Tag: statistics

Food Chem. 2021 Nov 11:131586. doi: 10.1016/j.foodchem.2021.131586. Online ahead of print.

ABSTRACT

Various structural types of polysaccharides are recognized by toll-like receptor 4 (TLR4). However, the mechanism of interaction between the polysaccharides with different structures and TLR4 is unclarified. This review summarized the primary structure of polysaccharides related to TLR4, mainly including molecular weight, monosaccharide composition, glycosidic bonds, functional groups, and branched-chain structure. The optimal primary structure for interacting with TLR4 was obtained by the statistical analysis. Besides, the dual-directional regulation of TLR4 signaling cascade by polysaccharides was also elucidated from an immune balance perspective. Finally, the 3D interaction model of polysaccharides to TLR4-myeloid differentiation factor 2 (MD2) complex was hypothesized according to the LPS-TLR4-MD2 dimerization model and the polysaccharides solution conformation. The essence of polysaccharides binding to TLR4-MD2 complex is a multivalent non-covalent bond interaction. All the arguments summarized in this review are intended to provide some new insights into the interaction between polysaccharides and TLR4.

PMID:34839969 | DOI:10.1016/j.foodchem.2021.131586

Curr Probl Diagn Radiol. 2021 Nov 2:S0363-0188(21)00167-5. doi: 10.1067/j.cpradiol.2021.10.001. Online ahead of print.

ABSTRACT

OBJECTIVE: The purpose of this study was to evaluate the use of virtual monoenergetic images (VMI) in pre-operative CT angiography of potential donors for living donor adult liver transplantation (LDALT), and to determine the optimal energy level to maximize vascular signal-to-noise and contrast-to-noise ratios (SNR and CNR, respectively).

MATERIALS AND METHODS: We retrospectively evaluated 29 CT angiography studies performed preoperatively in potential liver donors on a spectral detector CT scanner. All studies included arterial, early venous, and delayed venous phase imaging. Conventional polyenergetic images were generated for each patient, as well as virtual monoenergetic images in 10 keV increments from 40 -100 keV. Arteries (aorta and celiac, superior mesenteric, common hepatic, right and left hepatic arteries) were assessed on arterial phase images; portal venous system branches (splenic, superior mesenteric, main, right, and left portal veins) on early venous phase images; and hepatic veins on late venous phase images. Vascular attenuation, background parenchymal attenuation, and noise were measured on each set of virtual monoenergetic and conventional images.

RESULTS: Background hepatic and vascular noise decreased with increasing keV, with the lowest noise at 100 keV. Vascular SNR and CNR increased with decreasing keV and were highest at 40 keV, with statistical significance compared with conventional ( P < 0.05).

CONCLUSIONS: In preoperative CT angiography for potential liver donors, the optimal keV for assessing the vasculature to improve SNR and CNR is 40 keV. Use of low keV VMI in LDALT CT protocols may facilitate detection of vascular anatomical variants that can impact surgical planning.

PMID:34839975 | DOI:10.1067/j.cpradiol.2021.10.001

Mar Pollut Bull. 2021 Nov 25:113174. doi: 10.1016/j.marpolbul.2021.113174. Online ahead of print.

ABSTRACT

Sea urchins are highly abundant in the marine ecosystem where they graze limiting algal biomass and also serving as food for other predators. In this work, the presence of microplastics in the digestive tracts and gonads of 33 Diadema africanum sea urchins collected at two sampling points in Tenerife (Canary Islands, Spain) was studied. After separation and digestion of the digestive tracts and the gonads, the visualization of the filtrates under the stereomicroscope revealed the presence of 320 items which were microfibers (97.5%), fragments (1.9%) and films (0.6%), mainly blue (43.3 and 47.0% in the two sampling points, Tajao and El Porís, respectively) and translucent white (32.5 and 39.5%, respectively). Statistical analysis revealed that there were no significative differences in the contents of gonads and digestive tracts between both sampling locations. Regarding microfibers lengths, significative differences were only observed between the two sampling points, not between tissues. μRaman analysis showed that they were mainly cellulosic (46.0%), polypropylene (24.3%) and polyethylene terephthalate (24.3%). This study confirms for the first time the presence of microplastics in sea urchins from the Macaronesian region and also from Spain.

