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ABSTRACT: Charcot-Marie-Tooth (CMT) disease is characterized by hereditary sensorimotor polyneuropathy with foot deformity, sensorineural hearing loss, moderate developmental delay, and gait disturbance. CMT presenting with type 2 diabetes and an ulcer has not been reported. This article reports a man who presented with the symptoms mentioned above and also with a leg ulcer and type 2 diabetes. He was diagnosed with CMT disease based on family history and genetic testing. A skin defect in the left leg had manifested for more than 1 year, and results of initial fasting plasma glucose revealed type 2 diabetes. The evolution of these manifestations, coupled with a slowly progressive weakness, numbness, muscular wasting, and sensory impairment, strongly suggested the co-occurrence of 3 different diseases in the same individual.
The International Journal of Lower Extremity Wounds 02/2013; · 1.20 Impact Factor
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ABSTRACT: To perform a retrospective survey of the clinical features and clinical courses of diabetic foot patients with amputations hospitalized in the Second Affiliated Hospital of Zhejiang University from 2007 to 2011.According to the database from the medical records department in our hospital 36 cases of diabetic patients were selected out of 805 cases of amputees. The clinical information was recorded in detail. With the contact information provided in the medical record, telephone interviews were conducted for each patient and their family to complete the record for the current disease progression and the patient's treatment process. Among all of the patients with hospitalized amputations, 36/805(4.47%) were diabetic foot patients with amputations, accounting for 36/273(13.19%) of non-traumatic amputations. The average age of the diabetic patients with first-time amputations was 62 years, the average BMI was greater than 24.5kg/m2, and the waist-to-hip ratio was greater than 0.92. Among the 22 patients who completed the follow-up interviews, 17 had only small amputations. Diabetic amputation has become a common clinical problem. The patients were mainly elderly, overweight or obese. Amputations at the toe level still accounted for a large proportion of the patients. Overall, the follow-up interviews indicated that the patients lacked good understanding of and concern for their own disease, with unclear control of blood sugar and no standardized control method. Helping the patients to understand the disease and paying attention to health education may play a role in the prevention and treatment of diabetes and diabetic foot disease.
The International Journal of Lower Extremity Wounds 08/2012; 11(3):194-200. · 1.20 Impact Factor
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ABSTRACT: Nanotechnology is a highly promising field, with nanoparticles produced and utilized in a wide range of commercial products. Silver nanoparticles (AgNPs) has been widely used in clothing, electronics, bio-sensing, the food industry, paints, sunscreens, cosmetics and medical devices, all of which increase human exposure and thus the potential risk related to their short- and long-term toxicity. Many studies indicate that AgNPs are toxic to human health. Interestingly, the majority of these studies focus on the interaction of the nano-silver particle with single cells, indicating that AgNPs have the potential to induce the genes associated with cell cycle progression, DNA damage and mitochondrial associated apoptosis. AgNPs administered through any method were subsequently detected in blood and were found to cause deposition in several organs. There are very few studies in rats and mice involving the in vivo bio-distribution and toxicity, organ accumulation and degradation, and the possible adverse effects and toxicity in vivo are only slowly being recognized. In the present review, we summarize the current data associated with the increased medical usage of nano-silver and its related nano-materials, compare the mechanism of antibiosis and discuss the proper application of nano-silver particles.
Molecular Biology Reports 06/2012; 39(9):9193-201. · 2.93 Impact Factor
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ABSTRACT: Mechanical properties are essential considerations for the design of porous scaffolds in the field of tissue engineering. To develop a well-supported hybrid dermal substitute, poly(L-lactide-co-glycolide) (PLGA) yarns were knitted into a mesh with relative fixed loops, followed by incorporation into collagen-chitosan scaffolds (CCS) to obtain PLGA knitted mesh-reinforced CCS (PLGAm/CCS). The morphology and tensile strength in both the dry and wet state of PLGAm/CCS were investigated in vitro. To characterize the tissue response, specifically angiogenesis and tissue regeneration, PLGAm/CCS was embedded subcutaneously in Sprague-Dawley rats and compared with two control implants, i.e., PLGA mesh (PLGAm) and CCS. At weeks 1, 2, and 4 post surgery, tissue specimens were harvested for histology, immunohistochemistry, real-time quantitative PCR and Western blot analysis. These results demonstrated that the incorporation of PLGA knitted mesh into CCS can improve the mechanical strength with little influence on its mean pore size and porosity. After implantation, PLGAm/CCS can resist contraction and promote cell infiltration, neotissue formation, and blood vessel ingrowth, effectively. In conclusion, the mechanical strength of scaffolds can play a synergetic role in tissue regeneration and vascularization by maintaining its 3D microstructure. The ability of PLGAm/CCS to promote angiogenesis and induce in situ tissue formation demonstrates its strong potential in the field of skin tissue engineering.
