Alkali burn injury model of meibomian gland dysfunction in mice

AIM:To establish a stable,short-time,low-cost and reliable murine model of meibomian gland dysfunction(MGD).METHODS:A filter paper sheet soaked in 1.0 mol/L sodium hydroxide(NaOH)solution was used to touch the eyelid margin of C57BL/6J mice for 10s to establish the model.The other eye was left untreated as a control group.Eyelid margin morphological changes and the meibomian glands(MGs)were observed by slit lamp microscopy on days 5 and 10 post-burn.Hematoxylin-eosin(HE)staining and Oil red O staining were adopted in detecting the changes in MGs morphology and lipid deposition.Real-time polymerase chain reaction,Western blot,immunofluorescence staining and immunohistochemical staining were used to detect interleukin(IL)-6,IL-1β,IL-18,tumor necroses factor(TNF)-α,interferon(IFN)-γ,nicotinamide adenine dinucleotide phosphate(NADPH)oxidase 4(NOX4),3-nitroturosine(3-NT),4-hydroxynonenal(4-HNE)and cytokeratin 10(K10)expression changes in MGs.RESULTS:MGs showed plugging of orifice,glandular deficiency,abnormal acinar morphology,ductal dilatation,and lipid deposition after alkali burn.The expressions of IL-6,IL-18,IL-1β,IFN-γ,and TNF-αindicators of inflammation and oxidative stress in MGs tissues were significantly increased.Abnormal keratinization increased in the MG duct.CONCLUSION:A murine model of MGD is established by alkali burn of the eyelid margin that matches the clinical presentation of MGD providing a stable,short-time,lowcost,and reliable MGD model.The new method suggests efficient avenues for future research.

Angioinvasive mucormycosis in burn intensive care units:A case report and review of literature

BACKGROUND Mucormycosis is a rare,rapidly progressive and often fatal fungal infection.The rarity of the condition lends itself to unfamiliarity,delayed treatment,and poor outcomes.Diagnosis of fungal infections early enough to enable appropriate treatment occurs in less than half of affected patients.CASE SUMMARY An 11-year-old girl with a history of 15%total body surface area scald burns involving both lower limbs progressed to develop angioinvasive mucormycosis.This further led to a thrombosis of the right external iliac artery and vein and rapidly progressive necrosis of surrounding soft tissues.She also had dextrocardia and patent foramen ovale.A right hip disarticulation and serial aggressive debridements were performed but she went on to develop systemic sepsis with multisystem involvement and succumbed to the infection.Pathology revealed mucor species with extensive vascular invasion.CONCLUSION This case highlights the importance of maintaining vigilance for mycotic infections and acting appropriately when there are signs of fulminant wound infection.

The New Approach to the Diagnostics and Treatment of Endogenous Intoxication in Patients with Burn Injury

Background: The main causes of mortality in patients with burn injury are the development of systemic inflammatory process, multiple organ failure and septic complications. The aim of the research: Improvement of diagnostic and therapeutic approaches to the detection and elimination of endogenous intoxication in patients with burn injury. Materials and methods: The main study group consisted of 19 patients and the comparison group—of 10 patients with burn injury. 92 blood serum (BS) samples of the patients of the main group were tested, using the method of fluorescence spectroscopy (MFS). The advanced therapeutic tactics were proposed for the patients of both groups. The control group consisted of 40 healthy individuals (donors). BS of these patients was also tested using MFS. Results: Patients with burn injury have endogenous intoxication in their blood. The effective concentration of albumin is reduced in patients with burn injury due to the blockage of albumin binding centers by bacterial metabolism products. Fluorescence spectra (FS) of BS in patients with burn trauma and donors were obtained and investigated. Based on MFS results, an improved treatment regimen using infusion of albumin solution was proposed. Conclusions: An improved technique for the management of patients with burn injury is based on the use of MFS for the diagnostic evaluation of endogenous intoxication in them. The idea of pathological changes in albumin molecules in patients with burn injury is pathogenetically substantiated by the successful use of infusion of albumin solution in these patients on the basis of the MFS.

