[Visual analysis of the current research status and hotspots of electric burns at home and abroad]

Objective: To analyze the literature on electric burns published at home and abroad, and to explore the research hotspots and frontiers of electric burns. Methods: The bibliometric method was used. The Chinese and English literature related to electric burns published in China National Knowledge Infrastructure, Wanfang database, VIP database and the core collection of Web of Science database from January 1, 2013 to December 31, 2022 were searched respectively, and the CiteSpace 6.2.R2 software was used for analysis. The number of papers, authors, countries, and institutions of Chinese and English literature were counted respectively, and the co-occurrence analysis of keywords and mutation analysis and cluster analysis on the basis of the co-occurrence analysis were conducted, besides, the clustering time line figure was obtained after the keywords were sorted by time to explore the current research status and the evolution process of hotspots in the field of electric burns. Results: A total of 398 English papers were retrieved from the core collection of Web of Science database, and a total of 523 Chinese papers were retrieved from China National Knowledge Infrastructure, Wanfang database, and VIP database after duplicate check. From 2013 to 2022, the number of English literature published in the field of electric burns showed a steadily upward trend, and the number of published Chinese literature showed a downward trend and tended to be stable. In Chinese literature, a total of 302 authors as the first author published papers related to electric burns, with 17 core authors published ≥3 papers; in English literature, a total of 320 authors as the first author published papers related to electric burns. Researches on electric burns were carried out in 65 countries, with United States having the most cooperation with other countries and the largest number of papers published. A total of 512 institutions at home and abroad published papers related to electric burns, and the institutions with the largest number of Chinese and English papers were Shanghai Electric Power Hospital in China (n=14) and Hallym University in Korea (n=11), respectively. A total of 1 176 Chinese keywords and 1 068 English keywords were included for co-occurrence analysis after excluding keywords related to the searching words. The top three keywords in frequency in Chinese literature were surgical flap, wound repair, and nursing, and the top three keywords in frequency in English literature were management, epidemiology, and children. Ten clusters were obtained by keyword analysis in Chinese literature, and the largest cluster was wound healing, followed by clinical effects and surgical flaps. Seven clusters were obtained by keyword analysis in English literature, and the largest cluster was reconstructive surgical procedures, followed by chronic pain and shock. The persistent clusters in Chinese literature were wound healing and clinical outcomes, etc., and the prominent nodes in the recent two years were surgical timing, limb electric burns, and hypertrophic scars; the persistent clusters in English literature were reconstructive surgical procedures and chronic pain, etc., and the prominent nodes in the recent two years were predictors and burn management, etc. In Chinese literature, the keyword with the longest duration of mutation (2017-2021) was wrist electric burns, and the keyword with the highest intensity of mutation was flap repair; in English literature, the keyword with the longest duration of the mutation (2019-2022) was voltage, and the keyword with the highest intensity of mutation was prevention. Conclusions: There are similarities and differences in the research directions and hotspots of electric burns at home and abroad. Surgical flap repair is a common research hotspot at home and abroad. At present, domestic research focuses on wound healing, wrist electric burns, and other aspects, while international research focuses on treatment management, epidemiology, reconstruction, and other aspects.

Profile of patients with burns according to seasonal changes

OBJECTIVE

In this study, the aim was to discuss the effects of seasonal changes on the patient profile and number of patients hospitalised at our burn centre.

METHOD

All cases of burns that occurred between 1 January 2014 and 1 January 2020 at our hospital were investigated.

RESULTS

In total, 1417 patients were investigated, 799 of whom were male (56.4%) and 618 (43.6%) were female. The number of patients with burns in the 1-4 years age group was the highest of all the age groups. Scald burns and electrical burns were mostly observed in the spring; flame burns were mostly observed in the winter, and hot object contact and chemical burns were mostly observed in the summer. When considered in total, burn cases were mostly observed in spring and autumn.

