The entity of thermal-crush-avulsion hand injury (hot-press roller burns) treated with fast acting debriding enzymes (nexobrid): literature review and report of first case

Hand burns are present in >60% of all burn cases and in fire mass casualty incidents even up to 100%. Most trauma and especially burns may be detrimental to the complex and delicate structures of the hand by direct injury, indirect BICS (Burn Induced Compartment Syndrome and interstitial high pressure) or by delayed or faulty treatment. BICS represents a special threat as the increasing swelling and oedema of the small diameter hand and forearm will exert pressure on the capillary/venous system, eventually ending in irreversible damage to the skin, nerves, muscle and vascular bed. Immediate release of constricting skin by incisional escharotomy and sometimes fasciotomy may arrest this vicious cycle: escharotomy is simple for experienced hand or burn surgeons, but they are not always present at the primary treatment site. The diagnosis of BICS is not simple either, as the direct measurement of interstitial/compartment pressure is rarely done. Burns caused by hot rollers such as industrial linen ironing machines are especially traumatic as besides the "simple" thermal burn, the hot rollers exert immense crushing pressure to the hand caught between the rollers. Over the last few years, several publications have described the role of a newly approved Bromelain derived enzymatic debriding agent (NexoBrid) for burns in general and hand burns in particular, and its ability to resolve or prevent BICS. We present a rare severe thermal/crush hand injury case where we were able to successfully treat the patient with NexoBrid enzymatic debridement-escharotomy.

Bromelain-based enzymatic debridement and minimal invasive modality (mim) care of deeply burned hands

The objective was to critically review the data and assess the implications of NexoBrid [NexoBrid-NXB formerly Debrase Gel Dressing-DGD]^a in the special field of deep hand burns. Detailed analysis of endpoints in the treatment of hand burn patients was conducted as part of a multi-center, open label, randomized, controlled two-arm study to evaluate the safety and efficacy of NXB enzymatic debridement, comparing it to the current standard of care (SOC). These results were compared to a large cohort of patients treated with NXB in a previous, single arm study. Thirty-one burned hands were treated with NXB and 41 hand burns were in the SOC group. In the NXB group, 4 out of 31 hand burns (12.9%) required some excisional debridement compared to 29 out of the 41 (70.7%) in the SOC group (p<0.0001). Mean percentage of burn wound area excised in the NXB group was 4.4 ± 13.1% compared to 52.0 ± 41.4% in the SOC group (p<0.0001). None of the NXB-treated hands required escharotomy compared to 4 out of the 41 (9.7%) in the SOC group. NXB enzymatic debridement demonstrated a statistically significant reduction in burn wound excision and auto-grafting compared to SOC, and seems to prevent the need for emergency escharotomy. ^a DGD is produced by MediWound and distributed under the name NexoBrid®.

Borane-catalysed postpolymerisation modification of the Si–H bonds in poly(phenylsilane)

An unusually wide variety of new sidechains are introduced at a polysilane through chemoselective catalytic hydrosilation, heterodehydrocoupling, and demethanative coupling.

A new bromelain-based enzyme for the release of Dupuytren's contracture: Dupuytren's enzymatic bromelain-based release

Objectives

Injectable Bromelain Solution (IBS) is a modified investigational derivate of the medical grade bromelain-debriding pharmaceutical agent (NexoBrid) studied and approved for a rapid (four-hour single application), eschar-specific, deep burn debridement. We conducted an ex vivo study to determine the ability of IBS to dissolve-disrupt (enzymatic fasciotomy) Dupuytren’s cords.

Materials and Methods

Specially prepared medical grade IBS was injected into fresh Dupuytren’s cords excised from patients undergoing surgical fasciectomy. These cords were tested by tension-loading them to failure with the Zwick 1445 (Zwick GmbH & Co. KG, Ulm, Germany) tension testing system.

