Protective effect of early application of lytic cocktail on small intestine of severely scalded rats / 中华烧伤杂志

<p><b>OBJECTIVE</b>To study the protective effect of early application of lytic cocktail on small intestine of severely scalded rats.</p><p><b>METHODS</b>Sixty-six male SD rats were divided into sham injury group (SI, n=6), scald group (S, n=30) and scald+lytic cocktail group (SL, n=30) according to the random number table. After anesthesia, rats in the latter 2 groups were inflicted with 30% full-thickness scald, while rats in S group were sham scalded with 37 degrees C water. Resuscitation was carried out by intraperitoneal injection with 2 mLxkg(-1)x%TBSA(-1) lactated Ringer's solution in all rats; meanwhile 12 mL/kg lytic cocktail [1 mL pethidine (50 mg/mL)+1 mL chlorpromazine (25 mg/mL)+1 mL promethazine (25 mg/mL)+125 mL saline] was hypodermically injected to rats in SL group, while 12 mL/kg saline was injected into rats in the other 2 groups. Samples of blood and small intestine were harvested from S and SL groups at post scald hour (PSH) 3, 6, 12, 24, 48 and from SI group at PSH 3, with 6 rats in each group at each time point. Pathological changes in intestine were observed, and the expression of intercellular adhesion molecule 1 (ICAM-1) and CD68 were determined with immunohistochemistry at PSH 24 for S and SL groups and at PSH 3 for SI group. Plasma levels of D-lactate, diamine oxidase (DAO), IL-1beta, TNF-alpha, IL-10 were determined with ELISA. Data were processed with one-way analysis of variance.</p><p><b>RESULTS</b>(1) At PSH 24, mild hemorrhage, inflammatory cell infiltration and epithelial cell shedding were observed in small intestinal mucosa of rats in S group. Compared with S group, the intestinal villi of SL group were arranged regularly without obvious hyperemia and edema. (2) Expression levels of ICAM-1 and CD68 [(1.69+/-0.27)%, (0.80+/-0.09)%] in S group were significantly higher than those in SI group [(0.77+/-0.10)%, (0.30+/-0.05)%, with F value respectively 77.303 and 66.933, P<0.05 or P < 0.01] and SL group [(0.53+/-0.09)%, (0.32+/-0.06)%, with F value respectively 77.303 and 66.933, P values all below 0.01]. (3) D-lactate levels of rats in SL group were significantly lower than those of rats in S group at PSH 12, 24 (with F value respectively 20.936 and 19.854, P values all below 0.01), while DAO levels of rats in SL group were significantly lower than those of rats in S group at PSH 3, 12 (with F value respectively 21.930 and 11.342, P values all below 0.05). (4) The levels of IL-1beta and TNF-alpha in S group were significantly higher than those of SI group at each time point (P values all below 0.01). The levels of IL-1beta and TNF-alpha in SL group were significantly higher than those of S group at PSH 6, 12 and 24 (with F value respectively 96.517, 17.365, 79.715 and 21.328, 17.682, 28.424, P<0.05 or P<0.01). IL-10 level in SL group was higher than that in S group at each time point, and the differences were statistically significant at PSH 6 and 24 (with F value respectively 8.668, 19.634, P < 0.05 or P<0.01).</p><p><b>CONCLUSIONS</b>Early administration of lytic cocktail can attenuate edema and injury of intestinal mucosa in severely scalded rats. The mechanism may lie in that it can reduce the expression of ICAM-1 in intestinal mucosa, decrease the number of intestinal inflammatory cells and regulate the levels of inflammatory cytokines.</p>

Comparison between intermingled skin transplantation and microskin grafting in repairing massive deep burn / 中华烧伤杂志

