Retrospective analysis of 35 burn patients in different stages of pregnancy / 中华烧伤杂志

Objective: To summarize the clinical outcomes of burn patients in different stages of pregnancy and explore a rational therapeutic scheme for burns during pregnancy. Methods: A retrospective observational study was conducted. From June 2010 to June 2020, 21 patients who met the inclusion criteria were admitted to the Department of Burns of Wuhan Third Hospital and 14 patients who met the inclusion criteria were admitted to the Department of Burns of the First Affiliated Hospital of Nanchang University. Based on the pregnancy period when patients suffered burns, the 35 patients were divided into early pregnancy group with 18 patients (aged (26±4) years, with 8 (4, 11) weeks of gestation), middle pregnancy group with 10 patients (aged (26±3) years, with 21 (14, 27) weeks of gestation), and late pregnancy group with 7 patients (aged (30±5) years, with 32 (29, 35) weeks of gestation). All the patients received treatment including fluid resuscitation, anti-infection, wound treatment, and multidisciplinary comprehensive managements. The burn-related complications during the treatment, maternal outcomes, fetal outcomes, fetal delivery mode, gestational weeks at delivery, and newborn weight of patients in the 3 groups were recorded. Data were statistically analyzed with one-way analysis of variance, Kruskal-Wallis test, and Fisher's exact probability test. Results: During the treatment, there were 4, 4, and 2 patients who suffered wound infections and 1, 3, and 2 patients who developed shock symptoms, respectively, in early pregnancy group, middle pregnancy group, and late pregnancy group. There were no statistically significant differences in them among the 3 groups (P>0.05). One patient in late pregnancy group developed into multiple organ dysfunction syndrome after debridement. At last, all the pregnant women survived, and no statistically significant difference existed among the 3 groups (P>0.05). In early pregnancy group, middle pregnancy group, and late pregnancy group, the survived fetus cases were 9, 8, and 6, respectively, and the differences between them were not statistically significant (P>0.05). Variables including stillbirth and full-term birth were close in patients in the 3 groups (P>0.05), while the preterm birth and miscarriage in patients in the 3 groups were statistically different (P<0.05 or P<0.01), with the early pregnancy group having the most miscarriage cases and the fewest preterm birth cases. There were no statistically significant differences in fetal delivery mode, gestational weeks at delivery, and newborn weight among the patients with survived fetus in 3 groups (P>0.05). Conclusions: For patients suffering burns during early, middle, and late pregnancy, superior rates of maternal and fetal survival can be achieved after timely and adequate treatments including fluid resuscitation, anti-infection, wound treatment, and multidisciplinary comprehensive managements.

Comparative study of three scores in predicting the death risk of severe burn patients / 中华烧伤杂志

Objective: To explore the predictive values of the modified Baux score, Belgian Outcome in Burn Injury score, and Ryan score on the death risk of severe burn patients. Methods: A retrospective case series study was conducted. From February 2018 to November 2019, 260 severe burn patients who met the inclusion criteria were admitted to the Department of Burns of the First Affiliated Hospital of Nanchang University, including 158 males and 102 females, aged 36 (3, 53) years. According to the final outcome, the patients were divided into survival group (n=229) and death group (n=31). Data of patients were compared and statistically analyzed with chi-square test or Mann-Whitney U test between the two groups, including the gender, age, cause of burn, site of burn, total burn area, depth of burn, combined inhalation injury, and combined underlying diseases on admission, and the modified Baux score, Belgian Outcome in Burn Injury score, and Ryan score calculated based on part of the aforementioned data. The Kendall tau-b coefficient method was used to analyze the consistency of the above-mentioned three scores in 260 severe burn patients. The receiver operating characteristic (ROC) curves of the above-mentioned three scores predicting the death risk of 260 severe burn patients were drawn, and the area under the curve (AUC), the optimal threshold, and the sensitivity and specificity under the optimal threshold were calculated. The quality of AUC of the above-mentioned three scores was compared by Delong test. Results: The gender, site of burn, and depth of burn of patients between the two groups were all similar (P>0.05). The age, total burn area, proportion of flame burn, proportion of combined inhalation injury, and proportion of combined underlying diseases of patients in death group were significantly higher than those in survival group (with Z values of 5.53 and 17.78, respectively, χ2 values of 16.23, 15.89, and 17.78, respectively, P<0.01); the modified Baux score, Belgian Outcome in Burn Injury score, and Ryan score of patients in death group were 142 (115, 155), 7 (5, 7), 2 (2, 3), all significantly higher than 64 (27, 87), 1 (0, 3), 0 (0, 1) in survival group (with Z values of 7.91, 7.64, and 7.61, respectively, P<0.01). In 260 severe burn patients, the results between the modified Baux score and Ryan score, modified Baux score and Belgian Outcome in Burn Injury score, Ryan score and Belgian Outcome in Burn Injury score were significantly consistent (with Kendall tau-b coefficients of 0.75, 0.71, and 0.86, respectively, P<0.01). The AUCs of ROC curves of the modified Baux score, Belgian Outcome in Burn Injury score, and Ryan score for predicting the death risk of 260 severe burn patients were 0.92, 0.89, and 0.85, respectively (with 95% confidence intervals of 0.86-0.98, 0.83-0.95, and 0.78-0.93, respectively, P<0.01); the optimal thresholds were 106.5, 4.5, and 1.5 points, respectively; the sensitivity under the optimal threshold were 88.5%, 76.9%, and 73.1%, respectively, and the specificity under the optimal threshold were 88.5%, 87.2%, and 86.3%, respectively. The modified Baux score was similar to Belgian Outcome in Burn Injury score in the AUC quality (z=1.25, P>0.05), which were both significantly better than the AUC quality of Ryan score (with z values of 2.35 and 2.11, respectively, P<0.05). Conclusions: The modified Baux score, Belgian Outcome in Burn Injury score, and Ryan score have good ability in predicting the death risk of severe burn patients. From the perspective of clinical practice, the modified Baux score is more suitable as a predictive tool for the prognosis of severe burn patients.

