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Yang Y, Chen Q, Fan S, Lu Y, Huang Q, Liu X, Peng X. Glutamine sustains energy metabolism and alleviates liver injury in burn sepsis by promoting the assembly of mitochondrial HSP60-HSP10 complex via SIRT4 dependent protein deacetylation. Redox Rep 2024; 29:2312320. [PMID: 38329114 PMCID: PMC10854458 DOI: 10.1080/13510002.2024.2312320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
Burns and burn sepsis, characterized by persistent and profound hypercatabolism, cause energy metabolism dysfunction that worsens organ injury and systemic disorders. Glutamine (Gln) is a key nutrient that remarkably replenishes energy metabolism in burn and sepsis patients, but its exact roles beyond substrate supply is unclear. In this study, we demonstrated that Gln alleviated liver injury by sustaining energy supply and restoring redox balance. Meanwhile, Gln also rescued the dysfunctional mitochondrial electron transport chain (ETC) complexes, improved ATP production, reduced oxidative stress, and protected hepatocytes from burn sepsis injury. Mechanistically, we revealed that Gln could activate SIRT4 by upregulating its protein synthesis and increasing the level of Nicotinamide adenine dinucleotide (NAD+), a co-enzyme that sustains the activity of SIRT4. This, in turn, reduced the acetylation of shock protein (HSP) 60 to facilitate the assembly of the HSP60-HSP10 complex, which maintains the activity of ETC complex II and III and thus sustain ATP generation and reduce reactive oxygen species release. Overall, our study uncovers a previously unknown pharmacological mechanism involving the regulation of HSP60-HSP10 assembly by which Gln recovers mitochondrial complex activity, sustains cellular energy metabolism and exerts a hepato-protective role in burn sepsis.
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Affiliation(s)
- Yongjun Yang
- Clinical Medical Research Center, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Qian Chen
- Clinical Medical Research Center, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Shijun Fan
- Clinical Medical Research Center, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Yongling Lu
- Clinical Medical Research Center, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Qianyin Huang
- Clinical Medical Research Center, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Xin Liu
- Clinical Medical Research Center, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Xi Peng
- Clinical Medical Research Center, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
- State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), ChongqingPeople’s Republic of China
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Goh M, Du M, Peng WR, Saw PE, Chen Z. Advancing burn wound treatment: exploring hydrogel as a transdermal drug delivery system. Drug Deliv 2024; 31:2300945. [PMID: 38366562 PMCID: PMC10878343 DOI: 10.1080/10717544.2023.2300945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/05/2023] [Indexed: 02/18/2024] Open
Abstract
Burn injuries are prevalent and life-threatening forms that contribute significantly to mortality rates due to associated wound infections. The management of burn wounds presents substantial challenges. Hydrogel exhibits tremendous potential as an ideal alternative to traditional wound dressings such as gauze. This is primarily attributed to its three-dimensional (3D) crosslinked polymer network, which possesses a high water content, fostering a moist environment that supports effective burn wound healing. Additionally, hydrogel facilitates the penetration of loaded therapeutic agents throughout the wound surface, combating burn wound pathogens through the hydration effect and thereby enhancing the healing process. However, the presence of eschar formation on burn wounds obstructs the passive diffusion of therapeutics, impairing the efficacy of hydrogel as a wound dressing, particularly in cases of severe burns involving deeper tissue damage. This review focuses on exploring the potential of hydrogel as a carrier for transdermal drug delivery in burn wound treatment. Furthermore, strategies aimed at enhancing the transdermal delivery of therapeutic agents from hydrogel to optimize burn wound healing are also discussed.
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Affiliation(s)
- MeeiChyn Goh
- Institute of Medical Imaging, Hengyang Medical School, University of South China, Hengyang, China
| | - Meng Du
- Institute of Medical Imaging, Hengyang Medical School, University of South China, Hengyang, China
| | - Wang Rui Peng
- Institute of Medical Imaging, Hengyang Medical School, University of South China, Hengyang, China
- The Seventh Affiliated Hospital, Hunan Veterans Administration Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Phei Er Saw
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Nanhai Translational Innovation Center of Precision Immunology, Sun Yat-Sen Memorial Hospital, Foshan, China
| | - Zhiyi Chen
- Institute of Medical Imaging, Hengyang Medical School, University of South China, Hengyang, China
- The Seventh Affiliated Hospital, Hunan Veterans Administration Hospital, Hengyang Medical School, University of South China, Changsha, China
- The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
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Chouinard NH, Beaudoin Cloutier C, Chang SL, Savoie-White FH, Lachapelle P, Lantagne N, Laberge M, Poder TG, Guertin JR. The economic burden of burned patients for hospitalization in Canada. Burns 2024; 50:1494-1503. [PMID: 38627164 DOI: 10.1016/j.burns.2024.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 03/21/2024] [Accepted: 03/31/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Burn injuries pose a significant burden on both patients and healthcare systems. Yet, costs arising from the consumption of resources by these patients are rarely examined in Canada. OBJECTIVE The objective of this study was to assess real-world costs resulting from the initial hospitalization of patients admitted to a major burn unit in Quebec, Canada. METHODS A cost study based on a retrospective cohort was undertaken using in-hospital economic data matched to hospital chart data. Our cohort included all burn-injured patients admitted between April 1, 2017, and March 31, 2021, to the hospital's major burn unit during their initial hospitalization. Descriptive statistics were tabulated for sociodemographic and economic data. Costing data were analyzed unstratified and stratified according to burn severity (i.e., ≥ 20% of total body surface area [TBSA] vs. < 20%). Costs were presented in CAD 2021. RESULTS Our cohort included 362 patients, including 65 (18%) with TBSA ≥ 20%. The average initial hospitalization cost was $32,360 ($22,783 for < 20% TBSA and $76,121 for ≥ 20% TBSA). CONCLUSION Findings reveal that the total cost of the initial hospitalization, from a public hospital perspective, was $11,714,348. Our study underlines the substantial burden associated with burns and highlights the need for long-term cost evaluations.
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Affiliation(s)
- Naomi Hope Chouinard
- Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Canada; Centre de recherche du CHU de Québec-Université Laval, Canada; Centre de recherche en organogénèse expérimentale de l'Université Laval/LOEX, Canada
| | - Chanel Beaudoin Cloutier
- Centre de recherche du CHU de Québec-Université Laval, Canada; Centre de recherche en organogénèse expérimentale de l'Université Laval/LOEX, Canada; Département de chirurgie, Faculté de médecine, Université Laval, Canada
| | - Sue-Ling Chang
- Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Canada; Centre de recherche du CHU de Québec-Université Laval, Canada
| | - Félix H Savoie-White
- Centre de recherche du CHU de Québec-Université Laval, Canada; Département de chirurgie, Faculté de médecine, Université Laval, Canada; CHU de Québec-Université Laval, Canada
| | | | | | - Maude Laberge
- Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Canada; Centre de recherche du CHU de Québec-Université Laval, Canada; Vitam, Centre de recherche en santé durable - Université Laval, Canada
| | - Thomas G Poder
- Département de Gestion, Évaluation et Politique de Santé, École de Santé Publique de l'Université de Montréal, Canada; Centre de recherche de l'IUSMM, CIUSSS de l'Est de l'Île de Montréal, Canada
| | - Jason Robert Guertin
- Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Canada; Centre de recherche du CHU de Québec-Université Laval, Canada; Centre de recherche en organogénèse expérimentale de l'Université Laval/LOEX, Canada.
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Walker SB, Clack JE, Dwyer TA. An integrative literature review of factors contributing to hypothermia in adults during the emergent (ebb) phase of a severe burn injury. Burns 2024; 50:1389-1405. [PMID: 38627163 DOI: 10.1016/j.burns.2024.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 03/08/2024] [Accepted: 03/31/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND During the emergent (ebb) phase (first 72 h), the adult person with a severe burn experiences loss of body heat, decreased metabolism, and poor tissue perfusion putting them at risk of hypothermia, increased morbidity, and mortality. Therefore, timely and targeted care is imperative. AIM The aim of this integrative literature review was to develop a framework of the factors contributing to hypothermia in adults with a severe burn injury during the emergent (ebb) phase. METHODS An integrative review of research literature was undertaken as it provides an orderly process in the sourcing and evaluation of the literature. Only peer reviewed research articles, published in scholarly journals were selected for inclusion (n = 26). Research rigor and quality for each research article was determined using JBI Global appraisal tools relevant to the methodology of the selected study. FINDINGS Contributing factors were classified under three key themes: Individual, Pre-hospital, and In-hospital factors. CONCLUSION The structured approach enabled the development of an evidence-based framework identifying factors contributing to hypothermia in adults with a severe burn injury during the emergent (ebb) phase and adds knowledge to improve standardized care of the adult person with a severe burn injury.
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Affiliation(s)
- Sandra B Walker
- School of Nursing, Midwifery and Social Sciences Central Queensland University Bruce Highway Rockhampton, Queensland 4702, Australia.
| | - Jessica E Clack
- Ramsay Health Peninsula Private Hospital, Langwarrin, Victoria, Australia
| | - Trudy A Dwyer
- Appleton Institute - Central Queensland University, Australia
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Taramian S, Joukar F. Reported outcomes by using the online patient reported outcome measures. Burns 2024; 50:1707-1708. [PMID: 38704316 DOI: 10.1016/j.burns.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 03/05/2024] [Indexed: 05/06/2024]
Affiliation(s)
- Sonbol Taramian
- Department of Internal Medicine, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Farahnaz Joukar
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran.
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Hoisington AJ, Choy K, Khair S, Dyamenahalli KU, Najarro KM, Wiktor AJ, Frank DN, Burnham EL, McMahan RH, Kovacs EJ. Recent alcohol intake impacts microbiota in adult burn patients. Alcohol 2024; 118:25-35. [PMID: 38604285 DOI: 10.1016/j.alcohol.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/26/2024] [Accepted: 04/04/2024] [Indexed: 04/13/2024]
Abstract
Alcohol use is associated with an increased incidence of negative health outcomes in burn patients due to biological mechanisms that include a dysregulated inflammatory response and increased intestinal permeability. This study used phosphatidylethanol (PEth) in blood, a direct biomarker of recent alcohol use, to investigate associations between a recent history of alcohol use and the fecal microbiota, short chain fatty acids, and inflammatory markers in the first week after a burn injury for nineteen participants. Burn patients were grouped according to PEth levels of low or high and differences in the overall fecal microbial community were observed between these cohorts. Two genera that contributed to the differences and had higher relative abundance in the low PEth burn patient group were Akkermansia, a mucin degrading bacteria that improves intestinal barrier function, and Bacteroides, a potentially anti-inflammatory bacteria. There was no statistically significant difference between levels of short chain fatty acids or intestinal permeability across the two groups. To our knowledge, this study represents the first report to evaluate the effects of burn injury and recent alcohol use on early post burn microbiota dysbiosis, inflammatory response, and levels of short chain fatty acids. Future studies in this field are warranted to better understand the factors associated with negative health outcomes and develop interventional trials.
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Affiliation(s)
- Andrew J Hoisington
- Veterans Health Administration, Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC) for Veteran Suicide Prevention, Rocky Mountain Regional Veterans Affairs Medical Center (RMRVAMC), Aurora, CO, USA; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, CO, USA; Department of Systems Engineering and Management, Air Force Institute of Technology, Wright-Patterson Air Force Base, OH, USA
| | - Kevin Choy
- Department of Surgery, Division of GI, Trauma, and Endocrine Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Shanawaj Khair
- Department of Surgery, Division of GI, Trauma, and Endocrine Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Graduate Program in Molecular Biology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kiran U Dyamenahalli
- Department of Surgery, Division of GI, Trauma, and Endocrine Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kevin M Najarro
- Department of Surgery, Division of GI, Trauma, and Endocrine Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Veterans Health Administration, Eastern Colorado Health Care System, Rocky Mountain Regional Veterans Affairs Medical Center (RMRVAMC), Aurora, CO, USA
| | - Arek J Wiktor
- Department of Surgery, Division of GI, Trauma, and Endocrine Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Daniel N Frank
- GI and Liver Innate Immune Program, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA; Department of Medicine, Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ellen L Burnham
- Department of Medicine, Division of Infectious Diseases, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA; Alcohol Research Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Rachel H McMahan
- Department of Surgery, Division of GI, Trauma, and Endocrine Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Veterans Health Administration, Eastern Colorado Health Care System, Rocky Mountain Regional Veterans Affairs Medical Center (RMRVAMC), Aurora, CO, USA
| | - Elizabeth J Kovacs
- Veterans Health Administration, Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC) for Veteran Suicide Prevention, Rocky Mountain Regional Veterans Affairs Medical Center (RMRVAMC), Aurora, CO, USA; Department of Surgery, Division of GI, Trauma, and Endocrine Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Graduate Program in Molecular Biology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Veterans Health Administration, Eastern Colorado Health Care System, Rocky Mountain Regional Veterans Affairs Medical Center (RMRVAMC), Aurora, CO, USA; Alcohol Research Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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Wang C, Deng Y, Yao Y, Tan H. Demoralization syndrome in burn patients: A cross-sectional study. Burns 2024; 50:1640-1651. [PMID: 38555238 DOI: 10.1016/j.burns.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/08/2024] [Accepted: 02/21/2024] [Indexed: 04/02/2024]
Abstract
AIMS To investigate the status of demoralization syndrome and the factors affecting demoralization in burn patients. METHODS This study employed a cross-sectional research design and utilized a face-to-face questionnaire to gather data from adult burn patients with burn depths classified as second-degree or higher. The Demoralization Scale Mandarin Version, the Perceived Social Support Scale, the Herth Hope Index, and the Medical Coping Method Questionnaire were used to assess the level of demoralization, perceived social support, sense of hope, and coping strategies, respectively. General information, including socio-demographic data and disease characteristics, were collected. The patients' level of demoralization was categorized as the mean ± 1 standard deviation of the DS-MV scores. The data was analyzed using IBM SPSS 26.0 software to explore the relationship between the variables. RESULTS This study included 381 burn patients with a mean DS-MV score of 34.62 ± 18.319. Of these, 66 (17.3%) had mild demoralization, 241 (63.3%) had moderate demoralization, and 74 (19.4%) had severe demoralization. Cause of burn, total burn area, average monthly income of the individual, occupation, sense of hope, perceived social support, and medical coping strategies were the important factors associated with the severity of demoralization in burn patients. CONCLUSIONS Patients with burn injuries exhibit a notable prevalence and severity of demoralization indicating focused attention. By considering associated risk factors, healthcare professionals can devise and execute tailored intervention strategies aimed at mitigating the occurrence and intensity of demoralization in burn patients.
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Affiliation(s)
- Chang Wang
- School of Nursing, Guizhou Medical University, No. 9 Beijing Road, Yunyan District, Guiyang, China
| | - YunYun Deng
- School of Nursing, Guizhou Medical University, No. 9 Beijing Road, Yunyan District, Guiyang, China
| | - YiMing Yao
- Department of Nursing, Guangzhou Red Cross Hospital, Jinan University, No. 396, Tongfu Middle Road, Haizhu District, Guangzhou, China
| | - HuiYi Tan
- School of Nursing, Guizhou Medical University, No. 9 Beijing Road, Yunyan District, Guiyang, China; Department of Nursing, Guangzhou Red Cross Hospital, Jinan University, No. 396, Tongfu Middle Road, Haizhu District, Guangzhou, China.
