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Mutore KT, Koduri R, Alatrash N, Nomellini V. THE USE OF POLOXAMER 188 IN BURN INJURY TREATMENT: A SYSTEMATIC LITERATURE REVIEW. Shock 2024; 62:461-469. [PMID: 39178216 DOI: 10.1097/shk.0000000000002439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2024]
Abstract
ABSTRACT Although there have been numerous advancements in burn wound management, burn injuries are still a major cause of morbidity and mortality in the United States, and novel therapeutics are still needed to improve outcomes. Poloxamer 188 (P188) is a synthetic copolymer with Food and Drug Administration (FDA) approval that has many biological applications. This study aimed to review the literature on P188 in burn injuries and its effects based on burn mechanisms. We employed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to complete this systematic literature review. We searched the databases of Google Scholar, PubMed, and SCOPUS using the keywords burn, p188, poloxamer 188, and pluronic F68 in combination. Two reviewers independently screened the articles for inclusion. Articles that were not in English, were book chapters or conference proceedings, or did not evaluate P188 in the setting of burn injuries were excluded. We included a total of 33 full-text articles with both in vivo and in vitro preclinical studies. P188 was found to be beneficial in animal and cell studies evaluating electrical and thermal burn injuries. P188 was also found to be useful in burn wound management. Although its utility may be limited in radiation injuries, P188 may be helpful in delaying the initial damage caused by radiation burns. P188 therefore has the potential to be used as a therapy in both burn wound management and in the treatment of systemic injuries sustained through burns. Future studies should aim to assess the efficacy of P188 in clinical models of burn injury.
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Affiliation(s)
- Kevin T Mutore
- Division of Burn, Trauma, Acute, and Critical Care Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas
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Kruse M, Liesenborghs KE, Josuttis D, Plettig P, Guembel D, Lenz IK, Guethoff C, Gebhardt V, Schmittner MD. Early Autocalibrated Arterial Waveform Analysis for the Management of Burn Shock-A Cohort Study. J Intensive Care Med 2024; 39:655-664. [PMID: 38173245 DOI: 10.1177/08850666231224388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Adequate fluid therapy is crucial for resuscitation after major burns. To adapt this to individual patient demands, standard is adjustment of volume to laboratory parameters and values of enhanced hemodynamic monitoring. To implement calibrated parameters, patients must have reached the intensive care unit (ICU). The aim of this study was, to evaluate the use of an auto-calibrated enhanced hemodynamic monitoring device to improve fluid management before admission to ICU. We used PulsioflexProAqt® (Getinge) during initial treatment and burn shock resuscitation. Analysis was performed regarding time of measurement, volume management, organ dysfunction, and mortality. We conducted a monocentre, prospective cohort study of 20 severely burned patients, >20% total body surface area (TBSA), receiving monitoring immediately after admission. We compared to 57 patients, matched in terms of TBSA, age, sex, and existence of inhalation injury out of a retrospective control group, who received standard care. Hemodynamic measurement with autocalibrated monitoring started significantly earlier: 3.75(2.67-6.0) hours (h) after trauma in the study group versus 13.6(8.1-17.5) h in the control group (P < .001). Study group received less fluid after 6 h: 1.7(1.2-2.2) versus 2.3(1.6-2.8) ml/TBSA%/kg, P = .043 and 12 h: 3.0(2.5-4.0) versus 4.2(3.1-5.0) ml/TBSA%/kg, P = .047. Dosage of norepinephrine was higher after 18 h in the study group: 0.20(0.12-0.3) versus 0.08(0.02-0.18) µg/kg/min, P = .014. The study group showed no adult respiratory distress syndrome versus 21% in the control group, P = .031. There was no difference in other organ failures, organ replacement therapy, and mortality. The use of auto-calibrated enhanced hemodynamic monitoring is a fast and feasible way to guide early fluid therapy after burn trauma. It reduces the time to reach information about patient's volume capacity. Management of fluid application changed to a more restrictive fluid use in the early period of burn shock and led to a reduction of pulmonary complications.
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Affiliation(s)
- Marianne Kruse
- Department of Anesthesiology, Intensive Care and Pain Medicine, BG Klinikum Unfallkrankenhaus Berlin, Berlin, DE, Germany
| | - Konrad Ernst Liesenborghs
- Department of Anesthesiology, Intensive Care and Pain Medicine, BG Klinikum Unfallkrankenhaus Berlin, Berlin, DE, Germany
| | - David Josuttis
- Department of Anesthesiology, Intensive Care and Pain Medicine, BG Klinikum Unfallkrankenhaus Berlin, Berlin, DE, Germany
| | - Philip Plettig
- Department of Anesthesiology, Intensive Care and Pain Medicine, BG Klinikum Unfallkrankenhaus Berlin, Berlin, DE, Germany
| | - Denis Guembel
- Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, DE, Germany
- Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, DE, Germany
| | - Ida Katinka Lenz
- Department of Anesthesiology, Intensive Care and Pain Medicine, BG Klinikum Unfallkrankenhaus Berlin, Berlin, DE, Germany
| | - Claas Guethoff
- Centre for Clinical Research, Biostatistics, BG Klinikum Unfallkrankenhaus Berlin, Berlin, DE, Germany
| | - Volker Gebhardt
- Department of Anesthesiology, Intensive Care and Pain Medicine, BG Klinikum Unfallkrankenhaus Berlin, Berlin, DE, Germany
| | - Marc Dominik Schmittner
- Department of Anesthesiology, Intensive Care and Pain Medicine, BG Klinikum Unfallkrankenhaus Berlin, Berlin, DE, Germany
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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] [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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Legrand M, Clark AT, Neyra JA, Ostermann M. Acute kidney injury in patients with burns. Nat Rev Nephrol 2024; 20:188-200. [PMID: 37758939 DOI: 10.1038/s41581-023-00769-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 09/29/2023]
Abstract
Burn injury is associated with a high risk of acute kidney injury (AKI) with a prevalence of AKI among patients with burns of 9-50%. Despite an improvement in burn injury survival in the past decade, AKI in patients with burns is associated with an extremely poor short-term and long-term prognosis, with a mortality of >80% among those with severe AKI. Factors that contribute to the development of AKI in patients with burns include haemodynamic alterations, burn-induced systemic inflammation and apoptosis, haemolysis, rhabdomyolysis, smoke inhalation injury, drug nephrotoxicity and sepsis. Early and late AKI after burn injury differ in their aetiologies and outcomes. Sepsis is the main driver of late AKI in patients with burns and late AKI has been associated with higher mortality than early AKI. Prevention of early AKI involves correction of hypovolaemia and avoidance of nephrotoxic drugs (for example, hydroxocobalamin), whereas prevention of late AKI involves prevention and early recognition of sepsis as well as avoidance of nephrotoxins. Treatment of AKI in patients with burns remains supportive, including prevention of fluid overload, treatment of electrolyte disturbance and use of kidney replacement therapy when indicated.
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Affiliation(s)
- Matthieu Legrand
- Department of Anaesthesia and Perioperative Care, Division of Critical Care Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Audra T Clark
- Department of General Surgery, Division of Burn, Trauma, Critical Care, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Javier A Neyra
- Department of Internal Medicine, Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marlies Ostermann
- Department of Critical Care & Nephrology, King's College London, Guy's & St Thomas' Hospital, London, UK
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Tasleem S, Siddiqui AI, Zuberi MAW, Tariq H, Abdullah M, Hameed A, Aijaz A, Shah HH, Hussain MS, Oduoye MO. Mortality patterns and risk factors in burn patients: A cross-sectional study from Pakistan. BURNS OPEN 2024; 8:13-18. [DOI: 10.1016/j.burnso.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
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Kambouris AR, Brammer JA, Roussey H, Chen C, Cross AS. A combination of burn wound injury and Pseudomonas infection elicits unique gene expression that enhances bacterial pathogenicity. mBio 2023; 14:e0245423. [PMID: 37929965 PMCID: PMC10746159 DOI: 10.1128/mbio.02454-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 10/02/2023] [Indexed: 11/07/2023] Open
Abstract
IMPORTANCE The interaction between an underlying disease process and a specific pathogen may lead to the unique expression of genes that affect bacterial pathogenesis. These genes may not be observed during infection in the absence of, or with a different underlying process or infection during the underlying process with a different pathogen. To test this hypothesis, we used Nanostring technology to compare gene transcription in a murine-burned wound infected with P. aeruginosa. The Nanostring probeset allowed the simultaneous direct comparison of immune response gene expression in both multiple host tissues and P. aeruginosa in conditions of burn alone, infection alone, and burn with infection. While RNA-Seq is used to discover novel transcripts, NanoString could be a technique to monitor specific changes in transcriptomes between samples and bypass the additional adjustments for multispecies sample processing or the need for the additional steps of alignment and assembly required for RNASeq. Using Nanostring, we identified arginine and IL-10 as important contributors to the lethal outcome of burned mice infected with P. aeruginosa. While other examples of altered gene transcription are in the literature, our study suggests that a more systematic comparison of gene expression in various underlying diseases during infection with specific bacterial pathogens may lead to the identification of unique host-pathogen interactions and result in more precise therapeutic interventions.
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Affiliation(s)
- Adrienne R. Kambouris
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jerod A. Brammer
- US Army Institute of Surgical Research, Joint Base San Antonio Fort Sam Houston, Houston, Texas, USA
| | - Holly Roussey
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Chixiang Chen
- Division of Biostatistics and Bioinformatics, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Alan S. Cross
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Shao J, Zhu Z, Xu B, Wang S, Jin R, Yang M, Zhang W, Han C, Wang X. Triage and Evaluation of Blast-Injured Patients in Wenling Liquefied Petroleum Gas Tanker Explosion. J Burn Care Res 2023; 44:1492-1501. [PMID: 37184046 DOI: 10.1093/jbcr/irad068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Indexed: 05/16/2023]
Abstract
On June 13, 2020, a liquefied petroleum gas tanker exploded in Wenling. Here, the authors describe the mass casualty emergency response to the explosion. The authors collected the medical records of 176 inpatients at 8 hospitals in Taizhou and Hangzhou. The 176 inpatients with blast injuries comprised 70 females and 106 males, with an average age of 45.48 ± 19.96 years, and more than half of the patients were farmers. They were transported to six hospitals distributed around the explosion site in Taizhou in the initial rescue period and were grouped according to their new injury severity score as having mild, moderate, severe, or extremely severe injuries. Most patients with severe and extremely severe injuries were admitted to a superior hospital for postsecondary triage. Forty-four patients experienced primary blast injuries, 137 experienced secondary blast injuries, 37 experienced tertiary blast injuries, and 40 patients experienced quaternary blast injuries. Multiple blast injuries were suffered by 62 patients. Most patients (95.45%) suffered external injuries, with the chest, extremities, and face as the main affected areas. Burns were diagnosed in 26 adults, of whom 15.38%, 19.23%, 7.70%, and 57.69% suffered mild, moderate, severe, and extremely severe cases. Sixteen burn patients suffered from burn-blast injuries. Upper limbs and the head/face/neck area, as exposed areas, were more likely to experience a burn injury. Inhalation was the main accompanying injury. Of the eight patients who died in the prehospital session, seven had burn injuries. This report on the accident and injury characteristics of an open-air LPG-related explosion will facilitate responses to subsequent catastrophes.
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Affiliation(s)
- Jiaming Shao
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
- Key laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Emergency and Critical Disease
| | - Zhikang Zhu
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
- Key laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Emergency and Critical Disease
| | - Bin Xu
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
- Key laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Emergency and Critical Disease
| | - Shuangshuang Wang
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
- Key laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Emergency and Critical Disease
- Department of Burns, The First People's Hospital of Wenling, Taizhou, 317525, China
| | - Ronghua Jin
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
- Key laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Emergency and Critical Disease
| | - Min Yang
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
- Key laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Emergency and Critical Disease
| | - Wei Zhang
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
- Key laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Emergency and Critical Disease
| | - Chunmao Han
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
- Key laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Emergency and Critical Disease
| | - Xingang Wang
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
- Key laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Emergency and Critical Disease
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Abarca L, Guilabert P, Martin N, Usúa G, Barret JP, Colomina MJ. Epidemiology and mortality in patients hospitalized for burns in Catalonia, Spain. Sci Rep 2023; 13:14364. [PMID: 37658072 PMCID: PMC10474035 DOI: 10.1038/s41598-023-40198-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 08/07/2023] [Indexed: 09/03/2023] Open
Abstract
Burn injuries are one of the leading causes of morbidity worldwide. Although the overall incidence of burns and burn-related mortality is declining, these factors have not been analysed in our population for 25 years. The aim of this study has been to determine whether the epidemiological profile of patients hospitalized for burns has changed over the past 25 years. We performed a retrospective cohort study of patients hospitalised between 1 January 2011 and 31 December 2018 with a primary diagnosis of burns. The incidence of burns in our setting was 3.68/105 population. Most patients admitted for burns were men (61%), aged between 35 and 45 years (16.8%), followed by children aged between 0 and 4 years (12.4%). Scalding was the most prevalent mechanism of injury, and the region most frequently affected was the hands. The mean burned total body surface (TBSA) area was 8.3%, and the proportion of severely burned patients was 9.7%. Obesity was the most prevalent comorbidity (39.5%). The median length of stay was 1.8 days. The most frequent in-hospital complications were sepsis (16.6%), acute kidney injury (7.9%), and cardiovascular complications (5.9%). Risk factors for mortality were advanced age, high abbreviated burn severity index score, smoke inhalation, existing cardiovascular disease full-thickness burn, and high percentage of burned TBSA. Overall mortality was 4.3%. Multi-organ failure was the most frequent cause of death, with an incidence of 49.5%. The population has aged over the 25 years since the previous study, and the number of comorbidities has increased. The incidence and severity of burns, and the percentage of burned TBSA have all decreased, with scalding being the most prevalent mechanism of injury. The clinical presentation and evolution of burns differs between children and adults. Risk factors for mortality were advanced age, smoke inhalation, existing cardiovascular disease, full-thickness burn, and high percentage of burned TBSA.
