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

When I started my career as a burn doctor, I looked over all those chapters dealing with wound healing wishing desperately to help me understand the healing process and mechanism of wound. Whereas is that the whole picture of wound healing? Decades have passed; we are still following these protocols. Do we really have nothing better to do with wound healing? When I was asked to write this comment, I was thinking that we should think high and wide in facing wound healing.
Burns ; therapy ; Humans ; Wound Healing

Various skin defects resulting from mechanical injury, burns, chronic ulcers, and resection of tumor etc. are very common in clinic. The traditional treatment measure, such as grafting of autologous split-thickness skin remains the gold standard. However, its limitations are obvious, such as shortage of donor sites, creation of new injury, and scar formation. To realize regenerative or scarless repair of tissue defects has always been the dream of human being. The advent of tissue engineered skin (TES) provides an ideal access to tissue regeneration. After decades of development, several kinds of TES products have been developed and used in clinic, with promising effects. However, a large number of basic scientific problems regarding TES, as well as difficulties in translation of basic research to bedside should be taken into serious consideration. This article presents a comprehensive overview of strategies of construction of TES, the role of TES in regenerative wound repair, and its opportunities and challenges.
Humans ; Regenerative Medicine ; Skin ; injuries ; Skin, Artificial ; Tissue Engineering ; Wound Healing

OBJECTIVETo investigate the expression of Tenascin-C mRNA in keloids and hypertrophic Total RNA was isolated from normal adult skin. A cDNA fragment (base 5941-6481bp) of the scars.

METHODSfull-length human Tenascin-C cDNA was synthesized by polymerase chain reaction and subcloned in pGEM-T-easy. Dioxygen-labeled anti-sense and sense probes were synthesized by using a Sp6/T7 RNA synthesis kit in the present of Dig-UTP in vitro. The samples were taken from keloids in 10, hypertrophic scars in 10 and normal adult skin in 5. The hybridization was performed with 4% paraformaldehyde-fixed and wax-embedded sections to detect the Tenascin-C mRNA.

RESULTSThe Tenascin-C mRNA was negative in the normal adult epidermis and weakly located in the fibroblasts of the papillary dermis and the epidermal adnexa. In all of the 10 keloid specimens, the Tenascin-C mRNA was positive throughout the epidermis and widely distributed in the dermis included in the fibroblasts, endothelial cells and epidermal adnexa. In the specimens of the 3 hypertrophic scars,the Tenascin-C mRNA was also positive in the epidermis, but in the other 7 cases, it became negative. In the dermis of the hypertrophic scar,the Tenascin-C mRNA was weaker than that in the keloid, but stronger than that in the normal skin.

CONCLUSIONSThe expression of Tenascin-C mRNA is markedly enhanced in the keloids.

Cicatrix, Hypertrophic ; genetics ; metabolism ; pathology ; Female ; Humans ; Keloid ; genetics ; metabolism ; pathology ; Male ; RNA, Messenger ; metabolism ; Tenascin ; genetics ; metabolism

OBJECTIVETo investigate the influence of recombinant human growth hormone (rhGH) on the mortality of the patients with severe burns.

METHODSIn a prospective multi-center randomized clinical trial, 207 adult patients with severe burns were enrolled in the study, and they were randomly divided into treatment (T, with subcutaneous injection of rhGH) and placebo control (C, with subcutaneous injection of same amount of isotonic saline) groups. The mortality, incidence of hyperglycemia and sepsis in the two groups were observed.

RESULTSThe mortality rate in T group was 0.89% as compared with 5.26% in the C group (P >0.05). Hyperglycemia (blood glucose level over 10 mmol/L) was present in 36.61% of patients in T group but 18.95% in C group (P <0.01). There was no difference in the incidence of sepsis between the two groups (P > 0.05).

CONCLUSIONThe application of rhGH in appropriate dosage in adult patients with severe burns could be safe, but blood glucose level should be monitored during the administration.

Adolescent ; Adult ; Aged ; Blood Glucose ; Burns ; diagnosis ; drug therapy ; Female ; Human Growth Hormone ; therapeutic use ; Humans ; Male ; Middle Aged ; Pregnancy ; Prognosis ; Prospective Studies ; Treatment Outcome ; Young Adult

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

OBJECTIVETo evaluate the effectiveness and safety of hydroxyethyl starch (HES 130/ 0.4, 60 g/L) in resuscitation during shock stage of burns.

METHODSSixty-six burn patients who were admitted to hospital within 2 hours after burn injury requiring fluid resuscitation were enrolled into this study, and they were randomized into HES( n = 33, with HES as a component of fluid resuscitation) and plasma (P, n = 33, with plasma as a component of fluid resuscitation) groups. HES or plasma was given as colloid within 48 postburn hours (PBH), and only albumin [( 111 +/- 4) , ( 105 +/- 5 ) g for each group] were given to the patients during 3 to 7 postburn days (PBD). Heart rate, blood pressure, central venous pressure (CVP) , urine output per hour were measured, gain/loss of body fluid during the first and second 24 PBH were recorded, serum total protein, albumin, hemoglobin( Hb) , prothrombin time (PT) , fibrinogen; platelet ( PLT) , as well as liver and renal function, allergy and bleeding tendency were determined and observed at corresponding time-points.

