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Franken J, Mikler J. Reactive skin decontamination lotion (RSDL) safety with clinical antiseptics and hemostatic agents. Toxicol Lett 2024; 395:11-16. [PMID: 38484828 DOI: 10.1016/j.toxlet.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 04/21/2024]
Abstract
Reactive skin decontamination lotion (RSDL) is a Health Canada approved product used by the Canadian Armed Forces for removal and inactivation of toxic chemicals on skin. Although it is considered very safe when used as directed, questions have been raised regarding whether topical RSDL in the medical setting will react exothermically with antiseptic compounds on the casualty's epidermis that could result in thermal burns. Benchtop experiments were conducted to investigate reactivity of RSDL with various antiseptic compounds or hemostatic agents. Temperature changes were closely monitored in three different volume ratios, 1:10, 1:1, and 10:1 over a time course of 16 minutes. Chlorine based bleaches versus RSDL were included as a positive control and were the only combination that exhibited a significant exothermic reaction capable of causing minor thermal burns. RSDL was also evaluated with antiseptic solution applied to swine epidermal tissue without observation of visual irritation; then in lacerated skeletal muscle tissue which resulted in no measured temperature change. The conclusion of this study is that antiseptics and hemostatic agents can be used as required on a patient decontaminated with RSDL as no exothermic reaction will occur.
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Affiliation(s)
- Jessica Franken
- Defence Research and Development Canada - Suffield Research Centre, Department of National Defence, Suffield, Alberta, Canada.
| | - John Mikler
- Defence Research and Development Canada - Suffield Research Centre, Department of National Defence, Suffield, Alberta, Canada
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Alonso Claro J, Varela Elena J, Pacheco Compaña FJ. Stirred, not shaken; NexoBrid® innovative mixing technique. Burns 2024; 50:1039-1041. [PMID: 38402115 DOI: 10.1016/j.burns.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/06/2024] [Indexed: 02/26/2024]
Affiliation(s)
- Jesús Alonso Claro
- Plastic Surgery Department, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
| | - Jonathan Varela Elena
- Plastic Surgery Department, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
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Daher RP, Piccolo MS, Baeninger M, Gragnani A. Burnt hand outcomes tool: Translation, adaptation and validation into Brazilian Portuguese. Burns 2024; 50:1030-1038. [PMID: 38402116 DOI: 10.1016/j.burns.2024.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/24/2023] [Accepted: 01/30/2024] [Indexed: 02/26/2024]
Abstract
INTRODUCTION In burn trauma, hands are often injured due to defensive action or proximity to the causative agent, leading to significant morbidity during a patients work and social rehabilitation process. In this context, the use of patient-reported outcome measures is a first step in measuring and improving these outcomes. The Burned Hand Outcome Tool (BHOT) is a specific questionnaire for adults with burned hands aimed at quantifying outcomes related to this trauma. OBJECTIVE To translate, culturally adapt, and validate the BHOT into Brazilian Portuguese. METHODS Following established standards in the literature, the original English questionnaire was translated, back translated, and analyzed by a panel of experts in the field. Cultural adaptation of the translation was carried out with a sample of target patients. The questionnaire was validated concurrently with the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire translated into Portuguese, at three time points (0 h, 2 h, 48 h), with two different evaluators. RESULTS The cultural adaptation was conducted on a sample of 30 adult patients with hand burns without the need for reassessment of the translated items. The questionnaire validation was carried out on a sample of 100 adult patients with hand burns. The Cronbach's Alpha found at the first time point was 0.936. The correlations between the questionnaires varied from 0.656 to 0.915. CONCLUSION The Burned Hand Outcome Tool has been translated, culturally adapted, and validated for a target population in Brazilian Portuguese.
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Affiliation(s)
- R P Daher
- Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), Rua Botucatu, 740, 04023900, São Paulo, SP, Brazil
| | - M S Piccolo
- Orthopedics Department, Traumatology, Plastic Surgery and Physiotherapy, Medicine College, Universidade Federal de Goiás (UFG), Rua 4, 172, Setor Oeste, Goiânia, GO, Brazil
| | - M Baeninger
- Graduate Program in Translational Surgery, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), Rua Botucatu, 740, 04023900 São Paulo, SP, Brazil
| | - A Gragnani
- Plastic Surgery Division, Coordinator of Graduate Translational Surgery Program, UNIFESP/EPM, Rua Botucatu, 740, 04023900 São Paulo, SP, Brazil.
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Hou B, Zhang H, Zhou L, Hu B, Tang W, Ye B, Wang C, Xu Y, Zou L, Hu J. In silico analysis of intestinal microbial instability and symptomatic markers in mice during the acute phase of severe burns. BMC Microbiol 2024; 24:124. [PMID: 38622529 PMCID: PMC11017597 DOI: 10.1186/s12866-024-03266-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 03/17/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Severe burns may alter the stability of the intestinal flora and affect the patient's recovery process. Understanding the characteristics of the gut microbiota in the acute phase of burns and their association with phenotype can help to accurately assess the progression of the disease and identify potential microbiota markers. METHODS We established mouse models of partial thickness deep III degree burns and collected faecal samples for 16 S rRNA amplification and high throughput sequencing at two time points in the acute phase for independent bioinformatic analysis. RESULTS We analysed the sequencing results using alpha diversity, beta diversity and machine learning methods. At both time points, 4 and 6 h after burning, the Firmicutes phylum content decreased and the content of the Bacteroidetes phylum content increased, showing a significant decrease in the Firmicutes/Bacteroidetes ratio compared to the control group. Nine bacterial genera changed significantly during the acute phase and occupied the top six positions in the Random Forest significance ranking. Clustering results also clearly showed that there was a clear boundary between the communities of burned and control mice. Functional analyses showed that during the acute phase of burn, gut bacteria increased lipoic acid metabolism, seleno-compound metabolism, TCA cycling, and carbon fixation, while decreasing galactose metabolism and triglyceride metabolism. Based on the abundance characteristics of the six significantly different bacterial genera, both the XGboost and Random Forest models were able to discriminate between the burn and control groups with 100% accuracy, while both the Random Forest and Support Vector Machine models were able to classify samples from the 4-hour and 6-hour burn groups with 86.7% accuracy. CONCLUSIONS Our study shows an increase in gut microbiota diversity in the acute phase of deep burn injury, rather than a decrease as is commonly believed. Severe burns result in a severe imbalance of the gut flora, with a decrease in probiotics and an increase in microorganisms that trigger inflammation and cognitive deficits, and multiple pathways of metabolism and substance synthesis are affected. Simple machine learning model testing suggests several bacterial genera as potential biomarkers of severe burn phenotypes.
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Affiliation(s)
- Bochen Hou
- Department of Neurology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
- Department of Clinical Data Research, Chongqing Emergency Medical Center, Chongqing Key Laboratory of Emergency Medicine, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, 400014, China
- School of Computer Science, Chongqing University, Chongqing, 400030, China
| | - Honglan Zhang
- Department of Neurology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Lina Zhou
- Department of Clinical Data Research, Chongqing Emergency Medical Center, Chongqing Key Laboratory of Emergency Medicine, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, 400014, China
| | - Biao Hu
- Chongqing University of Technology, Chongqing, 400054, China
| | - Wenyi Tang
- Department of Clinical Data Research, Chongqing Emergency Medical Center, Chongqing Key Laboratory of Emergency Medicine, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, 400014, China
| | - Bo Ye
- Department of Clinical Data Research, Chongqing Emergency Medical Center, Chongqing Key Laboratory of Emergency Medicine, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, 400014, China
| | - Cui Wang
- Department of Neurology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Yongmei Xu
- Department of Neurology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Lingyun Zou
- Department of Clinical Data Research, Chongqing Emergency Medical Center, Chongqing Key Laboratory of Emergency Medicine, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, 400014, China.
| | - Jun Hu
- Department of Neurology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China.
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Efejuku TA, Wolf SE, Song J, Golovko G, El Ayadi A. THE RISKS OF FIRST ONSET PRIMARY HYPERTENSION DIAGNOSIS IN THERMAL-INJURED PATIENTS. Shock 2024; 61:541-548. [PMID: 38300832 DOI: 10.1097/shk.0000000000002310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
ABSTRACT Introduction: Hypertension is a prevalent condition in the United States and leads to an increased risk of developing various comorbidities. However, the impact of new-onset hypertension after severe burns on patient outcomes is not known. We posit that hypertension onset after severe burn is associated with increased risk of developing comorbidities and mortality. Methods: Using the TriNetX database, burned patients diagnosed with essential hypertension after injury were compared with those who did not develop hypertension; neither had prior hypertension. Each cohort was grouped by sex, percent total body surface area (TBSA) burned, and age, then propensity matched for sex, race, ethnicity, and laboratory values. Outcomes assessed were acute kidney injury (AKI), hyperglycemia, heart failure, myocardial infarction (MI), and death. Results: Those diagnosed with hypertension after severe burn were 4.9 times more likely to develop AKI, 3.6 times for hyperglycemia, 5.3 times for heart failure, 4.7 times for acute MI, and 1.5 times for mortality. Sex analysis shows that men were at greater risk for AKI (1.5 times), heart failure (1.1 times), and death (1.4 times). Women were 1.3 times more likely to develop hyperglycemia. Percent TBSA burned grouping showed increased risk for all outcomes with increasing severity. Age grouping indicated an elevated risk of developing AKI, heart failure, acute MI, and death. Conclusion: New-onset hypertension diagnosis in severely burned patients is associated with acute kidney injury, heart failure, acute MI, and death. Overall, males, older patients, and those with a higher % TBSA burned are at a higher risk of developing these comorbidities.
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Affiliation(s)
| | | | | | - Georgiy Golovko
- Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, Texas
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Rodriguez-Arguello J, Lienhard K, De Grood J, Geransar R, Somayaji R, Khan D, Conly J, Ho C, Parsons L. The Use of Silver Oxynitrate Wound Dressings in the Treatment of Chronic Wounds: A Feasibility Pilot Study. Adv Skin Wound Care 2024; 37:197-202. [PMID: 38353651 DOI: 10.1097/asw.0000000000000085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
OBJECTIVE To evaluate the feasibility and effectiveness of a silver oxynitrate (Ag 7 NO 11 ) dressing on wound healing in patients with stalled chronic wounds. METHODS A prospective pilot study was conducted to determine the feasibility and effect of using silver oxynitrate dressings within an outpatient setting in Alberta, Canada. A total of 23 patients (12 women and 11 men; mean age, 66.1 ± 13.8 years) with a chronic wound that failed to heal with conventional treatment were included in the study. Wound assessments including the Bates-Jensen Wound Assessment Tool, wound-related pain, wound size, and patient quality of life (QoL) were conducted at baseline, after dressing application for 1 and 2 weeks, and during 4- and 12-week follow-ups. RESULTS Dressing application at 1 and 2 weeks improved patients' wound healing progression as measured through significantly decreased Bates-Jensen Wound Assessment Tool scores with a more than 10% decrease at 4- and 12-week follow-up ( P < .001). Pain ( P = .004), and QoL psyche subscore ( P = .008) significantly improved at 4-week follow-ups, although wound area, perimeter, and QoL body and everyday subscores were not significantly affected. Wound size was not significantly affected. CONCLUSIONS The silver oxynitrate dressing may improve healing progression in patients with chronic wounds, enhance patient experience by reducing wound-related pain, and improve patients' mental well-being. Further studies are warranted to elucidate the effect of silver oxynitrate dressings on wound area, perimeter, and volume measurements.
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Affiliation(s)
- Jimena Rodriguez-Arguello
- At the Ward of the 21st Century (W21C) Research and Innovation Centre, Calgary, Alberta, Canada, Jimena Rodriguez-Arguello, BHSc, is Research Assistant; Karin Lienhard, PhD, CCRP, is Research Associate; and Rose Geransar, PhD, is Research Manager. Ranjani Somayaji, MD, is Assistant Professor, University of Calgary. John Conly, MD, is Medical Director, W21C Research and Innovation Centre and Infectious Disease Physician and Professor, Cumming School of Medicine, University of Calgary. Chester Ho, MD, is Professor and Division Director, Division of Physical Medicine and Rehabilitation, University of Alberta. Laurie Parsons, MD, is Dermatologist and Medical Director, Southern Alberta Sheldon Chumir Wound Clinic, and Clinical Associate Professor, University of Calgary
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Bharath S, Agarwal P, Prabhakar T, Ravi S, Sharma D, Dhakar JS. Correlation of thermal burn hepatic dysfunction with outcomes. Burns 2024; 50:611-615. [PMID: 38097440 DOI: 10.1016/j.burns.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 10/01/2023] [Accepted: 10/04/2023] [Indexed: 04/08/2024]
Abstract
INTRODUCTION Organ dysfunction and failure increase the morbidity and mortality following major burn. Alteration of liver morphology and function is common following major burns; however, it has not received much attention. In this study we have assessed the impact of thermal burn on liver in relation with mortality. MATERIAL AND METHODS 55 patients (33 female and 22 males) with TBSA 10-90% and age ranged from 18 to 75 years were included. A bed side serial ultrasonography to assess the volume of liver and liver function tests was done on the 2nd, 9th and 16th day following burn. Baseline demographic and clinical information such as age, gender, burn size and outcome of patient were also collected. RESULTS - 8 patients died during 2nd week following burn and 47 survived. The mean TBSA for survivors was 37% and for non survivors 80%. Mean liver volume in survivors steadily decreased from 1693.70 cm3 to 1631.31 cm3 over 3 weeks. Mean liver volume in non- survivors steadily increased from 1855.88 cm3 to 2028.50 cm3 over 2 weeks. Liver function test in survivors steadily improved while in non survivors it deteriorated over 2 weeks. CONCLUSION There is a correlation between altered liver morphology and function with mortality among severely burnt patients however liver volume did not show statistical significance. A decreasing trend of liver dysfunction parameters and hepatomegaly following burn is associated with good prognosis.
