Plasma gelsolin level and its relationship with the prognosis of patients with severe burns / 中华烧伤杂志

<p><b>OBJECTIVE</b>To observe the changes in plasma gelsolin (pGSN) level of patients with severe burn and to explore its relationship with sepsis and death of patients.</p><p><b>METHODS</b>One hundred and two patients with total burn area equal to or larger than 30% TBSA hospitalized from May 2010 to May 2012 were included as burn group. Twenty-five healthy volunteers were recruited as healthy control group. Peripheral venous blood of patients was harvested on post burn day (PBD) 1, 3, 7, 14, and 21 to determine the pGSN level with double antibody sandwich ELISA kits, and the same maneuver was carried out in healthy volunteers. (1) Patients in burn group were divided into three groups by burn size: small burn area group (30% - 49% TBSA, n = 39), medium burn area group (larger than 49% and smaller than or equal to 69% TBSA, n = 33), and large burn area group (larger than 69% and smaller than or equal to 99% TBSA, n = 30). (2) According to diagnostic criteria of burn sepsis, patients in burn group were divided into sepsis group (n = 43) and non-sepsis group (n = 59). (3) According to the prognosis of patients with sepsis, patients in sepsis group were further divided into non-survival sepsis group (n = 14) and survival sepsis group (n = 29). The levels of pGSN in above groups were compared, and their relationship with sepsis and death of patients was analyzed. Data were analyzed with analysis of variance, LSD test and one-way Logistic regressions.</p><p><b>RESULTS</b>(1) Levels of pGSN in burn group were obviously lower than those of healthy control group on PBD 1, 3, 7, 14, and 21 (with F values respectively 140.01, 369.52, 702.15, 360.14, 84.16, P values all below 0.01). (2) The mean levels of pGSN in large, medium, and small burn area groups at five time points were (43 ± 11), (85 ± 23), (124 ± 38) mg/L, showing statistically significant differences among them (F = 367.76, P < 0.01), and they were all lower than that of healthy control group [(326 ± 51) mg/L, P values all below 0.01]. (3) The mean levels of pGSN in sepsis group and non-sepsis group at the five time points were (77 ± 12), (122 ± 38) mg/L. Levels of pGSN in sepsis group were lower than those in non-sepsis group on PBD 3, 7, 14, and 21 (with F values respectively 30.35, 111.59, 209.36, 422.76, P values all below 0.01). (4) The mean levels of pGSN in non-survival sepsis group and survival sepsis group at the five time points were (53 ± 8) and (103 ± 25) mg/L. Levels of pGSN in non-survival sepsis group were lower than those in survival sepsis group on PBD 1, 3, 7, 14, and 21 (with F values respectively 9.05, 18.48, 41.34, 107.11, 180.48, P values all below 0.01). (5) Logistic regression analysis showed that the level of pGSN is the independent risk factor related to the complication of sepsis (odds ratio: 5.44, 95% confidence interval: 2.35 - 12.74, P < 0.01) and death (odds ratio: 5.52, 95% confidence interval: 2.34 - 12.19, P < 0.01) in burn patients.</p><p><b>CONCLUSIONS</b>Severe burn injury could down-regulate the pGSN level of patients, and it decreases along with the increase in the area and severity of burn trauma. pGSN level appears to be an early prognostic marker for patients suffering from severe burns.</p>

Epidemiological studies on close contacts of smear-positive tuberculosis patients in Shijiazhuang city from 2007 to 2008 / 中华预防医学杂志

