Analysis of clinical features and treatment of pyoderma gangrenosum / 中华烧伤杂志

Objective: To explore the clinical features and treatment of pyoderma gangrenosum (PG). Methods: A retrospective observational study was conducted. From January 2012 to July 2021, 25 patients with PG who met the inclusion criteria were admitted to Beijing Fucheng Hospital, including 16 males and 9 females, with the age of onset of disease being 14 to 75 years. Among them, the classification of PG identified 17 cases of ulcerative type, 6 cases of pustular type, 1 case of proliferative type, and 1 case of bullous type. Six patients were accompanied with systemic diseases, while 19 patients were not accompanied with systemic diseases. At the same time of systemic treatment with glucocorticoids, dressing changes or surgical skin grafting was performed on the wounds. The results of laboratory and histopathological examinations, the overall curative effects and follow-up of patients, the wound healing time of patients with negative and positive microbial culture results of wound secretion specimens, and the curative effects of patients with and without systemic diseases were analyzed. Results: The results of blood routine examination of 19 patients were abnormal, and all the immunological indexes were normal in all the patients; the microbial culture results of wound secretion specimens were positive in 14 patients; and the histopathological examination results of ulcer boundary tissue in 15 patients with rapid wound progress were mainly local tissue inflammatory changes. The wounds were cured in 17 patients, mostly healed in 7 patients, and not healed in 1 patient. After one-year's follow-up, the PG in 3 patients relapsed due to self-discontinuation of medication after discharge, and the wounds were healed gradually after adjustment of medication, while the remaining patients had no relapse. The days of wound healing in 14 patients with positive microbial culture results of wound secretion specimens were 21-55 days, and the days of wound healing in 11 patients with negative microbial culture results in wound secretion specimens were 20-54 days. In the 6 patients with systemic diseases, the wounds of 3 patients were cured, and the wounds of the other 3 patients were mostly healed. In the 19 patients without systemic diseases, the wounds of 14 patients were cured, the wounds of 4 patients were mostly healed, and the wound of 1 patient was not healed. Conclusions: The laboratory examination and pathological manifestations of patients with PG lacks characteristics, and their clinical manifestations are rich and diverse, thus PG can be easily misdiagnosed. The glucocorticoids combined with immunosuppressive therapy have good effects on PG. Surgical intervention can be performed on the wounds. Specifically, excessive debridement is not recommended in the acute phase, but skin grafting can be performed in the contraction phase.

Treatment strategies for mass burn casualties / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Mass burn casualties are always a great challenge to a medical team because a large number of seriously injured patients were sent in within a short time. Usually a high mortality is impending. Experiences gained from successful treatment of the victims may be useful in guiding the care of mass casualties in an armed conflict.</p><p><b>METHODS</b>Thirty-five burn victims in a single batch, being transferred nonstop by air and highway from a distant province, were admitted 48 hours post-injury. All patients were male with a mean age of (22.4 +/- 8.7) years. The burn extent ranged from 4% to 75% ((13.6 +/- 12.9)%) total body surface area. Among them, thirty-two patients were complicated by moderate and severe inhalation injury, and tracheostomy had been performed in 15 patients. Decompression incisions of burn eschar on extremities were done in 17 cases before transportation. All the thirty-five patients arrived at the destination smoothly via 4-hour airlift and road transportation. Among them, twenty-five patients were in critical condition.</p><p><b>RESULTS</b>These thirty-five patients were evacuated 6 hours from the scene of the injury, and they were transferred to a local hospital for primary emergency care. The patients were in very poor condition when admitted to our hospital because of the severe injury with delayed and inadequate treatment. Examination of these patients at admission showed that one patient was suffering from sepsis and multiple organ dysfunction syndrome. Dysfunction of the heart, lung, liver, kidney, and coagulation were all found in the patients. Forty-eight operations were performed in the 23 patients during one month together with comprehensive treatment, and the function of various organs was ameliorated after appropriate treatment. All the 35 patients survived.</p><p><b>CONCLUSIONS</b>A well-organized team consisting of several cooperative groups with specified duties is very important. As a whole, the treatment protocol should be individualized, basing on the extent of the injury and the care that the patient had received at the spot. During airlift, the stretchers should be arranged perpendicular to the longitudinal axis of the cabin. The treatment protocol in our hospital consisted mainly of prompt effective relief of all life-threatening complications, followed by early closure of burn wounds, appropriate use of anti-infection therapy, emphasis on nutritional support, correction of metabolic disorders, alleviation of immunosuppression, correction of coagulopathy, and effective support and protection of organ function.</p>

Characteristics of and strategies for patients with severe burn-blast combined injury / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Severe burn-blast combined injury is a great challenge to medical teams for its high mortality. The aim of this study was to elucidate the clinical characteristics of the injury and to present our clinical experiences on the treatment of such cases.</p><p><b>METHODS</b>Five patients with severe burn-blast combined injuries were admitted to our hospital 77 hours post-injury on June 7, 2005. The burn extent ranged from 80% to 97% (89.6% +/- 7.2%) of TBSA (full-thickness burns 75% - 92% (83.4% +/- 7.3%)). All the patients were diagnosed as having blast injury and moderate or severe inhalation injury. Functions of the heart, liver, kidney, lung, pancreas and coagulation were observed. Autopsy samples of the heart, liver, and lungs were taken from the deceased. Comprehensive measures were taken during the treatment, including protection of organ dys function, use of antibiotics, early anticoagulant treatment, early closure of burn wounds, etc. All the data were analyzed statistically with t test.</p><p><b>RESULTS</b>One patient died of septic shock 23 hours after admission (four days after injury), the others survived. Dysfunction of the heart, liver, lungs, pancreas, and coagulation were found in all the patients on admission, and the functions were ameliorated after appropriate treatments.</p><p><b>CONCLUSIONS</b>Burn-blast combined injury may cause multiple organ dysfunctions, especially coagulopathy. Proper judgment of patients' condition, energetic anticoagulant treatment, early closure of burn wounds, rational use of antibiotics, nutritional support, intensive insulin treatment, timely and effective support and protection of organ function are the most important contributory factors in successful treatment of burn-blast combined injuries.</p>

