Effects of panthenol-glutamine on intestine of rats with burn injury and its dose-effect relationship / 中华烧伤杂志

<p><b>OBJECTIVE</b>To study the effects of the panthenol-glutamine on intestinal damage and motor function of intestine in rats with burn injury as well as its dose-effect relationship.</p><p><b>METHODS</b>(1) Experiment 1. Ninety SD rats were divided into groups A-I according to the random number table, with 10 rats in each group. Rats in groups A-I were inflicted with 30% TBSA full-thickness burn and fed by gavage with panthenol and glutamine at post injury hour (PIH) 4, in the whole dosage of 1.00 and 4, 0.50 and 4, 0.25 and 4, 1.00 and 2, 0.50 and 2, 0.25 and 2, 1.00 and 1, 0.50 and 1, 0.25 and 1 g·kg(-1)·d(-1). The feeding was carried out twice a day to achieve the total dosage in 7 days. On drug withdrawal day, blood and intestinal tissue were harvested to detect the intestinal propulsion index, diamine oxidase (DAO) activity in serum, and the content of acetylcholine and intestinal mucosa protein. The best proportion of panthenol and glutamine was screened. (2) Experiment 2. Seventy SD rats were divided into normal control (NC), burn (B), burn+panthenol (B+P), burn+glutamine (B+G), and burn+low, moderate, or high dose of panthenol-glutamine (B+LPG, B+MPG, B+HPG) groups according to the random number table, with 10 rats in each group. Rats in the latter 6 groups were inflicted with 30% TBSA full-thickness burn. Rats in the latter 5 groups were fed by gavage with panthenol and (or) glutamine at PIH 4. Rats in group B+P were fed with panthenol for 1 g·kg(-1)·d(-1), rats in group B+G with glutamine for 4 g·kg(-1)·d(-1), rats in groups B+LPG, B+MPG, and B+HPG with panthenol and glutamine in the dosage of 0.50 and 2, 1.00 and 4, 2.00 and 8 g·kg(-1)·d(-1). The feeding was carried out twice a day to achieve the total dosage for 7 days. The indexes and time point for observation were the same as those of experiment 1. Meanwhile, the pathological change in intestine was observed. The same process was carried out in the rats of group NC. Data were processed with factorial designed analysis of variance (ANOVA), one-way ANOVA and Fisher's exact probability test. LSD was applied for paired comparison.</p><p><b>RESULTS</b>(1) The values of intestinal propulsion index and intestinal mucosa protein content in groups A and B were close (with P values all above 0.05), and were significantly higher than those of the other 7 groups (with P values all below 0.01). Content of acetylcholine in group A was significantly higher than that of the other 8 groups (with P values all below 0.01). DAO activity in groups A, D, and E was close in value (with P values all above 0.05), and all of the values were significantly lower than those of the other 6 groups (with P values all below 0.01). The best proportion of panthenol and glutamine was 1.00 and 4 g·kg(-1)·d(-1). (2) Compared with those of group NC, the intestinal propulsion index, the contents of acetylcholine and intestinal mucosa protein were decreased significantly, while the DAO activity obviously increased in group B (with P values all below 0.01); the intestinal propulsion index was decreased significantly in group B+P (P < 0.01); the intestinal propulsion index and content of acetylcholine were decreased significantly in group B+G (with P values all below 0.01); the intestinal propulsion index was decreased significantly in group B+LPG (P < 0.01); no obvious change was observed in groups B+MPG and B+HPG (with P values all above 0.05). Compared with those of group B [0.50 ± 0.07, (69 ± 10) µg/mL, (26 ± 11) µg/g, (0.672 ± 0.145) U/mL], the contents of acetylcholine and intestinal mucosa protein were increased significantly, DAO activity decreased significantly in group B+P (with P values all below 0.01); the contents of intestinal mucosa protein was increased significantly, DAO activity decreased significantly in group B+G (with P values all below 0.01); the contents of acetylcholine and intestinal mucosa protein were increased significantly in group B+LPG (with P values all below 0.01); the intestinal propulsion index, the contents of acetylcholine and intestinal mucosa protein were increased significantly, while the DAO activity obviously decreased in groups B+MPG and B+HPG [0.66 ± 0.07, 0.68 ± 0.05; (163 ± 24), (168 ± 15) µg/mL; (57 ± 7), (57 ± 7) µg/g; (0.203 ± 0.070), (0.193 ± 0.068) U/mL, with P values all below 0.01]. The levels of the four indexes in groups B+MPG and B+HPG were close or the same in values (with P values all above 0.05). Compared with those of group B, the numbers of rats with irregularly arranged villi in group B+P were decreased significantly (P < 0.05); the numbers of rats with villi decreased in height, irregularly arranged villi, and neutrophil infiltration in group B+G were decreased significantly (with P values all below 0.05); the numbers of rats with villi decreased in height, irregularly arranged villi, degeneration and necrosis of cells, and neutrophil infiltration in group B+LPG were decreased significantly (with P values all below 0.05); the numbers of rats with villi decreased in height and number, irregularly arranged villi, degeneration and necrosis of cells, and neutrophil infiltration in groups B+MPG and B+HPG were decreased significantly (with P values all below 0.05). There was no statistically significant difference between group B+HPG and group B+MPG for the former mentioned five indexes (with P values all above 0.05).</p><p><b>CONCLUSIONS</b>Combined application of panthenol and glutamine can obviously reduce intestinal mucosa damage and promote gastrointestinal motility of rats with burn injury, and they show curative effect superior to exclusive use of either of the two drugs. The best proportion of panthenol and glutamine is 1.00 and 4 g·kg(-1)·d(-1).</p>

