Developing trend of wound dressing / 中华烧伤杂志

The ideal wound dressing should have the functions of keeping wound moist and warm, preventing and treating wound infection, promoting wound healing, and so on; However there is no such ideal wound dressing in clinic. Dressings are likely to capable application to different kinds of wounds with multi-functions in the future. For the purpose of good tissue compatibility and permanent wound cover, auto- or allo- skin living cells should be integrated with biological dressings as real artificial skin by employing tissue engineering technology. Clinical application of smart dressings can enable wound management more personalized, effective, optimized, and convenient.

Reconsideration of burn scar treatment / 中华烧伤杂志

Since the mechanisms of scar formation are not fully understood, at least to date, there is no ideal method to prevent and treat scar after burn. In recent years, on the basis of conventional treatments, such as pressure therapy, external use of silicone gel, and intralesional injections of corticosteroids, the therapeutic approaches of fractional carbon dioxide laser treatment, injection of anti-vascular endothelial growth factor antibody, autologous fat transplantation, injection of botulinum toxin A, radiation therapy etc., have been gradually applied to treat burn scars. It is very important to select various methods individually and comprehensively according to the specific conditions of patients and scars. Meanwhile, it is necessary to continue to study and explore the possibility of targeted therapy in scar management.

Recognizing prevention and treatment of burn sepsis with the concept of holistic integrative medicine / 中华烧伤杂志

Sepsis remains a major cause of death in severe burns. The effect of sepsis management is influenced by its complicated pathophysiologic changes. In order to improve the outcome of burn sepsis, the predisposing factor of sepsis after burn analyzed by advanced technology, the early prevention, antibiotics therapy, and combined treatment in severe burns with sepsis are discussed using the concept of holistic integrative medicine.

Emphasize the diagnosis and treatment of infective endocarditis in patients with severe burn / 中华烧伤杂志

The incidence and mortality of infective endocarditis (IE) in patients with severe burn remain high, which are attributed to invasive procedures, bacteremia, and wound infection after burns. Clinical clues for IE in burns are usually masked by burn-related manifestations, so the diagnosis of IE may be delayed or missed. For burned patients with persistent bacteremia of unknown source, especially Staphylococcus aureus-induced bacteremia, the diagnosis of IE should be considered according to the Duke criteria, and early echocardiography performance is particularly important. Antibiotic therapy is the mainstay initial management, and early surgical intervention is strongly recommended once IE is clearly diagnosed in patients with burns. In order to lower the incidence and mortality of IE in burns, it is very important to take prophylactic procedures along with the whole course of burn management.

Independent risk factors for sepsis in patients with large area burns / 中华创伤杂志

Objective To determine the independent risk factors for sepsis in patients with large area burns.Methods The study enrolled 307 patients with large area burns treated from June 2014 to June 2015.Related variables included age,gender,visit time,emergency eschar open,burn index,tangential excision of eschar during shock stage,delayed resuscitation during shock stage,oxygen pressure(PaO2),carbon dioxide pressure (PaCO2),assisted ventilation mode,mechanical ventilation time,inhalation injury,prophylactic tracheotomy,continuous lactic acid rise,refractory hypernatremia,heart-lung disease history,and diabetes history.Correlation of the variables with the incidence of sepsis was observed.Independent predictors of sepsis in patients with large burns were differentiated using the Logistic regression analysis.Results Delayed resuscitation during shock period (OR =1.747,95％ CI 1.822-7.431,P ＜ 0.05),continuous lactic acid rise (OR =1.758,95％ CI 1.137-4.002,P ＜ 0.05),refractory hypernatremia (OR =2.985,95％ CI 1.074-6.782,P ＜ 0.05),moderate and severe inhalation injury(OR =14.764,95％ CI 0.892-47.323,P ＜ 0.05) and burn index (OR =5.017,95％ CI 1.075-23.572,P ＜ 0.05) were found be independently associated with sepsis in patients with large burns.Conclusions These independent risk factors for sepsis in large area burn patients deserve more attention.Early and timely treatment measures may reduce the incidence of sepsis.

Controlling infection and spread of carbapenems-resistant Klebsiella pneumoniae among burn patients / 中华烧伤杂志

The emergence and spread of carbapenems-resistant Klebsiella pneumoniae (CRKP) in burn ward is an important threat to burn management. CRKP isolates are resistant to almost all available antibiotics and are susceptible only to polymyxins and tigecycline. The mechanism of the drug resistance of CRKP is associated with the plasmid-encoded carbapenemase Klebsiella pneumoniae carbapenemase (KPC), a carbapenem-hydrolyzing β-lactamase. Antibiotics which can currently be used to treat CRKP infection include polymyxins, tigecycline, and some aminoglycosides. The efficacy of using antibiotics in combination is better than that of single-agent therapy for the treatment of CRKP infection in bloodstream. In order to control CRKP infection in burn patients, strategies for preventing CRKP dissemination in burn ward are strongly advocated.

