bluuebunny/crossref_metadata_2025 huggingface dataset:
Biophysical characterisation of DNA origami nanostructures reveals inaccessibility to intercalation binding sites
Authors: Miller Helen L , Contera Sonia , Wollman Adam J M , Hirst Adam , Dunn Katherine E , Schröter Sandra , O’Connell Deborah , Leake Mark C
Published: March 2020

Intercalation of drug molecules into synthetic DNA nanostructures formed through self-assembled origami has been postulated as a valuable future method for targeted drug delivery. This is due to the excellent biocompatibility of synthetic DNA nanostructures, and high potential for flexible programmability including facile drug release into or near to target cells. Such favourable properties may enable high initial loading and efficient release for a predictable number of drug molecules per nanostructure carrier, important for efficient delivery of safe and effective drug doses to minimise non-specific release away from target cells. However, basic questions remain as to how intercalation-mediated loading depends on the DNA carrier structure. Here we use the interaction of dyes YOYO-1 and acridine orange with a tightly-packed 2D DNA origami tile as a simple model system to investigate intercalation-mediated loading. We employed multiple biophysical techniques including single-molecule fluorescence microscopy, atomic force microscopy, gel electrophoresis and controllable damage using low temperature plasma on synthetic DNA origami samples. Our results indicate that not all potential DNA binding sites are accessible for dye intercalation, which has implications for future DNA nanostructures designed for targeted drug delivery.
Cyclotron radiation emission spectroscopy signal classification with machine learning in project 8
Authors: Esfahani A Ashtari , Böser S , Buzinsky N , Cervantes R , Claessens C , Viveiros L de , Fertl M , Formaggio J A , Gladstone L , Guigue M , Heeger K M , Johnston J , Jones A M , Kazkaz K , LaRoque B H , Lindman A , Machado E , Monreal B , Morrison E C , Nikkel J A , Novitski E , Oblath N S , Pettus W , Robertson R G H , Rybka G , Saldaña L , Sibille V , Schram M , Slocum P L , Sun Y-H , Thümmler T , VanDevender B A , Weiss T E , Wendler T , Zayas E
Published: March 2020

The cyclotron radiation emission spectroscopy (CRES) technique pioneered by Project 8 measures electromagnetic radiation from individual electrons gyrating in a background magnetic field to construct a highly precise energy spectrum for beta decay studies and other applications. The detector, magnetic trap geometry and electron dynamics give rise to a multitude of complex electron signal structures which carry information about distinguishing physical traits. With machine learning models, we develop a scheme based on these traits to analyze and classify CRES signals. Proper understanding and use of these traits will be instrumental to improve cyclotron frequency reconstruction and boost the potential of Project 8 to achieve world-leading sensitivity on the tritium endpoint measurement in the future.
Experimental investigation of the effect of processing parameters on densification, microstructure and hardness of selective laser melted 7075 aluminium alloy
Authors: O E Oko , C Mbakaan , E Barki
Published: March 2020

The 7075 aluminum alloy of the 7xxx series largely used for structures in modern aircraft has been successfully fabricated using selective laser melting (SLM) technology. The morphology of the initial 7075 aluminum alloy powders was characterized by a Zeiss Evo 50 Scanning electron microscope (SEM). Energy Dispersive x-ray (EDX) spectrometer attached to SEM was used as a tool to obtain the chemical composition of the powders. Processing parameters including scan speed, hatch distance and constant laser power (100 and 150 W) effect on densification, microstructure and hardness were investigated. The initial powder particles were found to be elongated and non-spherical and composed of Al, Zn, Mg, Cu, and Ag without Si. The result of the influence of processing parameters on properties of the as-built samples by SLM technology indicates that higher densification of parts can be gained using higher laser power and lower laser scan speed and hatch distance due to significant reduction in the number of pores. Two major types of pores including metallurgical and keyhole pores have been identified with the keyhole pores dominating the samples processed by low laser power of 100 W. The keyhole pores increase in size at a high scan speed and hatch distances. By using higher laser power of 150 W, the keyhole pores reduced significantly while metallurgical pores appear. The result of the hardness test conducted on the samples shows that high values of hardness can be achieved with low scan speed.
Functional composition and diversity of leaf traits in subalpine versus alpine vegetation in the Apennines
Authors: Stanisci Angela , Bricca Alessandro , Calabrese Valentina , Cutini Maurizio , Pauli Harald , Steinbauer Klaus , Carranza Maria Laura
Published: March 2020

