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Salemans RFC, van Uden D, van Baar ME, Haanstra TM, van Schie CHM, van Zuijlen PPM, Lucas Y, Scholten-Jaegers SMHJ, Meij-de Vries A, Wood FM, Edgar DW, Spronk I, van der Vlies CH. Timing of surgery in acute deep partial-thickness burns: A study protocol. PLoS One 2024; 19:e0299809. [PMID: 38466683 PMCID: PMC10927102 DOI: 10.1371/journal.pone.0299809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/14/2024] [Indexed: 03/13/2024] Open
Abstract
For deep partial-thickness burns no consensus on the optimal treatment has been reached due to conflicting study outcomes with low quality evidence. Treatment options in high- and middle-income countries include conservative treatment with delayed excision and grafting if needed; and early excision and grafting. The majority of timing of surgery studies focus on survival rather than on quality of life. This study protocol describes a study that aims to compare long-term scar quality, clinical outcomes, and patient-reported outcomes between the treatment options. A multicentre prospective study will be conducted in the three Dutch burn centres (Rotterdam, Beverwijk, and Groningen). All adult patients with acute deep-partial thickness burns, based on healing potential with Laser Doppler Imaging, are eligible for inclusion. During a nine-month baseline period, standard practice will be monitored. This includes conservative treatment with dressings and topical agents, and excision and grafting of residual defects if needed 14-21 days post-burn. The subsequent nine months, early surgery is advocated, involving excision and grafting in the first week to ten days post-burn. The primary outcome compared between the two groups is long-term scar quality assessed by the Patient and Observer Scar Assessment Scale 3.0 twelve months after discharge. Secondary outcomes include clinical outcomes and patient-reported outcomes like quality of life and return to work. The aim of the study is to assess long-term scar quality in deep partial-thickness burns after conservative treatment with delayed excision and grafting if needed, compared to early excision and grafting. Adding to the ongoing debate on the optimal treatment of these burns. The broad range of studied outcomes will be used for the development of a decision aid for deep partial-thickness burns, to fully inform patients at the point of consent to surgery and support optimal person-centred care.
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Affiliation(s)
- Roos F. C. Salemans
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
- Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands
| | | | - Margriet E. van Baar
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Tjitske M. Haanstra
- Department of Dermal Therapy, Faculty of Health, Nutrition & Sport, The Hague University of Applied Sciences, The Hague, the Netherlands
- Dutch Burns Foundation, Beverwijk, the Netherlands
- Research Group Relational Care, Centre of Expertise Health Innovation, The Hague University of Applied Sciences, The Hague, the Netherlands
| | | | - Paul P. M. van Zuijlen
- Burn Centre, Red Cross Hospital, Beverwijk, the Netherlands
- Department of Plastic and Reconstructive Surgery, Red Cross Hospital, Beverwijk, the Netherlands
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam Movement Sciences Institute, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
- Paediatric Surgical Centre, Emma’s Children’s Hospital, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | - Ymke Lucas
- Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands
| | | | - Annebeth Meij-de Vries
- Burn Centre, Red Cross Hospital, Beverwijk, the Netherlands
- Paediatric Surgical Centre, Emma’s Children’s Hospital, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
- Department of Surgery, Red Cross Hospital, Beverwijk, the Netherlands
| | - Fiona M. Wood
- Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- State Adult Burn Unit, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, Western Australia, Australia
| | - Dale W. Edgar
- Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- State Adult Burn Unit, Fiona Stanley Hospital, South Metropolitan Health Service, Murdoch, Western Australia, Australia
- Institute for Health Research, Burn Injury Research Node, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
- Burn Injury Research Unit, Faculty of Medicine and Dentistry, University of Western Australia, Crawley, Western Australia, Australia
- Safety and Quality Unit, Armadale Kalamunda Group Health Service, East Metropolitan Health Service, Mt Nasura, Western Australia, Australia
| | - Inge Spronk
- Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands
- Department of Dermal Therapy, Faculty of Health, Nutrition & Sport, The Hague University of Applied Sciences, The Hague, the Netherlands
- Research Group Relational Care, Centre of Expertise Health Innovation, The Hague University of Applied Sciences, The Hague, the Netherlands
| | - Cornelis H. van der Vlies
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
- Department of Trauma and Burn Surgery, Maasstad Hospital, Rotterdam, the Netherlands
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Stanton E, Karanas Y, Pham T, Gillenwater J, Sheckter CC. Inpatient Complications and Outcomes for Burn Patients Admitted with Methamphetamine Intoxication. J Burn Care Res 2024:irae014. [PMID: 38285638 DOI: 10.1093/jbcr/irae014] [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: 11/22/2023] [Indexed: 01/31/2024]
Abstract
Methamphetamine intoxication frequently complicates inpatient burn admissions. While single-institution studies describe adverse outcomes during resuscitation, little is known about the risks of amphetamine intoxication on inpatient complications and perioperative management. The US National Trauma Data Bank was queried for burn encounters between 2017-2021. Amphetamine intoxication was identified on admission. Primary outcomes included death, stroke, and myocardial infarction (MI). Secondary outcomes included organ failure and surgical management. Multivariable regressions modeled outcomes adjusting for available covariates including demographics, total body surface area (TBSA) burned, and inhalation injury. Bonferroni adjustments were applied. Our study identified a total of 73,968 primary burn encounters with toxicology screens. Among these, 800 cases (1.1%) were found to have positive methamphetamine drug screens upon admission. Methamphetamine users were significantly older (41.7 versus 34.9 years, p<.001), had a greater percentage of males (69.6 vs. 65.4, p=.045), were more likely to have inhalation injury (p<.001) and had larger %TBSA burns (16% vs. 13%, (p<.001). Methamphetamine users were no more likely to die, experience MI, or experience stroke during admission. In contrast, methamphetamine users were significantly more likely to have alcohol withdrawal (p=.019), AKI (p<.001), deep vein thrombosis (DVT) (p=.001) , pulmonary embolism (PE) (p=.039), sepsis (p=.026), and longer ICU stays (p<.001). Methamphetamine use was associated with a longer number of days to first procedure (p=.005). Of all patients who required surgery (15.0%), methamphetamine users required significantly more total debridements and reconstructive procedures (p<.001). While not associated with mortality, methamphetamine intoxication was associated with an increased risk of many complications including PE, DVT, AKI, sepsis, and longer ICU stays. Methamphetamine intoxication was associated with delays in surgical care.
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Affiliation(s)
- Eloise Stanton
- Division of Plastic and Reconstructive Surgery, University of Southern California, USA
| | - Yvonne Karanas
- Regional Burn Center, Santa Clara Valley Medical Center, USA
| | - Tam Pham
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington, USA
| | - Justin Gillenwater
- Division of Plastic and Reconstructive Surgery, University of Southern California, USA
| | - Clifford C Sheckter
- Regional Burn Center, Santa Clara Valley Medical Center, USA
- Department of Surgery, Stanford University, USA
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Radzikowska-Büchner E, Łopuszyńska I, Flieger W, Tobiasz M, Maciejewski R, Flieger J. An Overview of Recent Developments in the Management of Burn Injuries. Int J Mol Sci 2023; 24:16357. [PMID: 38003548 PMCID: PMC10671630 DOI: 10.3390/ijms242216357] [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: 09/25/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
According to the World Health Organization (WHO), around 11 million people suffer from burns every year, and 180,000 die from them. A burn is a condition in which heat, chemical substances, an electrical current or other factors cause tissue damage. Burns mainly affect the skin, but can also affect deeper tissues such as bones or muscles. When burned, the skin loses its main functions, such as protection from the external environment, pathogens, evaporation and heat loss. Depending on the stage of the burn, the patient's condition and the cause of the burn, we need to choose the most appropriate treatment. Personalization and multidisciplinary collaboration are key to the successful management of burn patients. In this comprehensive review, we have collected and discussed the available treatment options, focusing on recent advances in topical treatments, wound cleansing, dressings, skin grafting, nutrition, pain and scar tissue management.
