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2015 Vol. 31, No. 3

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Expert Forum
Current status in rehabilitation of burn injury in China
Jia Chiyu, Zou Xiaofang
2015, 31(3): 161-163. doi: 10.3760/cma.j.issn.1009-2587.2015.03.001
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Along with the advance in national economy, modern concept of burn rehabilitation from major burn injury implies that measures should be taken to help the patients return to society with dignity. This article briefly reviews the development and achievement of burn rehabilitation in our country, as well as the current difficulties in carrying out rehabilitation measures such as outmoded ideology, lack of trained personnel, low rate of popularization, outdated techniques and methodology, and relatively low level in scientific research, etc. The future development of burn rehabilitation in our country needs more social support, popular attention, and multidisciplinary joint efforts to help burn patients return to society with dignity. In order to fulfill this goal, we still have a long way to go.
Rehabilitation and Plastic Surgery of Burns
Clinical observation of the effects of lattice ultra pulse carbon dioxide laser combined with traditional Chinese medicine on the treatment of hyperplastic scar
Lei Jin, Hao Zhenming, Yu Lifeng, Duan Peng, Meng Yanbin
2015, 31(3): 164-167. doi: 10.3760/cma.j.issn.1009-2587.2015.03.002
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Objective To explore the clinical effects of lattice ultra pulse carbon dioxide laser combined with traditional Chinese medicine (Fuchunsan) on the treatment of postburn hyperplastic scar. Methods Sixty–three patients with hyperplastic scar after burn injury hospitalized from February 2012 to June 2014 in our department were treated with lattice ultra pulse carbon dioxide laser combined with traditional Chinese medicine (Fuchunsan). Patients were divided into early stage group (E, n=35), middle stage group (M, n=25), and late stage group (L, n=3) according to the formation time of scar, which was respectively 3 weeks to 3 months, longer than 3 months and less than or equal to 6 months, and 3 to 15 years in groups E, M, and L. The number of times of laser treatment of patients in each group was recorded. The degree of scar pain in patients of the three groups was assessed by the Numerical Rating Scale (NRS) before treatment and after treatment for 1, 2, and 3 times. The scar condition of patients in groups E and M was assessed by the Vancouver Scar Scale (VSS) before treatment and after treatment for 1, 3, and 5 times. Patients in group L did not receive VSS assessment but were evaluated by clinical observation only. Photos of scar in treating area were taken before treatment and after treatment for 3 and 5 times to evaluate the clinical effect. Data were processed with t test. Results Patients in groups E and M were treated with laser for (4.8±1.1) and (7.7±2.1) times respectively. In group L, the treatment was stopped in 2 patients after laser treatment for 5 times, and 1 patient received laser treatment for 12 times. The degree of pain in patients of groups E and M was alleviated significantly after treatment for one time, and the number of patients scoring 1–4 point (s) in NRS increased from 5 cases to 38 cases. After treatment for 2 and 3 times, the increase in the number of patients scoring 1–4 point (s) in NRS was on a small scale. Before treatment and after treatment for 1 time, VSS scores of patients in groups E and M were similar (with t values respectively 0.641 and 0.082, P values above 0.05). After treatment for 3 and 5 times, VSS scores of patients in group E were respectively (9.2±0.8) and (7.0±1.1) points, which were significantly lower than those in group M [(9.7±1.0) and (8.2±1.0) points, with t values respectively –1.993 and –4.433, P<0.05 or P<0.01]. After treatment for 3 times, the rate of improvement in appearance was respectively 88.6% (31/35) and 72.0% (18/25) in groups E and M, and it was respectively 100.0% (35/35) and 96.0% (24/25) after treatment for 5 times. No significant effect in appearance was found in the 3 patients in group L. Conclusions Early application of lattice ultra pulse carbon dioxide laser combined with traditional Chinese medicine (Fuchunsan) for the treatment of postburn hyperplastic scar is effective.