Burn injury induces histopathological changes and cellproliferation in liver of rats

AIM: To investigate effects of severe burn injury(BI) in rat liver through the histopathological and inflammatory markers analysis. METHODS: Forty-two male Wistar rats were distributed into two groups, control(C) and subjected to scald BI(SBI). The animals were euthanized one, four and 14 d post sham or 45% of the total body surface BI. Liver fragments were submitted to histopathological, morphoquantitative(hepatocyte area and cell density), ciclooxigenase-2(COX-2) immunoexpression, and gene expression [real-time polymerase chain reaction for tumor necrosis factor(TNF)-α, inducible nitric oxide synthase(i NOS) and caspase-3] methods. RESULTS: Histopathological findings showed inflammatory process in all periods investigated and hepatocyte degeneration added to increased amount of connective tissue 14 d post injury. Hepatocyte area, the density of binucleated hepatocytes and density of sinusoidal cells of SBI groups were increased when compared with control. COX-2 immunoexpression was stronger in SBI groups. No differences were found in TNF-α, i NOS and caspase-3 gene expression. CONCLUSION: BI induces histopathological changes, upregulation of COX-2 immunoexpression, and cell proliferation in liver of rats.

The effects of PAF antagonist on intestinal mucosal microcirculation after burn in rats

INTRODUCTIONGut originated infection(GOI)has been recognizedas a potential factor for postburn irreversible shock,early sepsis and multiple system organ failure.The intestinal mucosal barrier injury has beenimplicated as the cause of postburn GOI.However,pathogenesis of the lesion is not

Effects of nutritional support route on intestinal structure and function in the early stage of severe burn injury

Objective:To assesstheclinicaleffectsof enteralnutritionon intestinalstructureandfunctionintheearly stageof severeburns.Methods :Nineteencasesof severeburninjuryweredividedrandomlyintoenteralnutrition group(EN)andparenteralnutritiongroup(PN).Gastrin,motilin,malondialdehyde(MDA),superoxidedismutase(SOD),endotoxin,tumornecrosis(TNF),diamineoxidase(DAO)andlactulose/mannitol(L/M)weredeterminedon postburnday1,4,8,14(PBD)respectively.Results:Serumgastrinandmotilinon PBD4and8weresignificantly higherinENgroupthanin PN group(P<0.05-0.01).PlasmaMDAon PBD4andPBD8was obviouslylowerin EN groupthaninPNgroup(P<0.01).PlasmaSODon PBD4andPBD8was significantlyhigherinENgroupthaninPN group(P<0.01).Atthemosttimepoints,endotoxinandTNFweresignificantlylowerinENgroupthaninPN group(P<0.01).SerumDAOtendedto decreaseinENgroup,andon PBD4itwasobviouslylowerinENgroupthaninPN group(P<0.01).GutpermeabilityL/Mon PBD4,PBD8wasobviouslyinENgrouplowerthaninPN group(P<0.05-0.01).Therewas positivecorrelationbetweenL/MandDAO,andbetweenMDAandTNF(P<0.05-0.01),and negativecorrelationbetweenL/MandSOD(P<0.01).Conclusion:On thebasisof thefindings,itis consideredthat theearlyenteralnutritionis moreeffectiveto preservethesecretionandmotilityof gastrointestinaltract,decrease intestinalischemiaandreperfusioninjury,reduceintestinalpermeability,decreaseplasmaendotoxinandmediators,andmaintainmucosabarrierfunction.Enteralnutritionis superiorto parenteralnutritionintheearlystageof severe burninjury.

Effects of AMD3100 subconjunctival injection on alkali burn induced corneal neovascularization in mice

