Small Molecules Accelerate Skin Wound Healing: Shikonin Efficacy and Mechanism of Action in Mice / Las Moléculas Pequeñas Aceleran la Curación de Heridas en la Piel: Eficacia de Shikonin y Mecanismo de Acción en Ratones

SUMMARY: The objective of this study was to investigate the therapeutic wound healing potential and molecular mechanisms of shikonin as small molecules in vitro. A mouse burn model was used to explore the potential therapeutic effect of shikonin; we traced proliferating cells in vivo to locate the active area of skin cell proliferation. Through the results of conventional pathological staining, we found that shikonin has a good effect on the treatment of burned skin and promoted the normal distribution of skin keratin at the damaged site. At the same time, shikonin also promoted the proliferation of skin cells at the damaged site; importantly, we found a significant increase in the number of fibroblasts at the damaged site treated with shikonin. Most importantly, shikonin promotes fibroblasts to repair skin wounds by regulating the PI3K/AKT signaling pathway. This study shows that shikonin can effectively promote the proliferation of skin cell, and local injection of fibroblasts in burned skin can play a certain therapeutic role.

El objetivo de este trabajo fue investigar el potencial terapéutico de cicatrización de heridas y los mecanismos moleculares de la shikonina como moléculas pequeñas in vitro. Se utilizó un modelo de quemaduras en ratones para explorar el posible efecto terapéutico de la shikonina; Rastreamos las células en proliferación in vivo para localizar el área activa de proliferación de células de la piel. A través de los resultados de la tinción para patología convencional, encontramos que la shikonina tiene un buen efecto en el tratamiento de la piel quemada y promueve la distribución normal de la queratina de la piel en el sitio dañado. Al mismo tiempo, la shikonina también promovió la proliferación de células de la piel en el sitio dañado. Es importante destacar que encontramos un aumento significativo en la cantidad de fibroblastos en el sitio dañado tratado con shikonina. Lo más importante es que la shikonina promueve la función reparadora de fibroblastos en las heridas de la piel regulando la vía de señalización PI3K/ AKT. Este estudio muestra que la shikonina puede promover eficazmente la proliferación de células de la piel y que la inyección local de fibroblastos en la piel quemada puede desempeñar un cierto papel terapéutico.

Experimental study of transplantation of human umbilical cord mesenchymal stem cells in the treatment of alkali-burned cornea / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the efficacy of transplantation of human umbilical cord mesenchymal stem cells(hUCMSCs)in the treatment of corneal alkali burn in rabbits, and study the infiltration of polymorphonuclear neutrophils(PMNs)and the changes of vascular endothelial growth factor(VEGF)expression.METHODS: Corneal alkali burn models were established in right eyes of 75 healthy Japanese white rabbits, which were divided into three groups(group A, B and C), with 25 rabbits in each group. Group A was treated with amniotic membrane combined with hUCMSCs on the day after corneal alkali burn. Group B was treated with amniotic membrane only. Group C did not give any treatment after corneal alkali burn. At 3, 7, 14, 21 and 28d after corneal alkali burn, the corneal recovery was observed by slit lamp and photographed, the growth of corneal neovascularization(CNV)was scored, and corneal tissue was separated to make pathological sections. PMNs infiltration was observed by hematoxylin-eosin(HE)staining, and the expression of VEGF was determined by immunohistochemical staining.RESULTS: The growth of CNV in group A was much slower than that in group B at 14d after alkali burn. The CNV growth score around lesions of group A was significantly lower than that of group B(P<0.05). The quantity of PMNs increased on the 3d with the stromal layer of cornea infiltrated, relatively decreased on the 7d, shown a peak on the 14d, and then decreased gradually. Early infiltration after alkali burn was in the corneal stroma of the lesion area, and the extent of infiltration was equal to the ulcer area at later stage. The cell densities of corneal PMNs in group A and group B were significantly lower than those in group C at all time points after alkali burns(P<0.05), and those in group A were significantly lower than group B at 14 and 21d(P<0.05). The expression levels of corneal VEGF in all groups after alkali burn reached peak at 7～14d and decreased significantly at 28d, and the expression levels of VEGF in group A and group B at all time points after alkali burn were significantly lower than those in group C(P<0.05), and group A was significantly lower than that in group B at 7, 14 and 21d(P<0.05).CONCLUSION: The transplantation of hUCMSCs after alkali burn cornea can reduce the formation of CNV and inhibit corneal revascularization after alkali burn. The corneal pathological lesions and vascularization are closely related to PMNs and VEGF.

Manejo anestésico del paciente quemado / Anesthetic management of the burn patient

Resumen: El conocimiento de la fisiopatología de las quemaduras son base del manejo perioperatorio. Todos los órganos y sistemas resultan alterados y los cambios hemodinámicos en la fase aguda se caracterizan por una disminución del gasto cardíaco. Después de seis días de la lesión, ocurre un nuevo cambio hemodinámico, esta fase es conocida como estado hipermetabólico y su duración está en relación con la extensión y profundidad de la lesión. La lesión por inhalación es un factor importante a considerar como mal pronóstico y, de igual manera, el número de comorbilidades y/o trauma asociado. Durante este segundo período, los anestesiólogos tienen una participación continua y estrecha. Los problemas farmacológicos, manejo de vía aérea, accesos vasculares, hipotermia, monitoreo y control del dolor, entre otros, se hacen muy marcados. Por último, la fase de secuelas acompaña al paciente para toda su vida y la magnitud de los daños, costos y discapacidad serán directamente relacionados con la atención administrada durante las primeras dos fases.

