bluuebunny/crossref_metadata_2025_split huggingface dataset:
105 Implementation of a Burn Resource Team for Initial Debridement and Burn Management in a Pediatric Burn Center
Authors: Vitale Lisa C , Stankovic Curt , Cloutier Dawn , Shanti Christina M , Klein Justin D 
Published: April 2021

Abstract

Introduction
Each year, approximately 700 patients are treated at our verified pediatric burn center. Previously, all patients were fast tracked through the Emergency Department (ED) or directly admitted to the burn unit and received intravenous (IV) morphine and midazolam for analgesia. Although the process was efficient (goal &lt; 120 minutes), this strategy resulted in some patients being unable to tolerate wound debridement due to inadequate sedation. As a process improvement initiative, a burn resource team, consisting of experienced nurses was created. As part of the new process, all patients are initially evaluated and treated in the ED. The Pediatric Emergency Medicine team provides procedural sedation utilizing ketamine, allowing the resource team to assess, debride, and dress the wounds. The objective was to maintain efficiency with time to debridement and dressing application, while concurrently utilizing improved patient sedation.

Methods
Door to debridement time and sedation/analgesia for first debridement was retrospectively reviewed for each group. The pre-implementation group included 148 patients from May 2018 – April 2019. The post- implementation group included 163 patients from August 2019-July 2020. Specific inclusion criteria were age &lt; 18 years and TBSA ≤ 5%.

Results
Of the 148 patients in the pre-implementation group, 82 patients (56%) received morphine and midazolam for their analgesia. These patients had a mean TBSA of 1.5% (0.25 - 5%). 38 patients (26%) received only morphine with a mean TBSA of 1.25% (0.25 - 4%). 14 patients (9%) received hydrocodone with a mean TBSA of 0.75% (0.25 - 2.25%). The additional 14 patients (9%) received an alternate analgesic with a mean TBSA of 0.75% (0.25 - 1%). Average door to debridement time for this group was 97 minutes.
In the post implementation group, 94 of the 163 patients (58%) received ketamine sedation. These patients had a mean TBSA of 2 % (0.25 - 5%). 49 patients (30%) received Intranasal fentanyl and/or midazolam with a mean TBSA of 1% (0.25 - 4%). 13 patients (8%) received hydrocodone with a mean TBSA of 1% (0.5 - 3%). The additional 7 patients (4%) received alternate analgesics with a mean TBSA of 1 % (0.5 - 2%). Average door to debridement time for this group was 92 minutes.

Conclusions
The implementation of a burn resource team and administration of procedural sedation utilizing ketamine in the ED has improved sedation and analgesia for burn patients and marginally decreased time to debridement. There have been noticeable improvements in the consistency of the process as well as improved collaboration between the ED and burn teams.
112 Outbreak of Carbapenemase-Producing Enterobacteriaceae in a Regional Burn Centre
Authors: Rehou Sarah , Rotman Sydney , Avaness Melisa , Jeschke Marc G , Shahrokhi Shahriar 
Published: April 2021

Abstract

Introduction
Antimicrobial resistance is an increasing problem in hospitals worldwide, though the prevalence of carbapenemase-producing Enterobacteriaceae (CPE) in our region is low. Burn patients are among the most vulnerable to infection because of the loss of the protective skin barrier. Because of this, burn centres prioritize infection prevention and control with measures like additional precautions, enhanced environmental cleaning, dedicated facilities, and mandatory use of personal protective equipment (PPE).

Methods
This report describes a CPE outbreak in a regional burn centre. We hypothesized that contamination of in-room hand hygiene sinks with CPE was a potential source of transmission. In a period of 2.5 months, four nosocomial cases of CPE were identified, three containing the KPC gene and one VIM gene. There was more than one month between the first and second KPC case, with no overlap in patient stay or rooms.

Results
The first two cases were identified while there was no CPE patient source on the unit. CPE KPC gene was isolated in sink drains of three different rooms. In addition to the rigorous infection control practices already in place due to the unique patient population, additional outbreak control measures were implemented. The burn centre restricted admissions to complex burns or burns &gt;10% total body surface area, in consultation with the attending surgeon. No elective admissions were permitted. To avoid CPE exposure to new patients, initial admissions were rerouted to the emergency department and, if possible, the patient was admitted to another unit. Patient cohorting was implemented through nursing team separation for CPE positive and negative patients and geographical separation of CPE positive cases to one side of the unit.

