bluuebunny/crossref_metadata_2025 huggingface dataset:
Excimer laser coronary angioplasty without stenting in a 37-year-old man with acute coronary syndrome involving left main trunk: a case report
Authors: Shigeno Ryo , Hirohata Atsushi
Published: April 2024

Background

Excimer laser coronary angioplasty (ELCA) is utilized to reduce thrombus in acute coronary syndrome (ACS). However, the feasibility and safety of ELCA for patients with ACS involving the left main trunk (LMT) and bifurcation, as well as the safety of a stentless strategy with ELCA, are not well-documented.

Case summary

A 37-year-old man without any past medical history presented with chest pain. Electrocardiogram showed ST-segment elevation in leads I, aVL, and V2–V6. Emergent coronary angiography (CAG) showed a 99% stenosis from LMT to proximal left anterior descending artery (LAD). Intra-aortic balloon pumping (IABP) was initiated. Intravascular ultrasound revealed massive thrombus at the culprit lesion. Thrombus aspiration was not enough to reduce the thrombus, thus, we conducted thrombus vaporization with a 0.9 mm ELCA catheter. Coronary angiography after the procedure showed reduced thrombus with thrombolysis in myocardial infarction grade 3 flow. Considering his age and the complexity of stenting the LMT, we completed the procedure without stenting. After the intervention, we initiated triple antithrombotic therapy. On Day 3, we removed the IABP. On Day 11, CAG showed no significant stenosis. Optical coherence tomography revealed ulceration, indicating the presence of plaque disruption at the proximal LAD as the likely cause of thrombosis. With improvement in CAG findings, we stopped heparin and continued dual antiplatelet therapy. He was discharged on Day 20.

Discussion

Excimer laser coronary angioplasty without stenting can be an option for the patients with ACS involving LMT, especially for younger patients who are suitable to avoid stenting on bifurcation lesions for lifelong management.
The P2X7 Receptor is a Master Regulator of Microparticle and Mitochondria Exchange in Mouse Microglia
Authors: Falzoni Simonetta , Vultaggio-Poma Valentina , Chiozzi Paola , Tarantini Mario , Adinolfi Elena , Boldrini Paola , Giuliani Anna Lisa , Morciano Giampaolo , Tang Yong , Gorecki Dariusz C , Di Virgilio Francesco
Published: April 2024

Microparticles (MPs) are secreted by all cells, where they play a key role in intercellular communication, differentiation, inflammation, and cell energy transfer. P2X7 receptor (P2X7R) activation by extracellular ATP (eATP) causes a large MP release and affects their contents in a cell-specific fashion. We investigated MP release and functional impact in microglial cells from P2X7R-WT or P2X7R-KO mice, as well as mouse microglial cell lines characterized for high (N13-P2X7RHigh) or low (N13-P2X7RLow) P2X7R expression. P2X7R stimulation promoted release of a mixed MP population enriched with naked mitochondria. Released mitochondria were taken up and incorporated into the mitochondrial network of the recipient cells in a P2X7R-dependent fashion. NLRP3 and the P2X7R itself were also delivered to the recipient cells. Microparticle transfer increased the energy level of the recipient cells and conferred a pro-inflammatory phenotype. These data show that the P2X7R is a master regulator of intercellular organelle and MP trafficking in immune cells.
Validation of large animal models in mechanical valve research: a histologic comparison
Authors: Van Hecke Manon , Langenaeken Tom , Rega Filip , Roskams Tania , Meuris Bart
Published: April 2024

OBJECTIVES

Mechanical valves still require life-long anticoagulation. Preclinical animal testing is a crucial step in the assessment of valves; however, the chosen animal model should be carefully considered, and a well-controlled animal model of mechanical valve thrombosis has not been established yet. In this study, a histopathologic comparison was performed to evaluate the representativity of pigs and sheep as large animal models in bileaflet mechanical valve thrombosis research.

METHODS

10 pigs and 8 sheep were implanted with a bileaflet mechanical valve in pulmonary position. During follow-up, no anticoagulative therapy was administered. Pigs were sacrificed between 14 and 38 days for explantation and assessment of the valve. Sheep were sacrificed between 71 and 155 days. Thrombus samples were processed and (immuno)histochemical stainings were applied. A pathologist evaluated the samples morphologically and semiquantitatively and compared these samples to available slides from 3 human patients who underwent redo surgery for acute bileaflet mechanical valve thrombosis, caused by insufficient anticoagulation.

RESULTS

All pigs showed macroscopically evident thrombi on the mechanical valve surface at sacrifice. In contrast, none of the sheep showed any sign of thrombus formation. Histology showed a high fibrin content in thrombi of both human and porcine cases (3/3 vs 8/10). Porcine thrombi showed more cellular organization (0/3 vs 6/10), more calcification (0/3 vs 9/10) and more endothelialization (0/3 vs 6/10). Inflammatory cells were present in all samples and were considered physiological.

