OBJECTIVETo investigate the influence of early enteral nutrition with synbiotics on the plasma endotoxin level, the nutritional state, the inflammatory response and the incidence of infectious complications in severely burned patients.

METHODSRandomized double blind and control method was employed im the study. Forty severely burned patients were randomly divided into A and B groups with 20 in each group. The patients in group A received early enteral nutrition with synbiotics including four kinds of lactic acid bacteria and four kinds of fibers, while those in group B received early enteral nutrition with synbiotics including only four kinds of fibers. The patients with 80% to 280% coefficient unit burned surface(UBS) were further divided into A1 (n = 10) and B1 (n = 11) groups. The plasma endotoxin level in group A and B was determined dynamically on the 1st, 3rd, 7th, 10th, 14th, and 21st postburn days (PBD), and its abnormal rate in both groups was statistically analyzed in correlation with the normal endotoxin level. meanwhile, the mortality, the incidence of infectious complications and the blood bacterial culture results were compared between the two groups. The plasma levels of IL-1, IL-6 and prognostic inflammatory nutrition index (PINI) were also determined at the above time points.

RESULTSThe plasma endotoxin level in group A (37.9 +/- 5.4) ng/L was evidently lower than that in group B (59.1 +/- 7.9) ng/L (P < 0.05) on 10 PBD. The abnormal rate of plasma endotoxin in group A (36.7%) was evidently lower than that (49.2%) in group B (P < 0.05). Blood culture was positive in 3 patients in group A, and 5 in group B. There was no obvious difference in the incidence of infectious complication between the two groups. Two patients died in group A and 1 group B. There was no obvious difference in plasma IL-1 level between A1 and B1 groups at different time points. The plasma IL-6 level in A1 group in 10th and 14th PBD was evidently lower than that in B1 group (P < 0.05). The PINI in A1 group on the 10 PBD was remarkably lower than that in B1 group.

CONCLUSIONEarly enteral nutrition with synbiotics was helpful in decreasing inflammatory stress response and lowering the plasma endotoxin level. Enteral supplementation of synbiotics might be beneficial to the controlling of burn infection.

Adult ; Burns ; therapy ; Dietary Fiber ; administration & dosage ; therapeutic use ; Double-Blind Method ; Endotoxins ; blood ; Enteral Nutrition ; methods ; Female ; Humans ; Intestinal Mucosa ; drug effects ; Male ; Probiotics ; administration & dosage ; therapeutic use

Enteral Nutrition ; methods ; Humans ; Intestines ; pathology ; physiopathology

Enteral Nutrition ; Humans ; Infection Control ; methods ; Probiotics ; administration & dosage ; therapeutic use ; Stress Disorders, Traumatic ; immunology ; therapy

OBJECTIVETo investigate the effects of topical application of small dose of insulin on the wound healing of the scalded rats, so as to explore its mechanism.

METHODSThe rats employed in the study were subjected to deep partial thickness burn and were divided into group A (with subcutaneous injection of isotonic saline into the rat wounds as control), B and C (with subcutaneous injection of 0.1 U and 1 U insulin in the rat wounds respectively) and D (with subcutaneous injection of 0.1 U insulin in the rat abdomen as control). The wound healing time and wound healing rate were assessed every other day after 3 postburn days (PBDs). The histological changes of the wounds after injection were examined, the changes in the cell cycle of epidermal cells in the wound were analyzed by flow-cytometry, and blood glucose concentration of each group was determined.

RESULTSThe wound healing time in group B (18.36 +/- 4.12 d) was significantly shorter than that in other groups (A: 24.57 +/- 5.19 d, C: 21.46 +/- 2.97 d, D: 24.50 +/- 1.05 d, P < 0.01). The wound healing rate of the rats in group B in 5, 9, 11, 13, 15, 17 and 19 PBD was obviously higher than that in group A, and was markedly higher than that in group C on 17 PBD (P < 0.05 - 0.01). The epithelial layer was thinner with less epidermal nails but much more fibroblasts in epidermal layer in group A, while the epithelial layer was thicker with abundant epidermal nails in group B and C with many fibroblasts in the dermis. The amount of cells in S phase at 4 PBD in group B was dramatically higher than that in group A, and cells in G2M phase at 4 - 5 PBD in group B was also higher than that in group A and C (P < 0.05 - 0.01). The blood level of glucose in group A and B fluctuated between 3.42 to 4.62 mmol/L at 24 PBH, while that in group C and D decreased obviously 1 hour after injection (P < 0.01), but gradually returned to normal 4 hours after injection.

CONCLUSIONLocal injection of small dose of insulin may accelerate burn wound healing due to its role in promoting the proliferation and division of the repairing cells.

