The domestication of fire: the relationship between biomass fuel, fossil fuel and burns.

Primitive man's discovery and use of fire had a tremendous impact on modern development. It changed lifestyles, and brought with it new fuel sources and cooking methods. It also introduced devastation, injury, pain, disfigurement, and loss of life, and the need to continuously develop management, training and prevention programs.

Trends in injury-related deaths before and after dissolution of the Union of Soviet Socialist Republics.

The relationship of death rates due to injury with the dissolution of the Soviet empire deserves special focus because of the impact of injury deaths on the productive working population between the ages of 15 and 65 years. A retrospective review was performed of annual mortality rates due to intentional and unintentional injuries, using WHO data from 1980 to 2003. Using data from a comparison group in Western Europe, the nations of the former Union of Soviet Socialist Republics (USSR) were studied. Annual death rates were examined using polynomial regression after 3-year moving averages smoothed the plots. The majority of trends in injury-related death noted in the comparison group decreased constantly over time. In contrast, many nations of the former USSR experienced an initial decrease, reaching a nadir in 1985 - 1987, followed by an increase in injury-related deaths. Moreover, many of these nations experienced a subsequent decrease following the dissolution of the USSR in 1991. The monitoring of trends in injury mortality in countries experiencing social and political upheavals is warranted.

A multicenter review of toxic epidermal necrolysis treated in U.S. burn centers at the end of the twentieth century.

Toxic epidermal necrolysis (TEN) is a potentially fatal disorder that involves large areas of skin desquamation. Patients with TEN are often referred to burn centers for expert wound management and comprehensive care. The purpose of this study was to define the presenting characteristics and treatment of TEN before and after admission to regional burn centers and to evaluate the efficacy of burn center treatment for this disorder. A retrospective multicenter chart review was completed for patients admitted with TEN to 15 burn centers from 1995 to 2000. Charts were reviewed for patient characteristics, non-burn hospital and burn center treatment, and outcome. A total of 199 patients were admitted. Patients had a mean age of 47 years, mean 67.7% total body surface area skin slough, and mean Acute Physiology and Chronic Health Evaluation (APACHE II) score of 10. Sixty-four patients died, for a mortality rate of 32%. Mortality increased to 51% for patients transferred to a burn center more than one week after onset of disease. Burn centers and non-burn hospitals differed in their use of enteral nutrition (70 vs 12%, respectively, P < 0.05), prophylactic antibiotics (22 vs 37.9%, P < 0.05), corticosteroid use (22 vs 51%, P < 0.05), and wound management. Age, body surface area involvement, APACHE II score, complications, and parenteral nutrition before transfer correlated with increased mortality. The treatment of TEN differs markedly between burn centers and non-burn centers. Early transport to a burn unit is warranted to improve patient outcome.

Occupation-related burn injuries.

Unlike household burn injuries, the characteristics of burn injuries in the workplace have not been well described. In an effort to understand the causes and effects of occupation-related burn injuries and to aid in prevention, we sought to describe work-related burn injuries by frequency, burn type, age of the patients, body parts burned, and occupation of the patients. This was a statewide, cross-sectional study of all burns that occurred in the workplace during 1994. Data on fatal injuries were obtained from the National Census of Fatal Occupational Injuries. Survey data from the North Carolina Department of Labor were used for nonfatal injuries. Burns caused 34 deaths (15.3%) and 1720 injuries in the workplace in 1994. Of the nonfatal injuries, 1363 (79.2%) were caused by exposure to caustic substances or hot objects or substances. The head and upper extremities were the most frequently injured body parts (936 injuries; 57.6%). The average age of those burned was 30.7 years; most of the patients ranged from 25 to 35 years old. High-risk occupations included vehicle and equipment cleaners, food service personnel, and millwrights (11.3%, 5.3%, and 5.2% of burn injuries, respectively). Unlike the flame burns that occur in homes, exposure to caustics and hot objects and substances caused the majority of on-the-job burn injuries. Protective gear for the head and upper extremities may prevent a significant number of burns. Education and prevention programs may best be directed at workers with high-risk occupations and workers in the 25- to 35-year age range.

