The Chinese Journal of Burns Wounds and Surface Ulcers 1999, (4): 36-56
The General Situation of the Ten Years' Development of MEBT/ MEBO & Its Task in the 21st Century --Written in the 10th Anniversary after the Chinese Journal Of Burns Wounds & Surface Ulcers Started Publication Zhang Xiangqing 139 Hospital of Chinese People's Liberation Army (253002)
The Chinese Journal of Burns Wounds & Surface Ulcers is a country-level medical learned periodical directed by Ministry of Public Health. This quarterly has been published on a continuing basis for 10 years since November 1989, when the initial issue was released. In the past ten years, under the organization and leadership of editor-in-chief Xu Rongxiang, The Chinese Journal of Burns Wounds & Surface Ulcers has kept on carrying out the aim of publication, propagandizing and reporting the information about MEBT (Moist Exposed Burn Therapy) and MEBO (Moist Exposed Burn Ointment) zealously, and treating different kinds of body surface burns, wounds and ulcers, and related diseases. Great deals of experience and significant curative effects have been acquired. As is well known, MEBT/MEBO is a new therapy for burns invented by Xu Rongxiang, a young burn scholar of our country, in accordance with the law of life, and based on the dialectical theory, methods, prescriptions and drugs of tradition Chinese medicine, so it is called "Chinese burns wounds and ulcers medicine”. The academic key point of this technique is to expose the burn tissues tridimensionally in the physiologic moist environment, to regenerate and restore them according to the law of disease development (The Chinese Journal of Burns Wounds & Surface Ulcers, similarly hereinafter, 1989, 1: 4). Since it breaches the conventional routine therapy (dryness-scab-skin-grafting) in theory and practice, it is inevitable it led to disputes in some scholars of conventional therapeutics when it came into the world. In the past 10 years, with the principle of "let a hundred of flowers blossom and a hundred schools of thought contend", we have given full play to the strong points of different kinds of medical sciences, study, approach, summarized, and exchanged the experience in treating burn wounds and ulcers from all sides, accelerated academic advancement, and promoted the development of "burn wounds and ulcers medicine", and ensured the successful realization of " popularization plan of a hundred of fruits in 10 years". Under the commitment of the editorial board of periodical office, I skimmed through all the articles published in this periodical, and read through the important treatises, so as to summarize the 10 years' academic development of MEBT/MEBO and the task in the next century. The purpose is to review the past, look forward to the future objectively,
-1-
The Chinese Journal of Burns Wounds and Surface Ulcers 1999, (4): 36-56
popularize and develop this new technique unshakeably. We hope that MEBT/MEBO can serve for the human health all round in the early years of the next century. A. Statistical Analysis of Articles (A) Article Types and Constitution There were 39 issues (not including article compilation) and 1083 articles published from the initial issue of The Chinese Journal of Burns Wounds & Surface Ulcers to the second issue of 1999. These articles were classified, and the types and constitution of them were summarized in Table-1. Table-1
Types and Constituent Ratio of the 1083 Articles
Burns
Wounds and Ulcers 1
Monog raph
Plastics
Synthe sis 2
Scoo p
Nursi ng
Othe rs 3
Philo soph y
Numbe r of articles
437
225
141
66
63
62
40
39
10
Constit ution (%)
40.35
20.78
13.02
6.09
5.82
5.73
3.69
3.60
0.92
Rankin g
1
2
3
4
5
6
7
8
9
It can be seen from the Table that the occupancies (constituent ratio) of articles on burns, wounds and ulcers are 40.35% and 20.78% respectively (61.13% in total); the articles of monographic study on burns, wounds and ulcers are the third most (13.02%). That is to say, more than 2/3 of the 1083 articles (74.15%) are articles about burns, wounds and ulcers. It can be seen from this that The Chinese Journal of Burns Wounds & Surface Ulcers has given an outstanding contribution in summarizing and perfecting ‘Chinese burns wounds and ulcers medicine’. However, it also can be seen that the philosophical articles analyzing and illuminating MEBT/MEBO are insufficient, which will be the direction of improving and perfecting the content of this journal for the future. (B) Therapies and Constitution 1
