Effectiveness of recombinant human growth hormone ( rhGH) in treating critically ill or severe burned patients have been demonstrated. Although adverse effects of rhGH have also been identified, they are controllable. The dosage and timing of rhGH must be well designed, and hyperglycemia be controlled. Application of rhGH in critically ill patients should be deliberately considered.

Chronic diseases (ChDs) today constitute the leading cause of morbidity and mortality. Increasing evidence suggests that the production and development of ChDs are associated with amplified inflammation, which is caused by accumulation of advanced glycation end products (AGEs) and advanced lipexidation end products (ALEs).Heating, irradiation, and ionization, in combination with gross over-nutrition, significantly contribute to production of, exposure to and accumulation in the body of AGEs/ALEs. Furthermore, dietary AGEs restriction in animals seemed to be effective to extend life span. This paper elucidates the relationship between food and AGEs and the dietary measures to reduce AGEs/ALEs with an attempt to provide new methods for prevention and treatment of ChDs.

Objective: To evaluate the clinical effectiveness and safety of early total enteral nutrition (TEN) in severely burned patients. Methods: Forty one burned patients with total burn surface area over 30% were randomly assigned to TEN group (n=21) and CONT group (n=20). The two nutritional support protocols were similar in calorie and nitrogen intake within 7 d of treatment. Serum levels of visceral proteins and TNF-? were measured. Prognostic inflammatory and nutritional index (PINI) was postulated from formula. Results: Contrasting to a significant reduction (from 96.0?31.8mg/L to 69.4?17.3 mg/L, P

Nutrition Risk Screening 2002 (NRS 2002) was developed on the basis of 128 randomized controlled clinical studies by a group of experts led by Kondrup from the European Society for Parenteral and Enteral Nutrition (ESPEN).As the first evidence-based nutritional screening tool worldwide,NRS 2002 has been recommended for nutritional risk assessment of hospitalized patients in Europe for the addition of disease metabolism and its simplicity.In this article,we reviewed the increasing applications of NRS 2002 in China,pointed out the existing problems and made several suggestions on improvement for popularization and standardization of its clinical use.

Objective To study demographic features,clinical characteristics and in-hospital cost of patients due to different causes in one center in 2007-2011 and discuss their correlation.Methods A retrospective analysis was conducted on all patients who were treated with amputation from 2007 to the first half of 2011 in the Second Affiliated Hospital of Zhejiang University to carefully record their data,such as demographic characteristics,entity,medical history,clinical information,amputation location,amputation level,hospital day and medical cost.Results A total of 805 patients at age of (42.1 ± 18.1)years underwent amputation from 2007 to the first half of2011.Among them,the male patients accounted for 72.3％.The patients engaged in farm,industry and transportation accounted for 69.7％.Traumatic amputation occupied 66.1％,followed by 15.3％ of tumor amputation and diabetic amputation proportioned 4.5％,occupying 13.2％ of non-traumatic amputation.Ratios of lower limb amputations and amputations above levels of joints of palmar digitals and toes were 64.9％ and 61.7％.Mean hospital day was 20 days (range,14-34 days) and mean medical cost was 15 000 RMB (range,8 881-31 975 RMB).Conclusions Amputation largely occurs in the male adults and mainly results from trauma.High amputation,long hospital stay and high medical cost are the main characteristics.

Objective To observe the infection prevention, wound healing effect and safety of nanometer silver in treatment of Ⅱ degree burn wound. Methods The patients with 6%-10% TBSA Ⅱ degree burn wound ( deep or superficial) were randomly divided into test group ( treated with nanome-ter silver, n =35) and control group (treated with 1% sulfadiazine silver, n =35). Each group was reg-ulated to change dressing and medication one time a day for seven days on 5% superficial Ⅱ degree burn wound. Then, 1% iodophors and gauze were used for change dressing. Before and after change dressing, bacterial culture was done in two groups to observe the time for wound healing. The blood collected before change dressing and at days 1,7 and 14 after change dressing and urine within 24 hours were employed for detecting serum silver level and mean silver level in urine by using inductively coupled plasma mass-spec-trum ( thermoelectricity of American Ⅹ Series Ⅱ ). In the meantime, the liver and renal function was e-valuated at days 7 and 14. Results Positive rate of bacterial culture in test group and control group was 3% and 3.1% respectively after treatment, which showed a decrease compared with the levels before treatment (12. 1% and 15.6% respectively), with no statistical difference. The wound healing time of test group was (9. 18 ± 1.9) days, which was shorter than ( 12.9 ± 1.3 ) days in control group, with sta-tistical difference (P<0.01). Before treatment, the silver level of blood was ( 1.55 ± 1.26) μL and ( 1.54 ± 1.28 ) μg/L respectively in test group and control group, and silver level of urine within 24 hours was ( 1.67 ± 1.05 ) μg and ( 1.87 ± 1.37) μg respectively test group and control group, with no statistical difference (P > 0. 05 ). Silver medication could elevate the serum silver level ( P < 0.01 ), with lower level in test group than control group (P <0. 01 ). Average silver level of urine within 24 hours showed similar change with that in the serum. The patients showed normal renal function, with no abnormal change of ALT. Conclusions For Ⅱ degree burn wound, nanometer silver can more significantly short-en wound healing time compared with sulfadiazine silver. Moreover, nanometer silver has higher degree of safety on silve metabolism and is an ideal medcation for burn wound.

