Relationship between preoperative serum albumin concentrations and postoperative delirium in patients undergoing total knee/hip arthroplasty / 中华麻醉学杂志

Objective:To evaluate the relationship between preoperative serum albumin concentrations and postoperative delirium (POD) in the patients undergoing total knee/hip arthroplasty.Methods:Five hundred patients of both sexes, aged 50-90 yr, with body mass index of 50-80 kg, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, undergoing elective total knee or hip replacement under combined spinal-epidural anesthesia in our hospital from December 2021 to December 2022, were selected. Cerebrospinal fluid (CSF) samples were collected after successful subarachnoid puncture for determination of amyloid-beta 42 (Aβ42), total tau protein (T-tau) and phosphorylated tau protein (P-tau) concentrations using enzyme-linked immunosorbent assay. Confusion Assessment Method and Memorial Delirium Assessment Scale were used to evaluate the occurrence and severity of POD at 1-7 days after surgery (or before discharge), and the patients were divided into POD group and non-POD group (NPOD group). Logistic regression analysis was used to identify the risk factors for POD. The accuracy of plasma albumin concentration and CSF biomarker concentration in predicting POD was evaluated by the receiver operating characteristic (ROC) curve, and the mediating effect of CSF biomarker was analyzed.Results:A total of 343 patients were finally enrolled in the study, and the incidence of POD was 23.3%. There were statistically significant differences in age, preoperative plasma albumin concentration and Memorial Delirium Assessment Scale score in POD group as compared with NPOD group ( P<0.05). Before and after adjusting for confounding factors, decreased plasma albumin and increased concentrations of P-tau and T-tau in CSF before operation were the risk factors for POD, and increased concentrations of Aβ42, Aβ42/P-tau and Aβ42/T-tau ratio in CSF were protective factors for POD. The area under the ROC curve of preoperative plasma albumin concentrations in predicting POD was 0.668, and the area under the ROC curve of preoperative plasma albumin concentrations combined with CSF biomarker concentrations in predicting POD was 0.810 ( P<0.05). The direct effect of plasma albumin on POD was -0.009 869 2, the total effect was 0.029 443 7, and the mediating effect of P-tau accounted for 33.53% of the total effect. Conclusions:Decreased preoperative plasma albumin concentration is a risk factor for POD, and P-Tau in CSF serves as a key mediator in the relationship between serum albumin concentrations and postoperative delirium in the patients undergoing total knee/hip arthroplasty.

Relationship between preoperative mild cognitive impairment and postoperative delirium in patients undergoing total knee/hip arthroplasty / 中华麻醉学杂志

Objective:To evaluate the relationship between preoperative mild cognitive impairment (MCI) and postoperative delirium (POD) in the patients undergoing total knee/hip arthroplasty.Methods:A total of 625 patients, aged 50-90 yr, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, undergoing total knee and hip arthroplasty under combined spinal-epidural anesthesia from September 2021 to February 2022, were included.One day before surgery, the cognitive function was assessed using the Mini-Mental State Examination and the Montreal Cognitive Assessment scale.The patients were divided into non-MCI group (NMCI group) and MCI group according to the diagnostic criteria of MCI.The concentrations of amyloid beta 40 (Aβ40), amyloid beta 42 (Aβ42), total tau protein (T-tau) and phosphorylated tau protein (P-tau) in cerebrospinal fluid (CSF) were detected by enzyme-linked immunosorbent assay.The development of POD was assessed on 1-7 days after operation.The relationship between MCI and POD and relationship of concentrations of β40, Aβ42, T-tau and P-tau in CSFA, Aβ40/T-tau ratio, Aβ42/P-tau ratio and Aβ42/T-tau ratio with POD and MCI were analyzed using binary logistic regression.Results:Compared with NMCI group, the incidence of POD was significantly increased, the concentrations of Aβ42 and Aβ40 in CSF, Aβ40/T-tau ratio, Aβ42/P-tau ratio and Aβ42/T-tau ratio were decreased, and T-tau and P-tau concentrations in CSF were increased in MCI group ( P<0.05).The results of logistic regression analysis showed that before and after adjusting for confounding factors, increased MCI and concentrations of P-tau and T-tau in CSF were the risk factors for POD, and increased concentrations of Aβ42 and Aβ40 in CSF, Aβ40/T-tau ratio, Aβ42/P-tau ratio and Aβ42/T-tau ratio were protective factors for POD ( P<0.05); elevated concentrations of P-tau and T-tau in CSF were risk factors for MCI before and after adjusting for confounding factors, and increased concentrations of Aβ4 in CSF, Aβ40/T-tau ratio, Aβ42/P-tau ratio, and Aβ42/T-tau ratio were protective factors for MCI after adjusting for confounding factors ( P<0.05). Conclusions:Preoperative MCI are risk factors for POD in the patients undergoing total knee/hip arthroplasty.