Journal of the mechanical behavior of biomedical materials. 04/2012; 8:204-15.
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ABSTRACT: A novel dermal substitute of combining recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) with a porous heparinized collagen/chitosan scaffolds was developed, considering the inadequate angiogenesis during repair of full-thickness skin defects. The physicochemical properties of heparinized collagen/chitosan scaffolds were examined and in vitro release pattern of rhGM-CSF from scaffolds was measured by ELISA. Four groups of composite scaffolds (heparinized or unheparinized scaffolds loaded with or without rhGM-CSF) were fabricated for subcutaneous implantation in young adult male Sprague-Dawley (SD) rats. Tissue specimens were harvested at different time points after implantation for histopathological, immunohistochemical observation, and Western blotting analysis. The heparinized scaffolds (H(1)E) showed slower biodegradation and sustained release of rhGM-CSF in vitro, although no significantly different release pattern was observed between the H(1)E and unheparinized scaffolds (H(0)E). In vivo investigation revealed that the heparinized scaffolds loaded with rhGM-CSF (H(1)E/rhGM-CSF) had the best cellular adhesion and migration, new vessel formation, and highest expression of VEGF and TGF-β1, indicating promoted angiogenesis. This study demonstrated that composite dermal substitute of combining rhGM-CSF with a porous heparinized collagen/chitosan scaffolds could be a potential therapeutic agent for full-thickness skin defects because of its sustained delivery of rhGM-CSF.
Journal of Biomedical Materials Research Part B Applied Biomaterials 12/2011; 100(3):788-98. · 2.15 Impact Factor
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ABSTRACT: Knitting is an ancient and yet, a fresh technique. It has a history of no less than 1,000 years. The development of tissue engineering and regenerative medicine provides a new role for knitting. Several meshes knitted from synthetic or biological materials have been designed and applied, either alone, to strengthen materials for the patching of soft tissues, or in combination with other kinds of biomaterials, such as collagen and fibroin, to repair or replace damaged tissues/organs. In the latter case, studies have demonstrated that knitted mesh scaffolds (KMSs) possess excellent mechanical properties and can promote more effective tissue repair, ligament/tendon/cartilage regeneration, pipe-like-organ reconstruction, etc. In the process of tissue regeneration induced by scaffolds, an important synergic relationship emerges between the three-dimensional microstructure and the mechanical properties of scaffolds. This paper presents a comprehensive overview of the status and future prospects of knitted meshes and its KMSs for tissue engineering and regenerative medicine.
Journal of the mechanical behavior of biomedical materials. 10/2011; 4(7):922-32.
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Yufeng Jiang,
Sha Huang,
Xiaobing Fu,
Hongwei Liu,
Xingwu Ran,
Shuliang Lu,
Dahai Hu,
Qiang Li,
Hongwei Zhang,
Ying Li,
Runxiu Wang,
Ting Xie,
Biao Cheng,
Lingfeng Wang,
Yi Liu,
Xiangbai Ye, Chunmao Han,
Huade Chen
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ABSTRACT: Chronic cutaneous wounds represent a major health care burden in China. However, limited information exists regarding the epidemiologic changes associated with recent social and economic development. We designed a cross-sectional survey in 2,513 patients who underwent treatment of chronic cutaneous wounds from a nationally representative sample in 17 hospitals between 2007 and 2008. Results revealed the prevalence of chronic cutaneous wounds among hospitalized patients was 1.7‰. Patient ages ranged from 18 days to 96 years (median, 58 years). The highest ratios were among 40-60 and 60-80-year-old patients (31% and 38%, respectively). The leading causes of chronic cutaneous wounds were diabetes (31.3% men, 35.3% women) trauma (26.4% men, 19.2% women). Manual workers (38.5% men, 29.3% women) and retirees (27.9% men, 23.5% women) accounted for over half the chronic cutaneous wound patients. Regarding treatments, only 22.4% were treated with modern dressings or other novel technologies and more patients received antibiotics (77.8%). Treatment was paid for by the patients in 42.3% of cases, by social medical insurance in 25.0%, by commercial medical insurance in 4.8%, while 27.9% received free medical care. Approximately half the patients' wounds were completely healed at discharge (1,345/2,513). In conclusion, diabetes has recently become the leading cause of chronic cutaneous wounds in China. The large population and considerable financial burden mean that serious attention should be paid to the early detection, prevention and diagnosis of chronic cutaneous wounds, and suggest that an overall health insurance system should be established, especially for the elderly.