<p><b>OBJECTIVE</b>To study difference in curative effect between intermingled skin transplantation (IT) and microskin grafting (MG) in repairing massive deep burn.</p><p><b>METHODS</b>Clinical materials of 101 patients with massive deep burn hospitalized from 1992 to 2008 were retrospectively summarized. Patients were divided into IT group (n = 52) and MG group (n = 49). The size of initial donor site for autologous skin, the wound size initially covered with autologous skin, the survival rate of initial autologous skin grafting, the theoretical expansion multiple of the autologous skin, the actual expansion multiple of the autologous skin, the total size of donated autologous skin, the remained wound condition, and the function of large joint of patients in two groups were compared.</p><p><b>RESULTS</b>In IT group and MG group, the size of initial donor site for autologous skin was respectively (3.25 +/- 0.48)%TBSA and (3.01 +/- 0.21)%TBSA, the wound size initially covered by autologous skin was respectively (30.4 +/- 3.6)%TBSA and (41.4 +/- 1.3)%TBSA, the survival rate of autologous skin grafting was respectively (99.9 +/- 1.9)% and (87.5 +/- 6.8)%, the theoretical expansion multiple of the autologous skin was respectively 9.5 +/- 1.3 and 13.9 +/- 1.4, the actual expansion multiple of the autologous skin was respectively 9.5 +/- 1.3 and 12.0 +/- 1.5, the difference between two figures of each index was statistically significant (P < 0.05). There was no statistical significant difference between IT and MG group in respect of the total size of donated autologous skin [respectively (14.2 +/- 1.9) and (14.0 +/- 2.1)%TBSA, P > 0.05]. There were 23 patients (44.2%) with residual wounds over 0.5%TBSA in IT group, and 37 cases (75.5%) in MG group. There were 34 patients (65.4%) with good function of large joints in IT group, and 18 cases (36.7%) in MG group.</p><p><b>CONCLUSIONS</b>Expansion multiple of autologous skin after MG is obviously larger than that after IT, thus limited skin source can be fully used. The wound healing quality and the restoration of large joint function of patients treated with IT are better than those of patients treated with MG.</p>

To intensify our understanding about management of severe burn infection / 中华烧伤杂志

Nowadays, it is necessary to emphasize the three basic inseparable elements in the treatment of severe burn infection, which are systemic care, burn wound care, and rational use of antimicrobials topically or systematically. Systemic care has been shifted from simple nutritional support to maintaining the systemic homeostasis, including balancing immune-inflammatory response, and protecting organs from dysfunction. Some work focused on regulating systemic immune response in the initial phase and the balance of inflammatory response after occurrence of severe burn infection have been reported. These results at least broaden our thinking to recognize that treatment should not only destroy microbes, but also balance the response of the body. Escharectomy in earlier phase has been a consensus. Currently, we turn our vision into how to use "damage control surgery (DCS)" concept in management of severe burn. DCS in burn care includes the evaluation of perioperative situation more accurate to make a more appropriate surgical decision. Meanwhile, an overall strategy should be established to confront the rapidly increasing drug resistance of the pathogens. The release of endotoxin after use of antimicrobials, which has been studied widely, should be explored further.

Effect of different immunomodulation on inflammatory response in burn rats with sepsis / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the effect of Thymosin and growth hormone(GH) on inflammatory response in burn rats or burn rats with sepsis.</p><p><b>METHODS</b>Sixty-four SD rats were randomly divided into normal control group (NC, without treatment), sepsis group (S, with injection of LPS), sepsis + Thymosin group (ST, with successive injection of Thymosin and LPS), sepsis + GH group [SGH, with successive injection of recombinant human GH (rhGH) and LPS], burn group, burn + sepsis group (BS, with injection of LPS after burn), burn + sepsis + Thymosin group (BST, with successive injection of Thymosin and LPS after burn), burn + sepsis + GH (BSGH, with successive injection of rhGH and LPS after burn), with 8 rats in each group. Specimens of spleen tissues were harvested to determine HLA-DR in lymphocyte and evaluate inflammatory cell infiltration (score). Specimens of peripheral blood were collected to determine Toll-like receptor 4 (TLR4) level in monocyte and serum level of TNF-alpha, IL-4, IL-6, IL-10.</p><p><b>RESULTS</b>Compared with those in NC group, serum level of IL-10 in S group decreased obviously, while other indices increased obviously (P < 0.01). The levels of HLA-DR and TLR4 and serum level of TNF-alpha were similar between SGH and ST groups (P > 0.05). Compared with those in SGH group [(2.87 +/- 0.04) score, and IL-6 (0.0083 +/- 0.0018) microg/mg, IL-4 (0.0102 +/- 0.0021) microg/mg, IL-10 (0.0310 +/- 0.0027) microg/mg, respectively], degree of inflammatory cell infiltration (1.50 +/- 0.76) score and serum levels of IL-6, IL-4, IL-10 of rats in ST group decreased obviously (0.0064 +/- 0.0012, 0.0058 +/- 0.0024, 0.0230 +/- 0.0021 microg/mg, respectively, P < 0.01). The levels of HLA-DR, TLR4 and inflammatory cell infiltration degree of spleen in B group were respectively higher than those in NC group and lower than those in BS group. Compared with those in NC group, serum levels of TNF-alpha, IL-6 in B group increased significantly, while IL-4, IL-10 showed an opposite tendency. There was no obvious difference between BST and BSGH groups in serum levels of HLA-DR and IL-6 (P > 0.05). Compared with those in BST group, inflammatory cell infiltration degree in spleen and the levels of TLR, TNF-alpha obviously decreased (P < 0.01), while IL-4 and IL-10 levels increased in BSGH group (P < 0.01).</p><p><b>CONCLUSIONS</b>Inhibitive effects between Thymosin and GH on extensive inflammatory reaction were similar with or without trauma, and GH has better effect as compared with Thymosin when with trauma.</p>