PMID:34839951 | DOI:10.1016/j.marpolbul.2021.113174

Med Intensiva (Engl Ed). 2021 Dec;45(9):516-531. doi: 10.1016/j.medine.2021.03.001.

ABSTRACT

OBJECTIVE: The “Open Lung Approach” (OLA), that includes high levels of positive end-expiratory pressure coupled with limited tidal volumes, is considered optimal for adult patients with ARDS. However, many previous meta-analyses have shown only marginal benefits of OLA on mortality but with statistical heterogeneity. It is crucial to identify the most likely moderators of this effect. To determine the effect of OLA strategy on mortality of ventilated ARDS patients. We hypothesized that the degree of recruitment achieved in the control group (PaO₂/FiO₂ ratio on day 3 of ventilation), and the difference in Mechanical Power (MP) or Driving Pressure (DP) between experimental and control groups will be the most likely sources of heterogeneity.

DESIGN: A Systematic Review and Meta-analysis was performed according to PRISMA statement and registered in PROSPERO database. We searched only for randomized controlled trials (RCTs). GRADE guidelines were used for rating the quality of evidence. Publication bias was assessed. For the Meta-analysis, we used a Random Effects Model. Sources of heterogeneity were explored with Meta-Regression, using a priori proposed set of possible moderators. For model comparison, Akaike’s Information Criterion with the finite sample correction (AICc) was used.

SETTING: Not applicable.

PATIENTS: Fourteen RCTs were included in the study.

INTERVENTIONS: Not applicable.

MAIN VARIABLES OF INTEREST: Not applicable.

RESULTS: Evidence of publication bias was detected, and quality of evidence was downgraded. Pooled analysis did not show a significant difference in the 28-day mortality between OLA strategy and control groups. Overall risk of bias was low. The analysis detected statistical heterogeneity. The two “best” explicative meta-regression models were those that used control PaO₂/FiO₂ on day 3 and difference in MP between experimental and control groups. The DP and MP models were highly correlated.

CONCLUSIONS: There is no clear benefit of OLA strategy on mortality of ARDS patients, with significant heterogeneity among RCTs. Mortality effect of OLA is mediated by lung recruitment and mechanical power.

PMID:34839883 | DOI:10.1016/j.medine.2021.03.001

J Mol Diagn. 2021 Dec;23(12):1732-1740. doi: 10.1016/j.jmoldx.2021.08.013.

ABSTRACT

Complex insertion-deletion (indel) events in the globin genes manifest in widely variable clinical phenotypes. Many are incompletely characterized because of a historic lack of efficient methods. A more complete assessment enables improved prediction of clinical impact, which guides emerging therapeutic choices. Current methods have limited capacity for breakpoint assignment and accurate assessment of mutation extent, especially in cases containing duplications or multiple deletions and insertions. Technology, such as long-read sequencing, holds promise for significant impact in the characterization of indel events because of read lengths that span large regions, resulting in improved resolution. Four known complex β-globin gene cluster indel types were assessed using single-molecule, real-time sequencing technology and showed high correlation with previous reports, including the Caribbean locus control deletion (g.5,305,478_5,310,336del), a large β-gene duplication containing the Hb S mutation (g.4,640,335_5,290,171dup with g.5,248,232T>A, c.20A>T; variant allele fraction, 64%), and two nested variants (double deletions with intervening inversion): the Indian ^Gγ(^Aγδβ)⁰-thalassemia (g.5,246,804-5,254,275del, g.5,254,276_5,269,600inv, and g.5,269,601_5,270,442del) and the Turkish/Macedonian (δβ)⁰ thalassemia (g.5,235,064_5,236,652del, g.5,236,653_5,244,280inv, and g.5,244,281_5,255,766del). Our data confirm long-read sequencing as an efficient and accurate method to identify these clinically significant complex events. Limitations include high-complexity sample preparation requirements, which hinder routine use in clinical laboratories. Continued improvements in sample and data workflow processes are needed to accommodate volumes in a tertiary clinical laboratory.

