bluuebunny/crossref_metadata_2025_split huggingface dataset:
113 Successful Treatment of Sulfur Mustard Burns with Silver-Nylon Dressings
Authors: Barillo David J , Croutch Claire R , Barillo Anthony R , Reid Frances M 
Published: March 2020

Abstract

Introduction
Sulfur mustard (SM) is a chemical weapon first used in 1917 and in 11 subsequent regional conflicts including use by ISIS in Syria in 2016. SM skin exposure results in burns that are indolent, recurrent and hard to treat. Despite 100 years of experience, there is no standard of care for SM burns. We tested silver-nylon dressings in a porcine model of partial thickness SM injury.

Methods
The study was performed in an AAALAC-approved facility under Good Laboratory Practices (GLP) standards. A total of 1320 superficial or deep partial thickness burns were produced in 165 Gottingen minipigs by vapor cap exposure. The wounds were then debrided with 7 days of saline wet/wet dressings. Silver-nylon dressings were applied and changed daily, every 4 days or every 7 days. Control dressings were silver sulfadiazine changed daily. Dressings were left intact for 30 days followed by 7 days of no treatment. Animals were euthanized and wounds assessed by histopathology (primary endpoint). The non-inferiority margin for histopathology score was 1.5 (10% of maximum possible score).

Results
There was no mortality or wound infection seen. Silver-nylon when applied once every 7 days to superficial or deep wounds was not inferior to the comparator treatment, SSD on gauze, as evaluated by histopathology (Δ =0.38 95% CI = 0.15, p = 0.0001). There was no statistical difference when comparing silver nylon applied daily, every 4 days or every 7 days in either superficial or deep wounds Chart # 1). Blood silver levels were drawn pre-study, mid study and at autopsy. Blood silver levels were negative in all cases (n= 480). At study end, silver ion was detected in virtually all wounds. Mean skin silver ion levels in wounds treated with daily SSD on gauze or BCD bandage every 1, 4, or 7-days were 3.74, 3.61, 5.43, and 4.40 μg/g, respectively for deep dermal wounds and 2.41, 1.91, 3.75, and 2.73 μg/g,respectively for superficial dermal wounds.There was no statistically significant difference between any of the bandage treatments with regard to silver ion levels in skin punch biopsies collected on Study Day 46.

Conclusions
Silver nylon dressings provide effective treatment for sulfur mustard burns. As in prior studies, silver-nylon provides high wound silver levels without systemic absorption. The data from this study was submitted to the US Food and Drug Administration, resulting in the first-ever FDA clearance for a product indicated to treat sulfur-mustard skin burns.

Applicability of Research to Practice
Silver-nylon dressings can be successfully used to treat cutaneous partial-thickness sulfur mustard skin burns.
524 The Use of Enzymatic Debridement in Large Burns Two Years of Experience
Authors: Minic Jasminka , Governa Maurizio 
Published: March 2020

Abstract

Introduction
Modern era of treatment of burn injury stated with revolutionary approach of early surgical debridement followed by autologous skin grafting since early sixties of the last century. For many decades it’s been a gold standard treatment. It’ s considered effective although not selective approach in terms of blood loss and vital tissue preservation.
We hypothesized that selective enzymatic debridement could have the positive outcome in terms of local control of wound healing and could decrease systemic inflammatory response.

Methods
Since February 2017 till February 2019 in our Burn Unit, we treated over 50 cases of partially deep and deep burns. Thirty nine out of 50 was &gt;15% TBSA (15 - 85%). Most of the patients (34 out of 39) was treated in BU or ICU. According to our protocol allograft skin grafting followed enzymatic debridement. Skin biopsy was performed before and after treatment. Three cases died for other complications and comorbidity.

Results
We respected the gold standard performing complete selective debridement within 1,4 days. Mean age was 54,1ys (1.1–96 ys). No blood transfusion was necessary after enzymatic debridement. Only one procedure was necessary for the majority patients (32 out of 39 pt). Twenty eight out of 39 patients went to OR for skin grafting. For the burn wound completion there was a necessity of average 5,8% autografts. Infection was well controlled with antibiotics therapy. Five cases of sepsis and one case of bacteremia was registered.

