Aesthetic reconstruction of the scar contracture deformity in chin and neck with expanded flaps based on the "MRIS" principle / 中华烧伤杂志

Objective: The surgical reconstruction strategy for scar contracture deformity in chin and neck was explored, aiming to obtain better aesthetic outcome. Methods: A retrospective observational study was conducted. From December 2017 to April 2021, 34 patients with scar contracture deformity in chin and neck after burns were hospitalized in the Department of Plastic Surgery of the First Affiliated Hospital of Army Medical University (the Third Military Medical University), aged 12-54 years, including 13 males and 21 females, 4 cases with chin affected only, 7 cases with neck affected only, and 23 cases with both chin and neck affected. The scar areas were 48-252 cm2. All the patients were treated by operation with expanded flaps, following the "MRIS" principle of matching of the color and thickness of the repair flaps (match), reconstructing of the aesthetic features of subunits (reconstruction), design of incision according to the plastic principle (incision), and prevention of the surgical incision scar (scar). The rectangular or kidney shaped skin and soft tissue expander (hereinafter referred to as the expander) with rated capacity of 80-400 mL was embedded in the first stage, which was routinely expanded to 3-5 times of the rated capacity of the expander. In the second stage, scar resection and expanded flap excision were performed to repair the secondary wound, and the flap donor site was sutured directly. The expansion ratio of the expander (with average value being calculated), the type of flaps used, the reconstruction of local aesthetic morphology, the appearance of postoperative incision, the survival of flap, and the situation of donor and recipient sites observed during follow-up were recorded. Results: Among the 34 patients, the average expansion ratio of the implanted expander was 3.82 times of the rated capacity of the expander. Three cases were repaired by the expanded local pedicled flap only, 19 cases by the expanded shoulder and/or chest perforator pedicled flap only, 10 cases by the expanded local pedicled flap combined with the expanded shoulder and/or chest perforator pedicled flap, and 2 cases by the expanded local pedicled flap combined with the expanded free flap of the second intercostal perforator of internal thoracic artery. After scar resection, the shapes of lower lip and chin-lip groove were reconstructed in 10 cases, chin process reconstruction and chin lengthening were performed in 16 cases, and the cervico-mental angle and mandibular margin contour were reconstructed in 28 cases. The surgical incision was concealed, most of which were located at the natural junction or turning point of the chin and neck subunits. The vertical incision of neck was Z-shaped or fishtail-shaped. All the expanded flaps in 34 patients survived after operation, of which 8 patients had minor necrosis at the edge or tip of the expanded flaps 1-3 days after operation and healed after dressing change. During the follow-up of 3-18 months, little difference in color and thickness between the expanded flap and the skin of chin and neck was observed, and the aesthetic shape of chin and neck was significantly improved, with mild scar hyperplasia of surgical incision. Conclusions: Reconstruction of scar contracture deformity in chin and neck by using expanded flaps based on the "MRIS" principle is beneficial to improve the quality of surgery and achieve better aesthetic outcome.

Advances in the research of fluid resuscitation and its monitoring in burn patients / 中华烧伤杂志

Shock is the one of the most serious complications during the early stage of burn injury. Early effective fluid resuscitation, enabling the burn patient to pass through the shock stage smoothly and uneventfully, plays a necessary and essential role in the prevention of the subsequent organ complications, reduction of mortality and morbidity, and improvement in life quality. Rapid restoration of blood volume is the fundamental measure to prevent burn shock. In this review, the history and the current status of several important issues related to burn shock resuscitation, including the fluid replacement formula, quality of fluids, and monitoring of physiological parameters, were over viewed. The authors also proposed that a new therapeutic strategy to prevent microvascular permeability should be emphasized and developed in future, which may hopefully act as the most basic approach to prevent burn shock and its related complications.

Comparative study on the effect of restrictive fluid management strategy on the early pulmonary function of patients with severe burn / 中华烧伤杂志