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Cuijpers MD, Baartmans MGA, Joosten KFM, Dulfer K, van Zuijlen PPM, Ket JCF, Pijpe A. The efficacy of therapeutic interventions on paediatric burn patients' height, weight, body composition, and muscle strength: A systematic review and meta-analysis. Burns 2024; 50:1437-1455. [PMID: 38580580 DOI: 10.1016/j.burns.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 02/22/2024] [Accepted: 03/07/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVE To evaluate the efficacy of therapeutic interventions on pediatric burn patients' height, weight, body composition, and muscle strength. METHODS A systematic literature search was conducted in PubMed, Embase, and Web of Science up to March 2021. Eligible interventional studies reported metrics on the height, weight, body composition, or muscle strength of pediatric burn patients in a peer-reviewed journal. Meta-analyses were performed if ≥ 2 trials of clinical homogeneity reported on an outcome measure at the same time point post-burn. RESULTS Twenty-six interventional studies were identified, including twenty-two randomised controlled trials and four non-randomised trials. Most studies were conducted by a single institution. On average, the burn covered 45.3% ( ± 9.9) of the total body surface area. Three categories of interventions could be distinguished: rehabilitative exercise programs, pharmacologic agents, and nutrition support. CONCLUSIONS Each of the interventions had a positive effect on height, weight, body composition, or muscle strength. The decision to initiate an intervention should be made on a case-by-case basis following careful consideration of the benefits and risks. In future research, it is important to evaluate the heterogeneity of intervention effects and whether participation in an intervention allowed pediatric burn patients to reach the physical and functional status of healthy peers.
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Affiliation(s)
- Maxime D Cuijpers
- Burn Center, Red Cross Hospital, Vondellaan 13, 1942 LE Beverwijk, the Netherlands; Plastic, Reconstructive and Hand Surgery, Amsterdam UMC -Location VU University Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Tissue Function and Regeneration, Amsterdam Movement Sciences, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Association of Dutch Burn Centers, Zeestraat 27-29, 1941 AJ Beverwijk, the Netherlands.
| | - Martin G A Baartmans
- Department of Pediatrics, Maasstad Hospital, Maasstadweg 21, 3079 DZ Rotterdam, the Netherlands
| | - Koen F M Joosten
- Department of Pediatric and Neonatal Intensive Care, Erasmus MC-Sophia Children's Hospital, Dr. Molewaterplein 60, 3015 GJ Rotterdam, the Netherlands
| | - Karolijn Dulfer
- Department of Pediatric and Neonatal Intensive Care, Erasmus MC-Sophia Children's Hospital, Dr. Molewaterplein 60, 3015 GJ Rotterdam, the Netherlands
| | - Paul P M van Zuijlen
- Burn Center, Red Cross Hospital, Vondellaan 13, 1942 LE Beverwijk, the Netherlands; Plastic, Reconstructive and Hand Surgery, Amsterdam UMC -Location VU University Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Tissue Function and Regeneration, Amsterdam Movement Sciences, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Department of Plastic Surgery, Reconstructive and Hand Surgery, Red Cross Hospital, Vondellaan 13, 1942 LE Beverwijk, the Netherlands; Pediatric Surgical Centre, Emma Children's Hospital, Amsterdam University Medical Center - Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Johannes C F Ket
- Medical Library, VU University, de Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - Anouk Pijpe
- Burn Center, Red Cross Hospital, Vondellaan 13, 1942 LE Beverwijk, the Netherlands; Plastic, Reconstructive and Hand Surgery, Amsterdam UMC -Location VU University Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Tissue Function and Regeneration, Amsterdam Movement Sciences, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Association of Dutch Burn Centers, Zeestraat 27-29, 1941 AJ Beverwijk, the Netherlands.
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Blears E, Kuo SCE, Tiongco RFP, Suresh R, Cooney CM, Caffrey J. Associations of urban versus rural patient residence on outcomes after burn: A national inpatient sample database study. Burns 2024; 50:1463-1474. [PMID: 38584006 DOI: 10.1016/j.burns.2024.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 02/06/2024] [Accepted: 03/13/2024] [Indexed: 04/09/2024]
Abstract
INTRODUCTION Burn patients in rural areas may encounter poorer outcomes associated with barriers to care; however, residence has not been studied in a large sample. The association between rural-versus-urban residence and outcomes after burn was examined using the National Inpatient Sample (NIS) database. METHODS Using the 2019 NIS database, patients over 18 years with a primary diagnosis of burn or corrosive injury were included. Level of urbanization was categorized into six groups. Outcomes after burn such as in-hospital mortality, multifactorial shock, prolonged mechanical ventilation, length of stay, and total costs were analyzed after adjusting for demographic factors and hospital characteristics. RESULTS We included 4671 records, which represented a weighted population of 23,085 patients. Rural residence was associated with higher percentage of prior transfer but not in-hospital mortality. Compared to the most urbanized counties, encounters from the most rural counties were associated with higher odds of shock (aOR:2.62, 99% CI: 1.04-6.56, p = 0.007). CONCLUSION Burn encounters from less urbanized counties did not experience differences in mortality, rates of skin grafting, prolonged mechanical ventilation, length of stay, or overall costs. However, odds of shock were higher among the least urbanized counties. Despite improved triage and transportation systems across the US, disparities and challenges exist for burn patients from rural residence.
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Affiliation(s)
- Elizabeth Blears
- Bayview Burn Center, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Shih-Chiang Edward Kuo
- Bayview Burn Center, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Rafael Felix P Tiongco
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Rachana Suresh
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Carisa M Cooney
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Julie Caffrey
- Bayview Burn Center, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Yang Y, Zhang J, Wu S, Deng Y, Wang S, Xie L, Li X, Yang L. Exosome/antimicrobial peptide laden hydrogel wound dressings promote scarless wound healing through miR-21-5p-mediated multiple functions. Biomaterials 2024; 308:122558. [PMID: 38581764 DOI: 10.1016/j.biomaterials.2024.122558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/08/2024]
Abstract
Mesenchymal stem cell (MSC)-based therapy is an effective strategy for regenerative therapy. However, safety and ease of use are still issues to be overcome in clinical applications. Exosomes are naturally derived nanoparticles containing bioactive molecules, which serve as ideal cell-free therapeutic modalities. However, issues such as delivery, long-term preservation and activity maintenance of exosomes are other problems that limit their application. In this study, we proposed the use of rapid freeze-dry-thaw macroporous hydrogels for the encapsulation of HucMSC-derived exosomes (HucMSC-Exos) combined with an antimicrobial peptide coating. This exosome-encapsulated hyaluronic acid macroporous hydrogel HD-DP7/Exo can achieve long-term storage and transport by lyophilization and can be rapidly redissolved for treatment. After comprehensively comparing the therapeutic effects of HucMSC-Exos and HucMSC-loaded hydrogels, we found that HucMSC-Exos could also effectively regulate fibroblasts, vascular endothelial cells, and macrophages and inhibit myofibroblast-mediated fibrosis, thus promoting tissue regeneration and inhibiting scar formation in a mouse model of deep second-degree burn infection healing. These properties of lyophilized storage and whole-process-repair make HD-DP7/Exo have potential application value and application prospects.
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Affiliation(s)
- YuLing Yang
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - JiaNi Zhang
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - SiWen Wu
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yu Deng
- Hangzhou Wutong Tree Pharmaceutical Co., Ltd., Hangzhou, 310018, China
| | - ShiHan Wang
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Li Xie
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - XiaoPeng Li
- Hangzhou Wutong Tree Pharmaceutical Co., Ltd., Hangzhou, 310018, China.
| | - Li Yang
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Kruse M, Liesenborghs KE, Josuttis D, Plettig P, Guembel D, Lenz IK, Guethoff C, Gebhardt V, Schmittner MD. Early Autocalibrated Arterial Waveform Analysis for the Management of Burn Shock-A Cohort Study. J Intensive Care Med 2024; 39:655-664. [PMID: 38173245 DOI: 10.1177/08850666231224388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Adequate fluid therapy is crucial for resuscitation after major burns. To adapt this to individual patient demands, standard is adjustment of volume to laboratory parameters and values of enhanced hemodynamic monitoring. To implement calibrated parameters, patients must have reached the intensive care unit (ICU). The aim of this study was, to evaluate the use of an auto-calibrated enhanced hemodynamic monitoring device to improve fluid management before admission to ICU. We used PulsioflexProAqt® (Getinge) during initial treatment and burn shock resuscitation. Analysis was performed regarding time of measurement, volume management, organ dysfunction, and mortality. We conducted a monocentre, prospective cohort study of 20 severely burned patients, >20% total body surface area (TBSA), receiving monitoring immediately after admission. We compared to 57 patients, matched in terms of TBSA, age, sex, and existence of inhalation injury out of a retrospective control group, who received standard care. Hemodynamic measurement with autocalibrated monitoring started significantly earlier: 3.75(2.67-6.0) hours (h) after trauma in the study group versus 13.6(8.1-17.5) h in the control group (P < .001). Study group received less fluid after 6 h: 1.7(1.2-2.2) versus 2.3(1.6-2.8) ml/TBSA%/kg, P = .043 and 12 h: 3.0(2.5-4.0) versus 4.2(3.1-5.0) ml/TBSA%/kg, P = .047. Dosage of norepinephrine was higher after 18 h in the study group: 0.20(0.12-0.3) versus 0.08(0.02-0.18) µg/kg/min, P = .014. The study group showed no adult respiratory distress syndrome versus 21% in the control group, P = .031. There was no difference in other organ failures, organ replacement therapy, and mortality. The use of auto-calibrated enhanced hemodynamic monitoring is a fast and feasible way to guide early fluid therapy after burn trauma. It reduces the time to reach information about patient's volume capacity. Management of fluid application changed to a more restrictive fluid use in the early period of burn shock and led to a reduction of pulmonary complications.
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Affiliation(s)
- Marianne Kruse
- Department of Anesthesiology, Intensive Care and Pain Medicine, BG Klinikum Unfallkrankenhaus Berlin, Berlin, DE, Germany
| | - Konrad Ernst Liesenborghs
- Department of Anesthesiology, Intensive Care and Pain Medicine, BG Klinikum Unfallkrankenhaus Berlin, Berlin, DE, Germany
| | - David Josuttis
- Department of Anesthesiology, Intensive Care and Pain Medicine, BG Klinikum Unfallkrankenhaus Berlin, Berlin, DE, Germany
| | - Philip Plettig
- Department of Anesthesiology, Intensive Care and Pain Medicine, BG Klinikum Unfallkrankenhaus Berlin, Berlin, DE, Germany
| | - Denis Guembel
- Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, DE, Germany
- Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, DE, Germany
| | - Ida Katinka Lenz
- Department of Anesthesiology, Intensive Care and Pain Medicine, BG Klinikum Unfallkrankenhaus Berlin, Berlin, DE, Germany
| | - Claas Guethoff
- Centre for Clinical Research, Biostatistics, BG Klinikum Unfallkrankenhaus Berlin, Berlin, DE, Germany
| | - Volker Gebhardt
- Department of Anesthesiology, Intensive Care and Pain Medicine, BG Klinikum Unfallkrankenhaus Berlin, Berlin, DE, Germany
| | - Marc Dominik Schmittner
- Department of Anesthesiology, Intensive Care and Pain Medicine, BG Klinikum Unfallkrankenhaus Berlin, Berlin, DE, Germany
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12
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Katiyar S, Tripathi AD, Singh RK, Kumar Chaurasia A, Srivastava PK, Mishra A. Graphene-silymarin-loaded chitosan/gelatin/hyaluronic acid hybrid constructs for advanced full-thickness burn wound management. Int J Pharm 2024; 659:124238. [PMID: 38768692 DOI: 10.1016/j.ijpharm.2024.124238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/01/2024] [Accepted: 05/15/2024] [Indexed: 05/22/2024]
Abstract
Burn wounds (BWs) with extensive blood loss, along with bacterial infections and poor healing, may become detrimental and pose significant rehabilitation obstacles in medical facilities. Therefore, the freeze-drying method synthesized novel hemocompatible chitosan, gelatin, and hyaluronic acid infused with graphene oxide-silymarin (CGH-SGO) hybrid constructs for application as a BW patch. Most significantly, synthesized hybrid constructs exhibited an interconnected-porous framework with precise pore sizes (≈118.52 µm) conducive to biological functions. Furthermore, the FTIR and XRD analyses document the constructs' physiochemical interactions. Similarly, enhanced swelling ratios, adequate WVTR (736 ± 78 g m-2 hr-1), and bio-degradation rates were seen during the physiological examination of constructs. Following the in vitro investigations, SMN-GO added to constructs improved their anti-bacterial (against E.coli and S. aureus), anti-oxidant, hemocompatible, and bio-compatible characteristics in conjunction with prolonged drug release. Furthermore, in vivo, implanting constructs on wounds exhibited significant acceleration in full-thickness burn wound (FT-BW) healing on the 14th day (CGH-SGO: 95 ± 2.1 %) in contrast with the control (Gauze: 71 ± 4.2 %). Additionally, contrary to gauze, the in vivo rat tail excision model administered with constructs assured immediate blood clotting. Therefore, CGH-SGO constructs with an improved porous framework, anti-bacterial activity, hemocompatibility, and biocompatibility could represent an attractive option for healing FT-BWs.
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Affiliation(s)
- Soumya Katiyar
- School of Biochemical Engineering, Indian Institute of Technology (Banaras Hindu University), Varanasi 221005, India
| | - Abhay Dev Tripathi
- School of Biochemical Engineering, Indian Institute of Technology (Banaras Hindu University), Varanasi 221005, India
| | - Ritika K Singh
- School of Biotechnology, Institute of Science, Banaras Hindu University, Varanasi 221005, India
| | - Avinash Kumar Chaurasia
- School of Biotechnology, Institute of Science, Banaras Hindu University, Varanasi 221005, India
| | - Pradeep K Srivastava
- School of Biochemical Engineering, Indian Institute of Technology (Banaras Hindu University), Varanasi 221005, India
| | - Abha Mishra
- School of Biochemical Engineering, Indian Institute of Technology (Banaras Hindu University), Varanasi 221005, India.
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13
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Liu H, Yang D, Jia R, Wang W, Shang J, Liu Q, Liang Y. Dynamic optical coherence elastography for skin burn assessment: A preliminary study on mice model. JOURNAL OF BIOPHOTONICS 2024:e202400028. [PMID: 38877699 DOI: 10.1002/jbio.202400028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/03/2024] [Accepted: 04/28/2024] [Indexed: 06/16/2024]
Abstract
Skin burns that include tissue coagulation necrosis imply variations in stiffness. Dynamic phase-sensitive optical coherence elastography (OCE) is used to evaluate the stiffness of burned skin nondestructively in this paper. The homemade dynamic OCE was initially verified through tissue-mimicking phantom experiments regarding Rayleigh wave speed. After being burned with a series of temperatures and durations, the corresponding structure and stiffness variations of mice skin were demonstrated by histological images, optical coherence tomography B-scans, and OCE elastic wave speed maps. The results clearly displayed the variation in elastic properties and stiffness of the scab edge extending in the lateral direction. Statistical analysis revealed that murine skin burned at temperatures exceeding 100°C typically exhibited greater stiffness than skin burned at temperatures below 100°C. The dynamic OCE technique shows potential application for incorporating elasticity properties as a biomechanical extension module to diagnose skin burn injuries.
