Accurate area assessment of a burn injury and its treatment according to its depth of injury are the foundation of burn treatment due to its complexity, and various techniques and methods have been employed to solve these problems for many years. As the demand of modern medicine calls for individualized and precise therapeutic measures, it is clear that the traditional diagnostic and treatment measures are insufficient. The flourishing development of three-dimensional (3D) technology seems to provide new research approaches and technical opporturities for burn surgery. A series of techniques such as 3D model, 3D scanning, and 3D printing may be promising in advancing burn surgery through basic research to achieve rational clinical applications in the future. In this paper, the applications and achievements of 3D technology in burn surgery in recent years are summarized.
Body Surface Area ; Burns ; diagnosis ; pathology ; therapy ; Humans ; Image Processing, Computer-Assisted ; methods ; Therapy, Computer-Assisted

OBJECTIVETo introduce a safe and specific approach of (13)C magnetic resonance spectrum ((13)C MRS) spectroscopy and investigate the alterations in hepatic anabolism.

METHODSRelative anaplerotic, pyruvate recycling and gluconeogenic fluxes were measured by (13)C MRS isotopomer analysis of blood glucose from rats with 40% body surface area burn injury, and from rats exposed to sham injury. A short chain fatty acid, [U (13)C] propionate which was avidly extracted by the liver, was infused intravenously to deliver (13)C into the citric acid cycle. Proton-decoupled (13)C MRS of deproteinized plasma or extracts of the freeze-clamped liver were used to determine the distribution of (13)C in blood or hepatic glucose.

RESULTSThere was no difference in the multiplets detected in the glucose carbon-2 anomer from blood or liver after 45 or 60 minutes of the infusion of the propionate, indicating that steady-state isotopic conditions were achieved. Gluconeogenesis relative to citric acid cycle flux was not altered by burn injury; in both sham and burn groups the rate of glucose production was about equal to flux through citrate synthase. In the sham group of animals, the rate of entry of carbon skeletons into the citric acid cycle was about 4 times than that in the burn group. Similarly, flux through pyruvate kinase (again relative to citrate synthase) was significantly increased after the burn injury.

CONCLUSIONSSince results from analysis of the blood glucose are the same as that of the hepatic glucose, (13)C distribution in the glucose and hepatic metabolism can be assessed based on the (13)C MRS analysis of the blood glucose.

Animals ; Blood Glucose ; analysis ; Burns ; complications ; Carbon Isotopes ; Citric Acid Cycle ; physiology ; Disease Models, Animal ; Gluconeogenesis ; physiology ; Liver Diseases ; etiology ; pathology ; Liver Function Tests ; Magnetic Resonance Spectroscopy ; methods ; Male ; Probability ; Radiographic Image Enhancement ; Rats ; Rats, Sprague-Dawley ; Reference Values ; Sensitivity and Specificity

The stress response is a preexisting and adaptive behavioral mode of all living beings, which may bring deleterious consequences of dysfunction or failure of tissue and organ. This article aims to elaborate theories of stress response, summarize the manifestation and mechanism of acute stress response in critically burned patients, and help to improve clinical curative efficacy and prognosis of these patients by physiological, psychological and pharmacological methods.

OBJECTIVETo observe the role of Kupffer cells in the postburn production of TNFalpha, IL-1beta and IL-6 in severely scalded rats.

METHODS(1) The production of TNFalpha, IL-1beta and IL-6 from rat Kupffer cells stimulated by burn serum was observed. (2) The postburn change in the expression of cytokine mRNA from rat Kupffer cells was monitored. (3) The change in the plasma cytokine contents in scalded rats was determined after the application of gadolinium chloride, a specific inhibitor of Kupffer cells.

RESULTSKupffer cells could be stimulated by burn serum to release cytokines TNFalpha, IL-1beta and IL-6. The mRNA expression of TNFalpha, IL-1beta and IL-6 from rat Kupffer cells increased significantly after injury. But the postburn plasma levels of TNFalpha, IL-1beta and IL-6 decreased obviously to 34.71%, 36.99% and 33.7% of those in scalding group, respectively, after the Kupffer cell activity was inhibited.

CONCLUSIONThe plasma cytokines, i.e. TNFalpha, IL-1beta and IL-6, were primarily produced from Kupffer cells after injury in scalded rats, initiated by TNFalpha, IL-1beta and IL-6 mRNA transcription.

