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Abstract: Mammalian target of rapamycin (mTOR) is an important mediator for cross talk between nutritional signals and metabolic signals of insulin by downregulating insulin receptor substrate proteins. Therefore, mTOR inhibition could become a therapeutic strategy in insulin-resistant states, including insulin resistance induced by burn. We tested this hypothesis in the rat model of 30% TBSA full thickness burn, using the mTOR inhibitor rapamycin. Rapamycin (0.4mg/kg, i.p.) was injected 2h before euglycemic–hyperinsulinemic glucose clamps at 4 days after burn. IRS-1, phospho-serine307, phospho-tyrosine of IRS-1 and phospho-mTOR in muscle tissue were determined by immunoprecipitation and Western blot analysis or immunohistochemistry. Plasma TNF-α, insulin and C-peptide were determined before and after euglycemic–hyperinsulinemic glucose clamps. Our data showed that TNF-α, insulin and C-peptide significantly increased in the early stage after burn (P <0.01). The infused rates of total 10% glucose (GIR, mg/kgmin) significantly decreased at 4 days after burn. The level of IRS-1 serine307 phosphorylation in muscle in vivo significantly increased after burn (P <0.01), while insulin-induced tyrosine phosphorylation of IRS-1 significantly decreased (P <0.01). Inhibition of mTOR by rapamycin inhibited the phosphorylation of mTOR, reduced serine307 phosphorylation, elevated tyrosine phosphorylation and partly prevented the decrease of GIR after burn. However, TNF-α, insulin and C-peptide were not decreased by rapamycin treatment postburn. Taken together, these results indicate that the mTOR pathway is an important modulator of the signals involved in the acute regulation of insulin-stimulated glucose metabolism, and at least, partly contributes to burn-induced insulin resistance. mTOR inhibition may become a therapeutic strategy in insulin-resistant states after burn. [Copyright &y& Elsevier]

Burn wound excision and grafting is a common clinical practice that decreases patient morbidity and mortality. It is not known, however, if the salutary effects of this procedure are related to effects on interleukin 6 (IL-6) and tumor necrosis factor (TNF-) α, and to reducing insulin resistance after burn. Sprague–Dawley rats were randomly divided into three groups: control, burn, burn±excision groups. Rats in burn group were given a third-degree scald burn covering 30% total body surface area (TBSA) and no wound excision. Rats in burn±excision group were subjected to a 30% third-degree burn followed by complete excision and allografting of the injury site within 15min after burn. The rats in control group were treated in the same manner as the burn group, except that they were immersed in a room-temperature water. Glucose tolerance tests (GTT) were observed at 3 days after burn, euglycemic–hyperinsulinemic glucose clamps were performed at 4 days after burn and interleukin 6 (IL-6) and tumor necrosis factor (TNF-) α were determined after euglycemic–hyperinsulinemic glucose clamps. The levels of IL-6 and TNF-α increased after burn. Significant differences in GTT were observed between control and burn groups, and the rate of glucose infused measured in burned rats was significantly decreased compared with that in control at 4 days after burn. Early excision and grafting significantly decreased levels of IL-6 and TNF-α, and further reduced insulin resistance following thermal injury compared with burn group. Conclusion: Early excision and grafting appeared to have an effect on inflammatory mediators and further reduced insulin resistance induced by major burns. [Copyright &y& Elsevier]

Abstract: This study enrolled 22 participants with hypertrophic scarring after burn who received treatment with co-transplantation of acellular dermal matrix and epidermis of either normal skin or scar tissue. Scar thickness was evaluated with high frequency ultrasonography and the distribution of keratinocyte stem cells was detected by immunostaining. The results showed p63-positive keratinocyte stem cells throughout the epidermis of scar tissue. However, if co-transplanted on acellular dermal matrix, this effectively inhibited scar formation and pruritus, providing an alternative method to treat hypertrophic scarring. [Copyright &y& Elsevier]

