Effect of Diameter and Fenestration Area of the Liposuction Cannula on the Viability of the Adipocytes.

BACKGROUND: Loss of volume is perhaps the most frustrating problem of fat grafting. The process of fat grafting depends on different variables such as harvesting, processing, and injection techniques. Results between studies that evaluate the effect of the cannula size on fat graft survival have been controversial. However, the role of the fenestration area of the cannula has not been described. METHODS: Four custom-made cannulas with a single fenestration were used for this study. Cannulas vary in diameter and area of the fenestration. Healthy patients seeking primary liposuction of the abdomen for aesthetic reasons were included. Lipoaspiration was performed in a clockwise pattern, and the order of the cannulas was rotated. Negative pressure was maintained at 0.8 atm at all times. Ten ml of fat, obtained from the suction tube, was poured into 20-ml conical centrifugal tubes for further processing. One gram of lipoaspirate was extracted from each sample, and acridine orange stain was added. Adipocytes were extracted, extended in a frotis, and observed by a histologist (masked fashion) under fluorescence microscopy. Viability was reported in percentages per sample. RESULTS: The overall viability was 64.75% ± 18.58. The viability of the obtained samples ranged from 66.51± 20.66 % to 62.83 ± 18.1. In further analysis, comparing the viability according to the shaft diameter and fenestration area, there was no significant difference among groups. CONCLUSIONS: Neither the diameter of the cannula nor the size of the fenestrations are determining factors to affect the viability of the adipocytes. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Efficacy and Safety of Pirfenidone in Patients with Second-Degree Burns: A Proof-of-Concept Randomized Controlled Trial.

OBJECTIVE: Several studies suggest that pirfenidone may have a potential off-label use for wound healing. However, the effectiveness of this medication in patients with burns remains uncertain. Accordingly, investigators sought to assess wound re-epithelialization in patients with second-degree burns after adding pirfenidone to usual care. DESIGN AND SETTING: Single-center pilot, proof-of-concept, single-blind randomized controlled trial. PATIENTS AND INTERVENTION: Eight patients with second-degree burns were treated with occlusive hydrocolloid dressings and were randomly allocated to receive either no additional treatment or pirfenidone. OUTCOME MEASURES: The primary outcome of the study was to evaluate wound healing between groups based on the thickness of the re-epithelialized epidermis at day 7. Secondary outcomes were to qualitatively assess the development of fibrotic tissue in the dermis, anomalies in the basal membrane, and the development of collagen fibers by histologic analysis. Liver and renal functions were measured daily to assess the overall safety of oral pirfenidone. MAIN RESULTS: Patients treated with pirfenidone showed a remarkable improvement in wound re-epithelialization at day 7 (148.98 ± 13.64 vs 119.27 ± 15.55 µm; P = .029; 95% confidence interval, 4.14-55.29). Histologic evaluations showed less wound fibrosis in the pirfenidone group. CONCLUSIONS: A decrease in wound healing time by enhancing wound re-epithelialization was observed with pirfenidone. Larger clinical trials are needed to reach more reliable conclusions.

Determination of the Ratio of the Decantation Time and the Separation of Components in Lipoaspirate.

Decantation of the lipoaspirate is one of the most common techniques used to prepare the fat graft. The aim of the study was to determine the ideal time of decantation that provides the best separation of the components without compromising the viability of the adipocytes. METHODS: Thirty milliliters of fat were obtained from 11 healthy adults and decanted at room temperature for 0, 30, and 60 minutes. After decantation, the infiltration liquid and the remnant fat were measured with a volumetric pipette. Once the solution was removed, the remnant fat was centrifuged at 3000 rpm for 5 minutes to separate any residual solution, to measure the amount of actual fat obtained at that time point. Viability was determined with trypan blue staining for all the samples. RESULTS: After decantation, 9.4 ± 0.79 mL of fat was obtained at time 0, whereas 7.7 ± 1.56 mL was obtained at 30 minutes and 6.9 ± 0.92 mL at 60 minutes. Actual fat volume was 6.6 ± 1.56 mL, 5.5 ± 1.39, and 5.26 ± 1.3 mL, respectively. Viability at time 0 was 73.33 ± 0.06%, 72.57 ± 0.1% at 30 minutes, and 59.3 ± 0.09% at 60 minutes (P = 0.004). RESULTS: The fat grafting, processed by decantation, will have the best performance within a period of 30 minutes after harvesting, where the best rate of viability and separation of components will be achieved.