Animals ; Burns ; immunology ; metabolism ; Gadolinium ; pharmacology ; Interleukin-1 ; biosynthesis ; genetics ; Interleukin-6 ; biosynthesis ; genetics ; Kupffer Cells ; physiology ; RNA, Messenger ; analysis ; Rats ; Rats, Sprague-Dawley ; Tumor Necrosis Factor-alpha ; biosynthesis ; genetics

Objective: To validate the clinical effect of three dimensional human body scanning system BurnCalc developed by our research team in the evaluation of burn wound area. Methods: A total of 48 burn patients treated in the outpatient department of our unit from January to June 2015, conforming to the study criteria, were enrolled in. For the first 12 patients, one wound on the limbs or torso was selected from each patient. The stability of the system was tested by 3 attending physicians using three dimensional human body scanning system BurnCalc to measure the area of wounds individually. For the following 36 patients, one wound was selected from each patient, including 12 wounds on limbs, front torso, and side torso, respectively. The area of wounds was measured by the same attending physician using transparency tracing method, National Institutes of Health (NIH) Image J method, and three dimensional human body scanning system BurnCalc, respectively. The time for getting information of 36 wounds by three methods was recorded by stopwatch. The stability among the testers was evaluated by the intra-class correlation coefficient (ICC). Data were processed with randomized blocks analysis of variance and Bonferroni test. Results: (1) Wound area of patients measured by three physicians using three dimensional human body scanning system BurnCalc was (122±95), (121±95), and (123±96) cm^2, respectively, and there was no statistically significant difference among them ( F=1.55, P>0.05). The ICC among 3 physicians was 0.999. (2) The wound area of limbs of patients measured by transparency tracing method, NIH Image J method, and three dimensional human body scanning system BurnCalc was (84±50), (76±46), and (84±49) cm^2, respectively. There was no statistically significant difference in the wound area of limbs of patients measured by transparency tracing method and three dimensional human body scanning system BurnCalc (P>0.05). The wound area of limbs of patients measured by NIH Image J method was smaller than that measured by transparency tracing method and three dimensional human body scanning system BurnCalc (with P values below 0.05). There was no statistically significant difference in the wound area of front torso of patients measured by transparency tracing method, NIH Image J method, and three dimensional human body scanning system BurnCalc (F=0.33, P>0.05). The wound area of side torso of patients measured by transparency tracing method, NIH Image J method, and three dimensional human body scanning system BurnCalc was (169±88), (150±80), and (169±86) cm^2, respectively. There was no statistically significant difference in the wound area of side torso of patients measured by transparency tracing method and three dimensional human body scanning system BurnCalc (P>0.05). The wound area of side torso of patients measured by NIH Image J method was smaller than that measured by transparency tracing method and three dimensional human body scanning system BurnCalc (with P values below 0.05). (3) The time for getting information of wounds of patients by transparency tracing method, NIH Image J method, and three dimensional human body scanning system BurnCalc was (77±14), (10±3), and (9±3) s, respectively. The time for getting information of wounds of patients by transparency tracing method was longer than that by NIH Image J method and three dimensional human body scanning system BurnCalc (with P values below 0.05). The time for getting information of wounds of patients by three dimensional human body scanning system BurnCalc was close to that by NIH Image J method (P>0.05). Conclusions The three dimensional human body scanning system BurnCalc is stable and can accurately evaluate the wound area on limbs and torso of burn patients.

The occurrence, development, and prognosis of burn is a complicated pathophysiological process involving many organs and systems. With the development of science and technology and update of treatment concept, more and more new materials, new equipments, and new methods are applied to the diagnosis and treatment of burn. Animals similar to humans in anatomical structure and physiological function are the ideal models for research of burn. Nowadays, animal models of burn have been developed to simulate different aspects of burn. These models provide important essential support for elucidating the pathophysiological mechanism of burns and exploring new therapeutic interventions and materials for human beings. Understanding the advantages and limitations of these animal models is essential for the research of burn.

OBJECTIVETo investigate the characteristics of the intra- and extra-hepatocyte sodium ions distribution in scalded rats during early postburn stage,with the aim of improving burn shock resuscitation regime and the resuscitation effects.

METHODSAdult Sprague-Dawley rats were randomly divided into sham scalding (C, n = 12) and scalding (S, n = 7) groups. The rats in S group were subjected to 40% TBSA III degree scalding on the back and were catheterized via jugular vein for fluid resuscitation. The rats in C group were catheterized via jugular vein without fluid infusion and were sham scalded by warm water in temperature of 37 degrees. The changes in the intra- and extra-hepatocyte sodium ion contents were determined in vivo by (23)Na-magnetic resonance spectrum technology, while the existing state of the intra- and extra-hepatocyte sodium ion was determined by detecting (23)Na-magnetic resonance horizontal delaying time (T(2)).

RESULTSThe extra-hepatocyte sodium content in S group at 24 postburn hours (PBHs) was 17% less than that in C group. In addition, the T(2f) (fast T(2)) in S group remained stable but maintained a higher ratio during the observation time. This suggested that the sodium binding sites in extra-hepatocyte matrix increased relatively and that intra-hepatocyte sodium content increased by 57%. But the T(2) and the fast and slow parts of the T(2) kept stable, which implied that intra-hepatocyte catabolizing products were increased. This led to an increase in the sodium ion binding sites within intra-hepatocyte matrix in proportion to the sodium ion content.