A new concept of nutrition in treatment of burn injury: from nutrition support to nutrition therapy / 中华烧伤杂志

For many years, the major concerns in the treatment of a major burn injury have always been shock resuscitation, infection control, and wound treatment, while nutrition has been considered as a subordinate concern. The concept of nutrition in the treatment of a major burn has been recognized as "nutrition support", only with the purpose of restraining negative nitrogen balance through administration of energy and protein, in order to prevent malnutrition in patients with severe burn. In recent 10 years, however, increasing evidences have showed that optimal nutritional management could improve the outcome of severe burn patients. Now it is recognized that nutrition is not only to provide exogenous nutrients to improve nutritional status of the patients, but also to regulate cell metabolism, enhance cell activity, maintain and uphold the structure and function of the gastrointestinal mucosa, thus to improve patient's outcome. Therefore, the term of "nutrition support"seems to be far from comprehensiveness to reflect the purpose and the aim of this important treatment strategy. Medical literatures especially those in nutritional guidelines have begun to use the term of "nutrition therapy" instead of "nutrition support", which typifies the changes in nutritional concept, aim, means, and clinical evaluation. The aim of nutrition has changed from simply "providing nutritional substrate and improving nutritional status of patients" to "regulating cell metabolism, maintaining organ structure and function, and ultimately improving outcome of patient". Meanwhile, nutritional means has been more consummate, including special nutrients, hormones, and growth factors, in addition to use of conventional nutrients, in order to enhance therapeutic effect of nutrition in treatment of massive burn injury. Burn nutrition is no longer confined to maintenance of positive nitrogen balance, it should also consider the regulation of cell activity, metabolic status, immune and organ function. The purpose of the article is to analyze and discuss the important issues concerning nutrition therapy in treatment of burn injury, including risk screening, optimal energy supply and ratio of different nutritional ingredients, the choice of special nutrient, as well as the determination of optimal time for giving various nutritional supplements.

Mechanism of changes in intestinal epithelium permeability and its countermeasure after burn injury / 中华烧伤杂志

After a series of studies, we found that the intestinal permeability was increased, tight junction protein (zonula occluden-1) obviously decreased and redistributed, accompanied by an increase in expression of myosin light chain (MLC) phosphorylation in severely burned rats. After using inhibitor of MLC kinase (ML-9 2 mg/kg) or of Rho-associated kinase (Y-27632 2 mg/kg), above-mentioned changes could be alleviated. Therefore, to regulate the MLC phosphorylation of tight junction protein and perijunctional actin-myosin ring may be one of the key links to lessen the intestinal epithelium permeability after burn injury.

Glutamine and immunonutrition for burn patients / 中华烧伤杂志

Nutritional therapy is an important determinant of immune function in burn patients. However, common nutritional supplement given to patients with extensive deep burn is still therapeutically inefficient to block nutrients utilization due to metabolic disorder. Immunonutrition, a new nutrition therapeutic modality, has been used in severely burned patients for regulating cell function, improving metabolic state, and enhancing immune function. Glutamine (Gln) is often considered to be a prime immunonutrient in immunonutrition therapy for critically ill patients including those with serious burns. Our series of experimental and clinical studies have demonstrated that Gln administered in animals or patients could abate intestinal injury, accelerate repair of intestinal mucosa, improve nitrogen balance, abate immunosuppression, maintain immune homeostasis, ameliorate wound healing, and shorten hospital stay. Although the use of Gln for supportive care of severely burned patients is now well established, the science of its use is still in its infancy. There are some disputes in regard to its indication, dosage, and course of treatment, and the way of its supplementation, administration opportunity especially. These questions will be discussed in this paper, and we wish to propose the principle and method of administration of Gln in severely burned patients.

