Burns ; complications ; diagnosis ; prevention & control ; Humans ; Sepsis ; diagnosis ; etiology ; prevention & control

Most of the major advances in the prevention and treatment of burn sepsis and MODS have been made within the last 20 years. Improvements have been made in gaining a better understanding of the pathophysiology of burn sepsis and MODS, in revising the definition of sepsis and MODS, and in prevention and treatment of burn shock. Additionally, improvements have been made in fluid resuscitation in patients with burn shock and in early gastrointestinal feeding to prevent translocation of endotoxins from the gut. Other achievements have been made in using recombinant human growth hormone combined with intensive insulin therapy to control hyperglycemia, and potassium chloride to prevent hypokalemia in order to accelerate protein synthesis. Additional advances include early closure and coverage of the burn wound, rational use of antibiotics, immunological modulation to combat immunological dissonance. Also, advances have been made by using early anticoagulation treatment to prevent coagulopathy. In prevention and treatment of burn sepsis and MODS, comprehensive support for all organs during the course of treatment is emphasized. Although the advances in burn treatment have been extremely encouraging over the last 50 years, burn sepsis and MODS remain the most common cause of mortality in the critical ill. To cope with extreme environmental conditions, such as armed conflict and natural disasters, research is needed to optimize the oral resuscitation regime, and more efficacious treatment strategies that are based on an indepth understanding of the pathogenesis of sepsis.
Burns ; complications ; metabolism ; Humans ; Multiple Organ Failure ; etiology ; prevention & control ; Sepsis ; etiology ; prevention & control

Abdominal Neoplasms ; complications ; metabolism ; pathology ; surgery ; Adult ; Dendritic Cell Sarcoma, Follicular ; complications ; metabolism ; pathology ; surgery ; Diagnosis, Differential ; Female ; Humans ; Ki-1 Antigen ; metabolism ; Leukocytosis ; complications ; metabolism ; pathology ; surgery ; Receptors, Complement 3b ; metabolism ; Receptors, Complement 3d ; metabolism ; Young Adult

OBJECTIVETo investigate the protective effects of adiponectin on myocardial ischemia-reperfusion injury and the potential mechanisms in rats.

METHODSThirty-two male rats aged 8 weeks were randomly assigned to sham operation (sham), myocardial ischemia-reperfusion (MIR), diltiazem treatment (diltiazem) or adiponectin administration (APN) groups (n = 8 each). MIR rats underwent left anterior descending artery (LAD) occlusion for 30 min followed by 60 min reperfusion. Diltiazem (7 microg/g) and APN (120 ng/g) were given by caudal intravenous injection at the end of 30 min ischemia and the beginning of reperfusion for rats in diltiazem or APN groups. Animals were sacrificed after 60 min reperfusion for determining the myocardial nitric oxide (NO), Caspase 3, activity of AMP-activated protein kinase(AMPK) and concentration of peroxisome proliferators-activated receptor gamma (PPARgamma). Apoptotic cells were stained by Caspase 3 Activity Assay Kit and mitochondria in myocardial cells were observed by transmission electron microscope (TEM).

RESULTSThe myocardial Caspase 3 level was significantly increased [(168.50 +/- 30.08) micromol/L vs. (53.25 +/- 11.41) micromol/L, P < 0.01], AMPK activity, PPARgamma and NO concentrations were significantly reduced in MIR group compared with those in sham group (all P < 0.05) [(0.74 +/- 0.59) IU/ml vs. (25.63 +/- 4.61) IU/ml, P < 0.01; 0.1894 vs. 0.7949, P < 0.01; (6.359 +/- 1.355) micromol/L vs. (10.396 +/- 1.901) micromol/L, P < 0.01], these effects could be significantly reversed by APN. In comparison with MIR group, the levels of Caspase 3 in cardiac muscles were significantly lowered in Adiponectin group [(88.75 +/- 6.92) micromol/L vs. (168.50 +/- 30.08) micromol/L, P < 0.01], whereas the level of AMPK and PPARgamma, NO concentration in the cardiac muscle was remarkably increased [(27.22 +/- 4.76) IU/ml vs. (0.74 +/- 0.59) IU/ml, P < 0.01; 0.8613 vs. 0.1894, P < 0.01; (15.755 +/- 1.045) micromol/L vs. (6.359 +/- 1.355) micromol/L, P < 0.01]. APN also preserved the function and structure of mitochondria in rats post ischemia/reperfusion injury. The protective pharmacologic actions of APN were superior to that of diltiazem.

