bluuebunny/crossref_metadata_2025_split huggingface dataset:
108 An Evidence Based Laser Therapy Algorithm for the Treatment of Burn Scars
Authors: Roggy David , Sood Rajiv 
Published: March 2020

Abstract

Introduction
Hypertrophic scarring after burn injury can be extremely painful, cause profound itching, and affect the way patients view themselves and how the outside world perceives them. We have utilized laser therapy as a modality for scar modulation for our patients since 2013. In 2014, we initiated and completed a prospective IRB approved study to evaluate the outcome of scars treated with fractional CO2 laser therapy (FLT) utilizing objective and subjective tools. Recently, we have completed a prospective study evaluating the use of pulse dye laser (PDL) therapy and the impact on post-burn pruritis. In reviewing the outcomes from these two studies, we have developed an evidence based laser therapy algorithm for burn scar management.

Methods
The FLT study entailed a series of three CO2 laser treatments minimally 4–6 weeks apart with scar measurements and POSAS form completion performed prior to each laser treatment and four weeks after the last FLT. Scar measurements that included color, pliability, and scar thickness; and completion of the POSAS form were obtained prior to each laser therapy session and four weeks after the third laser treatment. The measurements of color, pliability, and scar thickness were measured with the Colorimeter, Cutometer, and ultrasound. The PDL study utilized the 5-D Itch scale to evaluate post-burn pruritis. A baseline measurement was obtained prior to any laser treatments. Each patient underwent two PDL sessions and a 5-D itch scale was completed four to six weeks after the second PDL session. The baseline measurement was then compared to the final 5-D itch scale measurement.

Results
Data from the FLT study is in Table 1 and shows that there were statistically significant improvements in the Patient and Observer POSAS scores, patient rated Itch score, scar thickness, and measured skin density. Changes to patient rated scar pain, scar color, and pliability were noted but were not of statistical significance. Data from the PDL study is in Table 2 and shows a statistically significant decrease in the treated patients’ post-burn pruritis.

Conclusions
In reviewing the outcomes of these two studies, we have developed an algorithm based on our studies. All of our patients undergoing laser therapy receive two PDL sessions that are four to six weeks apart followed by 3 FLT sessions. The use of both PDL and FLT decreases post-burn pruritis, decreases scar thickness, decreases pain, and increases patient satisfaction as shown in our research.

Applicability of Research to Practice
This research shows the benefit of the combination of PDL and FLT in an algorithmic approach to treat hypertrophic scars and burn pruritis.
513 Simplified Approach to Incorporating Glycemic Response Within a Continuous Insulin Infusion Algorithm to Improve Incidence of Hypoglycemia in a Single Burn Center
Authors: Hill David M , Hendrix Hayden , Velamuri Sai R , Sultan-Ali Ibrahim , Arif Faisal , Hickerson William L 
Published: March 2020

Abstract

Introduction
Attaining adequate glycemic control in burn patients can reduce infection-related mortality. Previous internal evaluation of four insulin infusion protocols showed a hypoglycemia (&lt; 60 mg/dL) rate of 0.6% and an average time within goal glycemic range (70-149 mg/dL) of 13.8 hours per day. A new algorithm underwent six iterations over two years before the final version was implemented. The purpose of our study was to assess the post-implementation performance of the newly-developed continuous insulin infusion (CII) protocol designed to adjust dosage based on glycemic fluctuation.

Methods
This study was a two year retrospective, IRB approved, review of adult patients admitted to a single burn center, who received a CII. The pre-implementation study served as a historical control comparator. The current study was powered to detect a 50% reduction in hypoglycemic events, requiring 4,245 point-of-care samples. Based on average usage, at least 20 patients were required for adequate power of 80 % and alpha of 0.05. Demographics, insulin infusion data, infection, and mortality outcomes were collected. Nominal data were analyzed by Fisher’s exact test. Continuous variables were compared using either Mann-Whitney U test or student’s t-test, depending on normality.