Clinical significance of continuous thrombocytopenia in predicting sepsis after severe burn / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore the relationship between continuous thrombocytopenia and sepsis in patients with severe burns.</p><p><b>METHODS</b>Clinical data of 148 severely burned patients admitted to our,two burn centers from January 2007 to December 2011 and conforming to the study criteria were retrospectively analyzed. All patients were divided into sepsis group (n =44) and non-sepsis group (n = 104) according to the presence or absence of sepsis within post burn day (PBD) 30. The data of age, gender, total burn area, full-thickness burn area, fluid infusion volume within post burn hour (PBH) 24, plasma concentration of calcium ion on PBD 1, plasma concentration of albumin on PBD 1, platelet count on PBD 1, acute physiology and chronic health evaluation (APACHE) II score on admission, the presence or absence of hypovolemic shock or inhalation injury on admission, the presence or absence of disseminated intravascular coagulation (DIC) within PBH 48, operation or no operation within PBD 3, thrombocytopenia duration within PBD 10, and mortality were statistically compared between two groups to screen the independent risk factors of sepsis. Data were processed with t test, chi-square test, single factor Logistic regression analysis, and multi-factor Logistic regression analysis.</p><p><b>RESULTS</b>Between two groups, there were statistically significant differences in total burn area, full-thickness burn area, plasma concentration of calcium ion on PBD 1, plasma concentration of albumin on PBD 1, APACHE II score on admission, presence or absence of hypovolem- ic shock on admission, presence or absence of inhalation injury on admission, presence or absence of DIC within PBH 48, and mortality (with t values from 2.433 to 4.082, χ2 values from 8. 818 to 31.528, P < 0.05 or P < 0.01). Furthermore, the duration of thrombocytopenia within PBD 10 in sepsis group was (5.2 ± 2.4) d, which was significantly longer than that in non-sepsis group [(2.9 ± 1.9) d, t =6. 189, P <0.01]. There were no statistically significant differences in the other indexes between two groups (with t values from 0.971 to 1. 250, χ2 values respectively 0. 054 and 1.529, P values above 0.05). Single factor and multi-factor Logistic regression analysis indicated that APACHE II score on admission and duration of thrombocytopenia within PBD 10 were closely related to occurrence of sepsis (with odds ratio respectively 1. 140 and 1.569, P values below 0.01).</p><p><b>CONCLUSIONS</b>Duration of thrombocytopenia within PBD 10 is one of the risk factors for sepsis in severely burned patients, which can reflect pathophysiological changes in the body, thus providing predictive value for the occurrence of sepsis.</p>

Effect of gene abaI expression on acinetobacter baumannii biofilm formation / 中华创伤杂志

Objective To investigate the influence of abaI expression on acinetobacter baumannii biofilm formation.Methods Acinetobacter baumannii strain S isolated from bums patients was collected for the study,while the standard strain ATCC19606 was served as the control.At 6,24 and 48 hours,the gene expressions of abaI,pgaA,pgaB and pgaC were detected by real-time fluorescent quantitative PT-PCR,secretion of N-acyl-homoserine lactones (AHLs) by biological sensor and biofilm formation by MTT method.Results (1) Gene expressions of abaI,pgaA,pgaB and pgaC at 6 hours were 8.63 ±5.93,1.98 ± 1.93,1.01 ± 1.32 and 2.67 ± 3.46 respectively,which showed a quick increase at 24 hours (22.81 ± 17.60,5.13 ± 4.32,5.66 ± 3.97,11.97 ± 7.75 respectively),followed by a rapid decline in 48 hours (3.43 ± 0.88,1.30 ± 0.24,3.01 ± 3.00,3.02 ± 3.29 respectively).Gene expressions of pgaB and pgaC at 6 hours and that of pgaA and pgaC at 48 hours revealed statistically significant differences from those at 24 hours (P ＜ 0.05).(2) AHLs showed a level of 18.49 ± 11.03 at 6 hours,reached a peak of 52.23 ± 15.95 at 24 hours,then descended to 5.53 ± 0.94 at 48 hours.AHLs level at 24 hours showed statistically significant difference from that at 6 hours and 48 hours (P ＜ 0.05).(3)Biofilm formation at 24 hours and 48 hours was 2.83 ±0.44 and 2.71 ±0.15 respectively,far higher than that at 6 hours (0.49 ± 0.11,P ＜ 0.05).(4) In the correlation analysis among AHLs,biofilm formation and gene abaI,pgaA,pgaB and pgaC expressions,significant positive correlation was found between abaI and pgaA and between AHLs and pgaC expression (P ＜ 0.05).Conclusion Acinetobacter baumannii may regulate gene expressions of pgaA and pgaC responsible for biofilm formation to adjust to the external environment by means of changing abaI gene expression and AHLs secretion.