Conclusions
Regardless it a limited number of patient and only one year of experience, obtained results are encouraging. Rapid enzymatic debridement as a minimally invasive tool permitted to control burn wound not only on the local level but it seam like that has improved pro and anti-inflammatory response in terms of better control of the SIRS. Further investigations will be necessary to confirm it.

Applicability of Research to Practice
This study is applicable inner practice. All the following data were took from our data base system.
565 Suicidality After Burn Injuries: A Systematic Review
Authors: Lerman Sheera F , Hultman C Scott , Cox Carrie A , Caffrey Julie 
Published: March 2020

Abstract

Introduction
Burn injuries are associated with substantial pain and disability and may lead to significant long term psychological distress including suicidality. Suicide is among the leading causes of death in the United States and burn survivors may be at increased risk due to the nature of their injury and psychiatric comorbidities. The purpose of this review is to assess the evidence as to the prevalence of suicidal ideations and behaviors (attempts and completed suicides) in burn survivors as well as assessment of risk and protective factors for these behaviors.

Methods
MEDLINE, CINAHL, EMBASE and PsycINFO databases were searched using search terms regarding suicide, suicidality and burn. Studies evaluating self-immolation were excluded unless they also measured suicidality after the injury. Fourteen observational and population-based studies which measured any type of suicidality (ideation, attempts or completed suicide) post-burn injuries underwent critical appraisal.

Results
Few studies directly measure suicidality after burn injuries, and even fewer measure changes in suicidality over time. Overall, burn survivors demonstrate elevated suicidal ideations with rates as high as 32%. Pain at discharge, perceived level of disfigurement and premorbid psychiatric comorbidities are among the significant risk factors for suicidal ideations. There is mixed evidence as to rates of completed suicide post-burn injury, though rates appear to be relatively low.

Conclusions
Results of this systematic review shed light on the scarcity of data on rates of suicidality among burn survivors. This is surprising given the multiple risk factors burn survivors possess including chronic pain, sleep disturbances, history of substance abuse, post-traumatic stress disorder, social isolation and depression which are linked to suicidality in the general population. In addition, individuals with self-inflicted burns may be at even higher risk given that previous suicide attempts are of the strongest predictor of future suicidality. More research is needed to better understand the impact of these risk factors in burn survivors and inform their care.

Applicability of Research to Practice
There is high importance in screening burn survivors for suicidal ideations at discharge from the hospital and following them over time in order to understand the magnitude of this phenomena and offer targeted interventions to vulnerable individuals.
599 Critical Burn Injury in Young Children: A New Challenge of Success
Authors: Lodescar Rachelle J , Bessey Palmer Q , Rabbitts Angela , Greenwald Bruce M , Gallagher James 
Published: March 2020

Abstract

Introduction
Critical burn injury in young children now happens rarely, thanks to many prevention efforts. The challenge that presents is that neither most burn center teams (BC) or pediatric critical care teams (PICU) have sufficient experience to maintain broad expertise in the care of these uncommon but vulnerable patients. Several years ago our BC team and PICU team agreed to co-manage these patients no matter where they were admitted in the hospital. The purpose of this report is to review the results of this cooperative approach.

Methods
We reviewed all pediatric admissions (age 0 to 15) admitted with acute burn injury from October 2015 – September 2019. We further identified those who were co-directed with the PICU. In those cases, senior members of both teams consulted either on the referral call or before the patient’s arrival, both teams rounded together on the patients, and most clinical decisions were made jointly. The burn team performed wound care with bedside caregivers from the PICU as needed. Where the patient was housed in the hospital (BC or PICU) was a secondary but joint decision, guided by the clinical needs of the patient and not by the preference of the team ‘in charge’ of the unit. Data were analyzed with SAS 9.4 and are expressed as Mean ± SEM. Differences in means were tested for significance with TTest and Chi Square.

Results
There were 799 patients admitted with burn injuries over the four-year period. Twenty-seven of them (3.4 ± 0.6 %) had a portion of their care co-directed. These were older than all other pediatric cases (4.9 ± 0.7 years vs 3.2 ± 1.5, p=0.03), and they had larger mean burn size (20 ± 7 % TBSA vs 4 ± 0.2, p=0.03). They more often had inhalation injury (40.7 ± 9.6 % vs 0.9 ± 0.3, p&lt; 0.01). The length of stay of the co-directed patients was longer than the other cases (14 ± 3 days vs 5 ± 1, p&lt; 0.01). Only two patients died: a four-year old with cardiac arrest at the scene from inhalation injury and a three-year old with inhalation injury and a deep burn &gt; 80% TBSA.