Bibliometric analysis of scientific articles on rehabilitation nursing for adult burn patients in China
Sun Ying, Cao Jie, Feng Ping, Zhang Lingjuan
2015, 31(3): 168-171. doi: 10.3760/cma.j.issn.1009-2587.2015.03.003
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Objective To analyze the current research status of rehabilitation nursing for adult burn patients in China, and to discuss the related strategies. Methods Chinese scientific articles on adult burn patients' rehabilitation nursing published from January 2003 to December 2013 were retrieved from 3 databases namely China Biology Medicine disc, Chinese Journals Full–text Database, and Chinese Science and Technology Journals Database. From the results retrieved, data with regard to publication year, journal distribution, research type, region of affiliation of the first author, and the main research content were collected. Data were processed with Microsoft Excel software. Results A total of 417 articles conforming with the criteria were retrieved. During the 11 years, the number of the relevant articles per year was on the rise, and the increasing rates in 2005, 2008, 2009, and 2013 were all above 30%. Regarding the distribution among journals, these 417 articles were published in 151 journals, with 188 articles in Source Journal for Chinese Scientific and Technical Papers, accounting for 45.08%. Regarding the research type, 173 out of the 417 articles were dealing with clinical experiences, accounting for 41.49%; 172 out of the 417 articles were dealing with experimental studies, accounting for 41.25%. The regions of affiliation of the first author were mainly situated in Guangdong province, Shandong province, Hunan province, and Jiangsu province, with Guangdong province contributing 58 articles, accounting for 13.91%. The research content of these articles was mainly focused on psychological nursing, nursing model, and health education, respectively 188, 101, and 85 articles, accounting for 45.08%, 24.22%, and 20.38%. Conclusions The research on rehabilitation nursing for adult burn patients in China has been carried out nationwide. Although the number of relevant papers is on the rise, the quality of these papers needs to be further improved. There is an urgent need for the guideline on rehabilitation nursing for adult burn patients in China so as to standardize the content and procedure of rehabilitation nursing.
Retrospective analysis of effects of metacarpus and phalanx traction on correction of scar contracture of hand after burn on the palm side
Hou Chunsheng, Liu Qingye, Hao Hongfei, Dong Yuying, Wang Feng, Lei Jin
2015, 31(3): 172-176. doi: 10.3760/cma.j.issn.1009-2587.2015.03.004
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Objective To analyze the effects of metacarpus and phalanx traction on correction of scar contracture of hand after burn on the palm side retrospectively. Methods A total of 32 patients with 39 affected hands with scar contracture on the palm side after burn were hospitalized from May 2010 to December 2014. Method of treatment: scar contracture was conservatively released followed by skin grafting, which was referred to as method A; Kirschner wire was inserted into the middle or distal phalanx of finger with contracture and the corresponding metacarpus in the shape of U for 2 to 7 weeks' traction, which was referred to as method B; traction frame was built based on the traction pile and anchor formed by Kirschner wire inserted through the second to the fifth metacarpus and distal phalanx of finger with contracture, and then the affected fingers were pulled into a straight position with rubber bands for 2 to 6 months, which was referred to as method C. Method A was used in patients who would be treated with thorough release of scar followed by skin grafting routinely. Method B was used in patients who would be treated with intramedullary Kirschner wire fixation after release of scar contracture and skin transplantation routinely. Method C was further used in patients when methods A and B failed to accomplish the expected result. Method C was used in the first place followed by method A in whom there might be vascular decompensation or exposure of tendon and bone after scar release, and those who failed to meet the expectation were treated with method C in addition. Patients who were unwilling to undergo surgery were treated with method C exclusively. During the course of treatment, the presence or absence of infection and slipping of Kirschner wire or its slitting through soft tissue were observed. The presence or absence of tendency of recurrence of scar contracture within 1 to 2 weeks after treatment was observed. The length of palmar skin measuring from the root of finger with contracture to wrist crease was measured before treatment, at the termination of treatment, and 1 month after the termination of treatment. Scar condition was assessed with the Vancouver Scar Scale (VSS) before treatment and 1, 3, and 6 month (s) after the termination of treatment. Before treatment and 1 month after the termination of treatment, the range of motion was measured with the Total Active Movement (TAM) method; hand function was evaluated by the Jebsen Test of Hand Function (JTHF), and the completion time was recorded. Data were processed with analysis of variance, LSD–t test, and t test. Results Twenty–four patients with 27 affected hands were treated with scheme A+ B; 5 patients with 7 affected hands were treated with method C exclusively; 2 patients with 3 affected hands were treated with scheme A+ B+ C; 1 patient with 2 affected hands were treated with scheme C+ A+ C. During the course of treatment, no complication such as infection or slicing of tissue was observed, but there was a slight shifting of U–shaped Kirschner wire in 14 affected hands of 13 patients. Tendency of recurrence of scar contracture was observed in 11 affected hands of 10 patients, but the scar contracture did not reoccur after treatment with orthosis. The skin length of palmar side was respectively (131.8±9.8) and (127.6±7.5) mm at the termination of treatment and 1 month after, and they were both significantly longer than that before treatment [(114.5±2.4) mm, with t values respectively 10.71 and 10.39, P values below 0.001]. The score of VSS was respectively (9.8±2.4), (9.7±1.7), (9.3±0.8), and (7.7±0.5) points before treatment and 1, 3, and 6 month (s) after the termination of treatment. Only the score at 6 months after the termination of treatment was significantly lower than that before treatment (t=3.28, P<0.01). The ratio of excellent and good results according to method TAM was respectively 2.6% (1/39) and 94.9% (37/39) before treatment and 1 month after the termination of treatment. The time for JTHF measurement was (13.9±4.1) min before treatment, and it was shortened to (11.0±2.8) min 1 month after the termination of treatment (t=3.65, P<0.001). Conclusions Single application of metacarpus and phalanx traction or its combination with skin transplantation after scar release in correcting scar contracture of the palm of hand after burn can lengthen the contracted tissue, and it is beneficial for the restoration of function and appearance of affected hand.
