Initiation, development, and achievements of burn rehabilitation therapy in China / 中华烧伤杂志

Burn rehabilitation in China started from compression therapy in the mid-1970s, which showed the dual effects of prevention and treatment of hypertrophic scars. It not only promoted functional rehabilitation but also strengthened the confidence of patients in rehabilitation treatment. Thereafter, more therapies were brought into practice, such as intra-scar injection of triamcinolone acetonide, application of plastic splints, hydrotherapy, exercises with equipment, skin care, local therapeutic massage, active and passive exercises, as well as external use of drugs for inhibiting scars and pigments. Since the beginning of the 21st century, rehabilitation therapies have been gradually increasing. Psychological rehabilitation, occupational therapy, external use of silicone gel, wax therapy and sound, light, electricity, and radiation therapy have been carried out. Many hospitals have established foundations and held summer camps for children. As far as the whole country is concerned, compared with the huge demand, we still face a number of problems such as shortage of working staff, limited working space, capital chain rupture, lack of multi-disciplinary cooperation, untimely treatment, and incomplete rehabilitation. Nowadays, with increasing knowledge of burn rehabilitation and number of practitioners, improvement of equipment and economic situation, the pace of rehabilitation has accelerated, and the overall implementation of burn rehabilitation therapy has shown great vitality. Patients with burn injury involving over 80% total burn surface area (TBSA) of total burn area or full-thickness burn over 60% TBSA were cured and recovered in different levels of hospitals nationwide, which not only reflects the superb level of burn treatment in China but also reflects the overall improvement of rehabilitation level of the country.

Severely burned patients after surgery: recombinant human growth hormone therapy its metabolic effects / 中华外科杂志

<p><b>OBJECTIVES</b>To observe the effect of recombinant human growth hormone on metabolism in severely burned patients.</p><p><b>METHODS</b>From January 1999 to January 2001, 50 patients, aged 12 to 50 years, with over 30% total body surface area (TBSA) and 10% full-thickness burns, were randomized in a double-blind study. In the control group normal saline was used as a placebo (control group), while 0.3 IU/kg(-1) /d(-1) recombinant human growth hormone was given from postoperative day 1 to day 10 in the rhGH group. The excised burn wounds were closed with microautograft and allograft skin. Blood samples were collected at 6:00 am for assaying of growth hormone, blood glucose, blood insulin, anti-insulin antibody, glucagon, cortisol, serum amino acid profile, transferring, proalbumin, total protein, dielectric, and resting energy expenditure (REE) was also measured.</p><p><b>RESULTS</b>The concentration of blood GH in both groups was lower (t = 2.806, P < 0.05) than that of physiological values before surgery. However, the concentration of GH on POD 3 in the rhGH group was significantly higher than that of normal values, but a higher level was observed on POD 7 in the rhGH group than that of the control group (t = 3.142, P < 0.05). Although the concentration of anti-insulin antibody was slightly increased, there was no significant difference between the two groups. The concentration of glucagons tended to decrease with an increase in the concentration of blood glucose, and it was marked in the rhGH group. There was no significant difference between the two groups. The concentration of cortisol was higher than normal values, but no significant difference was observed between the two groups. With the administration of rhGH, the plasma concentration of amino acids was lower than that of the control group (t = 2.714, P < 0.05), and the urinary output of 3-MH in the rhGH group was lower than that of the control group (t = 2.207, P < 0.05).</p><p><b>CONCLUSIONS</b>Administration of rhGH in patients with major burn after surgery could improve their metabolic status, namely, increased lipolysis energy, accelerated protein synthesis, accelerated gluconeogenesis, reduced muscle proteolytic rate, and reduced REE expenditure. There is no effect on stress hormone. rhGH exerts a beneficial effect on metabolism in severely burned patients, but hyperglycemia is apt to occur, and water, Na(+), Cl(-) retention are suggested.</p>

Healing of chronic cutaneous wounds by topical treatment with basic fibroblast growth factor / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the safety and efficacy of topical application of recombinant bovine basic fibroblast growth factor (rbFGF) on the healing of chronic cutaneous wounds.</p><p><b>METHODS</b>Twenty-eight patients with thirty-three chronic cutaneous wounds resulting from trauma, diabetes mellitus, pressure sore and radiation injuries were enrolled in this prospective, open-label crossover trial. Prior to treatment with rbFGF, all wounds failed to heal with conventional therapies within 4 weeks. All wounds were locally treated with rbFGF at a dose of 150 AU/cm(2). Healing time and the quality of wounds were used to evaluate the efficacy of the treatment.</p><p><b>RESULTS</b>Healing of all chronic wounds was expedited. During the study, eighteen wounds completely healed within 2 weeks, four healed within 3 weeks, and another eight completely healed within 4 weeks. Only three wounds failed to heal within 4 weeks, but healed at 30, 40 and 42 days after treatment with rbFGF. Thus, compared with conventional therapies, the effective rate of rbFGF treatment within 4 weeks was 90.9%. Histological assessment showed more abundant capillary sprouts or tubes and that fibroblasts were differentiated in wounds treated with rbFGF. No adverse side effects related to basic fibroblast growth factor were observed.</p><p><b>CONCLUSIONS</b>Our results indicate that rbFGF could be used to accelerate healing in chronic wounds. It is our belief that this may be a more effective method of chronic wound management.</p>