Effects of different doses of L-arginine on the serum levels of helper T lymphocyte 1 (Th1)/Th2 cytokines in severely burned patients / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the effects of L-arginine in different doses on the serum levels of helper T lymphocyte1 (Th1)/Th2 cytokines in severely burned patients.</p><p><b>METHODS</b>Twenty-nine severely burned patients, with total burn surface area from 50% to 80%TBSA, hospitalized within 20 hours after burn, were randomly divided into control group (10 cases, fed with 5% glucose saline 500 mL), L-arginine 200 mg group (10 cases, fed with 5% glucose saline 500 mL + 200 mg/kg L-arginine), L-arginine 400 mg group (9 cases, fed with 5% glucose saline 500 mL + 400 mg/kg L-arginine). All patients received enteral feeding through nasointestinal tube, started within 22 hours after burn. Fasting venous blood of all patients was harvested on post burn day (PBD) 1 (before enteral feeding), 3, 5, and 7 to determine serum contents of TNF-alpha, IL-1beta, TGF-beta(1) and IL-4 by radio-immunity method and enzyme-linked immunosorbent assay.</p><p><b>RESULTS</b>Serum contents of TNF-alpha and IL-1beta of patients in all groups increased rapidly after burn, and although contents of TNF-alpha (318 +/- 57) ng/mL and IL-1beta (218 +/- 47) pg/mL of patients in L-arginine 200 mg group peaked on PBD 5, they were still significantly lower than those of patients in control group [(389 +/- 34) ng/mL, (272 +/- 40) pg/mL, P < 0.05], but they decreased on PBD 7. Serum contents of TNF-alpha and IL-1beta in L-arginine 400 mg group were close to those of control group (P > 0.05). Serum contents of TGF-beta(1) and IL-4 of patients in each group increased slowly after burn, and content of TGF-beta(1) (110 +/- 16) pg/mL of patients in L-arginine 200 mg group was significantly higher than that of patients in control group [(83 +/- 20) pg/mL, P < 0.05] on PBD 5. There was no statistical significant difference between L-arginine 400 mg group and control group in respect of serum content of TGF-beta(1) (P > 0.05).</p><p><b>CONCLUSIONS</b>Compared with the dosage of 400 mg/kg L-arginine, the 200 mg/kg dose is more effective in reducing the release of Th1 cytokines and increasing Th2 cytokines production, hence maintaining Th1/Th2 cytokine ratio to produce better immune opsonization during the infection phase of severe burn.</p>

Achievements in burn surgery over the past 50 years in China / 中华烧伤杂志

This paper reflects briefly the main advancements of clinical and scientific research in the field of burn surgery over the past 50 years in China. It includes emergency care of massive burns, resuscitation, anti-infection, prevention and treatment of internal organ injury, metabolic and nutritional support, repair of wound and rehabilitation, and special types of burns. The article also covers the researches in pathology, microbiology, immunology, cell biology, molecular biology, and tissue engineering pertaining to burn injury.

Progress of burn research in metabolism and nutrition in China / 中华烧伤杂志

The achievements of burn metabolism and nutrition in China are briefly presented. Advance a new theory "Enterogenous Hypermetabolism". Develop a formula to calculate calorie needs in Chinese burn adults. Put forward new ideas on glucose absorption, neo glycogenesis, insulin resistance, and the use of hypoglycemic agent after burn injury. Observe the variation of plasma level of free aminoacids, investigate the changes and mechanisms of 26S proteasome and 19S regulator in skeletal muscle of burn trauma, and the clinical application and its mechanism of glutamine and arginine. Introduce the approach of (13)C NMR spectroscopy to investigate the alterations of hepatic anabolism functions in severely burned rats. Offer supplying the suitable dosage of vitamin A, C, E and microelement of zinc, copper, ferrum for burn patients. Carry out serial studies of early enteral and parenteral nutrition, and compare enteral nutrition with parenteral nutrition. Early enteral nutrition with synbiotics might be beneficial to the controlling of burn infection. Both glucagon like peptide-2 (GLP-2) and intestinal trefoil factor (ITF) exhibit protective effect on intestinal mucosa in minimizing injury and protecting barrier function. The choice of suitable opportunity to use rhGH (growth hormone) is investigated. In addition, advance the view points of ischemia and anoxia in metabolism, anti-inflammatory immune and nutrition.

How to evaluate energy requirement of burn patients ---- a question still needs farther investigation / 中华烧伤杂志

After a series of study of early feeding (EF), we consider the evaporative heat loss from the burn wound is not the main mechanism of burn hypermetabolism. EF could resuscitate the intestine, preserve its structural integrity and function, prevent bacterial translocation and release of inflammatory mediators, reduce muscle protein catabolism and hypermetabolism. Our studies concerning the relationship between EF and hypermetabolism have already extended to involve hypothalamus now. At the end of 1960s, the advancement in "Intravenous Hyperalimentation" has epoch-making significance, but it has been found later that energy has been oversupplied by this measure, thus it exacerbated visceral loading and led to disorder of internal environment, and it has been found not beneficial to alleviate hypermetabolism. Whether "hypocaloric nutrition" for post-operative patients of G-I (gastro-intestine) surgery is applicable to severe burn patients remains as a problem. Some specialists suggest it is better to supply 126 approximately 146 kJxkg(-1)x d(-1) in severe burn patients. After evaluating the bias and precision of 46 methods of estimating energy supply of burn patients reported from 1953 to 2000, Dickerson RN et al. concluded that the most precise, unbiased methods were those of Milner (1994), Zawacki (1970) and TMMU (1993, Third Military Medical University formula). Though formulas are simple and convenient to estimate energy supplementation, however, it is difficult to evaluate the requirement of energy when the patient's condition changes immensely.

