Chemical, Electrical, and Radiation Injuries

NVP-AUY922 relieves radiation-induced intestinal injury via regulating EPHX1

As a common side effect of radiotherapy, radiation-induced intestinal injury (RIII) greatly affects the prognosis of patients and the efficacy of radiotherapy. Current therapeutic strategies for RIII are still very limited. Thus, the identification of effective radioprotective agents is of great importance. NVP-AUY922 is an HSP90 inhibitor with favorable anti-inflammatory and antioxidant activities. It has been proven to mitigate radiation-induced lung injury. However, its effects on the alleviation of RIII remain unclear. In this study, our data indicated that NVP-AUY922 remarkably increased the survival rate after radiation exposure. NVP-AUY922 treatment could enhance the viability of intestinal stem cells (ISCs) and promote the recovery of the small intestine. In addition, it also inhibited intestinal inflammation and reshaped the gut microbiota structure. We found that the radioprotective effect of NVP-AUY922 is partially dependent on EPHX1. In addition, NVP-AUY922 could attenuate dextran sulfate sodium (DSS)-induced colitis and promote intestinal barrier recovery. Thus, our results suggest that NVP-AUY922 contributes to the amelioration of intestinal injury after radiation exposure, which offers a new approach for the prevention of RIII.

Progress in Nanotechnology for Treating Ocular Surface Chemical Injuries: Reflecting on Advances in Ophthalmology

Ocular surface chemical injuries often result in permanent visual impairment and necessitate complex, long-term treatments. Immediate and extensive irrigation serves as the first-line intervention, followed by various therapeutic protocols applied throughout different stages of the condition. To optimize outcomes, conventional regimens increasingly incorporate biological agents and surgical techniques. In recent years, nanotechnology has made significant strides, revolutionizing the management of ocular surface chemical injuries by enabling sustained drug release, enhancing treatment efficacy, and minimizing side effects. This review provides a comprehensive analysis of the etiology, epidemiology, classification, and conventional therapies for ocular chemical burns, with a special focus on nanotechnology-based drug delivery systems in managing ocular surface chemical injuries. Twelve categories of nanocarrier platforms are examined, including liposomes, nanoemulsions, nanomicelles, nanowafers, nanostructured lipid carriers, nanoparticles, hydrogels, dendrimers, nanocomplexes, nanofibers, nanozymes, and nanocomposite materials, highlighting their advantages in targeted delivery, biocompatibility, and improved healing efficacy. Additionally, current challenges and limitations in the field are discussed and the future potential of nanotechnology in treating ocular diseases is explored. This review presents the most extensive examination of this topic to date, aiming to link recent advancements with broader therapeutic strategies.

Neonatal chemical burns and child neglect

Differential diagnosis of agents of chemical burns can be challenging in neonates, especially in absence of a clear history of the event. A wide variety of chemical agents, from acids to basics, can be involved. Massive chemical burns over 21% of the body surface of a four-day-old male neonate were observed. At the physical examination, lower chest, abdomen, genital area and upper limbs showed full-thickness contact burns with a clear demarcation line of the skin breakdown related to necrosis of the subcutaneous layer. Head and fingers exhibited small hard brownish eschars. No clear history was referred by the parents, raising the suspect of a child neglect. Due to the critical conditions, it was not possible to identify the chemical agents causing the burns. The prompt excision and synthetic skin grafting was successfull and the baby survived. Considering all the different chemical agents found in the domestic environment, a combination of acid-basic agents may have been involved. Both parents were sentenced to nine years imprisonment for child neglect and wounding with intent.

Epidemiological characteristics and outcomes of special-cause burns: analysis of 33,619 burn patients in a major regional burn center in China from 2004 to 2021

Special-cause burn injuries are usually more severe and difficult to manage, and often contribute to a high mortality in severely injured patients. The aim of this study was to present the epidemiological characteristics of special-cause burn in a major regional burn center in China between 2004 and 2021 and determine the risk factors associated with the mortality of burn patients. A total of 33,619 burn patients were included the study, among which 4,452 (13.2%) were special-cause burn patients. Compared to the thermal burn group, the special-cause burn patients were usually male, elder, married and III-IV degree of burn with onset of upper extremity in summer and autumn. Moreover, a greater proportion of patients in the special-cause burn group underwent surgical treatment and amputation and had a higher median hospital stay and treatment costs. During the multivariate logistic regression, older age, male, unmarried, winter, III-IV degree of burn, ≥ 3 burn sites, and larger total body surface area (TBSA) of burn were significantly associated with higher burn mortality (all P < 0.05), however, patients with special-cause burn injuries have not increased odds for mortality (P > 0.05). These results suggested that special cause-burn patients suffer more severe injuries, resulting in longer hospital stays and higher health care expenditures, but it did not significantly increase the mortality risk. Therefore, burn clinicians should not only have the responsibility to cure burns, but also need to know and popularize burn epidemiological characteristic and precaution.

Greener healing: sustainable nanotechnology for advanced wound care

Wound healing involves a carefully regulated sequence of events, encompassing pro-inflammatory and anti-inflammatory stages, tissue regeneration, and remodeling. However, in individuals with diabetes, this process gets disrupted due to dysregulation caused by elevated glucose levels and pro-inflammatory cytokines in the bloodstream. Consequently, the pro-inflammatory stage is prolonged, while the anti-inflammatory phase is delayed, leading to impaired tissue regeneration and remodeling with extended healing time. Furthermore, the increased glucose levels in open wounds create an environment conducive to microbial growth and tissue sepsis, which can escalate to the point of limb amputation. Managing diabetic wounds requires meticulous care and monitoring due to the lack of widely available preventative and therapeutic measures. Existing clinical interventions have limitations, such as slow recovery rates, high costs, and inefficient drug delivery methods. Therefore, exploring alternative avenues to develop effective wound-healing treatments is essential. Nature offers a vast array of resources in the form of secondary metabolites, notably polyphenols, known for their antimicrobial, anti-inflammatory, antioxidant, glucose-regulating, and cell growth-promoting properties. Additionally, nanoparticles synthesized through environmentally friendly methods hold promise for wound healing applications in diabetic and non-diabetic conditions. This review provides a comprehensive discussion and summary of the potential wound-healing abilities of specific natural polyphenols and their nanoparticles. It explores the mechanisms of action underlying their efficacy and presents effective formulations for promoting wound-healing activity.