Clinical effects of gabapentin on the treatment of pruritus of scar resulting from deep partial-thickness burn
Li Zheng, Zhang Bing, Li Wei, Wang Qiang
2015, 31(3): 177-180. doi: 10.3760/cma.j.issn.1009-2587.2015.03.005
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Objective To study the clinical effects of gabapentin on the treatment of pruritus of scar resulting from deep partial–thickness burn. Methods A total of fifty–eight patients suffering from pruritus of scar after deep partial–thickness burn were hospitalized from January 2013 to January 2014. Patients were divided into placebo group (n=18, treated with oral vitamin C in the dose of 100 mg for 4 weeks, twice per day), cetirizine group (n=20, treated with oral cetirizine in the dose of 10 mg for 4 weeks, twice per day), and gabapentin group (n=20, treated with oral gabapentin in the dose of 300 mg for 4 weeks, twice per day). Before treatment and on post treatment day (PTD) 3 and 28, the Visual Analog Scale (VAS) was used to assess the itching degree, and the mean scores were recorded. The remission rates of pruritus on PTD 3 and 28 were calculated. The adverse effects were observed during treatment. Data were processed with analysis of variance, q test, and chi–square test. Results Compared with that before treatment, the itching degree of patients with light, moderate, and severe itching in placebo group was not relieved after treatment; the itching degree of patients with moderate or severe itching in cetirizine group was alleviated after treatment, but not in patients with light itching; itching degree of all patients in gabapentin group was significantly relieved after treatment. There were no obvious differences in VAS scores among the 3 groups before treatment (F=2.78, P>0.05). On PTD 3 and 28, the VAS scores of patients in both gabapentin group [(2.3±0.8) and (0.6±0.3) points] and cetirizine group [(4.2±1.7) and (2.8±1.2) points] were lower than those in placebo group [(5.7±2.0) and (5.7±1.9) points, with q values from 6.70 to 7.75, P values below 0.05]. The VAS scores of patients in gabapentin group on PTD 3 and 28 were lower than those in cetirizine group (with q values respectively 6.30 and 6.90, P values below 0.05). The remission rates of pruritus of patients in gabapentin group on PTD 3 and 28 were respectively (66±20)% and (91±17)%, and they were higher than those in cetirizine group [(33±8)% and (56±14)%, with q values respectively 4.70 and 3.82, P values below 0.05]. The remission rate of pruritus of patients in placebo group on PTD 3 and 28 was 0, which was lower than that of the other 2 groups each (with q values from 3.94 to 6.76, P values below 0.05). During the course of treatment, 5 patients in gabapentin group suffered from adverse effects including mild–to–moderate drowsiness and dizziness, but they disappeared one week later. No adverse effects were observed in patients of the other two groups. Conclusions For patients with deep partial–thickness burn, gabapentin can effectively alleviate scar itching after wound healing with safety.
Advances in the research of effects of music therapy on pain and anxiety in burn patients
Li Jinyi, Wang Yungui
2015, 31(3): 183-185. doi: 10.3760/cma.j.issn.1009-2587.2015.03.007
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Pain and anxiety engender major psychic problems during all phases of treatment for burn patients. Analgesic alone does not allay these problems satisfactorily in these patients. Music therapy, as an important complementary and alternative therapy, has been widely used in multiple medical fields. However, its positive effect on alleviation of pain and anxiety in burn patients is undefined. The objective of this review is to summarize the feasibility, application fields, methods, and the effectiveness of music therapy in allaying pain and anxiety of burn patients during the whole course of treatment.