CONCLUSION

Understanding seasonal epidemiology of burn injuries can facilitate seasonal injury prevention campaigns and education efforts. Burn centres can also allocate resources appropriately, according to the patient volume and possible burn outcomes for each season.

[Establishment and validation of a risk prediction model for disseminated intravascular coagulation patients with electrical burns]

Objective: To establish and validate a risk prediction model of disseminated intravascular coagulation (DIC) by the screening independent risk factors for the occurrence of DIC in patients with electrical burns. Methods: The retrospective case series study was conducted. The clinical data of 218 electrical burn patients admitted to Baogang Hospital of Inner Mongolia from January 2015 to January 2023 who met the inclusion criteria were collected, including 198 males and 20 females, with the age of (38±14) years. The patients were divided into DIC group and non DIC group based on whether they were diagnosed with DIC during the treatment period. The following data of patients of two groups were collected and compared, including age, gender, total burn area, full-thickness burn area, injury voltage, whether osteofascial compartment syndrome occurred within 1 day after injury, duration of stay in burn intensive care unit, total length of hospital stay, whether combined with inhalation injury and multiple injuries, whether shock occurred upon admission, the abbreviated burn severity index score, and the acute physiology and chronic health evaluation Ⅱ score. The laboratory examination data of the patients within 24 hours after admission were also collected, including blood routine indexes: white blood cell count (WBC), hemoglobin level, platelet count (PLT), and neutrophil count; coagulation indexes: activated partial thromboplastin time (APTT), prothrombin time, thrombin time, and levels of D-dimer and fibrinogen (FIB); blood biochemistry indexes: aspartic transaminase, alanine transaminase, direct bilirubin, total bilirubin, total protein, albumin, blood glucose, creatinine, and urea nitrogen; blood gas analysis indexes: blood pH value, arterial partial pressure of oxygen, arterial partial pressure of carbon dioxide, bicarbonate, and base excess; and cardiac zymogram indexes: levels of myoglobin, troponin, lactate dehydrogenase, creatine kinase (CK), and α-hydroxybutyrate dehydrogenase. Data were statistically analyzed with chi-square test, Fisher's exact probability test, independent sample t test, and Mann-Whitney U test. For the variables with statistically significant differences in single factor analysis, the least absolute value selection and shrinkage operator (LASSO) regression was used to reduce the dimension, and the predictive factors for DIC in 218 patients with electrical burns were screened. The above-mentioned predictors were included in multivariate logistic regression analysis to find out the independent risk factors for DIC in 218 patients with electrical burns, and to draw the prediction model nomograms. The performance of the prediction model was evaluated by the receiver operating characteristic (ROC) curve and the area under the ROC curve, and the prediction model was validated by the calibration curve and clinical decision curve analysis (DCA). Results: Compared with those in non DIC group, the total burn area, full-thickness burn area, total length of hospital stay, and the proportions of high voltage caused injury, occurrence of osteofascial compartment syndrome within 1 day after injury, combination of inhalation injury, and occurrence of shock upon admission of patients in DIC group were significantly increased/prolonged (with Z values of -2.53, -4.65, and -2.10, respectively, with χ2 values of 11.46, 16.00, 7.98, and 18.93, respectively, P<0.05). Compared with those in non DIC group, the APTT, level of D-dimer, myoglobin, WBC, PLT, and levels of FIB, total bilirubin, and CK of patients within 24 hours after admission in DIC group were significantly prolonged/increased (with Z values of -2.02, -4.51, and -3.82, respectively, with t values of -3.84, -2.34, -2.77, -2.70, and -2.61, respectively), and the level of total protein and blood pH value were significantly reduced (t=-2.85, Z=-2.03), P<0.05. LASSO regression analysis was carried out for the above 17 indicators with statistically significant differences. The results showed that injury voltage, the occurrence of shock upon admission, the occurrence of osteofascial compartment syndrome within 1 day after injury, and levels of D-dimer and total protein within 24 hours after admission were predictive factors for the occurrence of DIC in 218 patients with electrical burns (with regression coefficients of 0.24, 0.52, 0.35, 0.13, and -0.001, respectively). Multivariate logistic regression analysis showed that injury voltage, the occurrence of shock upon admission, the occurrence of osteofascial compartment syndrome within 1 day after injury, and D-dimer level within 24 hours after admission were independent risk factors for DIC in 218 patients with electrical burns (with odds ratios of 3.33, 4.24, 2.68, and 1.38, respectively, with 95% confidence intervals of 1.43-7.79, 1.78-10.07, 1.17-6.13, and 1.19-1.61, respectively, P<0.05). Based on the aforementioned four independent risk factors, the nomogram of prediction model for evaluating the probability of DIC in patients was drawn. The area under the ROC curve of prediction model was 0.88, and the 95% confidence interval was 0.82-0.95, indicating that the model had good predictive ability; the curve of prediction model tended to be near the ideal curve, indicating that the model had a high calibration degree; the clinical DCA of prediction model showed that the threshold probability of patients ranged from 4% to 97%, indicating that the model had good predictive ability. Conclusions: The injury voltage, the occurrence of shock upon admission, the occurrence of osteofascial compartment syndrome within 1 day after injury, and D-dimer level within 24 hours after admission are independent risk factors for the occurrence of DIC in patients with electrical burns. The prediction model established based on the above indicators can provide early warning for the occurrence of DIC in these patients.

