Ghrelin therapy improves survival after whole-body ionizing irradiation or combined with burn or wound: amelioration of leukocytopenia, thrombocytopenia, splenomegaly, and bone marrow injury

Exposure to ionizing radiation alone (RI) or combined with traumatic tissue injury (CI) is a crucial life-threatening factor in nuclear and radiological events. In our laboratory, mice exposed to (60)Co-γ-photon radiation (9.5 Gy, 0.4 Gy/min, bilateral) followed by 15% total-body-surface-area skin wounds (R-W CI) or burns (R-B CI) experienced an increment of ≥18% higher mortality over a 30-day observation period compared to RI alone. CI was accompanied by severe leukocytopenia, thrombocytopenia, erythropenia, and anemia. At the 30th day after injury, numbers of WBC and platelets still remained very low in surviving RI and CI mice. In contrast, their RBC, hemoglobin, and hematocrit were recovered towards preirradiation levels. Only RI induced splenomegaly. RI and CI resulted in bone-marrow cell depletion. In R-W CI mice, ghrelin (a hunger-stimulating peptide) therapy increased survival, mitigated body-weight loss, accelerated wound healing, and increased hematocrit. In R-B CI mice, ghrelin therapy increased survival and numbers of neutrophils, lymphocytes, and platelets and ameliorated bone-marrow cell depletion. In RI mice, this treatment increased survival, hemoglobin, and hematocrit and inhibited splenomegaly. Our novel results are the first to suggest that ghrelin therapy effectively improved survival by mitigating CI-induced leukocytopenia, thrombocytopenia, and bone-marrow injury or the RI-induced decreased hemoglobin and hematocrit.

Des-acyl-ghrelin (DAG) normalizes hyperlactacidemia and improves survival in a lethal rat model of burn trauma

Critical illness, including burn injury, results in elevated plasma lactate levels. Dysregulation of PI3K/Akt signaling has been shown to play a predominant role in the inactivation of skeletal muscle PDC and, hence, in hyperlactacidemia in rat models of sepsis and endotoxemia. This observation, and our previous finding that DAG can reverse burn-induced skeletal muscle proteolysis through the activation of PI3K/Akt pathway, led us to hypothesize that DAG may also attenuate hyperlactacidemia in burn injury. Our investigations revealed that burn injury significantly elevated both skeletal muscle lactate production and plasma lactate levels. Moreover, this was accompanied in skeletal muscle by a 5-7 fold increase in mRNA expression of pyruvate dehydrogenase kinases (PDK) 2 and 4, and a ∼30% reduction in PDC activity. DAG treatment of burn rats completely normalized not only the mRNA expression of the PDKs and PDC activity, but also hyperlactacidemia within 24h of burn injury. DAG also normalized epinephrine-induced lactate production by isolated skeletal muscles from normal rats. Moreover, DAG also improved survival in a lethal rat model of burn trauma. These findings with DAG may have clinical implications because chances of survival for critically ill patients are greatly improved if plasma lactate levels are normalized within 24h of injury.

[Clinical study on continuous plasma filtration absorption treatment for burn sepsis]

OBJECTIVE

To observe the therapeutic effects of continuous plasma filtration absorption (CPFA) treatment on burn sepsis.

METHODS

Thirty burn patients with sepsis hospitalized in Beijing Fengtai You'anmen Hospital from July 2009 to October 2012 were treated by CPFA for twice besides routine treatment. The blood samples were collected at five sites (A, B, C, D, and E, respectively) of blood purification equipment before and after CPFA, before and after hemoabsorption, and before hemofiltration. The plasma levels of TNF-α, IL-1β, IL-6, IL-10, interleukin-1 receptor antagonist (IL-1RA), soluble tumor necrosis factor receptor (sTNFR) I , and sTNFR-II from sites A, C, and E were determined with ELISA before CPFA was performed for the first time, and those from sites B and D were determined with ELISA after CPFA was performed for the first time. Plasma levels of the above-mentioned cytokines from sites A and B were determined with ELISA before CPFA and after CPFA was performed for the second time. The data of plasma levels of IL-1βP3, IL-1RA, sTNFR-I, sTNFR-II, and TNF-α before CPFA and after CPFA was performed for the second time were collected for calculation of the ratios of IL-1RA to IL-1β and sTNFR-I plus sTNFR-II to TNF-α. The expression rate of human leukocyte antigen DR (HLA-DR) on the CD14 positive monocytes, acute physiology and chronic health evaluation (APACHE) II score, body temperature, pulse, respiratory rate, and leukocyte count of patients were evaluated or recorded before CPFA and after CPFA was performed for the second time. Patients'condition was observed. Data were processed with paired t test.

RESULTS

The plasma levels of TNF-α, IL-1β, IL-6 and IL-10 from site B after CPFA was performed for the second time were significantly lower than those from site A before CPFA was performed for the first time (with t values respectively 7.05, 5.23, 4.73, 2.37, P values below 0.01). After CPFA was performed for the first time, the plasma levels of TNF-α, IL-1β, and IL-6 from site D were significantly lower than those from site C before CPFA was performed for the first time (with t values respectively 5.48, 2. 17, 1.78, P < 0.05 or P <0.01). The plasma levels of all cytokines were close between site B after CPFA was performed for the first time and site E before CPFA was performed for the first time (with t values from 0.04 to 1.05, P values above 0.05). The plasma levels of TNF-α, IL-1β, and IL-6 from site B after CPFA was performed for the second time were significantly lower than those from site A before CPFA was performed for the second time (with t values from 1.87 to 5.93, P <0.05 or P <0.01). The ratios of IL-1RA to IL-1β and sTNFR-I plus sTNFR-II to TNF-α, and expression rate of HLA-DR were increased significantly after CPFA was performed for the second time as compared with those before CPFA (with t values from 3.99 to 7. 80, P values below 0.01). APACHE II score after CPFA was performed for the second time was 11 ± 6, which was lower than that before CPFA (22 ± 7, t =4.63, P <0.01). After CPFA was performed for the second time, body temperature, pulse, and respiratory rate of patients were improved (with t values from 1.95 to 3.55, P values below 0.05) , and the leukocyte count was significantly decreased (t =4.36, P <0.01) as compared with those before CPFA. All patients survived and were discharged with length of stay of (27 ± 31) d, and no adverse effects occurred during CPFA treatment.

CONCLUSIONS

CPFA, which combines hemoabsorption and hemofiltration, can facilitate the treatment of burn sepsis by decreasing the level of pro-inflammatory cytokines efficiently, alleviating systemic inflammatory response, and improving the immune status.

[Clinical significance of continuous thrombocytopenia in predicting sepsis after severe burn]

OBJECTIVE

To explore the relationship between continuous thrombocytopenia and sepsis in patients with severe burns.

METHODS

Clinical data of 148 severely burned patients admitted to our,two burn centers from January 2007 to December 2011 and conforming to the study criteria were retrospectively analyzed. All patients were divided into sepsis group (n =44) and non-sepsis group (n = 104) according to the presence or absence of sepsis within post burn day (PBD) 30. The data of age, gender, total burn area, full-thickness burn area, fluid infusion volume within post burn hour (PBH) 24, plasma concentration of calcium ion on PBD 1, plasma concentration of albumin on PBD 1, platelet count on PBD 1, acute physiology and chronic health evaluation (APACHE) II score on admission, the presence or absence of hypovolemic shock or inhalation injury on admission, the presence or absence of disseminated intravascular coagulation (DIC) within PBH 48, operation or no operation within PBD 3, thrombocytopenia duration within PBD 10, and mortality were statistically compared between two groups to screen the independent risk factors of sepsis. Data were processed with t test, chi-square test, single factor Logistic regression analysis, and multi-factor Logistic regression analysis.

RESULTS

Between two groups, there were statistically significant differences in total burn area, full-thickness burn area, plasma concentration of calcium ion on PBD 1, plasma concentration of albumin on PBD 1, APACHE II score on admission, presence or absence of hypovolem- ic shock on admission, presence or absence of inhalation injury on admission, presence or absence of DIC within PBH 48, and mortality (with t values from 2.433 to 4.082, χ2 values from 8. 818 to 31.528, P < 0.05 or P < 0.01). Furthermore, the duration of thrombocytopenia within PBD 10 in sepsis group was (5.2 ± 2.4) d, which was significantly longer than that in non-sepsis group [(2.9 ± 1.9) d, t =6. 189, P <0.01]. There were no statistically significant differences in the other indexes between two groups (with t values from 0.971 to 1. 250, χ2 values respectively 0. 054 and 1.529, P values above 0.05). Single factor and multi-factor Logistic regression analysis indicated that APACHE II score on admission and duration of thrombocytopenia within PBD 10 were closely related to occurrence of sepsis (with odds ratio respectively 1. 140 and 1.569, P values below 0.01).

CONCLUSIONS

Duration of thrombocytopenia within PBD 10 is one of the risk factors for sepsis in severely burned patients, which can reflect pathophysiological changes in the body, thus providing predictive value for the occurrence of sepsis.

[Effects of reactive by burn rat serum oxygen species on apoptosis of pulmonary microvascular endothelial cells induced]

OBJECTIVE

To observe the level of intracellular reactive oxygen species (ROS) in rats with severe burn and pulmonary microvascular endothelial cells (PMVECs) treated with serum of rat with burn injury, and to investigate the relationship between ROS and apoptosis of PMVECs.

METHODS

(1) Twenty-four SD rats were divided into sham injury group ( n = 3) and burn group (n = 21) according to the random number table (the same grouping method below). Rats in burn group were inflicted with 30% TBSA full-thickness scald on the back, and rats in sham injury group were sham injured. Blood samples were collected from abdominal aorta at post injury hour 6, 12, 24, 36, 48, 60, 72 respectively from 3 rats of burn group. The serum content of ROS was assayed by ELISA. The same determination was performed in rats of sham injury group. (2) Five rats were subjected to scald injury as above, and burn serum was prepared 24 hours after injury. Another 5 rats without receiving any treatment were used to prepare normal serum. (3) Marginal pulmonary tissue was harvested from 20 SD young rats. Cells were cultured with tissue block method and indentified with immunohistochemical staining. The third passage of PMVECs in logarithmic phase were inoculated in 6-well plates and 12-well plates. PMVECs in both plates were divided into 4 groups: normal serum group, burn serum group, normal serum + MnTBAP group, and burn serum + MnTBAP group, with 3 wells in each group. Cells in the former 2 groups were respectively cultured with special nutrient solution of endothelial cells without serum added with 15% healthy rat serum or 15% burn rat serum. Cells in the latter 2 groups were cultured with the same culture conditions as in the former two groups correspondingly with addition of 100 µmol/L MnTBAP in the nutrient solution. After being cultured for 24 h, the content of ROS in PMVECs in 6-well plates was detected with flow cytometry. The apoptosis of PMVECs in 12-well plates was observed with acridine orange-ethidium bromide staining, and the apoptosis rate was calculated. Data were processed with one-way analysis of variance and LSD-t test.

RESULTS

(1) The serum contents of ROS in rats of burn group were respectively (187 ± 21), (235 ± 22), (231 ± 25), (291 ± 20), (315 ±23) nmol/mL at post injury hour 24, 36, 48, 60, 72, which were significantly higher than that in sham injury group [(141 ± 19) nmol/mL, with t values respectively 7. 86, 9. 57, 13. 87, 14.98, 18.40, P values below 0.01]. (2) Primary cells grew slowly and showed a cobblestone appearance. After passages, cells grew with orderly distribution. The positive rate of coagulation factor VIII of cells was (96 ± 5)% , and thus they were identified as PMVECs. (3) In normal serum group, burn serum group, normal serum + MnTBAP group, and burn serum + MnTBAP group, the contents of ROS in PMVECs were respectively 798 ± 40, 1 294 ± 84, 763 ± 59, 926 ± 42 ( F =93.01, P <0.01), and the apoptosis rates of PMVECs were respectively (6.2 ± 1.3)%, (57.3 ± 6. 7)%, (3.7 ± 0. 8)%, (28.7 ± 5. 7)% (F = 224.50, P <0.01) after being cultured for 24 h. Compared with those of normal serum group, the content of ROS and apoptosis rate of PMVECs in burn serum group increased significantly (with t values respectively 10.40 and 49.06, P values below 0.01). The content of ROS and apoptosis rate of PMVECs in burn serum + MnTBAP group were significantly lower than those in burn serum group (with t values respectively 7.48 and 23.94, P values below 0.01).

