Effect of nonpeptide NK1 receptor antagonist L-703,606 on the edema formation in rats at early stage after deep partial-thickness skin scalding

OBJECTIVE@#To investigate the effect and the relevant potential mechanism of nonpeptide neurokinin 1 (NK1) receptor antagonist L-703,606 in the edema formation after burn injury.@*METHOD@#L-703,606 treatment was performed in Sprague-Dawley (SD) rats at early stage after deep partial-thickness skin scalding. One hundred and fifty two adult male SD rats were used in the study and randomly divided into sham scald (SS, n=8), scald control (SC, n=48), and L-703,606 treatment (LT, n=48) groups. The rats in SC and LT groups were subjected to 20% total body surface area (TBSA) deep partial-thickness skin scalding. Modified Evans blue extravasation, tracing electron microscopy by lanthanum nitrate and mean water content assay were employed to observe and detect the changes of vascular permeability, ultrastructure and edema formation in adjacent tissue to the wounds and in the jejuna of rats at early stage (72 h) after scald.@*RESULTS@#The pathological increase of vascular permeability in the periwound tissue and jejunum of rats in LT group were significantly lower than that in SC group (P<0.01), and recuperated earlier. Meanwhile, the changes of water contents of corresponding tissues in LT group were lighter than those in SC group (P<0.01). The ultrastructural changes of the microvessels in the peri-wound tissue of LT group showed that the junctions between microvascular endothelium cells were more narrow than those of SC group, moreover, and the number of opening and the engorgement and cavitation of the vascular endothelium cells decreased, the areosis and edema in perivascular tissue lightened, and the precipitation of the high eletron density lanthanum tracing agent in the interspace of the tissue decreased significantly in LT group.@*CONCLUSIONS@#It is concluded that nonpeptide NK1-receptor antagonist L-703,606 could lighten the vascular permeability and edema formation in the periwound tissue and jejunum, and accelerate the normalization process of pathological changes in the tissues of rats after scald.

Systemic therapy for defects of skin and soft tissue on the knees after severe trauma or burn / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore the methods of systemic treatment of defects of skin and soft tissue on the knees after severe trauma or burn.</p><p><b>METHODS</b>Twenty patients with defects of skin and soft tissue on the knees after severe trauma or burn hospitalized in our center from January 2009 to December 2011. The injury areas on the knees ranged from 5 cm×4 cm to 30 cm×20 cm. The wounds were treated with radical debridement, vacuum sealing drainage, and douche through dripping to control infection in early stage. Then they were covered with transplantation of skin grafts plus flap or only with flap. Totally 8 local flaps (including 6 local rotation or transposition flaps and 2 saphenous artery flaps) and 12 free flaps (including 8 anterolateral thigh flaps and 4 latissimus dorsi musculocutaneous flaps) were used. The flap size ranged from 6 cm×5 cm to 32 cm×22 cm. The rehabilitation training of the knee joints was carried out in the early stage after wound healing.</p><p><b>RESULTS</b>All free skin grafts and flaps used in 15 patients survived. Thirteen of them were primarily healed, while some small parts of skin grafts of the other two patients were in poor condition because of infection, and they healed after another session of skin transplantation. Infection occurred under the free flap in one of the 5 patients transplanted with flaps only, which was healed after continuous douche through dripping and another surgical debridement following wet dressing. The knee joints were in good function during the follow-up period of 1 - 3 years.</p><p><b>CONCLUSIONS</b>The systemic therapy of radical debridement, vacuum sealing drainage technique, douche through dripping, transplantation of large autologous grafts and flaps, and the early rehabilitation training are effective and reliable in repairing defects of skin and soft tissue at the knee region after severe injuries.</p>

Repair of extensive deep burn wounds in late stage with free muscle flap / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore the means for the reconstruction of extensive deep burn wounds with exposure of bone and joint in late stage.</p><p><b>METHODS</b>Among all the patients with extensive deep burn hospitalized between January 2009 and May 2011, 5 patients presented wounds with exposure of bone and joint in the late stage of treatment that could not be covered by free skin grafts or flaps. Two of the five patients had more than 2 and the other 3 patients had only one such wound(s). The wound size ranged from 8 cm×5 cm to 21 cm×8 cm. Wounds were repaired by transplantation of 7 free muscle flaps (including 4 free rectus abdominis flaps and 3 latissimus dorsi flaps) combined with split-thickness skin grafts harvested from scalp.</p><p><b>RESULTS</b>All the muscle flaps and skin grafts survived. Wounds with bone and joint exposure healed well. At one-year follow-up of some patients, good appearance of repaired areas and normal function of joints were observed with no signs of ulceration, arthritis, or osteomyelitis.</p><p><b>CONCLUSIONS</b>Transplantation of free muscle flaps combined with split-thickness skin grafts harvested from the scalp provides satisfactory reconstruction for wounds with deep tissue exposure in patients with a shortage of skin donor site.</p>

