bluuebunny/crossref_metadata_2025_split huggingface dataset:
T6 Burn Survivors Can Perform Mild/moderate-intensity Exercise in Thermoneutral Conditions Without a Risk of Excessive Elevations in Core Body Temperature
Authors: Crandall Craig G , Belval Luke N , Cramer Matthew N , Huang Mu , Moralez Gilbert , Watso Joseph C , Kowalske Karen J 
Published: April 2021

Abstract

Introduction
Burned skin excision and subsequent grafting removes sweat glands, which impairs thermoregulation. Consequently, exercise prescribed for rehabilitation may expose individuals with burn injuries to a greater risk of hyperthermia, depending on exercise duration, intensity, and environmental temperature. Little is known regarding the risk of hyperthermia in adult burn survivors performing mild/moderate-intensity exercise under thermoneutral environmental conditions, i.e. conditions similar to the rehabilitation clinic and/or the gym. This project tested the hypothesis that burn survivors, across a wide range of percent total body surface area (%TBSA) burned, can participate in mild/moderate-intensity exercise in a thermoneutral environment without excessive elevations in core body temperature.

Methods
Twenty-eight well-healed burn survivors with low (23±5%TBSA; N=10), moderate (42±7%TBSA; N=9), and high (60±8%TBSA; N=9) sized burn injuries performed 60 minutes of cycle ergometry exercise (72±15 Watts, oxygen uptake rate of 1.25±0.21 L/min equivalent to 4.5±0.2 METs) in a 25°C and 23% relative humidity environment. Absolute gastrointestinal temperatures (Tcore) and changes in gastrointestinal temperatures (ΔTcore) were obtained at 15-minute increments throughout the exercise bout. A participant with an absolute Tcore of greater than 38.5°C, and/or a ΔTcore of &gt;1.5°C, at any time point during the trial was categorized as being at risk for hyperthermia.

Results
Sixty minutes of exercise increased Tcore in all groups (Low: 0.72±0.21°C; Moderate: 0.42±0.22°C; High: 0.77±0.25°C, all P&lt; 0.01 from pre-exercise baseline), resulting in similar absolute Tcore values of upon exercise termination (Low: 37.87±0.24°C; Moderate: 37.56±0.34°C; High: 37.76±0.47°C, P=0.19). Importantly, no participant was categorized as being at risk for hyperthermia, based upon the aforementioned criteria.

Conclusions
These data indicate that individuals with substantial %TBSA burned can exercise at a mild/moderate intensity for 60 minutes in thermoneutral environmental conditions without a risk of excessive elevations in body core temperature.
3 Development of School-Aged Life Impact Burn Recovery Evaluation (SA-LIBRE 5–12) Profile: Item Pool
Authors: Rodríguez-Mercedes Silvanys L , Rencken Camerin A , Patel Khushbu F , Grant Gabrielle G , Kinney Erin M , Stoddard Frederick J , Kazis Lewis E , Schneider Jeffrey C , Ryan Colleen M 
Published: April 2021

Abstract

Introduction
The transition from early childhood to teen years (5–12) is a critical time of development, which can be made particularly challenging by a burn injury. Currently, few validated standardized measures exist for this age group. This study aimed to generate item pools to create a computer adaptive test (CAT) assessing post-burn recovery in school-aged children.

Methods
Item pool development was based on the School-Aged Life Impact Burn Recovery Evaluation (SA-LIBRE5-12) Conceptual Model and the World Health Organization’s International Classification of Functioning, Disability, and Health for Children and Youth. Additional elements included a literature review, expert consensus meetings, and parent cognitive interviews. Candidate items assessing health outcomes were extracted from existing legacy measures during the literature review. Details of expert consensus meetings and parent cognitive interviews are in Table 1.