Relationship between preoperative levels of serum uric acid and postoperative delirium / 中华麻醉学杂志

Objective:To evaluate the relationship between preoperative levels of serum uric acid (SUA) and postoperative delirium (POD).Methods:Seven hundred and fifty patients of either sex, aged 50-90 yr, with American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective knee replacement under spinal-epidural anesthesia, were selected.Venous blood samples were collected before anesthesia and levels of SUA were determined by enzyme-coupled assay.L 3-4 was selected as the puncture space, and the cerebrospinal fluid (CSF) specimens were obtained from the subarachnoid space for determination of concentrations of β-amyloid 42, total tau (t-tau) and phosphorylated tau (p-tau) by enzyme-linked immunosorbent assay.The patients were divided into hyperuric acid group (group HS) and non-hyperuric acid group (group NS) according to clinical diagnostic criteria of hyperuricemia, and into POD group (group POD) and non-POD group (group NPOD) according to the occurrence of POD.Logistic regression was used to identify the risk factors for POD.The mediating effect of CSF biomarkers was analyzed.The efficacy of SUA and CSF biomarker concentrations in predicting POD was evaluated using the receiver operating characteristic curve. Results:A total of 699 patients were finally enrolled in the study, and the incidence of POD was 21.5%.The results of logistic regression analysis after adjusting for multiple confounding factors, such as age, sex, years of education, Mini-Mental State Examination score, smoking history, drinking history, hypertension and diabetes history, showed that increased concentrations of SUA and p-tau and t-tau in CSF were risk factors for POD ( P<0.05). The results of mediation analysis showed that the concentrations of p-tau and t-tau in CSF were the mediating factors of the relationship between SUA and POD, with mediating effects of 0.000 301 (95% confidence interval 0-0.000 152) and 0.000 236 (95% confidence interval 0-0.000 092), respectively, and the intermediary proportion were 14.9% and 11.7%, respectively.The area under the receiver operating characteristic curve of SUA in predicting POD was 0.774 ( P<0.05). Conclusions:Increased preoperative SUA is a risk factor for POD, and the accuracy of predicting POD is high, and concentrations of p-tau and t-tau in CSF are mediators of SUA affecting POD.

Effects of seawater immersion on the inflammatory response and oxygen free radical injury of rats with superficial partial-thickness scald at early stage / 中华烧伤杂志

Objective@#To study the effects of seawater immersion on the inflammatory response and oxygen free radical injury of rats with superficial-thickness scald at early stage.@*Methods@#Seventy Wistar rats were divided into healthy control group (HC, n=7), pure scald group (PS, n=21), scald+ fresh water immersion group (SF, n=21), and scald+ seawater immersion group (SS, n=21) according to the random number table. Rats in group HC did not receive any treatment, while 5% total body surface area superficial partial-thickness scald was made on the back of rats in the latter three groups. Rats in group PS lived freely immediately post burn, while wounds on the back of rats in groups SF and SS were immersed into fresh water and seawater, respectively. Serum and full-thickness skin tissue in the center of wounds on the back of 7 rats in groups PS, SF, and SS at post immersion (injury) hour (PIH) 2, 4, and 6 were collected, respectively, while serum and full-thickness skin tissue at the same position of the 7 rats in group HC were collected at PIH 6 of rats in other groups. Morphology of skin tissue was observed with HE staining; tumor necrosis factor-alpha (TNF-α) content in serum and skin tissue was determined by enzyme-linked immunosorbent assay; superoxide dismutase (SOD) content in serum and skin tissue was determined by hydroxylamine method; malondialdehyde content in serum and skin tissue was determined by thiobarbituric acid method. Data were processed with analysis of variance of factorial design, one-way analysis of variance, Welch test, LSD test, and Tamhane test.@*Results@#(1) Epidermal cells of skin tissue of rats in group HC arranged in order and continuously, and the dermis tissue and accessory structures were clear and complete. The skin layer and epidermis of wounds of rats in group PS had no significant change, but the edema of epidermis and dermis and infiltration of inflammatory cells enhanced over time at PIH 2, 4, and 6. The horny layer of epidermis of wounds of rats in group SF reduced, and the edema of epidermis and dermis and infiltration of inflammatory cells enhanced over time at PIH 2, 4, and 6; some epidermal cells disintegrated at PIH 6. The horny layer of epidermis of wounds of rats in group SS significantly reduced, along with the increase in disintegration of epidermal cells, the significant enhancement of edema of epidermis and dermis, and infiltration of a large number of inflammatory cells over time at PIH 2, 4, and 6. (2) Compared with (247±27) pg/mL in group HC, the serum content of TNF-α of rats in group PS significantly increased at PIH 2 and 4 [respectively (675±122) and (367±54) pg/mL, P<0.05 or P<0.01] but significantly decreased at PIH 6 [(147±27) pg/mL, P<0.01]; the serum content of TNF-α of rats in group SF significantly decreased at PIH 6 [(90±24) pg/mL, P<0.01]; the serum content of TNF-α of rats in group SS significantly increased at PIH 2, 4, and 6 [respectively (1 646±58), (2 086±114), and (2 951±58) pg/mL, with P values below 0.01]. Compared with (364±123) U/mL in group HC, the serum content of SOD of rats in group PS significantly increased at PIH 2 and 4 [respectively (489±13) and (447±14) U/mL, with P values below 0.05]; the serum content of SOD of rats in group SF significantly decreased at PIH 6 [(282±13) U/mL, P<0.05]; the serum content of SOD of rats in group SS significantly increased at PIH 2 [(461±23) U/mL, P<0.05] but significantly decreased at PIH 4 and 6 [respectively (226±8) and (205±10) U/mL, with P values below 0.01]. Compared with that in group HC, the serum content of malondialdehyde of rats in groups PS, SF, and SS significantly increased at PIH 2, 4, and 6 (with P values below 0.01). (3) Compared with that in group HC, the TNF-α content in wound tissue of rats in groups PS and SS significantly increased at PIH 2, 4, and 6 (P<0.05 or P<0.01), and the TNF-α content in wound tissue of rats in group SF significantly increased at PIH 2 and 4 (with P values below 0.01). Compared with that in group HC, the SOD content in wound tissue of rats in groups PS and SF significantly increased at PIH 2, 4, and 6 (P<0.05 or P<0.01), and the SOD content in wound tissue of rats in group SS significantly increased at PIH 2 and 4 (with P values below 0.01). Compared with that in group HC, the malondialdehyde content in wound tissue of rats in groups PS, SF, and SS significantly increased at PIH 2, 4, and 6 (with P values below 0.01).@*Conclusions@#Seawater immersion can enhance the inflammatory response and oxygen free radical injury of wounds and the whole body of rats with superficial partial-thickness scald at early stage.

