The application of early goal directed therapy in patients during burn shock stage.

Early goal directed therapy (EGDT) provided at the earliest stages of burn shock, has significant benefits for ordinary burn patients, however, its effect on patients with more than 80% of total surface area burned (TBSA) still remains unclear. In this study, 34 extensively burned patients with (87.3±5.6)% of total surface area burned were collected from January 2008 to January 2014. All burn patients here had similar monitoring or treatment modalities. Of these 34 burn patients, 13 patients were treated with EGDT under pulse indicator continuous cardiac output (PICCO) monitoring, and 21 patients were treated with conventional fluid management. Information obtained in the course of treatment included mean arterial pressure (MAP), central venous oxygen saturation (ScvO2), oxygenation index (PaO2/FiO2), blood lactic acid and urine volume, infusion volume (mL·1% TBSA-1·Kg-1), complications of over-resuscitation (hydrothorax or pulmonary edema), case rate of burn sepsis and fatality. Our results demonstrated that there existed significant difference between the two groups in parameters below: 1. Higher ScvO2 (%) after EGDT (EGDT: 78.1±8.6, CG: 65.5±11.2; t=-3.446, P<0.05), 2. Higher PaO2/FiO2 after EGDT (EGDT: 381.4±56.6, CG: 328.9±48.6; t=2-875, P<0.05), 3. Lower mean infusion volume after EGDT (mL·1% TBSA-1·Kg-1) (EGDT: 3.29±0.26, CG: 3.71±0.31; t=5.292, P<0.05), 4. Lower complications of over-resuscitation after EGDT (EGDT: 2/13, CG: 15/21; P<0.05); However, no statistical significance existed in parameters below: 1. MAP (EGDT: 76.2±13.1, CG: 74.3±15.6; t=-0.36, P>0.05), 2. Urine volume (EGDT: 0.83±0.12, CG: 0.85±0.17; t=0.370, P>0.05), 3. Case of burn sepsis (EGDT: 13/13, CG: 20/21; P=1), 4. Case fatality (EGDT: 1/13, CG: 3/21; P=1). The finding results showed that patients with more than 80% of total surface area burned during burn shock phase could get better outcome from EGDT.

Zileuton reduces inflammatory reaction and brain damage following permanent cerebral ischemia in rats.

5-Lipoxygenase inhibitor zileuton has been demonstrated to attenuate ischemic brain damage in rats of permanent focal cerebral ischemia in previous work. To further investigate the mechanism underlying zileuton's neuroprotection, adult male Sprague-Dawley rats underwent permanent middle cerebral artery occlusion (MCAO), then received treatment with zileuton or vehicle after the onset of ischemia. Neurological deficit, cerebral infarction, and morphological characteristic were measured 6 and 24 h after MCAO. The enzymatic activity of myeloperoxidase (MPO) was assessed 6 and 24 h after MCAO and the lipid peroxidation levels were evaluated by malondialdehyde assay. Expression of nuclear factor-kappa B (NF-kappaB) p65 in rat brain was detected by immunohistochemistry and Western blot. Expression of inducible nitric oxide synthase (iNOS) in rat brain was determined by RT-PCR and Western blot. Nitric oxide production in rat brain was also measured 24 h after MCAO. The concentration of TNF-alpha and IL-1beta in serum were detected by ELISA. Zileuton significantly reduced neurological deficit scores, cerebral infarct volume, MPO activity, and the lipid peroxidation levels. It also inhibited the expression of NF-kappaB and decreased the expression and activity of iNOS in rat brain. In addition, zileuton attenuated the release of TNF-alpha and IL-1beta in serum. Our results suggest that zileuton reduces inflammatory reaction and brain damage in a rat model of permanent focal cerebral ischemia. The neuroprotective effect of zileuton in cerebral ischemia might be associated with the inhibition of inflammatory reaction.