Multi-center clinical trial of FLAMIGEL (hydrogel dressing) for the treatment of residual burn wound / 中华烧伤杂志

<p><b>OBJECTIVE</b>To evaluate the effect of FLAMIGEL (hydrogel dressing) on the repair of residual burn wound.</p><p><b>METHODS</b>Sixty burn patients with residual wounds hospitalized in 6 burn units from November 2011 to May 2012 were enrolled in the multi-center, randomized, and self-control clinical trial. Two residual wounds of each patient were divided into groups T (treated with FLAMIGEL) and C (treated with iodophor gauze) according to the random number table. On post treatment day (PTD) 7 and 14, wound healing rate was calculated, with the number of completely healed wound counted. The degree of pain patient felt during dressing change was evaluated using the visual analogue scale (VAS). The mean numbers of wounds with score equal to zero, more than zero and less than or equal to 3, more than 3 and less than or equal to 6, more than 6 and less than or equal to 10 were recorded respectively. Wound secretion or exudate samples were collected for bacterial culture, and the side effect was observed. Data were processed with repeated measure analysis of variance, t test, chi-square test, and nonparametric rank sum test.</p><p><b>RESULTS</b>Wound healing rate of groups T, C on PTD 7 was respectively (67 ± 24)%, (45 ± 25)%, and it was respectively (92 ± 16)%, (72 ± 23)% on PTD 14. There was statistically significant difference in wound healing rate on PTD 7, 14 between group T and group C (F = 32.388, P < 0.01). Ten wounds in group T and four wounds in group C were healed completely on PTD 7, with no significant difference between them (χ(2) = 0, P > 0.05). Forty-two wounds in group T and seven wounds in group C healed completely on PTD 14, with statistically significant difference between them (χ(2) = 42.254, P < 0.01). Patients in group T felt mild pain during dressing change for 37 wounds, with VAS score higher than zero and lower than or equal to 3. Evident pain was observed in patients of group C during dressing change for 43 wounds, and it scored higher than 3 and less than or equal to 6 by VAS evaluation. There was statistically significant difference in mean number of wounds with different grade of VAS score between group T and group C (Z = -4.638, P < 0.01). Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, E. coli, Baumanii, and Staphylococcus epidermidis were all detected in both groups, but there was no statistical difference between group T and group C (χ(2) = 0.051, P > 0.05). No side effect was observed in either of the two groups during the whole trial.</p><p><b>CONCLUSIONS</b>FLAMIGEL can accelerate the healing of residual burn wounds and obviously relieve painful sensation during dressing change.</p>

Analysis of the molecular epidemiology and distribution of pathogenic bacteria in burn wards of Ruijin Hospital from 2004 to 2006 / 中华烧伤杂志

<p><b>OBJECTIVE</b>To analyse the distribution, drug resistance and epidemiology of pathogenic bacteria in the burn wards of Ruijin Hospital.</p><p><b>METHODS</b>Seventeen strains of Methicillin resistant staphylococcus aureus (MRSA), 52 strains of Pseudomonas aeruginosa (PA), and 11 strains of Acinetobacter baumannii (AB) isolated from the wound secretion, venous catheters, blood, urine and stool etc. were collected from burn patients hospitalized in our department from January 2004 to December 2006. The distribution and the drug resistance profile of bacteria were analyzed, and the homology analysis was performed by randomly amplified polymorphic DNA (RAPD).</p><p><b>RESULTS</b>MRSA, PA and AB were the major strains in our burn wards in recent years, of which Staphylococcus aureus (SA) was the most dominant. During these 3 years, MRSA accounted for 77% (63/82), 85% (63/74), and 75% (74/99), respectively, for SA isolated in this period. MRSA was resistant to Amikacin, Gentamicin, Erythromycin, Clindamycin and Levofloxacin; PA was resistant to Amikacin, Gentamicin, Piperacillin, Ceftazidime, Cefoperazone, Aztreonam and Imipenem; AB was resistant to Amikacin, Gentamicin, Piperacillin, Ceftazidime, Imipenem and Ciprofloxacin. Three bacteria were found to belong to the same type in the RAPD homology analysis.</p><p><b>CONCLUSIONS</b>There are many kind of multi-drug resistant pathogenic bacteria for nosocomial infection in our burn wards. To control the spread of infection due to above-mentioned 3 bacteria is the focus of nosocomial infection control.</p>

