bluuebunny/crossref_metadata_2025 huggingface dataset:
588 Early Physical Therapy Improves Burn Rehabilitation: Nationwide Study of Patients ≤30% Total Burn Surface Area
Authors: Richter Christopher G , Krishna Sunskruthi , Shah Suhaib , Segura Carolina , Ramgopal Yash , Durand Jean Pierre , Golovko Georgiy , Suman-Vejas Oscar E , Wolf Steven E , Ayadi Amina E I , Song Juquan
Published: April 2024

Introduction

While the benefits of physical therapy (PT) in burn patient rehabilitation is highlighted to great extent in literature, there are no national estimates on the effects of time from admission to initial PT evaluation. This study aims to evaluate how expedited PT evaluations influence outcomes in ≤30% total burn surface area (TBSA) patients.

Methods

A national database of deidentified patient records from 2015 to 2021 was analyzed. Thermal and chemical burn patients were categorized based on the time from initial injury to PT evaluation: < 48 hours (early) or ≥ 48 hours (delayed). The study included patients with well-documented injury severity of ≤30% TBSA, while those with unspecified burn injuries or respiratory tract involvement were excluded. The outcomes, measured at one year, included continued pain, disability, psychological burden, and mortality. Analysis was performed using independent z-tests with a set value of p< 0.05.

Results

The study included 2,386 patients with 58.6% evaluated by PT in the early cohort and 41.4% in the delayed cohort. The mean number of PT sessions per patient was consistent between both groups (6 sessions). At one year, the early evaluation cohort demonstrated significantly lower rates of pain (RR=0.579; CI=0.437-0.677; p< 0.0001), psychological burden (RR=0.702; CI=0.547-0.902; p=0.0052), and disability (RR=0.464; CI=0.234-0.855; p=0.0122). No significant difference in mortality was observed.

Conclusions

This study highlights the significant benefits of expedited PT evaluation within 48 hours of admission for patients with ≤30% TBSA. The timely initiation of PT not only reduces pain and disability but also diminishes psychological burden at one year among patients with similar injuries. These findings emphasize the importance of prompt interprofessional integration for improved quality of life outcomes in burn patients.

Applicability of Research to Practice

This study offers a focused examination of the tangible benefits associated with early PT evaluation in mild to moderate burn patients. The findings have the potential to substantially impact interprofessional standards of practice and patient care protocols.
589 An Examination of Balance Problems in the Burn Population
Authors: Santos Edward , Chacon Kaitlyn , Shepler Lauren , McMullen Kara , Slavin Mary D , van de Rijn Marc , Kowalske Karen J , Ryan Colleen M , Schneider Jeffrey C
Published: April 2024

Introduction

Balance is an important daily functional ability that is dependent on many intrinsic and extrinsic factors; balance impairments can lead to loss of independence, injury, falls, and quality of life limitations. However, balance is not well studied in the burn population. The aim of this study is to describe the frequency of balance impairments and associated long-term factors after burn injury.

Methods

Data from a multicenter longitudinal database from August 2015 to January 2023 was analyzed. Self-reported trouble with balance was collected at discharge and at 6, 12, 24 and 60 months after injury. The population was divided into those with and without balance impairments at 12 months. Demographic and clinical variables were compared between groups. Regression analyses examined the association between demographic and clinical characteristics and self-reported balance impairments at 12 months.

Results

Of the 572 participants that met inclusion criteria, 153 reported balance impairments at 12 months. Balance impairments were most frequently reported at discharge (40.3%) and continued over the five-year follow up periods (26.8 to 36.0%). Those with reported balance impairments were older (53.1±15.7 vs. 45.0±15.9 years) and less likely to be employed (49.0% vs. 74.2%); additionally, they were more likely to have Medicaid or Medicare insurance (22.7% or 31.3% vs 12.7% or 15.1%), inpatient rehabilitation (34.7% vs 21.3%), outpatient physical or occupational therapy at 12 months (41.7% vs 23.7%), vision problems (26.2% vs. 7.0%), leg or feet burns (79.8% vs. 62.1%), numbness in their feet (55.7% vs. 16.8%), and swollen feet or legs (46.3% vs. 14.9%) compared to those without balance impairments (p< 0.001 for all comparisons). Regression analysis demonstrated 4% increased odds of a balance impairment for every increase in year of age (p=0.001). Participants employed at the time of injury had 76% lower odds of reporting a balance impairment at one year (p< 0.05). Additionally, trouble with balance was 279% higher for participants who received outpatient physical or occupational therapy (p=0.005) and 537% higher for those that reported drug misuse (p=0.020).

Conclusions

This study found that balance impairments are commonly reported at discharge and persist for up to 5 years after injury. Results suggest that trouble with balance is more likely to be reported by individuals who are older, unemployed at the time of injury, receiving outpatient therapy services, and misusing drugs.

