ascorbic-acid and Burns

Topics: Ascorbic Acid; Burns; Humans; Risk Assessment; Vitamins

Ascorbic acid (AA) is an essential nutrient with many physiologic roles not limited to the prevention of scurvy. Beyond its role as a supplement, it has gained popularity in the acute care setting as an inexpensive medication for a variety of conditions. Because of limitations with absorption of oral formulations and reduced serum concentrations observed in acute illness, intravenous (IV) administration, and higher doses, may be needed to produce the desired serum concentrations for a particular indication. Following a PubMed search, we reviewed published studies relevant to AA in the acute care setting and summarized the results in a narrative review. In the acute care setting, AA may be used for improved wound healing, improved organ function in sepsis and acute respiratory distress syndrome, faster resolution of vasoplegic shock after cardiac surgery, reduction of resuscitative fluids in severe burn injury, and as an adjunctive analgesic, among other uses. Each indication differs in its level of evidence supporting exogenous administration of AA, but overall, AA was not commonly associated with adverse effects in the identified studies. Use of AA remains an active area of clinical investigation for various indications in the acute care patient population.

Topics: Ascorbic Acid; Burns; Critical Care; Humans; Respiratory Distress Syndrome; Resuscitation

Topics: Antioxidants; Ascorbic Acid; Burns; Hemorrhage; Humans; Sepsis; Wounds and Injuries

The inflammatory state after burn injury is characterized by an increase in capillary permeability that results in protein and fluid leakage into the interstitial space, increasing resuscitative requirements. Although the mechanisms underlying increased capillary permeability are complex, damage from reactive oxygen species plays a major role and has been successfully attenuated with antioxidant therapy in several disease processes. However, the utility of antioxidants in burn treatment remains unclear. Vitamin C is a promising antioxidant candidate that has been examined in burn resuscitation studies and shows efficacy in reducing the fluid requirements in the acute phase after burn injury.

Topics: Animals; Antioxidants; Ascorbic Acid; Burns; Fluid Therapy; Humans; Resuscitation

Vitamin C is not only an essential nutrient involved in many anabolic pathways, but also an important player of the endogenous antioxidant defense. Low plasma levels are very common in critical care patients and may reflect severe deficiency states.. Vitamin C scavenges reactive oxygen species such as superoxide and peroxynitrite in plasma and cells (preventing damage to proteins, lipids and DNA), prevents occludin dephosphorylation and loosening of the tight junctions. Ascorbate improves microcirculatory flow impairment by inhibiting tumor-necrosis-factor-induced intracellular adhesion molecule expression, which triggers leukocyte stickiness and slugging. Clinical trials in sepsis, trauma and major burns testing high-dose vitamin C show clinical benefit. Restoration of normal plasma levels in inflammatory patients requires the administration of 3 g/day for several days, which is 30 times the daily recommended dose.. The recent research on the modulation of oxidative stress and endothelial protection offer interesting therapeutic perspectives, based on the biochemical evidence, with limited or even absent side-effects.

Topics: Ascorbic Acid; Ascorbic Acid Deficiency; Burns; Critical Care; Critical Illness; Dietary Supplements; Humans; Nutrition Therapy; Oxidative Stress; Reactive Oxygen Species; Vitamins; Wounds and Injuries

An improved understanding of burn shock pathophysiology and subsequent development of fluid resuscitation strategies has led to dramatic outcome improvements in burn care during the 20th century. While organ hypoperfusion caused by inadequate resuscitation has become rare in clinical practice, there is growing concern that increased morbidity and mortality related to over-resuscitation is occurring more frequently in burn care. In order to reduce complications related to this concept of "fluid creep", such as respiratory failure and compartment syndromes, efforts should be made to resuscitate with the least amount of fluid in order to provide adequate organ perfusion. In this first part of a concise review, historic and current evidence regarding the available fluids is discussed, as well as some adjunctive treatments modulating the inflammatory response. In the second part, special reference will be made to the role of abdominal hypertension in burn care and the endpoints used to guide fluid resuscitation will be discussed. Finally, as urine output has been recognized as a poor resuscitation target, a resuscitation protocol is suggested in part two which includes new targets and endpoints that can be obtained with modern, less invasive hemodynamic monitoring devices.

Topics: Albumins; Ascorbic Acid; Burns; Colloids; Crystalloid Solutions; Endpoint Determination; Fluid Therapy; Humans; Isotonic Solutions; Plasmapheresis; Resuscitation

A short-cut systematic review was carried out to establish whether high-dose vitamin C can lead to lower fluid requirements, faster recovery and lower mortality in adult patients with burns of over 15% total body surface area (TBSA). Four studies were directly relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that preliminary evidence suggests vitamin C can reduce the volume required for fluid resuscitation, improve wound healing and reduce ventilation requirements in patients with severe burns. Further evidence from large trials is required to confirm this promising early evidence.

Topics: Adolescent; Ascorbic Acid; Burns; Evidence-Based Emergency Medicine; Fluid Therapy; Humans; Infusions, Intravenous; Male; Resuscitation

Some biochemical functions of vitamin C make it an essential component of parenteral nutrition (PN) and an important therapeutic supplement in other acute conditions. Ascorbic acid is a strong aqueous antioxidant and is a cofactor for several enzymes. The average body pool of vitamin C is 1.5 g, of which 3%-4% (40-60 mg) is used daily. Steady state is maintained with 60 mg/d in nonsmokers and 140 mg/d in smokers. Shocked surgical, trauma, and septic patients have a drastic reduction of circulating plasma ascorbate concentrations. These low concentrations require 3-g doses/d to restore normal plasma ascorbate concentrations, questioning the recommended PN dose of 100 mg/d. Determination of intravenous requirements is usually based on plasma concentrations, which are altered during the inflammatory response. There is no clear indicator of deficiency: serum or plasma ascorbate concentrations <0.3 mg/dL (20 micromol/L) indicates inadequate vitamin C status. On the basis of available pharmacokinetic data the 100 mg/d dose for patients receiving home PN and 200 mg/d for stable adult patients receiving PN are adequate, but requirements have been shown to be higher in perioperative, trauma, burn, and critically ill patients, paralleling oxidative stress. One recommendation cannot fit all categories of patients. Large vitamin C supplements may be considered in severe critical illness, major trauma, and burns because of increased requirements resulting from oxidative stress and wound healing. Future research should distinguish therapeutic use of high-dose ascorbic acid antioxidant therapy from nutritional PN requirements.

Topics: Antioxidants; Ascorbic Acid; Burns; Critical Illness; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Interactions; Drug Stability; Glucose; Home Care Services; Humans; Nutritional Requirements; Parenteral Nutrition; Patients; Pediatrics; Perioperative Care; Practice Guidelines as Topic; Wounds and Injuries

Burn trauma produces significant fluid shifts that, in turn, reduce cardiac output and tissue perfusion. Treatment approaches to major burn injury include administration of crystalloid solutions to correct hypovolemia and to restore peripheral perfusion. While this aggressive postburn volume replacement increases oxygen delivery to previously ischemic tissue, this restoration of oxygen delivery is thought to initiate a series of deleterious events that exacerbate ischemia-related tissue injury. While persistent hypoperfusion after burn trauma would produce cell death, volume resuscitation may exacerbate the tissue injury that occurred during low flow state. It is clear that after burn trauma, tissue adenosine triphosphate (ATP) levels gradually fall, and increased adenosine monophosphate (AMP) is converted to hypoxanthine, providing substrate for xanthine oxidase. These complicated reactions produce hydrogen peroxide and superoxide, clearly recognized deleterious free radicals. In addition to xanthine oxidase related free radical generation in burn trauma, adherent-activated neutrophils produce additional free radicals. Enhanced free radical production is paralleled by impaired antioxidant mechanisms; as indicated by burn-related decreases in superoxide dismutase, catalase, glutathione, alpha tocopherol, and ascorbic acid levels. Burn related upregulation of inducible nitric oxide synthase (iNOS) may produce peripheral vasodilatation, upregulate the transcription factor nuclear factor kappa B (NF-kappaB), and promote transcription and translation of numerous inflammatory cytokines. NO may also interact with the superoxide radical to yield peroxynitrite, a highly reactive mediator of tissue injury. Free radical mediated cell injury has been supported by postburn increases in systemic and tissue levels of lipid peroxidation products such as conjugated dienes, thiobarbituric acid reaction products, or malondialdehyde (MDA) levels. Antioxidant therapy in burn therapy (ascorbic acid, glutathione, N-acetyl-L-cysteine, or vitamins A, E, and C alone or in combination) have been shown to reduce burn and burn/sepsis mediated mortality, to attenuate changes in cellular energetics, to protect microvascular circulation, reduce tissue lipid peroxidation, improve cardiac output, and to reduce the volume of required fluid resuscitation. Antioxidant vitamin therapy with fluid resuscitation has also been shown to prevent burn related cardiac NF-kappaB nuclear migration, to

Topics: Animals; Antioxidants; Ascorbic Acid; Burns; Cardiac Output; Cytokines; Free Radicals; Humans; Lipid Peroxidation; Lipid Peroxides; NF-kappa B; Nitric Oxide

Oxidative stress is one of the main causes of pathophysiological alterations observed during burn injury. The present pilot study aimed to determine whether a specific oral antioxidant supplementation could in any way influence free radical blood values in patients affected by superficial partial thickness burns.. Plasma oxidants and plasma antioxidant capacity were analysed in 20 superficial partial thickness burn patients for a 2-week period; patients were randomly divided into two groups, one of which was supported with a specifically designed oral antioxidant formula (Squalene 100 mg, Vitamin C 30 mg, Coenzyme Q10 10 mg, Zinc 5 mg, Beta Carotene 3.6 mg, Bioflavonoids 30 mg, Selenium 55 mcg) administered daily, starting from the day of admission, for the whole study period.. No significant differences were found in plasma oxidants and plasma antioxidant capacity between the two groups of patients.. These results did not reflect any significant benefits of an antioxidant oral supplementation at usual dosages when considering oxidative plasmatic values of superficial partial thickness burn patients.