Clinical observation of different methods in the treatment of elderly patients with periodontal disease with type 2 diabetes / 中国基层医药

Objective To explore the clinical effects of different methods in the treatment of elderly patients with periodontal disease complicated with type 2 diabetes.Methods 60 elderly patients with periodontal disease complicated with type 2 diabetes were divided into 3 groups according to random number table method,each group in 20cases.Group A was treated periodontal disease and diabetes at the same time;Group B was given education work of periodontal disease,diabetes and oral health on the basis of group A;Group C received the laser adjuvant therapy on the basis of group A.The therapeutic effect,periodontal probing depth (PPD) and clinical attachment level (CAL) were observed.Results The effective rates of group A,group B,group C were 70％,80％,95％.Compared with group A,the effective rate of group B and group C increased significantly,the differences were statistically significant (x2 =6.458,P =0.004,x2 =5.361,P =0.001).The effective rate of group C was significantly higher compared with group B,the difference was statistically significant(x2 =8.264,P =0.000).3 months after treatment,the PPD and CAL of group A were (5.98 ± 0.36) mm,(1.46 ± 0.41) mm,respectively,which of group B were (3.01 ± 0.12) mm,(0.61 ± 0.16) mm,respectively,which of group C were (4.98 ± 0.45) mm,(0.93 ± 0.13) mm,respectively.Three months after treatment,the PPD and CAL of group B and group C were significantly reduced.Compared with group B after treatment,the PPD and CAL of group C significantly improved,the differences were statistically significant (t =3.689,P=0.005,t =6.358,P =0.000).Conclusion Education work of periodontal disease,diabetes and oral health and laser in the treatment of type 2 diabetes in elderly patients with periodontitis has obvious therapeutic effect,which is worthy of clinical application.

Effects of vacuum sealing drainage combined with irrigation of oxygen loaded fluid on wounds of pa- tients with chronic venous leg ulcers / 中华烧伤杂志