Conclusions
Critical burn injuries happen uncommonly in young children. They challenge burn centers, because they are unusual, and it is difficult for the burn team or the PICU team to maintain expertise in all aspects of their care. A cooperative, co-directed patient care model with both the BC and PICU teams may serve to provide optimal care to these infrequent but vulnerable patients.

Applicability of Research to Practice
Directly Applicable.
650 Exploring the Mechanism of Wound Healing in Rats of Different Ages Using a Burn Model
Authors: Shen Chuanan 
Published: March 2020

Abstract

Introduction
This study attempted to explore the mechanism of wound healing in rats of different ages using an reliable and reproducible burn model.

Methods
A self-made metal column, heated in a boiling water bath, was applied for different time periods to the lower back of rats of different ages in burn creation. Wounds were observed visibly at different time points post burning. Biopsies were obtained and examined at 72 h post burn to determine the depth of burns. In exploring the mechanism of wound healing in rats of different ages, we used primary antibodies including Anti-EGFR [EP38Y] (ab52894) and p75NTR (D4B3) for immunofluorescence of the skin paraffin sections (5μm) obtained from normal rats and on day 3 post burn creation. And we measured the expression of CD271 and EGFR.

Results
The contact durations producing the desired depth of injury in the rat model under constant temperature and pressure were: 3 seconds (deep second degree) and 5 seconds (third degree) in 1-month-old rats; 3 seconds (superficial second degree), 5 seconds (deep second degree), and 7–9 seconds (third degree) in 2-month-old rats; 3–5 seconds (superficial second degree), 7–9 seconds (deep second degree), and 11–13 seconds (third degree) in 12- and 18-month-old rats. The distribution of CD271 and epidermal stem cells showed no age-related changes (P＞0.05), and the expression of EGFR decreased with age in normal rats (P＜0.001). Compared with normal rats, the content of CD271 and epidermal stem cells and the expression of EGFR increased in burned rats.

Conclusions
The reliable and reproducible experimental model produces consistent burn injuries in rats of different ages. The number of CD271 and epidermal cells and the expression of EGFR increase during wound healing in rats, suggesting that CD271, epidermal cells and EGFR in epidermal stem cell membranes are associated with burn wound healing.

Applicability of Research to Practice
This research may be used in clinical practice in the future for better wound care.
715 Early Ambulation for Enhanced Recovery After Burn Surgery: A Systematic Review and Meta-analysis
Authors: Lagziel Tomer , Ramos Margarita , Klifto Kevin M , Steal Stella , Caffrey Julie , Hultman C Scott , Asif Mohammed 
Published: March 2020

Abstract

Introduction
Accurate models are a fundamental prognostic tool for risk stratification, therapy guidance, resource allocation, and comparative effectiveness research. Enhanced recovery after surgery protocols are developed to increase early post-operative recovery rates in surgical patients. Due to the unique nature of burn injuries and post-operative care, there is a need to develop a protocol unique to burn surgery, enhanced recovery after burn surgery.

Methods
The PubMed, Embase, Cochrane, and Web of Science databases were systematically searched. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) and Cochrane guidelines were strictly followed throughout the study. Search terms were utilized to capture the relevant studies relating to early ambulation of adult burn patients (&gt;18 years of age) and their post-surgical outcomes such as graft take, time to discharge, pain levels, VTEs, and length-of-stay.

Results
Thirteen of 888 studies retrieved from the search query were eligible for systematic review and meta-analysis. Patients with delayed ambulation, after 5 or more days were found to have increased pain levels at rest (p=0.02) and when ambulating (p=0.08). One study found an increased infection rate in late ambulatory patients (p=0.22). Most results from studies did not have significant data that was relevant to our extraction. For example, only one study assessed pain levels and only three studies notes zero venous thromboembolisms (without statistical significance).

Conclusions
Limited evidence exists relating to thromboembolic events and time-to-ambulation in post-operative burn patients. There are no significant differences in the number of events between early and late ambulation groups. Early ambulation should be included as part of the ERABS protocol for lower risks of hospital-acquired infections due to shorter lengths-of-stay. Decreased associated pain levels could lead to decreased risk for opioid dependence. Due to limited literature references, these conclusions are immature and more studies should be performed in order to develop more accurate and effective protocols.