Wounds and ulcers: Including body surface wounds, knife trauma, ulcers and the related diseases. Synthesis: Including lecture, review, commentary etc. 3 Others: including small renovation, small information, discussion etc. 2
-2-
The Chinese Journal of Burns Wounds and Surface Ulcers 1999, (4): 36-56
According to the content of the articles, there were 140808 cases with definite therapies (there might be duplicate cases in the articles written by authors from a same unit). 87.67% of the patients used MEBT/MEBO, 12.33% of the patients did not use MEBT/MEBO (Table-2). This shows that this publication attaches great importance to the unprecedented new technique, MEBT/MEBO beyond all else. Table-2
Therapies and Constituent Ratio of the 140808 Patients MEBT/MEBO
Non-MEBT/MEBO
Total
Number of Cases
123448
17360
140808
Constitution (%)
87.67
12.33
100.00
(C) Diseases Treated by MEBT/MEBO and Their Constitution The 123448 patients receiving MEBT/MEBO therapy are summarized in Table-3. Table-3
The 123448 Patients Receiving MEBT/MEBO Therapy and Their Constituent Ratio
Gynecolog ic Diseases
Diseases of Ophthalmolo gy, Otorhinolaryn gology and stomatology
Chilblain
Othe rs
Total
2038
1842
1379
719
515
123488
16.16
1.65
1.49
1.12
0.58
0.42
100.00
2
3
4
5
6
7
Burns
Wound s and Ulcers
Derm atologi cal Disea ses
Number of Cases
97000
19955
Constitu tion (%)
78.58
Ranking
1
8
Table-3 shows: Most of the patients receiving MEBT/MEBO therapy were burn patients, nearly 4/5 (78.58%) of the total cases. Wounds and ulcers were the second most diseases (16.16%), followed by dermatological diseases, gynecologic diseases, diseases of ophthalmology, otorhinolaryngology and stomatology, chilblain, non-body-surface diseases, and the cases using MEBO series of drugs. This also shows: burns, body surface wounds and ulcers are the best indications for MEBT/MEBO, while, in the 10 years' clinical practices, its indications have been expanded to the diseases of dermatology, gynecology, ophthalmology, otolaryngology, stomatology and chilblain etc. Because of its good curative effects,
-3-
The Chinese Journal of Burns Wounds and Surface Ulcers 1999, (4): 36-56
the use of MEBT/MEBO in treating diseases related to burns, wounds and ulcers is on the rise. The experience is abundant and valuable. (D) MEBT/MEBO and Treatment Level of Burns There were 97000 cases of burn patients receiving MEBT/MEBO therapy. Among them, 96840 patients were healed and the cure rate was 99.84%. There were 90428 patients with burn surface area less than 50% TBSA, among which 90304 patients were healed and the cure rate was 99.86%; there were 6572 patients with burn surface area greater than or equal to 50% TBSA, among which 6002 patients were healed, and the cure rate was 91.33% (see Table-4). According to the total cure rate and the cure rate of extensive burn lager than 50% TBSA, MEBT/MEBO is the top-ranking burn therapy in our country even in the world. Table-4
Therapeutic results of burn patients
Number of Cases
Number of Healed Cases
Cure Rate (%)
＜50% TBSA
90428
90306
99.87
≥50% TBSA
6572
6002
91.33
Total
97000
96840
99.84
(E) Statistics of the Patients Receiving Non-MEBT/MEBO Therapies In the past 10 years, The Chinese Journal of Burns Wounds & Surface Ulcers has not only propagandized and reported the technological development of MEBT/MEBO, but also published some articles unrelated to MEBT/MEBO, among which there 17360 cases. The therapies of these cases are summarized in Table 5 (see Table 5). Table 5
Therapies and Constituent Ratio of Non-MEBT/MEBO Cases Conventional Therapy
Epidemiological Survey
Plastics
Others
Total
9430
4977
2454
499
17360
Constitution (%)
54.32
28.67
14.14
2.87
100.00
Ranking
1
2
3
4
Number Cases
of
Note: The cases receiving conventional therapy included the control cases of MEBT/MEBO, treatment lessons, complication reports. Others included fundamental research and those with no indication of therapies.