Abstract: Knowledge of the pathophysiology of burns is the basis of perioperative management. All organs and systems are altered and hemodynamic changes in the acute phase are characterized by a decrease in cardiac output. After six days of injury a new hemodynamic change occurs, this phase is known as hypermetabolic state and its duration is in relation to the extent and depth of the injury. Inhalation injury is an important factor to consider as a poor prognosis and also the number of associated comorbidities and/or trauma. During this second period the Anesthesiologists have a continuous and close participation. Pharmacological problems, airway management, vascular access, hypothermia, monitoring and pain control among others become very marked. Finally, the phase of sequelae is for life and the magnitude of damages, costs and disability will be directly related to the care administered during the first two phases.

Terapia audiovisual. Propuesta para disminuir ansiedad en pacientes quemados durante su estancia en la unidad de cuidados intensivos / Audiovisual therapy. Proposal to decrease anxiety in burned patients during their stay in the Intensive Care Unit / Terapia audiovisual. Proposta para reduzir a ansiedade em pacientes queimados durante sua estadia em Unidade de Terapia Intensiva

Resumen: La atención y manejo del paciente quemado en México representa un reto para el personal médico, la estancia intrahospitalaria del quemado generalmente es prolongada, por lo que los pacientes pueden desarrollar complicaciones psicológicas derivadas del cambio en su aspecto físico y los tratamientos que este tipo de patología requiere, por lo que la aparición de ansiedad es común. El propósito de este trabajo es plantear una propuesta de terapia audiovisual como tratamiento alternativo y/o complementario en el control de la ansiedad en el paciente durante su estancia en la unidad de cuidados intensivos.

Abstract: The care and management of the burn patient in Mexico represents a challenge for the medical staff, the hospital stay of the burn is generally prolonged so that patients can develop psychological complications derived from the change in their physical appearance and the treatments that this type of pathology requires, so the appearance of anxiety is common. The purpose of this work is to propose a proposal of audiovisual therapy as an alternative and/or complementary treatment in the control of anxiety in the patient during his stay in the intensive care unit.

Resumo: O cuidado e o manejo do paciente queimado no México representam um desafio para a equipe médica, a internação do paciente queimado é geralmente prolongada para que os pacientes possam desenvolver complicações psicológicas derivadas da mudança em sua aparência física e dos tratamentos que este tipo de a patologia exige, então o aparecimento de ansiedade é comum. O objetivo deste trabalho é propor uma proposta de terapia audiovisual como alternativa e/ou tratamento complementar no controle da ansiedade do paciente durante sua permanência em unidade de terapia intensiva.

Assessment of antibacterial activity of Syzygium aromaticum extracts, antibiotics and silver sulphadiazine ointment against pathogenic bacteria isolated from the burned and unburned skin

Aims@#Skin burns remain a noteworthy general medical issue throughout the world, as it boosts a condition of immuno-suppression. The present research aimed to evaluate the efficacy of Syzygium aromaticum extracts, silver sulphadiazine ointment, and different commercially available topical antibiotics against pathogenic bacteria, isolated from the skin of burn patients.@*Methodology and results@#A total of 124 clinical pus samples were collected from the skin of burn patients, admitted to two different tertiary care burn units at Peshawar, Pakistan. From these pus samples, 6 bacterial isolates from burned skin (Staphylococcus epidermidis, Streptococcus, Klebsiella, Enterobacter, Bacillus and Pseudomonas spp.) were isolated, while 4 different bacterial isolates (Staphylococcus epidermidis, Staphylococcus aureus, Bacillus and Streptococcus spp.) were isolated from unburned skin via conventional culturing techniques. Further, antibacterial assays were performed to compare the efficacy of S. aromaticum extracts (methanolic and aqueous extract), silver sulphadiazine ointment, and different commercially available antibiotics against tested bacteria. It was observed that both methanolic and aqueous extracts of S. aromaticum were effective at all concentrations against all the tested bacteria. In addition, all the tested antibiotics expressed substantial activity against most of the bacterial isolates. While silver sulphadiazine ointment was observed to be less potent against isolated bacteria as compared to S. aromaticum extracts. @*Conclusion, significance and impact of study@#It was concluded that both aqueous and methanolic extracts of S. aromaticum were effective antimicrobial agents and could be used as an alternative to control bacterial infections of burn patients. This study would help to distinguish the risk factors of bacterial pathogenicity in burn patients and would also provide a guideline to utilize medicinal plants and their extracts to minimize the chances of antibiotic resistance phenomenon in burn patients.

Spatial-temporal of fire foci in the state of Rio de Janeiro, Brazil / Espaço-temporal de focos de fogo no estado do Rio de Janeiro, Brasil

This study evaluated the space-time variability of fire foci via environmental satellites for the State of Rio de Janeiro (SRJ) based on statistical procedures. The fire foci in the period of 2000 to 2015 were obtained from the BDQueimadas fire database. Descriptive, exploratory, and multivariate statistical analyses were performed in the software environment R i386 version 3.2.5. The north region had 6760 foci (21.11%), the south-central region had 3020 foci (9.43%), the Middle Paraíba had 6,352 foci (19.84%), the Metropolitan areas had 6671 foci (20.83%), and the Green Coast region had 292 foci (0.91%). The cluster analysis identified three homogeneous groups of fire foci (G1, G2, and G3) but did not include the municipality of Campos dos Goytacazes (NA). The G1 group (6.21 ± 0.01 foci, 57.61%) included areas throughout the state and covered the coastal region and lowlands towards the north. The G2 group (6.21 ± 0.01 foci, 34.81%) included the northern, south-central, and coastal shallows regions. The G3 group (6.21 ± 0.01 foci, 9.78%) included the mountain ranges of the state. Environmental characteristics and socioeconomic are crucial in the dynamics of fire foci in Rio de Janeiro.