Wound Repair and Regeneration 03/2011; 19(2):181-8. · 2.91 Impact Factor
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ABSTRACT: This is a work aimed to investigate the biodegradability, biocompatibility and mechanical property of the poly-lactide-co-glycolic acid (PLGA) knitted mesh preliminarily and to further explore its applications in tissue engineering and regenerative medicine. The biological property of PLGA mesh was investigated comprehensively with the degradation experiment in vitro, the acute cytotoxicity assay, the intradermal irritation test and the subcutaneous implantation test in vivo utilized. The degradation experiment in vitro demonstrated that the pH value of the removed solution fluctuated between 6.68 and 7.33. The elastic modulus of the PLGA mesh increased at first and then decreased afterwards. The acute toxicity test and the intradermal irritation test indicated that the PLGA mesh was with innocuity safety. The PLGA mesh accelerated degradation and was replaced gradually by the neotissue. The results of immunohistochemical staining demonstrated that the number of ED-1+ cells increased at first and then decreased afterwards. The PLGA mesh with excellent mechanical properties, good biocompatibility and favorable degradation ratio has the potential to be employed as a "skeleton" to reinforce the mechanical property of collagen-based dermal substitutes in tissue engineering.
Sheng wu yi xue gong cheng xue za zhi = Journal of biomedical engineering = Shengwu yixue gongchengxue zazhi 02/2011; 28(1):163-9.
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ABSTRACT: Re-epithelialization is the first and most important step in cutaneous wound healing. The vital role of epidermal cells, or keratinocytes, in accelerating wound healing has long been established. The technique of delivering the cultured and uncultured epidermal cells to the wound bed takes a variety of forms including cultured epithelial autografts (CEAs), tissue-engineered skin equivalent, epidermal suspension and microbead-loaded composite. These techniques, together with the keratinocyte culturing method and scaling up equipment, are still the ongoing research. Application of these techniques also bears direct impact on the outcome of the wounded patients. Best understanding of the delivery technique and its relationship with the culturing method and delivery vehicle could benefit not only the wounded patient but also the development of tissue-engineered skin equivalent.
Journal of Dermatological Treatment 10/2010; 23(3):224-37. · 1.23 Impact Factor
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ABSTRACT: The process of wound healing involves a complex interplay of cells, mediators, growth factors and cytokines. GM-CSF has been shown to be involved in a number of processes essential in this event. Topically applied rhGM-CSF has been reported to successfully treat wounds with diverse etiology, including burns, chronic venous leg ulcers, pressure ulcers, and leprosy ulcers, both in animal experiments and clinical studies. To evaluate the effect of the rhGM-CSF on wound healing, 8 RCT studies and 23 clinical studies and case reports are collected for analysis of the evidence. The overall effects of rhGM-CSF on the healing of wound are diverse. Topically applied rhGM-CSF is beneficial for deep partial-thickness burn wounds, chronic leg ulcers, and leprosy ulcers. rhGM-CSF may have a positive effect on other type of chronic ulcers such as pressure ulcers and cancer related ulcers, but the evidence is not sufficient for generalised use at present. rhGM-CSF is suggested have no accelerating effect on the healing of healthy wounds or surgical incisions.