Study of neovascularization disturbance in deep partial-thickness scald in rats with diabetes mellitus / 中华烧伤杂志

<p><b>OBJECTIVE</b>To study the relationship between the degree of neovascularization and non-healing wounds in scalded rats with diabetic mellitus.</p><p><b>METHODS</b>Sixty Sprague-Dawley rats were randomly divided into control group (C, n = 30, with treatment of isotonic saline) and streptozocin (STZ)-induced diabetic group (D, n = 30, with treatment of STZ), and then they were inflicted with 20% TBSA deep partial thickness scald. Wound specimens were harvested immediately after scald and on 1, 3, 7, 10, 14, 21 post scald days (PSD) to observe histological changes, and wound healing rates were calculated. Degree of neovascularization in wound (labeled with blue microsphere) and the quantity of vascular endothelial cells (labeled with red CD31) were also measured by double-labeling immunofluorescence.</p><p><b>RESULTS</b>Compared with those in C group, Wound healing rate and histological value scores were lowered, and the degree of neovascularization was abated markedly at each time point. The degree of neovascularization in D group (12.00 +/- 1.40) was obviously lower than that in C group on 7 PSD (60.00 +/- 3.00, P <0.01). There was no obvious difference in the number of vascular endothelial cells in both groups, however, the majority of endothelial cells had not formed functional capillaries in D group.</p><p><b>CONCLUSION</b>Vascular endothelial cell can proliferate actively with poor blood supply in diabetic nonhealing with deep partial-thickness scald wounds, but it is still poor in blood supply due to lack of functional capillaries.</p>

Effect of recombinant human granulocyte-macrophage colony stimulating factor on wound healing in patients with deep partial thickness burn / 中华烧伤杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of recombinant human granulocyte-macrophage colony stimulating factor (rhGM-CSF) hydrogel in wound healing in patients with deep partial thickness burn.</p><p><b>METHODS</b>The study was a multicenter, randomized, double-blind, placebo-controlled parallel clinical trial. Three hundred and twenty-one patients (302 cases finally fulfilled the protocol) with deep partial thickness burn were divided into A group (n = 200, with treatment of rhGM-CSF hydrogel, 100 microg/10 g/100 cm2/d), C group (n = 102,with treatment of placebo). Side-effect, systemic condition, wound healing time, wound healing rate, and total effective rate at different time points were observed.</p><p><b>RESULTS</b>There were no obvious differences in vital signs, wound secretion, wound edge reaction, blood and urine routine, liver and kidney function between two groups (P > 0.05). No side-effect was observed. The median wound healing time was 17 days in A group, which was obviously shorter than that in C group (20 days, P < 0.01). The mean wound healing rate in A group was 24.5%, 70.5%, 95.3%, 99.6% respectively on 8th, 14th, 20th, 28th day after treatment, which were obviously higher than that in C group (15.1%, 51.4%, 84.6%, 97.1%, respectively, P < 0.01). The total effective rates in A group on 8th, 14th, 20th day after treatment were also higher than that in C group (P < 0.01).</p><p><b>CONCLUSION</b>rhGM-CSF hydrogel can significantly accelerate wound healing in patients with deep partial thickness burn with certain safety.</p>

The intermingled transplantation used in severe burn patients after eschar excision / 中华烧伤杂志

In the early developing stage of burn surgery, severe burn patients with large and deep burn wound often died of complications because of shortage of auto-skin. The method of intermingled transplantation composed of a large sheet of partial thickness allo-skin with punched holes for in laying small pieces of partial thickness auto-skin was first advocated by Chinese doctors (Ruijin Hospital) in 1960's. This intermingled transplantation method has saved many severe burn patients with extensive full-thickness burn wound. The mortality rate of severe burn patients has decreased and the survival rate has increased remarkably since the intermingled transplantation treatment method used in the burn units. In this paper we review the process of formation of intermingled transplantation and the mechanisms of success of this Chinese method in repairing the large wound surface area after eschar excision. We will focus our discussion on the low systemic immunological reaction, the effect of auto-skin islet, local immunological tolerance induced by in layed auto skin, the balance of Th1 and Th2 cells and the effects of some cytokines such as IL-10 in local immunological tolerance and etc. after intermingled transplantation.