Applicability of Research to Practice

Balance assessments during inpatient care and follow up appointments may be used to identify persons living with burn injury that may benefit from balance interventions.
596 Elevated Cardiac Troponin I Level Within 72 Hours Correlated to Cardiac Dysfunction in Burned Patients
Authors: Segura Carolina , Obias Isabel B , Ramgopal Yash , Richter Christopher G , Krishna Sunskruthi , Shah Suhaib , Amador Dalton , Song Juquan , Golovko Georgiy , ayadi Amina E I , Wolf Steven E
Published: April 2024

Introduction

Severe burned patients are under a hyperadrenergic and hypermetabolic states. Without proper treatment, patients developed cardiac dysfunction and heart failure. Cardiac Troponin I (cTI) is released from cardiac tissue which is considered as having a high predictive value in cardiac injury. However, its biomarker potential in cardiac insult continues to be under investigation in burn patients. The purpose of this retrospective research study is to evaluate the role of cTI and its association to patients with burns.

Methods

The patients' de-identified data was analyzed and collected from a national database. 8,092 patients 18 years old or older with burns who had cTI lab value were enrolled in this study. Patients were grouped by the cTI mean level within 72 hours including patients with high cTI levels at >0.3 ng/mL (n= 1,879 patients), and patients with normal cTI level less than at 0.04 ng/mL (n= 3,265). The cohorts were further stratified by less than 20% TBSA and >20% TBSA to replicate the severity of burns. The 30-days incidences of acute myocardial infarction (MI), sepsis, and mortality were observed after two cohorts were stratified into severe or mild burns. The cohorts were balanced using propensity score matching of covariates: age at index, sex, race, and ethnicity.

Results

The groups that were further stratified into mild burn and severe burn had the following

results

The mild burn risk ratio (RR) and 95% confidence interval (CI) for MI was (0.146/0.091-0.235), sepsis (0.662/0.48-0.914), and mortality was (0.433/0.305-0.615). The severe burn cohort had a RR and a 95% CI for MI of (0.236/0.121-0.462), sepsis (1.194/0.766-1.859), and mortality (0.547/0.416-0.719).

Conclusions

The patients with earlier elevated cTI level within 72 hours had worse outcomes of MI and mortality in both severe and mild burns.

Applicability of Research to Practice

The study indicates the cTI predictive potential which could be applied to monitor the high risk of complications in severe injured patients.
599 To Titrate or Not to Titrate, That Is the Burning Question: Enoxaparin and VTE Prophylaxis
Authors: Vega Kevin , Palumbo Morgan , Cheng Ke , Anderson Jeffrey
Published: April 2024

Introduction

Patients who sustain burn injury undergo metabolic and physiologic changes that place them at elevated risk of developing venous thromboembolism (VTE). Although the benefit and safety of enoxaparin titration for prevention of VTE in trauma patients is well established, there is a lack of evidence regarding its applicability for burn injured patients. In this study, we sought to determine the safety and applicability of enoxaparin titration for burn injured patients admitted for treatment of their injury.

Methods

We performed a single center retrospective study of burn injured patients admitted to our American Burn Association verified burn center from June 2022 to June 2023. In May 2022, our burn center adopted the American Association for Surgeons in Trauma (AAST) protocol for enoxaparin dosing. This includes twice daily administration of enoxaparin, followed by measurement of anti-Xa levels prior to administration of the fourth or fifth dose. We previously administered a standard dose of 30mg twice daily. Anti-Xa levels were used to guide enoxaparin dose adjustments to remain within prophylactic range. Patients hospitalized for under 48 hours, with glomerular filtration rate less than 30, and with repeated refusal of enoxaparin were excluded.

Results

Eighty seven patients met our inclusion criteria. Fifty six patients started at 40mg twice daily dosing; the remainder started at 30mg twice daily dosing. Of these patients, forty two (48%) required dose adjustments by anti-Xa levels. Of those who required dose adjustment, thirty three (78%) required an increase. There was no significant difference in BMI (p=0.25) or inhalation injury (p=0.62) between patients who did and did not require enoxaparin titration. Patients who required titration had a non-significant trend toward larger percent total body surface area affected (p=0.08). There was also a significantly greater change in dosing for patients who required an increase in dose adjustment as opposed to those who required a decrease in dose adjustment (p < 0.0001). Finally, there was no difference in post-operative bleeding between patients who did and did not require dose titration (p=0.57).

Conclusions

Our results demonstrate that an individual approach to VTE prevention through enoxaparin titration is necessary in order to maintain appropriate prophylactic doses in burn injured patients. Furthermore, adoption of the AAST guidelines is safe and does not result in an increase in post-operative bleeding events.

Applicability of Research to Practice

This work highlights the safety and benefit of enoxaparin titration in burn injured patients to prevent VTE.
701 Effect of Methamphetamine Use on Transthoracic Echocardiographic Findings in Burn Patients
Authors: Sojka John H , Jbeily Elias , Silva Taylor , Rukmangadhan Samveda , Heard Jason , Sen Soman , Palmieri Tina L , Romanowski Kathleen S
Published: April 2024

Introduction

Methamphetamine use adversely effects the cardiovascular system leading to pulmonary hypertension and heart failure (HF) due to non-ischemic dilated cardiomyopathy with reduced ejection fraction (EF). Despite this, many methamphetamine (MA) users with HF have preserved EF and the adverse effects of their MA use may be overlooked. Subclinical cardiac dysfunction associated with MA use may become clinically apparent in patients experiencing a significant physiological stress like burn injury. We hypothesize that transthoracic echocardiogram (TTE) findings and outcomes of MA positive patients will be worse than those of MA negative patients.