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Affiliation(s)
- S Bharath
- Senior Resident Department of Surgery, NSCB Government Medical College, Jabalpur 482003, Madhya Pradesh, India
| | - Pawan Agarwal
- Professor and in charge Plastic Surgery Unit, Department of Surgery NSCB Government Medical College, Jabalpur 482003, Madhya Pradesh, India.
| | - Thangavel Prabhakar
- Resident Department of Surgery, NSCB Government Medical College, Jabalpur 482003, Madhya Pradesh, India
| | - Saranya Ravi
- Resident Department of Radiology, NSCB Government Medical College, Jabalpur 482003, Madhya Pradesh, India
| | - Dhananjaya Sharma
- Professor and head, Department of Surgery, NSCB Government Medical College, Jabalpur 482003, Madhya Pradesh, India
| | - Jagmohan Singh Dhakar
- Statistician and tutor, Department of Community Medicine, NSCB Government Medical College, Jabalpur 482003, Madhya Pradesh, India
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Zhang LY, Zheng WJ, Li K, JianPing-Ye, Qiu ZM, Zhao GJ, Jin PP, Chen LW, Tang YH, Hong GL, Lu ZQ. Risk model for predicting mortality in patients with necrotizing soft tissue infections in the intensive care unit. Burns 2024; 50:578-584. [PMID: 38238240 DOI: 10.1016/j.burns.2023.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 11/10/2023] [Accepted: 11/17/2023] [Indexed: 04/08/2024]
Abstract
BACKGROUND The goal of this study is to look into the factors that lead to death in patients with necrotizing soft tissue infections(NSTIs) in the intensive care unit and create a mortality risk model. METHODS The clinical data of 106 patients with necrotizing soft tissue infections admitted to intensive care unit(ICU) of the First Affiliated Hospital of Wenzhou Medical University between January 2008 and December 2021 were retrospectively analyzed. Univariate analysis and multivariate analysis were performed to evaluate the risk factors impacting patient mortality. The regression coefficient in binary logistic regression analysis was converted into the item score in the model, and then the model score of each patient was calculated. Finally, an ROC curve was constructed to evaluate the efficiency of the model for predicting mortality. Thirteen patients with NSTIs admitted to ICU between January 2022 and November 2022 were used to validate the model. RESULTS The death group had 44 patients, while the survival group had 62 patients. The overall mortality was 41.5%. Binary logistic regression analysis showed that risk factors for mortality were age≥ 60 years(OR:4.419; 95%CI:1.093-17.862; P = 0.037), creatinine ≥ 132μmol/L(OR:11.166; 95%CI:2.234-55.816; P = 0.003), creatine kinase ≥ 1104 U/L(OR:4.019; 95%CI:1.134-14.250; P = 0.031), prothrombin time ≥ 24.4 s(OR:11.589; 95%CI:2.510-53.506; P = 0.002), and invasive mechanical ventilation (OR:17.404; 95%CI:4.586-66.052; P<0.000). The AUC of the model for predicting mortality was 0.940 (95% CI:0.894-0.986). When the cut-off value for the model was 4 points, the sensitivity was 95.5% and the specificity was 83.9%. CONCLUSION The death risk model in this study for NSTIs patients in the intensive care unit shows high sensitivity and specificity. Patients with a score of ≥ 4 points have a higher risk of mortality.
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Affiliation(s)
- Lu-Yao Zhang
- Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China; Wenzhou Key Laboratory emergency and disaster medicine, Wenzhou 325000, China
| | - Wei-Jie Zheng
- Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China; Wenzhou Key Laboratory emergency and disaster medicine, Wenzhou 325000, China
| | - Ke Li
- Lishui People's Hospital, Lishui 323000, China
| | - JianPing-Ye
- Lishui People's Hospital, Lishui 323000, China
| | - Zhi-Min Qiu
- Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China; Wenzhou Key Laboratory emergency and disaster medicine, Wenzhou 325000, China
| | - Guang-Ju Zhao
- Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China; Wenzhou Key Laboratory emergency and disaster medicine, Wenzhou 325000, China
| | - Pin-Pin Jin
- Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China; Wenzhou Key Laboratory emergency and disaster medicine, Wenzhou 325000, China
| | - Long-Wang Chen
- Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China; Wenzhou Key Laboratory emergency and disaster medicine, Wenzhou 325000, China
| | - Ya-Hui Tang
- Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China; Wenzhou Key Laboratory emergency and disaster medicine, Wenzhou 325000, China
| | - Guang-Liang Hong
- Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China; Wenzhou Key Laboratory emergency and disaster medicine, Wenzhou 325000, China
| | - Zhong-Qiu Lu
- Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China; Wenzhou Key Laboratory emergency and disaster medicine, Wenzhou 325000, China.
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An SJ, Kayange L, Davis D, Peiffer S, Gallaher J, Charles A. Predictors of mortality following electrical and lightning injuries in Malawi: A decade of experience. Burns 2024; 50:754-759. [PMID: 37945505 PMCID: PMC10999340 DOI: 10.1016/j.burns.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 08/31/2023] [Accepted: 10/09/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Electrical injuries can be devastating, and data is lacking in low-resource settings. We aimed to identify predictors of mortality following electrical and lightning injuries (ELI) in Malawi. METHODS We performed a retrospective observational study of patients presenting with ELI and burn injuries at a tertiary hospital in Malawi from 2011 to 2020. Outcomes were compared and predictors of mortality were modeled. RESULTS A total of 382 ELI and 6371 burn patients were included. The mean ages for ELI and burn groups were 24 ± 14 and 11 ± 14 years, respectively (p < 0.01). Most patients were injured at home (91% in the burn group versus 51% in the ELI group, p < 0.01). The crude mortality rate in the ELI group was 28%, compared to 12% in the burn group (p < 0.01). On multivariate logistic regression, predictors of mortality included ELI (odds ratio [OR] 13.3, 95% confidence interval [CI] 7.2-24.5) and total body surface area burned (OR 1.1, 95% CI 1.1-1.1). Predicted mortality for ELI has increased over time (p = 0.05). CONCLUSIONS ELI confers more than 13 times higher odds of mortality than burn injuries in Malawi, with mortality risk increasing over time. More efforts are needed to prevent electrical hazards and implement timely interventions for patients with ELI.
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Affiliation(s)
- Selena J An
- Department of Surgery, University of North Carolina at Chapel Hill, 4001 Burnett Womack Building, CB 7050, Chapel Hill, NC 27599, USA
| | - Linda Kayange
- Department of Surgery, Kamuzu Central Hospital, Private Bag 149, Lilongwe, Malawi
| | - Dylane Davis
- University of North Carolina at Chapel Hill, School of Medicine, 1001 Bondurant Hall, CB 9535, Chapel Hill, NC 27599, USA
| | - Sarah Peiffer
- Baylor College of Medicine, 1 Moursund St, Houston, TX 77030, USA
| | - Jared Gallaher
- Department of Surgery, University of North Carolina at Chapel Hill, 4001 Burnett Womack Building, CB 7050, Chapel Hill, NC 27599, USA
| | - Anthony Charles
- Department of Surgery, University of North Carolina at Chapel Hill, 4001 Burnett Womack Building, CB 7050, Chapel Hill, NC 27599, USA; Department of Surgery, Kamuzu Central Hospital, Private Bag 149, Lilongwe, Malawi.
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Mc Kittrick A, Gustafsson L, Hodson T, Di Tommaso A. Clinical utility and validity testing of a co-designed outcome measure for hand burn injuries. Burns 2024; 50:666-673. [PMID: 38040615 DOI: 10.1016/j.burns.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 10/19/2023] [Accepted: 11/12/2023] [Indexed: 12/03/2023]
Abstract
INTRODUCTION A new outcome measure for hand burn injuries was co-designed within a Participatory Action Research framework with expert clinicians and individuals with hand burn injuries. The outcome measure reviews activities which are commonly interrupted post hand burn injuries and includes 18 activities. OBJECTIVE The aim of this study was to establish the clinical utility, face, and content validity of the newly developed outcome measure. METHODS Three constructs of interest were examined using study specific questionnaires from the perspectives of clinicians and individuals with hand burn injuries. Clinicians working in burns centres around Australia and New Zealand and individuals attending a burn centre within one tertiary hospital trialled the outcome measure. Upon testing the outcome measure each participant completed the questionnaire. RESULTS Twenty individuals with hand burn injuries and eight clinicians trialled the outcome measure. There was 85% agreement from individuals and 100% agreement from clinicians for face validity. Content validity was tested across the domains of relevance and clarity. Individuals rated all activities and clinicians rated 16 activities as relevant. Clarity of activities was high for both participant groups (>75% agreement). Clinical utility (measured in the domains of appropriateness, accessibility, practicability, and acceptability) was high, 95% of individuals reported agreement for practicability and 100% agreement for acceptability. Clinicians reported agreement of > 87.5% for appropriateness, accessibility, practicability, and acceptability. CONCLUSION The results demonstrated agreement for clinical utility, face, and content validity of the co-design outcome measure for hand burn injuries. Further validity and reliability testing is planned, including Rasch analysis.
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Affiliation(s)
- Andrea Mc Kittrick
- Department of Occupational Therapy, Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia; Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, QLD 4111, Australia.
| | - Louise Gustafsson
- Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, QLD 4111, Australia
| | - Tenelle Hodson
- Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, QLD 4111, Australia
| | - Amelia Di Tommaso
- Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, QLD 4111, Australia
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Elzagh A, Walsh K. Navigating the blaze of E-mobility - A call for safety in the era of lithium-ion batteries. Burns 2024; 50:775-776. [PMID: 38158286 DOI: 10.1016/j.burns.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Alaa Elzagh
- Manchester Burns Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, Greater Manchester M23 9LT, United Kingdom.
| | - Karl Walsh
- Manchester Burns Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, Greater Manchester M23 9LT, United Kingdom.
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Chopra CS, Abdirahman HJ, Mullikin AM, Abramov D, Aref Y, Lee CJ, Al-Hamad Daubs M, Reid CM. Reported Variability in General Surgery Training Across Integrated Plastic Surgery Residency Programs. Ann Plast Surg 2024; 92:457-462. [PMID: 38527353 DOI: 10.1097/sap.0000000000003837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
BACKGROUND Since their development, integrated plastic and reconstructive surgery (PRS) residency training programs have established diverse methods of incorporating general surgery training into graduate medical education. Programs have questioned the necessary duration and timing of such training. The aim of this study is to assess the landscape of general surgery exposure in integrated PRS residency programs. METHODS Thirty-six integrated PRS residency programs were included based on the availability of postgraduate year (PGY)-level rotation data. Rotations were measured in units of weeks with descriptive titles maintained as advertised by the program. Individual general surgery rotations were also categorized as being either PRS-aligned, American Board of Plastic Surgery (ABPS) Required Clinical (RC) or ABPS Strongly Suggested (SS). Statistical analyses were carried out on the relative proportions of each subcategory in the 2 parent groups. RESULTS All 36 programs evaluated required general surgery rotations in years PGY- 1 to -2. By PGY-3, 69% of programs required general surgery, and by PGY-6, 25%, and these were limited to 4- to 6-week rotations in burn, breast, or trauma. Looking across all 6 years, with 312 weeks of training total, the minimum number of weeks spent in general surgery rotations was 32, and the maximum number was 119, with an average of 61 weeks (±21).Programs were subcategorized into 2 groups based on whether they spent more (n = 16) or less (n = 20) than the net average number of weeks in ABPS RC + SS rotations. No significant difference was found in the relative proportion of PRS-aligned general surgery across groups. Programs with <60 weeks of general surgery had a relatively greater proportion of ABPS RC and SS rotations. CONCLUSIONS These data demonstrate that there exists significant variability in overall duration of general surgery training across integrated PRS training programs. When controlling overall general surgery exposure for variables of interest like PRS-aligned exposure or compatibility with ABPS requirements, we found no discernable educational model or patterns to explain the observed range in exposure. These results warrant reexamination of an ideal general surgery track within the integrated plastic surgery training model that optimizes training for the PRS resident.