Abstract: Nitrogen mustards are analogous to sulfur mustard and have similar toxic effects on tissues. With the recent surge in terror activity, mustard could be used by terrorists. Recently a group of patients suffered from skin injury caused by hot fluid containing nitrogen mustard were treated. All the patients displayed eye symptoms such as eye pain, photophobia, excessive tearing, and blurred vision. One patient suffered from severe inhalation injury. Laboratory examination showed the decrease of white blood cell count, which may result from the loss of neutrophils. At the same time, platelets were at lower level during the first 8 days and gamma-glutamyltransferase (gamma-GT), a marker of oxidative stress, was significantly increased. [Copyright &y& Elsevier]

Abstract: The aim of this study was to investigate the changes of glucose tolerance, insulin sensitivity, and euglycemic–hyperinsulinemic glucose clamps following a 30% TBSA full thickness third degree burn in rats. Sprague–Dawley rats weighing 160–170g received 30% TBSA full thickness third degree burn by immersing the back of trunk for 12s in a boiling water bath under anesthesia. Weight- and time-matched sham burn group (control) was treated in the same manner as the trauma group, except that they were immersed in a room-temperature water bath. After 12h overnight fasting, plasma insulin concentration was determined by ELISA using rat-insulin enzyme immunoassay kit (SPI-BIO) and blood glucose was assayed by glucose analyzer at 3 days after burn. Insulin sensitivity index was calculated by using slightly modified formula. The rat was injected with 5% glucose (2g/kg body weight, intraperitoneally) to observe the change of glucose tolerance at 3 days after burn. Euglycemic–hyperinsulinemic glucose clamps were performed at 4 days after burn. Insulin sensitivity index of burn group was significantly reduced compared with control group at 3 days after burn (0.58±0.23 versus 1.23±0.16, P <0.01). The significant difference of glucose tolerance was observed between the two groups and the glucose infused rate measured in burned rats was significantly decreased compared with that in control at 4 days after injury (7.23±1.35 versus 12.31±0.54, P <0.01). Conclusion: Burn causes the significant change of glucose metabolism and results in insulin resistance in rats. [Copyright &y& Elsevier]

Abstract: This study was made to evaluate the effect of SB203580, a specific p38 MAP kinase inhibitor, on burn-induced hepatic injury as well as the activation of nuclear factor (NF)-κB in severely burned rats. Sprague–Dawley rats were divided into three groups: (1) sham group, rats underwent sham burn; (2) burn group, rats given third-degree burns over 30% total body surface area (TBSA) and treated with vehicle plus lactated Ringer solution for resuscitation 4ml/(kg% TBSA); and (3) burn plus SB203580 group, rats given burn injury and fluid resuscitation plus SB203580 (10mg/kg i.v., 15min and 12h after burn). Hepatocellular injury (measured by serum levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT)) and hepatocellular function (determined by the indocyanine green dye retention rate (ICG R15)) were assessed at 24h post-burn. Liver histologic changes were also analyzed. Burn trauma resulted in increased serum aminotransferases concentrations, decreased ICG R15, elevated serum tumor necrosis factor (TNF)-α and interleukin (IL)-1β levels and hepatic TNF-α and IL-1β mRNA expressions, and worsen histologic condition. The level of Nuclear Factor (κ) inhibitor (IκBα) in liver was decreased and DNA-binding activity of Nuclear Factor-κB (NF-κB) was increased after thermal injury. p38 MAP kinase was more significantly activated in liver harvested from burn rats than from shams. SB203580 inhibited the activation of p38 MAP kinase, reduced the levels of TNF-α and IL-1β, and prevented burn-mediated liver injury. Both the IκBα level and NF-κB activity in the liver following burns was not affected by administration with SB203580. These findings suggest that (1) p38 MAP kinase activation is one important aspect of the signaling event that may mediate the release of TNF-α and IL-1β and contributes to burn-induced liver injury and (2) p38 MAP kinase does not influence the activation of NF-κB directly in the liver of severely burned rats. [Copyright &y& Elsevier]