Methods

Following IRB approval, data was collected on all patients admitted for burn injuries who had admission TTEs between January 2015 and December 2019. Patients were divided into two groups based on admission drug screen positivity for MA. Data collected included TTE findings, patient demographics, percent total body surface area (%TBSA) burned, length of stay (LOS), hospital charges, and mortality. The two groups were then matched based on age and burn %TBSA. Analysis on the total population and the matched data set was conducted with SAS statistical software using Chi-square, Fisher Exact, and Wilcoxon 2-sample tests.

Results

A total of 417 patients with TTEs were included, 295 MA negative and 122 MA positive (29.3%). In the total population, MA positive patients were younger (p< 0.0001), had larger burns (p=0.003), more inhalation injury (p=0.002), less aortic regurgitation (p< 0.0001), higher left ventricular EF (p=0.01), higher hospital charges (p=0.003), and lower mortality (p=0.02) than their MA negative counterparts. In the group matched for age and %TBSA, there was no significant difference in inhalation injury, sex, race, or BMI between groups. The MA negative group had significantly more patients with aortic regurgitation (p=0.02). All other TTE findings were not significantly different. No significant differences were found in LOS (p=0.25), operations (p=0.08), charges (p=0.19), or mortality (p=0.14). The circumstances of burn injuries were significantly different (p=0.03), where MA positive patients were more likely to be burned as a result of suspected assault or self-injury and MA negative patients were more likely to have accidental workplace related burns.

Conclusions

Patients who tested positive for MA on admission were younger and had larger burns. When controlled by matching, there were no differences in TTE findings or clinical outcomes related to testing MA positive.

Applicability of Research to Practice

Admission drug screen positivity for methamphetamine alone may not be an indication for obtaining TTE.
718 Predictors of Lengthened Admission in Elderly Burn Patients, a Secondary Analysis of 529 Cases
Authors: Zhu Xi Ming , Tedesco Diana , Shahrokhi Shahriar , Jeschke Marc G
Published: April 2024

Introduction

Existing research has examined the relationship between the amount of total body surface area (TBSA) burn and length of stay (LOS) for older adults. As a result, the conventional ratio of 1 day LOS/1% TBSA ratio has been updated to 2 days LOS/1% TBSA. In this study, we aim to elucidate patient and injury characteristics that affect our prognostic indicator, leading to a prolonged LOS.

Methods

This was a secondary analysis of a cohort study of surviving patients admitted to a tertiary adult burn center between January 1, 2006, and June 30, 2021. Older adult patients aged 60 and over were stratified into expected LOS (< 2.0 days/%TBSA) and greater than expected LOS (>2.0 days/%TBSA). Patient demographics, TBSA, inhalation injury, pre-admission co-morbidities, and in-hospital complications were tabulated. Logistic regressions were performed using IBM SPSS Statistics 29 and Stata Statistical Software: Release 18.

Results

529 patients with a mean age of 71 years were included for analysis of the older adult population. 266 patients had the expected LOS/TBSA ratio, and 263 exceeded this ratio. Univariable analysis indicated patients with greater age [1.03 (1.01 – 1.05) p = 0.002], hypertension [1.72 (1.22 – 2.42) p = 0.002], diabetes [1.95 (1.30 – 2.93) p = 0.001], respiratory disease [2.22 (1.40 – 3.53) p = 0.001], cardiac disease [1.75 (1.24 – 2.47) p = 0.002], psychiatric illness [1.75 (1.04 – 2.96) p = 0.035], and those who experienced complications (such as infection, graft failure, pneumonia, sepsis) [1.62 (1.14 – 2.30) p = 0.007] during admission were more likely to exceed their predicted LOS.

Multivariate analysis found that inhalation injury [3.73 (1.62 – 8.57) p = 0.002], diabetes [1.69 (1.04 – 2.77) p = 0.035], respiratory disease [1.86 (1.04 – 3.29) p = 0.035], psychiatric illness [1.50 (1.01 – 1.87) p = 0.04], alcohol use [2.18 (1.04 – 4.58) p = 0.04], and complications [3.63 (2.27 – 5.80) p < 0.0001] were contributing factors that increased the likelihood of patients exceeding predicted LOS. Diabetes was not a statistically significant contributor.

Conclusions

Progress has been made to identify patient and injury factors that increase the likelihood of increased LOS for older adult patients with burn injuries. This provides valuable data for physicians to better assess their patients and improve their quality of care.

Applicability of Research to Practice

Identification of key burn patient characteristics aids in prognostication. Determining length of stay aids with coordination of patient care with the multi-disciplinary team.
749 Clinical Decision Support Systems, Electronic Health Records and Fluid Resuscitation: Harnessing the Power of Technology
Authors: Pan Bowen , Richerbach Stacey , Menodiado Floredes , McGuire Robert , Hockenberry Tiffany , Richey Karen J , Foster Kevin N
Published: April 2024

Introduction

Electronic Health Record (EHR) raw data, in conjunction with analysis via Clinical Decision Support Systems (CDSS) has great potential to enhance bedside decision-making and improve patient outcomes. However, technology systems are often siloed, limiting interoperability, and creating inefficient workflows. Proprietary software is costly, lacks transparency and limits customization. The purpose of this project was to incorporate a custom burn fluid resuscitation CDSS into our existing EHR and evaluate safety and efficacy.