Burns: journal of the International Society for Burn Injuries 10/2010; 37(5):729-41. · 1.95 Impact Factor
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ABSTRACT: Angiogenesis of an implanted construct is one of the most important issues in tissue engineering and regenerative medicine, and can often take as long as several weeks. The vascular endothelial growth factor (VEGF) shows a positive effect on enhancing angiogenesis in vivo. But the incorporation of growth factors has many limitations, since they typically have half-lives only on the order of minutes. Therefore, in this work the DNA encoding VEGF was applied to enhance the angiogenesis of a collagen scaffold. A cationic gene delivery vector, N,N,N-trimethyl chitosan chloride (TMC), was used to form complexes with the plasmid DNA encoding VEGF. The complexes were then incorporated into the collagen scaffold, the loading being mediated by the feeding concentration and release in a sustained manner. In vitro cell culture demonstrated a significant improvement in the VEGF expression level from the TMC/DNA complexes containing scaffolds, in particular with a large amount of DNA. The scaffolds containing the TMC/DNA complexes were subcutaneously implanted into Sprague-Dawley mice to study their angiogenesis via macroscopic observation, hematoxylin-eosin staining and immunohistochemical staining. The results demonstrated that the incorporation of TMC/DNA complexes could effectively enhance the in vivo VEGF expression and thereby the angiogenesis of implanted scaffolds.
Acta biomaterialia 05/2009; 5(8):2983-94. · 3.98 Impact Factor
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ABSTRACT: Artificial dermis lacks a vascular network, and angiogenesis is slow in vivo. Controlled delivery of angiogenin (ANG), a potent inducer of angiogenesis, should promote angiogenesis in artificial dermis. In this study, a porous collagen-chitosan scaffold was fabricated and heparinized using N-(3-dimethylaminopropyl)-N'-ethylcarbodiimide (EDC) and N-hydroxysuccinimide (NHS) with a freeze-drying method. Using radioiodine labeling, the effect of heparin on the binding of ANG to the scaffold was studied. The release of ANG from the heparinized scaffold was investigated using a radioiodine labeling method or an enzyme-linked immunosorbent assay method. In vivo angiogenesis of the scaffold was studied for 28 days. All scaffolds possess three-dimensional porous structures, and their mean pore sizes increase upon EDC-NHS cross-linking. The binding of ANG to the scaffold showed a linear correlation with ANG concentration. With ANG concentrations of 160 ng/mL, the binding of ANG to the heparinized scaffold was 36.5%. In vitro, ANG was released from the heparinized scaffold in a controlled manner. The presence of ANG enhanced the angiogenesis of the heparinized scaffold after subcutaneous implantation into rabbits. The results of this study indicate that a porous collagen-chitosan scaffold loaded with ANG may be valuable in the development of artificial dermis requiring enhanced angiogenesis.
Tissue Engineering Part A 12/2008; 14(11):1775-85. · 4.64 Impact Factor
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ABSTRACT: Skin loss or damage affects severely the life quality of human being and can even cause death in many cases. We report here a bilayer dermal equivalent (BDE) composed of collagen-chitosan porous scaffold and silicone membrane, which can effectively induce the regeneration of dermis in an animal model of full thickness skin loss. The in vitro biosecurity test showed that the BDE had no cytotoxicity, and no remarkable sensitization and irritability. In vitro cell culture proved that the BDE had good biocompatibility to support the proliferation of fibroblasts. Animal test was performed on Bama miniature pig skin. Gross view and histological sections found plenty of fibroblasts and extracellular matrix in the regenerative scaffold after transplantation of the BDE for 4 weeks. Immunohistochemistry results proved that the BDE has the ability to support the angiogenesis of the regenerated dermis. All these results indicate that the BDE might be a promising equivalent in treating dermal loss.
