ISSN:0273-8481    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0273-8481    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0273-8481    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

This study investigated the frequency of sleep disturbance of burn survivors at 3 time points: during hospitalization (time 1: n = 237), 1 week after discharge (time 2: n = 149), and 2 months after discharge (time 3: n = 91). Predictors of sleep disturbance and its relationship to quality of life are explored. Measures of sleep, post-traumatic stress disorder, depression, anxiety, pain, and quality of life were administered at each time point. Fifty percent of participants had sleep disturbance while in the hospital and 1 week after discharge. Forty percent of participants continued to have sleep disturbance 2 months after discharge. In regression equations, emotional distress was a better predictor of sleep disturbance than pain and total body surface area burned at each time point. Sleep disturbance was significantly negatively correlated with all aspects of quality of life represented on the SF-36 Health Survey. Sleep disturbance is a common and often chronic postburn complication that warrants further research. (J Burn Care Rehabil 1998;19:480–86)

ISSN:0273-8481    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Thrombospondin-1 (TSP-1), an adhesive glycoprotein, plays an important role in platelet adhesion, inflammation, cell-to-cell interaction, and angiogenesis. TSP-1 is expressed by endothelial cells, fibroblasts, and macrophages. TSP-1's unique cysteine-serine-valine-threonine-cysteine-glycine (CSVTCG) specific receptor plays an important role in die binding and modulation of cellular adhesion and invasion. This article histologically and quantitatively evaluates TSP-1 and its CSVTCG receptor in adult burn wounds over time. Tissue was obtained from burn wounds on several days and samples that were 5 μm thick were placed on slides. Expression of TSP-1 and its CSVTCG receptor were evaluated immunohistochemically and quantitated by computer image analysis in units of absorbance. Immunoglobin G (IgG) (negative) controls were performed and subtracted from the TSP-1 sample to eliminate background absorbance readings. Serum (negative) control was used for the CSVTCG receptor. Platelet concentrates were used as the positive control. A quantitative examination of the results yielded the following information, expressed as absorbance ± standard error of the mean: TSP-1: day 1, 62.0 ± 10.13; day 3, 76.2 ± 6.90; day 5, 36.0 ± 3.96; day 7, 60.4 ± 5.67; and day 9, 29.5 ± 2.91. TSP-1 displays an early peak, followed by a steep decrease over die time period studied. The readings for the CSVTCG receptor are as follows: day 1, 33.8 ± 1.87; day 3, 34.5 ± 5.39; day 7, 39.1 ± 1.93; day 21, 39.1 ± 1.93; day 28, 34.8 ± 3.67. In contrast, the CVSTCG receptor continues to be present in die wound over time. Histologic findings are reported, and photographs and a histopathologic analysis are included. The information presented in this article leads to die conclusion diat temporal and histologic differences exist in the localization and expression of TSP-1 and its CSVTCG receptor. TSP-1 is up-regulated in injured tissues immediately after die injury; it is rapidly down-regulated as die tissue heals. In contrast, the levels of the CSVTCG receptor remain relatively constant during the healing process. These data are consistent with TSP-1's known role in cell-to-cell interaction, including the modulation of the growth factor and protease activity.

ISSN:0273-8481    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Cryopreservation and glycerol preservation are 2 successful methods for long-term preservation of human cadaver skin. Preservation is subjected to strict criteria to minimize the risk of disease transmission. This investigation compares the effects of glycerol preservation and cryopreservation on die inactivation of HIV-1. The effects of glycerol preservation and cryopreservation on inactivation of both extracellular and intracellular HIV-1Ba-Lwere investigated. After exposing HIV-1Ba-L-infected material to various concentrations of glycerol or to 10% dimethyl sulfoxide followed by cryopreservation, uninfected peripheral blood mononuclear cells were added to the treated material. At different time points during the culture, supernatants were taken to quantify HIV-1Ba-Land reverse transcriptase levels to determine HIV-1Ba-Linfectivity. Cell-free HIV-1Ba-Lwas inactivated within 30 minutes in 70% and 85% glycerol. Also, intracellular HIV-1Ba-Lin infected peripheral blood mononuclear cells or infected cadaver skin was completely inactivated by glycerol treatment in vitro. Cryopreservation did not show any extracellular or intracellular HIV-1Ba-Linactivation. Glycerol preservation–but not cryopreservation–of human cadaveric donor skin can inactivate both extracellular and intracellular HIV-1.

ISSN:0273-8481    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

This study investigates the hypothesis that continuous administration of indomediacin (a cyclo-oxygenase inhibitor) will chronically reduce body temperature (TB) in burned rats (ie, modulate “true” fever). Male Sprague-Dawley rats had radio transmitters and osmotic pumps (containing indomethacin) placed in the peritoneal cavity, and 7 days later large full-thickness scald burns were produced. Activity and TBwere continually recorded through the 14di postburn day (PBD). There were 4 experimental groups: burn + indomethacin (B-In),n= 9; burn + polyediylene glycol (B-Peg),n= 6; control + indomediacin (C-In),n= 9; and control + polyediylene glycol (C-Peg),n= 6. From PBD 5 through PBD 10, the B-Peg group had consistently and significantly higher TBduring light hours than the B-In, C-In, and C-Peg groups. From PBD 7 through PBD 12, the B-In group had an average TBduring light hours significantly lower or not different than the C-In and C-Peg groups. These results support the hypothesis that in this burned-rat model chronically increased TBduring the light hours may be “fever” (rather than hyperthermia) and that the final effector link could be a prostanoid because changes in activity do not explain the changes in body temperature. (J Burn Care Rehabil 1998;19:501–11)