Mediterranean high mountain grasslands are shaped by climatic stress and understanding their functional adaptations can contribute to better understanding ecosystems’ response to global change. The present work analyses the plant functional traits of high-elevation grasslands growing in Mediterranean limestone mountains to explore, at the community level, the presence of different plant strategies for resource use (conservative vs. acquisitive) and functional diversity syndromes (convergent or divergent). Thus, we compared the functional composition and diversity of the above-ground traits related to resource acquisition strategies of subalpine and alpine calcareous grasslands in the central Apennines, a mountain region characterized by a dry-summer Mediterranean climate. We used georeferenced vegetation plots and field-measured plant functional traits (plant maximum height, specific leaf area and leaf dry matter content) for the dominant species of two characteristic vegetation types: the subalpine Sesleria juncifolia community and the alpine Silene acaulis community. Both communities are of particular conservation concern and are rich in endemic species for which plant functional traits are measured here for the first time. We analysed the functional composition and diversity using the community-weighted mean trait index and the functional diversity using Rao’s function, and we assessed how much the observed pattern deviated from a random distribution by calculating the respective standardized effect sizes. The results highlighted that an acquisitive resource use strategy and relatively higher functional diversity of leaf traits prevail in the alpine S. acaulis community, optimizing a rapid carbon gain, which would help overcome the constraints exerted by the short growing season. The divergent functional strategy underlines the co-occurrence of different leaf traits in the alpine grasslands, which shows good adaptation to a microhabitat-rich environment. Conversely, in the subalpine S. juncifolia grassland, a conservative resource use strategy and relatively lower functional diversity of the leaf traits are likely related to a high level resistance to aridity over a longer growing season. Our outcomes indicate the preadaptation strategy of the subalpine S. juncifolia grassland to shift upwards to the alpine zone that will become warmer and drier as a result of anthropogenic climate change.
nanoTRON: a Picasso module for MLP-based classification of super-resolution data
Authors: Auer Alexander , Strauss Maximilian T , Strauss Sebastian , Jungmann Ralf
Published: March 2020

Motivation

Classification of images is an essential task in higher-level analysis of biological data. By bypassing the diffraction limit of light, super-resolution microscopy opened up a new way to look at molecular details using light microscopy, producing large amounts of data with exquisite spatial detail. Statistical exploration of data usually needs initial classification, which is up to now often performed manually.

Results

We introduce nanoTRON, an interactive open-source tool, which allows super-resolution data classification based on image recognition. It extends the software package Picasso with the first deep learning tool with a graphic user interface.

Availability and implementation

nanoTRON is written in Python and freely available under the MIT license as a part of the software collection Picasso on GitHub (http://www.github.com/jungmannlab/picasso). All raw data can be obtained from the authors upon reasonable request.

Contact

jungmann@biochem.mpg.de

Supplementary information

Supplementary data are available at Bioinformatics online.
A graph regularized generalized matrix factorization model for predicting links in biomedical bipartite networks
Authors: Zhang Zi-Chao , Zhang Xiao-Fei , Wu Min , Ou-Yang Le , Zhao Xing-Ming , Li Xiao-Li
Published: March 2020

Motivation

Predicting potential links in biomedical bipartite networks can provide useful insights into the diagnosis and treatment of complex diseases and the discovery of novel drug targets. Computational methods have been proposed recently to predict potential links for various biomedical bipartite networks. However, existing methods are usually rely on the coverage of known links, which may encounter difficulties when dealing with new nodes without any known link information.

Results

In this study, we propose a new link prediction method, named graph regularized generalized matrix factorization (GRGMF), to identify potential links in biomedical bipartite networks. First, we formulate a generalized matrix factorization model to exploit the latent patterns behind observed links. In particular, it can take into account the neighborhood information of each node when learning the latent representation for each node, and the neighborhood information of each node can be learned adaptively. Second, we introduce two graph regularization terms to draw support from affinity information of each node derived from external databases to enhance the learning of latent representations. We conduct extensive experiments on six real datasets. Experiment results show that GRGMF can achieve competitive performance on all these datasets, which demonstrate the effectiveness of GRGMF in prediction potential links in biomedical bipartite networks.

Availability and implementation

The package is available at https://github.com/happyalfred2016/GRGMF.

Contact

leouyang@szu.edu.cn

Supplementary information

Supplementary data are available at Bioinformatics online.
‘How can the governance of communities that care interventions be enhanced by understandings of community development?’: a case study in rural Australia
Authors: Downey Heather , Threlkeld Guinever
Published: March 2020

Communities That Care (CTC) is an evidence-based social development strategy that uses a structured process of intervention based on the evidence about risk and protective factors in communities. CTC uses particular governance groups as central instruments in a process that aims to build the capacity of communities to enhance the lives of young people. This article reports findings from a formal evaluation which used a collaborative governance lens to examine governance of the application of CTC in a small rural Australian community. Specifically, the evaluation focussed on the perspectives of members of the governance structures concerning CTC’s operation and value at the interstice of youth and rural disadvantage. Findings suggest the potential within CTC to achieve sustainable community change may be enhanced through an endogenous governance approach that recognizes and develops community residents’ potential for leadership. The CTC strategy is now utilized internationally. This article offers important insights for practitioners, organizations and communities considering implementing this approach.
Chromatographic Fingerprint Analysis of Radix Hedysari Using Supercritical Fluid Chromatography Coupled with Diode Array Detector
Authors: Wang Bo , Liu Xiaohua , Xue Zhiyuan , Yang Xiuyan , Fang Yaoyao , Zhao Lianggong , Feng Shilan
Published: March 2020