Results
Of the 27 records screened for inclusion, seven were excluded. The average patient was a 59-year-old Caucasian male with diabetes and a total body surface area burn of 17%. There were no differences in demographics between groups. Among the 20 records reviewed, 5,239 point-of-care glucoses were assessed. Post implementation, hypoglycemia rates were significantly lower (0.6% vs 0.2%; p &lt; 0.001). There was no difference in median blood glucose between groups (149.9 mg / dL vs. 146.5 mg / dL; p = 0.56) or time to achieve the goal glycemic range (6 vs 6.5 hours; p = 0.28). Time spent within goal glycemic range was not significantly different (13.8 vs. 14.7 hours / day; p = 0.23). The overall median time until glucoses were monitored after holding CII for down trending glucoses was 65.7 (53.5–111.3) minutes. Of the times CII were held, 53 of the follow up glucoses (25%) surpassed 200 mg / dL before subsequently settling. There was no differences in infection, length of stay, or survival.

Conclusions
The consolidation, education, and implementation of a single, dynamic CII algorithm reduced the incidence of hypoglycemia. The authors expect, education and diligence with follow up glucose monitoring will further improve time within goal glycemic range by preventing rebound hyperglycemia.

Applicability of Research to Practice
Improving glycemic control can be obtained by simple means. Implementing a two step algorithm that incorporates glycemic response and goal with vigorous education will reduce hypoglycemia and improve glycemic control.
531 Sex-based Differences in the Skin: Is It Just a Female Problem?
Authors: Duplisea Michael , Williams Felicia N , Ziemer Carolyn , Chrisco Lori , Laughon Sarah L , Nizamani Rabia , Cairns Bruce , Jones Samuel W 
Published: March 2020

Abstract

Introduction
Female gender is associated with poorer outcomes in burns, not necessarily related to co-morbid conditions. Our objective was to analyze the effect of gender in biopsy proven Stevens-Johnson syndrome (SJS) and Toxic epidermal necrolysis (TEN) spectrum disorders at our institution.

Methods
Patients were identified using Institutional Burn Center registry, and linked to the clinical and administrative data. All patients admitted with biopsy proven SJS, SJS/TEN overlap, and TEN between January 1, 2009 and December 31, 2018 were eligible for inclusion. Demographics, length of stay, and mortality were evaluated. Statistical analysis was performed with Students’ t-test, chi-squared, and Fischer’s exact test.

Results
One hundred and sixty-eight patients had biopsy proven SJS, SJS/TEN overlap, or TEN. Sixty-one percent of patients were female. The average age of female patients was 51 years while the average age of male patients was 44 years, p&lt; 0.05. Fifty-sex percent of female patients were black. All American Indian patients were female. Female patients had significantly longer lengths of stay, 34 days versus 22 days, p&lt; 0.05. Female patients had an average SCORTEN (a severity of illness score of TEN) compared to male patients. Thirty-three percent of female patients died compared to 18% of male patients, p&lt; 0.05. Two out of three American Indian patients in this cohort died.

Conclusions
Female gender is associated with increased mortality in burn patients, as well as in our cohort of patients with SJS/TEN. Females represent 51% of our state’s population, but 61% of patients with biopsy proven SJS, SJS/TEN overlap, and TEN at our institution. Compared to male patients, female patients presented with more severe disease (higher SCORTEN at presentation). Genomic, and proteomic studies looking at sex-based differences may be helpful in elucidating the origin of these differences.

