The New Approach to the Diagnostics and Treatment of Endogenous Intoxication in Patients with Burn Injury

Background: The main causes of mortality in patients with burn injury are the development of systemic inflammatory process, multiple organ failure and septic complications. The aim of the research: Improvement of diagnostic and therapeutic approaches to the detection and elimination of endogenous intoxication in patients with burn injury. Materials and methods: The main study group consisted of 19 patients and the comparison group—of 10 patients with burn injury. 92 blood serum (BS) samples of the patients of the main group were tested, using the method of fluorescence spectroscopy (MFS). The advanced therapeutic tactics were proposed for the patients of both groups. The control group consisted of 40 healthy individuals (donors). BS of these patients was also tested using MFS. Results: Patients with burn injury have endogenous intoxication in their blood. The effective concentration of albumin is reduced in patients with burn injury due to the blockage of albumin binding centers by bacterial metabolism products. Fluorescence spectra (FS) of BS in patients with burn trauma and donors were obtained and investigated. Based on MFS results, an improved treatment regimen using infusion of albumin solution was proposed. Conclusions: An improved technique for the management of patients with burn injury is based on the use of MFS for the diagnostic evaluation of endogenous intoxication in them. The idea of pathological changes in albumin molecules in patients with burn injury is pathogenetically substantiated by the successful use of infusion of albumin solution in these patients on the basis of the MFS.

Community Knowledge and Attitude about Burns First Aid (BFA) in Jazan, Saudi Arabia

Introduction and Significance: Burn injury (BI) is a considerable health issue which is responsible for around 300,000 deaths and affecting about 11 million people every year worldwide. In Saudi Arabia, the prevalence of BIs array from 112 to 518 per 100,000 per year. The appropriate awareness of performing first aid could facilitate to improve the outcomes of burns. Purpose and Objectives: To appraise the community that acknowledges burns, first aid, and associated factors among the community population in Jazan City, Saudi Arabia. The paper aims to identify limitations to encourage additional research and persuade legislators to develop improved burn-injury care recommendations and training programs. Materials and Methods: An observational-based sample survey was conducted among the people who live in Jazan City aging 13 years or more, during April 5 to May 5, 2023. Data collection was done by a validated online self-administrated questionnaire sent randomly to community members in different parts of Jazan City via social media platforms. Collected data were coded and cleaned by an excel program, and finally exported on SPSS 26.0 software. The variables were analyzed using descriptive statistics like frequencies and percentages. Also, the Chi-square test was used to investigate the relation between different variables, with a significance value of P Results: This study included 243 participants (about 62%) among them were mostly male participants (151) having a university degree. The majority of participants 75% did not take any form of BFA training in the past. This study shows that 69.9% of the participants have inadequate awareness, despite 72% having a constructive attitude towards burn first aid. Previous burn-related first aid training was significantly associated with participants’ knowledge of BFA at a p-value less than 0.05. Conclusion: This study indicates a high frequency of Jazan population having inadequate knowledge of burn first aid despite the high prevalence of a favorable attitude. There is a need to develop an effective nationwide burn prevention program and early burn first aid treatment in Saudi Arabia and promote a consistent guideline for burn first aid.

Mitsugumin 53 protects the kidney from severe burn injury in mice

Mitsugumin 53 (MG53), a newly identified muscle-specific protein, is an essential component of the cell membrane repair machinery in skeletal and cardiac muscle. However, the role of MG53 after burns in other tissues remains unclear. This study aims to investigate the possible roles of MG53 in the protection of the kidney after severe burn injury, and an animal scalding model of 30% of total body surface area (TBSA) was used. Recombinant human MG53 (rhMG53) or bovine serum albumin (BSA) was injected intravenously via the tail vein. Data showed that the mortality in the MG53-treated group was lower than that in control group. Administration of rhMG53 may alleviate histological alterations in renal tubular epithelial cells after burn injury. Renal tubular injury scores and the average optical density score of kidney injury molecule-1 (KIM-1) immunohistochemical staining in the MG53-treated group were significantly lower than those in control group (P < 0.001). Exogenous rhMG53 was found to be located in renal tubular epithelial cells. Numerous polymerase I and transcript release factor (PTRF) were expressed in the mouse kidney after severe scalding. In conclusion, our data indicate that MG53 protein protects the kidney by involving local PTRF after severe burn injury.