A newly and rapid supercritical fluid chromatography method for the simultaneous determination of 11 active compounds in Radix Hedysari samples has been developed and validated. Optimum separation was achieved on a HSS SB C18 column with a gradient elution at a flow rate of 1.5 mL/min, back pressure of 11.03 Mpa and diode array detector at 260 nm. The results from the quantitative data showed that contents of these 11 active compounds were different from plant regions. Especially the contents of formononetin in the Minxian county are ~6-fold than in wild Radix Hedysari. The chromatographic fingerprint of Radix Hedysari was recorded under the same chromatographic condition. Data analytic procedure was performed to differentiate the 25 batches of Radix Hedysari samples. Data from chromatographic fingerprint were also analyzed using hierarchical cluster analysis. The results showed that 23 batches of Radix Hedysari samples had a high similarity (> 0.90) and overall 25 batches of sample were divided into two clusters. Moreover, according to the comparison contents of active compounds in each Radix Hedysari samples, the cultivated location of Radix Hedysari was successfully distinguished. This method presented good stability, repeatability and precision and would be a useful and reliable approach for the quality control of Radix Hedysari. Moreover, all target compounds were quantified by ultra-high performance liquid chromatography–time-of-flight mass spectrometry.
Multimode multioffset phase analysis of surface waves, a new approach to extend MOPA to higher modes
Authors: Barone I , Strobbia C , Cassiani G
Published: March 2020

Multioffset phase analysis (MOPA) is a fairly recent technique for evaluating seismic surface wave dispersion and estimating the presence of lateral variations. The main limitation of MOPA is that it is based on the assumption of one predominant mode, usually the fundamental mode, in the wave propagation. However, MOPA can be extended (at least) to the two-mode case: this new technique will be called multimode MOPA (MMMOPA). The method employs both amplitude and phase spectral information. The analysis is performed for each frequency independently. The presence of two modes causes the amplitude to have an oscillating behaviour as a function of offset (beats): the spatial period of the oscillating amplitude is identified, amplitude maxima and minima are extracted, and the local wavenumber is computed via linear regression. The resulting multimodal dispersion curve is consequently derived. Model uncertainties can be estimated by propagating the experimental phase and amplitude error variances through the different steps of the analysis all the way to the final phase velocities. An algorithm running the process in an automatic way has been implemented and tested on both synthetic and real data, with success. This is the base for future developments that, in the MOPA framework, can take into account rapid lateral velocity variations within the same acquisition window and estimate the modal absorption, for the estimation of the damping ratio, even in the presence of multimode surface wave propagation.
Efficient spatial-spectral computation of local planar gravimetric terrain corrections from high-resolution digital elevation models
Authors: Goyal R , Featherstone W E , Tsoulis D , Dikshit O
Published: March 2020

Computation of gravimetric terrain corrections (TCs) is a numerical challenge, especially when using very high-resolution (say, ∼30 m or less) digital elevation models (DEMs). TC computations can use spatial or/and spectral techniques: Spatial domain methods are more exact but can be very time-consuming; the discrete/fast Fourier transform (D/FFT) implementation of a binomial expansion is efficient, but fails to achieve a convergent solution for terrain slopes >45°. We show that this condition must be satisfied for each and every computation-roving point pair in the whole integration domain, not just at or near the computation points. A combination of spatial and spectral methods has been advocated by some through dividing the integration domain into inner and outer zones, where the TC is computed from the superposition of analytical mass-prism integration and the D/FFT. However, there remain two unresolved issues with this combined approach: (1) deciding upon a radius that best separates the inner and outer zones and (2) analytical mass-prism integration in the inner zone remains time-consuming, particularly for high-resolution DEMs. This paper provides a solution by proposing: (1) three methods to define the radius separating the inner and outer zones and (2) a numerical solution for near-zone TC computations based on the trapezoidal and Simpson's rules that is sufficiently accurate w.r.t. the exact analytical solution, but which can reduce the computation time by almost 50 per cent.
Theoretical conceptions of intervention research addressing cancer control issues
Authors: Dupin Cécile-Marie , Estaquio Carla , Nabi Hermann
Published: March 2020

Population health intervention research (PHIR) involves the use of scientific methods to produce knowledge about policy and program interventions that operate within or outside of the health sector and have the potential to impact health at the population level. PHIR is a relatively new research field that has gained momentum internationally. When developing PHIR, it is important to have a program theory with the potential to increase intervention success by identifying underlying mechanisms, areas of failure and unintended outcomes. Since 2010, the French National Cancer Institute (Institut National du Cancer—INCa) has supported a national, competitive, dedicated call for proposals in PHIR to tackle cancer control issues. After 5 years of activity, specific analysis of the proposals submitted for funding and/or funded (n = 63) from descriptive and analytic perspectives was called for. Analysis of the data revealed diversity in terms of targeted populations, partnerships engaged and methodological approaches. Projects were more likely to be funded (n = 15) if presented with a robust methodological approach and diversity in methodology, and/or with research objectives at different levels of action. The analysis also revealed that researchers do not explicitly describe theoretical constructs underpinning their interventions to combat cancer. PHIR still needs improvement to better incorporate social, institutional and policy approaches to cancer control. Researchers should apply a theory-driven approach to distinguish between ‘program failure’ and ‘theory failure’. Following up the funded projects will allow successes and failures to be evaluated with respect to the use (or non-use) of theory-driven approaches.
A Phylogenetic Analysis of Hepatitis C Virus Transmission, Relapse, and Reinfection Among People Who Inject Drugs Receiving Opioid Agonist Therapy
Authors: Akiyama Matthew J , Lipsey Daniel , Ganova-Raeva Lilia , Punkova Lili T , Agyemang Linda , Sue Amanda , Ramachandran Sumathi , Khudyakov Yury , Litwin Alain H
Published: March 2020

Background

Understanding hepatitis C virus (HCV) transmission among people who inject drugs (PWID) is essential for HCV elimination. We aimed to differentiate reinfections from treatment failures and to identify transmission linkages and associated factors in a cohort of PWID receiving opioid agonist therapy (OAT).