<p><b>OBJECTIVE</b>To analyze the incidence of tuberculosis (TB) in people who were in close contact with smear-positive TB patients.</p><p><b>METHODS</b>A total of 19 159 subjects, including 17 334 family members and 1825 classmates of patients, in close contact with 6653 smear-positive TB patients in Shijiazhuang city from 2007 to 2008 were observed. All the classmates were tested by purified protein derivative (PPD) test and symptom screening, and all family members were screened by symptoms. All these subjects were trained with knowledge related to TB. The ones with positive PPD test and suspected TB symptoms were further examined by chest X-ray and sputum smear microscopy, and those without any symptom were followed up monthly throughout a two year period and were examined at any time if symptoms occurred.</p><p><b>RESULTS</b>A total of 281 patients with pulmonary TB were diagnosed in 2 years, including 176 family members and 105 classmates in all close contacts. The smear-positive incidences were 1466.67/100 000. The incidences for 14 - 25 years old group and more than 75 years old group were 2907.18/100 000 (83/2855) and 2650.96/100 000 (18/679), which were higher than those for other groups. Two higher incidences were related to close contact time periods of 6 months (929.07/100 000, 178/19 159) and 13 - 18 months (369.12/100 000, 70/18 964). Three highest incidences were observed in the roommates (11 384.62/100 000, 37/325), classmates (4533.33/100 000, 68/1500) and couples (1624.17/100 000, 86/5295).</p><p><b>CONCLUSION</b>Closer contact with smear-positive patients with TB may result in the higher chance of TB. Close contact for 6 months or 13 to 18 months caused more patients, and the 14 - 25 years old group and more than 75 years old group had higher incidences of TB.</p>

Influence of CD14 gene polymorphism on the expression of high mobility group box-1 protein in patients with severe burn / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the influence of the lipopolysaccharide receptor CD14-159C/T gene polymorphism on the synthesis and release of high mobility group box-1 protein (HMGB1), and its relation to sepsis in patients with severe burn.</p><p><b>METHODS</b>Venous blood from 35 patients with burn area equal to or larger than 30% TBSA was obtained on post burn day (PBD) 1, 3, 5, 7, 14, 21, and 28 respectively. Eleven volunteers were enrolled as healthy control group (HC).CD14-159C/T gene polymorphism was detected with polymerase chain reaction (PCR)-restriction fragment length polymorphism analysis. Plasma level of HMGB1 was determined with ELISA. Leukocyte HMGB1 mRNA expression was determined with RT-PCR. Data were processed with chi(2) test, analysis of variance, and t test.</p><p><b>RESULTS</b>Among the C-159T genotype of CD14 gene in the 35 patients, the distribution frequency of the T and the C allele was respectively 57.2% and 42.8%. Seven cases (20.0%) were homozygous for the C allele (CC), 16 cases (45.7%) were heterozygous (TC), and 12 cases (34.3%) were homozygous for the T allele (TT). Allele and genotype frequencies in cases were testified as reaching the Hard-Weinberg equilibrium. The incidence of sepsis was markedly lower in CC homozygous patients than in TC heterozygous and TT homozygous patients. Only one of the 3 septic patients in CC homozygous type died; 4 of 9 septic cases in TC heterozygous type and 4 of 7 septic cases in TT homozygous type died. Plasma levels of HMGB1 of patients were significantly elevated early on PBD 1 as compared with HC group, and higher values were found in TC heterozygous and TT homozygous patients than that in CC homozygous patients on PBD 14, 21, 28 (with F value respectively 3.5671, 4.2035, 3.8529, P < 0.05 or P < 0.01). Higher HMGB1 mRNA expression was found in septic patients as compared with non-sepsis patients on PBD 14 (1.5 +/- 0.5 vs. 1.2 +/- 0.4, t = -2.205, P < 0.05). Plasma level of HMGB1 was also respectively higher in septic patients than in non-sepsis patients on PBD 7, 21 [(44 +/- 29) ng/mL vs. (26 +/- 12) ng/mL, t = -2.355, P < 0.05; (25 +/- 15) ng/mL vs. (10 +/- 6) ng/mL, t = -3.872, P < 0.01)].</p><p><b>CONCLUSIONS</b>CD14C-159T gene polymorphism might markedly influence the synthesis and release of HMGB1, and it is associated with increase in susceptibility of sepsis in patients with severe burn.</p>