Current understanding of thermo(dys)regulation in severe burn injury and the pathophysiological influence of hypermetabolism,adrenergic stress and hypothalamic regulation-a systematic review

Background:In this systematic review,we summarize the aetiology as well as the current knowl-edge regarding thermo(dys)regulation and hypothermia after severe burn trauma and aim to present key concepts of pathophysiology and treatment options.Severe burn injuries with>20%total body surface area(TBSA)affected commonly leave the patient requiring several surgical procedures,prolonged hospital stays and cause substantial changes to body composition and metabolism in the acute and long-term phase.Particularly in severely burned patients,the loss of intact skin and the dysregulation of peripheral and central thermoregulatory processes may lead to substantial complications.Methods:A systematic and protocol-based search for suitable publications was conducted fol-lowing the PRISMA guidelines.Articles were screened and included if deemed eligible.This encompasses animal-based in vivo studies as well as clinical studies examining the control-loops of thermoregulation and metabolic stability within burn patients Results:Both experimental animal studies and clinical studies examining thermoregulation and metabolic functions within burn patients have produced a general understanding of core concepts which are,nonetheless,lacking in detail.We describe the wide range of pathophysiological alterations observed after severe burn trauma and highlight the association between thermoregulation and hypermetabolism as well as the interactions between nearly all organ systems.Lastly,the current clinical standards of mitigating the negative effects of thermodysregulation and hypothermia are summarized,as a comprehensive understanding and implementation of the key concepts is critical for patient survival and long-term well-being.Conclusions:The available in vivo animal models have provided many insights into the interwoven pathophysiology of severe burn injury,especially concerning thermoregulation.We offer an outlook on concepts of altered central thermoregulation from non-burn research as potential areas of future research interest and aim to provide an overview of the clinical implications of temperature management in burn patients.

Effects of combined radiation and thermal burn injury on the survival of skin allograft and immune function in rats

Abstract Objectives To investigate the effects of combined radiation and thermal burn injury on the survival of skin allografts and to analyze the relationship between the prolongation of allograft survival and the changes of immune functions of the thymocytes and splenocytes in rats. Methods Wistar rats were irradiated with 3, 4, 5, 6 and 8 Gy of gamma rays. Thirty minutes after radiation, 15% TBSA Ⅲ degree burn was inflicted to the rats. Twenty four hours after the burn injury, allografts were used to cover the burn wounds. In the 8 Gy group, 1 hour before skin grafting, the bone marrow cells (4×10 8) from the same donor were also transplanted. All rats were carefully observed after injury. The rats with single radiation injury of 5 Gy gamma rays, with single burn injury and with combined radiation burn injury were killed 3, 7, 10, 15 and 30 days after skin grafting for immunological assay and pathological study. Results All the allografts in the single burn group were rejected in 10 days. In the combined injury groups, the survival rates of the allografts in rats undergoing 3 and 4 Gy radiation were 20% and 30%, respectively. In the combined injury groups undergoing 5, 6 and 8 Gy radiation, the 10 day survival rates of the allografts were 69%, 88% and 100% respectively, and the 30 day survival rates in the three groups were 36%, 42% and 100% separately. The grafted allogenic skin, with normal epithelial cells and good vascularity, healed well with the recipient's skin. Hairs grew well from the allografts 30 days after grafting. Three, 7 and 15 days after allografting, in the single burn group, the proliferative activities of the thymocytes were 90%, 185% and 130% of the preinjury level, and the antibody forming capacities of the splenocytes were 200%, 171% and 300% of the preinjury level, respectively; in the combined injury groups, the proliferative activities were 6%, 99% and 91% of the preinjury level, and the forming capacities were 2%, 36% and 90% of the preinjury level. Conclusions The survival rate of allograft in rats undergoing combined radiation and thermal burn injury rises with the increase in radiation dosage. The allograft covering single bun injury is severely rejected by immune reaction. The prolongation of the survival of allograft in combined injury group mainly results from radiation that suppresses immune functions.