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Affiliation(s)
- L Abarca
- Anesthesia and Critical Care Department, Hospital Universitari Vall d'Hebron, 08035, Barcelona, Spain.
| | - P Guilabert
- Anesthesia and Critical Care Department, Hospital Universitari Alicante, Alicante, Spain
| | - N Martin
- Anesthesia and Critical Care Department, Hospital Clinic, Barcelona, Spain
| | - G Usúa
- Anesthesia and Critical Care Department, Hospital Universitari Vall d'Hebron, 08035, Barcelona, Spain
| | - Juan P Barret
- Plastic Surgery Department and Burn Centre, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Maria J Colomina
- Department of Anesthesia, Critical Care and Pain Clinic, Hospital Universitari de Bellvitge, Barcelona, Spain
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Osowski A, Hetmaniuk I, Fedchyshyn O, Sas M, Lomakina Y, Tkachuk N, Budarna O, Fik V, Fedoniuk L, Wojtkiewicz J. The Role of Lyophilized Xenodermotransplants in Repairing the Atria's Structure and the Peculiarities of Regenerative Processes after Thermal Trauma in an Experiment. Life (Basel) 2023; 13:1470. [PMID: 37511845 PMCID: PMC10381269 DOI: 10.3390/life13071470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/15/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023] Open
Abstract
The effects of severe burn injuries on the cardiovascular system, specifically the atria and auricles of the heart, were investigated. The potential benefits of using lyophilized xenodermotransplants as a treatment option were also evaluated. The experiments were conducted on adult guinea pigs divided into three groups: intact animals, animals with burns, and animals with burns who underwent early necrectomy followed by wound closure with lyophilized xenodermotransplants. Third-degree burns caused significant ultrastructural changes in atrial cardiomyocytes, leading to long-term destructive changes in the structural components of the atria. However, the use of lyophilized xenodermotransplants had a positive effect on the atrial ultrastructure over time. This study highlights the complex and varied effects of burn injuries on the body and the potential benefits of lyophilized xenodermotransplants in treating severe burn injuries. By preventing destructive changes in the heart and activating regenerative processes, lyophilized xenodermotransplants can improve the condition of the heart after thermal injury. Further research and development in this area are necessary for understanding the potential of lyophilized xenodermotransplants in tissue repair and regeneration.
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Affiliation(s)
- Adam Osowski
- Department of Human Physiology and Pathophysiology, University of Warmia and Mazury in Olsztyn, 2 Oczapowskiego Street, 10-719 Olsztyn, Poland
| | - Iryna Hetmaniuk
- Medical Biology Department, Horbachevsky Ternopil National Medical University, 2 Yu. Slovatskyi Street, 46001 Ternopil, Ukraine
| | - Olena Fedchyshyn
- Medical Biology Department, Horbachevsky Ternopil National Medical University, 2 Yu. Slovatskyi Street, 46001 Ternopil, Ukraine
| | - Mykhailo Sas
- Medical Biology Department, Horbachevsky Ternopil National Medical University, 2 Yu. Slovatskyi Street, 46001 Ternopil, Ukraine
| | - Yuliia Lomakina
- Department of Medical Biology and Genetics, Bukovinian State Medical University, 15 Yu. Fedkovich Street, 58000 Chernivtsi, Ukraine
| | - Nataliia Tkachuk
- Medical Biology Department, Horbachevsky Ternopil National Medical University, 2 Yu. Slovatskyi Street, 46001 Ternopil, Ukraine
| | - Olena Budarna
- Medical Biology Department, Horbachevsky Ternopil National Medical University, 2 Yu. Slovatskyi Street, 46001 Ternopil, Ukraine
| | - Volodymyr Fik
- Medical Biology Department, Horbachevsky Ternopil National Medical University, 2 Yu. Slovatskyi Street, 46001 Ternopil, Ukraine
| | - Larisa Fedoniuk
- Medical Biology Department, Horbachevsky Ternopil National Medical University, 2 Yu. Slovatskyi Street, 46001 Ternopil, Ukraine
| | - Joanna Wojtkiewicz
- Department of Human Physiology and Pathophysiology, University of Warmia and Mazury in Olsztyn, 2 Oczapowskiego Street, 10-719 Olsztyn, Poland
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10
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Akkoç MF, Bulbuloglu S, Kapi E, Bayram M, Gurgah T. Investigation of the monocyte/high-density lipoprotein ratio as a prognostic criterion in burn patients. Wound Repair Regen 2023; 31:233-239. [PMID: 36633915 DOI: 10.1111/wrr.13070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 11/18/2022] [Accepted: 01/03/2023] [Indexed: 01/13/2023]
Abstract
In this study, it was aimed to investigate the monocyte/high-density lipoprotein ratio as a prognostic criterion in adult burn patients. A descriptive and cross-sectional method was adopted in this study. The sample included 177 patients with burn injuries. This study was conducted in a research and training hospital in Turkey. Data were collected by the researchers in the burn unit. Descriptive methods, Kruskal-Wallis, Mann-Whitney U, ROC curve, and correlation analyses were used for the statistical analyses of the data. While 66.1% of the patients were second-degree burn patients, 96.6% of all patients recovered and were discharged from the hospital, and the rest died. In this study, the monocyte/high-density lipoprotein ratios of the patients decreased as their clinical condition worsened. The mean C-reactive protein value of the patients was 8.52 ± 5.02 on the 7th day. A statistically significant correlation was found between an increase in monocyte counts and a decrease in high-density lipoprotein concentrations at the 24th hour, 3rd day and 7th day after the burn (p < 0.01). The monocyte/high-density lipoprotein ratio can be considered a biomarker in the identification and follow-up of sepsis and morbidity durations in burn patients. A low monocyte/high-density lipoprotein ratio in burn patients can provide an insight into the severity of sepsis.
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Affiliation(s)
- Mehmet Fatih Akkoç
- Department of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Semra Bulbuloglu
- Division of Surgical Nursing, Nursing Department, Faculty of Health Sciences, Istanbul Aydin University, Istanbul, Turkey
| | - Emin Kapi
- Department of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Adana Health Application and Research Center, University of Health Sciences, Adana, Turkey
| | - Mehmet Bayram
- Department of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Tuba Gurgah
- Department of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
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Variation of the SOFA score and mortality in patients with severe burns: A cohort study. Burns 2023; 49:34-41. [PMID: 36202683 DOI: 10.1016/j.burns.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/30/2022] [Accepted: 09/13/2022] [Indexed: 01/06/2023]
Abstract
Multiple organ failure (MOF) is the leading cause of death in patients with burns requiring ICU admission. Quantifying the evolution of MOF, with the SOFA score, over the first few days after a severe burn may provide useful prognostic information. This retrospective cohort study aimed at evaluating the association between the evolution of the SOFA score between day 0 and day 3 and in-hospital mortality. All patients admitted for severe burns at the burn ICU of the Tours University Hospital between 2017 and 2020 and who stayed 3 days or more were included. Severe burns included: total body surface area burned (TBSA) ≥ 20 % or burns of any surface associated with one or more of the following items: (1) organ failure, (2) clinically significant smoke inhalation and/or cyanide poisoning, (3) severe preexisting comorbidities, (4) complex and specialized burn wound care. DeltaSOFA was defined as day 3 minus day 0 SOFA. One hundred and thirty-six patients were included. Median age was 52 years (38-70), median TBSA burned was 24 % (20-38), median day 0 SOFA was 2 (0-4) and median day 3 SOFA was 1 (0-5). In-hospital mortality was 10 %. There was a significant association between deltaSOFA and mortality that persisted after adjustment for age and TBSA (HR 1.37, 95 %CI 1.09-1.72, p < 0.01). Area under the receiver operating characteristics curve for the prediction of mortality by day 0 SOFA and deltaSOFA were 0.79 (95 %CI 0.69-0.89) and 0.83 (95 %CI 0.70-0.95) respectively. After exclusion of patients with TBSA burned< 15 %, deltaSOFA remained independently associated with mortality (HR 1.42 95 %CI 1.09-1.85, p < 0.01). In addition, SOFA variations allowed the identification of subgroups of patients with either very low or very high mortality. In patients with severe burns, SOFA score evolution between day 0 and day 3 may be useful for individualized medical and ethical decisions. Further multicenter studies are required to corroborate the present results.
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Emergency Care for Burn Patients-A Single-Center Report. J Pers Med 2023; 13:jpm13020238. [PMID: 36836472 PMCID: PMC9959911 DOI: 10.3390/jpm13020238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 02/03/2023] Open
Abstract
Burns, one of the main public health problems, lead to significant mortality and morbidity. Epidemiological studies regarding burn patients in Romania are scarce. The aim of this study is to identify the burn etiology, demographics, clinical characteristics, and outcomes in patients requiring treatment in a regional burn unit. DESIGN We performed a retrospective observational study of 2021. PATIENTS All patients admitted to our six-bed intensive care unit (ICU) were included. INTERVENTIONS The following data were collected for further analysis: demographics, burn pattern (etiology, size, depth, affected body region), type of ventilation, ABSI (Abbreviated Burn Severity Index) score, comorbidities, bioumoral parameters, and hospitalization days. RESULTS There were 93 burned patients included in our study that were divided into two groups: alive patients' group (63.4%) and deceased patients' group (36.6%). The mean age was 55.80 ± 17.16 (SD). There were 65.6% male patients, and 39.8% of the patients were admitted by transfer from another hospital. Further, 59 patients presented third-degree burns, from which 32.3% died. Burns affecting >37% of the total body surface area (TBSA) were noticed in 30 patients. The most vulnerable regions of the body were the trunk (p = 0.003), the legs (p = 0.004), the neck (p = 0.011), and the arms (p = 0.020). Inhalation injury was found in 60.2% of the patients. The risk of death in a patient with an ABSI score > 9 points was 72 times higher. Comorbidities were present in 44.1% of the patients. We observed a median LOS (length of stay) of 23 days and an ICU-LOS of 11 days. Logistic regression analysis showed that admission protein, creatinkinase, and leukocytes were independent risk factors for mortality. The general mortality rate was 36.6%. CONCLUSION A thermal factor was responsible for the vast majority of burns, 94.6% of cases being accidents. Extensive and full-thickness burns, burns affecting the arms, inhalation injuries, the need for mechanical ventilation, and a high ABSI score represent important risk factors for mortality. Considering the results, it appears that prompt correction of protein, creatinkinase, and leukocytes levels may contribute to improvement in severe burn patients' outcomes.
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Korkmaz HI, Flokstra G, Waasdorp M, Pijpe A, Papendorp SG, de Jong E, Rustemeyer T, Gibbs S, van Zuijlen PPM. The Complexity of the Post-Burn Immune Response: An Overview of the Associated Local and Systemic Complications. Cells 2023; 12:345. [PMID: 36766687 PMCID: PMC9913402 DOI: 10.3390/cells12030345] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/22/2022] [Accepted: 01/10/2023] [Indexed: 01/19/2023] Open
Abstract
Burn injury induces a complex inflammatory response, both locally and systemically, and is not yet completely unravelled and understood. In order to enable the development of accurate treatment options, it is of paramount importance to fully understand post-burn immunology. Research in the last decades describes insights into the prolonged and excessive inflammatory response that could exist after both severe and milder burn trauma and that this response differs from that of none-burn acute trauma. Persistent activity of complement, acute phase proteins and pro- and anti-inflammatory mediators, changes in lymphocyte activity, activation of the stress response and infiltration of immune cells have all been related to post-burn local and systemic pathology. This "narrative" review explores the current state of knowledge, focusing on both the local and systemic immunology post-burn, and further questions how it is linked to the clinical outcome. Moreover, it illustrates the complexity of post-burn immunology and the existing gaps in knowledge on underlying mechanisms of burn pathology.