PMID:34839893 | DOI:10.1016/j.jmoldx.2021.08.013

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2021 Sep;33(9):1084-1087. doi: 10.3760/cma.j.cn121430-20210425-00608.

ABSTRACT

OBJECTIVE: To observe the clinical effect of the cannula under laparoscopy, percutaneous puncture cannula, and conventional surgery cannula for peritoneal dialysis.

METHODS: From May 3, 2015 to February 14, 2020, 87 patients with end-stage renal disease needing peritoneal dialysis in Ningbo Zhenhai People’s Hospital were enrolled. These patients were divided into three groups including cannula under laparoscopy (23 cases), percutaneous puncture cannula (29 cases), and conventional surgery cannula (35 cases). The baseline characteristics, perioperative conditions (surgical time, post-surgical hospitalization time), the incidence of recent complications (abdominal hemorrhage, direct abdominal hemorrhage, incision pain, leakage, catheter shift, peritonitis), and long-term complications (catheter shift, peritonitis, hernia, thoracic and abdominal fistula, abdominal tube obstruction) among the three groups were compared.

RESULTS: Compared with the group of conventional surgery cannula, the operation time in the group of cannula under laparoscopy and the group of percutaneous puncture cannula were significantly shorter (minutes: 32.5±12.3, 28.9±11.8 vs. 61.3±15.4, both P < 0.05), the in-hospital stay in the group of cannula under laparoscopy and the group of percutaneous puncture cannula were reduced (days: 9.8±3.4, 9.2±2.6 vs. 10.7±3.2), but there was no statistical significance among the three groups (P > 0.05). The incidence of abdominal bleeding, rectus abdominis bleeding, and incision pain in the group of cannula under laparoscopy and the group of percutaneous puncture cannula were significantly lower than those in the group of conventional surgery cannula [incidence of abdominal bleeding: 4.3% (1/23), 3.4% (1/29) vs. 22.9% (8/35), incidence of rectus abdominis bleeding: 4.3% (1/23), 3.4% (1/29) vs. 22.9% (8/35), incidence of incision pain: 8.7% (2/23), 10.3% (3/29) vs. 42.9% (15/35), all P < 0.01]. The difference between the group of cannula under laparoscopy and the group of percutaneous puncture cannula had no statistical significance. Compared with the group of conventional surgery cannula and the group of percutaneous puncture cannula, the incidence of catheter displacement in the group of cannula under laparoscopy was significantly reduced [4.3% (1/23) vs. 27.6% (8/29), 31.4% (11/35), both P < 0.05]. Compared with the group of conventional surgery cannula and the group of percutaneous puncture cannula, the incidence of catheter displacement in long-term complications in the group of cannula under laparoscopy was significantly reduced [4.3% (1/23) vs. 24.1% (7/29), 31.4% (11/35), both P < 0.05], however, the difference of that between the group of conventional surgery cannula and the group of percutaneous puncture cannula was not statistically significant. The incidence of hernia in the group of cannula under laparoscopy was significantly higher than that in the group of percutaneous puncture cannula or in the group of conventional surgery cannula [21.7% (5/23) vs. 3.4% (1/29), 2.8% (1/35), both P < 0.05], and all of that were umbilical hernia, however, the difference of that between the group of percutaneous puncture cannula and the group of conventional surgery cannula was not statistically significant.

CONCLUSIONS: Compared with the traditional conventional surgical cannula placement methods, percutaneous puncture has the advantages of simple operation, short operation time, small trauma, but still cannot reduce the incidence of drift tube; laparoscopic peritoneal dialysis tube has the advantages of short operation time, small trauma and low catheter displacement rate, but increases the risk of umbilical hernia.

PMID:34839866 | DOI:10.3760/cma.j.cn121430-20210425-00608

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2021 Sep;33(9):1110-1115. doi: 10.3760/cma.j.cn121430-20210402-00497.

ABSTRACT

OBJECTIVE: To investigate the possible mechanism of ultrasound therapy in the rat model of sepsis.

