Wound sepsis is one of the main causes of death in patients with severe burn and trauma. The high incidence of burn wound sepsis in children is attributed to their imperfect immune system function, poor resistance against infection, and the weakened skin barrier function after burn. The key to reduce the mortality of pediatric patients with burn wound sepsis is to enhance the understanding of its etiology, epidemiology, pathogenesis, and diagnostic criteria, in order to improve its early diagnosis and treatment.
Burns ; complications ; prevention & control ; therapy ; Child ; Humans ; Sepsis ; diagnosis ; etiology ; mortality ; therapy ; Skin ; microbiology ; pathology ; Survival Rate ; Wound Infection ; mortality ; prevention & control ; therapy

OBJECTIVETo explore the clinical effects of lattice ultra pulse carbon dioxide laser combined with traditional Chinese medicine ( Fuchunsan ) on the treatment of postburn hyperplastic scar.

METHODSSixty-three patients with hyperplastic scar after burn injury hospitalized from February 2012 to June 2014 in our department were treated with lattice ultra pulse carbon dioxide laser combined with traditional Chinese medicine (Fuchunsan). Patients were divided into early stage group (E, n = 35), middle stage group (M, n = 25), and late stage group ( L, n = 3) according to the formation time of scar, which was respectively 3 weeks to 3 months, longer than 3 months and less than or equal to 6 months, and 3 to 15 years in groups E, M, and L. The number of times of laser treatment of patients in each group was recorded. The degree of scar pain in patients of the three groups was assessed by the Numerical Rating Scale (NRS) before treatment and after treatment for 1, 2, and 3 times. The scar condition of patients in groups E and M was assessed by the Vancouver Scar Scale (VSS) before treatment and after treatment for 1, 3, and 5 times. Patients in group L did not receive VSS assessment but were evaluated by clinical observation only. Photos of scar in treating area were taken before treatment and after treatment for 3 and 5 times to evaluate the clinical effect. Data were processed with t test.

RESULTSPatients in groups E and M were treated with laser for (4.8 ± 1.1) and (7.7 ± 2.1) times respectively. In group L, the treatment was stopped in 2 patients after laser treatment for 5 times, and 1 patient received laser treatment for 12 times. The degree of pain in patients of groups E and M was alleviated significantly after treatment for one time, and the number of patients scoring 1-4 point(s) in NRS increased from 5 cases to 38 cases. After treatment for 2 and 3 times, the increase in the number of patients scoring 1-4 point (s) in NRS was on a small scale. Before treatment and after treatment for 1 time, VSS scores of patients in groups E and M were similar (with values respectively 0.641 and 0. 082, P values above 0. 05). After treatment for 3 and 5 times, VSS scores of patients in group E were respectively (9.2 ± 0.8) and (7.0 ± 1.1) points, which were significantly lower than those in group M [ (9.7 ± 1.0) and (8.2 ± 1.0) points, with values respectively -1.993 and -4.433 , P < 0.05 or P < 0.01]. After treatment for 3 times, the rate of improvement in appearance was respectively 88.6% (31/35) and 72.0% (18/25) in groups E and M, and it was respectively 100.0% (35/35) and 96.0% (24/25) after treatment for 5 times. No significant effect in appearance was found in the 3 patients in group L.

CONCLUSIONSEarly application of lattice ultra pulse carbon dioxide laser combined with traditional Chinese medicine (Fuchunsan) for the treatment of postburn hyperplastic scar is effective.

Burns ; Cicatrix ; etiology ; prevention & control ; Humans ; Lasers, Gas ; therapeutic use ; Medicine, Chinese Traditional ; Postoperative Care ; methods ; Postoperative Complications ; prevention & control ; Treatment Outcome

Comprehensive prevention and treatment of burn infection should be further enhanced, as monotonous treatment is prone to fail to get satisfying curative effects. In the articles to be published in this issue, causative factors for burn infection are analyzed in depth and discussed from different angles, and they will lay the foundation for the comprehensive prevention and treatment of burn infection.
Burns ; complications ; prevention & control ; therapy ; Humans ; Infection Control ; methods ; Wound Infection ; etiology ; prevention & control

OBJECTIVETo explore the effect of nursing intervention on the prevention of burns in warm needling moxibustion.

METHODSTwo hundred patients received warm needling treatment were collected from January to December 2011 and were randomized into an observation group and a control group, 100 cases veceived ten hundreds of treatment in each group. In the control group, the routine nursing was applied in warm needling moxibustion. In the observation group, on the basic method as the control group, the nursing intervention was used. The burns incidence and the satisfaction of patients in warm needling moxibustion were recorded in the patients of the two groups.

