Recommendations for the regulation of medical practices of burn treatment during the outbreak of the coronavirus disease 2019 / 中华烧伤杂志

2019 novel coronavirus (2019-nCoV) is one of the beta coronaviruses and was identified as the pathogen of the severe "coronavirus disease 2019 (COVID-19)" in 2019. China has formally included the 2019-nCoV in the statutory notification and control system for infectious diseases according to the Law of the People's Republic of China on the Prevention and Treatment of Infectious Diseases. Currently, the national defending actions on the 2019-nCoV in China is in a critical period. Burn Department is also confronted with risk of infection by the 2019-nCoV. According to the guidelines on the diagnosis and treatment of COVID-19 (6th trial edition), the latest relative literature at home and abroad, the features of the COVID-19, recommendations for the COVID-19 prevention and control issued by the National Health Commission of China, and management experience of diagnosis and treatment in the related disciplines, we put forward recommendations for the medical practices of burn treatment during the outbreak of the COVID-19 in outpatient and emergency treatment, inpatient treatment, operation and ward management, etc. We hope these recommendations could benefit the professionals of the same occupation as us and related hospital managers, improve the treatment of burn during the outbreak of the COVID-19, and avoid or reduce the risk of infection of medical staff .

Advances in the research of application of immune modulation of phage in treatment of sepsis / 中华烧伤杂志

Phages are traditionally deemed to lyse host bacteria, while new evidences have convinced their immunomodulation effects in metazoan hosts during period of anti-infection treatment. For sepsis induced by bacteria, phage therapy has attracted widespread attention of researchers at home and abroad for its lytic and immunoregulation functions. Clinical and basic researches in mechanism, usage, dosage, and safety of phages in China are inadequate and urgent to be carried out in depth and strengthened. Here we review overall anti-inflammation functions of phages in the treatment of sepsis, influence of phages in human immune cells, and clinical advances in present researches of phage therapy for sepsis.

Attaching importance to sepsis-induced acute kidney injury after burn / 中华烧伤杂志

Acute kidney injury (AKI) is a common complication after severe burn, which portends a worse prognosis. Sepsis is the leading etiology of late AKI after severe burn. The pathogenesis of sepsis-induced AKI remains incompletely understood. Although there have been numerous preventive and therapeutic measures evaluated for sepsis-induced AKI, the precise and available intervention in sepsis-induced AKI after burn has yet to be defined.

Chinese burn referral criteria (2018 version) / 中华烧伤杂志

There is no national referral criteria for burns in China till now, which brings inconvenience and confusion. Based on the oversea experiences and the actual situation in China, many famous experts in burns discussed and developed this (2018 ). We hope these referral criteria will be helpful in clinical practice of burns and can be improved continuously through application.

Prognostic significance of serum procalcitonin in patients with burn sepsis / 中华烧伤杂志

<p><b>OBJECTIVE</b>To evaluate the clinical implication of serum procalcitonin (PCT) in patients with burn sepsis by analyzing its change.</p><p><b>METHODS</b>Twenty-eight extensively burned patients with sepsis hospitalized from January 2012 to December 2013 were recruited in this retrospective study. These patients were divided into death group (n = 12) and survival group (n = 16) according to the outcome. The baseline characteristics of patients in the two groups were similar. Some conventional indexes of sepsis, including white blood cell count, percentage of neutrophils, platelet count, organ function parameters [ALT, AST, total bile acid (TBA), creatinine, blood sodium], and acute physiology and chronic health evaluation (APACHE) II score were compared between the two groups when sepsis was diagnosed. Serum levels of PCT of patients in the two groups were determined immediately after diagnosis of sepsis, from post sepsis day (PSD) 1 to 4, and from PSD 5 to 8. Data were processed with t test, chi-square test, and nonparametric rank sum test (Keuskal-Wallis). Receiver operating characteristic (ROC) curve of serum PCT value was used to predict death for 28 burn patients when sepsis was diagnosed.</p><p><b>RESULTS</b>There were no statistically significant differences in white blood cell count, percentage of neutrophils, platelet count, APACHE II score, and organ function parameters between death group and survival group when sepsis was diagnosed (with t values from -0.601 to 1.726, P values above 0.05). The serum levels of PCT in death group immediately after diagnosis of sepsis, from PSD 1 to 4, and from PSD 5 to 8 were respectively (38.5 ± 41.3), (26.8 ± 38.5), (19.3 ± 16.3) ng/mL, which were significantly higher than those in survival group [(6.1 ± 2.3), (5.4 ± 2.9), (4.9 ± 3.6) ng/mL, with Z values from -4.364 to -2.955, P values below 0.01]. The total area under ROC curve of serum PCT value for predicting death for 28 patients with burn sepsis was 0.990, and 10.9 ng/mL was chosen as the optimal threshold value, with sensitivity of 91.7% and specificity of 100.0%.</p><p><b>CONCLUSIONS</b>Serum PCT value can be served as a vital prognostic indicator for patients with burn sepsis, which can be considered as a guide for rational use of antibiotics, also provide as a reference for treatment, in order to reduce mortality.</p>