Protective effect of lytic cocktail (inhibition of stress) on lung injury in severe burn rat / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the protective effect of inhibition of stress (lytic cocktail) on lung injury in severe burn rats at early stage.</p><p><b>METHODS</b>Sprague-Dawley rats inflicted with 30% TBSA full-thickness burn were randomly divided into A group (n = 36, fluid resuscitation with administration of lytic cocktail), B group (n = 36, fluid resuscitation only). Lung function was evaluated by partial pressure of oxygen (PaO2) in arterial blood and histopathologic changes on 3, 5, 7, 10 post burn day (PBD). The levels of malonyldialdehyde (MDA), myeloperoxidase (MPO), tumor necrosis factor-alpha(TNF-alpha) and interferon-gamma (IFN-gamma) in lung tissue were measured at the same time points.</p><p><b>RESULTS</b>The PaO2 level in A group on 3 PBD (12.58 +/- 0.41 kPa) was significantly higher than that in B group (8.86 +/- 0.23 kPa, P < 0.01). Compared with those in B group, the levels of MDA and MPO were significantly decreased in A group at each time point (P < 0.05 or 0.01), the levels of TNF-alpha on 3, 5, 7 PBD (P < 0.05 or 0.01) and IFN-gamma on 5, 7, 14 PBD (P < 0.01) were also decreased in A group. Swollen lung mesenchyme was alleviated, infiltration of inflammatory cell was lessened in A group.</p><p><b>CONCLUSION</b>Lytic cocktail combined with immediate fluid resuscitation can inhibit stess response, downregulate the expression of inflammatory factor, ameliorate lung function in severe burn rat at early stage.</p>

Analysis of methicillin resistant Staphylococcus aureus in burn ward of Ruijin hospital / 中华烧伤杂志

<p><b>OBJECTIVE</b>To analyze the epidemiology of methicillin resistant Staphylococcus aureus (MRSA) in molecular level in burn centre of Shanghai Ruijin hospital.</p><p><b>METHODS</b>The vicissitude of Staphylococcus aureus in the burn centre from 2003 to 2005 was analyzed with software WHONET5. Multiprimer random amplified polymorphic DNA(RAPD) was used to analyze the homology of 17 MRSA strains.</p><p><b>RESULTS</b>RAPD analysis (primer ERIC2 and RAPD7) showed that all 17 MRSA strains were identical (Burn-A type).</p><p><b>CONCLUSION</b>MRSA with same RAPD type is prevalent in our burn centre for many years, so emphasis should be laid on the anti-infection therapy and its cross infection control. Staphylococcus aureus;</p>

Influence of stress inhibition on invasive infection in burn wound during early postburn stage in severely burned rats / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the influence of inhibition of stress on the survival rate, organ dysfunction and (Th)1/Th2 cytokine profiles of the rats with invasive infection in the wound at early postburn stage.</p><p><b>METHODS</b>Sprague-Dawley rats inflicted with 30% TBSA full thickness burn were randomly divided into A (n = 36, with immediate resuscitation), B (n = 36, with immediate resuscitation and lytic cocktail administration). After subeschar injection of 0.1 ml Pseudomonas aeruginosa (10(8) CFU/ml) on 3rd postburn day, the subeschar bacterial quantitative analysis, the survival rate at 96 hours after bacteria injection, the parameters of organ dysfunction and the mRNA expression of IL-2, IL-4, IL-10 and IFN-gamma were determined by corresponding methods.</p><p><b>RESULTS</b>The quantity of subeschar bacteria was larger than 1 x 10(5)/gram in both groups. The survival rate in B group (66.7 +/- 2.6)% was obviously higher than that in A group (33.3 +/- 1.7)%, (P < 0.01). Inflammatory infiltration and pathological changes in the internal organs in B group were alleviated obviously compared with A group. The expression of IL-2 mRNA in B group was significantly lower than that in A group before bacterial inoculation, but increased at 48 and 96 hours after bacterial inoculation, while it was lowered in A group at the same time points (P < 0.05). The expression of IFN-gamma mRNA in A group was significantly lower than that in B group (P < 0.01), while that of IL-4 and IL-10 mRNA in A group was evidently higher than that in B group (P < 0.05 approximately 0.01).</p><p><b>CONCLUSION</b>Inhibition of the stress response during early postburn stage could be beneficial to the prevention of the bacterial invasion due to the changes in Th1/Th2 ratio.</p>