The present study was performed to evaluate the effects of escharectomy during burn shock stage on energy metabolism of viscera. 88 male Wistar rats were subjected to a 35% total body surface area fullthickness thermal injury. The rats were randomly divided into three groups: control group, escharectomy during burn shock stage group and escharectomy group after burn shock stage. The plasma levels of LPS and TNF ? and the tissue contents of ATP in the heart and liver were seguentially determined at different time points. The results showed that the contents of ATP in the heart and liver decreased rapidly postburn. The contents of ATP in escharectomy group during burn shock stage were significantly higher than that in the other groups ( P

To investigate the changes in the expression of intercellular adhesion molecule 1(ICAM 1) ,tumor necrosis factor ?(TNF ?) mRNA and MPO activity in rat liver after burns and the effects of escharectomy during burn shock stage on the expression of these parameters. One hundred and seventy six Wistar rats with 30% TBSA full thickness thermal injury were used. The mRNA expression of ICAM 1 and TNF ? were detected by reverse transcription polymerase chain reaction(RT PCR) in liver tissues at various intervals after burns with or without escharectomy during shock stage. Both expression of ICAM 1 and TNF ?mRNA in rat liver after burns began to increase at 4h postburn and peaked at 12h and 24h, respectively. Afterwards in groups of escharectomy at 8h and 24h postburn, the expressions of both ICAM 1 and TNF ? increased again, though the expression values were lower than the first peak values, and they returned to normal range at 96h postburn. But in groups of burn control and escharectomy at 96h postburn, their expressions still remained high on 7d postburn. In addition, MPO activity returned to normal levels at 96h postburn in groups with escharectomy during shock stage, while in groups burn control and escharectomy at 96h postburn, a high value of MPO activity persisted till 7d postburn. Our findings suggest that eschar could induce the production of inflammatory mediators such as ICAM 1 and TNF ? which damaged endothelial cells. Therefore, escharectomy as early as possible may play an important role in preventing the expression and release of adhesion molecules and the development of systemsc lnflammatory response syndrome.

Forty-five patients with burn area exceeding 30% TBSA were studied prospectively. Among these 45 patients, 13 developed multiple organ failure (MSOF). Blood superoxide, dismutase (SOD) activity and plasma malondialdehyde (MDA) levels were sequentially determined to assess the role of excessive release of oxygen radicals and lipid peroxidase injury in the mechanism of pathogenesis of postburn MSOF. The results showed that the anti-oxidation capacity of the body was markedly depressed and lipid peroxidase injury markedly increased after a severe burn injury. These changes were not only related to hypovolemic shock after the injury, but also the severity of the burn injury and infection.

Objectives:To investigate the effects of zinc supplements on the nutritional state of gut mucosa after major burns. Methods:Weanling rats were fed zinc deficient chows (zinc content: 1.6 ?g/g) for seven days to induce zinc deficient status. Then 20% TBSA deeper second degree scalds were made and the rats were divided into three groups fed on chows different in zinc contents. Zinc contents were 1.6 ?g/g, 24.7 ?g/g, 286.9 ?g/g respectively. A group of rats fed normal zinc content (24.7 ?g/g) diets before and after scalds was designed as control. Rats were killed on the eighth day after burns and certain sections of jejunum and ileum were resected. Vincristine was injected 6 hours before they were killed, which was supposed to block cell division in metaphase. DNA and protein contents as well as crypt cell production rate (CCPR) were calculated. Results: DNA contents and CCPR of jejunal mucosa were markedly improved in the group of zinc supplements. Protein contents were also improved to some extent. The same trend could be seen in ileac mucosa too. Conclusions: Zinc plays an important role on the nutritional states and proliferation of gut mucosal cells. To supplement zinc after major burns in rats with zinc deficent could help to repair the injured intestinal mucosa.

Objective To investigate a method of repairing complex tissue defects one stage in one finger or several fingers for more fine recipient site repairing and less donor area traum. Methods From August 2007 to August 2010,eight cases of 20 fingers were reconstructed according to the state of complex tissue defects in a hand,second toes (right or left side) were split into two or three parts as complex tissue flaps that may including joints,tendons,skin,nail beds,et al.These flaps then were translated to hand to repair complex tissue defects by anastomosing vessels.Results Twenty fingers in 8 cases were successfully reconstructed.Follow-up ranged from 3 months to 36 months,external appearance were fine.According to the Trial Evaluation Standard of Reconstructed Finger Function of Handsurgery Society of China,sixteen fingers were excellent,three fingers were good,one finger was fine.And there was no effect on foot.Conclusion Spliting single second toe is a good method for repairing more complex tissue defects in a hand.

