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Klimov AG, Biryukov AN, Tarasenko MY, Gritsaj AN, Strukov EY. [The use of reamberin in antishock therapy in severely burned patients]. Khirurgiia (Mosk) 2020:95-99. [PMID: 32105263 DOI: 10.17116/hirurgia202002195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A 51-year-old severely burned woman had hospitalized at the Clinic of Thermal Injuries of the S.M. Kirov Military Medical Academy with a diagnosis: flame burn in a surface area of 40% (11%)/II-III b degrees of head, neck, trunk, limbs. Inhalation injury of moderate severity. The infusion drug of the combined action reamberin, which has a volemic and antihypoxic effect, had added to the complex antishock therapy. The presented clinical observation demonstrates the favorable course of burn shock: stopping of burn shock 28 hours after injury.
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Affiliation(s)
- A G Klimov
- S.M. Kirov Military Medical Academy, St. Petersburg, Russia
| | - A N Biryukov
- S.M. Kirov Military Medical Academy, St. Petersburg, Russia
| | - M Yu Tarasenko
- S.M. Kirov Military Medical Academy, St. Petersburg, Russia
| | - A N Gritsaj
- S.M. Kirov Military Medical Academy, St. Petersburg, Russia
| | - E Yu Strukov
- S.M. Kirov Military Medical Academy, St. Petersburg, Russia
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Effect of TNF-α Concentration on Selected Clinical Parameters of Swine After Burns. J Vet Res 2018; 62:335-340. [PMID: 30584613 PMCID: PMC6296001 DOI: 10.2478/jvetres-2018-0047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 09/21/2018] [Indexed: 11/20/2022] Open
Abstract
Introduction The study aimed to observe TNF-α serum concentration as well as changes in respiration rate, body temperature, and pulse rate in burn victims during 84 h post burn. Material and Methods A total of 30 healthy pigs were divided into two groups: A, the test group and N, the control group. The experimental group suffered burns to 30% of the body surface, and after infliction of the burns both groups were closely monitored. Results The biggest increase in TNF-α serum concentration in the test subjects occurred around the 6th h of the study, and the second biggest increase took place between 12th and 36th h. In the 36th h, TNF-α was 2.5 times more concentrated in serum in the test group than in the control group. In the test group, the biggest increase in respiration rate occurred up to the 6th h post burn, on average up to 29/min. In the 12th h post burn, the mean pulse rate in the test group was 133/min and dropped to the lowest value in the 72nd h of the experiment. A gradual increase in body temperature up to 41.72°C was observed up to the 30th h post burn and decreased to a significant value of 40.74°C by the 84th h of the study. Conclusion In a period of a pronounced rise in TNF-α serum concentration, this parameter, pulse rate, and respiration rate are highly correlated and are also influenced by multiple inflammation forming factors.
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Song G, Jia J, Ma Y, Shi W, Wang F, Li P, Gao C, Zuo H, Fan C, Xin N, Wu Q, Shao Y. Experience and efficacy of surgery for retaining viable subcutaneous tissue in extensive full-thickness burns. Burns 2015; 42:71-80. [PMID: 26546384 DOI: 10.1016/j.burns.2015.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 06/14/2015] [Accepted: 06/21/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIM For adult patients with extensive full-thickness burns (EFTB), a fascial excision is mostly used but it causes a very significant deformity. This study aims to summarize experience and efficacy of surgery for retaining viable subcutaneous tissue in EFTB. METHOD Clinical data were reviewed for 31 consecutive adult patients with full-thickness burn (FTB) over 70% total body surface area (TBSA) and undergoing first tangential excision and skin grafting on subcutaneous tissue wound (TESGSTW) within 7 days post burn at our burn center between 2002 and 2013. RESULTS Average age, total burn area, and FTB area of 31 patients were 32.4 ± 12.8 years, 89.0 ± 6.2% and 80.4 ± 7.6% TBSA, respectively. Of these, 80.6% combined with inhalation injury and 71.0% supervened early shock. Eighteen patients who survived (58.1%) totally underwent 121 times of surgery, of which TESGSTW and autologous skin grafting were 41 and 88 times, respectively. Their average time and area of first tangential excision was 4.1 ± 0.6 days post burn and 33.8 ± 7.6% TBSA, respectively, and accumulated tangential excision area was 58.4 ± 10.8% TBSA. In 39 times of TESGSTW within 14 days post burn, cryopreserved alloskin or fresh young pigskin was applied on 84.6%, and average time and take rate of autologous skin grafting instead of grafted alloskin or xenoskin was 14.6 ± 0.7 days and 89.5 ± 1.4%, respectively. Scalp was the main donor site for autologous skin, especially microskin grafting. Systemic wound healing time roughly was 67.3 ± 1.9 days post burn, meanwhile, viable subcutaneous tissue was retained. Healed wounds were plump, and their extensibility and sensitivity were better by follow-up. CONCLUSION The surgical treatment in EFTB is practicable and effective.
