咪喹莫特治疗婴幼儿血管瘤

目的 探讨咪喹莫特治疗婴幼儿血管瘤( infantile hemangioma,IH)的临床适应证.方法 320例婴幼儿血管瘤,浅表型250例,深在型20例,混合型50例,年龄3～24周,隔日夜间睡前外用5％咪喹莫特乳青涂擦16周,随访至1岁.疗效评价分为6级,1级:完全消退;2级:75％≤消退≤99％;3级:50％≤消退＜75％;4级:25％≤消退＜50％;5级:消退＜25％;6级:未消退或增生.记录局部皮肤反应及全身不良反应.结果 浅表型、深在型、混合型IH的有效率分别为61.2％(153/250)、10.0％ (2/20)、60.0％( 30/50).浅表型和混合型之间比较差异无统计学意义(P=0.874),浅表型与深在型之间比较差异有统计学意义(P＜0.01),深在型与混合型之间比较差异有统计学意义(P＜0.01).咪喹莫特外用后4～8周,IH开始生长控制并出现消退现象.56.0％ (28/50)混合型IH出现深部病灶的增生.皮肤反应主要为红斑、表皮剥落、结痂,程度轻微.结论 浅表型IH和混合型IH的浅表病灶是外用咪喹莫特治疗的适应证,治疗后局部皮肤反应轻微,不引起局部组织萎缩和身体发育迟滞,对腔穴部位及皮肤皱褶处应避免使用,用药方式简单便捷,可作为IH浅表病灶的安全有效的治疗方法.     

透明质酸刺激因子对深Ⅱ度烧伤创面瘢痕形成的影响

从兔羊水及胎兔血清中提取透明质酸刺激因子（ＨＡＳＦ）液。将其用于深Ⅱ度烧伤创面，采用自身对照法，通过观测早期创面渗液中透明质酸（ＨＡ）含量变化、愈合后一个月局部组织的外观及镜下观和组织中胶原含量的分析，从中探讨了ＨＡＳＦ在深Ⅱ度烧伤创面愈合过程中对瘢痕形成的影响。此外还将ＨＡＳＦ用于体外培养的兔成纤维细胞，观测上清液中ＨＡ含量的改变。结果表明，ＨＡＳＦ可以明显提高创面渗液中ＨＡ的含量，体外实验也证实ＨＡＳＦ有促成纤维细胞产生ＨＡ的作用，而ＨＡ具有调节胶原合成的作用，可提高Ⅲ型胶原的比率，使胶原纤维变细，从而减轻瘢痕的产生。此外发现，在瘢痕组织中，Ⅰ、Ⅲ型胶原总量和正常皮肤间差异无显著意义（Ｐ＞０．０５）。     

Propolis and amnion reepithelialise second-degree burns in rats

Burns are serious consequences of trauma in terms of both imminent mortality and prolonged periods of morbidity. They are often accompanied by unsatisfactory cosmetic as well as functional and psychological outcomes. These complications emphasise the need for stronger efforts in achieving greater diversity and effectiveness in the treatment of skin burns. This study aimed to verify the effectiveness of gross and microscopic epidermal and dermal responses in the process of regenerative repair or healing of burns in rats that were treated either daily with 5% propolis ointment or by autologous amnion graft. Second-degree burns were inflicted in the neck region of female rats by contact with a hot metal (at 130 °C) for 5 s. Propolis treatment accelerated the process of tissue repair and led to decreased local inflammation, which indicates that treatment with propolis was successful in the initial period (7 days) and stimulated the production of collagen fibre (assessed by morphometry) in all the periods evaluated (14 and 21 days). Amnion treatment inhibited local inflammation (assessed macroscopically), stimulated local epithelial regeneration (assessed microscopically) and stimulated the production of collagen fibre (assessed by morphometry) in the days following burn. These treatments offer new therapeutic strategies for treating severe skin burns; these strategies may allow the minimisation of scar formation, a more rapid return of function and, ultimately, a better quality of life for burn patients.     

