bluuebunny/crossref_metadata_2025_split huggingface dataset:
140 Alpha-Mangostin Inhibits Proliferation, Promotes Apoptosis, and Modulates Fibrotic Gene Expression in Normal and Keloid Fibroblasts In Vitro
Authors: Supp Dorothy M , McFarland Kevin L , Hahn Jennifer M , Combs Kelly A 
Published: April 2021

Abstract

Introduction
Keloids are disfiguring lesions that result from an abnormal wound healing process. Despite the availability of numerous therapeutic options, keloids remain challenging to treat and often recur after therapy. α-Mangostin, a natural xanthone isolated from the fruit of the Mangosteen tree, has been used for centuries in many Southeast Asian nations for medicinal purposes, and has gained attention more recently due to its anti-inflammatory, antimicrobial, and antioxidant properties, with numerous studies suggesting possible anticarcinogenic activities. Hypothetically, α-mangostin may have therapeutic value for keloid suppression. To investigate this hypothesis, the effects of α-mangostin on fibroblast proliferation, apoptosis, and gene expression in vitro were analyzed.

Methods
Dermal fibroblasts were isolated and cultured from normal human skin and excised keloid lesions (3 donors each), and were treated with multiple doses (0–10 µm) of α-mangostin in vitro. Proliferation was measured using an MTT assay, gene expression was measured using quantitative real-time PCR (qPCR), and protein levels in culture media were measured by enzyme-linked immunosorbent assay (ELISA). Apoptosis was assessed by measuring expression of C/EBP homologous protein (CHOP), which mediates endoplasmic reticulum stress-induced apoptosis, by qPCR.

Results
Dose-dependent decreases in proliferation of keloid and normal fibroblasts were observed following treatment with α-mangostin. The α-mangostin treated fibroblasts displayed significantly increased expression of CHOP, indicating increased apoptosis. In addition, numerous changes in gene expression were observed in α-mangostin-treated keloid fibroblasts, including decreased expression of collagen type I alpha 1 chain (COL1A1) and increased expression of matrix metalloproteinase 1 (MMP1), MMP3, and MMP13. Secretion of pro-collagen I was decreased, and secretion of MMP1 and MMP3 proteins were increased, in α-mangostin-treated fibroblasts.

Conclusions
The results suggest that α-mangostin may exhibit antiproliferative, proapoptotic, and antifibrotic activities in keloid and normal fibroblasts.
144 Neck Splint Fabrication
Authors: Sher Malvina , Hunter Hope , Heffernan Jamie , Rabbitts Angela 
Published: April 2021

Abstract
Addressing the neck during burn rehabilitation is challenging, but critical as hypertrophy and contractures can result in adverse psychosocial, functional and cosmetic outcomes. Attention to the neck early in the rehabilitation process is crucial in minimizing scarring and preventing cervical contractures.
This video will demonstrate fabrication of a neck splint using silicon lined low-temperature thermoplastic material. The silicone-lined material is durable and has the capability of maintaining optimal pressure and position. It can be utilized alone or in a combination with compression garment to ensure 23 hours of pressure, which is crucial in preventing neck contractures, maintaining good cervical spine alignment and ROM, maximizing function and enhancing aesthetic appearance.
Based on our clinical experience, use of silicon lined low temperature thermoplastic splint allows for early and aggressive scar management. Furthermore, patients report improved compliance with wear and ease of care for this splint.
145 Positioning of Multiple Burned Joints- It Takes a Team
Authors: Dwertman Michelle N , Gallagher Catherine , Smith Michelle 
Published: April 2021

Abstract
Positioning of a burn patient with upper and lower extremity involvement is challenging and maintaining that position requires burn team support. This video displays positional strategies for the burn team to utilize to optimize recovery for the acute burn patient. Interventions strategies will include modifying the patient’s environment, management of orthotic devices and additional educational resources for successful execution of positional goals.
146 The Use of Biodegradable Temporizing Matrix
Authors: Gus Eduardo 
Published: April 2021