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Affiliation(s)
- Guodong Song
- Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China.
| | - Jun Jia
- Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China.
| | - Yindong Ma
- Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China.
| | - Wen Shi
- Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China.
| | - Fang Wang
- Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China.
| | - Peilong Li
- Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China.
| | - Cong Gao
- Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China.
| | - Haibin Zuo
- Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China.
| | - Chunjie Fan
- Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China.
| | - Naijun Xin
- Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China.
| | - Qiuhe Wu
- Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China.
| | - Yang Shao
- Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China.
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Widgerow AD, King K, Tocco-Tussardi I, Banyard DA, Chiang R, Awad A, Afzel H, Bhatnager S, Melkumyan S, Wirth G, Evans GRD. The burn wound exudate-an under-utilized resource. Burns 2014; 41:11-7. [PMID: 24986597 DOI: 10.1016/j.burns.2014.06.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 04/11/2014] [Accepted: 06/04/2014] [Indexed: 01/16/2023]
Abstract
INTRODUCTION The burn wound exudate represents the burn tissue microenvironment. Extracting information from the exudate relating to cellular components, signaling mediators and protein content can provide much needed data relating to the local tissue damage, depth of the wound and probable systemic complications. This review examines the scientific data extracted from burn wound exudates over the years and proposes new investigations that will provide useful information from this underutilized resource. METHOD A literature review was conducted using the electronic database PubMed to search for literature pertaining to burn wound or blister fluid analysis. Key words included burn exudate, blister fluid, wound exudate, cytokine burn fluid, subeschar fluid, cytokine burns, serum cytokines. 32 relevant articles were examined and 29 selected as relevant to the review. 3 papers were discarded due to questionable methodology or conclusions. The reports were assessed for their affect on management decisions and diagnostics. Furthermore, traditional blood level analysis of these mediators was made to compare the accuracy of blood versus exudate in burn wound management. Extrapolations are made for new possibilities of burn wound exudate analysis. RESULTS Studies pertaining to burn wound exudate, subeschar fluid and blister fluid analyses may have contributed to burn wound management decisions particularly related to escharectomies and early burn wound excision. In addition, information from these studies has the potential to impact on areas such as healing, scarring, burn wound conversion and burn wound depth analysis. CONCLUSION Burn wound exudate analysis has proven useful in burn wound management decisions. It appears to offer a far more accurate reflection of the burn wound pathophysiology than the traditional blood/serum investigations undertaken in the past. New approaches to diagnostics and treatment efficacy assessment are possible utilizing data from this fluid. Burn wound exudate is a useful, currently under-utilized resource that is likely to take a more prominent role in burn wound management.
