Circulating sFasL Levels Predict the Severity and Outcome of Burn Injury: A Prospective Observational Study.

BACKGROUND: Severe burn injury activates shock, inflammation, and blood cell system, but inappropriate reactions may lead to adverse outcomes. Soluble Fas ligand (sFasL) participates in apoptosis and inflammatory response. The circulating sFasL levels we investigated in association with the burn severity, shock, inflammation, blood cells, and mortality in patients with severe burns. METHODS: A total of 56 patients with severe burns were recruited. The levels of sFasL and the biomarkers reflecting shock, organ damage, inflammation, and blood cells at 48 h postburn were analyzed. We compared the practical situation of patients that stratified by median sFasL levels and investigated the predictive value of sFasL for mortality. RESULTS: High circulating sFasL levels were associated with the higher degrees of burn index, shock index, lactate, N-terminal probrain natriuretic peptide, total bilirubin, blood urea nitrogen, creatinine, tumor necrosis factor-α, interleukin-1ß, interleukin-8, intercellular adhesion molecule 1, and complement 3, and the lower degrees of oxygenation index, lymphocytes, and platelets. Multiple linear regression analysis showed that the higher tumor necrosis factor-α (P < 0.001) and the lower oxygenation index (P = 0.031) and lymphocytes (P = 0.043) were associated with the higher sFasL. High sFasL (a unit is 50 ng/L) (odds ratio [OR] 5.50 [95% CI 1.04-29.20], P = 0.045) was an independent predictor of increased mortality by multivariate logistic regression analysis. CONCLUSIONS: High circulating sFasL at 48 h postburn in patients with severe burns reflect shock, proinflammatory response, organ damage, and lymphocyte reductions and predict 30-day mortality.

Comparative effectiveness of different wound dressings for patients with partial-thickness burns: study protocol of a systematic review and a Bayesian framework network meta-analysis.

INTRODUCTION: Selecting a suitable wound dressing for patients with partial-thickness burns (PTBs) is important in wound care. However, the comparative effectiveness of different dressings has not been studied. We report the protocol of a network meta-analysis designed to combine direct and indirect evidence of wound dressings in the management of PTB. METHODS AND ANALYSIS: We will search for randomised controlled trials (RCTs) evaluating the wound-healing effect of a wound dressing in the management of PTB. Searches will be conducted in MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Cochrane Wounds Group Specialised Register and CINAHL. A comprehensive search strategy is developed to retrieve articles reporting potentially eligible RCTs. Besides, we will contact the experts in the field and review the conference proceedings to locate non-published studies. The reference lists of articles will be reviewed for any candidate studies. Two independent reviewers will screen titles and abstracts of the candidate articles. All eligible RCTs will be obtained in full text to perform a review. Disagreement on eligibility of an RCT will be solved by group discussion. The information of participants, interventions, comparisons and outcomes from included RCTs will be recorded and summarised. The primary outcome is time to complete wound healing. Secondary outcomes include the proportion of burns completely healed at the end of treatment, change in wound surface area at the end of treatment, incidence of adverse events, etc. ETHICS AND DISSEMINATION: The result of this review will provide evidence for the comparative effectiveness of different wound dressings in the management of PTB. It will also facilitate decision-making in choosing a suitable wound dressing. We will disseminate the review through a peer-review journal and conference abstracts or posters. TRIAL REGISTRATION NUMBER: PROSPERO CRD42016041574; Pre-results.

[Multi-center clinical trial of FLAMIGEL (hydrogel dressing) for the treatment of residual burn wound].