<p><b>OBJECTIVE</b>To evaluate the therapeutic effects of VSD combined with irrigation of oxygen loaded fluid on the growth of granulation tissue and macrophage polarization in chronic venous leg ulcers.</p><p><b>METHODS</b>Thiry-four patients with chronic venous leg ulcers hospitalized in our department from December 2010 to July 2014 were divided into VSD group ( A, n = 11) , VSD + irrigation group ( B, n = 11) , and VSD + oxygen loaded fluid irrigation group ( C, n = 12) according to the random number table. After admissian, debridement was performed, and granulation tissue in the center of the wound was harvested during the operation. After dehridement, the patients in group A were treated with VSD only (negative pressure from -30 to -25 kPa, the same below) ; the patients in group B were treated with VSD combining irrigation of normal saline; the patients in group C were treated with VSD combining normal saline loaded with oxygen irrigation (flow of 1 L/min) . On post treatment day (PTD) 7, the VSD devices were removed. Cross observation was conducted before debridement and on PTD 7. On PTD 7, the granulation tissue in the center of the wound was harvested for histopathological observation with HE staining and Masson staining, following calculation of granulation tissue coverage rate. After debridement but before the negative pressure therapy (hereinafter referred to as before treatment) and on PTD 7, partial pressure of oxygen of the skin around the wound was measured by transcutaneous tissue oxygen tension survey meter. On PTD 7, expression of vascular endothelial growth factor (VECF) was determined with immunohistochemistry. Before treatment and on PTD 7, cells with double positive expressions of induced nitric oxide synthase plus CD68 ( type I macro- phage) and arginase 1 plus CD68 ( type II macrophage) were observed with immunofluorescence staining and quantified. Data were processed with Fisher's exact test, one-way analysis of variance, covariance analysis, paired test, and LSD test.</p><p><b>RESULTS</b>(1) The gross observation showed that before debridement there was a certain amount of necrotic tissue and little granulation tissue in the wounds of patients in all the 3 groups. On PTD 7, new granulation tissue was found in the wounds of patients in all the 3 groups, and in group C its amount was the largest. (2) On PTD 7, the granulation tissue coverage rate of wounds in pa- tients of group C was higher than that of group A or B ( P <0.05 or P <0.01). (3) On PTD 7, HE staining showed that there appeared more abundant new born microvessels and fibroblasts in the wounds of patients in group C than those in groups A and B; Masson staining showed that there was more abundant fresh collagen distributed orderly in the wounds of patients in group C compared with group A or B. (4) On PTD 7, it was found that partial pressure of oxygen of the skin around the wounds in patients of group C [(40.7 +/- 4.1) mmHg, 1 mmHg = 0.133 kPa] was higher than that of group A [ (35.0 +/- 3.1) mmHg] or B [(35.4 +/- 2.7) mmHg, with P values below 0.01]; the partial pressure of oxygen of the skin around the wounds of patients in all the 3 groups was increased significantly compared with that before treatment (with values from 10.38 to 22.52, P values below 0.01). (5) On PTD 7, the expression of VECF in the wounds of patients in group C was higher than that in group A or B ( P <0.05 or P < 0.01). (6) On PTD 7, the number of type I macrophages in granulation tissue of patients was respectively 14.3 +/- 2.3, 11.5 +/- 3.0, and 10.7 +/- 2.3 per 400 times vision field in groups A , B, and C ( F = 25.14, P < 0.01), while the number in group C was less than that in group A or B ( P < 0.05 or P < 0.01). Compared with that before treatment, the number of type I macrophages was significantly decreased on PTD 7 in all the 3 groups (with values from 14.76 to 23. 73, P values below 0. 01). On PTD 7, the number of type II macrophages in granulation tissue of patients was respectively 32.7 +/- 3.2, 35.1 +/- 3.3 , and 41.3 +/- 3.2 per 400 times vision field in groups A, B, and C ( F = 81.10, P < 0.01), and the number in group C was lager than that in group A or B ( with P values below 0. 01). Compared with that before treatment, the number of type II macrophages in all the 3 groups was significantly increased (with t values from -69.34 to -47.95, P values below 0.01).</p><p><b>CONCLUSIONS</b>VSD combined with irrigation of oxygen loaded fluid can raise the partial pressure of oxygen of the skin around the wounds effectively, promoting the transition of macrophages from type I to type II, thus it may promote the growth of granulation tissue, resulting in a better recipient for skin grafting or epithelization.</p>

Effects of vacuum sealing drainage combined with irrigation of oxygen loaded fluid on chronic wounds in diabetic patients / 中华烧伤杂志