Este estudo avaliou a variabilidade espaço-temporal de focos de calor via satélites ambientais para o Estado do Rio de Janeiro (SRJ) com base em procedimentos estatísticos. Os focos de calor no período de 2000 a 2015 foram obtidos a partir do banco de dados de focos do BDQueimadas. Análises estatísticas descritivas, exploratórias e multivariadas foram realizadas no ambiente de software R i386 versão 3.2.5. A região Norte tinha 6760 focos (21,11%), a região Centro-Sul tinha 3020 focos (9,43%), o Médio Paraíba tinha 6,352 focos (19,84%), as áreas metropolitanas tinham 6671 focos (20,83%) e a Costa Verde região teve 292 focos (0,91%). A análise de agrupamento identificou três grupos homogêneos de focos de calor (G1, G2 e G3), mas não incluiu o município de Campos dos Goytacazes (NA). Em que se observa no grupo G1 uma forte presença de outliers com valores atípicos, em todos os anos da série temporal, sendo destaque para os anos de 2014 e 2015 que apresentam os maiores números de outliers seguidos dos valores das médias (20.46 e 18.85 focos) acima das medianas (14.00 e 12.50 focos). Comportamentos semelhantes foram observados nos grupos G2 e G3, sendo o grupo G2 com média (81.43 mm e 66.00 focos) e medianas (49.07 e 35.50 focos) com um DP de 27.89 focos de fogo. O grupo G3 com média (314.13 e 361.33 mm) e mediana (204.50 e 76.00 focos) e o maior DP (196,75 focos) em comparação aos demais grupos. Características ambientais e socioeconômicas são cruciais na dinâmica dos focos de calor no Rio de Janeiro.

Utilidad de la eritropoyetina en el paciente quemado grave con anemia. Revisión del tema / Usefulness of erythropoietin in seriously burned patient with anemia. Topic review

RESUMEN Fundamento: La quemadura grave representa el tipo de agresión biológica más severo que puede sufrir el organismo y ponen en peligro la vida del paciente por el permanente riesgo de sepsis y falla multisistémica progresiva. La anemia incide en la morbilidad y mortalidad del quemado en estado grave; su tratamiento ha pasado por diversos momentos en la historia y su corrección depende de las transfusiones sanguíneas que aumentan el riesgo de complicaciones y reacciones adversas. Objetivo: Actualizar los conocimientos sobre la utilidad de la eritropoyetina en el tratamiento de la anemia en el quemado grave. Desarrollo: La gravedad de la quemadura está determinada por la intensidad de la temperatura y la duración de la exposición. La anemia es una de las complicaciones más frecuentes en los quemados graves y su tratamiento en ocasiones se limita al uso de transfusiones de sangre, sin embrago la eritropoyetina es una alternativa terapéutica; pertenece a la familia de las citoquinas, alcanza la médula ósea, donde estimula células progenitoras cuyo objetivo es lograr su transformación en eritrocitos. La administración de eritropoyetina humana recombinante en el paciente quemado grave con anemia se considera eficaz, ya que al estimular los mecanismos de la eritropoyesis, produce una elevación paulatina pero mantenida del hematocrito acompañándose de otros efectos beneficiosos. Conclusiones: La eritropoyetina humana por sus características farmacológicas, se muestra como una opción de tratamiento para el paciente quemado grave con anemia al permitir la recuperación de manera sostenida de los valores de hemoglobina con un mínimo de complicaciones, disminuye el uso de transfusiones de sangre que pueden aumentar la morbilidad de estos enfermos.

ABSTRACT Background: The serious burn represents the most severe type of biological aggression the body can suffer and endangers the patient's life due to the permanent risk of sepsis and progressive multisystem failure. Anemia affects the morbidity and mortality of seriously burned patient in serious condition; its treatment has gone through different moments in history and its correction depends on blood transfusions that increase the risk of complications and adverse reactions. Objective: To update knowledge about the usefulness of erythropoietin in the treatment of anemia in seriously burned patient. Development: The severity of the burn is determined by the intensity of the temperature and the duration of the exposure. Anemia is one of the most frequent complications in seriously burned patient and its treatment is sometimes limited to the use of blood transfusions. However, erythropoietin is a therapeutic alternative; it belongs to the family of cytokines, reaches the spinal cord, where it stimulates progenitor cells with the objective of achieving their transformation into erythrocytes. The administration of recombinant human erythropoietin in seriously burned patient with anemia is considered effective, since by stimulating the mechanisms of erythropoiesis, it produces a gradual but sustained elevation of the hematocrit accompanied by other beneficial effects. Conclusions: Human erythropoietin, due to its pharmacological characteristics, is shown as a treatment option for seriously burned patient with anemia by allowing the sustained recovery of hemoglobin values with a minimum of complications, reducing the use of blood transfusions that can increase the morbidity of these patients.