CONCLUSIONS

Serum content of ROS was increased in severely burned rats. Burn rat serum stimulation on PMVECs can lead to the increase of the intracellular ROS and induce apoptosis. However application of MnTBAP can scavenge ROS and reduce the apoptosis induced by burn rat serum.

[System analysis of metabolic profile of blood in patients with thermal trauma]

AIM

To make multiparametric analysis of blood metabolic profile in early period of burn disease.

MATERIALS AND METHODS

We tested blood samples of 15 healthy adults (control group) and 60 patients with thermal trauma (main group--II-4IIIA, B degree of burn, more then 15 bsp). Parameters of lipid metabolism, level of glucose, lactate, malonic dialdehyde and some enzymes in blood plasma and erythrocytes were estimated.

RESULTS

In early period of burn disease we fixed the clear metabolic disorders, including tissues hypoxia, activation of plasma transaminases and oxidoreductases, inhibition of detoxication system, induction of oxidative stress. Connection of metabolic changes, associated with burn disease, was registered. It supported by numerous correlations between studied parameters, formed from first day after trauma.

CONCLUSIONS

Our data expand the knowledge about mating metabolic changes of catalytic activity of blood enzymes, forming in early period of burn disease (system metabolic disadaptation), and diagnostic value of some blood biochemical parameters in estimation of burned patient metabolism.

[INFLUENCE OF BURN SERUM ON PROLIFERATION AND ADIPOSE DIFFERENTIATION OF 3T3-L1 PREADIPOCYTES]

OBJECTIVE

To investigate the effect of burn on the fat metabolism by observing the effect of burn serum on the proliferation and adipose differentiation of 3T3-L1 preadipocytes.

METHODS

Forty-eight male Sprague Dawley rats were randomly divided into sham burn group and burn at 1, 4, 7, 14, and 21 days groups, 8 rats in each group. The rats in burn groups were made the full-thickness thermal burns comprising 30% total body surface area. At 1, 4, 7, 14, and 21 days after burn, the serum of burn rats was collected. The rats in sham burn group were not treated as normal control. The proliferation activity of 3T3-L1 cells was detected using MTT method after treated by normal and burn serum. The burn serum having the highest proliferation inhibitory effect was chosen for subsequent study. The growth of 3T3-L1 cells in normal serum group (group A), burn serum group (group B), normal serum and adipogenic induction group (group C), burn serum and adipogenic induction group (group D) was observed using inverted microscope. After 7 days of treatment, the adipocytes was stained by oil red O and the absorbance (A) value was measured. The mRNA and protein levels of preoxisome proliferator-activated receptor γ (PPAR-γ) and lipoprotein lipase (LPL) were detected by real-time quantitative PCR and Western blot.

RESULTS

The proliferation ability of 3T3-L1 cells was significantly reduced in the group treated by 4- or 7-day burn serum (P < 0.05), especially 7-day burn serum treatment group (P < 0.05). Under inverted microscope, the cell morphology in group A and group B had no obvious change, but a large number of fat cells were observed in group C and a few were observed in group D. The positive or weak positive oil red O staining was observed in group C or group D, respectively. The cell counting and A value were significantly higher in group A than in group B, and in group C than in group D (P < 0.05). The mRNA level of PPAR-γ in group B was significantly reduced when compared with that in group A (P < 0.05). No significant difference was found in LPL mRNA levels and protein levels of PPAR-γ and LPL between group A and group B (P > 0.05). The mRNA and protein levels of PPAR-γ and LPL were significantly attenuated in group D when compared with those in group C (P < 0.05).

CONCLUSION

The adipose differentiation of 3T3-L1 preadipocytes can be significantly reduced after treated by 7-day burn serum of rat.

[Prognostic significance of serum procalcitonin in patients with burn sepsis]

OBJECTIVE

To evaluate the clinical implication of serum procalcitonin (PCT) in patients with burn sepsis by analyzing its change.

METHODS

Twenty-eight extensively burned patients with sepsis hospitalized from January 2012 to December 2013 were recruited in this retrospective study. These patients were divided into death group (n = 12) and survival group (n = 16) according to the outcome. The baseline characteristics of patients in the two groups were similar. Some conventional indexes of sepsis, including white blood cell count, percentage of neutrophils, platelet count, organ function parameters [ALT, AST, total bile acid (TBA), creatinine, blood sodium], and acute physiology and chronic health evaluation (APACHE) II score were compared between the two groups when sepsis was diagnosed. Serum levels of PCT of patients in the two groups were determined immediately after diagnosis of sepsis, from post sepsis day (PSD) 1 to 4, and from PSD 5 to 8. Data were processed with t test, chi-square test, and nonparametric rank sum test (Keuskal-Wallis). Receiver operating characteristic (ROC) curve of serum PCT value was used to predict death for 28 burn patients when sepsis was diagnosed.

RESULTS

There were no statistically significant differences in white blood cell count, percentage of neutrophils, platelet count, APACHE II score, and organ function parameters between death group and survival group when sepsis was diagnosed (with t values from -0.601 to 1.726, P values above 0.05). The serum levels of PCT in death group immediately after diagnosis of sepsis, from PSD 1 to 4, and from PSD 5 to 8 were respectively (38.5 ± 41.3), (26.8 ± 38.5), (19.3 ± 16.3) ng/mL, which were significantly higher than those in survival group [(6.1 ± 2.3), (5.4 ± 2.9), (4.9 ± 3.6) ng/mL, with Z values from -4.364 to -2.955, P values below 0.01]. The total area under ROC curve of serum PCT value for predicting death for 28 patients with burn sepsis was 0.990, and 10.9 ng/mL was chosen as the optimal threshold value, with sensitivity of 91.7% and specificity of 100.0%.

CONCLUSIONS

Serum PCT value can be served as a vital prognostic indicator for patients with burn sepsis, which can be considered as a guide for rational use of antibiotics, also provide as a reference for treatment, in order to reduce mortality.

[Effects of blood purification in the treatment of patients with burn sepsis]

OBJECTIVE

To observe the effects of blood purification in the treatment of burn sepsis, in order to provide evidence for its application.

METHODS

Twenty-seven patients with burn sepsis admitted to our burn ward from June 2012 to December 2013, conforming to the study criteria, were divided into conventional treatment group (CT, n = 15) and blood purification group (BP, n = 12) according to the random number table. After the diagnosis of sepsis was confirmed, patients in group CT received CT, while patients in group BP received both CT and continuous veno-venous hemodiafiltration for 48 hours. At the time of diagnosis of sepsis (before treatment) and post treatment hour (PTH) 24 and 48, levels of blood lactate and PaO2 were analyzed with blood gas analyzer, and the oxygenation index (OI) was calculated; blood sodium, blood glucose, blood urea nitrogen (BUN), creatinine, white blood cell count (WBC), procalcitonin (PCT) were determined; acute physiology and chronic health evaluation (APACHE) II score was estimated basing on the body temperature, respiratory rate, mean arterial pressure, PaO2, and blood pH values. The levels of TNF-α, IL-8, and IL-6 in serum were determined by ELISA. Data were processed with Fisher's exact test, t test, analysis of variance for repeated measurement, LSD- t test, and LSD test.

RESULTS

(1) The levels of blood lactate of patients in group BP were significantly lower than those of group CT at PTH 24 and 48 (with t values respectively 1.62 and 2.44, P values below 0.05). Compared with that detected before treatment, the level of blood lactate in group BP was significantly decreased at PTH 48 (P < 0.05). The OI values of patients in group BP at PTH 24 and 48 [(247 ± 30), (288 ± 41) mmHg, 1 mmHg = 0.133 kPa] were significantly higher than those of group CT [(211 ± 32), (212 ± 30) mmHg, with t values respectively 3.02 and 5.63, P values below 0.01]. Compared with that detected before treatment, the OI values of patients in group BP at PTH 24 and 48 were significantly higher (P values below 0.01). (2) Compared with those of group CT at PTH 24 and 48, the levels of blood sodium, BUN, and creatinine were significantly lower (with t values from 1.74 to 6.75, P < 0.05 or P < 0.01), while the level of blood glucose was approximately the same (with t values respectively -0.92, -0.38, P values above 0.05) in group BP. Compared with those detected before treatment, the levels of blood sodium, BUN, and creatinine of group BP at PTH 24 and 48 were significantly lower (P < 0.05 or P < 0.01). (3) The levels of WBC and PCT of patients in group BP at PTH 24 and 48 were significantly lower than those of group CT (with t values from 2.11 to 6.63, P < 0.05 or P < 0.01). Compared with those detected before treatment, the levels of WBC and PCT of patients in group BP at PTH 24 and 48 were significantly lower (P < 0.05 or P < 0.01). (4) The APACHE II scores of patients in group BP at PTH 24 and 48 [(18.7 ± 2.6) and (16.7 ± 3.0) scores] were significantly lower than those of group CT [(23.1 ± 1.6) and (25.5 ± 1.6) scores, with t values respectively 5.44 and 9.87, P values below 0.01]. Compared with those calculated before treatment, the APACHE II scores of patients in group CT were significantly increased (P < 0.05 or P < 0.01), while those in group BP were decreased at PTH 24 and 48 (P < 0.05 or P < 0.01). (5) The levels of TNF-α, IL-6, and IL-8 in serum of patients in group BP at PTH 24 and 48 were significantly lower than those of group CT (with t values from 6.12 to 19.78, P values below 0.01). Compared with those detected before treatment, the levels of TNF-α, IL-6, and IL-8 in serum of group BP at PTH 24 and 48 were significantly decreased (with P values below 0.01).

CONCLUSIONS

BP+CT is effective in improving organ function, correcting the disorder of internal environment, and controlling inflammation. Therefore, BP is an important method in the treatment of burn sepsis.

[Effects of continuous sedation with propofol on peripheral blood mononuclear cell and intercellular adhesion molecule in beagles with combined burn-blast injuries]

OBJECTIVE

To observe the effects of continuous sedation with propofol on peripheral blood mononuclear cell (PBMC) and intercellular adhesion molecule 1 (ICAM-1) in beagles with combined burn-blast injuries.

METHODS

A total of 32 male beagles were randomly divided into 4 groups of normal control (NC), combined injury control (CC), propofol 1 (P1) and propofol 2 (P2) (n = 8 each). Except for NC group, the other 3 groups were subject to severe combined burn-blast injury. And sodium lactate Ringer's solution was infused after trauma according to the Parkland formula, including NC group. At the same time, P1 and P2 groups received continuous intravenous infusions of 2 mg×kg(-1)×h(-1), 5 mg×kg(-1)×h(-1) doses of propofol respectively for 72 hours. The serum concentrations of ICAM-1 and lymphocyte function associated antigen-1 (LFA-1) were measured by enzyme-linked immunosorbent assay (ELISA) at 6, 24, 48, 72 h post-injury. Flow cytometry was used to detect the major histocompatibility complex (MHC) antigen expression on CD14(+) monocytes, CD4(+)/CD8(+) T lymphocyte rate and PBMC apoptosis rate.

RESULTS

The level of ICAM-1 in CC group ((10.5 ± 1.1), (10.8 ± 1.3), (12.3 ± 1.4) ng/ml) was significantly higher than that in NC group ((7.4 ± 1.4), (7.4 ± 1.1), (7.4 ± 1.6) ng/ml) at 12, 24, 48 h post-injury (all P < 0.05). The level of ICAM-1 in P1 group was significantly lower than that in CC group ((10.7 ± 1.3) vs (12.3 ± 1.4) ng/ml) while the level of ICAM-1 in P2 group was significantly lower than that in P1 group at 72 h post-injury ((8.8 ± 1.4) vs (10.7 ± 1.3) ng/ml) (both P < 0.05). The level of LFA-1 in CC group ((7.3 ± 1.3), (8.4 ± 1.3), (9.6 ± 1.7) ng/ml) was significantly higher than that in NC group ((5.1 ± 1.2), (5.4 ± 1.3), (5.8 ± 1.2) ng/ml) at 24, 48, 72 h post-injury (all P < 0.05). MHC antigen expression on the CD14(+) monocytes of P2 group was obviously higher than that of CC and P1 groups ((46 ± 13)% vs (26 ± 15)% and (32 ± 12)%, both P < 0.05). The CD4/CD8 rate in P1 and P2 was significantly higher than that in CC group (1.71 ± 0.26, 1.82 ± 0.31 and 1.81 ± 0.24, 1.96 ± 0.24 vs 1.41 ± 0.34, 1.34 ± 0.26) at 48, 72 h post-injury (all P < 0.05). At 72 h post injury, the PBMC apoptosis rate in CC and P1 group was obviously higher than that of the NC group ((2.57 ± 0.21)% and (1.64 ± 0.10)% vs (0.81 ± 0.11)%) (both P < 0.01); the apoptosis rate in P2 group was significantly lower than that in P1 group ((1.09 ± 0.15)% vs (1.64 ± 0.10)%) (P < 0.01).