<p><b>OBJECTIVE</b>To evaluate the therapeutic effects of VSD combined with irrigation of oxygen loaded fluid on chronic wounds in diabetic patients.</p><p><b>METHODS</b>Twenty-six diabetic patients hospitalized in Nanfang Hospital of Southern Medical University from September 2010 to June 2013, with chronic ulcers on lower extremities conforming to the inclusive criteria, were divided into group VSD (n = 8), VSD + irrigation control group (VSD + IC, n = 9), VSD + oxygen loaded fluid irrigation group (VSD OLI, n = 9) according to the random number table. After gross observation was conducted and wound secretion was sent for bacterial culturing right after admission, debridement was performed. During the debridement, granulation tissue of wound center was harvested for determination of the activity of lactate dehydrogenase (LDH) and succinate dehydrogenase (SDH) with ELISA. After debridement, the patients in group VSD were treated with VSD (negative pressure from -30 to -25 kPa, the same below); the patients in group VSD + IC were treated with VSD combining irrigation of normal saline; the patients in group VSD + OLI were treated with VSD combining normal saline loaded with oxygen (flow of 1 L/min ) irrigation. Drainage tube blockage was recorded and its incidence rate was recorded during the treatment. On post treatment day (PTD) 7, tissue exudates were collected and analyzed with blood gas analyzer for determining the partial pressure of oxygen of the exudate. After the VSD was terminated, bacterial culture was conducted as before, and the bacterial clearance rate was calculated. After the calculation of granulation tissue coverage rate, the granulation tissue in the center of the wound was harvested for histopathological observation with HE staining; morphological characteristics and density of mitochondria were observed with transmission electron microscopy; the activity of LDH and SDH was estimated as before; microvascular density (MVD) was counted after CD31 antibody immunohistochemical staining. Then the second stage operation was performed. The method of second stage operation was recorded and survival rate of grafted skin or flap was calculated. Data were processed with one-way analysis of variance, LSD- t test, rank sum test, or Fisher's exact test.</p><p><b>RESULTS</b>(1) The gross observation showed that before debridement there was only necrotic tissue without granulation tissue in the wounds of patients in all the 3 groups. On PTD 7, granulation tissue was found in the wounds of patients in all the 3 groups. HE staining showed that there were more abundant newborn microvessels and regularly arranged fibroblasts in the wounds of group VSD + OLI; less newborn microvessels and relatively sparsely fibroblasts were observed in the wounds of group VSD + IC. There were only sparse newborn microvessels and fibroblasts in the wounds of group VSD. (2) Rates of drainage tube blockage, granulation tissue coverage, and bacterial clearance showed significant differences among the 3 groups (with F values from 10.98 to 770.24, P values below 0.01). The drainage tube blockage rate was significantly lower in groups VSD + IC and VSD + OLI [(2.0 ± 0.4)% and (1.9 ± 0.6)%] than in group VSD [(16.0 ± 1.3)%, with t values respectively 28.77 and 29.20, P values below 0.01]. (3) On PTD 7, the partial pressure values of oxygen of the exudate in groups VSD + IC, VSD + OLI, and VSD were respectively (111 ± 4), (43 ± 4), and (40 ± 4) mmHg (1 mmHg = 0.133 kPa, F = 882.76, P < 0.01). (4) The density of mitochondria in group VSD + OLI was obviously higher than that of the other 2 groups, full in shape, with complete outer membrane and no vacuolization. (5) During debridement, the activity of LDH and SDH in 3 groups showed no significant differences (with F values respectively 0.08 and 1.03, P values above 0.05). On PTD 7, the activity of LDH was lower in group VSD + OLI [(103 ± 15) U/L] than in group VSD + IC [(136 ± 16) U/L, t = 4.49, P < 0.01], while it was higher in group VSD [(155 ± 16) U/L] than in group VSD + IC (t = 2.47, P < 0.05). The activity of SDH was higher in group VSD + OLI [(2.93 ± 0.27) U/L] than that in group VSD + IC [(1.77 ± 0.22) U/L] or group VSD [(1.61 ± 0.19) U/L, with t values respectively 10.21 and 11.65, P values below 0.01]. (6) On PTD 7, there was more positive expression of CD31 in group VSD + OLI than in the other 2 groups. The MVD of groups VSD, VSD + IC, and VSD + OLI were respectively (109 ± 5), (124 ± 5), (141 ± 6) per 400 times visual field (F = 68.78, P < 0.01). (7) The patients in 3 groups mainly received skin or flap grafting as the second stage operation. The survival rates of skin and flap in group VSD + OLI were higher than those of groups VSD + IC and VSD (with t values from 3.32 to 8.26, P < 0.05 or P < 0.01), and the rates were higher in group VSD + IC than in group VSD (with t values respectively 2.67 and 3.18, P values below 0.05).</p><p><b>CONCLUSIONS</b>VSD + OLI is effective in reducing drainage tube blockage, removing necrotic tissue and bacteria, ameliorating ischemia and hypoxia of wound tissue, providing fresh wound bed for wound healing, and improving skin or flap graft survival rates.</p>