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Affiliation(s)
- Christina S Chopra
- From the Division of Plastic Surgery, Stony Brook University, Stony Brook, NY
| | - Hana J Abdirahman
- School of Medicine, University of California Riverside SOM, Riverside, CA
| | | | - Daniella Abramov
- College of Medicine, New York Institute of Technology COM, Westbury, NY
| | - Youssef Aref
- School of Medicine, California University of Science & Medicine SOM, Colton, CA
| | - Clara J Lee
- Department of General Surgery, Naval Medical Center San Diego, San Diego, CA
| | | | - Chris M Reid
- Division of Plastic Surgery, University of California San Diego, La Jolla, CA
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13
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Qiang K, Jiang H, Xing Y, Liang X, Luo Y, Wu X. Comparative efficacy of silver alginate dressings versus standard gauze in enhancing wound healing post-mastectomy for triple-negative breast cancer: A systematic review and meta-analysis. Int Wound J 2024; 21:e14558. [PMID: 38155417 PMCID: PMC10961884 DOI: 10.1111/iwj.14558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 12/01/2023] [Indexed: 12/30/2023] Open
Abstract
This meta-analysis evaluates the efficacy of silver alginate dressings (SAD) compared to standard gauze (SG) in enhancing wound healing and reducing scar formation post-mastectomy in patients with triple-negative breast cancer. From an initial pool of 1245 articles, five studies met the inclusion criteria. The analysis revealed that SAD significantly improve early wound healing 1 week post-mastectomy, as indicated by lower Redness, Edema, Ecchymosis, Discharge, and Approximation (REEDA) scales (I2 = 85%; Random: SMD: -7.08, 95% CI: -8.26 to -5.98, p < 0.01), compared to SG. Additionally, long-term scar outcomes measured by the Manchester Scar Scale (MSS) 5 months post-mastectomy showed a notable reduction in scar formation (I2 = 95%; Random: SMD: -12.97, 95% CI: -16.20 to -9.75, p < 0.01)) in the silver alginate group. The findings support the use of SAD in post-mastectomy care for triple-negative breast cancer patients but highlight the need for further research on long-term safety and cost-effectiveness.
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Affiliation(s)
- Kejiao Qiang
- Nursing DepartmentThe First People's Hospital of Nanyang CityNanyangChina
| | - Hong Jiang
- Surgical DepartmentThe Central Hospital of Enshi Tujia and Miao Autonomous PrefectureEnshiChina
| | - Yuanyuan Xing
- Nuclear Medicine DepartmentShenzhen Sun Yat Sen University Affiliated Seventh HospitalShenzhenChina
| | - Xin Liang
- Nursing DepartmentThe First People's Hospital of Nanyang CityNanyangChina
| | - Yangfei Luo
- Medicine DepartmentYangtze University College of Arts and SciencesJingzhouChina
| | - Xiao Wu
- General Surgery DepartmentLiyuan Hospital Affiliated To Tongji Medical College Huazhong University Of Science And TechnologyWuhanChina
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14
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Velamuri SR, Ali Y, Lanfranco J, Gupta P, Hill DM. Inhalation Injury, Respiratory Failure, and Ventilator Support in Acute Burn Care. Clin Plast Surg 2024; 51:221-232. [PMID: 38429045 DOI: 10.1016/j.cps.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
Sustaining an inhalation injury increases the risk of severe complications and mortality. Current evidential support to guide treatment of the injury or subsequent complications is lacking, as studies either exclude inhalation injury or design limit inferences that can be made. Conventional ventilator modes are most commonly used, but there is no consensus on optimal strategies. Settings should be customized to patient tolerance and response. Data for pharmacotherapy adjunctive treatments are limited.
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Affiliation(s)
- Sai R Velamuri
- Department of Surgery, College of Medicine, University of Tennessee, Health Science Center, Memphis, TN 38103, USA.
| | - Yasmin Ali
- Department of Surgery, College of Medicine, University of Tennessee Health Science Center, 910 Madison Avenue, 2nd floor Suite 217, Memphis, TN 38103, USA
| | - Julio Lanfranco
- Division of Pulmonary and Critical Care, University of Tennessee Health Science Center, 965 Court Avenue Room H316B, Memphis, TN 38103, USA
| | - Pooja Gupta
- Pulmonary and Critical Care, University of Tennessee Health Science Center, 965 court avenue, Room H316B, Memphis, TN 38103, USA
| | - David M Hill
- Department of Pharmacy, Regional One Health, University of Tennessee, 80 madison avenue, Memphis TN 38103, USA
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15
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Chen H, Wu X, Zou L, Zhang Y, Deng R, Jiang Z, Xin G. A comparative study of the predictive value of four models for death in patients with severe burns. Burns 2024; 50:550-560. [PMID: 38008701 DOI: 10.1016/j.burns.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/02/2023] [Accepted: 10/29/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVE To assess the prognostic value of the Ryan score, Belgian Outcome of Burn Injury (BOBI) score,revised Baux (rBaux) score, and a new model (a Logit(P)-based scoring method created in 2020) for predicting mortality risk in patients with extremely severe burns and to conduct a comparative analysis. METHODS A retrospective analysis was conducted on 599 burn patients who met the inclusion criteria and were admitted to the burn unit of the First Affiliated Hospital of Nanchang University from 2017 to 2022. Relevant information was collected, and receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) were plotted for each of the four models in assessing mortality in these burn patients using both age-stratified and unstratified forms. The ROC curve section was further compared with the area under the curve (AUC), optimal cutoff value, as well as its sensitivity and specificity. Additionally, the quality of the AUC was assessed using the Delong test. RESULT Among the patients who met the inclusion criteria, 532 were in the survival group and 67 in the death group. Irrespective of age stratification, the novel model exhibited superior performance with an AUC of 0.868 (95% CI: 0.838-0.894) among all four models predicting mortality risk in included patients, and also demonstrated better AUC quality than other models; the calibration curves showed that the accuracy of all four models was good; the DCA curves showed that the clinical utility of the novel model and rBuax score were better. In the comparison of four scoring models across different age groups, the new model demonstrated the largest AUC in both 0-19 years (0.954, 95% CI 0.914-0.979) and 20-59 years groups (0.838, 95% CI 0.793-0.877), while rBuax score exhibited the highest AUC in ≥ 60 years group (0.708, 95% CI of 0.602-0.800). The calibration curves showed that the four models exhibited greater accuracy within the age range of 20-59 years, while the DCA curves indicated that both the novel model and rBuax score scale displayed better prediction in both the 20-59 and ≥ 60 years groups. CONCLUSIONS All four models demonstrate accurate and effective prognostication for patients with severe burns. Both the novel model and rBaux score exhibit enhanced prediction utility. In terms of the model itself alone, the new model is not simpler than, for example, the rBaux score, and whether it can be applied clinicallyinvolves further study.
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Affiliation(s)
- Huayong Chen
- No.17, Yongwai Zhengjie, Donghu District, Nanchang, Jiangxi, 330006, China; The First Affiliated Hospital of Nanchang University, China; Master of Medicine, Yongwai Zhengjie, Donghu District, Nanchang, Jiangxi 330006, China
| | - Xingwang Wu
- No.17, Yongwai Zhengjie, Donghu District, Nanchang, Jiangxi, 330006, China; The First Affiliated Hospital of Nanchang University, China; Master of Medicine, Yongwai Zhengjie, Donghu District, Nanchang, Jiangxi 330006, China
| | - Lijin Zou
- No.17, Yongwai Zhengjie, Donghu District, Nanchang, Jiangxi, 330006, China; The First Affiliated Hospital of Nanchang University, China; Doctor of Medicine, Yongwai Zhengjie, Donghu District, Nanchang, Jiangxi 330006, China
| | - Youlai Zhang
- No.17, Yongwai Zhengjie, Donghu District, Nanchang, Jiangxi, 330006, China; The First Affiliated Hospital of Nanchang University, China; Doctor of Medicine, Yongwai Zhengjie, Donghu District, Nanchang, Jiangxi 330006, China
| | - Rufei Deng
- No.17, Yongwai Zhengjie, Donghu District, Nanchang, Jiangxi, 330006, China; The First Affiliated Hospital of Nanchang University, China; Master of Medicine, Yongwai Zhengjie, Donghu District, Nanchang, Jiangxi 330006, China
| | - Zhenyu Jiang
- No.17, Yongwai Zhengjie, Donghu District, Nanchang, Jiangxi, 330006, China; The First Affiliated Hospital of Nanchang University, China; Master of Medicine, Yongwai Zhengjie, Donghu District, Nanchang, Jiangxi 330006, China
| | - Guohua Xin
- No.17, Yongwai Zhengjie, Donghu District, Nanchang, Jiangxi, 330006, China; The First Affiliated Hospital of Nanchang University, China; Master of Medicine, Yongwai Zhengjie, Donghu District, Nanchang, Jiangxi 330006, China.
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16
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Dawson L, Ray AD, Wilfond BS, Johnson LM. To Swab or Not to Swab: Waiver of Consent to Collect Perianal Specimens from Incapacitated Patients With Severe Burn Injury. Am J Bioeth 2024; 24:108-109. [PMID: 38529965 DOI: 10.1080/15265161.2024.2308155] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
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17
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Hasatsri S, Jantrapanukorn B. Film dressings from Thai mango seed kernel extracts versus nanocrystalline silver dressings in antibacterial properties. J Pharm Pharm Sci 2024; 27:12674. [PMID: 38606395 PMCID: PMC11006813 DOI: 10.3389/jpps.2024.12674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/15/2024] [Indexed: 04/13/2024]
Abstract
Introduction: The extract from the Mango Seed Kernel (MSK) has been documented to exhibit antibacterial activity against Gram-positive and Gram-negative bacteria, including Staphylococcus aureus and Pseudomonas aeruginosa. This suggests that biomaterials containing MSK extract could be a viable alternative to conventional wound treatments, such as nanocrystalline silver dressings. Despite this potential, there is a notable gap in the literature regarding comparing the antibacterial effectiveness of MSK film dressings with nanocrystalline silver dressings. This study aimed to develop film dressings containing MSK extract and evaluate their antibacterial properties compared to nanocrystalline silver dressings. Additionally, the study aimed to assess other vital physical properties of these dressings critical for effective wound care. Materials and methods: We prepared MSK film dressings from two cultivars of mango from Thailand, 'Chokanan' and 'Namdokmai'. The inhibition-zone method was employed to determine the antibacterial property. The morphology and chemical characterization of the prepared MSK film dressings were examined with scanning electron microscopy (SEM) and Fourier-Transform Infrared Spectroscopy (FTIR), respectively. The absorption of pseudo-wound exudate and water vapor transmission rate (WVTR) of film dressings were evaluated. Results: The results showed that 40% of MSKC film dressing had the highest inhibition zone (20.00 ± 0.00 mm against S. aureus and 17.00 ± 1.00 mm against P. aeruginosa) and 20%, 30%, and 40% of MSKC and MSKN film dressings had inhibition zones similar to nanocrystalline silver dressing for both S. aureus and P. aeruginosa (p > 0.05). In addition, all concentrations of the MSK film dressings had low absorption capacity, and Chokanan MSK (MSKC) film dressings had a higher WVTR than Namdokmai MSK (MSKN) film dressings. Conclusion: 20%, 30%, and 40% of MSK film dressing is nearly as effective as nanocrystalline silver dressing. Therefore, it has the potential to be an alternative antibacterial dressing and is suitable for wounds with low exudate levels.
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Affiliation(s)
- Sukhontha Hasatsri
- Department of Pharmacy Practice, College of Pharmacy, Rangsit University, Pathum Thani, Thailand
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18
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19
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Miranda-de la Lama GC. Electro-thermal injuries in ruminants caused by electrical equipment during pre-slaughter operations: Forensic case reports from an animal welfare science perspective. Forensic Sci Int 2024; 356:111936. [PMID: 38290416 DOI: 10.1016/j.forsciint.2024.111936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 08/29/2023] [Accepted: 01/14/2024] [Indexed: 02/01/2024]
Abstract
The use of electrical equipment for herding and moving livestock (electric batons) or for stunning animals before slaughter (electric stunners) is widespread in the livestock and meat industries worldwide. The use of these equipment is restricted to specific procedures and/or exceptional circumstances that justify their rational use. However, these restrictions can be underestimated or disregarded due to ignorance, inexperience, incompetence or irresponsibility on the part of users, resulting in pain and suffering to the animals and, in some cases, electro-thermal injury. This report presents four forensic cases of electro-thermal injuries identified during post-mortem animal welfare assessments in slaughterhouses in Colombia, Mexico and Spain. Electro-thermal injuries caused by contact (accidental or intentional) of equipment electrodes with skin and subcutaneous tissue are presented. Although our cases are isolated events detected over a 5-year period, they provide a useful visual guide for technicians and veterinarians interested in the differential diagnosis between bruises and electro-thermal injuries. The differentiation of the equipment causing the injuries allows the identification and control of critical points for animal welfare along the pre-slaughter logistic chain and the elimination of inappropriate animal handling practices.
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Affiliation(s)
- Genaro C Miranda-de la Lama
- Group of Animal Welfare, Department of Animal Production & Food Science, Faculty of Veterinary Sciences, Agri-Food Institute of Aragon (IA2), University of Zaragoza, Zaragoza, Spain.
