Expression of oncoproteins c-fos and c-jun in hypertrophic scars and chronic dermal ulcers and their regulation of basic fibroblast growth factor

OBJECTIVE

To explore the characteristics of oncoprotein expression of c-fos and c-jun in hypertrophic scars and chronic dermal ulcers and their regulation of basic fibroblast growth factor (bFGF).

METHODS

Tissues of hypertrophic scars (n = 8), chronic dermal ulcers (n = 8) and normal skin (n = 5) were taken from 21 patients with burns and chronic dermal ulcers in operation. The ABC immunohistochemical method was used to characterize the gene product expression of c-fos, c-jun and bFGF in the above tissues.

RESULTS

In normal skin, both c-fos and c-jun protein expression and bFGF protein expression were observed. The signals of both oncoproteins were localized mainly in subcutaneous fibroblasts, but, positive expression of the bFGF protein was mainly in keratinocytes. In hypertrophic scars, positive expression of both oncoproteins could be found mainly in fibroblasts, but bFGF was mainly in fibroblasts and endothelial cells. In chronic dermal ulcers, endothelial cells, some of inflammatory cells and fibroblasts were positive for both of oncoproteins, but the expression of bFGF was only seen in fibroblasts and endothelial cells.

CONCLUSIONS

The results indicate that the interaction between both oncoproteins and bFGF exists, and the regulating action between protooncogenes and bFGF is a major course in wound healing. The different expressions of c-fos and c-jun gene products play an important role in regulate bFGF action, thus affecting wound healing.

Chromosomal location of murine disabled-2 gene and structural comparison with its human ortholog

Disabled-2 (Dab2) is one of the two mammalian orthologs of the Drosophila Disabled. The three spliced forms, p96, p93, and p67 of murine Dab2 cDNAs were first isolated as phosphoproteins functioning in the macrophage CSF-1 signal transduction pathway. Subsequently, the involvement of Dab2 in ovarian cancer development has been investigated: Dab2 expression is lost or greatly diminished in breast and ovarian cancers, and gene deletions have been found. Regulation of Disabled-2 expression is also found to be important in development and physiological functions. Structural information of the murine Dab2 gene is essential for studies of transcription regulation and gene function in mouse models. In this study, the mouse Dab2 gene coding sequence was identified and sequenced from three lambda phage clones containing the gene. Two BAC clones of mouse genomic DNA were also used to identify the sequences of the non-coding first exon and promoter. The first exon is separated from the second exon by a large (15 kb) intron. The mouse gene is about 40 kb in size and consists of 15 exons, producing a 3.6 kb message. The translation initiation site resides in the middle of the second exon. The mouse Dab2 gene structure is very similar to that of its human ortholog in exon/intron sizes and promoter sequences. The chromosomal localization of mouse Dab2 was mapped by FISH to chromosome 15A2, a site of syntax with the human 5p12 where human Dab2 gene resides. The information on the mouse Dab2 gene structure and promoter will be invaluable in studies of the involvement of Dab2 gene in cancer, expression, physiological function, and development in mouse models.

[The predictive value of serum neopterin for multiple organ dysfunction syndrome in extensively burned patients]

OBJECTIVE

To evaluate the predictive value of serum neopterin for multiple organ dysfunction syndrome (MODS) in extensively burned patients.

METHODS

Twenty-nine burn patients with TBSA of more than 70% were included in this study, and these patients were divided into two groups according to the occurrence of MODS. Blood samples were obtained on 1, 3, 7, 14, 21 and 28 postburn days (PBDs). And serum neopterin levels were determined by radioimmunossay. To evaluate the predictive power of neopterin, sensitivity, specificity, predictive value of a positive/negative test were calculated for the diagnosis of MODS.

RESULTS

Serum neopterin levels in MODS group were significantly higher than those in non-MODS group on 3, 7, 14 and 21 PBDs (P < 0.05 similar 0.01). And a positive correlation was found between neopterin levels and MODS scores in patients who developed MODS on 3, 7 and 21 PBDs (r = 0.470 similar 0.811). In a period of up to 28 PBDs, neopterin levels exceeding 35.0 nmol/L were associated with MODS by a clinical sensitivity of 81.1%, a specificity of 89.9%, a positive predictive value of 81.1%, and a negative predictive value of 89.9%.

