bluuebunny/crossref_metadata_2025_split huggingface dataset:
95 Incidence of Hypertrophic Scar Diagnosis in Burn Patients Prescribed Glucocorticoids
Authors: Joglar Alejandro A , Golovko George , Chokshi Shivan N , Efejuku Tsola A , Wermine Kendall , Gotewal Sunny , De La Tejera Giovanna , Villarreal Elvia L , Corona Kassandra K , Keys Phillip H , Song Juquan , Wolf Steven E , El Ayadi Amina 
Published: March 2022

Abstract

Introduction
Despite advancements in burn care, the optimal treatment to prevent or treat hypertrophic scars is still elusive. Therefore, the objective of this study is to compare the efficacy of five glucocorticoid medications commonly used in the treatment of hypertrophic scarring in burned patients using a large patient database.

Methods
Patients diagnosed with hypertrophic scarring, hypertrophic disorders of the skin, or scar conditions and fibrosis of skin at least one day after burn injury were identified in the TriNetX database. Hydrocortisone, methylprednisolone, dexamethasone, triamcinolone, and prednisone were the glucocorticoids investigated. Those who received a glucocorticoid on the same day or any time after the incidence of burn injury were compared to those who did not take glucocorticoids in the previous five years. Patients were stratified into four groups based on percent total body surface area (TBSA) burned: 0-9%, 10-19%, 20-39%, and 40-100%. A total of 165,041 burned patients were found who did not receive glucocorticoids, and 66,652 burn patients who received glucocorticoids after injury. Statistical analysis for comparison included a risk ratio with a significance defined as a p-value &lt; 0.05.

Results
In all burn patients identified, the risk of hypertrophic scarring diagnosis was reduced with methylprednisolone (RR=0.60, p&lt; 0.001) and prednisone (RR=0.37, p&lt; 0.001), while it was increased with dexamethasone (RR=2.48, p&lt; 0.001). Stratification based on %TBSA burned showed that diagnosis of hypertrophic scarring was reduced in the &lt; 10% TBSA group with methylprednisolone (RR=0.49, p&lt; 0.001) and prednisone (RR=0.33, p&lt; 0.001), while it was increased with dexamethasone (RR=3.6, p&lt; 0.001). Similarly, in the 10-19% TBSA group, the risk was reduced with prednisone (RR=0.57, p=0.024) while increased with dexamethasone (RR=2.2, p&lt; 0.001). No significant effect was observed with hydrocortisone or triamcinolone with any of the %TBSA groups examined. Patients treated with dexamethasone continued to show increased risk for hypertrophic scar diagnosis with 20-39% TBSA (RR=1.69, p&lt; 0.001) and 40-100% TBSA (RR=1.87, p&lt; 0.001).

Conclusions
While methylprednisolone and prednisone decreased the risk of hypertrophic scarring diagnosis among all burn patients identified, dexamethasone showed an increased risk of hypertrophic scarring diagnosis in all burn patients and in each %TBSA stratified group.
96 Poly-dl-lactide Copolymer-dressing Use on Burn Wounds and Skin Graft Donor Sites - An Institutional Review
Authors: Lagziel Tomer , Metoyer Garyn , Kawaji Qingwen , Akhavan Arya A , Cox Carrie A , Caffrey Julie , Hultman Charles S , Duraes Eliana F 
Published: March 2022

Abstract

Introduction
In burn surgical care, wound coverage and the corresponding dressing are paired to maximize the ability to promote re-epithelization, minimize pain and patient discomfort, dressing change frequency and overall cost. This dressing, a copolymer material based on DL lactic acid, has been described as a reliable alternative dressing for partial thickness burns as well as skin graft donor sites with comparable wound-healing quality and duration. Our aim is to assess outcomes results of this copolymer dressing at our institution, as applied to partial thickness burn wounds and graft donor sites.

Methods
We performed a retrospective analysis of 55 adult patients admitted between January 1, 2020 to August 25, 2021 for the treatment of partial thickness burns that were managed with a poly-DL-lactide copolymer skin substitute at the burn wound and/or autograft donor site. Three study groups were established based on application site: wound only (group 1), donor site only (group 2), and both (group 3). We assessed operative times, infections rates, complications, length of stay, readmission rates, and mortality.

Results
Preliminary data of 40 patients shows clinically similar results for analgesic requirements, operative length, and hospital LOS between group 1 and group 3. Group 2 showed higher analgesic requirements, lower operative times, a lower LOS, and lower readmission rates. Group 3 shows higher pain levels and longer operative times, when compared with groups 1 and 2, but lower readmission rates than group 1.