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Affiliation(s)
- Alan D Widgerow
- Director Center for Tissue Engineering, Plastic Surgery Dept, University of California, Irvine, United States.
| | - Kassandra King
- Researcher Center for Tissue Engineering, Plastic Surgery Dept, University of California, Irvine, United States
| | - Ilaria Tocco-Tussardi
- Researcher Center for Tissue Engineering, Plastic Surgery Dept, University of California, Irvine, United States
| | - Derek A Banyard
- Research Fellow Center for Tissue Engineering, Plastic Surgery Dept, University of California, Irvine, United States
| | - Ryan Chiang
- Researcher Center for Tissue Engineering, Plastic Surgery Dept, University of California, Irvine, United States
| | - Antony Awad
- Researcher Center for Tissue Engineering, Plastic Surgery Dept, University of California, Irvine, United States
| | - Hassan Afzel
- Researcher Center for Tissue Engineering, Plastic Surgery Dept, University of California, Irvine, United States
| | - Shweta Bhatnager
- Researcher Center for Tissue Engineering, Plastic Surgery Dept, University of California, Irvine, United States
| | - Satenik Melkumyan
- Researcher Center for Tissue Engineering, Plastic Surgery Dept, University of California, Irvine, United States
| | - Garrett Wirth
- Plastic Surgery Dept, University of California, Irvine, United States
| | - Gregory R D Evans
- Plastic Surgery Dept, University of California, Irvine, United States
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Abstract
Sepsis is a major cause of death worldwide and remains the subject of much research and debate within the critical care community. Despite advances in burn prevention, treatment, and rehabilitation, sepsis remains a common cause of death in patients who have sustained a severe burn injury. The unique physical, metabolic, and physiologic changes seen after major thermal injury mean that the management of sepsis in burns poses a particular challenge and differs in many respects to the management of sepsis in the general critical care population. This article describes current issues in the prevention, diagnosis, and treatment of sepsis in burns with a review of the associated literature. In addition, we discuss possible future therapies for managing this condition.
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Jing C, Jia-Han W, Hong-Xing Z. Double-edged effects of neuropeptide substance P on repair of cutaneous trauma. Wound Repair Regen 2010; 18:319-24. [PMID: 20412553 DOI: 10.1111/j.1524-475x.2010.00589.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To explore further the role of substance P (SP) in wound healing and scar formation, SP concentrations in wounds of scalded rats were assayed. Expressions of apoptosis-associated genes in fibroblasts cultured with SP were detected. SP concentrations in superficial wounds increased earlier than those in deep wounds. SP was associated with an increased proliferation and a decreased apoptosis of fibroblasts. It had a greater influence on keloid fibroblasts than on hypertrophic scar fibroblasts by elevating the expression of proliferating cell nuclear antigen and BCL-2 in fibroblasts. Spantide completely suppressed the effects of SP on hypertrophic scar fibroblasts, and partly inhibited its effects on keloid scar fibroblasts. SP may play an important role in wound healing by promoting wound fibroblast proliferation and inhibiting apoptosis. It may also participate in pathological scar formation by modulating the expression of apoptosis-associated genes. SP is postulated to play a dual role in wound repair.