Results

We completed a pilot concept-validation study that proved the efficacy of IBS to induce enzymatic fasciotomy in ten cords compared with control in ten cords. We then completed a dosing study with an additional 71 cords injected with IBS in descending doses from 150 mg/cc to 0.8 mg/cc. The dosing study demonstrated that the minimal effective dose of 0.5 cc of 6.25 mg/cc to 5 mg/cc could achieve cord rupture in more than 80% of cases.

Conclusions

These preliminary results indicate that IBS may be effective in enzymatic fasciotomy in Dupuytren’s contracture.

Cite this article: Dr G. Rubin. A new bromelain-based enzyme for the release of Dupuytren’s contracture: Dupuytren’s enzymatic bromelain-based release. Bone Joint Res 2016;5:175–177. DOI: 10.1302/2046-3758.55.BJR-2016-0072.

Dielectric spectroscopy for monitoring human pancreatic islet differentiation within cell-seeded scaffolds in a perfusion bioreactor system

The long-term in vitro culture and differentiation of human pancreatic islets is still hindered by the inability to emulate a suitable microenvironment mimicking physiological extracellular matrix (ECM) support and nutrient/oxygen perfusion. This is further amplified by the current lack of a non-invasive and rapid monitoring system to readily evaluate cellular processes. In this study, we realized a viable method for non-invasively monitoring isolated human pancreatic islets in vitro. Islets are induced to dedifferentiate into proliferative duct-like structures (DLS) in preparation for potential and subsequent re-differentiation into functional islet-like structures (ILS) in a process reminiscent of islet regeneration strategies. This long-term in vitro process is conducted within a three-dimensional microenvironment involving islets embedded in an optimized ECM gel supported by microfabricated three-dimensional scaffolds. The islet-scaffold is then housed and continuously perfused within chambers of a bioreactor platform. The process in its entirety is monitored through dielectric spectroscopy measurements, yielding an accurate representation of cellular morphology, functionality, and volume fraction. This non-invasive and real-time monitoring tool can be further manipulated to elucidate important information about the optimized cellular microenvironment required for maintaining long-term culture and achieve efficient differentiation for islet regeneration.

Abstract PD4-03: Adherence to diet, physical activity and body composition guidelines and breast cancer in the black women's health study

Background: While breast cancer incidence rates have declined in non-Hispanic Caucasian populations, rates have remained stable in African American women, who are often affected by more aggressive subtypes. Previous studies have found that adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention recommendations, and the similar American Cancer Society (ACS) guidelines, is associated with lower incidence of breast cancer. However, few African American women were included in these studies, and guidelines are based primarily on research among Caucasian women.

Objective: To evaluate the association between adherence to the WCRF/AICR cancer prevention recommendations and breast cancer incidence among African American women.

Design: The Black Women's Health Study is an ongoing prospective study of African American women from across the United States who were 21-69 years of age at baseline in 1995. They are followed biennially through health questionnaires. Among 49,103 women who were free of cancer at baseline and who provided relevant dietary and data on the baseline questionnaire, 1,827 incident cases of breast cancer were ascertained during follow-up through 2011. Questionnaire data on physical activity, body composition and diet were used to compute adherence scores for seven WCRF/AICR recommendations involving those factors. For each individual recommendation, participants were categorized as adherent (1 point), partially adherent (0.5 points) or non-adherent (0 points). Scores were summed to a total adherence score (maximum score: 7 points) and a diet only adherence score (maximum score: 5 points). Adherence scores (categorical and continuous) based on baseline data only and on time-varying data were assessed in relation to breast cancer incidence using Cox proportional hazards regression models, with control for potential confounding factors.

Results: In the analytic cohort, 8.5% of participants had an adherence score of 4.5-7.0, while 46% had a score less than 3.0. For individual recommendations, 15.2% were adherent to body weight recommendations, 24.7% were adherent to physical activity, and 5.4% were adherent to more than 4 diet recommendations. Participants were most likely to adhere to the alcohol recommendation (94.3%). In the time varying model, higher overall adherence (per 0.5 unit increase) was associated with lower breast cancer incidence (HR: 0.90, 95% CI: 0.84-0.96), with greater adherence to diet overall, physical activity, sugar beverage intake, and red and processed meat recommendations all significantly associated with reduced risk. The adherence score based on baseline variables was not associated with significantly reduced risk (HR: 0.96, 95% CI: 0.90-1.02), although meeting physical activity recommendations was associated.