CONCLUSION

These data indicated that the presence of constant high neopterin serum levels appear to be associated with the development of postburn MODS. Serum levels of neopterin might be a useful marker for the early identification of extensive burned patients at risk for MODS.

[The effects of extensive excision of massive invasive infected burn wound on the REE of burn patients with sepsis]

OBJECTIVE

To explore the effects of extensive excision of massive invasive infected burn wound on the REE of burn patients with sepsis.

METHODS

REEs and plasma levels of IL -- 6, IL -- 8, TNFalpha and LPS were determined before and after surgical interventions and when patients', condition improved in 8 burned cases with sepsis.

RESULTS

All the 8 patients survived after treatment. The REE level in patients after operation was significantly lower than those before the operation (P < 0.01). REE in patients whose condition improved decreased obviously when compared to that after operation (P < 0.01). The plasma levels of IL -- 6, IL -- 8, TNFalpha and LPS decreased markedly after the operation when compared to those before operation (P < 0.05). and there were lower levels of these factors when the patients', condition improved (P < 0.001). Furthermore, there were closely positive correlations between REE and plasma IL -- 6, IL -- 8, TNFalpha and LPS (P < 0.01).

CONCLUSION

Over -- releasing of some inflammatory mediators could be corrected by means of extensive excision of massive invasively infected burn wound. This might be beneficial to the control or the amelioration of the hypermetabolism in burn patients with sepsis.

Advances in wound healing research in China: From antiquity to the present

China is the largest developing country in the world with wounds occuring everyday and everywhere, representing one of the main killers of people. Prevention and treatment of wounds are the main tasks for Chinese surgeons. Although wound care and management have a long history in China, wound healing research and management have made significant progress only in recent years. In this article we give a brief account of the history of wound care and management in China. In addition, we introduce the main research fields and achievements in tissue repair and regeneration during recent times in this country. We hope that these works will benefit our foreign colleagues to know our work and enhance the communication among us.

Angular distributions of fast electrons, ions, and Bremsstrahlung x/gamma-rays in intense laser interaction with solid targets

We study the angular distributions of fast electrons, ions, and bremsstrahlung x/ gamma-rays generated during the interaction of an ultrashort intense laser pulse with solid targets. A relation is found on the angular directions for fast electrons and ions as a function of the particle's kinetic energy, experienced Coulomb potential changes, and the incident angle of the laser pulse. It is valid independent of the acceleration mechanisms and the polarization of the laser pulse, as confirmed by particle-in-cell simulations. The angular distribution of bremsstrahlung x/gamma-rays is presented to show explicitly its correlation with the corresponding angular distributions of electrons.

Structure, sequence, and promoter analysis of human disabled-2 gene (DAB2)

Disabled-2 (DAB2 for human and Dab2 for other species) is one of two mammalian orthologues of Drosophila Disabled. DAB2 exhibits properties of a tumor suppressor gene: the expression of DAB2 is eliminated in 85-95% of breast and ovarian tumors; homozygous deletions of the gene have been found in some of these tumors; and reintroduction of DAB2 expression suppresses tumorigenicity of carcinoma cells. To study the mechanisms of loss of expression and to detect possible mutations in tumors, we have investigated the genomic structure of the DAB2 gene. The complete DAB2 gene was identified and sequenced from four overlapping BAC clones found to contain the gene. Complement factor 9 (C9) gene was localized next to the DAB2 gene at the 3'-end of the BAC DNA fragments. The human DAB2 gene is about 35 kb in size and consists of 15 exons and 14 introns, producing an approximately 4-kb message. A spliced variant corresponding to mouse Dab2 p93 and a 3'-end spliced variant were also identified. The translation initiation site resides in the second exon, and the noncoding first exon is separated from the second exon by a 14-kb intron. The 420-bp sequence 5' of exon 1 contains a CpG island (39 CpG sites). This 420-bp putative promoter was found to contain the site for transcription initiation, identified by RNase protection assay, and is sufficient for active transcription in epithelial cells. The information about the gene structure of DAB2 will enable us to analyze possible mutations and the mechanisms of loss of DAB2 expression in tumors.