Role of corticotropin releasing factor receptor 2 antisense oligodeoxynucleotide of hypothalamus in hypermetabolism in rats with severe burn / 中华烧伤杂志

<p><b>OBJECTIVE</b>To observe the role of corticotropin releasing factor receptor 2 antisense oligodeoxynucleotide (CRFR2ASO) of hypothalamus in hypermetabolism in rats with severe burn.</p><p><b>METHODS</b>Stainless-steel cannula were implanted into the 3rd ventricle. According to different medicine delivered into the 3rd ventricle, 30 SD rats with 30% TBSA full-thickness burn were divided randomly into burn control group (BC, with injection of 3 microL saline), CRFR1ODN group (with injection of CRFR1ODN 10 microg), CRFR1ASO group (with injection of CRFR1ASO 10 microg), CRFR2ODN group(with injection of CRFR2ODN 10 microg), CRFR2ASO group (with injection of CRFR2ASO 10 microg), with 6 rats in each group. Another 6 rats served as normal control (NC) and they received isotonic saline 3 microL instead. Different medicines were respectively delivered into respective group on 5, 6 post injury day (PID), then 3 microL gentian violet was introduced on 7 PID. Resting energy expenditure (REE) value and the expression level of hypothalamus CRFR2mRNA and CRFR2 protein were determined.</p><p><b>RESULTS</b>REE value in BC, CRFR1ODN, CRFR1ASO, CRFR2ODN, CRFR2ASO groups was 11 840 +/- 987, 11 133 +/- 1100, 10 733 +/- 1338, 11 123 +/- 1321, 7563 +/- 890 kJx(m2)(-1)xd(-1), respectively, which were obviously higher than that in BC group [6641 +/- 526 kJx(m2)(-1)xd(-1), P < 0.05]. REE value in CRFR2ASO group was obviously lower than that in CRFR2ODN group (P < 0.01). The expression level of hypothalamus CRFR2 mRNA and its protein in BC group were increased after burn, which were obviously lower in CRFR2ASO group than NC group (P < 0.01).</p><p><b>CONCLUSION</b>Central application of CRFR2ASO can downregulate the expression level of hypothalamus CRFR2 mRNA and its protein, and reduce hypermetabolism. Hypothalamus CRFR2 may mediate hypermetabolism in burn rats.</p>

Protective effects of glycyl-glutamine dipeptide supplement on the heart function in burn rats / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the protective effects of glycyl-glutamine dipeptide supplement on the function of myocardial dynamics in severely burned rats, and to explore its mechanism.</p><p><b>METHODS</b>One hundred and thirty-six Wistar rats were randomly divided into five groups: i. e, control group (C, n = 8, without burns), burn group (B, n = 32), Gln group (Gln, n = 32), Gly group (Gly, n = 32) and Gly-Gln group (Gly-Gln, n = 32). The rats in the latter four groups were respectively treated with tyrosine (1.5 g x kg(-1) x d(-1)), glutamine (1.0 g x kg(-1) x d(-1)) and tyrosine (0.5 g x kg(-1) x d(-1)), glycine (0.5 g x kg(-1) x d(-1)) and tyrosine (1.0 g x kg(-1) x d(-1)), and Glycyl-glutamine dipeptide (1.5 g x kg(-1) x d(-1)) after receiving a 30% TBSA full-thickness burn on the back. Glutathione (GSH), adenosine monophosphate (AMP), adenosine diphosphate (ADP), adenosine triphosphate (ATP), cell energy charge (EC) and the index of myocardial dynamics (ASOP, AODP, LVSP, + dp/dtmax) were measured at 12, 24, 48, 72 post-burn hours (PBH).</p><p><b>RESULTS</b>The content of GSH, ATP, EC and the level of aortic systolic pressure (ASOP), aortic diastolic blood pressure (AODP), left ventricular end diastolic pressure (LVEDP) and maximum rate of intraventricular pressure rise/down (+ dp/dtmax) in B, Gln, Gly, Gly-Gln groups were obviously lower than those in C group (P < 0.01), while the levels of AMP and ADP showed an opposite tendency. Compared with B group, the above indices were ameliorated. The content of GSH (72.7 +/- 1.7) micromol/g in Gly-Gln group at 12 PBH was obviously higher than that in Gln group (67.8 +/- 3.8) micromol/g (P < 0.01). The levels of EC and AOSP were obviously higher in Gly-Gln group than that in Gln group (P < 0.01). The level of GSH, EC, AOSP in Gly-Gln groups were obviously higher than those in Gly group at 48 PBH.</p><p><b>CONCLUSION</b>Glycyl-glutamine dipeptide, Gly and Gln supplementation after burns can improve the content of GSH and high energy phosphate compound, and suppress the decline of myocardial dynamics function. The effects of Glycyl-glutamine dipeptide is better than single Gly or Gln, indicating that the protective effect on myocardial function after severe burns by Gln and Gly is synergistic.</p>