Hypertonic saline resuscitation protects against kidney injury induced by severe burns in rats

BackgroundProper fluid resuscitation can relieve visceral damage and improve survival in severely burned patients. This study compared the effectiveness of resuscitation with 400 mEq/L hypertonic saline (HS) and sodium lactate Ringer’s solution (LR) in rats with kidney injury caused by burn trauma.MethodsRats (Sprague-Dawley) underwent burn injury and were randomized into sham, LR, and HS groups. Samples from the kidney were assayed for water content ratio, histopathology, and oxidative stress (superoxide dismutase (SOD) and malondialdehyde (MDA)). Serum sodium, renal function (creatinine and cystatin (Cys)-C), and inflammatory response (tumor necrosis factor (TNF)-α, interleukin (IL)-1β, and high mobility group protein box (HMGB)-1) were also examined as serum markers.ResultsHypertonic saline resuscitation reduced the renal water content ratio and improved renal histopathology caused by severe burns. This effect was accompanied by reductions in serum creatinine and Cys-C as well as TNF-α, IL-1β, and HMGB1. Serum sodium concentration and SOD activity were increased, whereas MDA content was decreased in the kidney tissue of the HS group.ConclusionsThe data indicate that 400 mEq/L HS solution reduces hyponatremia and renal edema, inhibits the release of inflammatory mediators, and alleviates oxidative stress injury, thus protecting against kidney injury induced by severe burns.     

外源性一氧化碳释放分子2对严重烧伤小鼠肝脏炎性反应的抑制作用

目的 观察外源性一氧化碳释放分子2（CORM-2）对严重烧伤小鼠肝脏炎性反应的抑制作用，并探讨其机制。方法 将C57BL／6小鼠随机分成假伤组（模拟烧伤）、假伤＋CORM-2组、烧伤组、烧伤＋CORM-2组及烧伤＋二甲亚砜（DMSO）组，每组9只。假伤＋CORM-2组除伤后使用CORM-2以外，其他处理同假伤组。烧伤＋CORM-2组及烧伤＋DMSO组除伤后分别使用CORM-2、DMSO外，其余处理同烧伤组。于伤后24h检测小鼠血清丙氨酸转氨酶（ALT）及天冬氨酸转氨酶（AST）的水平，肝组织髓过氧化物酶（MPO）及核因子KB（NF-kB）活性，胞间黏附分子1（ICAM-1）和血管细胞黏附分子1（VCAM-1）蛋白的表达；检测各组小鼠肝窦内皮细胞（HSEC）经各自血清刺激后对中性粒细胞（PMN）的黏附作用。结果 与假伤组比较，烧伤组小鼠血清ALT、AST的水平[（398±34）、（122±22）U／L]及肝组织MPO活性、肝组织ICAM-1和VCAM-1蛋白表达水平均明显升高（P〈0．05或P〈0．01）。与烧伤组比较，烧伤＋CORM-2组上述情况明显改善，且NF-kB活性下降。与假伤组比较，烧伤组小鼠HSEC对PMN的黏附作用增强；烧伤＋CORM-2组该作用明显弱于烧伤组（P〈0．05）。结论 外源性CORM-2能明显抑制肝组织NF-kB活性，减少ICAM-l、VCAM-l蛋白的表达水平，减轻严重烧伤后组织中白细胞滞留，改善肝功能，可有效减轻肝脏炎性反应。     