CONCLUSIONAdiponectin could protect myocardial tissues from myocardial ischemia-reperfusion injury in rats, possibly by upregulating myocardial AMPK and PPARgamma expressions and preventing myocardial cells from apoptosis.

AMP-Activated Protein Kinases ; metabolism ; Adiponectin ; pharmacology ; Animals ; Apoptosis ; drug effects ; Caspase 3 ; metabolism ; Diltiazem ; pharmacology ; Male ; Myocardial Reperfusion Injury ; metabolism ; prevention & control ; Myocardium ; metabolism ; Nitric Oxide ; metabolism ; PPAR gamma ; metabolism ; Rats ; Rats, Sprague-Dawley

Prevention and treatment of infection in burn patients involve a wide range of issues. This present article is to introduce only briefly clinical experience focusing on this problem. Among them, satisfactory timely prevention and treatment of burn shock is imperative because it exerts tremendous impact on homeostasis, including especially deterioration of immune functions. Early gastro-intestinal feeding is known to help restore gastro-intestinal circulation after shock, and it is an important avenue to give important nutritional elements like glutamine. It is also very important to excise devitalized tissue, followed by total coverage of all open wounds as early as possible, so that nidus of infection is removed. Rational use of antibiotic, immunological modulation and other measured were also important contributory factors in successfully preventing and treating infection in patients with major burns.
Burns ; microbiology ; Humans ; Infection Control

OBJECTIVETo study the effect of extract of Ginkgo biloba (Egb761) on doxorubicin-associated cardiotoxicity in patients with breast cancer (BC).

METHODSSixty BC patients in stage IV were randomly assigned to two groups, the control group was treated with chemotherapy, using 4 cycles of PA protocol alone and the treated group with the same chemotherapy and Egb761. Changes in electrocardiogram (ECG), myocardial enzyme spectrum (MES) and ultrasono-cardiogram (USCG) before and after treatment were observed.

RESULTSAfter treatment, the incidence of abnormal ECG was lower in the treated group than in the control group (6.7% vs 30.0%); significant differences were found between the two groups in the parameters of MES (P< 0.05); USCG showed significant difference between the two groups in left ventricular diastolic diameter (LVDd), left ventricular systolic diameter (LVDs), ratio of early and late diastolic transmitral peak flow velocity (E/A) and fractional shortening (FS), while there was no significant difference in ejection fraction (EF).

CONCLUSIONEgb761 is an ideal drug for preventing and reducing the acute doxorbincin-induced cardiotoxicity; it could also be helpful for alleviating the chronic cardiotoxicity.

Adult ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Breast Neoplasms ; drug therapy ; Carcinoma, Ductal, Breast ; drug therapy ; Cardiomyopathies ; chemically induced ; physiopathology ; prevention & control ; Doxorubicin ; administration & dosage ; adverse effects ; Female ; Ginkgo biloba ; chemistry ; Humans ; Middle Aged ; Phytotherapy ; Plant Extracts ; therapeutic use ; Treatment Outcome ; Ventricular Dysfunction, Left ; physiopathology ; prevention & control

OBJECTIVETo investigate the expression of uncoupling protein (UCP)-2, 3 mRNA in skeletal muscle of the scalded rats after escharectomy at different post scalding stages.