2015, 31(3): 181-182. doi: 10.3760/cma.j.issn.1009-2587.2015.03.006
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2015, 31(3): 216-217. doi: 10.3760/cma.j.issn.1009-2587.2015.03.013
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2015, 31(3): 218-220. doi: 10.3760/cma.j.issn.1009-2587.2015.03.014
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2015, 31(3): 221-222. doi: 10.3760/cma.j.issn.1009-2587.2015.03.015
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2015, 31(3): 223-224. doi: 10.3760/cma.j.issn.1009-2587.2015.03.016
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2015, 31(3): 225-226. doi: 10.3760/cma.j.issn.1009-2587.2015.03.017
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2015, 31(3): 226-228. doi: 10.3760/cma.j.issn.1009-2587.2015.03.018
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2015, 31(3): 228-229. doi: 10.3760/cma.j.issn.1009-2587.2015.03.019
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2015, 31(3): 230-231. doi: 10.3760/cma.j.issn.1009-2587.2015.03.020
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2015, 31(3): 231-232. doi: 10.3760/cma.j.issn.1009-2587.2015.03.021
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Original Article
Significance of extravascular lung water index, pulmonary vascular permeability index, and intrathoracic blood volume index in the differential diagnosis of burn-induced pulmonary edema
Li Lei, Sheng Jiajun, Wang Guangyi, Lyu Kaiyang, Qin Jing, Liu Gongcheng, Ma Bing, Xiao Shichu, Zhu Shihui
2015, 31(3): 186-191. doi: 10.3760/cma.j.issn.1009-2587.2015.03.008
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Objective To appraise the significance of extravascular lung water index (EVLWI), pulmonary vascular permeability index (PVPI), and intrathoracic blood volume index (ITBVI) in the differential diagnosis of the type of burn–induced pulmonary edema. Methods The clinical data of 38 patients, with severe burn hospitalized in our burn ICU from December 2011 to September 2014 suffering from the complication of pulmonary edema within one week post burn and treated with mechanical ventilation accompanied by pulse contour cardiac output monitoring, were retrospectively analyzed. The patients were divided into lung injury group (L, n=17) and hydrostatic group (H, n=21) according to the diagnosis of pulmonary edema. EVLWI, PVPI, ITBVI, oxygenation index, and lung injury score (LIS) were compared between two groups, and the correlations among the former four indexes and the correlations between each of the former three indexes and types of pulmonary edema were analyzed. Data were processed with t test, chi–square test, Mann–Whitney U test, Pearson correlation test, and accuracy test [receiver operating characteristic (ROC) curve]. Results There was no statistically significant difference in EVLWI between group L and group H, respectively (12.9±3.1) and (12.1±2.1) mL/kg, U=159.5, P>0.05. The PVPI and LIS of patients in group L were respectively 2.6±0.5 and (2.1±0.6) points, and they were significantly higher than those in group H [1.4±0.3 and (1.0±0.6) points, with U values respectively 4.5 and 36.5, P values below 0.01]. The ITBVI and oxygenation index of patients in group L were respectively (911±197) mL/m2 and (136±69) mmHg (1 mmHg=0.133 kPa), which were significantly lower than those in group H [(1 305±168) mL/m2 and (212±60) mmHg, with U values respectively 21.5 and 70.5, P values below 0.01]. In group L, there was obviously positive correlation between EVLWI and PVPI, or EVLWI and ITBVI ( with r values respectively 0.553 and 0.807, P<0.05 or P<0.01), and there was obviously negative correlation between oxygenation index and EVLWI, or oxygenation index and PVPI (with r values respectively –0.674 and –0.817, P values below 0.01). In group H, there was obviously positive correlation between EVLWI and ITBVI ( r=0.751, P <0.01) but no obvious correlation between EVLWI and PVPI, oxygenation index and EVLWI, or oxygenation index and PVPI (with r values respectively –0.275, 0.197, and 0.062, P values above 0.05). The total area under ROC curve of PVPI value for differentiating the type of pulmonary edema was 0.987 [with 95% confidence interval (CI) 0.962–1.013, P<0.01], and 1.9 was the cutoff value with sensitivity of 94.1% and specificity of 95.2%. The total area under ROC curve of ITBVI value for differentiating the type of pulmonary edema was 0.940 (with 95% CI 0.860–1.020, P<0.01), and 1 077.5 mL/m2 was the cutoff value with sensitivity of 95.2% and specificity of 88.2%. Conclusions EVLWI, PVPI, and ITBVI have an important significance in the differential diagnosis of the type of burn–induced pulmonary edema, and they may be helpful in the early diagnosis and management of burn–induced pulmonary edema.