Electrocution - post-mortem presentations, problems and pitfalls

Deaths due to electrocution occur when there has been passage of an electric current through the body. Lethal mechanisms may involve the heart with ventricular fibrillation, or the respiratory muscles or brainstem respiratory centres with respiratory paralysis/cessation. The size of the current that flows through the body is directly dependent on the potential difference of the circuit and the resistance of the tissues. The majority of deaths are accidental, with suicides being less common and homicides being very rare. Problems arising in the evaluation of cases include situations where electrocution has clearly occurred from the scene findings, but no injuries are detectable at autopsy, or when electrical burns are found at autopsy with no defective equipment/circuitry identified at the death scene.

Caring for Patients With Electrical Burns Using the Holistic Neuman Systems Model: A Case Study

Patients with burns should be provided with holistic nursing care that considers all systems of the body. The Neuman Systems Model (NSM) is especially suited to holistic care as it proposes an open system approach and addresses five major interacting variables. This study aimed to investigate the applicability of the NSM when caring for a patient with electrical burns. In this case study, we planned and applied nursing care for a 20-year-old man with electrical burns based on the NSM. The study was conducted between November 25, 2018, and January 10, 2019. We used the six-item Neuman Diagnostic Tool (NDT) developed by Neuman in our interviews with the patient. We found that the electrical burns had caused multiple physiological, psychological, and sociocultural problems for our patient, most of which were physical problems, including the burn injury and subsequent limb amputation. The NDT guided our data collection and aided in our ability to determine stressors and formulate appropriate nursing diagnoses. The NSM strengthened the patient's flexible line of defense for coping individually and facilitated the identification of deficiencies in the normal and resistance lines of defense. The NSM provides a theoretical framework for nurses caring for patients with burns where entire systems are affected.

Epidemiology and outcome of 1442 pediatric burn patients: A single-center experience

BACKGROUND

Burns are common injuries among children resulting with significant mortality and morbidity, especially in developing countries. Epidemiological data may guide for the preventive measures and contribute reducing the incidence of burns in children. The aim of this study is to report the epidemiological features of pediatric burn patients treated in a tertiary burn center and to suggest preventive measures.

METHODS

Between January 1, 2015, and June 30, 2019, a total of 1442 children hospitalized in our burn center were evaluated retrospectively. Demographic, epidemiological, and clinical data including burn etiology, percentage of burned total body surface area (TBSA), hospital stay, infection, and mortality rate were reported.