Visualization enhancement by PCA-based image fusion for skin burns assessment in polarization-sensitive OCT

Polarization-sensitive optical coherence tomography (PS-OCT) is a functional imaging tool for measuring tissue birefringence characteristics. It has been proposed as a potentially non-invasive technique for evaluating skin burns. However, the PS-OCT modality usually suffers from high system complexity and relatively low tissue-specific contrast, which makes assessing the extent of burns in skin tissue difficult. In this study, we employ an all-fiber-based PS-OCT system with single-state input, which is simple and efficient for skin burn assessment. Multiple parameters, such as phase retardation (PR), degree of polarization uniformity (DOPU), and optical axis orientation, are obtained to extract birefringent features, which are sensitive to subtle changes in structural arrangement and tissue composition. Experiments on ex vivo porcine skins burned at different temperatures were conducted for skin burn investigation. The burned depths estimated by PR and DOPU increase linearly with the burn temperature to a certain extent, which is helpful in classifying skin burn degrees. We also propose an algorithm of image fusion based on principal component analysis (PCA) to enhance tissue contrast for the multi-parameter data of PS-OCT imaging. The results show that the enhanced images generated by the PCA-based image fusion method have higher tissue contrast, compared to the en-face polarization images by traditional mean value projection. The proposed approaches in this study make it possible to assess skin burn severity and distinguish between burned and normal tissues.

Gingerol containing polymeric nanofibers: a healing touch for accelerated wound recovery

OBJECTIVE

In the current research, 6-gingerol (GA)-loaded nanofiber drug delivery system were developed, and their potential usage in wound healing was evaluated.

SIGNIFICANCE

This study investigates the effectiveness of nanofibrous membranes composed of sodium alginate (SA), poly(vinyl alcohol) (PVA), and 6-gingerol (GA) as delivery systems for anti-inflammatory agents in the context of wound dressings.

METHODS

GA-loaded SA/PVA nanofiber was prepared using electrospinning. In vitro characterization of this nanofiber included the examination of comprehensive in vitro characterization, anti-inflammatory and antioxidant activities, cytotoxicity, a scratch tes and in vivo skin test.

RESULTS

GA was extracted from Zingiber officinale, and its successful isolation was confirmed through analyses such as H-NMR, C-NMR. Then GA was electrospuned into the SA/PVA nanofibers, and scanning electron microscopy (SEM) imaging revealed that the fiber diameters of the formulations ranged between 148 nm and 176 nm. Anti-inflammatory and antioxidant studies demonstrated that the effectiveness of GA increased with higher doses; however, this increase was accompanied by decreased cell viability. In vitro release studies revealed that GA exhibited a burst release within the first 8 h, followed by a controlled release, reaching completion within 24 h. Within the scope of in vitro release kinetics, release data are mathematically compatible with the Weibull model with high correlation. The scratch test results indicated that TB2 (%1 GA) promoted epithelialization. Furthermore, it was determined that TB2 (%1 GA) did not cause any irritation.

CONCLUSIONS

As a result, TB2 shows promise as a formulation for wound dressings, offering potential benefits in the field of wound care.

Multiple ileal perforations as late complications of electrical injury: A rare case report

Introduction

Electric injury-induced intestinal perforation is one of rare and lethal complications. Direct injury and ischemic changes are the mechanism of intestinal perforation. Proper surgical and non-surgical management may increase the survival chance.

Case presentation

A 21-year-old male was referred from rural hospital with history of electric burn injury two days before. On arrival, the patient started complaining bloating and abdominal x-ray revealed small intestine dilation. On fourth day post-event, the symptoms worsened and abdominal CT-scan revealed free peritoneal air. Exploratory laparotomy was performed, and two ileal perforations were found. Suturing of perforation and ileostomy were performed. Forequarter amputation of the right superior limb was performed on the seventh day post-event. On the third month, the ileostomy was closed.

Conclusion

Intestinal perforation may be one of late complications of electrical injury in abdomen. Proper clinical evaluation and management helps in morbidity and mortality reduction.

Effective Management of Acute Oral Chemical Burns After NaOH Ingestion: A Case Report

BACKGROUND Chemical burns in the oral cavity, although rare, cause more severe tissue damage than thermal burns, continuing tissue destruction even after removing the causative substance. Prompt identification of the substance, exposure extent, time from injury to treatment, and the injured area are imperative for effective management. This report details severe oral burns in an elderly woman from accidental NaOH ingestion. CASE REPORT A 70-year-old female patient was presented to our hospital approximately 15 h after inadvertent consumption of approximately 20 ml of NaOH (sodium hydroxide) solution. This incident led to oral discomfort and restricted mouth opening. The ingested solution, erroneously assumed to be a beverage, was later identified as a potent alkaline substance typically employed in grease removal. Initial manifestations included intense burning sensation, oral edema, and heightened salivation, which exacerbated on the following day, adversely impacting her alimentation and verbal communication. Clinical examination disclosed extensive damage to the oral mucosa. The diagnosis encompassed a chemical burn in the oral cavity coupled with chronic gastritis. The treatment regimen comprised dietary limitations, administration of famotidine for gastric acid suppression, intravenous hydration, nutritional support, oral care with Kangfuxin liquid, and nebulization therapy. Six months after therapy, she exhibited complete recovery, with the absence of discomfort and restored normal oral functions. CONCLUSIONS Timely and targeted treatment strategies, particularly nebulization medication and Kangfuxin liquid, are effective in managing chemical burns in the oral cavity, promoting wound healing, and preventing complications.