Applicability of Research to Practice
This study demonstrates sex-based differences related to skin desquamating disorders, and these outcomes, coupled with known disparities in burns, may indicate a need for hypervigilance in inpatient management for women, and a re-evaluation of prognostic scoring tools to include a variable for gender.
552 Ten Year Mortality Trends in Stevens Johnsons Syndrome and Toxic Epidermal Necrolysis Trends in a Single Burn Center
Authors: Duplisea Michael , Williams Felicia N , Ziemer Carolyn , Chrisco Lori , Nizamani Rabia , Laughon Sarah L , Cairns Bruce , Jones Samuel W 
Published: March 2020

Abstract

Introduction
Stevens-Johnson syndrome (SJS) and Toxic epidermal necrolysis (TEN) are a spectrum of rare, life-threatening drug reactions characterized by diffuse skin detachment and mucositis. Our objective was to describe and analyze mortality trends at our institution for patients with biopsy-proven SJS and TEN over the last decade.

Methods
Patients were identified using Institutional Burn Center registry, and linked to the clinical and administrative data. All patients admitted with biopsy proven SJS, SJS/TEN overlap, and TEN between January 1, 2009 and December 31, 2018 were eligible for inclusion. Demographics, length of stay (LOS), co-morbid conditions and mortality were evaluated. Statistical analysis was performed with Students’ t-test, chi-squared, and Fischer’s exact test.

Results
One hundred sixty-eight patients had biopsy-proven SJS, SJS/TEN overlap, or TEN. The average age was 48 years. Sixty-one percent of patients were female. The average length of stay was 30 days. Fifty-six percent of patients were Black. Twenty-seven percent of patients died. Increased mortality risk was significantly associated with female gender, age, underrepresented minorities, Human Immunodeficiency Virus, and chronic obstructive pulmonary disease. The presence or absence of malignancy or chronic kidney disease was not evaluated.

Conclusions
Biopsy proven SJS, SJS/TEN overlap, and TEN are associated with increased mortality for females, underrepresented minority populations, and patients with comorbidities. Black patients represent 28% of our state’s population, but 56% of patients with biopsy proven SJS, SJS/TEN overlap, and TEN at our institution. Further study is warranted to investigate and mitigate these outcome disparities in these patient populations.

Applicability of Research to Practice
This study highlights the importance of acknowledging that these at-risk patient populations must be protected with higher vigilance during evaluation, assessment of the offending agent, and resuscitation.
604 Comparing Disinfection of Different Dosages of Vaporized Hydrogen Peroxide in Burn Ward
Authors: Zhang Yin 
Published: March 2020

Abstract

Introduction
The objective of this study is to compare the disinfection effects using the vaporized hydrogen peroxide disinfection method in critical burn ward.

Methods
A 110m3 empty ward of the burn center was selected as the experimental site. The Bacillus subtilis var. niger spores were opened and placed in 15 unprepared positions (with 0 m, 1 m, 2 m, 3 m, and 4 m from the disinfection machine, each of which was divided into upper, middle, and The lower 3 planes), as well as the 15 points of the cloth (the same position as before), are fixed with hydrogen peroxide indicating tape. The amount of hydrogen peroxide was calculated according to the size of the ward (8 g/m3, 12 g/m3, respectively), and disinfected at a rate of 10 g/min of hydrogen peroxide release flow. After 5 hours of disinfection, the chemical indicator tape and the bacteria pieces were taken out. Observe the discoloration of the chemical indicating tape. The bacteria pieces were placed in a test tube containing the broth culture medium, and the results were observed after incubation in a 37 ° C incubator for 7*24 hours.