METHODSOne hundred and twenty Wistar rats were employed in the study, in which 8 served as normal control (C) and 112 were subjected to 30% TBSA 3rd degree scalding and then again, divided into 4 groups. The rats in A group were sacrificed on 8th, 24th, 96th, 120th and 168th post scalding hours (PSHs) without escharectomy. The rats in B group underwent escharectomy at 8 PSH, and those in C group underwent escharectomy at 24 PSH. All the rats in both groups were sacrificed on 96, 120 and 168 PSHs after escharectomy, Escharectomy was performed at 96 PSH in rats of D group, and they were sacrificed on 120 and 168 PSHs after escharectomy. The serum levels of leptin and TNFalpha, and the expression level of UCP2 mRNA were determined at all time points in all groups of rats.

RESULTS(1) The serum levels of leptin in A group were obviously lower than that in C group (P < 0.01) during 24 approximately 168 PSHs, while those in B, C and D groups were much higher than those in A group (P < 0.01) during 24 approximately 168 PSH. (2) The serum TNFalpha levels in A group at all time points were higher than that in control group, while that in B group at all time points were lower than that in A group (P < 0.05 or 0.01), and that in C group at 168 PSH was lower than that in A group (P < 0.05). (3) The UCP2 mRNA expression in skeletal muscle in A group was increased evidently since 8 PSH (P < 0.01), peaking at 24 PSH and lowering thereafter, while that in B and C groups at 168PSH was significantly lower than that in A group at the same time points (0.32 and 0.35 vs 0.71, P < 0.05). The trend of the change in UCP3 mRNA expression in skeletal muscle was similar to that of UCP2.

CONCLUSIONThe postburn up-regulation of UCP mRNA expression might play important roles in the increase of metabolic rate. Escharectomy during shock stage could lower down the expression of UCP2 and UCP3 mRNA expression, and it could be beneficial by lowering metabolic rate.

Animals ; Burns ; metabolism ; surgery ; Cicatrix ; metabolism ; surgery ; Ion Channels ; metabolism ; Male ; Mitochondrial Proteins ; metabolism ; Muscle, Skeletal ; metabolism ; RNA, Messenger ; metabolism ; Rats ; Rats, Wistar ; Time Factors ; Uncoupling Protein 2 ; Uncoupling Protein 3

Sepsis and septic shock as a result of an invasive infection are challenging problems in extensively burned patients, and frequently end in multiple organ dysfunction syndrome (MODS). It is of great significance to further elucidate the pathogenetic mechanisms, and to seek novel intervention strategies to prevent and treat sepsis/MODS secondary to severe burns. A more complete understanding of the pathogenetic mechanisms of postburn sepsis would certainly elicit a number of potential therapeutic strategies for it. It is our belief that comprehensive clinical measures for management of severe sepsis should include rapid, adequate fluid resuscitation for burn shock, early feeding, effective control of infection, early escharectomy, and reinforcement of organ support. Once burn wound sepsis occurs, prompt removal of infected necrotic tissue is the key procedure to ensure a successful result. Further study is necessary to determine the precise mechanisms of these protective effects and the clinical advantages for postburn sepsis using evidence-based methodology system.
Burns ; complications ; Humans ; Sepsis ; epidemiology ; etiology ; prevention & control