Methods

Following Institutional Review Board approval, a team was formed of representatives from the EHR vendor, local health informaticists, burn surgeons, burn nurses, and research staff. An initial equation using the Parkland formula as a starting point was created and run in the background during resuscitation of patients over the course of several months. The formula went through a feedback-based refinement cycle to better align with historical datasets and expert opinion. Following implementation, safety data was analyzed after each patient and then cumulatively compared to historical controls.

Results

A total of 17 adults were resuscitated using the CDSS, excluded from analysis were patients that had comfort care initiated within the first 12 hours. There were no significant differences for age, weight or TBSA between CDSS (n=13) and controls (CON) (n=138). The average ml/kg/TBSA in CDSS was 5.43 vs 6.49 CON (p=.259) and duration of resuscitation was 26.31 hours CDSS vs 31.83 hours CON (p< 0.0867). Mortality between groups was not significantly different CDSS 23% vs CON 24% (p=0.125). Several process improvements were realized, including availability of CDSS data at all workstations, full integration of data within the EHR thus providing one “source of truth,” the capability to have uninterrupted resuscitation across domains of care, enhanced efficiency in documentation by nursing, and the ability to have ongoing monitoring of safety and efficacy.

Conclusions

This proof-of-concept project demonstrates the feasibility of developing tools, namely burn fluid resuscitation, within the EHR that are user-centric and have fully integrated workflows. To date, no safety signals have been detected. Holding creative rights to the algorithm enables us to continue to refine the formula based on evolving evidence. With the future in mind, the CDSS is designed to incorporate data from automated IV infusion and urine output monitoring systems. The project provides a framework for the customization of additional Clinical Decision Support System projects, providing a powerful platform to drive quality improvement initiatives.

Applicability of Research to Practice

The framework for this project has outstanding potential to revolutionize how burn resuscitation care is provided and documented at the bedside.
755 Utilizing a Structured Critical Care Rounding Tool for Retrospective Morbidity and Mortality Review
Authors: Libraro Kaitlyn M , Heffernan Jamie M
Published: April 2024

Introduction

This 20-bed Burn ICU (BICU) previously reported on the creation and implementation of a methodical daily rounding tool for critical care burn patients. The initial goal of the tool was to improve interdisciplinary communication and investigate the characteristics of burn induced hypermetabolic response and systemic inflammatory syndrome (SIRS), a well-known and ever-challenging differential noted in the burn population. These rounding tools were completed on all critical care burn patients and ensured that necessary assessment points were evaluated the same way despite the provider on call. The quality RN then collected the tools for data collection and quality improvement review. Since its introduction, the tool has expanded its applicability from its original intention as a daily methodical rounding tool for improved interdisciplinary and MD to MD communication, to a retrospective quality tool enhancing morbidity and mortality quality reviews.

Methods

The rounding sheets are completed by a resident caring for a critical care patient based on that provider’s bedside assessment and recent chart review and are then presented to the team during rounds. The rounding Attendings evaluate the information as provided and make amendments to the document as needed. Following rounds, the Attending’s completed rounding tool is provided to bedside nursing and the quality RN. During morbidity and mortality reviews, the rounding sheets are retrospectively reviewed by the quality team to evaluate potential opportunities for improvement.

Results

The rounding tool has been utilized for the retrospective Quality review of 13 mortalities and 3 morbidities. The most utilized portion of the rounding tool has been the Burn Sepsis Screening Tool (BSST) section. In real time, the BSST assists in early identification of SIRS vs. hypermetabolic response. When utilized retrospectively, this tool plays a valuable role in evaluating opportunities for improvement specifically for timely diagnosis and treatment.

Conclusions

Modern medicine is reliant on the use of technology and Electronic Medical Records (EMR) in recording the information of a patient’s care and management. Similarly, retrospective morbidity and mortality quality reviews are highly dependent on the data entered by the provider into the EMR. A significant limitation of the EMR is a lack of subjective provider input and clinical judgment in the time surrounding certain decision making and diagnosis. Use of the rounding tool for retrospective review has proven beneficial to this burn center’s quality review process.

Applicability of Research to Practice

Directly applicable
758 Identifying the Gaps of the Inpatient to Outpatient Transition: The Role of the Patient Navigator
Authors: Kim Anika , Rutter Cindy , Chacon Daniel W , Flores Elizabeth , Gillenwater Justin , Gonzalez Karla Anel , Mojarro-Huang Elizabeth , Yenikomshian Haig A
Published: April 2024

Introduction

Patient navigators (PNs) are members of the community who help with the transition from inpatient to outpatient care. PNs have demonstrated efficacy in enhancing patient engagement and addressing care gaps in fields such as cancer and vulnerable populations, such as urban, low socioeconomic-status populations. Despite the long-term care needs of burn patients, the role of PNs in the aftercare of burn injury has not been studied. This research investigates the current use of PNs in burn care at a safety-net hospital and sheds light on potential areas of improvement.

Methods

This was a retrospective observational cohort study conducted from November 2022 to August 2023. Data regarding patient contacts, needs identification, and associated referral requisites were collected. The PN role was filled by a representative from a local nonprofit community center. The PN checked in with outpatients after their discharge and inpatients nearing discharge to identify their needs and facilitate appropriate referrals to the relevant community services.