Multi-center clinical study of acticoat (nanocrystalline silver dressing) for the management of residual burn wounds / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the clinical efficacy and safety of Acticoat (nanocrystalline silver dressing) for the treatment of residual burn wounds.</p><p><b>METHODS</b>Ninety-eight patients with 166 residual burn wounds were enrolled in the multi-center randomized clinical trials. In addition to the routine treatment, Acticoat was applied onto the wounds of the trial group once a day if there was much exudation from the wound, or the dressing change was made every other two days when the wounds were clean. Silver sulfadiazine (SD-Ag) was used in the control group of patients. The healing time was observed up to 20 days. The healing rate on the 15th day after treatment was taken as the percentage of healing.</p><p><b>RESULTS</b>The average healing time was (12 +/- 5) days after the application of Acticoat, which was significantly shorter than that in control wounds with SD-Ag (16 +/- 6) days, (P = 0.005 < 0.01). The total effective rate of the wounds for trial was 97.05%, which was higher than that in control (94.17%) group, but there was no statistically significant difference. The bacterial clearing rate of the Acticoat group on the 6th and 12th post treatment day was 21.7% and 43.5% respectively, which was significantly higher than that in control group. No side-effect was observed in the two groups during the study.</p><p><b>CONCLUSION</b>Acticoat with nanocrystalline silver can promote the healing of residual burn wounds effectively.</p>

The biological characteristics of dermal fibroblasts of the diabetic rats with deep-partial thickness scald / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the biological characteristics of dermal fibroblasts of the diabetic rats with deep partial thickness scald, and to explore its relationship with delayed wound healing due to diabetes.</p><p><b>METHODS</b>Sprague-Dawley rats weighing 250 g were randomly divided into control (NM, n=40) and STZ-induced diabetic (DM, n=50) groups, and then deep partial thickness scald involving 10% TBSA were reproduced in the two groups. Skin samples were harvested from the wounds on 0, 3, 7, 14 and 21 post scald day (PSD) for the determination of certain histological characteristics.</p><p><b>RESULTS</b>The thickness of dermis layer in DM group before injury was obviously thinner than that in NM group (P < 0.01). There was an infiltration of a large amount of chronic inflammatory cells and increased content of cutaneous glucose in the dermal tissue in DM group (2.77 mg/g) compared with 0.85 mg/g in NM group, (P < 0.01). An accumulation of advanced glycation end products (AGEs) was found in the dermal tissue in DM group. After the scalding, the percentage of fibroblasts in S phase and hydroxyproline synthesis in DM group was evidently lower than those in NM group. But the apoptosis rate of fibroblasts was much higher in DM group than that in NM group (P < 0.05 or 0.01).</p><p><b>CONCLUSION</b>It is found that the high contents of glucose and AGEs in diabetic skin exert untoward effects on biological characteristics of dermal fibroblast, probably constituting one of the underlying mechanisms of delay wound healing of scald in diabetic rats.</p>

Analysis of the influence on the prognosis and safety of arginine in patients with severe trauma and burns--a multi-center randomized double blinded, placebo controlled, clinical trail in 86 patients / 中华烧伤杂志

<p><b>OBJECTIVE</b>To observe the influence on prognosis and possible side-effects of arginine in</p><p><b>METHODS</b>Multi-center clinical trial, randomized double blinded patients with severe trauma and burns. and placebo control methods were employed in the study. Eighty-six patients with severe trauma and burns were randomly divided into control (C, n = 45) and arginine treatment (Arg, n = 41) groups. The patients in Arg group received arginine in dose of 0. 4 g x kg(-1) x d(-1) orally, while those in C group received same dose of placebo (tyrosine) for 7 days. All the patients in both groups were given diet with equal calories and equal nitrogen content. The changes in the wound healing time, hospital stay, and the incidence of side-effects of the medication in both groups of patients were observed and compared before and after the supplementation of arginine.</p><p><b>RESULTS</b>The wound healing time and hospital stay days of severe trauma patient in Arg group (n = 29) were 11. 1+/-2. 8 d and 19+/-6 d, which were all obviously shorter than those in C group (13. 2+/-5. 5 d, 22 +/-6 d, n =33, P <0.05). On the other hand, in severe burn patients there were no significant difference of the wound healing time (20+/-5 d vs 22+/-8 d, n = 12, P > 0. 05) and hospital stay days (28+/-6 d vs 29+/-8 d, n = 12, P >0. 05) between the Arg and C groups. In addition, in C and Arg groups, the occurrence of the side-effects were seldom (2. 44% vs 2. 22% , P = 1. 000) and it disappeared when the supplementation of drugs was stopped.</p><p><b>CONCLUSION</b>Oral feeding of arginine is beneficial in enhancing wound healing, reduction of hospital stay days in severe trauma patients and with little side-effects, but it is not beneficial to improve the prognosis of severe burn patients. Maybe this is due to inadequate number of case involved in the study.</p>