AIM: To investigate the therapeutic effects of local and systemic administration of AMD3100 for alkali burn induced corneal neovascularization (CNV) in mice. METHODS: CNV was induced in vivo by alkaline burn of cornea in C57BL/6 mice. AMD3100 was administrated topically by subconjunctival injection or systemically by intraperitoneal injection for 7 days; balanced salt solution was administrated topically or systemically as a control respectively. Inflammatory index was evaluated by slit-lamp biomicroscopy and inflammatory cells infiltrated to cornea tissue were detected by histologic analysis at multiple time points. CNV was compared between the local and systemic treated mice 2 weeks after alkali burn, as quantified by CD34 immunostaining. Fluorescence-Activated Cell Sorter Analysis was used to investigate the mobilizing effects of EPC in mice after subconjunctival injected or intraperitoneal injected AMD3100. Immunohistochemistry was used to detect the expression of endothelial progenitor cells (EPC) marker proteins VEGFR2 and CD34. RESULTS: Three days after alkali burn, infiltration of inflammatory cells was found in corneal tissue. At the first 7 days of local injection group, the number of inflammatory cells was significantly lower than that in systemic injection group. CNV could be seen at the 7(th) day, and at the 14(th) day reached the peak, then started to decrease. The number of CNV in the subconjunctival injection group was 7.57 +/- 1.26 per 0.034mm(2), compared to a number of 14.87 +/- 2.21 per 0.034mm(2) in the control group (P<0.05). On the contrary, the number of CNV in the intraperitoneal injection group was a little higher than that in the control group, 16.34 +/- 1.53 per 0.034mm(2) vs 13.26 +/- 1.87 per 0.034mm(2). The research also showed that intraperitoneally, but not subconjunctivally injected AMD3100 could mobilize EPC. On the other hand, subconjunctival, but not intraperitoneally injected AMD3100 could reduce the expression of EPC marker proteins. CONCLUSION: In mice locally administrated AMD3100 can reduce the number of alkali burn induced CNV. The number of inflammatory cells and inflammatory responses in corneal tissue.

A Rare Case of Multiple Scar Contractures after Burn Injury

A nine-year-old girl sustained extreme postburn contractures of the face, neck, both axillae, elbows, wrists, and ankles, due to flame injury 5 years ago. No primary and plastic surgical burn treatment was available in a remote area of China. From October, 2005 to April, 2007, all adhesions were released in five operations and the huge defects covered with local musculo-cutaneous flaps, z-plasties, and with thick split skin gafts. This led to an optimal functional result and an aesthetic restoration of the face, giving her, back her self-esteem in daily life.

Effects of Exogenous Na-DL-3-Hydroxybutyrate and Insulin on Skeletal Muscle Protein Metabolism in Rats after Early Severe Burn Injury

the effects of exogenous Na -DL- 3 - hydroxybutyratc (3- HOBNa) and insulin (I)on skeletal muscle protein metabolism in rats infected with 37% TBSA full thickness scald werestudied. It was found that the serum acetoacetatc (AcAc) of the burned animals showed nosignificant difference from the control on the 4th day postburn. but the free fatty acid (FFA) de-ereased markedly and the urinary 3 - methylhistidine (3 - MH ) excretion and the protein degrada-tion rate of the soleus muscle of the injured hind limb increased markedly. Infusion of3 - HOBNa for 3 consecutive days following bums could lower the urinary 3 - MH excretion andthe protein degradation rate of the soleus muscle with no significant influence on the skeletal muscleprotein anabolism. Moreover, investigations revealed that there was no synergistic effect ofinsulin -ketonc body combination on the anti- catabolic capacity in burned rats.

A study on mitochondrial respiratory dysfunction and lipid peroxidation in the liver after radiation,burn,and combined radiation-burn injuries in mice

Male mice were subjected to 6 Gy total body irradiation,20% TBSAfull-thickness burns,or combined radiation-burn injury and lipid peroxides(LPO),vita-min E,sulfhydryl group,respiratory control ratio(RCR),ADP/O ratio,and cytochromeoxidase activity of the liver mitochondria were determined in the first 9 d postinjury.Theresults are as follows:(1)LPO level increased in the early postinjury stage after combinedradiation-burn injury,on the 5th-7th day after irradiation and on the 7th day postburn.(2)Vitamin E level decreased significantly in the two groups of radiation and burn inju-ries but showed no significant decrease after combined injury.(3)The sulfhydryl groupshowed a tendency to increase in all the 3 groups.(4)The activity of cytochrome oxidaseincreased significantly on the 7th day after radiation but decreased considerably in theburn and combined injury groups.(5)RCR and ADP/O ratio decreased more significantlyin the combined injury group than in either the radiation group or the burn group.These facts suggest that the respiratory dysfunction of the liver mitochondria results mostprobably from the damage on the mitochondrial membrane due to lipid peroxidation.

