267株烧伤感染细菌的调查分析

目的：回顾性分析1995年1月至2003年12月间本院烧伤科细菌分布和菌种耐药情况，以指导临床合理用药。方法：收集烧伤病人创面分泌物、血液、痰液及静脉导管末端行普通细菌培养，统计细菌分布情况及常用药物的敏感性。结果：9年来共检出19种267株细菌．其中铜绿假单胞菌和金黄葡萄球菌占83．14％，并有逐渐增加的趋势。铜绿假单胞菌以亚胺培南、头孢哌酮／舒巴坦和多粘菌素B最敏感；氨曲南亦较敏感，且敏感性呈逐渐上升趋势。金黄色葡萄球菌以万古霉素最敏感．呋喃妥因、利福平次之，青霉素类和大部分头孢菌素则高度耐药。结论：目前烧伤感染仍以铜绿假单胞菌和金黄色葡萄球菌为主．防治该两种细菌感染是抗烧伤感染的主要任务。     

Peripheral thermal injury causes early blood–brain barrier dysfunction and matrix metalloproteinase expression in rat

Abstract

High mortality incidence after serious systemic thermal injury is believed to be linked to significant increases in cerebral permeability, ultimately leading to irreversible blood–brain barrier (BBB) breakdown. The aim of this study was to investigate whether disruption of microvascular integrity in a rat thermal injury model is associated with early matrix metalloproteinase (MMP) expression.

A total of 35 Sprague–Dawley rats were studied in thermal injury and control groups, each group containing two subgroups, one for brain edema and Evans blue analysis and another for MMP mRNA analysis. Thermally injured animals were anesthetized and submerged vertically in 85°C water to the neck for 6 seconds producing a third degree burn affecting 70% of the total body surface area. BBB integrity was determined by measuring amount of Evans blue after 7 hours of injury with a spectrophotometer. Brain edema was detected by calculating water content. Brain mRNA levels were determined with real-time PCR 3 and 7 hours post-injury.

Brain water content was significantly increased after peripheral injury at hour 7. Evans blue leakage was also significantly increased at the same time, suggesting an impaired BBB function after injury. Expressions of MMP-2 and MMP-9 mRNA in brain were increased as early as 3 hours after injury and remained at hour 7.

Our study demonstrated a significant increase in cerebral permeability that occurs after serious systemic thermal injury. The underlying mechanisms could be related to early expression of MMPs.     

不同生态型穿心莲的农艺性状及其叶中内酯含量的比较

【目的】分析引种不同来源穿心莲农艺性状及叶中穿心莲内酯和脱水穿心莲内酯含量,为品种选育提供依据。【方法】收集并引种不同产地穿心莲,记录种植过程中各农艺性状,于开花前采集叶,高效液相色谱(HPLC)法测定叶中穿心莲内酯和脱水穿心莲内酯含量,分析不同生态型、分蘖数、开花起始时间与穿心莲内酯的关系。【结果】不同生态型之间农艺性状及穿心莲内酯和脱水穿心莲内酯含量不同;大叶型穿心莲内酯和脱水穿心莲内酯含量较高;分蘖数、开花起始时间、穿心莲内酯含量三者相关分析结果显示分蘖数越多,开花起始时间越长,叶中穿心莲内酯含量越高。【结论】穿心莲优良品种应从大叶型品种中选育。     

A phase II prospective, non-comparative assessment of a new silver sodium carboxymethylcellulose (AQUACEL(®) Ag BURN) glove in the management of partial thickness hand burns

Background

Nylon-reinforced silver sodium carboxymethylcellulose (AQUACEL^® Ag BURN) dressings were developed to be pliable and conforming for the management of partial-thickness burns. This study evaluated the AQUACEL^® Ag BURN glove for the management of hand burns.

Methods

This 21-day, phase II, prospective, non-comparative study included 23 patients with partial-thickness hand burn of at least two fingers. The AQUACEL^® Ag BURN glove was applied to one hand and could remain in place up to 21 days until clinically indicated to change the glove. Dressings were evaluated 1, 2, 4, 6, 8, 14, and 21 days after initial application. Safety was the primary study endpoint.

Results

Sixteen (70%) hand burns re-epithelialized fully over a mean of 15.6 days. Initial application was easy/very easy for 20 (87%) patients. Mean time for initial dressing application was 5.4 min. At final evaluation, most patients gave ratings of excellent/good for conformability (91%), overall glove performance (74%), and appropriateness of sizes (83%). Mean pain score from 0 (none) to 10 (worst imaginable) was 3.43 at baseline; during the study, mean scores were 1.15 at rest and 2.29 during movement. Of 61 glove removals, most (72%) were easy/very easy, and 12% had fallen off. Adverse events (wound site or elsewhere) occurred in 15 (65%) patients. Treatment-related adverse events were wound pain (17%), maceration (9%), and stiff fingers (4%).

Conclusions

The AQUACEL^® Ag BURN glove was well tolerated in the management of partial-thickness hand burn. Many patients used only one glove. When glove changes were required, they were usually quick and easy.     