This study was designed to investigate the role of p38 mitogen-activated protein (MAP) kinase on Kupffer cells (KCs) secretion of proinflammatory cytokines such as tumor necrosis factor (TNF)-α and interleukin (IL)-1β and hepatic injury following burn trauma. 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 (TBSA) full-thickness burn and fluid resuscitation plus vehicle, and (4) burn rats given injury and fluid resuscitation plus SB203580. Rats from each group were killed at 24 h post-burn to examine plasma aspartate transaminase (AST) and alanine transaminase (ALT) and KCs were isolated. The KCs secretion of TNF-α and IL-1β and p38 MAP kinase activity (by Western blot analysis) were also examined. These studies showed by more significant activation of p38 MAP kinase in KCs harvested from burn rats than from shams. Burn trauma resulted in hepatic dysfunction and promoted KCs secretion of TNF-α and IL-1β. SB203580 inhibited p38 MAP kinase activity, reduced KCs secretion of proinflammatory cytokines, and alleviated burn-mediated hepatic dysfunction. These data suggest p38 MAP kinase activation is one important aspect of the signaling event that may mediate the KCs secretion of proinflammatory cytokines TNF-α and IL-1β following burn trauma. [Copyright &y& Elsevier]

Abstract: Objective: To identify treatment-related factors associated with mortality in massively burned adult patients. Methods: This retrospective cohort study examined survival outcomes at a burn unit of 54 beds and 10 burn ICU beds, totaling 900 admissions per year. The cases of 102 adult patients, admitted consecutively from January 1993 to October 2007, with massive burns (burn area>70% of the total body surface area, TBSA) were studied. Relevant variables were recorded from the initial injury and throughout the hospital course. Survival analysis, based on univariate and stepwise multivariate Cox proportional hazards regression, was performed to determine which variables predicted mortality. Results: The overall mortality rate was 30.4%. Burn size, severe inhalation injury, full-thickness burns, serum creatinine levels, inotropic support, platelet counts<20,000 per mm3, sepsis and ventilator dependency were significantly associated with mortality as determined by univariate analysis. Only sepsis, ventilator dependency and platelet counts were significant independent predictors of mortality as determined by multivariate analysis. Conclusions: Sepsis, ventilator dependence (indicating severe respiratory complications), and low platelet counts (indicating thrombocytopenia) are associated with increased mortality risk in adult patients with massive burns. Methods should be sought to ameliorate these complications during treatment in burn-care units. [Copyright &y& Elsevier]

Abstract: Background: This article reports a chemical burn incident that occurred on August 7th, 2005, when a Matsa typhoon hit Shanghai, China. This is the largest chemical burn incident reported in the literature for 20 years in China, involving 118 alkali burn patients who were rescued by the Burn Department of Shanghai Changhai Hospital independently. Methods: The scene of the incident was investigated, and the clinical, emergency and hospitalized data of the patients were summarized. Results: The main injurious chemical was a water solution of sodium hydroxide and ammonium chloride. The 118 victims were mostly young men with 5%TBSA deep thickness burn of both lower extremities, including 31 patients who had additional light coughing. Of 58 patients who were finally hospitalized, 42 patients received surgical treatment. Most of these patients recovered within 1 month. There were no deaths. Discussion: Retrospective analysis of the therapeutic data of the incident demonstrates that pre-designed disaster planning for emergency management of mass burn patients, an effective command group, accurate assessment of pathological conditions, and correct allocation of different casualties are key elements in successful management in a mass casualty even involving burn patients. In addition, it is essential for specialized personnel to take part in emergency treatment of chemical burns. [Copyright &y& Elsevier]