Multi-center clinical study of the effect of silver nitrate ointment on the partial-thickness burn wounds / 中华烧伤杂志

<p><b>OBJECTIVE</b>To evaluate the therapeutic effect of silver nitrate ointment on partial-thickness burn wounds, and observe its side-effects.</p><p><b>METHODS</b>Multi-center, randomized, positive drug paralleled self-controlled trial was carried out. Eighty patients with superficial partial-thickness burns, and 40 with deep-partial thickness burns were randomized into AgNO3 group and SD-Ag group according to drug topically applied to the wounds. The wound healing time, wound healing rate and bacterial culture of the wound, the effect and safety of the drug, as well as drug irritation to the wounds were studied in these two groups.</p><p><b>RESULTS</b>For the patients with superficial partial-thickness burn wounds, the wound healing time in silver nitrate group was (9.5 +/- 2.7) days, which was obviously shorter than that in SD-Ag group [(10.8 +/- 3.4) days, P <0.01]. The wound healing rate in silver nitrate group on 7 post-burn day ( PBD) was (77.9 +/- 20.5)%, which was obviously higher than that in SD-Ag group [(67.3 +/- 22.6) %, P < 0.01]. For those with deep-partial thickness burn wounds, the wound healing time in silver nitrate group was (21.5 +/- 4.8) days, which was evidently shorter than that in SD-Ag group [(23.3 +/- 6.4) days, P <0.01]. The wound healing rate in silver nitrate group on 20 PBD was (86.6 +/- 15.9)%, which was evidently higher than that in SD-Ag group [(78.5 +/- 17.7)%, P < 0.01]. Silver nitrate ointment has the same antibacterial effect as 1% SD-Ag cream, but it was less painful when applied to the open wounds.</p><p><b>CONCLUSION</b>Silver nitrate ointment is an effective and safe medicament for the clinical management of partial-thickness burn wounds.</p>

Influence of tangential excision within 24 postburn hours on the local wound inflammatory response in patients with deep partial thickness burn / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the influence of early tangential excision within 24 postburn hours on local wound inflammatory response and tissue injury in patients with deep partial thickness burn.</p><p><b>METHODS</b>Twelve patients with deep partial thickness burn were enrolled in the study. Tangential excision was performed within 24 postburn hours. The same wound of a patient was divided into three areas for harvesting tissue samples, i.e. pre-operation, post-operation and non-operation areas. For each patient, the biopsies from the pre-operation area were harvested before tangential excision, while those from post-operation and non-operation areas were harvested during 5 to 7 postburn days (PBDs). The contents of IL-8, MPO and MDA in wound tissue were determined by tissue culture and chemical colorimetry, respectively. HE and Mason's staining were employed to assess the degree of necrosis of the wound tissue.</p><p><b>RESULTS</b>The IL-8, MPO and MDA contents in the local wound tissue after tangential excision were 6.83 +/- 1.85 microg/L, 4.07 +/- 0.87 U/g, and 8.94 +/- 5.66 micromol/g, respectively, which were significantly lower than those from non-operation area (P < 0.01). The inflammatory response in the non-operative wound area was distinct with expansion of necrotic tissue area. In contrast, the local inflammatory response of the wound after tangential excision was ameliorated without the enlargement of necrotic tissue area.</p><p><b>CONCLUSION</b>Tangential excision within 24 postburn hours could be beneficial in ameliorating local inflammatory response, and in preventing progressive deepening of the burn wounds, thus it could accelerate wound healing in patients with deep partial thickness burn.</p>

The influence of dermal template on the expressions of signal transduction protein Smad 3 and transforming growth factor beta1 and its receptor during wound healing process in patients with deep burns / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the influence of dermal template on the expressions of signal transduction protein Smad 3 and transforming growth factor beta1 and its receptor during wound healing process in patients with deep burns.</p><p><b>METHODS</b>Twenty burn patients with excision of full thickness burn in the extremities were enrolled in the study and divided into two groups, i.e. template interfering group (E, n = 20, grafting of dermal template [allogeneic acellular dermal matrix] with razor thin autoskin) and control group (C, n = 20, grafting of razor thin autoskin only). The contralateral side served as the self-control. Tissue samples from the burn wounds were harvested at 1, 2, 3 and 4 post-operative weeks (POW) for immunohistochemistry staining. The positive expression rates of TGF-beta1, TbetaRI, TbetaRII and Smad3 proteins were determined by image analysis system.</p><p><b>RESULTS</b>The positive expressions of TGFbeta1, TbetaRI, TbetaRII and signal transduction protein Smad 3 in the tissue samples in both groups could be identified during 1 approximately 4 POW, and they diminished thereafter with the process of wound healing. The expression rate of TGF-beta1 in E group was (13.08 +/- 4.65)% at 1 POW and (9.03 +/- 1.89)% at 4 POW. The positive expression rate of above indices in E group was obviously lower than that in C group in corresponding time points (P < 0.05).</p><p><b>CONCLUSION</b>The expression levels of TGFbeta1, TbetaRI, TbetaRII and Smad 3 protein in deep burn wounds could be lowered by mixed grafting of dermal template with razor thin autoskin, which might be beneficial in ameliorating of scar hyperplasia in the burn wound.</p>

