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

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

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 (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 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 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

OBJECTIVETo explore the effectiveness of postoperative electron beam irradiation therapy for keloid.

METHODSForty-eight patients with 65 keloid sites were treated by surgical removal and postoperative 25 Gy electron beam irradiation from 1994 to 2002 and followed for over eighteen months. Statistical analysis was performed and therapeutic outcome was evaluated.

RESULTSThe overall recurrence rate was 26%. Higher post-treatment recurrence rates were noted with keloid forming at infected sites and in patients with family history (47.8% and 53.3%) (P < 0.05). Meanwhile, patient age, sex, keloid size and location had no increased likehood of recurrence rate.

CONCLUSIONThe study shows that postoperative electron beam irradiation therapy is a kind of safe and effective method in inhibiting recurrence of keloid formation and eradicating it.

Adult ; Combined Modality Therapy ; Electrons ; Female ; Follow-Up Studies ; Humans ; Keloid ; radiotherapy ; surgery ; Male ; Postoperative Care ; Recurrence ; Treatment Outcome

OBJECTIVETo investigate the possibility of differentiation of human mesenchymal stem cells (hMSC) into epidemic cells in vitro.

METHODShMSCs were segregated from normal adult human bone marrow by Percoll solution (1.073 g/ml) , and were cultured, purified, and amplified to 3th passage in vitro. Then the hMSCs were randomly divided into control group ( with treatment of normal L-DMEM medium) and experimental group (with treatment of L-DMEM medium containing epidermal growth factor,insulin,tretinoin, calcium chloride). After 7 days of culture, the morphologic changes of hMSCs in the 2 groups were observed with inverted phase contrast microscope. The expressions of P63 and PCK of hMSCs were assessed with immunohistochemical methods.

RESULTSThe shape of hMSCs in experimental group became irregular or oblong in shape, while that in control group were still in spindle shape. Immunohistochemical results showed that hMSCs were P63 and PCK positive in the experimental group, while those in control group were negative.

CONCLUSIONHuman mesenchymal stem cells can differentiate into epidemic cell in vitro.

Bone Marrow Cells ; cytology ; metabolism ; Cell Differentiation ; Cells, Cultured ; Epithelial Cells ; cytology ; Humans ; Keratins ; metabolism ; Membrane Proteins ; metabolism ; Mesenchymal Stromal Cells ; cytology

OBJECTIVETo evaluate the effect of the compound of Dan-shen root and azone for scar treatment.

METHODSThe rat skin in vitro and the human skin in vitro and vivo were separately examined their permeability of the mixture of the Dan-shen root and azone. The 301 patients with hypertrophic scar were randomly divided into two groups: one treated with elastic cloth paste (including silicone) contained in Dan-shen root with azone, and the another treated with only elastic cloth paste (including silicone).

RESULTSThe permeability of Dan-shen root with azone, passing through the rat skin in vitro and the human skin in vitro and vivo was significantly higher than both the distilled water and the normal saline (P < 0.05). In the clinical study for treatment of the hypertrophic scars, the efficient rate of the group with the Dan-shen root with azone was significantly higher than the control (91.4% vs. 71.3%) (P < 0.01).

CONCLUSIONThe Dan-shen root with azone could be easier to permeate the skin and more effective to treat the hypertrophic scar.

Adolescent ; Adult ; Aged ; Animals ; Azepines ; pharmacology ; Child ; Child, Preschool ; Cicatrix ; drug therapy ; Drugs, Chinese Herbal ; pharmacology ; Female ; Fibrinolytic Agents ; pharmacology ; Humans ; Male ; Middle Aged ; Phenanthrolines ; pharmacology ; Phytotherapy ; Rats ; Skin ; drug effects ; pathology ; Treatment Outcome