<p><b>OBJECTIVE</b>To retrospectively analyze the effect of restrictive fluid management strategy (RFMS) on the early pulmonary function and the prognosis of patients with extremely severe and extensive burn.</p><p><b>METHODS</b>Thirteen patients with extremely severe burn hospitalized from June 2010 to November 2011, being treated with RFMS in the fluid reabsorption stage, were enrolled as treatment group. Twenty-six patients with extremely severe burn hospitalized from March 2008 to November 2011, being treated with normal fluid therapy in the fluid reabsorption stage, were enrolled as control group. The match proportion between treatment group and control group was 1:2. Fluid intake, fluid output, fluid balance (the difference between fluid intake and output), and plasma albumin level from post burn day (PBD) 3 to 10, pulmonary oxygenation index on PBD 3, 5, 7, 10, and 14, occurrence of lung and blood stream infections from PBD 7 to 14, and occurrence of acute respiratory distress syndrome (ARDS), occurrence of other organ complications, and mortality within 2 weeks post burn (PBW) were recorded and compared. Measurement data were processed with t test and randomized blocks analysis of variance, enumeration data were processed with Fisher's exact test.</p><p><b>RESULTS</b>Daily fluid intake of patients showed a tendency of decrease in both groups from PBD 3 to 10. Except for that of PBD 4, there was no statistically significant difference between two groups in fluid intake (with F values from 0.072 to 1.939, P values all above 0.05). Daily fluid output of patients showed a tendency of increase in both groups from PBD 3 to 10. It peaked on PBD 10 in control group and PBD 6 in treatment group. The mean daily fluid output was higher in treatment group than in control group from PBD 4 to 9, but without statistically significant difference (with F values from 0.001 to 3.026, P values all above 0.05). Fluid balance lowered in both groups, and it was the lowest on PBD 10 in control group and PBD 6 in treatment group. Fluid balance was lower in treatment group than in control group from PBD 3 to 7, and it showed statistically significant differences on PBD 4, 5, and 6 (with F values from 4.799 to 8.031, P values below 0.05). Plasma albumin level was higher in treatment group than in control group from PBD 3 to 10, with statistically significant differences observed on PBD 4, 9, and 10 (with F values from 5.691 to 10.551, P < 0.05 or P < 0.01). Pulmonary oxygenation index was higher in treatment group than in control group from PBD 3 to 14, with statistically significant differences observed on PBD 7 (respectively 372 ± 78 in treatment group and 291 ± 92 in control group, F = 5.184, P < 0.05) and 14 (respectively 354 ± 39 in treatment group and 283 ± 72 in control group, F = 8.683, P < 0.05). Lung infection and blood stream infection were respectively observed in 1 and 4 patient (s) in treatment group, and 9 and 11 patients in control group from PBD 7 to 14. Occurrence of ARDS, occurrence of other organ complications, and mortality were fewer in treatment group than in control group within PBW 2, though the differences were not statistically significant (P values all above 0.05).</p><p><b>CONCLUSIONS</b>RFMS is a useful strategy in improving early pulmonary oxygenation of patients with extremely severe and extensive burn by promoting the process of fluid reabsorption and rebalance. This strategy may be also beneficial for the prevention of organ complications as well as a better prognosis in severely burned patients.</p>

Influence of microtubule depolymerization of myocardial cells on mitochondria distribution and energy metabolism in adult rats / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the influence of microtubule depolymerization of myocardial cells on distribution and activity of mitochondria, and energy metabolism of cells in adult rats.</p><p><b>METHODS</b>Myocardial cells of SD adult rats and SD suckling rats were isolated and cultured. They were divided into adult and suckling rats control groups (AC and SC, normally cultured without any stimulating factor), adult and suckling rats microtubule depolymerization agent groups (AMDA and SMDA, cultured with 8 micromol/L colchicine containing nutrient solution for 30 minutes) according to the random number table. (1) The expression of polymerized beta tubulin in myocardial cells of adult and suckling rats was detected with Western blot. (2) Myocardial cells of rats in AC and AMDA groups were collected. The expression of cytochrome c was detected with Western blot. Distribution of voltage-dependent anion channels (VDAC) and polymerized beta tubulin in myocardial cells were observed with immunofluorescent staining. Mitochondrial inner membrane potential was determined with immunocytochemical method. Activity of myocardial cells was detected with MTT method. Contents of ATP, adenosine diphosphate (ADP), and adenosine monophosphate (AMP) and energy charge of cells were determined with high performance liquid chromatography.</p><p><b>RESULTS</b>(1) The expression of polymerized beta tubulin:in AMDA group it was 0.52 + or - 0.07, which was obviously lower than that (1.25 + or - 0.12) in AC group (F = 31.002, P = 0.000); in SMDA group it was 0.76 + or - 0.12, which was significantly lower than that (1.11 + or - 0.24) in SC group (F = 31.002, P = 0.000), but was obviously higher than that in AMDA group (F = 31.002, P = 0.009). (2) The expression of cytochrome c in AC group was 0.26 + or - 0.03, which was obviously lower than that (1.55 + or - 0.13) in AMDA group (t = -24.056, P = 0.000). (3) Immunofluorescent staining result: in AC group, microtubules of myocardial cells were in linear tubiform, distributed in parallel with myocardial fiber; VDAC staining result showed that mitochondria were in granular form, distributed in the same direction as microtubules. In AMDA group, the normal distribution regularity of microtubules was destroyed, with weakened immune fluorescence intensity, microtubules structure indistinct, continuity lost, rough in appearance, and the distribution of mitochondria became disrupted. (4) Mitochondrial inner membrane potential in AC group fluorescent intensity was 1288 + or - 84, which was obviously higher than that (331 + or - 27) in AMDA group (t = 26.508, P = 0.000). (5) Cellular activity: in AC group absorbance value was 1.75 + or - 0.11, which was obviously lower than that (0.81 + or - 0.07) in AMDA group (t = 17.348, P = 0.000). (6) Energy metabolism: compared with those in AC group, content of ATP decreased, contents of ADP and AMP increased, and ATP/ADP value and energy charge decreased in AMDA group.</p><p><b>CONCLUSIONS</b>Microtubules and mitochondria distribute in the same direction in normal myocardial cells in adult rats. After microtubule depolymerization, mitochondria are arranged in disorder fashion; cytochrome c leaks from mitochondria; mitochondrial membrane potential, energy supply, and cellular activity decrease in the myocardial cells.</p>