Conclusions
The poly-DL-lactide copolymer skin substitute offers reliable wound coverage for a partial thickness burns while also reducing frequency of dressing changes and associated pain correlating to reduced length of hospital stay and wound healing interval.
98 Plasma Extracellular Vesicles Released After Sever Burn Injury Modulate Macrophage Function
Authors: Willis Micah L , Mahung Cressida , Wallet Shannon , Coleman Leon , Maile Robert 
Published: March 2022

Abstract

Introduction
Extracellular microvesicles (MVs) have emerged as key regulators of immune function across multiple diseases and potential biomarkers. Severe burn injury is a devastating trauma with significant immune dysfunction that results in an ~12% mortality rate due to sepsis-induced organ failure, pneumonia, and other infections. Severe burn causes a biphasic immune response: an early (0-72 hrs) hyper-inflammatory state, with release of pro-inflammatory damage-associated molecular pattern molecules (DAMPs), such as HMGB1, and cytokines (e.g.IL-1b), followed by an immunosuppressive state (1-2 weeks post injury), associated with increased susceptibility to life-threatening infections. We have reported that early after severe burn injury HMGB1 and IL-1b are enriched in plasma microvesicles (MVs), suggesting a role for MVs in post-burn immune activation. Here we tested the impact of MVs isolated after burn injury on phenotypic and functional consequences in vivo and in vitro using adoptive MV transfers.

Methods
We then assessed if the cargo of MVs following burn injury in humans could predict length of hospital stay. MVs isolated early from mice that underwent a 20% total body surface area (TBSA) burn injury (burn MVs) caused similar cytokine responses in naïve mice to those seen in burned mice early after injury. Burn MVs transferred to RAW264.7 macrophages caused similar functional (i.e. cytokine secretion) and genetic changes (measured by NanoStringTM) seen with their associated phase of post-burn immune dysfunction.

Results
Burn MVs isolated early (24h) induced MCP-1, IL-12p70 and IFNg, while MVs isolated later (1 and 2 weeks) blunted RAW proinflammatory responses to bacterial endotoxin (LPS). Unbiased LC-MS / MS proteomic analysis of early EVS (&lt; 72 h post-injury) showed similarities in human and mice.

Conclusions
In our sample of large burn injury, EV SAA1 and CRP correlated with TBSA injury in both sexes and were correlated with length of hospital stay in women.
100 Burn Causes Aberrant Macrophage Polarity Conversion in Skeletal Muscles, Which Is Mitigated by Auto/mitophagy-targeted Therapy
Authors: Sugawara Yoh , Khan Mohammed A , Morinaga Hiroyuki , Martyn Jeevendra , Yasuhara Shingo 
Published: March 2022

Abstract

Introduction
Major burn injury (BI) is associated with excessive inflammation. We have reported autophagy/mitophagy response defect in skeletal muscles in BI, leading to diminished homeostasis capability of cells and mitochondria. Macrophages play central roles in the process of wound healing, from causing inflammation, clearing cell debris, to coordinating tissue repair. Classically, M1 macrophages are considered as pro-inflammatory phenotype, and M2 as anti-inflammatory/pro-regeneration phenotype, though complexity of constituent of macrophage subpopulations, being increasingly recognized. The relationship between BI-induced autophagy/mitophagy defect and the regulation of macrophage polarity in BI has not been studied so far.

Methods
Body trunk BI covering 30% of body surface area or sham-bun (SB) treatment was administered to wild type mice. At post burn day (PBD) 5, mechanical injury was created in sternomastoid muscles (STM) by pressure injection of saline into the tissue ( &gt;3x fracture toughness) to study effect of BI on the wound healing process in muscles. STMs were harvested at post surgical day (PSD)1, 3, 7 and 14, and cryosectioned for immunohistochemistry against satellite cells (pax7), and macrophages (CD86 for M1, CD206 for M2, and F4/80 for general). As a therapeutic approach, we tested the effect of auto/mitophagy modulating drug, trehalose, whose pro-auto/mitophagy effect has been attributed to mitigation of the blocked flux of auto/mitophagy (due to BI) in our separate studies.

Results
SB control group showed both total and M1 macrophage numbers chronologically decreasing from PDS1 towards PSD14. BI caused delay in the subsiding of the macrophage infiltration. The greater majority of the macrophage in BI was CD86 (+) M1 phenotype, confirming the pro-inflammatory traits in BI (+46.4% of SB at PSD7). Contrarily, CD206 (+) M2 macrophage started from low numbers at PSD1 and increased towards PSD7 and 14 in SB. In BI, however, M1/M2 conversion was markedly delayed (-59% of SB at PSD7), which was mitigated by trehalose (+134% of BI at PSD7). Pax7 (+) muscle satellite cells increased from PSD1 towards PSD14 in SB, but the response was prominently defective in BI, and was normalized by trehalose.