Results
(1) Under the condition of no cover, the two disinfecting dose chemical indicating tapes are all discolored, and in the case of obstruction, they cannot be completely discolored; (2) When the amount of hydrogen peroxide disinfection is 8g/m3 and 12g/m3 respectively, The positive rates of unobstructed specimens were 6.67% and 2.67%, respectively, no significant difference (P= &gt;0.05), and there was no difference in disinfection effect between the positions (P &gt;0.05); (3) 8g/m3 disinfection dose The peak concentration is 255.9g, the peak concentration is 1h48min; the peak concentration is 337.6g at 12g/m3 disinfection, and the peak concentration is 2h26min. When the two disinfection doses were disinfected for 8 hours, the peak concentrations of the chambers were basically the same(1) Under the condition of no cover, the two disinfecting dose chemical indicating tapes are all discolored, and in the case of obstruction, they cannot be completely discolored; (2) When the amount of hydrogen peroxide disinfection is 8g/m3 and 12g/m3 respectively, The positive rates of unobstructed specimens were 6.67% and 2.67%, respectively, no significant difference (P= &gt;0.05), and there was no difference in disinfection effect between the positions (P &gt;0.05); (3) 8g/m3 disinfection dose The peak concentration is 255.9g, the peak concentration is 1h48min; the peak concentration is 337.6g at 12g/m3 disinfection, and the peak concentration is 2h26min. When the two disinfection doses were disinfected for 8 hours, the peak concentrations of the chambers were basically the same.

Conclusions
The use of vaporized hydrogen peroxide for terminal disinfection should be as full as possible to expose the items to be disinfected.

Applicability of Research to Practice
Disinfection.
651 NLRP3 Activation Induced by Neutrophil Extracellular Traps Sustains Inflammatory Response in the Diabetic Wound
Authors: Liu Dan 
Published: March 2020

Abstract

Introduction
Persistent inﬂammatory response in the diabetic wound impairs the healing process, resulting in significant morbidity and mortality. Mounting evidence indicates that the activation of NLRP3 inflammasome in macrophages (MF) contributes to the sustained inﬂammatory response and impaired wound healing associated with diabetes. However, the main trigger of NLRP3 inflammasome in the wounds is not known. Neutrophils, as sentinels of the innate immune system and key stimulators of MF, are immune cells that play the main role in the early phase of healing. Neutrophils release extracellular traps (NETs) as defense against pathogens. On the other hand, NETs induce tissue damage. NETs have been detected in the diabetic wound and implicated in the impaired healing process, but the mechanism of NETs suspend wound healing are elusive.

Methods
WB, immunofluorescence and immunocoprecipitation were used to detect the expression of NETs, NLRP3 inflammasome and IL-1b in diabetic foot ulcer wounds and the expression and activation of NLRP3 inflammsome after lowering the level of NETs. The role of NETs in activating macrophage inflammsome was verified and its mechanism was explored. Induced type I diabetic rats by STZ injection to detect the expression of NETs in the wound and observe the effects of exogenous DNase I on the expression of inflammasome and IL-1b in the wound, inflammatory cell infiltration and wound healing.

Results
NLRP3 and NETs are elevated in human and rat diabetic wounds. NETs overproduced in the diabetic wounds triggered NLRP3 inflammasome activation and IL-1b release. NETs up-regulated NLRP3 and pro-IL-1b levels via the TLR-4/TLR-9/NF-kB signalling pathway. NETs elicited ROS, which facilitated the association between NLRP3 and TXNIP, and activated the NLRP3 inflammasome. DNase I alleviated the activation of NLRP3 inflammasome, regulated the immune cell infiltration, and accelerated wound healing.

Conclusions
NETs contribute to the activation of NLRP3 inflammasome and sustained inflammatory response in the diabetic wound. NET digestion by DNase I alleviated the activation of NLRP3 inflammasome and accelerated wound healing.

Applicability of Research to Practice
707 Factors Associated with Early vs. Late AKI in Burn Patients
Authors: Respicio Jessicah A , Duffy Patrick , Smith Tyler M , Dyamenahalli Kiran U , Wiktor Arek J , Wagner Anne L Lambert 
Published: March 2020

Abstract

Introduction
Acute kidney injury (AKI) in burn patients is known to increase morbidity and mortality, with significant improvement after the initiation of renal replacement therapy (RRT). Our primary objective is to characterize the sub-population of burn patients with early (≤48 hours post-injury) versus late (&gt;48 hours post injury) onset of AKI. We hypothesize that patients with early onset AKI versus late onset AKI have different causalities, risk factors, and outcomes. A secondary aim is to investigate the timing and use of RRT in the setting of early and late AKI with the goal of improving morbidity and mortality.