Journal of Materials Science Materials in Medicine 12/2007; 18(11):2185-91. · 2.32 Impact Factor
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ABSTRACT: Wound dressing with high quality is a kind of highly demanded wound-repairing products. In this article, chitosan (CS) and hyaluronic acid (HA) were used to fabricate a novel wound dressing. CS/HA composite films with high transparency could be fabricated on glass or poly(methyl methacrylate) (PMMA) substrates, but not on poly(tetrafluoroethylene) (PTFE) plate. Along with the increase of HA amount, the resulting films became rougher as detected by atomic force microscopy (AFM). Increased also are water contact angle and water-uptake ratio. By contrast, increase of the HA amount weakened the water vapor permeability (WVP), bovine albumin adsorption, and fibroblast adhesion, which are desirable characteristics for wound dressing. In vivo animal test revealed that compared with the vaseline gauge the CS/HA film could more effectively accelerate the wound healing, and reduce the occurrence of re-injury when peeling off the dressing again. These results demonstrate that the CS mixed with a little amount of HA may produce inexpensive wound dressing with good properties for practical applications. Copyright © 2007 John Wiley & Sons, Ltd.
Polymers for Advanced Technologies 03/2007; 18(11):869 - 875. · 2.01 Impact Factor
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ABSTRACT: To construct three kinds of collagen-chitosan porous scaffolds with enhanced bio-stability and to investigate the histocompatibility of the scaffolds in vivo.
Collagen-chitosan porous scaffolds were fabricated by freeze-drying method, cross-linked using dehydrothermal treatment and glutaraldehyde, respectively. The morphology of the uncross-linked scaffold (scaffold 1), dehydrothermal cross-linked scaffold (scaffold 2) and glutaraldehyde cross-linked scaffold (scaffold 3) was studied by scanning electron microscopy. Three kinds of scaffolds were embedded subcutaneously on dorsal surface of 12 rabbit ears. The general and local responses were recorded daily. The bio-stability and histocompatibility of the scaffolds were observed by using HE staining after 3, 7, 14 and 28 days of operation.
The scaffolds had three-dimensional porous structures with a porosity of more than 90%, and possessed pore sizes of 120 +/- 10 microm, 80 +/- 15 microm and 170 +/- 20 microm, respectively. All experimental rabbits survived with good general condition during the study. All skin incisions healed well without obvious reactive red or swelling. Histological study showed that scaffold 1 was degraded rapidly with obvious inflammation. The degradation of scaffold 2 was slower than that of scaffold 1 and the inflammation of scaffold 2 was also milder than that of scaffold 1. Scaffold 3 possessed slow degradation property with slight inflammatory reaction, and rapid tissue regeneration.
The collagen-chitosan porous scaffolds have three-dimensional porous structures that are suitable for tissue regeneration. The bio-stability and histocompatibility of the scaffolds are enhanced after cross-linked. Glutaraldehyde cross-linked is better than dehydrothermal cross-linked, which can facilitate dermal tissue reconstruction.
Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery 11/2005; 19(10):826-30.
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ABSTRACT: Porous scaffolds for skin tissue engineering were fabricated by freeze-drying the mixture of collagen and chitosan solutions. Glutaraldehyde (GA) was used to treat the scaffolds to improve their biostability. Confocal laser scanning microscopy observation confirmed the even distribution of these two constituent materials in the scaffold. The GA concentrations have a slight effect on the cross-section morphology and the swelling ratios of the cross-linked scaffolds. The collagenase digestion test proved that the presence of chitosan can obviously improve the biostability of the collagen/chitosan scaffold under the GA treatment, where chitosan might function as a cross-linking bridge. A detail investigation found that a steady increase of the biostability of the collagen/chitosan scaffold was achieved when GA concentration was lower than 0.1%, then was less influenced at a still higher GA concentration up to 0.25%. In vitro culture of human dermal fibroblasts proved that the GA-treated scaffold could retain the original good cytocompatibility of collagen to effectively accelerate cell infiltration and proliferation. In vivo animal tests further revealed that the scaffold could sufficiently support and accelerate the fibroblasts infiltration from the surrounding tissue. Immunohistochemistry analysis of the scaffold embedded for 28 days indicated that the biodegradation of the 0.25% GA-treated scaffold is a long-term process. All these results suggest that collagen/chitosan scaffold cross-linked by GA is a potential candidate for dermal equivalent with enhanced biostability and good biocompatibility.