Purpose: The study was performed to estimate the diagnostic blood loss (DBL) volume during hospitalization and investigate its relationship with the development of moderate to severe hospital acquired anemia (HAA) and increased number of red blood cell (RBC) transfusion following extensive burns.Materials and Methods: This was a retrospective study of adult burned patients with total body surface area (TBSA) burn larger than 40%, who were admitted to burn center of Changhai hospital between January 2005 and December 2017.Results: We included a final number of 157 patients in the present study. Moderate to severe HAA within the fourth week postburn was developed in 46 of 121 patients who stayed over 28-day hospitalization. Patients with moderate to severe HAA had both significantly higher total DBL volume [245 (IQR: 183.75, 325.25) mL vs 168 (119, 163) mL ; P = 0.001] and DBL volume per day [10.22 (IQR: 8.57, 12.38) mL vs 6.63 (5.22, 10.42) mL/day; P = 0.005]. Logistic regression analysis revealed that both DBL volume per day and TBSA burn were independent risk factors for the development of moderate to severe HAA.Conclusions: Severely burned patients appear to be prone to develop HAA during hospitalization. The DBL volume contribute to the occurrence of moderate to severe HAA, which might be a modifiable target for preventing HAA. [ABSTRACT FROM AUTHOR]

Introduction: Blast injuries are complex types of physical trauma resulting from direct or indirect exposure to an explosion, which can be divided into four classes: primary, secondary, tertiary, and quaternary. Primary blast injury results in damage, principally, in gas-containing organs such as the lungs (blast lung injury, BLI). BLI is defined as radiological and clinical evidence of acute lung injury occurring within 12h of exposure to an explosion and not due to secondary or tertiary injury. BLI often combines with cutaneous thermal injury, a type of quaternary blast injury, either in terrorist bomb attacks or in civilian accidental explosions. This report summarizes our experience in the management of combined massive burn and BLI at a Shanghai Burn Center in China.Methods: A retrospective observational analysis of clinical data was performed for massive burn patients with or without BLI during a 20-year interval. Patient characteristics, causes of injury, clinical parameters, management, and outcomes were recorded and evaluated.Results: A total of 151 patients (120 males and 31 females) with severe burn injury (≥50% TBSA) treated at the Burn Center of Changhai Hospital in Shanghai between July 1997 and June 2017 were enrolled in this study. Their mean age was 38.6±17.8 (3-75) years. Among them, 28 patients had combined BLI and burn injury and 39 patients had no BLI or smoke inhalation injury (non-BLI-SII). No significant difference was observed in the burn area or full-thickness burn area between the two groups. The lowest PaO2/fraction of inspired oxygen (FiO2) ratio during the first 24h in BLI patients was significantly lower than that in non-BLI-SII patients. Exudative changes were observed by X-ray radiography in all BLI patients but not in non-BLI-SII patients within 6h after injury. A significantly higher proportion of colloids were used for fluid resuscitation in BLI patients than that in non-BLI-SII patients. A higher proportion and longer time of mechanical ventilation were needed for BLI patients than those for non-BLI-SII patients, and a higher proportion of patients received sedative agents in the BLI group than those in the non-BLI-SII group. The first escharectomy was performed relatively later in BLI patients than in non-BLI-SII patients because of more time taken by BLI patients to recover from lung injury. The length of ICU and hospital stay in BLI patients was significantly longer than that in non-BLI-SII patients. No significant difference in the overall mortality was detected between these two groups.Conclusion: It is a formidable challenge for clinicians to diagnose and manage massive burn patients combined with BLI. A comprehensive treatment approach is strongly recommended, including fluid resuscitation, airway management, mechanical ventilation, and surgical treatment. Given the high mortality of massive burn patients combined with BLI even in a recognized burn center, more prospective studies are encouraged to assess more effective strategies for the treatment of such patients. [ABSTRACT FROM AUTHOR]