Effect of heat injured keratinocytes supernatant on biological behavior of fibroblasts / 中华烧伤杂志

<p><b>OBJECTIVE</b>To observe the effect of the supernatant of heat injured keratinocytes (KC) on biological behavior of the dermal fibroblasts (Fb).</p><p><b>METHODS</b>Human dermal Fb were isolated and cultured. A model of heat injured KC (HaCaT) was reproduced in vitro. Supernatant of normal KC and the supernatant of KC culture 12 hours after heat injury were collected and diluted with non-serum DMEM in 1:1 volume ratio to make normal KC conditioned medium (NKCM) and heat injury KC conditioned medium (HKCM) respectively. Fb was respectively treated with non-serum DMEM and 2 kinds of conditioned medium. (1) The proliferation of Fb was detected with MTT method at post culture hour (PCH) 12, 24, 36, 48. (2) The apoptosis of Fb was determined by flow cytometry at PCH 12 (Fb were heat injured in advance; Fb without heat treatment was used as control). (3) At PCH 24, expression of a-SMA in Fb cytoplasm was determined with immunofluorescence method; expression of a-SMA mRNA in Fb was determined with real-time quantified PCR. Data were processed with one-way analysis of variance, and pairwise comparison among groups with LSD-t test.</p><p><b>RESULTS</b>(1) The proliferation of Fb: the absorbance value of Fb cultured with HKCM at PCH 12, 24, 36, 48 was respectively higher than that of Fb cultured with non-serum DMEM (with t value respectively 1.89, 2.35, 2.02, 1.94, and P values all below 0.01). There were significant statistical differences between the absorbance values of Fb cultured with HKCM and those of Fb cultured with NKCM at PCH 12, 24, and 48 (at PCH 12, t = 1.83, P < 0.01; at PCH 24, t = 2.91, P < 0.05; at PCH 48, t = 1.83, P < 0.05). (2) Apoptosis of Fb cultured with HKCM was diminished as compared with that of Fb cultured with NKCM and of Fb without treatment (t = 3.31, P < 0.05; t = 1.47, P < 0.01). (3) The expression of alpha-SMA (red fluorescence) in Fb cultured with non-serum DMEM or NKCM was less as seen under fluorescence scope, and it was obviously increased in Fb cultured with HKCM. (4) The relative expression amount of alpha-SMA mRNA in Fb cultured with HKCM was 1.32 +/- 0.06, which was higher than that both in Fb cultured with NKCM (1.14 +/- 0.07, t = 2.51, P < 0.05) and in Fb cultured with non-serum DMEM (1.00 +/- 0.09, t = 1.77, P < 0.05).</p><p><b>CONCLUSIONS</b>The supernatant of KC 12 hours after heat injury can obviously promote the proliferation of Fb, inhibit its apoptosis and accelerate transdifferentiation of Fb to myofibroblasts.</p>

Inhibitory effect of insulin on nuclear factor-kappa B nuclear translocation of vascular endothelial cells induced by burn serum / 中华烧伤杂志

