[Strategy for wound repair of skin and soft tissue defect and systematic rehabilitation treatment for functional reconstruction of patients with severe burn or trauma on knees]

Objective: Strategy for wound repair of skin and soft tissue defect and systematic rehabilitation treatment for functional reconstruction of patients with severe burn or trauma on knees. Methods: From January 2015 to October 2016, 26 patients with skin and soft tissue defect on knees after severe burn or trauma were hospitalized in our unit. Among these patients, 14 patients had patellar ligament defect, and 16 patients had knee joint capsule defect. Wound debridement was operated on 1 to 3 days after admission. After debridement, the area of skin and soft tissue defect ranged from 10 cm×7 cm to 42 cm×18 cm. Vacuum sealing drainage (VSD) treatment was performed after debridement, and flap transplantation operation was performed after VSD treatment for 5 to 7 days. Defects of nine patients were treated with local rotation flaps. Seven patients with skin and soft tissue defects on knees and knee joint capsule defects of 5 cm×3 cm to 9 cm×7 cm were treated with free anterolateral femoral flaps combined with fascia lata. Ten patients with skin and soft tissue defects on knees and patellar ligament defects of 6 cm×3 cm to 12 cm×4 cm were treated with free anterolateral femoral flaps combined with iliotibial tract. The area of flaps ranged from 11 cm×9 cm to 22 cm×15 cm. After flap transplantation operation, functional reconstruction of knee joint was carried out according to early, continuous, and sequential systematic rehabilitation treatment strategy. The pain degree and function of knee joint of patients were scored by the International Knee Documentation Committee (IKDC) Knee Evaluation Form before operation and 12 months after operation. The knee joint flexion and extension degrees of patients were measured by joint protractor in 2 weeks and 12 months after operation. The color Doppler ultrasound was used to evaluate integrity of knee joint capsule and continuity of patellar ligament of patients in 6 and 12 months after operation. Results: All flaps of 26 patients survived well, and wounds healed completely after the operation. Distal parts of flaps of 2 patients treated with free anterolateral femoral flaps had local necrosis after the operation, and their wounds healed after debridement and transplantation of autologous intermediate split-thickness skin graft of thigh. The IKDC Knee Evaluation Form score of patients was (79±8) points in 12 months after operation, which was significantly higher than (64±7) points before operation (t=7.20, P<0.05). The flexion degree of knee joint of patients was (117±10)° in 12 months after operation, which was significantly larger than (35±8)° in 2 weeks after operation (t=32.65, P<0.05). The extension degree of knee joint of patients was (12±9)° in 12 months after operation, which was significantly smaller than (61±9)° in 2 weeks after operation (t=19.63, P<0.05). In 6 and 12 months after operation, 9 patients treated with local rotation flaps had good integrity of knee joint capsule and continuity of patellar ligament; 7 patients treated with free anterolateral femoral flaps and fascia lata had good integrity of knee joint capsule; 10 patients treated with free anterolateral femoral flaps and iliotibial tract had good continuity of patellar ligament. During follow-up of 12 months, all flaps survived well; knees of all patients had good appearance; knee joints functioned normally. Conclusions: Good appearance and function of knees can be achieved by repairing wound of skin and soft tissue defect on knees after severe burn or trauma with local rotation flaps or free anterolateral femoral flaps with fascia lata or iliotibial tract plus systematic rehabilitation treatment of knee joint in early stage after flap transplantation operation.

Heavy metal concentrations in edible bivalves and gastropods available in major markets of the Pearl River Delta

Molluscs are able to accumulate heavy metals and impose health hazard to consumers. The main objective of the present study is to investigate the heavy metal concentrations in edible bivalves and gastropods available in major markets of the Pearl River Delta. Fourteen species of edible molluscs were purchased from six markets in Hong Kong and Guangdong Province. The fresh of these biota were tested for their cadmium (Cd), copper (Cu), zinc (Zn), lead (Pb), nickel (Ni), chromium (Cr), antimony (Sb) and tin (Sn) concentrations (based on wet weight). The results indicated that amongst the 14 edible molluscs, only Cd, Pb, Ni, Cr, Sb and Sn concentrations in three species (Ruditapes philippinarum, Perna viridis and Hemifusus tuba) were within the local regulatory limits. Over 60% of bivalve species exceeded maximum permitted levels of Cd (2 micrograms/g) and Cr (1 microgram/g), while over 40% of gastropod species exceeded the maximum levels of Sb (1 microgram/g) and Cr (1 microgram/g). Most of the samples collected from Hong Kong had significantly higher contents of Pb and Sb, but similar levels of Cd, Cu and Zn when compared with samples collected across the border (p < 0.05; p < 0.01; p < 0.001 respectively). In general, the molluscs purchased in Guangdong markets had higher metal contents than those purchased from the Hong Kong markets. When compared with the Provisional Tolerable Weekly Intake or Maximum Acceptable Daily Load recommended by FAO/WHO Expert Committee on Food Additives, Cd levels of five species (Anadara ferruginea, Pinna pectinata, Chlamys nobilis, Babylonia lutosa and Hemifusus terntanus) and Cr levels of seven species (Anadara ferruginea, Paphia undulata, Pinna pectinata, Babylonia lutosa, Hemifusus terntanus, Cymbium melo and Cipangopaludina chinensis) were higher than both the human daily acceptable limits (for Cd and Cr respectively) and the local regulatory levels (for Cd and Cr respectively).

[Effect of er-xian decoction and its disassembled prescription on enzyme activities and their gene expression of antioxidant enzymes in aging rat]

In order to study the mechanism of aging, this experiment adopted molecular biological techniques to observe the effect of Er-Xian decoction (EXD)and its disassembled prescription on the enzyme activities and their gene expression of superoxide dismutase (SOD)and catalase (CAT). The results showed that in old rat, the amount of lipid peroxide (LPO) increased significantly; the enzyme activities such as SOD, CAT decreased significantly; and the lowering of these activities had a direct bearing on the gene expression level of their enzyme protein. After treatment by EXD and its disassembled prescription in aging rat, the amounts of LPO reduced significantly, the activities of SOD, CAT enhanced significantly. Moreover, it was observed that the increasing of these enzyme activities was related to the enhancing of their gene expression. It was suggested that EXD had the effect of anti-aging in that it could raise the activities of antioxidant enzymes and reduce the product of free radicals by means of regulating and enhancing the gene expression levels of their enzyme protein.