终生存率的差异。结果:在分别按2.4ml/100g(A组)、2.5ml/100g(B组)、2.6ml/100g(C组)比例定容失血的大鼠模型中,各组大鼠生存率分别为:A组66.67%,B组42.86%,C组7.69%,A、B两组与C组大鼠的生存率相比较存在明显差异(P<0.05)。结论:即使是0.1ml/100g的微量失血对于该模型大鼠的生存率也是有显著影响的,这一点在大鼠的定容失血性休克模型实验中是不应被忽视的。     

Beneficial Effects of Hydrogen-Rich Saline on Early Burn-Wound Progression in Rats

Introduction

Deep burn wounds undergo a dynamic process known as wound progression that results in a deepening and extension of the initial burn area. The zone of stasis is more likely to develop more severe during wound progression in the presence of hypoperfusion. Hydrogen has been reported to alleviate injury triggered by ischaemia/reperfusion and burns in various organs by selectively quenching oxygen free radicals. The aim of this study was to investigate the possible protective effects of hydrogen against early burn-wound progression.

Methods

Deep-burn models were established through contact with a boiled, rectangular, brass comb for 20 s. Fifty-six Sprague-Dawley rats were randomly divided into sham, burn plus saline, and burn plus hydrogen-rich saline (HS) groups with sacrifice and analysis at various time windows (6 h, 24 h, 48 h) post burn. Indexes of oxidative stress, apoptosis and autophagy were measured in each group. The zone of stasis was evaluated using immunofluorescence staining, ELISA, and Western blot to explore the underlying effects and mechanisms post burn.

Results

The burn-induced increase in malondialdehyde was markedly reduced with HS, while the activities of endogenous antioxidant enzymes were significantly increased. Moreover, HS treatment attenuated increases in apoptosis and autophagy postburn in wounds, according to the TUNEL staining results and the expression analysis of Bax, Bcl-2, caspase-3, Beclin-1 and Atg-5 proteins. Additionally, HS lowered the level of myeloperoxidase and expression of TNF-α, IL-1β, and IL-6 in the zone of stasis while augmenting IL-10. The elevated levels of Akt phosphorylation and NF-κB p65 expression post burn were also downregulated by HS management.

Conclusion

Hydrogen can attenuate early wound progression following deep burn injury. The beneficial effect of hydrogen was mediated by attenuating oxidative stress, which inhibited apoptosis and inflammation, and the Akt/NF-κB signalling pathway may be involved in regulating the release of inflammatory cytokines.     

Dosimetric effects of brass mesh bolus on skin dose and dose at depth for postmastectomy chest wall irradiation

PurposeTo investigate the feasibility of using the brass mesh bolus as an alternative to tissue- equivalent bolus for post mastectomy chest wall cancer by characterizing the dosimetric effects of the 2-mm fine brass bolus on both the skin dose, the dose at depth and spatial distribution.Materials and methodsSurface dose and percent depth dose data were acquired for a 6 MV photon beam in a solid water phantom using MOSkin™, Gafchromic EBT3 film and an Advanced Markus ionization chamber. Data were acquired for the case of: no bolus, Face-up bass bolus, Face-down brass bolus, double brass bolus, 0.5 cm and 1.0 cm of Superflab TE bolus. The exit doses were also measured via MOSkin™ dosimeter and Markus ionization chamber. Gafchromic EBT3 film strips were used to plot dose profile at surface and 10 cm depth for Face-up brass, Face-down brass, double brass, 0.5 cm and 1.0 cm of Superflab TE bolus.ResultsThe surface dose measured via MOSkin™ dosimeter increased from 19.2 ± 1.0% to 63.1 ± 2.1% under Face-up brass discs, 51.2 ± 1.2% under Face-up brass spaces, 61.5 ± 0.5% under Face-down brass discs, and 41.3 ± 2.1% under Face-down brass spaces. The percentage difference in the dose measured under brass discs between Face-up versus Face-down was less than 2% for entrance dose and 10% for exit dose, whereas the percentage difference under brass spaces was approximately 3% for entrance dose and about 5% for the exit dose. Gafchromic EBT3 film strip measurements show that the mesh bolus produced ripple beam profiles due to the mesh brass construction.ConclusionsBrass bolus does not significantly change dose at depth (less than 0.5%), and the surface dose is increased similar to TE bolus. Considering this, brass mesh may be used as a substitute for TE bolus to increase superficial dose for chest wall tangent plans.     