Conclusions: Our findings suggest that adherence to the WCRF/AICR guidelines may lower risk of developing breast cancer in African American women. However, body weight and alcohol, factors that are widely considered important for breast cancer prevention appear to be less relevant in this population.

Citation Format: Nomura SJO, Yu J, Dash C, Rosenberg L, Palmer J, Adams-Campbell L. Adherence to diet, physical activity and body composition guidelines and breast cancer in the black women's health study. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr PD4-03.

In vivo burn diagnosis by camera-phone diffuse reflectance laser speckle detection

Burn diagnosis using laser speckle light typically employs widefield illumination of the burn region to produce two-dimensional speckle patterns from light backscattered from the entire irradiated tissue volume. Analysis of speckle contrast in these time-integrated patterns can then provide information on burn severity. Here, by contrast, we use point illumination to generate diffuse reflectance laser speckle patterns of the burn. By examining spatiotemporal fluctuations in these time-integrated patterns along the radial direction from the incident point beam, we show the ability to distinguish partial-thickness burns in a porcine model in vivo within the first 24 hours post-burn. Furthermore, our findings suggest that time-integrated diffuse reflectance laser speckle can be useful for monitoring burn healing over time post-burn. Unlike conventional diffuse reflectance laser speckle detection systems that utilize scientific or industrial-grade cameras, our system is designed with a camera-phone, demonstrating the potential for burn diagnosis with a simple imager.

Minimally invasive burn care: a review of seven clinical studies of rapid and selective debridement using a bromelain-based debriding enzyme (Nexobrid®)

Current surgical and non-surgical eschar removal-debridement techniques are invasive or ineffective. A bromelainbased rapid and selective enzymatic debriding agent was developed to overcome these disadvantages and compared with the standard of care (SOC). The safety and efficacy of a novel Debriding Gel Dressing (DGD) was determined in patients with deep partial and full thickness burns covering up to 67% total body surface area (TBSA). This review summarizes data from seven studies, four of which were randomized clinical trials that included a SOC or control vehicle. DGD eschar debridement efficacy was >90% in all studies, comparable to the SOC and significantly greater than the control vehicle. The total area excised was less in patients treated with DGD compared with the control vehicle (22.9% vs. 73.2%, P<0.001) or the surgical/non-surgical SOC (50.5%, P=0.006). The incidence of surgical debridement in patients treated with DGD was lower than the SOC (40/163 [24.5%] vs. 119/170 [70.0%], P0.001). Less autografting was used in all studies. Long-term scar quality and function were similar in DGD- and SOCtreated. DGD is a safe and effective method of burn debridement that offers an alternative to surgical and non-surgical SOC.

Abstract PD2-7: Vigorous exercise across the lifespan and reduced risk of estrogen receptor negative breast cancer in African American women

Background. Recreational exercise has been associated with a reduced risk of breast cancer, but evidence regarding breast cancer among African American women and about breast cancer subtypes is sparse.

Methods. We assessed lifetime vigorous exercise (average of high school, age 21, age 30, and baseline) in the Black Women's Health Study in relation to the incidence of invasive breast cancer overall (n = 1,377), estrogen receptor-positive (ER+) breast cancer (n = 556), estrogen receptor-negative (ER-) breast cancer (n = 327), and triple negative breast cancer (TN) (n = 103); analyses were based on 275,188 person years of follow-up of 44,704 African American women who were aged 30 or more at entry to the study. Cox proportional hazards models estimated incidence rate ratios (IRR) and 95% confidence intervals (CI), controlling for breast cancer risk factors.

