Achievements and challenge of treatment of electric burn over the past 50 years in China / 中华烧伤杂志

The electric burn is a kind of special injury, in which the injured areas are not big, but deep tissues and organs are often injured, resulting in higher rates of mortality and amputation than thermal injury. In the process of management, besides the treatment for systemic and pathologic changes, wound repair is also emphasized for restoration of function. In the past 50 years, ten thousand patients with electric burn were cured in our country, including hundreds of severe electric burn patients with extensive injury. Lots of operative regimes for electric burn were developed, and the scope of experimental research was broadening. As a result, six monographs concerning electric burns were published. However, clinical management of severe electric burn to give a satisfactory result is still difficult, therefore further indepth research is necessary, especially in the field of the use of artificial skin, vessels, nerves, muscular tendon, etc. from gene and tissue engineering to improve quality of wound repair.

Influence of intravenous infusion of D-fructose on post-operative blood glucose level in burn patients / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the influence of intravenous infusion of 50 g/L fructose on post-operative blood glucose level in burn patients, and to evaluate its therapeutic value and safety.</p><p><b>METHODS</b>A prospective, randomized, double blinded clinical trial was conducted. Forty-one burn patients with burn area ranging between 10% -30% of total body surface (TBSA) and third degree burns ranging between 1% -10% TBSA were enrolled in the study and randomized into experiment group (E, n = 21, with intravenous infusion of 500 ml of 50 g/L fructose daily for 3 days after escharectomy) and control group ( C, n = 20, with intravenous infusion of glucose 1 day after escharectomy for 3 days). Intravenous infusion of other carbohydrate liquids or oral intake of sugar was withhold within 4 hours of fructose or glucose infusion. Physical signs and side effects were observed during the administration. The plasma glucose contents before operation and on 1, 2 and 3 post-operation day( POD) were measured. The serum content of lactic acid, uric acid, hepatic and renal function were determined before operation and on 4 POD.</p><p><b>RESULTS</b>Physical signs before and after drug administration, and plasma glucose content before operation, as well as before and after fructose administration in 3 POD exhibited no obvious difference between the two groups ( P > 0. 05 ). The plasma glucose content was increased 3 days after operation in the control group, and it reached the peak on 3 POD [ (8. 4+/-3. 5) mmol/L] , which was markedly higher than that before glucose administration [ (6. 4+/-2.4) mmol/L, P <0. 01) ]. The plasma contents of lactic acid and uric acid showed no obvious difference ( P >0.05) between the two groups, and also no difference before and after operation ( P > 0. 05). No changes were observed in hepatic and renal functions.</p><p><b>CONCLUSION</b>Intravenous infusion of 50 g/L D-fructose is safe because it exerts little influence on blood glucose level.</p>

The role of low concentration of dexamethasone on the rabbit corneal epithelial cell / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: The study was undertaken to investigate the effort of Dexamethasone (DEX) on cultured rabbit corneal epithelial (RCE) cells and rabbit corneal epithelial wound healing.METHODS: For the in vitro experiments, primary cultures of RCE cells were used. DEX in different concentrations was added to cultured RCE cells. The effects were measured with tetrazolium salt (MTT)method and flow cytometry. For the in vivo wound-healing experiments, a central corneal deepithelialization was created and were treated with 0.1g/L DEX eyedrop randomly explain how randomly. Epithelial wound healing was evaluated clinically and analyzed histopathologically using light microscopy along with immunohistochemical staning and electronic microscopy.RESULTS: Less than 0.1g/L DEX didn't influence survival rate in cell culture conditions by MTT assay. Flow cytometric studies revealed that 0.1g/L DFX had no effect on cellular growth phase in cultured rabbit corneal epithelial cells. The mean time of the epithelial healing was significantly shorter in the DEX-treated group than in the control group at 24h. There were strong proliferative-cell-nuclear-antigen(PCNA) expressions in newly generated epithelial cells of both groups. The Dex-treated group had a more regular architecture of stromal lamella and significantly less inflammatory response than the control group under electronic microscopy.CONCLUSION: Less than 0.1g/L DEX had no inhibiting effect on cultured rabbit corneal epithelial cell growth.0.1g/L DEX eye drops can effectively promote epithelial growth and reduce inflammatory response, which may have useful clinical application at the early stage of corneal wound healing process.