RESULTS

The percentage of burned TBSA was 11.23±10.70 and the length of hospital stay was 14.38±18.1 days. In total, 89.18% of the patients (n=1286) experienced burn injury indoors. With regard to the etiology, scalding with hot water and tea was the most common in all age groups. Flame burn incidence increases after infancy, and electrical burns occur more in school age. A total of 10 patients (0.69%) were died and seven of them were delayed referrals from other hospitals.

CONCLUSION

Infants and males consist of the majority of our pediatric burn patients. The percentage of burned TBSA and length of hospital stay increased as the patient age increased. Childhood burn injuries are mainly scald burns that occur indoors, while their parents were nearby. Therefore, education programs focusing on primary prevention addressing family members are required to avoid pediatric burns.

[Possibility of determine taser's models by morfological features of the skin injuries]

The aim of study is to identify morfological signs of the skin damage, formed by electric discharge of different models of tasers, and therefore to determine construction features characterizing taser's models, as well as to detect the conditions of traumatization. As a result of experiment it was revealed that various morphological skin damages are caused by difference in the configuration of taser's terminal elements. It gives reason for an objective conclusion about stun gun's specific model.

[Use of double flaps in high-voltage electrical injury of scalp and calvaria: case report]

A 15-year-old boy sustained a high-voltage electrical injury with full-thickness scalp and calvarial bone necrosis in the parieto-occipital region. While necrotic soft tissues were debrided on the fifth day of injury, the devitalized calvaria was preserved. Bilayered coverage of the necrotic bone was achieved by transposition of 'bipedicled pericranial flap' and 'bipedicled scalp flap'. No complication was observed in the postoperative period. A bone resorption area, smaller than the original necrotic bone area, was observed in the long-term follow-ups.

Aeromonas infection in critically ill burn patients

Aeromonas infection in burn patients is extremely uncommon. Here we report on four cases of Aeromonas infection in burn patients admitted to the BICU at the Singapore General Hospital burn unit between June 2001 and May 2006. Two patients had positive blood cultures, and the other two had tissue samples with growth. There was no history of exposure to soil or fresh water in all patients. The average age of patients was 35 years (range 24-41) and the average % TBSA was 48% (range 35-80). Cultures were isolated between days 2 and 4 post burn. There was one mortality in the series. Increasing antibiotic resistance was noted among isolates of Aeromonas. Continued vigilance is essential to detect infection early, even in the absence of a suggestive history, with adequate debridement and appropriate antibiotic therapy.

Urologic complications of sexual trauma among male survivors of torture

OBJECTIVES

To describe the urologic and sexual complications of male survivors of sexual torture, including prevalence, sequelae, diagnosis, and treatment.

METHODS

Through chart reviews, we identified all male survivors of torture who had been treated for physical and/or psychological symptoms due to sexual trauma at the Boston Center for Refugee Health and Human Rights at Boston Medical Center between January 1, 2001 and January 1, 2002. Of the 72 men seen, 20 (28%) were survivors of sexual trauma. Our study focused on genital trauma leading to urologic and/or sexual dysfunction. Therefore, all cases of male genital trauma that had been referred to the urology department (3 of 20) were selected for this review.

RESULTS

The patients presented with chronic genital and erectile pain, lower urinary tract symptoms, and sexual dysfunction. The diagnostic workup included history, physical examination, and ultrasonography. Treatment included steroid injections for chronic pain and oral erectogenic agents for sexual dysfunction.

CONCLUSIONS

The apparent prevalence and severity of the physical and mental sequelae to sexual trauma make it an important area for screening when treating survivors of torture. Our study is the first of its kind to document urologic complications of sexual torture in a foreign-born U.S. cohort of tortured men, including prevalence, diagnosis, and treatment. The proposed use of steroid injections in the clinical treatment of these patients has not been previously reported.