Seawater exposure exacerbates scald burns-induced intestinal injury in rabbits: study of the mechanisms / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effect of seawater exposure on intestinal injury in rabbits with scald burns and explore the mechanisms.</p><p><b>METHODS</b>Sixty-three rabbits with scald burns covering 20% total body surface area were randomized equally into scald control group (group A), scald with freshwater exposure group (group B), and scald with seawater exposure group (group C). At 2, 4 and 8 h after scald burns, 7 rabbits from each group were sacrificed for detecting plasma superoxide dismutase (SOD) and lipid peroxide (LPO) levels and intestinal contents of prostaglandins (PGs) and for examining the intestinal pathologies; immunohistochemistry was used to detect the expression of Bax and Bcl-2 proteins in the small intestinal epithelium.</p><p><b>RESULTS</b>The rabbits in group C showed severer intestinal mucosal and barrier function damages than those in groups A and B. The plasma SOD activity and intestinal PGs contents were significantly lowered in group C than in groups A and B at 2, 4, and 8 h postburn (P<0.01) and reduced as the postburn time extended (P<0.01). In group C, plasma LPO content was the highest among the groups (P<0.01) and increased significantly with the seawater exposure time (P<0.01). The expression of Bax and Bcl-2 in the intestinal mucosal tissues was also the highest in group C (P<0.01) at 4 h and 8 h postburn and increased significantly with time (P<0.01).</p><p><b>CONCLUSION</b>Seawater exposure exacerbates scald burn-induced intestinal mucosal and barrier function damages in rabbits mainly by aggravating intestinal inflammation and structural damage, as evidenced by decreased intestinal PGs contents and plasma SOD activity, increased plasma PLO content, and enhanced Bax and Bcl-2 protein expressions in the intestinal mucosa.</p>

Expressions of fibroblast activation protein during skin scald burn healing in rats / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the time course of changes in the expression of fibroblast activation protein (FAP) during healing of skin scald burns in rats.</p><p><b>METHODS</b>Adult Wistar rats were randomized into two equal groups (n=42) and subject to superficial second degree and deep second degree scald burns on the dorsal skin groups, with 6 normal rats serving as the control group. At 6 h, 12 h, and 1, 3, 7, 14, and 21 days after burns, 6 rats from each group were sacrificed to detect FAP expression by immunohistochemistry and Western blotting.</p><p><b>RESULTS</b>FAP was expressed on the cell membrane and in the cytoplasm of the fibroblasts, especially those around the neovessels. In both burn groups, FAP expression increased significantly at 6 h after burns. In superficial burn group, FAP expression was comparable between 6 and 12 h and between 1 and 3 days (P>0.05), but showed significant differences between the other time points (P<0.05). In deep burn group, FAP expression was comparable between 12 h, 1 day and 3 days (P>0.05) but differed significantly between the other time points (P<0.05). In both burn groups, FAP expression reached the peak level at 7 days followed by a gradual declination. At 21 days after the burns, FAP maintained a significantly higher expression level than the control level (P<0.05).</p><p><b>CONCLUSION</b>The time course of the changes of FAP expression following scald burns suggests an important role of FAP in the healing process of scald burns.</p>

A retrospective analysis of fluid resuscitation in 94 patients with extensive burns / 南方医科大学学报

<p><b>OBJECTIVE</b>To analyze the clinical data of adult patients with total burn surface area (TBSA) greater than 50% in Guangzhou and explore the optimal fluid resuscitation protocols for these patients.</p><p><b>METHODS</b>The clinical data of 94 adult patients with a TBSA over 50% treated in our center during 1991-2010 were reviewed. and the former decade. Fluid resuscitation volume of various components in shock stage, urine volume, occurrence of visceral complications and mortality rate within 10 days after injury were compared between patients treated in 1991-1999 and those in 2000-2010.</p><p><b>RESULTS</b>The first 24-h crystalline colloidal fluid ratio, first 24-h infusion volume and the second 24-h crystalloid fluid coefficients were significantly greater in the patients treated in 2000-2010 than in those treated in 1991-1999. The visceral complications and mortality rate were significantly lower in the latter than in the former patients (7.69% vs 27.3% and 2.56% vs 18.18%, respectively, P<0.05).</p><p><b>CONCLUSION</b>For patients with extensive burns, an individualized fluid resuscitation regimen, an adequately high colloid/crystal rehydration ratio, and a greater total infusion volume according to the local climate of Guangzhou can be beneficial to reduce the incidence of visceral complications and the mortality rate.</p>

Effects of NF-κB activation on pathogenesis of early myocardial dysfunction induced by PMN in burned rats / 中华急诊医学杂志

