Molecular Mechanism of Traditional Chinese Ointment of Xuzhou Qufu Shengji in Infected Wounds

Background. Xuzhou Qufu Shengji Ointment (QFSJO) has been used in hospital and private medication for more than 30 years to treat the infective wounds after trauma. However, molecular investigation is lacking. This study used rats to explore the healing mechanism of QFSJO in promoting wound healing in human. Methods. One circular incision was individually generated on the back of 30 rats in three groups and challenged with 108 CFU (0.3 mL) of Staphylococcus aureus. Then, one of the trauma groups was treated with QFSJO gauze, and the control group was covered with a piece of Vaseline gauze, while the western medicine group was treated with erythromycin in a similar way. The dressing change of all the groups was performed once a day for three weeks. The anti-inflammation and proangiogenesis of QFSJO were evaluated by enzyme-linked immunosorbent assay (ELISA). The levels of angiogenesis associated factors, vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (b-FGF), hydroxyproline, and hemoglobin, were measured according to ELISA. The immunohistochemistry of CD31 and CD34 expression in granulation tissue was demonstrated and quantitatively analyzed for angiogenesis in granulation tissue in sites. Results. A faster wound healing ratio was observed in QFSJO-dressing-treated group than Vaseline- and erythrocin-treated groups. ELISA results showed that QFSJO promoted VEGF and b-FGF levels significantly in early stage of wound healing. QFSJO dressing group also showed an enhanced hydroxyproline and hemoglobin in granulation tissue. The expressions of CD31 and CD34 in granulation tissue of QFSJO group were higher than in the Vaseline and erythrocin groups. Conclusion. QFSJO improved the healing rate of the infective wounds by promoting the angiogenesis of granulation tissue and inhibiting the inflammation of the trauma tissue. Our finding suggests that QFSJO is able to help angiogenic capillary sprouts for collagen accumulates in the granulation tissue.

Mobile Phone Virtual Reality Game for Pediatric Home Burn Dressing Pain Management, a Randomized Clinical Trial

Importance: Virtual Reality (VR) gaming is considered a safe and effective alternative to standard pain alleviation in the hospital, we advocate for its use during repeated redressing at home. Objective: This study will address the effectiveness and feasibility of the Virtual Reality Pain Alleviation Tool (VR-PAT) that was developed by the research team for repeated at-home burn dressing changes. Design, Setting and Participants: Randomized clinical trial among patients recruited at the Nationwide Childrens Hospital (NCH) outpatient burn clinic between September 2019 and June 2021. We included English-speaking burn patients 5-17 years old requiring daily dressing changes for at least one week after first outpatient dressing change. Interventions: One group played an interactive VR-PAT game during dressing changes, while the other utilized standard distraction techniques available in the home for a week. Both child and caretaker were later asked to assess perceived pain. Those in the intervention group were asked to evaluate convenience and enjoyment of the VR-PAT game. Outcomes: Patients were asked to rate perceived pain on a scale of 1-10, and caregivers were asked to rate observed pain on a scale of 1-10. For the VR-PAT group, patients were also asked to rate various aspects of the VR game on a scale of 1-10 and caregivers were asked questions assessing ease of use. Conclusions: Subjects found the VR-PAT to be a useful distraction during home dressing changes and reported it be easy to implement. In the VR-PAT group, child and caregiver reported pain decreased as the week of dressing changes progressed and was lower than those in the control group after the fourth dressing change. Children playing the VR-PAT reported consistent happiness and fun as the week went on and increased realism and engagement, which means our results were not just due to the novel experience of VR-PAT.

Study on the Effect and Mechanism of Antibacterial Adhesive Hydrogel on Wound Healing

Bleeding and infection can cause significant increases in mortalities. Hydrogel sealants have attracted extensive attention for their ability to control bleeding. In this study, the adjuvant treatment with antibacterial adhesive hydrogel dressings was applied to patients with deep second-degree burns/scalds. The traditional medical dressing was regarded as control adjuvant treatment. The results indicated that the total positive rate of bacteria in wound secretions and the pain during dressing change in patients who used antibacterial adhesive hydrogel dressings were significantly reduced. The number of fibroblasts and new capillaries in the granulation tissue of the wound increased, and the patient’s wound healing is accelerated. The overall clinical effectiveness has been significantly improved. It is proven that the antibacterial adhesive hydrogel dressing has a significant effect on wound healing.

Clinical Nursing during CD4-Specific CAR T Cells Treatment for One Mycosis Fungoides Patient Improves Generalized Skin Lesion

