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.

Objevtive To study the effect of ubiquitin proteasome pathway inhibition on NF ?B activity and I?B?expression as well as TNF ? secretion in the liver in burned rats with sepsis. Methods Rats were subjected to 30% full thickness scald injury, followed by intraperitoneal injection of lipopolysaccharide (LPS), was used for this experiment to mimic early sepsis after burn. Sixty Wistar rats were randomly divided into normal control group, burn sepsis group, burn sepsis with proteasome inhibitor N Acetyl leucinyl leucinyl norleucinal (ALLN) treatment group, and burn sepsis with NF ?B inhibitor Pyrrolidine Dithiocarbamate (PDTC) treatment group with 6 rats in each group. The following parameters were measured with the method indicated in parentheses: NF ?B activity (electrophoretic mobility shift assay, EMSA), I?B ? expression (Western blotting), and TNF ? (Enzyme linked immunoadsordent assay, ELISA). Results These showed that NF ?B activity was markedly activated and reached its peak 1h after challenge ( P

Objective To investigate the mechanism of changes in skeletal muscle proteolytic rate after escharectomy during early stage of severe burn in rats. Methods One hundred and fifty six Wistar rats were subjected to 30% total body surface area (TBSA) full thickness burn on the back, and they were randomly divided into normal control group (group C), burn injury group (group B), escharectomy during early stage (1 PBD) group (group S)and escharectomy after early stage (4 PBD) group (group N). The extensor digitorium longus (EDL) muscle was collected from each rats using a technique that injury to the muscle was avoided, and the proteolytic rate of EDL was determined after in vitro muscle incubation with sufficient oxygen supply with amino acid automatic analyzer. Transcriptional expression of ubiquitin was assessed by Northern Blot. Results The myofibrillar proteolytic rate (MPR) was markedly increased at each time points after scald, and the MPR in group S was significantly decreased compared with group N. The expression of ubiquitin mRNA markedly increased in the three groups compared with group C, and was decreased in Group S. There was a significant positive correlation between MPR and expression of ubiquitin mRNA. Conclusion Escharectomy during early stage can alleviate protein catabolism in skeletal muscle, and may be related to decreased activity of ubiquitin proteasome pathway

Objective To investigate the influence of different stimulating factors on protein metabolism of rat skeletal muscle. Methods Three kinds of animal models were used in this study as follows: burn injury group (group B, n =40), endotoxin challenge group (group E, n =40), and burn injury followed by endotoxin challenge group (group B+E, n =40). The proteolytic rate of extensor digitorium longus (EDL) muscle was determined by amino acid auto analyzer after incubation in a muscle incubation system. Results The proteolytic rate of EDL muscle of rats was increased markedly in those three groups, especially the myofibrillar proteolytic rate. The protein breakdown of muscle in group E was higher than that of group B, and it was even much higher in group B+E. Conclusions As compared among burn injury, endotoxin challenge and burn injury followed by endotoxin challenge, the change in muscle proteolytic rate is correlated to seriousness of the injuries

OBJECTIVESTo observe the changes in proteolytic rate and the influence of escharectomy and skin-grafting during shock stage on the proteolytic rate of skeletal muscle in severely scalded rats, and to investigate necessity of escharectomy during shock stage.

METHODSWistar rats afflicted with 30%TBSA (total body surface area) full-thickness burn on the back were randomly divided into 3 groups: burn injury group (group B), escharectomy during shock stage group (group S), and escharectomy after shock stage group (group N). Escharectomy and skin-grafting was performed on the postburn day 1 (PBD1) and PBD4 in group S and N. The extensor digitorium longus (EDL) muscle was collected using a technique without injury to the muscle, and the proteolytic rate of the EDL was determined by the in-vitro muscle incubation system with sufficient oxygen supply and amino acid automatic analyzer.

RESULTSThe total proteolytic rate (TPR) in rat EDL muscles increased significantly (t > 2.988, P < 0.01) on PBD1, but no prominent changes were observed at other time points. There were no statistically significant changes in TPR between group S and group N, but the myofibrillar proteolytic rate (MPR) in rat EDL muscles increased markedly at each time point after scald (t > 2.988, P < 0.01). The MPR in group S decreased significantly as compared with that in group N on PBD2, 4, 5 (t = 2.311, P < 0.05; t = 3.054, 3.319, P < 0.01), and the mean values were 3.17, 2.33, 1.75 nmol/wet weight in g/3 h, respectively. No significant changes were observed between group N and S.

CONCLUSIONThe high protein catabolism of skeletal muscle can be alleviated by escharectomy and skin-grafting during shock stage, and it is beneficial to organics.