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Affiliation(s)
- H. Ibrahim Korkmaz
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam Movement Sciences (AMS) Institute, Amsterdam UMC, Location VUmc, 1081 HZ Amsterdam, The Netherlands
- Department of Molecular Cell Biology and Immunology, Amsterdam Infection and Immunity (AII) Institute, Amsterdam UMC, Location VUmc, 1081 HZ Amsterdam, The Netherlands
- Burn Center and Department of Plastic and Reconstructive Surgery, Red Cross Hospital, 1942 LE Beverwijk, The Netherlands
- Association of Dutch Burn Centres (ADBC), 1941 AJ Beverwijk, The Netherlands
| | - Gwendolien Flokstra
- Department of Molecular Cell Biology and Immunology, Amsterdam Infection and Immunity (AII) Institute, Amsterdam UMC, Location VUmc, 1081 HZ Amsterdam, The Netherlands
| | - Maaike Waasdorp
- Department of Molecular Cell Biology and Immunology, Amsterdam Infection and Immunity (AII) Institute, Amsterdam UMC, Location VUmc, 1081 HZ Amsterdam, The Netherlands
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
| | - Anouk Pijpe
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam Movement Sciences (AMS) Institute, Amsterdam UMC, Location VUmc, 1081 HZ Amsterdam, The Netherlands
- Burn Center and Department of Plastic and Reconstructive Surgery, Red Cross Hospital, 1942 LE Beverwijk, The Netherlands
- Association of Dutch Burn Centres (ADBC), 1941 AJ Beverwijk, The Netherlands
| | - Stephan G. Papendorp
- Burn Center and Department of Plastic and Reconstructive Surgery, Red Cross Hospital, 1942 LE Beverwijk, The Netherlands
- Intensive Care Unit, Red Cross Hospital, 1942 LE Beverwijk, The Netherlands
| | - Evelien de Jong
- Burn Center and Department of Plastic and Reconstructive Surgery, Red Cross Hospital, 1942 LE Beverwijk, The Netherlands
- Intensive Care Unit, Red Cross Hospital, 1942 LE Beverwijk, The Netherlands
| | - Thomas Rustemeyer
- Department of Dermatology, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands
| | - Susan Gibbs
- Department of Molecular Cell Biology and Immunology, Amsterdam Infection and Immunity (AII) Institute, Amsterdam UMC, Location VUmc, 1081 HZ Amsterdam, The Netherlands
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands
| | - Paul P. M. van Zuijlen
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam Movement Sciences (AMS) Institute, Amsterdam UMC, Location VUmc, 1081 HZ Amsterdam, The Netherlands
- Burn Center and Department of Plastic and Reconstructive Surgery, Red Cross Hospital, 1942 LE Beverwijk, The Netherlands
- Association of Dutch Burn Centres (ADBC), 1941 AJ Beverwijk, The Netherlands
- Paediatric Surgical Centre, Emma Children’s Hospital, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands
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14
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What do we know about experiencing end-of-life in burn intensive care units? A scoping review. Palliat Support Care 2022:1-17. [PMID: 36254708 DOI: 10.1017/s1478951522001389] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The aim of this article is to review and synthesize the evidence on end-of-life in burn intensive care units. METHODS Systematic scoping review: Preferred Reporting Items for Systemic Reviews extension for Scoping Reviews was used as a reporting guideline. Searches were performed in 3 databases, with no time restriction and up to September 2021. RESULTS A total of 16,287 documents were identified; 18 were selected for analysis and synthesis. Three key themes emerged: (i) characteristics of the end-of-life in burn intensive care units, including end-of-life decisions, decision-making processes, causes, and trajectories of death; (ii) symptom control at the end-of-life in burn intensive care units focusing on patients' comfort; and (iii) concepts, models, and designs of the care provided to burned patients at the end-of-life, mainly care approaches, provision of care, and palliative care. SIGNIFICANCE OF RESULTS End-of-life care is a major step in the care provided to critically ill burned patients. Dying and death in burn intensive care units are often preceded by end-of-life decisions, namely forgoing treatment and do-not-attempt to resuscitate. Different dying trajectories were described, suggesting the possibility to develop further studies to identify triggers for palliative care referral. Symptom control was not described in detail. Palliative care was rarely involved in end-of-life care for these patients. This review highlights the need for early and high-quality palliative and end-of-life care in the trajectories of critically ill burned patients, leading to an improved perception of end-of-life in burn intensive care units. Further research is needed to study the best way to provide optimal end-of-life care and foster integrated palliative care in burn intensive care units.
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15
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Wang J, Zhu Q, Li R, Zhang J, Ye X, Li X. YAP1 protects against septic liver injury via ferroptosis resistance. Cell Biosci 2022; 12:163. [PMID: 36182901 PMCID: PMC9526934 DOI: 10.1186/s13578-022-00902-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 09/19/2022] [Indexed: 11/06/2022] Open
Abstract
Background The liver plays crucial roles in sepsis and is one of the major targets for sepsis-related injuries. Ferroptosis, a newly emerged form of lytic cell death, has been implicated in sepsis related organ failure. Yes-associated protein1 (YAP1), a key regulator of the Hippo signaling pathway, may be involved in ferroptosis development. This study aimed to elucidate the role of YAP1 in septic liver injury through regulating ferroptosis, especially ferritinophagy-mediated ferroptosis. Results Cecal ligation and puncture (CLP) models were constructed in control (Yap1flfl) and liver-conditional knockout mice (Yap1fl/fl Alb-Cre) to induce septic liver injury, while LO2 cells with or without YAP1 overexpression/deletion were stimulated by lipopolysaccharide (LPS) in vitro. Our study showed YAP1 knockdown aggravated CLP-induced liver injury and inflammation, as well as accelerated hepatocyte ferroptosis, revealed by down-regulated expression of GPX4, FTH1 and SLC7A11, along with up-regulated expression of SFXN1 and NCOA4. Consistently, YAP1 deficiency aggravated LO2 cells ferroptosis, but YAP1 overexpression alleviated LPS-induced LO2 ferritinophagy, as evidenced by reduced mitochondrial ROS and Fe2+, along with down-regulated expression of SFXN1 and NCOA4. Further co-IP assay verified that YAP1 disrupted the interaction between NCOA4 and FTH1, thus prevent the degradation of ferritin to Fe2+, further reduced the ROS production and suppressed ferroptosis. Conclusion YAP1 inhibits ferritinophagy-mediated ferroptosis in hepatocytes, and YAP1 deficiency aggravates sepsis-induced liver injury. Supplementary Information The online version contains supplementary material available at 10.1186/s13578-022-00902-7.
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Affiliation(s)
- Jin Wang
- grid.413247.70000 0004 1808 0969Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei China
| | - Qian Zhu
- grid.413247.70000 0004 1808 0969Department of Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei China
| | - Rui Li
- grid.413247.70000 0004 1808 0969Department of Geriatrics, Zhongnan Hospital of Wuhan University, Wuhan, Hubei China
| | - Jing Zhang
- grid.413247.70000 0004 1808 0969Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei China
| | - Xujun Ye
- grid.413247.70000 0004 1808 0969Department of Geriatrics, Zhongnan Hospital of Wuhan University, Wuhan, Hubei China
| | - Xinyi Li
- grid.413247.70000 0004 1808 0969Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei China
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16
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Chen X, Wang K, Li D, Zhao M, Huang B, Su W, Yu D. Genetic and immune crosstalk between severe burns and blunt trauma: A study of transcriptomic data. Front Genet 2022; 13:1038222. [PMID: 36246590 PMCID: PMC9561827 DOI: 10.3389/fgene.2022.1038222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Severe burns and blunt trauma can lead to multiple organ dysfunction syndrome, the leading cause of death in intensive care units. In addition to infection, the degree of immune inflammatory response also affects prognosis. However, the characteristics and clinical relevance of the common mechanisms of these major diseases are still underexplored. Methods: In the present study, we performed microarray data analysis to identify immune-related differentially expressed genes (DEGs) involved in both disease progression in burns and blunt trauma. Six analyses were subsequently performed, including gene enrichment analysis, protein‐protein interaction (PPI) network construction, immune cell infiltration analysis, core gene identification, co-expression network analysis, and clinical correlation analysis. Results: A total of 117 common immune-related DEGs was selected for subsequent analyses. Functional analysis emphasizes the important role of Th17 cell differentiation, Th1 and Th2 cell differentiation, Cytokine-cytokine receptor interaction and T cell receptor signaling pathway in these two diseases. Finally, eight core DEGs were identified using cytoHubba, including CD8A, IL10, CCL5, CD28, LCK, CCL4, IL2RB, and STAT1. The correlation analysis showed that the identified core DEGs were more or less significantly associated with simultaneous dysregulation of immune cells in blunt trauma and sepsis patients. Of these, the downregulation of CD8A and CD28 had a worse prognosis. Conclusion: Our analysis lays the groundwork for future studies to elucidate molecular mechanisms shared in burns and blunt trauma. The functional roles of identified core immune-related DEGs and dysregulated immune cell subsets warrant further in-depth study.
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Affiliation(s)
- Xiaoming Chen
- Department of Plastic and burns Surgery, The Second Affiliated Hospital of Chengdu Medical College (China National Nuclear Corporation 416 Hospital), Chengdu, China
| | - Kuan Wang
- Department of Cosmetic Plastic and burns Surgery, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Dazhuang Li
- Department of Orthopedics, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Mingyue Zhao
- Department of Periodontology, Affiliated Stomatological Hospital of Zunyi MedicalUniversity, Zunyi, China
| | - Biao Huang
- Department of Plastic and burns Surgery, The Second Affiliated Hospital of Chengdu Medical College (China National Nuclear Corporation 416 Hospital), Chengdu, China
- *Correspondence: Biao Huang, ; Wenxing Su, ; Daojiang Yu,
| | - Wenxing Su
- Department of Plastic and burns Surgery, The Second Affiliated Hospital of Chengdu Medical College (China National Nuclear Corporation 416 Hospital), Chengdu, China
- *Correspondence: Biao Huang, ; Wenxing Su, ; Daojiang Yu,
| | - Daojiang Yu
- Department of Plastic and burns Surgery, The Second Affiliated Hospital of Chengdu Medical College (China National Nuclear Corporation 416 Hospital), Chengdu, China
- *Correspondence: Biao Huang, ; Wenxing Su, ; Daojiang Yu,
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17
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Yakupu A, Zhang J, Dong W, Song F, Dong J, Lu S. The epidemiological characteristic and trends of burns globally. BMC Public Health 2022; 22:1596. [PMID: 35996116 PMCID: PMC9396832 DOI: 10.1186/s12889-022-13887-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background Burns is a type of injury, caused by unintentional exposure to substances of high temperature, including hot liquid, solid, and objects radiating heat energy, placing a high burden not only on patients’ families but also on national healthcare systems globally. It is difficult for policymakers and clinicians to formulate targeted management strategies for burns because data on current epidemiological patterns worldwide are lacking. Methods Data on burns were obtained from the Global Burden of Disease (GBD) 2019 Study. The incidence, disability-adjusted life years (DALYs), and deaths of burns in 204 countries and regions from 1990 to 2019 were calculated and stratified by sex, age, geographical location, and sociodemographic index (SDI). The estimated annual percentage change (EAPC) of incidence, DALYs, and deaths was calculated to evaluate the temporal trends. All analyses were performed using R software, version 4.1.1, with 2-sided P-values < .05 indicating a statistically significant difference. Results A total of 8,378,122 new cases (95% UI, 6,531,887–10,363,109cases) of burns were identified globally in 2019, which is almost evenly split between men and women, and most of the new cases were concentrated in the 10–19-year age group. Besides, burns account for 111,292 deaths (95% UI, 132,392–88,188) globally in 2019, most of which were concentrated in those aged 1–4 years. The burden of burns measured in DALYs was 7,460,448.65 (95% UI, 5,794,505.89–9,478,717.81) in 2019, of which 67% and 33% could be attributed to YLLs and YLDs, respectively. The EAPC of incidence, DALYs, and deaths were negative, the age-standardized rate (ASR) of incidence, DALYs, and deaths were considered to be decreasing in most of the regions, and the EAPCs were negatively correlated with SDI levels, universal health coverage (UHC), and gross domestic product (GDP). Conclusion Globally, the age-standardized rates of burn incidence, DALYs, and mortality, as well as the number of burn DALYs and death cases will continuously decrease, but the number of new burn cases has an increasing tendency globally. In addition, the EAPCs of burns in incidence, DALYs, and deaths indicated that the burden of burns was considered to be decreasing in most of the regions. And from the relationship of EAPCs with SDI, UHC index, and GDP, indicate that prevention burns not only depend on health spending per capita but also depend on the education level per capita and healthcare system performance, but it does not mean higher health spending corresponds to higher UHC index, which needs high efficiency of translating health spending into individuals health gains. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13887-2.
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Affiliation(s)
- Aobuliaximu Yakupu
- Wound Healing Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Zhang
- Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Dong
- Wound Healing Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fei Song
- Wound Healing Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiaoyun Dong
- Wound Healing Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. .,Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. .,Shanghai Burn Institute, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, No. 197 Ruijin Er Road, Shanghai, 200025, China.
| | - Shuliang Lu
- Wound Healing Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. .,Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. .,Shanghai Burn Institute, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, No. 197 Ruijin Er Road, Shanghai, 200025, China.
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18
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Melquíades da Rocha BDF, Bochnia MF, Ioris RA, Damin R, de Araujo Santos Nigro MV, Nisihara RM. The impact of social isolation by COVID-19 on the epidemiological and clinical profiles of the burn patients. A retrospective study. Burns 2022; 48:976-983. [PMID: 35361496 PMCID: PMC8882480 DOI: 10.1016/j.burns.2022.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Social isolation, imposed by the COVID-19 pandemic, may imply changes in the clinical-demographic and epidemiological profiles of burn trauma victims. OBJECTIVE Evaluate the changes in the epidemiological profile of patients with burns that resulted in hospitalization during the social isolation period due to the COVID-19 pandemic, comparing with the same period in the previous year. METHODS The medical records of burn patients who were hospitalized in our Burn Center during the local confinement period (March 18th to August 31st, 2020) and during the same period in 2019 were analyzed. Data on demographic, clinical and hospitalization aspects were studied. RESULTS 470 patients were evaluated. In the pediatric population, a significant increase in the number of cases up to 2 years old (P = 0.0003), median of %TBSA (P = 0.037), full-thickness burns (P < 0.0001), involvement of hands (P = 0.024), debridement (P = 0.046) and grafting (P = 0.032) procedures, and higher scores of severity (P < 0.0001) were noted. In the adult population, it was only observed an increase in the burn-hospitalization interval (P = 0.029). CONCLUSION The pediatric population was heavily impacted by the imposed period of social isolation, presenting a greater severity of burns. In contrast, the epidemiology of burns for the adult population was slightly altered during the pandemic period.