Practical Review on the Contemporary Diagnosis and Management of Compartment Syndrome

Acute compartment syndrome (ACS) is a limb-threatening pathology that necessitates early detection and management. The diagnosis of ACS is often made by physical examination alone; however, supplemental methods such as compartment pressure measurement, infrared spectroscopy, and ultrasound can provide additional information that support decision-making. This practical review aims to incorporate and summarize recent studies to provide evidence-based approaches to compartment syndrome for both resource-rich and -poor settings among several patient populations.

Associated predictors of prolonged length of stay in patients surviving extensive burns: A large multicenter retrospective study

BACKGROUND

Patients with extensive burns are critically ill and have long treatment periods. Length of stay (LOS) is a good measure for assessing treatment. This study sought to identify predictors of prolonged LOS in patients with extensive burns (≥50% TBSA).

METHODS

This retrospective multicenter cohort study included adults aged ≥ 18 years who survived extensive burns in three burn centers in Eastern China between January 2016 and June 2022. Epidemiological, demographic and clinical outcomes data were extracted from electronic medical records and compared between patients with/without prolonged LOS, which was defined as LOS greater than the median. Logistic regression analysis was used to identify predictors of prolonged LOS.

RESULTS

The study sample included 321 patients, of whom 156 (48.6%) had an LOS of 58 days (IQR 41.0-77.0). Univariate regression analysis showed that increased total burn area and increased full-thickness burn area; electrical, chemical and other burns; increased erythrocytes, leukocytes, platelets or serum creatinine within 24 h of admission; concomitant inhalation injury, pulmonary edema, sepsis, bloodstream infection, wound infection, pulmonary infection, urinary tract infection, or HB < 70 g/L during hospitalization were associated with prolonged LOS in patients with extensive burns. Increased number of surgical operations, mechanical ventilation and renal replacement therapy were also associated with prolonged LOS (P < 0.05 or P < 0.001). Multivariate regression analysis revealed that increased total burn area (ratio 1.032, 95%CI 1.01-1.055; P = 0.004), electrical and chemical or other burns (3.282, 1.335-8.073; P = 0.01), development of wound infection (2.653 1.285-5.481; P = 0.008) and increased number of operative procedures (1.714, 1.388-2.116, P < 0.001) were significant predictors.

CONCLUSIONS

Increased area of full-thickness burn,occurrence of electrical and chemical or other burns,occurrence of wound infection and increased number of surgeries are the best predictors of prolonged LOS in patients with extensive burns. Clarifying relevant predictors of burn patients' LOS provides a reliable reference for clinical treatment.

Electrical Burn and Amputations in a Burn Center in Addis Ababa, Ethiopia

Background

Burn injuries are a global public health problem and continue to be one of the leading causes of unintentional death and injury. Electrical injuries, a relatively rare cause of burns, are increasingly being reported with higher rates of mortality in low and middle-income countries due to rapid industrialization in the absence of safety regulations. Electrical burn injuries can result in death, various organ system dysfunctions, or limb amputations.

Methods

A 5-year retrospective, cross-sectional study was conducted to assess the rate of amputation and associated risk factors in electrical burn injuries among burn patients at AaBET Hospital in Addis Ababa, Ethiopia.

Results

The rate of amputation among the 150 patients admitted with electrical burn in the study period was 33.3% (n = 50). A majority (62%; n = 31) of the patients were men (M:F 1.6:1) in the age range of 18-65 years. A fallen electrical wire coming in contact with the patients was the cause of the electrical burns in 50% of the cases. 65.3% of the patients had upper limb amputations, whereas 34.7% had lower limb amputations. Major amputations were more likely to occur when the entry site was the hand, whereas minor amputations were more likely to occur when the entry site was the scalp (P = 0.005).

Conclusions

Younger male patients were identified as the main victims of electrical burns that resulted in amputations. Electrical burns showed substantial morbidity and mortality of patients. Total body surface area and entry site being the hand significantly affected the level and site of amputation.

A 3D In Vitro Cortical Tissue Model Based on Dense Collagen to Study the Effects of Gamma Radiation on Neuronal Function

Studies on gamma radiation-induced injury have long been focused on hematopoietic, gastrointestinal, and cardiovascular systems, yet little is known about the effects of gamma radiation on the function of human cortical tissue. The challenge in studying radiation-induced cortical injury is, in part, due to a lack of human tissue models and physiologically relevant readouts. Here, a physiologically relevant 3D collagen-based cortical tissue model (CTM) is developed for studying the functional response of human iPSC-derived neurons and astrocytes to a sub-lethal radiation exposure (5 Gy). Cytotoxicity, DNA damage, morphology, and extracellular electrophysiology are quantified. It is reported that 5 Gy exposure significantly increases cytotoxicity, DNA damage, and astrocyte reactivity while significantly decreasing neurite length and neuronal network activity. Additionally, it is found that clinically deployed radioprotectant amifostine ameliorates the DNA damage, cytotoxicity, and astrocyte reactivity. The CTM provides a critical experimental platform to understand cell-level mechanisms by which gamma radiation (GR) affects human cortical tissue and to screen prospective radioprotectant compounds.

Patient-reported outcomes and their predictors 2 years after burn injury: A cross-sectional study

This study aimed to describe patient-reported outcomes 2 years after burn injury and to comprehensively elucidate predictors that may influence these outcomes. This cross-sectional, prospective study included 352 patients who were admitted to the Department of Burn Surgery at a tertiary teaching hospital between January 2017 and December 2020. We collected demographic and disease-related data and instructed participants to complete the Readiness for Hospital Discharge Scale (RHDS) and the Burn Specific Health Scale-Brief (BSHS-B) questionnaire. The overall score of patient-reported outcomes 2 years after burn injury was 126.55 ± 33.32 points, and the dimensions with the lowest scores were "hand function" (13.96 ± 5.75), "heat sensitivity" (14.84 ± 4.90), "treatment regimens" (13.41 ± 6.77) and "work" (11.30 ± 4.97). Multiple linear regression analysis revealed that less postburn pruritus, better readiness for hospital discharge, less total body surface area (TBSA), better social participation, white-collar jobs, older age, better sleep quality and burns not caused by electricity were associated with better outcomes. Patients experienced poor patient-reported outcomes 2 years after burn injury. Integrated rehabilitative care is necessary to address patients' unique needs and improve long-term patient-reported outcomes.