ISSN:0273-8481    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Septic episodes in thermal injuries are usually hallmarked by a series of physiologic parameters that include tachypnea, prolonged paralytic ileus, hyperthermia or hypothermia, altered mental status, thrombocytopenia, leukocytosis or unexplained leukopenia, acidosis, and hyperglycemia. Recent studies with polycystic kidney disease have clearly indicated that the limulus amebocyte lysate (LAL) assays were predictive of fungal infections in this patient population. Because both bacteria and fungi produce lipopolysaccharide that can be identified with die LAL assay, we randomly assayed sequential sera of 45 patients with major thermal injuries for positivity in the LAL assay, with use of the QCL-1000 kit (BioWhittaker, Walkersville, Md). The average burn size of this patient population was 63.43% total body surface area. The average age of the patient was 6.2 years. The sex distribution included 30 males and 15 females. The infectious agents included gram-positive cocci and gram-negative rods, and 14 patients had concomitant fungal infections. Eighty-five percent of the patients tested were positive for endotoxin, with levels ranging from < 0.1 EU/mL to > 1.0 EU/mL. The predominant organism isolated before or on the date the serum was drawn wasPseudomonas aeruginosa(51%), followed byKlebsiella pneumoniae(15%). The remaining 34% were a variety ofEnterobacteriaceae.Of the 14 patients who yielded a fungus, 3 had negative LAL assays. Two patients with an elevated LAL grew onlyStaphylococcus epidermidisin the bloodstream and the wounds. These data clearly indicate that the LAL assay cannot be relied on as the sole predictor of septic episodes; however, it can be an adjunctive test to confirm sepsis when the other parameters have been considered. (J Burn Care Rehabil 1998;19:512–15)

ISSN:0273-8481    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The ideal oral wound care analgesic for children should be palatable, provide potent analgesia of rapid onset and short duration, and require minimal, yet appropriate, monitoring. With use of a double-blinded crossover design, we compared the efficacy and safety of oral transmucosal fentanyl citrate (OTFC) (10 μg/kg) with die efficacy and safety of oral hydromorphone (60 μg/kg) in 14 pediatric inpatients (ages 4 to 17 years) undergoing daily burn wound care in a ward setting. Pulse oximetry, vital signs, side effects, patient pain scores, and observer scores for cooperation, anxiety, and sedation were recorded. Pulse oximetry, vital signs, cooperation, sedation, incidence of nausea or vomiting, and the amount of time it took to resume normal activities were similar in both treatment groups. OTFC resulted in improved pain scores before wound care and improved anxiolysis during wound care, but at other points it was similar in effect to hydromorphone. We conclude that OTFC is a safe and effective analgesic, that it may provide minor improvements in analgesia and anxiolysis compared with hydromorphone, and that it offers a palatable alternative route of opioid administration without intravenous access for wound care procedures in children. (J Burn Care Rehabil 1998:19;516–21)

ISSN:0273-8481    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

An estimated 2 million people a year are victims of elder abuse, which ranges from neglect and mistreatment to physical abuse. By the year 2020, a full 22% of the population will be aged 65 or older. This demographic explosion demands that we identify and protect those at risk. To investigate the incidence of elder abuse or neglect (EAN) and to determine clinician awareness of associated risk factors, we conducted a 1-year retrospective review of thermally injured patients aged 60 or older. Data included age, total body surface area burned, mechanism of injury, length of hospital stay, mortality, abuse or neglect risk factors, and referral to the appropriate social agency. We found that our elderly patients (n = 28) were poorly screened for EAN. While 64% to 96% of patients were screened for cognitive impairment, overall health, and financial resources, none were screened for risk factors of emotional isolation. None of the patient's caregivers, including any spouses, roommates, or guardians, were screened for risk factors of substance abuse, familial violence, dependency needs, or external stresses. With the use of available data, we were able to place 11 patients on the following levels of abuse or neglect: 1) low risk for abuse; 2) self-neglect; 3) neglect; and 4) abuse. By this scale, 7 patients (64%) were victims of self-neglect, 3 patients (27%) were victims of neglect, and 1 patient (9%) was a victim of abuse. Adult Protective Services intervened in 2 cases. Recognizing that all cases of EAN should be preventable, we cannot accept the socioeconomic impact of this entity. The 11 patients identified as victims of neglect, self-neglect, or abuse accounted for 135 hospital days and 8 fatalities. Before we can address EAN, health care personnel must be made aware of the problem and routine screening for risk factors must be implemented. The true incidence of EAN is likely underestimated because health care providers have difficulty recognizing its features. A standard assessment tool to screen for neglect or abuse should be used for each older adult admission. (J Burn Care Rehabil 1998;19:522–27)

ISSN:0273-8481    

出版商:OVID    

年代:1998

数据来源: OVID