Clinical assessment of colistin in treating infections caused by multidrug-resistant gram-negative bacillus in patients with severe burn / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the therapeutic effect and side effects of colistin in treating infections caused by multidrug-resistant (MDR) gram-negative bacillus in patients with severe burn in order to provide the basis for reasonable application of this antibiotic in clinic.</p><p><b>METHODS</b>Nine burn patients suffered from infections caused by MDR gram-negative bacillus admitted to our institute from August 2005 to January 2009 were involved in this study. On the premises that isolated bacteria were only sensitive to colistin or not sensitive to other antibiotics, patients were treated with intravenous drip of colistin (100 x 10(4) - 150 x 10(4) U/d), or intravenous drip combined with administration of the drug into respiratory tract by atomization or instillation (50 x 10(4) - 100 x 10(4) U/d). The bacteriologic and therapeutic effects and side effects (including neurotoxicity and nephrotoxicity, rise in serum levels of creatinine, urea nitrogen and cystatin C were detected and compared before and after administration) of colistin were observed.</p><p><b>RESULTS</b>Out of 9 patients, 7 patients were with bloodstream and pulmonary infections, 1 patient was with bloodstream, pulmonary, and invasive wound infections, and 1 patient was with bloodstream and urinary tract infections. The pathogenic bacteria were proved to be Pseudomonas aeruginosa, Acinetobacter baumannii and Pseudomonas maltophilia. After the administration of colistin, bacteria clearance rate of blood reached 92.3% in 9 patients; isolation rate of MDR gram-negative bacillus of sputum was significantly decreased in 7 patients with pulmonary infection (before treatment 58.2% v.s. after treatment 14.6%, P < 0.01); a complete MDR gram-negative bacillus clearance of urine was observed in 1 patient with urinary tract infection. Colistin was clinically effective in 8 patients but ineffective in 1 patient (effective rate 88.9%). Compared with those before administration, serum levels of creatinine and urea nitrogen were decreased after administration in all patients; no significant difference in serum level of cystatin C among 8 patients was detected, except an obvious elevation in serum level of cystatin C in 1 patient after colistin therapy, and it lowered 1 month after discontinuation. No neurotoxicity or other side effect was observed during medication and 5 days after discontinuation in all patients.</p><p><b>CONCLUSIONS</b>Reasonable application of colistin is a good option for treating infections caused by MDR gram-negative bacillus in patients with severe burn, as no other more effective drug is found.</p>