OBJECTIVETo observe the effectiveness of xenogenic(porcine) acellular dermal matrix grafting with thin autogenic skin on deep wounds with good wound-bed.

METHODS52 cases of patients with deep wounds were transplanted with xenogenic(porcine) acellular dermal matrix grafting and thin autogenic skin by two step method from Jan. 2000 to Feb. 2002.

RESULTS37 cases of patients achieved complete take(71.1%) and 15 cases got 95 percent take (28.9%) with none needing grafting again. 3-6 months' following up showed that skins of complex grafting had well-acceptable color and quality compared to nearby skin.

CONCLUSIONThis kind of xenogenic(porcine) acellular dermal matrix can be widely used on deep wounds with good wound bed as complex graft.

Adolescent ; Adult ; Animals ; Child ; Child, Preschool ; Dermatologic Surgical Procedures ; Dermis ; transplantation ; Female ; Humans ; Infant ; Male ; Middle Aged ; Skin ; injuries ; Skin Transplantation ; methods ; Swine ; Transplantation, Autologous ; Transplantation, Heterologous ; Wound Healing ; Wounds and Injuries ; surgery

Objective: To explore the effects of endostatin pretreatment on fibrosis of human skin fibroblasts and the mechanisms. Methods: Human skin fibroblasts were routinely cultured in vitro, and then the cells of passage 3 to 5 were used in the following experiments. The cells were divided into blank control, endostatin, platelet-derived growth factor-BB (PDGF-BB), endostatin+ PDGF-BB, transforming growth factor-β₁ (TGF-β₁), and endostatin+ TGF-β₁ groups according to the random number table, with 3 wells in each group. Cells in blank control group were cultured with DMEM medium for 24 h. Cells in endostatin group were cultured with DMEM medium containing 5 μg/mL endostatin for 24 h. Cells in PDGF-BB group and TGF-β₁ group were cultured with DMEM medium containing 200 ng/mL PDGF-BB and 10 ng/mL TGF-β₁ for 24 h, respectively. Cells in endostatin+ PDGF-BB group were pretreated with DMEM medium containing 5 μg/mL endostatin for 48 h and then cultured with DMEM medium containing 200 ng/mL PDGF-BB for 24 h. Cells in endostatin+ TGF-β₁ group were pretreated with DMEM medium containing 5 μg/mL endostatin for 48 h and then cultured with DMEM medium containing 10 ng/mL TGF-β₁ for 24 h. The content of type Ⅰ collagen in the cell culture supernatant of three wells in each group was determined by enzyme-linked immunosorbent assay. The protein expression levels of α-smooth muscle actin (α-SMA), PDGF receptor β (PDGFRβ), phosphorylated PDGFRβ (p-PDGFRβ), and phosphorylated extracellular signal-regulated protein kinases 1/2 (p-ERK1/2) of three wells in each group were detected by Western blotting. Data were processed with one-way analysis of variance and SNK test. Results: (1) Compared with (5.05±0.29) pg/mL in blank control group, content of type Ⅰ collagen in the cell culture supernatant of endostatin group [(4.72±0.37) pg/mL] was close to it (P>0.05), content of type Ⅰ collagen in the cell culture supernatant of PDGF-BB group and TGF-β₁ group [(8.60±0.57) and (9.20±0.64) pg/mL, respectively] was higher (with P values below 0.05). Content of type Ⅰ collagen in the cell culture supernatant of endostatin+ PDGF-BB group [(5.32±0.17) pg/mL] was lower than that of PDGF-BB group (P<0.05), and content of type Ⅰ collagen in the cell culture supernatant of endostatin+ TGF-β₁ group [(5.41±0.20) pg/mL] was lower than that of TGF-β₁ group (P<0.05). (2) Compared with those in blank control group, protein expression levels of α-SMA, PDGFRβ, p-PDGFRβ, and p-ERK1/2 of cells in endostatin group showed no obvious differences (with P values above 0.05), while those in PDGF-BB and TGF-β₁ group were significantly higher (with P values below 0.01). Protein expression levels of α-SMA, PDGFRβ, p-PDGFRβ, and p-ERK1/2 of cells in endostatin+ PDGF-BB group and endostatin+ TGF-β₁ group were significantly lower than those in PDGF-BB group and TGF-β₁ group, respectively (with P values below 0.05). Conclusions Pretreatment of endostatin can inhibit the fibrosis of human skin fibroblast and its transformation into myofibroblast, which may be related to the down-regulation of protein expression of p-PDGFRβ, PDGFRβ, and p-ERK.

Wound healing is a complex and sequential biological process involving various cells and factors under body′s regulation. Appropriate interventions play positive roles in promoting effective wound healing and improving healing quality. In the clinical practice, there are many new instruments, dressings, and drugs developed for wound care, including antibacterial dressings, wet dressings, precise debridement, negative pressure wound therapy, cytokines/growth factors, and dermal substitutes, which provide revolutionary means for wound treatment. This article summarizes the effective or mature methods in wound care, providing theoretical and practical basis for choosing appropriate treatment methods in different stages of wound.