Results

Over eight months, the PN liaised with 658 burn unit patients, comprising 406 outpatients and 252 inpatients. A focused examination of non-COVID services requested reveals that only 3.2% of outpatients requested referrals to community resources. This contrasts with inpatients, where a significantly larger fraction of 10.3% requested similar community service referrals. Figure 1 shows the breakdown of services requested.

Conclusions

While PNs are progressively integrated into various healthcare domains, the newly implemented program in burn care yielded low utilization rates, particularly among outpatients. The disparity between inpatient and outpatient engagement indicates the need to optimize the role of PNs in the transition process from the hospital to outpatient care in burn patients.

Applicability of Research to Practice

The aftercare for burn injuries is complex and extends beyond hospital discharge, requiring effective coordination between various healthcare and community resources. This study highlights the untapped potential of PNs in enhancing outpatient care in the setting of burn injury. Tailoring the PN training to meet the specialized needs of burn patients could enhance their role and improve patient outcomes, particularly for those who face barriers to engagement with the healthcare system.
801 Post-Burn Breast Reconstruction: A Systematic Review of Techniques
Authors: Marlar Riley , Lagziel Tomer , Ku Ying , Bishop Sarah N
Published: April 2024

Introduction

Breast burns, whether thermal, chemical, or electrical, represent a significant subset of burn injuries. The psychological and physical implications of these burns can be profound, particularly given the breast's anatomical and socio-cultural significance. Post-burn breast reconstruction is not only crucial for functional recovery but also for emotional and psychological rehabilitation. With evolving techniques over the years, there is a pressing need to systematically assess and consolidate information to guide future therapeutic directions.

Methods

A systematic search of PubMed, EMBASE, and the Cochrane Library was conducted following PRISMA guidelines, including studies published up to September 2022. Inclusion criteria comprised articles focusing on surgical techniques, outcomes, and complications of breast reconstruction following burn injuries. Data extraction included study characteristics, patient demographics, burn details, reconstructive techniques, outcomes, and complications. A qualitative synthesis was performed due to the heterogeneous nature of the included studies.

Results

The search yielded 80 relevant studies, emphasizing a myriad of reconstructive options including autologous tissue transfer, acellular dermal matrices, tissue expanders, and implant-based reconstructions. Flap-based reconstructions were exemplified for optimal aesthetic and functional outcomes with reduced donor site morbidity. However, each technique's success is contingent upon the burn’s extent, location, and patient-specific factors. Complications were varied, with infection, flap failure, and contracture being prevalent. Notably, advancements in regenerative medicine and bioengineering, such as tissue engineering and fat grafting, have shown promising results in restoring breast contour and improving scar quality.

Conclusions

This systematic review sheds light on the multifaceted domain of post-burn breast reconstruction. The key takeaway is the importance of individualized treatment plans, factoring in patient needs, burn characteristics, and available resources. The advent of regenerative techniques is certainly promising, emphasizing the need for continuous research to refine and innovate reconstruction methodologies further.

Applicability of Research to Practice

The evidence underscores the versatility of available reconstructive techniques, aiding clinicians in tailoring interventions based on individual patient needs, burn extent, and aesthetic considerations. This insight enables practitioners to refine surgical strategies, optimize outcomes, and mitigate complications. The highlighted advancements in regenerative medicine provide a framework for integrating innovative solutions in clinical practice, enhancing the scope of holistic burn management and improving patient quality of life.
806 Autologous Skin Cell Suspension Demonstrates Successful Outcomes in the Treatment of Burn and Wound Sites
Authors: Draper Brian , Austin Cindy , Sodade Oluwafolaranmi
Published: April 2024

Introduction

A new treatment paradigm increasing among burn and wound providers is the application of Autologous Skin Cell Suspension (ASCS). This system is a point-of-care therapy spraying on the patient's own cells promoting epidermal regeneration while reducing the amount of skin harvested for donor sites. Literature reports on the use of ASCS but there is a paucity of data describing the application of ASCS with temporal dermal substitutes and donor sites. The purpose of this study is to evaluate complex wound sites due to burns and other etiologies treated with ASCS solely or in combination with wound care applications. Also, a review of ASCS applied over donor sites is reported. We hypothesize the application of ASCS on complex wounds, burns and off-label usage on donor sites to demonstrate acceptable outcomes.

Methods

A retrospective chart review of burn and wound patients (N=53) treated with ASCS between 2019-2022 at a tertiary care center. Data was extracted from the electronic medical record. Treatments evaluated included ASCS only, ASCS with or without autologous split-thickness skin graft (STSG), and polyurethane bioabsorbable matrix (PBM) placement prior to ASCS. Wound healing results were collected on the off-label use of ASCS applied to donor sites. Each individual wound site was measured (cm2) and failure rate was calculated based on size of dermal substrate or graft loss. Statistical analysis software was used to summarize data which included descriptive demographics, wound type/size, graft fail size, percent total burn, adjunct procedures, comorbidities, systemic/ local wound infection rate, complications, length of stay, and overall patient outcome summary.