Abstract
Biodegradable temporizing matrix is a synthetic polyurethane dermal substitute that may have advantages over similar templates, which are mainly associated with its increased resistance to bacteria and infectious complications. It can be used to temporize large wounds in major burns, and to cover ungraftable beds, such as exposed bone or tendon. It has also been postulated to minimize the risk of scar contractures, which may warrant further studies. By means of a case report, this video illustrates its employment, showing the treatment stages of application, delamination, and grafting, as well as early postoperative results.
500 Burn Patient Recovery: Utilizing Virtual Connection During a Global Pandemic
Authors: Dines Margaret , Smith Tyler M , Dae Melanie K , Lambert Wagner Anne L 
Published: April 2021

Abstract

Introduction
Human connection is an essential element of healing for the burn survivor and their loved ones. The current global pandemic has created a barrier for in-person connection; hospitals nationwide have implemented visitor restrictions, which negatively impacts admitted patients. Our burn center integrated the use of video conferencing technology to increase connection amongst patients, loved ones, burn care team members, and burn survivors. We accomplished human interaction with our patients through virtual family meetings, peer support visits, and support groups.

Methods
Technology has been utilized in many different formats to help increase a patient’s connection with the outside world during the pandemic. Patient-centered family meetings were adapted to virtual formats and included the patient, the multidisciplinary burn care team, and the patient’s loved ones. We accomplished this by encouraging the patient’s family and the multidisciplinary team to join the meeting remotely, while the provider broadcasted from the patient room. In addition, the SOAR Peer Support group went entirely virtual, allowing survivors and peer supporters to attend and connect, despite in-person restrictions. Lastly, individual burn patient and SOAR visits were also adapted to the virtual platform.

Results
Video conferencing through a secured zoom platform was initiated in March 2020. From March 1, 2020 to September 24, 2020, 136 virtual family meetings were conducted, with an average of 4.5 family meetings per week. The quick adaptability to utilize technology allowed burn patients, loved ones, and burn care team members to continue to connect during times when those meetings would not have occurred. A virtual SOAR support group was held monthly, with an average of 3 attendees [2–6]. In this same time period, 14 SOAR Peer support individual meetings were conducted.

Conclusions
Despite the numerous challenges of a global pandemic, our Burn Center was able to proactively integrate technology to promote social connectedness. Utilization of technology allowed the burn multidisciplinary team to build trust with patients and their loved ones, offered invaluable patient-survivor relationships, and communicated the importance of social connection as an essential piece of burn recovery when our institution restricted visitors.
508 Cancel Burn Camp: No Way! Our Institutions Creation of a Virtual Burn Camp and What it Taught Us About Our Patients
Authors: Short Tracee 
Published: April 2021

Abstract

Introduction
Last year we planned and created our own burn camp. We saw a need not being served and jumped in a created a camp experience that was archived in a documentary and received stellar reviews by all who attended. The kids’ camp expectations was exceeded and everyone was looking forward to 2020. We planned for a great 2020 camp experience and then COVID struck. We debated about the safety to proceed with residential camp as we knew it. Other camps cancelled but our inner need to serve wouldn’t let us do this.

Methods
Our planning committee quickly shifted and began planning for how we can bring that experience to a virtual platform. We engaged our Facebook group and called every kid on our list to inform the parents of the change. We then created a daily schedule and purchased the items needed for all activities. We then sent or delivered these with a gift card to kids that couldn’t make the pickups. Pickups were scheduled in the cities where most of our kids reside. We conducted daily yoga and meditation, cooking classes, painting and campfire stories. We mixed daily online sessions with 3 tailgating meet ups. We invited guest lectures and left the virtual space open for the kids to hang out.

Results
At the final tailgate/virtual pizza party, we had an awards ceremony and received testimonials from kids and parents about how for the first-time siblings were able to participate. We delivered to 15 kids and had 20 attend the tailgate pickups. On average, we had 16 kids attend daily.