NITRIC OXIDE SYNTHESIS IN MYOCARDIUM FOLLOWING BURN INJURY IN RATS

The nitric oxide and cyclic GMP production in myocardium early after burn injury in rats were investi- gated. Nitric oxide synthase activity was measured in cytosols from the left ventricular wall of burned rats. Cytosols from the control group animals were shown to contain mainly Ca2+ dependent nitric oxide synthase （cNOS） with small amount of Ca2+ independent nitric oxide synthase （iNOS）. Following burn injury, there was a marked increase in iNOS activity with a peak at sh post-burn, however, myocardial cNOS ac- tivity was found to decline obviously. Parallel to iNOS induction there was a significant increase in myocar- dial nitric oxide and cyclic GMP production. All these changes were alleviated by treatment of the rats with dexamethasone. Since increases in cyclic GMP levels in the heart were associated with reduced myocardial contractility, it is possible that enhanced production of nitric oxide by a Ca2+, independent NO synthase ac- counts, at least in part, for the depression of myocardial contractility seen in burn animals and patients.

Inhibitory effect of polysulfated heparin endostatin on alkali burn induced corneal neovascularization in rabbits

AIM: To investigate anti-angiogenic effects of polysulfated heparin endostatin(PSH-ES) on alkali burn induced corneal neovascularization(NV) in rabbits.METHODS: An alkali burn was made on rabbit corneas to induce corneal NV in the right eye of 24 rabbits. One day after burn creation, a 0.2 m L subconjunctival injection of 50 μg/m L PSH-ES, 50 μg/m L recombinant endostatin(ES), or normal saline was administered every other day for a total of 14d(7 injections). Histology and immunohistochemisty were used to examine corneas.Corneal NV growth was evaluated as microvessel quantity and corneal vascular endothelial growth factor(VEGF)expression was measured by immunohistochemical assay.RESULTS: Subconjunctival injection of ES and PSHES resulted in significant corneal NV suppression, but PSH-ES had a more powerful anti-angiogenic effect than ES. Mean VEGF concentration in PSH-ES treated corneas was significantly lower than in ES treated and saline treated corneas. Histological examination showed that corneas treated with either PSH-ES or ES had significantly fewer microvessels than eyes treated with saline. Additionally corneas treated with PSH-ES had significantly fewer microvessels than corneas treated with ES.CONCLUSION: Both PSH-ES and recombinant ES effectively inhibit corneal NV induced by alkali burn.However, PSH-ES is a more powerful anti-angiogenic agent than ES. This research has the potential to provide a new treatment option for preventing and treating corneal NV.

COMPUTER SIMULATION OF SYSTEM CONTROLAPPLICATION IN DESIGNING ON ANTI-SHOCK RESUSCITATION THERAPY FOR BURN INJURED PATIENTS

Objective To create a new fluid resuscitation technique for burn injury patient which makes burninjury patient pass smoothly the acute phase with less edema. Methods Mathematical model of fluid and proteinbalance of burn injured patient in acute phase was adopted and computer simulation of the system control wasutilized. The fluid resuscitation protocol designed by computer simulation were applied to twelvepatients.Results The new method has better effects with less side- effects. Conclusion The computer- simulationdesigned fluid therapy protocol provide a better resuscitation than the fluid therapy protocol produced by usingempirical formula.

Recombinant outer membrane protein F-B subunit of LT protein as a prophylactic measure against Pseudomonas aeruginosa burn infection in mice

AIM: To study immunogenicity of outer membrane protein F(Opr F) fused with B subunit of LT(LTB), against Pseudomonas aeruginosa(P. aeruginosa). METHODS: The Opr F, a major surface exposed outer membrane protein that is antigenically conserved in various strains of P. aeruginosa, is a promising immunogen against P. aeruginosa. In the present study recombinant Opr F and Opr F-LTB fusion gene was cloned, expressed and purified. BALB/c mice and rabbits were immunized using recombinant Opr F and Opr F-LTB and challenged at the burn site with P. aeruginosa lethal dose of 104 CFU. The protective efficacy of rabbit anti Opr F Ig G against P. aeruginosa burn infection was investigated by passive immunization. RESULTS: It has been well established that the LTB is a powerful immunomodulator with strong adjuvant activity. LTB as a bacterial adjuvant enhanced immunogenicity of Opr F and anti Opr F Ig G titer in serum was increased. Experimental findings showed significantly higher average survival rate in burned mice immunized with Opr F-LTB than immunized with Opr F or the control group. Rabbits anti Opr F Ig G brought about 75% survival of mice following challenge with P. aeruginosa. Post challenge hepatic and splenic tissues of mice group immunized with Opr F-LTB had significantly lower bacterial load than those immunized with Opr F or the control groups. CONCLUSION: These results demonstrate that LTBfused Opr F might be a potential candidate protein for a prophylactic measure against P. aeruginosa in burn infection.