A clinical study of fungal infection in burn patients / 中华烧伤杂志

<p><b>OBJECTIVE</b>To address the features of the fungal infection after burn injury in clinic.</p><p><b>METHODS</b>Three thousand nine hundred and nine burn patients admitted to our institute from Jan. 2003 to Dec. 2006 were involved in this study. Two thousand two hundred and seventy-one samples were harvested for fungal detection by culture from 467 patients suspected to be infected by fungi based on their clinic manifestations. The collected samples included wound tissue, blood, urine, stool, sputum, catheters and others. The antibiotic sensitivity of the identified fungi were determined by routine method. When same kind of fungus was found from different samples taken from one patient, it was recorded as one positive sample. The samples were ranked in an ascending order as wound secretion, stool, urine, sputum and bronchial alveolar lavage fluid, arteriovenous catheter or urinary catheter, blood. Only the positive sample of the highest rank source was recorded as the positive strain of fungus from this particular patient.</p><p><b>RESULTS</b>It was found 61 fungal positive samples from the 2271 samples collected. Out of 467 patients, 38 strains of fungi were detected from 36 burn patients during the investigated period, the incidence was 0.92% (36/3909). The most three commonest types among the identified 38 strains of fungi were Candida tropicalis (42.1%), Candida albicans (31.6%) and Candida famata (T. Famata, 10.5%). The drug sensitivity tests demonstrated that most of the strains detected in this investigation, with the exception of candida glabrata, were sensitive to most of the routine antimycotics agents such as Amphotericin B, Fluconazole, and Itraconazole etc. Among the 36 fungus positive patients, in 18 patients the burn area exceeded 80% TBSA, 12 patients with 50%-79% TBSA, 4 patients with 30%-49% TBSA, and in 2 patients the burn area was smaller than 30% TBSA. It was found most of the fungal infections (77.78%) occurred 2 weeks after burn injury, and 8 of the 36 fungus-infected patients died (the mortality was 22.22%). Conclusions Further examinations are necessary to confirm the diagnosis in burn patients suspected to have fungal infection. Once fungal infections are confirmed, antimycotic therapy must be started immediately.</p>

Protective effect of enalaprilat injection against early postburn organ damage in rats / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the dose-effect relationship of enalaprilat (ENA) injection on the organ damage following early burn injury in rats.</p><p><b>METHODS</b>A total of 54 SD rats were subjected to 30% total body surface area III scald injury, and were randomly divided into simple scald group (B group, with conventional fluid transfusion after scald), ENA treated group (E1, E2, E3 group, with intraperitoneal enalaprilat injection of 1, 2, 4 mg/kg after scald respectively). Other 6 rats were taken as normal control. Aortic systolic pressure (AOSP), aortic diastolic blood pressure (AODP), mean arterial pressure (MAP), angiotensin 1, blood urea nitrogen (Bun), creatinine (Cr), creatinine kinase (CK), alanine aminotransferase (ALT), aspartate aminotransferase (AST) of the simple scald group, E1 group, E2 group and E3 group were investigated at 6 h and 12 h post burn.</p><p><b>RESULTS</b>Ang II, Bun, Cr, CK, ALT, AST levels in ENA treated group after 6 h and 12 hours were significantly lower than those of simple scald group (all P < 0.05). AOSP, AODP, MAP in ENA treated group after 6 and 12 hours were significantly higher than those of simple scald group (all P < 0.05).</p><p><b>CONCLUSION</b>Low-dose enalaprilat, injection (1 mg/kg) could alleviate organ damage in post-burned rats, but has little effect on AOSP and AODP.</p>

Clinical study on the repair of extensive deep burn wounds with autogenous fat granules and autologous microskin grafts in mixed grafting / 中华烧伤杂志

<p><b>OBJECTIVE</b>To observe the effects of autologous fat granules in mixed grafting microskin grafts on repair of extensive deep burn wounds in patients.</p><p><b>METHODS</b>Twenty patients hospitalized in our ward were enrolled for autogenous self-control test in wounds on both or symmetrical parts of wounds of the trunk, and they were randomly divided into experimental (E) trol (C) groups, the wounds in E group were repaired with autologous fat granules together with microskin in mixed grafting (volume ratio 1 : 1), and in C group only autologous microskin grafting was given. Wound healing rate was measured on 30th, 45th, and 60th day after operation. Wound specimens harvested for HE staining and PCNA immunohistochemistry examination on 7th, 14th, 21st, and after operation.</p><p><b>RESULTS</b>(1) The mean wound healing rate on 30th, 45th, and 60th day after E group was (56.3 +/- 3.1)%, (76.4 +/-6.1)%, (96.2 +/- 1.5)%, which were respectively higher C group [(28.3 +/-2.0)%, (47.3 +/-4.8)%, (85.4 +/- 2.2)%, P < 0.01]. HE staining showed epithelization in E group was earlier than that in C group, with regular arrangement of collagen fibers. The quantity NA positive cells in E group were larger than that in C group, and PCNA was mainly expressed cells of basal layer .</p><p><b>CONCLUSION</b>Autologous fat granules in mixed grafting with autologous microskin promote wound healing.</p>