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Affiliation(s)
- Heng Liu
- Institute of Modern Optics, Tianjin Key Laboratory of Micro-scale Optical Information Science and Technology, Nankai University, Tianjin, China
| | - Di Yang
- Institute of Modern Optics, Tianjin Key Laboratory of Micro-scale Optical Information Science and Technology, Nankai University, Tianjin, China
| | - Renfei Jia
- Institute of Modern Optics, Tianjin Key Laboratory of Micro-scale Optical Information Science and Technology, Nankai University, Tianjin, China
| | - Weike Wang
- Institute of Modern Optics, Tianjin Key Laboratory of Micro-scale Optical Information Science and Technology, Nankai University, Tianjin, China
| | - Jianwei Shang
- Department of Oral Pathology, Tianjin Stomatological Hospital, Hospital of Stomatology, Nankai University, Tianjin, China
| | - Quanzhong Liu
- Department of Dermatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yanmei Liang
- Institute of Modern Optics, Tianjin Key Laboratory of Micro-scale Optical Information Science and Technology, Nankai University, Tianjin, China
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14
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Godoi MM, Reis EM, Koepp J, Ferreira J. Perspective from developers: Tissue-engineered products for skin wound healing. Int J Pharm 2024:124319. [PMID: 38866084 DOI: 10.1016/j.ijpharm.2024.124319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/24/2024] [Accepted: 06/05/2024] [Indexed: 06/14/2024]
Abstract
Tissue-engineered products (TEPs) are at the forefront of developmental medicines, precisely where monoclonal antibodies and recombinant cytokines were 30 years ago. TEPs development for treating skin wounds has become a fast-growing field as it offers the potential to find novel therapeutic approaches for treating pathologies that currently have limited or no effective alternatives. This review aims to provide the reader with the process of translating an idea from the laboratory bench to clinical practice, specifically in the context of TEPs designing for skin wound healing It encompasses historical perspectives, approved therapies, and offers a distinctive insight into the regulatory framework in Brazil. We explore the essential guidelines for quality testing, and nonclinical proof-of-concept considering the Brazilian Network of Experts in Advanced Therapies (RENETA) and International Standards and Guidelines (ICH e ISO). Adopting a multifaceted approach, our discussion encompasses scientific and industrial perspectives, addressing quality, biosafety, non-clinical viability, clinical trial and real-word data for pharmacovigilance demands. This comprehensive analysis presents a panoramic view of the development of skin TEPs, offering insights into the evolving landscape of this dynamic and promising field.
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Affiliation(s)
- Manuella Machado Godoi
- Graduate Program in Pharmacology, Center of Biological Sciences, Federal University of Santa Catarina- UFSC, Florianópolis, SC, Brazil.
| | - Emily Marques Reis
- Department of Chemical and Food Engineering, Federal University of Santa Catarina- UFSC, Florianópolis, SC, Brazil; Biocelltis Biotecnologia, Florianópolis, SC, Brazil
| | - Janice Koepp
- Biocelltis Biotecnologia, Florianópolis, SC, Brazil
| | - Juliano Ferreira
- Graduate Program in Pharmacology, Center of Biological Sciences, Federal University of Santa Catarina- UFSC, Florianópolis, SC, Brazil.
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15
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Aizaz A, Nawaz MH, Ismat MS, Zahid L, Zahid S, Ahmed S, Abbas M, Vayalpurayil T, Rehman MAU. Development and characterization of polyethylene oxide and guar gum-based hydrogel; a detailed in-vitro analysis of degradation and drug release kinetics. Int J Biol Macromol 2024; 273:132824. [PMID: 38857736 DOI: 10.1016/j.ijbiomac.2024.132824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 05/09/2024] [Accepted: 05/30/2024] [Indexed: 06/12/2024]
Abstract
Herein, we synthesized hydrogel films from crosslinked polyethylene oxide (PEO) and guar gum (GG) which can offer hydrophilicity, antibacterial efficacy, and neovascularization. This study focuses on synthesis and material/biological characterization of rosemary (RM) and citric acid (CA) loaded PEO/GG hydrogel films. Scanning Electron Microscopy images confirmed the porous structure of the developed hydrogel film matrix (PEO/GG) and the dispersion of RM and CA within it. This porous structure promotes moisture adsorption, cell attachment, proliferation, and tissue layer formation. Fourier Transform Infrared Spectroscopy (FTIR) further validated the crosslinking of the PEO/GG matrix, as confirmed by the appearance of C-O-C linkage in the FTIR spectrum. PEO/GG and PEO/GG/RM/CA revealed similar degradation and release kinetics in Dulbecco's Modified Eagle Medium, Simulated Body Fluid, and Phosphate Buffer Saline (degradation of ∼55 % and release of ∼60 % RM in 168 h.). The developed hydrogel film exhibited a zone of inhibition against Escherichia. coli (2 mm) and Staphylococcus. aureus (9 mm), which can be attributed to the presence of RM in the hydrogel film. Furthermore, incorporating CA in the hydrogel film promoted neovascularization, as confirmed by the Chorioallantoic Membrane Assay. The developed RM and CA-loaded PEO/GG-based hydrogel films offered suitable in-vitro properties that may aid in potential wound healing applications.
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Affiliation(s)
- Aqsa Aizaz
- Centre of Excellence in Biomaterials and Tissue Engineering, Department of Materials Science and Engineering Government College University Lahore, 54000, Pakistan
| | - Muhammad Haseeb Nawaz
- Department of Materials Science & Engineering, Institute of Space Technology Islamabad, 1, Islamabad Highway, Islamabad, 44000, Pakistan
| | - Muhammad Sameet Ismat
- Department of Materials Science & Engineering, Institute of Space Technology Islamabad, 1, Islamabad Highway, Islamabad, 44000, Pakistan
| | - Laiba Zahid
- Department of Materials Science & Engineering, Institute of Space Technology Islamabad, 1, Islamabad Highway, Islamabad, 44000, Pakistan
| | - Sidra Zahid
- Department of Materials Science & Engineering, Institute of Space Technology Islamabad, 1, Islamabad Highway, Islamabad, 44000, Pakistan
| | - Sheraz Ahmed
- Department of Materials Science & Engineering, Institute of Space Technology Islamabad, 1, Islamabad Highway, Islamabad, 44000, Pakistan
| | - Mohamed Abbas
- Central Labs, King Khalid University, AlQura'a, Abha, P.O. Box 960, Saudi Arabia; Electrical Engineering Department, College of Engineering, King Khalid University, Abha 61421, Saudi Arabia
| | - Thafasalijyas Vayalpurayil
- Central Labs, King Khalid University, AlQura'a, Abha, P.O. Box 960, Saudi Arabia; Electrical Engineering Department, College of Engineering, King Khalid University, Abha 61421, Saudi Arabia
| | - Muhammad Atiq Ur Rehman
- Centre of Excellence in Biomaterials and Tissue Engineering, Department of Materials Science and Engineering Government College University Lahore, 54000, Pakistan; Department of Materials Science & Engineering, Institute of Space Technology Islamabad, 1, Islamabad Highway, Islamabad, 44000, Pakistan.
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16
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Turner E, Kelly C, Zuccaro J, Chakera H, Gus E, Fish JS. Assessing Pediatric Burn Wound Infection Using a Point-of-Care Fluorescence Imaging Device. J Burn Care Res 2024:irae046. [PMID: 38833179 DOI: 10.1093/jbcr/irae046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
Wound infection is the most common complication among pediatric burn patients. When not treated promptly, burn wound infection may lead to delayed healing, failure of skin grafts, or death. Standard burn wound assessment includes inspection for visual signs and symptoms of infection (VSSI) and microbial sampling. To aid in the assessment of burn wound infection, the MolecuLight, a point-of-care autofluorescence imaging device, was introduced at our pediatric burn program in 2020. The MolecuLight uses violet light to illuminate the wound bed, causing clinically relevant quantities of 29 different species of bacteria (>104 CFU/g) to fluoresce in real time. The objectives of this study were to evaluate the role of the MolecuLight in the management of pediatric burn wounds and determine if the findings from the MolecuLight corresponded to VSSI and/or microbial sampling. A retrospective review of patients 0-18 years who had burn wounds assessed with the MolecuLight between November 1, 2020 and June 8, 2023 was conducted. Data were extracted from the medical records of 178 eligible patients with 218 wounds imaged with the device. Fluorescence corresponded with VSSI in 81% of wounds and microbial findings in 82% of wounds. MolecuLight fluorescence, in combination with VSSI, improved sensitivity for detecting wound infections by 39% and decreased specificity by 19% compared to visual signs and symptoms in isolation. Incorporation of the MolecuLight in standard burn wound assessments can improve the detection of infections, which may promote improved wound healing outcomes and antimicrobial stewardship.
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Affiliation(s)
- Evan Turner
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Charis Kelly
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Jennifer Zuccaro
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Hawwa Chakera
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Eduardo Gus
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Joel S Fish
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, ON M5S 1A1, Canada
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17
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Appelbaum RD, Farrell MS, Gelbard RB, Hoth JJ, Jawa RS, Kirsch JM, Mandell S, Nohra EA, Rinderknecht T, Rowell S, Cuschieri J, Stein DM. Antibiotic prophylaxis in injury: an American Association for the Surgery of Trauma Critical Care Committee clinical consensus document. Trauma Surg Acute Care Open 2024; 9:e001304. [PMID: 38835634 PMCID: PMC11149135 DOI: 10.1136/tsaco-2023-001304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/11/2024] [Indexed: 06/06/2024] Open
Affiliation(s)
- Rachel D Appelbaum
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael S Farrell
- Department of Surgery, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
| | - Rondi B Gelbard
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - J Jason Hoth
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Randeep S Jawa
- Department of Surgery, Stony Brook University, Stony Brook, New York, USA
| | - Jordan M Kirsch
- Department of Surgery, Westchester Medical Center, Valhalla, New York, USA
| | - Samuel Mandell
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Eden A Nohra
- Department of Surgery, University of Colorado, Denver, Colorado, USA
| | | | - Susan Rowell
- Department of Surgery, The University of Chicago Medicine, Chicago, Illinois, USA
| | - Joseph Cuschieri
- Department of Surgery at ZSFG, University of California San Francisco, San Francisco, California, USA
| | - Deborah M Stein
- R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Maryland, USA
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18
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Aviv U, Beylin D, Biros E, Levi Y, Kornhaber R, Cleary M, Shoham Y, Haik J, Harats M. Efficacy of transfer form implementation for adult burn patients between institutions to the Israeli National Burn Center. Burns 2024; 50:1138-1144. [PMID: 38448317 DOI: 10.1016/j.burns.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/15/2024] [Accepted: 02/06/2024] [Indexed: 03/08/2024]
Abstract
Burns are serious injuries associated with significant morbidity and mortality. In Israel, burn patients are often transferred between facilities. However, unstructured and non-standardized transfer processes can compromise the quality of patient care and outcomes. In this retrospective study, we assessed the impact of implementing a transfer form for burn management, comparing two populations: those transferred before and after the transfer form implementation. This study included 47 adult patients; 21 were transferred before and 26 after implementing the transfer form. We observed a statistically significant improvement in reporting rates of crucial information obtained by Emergency Room clinicians and inpatient management indicators. Introducing a standardized transfer form for burn patients resulted in improved communication and enhanced primary management, transfer processes, and emergency room preparation. The burns transfer form facilitated accurate and comprehensive information exchange between clinicians, potentially improving patient outcomes. These findings highlight the importance of structured transfer processes in burn patient care and emphasize the benefits of implementing a transfer form to streamline communication and optimize burn management during transfers to specialized burn centers.
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Affiliation(s)
- Uri Aviv
- Department of Plastic and Reconstructive Surgery, National Burns Center, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel
| | - Dmitry Beylin
- Department of Plastic and Reconstructive Surgery, National Burns Center, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel; Clalit Health Services Management, Israel; Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel
| | - Erik Biros
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia; Townsville University Hospital, Townsville, QLD, Australia
| | - Yossef Levi
- Department of Plastic and Reconstructive Surgery, National Burns Center, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel
| | - Rachel Kornhaber
- Department of Plastic and Reconstructive Surgery, National Burns Center, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel; School of Nursing, Paramedicine and Healthcare Sciences, Charles Sturt, Bathurst, NSW 2795, Australia
| | - Michelle Cleary
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Sydney, NSW 2000, Australia
| | - Yaron Shoham
- Plastic Surgery Department, Burn Unit, Soroka University Medical Center, Israel; Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba 84105, Israel
| | - Josef Haik
- Department of Plastic and Reconstructive Surgery, National Burns Center, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel; Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel; Talpiot Leadership Program, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel; Institute for Health Research, University of Notre Dame, Fremantle, WA 6160, Australia
| | - Moti Harats
- Department of Plastic and Reconstructive Surgery, National Burns Center, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel; Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel; Talpiot Leadership Program, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel; Institute for Health Research, University of Notre Dame, Fremantle, WA 6160, Australia.
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19
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Li S, Zhao C, Shang G, Xie JL, Cui L, Zhang Q, Huang J. α-ketoglutarate preconditioning extends the survival of engrafted adipose-derived mesenchymal stem cells to accelerate healing of burn wounds. Exp Cell Res 2024; 439:114095. [PMID: 38759745 DOI: 10.1016/j.yexcr.2024.114095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 05/09/2024] [Accepted: 05/13/2024] [Indexed: 05/19/2024]
Abstract
The application of adipose-derived stem cells (ADSCs) in treating hard-to-heal wounds has been widely accepted, while the short-term survival rate remains an obstacle in stem cell therapy. The aim of this study is to investigate the effect of preconditioning ADSCs with α-ketoglutarate (α-KG) on the healing of acid burn wounds and cell survival within wounds. Preconditioning of ADSCs was performed by treating cells at passage 3 with 3.5 mM DM-αKG for 24 h. Proliferation and migration of ADSCs was examined. An acid burn wound was created on the dorsal skin of mice. Cell suspension of ADSCs (2 × 106 cells/ml), either pre-treated with α-KG or not, was injected subcutaneously around the margin of wound. At 1,4,7,10,14 days after injection, the percentage of wound closure was evaluated. Expression of pro-angiogenic factors, matrix molecules and HIF1-α in pretreated ADSCs or in wounds was evaluated by qRT-PCR and immunohistochemistry staining, respectively. The survival rate of DiO-labelled ADSCs was determined with the in vivo bioluminescent imaging system. Treating with α-KG induced an enhancement in migration of ADSCs, while their proliferation was not affected. Expression of Vegf and Fgf-2 was significantly increased. With injection of pretreated ADSCs, healing of wounds was remarkably accelerated, along with increased ECM deposition and microvessel density. Moreover, pretreatment with α-KG resulted a prolonged survival of engrafted ADSCs was observed. Expression of HIF-1α was significantly increased in ADSCs treated with α-KG and in wounds injected with preconditioned ADSCs. Our results revealed that healing of acid burn wound was accelerated with administration of ADSCs pretreated with α-KG, which induced elevated expression of HIF-1α and prolonged survival of engrafted stem cells.
