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Burn Wound Healing: Clinical Complications, Medical Care, Treatment, and Dressing Types: The Current State of Knowledge for Clinical Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031338. [PMID: 35162360 PMCID: PMC8834952 DOI: 10.3390/ijerph19031338] [Citation(s) in RCA: 76] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/13/2022] [Accepted: 01/21/2022] [Indexed: 02/01/2023]
Abstract
According to the World Health Organization (WHO), it is estimated that each year approximately 11 million people suffer from burn wounds, 180,000 of whom die because of such injuries. Regardless of the factors causing burns, these are complicated wounds that are difficult to heal and are associated with high mortality rates. Medical care of a burn patient requires a lot of commitment, experience, and multidirectional management, including surgical activities and widely understood pharmacological approaches. This paper aims to comprehensively review the current literature concerning burn wounds, including classification of burns, complications, medical care, and pharmacological treatment. We also overviewed the dressings (with an emphasis on the newest innovations in this field) that are currently used in medical practice to heal wounds.
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Liu Z, Liu L, Cheng X, Gao L. Expression and predictive value of HIF-1α and VEGF in patients with burns following treatment. Exp Ther Med 2020; 20:141. [PMID: 33093879 PMCID: PMC7571334 DOI: 10.3892/etm.2020.9270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/15/2020] [Indexed: 11/28/2022] Open
Abstract
The present study aimed to investigate the expression and predictive value of serum hypoxia-inducible factor-1α (HIF-1α) and vascular endothelial growth factor (VEGF) in patients with burns following treatment. A total of 84 patients with burns treated in Jinan City People's Hospital (Jinan, China) between June 2015 and August 2017 were selected and their clinical information was collected. The expression levels of HIF-1α and VEGF before and after treatment were detected via ELISA, and HIF-1α and VEGF levels in patients with effective and ineffective treatment were compared. The predictive values of HIF-1α and VEGF in clinical efficacy were determined using receiver operating characteristic (ROC) curves, and independent risk factors affecting treatment inefficacy were analyzed via multivariate logistic regression. It was revealed that HIF-1α decreased significantly (P<0.05) while VEGF significantly increased in patients after treatment. Patients with effective treatment presented significantly lower HIF-1α levels and higher VEGF levels compared with those with ineffective treatment. The ROC curve indicated that the area under the curve (AUC) of HIF-1α for treatment efficacy was 0.795, the 95% CI was 0.666-0.924, the specificity and sensitivity were 68.75 and 80.88%, respectively, and the Youden index was 49.63%. For VEGF, the AUC, 95% CI, specificity, sensitivity and Youden index were 0.826, 0.725-0.928, 68.75, 82.35 and 51.10% respectively. Moreover, under the joint detection of HIF-1α and VEGF, the AUC was 0.847, 95% CI was 0.746-0.947, specificity and sensitivity were 87.50 and 66.18%, respectively, with a Youden index of 53.68%. Multivariate analysis demonstrated that higher HIF-1α level, lower VEGF level and higher burn degree before treatment were independent risk factors for treatment inefficacy. HIF-1α levels decreased and VEGF levels increased in burn patients after treatment. HIF-1α and VEGF before treatment may therefore serve as predictors for treatment efficacy.