Conclusions
Despite aggressive infection control measures already in place at our burn centre, there was hospital acquired CPE colonization/infection. Given there was CPE acquisition when there was no positive patients on the unit and CPE contaminated sinks of the same enzyme were identified, it suggests that hospital sink drains can become a potential source of CPE.
123 A Novel Way of Thinking About Blast Injury Classification
Authors: Collier Zachary J , Choi Katherine J , Hulsebos Ian F , Pham Christopher H , Yenikomshian Haig A , Gillenwater Justin 
Published: April 2021

Abstract

Introduction
Blast injuries present unique challenges to civilian and military healthcare providers because of the complex and often severe nature of injuries spanning numerous anatomical regions, tissue types, and organ systems. Due to these factors, we devised a novel wound-focused classification system for implementation during triage and management of blast injuries to optimize outcomes and applied this system to patients treated at an ABA-certified burn center over 5 years.

Methods
A retrospective analysis of patients treated by an ABA-certified burn center for blast-related injuries from September 1, 2014 to October 31, 2019 was performed. Demographics, mechanism and distribution of injuries, interventions, and outcomes were evaluated. Injuries were classified using a wound-focused classification comprised of four zones: 1) areas closest to blast epicenter that had total or near-total tissue loss from the blast; 2) adjacent areas with thermal and chemical burns; 3) distant sites with shrapnel-related wounds; 4) injuries arising from barotrauma.

Results
We identified 64 patients who were mostly male (84%), averaging 38 ± 14 years old. Injury mechanisms included fireworks (19%), industrial accidents (16%), volatile fuels and drug labs (45%), and others including can, battery, lighter explosions (20%). All mechanisms had equivalent frequency of Zone 2 injuries with an average TBSA of 17 ± 18%. Drug-related blasts caused the highest TBSA (34 ± 23%) and the most full-thickness burns (33% vs average 23%). Fireworks had over five times (17% vs. 3%) more Zone 3 and three times (25% vs 8%) more Zone 4 injuries compared to the other mechanisms. Upper extremities were involved at twice the rate of other body regions (43% vs 19%). Patients presenting to our burn team over 24 hours after initial injury had infections in 50% of cases – a four-fold increase compared to non-delayed presentations (50% vs 13%). Overall, 45% required surgery (32% grafting, 3% flaps) but 100% of the drug-related blasts needed surgical intervention. Some patients (58%) required ICU admission with the highest rate (83%) in the drug-related group.

Conclusions
Blast injuries most often required admission for management of the Zone 2 component. Each blast mechanism resulted in distinct distributions of injury although fireworks had the greatest number of Zone 1, 3, and 4 injuries. Firework blasts were often less severe and more likely to present delayed with infectious complications. Larger blast mechanisms including drug-related lab explosions as well as industrial blasts had the highest rates of ICU admission, TBSA, full thickness depth, upper extremity involvement, and need for surgical intervention.
125 Minimal Effects of Intravenous Administration of Xenogeneic Adipose Derived Stem Cells on Organ Function in a Porcine 40%TBSA Burn Model
Authors: Heard Tiffany C , Gomez Belinda , Duarte Jamila , Dubick Michael A , Christy Robert J , Burmeister David M 
Published: April 2021

Abstract

Introduction
Adipose stem cells (ASCs) have shown therapeutic promise for inflammatory conditions that beget multi organ dysfunction, including burns. While ASCs have immunomodulatory properties, some studies have brought up safety concerns of increased pro-coagulant activity such as pulmonary microvascular thrombi formation after intravenous (IV) administration of ASCs. In the present study, the aims are two-fold: 1) to verify if IV administration of human ASCs promotes coagulation and 2) to determine if human ASCs affect organ function in a 40% total body surface area (TBSA) swine burn model.

Methods
Female Yorkshire swine (39.63 ± 8.26kg) were anesthetized and subjected to 40% TBSA full thickness contact burns according to a formerly established model. After recovery from anesthesia, animals were randomized to receive 15ml/kg Lactated Ringer’s Solution containing: 1- no ASCs; 2- a low dose (5x105 ASCs/kg), or 3- a high dose (5x106 ASCs/kg) over a 15-minute period as a bolus. Blood was collected at baseline (BL) and 3, 6, 12, and 24h post burn to determine the effect of ASCs on organ function and coagulation status. At 24h post-burn, animals were humanely euthanized, and kidney and liver tissue was collected for histological and Western blot analyses. Data is presented as mean ± SEM, and statistical significance was set at p&lt; 0.05.