Results. For ER- breast cancer, the IRRs for 1-2.2 hours/week, 2.3-2.9 hours/week, and 3+ hours/week relative to &lt;1 hour/week were 0.76 (95% CI 0.52-1.11), 0.78 (95% CI 0.52-1.17) and 0.53 (95% CI 0.31-0.90), respectively; the p value for trend was 0.058. The inverse association was apparent only among postmenopausal women. There was also an inverse association, although nonsignificant, of exercise with the incidence of TN breast cancer. Vigorous exercise was not associated with a reduction in ER+ breast cancer risk.

Conclusion. These results indicate that physical activity may protect against the development of ER- breast cancer in African American women. The association, if confirmed, is of great public health importance given the high mortality associated with this subtype and its higher incidence in African American women.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr PD2-7.

Mortality among African American women with sarcoidosis: data from the Black Women's Health Study

BACKGROUND

Sarcoidosis is a chronic systemic granulomatous disease of unknown etiology that disproportionately affects black females.  Few studies have specifically addressed causes of death in this population.

OBJECTIVES

To assess rates and causes of death among women with sarcoidosis in a prospective cohort study of U.S. black women.

DESIGN

The Black Women's Health Study is a follow-up study of 59,000 U.S. black women aged 21-69 (median age 38) at entry in 1995.  Data on demographic and lifestyle factors and medical conditions, including sarcoidosis, were obtained through biennial questionnaires.  Deaths and causes of death from 1995 through 2009 among study subjects were identified from National Death Index data. We assessed mortality rates among women with and without a history of sarcoidosis.  Poisson regression models were used to estimate age-adjusted mortality rates. Cox proportional-hazards models were used to estimate hazard ratios for mortality and 95% confidence intervals.

RESULTS

A total of 121 deaths occurred among 1,192 women with a history of sarcoidosis and 2813 deaths among women without sarcoidosis.  Mortality was greater at every age among women with sarcoidosis and the overall multivariable-adjusted hazard ratio was 2.44 (95% CI 2.03-2.93, p&lt;0.0001). Of the deaths among women with sarcoidosis, 24.7% were directly attributable to sarcoidosis.

CONCLUSIONS

In the Black Women's Health Study, women with sarcoidosis were more than twice as likely to die as women without the disease, with many of the deaths directly attributable to sarcoidosis.  Sarcoidosis is an important cause of premature death among black women with the disease.

The etiology of uterine sarcomas: a pooled analysis of the epidemiology of endometrial cancer consortium

BACKGROUND

Uterine sarcomas are characterised by early age at diagnosis, poor prognosis, and higher incidence among Black compared with White women, but their aetiology is poorly understood. Therefore, we performed a pooled analysis of data collected in the Epidemiology of Endometrial Cancer Consortium. We also examined risk factor associations for malignant mixed mullerian tumours (MMMTs) and endometrioid endometrial carcinomas (EECs) for comparison purposes.

METHODS

We pooled data on 229 uterine sarcomas, 244 MMMTs, 7623 EEC cases, and 28,829 controls. Odds ratios (ORs) and 95% confidence intervals (CIs) for risk factors associated with uterine sarcoma, MMMT, and EEC were estimated with polytomous logistic regression. We also examined associations between epidemiological factors and histological subtypes of uterine sarcoma.

RESULTS

Significant risk factors for uterine sarcoma included obesity (body mass index (BMI)≥30 vs BMI<25 kg m(-2) (OR: 1.73, 95% CI: 1.22-2.46), P-trend=0.008) and history of diabetes (OR: 2.33, 95% CI: 1.41-3.83). Older age at menarche was inversely associated with uterine sarcoma risk (≥15 years vs <11 years (OR: 0.70, 95% CI: 0.34-1.44), P-trend: 0.04). BMI was significantly, but less strongly related to uterine sarcomas compared with EECs (OR: 3.03, 95% CI: 2.82-3.26) or MMMTs (OR: 2.25, 95% CI: 1.60-3.15, P-heterogeneity=0.01).

CONCLUSION

In the largest aetiological study of uterine sarcomas, associations between menstrual, hormonal, and anthropometric risk factors and uterine sarcoma were similar to those identified for EEC. Further exploration of factors that might explain patterns of age- and race-specific incidence rates for uterine sarcoma are needed.