Non-severe burn injury increases cancer incidence in mice and has long-term impacts on the activation and function of T cells

Background:Recent evidence suggests that burn patients are at increased risk of hospital admission for infection,mental health conditions,cardiovascular disease and cancer for many years after discharge for the burn injury itself.Burn injury has also been shown to induce sustained immune system dysfunction.This change to immune function may contribute to the increased risk of chronic disease observed.However,the mechanisms that disrupt long-term immune function in response to burn trauma,and their link to long-term morbidity,remain unknown.In this study we investigated changes to immune function after burn injury using a murine model of non-severe injury.Methods:An established mouse model of non-severe burn injury(full thickness burn equivalent to 8%total body surface area)was used in combination with an orthotopic model of B16 melanoma to investigate the link between burns and cancer.Considering that CD8^(+)T cells are important drivers of effective tumour suppression in this model,we also investigated potential dysregulation of this immune population using mouse models of burn injury in combination with herpes simplex virus infection.Flow cytometry was used to detect and quantify cell populations of interest and changes in immune function.Results:We demonstrate that 4 weeks after a non-severe burn injury,mice were significantly more susceptible to tumour development than controls using an orthotopic model of B16 melanoma.In addition,our results reveal that CD8^(+)T cell expansion,differentiation and memory potential is significantly impaired at 1 month post-burn.Conclusions:Our data suggests that CD8^(+)T cell-mediated immunity may be dysfunctional for a sustained period after even non-severe burn injury.Further studies in patients to validate these findings may support clinical intervention to restore or protect immunity in patients after burn injury and reduce the increased risk of secondary morbidities observed.

Burn injury differentially alters whole-blood and organ glutathione synthesis rates: An experimental model

Previous studies from our laboratories revealed a reduced rate of whole-blood (WB) glutathione (GSH) synthesis in severely burned patients. To determine whether WB GSH metabolism is an indicator of the status of GSH metabolism in one or more of the major organs, we used a burn rabbit model to determine GSH concentrations and rates of synthesis in WB, liver, lungs, kidney, and skeletal muscle. L-[1-13C]-cysteine was infused intravenously for 6 h in rabbits at 3 days post-burn and in sham burn controls. WB and organ 13C-enrichment of cysteine and GSH was determined by gas chromatography/mass spectrometry. Plasma cysteine metabolic flux was increased significantly (P < 0.01) following burn injury. WB, liver, and lung GSH concentrations (P = 0.054, P < 0.05, and P < 0.05, respectively) and fractional rates of GSH synthesis (P < 0.05, P< 0.01, and P< 0.05, respectively) were reduced at 3 days post-burn. Kidney was unaffected. There also appears to be an increased rate of GSH transport out of the liver after burn injury. Hence, there is a differential impact of burn injury on tissue and organ GSH status, with WB qualitatively reflecting the changes in lung and liver. It will be important to determine whether these changes are due to alterations in the intrinsic capacity for GSH synthesis and/or availability of amino acid precursors of GSH.

Aquaporin-4 in the formation of cerebral edema following severe burns What role do arginine vasopressin levels play?

BACKGROUND： Aquaporin-4 （AQP-4）, which is able to rapidly transport water within the brain, is highly expressed in brain tissue. It also plays an important role in the formation of cerebral edema following brain injury. However, the role of AQP-4 in the formation of cerebral edema following severe bums remains unknown. OBJECTIVE： To study changes in AQP-4 protein and mRNA expression during formation of cerebral edema following severe burns, and to explore the correlation between AQP-4 protein and mRNA expression with plasma levels of arginine vasopressin （AVP）. DESIGN, TIME AND SETTING： A randomized, controlled, animal experiment was performed at the Research Center of Neuroscience, Chongqing Medical University from 2007 to 2008. MATERIALS： Biotin-labeled goat anti-rabbit antibody was provided by Beijing Zhongshan Biotechnology, China; in situ hybridization kit was provided by Wuhan Boster Biotechnology, China; rabbit anti-AQP-4 polyclonal antibody and horseradish peroxidase-labeled goat anti-rabbit IgG were provided by Chemicon, USA; AVP radioimmunoassay kit was provided by the Research Department of Neurobiology, the Second Military Medical University of Shanghai, China. METHODS： A total of 180 adult, healthy, Wistar rats were randomly assigned to control and burn groups with 30 rats in each group. The burn group was observed at five different time points： 2, 6, 12, 24, and 48 hours after burn. Hair on the mouse back was removed to expose skin on the back. After 1 day, skin with the hair removed was dipped into 100℃ water for 15 seconds to induce grade III bum injury that measures 30% of total bum surface area. MAIN OUTCOME MEASURES： Brain water content was measured using the dry-wet weight method. AQP-4 protein and mRNA expressions were detected using immunohistochemistry, in situ hybridization, Western blot, and reverse transcription-polymerase chain reaction; dynamic changes in plasma AVP were detected using radioimmunoassay. RESULTS： Brain water content gradually increased following severe burn injury. AQP-4 protein and mRNA expressions were upregulated in the supraoptic nucleus, suprachiasmatic nucleus, paraventricular nucleus, hippocampus, choroid plexus, and cerebral cortex. Plasma AVP levels increased following burn injury. AQP-4 protein and mRNA expressions positively correlated with brain water content and AVP levels during formation of cerebral edema （r= 0.870, 0.848, P 〈 0.01）. CONCLUSION： AQP-4 participated in the formation of cerebral edema following burn injury. Plasma AVP upregulated AQP-4 expression in brain tissue, thereby promoting formation of cerebral edema.