Delayed Demyelinating Disease of the Central Nervous System Following Low-Voltage Alternating Current Electrical Injury: A Case Report and Review of the Literature

Electrical injuries are relatively common types of mechanical trauma associated with significant morbidity and mortality. These injuries occur most commonly in adult men and account for approximately 3-7% of admissions to burn units. The type and amount of current, voltage, tissue resistance, and duration of current flow all influence the extent of injury and the patient outcome. A broad spectrum of central nervous system (CNS) and peripheral nervous systems (PNS) disorders caused by electrocution have been described in the literature. Here, we present a rare case of a 45-year-old man, electrocuted with a 240 V low-voltage alternating current (AC), four years prior to presentation, who has been admitted to our neurology clinic with a positive Lhermitte sign, paraparesis, proximal muscle pain, and distal paresthesia of the lower limbs, symptoms that had appeared one year after the electrocution. Magnetic resonance imaging (MRI) of the brain and spinal cord revealed multiple demyelinating lesions involving pons, juxtacortical and periventricular regions of the brain, and cervical and upper thoracic spinal cord. Given that other etiologies of demyelinating diseases of the CNS were excluded, we have interpreted this case and all accompanying pathologic findings as a consequence of electrical injury. Although the general epidemiologic reports regarding age, sex, type of current, circumstances, and site of electrocution correspond to the data of our reported case, this patient presents a delayed, rare neurologic complication with a nonspecific MRI pattern that we did not find in the literature. These patients should be carefully monitored not only during the acute phase but also over a longer period, because, as reported in this case, neurological complications may occur later after electrocution.

[Pay more attention to the management of burn wounds of special causes and sites]

The treatment of burn wounds of special causes and sites is a very challenging clinical work. In this paper, we briefly discussed the incidence rates of chemical burns, electric burns, facial burns, hand burns, and perineal burns, as well as the complexity and severity of pathological injury of the corresponding wound tissue. In addition, we briefly discussed the main principles and methods of clinical treatment, as well as the difficult problems to be solved. It is hoped to attract attention and provide reference for further improving the overall treatment ability of burns.

Bilateral Knee Soft-tissue Reconstruction after High-voltage Electrical Burn Injuries

This is the case of a 21-year-old man who had extensive and bilateral knee soft-tissue damage after a high-voltage electrical discharge. In its reconstruction, we simultaneously performed the pedicled medial sural artery perforator flap. Even though mild complications took place, this alternative proved helpful and reliable, providing an easily adjustable skin island and allowing for the patient's rapid rehabilitation and a satisfactory aesthetic outcome. Although this flap's reconstructive potential is known in other etiologies, the present report outlines its substantial potential in the case of electrical burn injuries, as it has barely been recognized before.

Protective mechanism of a novel aminothiol compound on radiation-induced intestinal injury

PURPOSE

With the development of nuclear technology and radiotherapy, the risk of radiation injury has been increasing. Therefore, it is important to find an effective radiation-protective agent. In this study, we designed and synthesized a novel compound called compound 8, of which the radioprotective effect and mechanism were studied.

MATERIALS AND METHODS

Before being exposed to ionizing radiation, mice were pretreated with compound 8. The 30-day mortality assay, hematoxylin-eosin staining, and immunohistochemistry staining assay were performed to evaluate the anti-radiation effect of the compound 8. TUNEL and immunofluorescence assays were conducted to study the anti-radiation mechanism of compound 8.

RESULTS

Compared to the IR + vehicle group, the 30-day survival rate of mice treated with 25 mg/kg of compound 8 was significantly improved after 8 Gy total body irradiation. In the morphological study of the small intestine, we found that compound 8 could maintain crypt-villus structures in the irradiated mice. Further immunohistochemical staining displayed that compound 8 could improve the survival of Lgr5⁺ cells, ki67⁺ cells, and lysozyme⁺ cells. The results of TUNEL and immunofluorescence assays showed that compound 8 could decrease the expression of apoptosis-related caspase-8/-9, γ-H2AX, Bax, and p53.

CONCLUSIONS

These results indicate that compound 8 exerts its effects by maintaining structure and function of small intestine. It also reduces DNA damage, promotes crypt proliferation and differentiation. Moreover, it may enhance the anti-apoptotic ability of small intestinal tissue by inhibiting the activation of p53 and blocking the caspase cascade reaction. Compound 8 can protect the intestinal tract from post-radiation damage, it is thus a new and effective protective agent of radiation.

Preparation, Characterization, Wound Healing, and Cytotoxicity Assay of PEGylated Nanophytosomes Loaded with 6-Gingerol

BACKGROUND

Nutrients are widely used for treating illnesses in traditional medicine. Ginger has long been used in folk medicine to treat motion sickness and other minor health disorders. Chronic non-healing wounds might elicit an inflammation response and cancerous mutation. Few clinical studies have investigated 6-gingerol's wound-healing activity due to its poor pharmacokinetic properties. However, nanotechnology can deliver 6-gingerol while possibly enhancing these properties. Our study aimed to develop a nanophytosome system loaded with 6-gingerol molecules to investigate the delivery system's influence on wound healing and anti-cancer activities.

METHODS

We adopted the thin-film hydration method to synthesize nanophytosomes. We used lipids in a ratio of 70:25:5 for DOPC(dioleoyl-sn-glycero-3-phosphocholine): cholesterol: DSPE/PEG2000, respectively. We loaded the 6-gingerol molecules in a concentration of 1.67 mg/mL and achieved size reduction via the extrusion technique. We determined cytotoxicity using lung, breast, and pancreatic cancer cell lines. We performed gene expression of inflammation markers and cytokines according to international protocols.

RESULTS

The synthesized nanophytosome particle sizes were 150.16 ± 1.65, the total charge was -13.36 ± 1.266, and the polydispersity index was 0.060 ± 0.050. Transmission electron microscopy determined the synthesized particles' spherical shape and uniform size. The encapsulation efficiency was 34.54% ± 0.035. Our biological tests showed that 6-gingerol nanophytosomes displayed selective antiproliferative activity, considerable downregulation of inflammatory markers and cytokines, and an enhanced wound-healing process.