Biomaterials 12/2003; 24(26):4833-41. · 7.40 Impact Factor
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ABSTRACT: A biodegradable scaffold for skin-tissue engineering was designed using collagen and chitosan, which are common materials for biomedical application. The scaffolds containing different amounts of chitosan were prepared by mixing the collagen and chitosan solutions followed by removal of the solvent using a freeze-drying method. The cross-linking treatment of these scaffolds was performed using the dehydrothermal treatment (DHT) method or glutaraldehyde (GA) to increase their biostability. The effect of the chitosan concentration and the cross-linking methods on the morphology of these scaffolds was studied by SEM. The water retention and the biodegradability in vitro of various collagen-chitosan scaffolds were investigated. Finally the biocompatibility of the collagen-chitosan (10 wt% chitosan) scaffold treated with different cross-linking methods was evaluated using a in vivo animal test. A mild inflammatory reaction could be detected in the early stages, and GA treatment can decrease the inflammatory reaction in a long-term implantation. After implantation for four weeks, all kinds of scaffolds, especially the GA-treated scaffolds (Col-GA) were filled with a large number of fibroblasts and were vascularized to a certain extent. These results suggest that the GA-treated scaffold has an increased biostability and excellent biocompatibility. It can be a potential candidate for skin-tissue engineering.
Journal of Biomaterials Science Polymer Edition 02/2003; 14(8):861-74. · 1.69 Impact Factor
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ABSTRACT: To observe the effectiveness of xenogenic(porcine) acellular dermal matrix grafting with thin autogenic skin on deep wounds with good wound-bed.
52 cases of patients with deep wounds were transplanted with xenogenic(porcine) acellular dermal matrix grafting and thin autogenic skin by two step method from Jan. 2000 to Feb. 2002.
37 cases of patients achieved complete take(71.1%) and 15 cases got 95 percent take (28.9%) with none needing grafting again. 3-6 months' following up showed that skins of complex grafting had well-acceptable color and quality compared to nearby skin.
This kind of xenogenic(porcine) acellular dermal matrix can be widely used on deep wounds with good wound bed as complex graft.
Zhonghua zheng xing wai ke za zhi = Zhonghua zhengxing waike zazhi = Chinese journal of plastic surgery 10/2002; 18(5):271-2.
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ABSTRACT: To investigate the change in the antibiotic resistant spectrum of Pseudomonas aeruginosa (PA) isolated from burn wounds and the production of inducible beta-lactamase.
VITEK-AMS system (total automatic bacterial identification and drug sensitivity system) and E-test concentration gradient were employed to perform bacterial identification and antibiotic sensitivity tests. K-B method was applied to detect inducible enzyme.
The resistance of PA to Cephalosporin and Imipenem was increased in the past 4 years from June of 1996 to June of 2000. Whereas the resistance to Cefoperazone/Sulbactam was least. There was an obvious difference of the resistance of PA to antibiotics during the 4 years (P < 0.05). The resistant rate to Imipenem ranged from 20% to 40%. PA was able to produce inducible enzymes among 120 strains of wild type of PA occupying 72.5% with Imipenam as the inducing agent.
The analysis of the antibiotic resistance of PA and the detection of inducible enzymes could be monitored from time to time and helpful in the correction of the use of antibiotics. Constant monitoring of antibiotic resistance might be beneficial to the prevention of outbreak of epidemics of PA infection in a burn unit.
Zhonghua shao shang za zhi = Zhonghua shaoshang zazhi = Chinese journal of burns 10/2002; 18(5):285-7.
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ABSTRACT: To evaluate the efficacy of piperacillin/tazobactam in the management of burn infection.
Sixty-three burn patients were enrolled in the study with burn sepsis or burn area more than 50%TBSA or full skin loss more than 30% TBSA. The administration regime of the antibiotics was 4.5 g intravenously administered every 8 hours in the treatment of burn sepsis or in the prophylactic management. The effectiveness was identified when the septic symptoms disappeared or focal infection did not develop into sepsis.
The overall clinical efficacy was 90.4%, and success in sepsis (control) was 75%. Furthermore, 95.7% of the focal infection was prevented from developing into systemic infection. The bacterial clearance rates were 71.4% and 51.4% in treatment and prophylaxis groups, respectively.
Piperacillin/taxobactam was effective in the treatment and/or prophylaxis of burn sepsis caused by bacteria susceptible to it, so it could be applied empirically.
Zhonghua shao shang za zhi = Zhonghua shaoshang zazhi = Chinese journal of burns 05/2002; 18(2):75-7.