Results
The high dose of ASCs significantly increased the circulating number of monocytes starting at 12 hours. Two-way ANOVA revealed a significant effect of ASCs on both prothrombin times (PT) and international normalized ratio (INR) (1.03 ± 0.04, 0.93 ± 0.03, and 1.02 ± 0.04 for no, low and high ASC groups, respectively at 24 hours). There were no differences in partial thromboplastin time, fibrinogen, or d-dimer levels. Both doses of ASCs briefly exacerbated burn-induced increases in total bilirubin at 3 hours (0.062 ± 0.025mg/dL, 0.148 ± 0.060mg/dL, and 0.211 ± 0.086mg/dL in no, low, and high ASC groups, respectively). ASCs did not alter urine output; yet, there was a significant effect of ASCs on creatinine. Western blotting revealed a rise in caspase expression in the liver of animals receiving a low dose of ASCs, while there was no difference in caspase expression in kidneys.

Conclusions
We show that IV administration of xenogeneic ASCs produces minimal changes in coagulation status and renal and hepatic dysfunction. Modest changes in the extrinsic coagulation pathway were dose-dependent, while exacerbation of liver dysfunction was brief and normalized after administration of ASCs was completed. We cannot rule out that continuous infusion of ASCs would not have a cumulative effect on organ dysfunction.
133 Oxidative Stress Can Be Significantly Influenced and Reduced by Polylactide-based Membrane Dressings
Authors: Haller Herbert , Demircan Mehmet , Gurunluoglu Kubilay 
Published: April 2021

Abstract

Introduction
Oxidative stress is part of the physiological response to local thermal injuries and has systemic effects in more extensive burns, vascular hyperpermeability, burn edema, cellular damage, and functions of the heart, lung, liver, kidneys, muscles, and other organs. Free NO and OH radicals affect mitochondrial function, and lower energy delivery to other organelles releases thermal energy, leading to hypermetabolism. Antioxidant therapies have attempted to reduce the consequences of oxidative stress with limited effects; however, the effect of external dressings is unclear. This study aimed to investigate the positive effects of polylactide-based membranes (PLM) on oxidative stress and clinical outcomes in burns.

Methods
Herein, a prospective study assessed the correlation between oxidative stress and the severity of injuries by measuring serum malonaldehyde (MDA) and glutathione levels and the total oxidant and antioxidant capacities (TOC and TAC) among children with electrical injuries. Furthermore, a prospective randomized study evaluated the TOC and TAC, MDA, glutathione, IL-6, TNF-α, and TGF-β levels, and the ratio of telomerase positive staining in epidermal cells along the particle thickness of burns in children, when comparing polylactide dressings to Hydrofiber Ag(HFAg), autografts, and controls.

Results
Coherence between measured oxidative stress and injury severity was apparent herein. Application of PLMs significantly reduced oxidative stress in partial-thickness burns compared to HFAg. PLMs decreased the TOC (4,91 VS. 16,78 µmol/L, day 7) and increased the TAC (14,47 VS. 4,34 µmol/L, day 7). The healing duration was lesser than that of HFAg (13 VS. 21 d). Proinflammatory IL-6 levels were significantly lower in the PLM group and TNF-α values were significantly reduced from days 7 to 14. The anti-inflammatory levels of TGF-β was significantly elevated (days 3–21) in the PLM Group. Telomerase levels and the cell count were higher in healed skin in the PLM group.

Conclusions
Oxidative stress depends on injury severity and is potentially influenced by dressings. PLM mediates the regulation of oxidative stress, as evident from the TOC and TAC, and pro- and anti-inflammatory cytokines including IL-6, TNF-α, and TGF-β by PLMs might positively influence the healing duration and skin quality in burns. These results could show that oxidative stress can be significantly influenced and reduced by PLM dressings.
134 The Effect of Adipose Derived Stromal Vascular Fraction on Stasis Zone in an Experimental Burn Model on Streptozocin – Induced Diabetic Rats
Authors: Uysal Cagri A , Ozkan Burak , Al Bayati Abbas Najimaldin Muhsun , Ozgun Gonca , Akinci Kadri , Toprak Ugur , Ertas Nilgun Markal , Haberal Mehmet 
Published: April 2021

Abstract

Introduction
Stasis zone is the encircling area of the coagulation zone which is a critical area determining the depth and width of the necrosis in burn patients. In our study we aim to salvage the stasis zone by injecting adipose derived stromal vascular fraction (ADSVF).