Protocolos de ultrasonografía en una Unidad Pediátrica de Quemados / Ultrasonography protocols in a Pediatric Burn Unit / Protocolos de ultrassom em uma unidade de queimados pediátrica

Resumen: Introducción: En las unidades pediátricas de quemados se atienden pacientes de urgencias y cuidados intensivos. La aplicación del ultrasonido como herramienta básica en el cuidado de pacientes gravemente enfermos en tiempo real, ha permitido responder a preguntas específicas sobre su condición clínica y se utiliza como una herramienta que guía diferentes procedimientos necesarios para el cuidado adecuado de este tipo de pacientes. Con estos antecedentes, y además del hecho de que el entorno de cuidados críticos está integrando las aplicaciones básicas del ultrasonido al monitoreo no invasivo, consideramos importante revisar los usos de la ecografía en una unidad pediátrica de quemados. Objetivo: Presentar los aspectos más importantes de los protocolos de ultrasonido más comunes en una unidad pediátrica de quemados. Material y métodos: Se realizó un estudio retrospectivo, observacional, descriptivo, longitudinal y homodémico sobre protocolos de ultrasonido en la Unidad de Quemados de los Servicios de Salud del Estado de Puebla anexa al Hospital para el Niño Poblano, especificando su importancia en la toma de decisiones en el manejo integral de pacientes pediátricos quemados. Resultados: Se encontró que cuatro protocolos eran los más utilizados en los pediátricos quemados: Focus Assessment Sonography in Trauma, Rapid Ultrasound In Shock, ecocardiografía enfocada y diámetro de la vaina del nervio óptico. Conclusión: La ecografía está cubriendo un campo más amplio en unidades de cuidados intensivos pediátricos. En la Unidad de Quemados de los Servicios de Salud del Estado de Puebla consideramos que es una herramienta de diagnóstico que no se puede posponer.

Abstract: Introduction: In pediatric burn units, emergency and intensive care patients are attended. The application of ultrasound as a basic tool in the care of seriously ill patients in real time, has allowed responding to specific questions about their clinical condition and used as a tool that guides different procedures necessary in the proper care of this type of patients. With this background and in addition to the fact that the critical care environment is integrating the basic applications of ultrasound in non-invasive monitoring, we consider it important to review the uses of ultrasonography in a pediatric burn unit. Objective: To present the most important aspects of the most common ultrasound protocols in a pediatric burn unit. Material and methods: A retrospective, observational, descriptive, longitudinal and homodemic study was conducted on ultrasound protocols in the Unidad de Quemados de los Servicios de Salud del Estado de Puebla anexa al Hospital para el Niño Poblano, specifying its importance in the decision making in the integral management of burned pediatric patients. Results: Four protocols were found to be the most used in the burned pediatric patients: FAST, RUSH, focused echocardiography and DVNO. Conclusion: Ultrasound is covering a wider field in pediatric intensive care units. In the Unidad de Quemados de los Servicios de Salud del Estado de Puebla we consider that it is a diagnostic tool that can not be postponed.

Resumo: Introdução: Nas unidades de queimados pediátrica são atendidos pacientes de emergência e terapia intensiva. A aplicação do ultrassom como ferramenta básica no atendimento de pacientes graves em tempo real, permitiu-nos responder a perguntas específicas sobre sua condição clínica e é utilizada como ferramenta que orienta os diferentes procedimentos necessários para o atendimento adequado desse tipo de paciente. Com esse pano de fundo e além do fato de o ambiente de cuidados intensivos integrar as aplicações básicas do ultrassom ao monitoramento não invasivo, consideramos importante revisar os usos do ultrassom em uma unidade de queimados pediátrica. Objetivo: Apresentar os aspectos mais importantes dos protocolos de ultrassom mais comuns em uma unidade de queimados pediátrica. Material e métodos: Foi realizado um estudo retrospectivo, observacional, descritivo, longitudinal e homodêmico dos protocolos de ultrassom no UQSSEP-HNP, especificando sua importância na tomada de decisão no manejo integral de pacientes pediátricos queimados. Resultados: Verificou-se que quatro protocolos foram os mais utilizados em pacientes pediátricos queimados: FAST, RUSH, ecocardiografia focada e DVNO. Conclusão: O ultrassom está cobrindo um campo mais amplo nas unidades de terapia intensiva pediátrica. No UQSSEP, consideramos uma ferramenta de diagnóstico que não pode ser posposta.

Pressures on La Lindosa, Guaviare: Land-Cover Change and Incidence of Fires Between 2012 and 2018 / Presiones ejercidas sobre la serranía de la lindosa, guaviare: cambios de cobertura e incidencia de fuegos entre 2012 y 2018

RESUMEN El cambio en el uso del suelo y el fuego como mecanismo utilizado para el mismo han creado perturbaciones ecológicas a grandes escalas, como lo son la fragmentación y aislamiento de ecosistemas importantes en paisajes tropicales. En el presente estudio, analizamos los cambios de uso del suelo entre los años 2012-2016 y los eventos de fuego entre los años 2016-2018, para identificar la dinámica de cambio espaciotemporal en la Serranía de la Lindosa, Guaviare, a partir de información oficial y sensores remotos. Para 2016 la cobertura boscosa se redujo en un 17 % correspondiendo con el aumento de vegetación secundaria y pastizales en el área. Los focos de fuego detectados estuvieron concentrados en el noroeste y sureste de la serranía, puntos coincidentes en zonas de bosque primario y zonas de pastizal consolidadas. Estos resultados indican que existe un proceso activo de deforestación en la serranía, que fragmenta la matriz boscosa dejando parches de bosque aislados, lo cual tendría repercusiones sobre la biodiversidad allí presente. Asimismo, la sinergia entre dicho proceso y el uso de fuego se muestra como amenaza constante, a diferentes escalas, sobre los diferentes ecosistemas. Esta información se presenta como herramienta para elaborar estrategias puntuales para evitar mayores repercusiones negativas sobre la serranía, que actualmente se encuentra en estado vulnerable.