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Affiliation(s)
- Chen Jing
- Department of Burns Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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Schintler M, Marschitz I, Trop M. The use of topical negative pressure in a paediatric patient with extensive burns. Burns 2005; 31:1050-3. [PMID: 16308100 DOI: 10.1016/j.burns.2005.03.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2004] [Indexed: 02/06/2023]
Affiliation(s)
- Michael Schintler
- Department of Plastic Surgery, Children's Burns Unit, Auenbruggerplatz 30, 8036 Graz, Austria
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Chen J, Jia-Han W, Hong-Xing Z. Inhibitory effects of local pretreated epidermis on wound scarring: A feasible method to minimize surgical scars. Burns 2005; 31:758-64. [PMID: 16006045 DOI: 10.1016/j.burns.2005.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2004] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To inhibit surgical scarring by pretreating epidermis at the operation site. METHODS Eight patients who were to undergo operation through a modified incision incisions technique and other eight subjects presenting for skin grafting were recruited. For the modified incision patients a method to make the site 'epidermis-free' was developed. At the operating site a split thickness rectangular skin flap was raised with a width of one cml transverse to the incision direction. Incision was then made through the exposed dermis. The flap was repositioned onto the incision site after intradermal suturing of the incision line following the subcutaneous operation. When skingrafting the graft was used in extended form by de-epithelialising the margins of the wound by 1cm before graft placement. Then a skin graft with medial full-thickness and marginal split-thickness areas was transplanted onto the extended wound. In the control site-matched groups, surgical skin incision and skin grafting were performed as usual. Clinical observation and immunohistological examination were applied to evaluate the wound healing and scar formation in all subjects. RESULTS Both epidermis-free incision and extended skin graft sites showed perfect wound healing with short-term subjective scarring disturbance and slight wound scars, different from the control groups. The histological results showed the healing tissues in the experimental groups were more similar to normal dermis than those in the control groups. The immuoreactivities of type I and type II collagen in epidermis-free incision were both much lower than those in the control incision and the ratio of type I to type III collagen in the experimental incision was nearer to normal value. CONCLUSION Pretreating local epidermis can effectively minimize postoperative scarring by modulating collagen synthesis.
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Affiliation(s)
- Jing Chen
- Burn Unit, Nanfang Hospital, Southern Medical University, Tonghe, Guangzhou, Guangdong 510515, PR China.
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Kita T, Yamaguchi H, Sato H, Kasai K, Tanaka T, Tanaka N. Role of p38 mitogen-activated protein kinase pathway on renal failure in the infant rat after burn injury. Shock 2005; 21:535-42. [PMID: 15167682 DOI: 10.1097/00024382-200406000-00007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The p38 mitogen-activated protein kinase (MAPK) pathway is a proinflammatory signal transduction pathway for the production of cytokines and cellular response to stress, such as bacterial LPS or ischemia. We examined the effects of FR167653, a specific inhibitor of p38 MAPK, to explore the relationship between intestinal barrier damage and remote renal dysfunction. Immunohistochemical data showed the accumulation of neutrophils in the intestine after burn, and a horseradish peroxidase (HRP) tracer experiment showed burn-induced intestinal barrier damage. Our quantitative bacterial culture data demonstrated that viable bacteria reached the remote organs after burn and prevented the invading viable bacteria from using FR167653. Western blotting identified increased phosphorylation of p38 MAPK in the kidney after burn, and it may also have shown the possibility that endotoxin associated with the bacterial translocation enhances the activation of the p38 MAPK pathway. We blocked the intestinal barrier damage using FR167653, which resulted in reduced neutrophils in the intestine. FR167653 also prevented the increased phosphorylation of p38 MAPK in the kidney, which resulted in reduced neutrophils in the glomerulus and the reduction of tumor necrosis factor (TNF)-alpha and interleukin (IL)-1 beta mRNA in the kidneys, and, finally, prevented burn-induced renal failure. This study provides evidence for the hypothesis that the p38 MAPK pathway controls inflammatory mediators and not only improves intestinal function but also reduces remote renal failure after burn. We identified the pathophysiologic role of the p38 MAPK pathway in the development of renal failure after burn.
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Affiliation(s)
- Toshiro Kita
- Department of Forensic Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
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Halpern MD, Holubec H, Dominguez JA, Meza YG, Williams CS, Ruth MC, McCuskey RS, Dvorak B. Hepatic inflammatory mediators contribute to intestinal damage in necrotizing enterocolitis. Am J Physiol Gastrointest Liver Physiol 2003; 284:G695-702. [PMID: 12529262 DOI: 10.1152/ajpgi.00353.2002] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Necrotizing enterocolitis (NEC) is a common and devastating gastrointestinal disease of premature infants. Along with pathological effects in the ileum, severe NEC is often accompanied by multisystem organ failure, including liver failure. The aim of this study was to determine the changes in hepatic cytokines and inflammatory mediators in experimental NEC. The well-established neonatal rat model of NEC was used in this study, and changes in liver morphology, numbers of Kupffer cells (KC), gene expression, and histological localization of IL-18, TNF-alpha, and inducible nitric oxide synthase were evaluated. Intestinal luminal TNF-alpha levels were also measured. Production of hepatic IL-18 and TNF-alpha and numbers of KC were increased in rats with NEC and correlated with the progression of intestinal damage during NEC development. Furthermore, increased levels of TNF-alpha in the intestinal lumen of rats with NEC was significantly decreased when KC were inhibited with gadolinium chloride. These results suggest an important role of the liver and the gut-liver axis in NEC pathogenesis.