Administration, Topical ; Animals ; Blood Glucose ; analysis ; Burns ; blood ; drug therapy ; physiopathology ; Cell Cycle ; drug effects ; Female ; Insulin ; administration & dosage ; Male ; Rats ; Rats, Sprague-Dawley ; Wound Healing ; drug effects

OBJECTIVETo observe the changes in plasma levels of lipopolysaccharide (LPS), tumor necrosis factor alpha (TNF-alpha) and interleukin-6 (IL-6) in burn patients with severe infection treated with Imipenem or Cefoperazone.

METHODSThirteen severe burn patients infected with gram negative bacilli were enrolled in the study in which 7 were treated with IPM and 6 with CPZ. Venous blood samples were harvested before and 2, 12, 24, 48 and 72 hours after the use of antibiotic for the determination of the plasma levels of LPS, TNF-alpha and IL-6, and correlative analysis was carried out among all the factors in regard to their changes.

RESULTSThe plasma levels of LPS in both groups were elevated 2 hours after the injection of either antibiotic, but it was more obvious in patients with CPZ when compared with that before treatment (13.95 +/- 5.44 pg/ml), and the levels were much higher than that after IPM (P < 0.05). The plasma LPS level declined thereafter. The plasma TNF-alpha level in CPZ group was 0.86 +/- 0.16 ng/ml at 2 hours after the use of antibiotic, and it was much higher than that before the use of the drug, and it was higher compared with IPM group. (P < 0.01). But there was no change in the plasma IL-6 level in all the patients at all the time points before and after the use of either drug. The plasma TNF-alpha levels in the two groups were positively correlated with the plasma levels of LPS and IL-6.

CONCLUSIONThe release of LPS and TNF-alpha from bacteria could be induced by the administration of different kinds of antibiotics in the management of burn patients infected by gram negative bacilli in different releasing amounts. And the TNF-alpha production was correlated with the release of LPS and IL-6.

Burns ; blood ; Cefoperazone ; therapeutic use ; Female ; Gram-Negative Bacterial Infections ; blood ; drug therapy ; Humans ; Imipenem ; therapeutic use ; Interleukin-6 ; blood ; Lipopolysaccharides ; blood ; Male ; Tumor Necrosis Factor-alpha ; analysis

OBJECTIVETo investigate the effect of lipopolysacharide (LPS) in different concentrations on the biological features and growth factor secretion power of U937 cell line.

METHODSIn vitro cultured U937 cells were stimulated by 0 (as control), 0.1, 1.0, 10.0, 50.0 and 100 micro g/ml LPS respectively for 24 hours. Thereafter, the cell proliferation ability was determined by MTT method. The cell apoptosis rate was determined by flow cytometry. The changes in the contents of transforming growth factor beta(1) (TGFbeta(1)) and vascular endothelial growth factor (VEGF) of the supernatant of the cell culture were assessed by ELISA.

RESULTSApoptosis and TGFbeta(1) secretion could be induced by LPS in dose of 0.1 to 100 micro g/ml when compared with that without LPS challenge (P < 0.05 - 0.01). In detail, LPS in lower dose (0.1, 1.0 and 10.0 micro g/ml) could promote the proliferation of U937 (P < 0.05 - 0.01) but exerted no effect on VEGF secretion. In contrary, LPS in high dose (50 and 100 micro g/ml) could promote VEGF secretion (P < 0.01) but exerted no effects on the proliferation of U937 cells.

CONCLUSIONU937 cells could be activated to increase the secretion of TGFbeta(1) by LPS in optimal dose of 0.1 - 10.0 micro g/ml, but the secretion of VEGF could only be promoted by LPS in higher concentration.

Apoptosis ; drug effects ; Cell Division ; drug effects ; Humans ; Lipopolysaccharides ; pharmacology ; Transforming Growth Factor beta ; analysis ; secretion ; Transforming Growth Factor beta1 ; U937 Cells ; drug effects ; secretion ; Vascular Endothelial Growth Factor A ; analysis ; secretion

OBJECTIVETo evaluate the efficiency of PGE(1) in relieving the circulatory disorder of ischemic skin flap.

METHODSNew Zealand rabbits were employed in the study with skip flaps each with the size of 2.5 x 6.0 cm(2) being raised from the back. PGE(1) cream in different concentrations, i.e. 0.2%, 0.4%, 0.8% was respectively topically applied to the skin flaps forming 3 groups (n = 10 in each group), while pure cream without PGE(1) was applied to those in control group (n = 30). The PGE(1) was applied 1 hour after the flap was opened, raised and sutured back. Blood perfusion in the flap was measured with Laser Doppler flowmetry before and 5, 10, 15, 20, 30, 45 and 60 mins after PGE(1) application. The tissue samples from the skin flap were harvested at 2 hours after PGE(1) application for immunohistological staining, and the cross sectional area of capillary lumens was measured under microscope. The survival area of the flap was assessed on the 3(rd) day after operation for the calculation of relative survival length of the flap. Clinically, PGE(1) ointment was applied onto the skin flap vulnerable to necrosis, and the outcome of the flap was observed thereafter.

