Overweight and Obesity: Overrepresentation in the Pediatric Reconstructive Burn Population:

Administration of circRNA_0075932 shRNA exhibits a therapeutic effect on burn-associated infection in obese rats

miR-495 and miR-142-3p suppress inflammatory response. Circ_0075932 is overexpressed in the burned skin of obese individuals and is involved in the regulation of PUM2 and AuroraA kinase, thus activating the NF-kB pathway. Obesity significantly influences the length of hospital stay for paediatric burn patients, who present symptoms of slower healing or greater functional impairment. In this study, the relationship between the abovementioned genes was assessed using an obese rat burn model. Luciferase assays, real-time PCR, Western blotting and ELISA assays were performed to explore the regulatory relationships of circRNA_0075932/miR-142, circRNA_0075932/miR-495, miR-142/NLRP3, and miR-495/PUM2. Luciferase assays indicated that miR-142 effectively suppressed the expression of circRNA_0075932/NLRP3 while miR-495 inhibited the expression of circRNA_0075932/PUM2. Downregulation of circRNA_0075932 suppressed the expression of circRNA_0075932/NLRP3/PUM2 and activated the expression of miR-142/miR-495. Exosomes collected from lenti-circRNA_0075932 shRNA-treated ADSCs showed remarkable efficiency in maintaining the post heat stress (PHS)-induced dysregulation of circRNA_0075932, miR-142, miR-495, NLRP3, PUM2, AuroraB, Ika, NF-kB, TNF-α, IL-1β, and MCP-1 in THP-1 cells. Moreover, EXO-Lenti-circRNA_0075932 shRNA significantly restored burn-induced dysregulation of circRNA_0075932, miR-142, miR-495, NLRP3, PUM2, AuroraB, Ika, NF-kB, TNF-α, IL-1β, and MCP-1 in obese rats. In conclusion, this study confirmed that the expression of circ_0075932 in adipose tissue is evidently increased in burn-associated infection in obese rats. Moreover, the administration of circ_0075932 shRNA exhibited a therapeutic effect upon burn-associated infection in obese rats by suppressing the expression of circ_0075932.

The Influence of Obesity on Treatment and Outcome of Severely Burned Patients

Obesity and the related medical, social, and economic impacts are relevant multifactorial and chronic conditions that also have a meaningful impact on outcomes following a severe injury, including burns. In addition to burn-specific difficulties, such as adequate hypermetabolic response, fluid resuscitation, and early wound coverage, obese patients also present with common comorbidities, such as arterial hypertension, diabetes mellitus, or nonalcoholic fatty liver disease. In addition, the pathophysiologic response to severe burns can be enhanced. Besides the increased morbidity and mortality compared to burn patients with normal weight, obese patients present a challenge in fluid resuscitation, perioperative management, and difficulties in wound healing. The present work is an in-depth review of the current understanding of the influence of obesity on the management and outcome of severe burns.

[Tissue expansion in child's burn reconstruction. Management principles and eleven years retrospective study of 42 patients]

PURPOSE

With constraints and a risk of complication, tissue expansion in child's burn sequelae need a controlled surgical procedure, and a therapeutic plan appropriate to the specific pediatric healing, growth, and development.

MATERIAL AND METHODS

Our principles of management and technical points are described. A retrospective study of tissue expansion in child's burn sequelae between 2005 and 2016 is submitted.

RESULTS

There are 185 expanders, 98 protocols in 41 children, over half of sequelae concerning scalp, neck and chest. Mean age at the first expansion was 10.3 years old (5.8 years after burn). There are in average 2,4 (1-8) protocols by patient, with 1.9 (1-4) expanders by procedure. Surgical repair was a flap (78.8%), a full-thickness skin graft (13.3%) or both. Fifteen patients (30 expanders (14.6%) and 22 protocols (22.4%)), had expansion's complications, mostly infections and expositions. Eight patients (14 expanders (7.6%) and 10 protocols (10.2%)) had reconstructive's complications. An increase of burn area was a risk factor of complication (significant). Complicated expanders rate by location was 7.9% (scalp), 12.5% (neck), 9.8% (supraclavicular), 10.5% (chest), 19.4% (abdomen), 30% (buttock), 29.4% (lower limb), 1/2 (face).

CONCLUSION

Tissue expansion in child's burn sequelae is ideal in scalp, good in neck, chest and proximal upper limb, and to do carefully in lower limb and face.

