Objective To investigate the dynamic features of high-density lipoproteins(HDL) in burn patients and the relationship between the changes and infectious complications.Methods One hundred and twenty patients,aged from 18 to 59 years and admitted within 24 hours of with thermal injury,were involved in present study including mild-moderate,severe and extensive burns groups each of 40 cases.Empty stomach blood samples were drawn on admission and at day 1,2,3,5,7,14 and 21 after burn injury.Serum triglyceride(TG),total cholesterol(TC),high-density lipoproteins(HDL),low-density lipoproteins(LDL),apolipoprotein A1(apoA1) and apolipoprotein B(apoB) were measured in all patients and compared with those of 40 healthy volunteers(control group).The infectious complications and outcome were monitored.Results In 120 patients,a total of 51 identifiable nosocomial infection episodes occurred in 32 patients.Of 6 dead cases,5 were related to infections.The incidence of infection in mild-moderate,severe and extensive burn groups were 7.5%,20.0% and 52.5%,respectively,with statistically significant difference(P0.05) on admission and day 1;from day 2 to day 21,the concentrations of TC,HDL and apoA1 in infection patients were lower than those in non-infection patients(P

To investigate the effective principles of early management in extensively burned patients,162 patients (from 1990 to 1999) with extensive burn were treated according to the following principles: ① prompt and rapid fluid resuscitation during shock stage for delayed resuscitation patients; ② early tracheostomy,air way humidification and lavage for moderate and severe inhalation injury;③ escharectomy and grafting performed during early stage, presenting the experiences of escharectomy during shock stage in grassroot hospitals ; ④ undergoing enteral nutritional support in early stage; ⑤ emphasizing the importance of functional excise in early stage to stress that rehabilitation therapy should be implemented throughout that whole course of treatment. The results showed that the successful rate of treatment was raised and the incidence of complications and disability decreased after implementing the aforementioned treatment principles in extensively burned patients. It is suggested that the application of “Five early Principle” on extensively burned patients is effective and feasible

Objective To investigate the mechanism of mastoparan-1 (MP-1) antagonizing lipopolysaecharide (LPS) in vitro. Methods The affinity of MP-1 for lipid A was assayed by biosensor, and the neutralization of MP-1 on LPS (2 μg/L) was detected by kinetic turbidimetric limulus test. After exposing fluorescin isothiecyanate (FITC) labeled LPS (FITC-LPS) to MP-1 at different concentrations (5, 10, 20, 40 μmol/L), the binding of FITC-LPS to murine RAW264.7 cells was analyzed by laser scanning confocal microscopy. The influence of MP-1 on TLR4 expression in RAW264.7 cells stimulated by LPS (100 μg/L) was detected by immunoeytochemieal staining. The expressions of TLR4, TNF-α and IL-6 at the gene and protein level were detected by RT-PCR and ELISA after exposing LPS (100 μg/ L) stimulated RAW264.7 cells to MP-1 at different concentrations. The effect of MP-1 on the viability of RAW264.7 cells was detected by MTT assay. Results MP-1 had high affinity to lipid A and could neutralize LPS. MP-1 at 10 μmol/L significantly inhibited not only binding of FITC-LPS to RAW264.7 (P < 0.05), but also protein and gene expressions of TLR4, TNF-α and IL-6 in LPS stimulated RAW264.7 cells in a dose-dependent manner (P < 0.05). No toxic effect of MP-1 on the viability of RAW264.7 cells was found (P > 0.05). Conclusions MP-1 inhibits cell viability mediated by LPS, which may be related to its neutralization of LPS and inhibition of binding of LPS to RAW264.7 cell membrane receptors.

Objectives To identify the Francisella strain isolated from blood of a patient with drowning-associated pneumonia.Methods The whole genome of the strain,designated Wenzhou1,was sequenced using the high throughput sequencing technology by 2000/miSeq system of Illumina platform,and the obtained genome draft was assembled by MicrobeTrakr Plus software.The phylogenetic neighbors of Wenzhou1 were obtained by NCBI BLAST analysis from GenBank database for the gene sequences of 16S rRNA,malate dehydrogenase(mdh),DNA-directed RNA polymerase subunit beta (rpoB) and succinate dehydrogenase subunit alpha (sdhA).The average nucleotide identity(ANI) between Wenzhou1 and its phylogenetic neighbors was analyzed by the software OrthoANI using NCBI BLAST search under the Java Runtime Environment Version 8.Results The genome size of Wenzhou1 was 1.96 × 106 bp,containing 74 contigs.The genomic G + C mol％ of Wenzhou1 was 32.1％,which was similar to the other species of genus Francisella and Allofranicella.Based on the analysis of NCBI BLAST of GenBank for the similarities of 16S rRNA gene,mdh gene,rpoB gene and sdbA gene sequences,Wenzhou1 was most closely related to F.hispaniensis FSC454 and Francisella cf.novicida 3523.The ANI of Wenzhou1 was 97.8％ to F.hispaniensis FSC454,97.5％ to 97.6％ to Francisella cf.novicida 3523,but only 91.3％ to 91.5％ to the four subspecies of F.tularensis.Conclusion ANI analysis based on whole genome sequence should be an accurate,effective method for bacterial identification.Wenzhou1 could be identified as F.hispaniensis by ANI with high-throughput whole genome sequencing technology.