Functional hemodynamic monitoring should be emphasized in intensive care for burn and trauma patients / 中华烧伤杂志

Hemodynamic monitoring is a very important measure for critically ill patients with burn and trauma, and it should be carried out throughout the course of treatment. Functional hemodynamic monitoring consists of the assessment of the dynamic interactions of hemodynamic variables in response to a defined volume change. Accordingly, response of fluid volume can be assessed in a quantitative fashion by measuring variation of both arterial pulse pressure and left ventricular stroke volunime during positive pressure breathing, or the change in cardiac output response to passive leg raising maneuver. Functional hemodynamic monitoring, contrary to that of static condition in order to realize dynamic and individual monitoring, is related to response to treatment, and it is a useful complement to static (routine) hemodynamic monitoring. At present, in the care of sepsis, shock, and mechanical ventilation, etc. related to burn injury and trauma, functional hemodynamic monitoring is more and more accepted and applied by medical personnel of ICU in burn and trauma departments. Therefore, further study on functional hemodynamic monitoring should be emphasized and practised.

Respiratory support and treatment of severe inhalation injury / 中华烧伤杂志

Although the study of inhalation injury is deepening gradually, its clinical treatment is still difficult, and its mortality rate remains high due to the complicated pathophysiologic characteristics. This article reviews the recent progress in research and treatment of inhalation injury, acute lung injury, and acute respiratory distress syndrome at home and abroad, focusing on the effect of mechanical ventilation models, including the non-invasive ventilation, lung protective ventilation, liquid ventilation, high frequency ventilation, on respiratory support in early stage of inhalation injury. The effects of medications for inhalation injury are summarized, and the prospect of stem cell therapy for inhalation injury is also discussed.

Effects of high frequency oscillatory ventilation combined with incremental positive end-expiratory pressure on respiratory and circulatory functions of dogs with inhalation injury / 中华烧伤杂志

<p><b>OBJECTIVE</b>To study the effects of high frequency oscillatory ventilation (HFOV) combined with incremental positive end-expiratory pressure (IP) on respiratory and circulatory functions, and lung histopathology of dogs with smoke inhalation injury.</p><p><b>METHODS</b>After being treated with conventional mechanical ventilation, 12 dogs were inflicted with severe smoke inhalation injury and divided into group HFOV and group HFOV+IP according to the random number table, with 6 dogs in each group. Then they received corresponding ventilation for 8 hours respectively. Blood gas analysis results (pH value, PaO2 and PaCO2 levels) and hemodynamic parameters [heart rate, mean arterial pressure (MAP), pulmonary arterial pressure (PAP), central venous pressure (CVP), cardiac output (CO)] were recorded before injury, immediately after injury, and at post ventilation hour (PVH) 2, 4, 6, and 8. The dogs of two groups were sacrificed at PVH 8. A healthy dog without any treatment and a dog with smoke inhalation injury but no subsequent treatment were sacrificed in addition. Lung tissues of all dogs were obtained for histopathological observation. Lung injury score examination was conducted in both groups. Data were processed with rank sum test, analysis of variance of repeated measurement, and LSD- t test.</p><p><b>RESULTS</b>(1) The PaO2 levels in both groups were significantly decreased immediately after injury, compared with those before injury (with t values respectively 4.960, 5.310, P values all below 0.01). The PaO2 levels in both groups from PVH 2 to PVH 8 were significantly increased, compared with those observed immediately after injury (with t values from 4.930 to 6.050, P values all below 0.01). At PVH 2, 4, and 8, PaO2 levels in group HFOV+IP were significantly higher than those in group HFOV (with t values from 3.775 to 5.774, P values all below 0.01); no statistically significant differences were observed in pH value and PaCO2 level at each time point between two groups (with t values from 0.002 to 0.997, P values all above 0.05). (2) There were no statistically significant differences in MAP, PAP, and CVP within two groups at each time point (with F values from 1.316 to 4.959, P values all above 0.05). In group HFOV, heart rate from PVH 2 to PVH 8 was significantly lower than that observed immediately after injury (with t values from 3.780 to 8.970, P values all below 0.01). In group HFOV+IP, CO at PVH 4, 6, and 8 was significantly lower than that observed immediately after injury (with t values from 3.990 to 11.200, P values all below 0.01). There were no statistically significant differences in MAP, PAP, and CVP between two groups at the same time point (with t values from 0.089 to 2.123, P values all above 0.05). At PVH 4, 6, and 8, heart rate in group HFOV+IP was higher than that in group HFOV (with t values from 2.931 to 7.229, P < 0.05 or P < 0.01), while CO was lower (with t values from 4.297 to 11.206, P values all below 0.01). (3) Compared with those of the healthy dog, inflammatory cell infiltration and bleeding in the lung were observed in alveolar space in both group HFOV and group HFOV+IP, while the degree was less serious than that of the dog with smoke inhalation injury only. Compared with those of group HFOV, inflammatory cell infiltration in group HFOV+IP was less significant, the alveolar structure was relatively intact, and no thickening of alveolar walls was observed. The lung injury score in group HFOV [(3.27 ± 0.24) points] was higher than that of group HFOV+IP [(2.79 ± 0.31) points, t = 27, P < 0.05].</p><p><b>CONCLUSIONS</b>HFOV combined with IP can improve gas exchange and alleviate pulmonary injury without any adverse effect on blood gas analysis or hemodynamic parameters. Therefore, it may be considered as an appropriate mode of ventilation for the treatment of smoke inhalation injury.</p>

