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PubMed2006

Metabolic effects of l-alanyl-glutamine in burned rats.

Burn injury elicits a sustained hypermetabolic state characterized by accelerated hepatic synthesis of amino acids and proteolysis leading to negative nitrogen balance. This paper was aimed at studying the effects l-alanyl-glutamine (Ala-Gln) exogenous offer to rats submitted to thermal burn. Twenty-four anesthetized male Wistar rats were submitted to scald burn of dorsal skin (30% body surface). Eighteen and 42-h later rats were randomized to receive (by gavage) 2ml of water (G-1) or equal volume (0.5g/kg weight/day) of Ala-Gln solution (G-2). Tissue and blood samples were collected at the end of 24 and 48-h post-burn trauma (PBT). Blood concentrations of metabolites (glucose, pyruvate, lactate and ketone bodies) were similar in all groups. There were significant differences in tissue metabolites concentrations in Ala-Gln treated rats (G-2) compared to control (G-1) following scald injury. The administration of Ala-Gln to burned rats induces a fall ATP (muscle, healthy skin), pyruvate and ketone bodies (liver) concentrations 24-h PBT. It also induces significant increase of lactate (burned skin) 24-h and glucose (liver) 28/48-h PBT. Rise of tissue lactate concentrations may be due to enhanced anaerobic glycolysis resulting from increased availability of glutamate, derived from glutamine, with possible activation of the malate-aspartate shuttle.

Animals↗
PubMed2006

Characteristics of burn patients at a major burn center in Shanghai.

In China, burns are becoming a major cause of morbidity and mortality with large societal and economic implications. To date, there is little epidemiological data on burns in China to direct prevention efforts. This study describes the characteristics of burn patients admitted to a major burn center in Shanghai using a burn registry developed in Toronto, Canada. A retrospective review of burn patients discharged from the Shanghai's Rui Jin Hospital Burn Unit, between March 1st 2002 and April 30th 2003, was conducted. Of 527 patients discharged, 307 were acute burn patients and 302 (98.4%) had complete data to be included in the study. There were 214 (71%) males and 88 (29%) females with a male to female ratio of 2.4:1. The median age was 30 years, and the median total body surface area burned was 10%. The majority of burns occurred at work (58%), and the most frequent etiology was flames (39%) followed by scalds (31%) and contact with hot objects (15%). Sixteen (5%) patients had inhalation injury and six (2%) patients died. There were 70 (23%) children (0-14 years), 221 (73%) adults (15-59 years) and 11 (4%) seniors (60 years and above). Children had more scald burns (83%) and the majority (83%) occurred at home. Adults had more flame burns (46%) and the majority (79%) were work-related injuries. Seniors had more flame burns (73%) and the majority (55%) occurred in domestic incidents. Seniors had deeper burns (13%, p=0.005), required more escharotomies (55%, p=0.002), required more operations (2, p=0.051) and had higher mortality (36%, p<0.001) than other age groups. These results provide compelling evidence for performing population-based studies to identify risk factors that are susceptible to modification in each age group.

Adult↗
PubMed1998

Stimulation of rat hepatic amino acid transport by burn injury.

Burn injury accelerates hepatic amino acid metabolism, but the role of transmembrane substrate delivery in this response has not been investigated. We therefore studied the effects of cutaneous scald injury on the Na+-dependent transport of glutamine and alanine in isolated rat liver plasma membrane vesicles. Scald injury resulted in liver damage and a 1.4- to 2.3-fold and 1.5- to 2.8-fold stimulation of hepatic transport rates for glutamine and alanine, respectively, proportional to the total burned surface area (TBSA) after 24 hours. Enhanced uptake of glutamine and alanine was attributable to increases in the maximum velocity (Vmax) of system N and system A activities, respectively. Hepatic amino acid transport activity remained elevated in vesicles from burned animals after 72 hours, but the degree of stimulation (1.3- to 1.7-fold for glutamine and 1.3- to 1.6-fold for alanine) was less than that observed 24 hours after thermal injury. Liver function tests returned to control values after 72 hours as well, indicating rectification of hepatic damage. In contrast to the induction of hepatic system A and system N activity in catabolic states such as cancer and endotoxemia, further studies showed that tumor necrosis factor (TNF) failed to play a significant role in burn-stimulated amino acid transport rates. When combined with plasma liver enzyme profiles, early transient hepatic amino acid transporter stimulation may support amino acid-dependent pathways involved in the repair of burn-dependent hepatic damage.