The protective effect of recombinant glucagons like peptide-2 on intestinal mucosa of burn rats / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the protective effect of recombinant glucagons like peptide-2 (GLP-2) on intestinal mucosa of rats with severe burns.</p><p><b>METHODS</b>SD rats of either sex were randomly divided into 4 groups: normal control (N, n = 6), burn control group (C, n = 6), recombinant GLP-2 group (Gr, n = 6, with subcutaneous injection of 100 nmol x kg(-1) x d(-1) recombinant GLP-2 at 4 post-burn hours (PBH) and synthesized GLP-2 group (G, n = 6, with subcutaneous injection of 100 nmol x kg(-1) x d(-1) synthesized GLP-2 at 4 PBH). Except the normal control group, all animals in the other groups received a 30% TBSA third degree burns, the rats were sacrificed on 7 postburn days (PBD) and the following indexes were determined: pathological examination of intestinal mucosa, mucosa permeability of intestinal mucosa, the ratio of mucosa wet weight and bowel mass or carcase weight, and the protein content of intestinal mucosa.</p><p><b>RESULTS</b>Compared with that in burn group [(0.350 +/- 0.040) mg/ml], the mucosa permeability significantly decreased in Gr (0.250 +/- 0.026) mg/ml and G (0.243 +/- 0.008) mg/ml groups, while the ratio of mucosa wet weight and carcase weight, the protein content of intestinal mucosa were significantly increased. In addition, the content of intestinal mucosal protein in Gr group [(57.9 +/- 2.8) mg/g wet weight] was higher than that in G group [(48.9 +/- 4.1) mg/g wet weight]. In contrast to normal controls, the villi of intestinal mucosa in rats on 7 PBD were obviously shortened and exfoliated, with deranged disposition and thinned basal membrane. No obvious difference of the injury was observed between Gr and G groups, and the injury was milder when compared with burn group.</p><p><b>CONCLUSION</b>Recombinant GLP-2, as well as synthesized GLP-2, exhibits obvious protective effect on intestinal mucosa in alleviating injury to intestinal mucosa in burn rats.</p>

Transfection and identification of the cloned strain that stably expressing glucagon like peptide-2 receptor in CaCO2 cell lines / 中华烧伤杂志

<p><b>OBJECTIVE</b>To establish Caco2 cell line with stable expression of glucagon like peptide-2 receptor( GLP-2R) , in order to establish an in vitro model for the study of protective mechanism of GLP-2 of the intestinal tract.</p><p><b>METHODS</b>The GLP-2R/pcDNA3. 1 ( + ) plasmid was verified by restriction endonuclease and sequencing , and then it was transfected into Caco2 cells with lipofectamine. After G418 selection, the clones with stable expression of GLP-2R were obtained by limited dilution cloning and expanding. The mRNA and protein expression of GLP-2R in normal human intestine, Caco2 cells, HER293, VE cells, as well as in transfected Caco2 cells were determined with RT-PCR and Western blot.</p><p><b>RESULTS</b>The sequence of GLP-2R/pcDNA 3. 1 plasmid was correct. No expression of GLP-2R mRNA and protein was found in HER293 and VE cells, but weak expression were found in Caco2 cells, and strong expression was found in normal human intestines. The expression of GLP-2R mRNA and protein expression in Caco2/GLP-2R ( + ) cells were obviously increased after transfection.</p><p><b>CONCLUSION</b>GLP-2R has special distribution. The expression of GLP-2R is weak in normal Caco2 cells. The establishment of Caco2/GLP-2R ( + ) cellular model is beneficial for the further research of the mechanism of action of GLP-2.</p>

Influence of glucose-insulin-potassium on the levels of inflammatory cytokines and prognosis of MODS in the scalded rats / 中华烧伤杂志

<p><b>OBJECTIVE</b>To evaluate the influence of glucose-insulin-potassium treatment (GIK) on the levels of inflammatory cytokines in the scalded rats with MODS.</p><p><b>METHODS</b>One hundred and twenty Sprague Dawley rats were inflicted with 30% TBSA full-thickness scalding, and MODS model was reproduced with intraperitoneal injection of endotoxin following burn injury. Then the rats were randomly divided into GIK, glucose (G) and control (C) groups, with 40 rats in each group. The serum contents of glucose, lactate acid, TNF-alpha, NO and IL-6 of the rats in the three groups were determined during 1 to 7 PSD, and the mortality rate within 7 PSD was observed.</p><p><b>RESULTS</b>The serum contents of glucose, lactate acid, TNF-alpha, NO and IL-6 of the rats in the GIK group were obviously lower than those in the other two groups during 1 to 7 PSD (P < 0.01), and reached the lowest level at 6 to 7 PSD (TNF-alpha: 2.37 +/- 0.54 microg/L; IL-6: 0.28 +/- 0.17 microg/L; NO: 29 +/- 9 micromol/L). The content of glucose and lactate acid in G group were obviously higher than those in control group (P < 0.01), but the contents of TNF-alpha, IL-6 and NO content were similar between these two groups (P > 0.05). The mortality in GIK group within 7 PSD was 20.0%, which was evidently lower than that in G (37.5%) and C (47.5%) groups (P < 0.05), while that between G and C groups was similar (P > 0.05).</p><p><b>CONCLUSION</b>The administration of GIK might ameliorate sepsis by reducing the levels of inflammatory cytokine after burns and endotoxin challenge.</p>