Effect of refrigeration in the viability and apoptosis of decanted adipocytes after liposuction.

OBJETIVO: Evaluar el efecto de la refrigeración en la apoptosis y la viabilidad del lipoaspirado en las primeras 2 horas después de la toma. MÉTODO: Se incluyeron 20 pacientes que fueron sometidas a una liposucción del abdomen por razones estéticas. Se obtuvieron 5 ml de grasa y se procesaron para su estudio. La viabilidad se determinó usando azul tripano. La apoptosis se determinó usando el ensayo TUNEL. RESULTADOS: Todas las pacientes eran mujeres, con una edad media de 36.5 años (rango: 21-67). Con respecto a la viabilidad, en el tiempo 0, en el grupo control fue del 59.08 ± 24% y en el grupo de refrigeración fue del 60.96 ± 22%; a los 60 minutos, los valores fueron del 50.82 ± 21% y el 55 ± 32.6%, respectivamente (p = 0.74); y a los 120 minutos, fueron del 42.69 ± 20.85% y el 50.33 ± 21%, respectivamente. En cuanto a la apoptosis, el porcentaje de células apoptóticas en el tiempo 0 fue del 37.87 ± 9.7% para el grupo de control y del 34.28 ± 9.74% para las muestras refrigeradas; a los 60 minutos, del 51.11 ± 8.64% y el 45.94 ± 9.15%, respectivamente; y a los 120 minutos, del 62.97 ± 13.33% y el 55.81 ± 9.45%, respectivamente. CONCLUSIONES: Refrigerar el lipoaspirado a 4 °C disminuyó la mortalidad y la apoptosis de los adipocitos en menos del 10% en las primeras 2 horas desde la toma.

OBJECTIVE: To evaluate the effect of refrigeration in the apoptosis and viability of the lipoaspirate in the first 2 h after harvesting. METHODS: 20 consecutive patients who underwent liposuction from the abdomen for esthetic reasons were included. 5 ml of fat were obtained and processed for study. The viability was obtained using trypan blue. Apoptosis was determined using TUNEL assay. RESULTS: All patients were female with a median age of 36.5 (21-67) years. On regard of the viability, at time 0, the viability in the control group was 59.08 ± 24% and 60.96 ± 22% in the refrigeration group. At 60 min, the values were 50.82 ± 21% versus 55 ± 32.6% (p = 0.74) and a 120 min, 42.69 ± 20.85% and 50.33 ± 21% respectively. On regard of apoptosis, the percentage of apoptotic cells at time 0 was 37.87 ± 9.7% for the control group and 34.28 ± 9.74% for refrigerated samples. At 60 min 51.11 ± 8.64% versus 45.94 ± 9.15% and at 120 min, 62.97 ± 13.33% versus 55.81 ± 9.45% respectively. CONCLUSIONS: Refrigerating the lipoaspirate at 4 °C decreased the mortality and apoptosis of the adipocytes in <10% within the first 2 h from harvesting.

Effectiveness of surgical treatment in chronic migraine.

OBJECTIVE: Migraine affects more than 35 million people in the United States of America, and 10% of the population in the world. The purpose of this study was to evaluate the effectiveness of surgical treatment in chronic migraine with frontal or occipital trigger areas. METHODS: We designed a pilot, proof of concept, and prospective study to analyze the effectiveness of surgical release of trigger nerves in severe frontal or occipital chronic migraines. The study was approved by the Ethics and Investigation Committee of Hospital Universitario Dr. José Eleuterio González (Monterrey, N.L., Mexico). We included patients diagnosed with chronic migraine by the neurology service of Hospital Universitario Dr. José Eleuterio González that attended our consult from March to December 2012. The patients were assessed by the MIDAS questionnaire and the diagnosis confirmed by injecting 2% lidocaine in the trigger sites. We realized a superior palpebral approach in frontal migraines to resection the glabellar muscles and an occipital approach to free the greater occipital nerve bilaterally. We evaluated complete and partial clinical response measuring the frequency, intensity, and duration of migraine episodes. RESULTS: We included three patients with Stage IV (severe incapacitating) frontal or occipital chronic migraines. Two were occipital trigger sites and one frontal. We obtained complete clinical response in two patients and a partial response in one. Pain intensity decreased in all patients. CONCLUSION: Surgical treatment is effective in Stage IV (severe incapacitating) frontal or occipital trigger chronic migraines.