Amino Acids↗
PubMed1996

Effect of thermal injury on the expression of transcription factors that regulate acute phase response genes: the response of C/EBP alpha, C/EBP beta, and C/EBP delta to thermal injury.

BACKGROUND: Eukaryotic organisms possess natural defense mechanisms that protect against stress stimuli. One such mechanism is the activation of families of stress response genes (e.g., the acute phase response). Transcription of many of these genes is regulated by the leucine zipper or bZIP proteins (CCAAT binding/enhancer binding proteins [C/EBPs]). The aim of this study was to show that the C/EBP transcription factor genes respond to thermal injury. METHODS: Age- and weight-matched male Buffalo, Sprague-Dawley, and Fischer 344 12- to 16-week-old rats (275 to 325 gm) received a 40% total body surface area scald burn. Total RNA was isolated from livers at 0, 2, 5, 12, 24, and 48 hours. Northern blot hybridization was performed with 32P-labeled C/EBP alpha, C/EBP beta, and C/EBP delta cDNAs. Relative amounts of each mRNA were determined by densitometric analyses. For Western analyses liver nuclear and cytoplasmic protein extracts were prepared from burned and control rats. Nuclear protein extracts were resolved by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, blotted onto a PVDF membrane, and detected by using an enhanced chemiluminescence detection kit. RESULTS: Expression of C/EBP genes is regulated in response to 40% total body surface area scald burn. A simultaneous decrease in C/EBP alpha and an increase in C/EBP beta and C/EBP delta mRNA levels occur in response to thermal injury. Western analyses detect changes in C/EBP alpha and C/EBP beta pool levels that suggest a differential regulation of these genes in response to thermal injury. CONCLUSIONS: The responses of C/EBP alpha, C/EBP beta, and C/EBP delta are similar in Buffalo, Sprague-Dawley, and Fischer rats. The induced level, however, of C/EBP beta mRNA was highest in the Sprague-Dawley strain and lowest in the Buffalo strain and correlates well with the mortality of these strains. Because C/EBP beta is associated with the transactivation of stress response genes, this may explain the intensity of the response in the susceptible strains. This agrees with our hypothesis that the higher degree of sensitivity of the Sprague-Dawley rat to stress relative to the Buffalo strain may be due to inherently higher levels of factors such as C/EBP whose functions are associated with activation of stress response genes.

Acute-Phase Reaction↗
PubMed2001

Assault by burning--a reappraisal.

Assault by burning is a serious form of trauma that often results in higher incidence of inhalation injury, longer intensive care unit (ICU) and hospital stay, and higher mortality rate than is observed in the general burn population. We evaluated the epidemiology and outcome of assault burn victims treated in a tertiary burn center over a 6-year period. Among the 1063 acute burn patients who had been admitted to the Burns Unit between March 1993 and February 1999, 28 (2.6%) had assault burn injuries either by scald, chemical or fire. The mean extent of burn was 21.9%+/-20.8% (range 2-90%) total body surface area and the mean length of hospital stay was 65.2+/-107.3 days (range 1-565). Nineteen out of 25 patients (67.9%) underwent 76 operations. Nine patients had inhalation injuries requiring intubation and ICU admission. Three patients died in the series, which yielded a mortality rate of 10.7%. Compared to the general burn population, the assault burn group had significantly larger burn size (P<0.001), higher incidence of inhalation injury (P<0.001), longer ICU and hospital stay (P<0.001), and higher mortality rate (P<0.005). When these 28 victims were grouped according to the type of assault burn injury into a fire group, chemical group and scald group, all the 9 ICU admission and the 3 mortalities belonged to the fire group. Assault by fire resulted in larger burn size (P=0.03), more inhalation injury (P<0.001) and longer ICU stay (P=0.02). Although the fire group had a longer hospital stay and higher mortality rate, this was statistically insignificant.