Protective effects of enalaprilat on the myocardial kinetics in rats at early stage of severe scald / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the therapeutic effects of Enalaprilat on the myocardial kinetics in rats at early stage of severe scald.</p><p><b>METHODS</b>Eighty-four SD rats were inflicted with 30% TBSA full-thickness scald, and randomly divided into scald (S, with intraperitoneal injection of isotonic saline according to Parkland formula, n=30), L (n=30), M (n=12) and H (n=12) groups. The rats in L,M,H groups were intraperitoneally injected with 1,2,4 mg/kg Enalaprilat. Other 6 healthy rats were enrolled into study as control (C group). The myocardial kinetic parameters including left ventricular systolic pressure (LVSP), left ventricular end diastolic pressure (LVEDP), +/- dp/dt max and the levels of A II in myocardium were observed at 1,3,6,12 and 24 post scald hour (PBH) in L and S groups,and at 6,12 PBH in M and H groups. The above indices in C group were also examined.</p><p><b>RESULTS</b>The levels of LVSP, LVEDP, +/- dp/dt max in C group were higher than those in other groups during 3-24 PBH (P < 0.05 or P < 0.01), while those in L,M,H groups were obviously higher than those in S group (P < 0.05 or P < 0.01). The level of +/- dp/dt max in H group at 6,12 PBH were obviously lower than those in L and M groups. The level of A II in S group at 1 PBH was (53.0 +/- 2.6) pg/200 mg, which was significantly higher than thatin C group [(14.8 +/- 0.7) pg/200 mg, P < 0.05 or P < 0.01]; it peaked at6 PBH and lowered afterwards, and they were significantly higher than that in C group at 24 PBH (P < 0.01). The levels of A II in L group during 3-24 PBH were obviously higher than those in C group (P < 0.01), which were also lower than those in S group. The level of A II in S group was significantly higher than in L,M,H groups at 6 PBH [(145.2 +/- 14.5) pg/200 mg. vs. (65.1 +/- 0.9) pg/200 mg, (53.6 +/- 1.1) pg/200 mg, (34.2 +/- 0.9) pg/200 mg, respectively, P < 0.01].</p><p><b>CONCLUSION</b>Myocardium can be obviously damaged at early stage after severe scald,cardiac function is impaired. Enalaprilat injection (especially at low dose) can significantly ameliorate the myocardial kinetics indices, and it seems to exert a protective effect on cardiac function.</p>

Clinical practice and evaluation of relative fluid resuscitation formula at burn shock stage / 中华烧伤杂志

<p><b>OBJECTIVE</b>To evaluate the application of the Third Military Medical University (TMMU) formula for fluid resuscitation on the major burn patients during shock stage.</p><p><b>METHODS</b>Seventy-one thermal injury patients (burn area more than 30% TBSA, without especial illness, hospitalization within 8 hour after burn) admitted from 2005 to 2007 were divided into adult group (n = 46), child group (n = 25). Fluid resuscitation was initiated as per the TMMU formula.</p><p><b>RESULTS</b>All patients survived the first 48 hours post burn injury and none developed recognized complications associated with fluid resuscitation. The average infused fluid was 16% approximately 38% more than the calculated in both adult and child groups. The average urine output during the first 24 hours post burn injury was 1.1 approximately 1.2 mL x kg(-1) x h(-1) in the two groups, but reached 1.2 mL and 1.7 mL x kg(-1) x h(-1) during the second 24 hours in adult and child groups respectively.</p><p><b>CONCLUSION</b>TMMU formula for fluid resuscitation is a feasible option for major burn patients. Individual fluid resuscitation, guided by the physiological response, is also important and necessary.</p>

