Annals of Burns and Fire Disasters - vol. XVII - n. 2 - June 2004 INTERNATIONAL ABSTRACTS
ASSESSMENT OF THE BIOLOGICAL PROPERTIES OF HUMAN SPLIT-SKIN ALLOGRAFTS DISINFECTED WITH PERACETIC ACID AND PRESERVED IN GLYCEROLIn order to render skin allografts derived from cadaver human donors safe for clinical use, and to enable them to be preserved and banked for long periods for use in the treatment of serious burn injuries and other conditions, it is essential to have effective methods of decontamination and preservation. The methods used must not have adverse effects on the graft properties necessary for clinical performance. We studied the application of a peracetic acid (PAA) disinfection protocol (3 h exposure 0.1% (v/v) PAA in phosphate-buffered saline ([PBS] at pH 7.0), coupled with preservation in either glycerol or propylene glycol to achieve these goals. An effective decontamination procedure was developed that did not have any significant detrimental effects on skin structure. The cadaver skin allografts were then treated with this disinfection protocol and subsequently preserved in either 85% (v/v) glycerol or propylene glycol in PBS; the biological properties of the allografts considered to be essential for successful clinical performance were then assessed. Graft cytotoxicity was assessed using both extract and contact assays; damage to the skin collagen was assessed using a collagenase susceptibility assay, and the grafts’ capacity to elicit an inflammatory response in vitro was evaluated by quantifying the production of the pro-inflammatory cytokine TNF-· by human peripheral blood mononuclear phagocytes. The grafts were not rendered cytotoxic or pro-inflammatory either by the disinfection protocol or by either of the preservation techniques. PAA disinfection and glycerol preservation protocol had no effect on collagenase susceptibility, while the disinfection protocol in combination with propylene glycol rendered some of the test samples significantly more susceptible to collagenase digestion. This study demonstrated the suitability of PAA disinfection combined with glycerol preservation for skin allografts. The use of propylene glycol as a preservation agent for skin requires further development. Lomas R.J., Cruse-Sawyer J.E., Simpson C., Ingham E., Bojar R., Kearney J.N. MATRIX METALLOPROTEINASE EXPRESSION IN CYTOKINE-STIMULATED HUMAN DERMAL FIBROBLASTSThis paper considers the effect of inflammatory cytokines on matrix metalloproteinase (MMP-l) and tissue inhibiting metalloproteinase (TIMP-1) production on human dermal fibroblasts. These play a central role in wound healing, which ranges from the synthesis and remodelling of the extracellular matrix (ECM) to the synthesis of growth factors. A balance of MMPs and TIMPs is crucial for successful wound repair. Human adult dermal fibroblasts were seeded in six well plates in complete media. Eighty to ninety percent confluent cells were treated with interleukin-1‚ (IL-1‚), interleukin-6 (IL-6), and tumour necrosis factor-· (TNF-·) (10 ng/ml) for 6 h in serum-free media with suitable controls run in triplicate. Supernatants were assayed for pro-MMP-1 and TIMP-1. Extracted total RNA was used for the reverse transcription polymerase chain reaction (RT-PCR) with sequence-specific primers for MMP-1, TIMP-1, and ‚-actin. Signal intensity was normalized to the internal control (‚-actin). The statistical analysis used ANOVA. MMP-1 and TIMP-1 mRNA expression were markedly increased with IL-6 and TNF-· treatment and remained unchanged with IL-1‚. Pro-MMP-1 protein levels were unchanged with TNF-· and significantly increased with IL-1‚ and IL-6 treatment. However, TNF-· significantly increased TIMP-1 protein levels. Our data suggest a differential regulation of MMP-1 and TIMP-1 protein levels by the cytokines found in stimulated dermal fibroblasts. Further characterization of this response will provide better understanding of the mechanisms of pathogenesis of the ECM and the potential role of metalloproteinases in post-injury tissue remodelling. Dasu M.R.K., Barrow R.E., Spies M., Herndon D.N. ROLE OF P38 MITOGEN-ACTIVATED PROTEIN KINASE IN KUPFFER CELL SECRETION OF THE PRO-INFLAMMATORY CYTOKINES AFTER BURN TRAUMAThis study was investigated the role of p38 mitogen-activated protein (MAP) kinase on Kupffer cell (KC) secretion of pro-inflammatory cytokines such as tumour necrosis factor (TNF)· and interleukin (IL)-1‚, as well as hepatic injury following burn trauma. A number of Sprague-Dawley rats were randomized into four groups: 1. sham burn