Adolescent↗
PubMed2002

Ruthenium red attenuated cardiomyocyte and mitochondrial damage during the early stage after severe burn.

OBJECTIVE: To investigate the effects of ruthenium red on cardiomyocyte and mitochondrial damage during the early stage after severe burn. METHODS: Adult Wistar rats were randomized into normal control group (control), burn group (burns) and ruthenium red-treated group (RR) (n=8). Rats in the burn and RR groups were scalded to 30% TBSA III degree, and 30 min later, resuscitated with Ringer's solution. Ruthenium red was injected into rats of RR group at a dose of 2mg kg(-1), and again 3h later. Rats were sacrificed at the 6th hour post-scald, myocardial mitochondrial respiratory function and Ca(2+) concentration ([Ca(2+)](m)), serum creatine kinase (CK) and lactate dehydrogenase (LDH), myocardial ATP, ADP, AMP and lactate contents were determined. RESULTS: [Ca(2+)](m) in the RR group was significantly lower than that of the burn group. Mitochondrial respiratory control rate (RCR) and ST(3) were higher than those of burns, but ST(4) was high compared to the control group. Serum CK and LDH of the RR group decreased significantly, and were 65.0 and 45.5% of the burn group, myocardial ATP content in the ruthenium red-treated group increased by 100.4% and lactate level was decreased by 53.5% compared to the burn group. CONCLUSIONS: Ruthenium red attenuated myocyte and mitochondrial damage during the early stage after severe burns.

Animals↗
PubMed2003

Unusual inflicted hot oil burns in a 7-year-old.

Pediatric burn injuries occur not infrequently as the result of abuse. While the majority of these burns are inflicted scald burns, those due to contact or contact/scald mechanisms may present diagnostic challenges. A child with unusual combined contact and scald burns caused by a metal spatula heated in hot cooking oil is described. The odd pattern of healed injury limited the initial diagnosis to inflicted healing burns. Despite the initial lack of disclosure, an inflicted etiology was supported by clearly delineated margins, macular lesions with hyper-pigmented rims and variegated central regions. Additional findings of numerous adult bites and bruises provided adjunctive support for an inflicted etiology. Aspects of this case are atypical for the usual demographics of a burn victim. This case extends the known presentations of inflicted contact/scald burns.

Bites, Human↗
PubMed2002

Epidemiology and mortality of burns in a general hospital of Eastern Sri Lanka.

This 2-year prospective study examined the epidemiology and mortality of 345 patients admitted with burn injuries. Sixty-four percent of all burns were accidental in nature and at least 25% were self-inflicted. The rest were due to assaults or had a doubtful cause. The median age was 22 years. Forty-one percent of the accidents were due to the fall of a homemade kerosene bottle lamp. The main cause was flames, followed by scalds. Females outnumbered males in all categories of burns except cases of assault, and suffered from a higher mortality. Most at risk of accidental burns were children between 1 and 4 years, who suffered primarily from scalds. Self-inflicted burns were most common among women aged 20-29 years. The overall median total body surface area (TBSA) burned was 16%. Self-inflicted and 'doubtful' burns were much more extensive and more often fatal than accidental ones. The overall mortality rate was 27%. Burns involving more than 50% of the body surface area were invariably fatal. Mortality was highest in the elderly and in the 20-29 years age group. Burns were the first single cause of mortality in the surgical wards. The case is made for the establishment of more Burns Units.

Accidental Falls↗
PubMed2003

Epidemiology of burns admitted to Ain Shams University Burns Unit, Cairo, Egypt.