Successful treatment of invasive burn wound infection with sepsis in patients with major burns

OBJECTIVE

To investigate the clinical characteristics of invasive burn wound infection with sepsis in patients with major burns and to summarize the successful experiences in the treatment of such patients.

METHODS

Eight patients with major burns, complicated by invasive burn would infection and sepsis were consecutively admitted to our hospital from September 1997 to October 1998. Among them, 6 patients developed multiple organ dysfunction syndrome (MODS) and 2 developed septic shock. The plasma concentrations of IL-6, IL-8, TNF alpha and lypopolysaccharide (LPS) were assayed before and after surgical intervention, as well as when the patient's vital signs became stable.

RESULTS

The patients' conditions usually deteriorated abruptly when extensive invasive burn wound infection emerged. While multi-microbial infection was usually found, Pseudomonas aeruginosa was the predominant bacteria isolated from the subeschar tissue. The plasma concentrations of IL-6, IL-8, TNF alpha and LPS before surgical intervention were significantly higher than those after surgical intervention (P < 0.05). The lowest levels of the inflammatory mediators were observed when the patients' conditions became stable, and the values were significantly lower than those before surgical intervention (P < 0.001).

CONCLUSION

Since the main cause of burn wound sepsis is the presence of a large area of infected burn wound, they should be excised and covered as early as possible. LPS and pro-inflammatory mediators play an important role in the pathogenesis of burn sepsis. Although favorable results should be attributed to comprehensive treatment, we believe that early, aggressive and thorough surgical excision of infected burn wounds, followed by sound and complete coverage of the area, play a crucial role.

[A system of microcomputer analysis for biological oxygen consumption and its application]

This paper introduces a microcomputer system of data analysis and methods of measuring oxygen consumption for biological materials. The system overcame some disadvantages of operating inconvenience and difficulties of collective and analytic data by traditional means. The system possesses functions of automatic enactment, collection, save/take and analysis for many experimental data. It can be used to measure oxygen consumption of tissues, cells and mitochondria.

Heparin-free hemodialysis in the treatment of hypernatremia in severely burned patients

BACKGROUND

Hypernatremia in severely burned patients is associated with high morbidity and mortality rates. As the causes of hypernatremia in major burn patients are still not clear, hemodialysis is the method of choice for the treatment. While hemodialysis is effective for the control of hypernatremia, it can cause bleeding complications that may be fatal for burn patients with extensive wounds and potential gastro-intestinal mucosal damage.

CLINICAL DATA

In the present study heparin-free hemodialysis in which the heparin is firmly absorbed to the haemofiltration membrane, hemophan, dispensed with systemic use of heparin. In two extensively burned patients with burn area of 100% TBSA and 98% TBSA respectively and hypernatremia with serum sodium concentration as high as 169 and 158 mmol/l respectively, heparin-free hemodialysis was performed five times and three times each.

RESULTS

Hypernatremia was satisfactorily corrected with no interference to the coagulation system in the two patients as indicated by clinical observation and biochemical analysis. The patient with burn area of 98% TBSA survived and the patient with burn area of 100% TBSA died of wound coverage failure 6 weeks after injury because of non-availability of autograft.

CONCLUSION

Heparin-free hemodialysis is an effective and safe method in the treatment of hypernatremia in extensively burned patients.

Restoration of positioning control following Disabled-2 expression in ovarian and breast tumor cells