METHODS: Seventy-eight male Sprague-Dawley (SD) rats were randomly divided into Sham group (n = 12), septic model group (n = 22), ultrasound treatment group (n = 22), methyllycaconitine citrate (MLA) combined with ultrasound treatment group (n = 22). In the Sham group, only the abdomen was opened, the cecum was found to be free, without cecal ligation and puncture (CLP). In the septic model group, CLP was used to replicate the septic rat model. After operation, each group of rats were subcutaneously injected with preheated 37 centigrade normal saline. The rats in the ultrasound treatment group were treated with ultrasound [Philips IU22 L9-3 ultrasound instrument and 9 MHz probe were used to break the sequence in the spleen area once every 6 seconds, with 1 second for each time, the mechanical index (MI) was 0.72, and the treatment time was 10 minutes]. In the MLA combined with ultrasound treatment group, α7 nicotinic acetylcholine receptor (α7nAChR) specific blocker MLA 4 mg/kg was injected intraperitoneally 30 minutes before operation, and ultrasound treatment was performed 2 hours after operation. The levels of tumor necrosis factor-α (TNF-α) and interleukin (IL-1β, IL-6) in serum of each group were measured by enzyme-linked immunosorbent assay (ELISA) at 24 hours after operation. The 10-day survival rate of each group was recorded, and the symptoms of each group were evaluated by clinical disease score (CDS). The histopathological changes of lung and colon were observed under light microscope.

RESULTS: Compared with the Sham group, the 10-day survival rate of rats in the septic model group was decreased significantly [40% (4/10) vs. 100% (6/6)], the CDS was (10.73±2.19 vs. 6.17±0.58) and the levels of TNF-α, IL-6, and IL-1β were increased significantly at 24 hours after operation [TNF-α (ng/L): 42.00±8.92 vs. 13.16±3.19, IL-6 (ng/L): 129.37±25.04 vs. 63.99±12.92, IL-1β (ng/L): 254.98±67.27 vs. 76.83±25.39, all P < 0.01]. Compared with the septic model group, the survival rate in the ultrasound treatment group was improved [70% (7/10) vs. 40% (4/10)], but there was no significant difference (P > 0.05). The CDS (7.64±2.68 vs. 10.73±2.19) and the expressions of TNF-α, IL-6, and IL-1β were significantly reduced at 24 hours after operation [TNF-α (ng/L): 16.93±6.02 vs. 42.00±8.92, IL-6 (ng/L): 73.65±24.38 vs. 129.37±25.04, IL-1β (ng/L): 111.86±14.08 vs. 254.98±67.27, all P < 0.01]. Compared with the ultrasound treatment group, the survival rate in the MLA combined with ultrasound treatment group was reduced [60% (6/10) vs. 70% (7/10)], but the difference was not statistically significant (P > 0.05). CDS was significantly increased (9.55±2.72 vs. 7.64±2.68), and the levels of TNF-α, IL-6 and IL-1β were significantly increased at 24 hours after operation [TNF-α (ng/L): 34.61±7.89 vs. 16.93±6.02, IL-6 (ng/L): 112.92±10.42 vs. 73.65±24.38, IL-1β (ng/L): 212.57±32.16 vs. 111.86±14.08, all P < 0.01]. Microscopically, in the septic model group, the alveolar septum was thickened, a large number of inflammatory cells infiltrated, normal pulmonary reticular structure disappeared, and pulmonary interstitium showed obvious hemorrhage and edema, meanwhile, the structure of colonic villi was obviously abnormal, with cells were edema and inflammatory cell infiltration, and the arrangement was disordered, so that the subepithelial space and the top of it fell off. After ultrasound treatment, the thickness of the alveolar interval in rats was similar to that in Sham group, without obvious inflammatory cell infiltration, and the pulmonary reticular structure was relatively intact. At the same time, the morphology of colonic villi was basically normal and orderly, the edema of cell was not obvious, and subcutaneous space and tip fall off were not obvious. After being antagonized by MLA, the rat lung tissue showed thickened alveolar septum, inflammatory cell infiltration, incomplete pulmonary network structure, hemorrhage and edema in the interstitium. The villi structure of the colon was faintly visible, with obvious cell edema and inflammatory cell infiltration, and the arrangement was abnormal.