Topics: Administration, Oral; Adolescent; Adult; Aged; Antioxidants; Ascorbic Acid; beta Carotene; Burns; Drug Combinations; Female; Flavonoids; Free Radicals; Humans; Male; Middle Aged; Oxidative Stress; Pilot Projects; Ubiquinone; Young Adult

High-dose ascorbic acid (vitamin C) therapy (66 mg/kg per hour) attenuates postburn lipid peroxidation, resuscitation fluid volume requirements, and edema generation in severely burned patients.. A prospective, randomized study at a university trauma and critical care center in Japan.. Thirty-seven patients with burns over more than 30% of their total body surface area (TBSA) hospitalized within 2 hours after injury were randomly divided into ascorbic acid and control groups. Fluid resuscitation was performed using Ringer lactate solution to maintain stable hemodynamic measurements and adequate urine output (0.5-1.0 ml/kg per hour). In the ascorbic acid group (n = 19; mean burn size, 63% +/- 26% TBSA; mean burn index, 57 +/- 26; inhalation injury, 15/ 19), ascorbic acid was infused during the initial 24-hour study period. In the control group (n = 18; mean burn size, 53% +/- 17% TBSA; mean burn index, 47 +/- 13; inhalation injury, 12/18), no ascorbic acid was infused. We compared hemodynamic and respiratory measurements, lipid peroxidation, and fluid balance for 96 hours after injury. Two-way analysis of variance and Tukey test were used to analyze the data.. Heart rate, mean arterial pressure, central venous pressure, arterial pH, base deficit, and urine outputs were equivalent in both groups. The 24-hour total fluid infusion volumes in the control and ascorbic acid groups were 5.5 +/- 3.1 and 3.0 +/- 1.7 mL/kg per percentage of burn area, respectively (P<.01). In the first 24 hours, the ascorbic acid group gained 9.2% +/- 8.2% of pretreatment weight; controls, 17.8% +/- 6.9%. Burned tissue water content was 6.1 +/- 1.8 vs 2.6 +/- 1.7 mL/g of dry weight in the control and ascorbic acid groups, respectively (P<.01). Fluid retention in the second 24 hours was also significantly reduced in the ascorbic acid group. In the control group, the ratio of PaO2 to fraction of inspired oxygen at 18, 24, 36, 48, and 72 hours after injury was less than that of the ascorbic acid group (P<.01). The length of mechanical ventilation in the control and ascorbic acid groups was 21.3 +/- 15.6 and 12.1 +/- 8.8 days, respectively (P<.05). Serum malondialdehyde levels were lower in the ascorbic acid group at 18, 24, and 36 hours after injury (P<.05).. Adjuvant administration of high-dose ascorbic acid during the first 24 hours after thermal injury significantly reduces resuscitation fluid volume requirements, body weight gain, and wound edema. A reduction in the severity of respiratory dysfunction was also apparent in these patients.

Topics: Adolescent; Adult; Aged; Ascorbic Acid; Burns; Dose-Response Relationship, Drug; Edema; Female; Fluid Therapy; Humans; Infusions, Intravenous; Isotonic Solutions; Lipid Peroxidation; Male; Middle Aged; Prospective Studies; Resuscitation; Ringer's Lactate; Water-Electrolyte Balance

Topics: Adult; Ascorbic Acid; Atmosphere Exposure Chambers; Baths; Blood Cell Count; Blood Proteins; Blood Urea Nitrogen; Body Surface Area; Burns; Calcium; Carbon Dioxide; Chlorides; Clinical Trials as Topic; Female; Humans; Hyperbaric Oxygenation; Male; Oxygen; Potassium; Skin Transplantation; Sodium; Transplantation, Autologous; Vitamin B Complex; Vitamin E; Wound Healing

To investigate the effect of vitamin C combined with recombinant basic fibroblast growth factor (rbFGF) on inflammatory factors and oxygen environment in patients with high-voltage electrical burns. A retrospective analysis of 98 patients with high-voltage electrical burns admitted to our hospital from January 2021 to April 2022. A total of 98 patients were divided into research group and control group, including 49 cases treated with vitamin C combined with rbFGF and 49 cases treated with only rbFGF. The disappearance time of clinical symptoms, wound healing rate, area of granulation tissue growth, level of inflammatory factors, oxygen environment were compared between two groups after one and three courses of treatment. After treatment, the disappearance time of erythema, pain, swelling, blisters, exudate symptoms, wound healing time, scab formation time, and hospitalisation time in the research group were significantly better than those in control group (P < .05). There was no significant difference in the wound healing rate and area of granulation tissue growth between the two groups after one course of treatment (P > .05), while it is significantly better than those in control group after three courses of treatment (P < .05). The inflammatory factors, succinate dehydrogenase (SDH), lactate dehydrogenase (LDH) scores in research group were significantly better than that in control group after three courses of treatment (P < .05). Vitamin C combined with rbFGF may be worthy to reduce inflammatory factors, regulate oxygen environment, which can be popularised and applied in clinical practice.

Topics: Ascorbic Acid; Burns; Burns, Electric; Fibroblast Growth Factor 2; Humans; Oxygen; Retrospective Studies

Topics: Animals; Antioxidants; Ascorbic Acid; Biocompatible Materials; Burns; Cell Line; Humans; Hydrogels; Keratinocytes; Male; Mice; Mice, Inbred C57BL; Wound Healing; Zea mays; Zein

Ascorbic acid (AA) is a potent oxygen-free radical scavenger. We hypothesized that treating severe burn patients with high doses of AA (HDAA) can reduce fluid resuscitation requirements and prevent organ dysfunction. We performed a unicentric, retrospective case-control study of 75 burn patients: 25 patients admitted from 2018 to 2019 with more than 30% Total Surface Body Surface Area (TSBA) burned who received HDAA (66 mg/kg/h as soon as possible after admission until 36 h after injury), and 50 patients admitted from 2014 to 2017 with similar Abbreviated Burn Severity Index (ABSI)/Baux scores who were treated with the same protocol but did not receive HDAA. During the first 24 hours of burn resuscitation the HDAA group required less fluids than the control group (3.06 ± 0.87 ml/kg/%TBSA vs 4.32 ± 1.51 P < .05), but the overall reduction of fluid requirements during the first 72 hours was not significant. There were no significant differences in Sequential Organ Failure Assessment (SOFA), other hemodynamic parameters, complications, or mortality. We also did not find an increase acute kidney injury in patients who received HDAA even though the mean urine oxalate/creatinine ratio was 0.61 (0.02-0.96). We conclude that in severe burn patients treated with a restrictive fluid therapy protocol, administration of HDAA can decrease only the initial fluid requirements but not total fluid intakes. We did not find differences in severity score after resuscitation or in mortality. Nor did we find an increase in renal failure in patients administered with HDAA.

Topics: Adult; APACHE; Ascorbic Acid; Body Surface Area; Burns; Case-Control Studies; Critical Illness; Female; Humans; Male; Middle Aged; Resuscitation; Retrospective Studies

Bioactive dressings are usually produced using natural or synthetic polymers. Recently, special attention has been paid to β-glucans that act as immunomodulators and have pro-healing properties. The aim of this research was to use β-1,3-glucan (curdlan) as a base for the production of bioactive dressing materials (curdlan/agarose and curdlan/chitosan) that were additionally enriched with vitamin C and/or hydrocortisone to improve healing of chronic and burn wounds. The secondary goal of the study was to compressively evaluate biological properties of the biomaterials. In this work, it was shown that vitamin C/hydrocortisone-enriched biomaterials exhibited faster vitamin C release profile than hydrocortisone. Consecutive release of the drugs is a desired phenomenon since it protects wounds against accumulation of high and toxic concentrations of the bioactive molecules. Moreover, biomaterials showed gradual release of low doses of the hydrocortisone, which is beneficial during management of burn wounds with hypergranulation tissue. Among all tested variants of biomaterials, dressing materials enriched with hydrocortisone and a mixture of vitamin C/hydrocortisone showed the best therapeutic potential since they had the ability to significantly reduce MMP-2 synthesis by macrophages and increase TGF-β1 release by skin cells. Moreover, materials containing hydrocortisone and its blend with vitamin C stimulated type I collagen deposition by fibroblasts and positively affected their migration and proliferation. Results of the experiments clearly showed that the developed biomaterials enriched with bioactive agents may be promising dressings for the management of non-healing chronic and burn wounds.

Topics: Anti-Inflammatory Agents; Antioxidants; Ascorbic Acid; Bandages; beta-Glucans; Burns; Collagen Type I; Drug Therapy, Combination; Fibroblasts; Humans; Hydrocortisone; Keratinocytes; Sepharose; Wound Healing

Topics: Antineoplastic Agents; Ascorbic Acid; Burns; Cohort Studies; Humans; Vitamins

Children are at high risk of injuries and wounds. The application of medical grade honey is a promising approach to improving the healing of wounds of various origin and severity. However, the use of medical grade honey in young paediatric patients remains limited. The aim of this study is to show the safety, efficacy and usefulness of medical grade honey in abdominal wounds, of different causes, in paediatric patients.. This was a prospective, observational case series evaluating five young infants with abdominal wounds at the General Hospital in Thessaloniki. All wounds were treated in the same manner with daily medical grade honey applied to the wound area and closely monitored.. All treated wounds rapidly presented granulation tissue formation and underwent re-epithelialisation. Peripheral oedema and inflammation decreased upon initial application. Necrotic tissue was effectively debrided when present. Slough was removed and no signs of infection were detected, irrespective of initial wound presentations. Scar formation was minimal and the full range of motion was preserved in all cases.. Based on this case study, medical grade honey is safe and effective in treating different abdominal wounds, including infected or dehisced wounds as well as burns. The easy application and broad applicability make medical grade honey recommendable as a first-line treatment in paediatric patients.