Establishment and management of a burn ICU / 中华烧伤杂志

This paper elaborates systemically the establishment and management of a burn ICU, and also the theory and technology related to shock resuscitation, respiratory support, infection, blood purification, nutritional support, cardiopulmonary resuscitation, sedation and analgesia, etc. from the perspective of critical care medicine. The relevant guidelines and recommendations are introduced in order to provide some guidance and help for the establishment of a burn ICU.

Observation on marrow-derived mesenchymal stem cells differentiating into functional cells in rabbit with smoke inhalation injury / 中华烧伤杂志

<p><b>OBJECTIVE</b>To observe the homing and differentiation of marrow-derived mesenchymal stem cells (MSC) transplanted intravenously in smoke inhalation injured rabbits.</p><p><b>METHODS</b>Thirty-two New Zealand big ear rabbits were divided into normal control group (NC), inhalation injury group (II), normal control + MSC treatment group (NM), and MSC treatment group (MT) according to the random number table, with 8 rabbits in each group. Rabbits in NC group were injected with 10 mL phosphate buffered saline (PBS) via ear marginal vein. Rabbits in NM group were injected with 10 mL PBS containing the third generation MSC labeled by BrdU (1 × 10(7) per 10 mL PBS) via ear marginal vein. Severe smoke inhalation injury model was reproduced in the other two groups, among them rabbits in II group were treated as rabbits in NC group, rabbits in MT group treated as rabbits in NM group. On the 7th and 28th day post treatment (PTD), lung tissue and trachea tissue were harvested from four groups for observation on injury with HE staining. Homing of MSC in injured tissue was observed with immunohistochemistry staining. The differentiation of MSC into functional cells was observed with immunohistochemical double staining of combining nuclear marker BrdU with lung (trachea) membrane-specific marker aquaporin-5 (AQP-5), alkaline phosphatase (AKP), CD34, and cytokeratin respectively.</p><p><b>RESULTS</b>(1) MSC homing in lung and trachea tissue was observed in MT group on PTD 7, which was not observed in NM group. (2) AQP-5, AKP, and CD34 positive MSC were observed in lung tissue in MT group on PTD 28, while cytokeratin positive MSC was not observed in trachea tissue. No positively marked MSC was observed in NM group. (3) Injury in lung and trachea was less severe in MT group than in II group; and the proliferation of fibroblasts was less in MT group.</p><p><b>CONCLUSIONS</b>Intravenous injection of MSC to rabbits with smoke inhalation injury can migrate to lung and trachea tissue at obviously inflammatory site, and differentiate into alveolar epithelial cells typeI and II, and pulmonary vascular endothelial cells, which may participate in the process of tissue repair in smoke inhalation injury.</p>

Effects of bone marrow-derived mesenchymal stem cells engraftment on vascular endothelial cell growth factor in lung tissue and plasma at early stage of smoke inhalation injury / 世界急诊医学杂志（英文）

BACKGROUND: This study was undertaken to determine the effect of mesenchymal stem cells (MSCs) engraftment on vascular endothelial cell growth factor (VEGF) in lung tissue, plasma and extravascular lung water at early stage of smoke inhalation injury. METHODS: A rabbit smoke inhalation injury model was established using a home-made smoke inhalation injury generator, and rabbits were divided into two groups randomly: a control group (S group, n=32) and a MSCs treatment group (M group,n=32). 10 ml PBS was injected via the ear marginal vein immediately at injury into the S group. Third generation MSCs with a concentration of 1×107/10 ml PBS were injected via the ear marginal vein immediately at injury into the M group. VEGF in peripheral blood and lung tissue were measured at 0 (baseline), 2, 4 and 6 hours after injection respectively and analyzed. The right lungs of rabbits were taken to measure lung water mass fraction. RESULTS: In the lung tissue, VEGF decreased gradually in the S group (P<0.05) and signifi cantly decreased in the M group (P<0.05), but it increased more signifi cantly than the values at the corresponding time points (P<0.05). In peripheral blood, VEGF increased gradually in the S group (P<0.05) and markedly increased in the M group (P<0.05), but it decreased more signifi cantly than the values at corresponding time points (P<0.05). CONCLUSION: MSCs engraftment to smoke inhalation injury could increase VEGF in lung tissue, decrease VEGF in plasma and reduce extravascular lung water, indicating its protective effect on smoke inhalation injury.