OBJECTIVETo explore the effects of fluid resuscitation during the shock stage of mass burn patients.

METHODSEleven major burn patients out of 25 were rescued at spot and were resuscitated. The treatment results were analyzed and concluded.

RESULTSThe eleven patients were all cured by smoothly living through the shock stage.

CONCLUSIONThe approaching of medical personnel to the site might be the guarantee of correct and timely fluid resuscitation during shock stage, which could be effective on the prevention of burn shock development.

Adult ; Burns ; therapy ; Humans ; Resuscitation ; Shock ; therapy

OBJECTIVETo investigate the application of tourniquet in burn patients during tangential excision on the extremities.

METHODSSeventy - nine burn patients who were arranged to receive tangential excision and skin grafting on the extremities were randomly divided into A and B groups. The patients in A group (n = 41) underwent the operation with the tourniquet applied continuously throughout the operation, while those in B group (n = 38), only with tourniquet applied during tangential excision. The amounts of blood loss and blood transfusion, the operation time and the take rate of grafted skin and the incidence of complications were investigated and recorded.

RESULTSThe amounts of blood loss and blood transfusion during operation in A group were 42% and 50% less than those in B group, respectively (P < 0.001). Moreover, the operation time on the upper and lower extremities in A group was much shorter (for 41% and 37%, respectively) than those in B group (P < 0.001). In addition, there was no difference of the take rate of skin graft and the incidence of subcutaneous hematoma between the two groups (P > 0.05).

CONCLUSIONContinuous tourniquet application during tangential excision on the extremities in burn patients was proved to be effective in reducing operational blood loss, blood transfusion and in shortening operation time.

Adult ; Blood Loss, Surgical ; prevention & control ; Blood Transfusion ; Burns ; surgery ; Extremities ; surgery ; Humans ; Skin Transplantation ; Tourniquets

OBJECTIVETo construct an double-layered tube-shaped poly (lactic-co-glycolic acid) (PLGA) scaffold composited with vascular endothelial growth factor (VEGF)/ platelet-derived growth factor (PDGF), and to evaluate in vivo the axial vascularization from femoral arteriovenous bundle encapsulated.

METHODSEighteen male adult New Zealand rabbits were assigned randomly into 3 groups: Experimental group (n = 8), experimental control group (n = 8), empty control group (n=2). The femoral arteriovenous bundle were separated and encapsulated in double-layered tubeshaped PLGA scaffold prepared by solution casting and particle leaching. According to the way of cell factors being composited to the prepared double-layered scaffold: 1) experimental group: VEGF in inner layer and PDGF in outer layer; 2) experimental control group: VEGF in inner layer with blank outer layer; 3) empty control group: Pure blank. Specimens were retrieved at 7, 10, 14, 21 days postoperatively (7, 10 days in empty control group). The histological evaluation was performed.

RESULTSAt 7 days postoperatively, blood vessel sprouts were observed in experimental group and experimental control group, radially from the central femoral arteriovenous bundle. At 10 days postoperatively, completely penetrations of the double-layered scaffold by abundant new generated blood vessel sprouts were observed, and density descended gradiently from inside to outside. At 14 days postoperatively, new blood vessels in experimental group showed more thickness and layered structure of the wall, while monolayer endothelial cells in experimental control group. At 21 days postoperatively, new blood vessels in experimental group showed more mature characteristics, while less density of blood vessels in experimental control group. There was no obvious blood vessel structure in empty control group.

CONCLUSIONThe double-layered tube-shaped PLGA scaffold composited with VEGF/PDGF could induce early angiogenesis.

Animals ; Lactic Acid ; Male ; Polyglycolic Acid ; Rabbits ; Tissue Engineering ; Vascular Endothelial Growth Factor A

Background: Cardiopulmonary resuscitation (CPR) strategies in COVID-19 patients differ from those in patients suffering from cardiogenic cardiac arrest. During CPR, both healthcare and non-healthcare workers who provide resuscitation are at risk of infection. The Working Group for Expert Consensus on Prevention and Cardiopulmonary Resuscitation for Cardiac Arrest in COVID-19 has developed this Chinese Expert Consensus to guide clinical practice of CPR in COVID-19 patients. Main recommendations: 1) A medical team should be assigned to evaluate severe and critical COVID-19 for early monitoring of cardiac-arrest warning signs. 2) Psychological counseling and treatment are highly recommended, since sympathetic and vagal abnormalities induced by psychological stress from the COVID-19 pandemic can induce cardiac arrest. 3) Healthcare workers should wear personal protective equipment (PPE). 4) Mouth-to-mouth ventilation should be avoided on patients suspected of having or diagnosed with COVID-19. 5) Hands-only chest compression and mechanical chest compression are recommended. 6) Tracheal-intubation procedures should be optimized and tracheal-intubation strategies should be implemented early. 7) CPR should be provided for 20-30 min. 8) Various factors should be taken into consideration such as the interests of patients and family members, ethics, transmission risks, and laws and regulations governing infectious disease control. Changes in management: The following changes or modifications to CPR strategy in COVID-19 patients are proposed: 1) Healthcare workers should wear PPE. 2) Hands-only chest compression and mechanical chest compression can be implemented to reduce or avoid the spread of viruses by aerosols. 3) Both the benefits to patients and the risk of infection should be considered. 4) Hhealthcare workers should be fully aware of and trained in CPR strategies and procedures specifically for patients with COVID-19.