CONCLUSIONS: Ultrasound treatment improves the prognosis of septic rats, MLA can reverse the anti-inflammatory effect of ultrasound therapy by antagonizing α7nAChR, suggesting that the protective mechanism of ultrasound in sepsis may be related to activating the cholinergic anti-inflammatory pathway mediated by α7nAChR.

PMID:34839871 | DOI:10.3760/cma.j.cn121430-20210402-00497

Zhonghua Wai Ke Za Zhi. 2021 Dec 1;59(12):982-986. doi: 10.3760/cma.j.cn112139-20210902-00415. Online ahead of print.

ABSTRACT

Objective: To examine the therapeutic effects of drug-coated balloon (DCB) and bare metal stent (BMS) on primary femoropopliteal disease (FPAD) in the real world. Methods: This was a retrospective analysis of single-center follow-up results at 12,24,and 36 months of patients with FPAD lesions that were treated with DCB and BMS at Department of Aortic and Vascular Surgery, National Center for Cardiovascular Diseases, Fu Wai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College.One-to-one propensity score matching(PSM) was performed to balance the covariance between DCB and BMS groups.There were both 71 patients in each group,aged (68.0±9.6) years(range: 46 to 90 years) and (68.8±7.3) years(range: 48 to 87 years),lesion lengths were (119.6±14.2)mm(range:40-380 mm) and (110.8±13.1)mm(range:40-400 mm).The covariates were balanced between DCB and BMS groups.Freedom from clinically driven target lesion reintervention (fCD-TLR) was determined by Kaplan-Meier curve.Log-rank test was used to compare the rates of fCD-TLR between DCB and BMS groups at 12,24,36 months post-operation. Results: The median follow-up period were 24.3 months (range:5.8 to 55.1 months).There was no death,amputation or reintervention within the 30 days after operation.The rates of fCD-TLR for DCB group at 12,24 and 36 months were 97.2%,85.9%,69.1%, and 95.8%,83.1%,59.2% for BMS group.There was no statistical difference between the two groups by Log-rank test (P=0.551). Conclusion: DCB and BMS can both maintain favorable clinical effects in FPAD patients at 12,24,36 months post-operation.

PMID:34839611 | DOI:10.3760/cma.j.cn112139-20210902-00415

Zhonghua Shao Shang Za Zhi. 2021 Nov 25;37:1-10. doi: 10.3760/cma.j.cn501120-20210601-00208. Online ahead of print.

