Risk factors for nosocomial bloodstream infections due to Acinetobacter baumannii: a case-control study of adult burn patients.
Risk factors for Acinetobacter baumannii bloodstream infection (BSI) were studied in patients with severe thermal injury in a burn intensive care unit where A. baumannii was endemic. Of 367 patients hospitalized for severe thermal injury during the study period, 29 patients with nosocomial A. baumannii BSI were identified (attack rate, 7.9%). Cases were compared with 58 matched controls without A. baumannii BSI. The overall mortality rate was 31% among cases and 14% among controls; only two deaths (7%) were considered directly related to A. baumannii BSI. Molecular typing of A. baumannii blood isolates by means of randomly amplified polymorphic DNA analysis and pulsed-field gel electrophoresis revealed the presence of three different strain types. Multivariate analysis showed that female gender (P = .027), total body surface area burn of > 50% (P = .016), prior nosocomial colonization with A. baumannii at a distant site (P = .0002), and use of hydrotherapy (P = .037) were independently associated with the acquisition of A. baumannii BSI in burn patients. These data underscore the need for effective infection control measures for this emerging nosocomial problem. (+info)
Effects of clonidine on myocardial beta-adrenergic receptor-adenyl cyclase-cAMP system after scalds in rats.
AIM: To study the role of clonidine (Clo) on the myocardial beta-adrenergic receptor (beta-AR)-adenyl cyclase (AC)-cAMP system after the scalds in rats. METHODS: A 30% skin-full-thickness scald was produced by immersing rats in 95 degrees C water for 9 s. Clo 0.1-3.0 mg.kg-1 was injected i.p. to rats at 30 min before scalds, yohimbine (Yoh) 0.05 mg.kg-1 or prazosin (Pra) 0.03 mg.kg-1 to rats at 30 min before i.p. Clo. beta-AR density and affinity, AC activity, phosphoric diester hydrolases (PDH) activity, and cAMP content were determined with radioreceptor assay, indirect method, enzymeradiochemical assay, and radioimmunoassay, respectively. RESULTS: Clo inhibited the decrease of the myocardial beta-AR density, the attenuation of AC activity, and the reduction of cAMP content at 12 h after the scalds. Yoh partially reversed the effects of Clo on the three parameters. But Pra did not. CONCLUSION: Clo reversed the changes of the myocardial beta-AR-AC-cAMP system resulted from the scalds in rats. (+info)
The thermal sensitivity of the polymodal nociceptors in the monkey.
1. The static and dynamic sensitivities to thermal and mechanical stimuli of polymodal nociceptors in hairy skin of the anaesthetized monkey have been investigated by recording activity in their primary nerve fibres. 2. Polymodal nociceptors responded to skin pricking, pinching and heating to temperatures higher than 40 degrees C. They did not respond to touch, stretch or cold. The conduction velocity of their axons was from 0.6 to 1.1 m/sec. 3. Three types of cutaneous receptive fields have been observed: single spot-like areas of 1-2 mm2; multiple spot-like areas of 1-2 mm2; and larger areas up to 25 mm2 with heterogeneous sensitivity. 4. Polymodal nociceptors were subjected to heat stimuli that commenced from a 33 or 37 degrees C adapting temperature. A series consisted of heating their receptive fields to 43, 45, 47 and 50 degrees C from one or the other adapting temperatures at a constant rate of 0.2 degrees C/sec. Each heat stimulus intensity was maintained for 4 min after which the skin was returned to the adapting temperature. Immediately after the first series the identical series was repeated in order to determine the effect of prior heating upon the dynamic responses to re-heating. The dynamic responses were characterized by three phases: an initiation of a discharge at a threshold level of skin temperature; a dynamic discharge during the suprathreshold change, that reached a peak frequency when the temperature reached its maximum; and an adaptation phase while the temperature remained at the high intensity. Adaptation was rapid initially, and then slowed during the final minutes at the high intensity. 5. Adapting the receptive field to either 33 degrees C or to 37 degrees C before the heat stimuli did not affect the sensitivity and the discharge pattern of the polymodal nocicpetors. 6. During the first series of stimulations, the threshold at which the individual polymodal nociceptors began to discharge to heat stimuli varied from 40 to 46.5 degrees C. The mean threshold of the population was 42.5 degrees C. 7. No change in the threshold was observed when responses to 0.2 and 1.5 degrees C/sec rates of heating were compared... (+info)