Study on the correlation between CD14 gene polymorphism and T cell-mediated immunity in severely burned patients / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the correlation between CD14 gene polymorphism and T cell-mediated immunity in severely burned patients.</p><p><b>METHODS</b>The blood samples of 77 patients with extensive burn injury (> 30% total body surface area) were collected, and CD14-159C/T gene polymorphism was determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). T lymphocyte cell proliferation and interleukin-2 (IL-2) production were determined, and the ratio of CD4(+)/CD8(+) T lymphocyte as well as apoptosis of CD4(+) T lymphocyte was examined by flow cytometry.</p><p><b>RESULTS</b>The ability of T lymphocyte proliferation was obviously decreased in severely burned patients. Compared with CC homozygote patients, proliferative activity of T lymphocyte to mitogen stimulation was significantly depressed in TT and TC patients on post burn days 5, 21, and 28 (P < 0.05 or P < 0.01). IL-2 production in TT, TC patients was constantly in low level after burns, while it was increased from post burn day 14 in CC patients. The ratio of CD4(+)/CD8(+) T lymphocytes was markedly decreased in TC, TT patients than that in CC patients, especially on post burn days 1, 3, 14, 21, and 28 (P < 0.05 or P < 0.01). Meanwhile, compared with CC homozygote patients, the apoptosis rates of CD3(+)CD4(+) T lymphocytes were much higher in TT patients on post burn days 5, 7, and 21 (P < 0.05), and in TC patients on days 7, 14 (P < 0.05), respectively. However, no obvious differences in parameters of immune function of T lymphocytes were found between TT and TC patients (P > 0.05).</p><p><b>CONCLUSION</b>CD14-159C/T polymorphism could influence the T cell-mediated immunity in extensively burned patients, which might participate in the development of septic complications secondary to major burns.</p>

Repair of occipital and nuchal wounds with inferior trapezius myocutaneous flaps in patients after high voltage electrical burn / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore the methods and effects of repair of occipital and nuchal wounds with inferior trapezius myocutaneous flap after deep electrical bum.</p><p><b>METHODS</b>Twelve patients with high-voltage electrical burn in occipital and nuchal regions were hospitalized to our ward from March 2003 to September 2007. They were repaired with improved inferior trapezius myocutaneous flaps after debridement. Flaps were of two types: (1) blood supply from cutaneous and perforator branches of the original segment of the superficial descending branch of transverse cervical artery. (2) combined blood supply from both superficial and deep descending branches of transverse cervical artery C, i.e., dorsal scapular artery). All flaps carried segmental and limited trapezius muscle cuff surrounding the vascular pedicle of the flap similar to a perforator flap.</p><p><b>RESULTS</b>Flaps survived completely primarily in eight cases. In two patients, infection developed in flaps adjacent to wounds with lignification; they healed after dress change. Necrosis appeared in distal end of flap (one case), it healed after re-operation. One patient with surviving flaps died of sepsis and multiple organ failure 21 days after operation. The flaps which survived were not swollen ; the donor sites at scapular region looked normal without pterygoid or pendulous scapula deformities.</p><p><b>CONCLUSION</b>Inferior trapezius myocutaneous flaps can be used to repair occipital and nuchal wounds, with the advantages of constant blood vessels, reliable blood supply, convenience for application.</p>

Change in T cell-mediated immunity and its relationship with high mobility group box-1 protein levels in extensively burned patients / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the change in T cell-mediated immunity and its relationship with plasma high mobility group box-1 protein (HMGB1) levels in severely burned patients.</p><p><b>METHODS</b>Thirty-five extensively burned patients (> 30% total body surface area) were included in this study, and were divided into MODS group (n = 13) and non-MODS group (n = 22). The blood samples were collected on post burn days 1, 3, 5, 7, 14, 21 and 28. The plasma levels of HMGB1 were measured by using ELISA, and T lymphocyte proliferation response and its IL-2 production ability in peripheral blood were determined too. In addition, the ratio of CD4+/CD8+ T cells were detected by using flow cytometry.</p><p><b>RESULTS</b>Plasma HMGB1 levels were markedly elevated on post burn day 1 in severely burned patients, and HMGB1 level was significantly higher in MODS group than in non-MODS group (P < 0.05). Lymph proliferation response and IL-2 production of T cells in peripheral blood, and the ratio of CD4+/CD8+ T cells in MODS group were markedly lower than those in non-MODS group on post burn days 1, 14, 21 and 28 (all P < 0.05). It indicated that plasma HMGB1 levels were negatively correlated to T cellular immune function parameters, including lymphocyte proliferation response, IL-2 production, and the ratio of CD4+/ CD8+ T cells in extensively burned patients (all P < 0.05).</p><p><b>CONCLUSIONS</b>Extensive burns could lead to T cellular immune dysfunction, which appears to be associated with the development of MODS. HMGB1, as an important late mediators of inflammation, might be involved in the pathogenesis of suppression of T cell-mediated immunity in these patients.</p>