Conclusions
Parents could see how their child benefitted from this community and the intent of camp. This event revealed exactly where our patients reside from a socioeconomic standpoint. Deliveries to some homes left our volunteers in tears. This helped explain the discrepancy between interest expressed and the numbers that showed daily for events. It also made us recognize that camp means even more as it is an escape from their realities.
510 A Case-controlled Retrospective Review of Fluid Resuscitation in Patients with Concomitant Burn and Trauma Injuries
Authors: Foster Kevin N , Mellon Christopher , Islas Claudia , Smith Soraya , Davis Vanessa , Richey Karen J 
Published: April 2021

Abstract

Introduction
Aggressive fluid resuscitation with crystalloid has been a mainstay of therapy in burn injuries for over 50 years. However, in trauma populations there has been a shift away from crystalloid based resuscitation and the early administration of blood products has been recommended. The primary objective of this study was to evaluate if large-volume crystalloid resuscitation of patients presenting with both burn and trauma injuries is associated with higher mortality and complications.

Methods
This was a matched case-controlled retrospective chart review of patients treated over a 5-year period that suffered mixed burn and trauma injuries (MI). Patients that suffered burn only injuries (BO) were used as the control and were matched on TBSA, age, and gender. All patients were resuscitated using the standard burn center resuscitation protocol.

Results
A total of 4,416 patients were admitted to the burn center during the study period. Of those 18 had concomitant burn and trauma injuries requiring burn fluid resuscitation and were successfully matched to BO patients. There was no difference in age, gender, ethnicity, % TBSA burned, presence of inhalation injury, or Injury Severity Score (ISS). BO patients were more likely to have flame/flash as the etiology of burn injury (p=.0257). With fluid resuscitation, there was no difference in the total volume of fluid administered, or the amount of crystalloid or colloid administered. MI patients were more likely to have received blood products than BO patients (472 ml vs 19 ml, p=.0387). There was no difference in the following outcome measures: mortality, ICU days, ventilator days, number of surgeries, infections, or major complications. The only significant outcome difference was that the BO patients had a greater hospital length of stay (44 days) than the MI patients (24 days, p &lt; 0.001).

Conclusions
Aggressive fluid resuscitation using existing burn resuscitation protocols did not result in greater complications in burn-trauma patients than in burn only patients. Crystalloid-based burn resuscitation is safe in patients with combined burn and trauma injuries.
515 Evaluation of growth hormone use in patients with large burns and complex wounds
Authors: Gayed Rita , Lindsey Lindsey , Mittal Rohit , Hodge Juvonda , Ingram Walter L 
Published: April 2021

Abstract

Introduction
Large burn injuries lead to an extensive and prolonged catabolic state that results in loss of body mass and impaired wound healing. To combat this hypermetabolic response, different strategies have been employed including early excision and grafting, infection control, early nutrition and anabolic therapies such as oxandrolone. Human growth hormone is of interest for burn patients because of its anabolic properties.
While its use has been associated with worse outcomes in the critically ill adult with sepsis, it has shown improved outcomes when used in pediatric burn patients. The purpose of this study was to retrospectively evaluate the appropriateness of human growth hormone use, its adverse events and cost in patients with large burns or complex wounds and poor wound healing.

Methods
This was an IRB approved, retrospective, single center chart review from 2011 to 2019 assessing human growth hormone prescribing patterns in the burn unit. The primary objective was appropriateness of use, defined as documentation of poor wound healing prior to initiation despite adequate nutrition delivery and use of standard anabolic therapies (i.e., oxandrolone). Secondary objectives included perceived benefit, adverse events and median therapy cost per patient of human growth hormone.

Results
Thirty-eight patients were included in the study, 79% of which were adults, with a median total body surface area involvement of 50% (IQR 40 to 71). Only forty-one per cent of patients receiving human growth hormone met our predefined criteria for appropriateness; this was primarily driven by poor documentation of wound healing. However, 80% of patients were receiving adequate nutrition and oxandrolone, indicating appropriate clinical use. Most adult patients received a dose of 20mg daily, while pediatrics received the weight based 0.2mg/kg daily dose. The median duration of treatment was 24 days (IQR 13–35) and median time from admission to growth hormone initiation was 27 days (IQR 12–34). Overall clinical improvement was noted in 53% of patients, as evident by increased weight, prealbumin and/or documentation of improved wound healing. The most common adverse effect noted was hyperglycemia, followed by new sepsis onset. The median therapy cost per patient was $42,000.