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Affiliation(s)
- Elżbieta Radzikowska-Büchner
- Department of Plastic, Reconstructive and Maxillary Surgery, National Medical Institute of the Ministry of the Interior and Administration, Wołoska 137 Street, 02-507 Warszawa, Poland;
| | - Inga Łopuszyńska
- Department of Plastic, Reconstructive and Maxillary Surgery, National Medical Institute of the Ministry of the Interior and Administration, Wołoska 137 Street, 02-507 Warszawa, Poland;
| | - Wojciech Flieger
- Department of Human Anatomy, Medical University of Lublin, Jaczewskiego 4 Street, 20-090 Lublin, Poland;
| | - Michał Tobiasz
- Department of Plastic Surgery, Reconstructive Surgery and Burn Treatment, Medical University of Lublin, Krasnystawska 52 Street, 21-010 Łęczna, Poland;
| | - Ryszard Maciejewski
- Faculty of Medicine, University of Warsaw, Żwirki i Wigury 101 Street, 02-089 Warszawa, Poland;
| | - Jolanta Flieger
- Department of Analytical Chemistry, Medical University of Lublin, Chodźki 4A Street, 20-093 Lublin, Poland
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Funasaka C, Hanai A, Zenda S, Mori K, Fukui M, Hirano N, Shinohara R, Fuse N, Wakabayashi M, Itagaki M, Tomioka Y, Nishina M, Arai Y, Kogawa T, Ozaki Y, Nishimura M, Kobayashi T, Hara F, Takano T, Mukohara T. Mitigation of paclitaxel-induced peripheral neuropathy in breast cancer patients using limb-cooling apparatus: a study protocol for a randomized controlled trial. Front Oncol 2023; 13:1216813. [PMID: 37483483 PMCID: PMC10361568 DOI: 10.3389/fonc.2023.1216813] [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: 05/04/2023] [Accepted: 06/16/2023] [Indexed: 07/25/2023] Open
Abstract
Background Chemotherapy-induced peripheral neuropathy (CIPN) is one of the most common adverse events that can significantly impair the quality of life of patients. Although limb cooling may be beneficial for preventing CIPN, logistical challenges exist in ensuring consistent efficacy and safety. The purpose of this randomized controlled trial is to validate whether limb cooling with strict temperature control can reduce CIPN in patients with breast cancer receiving weekly paclitaxel as a perioperative treatment. Methods This study is a multicenter, double-blinded, randomized controlled trial. We plan to enroll patients with breast cancer who are scheduled to receive 12 weekly doses of paclitaxel (60 min 80 mg/m2 intravenous infusion) as perioperative chemotherapy. Patients will be randomly divided into the intervention or control groups and undergo limb cooling therapy maintained at a constant temperature of 13°C and 25°C, respectively. The primary endpoint is the proportion of patients who report Patient Neurotoxicity Questionnaire (PNQ) ≥ D in their limbs by the end of the study treatment or at the time of discontinuation. Discussion The results of this trial will contribute to the establishment of new evidence for limb cooling therapy in the mitigation of CIPN and present a safe and stable cooling device that may be suitable for use in the clinic. Clinical trial registration https://jrct.niph.go.jp/en-latest-detail/jRCT2032210115, identifier jRCT2032210115.
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Affiliation(s)
- Chikako Funasaka
- Department of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
- Department of Experimental Therapeutics, National Cancer Center Hospital East, Kashiwa, Japan
| | - Akiko Hanai
- Medical Data Mathematical Reasoning Team, Advanced Data Science Project, RIKEN, Yokohama, Japan
| | - Sadamoto Zenda
- Department of Radiation Oncology, National Cancer Center Hospital East, Kashiwa, Japan
- Supportive and Palliative Care Research Support Office, National Cancer Center Hospital East, Kashiwa, Japan
| | - Keita Mori
- Department of Biostatistics, Clinical Research Center, Shizuoka Cancer Center, Shizuoka, Japan
| | - Makoto Fukui
- Clinical Research Support Office, National Cancer Center Hospital East, Kashiwa, Japan
| | - Nami Hirano
- Clinical Research Support Office, National Cancer Center Hospital East, Kashiwa, Japan
| | - Rie Shinohara
- Clinical Research Support Office, National Cancer Center Hospital East, Kashiwa, Japan
| | - Nozomu Fuse
- Clinical Research Support Office, National Cancer Center Hospital East, Kashiwa, Japan
| | - Masashi Wakabayashi
- Clinical Research Support Office, National Cancer Center Hospital East, Kashiwa, Japan
| | - Mai Itagaki
- Section of Research Administration, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yutaka Tomioka
- Division of Medical Device Innovation, National Cancer Center Hospital East, Kashiwa, Japan
| | - Michihiko Nishina
- Planning and Product Development Division, Nippon Sigmax Co, Ltd., Shinjuku, Tokyo, Japan
| | - Yasuaki Arai
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Takahiro Kogawa
- Department of Advanced Medical Development, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yukinori Ozaki
- Department of Advanced Medical Development, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
- Department of Breast Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Meiko Nishimura
- Department of Breast Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takayuki Kobayashi
- Department of Breast Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Fumikata Hara
- Department of Breast Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toshimi Takano
- Department of Breast Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toru Mukohara
- Department of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
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Photopolymerized silk fibroin gel for advanced burn wound care. Int J Biol Macromol 2023; 233:123569. [PMID: 36758758 DOI: 10.1016/j.ijbiomac.2023.123569] [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: 12/09/2022] [Revised: 01/24/2023] [Accepted: 02/02/2023] [Indexed: 02/10/2023]
Abstract
The future of burn wound treatment lies in developing bioactive dressings for faster and more effective healing and regeneration. Silk fibroin (SF) hydrogels have proven regenerative abilities and are being explored as a burn wound dressing. However, unfavorable gelation conditions limit the processability and clinical application. Herein a white light-responsive photopolymerization technique was adapted for gelation via photooxidation of tyrosine. To render the gel suitable for application to irregular and non-planar burn surfaces, SF gel-incorporated dressing (SFD) was fabricated. The mild gelation conditions using white light afforded the loading of drugs for local delivery. The moisture balance ability of the dressing was confirmed by the favorable measures of swelling capacity (106 ± 1 %) and moisture retention (≈10 h). The in vitro cytocompatibility of the gel was confirmed using HaCaT cells. Finally, in vivo performance of the SFD was tested on a second-degree burn in a rodent model. The gross analysis and histological assessment revealed scarless healing in SFD-treated groups. Overall, the SFD developed in this work is shown to be a promising candidate for advanced burn wound care.
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Francisco P, Neves Amaral M, Neves A, Ferreira-Gonçalves T, Viana AS, Catarino J, Faísca P, Simões S, Perdigão J, Charmier AJ, Gaspar MM, Reis CP. Pluronic® F127 Hydrogel Containing Silver Nanoparticles in Skin Burn Regeneration: An Experimental Approach from Fundamental to Translational Research. Gels 2023; 9:gels9030200. [PMID: 36975649 PMCID: PMC10048756 DOI: 10.3390/gels9030200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/09/2023] Open
Abstract
Presently, skin burns are considered one of the main public health problems and lack therapeutic options. In recent years, silver nanoparticles (AgNPs) have been widely studied, playing an increasingly important role in wound healing due to their antibacterial activity. This work is focused on the production and characterization of AgNPs loaded in a Pluronic® F127 hydrogel, as well as assessing its antimicrobial and wound-healing potential. Pluronic® F127 has been extensively explored for therapeutic applications mainly due to its appealing properties. The developed AgNPs had an average size of 48.04 ± 14.87 nm (when prepared by method C) and a negative surface charge. Macroscopically, the AgNPs solution presented a translucent yellow coloration with a characteristic absorption peak at 407 nm. Microscopically, the AgNPs presented a multiform morphology with small sizes (~50 nm). Skin permeation studies revealed that no AgNPs permeated the skin after 24 h. AgNPs further demonstrated antimicrobial activity against different bacterial species predominant in burns. A chemical burn model was developed to perform preliminary in vivo assays and the results showed that the performance of the developed AgNPs loaded in hydrogel, with smaller silver dose, was comparable with a commercial silver cream using higher doses. In conclusion, hydrogel-loaded AgNPs is potentially an important resource in the treatment of skin burns due to their proven efficacy by topical administration.
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Affiliation(s)
- Pedro Francisco
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, 1649-003 Lisbon, Portugal
| | - Mariana Neves Amaral
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, 1649-003 Lisbon, Portugal
- Instituto de Biofísica e Engenharia Biomédica (IBEB), Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016 Lisbon, Portugal
| | - Afonso Neves
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, 1649-003 Lisbon, Portugal
| | - Tânia Ferreira-Gonçalves
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, 1649-003 Lisbon, Portugal
- Instituto de Biofísica e Engenharia Biomédica (IBEB), Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016 Lisbon, Portugal
| | - Ana S. Viana
- Centro de Química Estrutural, Institute of Molecular Sciences, Faculdade de Ciências, Universidade de Lisboa, 1749-016 Lisbon, Portugal
| | - José Catarino
- Faculdade de Medicina Veterinária, Universidade Lusoófona de Humanidades e Tecnologias, 1749-024 Lisbon, Portugal
| | - Pedro Faísca
- Faculdade de Medicina Veterinária, Universidade Lusoófona de Humanidades e Tecnologias, 1749-024 Lisbon, Portugal
- CBIOS—Research Center for Biosciences & Health Technologies, Universidade Lusófona de Humanidades e Tecnologias, Campo Grande 376, 1749-024 Lisbon, Portugal
| | - Sandra Simões
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, 1649-003 Lisbon, Portugal
| | - João Perdigão
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, 1649-003 Lisbon, Portugal
| | - Adília J. Charmier
- DREAMS, Universidade Lusófona de Humanidades e Tecnologias, Campo Grande 376, 1749-024 Lisbon, Portugal
| | - M. Manuela Gaspar
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, 1649-003 Lisbon, Portugal
| | - Catarina Pinto Reis
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, 1649-003 Lisbon, Portugal
- Instituto de Biofísica e Engenharia Biomédica (IBEB), Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016 Lisbon, Portugal
- Correspondence: ; Tel.: +351-217-946-429 (ext. 14244)
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Żwierełło W, Piorun K, Skórka-Majewicz M, Maruszewska A, Antoniewski J, Gutowska I. Burns: Classification, Pathophysiology, and Treatment: A Review. Int J Mol Sci 2023; 24:ijms24043749. [PMID: 36835171 PMCID: PMC9959609 DOI: 10.3390/ijms24043749] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/05/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
Burns and their treatment are a significant medical problem. The loss of the physical barrier function of the skin opens the door to microbial invasion and can lead to infection. The repair process of the damage caused by the burn is impaired due to the enhanced loss of fluids and minerals through the burn wound, the onset of hypermetabolism with the concomitant disruption of nutrient supply, and derangements in the endocrine system. In addition, the initiated inflammatory and free radical processes drive the progression of oxidative stress, the inhibition of which largely depends on an adequate supply of antioxidants and minerals. Clinical experience and research provide more and more data to make the treatment of patients with thermal injury increasingly effective. The publication discusses disorders occurring in patients after thermal injury and the methods used at various stages of treatment.