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Affiliation(s)
| | - Mateus Franzoni Bochnia
- Mackenzie Evangelical School of Medicine Paraná, Curitiba, Brazil. Rua Padre Anchieta, 2770, 80730-000 Curitiba, Brazil
| | - Rafael Augusto Ioris
- Plastic Surgery Department and Burn Center, Hospital Universitário Evangélico Mackenzie, Alameda Augusto Stellfeld, 1908, 80730-150 Curitiba, Brazil
| | - Renata Damin
- Plastic Surgery Department and Burn Center, Hospital Universitário Evangélico Mackenzie, Alameda Augusto Stellfeld, 1908, 80730-150 Curitiba, Brazil
| | | | - Renato Mitsunori Nisihara
- Mackenzie Evangelical School of Medicine Paraná, Curitiba, Brazil. Rua Padre Anchieta, 2770, 80730-000 Curitiba, Brazil,Correspondence to: Rua Padre Anchieta, 2770, 80730-000 Curitiba, Paraná, Brazil
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19
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Abstract
Burns are a severe form of trauma that account for 1.1 million cases necessitating medical attention and 4500 mortalities annually in the United States alone. Importantly, the initial trauma is succeeded by extensive, prolonged physiological alterations that detrimentally impact multiple organ systems. Given the complexity of post-burn pathophysiology, in vitro experiments are insufficient to model thermal injuries. Therefore, compatible animal burn models are essential for studying burn-related phenomena. In this chapter, we discuss commonly employed small animal burn models and their comparability and applicability to human studies. In particular, we compare post-burn wound healing between the species as well as relevant hypermetabolic and inflammatory characteristics, providing a better understanding of the pros and cons of utilizing a small animal surrogate for human burns. We further provide an overview of the rodent scald burn model methodology as well as a comparison between elderly, aged and young animals, providing a guide for tailoring animal model choice based on the relevant research question.
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20
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Tapking C, Kilian K, Hundeshagen G, Haug V, Teufel A, Houschyar KS, Kneser U, Hirche C. Hepatic functional pathophysiology and morphological damage following severe burns: a systematic review and meta-analysis. J Burn Care Res 2021; 43:1074-1080. [PMID: 34894242 DOI: 10.1093/jbcr/irab239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Severe burns are devastating injuries affecting multiple organ systems. Little is known about the influence on the hepatic system and its physiology. This systematic review aimed to assess the current state of research on morphologic liver damage following severe burns. METHODS A search was conducted in Pubmed, Web of Science and Cochrane databases using PRISMA guidelines. Outcomes included serum levels of transaminases, fatty infiltration and necrosis. Weighted individual study estimates were used to calculate pooled transaminase levels and necrosis/fatty infiltration rates using a random-effects approach. Risk ratios (RRs) or Odds ratios (ORs) and 95% confidence intervals (CIs) were used to describe pooled estimates for risk factors. RESULTS The literature search retrieved 2548 hits, of which 59 studies were included into qualitative synthesis, and finally ten studies were included into meta-analysis. Studies were divided into those reporting autopsies and those reporting changes of serum transaminase levels. The majority of liver autopsies showed fatty infiltration 82% (95% CI39%-97%) or necrosis of the liver 18% (95% CI13%-24%). DISCUSSION Heterogeneity in studies on hepatic functional damage following severe burns was high. Only few were well-designed and published in recent years. Many studies could not be included because of insufficient numerical data. There is a high number of patients deceasing from burns that present with fatty infiltration or necrosis of hepatic tissue. Transaminases were elevated during the first days after burn. Further research on how severe burns affect the hepatic function and outcome, especially long-term, is necessary.
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Affiliation(s)
- C Tapking
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Unfallklinik Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - K Kilian
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Unfallklinik Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - G Hundeshagen
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Unfallklinik Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - V Haug
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Unfallklinik Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - A Teufel
- Department of Medicine II, Division of Hepatology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Clinical Cooperation Unit Health Metabolism, Center for Preventive Medicine and Digital Health Baden-Württemberg (CPDBW), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - K S Houschyar
- Department of Dermatology and Allergology, University Hospital of RWTH Aachen, Aachen, Germany
| | - U Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Unfallklinik Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - C Hirche
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Unfallklinik Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany.,Department of Plastic, Hand- and Reconstructive Microsurgery, Handtrauma- and Replantation Center BG Unfallklinik Frankfurt am Main gGmbH, Frankfurt/Main, Germany
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21
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Gibson BHY, Wollenman CC, Moore-Lotridge SN, Keller PR, Summitt JB, Revenko AR, Flick MJ, Blackwell TS, Schoenecker JG. Plasmin drives burn-induced systemic inflammatory response syndrome. JCI Insight 2021; 6:154439. [PMID: 34877937 PMCID: PMC8675186 DOI: 10.1172/jci.insight.154439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/27/2021] [Indexed: 12/12/2022] Open
Abstract
Severe injuries, such as burns, provoke a systemic inflammatory response syndrome (SIRS) that imposes pathology on all organs. Simultaneously, severe injury also elicits activation of the fibrinolytic protease plasmin. While the principal adverse outcome of plasmin activation in severe injury is compromised hemostasis, plasmin also possesses proinflammatory properties. We hypothesized that, following a severe injury, early activation of plasmin drives SIRS. Plasmin activation was measured and related to injury severity, SIRS, coagulopathy, and outcomes prospectively in burn patients who are not at risk of hemorrhage. Patients exhibited early, significant activation of plasmin that correlated with burn severity, cytokines, coagulopathy, and death. Burn with a concomitant, remote muscle injury was employed in mice to determine the role of plasmin in the cytokine storm and inflammatory cascades in injured tissue distant from the burn injury. Genetic and pharmacologic inhibition of plasmin reduced the burn-induced cytokine storm and inflammatory signaling in injured tissue. These findings demonstrate (a) that severe injury-induced plasmin activation is a key pathologic component of the SIRS-driven cytokine storm and SIRS-activated inflammatory cascades in tissues distant from the inciting injury and (b) that targeted inhibition of plasmin activation may be effective for limiting both hemorrhage and tissue-damaging inflammation following injury.
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Affiliation(s)
| | - Colby C Wollenman
- School of Medicine.,Department of Orthopaedic Surgery, Vanderbilt University Medical Center
| | - Stephanie N Moore-Lotridge
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center.,Vanderbilt Center for Bone Biology
| | | | - J Blair Summitt
- Department of Plastic Surgery, Vanderbilt University Medical Center; and.,Vanderbilt University Medical Center Burn Center, Vanderbilt University, Nashville, Tennessee, USA
| | - Alexey R Revenko
- IONIS Pharmaceuticals Pulmonary and Oncology Drug Discovery, Carlsbad, California, USA
| | - Matthew J Flick
- Department of Pathology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA.,University of North Carolina Blood Research Center, Chapel Hill, North Carolina, USA
| | - Timothy S Blackwell
- Department of Cancer Biology, Vanderbilt University, Nashville, Tennessee, USA.,Division of Pulmonary and Critical Care
| | - Jonathan G Schoenecker
- Department of Pharmacology.,Department of Orthopaedic Surgery, Vanderbilt University Medical Center.,Vanderbilt Center for Bone Biology.,Department of Pathology, Microbiology, and Immunology; and.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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22
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Foessl I, Haudum CW, Vidakovic I, Prassl R, Franz J, Mautner SI, Kainz S, Hofmann E, Obermayer-Pietsch B, Birngruber T, Kotzbeck P. miRNAs as Regulators of the Early Local Response to Burn Injuries. Int J Mol Sci 2021; 22:ijms22179209. [PMID: 34502118 PMCID: PMC8430593 DOI: 10.3390/ijms22179209] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 12/20/2022] Open
Abstract
In burn injuries, risk factors and limitations to treatment success are difficult to assess clinically. However, local cellular responses are characterized by specific gene-expression patterns. MicroRNAs (miRNAs) are single-stranded, non-coding RNAs that regulate mRNA expression on a posttranscriptional level. Secreted through exosome-like vesicles (ELV), miRNAs are intracellular signalers and epigenetic regulators. To date, their role in the regulation of the early burn response remains unclear. Here, we identified 43 miRNAs as potential regulators of the early burn response through the bioinformatics analysis of an existing dataset. We used an established human ex vivo skin model of a deep partial-thickness burn to characterize ELVs and miRNAs in dermal interstitial fluid (dISF). Moreover, we identified miR-497-5p as stably downregulated in tissue and dISF in the early phase after a burn injury. MiR-218-5p and miR-212-3p were downregulated in dISF, but not in tissue. Target genes of the miRNAs were mainly upregulated in tissue post-burn. The altered levels of miRNAs in dISF of thermally injured skin mark them as new biomarker candidates for burn injuries. To our knowledge, this is the first study to report miRNAs altered in the dISF in the early phase of deep partial-thickness burns.
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Affiliation(s)
- Ines Foessl
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria; (C.W.H.); (J.F.); (S.I.M.); (B.O.-P.); (P.K.)
- Correspondence: ; Tel.: +43-316-385-72936
| | - Christoph Walter Haudum
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria; (C.W.H.); (J.F.); (S.I.M.); (B.O.-P.); (P.K.)
- CBmed GmbH—Center for Biomarker Research in Medicine, 8010 Graz, Austria
| | - Ivan Vidakovic
- Gottfried Schatz Research Center (for Cell Signaling, Metabolism and Aging), Division of Biophysics, Medical University of Graz, 8010 Graz, Austria; (I.V.); (R.P.)
| | - Ruth Prassl
- Gottfried Schatz Research Center (for Cell Signaling, Metabolism and Aging), Division of Biophysics, Medical University of Graz, 8010 Graz, Austria; (I.V.); (R.P.)
| | - Joakim Franz
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria; (C.W.H.); (J.F.); (S.I.M.); (B.O.-P.); (P.K.)
- CBmed GmbH—Center for Biomarker Research in Medicine, 8010 Graz, Austria
| | - Selma I. Mautner
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria; (C.W.H.); (J.F.); (S.I.M.); (B.O.-P.); (P.K.)
- HEALTH—Institute for Biomedicine and Health Sciences, JOANNEUM RESEARCH Forschungsgesellschaft mbH, 8010 Graz, Austria; (S.K.); (T.B.)
| | - Sonja Kainz
- HEALTH—Institute for Biomedicine and Health Sciences, JOANNEUM RESEARCH Forschungsgesellschaft mbH, 8010 Graz, Austria; (S.K.); (T.B.)
| | - Elisabeth Hofmann
- Department of Surgery, Division of Plastic, Aesthetic and Reconstructive Surgery, Medical University of Graz, 8036 Graz, Austria;
| | - Barbara Obermayer-Pietsch
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria; (C.W.H.); (J.F.); (S.I.M.); (B.O.-P.); (P.K.)
| | - Thomas Birngruber
- HEALTH—Institute for Biomedicine and Health Sciences, JOANNEUM RESEARCH Forschungsgesellschaft mbH, 8010 Graz, Austria; (S.K.); (T.B.)
| | - Petra Kotzbeck
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria; (C.W.H.); (J.F.); (S.I.M.); (B.O.-P.); (P.K.)
- Department of Surgery, Division of Plastic, Aesthetic and Reconstructive Surgery, Medical University of Graz, 8036 Graz, Austria;
- COREMED—Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, 8010 Graz, Austria
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Holzer PW, Lellouch AG, Moulton K, Zhu L, Ng ZY, Overschmidt B, Gama AR, Leto Barone AA, Rosales I, Monroy R, Cetrulo CL. Clinical Impact of Cryopreservation on Split Thickness Skin Grafts in the Porcine Model. J Burn Care Res 2021; 41:306-316. [PMID: 32074295 DOI: 10.1093/jbcr/irz145] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Vital, genetically engineered, porcine xenografts represent a promising alternative to human cadaveric allografts (HCA) in the treatment of severe burns. However, their clinical value would be significantly enhanced if preservation and long-term storage-without the loss of cellular viability-were feasible. The objective of this study was to examine the direct impact of cryopreservation and the length of storage on critical in vivo and in vitro parameters, necessary for a successful, potentially equivalent substitute to HCA. In this study, vital, porcine skin grafts, continuously cryopreserved for more than 7 years were compared side-by-side to otherwise identically prepared skin grafts stored for only 15 minutes. Two major histocompatibility complex (MHC)-controlled donor-recipient pairs received surgically created deep-partial wounds and subsequent grafting with split-thickness porcine skin grafts, differentiated only by the duration of storage. Clinical and histological outcomes, as well as quantification of cellular viability via a series of 3-4,5-dimethylthiazol-2-yl]-2,5 diphenyltetrazolium bromide (MTT) assays, were assessed. No statistically significant differences were observed between skin grafts cryopreserved for 15 minutes vs 7 years. Parametric distinctions between xenografts stored for short- vs long-term durations could not be ascertained across independent clinical, histological, or in vitro evaluative methods. The results of this study validate the ability to reliably preserve, store, and retain the essential metabolic activity of porcine tissues after cryopreservation. Plentiful, safe, and readily accessible inventories of vital xenografts represent an advantageous solution to numerous limitations associated with HCA, in the treatment of severe burns.