OBJECTIVE: To evaluate the effect of FLAMIGEL (hydrogel dressing) on the repair of residual burn wound. METHODS: Sixty burn patients with residual wounds hospitalized in 6 burn units from November 2011 to May 2012 were enrolled in the multi-center, randomized, and self-control clinical trial. Two residual wounds of each patient were divided into groups T (treated with FLAMIGEL) and C (treated with iodophor gauze) according to the random number table. On post treatment day (PTD) 7 and 14, wound healing rate was calculated, with the number of completely healed wound counted. The degree of pain patient felt during dressing change was evaluated using the visual analogue scale (VAS). The mean numbers of wounds with score equal to zero, more than zero and less than or equal to 3, more than 3 and less than or equal to 6, more than 6 and less than or equal to 10 were recorded respectively. Wound secretion or exudate samples were collected for bacterial culture, and the side effect was observed. Data were processed with repeated measure analysis of variance, t test, chi-square test, and nonparametric rank sum test. RESULTS: Wound healing rate of groups T, C on PTD 7 was respectively (67 ± 24)%, (45 ± 25)%, and it was respectively (92 ± 16)%, (72 ± 23)% on PTD 14. There was statistically significant difference in wound healing rate on PTD 7, 14 between group T and group C (F = 32.388, P < 0.01). Ten wounds in group T and four wounds in group C were healed completely on PTD 7, with no significant difference between them (χ(2) = 0, P > 0.05). Forty-two wounds in group T and seven wounds in group C healed completely on PTD 14, with statistically significant difference between them (χ(2) = 42.254, P < 0.01). Patients in group T felt mild pain during dressing change for 37 wounds, with VAS score higher than zero and lower than or equal to 3. Evident pain was observed in patients of group C during dressing change for 43 wounds, and it scored higher than 3 and less than or equal to 6 by VAS evaluation. There was statistically significant difference in mean number of wounds with different grade of VAS score between group T and group C (Z = -4.638, P < 0.01). Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, E. coli, Baumanii, and Staphylococcus epidermidis were all detected in both groups, but there was no statistical difference between group T and group C (χ(2) = 0.051, P > 0.05). No side effect was observed in either of the two groups during the whole trial. CONCLUSIONS: FLAMIGEL can accelerate the healing of residual burn wounds and obviously relieve painful sensation during dressing change.

[Changes in the plasma levels of endotoxin in severe burn patients under the treatment of antibiotics].

OBJECTIVE: To investigate the changes in the plasma levels of endotoxin in severe burn patients during administration of antibiotics. METHODS: Fifty severe burn patients with burn area larger than 30% TBSA were enrolled in the study, and they were respectively treated with Netilmicin (A group), Cefoperazone (B group), Ceftazidime (C group) and Imipenem/Cilastatin (D group). Venous blood samples were harvested for determination of endotoxins levels before treatment and 1, 2, 3, 5, 7 post-treatment day (PTD). RESULTS: The plasma levels of endotoxin were elevated in different degrees in A, B and C groups. The plasma levels of endotoxin in B group were higher on 1, 2 PTD than on 3, 5, 7 PTD, and they were also higher than that in D group (P < 0.05). The plasma levels of endotoxin in C group reached the peak on 5 PTD [(0.398 +/- 0.172) EU/mL], which were higher than that before treatment [(0.251 +/- 0.142) EU/mL, P < 0.05] and other groups (P < 0.05). The plasma levels of endotoxin in D group were lower on 1, 2 PTD than that before treatment (P < 0.05). CONCLUSION: Different amounts of endotoxins can be released after treatment with antibiotics in severe burn patients. Attention should be paid to the effect of antibiotics on the levels of endotoxin in practice.

[Influence of polysaccharide from Aloe vera on the proliferation of the human epithelial cells cultured in vitro].