Perceived environmental restrictions for the participation of children with mild developmental disabilities

AIM

In light of the International Classification of Functioning, and Health (ICF) model, to assess whether parents of children with mild developmental disabilities perceived various environmental factors as barriers to their child's participation, and whether these factors have a unique contribution to the total explained variance of participation, beyond personal factors.

METHODS

Seventy-nine kindergarten children (mean age 5.20 ± 0.52 years old) with mild developmental disabilities and their parents participated in the study. Three questionnaires measuring the child's participation, performance skills and environmental factors were completed by the parents.

RESULTS

Parents perceived environmental factors as slightly restricting to their child's participation. Associations were found between home and education factors and the dimensions of child participation - independence, enjoyment and parental satisfaction. Although parents perceived human environmental factors as more restricting than physical factors at home, regression analysis revealed that the latter was found to affect the child participation dimension of independence beyond the contribution of personal factors.

INTERPRETATION

These findings are the first, to our knowledge, to support the contribution of environmental factors to the participation of young children with mild developmental disabilities. The results show that environmental factors have significant slight contribution to child's independence in participation beyond other predictors (i.e. personal factors). Therefore, it is recommended to include environmental restrictions measurement in the child evaluation process to facilitate effective intervention programs.

Personal and environmental pathways to participation in young children with and without mild motor disabilities

OBJECTIVE

Participation in everyday activities has a positive influence upon health and well-being and is considered as an outcome measure. According to recent models child participation is the product of the dynamic interaction between health states and both individual and environmental factors. Children with mild developmental disabilities often present decreased participation in everyday activities. The purpose of this study was to explore the extent to which individual and environmental factors explain the participation of young children, with and without mild motor disabilities.

METHODS

The study population included 58 kindergarten children together with their parents (29 children with mild motor disabilities who were referred to occupational therapy and 29 children without motor disabilities). Both groups of children were matched for: age; gender; age of parents; and socio-economic status (SES). We assessed participation using the Child Participation Questionnaire (intensity, diversity, independence, child enjoyment and parental satisfaction) and we assessed children's self-efficacy and motor abilities for individual factors. Parental self-efficacy and SES were collected by questionnaires.

RESULTS

Participation diversity (number of activities) was predicted by child and mother self-efficacy and by SES. Child independence and enjoyment as well as parental satisfaction were predicted by child motor ability but mainly by maternal self-efficacy. Results suggest that the total explained variance is more than double when the environmental variables (parental self-efficacy and SES) are inserted to the participation model.

CONCLUSIONS

Maternal self-efficacy and SES serve as facilitators to increased participation and well-being of children with mild motor disabilities.

Hypertension and risk of uterine leiomyomata in US black women

BACKGROUND

Previous studies have found a positive association between hypertension and risk of hysterectomy-confirmed uterine leiomyomata (UL). The association of hypertension with UL confirmed by ultrasound or other surgery is less clear.

METHODS

The present study evaluated the association of hypertension with UL incidence according to confirmation method (hysterectomy, other surgery or ultrasound) in the Black Women's Health Study, 1997-2007. We collected prospective data every 2 years on physician-diagnosed hypertension and UL in 22 530 premenopausal women. Validation sub-studies confirmed 99 and 96% of hypertension and UL self-reported diagnoses, respectively. Cox regression was used to estimate incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for the association of hypertension and UL, adjusting for potential confounders.

RESULTS

During 172 162 person-years of follow-up, there were 6447 incident cases of UL confirmed by ultrasound (n = 5111), hysterectomy (n = 670) or other surgery (n = 666). Treated hypertension was associated with UL confirmed by hysterectomy (IRR = 1.32, 95% CI: 1.06, 1.63), but it was not associated with UL confirmed by ultrasound (IRR = 1.05, 95% CI: 0.96, 1.16) or other surgery (IRR = 1.13, 95% CI: 0.88, 1.46).