CONCLUSION

Propofol may improve the immune function after combined burn-blast injuries through suppressing an excessive release of ICAM-1 and PBMC apoptosis in a concentration-dependent manner.

[N-stearoylethanolamine effect on the level of 11-hydroxycorticosteroids, cytokines IL-1, IL-6 and TNFalpha in rats with nonspecific inflammation caused by thermal burn of skin]

The mechanisms of anti-inflammatory action of saturated N-acylethanolamine--N-stearoylethanolamine (NSE) were investigated on the rat model of nonspecific inflammation (thermal burns of the skin). The results showed that the NSE application in a form of aqueous suspension (10 mg/ml) on the damaged skin area during 12 days significantly accelerated the healing process of burned wounds. NSE also prevented the increase of 11-hydroxycorticosteroids content in the blood of rats with burns. There was also found a significant decrease of cytokines (IL-1beta, IL-6 and TNFalpha) levels under the NSE action. This way may be one of the mechanisms of NSE anti-inflammatory action.

Pegylated G-CSF inhibits blood cell depletion, increases platelets, blocks splenomegaly, and improves survival after whole-body ionizing irradiation but not after irradiation combined with burn

Exposure to ionizing radiation alone (radiation injury, RI) or combined with traumatic tissue injury (radiation combined injury, CI) is a crucial life-threatening factor in nuclear and radiological accidents. As demonstrated in animal models, CI results in greater mortality than RI. In our laboratory, we found that B6D2F1/J female mice exposed to (60)Co-γ-photon radiation followed by 15% total-body-surface-area skin burns experienced an increment of 18% higher mortality over a 30-day observation period compared to irradiation alone; that was accompanied by severe cytopenia, thrombopenia, erythropenia, and anemia. At the 30th day after injury, neutrophils, lymphocytes, and platelets still remained very low in surviving RI and CI mice. In contrast, their RBC, hemoglobin, and hematocrit were similar to basal levels. Comparing CI and RI mice, only RI induced splenomegaly. Both RI and CI resulted in bone marrow cell depletion. It was observed that only the RI mice treated with pegylated G-CSF after RI resulted in 100% survival over the 30-day period, and pegylated G-CSF mitigated RI-induced body-weight loss and depletion of WBC and platelets. Peg-G-CSF treatment sustained RBC balance, hemoglobin levels, and hematocrits and inhibited splenomegaly after RI. The results suggest that pegylated G-CSF effectively sustained animal survival by mitigating radiation-induced cytopenia, thrombopenia, erythropenia, and anemia.

[Effect of severe burn on growth and development and the level of growth hormone in mice]

OBJECTIVE

To analyze the changes in body growth, learning and memory capabilities, exercise capacity, and the level of growth hormone (GH) in mice suffering from severe burn.

METHODS

One hundred and four healthy BALB/c mice aged from 3 to 4 weeks were divided into normal control group (NC, without treatment) , 7 s burn group (inflicted with 20%TBSA deep partial-thickness burn on the back), 10 s burn group (inflicted with 20%TBSA full-thickness burn on the back), and negative control group (simulating the treatment of two burn groups without injury) according to the random number table, with 26 mice in each group. The body weight, body length, and tail length of 8 mice in each group were measured before burn. Respectively 6 mice of two burn groups were sacrificed on post burn day (PBD) 1, 3, and 7 for determination of serum level of GH with enzyme-linked immunosorbent assay kit. The remaining 8 mice in each of the two burn groups were raised to adulthood. The body weight, body length, and tail length were measured on PBD 62, and the increased percentages of body weight, body length, and tail length were calculated. Morris water maze tests, including escape latency on PBD 66, 67, and 68, frequency of stepping over the platform location and proportion of staying time in the target quadrant on PBD 69, were used to examine the learning and memory capabilities. The time of loaded swimming and the time of pole-climbing on PBD 70 were used to assess the exercise capacity. Above-mentioned indexes were also determined in the two control groups at the same time points. Data were processed with one-way analysis of variance; Welch test was applied when equal variance was not assumed; independent samples t test was applied for paired comparison.

RESULTS

(1) The level of GH of mice in 7 s burn group on PBD 1 [(3 021 ± 506) pg/mL] was lower than that of group NC [(3 728 ± 412) pg/mL, t = 2.656, P < 0.05], while on PBD 3 and 7 [(3 098 ± 503) , (3 199 ± 275) pg/mL] they were close to those of group NC [(3 872 ± 785), (3 301 ± 600) pg/mL, with t values respectively 2.033 and 0.379, P values all above 0.05]. The levels of GH of mice in 10 s burn group on PBD 1, 3, and 7 were respectively (2 859 ± 447), (2 707 ± 151) , and (2 666 ± 222) pg/mL, which were lower than those of group NC (with t values respectively 3.504, 3.571, 2.429, P < 0.05 or P < 0.01). (2) The increased percentage of body weight, body length, and tail length of mice in group NC, 7 s burn group, and 10 s burn group were respectively (155 ± 22) %, (46 ± 6) %, (63 ± 10)%; (112 ± 57) %, (32 ± 12) %, (40 ± 15) %; (106 ± 36) %, (30 ± 8) %, (32 ± 7) %. The increased percentage of body weight of mice in 7 s burn group was close to that in group NC (t = 1.997, P > 0.05), while the increased percentages of other indexes of mice in the two burn groups were lower than those in group NC (with t values from 3.092 to 6.910, P values all below 0.01). (3) The escape latency values of mice in 10 s burn group on PBD 67 and 68 were respectively (33 ± 12), (33 ± 11) s, which were longer than those of group NC [(20 ± 8), (20 ± 7) s, with t values respectively 2.421 and 2.692, P values all below 0.05]. The frequency of stepping over the platform location of mice in 10 s burn group [(1.6 ± 1.8) times] was close to that of group NC [(3.2 ± 1.5) times, t = 1.989, P > 0.05]. The proportion of retention time in the target quadrant of mice in 10 s burn group [ (28 ± 7) %] was shorter than that of group NC[(48 ± 16)%, t = 3.076, P < 0.01]. The escape latency of mice in 7 s burn group on PBD 67 [(30 ± 7) s] was longer than that of group NC (t = 2.659, P < 0.05). The frequency of stepping over the platform location and the proportion of retention time in the target quadrant of mice in 7 s burn group [(2.0 ± 1.1) times, (36 ± 11) %, respectively] were close to those of group NC (with t values respectively 1.930, 1.670, P values all above 0.05). (4) The time of pole-climbing [(30 ± 11) s] and the time of loaded swimming [(38 ± 39) min] of mice in 10 s burn group were shorter than those of group NC [(47 ± 11) s, (122 ± 74) min, with t values respectively 3.108, 2.868, P < 0.05 or P < 0.01]. The time of loaded swimming of mice in 7 s burn group [(47 ± 12) min] was shorter than that of group NC (t = 2.855, P < 0.05), while the time of pole-climbing [(33 ± 14) s] was close to that of group NC (t = 2.044, P > 0.05).

CONCLUSIONS

For mice, severe burn can delay body growth, decrease the learning and memory capabilities, decrease exercise capacities, and reduce the serum level of GH.

[Advances in the research of rheological behavior of platelets and its regulation after burn]

Microcirculatory dysfunction of local wounds and distant tissues after burns results in ischemia and hypoxia of tissues and organs, thus affecting the course and prognosis of burns. Platelet is an important component of blood, and the changes in its rheological behavior influence the blood flow in the microcirculation, as well as the microvascular structure and function. The abnormality of platelet rheological behavior plays an important role in the occurrence and development of microcirculatory dysfunction after burn. Changes in rheological behavior of platelets are due to changes in platelet morphology, adhesion, aggregation, shrinkage functions, and release reaction. Investigation of platelet rheological behavior and its regulation after burn may be of significant implication in the analysis of patient's condition and instruction for treatment. This article reviews the changes in platelet rheological behavior and its regulation after burn in the aspects of morphology, adhesion, aggregation, shrinkage functions, and release reaction.

[Studying of cytokine dynamics in injured persons with severe burns for estimation of severity and prognosis]

Dynamics of a blood serum concentration of tumor necrosis factor-alpha (TNF- alpha), interleukines (IL-1beta, IL-10) in 35 patients, suffering severe burn, and possibility of application of these indices as biomarkers of the severity state and the complications prognosis, were studied. During the investigation there was established, that TNF-alpha concentration on the 8 - 10th and 19 - 21th day after trauma does the best for characterization of a burn total area, while the IL-1beta concentration on the 8 - 10th day after trauma - the deep affections severity and the IL-10 concentration on the 19 - 21th day after trauma - the deep affections severity. Hyperreactivity, caused by enhanced production of TNF-alpha, IL-1beta and IL-10, witnesses the raised risk of development of the organs complications. And adversely, hypo- and areactivity in extended and deep burns witnesses about enhanced risk of lethality. The blood serum concentration of TNF-alpha, IL-1beta and IL-10 is expedient to use as a biomarkers of the patients state severity and for the course prognosis of pathological process.

[Effects of polysaccharides from Bletillae Rhizoma on the protection in rats during deep second-degree burn wound healing]

OBJECTIVE

To study the effects of polysaccharides from Bletillae Rhizoma (RBP) on the protection in rats during deep second-degree burn wound healing.

METHODS

Thirty SD rats were randomly divided into blank control group, model control group and RBP group. After the establishment of rat deep second-degree burn wound, the wound was observed everyday and was recorded the healing time to calculate healing rate. Venous blood was collected at, 3, 7, 14, 21 and 28 d from burn rats via vena caudalis. Tachypleus RBP a cyte lysate (TAL) was used to assay the content of LPS in the plasma. Enzyme linked immunosorbent assay (ELISA) was employed to determine the levels of related proinflammatory cytokines such as TNF-alpha and IL-6 in the serum. Flow cytometry (FCM) was used to measure the positive percent of TLR4 in the peripheral blood at different time points.

RESULTS

Compared with model control group, RBP could significantly shorten the healing time (P < 0.01), decreased LPS, TNF-alpha and IL-6 levels in the serum at 7 d after burn (P < 0.01 or P < 0.05). FCM results suggested that RBP obviously decreased the positive percent of TLR4 in the peripheral blood of burn rats at 7 d after burn (P < 0.01 or P < 0.05).

CONCLUSION

BSP can promote burn wound healing,which might be associated with reduction the levels of LPS, TLR4 and related proinflammatory cytokines.

[Soluble form of trigger receptor expressed on myeloid cells-1 as a marker of burn wound mixed infection]

AIM

Detection ofearly non-bacteriological markers ofburn wound mixed microbial infection.

MATERIALS AND METHODS

The level of soluble form of trigger receptor expressed on myeloid cells-1 (sTREM-1) and cytokines in blood sera of 60 burn patients on days 3 - 6 and 10 - 17 after the burn was studied by solid phase enzyme immunoassay.

RESULTS

At the early periods of burn disease the level ofsTREM- 1 in sera may be a non-bacteriological marker of burn wound mixed infection: at days 3 - 6 after the injury - higher than 298.8 pg/ml, at days 10 - 17 after the burn - higher than 294.2 pg/ml.

CONCLUSION

Level of sTREM-1 in blood sera of patients with severe thermic injury could be proposed as an additional laboratory marker of burn wound mixed microbial infection.