Effects of microtubule depolymerization on spontaneous beating and action potential of cardiac myocytes in rats and its mechanism
Lan Xiaodong, Dang Yongming, Li Lingfei, Zhang Qiong, Huang Yuesheng
2015, 31(3): 192-198. doi: 10.3760/cma.j.issn.1009-2587.2015.03.009
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Objective To explore the effects of microtubule depolymerization (MD) on the spontaneous beating rate, action potential (AP), and oxygen consumption of cardiac myocytes in rats and its mechanism. Methods One–hundred and eighty neonatal SD rats divided into 12 batches were used in the experiment, and 15 rats in each batch were sacrificed for the isolation and culture of cardiac myocytes after the heart tissues were harvested. The cardiac myocytes were respectively inoculated in one 12–well plate filled with 6 round cover slips, one 12–well plate filled with 6 square cover slips, two cell culture flasks, and two cell culture dishes. After routine culture for three days, the cardiac myocytes from all the containers were divided into normal control group (NC, routinely cultured with 3 mL DMEM/F12 solution rewarmed at 37 ℃ for 3 h) and group MD (routinely cultured with 3 mL DMEM/F12 solution rewarmed at 37 ℃ and containing 8 μmol/L colchicine for 3 h) according to the random number table, with 3 holes, 1 flask, or 1 dish in each group. The morphological changes in microtubules were observed with confocal laser scanning microscope after immunofluorescent staining. The content of polymerized or dissociative α–tubulin was determined by Western blotting. Spontaneous beating rate of the cells was observed and calculated under inverted microscope. Dissolved oxygen concentration of DMEM/F12 solution containing cardiac myocytes was determined by oxygen microelectrode system before and after the addition of colchicine. Additionally, dissolved oxygen concentration of DMEM/F12 solution and colchicine+ DMEM/F12 solution was determined. The whole–cell patch–clamp technique was used to record AP, delayed rectifier K+ current (IK), and L–type Ca2+ current (ICa–L) in cardiac myocytes; current density–voltage (I–V) curves were drawn based on the traces. Data were processed with independent or paired samples t–test. Results (1) In group NC, microtubules of cardiac myocytes were around the nucleus in radial distribution with intact and clear linear tubiform structure. The microtubules in group MD were observed in dispersive distribution with damaged structure and rough linear tubiform structure. (2) In group MD, the content of dissociative α–tubulin of cells (0.61±0.03) was obviously higher than that in group NC (0.46±0.03, t=–6.99, P<0.05), while the content of polymerized α–tubulin (0.57±0.04) was significantly lower than that in group NC (0.88±0.04, t=9.09, P<0.05). (3) Spontaneous beating rate of cells was (59±8) times per min in group MD, which was distinctly higher than that in group NC [(41±7) times per min, t=5.62, P<0.01]. (4) Dissolved oxygen concentration of DMEM/F12 solution containing cardiac myocytes was (138.4±2.5) μmol/L, and it was reduced to (121.7±3.6) μmol/L after the addition of colchicine (t=26.31, P<0.05). There was no obvious difference in dissolved oxygen concentration between DMEM/F12 solution and colchicine+ DMEM/F12 solution (t=0.72, P>0.05). (5) Compared with that of group NC, AP morphology of cells in group MD changed significantly, with unobvious repolarization plateau phase and shorter action potential duration (APD). The APD20, APD50, and APD90 were respectively (36.2±3.8), (73.7±5.7), and (115.1±8.0) ms in group MD, which were significantly shorter than those of group NC [(40.2±2.3), (121.4±7.0), and (169.4±5.6) ms, with t values respectively 2.61, 15.88, and 16.75, P values below 0.05]. (6) Compared with that of group NC, the I–V curve of IK of cells in group MD moved up with higher current density under each test voltage (0 to 40 mV) after activation (with t values from 2.70 to 3.76, P values below 0.05). (7) There was not much alteration in current density of ICa–L under each test voltage (–30 to 50 mV) between 2 groups (with t values from –1.57 to 1.66, P values above 0.05), and their I–V curves were nearly overlapped. Conclusions After MD, the IK is enhanced without obvious change in ICa–L, making AP repolarization faster and APD shortened. Then the rapid spontaneous beating rate increases oxygen consumption of cardiac myocytes of rats.