Topics: Abdominal Injuries; Apitherapy; Appendectomy; Appendicitis; Ascorbic Acid; Bacteroides Infections; Burns; Burns, Chemical; Child; Child, Preschool; Dermatologic Agents; Drug Resistance, Multiple, Bacterial; Edema; Female; Gastrostomy; Greece; Honey; Humans; Infant; Infant, Newborn; Inflammation; Klebsiella Infections; Lanolin; Male; Neuroblastoma; Oils, Volatile; Ointments; Prospective Studies; Re-Epithelialization; Retroperitoneal Neoplasms; Surgical Wound Dehiscence; Surgical Wound Infection; Vitamin E; Vitamins; Zinc Oxide

In sepsis and burns, ascorbic acid (AA) is hypothesized advantageous during volume resuscitation. There is uncertainty regarding its safety and dosing. This study evaluated high dose AA (HDAA: 66 mg/kg/h for 24 hours) versus low dose AA (LDAA: 3.5 g/days) administration during the first 24 hours in severely burned adults. We conducted a retrospective study comparing fluid administration before and after switching from low dose to HDAA in severely burned adults. A total of 38 adults with burns >20% TBSA, who received either HDAA or LDAA were included in this retrospective study. AA serum concentrations were quantified at 0, 24, and 72 hours postburn. HDAA impact on hemodynamics, acid-base homeostasis, acute kidney injury, vasopressor use, resuscitation fluid requirement, urinary output, and the incidence of adverse effects was evaluated; secondary clinical outcomes were analyzed. AA plasma levels were 10-fold elevated in the LDAA and 150-fold elevated in the HDAA group at 24 hours and decreased in both groups afterwards. HDAA was not associated with a significantly increased risk of any complications. A significant reduction in colloid fluid requirements was noted (LDAA: 947 ± 1722 ml/24 hours vs HDAA: 278 ± 667 ml/24 hours, P = 0.029). Other hemodynamic and resuscitation measures, as well as secondary clinical outcomes were comparable between groups. HDAA was associated with higher AA levels and lower volumes of colloids in adults with severe burns. The rate of adverse events was not significantly higher in patients treated with HDAA. Future studies should consider prolonged administration of AA.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antioxidants; Ascorbic Acid; Burns; Colloids; Creatinine; Dose-Response Relationship, Drug; Female; Fluid Therapy; Humans; Infusions, Intravenous; Length of Stay; Male; Middle Aged; Renal Replacement Therapy; Resuscitation; Retrospective Studies; Shock; Urine; Vasoconstrictor Agents; Young Adult

Vitamin C is a well-documented antioxidant that reduces oxidative stress and fluid infusion in high doses; however, the association between high-dose vitamin C and reduced mortality remains unclear. This study evaluates the effect of high-dose vitamin C in severe burn patients under two varying thresholds.. We enrolled adult patients with severe burns (burn index ≥ 15) who were registered in the Japanese Diagnosis Procedure Combination national inpatient database from 2010 to 2016. Propensity score matching was performed between patients who received high-dose vitamin C within 1 day of admission (vitamin C group) and those who did not (control group). High-dose vitamin C was defined as a dosage in excess of 10 g or 24 g within 2 days of admission. The primary outcome was in-hospital mortality.. Eligible patients (n = 2713) were categorized into the vitamin C group (n = 157) or control group (n = 2556). After 1:4 propensity score matching, we compared 157 and 628 patients who were administered high-dose vitamin C (> 10-g threshold) and controls, respectively. Under this particular threshold, high-dose vitamin C therapy was associated with reduced in-hospital mortality (risk ratio, 0.79; 95% confidence interval, 0.66-0.95; p = 0.006). In contrast, in-hospital mortality did not differ between the control and high-dose vitamin C group under the > 24-g threshold (risk ratio, 0.83; 95% confidence interval, 0.68-1.02; p = 0.068).. High-dose vitamin C therapy was associated with reduced mortality in patients with severe burns when used under a minimum threshold of 10 g within the first 2 days of admission. While "high-dose" vitamin C therapy lacks a universal definition, the present study reveals that different "high-dose" regimens may yield improved outcomes.

Topics: Adult; Ascorbic Acid; Burns; Cephalosporins; Cohort Studies; Continuous Renal Replacement Therapy; Critical Illness; Humans; Tazobactam

Proper functioning of living organisms requires controlling the factors which govern the level of oxidative stress in the system, that is presence of free radicals at a given, rather low, level and preventing their excess. In this work it is shown that SA and AA active antioxidants, governing the oxidative stress in the wound, modify standard serum solution as well as burn affected necrotic eschar at the molecular structure level. In the case of incubation of skin fragments in SA and AA, the following findings were reported: modification of serum, that is appearance of low molecular weight oligomer bands in AA and recreation of native serum bands in SA. In frozen serum solutions modified by AA FTIR 1759 and 1420-1053 cm

Topics: Antioxidants; Ascorbic Acid; Burns; Free Radicals; Humans; Male; Middle Aged; Scattering, Small Angle; Skin; X-Ray Diffraction

In the present study, possibilities for using novel nanocomposites based on alginate and silver nanoparticles for wound treatment were investigated in a second-degree thermal burn model in Wistar rats. Silver nanoparticles (AgNPs) were electrochemically synthesized in alginate solutions that were further utilized to obtain the Ag/alginate solution and microfibers for subsequent in vivo studies. Daily applications of the Ag/alginate colloid solution, containing AgNPs, alginate and ascorbic acid (G3), wet Ag/alginate microfibers containing AgNPs (G5) and dry Ag/alginate microfibers containing AgNPs (G6) were compared to treatments with a commercial cream containing silver sulfadiazine (G2) and a commercial Ca-alginate wound dressing containing silver ions (G4), as well as to the untreated controls (G1). Results of the in vivo study have shown faster healing in treated wounds, which completely healed on day 19 (G4, G5 and G6) and 21 (G2 and G3) after the thermal injury, while the period for complete reepitelization of untreated wounds (G1) was 25 days. The macroscopic analysis has shown that scabs fell off between day 10 and 12 after the thermal injury induction in treated groups, whereas between day 15 and 16 in the control group. These macroscopic findings were supported by the results of histopathological analyses, which have shown enhanced granulation and reepithelization, reduced inflammation and improved organization of the extracellular matrix in treated groups without adverse effects. Among the treated groups, dressings based on Ca-alginate (G4-G6) induced enhanced healing as compared to the other two groups (G2, G3), which could be attributed to additional stimuli of released Ca

Topics: Alginates; Animals; Antioxidants; Ascorbic Acid; Bandages; Burns; Colloids; Male; Nanoparticles; Rats, Wistar; Silver; Skin; Wound Healing

Dimethyl sulfoxide (DMSO) is one of the most versatile solvents in biological science, therefore it is frequently used as a solvent in biological studies and as a vehicle for drug therapy. DMSO readily penetrates, diffuses through biological membranes and ipso facto increases fluidity of liposomal membranes modelling stratum corneum. Thermal injury is associated with the appearance of lipid peroxidation products in the burned skin. The influence of DMSO on protein structure and stability is concentration and temperature dependant. The aim of this study was to assess the impact of DMSO on human burn wounds and examine the interactions between DMSO and skin surface. The real problem in burn treatment is hypoalbuminemia. At the level of the laboratory studies there was an attempt at answering the question of whether the DMSO will modify the standard serum solution. In the case of the incubation of skin fragments in 1%-100% DMSO, the following findings were reported: modification of the serum, appearance of low molecular weight oligomer bands, disappearance of albumin bands or reconstruction of native serum bands during incubation in antioxidant solutions. The result of the modification is also the exposure of FTIR 1603 and 1046cm

Topics: Animals; Antioxidants; Ascorbic Acid; Burns; Dimethyl Sulfoxide; Humans; Male; Models, Biological; Skin; Spectroscopy, Fourier Transform Infrared; Swine

High dose ascorbic acid (HDAA) has been touted to ameliorate inflammation and reduce fluid requirements during burn shock resuscitation (BSR). Whether this leads to improved outcomes is not known. The authors' aim for this study was to compare ventilator days, ventilator-associated pneumonia, and mortality between patients who did and did not receive HDAA during BSR.The authors performed a retrospective case control study from 2012 to 2015. They identified 38 patients (HDAA) who received HDAA during BSR. Using age and %TBSA, the authors identified and matched 42 control patients (CTL) who did not receive HDAA for BSR during that same time period. The authors collected data for age, %TBSA, hospital days (LOS), ventilator days (VENT), inhalation injury (INH), ventilator-associated pneumonia (VAP), and mortality (MORT).There were no differences in age and %TBSA or %TBSA of third-degree burn injury between groups. There was no significant difference in the incidence of INH (HDAA-52% vs CTL-36%, P = .17) and the groups had similar LOS and VENT. Additionally, there was no significant difference in VAP incidence (HDAA-29% vs CTL-14%, P = .13) or mortality (HDAA-26% vs CTL-23%, P = .8). HDAA patients had a numerically higher incidence of acute renal failure requiring dialysis (23 vs 7%, P = .06) which was confirmed in a multivariate analysis (odds ratio 5.4; 95% confidence interval 1.1-26). HDAA, while potentially reducing inflammation and fluid requirements during BSR, may not improve any meaningful outcomes such as ventilator requirements, ventilator-associated pneumonia, and mortality.