Methods
A retrospective cohort study was conducted on all patients admitted to a verified burn center requiring RRT for AKI from 2015 – 2019. Patients were stratified by age, gender, percent total body surface area (TBSA), race, time of onset of AKI, timing of RRT initiation, hospital LOS, pre-admission co-morbidities, admission toxicology, and mortality.

Results
In total, 1537 burn patients were reviewed and 1.3% (n=20) required RRT for AKI. Out of this cohort, 70% developed early AKI and 30% developed late AKI. Early versus late AKI patients had the same median age (57). Patients with larger TBSA developed early AKI (median TBSA 51%) versus late AKI (median TBSA 21%). Half of the patients who developed late AKI presented with positive alcohol toxicology screens, while 86% of patients with early AKI tested negative. The patient mortality rate in early AKI was 57%, and the mortality rate in late AKI was 17%. Only 14% of early AKI patients required dialysis at discharge, while 33% of late AKI patients required dialysis at discharge. The majority of patients started on early RRT (&lt; 48 hours post injury) did not develop sepsis (43% developed sepsis), while the majority of patients started on late RRT (&gt;48 hours post injury) did develop sepsis (85%).

Conclusions
Positivity for alcohol on admission may be a predictor for development of late AKI, while larger TBSA may predict early AKI. Mortality is higher for patients with early AKI; however, the need for dialysis at discharge is higher in patients with late AKI. Our data further suggests that early initiation of RRT is negatively correlated with the development of sepsis.

Applicability of Research to Practice
A deeper understanding of associations and causality of early vs late onset AKI in burn patients will help guide further management and improve outcomes.
728 The Faces of Autologous Skin Cell Suspension as Epidermal Grafts
Authors: Van Hoorebeke Justin , Pang Alan , Kopari Nicole M 
Published: March 2020

Abstract

Introduction
Facial burns are frequently severe and are difficult to skin graft, which may lead to increased morbidity including chronic pain, scarring, and psychosocial stigma. The aim of this study was to describe outcomes of patients with facial burns who received autologous skin cell suspension as an epidermal graft.

Methods
A retrospective chart review of patients with facial burns admitted to an ABA verified Burn Center from January 2019 to August 2019 was performed. Each patient underwent tangential excision of superficial and deep partial-thickness burn wounds followed by autologous skin cell suspension applied as an epidermal autograft. The wounds were covered with a non-adherent dressing along with bismuth-impregnated, petroleum-based gauze. The dressings were secured in place with sutures to prevent disruption. On post-operative day 6 the dressings were removed with transition to an antimicrobial ointment applied to any remaining open wounds or a moisturizing lotion.

Results
Five patients, aged 41–89 years, were included. Total body surface ranged from 7–50%. Etiology of the burns included: flame from metal fabricating, assault followed by dousing the patient in gasoline and lighting on fire, flash flame from a water heater explosion, hot oil contact, and involvement in a house fire. 3 of the 5 patients had complete healing noted by post-operative day 6 with excellent results. Two patients required a second excision and application of autologous skin to small portions of the lateral face after healing the majority of the face. One patient developed mild microstomia requiring oral splinting. One of the two patients that required a second application developed ectropian to one of her eyes which was treated with temporary tarsorrhaphy. The second patient that required a second application, died during her hospitalization secondary to complications from her burns and underlying medical co-morbidities. Surviving patients reported satisfaction with the cosmetic outcomes.

Conclusions
Autologous skin cell suspension as an epidermal graft is a viable option for cosmetically important areas such as the face. This case series provides evidence for its validity when treating partial-thickness burns utilizing the above described protocol in conjunction with a multidisciplinary care team within a burn center.

Applicability of Research to Practice
By sharing our institutions experience with this relatively new technique we hope to share our positive outcomes as an alternative to stand excision and grafting to areas of significant cosmetic outcomes.