Conclusions
M1 to M2 conversion observed in SB was defective in BI with concomitant defect in satellite cell proliferation. Autophagy/mitophagy treatment drug, trehalose mitigated the phenotype conversion defect in macrophage.
102 Vaping of Vitamin E Acetate Causes Acute Lung Injury in a Dose-dependent Manner in Sheep
Authors: Homma Kento , Hashimoto Kazuki , Bazhanov Nikolay , Salsbury John , Traber Maret G , Enkhbaatar Perenlei 
Published: March 2022

Abstract

Introduction
The Centers for Disease Control and Prevention and the Food and Drug Administration have reported an increasing number of clinical cases of pulmonary injury following the use of e-cigarette/vaping products. Although the causative factors for the national outbreak of electronic-cigarette, or vaping product use-associated lung injury (EVALI) has not been established, CDC reported that vitamin E acetate (VEA) is strongly linked to the EVALI outbreak. In this study, we tested the hypothesis that VEA vaping causes acute lung injury in a dose-dependent manner in a sheep model.

Methods
Sheep were surgically prepared under anesthesia and analgesia with multiple vascular catheters (pulmonary arterial, left atrial, and femoral arterial). To assess pulmonary edema, the mediastinal lymph node vessel draining the lung was cannulated. After a 5-day surgical recovery, a tracheostomy tube and urinary catheter were placed. Then, the sheep were placed on a mechanical ventilator and VEA vaping was immediately started in the following groups: (1) vaped with glycerol (n=1); (2) vaped with 0.4mg of VEA (n=2); (3) vaped with 0.6mg of VEA (n=1); (4) vaped with 0.8mg of VEA (n=7); and (5) not injured, not treated (Sham, n=6). Sheep were resuscitated with lactated Ringer’s solution (4mL/kg/hr). Sheep in a conscious state was monitored with 4 hrs intervals for cardiopulmonary variables for 48 hrs.

Results
Pulmonary gas exchange, represented by the PaO2/FiO2 ratio, was unchanged in sham, glycerol, and 0.4 mg VEA groups. In the 0.6 VEA group, the PaO2/FiO2 ratio was decreased from 42 to 48 hrs, while in the 0.8 mg VEA group, it was strongly decreased starting at 24 hrs and remained low throughout the remaining period. Lung lymph flow, an index of pulmonary microvascular permeability, was increased more than 2-fold in 0.6 and 0.8 mg VEA groups. Lung compliance also tended to decrease in all VEA groups.

Conclusions
VEA vaping causes acute lung injury in a dose-dependent manner in sheep. Further studies should investigate underlying mechanistic aspects that cause increased microvascular permeability.
114 Long Term Impact of Hospital Acquired Multi-drug Resistant Organisms on Health-related Quality of Life
Authors: Ashford Nathaniel K , Oh Jamie , McMullen Kara , Carrougher Gretchen J , Hickey Sean A , Ryan Colleen M , Schneider Jeffrey C , Gibran Nicole S , Stewart Barclay T 
Published: March 2022

Abstract

Introduction
MDROs colonize wounds and cause infections for hospitalized burn patients, which may lead to increased infection risk, wound complications, longer (LOS) and more cost. Little is known about the long-term impacts of MDRO colonization and infection on burn survivors. We aimed to describe the impacts of colonization on long-term health-related quality of life (HRQoL), itch, and pain.

Methods
Data from adult participants in a multicenter longitudinal outcome study were used. Data was described and χ 2 and Kruskal-Wallis testing was applied to determine differences between the two groups. Outcomes included Veterans RAND 12 (VR-12) physical component summary score (PCS), and PROMIS 29 domains for pain intensity, fatigue, pain interference, physical function, and sleep disturbance. Pruritus was assessed using the 4-D Itch scale for total itch. Multilevel, multiple linear regressions were used for outcome measures at 6 m post-injury. Random effects regression with robust standard errors (SE) were used to evaluate the impacts over time.