Up-regulation of Tim-3 Expression Contributes to Development of Burn-induced T Cell Immune Suppression in Mice

T cell immunoglobulin and mucin domain 3 （Tim-3） is well known to negatively regulate T cells responses, but its role in burn-induced T cells immune suppression remains unclear. In the present study, in order to identify the relationship between Tim-3 expression and post-burn T cells immune suppression, C57BL/6 mice were subjected to burn injury or sham injury, and the liver and spleen were harvested at the day 1 after operation. The expression level of Tim-3 on hepatic or splenic T cells and the functional properties of Tim-3＋ T cells were evaluated. It was found burn injury induced dramatically elevated Tim-3 expression on both hepatic and splenic CD4＋ and CD8＋ T cells in contrast with the post-burn depletion of T cells. Furthermore, Tim-3 expression was correlated with the suppressive phenotype of T cells following burn injury, including increased expression of anti-inflammatory cytokine IL-10, decreased expression of pro-inflammatory cytokines IFN-γ and TNF-α, reduced T cell proliferation and elevated co-expression of Tim-3 and PD-1. Moreover, Tim-3＋ T cells subsets were more prone to spontaneous apoptosis than Tim-3- T cells subsets. Our findings reinforce the idea that the up-regulated expression of Tim-3 on T cells after burn injury plays an important role in the development and maintenance of burn-induced T cell immune suppression.

Isolation of Microorganisms According to Burned Body Surface: Experience in a Reference Center in Mexico City

Background: Burns is one of the most common and severe forms of trauma, as they cause an alteration in the protective barrier exerted by the skin. The objective of this work is to describe the bacterial pathogens that cause infections in the different body segments as well as to know the susceptibility in patients with burns during a period of two years. Methods: This study was conducted over a period of 2 years, January 2017 to January 2019. The analysis of the isolated microbiological agents was obtained from culture samples in different anatomic areas. The variables were measured in the general population and also by groups, considering: age, sex, TBSA with Wallace's rule of nine, anatomic area affected, type of burn, depth of burn, microorganism reported in cultures, antibiotics empirically administered and mortality rate. Results: Regardless of the anatomical segment studied, the most frequently isolated microorganism was Pseudomonas aeruginosa. Conclusions: Identification of the microorganisms that cause infection reduces the hospital stay, as well as the admission to the ICU. A fundamental research guideline is to pay more attention to the post-burn consequences, and the sequelae and functional limitations that it entails, since few since few studies focus on this aspect.

Devastating complication of negative pressure wound therapy after deep inferior epigastric perforator free flap surgery:A case report

BACKGROUND Thermal injuries on free transferred or replanted tissues resulting from loss of sensibility are an infrequent occurrence.They require immediate and appropriate management before they progress to an irreversible condition.Although negative pressure wound therapy(NPWT)can prevent wound progression by increasing microcirculation,the inappropriate application of NPWT on complicationthreatened transferred and replanted tissues can induce an adverse effect.CASE SUMMARY A 48-year-old woman who underwent immediate breast reconstruction with a deep inferior epigastric artery perforator free flap.While applying a heating pad directly to the flap site,she sustained a deep second to third-degree contact burn over 30%of the transferred flap on postoperative 7 d.As the necrotic changes had progressed,we applied an NPWT dressing over the burned area after en-bloc debridement of the transferred tissues on postoperative 21 d.After 4 d of NPWT application,the exposed fatty tissues of the flap changed to dry and browncolored necrotic tissues.Upon further debridement,we noted that the wound gradually reached total necrosis with a collapsed vascular pedicle of deep inferior epigastric artery.CONCLUSION Although NPWT has been shown to be successful for treating various wound types,the significant risk of NPWT application in short-lasting reconstructed flap wounds after thermal injury should be reminded.