Comparing the effect of high frequency oscillatory ventilation and conventional mandatory ventilation on the myocardial function of rabbit with inhalation injury / 中华烧伤杂志

<p><b>OBJECTIVE</b>To compare the effect of high frequency oscillatory ventilation (HFOV) and conventional mandatory ventilation (CMV) on the myocardial function of rabbits with inhalation injury.</p><p><b>METHODS</b>Steam inhalation injury model was reproduced in 16 New Zealand albino rabbits. They were randomly divided into CMV group (n = 8) and HFOV group (n = 8) by drawing lots, and they received ventilation in metered volume and HFOV treatment respectively. Heart blood was drawn from rabbits before they were sacrificed 4 hours after treatment to determine the plasma activity of lactate dehydrogenase 1 (LDH1) and creatine phosphorylated kinase (CPK-MB). Myocardial tissue from left ventricle was harvested and homogenized to determine the concentration of TNF-α and IL-8, the activity of caspase-1, and the activity of myosin-light-chain kinase (MLCK) and the ATPase of myosin light chain (MLC-ATPase) by enzyme-linked immunosorbent assay, spectrophotometry, and the nuclide liquid scintillation technique respectively. Part of the myocardial tissue sample was examined pathologically. Data were processed with analysis of variance.</p><p><b>RESULTS</b>(1) The activities of LDH1 and CPK-MB in plasma were obviously higher in CMV group than in HFOV group [(643 ± 108), (342 ± 48) U vs. (233 ± 92), (186 ± 36) U, with F value respectively 10.326 and 9.846, P values all below 0.01]. (2) The contents of TNF-α, IL-8 and the activity of caspase-1 in myocardial tissue homogenate were obviously higher in CMV group than in HFOV group [(181 ± 35), (89 ± 19) pg/g, and (0.56 ± 0.27) g/g protein vs. (94 ± 21), (43 ± 11) pg/g, and (0.24 ± 0.12) g/g protein, with F value respectively 8.239, 7.826, 5.716, P values all below 0.01]. (3) The activities of MLC-ATPase and MLCK were lower in CMV group than in HFOV group [(0.24 ± 0.12) µmol×mg(-1)×min(-1), (3.3 ± 1.1) mmol×mg(-1)×min(-1) vs. (0.48 ± 0.16) µmol×mg(-1)×min(-1), (7.7 ± 1.7) mmol×mg(-1)×min(-1), with F value respectively 4.125, 4.766, P values all below 0.01]. (4) No obvious necrosis, degeneration or inflammatory cell infiltration was observed in myocardial tissue of rabbits in 2 groups under light microscope; but the myocardial fiber was slightly swollen, and it was less marked in the HFOV group.</p><p><b>CONCLUSIONS</b>The influence of HFOV on myocardial myosin phosphorylation system of rabbits with inhalation injury is less than that of CMV.</p>

Effect of bone marrow-derived mesenchymal stem cells transplantation on the inflammatory response and lung injury in rabbit with inhalation injury / 中华烧伤杂志

<p><b>OBJECTIVE</b>To study the effect of bone marrow-derived mesenchymal stem cells (MSC) transplantation on the major inflammatory cytokines content in peripheral blood, lung water mass fraction, and lung tissue injury in rabbits with smoke inhalation injury.</p><p><b>METHODS</b>Sixteen adult New Zealand big ear rabbits were subjected to smoke inhalation injury and then were divided into pure injury group (PI, n = 8) and MSC transplantation group (MT, n = 8) according to the random number table. Via ear marginal vein, rabbits in PI group were injected with 10 mL phosphate buffered saline (PBS); rabbits in MT group were injected with 10 mL PBS containing the third passage MSC (1 x 10⁷ cell) isolated from marrow of healthy young New Zealand big ear rabbit. Another 8 rabbits were enrolled as normal control group (NC). Rabbits in NC group were injected with 10 mL PBS via ear marginal vein without smoke inhalation injury. Blood was harvested from rabbits in PI and MT groups at post injury hour (PIH) 2, 4, 6. Contents of TNF-α, IL-1β, IL-6, and IL-10 in serum were determined with ELISA. At PIH 24, left lung was harvested for morphology and histopathology observation; the right lung tissue was obtained to measure and calculate lung water mass fraction. Blood and lung tissue of rabbits in NC group were harvested and determined in the same way. Data were processed with t test.</p><p><b>RESULTS</b>(1) Serum contents of TNF-α in PI and MT groups at each time point were obviously higher than that in NC group (t = 2.43 - 9.57, P < 0.05 or P < 0.01). Serum contents of IL-1β and IL-6 in PI group at each time point were obviously higher than those in NC group (t = 8.49 - 19.80, P values all below 0.01). Serum content of IL-1β in MT group at each time point was close to that in NC group (t = 0.11 - 0.92, P values all above 0.05). Serum content of IL-6 in MT group at PIH 2 was close to that in NC group (t = 2.12, P > 0.05), but that of MT group increased significantly at PIH 4 and 6 (t = 2.83, P values all below 0.05). Serum contents of TNF-α, IL-1β, and IL-6 in MT group at each time point were obviously lower than those in PI group (t = 2.35 - 12.45, P < 0.05 or P < 0.01). (2) Serum content of IL-10 in MT group at PIH 2, 4, and 6 was respectively (13.0 ± 3.6), (11.6 ± 8.5), (15.2 ± 4.4) pg/mL, and they were higher than those in PI group [(5.5 ± 3.4), (5.0 ± 1.7), (7.9 ± 3.5) pg/mL, with t value respectively 4.28, 2.15, 3.67, P values all below 0.01]. Serum contents of IL-10 in PI and MT groups were obviously higher than that in NC group (t = 2.46-8.14, P < 0.05 or P < 0.01). (3) Lung tissue injury in MT group was alleviated markedly as compared with that in PI group. (4) At PIH 24, lung water mass fraction in MT group was (69 ± 7)%, which was obviously lower than that in PI group [(87 ± 6)%, t = 5.49, P < 0.01]. Compared with that in NC group [(48 ± 3)%], lung water mass fraction in PI and MT groups were increased obviously (with t value respectively 16.93 and 7.22, P values all below 0.01).</p><p><b>CONCLUSIONS</b>MSC transplantation can decrease pro-inflammatory cytokines, increase anti-inflammatory cytokines, decrease lung water mass fraction, ameliorate systemic inflammatory response, and protect lung tissue in rabbits with smoke inhalation injury.</p>