OBJETIVOS: La migraña crónica afecta a más de 35 millones de personas en los EE.UU. y al 10% de la población en México. El objetivo de este estudio fue valorar la efectividad del tratamiento quirúrgico en la migraña crónica con sitios detonantes frontal u occipital para proponerla como alternativa quirúrgica en nuestro medio. MÉTODO: Se incluyeron pacientes con diagnóstico de migraña crónica con sitios detonantes frontal u occipital valorados por el servicio de neurología del Hospital Universitario Dr. José Eleuterio González (Monterrey, N.L., México) que acudieron a consulta de marzo a diciembre de 2012, con la autorización del Comité de Ética e Investigación. Se valoraron mediante el cuestionario MIDAS, y los sitios gatillo se confirmaron con la inyección de lidocaína al 2%. Se realizó un abordaje en el surco palpebral superior para liberar los músculos corrugadores y procerus en caso de detonante frontal, y un abordaje occipital para liberar el nervio occipital mayor bilateral. Se valoró la respuesta clínica total y parcial según la intensidad, la frecuencia y la duración de los episodios migrañosos mensuales. RESULTADOS: Se incluyeron tres pacientes con migraña crónica en etapa IV (incapacidad grave), a los que correspondían dos sitios detonantes frontal y uno occipital. Obtuvimos dos pacientes con respuesta clínica completa y una con respuesta parcial. La intensidad del dolor mejoró en todos los pacientes. CONCLUSIONES: El tratamiento quirúrgico es efectivo en la migraña crónica con sitios detonantes frontal u occipital en pacientes con incapacidad grave.

Effect of Decantation Time on Viability and Apoptosis in Adipocytes After Liposuction.

BACKGROUND: The effect of decantation time on viability and apoptosis in adipocytes has not been described. The objective of the study was to describe viability and apoptosis in adipocytes up to 2 h after harvesting. METHODS: Twenty patients who underwent esthetic liposuction from the abdomen were included. The lipoaspirate was obtained from the infra-umbilical area with the tumescent technique. Liposuction was performed with a 60-ml syringe and a 3-ml cannula. Lipoaspirates were centrifuged at 50 g for 5 min at 0, 60 and 120 min after harvesting. One gram of fat was digested with 0.1% type 1 collagenase and incubated at 37 degrees for 30 min. Adipocytes were counted on 10 random microscopic fields. Apoptosis was determined by TUNEL assay. A fluorescence microscope was used to visualize the staining nuclei and cells. RESULTS: Regarding viability, immediately after harvesting, 57.6 ± 18.9% of the cells were viable, whereas 60 min after liposuction the viability decreased to 51.62 ± 8.8% and 120 min after liposuction the percentage of viable cells was 46.8 ± 16.9%. The percentage of apoptotic cells at time 0 was 38.2 ± 8.0%, whereas it was 51.24 ± 8.1% at 60 min and 62.9 ± 16.1% at 120 min after collection. CONCLUSIONS: Apoptosis and mortality of adipocytes after liposuction increase directly proportional to the time of decantation. Lipoinjection should be performed as soon as possible after harvesting. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A Test for the Clinical Evaluation of the Flexor Digitorum Superficialis of the Fifth Finger.

Physical examination is essential in diagnosing tendinous lesions. This is particularly true of the flexor digitorum superficialis of the little finger (FDS5), which is functionally absent in approximately 30% of the population. The objective of our study was to determine the diagnostic value of 3 clinical tests commonly used to assess the function of this tendon. METHODS: Patients with wounds of the FDS5 were included in this study. Under local or regional anesthesia, 3 described clinical tests were performed to assess the function of the FDS5: (i) the classic test; (ii) Stein's modified test, and (iii) Mecott's modified test. We determined sensitivity, specificity, and predictive values of all such tests. The integrity of the tendon was assessed surgically. Correlation among blinded observers was also established. RESULTS: A total of 28 subjects with a mean age of 28 years (ranging from 5 to 56) participated in this study. The classic test obtained a sensitivity of 100% and a specificity of 72%; Stein's test resulted in a sensitivity of 83% and a specificity of 95%, whereas Mecott's test reached a sensitivity of 100% and a specificity of 95%. CONCLUSIONS: Among the 3 tests described and used in our study, Mecott's modified test proved to be more sensitive and specific than the other two; therefore, we consider this to be the test that should be used in determining the integrity of the FDS5.

Effectiveness of surgical treatment in chronic migraine.