The physical interaction of epithelial cells with the basement membrane ensures correct positioning and acts as a survival factor for epithelial cells. Cells that detach from the basement membrane often undergo apoptosis; however, in carcinomas, this positional control is absent, permitting disorganized cell proliferation. In the majority of breast and ovarian carcinomas (85-90%), the expression of a candidate tumor suppressor, Disabled-2 (Dab2), is frequently lost. The Dab2-negative tumor cells are no longer in contact with an intact basement membrane, as indicated by the absence of collagen IV (in about 90% of cases). However, in the subset (10-15%) of ovarian tumors in which Dab2 expression is positive, the presence of a basement membrane-like structure around tumor cells was observed. Recombinant adenovirus-mediated expression of Dab2 was used in Dab2-negative ovarian and breast cancer cells, and re-expression of Dab2 was found to lead to cell death or growth arrest. Dab2 expression suppressed MAPK activation and c-fos expression. Plating the infected cells on a basement membrane matrigel rescued the cells from death and growth arrest. Thus, Dab2 exhibits a negative activity for cell growth and survival, which can be countered by attachment of the cells to basement membrane matrix. We conclude that Dab2 functions in cell positioning control and mediates the exigency for basement membrane attachment of epithelial cells. Loss of Dab2 may contribute to the basement membrane-independent, disorganized proliferation of tumor cells in ovarian and breast carcinomas.

[The significance of the expression of the HSP70 and HSP90 in the intestinal mucosa in scalded rats during early postburn stage]

OBJECTIVE

To investigate the changes in the expression, the tissue contents and the distribution of heat shock protein (HSP) 70 and HSP90 in the intestinal mucosa in scalded rats during early postburn stage and to elucidate the effects of heat shock response of intestinal mucosal cell on burn victim's systemic pathophysiology.

METHODS

The scalded rats were taken as the model. ELISA, immunoblotting analysis and immunohistochemical methods were employed to analyze and study the expression, the tissue contents and the distribution and their functional status of HSP70 and HSP90 in the intestinal mucosa.

RESULTS

(1) The free HSP70 content in the intestinal mucosa exhibited significantly transient decrease in the early postburn stage. (2) The total contents of HSP70 and HSP90 in the intestinal mucosa increased obviously postburn. (3) There exhibited remarkable heterogeneity of the molecular structure of HSP70 in the intestinal mucosa in the early postburn stage.

CONCLUSION

The expression and the changes in the contents and the tissue distribution of the two HSPs in the intestinal mucosal cell might play important roles in the cellular stress reaction of the intestinal mucosa and even in the intestinal barrier functional mechanism.

Genomic aberrations in human hepatocellular carcinomas of differing etiologies

We sought to assess whether genetic abnormalities in hepatocellular carcinoma differed in geographic locations associated with different risk factors. Comparative genomic hybridization (CGH) was applied to the genome-wide chromosomal analysis in 83 tumor samples from four different geographic origins. Samples were obtained from regions that differed in aflatoxin exposure: China (Hong Kong with low aflatoxin exposure and Shanghai with moderate aflatoxin exposure), Japan, and the United States (negligible aflatoxin exposure). Cases from Hong Kong and Shanghai were all hepatitis B virus (HBV) related, those from Japan were hepatitis C virus related, and those from the United States were HBV negative. In parallel, the mutational pattern of the whole p53 gene (exons 1-11) was also investigated in these cases. CGH revealed a complex pattern of chromosomal gains and losses, with the commonest aberration in each geographic location being chromosome 1q copy number gain (38-60%). Shanghai cases displayed the highest number of total aberrations per sample, with significant copy losses on 4q (75%), 8p (70%), and 16q (65%). Hepatitis C virus-related samples from Japan had a characteristically high incidence of 11q13 gain. p53 mutation(s) was detected in 23% of Hong Kong cases, 40% of Shanghai, 31% of Japan, but only 6% of the United States cases. The "aflatoxin-associated" codon 249 mutation was, however, identified only in samples from China (13% Hong Kong and 20% Shanghai). This finding, together with the highly aberrant pattern of genetic changes detected in the Shanghai series, is suggestive of the genotoxic effects of aflatoxin being more broadly based. It is also likely that there is a synergistic effect of HBV infection and high aflatoxin exposure in promoting hepatocellular carcinoma development. It appears from our CGH study that individual risk factors are indeed associated with distinct genetic aberrations, although changes in 1q gain appear common to all.

[Clinical use of acellular allogenic dermis or acellular porcine dermis with split-thickness autologous skin graft in 119 cases]

OBJECTIVE

To observe the effect of acellular allogenic dermis or acellular porcine dermis together with split-thickness autologous skin graft on coverage of deep burn wound and the wound of scar excision.