OBJECTIVE: To investigate the influence of polysaccharide from Aloe Vera (AP) on the proliferation of the human epithelial cells cultured in vitro. METHODS: The human epithelial cells undergoing 3 to 4 passages of confluence culture were randomly divided into control and 25, 50, 100, 200 and 400 mg/L AP groups according to different dosage of the polysaccharide (AP) added into the culture medium. In the control group (C), equal volume of DK-SFM medium was added to the culturing cells. The conjugation time of epithelial cells, the changes in the cell morphology and ultrastructure were observed under inverted phase contrast microscope and transmission electron microscope, respectively. The cell proliferation was measured by MTT, cell count analysis and [(3)H]-TdR incorporation. Flow cytometry analysis was employed to detect the cell cycle. The leakage rate of lactate dehydrogenase (LDH) was assayed for the evaluation of the epithelial cell injury. RESULTS: There was no significant difference in the morphology of the epithelial cells among the groups under inverted phase contrast microscope. But under the transmission electron microscope (TEM), the cells in 100 to 400 mg/L AP groups were seen to have proliferated actively, with euchromatin dominant in the nuclei, while heterochromatin was dominant in the cellular nucleus in control and 25 mg/L AP groups. The confluence time of epithelial cells in 50, 100, 200, 400 mg/L AP groups (154 +/- 12, 141 +/- 20, 130 +/- 19, 124 +/- 13) h preceded noticeably than that in control group (182 +/- 8) h, (P < 0.01). The cell proliferation in 100, 200, 400 mg/L groups reached the peak on the 5th day after AP treatment, while that in control and other groups was delayed by 1 to 2 days. The survival rate of the cells in 25 to 400 mg/L AP groups increased dramatically compared with that in control group, with its [(3)H]-TdR incorporation levels significantly increased in a dose dependent manner. The leakage rate of LDH in 200 and 400 mg/L AP groups was lower than that in control group (P < 0.01). The flow cytometric analysis of the cell cycle distribution revealed that the percentage of cell cycle from phase G0/G1 to G2/M and S in 25 to 400 mg/L AP groups increased significantly in a dose dependent manner compared with that in control group (P < 0.01). CONCLUSION: AP might be beneficial to the protection of epithelial cells by promoting cell proliferation through inducing the progression of epidermal cells from phase G0/G1 into G2/M and S phases.

[The change of the erythrocyte chemokine receptor binding activity in the shock stage of burn rats].

AIM: To investigate the change of the erythrocyte chemokine receptor(ECKR) binding activity in the shock stage of burn rats. METHODS: SD rats were randomly divided into two group, burn and control groups. In the burn group rats, 30% total body surface area (TBSA)were scalded to III degree. The binding activity of rat ECKR in the shock stage was detected by ELISA using IL-8 as ligand at various time points (0.5, 2, 4, 8, 16, 24 and 48 hours) after burn. RESULTS: Compared with control group, the binding activity of rat ECKR declined significantly half an hour after burn and maintained at low level for 48 hours (P<0.01). The comparison of the binding activity of rat ECKR at various time points after burn indicated that the binding activity declined gradually from 2 hours (P<0.01-0.05), reached lowest value 24 hrs, and then rose significantly 48 hrs after burn (P<0.01). CONCLUSION: The ECKR binding activity declined significantly after burn, suggesting erythrocytes may participate in the regulation of chemokines and play some role in the inflammation.

[Change of the erythrocyte chemokine receptor binding activity in scalded rats with Pseudomonas aeruginosa infection].

OBJECTIVE: To explore the influence of infection on the erythrocyte chemokine receptor (ECKR) binding activity in severely scalded rats. METHODS: The Sprague-Dawley (SD) rats were randomly divided into three group: sham scald group (A), burn and infection group (B) and infection group (C). The B group rats were scalded with 30% total body surface area (TBSA) of III degree, and the rats ECKR binding activity with interleukin-8 (IL-8) as ligand were detected by enzyme-linked immunosorbent assay (ELISA) at 1, 2, 4, 6 and 8 hours after infection. RESULTS: Compared to that in A group, ECKR binding activities declined significantly (both P<0.01) after infection in both of B and C groups, but they increased at 8 hours (P<0.01). ECKR binding activity in B group was significantly less at 2, 8 hours than that in C group after infection (both P<0.05). The declining range of ECKR binding activity was more in B group, in which the decline of ECKR binding activity appeared earlier (2 hours) than that in C (6 hours) group. CONCLUSION: The infection lead to the decline of ECKR binding activity in burned rats, and the erythrocytes might participate in the chemokine regulation and play a novel role in the infection.