Methods

We analyzed baseline and follow-up specimens from 150 PWID from 3 OAT clinics in the Bronx, New York. Next-generation sequencing data from the hypervariable region 1 of HCV were analyzed using Global Hepatitis Outbreak and Surveillance Technology.

Results

There were 3 transmission linkages between study participants. Sustained virologic response (SVR) was not achieved in 9 participants: 7 had follow-up specimens with similar sequences to baseline, and 2 died. In 4 additional participants, SVR was achieved but the participants were viremic at later follow-up: 2 were reinfected with different strains, 1 had a late treatment failure, and 1 was transiently viremic 17 months after treatment. All transmission linkages were from the same OAT clinic and involved spousal or common-law partnerships.

Conclusion

This study highlights the use of next-generation sequencing as an important tool for identifying viral transmission and to help distinguish relapse and reinfection among PWID. Results reinforce the need for harm reduction interventions among couples and those who report ongoing risk factors after SVR.
T2 Safety of Early Post-operative Range of Motion in Burn Patients with Newly Placed Hand Autografts
Authors: Dewey William S , Cunningham Kyle B , Shingleton Sarah K , Pruskowski Kaitlin A , Welsh Ashley M , Rizzo Julie A
Published: March 2020

Introduction

Patients who suffer hand burns are at a high risk for developing contractures, partly due to the presence of numerous cutaneous functional units, or contracture risk areas, located within the hand.

Patients who undergo split-thickness skin grafting (STSG) are often immobilized post-operatively for graft protection. Restricting mobility following a STSG is thought to protect against subdermal edema and shear forces, despite limited evidence.

Early range of motion (EROM) has been described previously. Recent practice at our burn center includes EROM following hand STSG to limit unnecessary immobilization. The purpose of this retrospective study was to determine if EROM is safe to perform after hand STSG and if there is any clinical benefit.

Methods

In an approved, retrospective, matched case-control study of adult patients who sustained hand burns, patients who received EROM were defined as cases; patients who did not receive EROM were considered controls and received the standard 3–5 days of post-operative immobilization in a resting hand splint. Adult patients admitted over a 3-year period were eligible for inclusion. Patients were evaluated for graft loss and range of motion.

Results

Seventy-two patients were included in this study; 37 EROM patients and 35 matched controls. EROM patients tended to have a larger area excised (170.4 ± 69.8cm2 vs. 132.9 ± 76.2cm2; p=0.034) and grafted (171 ± 70.8 cm2 vs. 132.9 ± 76.2 cm2; p=0.033).

Most patients were male, with an average age of 39 years. Patients had an average of approximately 5% TBSA burns with 1.5% to the hands. On post-op day (POD) 1 and 2, patients received EROM for an average of 30 minutes (29.25 ± 14.9 vs. 31 ± 16.4 minutes).

Six patients experienced minor graft loss. Three patients (8%) experienced graft loss not attributable to EROM. One patient (2.7%) experienced graft loss pre-EROM on POD2 and 3 patients (8%) experienced graft loss post-EROM on either POD1 or POD2. All graft loss was less than 1 cm in greatest dimension and no patient who experienced graft loss required additional surgery as they all closed by their first outpatient follow-up. Significantly more patients who received EROM achieved full digital flexion by the first outpatient visit (25/27=92.6% vs. 15/22=68.2%; p=0.028).

Conclusions

Performing EROM does not cause an increase in graft loss. All areas of graft loss from the EROM group healed without intervention. There appears to be a benefit to EROM since there was a significant improvement in the patients’ ability to make a full fist at initial outpatient follow up. Further prospective analysis is needed to examine the true clinical utility of EROM in the hand and other contracture-prone areas.

Applicability of Research to Practice

Clinical change in post-operative management after hand grafting.
1 The Impact of No Next of Kin Decision Makers on End-of-life Care
Authors: Ota Ryan K , Johnson Maxwell B , Pickering Trevor A , Garner Warren L , Gillenwater Justin , Yenikomshian Haig A
Published: March 2020

Introduction

For critically ill burn patients without a next of kin (NOK), the medical team is tasked with becoming the surrogate decision maker. This poses difficult ethical and legal challenges for burn providers. Despite this frequent problem, there has been no investigation of how the presence of a NOK affects treatment in burn patients. This study is the first to evaluate this relationship.

Methods

A retrospective chart review was performed on a cohort of patients who died during the acute phase of their burn care from a single burn center from 2015 to 2019. Inclusion criteria were age ≥18 years and mortality within 4-weeks of admission. Exclusion criteria were death from dermatologic disease or trauma. Variables collected included age, gender, mechanism of injury, length of stay (LOS), total body surface area (TBSA), revised Baux score, and the presence of a NOK. Fisher’s Exact Test and Student’s t-test were used for analysis.