Conclusions
Human growth hormone may serve as a salvage therapy for large burns with poorly healing wounds. Prior to initiating therapy, nutrition must be optimized and standard, more researched anabolic therapies should be started. While receiving therapy, patients should be monitored for both hyperglycemia and the development of new sepsis.
517 Hyperbaric Oxygen and Mortality in Burns with Inhalation Injury: a Study of the National Burn Repository
Authors: Nygaard Rachel M , Endorf Frederick W 
Published: April 2021

Abstract

Introduction
Mortality in burn injury is primarily influenced by three factors: age, percent burn (%TBSA), and presence of inhalation injury. Numerous modalities have been tried in an attempt to treat those patients with burns and inhalation injury, including the use of hyperbaric oxygen (HBO). The aim of our study was to find the national prevalence of HBO for burns with inhalation injury, and whether HBO influenced mortality in these often severely injured patients.

Methods
This retrospective study used the National Burn Repository (NBR) to identify hospital admissions of patients with both cutaneous burns and inhalation injuries. After applying exclusion criteria, a total of 13,044 patients were identified. Variables included in the multivariate regression analysis included: age, sex, race, payer, mechanism of burn injury, TBSA group, total procedure number, mechanical ventilator days, and treatment with HBO. The main outcome variable was mortality.

Results
Of the 13,044 patients, 67 had HBO therapy. The HBO patients were older (mean age 51.7 years vs. 42.8 years, p&lt; 0.001) but had smaller burns and thus a similar Baux score (66.6 vs. 65.2, p=0.661). The HBO patients had a higher mortality (29.9% vs. 17.5%, p= 0.01). On multivariate regression analysis, HBO was an independent predictor of mortality (OR= 2.484, p= 0.004). Other significant predictors of mortality included age, Black race, Medicaid or uninsured patients, and %TBSA.

Conclusions
The use of HBO for patients with burns and inhalation injury is uncommon in this database. It is unclear whether that reflects low prevalence or if individual centers do not all impute HBO into the NBR. For those patients in this database, HBO is an independent predictor of mortality. It can be difficult to determine the severity of inhalation injury in the NBR, so those patients receiving HBO could theoretically have more severe inhalation injury.
518 Massive Burn Injury Outcomes in Children
Authors: Martens Sally A , Romanowski Kathleen S , Palmieri Tina L , Greenhalgh David G , Sen Soman 
Published: April 2021

Abstract

Introduction
Advances in the care of burn injured pediatric patients has improved mortality over the last 20 years. However, massive burn injuries in pediatric patients, while overall rare, have a significant morbidity and mortality. The primary aim for this study is to analyze outcomes in massive pediatric burn injuries.

Methods
After institutional review board approval, a retrospective study of children with burn injuries 50% TBSA or greater who were admitted to our pediatric burn center from 2009 to 2019 was conducted. Data collected include age, gender, ethnicity, race, country of residence, % TBSA, degree of burn, presence of inhalation injury, hospital duration, intensive care duration, presence of tracheostomy, number and types of surgeries performed and discharge outcomes. All mean values are mean±standard deviation, all median values are median (interquartile range), and p-value &lt; 0.05 were considered significant.

Results
This study included 84 patients (60.7% male) with a mean age of 8±6 years old. The median time from injury to admission was 2(1–4) days. 56% of patients were from Mexico, 43% were from the United States and 1 patient was from American Samoa. 21% of the patients died. There was no difference in the extent of burn injury between patients who died (68±14% TBSA) versus those who lived (66±12% TBSA). The median length of stay was significantly shorter in the patients who died (19(5–44) vs. 74(35–138) days p=0.0001). Patients who died also suffered more inhalation injury (61% vs. 21%, p=0.01). After adjusting for age and TBSA, inhalation was a significant independent predictor of death (OR- 4.3, (1.4-13 95% CI), p=0.01).