OBJECTIVETo evaluate the safety and efficacy of topical application of recombinant bovine basic fibroblast growth factor (rbFGF) on the healing of chronic cutaneous wounds.

METHODSTwenty-eight patients with thirty-three chronic cutaneous wounds resulting from trauma, diabetes mellitus, pressure sore and radiation injuries were enrolled in this prospective, open-label crossover trial. Prior to treatment with rbFGF, all wounds failed to heal with conventional therapies within 4 weeks. All wounds were locally treated with rbFGF at a dose of 150 AU/cm(2). Healing time and the quality of wounds were used to evaluate the efficacy of the treatment.

RESULTSHealing of all chronic wounds was expedited. During the study, eighteen wounds completely healed within 2 weeks, four healed within 3 weeks, and another eight completely healed within 4 weeks. Only three wounds failed to heal within 4 weeks, but healed at 30, 40 and 42 days after treatment with rbFGF. Thus, compared with conventional therapies, the effective rate of rbFGF treatment within 4 weeks was 90.9%. Histological assessment showed more abundant capillary sprouts or tubes and that fibroblasts were differentiated in wounds treated with rbFGF. No adverse side effects related to basic fibroblast growth factor were observed.

CONCLUSIONSOur results indicate that rbFGF could be used to accelerate healing in chronic wounds. It is our belief that this may be a more effective method of chronic wound management.

Administration, Topical ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Chronic Disease ; Female ; Fibroblast Growth Factor 2 ; therapeutic use ; Humans ; Male ; Middle Aged ; Recombinant Proteins ; therapeutic use ; Skin ; injuries ; Skin Ulcer ; drug therapy ; Wound Healing ; drug effects

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

Objective To investigate a more pedect method for a nice outward appearance of a reconstructed thumb.Methods A free one-stage plasty second toe transfer for thumb reconstruction by interchanging the whole skin-nail flap from the great toe with another one from the second toe.Results There were 12 cases in this group,following-up 6-9 months in 8 cases,7 cases was excellent and 1 cases was good.The reconstructed thumb got a nice looking and more normal function while no blight to the great toe occurred.Conclusion It is an effective new procedure in ameliorating outward appearance of the reconstructed thumb by transferring the free moulded second toe.

BACKGROUND: Lung transplantation can improve quality of life of patients who get terminal pulmonary disease and also it can help to get better survival.Now it has become one of the best therapeutic methods for terminal pulmonary disease.However,limited donors leave the development of lung transplantation in dilemma.The emergence of living lobar transplantation and cadeveric lobar transplantation let this procedure much easier.OBJECTIVE: To evaluate the clinical probability of bilateral lobar transplantation.METHODS: Sequential bilateral lobar transplantation was performed for one 26 years old cystic fibrosis female.Cardiac pulmonary bypass was used during operation.Anti-rejection(Tacrolimus,mycophenolate,etc)and anti-infection was used postoperatively.RESULTS AND CONCLUSION: The recovery course postoperatively was smooth,and the recipient got out of hospital 7weeks later.Bilateral lobar transplantation could offer satisfied short-term pulmonary function.The long term results should be further evaluated.

The present case report was designed to summarize the clinical experience of operative technique. lung preservation, lung perfusion, and perioperative management. Of 7 cases who underwent allogenic single lung transplantation (LT), 3 were idiopathic pulmonary fibrosis, 2 were chronic obstructive pulmonary disease, 1 was silicosis, emphysema, and bulla, and I was tuberculosis in both sides and presented with destroyed lung in one side. All donors were already brain death. Donor lungs were well preserved utilizing Euro-Colins liquid or low-potassium dextran solution. Donors and recipients were matched in blood type. Of 7 cases selected,5 received single right lung transplantation, and 2 received single left LT. End-to-end anastomosis was performed for pulmonary branches and pulmonary arteries. while atrium-to-atrium anastomosis was performed for pulmonary vein. Antibiotics and immunosuppressants were routinely used prior to and subsequent to LT. Following LT, heart and lung function, usage of antibiotics, and adjustment of immunosuppressant were monitored. Stomal complications regarding bronchus and pulmonary artery and vein did not appear in any patient. Five cases survived for about 2 months, one for approximately 1 year, and one for nearly 2 years. Four cases died of multi-organ failure caused by pulmonary infection, and one of severe pulmonary hemorrhage caused by aspergillus sydowi infection. Rejection occurred in 6 cases. One case sufiered from rejection three times. Selection of indication, selection and preservafton of donor lung, LT operation and pre-and post-operative management of LT have acquired satisfactory achievements. High mortality occurred in patients with preoperative poor cardiac and pulmonary functions and postoperative severe infections accompany with application of immunosuppressant.