Objective: Migraine affects more than 35 million people in the United States of America, and 10% of the population in the world. The purpose of this study was to evaluate the effectiveness of surgical treatment in chronic migraine with frontal or occipital trigger areas. Methods: We designed a pilot, proof of concept, and prospective study to analyze the effectiveness of surgical release of trigger nerves in severe frontal or occipital chronic migraines. The study was approved by the Ethics and Investigation Committee of Hospital Universitario Dr. José Eleuterio González (Monterrey, N.L., Mexico). We included patients diagnosed with chronic migraine by the neurology service of Hospital Universitario Dr. José Eleuterio González that attended our consult from March to December 2012. The patients were assessed by the MIDAS questionnaire and the diagnosis confirmed by injecting 2% lidocaine in the trigger sites. We realized a superior palpebral approach in frontal migraines to resection the glabellar muscles and an occipital approach to free the greater occipital nerve bilaterally. We evaluated complete and partial clinical response measuring the frequency, intensity, and duration of migraine episodes. Results: We included three patients with Stage IV (severe incapacitating) frontal or occipital chronic migraines. Two were occipital trigger sites and one frontal. We obtained complete clinical response in two patients and a partial response in one. Pain intensity decreased in all patients. Conclusion: Surgical treatment is effective in Stage IV (severe incapacitating) frontal or occipital trigger chronic migraines.

Objetivos: La migraña crónica afecta a más de 35 millones de personas en los EE.UU. y al 10% de la población en México. El objetivo de este estudio fue valorar la efectividad del tratamiento quirúrgico en la migraña crónica con sitios detonantes frontal u occipital para proponerla como alternativa quirúrgica en nuestro medio. Método: Se incluyeron pacientes con diagnóstico de migraña crónica con sitios detonantes frontal u occipital valorados por el servicio de neurología del Hospital Universitario Dr. José Eleuterio González (Monterrey, N.L., México) que acudieron a consulta de marzo a diciembre de 2012, con la autorización del Comité de Ética e Investigación. Se valoraron mediante el cuestionario MIDAS, y los sitios gatillo se confirmaron con la inyección de lidocaína al 2%. Se realizó un abordaje en el surco palpebral superior para liberar los músculos corrugadores y procerus en caso de detonante frontal, y un abordaje occipital para liberar el nervio occipital mayor bilateral. Se valoró la respuesta clínica total y parcial según la intensidad, la frecuencia y la duración de los episodios migrañosos mensuales. Resultados: Se incluyeron tres pacientes con migraña crónica en etapa IV (incapacidad grave), a los que correspondían dos sitios detonantes frontal y uno occipital. Obtuvimos dos pacientes con respuesta clínica completa y una con respuesta parcial. La intensidad del dolor mejoró en todos los pacientes. Conclusiones: El tratamiento quirúrgico es efectivo en la migraña crónica con sitios detonantes frontal u occipital en pacientes con incapacidad grave.

Explanatory Model of Resilience in Pediatric Burn Survivors.

Identifying factors of adjustment in pediatric burn patients may facilitate appropriate mental health interventions postinjury. The aim of this is study was to explore the roles of both the patient's and caregivers' resilience and posttraumatic stress in pediatric burn survivor adjustment. For the purposes of the study, "51 patient-parent/guardian" dyads participated. Patients answered the Resilience Questionnaire for Children and Adolescents, and caregivers answered the Mexican Resilience Scale and the Davidson Trauma Scale. The roles of patient age, time since the burn, and size of burn injury were also considered. Statistical analyses included Spearman's ρ for correlations and structural equation modeling. P less than .05 was considered significant. Patients and caregivers reported high levels of resilience, and the majority of caregivers reported low severity of posttraumatic stress disorder symptoms. Pediatric burn survivors' resilience was associated with being younger at the time of the burn and less severity of intrusive and avoidance symptoms in caregivers; it was also associated with a higher resilience in caregivers. It can be concluded that psychological responses of caregivers of pediatric burn survivors affect the well being and positive adjustment of patients; thus psychological services for caregivers would likely have a double benefit for both caregivers and patients.

Reliable scar scoring system to assess photographs of burn patients.

