***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    Input: OBJECTIVE To determine whether propranolol and growth hormone ( GH ) have additive effects to combat burn-induced catabolism . SUMMARY BACKGROUND DATA Both GH and propranolol have been attributed anabolic properties after severe trauma and burn . It is conceivable that the two in combination would have additive effects . METHODS Fifty-six children with more than 40 % TBSA burns were r and omized to one of four anabolic regimens : untreated control , GH treatment , propranolol treatment , or combination GH plus propranolol therapy . Clinical treatment was identical for all groups . Resting energy expenditure was determined by indirect calorimetry and skeletal muscle protein kinetics were measured using stable amino acid isotope infusions before and after each anabolic regimen . RESULTS There were no differences in age , sex , or burn size between groups . Tachycardia and energy expenditure were decreased during propranolol treatment ( < .05 ) . The net balance of muscle protein synthesis and breakdown was improved during propranolol and GH plus propranolol treatment ( < .05 ) . There was no significant benefit of GH alone . No additive effect of combination therapy was seen . CONCLUSIONS Propranolol is a strongly anabolic drug during the early , hypercatabolic period after burn . No synergistic effect between propranolol and GH was identified BACKGROUND The catecholamine-mediated hypermetabolic response to severe burns causes increased energy expenditure and muscle-protein catabolism . We hypothesized that blockade of beta-adrenergic stimulation with propranolol would decrease resting energy expenditure and muscle catabolism in patients with severe burns . METHODS Twenty-five children with acute and severe burns ( more than 40 percent of total body-surface area ) were studied in a r and omized trial . Thirteen received oral propranolol for at least two weeks , and 12 served as untreated controls . The dose of propranolol was adjusted to decrease the resting heart rate by 20 percent from each patient 's base-line value . Resting energy expenditure and skeletal-muscle protein kinetics were measured before and after two weeks of beta-blockade ( or no therapy , in controls ) . Body composition was measured serially throughout hospitalization . RESULTS Patients in the control group and the propranolol group were similar with respect to age , weight , percentage of total body-surface area burned , percentage of body-surface area with third-degree burns , and length of time from injury to metabolic study . Beta-blockade decreased the heart rates and resting energy expenditure in the propranolol group , both as compared with the base-line values ( P<0.001 and P=0.01 , respectively ) and as compared with the values in the control group ( P=0.03 and P=0.001 , respectively ) . The net muscle-protein balance increased by 82 percent over base-line values in the propranolol group ( P=0.002 ) , whereas it decreased by 27 percent in the control group ( P not significant ) . The fat-free mass , as measured by whole-body potassium scanning , did not change substantially in the propranolol group , whereas it decreased by a mean ( + /-SE ) of 9+/-2 percent in the control group ( P=0.003 ) . CONCLUSIONS In children with burns , treatment with propranolol during hospitalization attenuates hypermetabolism and reverses muscle-protein catabolism Studies in children with burn injuries have demonstrated that propranolol improves metabolism and reduces muscle protein wasting . However , safety and efficacy in adults are less well established than in children . The purpose of this study was to determine safety of propranolol use in adult patients with burn injuries . Medical records were review ed for burn-injured adults receiving propranolol . Patients between 18 and 65 years old and with ≥20 % TBSA burn were included . Fifty-four patients met the criteria with mean age of 37 years and mean burn size of 38 % TBSA .  Propranolol dosages ranged from 0.1 to 3.8 mg/kg/day , with an average maximum dosage of 0.61 mg/kg/day . Mean heart rate decreased by 25 % during 4 weeks . Seventy-two percent of patients experienced at least one episode of hypotension and 15 % experienced bradycardia  . Propranolol doses were most frequently held for low blood pressure ; 32 % of patients had at least one dose held for hypotension . This retrospective analysis suggests that modest dosing of propranolol results in frequent episodes of hypotension or bradycardia . Our data suggest that adults do not tolerate the higher doses reported in a pediatric population . Despite potential beneficial anti-catabolic effects of propranolol , burn care providers must recognize potential iatrogenic hemodynamic effects of this intervention . Our data support the need for prospect i ve multicenter studies to delineate the safety and efficacy  of propranolol in adult burn-injured patients Burn patients have the highest metabolic rate among critically ill or injured patients . Because propranolol decreases energy expenditure and muscle protein catabolism , in this study , we hypothesized that propranolol would improve healing process and decrease wound-healing time . This study was a double-blind r and omized clinical trial ; a total of 79 burn patients who referred to this center from January 2006 to January 2007 fulfilled the inclusion criteria . Thirty-seven patients were r and omly placed in propranolol group and 42 in control group  . The propranolol group received propranolol orally with the dose of 1 mg/kg/d and maximum dose of 1.98 mg/kg/d given in six divided doses . This dose was adjusted to decrease the resting heart rate by 20 % from each patient ’s baseline value . The control group received placebo . The most common cause of burn in both groups was flame followed by flash . Patients with superficial burns in the propranolol group needed less time to heal for acceptable wound healing in superficial burns ( 16.13 ± 7.40 days vs 21.52 ± 7.94 days ; P = .004 ) . We also found that patients with deep burn injury needed less time to be ready for skin graft ( 28.23 ± 8.43 days vs 33.46 ± 9.17 days ; P = .007 ) when compared to that of the control group . The use of propranolol decreased the size of the burn wound that finally needed skin graft . Patients in the propranolol group with an average burn size of 31.42 % TBSA finally needed 13.75 % of TBSA skin graft compared with that of control patients with an average burn size of 33.61 % TBSA who needed 18.72 % of TBSA skin graft , and patients in the control group with an average burn size of 33.61 % TBSA finally needed 18.72 % of TBSA skin graft ( P = .006 ) . Patients in the propranolol group had a shorter hospital stay period than the control group ( 30.95 ± 8.44 days vs 24.41 ± 8.11 days ; P = .05 ) . Administration of propranolol , improved burn wound healing , and decreased healing time and hospital stay period . The use of propranolol decreased the surface area of wounds that needed to be skin grafted BACKGROUND Propranolol , a nonselective beta1 - 2 antagonist , attenuates hypermetabolism and catabolism in severely burned patients . However , recent data suggest that propranolol impairs immune function and enhances inflammation . The purpose of the present study was to determine the effect of propranolol administration on infection , sepsis , and inflammation in severely burned pediatric patients . PATIENTS A prospect i ve , intent-to-treat study was performed ; patient demographics ( age , gender , burn size , and mortality ) ; infectious episodes ( colony count greater then 10 ) ; and sepsis ( guidelines by the society of critical care medicine ) were determined . Hypermetabolic response was determined by resting energy expenditure ( REE ) , and the inflammatory response was determined by measuring serum cytokine expression . RESULTS Two hundred forty-five patients ( 143 controls , 102 propranolol ) were included into the study . There were no differences between the control and propranolol groups for age , gender distribution , burn size , third degree burn , and length of stay . Mortality was 6 % in the control group and 5 % in the propranolol group . Propranolol significantly decreased REE and predicted REE during acute hospital stay . Forty-three patients developed infections in the control group ( 30 % ) , whereas 21 developed infections in the propranolol group ( 21 % ) . The incidence of sepsis was 10 % for controls and 7 % for propranolol . Analysis of the cytokine expression profile in 20 patients in each group revealed that propranolol significantly decreased serum tumor necrosis factor and interleukin-1beta compared with controls ( p < 0.05 ) . CONCLUSION Propranolol treatment attenuates hypermetabolism and does not cause increased incidence of infection and sepsis Background Main contributors to adverse outcomes in severely burned pediatric patients are profound and complex metabolic changes in response to the initial injury . It is currently unknown how long these conditions persist beyond the acute phase post-injury . The aim of the present study was to examine the persistence of abnormalities of various clinical parameters commonly utilized to assess the degree hypermetabolic and inflammatory alterations in severely burned children for up to three years post-burn to identify patient specific therapeutic needs and interventions . Methodology /Principal Findings Patients : Nine-hundred seventy-seven severely burned pediatric patients with burns over 30 % of the total body surface admitted to our institution between 1998 and 2008 were enrolled in this study and compared to a cohort non-burned , non-injured children .  Demographics and clinical outcomes , hypermetabolism , body composition , organ function , inflammatory and acute phase responses were determined at admission and subsequent regular intervals for up to 36 months post-burn . Statistical analysis was performed using One-way ANOVA , Student 's t-test with Bonferroni correction where appropriate with significance accepted at p<0.05 . Resting energy expenditure , body composition , metabolic markers , cardiac and organ function clearly demonstrated that burn caused profound alterations for up to three years post-burn demonstrating marked and prolonged hypermetabolism , p<0.05 . Along with increased hypermetabolism , significant elevation of cortisol , catecholamines , cytokines , and acute phase proteins indicate that burn patients are in a hyperinflammatory state for up to three years post-burn p<0.05 . Conclusions Severe burn injury leads to a much more profound and prolonged hypermetabolic and hyperinflammatory response than previously shown . Given the tremendous adverse events associated with the hypermetabolic and hyperinflamamtory responses , we now identified treatment needs for severely burned patients for a much more prolonged time BACKGROUND There is no direct evidence that beta-blockers improve mortality in burn victims .  Beta-blockers attenuate hypermetabolic states in burned children , and perioperative use in elective adult cases has beneficial effects , which suggests that beta-blockers may also improve burn outcomes . However , beta-blockers decrease cardiac output and may decrease oxygen delivery , and theoretically may increase mortality . What is the effect of beta-blockers on healing time and mortality in burn patients ? METHODS This was a retrospective cohort study . We identified three cohorts of adult burn patients between 1996 and 2001 : all who were on beta-blockers ( BB ) before their injury ( PMH BB ) ; all who were initiated on BB during their hospitalization for management of hypertension or tachyarrhythmia ( HOSP BB ) ; and control , who were never treated with beta-blockers .  For each patient in the PMH BB and HOSP BB groups , two patients were placed in the control cohort by matching age and total body surface area burn . Premorbid conditions such as diabetes , hypertension , cardiac disease , renal insufficiency , and diuretic and calcium channel blocker use were analyzed . Multivariate regression models were used to identify independent modifiers . RESULTS There were 21 PMH BB , 22 HOSP BB , and 86 control patients . All PMH BB patients remained on their BB regimen in the hospital . HOSP BB patients were initiated on beta-blockers at a mean of 8.8 days postinjury . There were no differences in age ( mean , 58 + /- 17 years ) , total body surface area burned ( mean , 14 + /- 12 % ) , or mechanism of injury among the cohorts . The mortality rate was 5 % for the PMH BB cohort , 27 % for the HOSP BB cohort , and 13 % for controls . The mean healing times were 51 + /- 29 days for PMH BB patients , 79 + /- 54 days for HOSP BB patients , and 60 + /- 39 for controls . In multivariate analyses , PMH BB was associated with a significant decrease in fatal outcome and healing time ( p < or = 0.05 compared with control ) . CONCLUSION Beta-blockers have the potential to improve adult burn outcomes . Postinjury treatment should be studied in a r and omized , clinical trial OBJECTIVE To determine if the cardi 
    Output:
    
Occurrence of adverse events was not significantly different between the treated patients the and controls .
Limited evidence suggests beneficial effects of propranolol after burn injury , and its use seems safe .