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Affiliation(s)
- Zhufeng Liu
- Department of Burn Dermatology, Jinan City People's Hospital, Jinan, Shandong 271100, P.R. China
| | - Ling Liu
- Department of Burn Dermatology, Jinan City People's Hospital, Jinan, Shandong 271100, P.R. China
| | - Xuejuan Cheng
- Department of Nursing, The People's Hospital of Zouping City, Binzhou, Shandong 256200, P.R. China
| | - Liming Gao
- Department of Burn Dermatology, Jinan City People's Hospital, Jinan, Shandong 271100, P.R. China
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Liu L, Yin H, Hao X, Song H, Chai J, Duan H, Chang Y, Yang L, Wu Y, Han S, Wang X, Yue X, Chi Y, Liu W, Wang Q, Wang H, Bai H, Shi X, Li S. Down-Regulation of miR-301a-3p Reduces Burn-Induced Vascular Endothelial Apoptosis by potentiating hMSC-Secreted IGF-1 and PI3K/Akt/FOXO3a Pathway. iScience 2020; 23:101383. [PMID: 32745988 PMCID: PMC7399190 DOI: 10.1016/j.isci.2020.101383] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 06/05/2020] [Accepted: 07/15/2020] [Indexed: 02/07/2023] Open
Abstract
Vascular endothelium dysfunction plays a pivotal role in the initiation and progression of multiple organ dysfunction. The mesenchymal stem cell (MSC) maintains vascular endothelial barrier survival via secreting bioactive factors. However, the mechanism of human umbilical cord MSC (hMSC) in protecting endothelial survival remains unclear. Here, we found IGF-1 secreted by hMSC suppressed severe burn-induced apoptosis of human umbilical vein endothelial cells (HUVECs) and alleviated the dysfunction of vascular endothelial barrier and multiple organs in severely burned rats. Severe burn repressed miR-301a-3p expression, which directly regulated IGF-1 synthesis and secretion in hMSC. Down-regulation of miR-301a-3p decreased HUVECs apoptosis, stabilized endothelial barrier permeability, and subsequently protected against multiple organ dysfunction in vivo. Additionally, miR-301a-3p negatively regulated PI3K/Akt/FOXO3 signaling through IGF-1. Taken together, our study highlights the protective function of IGF-1 against the dysfunction of multiple organs negatively regulated by miR-301a-3p, which may provide the theoretical foundation for further clinical application of hMSC. IGF-1 secreted by hMSC suppressed severe burn-induced apoptosis of HUVECs miR-301a-3p directly regulated IGF-1 synthesis and secretion in hMSC DomiR-301a-3p protected against multiple organ dysfunction miR-301a-3p regulated PI3K/Akt/FOXO3 signaling through hMSC-secreted IGF-1
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Affiliation(s)
- Lingying Liu
- Nutrition Department, the Fourth Medical Center Affiliated to PLA General Hospital, Beijing 100037, China; Burns Institute of PLA, Department of Burn & Plastic Surgery, the Fourth Medical Center Affiliated to PLA General Hospital, Beijing 100037, China; College of Basic Medicine, the Inner Mongolia Medical University, Hohhot, 010110, Inner Mongolia, China
| | - Huinan Yin
- Burns Institute of PLA, Department of Burn & Plastic Surgery, the Fourth Medical Center Affiliated to PLA General Hospital, Beijing 100037, China
| | - Xingxia Hao
- College of Basic Medicine, the Inner Mongolia Medical University, Hohhot, 010110, Inner Mongolia, China
| | - Huifeng Song
- Burns Institute of PLA, Department of Burn & Plastic Surgery, the Fourth Medical Center Affiliated to PLA General Hospital, Beijing 100037, China
| | - Jiake Chai
- Burns Institute of PLA, Department of Burn & Plastic Surgery, the Fourth Medical Center Affiliated to PLA General Hospital, Beijing 100037, China.
| | - Hongjie Duan
- Burns Institute of PLA, Department of Burn & Plastic Surgery, the Fourth Medical Center Affiliated to PLA General Hospital, Beijing 100037, China
| | - Yang Chang
- Burns Institute of PLA, Department of Burn & Plastic Surgery, the Fourth Medical Center Affiliated to PLA General Hospital, Beijing 100037, China
| | - Longlong Yang
- Burns Institute of PLA, Department of Burn & Plastic Surgery, the Fourth Medical Center Affiliated to PLA General Hospital, Beijing 100037, China
| | - Yushou Wu
- Burns Institute of PLA, Department of Burn & Plastic Surgery, the Fourth Medical Center Affiliated to PLA General Hospital, Beijing 100037, China
| | - Shaofang Han
- Burns Institute of PLA, Department of Burn & Plastic Surgery, the Fourth Medical Center Affiliated to PLA General Hospital, Beijing 100037, China
| | - Xiaoteng Wang
- Burns Institute of PLA, Department of Burn & Plastic Surgery, the Fourth Medical Center Affiliated to PLA General Hospital, Beijing 100037, China
| | - Xiaotong Yue
- Burns Institute of PLA, Department of Burn & Plastic Surgery, the Fourth Medical Center Affiliated to PLA General Hospital, Beijing 100037, China
| | - Yunfei Chi
- Burns Institute of PLA, Department of Burn & Plastic Surgery, the Fourth Medical Center Affiliated to PLA General Hospital, Beijing 100037, China