CONCLUSIONS

Our results confirm the anti-cancer activity of PEGylated nanophytosome 6-gingerol, with superior activity exhibited in accelerating wound healing.

Pediatric First-Degree Burn Management With Honey and 1% Silver Sulfadiazine (Ag-SD): Comparison and Contrast

Background The cardinal area of managing fire wounds is guided by adequately evaluating the burn-induced lesion's profundity and size. Superficial second-degree burns are often treated through daily reinstating with fresh sterile bandaging with appropriate topical antimicrobials to allow rapid spontaneous epithelialization. Around the world, a wide variety of substances are used to treat these wounds, from honey to synthetic biological dressings. Objective This study intended to determine honey's therapeutic potential compared with 1% silver sulfadiazine (Ag-SD) in arsenal-caused contusion medicament fulfillment. Methods A total of 70 cases were evaluated in this research work after fulfilling the required selection criteria during the study period of January 2014 to December 2014 and January 2017 to December 2017. Purposive selection criteria were adopted in the study to select research patients. The patients in Group-1 (n = 35) relied on honey as medication, while patients in Group-2 (n = 35) relied on 1% Ag-SD. Results In Group-1, exudation (68.4%) and sloughing (82.9%) were substantially reduced by Days 3 and 5 of therapeutic intervention, respectively. However, in Group-2, a reduction of exudation (17.1%) and sloughing (22.9%) occurred after Days 3 and 5 of treatment, respectively. Completion of the epithelialization process was observed among Group-1 and Group-2 cases. It was detected after Days 7 and 10 of treatment at 36.3% and 77% (Group-1) and 27% and 67% (Group-2), respectively. Around 3 ml of 1% honey was required per body surface area per dressing in Group-1. On the other hand, in Group-2, 2 gm Ag-SD was needed per body surface area per dressing. Conclusion Patients treated with honey found better clinical outcomes in managing superficial partial-thickness burns.

Development of an Optimal Model of Combined Radiation and Biological Lesions

Since the search for the effective medication in combined lesions includes the selection of an optimal experimental model for such injuries, there is actually a study aimed at developing an optimal model of combined radiation-biology (Pasteurella) lesions. The pathogen Pasteurella multocida (as one of the most frequent pathogenic agents involved in both isolated and combined radiation-biology lesions of agricultural animals) was used as a model of a biological agent to reproduce experimental biological research. We employed the “Chinchilla” rabbits of 2.5–3.0 kg body weight as a biological model for doing combined radiation Pasteurella lesion. When determining the optimal model of combined radiation-biology (Pasteurella) lesion, we consider that in the joint action of various pathological agents on the organism, there is a synergistic effect of explosion agents, previously specifying minimal doses of external γ-radiation and pasteurellosis pathogen that in the joint action of nonfatal doses would be lethal. The first stage of the experiments determined the minimal doses of gamma rays and pasteurellosis pathogen that in joint action causes combined radiation-biology pathology. We examined 66 rabbits divided into 11 groups of 6 animals each to determine minimal doses of infectious agent-pasteurellosis pathogen. The animals of the first 9 groups were given subcutaneously Pasteurella species at doses 1·10⁹, 1·10⁸, 1·10⁷, 1·10⁶, 1·10⁵, 1·10⁴, 1·10³, 1·10², and 1·10¹ of microbial cells per animal of 0.3 ml suspension in volume; the 10th group of animals were given saline solution; the 11th served as a biological control group. In determining the minimal doses of gamma rays, we conducted experimental tests on 36 rabbits, which have been exposed to external γ-radiation in the “PUMA” system with a ¹³⁷Cs radiation source of the exposure dose of 5.38 R/min at doses 2.0, 4.0, 6.0, 8.0, 10, and 12 Gy. To specify the optimal model of radiation-pasteurellosis lesion, we used the rabbits subjected to a combined radiation-biology effect using minimal doses of gamma rays and pasteurellosis agent, leading to a lethal effect during their complex action. The researches revealed that 50% of the death of rabbits infected with pasteurellosis occurs using Pasteurella at a dose of 3.7·10⁴ microbial cells per kilogram (LD₅₀ = 3.7∙10⁴ m.c./kg), and 50% of radiation death in rabbits occurs when irradiated their gamma rays at a dose of 8.0 Gy (LD₅₀ = 8.0 Gy). The combined effect of nonlethal doses of the studied agents in the indicated doses on rabbits led to the aggravation of the course of radiation and pasteurellosis infection, causing the death of animals from combined radiation-pasteurellosis pathology. The model combined radiation-pasteurellosis disease ran its course rapidly, and the animals died 3 to 6 days after the onset. The autopsy of the animals that died from acute radiation-pasteurellosis pathogen had found swelling of the subcutaneous tissue in the pharynx and intermaxillary space of the neck, hyperemia, lymphoid nodular hyperplasia, numerous hemorrhages on the serous and mucous membranes and in the tissues of the parenchymal organs, serous or serous-fibrinous exudate, and in the chest and abdominal regions, pulmonary edema. The research stated that gamma radiation of rabbits at a dose of 8.0 Gy conducted before exposure with Pasteurella at LD₅₀ (3.7·10⁴ m.c./kg) declined the course of the pasteurellosis process, facilitated its generalization, and fastened the death of animals. Combined radiation-pasteurellosis infection ran its course rapidly, and the animals died within 3 to 6 days after the onset of the disease. The autopsy showed the pathologicoanatomic factors of the acute pasteurellosis: swelling of the subcutaneous tissue, purulent-catarrhal bronchopneumonitis, and pulmonary edema.