Effects of high frequency oscillatory ventilation and its combination with pulmonary surfactant treatment on inflammatory response in rabbit lung with inhalation injury / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the effects of high frequency oscillatory ventilation (HFOV) and its combination with administration of pulmonary surfactant (PS) on inflammatory response of lung tissue in rabbits with inhalation injury.</p><p><b>METHODS</b>Severe steam inhalation injury models were reproduced in 24 New Zealand albino rabbits. They were divided into control group (n = 8), HFOV group (n = 8), and HFOV + PS group (n = 8) according to the random number table, and they received ventilation in metered volume, HFOV, and HFOV + PS treatment respectively. Lung tissue samples of rabbits were collected at 3.5 h after treatment for pathological inspection and pulmonary injury score, assay of the activity of myeloperoxidase (MPO) and cysteinyl aspartate-specific protease 1 (caspase-1), and the determination of the contents of TNF-alpha, IL-18, IL-10, IL-13 and their mRNA expression.</p><p><b>RESULTS</b>Pathological change in different degree of rabbit lung tissue in each group were observed, and they were most obvious in the control group, and least in the HFOV + PS group. The lung tissue injury scores of control group, HFOV group, and HFOV + PS group was 3.71 +/- 0.43, 2.87 +/- 0.26, and 2.08 +/- 0.28 respectively. The difference between either two of them were statistically significant (P < 0.01). The MPO content and caspase-1 activity of rabbits in HFOV and HFOV + PS groups were obviously lower than those in control group (P < 0.01), and MPO content and caspase-1 activity of rabbits in HFOV + PS group were obviously lower than those in HFOV group (P < 0.05). In HFOV group and HFOV + PS group, the contents of TNF-alpha, IL-18 and their mRNA expression in lung tissue homogenates were obviously lower than those in control group (P < 0.01); while the contents of IL-10, IL-13 and their mRNA expression were obviously higher than those in control group (P < 0.01). Changes in these contents and expression in HFOV + PS group were more obvious than those in HFOV group (P < 0.05).</p><p><b>CONCLUSIONS</b>HFOV can alleviate inflammatory response in rabbit lung tissue and pulmonary injury induced by inhalation injury, and the effect is more obvious when combined with PS.</p>

Effect of early enteral immune nutrition on immune function of intestine in mice with severe burn / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the effects of early enteral nutrition supplemented with immune nutrient on intestine immune function in mice with severe burn.</p><p><b>METHODS</b>Twenty-four BALB/c mice were inflicted with 20% TBSA full-thickness scald, then they were randomly divided into EN(with oral administration of common enteral nutrition after 2 hours) and EIN (with oral administration of common enteral nutrition and glutamine, arginine after 2 hours) groups. Another 10 mice were used as the normal control (NC) group. The supplied energy ratio( carbohydrate: fat: protein)in former 2 groups was 82:3:15, and the ratio of energy to nitrogen was 150: 1. The energy requirement of each mouse was calculated according to 732.2 kJ x kg(-1) x d(-1), one third of the requirement was administrated on 1st day, and one half of it on 2nd day, and full energy requirement was started on the 3rd day,and the requirement was divided into 4-6 portions every day. The feed was isocaloric, isonitrogenous, and isovolumic for the 2 experimental groups. All mice were sacrificed and entire small intestine was harvested for determination of intestinal IgA level by ELISA, total Peyer's patches (PP) lymphocytes and their apoptosis ratio, and changes in PP lymphocytes (CD3+, CD4+, CD19+) on 7th day of the experiment.</p><p><b>RESULTS</b>Compared with those in NC group [(4.5 +/- 0.6) x 10(6), (42 +/- 7) microg/cm, respectively], total PP lymphocytes and intestinal IgA levels in EN and EIN groups obviously decreased [(2.3 +/- 0.4) x 10(6), (35 +/- 6) microg/cm, (3.8 +/- 0. 5) x 10(6), (38 +/- 6), microg/cm, respectively, P < 0.05] , among which the values in EIN group were higher than EN group (P < 0.05). The changes in PP lymphocytes were similar to that of total PP lymphocytes. Compared with that in NC group [(4.8 +/- 2.1)%], the apoptosis ratio of PP lymphocytes in EN and EIN groups significantly increased [(12.7 +/- 2.4)%, (8.0 +/- 1.7)%, respectively, P < 0.05], however the ratio in EIN group was lower than that of EN group (P < 0.05).</p><p><b>CONCLUSIONS</b>Early enteral nutrition supplemented with immune nutrient can improve intestinal immune function in mice with severe burn.</p>