RESULTSThere were no obvious differences in heart rate, blood pressure, CVP and urine output per hour within 24 PBH between the two groups (P > 0.05). Also there was no difference in gain/loss of body fluid during the first and second 24 PBH. The content of hemoglobin on 1 ,3, 7,14 PBD ,and the PT, the content of fibrinogen, the number of PLT on 1,3,14 PBD also exhibited no difference between the two groups (P > 0.05). The serum contents of total protein and albumin in HES group were [(31 +/- 3) g/L, (30 +/- 3)g/L ] on 1 PBD, and [(20.4 +/- 3.6) g/L, (18.4 +/-2.3) g/L] on 3 PBD, which were obviously lower than those in P group [(45 +/- 4) g/L, (39 +/- 3) g/L on 1 PBD, and 1 (24.5 +/- 4.3) g/L, (21.3 +/- 3.9) g/L) on 3 PBD, (P <0. 01). Though the serum content of albumin on 7 PBD was similar in the two groups (P > 0.05), the serum total protein in HES group (40 +/- 4) g/L was markedly lower than that in P group [(45 +/- 4) g/L, P < 0.01] . Within 7 PBD, no abnormal bleeding was found in the two groups, and the liver function and renal function were similar. There were 4 cases showing allergic reaction in plasma group while none in HES group.

CONCLUSIONNew type of HES can partially substitute plasma and be used in fluid resuscitation for burn patients. However, plasma protein replenishment should still be emphasized.

Adult ; Burns ; therapy ; Female ; Humans ; Hydroxyethyl Starch Derivatives ; therapeutic use ; Male ; Middle Aged ; Resuscitation ; methods ; Shock ; therapy

Rapid angiogenesis is one of the major issues in the field of tissue engineering, and it is an urgent problem to be solved. The process and related mechanism of angiogenesis have been deeply researched. Meanwhile, various methods or strategies for promoting angiogenesis, involving the application of stem cells and growth factors, and construction and modification of biomaterial scaffolds, have also been reported. On one hand, many remarkable advances in the field of promoting angiogenesis have been achieved; on the other hand, the complexity of mechanism and regulation of angiogenesis have gradually been recognized and emphasized. This paper presents a comprehensive overview of advances in research of the strategies for promoting angiogenesis in the field of tissue engineering.
Animals ; Biocompatible Materials ; Humans ; Neovascularization, Physiologic ; Stem Cells ; Tissue Engineering ; Tissue Scaffolds

OBJECTIVETo isolate MSCs from adult human bone marrow cells and to induce them into adipocytes.

METHODSMSCs were isolated from adult human bone marrow aspirated by Percoll and expanded in L-DMEM. The surface antigen of MSCs, CD14, CD34, CD45, CD44, VLA-1, HLA-DR and cell cycle were analysed on a FACScan flow cytometer. MSCs were cultured in adipogenisis inducing medium including insulin, 1-methyl-3-isobutylxanthine, indomethine and dexamethasone for 7 days and stained with Oil Red O.

RESULTSMSCs grew as adherent cells and expanded more than 10 passages. They were positive for CD44 and negative for CD14, CD34, CD45, HLA-DR. The expression of VLA-1 was weak. After 7 days of adipocyte inducing, about 85%of the cells displayed accumulation of lipid vacuoles, as detected by Red Oil O.

CONCLUSIONMSCs isolated and cultured from adult human bone marrow can be induced to adipogenisis committed differentiation.

Adipocytes ; physiology ; Adult ; Antigens, CD34 ; analysis ; Bone Marrow Cells ; physiology ; Cell Differentiation ; Cell Separation ; methods ; Cells, Cultured ; HLA-DR Antigens ; analysis ; Humans ; Hyaluronan Receptors ; analysis ; Lipopolysaccharide Receptors ; analysis ; Stem Cells ; physiology

OBJECTIVETo investigate the status of nutritional support therapy in moderate and severe burn patients.

METHODSThe burn patients with age over 16 y and burn area larger than 20% TBSA were enrolled in the retrospective study. According to length of stay, all patients were divided into the first period (271 cases, was from 1994 to 2001 year), and second period (273 cases, from 2002 to 2007 year), and they were subdivided into a (20% - 30% TBSA), b (31% - 50% TBSA), c (51% - 70% TBSA), d (larger than 70% TBSA) groups. The death rate and ratio of nutritional support therapy were compared. The change in albumin and other indices (including side-effects, complication, etc) were analyzed in each group in second period.

RESULTSThere were similar in general conditions in both groups, however, some were obvious difference in two periods between nutritional support therapy rate (74.17% in first period vs 85.35% in second period, P < 0.01), and the ratio of parenteral nutrition to enteral nutrition (1.5:1.0 in first period, 1.0:1.5 in second period, P < 0.01). There were also significant differences in albumin levels among each group in second period on 4, 7, 14 days after burn (P < 0.05). In the second period, parenteral nutrition preparation was mostly delivered through central vein in the form of "all-in-one", among them 62 cases of positive catheter cultures were found. Enteral nutrition was delivered by oral route in 108 cases, naso-gastric or naso-enteric tubes with pump in 165 cases. 27 cases with severe gastrointestinal complications and 2 cases with inhalation pneumonia occurred.

CONCLUSIONThe ratio of parenteral nutrition and enteral nutrition in burn patients was higher in our ward than average level in China. There is still a long way ahead to optimize nutritional therapy.

Adolescent ; Adult ; Burns ; therapy ; Enteral Nutrition ; Female ; Humans ; Male ; Middle Aged ; Parenteral Nutrition ; Retrospective Studies ; Treatment Outcome ; Young Adult