Effects of adipose-derived mesenchymal stem cells over-expressing glial cell line-derived neurotrophic factor on electrically injured sciatic nerve of rats
Yang Chen, Hu Dahai, Zheng Zhao, Bai Xiaozhi, Wang Yaojun, Tang Chaowu
2015, 31(3): 199-204. doi: 10.3760/cma.j.issn.1009-2587.2015.03.010
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Objective To observe the effects of adipose-derived mesenchymal stem cells (ADSCs) with continous over-expression of glial cell line-derived neurotrophic factor (GDNF) on the motor function recovery and nerve regeneration of sciatic nerve of rats after electrical injury. Methods Five SD rats were collected to prepare ADSCs with over-expression of GDNF. One hundred and fifty SD rats were divided into normal control group (N), GDNF-ADSCs group (GA), ADSCs group (A), GDNF group (G), and physiological saline group (P) according to the random number table, with 30 rats in each group. Rats in group N were routinely fed without treatment, and rats in the other 4 groups were inflicted with electrical injury on sciatic nerve of thigh of the right hind leg. Rats in groups GA, A, G, and P were respectively injected with 100 μL suspension of ADSCs with over-expression of GDNF (1×107 cells per mL), 100 μL ADSCs suspension (1×107 cells per mL), 100 μL GDNF solution (100 mg/L), and 100 μL physiological saline to the surface of the injured nerves immediately after injury. Six rats of each group were collected for measuring hind limb stride from post injury week (PIW) 1 to 8, and morphology of the sciatic nerves was observed in PIW 8. In PIW 4, the protein expression of GDNF of sciatic nerves of the rest rats in each group was determined with Western blotting. Data were processed with one-way analysis of variance, analysis of variance of repeated measurement, and SNK test. Results Compared with that of group N, the hind limb stride values in groups GA, A, G, and P were significantly lower at each time point (with P values below 0.05). Compared with those of group P, the hind limb stride values in group GA from PIW 3 to 8, in group A in PIW 3, 5, and 7, and in group G in PIW 3, 5, 7, and 8 were significantly longer (with P values below 0.05). The hind limb stride values in group GA from PIW 4 to 8 were respectively (10.83±0.97), (13.25±1.40), (12.86±1.42), (14.06±1.50), and (15.09±1.17) cm, which were significantly longer than those in group A [(8.90±0.82), (9.03±0.57), (9.27±0.36), (9.86±0.36), and (9.52±0.58) cm] and group G [(8.87±0.69), (8.51±1.18), (9.34±0.87), (9.76±0.67), and (9.50±1.22) cm], with P values below 0.05. Compared with that of group N, the number of myelinated nerve fibers of sciatic nerves was obviously decreased in group P but obviously increased in groups GA, A, and G; the diameter of axons was obviously shorter, and the myelin thickness was obviously increased in groups GA, A, G, and P in PIW 8 (with P values below 0.05). The number of myelinated nerve fibers in group GA was 31.2±0.8, which was significantly higher than that in group A (23.7±2.7), group G (22.3±2.7), or group P (9.3±2.8), with P values below 0.05. The diameter values of axons among groups P, A, G, and GA were similar (with P values above 0.05). The myelin thickness of rats in group GA was (3.41±0.34) μm, which was significantly thicker than that in group A [(2.64±0.37) μm] or group G [(2.41±0.34) μm], with P values below 0.05. In PIW 4, the protein expression of GDNF of sciatic nerves was significantly higher in groups P, A, G, and GA than in group N (with P values below 0.05), and the protein expression of GDNF in group GA was significantly higher than that in group P, A, or G (with P values below 0.05). Conclusions ADSCs over-expressing GDNF protein can obviously promote the motor function recovery and nerve regeneration of sciatic nerve of rats after electrical injury.