Reconstruction and prokaryotic expression of human high mobility group box 1 protein / 第三军医大学学报

Objective To design and prepare recombinant mutant human high mobility group box 1 protein (HMGB1s) that can combine with HMGB1 receptors but cannot produce inflammatory effect, and accordingly lead to the creation of a new potential agent for anti-inflammatory therapy. Methods This experiment was based on successful clone and expression of human HMGB1.Six mutant HMGB1 cDNA were designed and constructed by one step inverse PCR. They were cloned into prokaryotic expressive vector pQE80L and followed with production of mutant HMGB1s and identification by Western blotting. Results Six mutant proteins were designed and constructed into prokaryotic expressive vector pQE80L. The recombinant HMGB1 proteins were obtained and identified by Western blotting. Conclusion Human HMGB1 mutants have been successfully constructed and the expression and characterization of intent proteins are identified. It will lay a foundation for further study on biological functions of HMGB1.

In situ re-grafting of the scalp skin flap after its covering of the exposed devitalized skull following electrical injury / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the clinical therapeutic effects of in situ re-grafting of the scalp skin flap after its covering of the exposed devitalized skull following electrical injury.</p><p><b>METHODS</b>The scalp wounds were debrided during the early postburn stage and the necrotic skull was preserved. The wounds with necrotic skull were then covered with an adjacent scalp skin flap. The grafted scalp skin flap was re-grafted back to the donor site 3 - 6 months after the first operation. The remaining scalp wound with fresh granulation tissue was recovered with split-thickness skin grafts.</p><p><b>RESULTS</b>Ten scalp skin flaps were applied in 8 cases of electrical injury of the skull with the maximal defect of 24 cm x 10 cm and all survived very well free from infection or necrosis. The wounds were closed primarily.</p><p><b>CONCLUSION</b>In situ re-grafting of the scalp skin flap after its covering of the exposed devitalized skull following electrical injury shortened the wound healing time with satisfactory contour.</p>

Amplification and Identification of Immature Dendritic Cells Resistant to Maturation from Human Peripheral Blood Monocytes / 中国医师杂志

Objective To establish a method for in vitro induction and amplification of immature dendritic cells(DCs) with maturation resistance from human peripheral blood. Methods Mononuclear cells separated from peripheral blood were cultured with rhGM-CSF and rhIL-4 for 9 days, and rhIL-10 was added into medium at the 7th day. The suspending cells were examined with scanning electronic microscope and flow cytometry, and their ability for stimulating non-sensitized T lymphocyte proliferation was observed by mixed lymphocyte reaction(MLR). Cultured cells were stimulated with LPS and TNF-? for additional 2 days, respectively, and MLR was performed again. Results rhGM-CSF+rhIL-4-induced and IL-10-treated peripheral blood mononuclear cells(PBMC) exhibited typical morphological characteristics and immunological phenotype of DCs with high expression of CD1a and no expression of CD 83 on the cellular surface. Costimulating molecules CD 40 and CD 86 expressions were down-regulated.The capability of cultured cells for stimulating the proliferation of non-sensitized T lymphocyte was weak, and the same result was observed in cultured cells stimulated with LPS or TNF-?. Conclusion Immature dendritic cells with maturation resistance were obtained by culturing with IL-10,which might be a useful in the induction of immune tolerance of allogenic skin grafting for the major burn patients with deep burn wounds.

Effects of Early Enteral Feeding on the Preservation of Intestinal Mucosal Barrier in Severely Burned Patients / 中国医师杂志

Objective To study the effects of early enteral feeding on the preservation of intestinal mucosal barrier in severely burned patients. Methods Twenty-two patients with severe burn were randomly divided into early enteral feeding group (EF) and delayed enteral feeding group (DF). The levels of serum endotoxin and TNF-? were dynamically detected in the patients of both groups, and two unmetabolized sugars (lactose and mannitol) were orally administered in these patients on 1d, 3d and 5d of postburn. The concentrations of lactose and mannitol in urinary and the L/M ratio were observed. Intestinal permeability was assessed by the L/M ratio. Results The levels of serum endotoxin and TNF-? in severely burned patients were significantly higher than in normal (P