Study on the relationship between the human leucocyte antigen-DR expression on CD14+ monocytes and sepsis / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the changes in the expression of HLA-DR on CD14+ monocytes of burn patients with delayed resuscitation, and to analyze the relationship between it and sepsis.</p><p><b>METHODS</b>Twenty-five patients with total burn surface area over 30% TBSA and delayed resuscitation were enrolled in the study, among which 7 were complicated by sepsis during hospitalization. Peripheral blood was collected on 1, 3, 7, 14 and 28 post-burn days (PBD), and the blood of the patients with sepsis were also collected on the 1 and 2 days after the occurrence of sepsis. Twenty healthy volunteers were enrolled as controls. Expression rate of HLA-DR on CD14+ monocytes was determined by flow cytometry. The level of TNF-alpha and IL-10 were measured by ELISA.</p><p><b>RESULTS</b>Expression rate of HLA-DR antigen on CD14+ monocytes in burn patients without sepsis on 1, 3, 7, 14, 28 PBD were (15 +/- 6)%, (7 +/- 5)%, (26 +/- 17)%, (28 +/- 16)% and (47 +/- 16)%, respectively, which were obviously lower than that of healthy people [(92 +/- 10)%, P < 0.01], and it was also markedly lower on 1 and 2 days after the occurrence of sepsis than that of controls and those of patients without sepsis on 1, 7, 14, 28 PBD (P < 0.01). The positive rate and concentration of TNF-alpha in patients with sepsis were obviously higher than that of healthy people and patients without sepsis (P < 0.05 or P < 0.01). There was a negative correlation between the expression rate of HLA-DR on CD14+ monocytes and IL-10 levels, and it showed significant difference on 1, 7, and 28 PBD (r = -0.9963, -0.7459, -0.8474, respectively, P < 0.01).</p><p><b>CONCLUSION</b>Immune function is suppressed and proinflammatory mediators are excessively released in severely burn patients after delayed resuscitation, especially when complicated with sepsis. Expression of HLA-DR on CD14+ monocytes may be an useful parameter for monitoring the immune function of burn patients.</p>

Expression of matrix metalloproteinase-2, -9 and their inhibitor-1 in hypertrophic scars / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the gene expression of matrix metalloproteinases (MMP-2, MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) in proliferative and mature hypertrophic scars.</p><p><b>METHODS</b>Total RNA from 8 normal skin samples and from 16 human hypertrophic scar samples of different maturing stage was respectively extracted, and then mRNA was isolated. The gene expressions of MMP-2, MMP-9 and TIMP-1 in these samples were examined with reverse transcription-polymerase chain reaction (RT-PCR).</p><p><b>RESULTS</b>The gray scale ratio of MMP-2, MMP-9 and TIMP-1 transcription in normal skin were (3.8 +/- 0.7)%, (5.8 +/-4.4)%, (30.3 +/- 3.0)%, respectively, which were obviously higher than those in proliferative hypertrophic scar [(14 +/- 5)%, (18 +/- 5)%, (38 +/- 4)%, P < 0.05]. The expression of MMP-2 and MMP-9 genes in mature hypotrophic scar returned to normal level, but that of TIMP-1 remained high when compared with that of normal level (P < 0. 05).</p><p><b>CONCLUSION</b>The increase in MMP-2, MMP-9 and TIMP-1 gene expression might be involved in the formation of hypertrophic scars, while the lowering of MMP-2 and MMP-9 gene expression might be associated with the maturation of hypertrophic scars.</p>

The clinical significance of changes in immunological function of T lymphocyte in severe burn patients with sepsis / 中华烧伤杂志