Influence of the enteral feeding of levorotatory arginine on severely burned patients during shock stage / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the effects and the mechanism of action of postburn dietary supplementation of levorotatory arginine (L-Arg) on burn shock resuscitation in severely burned patients.</p><p><b>METHODS</b>This study was designed to be a prospective, randomized, single blinded and controlled one. Twenty burn patients with total burn surface area (TBSA) more than 30% were enrolled and randomized into two groups; 1) Group A (n = 10): enteral feeding of 50 g/L glucose normal saline (GNS) 500 ml per day containing L-Arg (400 mg/kg.day) at equal pace with fluid infusion for shock resuscitation for 4 days. 2) Group C (n = 10): enteral feeding with only 50 g/L GNS 500 ml per day for 4 days. All of the twenty patients received equal amount of enteral feeding via an intra-gastric tube with the aid of an enteral feeding pump, started within 24 postburn hours (PBH). Venous blood was harvested from all the patients in both groups on 1, 2, 3 and 4 postburn day (PBD) for the determination of serum content of nitric oxide (NO), malondialdehyde (MDA) and the activity of serum superoxide dismutase (SOD). And the arterial content of lactate (BL) was also determined concomitantly.</p><p><b>RESULTS</b>The results indicated that the serum SOD activity in group A was increased after burns, peaked on 4 PBD (68 +/- 23 U/ml), and it was obviously higher than that in group C (31 +/- 9 U/ml, P < 0.01). The serum contents of MDA and NO were decreased in both groups after burns. On 2 PBD, the serum NO level in group A decreased to the lowest level (50 +/- 14 micromol/L), which was obviously lower compared with group C (78 +/- 22 micromol/L, P < 0.01). On 4 PBD, serum MDA levels in group A (3.4 +/- 0.8 micromol/L) and group C (3.5 +/- 1.3 micromol/L) were decreased to the lowest level. The BL content in group A was obviously lower than that in group C on 2 and 3 PBD (P < 0.05 or 0.01).</p><p><b>CONCLUSION</b>Enteral supplementation of L-arginine can decrease excessive NO production to a relatively normal level, and it might be beneficial to resuscitation of burn shock. It might also exert a protective effect against ischemia/reperfusion injury to burn patients.</p>

Comparative study on the influence of arginine hydrochloride and arginine acetate on the immune function and acid-base balance in rabbits with severe burns / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the influence of arginine hydrochloride and arginine acetate on the immune function and acid-base balance in rabbits with severe burns.</p><p><b>METHODS</b>One hundred and ten flap-eared rabbits were used in the study, in which 8 served as normal control, while the rest were inflicted with 30% TBSA full thickness burn. All the rabbits were divided into 10 groups, i.e. normal control (C, n = 14), burn control (B, n = 14, with intravenous infusion of Ringer's solution), 0.3 g/kg arginine hydrochloride (AH, n = 12), 0.3 g/kg arginine acetate (AA, n = 10), 0.6 g/kg AH (n = 10), and 0.6g/kg AA (n = 10) groups, 1.2 g/kg AH (n = 10), 1.2 g/kg AA (n = 10), 2.4 g/kg AA (n = 14) and 2.4 g/kg AH (n = 12) groups. AA and AH in different doses were fed to rabbits in corresponding groups 2 times a day for 7 days. The changes in the immune function, acid-base balance, chloride ion metabolism, and mortality were determined.</p><p><b>RESULTS</b>Disorder in immune system was found after severe burns, with enhanced immune function at the beginning and weakening afterwards. The lymphocytic transformation rate, the CD4/CD8 ratio, the phagocytosis rate and the chemotactic index of white blood cells on 7 post burn day (PBD) were obviously lower in B group compared with C group (P < 0.05 or 0.01). These indices were obviously higher in 1.2, 2.4 g/kg AA and AH groups than those in B group on 7 PBD (P < 0.05 or 0.01). There was no difference in improvement of immune functions between 0.3, 0.6g/kg AH, AA group and B group. The values of blood pH, base excess (BE), buffer base (BB), HCO(3)(-) level in AH group were significantly lower than those in C group on 7 PBD (P < 0.05 or 0.01), while there were no obvious changes in AA group, they were obviously higher than those in AH group (P < 0.05 or 0.01). The contents of chloride ion in but 2.4 g/kg AH group during 5 to 7 PBD were obviously higher than those in C group and 2.4 g/kg AA group (P < 0.05 or 0.01), while no difference was found between 2.4 g/kg AA and C groups. The mortality in B group was obviously higher than that in 0.3, 0.6, 1.2 g/kg AH and AA groups (P < 0.05 or 0.01), but significantly lower than that in 2.4 g/kg AA and AH groups (P < 0.05).</p><p><b>CONCLUSION</b>Disorders in immune functions were observed in severely burned rabbits. Administration of arginine acetate as well as arginine hydrochloride could enhance the immune function, but arginine acetate seemed to be safer than arginine hydrochloride. Excessive dosage should be avoided to prevent a rise of the mortality.</p>