Preliminary study on the improvement of wound microcirculation and retrospection on several methods of the management of deep partial thickness burn wound / 中华烧伤杂志

<p><b>OBJECTIVE</b>To analyze several methods of wound repair for deep partial thickness burn wounds retrospectively, so as to evaluate the significance of improvement of wound microcirculation on wound healing.</p><p><b>METHODS</b>(1) 2,976 burn patients admitted to our department were enrolled in the study, among them 614 undertook tangential excision, 32, eschar abrasion, 86 allo-skin coverage after debridement, 1836 tropical application of silver sulfadiazine and 408 with traditional Chinese medicine (Jing Wan Hong ointment) with gauze bandage. The results of the management with different methods were compared. (2) Rat model with deep partial thickness burn was reproduced and topical application of silver sulfadiazine was given. The rats were randomly divided into control (n = 10, with normal saline injected via caudal vein within 5 minutes postburn), and treatment (n = 10, with batroxobin injected via caudal vein within 5 minutes postburn) groups. The blood flow perfusion unit in the wound skin was measured before burn and at 0.5 to 72 postburn hours by Laser Doppler. The wound healing rate, contraction rate and wound healing time in each group were calculated on 14 and 18 postburn days (PBDs). The number of hair follicles after wound healing was observed by histological method.</p><p><b>RESULTS</b>(1) The burn wound treated by tangential excision healed within 2 to 3 post operation weeks (POWs), with the healing rate of 94.8% in patients with burn covering 50% - 70% TBSA and 93.4% in those with burn of 80% approximately 98% TBSA. The healing time of patients with allo-grafts coverage after eschar abrasion was 13.8 +/- 2.1 days without scar formation. The wound healing time was 18.0 +/- 2.3 day in 82 patients with allo-graft coverage after debridement, and it was 26.0 +/- 3.2 days with subeschar healing in 1658 patients with topical application of silver sulfadiazine. Infection in burn wound was encountered in most patients undergoing traditional Chinese medicine bandage treatment with wound healing time of 26.0 +/- 2.8 days in the lower extremities. (2) The blood flow perfusion unit of the rats in the treatment group was significantly higher than that in the control group (P < 0.01). The wound healing rate in treatment group on 14 and 18 PBD was obviously higher than that in the control group (P < 0.01). But the wound contraction rate in the two groups was similar (P > 0.05). The wound healing time in treatment group was much shorter than that in control group (P < 0.01). A few hair follicles remained in the dermis of the rats in the control group on 30 PBD, and the number was evidently smaller than that in the treatment group (P < 0.01).</p><p><b>CONCLUSION</b>Early tangential excision and eschar abrasion remained better methods in the management of deep partial thickness burn wounds, as they could ameliorate burn wound infection, shorten treatment period, raise wound healing rate and quality. Application of batroxobin could accelerate wound healing rate by improving wound microcirculation in deep partial thickness burn wound.</p>

Influence of hyperoxic fluid on the down-regulated proteins of intestinal mucosa in scalded rats / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the influence of hyperoxic fluid on the down-regulated proteins of intestinal mucosa in scalded rats, so as to provide a theoretical basis for the clinical use of hyperoxic fluid.</p><p><b>METHODS</b>Sprague-Dawley (SD) rats with 35% TBSA full-thickness scald were randomly divided into scald control (S, n = 6,with intraperitoneal fluid infusion after scalding), hyperoxic (H, n = 6, with hyperoxic fluid infusion after scalding) groups. Six rats without scald injury served as normal group. The proteins in the intestinal mucosa were separated with the two-dimensional electrophoresis (2-DE), and were analyzed with ImageMaster 2D Elite. The influence of hyperoxic fluid on the down-regulated proteins of intestinal mucosa in scalded rats was studied with bio-spectrum, protein bank and document analysis.</p><p><b>RESULTS</b>(1) Among the 34 down-regulated protein spots in S group, 9 of them definitely exhibited up-regulation compared with those in H group. (2) The expression of mitochondrial aconitase, alpha-propionyl-CoA carboxylase, short chain of hydroxyacyl-Coenzyme A dehydrogenase, transcription factor EB (estradiol benzoate), triosephosphate isomerase 1, T cell receptor V delta 6, and dynein-like protein-5 in H group were significantly up-regulated.</p><p><b>CONCLUSION</b>The hyperoxic fluid could up-regulate the down-regulated proteins in rat intestinal mucosa at early postburn stage, so that the barrier function of intestinal mucosa of rats with severe burns could be partially recovered.</p>