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Affiliation(s)
- Paul W Holzer
- Center for Transplantation Science (CTS), Massachusetts General Hospital, Boston, Massachusetts, USA.,XenoTherapeutics, Inc., Boston, Massachusetts, USA.,Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
| | - Alexandre G Lellouch
- Center for Transplantation Science (CTS), Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Laurence Zhu
- XenoTherapeutics, Inc., Boston, Massachusetts, USA
| | - Zhi Yang Ng
- Center for Transplantation Science (CTS), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bo Overschmidt
- Center for Transplantation Science (CTS), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amon-Ra Gama
- Center for Transplantation Science (CTS), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Angelo A Leto Barone
- Center for Transplantation Science (CTS), Massachusetts General Hospital, Boston, Massachusetts, USA.,Johns Hopkins Hospital, Johns Hopkins University, Baltimore Maryland, USA
| | - Ivy Rosales
- Center for Transplantation Science (CTS), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rod Monroy
- XenoTherapeutics, Inc., Boston, Massachusetts, USA
| | - Curtis L Cetrulo
- Center for Transplantation Science (CTS), Massachusetts General Hospital, Boston, Massachusetts, USA.,XenoTherapeutics, Inc., Boston, Massachusetts, USA
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Gong Y, Peng Y, Luo X, Zhang C, Shi Y, Zhang Y, Deng J, Peng Y, Luo G, Li H. Different Infection Profiles and Antimicrobial Resistance Patterns Between Burn ICU and Common Wards. Front Cell Infect Microbiol 2021; 11:681731. [PMID: 34277469 PMCID: PMC8278283 DOI: 10.3389/fcimb.2021.681731] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/18/2021] [Indexed: 01/12/2023] Open
Abstract
Infection is the leading cause of complications and deaths after burns. However, the difference in infection patterns between the burn intensive care unit (BICU) and burn common wards (BCW) have not been clearly investigated. The present study aimed to compare the infection profile, antimicrobial resistance, and their changing patterns in burn patients in BICU and BCW. Clinical samples were analyzed between January 1, 2011, and December 31, 2019, in the Institute of Burn Research in Southwest China. The patient information, pathogen distribution, sources, and antimicrobial resistance were retrospectively collected. A total of 3457 and 4219 strains were detected in BICU and BCW, respectively. Wound secretions accounted for 86.6% and 44.9% in BCW and BICU, respectively. Compared with samples in BCW, samples in BICU had more fungi (11.8% vs. 8.1%), more Gram-negative bacteria (60.0% vs. 50.8%), and less Gram-positive bacteria (28.2% vs. 41.1%). Acinetobacter baumannii were the most common pathogen in BICU, compared with Staphylococcus aureus in BCW. S. aureus was the most frequent pathogen in wound secretions and tissues from both BICU and BCW. However, A. baumannii were the first in blood, sputum, and catheter samples from BICU. Overall, the multidrug-resistance (MDR) rate was higher in BICU than in BCW. However, the gap between BICU and BCW gradually shortened from 2011 to 2019. The prevalence of MDR A. baumannii and Klebsiella pneumonia significantly increased, especially in BCW. Furthermore, Carbapenem resistance among K. pneumoniae significantly increased in BICU (4.5% in 2011 vs. 40% in 2019) and BCW (0 in 2011 vs. 40% in 2019). However, the percentage of MDR P. aeruginosa sharply dropped from 85.7% to 24.5% in BICU. The incidence of MRSA was significantly higher in BICU than in BCW (94.2% vs. 71.0%) and stayed at a high level in BICU (89.5% to 96.3%). C. tropicalis and C. albicans were the two most frequent fungi. No resistance to Amphotericin B was detected. Our study shows that the infection profile is different between BICU and BCW, and multidrug resistance is more serious in BICU than BCW. Therefore, different infection-control strategies should be emphasized in different burn populations.
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Affiliation(s)
- Yali Gong
- Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing, China
| | - Yuan Peng
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xiaoqiang Luo
- Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing, China
| | - Cheng Zhang
- Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing, China
| | - Yunlong Shi
- Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing, China
| | - Yixin Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Jun Deng
- Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing, China
| | - Yizhi Peng
- Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing, China
| | - Gaoxing Luo
- Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing, China
| | - Haisheng Li
- Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing, China
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Song H, Yuan Z, Peng Y, Luo G. Extracorporeal membrane oxygenation combined with continuous renal replacement therapy for the treatment of severe burns: current status and challenges. BURNS & TRAUMA 2021; 9:tkab017. [PMID: 34212063 PMCID: PMC8240511 DOI: 10.1093/burnst/tkab017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/26/2021] [Indexed: 11/25/2022]
Abstract
Severe burns often cause various systemic complications and multiple organ dysfunction syndrome, which is the main cause of death. The lungs and kidneys are vulnerable organs in patients with multiple organ dysfunction syndrome after burns. Extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT) have been gradually applied in clinical practice and are beneficial for severe burn patients with refractory respiratory failure or renal dysfunction. However, the literature on ECMO combined with CRRT for the treatment of severe burns is limited. Here, we focus on the current status of ECMO combined with CRRT for the treatment of severe burns and the associated challenges, including the timing of treatment, nutrition support, heparinization and wound management, catheter-related infection and drug dosing in CRRT. With the advancement of medical technology, ECMO combined with CRRT will be further optimized to improve the outcomes of patients with severe burns.
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Affiliation(s)
- Huapei Song
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Street, Chongqing 400038, China
| | - Zhiqiang Yuan
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Street, Chongqing 400038, China
| | - Yizhi Peng
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Street, Chongqing 400038, China
| | - Gaoxing Luo
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Street, Chongqing 400038, China
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26
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Glucose Metabolism in Burns-What Happens? Int J Mol Sci 2021; 22:ijms22105159. [PMID: 34068151 PMCID: PMC8153015 DOI: 10.3390/ijms22105159] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 11/16/2022] Open
Abstract
Severe burns represent an important challenge for patients and medical teams. They lead to profound metabolic alterations, trigger a systemic inflammatory response, crush the immune defense, impair the function of the heart, lungs, kidneys, liver, etc. The metabolism is shifted towards a hypermetabolic state, and this situation might persist for years after the burn, having deleterious consequences for the patient's health. Severely burned patients lack energy substrates and react in order to produce and maintain augmented levels of glucose, which is the fuel "ready to use" by cells. In this paper, we discuss biological substances that induce a hyperglycemic response, concur to insulin resistance, and determine cell disturbance after a severe burn. We also focus on the most effective agents that provide pharmacological modulations of the changes in glucose metabolism.
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27
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Mcwilliams TL, Twigg D, Hendricks J, Wood FM, Ryan J, Keil A. The implementation of an infection control bundle within a Total Care Burns Unit. Burns 2021; 47:569-575. [PMID: 33858714 DOI: 10.1016/j.burns.2019.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 12/07/2019] [Accepted: 12/22/2019] [Indexed: 11/16/2022]
Abstract
AIM To evaluate the impact of the implementation of a best practice infection prevention and control bundle on healthcare associated burn wound infections in a paediatric burns unit. BACKGROUND Burn patients are vulnerable to infection. For this patient population, infection is associated with increased morbidity and mortality, thereby representing a significant challenge for burns clinicians who care for them. METHODS An interrupted time series was used to compare healthcare associated burn wound infections in paediatric burn patients before and after implementation of an infection prevention and control bundle. Prospective surveillance of healthcare associated burn wound infections was conducted from 2012 to 2014. Other potential healthcare associated infection rates were also reviewed over the study period, including urinary tract infections, pneumonia, upper respiratory tract infections and sepsis. An infection prevention and control bundle developed in collaboration between the paediatric burn unit and infection control clinicians was implemented in 2013 in addition to previous standard practice. RESULTS During the study period a total of 626 patients were admitted to the paediatric burns unit. Healthcare associated burn wound infections reduced from 34 in 2012 to 0 in 2014 following the implementation of the infection prevention and control bundle. Pneumonia and sepsis also reduced to 0 in 2013 and 2014, however one upper respiratory tract infection occurred in 2013 and urinary tract infections persisted in 2013. CONCLUSION The implementation of an infection prevention and control bundle was effective in reducing healthcare associated burn wound infections, pneumonia and sepsis within our paediatric burns unit. Urinary tract infections remain a challenge for future improvement.
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Affiliation(s)
- Tania Lorena Mcwilliams
- Perth Children's Hospital, Australia; Edith Cowan University, Australia; Princess Margaret Hospital for Children, Australia.
| | - Di Twigg
- Edith Cowan University, Australia.
| | | | - Fiona Melanie Wood
- Perth Children's Hospital, Australia; Princess Margaret Hospital for Children, Australia.
| | - Jane Ryan
- Princess Margaret Hospital for Children, Australia
| | - Anthony Keil
- Perth Children's Hospital, Australia; Princess Margaret Hospital for Children, Australia
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28
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Wen JJ, Williams TP, Cummins CB, Colvill KM, Radhakrishnan GL, Radhakrishnan RS. Effect of Mitochondrial Antioxidant (Mito-TEMPO) on Burn-Induced Cardiac Dysfunction. J Am Coll Surg 2021; 232:642-655. [PMID: 33421567 PMCID: PMC8753741 DOI: 10.1016/j.jamcollsurg.2020.11.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 11/30/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Imbalance of oxidants/antioxidants results in heart failure, contributing to mortality after burn injury. Cardiac mitochondria are a prime source of reactive oxygen species (ROS), and a mitochondrial-specific antioxidant may improve burn-induced cardiomyopathy. We hypothesize that the mitochondrial-specific antioxidant, Triphenylphosphonium chloride (Mito-TEMPO), could protect cardiac function after burn. STUDY DESIGN Male rats had a 60% total body surface area (TBSA) scald burn injury and were treated with/without Mito-TEMPO (7 mg/kg-1, intraperitoneal) and harvested at 24 hours post-burn. Echocardiography (ECHO) was used for measurement of heart function. Masson Trichrome and hematoxylin and eosin (H & E) staining were used for cardiac fibrosis and immune response. Qualitative polymerase chain reaction (qPCR) was used for mitochondrial DNA replication and gene expression. RESULTS Burn-induced cardiac dysfunction, fibrosis, and mitochondrial damage were assessed by measurement of mitochondrial function, DNA replication, and DNA-encoded electron transport chain-related gene expression. Mito-TEMPO partially improved the abnormal parameters. Burn-induced cardiac dysfunction was associated with crosstalk between the NFE2L2-ARE pathway, PDE5A-PKG pathway, PARP1-POLG-mtDNA replication pathway, and mitochondrial SIRT signaling. CONCLUSIONS Mito-TEMPO reversed burn-induced cardiac dysfunction by rescuing cardiac mitochondrial dysfunction. Mitochondria-targeted antioxidants may be an effective therapy for burn-induced cardiac dysfunction.
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Affiliation(s)
- Jake J Wen
- Department of Surgery, University of Texas Medical Branch, Galveston, TX
| | - Taylor P Williams
- Department of Surgery, University of Texas Medical Branch, Galveston, TX
| | - Claire B Cummins
- Department of Surgery, University of Texas Medical Branch, Galveston, TX
| | - Kayla M Colvill
- Department of Surgery, University of Texas Medical Branch, Galveston, TX
| | | | - Ravi S Radhakrishnan
- Department of Surgery, University of Texas Medical Branch, Galveston, TX; Department of Pediatrics, University of Texas Medical Branch, Galveston, TX.
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29
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Idrovo JP, Boe DM, Kaahui S, Walrath T, McMahan RH, Kovacs EJ. Advanced age heightens hepatic damage in a murine model of scald burn injury. J Trauma Acute Care Surg 2021; 90:731-737. [PMID: 33306599 PMCID: PMC7979479 DOI: 10.1097/ta.0000000000003048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Elderly burn patients exhibit a lower survival rate compared with younger counterparts. The liver is susceptible to damage after burn injury, which predisposes to poor outcomes. Lipid homeostasis and the antioxidant glutathione system play fundamental roles in preserving liver integrity. Herein, we explored changes in these major pathways associated with liver damage in the aging animals after burn injury. METHODS We compared liver enzymes, histology, lipid-peroxidation, and glutathione-metabolism profiles from young and aged female mice after a 15% total body surface area burn. Mice were euthanized at 24 hours after injury, and livers and serum were collected. RESULTS Aged burn animals exhibited elevated (p < 0.05) aspartate aminotransferase and alanine aminotransferase levels and increased inflammatory cell infiltration, edema, and necrosis compared with their younger counterparts. The percentage of adipophilin-stained area in livers from young sham, young burn, aged sham, and aged burn groups was 10%, 44%, 16%, and 78% (p < 0.05), respectively. Liver malondialdehyde levels were 1.4 ± 0.5 nmol/mg, 2.06 ± 0.2 nmol/mg, 1.81 ± 0.12 nmol/mg, and 3.45 ± 0.2 nmol/mg (p < 0.05) in young sham, young burn, aged sham, and aged burn mice, respectively. Oxidized glutathione (GSSG) content increased 50% in the young burn, and 88% in aged burn animals compared with the young sham group (p < 0.05). The reduced glutathione GSH/GSSG ratio was significantly reduced by 54% in aged burn mice compared with young sham animals (p < 0.05). Furthermore, glutathione peroxidase gene expression showed a 96% decrease in the aged burn group compared with young sham mice (p < 0.05). CONCLUSION Aged burn animals exhibit severe liver damage from heightened lipid peroxidation and inadequate antioxidative response. The increased peroxidation is associated with abundant lipid deposits in hepatic tissue postburn and a weak antioxidative response due to hepatic glutathione peroxidase downregulation. Further studies will focus on the functional significance of these findings concerning hepatic homeostasis.