Results

A total of 53 burn and wound patients were included, 46(87%) and 7(13%), respectively. The mean age was 44.3 (SD 20.6) years with 35(66%) patients being male. The mean total burn surface area was 30% (SD 23.8%). The most common comorbidities were hypertension, coronary artery disease and kidney disease. Highest complication was infection n=26 (49%), 11 local, 7 systemic and 8 both. A total of 577 injury sites were evaluated. The fail rate for PBM+STSG+ASCS, STSG+ASCS, ASCS+ non-donor site, and ASCS on donor site was (2.9%, 0.4%, 0.0%, 0.5%), respectively. No complications were reported with ASCS on donor sites. The percent fail of STSG’s without ASCS was 6.6% and reduced to 0.4% when used in combination with STSG+ASCS.

Conclusions

The findings of this study data demonstrate the successful application of ASCS even in the presence of infection on burn and complex wounds used alone or in conjunction with PBM. The results support the off-label use of ASCS on donor sites.

Applicability of Research to Practice

This study demonstrates the effectiveness of ASCS on wounds as well as the use on donor sites. This study adds to the growing literature evaluating the use of ASCS on burn wounds.
810 Development of a Porcine Burn Wound Model
Authors: Singer Adam J , McClain Steve
Published: April 2024

Introduction

Deep partial thickness burns generally require more than 2-3 weeks to heal often resulting in hypertrophic scarring and patient morbidity. Because the skin of pigs most closely resembles that of humans, the pig is often used as an experimental burn wound model. We describe the development of a reproducible burn wound model in Yorkshire pigs.

Methods

We created standardized 5 x 5 cm burns on the backs and flanks of anesthetized domestic pigs (30 kg) using a radiant heating device set at 600 degrees C and applied to the animal’s skin for 5, 10, or 15 seconds. Full thickness 4 mm punch biopsies were obtained from the burns at 4 and 24 hours for burn depth evaluation. The tissue sections were stained with Hematoxylin and Eosin, HMGB-1 (a marker of necrosis) and activated cleaved caspase 3 (a marker of apoptosis). The tissue sections were viewed by a board-certified dermatopathologist blinded to duration of exposure. The primary outcome was the deepest level of injury to the blood vessels or epithelial appendices (hair follicles or apocrine glands).

Results

Exposure of the pigs’ skin to the heating device for periods of 5, 10, and 15 seconds resulted in superficial partial, deep partial and full thickness burns respectively. Average depth of dermal injury 24 hours after exposure was 0.4 mm, 1.3 mm, and 2.4 mm for exposure times of 5, 10 and 15 seconds respectively.

Conclusions

We describe a standardized porcine model for creating reproducible superficial partial, deep partial and full thickness burns.

Applicability of Research to Practice

This model is now being used to investigate novel therapies for deep burns.
811 The Cytotoxic Effect of CHG, Dial, and Johnson & Johnson on Human Burn Wounds
Authors: Ahmed Rabia , Zajac Jocelyn C , Liu Aiping , Pashaj Joana , Gibson Angela
Published: April 2024

Introduction

Chlorhexidine gluconate (CHG) and soaps are commonly used to prevent burn wound infections in patients. However, it is thought that these antiseptic reagents may be cytotoxic to human skin and may impede proper healing of burn wounds. We have previously shown profound cytotoxicity of CHG in excisional wounds using an ex vivo human skin model. The purpose of this study was to observe the effects of CHG, Dial, and Johnson & Johnson (J&J) baby soap on cytotoxicity using an ex vivo human skin model of burn.

Methods

Partial thickness burns were created on the skin samples using a customized burn device at 150 °C for 6 seconds (n =3 per condition per time point). The burn wounds were treated daily with either CHG, Dial, J&J, or PBS (phosphate buffered saline) for 20 seconds using a cotton tipped applicator and then aspirated and rinsed using 1 milliliter of PBS 3 times to mimic clinical practice. The tissue samples were then cultured for 7 days in 37 °C with 5% CO2. We used PBS as positive control for cell viability and full thickness boiled samples as negative control for 100% of cell death. The cytotoxicity of CHG, Dial, J&J, was measured using lactate dehydrogenase (LDH) staining and an MTT viability assay on days 1 and 7. A two-way ANOVA statistical test was performed on the MTT with additional Tukey analysis between time points and treatment groups.

Results

In this ex vivo human skin model, we observed progressive loss of viability of PBS treated burn wounds indicative of burn progression. For better comparison among groups, in the MTT assays, we corrected for weight and normalized to PBS. We found a significant difference in viability between CHG and PBS on day 7 (p=.0388). In the samples stained with LDH: CHG, Dial, J&J, and PBS all show visible viable tissue on day 1. On day 7, while all samples have viable cells outside of the area of burn injury, the viability has decreased visibly in the cells surrounding the original burn region on both CHG and Dial treated samples. However, there were no significant differences in the overall amount of viable tissue between days or treatment groups.

Conclusions

This study shows that CHG is toxic to the human skin starting from day 1 and leads to loss of viable skin cells extending outside of the original burn region by day 7. When applied to burn wounds for up to 7 days, J&J is less cytotoxic to the skin cells compared to the Dial soap. Additionally, this model may be utilized to study burn wound progression in isolation of perfusion to identify non-vascular mechanisms of burn wound progression.