Transdermal deferoxamine administration improves excisional wound healing in chronically irradiated murine skin

BACKGROUND

Radiation-induced skin injury is a well-known risk factor for impaired wound healing. Over time, the deleterious effects of radiation on skin produce a fibrotic, hypovascular dermis poorly suited to wound healing. Despite increasing understanding of the underlying pathophysiology, therapeutic options remain elusive. Deferoxamine (DFO), an iron-chelating drug, has been shown in prior murine studies to ameliorate radiation-induced skin injury as well as improve wound healing outcomes in various pathologic conditions when administered transdermally. In this preclinical study, we evaluated the effects of deferoxamine on wound healing outcomes in chronically irradiated murine skin.

METHODS

Wild-type mice received 30 Gy of irradiation to their dorsal skin and were left to develop chronic fibrosis. Stented excisional wounds were created on their dorsal skin. Wound healing outcomes were compared across 4 experimental conditions: DFO patch treatment, vehicle-only patch treatment, untreated irradiated wound, and untreated nonirradiated wounds. Gross closure rate, wound perfusion, scar elasticity, histology, and nitric oxide assays were compared across the conditions.

RESULTS

Relative to vehicle and untreated irradiated wounds, DFO accelerated wound closure and reduced the frequency of healing failure in irradiated wounds. DFO augmented wound perfusion throughout healing and upregulated angiogenesis to levels observed in nonirradiated wounds. Histology revealed DFO increased wound thickness, collagen density, and improved collagen fiber organization to more closely resemble nonirradiated wounds, likely contributing to the observed improved scar elasticity. Lastly, DFO upregulated inducible nitric oxide synthase and increased nitric oxide production in early healing wounds.

CONCLUSION

Deferoxamine treatment presents a potential therapeutic avenue through which to target impaired wound healing in patients following radiotherapy.

Cellular and biological factors involved in healing wounds and burns and treatment options in tissue engineering

Severe traumatic wounds and burns have a high chance of mortality and can leave survivors with many functional disabilities and cosmetic problems, including scars. The healing process requires a harmonious interplay of various cells and growth factors. Different structures of the skin house numerous cells, matrix components and growth factors. Any disturbance in the balance between these components can impair the healing process. The function of cells and growth factors can be manipulated and facilitated to aid tissue repair. In the current review, the authors focus on the importance of the skin microenvironment, the pathophysiology of various types of burns, mechanisms and factors involved in skin repair and wound healing and regeneration of the skin using tissue engineering approaches.

Electrical Injuries and Neurosurgery: A Case Report and Review of Literature

Introduction Electrical injuries account for 5 to 27% of admissions to burn units. The nervous system is affected in as much as 21% of nervous injuries, with reported mortality.

Case Report The authors report a case of a patient presenting to the neurosurgical service with a traumatic brain injury (TBI) caused due to an electrical burn. Available data was reviewed through a PubMed search of literature, with special attention to the nature of presentation, classification of such injuries, the pathophysiology of the events that arise, complications to be expected, and the guidelines for management.

Conclusion It is possible for electrical injuries to cause TBIs requiring neurosurgical intervention.

Reconstruction of the Upper Extremity High-Voltage Electrical Injury: A Pediatric Burn Hospital's 13-Year Experience

High-voltage electrical injury is a rare yet destructive class of burn injury that persists as a serious public health issue. High-voltage exposure is commonly associated with complex wounds to the upper extremities, which can be a significant challenge for burn and plastic surgeons to reconstruct. This intensive and multistage reconstructive process is especially difficult in the growing child. Maximizing upper extremity function is a top priority, as it can have a significant impact on a patient's quality of life. Therefore, this retrospective review describes lessons learned during a 13-year experience at a specialized pediatric burn hospital with reconstruction of the upper extremity after severe high-voltage injury in 37 children. We found that adherence to the following principles can help promote meaningful functional recovery. These include: (1) frequent assessment during early acute care for the evolving need of decompression or amputation, (2) serial surgical debridement that follows a tissue-sparing technique, (3) wound closure by skin grafting or use of flaps (particularly groin or abdominal pedicled flaps) when deep musculoskeletal structures are involved, (4) early multidisciplinary intervention for contracture prevention and management including physical and occupational therapy, splinting, and fixation, (5) secondary reconstruction that focuses on the simplest possible techniques to repair chronic skin defects such as laser therapy, local tissue rearrangements, and skin grafting, (6) complex secondary reconstruction to address deeper tissue contractures or tendon and peripheral nerve deficits, and (7) amputation with preservation of growth plates, soft tissue transfer, and long-term prosthetic management when limb salvage is unlikely.

Patterns and outcomes of high-voltage versus low-voltage pediatric electrical injuries: an 8-year retrospective analysis of a tertiary-level burn center

INTRODUCTION

Although electrical injuries (EIs) are rare traumas in the pediatric age group, they are considered one of the most devastating injuries. We aimed to evaluate the patterns and outcomes of pediatric high-voltage (HVI) vs. low-voltage injuries (LVIs), admitted to the burn center within the efforts of determining evidence-based data for contributing to burn prevention strategies.

METHODS

A retrospective study was conducted on children with EIs hospitalized in the Burn Center of Adana City Training and Research Hospital (ACTRH) for eight years (2013-2020). Data including the patients' clinical and demographic characteristics, the percentage of total body surface area with burns (TBSA%), length of hospital stay (LOS), exposure place, electrical current type, and treatment results were collected and analyzed.

RESULTS

EIs were detected in 57 (2.5%) of 2243 acute pediatric burn injury admissions. EIs were most frequently observed in the form of HVIs, among children within the age range of 13-18 years, mostly in residential outdoor environments, where the high-power lines still passing close to the home roofs and balconies, resulting from contact with them. Besides, with a lesser extent in LVIs, in the home environment among children under five years, which was caused by connection with substandard electrical cords/poor-quality electrical devices and inserting an object into the electric sockets. Concerning the mean of TBSA%, HVIs suffered more extensive burns than LVIs. The most frequently affected anatomical regions among HV and LVIs were the upper limb, followed by the lower limb. While superficial partial- and deep partial-thickness burns were significantly more common among the LVIs, full thickness burns were more prevalent among the HVIs. The amputation rate was 12% which only one of them was major amputation (forearm above the elbow joint). HVIs had more elevated CK and CK-MB levels than LVIs but were not correlated with ECG findings. Only one death (caused by HVI) was observed, with a mortality rate of 1.8%.

