bluuebunny/crossref_metadata_2025_split huggingface dataset:
45 Endothelial Damage Occurs Early After Inhalation Injury as Measured by Increased syndecan-1 Levels
Authors: Kelly Edward J , Keyloun John W , Carney Bonnie C , Moffatt Lauren T , Shupp Jeffrey W 
Published: March 2022

Abstract

Introduction
Inhalation injury is a significant cause of morbidity and mortality in the burn patient population. However, the pathogenesis of inhalation injury and its potential involvement in burn shock is not well understood. Pre-clinical studies have shown endothelial injury, as measured by syndecan-1 levels, to be involved in the increased vascular permeability seen in shock states. Furthermore, the lung has been identified as a site of significant syndecan-1 shedding. Here we aim to characterize the contribution of endotheliopathy caused by inhalation alone in a swine model.

Methods
Eight female Yorkshire pigs were used in this experiment. A custom-made smoke box was employed to deliver smoke via endotracheal tube directly into the swine lungs. Carboxyhemoglobin levels were then titrated to a level of 50-75%. Blood was collected at induction of anesthesia, pre-injury, 30 minutes, and at hours 1, 2, 4, 6, and 12 post-injury and was stored in EDTA tubes from which plasma was separated and stored for future analysis. Pigs were necropsied immediately after completion of the experiment and lung samples were placed in all-protect and flash frozen. Histology was performed on lung sections and a validated, published scoring system composed of 5 parameters (neutrophils in the alveolar space, neutrophils in the interstitial space, hyaline membrane formation, protein detritus in the alveolar space and septum thickening) was used to assess lung injury severity (between 0 and 1).Plasma Syndecan-1 (SDC-1) was quantified by ELISA. All data was compared to Syndecan-1 levels measured at induction. Conditions were analyzed with one-way ANOVA with multiple comparisons and Dunnett’s correction for multiple comparisons.

Results
Syndecan-1 levels at induction were 13.74 ± 2.03 ng/ml. Pre-injury and 30 minutes post-injury levels remained similar. Syndecan-1 levels at hour 2 post-injury increased 37% from induction (18.36 ± 1.28 ng/ml, p=0.0057). This trend continued with a 47% percent increase from induction at hour 4 post-injury (19.62 ± 2.15 ng/ml, p=0.0033) and a 49% increase from induction at hour 6 post-injury (20.42 ± 2.43 ng/ml, p=0.0011). Histological sections showed higher lung injury severity compared to control pigs (0.1-0.3 vs. 0.5-0.74, p&lt; .05).

Conclusions
Significant increases in syndecan-1 levels in this animal model provide evidence for a connection between smoke inhalation injury and endothelial injury. Furthermore, the endotheliopathy that leads to burn shock could be exacerbated by inhalation injury, leading to the poor clinical outcomes that are often seen in patients with combined burn and inhalation injuries. Future research should focus on the mechanisms underlying inhalation injury and its contribution to shock physiology.
51 Wireless Electroceutical Dressing for the Treatment of Biofilm Infected Burn Wounds
Authors: Nuutila Kristo , Diaz Victoria , Anselmo Kristin , Steiner Shomita , Sen Chandan K , Carlsson Anders H , Chan Rodney K , Roy Sashwati 
Published: March 2022

Abstract

Introduction
Burn injuries are common to all military conflicts. In combat, eradication and prevention of burn wound infection is complicated by high rates of soft tissue contamination and prolonged delays to definitive stateside care. Furthermore, in the battlefield setting the salvage rate for infected burned extremities is low. Therefore, a simple, easy, non-invasive and rapid method to protect the wound, while also inhibiting infection, would represent a significant advance in the treatment of combat burn wounds. The purpose of this clinical trial was to investigate the efficacy of an FDA approved disposable and easily portable, wireless electroceutical dressing (WED) in the treatment of burn wounds. The hypothesis was that a low electric field generated by the moisture-activated WED will reduce infection load, improve graft survival and take, enhance wound healing and restore skin barrier function of biofilm infected wounds.