ABSTRACT

Objective: To investigate the effects and cell signaling mechanism of glutamine on rat cardiomyocytes intervened with serum from burned rat (hereinafter referred to as burn serum). Methods: The experimental research method was applied. Ten gender equally distributed Wistar rats aged 7-8 months were taken to prepare normal rat serum (hereinafter referred to as normal serum), another twenty gender equally distributed Wistar rats aged 7-8 months were taken to prepare burn serum after full- thickness burn injury of 30% total body surface area, and cardiomyocytes were isolated from 180 Wistar rats aged 1-3 days by either gender and used in the following experiments. The cells were divided into normal serum group and burn serum group according to the random number table (the same grouping method below), and cultured with the corresponding serum. At post culture hour (PCH) 1, 3, 6, 9, and 12, trypanosoma blue exclusion test was used to detect the cell survival rate. The cells were divided into burn serum alone group, burn serum+4 mmol/L glutamine group, burn serum+8 mmol/L glutamine group, burn serum+12 mmol/L glutamine group, burn serum+16 mmol/L glutamine group, and burn serum+20 mmol/L glutamine group, and were treated with burn serum alone or added with the corresponding final molarity of glutamine and cultured with the time point screened in the experiment before, then the cell survival rate was dected as before. then The cells were divided into normal serum alone group, burn serum alone group, burn serum+12 mmol/L glutamine group, burn serum+16 mmol/L glutamine group, and burn serum+20 mmol/L glutamine group and treated the same as before. After 30 min of culture, phosphorylation level of mammalian target of rapamycin complex 1 (mTORC1), p70 ribosomal protein S6 kinase (P70 S6k), and eIF4E-binding protein 1 (4E-BP1) were detected by Western blotting. Cells were divided into normal serum group, burn serum alone group, burn serum+12 mmol/L glutamine group, burn serum+12 mmol/L glutamine+25 ng/mL rapamycin group, and treated correspondingly. At PCH 1, 3, and 6, the expressions of heat shock protein 70 (HSP70) and metallothionein (MT), and the morphology of microtubule were observed with immunofluorescence method. The number samples in each index at each time point in each group were all 10. Data were statistically analyzed with analysis of variance of factorial design, one-way analysis of variance, least significant difference t test, least significant difference test, and Bonferroni correction. Results: At PCH 1, 3, 6, 9, and 12, the cell survival rates in burn serum group were significantly lower than those in normal serum group (t=4.950, 16.752, 35.484, 34.428, 27.781, P<0.01). Compared within group at PCH 1, the cell survival rate was significantly decreased in burn serum group at PCH 3, 6, 9, and 12 (P<0.05). Compared within group at PCH 3, the cell survival rate was significantly decreased in burn serum group at PCH 6, 9, and 12 (P<0.05). Compared within group at PCH 6 and 9, the cell survival rate was significantly decreased in burn serum group at PCH 12 (P<0.05). There were no statistically significant differences in the cell survival rate among burn serum group at PCH 6 and 9 (P>0.05). Thus PCH 6 was selected as the subsequent intervention time of burn serum. At PCH 6, compared with burn serum alone group, the cell survival rates in burn serum+4 mmol/L glutamine group, burn serum+8 mmol/L glutamine group, burn serum+12 mmol/L glutamine group, burn serum+16 mmol/L glutamine group, and burn serum+20 mmol/L glutamine group were significantly increased (P<0.01). There were no statistically significantl differences in cell survival rate in burn serum+12 mmol/L glutamine group and burn serum+16 mmol/L glutamine group (P>0.05). There were no statistically significantl differences in cell survival rate in burn serum+16 mmol/L glutamine group and burn serum+20 mmol/L glutamine group (P>0.05). Thus 12, 16, and 20 mmol/L were selected as the subsequent intervention concentrations of glutamine. After 30 min of culture, the phosphorylation levels of mTORC1, P70 S6k, and 4E-BP1 of cells were respectively 1.001±0.042, 0.510±0.024, 0.876±0.022, 0.836±0.074, 0.856±0.041, 1.00±0.11, 0.38±0.09, 0.95±0.13, 0.96±0.13, 0.89±0.24, 1.00±0.07, 0.29±0.08, 0.87±0.27, 0.68±0.08, 0.60±0.21 in normal serum group, burn serum alone group, burn serum+12 mmol/L glutamine group, burn serum+16 mmol/L glutamine group, and burn serum+20 mmol/L glutamine group. Compared with normal serum group, the phosphorylation levels of mTORC1, P70 S6k, and 4E-BP1 of cells were decreased in the other 4 groups (P<0.01). Compared with burn serum alone group, the phosphorylation levels of mTORC1, P70 S6k, and 4E-BP1 of cells were increased in the other 3 groups (P<0.01). The phosphorylation levels of mTORC1, P70 S6k, and 4E-BP1 of cells were similar in burn serum+12 mmol/L glutamine group, burn serum+16 mmol/L glutamine group, and burn serum+20 mmol/L glutamine group (P>0.05). The phosphorylation level of 4E-BP1 of cells in burn serum+12 mmol/L glutamine group was significantly higher than the levels in burn serum+16 mmol/L glutamine group and burn serum+20 mmol/L glutamine group (P<0.05). At PCH 1, 3, and 6, the expressions of HSP70 and MT of cells in burn serum alone group were significantly higher than those in normal serum group (P<0.01); the protein expressions of HSP70 and MT of cells in burn serum+12 mmol/L glutamine group were significantly higher than those in burn serum alone group (P<0.05); the protein expressions of HSP70 and MT of cells in burn serum+12 mmol/L glutamine+25 ng/mL rapamycin group were significantly lower than those in burn serum+12 mmol/L glutamine group (P<0.05). The microtubular structure was integral, network alinement, stain uniformity in normal serum group at PCH 1, 3, and 6. In burn serum alone group, some microtubules were broken and the grid arrangement was disordered at PCH 1; the microtubule structure near the nucleus was clear, while the microtubule at the distal end of the nucleus was blurred at PCH 3; the microtubule structure was blurred at PCH 6. The microtubular damage of cells was alleviated in burn serum+12 mmol/L glutamine group compared with burn serum alone group. The morphology of microtubule of cells in burn serum+12 mmol/L glutamine+25 ng/mL rapamycin group at each time point was similar to that of burn serum alone group. Conclusions: The burn serum can lead to cardiomyocyte damage and cell survival rate decrease in mice. Glutamine can exert cell protective function through regulating the mTOR-P70 S6k-4E-BP1 signaling pathway, thus promoting the expressions of HSP70 and MT and stabilize the microtubule structure.