To investigate and compare the expression of intercellular adhesion molecule-1 (ICAM-1) in different organs of the mice with endotoxic shock induced by lipopolysaccharide (LPS), protein and mRNA of ICAM-1 were measured by Western blotting and RT-PCR respectively in different organs of BALB/c mice administered intraperitoneally with 5 mg/kg LPS. The results showed that the constitutive expression of ICAM-1 protein and mRNA was the greatest in the lungs, followed by the spleen, kidney and intestine. After LPS stimulation, the upregulation of ICAM-1 was still greatest in the lungs, followed by the liver, spleen, heart, kidney and intestine. Compared with the normal mice, the expression of ICAM-1 protein in endotoxic shocked mice increased by 4.5-fold in the lungs, 3.0-fold in the kidney, 1.5-fold in the spleen; the expression in the liver and heart was negative under normal condition and changed into positive during endotoxic shock; but ICAM-1 expression in the intestine did not change significantly. The expression of ICAM-1 mRNA also increased consistently. These data highlight that LPS can up-regulate ICAM-1 protein and mRNA expression in different tissues of the mice with endotoxic shock. The difference in ICAM-1 expression among the organs may lead to different sensitivity of organ damage in endotoxic shock. This suggests that inhibition of ICAM-1 expression may be a useful principle for prevention and treatment of endotoxic shock.
Animals ; Intercellular Adhesion Molecule-1 ; biosynthesis ; Kidney ; metabolism ; Lipopolysaccharides ; Lung ; metabolism ; Male ; Mice ; Mice, Inbred BALB C ; RNA, Messenger ; biosynthesis ; Shock, Septic ; chemically induced ; metabolism

OBJECTIVETo study the effects of insulin on the proteolysis of cultured rabbit skeletal muscular myotubes in vitro, and their possible mechanisms.

METHODSMuscles of lower limbs of juvenile rabbits were isolated for tissue-block culture. After passage, myoblasts were formed and fused into myotubes. Then the protein in myotubes was radiolabelled with L-[ 3,5-3H] tyrosine. The myotubes were cultured in DMEM medium containing 100 nmol/L insulin (n = 24, group B) , 100 nmol/L dexamethasone (n = 24, group C) , 100 nmol/L insulin and 100 nmol/L dexamethasone (n = 24, group D) , no insulin or dexamethasone (n =24, group A), respectively. Twenty-four hours after culture, the L-[3,5-3H] tyrosine content in culture medium and cells were determined, and the degradation rates of protein were calculated. The mRNA expressions of ubiquitin and protease C2 subunit were determined by Northern blot.

RESULTSThe degradation rates of myotube protein in group A(0. 38+/-0.04) was obviously lower than that in group C (0.50+/-0.03, P <0.01), but it was obviously higher than that in group B(0. 35+/-0.03, P <0.05). Though the degradation rates of myotube protein in group D (0.41+/-0. 03) was evidently lower than that in group C ( P < 0.01) , it was still higher than that in group A( P < 0.05 ). The mRNA expressions of ubiquitin and protease C2 subunit in group A ( the scale: 2. 4 kb ubiquitin was 0. 82+/-0. 15, 1. 2 kb ubiquitin was 0. 60+/-0. 10, C2 subunit was 0. 75+/-0. 16) was obviously lower than that in group C ( the scale: 2.4 kb ubiquitin was 2. 15+/-0. 23, 1.2 kb ubiquitin was 1.50+/-0. 14,C2 subunit was 1.50+/-0. 13 , P <0. 01) , but it in group D was lower than that in group C (the scale: 2. 4 kb ubiquitin was 1. 25+/-0. 17, 1. 2 kb ubiquitin was 0. 85+/-0. 09, C2 subunit was 0. 90+/-0. 15, P <0. 01) , and it was similar to that in group B (the scale: 2.4 kb ubiquitin was 0. 85+/-0.07, 1.2 kb ubiquitin was 0. 65+/- 0. 12, C2 subunit was 0. 76 +/-0. 09, P > 0. 05).

CONCLUSIONThe effects of insulin on the activity of ubiquitin-proteasome pathway and the proteolytic rate in normal myotubes were relatively weak. However, insulin can significantly inhibit the effects of dexamethasone on the gene expressions of ubiquitin system and the proteolytic rate in myotubes, but the mechanism needs further research.

Animals ; Cells, Cultured ; In Vitro Techniques ; Insulin ; pharmacology ; Male ; Muscle Fibers, Skeletal ; drug effects ; metabolism ; Muscle Proteins ; metabolism ; Rabbits ; Ubiquitin ; metabolism