Relationship of drug resistance in acinetobacter baumannii isolated from the burn patients with the expression alteration of efflux pump adeAB / 中华创伤杂志

Objective To observe the expressions of efflux pump gene cluster adeAB in acinetobacter baumannii isolated from the burn patients and the expression changes of its upstream regulatory genes adeR and adeS and determine the influence of those genes on drug resistance of acinetobacter baumannii.Methods Nine drug-resistant strains and nine sensitive strains of acinetobacter baumannii isolated from the burn patients treated between June 2012 and March 2013 were used.After strain identification using 16SrDNA sequencing,acinetobacter baumannii standard strain ATCC19606 was employed as the control.mRNA expressions of efllux pump genes adeA and adeB and their upstream regulatory genes adeR and adeS were detected by real-time quantitative PCR.Results (1) adeA and adeB genes presented higher expressions in drug-resistant strains (3.71 ±0.95,76.16 ± 8.75) than in sensitive strains (0.92 ± 0.94,0.72 ± 0.78) (F =38.71,663.65 respectively,both P ＜ 0.05).(2) adeS and adeR genes showed higher expressions in drug resistant strains (18.02 ± 6.71,3.02 ± 2.69) than in sensitive strains (1.64±1.51,0.76±0.61) (F =51.04,5.57 respectively,bothP＜0.05).Conclusions The over-expression of efflux pump gene cluster adeAB induced by the expression alteration of its upstream regulatory genes adeR and adeS is closely associated with the drug resistance of acinetobacter baumannii in the burn patient.Besides,the regulatory genes may depend on adeS to sense the nosocomial environment condition,activate or inactivate adeR and hence regulate efflux pump expression.

Changes of platelet microparticles and its clinical significance in severely burned patients / 中华创伤杂志

ObjectiveTo investigate the clinical significance of changes of platelet microparticles (PMPs) in burn and burn infection patients.MethodsThe patients were divided into burn shock group (n =44),burn infection group (n =33) and control group (n =11 ).Plasma PMPs were determined by flow cytometry and were recorded in absolute value and in particle proportion.Also,the frequently used biochemical indicators were detected and analyzed for their relationship with PMPs.ResultsCD41 + PMPs levels in the burn shock and burn infection groups were higher than those in the control group (P ＜ 0.01 ) and they showed positive relation with extent of burn ( r =0.258,P ＜ 0.05 ).Stepwise regression analysis indicated that r-glutamyltranspeptidase (r-GT),extent of burn and alanine aminotransferase (ALT) entered CD41 + PMPs level regression equation.ConclusionThe increase of PMPs levels may be closely correlated with the pathological coagulation state in severe burn patients.

Immunotolerance following intermingled skin transplantation / 中国组织工程研究

PUBMED Database and Vip Database were undertaken to identify relevant articles on intermingled skin transplantation. Skin cuticular layer consists of keratinocytes and dendritic cells (DCs), so the researches on intermingled skin transplantation includes the chimerism of allo-keratinocyte and the chimerism of allo-DCs. There is no study about the chimerism of allo-DCs at present. The investigations on skin microchimerism are limited to the immunotolerance induced by exogenous stem cell transplantation, and the microchimerism phenomenon has not been found in allo-skin transplantation and intermingled skin transplantation. Regulating T cells, Th3 cells and NKT cells play important roles in the induction of the immunotolerance after intermingled skin transplantation.

Study on the intra- and extra-hepatocyte distribution of sodium ions in scalded rats during early postburn stage / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the characteristics of the intra- and extra-hepatocyte sodium ions distribution in scalded rats during early postburn stage,with the aim of improving burn shock resuscitation regime and the resuscitation effects.</p><p><b>METHODS</b>Adult Sprague-Dawley rats were randomly divided into sham scalding (C, n = 12) and scalding (S, n = 7) groups. The rats in S group were subjected to 40% TBSA III degree scalding on the back and were catheterized via jugular vein for fluid resuscitation. The rats in C group were catheterized via jugular vein without fluid infusion and were sham scalded by warm water in temperature of 37 degrees. The changes in the intra- and extra-hepatocyte sodium ion contents were determined in vivo by (23)Na-magnetic resonance spectrum technology, while the existing state of the intra- and extra-hepatocyte sodium ion was determined by detecting (23)Na-magnetic resonance horizontal delaying time (T(2)).</p><p><b>RESULTS</b>The extra-hepatocyte sodium content in S group at 24 postburn hours (PBHs) was 17% less than that in C group. In addition, the T(2f) (fast T(2)) in S group remained stable but maintained a higher ratio during the observation time. This suggested that the sodium binding sites in extra-hepatocyte matrix increased relatively and that intra-hepatocyte sodium content increased by 57%. But the T(2) and the fast and slow parts of the T(2) kept stable, which implied that intra-hepatocyte catabolizing products were increased. This led to an increase in the sodium ion binding sites within intra-hepatocyte matrix in proportion to the sodium ion content.</p><p><b>CONCLUSION</b>During early postburn stage, the extra-hepatocyte sodium in a remote organ such as the liver exhibited relative deficiency due to its ingress into hepatocyte cytoplasm and to the increase of sodium combining sites.</p>