Results
The study included 704 individuals and 92 were MDRO colonized (13%). Colonized patients had larger burns (25% TBSA, IQR 9-45 vs. 8% TBSA, IQR 3–20; p &lt; .001), more operations (4, IQR 2-7 vs. 1, IQR 1-3; p &lt; .001), more grafting (17% TBSA, IQR 3-46 vs. 3% TBSA, IQR 1- 9; p &lt; .001), more ventilator days (2, IQR 0–8 vs. 0 IQR 0-0; p &lt; .001), and longer LOS (34 days, IQR 17 – 64 vs. 16, IQR 9 - 27; p &lt; .001). Adjusting for confounding covariables, such as demographics, colonization was associated with a lower PCS score (OR -0.33, 95% CI -0.68, -0.06; p=.018); a higher fatigue score (OR 0.46, 95% CI 0.13, 0.79; p = .007) and worse itch (OR 0.4, 95% CI -0.01, 0.75; p = .036). There was no association with pain intensity, pain interference, or sleep disturbance. Random effects regression indicated that colonization was associated with lower PCS (OR -5.0, 95% CI -8.60, -1.39; p = .007).

Conclusions
Impact of colonization extends beyond the immediate hospitalization and likely has long-term effects on HRQoL. Given our observation of lower physical function after MDRO, more granular research on taxa-specific effects, timing of colonization, and interventions are indicated to elucidate the impact on HRQoL.
120 The Association of Admission Cultures with Burn Outcomes
Authors: Baird Maree , Wall Joyce E , Man Angela , Allabadi Najib M , Jeschke Marc G , Savetamal Alisa , Schulz John T , Skipton Romanowski Kathleen S 
Published: March 2022

Abstract

Introduction
Burn patients are susceptible to infections. It is thought that burn wounds are initially sterile and become colonized by commensal and environmental microorganisms. Many burn centers have protocols to routinely screen patients for infection on admission. The ability of culture results to predict outcomes in burn patients has not been examined. In this study, we aim to examine the relationship between admission cultures and burn outcomes. We hypothesize that patients who have positive cultures on admission will have increased mortality and length of stay (LOS).

Methods
A retrospective chart review was conducted using electronic medical records for all adult patients admitted to three ABA verified burn centers from January 2016 -December 2017. Data collected included patient demographics, burn injury, burn outcomes, and cultures obtained within the first 24 hours of admission. Data analysis was conducted using Chi-square, Fisher Exact, Spearman Correlation, Wilcoxon 2-sample, and Kruskal-Wallis tests.

Results
A total of 1615 patients (mean age 45.87±17.65 years, 1145 males [70.9%]) were analyzed. Mean total body surface area burn (TBSA) was 9.6±14.2% and 10% had inhalation injuries. In this study population, the median LOS was 7 days (Interquartile range [IQR] = 12) and 72 patients (4.5%) expired. Older patients (p &lt; .0001), those with higher scores on the 11-factor modified frailty index (mFI-11) (p &lt; 0.0001), a higher TBSA (p&lt; .0.0001) and inhalation injury (p &lt; 0.0001) had a higher mortality rate. In examining the effect of admission cultures on mortality, there was no significant difference in mortality based on wound culture (p 0.14), Clostridium difficile (C. diff) (p 0.25), or urine culture (p=0.79) results. Patients with positive Methicillin-Resistant Staphylococcus Aureus (MRSA) screening (p 0.04) and those with positive blood cultures (p 0.01) were more likely to die from their injuries. Older patients (r= 0.14, p &lt; 0.0001), those with a larger TBSA (r=0.49, p &lt; 0.0001), and a higher MFI-11 score (r=0.12, p &lt; 0.0001) had and increased LOS.. There was no association between LOS and positive wound cultures (p 0.08), or blood cultures (p 0.49) upon admission. Patients with positive MRSA results (p 0.003) and urine cultures (p 0.01) upon admission had a longer LOS while those with positive C. diff results had a shorter LOS (p 0.01).

Conclusions
Mortality is associated with standard predictors of outcomes (age, burn size, inhalation injuries, frailty scores) and positive MRSA screens and blood cultures. Patients with larger burns (define larger burn-maybe use the degree scale), a positive MRSA and negative C. diff had a longer LOS. Based on these results, cultures should be considered in all patients upon admission to the hospital as they are predictive of burn outcomes.
125 Community Socioeconomic Status Is Associated with Social Participation Outcomes
Authors: Kelter Brian M , Shepler Lauren J , Ni Pengsheng , Kazis Lewis E , Stewart Barclay T , Ryan Colleen M , Schneider Jeffrey C 
Published: March 2022

Abstract

Introduction
Socioeconomic factors are recognized as important social determinants of health. Data however are sparse describing the relationship between socioeconomic status and long term burn outcomes. This study aims to examine associations between community-level socioeconomic status and social participation outcomes in burn survivors.