Characterization of early thermal burns and the effects of hyperbaric oxygen treatment: a pilot study

BACKGROUND AND AIMS

Studies investigating hyperbaric oxygen treatment (HBOT) to improve outcome in burns have been inconclusive. In this study, we aimed to characterize early thermal burns injury in adult patients with < 40% total body surface area (TBSA) and to determine the effects of HBOT administered within 24 h to 48 h of a burn injury.

METHODS

Seventeen subjects were randomized into control (n = 9) and HBOT treatment (n = 8) arms. Burn depth, measured by laser Doppler imaging (LDI) and histologically, white blood cell (WBC) count and plasma cytokine inflammatory markers were assessed at 24 h (pre HBOT) and 48 h (post HBOT) post burn, as were immunohistochemistry and microbiology of burns tissue samples at 48 h post burn.

RESULTS

WBC count and serum interleukin (IL)-1β, IL-4, IL-6, IL-10 and interferon-γ were significantly elevated 24 h after burn, but no significant changes in any of these parameters were found with HBOT. HBOT had no significant effect on burn depth. Two HBOT patients and four control patients developed positive bacterial cultures.

CONCLUSIONS

Slower than anticipated recruitment resulted in considerably fewer patients than planned being studied. Inflammatory markers were significantly increased at 24 h in patients with < 40% TBSA burn. Early HBOT had no apparent effects on any of the parameters measured in this small pilot study. HBOT may possibly have a broad-spectrum antimicrobial effect worthy of further study. We report our methodology in detail as a possible model for future burns studies.

[Effects of fluid resuscitation programs on the levels of inflammatory mediators during burn shock stage]

OBJECTIVE

To explore the effects of different methods of fluid resuscitation on the levels of inflammatory mediators during burn shock stage.

METHODS

Twenty-four miniature swine were numbered from 1 to 24 and randomly divided by EXCEL 2007 into 4 groups of succinylated gelatin, hydroxyethyl starch, Parkland and allogeneic plasma (n = 6 each). Severe burn shock model was established. Succinylated gelatin, hydroxyethyl starch (130/0.4), Ringer's lactate and swine allogenic plasma were used as resuscitation fluid (alternative colloid) according to the burn shock recovery principles (beginning at 2 h post-injury). The parameters of heart rate (HR), blood pressure (BP), urine volume and central venous pressure (CVP) before and within 48 h post-burn were recorded. And the levels of tumor necrosis factor alpha (TNF-α), interleukin (IL) -1β and IL-8 were measured at the time of pre-injury as well as 4 h, 8 h, 24 h and 48 h post-injury. Statistical analyses were performed.

RESULTS

All swine survived the shock stage. TNF-α in succinylated gelatin group was significantly higher at 48 h post-injury than that in allogeneic plasma group ((351 ± 74) vs (215 ± 44) ng/L, P < 0.05). TNF-α in hydroxyethyl starch group was significantly higher at 8 h post-injury than that in allogeneic plasma group ((327 ± 38) vs (249 ± 29) ng/L, P < 0.05). And they were both higher than the pre-burn levels (both P < 0.05). Compared with pre-injury ((508 ± 64) ng/L), the level of IL-1β in succinylated gelatin group increased substantially at 4 h ((563 ± 76) ng/L), 8 h ((589 ± 76) ng/L) and 48 h ((736 ± 42) ng/L) post-injury (all P < 0.05). The hydroxyethyl starch group was higher at 48 h post-injury than that at pre-injury ((574 ± 72) vs (492 ± 41) ng/L, P < 0.05). Also in Parkland group, the levels were higher at 24 h and 48 h hours post-injury than that at pre-injury ((575 ± 31), (584 ± 65) vs (498 ± 33) ng/L, both P < 0.05). Only succinylated gelatin group was significantly higher (P < 0.01) at 48 h post-injury than allogeneic plasma group ((561 ± 48) ng/L). Compared with pre-injury ((561 ± 48) ng/L), the level of IL-8 in succinylated gelatin group increased significantly at 8 h ((1012 ± 100) ng/L), 24 h post-burn ((993 ± 87) ng/L), significantly higher than allogeneic plasma group ((866 ± 99) ng/L) at 24 h (all P < 0.05). Although hydroxyethyl starch and Parkland groups increased significantly at 4 h post-injury and 8 h, 48 h post-injury versus those at pre-injury (all P < 0.05). There was no significant difference at each time point compared with pre-burn (P > 0.05).

CONCLUSIONS

The recovery regimens of hydroxyethyl starch and Parkland groups may restrain the levels of inflammatory mediators. And the effects are similar to those of allogeneic plasma group.

[Effects of glutamine combined with ulinastatin on inflammatory response of patients with severe burn injury]

OBJECTIVE

To observe the effects of glutamine combined with ulinastatin on inflammatory response of patients with severe burn injury.

METHODS

Sixty patients with severe burn injury admitted to our burn wards from January 2010 to December 2011 conforming to the study criteria were divided into control group (C, n = 20), glutamine group (G, n = 20), and glutamine combined with ulinastatin group (G + U, n = 20) according to the random number table. Another 10 healthy volunteers were chosen as normal control group (NC). Isonitrogenous and isocaloric nutrition supports were given to patients in groups C, G, and G + U from post burn day (PBD) 2. 0.3 g/kg protein in the form of glutamine dipeptide was given to patients in group G for 10 days. 0.3 g/kg protein was given to patients in group G + U for 10 days with the same amount of glutamine dipeptide as that in group G, followed by intravenous injection of 100 kU ulinastatin (once per 8 hours) for 7 days during 10 days. The nitrogen concentration of 24 h urine was determined with Kieldahl nitrogen determination method, and nitrogen balance was calculated one day before treatment and ten days after treatment. Meanwhile, the levels of D-lactate in serum was determined by colorimetric method, the levels of diamine oxidase (DAO), TNF-α, and IL-6 by enzyme-linked immunosorbent assay, and LPS level by kinetic turbidimetric assay with TAL. Above-mentioned indexes were also examined in group NC. The wound healing rate on PBD 30, total hospital stay days, and the incidence of burn sepsis of all burn patients were recorded. Data were processed with one-way analysis of variance, LSD test, t test, and chi-square test.

RESULTS

Compared with that in group C [(-5.40 ± 1.67) g/d], nitrogen balance in group G was significantly increased ten days after treatment [(-1.35 ± 0.59) g/d, P < 0.01]. The serum levels of D-lactate, DAO, LPS, TNF-α, and IL-6 in group G ten days after treatment were significantly lower than those in group C (P < 0.05 or P < 0.01). No statistically significant difference was observed in nitrogen balance and the serum levels of D-lactate, DAO between group G + U and group G (P values all above 0.05). The serum levels of LPS, TNF-α, and IL-6 in group G + U ten days after treatment were respectively (0.167 ± 0.064) EU/mL, (43 ± 14) pg/mL, (139 ± 23) pg/mL, which were significantly lower than those in group G [(0.240 ± 0.079) EU/mL, (59 ± 8) pg/mL, (195 ± 31) pg/mL, respectively, P < 0.05 or P < 0.01]. The would healing rate on PBD 30 and total hospital stay days in group G were respectively higher and shorter than those in group C (P values all below 0.01), but no statistically significant difference in the incidence of burn sepsis was found between them (P > 0.05). The would healing rate on PBD 30 in group G+U [(96 ± 4)%] was enhanced, and total hospital stay days [(41 ± 4) d] were lowered than those in group G [(88 ± 7)%, (49 ± 5)d, P values all below 0.01]. The incidence of burn sepsis of patients in group G + U (5%) was significantly lower than that in group C (35%, χ(2) = 6.234, P < 0.05).

CONCLUSIONS

Glutamine combined with ulinastatin treatment can alleviate damage to intestine after severe burn injury, lower the serum level of inflammatory cytokines, promote wound healing, and reduce the incidence of burn sepsis.

Serum albumin level as a risk factor for mortality in burn patients

OBJECTIVE

Hypoalbuminemia is a common clinical deficiency in burn patients and is associated with complications related to increased extravascular fluid, including edema, abnormal healing, and susceptibility to sepsis. Some prognostic scales do not include biochemical parameters, whereas others consider them together with comorbidities. The purpose of this study was to determine whether serum albumin can predict mortality in burn patients.

METHODS

We studied burn patients ≥16 years of age who had complete clinical documentation, including the Abbreviated Burn Severity Index, serum albumin, globulin, and lipids. Sensitivity and specificity analyses were performed to determine the cut-off level of albumin that predicts mortality.

RESULTS

In our analysis of 486 patients, we found that mortality was higher for burns caused by flame (p=0.000), full-thickness burns (p=0.004), inhalation injuries (p=0.000), burns affecting >30% of the body surface area (p=0.001), and burns associated with infection (p=0.008). Protein and lipid levels were lower in the patients who died (p<0.05). Albumin levels showed the highest sensitivity and specificity (84% and 83%, respectively), and the area under the receiver-operating characteristic curve (0.869) had a cut-off of 1.95 g/dL for mortality.

CONCLUSION

Patients with albumin levels <2 g/dL had a mortality risk of >80%, with 84% sensitivity and 83% specificity. At admission, the albumin level could be used as a sensitive and specific marker of burn severity and an indicator of mortality.

[Effect of serum from severe burn patients on biology characteristics of human umbilical cord mesenchymal stem cells]

OBJECTIVE

To investigate the effect of the serum from severe burn patients on the biology characteristics of human umbilical cord mesenchymal stem cells (hUCMSCs) in vitro, so as to explore the feasibility of hUCMSCs transplantation for treating severe burn.

METHODS

The 3rd passage of hUCMSCs were randomly divided into 3 groups: 10% fetal bovine serum group (group A), 10% normal serum group (group B), and 10% burn serum group (group C). At 24 hours, 72 hours, and 6 days after culture, the cell morphology and density were observed by inverted microscope; the cell proliferation was assessed by MTT; after 6 days of culture, the cell cycle by propidium iodide staining and flow cytometry, the apoptosis by acridine orange/ ethidium bromide staining, and the cell senescence by beta-galactosidase staining; the levels of tumor necrosis factor alpha (TNF-alpha), interleukin 1 (IL-1), platelet-derived growth factor (PDGF), and insulin-like growth factor 1 (IGF-1) in serum were detected by a double-antibody sandwich ELISA kit.

RESULTS

hUCMSCs were long spindle/polygon in 3 groups. The cell fusion of group C was obviously faster than that in group A and group B. The cell proliferation curves showed that the velocity and number of cell proliferation in group C were significantly higher than those in group A and group B at 2-6 days after culture (P < 0.05). The rates of proliferation period (S) of hUCMSCs were 9.21% +/- 1.02%, 11.79% +/- 1.87%, and 20.54% +/- 2.03%, respectively in groups A, B, and C at 6 days, and group C was significantly higher than that of group A and group B (P < 0.05). The hUCMSCs showed normal morphology and structure in 3 groups, and no apoptosis cells was observed. The positive cells percentage of group C (2.6% +/- 0.1%) was significantly lower than that of group A (4.8% +/- 0.2%) and group B (3.8% +/- 0.4%) (P < 0.05). The levels of TNF-alpha, IL-1, PDGF, and IGF-1 in group C were significantly higher than those in group B (P < 0.05).

CONCLUSION

The higher levels of cytokines in serum from the severe burn patients can significantly stimulate hUCMSCs proliferation, prevent cells apoptosis, and reduce cells senescence. Therefore, it is feasible to use hUCMSCs transplantation for treating severe burn patients.

[Clinical study on hematocrit used as a predictor for evaluation of resuscitation effect in the early shock stage after burn]

OBJECTIVE

To explore the clinical significance of hematocrit used as a predictor for diagnosis and evaluation of resuscitation effect in the early shock stage after burn.

METHODS

Clinical data of 131 severely burned patients admitted to our burn unit from January 2000 to December 2011 were retrospectively analyzed. The burn patients were divided into group A (n = 80) and group B (n = 51) based on the hematocrit level at post burn hour (PBH) 24. The hematocrit levels in group A were less than or equal to 0.50, which in group B were higher than 0.50. There were no statistically significant differences between two groups in age, gender, body weight, admission time after burn, total burn area, full-thickness burn area, and degree of inhalation injury (P values all above 0.05). Hematocrit levels in the shock stage were recorded. Total urine output, base excess, and the volume of fluid infused per kg per %TBSA at PBH 24 were recorded. Rates of complication and mortality were recorded. Data were processed with t test, chi-square test, and Wilcoxon rank sum test.