Hands are frequent sites of burn but few related studies were reported in China. The aim of this study was to examine the impacts of gender, age, seasons, place, etiology, total body surface area (TBSA), depth, infection and comorbidities on prognosis following injury in a cohort of hand burn inpatients. This is a retrospective study of total 378 inpatients admitted to the burn center of Changhai hospital from January 2009 to December 2013. The present research showed the male inpatients were predominant and most of the inpatients aged from 20 to 49. Flame (37.04%) and electricity (25.40%) were the major causes of hand burns. Hand burns happened more commonly in work place (60.85%). The study preliminarily pointed out that male, flame and depth were the most significant factors impacting surgery. The main factors relevant to amputation were identified including the electrical burns and other etiology of burns. In addition, depth of hand burns was proved to have a higher impact on length of hospital stay (LOS) than other factors. The results of this study not only provide the necessary information of hand burns in Eastern China but also give the suggestions for the prevention of hand burns. [ABSTRACT FROM AUTHOR]

Background This article reports a chemical burn incident that occurred on 31 August 2013 in Shanghai. We describe situations at the scene, emergency management, triage, evacuation, and follow-up of the victims. Method The scene of the incident and information on the 41 victims of this industrial chemical incident were investigated. The emergency management, triage, evacuation, and hospitalization data of the patients were summarized. Results At the time of the incident, 58 employees were working in a closed refrigerator workshop, 41 of whom sustained burns following the leakage of anhydrous ammonia. Ten victims died of severe inhalation injury at the scene, and another five victims died during the process of evacuation to the nearest hospital. After receiving information on the incident, a contingency plan for the burn disaster was launched immediately, and a first-aid group and an emergency and triage group were dispatched by the Changhai Hospital to the scene to aid the medical organization, emergency management, triage, and evacuation. All casualties were first rushed to the nearest hospital by ambulance. The six most serious patients with inhalation injuries were evacuated to the Changhai Hospital and admitted to the burn intensive care unit (BICU) for further treatment, one of whom died of respiratory failure and pulmonary infection. Conclusion This mass casualty incident of anhydrous ammonia leakage caused potential devastating effects to the society, especially to the victims and their families. Early first-aid organization, emergency management, triage, and evacuation were of paramount importance, especially rapid evaluation of the severity of inhalation injury, and subsequent corresponding medical treatment. The prognosis of ammonia burns was poor and the sequelae were severe. Management and treatment lessons were drawn from this mass casualty chemical burn incident. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The study aims to evaluate the quality of life (QOL) in burn patients in China and find out principal influencing factors, so as to provide evidence for interventions. Methods: A total of 271 burn patients in three major burn units in China were asked to fill in the adapted Chinese version (ACV) of the Burn Specific Health Scale-Brief (ACV BSHS-B) in order to seek out the principal influencing factors in combination with a self-designed demographic and disease condition questionnaire. Multivariable linear regression was used to analyse the principal influencing factors. Results: The findings showed that there were seven principal influencing factors for the overall ACV BSHS-B score. They were: percent total body surface area (TBSA) burned (with the standardised regression coefficient being −0.594), burn area of lower limber (0.241), itch level (−0.227), pain level (−0.220), gender (0.217), mechanical ventilation (0.216) and hand deformity (−0.141). Conclusion: QOL decreased in burn patients to different degrees depending on the intensity of burns. With a better understanding of influencing factors of burn patients’ QOL, the medical and nursing staff can take specific countermeasures to help patients gain a higher QOL. [Copyright &y& Elsevier]