CONCLUSION

Pediatric EIs are less common than scald or fire-flame related burns in this age group but can cause significant morbidity and even mortality, especially in severe burns. It is possible to prevent possible morbidity and mortality by strengthening compliance with safety precautions, especially with parental education and raising social awareness. In this context, taking necessary precautions for passing high voltage power lines under the ground, the standardization of electrical cables by the relevant legal regulations, the use of socket covers in homes, promoting the widespread use of residual current relays and arrangements to be taken against the use of illegal electricity are among measures for the prevention strategy.

Paediatric chemical burns: a clinical review

Although they account for a small proportion of burns in paediatrics, injuries from chemicals can be just as devastating as other mechanisms of burn injury. At least 25,000 chemicals exist which can cause burns: in children, they are often caused by household chemicals via accidental exposure. The mechanism by which corrosive substances produce chemical burns highlights the importance of early and plentiful irrigation of the burn area, removal of contaminated clothes and careful clinical assessment. Surgical intervention is uncommon but often follows the principles for thermal burns. This article reviews the aetiology, incidence, clinical presentation, management, complications and prevention of chemical burns. What is Known • Chemical burns in paediatrics are often caused by accidental exposure to chemicals available at home • Differences in the pathophysiology of chemical burns reinforces the need for early irrigation What is New • New irrigation fluids show promise in adults and need further study in children • The nature of chemical cutaneous burns can make assessment of wound depth difficult. Laser Doppler Imaging (LDI) is an accurate technique that can be used clinically to determine burn depth in thermal burns and is an area of future interest in the assessment of chemical burns.

[Staged repair strategy for chronic sacrococcygeal radiation ulcer]

Objective: To investigate the clinical effect of staged repair strategy for chronic sacrococcygeal radiation ulcer. Methods: The retrospective cohort study method was applied. Twelve patients with chronic sacrococcygeal radiation ulcer were admitted to Beijing Jishuitan Hospital from January 2010 to June 2020, including 7 males and 5 females, aged 38-74 years. The thorough debridement was performed in the first stage, with wounds area after debridement ranging from 8 cm×6 cm to 22 cm×14 cm, and continuous vacuum sealing drainage (VSD) was performed after the debridement operation. In the second stage, personalized surgery scheme was formulated according to the patient's age, systemic condition, vascular condition, and the position, size, and depth of wound. Six cases were reconstructed with superior/inferior gluteal artery perforator flaps, 4 cases were repaired with gluteus maximus myocutaneous flaps, 1 case was repaired with pedicled latissimus dorsi myocutaneous flap, and 1 case was reconstructed with free transplantation of latissimus dorsi myocutaneous flap. The area of flaps or myocutaneous flaps ranged from 10 cm×8 cm to 25 cm×18 cm. Donor sites of the flaps were sutured primarily in 9 patients and in the other 3 patients were repaired with intermediate split-thickness skin graft in back. The survival of flap or myocutaneous flap after operation, recurrence of tumor, and the appearance and texture of flap or myocutaneous flap, and wound healing were observed during follow-up. Results: Flaps or myocutaneous flaps in 11 patients survived after operation, and superior gluteal artery perforator flap in 1 patient had partial distal necrosis, which was covered again with flap pushed to the distal after debridement and resection of the necrotic tissue. The wounds in 8 patients achieved primary healing, 1 patient repaired with superior gluteal artery perforator flap experienced subcutaneous infection, 1 patient repaired with superior gluteal artery perforator flap suffered distal venous congestion of the flap, and 1 patient repaired with gluteus maximus myocutaneous flap had hematoma under myocutaneous flap, and 1 patient repaired with retrograde latissimus dorsi myocutaneous flap had incision exudation and dehiscence, which were all healed after dressing change, etc. There was no recurrence of tumor after the operation. The wounds healed well during follow-up of 2-52 months after discharge, with no recurrence of infection, and the flaps were soft in texture, with satisfactory appearance and well healed donor sites. Conclusions: On the basis of thorough debridement and VSD in the first stage, superior/inferior gluteal artery perforator flap, gluteus maximus myocutaneous flap, or pedicled/free latissimus dorsi myocutaneous flap with abundant blood supply is applied to repair chronic sacrococcygeal radiation ulcer in the second stage. The staged operation is reliable, with minimal injury to the donor site of flap and satisfactory therapeutic effect.

Garlic burn injuries- a systematic review of reported cases

Medicinal plants have many beneficial effects on human health. Garlic (Allium sativum, Alliaceae) is one of the most famous herbal species, used for various diseases and conditions. Unfortunately, garlic is also associated with adverse effects, including cutaneous manifestations. In this review, burn injuries caused by application of raw garlic are reported. Searching through PubMed, Google Scholar and ResearchGate, a total of 32 articles with 39 patients were found. Demographics of patients, reasons for garlic use, details on garlic application, as well as description of burns and its treatment are thoroughly described and discussed. In most of the cases, garlic caused second-degree burns, although some circumstances can cause formation of necrotic tissue. Various body parts were affected, legs being most common. The chemistry of garlic is also presented, with focus on volatile organic sulfur compounds, which also seem to be responsible for burns formation. Treatment of garlic burns was mainly symptomatic, and various types of drugs were used. Although not commonly expected, garlic should be taken into consideration as causative agents of burns by treating doctors, and patients should be advised against application of fresh garlic onto skin and mucosa.

Electrical Injuries in Children: A 10-Year Experience at a Tertiary Pediatric Burn Center

Electrical injuries comprise 4% of cases but have higher morbidity and mortality. This study aims to share our experiences with pediatric electrical injuries and propose strategies to prevent them. The files of pediatric electrical injuries between 2010 and 2020 were reviewed retrospectively. The following were investigated: age, gender, cause, length of stay in the pediatric burn center, total burned surface area, voltage-type, and surgical procedures performed. The patients from low- and high-voltage groups were compared. Eighty-five patients were treated in the last 10 years. Seventy were males, the mean age was 9.9 years, the average length of stay in pediatric burn center was 18.2 days, and the average total burned surface area was 11.7%. Forty-three patients were injured with high-voltage and 42 with low-voltage electricity. Fasciotomy was performed in 25 patients, grafting in 40 patients, and amputation in 12 patients. The most often amputated limb was the right arm/forearm. Psychiatric disorders developed in 24 patients. One patient died. In conclusion, the incidence of high-voltage electrical injuries increases with age. They are more prevalent in males, more often accompanied by additional trauma, and have higher total burned surface area, surgical procedures are performed more often, and hospitalization times are longer. For prevention, precautions should be taken by governments and families, and education is critical.