CONCLUSIONS

Contrary to sheep, pigs develop thrombi on their mechanical valves in the short-term if no anticoagulation is administered. Histologic comparison of human and porcine thrombi shows comparable findings. The pig model might serve interestingly for further research on valve thrombosis, if it shows not to be an overly aggressive model.
Surgical techniques using an attached patch for large left ventricular pseudoaneurysm after inferior acute myocardial infarction
Authors: Yamada Ryotaro , Okamura Homare , Wada Yohnosuke , Yamaguchi Atsushi
Published: April 2024

We report a case of large left ventricular pseudoaneurysm after inferior acute myocardial infarction. Patch repair is commonly performed; however, only a few studies have described specific surgical techniques for left ventricular pseudoaneurysm repair of the inferior left ventricular wall. As an optimal repair technique for left ventricular pseudoaneurysm of the inferior left ventricular wall is lacking, we believe our technique is safe and effective in repairing this pathology.
Long-term exposure to ambient air pollution and risk of microvascular complications among patients with type 2 diabetes: a prospective study
Authors: Wang Bin , Sun Ying , Zhang Kun , Wang Yuying , Tan Xiao , Wang Ningjian , Lu Yingli
Published: April 2024

Background

Patients with type 2 diabetes (T2D) may disproportionately suffer the adverse cardiovascular effects of air pollution, but relevant evidence on microvascular outcome is lacking. We aimed to examine the association between air pollution exposure and the risk of microvascular complications among patients with T2D.

Methods

This prospective study included 17 995 participants with T2D who were free of macro- and micro-vascular complications at baseline from the UK Biobank. Annual average concentrations of particulate matter (PM) with diameters <2.5 μm (PM2.5), <10 μm (PM10), nitrogen dioxide (NO2) and nitrogen oxides (NOx) were assessed using land use regression models. Cox proportional hazards regression was used to estimate the associations of air pollution exposure with incident diabetic microvascular complications. The joint effects of the air pollutant mixture were examined using quantile-based g-computation in a survival setting.

Results

In single-pollutant models, the adjusted hazard ratios (95% confidence intervals) for composite diabetic microvascular complications per interquartile range increase in PM2.5, PM10, NO2 and NOx were 1.09 (1.04–1.14), 1.06 (1.01–1.11), 1.07 (1.02–1.12) and 1.04 (1.00–1.08), respectively. Similar significant results were found for diabetic nephropathy and diabetic neuropathy, but not for diabetic retinopathy. The associations of certain air pollutants with composite microvascular complications and diabetic nephropathy were present even at concentrations below the World Health Organization limit values. Multi-pollutant analyses demonstrated that PM2.5 contributed most to the elevated risk associated with the air pollutant mixture. In addition, we found no interactions between air pollution and metabolic risk factor control on the risk of diabetic microvascular complications.

Conclusions

Long-term individual and joint exposure to PM2.5, PM10, NO2 and NOx, even at low levels, was associated with an increased risk of diabetic microvascular complications, with PM2.5 potentially being the main contributor.
High Art, High Artists
Authors: Fokt Simon
Published: April 2024

Artists rarely shy away from a drink and other psychoactive substances, yet it seems that there has never been much discussion on what aesthetic or artistic relevance this has to their works and their reception. I outline the scale of the phenomenon focusing on some prominent examples and distinguish a subset of what I call ‘high artworks’. In such artworks, I argue, drug experiences are encoded: their drug-related contextual and intrinsic properties or content are aesthetically or artistically relevant and should be mentioned in any in-depth analysis. I then further argue that it is impossible or at least very difficult to fully appreciate or produce optimal evaluations of a high artwork, unless one has oneself had drug-induced experiences of the kind encoded in the work. This is because such experiences afford one the relevant phenomenal knowledge that is otherwise inaccessible, yet required to gain an adequate level of competence allowing one to fully grasp the work.
Posaconazole in paediatric malignancy and haematopoietic stem cell transplant: dosing to achieve therapeutic concentration
Authors: Weerdenburg Heather , Walker Hannah , Curtis Nigel , Duffull Stephen , Haeusler Gabrielle , Cole Theresa , Gwee Amanda
Published: April 2024

Objectives

Posaconazole is increasingly used for the treatment and prophylaxis of invasive fungal infections in immunocompromised children. We aimed to review evidence for paediatric posaconazole dosing regimens focusing on attainment of target concentrations and frequency of adverse effects.

Methods

In May 2023, the Cochrane, Embase, MEDLINE and PubMed databases were searched for articles reporting posaconazole dosing in children with malignancy or post-haematopoietic stem cell transplantation. Studies reporting the attainment of target serum concentrations were included.

Results

Overall, 24 studies were included. Eighteen studies of the oral suspension consistently reported poor attainment of target concentrations for prophylaxis (≥0.7 µg/mL, 12%–78%) despite high daily doses of 14–23 mg/kg/day (max. 1200 mg/day). Target attainment was significantly affected by gastric pH and food intake. Six studies of the delayed-release tablet (DRT) reported 58%–94% achieved concentrations ≥0.7 µg/mL, with the majority using lower doses of 4–12 mg/kg/day (max. 300 mg/day). Similarly, one study of powder for oral suspension found 67%–100% achieved target concentrations with a dose of 6 mg/kg/day (max. 300 mg/day). As expected, the IV formulation had high attainment of prophylaxis targets (81%–90%) with 6–10 mg/kg/day (max. 400 mg/day). All formulations were well tolerated, and no relationship between adverse effects and posaconazole concentrations was identified.