Results

In total, 67 patients met inclusion criteria. Of these patients, 14 (21%) did not have a NOK involved in medical decisions. Table 1 shows the means and odds ratio between the two groups. Patients without a NOK were younger (p < 0.05), more likely to be homeless (p < 0.01), had higher TBSA (p < 0.01), had shorter LOS (p < 0.01), and were 5 times less likely to receive comfort care (p < 0.05). Gender and ethnicity were not statistically significant.

Conclusions

Patients without a NOK present to participate in medical decisions are transitioned to comfort care less often despite having a higher burden of injury. This disparity in standard of care between the two groups demonstrates a need for a cultural shift in burn care to prevent suffering of these marginalized patients. Burn providers should be empowered to reduce suffering when no decision maker is present.

Applicability of Research to Practice

We report that the absence of a NOK has a significant impact leading to a decreased initiation of comfort care in critically ill burn patients. National protocols should be created to allow burn providers to act as a surrogate to prevent prolonged suffering.
10 Hypoglycemic Episodes Predict Length of Stay in Patients with Acute Burns
Authors: Pham Christopher H , Vrouwe Sebastian Q , Tsai Karen , Collier Zachary J , Grote Andrea C , Angell Trevor E , Garner Warren L , Gillenwater Justin , Yenikomshian Haig A
Published: March 2020

Introduction

Hypoglycemic episodes are associated with worse hospital outcomes, and their incidence varies by institution. We sought to define the prevalence of hypoglycemic episodes at our burn center and determine their association with hospital outcomes.

Methods

We retrospectively reviewed all consecutive adult and pediatric patients admitted to our burn center from 2015 to 2019. Patient demographics and burn characteristics were recorded. The primary outcome was mortality, and secondary outcomes were total length of stay (LOS) and intensive care unit LOS (ICU LOS). All patients experiencing hypoglycemic episodes were compared to patients who did not experience hypoglycemic episodes (controls) using two-tailed t, chi-squared, and multivariate logistic and multiple linear regression analyses.

Results

A total of 914 patients with acute burns were admitted during the study period. Thirty-three patients (4%) experienced hypoglycemic episodes (< 60 mg/dL). Of these, 17 patients (52%) experienced a single hypoglycemic episode, while the remainder (N=16) experienced multiple hypoglycemic episodes. There were no significant differences in age, sex, or presence of inhalation injury between hypoglycemic patients and controls. Patients that experienced a hypoglycemic episode had significantly greater TBSA involvement (23% vs. 11%, p< 0.00), higher prevalence of diabetes (48% vs. 20%, p< 0.00), higher mortality (18% vs. 7%, p=0.01), longer total LOS (39 vs. 13 days, p< 0.00), and longer ICU LOS (28 vs. 4 days, p< 0.00). A single hypoglycemic episode was associated with prolonging total LOS by 19 days (p< 0.00) and ICU LOS by 18 days (p< 0.00). Hypoglycemic episodes were not associated with higher odds of mortality (OR=0.9, 95% CI 0.3–3.0, p >0.05).

There were no differences in outcomes between patients with single or multiple hypoglycemic episodes. Patients with multiple hypoglycemic episodes more frequently had a history of diabetes (81% vs. 18%, p< 0.00), and worse glucose control (HbA1c, 9% vs. 7%, p=0.04) compared to patients with single episodes.

Conclusions

Hypoglycemic episodes were associated with longer total and ICU LOS in our study but did not portend higher mortality.

Applicability of Research to Practice

Quality improvement efforts to prevent hypoglycemic episodes should focus efforts on known diabetics with high HbA1c levels.
43 Activation of CCL2/CCR2 Signaling Axis Is Responsible for Spinal Cord Inflammation and Loss of Muscle Mass in Mice After Burn Injury
Authors: Khan Mohammed A , Sakuma Miyuki , Yasuhara Shingo , Ma Li , Chen Jingyuan , Palaniyar Nades , Martyn Jeevendra , Ren Yang
Published: March 2020

Introduction

Burn-induced systemic inflammation (BISI) can induce inflammatory responses in peripheral nervous system and also cause neuroinflammation in the central nervous system, leading to morbidity and mortality. The mechanisms of neuromotor impairment involving CCL2/CCR2 signaling axis are largely unknown. We hypothesized that BISI causes neuroinflammation in the spinal cord, and this inflammatory response can lead to motor neuronal damage, disintegration of nerve termini and eventually muscle wasting.

Methods

Cytokines/chemokines were estimated by Cytokine Antibody Array. Nerve termini and muscle fibers in abdominal muscle, and motor neuronal apoptosis in the spinal cord were analyzed by fluorescent microscopy and immunochemical analyses.

Loss of muscle mass was assessed by wet weight of the muscles compared with control in mice after BISI.