Dietary olive oil enhances murine lymphocyte calcium uptake.

BACKGROUND: Dietary lipids enhance immune function and improve outcome from injury or infection in animal models. We tested the hypothesis that amount, type, or both, of dietary lipid increases intracellular calcium concentration, a surrogate for lymphocyte activation. METHODS: Mice were fed 2 weeks on semipurified diets with 5% (by weight [w/w]), 10% (w/w), or 20% (w/w) dietary fat consisting of coconut, olive, safflower, or linseed oil. Changes in intracellular calcium concentration after mitogen stimulation of splenic lymphocytes was estimated by using flow cytometry. RESULTS: Olive oil diets increase intracellular calcium concentration after concanavalin A, lipopolysaccharide, and CD3 stimulation. On the other hand, linseed oil (which is high in omega-3 fatty acids, which have been shown in other studies to enhance immune function) depresses intracellular calcium levels. The amount of dietary fat had no effect on intracellular calcium. CONCLUSION: Olive oil merits further study in the application of nutritional pharmacology to immunomodulation of the critically injured, because it may enhance lymphocyte function.

High-fat diets suppress CD3 and CD25 expression on the surface of murine lymphocytes.

To determine the effects of dietary fats on surface antigen expression, we tested the effects of amount and type of dietary fat on murine lymphocytes. Mice were fed diets with 12 en%, 23 en%, or 47 en% fat containing coconut, olive, safflower, or linseed oil. After 2 wk of ad libitum feeding, the mice were killed and splenic lymphocytes were harvested. Lymphocytes were incubated with fluorescent-tagged monoclonal antibodies and assayed for mean and total surface expression using flow cytometry. Our results show that high-fat (47 en%) diets suppress expression of CD3 and CD25 antigens. We also found that linseed-oil diets suppress expression of CD11a but enhance expression of CD25 antigens. Both CD3 and CD25 are critical for lymphocyte activation, and we conclude that immunosuppression associated with high-fat diets may be associated with suppression of these surface antigens.

Nutritional support for burn injuries.

There are approximately 2,000,000 burns each year in the United States that require medical treatment. Fortunately, most of these can be treated on an outpatient basis; however, 100,000 patients are hospitalized yearly. The mortality rate is higher in patients with large burns or smoke inhalation injury or both, or in patients otherwise compromised by age or concomitant disease. Thermal injury leads to suppression of the immune response, and infectious morbidity is common in all burn patients. In addition, the injury and recovery processes are attended by tremendous catabolism of host tissues, leaving patients debilitated and functionally impaired. Medical nutrition therapy plays a key role in the support of the burn patient, supporting the immune system and blunting the hypermetabolic response.

Surveillance of burn wound infections: a proposal for definitions.

The diagnosis of burn wound infections is a subjective art, with no recent attempts to standardize or validate the definitions of terms used to discuss such infections. The Centers for Disease Control included definitions of types of burn wound infections in its definitions for nosocomial infections in 1988. Although the other Centers for Disease Control criteria for nosocomial infections have epidemiological applications, its criteria for burn wound infections have neither clinical nor epidemiological value to burn centers and their health care providers. With the approval of the Board of Trustees of the American Burn Association, the authors of this article formed a working subcommittee of the Committee on the Organization and Delivery of Burn Care. Definitions of burn wound infections are presented for consideration for application in either of 2 areas: (1) surveillance of burn wound infections in burn centers and (2) standardized criteria for multicenter clinical trials or national registries.

Chemical dependency in patients with burn injuries: a fortress of denial.