Analysis of the therapeutic effect and the safety of glutamine granules per os in patients with severe burns and trauma / 中华烧伤杂志

<p><b>OBJECTIVE</b>To observe the therapeutic effect and possible side effects of glutamine granules per os in patients with trauma, burns and major operations.</p><p><b>METHODS</b>Patients inflicted with severe burns, trauma and major operations were enrolled in the study. One hundred and twenty patients were randomly divided into two groups, 60 in control group (C) and 60 in glutamine group (Gln). Randomized double blind and placebo control methods were employed in the study. All the patients in both groups were given diet with equal calories and equal nitrogen content. The patients in Gln group received glutamine granules in dose of 0.5 g.kg(-1).d(-1) orally or by gavage, while those in C group received same dose of placebo (glycine) for 7 days. The changes in the intestinal mucosal barrier function, the protein metabolism, the immune function, hepatic and renal functions, and the incidence of side effects of the medication in both groups of patients were observed and compared before and after the supplementation of glutamine or glycine.</p><p><b>RESULTS</b>The plasma contents of glutamine, proteins and interleukin 2 in both groups were all lower than normal values. But the plasma diamine oxidase (DAO) activity, endotoxin content, intestinal mucosal permeability (urine lactose/mannitol, L/M) and urine excretion of nitrogen increased obviously in both groups. The plasma glutamine concentration in Gln group increased by 38.04% after the administration of Gln for 7 days (P < 0.01). The plasma contents of pro-albumin, transferrin, and IL-2 were obviously higher than those in the C group (the increase rates were 21.19%, 51.11%, 57.54%, respectively, P < 0.01). The plasma DAO activity, L/M ratio, endotoxin content and urine nitrogen excretion in Gln group were evidently lower than those in C group (the decrease rates were 47.26%, 52.18, 22.22% and 27.78%, respectively, P < 0.05 or 0.01). There was no obvious difference in the plasma levels of total protein and albumin, the indices in blood and urine test, or the hepatic and renal functions between the two groups before and after the amino acid supplementation. Mild side effects such as nausea, diarrhea, constipation occurred in both groups, but all of them disappeared spontaneously afterwards (P > 0.05).</p><p><b>CONCLUSION</b>Oral administration of glutamine could be helpful to increase plasma concentration of glutamine and to ameliorate obviously the intestinal mucosal injury, to promote systemic protein synthesis and to inhibit protein catabolism and to upgrade systemic immune function with little side effect in patients with severe injury.</p>

An experimental study on the relationship between the extracellular matrix and apoptosis of intestinal epithelium after burn injury / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore the relationship between the extracellular matrix and apoptosis of intestinal epithelium after burn injury.</p><p><b>METHODS</b>Thirty Wistar rats were employed in the study and were randomly divided into normal control (C) and 6 PBH (postburn hour), 12 PBH, 1 PBD (postburn day), 3 PBD and 5 PBD group with 5 rats in each group. The rats in burn groups were sacrificed at 0, 6 and 12 PBHs and 1, 3 and 5 PBDs. The apoptotic cell count and the caspases-3 activity of intestinal mucosal epithelium, and the extracellular matrix component laminin and type IV collagen were determined and their correlation was analyzed.</p><p><b>RESULTS</b>The apoptotic cell count and the caspases-3 activity of intestinal mucosal epithelium in burn groups were obviously higher than those in C group (P < 0.05 or 0.01), while the intestinal mucosal contents of laminin and type IV collagen in burned groups were much lower than those in C group (P < 0.05 or 0.01). By linear correlative analysis, it was shown that the changes in the intestinal mucosal contents of laminin and type IV collagen in burned groups were negatively correlated with the change in apoptotic cell count (r = -0.575, -0.613, P < 0.05).</p><p><b>CONCLUSION</b>Intestinal epithelial apoptosis was enhanced after burn injury, and it was correlated with the change in the components of the extracellular matrix.</p>