Methods
A phase I, prospective, randomized, controlled clinical trial was performed to evaluate the efficacy of the WED dressing as compared to the standard of care (SoC) dressing to prevent and disrupt biofilms. Subjects were screened from inpatient admissions for traumatic burns &gt;300cm2 in size. In total 38 subjects were enrolled to the study. Subject burn wounds were divided into two parts and randomized to receive either the SoC dressing or the WED dressing. Dressings were changed on day 4, removed on day 7 and the burns were followed for 30 days. Small biopsies were collected on days 4 and 7 for histology, SEM examination of biofilm and for quantitative bacteriological analysis. In addition, non-invasive wound imaging techniques were utilized to study wound healing. Furthermore, Vancouver scar scale and patient observer scar assessment were used to evaluate quality of healing.

Results
The results showed that at the time of dressing removal, non-grafted burns that were treated with the WED dressing presented statistically significantly less biofilm in comparison to the SoC treated burns (p &lt; 0.05). The results also demonstrated that the WED dressing was more efficient at eradicating biofilm than the SoC dressing. At the time of the dressing removal, biofilm score [0-3] had decreased in 48% of the WED dressing treated burns in comparison to 28% in the SoC treated burns. In terms of wound healing and quality of healing no significant differences were observed between the WED and the SoC dressings.

Conclusions
This trial demonstrated that the WED dressing was more efficient against biofilm infection than the SoC dressing. In addition, the study concluded that the WED dressing performed equally well as the SoC in terms of burn wound healing.
52 Refinement of a Histologic Algorithm for Burn Depth Categorization Using 1142 Consecutive Burn Wound Biopsies
Authors: Phelan Herb A , Holmes James H , Hickerson William L , Cockerell Clay J , Shupp Jeffrey W , DiMaio J Michael , Carter Jeffrey E 
Published: March 2022

Abstract

Introduction
Our group previously reported a theoretical burn biopsy algorithm (BBA-V1) for the categorization of burn wound depth based on histologic analysis, and informed it with the largest series of burn wound biopsies in the literature. That iteration of the BBA resulted in clinical misclassification rates consistent with past literature. Since our last report of that process, we have refined the algorithm with new criteria and a larger repository of burn wound biopsies. Here, we sought to promulgate this newer, simpler version of the BBA (BBA-V2).

Methods
This was an IRB-approved, prospective, multicenter study. Patients with burn wounds assessed by burn experts as requiring excision and autograft underwent 4mm biopsies procured every 25cm2. Serial still photos were obtained at enrollment and at excision intraoperatively.
Using H&E with whole slide scanning, a board-certified dermatopathologist assessed each burn biopsy. The criteria used for categorization of burn wound depth in BBA-V1 were: 1) proportion of necrotic adnexal structures, and 2) presence/absence of each of epidermis, papillary dermis, and reticular dermis. The criteria used for BBA-V2 were: 1) magnitude of reticular dermal degeneration, 2) proportion of necrotic adnexal structures, and 3) magnitude of vessel thrombosis.
Biopsy pathology results were correlated with still photos by 3 burn experts for consensus of final burn depth diagnosis. Superficial partial thickness (SPT) wounds were considered to be burn wounds likely to have healed without surgery, while deep partial thickness (DPT) and full thickness (FT) were considered unlikely to heal by 21 days.

Results
The development of BBA V-1 was previously informed by 66 subjects with 117 wounds and 816 biopsies, and resulted in wound categorizations as follows: SPT (20%), DPT (43%), and FT (37%). Therefore, according to BBA-V1, 20% of burn wounds were incorrectly judged as needing excision and grafting by the clinical team. The overall cohort was enlarged to 162 subjects with 294 wounds and 1142 biopsies. The most recent 838 burn wound biopsies were then re-reviewed and re-categorized according to the new BBA-V2 criteria and algorithm. Under BBA-V2, 3% of all burn wound biopsies were categorized as superficial partial thickness, 69% were categorized as deep partial thickness, and 29% were categorized as full thickness.