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Affiliation(s)
- Shuaijun Li
- Department of Reconstructive and Regenerative Surgery, Shanghai Tongji Hospital Tongji University School of Medicine, Shanghai, China; Department of Stem Cells and Regenerative Medicine, Tongji University School of Medicine, Shanghai, China
| | - Cheng Zhao
- Department of Reconstructive and Regenerative Surgery, Shanghai Tongji Hospital Tongji University School of Medicine, Shanghai, China; Department of Stem Cells and Regenerative Medicine, Tongji University School of Medicine, Shanghai, China
| | - Guoying Shang
- Department of Reconstructive and Regenerative Surgery, Shanghai Tongji Hospital Tongji University School of Medicine, Shanghai, China
| | - Jun-Ling Xie
- Research Center for Translational Medicine at East Hospital, School of Medicine, Tongji University, Shanghai 200010, China
| | - Lei Cui
- Department of Reconstructive and Regenerative Surgery, Shanghai Tongji Hospital Tongji University School of Medicine, Shanghai, China; Department of Stem Cells and Regenerative Medicine, Tongji University School of Medicine, Shanghai, China.
| | - Qun Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200011, China.
| | - Jiefeng Huang
- Department of Plastic Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
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20
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Katiyar S, Singh D, Tripathi AD, Chaurasia AK, Singh RK, Srivastava PK, Mishra A. In vitro and in vivo assessment of curcumin-quercetin loaded multi-layered 3D-nanofibroporous matrix prepared by solution blow-spinning for full-thickness burn wound healing. Int J Biol Macromol 2024; 270:132269. [PMID: 38744363 DOI: 10.1016/j.ijbiomac.2024.132269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/19/2024] [Accepted: 05/08/2024] [Indexed: 05/16/2024]
Abstract
Burn wounds (BWs) cause impairment of native skin tissue and may cause significant microbial infections that demand immediate care. Curcumin (Cur) and quercetin (Que) exhibit antimicrobial, hemocompatibility, ROS-scavenging, and anti-inflammatory properties. However, its instability, water insolubility, and low biological fluid absorption render it challenging to sustain local Cur and Que doses at the wound site. Therefore, to combat these limitations, we employed blow-spinning and freeze-drying to develop a multi-layered, Cur/Que-loaded gelatin/chitosan/PCL (GCP-Q/C) nanofibroporous (NFP) matrix. Morphological analysis of the NFP-matrix using SEM revealed a well-formed multi-layered structure. The FTIR and XRD plots demonstrated dual-bioactive incorporation and scaffold polymer interaction. Additionally, the GCP-Q/C matrix displayed high porosity (82.7 ± 2.07 %), adequate pore size (∼121 μm), enhanced water-uptake ability (∼675 % within 24 h), and satisfactory biodegradation. The scaffolds with bioactives had a long-term release, increased antioxidant activity, and were more effective against gram-positive (S. aureus) and gram-negative (E. coli) bacteria than the unloaded scaffolds. The in vitro findings of GCP-Q/C scaffolds showed promoted L929 cell growth and hemocompatibility. Additionally, an in vivo full-thickness BW investigation found that an implanted GCP-Q/C matrix stimulates rapid recuperation and tissue regeneration. In accordance with the findings, the Gel/Ch/PCL-Que/Cur NFP-matrix could represent an effective wound-healing dressing for BWs.
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Affiliation(s)
- Soumya Katiyar
- School of Biochemical Engineering, Indian Institute of Technology (Banaras Hindu University), Varanasi 221005, India
| | - Divakar Singh
- School of Biochemical Engineering, Indian Institute of Technology (Banaras Hindu University), Varanasi 221005, India
| | - Abhay Dev Tripathi
- School of Biochemical Engineering, Indian Institute of Technology (Banaras Hindu University), Varanasi 221005, India
| | - Avinash Kumar Chaurasia
- School of Biotechnology, Institute of Science, Banaras Hindu University, Varanasi 221005, India
| | - Ritika K Singh
- School of Biotechnology, Institute of Science, Banaras Hindu University, Varanasi 221005, India
| | - Pradeep K Srivastava
- School of Biochemical Engineering, Indian Institute of Technology (Banaras Hindu University), Varanasi 221005, India
| | - Abha Mishra
- School of Biochemical Engineering, Indian Institute of Technology (Banaras Hindu University), Varanasi 221005, India.
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21
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Zang T, Fear MW, Parker TJ, Holland AJA, Martin L, Langley D, Kimble R, Wood FM, Cuttle L. Inflammatory proteins and neutrophil extracellular traps increase in burn blister fluid 24h after burn. Burns 2024; 50:1180-1191. [PMID: 38490838 DOI: 10.1016/j.burns.2024.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 02/15/2024] [Accepted: 02/27/2024] [Indexed: 03/17/2024]
Abstract
Burn wound blister fluid is a valuable matrix for understanding the biological pathways associated with burn injury. In this study, 152 blister fluid samples collected from paediatric burn wounds at three different hospitals were analysed using mass spectrometry proteomic techniques. The protein abundance profile at different days after burn indicated more proteins were associated with cellular damage/repair in the first 24 h, whereas after this point more proteins were associated with antimicrobial defence. The inflammatory proteins persisted at a high level in the blister fluid for more than 7 days. This may indicate that removal of burn blisters prior to two days after burn is optimal to prevent excessive or prolonged inflammation in the wound environment. Additionally, many proteins associated with the neutrophil extracellular trap (NET) pathway were increased after burn, further implicating NETs in the post-burn inflammatory response. NET inhibitors may therefore be a potential treatment to reduce post-burn inflammation and coagulation pathology and enhance burn wound healing outcomes.
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Affiliation(s)
- Tuo Zang
- Queensland University of Technology (QUT), Faculty of Health, School of Biomedical Sciences, Centre for Children's Health Research, South Brisbane, Queensland, Australia
| | - Mark W Fear
- Burn Injury Research Unit, School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Tony J Parker
- Queensland University of Technology (QUT), School of Biomedical Sciences, Faculty of Health, Kelvin Grove, Queensland, Australia
| | - Andrew J A Holland
- The Children's Hospital at Westmead Burns Unit, Kids Research Institute, Department of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, New South Wales, Australia
| | - Lisa Martin
- Burn Injury Research Unit, School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Donna Langley
- Queensland University of Technology (QUT), Faculty of Health, School of Biomedical Sciences, Centre for Children's Health Research, South Brisbane, Queensland, Australia
| | - Roy Kimble
- Children's Health Queensland, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Fiona M Wood
- Burn Injury Research Unit, School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia; Burns Service of Western Australia, Perth Children's Hospital and Fiona Stanley Hospital, Perth, WA, Australia
| | - Leila Cuttle
- Queensland University of Technology (QUT), Faculty of Health, School of Biomedical Sciences, Centre for Children's Health Research, South Brisbane, Queensland, Australia.
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22
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Jiang Y, Zhou P, Liu AY, Liu S, Chen XL, Wang F. Efficacy of hydrosurgical eschar excision following MEEK microskin grafting in patients with massive burns: A retrospective study of a single center. Burns 2024; 50:1223-1231. [PMID: 38490834 DOI: 10.1016/j.burns.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/31/2024] [Accepted: 02/27/2024] [Indexed: 03/17/2024]
Abstract
INTRODUCTION One of the most common traumatic injuries, burn injuries lead to at least 180,000 deaths each year worldwide. Massive burns result in severe tissue loss and increase the rate of infection. Eschar excision with skin grafting is the gold standard of treatments for massive burns. Retaining dermis tissue is the key to ensuring the survival of skin grafts and rapidly closing exposed tissues. Traditional eschar excision with Humby or Weck knife controls the depth of excision until the dermis, but ensuring the accuracy of excision is challenging. Hydrosurgery minimizes damage to uninjured tissues during the removal of necrotic tissues. A foot pedal is used to adjust debridement depth for precise debridement. To figure out the clinical advantages and risks of using hydrosurgery in treating massive burns, this study has been conducted. METHOD Forty-two patients with massive burns and total body surface area (TBSA) of > 30% were treated at the First Affiliated Hospital of Anhui Medical University from May 2020 to January 2023. They underwent hydrosurgical eschar excision with MEEK microskin graft (n = 23) or tangential excision with MEEK microskin graft (n = 19). RESULT No statistically significant differences (p > 0.05) in the following demographics were found between the two groups: age, weight, TBSA, deep-partial-thickness burn, gender, inhalation injury, shock, excision area, and MEEK ratio. By contrast, statistically significant differences in per unit area of operation time, per unit area of operation spending, hospitalization cost, hospitalization duration, wound-healing time, skin graft survival, and scar quality were found between hydrosurgical excision group with MEEK microskin graft and conventional excision group with MEEK microskin graft. CONCLUSION The hydrosurgical excision system showed better clinical effects for patients with massive burns.
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Affiliation(s)
- Yan Jiang
- Department of Burns, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, PR China
| | - Ping Zhou
- Department of Burns, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, PR China
| | - Ao-Ya Liu
- Department of Burns, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, PR China
| | - Sheng Liu
- Department of Burns, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, PR China
| | - Xu-Lin Chen
- Department of Burns, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, PR China
| | - Fei Wang
- Department of Burns, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, PR China.
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23
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Daltveit S, Kleppe L, Petterteig MO, Moi AL. Photographs in burn patient diaries: A qualitative study of patients' and nurses' experiences. Intensive Crit Care Nurs 2024; 82:103619. [PMID: 38185023 DOI: 10.1016/j.iccn.2023.103619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE To explore burn patients' and burn intensive care nurses' experiences of the photos in patient diaries. DESIGN A qualitative inductive study using thematic analysis was performed. We conducted individual interviews with six former burn patients (age range 20-77 years; four women), and two focus groups with 11 burn intensive care nurses (age range 38-61 years; all women). Data from patients and nurses were analysed together, and the findings reported according to the consolidated criteria for reporting qualitative research (COREQ). SETTING A Norwegian burn centre where the writing of diaries including text and photos has been practiced for approximately two decades. FINDINGS Three main themes were derived from the combined analysis of the two data sets: hesitating when facing photos; visualising others care; and visualising the trajectory from burn trauma to recovery. Although the patients worried beforehand about what they would see in the photos and the nurses feared to select frightening photos, the photos were welcome, and several patients said they would have liked even more. The photos filled in gaps of memory, told more than words, and did not lie. Photos of family, friends or staff demonstrated shared actions that supported memories and recovery. CONCLUSION Both the burn patients and the burn intensive care nurses considered photos to be an essential part of the diary that gave context and provided a factual presentation of the patients' pathway of treatment, care and recovery. IMPLICATION FOR CLINICAL PRACTICE Tailored information about photo content should be offered to patients before a diary is handed over to them. Nurses should attempt to include photos covering the patients' entire stay at the burn centre, as well as photos of family, friends and staff. Individual nurses should be supported in their practical selection of photos for the diary.
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Affiliation(s)
- Siri Daltveit
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Inndalsveien 28, 5063 Bergen, Norway.
| | - Lena Kleppe
- Department of Plastic, Hand and Reconstructive Surgery, National Burn Centre, Haukeland University Hospital, PO Box 1400, 5021 Bergen, Norway
| | - Marie Opsanger Petterteig
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, PO Box 1400, 5021 Bergen, Norway
| | - Asgjerd Litleré Moi
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Inndalsveien 28, 5063 Bergen, Norway; Department of Plastic, Hand and Reconstructive Surgery, National Burn Centre, Haukeland University Hospital, PO Box 1400, 5021 Bergen, Norway; Faculty of Health Sciences, VID Specialized University, Ulriksdal 10, 5009 Bergen, Norway
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24
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Bieerkehazhi S, Barayan D, Khalaf F, de Brito Monteiro L, Aijaz A, Volk C, Matveev A, Saldanha S, Faour S, Jeschke MG. BURNS INDUCE ALTERATIONS IN THE ACYL PROTEOME OF MICE AND HUMANS. Shock 2024; 61:877-884. [PMID: 38661185 DOI: 10.1097/shk.0000000000002355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
ABSTRACT Hypermetabolic reprogramming triggered by thermal injury causes substantial morbidity and mortality. Despite the therapeutic potential of targeting this response, the underlying mechanisms remain poorly understood. Interestingly, protein S-acylation is a reversible posttranslational modification induced by metabolic alterations via DHHC acyltransferases. While this modification aids in the regulation of cellular functions, deregulated S-acylation contributes to various diseases by altering protein structure, stability, and localization. However, whether and how S-acylation may impact morbidity and mortality during postburn hypermetabolism is unknown. In this study, we discovered that alterations in the acyl proteome play a key role in mediating adverse outcomes that occur after burn injury. Using a murine model, we show that burn injury induces profound changes in the expression of various DHHC isoforms in metabolic organs central to regulating postburn hypermetabolism, the adipose tissue, and liver. This was accompanied by increased levels of S-acylated proteins in several pathways involved in mediating the adverse hypermetabolic response, including ER stress, lipolysis, and browning. In fact, similar results were also observed in adipose tissue from severely burned patients, as reflected by increased S-acylation of ERK1/2, eIF2a, ATGL, FGF21, and UCP1 relative to nonburn controls. Importantly, pharmacologically targeting this posttranslational modification using a nonselective DHHC inhibitor effectively attenuated burn-induced ER stress, lipolysis, and browning induction in an ex vivo explant model. Together, these findings suggest that S-acylation may facilitate the protein activation profile that drives burn-induced hypermetabolism and that targeting it could potentially be an effective strategy to restore metabolic function and improve outcomes after injury.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Sara Faour
- David Braley Research Institute, Hamilton, Ontario, Canada
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25
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Theodorou DJ, Theodorou SJ, Gelalis ID. Medico-legal evaluation of burn trauma injuries. Epidemiological features and predictors of mortality and other adverse outcomes. Injury 2024; 55:111579. [PMID: 38692210 DOI: 10.1016/j.injury.2024.111579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 04/14/2024] [Indexed: 05/03/2024]
Affiliation(s)
- Daphne J Theodorou
- Department of Radiology, General Hospital of Ioannina, Ioannina, Greece.
| | | | - Ioannis D Gelalis
- Department of Orthopaedic Surgery and Traumatology, University of Ioannina, Ioannina, Greece
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26
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Wang Y, Cai C, Zhu Z, Duan D, Xu W, Shen T, Wang X, Xu Q, Zhang H, Han C. Models predicting mortality risk of patients with burns to ≥ 50% of the total body surface. Burns 2024; 50:1277-1285. [PMID: 38490836 DOI: 10.1016/j.burns.2024.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/24/2024] [Accepted: 02/27/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Several models predicting mortality risk of burn patients have been proposed. However, models that consider all such patients may not well predict the mortality of patients with extensive burns. METHOD This retrospective multicentre study recruited patients with extensive burns (≥ 50% of the total body surface area [TBSA]) treated in three hospitals of Eastern China from 1 January 2016 to 30 June 2022. The performances of six predictive models were assessed by drawing receiver operating characteristic (ROC) and calibration curves. Potential predictors were sought via "least absolute shrinkage and selection operator" regression. Multivariate logistic regression was employed to construct a predictive model for patients with burns to ≥ 50% of the TBSA. A nomogram was prepared and the performance thereof assessed by reference to the ROC, calibration, and decision curves. RESULT A total of 465 eligible patients with burns to ≥ 50% TBSA were included, of whom 139 (29.9%) died. The FLAMES model exhibited the largest area under the ROC curve (AUC) (0.875), followed by the models of Zhou et al. (0.853) and the ABSI model (0.802). The calibration curve of the Zhou et al. model fitted well; those of the other models significantly overestimated the mortality risk. The new nomogram includes four variables: age, the %TBSA burned, the area of full-thickness burns, and blood lactate. The AUCs (training set 0.889; internal validation set 0.934; external validation set 0.890) and calibration curves showed that the nomogram exhibited an excellent discriminative capacity and that the predictions were very accurate. CONCLUSION For patients with burns to ≥ 50%of the TBSA, the Zhou et al. and FLAMES models demonstrate relatively high predictive ability for mortality. The new nomogram is sensitive, specific, and accurate, and will aid rapid clinical decision-making.