Conclusions

The required posaconazole dose in immunocompromised children varies depending on the formulation. The IV infusion had the highest attainment of therapeutic concentration followed by the DRT and powder for suspension. By contrast, the oral suspension had low attainment of target concentrations despite higher daily doses.
Antagonistic effect of Bacillus and Pseudomonas combinations against Fusarium oxysporum and their effect on disease resistance and growth promotion in watermelon
Authors: Yang Dongya , Zhang Xueqing , Li Zhaoxuan , Chu Rui , Shah Sadiq , Wang Xiaozhuo , Zhang Xueyan
Published: April 2024

Aims

We aimed to develop an effective bacterial combination that can combat Fusarium oxysporum infection in watermelon using in vitro and pot experiments.

Methods and results

In total, 53 strains of Bacillus and 4 strains of Pseudomonas were screened. Pseudomonas strains P3 and P4 and Bacillus strains XY-2–3, XY-13, and GJ-1–15 exhibited good antagonistic effects against F. oxysporum. P3 and P4 were identified as Pseudomonas chlororaphis and Pseudomonas fluorescens, respectively. XY-2–3 and GJ-1–15 were identified as B. velezensis, and XY-13 was identified as Bacillus amyloliquefaciens. The three Bacillus strains were antifungal, promoted the growth of watermelon seedlings and had genes to synthesize antagonistic metabolites such as bacilysin, surfactin, yndj, fengycin, iturin, and bacillomycin D. Combinations of Bacillus and Pseudomonas strains, namely, XY-2–3 + P4, GJ-1–15 + P4, XY-13 + P3, and XY-13 + P4, exhibited a good compatibility. These four combinations exhibited antagonistic effects against 11 pathogenic fungi, including various strains of F. oxysporum, Fusarium solani, and Rhizoctonia. Inoculation of these bacterial combinations significantly reduced the incidence of Fusarium wilt in watermelon, promoted plant growth, and improved soil nutrient availability. XY-13 + P4 was the most effective combination against Fusarium wilt in watermelon with the inhibition rate of 78.17%. The number of leaves; aboveground fresh and dry weights; chlorophyll, soil total nitrogen, and soil available phosphorus content increased by 26.8%, 72.12%, 60.47%, 16.97%, 20.16%, and 16.50%, respectively, after XY-13 + P4 inoculation compared with the uninoculated control. Moreover, total root length, root surface area, and root volume of watermelon seedlings were the highest after XY-13 + P3 inoculation, exhibiting increases by 265.83%, 316.79%, and 390.99%, respectively, compared with the uninoculated control.

Conclusions

XY-13 + P4 was the best bacterial combination for controlling Fusarium wilt in watermelon, promoting the growth of watermelon seedlings, and improving soil nutrient availability.
23 Beyond the Bedside: Mediating Vacancy in a Specialty Educator Role
Authors: Richerbach Stacey , Hockenberry Tiffany , Foster Kevin N
Published: April 2024

Introduction

National recognition of burn nursing as a specialty is new, but nationwide challenges to recruitment and retention of qualified burn nurses are longstanding. As nursing shortages have reverberated throughout the US, the role of the nurse educator has become integral to onboarding success and continuing education. In a specialty such as burn, the role of the nurse educator is of immense importance. In 2021, the Burn Nurse Educator (BNE) at our facility transitioned from full to part-time. The vacancy in the BNE role proved difficult to fill. Rather than lower the requirements for the position, our team opted to bridge the gap with implementation of a staff-led Burn Education Committee.

Methods

The part-time BNE and Burn Nurse Specialist worked in tandem as co-chairs and recruited committee members. Recruitment was initiated through word of mouth and formal advertisements in the weekly staff newsletter. Recruitment for the Burn Education Committee (BEC) was restricted to staff employed in the Burn Center, but remained open to various roles (e.g., registered nurses, certified burn techs, therapists, etc.). Upon recruiting members, the committee instituted bi-monthly meetings. A Learning Needs Assessment was disseminated to Burn Staff. Topics of interest for education were introduced within the committee, and members collaborated within the group to produce education in a variety of formats.

Results

The BEC developed presentations, tipsheets and flyers, assisted with simulation and mock code events, and members aided in burn-specific course development. As the learning needs expressed by staff per the Learning Needs Assessment were satisfied, the BEC worked to develop education to aid with onboarding and continuing education. Two buckets of virtual lessons were developed for staff. In the first bucket, virtual modules included Introduction to Burn course and Burn Nurse Standards. The first bucket is completed by new staff during orientation and is scheduled to recur annually. The second bucket includes the virtual lessons: Intra-abdominal Pressure Monitoring, Management of Patients with Large Burns, Pediatric Fluid Resuscitation, Train of Four Peripheral Nerve Stimulation, and Warming Measures for Burn Patients. This recurring bucket is scheduled annually and completion is due before our busy season commences.

Conclusions

Feedback from staff was positive, and interest in the committee increased as evidenced by additional staff joining the committee. Implementation of a staff-led BEC has revealed several benefits. Clinical staff have an expedited means of sharing education needs. Additionally, committee members have an expanded sense of purpose in the Burn Center and make an impact that spans beyond the bedside.