Results

Our data showed that CCL2 was significantly increased in the serum (>2.4 fold) at day 1 and 3 after BISI in vivo. Iin the extracellular medium (>2.0 fold) of organotypic spinal cord explant after exposure to exogenous histones ex vivo at day1. Neuroinflammation in the spinal cord after BISI caused motor neuronal apoptosis, nerve termini disintegration, and loss of muscle mass of soleus (63.4 + 5.1%), tibialis (72.3 + 2.7%) and gastrocnemius (70.2 + 1.1%) compared to sham burn injured wild-type (WT) or YFP-neurons expressing transgenic mice. In contrast, GTS-21 reduced neuroinflammation and significantly prevented loss of muscle mass of soleus (86.8 + 0.2%), tibialis (85.4 + 4.5%) and gastrocnemius (89.0 + 4.0%). Depletion of macrophages by PBS-liposomes in burned mice showed transmigration of CCR2-containing monocytes-derived macrophages (CCR2-MDMΦ) in the ventral horn of the spinal cord, and led to the loss of all three muscles (soleus, 62.4 + 2.6%; tibialis, 86.3 + 3.5; gastrocnemius, 81.4 + 1.7%). Nevertheless, depletion of macrophages by Clophosomes in burned mice inhibited the transmigration of CCR2-MDMΦ, and protected muscle mass (soleus, 96.6 + 3.9%; tibialis, 101 + 3.9%; gastrocnemius, 98.3 + 1.2%) significantly. Subsequently, we demonstrated that the knocking out of CCR2 gene in mice protected motor neuronal apoptosis and inhibited loss of muscle mass of soleus, tibialis and gastrocnemius from 63.4 + 5.1%, 72.3 + 2.7% and 70.2 + 1.1% in WT mice to 82.1 + 4.7%, 85.4 + 4.5% and 95.8 + 3.2% in CCR2KO mice, respectively, after BISI.

Conclusions

Collectively, these results suggest activated macrophages creep to the spinal cord through CCL2/CCR2 signaling axis after BISI to cause neuroinflammation, leading to motor neuronal damage, nerve disintegration and muscle wasting.

Applicability of Research to Practice

These findings will be useful to understand the pathology occurring in burned patients and to develop the therapeutics measures to protect them from BISI.
49 Indocyanine Green Angiography in the Surgical Evaluation of Partial Thickness Burn Wounds
Authors: Mulay Sagar , Klein Gabriel , Dagum Alexander , Sandoval Steven , Borrero Michael
Published: March 2020

Introduction

While treatment of 1st and 3rd degree burns is fairly well understood, second-degree burns pose a challenge. This can lead to delayed treatment, or unnecessary operations, either of which can lead to scarring, contractures, infections, and poor cosmetic outcomes. While Laser Doppler Imaging has been used to differentiate second degree burns it is not reliable in studying uneven surfaces, requires long scan times, and has limited penetration. ICG angiography, which has gained wide use in breast reconstruction, can circumvent many of these issues. In this study, we used ICG angiography to investigate 2nd degree burns in an effort to develop an objective measure to differentiate deep from superficial 2nd degree burns.

Methods

All patients with 2nd degree burns covering greater than 1% total body surface and consented to the study were enrolled. Exclusion criteria included iodide allergy and the inability to follow up. All burns presented within 48 hours of injury. Patients were evaluated with ICG imaging on presentation and re-imaged at 24-hour intervals up to 72 hours after the initial injury and at the time of excision. The patients were managed by a blinded Burn Surgeon, with follow up pictures performed at 2 weeks, 1 month, 6 months, and 1 year. All images were analyzed using software to determine if areas with different scores ended up receiving operative or conservative treatment.

Results

Thus far 6 patients have enrolled in the study. All patients presented following flash burns, with BSA ranging from 10–30%. Of the 6 patients, only one required operative treatment. For the five patients treated conservatively areas of burn presented with SPY Q readings ranging from 70–110. These readings improved universally with each subsequent image, often by 10–20 each image, although one burn was found to double its perfusion by 72 hours post-injury. In contrast, the patient requiring operative intervention presented with a SPY-Q reading of 20–30. While there was a minor improvement, the maximum reading the area of resection reached was only 40–50. The patient was eventually taken to the OR for debridement and STSG.

Conclusions

While these preliminary results are limited due to the small sample size of our population, we feel that this study demonstrates the utility of ICG angiography in the diagnosis of second-degree burns. Our previous work on a porcine model verified that SPY can be used to measure both vertical and horizontal burn progression, and our early results in this study show a sharp difference between the patients treated conservatively, and the one patient requiring operative intervention.

Applicability of Research to Practice

Using these results, we plan to develop an objective cut off that will serve as a benchmark for when operative intervention is required. And with a secondary objective to evaluate the level excision.
68 Application of the Modified Hospital Length of Stay Predictor
Authors: Dao Sylvia , Lynch Heather
Published: March 2020

Introduction

Developing formulas to predict accurate length of stay (LOS) is challenging in burn patients as many complex variables can effect LOS. A recently published article in 2016 provided new formulas (NFs) to predict hospital LOS. Our goal is to compare our patients actual LOS (ALOS) to the NFs published, the traditional 1day/%TBSA rule, and to the hospital expected LOS (ELOS) based on patients CMI/DRGs.