CONCLUSIONDuring early postburn stage, the extra-hepatocyte sodium in a remote organ such as the liver exhibited relative deficiency due to its ingress into hepatocyte cytoplasm and to the increase of sodium combining sites.

Animals ; Binding Sites ; Burns ; metabolism ; Hepatocytes ; metabolism ; Magnetic Resonance Spectroscopy ; Rats ; Rats, Sprague-Dawley ; Sodium ; metabolism

Hyperpigmentation and hypopigmentation are complications commonly seen in burn patients after wound healing, which may have seriously adverse impact on the appearances of the patients. The change of skin color in the exposed areas such as the face and hands may cause great psychological burden on the patients. While the occurrence and development mechanisms of hyperpigmentation and hypopigmentation post burns are unclear, it is generally believed to be associated with excess or deficiency of melanin content in the epidermis. Therefore, the therapeutic strategies of hyperpigmentation or hypopigmentation are as follows: the former focuses on inhibiting the synthesis of melanin and reducing the content of melanin in the skin, while the latter can restore the normal skin color by improving the function of melanocytes to promote the synthesis of melanin. In recent years, the therapeutic technologies for abnormal melanin metabolism after burns have developed rapidly. In this paper, treatment strategies commonly used in clinical practice are summarized in terms of photoelectric therapies, drugs, and operations, aiming to provide references for the treatment of patients who suffer abnormal pigmentation after burns.

Massive burns are catastrophic accidents, usually brings about serious injuries, vast social influence, and great difficulties in treatment. It can impose a big challenge on nursing managers with difficulty in nursing care quality assurance due to a surge of nursing workload within a short period of time and great pressure on nurses. In China, the nursing work mode for dealing with massive burns is to mobilize nursing manpower within the hospital or even outside the hospital by activating the emergency response plan. This mode, however, only ensures the adequacy of nursing staff, but not the professionalism of nursing specialty. In dealing with massive burns, the overseas nursing work mode pays more attentions to scientific transportation of patients, efficient triage, and quality control, which are more systematic and comprehensive. Based on the current status of medical treatment in China and our working experience in the Department of Burn Surgery of the First Affiliated Hospital of Naval Medical University, this article reviewed and discussed the working mode from 2 perspectives, i. e. nursing human resource management and nursing quality control, with an aim to provide a reference for the optimization of the nursing work mode for dealing with mass burns in China.

Objective:To investigate the clinical effects of negative pressure wound therapy (NPWT) in treating the poor healing of incisions after different abdominal operations.Methods:The retrospective observational study was conducted. From June 2019 to December 2020, 42 patients with poor healing of incisions after abdominal surgery were admitted to Center of Burns and Trauma of the First Affiliated Hospital of Naval Medical University, including 29 males and 13 females, aged 23-81 years. The disease course of poor healing of abdominal incision was 3-60 d. The preoperative examination of patients was completed after admission, and NPWT was used after debridement. According to the dehiscence level of incision, the negative pressure value of -10.64 to -6.65 kPa was set. The incisions were sutured in the second stage when the incisions had good blood circulation. The cause of abdominal surgery, the dehiscence level and the cause of poor healing of abdominal incision were investigated, and the final healing of abdominal incision and the occurrence of complication were observed.Results:The causes of abdominal operations in this group of patients who ocurred poor healing of abdominal incisions were ranked according to the composition ratio, with the top 4 causes being colon cancer (9 cases, accounting for 21.4%), bile duct disease (8 cases, accounting for 19.0%), liver cancer (5 cases, accounting for 11.9%), and appendicitis (4 cases, accounting for 9.5%). There were 25 cases (59.5%) with dehiscence of abdominal incision in the deep fascia layer, and the other 17 cases (40.5%) with dehiscence of abdominal incision in the superficial fascia layer. The causes of poor healing of abdominal incision were ranked according to the composition ratio, with the top 3 causes being infection (24 cases, accounting for 57.1%), fat liquefaction (11 cases, accounting for 26.2%), and suture reaction (5 cases, accounting for 11.9%). The blood circulation in 40 patients was improved after being treated with NPWT, and the incisions were sutured in the second stage. The incisions healed well when the suture lines were removed in the second to third week. Intestinal fistula and bile leakage developed during the NPWT treatment, respectively in the other 2 patients, in which negative pressure equipment was removed subsequently, and the incisions healed after adequate drainage and conventional dressing changes.Conclusions:NPWT is effective in treating poor healing of abdominal incision after different abdominal surgeries. The clinicians need to comprehensively assess the patient's condition to determine when and how to use NPWT to avoid the occurrence of intestinal fistula, bile leakage, and other complications.