ABSTRACT The change in land use and fire as a mechanism used for this change, have created ecological disturbances at large scales, such as the fragmentation and isolation of essential ecosystems within tropical landscapes. In the present study, we analyze the land-use changes along 2012-2016 and fire events between 2016-2018, to identify the dynamics of spatial-temporal change in the Serranía La Lindosa, Guaviare using official information and remote sensors. Forest cover was reduced by 17 %, during 2012-2016, corresponding to an increase in secondary vegetation and pastures in the area. The fire-hotspots detected were concentrated on the northwest and southeast of the mountain range, coinciding with areas of primary forest and consolidated pasture areas. These results show that there is an active process of deforestation in La Lindosa, leaving a fragmented matrix and isolated forest patches, which would have repercussions on the local biodiversity. Besides, the synergy between this process and the use of fire, represent a constant threat, at different scales, on the different ecosystems. This information is presented as a resource to elaborate punctual strategies in order to avoid greater negative repercussions on the mountain range area, which is currently in a vulnerable state.

Utilidad del valor de procalcitonina y proteína C reactiva en niños con quemaduras / Utility of procalcitonin and c reactive protein in children with burns

Antecedentes. Son múltiples los recursos utilizados en el manejo de niñosquemados,debido a la respuesta inflamatoria secundaria a quemadurases necesario determinar la ausencia o presencia de infecciones asociadas, ya que constituyen la principal causa de muerte en pacientes quemados pediátricos. El uso de la procalcitonina y proteína C reactivasirven de apoyo en el seguimiento y diagnóstico de infecciones. Objetivo. Determinarla utilidad de procalcitonina y proteína C reactivacomo reactantes agudos en niños quemados. Métodos. Se revisaron 74 pacientes pediátricos quemados en el hospital Dr. Francisco de Icaza Bustamante, del año 2015. Fue undiseño no experimental, de tipo descriptivo, de corte trasversal. Resultados.Los niños atendidos por quemaduras fueron masculinos con 56,75% y femenino del 43,25%. Con mayor frecuencia estuvieron los pacientes entre 0-3 años de edad con 56,75%; y de este el masculino tuvo el 33,78% comparado con el femenino del 22,97%, la mayoría de quemaduras fue secundaria a líquidos calientes (68,92%). La afectación de superficie corporal quemada estuvo entre 10 a <20% (64,86%) y fueron del grado II de profundidad (66,21%). El índice de gravedad tuvo un 51,35% como grave. Conclusiones.Las pruebas de PCR y PCT como reactantes de fase aguda no mostraron un valor significativo de utilidad que pudiera relacionar u orientar dicho resultado con el Índice de Gravedad, evidenciando que en este grupo de pacientes no influyó en el manejo terapéutico en las diferentes fases descritas.

Background.There are multiple resources used in the management of burned children; due to the inflammatory response secondary to burns, it is necessary to determine the absence or presence of associated infections, since they are the main cause of death in burned pediatric patients. The use of procalcitonin and C-reactive protein, support the follow-up and diagnosis of infections. Objective.To determine the utility of procalcitonin and C reactive protein as acute reactants in burned children. Methods.We reviewed 74pediatric patients burned at the hospital Dr. Francisco de Icaza Bustamante, January 1-December 31, 2015. It was a non-experimental, descriptive, cross-cut design. Result.The children treated for burns were male with 56.75% and female with 43,25%. Morefrequent were patients between 0-3 years of age with 56,75%; and of this the masculine had 33,78%compared to the feminine of 22,97%, the majority of burns was secondary to hot liquids (68,92%). The affectation of burned corporal surface was between 10 to <20% (64,86%) and theywere of degree II of depth (66,21%). The severity index had 51,35% as serious.Conclusions. PCR and PCT tests as acute phase reactants did not show a significant value of utility that could relate or guide the result with the Severity Index, evidencing that in this group of patients it did not influence the therapeutic management in the different phases described.

Effect of PMNs and MMP-9 on corneal injury after alkali burn / 国际眼科杂志(Guoji Yanke Zazhi)

@#AMI: To study the relationship between the infiltration of polymorphonuclear neutrophils(PMNs)and the expression of matrix metalloproteinases 9(MMP-9)in corneal stroma injury after alkali burn.<p>METHODS: Cornea alkali-burned model was made in 25 rabbits, then animals were grouped and sacrificed at 3d, 7d, 14d, 21d and 28d, respectively. The condition developing of alkali-burned cornea was observed by slit lamp biommicroscopy. The corneas were enucleated for histopathological examination. The infiltration of PMNs was identified by hematoxylin eosin(HE)staining and the expression of MMP-9 was identified by immunohistochemisty in different periods.<p>RESULTS: The quantity of PMNs and MMP-9 increased on the 3d, reached the lower level on 7d, shown a peak on the 14d, then decreased gradually. The area and depth of corneal stroma after alkali burn were the most severe on the 14d.<p>CONCLUSION: During the wound healing process, alkali-burned cornea has close relation with the infiltration of PMNs and the expression of MMP-9. The infiltration of PMNs and the expression of MMP-9 is positively correlated in corneal stroma injury after alkali burn.