This study was prospectively carried out on 880 acutely burned patients admitted to the Burn Unit of Ain Shams University in Cairo, Egypt, during the period from the 1 May 1995 to the 31 October 2001, with the objective to analyze the epidemiological features of burned patients in our country. The means of age and percentage total body surface area burned (TBSB) were 27.8+/-2.9 years and 32+/-5.7%, respectively. Most of the patients were city dwellers and were self-referred to the Burn Unit. There were no significant yearly variations in hospital admissions. Seasonal variations in the form of peaks in winter and spring were noticed. Females (53.1%) were more prevalent than males (46.8%). Adults (61%) superceded children (39%). Male children (42.7%) population exceeded female children (35.8%). In contrast, adult females (64.1%) surpassed adult males (57.2%). The commonest burn location was home followed by outdoors then, work locations. Females were most commonly burned at home and mainly suffered from flame and scald burns. Males were most commonly burned in outdoor and work locations than at home and mainly sustained electric and flame burns. There was no difference in the mean percentage TBSB and burn depth in both sexes. Children were mostly burned at home and were mainly victims of scald and flame burns. They had lower rates of full thickness burns compared to adults. Adults were mostly burned in outdoor and work locations and mainly sustained flame and electrical injuries. The results of this study clearly highlighted the specific epidemiological features of burned patients in our area, and thus should provide the necessary information to develop proper burn prevention programs, thereby reducing the frequency of burns and burn-related deaths.

Accident Prevention↗
PubMed2003

Epidemiology of burns presenting to an emergency department in Shiraz, South Iran.

A retrospective study of 1493 burn patients attending the Ghotbeddin emergency burn center in Shiraz, South Iran during the 1 year period 2001-2002 was undertaken in order to describe the epidemiological features of burns in Shiraz. The following results were obtained: the mean age of attendees was 21.84+/-19.05 with an overall male to female ratio of 1.12. 41.2% of patients were children under 15 years with a M/F ratio of 1.36. The main causes of burns were scalds (53%) followed by flame (25%). The frequency of scalds was much higher among children (70%). The majority of accidents (81%) occurred at home, 5.2% occurred in workplace and domestic accidents were more frequent among women. The mean total body surface area (TBSA) burned was 7.4+/-14.3%. Extensive TBSA had a significant association with flame burns and sex, showing that female patients have higher risk for more extensive burns. Finally, there was a significant seasonal variation for burns, with most burns occurring in winter months.

Accidents, Home↗
PubMed2003

Epidemiology of hospitalized burns patients in Taiwan.

Previous studies based on either single hospital data or sampling of specific groups of hospitalized burns victims in Taiwan have provided only minimal epidemiological information. The study is designed to provide additional data on the epidemiology of hospitalized burns patients in Taiwan. Data were obtained from the Burn Injury Information System (BIIS), which brings together information supplied by 34 contracted hospitals. The study time course spanned a 2-year period from July 1997 to June 1999. Patient characteristics (age, sex, education level, etc.), causes and severity of injuries, and medical care measures were explored. A total of 4741 patients were registered with BIIS over the study period. The majority of hospitalized patients (67%) were male. The age distribution of burns patients showed peaks occurring at the age groups of 0-5 and 35-44 years. Over the time course of a day, burn injuries occurred more frequently from 10:00 to 12:00 h and 16:00 to 18:00 h. Injuries suspected as the result of suicide, homicide or child abuse accounted for 4.8% of hospitalized cases. More than 48% of the burns occurred in the home. The leading type of burn injury was scalding, followed by naked flame, explosion, electrical burns, and chemical burns due to caustic or corrosive substances. The mean percent total body surface area (%TBSA) for adults was 19%, and for young children was 12%. The average length of hospital stay was 18 days. In conclusion, children under 5 years and adults between 35 and 44 years of age are two high-risk groups for burn injuries. Corresponding to meal preparation time, hot substances such as boiling water, hot soup, etc. are the most common agents responsible for scalds. Prevention programs for reducing the risk of burn injuries during cooking and eating are required, especially for parents with young children.