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Affiliation(s)
- Wojciech Żwierełło
- Department of Medical Chemistry, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Krzysztof Piorun
- West Pomeranian Center for Treating Severe Burns and Plastic Surgery, 72-300 Gryfice, Poland
| | - Marta Skórka-Majewicz
- Department of Medical Chemistry, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Agnieszka Maruszewska
- Department of Physiology and Biochemistry, Institute of Biology, University of Szczecin, 71-412 Szczecin, Poland
| | - Jacek Antoniewski
- Department of Medical Chemistry, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Izabela Gutowska
- Department of Medical Chemistry, Pomeranian Medical University, 70-204 Szczecin, Poland
- Correspondence:
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8
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Hayashi K, Sasabuchi Y, Matsui H, Nakajima M, Otawara M, Ohbe H, Fushimi K, Ono K, Yasunaga H. Does early excision or skin grafting of severe burns improve prognosis? A retrospective cohort study. Burns 2023; 49:554-561. [PMID: 36774244 DOI: 10.1016/j.burns.2023.01.013] [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: 09/22/2022] [Revised: 01/17/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
The present study aimed to investigate the appropriate timing of excision or skin grafting of burn wounds in patients with severe burns. We retrospectively analyzed data from the Diagnosis Procedure Combination Database, a nationwide inpatient database in Japan. Patients with severe burns (burn index ≥10) who underwent excision or skin grafting within 7 days from September 2010 to March 2019 were included. We defined the early surgery group as patients who underwent excision or skin grafting within 2 days of admission and the delayed surgery group as those who underwent surgery within 3-7 days of admission. Propensity score matching was used to compare the in-hospital mortality between the two groups, yielding a cohort of 389 pairs. A total of 2362 eligible patients were categorized into the early surgery group (n = 626) and delayed surgery group (n = 1736). The overall in-hospital mortality was 19.6%. In-hospital mortality did not differ significantly between the early surgery (15.9%) and the delayed surgery groups (17.2%; p = 0.70). These results suggest that excision or skin grafting within 2 days of admission was not associated with improved in-hospital mortality compared with surgery thereafter for patients with severe burns.
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Affiliation(s)
- Kentaro Hayashi
- Department of Emergency and Critical Care Medicine, Dokkyo Medical University, Tochigi, Japan; Data Science Center, Jichi Medical University, Tochigi, Japan.
| | | | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Mikio Nakajima
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan; Emergency and Critical Care Center, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan; Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Masayuki Otawara
- Emergency and Critical Care Center, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan; Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Kazuyuki Ono
- Department of Emergency and Critical Care Medicine, Dokkyo Medical University, Tochigi, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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9
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Burns. PHYSICIAN ASSISTANT CLINICS 2023. [DOI: 10.1016/j.cpha.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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10
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Altemir A, Boixeda P. [Translated article] Laser Treatment of Burn Scars. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:T938-T944. [DOI: 10.1016/j.ad.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 06/20/2022] [Indexed: 11/07/2022] Open
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Altemir A, Boixeda P. Tratamiento láser de cicatrices por quemaduras. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:938-944. [DOI: 10.1016/j.ad.2022.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 05/31/2022] [Accepted: 06/20/2022] [Indexed: 10/15/2022] Open
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Han D, Wei Y, Li Y, Zha X, Li R, Xia C, Li Y, Yang H, Xie J, Tian S. Epidemiological and Clinical Characteristics of 5,569 Pediatric Burns in Central China From 2013 to 2019. Front Public Health 2022; 10:751615. [PMID: 35425744 PMCID: PMC9001893 DOI: 10.3389/fpubh.2022.751615] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 03/03/2022] [Indexed: 11/21/2022] Open
Abstract
Background Pediatric burns of all the ages are prevalent worldwide, posing a severe health risk to children. This study aims to examine pediatric burns' clinical characteristics and epidemiology in central China. Methods The pediatric patients of the Burn Research Center, Department of the First People's Hospital of Zhengzhou City from 2013 to 2019 were retrospectively studied and the relevant data were collected from the hospitalized medical records [e.g., demographic, etiology, length of stay (LOS), age, gender, burn area and depth, number of surgeries, cost, and outcome]. Results A total of 5,569 pediatric burn patients were included, accounting for 43.9% of the total burn population. Electric burns represented a relatively small proportion (1.17%) but were more likely to lead to disabilities or death than scalds (90.63%) and flames (5.12%). The median age was 2 years [interquartile range (IQR): 1–4] and the boys/girls ratio ranged from 1.3:1 to 1.6:1. The most commonly burnt anatomic sites were the limbs (38.3%), with a median %TBSA (total body surface area) of 6 (IQR: 4–10). The complications of shock and pneumonia accounted for 7.6 and 19.2%, respectively. The peak months of pediatric burns included January, May, and August and the rural/urban ratio reached 1.61:1. The percentage of burn wounds treated surgically increased considerably from 2013 to 2019 (3.8 vs. 37.8%). The median hospital LOS was 15 days (IQR: 8–28 days), with the three high-risk factors (e.g., more surgeries, more %TBSA, full-thickness skin burns). The median cost of hospitalization was 1,511 USD (IQR: 848–2,648 USD) and the main risk factors consisted of full-thickness burns, more %TBSA, longer LOS, and more surgical procedures. Among all the patients, LA50 was 78.63% (95% CI = 75.12–83.45) and the overall mortality reached 0.1% since seven deaths were recorded. Conclusion Scalds, flames, contact, and chemicals are the main causes of burns among children aged 1–5 years in central China. Accordingly, various prevention strategies should be employed depending upon the cause of the burn.
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Affiliation(s)
- Dawei Han
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou, China
| | - Ying Wei
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou, China
| | - Yancang Li
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou, China
| | - Xinjian Zha
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou, China
| | - Rui Li
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chengde Xia
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou, China
| | - Yun Li
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou, China
| | - Huanna Yang
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou, China
| | - Jiangfan Xie
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou, China
| | - Shemin Tian
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou, China
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Expert consensus on the prevention and first-aid management of burns in children. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:1191-1199. [PMID: 34911600 PMCID: PMC8690712 DOI: 10.7499/j.issn.1008-8830.2109026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Burns are the second leading cause of unintentional injuries in children and are one of the major causes of disability in children. Timely and effective first-aid management of burns can have a major impact on the prognosis, but there is still a lack of the knowledge on burn management in the general public. With reference to expert opinions and related literature, this consensus summarizes the causes of burns, preventive measures, first-aid methods for common types of burns, and the prevention and treatment of serious complications of burns. It also provides recommendations on the most appropriate pre-hospital treatment. This consensus aims to emphasize the importance of burn prevention, improve the ability of first-aid treatment among witnesses and rescuers, avoid further injury caused by inappropriate treatment, and reduce the mortality and disability rates of burns and the harm to family and society. It can be used as guidance for pre-hospital treatment of childhood burns by first responders, parents, and passers-by.
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Sun T, Ying W, Wang S, Chen C, Sun P, Tan J. Clinical Application of Vacuum Sealing Drainage for the Treatment of Deep Burn Wounds. Am Surg 2021:31348211054527. [PMID: 34797180 DOI: 10.1177/00031348211054527] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study aimed to determine the effect of the clinical application of vacuum sealing drainage (VSD) on the treatment of deep burn wounds. METHODS This single-blind, randomized, controlled study included patients who were admitted to our hospital with deep burns from January 2018 to December 2020; the patients were randomly divided into the VSD and control (CON) groups. The number of days from treatment to skin grafting; survival rate of the first skin graft; rate of positive bacterial culture; visual analog scale (VAS) pain score; and durations of wound healing, antibiotic drug use, and hospitalization were analyzed and compared between the groups. RESULTS The application of VSD significantly shortened the number of days from treatment to skin grafting (P < .05); improved the survival rate of the first skin graft in patients with severe burns (P < .05); reduced the rate of positive bacterial culture (P < .05); reduced the VAS pain score (P < .05); and shortened the durations of wound healing (P < .05), antibiotic drug use (P < .05), and hospitalization (P < .05). CONCLUSION Vacuum sealing drainage had a good clinical effect on the recovery of deep burn wounds.