RESULTS

Hematocrit level of group A at PBH 24 was decreased to about 0.45, while that of group B was decreased to about 0.55. The urine output in group A at PBH 24 [(61 ± 22) mL/h] was higher than that in group B [(53 ± 20) mL/h, t = 2.212, P < 0.05]. Base excess in group A at PBH 24 [(-6.1 ± 2.9) mmol/L] was significantly higher than that in group B [(-9.0 ± 3.8) mmol/L, t = 4.888, P < 0.01]. The volume infused per kg per %TBSA was higher in group A [(1.9 ± 0.4) mL·kg(-1)·%TBSA(-1)] than in group B [(1.7 ± 0.4) mL·kg(-1)·%TBSA(-1), t = 2.472, P < 0.05]. The rates of complication and mortality in group A [11.3%(9/80), 8.8%(7/80), respectively] were significantly lower than those in group B [27.5%(14/51), 21.6%(11/51), with χ(2) values respectively 5.648 and 4.318, P values all below 0.05].

CONCLUSIONS

Hematocrit can indirectly reflect resuscitation effect in the burn shock stage. Whether hematocrit level can be lowered to 0.45-0.50 during the first 24 hours after burn may be an important index for evaluation of fluid resuscitation effect in the early shock stage after severe burn.

[Effect of mannitol on serum tumor necrosis factor-α and interleukin-6 levels and the mechanism of its organ-protective effect in rabbits early after severe burn injury]

OBJECTIVE

To investigate the protective effect of mannitol therapy on the vital organs and explore the underlying mechanisms in New Zealand rabbits with severe burn injury.

METHODS

Twelve New Zealand rabbits with severe burn injury (30% of TBSA) were randomized to receive fluid resuscitation with saline (control) or mannitol therapy starting at 1 h after the injury. Serum and urine samples were collected before and at 1, 4, 8, 24, and 48 h after the injury for detection of TNF-α, IL-6, ALT, AST, GGT, CK, CK-MB, BUN and Cr levels using sandwich ELISA.

RESULTS

One hour after sever burn injury, the serum levels of TNF-α and IL-6 began to increase along with ALT, AST, GGT, CK, CK-MB, BUN and Cr levels. Compared with control group, the rabbits in mannitol group showed significantly higher 48 h urine excretion of TNF-α (145 ± 8 vs 78 ± 1 0 pg/ml, P<0.05) and IL-6 (93 ± 6 vs 40 ± 8 pg/ml, P<0.05) but with lowered serum levels of TNF-α (0.62 ± 0.02 vs 0.83 ± 0.02 pg/ml, P<0.05) and IL-6 (0.45 ± 0.03 vs 0.56 ± 0.03 pg/ml, P<0.05) as well as lowered serum ALT, AST, GGT, CK, CK-MB, BUN and Cr levels (P<0.05).

CONCLUSION

In rabbits with severe burn injury, mannitol therapy can decrease serum TNF-α and IL-6 levels early after the injury to ameliorate potential functional impairment of the heart, liver and kidneys.

[Plasma gelsolin level and its relationship with the prognosis of patients with severe burns]

OBJECTIVE

To observe the changes in plasma gelsolin (pGSN) level of patients with severe burn and to explore its relationship with sepsis and death of patients.

METHODS

One hundred and two patients with total burn area equal to or larger than 30% TBSA hospitalized from May 2010 to May 2012 were included as burn group. Twenty-five healthy volunteers were recruited as healthy control group. Peripheral venous blood of patients was harvested on post burn day (PBD) 1, 3, 7, 14, and 21 to determine the pGSN level with double antibody sandwich ELISA kits, and the same maneuver was carried out in healthy volunteers. (1) Patients in burn group were divided into three groups by burn size: small burn area group (30% - 49% TBSA, n = 39), medium burn area group (larger than 49% and smaller than or equal to 69% TBSA, n = 33), and large burn area group (larger than 69% and smaller than or equal to 99% TBSA, n = 30). (2) According to diagnostic criteria of burn sepsis, patients in burn group were divided into sepsis group (n = 43) and non-sepsis group (n = 59). (3) According to the prognosis of patients with sepsis, patients in sepsis group were further divided into non-survival sepsis group (n = 14) and survival sepsis group (n = 29). The levels of pGSN in above groups were compared, and their relationship with sepsis and death of patients was analyzed. Data were analyzed with analysis of variance, LSD test and one-way Logistic regressions.

RESULTS

(1) Levels of pGSN in burn group were obviously lower than those of healthy control group on PBD 1, 3, 7, 14, and 21 (with F values respectively 140.01, 369.52, 702.15, 360.14, 84.16, P values all below 0.01). (2) The mean levels of pGSN in large, medium, and small burn area groups at five time points were (43 ± 11), (85 ± 23), (124 ± 38) mg/L, showing statistically significant differences among them (F = 367.76, P < 0.01), and they were all lower than that of healthy control group [(326 ± 51) mg/L, P values all below 0.01]. (3) The mean levels of pGSN in sepsis group and non-sepsis group at the five time points were (77 ± 12), (122 ± 38) mg/L. Levels of pGSN in sepsis group were lower than those in non-sepsis group on PBD 3, 7, 14, and 21 (with F values respectively 30.35, 111.59, 209.36, 422.76, P values all below 0.01). (4) The mean levels of pGSN in non-survival sepsis group and survival sepsis group at the five time points were (53 ± 8) and (103 ± 25) mg/L. Levels of pGSN in non-survival sepsis group were lower than those in survival sepsis group on PBD 1, 3, 7, 14, and 21 (with F values respectively 9.05, 18.48, 41.34, 107.11, 180.48, P values all below 0.01). (5) Logistic regression analysis showed that the level of pGSN is the independent risk factor related to the complication of sepsis (odds ratio: 5.44, 95% confidence interval: 2.35 - 12.74, P < 0.01) and death (odds ratio: 5.52, 95% confidence interval: 2.34 - 12.19, P < 0.01) in burn patients.

CONCLUSIONS

Severe burn injury could down-regulate the pGSN level of patients, and it decreases along with the increase in the area and severity of burn trauma. pGSN level appears to be an early prognostic marker for patients suffering from severe burns.

[Impact of xenoimplants on metabolic changes in the liver of rats in combined trauma]

In recent years there are intensively studied the role of hepatocytic affection in the complications progress in trauma of various genesis, including the multiple and combined. Positive correcting impact of lyophilized xenoimplants on the hepatic markers activity was demonstrated in the animal blood plasm while severe and combined trauma. Activity of alkaline phosphatase and gammaglutamyltranspeptidase in laboratory animals in polytrauma have had reduced essentially after correction performance during 1 week, and while combined trauma--on the 3rd day.

[Dynamics of changes of the endogenous intoxication indices in the animals, suffering severe and combined trauma, after correction, using xenotransplants]

The main cause in formation of the polyorgan insufficiency syndrome, which is a definitive one in severe trauma, is a syndrome of endogenous intoxication. While simulation of the mechanical trauma, of the burn on the polytrauma background there were noted essential enhancement of the middle molecular mass peptides (MMMP) content and the transaminases activity with maximum value at the 7th day of follow-up. The degree of the investigated indices enhancement on the burn background have had overweighted such after the mechanical trauma. There was established, that application of xenodermoplasty for temporary substitution of the affected skin impacts positively the organism general state, promotes the MMMP concentration reduction and the transaminases activity normalization.

Contributions of severe burn and disuse to bone structure and strength in rats

Burn and disuse results in metabolic and bone changes associated with substantial and sustained bone loss. Such loss can lead to an increased fracture incidence and osteopenia. We studied the independent effects of burn and disuse on bone morphology, composition and strength, and microstructure of the bone alterations 14days after injury. Sprague-Dawley rats were randomized into four groups: Sham/Ambulatory (SA), Burn/Ambulatory (BA), Sham/Hindlimb Unloaded (SH) and Burn/Hindlimb Unloaded (BH). Burn groups received a 40% total body surface area full-thickness scald burn. Disuse by hindlimb unloading was initiated immediately following injury. Bone turnover was determined in plasma and urine. Femur biomechanical parameters were measured by three-point bending tests and bone microarchitecture was determined by micro-computed tomography (uCT). On day 14, a significant reduction in body mass was observed as a result of burn, disuse and a combination of both. In terms of bone health, disuse alone and in combination affected femur weight, length and bone mineral content. Bending failure energy, an index of femur strength, was significantly reduced in all groups and maximum bending stress was lower when burn and disuse were combined. Osteocalcin was reduced in BA compared to the other groups, indicating influence of burn. The reductions observed in femur weight, BMC, biomechanical parameters and indices of bone formation are primarily responses to the combination of burn and disuse. These results offer insight into bone degradation following severe injury and disuse.

[The dynamics of endogenic intoxication in patients with extensive burns]

The sampling consisted of 22 patients with extensive burns with total affected area from 20% to 84% of body surface and with deep burns area from 10% to 40%. The suppurative complications in the form of sepsis were diagnosed in 10 and the transitory bacteremia in 12 victims. The total and effective concentration of albumin, the content of medium molecular peptides in dynamics at 1-3, 7, 14 and 21 days from the moment of trauma were detected to objectively evaluate the endogenic intoxication. The degree of intensity of endogenic intoxication was studied using such integral indicator as effective utilization factor In patients with extensive burns the endogenic intoxication was diagnosed on the basis of total and effective concentration of albumin and increase of content of medium molecular peptides. However the detection of endogenic intoxication of the basis of effective utilization factor is a more informative as compared with the analysis of these indicators separately and, hence, it promote the prescription of more appropriate disintoxication therapy its effectiveness evaluation including.

[Coagulation and fibrinolytic activity of lymph in various pathological conditions (review of own and literature data)]

The review presents information by the author and his collaborators, as well as literature data on the coagulation of lymph in blood loss, convulsive syndrome, trauma, crush syndrome, bums, injections of thrombin and heparin, an experimental thrombosis and other pathological conditions. It is shown that the coagulation of lymph in the development of pathological conditions in tissues may outpace changes observed in the blood. We present evidence that dissolution of fibrin clots in the lymph tissue if damaged, is many times faster than in the blood.

Esophageal SpO2 measurements from a pediatric burns-patient: a case study

Pulse oximetry is being used in everyday clinical practice in anesthesia utilizing peripheral saturation sensors. However, it may be unreliable in certain clinical situations such as peripheral hypoperfusion. Similar situations occur in burns patients and more importantly burns to extremities which limit the sites available for measurement of peripheral oxygen saturation (SpO2). To overcome these limitations, the esophagus has been investigated as an alternative measurement site, as perfusion may be preferentially preserved centrally. A miniaturized reflectance esophageal saturation (SpO2 probe has been constructed utilizing infrared and red photodiodes and a photodetector. Our case study was aimed at evaluating the reliability of esophageal pulse oximetry in a major burns infant. Measurable photoplethysmographic (PPG) traces and SpO2 values were obtained in the neonatal esophagus. It was found that the esophageal pulse oximeter results were in good agreement with oxygen saturation measurements obtained by a commercial ear lobe pulse oximeter. This study suggests that the esophagus can be used as an alternative site for monitoring arterial blood oxygen saturation by pulse oximetry in burned infants.

[Changes in the content of reduced glutathione in severe injuries and multiple trauma]

We explored the changes in reduced glutathione in pathogenesis of severe and combined trauma. Under conditions of our experiments both in blood plasma and tissue of liver, kidneys and heart the concentration of reduced glutathione is decreased. Comparison of the changes ofglutathione that occur in animals of the first experimental group (only severe group) with the same in animals of the second and the third groups, caused by the influence of extra mechanical defect and skin burn, showed that in the last group the disorders of functional status system of antioxidant protection occur more often than in only severely injured animals. The largest significant decrease (34%) in the content of GSH on the 3rd day after injury we found in liver of seriously injured burned animals. In animals of the first and second groups the content of GSH decreased by 27 and 33.7%, respectively.

Association of postburn fatty acids and triglycerides with clinical outcome in severely burned children

CONTEXT

Free fatty acids (FFAs) and triglycerides (TGs) are altered postburn, but whether these alterations are associated with postburn outcomes is not clear.

