A Randomized,Multi-center and Parallel Control Clinical Trial for Acidic Fibroblast Growth Factor in the Treatment of Deep Second Degree Burn / 中国药师

Objective:To evaluate the efficacy and safety of recombinant human acidic fibroblast growth factor( rh-aFGF)and re-combinant human basic fibroblast growth factor( rh-bFGF)in the treatment of deep second degree burn. Methods:A multicenter,pro-spective,randomized and double-blind clinical trial was conducted. Totally 216 cases of deep second degree burn were selected from five research centers and given appropriate antibiotics and nutritional supplement therapy. The wound of 108 cases in the observation group were rinsing with rh-aFGF(one bottle / 5cm2)according to the wound area at the time of admission followed by rh-aFGF daily spraying,3-4 press/cm2 ,6-8 times a day. The 108 patients in the control group were treated with rh-bFGF with the same regimen as the observation group. After the 30-day follow-up,the wound healing was evaluated in the two groups. Results:The complete healing time,debridement time,complete healing rate in 12 days and 15 days in the observation group were all better than those in the control group(P<0. 05). After the 7-day treatment,the level of leukocyte and seepage score of the observation group were both lower than those of the control group(P<0. 01). The moderate rate showed significant difference between the two groups(P<0. 05). Conclu-sion:rh-aFGF shows better clinical efficacy than rh-bFGF in the treatment of deep second degree burn with the similar safety.

An inquiry into the relevant issues about burn sepsis / 中华烧伤杂志

Since the definition of sepsis was proposed in Chest by American College of Chest Physicians and Society of Critical Care Medicine in 1992, researches on burn sepsis have focused on the regulation of immune-inflammation response resulting in minimizing tissue injury resulted from excessive inflammatory response. Treatment of sepsis should focus on effect of early circulation oxygenation support in preventing and treating multiple organ dysfunction. The hypothesis of producing a hibernation-like state which might prevent multiple organ dysfunction in patients with sepsis provides us a new therapeutic strategy in protecting organs in the early stage of sepsis in future.

The characteristics of elderly burns in Shanghai.

OBJECTIVE: This study aims to analyse the epidemiologic characteristics of severe burn in the elderly in Shanghai and to discusses a possible prevention programme for this population. METHODS: A retrospective review of all medical records of elderly patients (aged 60 and older) admitted with acute burns to the Burn Center of the RuiJin Hospital between January 1996 and December 2004 was carried out. Patient demographics, etiology of burn, mechanism of injury, burn extent, anatomical areas burned, number of operations, and outcomes were reviewed. RESULTS: A total of 201 (5.8% of hospitalised patients) elderly patients (mean age (+/-SD) of 69.3+/-7.1 years (range 60-90 years)) were admitted. Majority of the patients were men (62.2%) and the most common etiologies were flames (52.7%) and scalds (39.8%). The majority of burns occurred at home (73.6%), followed by burns at workplace (15.9%) and public areas (10.5%). The median total body area burned was 11.7% (range 0-84%), and the majority of burns were classified as mild (60.2%) and moderate (32.8%). Predominant anatomical areas involved were the legs (76.1%), arms (67.2%), head and neck (49.8%) and hands (49.3%). The most common pre-injury conditions were cardiovascular diseases (25.9%), diabetes (8.5%) and neurological diseases (6%). Eighty-seven patients (43.3%) required surgical treatment. The most common complications were multiple organ failure (2%), pneumonia (1%) and wound infection (1%). Sixteen patients (8%) died: half of them in hospital, and the rest at home. There was a significant correlation between post-injury complications and death (r=0.69, p<0.001). The mean total hospitalisation cost was yen 22993.09 (US$ 3381.34). CONCLUSIONS: Domestic and workplace burns with devastating consequences are very common in the elderly population in Shanghai. Burn prevention education and implementation of safety measures at home and at workplace would help reduce such incidences.

Characteristics of burn patients at a major burn center in Shanghai.

In China, burns are becoming a major cause of morbidity and mortality with large societal and economic implications. To date, there is little epidemiological data on burns in China to direct prevention efforts. This study describes the characteristics of burn patients admitted to a major burn center in Shanghai using a burn registry developed in Toronto, Canada. A retrospective review of burn patients discharged from the Shanghai's Rui Jin Hospital Burn Unit, between March 1st 2002 and April 30th 2003, was conducted. Of 527 patients discharged, 307 were acute burn patients and 302 (98.4%) had complete data to be included in the study. There were 214 (71%) males and 88 (29%) females with a male to female ratio of 2.4:1. The median age was 30 years, and the median total body surface area burned was 10%. The majority of burns occurred at work (58%), and the most frequent etiology was flames (39%) followed by scalds (31%) and contact with hot objects (15%). Sixteen (5%) patients had inhalation injury and six (2%) patients died. There were 70 (23%) children (0-14 years), 221 (73%) adults (15-59 years) and 11 (4%) seniors (60 years and above). Children had more scald burns (83%) and the majority (83%) occurred at home. Adults had more flame burns (46%) and the majority (79%) were work-related injuries. Seniors had more flame burns (73%) and the majority (55%) occurred in domestic incidents. Seniors had deeper burns (13%, p=0.005), required more escharotomies (55%, p=0.002), required more operations (2, p=0.051) and had higher mortality (36%, p<0.001) than other age groups. These results provide compelling evidence for performing population-based studies to identify risk factors that are susceptible to modification in each age group.