<p><b>OBJECTIVE</b>To observe the immunological function changes in T lymphocyte in severe burn patients with sepsis, and to explore its relationship with sepsis.</p><p><b>METHODS</b>Fifty-nine burn patients with burn surface exceeding 30% TBSA were enrolled in the study, and they were divided into sepsis group (S, n =43) and non-sepsis group (NS, n = 16). The peripheral venous blood samples of the patients in both groups were collected on 1, 3, 5, 7, 14, 21 and 28 post-burn days (PBD). The T lymphocyte proliferation ability and the interleukin-2 (IL-2) level in both groups were observed and the correlation between them were analyzed. The percentage of CD3+/CD4+ T lymphocytes and its apoptosis rate were determined by flow cytometry and the correlation between them was analyzed.</p><p><b>RESULTS</b>Compared with that in NS group, the proliferation ability of T lymphocyte and the level of IL-2 were significantly decreased in patients in S group on 1, 14, 21, and 28 PBD (P < 0.05 or P < 0.01). The inhibition of T lymphocyte proliferation was positively correlated to the low level of IL-2 production in burn patients (r = 0.82, P < 0.01). The percentage of CD3+/CD4+ T lymphocytes in S group were obviously lower than that in NS group on 1, 5, 14, 21, 28 PBD, whereas on opposite tendency in the apoptosis rate of CD3+ CD4+ T lymphocytes were found at the same time (P < 0.05 or P < 0.01). The percentage of CD3+/CD4+ T lymphocytes was negatively correlated to apoptosis rate of T lymphocytes (r = -0.66, P < 0.05).</p><p><b>CONCLUSION</b>The immunological function of T lymphocyte in severely burn patients with sepsis is depressed persistently. Apoptosis of T lymphocyte may participate in the pathological process of cell immunological disorder induced by sepsis.</p>

Clinical significance of changes in quantitative expression of human leukocyte antigen DR in severely burned patients / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical significance of kinetic changes in quantitative expression of human leukocyte antigen DR (HLA-DR) in severely burned patients.</p><p><b>METHODS</b>The blood samples of 77 extensively burned patients (>30% of total body surface area) were serially collected in the present study. The expression of HLA-DR on CD14(+) mononuclear cell surface in burned patients were quantified by flow cytometry (using monoclonal antibody, QuantiBRITETM Anti-HLA-DR PE(*)/Anti-Monocyte PerCP-Cy5.5) on days 1, 3, 5, 7, 14, 21 and 28 post burn.</p><p><b>RESULTS</b>The expressions of HLA-DR on CD14(+) mononuclear cell surface in severely burned patients were significantly lower than those in healthy volunteers from the first day post burn (P < 0.05), and the value of HLA-DR expression was negatively correlated with the burned area (r = -0.7232, P < 0.05). The expression of HLA-DR in patients complicated with multiple organ dysfunction syndrome (MODS) was persistently decreased following major burns, and it was significantly lower than that of non-MODS patients on days 3, 14, 21 and 28 post burn (P < 0.05). The incidence rate of MODS rose markedly along with the lowering of HLA-DR expression, accompanied with poorer prognosis.</p><p><b>CONCLUSIONS</b>Extensive burns could result in marked damage in expression of HLA-DR on CD14(+) mononuclear cell surface and immunologic dysfunction. Quantitative measurement of HLA-DR expression might be of significance in forecasting the development of MODS and prognosis in extensively burned patients.</p>

Effects of the escharectomy during burn shock stage on expression of glucose translator-4 mRNA in skeletal muscle and adipose tissue / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of the escharectomy during burn shock stage on expression of glucose translator-4 (GLUT4) mRNA in skeletal muscle and adipose tissue.</p><p><b>METHODS</b>30% TBSA scalded rats were employed. Escharectomy were conducted at 8 h, 24 h, 168 h after burns respectively. Insulin, glucagon, cortisol and glucose levels in serum were analyzed. RT-PCR were employed to analyze GLUT4 mRNA expression in skeletal muscle and adipose tissue.</p><p><b>RESULTS</b>Glucagon, cortisol and glucose levels in serum were declined in groups which escharectomy were conducted during burn shock stage. GLUT4 mRNA expression in both skeletal muscle and adipose tissue were downregulated after burns and escharectomy conducted during burn shock stage made it restored to near normal.</p><p><b>CONCLUSION</b>GLUT4 mRNA expression will declined after major burns in skeletal muscle and adipose tissue. Escharectomy during shock stage could make it upregulated, which will be helpful to improve glucose metabolism and hypermetabolism after major burns.</p>