RESULTSThe burns incidence was 0.6% (6/1000) in the observation group, which was lower apparently than 1. 5% (15/1000) in the control group (P<0. 05). The satisfaction of patients in warm needling moxibustion was 99.0% (99/100) in the observation group, which was higher obviously than 88.0% (88/100) in the control group (P<0. 01).

CONCLUSIONThe nursing intervention prevents effectively from burns in warm needling moxibustion, reduces medical injuries, avoids the pains of patients and plays the active role in the patient satisfaction.

Acupuncture Points ; Adult ; Burns ; etiology ; prevention & control ; Female ; Humans ; Male ; Middle Aged ; Moxibustion ; adverse effects ; instrumentation ; Young Adult

Burns and traumas are common injuries during both peace time and wartime. Lung is the earliest organ subjected to dysfunction and the incidence is highest. The systemic protective technology for the burn and trauma related lung injuries is based on evidence-based medicine and translational medicine. It includes a series of effective measures, such as rescue and treatment scheme for massive burn casualties, prophylactic tracheostomy, protective ventilation strategy, sequential cell protection, and prevention and treatment of sequelae, which prevents aggravation of lung injuries caused by ischemia reperfusion, oxidative stress, and iatrogenic factors, as well as reduces the incidence of complications to ensure the recovery after burns and traumas.
Burns ; complications ; Evidence-Based Medicine ; Humans ; Lung Injury ; etiology ; prevention & control ; Translational Medical Research

Burns ; etiology ; physiopathology ; surgery ; Diabetes Mellitus ; Female ; Humans ; Hyperbaric Oxygenation ; Knee Injuries ; surgery ; Middle Aged ; Negative-Pressure Wound Therapy ; Patellar Ligament ; injuries ; Postoperative Complications ; prevention & control ; Skin Transplantation

OBJECTIVETo observe the preventive and therapeutic effect of advanced airway management on pulmonary infection in patients with inhalation injury after tracheotomy.

METHODSfourteen burn patients with inhalation injury admitted to our hospital from January 2001 to December 2004 were enrolled as control (C) group, and they were treated with conventional systemic therapy and management of airway. Twenty-seven burn patients with inhalation injury admitted to our hospital from January 2005 to October 2009 were enrolled as advanced (A) group, and they were treated with conventional systemic therapy and advanced airway management, including bedside isolation of airway, fixation of both oxygen supply tube and humidifying tube, humidification in specific body position, thinning of sputum, lavement of airway and procedural sputum elimination, steam inhalation combined with medicine, and suction of sputum with interrupted negative pressure. Result of bacterial culture of sputum (the 7th day after tracheotomy) and chest X-ray (at admission and the 7th day after tracheotomy), pulmonary infection, change in blood gas analysis index and oxygen saturation (SO(2)), (within 7 days after tracheotomy), and the number of patients curd in 2 groups were observed and compared.

RESULTS(1) Positive result of bacterial culture of sputum was observed in 11 (78.6%) patients in C group and 12 (44.4%) patients in A group. The difference between them was statistically significant (chi(2) = 4.36, P < 0.05). The main bacterium detected was Pseudomonas aeruginosa. (2) Pneumonia was suspected in 7 patients (25.9%) in A group by chest X-ray, which was obviously fewer than that in C group (8 Cases, 57.1%, chi(2) = 3.87, P < 0.05). The result was in accordance with the diagnosis of pulmonary infection. (3) No CO(2) retention, SO(2) and PaCO(2) abnormality caused by asphyxia was observed in 2 groups, PaCO(2) value in A group was close to that in C group (t = 0.89, P > 0.05). (4) In C group, 9 (64.3%) patients were cured, 5 patients died of pneumonia, wound sepsis, and MODS. In A group, 25 (92.6%) patients were cured, 2 patients died of MODS. Number of cure was obviously larger in A group than in C group (chi(2)= 5.22, P < 0.05).

CONCLUSIONSThe advanced airway management has better effects on isolation and humidification of airway, and thinning, drainage, and elimination of sputum. And it can decrease the probability of blind suction and injury to airway, and it prevents pulmonary infection following tracheotomy.

Adult ; Airway Management ; Burns, Inhalation ; therapy ; Female ; Humans ; Lung Diseases ; etiology ; prevention & control ; Male ; Middle Aged ; Respiratory Tract Infections ; etiology ; prevention & control ; Tracheotomy ; Young Adult

The prevention and treatment of complications are very important aspects in burn treatment. We should pay attention to the fundamental research, clinical prevention and treatment of complications. We have had good grasp of the subjects by fundamental research such as MODS. We must keep complications in mind when signs, symptoms, monitoring index and laboratory reports are inconsistent to the usual course of the injury, and we must guard against the occurrence of complications in the whole course of burn treatment. Consideration must be given to the treatment of both complications and the primary disease in order to slow down deterioration of patient, and guarantee the curative effect. There are still many unknown areas of burn complications for us to explore and discover.
Burns ; complications ; Multiple Organ Failure ; etiology ; prevention & control