Applicability of Research to Practice

Although CHG is currently standard-of-care for many burn centers, physicians should take the cytotoxicity of CHG into consideration when using CHG to prevent burn wound infection. Compared to Dial soap, J&J soap may be a good alternative to CHG, because J&J is less cytotoxic to normal skin cells.
Retail Karma: How Our Shopping Sins Influence Evaluation of Service Failures
Authors: Li Ran , Zhang Meng , Aggarwal Pankaj
Published: April 2024

Consumers have an intuitive belief in “karma” which dictates that bad (good) actions lead to bad (good) outcomes. Consequently, consumers perceive a causal connection between their own wrongdoing toward a company and a subsequent service failure that they experience in their interactions with another company. Eight experiments employing different contexts consistently show that consumers who have previously wronged a company (compared to those in a control group) evaluate another unrelated company more positively in response to a service failure by this company. We argue that this more positive evaluation is due to the greater blame consumers assign to themselves as dictated by the “karmic beliefs” held by consumers whereby the subsequent poor service by a different firm is seen as a karmic payback for their own prior transgression. The proposed effect is mitigated when a person’s karmic belief is reduced. We also examine a number of alternative explanations (e.g., negative experiences, moral balancing, and immanent justice reasoning) and find that our observed effect is more consistent with a karma-based account.
Lower subjective social status is associated with increased adiposity and self-reported eating in the absence of hunger due to negative affect among children reporting teasing distress
Authors: Cheon Bobby K , Smith Meegan R , Bittner Julia M P , Loch Lucy K , Haynes Hannah E , Bloomer Bess F , Te-Vazquez Jennifer A , Bowling Andrea I , Brady Sheila M , Tanofsky-Kraff Marian , Chen Kong Y , Yanovski Jack A
Published: April 2024

Objectives

Low social standing and teasing are independently associated with increased body mass index (BMI) and overeating in children. However, children with low social status may be vulnerable to teasing.

Methods

We tested the statistical interaction of subjective social status (SSS) and subjective socioeconomic status (SSES) and teasing distress on BMI, fat mass index (FMI), and eating in the absence of hunger (EAH) in children (Mage = 13.09 years, SD = 2.50 years; 27.8% overweight/obese). Multiple linear regressions identified the main effects of self-reported SSS (compared to peers in school), distress due to teasing, and their interaction on BMI (n = 115), FMI (n = 114), and child- (n = 100) and parent-reported (n = 97) EAH.

Results

Teasing distress was associated with greater BMI, FMI, and child-reported EAH due to negative affect (a subscale of EAH) and total EAH scores. There were no associations of SSS with these outcomes. However, there was an interaction between SSS and teasing distress for BMI, FMI, and EAH from negative affect such that lower SSS was associated with higher BMI, FMI, and EAH from negative affect in the presence of teasing distress. However, there were no main effects or interactions (with teasing distress) of SSES on the outcomes.

Conclusions

These findings suggest that the relationship between lower SSS and increased adiposity and overeating behaviors may be exacerbated by other threats to social standing, such as teasing. Children exposed to multiple social threats may be more susceptible to eating beyond physiological need and obesity than those who experience a single form of perceived social disadvantage.
miR-1972 inhibits hepatocellular carcinoma proliferation by targeting GZMH-mediated DNA replication in the cell cycle
Authors: Jin Yun , Dai Yihe , Qiao Ou , Hu Pingping , Han Jiang
Published: April 2024

Aim

To understand the regulatory roles of miR-1972 and GZMH in hepatocellular carcinoma (HCC) and explore their potential as therapeutic biomarkers.

Methods

In vitro verification of the regulation of malignant cell behavior by differential expression of miR-1972 in HCC cells. The GSE113996 dataset was studied using weighted gene co-expression network analysis (WGCNA) and differential expressed genes respectively to identify the key prognostic gene GZMH and assess the effect of its differential expression on the prognosis of the patient. Finally, the regulation of GZMH expression by miR-1972 was verified, and the effect of their combination on HCC cell behavior was analyzed.

Results

Inhibition of miR-1972 can reduce cell proliferation, migration, and invasion, while overexpression of miR-1972 has the opposite effect in HCC cells. According to the data, a positive prognosis for HCC was linked with higher GZMH expression. Interestingly, miR-1972 was observed to reverse-regulate the expression of GZMH. Besides, the combined regulation of GZMH and miR-1972 has been discovered to affect the cell growth, invasive capacity, and migratory potential of HCC cells, especially the cell cycle arrest in the G2 phase.

Conclusions

miR-1972 regulates the malignant behavior of HCC cells, especially cell proliferation, by regulating GZMH expression.
Dare to be resilient: the key to future pesticide-free orchards?
Authors: Serrie Marie , Ribeyre Fabienne , Brun Laurent , Audergon Jean-Marc , Quilot Bénédicte , Roth Morgane
Published: April 2024