The role of Kupffer cells on the postburn production of TNFalpha, IL-1beta and IL-6 in severely scalded rats / 中华烧伤杂志

<p><b>OBJECTIVE</b>To observe the role of Kupffer cells in the postburn production of TNFalpha, IL-1beta and IL-6 in severely scalded rats.</p><p><b>METHODS</b>(1) The production of TNFalpha, IL-1beta and IL-6 from rat Kupffer cells stimulated by burn serum was observed. (2) The postburn change in the expression of cytokine mRNA from rat Kupffer cells was monitored. (3) The change in the plasma cytokine contents in scalded rats was determined after the application of gadolinium chloride, a specific inhibitor of Kupffer cells.</p><p><b>RESULTS</b>Kupffer cells could be stimulated by burn serum to release cytokines TNFalpha, IL-1beta and IL-6. The mRNA expression of TNFalpha, IL-1beta and IL-6 from rat Kupffer cells increased significantly after injury. But the postburn plasma levels of TNFalpha, IL-1beta and IL-6 decreased obviously to 34.71%, 36.99% and 33.7% of those in scalding group, respectively, after the Kupffer cell activity was inhibited.</p><p><b>CONCLUSION</b>The plasma cytokines, i.e. TNFalpha, IL-1beta and IL-6, were primarily produced from Kupffer cells after injury in scalded rats, initiated by TNFalpha, IL-1beta and IL-6 mRNA transcription.</p>

Study on the Composite Graft with an Acellular Xeno-dermis and Cultured Keratinocyte Sheets / 中国医师杂志

Objective To study a graft method of an acellular dermis composited with cultured human keratinocyte sheets,and investigate the outcomes of the composite graft on full-thickness wounds.Methods Using porcine skins,we prepared the acellular dermis and cultured human keratinocyte sheets in vitro.Athymic null mice were divided into the experimental group and the control group,the acellular xeno-dermis was implanted into the subcutaneous of the dorsal skin in experimental group,one week after the implantation the cultured keratinocyte sheets were grafted on the full-thickness defective area of the dorsal skin in the experimental group,in control group only implanted human keratinocyte sheet on the defective area wound,healing status was regular assessed,and biopsies for histological analysis and immunohistochemistry test were performed in post-operation.Results Compared with the control group,the appearance of wound coverage in the experimental group was better.Moreover,the histologic analysis revealed that fully differentiated epidermis,organized proliferated collagen fibers and significant reconstruction of epidermis-dermis junction were seen in the experimental group which lack of the acute immuno-rejection response.Conclusion As a kind of dermal substitutes,the acellular xeno-dermis can be compositely transplanted with cultured human keratinocyte sheet and can improve the quality of wound healing.

EXPERIMENTAL STUDY ON THE PREPARATION AND TRANSPLANTATION OF COMPOSITE SKIN COMPOSED OF ACELLULAR DERMIS AND KERATINOCYTES / 解放军医学杂志

To study the method of preparing the composite skin composed of keratinocytes and acellular dermis, and to investigate the efficacy as well as its histological changes after being grafted on wounds of athymic mice. Compared with keratinocyte sheet grafting, the wounds grafted with composite skin had better healing rate, appearance and less wound contraction rate. Moreover, histological examination revealed fully differentiated epidermis, organized proliferated collagen fibres, and distinct reconstruction of epidermis-dermis junction in composite skin group, with absence of acute immuno-rejection response. As a new kind of skin substitutes, the composite skin can improve the quality of wound healing.

The Changes of Serum Myocardial Enzymogram in Bum Patients / 第二军医大学学报

The serum myocardial enzymes and isoenzymes activities were measured in 65 bum patients. The results showed that serum CK, CK-MB, LDH and AST activities, and CK-MB/CK and LDH1/LDH2 ratios were markedly elevated after burn injury. The CK-MB/CK ratio in major bum patients was higher than 0.05 1 -3d and 14d postbum. The results suggest that myocardial cells of serious bum patients are significantly injured in both early period and 14 d postbum.