Methods
Intraperitoneal Streptozotocin was administered for the induction of diabetes mellitus (DM) and the development of DM was confirmed by the measurement of blood glucose levels in the blood samples with blood glucometer weekly 48 hours after injection. Rats with blood glucose levels above 200 mg/dl were accepted as diabetic. The diabetic animals were followed for 4 weeks before the intervention.
Thermal injury was applied on dorsum of diabetic Sprague – Dawley rats (n=20) according to the previously described ‘‘comb burn’’ model. After the burn injury (30 minutes) on Sprague - Dawley rats; rat dorsum was separated into 2 equal parts consisting of 4 burn zones (3 stasis zone) on each pair. ADSVF cells harvested from inguinal fat pads of diabetic Sprague - Dawley rats (n=5) were injected on the right side while same amount of phosphate buffered saline (PBS) injected on the left side of the same animal.
One week later, average vital tissue on the statis zone was determined by macroscopy, angiography and microscopy. Vascular density, inflammatory cell density and gradient of fibrosis were determined via immunohistochemical assay.

Results
Macroscopic stasis zone tissue survivability percentage (32 ± 3.28 %, 57 ± 4.28 %), average number of vessels (10.28 ± 1.28, 19.43 ± 1.72), capillary count (15.67 ± 1.97, 25.35 ± 2.15) and vascular density (1.55 ± 0.38, 2.14 ± 0.45) were higher on ADSVF side. Fibrosis gradient (1.87 ± 0.51, 1.50 ± 0.43) and inflammatory cell density (1.33 ± 0.40, 1.20 ± 0.32) were higher on the PBS side.

Conclusions
Macroscopic and microscopic findings determined that ADSVF has a statistically significant benefit for salvaging stasis zone on acute burn injuries in DM.
139 Topical Exogenous Nutrient and Saline Supplementation to Improve Skin Graft Survival: From Lab to Operating Room
Authors: Cooper Laura E , Bohan Phillip Kemp , Christy Sean E , Chapa Javier A , Chan Rodney K , Carlsson Anders H 
Published: April 2021

Abstract

Introduction
Skin grafting of poorly vascularized wound beds, (e.g. exposed fascia, tendon, or bone) is often a multi-stage procedure, resulting in persistent open wounds and long-term complications such as scarring and contracture. Single-stage skin replacement could mitigate these downsides. Here we present the addition of topical nutrients and negative-pressure wound therapy (NPWT) + saline instill to improve graft take, and a case report of treatment of a non-healing wound in a single-stage procedure.

Methods
Ex vivo, STSGs (12/1000ths in) were harvested from swine (Sus scrofa domestica) post-euthanasia and transferred into wells with distilled water, PBS, Tyrode’s Buffer, high (4.5g/L) and low (2g/L) glucose DMEM, EpiLife, or William’s E (WE) media for 7 days, followed by performance of biochemical analyses and immunohistochemistry. In vivo, 20 full-thickness 5cm-diameter excisional wounds on the dorsum of two anesthetized swine were treated with dermal substitutes (DS, 0.4mm, 0.8mm, 1.2mm, or 1.6mm thickness), STSG, and NPWT with or without intermittent saline instill (3x daily, 300mL, 15-minute soak). Re-epithelialization was assessed at day 7 and 14. Lastly, a chronic 800cm2 left knee wound was treated with NPWT + instill (every 3.5 hours, 80mL, 10-minute soak, 3-day duration) over a 12/1000ths inch STSG.

Results
DMEM with high glucose (DMEM-HG) and WE produced the most lactic acid and enzymatic carbonate. Lactate dehydrogenase activity was lowest with WE. DMEM-HG had the highest glucose consumption but the most unconsumed glucose, with WE resulting in the next highest amount. Immunohistochemistry showed DMEM-HG or WE had the most dividing and least dying cells. In the porcine model, DS of 0.8mm, 1.2mm, and 1.6mm thicknesses inhibited graft take significantly (p&lt; 0.01, p=0.02, p&lt; 0.01, respectively) for all NPWT alone wounds. Addition of saline instill showed significant improvement in graft take (p=0.03) for 0.8mm DS wounds. 1.2mm and 1.6mm DS wounds continued to show significantly decreased graft take (p=0.03 and p=0.02, respectively). All 0.4mm DS wounds performed similar to control. Clinically, following NPWT removal on post-op day 3, almost complete STSG take was observed without exudate, pus, or malodor within the wound bed.