Analysis of the mechanism of drug resistance of VIM-2-type metallo-β-lactamase-producing Acinetobacter baumannii isolated from burn patients and its homology
Yang Xili, Li Yue, Zhan Jianhua, Guo Fei, Min Dinghong, Wang Nianyun, Li Guohui, Guo Guanghua
2015, 31(3): 205-210. doi: 10.3760/cma.j.issn.1009-2587.2015.03.011
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Objective To study the drug resistance of Acinetobacter baumannii (AB) producing VIM–2–type metallo–β–lactamase (MBL) isolated from burn patients of our ward against carbapenem antibiotics and its homology. Methods A total of 400 strains of AB (identified) were isolated from sputum, urine, blood, pus, and wound drainage of burn patients hospitalized in our ward from September 2011 to March 2014. Drug resistance of the 400 strains of AB to 15 antibiotics, including compound sulfamothoxazole, aztreonam, etc., was tested using the automatic microorganism identifying and drug sensitivity analyzer. Among the carbapenems–resistant AB isolates, modified Hodge test was applied to screen carbapenemase–producing strains. The carbapenemase genes of the carbapenemase–producing strains, and the mobile genetic elements class 1 integron (Intl1) gene and conserved sequence (CS) of carbapenemase–producing strains carrying blaVIM–2 gene were determined with PCR and DNA sequencing. For carbapenemase–producing strains carrying blaVIM–2 gene, synergism test with imipenem–ethylene diamine tetraacetic acid (EDTA) and enhancement test with imipenem–EDTA and ceftazidime–EDTA were used to verify the MBL–producing status. Drug resistance of the VIM–2–type MBL–producing AB strains was analyzed. For VIM–2–type MBL–producing AB strains, plasmid conjugation experiment was used to explore the transfer of plasmid; outer membrane protein (OMP) CarO gene was detected by PCR. For VIM–2–type MBL–producing AB strains carrying CarO gene, the protein content of CarO was analyzed with sodium dodecyl sulfate polyacrylamide gel electrophoresis. The repetitive consensus sequence of Enterobacteriaceae genome PCR (ERIC–PCR) was carried out for gene typing of VIM–2–type MBL–producing AB strains to analyze their homology. Results (1) The resistant rates of the 400 strains of AB against levofloxacin and compound sulfamethoxazole were low. A total of 381 carbapenems–resistant AB strains were screened, including 240 carbepenemase–producing strains. (2) Out of the 240 carbepenemase–producing strains, 18 strains were found to harbor the blaVIM–2 gene, accounting for 7.5%; 133 strains carried the blaTEM–1 gene, accounting for 55.42%; 195 strains carried the blaOXA–23 gene, accounting for 81.25%; 188 strains carried the blaarmA gene, accounting for 78.33%. (3) Eighteen carbepenemase–producing strains which carried the blaVIM–2 gene were found to carry the Intl1 gene, showing the Intl1–VIM linkage. Simultaneously, Intl1 variable area CS showed diversity. (4) Eighteen carbepenemase–producing strains which carried the blaVIM–2 gene were verified to produce MBL. The resistant rates of the 18 strains of AB against compound sulfamethoxazole were the lowest, followed by levofloxacin and cefoperazone/sulbactam, and those against the other antibiotics were above 60.00%. (5) Through multiple joint tests, plasmid conjugation experiment positive transfer strain was not found in 18 VIM–2–type MBL–producing AB strains. (6) Nine out of the 18 VIM–2–type MBL–producing AB strains were found to carry CarO gene. The OMP CarO of VIM–2–type MBL–producing AB strains carrying CarO gene was lost or lowered in the protein content. (7) The 18 VIM–2–type MBL–producing AB strains were classified into 6 genotypes by the ERIC–PCR. There were respectively 6, 4, 3, and 1 stain (s) in genotypes A, B, C, and F, and there were 2 strains in genotypes D and E respectively. Conclusions The resistance mechanism of AB against carbapenems is mainly mediated by blaTEM–1, blaOXA–23, and blaarma; meanwhile, VIM–2–type MBL–producing and lack or change in OMP CarO are attributable to carbapenems resistance of clinically isolated AB from burn wards, and the Intl1 gene may take a part in blaVIM–2 gene transmission.