<p><b>OBJECTIVE</b>To study the inhibitory effects of insulin on nuclear factor-kappa B (NF-kappaB) nuclear translocation of vascular endothelial cells induced by burn serum and its correlative mechanism.</p><p><b>METHODS</b>Human umbilical vein endothelial cells (HUVECs) were cultured in vitro and divided into 5 groups: blank control group (BC, ordinary culture without any stimulation), normal serum control group (NS, cultured with nutrient solution containing 20% healthy human serum), burn serum stimulation group (BS, cultured with nutrient solution containing 20% burn human serum), burn serum+insulin treatment group (BI, cultured with nutrient solution containing 20% burn human serum and 1x10(-7) mol/L insulin), inhibitor pretreatment group [IP, pretreated with 50 micromol/L protein kinase B (Akt) specific inhibitor LY-294002, then cultured with the same medium as used in BI group 30 minutes later] according to the random number table. Six hours later, the injury and apoptosis of HUVECs was respectively observed by the scanning electron microscope and determined by the flow cytometry. Meanwhile, the phosphorylation of inhibitor kappa B-alpha (p-IkappaB-alpha) and Akt (p-Akt) in cytoplasm, and the content of NF-kappaB-p65 in nucleus were determined with Western blot.</p><p><b>RESULTS</b>(1) Compared with those in BC group, HUVECs in BS group shrank obviously with irregular nuclear structure, and intercellular links jagged or vanished. Slight change was observed in HUVECs structure in NS and BI groups, with the cell ductility and nuclear structure much better than those in BS group. (2) The apoptosis rates of HUVECs in BS group [(28.5+/-2.3)%], BI group [(22.3+/-1.8)%], and IP group [(29.7+/-2.4)%] were all obviously higher than that in BC group [(15.7+/-2.2)%, F=14.288, P<0.05 or P<0.01]. There was no significant statistical difference between NS group [(17.0+/-2.5)%] and BC group in apoptosis rate (F=14.288, P>0.05). The apoptosis rate of HUVECs in BI group was obviously lower than that in BS group (F=14.288, P<0.05). (3) Compared with those in BC group, the protein expressions of p-IkappaB-alpha in cytoplasm and NF-kappaB-p65 in nucleus were up-regulated, and the protein expression of p-Akt in cytoplasm was down-regulated in BS and IP groups. The expression levels of the three proteins in NS and BI groups were close to those in BC group.</p><p><b>CONCLUSIONS</b>Insulin could inhibit the IkappaB phosphorylation, and then restrict NF-kappaB nuclear translocation and improve the vascular endothelial cells function accordingly through regulating phosphatidylinositol 3 kinase/Akt pathway.</p>

Repair of devastating wounds with free composite tissue flap / 中华烧伤杂志

<p><b>OBJECTIVE</b>To study the safety and effects of free composite tissue flaps in repairing devastating wounds in early stage.</p><p><b>METHODS</b>One hundred and twenty-three patients with 128 devastating wounds hospitalized in our burns center from 2005 to 2009 were repaired with free flaps or composite tissue flaps. Flap types used included 58 latissimus dorsi muscular flaps, 32 anterolateral thigh flaps, 21 circumflex scapular flaps, 6 dorsalis pedis composite flaps, 3 big toe nail skin flaps, 3 forearm flaps, and 1 lateral thoracic flap. One wound was repaired with lateral lower leg flap with fibula, and 3 wounds with free latissimus dorsi muscular flap plus skin graft.</p><p><b>RESULTS</b>Vascular crisis was observed in 10 transplanted flaps 1 to 5 days after operation; 6 flaps with this complication were saved after emergency surgical exploration. Total survival rate of transplanted flaps and composite tissue flaps was 95.3% (122/128). All patients were followed up for 3 months to 4 years; satisfactory appearance and restoration of partial function were found in all of them.</p><p><b>CONCLUSIONS</b>Free composite tissue transplantation reduces amputation rate, achieves primary reconstruction of function with good appearance, shortens length of hospital stay, and reduces surgical operation time, complications, and treatment cost. It is a good approach in the repair of massive devastating soft tissue injury.</p>

Microsurgical repair of skin and soft tissue defects on head, face, and neck / 中华烧伤杂志

<p><b>OBJECTIVE</b>To study the microsurgical method of repairing skin and soft tissue defects on head, face, and neck.</p><p><b>METHODS</b>Thirty-one patients with skin and soft tissue defects on the head, face, or neck were hospitalized from July 2007 to May 2010, including 10 cases of scalp defects, 4 cases of skin and soft tissue defects on face, and 17 cases of skin and soft tissue defects on neck. Among them, the cause in 20 cases was trauma, and in 11 cases they were secondary to release of cicatricial contraction. Free flaps were transplanted to repair the wounds, including 13 latissimus dorsi flaps, 3 lateral thoracic flaps, 5 scapular flaps, and 10 anterolateral thigh flaps. The area of flaps ranged from 8 cm × 5 cm to 25 cm × 18 cm.</p><p><b>RESULTS</b>All flaps survived, and all the wounds healed by first intention. The average length of hospital stay was 16.7 days. Twenty-eight patients were followed up for 2 months, and in all of them satisfactory function and appearance were restored.</p><p><b>CONCLUSIONS</b>Free flap graft based on microsurgery can repair wound of skin and soft tissue defects on head, face and neck by a single operation, which eases suffering of patients, and shortens the length of hospital stay.</p>

