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Enhancement of resistance to post-burn sepsis by dendritic cells
S60
Burns 3 3 S ( 2 0 0 7 ) S1–S172
Enhancement of resistance to post-burn sepsis by dendritic cells Liang H., Wang Z., Liu D., Hao T., Xu X. Research Institute of Surgery, Daping Hospital, PR China E-mail address: huaping [email protected] (H. Liang). Dendritic cells (DCs) play an important role in the defense against sepsis, it is unknown, however, whether or not DCs dysfunction after burn injury contributes to increased mortality induced by cecal ligation and puncture (CLP). The purpose of this study is to determine the effects of burn injury on spleen DCs functions and their relationship with high CLP mortality. Spleen DCs prepared from burn-injured mice could produce less IL-12 and more IL-10 than that of sham-injured mice, a significant alteration in burninjured mice was observed in ConA-induced splenocytes proliferation and IL-2, IL-12 and IFN-gamma production, whereas IL-10 production was increased and IL-4 production was unaltered. Adoptive transfer of splenic DCs prepared from normal or shaminjured, but not injured, mice before CLP performance could significantly prevent a high post-burn CLP mortality, and promote the Th1/Th2 cytokine balance in the spleen. Thus, DCs supplementation appears to restore, at least partially, the injured host resistance to infectious challenge. These findings strongly suggested that spleen DCs are markedly affected as a consequence of the post-burn systemic responses and that restoration of their function may serve as a potential strategy to reverse burn injury-induced immunosuppression.
Acknowledgement This study was supported by the national basic research program of China (No. 2005CB522602). doi:10.1016/j.burns.2006.10.143 Silver dressings: The need for evidence based medicine Hermans M.H. Hermans Consulting Inc., USA E-mail address: [email protected]. Ionised silver (Ag+ ) is an effective antimicrobial agent with few side effects. To date, at least ten dressings containing silver have been introduced to the bum care market. Manufacturers claim broad antimicrobial efficacy and many other beneficial properties but proof of these claims is often confusing or misleading. As examples: • Conclusions on silver solubility and concentration in distilled water (used as proof of a higher effective dose) cannot be extrapolated to a clinical situation: exudate (in contrast to distilled water) contains large amounts of Cl− ions and most Ag+ will precipitate as biologically inactive AgCl. • A series of case histories may be presented as clinical proof and trials are presented without statistical analysis or are done against comparators (such as impregnated gauze) that are not beneficial for wound healing: the trial set up is biased. • Clinical work often is done with groups of wounds that are not comparable and some companies simply extrapolate from clinical or in vitro results obtained for other silver dressings. Clinical trials provide the only real proof. For these trials, an appropriate comparator should be used, strict inclusion and exclusion criteria should define the subject population, and the study hypothesis should be well defined too. A protocol for partial thickness burns should leave room for secondary tangential excision if deemed necessary and long-term follow up should be attempted to check for scar quality. Results should be analyzed using the appropriate statistics. Evidence based medicine is “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.” In this context, true, scientifically sound evidence (in other words, results from real clinical trials) on materials’ efficacy for managing partial thickness burns is only available for two or three types of silver containing dressings. It is the task of the clinician to look for such real evidence before deciding on which (new) dressing is to be used on his or her patients. doi:10.1016/j.burns.2006.10.144
Burns 3 3 S ( 2 0 0 7 ) S1–S172
Enhancement of resistance to post-burn sepsis by dendritic cells Liang H., Wang Z., Liu D., Hao T., Xu X. Research Institute of Surgery, Daping Hospital, PR China E-mail address: huaping [email protected] (H. Liang). Dendritic cells (DCs) play an important role in the defense against sepsis, it is unknown, however, whether or not DCs dysfunction after burn injury contributes to increased mortality induced by cecal ligation and puncture (CLP). The purpose of this study is to determine the effects of burn injury on spleen DCs functions and their relationship with high CLP mortality. Spleen DCs prepared from burn-injured mice could produce less IL-12 and more IL-10 than that of sham-injured mice, a significant alteration in burninjured mice was observed in ConA-induced splenocytes proliferation and IL-2, IL-12 and IFN-gamma production, whereas IL-10 production was increased and IL-4 production was unaltered. Adoptive transfer of splenic DCs prepared from normal or shaminjured, but not injured, mice before CLP performance could significantly prevent a high post-burn CLP mortality, and promote the Th1/Th2 cytokine balance in the spleen. Thus, DCs supplementation appears to restore, at least partially, the injured host resistance to infectious challenge. These findings strongly suggested that spleen DCs are markedly affected as a consequence of the post-burn systemic responses and that restoration of their function may serve as a potential strategy to reverse burn injury-induced immunosuppression.
Acknowledgement This study was supported by the national basic research program of China (No. 2005CB522602). doi:10.1016/j.burns.2006.10.143 Silver dressings: The need for evidence based medicine Hermans M.H. Hermans Consulting Inc., USA E-mail address: [email protected]. Ionised silver (Ag+ ) is an effective antimicrobial agent with few side effects. To date, at least ten dressings containing silver have been introduced to the bum care market. Manufacturers claim broad antimicrobial efficacy and many other beneficial properties but proof of these claims is often confusing or misleading. As examples: • Conclusions on silver solubility and concentration in distilled water (used as proof of a higher effective dose) cannot be extrapolated to a clinical situation: exudate (in contrast to distilled water) contains large amounts of Cl− ions and most Ag+ will precipitate as biologically inactive AgCl. • A series of case histories may be presented as clinical proof and trials are presented without statistical analysis or are done against comparators (such as impregnated gauze) that are not beneficial for wound healing: the trial set up is biased. • Clinical work often is done with groups of wounds that are not comparable and some companies simply extrapolate from clinical or in vitro results obtained for other silver dressings. Clinical trials provide the only real proof. For these trials, an appropriate comparator should be used, strict inclusion and exclusion criteria should define the subject population, and the study hypothesis should be well defined too. A protocol for partial thickness burns should leave room for secondary tangential excision if deemed necessary and long-term follow up should be attempted to check for scar quality. Results should be analyzed using the appropriate statistics. Evidence based medicine is “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.” In this context, true, scientifically sound evidence (in other words, results from real clinical trials) on materials’ efficacy for managing partial thickness burns is only available for two or three types of silver containing dressings. It is the task of the clinician to look for such real evidence before deciding on which (new) dressing is to be used on his or her patients. doi:10.1016/j.burns.2006.10.144