Conclusions
Over the past decade, nearly 80% of children with massive burn injuries survived. The children who died as a result of their massive burn injury, died within the first month of admission. Inhalation injury significantly and independently increases the risk of dying in pediatric patients with a massive burn injury.
519 The Routine Addition of Maintenance IV Fluid is Not Warranted during all Pediatric Burn Resuscitation: A Retrospective Study
Authors: Senthil-Kumar Prabhu , Zieger Madeline , Hartman Brett C 
Published: April 2021

Abstract

Introduction
Pediatric burn resuscitation has improved dramatically over the years with improved survival and outcomes. Recent studies have shown the amount of fluid given (ml/kg/%TBSA) has direct correlation to the outcomes. Over resuscitation (fluid creep) results in multiple systemic and wound complications. We hypothesize the addition of maintenance IV fluid with Parkland resuscitation fluid in younger pediatric burns (&lt; 30kg) may not be needed to achieve adequate end points of resuscitation.

Methods
We performed a retrospective chart analysis of our pediatric burn patients at our institution by categorizing younger patients (&lt; 30kg) into two groups: The maintenance IV fluid (MF) group and the resuscitation fluid (RF) only group. We identified 18 patients that met the criteria with 9 patients in each group. All of the patients in both groups were under 30kg, age range 2-8yrs, and TBSA: 16–50 %. We included 3 patients under 20% TBSA that were resuscitated due to full thickness burns and smoke inhalation injury. We analyzed their hourly and 24-hour fluid administration including all oral intake and tube feeds as well as their hourly vitals, urine output, and laboratory values during the resuscitation.

Results
We found that the RF group received 1.311+/- 1.295 cc/kg cc less fluid compared to the MF group without any hypoglycemic events or deleterious hemodynamic effects. The patients who had good oral intake or received tube feeds during resuscitation resulted in significantly less resuscitation volume than the estimated resuscitation volume in both groups.

Conclusions
We conclude that resuscitation can be safely done in pediatric burn patients under 30 kg without adding routine maintenance IV fluid. Early oral and enteral feeding is very critical in all burn patients. The volume that was administered enterally should also be considered in hourly fluid titration rates to reduce the resuscitation fluids given thereby preventing fluid creep and ensuing deleterious complications.
526 Outcomes of Burn Patients with Pre-Existing Human Immunodeficiency Virus: A Systematic-Review and Meta-Analysis
Authors: Mafla Laura M , Quiroga Luis H , Cemaj Sophie L , Khalil Nora , Hultman Charles S 
Published: April 2021

Abstract

Introduction
Burn injuries are well known to cause a state of immunosuppression in patients. This can result in wound infections, a common complication in burn injuries, that can lead to sepsis and increased mortality. Human immunodeficiency virus (HIV) is also known to cause immunosuppression in patients. The outcomes of burn patients with pre-existing HIV infections, however, are not yet completely understood. We conducted a systematic review and meta-analysis to compare the outcomes of burn patients with pre-existing HIV against those without this chronic infection.

Methods
We searched MEDLINE (Pubmed), Google Scholar, Scopus, and Embase for studies that compared outcomes and complications between burn patients with and without HIV. From this search, we screened 445 articles. Through our selection criteria, five articles focusing on HIV patients were selected for systematic review and meta-analysis. Data were analyzed using the Cochrane Review Manager (RevMan) Data Analysis package to produce pooled odds ratios and mean differences from the random effect model.

Results
Five studies observing a total of 24,419 burn patients, published between 2000 and 2017, were included. Of these, two are prospective studies and three are retrospective chart reviews. The primary outcome of mortality for HIV+ patients compared to HIV- patients had an odds ratio of 2.04 (CI= 0.46–9.14) in the random effects model. Secondary outcomes of sepsis and wound infection odds ratios were 1.47 (CI= 0.44–4.99) and 1.10 (CI= 0.28–4.25), respectively. The length of stay (LOS) between studies showed an overall mean difference of 0.95 (CI=-8.08–9.99). Most studies had a greater proportion of male patients. TBSA between studies ranged from 13.1% and 35%.

Conclusions
From our results, we concluded that HIV+ had a tendency toward greater mortality (OR=2.04) and sepsis (OR=1.47). However, mortality and sepsis had confidence intervals of [0.46–9.14] and [0.44–4.99], respectively. Therefore, we cannot definitively state that HIV infection is responsible for greater mortality or sepsis in burn patients. Additionally, LOS analysis also showed a wide confidence interval [-8.08–9.99], preventing us from making reliable deductions about this outcome. We believe further research is needed before universal conclusion or recommendations are appropriate.