In response to cutaneous injury, expression of collagenase-1 is induced in keratinocytes via alpha2beta1 contact with native type I collagen, and enzyme activity is essential for cell migration over this substratum. However, the cellular mechanism(s) mediating integrin signaling remain poorly understood. We demonstrate here that treatment of keratinocytes cultured on type I collagen with epidermal growth factor receptor (EGFR) blocking antibodies or a specific receptor antagonist inhibited cell migration across type I collagen and the matrix-directed stimulation of collagenase-1 production. Additionally, stimulation of collagenase-1 expression by hepatocyte growth factor, transforming growth factor-beta1, and interferon-gamma was blocked by EGFR inhibitors, suggesting a required EGFR autocrine signaling step for enzyme expression. Collagenase-1 mRNA was not detectable in keratinocytes isolated immediately from normal skin, but increased progressively following 2 h of contact with collagen. In contrast, EGFR mRNA was expressed at high steady-state levels in keratinocytes isolated immediately from intact skin but was absent following 2 h cell contact with collagen, suggesting down-regulation following receptor activation. Indeed, tyrosine phosphorylation of the EGFR was evident as early as 10 min following cell contact with collagen. Treatment of keratinocytes cultured on collagen with EGFR antagonist or heparin-binding (HB)-EGF neutralizing antibodies dramatically inhibited the sustained expression (6-24 h) of collagenase-1 mRNA, whereas initial induction by collagen alone (2 h) was unaffected. Finally, expression of collagenase-1 in ex vivo wounded skin and re-epithelialization of partial thickness porcine burn wounds was blocked following treatment with EGFR inhibitors. These results demonstrate that keratinocyte contact with type I collagen is sufficient to induce collagenase-1 expression, whereas sustained enzyme production requires autocrine EGFR activation by HB-EGF as an obligatory intermediate step, thereby maintaining collagenase-1-dependent migration during the re-epithelialization of epidermal wounds. (+info)
Role of L-selectin in physiological manifestations after burn and smoke inhalation injury in sheep.
The effects of a monoclonal antibody against L-selectin [leukocyte adhesion molecule (LAM)1-3] on microvascular fluid flux were determined in conscious sheep subjected to a combined injury of 40% third-degree burn and smoke inhalation. This combined injury induced a rapid increase in systemic prefemoral lymph flow (sQlymph) from the burned area and a delayed-onset increase in lung lymph flow. The initial increase in sQlymph was associated with an elevation of the lymph-to-plasma oncotic pressure ratio; consequently, it leads to a predominant increase in the systemic soft tissue permeability index (sPI). In an untreated control group, the increased sPI was sustained beyond 24 h after injury. Pretreatment with LAM1-3 resulted in earlier recovery from the increased sPI, although the initial responses in sQlymph and sPI were identical to those in the nontreatment group. The delayed-onset lung permeability changes were significantly attenuated by pretreatment with LAM1-3. These findings indicate that both leukocyte-dependent and -independent mechanisms are involved in the pathogenesis that occurs after combined injury with burn and smoke inhalation. (+info)
Insulin but not growth hormone stimulates protein anabolism in skin wound and muscle.
