Silver serum levels in burned patients treated with silver sulfadiazine and its toxicity on inflammatory cells

BackgroundSilver sulfadiazine (SSD) has been widely used in burned patients for the prevention of local infections. To be biologically active and exert antimicrobial properties, silver needs to be present in the form of silver ions (Ag¹⁺) that bind to negatively charged proteins, namely, the RNA and DNA in microorganisms. However, previous published studies conducted with SSD in the 1990s reported a high level of silver absorption through damaged skin and noted the potential cytotoxicity of Ag¹⁺ to human cells. SSD toxicity, however, had been described in cell cultures using arbitrary silver concentrations. In the present study, we determined the serum silver levels in burned patients treated with SSD and, taking into account the molar Ag¹⁺ concentrations found in these patients, we evaluated the Ag¹⁺ toxicity effects on inflammatory cells (ROS and cytokine production) in vitro.MethodsTwenty patients with an average burned body surface area of 27.68% were included in this study.ResultsPatients’ Ag¹⁺ serum levels reached up to 558 times those of the unexposed controls. Ag¹⁺ was then added to inflammatory cells in vitro at levels up to 2000 times the level of the control, and there was no effect on the viability of the cells nor on the rate of apoptosis. We observed a decrease in reactive oxygen species production by mononuclear (MN) and polymorphonuclear (PMN) cells, as well as a substantial decrease in cytokines IL-1β, IL-6, IL-8, IL-10, and TNF-α production by leukocytes (MN and PNM).ConclusionThese findings suggest that Ag¹⁺ may contribute to negative outcomes after burns, decreasing the primary defense mechanism (respiratory burst) and altering cytokine production.     

Influence of inhalation injury on energy expenditure in severely burned children

ObjectiveDetermine the effect of inhalation injury on burn-induced hypermetabolism in children.DesignProspective study comparing hypermetabolism (i.e., resting energy expenditure and oxygen consumption) in burned children with and without inhalation injury during acute hospitalization.SettingSingle pediatric burn center.PatientsEighty-six children (1–18 years) with ≥40% total body surface area burns were stratified to two groups: no inhalation injury and inhalation injury.InterventionsNone.Main measurements and resultsInhalation injury was diagnosed based on bronchoscopic evaluation. At admission, PaO₂:FiO₂ ratios (an index of respiratory distress) were significantly higher in patients with no inhalation injury than in patients with inhalation injury. No differences were detected in resting energy expenditure or percent of the predicted basal metabolic rate between groups. Additionally, oxygen consumption did not significantly differ between groups.ConclusionsInhalation injury does not augment the burn-induced hypermetabolic stress response in children, as reflected by resting energy expenditure and oxygen consumption.     

Determining clinically meaningful thresholds for innovative burn care products to reduce autograft: A US burn surgeon Delphi panel

Reducing the amount of donor skin needed for definitive wound closure can improve outcomes in patients with severe burns. This Delphi Consensus Panel (DCP) aimed to achieve expert consensus on the percentage reduction in donor skin for autograft that constitutes a clinically meaningful benefit. A two-round DCP of fifteen US burn surgeons was conducted via a web-based survey platform. Fourteen panelists (93.3%) completed both rounds. In Round 2, consensus, defined as ≥70% agreement, was achieved for five of the seven consensus statements. All panelists agreed that a clinically meaningful reduction in the amount of donor skin required would facilitate wound management and decrease donor site morbidity experienced by patients. Furthermore, based on three treatment scenarios, consensus was achieved for a clinically meaningful reduction in the amount of donor skin required for autograft for the adult population in deep partial-thickness and full-thickness burns. Findings from this DCP indicate that an innovative cellular and/or tissue product that would reduce the needed amount of donor skin, by the identified thresholds, has the potential to improve the outcomes for patients with severe burn injuries in a meaningful way.     

烧伤中心分离菌变迁趋势及院内感染综合防控的研究

目的了解烧伤病房细菌变迁趋势,为临床抗感染治疗提供依据,制定并实施针对性综合防控措施,减少或避免院内感染的发生。方法收集2001年至2008年间本院烧伤中心不同来源标本细菌培养结果;分析对比实施院感综合防控措施前后各一年,烧伤重症监护病区（BICU）空气及环境采样细菌培养结果;通过部分耐药鲍曼不动杆菌基因分型研究,了解该菌患者间交叉传播情况。结果 8年间列前五位的病原菌分别是金黄色葡萄球菌（31.4%）、铜绿假单胞菌（19.1%）、不动杆菌（12.7%）、大肠埃希菌（6.2%）、阴沟肠杆菌（5.4%）。分年度排名显示,不动杆菌检出率近年来明显上升,2006年后升至第二位,2008年超过金黄色葡萄球菌成为检出率最高的细菌。实施院感综合防控措施前后各一年BICU空气采样合格率分别为80.5%及95.8%（P〈0.01）,环境采样细菌培养合格率分别为82.3%及97.0%（P〈0.01）,差异均有统计学意义。随机引物扩增DNA指纹图谱检测未见相同基因型鲍曼不动杆菌在患者间传播。结论 8年间烧伤病房的检出细菌谱发生明显变化,不动杆菌近年来超过以往最多见的金黄色葡萄球菌和铜绿假单胞菌上升为第一位,且主要为广泛耐药的鲍曼不动杆菌,对危重烧伤患者的救治构成威胁。综合防控措施对减少病区内感染机会,尤其是细菌的交叉传播能起到明显效果。     

电烧伤大鼠创面组织中VEGF及血清ET-1表达水平的变化

目的 探讨电烧伤大鼠血管内皮生长因子(VEGF)和内皮素1(ET-1)的动态变化.方法 将大鼠64只随机分成2组:电烧伤组(56只)和对照组(8只).采用免疫组织化学方法测定伤后1d,3d,7d和14d的创周组织中VEGF的表达.采用ELISA方法测定烧伤后2h,6h,12h,24h血清ET-1的浓度.结果 伤后各个时间点创周组织VEGF蛋白表达均高于正常,VEGF表达在伤后第7天达到峰值.血清ET-1浓度显著升高,2h即明显高于正常值,6h达到峰值,此后逐渐下降,伤后24h仍明显高于正常.结论 电烧伤后VEGF和ET-1的表达均显著升高,这二种变化可能参与烧伤后微血管通透性的调节.     