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Affiliation(s)
- Yiran Wang
- Department of Burns & Wound Care Center, the Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China; The Key Laboratory of the Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China; Center of Clinical Epidemiology & Biostatistics, Department of Scientific Research, the Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
| | - Chenghao Cai
- Department of Burns & Wound Care Center, the Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China; The Key Laboratory of the Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China; Center of Clinical Epidemiology & Biostatistics, Department of Scientific Research, the Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
| | - Zhikang Zhu
- Department of Burns & Wound Care Center, the Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China; The Key Laboratory of the Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China; Center of Clinical Epidemiology & Biostatistics, Department of Scientific Research, the Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
| | - Deqing Duan
- Department of Burns, the First Affiliated Hospital of Nanchang University, Nanchang, China; Center of Clinical Epidemiology & Biostatistics, Department of Scientific Research, the Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
| | - Wanting Xu
- Department of Burn Injury, the First Affiliated Hospital of Anhui Medical University, Hefei, China; Center of Clinical Epidemiology & Biostatistics, Department of Scientific Research, the Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
| | - Tao Shen
- Department of Burns & Wound Care Center, the Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China; Center of Clinical Epidemiology & Biostatistics, Department of Scientific Research, the Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
| | - Xingang Wang
- Department of Burns & Wound Care Center, the Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China; The Key Laboratory of the Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China; Center of Clinical Epidemiology & Biostatistics, Department of Scientific Research, the Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China.
| | - Qinglian Xu
- Department of Burn Injury, the First Affiliated Hospital of Anhui Medical University, Hefei, China; Center of Clinical Epidemiology & Biostatistics, Department of Scientific Research, the Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China.
| | - Hongyan Zhang
- Department of Burns, the First Affiliated Hospital of Nanchang University, Nanchang, China; Center of Clinical Epidemiology & Biostatistics, Department of Scientific Research, the Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China.
| | - Chunmao Han
- Department of Burns & Wound Care Center, the Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China; The Key Laboratory of the Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China; Center of Clinical Epidemiology & Biostatistics, Department of Scientific Research, the Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China.
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27
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Wu J, Ma Q, Zhou X, Wei Y, Liu Z, Kang H. Segmentation and quantitative analysis of optical coherence tomography (OCT) images of laser burned skin based on deep learning. Biomed Phys Eng Express 2024; 10:045026. [PMID: 38718764 DOI: 10.1088/2057-1976/ad488f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/08/2024] [Indexed: 05/22/2024]
Abstract
Evaluation of skin recovery is an important step in the treatment of burns. However, conventional methods only observe the surface of the skin and cannot quantify the injury volume. Optical coherence tomography (OCT) is a non-invasive, non-contact, real-time technique. Swept source OCT uses near infrared light and analyzes the intensity of light echo at different depths to generate images from optical interference signals. To quantify the dynamic recovery of skin burns over time, laser induced skin burns in mice were evaluated using deep learning of Swept source OCT images. A laser-induced mouse skin thermal injury model was established in thirty Kunming mice, and OCT images of normal and burned areas of mouse skin were acquired at day 0, day 1, day 3, day 7, and day 14 after laser irradiation. This resulted in 7000 normal and 1400 burn B-scan images which were divided into training, validation, and test sets at 8:1.5:0.5 ratio for the normal data and 8:1:1 for the burn data. Normal images were manually annotated, and the deep learning U-Net model (verified with PSPNe and HRNet models) was used to segment the skin into three layers: the dermal epidermal layer, subcutaneous fat layer, and muscle layer. For the burn images, the models were trained to segment just the damaged area. Three-dimensional reconstruction technology was then used to reconstruct the damaged tissue and calculate the damaged tissue volume. The average IoU value and f-score of the normal tissue layer U-Net segmentation model were 0.876 and 0.934 respectively. The IoU value of the burn area segmentation model reached 0.907 and f-score value reached 0.951. Compared with manual labeling, the U-Net model was faster with higher accuracy for skin stratification. OCT and U-Net segmentation can provide rapid and accurate analysis of tissue changes and clinical guidance in the treatment of burns.
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Affiliation(s)
- Jingyuan Wu
- Beijing Institute of Radiation Medicine, Beijing 100850, People's Republic of China
- College of Life Sciences, Hebei University, Baoding, Hebei 071002, People's Republic of China
| | - Qiong Ma
- Beijing Institute of Radiation Medicine, Beijing 100850, People's Republic of China
| | - Xun Zhou
- Beijing Institute of Radiation Medicine, Beijing 100850, People's Republic of China
| | - Yu Wei
- Beijing Institute of Radiation Medicine, Beijing 100850, People's Republic of China
- College of Life Sciences, Hebei University, Baoding, Hebei 071002, People's Republic of China
| | - Zhibo Liu
- Beijing Institute of Radiation Medicine, Beijing 100850, People's Republic of China
| | - Hongxiang Kang
- Beijing Institute of Radiation Medicine, Beijing 100850, People's Republic of China
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28
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Wang B, Du L, Dong B, Kou E, Wang L, Zhu Y. Current Knowledge and Perspectives of Phage Therapy for Combating Refractory Wound Infections. Int J Mol Sci 2024; 25:5465. [PMID: 38791502 PMCID: PMC11122179 DOI: 10.3390/ijms25105465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/09/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024] Open
Abstract
Wound infection is one of the most important factors affecting wound healing, so its effective control is critical to promote the process of wound healing. However, with the increasing prevalence of multi-drug-resistant (MDR) bacterial strains, the prevention and treatment of wound infections are now more challenging, imposing heavy medical and financial burdens on patients. Furthermore, the diminishing effectiveness of conventional antimicrobials and the declining research on new antibiotics necessitate the urgent exploration of alternative treatments for wound infections. Recently, phage therapy has been revitalized as a promising strategy to address the challenges posed by bacterial infections in the era of antibiotic resistance. The use of phage therapy in treating infectious diseases has demonstrated positive results. This review provides an overview of the mechanisms, characteristics, and delivery methods of phage therapy for combating pathogenic bacteria. Then, we focus on the clinical application of various phage therapies in managing refractory wound infections, such as diabetic foot infections, as well as traumatic, surgical, and burn wound infections. Additionally, an analysis of the potential obstacles and challenges of phage therapy in clinical practice is presented, along with corresponding strategies for addressing these issues. This review serves to enhance our understanding of phage therapy and provides innovative avenues for addressing refractory infections in wound healing.
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Affiliation(s)
- Bo Wang
- Department of Dermatology, Naval Medical Center, Naval Medical University, Shanghai 200052, China
| | - Lin Du
- Department of Dermatology, Naval Medical Center, Naval Medical University, Shanghai 200052, China
| | - Baiping Dong
- Department of Dermatology, Naval Medical Center, Naval Medical University, Shanghai 200052, China
| | - Erwen Kou
- Department of Dermatology, Naval Medical Center, Naval Medical University, Shanghai 200052, China
| | - Liangzhe Wang
- Department of Dermatology, Naval Medical Center, Naval Medical University, Shanghai 200052, China
| | - Yuanjie Zhu
- Department of Dermatology, Naval Medical Center, Naval Medical University, Shanghai 200052, China
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29
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Su S, Zhang Y, Wu D, Wang C, Hu J, Wei Y, Peng X. 1H-nuclear magnetic resonance analysis reveals dynamic changes in the metabolic profile of patients with severe burns. BURNS & TRAUMA 2024; 12:tkae007. [PMID: 38756185 PMCID: PMC11097601 DOI: 10.1093/burnst/tkae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 02/08/2024] [Accepted: 02/29/2024] [Indexed: 05/18/2024]
Abstract
Background Severe burn injury causes a hypermetabolic response, resulting in muscle protein catabolism and multiple organ damage syndrome. However, this response has not yet been continuously characterized by metabolomics in patients. This study aims to quantify temporal changes in the metabolic processes of patients with severe burns. Methods We employed 1H-nuclear magnetic resonance (NMR) spectroscopy to scrutinize metabolic alterations during the initial 35 days following burn injury in a cohort of 17 adult patients with severe burns, with 10 healthy individuals included as controls. Plasma specimens were collected from patients on postburn days 1, 3, 7, 14, 21, 28 and 35. After performing multivariate statistical analysis, repeated-measures analysis of variance and time-series analysis, we quantified changes in metabolite concentrations. Results Among the 36 metabolites quantified across 119 samples from burn patients, branched-chain amino acids, glutamate, glycine, glucose, pyruvate, lactate, trimethylamine N-oxide and others exhibited obvious temporal variations in concentration. Notably, these metabolites could be categorized into three clusters based on their temporal characteristics. The initial response to injury was characterized by changes in lactate and amino acids, while later changes were driven by an increase in fatty acid catabolism and microbial metabolism, leading to the accumulation of ketone bodies and microbial metabolites. Conclusions Metabolomics techniques utilizing NMR have the potential to monitor the intricate processes of metabolism in patients with severe burns. This study confirmed that the third day after burn injury serves as the boundary between the ebb phase and the flow phase. Furthermore, identification of three distinct temporal patterns of metabolites revealed the intrinsic temporal relationships between these metabolites, providing clinical data for optimizing therapeutic strategies.
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Affiliation(s)
- Sen Su
- Clinical Medical Research Center, Southwest Hospital, Third Military Medical University (Army Medical University), Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Yong Zhang
- Department of Burns and Plastic Surgery, General Hospital of Xinjiang Military Command, Youhao North Road, Shayibake District, Urumqi, 830092, China
| | - Dan Wu
- Clinical Medical Research Center, Southwest Hospital, Third Military Medical University (Army Medical University), Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Chao Wang
- State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Jianhong Hu
- State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Yan Wei
- Clinical Medical Research Center, Southwest Hospital, Third Military Medical University (Army Medical University), Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Xi Peng
- Clinical Medical Research Center, Southwest Hospital, Third Military Medical University (Army Medical University), Gaotanyan Street, Shapingba District, Chongqing, 400038, China
- State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Gaotanyan Street, Shapingba District, Chongqing, 400038, China
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30
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Al-Qaisi T, Al-Rawadeih S, Alsarayreh A, Qaisi YA, Al-Limoun M, Alqaraleh M, Khleifat K. The effects of Anchusa azurea methanolic extract on burn wound healing: Histological, antioxidant, and anti-inflammatory evaluation. Burns 2024:S0305-4179(24)00148-7. [PMID: 38760186 DOI: 10.1016/j.burns.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/26/2024] [Accepted: 05/02/2024] [Indexed: 05/19/2024]
Abstract
Anchusa azurea one of the medicinal plants that has been traditionally used for treat burn wounds. However, the traditional claim that A.azurea can hasten burn wound healing has not been supported by scientific studies. This experiment used a male Wistar rats model to investigate the activity of A. azurea aerial parts methanolic extract in burn wound healing. To determine their ability to help in healing burn wounds in rat models, the active components of the aerial parts of A. azurea were extracted with 80% methanol, then, 1% and 10% ointments were prepared from the extract, and applied topically. The LCMS chromatography of A. azurea plant extract showed different active ingredients, including phenolic compounds, flavonoids, fatty acids, and others. The plant extract's investigated as anti-inflammatory, antioxidant, and histological effects on the burn wound healing process. The results showed a significant (p-value < 0.025) rate of burn wound healing with 78.6% and 84.8% contraction, respectively using 1% and 10% (w/w) extract ointments after 12 days. These results were corroborated by histological observations such as collagen deposition, re-epithelialization, and repair of the remaining skin tissues without any sign of cutaneous toxicity. The plant extract showed significant (p-value < 0.025) antioxidant effect at the highest tested dose of 500 µg/mL, scavenging 89.78% of the DPPH with an IC50 of 213.6 µg/mL. These results confirmed by histological changes observations of collagen deposition, re-epithelialization, and reformation of remaining skin tissues without any signs of dermal toxicity. The plant extract exhibited significant (p-value < 0.025) level of antioxidant agents, by scavenging 89.78% of the DPPH at 500 µg/mL with IC50 of 213.6 µg/mL. Additionally, all pro-inflammatory cytokines examined, including IL-6 and IL-10, the results exhibited reduction in IL-6 level and increase IL-10 level. The aerial extract of the A. azurea plant revealed a wealth of several significant active ingredients, including phenolic compounds, flavonoids, fatty acids, and others, suggesting the potential for anti-inflammatory, burn wound-healing, and antioxidant medications. These findings can open an avenue to find new therapeutics for burn wounds healing, anti-inflammatory and antioxidant properties.
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Affiliation(s)
- Talal Al-Qaisi
- Faculty of Allied Medical Sciences, Al-Ahliyya Amman University, Amman, Jordan
| | - Saddam Al-Rawadeih
- Biology Department, College of Science, Mutah University, Al-Karak, Jordan
| | - Ahmad Alsarayreh
- Biology Department, College of Science, Mutah University, Al-Karak, Jordan.
| | - Yaseen Al Qaisi
- Biology Department, College of Science, Mutah University, Al-Karak, Jordan
| | - Muhamad Al-Limoun
- Biology Department, College of Science, Mutah University, Al-Karak, Jordan
| | - Moath Alqaraleh
- Department of Medical Laboratory Sciences, Faculty of Science, Al-Balqa Applied University, Al-Salt 19117, Jordan
| | - Khaled Khleifat
- Biology Department, College of Science, Mutah University, Al-Karak, Jordan
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Tao W, Xu G, Zhou J, Luo Y, Li PS. Glutamine Supplementation on Burn Patients: A Systematic Review and Meta-analysis. J Burn Care Res 2024; 45:675-684. [PMID: 38243579 DOI: 10.1093/jbcr/irae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Indexed: 01/21/2024]
Abstract
To evaluate the effect of glutamine supplement on patients with burns, we conducted a systematic review and meta-analysis via synthesizing up-to-date studies. Databases including PubMed, Cochrane Central Register, EMBASE, Google scholar, Wanfang data, and ClinicalTrials.gov were searched up to October 2023 to find randomized trials evaluating glutamine supplement on patients with burns. The main outcomes included hospital stay, in-hospital mortality, infection, and wound healing. Twenty-two trials that randomized a total of 2170 patients were included in this meta-analysis. Pooled the length of hospital stay was shortened by glutamine supplement (weighted mean differences [WMD] = -7.95, 95% confidence interval [CI] -10.53 to -5.36, I2 = 67.9%, 16 trials). Both pooled wound healing rates (WMD = 9.15, 95% CI 6.30 to 12.01, I2 = 82.7%, 6 studies) and wound healing times (WMD = -5.84, 95% CI -7.42 to -4.27, I2 = 45.7%, 7 studies) were improved by glutamine supplement. Moreover, glutamine supplement reduced wound infection (risk ratios [RR] = 0.38, 95% CI 0.21 to 0.69, I2 = 0%, 3 trials), but not nonwound infection (RR = 0.88, 95% CI 0.73 to 1.05, I2 = 39.6%, 9 trials). Neither in-hospital mortality (RR = 0.95, 95% CI 0.74 to 1.22, I2 = 36.0%, 8 trials) nor the length of intensive care unit stay (WMD = 1.85, 95% CI -7.24 to 10.93, I2 = 78.2%, 5 studies) was improved by glutamine supplement. Subgroup analysis showed positive effects were either influenced by or based on small-scale, single-center studies. Based on the current available data, we do not recommend the routine use of glutamine supplement for burn patients in hospital. Future large-scale randomized trials are still needed to give a conclusion about the effect of glutamine supplement on burn patients.