A cost-effectiveness analysis of comprehensive rehabilitation treatment of hand burn / 中华烧伤杂志

<p><b>OBJECTIVE</b>To observe the effect of comprehensive rehabilitation treatment on hand burn, and to make a cost-effectiveness analysis.</p><p><b>METHODS</b>Sixty-two patients with ninety-eight affected hands were divided into rehabilitation group (32 cases, 48 hands) and control group (30 cases, 50 hands). Patients in rehabilitation group received comprehensive rehabilitation treatment at early stage after burn; patients in control group were given instructions for function training at the same time. The functions of the hands to be restored including grasp, hold, pinch, nip, forearm pronation and supination, fetching, laying, and writing abilities of patients in both groups were quantitatively evaluated with Carroll's upper extremity function test before treatment and 5 months after. Direct medical costs of patients in both groups within 5 months were respectively added up to make a cost-effectiveness analysis.</p><p><b>RESULTS</b>In rehabilitation group, function of digital opposition, palmar opposition, holding, and pinching of 37 hands recovered well, with which patients could pick food, put on clothes, go to toilet, and self-care etc. independently. Function of digital opposition, palmar opposition, holding, pinching half recovered in 7 hands, accompanied with well recovered of metacarpophalangeal function, but recovery of function of interphalangeal joint was less satisfactory. Although patients could grasp and hold, they were still poor in fine and harmonized activities. Joint ranges of motion of 4 hands were poor with limited function, and this was resulted from not strictly following treatment for remaining granulation wound. In control group, 23 hands received reconstructive surgery, 14 of them recovered with good function, but were poor in most of fine and harmonized activities. Severe claw hands were found in 13 hands. The ratio between total mean cost value and total function increment value in rehabilitation group (181 +/- 11) was obviously lower than that in control group (298 +/- 30, P < 0.01).</p><p><b>CONCLUSIONS</b>Comprehensive rehabilitation treatment at early stage after hand burn has a good effect on prevention and treatment of hand deformity, promoting recovery of hand function and improving hand appearance. It is also less costly.</p>

Surgical therapy for massive deep skin and soft tissue injuries / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore the methods of repair of massive deep skin and soft tissue injuries.</p><p><b>METHODS</b>Fifty-six patients with deep skin and soft tissue injuries were hospitalized from July 2006 to January 2008. Among them, 23 cases were caused by burn, 17 cases by electric injury, 7 cases by hot crush injury, 6 cases by avulsion injury, and 3 cases due to other reasons (including traffic accident, crush injury, soft tissue infection respectively). Sixty-five skin flaps were raised to repair and reconstruct the injured tissues, including 21 local flaps, 18 distant pedicled skin flaps, and 26 free skin flaps. The area of skin flaps ranged from 1.5 cm x 1.0 cm to 39.0 cm x 23.0 cm.</p><p><b>RESULTS</b>Sixty skin flaps survived completely, partial necrosis occurred in 3 flaps, and complete necrosis in 2 flaps. There was no obvious difference in average survival rate among local skin flaps (95.2%), distant pedicled skin flaps (88.8%), and free skin flaps (92.3%, P > 0.05).</p><p><b>CONCLUSIONS</b>Skin flap transposition can be still considered as the major effective method in repair of massive deep skin and soft tissue injury. On the premises of high survival rate, free skin flap transposition can be considered as the first choice.</p>

Reproduction of a model of heat injured keratinocyte in vitro and observation on its apoptosis rate / 中华烧伤杂志

<p><b>OBJECTIVE</b>To reproduce a model of heat injured KC in vitro and explore its apoptosis rate of KC due to heat injury at different temperature.</p><p><b>METHODS</b>Human KCs were cultured in vitro, and they were incubated at 37, 41, 43, 45, 48, and 51 degrees C respectively for 10 mins in water bath. Trypan blue staining and Hoechst 33258 fluorescence staining were used respectively to determine necrosis and apoptosis of KC. Rates of apoptosis and necrosis of KC were analyzed quantitatively by flow cytometer. The proliferation activity of KC after heat injury was detected by MTT test.</p><p><b>RESULTS</b>The results of trypan blue staining, Hoechst 33258 fluorescence staining, and flow cytometer demonstrated that number of apoptotic and necrotic KC increased gradually along with a rise of water bath temperature. The rates of apoptosis and necrosis of KC were respectively (12.3 +/- 3.2)% and (14.1 +/- 1.6)% at 45 degrees C, (27.7 +/- 5.1)% and (58.0 +/- 4.2)% at 48 degrees C. Rate of KC necrosis reached up to (83.0 +/- 5.3)% at 51 degrees C. Inhibition of KC growth reached a stationary phase when the injurious temperature reached 45 degrees C as observed with MTT test.</p><p><b>CONCLUSIONS</b>Heat injury can induce apoptosis and growth inhibition of KC in vitro. Incubating KC at 45 degrees C for 10 mins is a good condition to reproduce a model of heat injured KC in vitro. This model may be used to study the biological character and apoptosis of KC after burn injury.</p>