Applicability of Research to Practice

This study demonstrates a novel and effective method to provide ongoing burn education to nursing staff in the face of limited resources.
535 An Analysis of Hospital Cost and Reimbursement for Burn Care : Are We Keeping Up?
Authors: Fleischman Mariah , Bhavsar Dhaval , Jean Grace
Published: April 2024

Introduction

Hospital based care for burn patients is very resource intensive. Care of large surface area burn patients involve prolonged ICU stays, numerous surgeries, routine use of costly skin substitutes, almost daily wound care, longitudinal rehabilitation services. Discrepancies between hospital-related burn care costs and reimbursement can negatively impact financial health of burn centers. In this study, we evaluated trends in cost of burn care and reimbursement.

Methods

We reviewed available data from Center for Medicare and Medicaid Services (CMS) for years 2013-2021. The information obtained included submitted total hospital charges, total payments, and hospital payment for DRG (disease related group) codes 9127, 928, and 929 (related to burn care). Additionally, same data was collected for DRG codes related to Bronchitis, Heart Failure, and skin ulcer. Burn associated cost of care and reimbursement was compared against skin ulcer wounds, heart failure, and bronchitis to determine funding variance between different diagnoses. Rate of increase in cost of providing burn care and CMS reimbursement were compared. These changes were also compared to annualized inflation data available through Department of Labor.

Results

We observed trend of increasing burn care costs as evidenced by submitted charges from 2013-2021. Year to year increase for submitted charges was nearly 12%. Reimbursement for burn care increased over the same period too though this increase lagged the increase in cost of care. Year to year increase for total medicare reimbursement was nearly 8% over 2013-2021. Increase in CMS reimbursement was higher than the anticipated numbers based on inflation adjustment alone though lagged far behind real increase in cost of care. Reimbursement data for Skin ulcer, but not Bronchitis and Heart Failure, followed similar trend. Results are tabulated in attached graph.

Conclusions

Cost of providing burn care has increased significantly over the observed period of 2013-2021. Though reimbursements have increased also during this time, they have not kept up with increase in cost of care. This discrepancy suggests burn centers may be experiencing worsening financial stress. While healthcare costs increase annually due to inflation, the greater incremental increase in burn and skin ulcer wound care compared to other conditions reflects a financial demand that cannot be due to inflation alone.

Applicability of Research to Practice

Understanding healthcare economics related to burn care may help us run improve fiscal health of burn centers.
578 A Cross-Sectional Study of Sex, Race, and Ethnic Representation in Burn Clinical Trials
Authors: Sheikh-Oleslami Sara , Tao Brendan , Papp Bettina , Luthra Shreya , Papp Anthony
Published: April 2024

Introduction

The demographic proportions of plastic surgery trials approximating real-world disease are not well studied. Judicious trial representation is essential in treatment evaluation across diverse patient populations. Herein, we investigate sex, racial and ethnic disparities in patient enrollment across burn trials.

Methods

Cross-sectional analysis of participants enrolled in high-quality, reduced risk of bias, randomized controlled trials (RCT) registered on clinicaltrials.gov under the query “burn”. Completed RCTs reporting minimum two demographic groups, employing double masking or greater, with results accessible through registry or publications were included. Trial characteristics (country, site location, year, study phase, masking) and demographic data (sex, race, ethnicity) were collected. The Global Burden of Disease database provided sex-based burn disease burdens.

Results

The primary outcome was the population-to-prevalence ratio of enrolled female participants. Secondary outcomes included representation of racial and ethnic populations as related to blinding, phase, and study/sponsor locations. Of 546 trials, 41 were included (2919 participants). All reported sex demographics, females comprising 37.02% of all participants (PPR=0.71, 95%CI [0.59,0.82], likely indicating underrepresentation against their empiric disease burden). Only 7 and 9 reported ethnicity and race, respectively, although not comprehensively. Caucasians and Black persons comprised 57.52% and 21.80% of participants, respectively, while only 9.80% had Hispanic/Latino ethnicity.

Conclusions

Females are likely underrepresented in high-quality, US-registered burn trials, unreflective of their real-world disease burden. Further, severe underreporting of race and ethnicity was noted. It is imperative that future trials collect and report demographic data, namely race and ethnicity, and attempt enrolment of diverse demographics and equitable populations for promotion of study generalizability of efficacy data across relevant populations.

Applicability of Research to Practice

As there is natural variation in the effect of various medications, treatments, or medical products used amongst different sexes and diverse races due to factors such as differing physiological and genetic characteristics, enrolment of participants reflective of the disease pool studied is essential in investigations of treatments or devices intended for clinical practice. Failure to encompass all populations, due to lack of diversity in undergoing treatments further compounds healthcare disparity.
579 An Analysis of Burn ICU Days from the National Injury Resource Database
Authors: Ivanko Anastasiya , Schoen Jonathan E , Hickerson William L , Phelan Herb A , Phillips Bart D , Carter Jeffrey E , Danos Denise
Published: April 2024

Introduction

Burns are a time-sensitive injury that require accurate assessment, triage, and treatment. Access to burn treatment has been a challenge since only 2% of hospitals in the United States have a burn center. To guide clinicians, the ABA created burn center referral guidelines. The objective of this study was to investigate the National Injury Resource Database (NIRD) and 2021 claims data to discern if patients with a primary diagnosis of burn injury and requiring ICU-level care were treated at burn centers.