Characteristics of 1494 pediatric burn patients in Shanghai.

To analyze the epidemiological characteristics of pediatric burn patients in Shanghai and to determine the targets for a pediatric burn prevention program, a retrospective review of all medical records of acute pediatric burn patients (age

Histological observation of the effects of tangential excision within twenty-four postburn hours on the progressive injury of the progression of deep partial thickness burn wound / 中华烧伤杂志

<p><b>OBJECTIVE</b>To evaluate the effects of early tangential excision on the prevention of the progression of deep partial thickness burn wound.</p><p><b>METHODS</b>Twelve burn patients with deep partial thickness burn wound were enrolled and received tangential excision of the burn wound within 24 postburn hours (PBHs). The histological samples were harvested from the wound before and 5 - 7 postoperative days (PODs) after the operation and the wound without operation 5 - 7 postburn days (PBDs). The samples were observed by means of HE staining, Masson's staining and the labelling of Vimentin antigen positive cells by immunohistological skill.</p><p><b>RESULTS</b>The inflammatory reaction of the burn wound without operation aggravated progressively along with that of disease and the tissue necrosis area enlarged. And the residual skin appendages disappeared due to the enhanced inflammatory reaction. The brown area expanded and light green area shrinked by Masson's staining. The Vimentin antigen positive cell count decreased significantly. But in the burn wound being performed tangential excision within 24 PBHs, focal inflammatory reaction exhibited evident ligher than that in burn wound without operation. Moreover, there appeared fresh granulation formation and partial epithelial coverage with no enlarged necrotic tissue area in the operated wound when compared with that in non-operated wound (P < 0.05). Furthermore, the light green area exhibited no obvious shrinking by Masson's staining and the Vimentin antigen positive cell count was much more in the operation area than that in non-operative area (P < 0.05).</p><p><b>CONCLUSION</b>It might be beneficial to the host to perform tangential excision within 24 PBHs, which could remove burn wound necrotic tissue in time and hamper the progression of tissue degenerative injury. The healing process of deep partial thickness burn wound was therefore accelerated.</p>

A multicenter clinical trial of piperacillin/tazobactam in burn infection / 中华烧伤杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of piperacillin/tazobactam in the management of burn infection.</p><p><b>METHODS</b>Sixty-three burn patients were enrolled in the study with burn sepsis or burn area more than 50%TBSA or full skin loss more than 30% TBSA. The administration regime of the antibiotics was 4.5 g intravenously administered every 8 hours in the treatment of burn sepsis or in the prophylactic management. The effectiveness was identified when the septic symptoms disappeared or focal infection did not develop into sepsis.</p><p><b>RESULTS</b>The overall clinical efficacy was 90.4%, and success in sepsis (control) was 75%. Furthermore, 95.7% of the focal infection was prevented from developing into systemic infection. The bacterial clearance rates were 71.4% and 51.4% in treatment and prophylaxis groups, respectively.</p><p><b>CONCLUSION</b>Piperacillin/taxobactam was effective in the treatment and/or prophylaxis of burn sepsis caused by bacteria susceptible to it, so it could be applied empirically.</p>

Effect of necrotic tissue on progressive injury in deep partial thickness burn wounds / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the influence of necrotic tissue on progressive injury in deep partial thickness burn wounds.</p><p><b>METHODS</b>Tissue specimens were cultured both for estimation of IL-8, EGF, bFGF, PDGF-AB and histopathological examination, from the pre-operation, post-operation, and non-operation wounds from seven patients with deep partial thickness burn.</p><p><b>RESULTS</b>In seven specimens from the non-operation group, IL-8 release increased compared with those in the post-operation group (P < 0.001), while the levels of EGF, bFGF, PDGF-AB release were lower than those in the post-operation group. Histopathological examination revealed that in the non-operation group, the degree of neutrophil infiltration was enhanced, the extent of tissue necrosis enlarged, and residual skin appendages disappeared. In contrast, in the post-operation group, the degree of inflammatory response was decreased, with the formation of fresh granulation tissue and epithelialization.</p><p><b>CONCLUSION</b>This study suggests that the presence of necrotic tissue could be the inhibitory factor in the wound healing process, as it might cause tissue progressive injury leading to the delay of wound healing. To promote wound healing, active tangential excision is recommended to remove necrotic tissue.</p>

Significance of Arterial Base Deficit in Patients with Severe Burn Injuries / 上海第二医科大学学报

ObjectiveTo investigate the changes of arterial base deficits (BD) in the early stageof extensive burned patients. MethodsWe perform a retrospective review of 126 patients with a totalbody surface area (TBSA) over 30% whose resuscitations were initiated with the Ruijin formula to ob-serve the BD changes and analyze the relationship of BD and TBSA at different postburn time intervals insurvivors and deaths. ResultsWithin 48h after burn injury, the BD value improved gradually. Thedifference between survivors and nonsurvivors was significant at 4 to 8h interval after burn injury ( P <0.05). BD was correlated with TBSA strongly during 4 to 16h after burn injury ( P ≤0.05)in nonsur-vivors, but not in survivors. The incidence of the shock－ related complications in survivors was higherthan in nonsurvivors. ConclusionBD could be one of monitor index in the shock stage after severeburM injury.