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20
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Owings CG, McKee-Zech HS, Orebaugh JA, Devlin JL, Vidoli GM. The utility of blow fly (Diptera: Calliphoridae) evidence from burned human remains. Forensic Sci Int 2024; 356:111962. [PMID: 38359753 DOI: 10.1016/j.forsciint.2024.111962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 02/17/2024]
Abstract
Burning of human remains is a common method to conceal or destroy evidence associated with homicides and illegal activities. However, data regarding blow fly colonization of burned remains are scarce, with all previously published empirical studies focusing only on non-human animals. It is critically important to obtain basic data on blow fly colonization patterns of burned human remains as such evidence may represent the only feasible method for PMI estimation in cases of burning. In this study, we thermally altered six human donors to a Crow-Glassman Scale Level 3 (CGS-3) and placed them at the Anthropology Research Facility at the University of Tennessee in Summer 2021, Spring 2022, and Summer 2022. Six unburned human donors were used as controls. Observations for insect activity began within 24 h of placement and continued twice weekly through decomposition. Age estimations were performed with immature blow flies to estimate the time of colonization (TOC), and accuracy was assessed against the time of placement for each donor. All burned donors examined in this study were colonized by blow flies. No significant difference in species composition was determined between treatments, though TOC estimations from burned donors were slightly (but significantly) less accurate than TOC estimations from unburned donors (80% vs. 83% accuracy; χ2 = 0.041, df = 1, P = 0.840). These results indicate that blow flies can successfully colonize human remains burned to CGS-3 and that accurate TOC estimations can still be generated from larval specimens. Though several limitations to this study exist (e.g., inconsistent donor BMI, lack of donor temperature data), our results underscore the utility of entomological evidence in cases of burned human remains.
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Affiliation(s)
- Charity G Owings
- Department of Entomology and Plant Pathology, University of Tennessee, 2505 EJ Chapman Dr., 370 Plant Biotechnology Building, Knoxville, TN 37996, United States.
| | - Hayden S McKee-Zech
- Department of Anthropology, University of Tennessee, 1621 Cumberland Ave., Knoxville, TN 37996, United States
| | - Jack A Orebaugh
- Department of Anthropology, University of Tennessee, 1621 Cumberland Ave., Knoxville, TN 37996, United States
| | - Joanne L Devlin
- Department of Anthropology, University of Tennessee, 1621 Cumberland Ave., Knoxville, TN 37996, United States
| | - Giovanna M Vidoli
- Department of Anthropology, University of Tennessee, 1621 Cumberland Ave., Knoxville, TN 37996, United States
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Tohidian M, Tohidian M, Gangiazad M. Circular RNA: The promising genetic key between burn and cancer. Burns 2024; 50:533-534. [PMID: 38097441 DOI: 10.1016/j.burns.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 11/24/2023] [Indexed: 02/24/2024]
Affiliation(s)
- Mobina Tohidian
- Department of Anatomical Sciences, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Mahdi Tohidian
- Department of Polymer Engineering and Color Technology, Amirkabir University of Technology, Tehran, Iran.
| | - Mojtaba Gangiazad
- Department of Radiology, Tehran University of Medical Sciences, Tehran, Iran.
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22
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Tsai AJ. Is diabetes mellitus an independent contributor towards burns mortality? Burns 2024; 50:526-527. [PMID: 38092604 DOI: 10.1016/j.burns.2023.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 09/29/2023] [Indexed: 02/24/2024]
Affiliation(s)
- Allen J Tsai
- Department of Surgery, Western Reserve Health Education Inc., College of Medicine, Northeast Ohio Medical University, OH, USA.
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23
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Sun H, Shen W, Zhong HJ. The crucial role of surface roughness in scar keloid assessment. Burns 2024; 50:535-536. [PMID: 38182451 DOI: 10.1016/j.burns.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/07/2024]
Affiliation(s)
- Hui Sun
- Department of Dermatology, Huzhou Central Hospital, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, Zhejiang 313003, China; Zhejiang North Medical Center (Huzhou Central Hospital), Huzhou, Zhejiang 313003, China; Department of Dermatology, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine (Huzhou Central Hospital), Huzhou, China.
| | - Wei Shen
- Department of Dermatology, Huzhou Central Hospital, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, Zhejiang 313003, China; Zhejiang North Medical Center (Huzhou Central Hospital), Huzhou, Zhejiang 313003, China; Department of Dermatology, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine (Huzhou Central Hospital), Huzhou, China
| | - Hua-Jie Zhong
- Department of Dermatology, Huzhou Central Hospital, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, Zhejiang 313003, China; Zhejiang North Medical Center (Huzhou Central Hospital), Huzhou, Zhejiang 313003, China; Department of Dermatology, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine (Huzhou Central Hospital), Huzhou, China.
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24
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Simonit F, Da Broi U, Giudici F, Sciarappa OE, Innocenti D, Desinan L. Autopsy findings in fire deaths in relation to manner of death: Analysis of autopsy records in Friuli, Italy (1993-2020). Leg Med (Tokyo) 2024; 67:102372. [PMID: 38154314 DOI: 10.1016/j.legalmed.2023.102372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/20/2023] [Indexed: 12/30/2023]
Abstract
The determination of the cause and manner of death can be particularly difficult in burned and charred bodies and autopsy remains a key element in the investigation. In this study, 39 autopsy records of fire deaths were reviewed in relation to the manner of death (25 accidents, 8 suicides, 3 homicides and 3 instances in which the manner of death remained undetermined). The analysis focused on the study of the burns, the degree to which the bodies were consumed by fire and the evidence of signs of vital exposure to fire and of non-fire-related injuries. Total surface body area (TBSA) was found to be significantly higher (p = 0.02) in suicides than in accidents. Moreover, the degree of destruction according to the Crow-Glassman Scale and the presence of a pugilistic posture tended to be higher in suicides compared to accidental deaths, whereas such parameters were found to be variable in homicides. With regard to the anatomical distribution of burns, in contrast with the literature, the feet were affected by burning in all suicides, with a significantly higher prevalence than in accidents (p < 0.01). Traumatic non-fire related injuries were noted in all homicides (with no signs of vital exposure to fire), 1 complicated suicide, 1 undetermined death and 13 accidents. We found that very few studies have focused on the analysis of burn distribution and extension according to manner of death and that there is currently no standardised anatomical model with which to study these variables for forensic purposes.
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Affiliation(s)
- Francesco Simonit
- Università degli Studi di Udine, Dipartimento di Area Medica, Medicina Legale, Italy.
| | - Ugo Da Broi
- Università degli Studi di Udine, Dipartimento di Area Medica, Medicina Legale, Italy
| | - Fabiola Giudici
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Orazio Elia Sciarappa
- Università degli Studi di Udine, Dipartimento di Area Medica, Medicina Legale, Italy
| | - Dario Innocenti
- Università degli Studi di Udine, Dipartimento di Studi Umanistici, Italy
| | - Lorenzo Desinan
- Università degli Studi di Udine, Dipartimento di Area Medica, Medicina Legale, Italy
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Aschacher O, Pauzenberger R, Hacker S. Reply to Letter to the Editor on "Is diabetes mellitus an independent contributor towards burns mortality?". Burns 2024; 50:527-528. [PMID: 38065803 DOI: 10.1016/j.burns.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/17/2023] [Indexed: 02/24/2024]
Affiliation(s)
- Olivia Aschacher
- Department of Emergency Medicine, Clinic Floridsdorf, Brünnerstrasse 68, 1210 Vienna, Austria
| | - Reinhard Pauzenberger
- Private Practice Dr. Reinhard Pauzenberger, Hauptstraße 7, 4861 Schörfling am Attersee, Austria
| | - Stefan Hacker
- Private Practice Dr. Stefan Hacker, Tulpengasse 2/2, 1080 Vienna, Austria.
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Qiu ZK, Yang E, Yu NZ, Zhang MZ, Zhang WC, Si LB, Wang XJ. The biomarkers associated with epithelial-mesenchymal transition in human keloids. Burns 2024; 50:474-487. [PMID: 37980270 DOI: 10.1016/j.burns.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 08/25/2023] [Accepted: 09/10/2023] [Indexed: 11/20/2023]
Abstract
INTRODUCTION A keloid is a type of benign fibrotic disease with similar features to malignancies, including anti-apoptosis, over-proliferation, and invasion. Epithelial-mesenchymal transition (EMT) is a crucial mechanism that regulates the metastatic behavior of tumors. Thus, identifying EMT biomarkers is paramount in comprehensively understanding keloid pathogenesis. METHODS To identify the differentially expressed genes (DEGs) GSE92566 dataset, with 3 normal skin and 4 keloid tissues, was downloaded from GEO databases to identify the differentially expressed genes (DEGs). Further, EMT-related genes were downloaded from dbEMT 2.0 databases and intersected with GSE92566 DEGs to identify EMT-related-DEGs (ERDEGs). Subsequently, the ERDEGs were used for GO, KEGG, gene set enrichment analysis (GSEA), protein-protein interaction (PPI), and miRNAs-mRNAs network analysis. To predict small molecules for EMT inhibition, the ERDEGs were imported to cMAP databases, whereas hub genes were imported to DGidb databases. Finally, we carried out qRT-PCR and in vitro experiments to validate our findings. RESULTS A total of 122 ERDEGs were identified, including 59 upregulated and 63 down-regulated genes. Moreover, enrichment analysis revealed that focal adhesion, AMPK signal pathway, Wnt signal pathway, and EMT biological process were significantly enriched. STRING databases and Cytoscape software were used to construct the PPI network and EMT-related hub genes. Further, 3 modules were explored from the PPI network using the Molecular Complex Detection (MCODE) plugin. In the Cytohubba plugin, 10 hub genes were explored, including FN1, EGF, SOX9, CDH2, PROM1, EPCAM, KRT19, ITGB1, CD24, and KRT18. These genes were then enriched for the focal adhesion pathway. We constructed a microRNA (miRNA)-mRNA network, which predicted hsa-miR-155-5p (8 edges), hsa-miR-124-3p (7 edges), hsa-miR-145-5p (5 edges), hsa-miR-20a-5p (5 edges) and hsa-let-7b-5p (4 edges) as the most connected miRNAs regulating EMT. Based on the ERDEGs and 10 hub genes mentioned above, ribavirin demonstrated high drug-targeting relevance. Subsequently, qRT-PCR confirmed that the expression of FN1, ITGB1, CDH2, and EPCAM corroborated with previous findings. qRT-PCR also showed that the expression levels of hsa-miR-124-3p and hsa-miR-145-5p were significantly lower in keloids and hsa-miR-155-5p was upregulated in keloids. Finally, by treating human keloid fibroblasts (HKFs) with ribavirin in vitro, we confirmed that ribavirin could inhibit HKFs proliferation and EMT. CONCLUSION In summary, this work provides novel EMT biomarkers in keloids and predicts new small target molecules for keloid therapy. Our findings improve the understanding of keloid pathogenesis, providing new treatment options.
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Affiliation(s)
- Zi-Kai Qiu
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Elan Yang
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Nan-Ze Yu
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Ming-Zi Zhang
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Wen-Chao Zhang
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Lou-Bin Si
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xiao-Jun Wang
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
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Chanas T, Gibson G, Langenstroer E, Herrmann DJ, Carver TW, Alexander K, Chui SHJ, Rein L, Ha M, Maynard KM, Bamberg K, O'Keefe M, O'Brien M, Gonzalez MC, Hobbs B, Pajoumand M, Peppard WJ. Multicenter study evaluating target attainment of anti-Factor Xa levels using various enoxaparin prophylactic dosing practices in adult trauma patients. Pharmacotherapy 2024; 44:258-267. [PMID: 38148134 DOI: 10.1002/phar.2904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/08/2023] [Accepted: 12/05/2023] [Indexed: 12/28/2023]
Abstract
STUDY OBJECTIVE Enoxaparin is standard of care for venous thromboembolism (VTE) prophylaxis in adult trauma patients, but fixed-dose protocols are suboptimal. Dosing based on body mass index (BMI) or total body weight (TBW) improves target prophylactic anti-Xa level attainment and reduces VTE rates. A novel strategy using estimated blood volume (EBV) may be more effective based on results of a single-center study. This study compared BMI-, TBW-, EBV-based, and hybrid enoxaparin dosing strategies at achieving target prophylactic anti-Factor Xa (anti-Xa) levels in trauma patients. DESIGN Multicenter, retrospective review. DATA SOURCE Electronic health records from participating institutions. PATIENTS Adult trauma patients who received enoxaparin twice daily for VTE prophylaxis and had at least one appropriately timed anti-Xa level (collected 3 to 6 hours after the previous dose after three consecutive doses) from January 2017 through December 2020. Patients were excluded if the hospital-specific dosing protocol was not followed or if they had thermal burns with > 20% body surface area involvement. INTERVENTION Dosing strategy used to determine initial prophylactic dose of enoxaparin. MEASUREMENTS The primary end point was percentage of patients with peak anti-Xa levels within the target prophylactic range (0.2-0.4 units/mL). MAIN RESULTS Nine hospitals enrolled 742 unique patients. The most common dosing strategy was based on BMI (43.0%), followed by EBV (29.0%). Patients dosed using EBV had the highest percentage of target anti-Xa levels (72.1%). Multiple logistic regression demonstrated EBV-based dosing was significantly more likely to yield anti-Xa levels at or above target compared to BMI-based dosing (adjusted odds ratio (aOR) 3.59, 95% confidence interval (CI) 2.29-5.62, p < 0.001). EBV-based dosing was also more likely than hybrid dosing to yield an anti-Xa level at or above target (aOR 2.30, 95% CI 1.33-3.98, p = 0.003). Other pairwise comparisons between dosing strategy groups were nonsignificant. CONCLUSIONS An EBV-based dosing strategy was associated with higher odds of achieving anti-Xa level within target range for enoxaparin VTE prophylaxis compared to BMI-based dosing and may be a preferred method for VTE prophylaxis in adult trauma patients.