| | - Wei Liu
- Burns Institute of PLA, Department of Burn & Plastic Surgery, the Fourth Medical Center Affiliated to PLA General Hospital, Beijing 100037, China
| | - Qiong Wang
- Department of Burn Surgery, the Third Affiliated Hospital of Inner Mongolia Medical University (Inner Mongolia BaoGang Hospital), Baotou 014010, Inner Mongolia, China
| | - Hongyu Wang
- Department of Burn Surgery, the Third Affiliated Hospital of Inner Mongolia Medical University (Inner Mongolia BaoGang Hospital), Baotou 014010, Inner Mongolia, China
| | - Hailiang Bai
- Department of Plastic Surgery, The Second Hospital, Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
| | - Xiuxiu Shi
- Department of Orthopedic Rehabilitation, the Fourth Medical Center Affiliated to PLA General Hospital, Beijing, 100037, China
| | - Shaozeng Li
- Department of Clinical Laboratory, the Fourth Medical Center Affiliated to PLA General Hospital, Beijing 100037, China
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Qin FJ, Hu XH, Chen Z, Chen X, Shen YM. Protective effects of tiopronin against oxidative stress in severely burned patients. DRUG DESIGN DEVELOPMENT AND THERAPY 2019; 13:2827-2832. [PMID: 31496659 PMCID: PMC6698164 DOI: 10.2147/dddt.s215927] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/09/2019] [Indexed: 11/26/2022]
Abstract
Objective Tiopronin is an antioxidant. This study investigated the protective effect of tiopronin on oxidative stress in patients with severe burns. Method Patients aged between 16 and 65 years old with >30% body surface area burns admitted to our burn unit from July 2011 to September 2016 were randomly divided into 3 groups: group A treated with tiopronin (15 mg/kg. 24 hrs), group B with vitamin C (792 mg/kg. 24 hrs), the other group with standard treatment (group C). All 3 groups also received standard treatment. Blood superoxide dismutase (SOD), malondialdehyde (MDA), and the biochemical indexes of liver, kidney, and heart were determined before treatment and 24 and 48 hrs after treatment. Samples from 8 normal healthy adult volunteers were also measured. The resuscitation fluid volume requirement for the first 24 hrs was calculated for 3 groups. Results The serum levels of MDA and the biochemical indexes in severely burned patients were higher than those in healthy volunteers (P<0.01). The serum SOD level of burn patients was lower (P<0.01). After treatment, the levels of SOD increased, the levels of MDA decreased, and the biochemical indexes of heart, liver, and kidney improved; these changes were more obvious in group A and group B compared to group C (P<0.05), and these changes were more obvious in group A compared to group B (P<0.05) at 48 hrs after treatment. There is less resuscitation fluid volume requirement to maintain adequate stable hemodynamic and urine output in the first 24 hrs in group A and group B compared to group C (P<0.05). Conclusion Treatment with tiopronin could exert protective effects against burn-induced oxidative tissue damage and multiple-organ dysfunction, and also could reduce the volume of required fluid resuscitation in severely burned patients.
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Affiliation(s)
- Feng-Jun Qin
- Department of Burns, Beijing Jishuitan Hospital, Beijing, People's Republic of China
| | - Xiao-Hua Hu
- Department of Burns, Beijing Jishuitan Hospital, Beijing, People's Republic of China
| | - Zhong Chen
- Department of Burns, Beijing Jishuitan Hospital, Beijing, People's Republic of China
| | - Xu Chen
- Department of Burns, Beijing Jishuitan Hospital, Beijing, People's Republic of China
| | - Yu-Ming Shen
- Department of Burns, Beijing Jishuitan Hospital, Beijing, People's Republic of China
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Bcl-2 Family Overexpression and Chemoresistance in Acute Myeloid Leukemia. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2018. [DOI: 10.2478/sjecr-2018-0064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The family of Bcl-2 proteins is one of the most responsible for apoptosis pathway, that is a critical process to the maintenance of tissue homeostasis. Bcl-2 is an essential apoptotic regulator belonging to a family of functionally and structurally related proteins known as the Bcl-2 family. Some members of this family act as anti-apoptotic regulators, whereas others act in pro-apoptotic function. The relationship between the pro and anti-apoptotic proteins can regulate whether cells begin the apoptosis or remain its life cycle. Increasing of Bcl-2 expression has been found in some hematologic diseases, such as Acute Myeloid Leukemia (AML) and their effects on responsiveness to anticancer therapy have been recently described. Thus, this review aims to discuss apoptosis and the role of the Bcl-2 family of proteins in chemoresistance when overexpressed in patients committed with Acute Myeloid Leukemia submitted to chemotherapy treatment.