Surgical treatment of multiple pressure scores / 中华烧伤杂志

<p><b>OBJECTIVE</b>To summarize the methods and results of the surgical treatment of patients with multiple pressure sores.</p><p><b>METHODS</b>Twenty-one patients with 56 multiple pressure sores, hospitalized from January 2001 to May 2007, were treated with transfer of various skin flaps together with skin grafting. The pressure sores were respectively located in sacrococcygeal region (21 wounds), ischial tuberosity (14 wounds), greater trochanter of femur (13 wounds) and other sites (8 wounds). All the patients were given systemic supporting treatment in perioperative period and early debridement . The wounds were repaired with flaps, fascio-musculocutaneous flaps, or free skin grafts according to their size, depth, position and the condition of adjacent skin and soft tissue. Continuous irrigation, negative pressure suction, regular posture changes in turning frame after operation were also emphasized.</p><p><b>RESULTS</b>Twenty-five wounds were repaired by fascio-cutaneous flap or myocutaneous flap with healing rate of 90%. Thirteen wounds were repaired by adjacent regional flap with healing rate of 85%. Eight wounds were treated with direct suturing,among which 6 healed completely. Ten wounds were treated with free skin grafting,among whom 7 healed completely. Among 9 delayed healing wounds, 4 wounds healed after debridement and suturing or free skin transplantation for second time, 4 wounds healed by dressing change in a short time, and in the last a chronic sinus remained. Follow-up over 6 months, multiple pressure sores recurred in 3 patients.</p><p><b>CONCLUSION</b>Enhancing systemic supporting treatment in perioperative period, using fascio-cutaneous flap or myocutaneous flap to repair multiple sores, followed by continuous irrigation and negative pressure suction after operation, and regular postural change on turning frame, contribute a rate of success for management of multiple pressure sores.</p>

The anti-apoptosis effect of intensive insulin treatment on cardiac myocytes in severe scald rats / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the anti-apoptosis effect of intensive insulin treatment on cardiac myocytes and its underlying mechanism in severe scald rats.</p><p><b>METHODS</b>Twelve SD rats were suffered from 30% TBSA full thickness scald, and they were divided into: IT group [with intravenous injection of isotonic saline including insulin (15 mU x kg(-1) x min(-1)) and 100 g/L glucose], B group [with treatment of isotonic saline (2 mL x kg(-1) x %TBSA(-1) x 8 h(-1)]. Six SD rats received sham burn as controls[sham(S)group, with treatment of fluid at physiologic dose]. + dp/ dtmax (the rate of the rise of left ventricular pressure) and -dp/ dtmax (the rate of the fall of left ventricular pressure)at 6 post burn hour (PBH)were recorded. Apoptosis were determined by TUNEL staining and DNA ladder. The phosphorylation f Akt and protein expression of Bcl-2 in cardiomyocyte were assayed by Western blotting.</p><p><b>RESULTS</b>The + dp/ dtmax in the S group, IT group and B group at6 PBH were respectively (5.5 +/- 0.5) x 10(3) mm Hg/s, (3.4 +/- 0.4) x 10(3 mm Hg/s and (2.5 +/- 0.5) x 10(3) mm Hg/s (1 mm Hg = 0.133 kPa), the - dp/ dtmax were respectively (4.55 +/- 0.34) x 10(3) mmHg/s, (2.94 +/- 0.22) x 10(3) mm Hg/s and (2.05 +/- 0.19) x 10(3) mmHg/s.The +/- dp/dtmax in IT group was significantly higher than those in B group( P < 0.01). The apoptosis index in B group was (13.1 +/- 3.4)%, which was obviously higher than that in IT group (6.7 +/- 1.8)% and S group (0.6 +/- 0.4)% (P < 0.01). DNA ladder showed that no DNA fragmentation in S group, but obvious DNA fragmentation forming ladder pattern in B group, and no obvious ladder pattern in IT group. The phosphorylation of Akt and level of Bcl-2 protein in B group were markedly higher than those in IT group ( P < 0.05 or P < 0.01).</p><p><b>CONCLUSION</b>Intensive insulin treatment can upregulate the activity of Akt and enhance the expression of Bcl-2, and they might constitute the mechanisms for anti-apoptosis in cardiomyocyte and protection of cardiac function.</p>