Infection control and prevention in burn victims:The role of nurses

Burn injury is a major public health concern,with an estimated 180,000 deaths each year associated with burn-related infections.The majority of these occur in low-and middle-income countries,and almost two-thirds occur in the World Health Organization African and South-East Asia Regions.There is a risk of an escalation of burn injury site infections if nurses who are directly involved in burn care do not develop a mechanism to mitigate this risk in the coming years.Hence,this study aims at explaining what burn injuries are and how nurses can prevent the occurrence of infection among burn victims.This review analyzed published studies using keywords such as burn injury,infection in burn patients,and nurses’involvement in infection prevention and control(IPC)on search engines such as PubMed,Science Direct,and Google Scholar.The literature was retrieved and reviewed for eligibility to capture just the variables indicated in this seminar objective;the date range chosen in the literature search was from 2015 to 2023.The study found that many patients die from burn injuries as a result of exposure to infection and most nurses are not adequately informed about infection control.The study also found that nurses’responsibilities include proper hand hygiene,wound care,the use of personal protective equipment,antibiotic medication,cleaning the patient’s surroundings,and preventing patient cross-contamination.Burn injuries pose a significant risk to patients,necessitating infection control and prevention.Therefore,nurses in burn units should be informed on IPC practices and also educate patients,families,and coworkers on their importance.

Current Problems of Diagnostics and Treatment of Purulent-Inflammatory Diseases and Sepsis in Medical Practice

Background: Poor treatment of burns can lead to sepsis and even death. Especially promising is the use of the method of fluorescence spectroscopy for its diagnostics. The aim of the research is to create a pathogenetic concept as the basis of a diagnostic and treatment model of purulent-inflammatory diseases and sepsis. Material and methods: The study lasted from 2001 to 2019 and included 4 stages. The experimental base of luminescent research at all stages was the luminescence laboratory of the Department of Experimental Physics of the Ivan Franko National University of Lviv. The study was performed by using optical monochromators MDR-2 and MDR-12. The excitation of the blood serum was performed with light with a wavelength of 280 nm, which corresponds to the glow region of human serum albumin. Results: The main indicators, used for the analysis, were the fluorescence intensity (IF) and the position of the maximum fluorescence band (λmax). The object of the study was samples of the blood serum of patients of the main and control groups. In the case of the presence of endogenous intoxication in the body, albumin binding centers are blocked by the products of bacterial metabolism and therefore such “pathological” albumin is unable to perform its functions, including transport and detoxification. Conclusions: The pathogenetic concept as the basis of the diagnostic and treating model of purulent-inflammatory diseases and sepsis was devised. In particular, the important role of albumin solution infusion in the treatment of the above-mentioned diseases was established.

Supramolecular hybrid hydrogels as rapidly on-demand dissoluble,self-healing,and biocompatible burn dressings

Despite decades of efforts,state-of-the-art synthetic burn dressings to treat partial-thickness burns are still far from ideal.Current dressings adhere to the wound and necessitate debridement.This work describes the first“supramolecular hybrid hydrogel(SHH)”burn dressing that is biocompatible,self-healable,and on-demand dissoluble for easy and trauma-free removal,prepared by a simple,fast,and scalable method.These SHHs leverage the interactions of a custom-designed cationic copolymer via host-guest chemistry with cucurbit[7]uril and electrostatic interactions with clay nanosheets coated with an anionic polymer to achieve enhanced mechanical properties and fast on-demand dissolution.The SHHs show high mechanical strength(>50 kPa),self-heal rapidly in~1 min,and dissolve quickly(4-6 min)using an amantadine hydrochloride(AH)solution that breaks the supramolecular interactions in the SHHs.Neither the SHHs nor the AH solution has any adverse effects on human dermal fibroblasts or epidermal keratinocytes in vitro.The SHHs also do not elicit any significant cytokine response in vitro.Furthermore,in vivo murine experiments show no immune or inflammatory cell infiltration in the subcutaneous tissue and no change in circulatory cytokines compared to sham controls.Thus,these SHHs present excellent burn dressing candidates to reduce the time of pain and time associated with dressing changes.