RESULTSThe blood perfusion in animal skin flaps was increased evidently after PGE(1) application, especially at 30 mins after PGE(1) usage when compared with that in control group (P < 0.05). The capillaries in the skin flap in PGE(1) application groups were dilated obviously after drug usage as observed under microscope (P < 0.05). The survival area and relative survival length in groups 1 and 2 on the 3(rd) post-operational day were much more increased when compared with those in other groups (P < 0.01). Clinically, the skin flaps treated with PGE(1) survived well even in the distal end of the flaps.

CONCLUSIONThe blood perfusion and the survival rate of the skin flaps could be improved by local application of PGE(1) in concentrations of 0.2% or 0.4%.

Adult ; Alprostadil ; administration & dosage ; Animals ; Female ; Humans ; Ischemia ; drug therapy ; Male ; Rabbits ; Surgical Flaps ; blood supply

OBJECTIVETo explore the significance and the role of the p53 gene mutation in the exon 4 to 8 in keloid fibroblasts.

METHODSTissue samples from twelve patients with keloid and twelve hyperplastic scar respectively were harvested for in vitro culture of fibroblasts, and normal skin samples from the same patients were employed as the control. Polymerase chain reaction-based single-strained conformational polymorphism (PCR-SSCP) and DNA sequencing were employed to detect p53 gene mutations of the fibroblasts.

RESULTSThe points and frameshift mutations in the exon 4, 5, 6, 7 of p53 gene were identified in 9 of the 12 keloid tissue samples. No p53 gene mutation was detected in all hyperplastic scar and normal skin samples.

CONCLUSIONp53 gene mutation might play an important role in the formation and development of keloids.

Female ; Fibroblasts ; metabolism ; Genes, p53 ; Humans ; Keloid ; genetics ; Male ; Mutation

OBJECTIVETo establish an ideal model of human hyperplastic scar (HS) in nude mice, so as to provide us a new model to carry out further studies on the mechanism of HS development.

METHODSFull skin defect sized 2.0 cm x 1.5 cm was created on the back of 100 nude mice. The defect was thereafter covered with full thickness human skin. After the grafted skin survived, the nude mice were subjected to deep partial thickness burn of the grafted skin with heated copper rod. The development of the hyperplasia of the scar after wound healing was observed histologically and grossly.

RESULTSGrafted full-thickness human skin took and survived well in 86 out of 100 nude mice. There was obvious and continuous hyperplasia of scar in 67 mice (78%). The external appearance and histological features of the HS appeared similar to those in human HS. The average thickness of the scar was 0.34 cm, with the thickest part measuring 0.6 cm. In addition, the time of hyperplastic change lasted for 63 - 217 days in average of 128 days.

CONCLUSIONObvious and continuous scar hyperplasia could be found in this model, and the whole process beginning from wound healing to the formation of HS could be easily observed. The model was therefore suitable and ideal for the study of HS.

Animals ; Cicatrix, Hypertrophic ; etiology ; pathology ; Disease Models, Animal ; Female ; Male ; Mice ; Mice, Nude

OBJECTIVETo investigate the expression of tenascin-C (Tn-C) in keloid and hyperplastic scar (HS).

METHODSTissue samples were harvested from 10 patients with keloid and 10 with HS (6 - 10 months) and from the skin of 5 adult healthy volunteers. The expression of Tn-C in these samples was determined with immunohistochemistry method.

RESULTSThere was scarce expression of Tn-C in the skin tissue in adult healthy volunteers, and it was only present in the dermal papillae at the dermis epidermis conjunctions and partly in the blood vessels and skin appendages adjacent to the basement membrane. There was enhanced expression of Tn-C in the dermal scar tissue and skin appendages in both keloid and HS, especially in keloid, which exhibited a diffused pattern in the tissue. When compared with that in normal skin, the Tn-C expression in the normal skin adjacent to the keloid was enhanced markedly, but not in the normal skin near HS tissue.

CONCLUSIONThere was increased Tn-C expression in keloid and HS (6 - 10 months).

Cicatrix, Hypertrophic ; metabolism ; Female ; Humans ; Immunohistochemistry ; Keloid ; metabolism ; Male ; Skin ; chemistry ; Tenascin ; analysis