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Affiliation(s)
- Tao Sun
- Department of Burns and Plastic Surgery, The First People's Hospital of Wenling, Wenling, China
| | - Wenjie Ying
- Department of Burns and Plastic Surgery, The First People's Hospital of Wenling, Wenling, China
| | - Shuangshuang Wang
- Department of Burns and Plastic Surgery, The First People's Hospital of Wenling, Wenling, China
| | - Caiqiang Chen
- Department of Burns and Plastic Surgery, The First People's Hospital of Wenling, Wenling, China
| | - Pengyu Sun
- Department of Burns and Plastic Surgery, The First People's Hospital of Wenling, Wenling, China
| | - Jinglei Tan
- Department of Burns and Plastic Surgery, The First People's Hospital of Wenling, Wenling, China
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Recognition and Management of Toxic Erythema of Chemotherapy for the Inpatient Dermatologist. CURRENT DERMATOLOGY REPORTS 2021. [DOI: 10.1007/s13671-021-00344-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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16
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Lumintang L, Adnyana IMS, Hamid AR, Sanjaya H, Golden N, Astawa P, Darmajaya M, Sumadi IWJ. The Effect of Topical Corticosteroid Time of Application on Fibroblast and Type III Collagen Expression in Oryctolagus cuniculus with Deep Dermal Burn Wound (As an Indicator for the Best Time to Start Topical Corticosteroid Application in Preventing Hypertrophic Scar). Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Hypertrophic scar is an abnormal scar that causes physical deteriorations, psychological problems, and aesthetic issues. An excessive number of fibroblasts and collagen III expressions are histopathology indicators for the hypertrophic scar. The role of topical corticosteroids in suppressing inflammation and hypergranulation had widely demonstrated in previous studies. However, there is no study related to the application of topical corticosteroids as prevention of hypertrophic scars from burn wound found. Hence, this study aimed to examine the evidence of the effects of corticosteroid topical in decreasing the number of fibroblasts and type III collagen expression and the best time to start its application in preventing hypertrophic scars.
Methods: This randomized experimental post-test only study involved 54 deep dermal burn wounds on the ventral ear of female Oryctolagus cuniculus that distributed into three groups based on the healing phases. Each group consisted of treatments and controls. Corticosteroid topical application on the first treatment group (inflammatory phase group), the second group (proliferation phase group), and the third group (remodelling phase group) was started on day 3, on day 10, and day 21, respectively. Specimens taken on day 35. Haematoxylin-Eosin and Immunohistochemically staining performed to measure the number of fibroblasts and type III collagen and to observe the epithelization and inflammation process.
Results: The number of fibroblasts significantly decreased in the second treatment group (p =0.001) and followed by the first group (p = 0.016), but no significant decrease found in the third group (p = 0.430). The type III collagen decreased significantly in the second treatment group (p = 0.000) and followed by the third group (p = 0.019), but no significant decrease found in the first group. There was no statistically different number of fibroblast and type III collagen discovered between the controls. Complete epithelization found in all groups. Also, no ongoing inflammation found in all groups.
Conclusion
: Topical corticosteroids on deep dermal burn wound revealed to be effective in reducing the number of fibroblasts and type III collagen with no healing disruption. The proliferation phase found to be the best time to start the application of topical corticosteroids.
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Wu M, Rubin AE, Dai T, Schloss R, Usta OB, Golberg A, Yarmush M. High-Voltage, Pulsed Electric Fields Eliminate Pseudomonas aeruginosa Stable Infection in a Mouse Burn Model. Adv Wound Care (New Rochelle) 2021; 10:477-489. [PMID: 33066719 DOI: 10.1089/wound.2019.1147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective: The incidence of severe infectious complications after burn injury increases mortality by 40%. However, traditional approaches for managing burn infections are not always effective. High-voltage, pulsed electric field (PEF) treatment shortly after a burn injury has demonstrated an antimicrobial effect in vivo; however, the working parameters and long-term effects of PEF treatment have not yet been investigated. Approach: Nine sets of PEF parameters were investigated to optimize the applied voltage, pulse duration, and frequency or pulse repetition for disinfection of Pseudomonas aeruginosa infection in a stable mouse burn wound model. The bacterial load after PEF administration was monitored for 3 days through bioluminescence imaging. Histological assessments and inflammation response analyses were performed at 1 and 24 h after the therapy. Results: Among all tested PEF parameters, the best disinfection efficacy of P. aeruginosa infection was achieved with a combination of 500 V, 100 μs, and 200 pulses delivered at 3 Hz through two plate electrodes positioned 1 mm apart for up to 3 days after the injury. Histological examinations revealed fewer inflammatory signs in PEF-treated wounds compared with untreated infected burns. Moreover, the expression levels of multiple inflammatory-related cytokines (interleukin [IL]-1α/β, IL-6, IL-10, leukemia inhibitory factor [LIF], and tumor necrosis factor-alpha [TNF-α]), chemokines (macrophage inflammatory protein [MIP]-1α/β and monocyte chemoattractant protein-1 [MCP-1]), and inflammation-related factors (vascular endothelial growth factor [VEGF], macrophage colony-stimulating factor [M-CSF], and granulocyte-macrophage colony-stimulating factor [G-CSF]) were significantly decreased in the infected burn wound after PEF treatment. Innovation: We showed that PEF treatment on infected wounds reduces the P. aeruginosa load and modulates inflammatory responses. Conclusion: The data presented in this study suggest that PEF treatment is a potent candidate for antimicrobial therapy for P. aeruginosa burn infections.
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Affiliation(s)
- Mengjie Wu
- Department of Orthodontics, The Affiliated Stomatology Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Center of Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrey Ethan Rubin
- Porter School of Environment and Earth Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Tianhong Dai
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Vaccine and Immunotherapy Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rene Schloss
- Department of Biomedical Engineering, Rutgers University, Piscataway, New Jersey, USA
| | - Osman Berk Usta
- Center of Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexander Golberg
- Porter School of Environment and Earth Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Martin Yarmush
- Center of Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Biomedical Engineering, Rutgers University, Piscataway, New Jersey, USA
- Shriners Burn Hospital for Children, Boston, Massachusetts, USA
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18
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Qadir A, Ahmad U, Ali A, Shahid A, Aqil M, Khan N, Ali A, Almalki WH, Alghamdi S, Barkat MA, Beg S. Lipid engineered nanoparticle therapy for burn wound treatment. Curr Pharm Biotechnol 2021; 23:1449-1459. [PMID: 34425743 DOI: 10.2174/1389201022666210823110532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 07/04/2021] [Accepted: 07/06/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Skin is the largest organ of the human body protecting the underlying organs and tissues from any foreign attack. Any damage caused in the skin may sometimes result in serious consequences within the internal body tissues. Burn is one such issue that damage the layers of skin and thereby makingthe skin vulnerableand pronefor any foreign matter to enter and cause serious diseases. METHODS An online literature assessment was steered for the lipid nanoparticles, burn wound treatments, and different types of nanoformulation. Appropriate information was taken from different electronic scientific databases such as Web of Science, Elsevier, Science Direct, Springer, PubMed, Google Scholar etc.,Additional data was summarized from textbooks, local prints and scripts. RESULTS Recent innovations and developments in nanotechnology-based drug delivery systems has shown promising results in minimizing the drawbacks associated with conventional therapies. Lipid based nanoparticles possess capabilities to deliver active agents to their target site without the possibility of degradation. Conventional therapy of burn wound is costly and the treatment is long lasting, making the patient uncomfortable. Moreover, italso doesn't yield satisfactory results or narrow effects.Encapsulation of bioactives inside the lipid core protects the active entity from pH and enzymatic degradations. CONCLUSION This review highlights the drawbacks associated with the conventional dosage forms. A lot of consideration is focused on the advancement of nanomaterials using innovative methods in wound care for treating burn wounds with the faster healing effect.This review article highlights recent developments in lipid based nanoformulations for treatment of burn wound injury.