Effects of arginine enriched enteral nutrition on nutritional status and cellular immunity in burn patients / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the effects of arginine enriched enteral nutrition (EN) on nutritional status and cellular immunity of severely burned patients.</p><p><b>METHODS</b>Randomized, single blind, parallel and positive control investigation was employed in the study. Thirty severely burned patients were divided into enteral immune nutrition (EIN) group and EN group. Sixteen patients in EIN group received enteral nutrition enriched with arginine, while the other 14 patients in EN group received standard enteral nutrition. Nutritional support was continued for 14 days. Gastrointestinal reaction of patients in 2 groups was observed. Fasting venous blood was drawn from patients of both groups before receiving nutrition treatment and on the morning of 7th, 14th day of treatment. Level of serum protein, hepatic function parameters, renal function parameters, fasting-blood glucose, and subpopulations of T lymphocytes in peripheral blood were determined.</p><p><b>RESULTS</b>(1) Incidence of gastrointestinal side effect in EIN group (25.0%) was close to that of EN group (21.4% , P > 0.05). (2) Compared with pre-treatment days, levels of prealbumin and transferrin in serum of patients in 2 groups on 7th and 14th post-treatment days were significantly increased (P < 0.05 or P < 0.01), but there was no significant difference between 2 groups. The level of total serum protein on 14th day of treatment of patients was significantly increased in both groups, and that of EIN group (66 +/- 7 g/L) was significantly higher compared with that in EN group (64 +/- 11 g/L, P < 0.05). The level of serum albumin (29 +/- 5, 32 +/- 5 g/L, respectively) of patients in EIN group on 7th and 14th day of treatment were significantly higher than that (26 +/- 4 g/L, P < 0.05) in pre-treatment days, however there was no significant difference in EN group. (3) There was no significant difference in respect of hepatic function, renal function, and fasting-blood glucose between pre-treatment and post-treatment periods in both groups (P > 0.05). (4) The ratio of CD4(+), CD8(+) on 14th day of treatment in EIN group was close to that of pretreatment level. In EN group, cell percentage of CD4(+) significantly decreased, while that of CD8(+) significantly increased (P < 0.05), and CD4(+) was significantly higher [(56 +/- 8)%] in EIN group than that in EN group [(55 +/- 12)%, P < 0.05]. In both groups, cell percentage of CD3(+) was significantly higher than that in pre-treatment days (P < 0.05), while there was no obvious change in CD4(+)/CD8(+).</p><p><b>CONCLUSIONS</b>Arginine enriched enteral nutrition can effectively improve nutritional status and cellular immune function of burn patients.</p>

Experimental study on the transfection of human vascular endothelial growth factor 165 gene into human marrow mesenchymal stem cells / 中华烧伤杂志

<p><b>OBJECTIVE</b>To establish an effective method of transfecting human marrow mesenchymal stem cells (MSC) with human vascular endothelial growth factor 165 (VEGF 165) gene.</p><p><b>METHODS</b>MSCs isolated and cultured in vitro were divided into transfection group (pShuttle-CMV/VEGF 165 plasmid was transfected into MSCs through liposome-mediating method), empty plasmid group (pShuttle-CMV vehicle was transfected into MSCs as control), liposome group (liposome was transfected into MSCs as control) and control group (normal culture). Expressions of mRNA and protein of MSCs were determined by RT-PCR, enzyme-linked immunosorbent assay and Western Blot. Sensitivity to MSCs on VEGF plasmid transfection was detected by MTT test.</p><p><b>RESULTS</b>Expression level of VEGF 165 gene mRNA in transfection group, empty plasmid group, liposome group, and control group was respectively 0.89 +/- 0.03, 0.34 +/- 0.04, 0.40 +/- 0.03, and 0.30 +/- 0.03, and the difference between transfection group and the other three groups was statistically significant (P < 0.01). Content of VEGF protein in transfection group, empty plasmid group, liposome group, and control group was respectively (778 +/- 35), (543 +/- 24), (561 +/- 28), (571 +/- 23) pg/mL, and the difference between transfection group and the other three groups was statistically significant (P < 0.01). In the transfection group, expression level of VEGF protein peaked on 7(th) day after transfection, which was decreased gradually later. In transfection group, expression level of VEGF 165 protein was obviously higher than that of the other three groups (P < 0.01), and no inhibitory effect of VEGF plasmid transfection on MSCs proliferation was found.</p><p><b>CONCLUSIONS</b>The method for transfecting human VEGF 165 gene into MSCs is established in this research, through which target gene and protein can express effectively.</p>

Treatment of inhalation injury with high frequency ventilation / 中华烧伤杂志

High frequency ventilation (HFV) is a kind of lung protective ventilation strategy. High-frequency jet ventilation (HFJV) can decrease the water content, relocate interstitial fluid and accelerate lymph flow in the lung of dogs with smoke inhalation injury. HFJV can effectively improve breathing mechanics and gas exchange in dogs with smoke inhalation injury. Clinical application also proves that HFV is efficient in treatment of inhalation injury.

Effects of different enteral nutrition formulae combined with recombinant human growth hormone on inflammatory response in rats with scald injury / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the effects of enteral immunonutrition or enteral nutrition combined with recombinant human growth hormone (rhGH) on inflammatory response in rats with severe scald.</p><p><b>METHODS</b>One hundred and twenty-eight SD rats were inflicted with 30% TBSA full-thickness scald, then they were divided into enteral nutrition (EN), enteral immunonutrition (EIN), EN combined with rhGH (EN + rhGH) and EIN combined with rhGH (EIN + rhGH) groups according to random number table. The serum levels of endotoxin, IL-6 and TNF-alpha as well as the expression of CD14 and TNF-alpha mRNA in liver were determined on the 1, 4, 7, 10 post scald day (PSD). Eight normal SD rats served as control, and above indices were also examined in this group (C group).</p><p><b>RESULTS</b>The levels of endotoxin, IL-6 and TNF-alpha as well as the expression of CD14mRNA, TNF-alphamRNA in EN, EIN, EN + rhGH, EIN + rhGH groups were remarkably higher than those of C group at each time point. The levels of endotoxin, IL-6 and TNF-alpha as well as the expression of CD14 mRNA, TNF-alpha mRNA in EIN and EN + rhGH groups were lowered significantly on 4, 7 and 10 PSD compared with those of EN group (P < 0.05 or P < 0.01). The levels of endotoxin (0.37 +/- 0.07 EU/mL), IL-6 (289 +/- 49 ng/L) and TNF-alpha (1.87 +/- 0.32 microg/L) as well as the expression of CD14 mRNA (0.39 +/- 0.05), TNF-alpha mRNA (0.47 +/- 0.03) in EIN + rhGH group were also obviously lower than those [(0.48 +/- 0.08) EU/mL, (364 +/- 53) ng/L, (2.50 +/- 0.48) microg/L, 0.67 +/- 0.06, 0.66 +/- 0.05, P < 0.05 or P < 0.01, respectively] in EIN group on 10 PSD (P < 0.05 or P < 0.01).</p><p><b>CONCLUSION</b>Enteral immunonutrition combined with rhGH can ameliorate inflammatory response, in which rhGH has a collaborative effect.</p>