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Affiliation(s)
- Wei Tao
- Department of Burn and Plastic Surgery, Clinical Medical College, Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu 225001, China
| | - Gang Xu
- Department of Burn and Plastic Surgery, Clinical Medical College, Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu 225001, China
| | - Jie Zhou
- Department of Burn and Plastic Surgery, Clinical Medical College, Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu 225001, China
| | - Yi Luo
- Department of Burn and Plastic Surgery, Clinical Medical College, Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu 225001, China
| | - Ping-Song Li
- Department of Burn and Plastic Surgery, Clinical Medical College, Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu 225001, China
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Yue Q, Wu H, Xi M, Li F, Li T, Li Y. Filter Lifespan, Treatment Effect, and Influencing Factors of Continuous Renal Replacement Therapy for Severe Burn Patients. J Burn Care Res 2024; 45:764-770. [PMID: 38113522 PMCID: PMC11073580 DOI: 10.1093/jbcr/irad196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Indexed: 12/21/2023]
Abstract
Continuous renal replacement therapy (CRRT) is often disrupted due to various factors, such as patient-related issues, vascular access complications, treatment plans, and medical staff factors. This unexpected interruption is referred to as non-selective filter stoppage and can result in additional treatment expenses. This study conducted a retrospectively analyzed 501 CRRT filters used in 62 patients with severe burns, lifespan and therapeutic effect of all filters were mainly analyzed, used logistic regression analysis was performed to identify risk factors associated with non-selective cessation filters. Out of 493 filters, 279 cases received heparin (56.60%), the median lifespan of the filter was 14.08 h (25th, 75th quantile: 7.30, 21.50); 128 cases were treated with nafamostat mesylate (26.00%), and the median lifespan of the filter was 16.42 h (10.49, 22.76); 86 cases were treated with sodium citrate (17.40%), and the median lifespan of the filter was 31.06 h (19.25, 48.75). In addition, significant differences were observed in the electrolyte index, renal function index, and procalcitonin levels before and after treatment with a single filter (P < .001). Multivariate logistic regression showed that the risk of non-selective cessation of sodium citrate anticoagulants was lower than that of heparin anticoagulation. Overall, CRRT is progressively becoming more prevalent in the treatment of patients with severe burns. The lifespan of individual filters and total patient treatment duration showed a consistent upward trend. The filter's lifespan was notably greater during sodium citrate anticoagulation when compared to nafamostat mesylate and heparin, meanwhile notably reducing the risk of non-selective cessation. Therefore, we recommend sodium citrate for anticoagulation in patients without any contraindications.
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Affiliation(s)
- Qian Yue
- Medical College of Wuhan University of Science and Technology, Wuhan, China
| | - Hong Wu
- Wuhan Institute of Burns, Tongren Hospital of Wuhan University (Wuhan Third Hospital), Wuhan, China
| | - Maomao Xi
- Wuhan Institute of Burns, Tongren Hospital of Wuhan University (Wuhan Third Hospital), Wuhan, China
| | - Feng Li
- Wuhan Institute of Burns, Tongren Hospital of Wuhan University (Wuhan Third Hospital), Wuhan, China
| | - Tiantian Li
- Wuhan Institute of Burns, Tongren Hospital of Wuhan University (Wuhan Third Hospital), Wuhan, China
| | - Yinyin Li
- Wuhan Institute of Burns, Tongren Hospital of Wuhan University (Wuhan Third Hospital), Wuhan, China
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Hegde P, Gibikote S, Kumar A, Thenmozhi M, Jehangir S. Knowledge of prevention and first aid in burn injuries among health care workers and non-health care persons in India. Burns 2024; 50:1024-1029. [PMID: 38280840 DOI: 10.1016/j.burns.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 12/22/2023] [Accepted: 01/10/2024] [Indexed: 01/29/2024]
Abstract
Appropriate and timely first aid reduces morbidity in burns. This study aims to assess the knowledge of first aid in burns among healthcare workers (HCW) and nonhealthcare workers. (NHCW). METHODS A survey, distributed in both paper and Google survey formats, presented five sample cases with multiple-choice answers. Participants recorded the most suitable first aid management for each scenario. Correct answers were provided on completion. RESULTS Out of the total 753 participants, only 89 (11.8%) got all five answers correct. 16% HCW and 6% NHCW could answer all 5 questions correctly (with a true HCW:NHCW ratio of 2.67:1). Providing care for individuals with burns substantially raised the probability of giving accurate responses (p = 0.0001). While attending the general First Aid Course did not affect the responses (p = 0.08), participation in the Burns First Aid Course demonstrated slightly improved results (p = 0.052). The scenario involving liquid petroleum gas leakage saw a high proportion of correct responses, likely influenced by media coverage. CONCLUSION We find a clear need for adequate training in burns first aid due to low awareness among healthcare workers (HCW) and non-healthcare workers (NHCW). Factors such as participation in burn first aid courses and gaining firsthand experience in treating burns were found to be linked to improved knowledge of burns prevention and first aid. Utilizing various media channels could be a valuable strategy to reach a broader audience, especially in remote and inaccessible areas.
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Affiliation(s)
- Priyanka Hegde
- Department of Paediatric Surgery, Christian Medical College, Vellore, Tamil Nadu 632004, India
| | - Siddharth Gibikote
- Department of Paediatric Surgery, Christian Medical College, Vellore, Tamil Nadu 632004, India
| | - Arun Kumar
- Department of Paediatric Surgery, Christian Medical College, Vellore, Tamil Nadu 632004, India
| | - M Thenmozhi
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu 632004, India
| | - Susan Jehangir
- Department of Paediatric Surgery, Christian Medical College, Vellore, Tamil Nadu 632004, India.
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Ishibashi H, Yoshinaga R, Yamada T. Outpatient superficial partial-thickness burn care of an elderly patient successfully treated with Eppikajutsuto. J Gen Fam Med 2024; 25:158-161. [PMID: 38707700 PMCID: PMC11065149 DOI: 10.1002/jgf2.685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 05/07/2024] Open
Abstract
Eppikajutsuto (EPTJ) is used to reduce redundant body fluids and suppress inflammation. We observed that EPTJ shortened the duration of treatment in an elderly patient with burn injuries. A 96-year-old man suffered superficial partial-thickness burns on the dorsum of his right hand and left knee. The injuries showed early improvement with the use of EPTJ. This suggests that EPTJ could contribute to shortening the duration of healing for superficial partial-thickness burns in elderly patients who may experience slow wound healing and have a high mortality rate. Eppikajutsuto needs to be considered as a treatment for burns in primary care.
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Affiliation(s)
- Hiroki Ishibashi
- Department of EmergencyIizuka HospitalIizuka CityJapan
- Munakata City National Health Insurance Oshima ClinicMunakata CityJapan
| | - Ryo Yoshinaga
- Department of Japanese Oriental MedicineIizuka HospitalIizuka CityJapan
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Maddipatla SP, McLoone P, Puxty K, McGovern C. The incidence of cancer following hospitalisation for a burn injury in Scotland 2009-2019: A retrospective cohort study. Burns 2024; 50:866-873. [PMID: 38494397 DOI: 10.1016/j.burns.2024.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Studies suggest increased occurrence of cancer in persons who have experienced a burn injury with hospital admission. OBJECTIVE To determine the incidence of cancer among those hospitalised for burn injuries in Scotland compared with a similar group without a history of burn injury hospitalisation. METHOD A retrospective cohort design was used to compare cancer (ICD10 C00-97, excluding C44) incidence in two groups: 6805 burn injury patients discharged from Scottish hospitals between 2009 and 2019, and 25,946 subjects from the general population who were matched to burn patients by sex, year of birth, and degree of social deprivation. Cancer incidence was identified from the Scottish cancer registry. Cox proportional hazard regression was used to model time to cancer incidence adjusting for age, sex, degree of deprivation and presence of a comorbidity. Cancer risk was presented as standardised incidence ratios (SIRs) and hazard ratios (HR). RESULTS We found a higher prevalence of pre-existing conditions, particularly alcohol abuse among patients with burns. Pre-existing cancers were more common in the burn cohort (3.5%) than the comparison group (1.7%) and were excluded from further analysis. Over a median follow-up of 4-5 years, a total of 236 (3.5%) burn patients and 969 (3.7%) persons in the comparison group were diagnosed with cancer. At 0-6 months the cancer SIR for burn patients was 1.88 95% CI (1.40-2.52). After excluding the first six months of follow-up, the overall incidence of cancer was marginally elevated in burn patients (SIR 1.04, 95% CI 0.90-1.19, p = 0.62) and not statistically different from the incidence in comparison subjects (adjusted HR 1.03, 95% CI 0.88-1.21, p = 0.71). CONCLUSIONS Patients that suffer burn injury have a higher incidence of cancer than the general population and a group matched by age, sex and degree of deprivation. A higher incidence of adverse health-related behaviours such as smoking, alcohol use and pre-existing health conditions among many patients that suffer a burn most likely explain this observed increase. Any persisting inflammatory or immune dysfunction following burn injury is unlikely to account for the increase in cancers in this study.
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Affiliation(s)
- Sai Phani Maddipatla
- Public Health, School of Health & Wellbeing, University of Glasgow, United Kingdom
| | - Philip McLoone
- Public Health, School of Health & Wellbeing, University of Glasgow, United Kingdom.
| | - Kathryn Puxty
- Intensive Care Unit, Glasgow Royal Infirmary, Glasgow, United Kingdom
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Roy S, Mukherjee P, Kundu S, Majumder D, Raychaudhuri V, Choudhury L. Microbial infections in burn patients. Acute Crit Care 2024; 39:214-225. [PMID: 38863352 PMCID: PMC11167422 DOI: 10.4266/acc.2023.01571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/16/2024] [Accepted: 03/27/2024] [Indexed: 06/13/2024] Open
Abstract
Polymicrobial infections are the leading causes of complications incurred from injuries that burn patients develop. Such patients admitted to the hospital have a high risk of developing hospital-acquired infections, with longer patient stays leading to increased chances of acquiring such drug-resistant infections. Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Proteus mirabilis are the most common multidrug-resistant (MDR) Gram-negative bacteria identified in burn wound infections (BWIs). BWIs caused by viruses, like Herpes Simplex and Varicella Zoster, and fungi-like Candida spp. appear to occur occasionally. However, the preponderance of infection by opportunistic pathogens is very high in burn patients. Variations in the causative agents of BWIs are due to differences in geographic location and infection control measures. Overall, burn injuries are characterized by elevated serum cytokine levels, systemic immune response, and immunosuppression. Hence, early detection and treatment can accelerate the wound-healing process and reduce the risk of further infections at the site of injury. A multidisciplinary collaboration between burn surgeons and infectious disease specialists is also needed to properly monitor antibiotic resistance in BWI pathogens, help check the super-spread of MDR pathogens, and improve treatment outcomes as a result.
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Affiliation(s)
- Souvik Roy
- Postgraduate and Research Department of Biotechnology, St. Xavier’s College (Autonomous), Kolkata, India
| | - Preeti Mukherjee
- Postgraduate and Research Department of Biotechnology, St. Xavier’s College (Autonomous), Kolkata, India
| | - Sutrisha Kundu
- Postgraduate and Research Department of Biotechnology, St. Xavier’s College (Autonomous), Kolkata, India
| | - Debashrita Majumder
- Postgraduate and Research Department of Biotechnology, St. Xavier’s College (Autonomous), Kolkata, India
| | - Vivek Raychaudhuri
- Postgraduate and Research Department of Biotechnology, St. Xavier’s College (Autonomous), Kolkata, India
| | - Lopamudra Choudhury
- Department of Microbiology, Sarsuna College (under Calcutta University), Kolkata, India
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Bickel J, Aboutara N, Jungen H, Szewczyk A, Müller A, Ondruschka B, Iwersen-Bergmann S. Morphine concentrations in fatalities after palliative treatment of acute burn injury. Int J Legal Med 2024; 138:839-847. [PMID: 38231204 PMCID: PMC11004028 DOI: 10.1007/s00414-024-03164-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/08/2024] [Indexed: 01/18/2024]
Abstract
The evaluation of a morphine concentration in postmortem blood is routine for a forensic toxicologist. We here report three fatal cases where we found high morphine concentrations with 7.96, 4.30, and 5.82 mg/l in femoral blood that have to be estimated as unusually high. All these individuals died due to severe burn injuries and obtained morphine in the context of their palliative care in the last hours of their lives. According to the autopsy results, the cause of death in case 1 was burn disease with burns of about 90% of the body surface area (BSA), case 2 burn trauma, and case 3 burn shock. Besides morphine, propofol, fentanyl, sufentanil, midazolam, diazepam, lorazepam, cefazolin, and rocuronium were detected in femoral blood. The findings fitted well with the detailed clinical documentation. Further evidence of therapeutic concentrations of quetiapine, duloxetine, and melperone could be matched to preexisting medication of the individuals. Physiologically based pharmacokinetic modelling (PBPK) was applied, developed for the intravenous administration of morphine, to find an explanation for the high morphine concentrations in femoral blood. Quantification of morphine in body fluids and tissue was performed to calculate morphine tissue concentration ratios to the morphine concentration in femoral blood. The presented cases show that pharmacokinetic simulations can reflect decreased renal clearance and decreased hepatic metabolism in general. However, this prediction is not sufficient to explain the high morphine concentrations in femoral blood measured here. It can be assumed that burn shock in particular leads to altered pharmacokinetics, namely decreased distribution of morphine.
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Affiliation(s)
- Julian Bickel
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Nadine Aboutara
- Research Centre Borstel Leibniz Lung Centre, Borstel, Germany
| | - Hilke Jungen
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Szewczyk
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Müller
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Benjamin Ondruschka
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Zhang S, Yang W, Gong W, Lu Y, Yu DG, Liu P. Recent progress of electrospun nanofibers as burning dressings. RSC Adv 2024; 14:14374-14391. [PMID: 38694552 PMCID: PMC11061782 DOI: 10.1039/d4ra01514b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/25/2024] [Indexed: 05/04/2024] Open
Abstract
Burns are a global public health problem, which brings great challenges to public health and the economy. Severe burns often lead to systemic infection, shock, multiple organ failure, and even death. With the increasing demand for the therapeutic effect of burn wounds, traditional dressings have been unable to meet people's needs due to their single function and many side effects. In this context, electrospinning shows a great prospect on the way to open up advanced wound dressings that promote wound repairing and prevent infection. With its large specific surface area, high porosity, and similar to natural extracellular matrix (ECM), electrospun nanofibers can load drugs and accelerate wound healing. It provides a promising solution for the treatment and management of burn wounds. This review article introduces the concept of burn and the types of electrospun nanofibers, then summarizes the polymers used in electrospun nanofiber dressings. Finally, the drugs (plant extracts, small molecule drugs and nanoparticles) loaded with electrospun burn dressings are summarized. Some promising aspects for developing commercial electrospun burn dressings are proposed.
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Affiliation(s)
- Shengwei Zhang
- School of Health Science and Engineering, University of Shanghai for Science and Technology Shanghai 200093 China
| | - Wei Yang
- The Base of Achievement Transformation, Shidong Hospital Affiliated to University of Shanghai for Science and Technology Shanghai 200443 China
| | - Wenjian Gong
- School of Materials and Chemistry, University of Shanghai for Science and Technology Shanghai 200093 China
| | - Yuhang Lu
- School of Materials and Chemistry, University of Shanghai for Science and Technology Shanghai 200093 China
| | - Deng-Guang Yu
- School of Materials and Chemistry, University of Shanghai for Science and Technology Shanghai 200093 China
| | - Ping Liu
- The Base of Achievement Transformation, Shidong Hospital Affiliated to University of Shanghai for Science and Technology Shanghai 200443 China
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Gur I, Zilbert A, Toledano K, Roimi M, Stern A. Clinical impact of fungal colonization of burn wounds in patients hospitalized in the intensive care unit: a retrospective cohort study. Trauma Surg Acute Care Open 2024; 9:e001325. [PMID: 38666015 PMCID: PMC11043691 DOI: 10.1136/tsaco-2023-001325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 03/30/2024] [Indexed: 04/28/2024] Open
Abstract
Background Invasive fungal infections in burn victims significantly increase mortality and hospitalization. The effect of fungal burn wound colonization has not been established. Methods All adult patients hospitalized in the intensive care unit (ICU) with burns ≥10% of total body surface area (TBSA) between 2005 and 2021 were included. Superficial swabs were collected whenever clinical suspicion of wound colonization was raised, and deep tissue samples were sent at any wound excision. The primary outcome was the incidence of invasive fungal infections defined as any deep tissue fungal infection or fungemia. Results Of 242 patients included, 39 (16.1%) had fungal wound colonization, 22 (56.4%) with yeasts and 24 (61.5%) molds. Patients with fungal colonization had a significantly higher rate of invasive fungal infections (82.1% vs 3.9%, p<0.001), candidemia (15.4% vs 3.4%, p=0.002), as well as longer ICU stay (61.5±57.6 vs 19±40.5 days, p<0.001), and higher in-ICU mortality (43.6% vs 15.8%, p<0.001). Survival analysis showed fungal colonization to be associated with significantly increased risk of invasive infection (aHR 25, 95% CI (9.67 to 64.62)), even when adjusted for age, TBSA, sequential organ failure assessment scores, Charlson Comorbidity Index and the presence of bacteremia. Conclusions Fungal burn wound colonization is associated with increased risk of invasive fungal infections and mortality. Level of Evidence This a single center, retrospective cohort study.