Conclusions
Our study demonstrates that by adding dermal degeneration severity and vessel thrombosis to our previous criterion of adnexal structure necrosis, BBA-V2 had a much higher rate of concordance with visual clinical assessment for burn wounds clinically judged as needing surgical excision. This study serves as the largest analysis of burn biopsies by modern day burn experts.
55 Initial Experience Using Artificial Intelligence for the Assessment of Pediatric Burn Depth
Authors: Holmes James H , Phelan Herb A , Shupp Jeffrey W , DiMaio J Michael , Carter Jeffrey E 
Published: March 2022

Abstract

Introduction
Estimation of burn depth, and hence severity, is critical for burn management. Burn depth estimates vary widely, and these inaccuracies can be compounded in pediatric burns. A reliable, objective, non-invasive device for the accurate assessment of burn depth is needed. A non-invasive imaging technology, using multispectral imaging (MSI) combined with a machine learning algorithm (MLA), is being developed as a tool for burn depth assessment. The results of the initial multi-center study using this artificial intelligence (AI) technology in pediatric burns are presented.

Methods
The MSI device was used to image subjects &lt; 18y of age with thermal burns &lt; 50% TBSA. It captured a set of images measuring the reflectance of visible and near-IR light, within a 23x23 cm field-of-view. Images were collected from up to 2 separate burned regions within 72 hours of injury that were then serially imaged for up to 7d post-injury. Burns that the investigator believed would heal spontaneously (superficial or superficial partial-thickness) were managed per institutional standard of care (SOC) and assessed at 21d post-injury for complete healing. Burns that the investigator felt would not heal by 21d post-injury (deep partial-thickness or full-thickness) were excised and grafted per institutional SOC, with multiple biopsies being taken prior to excision.
Regions of non-healing burn within every MSI image were identified by a panel of 3 burn surgeons. To accurately identify these non-healing regions, the panel of surgeons was given access to 1 of 2 clinical reference standards: a) the 21-day healing assessments for burns allowed to heal spontaneously; or b) pathology reports detailing histologic analyses from the biopsies.
This information was then used to develop a type of MLA called a convolutional neural network (CNN) that could automatically identify the regions of non-healing burn within an image. From these data, an ensemble of 8 separate CNN algorithms was used to automatically identify non-healing burn tissue. Training and test accuracies of the ensemble CNN were calculated using cross-validation at the level of the subject.

Results
Twenty-four (24) pediatric burn patients were enrolled, with 26 burned areas being serially imaged. The age range of the subjects was 7 months - 17y, with a mean age of 5.7y. Subjects had a mean burn size of 8.0 ± 4.2% TBSA, and 70% of the subjects were male. The AI performance results showed an accuracy of 88.2 ± 3.7%, sensitivity of 80.0 ± 14.6%, specificity of 88.0% ± 3.7%, and an area under the curve (AUC) of 0.92.

Conclusions
Our study demonstrates an improvement in the accuracy of burn depth assessment over the traditional exam, which could lead to improved burn care.
77 Impacts of Financial Assistance on Quality of Life Among People Living with Burn Injury
Authors: Martz Flora , McMullen Kara , Carrougher Gretchen J , Wolf Steven E , Schneider Jeffrey C , Stewart Barclay T , Sheckter Clifford C , Bunnell Aaron E 
Published: March 2022

Abstract

Introduction
Financial toxicity negatively impacts recovery after injury. Financial assistance (FA; e.g., disability income, food stamps, low-income housing voucher) may mitigate the impacts of financial toxicity. We aimed to describe FA after burn injury and its association with health-related quality of life (HRQL) and return to work.

Methods
Data from adult participants participating in a multicenter longitudinal database from 2015 to 2021 were used for complete-case analysis. Participants were separated into two groups: those who received any form of financial assistance due to their burn injury, and those who did not. The cohort and FA were described. Multi-level, mixed-effects, linear regression was performed to assess the associations of FA with VR-12 Physical and Mental Health Component Summary scores (PCS, MCS) and return to work. Lastly, a propensity score analysis matched 3:1 on age, gender, pre-injury PCS and MCS, burn size, length of hospital stay, and the number of operations as a result of burn injury was used to maximally reduce potential confounding.