Topics: Adult; Age Factors; Antioxidants; Ascorbic Acid; Burns; Female; Fluid Therapy; Humans; Incidence; Length of Stay; Male; Middle Aged; Pneumonia, Ventilator-Associated; Respiration, Artificial; Resuscitation; Retrospective Studies; Shock; Survival Rate; Treatment Outcome; Young Adult

To assess the action of vitamin C on the expression of 84 oxidative stress related-genes in cultured skin fibroblasts from burn patients.. Skin samples were obtained from ten burn patients. Human primary fibroblasts were isolated and cultured to be distributed into 2 groups: TF (n = 10, fibroblasts treated with vitamin C) and UF (n = 10, untreated fibroblasts). Gene expression analysis using quantitative polymerase chain reaction array was performed for comparisons between groups.. The comparison revealed 10 upregulated genes as follows: arachidonate 12-lipoxygenase (ALOX12), 24-dehydrocholesterol reductase (DHCR24), dual oxidase 1 (DUOX1), glutathione peroxidase 2 (GPX2), glutathione peroxidase 5 (GPX5), microsomal glutathione S-transferase 3 (MGST3), peroxiredoxin 4 (PRDX4), phosphatidylinositol-3,4,5-trisphosphate dependent Rac exchange factor 1 (P-REX1), prostaglandin-endoperoxide synthase 1 (PTGS1), and ring finger protein 7 (RNF7).. Cultured fibroblasts obtained from burn patients and treated with vitamin C resulted in 10 differentially expressed genes, all overexpressed, with DUOX1, GPX5, GPX2 and PTGS1 being of most interest.

Topics: Adult; Arachidonate 12-Lipoxygenase; Ascorbic Acid; Burns; Cells, Cultured; Cross-Sectional Studies; Cyclooxygenase 1; Dual Oxidases; Female; Fibroblasts; Gene Expression; Glutathione Peroxidase; Glutathione Transferase; Guanine Nucleotide Exchange Factors; Humans; Male; Nerve Tissue Proteins; Oxidative Stress; Oxidoreductases Acting on CH-CH Group Donors; Peroxiredoxins; Real-Time Polymerase Chain Reaction; Reference Values; Reproducibility of Results; Skin; Statistics, Nonparametric; Ubiquitin-Protein Ligases; Young Adult

Wound treatment and healing is complex and is comprised of an elaborate set of processes including cellular, spectroscopic and biochemical ones as well as the "reaction" of local tissue to thermal injury. Vitamin C as l-ascorbic acid (LA) prevents injurious effects of oxidants because it reduces reactive oxygen species to stable molecules, it becomes oxidized to the short-lived ascorbyl radical. As a result, antioxidant treatment may contribute to minimizing injury in burn patients. The aim of this study is to assess changes in molecular structure of collagen extracted from human epidermis burn wound scab during incubation of the epidermis in l-ascorbic acid solution. The study will be performed using FTIR and FT Raman spectroscopies. During this research it was observed that the intensity of Raman peaks increased where healing was being modified by LA. The intensity of the amide III band at 1247cm

Topics: Administration, Topical; Aged; Antioxidants; Ascorbic Acid; Burns; Collagen; Electrophoresis, Cellulose Acetate; Female; Humans; Male; Microscopy, Electron, Scanning; Middle Aged; Models, Biological; Skin; Spectroscopy, Fourier Transform Infrared; Tissue Culture Techniques

To study the clinical effects of gabapentin on the treatment of pruritus of scar resulting from deep partial-thickness burn.. A total of fifty-eight patients suffering from pruritus of scar after deep partial-thickness burn were hospitalized from January 2013 to January 2014. Patients were divided into placebo group (n =18, treated with oral vitamin C in the dose of 100 mg for 4 weeks, twice per day) , cetirizine group (n = 20, treated with oral cetirizine in the dose of 10 mg for 4 weeks, twice per day) , and gabapentin group (n = 20, treated with oral gabapentin in the dose of 300 mg for 4 weeks, twice per day) . Before treatment and on post treatment day (PTD) 3 and 28, the Visual Analog Scale (VAS) was used to assess the itching degree, and the mean scores were recorded. The remission rates of pruritus on PTD 3 and 28 were calculated. The adverse effects were observed during treatment. Data were processed with analysis of variance, q test, and chi-square test.. Compared with that before treatment, the itching degree of patients with light, moderate, and severe itching in placebo group was not relieved after treatment; the itching degree of patients with moderate or severe itching in cetirizine group was alleviated after treatment, but not in patients with light itching; itching degree of all patients in gabapentin group was significantly relieved after treatment. There were no obvious differences in VAS scores among the 3 groups before treatment (F = 2.78, P > 0.05). On PTD 3 and 28, the VAS scores of patients in both gabapentin group [(2.3 ± 0.8) and (0.6 ± 0.3) points] and cetirizine group [(4.2 ± 1.7) and (2.8 ± 1.2) points] were lower than those in placebo group [(5.7 ± 2.0) and (5.7 ± 1.9) points, with q values from 6.70 to 7.75, P values below 0.05]. The VAS scores of patients in gabapentin group on PTD 3 and 28 were lower than those in cetirizine group (with q values respectively 6.30 and 6.90, P values below 0.05). The remission rates of pruritus of patients in gabapentin group on PTD 3 and 28 were respectively (66 ± 20)% and (91 ± 17)%, and they were higher than those in cetirizine group [(33 ± 8)% and (56 ± 14)%, with q values respectively 4.70 and 3.82, P values below 0.05]. The remission rate of pruritus of patients in placebo group on PTD 3 and 28 was 0, which was lower than that of the other 2 groups each (with q values from 3.94 to 6.76, P values below 0.05). During the course of treatment, 5 patients in gabapentin group suffered from adverse effects including mild-to-moderate drowsiness and dizziness, but they disappeared one week later. No adverse effects were observed in patients of the other two groups.. For patients with deep partial-thickness burn, gabapentin can effectively alleviate scar itching after wound healing with safety.

Topics: Amines; Analgesics; Ascorbic Acid; Burns; Cetirizine; Cicatrix; Cyclohexanecarboxylic Acids; Gabapentin; gamma-Aminobutyric Acid; Humans; Pruritus; Skin Transplantation; Treatment Outcome; Visual Analog Scale; Wound Healing

Quantitative monitoring of the redox status is the foundation for redox-related treatment. The purpose of this study was to evaluate the reliability of a new depolarization curve method for plasma redox potential (ORP) monitoring.. Using the new method, we performed redox determinations for the first time under different sample-handling conditions, including redox titration experiments using KMnO4 and vitamin C and dynamic redox monitoring in burn patients. The relative ORP value (ΔORP) method (improved traditional method) was used as the reference.. The new method's better reliability, electrochemical specificity and practicability, and known group validity, which are closely associated with the redox-related pathological processes of severe burns, were confirmed. Furthermore, bidirectional change in the redox status in severe burn patients was also observed for the first time.. This simple, stable new method could be a better practical tool for making the dynamic monitoring of the redox status feasible and for providing useful quantitative information for the judgment of redox-related pathological process, thus improving corresponding individualized treatments that rely on quantitative adjustments to the redox status.

Topics: Abbreviated Injury Scale; Adult; Ascorbic Acid; Blood Chemical Analysis; Burns; Electrochemistry; Electrodes; Female; Humans; Male; Methemoglobin; Middle Aged; Monitoring, Physiologic; Oxidation-Reduction; Oxidative Stress; Potassium Permanganate; Reperfusion Injury; Reproducibility of Results; Sensitivity and Specificity; Sepsis; Shock; Uric Acid

To investigate the ability of ascorbic acid to protect the testes from damage in severe burns.. Experimental study.. University of Lagos Medical School, Department of Anatomy.. 28 adult male Wistar rats (250-300 g).. Third degree burn was induced on 40% body surface area of rats and they were given ascorbic acid at 4 mg/kg over 8 weeks.. Weight of reproductive organs and epididymal sperm parameters were measured. Oxidative status was assayed and a semi-quantitative assessment of histologic changes was also carried out.. Burn caused severe seminiferous tubular damage, especially germ cell loss (p<0.05). This was matched by significant reduction in sperm density and morphology (p<0.05). Burn also increased oxidative stress, with elevated malondialdehyde (MDA) levels (p<0.01) and changes in catalase and superoxide dismutase enzyme levels. Ascorbic acid prevented the changes in all sperm parameters. It normalized MDA levels (p<0.01) and attenuated changes in the levels of catalase and superoxide dismutase. Ascorbic acid treatment also significantly reduced histologic damage to seminiferous tubules.. This study shows that severe thermal injury causes significant testicular damage and impairs spermatogenesis. It also shows that ascorbic acid protects the testis from such damage and therefore has the potential to be a useful adjunct therapy during treatment of young males with severe burns.

Topics: Animals; Antioxidants; Ascorbic Acid; Burns; Catalase; Male; Malondialdehyde; Oxidative Stress; Rats; Rats, Wistar; Seminiferous Tubules; Sperm Motility; Spermatogenesis; Spermatozoa; Superoxide Dismutase; Testis; Testosterone

Thermal injuries with more than 20% of burned body surface area (BSA) lead to systemic shock with generalised oedema in addition to local tissue destruction. This condition, known as burn injury, is caused by immunmodulative mediators whose individual significance is not known in detail. We present an experimental model where plasma of burned animals (burn plasma) is transmitted to healthy animals, to trigger burn iniury without performing direct burn trauma.. The systemic oedema is measured by extravasation of fluorescent albumin in mesenterial venules of Wistar rats. In addition, leukocyte-endothelial interactions ("leukocyte rolling and sticking") is examined.. The systemic capillary leak is induced by both direct thermal trauma as well as by infusion of burn plasma. This is evident even after plasma dilution (1% in Ringer's lactate) of the burn plasma. In addition, topical therapy for burned animals (donors) with cerium nitrate led to a significant reduction of plasma extravasation in receiver animals. In addition, systemic antioxidant therapy with high-dose vitamin C of receiver animals, led to a significant reduction of the capillary leak. Leukocyte-endothelial interactions are not significantly affected in either case.. In summary, for the first time a reliable model of burn injury has been established, which eliminates mediator-independent effects. In addition, our studies show that antioxidant therapy with high doses of vitamin C and topical treatment with cerium nitrate both reduce the systemic capillary leak in receiver animals. Their positive influence could therefore soon be integrated in clinical treatment algorithms.