KIM-1及NGAL在苯酚烧伤致大鼠早期肾损伤中的表达水平及意义

目的 观察肾损伤分子-1（KIM-1）及中性粒细胞明胶酶相关载脂蛋白（NGAL）在苯酚烧伤致大鼠早期肾损伤中的表达水平,并分析其临床意义。方法 将48只SD大鼠随机分为对照组6只、实验组42只,对照组大鼠仅做背部脱毛处理,实验组大鼠建立苯酚烧伤模型,分别于烧伤后15、45 min以及2、4、8、16、32 h观察肾脏组织病理变化,并采用酶联免疫吸附试验（ELISA）法检测KIM-1、NGAL水平,肌氨酸氧化酶法检测血肌酐（Scr）水平,分析KIM-1、NGAL与肾损伤的相关性及其对肾损伤的诊断价值。结果 苯酚烧伤大鼠创面呈浅红色至棕红色、质地稍韧,且伴有全身抽搐及肉眼血尿等表现;苏木精-伊红（HE）染色结果显示,烧伤32 h内大鼠肾脏组织逐渐出现肾小管空泡样变性、蛋白质管型、肾小管扩张、肾小管坏死等病理改变;烧伤后32 h内大鼠血清KIM-1、NGAL水平均呈先升高后降低的趋势,其中KIM-1水平于烧伤后15 min开始升高,8 h到达高峰;NGAL水平于烧伤后2 h开始升高,16 h到达高峰;而Scr水平升高不明显;血清KIM-1、NGAL水平与早期肾损伤具有显著相关性（r=0.664、0.730,P均＜0.001）,两者联合检测对诊断早期肾损伤具有显著优势。结论 血清KIM-1及NGAL水平与苯酚烧伤致大鼠早期肾损伤程度密切相关,对诊断苯酚烧伤致大鼠早期肾损伤具有较高的临床应用价值。     

烧伤患者医院感染危险因素的Meta分析

【摘要】 目的 系统分析烧伤患者发生医院感染的危险因素。 方法 计算机检索中国期刊全文数据库 (中国知网)、中文科技期刊数据库 (维普)、中国学术期刊数据库 (万方)、 中国生物医学文献数据库 (CBM)? PubMed、 The Cochrane Library 中 2019 年 6 月前公开发表的烧伤患者医院感染危险因素研究的文献, 根据纳入与排除标准筛选符合标准的文献, 采用纽卡斯尔-渥太华量表 (NOS) 对纳入文献进行质量评价, 采用 Rev Man 5软件对纳入文献进行统计分析。结果 共纳入符合标准的文献 13 篇, 包含烧伤患者 12537 例, 发生医院感染者1577 例, 纳入危险因素12 个, 其中年龄 (OR=2.47,95%CI为1.52～3.99）、烧伤程度 （OR=3.99,95%CI为1.42～11.22）、烧伤面积（OR=13.45,95%CI为7.74～24.21）、吸入性损伤（OR=7.22,95%CI为4.08～12.78）、糖尿病 （OR=1.49,95%CI为1.12～1.97）、预防性使用抗生素 （OR=5.55,95%CI为2.81～10.96）、手术（OR=4.85,95%CI为1.71～13.79）、气管切开 （OR=4.79,95%CI为2.19～10.49）、有创呼吸机的使用（OR=7.23,95%CI为5.04～10.38）、住院时间（OR=7.38,95%CI为2.68～20.33）是烧伤患者发生医院感染的危险因素。 结论 烧伤患者的一般情况? 疾病情况及治疗情况均可影响烧伤患者医院感染的发生 及发展, 临床治疗中应正确识别烧伤感染高危人群, 及时干预相关危险因素, 以提高治疗效果。     

芭克硅胶软膏联合压力疗法防治面部深Ⅱ度烧伤后瘢痕疗效观察

【摘要】目的 观察芭克硅胶软膏联合压力疗法防治面部深Ⅱ度烧伤后瘢痕的临床疗效。方法 选取2015年10月至2017年12月毕节市第一人民医院收治的38例面部深Ⅱ度烧伤患者作为研究对象,并按照随机数表法将其随机分为研究组(20例)与对照组(18例),研究组患者于创面愈合后予以芭克硅胶软膏联合定制压力面罩治疗,对照组患者于创面愈合后2～3周单纯应用定制压力面罩治疗,对比观察两组患者治疗第1～3、1～6及4～6个月瘢痕评分改善情况。结果 研究组患者治疗第1～3、1～6个月的瘢痕改善分值为(4.65±0.49)分、（7.05±0.39)分,明显高于对照组患者治疗第1～3、1～6个月的瘢痕改善分值(2.61±0.92)分、(5.11±1.08)分(t=8.678、7.511,P均<0.001);研究组患者治疗第4~6个月的瘢痕改善分值为(2.40±0.68)分,与对照组治疗第4～6个月的瘢痕改善分值(2.50±0.92)分无明显差异(t=0.377,P=0.709)。结论 与单纯压力疗法相比,芭克硅胶软膏联合压力疗法防治面部深Ⅱ度烧伤后瘢痕的效果更好,且以3个月内瘢痕改善效果最为明显,值得临床推广应用。