Selection of surgical methods for postburn scar contracture deformity in children′s hands / 中华整形外科杂志

Objective@#To explore the surgical methods for children with contracture deformity on hands after burn.@*Methods@#From January 2014 to January 2018, 33 pediatric patients, a total of 42 hands with scar contracture deformities were reviewed. There were 24 males and 9 females, aged from 11 months to 6 years and 7 months. Among them, 20 hands were volar metacarpophalangeal joint contractures, 9 were volar interphalangeal joint contractures, 7 were dorsal metacarpophalangeal joint contractures (3 claw-shaped hands), 3 were hand back contractures, and 3 were palm contractures. Of the 42 hands, 36 hands were repaired with full-thickness skin grafts or split-thickness skin grafts, after the removal of contracted scar, and 6 hands were repaired with abdominal skin flaps, due to the tendon or bone exposure after the scar removal.@*Results@#Skin grafts on 31 hands were all survived after 2 weeks. However, the survival area of 3 skin grafts was about 90%, and 2 skin grafts survived about 80%. All of them healed well after dressing changing. The 6 hands repaired with abdominal skin flap healed well too. After 1-2.5 years of follow-up, finger scar contracture occurred in 4 hands with skin grafting, and they were performed scar excision and sheet skin grafting. Three hands were treated with Z-plasty, due to web space contracture. The function of other hands were normal, without contracture or deformity. The skin color and texture were similar to the surrounding skin, with limited pigmented. Scars on the edge of skin grafts was not obvious. Patients and their families were satisfied.@*Conclusions@#The sheet skin graft is the main method for postburn scar contracture in children′s hands. The abdominal skin flap should be considered, if tendon or bone is exposed, especially for large wound or multiple sites.

Factor XIII-guided treatment algorithm reduces blood transfusion in burn surgery / Algoritmo de tratamento guiado pelo fator XIII reduz a transfusão sanguínea na cirurgia de queimados

Abstract Background and objectives: Major burn surgery causes large hemorrhage and coagulation dysfunction. Treatment algorithms guided by ROTEM® and factor VIIa reduce the need for blood products, but there is no evidence regarding factor XIII. Factor XIII deficiency changes clot stability and decreases wound healing. This study evaluates the efficacy and safety of factor XIII correction and its repercussion on transfusion requirements in burn surgery. Methods: Randomized retrospective study with 40 patients undergoing surgery at the Burn Unit, allocated into Group A those with factor XIII assessment (n = 20), and Group B, those without assessment (n = 20). Erythrocyte transfusion was guided by a hemoglobin trigger of 10 g.dL-1 and the other blood products by routine coagulation and ROTEM® tests. Analysis of blood product consumption included units of erythrocytes, fresh frozen plasma, platelets, and fibrinogen. The coagulation biomarker analysis compared the pre- and post-operative values. Results and conclusions: Group A (with factor XIII study) and Group B had identical total body surface area burned. All patients in Group A had a preoperative factor XIII deficiency, whose correction significantly reduced units of erythrocyte concentrate transfusion (1.95 vs. 4.05, p = 0.001). Pre- and post-operative coagulation biomarkers were similar between groups, revealing that routine coagulation tests did not identify factor XIII deficiency. There were no recorded thromboembolic events. Correction of factor XIII deficiency in burn surgery proved to be safe and effective for reducing perioperative transfusion of erythrocyte units.

Resumo Justificativa e objetivos: A cirurgia no grande queimado causa hemorragia de grande porte e disfunção da coagulação. Os algoritmos de tratamento guiados por ROTEM® e fator VIIa reduzem as necessidades de hemoderivados, mas falta evidência em relação ao fator XIII. A deficiência do fator XIII altera a estabilidade do coágulo e diminui a cicatrização. Este estudo avalia a eficácia e a segurança da correção do fator XIII e sua repercussão nas necessidades transfusionais na cirurgia do queimado. Métodos: Estudo retrospectivo randomizado de 40 doentes submetidos à cirurgia na Unidade de Queimados alocados em grupo A com estudo do fator XIII (n = 20) e grupo B sem estudo (n = 20). A transfusão eritrocitária foi guiada por gatilho de hemoglobina de 10 g.dL-1 e os outros hemoderivados por testes de coagulação de rotina e ROTEM®. A análise do consumo de hemoderivados incluiu unidades de eritrócitos, plasma fresco congelado, plaquetas e fibrinogênio. A análise dos biomarcadores da coagulação comparou os valores pré e pós-operatórios. Resultados e conclusões: O grupo A (com estudo de fator XIII) e o grupo B apresentaram área de superfície corporal total queimada idêntica. Todos os doentes do grupo A revelaram déficit pré-operatório de fator XIII, cuja correção reduziu significativamente a transfusão de unidades de concentrado eritrocitário (1,95 vs. 4,05, p = 0,001). Os biomarcadores de coagulação pré e pós-operatórios foram semelhantes entre os grupos, revelaram que os testes de coagulação de rotina não identificam o déficit de fator XIII. Sem eventos tromboembólicos registrados. A correção do fator XIII na cirurgia do queimado revelou-se segura e eficaz na redução da transfusão perioperatória de unidades de eritrócitos.

