ASSESSMENT OF IMPROVED WOUND HEALING, RECOVERY AND REHABILITATION IN SEVERELY

这个子项目是利用由NIH/NCRR资助的中心拨款提供的资源的许多研究子项目之一。子项目和调查员(PI)可能从另一个NIH来源获得了主要资金，因此可能会出现在其他CRISE条目中。列出的机构是针对中心的，而不一定是针对调查员的机构。对烧伤的应激反应以激素变化为特征，包括循环中儿茶酚胺、皮质醇和胰高血糖素水平的增加。这些变化导致高分解代谢状态，其特征是持续的肌肉无力、心动过速、早期疲劳和正常活动，以及生长停滞。这种持续的分解代谢状态导致烧伤患者瘦体重的显著减少，即使患者吃得很好。我们已经能够通过生长激素和胰岛素治疗来减轻急性烧伤患者的这些反应。我们的工作证实，烧伤患者的血清生长激素(GH)和IGF-1水平远低于正常，甚至低于“低正常”水平。奥雄酮是一种口服合成睾酮类似物，已用于急性和康复中的成人烧伤患者，通过这些患者的体重增加和尿氮平衡恢复来衡量，结果令人振奋。它还成功地用于特纳综合征儿童和其他病理性生长迟缓的情况，在恶病质酒精性肝炎和艾滋病消耗性肌病患者中使用。抗阻运动对肌肉强化和肌肉蛋白质合成有既定的影响。这些有益的影响在成年人和青少年中都得到了很好的证明。高强度的阻力训练似乎也能有效地增加青春期前的肌肉力量，可能是通过增加神经肌肉的激活水平以及内在肌肉收缩和肥大来实现的。

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.