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Affiliation(s)
- Ivan Gur
- Rambam Health Care Campus, Haifa, Israel
| | | | - Kochava Toledano
- Rambam Health Care Campus, Haifa, Israel
- Technion Israel Institute of Technology, Haifa, Israel
| | - Michael Roimi
- Rambam Health Care Campus, Haifa, Israel
- Technion Israel Institute of Technology, Haifa, Israel
| | - Anat Stern
- Rambam Health Care Campus, Haifa, Israel
- Technion Israel Institute of Technology, Haifa, Israel
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Lipovy B, Hladik M, Vyklicka K, Kocmanova I, Lengerova M, Kren L, Srnik M, Bohm J, Andrla P, Borilova Linhartova P. Rare multi-fungal sepsis: a case of triple-impact immunoparalysis. Folia Microbiol (Praha) 2024:10.1007/s12223-024-01165-0. [PMID: 38647991 DOI: 10.1007/s12223-024-01165-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 04/10/2024] [Indexed: 04/25/2024]
Abstract
Patients with burn injury and inhalation injury are highly susceptible to infectious complications, including opportunistic pathogens, due to the loss of skin cover and mucosal damage of respiratory tract as well as the disruption of homeostasis. This case report, a 34-year-old man suffered critical burns, provides the first literature description of triple-impact immunoparalysis (critical burns, inhalation injury, and SARS-CoV-2 infection), leading to a lethal multifocal infection caused by several fungi including very rare environmental representatives Metschnikowia pulcherrima and Wickerhamomyces anomalus. The co-infection by these common environmental yeasts in a human is unique and has not yet been described in the literature. Importantly, our patient developed refractory septic shock and died despite targeted antifungal therapy including the most potent current antifungal agent-isavuconazole. It can be assumed that besides immunoparalysis, effectiveness of therapy by isavuconazole was impaired by the large distribution volume in this case. As this is a common situation in intensive care patients, routine monitoring of plasmatic concentration of isavuconazole can be helpful in personalization of the treatment and dose optimization. Whatmore, many fungal species often remain underdiagnosed during infectious complications, which could be prevented by implementation of new methods, such as next-generation sequencing, into clinical practice.
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Affiliation(s)
- Bretislav Lipovy
- Department of Burns and Plastic Surgery, Faculty of Medicine, Institution Shared With University Hospital Brno, Masaryk University, Jihlavska 20, Brno, Czech Republic
- CEITEC - Central European Institute of Technology, Brno University of Technology, Purkynova 656/123, Brno, Czech Republic
| | - Martin Hladik
- Department of Burns and Plastic Surgery, Faculty of Medicine, Institution Shared With University Hospital Brno, Masaryk University, Jihlavska 20, Brno, Czech Republic
| | - Katerina Vyklicka
- RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, Brno, Czech Republic
| | - Iva Kocmanova
- Department of Clinical Microbiology and Immunology, University Hospital Brno, Jihlavska 20, Brno, Czech Republic
| | - Martina Lengerova
- Department of Internal Medicine - Haematology and Oncology, Faculty of Medicine, Institution Shared With University Hospital Brno, Masaryk University, Jihlavska 20, Brno, Czech Republic
| | - Leos Kren
- Department of Pathology, Faculty of Medicine, Institution Shared With University Hospital Brno, Masaryk University, Jihlavska 20, Brno, Czech Republic
| | - Michal Srnik
- Department of Forensic Medicine, Institutions Shared With St. Anne's Faculty Hospital, Faculty of Medicine, Masaryk University, Pekarska 664/53, Brno, Czech Republic
| | - Jan Bohm
- RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, Brno, Czech Republic
| | - Petr Andrla
- RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, Brno, Czech Republic
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He H, Huang W, Zhang S, Li J, Zhang J, Li B, Xu J, Luo Y, Shi H, Li Y, Xiao J, Ezekiel OC, Li X, Wu J. Microneedle Patch for Transdermal Sequential Delivery of KGF-2 and aFGF to Enhance Burn Wound Therapy. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2024:e2307485. [PMID: 38623988 DOI: 10.1002/smll.202307485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/19/2023] [Indexed: 04/17/2024]
Abstract
Severe burn wounds usually destroy key cells' functions of the skin resulting in delayed re-epithelization and wound regeneration. Promoting key cells' activities is crucial for burn wound repair. It is well known that keratinocyte growth factor-2 (KGF-2) participates in the proliferation and morphogenesis of epithelial cells while acidic fibroblast growth factor (aFGF) is a key mediator for fibroblast and endothelial cell growth and differentiation. However, thick eschar and the harsh environment of a burn wound often decrease the delivery efficiency of fibroblast growth factor (FGF) to the wound site. Therefore, herein a novel microneedle patch for sequential transdermal delivery of KGF-2 and aFGF is fabricated to enhance burn wound therapy. aFGF is first loaded in the nanoparticle (NPaFGF) and then encapsulated NPaFGF with KGF-2 in the microneedle patch (KGF-2/NPaFGF@MN). The result shows that KGF-2/NPaFGF@MN can successfully get across the eschar and sequentially release KGF-2 and aFGF. Additional data demonstrated that KGF-2/NPaFGF@MN achieved a quicker wound closure rate with reduced necrotic tissues, faster re-epithelialization, enhanced collagen deposition, and increased neo-vascularization. Further evidence suggests that improved wound healing is regulated by significantly elevated expressions of hypoxia-inducible factor-1 alpha (HIF-1ɑ) and heat shock protein 90 (Hsp90) in burn wounds. All these data proved that KGF-2/NPaFGF@MN is an effective treatment for wound healing of burns.
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Affiliation(s)
- Huacheng He
- School of Pharmaceutical Science, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, P. R. China
- Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Wenzhou, Zhejiang, 325000, P. R. China
| | - Wen Huang
- School of Pharmaceutical Science, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, P. R. China
| | - Shihui Zhang
- School of Pharmaceutical Science, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, P. R. China
| | - Jie Li
- School of Pharmaceutical Science, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, P. R. China
| | - Jian Zhang
- School of Pharmaceutical Science, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, P. R. China
| | - Bingxin Li
- School of Pharmaceutical Science, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, P. R. China
| | - Jie Xu
- School of Pharmaceutical Science, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, P. R. China
| | - Yuting Luo
- School of Pharmaceutical Science, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, P. R. China
| | - Huiling Shi
- School of Pharmaceutical Science, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, P. R. China
| | - Yue Li
- School of Pharmaceutical Science, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, P. R. China
| | - Jian Xiao
- School of Pharmaceutical Science, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, P. R. China
| | - Odinaka Cassandra Ezekiel
- School of Pharmaceutical Science, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, P. R. China
| | - Xiaokun Li
- School of Pharmaceutical Science, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, P. R. China
| | - Jiang Wu
- School of Pharmaceutical Science, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, P. R. China
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Hou B, Zhang H, Zhou L, Hu B, Tang W, Ye B, Wang C, Xu Y, Zou L, Hu J. In silico analysis of intestinal microbial instability and symptomatic markers in mice during the acute phase of severe burns. BMC Microbiol 2024; 24:124. [PMID: 38622529 PMCID: PMC11017597 DOI: 10.1186/s12866-024-03266-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 03/17/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Severe burns may alter the stability of the intestinal flora and affect the patient's recovery process. Understanding the characteristics of the gut microbiota in the acute phase of burns and their association with phenotype can help to accurately assess the progression of the disease and identify potential microbiota markers. METHODS We established mouse models of partial thickness deep III degree burns and collected faecal samples for 16 S rRNA amplification and high throughput sequencing at two time points in the acute phase for independent bioinformatic analysis. RESULTS We analysed the sequencing results using alpha diversity, beta diversity and machine learning methods. At both time points, 4 and 6 h after burning, the Firmicutes phylum content decreased and the content of the Bacteroidetes phylum content increased, showing a significant decrease in the Firmicutes/Bacteroidetes ratio compared to the control group. Nine bacterial genera changed significantly during the acute phase and occupied the top six positions in the Random Forest significance ranking. Clustering results also clearly showed that there was a clear boundary between the communities of burned and control mice. Functional analyses showed that during the acute phase of burn, gut bacteria increased lipoic acid metabolism, seleno-compound metabolism, TCA cycling, and carbon fixation, while decreasing galactose metabolism and triglyceride metabolism. Based on the abundance characteristics of the six significantly different bacterial genera, both the XGboost and Random Forest models were able to discriminate between the burn and control groups with 100% accuracy, while both the Random Forest and Support Vector Machine models were able to classify samples from the 4-hour and 6-hour burn groups with 86.7% accuracy. CONCLUSIONS Our study shows an increase in gut microbiota diversity in the acute phase of deep burn injury, rather than a decrease as is commonly believed. Severe burns result in a severe imbalance of the gut flora, with a decrease in probiotics and an increase in microorganisms that trigger inflammation and cognitive deficits, and multiple pathways of metabolism and substance synthesis are affected. Simple machine learning model testing suggests several bacterial genera as potential biomarkers of severe burn phenotypes.
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Affiliation(s)
- Bochen Hou
- Department of Neurology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
- Department of Clinical Data Research, Chongqing Emergency Medical Center, Chongqing Key Laboratory of Emergency Medicine, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, 400014, China
- School of Computer Science, Chongqing University, Chongqing, 400030, China
| | - Honglan Zhang
- Department of Neurology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Lina Zhou
- Department of Clinical Data Research, Chongqing Emergency Medical Center, Chongqing Key Laboratory of Emergency Medicine, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, 400014, China
| | - Biao Hu
- Chongqing University of Technology, Chongqing, 400054, China
| | - Wenyi Tang
- Department of Clinical Data Research, Chongqing Emergency Medical Center, Chongqing Key Laboratory of Emergency Medicine, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, 400014, China
| | - Bo Ye
- Department of Clinical Data Research, Chongqing Emergency Medical Center, Chongqing Key Laboratory of Emergency Medicine, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, 400014, China
| | - Cui Wang
- Department of Neurology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Yongmei Xu
- Department of Neurology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Lingyun Zou
- Department of Clinical Data Research, Chongqing Emergency Medical Center, Chongqing Key Laboratory of Emergency Medicine, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, 400014, China.
| | - Jun Hu
- Department of Neurology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China.
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Kittrick AM, Jones A, Morgan LT. Timepoint for return to occupations post-burn injury using the Canadian Occupational Performance Measure (COPM). Aust Occup Ther J 2024. [PMID: 38616179 DOI: 10.1111/1440-1630.12948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 03/03/2024] [Accepted: 03/09/2024] [Indexed: 04/16/2024]
Abstract
INTRODUCTION The Canadian Occupational Performance Measure (COPM) was implemented at a state-wide burns service to ensure compliance with current best evidence as outlined by the Australian and New Zealand Burns Association 'burn trauma rehabilitation: allied health practice guidelines'- Chapter 7 Measuring Post-Burn Recovery, as a standard outcome measure for individuals with an admission time greater than 24 h. The primary aim of this study is to determine if individuals have a minimal important change in performance and satisfaction with activities that were identified as problematic on the COPM prior to their acute discharge. Previous research confirmed the feasibility of using the COPM in the acute burn ward and recommended the most appropriate timepoint for re-measurement be confirmed, which is the secondary objective of this study. The benefits of confirming this timepoint include ensuring efficient use of clinicians' time without compromising the accuracy of the assessment and ensuring effective translation of the guidelines' recommendation. METHODS A prospective longitudinal study was undertaken, where all individuals who previously completed a COPM prior to acute discharge were sought to complete a re-assessment while accessing outpatient services. Time frames for re-assessment were open. Only individuals who were actively receiving occupational therapy outpatient services were included. COPM assessments were completed in person where possible, particularly for participants who required an interpreter, with phone and video calls also used when needed. RESULTS A total of 37 participants were included, with the timeframe between initial and post-COPM assessment ranging from 2 to 643 days. Outcomes plateaued at approximately 12 months (365 days) post-initial measurement (prior to discharge from acute ward). The most common occupational performance goals that participants identified were returning to work, sport, and driving. 86.5% of participants increased their satisfaction with these activities. The results of this study demonstrate improvements across the domains of performance and satisfaction occur for individuals with burns at approximately 3 months and 12 months post-injury. CONCLUSION Based on this study, it is suggested that when using the COPM assessment in a tertiary burn setting, re-measurement be completed no earlier than 3 months and later than 12 months from burn injury, or upon discharge from the service. The findings from this study will be translated into clinical practice at this facility.
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Affiliation(s)
- Andrea Mc Kittrick
- Department of Occupational Therapy, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Amber Jones
- Department of Occupational Therapy, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Lachlan T Morgan
- School of Allied Health, Australian Catholic University, Banyo, Australia
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Ouyang J, Sun L, She Z, Li R, Zeng F, Yao Z, Wu S. Microneedle System with Biomarker-Activatable Chromophore as Both Optical Imaging Probe and Anti-bacterial Agent for Combination Therapy of Bacterial-Infected Wounds and Outcome Monitoring. ACS APPLIED MATERIALS & INTERFACES 2024. [PMID: 38593207 DOI: 10.1021/acsami.4c03534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
Wounds infected with bacteria, if left untreated, have the potential to escalate into life-threatening conditions, such as sepsis, which is characterized by widespread inflammation and organ damage. A comprehensive approach to treating bacterial-infected wounds, encompassing the control of bacterial infection, biofilm eradication, and inflammation regulation, holds significant importance. Herein, a microneedle (MN) patch (FM@ST MN) has been developed, with silk fibroin (SF) and tannic acid-based hydrogel serving as the matrix. Encapsulated within the MNs are the AIEgen-based activatable probe (FQ-H2O2) and the NLRP3 inhibitor MCC950, serving as the optical reporter/antibacterial agent and the inflammation regulator, respectively. When applied onto bacterial-infected wounds, the MNs in FM@ST MN penetrate bacterial biofilms and gradually degrade, releasing FQ-H2O2 and MCC950. The released FQ-H2O2 responds to endogenously overexpressed reactive oxygen species (H2O2) at the wound site, generating a chromophore FQ-OH which emits noticeable NIR-II fluorescence and optoacoustic signals, enabling real-time imaging for outcome monitoring; and this chromophore also exhibits potent antibacterial capability due to its dual positive charges and shows negligible antibacterial resistance. However, the NLRP3 inhibitor MCC950, upon release, suppresses the activation of NLRP3 inflammasomes, thereby mitigating the inflammation triggered by bacterial infections and facilitating wound healing. Furthermore, SF in FM@ST MN aids in tissue repair and regeneration by promoting the proliferation of epidermal cells and fibroblasts and collagen synthesis. This MN system, free from antibiotics, holds promise as a solution for treating and monitoring bacterially infected wounds without the associated risk of antimicrobial resistance.