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Affiliation(s)
- Juan-Pablo Idrovo
- From the Division of G.I., Trauma, and Endocrine Surgery, (J.-P.I., D.M.B. S.K., T.W., R.H.M., E.J.K.), Division of Burn Research, Department of Surgery (D.M.B., T.W., R.H.M., E.J.K.), Department of Immunology and Microbiology (D.M.B., T.W., E.J.K.), Division of Alcohol Research, Department of Surgery (R.H.M., E.J.K.), University of Colorado, Aurora, Colorado
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30
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Jansson MM, Ohtonen PP, SyrjÄlÄ HP, Ala-Kokko TI. Changes in the incidence and outcome of multiple organ failure in emergency non-cardiac surgical admissions: a 10-year retrospective observational study. Minerva Anestesiol 2020; 87:174-183. [PMID: 33300319 DOI: 10.23736/s0375-9393.20.14374-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND During the past decades, epidemiologic data of independent predictors of multiple organ failure (MOF), incidence, and mortality have changed. The aim of the study was to assess the potential changes in the incidence and outcomes of MOF for one decade (2008-2017). In addition, resource utilization was considered. METHODS Patients were eligible for inclusion if they were adults, admitted to the ICU between January 1, 2008 and December 31, 2017, and had complete data sets regarding MOF. MOF was defined as organ failure separately with and without central nervous system (CNS) failure. The onset of MOF was defined as being early (≤48 h of ICU admission) and late (>48 h after ICU admission). RESULTS Of a total of 13,270 patients enclosed in this study, 44.6% of the patients developed MOF with and 31.4% without CNS failure. MOF-related mortality decreased in patients with (adjusted IRR 0.972 [95% CI 0.948 to 0.996], P=0.022) and without (adjusted IRR 0.957 [95% CI 0.931 to 0.983], P=0.0013) CNS failure. In addition, the incidence (adjusted IRR 0.970 [95% CI 0.950 to 0.991], P=0.006) and mortality (adjusted IRR 0.968 [95% CI 0.940 to 0.996], P=0.025) of early-onset MOF decreased, while the incidence and mortality of late-onset MOF remained constant. The length of ICU (P=0.024) and hospital (P=0.032) stays decreased while the length of mechanical ventilation remained constant (P=0.41). CONCLUSIONS Despite all improvements in intensive care during the last decades, the incidence of late-onset MOF remains a resource-intensive, morbid, and lethal condition. More research on etiologies, signs of organ failure, and where and when to start treatment is needed to improve the prognosis of late-onset MOF.
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Affiliation(s)
- Miia M Jansson
- Research Group of Medical Imaging, Physics and Technology, Faculty of Medicine, University Hospital of Oulu, Oulu, Finland -
| | - Pasi P Ohtonen
- Division of Operative Care, Medical Research Center Oulu, University Hospital, of Oulu, Oulu, Finland
| | - Hannu P SyrjÄlÄ
- Department of Infection Control, University Hospital of Oulu, Oulu, Finland
| | - Tero I Ala-Kokko
- Division of Intensive Care, Department of Anesthesiology, Research Group of Surgery, Anesthesiology and Intensive Care, Medical Research Center Oulu, University Hospital of Oulu, Oulu, Finland
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31
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Jin R, Shao J, Ho JK, Yu M, Han C. A Retrospective Multicenter Study of 1898 Liquefied Petroleum Gas-Related Burn Patients in Eastern China From 2011 to 2015. J Burn Care Res 2020; 41:1188-1197. [PMID: 32353117 DOI: 10.1093/jbcr/iraa067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Liquefied petroleum gas (LPG) is a widely used environment-friendly fuel. Previous studies have shown an increasing number of LPG-related burns. Our study was designed to evaluate the epidemiologic pattern of these injuries and provide recommendations for burn prevention. This retrospective study included all patients with LPG-related burns from eight burn centers in Zhejiang Province, China between 2011 and 2015. Database variables included patient demographics, accident characteristics, and injury characteristics. The association between different categorical variables was identified using the chi-square test. And the association between two or more means of quantitative variables was analyzed by the one-way analysis of variance or t-test. A total of 1898 patients were included, 47.31% were males and 52.69% were females. The predominant age group was 31 to 70 years (74.50%), and the majority were poorly educated and the incidence peaked from June to September. The most common place of occurrence was home (74.08%) and gas leak (96.52%) was the most common cause. The four limbs (43.33%) were the most frequently affected areas; the mean burn area was 25.19 ± 20.97% of the total body surface area and most patients (46.89%) suffered from moderate burns. The mean length of hospital stay was 17.66 ± 16.55 days and the majority of patients (89.36%) recovered with a 0.84% mortality rate. Our findings reflected that the increase in incidence rate was alarming, and the causes resulting in LPG-related burns have not gained much attention yet. Therefore, this calls for simple but strict measures aiming at each hazardous step during the use of LPG to prevent these burn injuries.
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Affiliation(s)
- Ronghua Jin
- Department of Burns & Wound Care Center, The Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
| | - Jiaming Shao
- Department of Burns & Wound Care Center, The Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
| | - Jon Kee Ho
- Department of Burns & Wound Care Center, The Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
| | - Meirong Yu
- Clinical Research Center, The Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
| | - Chunmao Han
- Department of Burns & Wound Care Center, The Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
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Sumsuzzman DM, Choi J, Khan ZA, Hong Y. Protective Effects of Melatonin against Severe Burn-Induced Distant Organ Injury: A Systematic Review and Meta-Analysis of Experimental Studies. Antioxidants (Basel) 2020; 9:antiox9121196. [PMID: 33261180 PMCID: PMC7760393 DOI: 10.3390/antiox9121196] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/22/2020] [Accepted: 11/24/2020] [Indexed: 12/21/2022] Open
Abstract
Extensive burns result in a local wound response and distant-organ injury (DOI) caused by oxidative-stress and inflammation. Melatonin (MT) shows promise in alleviating oxidative-stress and inflammation, but its role in thermal injury is largely unexplored. The present systematic review and meta-analysis were designed to assess the effects of MT on oxidative-stress and inflammatory markers against severe burn-induced DOI. Mean difference (MD)/standard mean difference (SMD) with 95% confidence interval (CI) were estimated using fixed-effect/random-effects models. Eighteen experimental studies met the inclusion criteria. Compared with the control group, MT significantly decreased the levels of malondialdehyde (SMD, −1.03; 95% CI, −1.30, −0.76, p < 0.00001) and 4-hydroxynonenal (MD, −1.06; 95% CI, −1.57, −0.56, p < 0.0001). Additionally, MT increased the levels of glutathione (SMD, 1.94; 95% CI, 1.27, 2.61, p < 0.00001) and superoxide-dismutase (SMD, 0.76; 95% CI, 0.08, 1.45, p = 0.03). Finally, MT significantly decreased the levels of tumor necrosis factor-α (SMD, −1.34; 95% CI, −1.92 to −0.77; p < 0.00001) and C-reactive protein (MD, −12.67; 95% CI, −16.72 to −8.62; p < 0.00001). Meta-analysis indicates that severe burn followed by immediate MT (10 mg/kg) intervention shows significant beneficial effects after 24-h against DOI by regulating oxidative-stress and the inflammatory response.
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Affiliation(s)
- Dewan Md. Sumsuzzman
- Department of Rehabilitation Science, Graduate School of Inje University, Gimhae 50834, Korea; (D.M.S.); (J.C.)
- Biohealth Products Research Center (BPRC), Inje University, Gimhae 50834, Korea;
- Ubiquitous Healthcare & Anti-Aging Research Center (u-HARC), Inje University, Gimhae 50834, Korea
- Department of Physical Therapy, College of Healthcare Medical Science & Engineering, Gimhae 50834, Korea
| | - Jeonghyun Choi
- Department of Rehabilitation Science, Graduate School of Inje University, Gimhae 50834, Korea; (D.M.S.); (J.C.)
- Biohealth Products Research Center (BPRC), Inje University, Gimhae 50834, Korea;
- Ubiquitous Healthcare & Anti-Aging Research Center (u-HARC), Inje University, Gimhae 50834, Korea
- Department of Physical Therapy, College of Healthcare Medical Science & Engineering, Gimhae 50834, Korea
| | - Zeeshan Ahmad Khan
- Biohealth Products Research Center (BPRC), Inje University, Gimhae 50834, Korea;
- Ubiquitous Healthcare & Anti-Aging Research Center (u-HARC), Inje University, Gimhae 50834, Korea
- Department of Physical Therapy, College of Healthcare Medical Science & Engineering, Gimhae 50834, Korea
| | - Yonggeun Hong
- Department of Rehabilitation Science, Graduate School of Inje University, Gimhae 50834, Korea; (D.M.S.); (J.C.)
- Biohealth Products Research Center (BPRC), Inje University, Gimhae 50834, Korea;
- Ubiquitous Healthcare & Anti-Aging Research Center (u-HARC), Inje University, Gimhae 50834, Korea
- Department of Physical Therapy, College of Healthcare Medical Science & Engineering, Gimhae 50834, Korea
- Department of Medicine, Division of Hematology/Oncology, Harvard Medical School-Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
- Correspondence: ; Tel.: +82-55-320-3681; Fax: +82-55-329-1678
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Idrovo JP, Boe DM, Kaahui S, Yang WL, Kovacs EJ. Hepatic inflammation after burn injury is associated with necroptotic cell death signaling. J Trauma Acute Care Surg 2020; 89:768-774. [PMID: 33017135 PMCID: PMC8386183 DOI: 10.1097/ta.0000000000002865] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Burn injury still has a high attributable mortality. The elevated mortality rate of severe burns is still concerning. Hepatic inflammation and injury are common after burns and are associated with poor outcomes. Necroptosis is a programmed cell death linked with inflammation. Thus, assessing necroptotic pathways in the liver can lead to new therapeutic modalities to improve mortality after severe burns. METHODS Mice underwent 15% total body surface area burn or sham injury. Three hours after burn, the mice were euthanized to collect blood and livers. Histology, injury markers, genes expression, and tissue protein levels were compared between groups. RESULTS Compared with sham, burned mice had heightened liver inflammatory cell infiltration and edema. Serum aspartate aminotransferase and alanine aminotransferase were increased by 4.9- and 3.4-fold, respectively, in burned mice relative to sham (p < 0.05). Expression of tumor necrosis factor α, interleukin-6, interleukin-1β, and CXCL1 (KC) genes were elevated in livers of burned mice by 10-, 86-, 10-, and 828-fold, respectively, compared with sham (p < 0.05). Expression of necroptotic genes, namely, receptor-interacting protein kinases 1 and 3, and mixed lineage kinase domain-like in livers of burned mice were increased by 10-, 13-, and 4.5-fold, respectively, relative to sham (p < 0.05). Receptor-interacting protein kinase 1 and phosphorylated mixed lineage kinase domain-like protein levels measured by Western-blot in livers after burn injury were elevated by 22- and 17-fold, respectively, compared with sham (p < 0.05). CONCLUSION Liver damage occurs early after burns in mice and is associated with elevation of proinflammatory cytokines, chemokine, and proteins involved in the necroptotic pathway. This study suggests that necroptosis plays a role in the pathogenesis of liver failure secondary to burn injury.
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Affiliation(s)
- Juan-Pablo Idrovo
- From the Division of GI, Trauma, and Endocrine Surgery, Department of Surgery (J.-P.I., S.K.), Division of GI, Trauma, and Endocrine Surgery, Department of Surgery, Burn Research Program (D.M.B., E.J.K.), and Department of Immunology and Microbiology (D.M.B., E.J.K.), University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado; Department of Radiation Oncology (W.-L.Y.), Albert Einstein College of Medicine, Bronx, New York; Division of GI, Trauma, and Endocrine Surgery, Department of Surgery, Alcohol Research Program (E.J.K.), University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
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Holzer PW, Chang E, Wicks J, Scobie L, Crossan C, Monroy R. Immunological response in cynomolgus macaques to porcine α-1,3 galactosyltransferase knockout viable skin xenotransplants-A pre-clinical study. Xenotransplantation 2020; 27:e12632. [PMID: 32781479 DOI: 10.1111/xen.12632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 07/02/2020] [Accepted: 07/10/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Allogeneic skin recovered from human deceased donors (HDD) has been a mainstay interim treatment for severe burns, but unfortunately risk of infectious disease and availability limitations exist. Genetically engineered ɑ-1,3 galactosyltransferase knockout (GalT-KO) porcine source animals for viable skin xenotransplants may provide a promising clinical alternative. METHODS Four cynomolgus macaque recipients received full-thickness surgical wounds to model the defects arising from excision of full-thickness burn injury and were treated with biologically active skin xenotransplants derived from GalT-KO, Designated Pathogen Free (DPF) miniature swine. Evaluations were conducted for safety, tolerability, and recipient immunological response. RESULTS All skin xenotransplants demonstrated prolonged survival, vascularity, and persistent dermal adhesion until the study endpoint at post-operative day 30. No adverse outcomes were observed during the study. Varying levels of epidermolysis coincided with histologic detection of CD4+ and CD8+ T cells, and other cellular infiltrates in the epidermis. Recipient sera IgM and IgG demonstrated significant antibody immune response to non-α-1,3-galactose porcine xenoantigens. Separately, specific wound healing mediators were quantified. Neither porcine cell migration nor PERV were detected in circulation or any visceral organs. CONCLUSIONS These results provide a detailed analysis of vital skin xenotransplants utilizing a non-human primate model to predict the anticipated immunological response of human patients. The lack of adverse rejection even in the presence of elevated Ig indicates this is a prospective therapeutic option. The findings reported here directly supported regulatory clearance for a first-in-man, Phase I xenotransplantation clinical trial.
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Jansson M, Ohtonen P, Syrjälä H, Ala‐Kokko T. The proportion of understaffing and increased nursing workload are associated with multiple organ failure: A cross‐sectional study. J Adv Nurs 2020. [DOI: 10.1111/jan.14410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/02/2020] [Accepted: 03/16/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Miia Jansson
- Research Group of Medical Imaging, Physics and Technology University of Oulu Oulu Finland
- Oulu University Hospital Oulu Finland
| | - Pasi Ohtonen
- Division of Operative care Oulu University Hospital Oulu Finland
- Medical Research Center Oulu University of Oulu Oulu Finland
| | - Hannu Syrjälä
- Department of Infection Control Oulu University Hospital Oulu Finland
| | - Tero Ala‐Kokko
- Medical Research Center Oulu University of Oulu Oulu Finland
- Division of Intensive Care Department of Anesthesiology Oulu University Hospital Oulu Finland
- Research Group of Surgery, Anesthesiology and Intensive Care Medical Research Center Oulu Oulu Finland
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Abstract
Burn injuries are under-appreciated injuries that are associated with substantial morbidity and mortality. Burn injuries, particularly severe burns, are accompanied by an immune and inflammatory response, metabolic changes and distributive shock that can be challenging to manage and can lead to multiple organ failure. Of great importance is that the injury affects not only the physical health, but also the mental health and quality of life of the patient. Accordingly, patients with burn injury cannot be considered recovered when the wounds have healed; instead, burn injury leads to long-term profound alterations that must be addressed to optimize quality of life. Burn care providers are, therefore, faced with a plethora of challenges including acute and critical care management, long-term care and rehabilitation. The aim of this Primer is not only to give an overview and update about burn care, but also to raise awareness of the ongoing challenges and stigmata associated with burn injuries.