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Affiliation(s)
- Tyler Chanas
- ECU Health Medical Center, Greenville, North Carolina, USA
| | | | | | - David J Herrmann
- Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Thomas W Carver
- Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kaitlin Alexander
- University of Florida College of Pharmacy, Gainesville, Florida, USA
| | | | - Lisa Rein
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michael Ha
- UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | - Kaylee M Maynard
- University of Rochester Medical Center, Rochester, New York, USA
| | | | - Mary O'Keefe
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Marisa O'Brien
- UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | | | - Brandon Hobbs
- Orlando Regional Medical Center, Orlando, Florida, USA
| | | | - William J Peppard
- Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Meriç S, Vartanoglu Aktokmakyan T, Hacım NA, Gullu HF, Tokocin M, Önen Ö, Turan M. Risk of burns in pressure cooker usage: a comprehensive analysis of explosive injuries. ULUS TRAVMA ACIL CER 2024; 30:216-220. [PMID: 38506385 DOI: 10.14744/tjtes.2024.38131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
BACKGROUND Despite the widespread use of pressure cookers for quick and efficient cooking, literature has insufficiently highlighted the potential dangers resulting from inappropriate handling. This study aims to provide a comprehensive overview of 32 patients who presented with pressure cooker burns, emphasizing the serious risks associated with their misuse. METHODS Retrospective data were collected from patients admitted to Bağcılar Training and Research Hospital Burn Center between 2017 and 2020 with pressure cooker burns in Türkiye. Data encompassed patient characteristics, burn causes, locations, severities, treatments, and clinical outcomes. RESULTS The study included 32 patients (29 female/3 male) with a mean age of 42.3 (8-83). Patients were categorized based on burn areas, revealing associated injuries such as ocular (34.3%) and ear injuries (6.25%). The average hospital stay was 10.5 days [2-37]. While five pressure cookers exploded due to product-related issues, 26 explosions resulted from user errors (15.6%/81.2%). Importantly, no mortality was observed among the patients. CONCLUSION While pressure cookers facilitate rapid food preparation, this study underscores the severe risks arising from product or usage errors. This study emphasizes the need for more effective usage instructions and increased awareness about pressure cookers to prevent burn risks. We anticipate that educational programs focused on safe pressure cooker use could significantly reduce the incidence of serious injuries.
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Affiliation(s)
- Serhat Meriç
- Department of General Surgery, Bagcilar Training and Research Hospital, Istanbul-Türkiye
| | | | - Nadir Adnan Hacım
- Department of General Surgery, Bagcilar Training and Research Hospital, Istanbul-Türkiye
| | - Hasim Furkan Gullu
- Department of General Surgery, Bagcilar Training and Research Hospital, Istanbul-Türkiye
| | - Merve Tokocin
- Department of General Surgery, Bagcilar Training and Research Hospital, Istanbul-Türkiye
| | - Önder Önen
- Department of General Surgery, Bagcilar Training and Research Hospital, Istanbul-Türkiye
| | - Mustafa Turan
- Department of General Surgery, Bagcilar Training and Research Hospital, Istanbul-Türkiye
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Herring G, Tennant LB, Willacker JJ, Johnson M, Siegel RB, Polasik JS, Eagles-Smith CA. Wildfire burn severity and stream chemistry influence aquatic invertebrate and riparian avian mercury exposure in forested ecosystems. Ecotoxicology 2024; 33:131-141. [PMID: 38381206 DOI: 10.1007/s10646-024-02730-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 02/22/2024]
Abstract
Terrestrial soils in forested landscapes represent some of the largest mercury (Hg) reserves globally. Wildfire can alter the storage and distribution of terrestrial-bound Hg via reemission to the atmosphere or mobilization in watersheds where it may become available for methylation and uptake into food webs. Using data associated with the 2007 Moonlight and Antelope Fires in California, we examined the long-term direct effects of wildfire burn severity on the distribution and magnitude of Hg concentrations in riparian food webs. Additionally, we quantified the cross-ecosystem transfer of Hg from aquatic invertebrate to riparian bird communities; and assessed the influence of biogeochemical, landscape variables, and ecological factors on Hg concentrations in aquatic and terrestrial food webs. Benthic macroinvertebrate methylmercury (MeHg) and riparian bird blood total mercury (THg) concentrations varied by 710- and 760-fold, respectively, and Hg concentrations were highest in predators. We found inconsistent relationships between Hg concentrations across and within taxa and guilds in response to stream chemical parameters and burn severity. Macroinvertebrate scraper MeHg concentrations were influenced by dissolved organic carbon (DOC); however, that relationship was moderated by burn severity (as burn severity increased the effect of DOC declined). Omnivorous bird Hg concentrations declined with increasing burn severity. Overall, taxa more linked to in situ energetic pathways may be more responsive to the biogeochemical processes that influence MeHg cycling. Remarkably, 8 years post-fire, we still observed evidence of burn severity influencing Hg concentrations within riparian food webs, illustrating its overarching role in altering the storage and redistribution of Hg and influencing biogeochemical processes.
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Affiliation(s)
- Garth Herring
- U.S. Geological Survey, Forest and Rangeland Ecosystem Science Center, Corvallis, OR, 97331, USA.
| | - Lora B Tennant
- U.S. Geological Survey, Forest and Rangeland Ecosystem Science Center, Corvallis, OR, 97331, USA
- Nez Perce Tribe, Department of Fisheries Resource Management, Joseph, OR, 97846, USA
| | - James J Willacker
- U.S. Geological Survey, Forest and Rangeland Ecosystem Science Center, Corvallis, OR, 97331, USA
| | - Matthew Johnson
- National Park Service, Inventory & Monitoring Division, Southern Colorado Plateau Network, Flagstaff, AZ, 86001, USA
| | - Rodney B Siegel
- The Institute for Bird Populations, Petaluma, CA, 94953, USA
| | - Julia S Polasik
- The Institute for Bird Populations, Petaluma, CA, 94953, USA
- Teton Raptor Center, Wilson, WY, 83014, USA
| | - Collin A Eagles-Smith
- U.S. Geological Survey, Forest and Rangeland Ecosystem Science Center, Corvallis, OR, 97331, USA
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Thamizhchelvan AM, Masoud AR, Su S, Lu Y, Peng H, Kobayashi Y, Wang Y, Archer NK, Hong S. Bactericidal Efficacy of the Combination of Maresin-like Proresolving Mediators and Carbenicillin Action on Biofilm-Forming Burn Trauma Infection-Related Bacteria. Int J Mol Sci 2024; 25:2792. [PMID: 38474038 PMCID: PMC10932429 DOI: 10.3390/ijms25052792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/16/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
Biofilm-associated bacterial infections are the major reason for treatment failure in many diseases including burn trauma infections. Uncontrolled inflammation induced by bacteria leads to materiality, tissue damage, and chronic diseases. Specialized proresolving mediators (SPMs), including maresin-like lipid mediators (MarLs), are enzymatically biosynthesized from omega-3 essential long-chain polyunsaturated fatty acids, especially docosahexaenoic acid (DHA), by macrophages and other leukocytes. SPMs exhibit strong inflammation-resolving activities, especially inflammation provoked by bacterial infection. In this study, we explored the potential direct inhibitory activities of three MarLs on Gram-positive (Staphylococcus aureus) and Gram-negative (Pseudomonas aeruginosa and Escherichia coli) bacteria in their biofilms that are leading bacteria in burn trauma-related infections. We also examined the effects of MarLs on the bactericidal activities of a typical broad-spectrum antibiotic, carbenicillin (carb), on these bacteria in their preformed biofilms. The results revealed that MarLs combined with carbenicillin can inhibit the survival of Gram-positive and Gram-negative bacteria in their biofilms although MarLs alone did not exhibit bactericidal activity. Thus, our findings suggest that the combination of MarLs and carbenicillin can lower the antibiotic requirements to kill the bacteria in preformed biofilms.
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Affiliation(s)
- Anbu Mozhi Thamizhchelvan
- Neuroscience Center of Excellence, School of Medicine, Louisiana State University Health New Orleans, 2020 Gravier St., New Orleans, LA 70112, USA
| | - Abdul-Razak Masoud
- Neuroscience Center of Excellence, School of Medicine, Louisiana State University Health New Orleans, 2020 Gravier St., New Orleans, LA 70112, USA
| | - Shanchun Su
- Neuroscience Center of Excellence, School of Medicine, Louisiana State University Health New Orleans, 2020 Gravier St., New Orleans, LA 70112, USA
| | - Yan Lu
- Neuroscience Center of Excellence, School of Medicine, Louisiana State University Health New Orleans, 2020 Gravier St., New Orleans, LA 70112, USA
| | - Hongying Peng
- Biostatistics, Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH 45221, USA
| | - Yuichi Kobayashi
- Department of Bioengineering, Tokyo Institute of Technology, Box B-52, Nagatsuta-cho 4259, Midori-ku, Yokohama 226-8501, Kanagawa, Japan
- Organization for the Strategic Coordination of Research and Intellectual Properties, Meiji University, 1-1-1 Higashimita, Tama-ku, Kawasaki 214-8571, Kanagawa, Japan
| | - Yu Wang
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, MD 21231, USA; (Y.W.); (N.K.A.)
| | - Nathan K. Archer
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, MD 21231, USA; (Y.W.); (N.K.A.)
| | - Song Hong
- Neuroscience Center of Excellence, School of Medicine, Louisiana State University Health New Orleans, 2020 Gravier St., New Orleans, LA 70112, USA
- Department of Ophthalmology, School of Medicine, Louisiana State University Health New Orleans, 2020 Gravier St., New Orleans, LA 70112, USA
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Wermine K, Song J, Gotewal S, Huang L, Corona K, Bagby S, Villarreal E, Chokshi S, Efejuku T, Chaij J, Joglar A, Iglesias NJ, Keys P, De La Tejera G, Golovko G, El Ayadi A, Wolf SE. The Utilisation of INR to identify coagulopathy in burn patients. PLoS One 2024; 19:e0278658. [PMID: 38394094 PMCID: PMC10889632 DOI: 10.1371/journal.pone.0278658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/21/2022] [Indexed: 02/25/2024] Open
Abstract
Studies conflict on the significance of burn-induced coagulopathy. We posit that burn-induced coagulopathy is associated with injury severity in burns. Our purpose was to characterize coagulopathy profiles in burns and determine relationships between % total burn surface area (TBSA) burned and coagulopathy using the International Normalized Ratio (INR). Burned patients with INR values were identified in the TriNetX database and analyzed by %TBSA burned. Patients with history of transfusions, chronic hepatic failure, and those on anticoagulant medications were excluded. Interquartile ranges for INR in the burned study population were 1.2 (1.0-1.4). An INR of ≥ 1.5 was used to represent those with burn-induced coagulopathy as it fell outside the 3rd quartile. The population was stratified into subgroups using INR levels <1.5 or ≥1.5 on the day of injury. Data are average ± SD analyzed using chi-square; p < .05 was considered significant. There were 7,364 burned patients identified with INR <1.5, and 635 had INR ≥1.5. Comparing TBSA burned groups, burn-induced coagulopathy significantly increased in those with ≥20% TBSA; p = .048 at 20-29% TBSA, p = .0005 at 30-39% TBSA, and p < .0001 for 40% TBSA and above. Age played a significant factor with average age for those with burn-induced coagulopathy 59 ± 21.5 years and 46 ± 21.8 for those without (p < .0001). After matching for age, TBSA, and demographics, the risk of 28 day-mortality was higher in those with burn-induced coagulopathy compared to those without (risk difference 20.9%, p < .0001) and the odd ratio with 95% CI is 4.45 (3.399-5.825). Investigation of conditions associated with burn-induced coagulopathy showed the effect of heart diseases to be significant; 53% of patients with burn-induced coagulopathy had hypertension (p < .0001). Burn-induced coagulopathy increases with %TBSA burned. The information gained firmly reflects a link between %TBSA and burn-induced coagulopathy, which could be useful in prognosis and treatment decisions.
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Affiliation(s)
- Kendall Wermine
- School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Juquan Song
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Sunny Gotewal
- School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Lyndon Huang
- School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Kassandra Corona
- School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Shelby Bagby
- School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Elvia Villarreal
- School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Shivan Chokshi
- School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Tsola Efejuku
- School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Jasmine Chaij
- School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Alejandro Joglar
- School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Nicholas J. Iglesias
- School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Phillip Keys
- School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Giovanna De La Tejera
- School of Medicine, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Georgiy Golovko
- Department of Pharmacology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Amina El Ayadi
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Steven E. Wolf
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, United States of America
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Nandi A, Parui A. "And Then It Spreads": contagion and disease as metaphors of sociomoral contamination in Charles Burns' graphic novel Black Hole. Med Humanit 2024; 50:12-20. [PMID: 37657911 DOI: 10.1136/medhum-2023-012625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 09/03/2023]
Abstract
This article attempts to demonstrate how Charles Burns' graphic novel Black Hole (1995) construes the prevalence of contagion and pathological transformation(s) as metaphors of social contamination operating within a biopolitics of segregation. Through a study of plague, infection and strange mutations in Burns' novel, this article offers a critical evaluation of the monstrous body and investigates how Black Hole portrays the social reception of a sexually contagious virus through conditions of sickness and exclusion, which become biopolitical in quality. It examines, through close reading, how Burns' novel uses metaphors of contagion, abjection and desire, often fusing those in order to foreground the complex intercorporeal state of the segregated subject and in the process dramatises the urgent need to revaluate conventional strategies of isolation and otherisation through a reconsideration of the biopolitical notions around engagement, community and immunity.