Melatonin reduces oxidative damage to skin and normalizes blood coagulation in a rat model of thermal injury

This study was designed to determine the effect of melatonin treatment on the glutathione (GSH) and lipid peroxidation (LPO) levels in the skin as well as prothrombin time (PT) and fibrin degradation products (FDPs) in the blood of rats with thermal injury. Under ether anaesthesia, the shaved dorsum of the rats was exposed to 90 degrees C bath for 10 s to induce burn injury. Rats were decapitated either 3 or 24 hours after burn injury. Melatonin (10 mg/kg) was administered i.p. immediately after burn injury to same animals. In the 24 hour burn group, melatonin injections were repeated for two more occasions 8 and 16 h after burn injury. In the control group the same protocol was applied except that the dorsum was exposed to a 25 degrees C water bath for 10 s. Severe skin scald injury (30% of total body surface area) caused a significant decrease in PT at post burn 3 and 24 hours. FDPs was not increased at post burn 3 hour but was significantly increased at post burn 24 hour. GSH levels were significantly depressed at post burn 3 hour but were not changed at post burn 24 hour. LPO levels were significantly increased both at post burn 3 and 24 hours. Skin protein levels were significantly reduced at post burn 24 hour as evidenced by electrophoresis. Treatment of rats with melatonin normalized PT levels both at post burn 3 and 24 hours. FDP decreased at post burn 24 hour due to melatonin treatment. GSH levels significantly increased as a result of melatonin treatment both at post burn 3 and 24 hours melatonin treatment. LPO levels were not changed by melatonin at post burn 3 hour; however, the melatonin significantly decreased LPO values at post burn 24 hours. In conclusion, exogenously administered melatonin reduced skin oxidant damage and normalized the activated blood coagulation induced by thermal trauma.     

Comparative Study of 1,064-nm Laser-Induced Skin Burn and Thermal Skin Burn

Infrared lasers are widely used in medicine, industry, and other fields. While science, medicine, and the society in general have benefited from the many practical uses of lasers, they also have inherent safety issues. Although several procedures have been put forward to protect the skin from non-specific laser-induced damage, individuals receiving laser therapy or researchers who use laser are still at risk for skin damage. This study aims to understand the interaction between laser and the skin, and to investigate the differences between the skin damage caused by 1,064-nm laser and common thermal burns. Skin lesions on Wistar rats were induced by a 1,064-nm CW laser at a maximum output of 40 W and by a copper brass bar attached to an HQ soldering iron. Histological sections of the lesions and the process of wound healing were evaluated. The widths of the epidermal necrosis and dermal denaturalization of each lesion were measured. To observe wound healing, the epithelial gap and wound gap were measured. Masson’s trichrome and picrosirius red staining were also used to assess lesions and wound healing. The thermal damage induced by laser intensified significantly in both horizontal dimension and in vertical depth with increased duration of irradiation. Ten days after wounding, the dermal injuries induced by laser were more severe. Compared with the laser-induced skin damage, the skin burn induced by an HQ soldering iron did not show a similar development or increased in severity with the passage of time. The results of this study showed the pattern of skin damage induced by laser irradiation and a heated brass bar. This study also highlighted the difference between laser irradiation and thermal burn in terms of skin damage and wound healing, and offers insight for further treatment.     