Objective To investigate the effects of NF-κB activation on paihogenesis of PMN aggregation in myocardium and early myocardial dysfunction induced by polymorphonuclear leukocyte (PMN) in burned rats. Method One hundred and seventy wistar rats were randomly divided into three groups, control group ( n = 20, with isotonic saline solution), bum group ( n = 90, with isotonic saline solution after bum), bum and pyrrolidine dithioncarbamate group ( PDTC group, n = 60, with isotonic saline solution and 250 mg/kg PDTC after bum). The rats in bum group and PDTC group underwent 35% TBSA full-thickness bums on the back. The acb'vaty of myocardial NF-κB was tested by electrophoretic mobility shift assay (EMSA) at 1, 3, 6, 12,24 postbum hours (PBH). Expressions of myocardial IL-8 and ICAM-1 mRNA were assessed by reverse transcription polymerase chain reaction (RT-PCR) at 3,6,12,24 PBH. Meanwhile, the avtivity of myocardial myeloperoxidse(MPO), the left ventricular systolic pressure(LVSP) and the left ventricular end diastolic pressure (LVEDP) as well as maximum positive and negative left ventricular pressure change (± dp/dtmax) were observed at 3,6,12,24 PBH. Results The activity of myocardial NF-κB in bum groups was markedly increased at 1 PBH [(20.27± 3.43) × 104 A] .which was obviously higher than that in control group [(2.18±0.38) × 104 A, P ＜ 0.01], and was still higher than that in control group at 24 PBH ( P ＜ 0.01). The expressions of myocardial IL-8 and ICAM-1 mRNA and avtivity of myocardial myeloperoxidse were obviously higher than that in control group at 3,6,12,24 PBH respectively (P ＜ 0.01), LVSP and ± dp/dtmax significantly were lower, but LVEDP was higher than that in control group during 3-24 PBH (P ＜ 0.01). Compared with that in bum group, these indices were ameliorated in PDTC group. Conclusions Severe bum might activate myocardial NF-κB, which ultimately lead to the production of cytokines, PMN aggregation in myocardium and deterioration of cardiac contractility and relaxation consequently.

Strengthen the Key Position of Teaching Relying on the Construction of Excellent Courses / 中华医学教育探索杂志

The construction of excellent courses is one important measure of carrying out the teaching quality project in university.To improve the quality of the construction of excellent courses,we must emphasize some basic operation strategies such as practical results,innovation,digital processing and integration.We should adopt workable measures to carry out the teaching quality project in university and strengthen the key position of teaching.

Exploration on Bilingual Teaching of Burn Surgery for Seven-year Medical Program Students / 中华医学教育探索杂志

Objective:To explore the mode,methods,and attentive problems of bilingual teaching of Burn Surgery for Seven-year medical program students.Methods:The bilingual teaching project of Burn Surgery was considered comprehensively from various angles,such as the teaching mode,methodology,teacher training,teaching material selection and teaching management in specialized course.Conclusion:It is very necessary to develop bilingual education for Seven-year program students.The course of bilingual teaching should be student-oriented to improve their integrated ability of English and to assure mastery of professional theory and knowledge.

Attempt at and Exploration on the Network Teaching During Standardized Training in Residents / 中华医学教育探索杂志

Objective:To explore the mode,methods,and attentive problems of the network teaching carried out during the standardized training in residents.Methods:The project of carrying out network teaching during the standardized training in residents was considered comprehensively from various angles,such as teaching mode,teacher training,construction of the network teaching system and resources base,teaching management in specialized course.Conclusion:It is very necessary and helpful to develop network teaching during the standardized training in residents.The course of network teaching should be student-oriented,carried out to improve their self-educated ability and to assure mastery of professional theory and knowledge.

An experimental study on the role of early postburn massive escharectomy on the prevention of internal organ dysfunction / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore the role of massive escharectomy at early postburn stage in the prevention of internal organ dysfunction.</p><p><b>METHODS</b>(1) Ten cases of severely burned patients were randomly divided into early (A) and non-early escharectomy (B) groups in equal number. Venous blood samples were harvested from the patients of the two groups in 1, 3 and 7 postburn days (PBDs), And the samples from 6 healthy volunteers were taken as the control. The serum was separated from the above blood samples and was employed to stimulate cultured HUVECs in vitro. The cell viability and permeability was observed after the stimulation. (2) Seventy Wistar rats inflicted with 30% TBSA III degree scalding were used as an animal model, and were randomized into early (C, n = 30) and non-early escharectomy (D, n = 30) groups, with 5 normal rats as control in each group. Intra-peritoneal fluid infusion was carried out at 1, 3, 6, 12, 24 and 48 postburn hours (PBHs) in rats in both groups. The rats were killed by blood letting at 1 hour after fluid supplementation. The changes in peritoneal macrophage (M Phi) activation state and plasma contents of LPS, IL-8, PLA(2) and MDA were determined at 48 hours after escharectomy in the rats.</p><p><b>RESULTS</b>The cell viability and permeability of the HUVECs co-cultured with the serum from burn patients in E group was much better preserved than that in B group. On the other hand, the peritoneal M Phi activation and the plasma contents of LPS, IL-8, PLA(2) and MDA in C group were obviously decreased compared with those in D group.</p><p><b>CONCLUSION</b>Early postburn escharectomy to remove denatured burned tissue were proved to be helpful in ameliorating endothelial injury and in inhibiting activation of inflammatory cells. Therefore, early escharectomy was assumed to be beneficial in the prevention of postburn SIRS and MODS.</p>