Effects of Puerarin on Myocardial Tissue Injury and Inflammatory Response in Severely Burned Rats / 医学研究杂志

Objective To investigate the effects of Puerarin on myocardial tissue injury and inflammatory response in severely burned rats and its mechanism. Methods The model rats with 30％ TBSA (three degree) were made by bathing in 92℃ water for 18s; Sham burn group, model control group, puerarin 50, 100, 200, 400mg /kg treated groups were set. The histopathological changes of myocardial tissue were observed. The content of myocardial enzymes and cTnT in serum was determined. The activity of antioxidase and the content of MDA in myocardial tissue was measured. The apoptosis of cardiomyocytes was observed. The expression of apoptosis-related proteins was determined. The level of inflammatory cytokines in serum was determined. Results Compared with model control group, the histopathological changes of puerarin treated groups were significantly improved, especially the 200mg /kg group. The content of AST, CPK, LDH, cTnT in serum of Puerarin(100, 200, 400mg /kg) treated groups were significantly decreased. The activity of SOD, CAT, MPO were significantly increased and the content of MDA was significantly decreased. The apoptosis of cardiomyocytes was significantly improved, and the AI was significantly decreased. The expression of cleaved caspase-3, Bax were significantly down-regulated and the Bcl-2 was significantly up-regulated, the Bcl-2 /Bax was significantly increased. The levels of TNF-α, IL-6, IL-8 in serum were significantly decreased, the level of IL-1 in serum of puerarin 200mg /kg treated group was significantly decreased and the IL-10 was significantly increased. All of the differences above were significant(P ＜ 0. 05). Conclusion Puerarin has inhibitive effects on myocardial tissue injury and inflammatory responses in severely burned rats, which was perhaps related to its effects of improving antioxidant enzyme activity, altering the expression of apoptosis-related proteins and affecting the content of inflammatory cytokines.

The Effect of Burned Liver on the Length, Weight and Development of Megaselia scalaris (Loew) (Diptera: Phoridae) – A Preliminary Assessment and Implications in Forensic Entomology / Jurnal Sains Kesihatan Malaysia

@#Development of insects in laboratory for minimum post mortem interval estimation (mPMI) or time of colonisation (TOC) in forensic entomology can be affected by the type and quality of food consumed during larval period. Since mPMI estimation also involves analysis of larval specimens collected from burned human remains, it is important to study if burned tissues could affect growth of sarcosaprophagous larvae. This study investigated the effect of burned tissues on the size and developmental period of Megaselia scalaris (Loew) (Diptera: Phoridae), a species of forensic importance. Development of M. scalaris on 75 g burned cow’s liver was compared with control liver in three study replicates. Mean larval length (2.87 ± 0.11 mm) and weight (0.81 ± 0.08 mg) of M. scalaris larvae in burned liver diets were significantly lower than larval length (5.03 ± 0.15 mm) and weight (2.85 ± 0.21 mg) of control liver diets (p < 0.001) whilst mean pupal length (2.53 ± 0.06 mm) and weight (0.92 ± 0.06 mg) in burned liver diets were significantly lower than pupal length (3.52 ± 0.06 mm) and weight (2.84 ± 0.16 mg) in control liver diets (p < 0.001). Development of larvae in burned liver was 5-9 hours slower than those feeding on control liver based on single observation. Although the assessment is preliminary, the findings indicate physical growth of larvae feeding on burned animal tissues was affected and entomological specimens recovered from burned remains should be evaluated carefully to avoid errors in mPMI/TOC estimation. Limitations and suggestions for further research are also presented herein.

Assigning dates and identifying areas affected by fires in Portugal based on MODIS data

ABSTRACT An automated procedure is here presented that allows identifying and dating burned areas in Portugal using values of daily reflectance from near-infrared and middle-infrared bands, as obtained from the MODIS instrument. The algorithm detects persistent changes in monthly composites of the so-called (V,W) Burn-Sensitive Index and the day of maximum change in daily time series of W is in turn identified as the day of the burning event. The procedure is tested for 2005, the second worst fire season ever recorded in Portugal. Comparison between the obtained burned area map and the reference derived from Landsat imagery resulted in a Proportion Correct of 95.6%. Despite being applied only to the months of August and September, the algorithm is able to identify almost two-thirds of all scars that have occurred during the entire year of 2005. An assessment of the temporal accuracy of the dating procedure was also conducted, showing that 75% of estimated dates presented deviations between -5 and 5 days from dates of hotspots derived from the MODIS instrument. Information about location and date of burning events as provided by the proposed procedure may be viewed as complementary to the currently available official maps based on end-of-season Landsat imagery.

Epidemiología de pacientes quemados en el Hospital Roberto del Río 2013-2015 y su variación según la estacionalidad / Epidemiology of patients burned in the Hospital Roberto del Río 2013-2015 and its variation according to seasonality

Las quemaduras en la población pediátrica tienen alta morbimortalidad, con secuelas importantes. Estudios han analizado su patrón epidemiológico y postulan que su conocimiento permite anticipar la incidencia y mejorar el tratamiento. El objetivo de este trabajo es determinar el patrón epidemiológico de las quemaduras en la población del Hospital Roberto del Río.