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Affiliation(s)
- Marc G Jeschke
- Ross Tilley Burn Center, Department of Surgery, Sunnybrook Health Science Center, Toronto, Ontario, Canada.
- Departments of Surgery and Immunology, University of Toronto, Toronto, Ontario, Canada.
| | - Margriet E van Baar
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, Netherlands
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, Netherlands
| | - Mashkoor A Choudhry
- Burn and Shock Trauma Research Institute, Alcohol Research Program, Stritch School of Medicine, Loyola University Chicago Health Sciences Division, Maywood, IL, USA
| | - Kevin K Chung
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Nicole S Gibran
- Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Sarvesh Logsetty
- Departments of Surgery and Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Holzer P, Adkins J, Moulton K, Zhu L, Monroy R, Cetrulo CL. Vital, Porcine, Gal-Knockout Skin Transplants Provide Efficacious Temporary Closure of Full-Thickness Wounds: Good Laboratory Practice-Compliant Studies in Nonhuman Primates. J Burn Care Res 2020; 41:229-240. [DOI: 10.1093/jbcr/irz124] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AbstractVital, genetically engineered porcine skin transplants have long been regarded as a promising treatment option for severe burn wounds. The objective of this two-part, preclinical study was to evaluate the ability of vital, split-thickness skin xenotransplants derived from designated pathogen-free, alpha 1,3 galactosyltransferase knockout miniature swine to provide temporary wound closure of full-thickness wound defects intended to model severe and extensive, deep partial- and full-thickness burn wounds. In part 1 of the study, four full-thickness wound defects were introduced in four cynomolgus macaques recipients and, then engrafted with two xenografts and two allografts to achieve temporary wound closure. On POD-15, autografts were used to achieve definitive wound closure and were observed until POD-22. In part 2 of the study, four additional subjects each received two full-thickness wound defects, followed by two xenografts to achieve temporary wound closure, and were observed postoperatively for 30 days without further intervention. All grafts were assessed for signs of adherence to the wound bed, vascularity, and signs of immune rejection via gross clinical and histological methods. Xenograft and allograft comparators were equivalent in part 1, and later autografts were otherwise indistinguishable. In part 2, all xenotransplants demonstrated adherence, vascularity, and survival until POD-30. These were unexpected results that exceed previously published findings in similar models. Furthermore, the ensuing GLP-study report directly supported regulatory clearance, permitting a phase I clinical trial. This solution holds great promise as an alternative to human cadaver allograft, the current standard of care for the treatment of severe burns.
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Affiliation(s)
| | - Jon Adkins
- XenoTherapeutics, Grantham, New Hampshire
| | | | | | - Rod Monroy
- XenoTherapeutics, Grantham, New Hampshire
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Weaver AJ, Brandenburg KS, Smith BW, Leung KP. Comparative Analysis of the Host Response in a Rat Model of Deep-Partial and Full-Thickness Burn Wounds With Pseudomonas aeruginosa Infection. Front Cell Infect Microbiol 2020; 9:466. [PMID: 31998665 PMCID: PMC6967395 DOI: 10.3389/fcimb.2019.00466] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 12/17/2019] [Indexed: 12/12/2022] Open
Abstract
Burn wound injury affects soldiers and civilians alike, often resulting in a dynamic, but un-orchestrated, host response that can lead to infection, scarring, and potentially death. To mitigate these factors, it is important to have a clinically relevant model of burn wound infection that can be utilized for advancing burn wound treatments. Our previous reports have demonstrated the ability of Pseudomonas aeruginosa to generate a biofilm infection within a modified Walker-Mason rat burn model of deep-partial (DPT) and full-thickness (FT) burn wounds (10% total body surface area) in male Sprague-Dawley rats (350–450 g). Here, we further define this model with respect to the host response when challenged with P. aeruginosa infection between the two burn types. Following burn injury and immediate surface exposure to P. aeruginosa, inflammation at the local and systemic levels were monitored for an 11 days period. Compared to burn-only groups, infection with P. aeruginosa further promoted local inflammation in both DPT and FT burn wounds, which was evident by enhanced cellular influx (including neutrophils and monocytes), increased levels of several pro-inflammatory cytokines (IL-1β, IL-6, GRO/KC, andMIP-1α), and reduced IL-10. Systemically, only minor changes were seen in circulating white blood cells and cytokines; however, increases in high mobility group box-1 (HMGB-1) and hyaluronan, as well as decreases in fibronectin were noted particularly in FT burns. Compared to the burn-only group, P. aeruginosa infection resulted in sustained and/or higher levels of HMGB-1 and hyaluronan. Combined with our previous work that defined the burn depth and development of P. aeruginosa biofilms within the wound, this study further establishes this model by defining the host response to the burn and biofilm-infection. Furthermore, this characterization shows several similarities to what is clinically seen and establishes this model for future use in the development and testing of novel therapeutics for burn wound treatment at home and on the battlefield.
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Affiliation(s)
- Alan J Weaver
- Department of Dental and Craniofacial Trauma Research, United States Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, TX, United States
| | - Kenneth S Brandenburg
- Department of Dental and Craniofacial Trauma Research, United States Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, TX, United States
| | - Brian W Smith
- Research Support Division, United States Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, TX, United States
| | - Kai P Leung
- Department of Dental and Craniofacial Trauma Research, United States Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, TX, United States
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Ogura A, Tsurumi A, Que YA, Almpani M, Zheng H, Tompkins RG, Ryan CM, Rahme LG. Associations between clinical characteristics and the development of multiple organ failure after severe burns in adult patients. Burns 2019; 45:1775-1782. [PMID: 31690472 DOI: 10.1016/j.burns.2019.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 01/07/2019] [Accepted: 02/14/2019] [Indexed: 11/24/2022]
Abstract
To determine the association between potential risk factors and multiple organ failure (MOF) in severe burn adult patients, we performed a secondary analysis of data from the "Inflammation and the Host Response to Injury" database, which included patients from six burn centers in the United States between 2003 and 2009. Three hundred twenty-two adult patients (aged ≥16 years) with severe burns (≥20.0% total body surface area [TBSA]) were included. MOF was defined according to the Denver score. Potential risk factors were analyzed for their association with MOF. Models were built using multivariable logistic regression analysis. Eighty-eight patients (27.3%) developed MOF during the study period. We found that TBSA, age, and inhalation injury were significant risk factors for MOF. This predictive model showed good performance, with the total area under the receiver operating characteristic curve being 0.823. Moreover, among patients who developed MOF, inhalation injury was significantly associated with the development of MOF in the acute phase (within three days of injury) (adjusted odds ratio 3.1; 95% confidence interval 1.1-8.3). TBSA, age, lactate, and Denver score within 24h were associated with the late phase development of MOF. Thus, we have identified key risk factors for the onset of MOF after severe burn injury. Our findings contribute to the understanding of individualized treatment and will potentially allow for efficient allocation of resources and a lower threshold for admission to an intensive care unit, which can prevent the development of MOF and eventually reduce mortality.
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Affiliation(s)
- Asako Ogura
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, 340 Thier Research Building, 50 Blossom Street, Boston MA 02114, USA
| | - Amy Tsurumi
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, 340 Thier Research Building, 50 Blossom Street, Boston MA 02114, USA; Shriners Hospitals for Children, 51 Blossom St., Boston, MA 02114, USA
| | - Yok-Ai Que
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Marianna Almpani
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, 340 Thier Research Building, 50 Blossom Street, Boston MA 02114, USA; Shriners Hospitals for Children, 51 Blossom St., Boston, MA 02114, USA
| | - Hui Zheng
- Biostatistics Center, Massachusetts General Hospital, and Harvard Medical School, 50 Staniford St., Boston, MA 02114, USA
| | - Ronald G Tompkins
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, 340 Thier Research Building, 50 Blossom Street, Boston MA 02114, USA
| | - Colleen M Ryan
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, 340 Thier Research Building, 50 Blossom Street, Boston MA 02114, USA; Shriners Hospitals for Children, 51 Blossom St., Boston, MA 02114, USA
| | - Laurence G Rahme
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, 340 Thier Research Building, 50 Blossom Street, Boston MA 02114, USA; Shriners Hospitals for Children, 51 Blossom St., Boston, MA 02114, USA; Department of Microbiology and Immunobiology, Harvard Medical School, 77 Ave. Louis Pasteur, Boston, MA 02114, USA.
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Shalaby SA, Fouad Y, Azab SMS, Nabil DM, Abd El-Aziz YA. Predictors of mortality in cases of thermal burns admitted to Burn Unit, Ain Shams University Hospitals, Cairo. J Forensic Leg Med 2019; 67:19-23. [PMID: 31376649 DOI: 10.1016/j.jflm.2019.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/02/2019] [Accepted: 07/28/2019] [Indexed: 11/28/2022]
Abstract
In cases of death due to burn injury, it may be of great medico-legal importance to determine if the death is caused by fatal burn injury or due to other factors related to treatment. Therefore, this study aimed to investigate early predictors of mortality in patients with thermal burns admitted to Burn Unit, Ain Shams University Hospitals during a period of one year (2011). The study included 152 cases, mortalities represented 20.4% of the included cases (31 cases). Binary logistic regression analysis showed that, total body surface area (TBSA) of the burns and APACHE III score were significant predictors of mortality. This model resulted in accurate classification of 95.9% of the cases. Further multi-centric studies on larger sample sizes are recommended to validate the results of this study. Also, it is important to study the effect of co-morbidities as confounding factors on the prediction of mortality in patients with thermal burns.
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Affiliation(s)
- Sawsan A Shalaby
- Department of Forensic Medicine and Toxicology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Yasser Fouad
- Department of Forensic Medicine and Toxicology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Sonya M S Azab
- Department of Forensic Medicine and Toxicology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Dalia M Nabil
- Department of Forensic Medicine and Toxicology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Yasser A Abd El-Aziz
- Plastic Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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DYNAMICS OF HISTOCHEMICAL CHANGES IN THE SKIN OF RATS WITHIN A MONTH AFTER THE BURNING OF II-III DEGREES ON THE BACKGROUND OF THE INJECTION FIRST 7 DAYS HAES-LX-5% SOLUTION. WORLD OF MEDICINE AND BIOLOGY 2018. [DOI: 10.26724/2079-8334-2018-4-66-180-184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Affiliation(s)
- Ascanio Tridente
- Intensive Care Unit, Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust, Warrington Road, Prescot L35 5DR, UK
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
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Belba MK, Petrela EY, Belba AG. Epidemiology and outcome analysis of sepsis and organ dysfunction/failure after burns. Burns 2017; 43:1335-1347. [DOI: 10.1016/j.burns.2017.02.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 02/20/2017] [Accepted: 02/24/2017] [Indexed: 11/15/2022]
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Ginsenoside Rg3 attenuates sepsis-induced injury and mitochondrial dysfunction in liver via AMPK-mediated autophagy flux. Biosci Rep 2017; 37:BSR20170934. [PMID: 28779013 PMCID: PMC5577177 DOI: 10.1042/bsr20170934] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 08/04/2017] [Accepted: 08/04/2017] [Indexed: 12/13/2022] Open
Abstract
Sepsis-led mitochondrial dysfunction has become a critical pathophysiological procedure in sepsis. Since ginsenosides have been applied in the treatment of mitochondrial dysfunction, ginsenoside Rg3 was employed to study its effects on the mitochondrial dysfunction induced by sepsis. The apoptosis rate, oxygen consumption rate (OCR), reactive oxygen species (ROS), antioxidant glutathione (GSH) pools, and mitochondrial transmembrane potential (MTP) were determined in LPS-induced sepsis hepatocytes treated with different concentrations of Rg3. Then, the protein expression levels of mitochondrial biogenesis related transcription factors, autophagy-related proteins, and AMP-activated protein kinase (AMPK) signal pathway related proteins were determined by Western blotting in both in vitro and in vivo sepsis models. Rg3 shows functions of promotion of OCR, attenuation of ROS, and maintenance of GSH pools, and its conjugating activity in the in vitro sepsis models. Rg3-treated cells were observed to have a higher MTP value compared with the LPS only induced cells. Moreover, Rg3 treatment can inhibit mitochondrial dysfunction via increasing the protein expression levels of mitochondrial biogenesis related transcription factors. Rg3 treatment has the function of inhibitor of apoptosis of human primary hepatocytes, and Rg3 can up-regulate the autophagy-related proteins and activate AMPK signal pathway in sepsis models. Meanwhile, the mitochondrial protective function exerted by Rg3 decreased after the autophagy inhibitors or AMPK inhibitor treatment in LPS-induced human primary hepatocytes. Rg3 can improve mitochondrial dysfunction by regulating autophagy in mitochondria via activating the AMPK signal pathway, thus protecting cell and organ injuries caused by sepsis.