Application with a series of orthotic splints for recovery of hand function after burn / 中华烧伤杂志

<p><b>OBJECTIVE</b>To observe the effect of static and dynamic splints on recovery of hand functions in burn patients.</p><p><b>METHODS</b>Thirty-two burn patients with 52 injured hands were treated with orthotic splints (single or combined application) during different therapeutic stages. Carroll's upper limb functional test was used to evaluate the function of upper limbs and hands from rough to fine movements, including grasp, pinch, nip, forearm pronation and supination, fetching, etc. The hand functions were compared before and after treatment.</p><p><b>RESULTS</b>There were 7 hands with grade IV function, 15 hands with grade III, 23 hands with grade II, and 7 hands with grade I before treatment, while 9 hands achieved grade IV function, 28 hands grade V, 9 hands grade VI, and 6 hands grade III after treatment for three months. Twenty-eight patients with 46 hands recovered well enough to handle daily chores, including digital opposition, palmar opposition, grasp, pinch, etc.</p><p><b>CONCLUSION</b>The manual splints offer good effects on preventing and treatment scar contracture of hand after burn, and they can promote the recovery of hand functions.</p>

Study on crosstalk between phosphatidylinositol 3 -kinase/Akt pathway and p38 mitogen-activated protein kinase pathway in cardiomyocyte with challenge of burn serum / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the possibility of crosstalk between phosphatidylinositol 3-kinase (PI3-K)/Akt pathway and p38 mitogen-activated protein kinase (p38MAPK) pathway in cardiomyocyte with challenge of burn serum, and to explore their influence on cardiomyocyte injury after burn.</p><p><b>METHODS</b>The model of murine cardiomyocyte with stimulation of burn serum was established. (1) The level of Akt and p38 phosphorylation in cardiomyocyte were examined with stimulation of 10% burn serum before stimulation and 1, 3, 6, 12, 24 hour after stimulation. (2) The levels of Akt and p38 phosphorylation in cardiomyocyte were determined with stimulation of burn serum (at concentration of 5%, 10%, 20%) or 10% burn serum plus insulin (at concentration of 1 x 10(-8), 1 x 10(-7), 1 x 10(-6)mol/L). The content of creatine kinase (CK) in supernate was also detected. (3) Addition to the inhibitor of p38 MAPK pathway (SB203580) and PI3K/Akt pathway (LY294002), the level of p38MAPK, PI3K/Akt and the content of CK in supernate were determined.</p><p><b>RESULTS</b>(1) The level of p-p38 in cardiomyocyte was 4.0 +/- 0.8, 3.6 +/- 0.8, 5.1 +/- 1.6, 2.4 +/- 0.5, 3.0 +/- 0.6 at 1, 3, 6, 12, 24 hour (s) after stimulation of burn serum, which was obviously higher than that immediate after stimulation (1.0, P < 0.01). The level of p-Akt was 0.15 +/- 0.07, 0.64 +/- 0.10, 0.26 +/- 0.08, 0.38 +/- 0.11, 0.59 +/- 0.13, which was obviously lower than that before stimulation (1.00, P < 0.01). (2) With stimulation of different concentration of burn serum or burn serum plus insulin, the level of p-Akt and p-p38 changed in the opposite directions comparatively. The content of CK increased along with increase of burn serum concentration, but decreased obviously with treatment of insulin (P < 0.05 or 0.01). (3) Low level of p38 induced by burn serum was increased after treatment of LY294002, which neutralized the protection of insulin (P < 0.01). Low level of p-Akt induced by burn serum increased after treatment of SB203580 (P < 0.01), which inhibited the release of CK induced by burn serum.</p><p><b>CONCLUSION</b>There is being crosstalk between PI3K/Akt pathway and p38 MAPK pathway in cardiomyocytes with challenge of burn serum, which may regulate cardiomyocytes.</p>

Functional reconstruction of multiple severe deformities after extensive deep burn / 中华烧伤杂志