Chemical dependency is frequently encountered in patients admitted to burn centers. We were interested in the prevalence of chemical dependency among our patients, as well as the rate at which those patients sought further treatment after discharge. Blood and urine specimens were collected within 24 hours of admission from 843 patients more than 18 years of age admitted with acute injuries. Many patients admitted to substance abuse during routine psychosocial evaluation; others admitted only when confronted by the counselor with positive toxicology test results. Of 51 patients counseled, 12 denied a history of chemical dependency. Of the other 39, 21 admitted to a history of chemical dependency, and 31 tested positive for either alcohol or drugs in toxicology screening. Every patient identified with chemical dependency was informed of existing substance abuse programs and given the opportunity to be referred to any of these programs. Only half of the patients who were offered rehabilitation therapy accepted treatment.

Involvement of CD44 and the cytoskeletal linker protein ankyrin in human neutrophil bacterial phagocytosis.

The leukocyte CD44 and CD45 cell surface receptors are associated via the linker proteins ankyrin and fodrin with the cytoskeleton, which itself is important in immune cell functions such as adherence, chemotaxis, and phagocytosis. The effects of rat antihuman CD44 and CD45 monoclonal antibodies on phagocytosis of fluoresceinated heat-killed Staphylococcus aureus 502A by normal human neutrophils (PMNs) during 2 hr incubation in RPMI-1640 was studied via flow cytometry and confocal microscopy. Flow cytometry was performed using an excitation wavelength of 488 nm, fluorescence being measured at 515-560 nm on 50,000 PMNs per sample. Confocal microscopy was performed on samples after further incubation with rhodamine-conjugated antiankyrin. Anti-CD44 resulted in an increase of 27-31% compared to control (P = 0.004) in the proportion of PMNs fluorescing, an increase of 17-24% (P = 0.001) in mean intracellular fluorescence per PMN, and an increase in total PMN fluorescence of 50-58% compared to control (P < 0.001). In contrast, anti-CD45 had little effect on phagocytosis. Colchicine (a microtubule-disrupting agent) enhanced, whereas cytochalasin-D (a microfilament inhibitor) inhibited bacterial phagocytosis; cytochalasin-D completely abrogated the effect of anti-CD44 on this PMN function. Hyaluronic acid augmented phagocytosis by an increment similar to that observed with anti-CD44. Two-color flow cytometry and confocal microscopy demonstrated that ankyrin always colocalized with ingested fluorescein isothiocyanate (FITC)-labeled bacteria. These data strongly suggest that CD44 is involved in bacterial phagocytosis, provide further evidence of CD44 receptor linkage to cytoskeletal elements in human leukocytes, and suggest that ankyrin has a significant role in the transport of phagosomes.

Fatty acid unsaturation increases expression and capping of murine lymphocyte CD44 and CD45.

We studied the effect of incubating murine lymphocytes with cis-unsaturated fatty acids on expression and capping of CD44 and CD45. Lymphocytes were incubated with stearic (18:0) or oleic (18:1 omega-9) acid bound to bovine serum albumin (BSA). After incubation with rat anti-CD44 or anti-CD45 monoclonal antibodies and then with fluorescent-labeled anti-rat antibody, mean fluorescence intensity (FI) was measured by using flow cytometry. Capping was measured after warning and fixation in paraformaldehyde. Steady-state fluorescence anisotropy (rs) was measured after the cells had been incubated with trimethylammoniumdiphenylhexatriene. Incubation with oleic acid, but not stearic acid or BSA alone, was associated with an increase in FI of CD44. Expression of CD45, however, was increased by both stearic and oleic acids to the same degree over BSA controls. CD44 and CD45 capping were both increased by incubation with oleic acid. Rs was decreased in cells incubated with oleic acid, suggesting an increase in membrane fluidity. We conclude that incubation with oleic acid increases expression of CD44 and increases capping of both CD44 and CD45. These findings were confirmed in feeding experiments, in which rs was reduced and CD44 capping increased by polyunsaturated fatty acid diets.

Association of murine splenocyte CD3 complex to the cytoskeleton: absence of modulation by exogenous fatty acids.