Results
Items assessing health outcomes (n=3,732) were extracted during the literature review. Experts binned items across three domains: 1) Physical Functioning (55 items), 2) Psychological Functioning (80 items), and 3) Family and Social Functioning (57 items). Six cognitive interviews were conducted. Qualitative data resulted in further review of 86 items. The results of the cognitive interviews indicated that item stems and response choices were interpretable by respondents.

Conclusions
This study developed an item pool (n=192) to assess post-burn recovery of school-aged children. The next step in the SA-LIBRE5-12 CAT Profile development will be field-testing for the calibration and item response theory-based validation of the assessment.
8 Variations in COMT Gene Are Not Associated with Patient-Reported Outcomes: A Multicenter Collaborative Proof of Concept Study
Authors: Sibbett Stephen H , Oh Jamie , Wolfe Audrey E , Schneider Jeffrey C , Kowalske Karen J , Stewart Barclay T , Gibran Nicole S 
Published: April 2021

Abstract

Introduction
Variant single nucleotide polymorphisms (SNPs) in the catechol-O-methyl transferase (COMT) gene have previously been associated with pain thresholds, resiliency, and cognitive functioning. Known colloquially as the “warrior/worrier” gene, the GG variant is associated with higher resilience whereas the AA variant is associated with lower resilience. The aim of this study is to demonstrate the feasibility of correlating a genomic data repository with multicenter national longitudinal burn data.

Methods
From August 2018 to July 2020, participant cheek swabs were collected in-person or by mail at three burn centers and sent to the lead center for DNA isolation and storage. COMT SNPs were determined by polymerase chain reaction (PCR). SNP data were merged with a multicenter burn database. Outcomes of interest included the Patient-Reported Outcomes Measurement Information System (PROMIS-29), Community Integration Questionnaire (CIQ), Veterans RAND 12 (VR-12) physical (PCS) and mental component summary (MCS) scores, posttraumatic stress disorder (PTSD) measure, and Posttraumatic Growth Inventory (PTGI). Follow-up data were obtained at 6 months post-discharge. We used a Kruskal-Wallis test to determine associations between COMT SNPs and outcomes.

Results
Of the 126 cheek swabs obtained, DNA was successfully isolated from 124 swabs, and PCR SNP analysis was successful for 111 swabs. The distribution of COMT SNPs in our study population was consistent with the general population. Kruskal-Wallis analysis revealed no association between COMT SNPs and patient outcomes. Median PTGI scores trended toward significance, but in the opposite direction than predicted for COMT genotypes.

Conclusions
A national longitudinal database can be feasibly supplemented by a genomic data repository. Variation in the COMT gene did not correlate with health-related quality of life measures examined in a small cohort of burn survivors. Lack of statistical significance can be attributed to small sample size.
20 Chronic Cardiovascular Dysfunction Following Lower Extremity Amputation in Burn Patients
Authors: Hallman Taylor , El Ayadi Amina , Ozhathil Deepak K , Golovko George , Song Juquan , Wolf Steven E 
Published: April 2021

Abstract

Introduction
Long-term chronic cardiovascular dysfunction is a well-reported outcome in patients who have suffered severe burns associated with diminished muscle mass and hypermetabolism. Devastating burn injuries sometimes warrant extremity amputation to preserve life over limb. A lower extremity amputation can exacerbate the risk of burn-related sequelae due to prolonged recovery and reduced mobility. We queried a large multi-institutional national database to investigate whether lower extremity amputations in those with severe burns were associated with increased incidence of chronic myocardial dysfunction syndromes.

Methods
We accessed the TriNetX Global Health Research Network and queried ICD-10 codes for burn injuries (T20-25, T30-32) across 41 participating health care organizations. Comparative cohorts of patients who underwent lower extremity amputations and those who did not were identified. A matched case-control analysis of these cohorts accounting for age and gender matching was compared for the subsequent diagnosis of chronic cardiac dysfunction syndromes (I50.22, I50.32, I50.42, I50.812).

