This article briefly reviews some of the mechanisms involved in the pathogenesis of neurological diseases, i.e. damage mechanisms (DM), and their interactions and overlap with protection and reparatory processes (i.e. endogenous defence activities). A relationship between DM and endogenous defence activity (EDA) regarding therapy principles will also be described. Currently, it is difficult to find the correct therapeutic approach for brain protection and recovery, especially because we do not fully understand all of the endogenous neurobiological processes, the complete nature of the pathophysiological mechanisms and the links between these two categories. Moreover, we continue to use a simplistic and reductionist approach in this respect. Endogenous neurobiological processes, such as neurotrophicity, neuroprotection, neuroplasticity and neurogenesis, are central to protection and recovery and represent the background of EDA. The biological reality of the nervous system is far more complex. In fact, there is an endogenous holistic process of neuroprotection and neurorecovery that should be approached therapeutically in an integrated way. The current tendency to exclusively frame drug activity in terms of single mechanisms and single focus effect might distract from other paradigms with greater explanatory power and hinder the development of more effective treatment strategies. A change of concept is required in pharmacological brain protection and recovery. Prospective considerations include an integrated pharmacological approach, focusing on drugs with multimodal activity and pleiotropic neuroprotective effect which are biological drugs, rather than single mechanism drugs, which usually are chemical drugs.

Background: Although it was initially assumed that erythropoietin (EPO) was a hormone that only affected erythropoiesis, it has now been proposed that EPO plays an additional key role in the regulation of acute and chronic tissue damage. Via the inhibition of inflammatory reactions and of apoptosis, stem cell recruitment, advancement of angiogenesis and growth factor release, EPO enhances healing and thus restitutio ad integrum after trauma. Human skin contains EPO receptors and is able to synthesize EPO. We therefore hypothesize that EPO is able to optimize wound healing in thermally injured patients.

BackgroundAlthough it was initially assumed that erythropoietin (EPO) was a hormone that only affected erythropoiesis, it has now been proposed that EPO plays an additional key role in the regulation of acute and chronic tissue damage.Via the inhibition of inflammatory reactions and of apoptosis, stem cell recruitment, advancement of angiogenesis and growth factor release, EPO enhances healing and thus restitutio ad integrum after trauma. Human skin contains EPO receptors and is able to synthesize EPO. We therefore hypothesize that EPO is able to optimize wound healing in thermally injured patients.Methods/DesignThis is a large, prospective, randomized, double-blind, multi-center study, funded by the German Federal Ministry of Education and Research, and fully approved by the designated ethics committee. The trial, which is to investigate the effects of EPO in severely burned patients, is in its recruitment phase and is being carried out in 13 German burn care centers. A total of 150 patients are to be enrolled to receive study medication every other day for 21 days (EPO 150 IU/kg body weight or placebo). A follow-up of one year is planned. The primary endpoint of this study is the time until complete re-epithelialization of a defined skin graft donor site is reached. Furthermore, clinical parameters such as wound healing, scar formation (using the Vancouver scar scale), laboratory values, quality of life (SF-36), angiogenic effects, and gene- and protein-expression patterns are to be determined. The results will be carefully evaluated for gender differences.DiscussionWe are seeking new insights into the mechanisms of wound healing in thermally injured patients and more detailed information about the role EPO plays, specifically in these complex interactions. We additionally expect that the biomimetic effects of EPO will be useful in the treatment of acute thermal dermal injuries.Trial registrationEudraCT Number: 2006-002886-38, Protocol Number: 0506, ISRCT Number: http://controlled-trials.com/ISRCTN95777824/ISRCTN95777824.

Objective: Geriatric patients represent a separate group in the treatment of burn injury regarding pathogenesis, pathophysiology and therapeutic procedure. Methods: From 2000 to 2010 on our burn unit 53 patients aged over 60 years were treated. The mean age of the 27 women and 26 men was 76 years (60-102 years), with an average of 33.2% of total burn surface area. 25 patients (47.2%) had severe inhalation injury, 77.4% of the patients suffered full thickness burn injuries. Mean ABSI Score was 12. Relevant additional diseases were coronary heart disease, heart insufficiency, hypertension, COPD, adiposity and chronic alcoholism. Results: 22 patients were treated by early operative intervention (day 0-4), 13 of these patients survived further process. In 17 cases first operative procedure could take place only at a later date, 14 patients deceased before operation. 26 patients developed pneumonia. The total morbidity amounted to 26 of 53 patients (49%). A total of 19 injured with a burn index over 80 survived. 9 of them had an index of more than 100. Usual indices as the "Zellweger Index" and the ABSI-Score are not adequate to determine the prognosis of thermal injuries in the elderly. Conclusion: The treatment of elderly with burn trauma is affected by many factors. Compared to younger patients the increased incidence of an inhalation injury is decisive for the prognosis of older patients. The frequency of pre-existing diseases is clearly largely than with younger burn injured patients. These prognostically relevant parameters were not sufficiently considered by established score systems.

Mechanical ventilation in TEN patients is associated with an increased mortality rate, but the timing of initiation of mechanical ventilation does not affect the patient survival rates.