OBJECTIVE

The aim of the present study was to analyze lipid metabolic profiles in pediatric burn patients and to correlate these profiles with patient outcomes and hospital courses.

DESIGN AND SETTING

We conducted a prospective cohort study at an academic pediatric hospital burn center.

PATIENTS

Our study included 219 pediatric burn patients.

MAIN OUTCOME MEASURES

Patients were stratified according to their plasma TG and FFA levels. Main patient outcomes, such as postburn morbidity and mortality, and clinical metabolic markers were analyzed.

RESULTS

All groups were similar in demographics and injury characteristics. Patients with elevated TGs had significantly worse clinical outcomes associated with increased acute-phase protein synthesis indicating augmented inflammation and hypermetabolism, whereas increased FFAs did not seem to profoundly alter postburn outcomes.

CONCLUSIONS

Elevated TGs, but not FFAs, postburn are associated with worsened organ function and clinical outcomes.

[Correction of metabolic hypoxia in patients with severe burn injury and septic toxemia]

The clinical efficacy of the preparation reamberin in correction of metabolic hypoxia in patients with severe thermal burn injury under septicotoxemia was studied. It was established high efficacy of the preparation in the correction of the antioxidant defense system, its considerable antitoxic activity. Established role of reamberin in maintaining the functioning of the humoral detoxication systems, and antimicrobial resistance in patients with severe thermal injury.

Hyperglycemia exacerbates burn-induced liver inflammation via noncanonical nuclear factor-κB pathway activation

Hyperglycemia and inflammation are hallmarks of burn injury. In this study, we used a rat model of hyperglycemia and burn injury to investigate the effects of hyperglycemia on inflammatory responses in the liver. Hyperglycemia was induced in male Sprague-Dawley rats with streptozotocin (STZ) (35-40 mg/kg), followed by a 60% third-degree scald burn injury. Cytokine levels (by multiplex, in cytosolic liver extracts), hormones (by enzyme-linked immunosorbent assay [ELISA], in serum), nuclear factor (NF)-κB protein deoxyribonucleic acid (DNA) binding (by ELISA, in nuclear liver extracts) and liver functional panel (using VetScan, in serum) were measured at different time points up to 7 d after burn injury. Blood glucose significantly increased after burn injury in both groups with different temporal patterns. Hyperglycemic rats were capable of endogenous insulin secretion, which was enhanced significantly versus controls 12 h after burn injury. DNA binding data of liver nuclear extracts showed a robust and significant activation of the noncanonical NF-κB pathway in the hyperglycemic versus control burn animals, including increased NF-κB-inducing kinase expression (p < 0.05). Liver acute-phase proteins and cytokine expression were increased, whereas secretion of constitutive proteins was decreased after burn injury in hyperglycemic versus control animals (p < 0.05). These results indicate that burn injury to the skin rapidly activated canonical and noncanonical NF-κB pathways in the liver. Robust activation of the NF-κB noncanonical pathway was associated with increased expression of inflammatory markers and acute-phase proteins, and impaired glucose metabolism. Hyperglycemia is detrimental to burn outcome by augmenting inflammation mediated by hepatic noncanonical NF-κB pathway activation.

[Effect of salvia miltiorrhiza and Ligustrazine injection on the early myocardial damage of patients with severe burn]

OBJECTIVE

To observe the effect of salvia miltiorrhiza and ligustrazine injection on the early myocardial damage of severely burned patients.

METHODS

Twenty severely burned patients hospitalized from January 2010 to August 2011, with burn area equal to or more than 50% TBSA, were divided into two groups following hospitalization sequence, with odd number patients entering treatment group (T, n = 10) and even number patients entering control group (C, n = 10). Patients in C group were treated with routine methods, including fluid resuscitation based on the Third Military Medical University formula, anti-infection treatment, support treatment, and organ-protection treatment, etc. In addition to routine treatment methods, patients in T group received intravenous infusion of 250 mL glucose injection (50 g/L) containing 10 mL salvia miltiorrhiza and ligustrazine concoction, once a day, and continued for three days. Venous blood of patients was drawn at post burn hour (PBH) 12, 24, 48, and 72 to determine the plasma levels of cardiac troponin I (cTnI), creatine kinase isozyme MB (CK-MB), and atrial natriuretic peptide (ANP). Data were processed with t test.

RESULTS

At each time point, levels of cTnI, CK-MB, and ANP were lower in T group than in C group. Differences in contents of these parameters between two groups were statistically significant at most time points, with t values from 2.136 to 2.918, P < 0.05 or P < 0.01. Plasma levels of cTnI, CK-MB, and ANP in both groups peaked at PBH 12, which were respectively (28 ± 10) ng/mL, (76 ± 13) U/L, (430 ± 87) pg/mL in T group, and (38 ± 11) ng/mL, (87 ± 10) U/L, (453 ± 91) pg/mL in C group. From PBH 24 to 72, contents of above-mentioned parameters decreased gradually in both groups.

CONCLUSIONS

Early use of salvia miltiorrhiza and ligustrazine injection in severely burned patients can effectively reduce myocardial damage, thus protect the myocardium from injury.

Retinol binding protein: marker for insulin resistance and inflammation postburn?

INTRODUCTION

Burn injury leads to vast changes in both metabolic and inflammatory responses and is associated with increased morbidity and mortality. Insulin resistance (IR) and hyperglycemia are major components of the hypermetabolic response found in burn-injured patients and subsequently contribute to adverse outcomes. Studies have shown that increased systemic retinol binding protein (RBP) levels are associated with IR and hyperinflammation in diabetic and obese patients. The aim of this study was to determine RBP profiles and to test the hypothesis that elevated RBP levels are associated with both IR and the inflammatory response in burned patients.

METHODS

RBP was measured in 372 patients during the acute stay postburn. Patients' demographics, glucose levels, and insulin administration were recorded. Cytokines, hormones, plasma proteins, and organ markers were measured. The average of all measurements of RBP (2.1 mg/dL) was used to divide patients into high and low groups. Statistical analysis was performed by Student t test. Statistical significance was accepted at P < .05.

RESULTS

Fifty-one patients (high group) had elevated RBP levels during acute hospitalization and demonstrated a significant higher incidence of multiorgan failure, sepsis, and mortality (P < .05). Moreover, in the high group, a significant increase of IR, inflammatory cytokines, and catabolic and organ-specific markers were detected (P < .05).

CONCLUSIONS

Increased RBP levels postburn correlate with increased IR, inflammatory and catabolic responses, incidence of multiorgan failure, and mortality. RBP may be a novel biomarker to monitor these detrimental responses postburn.

[The protective effects of insulin on cardiocyte apoptosis challenged by burn serum]

OBJECTIVE

To investigate the protective effects of insulin on burn serum-challenged cardiocyte apoptosis and its mechanism.

METHODS

Burn-serum challenged cardiocytes were pretreated with insulin and inhibitors to pathway SB203580 and LY294002. The expression of cardiac myofilament proteins cleaved-caspase-3, Bax and phosphorylation nuclear factor-ΚB inhibitive factor α (p-IΚBα) were examined by Western blotting. The mRNA expression of tumor necrosis factor-α (TNF-α) was determined by real-time reverse transcription-polymerase chain reaction (RT-PCR). Apoptosis of cardiocyte was observed after Hoechst 33258 staining. Further blocking experiments were used to investigate the cytoprotective pathway of insulin.

RESULTS

Insulin could significantly decrease the expression of cleaved-caspase-3 (2.22 ± 0.30 vs. 4.84 ± 0.74, P < 0.01), Bax (1.33 ± 0.35 vs. 3.74 ± 0.65, P < 0.01), p-IΚBα (1.43 ± 0.62 vs. 3.62 ± 0.74, P < 0.01), TNF-α (0.72 ± 0.27 vs. 2.02 ± 0.63, P < 0.01) and the cardiocyte apoptosis rate [(9.4 ± 3.4)% vs. (19.1 ± 5.6)%, P < 0.01] in cardiocytes challenged by burn serum. Further blocking experiments showed that LY294002, phosphatidylinositol-3-kinase (PI3K)/Akt activation inhibitor, could mitigate the protective effects of insulin. Meanwhile, SB203580, an inhibitor of p38 mitogen-activated protein kinase (p38MAPK) pathway, was able to inhibit cardiocyte injury challenged by burn serum, and it was as effective as insulin.

CONCLUSION

For cardiocytes challenged by burn serum, insulin may decrease inflammatory cytokine expression and apoptosis via regulating PI3K/Akt and p38MAPK pathway.

[Changes in serum contents of interleukin-6 and interleukin-10 and their relation with occurrence of sepsis and prognosis of severely burned patients]

OBJECTIVE

To observe the changes in serum contents of interleukin-6 (IL-6) and interleukin-10 (IL-10) in patients with severe burn injury, and to investigate their relation with occurrence of sepsis and prognosis of patients.

METHODS

One-hundred and sixty adult patients admitted into our hospital (1.0 ± 6.0) h after injury during March 2007 to March 2011 with massive and severe burns were enrolled in the investigation. Patients were divided into non-sepsis group (NS, n = 112), sepsis-survival group (SS, n = 36), and sepsis-deceased group (SD, n = 12) based on the occurrence of sepsis and death. Sepsis occurred on post burn day (PBD) 9 ± 5 in patients in the latter two groups. Patients died on PBD 18 ± 4 in SD group. Twenty healthy adult volunteers were chosen as healthy control group (HC). The age of subjects for observation among four groups, and total burn area and full-thickness burn area of patients among NS, SS, and SD groups were compared. Serum was isolated from blood samples collected from each patient every day from day of admission till PBD 20 to determine the contents of IL-6 and IL-10 by ELISA, and the same determinations were done in HC group. Data of trial subjects were processed with one-way analysis of variance. Data of IL-6 and IL-10 contents were processed with analysis of variance of repeated measure data and SNK method (q test).

RESULTS

(1) There was no significant statistical difference among four groups in age (F = 2.090, P > 0.05). Total burn areas of patients in SS and SD groups were significantly larger than that in NS group (q test, with P values both below 0.05), and total burn area of patients in SD group was obviously larger than that in SS group (q test, P < 0.05). Full-thickness burn areas of patients in SS and SD groups were significantly larger than that in NS group (q test, with P values both below 0.05). (2) Serum contents of IL-6 of patients in NS, SS, and SD groups from PBD 1 to 20 were obviously higher than that of volunteers in HC group. There was no significant statistical difference among NS, SS, and SD groups in serum contents of IL-6 from PBD 1 to 7 (with F value from 0.188 to 2.897, P values all above 0.05). Serum content of IL-6 of patients in NS group decreased from PBD 4. Serum content of IL-6 of patients in SS group decreased gradually from PBD 13, but that in SD group increased continuously at the same time points. Serum contents of IL-6 of patients in NS group [(262 ± 25) pg/mL on PBD 8] were lower than those in SS group [(287 ± 38) pg/mL on PBD 8, q test, P < 0.05] and SD group [(299 ± 22) pg/mL on PBD 8, q test, P < 0.05] from PBD 8. Serum contents of IL-6 of patients in SS group [(300 ± 33) pg/mL on PBD 13] were obviously lower than those in SD group [(338 ± 22) pg/mL on PBD 13, q test, P < 0.05] from PBD 13. (3) Serum contents of IL-10 of patients in NS, SS, and SD groups were higher than that in HC group at each time point. There was no significant statistical difference among NS, SS, and SD groups in serum contents of IL-6 from PBD 1 to 5 (with F values from 1.802 to 2.538, P values all above 0.05). Serum content of IL-10 of patients in NS group was obviously lower than that of patients in SD group from PBD 6 (q test, P values all below 0.05). On PBD 8, serum content of IL-10 of patients in SS group [(54 ± 19) pg/mL] was obviously lower than that in SD group [(91 ± 23) pg/mL, q test, P < 0.05]. The sum of sensitivity (83.33%, 10/12) and specificity (91.67%, 33/36) minus 1 was maximum when the critical value of IL-10 content was set at 77 pg/mL based on the comparison between SS group and SD group in serum content of IL-10 on PBD 8.

CONCLUSIONS

The occurrence and outcome of sepsis is related to burn area and depth when the patients are in similar age. Serum contents of IL-6 and IL-10 play important roles in the pathogenesis of sepsis after burn. IL-6 content in early stage shall not be used in predicting the prognosis of patients with sepsis. IL-10 continuously higher than 77 pg/mL in early stage forecasts unfavorable prognosis of patient.