METHODS

Acellular allogenic dermis or acellular porcine dermis produced by our unit, with split-thickness autologous skin graft, were used in repairing various wounds in 119 cases. The take rate of various wounds was compared, and the take rate of wounds in which autologous skin from different sites was used to cover either acellular allogenic dermis or acellular porcine dermis was also compared. Histological examination and follow-up were made in some cases.

RESULTS

After tangential excision, eschar excision and scar excision, the wounds were covered with either allogenic acellular dermis or porcine acellular dermis and autologous split-thickness skin. The take rate was found to be (93.4 +/- 3.4)%, (92.1 +/- 4.6)%, (94.5 +/- 3.5)%, respectively. There was no a significant difference in take rate (P > 0.05). No significant difference in take rate between the transplantation of allogenic acellular dermis with autologous split-thickness skin and transplantation of porcine acellular dermis with autologous split-thickness skin was found (P > 0.05). When autologous split-thickness skin harvested from the trunk or extremities was used, the take rate was (93.1 +/- 4.8)%, (89.0 +/- 6.2)%, respectively, whereas the take rate was only about 70% - 80% when skin harvested from the scalp was used. The take rate was only about 40% when acellular allogenic dermis and autologous micro-skin graft were used to cover the wound. Histological examination 19 months after the transplantation revealed normal structure. Collagenous fibers were orderly arranged. There was no apparent hyperplasia of collagenous fibers. Hair follicles, sweat glands and other skin appendages were not found in the healed area. Grossly, no obvious pigmentation was seen, the surface was smooth with slight wound contraction, and the consistency was flexible.

CONCLUSION

Acellular allogenic split-thickness dermis or acellular porcine split-thickness dermis with autologous split-thickness dermis for coverage of deep burn wound and the wound of scar excision is an ideal material.

[Hemostatic variations associated with acute leukemia: clinical and prognostic significance]

OBJECTIVE

To study the hemostatic abnormalities and their association with bleeding manifestation and prognosis in acute leukemia (AL) patients.

METHODS

A series of hemostatic parameters were determined in 93 cases of AL using ELISA or chromogenic assay.

RESULTS

At diagnosis, plasma levels of P-selectin, soluble fibrinomonomer complex (SFMC), thrombomodulin (TM), tissue plasminogen activator, D-dimer (D-D) were significantly elevated, but protein C antigen (PC:Ag), plasminogen (PLG), alpha(2)-antiplasmin (alpha(2)-PI) and plasminogen activator inhibitor (PAI) were decreased, and fibrinogen (Fg), PC activity (PC:A) and protein S (PS) were in normal range. All the above abnormalities returned to normal after complete remission (CR) except for PC:A and PC:Ag. Platelet counts, Fg, SFMC, PLG, alpha(2)-PI and D-D were significantly associated with hemorrhagic manifestations. TM, PS and PAI were related to prognosis.

CONCLUSION

There existed the consumption of platelets as well as the activation of coagulant, anticoagulant and fibrinolytic systems in AL, which was greatly improved after CR.

[Anisodamine in prevention and treatment of sepsis of severely burned patients]

OBJECTIVE

To observe the preventive effect of anisodamine on possible sepsis of patients with major burns and the effect of anisodamine on patients with sepsis.

METHODS

Forty-two patients with extensive burn admitted to our burn institute from April 1998 to November 1999 were divided randomly into two groups: treatment group (T group) and control group (C group). In the T group, all 20 patients received fluid resuscitation regimen with anisodamine, and in the C group, 22 patients received the regimen with no anisodamine. A tonometry catheter was positioned in the stomach, connecting with the automatic gas analysis machine (Datex-Engstrom Corporation, Dutch) for determining gastric intramucosal pH (pHi). The plasma concentrations of diamine oxidase (DAO) and endotoxin were measured. Correlation analysis between pHi, DAO and endotoxin were made respectively during early stage of postburn. All the parameters in 7 patients with sepsis before and after administration of anisodamine were compared with those in 6 patients with sepsis without use of anisodamine.