OBJECTIVE: To observe the expression of high mobility group box chromosomal protein 1(HMGB1) in RAW264.7 macrophages after interfering with burning serum and qinghuobaidu-yin (QHBDY), and to find out the endogenous protection mechanism of QHBDY resisting inflammation reaction. METHODS: RT-PCR was used to detect the expression of HMGB1 in RAW264.7 macrophages after interfering RAW264.7 macrophages with normal SD rat serum, burning SD rat serum, and QHBDY feeding SD rat serum. RESULTS: Small quantity of HMGB1 mRNA was expressed in RAW264.7. The expression of HMGB1 mRNA fluctuated around the standard level after interfering with normal serum of SD rats. The expression of HMGB1 mRNA rose at 3 h, and then decreased to the standard level; at 18 h, it rose rapidly; at 36 h, it reached the peak; and at 48 h, it remained at the high level after interfering with burning serum. The expression of HMGB1 mRNA increased at 3 h, and then decreased to the standard level. At 24 h, it started to rise after interfering with herb serum, and was lower than that of; the burning serum group (P<0.05). CONCLUSION Burning serum can increase the expression of HMGB1 mRNA in RAW264.7. QHBDY can decrease the high expression of HMGB1 mRNA in RAW264.7 caused by burning serum.
Animals ; Burns ; complications ; immunology ; Cell Line ; Drugs, Chinese Herbal ; pharmacology ; HMGB1 Protein ; genetics ; metabolism ; Macrophages ; cytology ; metabolism ; Male ; Mice ; RNA, Messenger ; genetics ; metabolism ; Rats ; Rats, Sprague-Dawley ; Systemic Inflammatory Response Syndrome ; etiology ; metabolism ; prevention & control

OBJECTIVETo investigate the effect of vitamin C (VC) on alleviating peroxidative damage in gut of dogs during enteral fluid resuscitation of severe burn shock.

METHODSEighteen male Beagle dogs were subjected to 50% total body surface area (TBSA) full-thickness burn 24 hours after duodenostomy and cannulation of cervical artery and vein. The dogs were divided into no resuscitation (NR) group (no treatment after burn), enteral resuscitation (ER) group, and ER+VC group according to the random number table, with 6 dogs in each group. Dogs in ER and ER+VC groups were respectively infused with glucose-electrolyte solution (GES) and GES containing 250 mg/kg VC through duodenostomy tube 30 minutes after burn. The infusion rate and volume of GES were in accordance with Parkland formula. Venous blood of dogs was drawn before (0) and at 2, 4, 6, and 8 post burn hours (PBH) to determine the activity of diamine oxidase (DAO) in plasma. Dogs were sacrificed at PBH 8 to collect specimens of jejunum tissue for determining the content of malondialdehyde (MDA), and activity of myeloperoxidase (MPO), xanthine oxidase (XOD) and superoxide dismutase (SOD), and assessment of the water ratio of intestinal tissue by dry-wet weight method.

RESULTS50% TBSA burn injury resulted in significant elevation of DAO in every group. The activity of DAO in ER group was obviously higher than that in NR group at PBH 6 and 8 (P < 0.05), but DAO activity in ER+VC group was significantly lower than those in the other two groups after PBH 2 (P < 0.05 or P < 0.01). MDA content, MPO and XOD activity and the water ratio of intestinal tissue [(5.74 +/- 0.51) nmol/mg, (2.08 +/- 0.46) U/g, (58.4 +/- 3.8) U/mg, (81.5 +/- 1.8)%] in ER group at PBH 8 was respectively significantly higher than that in NR group [(5.43 +/- 0.25) nmol/mg, (1.55 +/- 0.21) U/g, (50.1 +/- 2.8) U/mg, (78.3 +/- 1.5)%, P < 0.05 or P < 0.01]. While the activity of SOD in ER group (72 +/- 12) U/mg was lower than that in NR group (97 +/- 20) U/mg. MDA content, MPO and XOD activity and water ratio of intestinal tissue in ER+VC group was respectively lower than that in ER group, with activity of SOD in the former group higher than that in the latter group (P < 0.01).

CONCLUSIONSVitamin C can alleviate peroxidative damage and tissue edema in gut induced by ischemia and reperfusion, and intestinal complications during oral rehydration during burn shock can be reduced.

Animals ; Ascorbic Acid ; therapeutic use ; Burns ; therapy ; Dogs ; Fluid Therapy ; adverse effects ; Intestine, Small ; metabolism ; Male ; Oxidative Stress ; Reactive Oxygen Species ; metabolism ; Reperfusion Injury ; etiology ; prevention & control ; Shock ; therapy