Procalcitonin levels within 48 hours after burn injury as a prognostic factor

PURPOSE

This study was performed to evaluate the clinical significance of procalcitonin in burn patients and to investigate whether procalcitonin levels at admission can be a prognostic indicator for sepsis and mortality.

MATERIALS AND METHODS

Between January 2009 and December 2010, procalcitonin levels in 175 patients were tested within the first 48 hours after burn injury. Serum procalcitonin was measured using an enzyme-linked fluorescence assay. Mortality rates and positive culture rates of blood, wound, and sputum were evaluated among the subgroups divided by burn size, procalcitonin levels, and clinical prognosis.

RESULTS

Positive blood culture and mortality rates correlated significantly with procalcitonin concentrations within the first 48 hours after burn injury. The area under the ROC curve for procalcitonin related to mortality was 0.844. Survival analysis revealed that the mortality rate was significantly higher in patients with procalcitonin concentrations ≥ 2 ng/mL than in patients with procalcitonin concentrations < 2 ng/mL (P < 0.001). Multivariate analysis demonstrated that procalcitonin was an independent prognostic factor for burn patients (Hazard ratio = 3.16, P = 0.001).

CONCLUSIONS

Procalcitonin concentrations determined within the first 48 hours after burn injury can be a useful prognostic indicator for sepsis and mortality in burn patients.

Inducible nitric oxide synthase deficiency ameliorates skeletal muscle insulin resistance but does not alter unexpected lower blood glucose levels after burn injury in C57BL/6 mice

Burn injury is associated with inflammatory responses and metabolic alterations including insulin resistance. Impaired insulin receptor substrate-1 (IRS-1)-mediated insulin signal transduction is a major component of insulin resistance in skeletal muscle following burn injury. To further investigate molecular mechanisms that underlie burn injury-induced insulin resistance, we study a role of inducible nitric oxide synthase (iNOS), a major mediator of inflammation, on burn-induced muscle insulin resistance in iNOS-deficient mice. Full-thickness third-degree burn injury comprising 12% of total body surface area was produced in wild-type and iNOS-deficient C57BL/6 mice. Insulin-stimulated activation (phosphorylation) of IR, IRS-1, and Akt was assessed by immunoblotting and immunoprecipitation. Insulin-stimulated glucose uptake by skeletal muscle was evaluated ex vivo. Burn injury caused induction of iNOS in skeletal muscle of wild-type mice. The increase of iNOS expression paralleled the increase of insulin resistance, as evidenced by decreased tyrosine phosphorylation of IR and IRS-1, IRS-1 expression, insulin-stimulated activation of phosphatidylinositol 3-kinase and Akt/PKB, and insulin-stimulated glucose uptake in mouse skeletal muscle. The absence of iNOS in genetically engineered mice significantly lessened burn injury-induced insulin resistance in skeletal muscle. In wild-type mice, insulin tolerance test revealed whole-body insulin resistance in burned mice compared with sham-burned controls. This effect was reversed by iNOS deficiency. Unexpectedly, however, blood glucose levels were depressed in both wild-type and iNOS-deficient mice after burn injury. Gene disruption of iNOS ameliorated the effect of burn on IRS-1-mediated insulin signaling in skeletal muscle of mice. These findings indicate that iNOS plays a significant role in burn injury-induced skeletal muscle insulin resistance.

Fibrinogen function after severe burn injury

BACKGROUND

Evidence regarding hypercoagulability in the first week after burn trauma is growing. This hypercoagulable state may partly be caused by increased fibrinogen levels. Rotational thrombelastometry offers a test which measures functional fibrinogen (FIBTEM(®)). To test the hypothesis that in patients with severe burn injury fibrinogen function changes over time, we simultaneously measured FIBTEM(®) and fibrinogen concentration early after burn trauma.

METHODS

After Ethics Committee approval consecutive patients with severe burn trauma admitted to the burn intensive care unit of the General Hospital of Vienna were included in the study. Blood examinations were done immediately and 12, 24 and 48 h after admission. At each time point fibrinogen level (Clauss) and 4 commercially available ROTEM(®) tests were performed.

RESULTS

20 consecutive patients were included in the study. Fibrinogen level and FIBTEM(®) MCF were within the reference range until 24 h after burn trauma but increased significantly 48 h after trauma. There was a significant correlation between FIBTEM(®) MCF and fibrinogen level (R=0.714, p<0.001).

CONCLUSION

The results of this prospective observational clinical study show that fibrinogen function changes early after burn trauma and can be visualized by ROTEM(®) with the fibrinogen-sensitive FIBTEM(®) test.

Human albumin solution for resuscitation and volume expansion in critically ill patients

BACKGROUND

Human albumin solutions are used for a range of medical and surgical problems. Licensed indications are the emergency treatment of shock and other conditions where restoration of blood volume is urgent, such as in burns and hypoproteinaemia. Human albumin solutions are more expensive than other colloids and crystalloids.

OBJECTIVES

To quantify the effect on mortality of human albumin and plasma protein fraction (PPF) administration in the management of critically ill patients.

SEARCH METHODS

We searched the Cochrane Injuries Group Specialised Register (searched 31 May 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2), MEDLINE (Ovid) (1948 to week 3 May 2011), EMBASE (Ovid) (1980 to Week 21 2011), CINAHL (EBSCO) (1982 to May 2011), ISI Web of Science: Science Citation Index Expanded (SCI-EXPANDED) (1970 to May 2011), ISI Web of Science: Conference Proceedings Citation Index - Science (CPCI-S) (1990 to May 2011), PubMed (www.ncbi.nlm.nih.gov/sites/entrez/) (searched 10 June 2011, limit: last 60 days). Reference lists of trials and review articles were checked, and authors of identified trials were contacted.

SELECTION CRITERIA

Randomised controlled trials comparing albumin or PPF with no albumin or PPF or with a crystalloid solution in critically ill patients with hypovolaemia, burns or hypoalbuminaemia.

DATA COLLECTION AND ANALYSIS

We collected data on the participants, albumin solution used, mortality at the end of follow up, and quality of allocation concealment. Analysis was stratified according to patient type.

MAIN RESULTS

We found 38 trials meeting the inclusion criteria and reporting death as an outcome. There were 1,958 deaths among 10,842 trial participants.For hypovolaemia, the relative risk of death following albumin administration was 1.02 (95% confidence interval (CI) 0.92 to 1.13). This estimate was heavily influenced by the results of the SAFE trial, which contributed 75.2% of the information (based on the weights in the meta-analysis). For burns, the relative risk was 2.93 (95% CI 1.28 to 6.72) and for hypoalbuminaemia the relative risk was 1.26 (95% CI 0.84 to 1.88). There was no substantial heterogeneity between the trials in the various categories (Chi(2) = 26.66, df = 31, P = 0.69). The pooled relative risk of death with albumin administration was 1.05 (95% CI 0.95 to 1.16).

AUTHORS' CONCLUSIONS

For patients with hypovolaemia, there is no evidence that albumin reduces mortality when compared with cheaper alternatives such as saline. There is no evidence that albumin reduces mortality in critically ill patients with burns and hypoalbuminaemia. The possibility that there may be highly selected populations of critically ill patients in which albumin may be indicated remains open to question. However, in view of the absence of evidence of a mortality benefit from albumin and the increased cost of albumin compared to alternatives such as saline, it would seem reasonable that albumin should only be used within the context of well concealed and adequately powered randomised controlled trials.

[Changes in peripheral dendritic cells in serious burn patients and its clinical significance]

OBJECTIVE

To explore the changes in peripheral dendritic cells (DCs) in serious burn patients and its relationship with the burn severity and pathogenesis of sepsis.

METHODS

Twenty-two serious burn patients were divided into the burn group (n = 10) and the burn sepsis group (n = 12) according to diagnostic criteria of sepsis, they were stratified according to the total burn surface area (TBSA), into the TBSA I group (TBSA 30%-50%, n = 14) and the TBSA II group (TBSA 51%-80%, n = 8). Peripheral blood of all patients was collected on 1, 3, 7 ,14 ,20 day after burn. The number of two subtypes of peripheral DC i. e myeloid dendritic cells [mDC, Lineage1(-)HLA-DR(+)CD11c(+)] and plasmacytoid dendritic cells [pDC, Lineage1(-)HLA-DR(+)CD123(+)] were quantified by flow cytometer. Ten healthy volunteers served as normal controls at the same time.

RESULTS

In the healthy control group, mDC in the peripheral blood was (0.450 ± 0.150)% and pDC was (0.241 ± 0.084)%. Compared with the healthy control group, in the burn group both mDC [(0.257 ± 0.116)%, (0.274 ± 0.086)%, (0.317 ± 0.056)%] and pDC [(0.122 ± 0.058)%, (0.165 ± 0.051)%, (0.177 ± 0.024)%] decreased significantly on 1, 3, 7 day after burn (all P < 0.05), and the number returned to the normal level on 14 day and 20 day. Compared with the burn group, the number of mDC [(0.230 ± 0.090)%] and pDC [(0.114 ± 0.071)%] in patients of the burn sepsis group were significantly lower (both P < 0.05) on 1 day after burn. Both cells [mDC (0.246 ± 0.076)% vs. (0.412 ± 0.097)% and pDC (0.097 ± 0.032)% vs. (0.203 ± 0.039)%] were still significantly lower (both P < 0.05) on 20 day. Both mDC [(0.266 ± 0.062)%, (0.289 ± 0.071)%, (0.351 ± 0.054)%] and pDC [(0.131 ± 0.025)%, (0.163 ± 0.037)%, (0.178 ± 0.038)%] in the patients in the TBSA I group decreased significantly on 1, 3, 7 day after burn as compared with those of the healthy control group(all P < 0.05), and they returned to the normal level on 14 day and 20 day. Compared with the TBSA I group, mDC [(0.227 ± 0.070)%] and pDC [(0.112 ± 0.047)%] in patients of the TBSA II group decreased significantly(both P < 0.05)on 1 day after burn, and both cells [mDC (0.297 ± 0.072)% vs. (0.423 ± 0.046)% and pDC (0.107 ± 0.061)% vs.(0.197 ± 0.042)%] were still significantly lower (both P < 0.05) on 20 day.

CONCLUSION

Both the number of mDC and pDC decrease in peripheral blood in early stage in serious burn patients, and those who have more serious burn have lower number of mDC or pDC. Deficiency in mDCs and pDC subsets may contribute to immunosuppression in burn victims, and those who suffered obvious loss of mDC and pDC are susceptible to sepsis following severe burn. It indicates that the percentage of mDC and pDC can be a predictive index of sepsis after burn.

[Effects of intestinal trefoil factor combined with mucin on immune function of burn serum treated intestinal epithelial cells]

OBJECTIVE

To observe the effect of intestinal trefoil factor (ITF) combined with mucin on immune function of intestinal epithelial cells (IEC) after being treated with burn rat serum.

METHODS

The rat IEC-6 cell lines were divided into control group (C, cultured in DEME medium containing 10% calf serum), burn control group (BC, cultured in DEME medium containing 10% burn rat serum), burn serum + ITF group (B + I, cultured in DEME medium containing 10% burn rat serum and 25 microg/mL ITF), burn serum + mucin group (B + M, cultured in DEME medium containing 10% burn rat serum and 250 microg/mL mucin), and burn serum + ITF + mucin group (B + I + M, cultured in DEME medium containing 10% burn rat serum, 25 microg/mL ITF, and 250 microg/mL mucin) according to the random number table. Meanwhile, 200 microL suspension of E. coli with density of 1 x 10(8) CFU/mL was added to each culture. At post culture minute (PCM) 15, 30 and post culture hour (PCH) 1, 2, 3, the number of bacteria adherent to IEC-6 was counted after Wright-Giemsa staining, and cell survival rate was calculated after trypan blue staining, with 20 samples in each group at each time point. (2) Other samples of IEC-6 cells without addition of E. coli were divided into BC, B + I, B + M, and B + I + M groups with the same treatment as above. The supernatant contents of IL-6, IL-8, and TNF-alpha were determined by radioimmunoassay at PCH 3, 6, 12, 24, 48, with 6 samples in each group at each time point. Data were processed with t test.