Role of p38 mitogen activated protein kinase in the regulation of membrane myocardiac phospholipids degradation in early stage of severe burn rat / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the role of p38 mitogen activated protein kinase ( p38 MAPK) in the regulation of cytosolic phospholipase A2 ( cPLA2 ) expression and degradation of membrane phospholipids in myocardium in early stage of burn rats.</p><p><b>METHODS</b>Wistar rats were randomized into normal group (n = 8), burn(n =40) , burn and SB203580(n = 16), burn and isotonic saline( n = 16) groups, with 8 rats at each time-points. There were 5 time-points in burn group, and 2 time-points in other groups. The rats in the latter 3 groups were inflicted with 40% TBSA full-thickness burns, and those in burn and SB203580, burn and isotonic saline groups were administered with SB203580 (p38 MAPK inhibitor) or isotonic saline, respectively. The levels of cPLA2 mRNA and membrane phospholipids in myocardium were detected with RT-PCR. In the same experiment, the effect of SB203580 on cPLA2 expression in rat myocardial cells was determined after hypoxia and burn serum treatment in vitro.</p><p><b>RESULTS</b>The level of myocardial cPLA2 mRNA in burn group at each time-point was obviously higher than those in normal group (0. 280 +/- 0. 020) , and it reached the peak value at 3 PBH. In contrast, the level of cardiac membrane phospholipids was lowered immediately after burns, and it reached the lowest level at 6 PBH [(0. 052 +/- 0. 017) mg phosphorus/mg protein]. Herein, a significant negative correlation was showed between the levels of cPLA2 mRNA and cardiac membrane phospholipids ( r = - 0. 53, P < 0. 05). Administration of SB203580, however, inhibited the increased activity of p38 MAP kinase, suppressed the upregulation of cPLA2(72% and 51% of those in burn and saline group, P <0. 01) , and markedly increased the levels of membrane phospholipids in myocardium at 6 and 12 PBH. In addition, treatment of cardiac myocytes with SB203580 also abolished the upregulation of cPLA2 mRNA elicited by hypoxia and burn serum challenge.</p><p><b>CONCLUSION</b>p38 MAP kinase play an important role in the burn-induced degradation of cardiac membrane phospholipids in rat through the upregulation of myocardial expression of cPLA2 mRNA in the myocardial cells.</p>

Protective effects of administration of enalapril maleate on rat myocardial damage in early stage of burns / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the preventive and therapeutic effects of enalapril maleate (Enalaprilat) (E) on myocardial damage in early stage after burns.</p><p><b>METHODS</b>A total of 60 SD rats were subjected to 30% TBSA III degree scald injury, and randomly divided into scald group (with conventional fluid transfusion after scald) and ENA group (with intraperitoneal injection of 1 mg/kg Enalaprilat after scald). Normal control consisted of 6 rats. Plasma levels of cTnI and CK-MB were determined in all the groups at 1, 3, 6, 12, 24 post-scald hours (PSH) by enzyme linked immunosorbent assay. The pathological changes in myocardium were observed at the same time-points.</p><p><b>RESULTS</b>(1) The serum level of cTnI and CK-MB in scald group were significantly higher than that of normal controls at each time-point (P < 0.01). The serum level of cTnI and CK-MB in ENA group were (1.32 +/- 0.12 microg/L to 2.47 +/- 0.22 microg/L) and (438 +/- 68 U/L to 5569 +/- 322 U/L), respectively, which were obviously lower than those in B group (6.42 +/- 0.96 microg/L to 15.10 +/- 3.69 microg/L) and (2556 +/- 74 U/L to 8047 +/- 574 U/L, P < 0.05 or P < 0.01) at different time-points. (2) Compared with normal controls, cloudy swelling, stromal blood vessel dilatation and congestion inflammatory cell infiltration were observed in scald group, but these pathological changes were less marked in ENA group.</p><p><b>CONCLUSION</b>Severe myocardial damage in rat occurred early after burns. Enalaprilat injection can markedly alleviate myocardial damage.</p>

Changes of respiratory and hemodynamic functions in children with laparoscopic Nissen's fundoplication / 上海第二医科大学学报

Objective To observe the changes of respiratory and hemodynamic functions in children with different age undergoing laparoscopic Nissen's fundoplication(LNF). Methods Thirty-three children with LNF were divided into three groups according to the age: group Ⅰ,1 to 12 months,n=13;group Ⅱ,1 to 3 years old,n=10;and group Ⅲ,4 to 7 years,n=10.Heart rate(HR),mean arterial pressure,Ppeak,compliance of the respiratory system(CRS) and end-tidal carbon dioxide pressure(PETCO2) were recorded 5 min before pneumoperitoneum(T0),10 min(T1),60 min(T2) after pneumoperitoneum and 10 min after deflation(T3),and parameters of blood gas analysis such as PaCO2 were measured at the same time. Results Compared with those at T0,HR,Ppeak,PETCO2 and the difference between PaCO2 and PETCO2(Pa-ETCO2)were significantly increased at T1 and T2,while CRS was significantly decreased.The most significant changes were found in group Ⅰ. Conclusion The changes of respiratory and hemodynamic functions are observed in children undergoing LNF,and anesthesia management should be enhanced for those within 1 to 12 months old who experience the most significant changes.