Methods

Data was collected from Jan ‘16 to Dec ‘18 on all patients >18 years of age using NTRACS burn registry. We excluded deaths, non-burns, readmissions, any records with missing information, and any patients transferred to another acute care hospital. We performed multiple regression to examine the relationship between LOS with age, inhalational injury (INHINJ), and TBSA on all patients. We divided this population into three groups per the NFs recommendations: 1) INHINJ; 2) without INHINJ < 40 years old; 3) without INHINJ >40 years old. Using these three groups, we calculated the difference between ALOS to 1) the traditional LOS formula, 2) the NFs as established in the 2016 article, and to 3) the hospitals ELOS metrics. For acuity comparison, we also calculated average CMI in each study group. The NFs published are as follows:

Results

The multiple regression model with all three variables (Age, % TBSA, and INHINJ) produced R² = 0.321, F(3,883) = 139.23, p < .05. INHINJ, age, and TBSA had significant positive regression, indicating an increase or presence of all three variables will lengthen LOS. The regression equation is: LOS = (-3.93) +1.71(AGE) +1.11(TBSA) +15.81 (Inhalation). Every year increase in age increased LOS by 1.71 days. Every 1% increase in TBSA increased LOS by 1.11 days. Presence of INHINJ (0= no INHINJ; 1= INHINJ) increased LOS by 15.81 days. Table 1 depicts the mean ± SD of the difference in LOS (predicted - actual) for the three predictive models of LOS. Negative values indicate underestimation of LOS and positive values indicate overestimate of LOS.

Conclusions

Application of the predictive LOS formulas has underestimated LOS in this population, with the exception of the NFs to predict LOS on patients >40 years old without INHINJ. Furthermore, an R² value of 0.32 indicates that the variables utilized in this study do not account for 68% of the variation we see. This is further exemplified by the wide standard deviations, particularly in the INHINJ group.

Applicability of Research to Practice

Directly Applicable.
119 A Nitric Oxide Releasing Bio-active Wound Dressing for Burn Wound Infection Treatment
Authors: Roy Jahnabi , Estes Lori , Christy Robert J , Handa Hitesh , Natesan Shanmugasundaram
Published: March 2020

Introduction

The future of multi-domain battlefield operation requires wound dressings to prevent infection at the point of injury. Majority of antimicrobial agents only target wound infection while other healing events are left to their natural fates. Nitric oxide (NO) acts against both gram-positive and -negative bacteria and has the potential to positively affect wound healing. In this study we have developed a novel wound dressing integrated with a NO donor - S-nitroso- glutathione (GSNO) in a hybrid formulation of alginate and poly(vinyl alcohol) (PVA) to prevent/treat burn wound infection.

Methods

The NO releasing wound dressing was fabricated using PVA, alginate, and glycerol, crosslinked with CaCl2 incorporating GSNO. Thereafter, release kinetics were measured up to 4 days. The antibacterial efficacy was determined against both P. aeruginosa and S. aureus. Then the biocompatibility of the NO wound dressing was assessed using in vitro fibroblast proliferation and wound healing assay. Finally, the efficacy of the wound dressing was assessed in vivo using a 3-cm diameter porcine burn wound infection model.

Results

The Alginate-PVA-GSNO dressing showed a desired physiological level NO flux of 4.42 × 10-10 mol cm-2 min-1 for 72 hours. Alginate−PVA−GSNO dressings showed ~3 log reduction in S. aureus and ~2 log reduction in P. aeruginosa CFU/mg when compared to control. The NO-releasing dressing improved fibroblast proliferation and migration resulting in complete closure of the wound within 48 h in vitro. The safety and efficacy of NO-releasing dressing were successfully established in the both P. aeruginosa and S. aureus infected porcine burn wounds. Histological assessments are carried out to determine the effect of NO-releasing dressing on overall healing process.

Conclusions

This study shows Alginate−PVA-GSNO wound dressing provides antimicrobial and wound healing properties in vitro. Preliminary in vivo wound healing studies established the safety and efficacy profile of NO-releasing dressing to treat burn wounds.

Applicability of Research to Practice

An easy to apply, field deployable and effective antimicrobial wound dressing is still a major requisite for combat burn wounds. NO delivering alginate-PVA based wound dressing may be an ideal candidate to inhibit infection as well as promote the wound healing process.
128 The Effects of Acupuncture on Pain on the Burn Service
Authors: Chin Theresa L , Burton Kimberly , Thomas Mini , Bernal Nicole O , Nourani Bobby , Nunez Molly , Li Sheng , Rychlock Rachel , Horie Mariko , Malik Shaista , Joe Victor C
Published: March 2020

Introduction

Acupuncture is a well known modality in traditional Chinese medicine to treat various ailments including pain. There is increasing evidence that acupuncture reduces postoperative pain, but it is poorly studied, especially in burn and wound patients. We report our initial experience with acupuncture treatment associated with burns and wounds on our burn service.

Methods

Our hospital now employs acupuncturists as part of implementation of integrative health modalities. Data on Burn service patients who underwent acupuncture were prospectively collected. Patients consented prior to treatment. Additional reasons for treatment other than pain were collected. Pain scores before and after the session were recorded. If patients were sleeping at the end of treatment and a pain score could not be obtained, the pain score was assigned zero. Side effects, including local bleeding, bruising, needling discomfort and short-term nerve irritation, were followed.