Animals ; Burns ; metabolism ; surgery ; Disease Models, Animal ; Male ; Muscle, Skeletal ; metabolism ; Peptide Hydrolases ; metabolism ; Rats ; Rats, Wistar ; Shock, Surgical ; Skin Transplantation

Objective:To investigate the characteristics of short-term prognostic factors in very elderly patients with acute coronary syndrome (ACS).Methods:A total of 2 912 ACS patients admitted to Shengjing Hospital of China Medical University from January 1, 2010 to October 31, 2014 and treated with percutaneous coronary intervention (PCI) were enrolled and divided into two groups according to age: very elderly group (≥75 years, 480 cases) and control group (< 75 years, 2 432 cases). The clinical data and coronary artery lesions of the included patients were detected. Major cardiovascular adverse events (MACE) occurred within 30 d after discharge were followed up and recorded. The short-term prognostic factors in very elderly patients with ACS were analyzed by Logistic regression.Results:Compared with control group, the percentage of hypertension, global registry of acute coronary events (GRACE) score, high density lipoprotein cholesterol, N-terminal pro-brain natriuretic peptide, the left main lesion ratio and Gensini score in very elderly group were higher, while the percentage of men, number of smoking, hyperlipidemia proportion, red blood cell count, white blood cell count, blood platelet count, albumin, and long term oral administration of aspirin, clopidogrel, statins, angiotensin receptor inhibitor after discharge were lower, and the differences were statistically significant ( P<0.01 or<0.05). During the follow-up period, the all-cause mortality in very elderly group was higher than that in control group: 2.5%(12/480) vs. 0.9% (21/2 432), and the difference was statistically significant ( P<0.01). Multivariate analysis showed that oral angiotensin converting enzyme inhibitor was a protective factor for elderly ACS patients after discharge ( OR = 0.046, 95% CI 0.006 to 0.383, P = 0.004). The receiver operating characteristic curve analysis showed that Gensini score ≥ 87.75 scores was a threshold value for all-cause mortality. The all-cause mortality ratio in high Gensini score (≥ 87.75 scores) group was higher than that in low Gensini score (<87.75 scores) group: 6.6% (9/137) vs. 0.9% (3/343), and the difference was statistically significant ( P<0.01). Conclusions:Very elderly patients with ACS have their own characteristics from both clinical history and prognostic factors. Patients with Gensini score of ≥ 87.75 scores should be closely observed, and drug treatment during hospitalization should be intensified if necessary. Follow-up should be strengthened for such patients, and oral drug treatment should be continued after discharge.

This paper is to introduce our experiences in treating 2 batches of 13 burn victims transferred from remote areas on postburn days 3 and 4. Methods Thirteen burn victims of 2 mass casualties were transferred to our burns institute from remote areas on postburn days 3 and 4 on June 27, 2001 and June 2, 2002, respectively. There were 4 males and 9 females, age ranged from 20 to 43 years, with a mean age of 31.1±6.2 years. The mean total burn area was 74.3%±24.7% TBSA (range, 25% to 97%). Among them, 10 patients suffered from serious burn with mean total burn area involving 86.0%±11.5% TBSA (range, 60% to 97%), and mean full-thickness burn of 63.9%±26.3% TBSA. Four patients also manifested signs of severe inhalation injury, and 6 patients with moderate inhalation injury. In three patients with mean total burn area covering 35.5%±10.0% TBSA (range, 25% to 45%), with mean full-thickness burn of 15.3%±5.0%, were al having moderate inhalation injuries. Among these 13 patients, 3 were having high body temperature (39℃), while 3 manifested hypothermia. The heart rate was 140-160/min, and respiratory rate 26 to 32/min in 6 patients. Abdominal distension or loss of bowel sound were found in 4 patients. Low white cell and platelet count were found in some patients. In 13 cases, liver function, renal function, myocardiac enzyme, and coagulation function were abnormal. Results Among 13 burn victims, one patient died of myocarditis on postburn day 29, and another one died of hepatic failure (history of chronic hepatitis B) on postburn day 45 with only 2% TBSA of burn wound remained open. Conclusion Burns victims occurred in mass casualties who were transferred from remote areas to our Burns Institute were all in critical condition, usually with multiple complications, demanding most meticulous care. Our strategies in this regard consisted of dispatch of experienced surgeons and nurses to the referring hospitals and the airport to receive the patients to offer appropriate care to them during the journey,organization of the medical staff so that each of them was ordained specific function, thus conditions of the patients were evaluated immediately and appropriate treatment started expeditiously for those lethal complications on arrival. Timely and exact comprehensive treatments were prerequisite to save the patients’ life. Adequate metabolic support should be emphasized, and coagulant of anticoagulant treatment should be carried out when indicated.