BACKGROUND: Several scar-scoring scales exist to clinically monitor burn scar development and maturation. Although scoring scars through direct clinical examination is ideal, scars must sometimes be scored from photographs. No scar scale currently exists for the latter purpose. MATERIALS AND METHODS: We modified a previously described scar scale (Yeong et al., J Burn Care Rehabil 1997) and tested the reliability of this new scale in assessing burn scars from photographs. The new scale consisted of three parameters as follows: scar height, surface appearance, and color mismatch. Each parameter was assigned a score of 1 (best) to 4 (worst), generating a total score of 3-12. Five physicians with burns training scored 120 representative photographs using the original and modified scales. Reliability was analyzed using coefficient of agreement, Cronbach alpha, intraclass correlation coefficient, variance, and coefficient of variance. Analysis of variance was performed using the Kruskal-Wallis test. Color mismatch and scar height scores were validated by analyzing actual height and color differences. RESULTS: The intraclass correlation coefficient, the coefficient of agreement, and Cronbach alpha were higher for the modified scale than those of the original scale. The original scale produced more variance than that in the modified scale. Subanalysis demonstrated that, for all categories, the modified scale had greater correlation and reliability than the original scale. The correlation between color mismatch scores and actual color differences was 0.84 and between scar height scores and actual height was 0.81. CONCLUSIONS: The modified scar scale is a simple, reliable, and useful scale for evaluating photographs of burn patients.

Retinol binding protein: marker for insulin resistance and inflammation postburn?

INTRODUCTION: Burn injury leads to vast changes in both metabolic and inflammatory responses and is associated with increased morbidity and mortality. Insulin resistance (IR) and hyperglycemia are major components of the hypermetabolic response found in burn-injured patients and subsequently contribute to adverse outcomes. Studies have shown that increased systemic retinol binding protein (RBP) levels are associated with IR and hyperinflammation in diabetic and obese patients. The aim of this study was to determine RBP profiles and to test the hypothesis that elevated RBP levels are associated with both IR and the inflammatory response in burned patients. METHODS: RBP was measured in 372 patients during the acute stay postburn. Patients' demographics, glucose levels, and insulin administration were recorded. Cytokines, hormones, plasma proteins, and organ markers were measured. The average of all measurements of RBP (2.1 mg/dL) was used to divide patients into high and low groups. Statistical analysis was performed by Student t test. Statistical significance was accepted at P < .05. RESULTS: Fifty-one patients (high group) had elevated RBP levels during acute hospitalization and demonstrated a significant higher incidence of multiorgan failure, sepsis, and mortality (P < .05). Moreover, in the high group, a significant increase of IR, inflammatory cytokines, and catabolic and organ-specific markers were detected (P < .05). CONCLUSIONS: Increased RBP levels postburn correlate with increased IR, inflammatory and catabolic responses, incidence of multiorgan failure, and mortality. RBP may be a novel biomarker to monitor these detrimental responses postburn.

The role of acute pancreatitis in pediatric burn patients.

Few publications recognize acute pancreatitis as a complication after large burns, consequently the incidence and outcome acute pancreatitis after burn in children is not well defined. The aim of this study was to determine the incidence, morbidity, and mortality relating to acute pancreatitis in a pediatric burn population and to correlate clinical diagnosis with autopsy findings to determine the incidence of unrecognized pancreatitis. Records of 2699 patients with acute burns were reviewed. Acute pancreatitis was defined as abdominal pain and/or feeding intolerance in addition to a three-fold elevation of amylase and/or lipase. One-hundred twenty-seven burned children served as the control cohort. To assess the presence of autopsy confirmed AP in pediatric burn patients, we evaluated autopsy reports of 78 children who died from burns, looking for reported evidence of pancreatic inflammation, and fat/parenchymal necrosis. Our data show that acute pancreatitis in children has a low incidence after burn. The study included 2699 patients of which 13 were suffering acute pancreatitis (13/2699 = 0.05%). Mortality is significantly higher for the acute pancreatitis group vs. the control group, p < 0.05. Autopsy reports established 11 of 78 patients with evidence of pancreatitis, resulting in an incidence of 0.17% for pancreatitis at autopsy. Although it has low incidence, acute pancreatitis is associated with increased mortality in severely burned pediatric patients, which underlines the importance of increased vigilance in the evaluation and treatment of pancreatitis in burned children.

Impact of anesthesia, analgesia, and euthanasia technique on the inflammatory cytokine profile in a rodent model of severe burn injury.