Electrolytic lesions to nucleus accumbens core and shell have dissociable effects on conditioning to discrete and contextual cues in aversive and appetitive procedures respectively

The nucleus accumbens (n. acc.) has been implicated in conditioning to both discrete and contextual cues but its precise role is as yet controversial because conflicting patterns of effect have been reported. These inconsistencies may relate to the extent to which the lesions used encroach on different subfields of n. acc. and the use of different task variants. The present study compared the effects of selective lesions of shell and core subfields of nucleus accumbens (n. acc.) across aversive and appetitive trace conditioning variants. In both experiments, an auditory stimulus was contiguous with footshock or food, or presented at a trace interval. A continuous flashing light in each case provided an experimental background stimulus. Conditioning to the cues provided by the experimental chambers was also assessed. Rats with electrolytic lesions to the n. acc. shell and core showed different patterns of effect in aversive (Experiment 1) and appetitive (Experiment 2) variants of this procedure. In Experiment 1, the core lesion reduced the difference between trace and contiguously conditioned groups, in responding to the discrete noise stimulus. However, neither lesion had any detectable effect on contextual conditioning. In Experiment 2, the shell lesion clearly increased contextual conditioning, selectively in the trace conditioned group, but neither lesion had any detectable effect on discrete cue conditioning. Thus, whilst the shell and core lesions produced dissociable effects on discrete cue and contextual conditioning, the conclusions to be drawn depend on the procedural variant in use.

[Diagnostic image (197). A man who suddenly collapsed]

A 40-year-old man suffered a witnessed collapse with brief loss of consciousness, due to electrical injury.

Effects of stimulus parameters on seizure duration and ECS-induced retrograde amnesia

A selected electroconvulsive therapy stimulus dose can result from different combinations of pulse amplitude, pulse width, pulse frequency, and stimulus duration; however, the roles of these stimulus variables in the effects of the overall stimulus dose are not clearly understood. A series of studies on Wistar rats was therefore conducted to assess the effects of different stimulus compositions at constant stimulus charge. In the first two studies, two differently composed 60 mC charge unidirectional electroconvulsive shock (ECS) stimuli were administered once daily for 3 days, while in the third study three differently composed 120 mC charge unidirectional ECS stimuli were administered on a single occasion. At constant charge, a markedly longer stimulus duration was associated with ear burns and an approximately 12.5% longer seizure duration. At constant charge, however, different stimulus compositions were not associated with different degrees of impairment in two passive avoidance models of ECS-induced retrograde amnesia. These preliminary findings have implications for the choice of stimulus settings during dose titration and dose selection procedures. While the findings encourage further investigation, it appears that variations in stimulus duration are biologically significant, but minor variations in other stimulus elements may not influence the effects of electrically induced seizures very much.

Electrical and lightning injuries

Electricity and lightning can cause injury in a variety of ways, some of which may remain hidden from the unsuspecting physician until it is too late. Prompt and, if necessary, prolonged resuscitation are of proven benefit. Particular attention must be paid to the patient who suffers high-voltage injury, and deep electrothermal burns on damage to vital organs should be excluded. Uncommonly late sequelae are seen, and such patients require appropriate care.

[Electrical injuries during laparoscopy]

Electrical injury is uncommon during surgical laparoscopy, but may be serious. Following a comprehensive literature review, we describe five mechanisms of burn injuries: direct contact, electric arc, insulation failure, direct or capacitive coupling. We discuss these mechanisms and suggest simple preventive measures designed to ensure optimal safety.

Primary cutaneous aspergillosis: our experience in 10 years

We describe nine patients with primary cutaneous aspergillosis who were diagnosed during the 10-year period between 1987 and 1996. All except one were adults. Seven of those nine cases had an immunocompromised state. Among the immunocompromised patients, six had burn wounds and one was a renal transplant recipient. Aspergillus flavus was isolated from seven patients and A. fumigatus from one, and in one other case the species could not be determined. Three patients who had total burn surface area of more than 70% died. The other patients responded well to extensive surgical debridement with or without institution of oral itraconazole.