To explore new measures for functional reconstruction of multiple severe deformities as a result of extensive deep burn (total burn surface area > or = 90% TBSA, including deep burn > or = 70%TBSA) in late stage. Twelve severe burn patients with above-mentioned deformities were hospitalized in our ward during 1960--2005, the scars resulted from burns were distributed from head to foot with 173 deformities, including 27 scar ulcers. All patients lacked of self-care ability, among them some could not stand. Due to inadequate skin source, deformities were corrected by skin from matured scars expanded with subcutaneous balloon at late postburn stage. Following our former clinical experience, anatomic investigation and experimental research, we chose the following methods to correct deformities and restore functions: application of split-thickness scar skin after expansion (88 wounds); use of scar skin flap/scar-Achilles tendon flaps (59 wounds); combination of thin split-thickness skin grafts from scar and allogeneic acellular dermal matrix (composite skin, 40 wounds). All grafts survived, the appearance and function were improved obviously without complications. Follow-up 1-40 years, all patients could take care themselves with satisfactory function and appearance, and among them 8 patients returned to work (one had worked for 40 years), 2 patients married and had children. The above-mentioned measures are safe, reliable and effective for functional reconstruction of deformities.

The protective effect of early insulin treatment on vascular endothelial cells in severely scalded rats / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the protective effect of insulin on vascular endothelial cells of rats at early post-burn stage,and its mechanism.</p><p><b>METHODS</b>Adult male Sprague-Dawley rats were randomly divided into 3 groups: i. e, sham scald group (n = 7), scald group (n = 7) and treatment group (n = 7). The rats in the latter 2 groups were subjected to 30% TBSA full-thickness burns with 94 degrees C water, and the sham scald rats were treated with 37 degrees C water. Intra-peritoneal injection of 40 ml/kg isotonic saline solution and subcutaneous injection of 3 units/kg insulin were given to the rats in treatment group after being subjected to 30% TBSA full-thickness burns. Subcutaneous injection of equal amount of isotonic saline was given to the sham and burn groups. The changes in vascular endothelial cell structure were observed with electron microscopy at 24 post-scald hours(PSH). Meanwhile, the blood glucose contents, the serum levels of nitric oxide (NO) and nitric oxide synthetase (NOS) were determined with oxidase method and colorimetric method, respectively.</p><p><b>RESULTS</b>The injury of arterial endothelial cells in the treatment group was obviously alleviated compared with that in burn group. The blood glucose content in the treatment group (7.1 +/- 0.7 mmol/L) was significantly lower than that in scald group (8.2 +/- 1.0 mmol/L, P < 0.05), though it was much higher in both groups than that in sham scald group (4.9 +/- 0.8 mmol/L, P < 0.01) at 24 PBH. The serum content of NO, total NOS and cNOS in treatment group were obviously higher than those in scald group (P < 0.01), but there was no obvious difference in iNOS content between the two groups(P > 0.05).</p><p><b>CONCLUSION</b>Insulin exhibits protective effect on vascular endothelial cells in severely scalded rats at the early post-burn stage, and it is attributed to its promotion of cNOS level leading to NO production.</p>

The protective effect of intensive insulin treatment on the myocardium in severely scalded rats / 中华烧伤杂志

<p><b>OBJECTIVE</b>To study the protective effect of intensive insulin treatment on the myocardium of severely scalded rats, and to primarily explore its mechanism.</p><p><b>METHODS</b>Eighteen SD rats were divided into three groups, with 6 rats in each group. The rats in burn and intensive insulin group were inflicted with 30% TBSA full-thickness injury on the back. Isotonic saline containing 0.12 U/ml insulin solution, and 100 g/L glucose solution were infused into the rats in the intensive insulin group to keep plasma glucose at the level of 4.0 - 6.6 mmol/L (the total fluid amount was 2 ml x kg(-1) x 8h(-1)). In sham burn group,fluid was given according to physiological demand. The same amount of isotonic saline was infused into the rats in burn group. The venous blood was obtained for the detection of plasma glucose contents, and the left ventricular systolic pressure (LVSP) and left ventricular end-diastolic pressure (LVEDP) were recorded via aortic ventricle cannula before scald and at 1, 2, 3, 4, 5, 6 post-scald hours (PSH). The tissue of the left ventricle was harvested at 6 PSH for the detection of troponin T expression in myocardiocytes.</p><p><b>RESULTS</b>Plasma glucose level was increased to (7.6 +/- 1.7) mmol/L - (8.4 +/- 4.7) mmol/L in burn group during 1-6 PSH, which was significantly higher than that in intensive insulin group (4.5 +/- 0.9) mmol/L - (5.2 +/- 1.3) mmol/L, P < 0.01). Compared with the intensive insulin group, LVSP was markedly decreased in the burn group (60 +/- 11 mm Hg vs 72 +/- 8 mm Hg, P < 0.05) at 1 PSH,whereas LVEDP was increased significantly (21.3 +/- 11.3 mmHg vs 11.7 +/- 5.2 mmHg, P < 0.05). Intensive insulin treatment could significantly inhibit the loss of troponin T protein in myofilaments of myocardium.</p><p><b>CONCLUSION</b>Intensive insulin treatment possesses a protective effect on myocardia function after severe burns, and it may be related to its preventive effect on the loss of contractile protein in cardiocytes.</p>