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Affiliation(s)
- Arindam Nandi
- Humanities and Social Sciences, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India
| | - Avishek Parui
- Humanities and Social Sciences, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India
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Stephens M, Chester-Bessell D, Rose S. Wound care in hard-to-reach populations: rough sleepers. Br J Nurs 2024; 33:S34-S37. [PMID: 38386529 DOI: 10.12968/bjon.2024.33.4.s34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
People sleeping rough commonly develop wounds and other skin disorders. Wounds vary and develop for multiple reasons. They include acute wounds such as burns, infected injection sites, abscesses and cellulitis, as well as chronic wounds such as pressure ulcers; rough sleepers have a high prevalence of lower limb wounds. Skin and soft tissue infections are common, especially in people who inject drugs via subcutaneous or intramuscular routes. Emergency departments are often the pathways into healthcare for homeless people as traditional health and care systems often fail to meet their needs. Across England, initiatives have been developed to improve access to wound care for those who sleep rough. A case study illustrates the care of a homeless man presenting with a lower limb wound.
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Abstract
Burn nurses care for patients throughout the recovery continuum.
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Affiliation(s)
- Gretchen J Carrougher
- Gretchen J. Carrougher is research nurse supervisor/Northwest Regional Burn Model System program coordinator at the University of Washington Medicine Regional Burn Center, Harborview Medical Center, Seattle. Contact author: . The author has disclosed no potential conflicts of interest, financial or otherwise
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35
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Cahn J. Clinical Issues - February 2024. AORN J 2024; 119:169-173. [PMID: 38275264 DOI: 10.1002/aorn.14082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 10/17/2023] [Indexed: 01/27/2024]
Abstract
Retaining count sheets in the patient's medical record Key words: count sheet, medical record, procedural risk factor, retained surgical item, surgical count. Counting instruments during cavity closure Key words: uterine cavity, abdominal cavity, fetal procedure, cesarean delivery, instrument count. Surgical wound classification of procedures involving cancer removal Key words: cancer, contamination, infection, surgical wound classification, decision making. Placing an electrosurgical unit dispersive electrode over a tattoo Key words: dispersive electrode placement, metallic pigment, burn, tattoo, electrosurgical unit (ESU).
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36
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Ghadarjani R, Gharaei Nejad K. Implanting deep learning models for burn wound assessment. Burns 2024; 50:286-287. [PMID: 38042628 DOI: 10.1016/j.burns.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/12/2023] [Indexed: 12/04/2023]
Affiliation(s)
- Reyhaneh Ghadarjani
- Department of Pathology, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Kaveh Gharaei Nejad
- Department of Dermatology, Skin Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran.
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Pompermaier L, Steinvall I, Elmasry M, Eladany MM, Abdelrahman I, Fredrikson M, Sjöberg F. Long-term mortality after self-inflicted burns. Burns 2024; 50:252-261. [PMID: 37805374 DOI: 10.1016/j.burns.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 09/18/2023] [Accepted: 09/22/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Those with self-inflicted burns are a small but consistent group among burn patients, with large injuries and conflicting findings regarding their in-hospital mortality. Overall, burn survivors have a shorter life expectancy, as compared with national controls, but long-term mortality after self-inflicted burns is understudied. The aim of this retrospective study was to investigate possible differences in long-term mortality among survivors after self-inflicted and accidental burns. METHODS All adult patients with burns admitted at the Linköping Burn Centre and discharged alive between 2000 and 2017 were included, and end of follow up was April 26, 2021. Those with unknown survival status at that time were excluded. A Cox proportional hazards regression model, adjusted for age and sex, was used to analyse long term mortality. RESULTS Among the 930 patients included in this study, 37 had self-inflicted burns. Overall, median follow up period was 8.8 years and crude mortality was 24.7%. After adjustment for age and sex, self-inflicted burns were independently associated with long-term mortality, Hazard Ratio= 2.08 (95% CI 1.13-3.83). Post hoc analysis showed that the effect was most pronounced during the first years after discharge although it was noticeable over the whole study period. CONCLUSION Long-term risk of mortality after discharge from a burn centre was higher in patients with self-inflicted burns than in patients with accidental burns. The effect was noticeable over the whole study period although it was most pronounced during the first years after discharge.
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Affiliation(s)
- Laura Pompermaier
- Department of Hand Surgery, Plastic Surgery and Burns, and Department of Biomedical and Clinical Sciences Linköping University, Linköping, Sweden.
| | - Ingrid Steinvall
- Department of Hand Surgery, Plastic Surgery and Burns, and Department of Biomedical and Clinical Sciences Linköping University, Linköping, Sweden
| | - Moustafa Elmasry
- Department of Hand Surgery, Plastic Surgery and Burns, and Department of Biomedical and Clinical Sciences Linköping University, Linköping, Sweden
| | - Mostafa M Eladany
- Department of Anesthesiology & Intensive Care, Faculty of Medicine, Suez Canal University, Egypt
| | - Islam Abdelrahman
- Department of Hand Surgery, Plastic Surgery and Burns, and Department of Biomedical and Clinical Sciences Linköping University, Linköping, Sweden
| | - Mats Fredrikson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Folke Sjöberg
- Department of Hand Surgery, Plastic Surgery and Burns, and Department of Biomedical and Clinical Sciences Linköping University, Linköping, Sweden; Department of Anaesthesiology and Intensive Care, Linköping University, Linköping, Sweden
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Kamta J, Maynard K, Schult RF, Bell DE, Jones CMC, Acquisto NM. Evaluation of hydroxocobalamin use for the treatment of suspected cyanide toxicity secondary to smoke inhalation. Burns 2024; 50:157-166. [PMID: 37777459 DOI: 10.1016/j.burns.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 07/21/2023] [Accepted: 08/29/2023] [Indexed: 10/02/2023]
Abstract
Hydroxocobalamin is used for cyanide toxicity after smoke inhalation, but diagnosis is challenging. Retrospective studies have associated hydroxocobalamin with acute kidney injury (AKI). This is a retrospective analysis of patients receiving hydroxocobalamin for suspected cyanide toxicity. The primary outcome was the proportion of patients meeting predefined appropriate use criteria defined as ≥1 of the following: serum lactate ≥8 mmol/L, systolic blood pressure (SBP) <90 mmHg, new-onset seizure, cardiac arrest, or respiratory arrest. Secondary outcomes included incidence of AKI, pneumonia, resolution of initial neurologic symptoms, and in-hospital mortality. Forty-six patients were included; 35 (76%) met the primary outcome. All met appropriate use criteria due to respiratory arrest, 15 (43%) for lactate, 14 (40%) for SBP, 12 (34%) for cardiac arrest. AKI, pneumonia, and resolution of neurologic symptoms occurred in 30%, 21%, and 49% of patients, respectively. In-hospital mortality was higher in patients meeting criteria, 49% vs. 9% (95% CI 0.16, 0.64). When appropriate use criteria were modified to exclude respiratory arrest in a post-hoc analysis, differences were maintained, suggesting respiratory arrest alone is not a critical component to determine hydroxocobalamin administration. Predefined appropriate use criteria identify severely ill smoke inhalation victims and provides hydroxocobalamin treatment guidance.
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Affiliation(s)
- Jeff Kamta
- (Attribution) University of Rochester Medical Center, Department of Pharmacy, 601 Elmwood Ave, Box 638, Rochester, NY 14642, USA.
| | - Kaylee Maynard
- (Attribution) University of Rochester Medical Center, Department of Pharmacy, 601 Elmwood Ave, Box 638, Rochester, NY 14642, USA
| | - Rachel F Schult
- (Attribution) University of Rochester Medical Center, Department of Pharmacy, 601 Elmwood Ave, Box 638, Rochester, NY 14642, USA; University of Rochester Medical Center, Department of Emergency Medicine, 601 Elmwood Ave, Box 655, Rochester, NY 14642, USA
| | - Derek E Bell
- UR Medicine Plastic Surgery, 160 Sawgrass Dr., Suite 120, Rochester, NY 14620, USA
| | - Courtney M C Jones
- University of Rochester Medical Center, Department of Emergency Medicine, 601 Elmwood Ave, Box 655, Rochester, NY 14642, USA
| | - Nicole M Acquisto
- (Attribution) University of Rochester Medical Center, Department of Pharmacy, 601 Elmwood Ave, Box 638, Rochester, NY 14642, USA; University of Rochester Medical Center, Department of Emergency Medicine, 601 Elmwood Ave, Box 655, Rochester, NY 14642, USA
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O'Guinn ML, Vojvodic V, Ourshalimian S, Garcia I, Chaudhari PP, Spurrier R. Seasonality and temporal variation of pediatric trauma in Southern California. Injury 2024; 55:111266. [PMID: 38141391 DOI: 10.1016/j.injury.2023.111266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 12/01/2023] [Accepted: 12/02/2023] [Indexed: 12/25/2023]
Abstract
INTRODUCTION Seasonality of pediatric trauma has been previously described, although the association of season with hour of presentation is less understood. Both factors have potential implications for resource allocation and team preparedness. METHODS A multicenter retrospective study was conducted to analyze the records of injured children <18 years-old who presented to one of the 15 trauma centers within Los Angeles County. Data from the County Trauma and Emergency Medicine Information System Registry was abstracted from 1/1/10 to 12/31/21. Patient demographics, mechanism of injury (MOI) and time of presentation by season were analyzed using Kruskal Wallis tests and chi-square tests. RESULTS A total of 30,444 pediatric trauma presentations were included. Both the time of presentation and the MOI differed significantly by season with p < 0.001. Autumn had a higher incidence of pedestrian injuries during hours of 08:00 and 15:0020:00, and sports injuries from 16:00 to 21:00. In the Summer there were more burns between 17:00 and 23:00 and falls from greater than 10 ft after 13:00. The mode of transport used was also different across seasons (p = 0.03), with the use of both air and ground EMS greatest during summer and least during winter. The hours of greatest utilization remained relatively constant for all seasons for air transport (18:00-19:00 h) and ground transport (19:00-20:00 h). CONCLUSION These data demonstrate the significant seasonal and temporal variation within pediatric trauma. These findings could be used to inform improvements in emergency response, and resource allocation in particular.
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Affiliation(s)
- MaKayla L O'Guinn
- Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, United States
| | - Vanya Vojvodic
- Keck School of Medicine of University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033, United States
| | - Shadassa Ourshalimian
- Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, United States
| | - Iris Garcia
- Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, United States
| | - Pradip P Chaudhari
- Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, United States; Keck School of Medicine of University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033, United States
| | - Ryan Spurrier
- Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, United States; Keck School of Medicine of University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033, United States; University of Southern California, 3470 Trousdale Parkway, Los Angeles, CA 90089, United States.
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Itakussu EY, Morita AA, Kakitsuka EE, Kuwahara RM, Anami EHT, Pitta F, Hernandes NA. The Brazilian-Portuguese version of the Upper Extremity Functional Index (UEFI): Translation, cross-cultural adaptation and measurement properties for Brazilian adults after a burn injury. Burns 2024; 50:219-225. [PMID: 37690965 DOI: 10.1016/j.burns.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVES To translate, cross-culturally adapt, validate, verify the reliability and estimate the minimal detectable change (MDC) of the UEFI to Brazilian Portuguese (UEFI-Br) for burns. METHODS The study was carried out with 131 Brazilian burn cases at two time points, at discharge and at the first outpatient follow-up (15-21 days after discharge) in a Burn Treatment Center. The adaptation process of the UEFI was based on international recommendations. The Burn Specific Health Scale-Brief-Br (BSHS-B-Br) was also applied in order to analyze construct validity of the UEFI-Br and distribution-based methods were used to estimate its MDC. RESULTS Intra- and inter-rater reliability were good with ICC of 0.986 (CI 95 %: 0.98-0.99) and 0.969 (CI 95 %: 0.955-0.979), respectively, at discharge and 0.997 (CI 95 %: 0.996-0.998) and 0.987 (CI 95 %: 0.981-0.991), respectively, at the first outpatient follow-up appointment. We found good internal consistency with Cronbach's α values of 0.987 and 0.996, respectively, at the two times. The SEM was 4.42 and 2.31 at the first and second time points, respectively. The UEFI-Br scores demonstrated strong correlation with the Burn Specific Health Scale-Brief-Br (BSHS-B-Br) function domain scores (r = 0.87-0.90). No significant correlation was found between UEFI-Br scores and participants' characteristics. The MDC of the UEFI-Br lies between 11 and 13 points. CONCLUSION The Brazilian version of the UEFI-Br, a useful tool to assess upper limb function and disability, is a valid and reliable tool for use with Brazilian burn survivors. The MDC for the instrument was determined to be 11-13 points.