Pediatric burns have high morbi-mortality, with important sequelae for children. Studies have analyzed their epidemiological pattern and suggest that this knowledge would help on burn prevention and treatment. The purpose of this investigation is to identify the epidemiological pattern on the Roberto del Río Hospital burned patients.

The protective effects of dexmedetomidine on myocardial injury of severely burned patients / 实用医学杂志

Objective To investigate the protective effects of dexmedetomidine on myocardial injury of severe burn patients. Methods Seventy-eight cases of severe burn patients were enrolled in this study in our hospital from May 2014 to May 2016. According to the clinical characteristics of treatment, the patients were divided into the control group and the observation group, with 39 cases in each group. Patients in the control group were treated with midazolam sedation on the basis of conventional burns, and patients in the observation group were treated with dexmedetomidine combined with midazolam sedation. The myocardial function-related indicators, heart rate (HR) and mean arterial pressure (MAP) of patients were compared between the 2 groups after treatment. Results (1) The SOD, MDA, CK-MB, cTnI and TNF-αof the two groups after treatment were significantly lower than those before treatment, and the degree of reduction in the observation group was significantly higher than that in the control group (P<0.05);(2) There were significant changes in MAP and HR before and after treatment in the both 2 groups. The decrease s of HR and the degree of MAP elevation in the observation group were significantly higher than those in the control group (P < 0.05, respectively). Conclusions Dexmedetomidine can improve the SOD activity of patients with severe burns, and the decreased expressions of CK-MB, cTnI and TNF-αcan reduce the degree of damage to myocardial tissue microstructure, and can protect the myocardium of patients with severe burns.

Changes in infiltration of polymorphonuclear neutrophils in alkali-burned cornea of conjunctival flap covering / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To study the infiltration of polymorphonuclear neutrophils ( PMNs ) after conjunctival flap covering in alkali-burned cornea. ●METHODS: Rabbit cornea alkali-burned model was made, then 50 rabbits were randomly divided into the experimental group ( n=25 ) and the control group ( n=25 ) . At the same time the surgery of conjunctival flap covering was given to rabbits of the experimental group. The condition developing of alkali-burned cornea was observed by slit lamp biomicroscopy, and took photos in two groups. The infiltration of PMNs was identified by hematoxylin eosin ( HE) staining in different periods. ●RESULTS:The quantity of PMNs increased on the 3d, reached the lower level on 7d, shown a peak on the 14d, then decreased gradually. PMNs level of the experimental group was significantly lower than that in the control group, and the difference of 3, 14 and 21d was significant (P ●CONCLUSION: During the wound healing process, alkali - burned cornea has close relation with the infiltration of PMNs. The treatment of conjunctival flap covering for the severe alkali-burned cornea was found to have good effect.

Spread of Efflux Pump Overexpressing-Mediated Fluoroquinolone Resistance and Multidrug Resistance in Pseudomonas aeruginosa by using an Efflux Pump Inhibitor / 감염과화학요법

BACKGROUND: Fluoroquinolone resistance in Pseudomonas aeruginosa may be due to efflux pump overexpression and/or target mutations. We designed this study to investigate the efflux pump mediated fluoroquinolone resistance and check the increasing effectiveness of fluoroquinolones in combination with an efflux pumps inhibitor among P. aeruginosa isolates from burn wounds infections. MATERIALS AND METHODS: A total of 154 consecutive strains of P. aeruginosa were recovered from separate patients hospitalized in a burn hospital, Tehran, Iran. The isolates first were studied by disk diffusion antibiogram for 11 antibiotics and then minimum inhibitory concentration (MIC) experiments were performed to detect synergy between ciprofloxacin and the efflux pump inhibitor, carbonyl cyanide-m-chlorophenyl hydrazone (CCCP). Then to elucidate the inducing of multi drug resistance due to different efflux pumps activation in Fluoroquinolone resistant isolates, synergy experiments were also performed in random ciprofloxacin resistant isolates which have overexpressed efflux pumps phenotypically, using CCCP and selected antibiotics as markers for Beta-lactams and Aminoglycosides. The isolates were also tested by polymerase chain reaction (PCR) for the presence of the MexA, MexC and MexE, which encode the efflux pumps MexAB-OprM, MexCD-OprJ and MexEF-OprN. RESULTS: Most of the isolates were resistant to 3 or more antibiotics tested. More than half of the ciprofloxacin resistant isolates exhibited synergy between ciprofloxacin and CCCP, indicating the efflux pump activity contributed to the ciprofloxacin resistance. Also increased susceptibility of random ciprofloxacin resistant isolates of P. aeruginosa to other selected antibiotics, in presence of CCCP, implied multidrug extrusion by different active efflux pump in fluoroquinolones resistant strains. All of Ciprofloxacin resistant isolates were positive for MexA, MexC and MexE genes simultaneously. CONCLUSION: In this burn hospital, where multidrug resistant P. aeruginosa isolates were prevalent, ciprofloxacin resistance and multidrug resistance due to the overexpression of fluoroquinolones mediated efflux pumps has also now emerged. Early recognition of this resistance mechanism should allow the use of alternative antibiotics and use an efflux pumps inhibitor in combination with antibiotic therapy.