Clinical management of deep facial burn / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore the better clinical methods for the management of deep facial burn with optimal quality. Methods Fifty-four patients with deep facial burns were enrolled in the study and were divided into delayed skin grafting group (n=48) and early escharectomy group (n=6). In delayed grafting group, after the erosion of new born granulation tissue to the basal layer with blade holder or with peel or eschar shaving method at 3 postburn weeks (PBW) according to the eschar separation and granulation growth status, the whole face of the patients were divided into 10 regions and were then covered by split thickness auto skin. The same treatment was performed on the patients in early escharectomy group at 1 PBW. Physical therapy and plastic surgery were applied after skin grafting, and the patients were followed up from 3 month to 11 years. The first operation time, postburn facial operation time, operation times to repair the whole face, blood content of Hb, the amount of blood transfusion and hemorrhage and the prognosis were compared between the two groups.</p><p><b>RESULTS</b>There was no difference between the two groups in regards to the first operation time, the total operation times,blood concentration of Hb before and after operation,and the amount of blood transfusion during the operation (P > 0.05). The operation time in delayed grafting group (21.9 +/- 3.2) d was obviously later than that in early escharectomy group (12.6 +/- 1.3) d, (P < 0.05). And there was evidently less amount of hemorrhage during operation(98 +/- 52) ml/100 cm2 than that in early escharectomy group (331 +/- 121) ml/100 cm2 (P < 0.01). The facial appearance of the patients in delayed grafting group was plump with more elasticity and richer expression compared with those in early grafting group. There exhibited different degrees of microstomia and both eyebrow defect in both groups during and after 1 postoperative year. In addition, mild to moderate ectropion and hypertrophic scar on the conjunction of grafted skin could appear in 80% of these patients. These deformities might be corrected by several times of plastic surgery.</p><p><b>CONCLUSION</b>Based on the principle of arranging skin grafts according to the cosmetic and functional area units, split thickness skin grafting can provide satisfactory results for the repair of deep burn injury involving whole face when the wounds were treated with eschar peeling, tangential excision, escharectomy, granulation tissue scaling, or early escharectomy. In comparison with early escharectomy, eschar peeling, tangential excision, escharectomy, or granulation tissue scaling can get better results with less bleeding, full and round facial appearance, more elasticity of grafted skin and richer facial expression appearance after the operation. Meanwhile, effective physical therapy and scheduled plastic surgery after skin grafting can also be very important in achieving cosmetic results in the repair and reconstruction of whole facial deep burn.</p>

Repair of contracture deformities of the patients with extremely limited donor skin at late postburn stage / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore new methods to repair postburn contracture deformities in patients with extremely limited donor skin.</p><p><b>METHODS</b>Five severely burned patients with extremely limited donor skin but severe deformities were enrolled in the study. The mature and the pliable scarred skin was utilized as the donor site for reconstruction of the postburn deformities. Split-thickness scarred skin was harvested for repair of postburn deformities after the scarred skin was expanded by expander, while thin razor-thin scarred skin with allo-acellular dermal matrix (ADM) was employed for the repair of postburn deformities when skin expansion was not feasible.</p><p><b>RESULTS</b>All the expanded scarred skin and composite skin grafts survived completely with good function and configuration. The long-term follow-up result was satisfactory, and the grafted skin was similar to that with split-thickness skin grafting.</p><p><b>CONCLUSION</b>It is feasible to employ various split-thickness scarred skin for the reconstruction of postburn deformities. This technique is a new effective procedure for the reconstruction of postburn deformities, especially for those with extreme scarcity of donor site.</p>