OBJECTIVETo explore the effects of recombinant human growth hormone (rhGH) when applied postoperatively on the metabolism of branch chain amino acid in severely burned patients.

METHODSFifty burn patients, aged 12 - 50 years and inflicted by more than 30% TBSA with 10% or more of III degree burn and admitted from the January of 1999 to the January of 2001 were enrolled in the study. The patients were randomly divided into rhGH treating (rhGH group) and control groups. Escharectomy was performed within 3 postburn day (PBDs). rhGH (0.3 IU/kg) was injected percutaneously every evening for ten days since the 1st postoperative day (POD). The changes of the plasma levels of GH and branch chain amino acid and the urine level of 3-methyl histidine (3-MH) were observed in the morning in the patients from the two groups.

RESULTSThe plasma GH level before operation decreased obviously in two groups of patients when comparing with normal value (P < 0.05). The plasma GH level in rhGH group was evidently higher than that in control group since the 3rd POD (P < 0.05). There was significant increase of the output amount of urine 3-MH in all patients, but which was obviously higher in control group than that in rhGH group (P < 0.05). The plasma levels of branch chain amino acid in burn patients before and one day after operation were lower than normal levels. The plasma levels of valine, isoleucine and leucine increased to peak values at POD 3 in rhGH group and at POD 7 in control group and decreased thereafter. The plasma branch chain amino acid level in rhGH group was evidently lower than that in control group since POD 7 (P < 0.05). The plasma GH level in rhGH group was negatively and significantly correlated with the urine output amount of 3-MH (P < 0.01).

CONCLUSIONPostoperative application of rhGH in major burn patients might be beneficial to the protein synthesis from amino acids by skeletal muscles and to the decrease of muscle protein degrading rate.

Adolescent ; Adult ; Amino Acids ; metabolism ; urine ; Burns ; blood ; metabolism ; urine ; Child ; Female ; Human Growth Hormone ; blood ; pharmacology ; Humans ; Male ; Middle Aged ; Muscle, Skeletal ; drug effects ; metabolism ; Recombinant Proteins ; blood ; pharmacology

OBJECTIVESTo observe the effect of recombinant human growth hormone on metabolism in severely burned patients.

METHODSFrom January 1999 to January 2001, 50 patients, aged 12 to 50 years, with over 30% total body surface area (TBSA) and 10% full-thickness burns, were randomized in a double-blind study. In the control group normal saline was used as a placebo (control group), while 0.3 IU/kg(-1) /d(-1) recombinant human growth hormone was given from postoperative day 1 to day 10 in the rhGH group. The excised burn wounds were closed with microautograft and allograft skin. Blood samples were collected at 6:00 am for assaying of growth hormone, blood glucose, blood insulin, anti-insulin antibody, glucagon, cortisol, serum amino acid profile, transferring, proalbumin, total protein, dielectric, and resting energy expenditure (REE) was also measured.

RESULTSThe concentration of blood GH in both groups was lower (t = 2.806, P < 0.05) than that of physiological values before surgery. However, the concentration of GH on POD 3 in the rhGH group was significantly higher than that of normal values, but a higher level was observed on POD 7 in the rhGH group than that of the control group (t = 3.142, P < 0.05). Although the concentration of anti-insulin antibody was slightly increased, there was no significant difference between the two groups. The concentration of glucagons tended to decrease with an increase in the concentration of blood glucose, and it was marked in the rhGH group. There was no significant difference between the two groups. The concentration of cortisol was higher than normal values, but no significant difference was observed between the two groups. With the administration of rhGH, the plasma concentration of amino acids was lower than that of the control group (t = 2.714, P < 0.05), and the urinary output of 3-MH in the rhGH group was lower than that of the control group (t = 2.207, P < 0.05).

CONCLUSIONSAdministration of rhGH in patients with major burn after surgery could improve their metabolic status, namely, increased lipolysis energy, accelerated protein synthesis, accelerated gluconeogenesis, reduced muscle proteolytic rate, and reduced REE expenditure. There is no effect on stress hormone. rhGH exerts a beneficial effect on metabolism in severely burned patients, but hyperglycemia is apt to occur, and water, Na(+), Cl(-) retention are suggested.

Adolescent ; Adult ; Amino Acids ; blood ; Burns ; blood ; drug therapy ; surgery ; Child ; Female ; Growth Hormone ; therapeutic use ; Human Growth Hormone ; genetics ; therapeutic use ; Humans ; Insulin ; blood ; Male ; Middle Aged ; Recombinant Proteins ; therapeutic use ; Sodium Chloride ; blood