[Characterization and biological significance of peripheral blood dendritic cell subsets in patients with severe burn].

OBJECTIVE: To investigate the characteristics of dendritic cells (DCs) in patients with severe burn. METHODS: Peripheral blood samples were obtained from 12 patients with severe burn 1, 2, 3, and 4 weeks after burn, and from 10 healthy donors as controls. Mononuclear cells were isolated, and GM-CSF 1000 and IL-4 were used to induce the transformation of DCs. Mature DCs were harvested and underwent flow cytometry to detect the expression of HLA-DR, CD80, CD83, CD86, CD14, and CD11c. RESULT: 1, 2, 3, and 4 weeks after burn, the expression levels of HLA-DR were 62.1% +/- 8.4%, 65.0% +/- 6.2%, 68.4% +/- 5.7%, and 75.4% +/- 8.4% respectively; the expression levels of CD80 were 12.9% +/- 3.7%, 14.7% +/- 2.5%, 16.1% +/- 4.2%, and 16.2% +/- 4.8%; the expression levels of CD83 were 15.1% +/- 4.2%, 15.1% +/- 4.0%, 22.2% +/- 7.7%, and 21.3% +/- 7.0% respectively; the expression levels of CD86 were 69.2% +/- 7.1%, 70.5% +/- 5.4%, 75.1% +/- 6.1%, and 79.6% +/- 6.4% respectively, all significantly lower than that of the control group (84.3% +/- 8.2%, all P < 0.001). 1, 2, 3, and 4 weeks after burn, the expression levels of CD14 in the DCs of the severe burn patients were 12.7% +/- 1.9%, 12.0% +/- 1.5%, 11.3% +/- 1.3%, and 9.3% +/- 1.7% respectively, all significantly higher than that of the control group (7.3% +/- 1.5%, P < 0.001). 1, 2, 3, and 4 weeks after burn, the expression levels of CD11c in the DCs of the severe burn patients were 86.8% +/- 6.1%, 89.5% +/- 5.1%, 91.3% +/- 2.8%, and 89.4% +/- 4.0% respectively, a little lower than that of the control group, however, without significant difference (92.6% +/- 3.8%, P > 0.05). CONCLUSION: The functions of DCs in the patients with severe burn are declined, which may partly contribute to infection after burn.

[Experimental and clinical study on the treatment of ischemic skin flap with topical application of PGE1].

OBJECTIVE: To evaluate the efficiency of PGE(1) in relieving the circulatory disorder of ischemic skin flap. METHODS: 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. RESULTS: 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. CONCLUSION: 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%.

[Fluid management and cause of death during shock period in patients with severe burns or burns complicated by inhalation injury].

OBJECTIVE: To explore fluid management and cause of death during shock period in severe burns or burns with inhalation injury. METHODS: One hundred and twelve patients with severe burns or burn complicated by inhalation injury admitted to our hospital from 1991 to 2000 were analyzed. The fluid management and death conditions during shock period were discussed. RESULTS: The fluid volume for resuscitation could be described as follows: the total fluid volume was 2.2 ml/(%TBSA.kg) including colloid fluid 0.5 ml/(%TBSA.kg), crystalloid fluid 1 ml/(%TBSA.kg)and water 0.7 ml/(%TBSA.kg) during first 24 hours. The total fluid volume was 1.8 ml/(%TBSA.kg) including colloid fluid 0.4 ml/(%TBSA.kg), crystalloid fluid 0.7 ml/(%TBSA.kg) and water 0.7 ml/(%TBSA.kg) during second 24 hours. There were no difference in fluid management between burns and burns with inhalation injury. Seven patients died due to respiratory failure during shock period. CONCLUSIONS: Many fluid formula can provide guidance for resuscitation and it is very important that early fluid therapy should accord with concrete clinical conditions of patients in order to pass smoothly through shock period. Early fluid management is not different between burns and burns with inhalation injury.