Impact of Adding Protein Supplementation to Exercise Training on Lean Body Mass and Muscle Strength in Burn Patients

Effectiveness of physiotherapist-led exercise interventions for burn rehabilitation: A systematic review and meta-analysis

BACKGROUND

Exercise is utilised by physiotherapists to prevent complications and improve overall function and quality of life post-burn. However, the effect of physiotherapist-led exercise has not been comprehensively reviewed. Consequently, this study aimed to investigate the effectiveness of physiotherapy exercises for persons' post-burn.

METHODS

PubMed, CINAHL, Cochrane Library, and Web of Science were searched from database inception to September 27, 2024, to identify relevant studies. Two independent reviewers screened and selected the articles. Studies were included if they were randomised controlled trials of physiotherapy exercises to improve functional outcomes in persons with post burn injuries. Extracted data included author's surname and year, country, population type, sample size, age, and total body surface area, mode, frequency and duration of exercise. The quality of the evidence was assessed with the Cochrane risk of bias (RoB 2.0) tool. Narrative synthesis and meta-analysis were conducted to examine exercise effect on physical, physiological and psychological outcomes.

RESULTS

Out of 3610 records screened, eight articles involving 393 participants were deemed eligible for inclusion. Physiotherapy exercises significantly improved lean body mass and pulmonary function but did not improve quality of life. Meta-analysis showed significant effects for aerobic capacity (Hedge's g = 1.13, 95% confidence interval: 0.44-1.83, p = 0.00) and muscle strength (Hedge's g = 2.27, 95% confidence interval: 0.42-4.13, p = 0.02).

CONCLUSION

Physiotherapy exercises have positive impacts on physical, physiological and psychological outcomes particularly aerobic capacity and muscle strength in individuals' post burns. The heterogeneity in effects for all outcomes highlights the need for further research.

Whey protein-loaded 3D-printed poly (lactic) acid scaffolds for wound dressing applications

Chronic skin wounds pose a global clinical challenge, necessitating effective treatment strategies. This study explores the potential of 3D printed Poly Lactic Acid (PLA) scaffolds, enhanced with Whey Protein Concentrate (WPC) at varying concentrations (25, 35, and 50% wt), for wound healing applications. PLA's biocompatibility, biodegradability, and thermal stability make it an ideal material for medical applications. The addition of WPC aims to mimic the skin's extracellular matrix and enhance the bioactivity of the PLA scaffolds. Fourier Transform Infrared Spectroscopy results confirmed the successful loading of WPC into the 3D printed PLA-based scaffolds. Scanning Electron Microscopy (SEM) images revealed no significant differences in pore size between PLA/WPC scaffolds and pure PLA scaffolds. Mechanical strength tests showed similar tensile strength between pure PLA and PLA with 50% WPC scaffolds. However, scaffolds with lower WPC concentrations displayed reduced tensile strength. Notably, all PLA/WPC scaffolds exhibited increased strain at break compared to pure PLA. Swelling capacity was highest in PLA with 25% WPC, approximately 130% higher than pure PLA. Scaffolds with higher WPC concentrations also showed increased swelling and degradation rates. Drug release was found to be prolonged with increasing WPC concentration. After seven days of incubation, cell viability significantly increased in PLA with 50% WPC scaffolds compared to pure PLA scaffolds. This innovative approach could pave the way for personalized wound care strategies, offering tailored treatments and targeted drug delivery. However, further studies are needed to optimize the properties of these scaffolds and validate their effectiveness in clinical settings.

An Appraisal of Pharmacotherapy-Pertinent Literature Published in 2021 and 2022 for Clinicians Caring for Patients With Thermal or Inhalation Injury

Studies focusing on pharmacotherapy interventions to aid patients after thermal injury are a minor focus in burn injury-centered studies and published across a wide array of journals, which challenges those with limited resources to keep their knowledge current. This review is a renewal of previous years' work to facilitate extraction and review of the most recent pharmacotherapy-centric studies in patients with thermal and inhalation injury. Twenty-three geographically dispersed, board-certified pharmacists participated in the review. A Medical Subject Heading-based, filtered search returned 2336 manuscripts over the previous 2-year period. After manual review, 98 (4%) manuscripts were determined to have a potential impact on current pharmacotherapy practice. The top 10 scored manuscripts are discussed. Only 17% of those reviewed were assessed to likely have little effect on current practice. The overall impact of the current cohort was higher than previous editions of this review, which is encouraging. There remains a need for investment in well-designed, high-impact, pharmacotherapy-pertinent research for patients sustaining thermal or inhalation injuries.