Results
The analysis included 1,237 participants [725 who received FA, 512 who did not receive FA (NFA)]. Participants who received FA due to their burn injury were more likely to be younger (median 42 FA vs 48 NFA, p-value &lt; 0.001), racially minoritized (19.2% FA vs 14.3% NFA, p-value &lt; 0.001), have larger injuries (21% FA vs. 10% TBSA NFA, p-value &lt; 0.001), longer hospital stays (median 29.5 days FA vs. 17 days NFA, p-value &lt; 0.001), more days before returning to work (median 220 days FA vs 79 days NFA, p-value &lt; 0.001), and have a workers compensation insurance payer (23.6% FA vs. 9.38% NFA, p-value &lt; 0.001) compared to peers who did not receive FA. The number of participants who received new FA decreased after the 6-month time point: 11% at discharge, 33% at 6 months, and 15% at 12 months. Propensity score analysis demonstrated that receiving FA was associated with lower PCS and MCS scores at all time points and longer time to return to work (Table 1).

Conclusions
Given that financial toxicity is associated with unsatisfactory recovery after injury, efforts to reduce financial stressors are needed. FA seems somewhat matched to patients with greater recovery challenges (e.g., larger injuries, more complex hospitalizations). Additionally, most patients do not receive FA for a prolonged period (e.g., &gt;6 months). While FA is associated with lower HRQL and longer return to work, these data may represent improvement compared to what people living with burn injury might have experienced without FA and represent unmeasured confounding.
78 Classification and Regression Tree Model for Predicting Satisfaction with Life Scale Scores After Burn Injury
Authors: Bissoon Zephorah , Gause Emma L , Carrougher Gretchen J , Baker Claudia , Wiechman Shelley A , Pham Tam N , Gibran Nicole S , Stewart Barclay T 
Published: March 2022

Abstract

Introduction
Current early burn care prognostication models predict in-hospital mortality (e.g., revised Baux Score). However, patients, families and clinicians need more holistic tools in the hours and days after injury to identify specific factors that might affect their quality of life and indicate a need for more intensive services. This project aims to predict Satisfaction with Life (SWL) in survivors of burn injury using patient, injury, and care factors available within 24 hours of admission.

Methods
Two hundred and fourteen participants were identified from a multicenter national longitudinal database and merged with clinical data from a single institution's trauma registry. Patients were randomized into a training dataset (80%) and a testing dataset (20%). A CART algorithm was used to examine the relative contributions of individual predictor variables in classifying low SWL at six-month follow up (SWL ≤ 20). Seventeen covariables obtained within 24 hours of index hospital admission were analyzed from five domains: demographics, comorbidities, injury, care, and host response to injury. Lab values were those closest to but not greater than 24 hours after index hospital admission.

Results
Multiple covariables contributed to the SWL score. CART analysis selected a pre-injury SWL score &lt; 31 as the first node and strongest indicator of low SWL. CART then selected the following subgroups at risk for SWL ≤ 20 at 6 months: (1) hematocrit &gt;55%; (2) lactate &gt;4 mmol/L, age &gt; 59; (3) total body surface area (TBSA) burned &gt;30%, presence of a hand, neck, and/or face burn. The cross-validated predictive accuracy of the CART model was 69.4% with a cross-validated relative error of 0.379. In the validation data set, sensitivity and specificity were 62.5% and 72.0%, respectively.

Conclusions
The findings demonstrate the potential feasibility of creating a model that can predict a clinically meaningful quality of life outcome using covariables gathered within hours of hospital admission after burn injury. Predictive measures suggest that while some of the included covariables may be associated with SWL, they are not consistently and reliably predictive of low SWL alone. With more data and additional refined inputs, a similar model could be used to identify those in need of more intensive services earlier on in the hospitalization.
87 Comparing the Efficiency of Tumescent Infiltration Techniques in Burn Surgery
Authors: Fouché Tom , Bond Stephanie , Vrouwe Sebastian Q 
Published: March 2022

Abstract

Introduction
Tangential excision and grafting of burn wounds results in significant intra-operative blood loss. Infiltration of a dilute epinephrine solution is routinely performed to reduce bleeding from both the eschar and donor sites. Tumescence infiltration has been described using both a manual technique or a pump device. The purpose of this study is to compare the efficiency of these two methods in terms of time and economy of motion.