Applicability of Research to Practice
Burn surgery recovery patients are unique. Therefore, specialized protocols must be developed to enhance their post-operative care.
720 Scalds and Contact Burns: Are They Really Different?
Authors: Singer Adam , Baer Evyatar , Thode Henry 
Published: March 2020

Abstract

Introduction
Prior studies comparing scalds and contact burns rarely address the affect of burn etiology on burn depth. However, it is commonly believed that scalds tend to heal faster than similarly sized contact and flame burns. As a result, expectant therapy is often preferred after scald injuries. We compared the percentages of full-thickness burns based on burn etiology controlling for burn size, location and patient age. We hypothesized that the percentage of full thickness burns would be lower after scalds compared with contact and flame burns.

Methods
We performed a retrospective chart review of a prospectively collected burn registry of all patients admitted to a regional burn center between 2000–2010. Data collection included patient and burn characteristics including age, gender, body location, and burn etiology. We compared the percentages of full thickness burns among scald, contact and flame burns using Chi-square tests. Stepwise logistic regression was used to adjust for age, location, and burn size.

Results
There were 1038 patients in the study with either scald (n=537, 52%), fire/flame (n=434, 42%) or contact (n=67, 6%) burn. Mean (SD) age was 29 (25); 75% were male. Mean (SD) total body surface area (TBSA) was 11 (13)%. Mean (SD) length of stay was 10 (18) days. The percentages of full thickness burns by etiology were scalds 13.1%, fire/flame 34%, and contact burns 45% (P&lt; 0.001). Patients with scalds were younger (22+/-24) than patients with contacts (32+/-28) and fire/flame (38+/-22) burns. Multivariate analysis for predicting full thickness burns found that compared with contact burns, scalds were less likely full thickness (OR 0.23, 95%CI 0.11–0.48) while fire/flame burns were as likely to be full thickness (OR 0.54, 95%CI 0.26–1.15). TBSA and age were also associated with full thickness burns (OR 1.06, 95%CI 1.04–1.09 and OR 1.015, 95%CI 1.007–1.024, respectively). Burns on the head and neck were less likely to be full thickness (OR 0.30, 95%CI, 0.11–0.82).

Conclusions
Scald burns are significantly less likely to be full thickness than contact or fire/flame burns.

Applicability of Research to Practice
Based on these results, expectant therapy may be more appropriate for scalds than contact or fire/flame burns.
735 Advantages of Biocellulose for Burn Injures
Authors: Sanches-Pinto Debora C , Mota Wellington M , Gomez David S , Gemperli Rolf 
Published: March 2020

Abstract

Introduction
Facial burns are extremely important biological dressings have been developed as temporary substitutes for human skin to avoid infection and accelerate tissue repair, with comfort to the patient. The biocellulose film is produced by the bacterium Acetobacter xylinium. After dehydration process, the obtained product turns into a film. We also use the celluloses film hydrated. Aim: To show the experience of the use of a biocellulose membrane in our hospital, for facial superficial second degree burns.x’x’

Methods
This study took place from January 2009 till December 2017. We selected forty five patients with facial superficial second degree burns treated with a biocellulose film since day one post burn. It remained on the face until the complete epithelialization and spontaneous detachment. We studied 45 patients (25 children and 20 adults). We evaluated the final healing time, the pain, the dressing changes and the facility of application (notes from 0 to 10).

Results
The evaluation note for the ease of application varied from 7 and 8 (40%) and 9 to 10 (60%). We saw spontaneous detachment of the dressing in all cases till day 10. The grade of pain varied from 0 to 2. After day 4 no one referred pain. The full epithelization occurred in 8 days in 90% of children and in 10 days in the other 10% of the children. The restoration in the adults followed t the same pattern.

Conclusions
The biocellulose dressing seems to be a good option for superficial facial burns. It is painless, easy to apply and has a good cost benefit relation. The authors suggest longer randomized studies.