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Affiliation(s)
- Melissa D Halpern
- Department of Pediatrics and Steele Memorial Children's Research Center, University of Arizona, Tucson, Arizona 85724, USA.
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Cho K, Adamson LK, Park J, Greenhalgh DG. Burn injury-mediated alterations in cell cycle progression in lymphoid organs of mice. Shock 2003; 19:138-43. [PMID: 12578122 DOI: 10.1097/00024382-200302000-00009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A key event in the cellular and molecular pathogenesis of multiple organ failure (MOF) after burn injury may be the change in profiles of the cell cycle progression in affected organs. We investigated the effects of burn injury on cell cycle progression in immune organs. Cell cycle analysis in the lymphoid tissues of mice after 18% burn injury revealed that S phase entry was temporarily arrested in the thymus 1 day after injury, whereas the spleen had substantially increased S phase entry at day 8. This mode of cell cycle regulation was reproduced in different age groups and strains of mice. Furthermore, the reactivity to the Ki-67 antibody (indicative of proliferation) was markedly reduced in the thymic cortex at day 1. There was a distinct pattern of hematopoietic foci formation and increased reactivities to the Ki-67 antibody in myelogenous cells in the red pulp of spleen at day 7, consistent with the elevated S phase entry. These data suggest that differential regulation of cell cycle progression may play a crucial role in the phenotypic changes in immune organs after burn injury.
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Affiliation(s)
- Kiho Cho
- Bum Surgery, Shriners Hospitals for Children Northern California, Sacramento, California 95817, USA
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Cho K, Adamson LK, Greenhalgh DG. Parallel Self-Induction of TNF-α and Apoptosis in the Thymus of Mice after Burn Injury. J Surg Res 2001; 98:9-15. [PMID: 11368531 DOI: 10.1006/jsre.2001.6157] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Burn injury often causes multiple organ failure as well as skin damage. Several studies suggest that TNF-alpha plays an important role in postinjury immunosuppression by altering lymphoid tissues. We investigated the regulation of TNF-alpha expression and apoptosis in the spleen and thymus of mice after burn injury. MATERIALS AND METHODS C57BLKS/J mice were subjected to 18% TBSA full-thickness burn and the spleen and thymus were harvested at various time points (3 h to 29 days). The expression of TNF-alpha mRNA and protein in tissue extracts was analyzed by RT-PCR and ELISA. Apoptosis was measured by flow cytometry using annexin V staining. RESULTS Burn injury induced TNF-alpha mRNA expression in the thymus at Day 1 and it returned to the basal levels at Day 14 and thereafter. Similarly, TNF-alpha mRNA up-regulation peaked between Day 1 and Day 3 in the spleen. Induction of TNF-alpha protein peaked at Day 1 in the thymus, whereas, TNF-alpha protein was unchanged in the spleen after burn injury. There was a twofold increase in apoptotic cells at Day 1 in the thymus, which is consistent with mRNA and protein data. In contrast, burn injury did not change apoptotic events in the spleen. CONCLUSIONS The parallel induction of TNF-alpha mRNA, TNF-alpha protein, and apoptosis suggests that TNF-alpha may contribute to immunosuppression after burn injury by inducing apoptosis in the thymus.
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Affiliation(s)
- K Cho
- Department of Surgery, Shriners Hospitals for Children Northern California, Sacramento, California 95817, USA
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