Effects of resuscitation with different kinds of colloids on oxygen metabolism in swine during shock stage of burn injury
Shi Jianwu, Huang Wenxiang, Shi Xiaoli, Zhou Jianjun, Xing Nan, Chen Jiong
2015, 31(3): 211-215. doi: 10.3760/cma.j.issn.1009-2587.2015.03.012
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Objective To explore the effects of resuscitation with different kinds of colloids on oxygen metabolism of swine during shock stage of burn injury. Methods Eighteen Guangxi Bama miniature swine were inflicted with 40% TBSA full–thickness burn on the back. And then they were divided into succinylated gelatin group (S), hydroxyethyl starch group (H), and allogeneic plasma group (A) according to the random number table, with 6 swine in each group. The fluid resuscitation was begun at post injury hour (PIH) 2. The colloids used in groups S, H, and A were respectively succinylated gelatin, 60 g/L hydroxyethyl starch 130/0.4, and allogeneic plasma. The blood pressure, urine volume, heart rate, and central venous pressure (CVP) were recorded before injury and at the first and second PIH 24. The volume of resuscitation fluid was recorded at the first and second PIH 24. The changes in oxygen delivery, oxygen consumption, oxygen extraction ratio and D–lactate were determined and calculated before injury and at PIH 4, 8, 24, and 48. Data were processed with analysis of variance of repeated measurement, one–way analysis of variance, and LSD test. Results There were no statistically significant differences among the three groups in blood pressure, urine volume, heart rate, and CVP at each time point (with P values above 0.05). There were no statistically significant differences in resuscitation fluid volume among the three groups at the first and second PIH 24 (with F values respectively 0.239 and 2.023, P values respectively 0.790 and 0.167). The oxygen consumption of swine in group S was (201±38) L·min–1·m–2 at PIH 48, which was significantly higher than that in group A [(150±37) L·min–1·m–2,P<0.05], and the oxygen consumption was similar among the three groups at the rest time points (with P values above 0.05). The oxygen delivery of swine in group S was (484±63) L·min–1·m–2 at PIH 8, and it was significantly lower than that in group A [(652±65) L·min–1·m–2,P<0.01]. The oxygen delivery of swine in group S reached (903±132) and (1 028±98) L·min–1·m–2 at PIH 24 and 48, respectively, and they were significantly higher than those in group A [(686±72) and (720±75) L·min–1·m–2, with P values below 0.01]. Oxygen delivery in group H was similar to that of group A at each time point (with P values above 0.05). The oxygen extraction ratio in group S or group H was close to that of group A at each time point (with P values above 0.05). The D–lactate level in group S was (69±9) mmol/L, and it was significantly higher than that in group A [(52±4) mmol/L, P<0.01] at PIH 48. The D–lactate level was similar among the three groups at the rest time points (with P values above 0.05). Conclusions According to the changes in oxygen metabolism of swine during shock stage of burn injury resuscitated with different kinds of colloids, it is found that allogeneic plasma is better than artificial colloid, and 60 g/L hydroxyethyl starch 130/0.4 is superior to succinylated gelatin.
Review
Advances in the research of early systemic use of prophylactic antibiotics in severe burns
Zhan Rixing, Wu Jun, Peng Yizhi, Luo Gaoxing
2015, 31(3): 233-235. doi: 10.3760/cma.j.issn.1009-2587.2015.03.022
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Infection is the most common complication and the most common cause of death in burn patients. It is very important to employ anti-infection measures reasonably and effectively for victims of major burns. However, a consensus of opinion of how to use systemic antibiotics in prophylaxis of infection in the early stage of burn is still lacking. The indications of the early systemic use of prophylactic antibiotics are discussed in this article.
Current situation of research and application of Parkland formula in burn resuscitation
Zhang Donghai, Chai Jiake
2015, 31(3): 235-237. doi: 10.3760/cma.j.issn.1009-2587.2015.03.023
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Parkland formula is the most widely used resuscitation formula in burn care. However, a growing number of disputes have been raised along with the development of medical technology, among which its total volume and composition of the fluid are the two foci. Firstly, Parkland formula may lead to an untoward phenomenon nicknamed"fluid creep", which may lead to complications such as abdominal compartment syndrome. Secondly, along with the deeper understanding of how permeability of blood vessels changes after burn injury, colloid is recommended to be given after the third 8 h post-burn. Additionally, controversy exists in the choice of different colloid solutions. The safety of different colloid solutions remains to be further elucidated. This article will deal with all of the above-mentioned problems.
Advances in the experimental study of the use of mesenchymal stem cells for the treatment of inhalation injury
Zhu Feng, Guo Guanghua
2015, 31(3): 238-240. doi: 10.3760/cma.j.issn.1009-2587.2015.03.024
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Inhalation injury seriously threatens the survival and quality of life in burn and trauma patients. So far there is no breakthrough in the treatment of inhalation injury. A significant advance has been witnessed in the experimental study of the use of stem cells in the treatment of lung injury in recent years. In this paper, according to the results of our study in the systemic transplantation of bone marrow mesenchymal stem cells for the treatment of inhalation injury, the effect of mesenchymal stem cells on anti-inflammatory process and repair of lung tissues in inhalation injury, and its possible mechanisms are reviewed.

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