Experimental and clinical study on the treatment of ischemic skin flap with topical application of PGE1 / 中华烧伤杂志

<p><b>OBJECTIVE</b>To evaluate the efficiency of PGE(1) in relieving the circulatory disorder of ischemic skin flap.</p><p><b>METHODS</b>New Zealand rabbits were employed in the study with skip flaps each with the size of 2.5 x 6.0 cm(2) being raised from the back. PGE(1) cream in different concentrations, i.e. 0.2%, 0.4%, 0.8% was respectively topically applied to the skin flaps forming 3 groups (n = 10 in each group), while pure cream without PGE(1) was applied to those in control group (n = 30). The PGE(1) was applied 1 hour after the flap was opened, raised and sutured back. Blood perfusion in the flap was measured with Laser Doppler flowmetry before and 5, 10, 15, 20, 30, 45 and 60 mins after PGE(1) application. The tissue samples from the skin flap were harvested at 2 hours after PGE(1) application for immunohistological staining, and the cross sectional area of capillary lumens was measured under microscope. The survival area of the flap was assessed on the 3(rd) day after operation for the calculation of relative survival length of the flap. Clinically, PGE(1) ointment was applied onto the skin flap vulnerable to necrosis, and the outcome of the flap was observed thereafter.</p><p><b>RESULTS</b>The blood perfusion in animal skin flaps was increased evidently after PGE(1) application, especially at 30 mins after PGE(1) usage when compared with that in control group (P < 0.05). The capillaries in the skin flap in PGE(1) application groups were dilated obviously after drug usage as observed under microscope (P < 0.05). The survival area and relative survival length in groups 1 and 2 on the 3(rd) post-operational day were much more increased when compared with those in other groups (P < 0.01). Clinically, the skin flaps treated with PGE(1) survived well even in the distal end of the flaps.</p><p><b>CONCLUSION</b>The blood perfusion and the survival rate of the skin flaps could be improved by local application of PGE(1) in concentrations of 0.2% or 0.4%.</p>

An observation of the effects of Tiopronin on the oxygen free radicals in severely scalded rats receiving delayed fluid resuscitation / 中华烧伤杂志

<p><b>OBJECTIVE</b>To observe the harmful effects of oxygen free radicals and the protective roles of Tiopronin in severely scalded rats after delayed fluid resuscitation.</p><p><b>METHODS</b>Rats inflicted with 30% III degree scald on the back were employed as the model. They were divided into delayed resuscitation (D) and Tiopronin treatment (T) groups. The changes in superoxide dismutase (SOD) and malonyldialdehyde (MDA) in plasma and subeschar fluid were determined at 24 to 48 postburn hours (PBHs) by means of electron spin resonance (ESR) technique and other routine methods. And the pathomorphological changes in the heart, liver, kidneys and small intestine, and changes in the blood biochemical indices were simultaneously determined. Normal rats were taken as control group (N).</p><p><b>RESULTS</b>The plasma SOD level was was lower than that in N group, while the MDA content in plasma and subeschar fluid in D group was much higher than that in N group. Changes in all the blood biochemical and internal organ pathomorphology were more obvious in the D group. on the other hand, the rat plasma SOD level in T group increased obviously (P < 0.01) while the MDA contents was decreased in T group (P < 0.05) when compared with those rats of D group. In addition, the internal organ pathomorphology and blood biochemical indices were improved evidently in T group.</p><p><b>CONCLUSION</b>Oxidative stress injury was evoked in severely scalded rats after delayed fluid resuscitation, and it could be protected to some extent by Tiopronin.</p>