Conclusions
While additional studies are ongoing to determine the optimal nutrient supplementation, WE performed the best overall thus far. In vivo, 0.8mm DS created a successful model of a poorly vascularized wound bed, as NPWT + instill overcame this thickness. The novel use of NPWT + instill treatment over STSG clinically shows promise to improve graft take in the future.
141 Mild Burns Combined with Diet Induced Demyelination Does Not Affect Skeletal Muscle Function
Authors: Vardarli Emre , Bhattarai Nisha , El Ayadi Amina , Wang Y E , Jay Jayson W , Prasai Anesh , Rontoyanni Victoria G , Wolf Steven E , Song Juquan 
Published: April 2021

Abstract

Introduction
Severe burns result in decreased skeletal muscle mass and function. Recent evidence suggests that massive burns disrupt the motor-neural system including motor neurons to partially explain skeletal muscle dysfunction in response to burns. However, impact of demyelination on burn induced skeletal muscle dysfunction has not been investigated. The purpose of this study was to determine the impact of exaggerated demyelination on skeletal muscle dysfunction after burn.

Methods
C57BL/6 (20-25g, male, n = 26) mice were separated into 6 groups (4–5 animals per group) by diet, burn injury and timepoint (burn or sham groups with two different diets measured at two different timepoints). Mice were fed with either cuprizone diet (0.2 %) to induce severe demyelination or regular diet (18 % protein) for 5 weeks prior to injury. Burns were administered by immersing the dorsal side of the animal into ~95 °C hot water for 10 seconds (~15 % body surface area, full thickness burn). In-situ gastrocnemius function was assessed by attaching the distal tendon of the muscle to a lever arm of a force transducer and stimulating the muscle via exposed sciatic nerve while the animal was under anesthesia. In-situ gastrocnemius muscle function was evaluated 3- and 7-days after burn.

Results
Food intake was 30 % higher in cuprizone diet group compared to the regular diet group (p=0.002). However, there was no significant difference in body weight among groups (p=0.071). No significant difference was found in gastrocnemius wet weight, peak twitch tension, time to reach peak twitch tension, peak twitch half relaxation time, force-frequency relationship, maximum tetanic force, and fatigue index among groups (burn effect, diet effect, time effect, and their interactions; NS).

Conclusions
Mild burns combined with demyelination by diet had no effect on skeletal muscle function on our timepoints, and 15 % TBSA burn size was not sufficient to induce skeletal muscle dysfunction. The impact of burn induced neural damage on muscle function and performance indicates further investigation.
143 Galunisertib Exerts Targeted Anti-Fibrotic Effects in In Vitro Models of Burn Wound Healing
Authors: Peterson Joshua M , Prasai Anesh , Jay Jayson W , Wolf Steven E , El Ayadi Amina 
Published: April 2021

Abstract

Introduction
Inhibition of TGF-β has shown promising in vitro and in vivo results for reduction of hypertrophic scarring after burn injury. However, TGF-β regulates diverse cellular pathways apart from fibrosis, including physiologic wound healing, cell cycle control, and homeostasis. Galunisertib, a novel small molecular tyrosine kinase inhibitor of TGF-beta receptor type 1, specifically targets downstream pro-fibrotic pathways of TGF-β signaling, has an excellent adverse effect profile, and minimal off-target effects. We hypothesized that galunisertib diminishes fibrotic phenotypes in a targeted fashion, making it a promising candidate drug for prevention of hypertrophic burn scar and contracture.

Methods
Commercially available fibroblasts were treated with TGF-β at concentrations typical of burn wounds to induce fibrotic phenotype fibroblasts (FPF). FPF cells were treated with galunisertib for 0, 1, 2, 3, and 7 days at concentrations ranging from 0.01 μM to 100 μM. FPF viability and proliferation were assessed with MTT assay. Modulation of FPF cell fibrotic gene and was analyzed using quantitative real-time PCR (qRT-PCR) of COL1A1, COL3A1, FN1, αSMA, CTGF, DCN, MMP1, and MMP13. Analysis of phenotype modulation was performed by western blotting of P-Smad2/3, collagen-1, fibronectin, and αSMA. Statistical analysis performed with students t-test and ANOVA.

Results
TGF-β treated FPF cells had significantly increased proliferation relative to commercially available fibroblasts, which was attenuated by treatment with 2.5–10 μM galunisertib at 2 or 3 days after treatment in a concentration dependent manner (p &lt; 0.05) while also not causing a relative decrease in proliferation. Expression of FPF downstream pro-fibrotic genes underwent significant fold changes (FN1, αSMA, CTGF: p &lt; 0.05). Protein expression showed decrease in both SMAD2/3 phosphorylation and fibrotic protein expression. Scratch assay analysis is ongoing.

Conclusions
Galunisertib exerts targeted dose-dependent inhibition of fibrotic gene expression and phenotypes in vitro without hindering cellular proliferation.