Topics: Animals; Anti-Infective Agents, Local; Antioxidants; Ascorbic Acid; Blood Flow Velocity; Burns; Capillary Leak Syndrome; Cell Adhesion; Cerium; Cytokines; Disease Models, Animal; Edema; Extravasation of Diagnostic and Therapeutic Materials; Leukocytes; Male; Mesenteric Veins; Microcirculation; Plasma; Rats; Rats, Wistar; Shock; Venules

This study aims to evaluate percutaneous collagen induction (PCI) in post-burn scarring.. Patients with scarring after burn frequently request help in improving the aesthetic appearance of their residual cicatricial deformity. Their scars are generally treated by tissue transfer, W- and Z-plasties, flaps, cortisone injections or ablative procedures that injure or destroy the epidermis and its basement membrane and subsequently lead to fibrosis of the papillary dermis. The ideal treatment would be to preserve the epidermis and promote normal collagen and elastin formation in the dermis.. A total of 16 consecutive patients (average age: 37+/-15.5 years, average body mass index (BMI): 25.7) in Germany with post-burn scarring.. PCI using the Medical Roll-CIT (Vivida, Cape Town, South Africa). This device was designed to multiply-puncture the skin to the level of the dermal scar to institute remodelling. Patients were prepared with topical vitamin A and C cosmetic creams for a minimum of 4 weeks preoperatively to maximise collagen stimulation.. The outcome was measured rating (visual analogue scale (VAS) and Vancouver Scar Scale (VSS)), histological specimen 12 months after intervention.. On average, patients rated their improvement as a mean of 80% better (+/-15.5) than before treatment. Histologic examination revealed considerable increase in collagen and elastin deposition 12 months postoperatively. The epidermis demonstrated 45% thickening of stratum spinosum and normal rete ridges as well as the normalisation of the collagen/elastin matrix in the reticular dermis at 1 year postoperatively.. This pilot study shows that PCI appears to be a safe method for treating post-burn scarring without destroying the epidermis. The procedure can be repeated safely and is also applicable in regions where laser treatments and deep peels are of limited use. However, it is necessary to initiate an efficacy trial to prove the data of this pilot study.

Topics: Administration, Topical; Adult; Ascorbic Acid; Burns; Cicatrix; Cohort Studies; Collagen; Elastin; Epidermis; Female; Humans; Male; Middle Aged; Pain Measurement; Patient Satisfaction; Pilot Projects; Preoperative Care; Punctures; Vitamin A

To investigate the effect of vitamin C (VC) on visceral lipid oxidative injury during oral fluid resuscitation of burn shock.. Twelve male Beagle dogs were surgically prepared for arterial and venous cannulation, and 24 hours later they were subjected to a 50% TBSA full-thickness flame injury. In the first 24 hours after burn dogs were resuscitated with gastric infusion of either glucose-electrolyte solution (GES group, n = 6) or GES containing 250 mg/kg of VC (GES/VC group, n = 6). The delivery rate and volume of GES was in accordance with that of Parkland formula (4 ml x kg(-1) x 1% TBSA(-1) in the first 24 hours). In the second 24 hours all animals received delayed i.v. fluid resuscitation. At end of 72 hours after injury, animals were sacrificed, and specimens of heart, lung, liver, kidney and jejunum were harvested for evaluation of xanthine oxidase (XOD), malondialdehyde (MDA) and assessment of the tissue water content (ratio of dry to wet weight) of organs. The plasma levels of alanine aminotransferase (ALT), creatinine (Cr), MB isoenzyme of creatine kinase (CK-MB) and diamine oxidase (DAO) were determined at same time.. At 72 hours after burn it was showed significant higher activities of XOD in GES/CAR than GES group in heart, kidney and jejunum, and lower contents of MDA in heart, lung, liver, kidney and jejunum (P all < 0.01). Tissue water contents were significantly lower in GES/CAR than GES group in heart [(75.4 +/-1.1)% vs (78.5 +/- 0.8)%], lung [(68.1 +/- 0.9)% vs (73.9 +/- 1.0)%], liver [ (75.2 +/- 0.8)% vs (78.3 +/- 1.2)%], kidney [(73.8 +/- 1.1)% vs (78.1 +/- 0.8)%] and jejunum [(76.3 +/- 0.8)% vs ( 80.4 +/- 0.6)] respectively, all P < 0.01. The levels of ALT, CK-MB, Cr and DAO in GES/CAR group were (46.6 +/- 2.49) U/L, (43.4 +/- 7.05) mol/L, (7156 +/- 596) U/L and (1.86 +/- 0.45) U/L respectively, all significantly lower than those of the GES group [(86.9 +/- 7.89) U/L, (95.2 +/- 1.23) mol/L, (8023 +/- 384) U/L and (2.68 +/- 0.61) U/L respectively, all P < 0.05].. The results indicated that vitamin C alleviated visceral tissue edema and organ injury by inhibiting free radical production during oral fluid resuscitation of burn shock.

Topics: Animals; Ascorbic Acid; Burns; Dogs; Fluid Therapy; Male; Oxidative Stress; Reactive Oxygen Species; Reperfusion Injury; Shock

To investigate the effect of vitamin C (VC) on alleviating peroxidative damage in gut of dogs during enteral fluid resuscitation of severe burn shock.. Eighteen male Beagle dogs were subjected to 50% total body surface area (TBSA) full-thickness burn 24 hours after duodenostomy and cannulation of cervical artery and vein. The dogs were divided into no resuscitation (NR) group (no treatment after burn), enteral resuscitation (ER) group, and ER+VC group according to the random number table, with 6 dogs in each group. Dogs in ER and ER+VC groups were respectively infused with glucose-electrolyte solution (GES) and GES containing 250 mg/kg VC through duodenostomy tube 30 minutes after burn. The infusion rate and volume of GES were in accordance with Parkland formula. Venous blood of dogs was drawn before (0) and at 2, 4, 6, and 8 post burn hours (PBH) to determine the activity of diamine oxidase (DAO) in plasma. Dogs were sacrificed at PBH 8 to collect specimens of jejunum tissue for determining the content of malondialdehyde (MDA), and activity of myeloperoxidase (MPO), xanthine oxidase (XOD) and superoxide dismutase (SOD), and assessment of the water ratio of intestinal tissue by dry-wet weight method.. 50% TBSA burn injury resulted in significant elevation of DAO in every group. The activity of DAO in ER group was obviously higher than that in NR group at PBH 6 and 8 (P < 0.05), but DAO activity in ER+VC group was significantly lower than those in the other two groups after PBH 2 (P < 0.05 or P < 0.01). MDA content, MPO and XOD activity and the water ratio of intestinal tissue [(5.74 +/- 0.51) nmol/mg, (2.08 +/- 0.46) U/g, (58.4 +/- 3.8) U/mg, (81.5 +/- 1.8)%] in ER group at PBH 8 was respectively significantly higher than that in NR group [(5.43 +/- 0.25) nmol/mg, (1.55 +/- 0.21) U/g, (50.1 +/- 2.8) U/mg, (78.3 +/- 1.5)%, P < 0.05 or P < 0.01]. While the activity of SOD in ER group (72 +/- 12) U/mg was lower than that in NR group (97 +/- 20) U/mg. MDA content, MPO and XOD activity and water ratio of intestinal tissue in ER+VC group was respectively lower than that in ER group, with activity of SOD in the former group higher than that in the latter group (P < 0.01).. Vitamin C can alleviate peroxidative damage and tissue edema in gut induced by ischemia and reperfusion, and intestinal complications during oral rehydration during burn shock can be reduced.

Topics: Animals; Ascorbic Acid; Burns; Dogs; Fluid Therapy; Intestine, Small; Male; Oxidative Stress; Reactive Oxygen Species; Reperfusion Injury; Shock

The 22 supersetnd Hohenheim Consensus Workshop took place in at the University of Stuttgart-Hohenheim. The subject of this conference was vitamin C and its role in the treatment of endothelial dysfunction. Scientists, who had published and reviewed scientific and regulatory papers on that topic were invited, among them basic researchers, toxicologists, clinicians and nutritionists. The participants were presented with eleven questions, which were discussed and answered at the workshop, with the aim of summarising the current state of knowledge. The explicatory text accompanying the short answers was produced and agreed on after the conference and was backed up by corresponding references. The therapeutic relevance of administration of the physiological antioxidant vitamin C in high parenteral doses in Endothelial Dependent Pathophysiological Conditions (EDPC) was discussed. Endothelial dysfunction is defined as including disturbed endothelial dependant relaxation of resistance vessels, breakdown of the microvascular endothelial barrier and/or loss of anti-adhesive function. It occurs in severe burn injury, intoxications, acute hyperglycemia, sepsis, trauma, and ischemic-reperfusion tissue injury and is induced by oxidative stress. Reduced plasma ascorbate levels are a hallmark of oxidative stress and occur in severe burns, sepsis, severe trauma, intoxication, chemotherapy/radiotherapy and organ transplantation. Vitamin C directly enhances the activity of nitric oxide synthase, the acyl CoA oxidase system and inhibits the actions of proinflammatory lipids. There is experimental evidence that parenteral high-dose vitamin C restores endothelial function in sepsis. In vitro, supraphysiological concentrations (> 1mM) of ascorbate restore nitric oxide bioavailability and endothelial function. Only parenterally, can enough vitamin C be administered to combat oxidative stress. There is no evidence that parenteral vitamin C exerts prooxidant effects in humans. Theoretical concerns in relation to competitive interactions between vitamin C and glucose cellular uptake are probably only relevant for oxidised vitamin C (dehydroascorbate).