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Affiliation(s)
- Abdul Qadir
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard New Delhi. India
| | - Usama Ahmad
- Faculty of Pharmacy, Integral University, Lucknow. India
| | - Asad Ali
- Faculty of Pharmacy, Integral University, Lucknow. India
| | - Aisha Shahid
- Faculty of Pharmacy, Integral University, Lucknow. India
| | - Mohd Aqil
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard New Delhi. India
| | - Nausheen Khan
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard New Delhi. India
| | - Athar Ali
- Centre for Transgenic Plant Development, Department of Biotechnology, Jamia Hamdard, New Delhi. India
| | - Waleed H Almalki
- Department of Pharmacology and Toxicology, College of Pharmacy, Umm Al-Qura University, Makkah. Saudi Arabia
| | - Saad Alghamdi
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah. Saudi Arabia
| | - Md Abul Barkat
- Department of Pharmaceutics, College of Pharmacy, University of Hafr Al Batin, Al Jamiah, Hafr Al Batin 39524. Saudi Arabia
| | - Sarwar Beg
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard New Delhi. India
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Hew JJ, Parungao RJ, Mooney CP, Smyth JK, Kim S, Tsai KHY, Shi H, Chong C, Chan RCF, Attia B, Nicholls C, Li Z, Solon-Biet SM, Le Couteur DG, Simpson SJ, Jeschke MG, Maitz PK, Wang Y. Low-protein diet accelerates wound healing in mice post-acute injury. BURNS & TRAUMA 2021; 9:tkab010. [PMID: 34377708 PMCID: PMC8350350 DOI: 10.1093/burnst/tkab010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/06/2020] [Accepted: 03/11/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Wound healing processes are influenced by macronutrient intake (protein, carbohydrate and fat). The most favourable diet for cutaneous wound healing is not known, although high-protein diets are currently favoured clinically. This experimental study investigates the optimal macronutrient balance for cutaneous wound healing using a mouse model and the Geometric Framework, a nutrient modelling method, capable of analyzing the individual and interactive effects of a wide spectrum of macronutrient intake. METHODS Two adjacent and identical full-thickness skin excisions (1 cm2) were surgically created on the dorsal area of male C57BL/6 mice. Mice were then allocated to one of 12 high-energy diets that varied in protein, carbohydrate and fat content. In select diets, wound healing processes, cytokine expression, energy expenditure, body composition, muscle and fat reserves were assessed. RESULTS Using the Geometric Framework, we show that a low-protein intake, coupled with a balanced intake of carbohydrate and fat is optimal for wound healing. Mice fed a low-protein diet progressed quickly through wound healing stages with favourable wound inflammatory cytokine expression and significantly accelerated collagen production. These local processes were associated with an increased early systemic inflammatory response and a higher overall energy expenditure, related to metabolic changes occurring in key macronutrient reserves in lean body mass and fat depots. CONCLUSIONS The results suggest that a low-protein diet may have a greater potential to accelerate wound healing than the current clinically used high-protein diets.
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Affiliation(s)
- Jonathan J Hew
- Burns Research and Reconstructive Surgery, ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney, Australia 2139
| | - Roxanne J Parungao
- Burns Research and Reconstructive Surgery, ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney, Australia 2139
| | - Craig P Mooney
- Burns Research and Reconstructive Surgery, ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney, Australia 2139
| | - Julian K Smyth
- Burns Research and Reconstructive Surgery, ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney, Australia 2139
| | - Sarah Kim
- Bone Biology Group, ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney, Australia 2139
| | - Kevin H-Y Tsai
- Adrenal Steroids Laboratory, ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney, Australia 2139
| | - Huaikai Shi
- Burns Research and Reconstructive Surgery, ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney, Australia 2139
| | - Cassandra Chong
- Burns Research and Reconstructive Surgery, ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney, Australia 2139
| | - Renee C F Chan
- Electron Microscopy Unit, Anatomical Pathology, Concord Hospital, Sydney, Australia 2139
| | - Beba Attia
- Electron Microscopy Unit, Anatomical Pathology, Concord Hospital, Sydney, Australia 2139
| | - Caroline Nicholls
- Burns Unit, Concord Repatriation General Hospital, Concord, Australia 2139
| | - Zhe Li
- Burns Research and Reconstructive Surgery, ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney, Australia 2139
- Burns Unit, Concord Repatriation General Hospital, Concord, Australia 2139
| | - Samantha M Solon-Biet
- Ageing and Alzheimer Institute and ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney, Australia 2139
- Charles Perkins Centre and School of Life and Environmental Sciences, University of Sydney, Australia 2006
| | - David G Le Couteur
- Ageing and Alzheimer Institute and ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney, Australia 2139
| | - Stephen J Simpson
- Charles Perkins Centre and School of Life and Environmental Sciences, University of Sydney, Australia 2006
| | - Marc G Jeschke
- Sunnybrook Research Institute, Toronto, Ontario, Canada, M4N 3M5
| | - Peter K Maitz
- Burns Research and Reconstructive Surgery, ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney, Australia 2139
- Burns Unit, Concord Repatriation General Hospital, Concord, Australia 2139
| | - Yiwei Wang
- Burns Research and Reconstructive Surgery, ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney, Australia 2139
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, PR China 210023
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20
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Zhu Z, Kong W, Wang H, Xiao Y, Shi Y, Gan L, Sun Y, Tang H, Xia Z. Prevalence and predictors of scar contracture-associated re-hospitalisation among burn inpatients in China. Sci Rep 2021; 11:14973. [PMID: 34294790 PMCID: PMC8298512 DOI: 10.1038/s41598-021-94432-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/09/2021] [Indexed: 11/16/2022] Open
Abstract
Scar contracture, a common destructive complication causing increased re-hospitalisation rate of burn survivors and aggravated burden on the medical system, may be more seriously in Chinese population because of their higher susceptibility to scar formation. This study aims to evaluate the prevalence and predictors of scar contracture-associated re-hospitalisation among Chinese burn inpatients. This cross-sectional study screened burn inpatients hospitalised during 2013 to 2018 through the Hospital Quality Monitoring System database, among whom re-hospitalised for scar contracture were identified. Variables including sex, age, occupations, burn area, burn site and surgical treatment were analysed. Potential predictors of scar contracture-associated re-hospitalisation among burn inpatients were determined by univariate regression analyses. Of the 220,642 burn inpatients, 2146 (0.97%) were re-hospitalised for scar contracture. The re-hospitalised inpatients were predominantly men and blue-collar workers, showing younger median age at the time of burns, larger burn sizes, and higher percentage of surgical treatment compared other burn inpatients. Significant univariate predictors of scar contracture-associated re-hospitalisation included male sex, age < 50 years, blue-collar work, ≥ 40% total body superficial area burned, inhalation injured, and surgical treatment. Scar contracture is an intractable complication and a significant factor to increase re-hospitalisation rate among Chinese burn inpatients.
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Affiliation(s)
- Zhe Zhu
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University, Burn Institute of PLA, Research Unit of Key Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, Shanghai, 200433, China
| | - Weishi Kong
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University, Burn Institute of PLA, Research Unit of Key Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, Shanghai, 200433, China
| | - Haibo Wang
- Clinical Trial Unit, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China.,Centre for Data Science in Health and Medicine, Peking University, Beijing, 100191, China
| | - Yongqiang Xiao
- Department of Burn and Plastic Surgery, The 970Th Hospital of People's Liberation Army, Yantai, 264000, Shandong, China
| | - Ying Shi
- China Standard Medical Information Research Center, 288 Haide 2nd road, Shenzhen, 518000, China
| | - Lanxia Gan
- China Standard Medical Information Research Center, 288 Haide 2nd road, Shenzhen, 518000, China
| | - Yu Sun
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University, Burn Institute of PLA, Research Unit of Key Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, Shanghai, 200433, China.
| | - Hongtai Tang
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University, Burn Institute of PLA, Research Unit of Key Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, Shanghai, 200433, China.
| | - Zhaofan Xia
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University, Burn Institute of PLA, Research Unit of Key Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, Shanghai, 200433, China.
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PREVALENCE, TREATMENT, AND SURVIVAL OF BURNED WILDLIFE PRESENTING TO REHABILITATION FACILITIES FROM 2015 TO 2018. J Zoo Wildl Med 2021; 52:555-563. [PMID: 34130398 DOI: 10.1638/2020-0093] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2020] [Indexed: 11/21/2022] Open
Abstract
In recent decades, wildfires have increased in frequency and geographic scale across the globe. The human health implications and ecological succession after wildfires are well documented and studied, but there is a lack of empirical research about the direct effects of wildfires on wildlife. Recent wildfires have demonstrated the need to better understand animal burn injuries and innovations in veterinary burn treatment. An online survey was distributed to wildlife rehabilitation facilities internationally to collect baseline information about the number and type of burned wildlife cases admitted, treatments used, and survivorship of wildlife affected by wildfires. Approximately 80% (n = 49) of all respondents (n = 61) reported admitting cases of burned wildlife from 2015 to 2018. Respondents included facilities from six different countries and roughly 43% of facilities reported having a veterinarian on staff. Electrical burns were most commonly reported with 89% of respondents stating that they had seen electrical burns while 38% of respondents reported seeing wildfire-source thermal burns in wildlife patients. Respondents were asked about their frequency of use of different treatment methods. Bandages, colloid fluids, and opioids were used at significantly higher rates at facilities with veterinarians compared with facilities that did not report having a veterinarian; however, survival of burned wildlife patients did not significantly differ based on the factor of having a veterinarian on staff. Long-term and short-term complications were commonly reported for wildlife burn patients; 88% of facilities reported scarring, 81% reported alopecia, and 61% reported sepsis. Burned animals admitted to facilities were reported to have equal odds of dying and surviving. Burn care recommendations have changed considerably in recent decades. This study provided a unique opportunity to compare contemporary recommendations in human medicine with current methods used in wildlife rehabilitation facilities to identify potential areas of further investigation and improvement for wildlife medicine.