吲哚昔芬对大鼠成骨细胞增殖和Ⅰ型胶原合成的影响

目的研究吲哚昔芬对大鼠成骨细胞增殖和Ⅰ型胶原合成的影响。方法分离、培养大鼠头盖骨成骨细胞,分别采用四唑盐(MTT)比色实验和3H-Proline(3氢-脯氨酸)法测定成骨细胞增殖和Ⅰ型胶原合成的情况。结果吲哚昔芬作用大鼠成骨细胞48、72h,1×10-10 mol/L吲哚昔芬与对照组比较,MTTA490nm值显著升高(P<0.05),1×10-9、1×10-8 mol/L的吲哚昔芬使MTTA490nm值进一步升高(P<0.01)。经1×10-10 mol/L吲哚昔芬作用72、96h,3H-Proline掺入值显著升高(P<0.05),1×10-9、1×10-8 mol/L的吲哚昔芬使3H-Proline掺入值进一步升高(P<0.05)。分别用1×10-10 mol/L吲哚昔芬和雌二醇作用大鼠成骨细胞72h,二者的MTTA490nm值和3H-Proline掺入值均显著高于对照组,且吲哚昔芬MTTA490nm值和3H-Proline掺入值显著高于雌二醇(P<0.05)。结论吲哚昔芬发挥抗骨质疏松作用在短期主要促进成骨细胞增殖,中期既促进成骨细胞增殖又促进Ⅰ型胶原合成,而长期效应主要是通过促进胶原合成实现,并且其效应显著强于雌二醇,提示吲哚昔芬对骨质疏松的防治作用可能优于雌二醇。     

Mouse models in burns research: Characterisation of the hypermetabolic response to burn injury

ObjectiveThe aim of the study is to characterise burn induced hypermetabolism in a mouse model.Summary Background DataThere are many mouse models of burn injury currently available however, their use in burns research is limited by the general assumption that post-burn hypermetabolism is difficult to study in these models.MethodsMale Balb/c mice were subjected to either a small (1 cm²) or large (4 cm²) contact burn. The hypermetabolic response to burn injury was determined by measuring changes in basal energy expenditure. The hormonal and inflammatory mediators of hypermetabolism, and the catabolic alterations secondary to hypermetabolism were also examined.ResultsPost-burn hypermetabolism was induced in both models of small and large burn. However, large burns resulted in prolonged wound healing, a more pronounced and sustained increase in basal energy expenditure, and a greater stress and systemic inflammatory response with profound catabolic consequences.ConclusionsIn the present study, we have successfully characterised the burn induced systemic hypermetabolic response in a mouse model of small and large burn. These models may prove useful for researchers studying the complex aetiology of hypermetabolism and interventions.     

Medical futility and the burns patient

Since its inception in the 1980s ‘futility’ has been a controversial concept. The history of this concept, its definition and application to burns care are discussed from the perspective of a burn surgeon. Although introduced as an objective (value-free) criterion, futility proves impossible to objectivate and judgements about the value of human life always play a role. The roles of the patient, the doctor, the ‘politician’ and society at large in futility-decisions are discussed.     

Amnion in the treatment of pediatric partial-thickness facial burns

BACKGROUND: Wound coverage for second-degree burns remains a clinical challenge. Human amniotic membranes have been used for many years in the treatment of burns; however, no large prospective clinical trials have been published. In this article, we present a novel and standardized procurement and processing method for amnion and investigate, whether the use of this biological dressing is safe and may represent a new therapeutic option for children with partial-thickness facial burns compared to standard topical treatment. METHODS: Patients with partial-thickness burns of the face, neck and head admitted between 2003 and 2005 were included in this study. They were divided into two groups to receive either amnion (n=53) or topical antimicrobials (n=49). Demographics (age, gender, ethnicity, TBSA, burn areas), length of hospital stay (LOS), rate of infections (RI), time to total healing, and frequency of dressing changes were compared between the two groups. The long-term outcome was assessed in nine patients in the amnion group and eight patients in the topical group, who returned for up to 12-month follow-up visits. RESULTS: Patients in the amnion group had significantly less dressing changes then in the control group (p<0.05). Time to healing, length of stay and the development of hypertrophic scarring was not different between the groups. Use of amnion was not associated with an increased risk of local infection. CONCLUSION: This study indicates that amnion is safe and has advantages as wound coverage for second-degree facial burns compared to the standard topical ointments. Further studies with the use of amniotic membranes on the trunk and the extremities, as well as for coverage of grafted third-degree burns, have yet to be performed.     