Topics: Acute Disease; Acyl-CoA Oxidase; Ascorbic Acid; Burns; Endothelium, Vascular; Glucose; Heart Failure; Humans; Hyperglycemia; Infusions, Parenteral; Myocardial Ischemia; Nitric Oxide Synthase Type III; Oxidative Stress; Poisoning; Reperfusion Injury; Sepsis

The purpose of this study was to determine the effects of combined use of L-carnitine and vitamin C on partially burned skin flap in an experimental rat model.. In the rat dorsal skin, a 10 x 3 cm flap was marked. The most distal 3 x 3 cm part was burned to full thickness. Twenty-four rats were randomized into four groups with 6 animals in each. Group 1 was simply followed up. Group 2 was given 0.5 mg/kg vitamin C per day for 7 days, group 3 100 mg/kg carnitine per day for 7 days, and group 4 both carnitine and vitamin C. On the eighth postoperative day, the animals were sacrificed and examined. The surviving and necrotic areas were determined by macroscopic examination and measured with a planimeter.. The areas of flap necrosis were measured. The median surviving areas and areas of flap necrosis, respectively, of the groups were: group 1, 16.0 cm(2) and 14.0 cm(2); group 2, 18.25 cm(2) and 11.75 cm(2); group 3, 20.0 cm(2) and 10 cm(2) ; and group 4, 23.75 cm(2) and 6.25 cm(2). The surviving areas of the groups were found to be significantly different (p=0.000).. The risk of ischemia-induced necrosis in flap attempts made in damaged tissues may be reduced by the combination of two promising agents, L-carnitine and vitamin C. L-carnitine appears to be the major contributing factor that reduces necrosis, and vitamin C an additive agent.

Topics: Animals; Antioxidants; Ascorbic Acid; Burns; Carnitine; Disease Models, Animal; Rats; Rats, Sprague-Dawley; Skin; Surgical Flaps

Fluid resuscitation to maintain adequate tissue perfusion while reducing edema in the severely burned patient remains a challenge. Recent studies suggest that reactive oxygen species generated by thermal injury are involved in edema formation associated with burn. The present study tested the hypothesis that adding a free radical scavenger to the resuscitation fluid would reduce total fluid requirements in the treatment of severe thermal injury. Anesthetized chronically instrumented sheep received a 40% total body surface area full-thickness flame burn. At 1 h after injury, animals were resuscitated with lactated Ringer's (LR, n = 14) as control, LR containing high doses of vitamin C (VC, n = 6), 1000 mOsM hypertonic saline (HS, n = 7), or 1000 HS containing VC (HS/VC, n = 7) in coded bags so that investigators were blinded to the treatment. Fluids were infused at an initial Parkland rate of 10 mL/kg/h, adjusted hourly to restore and maintain urine output at 1 to 2 mL/kg/h. Sheep in the VC or HS/VC group received 250 mg/kg VC in the first 500 mL of LR or HS, and then 15 mg/kg/h thereafter. Hemodynamic variables and indices of antioxidant status were measured. At 48 h postburn, sheep were euthanized, and heart, liver, lung, skeletal muscle, and ileum were evaluated for antioxidant status. All fluid resuscitation regimens were equally effective in restoring cardiac output to near baseline levels; no treatment effects were apparent on arterial pressure or heart rate. VC infusion significantly reduced fluid requirements and, therefore, net fluid balance (fluid in, urine out) by about 30% at 6 h and about 50% at 48 h in comparison with the LR group (P < 0.05). HS and HS/VC reduced fluid requirements by 30% and 65%, respectively, at 6 h, but the volume-sparing effect of HS was not observed after 36 h and that of HS/VC was lost after 12 h. Plasma total antioxidant potential increased about 25-fold (P < 0.05) at 2 and 3 h in response to VC infusion compared with the LR and HS groups, and remained about 5- to 10-fold higher throughout the rest of the study. VC infusion also prevented the 4-fold increase in plasma thiobarbituric acid reactive substances seen in the LR group early after burn (P < 0.05). Tissue antioxidant status was similar between groups. In this sheep burn model, continuous high-dose VC infusion reduced net fluid balance, reduced indices of plasma lipid peroxidation, and maintained overall antioxidant status in comparison with standard-of-care LR

Topics: Animals; Antioxidants; Arteries; Ascorbic Acid; Burns; Edema; Female; Fluid Therapy; Free Radical Scavengers; Hematocrit; Hemodynamics; Lipid Peroxidation; Resuscitation; Saline Solution, Hypertonic; Sheep; Shock, Traumatic; Sodium Chloride; Thiobarbituric Acid Reactive Substances; Time Factors; Tissue Distribution

This study examined the effects of antioxidant vitamins A, C, and E on nuclear transcription factor-kappa B (NF-kappaB) nuclear translocation, on secretion of inflammatory cytokines by cardiac myocytes, and on cardiac function after major burn trauma.. Adult rats were divided into four experimental groups: group I, shams; group II, shams given oral antioxidant vitamins (vitamin C, 38 mg/kg; vitamin E, 27 U/kg; vitamin A, 41 U/kg 24 hours before and immediately after burn); group III, burns (third-degree scald burn over 40% total body surface area) given lactated Ringer's solution (4 mL/kg/% burn); and group IV, burns given lactated Ringer's solution plus vitamins as described above. Hearts were collected 4, 8, 12, and 24 hours after burn to assay for NF-kappaB nuclear translocation, and hearts collected 24 hours after burn were examined for cardiac contractile function or tumor necrosis factor-alpha secretion by cardiomyocytes.. Compared with shams, left ventricular pressure was lower in burns given lactated Ringer's solution (group III) (88 +/- 3 vs. 64 +/- 5 mm Hg, p < 0.01) as was +dP/dt max (2,190 +/- 30 vs. 1,321 +/- 122 mm Hg/s) and -dP/dt max (1,775 +/- 71 vs. 999 +/- 96 mm Hg, p < 0.01). Burn injury in the absence of vitamin therapy (group III) produced cardiac NF-kappaB nuclear migration 4 hours after burn and cardiomyocyte secretion of tumor necrosis factor-alpha, interleukin-1beta, and interleukin-6 by 24 hours after burn. Antioxidant therapy in burns (group IV) improved cardiac function, producing left ventricular pressure and +/-dP/dt (82 +/- 2 mm Hg, 1,880 +/- 44 mm Hg, and 1,570 +/- 46 mm Hg/s) comparable to those measured in shams. Antioxidant vitamins in burns inhibited NF-kappaB nuclear migration at all times after burn and reduced burn-mediated cytokine secretion by cardiomyocytes.. These data suggest that antioxidant vitamin therapy in burn trauma provides cardioprotection, at least in part, by inhibiting translocation of the transcription factor NF-kappaB and interrupting cardiac inflammatory cytokine secretion.

Topics: Animals; Antioxidants; Ascorbic Acid; Body Surface Area; Burns; Disease Models, Animal; Drug Evaluation, Preclinical; Hemodynamics; Inflammation; Injury Severity Score; Interleukin-1; Interleukin-6; Myocardial Contraction; Myocardium; NF-kappa B; Oxidative Stress; Protein Transport; Rats; Rats, Sprague-Dawley; Time Factors; Tumor Necrosis Factor-alpha; Vitamin A; Vitamin E

To investigate the protective effects of metallothionein (MT) on severely scalded rats inflicted by oxygen free radicals after delayed resuscitation.. Wistar rats inflicted by 30% TBSA III degree scalding injury were taken as the model. Fifty-Six rats were randomly divided into four groups, i.e. normal control, delayed resuscitation, MT treated and VitC treated groups. The changes in superoxide dismutase (SOD) and malondialdehyde (MDA) contents in plasma and subeschar edematous fluid were determined at 24 and 48 postburn hours with traditional indirect detecting method and electron spin resonance (ESR). Pathomorphological examination was simultaneously carried out for cardiac, hepatic, renal and intestinal samples. Plasma biochemical indices were determined at the same time.. In delayed resuscitation group, SOD content decreased and the MDA contents increased in plasma and subeschar fluid obviously, with remarkable changes in the pathomorphology of all the internal organs and the blood biochemical indices. But in MT treating group, SOD content increased (P < 0.05) with decreased content of MDA (P < 0.05) and the pathomorphology and blood biochemical indices improved significantly when compared with those in delayed resuscitation group and VitC treatment group.. MT treatment might be beneficial in the management of severely scalding rats infliced by oxygen free radicals.