Accidents, Home↗
PubMed1994

Declining incidence of paediatric burns in Scotland: a review of 1114 children with burns treated as inpatients and outpatients in a regional centre.

This retrospective study of paediatric burns in the Lothian region involved a review of 1114 case notes of children up to the age of 12 years, treated for burns as inpatients and outpatients, during a 3-year period between 1988 and 1990. There were more boys than girls and 79 per cent were below 5 years of age. 71.5 per cent were treated as outpatients only, whereas 28.5 per cent were admitted. The Lothian region had the highest incidence of burns of children in Scotland. There has been a statistically significant downward linear trend in burn rates and admissions in Scotland during the 20 years but in this hospital burns admissions have significantly diminished only since 1987. The number of flame burns has declined and a high proportion of the victims were scalded. Efforts need to be made to reduce the large number of scalds by educational and legislative measures.

Adolescent↗
PubMed1994

Multivariate and vectorial analysis of pharmacological signalling: diaphragm inositol 1,4,5-triphosphate under the duress of burn trauma.

Aberrant signal transduction processes within the diaphragm contribute to the weakness of this primary muscle involved in respiration. The importance of this report emphasizes how scald burn injury manifests distant systemic effects which impact on respiration. Scald burn injury from hot water is a common type of thermal injury in three specific patient groups: young children, the elderly, and the mentally and physically handicapped. Multivariate and vectorial analyses are presented within this paper with application to the effects of burn trauma on pharmacological signal transduction systems in the diaphragm. Multivariate equations showed the dependence of IP, on three to five independent variables. The independent variables included: burn size, glycerophosphate, and other polyinositols (inositol 1,4 biphosphate (I1,4P2), inositol 1 phosphate (I1P) and inositol). Graphic illustration of the equations used vectorial analysis. The multivariate analysis gives rise to a wider class of contributing factors than those observed using standard univariate relationships. This may be useful clinically in the identification of therapeutic agents for the treatment of respiratory problems in burn patients.

Animals↗
PubMed1997

Long-term psychosocial sequelae of paediatric burns.

Ninety-one patients burn-injured in their childhood were assessed by mailed interview and clinical re-examination in 1994. On average, the patients had sustained injuries to 11.9 per cent (SD = 8.8) of their TBSA (maximum 50 per cent), the injuries were mainly scalds (90.1 per cent). Nineteen patients (20.9 per cent) remembered the event and 23 (25.3 per cent) remembered their hospitalisation. The hospitalisation vignettes were significantly associated with painful memories among children older than 3 yr (Fisher's exact test P = 0.04). Seventeen patients (18.7 per cent) had recollections of pain during hospitalisation. They had been confined for an average of 30.9 days. Twenty-one patients (23.1 per cent) had a fear of hot water and fire, and 39 (42.9 per cent) were cautious. The median age at the time of admission was 1.7 yr. The re-examined patients had good school marks and their rate of educational qualifications did not differ from the Finnish national average. No less than one fifth (20.8 per cent, N = 11) had some difficulties with contact with the opposite gender in their adolescence but only one had difficulties later. Fifty-five patients (mostly female, chi 2 = 13.06, DF = 2, P < 0.01) expressed annoyance at their scars, but no more than one third (N = 17) kept them covered continuously. Only five (5.5 per cent) with visible scars had no memories or special psychosocial sequelae. Almost everyone burn-injured in childhood will have some memories of burn care as an adult. However, the negative psychosocial sequale are modest after the typical paediatric burns, scalds, in early childhood.

Adaptation, Psychological↗
PubMed1998

Long-term functional sequelae after paediatric burns.