Methods
Data was obtained from the Life Impact Burn Recovery Evaluation (LIBRE) Journey study that assesses longitudinal social participation outcomes of community dwelling burn survivors. Subjects were linked to the Distressed Communities Index (DCI), which combines seven indicators into a metric that depicts community economic well-being. Participants were categorized by time since burn (&lt; 5, 5-15, ≥15 years). Linear regression models examined associations between DCI (zip code and county levels) and LIBRE domain scores (Family & Friends, Social Interactions, Social Activities, Work & Employment).

Results
The study included 314 burn survivors, (mean age 44.1 years; 61.0% female; 48.6% married; 82.8% white). The population was distributed among the time since injury categories (&lt; 5: 35.8%, 5-15: 27.5%, ≥15: 36.7%). Approximately 18% of subjects were categorized in the “at risk” or “distressed” DCI categories. For survivors less than five years from burn, a DCI score increase of 1 standard deviation (worse socioeconomic status) at the zip code level was associated with decreased Family & Friends and Social Activity scores of 2.6 (p=.01) and 2.0 points (p=0.04), respectively (small effect sizes). This relationship was even stronger when controlling for sociodemographic factors. In regression analysis, survivors within the first five years from injury living in “at risk” or “distressed” communities showed worse Family & Friend scores by 6.5 points compared to those living in “prosperous” communities, even after adjusting for age, gender, race, ethnicity, education, and marital status (p=0.04; moderate effect size). There were no significant associations between DCI and LIBRE domain scores for survivors assessed beyond 5 years from injury.

Conclusions
Social participation outcomes were worse in burn survivors who lived in socioeconomically disadvantaged neighborhoods. Burn survivors who face socioeconomic challenges may need additional support to address social disparities to improve outcomes.
525 Dysphagia in Thermal Injury: The Impact of Inhalation Injury on Incidence and Recovery
Authors: Weiner Bailey , Halfacre Harper , Lee Jenny , Harvin John A 
Published: March 2022

Abstract

Introduction
Dysphagia is known to be a prevalent condition in the burn population. Dysphagia can lead to adverse events such as aspiration pneumonia, dehydration, and malnutrition. However, there is little data on the incidence and duration of dysphagia specifically in the inhalation injury subset of burn patients. The aim of this study is to determine the incidence and factors that contribute to dysphagia in the inhalation injury burn population as compared to the cutaneous burn population.

Methods
A retrospective study was conducted of patients admitted to a burn center from January 2016 - January 2021 and intubated for &gt;48 hours. Patients who died during hospitalization or transferred hospitals were excluded. Dysphagia duration was analyzed based on days free from the ventilator. Two groups were compared: 1) non-inhalational injury vs inhalational injury patients and 2) Grade 1 vs Grade ≥2 inhalational injury patients. Statistical analysis included student’s t-test, chi-square test, and Kruskal-Wallis test. Bayesian generalized linear models were created to measure the independent association of inhalational injuries with the outcomes.

Results
During the study period, 142 patients were admitted, of whom 49 patients had inhalation injury (35%). Inhalational injury patients had a lower %TBSA burn than non-inhalational injury patients (mean 18% ± 21% vs 31% ± 15%, p&lt; 0.001). There were no significant differences in age, sex, tracheostomy placement, ventilator days, or hospital length of stay between the two groups. The inhalational injury group had a higher rate of dysphagia at the first Speech Language Pathologist (SLP) instrumental assessment (88% versus 51%, p&lt; 0.001) and at discharge (55% versus 28%, p=0.001). After controlling for %TBSA, inhalational injury was independently associated with an increased odds of dysphagia at first SLP instrumental assessment (OR 13.0, 95% CrI 4.7-43.4, posterior probability ≥99%) and at discharge (OR 3.2, 95% CrI 1.5-6.9, posterior probability ≥99%). Additionally, inhalational injury patients had a longer period of dysphagia post-extubation with an average of 9.5 vs 7.1 days to any diet (p&lt; 0.006) and average of 12.6 vs 7 days to a regular texture diet (p &lt; 0.001). Grade 1 inhalational injuries had no difference in duration of dysphagia or dysphagia at discharge compared to Grade ≥2 inhalational injury patients.

Conclusions
Inhalational injury was independently associated with dysphagia upon initial SLP instrumental assessment and at discharge. Patients with an inhalational injury also had a longer dysphagia resolution time. The severity of the inhalation injury did not impact dysphagia incidence.