Methods

After obtaining IRB approval, NIRD, a validated composite of 53 databases representing Burn and Trauma centers in the United States, and de-identified 2021 claims data, which included hospitals, free-standing emergency rooms, Burn Centers (BC), and Trauma Centers (TC), were merged. Burn ICU days (BICUD) were used as opposed to admissions given the potential for interfacility transfers. Descriptive statistics were calculated using Excel, with logistic regression analysis of additional facility variables

Results

Our study included 8,241 facilities with 615 TCs, and 134 BCs. Previous work has noted that 481 of the 615 TCs are NOT at facilities with a BC, and that 18 of the 134 BCs are NOT at facilities with a TC. Of the total 784,309 BICUD, 60.7% occurred at facilities without BCs or TCs and 39.3% occurred at facilities with either a TC or BC. 10.8% occurred at facilities with TC without a BC. 28.5% occurred at facilities with a BC, of which 87.2% occurred at facilities with TCs and 12.8% occurred at BCs without TCs.

Conclusions

Our data shows that the majority of BICUD occur at facilities with neither BCs nor TCs. Patients requiring BICUD likely meet ABA referral criteria and if treated at non-BC, are not included in the Burn Care Quality Platform (BCQP). Additional studies are needed to discern the validity of the data, and the quantity/quality of the care occurring at all facilities, and if that care meets ABA referral criteria to a BC.

Applicability of Research to Practice

This abstract sheds light on where the majority of burn patients are treated, and therefore will help pave the road to better understanding the quantity/quality burn care that occurs outside of burn and trauma centers.
584 Improving the Quality of Trainee Burn Size Estimation on Admission to a Regional Burn Center
Authors: Bullis Jack , Kurup Meghna , Mickelson Lori , Gibson Angela , Faucher Lee D , Nosanov Lauren B
Published: April 2024

Introduction

Accurate estimation of total body surface area (TBSA) with documentation on a Lund Browder (LB) chart is critical in guiding burn treatment and determining proper level of care. Recent quality improvement (QI) review of a series of patients admitted to our regional burn center has raised concerns about inaccurate admission TBSA estimations. The purpose of this study is to evaluate initial LB charts and subsequent iterations throughout the hospitalization in order to identify opportunities to improve TBSA fidelity and subsequent delivered care.

Methods

The Burn Center institutional registry was queried for all patients admitted over a three-month period. After exclusion of those with non-burn etiologies, retrospective chart review was performed for remaining patients to gather data on demographics, injury characteristics, and clinical outcomes. TBSA estimations assessed included outside hospital, Emergency Department, burn center admission, and all other completed LB diagrams from the index hospitalization. Patients were subcategorized by time of admission and whether admitting attending staff was primarily specialized in Burns. Percentage difference between admission and final LB was computed to analyze under- and over-estimation tendencies.

Results

After exclusions, 100 patients – 53 adult and 47 pediatric cases – admitted 5/2023-8/2023 were included for analysis. The patient cohort was young (median 19 years) and predominantly male (65.0%). Most common burn etiologies were flame (33.0%), scald (28.0%), and contact (24.0%). Night/weekend admissions by the covering Acute Care surgeons comprised 54.0%. Admission total TBSA was equivalent to final TBSA for 75.0%, while 14.0% initially underestimated and 11.0% overestimated. Among patients with TBSA ≧ 20.0%, 44.4% had consistent initial to final TBSA while 55.6% underestimated, all of whom were admitted by a non-Burn physician at night or on the weekend. In this large burn cohort, the percent difference of underestimation ranged from 4.1-21.9%.

Conclusions

Lack of experience and familiarity with burn size estimation may make LB completion challenging, with associated clinical consequences. In our patient population this was particularly a problem in larger burns admitted by covering Acute Care Surgery staff. While over-estimation by referring facility and Emergency Medicine providers is common, admission initial LBs tended to underestimate in these cases. Further QI work is planned to improve the accuracy of initial TBSA calculations through use of a physician-nursing huddle protocol.

Applicability of Research to Practice

Inaccurate estimations of TBSA, especially upon admission, can lead to life-threatening consequences from inappropriate resuscitation and mis-triage. Our goal is to target initial LB completion processes to improve care while also fostering interprofessional teamwork.
595 Unremitting Pro-inflammatory Cell Phenotypes and Macrophage Activity, Following Paediatric Burn Injury
Authors: Langley Donna , Krenske Emma , Zimmermann Kate , Stefanutti Giorgio , Kimble Roy M , Holland Andrew J A , Fear Mark , Wood Fiona M , Kenna Tony , Cuttle Leila
Published: April 2024

Introduction

Burns patients are susceptible to infection, and some studies suggest patients exhibit post-burn immunosuppression. However, the trajectory of immune cells after a burn injury are unknown. Furthermore, the immune cells associated with poor healing outcomes are also unknown. Aim 1 of this study characterised the immune profile of paediatric burn patients for over 18 months post-burn. Aim 2 identified the immune cells and inflammatory markers related to delayed burn wound healing.