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Affiliation(s)
- Edna Yukimi Itakussu
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Paraná, Brazil; Burn Treatment Center, University Hospital of State University of Londrina (HU-UEL), Londrina, Paraná, Brazil.
| | - Andrea Akemi Morita
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Paraná, Brazil
| | - Emely Emi Kakitsuka
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Paraná, Brazil
| | - Reinaldo Minoru Kuwahara
- Burn Treatment Center, University Hospital of State University of Londrina (HU-UEL), Londrina, Paraná, Brazil
| | - Elza Hiromi Tokushima Anami
- Burn Treatment Center, University Hospital of State University of Londrina (HU-UEL), Londrina, Paraná, Brazil
| | - Fabio Pitta
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Paraná, Brazil
| | - Nidia Aparecida Hernandes
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Paraná, Brazil
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Surette KE, Abouzeid C, Shepler LJ, McMullen KA, Cancio JM, Cancio LC, Hickey SA, Mandell SP, Stewart BT, Wolf SE, Kazis LE, Ryan CM, Schneider JC. Examining the association between military service history and outcomes after burn injury. Burns 2024; 50:59-65. [PMID: 37709564 PMCID: PMC10872572 DOI: 10.1016/j.burns.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/30/2023] [Accepted: 08/10/2023] [Indexed: 09/16/2023]
Abstract
INTRODUCTION The association between military service history and long-term outcomes after burn injury is unknown. This study uses data from the Burn Model System National Database to compare outcomes of individuals with and without self-reported military service history. METHODS Outcome measures were assessed at 12 months after injury including the Veterans Rand-12 Item Health Survey/Short Form-12, Satisfaction With Life Scale, Patient Reported Outcomes Measure Information System 29, 4-D Itch scale, Post Traumatic Stress Disorder Check List - Civilian Version, self-reported Post Traumatic Stress Disorder, and employment status. This study included 675 people with burns of whom 108 reported a history of military service. RESULTS The military service history group was more likely to be older, and male. Those with military service were most likely to be on Medicare insurance and those without military service history were most likely to be on Private Insurance/HMP/PPO. No significant differences were found between those with and without military service history in the outcome measures. CONCLUSIONS Further research should examine differences in outcomes between civilians and those with military service history, including elements of resilience and post traumatic growth.
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Affiliation(s)
- Kate E Surette
- Shriners Children's Hospital-Boston, 51 Blossom St., Boston, MA 02114, United States
| | - Cailin Abouzeid
- Spaulding Rehabilitation Hospital, 300 1st Ave., Charlestown, MA 02129, United States
| | - Lauren J Shepler
- Spaulding Rehabilitation Hospital, 300 1st Ave., Charlestown, MA 02129, United States
| | - Kara A McMullen
- Harborview Medical Center, University of Washington, 325 9th Ave., Seattle, WA 98104, United States
| | - Jill M Cancio
- US Army Institute of Surgical Research, Fort Sam Houston, 3698 Chambers Rd., San Antonio, TX 78234, United States
| | - Leopoldo C Cancio
- US Army Institute of Surgical Research, Fort Sam Houston, 3698 Chambers Rd., San Antonio, TX 78234, United States
| | - Sean A Hickey
- Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, United States
| | - Samuel P Mandell
- University of Texas Southwestern, 5323 Harry Hines Blvd., Dallas, TX 75390, United States
| | - Barclay T Stewart
- Harborview Medical Center, University of Washington, 325 9th Ave., Seattle, WA 98104, United States
| | - Steven E Wolf
- University of Texas Medical Branch, 1302 Mechanic St., Galveston, TX 77550, United States
| | - Lewis E Kazis
- Boston University School of Public Health, 715 Albany St., Boston, MA 02218, United States; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States; Spaulding Rehabilitation Outcomes Center, 300 1st Ave., Charlestown, MA 02129, United States
| | - Colleen M Ryan
- Shriners Children's Hospital-Boston, 51 Blossom St., Boston, MA 02114, United States; Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, United States; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States
| | - Jeffrey C Schneider
- Spaulding Rehabilitation Hospital, 300 1st Ave., Charlestown, MA 02129, United States; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States; Spaulding Rehabilitation Outcomes Center, 300 1st Ave., Charlestown, MA 02129, United States.
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Ali S, Assafi M. Prevalence and antibiogram of Pseudomonas aeruginosa and Staphylococcus aureus clinical isolates from burns and wounds in Duhok City, Iraq. J Infect Dev Ctries 2024; 18:82-92. [PMID: 38377094 DOI: 10.3855/jidc.18193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/19/2023] [Indexed: 02/22/2024] Open
Abstract
INTRODUCTION this study aimed to isolate P. aeruginosa and S. aureus, investigate the antimicrobial resistance of collected isolates, and investigate the distribution of exoU and mecA genes in P. aeruginosa and S. aureus isolates. METHODOLOGY Out of 150 samples, 32 isolates were identified as P. aeruginosa, 48 isolates were identified as S. aureus. All isolates were checked for AST. Then, a PCR was applied to detect exoU and mecA genes in P. aeruginosa and S. aureus. RESULTS 12.0% and 29.3% of the samples showed co-isolates and single isolates of studied pathogens, respectively. Regarding burn samples, S. aureus was the most prevalent pathogen (38.0%, 38/100) among males (41.8%, 23/55), followed by P. aeruginosa (27.0%, 27/100) among females (28.9%, 13/45). The highest burn infection rates of S. aureus (50.0%) and P. aeruginosa (32.7%) were recorded among age groups (≥ 50) and (18-49), respectively. Comparatively, wound samples were less infected with these pathogens. P. aeruginosa isolates usually exhibited high resistance to gentamicin, tobramycin, and netilmicin, whereas, imipenem showed low resistance at 46.87%. S. aureus isolates were susceptible to trimethoprim-sulphamethoxazole and rifampin. 56.25% of P. aeruginosa isolates were exoU positive and 37.5% of S. aureus isolates were mecA positive. Results of the cefoxitin inhibition zone with mecA gene amplification, 33.3% isolates were MRSA, 4.2% isolates were nmrMRSA, and 62.5% isolates were MSSA. Most of the resistant isolates of P. aeruginosa carried the exoU gene, 80% resistant isolates to imipenem were exoU positive. CONCLUSIONS S. aureus was more predominant than P. aeruginosa in burns and wounds infections.
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Affiliation(s)
- Samir Ali
- Department of Biology, College of Science, University of Duhok, Duhok, Kurdistan Region-Iraq
| | - Mahde Assafi
- Department of Biology, College of Science, University of Duhok, Duhok, Kurdistan Region-Iraq
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Wang J, Li Y, Zeng W, Jiang W. Circumlimbal suture and laser burns: Comparison between two different chronic glaucoma models. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2024; 49:84-94. [PMID: 38615170 PMCID: PMC11017032 DOI: 10.11817/j.issn.1672-7347.2024.230112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Indexed: 04/15/2024]
Abstract
OBJECTIVES Glaucoma is a multifactorial optic neuropathy with a high rate of irreversible visual loss, and its pathogenesis is complex and still unclear. Elevated intraocular pressure (IOP) is well recognized as the sole modifiable risk factor for the development of glaucoma in the majority of cases. This study aims to compare 2 different methods of inducing chronic ocular hypertension by circumlimbal suture or by laser burns in degree and lasting time of the IOP, different status of the retina and retinal ganglion cells (RGCs), and changes of the microstructure of neurons. METHODS The chronic ocular hypertension models were induced by 2 different ways. One kind of the models was built by unilateral circumlimbal suture (10/0) implantation (suture group), another kind of model was built by laser burns at trabecular meshwork and episcleral veins (laser group). The untreated contralateral eye served as the control group. Changes in IOP were observed and regularly monitored in the 2 groups of rats. HE staining was applied to observe the retinal and optic nerve pathology. Transmission electron microscope (TEM) was used to observe the mitochondrial morphology. RGCs were specifically labeled with Brn3b antibody and counted. The expression of caspase-3 was detected by Western blotting to clarify the apoptosis of RGCs. RESULTS Compared with the control group, IOP were significantly increased in the suture group and the laser group (both P<0.05). The suture group induced a 1.5-fold elevation of IOP, and sustained for 8 weeks. The laser group induced a 2-fold elevation of IOP for 12 weeks. Both methods could cause RGCs loss (both P<0.05), which were verified by pathology and immune staining of Brn3b. The expressions of caspase-3 were also increased (both P<0.05). The mitochondrial morphology became more fragment, which changed from long shape to round and small one under TEM in 2 models. For comparison, the pathology changes of retinal structure in suture group were not obviously than those in the laser group. CONCLUSIONS Circumlimbal suture can build an effective model of chronic elevated IOP and induce glaucomatous pathologic changes similar to those in the laser photocoagulation, but the pathologic changes are milder than those in laser photocoagulation. Compare with translimbal laser photocoagulation, equipment and skill demand for circumlimbal suture is less.
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Affiliation(s)
- Jun Wang
- Department of Ophthalmology, Second Xiangya Hospital, Central South University, Changsha 410011.
- Hunan Clinical Research Center of Ophthalmic Disease, Changsha 410011, China.
| | - Yue Li
- Department of Ophthalmology, Second Xiangya Hospital, Central South University, Changsha 410011
- Hunan Clinical Research Center of Ophthalmic Disease, Changsha 410011, China
| | - Wenjie Zeng
- Department of Ophthalmology, Second Xiangya Hospital, Central South University, Changsha 410011
- Hunan Clinical Research Center of Ophthalmic Disease, Changsha 410011, China
| | - Wenmin Jiang
- Department of Ophthalmology, Second Xiangya Hospital, Central South University, Changsha 410011.
- Hunan Clinical Research Center of Ophthalmic Disease, Changsha 410011, China.
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Rafiei S, Bouzari M. Genomic analysis of vB_PaS-HSN4 bacteriophage and its antibacterial activity (in vivo and in vitro) against Pseudomonas aeruginosa isolated from burn. Sci Rep 2024; 14:2007. [PMID: 38263187 PMCID: PMC10805781 DOI: 10.1038/s41598-023-50916-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 12/28/2023] [Indexed: 01/25/2024] Open
Abstract
The most frequent infections caused by Pseudomonas aeruginosa are local infections in soft tissues, including burns. Today, phage use is considered a suitable alternative to cure infections caused by multi-drug-resistant (MDR) and extensively drug-resistant (XDR) bacteria. We investigated the potential of a novel phage (vB_PaS-HSN4) belonging to Caudoviricetes class, against XDR and MDR P. aeruginosa strains in vivo and in vitro. Its biological and genetic characteristics were investigated. The phage burst size and latent were 119 and 20 min, respectively. It could tolerate a broad range of salt concentrations, pH values, and temperatures. The combination with ciprofloxacin significantly enhanced biofilm removal after 24 h. The genome was dsDNA with a size of 44,534 bp and encoded 61 ORFs with 3 tRNA and 5 promoters. No virulence factor was observed in the phage genome. In the in vivo infection model, treatment with vB_PaS-HSN4 increased Galleria mellonella larvae survival (80%, 66%, and 60%) (MOI 100) and (60%, 40%, and 26%) (MOI 1) in the pre-treatment, co-treatment, and post-treatment experiments, respectively. Based on these characteristics, it can be considered for the cure of infections of burns caused by P. aeruginosa.
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Affiliation(s)
- Solmaz Rafiei
- Department of Cell and Molecular Biology and Microbiology, Faculty of Biological Science and Technology, University of Isfahan, Hezar-Jereeb Street, Isfahan, 81746-73441, Iran
| | - Majid Bouzari
- Department of Cell and Molecular Biology and Microbiology, Faculty of Biological Science and Technology, University of Isfahan, Hezar-Jereeb Street, Isfahan, 81746-73441, Iran.