Cardiac effects of burn injury complicated by aspiration pneumonia-induced sepsis

Early fluid resuscitation, antimicrobials, early excision, and grafting have improved survival in the early postburn period; however, a significant incidence of pneumonia-related sepsis occurs after burn injury, often progressing to multiple organ failure. Recent studies have suggested that this initial injury (burn injury) primes the subject, producing an exaggerated response to a second insult, such as pneumonia-related sepsis. We developed an experimental animal model that included a third-degree burn over 40% of the total body surface area, followed by sepsis (intratracheal administration of Streptococcus pneumoniae, 4 x 106 colony-forming unit), which was produced either 48 or 72 h after burn injury in adult male rats. Hearts harvested after either burn alone, sepsis alone, or burn plus sepsis were used to assess either contractile function (Langendorff) or cardiomyocyte secretion of tumor necrosis factor-alpha, interleukin (IL)-1beta, IL-6, and IL-10 (ELISA). Experimental groups included the following: 1). sham (sham burn and no sepsis); 2). burn injury alone studied either 24, 48, or 72 h postburn; 3). pneumonia-related sepsis in the absence of burn injury; and 4). pneumonia-induced sepsis studied either 48 or 72 h after an initial burn injury. Burn injury alone (24 h) or sepsis alone produced myocardial contractile defects and increases in pro- and anti-inflammatory cytokine secretion by cardiomyocytes. Sepsis that occurred 48 h postburn exacerbated the cardiac contractile defects seen with either burn alone or sepsis alone. Sepsis that occurred 72 h postburn produced contractile defects resembling those seen in either burn alone or sepsis alone. In conclusion, our data suggest that burn injury primes the subject such that a second insult early in the postburn period produces significantly greater cardiac abnormalities than those seen with either burn alone or sepsis alone.     

豚鼠皮肤光过敏试验方法的建立

目的探索并建立豚鼠光过敏试验的方法。方法采用TBS作为阳性对照物,同时设立阴性对照组。分别于第1天、第4天、第7天对豚鼠皮肤进行UV-A紫外光诱导,诱导剂量紫外光强度为30 J/cm2;于第一次诱导后28 d对豚鼠皮肤采用UV-A紫外光激发,激发强度为9 J/cm2。结果阴性对照组24 h、48 h、及72 h豚鼠光过敏试验阳性率均为0,阳性对照组为24 h、48 h、及72 h豚鼠光过敏试验阳性率均为100%。结论本研究成功建立了豚鼠皮肤光过敏试验模型,TBS可作为阳性对照物。     

Molecular and pharmacological approaches to inhibiting nitric oxide after burn trauma

Whereas controversial, several studies have suggested that nitric oxide (NO) alters cardiac contractility via cGMP, peroxynitrite, or poly(ADP ribose) synthetase (PARS) activation. This study determined whether burn-related upregulation of myocardial inducible NO synthase (iNOS) and NO generation contributes to burn-mediated cardiac contractile dysfunction. Mice homozygous null for the iNOS gene (iNOS knockouts) were obtained from Jackson Laboratory. iNOS knockouts (KO) as well as wild-type mice were given a cutaneous burn over 40% of the total body surface area by the application of brass probes (1 x 2 x 0.3 cm) heated to 100 degrees C to the animals' sides and back for 5 s (iNOS/KO burn and wild-type burn). Additional groups of iNOS KO and wild-type mice served as appropriate sham burn groups (iNOS/KO sham and wild-type sham). Cardiac function was assessed 24 h postburn by perfusing hearts (n = 7-10 mice/group). Burn trauma in wild-type mice impaired cardiac function as indicated by the lower left ventricular pressure (LVP, 67 +/- 2 mmHg) compared with that measured in wild-type shams (94 +/- 2 mmHg, P < 0.001), a lower rate of LVP rise (+dP/dtmax, 1,620 +/- 94 vs. 2,240 +/- 58 mmHg/s, P < 0.001), and a lower rate of LVP fall (-dP/dtmax, 1,200 +/- 84 vs. 1,800 +/- 42 mmHg/s, P < 0.001). Ventricular function curves confirmed significant contractile dysfunction after burn trauma in wild-type mice. Burn trauma in iNOS KO mice produced fewer cardiac derangements compared with those observed in wild-type burns (LVP: 78 +/- 5 mmHg; +dP/dt: 1,889 +/- 160 mmHg/s; -dP/dt: 1,480 +/- 154 mmHg/s). The use of a pharmacological approach to inhibit iNOS (aminoguanidine, given ip) in additional wild-type shams and burns confirmed the iNOS KO data. Whereas the absence of iNOS attenuated burn-mediated cardiac contractile dysfunction, these experiments did not determine the contribution of cardiac-derived NO versus NO generated by immune cells. However, our data indicate a role for NO in cardiac dysfunction after major trauma.     