Dietary supplementation with inulin improves burn-induced skeletal muscle atrophy by regulating gut microbiota disorders

Inulin, as a prebiotic, could modulate the gut microbiota. Burn injury leads to gut microbiota disorders and skeletal muscle catabolism. Therefore, whether inulin can improve burn-induced muscle atrophy by regulating microbiota disorders remains unknown. This study aimed to clarify that inulin intake alleviates gut microbiota disorders and skeletal muscle atrophy in burned rats. Rats were divided into the sham group, burn group, prebiotic inulin intervention group, and pseudo-aseptic validation group. A 30% total body surface area (TBSA) third-degree burn wound on dorsal skin was evaluated in all groups except the sham group. Animals in the intervention group received 7 g/L inulin. Animals in the validation group received antibiotic cocktail and inulin treatment. In our study inulin intervention could significantly alleviate the burn-induced skeletal muscle mass decrease and skeletal myoblast cell apoptosis. Inulin intake increased the abundances of Firmicutes and Actinobacteria but decreased the abundance of Proteobacteria. The biosynthesis of amino acids was the most meaningful metabolic pathway distinguishing the inulin intervention group from the burn group, and further mechanistic studies have shown that inulin can promote the phosphorylation of the myogenesis-related proteins PI3K, AKT and P70S6K and activate PI3K/AKT signaling for protein synthesis. In conclusion, inulin alleviated burn induced muscle atrophy through PI3K/AKT signaling and regulated gut microbiota dysbiosis.

Effects of a Graphene Heating Device on Fatigue Recovery of Biceps Brachii

Far-infrared (FIR) is considered to be an ideal method to promote fatigue recovery due to its high permeability and strong radiation. In this paper, we report a flexible and wearable graphene heating device to help fatigue recovery of human exercise by using its high FIR divergence property. This study compares two different fatigue recovery methods, graphene far-infrared heating device hot application and natural recovery, over a 20 min recovery time among the male colleges' exhaustion exercise. Experimental results show that the achieved graphene device holds excellent electro-thermal radiation conversion efficiency of 70% and normal total emissivity of 89%. Moreover, the graphene FIR therapy in our work is more energy-efficient, easy to use, and wearable than traditional fatigue recovery methods. Such an anti-fatigue strategy offers new opportunities for enlarging potential applications of graphene film in body science, athletic training recovery, and wearable devices.

Nutrition after severe burn injury

PURPOSE OF REVIEW

Severe burn injury causes significant metabolic changes and demands that make nutritional support particularly important. Feeding the severe burn patient is a real challenge in regard to the specific needs and the clinical constraints. This review aims to challenge the existing recommendations in the light of the few recently published data on nutritional support in burn patients.

RECENT FINDINGS

Some key macro- and micro-nutrients have been recently studied in severe burn patients. Repletion, complementation or supplementation of omega-3 fatty acids, vitamin C, vitamin D, antioxidant micronutrients may be promising from a physiologic perspective, but evidence of benefits on hard outcomes is still weak due to the studies' design. On the contrary, the anticipated positive effects of glutamine on the time to discharge, mortality and bacteremias have been disproved in the largest randomized controlled trial investigating glutamine supplementation in burns. An individualized approach in term of nutrients quantity and quality may proof highly valuable and needs to be validated in adequate trials. The combination of nutrition and physical exercises is another studied strategy that could improve muscle outcomes.

SUMMARY

Due to the low number of clinical trials focused on severe burn injury, most often including limited number of patients, developing new evidence-based guidelines is challenging. More high-quality trials are needed to improve the existing recommendations in the very next future.