Changes in the expression of rat hepatic lipid metabolism related genes in response to burn wound sepsis as assessed by DNA arrays / 中华烧伤杂志

<p><b>OBJECTIVE</b>To examine the expression profile of lipid metabolism-related genes in liver of scalded rats with wound sepsis, and to analyze its significance.</p><p><b>METHODS</b>Sixty male Wistar rats with 30% TBSA full-thickness scald wound on the back were enrolled in the study and randomly divided into wound sepsis group (n = 30) and control group (n = 30, with scald). Pseudomonas aeruginosa was inoculated to the wounds in sepsis group. Corresponding indices were determined to verify the diagnosis of wound sepsis. The rats were sacrificed and fresh liver tissues were obtained at 96 post-scald hours (PSH). Total RNA of liver was isolated with Trizol and the different expression of lipid metabolism related genes in response to burn wound sepsis was assessed by DNA microarray.</p><p><b>RESULTS</b>By comparing expression profile of the two groups, totally 47 genes were observed to be differentially expressed in rat hepatic tissues, among them 9 genes were related to lipid metabolism. Among them, those which were upregulated were genes in relation with transportation and activation of fatty acid, and those downregulated were genes related in providing energy for fatty acid oxidation in mitochondria.</p><p><b>CONCLUSION</b>The occurrence of wound sepsis in scalded rats can induce changes in the expression of hepatic lipid metabolism related genes in hepatic tissues, and aggravate</p>

The influence of lipopolysaccharide on adipose metabolism in liver during shock stage of scalded rats / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the influence of lipopolysaccharide (LPS) on adipose metabolism in liver during shock stage of scalded rats.</p><p><b>METHODS</b>Sixty adult Wistar rats were inflicted with 30% TBSA full thickness scald and were randomly divided into 3 groups: i. e. sham group (control, n = 20), simple scald group [(n = 20) and LPS group (n = 20, with intra-peritoneal injection of 3.0 mg/kg LPS at 2 postscald hour (PSH)]. The contents of LPS, tumor necrosis factor alpha (TNF-alpha), free fatty acids (FFA) in plasma and adenosine triphosphate (ATP), triglyceride (TG), malonaldehyde (MDA) in liver in each group were determined at 24 and 48 PSH. The histological changes in hepatic tissue in each group were also observed.</p><p><b>RESULTS</b>The plasma contents of FFA in LPS group at 24 and 48 PSH were 2.3 +/- 0.3 mmol/L and 2.5 +/- 0.4 mmol/L, respectively, which were obviously higher than those in control (0.4 +/- 0.3 mmol/L, 0.5 +/- 0.3 mmol/L) and scald (0.9 +/- 0.3, 1.2 +/- 0.5 mmol/L, P <0.01) groups. Meanwhile, there was obvious difference in the contents of TG and ATP in liver between LPS group (TG: 530 +/- 30 mmol/g, ATP: 1.7 +/- 0.5 micromol/g) and scald group (TG: 242 +/- 27 mmol/g, ATP: 6.0 +/- 2.4 micromol/g, P < 0.01). Pathological examination revealed that adipose denaturalization and injury to mitochondria in hepatocytes in scald group were significantly milder than those in LPS group. The morphology of hepatocyte in control group appeared normal.</p><p><b>CONCLUSION</b>LPS challenge to burn subjects could induce impairment in utilizing fat derived energy, and it would aggravate adipose denaturalization in the liver.</p>

The effects of early escharectomy on resting energy expenditure in the severely burned patients / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the effect of early escharectomy on resting energy expenditure (REE) in severely burned patients dynamically with the metabolic monitoring and diagnostic system.</p><p><b>METHODS</b>Fifty-six adult male patients with severe burns were divided into early escharectomy (group A, n = 39, escharectomy within 5 PBDs) and non-early escharectomy (group B, n = 17, escharectomy after 5 PBDs) groups. The wounds of full thickness and deep partial thickness burn in the two groups were all excised and covered with allogeneic skin and autologous micro-skin in the first operation. The changes in REE were observed dynamically at the bedside of the patients with the metabolic monitoring and diagnostic system. The plasma contents of IL-6, IL-8, TNF-alpha and LPS from 9 patients in group A and 7 in group B were also determined dynamically.</p><p><b>RESULTS</b>All patients survived. The REE in both groups was elevated markedly, but REE in group A was lower compared with group B before and after escharectomy within 14 days. (P < 0.05). The plasma level of IL-6, IL-8, TNF-alpha and LPS in group A were obviously lower than those in group B (P < 0.05).</p><p><b>CONCLUSION</b>The hypermetabolic response of burn patients with severe burns could be lowered by early escharectomy, and it seemed to be related to the decrease of the release of proinflammatory mediators.</p>