A Novel Model of Human Skin Pressure Ulcers in Mice

Introduction

Pressure ulcers are a prevalent health problem in today''s society. The shortage of suitable animal models limits our understanding and our ability to develop new therapies. This study aims to report on the development of a novel and reproducible human skin pressure ulcer model in mice.

Material and Methods

Male non-obese, diabetic, severe combined immunodeficiency mice (n = 22) were engrafted with human skin. A full-thickness skin graft was placed onto 4×3 cm wounds created on the dorsal skin of the mice. Two groups with permanent grafts were studied after 60 days. The control group (n = 6) was focused on the process of engraftment. Evaluations were conducted with photographic assessment, histological analysis and fluorescence in situ hybridization (FISH) techniques. The pressure ulcer group (n = 12) was created using a compression device. A pressure of 150 mmHg for 8 h, with a total of three cycles of compression-release was exerted. Evaluations were conducted with photographic assessment and histological analysis.

Results

Skin grafts in the control group took successfully, as shown by visual assessment, FISH techniques and histological analysis. Pressure ulcers in the second group showed full-thickness skin loss with damage and necrosis of all the epidermal and dermal layers (ulcer stage III) in all cases. Complete repair occurred after 40 days.

Conclusions

An inexpensive, reproducible human skin pressure ulcer model has been developed. This novel model will facilitate the development of new clinically relevant therapeutic strategies that can be tested directly on human skin.     

When does a random flap die?

A random flap can be constructed, its circulation determined, and the ischemic portion identified. Left untreated for a period, the critical ischemia time, the ischemic portion will die and is clinically recognized several days later. What is not known is when this tissue, destined to die, actually dies. To ascertain this time, we compared the percent necrosis of a distal 3 x 3 cm segment of a 10 x 3 cm reverse McFarlane random flap with a known distribution of necrosis to the percent necrosis of the distal 3 x 3 cm of full-thickness skin grafts taken from a similar reverse McFarlane flap at 0, 4, 8, 12, and 16 hours after pedicle construction. Implicit in this experiment is the assumption that necrosis of the full-thickness skin grafts in excess of that of control animals represented skin no longer viable. Sometime between 8 and 12 hours, the percent necrosis of the full-thickness skin grafts surpassed that of the control, and it was concluded that this graft was dead prior to grafting. Thus it is suggested that critical ischemia time and death of the flap tissue are nearly identical, and the latter occurs at between 8 and 12 hours.     

Repair of major defects of the chest wall and spine with the latissimus dorsi myocutaneous flap.

The latissimus dorsi myocutaneous flap is a remarkably durable and versatile flap. Flap necrosis did not occur in any of our patients. One can safely carry with it skin segments as narrow as 3 cm, or as wide as 30 cm. In addition to the 5 cases presented, we have used the flap to repair axillary burn contractures, for breast reconstruction after a transverse incision, and for coverage of the upper arm and shoulder. The applications of this flap challenge the creative imagination of the surgeon and allow a simplified reconstruction, compared to other good methods. The newly described posterior advancement of a latissimus dorsi myocutaneous flap is suggested as the preferred method to repair meningomyelocele defects.