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Fatalities from a Greek Burn Unit-A clinicopathological correlation of 129 cases. Burns 2017; 44:226-229. [PMID: 28789802 DOI: 10.1016/j.burns.2017.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/04/2017] [Accepted: 07/06/2017] [Indexed: 11/22/2022]
Abstract
INTRODUCTION This is a retrospective study of the hospital data and autopsy reports of burn patients who died in the Burn Unit of the Department of Plastic and Reconstructive Surgery, Microsurgery and Burn Center of "G. Gennimatas" Hospital of Athens, Greece during the period 1999-2005. MATERIALS AND METHODS The records of the burn victims deceased during the period 1999-2005 were reviewed and the cause of injury, percentage of body surface area (BSA) burned, age, gender, and co-morbidities were documented. Moreover, the autopsy findings per system were recorded and compared to clinical reports to analyze any inconsistencies. RESULTS Between 1999 and 2005, 368 patients were hospitalized in the Burn Unit of "G. Gennimatas" Hospital of Athens, Greece. One-hundred and twenty-nine patients died. The first three causes of death in autopsy reports were: pneumonia (30 patients), myocardial infarction (17 cases) and multiple organ failure (15 patients). Three patients had class I diagnostic discrepancies, 5 patients had class II diagnostic discrepancies and minor diagnostic errors (class III and IV) were documented in 20 patients. CONCLUSIONS Although the percentage of discrepancies of premortem compared to postmortem diagnosis in this series of deceased burn patients is small (2.3%), we believe that it is sufficient to justify the performance of autopsies.
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C-C Chemokine Receptor Type 2 Expression on Monocytes Before Sepsis Onset Is Higher Than That of Postsepsis in Septic Burned Patients: A New Predictor for Sepsis in Burned Injury. Ann Surg 2017; 264:392-8. [PMID: 26727083 DOI: 10.1097/sla.0000000000001531] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The present study aims to investigate the alterations in monocytes (Mo) and dendritic cells (DCs) in septic burned patients with a special focus on C-C chemokine receptor type 2 (CCR2) expressions on classical Mo. BACKGROUND The phenotypes of Mo and DCs, particularly CCR2 expression on Mo, are not fully explored in severely burned patients with sepsis. METHODS The prospective cohort study was conducted in Ross Tilley Burn Centre and Sunnybrook Research Institute (Toronto, Canada). We enrolled 8 healthy patients and 89 burned patients with various burned sizes, of those burned patients, 12 were with sepsis. Blood was collected upon admission to the hospital and throughout their course in hospital. The expression of human leukocyte antigen-DR was determined on all DCs and Mo, along with CCR2 on CD14/CD16 Mo. RESULTS We found a profound decrease in human leukocyte antigen-DR on Mo and DCs in burned patients with sepsis compared with healthy controls and nonseptic burned patients. In addition, septic burned patients presented an increased CCR2 expression on classical Mo (CD14/CD16), which was paralleled by greater chemokine (C-C motif) ligand 2 concentrations in the plasma when compared with controls and nonseptic burned patients. Furthermore, burned patients with sepsis had a more profound expansion of CD14/CD16 Mo when compared with nonseptic burned patients. CONCLUSION Our results demonstrate that burned patients with sepsis have more profound impairment of monocytes and dendritic cells than burned patients without sepsis. With CCR2 level on Mo before sepsis onset being higher than postsepsis, CCR2 expression could be a new predictor of sepsis onset in severe burn injury.
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Abstract
OBJECTIVES Innate immune dysfunction after major burn injuries increases the susceptibility to organ failure. Lipid mediators of inflammation resolution, e.g., resolvin D2, have been shown recently to restore neutrophil functionality and reduce mortality rate in a rat model of major burn injury. However, the physiological mechanisms responsible for the benefic activity of resolvin D2 are not well understood. DESIGN Prospective randomized animal investigation. SETTING Academic research setting. SUBJECTS Wistar male rats. INTERVENTIONS Animals were subjected to a full-thickness burn of 30% total body surface area. Two hours after burn, 25 ng/kg resolvin D2 was administered IV and repeated every day, for 8 days. At day 10 post burn, 2 mg/kg of lipopolysaccharide was administered IV, and the presence of renal and hepatic injuries was evaluated at day 11 post burn by histology, immunohistochemistry, and relevant blood chemistry. MEASUREMENTS AND MAIN RESULTS In untreated animals, we found significant tissue damage in the kidneys and liver, consistent with acute tubular necrosis and multifocal necrosis, and changes in blood chemistry, reflecting the deterioration of renal and hepatic functions. We detected less tissue damage and significantly lower values of blood urea nitrogen (26.4 ± 2.1 vs 36.0 ± 9.3 mg/dL; p ≤ 0.001), alanine aminotransferase (266.5 ± 295.2 vs 861.8 ± 813.7 U/L; p ≤ 0.01), and total bilirubin (0.13 ± 0.05 vs 0.30 ± 0.14 mg/dL; p ≤ 0.01) in resolvin D2-treated rats than in untreated animals. The mean blood pressure of all animals was above 65 mm Hg, indicating adequate tissue perfusion throughout the experiments. We measured significantly larger amounts of chromatin in the circulation of untreated than of resolvin D2-treated rats (575.1 ± 331.0 vs 264.1 ± 122.4 ng/mL; p ≤ 0.05) and identified neutrophil extracellular traps in kidney and liver tissues from untreated rats, consistent with the tissue damage. CONCLUSIONS Pathologic changes in kidney and liver tissues in a rat model of major burn and endotoxin insults are ameliorated by resolvin D2.
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Rech TH, Boniatti MM, Franke CA, Lisboa T, Wawrzeniak IC, Teixeira C, Maccari JG, Schaich F, Sauthier A, Schifelbain LM, Riveiro DFM, da Fonseca DLO, Berto PP, Marques L, Dos Santos MC, de Oliveira VM, Dornelles CFD, Vieira SRR. Inhalation injury after exposure to indoor fire and smoke: The Brazilian disaster experience. Burns 2016; 42:884-90. [PMID: 26975698 DOI: 10.1016/j.burns.2016.02.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 01/14/2016] [Accepted: 02/18/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the pre-hospital, emergency department, and intensive care unit (ICU) care and prognosis of patients with inhalation injury after exposure to indoor fire and smoke. MATERIALS AND METHODS This is a prospective observational cohort study that includes patients admitted to seven ICUs after a fire disaster. The following data were collected: demographic characteristics; use of fiberoptic bronchoscopy; degree of inhalation injury; percentage of burned body surface area; mechanical ventilation parameters; and subsequent events during ICU stay. Patients were followed to determine the ICU and hospital mortality rates. RESULTS Within 24h of the incident, 68 patients were admitted to seven ICUs. The patients were young and had no comorbidities. Most patients (n=35; 51.5%) only had an inhalation injury. The mean ventilator-free days for patients with an inhalation injury degree of 0 or I was 12.5±8.1 days. For patients with an inhalation injury degree of II or III, the mean ventilator-free days was 9.4±5.8 days (p=0.12). In terms of the length of ICU stay for patients with degrees 0 or I, and patients with degrees II or III, the median was 7.0 days (5.0-8.0 days) and 12.0 days (8.0-23.0 days) (p<0.001), respectively. In addition, patients with a larger percentage of burned surface areas also had a longer ICU stay; however, no association with ventilator-free days was found. The patients with <10% of burned body surface area showed a mean of 9.2±5.4 ventilator-free days. The mean ventilator-free days for patients who had >10% burned body surface area was 11.9±9.5 (p=0.26). The length of ICU stay for the <10% and >10% burned body surface area patients was 7.0 days (5.0-10.0 days) and 23.0 days (11.5-25.5 days) (p<0.001), respectively. CONCLUSIONS We conclude that burn patients with inhalation injuries have different courses of disease, which are mainly determined by the percentage of burned body surface area.
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Affiliation(s)
- Tatiana Helena Rech
- Department of Intensive Care Medicine, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, Porto Alegre, Brazil
| | - Márcio Manozzo Boniatti
- Department of Intensive Care Medicine, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, Porto Alegre, Brazil.
| | - Cristiano Augusto Franke
- Department of Intensive Care Medicine, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, Porto Alegre, Brazil
| | - Thiago Lisboa
- Department of Intensive Care Medicine, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, Porto Alegre, Brazil
| | - Iuri Christmann Wawrzeniak
- Department of Intensive Care Medicine, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, Porto Alegre, Brazil
| | - Cassiano Teixeira
- Department of Intensive Care Medicine, Hospital Moinhos de Vento, Ramiro Barcelos, 910, Porto Alegre, Brazil
| | - Juçara Gasparetto Maccari
- Department of Intensive Care Medicine, Hospital Moinhos de Vento, Ramiro Barcelos, 910, Porto Alegre, Brazil
| | - Felipe Schaich
- Department of Intensive Care Medicine, Hospital Moinhos de Vento, Ramiro Barcelos, 910, Porto Alegre, Brazil
| | - Angelica Sauthier
- Department of Intensive Care Medicine, Hospital de Pronto Socorro de Porto Alegre, Largo Teodoro Herzl, Porto Alegre, Brazil
| | - Luciele Medianeira Schifelbain
- Department of Intensive Care Medicine, Hospital de Caridade Dr. Astrogildo de Azevedo, Presidente Vargas, 2291, Santa Maria, Brazil
| | | | | | - Paula Pinheiro Berto
- Department of Intensive Care Medicine, Santa Casa de Misericórdia, Professor Annes Dias, 295, Porto Alegre, Brazil
| | - Leonardo Marques
- Department of Intensive Care Medicine, Santa Casa de Misericórdia, Professor Annes Dias, 295, Porto Alegre, Brazil
| | - Moreno Calcagnotto Dos Santos
- Department of Intensive Care Medicine, Hospital Nossa Senhora da Conceição, Francisco Trein, 596, Porto Alegre, Brazil
| | - Vanessa Martins de Oliveira
- Department of Intensive Care Medicine, Hospital Nossa Senhora da Conceição, Francisco Trein, 596, Porto Alegre, Brazil
| | | | - Sílvia Regina Rios Vieira
- Department of Intensive Care Medicine, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, Porto Alegre, Brazil
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49
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Notch1 Pathway Protects against Burn-Induced Myocardial Injury by Repressing Reactive Oxygen Species Production through JAK2/STAT3 Signaling. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2016; 2016:5638943. [PMID: 27057278 PMCID: PMC4736405 DOI: 10.1155/2016/5638943] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 11/09/2015] [Indexed: 12/21/2022]
Abstract
Oxidative stress plays an important role in burn-induced myocardial injury, but the cellular mechanisms that control reactive oxygen species (ROS) production and scavenging are not fully understood. This study demonstrated that blockade of Notch signaling via knockout of the transcription factor RBP-J or a pharmacological inhibitor aggravated postburn myocardial injury, which manifested as deteriorated serum CK, CK-MB, and LDH levels and increased apoptosis in vitro and in vivo. Interruption of Notch signaling increased intracellular ROS production, and a ROS scavenger reversed the exacerbated myocardial injury after Notch signaling blockade. These results suggest that Notch signaling deficiency aggravated postburn myocardial injury through increased ROS levels. Notch signaling blockade also decreased MnSOD expression in vitro and in vivo. Notably, Notch signaling blockade downregulated p-JAK2 and p-STAT3 expression. Inhibition of JAK2/STAT3 signaling with AG490 markedly decreased MnSOD expression, increased ROS production, and aggravated myocardial injury. AG490 plus GSI exerted no additional effects. These results demonstrate that Notch signaling protects against burn-induced myocardial injury through JAK2/STAT3 signaling, which activates the expression of MnSOD and leads to decreased ROS levels.
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50
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Egea-Guerrero JJ, Martínez-Fernández C, Rodríguez-Rodríguez A, Bohórquez-López A, Vilches-Arenas A, Pacheco-Sánchez M, Guerrero JM, Murillo-Cabezas F. The utility of C-reactive protein and procalcitonin for sepsis diagnosis in critically burned patients: A preliminary study. Plast Surg (Oakv) 2015. [DOI: 10.1177/229255031502300412] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective To assess the utility of C-reactive protein (CRP) and procalcitonin (PCT) as biomarkers of infection in patients with severe burn injury. Methods The present study included severe burn injury patients consecutively admitted to the Virgen del Rocío University Hospital (Andalucia, Spain) intensive care unit during a 12-month period. The variables of interest were: age, sex, mechanism of injury, percentage of burned body surface area, the Abbreviated Burn Severity Index (ABSI) and the absence/presence of sepsis. The authors analyzed serum levels of CRP and PCT at admission and every 48 h thereafter until intensive care unit discharge or death. Each determination was considered to be a sample or unit of analysis. Results A total of 157 determinations were analyzed from 17 severe burn injury patients. Fifty-four samples were considered to be septic, 25 of which corresponded to the first day of a new onset of sepsis. The mean duration of these symptoms was four days (interquartile range two to five days). Significant differences were found in the distributions of CRP and PCT values between sepsis and no-sepsis samples. Analysis of the changes in these biomarkers over time showed that PCT increase (ΔPCT) differentiated these diagnoses, whereas CRP increase (ΔCRP) did not. ROC curve analysis revealed that ΔPCT could predict positive sepsis samples (area under the curve 0.75 [95% CI 0.58 to 0.90]; P=0.003). Conclusion These preliminary results showed that PCT had a better discriminatory capacity than CRP for identifying infectious processes in patients with severe burn injury. A larger sample size would be needed to confirm these results.
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Affiliation(s)
- Juan J Egea-Guerrero
- Intensive Care Unit, Hospital Universitario Virgen del Rocío, Sevilla, Andalucia, Spain
| | | | | | | | - Angel Vilches-Arenas
- Intensive Care Unit, Hospital Universitario Virgen del Rocío, Sevilla, Andalucia, Spain
| | - María Pacheco-Sánchez
- Intensive Care Unit, Hospital Universitario Virgen del Rocío, Sevilla, Andalucia, Spain
| | - Juan M Guerrero
- Intensive Care Unit, Hospital Universitario Virgen del Rocío, Sevilla, Andalucia, Spain
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