Coagulation dysfunction of severe burn patients: A potential cause of death.

BACKGROUND: Research on coagulation dysfunction following burns is controversial. This study aimed to describe the coagulation changes in severe burn patients by examining coagulation parameters. METHODS: Patients with third-degree total body surface area (TBSA) burns of ≥30% were enrolled between 2017 and 2020. Platelet (PLT) count and coagulation indexes (including APTT, INR, FIB, DD, and AT Ⅲ) were measured at admission and once weekly for 8 weeks, and statistical analysis was performed. The patient medical profiles were reviewed to extract demographic and clinical data, including TBSA, third-degree TBSA, and inhalation injury. The total intravenous fluids and transfusions of crystalloids, fresh frozen plasma (FFP), and red blood cells (RBC) were calculated during the forty-eight-hour period. The number of sepsis cases was recorded. RESULTS: We enrolled 104 patients , and while the overall coagulation trend fluctuated, inflection points appeared around one week and demonstrated hypercoagulability. INR was significantly higher in the non-survival group than in the survivors' group from admission to three weeks after burn (all p<0.01). From post-injury week 1 to post-injury week 3, the APTT in the non-survival group was greater than in the survival group, but the non-survival group's PLT count was lower than that in the survival group (all p<0.05). At two and three weeks after burns, the FIB levels in the non-survival group were significantly lower than those of the survival group (both p<0.01). The prevalence of inhalation injury and the proportion of sepsis cases were significantly higher in the non-survival group than in the survival group ( p ＜ 0.05, p ＜ 0.001, respectively). At the time of death, APTT, INR, and FDP levels were significantly higher in the non-survival group in the survivor group, and FIB, ATIII, and PLT were significantly lower than in the survivor group (all p<0.01). On the day of death, nine of the 12 dead patients had disseminated intravascular coagulation (DIC). CONCLUSIONS: Coagulation dysfunction was most prominent in severe burn patients 1 week after injury and presented as hypercoagulability. Large-area burn injury, large amounts of fluid resuscitation, inhalation injury, and sepsis may all contribute to coagulation dysfunction, which can further develop into DIC and even death in severe burns patients.

Mechanistic studies on the role of TGF-ß1 in angiogenesis through EndMT.

OBJECTIVE: This study aims to investigate the mechanism of transforming growth factor-ß1 (TGF-ß1) in promoting angiogenesis through endothelial-to-mesenchymal transition (EndMT). METHODS: The mesenchymal transition of human umbilical vein endothelial cells (HUVECs) was induced by TGF-ß1. The angiogenesis, migration, and proliferation of HUVECs undergoing EndMT were examined by tube formation assay, scratch assay, Transwell assay, and CCK-8 assay. RESULTS: The outcomes revealed that EndMT promoted angiogenesis, migration, and proliferation of HUVECs and the secretion of the vascular endothelial growth factor (VEGF) of HUVECs. Phosphorylated AKT (p-AKT) increased in EndMT by inhibiting the mitigation of angiogenesis. CONCLUSION: EndMT induces angiogenesis by promoting the secretion of VEGF, and p-AKT participates in this regulation.

[Involvement of PI 3 K/Akt/mTOR Signaling in Protective Effects of Moxibustion for Premature Ovarian Failure in Rats].

OBJECTIVE: To study the protective effect of moxibustion for tripterygium-induced premature ovarian failure (POF) and its underlying mechanisms in rats. METHODS: Forty-five female SD rats were randomly divided into normal control, POF model and moxibustion groups (n＝15/group). The POF model was induced by intragastric administration of Triptolide (40 mg/kg), once daily for 6 weeks. From the 4th week after modeling, moxibustion was given at "Guanyuan" (CV 4) and bilateral "Sanyinjiao" (SP 6) for 10 min, once daily for 3 weeks. Pathological changes of ovary tissues were determined by hematoxylin-eosin (HE) staining. The serum estradiol (E2), luteinizing hormone (LH), follicle-stimulating hormone (FSH), interleukin-6 (IL-6) and interleukin-1 ß (IL-1 ß) contents were measured by enzyme-linked immunosorbent assay (ELISA). The expression levels of phosphatidyl inositol 3- kinase (PI 3 K), protein kinase B (Akt) and mammalian target of rapamycin (mTOR) proteins of the ovarian tissue were detected by Western blot. RESULTS: After modeling, HE staining showed that the numbers of ovarian follicles and follicular granulocytes and corpora luteum layers were decreased, and the number of corpora atretica was increased in the model group. The content of serum E2 was markedly decreased and those of serum LH, FSH, IL-6 and IL-1 ß were markedly increased in the model group (P<0.01), and the expression levels of ovarian p-PI 3 K, p-Akt and p-mTOR were markedly increased after modeling relevant to the control group (P<0.01). Following moxibustion, the pathological damage of ovarian tissue was improved, the contents of serum LH, FSH, IL-6, IL-1 ß, and the levels of p-PI 3 K, p-Akt and p-mTOR proteins in the ovarian tissue were significantly decreased (P<0.05, P<0.01), and the content of serum E2 was markedly increased (P<0.05) in comparison with the model group. CONCLUSION: Moxibustion can improve POF in POF rats, which may be related to its actions in inhibiting PI 3 K/Akt/mTOR signaling, down-regulating serum IL-6, IL-1 ß, and regulating serum hormones.