Pediatric thermal burn injury:A retrospective analysis from pediatric care institutes,Eastern India

Objective:Pediatric burns pose difficult healthcare issues in underdeveloped nations.Due to the scarcity of pediatric burn care facilities and qualified burn‑care staff,patients are frequently referred from a rural hospital.This study explores the burn‑treatment approach that could be used in rural hospitals in the absence of a dedicated pediatric burn care facility.Materials and Methods:A retrospective analysis of clinical data of 199 children who received treatment for burn‑injury in an isolated general surgical ward.Wound debridement under anesthesia at the earliest was the cornerstone of the treatment plan for this cohort.Until the wounds healed,the treatment was repeated every alternate day.The patient’s demographic data,number of surgical dressings,length of hospital stay,and outcome were analyzed.Results:The mean age of the patients was 51.68±23.79 months.The male‑female ratio was 1.45:1.The survival rate was 99.00%.The disability rate was 4.52%.Univariate logistic regression identified the age group,total body surface area affected,depth of the wound,and time of intervention as statistically significant variables(P<0.05)predicting the disfigurement.Multivariate logistic regression identified the time intervals between surgical intervention and injury as an important predictor of morbidity.In addition,delayed presentation and delayed intervention led to a longer hospital stay,and more interventions than the early intervention cohort.Conclusions:Early debridement accelerates recovery and lessens the need for future skin grafts or contracture procedures.This approach can be used in rural hospitals as well because pediatric burns can be manageable in an isolated general ward.

Burn Injuries in Elderly—A Retrospective Analysis of a Ten Year Period

Objective: Geriatric patients represent a separate group in the treatment of burn injury regarding pathogenesis, pathophysiology and therapeutic procedure. Methods: From 2000 to 2010 on our burn unit 53 patients aged over 60 years were treated. The mean age of the 27 women and 26 men was 76 years (60 - 102 years), with an average of 33.2% of total burn surface area. 25 patients (47.2%) had severe inhalation injury, 77.4% of the patients suffered full thickness burn injuries. Mean ABSI Score was 12. Relevant additional diseases were coronary heart disease, heart insufficiency, hypertension, COPD, adiposity and chronic alcoholism. Results: 22 patients were treated by early operative intervention (day 0 - 4), 13 of these patients survived further process. In 17 cases first operative procedure could take place only at a later date, 14 patients deceased before operation. 26 patients developed pneumonia. The total morbidity amounted to 26 of 53 patients (49%). A total of 19 injured with a burn index over 80 survived. 9 of them had an index of more than 100. Usual indices as the “Zellweger Index” and the ABSI-Score are not adequate to determine the prognosis of thermal injuries in the elderly. Conclusion: The treatment of elderly with burn trauma is affected by many factors. Compared to younger patients the increased incidence of an inhalation injury is decisive for the prognosis of older patients. The frequency of pre-existing diseases is clearly largely than with younger burn injured patients. These prognostically relevant parameters were not sufficiently considered by established score systems.

Burn Injury Due to Hot Water Bottle

Hot water bottles, generally used to comfort and relief from aches and pains. We present a case of scald burn caused by hot water bottle. The circumstances of this injury and preventive measures are discussed in this case report.