Cell-spray auto-grafting technology for deep partial-thickness burns: Problems and solutions during clinical implementation

Cell-spray autografting is an innovative early treatment option for deep partial-thickness burn wounds. As an alternative to non-operative management, cell-spray autografting can achieve rapid wound re-epithelialization, particularly in large wounds. When compared to traditional mesh autografting for deep partial-thickness burn wounds, cell-spray autografting can accomplish re-epithelialization with a much smaller donor site. In this review, we describe the development of a biomedical engineering method for isolation and immediate distribution of autologous, non-cultured, adult epidermis-, and adult dermis-derived stem cells. We present data on cell isolation procedures in 44 patients with deep partial-thickness burns performed over five years under an innovative practice IRB. Treated patients presented with a variety of burn wound etiologies and a wide range of TBSA. Overall clinical results were very satisfying. The average hospital length of stay following treatment was seven days. Over the time period, the donor-site to burn-wound surface area ratio was enhanced from 1:80 to 1:100. A detailed analysis of all process-related biotechnology and operative problems, pitfalls, and solutions was performed and is reported herein. Strategies for future clinical studies are discussed.     

Development of delirium: Association with old age,severe burns,and intensive care

BackgroundDelirium is defined as a disturbance of attention and awareness that develops over a short period of time, is a change from the baseline, and typically fluctuates over time. Burn care involves a high prevalence of known risk factors for delirium such as sedation, inflammation, and prolonged stay in hospital. Our aim was to explore the extent of delirium and the impact of factors associated with it for adult patients who have been admitted to hospital with burns.MethodsIn this retrospective study, all adult patients who had been admitted with burns during a four-year period were studied, including both those who were treated with intensive care and intermediate care only (no intensive care). Daily records of the assessment of delirium using the Nursing Delirium Screening Scale (Nu-DESC) were analysed together with age, sex, the percentage of total body surface area burned, operations, and numbers of wound care procedures under anaesthesia, concentrations of plasma C-reactive protein, and other clinical variables. Logistic regression was used to analyse factors that were associated with delirium and its effect on mortality, and linear regression was used to analyse its effect on the duration of hospital stay.ResultsFifty-one patients (19%) of the total 262 showed signs of delirium (Nu-DESC score of 2 or more) at least once during their stay in hospital. Signs of delirium were recorded in 42/89 patients (47%) who received intensive care, and in 9/173 (5%) who had intermediate care. Independent factors for delirium in the multivariable regression were: age over 74 years; number of operations and wound care procedures under anaesthesia; and the provision of intensive care (area under the curve 0.940, 95% CI 0.899–0.981). Duration of hospital stay, adjusted for age and burn size, was 13.2 (95% CI 7.4–18.9, p < 0.001) days longer in the group who had delirium. We found no independent effects of delirium on mortality.ConclusionWe found a strong association between delirium and older age, provision ofr intensive care, and number of interventions under anaesthesia. A further 5% of patients who did not receive intensive care also showed signs of delirium, which is a finding that deserves to be thoroughly investigated in the future.     

The year in burns 2013

Approximately 3415 research articles were published with burns in the title, abstract, and/or keyword in 2013. We have continued to see an increase in this number; the following reviews articles selected from these by the Editor of one of the major journals (Burns) and colleagues that in their opinion are most likely to have effects on burn care treatment and understanding. As we have done before, articles were found and divided into the following topic areas: epidemiology of injury and burn prevention, wound and scar characterization, acute care and critical care, inhalation injury, infection, psychological considerations, pain and itching management, rehabilitation and long-term outcomes, and burn reconstruction. The articles are mentioned briefly with notes from the authors; readers are referred to the full papers for details.     

高压电烧伤对肝脏的影响及其临床分析

对1992～1995年间116例高压电烧伤患者进行了肝功能异常变化的观察,并观察了电烧伤的某些特点对其产生的影响,旨在提高临床诊断与治疗的正确性。结果表明:在电接触伤的患者中 ALT升高者为54%,部分患者血清学检测阳性。提示临床应予以足够重视。     

Treatment of burns with topical Heparin

Summary This prospective study was undertaken to analyse the incidence of relief of pain in our burn unit by the topical application of Heparin in 450 cases of burns irrespective of age and percentage of burn from Oct. 1977 to June 1978. The observations were recorded in proformas and results thus analysed. This study shows that topical Heparin is very useful in the cases of burns for the relief of pain without any untoward effects.     