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Yue X, Liu L, Wu Y, Liu X, Li S, Zhang Z, Han S, Wang X, Chang Y, Bai H, Chai J, Hu S, Wang H. Preparation and evaluation of chitosan-polyvinyl alcohol/polyhexamethylene guanidine hydrochloride antibacterial dressing to accelerate wound healing for infectious skin repair. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:482. [PMID: 33850879 PMCID: PMC8039659 DOI: 10.21037/atm-21-509] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Wound infections, especially multidrug-resistant (MDR) bacterial infections, are a major challenge in clinical medicine. Methods In this study, a new type of antibacterial sponge was prepared from a solution containing a chitosan-polyvinyl alcohol (CTS-PVA) emulsion with added polyhexamethylene guanidine hydrochloride (PHMG) in a homogeneous medium using lyophilization technology. The antibacterial ability of and CTS-PVA/PHMG sponge against Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Candida albicans, Methicillin-resistant Staphylococcus aureus, multidrug-resistant Pseudomonas aeruginosa, and multidrug-resistant Acinetobacter baumannii in vitro. The structure and physical properties were characterized. The sponge dressing was tested in a Pseudomonas aeruginosa-infected full-thickness mouse skin wound defect model. The effects were evaluated by wound area measurement and histological analysis. Results The CTS-PVA/PHMG sponge showed broad-spectrum antibacterial ability, including for MDR bacterial stains from clinical sources, while maintaining excellent physicochemical properties, including a high swelling degree and good moisture retention capability. Scanning electron microscopy images displayed the surface morphology of the CTS-PVA/PHMG sponge dressing. The detection of the wound healing rate and histological analysis supported that the new dressing can alleviate the inflammation and accelerate the healing speed of infected wounds and in vivo. Conclusions CTS-PVA/PHMG sponge shows broad-spectrum antibacterial activity, which can provide a new pathway for clinical prevention and treatment of superbug-infected wounds.
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Affiliation(s)
- Xiaotong Yue
- Burns Institute of PLA, Department of Burns and Plastic Surgery, the Fourth Medical Center Affiliated to PLA General Hospital, Beijing, China
| | - Lingying Liu
- Burns Institute of PLA, Department of Burns and Plastic Surgery, the Fourth Medical Center Affiliated to PLA General Hospital, Beijing, China
| | - Yushou Wu
- Burns Institute of PLA, Department of Burns and Plastic Surgery, the Fourth Medical Center Affiliated to PLA General Hospital, Beijing, China
| | - Xiangyu Liu
- Burns Institute of PLA, Department of Burns and Plastic Surgery, the Fourth Medical Center Affiliated to PLA General Hospital, Beijing, China
| | - Shaozeng Li
- Department of Clinical Laboratory, the Fourth Medical Center Affiliated to PLA General Hospital; Beijing, China
| | - Zihao Zhang
- Burns Institute of PLA, Department of Burns and Plastic Surgery, the Fourth Medical Center Affiliated to PLA General Hospital, Beijing, China
| | - Shaofang Han
- Burns Institute of PLA, Department of Burns and Plastic Surgery, the Fourth Medical Center Affiliated to PLA General Hospital, Beijing, China
| | - Xiaoteng Wang
- Burns Institute of PLA, Department of Burns and Plastic Surgery, the Fourth Medical Center Affiliated to PLA General Hospital, Beijing, China
| | - Yang Chang
- Burns Institute of PLA, Department of Burns and Plastic Surgery, the Fourth Medical Center Affiliated to PLA General Hospital, Beijing, China
| | - Hailiang Bai
- Burns Institute of PLA, Department of Burns and Plastic Surgery, the Fourth Medical Center Affiliated to PLA General Hospital, Beijing, China
| | - Jiake Chai
- Burns Institute of PLA, Department of Burns and Plastic Surgery, the Fourth Medical Center Affiliated to PLA General Hospital, Beijing, China
| | - Sen Hu
- Research Laboratory of Trauma Surgery, the Fourth Medical Center Affiliated to PLA General Hospital, Beijing, China
| | - Hongyu Wang
- Department of Burn Surgery, the Third Affiliated Hospital of Inner Mongolia Medical University (Inner Mongolia Baogang Hospital), Baotou, China
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23
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Qiu L, Jin X, Wang JJ, Tang XD, Fang X, Li SJ, Wang F, Chen XL. Plasma Neutrophil-to-Lymphocyte Ratio on the Third Day Postburn is Associated with 90-Day Mortality Among Patients with Burns Over 30% of Total Body Surface Area in Two Chinese Burns Centers. J Inflamm Res 2021; 14:519-526. [PMID: 33658827 PMCID: PMC7917389 DOI: 10.2147/jir.s294543] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 02/03/2021] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Neutrophil-to-lymphocyte ratio (NLR) is a marker of inflammation. This study aimed to evaluate the potential role of NLR to predict 90-day mortality. METHODS Data of 577 patients with burns over 30% of total body surface area were collected and retrospectively analyzed. The risk factors for 90-day mortality were evaluated using logistic regression analyses. Receiver operating characteristic (ROC) curve analysis of the 3rd day NLR was performed and the optimal cut-off value was calculated. The 90-day mortality rates were compared between high and low NLR groups using Kaplan-Meier analysis. RESULTS Age, mechanical ventilation, burn index, 3rd day NLR, and 7th day red blood cell and platelet (PLT) counts were found to be independent predictive values for 90-day mortality. In contrast, percentage of total body surface area burned, inhalation injury, 1st day white blood cell and neutrophil counts, the 3rd day lymphocytes and PLT counts, and 7th day hemoglobin level were not independently associated with 90-day mortality. The area under the ROC curve of the 3rd day NLR for severe burn-delayed death prediction was 0.665 (95% confidence interval, 0.591-0.739), and the optimal cut-off value of the 3rd day NLR was 10.50. The 90-day mortality rates differed significantly between the NLR >10.5 group and the NLR ≤ 10.5 group (17.03% vs 5.92%, respectively; P < 0.01). CONCLUSION These results suggested that the 3rd day NLR was associated with an increased risk of death in severely burned patients; thus, it can provide useful information to predict 90-day mortality.
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Affiliation(s)
- Le Qiu
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Xu Jin
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Jun-Jie Wang
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Xu-Dong Tang
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Xiao Fang
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Shi-Ji Li
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Fei Wang
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Xu-Lin Chen
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
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24
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Moreno DAN, Saladini MS, Viroel FJM, Dini MMJ, Pickler TB, Amaral Filho J, dos Santos CA, Hanai-Yoshida VM, Grotto D, Gerenutti M, Hyslop S, Oshima-Franco Y. Are Silver Nanoparticles Useful for Treating Second-Degree Burns? An Experimental Study in Rats. Adv Pharm Bull 2021; 11:130-136. [PMID: 33747860 PMCID: PMC7961217 DOI: 10.34172/apb.2021.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 02/14/2020] [Accepted: 04/16/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose: In this work, the potential usefulness of silver nanoparticles (AgNPs) for treating burn wounds was examined. Methods: Second-degree burns were induced in male Wistar rats by touching the skin with a heated (70°C) metallic device for 10 s, after which the animals were randomly allocated to one of two groups: control (n=8, treated with sterile saline) and experimental (n=8, treated with AgNPs, 0.081 mg/mL; 50 µL applied to the burn surface). Seven, 14, 21 and 28 days after lesion induction two rats from each group were killed and blood samples were collected for a complete blood count and to assess oxidative stress. The livers were examined macroscopically and skin samples were collected for histological analysis. Results: Macroscopically, wound healing and skin remodeling in the experimental group were similar to the saline-treated rats. Likewise, there were no significant differences in the histological parameters between the two groups. However, treatment with AgNPs caused a persistent reduction in white blood cell (WBC) counts throughout the experiment, whereas platelet counts increased on days 7 and 28 but decreased on days 14 and 21; there was also an increase in the blood concentration of reduced glutathione on day 7 followed by a decrease on days 21 and 28. There were no significant changes in blood glutathione peroxidase (GSH-Px) and catalase (CAT) activities or in the serum concentration of thiobarbituric acid reactive substances. Conclusion: The findings of this study raise questions about the potential transitory effects of AgNPs based on the changes in WBC and platelet counts, blood glutathione concentrations and macroscopic hepatic alterations.