The cytoplasmic regions of the CD3 complex are presumably involved in signal transduction following ligand-receptor binding. We investigated the effects of incubating either stearic or oleic acid on the association of murine lymphocyte CD3 complex with the cytoskeleton. Both cytochalasin D, an inhibitor of microfilament formation, and W7, an inhibitor of calmodulin, inhibited capping of CD3. The association of CD3 with the cytoskeleton was confirmed by confocal laser scanning microscopy studies, which showed co-localization of the cross-linked CD3 receptors and the membrane attachment proteins ankyrin and fodrin. Although exogenous oleic acid increased plasma membrane fluidity, neither expression nor capping of CD3 receptors was increased. Nonetheless, oleic acid did increase uptake of tritiated thymidine after binding of anti-CD3 antibodies. Lymphoproliferation was progressively inhibited by both cytochalasin D and W7, confirming the importance of intact cytoskeleton for cellular activation.

Supplemental L-arginine HCl augments bacterial phagocytosis in human polymorphonuclear leukocytes.

That L-arginine (L-Arg) augments the host response to acute bacterial sepsis suggests that this amino acid intervenes early in the immune response, perhaps via the nitric oxide synthetase (NOS) pathway. The effect of L-Arg supplementation on in vitro phagocytosis of fluorescein-labeled, heat-killed Staphylococcus aureus by peripheral blood neutrophils (PMNs) from 12 normal human volunteers was studied. Separated PMNs were incubated for 2 h with labeled bacteria, with and without supplemental L-Arg, D-arginine, glycine, and/or the NOS inhibitors L-canavanine, aminoguanidine, or L-NG-nitroarginine methyl ester. PMNs were fixed and extracellular fluorescence quenched with crystal violet. By flow cytometry and confocal microscopy, L-Arg supplementation was shown to result in a highly significant increase in PMN bacterial phagocytosis, the maximal effect being seen with L-Arg 380 microM and falling off with higher concentrations. This augmentation was completely abrogated by NOS inhibitors in molar excess, but inhibitors alone did not suppress phagocytosis below that of unsupplemented controls. Neither D-arginine nor glycine affected phagocytosis; the L-Arg effect was stereospecific and not related to utilization of L-Arg as an energy source. L-Arg supplementation significantly enhances bacterial phagocytosis in human neutrophils, perhaps by effects on cytoskeletal phenomena, and this appears to be mediated through NOS activity. Phagocytosis by nonspecific immune cells which intervene early in the response to sepsis is critically important, and beneficial effects of L-Arg on the clinical course of sepsis may be due at least in part to augmentation of phagocyte function.

Comparison of length of hospital stay to mortality rate in a regional burn center.

Data were collected prospectively from 196 patients admitted to our regional burn center during a 10-month period. Fifteen patients died during hospitalization, for a mortality rate of 7.7%. The mean hospital stay of the 181 patients who survived was 13.9 days (+/- 13.7 SD), ranging from 2 to 89 days. The mean burn size was 9.2% (+/- 11% SD), ranging from 0.5% to 60% total body surface area. One hundred ten patients received at least 1 day of antibiotic treatment, and 22 patients required ventilatory support during hospitalization. Hospital stay was longer for those requiring antibiotics (18.6 days vs 7 days) or ventilatory support (34.4 days vs 11.2 days). When these and other variables were entered into a linear regression model, the most powerful predictors of hospital stay were burn size and duration of antibiotic use (p = 0.0001), followed next by the presence of other traumatic injuries (p = 0.047).

High doses of dietary arginine during repletion impair weight gain and increase infectious mortality in protein-malnourished mice.

There is considerable evidence for the beneficial effects of dietary arginine, a conditionally-essential amino acid that enhances anabolism and T-cell function. However, the safety and efficacy of higher doses of arginine supplementation following infection have not been investigated completely. These issues were explored therefore, in a murine model of malnutrition and infection. Severe protein malnutrition was induced by feeding mice for 6 weeks on an isoenergetic diet containing only 10 g protein/kg. Mice were then allowed to consume diets with normal amounts of protein (200 g/kg) with 50 g/kg provided as amino acid mixtures of glycine and arginine in which the arginine content ranged from 0 to 50 g/kg. During the repletion period a significant weight gain was noted in the groups fed on diets with either 10 or 20 g arginine/kg, but not in the group fed on the diet with 50 g arginine/kg, compared with the diet with 0 g arginine/kg. Mortality rates after infection with Salmonella typhimurium were not decreased by the addition of 10 or 20 g arginine/kg to the diet, and were in fact worsened by supplementation with 50 g arginine/kg. The results of the present study showed that not only are the beneficial effects of arginine supplementation after infection lost when high doses are administered, but also that these high doses become toxic. Mice fed on higher doses showed significant impairment of weight gain and an increase in mortality rates.

