ASSESSMENT OF IMPROVED WOUND HEALING, RECOVERY AND REHABILITATION IN SEVERELY

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The stress response to burn is characterized by hormonal alterations, which include increased circulating levels of catecholamines, cortisol and glucagon. These changes result in a hypercatabolic state, which is characterized by persistent muscle weakness, tachycardia, early fatigue with normal activity, and growth arrest. This persistent catabolic state results in a significant loss of lean body mass in burn patients, even when the patients are well fed. We have been able to attenuate these responses in acute burn patients with growth hormone and insulin treatment. Our work verifies that in burn patients the serum levels of growth hormone (GH) and IGF- 1 are well below normal, even below "low normal" levels. Oxandrolone, an oral synthetic testosterone analogue, has been used in acute and rehabilitating adult burn patients with promising results as measured by weight gain and restoration of urinary nitrogen balance in these patients. It also has been used successfully in children with Turner's syndrome and in situations of other pathologic delays in growth, in cachectic alcoholic hepatitis, and in patients with AIDS wasting myopathy. Resistance exercise has an established influence on muscle strengthening and muscle protein synthesis. These beneficial effects have been well documented in both adults and adolescents. High intensity resistance training also appears to be effective in increasing muscle strength in preadolescents, possibly by increasing levels of neuromuscular activation and intrinsic muscle contraction and hypertrophy.