PURPOSE: This study was designed to develop and test a Chinese burn patient-specific quality of life (QOL) scale based on the burn-specific health scale - brief (BSHS - B) to provide an effective assessment tool to measure quality of life in Chinese burn patients. METHOD: Delphi method was used after the translation, back translation and pre-commissioning tests of BSHS - B, to amend the description of the items for cultural adaptation. The adapted Chinese version (ACV) of the BSHS - B was tested for internal consistency and validity of construct on a group of 271 burn patients from three major burn units in China. RESULTS: Thirty-eight items within six domains of ACV BSHS-B were developed with scoring '0-4' in each item. The mean total score for our study group was 98.36 (standard deviation (S.D.)=37.86), ranging from 13 to 150. The total Cronbach's alpha value was 0.97 and total split-half reliability was 0.98, demonstrating that the internal consistency of the ACV was very high. Pearson correlations among the six domains of ACV BSHS - B were statistically significant. Exploratory factor analysis results showed that the six-factor function explained 78.30% of total variance; each entry in the corresponding domain had a factor-loading value higher than 0.4, indicating that the scale has a good validity. CONCLUSION: The ACV of the BSHS - B showed good reliability and validity, and can be used as a tool for assessing the QOL in Chinese burn patients. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: This study was designed to develop and test a Chinese burn patient-specific quality of life (QOL) scale based on the burn-specific health scale – brief (BSHS – B) to provide an effective assessment tool to measure quality of life in Chinese burn patients. Method: Delphi method was used after the translation, back translation and pre-commissioning tests of BSHS – B, to amend the description of the items for cultural adaptation. The adapted Chinese version (ACV) of the BSHS – B was tested for internal consistency and validity of construct on a group of 271 burn patients from three major burn units in China. Results: Thirty-eight items within six domains of ACV BSHS-B were developed with scoring ‘0–4’ in each item. The mean total score for our study group was 98.36 (standard deviation (S.D.)=37.86), ranging from 13 to 150. The total Cronbach''s alpha value was 0.97 and total split-half reliability was 0.98, demonstrating that the internal consistency of the ACV was very high. Pearson correlations among the six domains of ACV BSHS – B were statistically significant. Exploratory factor analysis results showed that the six-factor function explained 78.30% of total variance; each entry in the corresponding domain had a factor-loading value higher than 0.4, indicating that the scale has a good validity. Conclusion: The ACV of the BSHS – B showed good reliability and validity, and can be used as a tool for assessing the QOL in Chinese burn patients. [Copyright &y& Elsevier]

Abstract: Background: There are few studies reporting the level of pre-hospital emergency management of burn patients and related influencing factors in China. This study is a summary of our investigation on emergency education and people''s awareness about pre-hospital emergency management of burn patients in Shanghai, China, and analyses key factors influencing pre-hospital emergency management of burn patients. Methods: The survey was conducted by questionnaire in burn patients who sought initial clinical visits at the Burn Center of Changhai Hospital (Shanghai, China) between November 2009 and December 2010, including demographic data, burn conditions, pre-hospital emergency management and education about emergency burn management. Data were statistically treated by SPSS software. Results: Altogether 1868 effective questionnaire forms were collected; 33.9% of these burn patients received cooling treatment before admission and 32.2% of them used ‘folk remedies’ or antibiotics to treat the wound surface. Only 12.2% of these burn patients had received education about the knowledge of emergency management, mainly through public media (38.2%), relatives and friends (24.6%), Internet (15.8%), workplace (11.4%) and schools (10.1%). The result of logistic regression analysis showed that emergency education, especially via Internet and workplace, played an important role in pre-hospital emergency management, and that different channels of emergency education affected different age groups of people: network and unit education mainly affected young adults, while relatives and friends mainly affected elderly people. In addition, educational level was an important factor favourably affecting ‘cooling therapy’. Conclusions: The level of emergency burn management and related education is relatively low in China at present, and it is therefore necessary to intensify education about pre-hospital emergency management to raise the level of emergency burn management. At the same time, more attention should be paid to age- and population-specific education. Finally, universal emergency education should be included in the national basic education as a long-term strategy. [Copyright &y& Elsevier]

