Improved survival with an innovative approach to the treatment of severely burned patients: development of a burn treatment manual.

The management of severely burned patients remains a major issue worldwide as indicated by the high incidence of permanent debilitating complications and poor survival rates. In April 2012, the Advanced Emergency & Critical Care Medical Center of the Okayama University Hospital began implementing guidelines for severely burned patients, distributed as a standard burn treatment manual. The protocol, developed in-house, was validated by comparing the outcomes of patients with severe extensive burns (SEB) treated before and after implementation of these new guidelines at this institution. The patients included in this study had a burn index (BI) ≥30 or a prognostic burn index (PBI = BI + patient's age) ≥100. The survival rate of the patients with BI ≥30 was 65.2% with the traditional treatment and 100% with the new guidelines. Likewise, the survival rate of the patients with PBI ≥100 was 61.1% with the traditional treatment compared to 100% with the new guidelines. Together, these data demonstrate that the new treatment guidelines dramatically improved the treatment outcome and survival of SEB patients.

La prise en charge des patients gravement brûlés est toujours un problème majeur dans le monde, avec une mortalité élevée et de lourdes séquelles chez les survivants. En Avril 2012, le Centre de l'Hôpital de l'Université d'Okayama a commencé à distribuer un manuel pour le traitement des patients gravement brûlés. Notre protocole a été validé en comparant les résultats des patients souffrant de brûlures étendues traités avant et après la mise en oeuvre de ces nouvelles lignes directrices. Les patients inclus dans cette étude avaient une surface brûlée (SB) ≥30% ou un index de Baux (IBx= SB + âge du patient) ≥100. Le taux de survie chez les patients atteints sur ≥30% SB était de 65.2% avant et 100% après. Le taux de survie chez les patients avec un IBx ≥100 était de 61.1% avant et 100% après. Ces données démontrent que les nouvelles lignes directrices de traitement ont amélioré considérablement la survie chez ces patients.

Consumption of medium- and long-chain triacylglycerols decreases body fat and blood triglyceride in Chinese hypertriglyceridemic subjects.

OBJECTIVES: To investigate the effects of medium- and long-chain triacylglycerol (MLCT) on blood triglyceride (TG) in Chinese hypertriglyceridemic subjects. METHODS: A double-blind controlled clinical trial was carried out, in which 112 subjects with hypertriglyceridemia were randomly divided into two dietary oil groups: (1) long-chain triacylglycerol (LCT) and (2) MLCT. All subjects were requested to ingest fixed energy and to continue their normal activity levels, and to consume LCT or MLCT oil at 25-30 g daily during the study period. Anthropometric measurements of body weight, body mass index (BMI), body fat, body fat percentage, waist and hip circumference (WC and HC), areas of subcutaneous and visceral fat by computed tomography scanning and blood biochemical markers were measured at the beginning and end of the study. RESULTS: There were 50 and 51 subjects left in LCT and MLCT groups, respectively. There were no significant differences in daily intake of energy, protein, fat and carbohydrate, as well as the daily physical activity between the two groups during the study. After 8 weeks, MLCT group showed a significant decrease in body weight, BMI, WC, HC, ratio of WC and HC, body fat, body fat percentage and subcutaneous fat when compared with the initial values. The decrease in body weight, BMI, WC, body fat and subcutaneous and visceral fat was significantly greater in MLCT group than that in the LCT group. Furthermore, the serum concentrations of TG in MLCT group were significantly lower than those in the LCT group. CONCLUSIONS: Consumption of MLCT may reduce body weight, body fat and blood TG in hypertriglyceridemic subjects under an appropriate dietary regime.

Safety evaluation of a medium- and long-chain triacylglycerol oil produced from medium-chain triacylglycerols and edible vegetable oil.

To reduce the incorporation of dietary lipids into adipose tissue, modified fats and oils have been developed, such as medium-chain triacylglycerols (MCT). Typical dietary lipids from vegetable oils, termed long-chain triacylglycerols (LCT), are degraded by salivary, intestinal and pancreatic lipases into two fatty acids and a monoacyl glycerol; whereas, MCT are degraded by the same enzymes into three fatty acids and the simple glycerol backbone. Medium-chain fatty acids (MCFA) are readily absorbed from the small intestine directly into the bloodstream and transported to the liver for hepatic metabolism, while long-chain fatty acids (LCFA) are incorporated into chylomicrons and enter the lymphatic system. MCFA are readily broken down to carbon dioxide and two-carbon fragments, while LCFA are re-esterified to triacylglycerols and either metabolized for energy or stored in adipose tissue. Therefore, consumption of MCT decreases the incorporation of fatty acids into adipose tissue. However, MCT have technological disadvantages precluding their use in many food applications. A possible resolution is the manufacture and use of a triacylglycerol containing both LCT and MCT, termed medium- and long-chain triacylglycerol (MLCT). This manuscript describes studies performed for the safety evaluation of a MLCT oil enzymatically produced from MCT and edible vegetable oil (containing LCT), by a transesterification process. The approximate fatty acid composition of this MLCT consists of caprylic acid (9.7%), capric acid (3.3%), palmitic acid (3.8%), stearic acid (1.7%), oleic acid (51.2%), linoleic acid (18.4%), linolenic acid (9.0%), and other fatty acids (2.9%). The approximate percentages of long (L) and medium (M) fatty acids in the triacylglyerols are as follows: L, L, L (55.1%), L, L, M (35.2%), L, M, M (9.1%), and M, M, M (0.6%). The studies included: (1) acute study in rats (LD50>5000 mg/kg); (2) 6 week repeat-dose safety study via dietary administration to rats (NOAEL of 3500 mg/kg/day), (3) in vitro genotoxicity studies using Salmonella typhimurium and Escherichia coli (negative at 5000 mg/plate), and (4) a four-week, placebo-controlled, double blind, human clinical trial utilizing 20 test subjects (no effects at 42 g MLCT/day). These data are corroborated by other studies published in the peer-reviewed literature on analogous MLCTs.