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Affiliation(s)
| | - Mirela Santos Saladini
- Veterinary Medicine Graduate Course, University of Sorocaba (UNISO), Sorocaba, SP, Brazil
| | | | - Murilo Melo Juste Dini
- Graduate Program in Pharmaceutical Sciences, University of Sorocaba (UNISO), Sorocaba, SP, Brazil
| | - Thaisa Borim Pickler
- Laboratory for Toxicological Research (Lapetox), University of Sorocaba (UNISO), Sorocaba, SP, Brazil
| | - Jorge Amaral Filho
- Veterinary Medicine Graduate Course, University of Sorocaba (UNISO), Sorocaba, SP, Brazil
| | | | - Valquíria Miwa Hanai-Yoshida
- Graduate Program in Environmental and Technological Processes, University of Sorocaba (UNISO), Sorocaba, SP, Brazil
| | - Denise Grotto
- Graduate Program in Pharmaceutical Sciences, University of Sorocaba (UNISO), Sorocaba, SP, Brazil
- Graduate Program in Environmental and Technological Processes, University of Sorocaba (UNISO), Sorocaba, SP, Brazil
| | - Marli Gerenutti
- School of Medical Sciences of the Pontifical Catholic University of São Paulo (PUC-SP), Sorocaba, SP, Brazil
| | - Stephen Hyslop
- Department of Pharmacology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Yoko Oshima-Franco
- Graduate Program in Pharmaceutical Sciences, University of Sorocaba (UNISO), Sorocaba, SP, Brazil
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25
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Yoshimura Y, Saitoh D, Yamada K, Nakamura T, Terayama T, Ikeuchi H, Sasaki J, Nemoto M. Comparison of prognostic models for burn patients: A retrospective nationwide registry study. Burns 2020; 46:1746-1755. [PMID: 33148486 DOI: 10.1016/j.burns.2020.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/03/2020] [Accepted: 10/08/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Prognostic burn index (PBI) is a unique model utilized to predict mortality of burn patients in Japan. In contrast, other prediction models are rarely used in Japan, and their accuracy and predictive value are unknown. The present study aimed to compare commonly used burn prediction models and determine the appropriate model for mortality prediction in Japanese burn patients. METHODS Japanese burn patients registered in the nationwide burn registry of Japanese Society for Burn Injury between April 1, 2011 and March 31, 2019 were reviewed retrospectively. The prognostic performance of PBI was compared with Baux score, revised Baux score, abbreviated burn severity index (ABSI), Ryan score and Belgian outcome in burn injury score (BOBI). The primary outcome was in-hospital mortality. RESULTS The study included 7911 acute burn patients. The overall mortality rate was 10.7%, the median age was 52 (interquartile range, 26-72) years, and the median % total body surface area was 7% (interquartile range, 3%-17%). The areas under the receiver operating characteristic curve for PBI, Baux score, ABSI, revised Baux score, Ryan score, and BOBI were 0.940 (95% confidence interval [CI]: 0.931-0.948), 0.943 (95% CI: 0.934-0.951; p=0.002), 0.945 (95% CI: 0.937-0.953; p=0.058), 0.946 (95% CI: 0.937-0.953; p=0.002), 0.859 (95% CI: 0.846-0.870; p<0.001), and 0.896 (95% CI: 0.885-0.905; p<0.001), respectively. CONCLUSION Although the performance of PBI was good, it was not superior to the Baux score, revised Baux score, and ABSI. These three scores have a high prognostic accuracy. Hence, they are considered as alternative burn prognostic scores in Japan. The Baux score was an optimal prognostic model for patients with burns in Japan.
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Affiliation(s)
- Yuya Yoshimura
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Saitama, Japan; Department of Emergency and Acute Medicine, Saitama Medical University International Medical Center, Saitama, Japan.
| | - Daizoh Saitoh
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Saitama, Japan; Division of Traumatology, Research Institute, National Defense Medical College, Saitama, Japan
| | - Kohei Yamada
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Saitama, Japan
| | - Takahiro Nakamura
- Department of Mathematics, National Defense Medical College, Saitama, Japan
| | - Takero Terayama
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Saitama, Japan
| | - Hisashi Ikeuchi
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Saitama, Japan
| | - Junichi Sasaki
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Manabu Nemoto
- Department of Emergency and Acute Medicine, Saitama Medical University International Medical Center, Saitama, Japan
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26
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Oba J, Okabe M, Yoshida T, Soko C, Fathy M, Amano K, Kobashi D, Wakasugi M, Okudera H. Hyperdry human amniotic membrane application as a wound dressing for a full-thickness skin excision after a third-degree burn injury. BURNS & TRAUMA 2020; 8:tkaa014. [PMID: 32733973 PMCID: PMC7382972 DOI: 10.1093/burnst/tkaa014] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/08/2020] [Indexed: 12/18/2022]
Abstract
Background Severe burn injuries create large skin defects that render the host susceptible to bacterial infections. Burn wound infection often causes systemic sepsis and severe septicemia, resulting in an increase in the mortality of patients with severe burn injuries. Therefore, appropriate wound care is important to prevent infection and improve patient outcomes. However, it is difficult to heal a third-degree burn injury. The aim of this study was to investigate whether hyperdry human amniotic membrane (HD-AM) could promote early granulation tissue formation after full-thickness skin excision in third-degree burn injury sites in mice. Methods After the development of HD-AM and creation of a third-degree burn injury model, the HD-AM was either placed or not placed on the wound area in the HD-AM group or HD-AM group, respectively. The groups were prepared for evaluation on postoperative days 1, 4 and 7. Azan staining was used for granulation tissue evaluation, and estimation of CD163, transforming growth factor beta-1 (TGF-β1), vascular endothelial growth factor (VEGF), CD31, alpha-smooth muscle actin (α-SMA) and Iba1 expression was performed by immunohistochemical staining. Quantitative reverse-transcription polymerase chain reaction (PCR) was used to investigate gene expression of growth factors, cell migration chemokines and angiogenic and inflammatory markers. Results The HD-AM group showed significant early and qualitatively good growth of granulation tissue on the full-thickness skin excision site. HD-AM promoted early-phase inflammatory cell infiltration, fibroblast migration and angiogenesis in the granulation tissue. Additionally, the early infiltration of cells of the immune system was observed. Conclusions HD-AM may be useful as a new wound dressing material for full-thickness skin excision sites after third-degree burn injuries, and may be a new therapeutic technique for improving the survival rate of patients with severe burn injuries.
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Affiliation(s)
- Jiro Oba
- Department of Emergency and Disaster Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Motonori Okabe
- Department of Regenerative Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama 930-0194, Japan
| | - Toshiko Yoshida
- Department of Regenerative Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama 930-0194, Japan
| | - Chika Soko
- Department of Regenerative Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama 930-0194, Japan
| | - Moustafa Fathy
- Department of Regenerative Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama 930-0194, Japan.,Department of Biochemistry, Faculty of Pharmacy, Minia University, Minia 61519, Egypt
| | - Koji Amano
- Department of Emergency Surgery, Sakai City Medical Center, Sakai, Osaka 594-8304, Japan
| | - Daisuke Kobashi
- Department of Emergency and Disaster Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Masahiro Wakasugi
- Department of Emergency and Disaster Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Hiroshi Okudera
- Department of Emergency and Disaster Medicine, University of Toyama, Toyama 930-0194, Japan
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27
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Salyer CE, Bomholt C, Beckmann N, Bergmann CB, Plattner CA, Caldwell CC. Novel Therapeutics for the Treatment of Burn Infection. Surg Infect (Larchmt) 2020; 22:113-120. [PMID: 32429749 DOI: 10.1089/sur.2020.104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Burn injury continues to be a significant cause of morbidity and death, with infectious complications being the primary cause of death. Patients are susceptible to overwhelming infection secondary to both the physical breakdown of the skin and mucosal barrier and the immune dysfunction that accompanies the inflammatory response to a major burn. With resistance to traditional antibiosis looming as a serious threat to patient outcome, advancement in the treatment of burn infections is imperative. Methods: Between February 15 and March 15, 2020, a search of Pubmed and clinicaltrials.gov was performed using search terms such as "burn immunotherapy," "therapeutic microorganisms in burn," "burn infection clinical trials," and applicable variations. Results: Topical antimicrobial drugs continue to be standard of care for burn wound injuries, but personalized and molecular treatments that rely on immune manipulation of the host show great promise. We discuss novel therapeutics for the treatment of burn infection: Probiotics and therapeutic microorganisms, immune modulators, tailored monoclonal antibodies, and extracellular vesicles and proteins. Conclusions: The treatment strategies discussed employ manipulation of structure and function in host immune cells and pathogen virulence for improved outcomes in burn infection.
