Animals ; Burns ; complications ; Cicatrix ; etiology ; physiopathology ; Fetus ; physiopathology ; Humans ; Wound Healing

Parkland formula is the most widely used resuscitation formula in burn care. However, a growing number of disputes have been raised along with the development of medical technology, among which its total volume and composition of the fluid are the two foci. Firstly, Parkland formula may lead to an untoward phenomenon nicknamed "fluid creep", which may lead to complications such as abdominal compartment syndrome. Secondly, along with the deeper understanding of how permeability of blood vessels changes after burn injury, colloid is recommended to be given after the third 8 h post-burn. Additionally, controversy exists in the choice of different colloid solutions. The safety of different colloid solutions remains to be further elucidated. This article will deal with all of the above-mentioned problems.
Burns ; physiopathology ; therapy ; Fluid Therapy ; methods ; Humans ; Isotonic Solutions ; therapeutic use ; Resuscitation ; methods ; Treatment Outcome

OBJECTIVE To analyze the changes in bacteria constitution in severe burn wounds in different stages so as to provide reference for clinical prevention and treatment.METHODS A total of 36 casualties with severe burn injuries(≥50.0% total burn surface area) and hospitalized within 5 days post-burns from 2004 to 2006 were enrolled in the study.Samples were collected in the burn wounds from the first day to two months post-burns.RESULTS Totally 476 bacterial strains were isolated and Gram-negative bacteria accounted for 64.1%.However,in term of the single bacterial strain,Staphylococcus aureus(SAU) ranked first and the follows were Pseudomonas aeruginosa(PAE) and Acinetobacter baumannii(ABA).During the first week and the six weeks to 2 months post-burns,Gram-positive bacteria were dominant and SAU ranked first.From the second week to the fifth week,Gram-negative bacteria were dominant,PAE and ABA were the main bacteria.Even though Gram-negative bacteria dominated in these periods,SAU still ranked the first or the second in terms of single bacterial strain.CONCLUSIONS Bacteria constitution in burn wounds differs in different stages.It must be stressed to prevent infections of SAU regardless of any stages,as well as ABA infections since the percentage of ABA has increased markedly in recent years.

The present article summarized briefly the experiences and lessons learned in the management of mass burn casualties,and also gave a brief account of the present status of the system of emergency care of mass casualties in our country.The authors proposed herewith an organizational system conforming to the status quo of our country.It was suggested that through learning from attending seminars and training in specialty centers,devotion to intensive research of relevant problems and constant interchange of experiences and ideas,the ability of professional staff to meet the needs of urgent and heavy duty could be raised in salvaging mass casualties both in peace time and war.

In recent years, negative pressure wound therapy (NPWT) technique has been widely used in burn surgery, including wound repair, skin grafting, and cosmetic procedures, showing promising clinical results. Based on the literature and clinical experience, the mechanism of NPWT and its clinical application in burn surgery are briefly iterated herewith.
Burns ; surgery ; Humans ; Negative-Pressure Wound Therapy ; Skin ; Skin Transplantation ; Wound Healing

It is well known that in patients with severe burn, especially when complicated by sepsis, the breakdown of body proteins is acceleraled, producing a hypercalabolic response. Negative nitrogen balance and malnutrition will develop rapidly, predisposing to various complications. High calori intake and enhancement of anabolic process might fail to improve the patient′s nutritional condition. A skeletal muscles account for over 50% of body cell dry weight, their catabolism exerts profound effect on whole body metabolism. By using modern molecular biology techniques, one of the mechanisms underlying skeletal muscle proteolysis is shown to be activation of the ubiquitin proteasome pathway. The role of its possible modulating factors in inducing muscle protein breakdown after burn injury was explored in rat models of burn injury with or without sepsis. Muscle spesimens obtained from severely burned patient with sepsis was also collected for study.The results were as follows. (1)The total and myofibrillar proteolytic rate in extensor digitorum longus (EDL) muscle was increased markedly, especially the expressions of ubiquitin, and mRNA of subunit RC2(the largest subunit of 20s proteasome) were prominantly increased in EDL muscle. There was a significant positive correlation between the proteolytic rate and the expression of mRNA of ubiquitin, or mRNA of subunit RC2, after the stimulation of burn injury. On the other hand, there was no significant change in proteolytic rate and transcription of ubiquitin in soleus (SOL) muscle. (2)The myofibrillar proteolytic rate and the ubiquitin proteasome component were significantly enhanced in rats with sepsis compared with control group. There were significant positive correlations among plasma concentration of endotoxin, TNF ?, cortisol and respective values of myofibrillar proteolytic rate, and ubiquitin proteasome component. (3)There were significant positive correlations between the urinary output of 3 methylhistidine (3 MH)in 24h urine and respective values of plasma concentration of cortisol, TNF ?, and endotoxin in severely burned patients with sepsis. The expressions of ubiquitin mRNA 2 4 kilobase pair (?B), 1.2kb, C 2 subunit mRNA and the protein expressions of ubiquitin in quadriceps femoris muscle were significantly increased compared with the control group. (4)Muscle proteolytic rate was markedly enhanced when myotube was cultured with TNF ?. However, by using the ubiquitin proteasome inhibitor mG132, significant decrease in the muscle proteolyitc rate was observed. (5)Glucocorticoid could increase the skeletal muscle proteolytic rate, especially the myofibrillar proteolytic rate, through activating the ubiquitin proteasome system at gene level. However, this effect could be greatly bluned by glucocorticoid receptor antagonist RU38486. (6)NF ?B activity in skeletal muscle of burned rat with sepsis was markedly increased. However, by using inhibitor of NF ?B, the NF ?B activity was down regwlated in the muscle, and a decrease in the total and myofibrillar proteolytic rate was observed. (7)Decrease in transcriptional expression of ubiquitin and reduction in the skeletal muscle proteolytic rate were found when escharectomy was performed during early stage of burn injury. The results suggested that the treatment strategies for prevention of skeletal muscle proteolysis of postburn sepsis should firstly be aimed at eradication of devitalized tissues, i.e. prevention of sepsis by reonoval of the primary injury. Secondly, attention should be paid to modulating or controlling the process of ubiquitin proteasome pathway in response to burn injury, and this might provide an effective way to reduce skeletal muscle protein wasting by specifically inhibiting the specific enzymes or subunits involved in the enhancement of the activity of ubiquitin proteasome pathway after burn injury. However, more studies in the ubiquitin proteasome proteolytic pathway in severe burn injury are necessary to confirm this assertion.