Results
A total of 347,156 patients did not undergo lower extremity amputation, and their demographics showed a mean age of 38 years, 54% males, 60% white and 18% African American. In contrast, 1,535 patients underwent lower extremity amputation with a mean age was 59 years, 73% were male, 60% white and 24% African American. Burn patients who underwent amputations showed a comparative increased risk of 5.77% (p &lt; 0.0001) for developing of chronic cardiac dysfunction compared to those who did not undergo amputations (RR 3.512, 95% CI: 2.39–5.16). One year following injury this comparative risk diminished to 3.45% (p &lt; 0.0001; RR 3.14, 95% CI: 1.96–5.04). The difference in risk was not significant 3 years after burn injury (0.538%, p = 0.2163, RR 1.54, 95% CI: 0.77–3.09).

Conclusions
Patients who underwent amputations after severe burn are at increased risk of developing chronic cardiac dysfunction compared to those that did not undergo amputation; the significance appears to diminish with time. Further research is indicated to elucidate the mechanism for this relationship.
21 Navigating Controversial Therapies for Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Syndrome Using Large Database Analysis
Authors: Ozhathil Deepak K , Gore Nicholas A , Nguyen Kayla Y , Golovko George , Pham Judy , Gutierrez Garret , Song Juquan , El Ayadi Amina , Wolf Steven E 
Published: April 2021

Abstract

Introduction
Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis Syndrome (TENS) are part of a spectrum of autoimmune conditions, which cause epidermal detachment and keratinocyte necrosis. Due to the rare incidence, a dramatic heterogeneity in treatment algorithms and prolonged discussion of controversial therapies has ensued. We queried a large national data network to better understand how these therapies are actually implemented and the relative impact on survival.

Methods
The TriNetX Global Health Research Network (41 healthcare organizations) was queried using ICD-10 codes (L51.1 - 51.3) to identify patients diagnosed with SJS or TENS from 2000 to 2020. A treatment frequency map was constructed to determine the most common treatment groupings, and cohorts were indexed based on the most frequent isolated and combined therapy algorithms: systemic steroids (SS), diphenhydramine (DH), cyclosporine (CS), intravenous immunoglobulin (IVIG) and tumor necrosis factor alpha inhibitors (TNFαi). Cohorts were case matched for demographics against a restricted control group (RC; patients who did not receive any of the above-mentioned therapies) and an unrestricted control group (UC, all patients diagnosed with SJS or TENS) to evaluate mortality risk, survival probability, and to uncover Type II error.

Results
Cohorts were UC (6,196), RC (2,248), SS+DH (3,459), SS (1,269), SS+CS (1,554), DH (479), CS (52), IVIG (10) and TNFi (10). The treatment map showed 36.3% of patients did not receive any of the listed therapies. Of those that did 48.2% initially got SS, 24.3% got DH, 15.4% got SS+DH and 3% got SS+CS. Patients who received SS had a 8.51% mortality risk and 2.84% risk reduction compared to UC (p = 0.017). However, the Hazard Ratio (HR) was 0.80 (95% CI: 0.57, 1.23) showing no survival advantage. Compared to RC risk reduction decreased to 0.47% (p = 0.667). SS+DH showed a risk reduction of 1.13% compared to UC (p = 0.113; HR 0.89, 95% CI: 0.69, 1.16), but this advantage resolved when compared to RC. Similarly, SS+CS had a risk reduction of 2.12% compared to UC (p = 0.039; HR 0.80, 95% CI: 0.58, 1.09), which decreased to 0.07% (p = 0.947) when compared to RC. DH and CS had no significant risk reduction (p = 0.25 - 1.00) or survival advantage. IVIG and TNFαi were underpowered for analysis.