Effects of medium and long-chain triglyceride on the immune function of burn patients during early postburn stage / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore the effects of medium and long-chain triglyceride on the immune function of burn patients during early postburn stage and its possible mechanism.</p><p><b>METHODS</b>Thirty burn patients with TBSA exceeding 30% were enrolled in this study and were randomly divided into two groups (n = 15 in each group). The patients in F group were supplemented orally with enteral nutrient Fresubin 750MCT containing medium (MCT) and long-chain triglyceride (LCT), and those in N group with Nutrition containing only LCT. All the patients were treated with nutritional support beginning from 24 PBH, continued for 10 days. The changes in plasma levels of IL-2, IL-4, PGE(2) and T lymphocyte transformation rate (LTR) in peripheral blood of patients in the two groups were determined on 1, 4, 7 and 10 postburn days (PBDs).</p><p><b>RESULTS</b>The plasma IL-2 level in all time points exhibited no difference in all patients (P > 0.05). The plasma level of PGE(2) on PBD 4 in F group was obviously lower than that in N group (P < 0.01). The plasma level of IL-4 on PBDs 4, 7 and 10 in F group were evidently higher than that in N group (P < 0.01). The T LTR in peripheral blood on PBDs 4 and 7 in F group was much higher than that in N group (P < 0.05 - 0.01).</p><p><b>CONCLUSION</b>Enteral nutrient containing MCT/LCT seemed to be superior to that containing only LCT in the improvement of postburn immune function in burn patients.</p>

The isolation and purification of 19S regulator compound and the change of its protein level in rat skeletal muscle after severe scalding / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore the role of 19S regulator compound protein in the degradation of skeletal muscle protein in scalded rats.</p><p><b>METHODS</b>Wistar rats were scalded and they were randomly divided into normal and 1, 2, 3, 5, and 7 postburn day (PBD) groups with 8 rats in each group. The 19S regulator compound of skeletal muscle in scalded rats was isolated and purified with chromatography. Rabbit-anti-rat antibody IgG of 19S regulator compound was prepared conventionally. The antibody was injected to rats in injection group (I) in which 19S antibody in dose of 3 mg/kg BW was injected for two times via tail vein with 6-hour interval. The rats in I group were decapitated on 1, 2 and 3 post-injection days, respectively. The scalded rats in control group (C) were treated in the same way, except that the antibody was replaced by normal saline. The change in content of 19S regulator compound was determined by western-blot. Meanwhile, the releasing rate of tyrosine from the skeletal muscle of scalded rats was also detected by fluorescent photography.</p><p><b>RESULTS</b>19S regulator compound with high purity was obtained. The content of 19S regulator compound in rat skeletal muscle was increased significantly after 2 PBD. But the protein degradation rate was also obviously increased on 2 PBD. The antibody of 19S compound might inhibit the enhancement of protein degradation.</p><p><b>CONCLUSION</b>Burn injury might up-regulate the protein level of skeletal muscle 19S regulator compound, which therefore activated the protein degradation by 26S protease compound. This might be an important factor leading to postburn negative nitrogen balance.</p>

Influence of glucagon-like peptide-2 on the proliferation of the intestinal mucosal cells in scalded rats / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore the influence of glucagon-like peptide-2 (GLP-2) on the proliferation of the intestinal mucosal cells in scalded rats.</p><p><b>METHODS</b>Fifty-five Wistar rats were employed in the study and were randomly divided into normal control (C), simple scald (S) and scald with GLP-2 treatment (G) groups. The rats in G group received GLP-2 introperitoneally in a dose of 200 micro g/kg two times a day. The rats in S and G groups were sacrificed at 6 postburn hours (PBHs), 12 PBHs, 1 postburn day (PBD1), PBD3 and PBD5 and the rats in C group were also sacrificed. Plasma diamine oxidase (DAO) activity, cell cycle protein cyclin D expression and the proliferating cell nuclear antigen (PCNA) in all groups were determined. And the histological change in the intestinal mucosal tissue was observed simultaneously. with all the above determinations.</p><p><b>RESULTS</b>Compared with those in C group, the PCNA expression at 6 and 12 PBHs in S group was enhanced slightly and weakened at PBD1, reaching the lowest level at PBD3 and it was still lower than that in C group at PBD5. Changes in PCNA in G group were similar to that in S group, except that the expression at PBD3 and PBD5 was stronger than that in S group. The intestinal mucosal cyclin D protein expression was increased at 6 and 12 PBHs in S group, but decreased by 40% before injury at PBD1. Nevertheless, the cyclin D protein expression in G group was much higher than that in S group at PBD1, PBD3 and PBD5. The plasma DAO activity increased significantly in rats after burn injury. But the activity decreased obviously after GLP-2 treatment for 5 days (P < 0.01). It was observed histologically in G group that the lining of Exogenous intestinal villi was regular and well arranged without evident epithelial exfoliation.</p><p><b>CONCLUSION</b>Exogenous GLP-2 might ameliorate intestinal mucosal injury in scalded rats, and promotion of the expression of PCNA and cyclin D, resulting in proliferation of injured intestinal mucosal cells, might be the underlying mechanisms.</p>