Study on integrated treatment of severe burn in batch patients

Objective:To explore the burn treatment and first aid flow mode in batch patients.Methods:A retrospective analysis was performed on the treatment experience of 10 or more patients in the group burn accident admitted to the Third Affiliated Hospital of Inner Mongolia Medical University from 2008 to 2020,in order to acquire the general information(e.g.,age,sex[male and female],injury causes and factors,total burn surface area,inhalation injury and compound injury),the time when each first-aid rescue team was in place;the reception time of the triage group;specialist rescue start time;treatment process and treatment outcome in patients with severe burns,such as the establishment time of deep venous access.Results:67 cases(n=68)of patients were cured and the curative ratio was 98.5%.The average time from the rescue order of the commander-in-chief to the placement of each medical group was 8.8 minutes,the average reception time of the triage group was 4.5 minutes,the average specialist rescue start time was 18.6 minutes,and the average establishment time of deep vein access for patients with severe burns was about 11.3 minutes.Conclusions:Scientific and reasonable pre-hospital emergency triage and treatment for burn patients can be achieved by implementing integrated treatment.

Significance of D-dimer assay in the diagnosis of acute pulmonary embolism after deep second-degree burn in rabbits

Objective: To explore the significance of D-dimer assay in the diagnosis of acute pulmonary embolism (APE) after deep second-degree burn by detecting the changes of plasma D-dimer in rabbits with deep second-degree burn and in different phases of burn with concomitant pulmonary embolism. Methods: 48 healthy male or female Chinese white rabbits, were randomly divided into: control group, burn group, burn shock group, burn shock + pulmonary embolism group, burn infection group and burn infection + pulmonary embolism group, with 8 rabbits in each group. By use of the ELISA method, the plasma D-dimer was determined on 1 d, 3 d, 5 d, 7 d, 14 d and 21 d after modeling in the burn group and the control group, and the plasma D-dimer in other groups was detected in 30 min, 1 h, 3 h, 6 h, 24 h after modeling. Results: The expression of D-dimer in the burn group was higher than that in the control group on 1 d, 3 d, 5 d and 7 d (p < .05). There were significant differences in the expression of D-dimer in the burn shock + pulmonary embolism group in comparison to the burn shock group (p < .05). There were also some significant differences in the expression of D-dimer in the burn infection+ pulmonary embolism group in comparison with the burn shock + pulmonary embolism group (p < .05). Conclusions: There were some differences in the expression of D-dimer in each group. D-dimer can be used as one of diagnostic indexes for deep second-degree burn with pulmonary embolism.

Flame Burn Injury in Yichang of China:the Trends,Complications,and Risk Factor Analysis

Background A flame burn is an injury of body tissues,including respiratory tract damage,due to exposure to a flame or its dense smoke.Flame burns cause some of the most physically and psychologically devastating forms of trauma.Compared to scald burns,flame burn patients have a higher mortality rate and a higher frequency of multiorgan failure.The purpose of this research was to investigate the trends,complications,and mortality risk factors of flame burns at the Department of Plastic and Burn Surgery(DPBS)of the People’s Hospital of China Three Gorges University(PHCTGU).Methods A retrospective analysis of 48 flame burn patients—accounting for 8.3%of the 576 burn victims admitted for burns at the PHCTGU from February 1,2010,to September 30,2019—was performed after collecting information from the Burns Registry of the said hospital.Results The proportion of patients with flame burns was 8.3%(n=48).The mean total body surface area(TBSA)affected was 27.6%.The mean duration of hospitalization was 32.5 days.The etiologies of the flame burns were as follows:gas explosions(21,43.8%),ethanol(8,16.7%),charcoal fire(7,14.6%),petrol explosions(4,8.3%),wooden houses(4,8.3%),and others,including dust,cigarette lighter,and burning incense,accounting for 8.3%of cases(4).Finally,42(87.5%)patients were treated and discharged,and 6(12.5%)patients died.Complications included scarring in 38(90.5%)patients,severe scar contractures on different parts of the body in 25(60.0%)patients,scar ulcer in 6(14.3%)patients,keloids in 3(7.1%)patients,and scar cancer in 1(2.4%)patient.Multiple complications occurred in the same patient.The only risk factor for mortality that was identified was TBSA(P=0.043).Conclusions Our study revealed that a small population(8.3%)was injured by flame burns,but 6 deaths were recorded.Society must continually enhance safeguard procedures to flames and strengthen education to protect life and avoid severe complications.