Conclusions
The most common treatments for patients diagnosed with SJS or TENS are systemic steroids, diphenhydramine, or a combination of the two. Unfortunately, none of the above therapies confer a significant survival advantage. Furthermore, some therapies raised concern for Type II errors when the control group is not adjusted for alternative therapies.
23 Nutritional Intake and Weight Change in Severely Burned Patients
Authors: Fossati Sandrine O , Shields Beth A , Cole Renee E , Kieffer Adam J , Vega Saul J , Aden James K , Williams Alicia M , Cancio Leopoldo C 
Published: April 2021

Abstract

Introduction
Nutrition is crucial for recovery from burn injuries, as severe weight (wt.) loss can lead to impaired immunity and wound healing, infections, skin graft failure, and mortality. Previous studies recommended avoiding more than 10% wt. loss, as this level resulted in increased infection rates. However, wt. loss is often not quantifiable during the critical illness phase, with severe edema masking non-fluid related body wt. changes. Energy (kcal) deficits can be used to estimate wt. loss until the edema has resolved, but previous studies in non-burn patients indicate that actual wt. loss is less than the commonly used 3500 kcal per pound of fat (7700 kcal per kg of fat). The objective of this performance improvement project was to evaluate nutritional intake and the resulting dry wt. change in severely burned patients.

Methods
This performance improvement project was approved by our regulatory compliance division. We performed a retrospective evaluation on patients with at least 20% total body surface area (TBSA) burns admitted for initial burn care to our intensive care unit over a 7-year period. Patients who died or who had major fascial excisions or limb amputations were excluded. Patients who did not achieve a recorded dry wt. after wound healing were not included in this analysis. Retrospective data were collected, including sex, age, burn size, kcal intake, kcal goal per the Milner equation using activity factor of 1.4, admission dry wt., dry wt. after wound healing (defined as less than 10% TBSA open wound), and days to dry wt. after wound healing. Descriptive statistics and linear regression were performed using JMP. Significance was set at p&lt; 0.05.

Results
The 30 included patients had the following characteristics: 90% male, 30 ± 11 years old, 45% ± 15% TBSA burn. They received 2720 ± 1092 kcal/day, meeting 68% ± 24% kcal goal, and took approximately 53 ± 30 days from injury to achieve dry wt. after wound healing. These patients had wt. loss of 8 ± 8 kg from the kcal deficit of 69,819 ± 51,704 during this time period. The kcal deficit was significantly associated with wt. change [p &lt; 0.001, R2 = 0.49, wt. change in kg = (-0.000103 x kcal deficit) – 1]. This translates to one kg of body wt. loss resulting from 9709 kcal deficit.

Conclusions
This performance improvement project found that an energy deficit of approximately 9700 kcal in our patients equates to 1 kg of body mass loss (4400 kcal deficit equates to 1 pound of body mass loss). These findings are similar to wt. loss studies in other patient populations and contrary to the commonly used 3500 kcal per pound of fat (7700 kcal per kg of fat).
32 Does the Use of Silicone Gel Sheeting Impact the Overall Physiology of Hypertrophic Scar Development? A Feasibility Trial Using Laser Doppler Imaging to Assess Perfusion in Native Skin and Immature Burn Scar
Authors: Vocke Scott F , Dean Brooke , Andre Gregory , Caffrey Julie 
Published: April 2021

Abstract

Introduction
The use of silicone gel sheeting (SGS) has long been observed clinically as an effective modality in reducing hypertrophic scar (HTS) formation. Although the use of SGS is widely accepted, the exact mechanism is not fully understood. Prevailing theory suggests silicone suppresses collagen production in immature active scar. Collagen production is enhanced as blood flow increases in areas of scar hyperemia. Reduction of blood perfusion to the immature scar may act as a potential mechanism in limiting excessive scar proliferation.

Methods
Laser Doppler Imaging (LDI) was used to assess 2 areas in 2 subjects (85% TBSA w/ CEA and native skin control): A control site and SGS testing site were traced on the skin of each subject and 5 LDI scans were performed on both subjects: 1) initial without SGS; 2) initial with SGS applied; 3) 4-hours post-SGS application with SGS on; 4) 4-hours post-SGS application immediately after removal; 5) 15-minutes post-SGS removal. The control and testing site for both subjects were then analyzed using the LDI software and the average perfusion units (PU) over the region of interest (ROI1: testing site; ROI2: control site) areas were calculated for each scan.