THE EFFECTS OF ESCHARECTOMY DURING BURN SHOCK STAGE ON THE mRNA EXPRESSION OF INTERCELLULAR ADHESION MOLECULE-1 AND TUMOR NECROSIS FACTOR-? IN RAT LIVER / 解放军医学杂志

To investigate the changes in the expression of intercellular adhesion molecule 1(ICAM 1) ,tumor necrosis factor ?(TNF ?) mRNA and MPO activity in rat liver after burns and the effects of escharectomy during burn shock stage on the expression of these parameters. One hundred and seventy six Wistar rats with 30% TBSA full thickness thermal injury were used. The mRNA expression of ICAM 1 and TNF ? were detected by reverse transcription polymerase chain reaction(RT PCR) in liver tissues at various intervals after burns with or without escharectomy during shock stage. Both expression of ICAM 1 and TNF ?mRNA in rat liver after burns began to increase at 4h postburn and peaked at 12h and 24h, respectively. Afterwards in groups of escharectomy at 8h and 24h postburn, the expressions of both ICAM 1 and TNF ? increased again, though the expression values were lower than the first peak values, and they returned to normal range at 96h postburn. But in groups of burn control and escharectomy at 96h postburn, their expressions still remained high on 7d postburn. In addition, MPO activity returned to normal levels at 96h postburn in groups with escharectomy during shock stage, while in groups burn control and escharectomy at 96h postburn, a high value of MPO activity persisted till 7d postburn. Our findings suggest that eschar could induce the production of inflammatory mediators such as ICAM 1 and TNF ? which damaged endothelial cells. Therefore, escharectomy as early as possible may play an important role in preventing the expression and release of adhesion molecules and the development of systemsc lnflammatory response syndrome.

The effects of zinc supplements after burns on the nutritional state of gut mucosa in rats with zinc-deficient / 肠外与肠内营养

Objectives:To investigate the effects of zinc supplements on the nutritional state of gut mucosa after major burns. Methods:Weanling rats were fed zinc deficient chows (zinc content: 1.6 ?g/g) for seven days to induce zinc deficient status. Then 20% TBSA deeper second degree scalds were made and the rats were divided into three groups fed on chows different in zinc contents. Zinc contents were 1.6 ?g/g, 24.7 ?g/g, 286.9 ?g/g respectively. A group of rats fed normal zinc content (24.7 ?g/g) diets before and after scalds was designed as control. Rats were killed on the eighth day after burns and certain sections of jejunum and ileum were resected. Vincristine was injected 6 hours before they were killed, which was supposed to block cell division in metaphase. DNA and protein contents as well as crypt cell production rate (CCPR) were calculated. Results: DNA contents and CCPR of jejunal mucosa were markedly improved in the group of zinc supplements. Protein contents were also improved to some extent. The same trend could be seen in ileac mucosa too. Conclusions: Zinc plays an important role on the nutritional states and proliferation of gut mucosal cells. To supplement zinc after major burns in rats with zinc deficent could help to repair the injured intestinal mucosa.

EFFECTS OF ESCHARECTOMY DURING BURN SHOCK STAGE ON ENERGY METABOLISM OF VISCERA IN RATS / 解放军医学杂志

The present study was performed to evaluate the effects of escharectomy during burn shock stage on energy metabolism of viscera. 88 male Wistar rats were subjected to a 35% total body surface area fullthickness thermal injury. The rats were randomly divided into three groups: control group, escharectomy during burn shock stage group and escharectomy group after burn shock stage. The plasma levels of LPS and TNF ? and the tissue contents of ATP in the heart and liver were seguentially determined at different time points. The results showed that the contents of ATP in the heart and liver decreased rapidly postburn. The contents of ATP in escharectomy group during burn shock stage were significantly higher than that in the other groups ( P

THE ROLE OF LIPID PEROXIDASE INJURY IN THE MECHANISM OF PATHO-GENESIS OF POSTBURN MULTIPLE ORGAN FAILURE / 解放军医学杂志

Forty-five patients with burn area exceeding 30% TBSA were studied prospectively. Among these 45 patients, 13 developed multiple organ failure (MSOF). Blood superoxide, dismutase (SOD) activity and plasma malondialdehyde (MDA) levels were sequentially determined to assess the role of excessive release of oxygen radicals and lipid peroxidase injury in the mechanism of pathogenesis of postburn MSOF. The results showed that the anti-oxidation capacity of the body was markedly depressed and lipid peroxidase injury markedly increased after a severe burn injury. These changes were not only related to hypovolemic shock after the injury, but also the severity of the burn injury and infection.