[The efficacy of biological dressing containing calcium and magnesium on the management of hydrofluoric acid burns].

OBJECTIVE: To observe the efficacy of biological dressing containing calcium and magnesia (sheep dermis absorbing calcium and magnesia and cross-link with glutaraldehyde) on the management of hydrofluoric acid burns in rats and patients. METHODS: Wistar rats were randomly divided into A ( n = 24, normal control, with isotonic saline dressing after burns), B ( n = 32, with isotonic saline dressing treatment after hydrofluoric acid burns), C ( n = 32, with wet-dressing treatment after hydrofluoric acid burns), and D ( n = 32, with biological dressing treatment after hydrofluoric acid burns) groups. The rats in the latter 3 groups were inflicted with 3 cm x 3 cm TBSA full-thickness burns, and mortality, concentration of blood calcium , histopathological observation were carried out at 4,8,24 and 72 postburn hours (PBH), with 8 rats at each time-points. In addition, 46 patients with hydrofluoric acid burns were divided into E (with wet-dressing treatment) and F (with biological dressing treatment) groups to compare the curative effect. RESULTS: The mortality in A,B,C,D groups were 0,31.2% ,15. 6% ,6. 2% , respectively. The wound in B group was deepened gradually after burns, but that in D group was slighter when compared with that in C group. The concentration of blood calcium in A group was higher than that in B, C and D groups at each time-points, and that in D groups was higher than that in B and C groups. The concentration of blood calcium in D group at 8 and 24 PBH were [(2.215 +/-0.008) ,(2.216 +/-0.008) mmol/L], which were obviously higher than those in B [(1.813 +/-0.017),(1.912 +/-0.013)mmol/L l] and C [(2.015 +/-0.006), (2.018 +/-0. 010)mmol/L] groups, (P <0. 01). The clinical outcome in E group was much better than that in F group. CONCLUSION: Biological dressing containing calcium and magnesium can be applied in the emergency management and following treatment after hydrofluoric acid burns.

[Advance of lower cervical spine pedicle screw fixation in treatment of lower cervical spine instability].

OBJECTIVE: To review the anatomic character of lower cervical pedicle, the placement and the biomechanical stability of the cervical pedicle screw fixation, the clinical application and the complication caused by fixation. METHODS: The literature concerned the cervical pedicle screw fixation in recent years were extensively reviewed. RESULTS: The cervical pedicle screw fixation can be widely used in the lower cervical spine instability according to the anatomic character of lower cervical pedicle, and the good biomechanical stability of the cervical pedicle screw fixation, and the complication can be controlled. CONCLUSION: The cervical pedicle screw fixation is an effective internal fixation for the lower cervical spine instability.

[Clinical application of interbody cage systems in the lumbar spine].

OBJECTIVE: To study the clinical value of interbody cage systems in the surgical treatment of unstable lumbar segment, and evaluate the biomechanical properties. METHODS: Ninety-seven cases were selected for operation by posterior lumbar interbody fusion with the BAK-cage or TFC device. Of the patients, 18 were diagnosed as lumbar disc degeneration disease (DDD), 37 as lumbar stenosis, 23 as spondylolisthesis, and 19 as unstable traumatic lesion. Thirty-six of them received additional posterior pedicle devices; 13 cases with severe mechanical back pain underwent anterior interbody fusion with the BAK-cage or TFC or interbod spacer, 4 of them underwent surgery once again. A new anterior Mesh-cage was used in spinal reconstruction for some patients, including 8 patients with thoracolumbar tumor, 2 with lumbar burst fracture, and 1 with osteoportic late collapse of a vertebral body. RESULTS: In the follow-up for an average of 21 months, 63 patients were available for review. The clinical results were excellent and good in 91.2% of the patients who underwent posterior interbody cage fusion; the preoperative percentage of slip was corrected in 89% of the patients with spondlyolithsis and in 100% of the patients with traumatic dislocation. The satisfactory rate was 94.6% in the patients with severe back pain who underwent anterior interbody cage fusion. The rate of union in the grafted area was 95% at the 6th month after the operation. A preliminary experience showed that the clinical effect was obvious as the Mesh-cage was used in the patients with tumor, symptoms were relieved and motion ability was greatly improved in these patients. CONCLUSION: The interbody cage implant produces immediate stabilisation on unstable spinal segments, offers a conductive biomechanical environment for interbody graft healing by distraction properties and weight bearing function, and restores the normal interbody space and spinal column lordosis with satisfactory clinical effects on such diseases as DDD, traumatic lesion, osteoporotic late collapse of a vertebral body and spinal tumors.