Topics: Alanine Transaminase; Animals; Ascorbic Acid; Aspartate Aminotransferases; Blood Urea Nitrogen; Body Fluids; Burns; Creatine Kinase; Creatine Kinase, MB Form; Female; Hydroxybutyrate Dehydrogenase; Isoenzymes; L-Lactate Dehydrogenase; Male; Malondialdehyde; Metallothionein; Rats; Rats, Wistar; Reactive Oxygen Species; Superoxide Dismutase; Time Factors

edema formation after thermal injury is rapid and fulminant within the first hour after injury and increased microvascular permeability has been claimed to be the main responsible mechanism. An acute decrease in interstitial fluid hydrostatic pressure (P(if)) down to -150 mm Hg has recently been reported in dermal burns. This strong negative tissue pressure creates a 'suction' on the fluid in the capillaries. Furthermore, high dose vitamin C (VC) has been shown to reduce postburn edema and fluid requirements following major burn injuries. This led to the present study, aimed at investigating whether VC administered after thermal injury in rats, could attenuate the strongly negative P(if). Edema volume was measured by total tissue water content (TTW) and extravasation of albumin (Ealb).. a prospective, open experimental study.. pentobarbital-anesthetized rats received either a full-thickness burn injury covering 10% of total body surface area, or a sham burn. The rats were given VC or equal volumes normal saline (NS) either before the burn, 5 or 30 min after the injury. VC (25 mg/ml in NS, osmolality 272 mOsm/l) was administered as a bolus (66 mg/kg) followed by infusion (33 mg/kg/h). The animals were divided into 7 groups (6 animals in each) according to the timing of VC/NS administration: (1) VC-preburn, (2) VC-5 min postburn, (3) VC-30 min postburn, (4) NS-preburn, (5) NS-5 min postburn, (6) NS-30 min postburn and (7) VC-pre sham burn group. All groups were duplicated for series I and II.. in series I; P(if) was measured using a sharpened glass micropipette connected to a servo-controlled counter pressure system. Measurements were averaged in the following time periods: preburn, 5-20, 21-40, 41-60 and 61-90 min postburn. In series II; Ealb and TTW were measured in burned and non-burned skin by radio-labelled albumin and wet-dry weights, respectively.. in the sham control group (VC-pre-sham burn), P(if) ranged between -1 and -2 mm Hg and did not change throughout the experimental period. In the NS group (placebo), P(if) fell to -46.8 +/- 10.1 (1 S.D.) mm Hg at 5-20 min after the injury and were -23.1 +/- 13.4 and -11.6 +/- 4.1 mm Hg at 21-40 and 41-60 min postburn. P(if) returned to preburn values at 61-90 min post injury. In the VC groups, there was a marked attenuation of the negative P(if) to average -10.1 +/- 11.8 mm Hg at 5-20 min, -2 +/- 1.7 and -0.6 +/- 1.2 mm Hg at 21-40 and 41-60 min after injury, respectively (all p < 0.01 compared to NS). TTW in burned skin of the NS-5 min groups was 3.12 +/- 0.28, VC5-min group was 2.57+/-0.69 and VC sham was 1.77+/-0.19 ml/g DW, respectively (p < 0.01 compared to sham control for all values). In all the VC-groups TTW values were higher than sham control and lower than in the corresponding NS-groups (p > 0.05 both ways). No statistical significant differences were found between Ealb-values in the VC- and NS-groups.. high-dose vitamin C attenuates the development of strongly negative P(if) in burned dermis and reduces the edema as measured by TTW. No significant change in Ealb was found. Vitamin C was thus found to have potential beneficial effects on the acute postburn edema generation.

Topics: Analysis of Variance; Animals; Ascorbic Acid; Burns; Cell Membrane Permeability; Disease Models, Animal; Dose-Response Relationship, Drug; Edema; Extracellular Space; Hydrostatic Pressure; Rats; Rats, Wistar; Reference Values; Time Factors; Wound Healing

Oxygen radicals may play an important role in injury due to thermal burns. High-dose antioxidant ascorbic acid (vitamin C, Cenolete, Abbott Laboratory, Abbott Park, Ill) therapy reduces edema of burned and unburned tissue, lipid peroxidation, and subsequent resuscitation fluid volume requirement in experimental burn models.. To determine the hemodynamic effects of delayed initiation (2 hours after injury) of antioxidant therapy in patients with second-degree burns.. Experimental study. MATERIALS AND INTERVENTION: Burns over 70% of body surface area were produced by subxiphoid immersion of 12 guinea pigs in 100 degrees C water for 3 seconds. The animals were resuscitated with Ringer's lactated solution according to the Parkland formula (4 mL/kg for 1% of burned body surface area during the first 24 hours) from 0.5 to 2 hours following injury, after which the resuscitation fluid volume was reduced to 25% of the Parkland formula. Animals received Ringer's lactated solution to which ascorbic acid (340 mg/kg during the first 24 hours) was added (vitamin C group [n = 6]) or Ringer's lactated solution only (control group [n = 6]).. Heart rates, mean arterial blood pressure, cardiac output, hematocrit level, and water content in burned and unburned tissue were measured before injury and at intervals thereafter.. There were no significant differences in heart rates (P = .29) and blood pressures (P = .53) between the 2 groups throughout the 24-hour study period. No animal died. The vitamin C group showed significantly lower hematocrit levels (P < .05) and significantly higher cardiac output values (P < .05) at 7 hours following burn injury and at intervals thereafter (P < .001).. With delayed initiation of high-dose ascorbic acid therapy, the 24-hour fluid resuscitation volume was reduced to 32.5% of the Parkland formula, while maintaining adequate cardiac output values.

Topics: Animals; Ascorbic Acid; Body Fluids; Burns; Guinea Pigs; Hemodynamics; Resuscitation; Time Factors

We studied the hemodynamic effects of delayed initiation (6 h postburn) of antioxidant therapy with high-dose vitamin C in second-degree thermal injuries. Seventy percent body surface area burns were produced by subxiphoid immersion of 12 guinea pigs into 100 degrees C water for 3 s. The animals were resuscitated with Ringer's lactate solution (R/L) according to the Parkland formula (4 ml/kg/% burn during the first 24 h) from 6 h postburn, after which the resuscitation fluid volume was reduced to 25% of the Parkland formula volume. Animals were divided into two groups. The vitamin C group (n = 6) received R/L to which vitamin C (340 mg/kg/24 h) was added after 6 h postburn. The control group (n = 6) received R/L only. Both groups received identical resuscitation volumes. Heart rates, mean arterial blood pressure, cardiac output, hematocrit level, and water content of burned and unburned tissue were measured before injury and at intervals thereafter. No animals died. There were no significant differences in heart rates or blood pressures between the two groups throughout the 24-h study period. The vitamin C group showed significantly (P < 0.05) lower hematocrits 8 and 24 h postburn, and higher cardiac outputs after 7 h postburn. At 24 h postburn, the burned skin in the vitamin C group had a significantly (P < 0.05) lower water content (73.1 +/- 1.1) than that of the control group (76.0 +/- 0.8). In conclusion, delayed initiation of high-dose vitamin C therapy beginning 6 h postburn with 25% of the Parkland formula volume significantly reduced edema formation in burned tissue, while maintaining stable hemodynamics.

Topics: Animals; Ascorbic Acid; Blood Pressure; Burns; Cardiac Output; Edema; Fluid Therapy; Guinea Pigs; Heart Rate; Hematocrit; Isotonic Solutions; Ringer's Lactate; Time Factors

Copper (Cu) status is often judged by the plasma level of its chief transport protein, ceruloplasmin (Cp). Only copper deficiency and heredity are known to decrease circulating Cp. Cp is an acute-phase responsive protein in trauma and it is also induced by Cu supplementation. Despite this, plasma concentrations of Cp remain low during the acute recovery from major burn injury. The high provision of vitamin C typically used in burn patients may influence these observations when an indirect oxidase activity assay is used. We employed a radial immunodiffusion (RID) assay specific for the Cp protein as well as an indirect oxidase assay for Cp in a series of 11 burned children who were supplemented with both Cu and vitamin C, either enterally or parenterally. Our findings confirm that low Cp is a characteristic of the acute recovery from major burns. The oxidase assay is shown to be valid for very low Cp levels even during high vitamin C provision. When these data are combined with our previously reported series, a strong relationship between the size of the open wound area and the amount of circulating Cp is demonstrated. Copper supplementation by either the enteral or parenteral routes is only marginally successful in restoring Cp toward normal levels.

Topics: Adolescent; Ascorbic Acid; Burns; Ceruloplasmin; Child; Child, Preschool; Copper; Humans; Immunodiffusion; Infant; Oxidoreductases

Topics: Adult; Aged; Ascorbic Acid; beta Carotene; Burns; Carotenoids; Enteral Nutrition; Female; Humans; Lycopene; Male; Middle Aged; Time Factors; Vitamin A; Vitamin E

Most nutrition laboratory testing relies on serum concentrations of ingested nutrients, their coenzymes, proteins, or lipids. Alternatively, functional tests measure a specific physiological process or biochemical reaction. We compared these two approaches to nutritional assessment in intensive-care burn patients, in whom the serum concentrations of transthyretin (prealbumin), albumin, transferrin, carotene, retinol, ascorbic acid, copper, cholesterol, iron, and calcium were all below established reference ranges. In contrast, serum triglyceride concentrations were often above the reference range. Functional tests for thiamin, riboflavin, pyridoxine, and iron (by zinc protoporphyrin/heme ratio) in these patients all showed normal values. Dietary intake, weight trends, and nitrogen balances all indicated that these patients' estimated caloric and protein needs had been met. These findings suggest that static measurements of serum concentrations may be unreliable indicators of nutritional status in burn patients.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ascorbic Acid; Burns; Calcium; Carotenoids; Cholesterol; Copper; Female; Humans; Iron; Male; Middle Aged; Nutritional Status; Reference Values; Serum Albumin; Transferrin; Triglycerides; Vitamin A

We studied the haemodynamic effects of antioxidant therapy with high-dose vitamin C administration (170 mg/kg/24 h) in guinea-pigs with 70 per cent body surface area deep dermal burns. The animals were divided into three groups of six animals each. Group 1 was resuscitated with Ringer's lactate solution according to the Parkland formula; group 2 with 25 per cent of the Parkland formula with vitamin C; and group 3 with 25 per cent of the Parkland formula without vitamin C. There were no significant differences in heart rates or in blood pressures between the groups throughout the 24-h study period. Group 3 showed significantly higher haematocrit values at 3 h postburn and thereafter as compared with those of group 2. The cardiac output values of group 2 were significantly higher than those of group 3, but equivalent to those of group 1. The water content of the burned skin in group 2 was significantly lower than that in the other groups, indicating that increased postburn capillary permeability was minimized by the administration of vitamin C. With adjuvant high-dose vitamin C administration, we were able to reduce the 24-h resuscitation fluid volume from 4 ml/kg/per cent burn to 1 ml/kg/per cent burn, while maintaining adequate cardiac output.