RESULTS

(1) Compared with that in C group, count of adherent bacteria to IEC-6 in BC group at each time point was significantly increased (with t values from 2.947 to 8.149, P values all below 0.01). Compared with those in BC group, the counts in B + I, B + M, B + I + M groups at the major time points were significantly decreased (with t values from -4.733 to -2.180, P < 0.05 or P < 0.01). (2) Compared with that in C group, cell survival rate in BC group at each time point was obviously lowered (with t values from -4.126 to -2.363, P values all below 0.05). Cell survival rates in B + I and B + M groups at some time points were significantly elevated as compared with those in BC group (with t values from 2.120 to 3.423, P < 0.05 or P < 0.01). Cell survival rate in B + I + M group at PCM 15 and PCH 3 was respectively (96.7 +/- 2.4)% and (84.0 +/- 6.7)%, which was respectively higher than that in B + I and B + M groups [(94.5 +/- 3.1)%, t = 2.507, P < 0.05; (77.1 +/- 8.2)%, t = 2.934, P < 0.01]. (3) The contents of TNF-alpha in supernatant of B + I + M group at PCH 6, 12, 24, 48 were significantly lower than those in the other 3 groups (with t values from -6. 914 to -2.889, P < 0.05 or P < 0.01). The contents of IL-6 in supernatant of B + I + M group at some time points were significantly lower than those in the other 3 groups (with t values from -7. 657 to -2.580, P < 0.05 or P < 0.01). The contents of IL-8 in supernatant of B + I + M group at PCH 6, 12, 24, 48 were significantly lower than those in BC and B + M groups (with t values from - 8.802 to - 3.640, P values all below 0.01), and those in B + I + M group at PCH 12, 24 were lower than those in B + I group (with t value respectively -2.786, -2.740, P value all below 0.05).

CONCLUSIONS

ITF can maintain immune function and homeostasis of IEC, prevent bacterial adherence, decrease cell death rate, and reduce release of inflammatory mediators. The effect can be strengthened with addition of mucin.

[Effects of intestinal trefoil factor combined with mucin on ability of proliferation and migration of intestinal epithelial cells after being treated by rat burn serum]

OBJECTIVE

To observe the effect of intestinal trefoil factor (ITF) combined with mucin on the ability of proliferation and migration of intestinal epithelial cells (IEC) after being treated by burn rat serum.

METHODS

The rat IEC-6 cell lines were subcultured and divided into control group (C, cultured with DMEM medium containing 10% calf serum), burn serum group (BS, cultured with DMEM medium containing 10% burn rat serum), burn serum + ITF group (B + I, cultured with DMEM medium containing 10% burn rat serum and 25 microg/mL ITF), burn serum + mucin group (B + M, cultured with DMEM medium containing 10% burn rat serum and 250 microg/mL mucin), and burn serum + ITF + mucin group (B + I + M, cultured with DMEM medium containing 10% burn rat serum, 25 microg/mL ITF, and 250 microg/mL mucin) according to the random number table. Cells were counted on post culture day (PCD) 0, 1, 2, 3, 4, reflecting cell proliferation ability. Cell migration distance was measured at post scratch hour (PSH) 12, 24, 36, 48, 72. Then, cells of each group were placed in upper compartment of Transwell chamber while the corresponding medium was respectively added into lower compartment of Transwell chamber. Cells in lower compartment of Transwell chamber were counted at post culture hour (PCH) 4, 6, 8, 10, 12, reflecting cytomorphosis ability. Data were processed with t test.

RESULTS

(1) Cell proliferation ability. The cell numbers in BS group on PCD 0, 1, 2, 3, 4 were significantly less than those in C group (with t values from -16.569 to -2.613, P < 0.05 or P < 0.01). The cell number showed no statistical difference between B + I and BS groups, and between B + M and BS groups at each time point (with t values respectively from 0.037 to 0.740 and 0.116 to 0.429, P values all above 0.05). The cell number in B + I + M group on PCD 2 was respectively larger than that in BS group (t = 6.484, P < 0.01) and B + I group ( t = 3.838, P < 0.01). (2) Cell migration distance in BS group at PSH 12, 24, 36, 48, 72 was significantly shorter than that in C group (with t values from -37.594 to -6.727, P values all below 0.01). There was no obvious difference in cell migration distance between BS and B + M groups at each time point (with t values from 0.055 to 0.589, P values all above 0.05). Cell migration distance in B + I group at PSH 12, 24, 36 was respectively (47 +/- 6), (126 +/- 13), (170 +/- 11) microm, all longer than those in BS group [(42 +/- 7), (98 +/- 14), (154 +/- 22) microm, with t values from 2.230 to 4.817, P < 0.05 or P < 0.01]. Cell migration distance in BS group at PSH 12, 24, 36, 48, 72 and B + I group at PSH 12, 24, 36, 48 was respectively shorter than that in B + I + M group (with t values respectively from 2.982 to 7.390 and 2.707 to 2.918, P < 0.05 or P < 0.01). (3) Cytomorphosis ability. Compared with those of C group, cell counts in lower compartment of BS group at PCH 4, 6, 8, 10, 12 were significantly decreased (with t values from -23.965 to -6.436, P values all below 0.01). Cell count in lower compartment of BS group at PCH 4, 6, 8, 10, 12 was respectively less than that of B + I group (with t values from 3.650 to 10.028, P values all below 0.01) and similar to that of B + M group (with t values from 0.199 to 0.797, P values all above 0.05). Cell counts in lower compartment of B + I + M group at PCH 4, 6, 8, 10, 12 were significantly larger than those of BS group (with t values from 4.313 to 15.100, P values all below 0.01). Cell count in lower compartment of B + I + M group at PCH 10 (328 +/- 47) and PCH 12 (465 +/- 37) was respectively larger than that in B + I group (277 +/- 25, 353 +/- 34, with t value respectively 3.051, 6.945, P values all below 0.01).

CONCLUSIONS

ITF can improve cytomorphosis ability for promoting cell migration with limited effect on cell proliferation, which can be enhanced with addition of mucin. The main mechanism of ITF in maintaining intestinal mucosal barrier may be attributed to acceleration of cell migration.

[Modulatory effect of insulin on scalded rat serum-induced apoptosis of skeletal myoblast]

OBJECTIVE

To study the modulatory effect of insulin on apoptosis of skeletal myoblast (L6 cells) by serum of scalded rat and its mechanism.

METHODS

L6 cells cultured with DMEM medium containing 10% FBS were divided into control (C, added with 20% normal rat serum), serum from rat with scald injury (S, added with 20% serum from scalded rat), insulin (I, added with 20% normal rat serum and 100 nmol/L insulin), and serum of scalded rat + insulin (SI, added with 20% serum of scalded rat + 100 nmol/L insulin) groups according to the random number table. After being cultured for 48 hours, apoptosis was observed with Hoechst 33258 staining and its number counted, annexin V -FITC/PI double-labeling method was used to assess apoptosis rate, the protein levels of phosphorylated (p-) Akt, p-PI3K, Bax, Bcl-2, and active caspase-3 were determined by Western blotting. Data were processed with grouped or paired t test.

RESULTS

(1) The amount of apoptosis with typical morphological change in S group [(59.6 +/- 3.9) per visual field] was more than that in C, I, and SI groups [(4.9 +/- 2.6), (5.5 +/- 2.1), (19.7 +/- 2.3) per visual field, with t value respectively 28.53, 29.86, 21.53, P values all below 0.01]. (2) Apoptotic rate in S group was (18.5 +/- 1.8)%, which was markedly higher than that in C, I, and SI groups [(1.1 +/- 0.6)%, (1.5 +/- 0.3)%, (7.8 +/- 0.6)%, with t value respectively 22.41, 22.83, 13.92, P values all below 0.01]. (3) Compared with those in C group, the protein levels of Bax and active caspase-3 in S group were up-regulated (1.12 +/- 0.63 vs. 0.16 +/- 0.03, 2.15 +/- 0.51 vs. 0.21 +/- 0.03, with t value respectively 3.80, 10.69, P values all below 0.01), the protein level of p-Akt was lowered (0.20 +/- 0.03 vs. 0.42 +/- 0.07, t = -8.46, P < 0.01), and the protein levels of p-PI3K and Bcl-2 showed no statistical difference (0.19 +/- 0.03 vs. 0.26 +/- 0.09, 0.17 +/- 0.03 vs. 0.28 +/- 0.07, with t value respectively -2.73, - 1.14, P values all above 0.05). The protein levels of Bax (0.40 +/- 0.14) and active caspase-3 (0.83 +/- 0.18) in SI group were lowered (t = -3.23, P < 0.05; t = 6.66, P < 0.01) and the protein levels of p-Akt, Bcl-2, and p-PI3K in SI group were elevated (0.39 +/- 0.10, 0.78 +/- 0.03, 0.47 +/- 0.12, with t value respectively 4.07, 18.71, 5.05, P < 0.05 or P < 0.01) as compared with those in S group.

CONCLUSIONS

Serum from scalded rat can induce apoptosis in skeletal myoblast, and the effect can be inhibited by insulin through PI3K/Akt signal pathway.

[Determination of clinical efficacy of REGEN-D 150 preparation for local treatment of burns]

Clinical efficacy of preparation REGEN-D 150 for local treatment of burns was analyzed. In accordance to the data obtained, the preparation application for the burns treatment have secured the local inflammatory reaction reduction in the affection zone, reparative processes optimization in the burn wound and saving the functional possibilities of phagocytic cells on optimal level.

[Effect of N-stearoylethanolamine on free amino acid levels in rat plasma and liver with burn]

The effect of the endocannabinoid congener N-stearoylethanolamine (NSE) on the content of plasma and liver free amino acids in burned rats was studied. The animals after the thermal burn of the skin received per os during 7 days the water suspension of NSE in the doze 10 mg/kg of body weight. In the other group of rats the suspension was applied on the wound (the concentration of NSE was 10 mg/ml). In experimental animals the total amount of free amino acids in plasma decreased after burn while the total amount of free amino acids in liver significantly increased. In burn animals the ratio of plasma and liver Phe/Tyr and Gly/Val was found to be augmented while the Fischer ratio (Ile+Leu+Val/Phe+Tyr) diminished compared with intact rats. It was shown for the first time that NSE caused normalization of the concentration of some free amino acids and of Phe/Tyr, Gly/Val ratios, and the Fischer ratio in blood plasma and liver of rats with the burn injury. Altogether, these data demonstrate that NSE possesses adaptogenic properties, and is involved in the organism response to a burn. These findings suggest possibility of NSE usage for burn treatment.

Impact of hypernatremia on burn wound healing: results of an exploratory, retrospective study

Severely burned patients need extensive initial fluid resuscitation. Formulas to calculate fluid needs during burn shock are well established. However, protocols for normalizing circulating fluid volume after cellular integrity has recovered do not exist. Resultant electrolyte shifts can cause hypernatremia, a possible sign of hypovolemia, which may in turn result in decreased tissue perfusion, subsequently affecting burn wound healing. The purpose of this retrospective chart review was to explore the hypothesis that hypernatremia in burn patients is a possible sign of systemic dehydration and that dehydration may affect burn wound skin graft take. Medical chart data from otherwise healthy burn victims with deep partial-thickness burns (total burn surface area [TBSA] >10%) who underwent skin grafting 7 days post injury were reviewed. Thirty (11 female; 19 male) patients with an average TBSA of 30% (± 11%) and an Abbreviated Burn Severity Index (ABSI) score of 7.9 (± 1.8) were included. Of those, 17 had normal average serum levels between day 2 and 6 following injury and 13 developed hypernatremia (serum sodium ≥146 mmol/L) an average of 5.5 days (± 1.5) after injury. Patients in this group underwent an average of 1.3 (± 0.8) re-grafting procedures compared to 0.35 (± 0.5) for patients without hypernatremia (P = 0.001). There was good correlation (r = 0.525) between daily infusion-diuresis ratios (IDR) and serum sodium levels, as well as between serum sodium levels and re-skin grafting occurrences (r = 0.62). The results indicate that research to confirm that hypernatremia is an indicator of dehydration and affects skin graft take is warranted and that protocols to optimize fluid volume following burn shock treatment are needed.