Xuebijing Injection(血必净注射液)Increases Early Survival Rate by Alleviating Pulmonary Vasopermeability in Rats Subjected to Severe Burns

Objective： To investigate the effects of Xuebijing Injection（血必净注射液, XBJ） on survival rate and pulmonary vasopermeability in a rat model of severe scald injury. Methods： Rats were divided into two experiments： experiment 1 was monitored for 12 h post-injury for survival analysis after severe burns; in experiment 2, rats were killed for determination of pulmonary vascular permeability and pro-inflammatory mediators. In both experiments, rats were subject to third-degree 50% total body surface area（TBSA） burns or sham injury followed by XBJ or normal saline（NS） treatment. In addition, rat pulmonary microvascular endothelium cells（PMECs） were pretreated with either XBJ or phosphate buffer saline（PBS）, and then subjected to sham serum or scald serum stimulation for 2 or 6 h, followed by transwell examination for the permeability of PMECs. Meanwhile, pro-inflammatory mediators in PMECs culture supernatant were also investigated. Results： The average survival time in the scald＋XBJ group was 582.1±21.2 min, which was significantly longer than that in the scald ＋ NS group（345.8±25.4 min, P〈0.01）. Plasma levels of tumor necrosis factor-alpha（TNF-α）, E-selectin, interleukin-6（IL-6）, vascular permeability and water content of lung tissues were significantly increased in animals after severe burns（P〈0.01）. However, administration of XBJ significantly decreased these levels in plasma and lung tissue. In in vitro cell experiments, XBJ markedly attenuated permeability in PMECs monolayer and reduced the levels of TNF-α, IL-6 and soluble E-selectin after stimulation with scald serum（P〈0.01）. Conclusions： XBJ increases early survival rate by alleviating pulmonary vasopermeability and inhibiting pro-inflammatory mediators in rats subjected to lethal scald injury. XBJ may be a potent drug in treatment of severe burns.

Perceptions and experiences of female burn survivors with facial disfigurement

Purpose This study aimed at exploring the perceptions and experiences of female burn survivors with facial disfigurement in Pakistan.Methods Two different quantitative and qualitative studies were conducted,of which the data were collected from 100 burn patients.A pilot interview protocol was developed.An indepth interview of five female burn survivors with facial disfigurement was taken in Lahore,Pakistan.The transcripts were analyzed using thematic analysis and four major themes were identified,respectively physical appearance,posttraumatic growth,relationships and coping strategies.Results Thematic analysis reflected differences in attributional style,perceptions and individual experiences of female burn survivors with facial disfigurement.The study showed the importance of physical appearance for different burn survivors and how their life had changed after suffering from a burn injury.Conclusion It could be easy to have a positive outlook towards life and accept visible differences post injury for the burn survivors,who are grateful for life,get a strong family support and have available resources.On the contrary,with low self-esteem,lack of a family support and available resources,patients would be dissatisfied with their life.

Venous thromboembolism prophylaxis practice and its association with outcomes in Australia and New Zealand burns patients

Background:Patients with burn injuries are considered to have an increased risk of venous thromboembolism(VTE).While untreated VTEs can be fatal,no studies have examined chemoprophylaxis effectiveness.This study aimed to quantify the variation in prevalence of VTE prophylaxis use in patients in Australian and New Zealand burns units and whether prophylaxis use is associated with in-hospital outcomes following burn injury.Methods:Admission data for adult burns patients(aged≥16 years)admitted between 1 July 2016 and 31 December 2018 were extracted from the Burns Registry of Australia and New Zealand.Mixed effects logistic regression modelling investigated whether VTE prophylaxis usewas associated with the primary outcome of in-hospital mortality.Results:There were 5066 admissions over the study period.Of these patients,81%(n=3799)with a valid response to the VTE prophylaxis data field received some form of VTE prophylaxis.Use of VTE prophylaxis ranged from 48.6%to 94.8%of patients between units.In-hospital death was recorded in<1%of patients(n=33).After adjusting for confounders,receiving VTE prophylaxis was associated with a decrease in the adjusted odds of in-hospital mortality(adjusted odds ratio=0.21;95%CI,0.07–0.63;p=0.006).Conclusions:Variation in the use of VTE prophylaxis was observed between the units,and prophylaxis use was associated with a decrease in the odds of mortality.These findings provide an opportunity to engage with units to further explore differences in prophylaxis use and develop future best practice guidelines.