Protection of heat shock preconditioning on acute gastric mucosal lesion in scalded rats and its mechanism / 中华烧伤杂志

<p><b>OBJECTIVE</b>To observe the influence of heat shock preconditioning on the expressions of heat shock protein (HSP) 60 and HSP 70 and on the activities of cytochrome oxidase (CCO) and superoxide dismutase (SOD) in mitochondria in gastric mucosa of severely scalded rats, and to investigate its protective mechanism on acute gastric mucosal lesion in rats with severe scald.</p><p><b>METHODS</b>One hundred and forty-four Wistar rats were randomized into three groups, i. e. scald group ( n = 40, acute gastric mucosal lesion was made after scald, other 8 normal rats without scald were employed as blank control); HS group ( n =40, with heat shock preconditioning 20 h before scald), and other 8 rats preconditioned with heat shock but without scald were employed as experimental control I; actinomycin D group ( n = 40, with intraperitoneal injection of 0. 1 mg/kg actinomycin D 30 min before heat shock preconditioning and other treatment as HS group), and other 8 rats with merely actinomycin D injection were employed as experimental control II. Eight rats in each group were sacrificed and laparotomized at 3, 6, 12, 24 and 48 post-scald hours (PSH) , respectively to determine the index of gastric mucosal lesions (UI ) , the mRNA expressions of HSP70 and protein expression of HSP60 and HSP70, and the changes in the activities of SOD and CCO.</p><p><b>RESULTS</b>UI of the scalded rats increased as the time elapses, reaching the peak (12. 8 +/- 1.9) at 24 PSH. In addition, UI in HS group was significantly lower than that in scald group at each time-point except that at 3 PSH ( P < 0. 05 or 0. 01). The extent of gastric mucosal lesion in rats in actinomycin D group was obviously aggravated compared with that in scald and HS groups ( P <0. 05). The HSP70 mRNA expression in both scald and HS groups was increased at each time-points except for 48PBH, while that in actinomycin D group was increased at 24 PBH and 48PBH. The expressions of HSP70 and HSP60 were greatly increased in HS group compared with those in scald group ( P < 0. 05 or 0. 01) , while those in actinomycin D group were significantly inhibited ( P < 0. 05). The activities of CCO and SOD were gradually decreased in gastric mucosa in scald group, but it was greatly improved by HS preconditioning at 6, 12, 24 PSH ( P < 0. 05 or 0. 01).</p><p><b>CONCLUSION</b>Heat shock preconditioning is beneficial for the protection of acute gastric mucosal lesion of rats after severe scald, due to increase of HPS60 and HSP70 expression, and increase of CCO and SOD activities in mitochondria.</p>

The influence of early enteral immunonutrition on immunological function of body and intestine in severely scalded rats / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the influence of early enteral immunonutrition on immunological function of body and intestine in severely scalded rats.</p><p><b>METHODS</b>Sixty-four healthy adult SD rats were subjected to 30% TBSA full-thickness scald and randomly divided into enteral nutrition group (EN, n = 32) and enteral immunonutrition group (EIN, n = 32). Another 8 healthy rats were enrolled as normal controls. The changes in CD3+, CD4+, CD8+ T lymphocyte subsets, the PCNA expression in intestinal mucosa,the amount of plasmocytes in lamina propria of small intestine and the content of s-IgA in small intestine were determined on 1, 4, 7 and 10 post-burn days (PBD).</p><p><b>RESULTS</b>(1) CD3+, CD4+ and the ratio of CD4+/CD8+ were remarkably declined, while CD8+ was obviously raised after scald in EN group, and there were statistically significant differences at most of time-points when compared with those in control group (P < 0.05 or P < 0.01). CD3+, CD4+ and the ratio of CD4+/CD8+ on 7 and 10 PBD in EIN group were obviously higher (increased from 4 PBD on, and it was 1.86 +/- 0.25 on 10 PBD) than those in EN group (CD4+/CD8+ was 1.26 +/- 0.10 on 10 PBD), while CD8+ in EIN group was evidently lower than that in EN group (P < 0.01). (2) The level of PCNA expression in intestinal mucosa, the amount of plasmocytes in lamina propria of small intestine and the content of s-IgA in small intestine in EIN group were increased significantly compared with EN group on 4, 7, 10 PBD (P < 0.05 or P < 0.01).</p><p><b>CONCLUSION</b>Early enteral immunonutrition can improve immunological function of body and intestine after severe scald, with better results than enteral nutrition.</p>