Objective: To summarize the clinical nursing approach to CART treatment in one mycosis fungoides patient with generalized skin lesions, and to provide experience for reference in clinical nursing for such patients undergoing CART treatment. Method: Case Presentation: The patient, female, aged 43 years, was pathologically diagnosed to mycosis fungoides. Clinical state was tumor stage, as well TNMB stage was T4N3M0B1. The patient was admitted to the hospital with diffuse crimson papules, nodules, tumor, associated with brown, black pigmentation, complained of pruritus. The tumor surface ulcerated and oozing fluid at the surface of the head, bilateral cheeks, bilateral axillae, abdomen, right groin appeared infiltrated with flower like growth, the large of which was about 6x7 cm, and microorganism culture of secretory showed acinetobacter baumannii and corynebacterium striatum. Human derived CD4-CART treatment was given after chemotherapy pretreatment. The patient occurred severe granulocytic deficiency, fever, skin infection, gastrointestinal bleeding, respiratory failure, cardiac insufficiency, secondary hemophagocytic syndrome. Nursing strategy: 1. Strengthen basic care and application of sterile laminar flow beds. 2. Closely monitor physical signs, and discover early high fever, hypotension, low blood oxygen and other CRS reactions. 3. Special professional person conducted sterile dressing change to avoid cross infection; Perform weekly microorganism culture of secretory and adjust antibiotics symptomatically; Mechanical debridement and the use of debridement glue are given to the wound accompanied by yellow excoriation, black scab; Prevention of infection using fusidic acid cream, silver pyrimidine sulfate dressings, and hydrophilic silver containing dressings; Lesional wounds are covered with a lipidic hydrogel foam dressing to achieve wet healing. 4. Reinforce nutritional support and psychological care. Result: After the fusion of CAR T cells, the patient developed grade 4 cytokine release syndrome (CRS), grade 0 ICANS. Fever appeared on the day 0 of fusion, the body temperature was up to 40.1℃. The fever sustained 16 days. No septic shock occurred; Hypoxemia was noted on day 4 after fusion to a minimum of 69% with invasive ventilator assisted breathing and life support given; On day 4 after fusion, the capillary leak syndrome occurred, and the systemic tumor and skin lesion were swollen compared with before, resulting in marked wound redness and oozing fluid. After active treatment, careful nursing with aseptic dressing change, the patient successfully passed through the CRS reaction period, and the lesional skin wound was completely repaired after 3 months. Conclusions: T cells are absent after CD4-CAR T cell therapy, and patients present with a state of immunodeficiency that predisposes to opportunistic infections. Severe patients with mycosis fungoides associated with systemic skin lesions treated with CART are prone to severe cytokine release syndrome, which can manifest as hyperthermia, severe agranulocytosis, thrombocytopenia, and capillary leak syndrome, and may easily lead to more precancerous wounds. At this time, close observation of the changes in the life condition, active control of the CRS response, while supplemented with sterile debridement replacement, systemic symptomatic use of antibiotics, can reduce the incidence of infection, improve the safety of treatment, and ultimately promote the repair of tumor skin lesions wounds. Disclosures No relevant conflicts of interest to declare.

Comparison of Satisfaction Levels between Conventional and Silicone-Adhesive Polyurethane Foam Materials in Patients with Skin Wounds

Background: Polyurethane (PU) foam dressing materials have been widely used in commercial wound dressing applications. However, the repeated application of adhesive tapes to keep the foam dressings in place can result in minor injuries to the peri-wound skin. Silicone-adhesive PU foam dressing materials have been developed to prevent such injuries. In this study, the satisfaction levels between conventional and silicone-adhesive PU foams were assessed through a survey of patients and physicians.Methods: A survey study of 140 patients with skin wounds was conducted in a single institution between July 2019 and May 2020. The patients were first treated with either conventional PU foam or silicone-adhesive PU foam, after which they were asked to record their levels of pain, adhesiveness, waterproofness, and satisfaction. At the next visit, dressings of the other material were applied to their wounds, and the same assessment process was repeated at the next dressing change.Results: The silicone-adhesive PU foam dressings demonstrably reduced the levels of dressing-related trauma and pain, compared to that of patients treated with conventional PU foam dressings. The silicone-adhesive PU foam dressings were also associated with substantially higher scores of satisfaction and waterproofness. In comparison, the mean adhesiveness score was superior in the group treated with conventional PU foam dressings, compared to that of the group treated with silicone-adhesive PU foam dressings.Conclusion: Silicone-adhesive PU foam contributed to minimizing pain during dressing change and increasing patient’s comfort. As a result, patients preferred dressing with silicone-adhesive PU foam over conventional PU foam.

A Royal Jelly Mixture with Berberine for Dressing Change on a Refractory Skin Ulcer: A Case Report

It has been reported that a 92-year-old female had got a bruise superficialwound on her right leg one and a half years ago, developing into refractoryskin ulcer due to improper management before. A prepared cream, mixedroyal jelly with berberine for dressing change, was made on the scenethrough the crush of berberine tablets, working with fresh royal jelly.Topical dressing change with the cream was done every 3 days, and twomonths later, such the ulcer became clean and was covered fully with freshgranulation tissue. This kind of cream consists of the ingredients of TCMpurely, free of antibiotic, and being quite effective clinically, also helpfulfor proper use of antibiotic.

Analysis of the Clinical Effect of Vacuum Sealing Drainage on Patients with Limb Trauma

To analyze the clinical effect of vacuum sealing drainage (VSD) on patients with limb trauma. Methods: 136 patients with limb trauma received by our hospital from October 2018 to October 2019 were selected as the study objects. According to the random number method, they were divided into two groups, 68 cases in each group. The control group was treated with conventional dressing change. The study group was treated with VSD to observe the wound healing effect, wound area and complications before and after treatment for 7 days. Result: After 7 days of treatment, the area of wound in the study group was significantly smaller than that in the control group, and the effect of wound treatment in the study group was significantly higher than that in the control group (P < 0.05); the incidence of complications in the study group was significantly lower than that in the control group (P < 0.05). Conclusion: VSD can effectively repair the wounds of patients with limb trauma, significantly improve the clinical treatment effect, and effectively prevent the occurrence of treatment complications, which is worth promoting.