To study the effects of TNF ? on the protein metabolism and the ubiquitin system gene expression in isolated skeletal muscles, after dissecting and isolating the extensor digitorium longus (EDL) muscles, the in vitro oxygen rich muscle incubation system and as high performance liquid chromatography were used to assess proteolytic rate of the samples. The EDL muscles in study group were incubated with media containing 6 000 U/ml recombinant rat TNF ?. In control group, the media were of the same composition as that of the study group except recombinant rat TNF ?. The expressions of ubiquitin mRNA and C 2 mRNA in rat EDL muscles were determined by Northern blot analysis. No notable difference was observed in the total and myofibrillar proteolytic rate in EDL muscles between the two groups. The expressions of ubiquitin mRNA(2 4kb) and C2 mRNA of EDL muscle incubated with medium containing TNF ? were increased by 151% and 56%, respectively, as compared with those in control group. TNF ? could directly strengthen the function of ubiquitin dependent proteolytic system, but further studies are necessay to elucidate whether TNF ? could directly increase the proteolytic rate in skeletal muscle.

To determine the effect of recombinant human growth hormone (rhGH) on postburn hypermetabolism postburn, sixteen male minipigs were inflicted with 35% TBSA full thickness burns, and the burned minipigs were then randomly divided into two groups: rhGH group and control group. REEs were monitored by means of Cardiorespiratory Diagnostic Systems (Medical Graphics Corporation, USA). The sequential changes in serum levels of GH, IGF 1,insulin,glucagon,cortisol,albumin were analyzed. The level of REE is significantly lower in rhGH treated groupas as compared with that of control, while the serum concentrations of GH, IGF 1, albumin are higher in the former, Body weighf gain is observed in rhGH treated group with no significant effect on serum concentration of insulin,glucagon and cortisol. RhGH therapy is thus helpful in the control of hypermetabolism after extensive burn.

To observe the changes in proteolytic rate of different kinds of skeletal muscle and the content of serum glucocorticoid in rats after burn injury,to compare the response of different types of skeletal muscle to burn injury,and to preliminarily investigate the factors modulating skeletal muscle proteolysis after burn injury, Wistar rats were inflicted 30%TBSA(total body surface area) full-thickness burn. The rats were randomly divided into 4 groups as the following: 2h, 6h, 12h and 24h after burn injury, each time point was matched with a sham control group. In-vitro muscle incubation system with sufficient oxygen supply as well as amino acid automatic analyzer were used for the assessment of the proteolytic rate of extensor digitorium longus(EDL) and soleus(SOL)muscles. The level of serum glucocorticoid was determined with radio-immuno assay. The result indicated that total proteolytic rate and myofibrillar proteolytic rate in EDL muscle increased strikingly at each time point after burn injury, and the rise of myofibrillar proteolytic rate was even greater in magnitude. No statistically significant difference in total and myofibrillar proteolytic rate occurred in SOL muscle during postburn period. Serum glucocorticoid notably increased in each observation time point compared with that of normal control( P

To study the regularity of ubiquitin and ubiquitinated protein expression in rat skeletal muscle after burn injury, the molecular mechanism of skeletal muscle protein catabolism was investigated. Wistar rats were inflicted on a 30% full thickness burn. They were grouped according to the time of sacrifice :2, 6, 12 and 24 hours after burn, each group included normal control. The extensor digitorium logus (EDL) muscle was taken to assay the proteolytic rate and the expression of ubiquitin and ubiquitinated protein during postburn period. It was found that proteolytic rate of EDL muscle was markedly enhanced, especially in myofibrillar proteolytic rate, by 185% and 153% at 12h and 24h after burn injury, respectively. The contents of free ubiquitin and ubiquitinated protein in rat EDL muscle were significantly increased after burn injury, especially at 12 and 24 hour. The contents of free ubiquitin and ubiquitinated protein increased 33% and 186% at 12h postburn, increased 30% and 163% at 24h,respectively. The high protein catabolism of skeletal muscle during postburn stage is in close relation to high expression of free ubiquitin and ubiquitinated protein.