CONCLUSIONS

Treated hypertension was associated with UL confirmed by hysterectomy, but not UL confirmed by other methods (other surgery or ultrasound). These data suggest it is premature to conclude that hypertension is related to an increased risk of UL. Additional studies are needed to assess whether the association with hysterectomy-confirmed UL can be explained by other sources of bias, such as patient or physician preferences for specific types of medical care.

How do young children with DCD participate and enjoy daily activities?

Developmental problems may decrease participation of children. The objective of this study was to evaluate multidimensional aspects of participation amongst preschool children with and without DCD. Participants included 63 children with mean age of 4.96 years (SD=0.62; range=4.02-6.35 years). Twenty one children were diagnosed with DCD, 21 children without DCD who were referred to OT due to mild developmental problems, and 21 children from mainstream public kindergartens whom did not require any developmental intervention. All three groups were matched for age, gender, and socioeconomic status. Children were administered the M-ABC2 and their parents completed the PSQ questionnaire. Results indicate significant differences in level of independence and subjective measures of participation (enjoyment and parents' satisfaction) between the DCD group and the two other groups. The results indicate that from a young age, and in comparison to their peers, the participation of children with DCD is compromised. The integration of the DSM diagnostic criteria and the ICF perception of health enables us to capture the full scope of DCD and its complexity.

Development and validation of the Documentation of Occupational Therapy Session during Intervention (D.O.T.S.I.)

OBJECTIVE

To developed and validate a form for Documentation of Occupational Therapy Session during Intervention (D.O.T.S.I) based on the OTPF. This form may fill the need for more consistent and detailed documentation of the intervention process.

METHOD

Fifty five pediatric OT's documented 2-3 treatment sessions. A total of 120 treatment sessions were recorded. Construct validity was assessed through known-groups differences, once based on age groups and once based on context groups.

RESULTS

Significant inter-rater reliability in most sub-categories was found with a good Cronbach alpha coefficient. Construct validity was established by significant differences between the two settings (educational and clinic) and the two age groups.

CONCLUSION

The D.O.T.S.I. form as a reliable and valid measure enables to simply document intervention in a unified and professional method. The documentation method of the D.O.T.S.I. stimulates clinical reasoning by allowing the therapist to reflect on the process of intervention and plan future progress.

Can personal and environmental factors explain dimensions of child participation?

OBJECTIVE

One of the main goals of paediatric occupational therapists and other health professionals is to enhance child participation in age-related activities within their communities. According to theoretical models, the act of participation has numerous dimensions, affected by personal and environmental factors. However, there have been relatively few studies undertaken to validate this theory. The purpose of this study was to explore the extent to which personal and environmental factors explain each of five distinct dimensions of child participation, which are: diversity, intensity, independence, enjoyment and subsequent parental satisfaction.

METHOD

A convenient sample of 70 kindergarten children without developmental disabilities together with their parents participated in the study. Data were collected using standardized assessments for personal factors and questionnaires for environmental factors.

RESULTS

The findings confirmed our hypothesis and revealed that with typical children, motor and cognitive abilities affect participation diversity. Moreover, performance skills and self-perceptions of competence affect their independence levels, while environmental factors contribute to frequency of participation and parental satisfaction. However, these factors on their own do not fully explain the degree of enjoyment experienced by children.

CONCLUSIONS

The findings highlight the importance of measuring the full range of participation dimensions, and provide empirical evidence about the nature of child participation. Further studies are warranted to validate this approach for children with developmental difficulties.

Obesity and poor breast cancer prognosis: an illusion because of hormone replacement therapy?