Effect of ulinastatin on the management of early myocardiac injury after severe burns / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the effect of Ulinastatin on the management of early myocardial injury and its mechanisms.</p><p><b>METHODS</b>Thirty-four severe burn patients with TBSA exceeding 50% were admitted into our hospital within 24 hrs after burns, and they were divided into burn group (n=17) and ulinastatin-treated group (n=17, UTI group). All patients received conventional treatment. The patients in UTI group were given 100,000 U ulinastatin intravenously immediately after admission, 3 times a day for a week. The plasma content of troponin I (cTnI) , creatine kinase (CK-MB) and PMN elastase were determined on 2, 4 and 7 postburn days (PBD), and the correlate relationship among these three indices were analyzed.</p><p><b>RESULTS</b>(1) The plasma content of cTnI and PMN elastase at 2, 4, 7 PBDs were significantly higher than that of normal value (P < 0.01), but they were obviously lower in UTI group than that in burn group. (2) Compared with normal value, the plasma content of CK-MB in burn group was increased significantly on 2, 4 and 7 PBDs (P < 0.01), and it reached the peak on 4 PBD. Though it was obviously higher in UTS group on 2 and 4 PBDs compared with the normal value, but it was lower than that in burn group ( P < 0.05 or 0.01) , and it returned to normal value on 7 PBD. (3) There exhibited positive correlation among the PMN elastase content, cTnI content and CK-MB activity of the 34 patients. The correlation index of PMN elastase content and cTnI content was 0. 904, while that between cTnI content and CK-MB activity was 0.922, and that between PMN elastase content and CK-MB activity was 0.829 (P < 0.01).</p><p><b>CONCLUSION</b>Ulinastatin is beneficial in alleviating myocardial injury after severe burns, and it reduces the release of PMN elastase.</p>

Clinical research of the effect of shengmai injection on the management of "shock heart " after burns / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the effect of Shengmai injection on the management of "shock heart" after burns.</p><p><b>METHODS</b>Twenty patients with severe burns were enrolled in the study and randomly divided into two groups according to the clinical research method, i.e. treatment group (n= 10, with intravenous infusion of 40 ml Shengmai injection together with 250ml 50 g/L glucose solution for 3 days, 1 time/ per day) and control group(n = 10, with intravenous infusion of 290 ml 50 g/L glucose injection liquid for 3 days, 1 time/per day). Beside the venous line used for routine fluid resuscitation for burn shock, another venous line was set up after hospitalization for the administration of the drug. Blood samples were obtained from the femoral vein in both groups at 12 post-burn hour( PBH) , and on 1, 2, 3, 4 and 5 post burn days (PBD) for the determination of serum contents of creatine kinase-MB (CK-MB), lactate dehydrogenase (LDH) and cardiac troponin I (cTnI). The changes in hepatic and renal function, as well as coagulability were determined before drug infusion and on 1 , 2, 3, 5 and 7 PSDs.</p><p><b>RESULTS</b>The serum content of CK-MB, LDH and cTnI reached the peak at 12 PBH in both groups[ (52+/-20)U/L, (5.9+/-1.3) micromol x s(-1) L(-1), (0. 274+/-0. 231) microg/L in treatment group and [(9+/-31)U/L, (8.5+/-1l.8) micromol x s(-1) x L(-1) , (0. 584+/-0. 192) microg/L in control group]. All of them decreased with the passage of time, but in the treatment group they decreased more markedly within 2 or 3 PBD compared with those in control group ( P < 0.05).</p><p><b>CONCLUSION</b>Early administration of Shengmai intravenously is beneficial to the protection of myocardial cells and in the management of the "shock heart" damage.</p>