PMID:34839600 | DOI:10.3760/cma.j.cn501120-20210601-00208

Zhonghua Shao Shang Za Zhi. 2021 Nov 24;37:1-7. doi: 10.3760/cma.j.cn501120-20210325-00103. Online ahead of print.

ABSTRACT

Objective: To explore the clinical effects of artificial dermis combined with split-thickness skin for repair of wounds with bone and tendon exposure in the hand and foot. Methods: A prospective randomized controlled study was conducted. From October 2018 to February 2020, 82 patients with bone and tendon exposed wounds in the hand and foot admitted to Zhengzhou First People’s Hospital who met the inclusion criteria were selected. All the patients were divided into flap group (41 cases, including 27 males and 14 females) and artificial dermis+split-thickness skin group (41 cases, including 29 males and 12 females) according to the random number table, both aged (37±7) years. After complete debridement of wounds of patients in the two groups, the wound of patients in flap group was transplanted with anterolateral femoral free flap; the wound of patients in artificial dermis+split-thickness skin group was grafted with artificial dermis and given continuous negative pressure suction, and autologous lateral thigh split-thickness skin was grafted until complete vascularization of artificial dermis. One week after autologous skin graft/flap grafting, the survival of wound graft was observed and the graft survival rate was calculated. The complete wound healing time, number of operation, length of hospital stay, hospitalization cost, the occurrence of surgery-related complications during hospitalization after autologous skin graft/flap grafting were recorded, and the incidence of complication was calculated. Six months after autologous skin graft/flap grafting, the scar hyperplasia of grafting area was evaluated by Vancouver Scar Scale (VSS), while the recovery of hand and foot function were evaluated by Total Action Mobility (TAM) System Rating method and American Orthopaedic Foot and Ankle Society Ankle and Hindfoot Function Scale (AOFAS-AHS), respectively. Data were statistically analyzed with chi-square test, Fisher’s exact probability test, and independent sample t test. Results: One week after autologous skin graft/flap grafting, the survival rates of wound grafts were similar in the two groups (P>0.05). The complete wound healing time and length of hospital stay were (29±5) and (35±5) d for patients in artificial dermis+split-thickness skin group, respectively, which were significantly longer than (22±4) and (28±5) d in flap group (t=6.96, 6.22, P<0.01). Compared with those in flap group, the number of operation was fewer (t=7.39, P<0.01), the incidence of surgery-related complications during hospitalization after autologous skin graft/flap grafting was lower (P<0.01), but there was no significant change in hospitalization cost of patients in artificial dermis+split-thickness skin group (P>0.05). Six months after autologous skin graft/flap grafting, the VSS scores of grafting area of patients in the two groups were similar (t=0.32, P>0.05); the TAM score and AOFAS-AHS score of hand and foot function of patients in artificial dermis+split-thickness skin group were 40±6 and 62±12, respectively, which were significantly higher than 34±6 and 53±11 of flap group (t=4.66, 3.41, P<0.01). Conclusions: Repairing wounds with bone and tendon exposure in hand and foot with artificial dermis and split-thickness skin reduces the incidence of surgery-related complications, improves postoperative hand and foot joint function of patients, and results in fewer number of operation compared with flap repair, without significant scar hyperplasia, but may prolong wound healing time and length of hospital stay.

PMID:34839603 | DOI:10.3760/cma.j.cn501120-20210325-00103