Anesthetics used in burn and trauma animal models may be influencing results by modulating inflammatory and acute-phase responses. Accordingly, we determined the effects of various anesthetics, analgesia, and euthanasia techniques in a rodent burn model. Isoflurane (ISO), ketamine-xylazine (KX), or pentobarbital (PEN) with or without buprenorphine were administered before scald-burn in 72 rats that were euthanized without anesthesia by decapitation after 24 h and compared with unburned shams. In a second experiment, 120 rats underwent the same scald-burn injury using KX, and 24 h later were euthanized under anesthesia or carbon dioxide (CO2). In addition, we compared euthanasia by exsanguination with that of decapitation. Serum cytokine levels were determined by an enzyme-linked immunosorbent assay. In the first experiment, ISO was associated with elevation of cytokine-induced neutrophil chemoattractant 2 (CINC-2) and monocyte chemotactic protein 1 (MCP-1), and KX and PEN was associated with elevation of CINC-1,CINC-2, IL-6, and MCP-1. Pentobarbital also decreased IL-1". IL-6 increased significantly when ISO or PEN were combined with buprenorphine. In the second experiment, euthanasia performed by exsanguination under ISO was associated with reduced levels of IL-1", CINC-1, CINC-2, and MCP-1, whereas KX reduced CINC-2 and increased IL-6 levels. Meanwhile, PEN reduced levels of IL-1" and MCP-1, and CO2 reduced CINC-2 and MCP-1. In addition,decapitation after KX, PEN, or CO2 decreased IL-1" and MCP-1, although we found no significant difference between ISO and controls. Euthanasia by exsanguination compared with decapitation using the same agent also led to modulation of several cytokines. Differential expression of inflammatory markers with the use of anesthetics and analgesics should be considered when designing animal studies and interpreting results because these seem to have a significant modulating impact. Our findings indicate that brief anesthesia with ISO immediately before euthanasia by decapitation exerted the least dampening effect on the cytokines measured. Conversely, KX with buprenorphine may offer a better balance during longer procedures to avoid significant modulation. Standardization across all experiments that are compared and awareness of these findings are essential for those investigating the pathophysiology of inflammation in animal models.

The use of exenatide in severely burned pediatric patients.

INTRODUCTION: Intensive insulin treatment (IIT) has been shown to improve outcomes post-burn in severely burnt patients. However, it increases the incidence of hypoglycemia and is associated with risks and complications. We hypothesized that exenatide would decrease plasma glucose levels post-burn to levels similar to those achieved with IIT, and reduce the amount of exogenous insulin administered. METHODS: This open-label study included 24 severely burned pediatric patients. Six were randomized to receive exenatide, and 18 received IIT during acute hospitalization (block randomization). Exenatide and insulin were administered to maintain glucose levels between 80 and 140 mg/dl. We determined 6 AM, daily average, maximum and minimum glucose levels. Variability was determined using mean amplitude of glucose excursions (MAGE) and percentage of coefficient of variability. The amount of administered insulin was compared in both groups. RESULTS: Glucose values and variability were similar in both groups: Daily average was 130 ± 28 mg/dl in the intervention group and 138 ± 25 mg/dl in the control group (P = 0.31), MAGE 41 ± 6 vs. 45 ± 12 (respectively). However, administered insulin was significantly lower in the exenatide group than in the IIT group: 22 ± 14 IU patients/day in the intervention group and 76 ± 11 IU patients/day in the control group (P = 0.01). The incidence rate of hypoglycemia was similar in both groups (0.38 events/patient-month). CONCLUSIONS: Patients receiving exenatide received significantly lower amounts of exogenous insulin to control plasma glucose levels. Exenatide was well tolerated and potentially represents a novel agent to attenuate hyperglycemia in the critical care setting. TRIAL REGISTRATION: NCT00673309.

The role of hyperglycemia in burned patients: evidence-based studies.

Severely burned patients typically experience a systemic response expressed as increased metabolism, inflammation, alteration of cardiac and immune function, and associated hyperglycemia. Hyperglycemia has been associated with an increased risk of morbidity and mortality in critically ill patients. Until recently and for many years, hyperglycemia has been expectantly managed and considered a normal and desired response of an organism to stress. However, findings reported from recent studies now suggest beneficial effects of intensive insulin treatment of critically ill patients. The literature on the management of hyperglycemia in severely burned patients is sparse, with most of the available studies involving only small numbers of burned patients. The purpose of this article is to describe the pathophysiology of hyperglycemia after severe burns and to review the available literature on the outcome of intensive insulin treatment and other anti-hyperglycemic modalities in burned patients in an evidence-based medical approach.