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Affiliation(s)
- Juan Ouyang
- Biomedical Division, State Key Laboratory of Luminescent Materials and Devices, Guangdong Provincial Key Laboratory of Luminescence from Molecular Aggregates, College of Materials Science and Engineering, South China University of Technology, Guangzhou 510640, China
| | - Lihe Sun
- Biomedical Division, State Key Laboratory of Luminescent Materials and Devices, Guangdong Provincial Key Laboratory of Luminescence from Molecular Aggregates, College of Materials Science and Engineering, South China University of Technology, Guangzhou 510640, China
| | - Zunpan She
- Biomedical Division, State Key Laboratory of Luminescent Materials and Devices, Guangdong Provincial Key Laboratory of Luminescence from Molecular Aggregates, College of Materials Science and Engineering, South China University of Technology, Guangzhou 510640, China
| | - Rong Li
- Biomedical Division, State Key Laboratory of Luminescent Materials and Devices, Guangdong Provincial Key Laboratory of Luminescence from Molecular Aggregates, College of Materials Science and Engineering, South China University of Technology, Guangzhou 510640, China
| | - Fang Zeng
- Biomedical Division, State Key Laboratory of Luminescent Materials and Devices, Guangdong Provincial Key Laboratory of Luminescence from Molecular Aggregates, College of Materials Science and Engineering, South China University of Technology, Guangzhou 510640, China
| | - Zhicheng Yao
- Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China
| | - Shuizhu Wu
- Biomedical Division, State Key Laboratory of Luminescent Materials and Devices, Guangdong Provincial Key Laboratory of Luminescence from Molecular Aggregates, College of Materials Science and Engineering, South China University of Technology, Guangzhou 510640, China
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Farzanbakhsh S, Shahrbaf MA, Madani H, Dahmardei M, Sadri B, Vosough M. A single-center, open-labeled, randomized, 6-month, parallel-group study to assess the safety and efficacy of allogeneic cultured keratinocyte sheet transplantation for deep second-degree burn wounds: rationale and design of phase I/II clinical trial. Trials 2024; 25:226. [PMID: 38556879 PMCID: PMC10983673 DOI: 10.1186/s13063-024-08070-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 03/20/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Burn-related injuries are a major global health issue, causing 180,000 deaths per year. Early debridement of necrotic tissue in association with a split-thickness skin graft is usually administered for some of the 2nd- and 3rd-degree injuries. However, this approach can be complicated by factors such as a lack of proper donor sites. Artificial skin substitutes have attracted much attention for burn-related injuries. Keratinocyte sheets are one of the skin substitutes that their safety and efficacy have been reported by previous studies. METHODS Two consecutive clinical trials were designed, one of them is phase I, a non-randomized, open-label trial with 5 patients, and phase II is a randomized and open-label trial with 35 patients. A total number of 40 patients diagnosed with 2nd-degree burn injury will receive allogenic keratinocyte sheet transplantation. The safety and efficacy of allogeneic skin graft with autograft skin transplantation and conventional treatments, including Vaseline dressing and topical antibiotic, will be compared in different wounds of a single patient in phase II. After the transplantation, patients will be followed up on days 3, 7, 10, 14, 21, and 28. In the 3rd and 6th months after the transplantation scar, a wound closure assessment will be conducted based on the Vancouver Scar Scale and the Patient and Observer Scar Assessment Scale. DISCUSSION This study will explain the design and rationale of a cellular-based skin substitute for the first time in Iran. In addition, this work proposes this product being registered as an off-the-shelf product for burn wound management in the country. TRIAL REGISTRATION Iranian Registry of Clinical Trials (IRCT) IRCT20080728001031N31, 2022-04-23 for phase I and IRCT20080728001031N36, 2024-03-15 for phase II.
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Affiliation(s)
- Shayan Farzanbakhsh
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Mohammad Amin Shahrbaf
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Hoda Madani
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Mostafa Dahmardei
- Department of Plastic & Reconstructive Surgery, School of Medicine, Stem Cell and Regenerative Medicine Research Center, Shahid Motahari Burns Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Bahareh Sadri
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Massoud Vosough
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran.
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Jeong T, Alessandri-Bonetti M, Pandya S, Liu H, Stofman GM, Egro FM. The Development and Management of Neck Burn Scar Contracture Recurrence: A Single-Center Retrospective Cohort Study. Ann Plast Surg 2024; 92:S142-S145. [PMID: 38556663 DOI: 10.1097/sap.0000000000003854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Burn neck contractures pose a great challenge for reconstructive surgeons. A paucity of literature exist regarding long-term outcomes based on different surgical management strategies. The aim of this study was to evaluate the long-term outcomes of the treatment of neck burn scar contractures and evaluate surgical strategies according to their long-term effectiveness and associated complications. METHODS A retrospective cohort study was conducted to review outcomes of neck contractures release after burn injury. All patients operated on between January 2009 and February 2023 at a single institution were included. RESULTS A total of 20 patients developed neck burn scar contracture and were included in this study. The mean age was 32.9 ± 20.3 years. The burn injuries were most commonly thermal (n = 19, 95%). All burn injuries were full-thickness burns, with an average neck defect size of 130.5 ± 106.0 cm2. Overall, 45 surgical scar release procedures were performed on the 20 patients who developed a neck contracture. Patients underwent 1.65 ± 1.04 surgeries on average to address neck contracture. Although 25% of patients only received 1 surgery to treat neck contracture, some patients underwent as many as 8 surgeries. Contracture recurrence (CR) was the most common complication and occurred in 28.9% of the cases. The mean percentage total body surface area did not significantly differ in CR patients (26.7% ± 14.9%) and no-CR patients (44.5% ± 30.2%). However, there was a significant difference (P = 0.01) in the average neck defect size between CR patients (198.5 ± 108.3 cm2) and no-CR patients (81.1 ± 75.1 cm2). CONCLUSIONS This study showed that risk factors for initial burn scar contractures may differ from those associated with CR, highlighting the importance of neck defect size as a predictor. The study also examines various surgical approaches, with Z-plasty showing promise for managing CR. However, the absence of data on neck range of motion is a limitation. This research underscores the complexity of managing CR and emphasizes the need for ongoing postoperative monitoring.
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Affiliation(s)
- Tiffany Jeong
- From the Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
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Collier ZJ, Gillenwater J. Fluid Resuscitation and Cardiovascular Support in Acute Burn Care. Clin Plast Surg 2024; 51:205-220. [PMID: 38429044 DOI: 10.1016/j.cps.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
Acute burn injury creates a complex and multifactorial local response which may have systemic sequelae such as hypovolemia, hypothermia, cardiovascular collapse, hypercoagulability, and multi-system organ failure. Understanding the underlying pathophysiology of burn shock, the initial burn triage and assessment, calculation of fluid requirements, and the means of tailoring ongoing interventions to optimize resuscitation are critical for overcoming the wide spectrum of derangements which this condition creates. As a result, this article discusses the various key points in order to garner a greater understanding of these nuances and the optimal pathway to take when tackling these challenging issues.
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Affiliation(s)
- Zachary J Collier
- Division of Plastic & Reconstructive Surgery, USC Department of Surgery, University of Chicago, 1510 San Pablo Street, Suite 415, Los Angeles, CA 90033, USA
| | - Justin Gillenwater
- Division of Plastic & Reconstructive Surgery, USC Department of Surgery, University of Chicago, 1510 San Pablo Street, Suite 415, Los Angeles, CA 90033, USA; Plastic and Reconstructive Surgery, University of Southern California.
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Boekema BKHL, Chrysostomou D, Ciprandi G, Elgersma A, Vlig M, Pokorná A, Peters LJF, Cremers NAJ. Comparing the antibacterial and healing properties of medical-grade honey and silver-based wound care products in burns. Burns 2024; 50:597-610. [PMID: 37940425 DOI: 10.1016/j.burns.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/28/2023] [Accepted: 10/05/2023] [Indexed: 11/10/2023]
Abstract
Burns are a major global healthcare concern, often complicated by the presence of bacteria such as Pseudomonas aeruginosa in the wounds. Silver-based dressings are commonly used in the treatment of burns but can cause skin irritation and delay healing time. Medical-grade honey (MGH) provides an interesting alternative. This study investigated the antimicrobial effects and possible cytotoxicity of L-Mesitran Soft (MGH-gel) and its individual components, Medihoney (Manuka), Flammazine (silver sulphadiazine), and silver nitrate (AgNO3) in an ex vivo human burn wound model. Bacterial survival and wound healing parameters, including re-epithelialization and keratinocyte proliferation were assessed. L-Mesitran, Flammazine, and AgNO3 reduced P. aeruginosa numbers below detection levels. L-Mesitran Soft exhibited a significantly stronger antimicrobial effect compared to Medihoney. The individual components of L-Mesitran contributed significantly to its antibacterial efficacy, thus suggesting synergistic activities. Moreover, L-Mesitran, Flammazine, and AgNO3 slightly inhibited re-epithelialization while Medihoney treatment resulted in a complete lack of re-epithelialization and keratinocyte proliferation. Furthermore, clinical cases illustrated the effectiveness of MGH therapy in infected burns. Overall, L-Mesitran Soft had similar effects as silver-based products on bacterial load and epidermal regeneration, but outperformed Medihoney. Therefore, supplemented MGH could be used as an effective alternative to silver-based dressings for P. aeruginosa-infected burns.
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Affiliation(s)
- Bouke K H L Boekema
- Preclinical Research, Association of Dutch Burn Centers (ADBC), P.O. Box 1015, 1940 AE Beverwijk, the Netherlands; Plastic, Reconstructive and Hand Surgery, AUMC, Amsterdam, the Netherlands
| | - Daniela Chrysostomou
- Wound Clinic Health@45, Linksfield Road 45, Dowerglen, Johannesburg 1612, South Africa; Department of Health Sciences, Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Guido Ciprandi
- Bambino Gesu' Children's Hospital, Research Institute Division of Plastic and Maxillofacial Surgery, Department of Surgery, Sant' Onofrio Square 4, 00165 Rome, Italy
| | - Anouk Elgersma
- Preclinical Research, Association of Dutch Burn Centers (ADBC), P.O. Box 1015, 1940 AE Beverwijk, the Netherlands
| | - Marcel Vlig
- Preclinical Research, Association of Dutch Burn Centers (ADBC), P.O. Box 1015, 1940 AE Beverwijk, the Netherlands
| | - Andrea Pokorná
- Department of Health Sciences, Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czech Republic; College of Polytechnics Jihlava, Jihlava, Czech Republic
| | - Linsey J F Peters
- Triticum Exploitatie BV, Sleperweg 44, 6222 NK Maastricht, the Netherlands
| | - Niels A J Cremers
- Triticum Exploitatie BV, Sleperweg 44, 6222 NK Maastricht, the Netherlands; Department of Gynecology and Obstetrics, Maastricht University Medical Center, 6202 AZ Maastricht, the Netherlands.
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Yang X, Zheng E, Sun X, Reynolds A, Gonzalez M, Villamil JH, Pando BD, Smith DJ, Yuan SY, Wu MH. C-TYPE LECTIN-2D RECEPTOR CONTRIBUTES TO HISTONE-INDUCED VASCULAR BARRIER DYSFUNCTION DURING BURN INJURY. Shock 2024; 61:592-600. [PMID: 37878490 PMCID: PMC10997737 DOI: 10.1097/shk.0000000000002237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
ABSTRACT Severe burns are associated with massive tissue destruction and cell death where nucleus histones and other damage-associated molecular patterns are released into the circulation and contribute to the pathogenesis of multiple-organ dysfunction. Currently, there is limited information regarding the pathophysiology of extracellular histones after burns, and the mechanisms underlying histone-induced vascular injury are not fully understood. In this study, by comparing the blood samples from healthy donors and burn patients, we confirmed that burn injury promoted the release of extracellular histones into the circulation, evidenced by increased plasma levels of histones correlating with injury severity. The direct effects of extracellular histones on human endothelial monolayers were examined, and the results showed that histones caused cell-cell adherens junction discontinuity and barrier dysfunction in a dose-related manner. Like burn patients, mice subjected to a scald burn covering 25% total body surface area also displayed significantly increased plasma histones. Intravital microscopic analysis of mouse mesenteric microcirculation indicated that treatment with a histone antibody greatly attenuated burn-induced plasma leakage in postcapillary venules, supporting the pathogenic role of extracellular histones in the development of microvascular barrier dysfunction during burns. At the molecular level, intrigued by the recent discovery of C-type lectin domain family 2 member D (Clec2d) as a novel receptor of histones, we tested its potential involvement in the histone interaction with endothelial cells. Indeed, we identified abundant expression of Clec2d in vascular endothelial cells. Further proximity ligation assay demonstrated a close association between extracellular histones and endothelial expressing Clec2d. Functionally, in vivo administration of an anti-Clec2d antibody attenuated burn-induced plasma leakage across mesenteric microvessels. Consistently, Clec2d knockdown in endothelial cells partially inhibited histone-induced endothelial barrier dysfunction. Together, our data suggest that burn injury-induced increases in circulating histones contribute to microvascular leakage and endothelial barrier dysfunction via a mechanism involving the endothelial Clec2d receptor.
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Affiliation(s)
- Xiaoyuan Yang
- Department of Molecular Pharmacology and Physiology, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Ethan Zheng
- Department of Molecular Pharmacology and Physiology, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Xiaoqi Sun
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Amanda Reynolds
- Department of Molecular Pharmacology and Physiology, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Monica Gonzalez
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Juan Hernandez Villamil
- Department of Molecular Pharmacology and Physiology, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Briana D. Pando
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - David J. Smith
- Department of Plastic Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Sarah Y. Yuan
- Department of Molecular Pharmacology and Physiology, University of South Florida Morsani College of Medicine, Tampa, Florida
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Mack H. Wu
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
- James A Haley Veterans’ Hospital, Tampa, Florida
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Yang L, Yuan B, Ju Y, Liu W, Wang Y. Effect of quality nursing care on wound pain and anxiety in burn patients: A meta-analysis. Int Wound J 2024; 21:e14798. [PMID: 38572761 PMCID: PMC10993347 DOI: 10.1111/iwj.14798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 02/04/2024] [Indexed: 04/05/2024] Open
Abstract
To systematically evaluate the effects of quality nursing care on wound pain and anxiety in burn patients. Computerised searches of PubMed, Google Scholar, Cochrane Library, Embase, Wanfang, China Biomedical Literature Database and China National Knowledge Infrastructure databases randomised controlled trials (RCTs) on the application of quality nursing care to burn patients were carried out from database inception to October 2023. Literature was screened and evaluated by two researchers based on inclusion and exclusion criteria, and data were extracted from the final included literature. Stata 17.0 software was employed for data analysis. Overall, 15 RCTs and 1115 burn patients were included, including 563 and 552 in the quality care and routine care groups. It was found that, compared with routine care, burn patients who implemented quality care had significantly less wound pain (SMD: -1.79, 95% CI: -2.22 to -1.36, p < 0.001), anxiety (SMD: -2.71. 95% CI: -3.49 to -1.92, p < 0.001) and depression (SMD: -1.74, 95% CI: -2.35 to -1.14, p < 0.001) levels were significantly reduced post-trauma.
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Affiliation(s)
- Ling Yang
- Department of BurnThe Southwest Hospital of Army Medical UniversityChongqingChina
| | - Bo‐Qin Yuan
- Department of BurnThe Southwest Hospital of Army Medical UniversityChongqingChina
| | - Yang‐Yang Ju
- Department of BurnThe Southwest Hospital of Army Medical UniversityChongqingChina
| | - Wei Liu
- Department of BurnThe Southwest Hospital of Army Medical UniversityChongqingChina
| | - Yang‐Ping Wang
- Department of BurnThe Southwest Hospital of Army Medical UniversityChongqingChina
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