Chitosan and phospholipid assisted topical fusidic acid drug delivery in burn wound: Strategies to conquer pharmaceutical and clinical challenges, opportunities and future panorama

Burn is the immense public health issue globally. Low and middle income countries face extensive deaths owing to burn injuries. Availability of conventional therapies for burns has always been painful for patients as well as expensive for our health system. Pharmaceutical experts are still searching reliable, cheap, safe and effective treatment options for burn injuries. Fusidic acid is an antibiotic of choice for the management of burns. However, fusidic acid is encountering several pharmaceutical and clinical challenges like poor skin permeability and growing drug resistance against burn wound microbes like Methicillin resistant Staphylococcus aureus (MRSA). Therefore, an effort has been made to present a concise review about molecular pathway followed by fusidic acid in the treatment of burn wound infection in addition to associated pros and cons. Furthermore, we have also summarized chitosan and phospholipid based topical dermal delivery systems customized by our team for the delivery of fusidic acid in burn wound infections on case-to-case basis. However, every coin has two sides. We recommend the integration of in-silico docking techniques with natural biomacromolecules while designing stable, patient friendly and cost effective topical drug delivery systems of fusidic acid for the management of burn wound infection as future opportunities.

Reconstruction of radiation-induced ulcers with free flaps using the perforating vessel as a recipient vessel

BACKGROUND

Free flaps can be options for coverage of radiation ulcers. However, due to radiation damage, it may be hard to find and dissect a reliable recipient vessel for microsurgical anastomosis. When the radiation fields are targeted for deep tissues, superficial tissues may be less affected by radiation. Therefore, damage to perforator vessels near the skin may be lesser than that to the major vessels in deeper structures. We would like to introduce our experiences of using these less injured perforating vessels within or near the wound as recipient vessels for free flap coverage.

PATIENTS AND METHODS

From 2013 to 2015, 11 patients underwent free flap coverage for the treatment of radiation-induced ulceration. The location of ulcers were three cases of thigh, two cases of inguinal area, axilla, trochanteric area, chest wall, lower leg, perineal area, and back. Eleven cases were reconstructed using the anterolateral thigh (ALT) perforator flap, and in one case, the thoracodorsal artery perforator (TDAP) flap was used for inguinal area defect. With preoperative computed tomography, we found perforating vessels around the radiation ulcer. The perforating vessels that were identified before the operation were detected by hand-held Doppler during the operation and meticulous dissection was performed. In all-cases, the perforating vessels were accompanied by vena commitantes. A reliable perforator is one with visible pulsation, strong sound detected on Doppler, and sufficient diameter, preferably larger than 0.6 mm. Anastomosis was performed after confirming that the blood vessel was reliable.

RESULTS

The flap sizes ranged from 7 × 6 cm to 24 × 10 cm. No flap total necrosis developed. Patients were followed in the outpatient clinic for 21 to 31 months postoperatively. No patients experienced recurrence of ulceration during the follow-up.

CONCLUSIONS

In free flap reconstruction of radiation ulcers, using perforating vessels within or outside the ulcer as recipient vessels provided less damaged vessels and healthier flaps for the defects with minimal wound complications. These perforating vessels can be a good option as recipient vessel for free flap coverage of radiation ulcers.

A Histologic Perspective on Electrical and Thermal Burn-Injured Human Skin

OBJECTIVE

To analyze specific spectroscopic (FT-Raman) and thermal (limiting oxygen index) aspects of skin samples exposed to electrical injury compared with thermal injury.

METHODS

An observational case-control study was conducted at the Dr Stanislaw Sakiel Center for Burns Treatment in Siemianowice, Silesia, Poland. A scanning electron microscope was used to diagnose and illustrate the topography of skin samples from electrical and thermal burns and the morphologic effects on damaged versus undamaged skin surfaces. In particular, researchers attempted to detect spectroscopic and thermal changes at the molecular level, namely, specific biomarkers of tissue degeneration and their regeneration under the influence of the applied modifiers (antioxidants and orthosilicic acid solutions).

RESULTS

Modification with L-ascorbic acid and hydrogel of orthosilicic acid caused an increase in the intensity of the amide I Raman peaks, whereas modification with sodium ascorbate and orthosilicic acid resulted in the separation of the band protein side chains (1,440-1,448 cm), which is a part of tissue regeneration. The best result was obtained when the skin was treated with 7% orthosilicic acid (limiting oxygen index, 26%).

CONCLUSIONS

Antioxidant treatment may be advantageous in minimizing injury in patients with thermal burns but not always in electrical burns.

Novel pharmacotherapy for burn wounds: what are the advancements

INTRODUCTION

The prognosis for severe burns has improved significantly over the past 50 years. Meanwhile, burns have become an affliction mainly affecting the less well-developed regions of the world. Early excision and skin grafting has led to major improvements in therapeutic outcomes.

AREAS COVERED

The purpose of this article is to survey the use of pharmacotherapy to treat different pathophysiological complications of burn injury. The author, herein, discusses the use of drug treatments for a number of systemic metabolic disturbances including hyperglycemia, elevated catabolism, and gluconeogenesis.

EXPERT OPINION

Advancements in personalized and molecular medicine will make an impact on burn therapy. Similarities between severe burns and other critically ill patients will lead to cross-fertilization between different medical specialties. Furthermore, advances in stem cells and tissue regeneration will lead to improved healing and less lifelong disability. Indeed, research in new drug therapy for burns is actively progressing for many different complications.