Topics: Animals; Ascorbic Acid; Burns; Capillary Permeability; Cardiac Output; Guinea Pigs; Hematocrit; Hemodynamics; Infusions, Intravenous; Resuscitation

A burned guinea-pig model (30 per cent BSA) was used to study the effect of vitamin C on immune and metabolic responses following burn trauma. Thirty-six guinea-pigs received identical enteral diets (175 kcal/kg) except for the amount of vitamin C. Groups I, II, III and IV were given formulae delivering no vitamin C, (1 RDA) 15 mg/kg/day, 75 mg/kg/day or 375 mg/kg/day, respectively. Resistance to infection was evaluated by injecting each animal with 0.1 ml of 1 x 10(9) Staph. aureus 502A subcutaneously on day 10. On day 14, Staph. aureus abscesses were excised and the numbers of viable colonies were determined. Results showed no statistical differences between groups in the clearance of Staph. aureus. From days 2 to 12, animals in groups I, II and III had body weights of approximately 97 per cent of preburn body weight. Animals in group IV, however, had a body weight gain, 102 per cent of preburn body weight on day 12. Animals in group IV also had significantly lower metabolic rates on day 12 as compared to the animals in the other groups. These results suggest that large amounts of vitamin C have beneficial effects on the maintenance of body weight and metabolic rate following burn trauma.

Topics: Animals; Ascorbic Acid; Body Weight; Burns; Enteral Nutrition; Female; Guinea Pigs; Organ Size; Staphylococcal Infections

Thermal injury generates free radicals from various cellular populations, and modulation of free radical activity with scavengers may improve outcome. Balb/c mice were infected with Ps. aeruginosa the day after burn injury and mortality rates observed. Tocopherol was given by gavage daily for 4 days starting 2 days before burn. Survival was improved in the groups receiving 25 and 250 IU/kg compared to control. In other groups, tocopherol was given after burn, but mortality rates were not changed. Treatment with the oxygen radical scavengers ascorbic acid, and a combination of superoxide dismutase and catalase had no effect on mortality. We conclude that ascorbic acid, superoxide dismutase, and catalase do not appear to benefit survival after thermal injury and infection in this murine model. Tocopherol given in high doses of at least 25 IU/kg by gavage preceding injury and continued thereafter for 2 days did improve survival, but this benefit was not seen if tocopherol was not started until after injury.

Topics: Animals; Antibody Formation; Antioxidants; Ascorbic Acid; Burns; Catalase; Female; Free Radicals; Hemolytic Plaque Technique; Mice; Mice, Inbred BALB C; Pseudomonas Infections; Superoxide Dismutase; Vitamin E

Topics: Adolescent; Adult; Ascorbic Acid; Burns; Female; Humans; Male; Middle Aged; Nutritional Requirements; Vitamin A

Topics: Ascorbic Acid; Burns; Dose-Response Relationship, Drug; Erythrocytes; Female; Glucosephosphate Dehydrogenase Deficiency; Hemolysis; Humans; Male; Middle Aged; Uric Acid

Topics: Aged; Ascorbic Acid; Black People; Burns; Glucosephosphate Dehydrogenase Deficiency; Hemolysis; Humans; Male

Topics: Adult; Aged; Ascorbic Acid; Ascorbic Acid Deficiency; Burns; Child; Contraceptives, Oral; Depression; Female; Folic Acid; Folic Acid Deficiency; Humans; Infant; Infections; Leg Ulcer; Pyridoxine; Scurvy; Vitamin B 12 Deficiency; Vitamin D; Vitamin D Deficiency; Vitamins; Wound Healing; Zinc

Topics: Animals; Ascorbic Acid; Burns; Collagen; Granulation Tissue; Guinea Pigs; Male; Surgical Procedures, Operative; Time Factors; Wound Healing; Wounds and Injuries

Topics: Animals; Ascorbic Acid; Burns; Colorimetry; Flavonoids; Kidney; Liver; Muscles; Rats; Tannins; Time Factors

Topics: Acid Phosphatase; Adrenal Glands; Alkaline Phosphatase; Animals; Ascorbic Acid; Blood Glucose; Blood Proteins; Burns; Flavonoids; Glycogen; Guinea Pigs; Hydrolyzable Tannins; L-Lactate Dehydrogenase; Liver; Muscles; Nucleic Acids; Pyruvates; Succinate Dehydrogenase; Tannins; Time Factors

Topics: Animals; Ascorbic Acid; Burns; Collagen; Evaluation Studies as Topic; Follow-Up Studies; Fractures, Bone; Guinea Pigs; Male; Prognosis; Radiography; Wound Healing

Topics: Adolescent; Adult; Age Factors; Aged; Ascorbic Acid; Blood Transfusion; Burns; Female; Humans; Leukocytes; Male; Middle Aged; Sex Factors; Skin; Skin Transplantation; Time Factors; Wound Healing

Topics: Adenosine Triphosphate; Animals; Ascorbic Acid; Burns; Carbohydrate Metabolism; Dermatologic Agents; Glycogen; Liver; Muscles; Phosphorus; Pyruvates; Rats; Steam; Tannins; Time Factors

Topics: Acid Phosphatase; Adrenal Medulla; Alkaline Phosphatase; Animals; Ascorbic Acid; Burns; Chromaffin System; Epinephrine; Esterases; Male; Microscopy, Electron; Rats; Rats, Inbred Strains

Topics: Ascorbic Acid; Atrophy; Body Temperature Regulation; Burns; Fractures, Bone; Glycosuria; Humans; Hyperglycemia; Muscle Proteins; Nutritional Physiological Phenomena; Proteins; Wounds and Injuries

Topics: Adult; Aged; Ascorbic Acid; Body Surface Area; Burns; Burns, Chemical; Burns, Electric; Germany, West; Humans; Middle Aged; Phosphorus; Rutin; Water-Electrolyte Balance; Wound Infection

Topics: 17-Hydroxycorticosteroids; Adrenal Glands; Alkaline Phosphatase; Animals; Ascorbic Acid; Burns; Cholesterol; Histocytochemistry; Hyperplasia; Lipid Metabolism; Organ Size; Rabbits; Shock, Traumatic

Topics: Animals; Ascorbic Acid; Burns; Collagen; Guinea Pigs; Male; Surgical Procedures, Operative; Wound Healing

Topics: Aminosalicylic Acids; Ascorbic Acid; Burns; Chlortetracycline; Dihydrostreptomycin Sulfate; Humans; Immunodiffusion; Penicillin V; Riboflavin; Thiamine; Vitamin B Complex

Topics: Adrenal Glands; Adrenalectomy; Adrenocorticotropic Hormone; Animals; Ascorbic Acid; Burns; Dexamethasone; Hypophysectomy; Male; Pituitary Gland; Rats; Sodium Chloride; Stress, Physiological

Topics: Adolescent; Adult; Aged; Ascorbic Acid; Bandages; Burns; Child; Child, Preschool; England; Female; Humans; Infant; Infant, Newborn; Male; Middle Aged; Outpatient Clinics, Hospital; Sweden; Tannins

Topics: 4-Aminobenzoic Acid; Adrenal Cortex Hormones; Adrenal Glands; Aminobenzoates; Ascorbic Acid; Blood Chemical Analysis; Burns; Citrates; Dihydroergotoxine; Ergot Alkaloids; Glycogen; Histamine H1 Antagonists; Histocytochemistry; Ketoglutaric Acids; Lactates; Lipids; Liver; Metabolism; Muscles; Pharmacology; Pyruvates; Rats; Wound Healing

Topics: Adolescent; Ascorbic Acid; Bandages; Baths; Blood Transfusion; Burns; Child; Classification; Contracture; Debridement; Drug Therapy; Gluconates; Humans; Infant; Mortality; Penicillins; Potassium; Psychotherapy; Regeneration; Shock; Silver Nitrate; Skin; Skin Transplantation; Sodium Chloride; Streptomycin; Toxicology; Wound Infection

Topics: Ascorbic Acid; Biochemical Phenomena; Burns; Carbohydrate Metabolism; Humans; Tyrosine

Topics: Adaptation, Physiological; Ascorbic Acid; Burns; Humans; Pantothenic Acid; Pyridoxine; Vitamin B 6

Topics: Ascorbic Acid; Burns; Carbohydrate Metabolism; Gastrointestinal Tract; Humans; Male; Testis

Topics: Animals; Ascorbic Acid; Burns; Diuresis; Diuretics; Dogs; Hormones; Pituitary Gland; Pituitary Gland, Posterior; Pituitary Hormones, Posterior; Vasopressins

Topics: Ascorbic Acid; Burns; Tetraethylammonium; Vitamins

Topics: Ascorbic Acid; Biochemical Phenomena; Burns; Nitrogen; Vitamins

Topics: Alkalies; Ascorbic Acid; Burns; Cornea; Corneal Injuries; Eye Burns; Humans

Topics: Animals; Ascorbic Acid; Blood Volume; Burns; Diuretics; Dogs; Hypotension; Vitamins

Topics: Ascorbic Acid; Burns; Diuresis; Research; Serotonin; Serotonin Agents; Vitamins

Topics: Animals; Ascorbic Acid; Burns; Diuretics; Dogs; Research; Vitamins

Topics: Animals; Ascorbic Acid; Burns; Dogs; Oliguria; Urination Disorders; Vitamins

Topics: Ascorbic Acid; Burns; Humans; Vitamins

Topics: Adrenal Glands; Ascorbic Acid; Burns; Liver

Topics: Ascorbic Acid; Burns; Humans; Male; Niacin; Nicotinic Acids; Riboflavin; Thiamine