Influence of dermal template on the biomechanical compliance of wound tissue / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the influence of dermal template on the biomechanical compliance of wound tissue during wound repair.</p><p><b>METHODS</b>One hundred and forty-four SD rats subjected to full-thickness skin loss on the dorsum were enrolled in the study, and they were randomly divided into A (n = 6, without grafting on wound), B (n = 6, with full thickness skin grafting on wound), C (n = 6, with razor thin skin grafting on wound) and D [n = 6, with acellular dermal matrix (ADM) and razor thin skin grafting on wound] groups. The tissue samples from the wounds were harvested 1, 2, 4, 6, 12 and 20 weeks after the operation. The biomechanical compliance of the wound was assessed by Instron biomechanics tensiometer. The expression of alpha-SMA in the dermal fibroblasts of each group was determined by immunohistochemistry (ABC) method.</p><p><b>RESULTS</b>The biomechanical compliance of the wound in D group was higher than that in A and C groups (P < 0.05), but lower than that in B group during 4 to 20 weeks after operation (P < 0.05). The expression of alpha-SMA in D group (7.53 +/- 0.98)% was lower than that in A (26.99 +/- 2.90)% and C (2.18 +/- 2.79)% groups (P < 0.01), but higher than that in B group at 4 weeks after operation (P < 0.05).</p><p><b>CONCLUSION</b>Dermal template might affect the scar formation during wound healing, in improving wound healing quality by enhancing the biomechanical compliance of wound tissue.</p>

Bio-inductive effects of inorganic elements on skin wound healing / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore the bio-inductive effects of inorganic elements (Dermlin) on the human epithelial proliferation and differentiation and their promoting effects on skin wound healing.</p><p><b>METHODS</b>1 ). Cellular test: Normal human skin epithelial cells were cultured with 20 g/L Dermlin supplemented culture medium (E group) and regular culture medium (C group), respectively. The cell proliferation rate and the expressions of type IV collagen and epidermal growth factor (EGF) in the supernatant were determined in 12 and 20 post culture days (PCD). (2). Animal test: Self-consubstantiality control was employed in the study. Sixty Sprague - Dawley rats were inflicted with two symmetric 10% TBSA of superficial or deep partial thickness scald on the back of each rat, and were divided into control[ C, with topical application of silver sulfadiazine (SD - Ag) cream to the wounds] and treatment (T, with 1 g/100 cm2 Dermlin topical application to the wounds) groups. The pathological changes in wound skin were observed and the wound healing rate was calculated on 3, 5, 7, 10, 14 and 18 post treatment day (PTD). (3). Randomized, double-blinded and consubstantiality control method was employed in the clinical trial. Ninety patients were enrolled in the clinical study, among them 30 cases with 60 donor site wounds, 30 with 60 superficial and 30 with 60 deep partial thickness burn wounds were included. Dermlin in dose of 1 g/100 cm2 was applied to the wounds in T group and SD - Ag cream in C group for up to 18 days. Furthermore, sixty patients with diabetic foot ulcers were included for 1 g/100 cm2 Dermlin treatment. The wound healing rate was observed. And the blood and urine test and the indices of hepatic and renal function were determined.</p><p><b>RESULTS</b>1). Cellular test: The cell proliferation rate and the expression of type IV collagen and EGF in the culture supernatant were obviously higher than those in control group at the same time points (P < 0.01). 2). Animal test: Hyperplastic granulation tissue occurred in the rat wound in the T group since 5 PTD, while that occurred in the C group since 7 PTD. The healing rate of superficial thickness wound in T group on 7, 10, 14 PTD, and that of deep partial thickness wound in T group on 5, 10, 18 PTD were obviously higher than that in the C group (P <0.05). 3). Clinical study indicated that the wound healing rate of the patients with superficial or deep partial thickness scald in the T group was evidently higher than that in the C group on 5 and 10 PTD (P <0.05), but the wound healing time of the superficial, deep partial thickness wound and donor site wound in the T group was significantly shorter than that in the C group (P < 0.05). Before treatment, the square of the ulcers on the foot of the patients with diabetic was (39 +/- 28) cm2, and it was reduced to (19 +/- 23) cm2 2 weeks later, with the therapeutic efficacy reaching 62.5% . For all patients, no obvious change was found in the blood test and hepatic and renal function indices.</p><p><b>CONCLUSION</b>The inorganic element (Dermlin) is beneficial to wound healing and to the proliferation and differentiation of epithelial cells.</p>