Abstract: Objectives: We sought to evaluate the long term health-related quality of life (HRQOL) in patients survived severely extensive burn and identify their clinical predicting factors correlated with HRQOL. Methods: A cross-sectional study was conducted in 20 patients survived more than 2years with extensive burn involving ≥70% total body surface area (TBSA) between 1997 and 2009 in a burn center in Shanghai. Short Form-36 Medical Outcomes Survey (SF-36), Brief Version of Burn Specific Health Scale (BSHS-B) and Michigan Hand Outcome Questionnaire (MHQ) were used for the present evaluation. SF-36 scores were compared with a healthy Chinese population, and linear correlation analysis was performed to screen the clinical relating factors predicting physical and mental component summary (PCS and MCS) scores from SF-36. Results: HRQOL scores from SF-36 were significantly lower in the domains of physical functioning, role limitations due to physical problems, pain, social functioning and role limitations due to emotional problems compared with population norms. Multiple linear regression analysis demonstrated that only return to work (RTW) predicted improved PCS. While age at injury, facial burns, skin grafting and length of hospital stay were correlated with MCS. Work, body image and heat sensitivity obtained the lowest BSHS-B scores in all 9 domains. Improvements of HRQOL could still be seen in BSHS-B scores in domains of simple abilities, hand function, work and affect even after a quite long interval between burns and testing. Hand function of extensive burn patients obtained relatively poor MHQ scores, especially in those without RTW. Conclusions: Patients with extensive burns have a poorer quality of life compared with that of general population. Relatively poor physical and psychological problems still exist even after a long period. Meanwhile, a trend of gradual improvements was noted. This information will aid clinicians in decision-making of comprehensive systematic regimens for long term rehabilitation and psychosocial treatment. [Copyright &y& Elsevier]

Abstract: Objective: To explore the risk factors relating to lower digestive tract haemorrhage in severe burns and summarise the experience in clinical diagnosis and treatment. Method: General data of 103 patients with severe extensive burns (EBs) admitted to our burn centre in Shanghai between 1997 and 2009 were reviewed retrospectively. The risk factors relating to EB-complicated lower digestive tract haemorrhage were analysed systematically with respect to the clinical features and experiences in treatment, and prognosis. Results: Of the 103 severe EBs, five developed lower digestive tract haemorrhage with an occurrence of 4.9%. Four of them were proved to have multiple mucosal erosions in caecum, colon and rectum, and the remaining one was proved rectal ulcerative haemorrhage. In comparison with upper digestive tract haemorrhage, lower digestive tract haemorrhage in the present group was characterised by a longer duration (median 4.0 days, interquartile range (IQR) 1.5–14.5 days vs. median 2.0 days (IQR 1.0–3.0 days), P <0.05). Deep burns, especially fourth-degree burns, with complications of severe systemic infection, formed the main risk factors relating to lower digestive tract haemorrhage in severe EB patients. Conclusion: Severe EB-complicated lower digestive tract haemorrhage is a critical condition in burns, which usually have deep wounds with severe infection surfaces that are difficult to deal with. Enteroscopic haemostasis in controlling lower digestive tract haemorrhage is usually ineffective. Clinical experiences indicate that early management of the wound with effective preventive and therapeutive measures for infection control may be a good choice in the prevention and treatment of lower digestive tract haemorrhage leading to improvement in its prognosis. [Copyright &y& Elsevier]

Abstract: Alternation of surface markers on monocytes is associated with the development of inflammation. The goals of the present study were to detect CD47 expression on monocytes by flow cytometry and explore its relationship with disease severity and MODS in burned patients. The results show CD47 expression on monocytes from all burned patients (n =21) was lower than that from the healthy population (n =21) for 24 days after burn. There was a significant difference in CD47 expression on monocytes between the patients with differing burn severity in the first 7 days after injury (P <0.05). Considering the relationship between CD47 expression and MODS, we found the CD47 expression on monocytes from patients with MODS was lower (P <0.05) in the first 3 days after injury than that from patients without MODS. In conclusion, diminished CD47 expression on monocytes is associated with burn severity and the occurrence of MODS in burn patients. [Copyright &y& Elsevier]