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Affiliation(s)
- Christen E Salyer
- Division of Research and Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Christina Bomholt
- Division of Research and Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Nadine Beckmann
- Division of Research and Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Christian B Bergmann
- Division of Research and Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Courtney A Plattner
- Urology Division, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Charles C Caldwell
- Division of Research and Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Research, Shriners Hospital for Children, Cincinnati, Ohio, USA
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28
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Yang ML, Yuan FL, Lv GZ. Letter to the Editor on "Severe chemical burn leaving an irredeemable scar because of unskilled chemical peel at an oriental medicine clinic". Int Wound J 2019; 16:1068. [PMID: 31140722 DOI: 10.1111/iwj.13150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 05/12/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- Man-Ling Yang
- Wuxi Clinical Medicine School of Integrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, Wuxi, China.,Department of Orthopaedics and Central Laboratory, Third Hospital Affiliated to Nantong University, Wuxi, China
| | - Feng-Lai Yuan
- Wuxi Clinical Medicine School of Integrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, Wuxi, China.,Department of Orthopaedics and Central Laboratory, Third Hospital Affiliated to Nantong University, Wuxi, China
| | - Guo-Zhong Lv
- Wuxi Clinical Medicine School of Integrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, Wuxi, China.,Department of Orthopaedics and Central Laboratory, Third Hospital Affiliated to Nantong University, Wuxi, China
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29
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Olbrisch K, Kisch T, Thern J, Kramme E, Rupp J, Graf T, Wicha SG, Mailänder P, Raasch W. After standard dosage of piperacillin plasma concentrations of drug are subtherapeutic in burn patients. Naunyn Schmiedebergs Arch Pharmacol 2018; 392:229-241. [PMID: 30368548 DOI: 10.1007/s00210-018-1573-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 10/19/2018] [Indexed: 12/21/2022]
Abstract
Infections are a major problem in patients with burn diseases. Mortality is high despite antibiotic therapy as studies are controversial concerning drug underdosing. The aims of this prospective, observational study were to monitor plasma concentrations of piperacillin during standard piperacillin/tazobactam treatment in 20 burn patients and 16 controls from the intensive care unit (ICU) and to optimize doses by in silico analyses. Piperacillin/tazobactam (4/0.5 g, tid) was administered over 0.5 h. Blood samples were taken at 1, 4, and 7.5 h after the end of the infusion. Free piperacillin plasma concentrations were determined. Pharmacokinetic parameters and in silico analysis results were calculated using the freeware TDMx. The primary target was defined as percentage of the day (fT>1xMIC; fT>4xMIC) when piperacillin concentrations exceeded 1xMIC/4xMIC (minimum inhibitory concentration), considering a MIC breakpoint of 16 mg/L for Pseudomonas aeruginosa. In an off-label approach, two burn patients were treated with 8/1 g piperacillin/tazobactam, 3 h qid. fT>1xMIC (55 ± 22% vs. 77 ± 24%) and fT>4xMIC (17 ± 11% vs. 30 ± 11%) were lower in burn than in ICU patients after 4/0.5 g, 0.5 h, tid. In silico analyses indicated that fT>1xMIC (93 ± 12% burn, 97 ± 4% ICU) and fT>4xMIC (62 ± 23% burn, 84 ± 19% ICU) values increase by raising the piperacillin dosage to 8/1 g qid and prolonging the infusion time to 3 h. Off-label treatment results were similar to in silico data for burn patients (84%fT>1xMIC and 47%fT>4xMIC). Standard dosage regimens for piperacillin/tazobactam resulted in subtherapeutic piperacillin concentrations in burn and ICU patients. Dose adjustments via in silico analyses can help to optimize antibiotic therapy and to predict respective concentrations in vivo. Trial registration: NCT03335137, registered 07.11.2017, retrospectively.
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Affiliation(s)
- Katharina Olbrisch
- Institute of Experimental and Clinical Pharmacology and Toxicology, University of Lübeck, Lübeck, Germany
- Department of Pharmacy, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Tobias Kisch
- Clinic of Plastic Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Julia Thern
- Department of Pharmacy, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Evelyn Kramme
- Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Jan Rupp
- Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Tobias Graf
- University Heart Centre Lübeck, Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Sebastian G Wicha
- Clinical Pharmacy, Institute of Pharmacy, University of Hamburg, Hamburg, Germany
| | - Peter Mailänder
- Clinic of Plastic Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Walter Raasch
- Institute of Experimental and Clinical Pharmacology and Toxicology, University of Lübeck, Lübeck, Germany.
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany.
- CBBM (Center of Brain, Behavior and Metabolism), University of Lübeck, Lübeck, Germany.
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30
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Burn injury: Challenges and advances in burn wound healing, infection, pain and scarring. Adv Drug Deliv Rev 2018; 123:3-17. [PMID: 28941987 DOI: 10.1016/j.addr.2017.09.018] [Citation(s) in RCA: 291] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/15/2017] [Accepted: 09/18/2017] [Indexed: 12/18/2022]
Abstract
Severe burn injuries are the most traumatic and physically debilitating injuries affecting nearly every organ system and leading to significant morbidity and mortality. Early burn wound excision and skin grafting are common clinical practices that have significantly improved the outcomes for severe burn injured patients by reducing mortality rate and days of hospital stay. However, slow wound healing, infection, pain, and hypertrophic scarring continue to remain a major challenge in burn research and management. In the present article, we review and discuss issues in the current treatment of burn injuries; the advances and novel strategies developed in the past decade that have improved burn management; and also, pioneer ideas and studies in burn research which aims to enhance burn wound care with a focus on burn wound infection, pain management, treatments for scarring and skin tissue engineering.
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31
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Tagami T, Matsui H, Moroe Y, Fukuda R, Shibata A, Tanaka C, Unemoto K, Fushimi K, Yasunaga H. Antithrombin use and 28-day in-hospital mortality among severe-burn patients: an observational nationwide study. Ann Intensive Care 2017; 7:18. [PMID: 28220452 PMCID: PMC5318343 DOI: 10.1186/s13613-017-0244-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 02/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous studies have suggested that antithrombin may be beneficial for treating coagulopathy in patients with severe burns. However, robust evidence for this idea is lacking. We examined the hypothesis that antithrombin may be effective in treating patients with severe burns. METHODS We performed propensity score-matched analyses of the nationwide administrative Japanese Diagnosis Procedure Combination inpatient database. We identified patients with severe burns (burn index ≥ 10) who were recorded in the database from 1 July 2010 to 31 March 2013. We compared patients who were administered antithrombin within 2 days of admission (antithrombin group) and those who were not administered antithrombin (control group). The main outcomes were 28-day mortality and ventilator-free days (VFDs). RESULTS Eligible patients (n = 3223) from 618 hospitals were categorized into either an antithrombin group (n = 152) or control group (n = 3071). Propensity score matching created a matched cohort of 103 pairs with and without antithrombin. Twenty-eight-day mortality was lower in the antithrombin group compared with the control group in propensity-matched analysis (control vs. antithrombin, 47.6 vs. 33.0%; difference, 14.6%; 95% confidence interval [CI] 1.2-28.0). Cox regression analysis showed a significant difference in 28-day in-hospital mortality between the control and antithrombin propensity-matched groups (hazard ratio 0.58; 95% CI 0.37-0.90). There were significantly more VFDs in the antithrombin compared with the control group in propensity score-matched analysis (control vs. antithrombin, 12.6 vs. 16.4 days; difference -3.7; 95% CI -7.2 to -0.12). CONCLUSIONS This nationwide database study demonstrated that antithrombin use may improve 28-day survival and increase VFDs in patients with severe burns. Further prospective studies are required to confirm these results.
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Affiliation(s)
- Takashi Tagami
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1138555, Japan. .,Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan.
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1138555, Japan
| | - Yuuta Moroe
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Reo Fukuda
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Ami Shibata
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Chie Tanaka
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Kyoko Unemoto
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Informatics and Policy, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1138555, Japan
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32
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Girard D, Laverdet B, Buhé V, Trouillas M, Ghazi K, Alexaline MM, Egles C, Misery L, Coulomb B, Lataillade JJ, Berthod F, Desmoulière A. Biotechnological Management of Skin Burn Injuries: Challenges and Perspectives in Wound Healing and Sensory Recovery. TISSUE ENGINEERING PART B-REVIEWS 2017; 23:59-82. [DOI: 10.1089/ten.teb.2016.0195] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Dorothée Girard
- University of Limoges, Myelin Maintenance and Peripheral Neuropathies (EA 6309), Faculties of Medicine and Pharmacy, Limoges, France
| | - Betty Laverdet
- University of Limoges, Myelin Maintenance and Peripheral Neuropathies (EA 6309), Faculties of Medicine and Pharmacy, Limoges, France
| | - Virginie Buhé
- University of Western Brittany, Laboratory of Neurosciences of Brest (EA 4685), Brest, France
| | - Marina Trouillas
- Paris Sud University, Unité mixte Inserm/SSA 1197, IRBA/CTSA/HIA Percy, École du Val de Grâce, Clamart, France
| | - Kamélia Ghazi
- Sorbonne University, Université de Technologie de Compiègne, CNRS UMR 7338 Biomechanics and Bioengineering, Centre de Recherche Royallieu, Compiègne, France
| | - Maïa M. Alexaline
- Paris Sud University, Unité mixte Inserm/SSA 1197, IRBA/CTSA/HIA Percy, École du Val de Grâce, Clamart, France
| | - Christophe Egles
- Sorbonne University, Université de Technologie de Compiègne, CNRS UMR 7338 Biomechanics and Bioengineering, Centre de Recherche Royallieu, Compiègne, France
| | - Laurent Misery
- University of Western Brittany, Laboratory of Neurosciences of Brest (EA 4685), Brest, France
| | - Bernard Coulomb
- Paris Sud University, Unité mixte Inserm/SSA 1197, IRBA/CTSA/HIA Percy, École du Val de Grâce, Clamart, France
| | - Jean-Jacques Lataillade
- Paris Sud University, Unité mixte Inserm/SSA 1197, IRBA/CTSA/HIA Percy, École du Val de Grâce, Clamart, France
| | - François Berthod
- Centre LOEX de l'Université Laval, Centre de recherche du CHU de Québec and Département de Chirurgie, Faculté de Médecine, Université Laval, Québec, Canada
| | - Alexis Desmoulière
- University of Limoges, Myelin Maintenance and Peripheral Neuropathies (EA 6309), Faculties of Medicine and Pharmacy, Limoges, France
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