RESULTS

The incidence of sepsis in the T group was lower (20.0%) than that in C group (40.9%). The gastric pHi value in the early period of postburn was significantly higher in the T group than in the C group (P < 0.05). Concurrently, the plasma concentrations of DAO and endotoxin were significantly lower in the T group than in the C group (P < 0.05 or 0.01). A significant negative correlation was seen between the gastric pHi and respective values of DAO, endotoxin (P < 0.05 or 0.01). There were a decrease in gastric pHi, and an increase in plasma DAO and endotoxin level in patients with septic episode; however all the parameters after administration of anisodamine were improved compared with those in septic patients without use of anisodamine.

CONCLUSIONS

Intestinal ischemic injury plays an important role in provoking sepsis during early postburn period. Anisodamine is effective in restoring intestinal circulation both in the shock phase and after the development of sepsis.

[Prevention and treatment of MODS in severely burned patients: an institute based retrospective study]

OBJECTIVE

To determine if the preventive and treatment measures developed from basic and clinical research work have any effects on the incidence and outcome of MODS in severely burned patients.

METHODS

657 extensively burned patients (burn size exceeding 30% TBSA) admitted to the clinical department from January 1970 through October 1999 were studied. The morbidity and mortality rates were compared in patient groups hospitalized before and after January 1990 when major preventive and treatment measures began to be extensively executed. These measures consisted of prompt, rapid and adequate fluid resuscitation, restoration of bowel blood supply with anisodamine (654 - 2), use of oxygen free radical scavengers (e.g. mannitol, vitamin C and E), extensive escharectomy during shock stage, early tube feeding, support of organ function, etc.

RESULTS

Before 1990 when very few preventive and treatment measures were applied, the incidence of MODS, 17.3% (64 out of 369), and the death rate 87.5% (56 out of 64). After 1990, with the application of various preventive measures and treatment, the morbidity and mortality rates were reduced to 6.9% (20/288) and 40.0% (8/20), respectively.

CONCLUSION

Our results suggest that measures which mitigate or eliminate the predisposing and causative factors of MODS may be salutary in the prevention and treatment of MODS after extensive burn injury.

[The effect of pentoxifylline on endotoxin-induced biopterin formation in rabbits]

OBJECTIVE

To observe the potential effect of pentoxifylline on endotoxin-mediated biopterin (tetrahydrobiopterin and more oxidized species) formation and systemic hemodynamics.

METHODS

Rabbits were subjected to endotoxic shock induced by a bolus intravenous injection of E. coli O26B6 lipopolysaccharide (400 microg/kg). 28 animals were divided into sham-operation group (n = 8), endotoxic shock group (n = 10), and pentoxifylline-treated group (n = 10). Plasma biopterin and tumor necrosis factor-alpha (TNF) levels, and guanosine triphosphate cyclohydrolase I (GTP-CHI) activity in tissues were determined at various intervals.

RESULTS

Treatment with pentoxifylline significantly decreased plasma biopterin and TNF levels at 2 to 8 hours after endotoxin challenge (P < 0.05, P < 0.01), and inhibited GTP-CHI activities in the liver, lung, and myocardial tissues (P < 0.05). Meanwhile, systemic hemodynamic parameters, including mean arterial pressure, cardiac output, and total peripheral resistance, in the treatment group were much higher than those in the endotoxic shock group.

CONCLUSIONS

These data suggest that early treatment with pentoxifylline can effectively inhibit endotoxin-induced biopterin synthesis and release, and markedly improve systemic hemodynamics during septic shock.

Effect of extensive excision of burn wound with invasive infection on hypermetabolism in burn patients with sepsis

OBJECTIVE

To evaluate the effect of extensive excision of invasive burn wound infection on hypermetabolic response in burn patients with sepsis.

METHODS

Eight patients with major burn, complicated by invasive burn wound infection and sepsis, were consecutively admitted to our hospital from September 1997 to October 1998. Resting energy expenditures (REEs) were monitored by means of cardiorespiratory diagnostic system (Medical Graphics Corporation, USA) at patients' bedside. Plasma concentration of IL-6, IL-8, TNF-alpha, and LPS were assayed before and after surgical intervention and at the time when the patients' vital signs became stable. Correlation analysis between REEs and IL-6, IL-8, TNF-alpha, and LPS were made, respectively.