ACUTE INFLAMMATION IN THE RENAL CORTEX AND MEDULLA FOLLOWING THERMAL INJURY

As determined by serial histologic study, the leukocyte component of the acute inflammatory response to thermal injury in the medulla of the kidney of rabbits was markedly delayed and diminished in intensity when compared with the response of the cortex. Similar differences in granulocyte mobilization between cortex and medulla were seen following the inoculation of bacteria. Hydronephrosis produced by ureteral ligation had no discernible effect upon the inflammatory response in either cortex or medulla following thermal burns. The susceptibility of the cortex to E. coli infection was markedly enhanced during leukopenia induced by nitrogen-mustard. These results suggest that deficiencies in granulocyte mobilization play an important role in the increased susceptibility of the renal medulla to bacterial infection.

Investigation of deaths related to electrical injury

Even though the use of electricity is an integral part of our lives, the number of accidents and deaths related to electricity is on the decline. This is due to increased awareness of electrical hazards and, in large part, to increased inclusion of safety mechanisms by manufacturers. However rare, electrical injury and related death can present a complicated case in the emergency department and for death investigators. Sometimes the circumstances of the physical scene are unclear because of intentional or accidental alterations or the investigator's inability to reconstruct events leading to the injury. This may hinder the initial clinical assessment. We present cases of typical and atypical deaths from electrical injury and review clinical and investigative procedures to assist in the treatment of patients with electrical injuries.

Electric shock, Part I: Physics and pathophysiology

Electric shock causes injury and death through a variety of mechanisms. The proper treatment of a patient with electric shock depends upon the nature of the injuries sustained. The primary electric injuries to be expected depend in large part on the type of electric energy source, the amount and duration of current flow, and the parts of the body affected. Secondary injury can be caused by trauma associated with the electric accident such as falls and explosions.

[Transportation during the night with the military anesthesia and resuscitation service: importance in urgent transfers]

The A.A. show a clinic case of a 37 years old person injured by a thunder due to a contact with high intensity electric energy, with a lot of scalds of first, second and third degree, on 70% of the body surface, in which there was necessity of Air-Force to bring the person out of the Region border, and out of the working time of the Regional helicopter assistance. The A.A. want you to know the importance of S.A.R. in particular weather situations and places that are not contemplated by Regional helicopter assistance lous.

[Traumatic injuries of the oral mucosa]

Injuries of the oral mucosa have a favourable prognosis provided they are treated adequately. The dentist is mostly confronted with this kind of injuries in young patients and should be familiar with the diagnosis, the treatment and the late complications that may occur.

Device and methods for the measurement of energy transfer in experiments involving thermal and electrical injuries of skin

This work is part of a larger investigation aiming at tracing differences between injuries caused by heat and electricity. Electrodes and heaters similar to the electrodes of an electric cattle baton are used to dissipate approximately 40 joules in 40 seconds in pig skin. Voltages in the range 40-60 volts (AC or DC) are applied via stainless steel electrodes and temperatures in the range 50-100 degrees C are applied via heaters made of copper wire. Heat transfer is controlled by electronically regulated heaters utilizing the temperature dependence of the heater wire itself as a thermometer. Transfer of electricity takes place from either commercial DC supply, from transformed voltage from the mains or from a sine voltage generator connected to a power amplifier. The energy transfer is in all cases measured by electronic integration of the dissipated power in time. The power supplied to th electrodes or the heaters is found by electronic multiplication of the applied voltage and current. Typical power vs. time curves are presented.

A simplified technique for free transfer of groin flaps, by use of a Doppler Probe

Our application of the Doppler probe to microvascular surgery is discussed, including the monitoring of the superficial circumflex iliac artery in free groin flaps. Our technique of free groin flap transplantation is compared to that of others. Three of our cases are discussed.

The burnt patient: a general view

Images