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Hristova M, Tzaneva M, Bekyarova G, Chivchibashi D, Stefanova N, Kiselova-Kaneva Y. Molecular Mechanisms of Melatonin Protection from Gastric Mucosal Apoptotic Injury in Experimental Burns. Molecules 2018; 23:molecules23040749. [PMID: 29587343 PMCID: PMC6017416 DOI: 10.3390/molecules23040749] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 03/20/2018] [Accepted: 03/21/2018] [Indexed: 12/19/2022] Open
Abstract
Melatonin, a basic secretory pineal gland product, is a nontoxic, multifunctional molecule. It has antioxidant and anti-apoptotic activities and protects tissues from injury. The objective of the present study was to determine the molecular mechanism of melatonin anti-apoptotic effect on gastric injury in a rat burn model. We hypothesized that melatonin gastric protection may be related to the activation of transcription erythroid 2-related factor 2 (Nrf2). Using a 30% total body surface area (TBSA) rat burn model, melatonin (10 mg/kg, i.p.) was injected immediately and 12 h after thermal skin injury. Via light immunohistochemistry, we determined the tissue level of 4-hydroxy-2-nonenal (4-HNE) as a marker of lipid peroxidation, Bcl-2 and Bax as apoptosis-related proteins, and Nrf2. Results are presented as medians (interquartile range (IQR)). Thermal trauma in burned animals, compared with the controls, increased the expression of pro-apoptotic Bax protein (1.37 (0.94–1.47)), decreased anti-apoptotic Bcl-2 protein (1.16 (1.06–1.23), p < 0.001) in epithelial cells, and elevated Bax/Bcl-2 ratios (p < 0.05). Tissue 4-HNE and Nrf2 levels were increased following severe burns (1.55 (0.98–1.61) and 1.16 (1.01–1.25), p < 0.05, respectively). Melatonin significantly decreased 4-HNE (0.87 (0.74–0.96), p < 0.01) and upregulated Nrf2 (1.55 (1.52–1.65), p < 0.001) levels. It also augmented Bax (1.68 (1.5–1.8), p < 0.001) and Bcl-2 expressions (1.96 (1.89–2.01), p < 0.0001), but reduced Bax/Bcl-2 ratios (p < 0.05). Our results suggest that experimental thermal trauma induces oxidative gastric mucosal injury. Melatonin manifests a gastroprotective effect through Nrf2 activation, lipid peroxidation attenuation, and Bax/Bcl-2 ratio modification as well.
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Affiliation(s)
- Minka Hristova
- Department of Physiology and Pathophysiology, Medical University of Varna, Varna 9002, Bulgaria.
| | - Maria Tzaneva
- Department of Preclinical and Clinical Sciences, Medical University of Varna, Varna 9002, Bulgaria.
- Department of General and Clinical Pathology, Forensic Science and Deontology, Medical University of Varna, Varna 9010, Bulgaria.
| | - Ganka Bekyarova
- Department of Physiology and Pathophysiology, Medical University of Varna, Varna 9002, Bulgaria.
| | - Dariya Chivchibashi
- Department of Physiology and Pathophysiology, Medical University of Varna, Varna 9002, Bulgaria.
- Department of General and Clinical Pathology, Forensic Science and Deontology, Medical University of Varna, Varna 9010, Bulgaria.
| | - Nadezhda Stefanova
- Department of General and Clinical Pathology, Forensic Science and Deontology, Medical University of Varna, Varna 9010, Bulgaria.
| | - Yoana Kiselova-Kaneva
- Department of Biochemistry, Molecular Medicine and Nutrigenomics, Medical University of Varna; Varna 9002, Bulgaria.