rats given vehicle; 2. sham burn rats given the p38 MAP kinase inhibitor SB203580 (10 mg/kg i.v., 15 min and 12 h after sham burn); 3. rats given a 30% total body surface area full-thickness burn and fluid resuscitation plus vehicle; 4. burn rats given injury and fluid resuscitation plus SB203580. Rats in each group were killed 24 h post-burn in order to examine plasma asportate transaminase (AST) and alanine transaminase (ALT), and KCs were isolated. KC secretion of TNF-· and IL-‚ and p38 MAP kinase activity (by Western blot analysis) were also examined. These studies showed more significant activation of p38 MAP kinase in KCs harvested from burn rats than from shams. Burn trauma caused hepatic dysfunction and promoted KC secretion of TNF-· and IL-1‚. SB203580 inhibited p38 MAP kinase activity, reduced KC secretion of pro-inflammatory cytokines, and alleviated burn-mediated hepatic dysfunction. These findings would suggest that p38 MAP kinase activation is an important aspect of the signalling event that may mediate KC secretion of the pro-inflammatory cytokines TNF-· and IL-1‚ following burn trauma. Chen X.-L., Xia Z.-F., Wei D., Han S., Ben D.-F., Wang G.-Q. EFFECTS OF PANAX NOTOGINSENG SAPONINS ON MYOCARDIAL GSAU MRNA EXPRESSION AND ATPASE ACTIVITY AFTER SEVERE SCALD IN RATSAn investigation was made of the changes in myocardial Gs· mRNA expression and ATPase and the effects thereon of Panax notoginseng saponins (PNS) after burns in rats. Wistar rats were placed in a 95 °C water bath for 10 sec to produce 30% TBSA full-thickness scalds. Myocardial Gs· mRNA level, cAMP content, and adenyl cyclase (AC) activities were determined respectively with dot blotting hybridization, radioimmunoassay, and indirect method. The ATPase activities in the plasma membrane of cardiomyocytes and erythrocytes were measured colorimetrically. At 3, 6, and 9 h post-scald the myocardial Gs· mRNA expression decreased significantly. PNS (100, 200 mg/kg-1, i.p.) considerably increased these levels. This elevation correlated significantly with the PNS dose. At 3, 6, 9, 12, 24, and 48 h post-scald the myocardial cAMP content and AC basal activity were significantly reduced. PNS (100, 200 mg/kg-1) increased cAMP content and markedly enhanced AC activity compared with the 3rd-hour post-burn group. The activity of (Ca2+-Mg2+)-ATPase and (Na+-K+)-ATPase in plasma membrane of myocardial cells and red blood cells in the scald group was significantly lower than that in the normal control group. PNS (100 mg/kg-1, i.p.) significantly improved these indices post-scald. These findings suggest that the effects of PNS on the myocardium of burned rats involved its action to increase myocardial Gs· mRNA expression and AC activity, CAMP content, and ATPase activities. Zhang H.-G., Li X.-H., Yang Z.-C. SEROVAR DETERMINATION, DRUG RESISTANCE PATTERNS, AND PLASMID PROFILES OF PSEUDOMONAS AERUGINOSA ISOLATED FROM BURN PATIENTS AT TWO HOSPITALS IN TEHRAN (IRAN)An assessment was made of the serovars and drug susceptibility patterns of 265 isolates of Pseudomonas aeruginosa cultured from burn patients during 2001-2002 in two hospitals (Tohid and Motahari) in Tehran. Serovar distribution was different in the two hospitals. Most of the isolates at Tohid belonged to serovar 0:1, but 21 and 13% of them were respectively untypable or polyagglutinable. Serovar 0:11 was found to be the most prevalent serovar at Motahari. All the strains were multiresistant to tetracyclin, carbenicillin, amikacin, ceftazidime, sulphamethoxazol, ciprofloxacin, tobramycin, kanamycin, cefotaxime, and gentamicin. Further analysis of the strains by plasmid profiling showed that 95% of the isolates carried two megaplasmids. There was however no correlation between the serotyping and the presence of plasmids. Modifications in the drug susceptibility patterns and ‚-lactamase production of some cured derivatives were observed after the strains had lost their plasmids. The emergence of multidrug-resistant strains of Pseudomonas aeruginosa is a serious cause of concen in burn patients hospitalized in Tehran. Shahcheraghi F., Feizabadi M.M., Yamin V., Abiri R., Abedian Z. BURN AND RECONSTRUCTIVE SURGERY CLINIC. FACULTY HOSPITAL OF THE MASARYK UNIVERSITY IN BRNO - 20 YEARSThis is an account of the twenty years that have passed since the foundation of the first specialized burn centre in Brno in the Czech Republic. The Independent Burn Centre in Brno was, in the concept of Czechoslovak health care, founded soon after the Second World War, particularly thanks to the Prague-based