A sandwich structure composite wound dressing with firmly anchored silver nanoparticles for severe burn wound healing in a porcine model

Wounds may remain open for a few weeks in severe burns,which provide an entry point for pathogens and microorganisms invading.Thus,wound dressings with long-term antimicrobial activity are crucial for severe burn wound healing.Here,a sandwich structure composite wound dressing anchored with silver nanoparticles(AgNPs)was developed for severe burn wound healing.AgNPs were in situ synthesized on the fibers of chitosan nonwoven fabric(CSNWF)as the interlayer of wound dressing for sustained release of silver ion.The firmly anchored AgNPs could prevent its entry into the body,thereby eliminating the toxicity of nanomaterials.The outer layer was a polyurethane membrane,which has a nanoporous structure that could maintain free transmission of water vapor.Chitosan/collagen sponge was selected as the inner layer because of its excellent biocompatibility and biodegradability.The presence of AgNPs in the CSNWF was fully characterized,and the high antibacterial activity of CSNWF/AgNPs was confirmed by against Escherichia coli,Pseudomonas aeruginosa and Staphylococcus aureus.The superior wound healing effect on deep dermal burns of presented composite wound dressing was demonstrated in a porcine model.Our finding suggested that the prepared AgNPs doped sandwich structure composite wound dressing has great potential application in severe wound care.

The contradictory role of androgens in cutaneous and major burn wound healing

Wound healing is a complex process involving four overlapping phases:haemostasis,inflammation,cell recruitment and matrix remodeling.In mouse models,surgical,pharmacological and genetic approaches targeting androgen actions in skin have shown that androgens increase interleukin-6 and tumor necrosis factor-αproduction and reduce wound re-epithelization and matrix deposition,retarding cutaneous wound healing.Similarly,clinical studies have shown that cutaneous wound healing is slower in men compared to women.However,in major burn injury,which triggers not only local wound-healing processes but also systemic hypermetabolism,the role of androgens is poorly understood.Recent studies have claimed that a synthetic androgen,oxandrolone,increases protein synthesis,improves lean body mass and shortens length of hospital stay.However,the possible mechanisms by which oxandrolone regulates major burn injury have not been reported.In this review,we summarize the current findings on the roles of androgens in cutaneous and major burn wound healing,as well as androgens as a potential therapeutic treatment option for patients with major burn injuries.

Burn recidivism:a 10-year retrospective study characterizing patients with repeated burn injuries at a large tertiary referral burn center in the United States

Background:Psychiatric and substance use disorders are common among trauma and burn patients and are known risk factors for repeat episodes of trauma,known as trauma recidivism.The epidemiology of burn recidivism,specifically,has not been described.This study aimed to characterize cases of burn recidivism at a large US tertiary care burn center and compare burn recidivists(RCs)with non-recidivists(NRCs).Methods:A 10-year retrospective descriptive cohort study of adult burn patients admitted to the North Carolina Jaycee Burn Center was conducted using data from an electronic burn registry and the medical record.Continuous variables were reported using medians and interquartile ranges(IQR).Chi-square and Wilcoxon-Mann-Whitney tests were used to compare demographic,burn,and hospitalization characteristics between NRCs and RCs.Results:A total of 7134 burn patients were admitted,among which 51(0.7%)were RCs and accounted for 129(1.8%)admissions.Of the 51 RCs,37 had two burn injuries each,totaling 74 admissions as a group,while the remaining 14 RCs had between three and eight burn injuries each,totaling 55 admissions as a group.Compared to NRCs,RCs were younger(median age 36 years vs.42 years,p=0.02)and more likely to be white(75%vs.60%,p=0.03),uninsured(45%vs.30%,p=0.02),have chemical burns(16%vs.5%,p<0.0001),and have burns that were≤10%total body surface area(89%vs.76%,p=0.001).The mortality rate for RCs vs.NRCs did not differ(0%vs.1.2%,p=0.41).Psychiatric and substance use disorders were approximately five times greater among RCs compared to NRCs(75%vs.15%,p<0.001).Median total hospital charges per patient were nearly three times higher for RCs vs.NRCs($85,736 vs.$32,023,p<0.0001).Conclusions:Distinct from trauma recidivism,burn recidivism is not associated with more severe injury or increased mortality.Similar to trauma recidivists,but to a greater extent,burn RCs have high rates of comorbid psychiatric and medical conditions that contribute to increased health care utilization and costs.Studies involving larger samples from multiple centers can further clarify whether these findings are generalizable to national burn and trauma populations.