RESULTS

A total of 8 treated patients survived. Values of REE before surgical intervention were significantly higher than those after surgical intervention (P < 0.01), and when patients' vital signs became stable the values were significantly lower than those after surgical intervention (P < 0.01). The plasma concentrations of IL-6, IL-8, TNF-alpha, and LPS after excision of invasive burn wound infection were significantly lower than those before surgical intervention (P < 0.05). The lowest levels of these inflammatory mediators were observed when the conditions of patients became stable, and the values were significantly lower than those before surgical intervention (P < 0.001). There was a significant positive correlation between REE level and respective values of plasma IL-6, IL-8, TNF-alpha, and LPS (P < 0.01).

CONCLUSIONS

It seemed that the extensive excision of invasively infected burn wound in patients with major burn should be performed as early as possible to reduce an increased release of inflammatory mediators and to control the hypermetabolic response during sepsis.

[The experience of the management of burn sepsis with different strategies in our department during the past 29 years]

OBJECTIVE

To retrospectively sum up the experiences in the prevention and treatment of sepsis after thermal injury.

METHODS

From January 1970 through October 1998, altogether 5 330 burn patients were admitted to our burn center, and among them 451 patients developed sepsis. To analyze the efficacy of different treatment strategies developed during these 29 years, three periods were divided, namely 1970 to 1979, 1980 to 1992, and 1993 to 1998. The incidence and mortality of sepsis were compared, thereupon the efficacy of different treatment strategies were analyzed.

RESULTS

The overall incidence and mortality of sepsis in all patients and those in patients with burn extent exceeding 30% TBSA were significantly lower in the latter period compared with the former two periods (P < 0.05 similar 0.01). In addition, in the last period, blood levels of LPS, TNFalpha, IL -- 6, and IL -- 8 were obviously higher throughout the course of MODS, especially before death, in the patients who finally died of sepsis, complicated by MODS, compared with those in the survivors (P < 0.05 similar 0.01).

CONCLUSION

Summing up our experiences, it is our belief that the treatment strategies for prevention of postburn sepsis in extensively burned patients should include rapid, adequate fluid resuscitation for burn shock, effective control of infection, early excision of deep burnwounds followed by good skin coverage, and reinforcement of organ support. Once burn wound sepsis occurs, prompt removal of infected necrotic tissue is the key procedure to ensure a successful result.

Recombinant bovine basic fibroblast growth factor accelerates wound healing in patients with burns, donor sites and chronic dermal ulcers

OBJECTIVE

To evaluate the effect of recombinant bovine basic fibroblast growth factor (rbFGF) on accelerating healing of burn wounds, donor sites and chronic dermal ulcers in multicenters.

METHODS

One thousand and twenty-four patients with burns, donor sites and chronic dermal ulcers were recruited for this prospective and multicenter clinical trial and another 641 patients with the similar wounds were used as controls. All patients were divided into three groups: burn group, donor site group, and chronic dermal ulcer group. In the burn group, 654 patients with superficial second-degree burns(superficial II degree) or deep second-degree burns(deep II degree) were treated topically with either recombinant bovine basic fibroblast growth factor (rbFGF plus vehicle, rbFGF 150 AU/cm2/day, 330 patients) or placebo (vehicle without rbFGF, 324 patients). In the donor site group, 509 patients were treated with rbFGF and 317 patients with placebo in a similar way as described elsewhere. In the chronic dermal ulcer group, 185 patients were treated with rbFGF and the controls were themselves. Photography, histological evaluation and clinical examination were used to evaluate the results of wound healing.

