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>

Distribution and clinical significance of CD14 promoter-159C/T polymorphism in patients with extensive burn / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate association of CD14-159C/T polymorphism with expression of leukocyte CD14 mRNA and plasma soluble CD14 (sCDI4) level in severe burn patients.</p><p><b>METHODS</b>Seventy-seven patients with total burn surface area equal to or over 30% TBSA were hospitalized in the First Hospital Affiliated to the PLA General Hospital and Beijing You'anmen Hospital from June 2004 to June 2006. Blood samples were collected on 1st, 3rd, 5th, 7th, 14th, 21st, and 28th postburn day (PBD) for determination of CD14-159C/T polymorphism by PCR-subsequent restriction fragment length polymorphism (RFLP) analysis,plasma level of sCD14 and leukocyte CD14 mRNA expression were measured by ELISA and RT-PCR.</p><p><b>RESULTS</b>Frequency of the T and C allele was 59.1%, 40.9%, respectively. Seven cases (9.1%) were homozygote (CC genotype), 49 cases (63.6%) were heterozygote (TC genotype), and 2 cases (27.3%) were TT homozygous allele,which reached the Hard-Weinberg equilibrium. Three cases with CC homozygote, 38 cases with TC heterozygote, and 15 cases with TT homozygous allele were complicated with sepsis, ending in MODS in 1, 19, 10 cases, respectively. Expression of leukocyte CD14 mRNA +/- 35, re- spectively), which were markedly higher than that in patients with CC homozygote during 7th-21st PBD (P < 0.05 or 0.01). The plasma level of sCD14 in patients with CC homozygote was significantly lower than that in patients with TC heterozygote on 5 PBD (85 +/- 46 microg/L vs 134 +/-43 mmicrog/L, P < 0.01), which were higher in patients with TC heterozygote and TT homozygous allele than that in patients with CC homozygote on 21st, 28thh PBD (P < 0.01). Conclusions In CD14 gene promoter-159C/T polymorphism, the gene and protein expression of CD14 in patients with TT, TC genotype are much higher than those in patients with CC homozygote. CD14 gene promoter-159 C/T polymorphism with TT homozygote may be one of the major markers in extensive burn patients in whom infection may progress to MODS. Compared with other genetypes, the incidence of MODS in sepsis patients with TT genotype increase markedly.</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>

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>