Animals ; Burns ; complications ; Cicatrix ; etiology ; physiopathology ; Fetus ; physiopathology ; Humans ; Wound Healing

Parkland formula is the most widely used resuscitation formula in burn care. However, a growing number of disputes have been raised along with the development of medical technology, among which its total volume and composition of the fluid are the two foci. Firstly, Parkland formula may lead to an untoward phenomenon nicknamed "fluid creep", which may lead to complications such as abdominal compartment syndrome. Secondly, along with the deeper understanding of how permeability of blood vessels changes after burn injury, colloid is recommended to be given after the third 8 h post-burn. Additionally, controversy exists in the choice of different colloid solutions. The safety of different colloid solutions remains to be further elucidated. This article will deal with all of the above-mentioned problems.
Burns ; physiopathology ; therapy ; Fluid Therapy ; methods ; Humans ; Isotonic Solutions ; therapeutic use ; Resuscitation ; methods ; Treatment Outcome

In recent years, negative pressure wound therapy (NPWT) technique has been widely used in burn surgery, including wound repair, skin grafting, and cosmetic procedures, showing promising clinical results. Based on the literature and clinical experience, the mechanism of NPWT and its clinical application in burn surgery are briefly iterated herewith.
Burns ; surgery ; Humans ; Negative-Pressure Wound Therapy ; Skin ; Skin Transplantation ; Wound Healing

The present article summarized briefly the experiences and lessons learned in the management of mass burn casualties,and also gave a brief account of the present status of the system of emergency care of mass casualties in our country.The authors proposed herewith an organizational system conforming to the status quo of our country.It was suggested that through learning from attending seminars and training in specialty centers,devotion to intensive research of relevant problems and constant interchange of experiences and ideas,the ability of professional staff to meet the needs of urgent and heavy duty could be raised in salvaging mass casualties both in peace time and war.

It is well known that in patients with severe burn, especially when complicated by sepsis, the breakdown of body proteins is acceleraled, producing a hypercalabolic response. Negative nitrogen balance and malnutrition will develop rapidly, predisposing to various complications. High calori intake and enhancement of anabolic process might fail to improve the patient′s nutritional condition. A skeletal muscles account for over 50% of body cell dry weight, their catabolism exerts profound effect on whole body metabolism. By using modern molecular biology techniques, one of the mechanisms underlying skeletal muscle proteolysis is shown to be activation of the ubiquitin proteasome pathway. The role of its possible modulating factors in inducing muscle protein breakdown after burn injury was explored in rat models of burn injury with or without sepsis. Muscle spesimens obtained from severely burned patient with sepsis was also collected for study.The results were as follows. (1)The total and myofibrillar proteolytic rate in extensor digitorum longus (EDL) muscle was increased markedly, especially the expressions of ubiquitin, and mRNA of subunit RC2(the largest subunit of 20s proteasome) were prominantly increased in EDL muscle. There was a significant positive correlation between the proteolytic rate and the expression of mRNA of ubiquitin, or mRNA of subunit RC2, after the stimulation of burn injury. On the other hand, there was no significant change in proteolytic rate and transcription of ubiquitin in soleus (SOL) muscle. (2)The myofibrillar proteolytic rate and the ubiquitin proteasome component were significantly enhanced in rats with sepsis compared with control group. There were significant positive correlations among plasma concentration of endotoxin, TNF ?, cortisol and respective values of myofibrillar proteolytic rate, and ubiquitin proteasome component. (3)There were significant positive correlations between the urinary output of 3 methylhistidine (3 MH)in 24h urine and respective values of plasma concentration of cortisol, TNF ?, and endotoxin in severely burned patients with sepsis. The expressions of ubiquitin mRNA 2 4 kilobase pair (?B), 1.2kb, C 2 subunit mRNA and the protein expressions of ubiquitin in quadriceps femoris muscle were significantly increased compared with the control group. (4)Muscle proteolytic rate was markedly enhanced when myotube was cultured with TNF ?. However, by using the ubiquitin proteasome inhibitor mG132, significant decrease in the muscle proteolyitc rate was observed. (5)Glucocorticoid could increase the skeletal muscle proteolytic rate, especially the myofibrillar proteolytic rate, through activating the ubiquitin proteasome system at gene level. However, this effect could be greatly bluned by glucocorticoid receptor antagonist RU38486. (6)NF ?B activity in skeletal muscle of burned rat with sepsis was markedly increased. However, by using inhibitor of NF ?B, the NF ?B activity was down regwlated in the muscle, and a decrease in the total and myofibrillar proteolytic rate was observed. (7)Decrease in transcriptional expression of ubiquitin and reduction in the skeletal muscle proteolytic rate were found when escharectomy was performed during early stage of burn injury. The results suggested that the treatment strategies for prevention of skeletal muscle proteolysis of postburn sepsis should firstly be aimed at eradication of devitalized tissues, i.e. prevention of sepsis by reonoval of the primary injury. Secondly, attention should be paid to modulating or controlling the process of ubiquitin proteasome pathway in response to burn injury, and this might provide an effective way to reduce skeletal muscle protein wasting by specifically inhibiting the specific enzymes or subunits involved in the enhancement of the activity of ubiquitin proteasome pathway after burn injury. However, more studies in the ubiquitin proteasome proteolytic pathway in severe burn injury are necessary to confirm this assertion.