Methods
Consecutive adult burn patients who required excision and grafting were enrolled in the study. Manual infiltration consisted of an aspirating syringe (10 mL), spinal needle (18 gauge), and three-way stopcock connected to sterile tubing. Pump infiltration consisted of a blunt cannula and infiltration pump (300 mL/minute). Prior to each case, patients were randomized into either the manual or pump tumescent technique. Excisions of &lt; 2% TBSA were excluded, along with specific anatomic regions (head and neck, genitalia, hands and forearms, feet, and legs below the knee). Infiltration with epinephrine-saline solution (1:500,000) was performed to the endpoint of tissue tumescence by a single surgeon for consistency. ImageJ software was used to calculate the surface area to be infiltrated. The infiltration was filmed and later coded for duration, number of maneuvers, and total volume of tumescence injected. Any complications related to the infiltration of tumescence were collected.

Results
A total of 14 patients were enrolled, and 16 cases were randomized to either manual (N=8) or pump infiltration (N=8). Participants were 71% male, with a mean age of 41.8 years, and mean burn size of 16.9% TBSA. The pump method required less time (2.0 cm2/s vs 1.1 cm2/s, p&lt; 0.001) and fewer maneuvers (37.8 cm2/move vs 1.1 cm2/move, p&lt; 0.001). Use of the infiltration pump also resulted in a reduced volume of fluid required to reach the endpoint of tumescence (1.7 mL/cm2 vs 2.4 mL/cm2, p=0.01). No complications were reported related to the process of tumescence in either group.

Conclusions
Compared to the manual technique, use an infiltration pump was significantly more efficacious in terms of both time and economy of motion. Additionally, less fluid volume was required to achieve the endpoint of tumescence.
90 Efficacy of Porcine Skin Xenotransplants Indistinguishable from Allograft in First-in-human Clinical Evaluation
Authors: Holzer Paul , Chang Elizabeth J , Lu Diana , Adkins Jon , Rogers Kaitlyn , Man Angela , Chang Kristina , Wicks Joan , Ko Dicken S C , Schulz John T , Kaiser Robert A , Swartz Harold M , Cetrulo Curtis L , Monroy Rod , Goverman Jeremy 
Published: March 2022

Abstract

Introduction
Human cadaver allograft (HCA) is the current standard of care for temporary wound closure of large burns, but a critical need for high-quality alternatives exists. Porcine skin shares many similarities with human skin, and hyperacute rejection is prevented via a single genetic modification. Like human skin, non-terminally sterilized porcine skin contains viable dermal and epidermal cells and intact vasculature that enables restoration of barrier function. These characteristics are distinct from those of traditional, terminally sterilized “xenografts” and may offer greater therapeutic capability. We report here key efficacy outcomes specific to severe burn care from a first-in-human clinical trial to assess the capability of genetically engineered porcine skin xenotransplants to provide temporary wound closure for severe and extensive deep-partial and full-thickness burn wounds, compared to HCA.

Methods
Split-thickness skin containing epidermal and dermal layers was harvested from Designated Pathogen Free, GalT-KO, porcine donors, cGMP processed to achieve USP&lt; 71 &gt; sterility and cryopreserved to retain &gt;70% cell viability. These were transplanted side by side with HCA on debrided full-thickness burn wounds in six human subjects. Temporary wound closure, incidence of complete wound closure following autografting, and quality of healing, including scarring, contour, and feel of healed skin, normalization of skin markings or pigmentation, were independently assessed.

Results
Across all patients and assessment time points, adherence, vascularity, and overall appearance were indistinguishable between porcine skin xenotransplants and HCA control. After surgical removal, wound beds treated with each type of dressing were perfused and otherwise appeared equivalent and clinically suitable for autografting. Long-term outcomes were comparable between wound sites treated with porcine skin or HCA with no discernable differences in scarring or cosmesis.

Conclusions
Skin xenotransplants effectively provided temporary wound closure and restoration of barrier function via intact native vasculature, active cells, decreased antigenicity, and high-quality tissue architecture unimpacted by cryopreservation and thawing. These results show clinical promise as an interchangeable alternative to HCA in the treatment of severe burns. Expanded clinical evaluation is ongoing.