AIR TRANSPORTATION OF SEVERELY BURNED GROUP PATIENTS DURINGSHOCK STAGE / 解放军医学杂志

It has not been well agreed on transportation of severely burned patients for a long distance during shock stage due to having high risks. After meticulouss preparation and much effort, a group of severely burned patients during shock period were safely transferred by air far away from our hospital in Aug. 2000, and fluid resuscitation and hemodynamical stabilization were maintained on the plane. The process passed smoothly. All the patients survived finally after active and effective treatment in our burn center. The experience shows that transportation by air of burned patients for a long distance during shock stage is possible on condition that all relative measures are properly carried out during the journey.

EXPLORATION ON THE HEMODYNAMIC CHARACTERISTICS DURING BURN SHOCK STAGE IN DOGS IMMIGRAT- ED ONTO HIGH ALTITUDE / 解放军医学杂志

To explore the hemodynamic characteristics during burn shock stage in dogs immigrated onto high altitude, dogs scalded with 40% TBSA of Ⅲ degree burn (n=8) were randomly divided into a high altitude treatment group (H group) and a flatlands treatment group (F group) . All subjects were infused with lactated Ringefs solution at 1 postburn hour according to the Parkland formula. The changes in hemodynamic parameters, organ water content, pulmonary microvascular permeability, serum activity of PLA2 and CK-MB were determined. The results showed that under simulated high altitude condition sustained hypoxemia and acidosis as well as hypoxic damage of myocardial function were present before scalding, and sustained increase of PAP, PCWP and RVWI, even pulmonary hypertension and lung edema were found at 24 postburn hour in H group. At 48 postburn hour, the organ water content of heart, lung, etc increased more remarkably but urine output decreased more obviously in H group than those in F group. Serum activity of PLA2 and CK-MB increased gradually after burn. It is suggested that tissue edema may easily supervene with infusion according to Parkland formula under plateau condition. Hypoxic damage of organs should be corrected by increase of colloid volume resuscitation and dehydration treatment. Administration of hypertonic solution is able to correct burn shock.

Effects of escharectomy at different time points on myocardial damages in scalded rats during shock stage / 第三军医大学学报

Objective　To investigate the effects of escharectomy at different time points on myocardial damages in scalded rats during shock stage. Methods　A total of 42 rats were inflicted with 30% TBSA Ⅲ scalding on their backs and then randomly and equally divided into 7 groups: burned control group (C) and escharectomy groups at hour 1, 3, 6, 12, 24 and 36 postburn. Another 6 rats were employed as normal control (N). The serum levels of creatine kinase isoenzymes MB (CKMB), aspartate aminotransferase (AST) were determined and morphological changes in myocardial tissues were observed 72 hours after the burn. Results　The serum levels of CKMB and AST were higher in the C group than in other groups, and the levels in escharectomy groups were increased along with the prolongation of scar cutting. Pathologically, the myocardial tissues were severely damaged in C group, and the later the scars were cut, the severe the damages were in the escharectomy groups except the 2 groups with scars cut at hour 1 and 3. Conclusion　Escharectomy in shock stage can effectively prevent the damage of the myocardial tissues from postburn injury and the earlier it is performed, the better the result is.

Effects of burn sera on I?B? degradation and NF-?B activation in monocytes in vitro / 中国病理生理杂志

AIM: To investigate the effects of burn sera on I?B? degradation, NF-?B activation in peripheral blood monocytes (PBMCs) in order to explore the role of burn sera on activation of monocytes. METHODS: PBMCs isolated from healthy volunteers were stimulated by sera from healthy volunteers and burn patients and by burn sera together with PDTC (pyrrolidine dithioncarbamate). Activation of monocytic NF-?B was tested by electrophoretic mobility shift assay (EMSA) and the degradation of monocytic I?B? was determined by Western blotting. RESULTS: When compared to that in control group, cytosolic I?B? degradation occurred within 30 min after PBMCs stimulated by burn sera, and peaked at 60 min. But I?B? gradually recovered in the cytoplasm after 2 h of stimulation. Meanwhile, activity of monocytic NF-?B was markedly increased, reached the peak at 30 min to 60 min after stimulation, and gradually decreased after 2 h of stimulation. PDTC (an antioxidants) effectively inhibited the monocytic I?B? degradation and activation of NF-?B induced by burn sera. CONCLUSION: Burn sera might induce the degradation of I?B?, then activate NF-?B, which ultimately lead to the secretion of cytokines from the monocytes. [