-4-
The Chinese Journal of Burns Wounds and Surface Ulcers 1999, (4): 36-56
17360 patients receiving non-MEBT/MEBO treatment were summarized in Table 5. Among them, there were the control cases of MEBT/MEBO (54.32%), general epidemiological survey cases (28.67%), plastic cases (14.14%), and other cases related in monographic study and other studies (2.87%). The cases receiving conventional therapy included the control cases of MEBT/MEBO, and the cases related to the treatment lessons and complications. Plastic cases included surgery plastic cases and the patients treated with MEBO ScarReducer. B. Evaluation on Large-amount Burn Clinical Data The articles containing more than 1000 cases are called large-amount clinical data, and there are 13 articles of large-amount clinical data in the 437 MEBT/MEBO burn articles published in the 39 periodicals. According to the order of time when the articles were published, they include "clinical investigation report of 2076 cases treated with burn moist exposed burn therapy" written by Zhang Linxiang, Yang Kefei (1989, initial issue: 22); "clinical analysis on 1567 burn patients treated with moist exposed burn therapy"(1991, 1: 25) written by Yang Kefei, Yangjun et al., "clinical analysis of 1003 burn patients treated with moist exposed burn therapy" written by Zhao Junxiang, Yang Guoming et al.; and the articles written by Qiao Haibing (1994, 3: 29), Wi Yuyun (1996, 1: 32), Wang Hezhen (1996, 1: 27), Zhao Junxiang (1998, 4: 24), Xiao Xinming (1998, 4: 26), Wang Hong( 1998, 4: 27), Hui Lei (1998, 2: 28), Xu Degao (1998, 4: 30), Sha Guangxin (1998, 4: 31), Zhou Baoguo (1998, 4: 35). The articles are considered to be with precise structure, true content and reliable materials based on the careful study on the above 13 articles. For example, the total cure rates were between 94.36% and 99.80% (not including the data of medium to small area burns). It is better in analgesia effects and the degree it decreases the patients' pains is bigger than that of conventional therapy. It can be concluded that MEBT/MEBO has definite curative effects and good repeatability. It should be noted that the articles written by Zhang Linxiang and Yang Kefei were published in the initial issue, when MEBT/MEBO came into being in our country. The two old specialists, who had used conventional therapy for many years, used the new technique like sailing against the current, and had foreknowledge in the theory of Xu at that time, which indicated their vision in the development of science was still keen although they were old. What they did not only produced deep influence on the decision by Ministry of Public Health on September 1, 1991, who decided to popularize the moist exposed burn therapy and moist exposed burn ointment in all country, but also were the true turn of the revolutionary academic advancement ("the great historic turn on burn therapeutics") in thought and actions. Undoubtedly, their foreknowledge and actions were a noiseless call to the young scholars, the subsequent scientists who transformed and carried out the MEBT/MEBO techniques.
-5-
The Chinese Journal of Burns Wounds and Surface Ulcers 1999, (4): 36-56
For this reason, we should praise them for the popularization of MEBT/MEBO techniques and their great devotions to the start-up of the "popularization plan of a hundred of fruits in 10 years" of Ministry of Public Health, at the time 10 years after The Chinese Journal of Burns Wounds & Surface Ulcers started publication. There were also other old specialists who struck out on this new path, such as professor Ma Enqing. He is the burn surgery professor of Hunan Medical University, who has great scientific attainments in burns, and made an example for us in understanding, popularizing MEBT/MEBO techniques and the related fundamental research. Professor Xu Rongxiang evaluated these old specialists as follows: the innovation in academic thought and medical treatment techniques is not a simple thing some people do not have such good idea, concept, academic sense and scholastic attainments as professors Zhang Linxiang, Yang Kefei, Ma Enqing, Zhang Xiangqing do (1997, 3: 33). The contributions by Professor Ma Enqing are to be described in "infection of burn" and related sections. "Clinical analysis of 1003 patients treated with moist exposed burn therapy" was written by the two middle-aged and young scholars, Zhao Junxiang and Yang Guoming in the early nineties (1992, 1: 36). They summarized the clinical experience in treating 1003 burn patients with MEBT/MEBO in the burn center, Nanshi hospital, Henan, in the nearly 3 years between December, 1987 to October, 1990. Among them, there were 386 cases of severe and very severe burns (38.5%), 118 cases of children with severe burns or burns with burn surface area exceeding 50%TBSA (11.8%). There were 977 cases in this group, and the total cure rate was 97.41%. According to the data provided by the article, the