Applicability of Research to Practice
New technologies that are cheape, less painfull and efective can be of a great value not only for us but for everyone who work with burn patients.
744 Shrove Tuesday Related Injuries in Children, 8 Years’ Experience of Single Paediatric Burns Centre
Authors: Bednarz Bartlomiej , Thakkar Mehul , Sen Sankhya 
Published: March 2020

Abstract

Introduction
Shrove Tuesday, also known as Pancake Day is one of the Christian traditions in many countries and marks the beginning of Lent. Many families cook pancakes together by frying batter. It is considered to be a fun and simple activity. Children often get heavily involved. This creates a danger of pancake related burn injuries. We have noticed a significant number of burns around Pancake Day and herein report our observed epidemiology of these injuries.

Methods
Burns admissions/assessments during the period around Shrove Tuesday were identified from our burns database over an eight year period (2011–2019). Pancake related injuries were identified and then reviewed to look for commonalities.

Results
52 patients were identified. The age ranged from 20 months to 15 years (average 5.94 years, median 6, mode 3). 50 (96.1%) of these injuries were contact burns with pan/hob. The remaining 2 (3.9%) were minor scalds form hot oil. 47 patients (90.3%) had burns localised to the hands. 16 (30.7%) patients had burns involving the index finger, which was usually an isolated injury. 14 (26.9%) patients were burnt whilst trying to toss the pancake. The average age of the patient differed depending on the causative mechanism: 3.63 years for touching hob, 5.71 years from touching the frying pan, 7.21 years for burns associated with pancake tossing. The average burn size was 0.2% TBSA. None required admission, excision or grafting.

Conclusions
This research consolidates the knowledge about Shrove Tuesday related injuries in children: the need for close supervision of children in kitchen is highlighted. The causative mechanism changes as children grow up.

Applicability of Research to Practice
This knowledge can be used in targeting prevention strategies and campaigns, particularly at the beginning of Lent.
846 Effects of Ceragenins on Pseudomonas Aeruginosa Biofilm Formation in Burn Wounds in a Porcine Model
Authors: Savage Paul B 
Published: March 2020

Abstract

Introduction
Damage from burn wounds compromises the protective function of the skin, increasing susceptibility to bacterial and fungal infections and sepsis. Pseudomonas aeruginosa is commonly infects burn injuries and is associated with high morbidity, especially in large total burn surface area injuries. Silver sulfadiazine (SSD), the standard topical antimicrobial used for burn wounds, has been associated with irritation, scarring and other adverse effects creating a need for alternative treatment options. Ceragenins are small-molecule mimics of endogenous antimicrobial peptides. In this pilot study, two ceragenins, CSA-44 and CSA-144 were assessed for their ability to reduce P. aeruginosa in a porcine burn wound model.

Methods
One pathogen-free female pig was appropriately prepared and 48 burn wounds were generated, under general anesthesia, on the back and flank area by direct contact with a heated brass rod. Wounds were inoculated with P. aeruginosa and biofilm was allowed to form for 24 hours. Four of the wounds were analyzed 24 hours post inoculation to establish baseline bacterial counts. R emaining wounds were treated with a vehicle control, SSD (positive control) or formulations of CSA-44 and CSA-144 in gel, cream and aqueous forms. After 7 days of treatment, tissue samples from the wounds were excised and bacterial counts were determined (colony forming units per milliliter of tissue). Percent decreases in bacterial counts were evaluated for each wound. The wounds were also observed for erythema and irritation over the course of the study.

Results
The greatest reductions in bacterial counts after treatment were seen in wounds treated with aqueous CSA-44 at 0.05 % (99.6% reduction) and aqueous CSA-144 at 0.05% (98.4% reduction), which were both greater than the bacterial reductions seen in wounds treated with SSD. Additionally, after the second day of treatment, wounds treated with aqueous CSA-44 and CSA-144 showed reduced erythema, while wounds treated with SSD continued to show swelling and redness.

Conclusions
This study demonstrates the effective antimicrobial action of aqueous formulations of ceragenins CSA-44 and CSA-144. The bacterial reduction seen with aqueous CSA-44 and CSA-144 were greater than the positive control (SSD). Furthermore, treatment with CSA-44 showed reduced signs of irritation, which were not observed with SSD. Even within this small sample size, the superior antimicrobial ability of ceragenins, without the negative effects of SSD becomes apparent.

Applicability of Research to Practice
Ceragenins provide a means of replacing endogenous defenses against infection in burn wounds.