ICU-Acquired Weakness Is Associated With Differences in Clinical Outcomes in Critically Ill Children

OBJECTIVE

ICU-acquired weakness, comprised critical illness myopathy and critical illness neuropathy, occurs in a significant proportion of critically ill adults and is associated with high morbidity and mortality. Little is known about ICU-acquired weakness among critically ill children. We investigated the incidence of ICU-acquired weakness among PICUs participating in the Virtual PICU Systems database. We also sought to identify associated risk factors for ICU-acquired weakness and evaluate the hypothesis that ICU-acquired weakness is associated with poor clinical outcomes.

DESIGN

Retrospective cohort study.

SETTING

PICU.

MEASUREMENTS AND MAIN RESULTS

Virtual PICU System was queried for critical illness myopathy and critical illness neuropathy between January 2009 and November 2013. Demographic, admission, and clinical outcome variables including mechanical ventilation days, PICU length of stay, and discharge disposition were analyzed. The Pediatric Index of Mortality-2 was used to evaluate and control for illness severity and risk of mortality. Among 203,875 admissions, there were 55 cases of critical illness myopathy reported and no cases of critical illness neuropathy, resulting in an incidence of 0.02%. Mechanical ventilation days were higher among patients with ICU-acquired weakness versus those who did not develop ICU-acquired weakness (31.6 ± 28.9 vs 9.3 ± 20.6; p < 0.001). In our multivariable analysis, when controlling for Pediatric Index of Mortality-2, ICU-acquired weakness was more frequently reported in those with admission diagnoses of respiratory illness and infection and the need for mechanical ventilation, renal replacement therapy, extracorporeal life support, and tracheostomy. ICU-acquired weakness was associated with a longer PICU length of stay, episodes requiring mechanical ventilation, and discharge to an intermediate, chronic care, and rehabilitation care unit. ICU-acquired weakness was not independently associated with mortality.

CONCLUSIONS

ICU-acquired weakness is uncommonly diagnosed among PICU patients reported in Virtual PICU System. ICU-acquired weakness is associated with critical care therapies, invasive procedures, and resource utilization. Limitations of our retrospective study include underrecognition of ICU-acquired weakness and lack of standardized diagnostic criteria within Virtual PICU System. Prospective studies are needed to better understand the true incidence, risk factors, and clinical course for patients who develop ICU-acquired weakness.

Nutrition and metabolism in the rehabilitative phase of recovery in burn children: a review of clinical and research findings in a speciality pediatric burn hospital

During the rehabilitation phase of burn injury, patient care transitions from critical care medicine to restorative treatment strategies that encompass physical and occupational therapies, nutrition repletion, and psychosocial support for community reintegration. As pediatric burn patients undergo rehabilitation, nutrition assessment remains ongoing to define nutritional status and any alterations in metabolism that may take place. For some, a persistent hypermetabolic state appears evident, and weight loss may continue. The severity and duration however varies among patients. Many patients enter their rehabilitative phase with visible lean body mass depletion, and the focus of nutritional therapy for them shifts to replenishing nutritional status, while supporting rehabilitative efforts. Over the past decade, we have conducted studies on energy and protein metabolism, body composition, including bone mineralization, and general wellness in over 130 patients to better understand changes in metabolism and nutritional status during the rehabilitative phase of recovery. This abstract summarizes our findings.

Pediatric obesity and safety in inpatient settings: a systematic literature review

OBJECTIVE

Pediatric obesity affects more than 16% of American children and is associated with worse outcomes in hospitalized patients. A systematic literature review was performed to identify studies of adverse care events affecting obese pediatric patients in the emergency room, operating room, or inpatient wards.

EVIDENCE REVIEW

We systematically searched Medline for articles published from 1970 to 2013 regarding obesity and patient safety events in pediatric acute care settings. We determined the study design, number of patients studied, definition and prevalence of obesity, the relevant acute care setting, the specific association with obesity addressed, and the results of each study.

RESULTS AND CONCLUSION

Thirty-four studies documented both procedural complications and issues with general hospital care. Most were retrospective and focused on surgery or anesthesia. Obese patients may have increased risk for a variety of adverse events. Further study could improve institutional patient safety guidelines to enhance care for obese children.

Obesity and burns

The population of overweight patients presenting to burn facilities is expected to increase significantly over the next decades due to the global epidemic of obesity. Excess adiposity mediates alterations to key physiological responses and poses challenges to the optimal management of burns. The purpose of this study is to document the general epidemiological aspects of thermal injuries in the obese population, outline relevant physiological aspects associated with obesity, and draw attention to topics relating to the management, rehabilitation, and prognosis of burns in this emerging subpopulation of patients.