Results

From March to October 2019, nineteen patients on the Burn service were treated with acupuncture for a total of 178 sessions. Median age was 56 years (IQR:46–64.5). One pediatric patient was treated. Most (70%, n=14) were burn patients and 6 patients had other types of wounds. Median TBSA for burn patients was 8.5% (IQR:5.4–10.4). The number of treatments per patient ranged from 1–23 with a median of 5 (IQR:2.5–19). The median pain score prior to acupuncture treatment was 3 (IQR:0–5) and after treatment was 0 (IQR:0–2.25). Almost half (48%) of the treatments included other symptoms besides pain, most commonly for sleeping disorders (n=33) and anxiety (n=28). No side effects of acupuncture were reported. The most common auricular acupuncture points were shenmen and sympathetic, which targets relaxation and pain. Large Intestine 4, located on the hand, and Liver 3, located on the foot, were the most common body acupuncture points, which target relaxation and generalized pain.

Conclusions

Acupuncture appears to mitigate burn and wound pain and can be used to treat other acute ailments besides pain. There are few side effects of acupuncture on burn and wound patients. Based on our initial experience, a prospective observational study to identify the efficacy of acupuncture in burn patients for pain control and other symptoms is being developed.

Applicability of Research to Practice

In light of the opioid crisis, new applications of nonopioid modalities for pain management should be investigated. Acupuncture is low risk with potential benefit without opioids. Furthermore, other symptoms such as sleep disturbances and anxiety may be treated without pharmacologic medications.
533 Establishment and Effects of a Method for Wound Repair in Patients with Extensive Deep Burns Using Fresh Skin Allografts and Autologous Micrograft
Authors: Shen Chuanan , Sun Tianjun , Deng Huping , Niu Yuezeng
Published: March 2020

Introduction

This study was to establish a method for wound repair in patients with extensive deep burns using fresh allogeneic scalp combined with autologous micrograft.

Methods

Two patients with burn injuries involving 90% (3rd degree, 70%) and 97% (3rd degree, 85%) total body surface area (TBSA) respectively were treated with fresh scalp allografts donated by 32 males aged (31.5 ± 8.2) years or autologous micrografting. The bilateral limbs with third-degree burns were selected as treatment and control groups. Wounds in the treatment group were treated with fresh allogeneic scalp and autologous micrograft, while wound in the control group received MEEK grafting. Preoperatively, the surgical area on the extremities was calculated to estimate the necessary amount of allogeneic scalp and MEEK grafts. Fresh scalps (0.30 - 0.35 mm) were harvested from each donor to prepare a larger piece of skin allograft. Autologous micrografts were transported onto the epidermis of the skin allograft. The treatment and control group received grafting according to our protocol. The donors received follow-up visits after 3 months to see if there is alopecia and scar hypertrophy. The wound coverage rate was observed in both treatment and control groups on postoperative weeks 2, 3, 4 and 5.

Results

The donor sites in all allogeneic skin donors healed within 10 days postoperatively. The scalp recovered well without any alopecia or scar hypertrophy during the follow-up visits. The wound coverage rate of the treatment group was approximate to or higher than that of the control group.

Conclusions

Considering that allogeneic skin is scarce and expensive and the patient’s relatives are willing to help save the patient’s life by donating the scalp, this method may be a feasible clinical treatment option.

Applicability of Research to Practice

This study is a clinical study which is highly applicable in practice.
544 Examining the Characteristics of Eligible Burn Survivors Who Did Not Consent to Participate in a Longitudinal National Database
Authors: Wolfe Audrey E , Stockly Olivia , Grant Gabrielle G , Gibran Nicole S , Carrougher Gretchen J , Holavanahalli Radha K , McMullen Kara , Schneider Jeffrey C , Ryan Colleen M
Published: March 2020

Introduction

As one of the largest prospective, longitudinal, multi-center research data repositories for burn survivors, the Burn Model System (BMS) National Database is in a unique position to explore the characteristics of burn survivors who choose not to participate in long-term research. Given recent shifts in research priorities to include underserved and vulnerable populations, the purpose of this study was to assess the extent to which the research population of the BMS National Database is representative.

Methods

Data from the BMS national database collected from 1994 through June 2019 were analyzed. Demographic characteristics were compared between individuals who did and did not consent to be participants of the BMS database. Regression analyses were used examine any correlation between demographic characteristics and study participation controlling for BMS site and eligibility criteria.

Results

A total of 7,451 burn survivors age 0–99 years old (6,418 consented; 1,033 did not consent) were included in the analysis. The two populations did not differ significantly by gender or race. However, individuals who did not consent for the BMS database were older and more often Hispanic/Latino (p< 0.001) (Table 1). In regression analyses, age and ethnicity were significant predictors for enrollment into the BMS database with individuals over 80 years of age being 80% less likely to consent and those who are Hispanic/Latino being approximately 66% less likely to consent (Table 2).

Conclusions

It is important to understand the extent to which the BMS database captures individuals most affected by burn injuries who are considered underserved or vulnerable. In this long-term study older adults (80+ years old) and individuals who identify as Hispanic/Latino were less likely to consent and enroll. Researchers are challenged to understand why these individuals are not participating in longitudinal research and develop strategies to improve enrollment in these vulnerable populations.

Applicability of Research to Practice

Underserved and vulnerable burn survivor populations must be represented in research studies to gather as much information as possible about their recovery and long-term outcomes. Information on outcomes is vital for care decisions.