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ROS-Mediated NLRP3 Inflammasome Activity Is Essential for Burn-Induced Acute Lung Injury. Mediators Inflamm 2015. [PMID: 26576075 DOI: 10.1155/2015/720457(2015).] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The NLRP3 inflammasome is necessary for initiating acute sterile inflammation. However, its role in the pathogenesis of burn-induced acute lung injury (ALI) is unknown. This study aimed to determine the role of the NLRP3 inflammasome and the signaling pathways involved in burn-induced ALI. We observed that the rat lungs exhibited enhanced inflammasome activity after burn, as evidenced by increased levels of NLRP3 expression and Caspase-1 activity and augmented inflammatory cytokines. Inhibition of NLRP3 inflammasome by BAY11-7082 attenuated burn-induced ALI, as demonstrated by the concomitant remission of histopathologic changes and the reduction of myeloperoxidase (MPO) activity, inflammatory cytokines in rat lung tissue, and protein concentrations in the bronchoalveolar lavage fluid (BALF). In the in vitro experiments, we used AMs (alveolar macrophages) challenged with burn serum to mimic the postburn microenvironment and noted that the serum significantly upregulated NLRP3 inflammasome signaling and reactive oxygen species (ROS) production. The use of ROS scavenger N-acetylcysteine (NAC) partially reversed NLRP3 inflammasome activity in cells exposed to burn serum. These results indicate that the NLRP3 inflammasome plays an essential role in burn-induced ALI and that burn-induced NLRP3 inflammasome activity is a partly ROS-dependent process. Targeting this axis may represent a promising therapeutic strategy for the treatment of burn-induced ALI.
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ROS-Mediated NLRP3 Inflammasome Activity Is Essential for Burn-Induced Acute Lung Injury. Mediators Inflamm 2015. [PMID: 26576075 DOI: 10.1155/2015/720457(2015)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The NLRP3 inflammasome is necessary for initiating acute sterile inflammation. However, its role in the pathogenesis of burn-induced acute lung injury (ALI) is unknown. This study aimed to determine the role of the NLRP3 inflammasome and the signaling pathways involved in burn-induced ALI. We observed that the rat lungs exhibited enhanced inflammasome activity after burn, as evidenced by increased levels of NLRP3 expression and Caspase-1 activity and augmented inflammatory cytokines. Inhibition of NLRP3 inflammasome by BAY11-7082 attenuated burn-induced ALI, as demonstrated by the concomitant remission of histopathologic changes and the reduction of myeloperoxidase (MPO) activity, inflammatory cytokines in rat lung tissue, and protein concentrations in the bronchoalveolar lavage fluid (BALF). In the in vitro experiments, we used AMs (alveolar macrophages) challenged with burn serum to mimic the postburn microenvironment and noted that the serum significantly upregulated NLRP3 inflammasome signaling and reactive oxygen species (ROS) production. The use of ROS scavenger N-acetylcysteine (NAC) partially reversed NLRP3 inflammasome activity in cells exposed to burn serum. These results indicate that the NLRP3 inflammasome plays an essential role in burn-induced ALI and that burn-induced NLRP3 inflammasome activity is a partly ROS-dependent process. Targeting this axis may represent a promising therapeutic strategy for the treatment of burn-induced ALI.
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ROS-Mediated NLRP3 Inflammasome Activity Is Essential for Burn-Induced Acute Lung Injury. Mediators Inflamm 2015; 2015:720457. [PMID: 26576075 PMCID: PMC4630408 DOI: 10.1155/2015/720457] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 08/09/2015] [Indexed: 12/20/2022] Open
Abstract
The NLRP3 inflammasome is necessary for initiating acute sterile inflammation. However, its role in the pathogenesis of burn-induced acute lung injury (ALI) is unknown. This study aimed to determine the role of the NLRP3 inflammasome and the signaling pathways involved in burn-induced ALI. We observed that the rat lungs exhibited enhanced inflammasome activity after burn, as evidenced by increased levels of NLRP3 expression and Caspase-1 activity and augmented inflammatory cytokines. Inhibition of NLRP3 inflammasome by BAY11-7082 attenuated burn-induced ALI, as demonstrated by the concomitant remission of histopathologic changes and the reduction of myeloperoxidase (MPO) activity, inflammatory cytokines in rat lung tissue, and protein concentrations in the bronchoalveolar lavage fluid (BALF). In the in vitro experiments, we used AMs (alveolar macrophages) challenged with burn serum to mimic the postburn microenvironment and noted that the serum significantly upregulated NLRP3 inflammasome signaling and reactive oxygen species (ROS) production. The use of ROS scavenger N-acetylcysteine (NAC) partially reversed NLRP3 inflammasome activity in cells exposed to burn serum. These results indicate that the NLRP3 inflammasome plays an essential role in burn-induced ALI and that burn-induced NLRP3 inflammasome activity is a partly ROS-dependent process. Targeting this axis may represent a promising therapeutic strategy for the treatment of burn-induced ALI.
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