Pamidronate Attenuates Muscle Loss After Pediatric Burn Injury

Children who are burned >40% total body surface area lose significant quantities of both bone and muscle mass because of acute bone resorption, inflammation, and endogenous glucocorticoid production, which result in negative nitrogen balance. Because administration of the bisphosphonate pamidronate within 10 days of the burn injury completely prevents the bone loss, we asked whether muscle protein balance was altered by the preservation of bone. We reviewed the results from 17 burned pediatric subjects previously enrolled in a double‐blind randomized controlled study of pamidronate in the prevention of post‐burn bone loss and who were concurrently evaluated for muscle protein synthesis and breakdown by stable isotope infusion studies during the acute hospitalization. We found a significantly lower fractional protein synthesis rate (FSR) in the pamidronate group and a correspondingly lower rate of appearance of the amino acid tracer in venous blood, suggesting lower muscle protein turnover. Moreover, net protein balance (synthesis minus breakdown) was positive in the subjects receiving pamidronate and negative in those receiving placebo. Muscle fiber diameter was significantly greater in the pamidronate subjects and leg strength at 9 months post‐burn was not different between subjects who received pamidronate and normal physically fit age‐matched children studied in our lab. Leg strength in burned subjects who served as controls tended to be weaker, although not significantly so. If substantiated by a larger study, these results suggest that bone may have a paracrine mechanism to preserve muscle and this finding may have implications for the treatment of sarcopenia in the elderly. © 2014 American Society for Bone and Mineral Research.     

加味二妙液治疗烧伤150例临床观察

【目的】观察比较具有清热解毒、凉血消炎功效的加味二妙液与京万红对烧伤创面的疗效差异。【方法】采用简单随机方法将272例Ⅱ°烧伤患者分为加味二妙液组(150例)和京万红组(122例),分别采用加味二妙液(主要由苍术、黄柏、防风、荆芥穗、雄黄、苦参、虎杖、甘草等组成)和京万红外敷治疗。比较两组的烧伤创面愈合时间。【结果】无论是浅Ⅱ°烧伤,还是深Ⅱ°烧伤,加味二妙液组创面愈合时间均短于亲万红组(均P<0.05)。【结论】对一些烧伤面积不大的Ⅱ°烧伤,使用加味二妙液能缩短愈合时间。且价格低廉,取材方便,适于向基层医院推广。     

Pharmacological and haematological results of rat skin burn injury treatment with Cu(II)<Subscript>2</Subscript>(3,5-diisopropylsalicylate)<Subscript>4</Subscript>

This research was performed to determine whether or not treatment of burn-injured rats with Cu(II)₂(3,5-diisopropylsalicylate)₄(Cu(II)₂(3,5-DIPS)₄) facilitated recovery from burn-injury. Four groups of adult male rats received a standard skin burn 1 h before an initial subcutaneous treatment which was continued daily for three days with either 0, 5, 10 or 20μmol Cu(II)₂(3,5-DIPS)₄/kg body mass. A fifth group was given no treatment. A sixth group served as a non-burn-injured non-treated normal control group. At 3 h and on days 1, 2, 3, 7 and 14 post-burn-injury blood samples were obtained from rats in all groups for the determination of leukocyte, platelet and erythrocyte counts, clotting times, hemoglobin and hematocrit values. Total protein and middle mass peptides in plasma, as well as plasma lipid and erythrocyte membrane peroxidation products were determined on days 7 and 14. Burn wound healing and body mass were determined daily from day 0 to 6 with a notation of crust rejection by day 14. Treatment with Cu(II)₂(3,5-DIPS)₄ produced effects consistent with a facilitation of Cu-dependent immune-mediated physiological inflammatory responses to burn injury. It is concluded that treatment of burn injury with Cu(II)₂(3,5-DIPS)₄ supports Cu-dependent physiological responses involved in overcoming burn injury, which may have been further optimized by continued treatment beyond day 2, the last day of treatment.     

Pressure therapy for scars: Myth or reality? A systematic review

BackgroundHypertrophic scarring is a deviate occurrence after wound closure and is a common burn sequela. The mainstay of scar treatment consists of a trifold approach: hydration, UV-protection and the use of pressure garments with or without extra paddings or inlays to provide additional pressure. Pressure therapy has been reported to induce a state of hypoxia and to reduce the expression pattern of transforming growth factor-β1 (TGF-β1), therefore limiting the activity of fibroblasts. However, pressure therapy is said to be largely based on empirical evidence and a lot of controversy concerning the effectiveness still prevails. Many variables influencing its effectivity, such as adherence to treatment, wear time, wash frequency, number of available pressure garment sets and amount of pressure remain only partially understood. This systematic review aims to give a complete and comprehensive overview of the currently available clinical evidence of pressure therapy.MethodsA systematic search for articles concerning the use of pressure therapy in the treatment and prevention of scars was performed in 3 different databases (Pubmed, Embase, and Cochrane library) according to the PRISMA statement. Only case series, case-control studies, cohort studies, and RCTs were included. The qualitative assessment was done by 2 separate reviewers with the appropriate quality assessment tools.ResultsThe search yielded 1458 articles. After deduplication and removal of ineligible records, 1280 records were screened on title and abstract. Full text screening was done for 23 articles and ultimately 17 articles were included. Comparisons between pressure or no pressure, low vs high pressure, short vs long duration and early vs late start of treatment were investigated.ConclusionThere is sufficient evidence that indicates the value of prophylactic and curative use of pressure therapy for scar management. The evidence suggests that pressure therapy is capable of improving scar color, thickness, pain, and scar quality in general. Evidence also recommends commencing pressure therapy prior to 2 months after injury, and using a minimal pressure of 20–25 mmHg. To be effective, treatment duration should be at least 12 months and even preferably up to 18–24 months. These findings were in line with the best evidence statement by Sharp et al. (2016).