Results
Perfusion within both ROI had a marked increase in perfusion for HTS scans after 4-hours when compared to the initial scan. However, after initial SGS application to ROI1, the mean PU decreased by 23.1% while the perfusion to ROI2 remained relatively constant (-5.8%). Subsequently, the ROI2 increased in mean PU by 23.4% 4-hours after the initial scan while the ROI1 showed a blunted response in perfusion in comparison increasing by only 2.3%.

Conclusions
Perfusion for both NS and HTS were notably decreased when SGS was applied compared to the matched ROI without SGS. In addition, prolonged SGS application created a greater difference in perfusion between silicone (less perfusion) and non-silicone sites (greater perfusion) for both NS and HTS when compared to initial SGS application demonstrating a greater effect on perfusion the longer SGS was worn.
33 An Evidence Based Laser Therapy Algorithm for the Treatment of Burn Scars
Authors: Sood Rajiv 
Published: April 2021

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.
35 Outcomes for Hand Burns Treated with Autologous Skin Cell Suspension in 20% TBSA and Smaller Injuries
Authors: Taylor George M , Carter Jeffrey E , Tuggle Charles T , Barnett Scott , Phelan Herb A 
Published: April 2021

Abstract

Introduction
Our group has previously reported our experience with autologous skin cell suspension (ASCS) in the treatment of all subjects with hand burns regardless of the total body surface area (TBSA) involved. In order to better address the confounder of TBSA on burn outcomes, we sought to analyze our experience in a cohort of subjects whose TBSA totaled 20% or less. We hypothesized that the use of ASCS in conjunction with a 2:1 meshed autograft would provide comparable outcomes to hand burns treated with smaller meshed autograft alone.

Methods
A retrospective review was conducted for deep 2nd and 3rd degree hand burns treated with split thickness autograft (STAG) at our urban verified burn center between April 2018 to September 2020. Exclusion criterion was a TBSA greater than 20%. The cohorts were those subjects treated with ASCS in combination with STAG (ASCS(+)) versus those treated with STAG alone (ASCS(-)). All ASCS(+) subjects were treated with 2:1 meshed STAG and ASCS overspray while all ASCS(-) subjects had 1:1 or piecrust mesh only. Outcomes included demographics, proportion returning to work (RTW), length of time for RTW, and time to wound closure. Mann-Whitney U test was used for comparisons of continuous variables, and Fishers Exact test for categorical variables. Values are reported as median and interquartile range.

Results
Fifty-one subjects fit the study criteria (ASCS(+) n=31, ASCS(-) n=20). The ASCS(+) group was significantly older than the ASCS(-) cohort (44 yrs. [32, 54] vs 32 [27.5, 37], p=0.009) with larger %TBSA burns (15% [9.5, 17] vs 2% [1, 4], p &lt; 0.0001), and larger size hand burns (190 cm2 [120, 349.5] vs 126 cm2 [73.5, 182], p=0.015). Comparable results were seen between ASCS(+) and ASCS(-), respectively, for time to wound closure (9 days [7, 13] vs 11.5 [6.75, 14], p=0.63), proportion RTW (61% vs 70%, p=0.56), and days for RTW among those returning (35 [28.5, 57] vs 33 [20.25, 59], p=0.52). The ASCS(+) group had two graft infections with no reoperations, while ASCS(-) had one infection with one reoperation. No subjects in either group had a dermal substitute placed.

Conclusions
Despite being significantly older, having larger hand wounds, and larger overall wounds within the parameters of the study criteria, patients with 20% TBSA burns or smaller whose hand burns were treated with 2:1 mesh and ASCS overspray had comparable time to wound closure and return to work as subjects treated with 1:1 or pie-crust meshed STAG. Our group plans to follow this work with scar assessments for a more granular picture of pliability and reconstructive needs.