High body mass index (BMI) and use of hormone replacement therapy (HRT) increase the risk of postmenopausal breast cancer. It has been shown that BMI modifies the effect of HRT, as its influence is most pronounced in lean women. We investigated the influence of BMI and HRT on prognosis in 2640 postmenopausal women diagnosed with breast cancer in Sweden in 1993-1995, taking into account HRT and mammography before diagnosis. Logistic and Cox regression were used. In non-users of HRT, obese women (BMI >30) compared with normal weight women (BMI <25) had a similar prognosis (hazard ratio (HR) 1.1, 95% confidence interval (CI) 0.8-1.6), despite larger tumours found in obese women. Obese HRT users had less favourable tumour characteristics and poorer prognosis compared with normal weight women (HR 3.7, 95% CI 1.9-7.2). The influence of BMI on breast cancer prognosis was similar whether diagnosed by mammographic screening or not. We found a similar prognosis of postmenopausal breast cancer-specific death regardless of BMI in non-users of HRT, but among HRT users obesity was associated with a poorer breast cancer prognosis.

Pediatric burns in the Bedouin population in southern Israel

Burn trauma is an important public health concern, with increased risk for burns in children. A cross-sectional study was performed to describe the epidemiological characteristics and risk factors for burns in hospitalized Bedouin children in Soroka University Medical Center during the years 2001–2002. In a population of 558 hospitalized burn-injured patients, 282 Bedouin children were identified. Two hundred and sixty five patients (94.0%) had burns involving less than 20% of the body surface area. Cause of the burns was scald in 190 patients (67.4%), fire in 80 patients (28.4%), chemical in 8 patients (2.8%), and explosion in 2 patients (0.7%). Two female patients (0.7%) aged 11 and 17 years died of their burns that were caused by fire. The mean length of hospitalization was 9.8 days. Pediatric burn injury has become a significant public health problem in the Bedouin population of the Negev. To reduce the burden of burn injury, it is necessary to increase current efforts in prevention of burns.

Burns at the soroka university medical center - a two-year experience

Background. Burn trauma is a major public health concern, with increased risk for burns in children. Objectives. To characterize the profile of injured burn patients and to identify patients who are prone to burn injury. Methods. This is a cross-sectional study including all patients who were admitted to the Burns and Plastic Surgery Department, Soroka University Medical Center, Israel, between 1 January 2001 and 31 December 2002. Results. Five hundred and fifty-eight patients with a mean age of 15.4 yr (SD, 19.5 yr) were included in the study. There were 348 male patients (62.4%). The cause of the burns was scalding in 314 patients (56.3%), flame in 177 (31.7%), chemicals in 31 (5.6%), explosion in 20 (3.6%), and electricity in four (0.7%). There were 325 Bedouin patients (58.2%) and 221 Jewish patients (39.6%). In Bedouins, 235 patients (72.3%) were children below 5 yr, compared to 59 Jewish patients (26.7%) (p < 0.001). Eighteen burn patients (3.2%) expired. A multivariate analysis demonstrated that age and percentage of body surface area involved in the burn were significantly associated with mortality. Conclusions. The epidemiological characteristics of the burned population in Soroka University Medical Center are described. Burn injury has become a principal public health problem, particularly in Bedouin children.

Pancreatic small cells: Analysis of quiescence, long-term maintenance and insulin expression in vitro

We have previously identified a novel population of small cells in human and canine pancreas characterized by immature morphology, quiescence, and a glucose-responsive insulin secretion. Based on their immature phenotype and predominant presence in small islets, we have hypothesized that small cells serve as islet progenitors. This hypothesis remains untested, however, due to persistent quiescence and scarcity of small cells in vitro. We have recently developed a culture medium that allowed for modest small cell proliferation. In this study we characterized the expression of genes potentially involved in small cell growth regulation by Q-RT-PCR. Our results suggest that quiescence of small cells correlates with up-regulation of Cdk inhibitors p27(Kip1), p16(INK4a) and p21(CIP1), PTEN, Hep27 and Foxo1a and with down-regulation of c-Myc and the receptors for EGF, FGF2 and HGF. The exit from quiescence correlates with activation of EGFR expression and down-regulation of p27(Kip1) and p16(INK4a). We also report here that small cells can be maintained in long-term non-adherent cultures preserving insulin and glucagon production for up to 208 days. Therefore, expansion of small cells in vitro may have a significant potential for the treatment of diabetes. This study is an important step in understanding the mechanisms involved in small cell growth regulation, which is required to fully evaluate their functional potential.