Considering the urgent need for more sustainable fruit tree production, it is high time to find durable alternatives to the systematic use of phytosanitary products in orchards. To this end, resilience can deliver a number of benefits. Relying on a combination of tolerance, resistance, and recovery traits, disease resilience appears as a cornerstone to cope with the multiple pest and disease challenges over an orchard’s lifetime. Here, we describe resilience as the capacity of a tree to be minimally affected by external disturbances or to rapidly bounce back to normal functioning after being exposed to these disturbances. Based on a literature survey largely inspired from research on livestock, we highlight different approaches for dissecting phenotypic and genotypic components of resilience. In particular, multisite experimental designs and longitudinal measures of so-called ‘resilience biomarkers’ are required. We identified a list of promising biomarkers relying on ecophysiological and digital measurements. Recent advances in high-throughput phenotyping and genomics tools will likely facilitate fine scale temporal monitoring of tree health, allowing identification of resilient genotypes with the calculation of specific resilience indicators. Although resilience could be considered as a ‘black box’ trait, we demonstrate how it could become a realistic breeding goal.
Unique photosynthetic strategies employed by closely related Breviolum minutum strains under rapid short-term cumulative heat stress
Authors: Deore Pranali , Tsang Min Ching Sarah Jane , Nitschke Matthew R , Rudd David , Brumley Douglas R , Hinde Elizabeth , Blackall Linda L , van Oppen Madeleine J H
Published: April 2024

The thermal tolerance of symbiodiniacean photo-endosymbionts largely underpins the thermal bleaching resilience of their cnidarian hosts such as corals and the coral model Exaiptasia diaphana. While variation in thermal tolerance between species is well documented, variation between conspecific strains is understudied. We compared the thermal tolerance of three closely related strains of Breviolum minutum represented by two internal transcribed spacer region 2 profiles (one strain B1–B1o–B1g–B1p and the other two strains B1–B1a–B1b–B1g) and differences in photochemical and non-photochemical quenching, de-epoxidation state of photopigments, and accumulation of reactive oxygen species under rapid short-term cumulative temperature stress (26–40 °C). We found that B. minutum strains employ distinct photoprotective strategies, resulting in different upper thermal tolerances. We provide evidence for previously unknown interdependencies between thermal tolerance traits and photoprotective mechanisms that include a delicate balancing of excitation energy and its dissipation through fast relaxing and state transition components of non-photochemical quenching. The more thermally tolerant B. minutum strain (B1–B1o–B1g–B1p) exhibited an enhanced de-epoxidation that is strongly linked to the thylakoid membrane melting point and possibly membrane rigidification minimizing oxidative damage. This study provides an in-depth understanding of photoprotective mechanisms underpinning thermal tolerance in closely related strains of B. minutum.
Asteroseismology of three evolved stars in M67: testing systematic biases in seismic masses and ages
Authors: Li (李坦达) Tanda , Bi (毕少兰) Shaolan , Davies Guy R , Bedding Timothy R , Li (李亚光) Yaguang , Stello Dennis , Reyes Claudia
Published: April 2024

Asteroseismology can precisely characterize stars, but the accuracy of seismic inference is still an open question. In this work, we use three evolved stars, including one late subgiant (EPIC 211411922) and two young red giants (EPIC 211409560 and EPIC 211416749) in the open cluster M67 to validate seismic inferences of stellar mass and age. We start by measuring oscillation mode frequencies and identifying acoustic and mixed modes in all three stars. We then fit the stars to determine their masses and ages with a detailed modelling approach. Our age estimates for all stars agree well with the literature consensus age range of M67 (3.0–5.0 Gyr). Mass estimates for EPIC 211411922 and EPIC 211409560 are sensible because they are slightly higher than the typical turn-off mass of the cluster. The inferred mass for EPIC 211416749 is underestimated by 5–10 per cent compared with the turn-off mass, but this could be caused by poor data quality. Our results indicate that the detailed modelling can determine sensible masses and ages for evolved stars near the base of the red giant branch.
GHOST commissioning science results – III. Characterizing an iron-poor damped Lyman α system
Authors: Berg Trystyn A M , Hayes Christian R , Cristiani Stefano , McConnachie Alan , Robertson J Gordon , Sestito Federico , Simpson Chris , Waller Fletcher , Chin Timothy , Densmore Adam , Diaz Ruben J , Edgar Michael L , Fuentes Lettura Javier , Gómez-Jiménez Manuel , Kalari Venu M , Lawrence Jon , Margheim Steven , Pazder John , Ruiz-Carmona Roque , Salinas Ricardo , Silva Karleyne M G , Silversides Katherine , Venn Kim A
Published: April 2024

The Gemini High-resolution Optical SpecTrograph (GHOST) is a new Echelle spectrograph available on the Gemini-South telescope as of Semester 2024A. We present the first high-resolution spectrum of the quasar J1449−1227 (redshift zem = 3.27) using data taken during the commissioning of GHOST. The observed quasar hosts an intervening iron-poor {[Fe/H] = −2.5} damped Lyman α system (DLA) at redshift z = 2.904. Taking advantage of the high spectral resolving power of GHOST (R ≈ 55 000), we are able to accurately model the metal absorption lines of the metal-poor DLA and find a supersolar [Si/Fe], suggesting that the DLA gas is in an early stage of chemical enrichment. Using simple ionization models, we find that the large range in the C iv/Si iv column density ratio of individual components within the DLA’s high-ionization absorption profile can be reproduced by several metal-poor Lyman limit systems surrounding the low-ionization gas of the DLA. It is possible that this metal-poor DLA resides within a complex system of metal-poor galaxies or filaments with inflowing gas. The high spectral resolution, wavelength coverage, and sensitivity of GHOST make it an ideal spectrograph for characterizing the chemistry and kinematics of quasar absorption lines.