Methods

Flow cytometry was used to measure 26 cell lineage markers, chemokines and cytokines from both pro-inflammatory and anti-inflammatory immune profiles. In aim 1, Peripheral Blood Mononuclear Cells from 6 paediatric burn patients who had returned for burn and scar treatments over 4+ timepoints within 12 months post-burn were compared to 4 healthy controls. Aim 2 recruited 10 burn patients who re-epithelialized in < 21 days, 10 patients who re-epithelialized in >21 days, and 10 healthy control patient cells. All participants were children under 10 years age, with partial or full thickness scald or contact burns, 1-34% TBSA. Healthy controls were age and gender-matched.

Results

While the level of basic immune cells such as CD4 and CD8 T cells remained relatively constant, over time T cells differentiated into proinflammatory cell phenotypes including Th17 and γδ-T cells. There was a 3-fold increase of IL-17 production from γδ-T cells in the first 3 weeks post-burn(p< 0.01). CCR4+CCR6+ T-regulatory cells positive were elevated at 9-18 months post-burn (p< 0.05). Alternatively activated (M2) macrophages displayed a 3.5-fold increase compared with controls (p< 0.01). Aim 2 preliminary results showed children with burns who re-epithelialized in under 21 days had variable abundance of T regulatory cells. Further, children with burns had a higher abundance of double positive CCR4+CCR6+ Tregs than healthy controls.

Conclusions

Our results indicate immune cells do not increase or decrease over time post-burn, but they become highly specialised, inflammatory, and skin homing. These changes persist for 18 months post-burn, and this post-burn “immune distraction” may limit the ability of immune cells to prioritise responses to other threats, such as infections. Additionally, therapies which target the immune cells associated with delayed wound healing may enhance healing outcomes for paediatric burn patients.

Applicability of Research to Practice

This project identifies targets in the immune/inflammatory response which if mediated, could improve burn wound healing outcomes.
598 Structural Characterization and Safety Validation of Cultured Skin Cells in Pediatric Incubators: A Preliminary Report
Authors: Kleintjes Wayne G , Prinsloo Tarryn K
Published: April 2024

Introduction

Skin substitutes, such as cultured epithelial autografts (CEA), have been utilized for wound treatment with improved outcomes. CEA can be used as a ‘stand-alone’ treatment, but combining it with temporary coverage has shown to increase graft take. The aim of this preliminary observational and prospective controlled study was to report on the histological findings of the cultured CEA and to demonstrate its safety for routine use.

Methods

Skin cells were retrieved from biopsies and placed in autologous platelet-rich plasma. The cells were then seeded onto bacteria- and fungi binding dressing pads that is routinely used and incubated in pediatric incubators at 37 °C. Fresh plasma was applied daily and amorphous hydrogel administered every third or fourth day. After 2 weeks, confluence was reached, the culture sample was fixed with to the slide. Hematoxylin and eosin, and Masson’s Trichrome stains were used for histological evaluation. Light microscopy at 4X and 10X magnification was used to observe the cultured epithelial layers and cells, respectively. Bacteriological safety was externally assessed by analyzing wound swabs of the confluent monolayers grown in both pediatric and standard culture incubators (n=10 each) before and after transplant for microscopy and culturing. The primary outcome of was skin histology and the secondary outcome was the presence of pathogens.

Results

Typical epidermal and dermal (papillary and reticular) layers were clearly observed, along with the classical differentiation patterns of the epidermal sublayers. Keratinocytes were observed as densely packed colonies along with the mediated spread of collagen. The potential presence of adipose droplets could not be excluded. No pathogenic organisms were observed in any of the cell culture specimens tested.

Results

Typical epidermal and dermal (papillary and reticular) layers were clearly observed, along with the classical differentiation patterns of the epidermal sublayers. Keratinocytes were observed as densely packed colonies along with the mediated spread of collagen. The potential presence of adipose droplets could not be excluded. No pathogenic organisms were observed in any of the cell culture specimens tested.

Conclusions

The differentiated nature of this dressing-grown CEA emulated the epidermis to a large degree. Cell differentiation was not only indicative of functional integrity, but mechanical integrity outcomes of the technique as well. No difference could be demonstrated between the different incubators in terms of the pathogenic bacteria grown or cell culture growth.

Applicability of Research to Practice

These preliminary findings suggest that the cultivated CEA using the modified technique may possess ideal skin-related characteristics that is safe for use. This is essential for favorable grafting outcomes that is not limited as treatment for burn wounds only.
800 Increased Incidence of Intraoperative Hypothermia in Burn Patients Administered Famotidine Preoperatively
Authors: Bingi Sai Pranathi , Jilani Taha , Free John , Pang Alan , Griswold John A
Published: April 2024

Introduction

Interoperative hypothermia is a surgical complication that can result in a variety of adverse intraoperative and postoperative outcomes such as cardiovascular events, infection, and hemorrhage. Burn patients are especially at risk of hypothermia due to prolonged surface exposure and impaired skin thermoregulation. The stress and metabolic demands caused by burn injuries further impair the body’s thermoregulatory responses. Famotidine, a widely used H2 receptor antagonist, is administered preoperatively to prevent stress ulcers in patients undergoing surgery with general anesthesia. Previous studies have shown that Famotidine can decrease core temperature through central thermoregulation. However, other studies provide conflicting results. As burn patients are especially at risk of interoperative hypothermia, it is important to study the role of famotidine in producing intraoperative hypothermia in these patients under general anesthesia.