The influence of L-arginine on the angiogenesis in burn wounds in diabetic rats / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the possible mechanism of L-arginine supplementation on the angiogenesis of burn wounds in diabetic rats.</p><p><b>METHODS</b>One hundred male Sprague-Dawley (SD) rats were used in the study and were randomly divided into A (scalding control, n = 25), B (scalding of the rats with diabetes, n = 25), C (L-glycine control, n = 25) and D (L-arginine supplementation, n = 25) groups. Diabetes was produced by intra-peritoneal injection of streptozotocin (STZ) in B, C and D groups. The rats in C and D groups were gavaged with L-glycine and L-arginine in dose of 200 mg.kg(-1).d(-1), respectively. The glucose content of the back skin tissue was determined for five rats in each group eight weeks after STZ administration. Deep partial thickness scalding of 20% TBSA was engendered on the back in the other 80 rats. The wound area, wound healing rate, and microvascular density with CD34 immunohistochemistry staining were determined on 3rd, 7th, 14th, and 21st post scalding days (PSDs), In addition, the amount of nitric oxide (NO) released from the wound tissue and the tissue contents of vascular endothelial growth factor (VEGF) and transforming growth factor beta1 (TGF-beta1) from wound were determined at the above time points.</p><p><b>RESULTS</b>Compared to those in group B, the wound healing rate in group D increased significantly since the 7th PSD [(44.10 +/- 3.50)%, P < 0.05], and the wound MVD value was increased significantly at all postburn time points. Furthermore, the levels of VEGF, NO and TGF-beta1 in the wound tissue was also increased significantly, while the glucose content in the cutaneous tissue was decreased to (1.380 +/- 0.120) mg/g.</p><p><b>CONCLUSION</b>L-arginine supplementation could be beneficial to the angiogenesis in the burn wound of the rats with diabetes, as well as to wound healing by increasing the synthesis and the release of VEGF, NO and TGF-beta1 from burn wound and by decreasing the glucose content in the cutaneous tissue of diabetic rats.</p>

Establishment of an animal model with hypertrophic scar / 中华烧伤杂志

<p><b>OBJECTIVE</b>To establish an animal model of hypertrophic scar on the rabbit ears and to observe the dynamic process of scar formation on the ventral side of the rabbit ears.</p><p><b>METHODS</b>Full skin defect (2 cm x 5 cm in diameter) was created on the ventral side of 60 ears in 32 New Zealand white rabbits. 1% silver sulfadiazine cream was applied to the wounds, and the dressing was changed once a week till wound healing. Four ears without operation were taken as control. Wound healing under natural condition was observed continuously for 12 months after the operation. The scar proliferation on the rabbit ears was observed by light microscope and transmission electron microscope, and the scar index was determined by computer image analyzing system.</p><p><b>RESULTS</b>The color, thickness and texture of the wounds on the rabbit ears after epithelization underwent a process of scar overgrowth, maturation and degeneration. The change in scar index was in accordance with the wax and wane of scar proliferation.</p><p><b>CONCLUSION</b>The hypertrophic scar formed on the ventral side of rabbit ears after natural healing of full thickness skin wounds was similar to that in humans. The results indicated that this animal model was ideal for the study of the developmental mechanism of hypertrophic scars and for the evaluation of the efficacy of the prevention and treatment of hypertrophic scars.</p>