Introduction: Early diagnosis and treatment for thermal injury with septic complications continue to be a serious clinical problem. In this study, plasma biomarkers of rats in the burn and/or septic models were investigated with a metabolomic method. Methods: Rat plasma samples were analyzed by ultra-performance liquid chromatography–quadrupole time-of-flight mass spectrometry (UPLC–Q-TOF-MS). Multivariate analysis, the principal components analysis (PCA), was used to validate metabolic changes. In addition, another multivariate method, the orthogonal partial least-squares analysis (OPLS), was used to profile potential biomarkers in models. Results: Nine characteristic metabolites, including hypoxanthine, indoxyl sufate, glucuronic acid, gluconic acid, proline, uracil, nitrotyrosine, uric acid, and trihydroxy cholanoic acid were identified in models of thermal injury and/or sepsis. Conclusion: These biomarkers were mainly involved in oxidative stress and tissue damage, and might supply evidence for distinguishing burned septic patients from non-septic ones. [Copyright &y& Elsevier]

Abstract: The 105 patients admitted to our Burn Institute from 1st January 1996 to 31st December 2007, with ship fire-related burns were studied retrospectively. The mean age was 30.2±12.6 years with a range of 1–58. One hundred and three patients (98.1%) were men and 2 (1.9%) women. The mean total burn surface area (TBSA) was 46.5%, mostly deep burns. The most common areas of burn were the head, neck and upper limb. Summer months July, August, June and September were times of highest incidence. Fifty-seven (54.3%) patients had inhalation injury, 42 received tracheotomy, and 38 received mechanical ventilation. The treatment was complex, difficult, long, and costly. The interval between burn and start of resuscitation ranged from 2.1 to 67h with a mean of (5.9±4.4)h. Forty-two patients (40%) started intravenous fluid resuscitation 6h after burn. Twenty-four patients (23%) received insufficient fluid resuscitation developed hypotension and severe shock at admission. Ninety-two (87.6%) patients required operations including tracheotomy, debridement and grafting, per patient was 5.2. The mean length of hospital stay was 44.2 days. Pulmonary edema was the most common complication during the early post-burn period (within 7 days), and sepsis during the later period (>7 days). Nine patients died of MODS or sepsis, giving a mortality rate of 8.57%. Conclusion: Caution and preventive measures are needed for persons in ships for fire-related burns. [Copyright &y& Elsevier]

Abstract: Objective: To reveal the characteristic and distribution of length of hospital stay (LOS) and direct hospitalisation costs of paediatric scald. Methods: A prospective case series observation was performed from January 2005 to December 2006 at the Burn Center, Changhai Hospital, Shanghai, China. The information, such as demographics, clinical diagnosis and treatments since admission, of the paediatric scald patients included in the series was recorded. The direct cost of a treatment event was recorded into the price system when it was incurred. All cost data were summarised on completion of the study. The distribution of LOS and the hospitalisation costs were recorded by gender, age, total burn area, depth of burn, blood transfusion and patterns of treatment. Mann–Whitney signed-rank test was used to assess the differences between continuous, non-normally distributed variables, and multiple linear regression was used to model LOS and direct hospitalisation costs. Statistical analyses were undertaken with SPSS 15.0 statistical software. Results: Patients aged 3 years or less accounted for more than half of the total LOS and hospitalisation costs, patients with burn area less than 10%TBSA (total burn surface area) accounted for more than 70% of the total LOS and more than half of the hospitalisation costs and patients with second-degree burn accounted for more than 78% of the total LOS and hospitalisation costs. Depth of burn, area of burn, patterns of treatment and blood transfusion were independent predictors of LOS; whereas LOS, area of burn and blood transfusion were independent predictors of hospitalisation costs. Conclusion: Paediatric scalds have particular characteristics in terms of distribution of LOS and direct hospitalisation costs and the factors influencing them. The data presented in this study should assist burn care practitioners and hospital epidemiologists estimate and compare the economic burden of paediatric burns at other institutions; it may also be useful in resource allocation and cost-effectiveness analysis of treatment versus prevention strategies. [Copyright &y& Elsevier]