half lethal burn area (LA50) was 82.11%TBSA. The curative effects of Nanshi Hospital in the late 1980s and early 1990s were as followed: the probability of dying was 50% when the burn area was 82.11%TBSA. It has been reported domestically that the half lethal burn area is 75.93%TBSA. The author also indicated: LA50 had reached 75-80%TBSA or above in our country (Li Ao et al., Burn Therapeutics, the peoples medical publishing house, 1995; 2). The reason Nanshi Hospital acquired such good curative effects may include both the supervision and direction by Professor Xu Rongxiang, and the use of new MEBT/MEBO techniques by the middle-aged and young scholars without blind worship for conventional therapy. C. Study on Improving Stasis Zone There were 3 pathological zones in the deep burn wound from superficies to interior: the surface layer (or core zone) is the inconvertible necrotic zone, the bottom layer (or peripheral zone) is the hyperemia zone and inflammatory reaction zone; the layer between the above zones is the stasis zone. According to the above pathological changes, the key points of burn wound treatment includes not only to prevent the
-6-
The Chinese Journal of Burns Wounds and Surface Ulcers 1999, (4): 36-56
stasis zone from developing into hyperemia zone, but also to treat it with effective therapies to reduce and recover it, which is the fundamentality of the technical design of MEBT/MEBO. The microcirculation change law of conventional dry exposed therapy had been proved by Professor Xu Rongxiang through the experimental study on the microcirculation of burnt rabbit ear (1994, 4: 42): after injury, the blood capillaries of stasis zone and hyperemia zone were constricted, and the blood stream in the blood capillaries increased; 30 minutes after injury, the blood vessels were blurred, and the tissue edema was apparent; 3 days after burn injury, the wounds turn dry, most of the terminal capillary blood vessels were stagnant, the blood stream decreased, and the number of blood vessels was reduced; 10 days after injury, the injury area was almost completely necrotic, and only 1 case recovered (1/7). MEBT/MEBO treatment group: The changes within 10 minutes after injury was similar to that of the conventional treatment group, but the tissue edema and the blood vessel blur change occurred later than those of the conventional treatment group did; 3 days after burn injury, the wound was moist, most of the terminal blood vessels were in flow condition, the flowing true capillaries increased, the blood capillary blood stream in the core zone was normal, there was no formation of blood capillary network in the stasis zone, but there still existed true capillaries and blood stream; 10 days after injury, most of the wounds were healed (6/7). It is believed at present that the progressive necrosis of the stasis zone includes several change events, such as dermis ischemia, blood clotting and blood vessel obstruction. It has many kinds of causes, and it is related to vasospasm, abnormal hemorrheology, oxygen free radical and neutrophilic granulocyte conglutination etc. It was brought forward by Xu Rongxiang many years ago that the enlargement of burn wound stasis zone occurred not only in the local part, but also in the whole body. There forms progressive thrombosis in the microcirculation of whole body due to the blood coagulation mechanism, blood vessel structure and pelohemia changes in the local area. The changes in the local area and in the whole body interact as both cause and effect. The above viewpoint of Xu was confirmed by Wang Guangshun et al. in "study on the hemorrheology in the burnt rabbits treated with MEBO". The apparent viscosity of blood and the plasma viscosity of the 10% TBSA Ⅱ degree burns in the back of rabbit treated with dry exposed therapy alone were significantly higher than those in the MEBO treatment group. The above indices only increased 24 hours after injury in the MEBO treatment group, and there were no statistical difference between the normal animals and the burnt animals 2, 3, 6 days after injury. As a result, in MEBO treatment, the drugs act on the local area, but they can improve the microcirculation indices of the whole body (hemorrheology), thereby promote the restoration of the local burnt areas. It has been proved by the animal experiments by Yan Ze et al. (First Military Medical University) recently (1998, 4: 21) that there was a sharp decline of blood in the
-7-
The Chinese Journal of Burns Wounds and Surface Ulcers 1999, (4): 36-56
microcirculation in the stasis zone in the burn wounds of both the MEBO treatment group and conventional dry exposed therapy group in the early stage of Ⅲ degree burns in the rabbit back, which decreased to the minimal values after 2 hours. However, the blood flow decreases in different time phases (5min-72h) in the conventional therapy group were significantly greater than those in the MEBO treatment group (p