Effectiveness of Biobrane for treatment of partial-thickness burns in children

Purpose

Wound care for partial-thickness burns should alleviate pain, decrease hospital length of stay, and be readily applied to a variety of wounds. The effectiveness of Biobrane (UDL Laboratories, Rockford, IL) is compared with that of Beta Glucan Collagen (BGC; Brennan Medical, St. Paul, MN) in a retrospective cohort study.

Methods

A retrospective chart review of all children treated at a tertiary care pediatric hospital between 2003 and 2009 identified patients with partial-thickness burns treated with Biobrane. These patients were compared with historical controls treated with BGC.

Results

A total of 235 children between the ages of 4 weeks and 18 years with an average of 6.0% body surface area partial-thickness burns were treated with Biobrane. In a multivariate statistical analysis, patients treated with Biobrane healed significantly faster than those treated with BGC (Biobrane vs BGC: median, 9 vs 13 days; P = .019; hazard ratio, 1.68). In addition, patients who required inpatient treatment trended toward having shorter length of hospital stay in the Biobrane group (2.6 vs 4.1 days, P = .079).

Conclusion

Partial-thickness burn care consists of early debridement and application of a burn wound dressing. Biobrane dressings result in faster healing compared with BGC and may decrease hospital length of stay for patients requiring inpatient admission.     

Biobrane--a useful adjunct in the therapy of outpatient burns

Fifty-five patients with partial thickness burns ranging from 1% to 10% of their body surfaces have been treated with Biobrane (Woodroof Laboratories, Santa Ana, CA) dressings on an outpatient basis. This material is a biosynthetic skin prosthesis that was introduced commercially in 1979. Advantages of Biobrane over other conventional dressings in outpatient burn care have been the significant pain relief, reduced number of dressing changes, decreased patient visits, and satisfactory epithelization in 7 to 14 days, ease of application and removal, and cost effectiveness. The dressing must be placed on clean wounds judged to be partial thickness in depth. Topical antibiotics are unnecessary in the care of these patients.     

Management of burns

Burns represent a huge global economic and social burden due to the injury severity and the highly resource intensive treatment and rehabilitation required. The World Health Organization is aiming to reduce this with a program of education, burns prevention and first aid measures. Assessment of the size and depth of a burn is paramount to determine the treatment each burn will require but can be challenging, even for experts. Many developed countries have set up regional networks to centralize burns services but in the event of a major incident involving significant burns it is likely that these services would be quickly overwhelmed and support from the national and international community would need to be sought.     

Meta-analysis of early excision of burns

AIMS: This meta-analysis sought to establish if early excision and grafting is better or equivalent to the conservative treatment of burns in both children and adults with minor or major burns. The outcomes of interest are mortality, wound healing time, duration of sepsis, operating hours, complications of surgery, length of hospital stay, blood transfusion requirements and long term morbidity like joint contractures and hypertrophic scarring. METHODS: We searched MEDLINE (1966-July 2004), EMBASE (1980-August 2004) and the Cochrane Central Register of Controlled Trials (CENTRAL) with the keywords 'early excision' and 'burns'. This yielded 441 articles of which 15 were randomized controlled trials. Only six trials met the inclusion criteria. RESULTS: There was a significant reduction in mortality with early excision of burns when compared with traditional treatment only in patients without inhalational injury (RR 0.36, 95% CI 0.20 to 0.65). The blood transfusion requirement is significantly higher in the early excision group but the length of hospital stay was significantly shorter (WMD -8.89, 95% CI -14.28 to -3.50). There was no conclusive evidence on the difference between the two groups in terms of duration of sepsis, wound healing time and skin graft take. CONCLUSION: Early excision of burns is beneficial in reducing mortality (in patients without inhalational injury), length of hospital stay. The only drawback is the greater volume of blood loss.     

Erythropoietin therapy in burns

Summary The aim of this study was to evaluate the effect of recombinant human erythropoietin on burn patients. The pilot study has shown that epoietin medication is harmless. As expected, it activated reticulocytogenesis. But epoietin did not reduce the need for homologous blood substitution.