An experimental study on the influence of hypoxia induction factor-1alpha on the glycolysis of the rat myocardial cell under hypoxic condition / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the influence of hypoxia induction factor-1alpha (HIF-1alpha) on glycosis of rat myocardial cell under hypoxic condition.</p><p><b>METHODS</b>The myocardial cells of the rats were routinely isolated and cultured. The cells were divided into single hypoxia (H) and HIF-1alpha inhibiting (I) groups. The cells in H group were cultured in glucose-free medium with mixed low-oxygen gas [1% O2, 94% N2 and 5% CO2 (v/v)]. While the cells in I group were cultured with low-oxygen gas after the cell model of low expression of HIF-1alpha protein constructed by RNAi technique. The cells in both groups were all observed before hypoxia (routine culture) and at the time points of 1, 3, 6, 12 and 24 hours of hypoxia. The LA (lactate acid ) content in the supernatant of the culture and the activity of the key enzymes in glycolysis such as hexokinase (HK), phosphofructokinase (PFK) and lactate dehydrogenase (LDH) of both groups of cells were determined at all the time points.</p><p><b>RESULTS</b>(1) After hypoxia, the HK and PFK activities of the rat myocardial cells in H and I groups were obviously increased at the beginning and decreased thereafter when compared with that before hypoxia. While the activities of HK and PFK in H group at 1, 3 and 6 hours after hypoxia were evidently higher than those in I group (P <0.05 or 0.01), and the peak activity of them in H and I groups was 159 +/- 13 U/g vs 133 +/- 55 U/g, and 298 +/- 44 U/g vs 188 +/- 55 U/g, respectively. (2) Compared with normal control (92 +/- 12 U/g), the LDH activity of the cells in H group after hypoxia increased significantly, reaching the peak at 6 hours after hypoxia (2 568 +/- 125 U/g, P < 0. 01), and it decreased thereafter, while that in I group peaked at 3 hours after hypoxia (2125 +/- 126 U/g, P <0.01). The LA content in the culture supernatant in H group increased significantly after hypoxia with the passage of time, while that in I group increased in smaller magnitude (P <0.01).</p><p><b>CONCLUSION</b>High expression of HIF-1alpha in the rat myocardial cells after hypoxia could directly cause continuous enhancement of cell glycolysis, which was beneficial to the protection of myocardial cells under hypoxic condition.</p>

Influence of mechanical stretch on the expression of myosin heavy chain mRNA in cardiomyocyte subjected to ischemia and hypoxia / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the influence of mechanical stretch on the expression of myosin heavy chain (MHC) mRNA in cardiomyocyte subjected to ischemia and hypoxia.</p><p><b>METHODS</b>Mechanical stretch model of in vitro cultured cardiomyocyte was established for the study. The cells were processed by non-sugar hypoxic stimuli to simulate postburn ischemic and/or hypoxic injuries. The cells were then divided into normal control (N), 10% stretch (S), ischemic and hypoxic culture (IHC), 10% stretch with ischemia and hypoxia (SIHC) groups. The changes in MHC mRNA expression were observed at 1, 3, 6 and 12 post treatment hours (PTHs) by RT-PCR and were statistically analyzed with gel image analysis software.</p><p><b>RESULTS</b>The expression of both alpha and beta MHC mRNA increased in 10% stretch group, especially of beta MHC mRNA (P < 0.01). The transformation of alpha MHC mRNA to beta MHC mRNA was accelerated in IHC group, and alpha MHC mRNA expression was decreased at 12 PTH. The expression of beta MHC mRNA was increased after ischemia and hypoxia, peaked at 6 PTH, and decreased thereafter (P < 0.05). The transformation of alpha MHC mRNA to beta MHC mRNA was more obvious in SIHC group, and which was intensified along with the elapse of stimulation time. The expression of both alpha and beta MHC mRNA were down-regulated at 12 PTH (P < 0.05).</p><p><b>CONCLUSION</b>Down regulation of MHC mRNA expression by ischemia and hypoxia could be aggravated by mechanical stretch, indicating that mechanical stretch might be a possible cause for cardiac dysfunction.</p>

An experimental study of the intracellular distribution and the activation of mitogen-activated protein kinases in myocardial cells in scalded rats / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the intracellular distribution and the activation of mitogen-activated protein kinases (MAPKs) in myocardial cells in scalded rats.</p><p><b>METHODS</b>Wistar rats were used in this study and forty of them were inflicted with 40% III degree scald on the back and eight normal ones as control. The samples of plasma and myocardial tissue were harvested at 1, 3, 6, 12 and 24 postburn hours (PBHs), and samples were also obtained from normal rats as control. The plasma CK-MB activity was determined by routine method. The activation states of all the members of MAPKs [p38 kinase, ERKs (extracellular signal-regulated protein kinases) and JNK (c-Jun N-terminal kinase)] in the myocardial tissue samples were detected by Western blotting. The tissue slides were stained by immunohistochemistry methods.</p><p><b>RESULTS</b>Activation of p38 kinase and ERK with nuclear translocation was found postburn, especially during 1, 3 and 6 PBHs (P < 0.01). But there was no activation of JNK during 1 - 24 PBHs. The plasma CK-MB content increased at 3 PBH and reached summit at 12 PBHs (P < 0.05 - 0.01).</p><p><b>CONCLUSION</b>p38 kinase and ERK signal pathways might play important roles in the early postburn injury of myocardial cells, inducing myocardial injury.</p>