Diets high in polyunsaturated oils decrease lymphocyte membrane anisotropy and B-cell mitogenesis.

Balb/c mice were fed semipurified diets containing 40% of total calories as lipids: olive, safflower, or fish oil. After 2 weeks of feeding, splenic mononuclear cells were isolated and assayed for steady-state fluorescence anisotropy by means of the probe diphenylhexatriene. Splenocytes were also incubated with the mitogens concanavalin A, phytohemagglutinin, or lipopolysaccharide; subsequent uptake of tritiated thymidine was measured as an index of proliferation. No differences were observed in the membrane anisotropy and mitogenesis of mice fed the olive oil diet (high in monounsaturated fatty acids) and the control group. However, membrane anisotropy was significantly lowered in mice fed the safflower or fish oil diets (high in polyunsaturated fatty acids), and the mitogenic response to lipopolysaccharide was suppressed. Mitogenic responses to concanavalin A and phytohemagglutinin were not significantly affected by the type of lipid in the diet.

Omega-3 polyunsaturated fatty acids: benefit or harm during sepsis?

omega-3 polyunsaturated fatty acids (PUFAs) are potent modulators of the immune response. Their inclusion in enteral diets may benefit surgical patients recovering from injury or infection. Caution should be used when supplementing omega-3 PUFAs, particularly when fish oil is used as the source. The long-chain, highly polyunsaturated fatty acids in fish oil are prone to autoxidation, and can potentially damage cells by forming free radicals. In addition, fish oil may impair the hemostatic response by inhibiting platelet aggregation. Finally, the biochemical and biological end points for the use of omega-3 PUFAs have not been clearly established. Thus, although omega-3 PUFAs offer tremendous potential as immunomodulators, they also offer potential toxicities, and we must employ them in our clinical practice with this understanding.

The esterified plasma fatty acid profile is altered in early HIV-1 infection.

Previous studies have shown that alterations in micronutrient utilization occur in patients with Acquired Immune Deficiency Syndrome. In this study, total plasma fatty acid composition was measured in 36 homosexual men infected with the Human Immunodeficiency Virus 1 (HIV-1) and in 17 HIV-1 seronegative homosexual men in order to evaluate differences associated with early HIV-1 infection. Immunologic assessment included CD4 cell number count and lymphocyte blastogenesis in response to the mitogens phytohemagglutinin (PHA) and pokeweed (PWM). The mean total amount of omega 6 polyunsaturated fatty acids (18:2 and 20:4) was significantly lower in the HIV-1 seropositive subjects (38 +/- 8.1% SD) as compared to HIV-1 seronegative subjects (43 +/- 4.2%; P = 0.0027). This was also reflected in a higher level of total saturated fatty acids (16:0 and 18:0) in HIV-1 seropositive subjects (30 +/- 2.2% vs. 26 +/- 2.8%; P = 0.0001). The ratio of linoleic to arachidonic acid (18:2 to 20:4) was higher in the HIV-1 seropositive group (6.76 +/- 4.88) compared to the HIV-1 seronegative group (4.86 +/- 1.37; P = 0.0213). The response to PHA in seropositive subjects correlated inversely with total plasma omega 6 fatty acids (r = -0.36; P = 0.027), and directly with the 18:2 to 20:4 ratio (r = 0.33; P = 0.046). CD4 cell counts and the response to PWM did not correlate with plasma fatty acid levels in HIV-1 seropositive subjects.(ABSTRACT TRUNCATED AT 250 WORDS)