Ninety-one patients with at least 5 per cent (median 10 per cent, maximum 50 per cent) total body surface area (TBSA) burns were clinically re-examined on average 17.3 yr after primary injury. The patients had sustained mostly superficial dermal scalds. The most common long-term functional sequelae were impaired tanning (n = 67; 77.7 per cent), diminished tactile sensibility (n = 50; 56.2 per cent) and increased reddening (n = 14; 15.6 per cent) either in the sun or the Finnish sauna. Five patients (6.3 per cent) had limited joint mobility and one patient experienced constrictive scars on her trunk during pregnancy. Scar appearance was significantly associated with impaired tactile sense (chi 2 = 11.87, DF = 2, p < 0.01; Spearman's R = 0.27, p = 0.03). Surprisingly, better scar appearance showed more disturbed touch sensation. The primary operative treatment (early excision and split skin grafting) was not associated with diminished sense of touch (chi 2 = 1.24, DF = 1, p = 0.27). Neither were scar appearance and poor tanning significantly associated (chi 2 = 1.63, DF = 1, p = 0.4). Only three patients suffered no functional detriments. In this series the harmful functional consequences were generally slight. The aetiological background (scalds) and the relatively small, superficially burned skin area probably explains the good late outcome. However, since nearly every burn-injured child will have some signs of the injury in adulthood, children present a constant challenge in the effort for better burn care and prevention.

Abdominal Injuries↗
PubMed1998

Effect of cutaneous burn injury and resuscitation on the cerebral circulation in an ovine model.

The aim of our study was to evaluate the effects of a large cutaneous burn injury on the cerebral circulation. Anesthetized sheep (n = 8) were prepared with vascular catheters, a urinary catheter and a Richmond bolt for intracranial pressure monitoring. A scald injury was inflicted on 70 percent of total body surface area with hot water. Resuscitation was started 30 min after scald with Ringer's lactate to restore and maintain baseline oxygen delivery. Resuscitation maintained blood pressure, cardiac output and urine output at normal levels. Brain blood flow was measured with colored microspheres. During resuscitation intracranial pressure rose slowly from 10.6 +/- 1.5 to 17.0 +/- 4.0 mmHg (P < 0.05) and cerebral perfusion pressure was reduced from 86.4 +/- 6.8 to 64.1 +/- 2.8 mmHg (P < 0.05). During early resuscitation cerebrovascular resistance declined to maintain brain blood flow and oxygen delivery at baseline or better. After 6 h, mean cerebrovascular resistance was inappropriately increased during a period of reduced cerebral perfusion pressure which resulted in brain blood flow reductions of half the baseline levels. These data suggest that autoregulation maintains brain blood flow immediately after burn shock and early resuscitation, but the autoregulation may be less effective as burn resuscitation proceeds.

Animals↗
PubMedDate not supplied

The last 10 years in a burn centre in Ankara, Turkey: an analysis of 5264 cases.

This is a retrospective study analysing 5264 patients treated in the burn centre at Gülhane Military Medical Academy from 1 January 1986 to 31 December 1995. Our burn centre is not only the first, but one of the best established and supported in Turkey. Our present study has the largest patient group of other previously published studies from Turkey. Of the total patients studied, 4464 patients had minor burns and were treated on an outpatient basis and 800 patients had moderate to major burns. Although our centre is in a military area in Ankara, only 1047 (20 per cent) patients were military personnel and the military-related burn causes comprised only 6 per cent of the total. The remaining 4217 (80 per cent of the total patients) were civilians. Flame injuries were also more frequent in military patients than civilians. Minor burns were most common in the age group 0-10 years old (40 per cent) and moderate to major burns in the age group 21-30 years (54 per cent). Scalds were the main cause of paediatric burns. Male patients were dominant. The overall mortality among inpatients was 18.2 per cent and mean total body surface area (TBSA) was 57.6 per cent in patients who died. 134 patients demonstrated inhalation injury and 82 per cent of these patients died. The epidemiological pattern of our patients is similar to that in other studies from developed countries, although some ethnic causative factors could be found. Our study indicates that emergency measures should be taken to prevent flame injuries at military barracks and industrial workplaces and scalding accidents to children at home and throughout the country.

Adolescent↗