Experimental study on the role of cytokines and keratinocytes in the survival mechanism of auto and allogeneic mixed skin grafting / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore the role of cytokines and keratinocytes in the survival mechanism of mixed auto and allogeneic skin grafting.</p><p><b>METHODS</b>Thirty-six SD rats were employed in the study. The rat model with mixed auto and allogeneic skin grafting and mixed human epithelial and lymphocytic culture (MELC) model were established. The change of IL-10 in the serum and the supernatant of the cultured tissue sample from the local wound was observed after the mixed skin grafting in scalded rats. And the role of epithelium in the induction of immunosuppression in vitro was monitored.</p><p><b>RESULTS</b>The serum IL-10 content in the rats with mixed skin grafting (25.89 +/- 2.82 ng/L) at 7 postoperative day (POD) was evidently higher than that in normal rats (14.20 +/- 2.43 ng/L) (P < 0.05). The IL-10 content in the culture supernatant of rat tissue samples exhibited evident different during 4-14 PODs (P < 0.05-0.01), while which was no difference to that in normal rat on 21st and 28th POD. The inhibiting effects of autologous epithelia and keratinocytes in MELC system were correlated with their dosage. After the adding of autologous keratinocytes to MELC system the cytokines secreted from Th1 could induce the secretion of cytokines from Th2 by IL-10 mediation. This effect could be corrected by the addition of monoclonal antibody of IL-10.</p><p><b>CONCLUSION</b>The keratinocytes inlayed in the autoskin during mixed grafting could increase the local IL-10 level by activating Th2 cells, which might be one of the important reasons of the survival of mixed skin grafting.</p>

Investigation on the drug resistance of Pseudomonas aeruginosa in our burn ward in the past 11 years / 中华烧伤杂志

<p><b>OBJECTIVE</b>To analyze the use of antibiotics and the drug resistance of Pseudomonas aeruginosa in the burn ward of our hospital in the past 11 years, so as to optimize the use of antibiotics in the future.</p><p><b>METHODS</b>Bacterial epidemiology during 1991-2001 in our burn ward was investigated. The change of the drug resistance of Pseudomonas aeruginosa was observed by defined daily dose (DDD) of antibiotics in adult patients and by the ranking of antibiotic administration days.</p><p><b>RESULTS</b>(1) Staphylococcus aureus (10.53%-34.40%) and Pseudomonas aeruginosa (75.66%-11.47%) were dominant in our burn ward. (2) Predominant antibiotics used included Penicillin, Amikacin, Vancomycin, Imipenem and Ceftazidime. (3) There was increasing drug resistance of Pseudomonas aeruginosa to the following antibiotics ranking in following order: Piperacillin (41.57%-100.00%), Imipenem (36.36%-98.46%), Ceftazidime (23.46%-97.85%), Amikacin (13.16%-100.00%) and ciprofloxacin (6.90%-100.00%).</p><p><b>CONCLUSION</b>There was increasing drug resistance of Pseudomonas aeruginosa to all antibiotics, which might be related to antibiotic abuse.</p>

An experimental study on the effects of postburn dietary supplementation of enhanced nutrients / 中华烧伤杂志

<p><b>OBJECTIVE</b>To evaluate the effects of postburn dietary supplementation of arginine (Arg), omega-3 polyunsaturated fatty acid (omega-3PUFA) and glutamine (Glu) on the metabolism, immunology and wound healing in scalded rats.</p><p><b>METHODS</b>Thirty Sprague-Dawley (SD) rats inflicted with 30% total body surface area deep partial thickness scald on the back after the gastrostomy catheter was placed were employed as the model. The rats were randomly divided into A and B groups, and all of them received continuous isonitrogenous (25% protein, 12% fat, 63% carbohydrate), isocaloric (175 kcal/kg/day), and isovolemic intragastric tube feedings. The contents of Arg, omega-3PUFA, Glu in the dietary of B group were enriched. The parameters were measured on the 10th day after injury, including the response of spleen cells to ConA, the plasma levels of PGE(2), IL-2, albumin, transferrin, glucagons, cortisol in blood, the urinary content of vanillylmandelic acid (VAM) in 24-hour urine, the content of hydroxyproline, the ratio of type I to type III collagen in burn wounds, and the nitrogen content in the liver and in the jejunal mucosa, as well as the weight changes, skin delayed hypersensitivity test, and wound healing time.</p><p><b>RESULTS</b>It was revealed that the serum level of albumin, the nitrogen content in the liver and in the jejunal mucosa were obviously higher in B than those in A group. At the same time, there was no statistical difference in the plasma levels of cortisol and glucagons and urinary content of VAM between the two groups, nor in body weight changes. Meanwhile, the response of spleen cells to ConA and the skin delayed hypersensitivity induced by DNFB 14 days after injury in group B were also enhanced compared with those in group A. Although the expression of PGE2 from peritoneal macrophages was lower, the content of hydroxyproline from burn wounds in group B was significantly higher than that in group A, and the ratio of type l to type III collagen in group B was significantly lower than that in group A. Compared with group A, the wound healing time in group B was significantly shortened (P < 0.05).</p><p><b>CONCLUSION</b>The low-fat and high-protein feeding diet with enriched arginine, omega-3 PUFA, glutamine could benefit the nutritional status after burn injury, thus improve the immunological function and promote wound healing.</p>