Effects of glutamine enriched enteral feeding on immunoregulation in burn patients / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the effects of glutamine enriched enteral feeding on immunoregulation in burn patients.</p><p><b>METHODS</b>Twenty burn patients were randomly divided into enteral nutrition (EN) group and enteral immune nutrition (EIN) group, with 12 patients in each group. Patients in EN group received a standard enteral formula, while those in EIN group received an enteral formula enriched with glutamine after hospital admission. Nutritional support was continued for 10 days. Blood samples were obtained to determine plasma level of total protein (TP), albumin (ALB), prealbumin (PAB) and transferrin (TF) at 1, 4, 7, 10 post-burn days (PBD). At the same time the concentration of immunoglobulin (IgA, IgG and IgM) were determined, the percentage of CD3+, CD4+, CD8+ subpopulations of T lymphocytes, and the ratio of CD4+/CD8+ were determined by FCM.</p><p><b>RESULTS</b>(1) There were no obvious difference of the plasma level of TP, ALB, TF, CD3+, IgM between the two groups at each time-point (P > 0.05). (2) The plasma PAB contents in EIN group were significant higher than that in EN group on 4 PBD [(90 +/- 14 vs 60 +/- 15) mg/L, P < 0.05], 7 PBD [(92 +/- 16 vs 64 +/- 13) mg/L, P < 0.05] and 10 PBD [(106 +/- 21 vs 72 +/-16) mg/L, P < 0.05]. (3) The percentage of CD4+ subpopulation and ratio of CD4+/CD8+ in EIN group were obviously higher than those in EN group on 7 PBD [CD4+ (55 +/- 5 vs 45 +/- 5)%, CD4+/CD8+ (1.92 +/- 0.31 vs 1.53 +/- 0.27)%, P < 0.05] and 10 PBD [CD4+ (56 +/- 5 vs 49 +/- 5)%, CD4+/CD8+ (2.36 +/- 0.36 vs 1.72 +/- 0.42), P < 0.05]. (4) The concentration of IgA and IgG in EIN group were markedly higher than that in EN group on 7 PBD [IgA (2.8 +/- 0.6 vs 2.2 +/- 0.5) g/L, IgG (12.1 +/- 1.3 vs 9.8 +/- 1.2) g/L, P < 0.05] and 10 PBD [IgA (3.1 +/- 0.6 vs 2.5 +/- 0.5) g/L, IgG (14.2 +/- 1.3 vs 10.4 +/- 1.3) g/L, P < 0.05].</p><p><b>CONCLUSION</b>These findings suggest that glutamine enriched enteral feeding can improve nutritional status by promoting the synthesis of IgA, IgG, and increasing the PAB concentration, and corrected immunologic dysfunction in burn patients.</p>

Experimental study on xenogenic acellular dermal matrix incorporated with silver / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the biological characteristics of xenogenic acellular dermal matrix( Xeno-ADM) incorporated with silver, and to observe its effect in grafting.</p><p><b>METHODS</b>Xeno-ADM was prepared with 0. 25% trypsin and 0. 5% triton X-100 , and then it was immersed in 2 g/L silver nitrate solution to prepare xeno-ADM incorporated with silver. The bacterial inhibitory effect of two kinds of xeno-ADM on burn wound was determined, and the histological characteristic of the wounds was observed with optical microscope, transmission electron microscope and scanning electron microscope. The Ag+ content in the xeno-ADM incorporated with silver was measured with atomic absorption spectrometer. Twenty-seven rabbits with full-thickness skin defects on the back were randomly divided into three groups, i. e. split-thickness skin autograft only( group A, n = 9) , xeno-ADM with overlying split-thickness skin autograft( group B, n = 9) , xeno-ADM incorporated with silver with overlying split-thickness skin autograft ( group C, n = 9). The skin specimens from grafted area in each group were harvested at 2,4 and 6 post-operation weeks( POW) and examined under light microscope and transmission electron microscope. The condition of the graft, the contraction degree of the grafts and the historical changes in grafting area were observed at 2,4,6 POW. The survival rate of the grafts was calculated and the proliferative activity of the lymphocyte in each group was determined at 2 POW.</p><p><b>RESULTS</b>1. Compared with xeno-ADM, the anti-bacterial effect of xeno-ADM incorporated with silver was much better ( P < 0. 05). No epidermis was seen in both types of xenografts ,and the collagen fibers were even in size and arranged regularly, with no obvious degeneration, and the dermis was also devoid of cells and cellular components. The Ag + content in xeno-ADM incorporated with silver measured (2. 7+/-0. 7) mg/g. 2. The grafts in B and C groups presented similar color to that of normal skin at 6 POW, and it was smooth, with fine texture and no scarring. The collagen fibers was arranged regularly, and conjunction between epidermis and dermis, the structure of basal cell desmosome and semi-desmosome were well reconstructed. The grafts in A group was in dark red color, with obvious contraction, and easily broken. The contraction rate in A group at 2,4 and 6 POW were obviously higher than those in B and C groups( P < 0. 05), while no obvious difference was observed between B and C groups. ( P >0. 05). The overall survival rate of the grafts in C group at 2 POW was 91.7% , which was evidently higher than that in A (77.8%) and B (80. 6% ) groups. The lymphocyte proliferative activity exhibited no difference among A, B and C groups( P >0.05).</p><p><b>CONCLUSION</b>The xeno-ADM incorporated with silver has good anti-bacterial effect. In addition, it preserves the basic tissue structure and integral collagen fiber scaffold, without cells to induce rejection, so that it can be used as an ideal dermal substitute.</p>