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刘 前, 周 建, 王 文, 陈 学, 许 亚, 黄 海, 糜 菁. [A prospective study of super-thin anterolateral thigh flap harvesting assisted by high-frequency color Doppler ultrasound in detecting perforators in deep adipose layers]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2024; 38:62-68. [PMID: 38225843 PMCID: PMC10796232 DOI: 10.7507/1002-1892.202310091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/20/2023] [Indexed: 01/17/2024]
Abstract
Objective To investigate the clinical application of high-frequency color Doppler ultrasound (HFCDU) in detecting perforators in the deep adipose layers for harvesting super-thin anterolateral thigh flap (ALTF). Methods Between August 2019 and January 2023, 45 patients (46 sides) with skin and soft tissue defects in the foot and ankle were treated, including 29 males and 16 females, aged from 22 to 62 years, with an average of 46.7 years. The body mass index ranged from 19.6 to 36.2 kg/m 2, with an average of 23.62 kg/m 2. The causes of injury included traffic accident injury in 15 cases, heavy object crush injury in 20 cases, mechanical injury in 8 cases, heat crush injury in 1 case, and chronic infection in 1 case. There were 20 cases on the left side, 24 cases on the right side, and 1 case on both sides. After thorough debridement, the wound size ranged from 5 cm×4 cm to 17 cm×11 cm. All patients underwent free super-thin ALTF transplantation repair. HFCDU was used to detect the location of the perforators piercing the deep and superficial fascia, as well as the direction and branches of the perforators within the deep adipose layers before operation. According to the preoperative HFCDU findings, the dimensions of the super-thin ALTF ranged from 6 cm×4 cm to 18 cm×12 cm. The donor sites of the flaps were directly sutured. Results A total of 55 perforators were detected by HFCDU before operation, but 1 was not found during operation. During operation, a total of 56 perforators were found, and 2 perforators were not detected by HFCDU. The positive predictive value of HFCDU for identifying perforator vessels was 98.2%, and the sensitivity was 96.4%. Among the 54 perforators accurately located by HFCDU, the orientation of the perforators in the deep adipose layers was confirmed during operation. There were 21 perforators (38.9%) traveled laterally and inferiorly, 12 (22.2%) traveled medially and inferiorly, 14 (25.9%) traveled laterally and superiorly, 5 (9.3%) traveled medially and superiorly, and 2 (3.7%) ran almost vertically to the body surface. Among the 54 perforators accurately located by HFCDU, 35 were identified as type 1 perforators and 12 as type 2 perforators (HFCDU misidentified 7 type 2 perforators as type 1 perforators). The sensitivity of HFCDU in identifying type 1 perforators was 100%, with a positive predictive value of 83.3%. For type 2 perforators, the sensitivity was 63.2%, and the positive predictive value was 100%. The surgeries were successfully completed. The super-thin ALTF had a thickness ranging from 2 to 6 mm, with an average of 3.56 mm. All super-thin ALTF survived, however, 1 flap experienced a venous crisis at 1 day after operation, but it survived after emergency exploration and re-anastomosis of the veins; 1 flap developed venous crisis at 3 days after operation but survived after bleeding with several small incisions; 3 flaps had necrosis at the distal edge of the epidermis, which healed after undergoing dressing changes. All 45 patients were followed up 6-18 months (mean, 13.6 months). Three flaps required secondary defatting procedures, while the rest had the appropriate thickness, and the overall appearance was satisfactory. Conclusion Preoperative application of HFCDU to detect the perforator in the deep adipose layers can improve the success and safety of the procedure by facilitating the harvest of super-thin ALTF.
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Affiliation(s)
- 前圆 刘
- 苏州大学苏州医学院(江苏苏州 215123)Suzhou Medical College of Soochow University, Suzhou Jiangsu, 215123, P. R. China
- 苏州大学附属无锡九院运动医学科(江苏无锡 214062)Department of Sport Medicine, Wuxi 9th People’s Hospital Affiliated to Soochow University, Wuxi Jiangsu, 214062, P. R. China
| | - 建东 周
- 苏州大学苏州医学院(江苏苏州 215123)Suzhou Medical College of Soochow University, Suzhou Jiangsu, 215123, P. R. China
| | - 文成 王
- 苏州大学苏州医学院(江苏苏州 215123)Suzhou Medical College of Soochow University, Suzhou Jiangsu, 215123, P. R. China
| | - 学明 陈
- 苏州大学苏州医学院(江苏苏州 215123)Suzhou Medical College of Soochow University, Suzhou Jiangsu, 215123, P. R. China
| | - 亚军 许
- 苏州大学苏州医学院(江苏苏州 215123)Suzhou Medical College of Soochow University, Suzhou Jiangsu, 215123, P. R. China
| | - 海 黄
- 苏州大学苏州医学院(江苏苏州 215123)Suzhou Medical College of Soochow University, Suzhou Jiangsu, 215123, P. R. China
| | - 菁熠 糜
- 苏州大学苏州医学院(江苏苏州 215123)Suzhou Medical College of Soochow University, Suzhou Jiangsu, 215123, P. R. China
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Mohammed RN, Aziz Sadat SA, Hassan SMA, Mohammed HF, Ramzi DO. Combinatorial Influence of Bone Marrow Aspirate Concentrate (BMAC) and Platelet-Rich Plasma (PRP) Treatment on Cutaneous Wound Healing in BALB/c Mice. J Burn Care Res 2024; 45:59-69. [PMID: 37262317 PMCID: PMC11023107 DOI: 10.1093/jbcr/irad080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Indexed: 06/03/2023]
Abstract
Bone marrow, a soft spongy tissue, is containing mesenchymal stem cells, that are well-recognized according to their self-renewability and stemness. Therefore, we hypothesized that bone marrow aspirate concentrate (BMAC) could have a pivotal influence on the process of wound healing in particular when it is combined with platelet-rich plasma (PRP). Thirty-six albino mice (BALB/c) were used in the study and they were grouped as negative-control, PRP treated, BMAC treated and BMAC plus PRP treated. An incisional wound (1 cm2) was made at the back of mouse and their wounds were treated according to their treatment plan and group allocations. Later, the skin at the treated wound sites was collected on days 7, 14, and 21 for histopathological investigation. The results showed that there was a statistically significant difference in BMAC+PRP-treated wounds over the rest of the treated groups in the acceleration of wound healing throughout the experiment by increasing the rate of wound contraction, re-epithelization process, and granulation tissue intensity with fluctuated infiltration in the number of the neutrophils, macrophages, and lymphocytes, also restoration of the epidermal and dermal thickness with less scarring and hair follicle regeneration vs to the negative-control, PRP and BMAC only treated groups. Our findings indicated that BMAC containing mesenchymal stem cells is an efficient approach, which can be used to enhance a smooth and physiopathological healing process, especially when it is used in combination with PRP.
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Affiliation(s)
- Rebar N Mohammed
- Medical Laboratory Analysis Department, College of Health Sciences, Cihan University of Sulaimaniya, Kurdistan Region, Iraq
- Department of Microbiology, College of Veterinary Medicine, University of Sulaimnai, Suleimanyah, Iraq
| | - Sadat Abdulla Aziz Sadat
- Department of Microbiology, College of Veterinary Medicine, University of Sulaimnai, Suleimanyah, Iraq
| | - Snur M A Hassan
- Department of Anatomy and Pathology, College of Veterinary Medicine, University of Sulaimnai, Suleimanyah, Iraq
| | - Hawraz Farhad Mohammed
- Department of Microbiology, College of Veterinary Medicine, University of Sulaimnai, Suleimanyah, Iraq
| | - Derin Omer Ramzi
- Department of Basic sciences, College of Veterinary Medicine, University of Sulaimnai, Suleimanyah, Iraq
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47
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Hua Y, Ou X. A Case Report of Severe Accidental Acute Ammonia Exposure. J Burn Care Res 2024; 45:250-252. [PMID: 37837658 PMCID: PMC11023070 DOI: 10.1093/jbcr/irad157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Indexed: 10/16/2023]
Abstract
Introduction Burn injury during pregnancy is uncommonly studied, but represents a potentially devastating public health crisis. There is the potential for multiple people injured and lives lost. The aim of this study was to review our institution’s experience with this rare subgroup and to isolate specific trends. Methods A retrospective study of burn injuries in pregnant women, admitted from 2013-2023 to a single burn center, was conducted to determine outcomes of pregnant patients. Data on these patients were collected utilizing the burn registry and a manual chart review. Results Forty patients were identified and stratified by age, weeks of gestation, mechanism of burn injury, TBSA, length of stay, ICU status, surgical intervention, maternal and fetal mortality, and substance use. The mean average age was 27.6 years, and patients were, on average, 20.8 weeks pregnant. The majority of the injuries being sustained were from scald burns (22), followed by flame (12), chemical (3), contact (2), and electrical (1), with one reported inhalation injury. TBSA ranged from 0-40%, with an average TBSA of 4.5%. Length of stay averaged 5.3 days, and 12 patients were admitted to the ICU, with a mean ICU length of stay of 4.3 days. The majority of patients did not receive any surgical intervention, but for those who did, they received either skin replacement (11), or skin substitute (4). During this time, there was one live birth, and no maternal or fetal deaths. Of those admitted, 12 (30%) tested positive for illegal substance use (22.5% marijuana, 7.5% cocaine), and 5 (12.5%) identified as a smoker. Conclusions The high incidence of substance use in this population was a surprising finding and warrants further investigation. There is a need for a multi-center, retrospective study to better understand trends in this unique population, with a focus on substance use. Applicability of Research to Practice Investigating substance use in this population will help us understand how to better treat these patients.
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Affiliation(s)
- Yusi Hua
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xiaofeng Ou
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
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Zhang H, Zhao J, Farzan R, Alizadeh Otaghvar H. Risk predictions of surgical wound complications based on a machine learning algorithm: A systematic review. Int Wound J 2024; 21:e14665. [PMID: 38272811 PMCID: PMC10805538 DOI: 10.1111/iwj.14665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 12/24/2023] [Accepted: 12/29/2023] [Indexed: 01/27/2024] Open
Abstract
Surgical wounds may arise due to harm inflicted upon soft tissue during surgical intervention, and many complications and injuries may accompany them. These complications can lead to prolonged hospitalization and poorer clinical outcomes. Also, Machine learning (ML) is a Section of artificial intelligence (AI) that has emerged in medical care and is increasingly used for diagnosis, complications, prognosis and recurrence prediction. This study aims to investigate surgical wound risk predictions and management using a ML algorithm by R programming language analysis. The systematic review, following PRISMA guidelines, spanned electronic databases using search terms like 'machine learning', 'surgical' and 'wound'. Inclusion criteria covered experimental studies from 1990 to the present on ML's application in surgical wound evaluation. Exclusion criteria included studies lacking full text, focusing on ML in all surgeries, neglecting wound assessment and duplications. Two authors rigorously assessed titles, abstracts and full texts, excluding reviews and guidelines. Ultimately, relevant articles were then analysed. The present study identified nine articles employing ML for surgical wound management. The analysis encompassed various surgical procedures, including Cardiothoracic, Caesarean total abdominal colectomy, Burn plastic surgery, facial plastic surgery, laparotomy, minimal invasive surgery, hernia repair and unspecified surgeries. ML was skillful in evaluating surgical site infections (SSI) in seven studies, while two extended its use to burn-grade diagnosis and wound classification. Support Vector Machine (SVM) and Convolutional Neural Network (CNN) were the most utilized algorithms. ANN achieved a 96% accuracy in facial plastic surgery wound management. CNN demonstrated commendable accuracies in various surgeries, and SVM exhibited high accuracy in multiple surgeries and burn plastic surgery. In sum, these findings underscore ML's potential for significant improvements in postoperative management and the development of enhanced care techniques, particularly in surgical wound management.
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Affiliation(s)
- Hui Zhang
- The Second Clinical Medical SchoolLanzhou UniversityLanzhouChina
| | - Junde Zhao
- Department of Clinical Medicine, Health Science CenterLanzhou UniversityLanzhouChina
| | - Ramyar Farzan
- Department of Plastic & Reconstructive Surgery, School of MedicineGuilan University of Medical SciencesRashtIran
| | - Hamidreza Alizadeh Otaghvar
- Associate Professor of Plastic Surgery, Trauma and Injury Research CenterIran University of Medical SciencesTehranIran
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Ho SR, Huang HC. Silver nitrate burns following umbilical granuloma treatment. Pediatr Neonatol 2024; 65:94-95. [PMID: 37648605 DOI: 10.1016/j.pedneo.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 06/11/2023] [Accepted: 06/16/2023] [Indexed: 09/01/2023] Open
Affiliation(s)
- Shau-Ru Ho
- Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsin-Chung Huang
- Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
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50
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Whitley A, Baláž P, Kavalírek J, Hanusová J, Gürlich R. Evaluating the impact of an anti-microbial silver-impregnated surgical dressing on wound infections and healing: A randomised clinical trial. Wound Repair Regen 2024; 32:67-73. [PMID: 38111101 DOI: 10.1111/wrr.13142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/09/2023] [Accepted: 11/19/2023] [Indexed: 12/20/2023]
Abstract
StopBac is an innovative silver-impregnated antimicrobial dressing specifically designed to reduce surgical site infections and enhance healing. The primary objective of this study was to compare infection healing rate at 30 days after surgery between primarily closed surgical wounds covered with StopBac and those covered with Cosmorpor, a standard surgical dressing. Between 1.3.2023 and 30.4.2023, we conducted a prospective screening of all patients undergoing surgical operations within a single surgical department. Patients were randomised into either the Cosmopor group or the StopBac group. Outcome measures were superficial and deep surgical site infections and healed wounds. Data concerning patient and surgical factors were prospectively collected and analysed. The analysis comprised 275 patients, divided into two groups: 140 patients in the StopBac group and 135 in the Cosmopor group. The StopBac dressing was associated with a reduced rate of infection, with an odds ratio of 0.288 (p < 0.001), and an increased likelihood of wound healing at 30 days after surgery. The odds ratio for healing at 30 days was 4.661 (p < 0.001). StopBac was associated with a lower incidence of surgical wound infections and a higher probability of healing at 30 days after surgery, when compared with standard dressing.
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Affiliation(s)
- Adam Whitley
- Department of Surgery, University Hospital Královské Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Peter Baláž
- Department of Surgery, University Hospital Královské Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
- Vascular Surgery, Cardiocenter, University Hospital Královské Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jan Kavalírek
- Faculty of Biomedical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Jitka Hanusová
- Faculty of Biomedical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Robert Gürlich
- Department of Surgery, University Hospital Královské Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
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