academician FrantisŠek Burian. The main impulse for the creation of an independent burn centre in the setting of a trauma hospital was the occurrence of three accidents in a heating plant in Brno, which caused dozens of victims. The unit then had a capacity of 10 beds with one to two intensive care beds with a small dressing change room. As an expression of the respect of the scientific community, our workplace has been given the statute of Clinic. The Clinic of Burns and Reconstructive Surgery of the Medical Faculty of Masaryk University in Brno is now a teaching and medical institution. It is divided into two parts: a burns department and a reconstructive surgery department. The burns department has three units: an intensive care unit with five beds, an intermediate care unit with three beds, and a children's unit with nine standard beds. There are also two out-patient departments. The clinic employs 24 physicians, of whom 11 are plastic surgeons, seven surgeons awaiting their second attestation, and one paediatrician. An internist and a psychologist are among our regular visiting consultants. There are 54 nurses, 13 members of auxiliary staff, and three therapists. A full account is given of patient turnover and the types of treatment administered. Future prospects are also outlined. Brychta P. FIRST INTERNATIONAL CONVENTION FOLLOWING TERROR ATTACKS OF SEPTEMBER 11, 2001An international congress organized by several institutions was held on 27-28 September 2002, in Hamburg, Germany. The organizers were: Fire and Rescue Services Academy, Hamburg; Institut für Notfallmedizin des LBK, Hamburg; Bundesakademie für Sicherheitspolitik; and Deutsches Komität für Katastrophenversorge, in collaboration with: Fire Department, New York; Emergency Medical Services, New York Public Health Services, and Homeland Defense Committee, Washington, DC. The Congress was attended by some 550 delegates from 14 countries. The sessions were opened by a detailed report on the terrorist attack on New York presented by commanders of the fire brigades who survived. Their reports on the rescue operations in the World Trade Centers were a devastating recognition that in such extensive catastrophes prevention, triage, and treatment are impossible. A detailed account is presented of the insurmountable problems involved. Another part of the programme was devoted to repeated anthrax threats to workers of the Hart-Building in Washington, and an analysis of a civilian mass disaster caused by chemical substances in Japan was also reported. One speaker concentrated on the changes in the character of terrorist attacks in the last 30 years, listing seven specific aspects. The Conference concluded with a number of important recommendations in order to increase preparedness for such attacks. Acta Chirurgiae Plasticae, 45: 73-4, 2003 IMPORTANCE OF SPECIALIZED DEPARTMENTS FOR THE TREATMENT OF BURNSSpecialized departments for the treatment of burns have a long and varied history, and this paper describes the experience of what is now the Czech Republic, ranging from as long ago as the sixteenth century until modern times, when the pioneering work of Burian was very influential. In severe thermal, electric, chemical, and radiation injuries there are two tasks: to provide comprehensive and continuous care to ensure survival and to guarantee quality of life by an interdisciplinary approach from the time of the injury to long-term rehabilitation. Adequate experience can be obtained only by concentrating burn care in specialized centres equipped with all the necessary equipment and personnel. Königová R. SUCCESSFUL TREATMENT OF A CRITICALLY BURNED PATIENT (CASE REPORT)The case is documented of a critically burned patient who despite a number of problems was successfully treated. The patient had sustained IIb-III electrical burns in 83% TBSA. Successful therapy in such cases depends not only on up-to-date methods of intensive care but also on good teamwork and high professional levels of competence, in a specialized workplace. Mager R., RŠihová H. PAIN MANAGEMENT IN CHILDREN WITH BURN INJURIESThermic injury is inevitably associated with pain, and specific algorithms of anaesthesia are provided that could prove useful in the treatment of burned children during the successive pre-hospitalization and hospitalization phases, with advice for the general practitioner in the first place, then for care in the ambulance, and finally hospital care. Seidlová D., Zemanová J., Cˆundrle I., Suchánek I.
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