Methods

To answer this question, we conducted a retrospective study using the electronic medical records of Burn Intensive Care Unit patients. Patients were matched based on demographic criteria such as age, gender, body mass index (BMI), and race. We defined intraoperative hypothermia as a decrease in core body temperature below 36.5 degrees Celsius during a surgical procedure.

Results

When comparing groups using a chi-squared test of independence, we found that patients who received famotidine preoperatively (n = 58) had a higher incidence of interoperative hypothermia versus those that did not receive famotidine preoperatively (n = 137). The statistical significance of this incidence was higher when excluding BMIs of greater than 30 (p = 0.002) versus greater than 35 (p = 0.009) or greater than 40 (p = 0.065).

Conclusions

The observed relationship between patients who received famotidine preoperatively and interoperative hypothermia is stronger when excluding patients with a BMI greater than 30 versus excluding patients with a BMI greater than 40. This relationship may be due to the fact that those with higher BMIs are less likely to develop hypothermia, overcoming the physiological effect that famotidine creates.

Applicability of Research to Practice

Given the relationship between thermoregulation and potential mortality, there is a clear motivation to reduce hypothermia in burn patients to improve patient outcomes. In fact, hypothermia increases the risk of infection, which is a major cause of mortality in burn patients. Since Famotidine was shown to increase the incidence of intraoperative hypothermia under general anesthesia, we suggest a safer option be explored.
Radiation-influenced magnetohydrodynamic third-grade nanofluid flow around non-linearly stretched cylinder
Authors: Akbar Asia Ali , Awan Aziz Ullah , Niazai Shafiullah , Nadeem Sohail , Ahammad N Ameer , Alroobaea Roobaea , Alzubadi Hanadi , Gamaoun Fehmi
Published: April 2024

This analysis considers the magnetized third-grade fluid stream and microorganisms over a non-linear stretchy cylinder. The radiation impacts are taken into consideration. The effects of the governing flow at the cylinder are represented in the form of PDEs employing boundary layer approximations. The system of the PDEs is further reduced in dimensionless form after applying the similarity transformations. The dimensionless system of non-linear ODEs is solved through the numerical technique bvp4c. The effects of radiation and magnetism on the third-grade liquid over a non-linear extending cylinder are highlighted in graphs and numerically in tabular form. The influence of fluid variables on the velocity curve, such as third-grade parameters, second-grade coefficients, and Reynolds number, is illustrated and explored. Suitable ranges for the parameters $( {1 \le \eta \le 10,\ 0.2 \le {{\alpha }_1} \le 0.5,\ 0 \le {{\alpha }_1} \le 1.5,\ 0.1 \le \beta \le 0.3,\ 0.1 \le \gamma \le 1.6,\ 0.05 \le M \le 0.15,\ 0.5 \le \delta \le 2.0,\ 0.7 \le Pr \le 1.3,\ 0.1 \le Rd \le 0.4,0.1 \le}$  ${e \le 0.4} )$ are chosen depending upon the convergence of the numerical method. The widths of the velocity and momentum boundary layers are revealed to be increasing functions of the curvature parameter. The temperature curve declines when boosting third-grade parameters, thermal stratification, and Hartmann number while boosting up for curvature and radiation parameters.
Genomic diversity and demographic history of the endangered Sichuan hill-partridge (Arborophila rufipectus)
Authors: Liu Yi , Kuang Weimin , Yue Bisong , Zhou Chuang
Published: April 2024

Species conservation can be improved by knowledge of genetic diversity and demographic history. The Sichuan hill-partridge (Arborophila rufipectus, SP) is an endangered species endemic to the mountains in southwestern China. However, little is known about this species’ genomic variation and demographic history. Here, we present a comprehensive whole-genome analysis of six SP individuals from the Laojunshan National Nature Reserve in Sichuan Province, China. We observe a relatively high genetic diversity and low level of recent inbreeding in the studied SP individuals. This suggests that the current population carries genetic variability that may benefit the long-term survival of this species, and that the present population may be larger than currently recognized. Analyses of demographic history showed that fluctuations in the effective population size of SP are inconsistent with changes of the historical climate. Strikingly, evidence from demographic modeling suggests SPs population decreased dramatically 15,100 years ago after the Last Glacial Maximum, possibly due to refugial isolation and later human interference. These results provide the first detailed and comprehensive genomic insights into genetic diversity, genomic inbreeding levels, and demographic history of the Sichuan hill-partridge, which are crucial for the conservation and management of this endangered species.
Teaching children pedestrian safety in virtual reality via smartphone: a noninferiority randomized clinical trial
Authors: Schwebel David C , Johnston Anna , McDaniel Dominique , Severson Joan , He Yefei , McClure Leslie A
Published: April 2024

Objective

To evaluate whether child pedestrian safety training in a smartphone-based virtual reality (VR) environment is not inferior to training in a large, semi-immersive VR environment with demonstrated effectiveness.