We have measured protein kinetics in the scalded skin and normal muscle in anesthetized rabbits. On the 7th day after ear scald, L-[ring-13C6]phenylalanine was infused as a tracer, and the ear and hindlimb were used as arteriovenous units to reflect skin and muscle protein kinetics. Insulin was infused at 0.6 or 2.3-3.4 mU. kg-1. min-1 in the low-dose and high-dose insulin groups. In the growth hormone group, recombinant human growth hormone was administered at 2 mg. kg-1. day-1 after the ear was scalded. The results were compared with a control group in which the ear was scalded but otherwise was not treated. In the control group, net protein loss in the scalded skin and muscle was 23.1 +/- 21.4 and 3.9 +/- 1.5 micromol. 100 g-1. h-1, respectively. Insulin infusion at either high or low dose reduced net protein loss to near zero by inhibiting proteolysis. In contrast, growth hormone treatment had no anabolic effect on either tissue. In conclusion, insulin but not growth hormone has an anabolic effect on scalded skin and normal muscle; low-dose insulin is as effective in achieving an anabolic effect on both tissues, with less hypoglycemic response than high-dose insulin. (+info)
Acute hand burns in children: management and long-term outcome based on a 10-year experience with 698 injured hands.
OBJECTIVE: To document long-term results associated with an coordinated plan of care for acutely burned hands in children. SUMMARY AND BACKGROUND DATA: Optimal hand function is a crucial component of a high-quality survival after burn injury. This can be achieved only with a coordinated approach to the injuries. Long-term outcomes associated with such a plan of care have not been previously reported. METHODS: Over a 10-year period, 495 children with 698 acutely burned hands were managed at a regional pediatric burn facility; 219 children with 395 injured hands were followed in the authors' outpatient clinic for at least 1 year and an average of >5 years. The authors' approach to the acutely burned hand emphasizes ranging and splinting throughout the hospital stay, prompt sheet autograft wound closure as soon as practical, and the selective use of axial pin fixation and flaps. Long-term follow-up, hand therapy, and reconstructive surgery are emphasized. RESULTS: Normal functional results were seen in 97% of second-degree and 85% of third-degree injuries; in children with burns involving underlying tendon and bone, 70% could perform activities of daily living and 20% had normal function. Reconstructive hand surgery was required in 4.4% of second-degree burns, 32% of third-degree burns, and 65% of those with injuries involving underlying bone and tendon. CONCLUSIONS: When managed in a coordinated long-term program, the large majority of children with serious hand burns can be expected to have excellent functional results. (+info)
Muscle protein catabolism after severe burn: effects of IGF-1/IGFBP-3 treatment.
OBJECTIVE: To determine the effects of recombinant human insulin-like growth factor-1 (IGF-1) complexed with its principal binding protein, IGFBP-3, on skeletal muscle metabolism in severely burned children. SUMMARY BACKGROUND DATA: Severe burns are associated with a persistent hypermetabolic response characterized by hyperdynamic circulation and severe muscle catabolism and wasting. Previous studies showed that nutritional support and pharmacologic intervention with anabolic agents such as growth hormone and insulin abrogated muscle wasting and improved net protein synthesis in the severely burned. The use of these agents, however, has several adverse side effects. A new combination of IGF-1 and IGFBP-3 is now available for clinical study. METHODS: Twenty-nine severely burned children were prospectively studied before and after treatment with 0.5, 1, 2, or 4 mg/kg/day IGF-1/IGFBP-3 to determine net balance of protein across the leg, muscle protein fractional synthetic rates, and glucose metabolism. Another group was studied in a similar fashion without IGF-1/IGFBP-3 treatment as time controls. RESULTS: Seventeen of 29 children were catabolic before starting treatment. The infusion of 1.0 mg/kg/day IGF-1/IGFBP-3 increased serum IGF-1, which did not further increase with 2.0 and 4.0 mg/kg/day. IGF-1/IGFBP-3 treatment at 1 to 4 mg/ kg/day improved net protein balance and increased muscle protein fractional synthetic rates. This effect was more pronounced in catabolic children. IGF-1/IGFBP-3 did not affect glucose uptake across the leg or change substrate utilization. CONCLUSIONS: IGF-1/IGFBP-3 at doses of 1 to 4 mg/kg/day attenuates catabolism in catabolic burned children with negligible clinical side effects. (+info)