The protective role of hyperoxic Ringer's solution on the hepatic injury in rats with burn shock / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore the dynamic postburn changes in rat hepatic function and the effects of hyperoxic Ringer's solution resuscitation on the function.</p><p><b>METHODS</b>One hundred and ninety Wistar rats of both sexes with body weight of 250 - 300 g were employed as the model and were divided into 6 groups as A, B, C, D, E and F groups as follows: normal control (A, n = 10), early resuscitation with Ringer's solution (B, n = 40), delayed resuscitation with Ringer's solution (C, n = 30), early resuscitation with hyperoxic Ringer's solution (D, n = 40), delayed hyperoxic Ringer's solution resuscitation (E, n = 30) and burn control (F, n = 40). Blood samples were drawn from the injured rats under anesthesia at 6, 12, 24 and 48 postburn hours (PBHs), and the serum contents of ALT, AST and MDA in these blood samples were determined. Hepatic tissue samples were also harvested at the same time and served histologically.</p><p><b>RESULTS</b>The plasma ALT level at 6 PBH in all groups was higher than that in A group (P < 0.05). There was significant difference of plasma ALT levels between hyperoxic Ringer's solution treatment group an other treatment groups (P < 0.05). And there was evident difference of plasma ALT levels between hyperoxic Ringer's solution treatment groups and other treatment groups (P < 0.05). The dynamic change in plasma AST was almost similar to that of ALT. The plasma MDA level was increased obviously after injury, especially in F group (highest level). Furthermore, the MDA level in C group was higher than that in B group. The plasma MDA levels in D and E groups were evidently lower than that in all other groups (P < 0.05). It was revealed by histological examination that there were different degrees of degeneration an necrosis of hepatocytes during early postburn stage, but less so in D group.</p><p><b>CONCLUSION</b>Fluid resuscitation during early postburn stage with hyperoxic Ringer's solution could inhibit the production of oxygen free radicals and blunt lipid peroxidation, and it could also enhance the host tolerance to hypoxia and prevent hepatocytes from injury, thus hepatic function was protected.</p>

Separation and identification of down-regulated proteomics of intestinal mucosa in scalded rats / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore the pathogenesis of postburn intestinal mucosal injury in scalded rats.</p><p><b>METHODS</b>The rats inflicted with full thickness burn were employed as the model. The two-dimensional electrophoresis (2-DE) was employed to identify the down-regulating proteins from the differential proteins in scalded rats. Spot detection and matching were performed with Image Master 2D Elite. Mass spectrometry was performed on Bruker BIFLEX III TOF.</p><p><b>RESULTS</b>There are 34 points of proteins in intestinal mucosa in scalded rats which were down-regulated at 6 and 12 postburn hours. Among them 22 proteins were employed for the identification and analysis. Mitochondrial aconitase, alpha-propionyl -CoA carboxylase heavy chain A of F1-ATPase in rat liver, Troponin short-chain of hydroxyacyl-coenzyme A dehydrogenase, alpha-subunit of P-electronic transferring flavoprotein (ETF) were down-regulating proteins correlated with mitochondria in intestinal mucosa in severely scalded rats. Triosephosphate isomerase 1 and cytosolic epoxide hydrolase were down-regulating proteins participated in metabolism of scalded rats. Fibromodulin, dynein-like protein, Troponin-2 and myosin light chain 3 alkali (MLC) were down-regulating proteins correlated with cellular skeletal protein. Glucocorticoid-inducible protein, nuclear factor1-B2, BRCA1, transcriptive factor EB (estradiol benzoate), beta2 subunit of G-protein, N-methyl-D-aspartate receptor1 (NMDAR) were down-regulating proteins participated in postburn regulation of intestinal mucosa in scalded rats. T-cell receptor-V-delta 6 and Ig heavy chain V region protein 1 were down-regulating proteins correlated with the immunomodulation of intestinal mucosa in scalded rats.</p><p><b>CONCLUSION</b>The down-regulating proteins of intestinal mucosa in scalded rats exhibited close relationship with mitochondria.</p>