RESULTS

All of superficial second-degree burns, deep second-degree burns and the donor sites treated with recombinant bovine basic fibroblast growth factor had an accelerated rate of granulation tissue formation and epidermal regeneration as compared with that in the controls. Superficial second-degree burns and deep second-degree burns treated with recombinant bovine basic fibroblast growth factor healed in 9.89 +/- 2.45 and 17.04 +/- 4.56 days, respectively, whereas the average healing time in those receiving placebo was 12.35 +/- 2.74 and 21.21 +/- 4.88 days. The donor sites treated with rbFGF or placebo healed in 10.68 +/- 4.55 and 14.74 +/- 6.46 days, respectively. All chronic dermal ulcers except 12 patients treated with rbFGF healed within 6 weeks. Histological evaluation of punch-biopsy specimens from the burn wounds, donor sites and chronic dermal ulcers seven days after treatment supported the impression of accelerated wound healing after rbFGF treatment.

CONCLUSIONS

rbFGF is effective in shortening the wound healing time and improving the wound healing quality. Accelerating wound healing is of clinical benefit in reducing the length of hospitalization, costs and emotional burden of the patient.

[Treatment of invasive burn wound infection with sepsis: a clinical study]

OBJECTIVE

To further improve the treatment of burn wound sepsis.

METHODS

Eight patients with burn wound sepsis, of whom 6 with MODS and two with septic shock, were treated consecutively in our hospital from September 1997 to October 1998. The plasma concentrations of IL-6, IL-8 TNF and LPS were assayed before and after surgical intervention and at the time when the patients' vital signs became stable.

RESULTS

(1) The patients' conditions abruptly deteriorated when the burn wound sepsis emerged. (2) The major causative factor related to burn wound sepsis was extensive burn injuries, with large area of deep burn remained open. (3) Although colonization by multiple pathogenic bacteria was found, Pseudomonas aeruginosa was the most frequent bacteria isolated from the subeschar tissue. (4) The plasma concentrations of IL-6, IL-8, TNF and LPS before surgical intervention were significantly higher than those after surgical intervention (P < 0.05); (5) The lowest level of the inflammatory mediators were observed when the conditions of patients became stable, and the values were significantly lower compared with those before surgical intervention (P < 0.001).

CONCLUSIONS

The main cause of burn wound sepsis is the presence of a large area of infected open deep burn wounds, which should be excised and covered early. LPS and pro-inflammatory mediators play an important role in the pathogenesis of burn wound sepsis. Favorable results in the treatment attribute to appropriate application of multiple treatments, and early, aggressive and thorough surgical excision of invasive burn infectious tissue and closure of wounds play a crucial role.

[Effect of escharectomy during burn shock stage on stress response]

OBJECTIVE

To investigate changes in hormones of plasma and the effect of escharectomy during burn shock stage on early stress response after burn.

METHODS

Sixteen male minipigs were subjected to a 35% TBSA III degree burn injury. The burned minipigs were randomly divided into two groups: escharectomy during burn shock stage group (S group) and escharectomy group after burn shock stage (N group). The sequential changes in plasma levels of insulin, glucagon, cortisol, GH, IGF-I, albumin were analyzed.

RESULTS

The serum concentration of insulin, glucagon, cortisol increased to some degree, whereas the serum concentration of GH, IGF-I decreased obviously after burn. As compared with the N group, no significant difference in the serum concentration of glucagon, cortisol, GH, IGF-I, was observed.

CONCLUSIONS

Escharectomy during burn shock stage could not aggravate stress response after burn.

[The effect of early escheractomy on expression of ICAM-1 and E-selectin mRNA of endothelial cells]

OBJECTIVES

To examine the effect of burned serum on change in endothelial cell ICAM-1 and E-selectin mRNA expression and whether these alterations can be corrected by the means of escharectomy during burn shock period.

METHODS

One hundred and seventy-six Wistar rats with 30% III degree TBSA on back were studied. Endothelial cell ICAM-1 and E-selectin mRNA were tested with the method of RT-PCR.

RESULTS

ICAM-1 and E-selectin expression showed an increase after stimulation by serum of 4 hours post burn, reaching peak levels 168 hours after injury. ICAM-1 and E-selectin expression levels could decrease to baseline within 168 hours in the rats which underwent escharectomy during shock stage, but kept higher than normal in rats without escharectomy or underwent 96 hours post burn.

CONCLUSIONS

These findings suggest that eschar can induce endothelial cells to express adhesion molecule. Early escharectomy is important to prevent adhesion molecule expression and SIRS.