Methods

Five hundred 7- and 8-year-old children participated; 479 were randomized to one of two conditions: Learning to cross streets in a smartphone-based VR or learning in a semi-immersive kiosk VR. The systems used identical virtual environments and scenarios. At baseline, children’s pedestrian skills were assessed in both VR systems and through a vehicle approach estimation task (judging speed/distance of oncoming traffic on monitor). Training in both conditions comprised at least six 30-min sessions in the randomly assigned VR platform and continued for up to 25 visits until adult-level proficiency was obtained. Following training and again 6 months later, children completed pedestrian safety assessments identical to baseline. Three outcomes were considered from assessments in each VR platform: Unsafe crossings (collisions plus close calls), time to contact (shortest time between child and oncoming simulated traffic), and missed opportunities (unselected safe opportunities to cross).

Results

Participants achieved adult-level street-crossing skill through VR training. Training in a smartphone-based VR system was generally not inferior to training in a large semi-immersive VR system. There were no adverse effects.

Conclusions

Seven- and 8-year-old children can learn pedestrian safety through VR-based training, including training in a smartphone-based VR system. Combined with recent meta-analytic results, the present findings support broad implementation and dissemination of child pedestrian safety training through VR, including smartphone-based VR systems.
Hysteroscopic management of complete septate uterus with septate cervix, and longitudinal vaginal septum: a case report
Authors: Ahmed Nahida Hama Ameen , Sabr Nasren Sharef , Bapir Rawa , Hiwa Dilan S , Hasan Ali H , Salih Rawezh Q , Tahir Soran H , Abdalla Berun A , Othman Snur , Kakamad Fahmi H
Published: April 2024

Mullerian anomalies occur as a result of errors during embryogenesis. The estimated incidence of these anomalies is around 1% in the general population and 3% in women complaining of suboptimal reproductive outcomes and infertility. A 21-year-old female patient was referred to our hospital due to primary infertility for 18 months. After a proper history, physical examination and further diagnostic steps, including ultrasound and magnetic resonance imaging, a diagnosis of complete septate uterus with septate cervix and longitudinal vaginal septum was made. Following hysteroscopic resection of all the septa and two cycles of ovulation induction, the patient was able to conceive. However, she needed cervical cerclage later due to cervical insufficiency. The baby was delivered at term and was healthy. A uterine, cervical and longitudinal vaginal septum is a unique entity of Mullerian anomalies. Resection of all septa through a hysteroscopic approach resulted in a good outcome for our patient.
Oligometastatic colorectal adenocarcinoma to the spleen and ovaries
Authors: Heath Lucienne , Novis Elan , Rabindran Joel , van Laar Veth Alexander , Yang Tao , Barnet Megan B , Gett Rohan
Published: April 2024

In the context of colorectal cancer, splenic and ovarian metastases are rare outside of widely disseminated disease. Growing evidence suggests that ‘oligometastatic’ or limited metastatic disease can be treated surgically with good oncological outcomes. Splenic and ovarian metastases are not well represented in studies of oligometastatic colorectal cancer, resulting in uncertainty in the best management for these patients. We present the case of a 78-year-old woman diagnosed with oligometastatic colorectal cancer to bilateral ovaries and spleen, 5 years after resection of a primary colon cancer. The patient was treated with a bilateral salpingo-oopherectomy and subsequent open splenectomy. We discuss the role of surgery and peri-operative chemotherapy in the management of oligometastatic colorectal cancer involving atypical sites.
Distribution and recovery phase of geomagnetic storms during solar cycles 23 and 24
Authors: Mishra Wageesh , Sahani Preity Sukla , Khuntia Soumyaranjan , Chakrabarty Dibyendu
Published: April 2024

Coronal mass ejections (CMEs) and Stream Interaction Regions (SIRs) are the main drivers of intense geomagnetic storms. We study the distribution of geomagnetic storms associated with different drivers during solar cycles 23 and 24 (1996–2019). Although the annual occurrence rate of geomagnetic storms in both cycles tracks the sunspot cycle, the second peak in storm activity lags the second sunspot peak. SIRs contribute significantly to the second peak in storm numbers in both cycles, particularly for moderate to stronger-than-moderate storms. We note semiannual peaks in storm numbers much closer to equinoxes for moderate storms, and slightly shifted from equinoxes for intense and stronger-than-intense storms. We note a significant fraction of multiple-peak storms in both cycles due to isolated ICMEs/SIRs, while single-peak storms from multiple interacting drivers, suggesting a complex relationship between storm steps and their drivers. Our study focuses on investigating the recovery phases of geomagnetic storms and examining their dependencies on various storm parameters. Multiple-peak storms in both cycles have recovery phase duration strongly influenced by slow and fast decay phases with no correlation with the main phase build-up rate and Dst peak. However, the recovery phase in single-peak storms for both cycles depends to some extent on the main phase build-up rate and Dst peak, in addition to slow and fast decay phases. Future research should explore recovery phases of single and multiple-peak storms incorporating in situ solar wind observations for a deeper understanding of storm evolution and decay processes.