OBJECTIVE To analyze the changes in bacteria constitution in severe burn wounds in different stages so as to provide reference for clinical prevention and treatment.METHODS A total of 36 casualties with severe burn injuries(≥50.0% total burn surface area) and hospitalized within 5 days post-burns from 2004 to 2006 were enrolled in the study.Samples were collected in the burn wounds from the first day to two months post-burns.RESULTS Totally 476 bacterial strains were isolated and Gram-negative bacteria accounted for 64.1%.However,in term of the single bacterial strain,Staphylococcus aureus(SAU) ranked first and the follows were Pseudomonas aeruginosa(PAE) and Acinetobacter baumannii(ABA).During the first week and the six weeks to 2 months post-burns,Gram-positive bacteria were dominant and SAU ranked first.From the second week to the fifth week,Gram-negative bacteria were dominant,PAE and ABA were the main bacteria.Even though Gram-negative bacteria dominated in these periods,SAU still ranked the first or the second in terms of single bacterial strain.CONCLUSIONS Bacteria constitution in burn wounds differs in different stages.It must be stressed to prevent infections of SAU regardless of any stages,as well as ABA infections since the percentage of ABA has increased markedly in recent years.

Objective To investigate the effect of integrin expression on procollagen synthesis of fibroblasts in wound healing. Methods Antisense oligonucleotides were used to intercept the expression of integrin ? 5 or ? 1 subunit on fibroblasts respectively in wound healing, then the changes of procollagen mRNA were detected by RT-PCR. Results The antisense oligoncleotdes could specifically inhibit the expression of integrin subunit. Decreased expression of integrin?5 or ?1 subunit on fibroblasts significantly lowered mRNA of procollagen ? 1(Ⅰ) and ? 1(Ⅲ). Conclusion Reduction of integrin expression on fibroblasts in wound may inhibit procollagen synthesis in the level of transcription. These results provide the experimental gists on studying of scar reduction in wound healing.

Objective To study the effect of testosterone on skeletal muscle atrophy of rats induced by dexamethasone,and to explore the relationship between androgen and ubiquitin ligase expression in skeletal muscle.Methods Forty female SD rats were randomly divided into four group:control group(CON),dexamethasone group(DEX),testosterone group(TES)and testosterone plus dexamethasone group(TES+DEX).Blood samples were collected from the abdominal aorta and then centrifuged.The supernatant was collected and stored at-20℃.Gastrocnemius was removed and stored at-80℃.The cross-sectional area(CSA)of muscle fiber was determined by microscopic images of digitized muscle sections,using a computer-based imaging processing system.The expression of muscle atrophy F-box(MAFbx)and muscle RING finger-1(MuRF1)mRNA in skeletal muscle was determined by real-time PCR.The expression of testosterone protein in serum was determined by immunoradiometry.Results Dexamethasone increased the expression of MAFbx and MuRF1 mRNA in skeletal muscle(P

Objective To study the therapeatic effect of testosterone on skeletal muscle atrophy induced by dexamethasone in rat, and to explore the relationship between androgen and insulin like growth factor 1 (IGF-1) expression in skeletal muscle and serum. Methods Forty female Sprague-Dawley rats were randomly divided into four groups: control group (CON) in which the rats were injected with saline and sesame oil for 10 days; dexamethasone group (DEX) in which the rats were injected with dexamethasone and sesame oil for 10 days; testosterone group (TES) in which the rats were injected with saline and testosterone for 13 days; and the testosterone+dexamethasone group (TES+DEX) in which the rats were injected with dexamethasone and testosterone. The animals were weighed daily. 24 hours following the final injection, animals were weighed and sacrificed. Blood samples were withdrawn from the abdominal aorta and centrifuged at 3 000r/min for 10min. The supernatant was collected and stored at -20?C. Gastrocnemius muscle was removed, weighed and stored at -80?C. IGF-1 mRNA expression in skeletal muscle was determined by real-time PCR. IGF-1 protein expression in serum was determined by enzyme-linked immunosorbent assay (ELISA). Results Testosterone attenuated the body weight loss and gastrocnemius muscle weight loss in rats as a result of dexamethasone adminishation (P

Objective To explore the diagnosis and topical treatment of diabetic foot in patients with burns.Methods Sixty-five patients with burns complicated with diabetic foot were admitted from Jan.2002 to Dec.2006.Bacterial culture of wound excretion,peripheral nerve electromyography and vascular ultrasonography of both lower extremities were performed in a part of patients.Twenty-four patients received topical treatment,including immersion bath with hypertonic saline solution and the application of epidermal growth factor,fibroblast growth factor and complex lysozyme disinfectant.Forty-one patients underwent surgical treatment.The operation methods,surgical treatment included debridement followed by direct closure,split-thickness skin grafting,repair with local skin flap or cross leg skin flap,or amputation of foot,as determined according to the condition of the wound.Results The positive rate of bacterial culture of wound excretion was 88.7%(47/53)on admission and 30.2%(16/53)one week after topical treatment.There were abnormal findings of peripheral nerve electromyography in all 31 cases.Vascular ultrasonography revealed pathological findings in both lower extremities of all 12 patients with vascular lesion,and 9 in 16 cases without vascular lesion.The lesions in all patients except 2,who were discharged in advance,healed and the cure rate was 96.9%.Conclusion Peripheral nerve electromyography and vascular ultrasonography of both lower extremities are promising auxiliary examinations for the diagnosis of diabetic foot in patients with burns.Topical treatment,which includes immersion bath with hypertonic saline solution and the application of growth factors and complex lysozyme disinfectant,as well as appropriate surgical management,plays an important role in the wound healing.